转利之，且排日不废。继又自言患痈疽者，每有泄泻，皆是恶候，此是不能无疑者也。借曰前用
大黄，恐因病体实，而大腑秘结，有积热沉痼之积者发也，止可破结导滞，推令转动而已，岂可
谓极转利之，而且排日不废乎？若下利之后，又与利药，恐非防微杜渐之意。疮之始作，即《周
礼》肿疡之时也。肿在肌肉，若非大满大实坚之证，自当行仲景发表之法，借五香汤为例，散之
于外，何必遽以峻下之药，以夺其里，自取其祸乎。
《精要》云∶大凡痈疽，不可舍五香汤。此又不能无言者也。开卷便于第一论中详言之，吾
不知良甫之时，有许多大腑坚秘，病气郁塞。若是之顽浓，可以骤散而大下者。若果有之，亦当
开陈时之先后，证之可否，庶乎后人不敢孟浪杀人也。或曰∶痈疽用大黄走泄以去毒，自孙真人
行《千金方》已言之矣，良甫祖述其说，何吾子病之深也？曰∶大黄除诸实热，而性峻急，孙以
盛行奇术于公卿间，时在晚宋，民不知兵，交游于富贵之家，肉食之辈，固皆捷效。今良甫不分
贫富苦乐劳逸，一概用之，宁无孟浪之患乎？况有房劳而虚者，忧怒而虚者，极意贪求而虚者，
强力动劳而虚者，大醉过饱而虚者，皆因气弱而涩，血少而浊，生疽固是难治之病，若大腑秘而
稍安谷食，肯守戒律，甘心淡味者，犹为可治，但费补工夫耳。苟因旬日半月，大便秘实，不知
其气不降也，便以为实，而行大黄；些少寒热，不知其血气不和也，便以为有外感，而行表散，
如此害人甚速。
〔垣〕疮疡及诸病面赤，虽伏火热，禁不得攻里，为阳气怫郁，邪气在经，宜发表以去之。
故曰∶火郁则发之。虽大便数日不见，宜多攻其表，以发散阳气，少加润燥药以润之。如见风脉
风证，只用发表风药，便可以通利大便。若只干燥秘涩，尤宜润之，慎不可下也。九窍不利，皆不
可下，疮疡郁冒，俗呼昏迷是也，慎不可下，汗之则愈。
〔丹〕排脓内补十宣散，若用之于些少痈疽与冬月，尽可助内托之功。若于冬月肿疡用之，亦
可转重就轻，移深为浅。若溃疡与夏月用之，其桂、朴之温散，佐以防风、白芷，吾恐虽有参、
，难为倚仗、比见世人用
此方者，不分痈疽冬夏，无经络，无先后，如盲人骑瞎马，半夜临深池，危哉。又云∶内补十宣
散，泻卫燥血药太多，止可用于轻小证候，虚之甚者，恐难倚仗。
《精要》云∶内托散，一日至三日之内，进十数服，治毒瓦斯攻冲脏腑，名护心散。此方专为
服丹石而发疽者，若不因丹石而发，恐非必用之剂。若夫年老者，病深者，证惫者，体重者，绿
豆虽补，将有不胜重任之患矣。
〔仲〕疮家虽身疼痛，不可发汗，汗之则 。（发汗为大汗出，非谓诸托里之药轻轻表散也。）
李世英疽不热不痛，属阴。切不可用冷药敷贴，恐逼毒瓦斯入内。
〔丹〕夫外施敷贴，正与发表之意同。经曰∶发表不远热。大凡气得热则散，冷则敛。向见郑
经历，性嗜酒与煎爆，年五十余，忽春末夏初，在额丝竹空穴涌出一角，长短大小如鸡距稍坚，
求予治。予曰∶此非膏粱所致而何？宜断浓味，先解食毒，针灸以开泄壅滞，未易治也。此少阳
经所过，气多血少者。郑以惮烦，召他医，以大黄、朴硝、脑子等冷药罨之，一夕豁开如酱蚶，
径三寸，一二日后，血自蚶中溅出，高数尺而死。此冷药外逼，热郁不得发，宜其发之暴如此也。
蜞针法谓开门放毒，以为要捷，恐可施于轻小证候耳。愚谓蜞之所吮，止肤间恶血。若积毒
于脏腑者，徒竭之于外，而不及于里，恐未为得。往见张兄之子，甫二岁，遍身赤疹如霞片。
予向见其母久病 ，谓毒热在血所成者。张曰∶谁不因母血所成，何谓毒热之血。予曰∶其母
虽，食肉如平时，肉性热与宿疾之热相搏，非毒欤。张不之信，自取五六大蜞吮其血，疹顿消，
乳食起居如旧。予曰∶非其治也，未可以为喜。张怒。越二三日，大发热而暴死。非竭之于外，血
去而气不能独居乎。
《精要》云∶口干与口渴不同，不宜用丹药镇坠，用之其祸如反掌。用桑枝煎五味汤，以救
阴水，甚妙方也。而不言食味起火，怒气生火，房劳激火，吾恐渴未易除也。
《精要》谓头上有发毒者，不得灸，恐因火气拔起，热毒炎上，动病邪而添病。愚谓此言过矣，
火本以畅达，拔引郁毒，此从治之意也。头为诸阳所聚之处，艾炷宜小，壮数宜少，小者如椒粒，少
者三五炷而已。若孟浪
如腹背上引痛灸至不痛，不痛灸至痛为例，斯为误矣。
按东垣灸元好问脑疽，以大艾炷如两核许者，至百壮，始觉痛而痊。由是推之，则头上
发毒，灸之痛者，艾炷宜小，壮数宜少，如不痛者，艾炷大，壮数多，亦无妨也。又引陈日华之
说，谓于始发时，用针灸十死八九。此未之思也。切详因灸而死者，必其血虚，孤阴将绝，
无以承当火气，脉必浮数而大鼓，与精神必短而昏，岂可泛言始发不可灸以误人。
〔《保》〕疮疽已觉微漫肿硬，皮不变色，脉沉不痛者，当外灸之，引邪气出而方止。经曰∶
陷者灸之。如外微觉木硬而不痛者，当急灸之，是邪气深陷也。浅者不可灸，慎之。如有脓水，
亦不可灸，当刺之。
按刺之脓出，不肿痛者，邪已去矣。不宜灸。若刺之脓出，而痛肿不止者，亦当于肿上
灸之无妨。又毒虽浅，却有十数头肿痛者，亦灸之无妨。
〔涓〕一有痈疽疮疖，须顺时节，春夏为正，易为整理。缘天气温和，肌肉缓慢而暖，故易治。
其有肉冷，是患人气虚所致，但以温药调顺气血，外即用温暖溃脓膏药贴之令穴，候穴抽脓尽，
急用生肌长肉药满疮口，不宜缓慢，恐至秋冬成漏疮也。或在秋冬发者，乃春夏内先有发蒸热毒，
遇一阴生后，再有伏毒，至秋冬间又因食毒物酒面房欲之事，忽发初觉微小，数日之间肿大疼不
可忍。初得大便五七日不通，小便淋沥者，是其候也。先调脾脏气令实，次服发穴排脓消毒去积
之药，内托温平，不得用太热涩之药。缘脾中脏要和暖，如用热药，恐气涩而不流畅，致荣卫不
调也。贴即用温凉药，不得用冷药，恐逼入毒瓦斯，须引脓外透，方渐安矣。
〔仲〕诸浮数脉，应当发热，而反洒淅恶寒，若有痛处，当发其痈。
〔《精》〕阴滞于阳则发痈，阳滞于阴则发疽。而此二毒，发无定处，当以脉别之，浮洪滑数
为阳，微沉缓涩为阴。阴则热治，阳则冷治。
上阳脉当以痈法治之，阴脉当以疽法治之，不必拘于热治冷治也。
〔垣〕身重脉缓湿胜者，除湿。身热脉大，心躁时肿，乍来乍去者，清热。诸痛眩晕动摇，脉弦
者，去风。
气涩气滞，干燥，亡津液，脉涩者，泻气补血。寒胜则脉浮，食不入，便溺多，恶寒脉紧者，宜
泻寒水。肾脉涩甚，为大痈。（全文见虚实法。）
〔涓〕夫人生最可忧者，发背也，其种有五∶
一曰阳毒。因风热而有，或患热毒消渴，或先患伤寒，余有阳毒触处蓄积，起于背脊膂之间，
不问椎数，但从两夹脊起，止腰上，满背 热，如炊之状，赤紫或红如焰，脓毒难成，成后不止，
止后痛不除，蓦忽数日之间，复平如旧，将谓肿消，此是内攻肉陷，不可疗矣。
二曰阴毒发背。是气冷而作，初如黍米粒起，情绪不快， 而痛，直应前心，心忪怔，
头目昏重，寒热如疟。五七日后，始发引攻肿，开阔难收，内积有脓，深沉迟缓未透，宜急以补
气汤药内托，外以抽脓药贴之。宜急见脓，无脓，即平愈未期。
三曰有人多服金石烧炼之药，毒恶流滞成发背者，初起如丹疹之状， 渐开如汤火疮，面
色如朱，心膈烦躁，多渴嗜冷，其疮难起，起即惊人，犹胜于阴阳二毒者，缘此有解金石药毒汤散
治其内也，赖有根底分明，亦须急疗方安。
四曰人有患酒食毒发背者。此疾非近得之，乃脏腑久积，乘饥乘困，食之便睡，或多食酒肉，
冷热粘滑，肥鲜炽腻，未下胸膈，房室不禁，恣意当风取快，脾脏气虚不能受，乘发毒攻背，两夹
脊不问椎数。初起痈头如小弹子，后大如拳，坚如石，痛遍四肢，加之拘急，口苦舌干，腹急，大
小便涩。十数日后，头面手足虚肿，及脏腑通泄如利，内急痛者，是其症也。喜方肿引，急用收肿
发穴溃脓汤药，内实外泄，脓水不可放纵，迟缓则皮肉腐坏，伤骨烂筋，渐成脓多，因而感邪内
败者，死矣。
五曰人有冒山岚瘴气发背。毒瓦斯先在脏腑，年月浸远，气血虚损衰弱。初起肿色青黑如靴，
皮顽痹痛，深附筋骨彻髓，按之如木石，引手加深，方觉似有痛处。至五七日，毒瓦斯浮浅，肿高
色变青白，有如拳打之状，寒战似疟，及有风候，头动口偏，手足厥逆，眼黑睛小，白多而慢。
此内有邪气相搏，急破出清血三五升，方有黄脓白汁相和发泄，其皮不宽不慢亦急，胀痛亦不住，直
至色退热疼方愈。亦宜急急追赶脓与毒瓦斯外出无害。
初患肿，三日内灸者生。八日内脓成，针烙导引者生。未瘥，慎劳力者生。慎忌食者生。慎
喜怒者生。惧肿猛疗者生。急疗者生。不讳发背者生。
待脓自出，不导引者死。未内攻，而针烙用药导引者生；内攻后，导引针烙者死。 热
痛方盛以前疗者生，如过此后已内攻者死。脓成后，不出不导引，但敷药者死。如赤白痢气急者，是
已内攻，医疗无益，必死。痈不救，十得五生；疽不疗，十全死。轻肿怕痛者必死。不遇良方
者死。节候不根据法者必死。愚执恣意用性逸情者死。
有发背痈，有发背疽，如毒瓦斯勇猛而发，如火焚茅，易于败坏。初发即可如黍米粒大，三
两日渐赤引肿如手掌面大，五七日如碗面大，即易为攻， 热赤引如火烧之状，浮面渐溃烂阔开，
内发肿如炊之状，外烂皮肉如削，去紫瘀脓汁多而肿不退，疼亦不止，发渴发逆，饮食不下，呕
吐气急，浮浅开阔者，尤宜发脓托毒汤药，用之必愈。（阳证，实也。）其间有只如盏面大者，此
非不大，缘为毒瓦斯深沉，内虚，毒瓦斯近膜也。此必内攻，近入脏腑，却外入四肢。先攻头面虚
浮，后攻手面，次攻两足面肿，名曰毒瓦斯散入四肢。其人声嘶气脱，眼睛黑小，十指肿黑干焦不
治。（阴证，虚也。）
〔《精》〕凡痈疽初发肿硬高者，而毒瓦斯却浅，此乃六腑不和为痈，其证属阳，势虽急而易治。
若初发如粟粒，甚则如豆许，与肉俱平，或作赤色，时觉痒痛，痒时慎勿抓破，此乃五脏不调为疽，
其证属阴，盖毒瓦斯内蓄已深，势虽缓而难治。
始发一粒如麻豆大，身体便发热，生疽处肿大热痛，此为发于外，虽大如盆，治之百可百活。（阳
症，实也。）或身体不热，自觉倦怠，生疽处亦不热，数日后渐大，不肿不痛，低陷而坏烂，此
为发于内，虽神仙无如之何。（阴症，虚也。）
〔《保》〕木香散治小儿斑后生痈如神。（出小儿门。）
地骨皮（一两） 木香（半两） 穿山甲（炙黄，二钱五分） 麝香（一字）
上末，米饮下三钱。
转利（通利大便）的方法，并且每天坚持使用。接着又有人说患痈疽的人，常常伴有泄泻，这都是恶兆，对此我不能不表示怀疑。假如说之前使用大黄，是担心因为病人体质实盛，导致大肠便秘，有积热深伏的病症发作，那也只能用来破除结滞、导引积滞，推动大便转动而已，怎么能说是极力地通利大便，而且日复一日不停止呢？如果在已经下利之后，再给予通便的药物，恐怕不符合“防微杜渐”的本意。疮疡刚开始发作的时候，就是《周礼》中所说的“肿疡”阶段。肿胀在肌肉之间，如果不是大满、大实、坚硬的证候，自然应当采用张仲景的发表法，以五香汤为例，将邪气发散于体表，何必急于用峻猛的泻下药，去攻伐体内正气，自招祸患呢？
《精要》说：大凡痈疽，不可舍弃五香汤不用。对此我又不能不有所议论了。我在开篇第一论中已经详细论述过，我不知道良甫那个时代，有多少人大肠坚硬秘结，病气郁塞如此顽固浓重，可以骤然发散并猛烈攻下的。如果确实有这种情况，也应当陈述时间的先后顺序，论证证候是否适宜，这样后人才不敢鲁莽杀人。或者有人说：治疗痈疽使用大黄走泄以去除毒邪，自从孙思邈在《千金方》中就已经说过了，良甫沿袭他的说法，为什么我批评得这么严厉呢？回答说：大黄能清除各种实热，但药性峻猛急迫。孙思邈当时在公卿贵族间盛行医术，处于晚宋时期，百姓不知战乱，交往的都是富贵人家、吃肉的人家，所以效果确实迅速。如今良甫不分贫富、苦乐、劳逸，一概使用大黄，难道没有鲁莽致祸的隐患吗？况且有因房事过度而虚损的，因忧怒而虚损的，因极度贪求欲望而虚损的，因强力劳作而虚损的，因大醉过饱而虚损的，这些都是因为气弱而运行涩滞，血少而浑浊，生发疽本来就是一种难治的疾病，如果大肠虽然秘结但稍微能吃些谷食，肯遵守戒律，甘心吃清淡食物的人，还是可治的，只是需要多费补益的功夫罢了。如果因为十天半月大便干结，不知道这是因为气不下降，就认为是实证，而使用大黄；有些许寒热症状，不知道这是因为气血不和，就认为是外感，而使用解表发散药，这样害人性命非常快。
〔李东垣〕疮疡及其他疾病出现面色红赤，虽然有伏火内热，禁止攻里，因为这是阳气怫郁，邪气在经络，应当用发表法来祛除它。所以说：“火郁则发之”。即使几天不大便，也应该多从表面发散，以疏散阳气，少量加入润燥药来滋润。如果见到风脉风证，只用发表祛风的药物，就可以使大便通利。如果只是干燥秘涩，尤其应该滋润，千万不要攻下。九窍不通利，都不可攻下，疮疡出现的昏冒，俗称昏迷，千万不可攻下，发汗就会痊愈。
〔朱丹溪〕排脓内补十宣散，如果用在轻微的痈疽或冬季，完全可以辅助内托的功效。如果在冬季用于肿疡，也可以使病情由重转轻，由深变浅。如果用于溃疡或夏季，其中桂枝、厚朴的温散作用，配合防风、白芷，我担心虽然有参、芪等补气药，也难以倚仗。近来见世人使用此方，不分痈疽发病季节，不顾经络先后，如同盲人骑瞎马，半夜站在深池边，非常危险。又说：内补十宣散，泻卫气、燥血的药物太多，只可用于轻微小的证候，虚损严重的，恐怕难以倚仗。
《精要》说：内托散，在发病一至三天内，服用十几服，治疗毒瓦斯攻冲脏腑，名叫护心散。这个方子专门针对服用丹石类药物后引发的疽，如果不是因为服用丹石而引发，恐怕不是必用的药剂。至于年老体弱、病位深、证候疲惫、身体沉重的人，虽然绿豆有补益作用，但恐怕会有不胜重任的隐患。
〔张仲景〕患有疮疡的人，即使身体疼痛，也不可以发汗，发汗就会导致痉挛。（注：发汗是指大汗出，并不是指各种托里药轻轻解表的意思。）
李世英患疽，不热不痛，属于阴证。千万不可用冷药敷贴，恐怕会逼迫毒瓦斯进入体内。
〔朱丹溪〕外用敷贴，正与发表的意思相同。经书说：发表不远热。大凡气得到热就会消散，遇到冷就会收敛。以前见过郑经历，性格嗜好喝酒和煎炸爆炒食物，五十多岁时，忽然在春末夏初，额头的丝竹空穴涌出一个角状物，长短大小像鸡距一样稍硬，请求我治疗。我说：这不是膏粱厚味所致还能是什么？应当断绝浓味食物，先解除饮食之毒，用针灸来开通宣泄壅滞，不容易治疗。这是少阳经经过的地方，气多血少的经脉。郑经历因为怕麻烦，召请其他医生，用大黄、朴硝、冰片等冷药罨敷，一夜之间溃烂如酱蚶，直径三寸，一两天后，血液从溃烂处溅出，高达数尺而死。这是冷药在外逼迫，热气郁结不得发散，所以爆发得如此猛烈。
蜞针法说是开门放毒，认为是最快捷的方法，恐怕只适用于轻微小的证候。我认为蜞虫所吮吸的，只是皮肤间的恶血。如果积毒在脏腑，只在外面竭尽毒邪，而不能到达内部，恐怕不是恰当的做法。过去见过张兄的儿子，刚两岁，全身红色疹子像霞片一样。我之前见他母亲久病，说是毒热在血分形成的。张兄说：谁不是因为母血形成的，为什么说毒热的血。我说：他母亲虽然吃肉像平时一样，但肉性热与宿疾的热相搏，不是毒吗？张兄不相信，自己取五六只蜞虫吮吸孩子的血，疹子顿时消退，乳食起居如旧。我说：这不是正确的治疗，不可以为此高兴。张兄生气了。过了两三天，孩子大发热而暴死。这不是因为在外面竭尽毒邪，血去而气不能单独存在吗？
《精要》说：口干与口渴不同，不宜用丹药镇坠，用了其祸患如反掌之间发生。用桑枝煎五味汤，来救阴水，是非常好的方子。但没有提到饮食口味起火、怒气生火、房劳激火，我恐怕口渴不容易消除。
《精要》说头上有发毒的，不得灸，恐怕因为火气拔起，热毒炎上，动病邪而增加病情。我认为这话过分了，火本是用来畅达的，拔引郁毒，这是从治的意思。头是诸阳汇聚的地方，艾炷宜小，壮数宜少，小的像花椒粒，少的三五壮而已。如果鲁莽地像腹部背部引痛灸至不痛，不痛灸至痛那样做，那就是错误了。
按：李东垣灸元好问的脑疽，用大的艾炷像两个核那么大，到一百壮，才觉得痛而痊愈。由此推断，那么头上发毒，灸之痛的，艾炷宜小，壮数宜少；如果不痛的，艾炷大，壮数多，也没有妨碍。又引用陈日华的说法，说在刚开始发作时，用针灸十死八九。这是没有深思。仔细考察因灸而死的人，一定是血虚，孤阴即将断绝，无法承受火气，脉象一定浮数而大鼓，精神一定短少而昏沉，怎么可以泛泛地说刚开始不可灸来误导人。
〔《保命集》〕疮疽已经感觉微微漫肿硬，皮色不变，脉沉不痛的，应当外灸，引导邪气外出然后停止。经书说：陷者灸之。如果外面微微觉得木硬而不痛，应当紧急灸之，这是邪气深陷。浅表的不可灸，要小心。如果有脓水，也不可灸，应当刺破。
按：刺破后脓出，不肿痛，说明邪气已去，不宜灸。如果刺破后脓出，而肿痛不止，也应当在肿处灸之无妨。另外毒虽浅，但有十几个头肿痛，也灸之无妨。
〔王涓〕一旦有痈疽疮疖，必须顺应时节，春夏为正时，容易整理。因为天气温和，肌肉缓慢而暖，所以容易治。其中有肉冷的，是患者气虚所致，只用温药调理顺气血，外用温暖溃脓膏药贴之令穴，等穴位抽脓尽，急忙用生肌长肉药填满疮口，不宜缓慢，恐怕到了秋冬变成漏疮。或者在秋冬发作的，乃是春夏内先有发蒸热毒，遇到一阴生后，再有伏毒，到了秋冬间又因食毒物酒面房欲之事，忽然发作，初觉微小，数日之间肿大疼不可忍。初得病大便五七日不通，小便淋沥的，是它的征候。先调脾脏气令其实，其次服用发穴排脓消毒去积的药，内托温平，不要用太热涩的药。因为脾中脏要和暖，如果用热药，恐怕气涩而不流畅，导致营卫不调。贴敷即用温凉药，不要用冷药，恐怕逼迫毒瓦斯入内，须引导脓液外透，方才渐渐安宁。
〔张仲景〕各种浮数脉，应当发热，反而洒淅恶寒，如果有痛处，当发为痈。
〔《精义》〕阴滞于阳则发痈，阳滞于阴则发疽。而这二种毒，发无定处，应当以脉象辨别，浮洪滑数为阳，微沉缓涩为阴。阴证则用热治，阳证则用冷治。
上述阳脉当以痈法治之，阴脉当以疽法治之，不必拘泥于热治冷治。
〔李东垣〕身重脉缓湿胜者，除湿。身热脉大，心躁时肿，乍来乍去者，清热。诸痛眩晕动摇，脉弦者，去风。
气涩气滞，干燥，亡津液，脉涩者，泻气补血。寒胜则脉浮，食不入，便溺多，恶寒脉紧者，宜泻寒水。肾脉涩甚，为大痈。（全文见虚实法。）
一是阳毒。因风热而有，或患热毒消渴，或先患伤寒，余有阳毒触处蓄积，起于背脊膂之间，不问椎数，但从两夹脊起，止腰上，满背热，如炊之状，赤紫或红如焰，脓毒难成，成后不止，止后痛不除，蓦忽数日之间，复平如旧，将谓肿消，这是内攻肉陷，不可疗矣。
二是阴毒发背。是气冷而作，初如黍米粒起，情绪不快，闷而痛，直应前心，心忪怔，头目昏重，寒热如疟。五七日后，始发引攻肿，开阔难收，内积有脓，深沉迟缓未透，宜急以补气汤药内托，外以抽脓药贴之。宜急见脓，无脓，即平愈未期。
三是有人多服金石烧炼之药，毒恶流滞成发背者，初起如丹疹之状，渐渐开如汤火疮，面色如朱，心膈烦躁，多渴嗜冷，其疮难起，起即惊人，犹胜于阴阳二毒者，缘此有解金石药毒汤散治其内也，赖有根底分明，亦须急疗方安。
四是人有患酒食毒发背者。此疾非近得之，乃脏腑久积，乘饥乘困，食之便睡，或多食酒肉，冷热粘滑，肥鲜炽腻，未下胸膈，房室不禁，恣意当风取快，脾脏气虚不能受，乘发毒攻背，两夹脊不问椎数。初起痈头如小弹子，后大如拳，坚如石，痛遍四肢，加之拘急，口苦舌干，腹急，大小便涩。十数日后，头面手足虚肿，及脏腑通泄如利，内急痛者，是其症也。喜方肿引，急用收肿发穴溃脓汤药，内实外泄，脓水不可放纵，迟缓则皮肉腐坏，伤骨烂筋，渐成脓多，因而感邪内败者，死矣。
五是人有冒山岚瘴气发背。毒瓦斯先在脏腑，年月浸远，气血虚损衰弱。初起肿色青黑如靴，皮顽痹痛，深附筋骨彻髓，按之如木石，引手加深，方觉似有痛处。至五七日，毒瓦斯浮浅，肿高色变青白，有如拳打之状，寒战似疟，及有风候，头动口偏，手足厥逆，眼黑睛小，白多而慢。此内有邪气相搏，急破出清血三五升，方有黄脓白汁相和发泄，其皮不宽不慢亦急，胀痛亦不住，直至色退热疼方愈。亦宜急急追赶脓与毒瓦斯外出无害。
初患肿，三日内灸者生。八日内脓成，针烙导引者生。未瘥，慎劳力者生。慎忌食者生。慎喜怒者生。惧肿猛疗者生。急疗者生。不讳发背者生。
待脓自出，不导引者死。未内攻，而针烙用药导引者生；内攻后，导引针烙者死。热痛方盛以前疗者生，如过此后已内攻者死。脓成后，不出不导引，但敷药者死。如赤白痢气急者，是已内攻，医疗无益，必死。痈不救，十得五生；疽不疗，十全死。轻肿怕痛者必死。不遇良方者死。节候不根据法者必死。愚执恣意用性逸情者死。
有发背痈，有发背疽，如毒瓦斯勇猛而发，如火焚茅，易于败坏。初发即可如黍米粒大，三两天日渐赤引肿如手掌面大，五七日如碗面大，即易为攻，热赤引如火烧之状，浮面渐溃烂阔开，内发肿如炊之状，外烂皮肉如削，去紫瘀脓汁多而肿不退，疼亦不止，发渴发逆，饮食不下，呕吐气急，浮浅开阔者，尤宜发脓托毒汤药，用之必愈。（阳证，实也。）其间有只如盏面大者，此非不大，缘为毒瓦斯深沉，内虚，毒瓦斯近膜也。此必内攻，近入脏腑，却外入四肢。先攻头面虚浮，后攻手面，次攻两足面肿，名曰毒瓦斯散入四肢。其人声嘶气脱，眼睛黑小，十指肿黑干焦不治。（阴证，虚也。）
〔《精义》〕凡痈疽初发肿硬高者，而毒瓦斯却浅，此乃六腑不和为痈，其证属阳，势虽急而易治。若初发如粟粒，甚则如豆许，与肉俱平，或作赤色，时觉痒痛，痒时慎勿抓破，此乃五脏不调为疽，其证属阴，盖毒瓦斯内蓄已深，势虽缓而难治。
始发一粒如麻豆大，身体便发热，生疽处肿大热痛，此为发于外，虽大如盆，治之百可百活。（阳症，实也。）或身体不热，自觉倦怠，生疽处亦不热，数日后渐大，不肿不痛，低陷而坏烂，此为发于内，虽神仙无如之何。（阴症，虚也。）
地骨皮（一两） 木香（半两） 穿山甲（炙黄，二钱五分） 麝香（一字）
上为末，米饮下三钱。
The method of promoting bowel movement (Zhuàn Lì) is employed, and it is not discontinued on a daily basis. Subsequently, it was claimed that patients suffering from carbuncles and sores often experience diarrhea, which is considered an ominous sign; I cannot but harbor doubts about this assertion. If one argues that Dahuang (Rhei Radix et Rhizoma) was used previously out of concern for the patient's robust constitution leading to constipation of the large intestine due to entrenched accumulated heat, its purpose should only be to break up stagnation and guide it out, facilitating bowel movement. How can it be described as excessively promoting diarrhea without cessation day after day? If laxatives are administered again after diarrhea has already occurred, this would likely contradict the principle of preventing trouble before it arises. The initial stage of a sore corresponds to the "Swelling Sore" (Zhǒng Yáng) mentioned in the *Rites of Zhou*. When swelling occurs in the muscles, unless there is a syndrome of fullness, excess, and hardness, one should naturally adopt Zhang Zhongjing's method of releasing the exterior. Taking Wuxiang Tang (Five Fragrances Decoction) as an example, the pathogenic factor should be dispersed outward. Why resort abruptly to harsh purgatives to attack the interior and invite disaster upon oneself?
The *Jingyao* states: "Generally speaking, for carbuncles and sores, one should not discard Wuxiang Tang." Regarding this, I must offer some comments. In the first discussion at the beginning of the book, I elaborated on this. I do not know if, in Liangfu's time, there were many cases of hard constipation of the large intestine with such stubborn and dense obstruction of pathological qi that they could be suddenly dispersed and heavily purged. If such cases indeed existed, the sequence of timing and the appropriateness of the syndrome should have been clearly explained, so that later generations would not dare to recklessly kill people. Or someone might say: "Using Dahuang to drain and eliminate toxins in treating carbuncles and sores was stated by Sun Simiao in the *Qianjin Fang*; Liangfu followed his theory, why do you criticize him so severely?" I reply: Dahuang clears various excess-heat conditions, but its nature is harsh and urgent. Sun Simiao practiced medicine widely among nobles and officials during the late Song Dynasty, when the people were unfamiliar with war and socialized mainly with wealthy families who consumed meat; thus, the effects were indeed rapid. Today, Liangfu uses Dahuang indiscriminately regardless of wealth, hardship, leisure, or labor. Could this not lead to reckless harm? Moreover, there are those deficient due to excessive sexual activity, those deficient due to worry and anger, those deficient due to extreme greed, those deficient due to strenuous labor, and those deficient due to drunkenness and overeating. These individuals suffer from weak qi causing sluggish circulation and scant blood causing turbidity. Developing a gangrenous sore is inherently difficult to treat. However, if the large intestine is constipated but the patient can still consume some grain food, is willing to observe dietary restrictions, and accepts bland flavors, the condition remains treatable, though it requires more effort in tonification. If, however, because of constipation lasting ten days or half a month, one fails to recognize that this is due to descending qi failing to descend rather than excess, and proceeds to use Dahuang; or if, due to slight chills and fever, one fails to recognize disharmony of qi and blood rather than an external contraction, and proceeds to use diaphoretic herbs, such practices harm lives very quickly.
[Li Dongyuan] For sores and other diseases presenting with facial redness, even if there is latent fire-heat, internal purging is prohibited because this indicates constrained yang qi with pathogens in the meridians; one should release the exterior to dispel them. Thus it is said: "When fire is constrained, disperse it." Even if there has been no bowel movement for several days, one should focus on dispersing from the exterior to ventilate yang qi, adding a small amount of moistening-dryness herbs. If wind-pulse and wind-syndromes are present, using exterior-releasing wind-dispelling herbs alone can facilitate bowel movement. If there is only dryness and constipation, moistening is particularly indicated; internal purging must be avoided. When the nine orifices are obstructed, purging is contraindicated. Coma associated with sores, commonly called unconsciousness, must not be treated with purging; sweating will lead to recovery.
[Zhu Danxi] Painong Neibu Shixuan San (Ten-Accumulation Powder for Draining Pus and Tonifying Internally), if used for minor carbuncles and sores or in winter, can fully assist the function of internal support. If used for swelling sores in winter, it can transform severe conditions into mild ones and deep conditions into superficial ones. However, if used for ulcerated sores or in summer, the warming and dispersing properties of Guizhi (Cinnamomi Ramulus) and Houpo (Magnoliae Officinalis Cortex), assisted by Fangfeng (Saposhnikoviae Radix) and Baizhi (Angelicae Dahuricae Radix), make me fear that despite the presence of Renshen (Ginseng Radix) and Huangqi (Astragali Radix), reliance on this formula is precarious. Recently, I have seen people using this formula without distinguishing between carbuncles and sores, seasons, meridians, or stages, like a blind man riding a blind horse standing by a deep pool at midnight—extremely dangerous. It is also stated: "Paion Neibu Shixuan San contains too many herbs that drain defensive qi and dry blood; it is only suitable for mild and small syndromes. For severe deficiency, it is unreliable."
The *Jingyao* states: "Neituo San, taken in doses of ten or more within one to three days of onset, treats toxic factors attacking the zang-fu organs, named Huxin San (Heart-Protecting Powder). This formula is specifically for sores caused by taking cinnabar and sulfur pills. If not caused by these substances, it may not be essential. For the elderly, those with deep disease, exhausted syndromes, or heavy bodies, although Lv Dou (Vigna radiata) has tonifying properties, there is a risk of the body being unable to bear the burden."
[Zhang Zhongjing] Patients with sores, even if experiencing body pain, should not undergo sweating therapy; sweating will lead to spasms. (Note: Sweating refers to profuse sweating, not the mild exterior-releasing effect of various internal-supporting herbs.)
Li Shiying suffered from a gangrenous sore that was neither hot nor painful, indicating a Yin syndrome. Cold medicines applied externally must absolutely be avoided, as this may force toxic factors inward.
[Zhu Danxi] External application is similar in intent to releasing the exterior. The Classics state: "Releasing the exterior does not avoid heat." Generally, qi disperses with heat and contracts with cold. I once treated Zheng Jingli, who loved alcohol and fried foods. In his fifties, around late spring and early summer, a horn-like protrusion emerged at the Sizhukong (Ex2) acupoint on his forehead, hard like a chicken spur. I said: "Is this not caused by rich diet? You must stop rich foods, resolve dietary toxicity, and use acupuncture and moxibustion to open and drain stagnation. This is difficult to treat." This area belongs to the Shaoyang Meridian, where qi is abundant and blood is scarce. Zheng, fearing trouble, summoned another doctor who applied cold medicines like Dahuang, Xiaomingjiao (Natrii Sulfas), and Bingpian (Borneolum Syntheticum). Overnight, it ulcerated like a sauce clam, three inches in diameter. One or two days later, blood spurted from the wound several feet high, and he died. This was due to cold medicines forcing externally, causing heat to constrain and fail to vent, leading to such violent eruption.
The Leech Therapy (Qí Zhēn Fǎ) claims to open the gate to release toxins, considering it swift and effective. I believe this applies only to mild and small syndromes. Leeches suck only evil blood from the skin. If toxins accumulate in the zang-fu organs, exhausting them only on the surface without reaching the interior is inappropriate. I once saw the son of Brother Zhang, aged two, covered in red rashes like clouds. His mother had long suffered from a disease I attributed to toxic heat in the blood. Zhang asked: "Doesn't everyone originate from maternal blood? Why call it toxic heat blood?" I replied: "Although his mother ate meat as usual, the heat nature of meat combined with her chronic illness constitutes toxicity." Zhang did not believe me and applied five or six leeches to suck the child's blood. The rash disappeared instantly, and feeding and behavior returned to normal. I said: "This is not proper treatment; do not rejoice." Zhang became angry. Two or three days later, the child developed high fever and died suddenly. Was this not because exhausting blood externally left qi unable to exist independently?
The *Jingyao* states: "Dry mouth and thirst are different; alchemical pills should not be used for suppression, as the disaster will be immediate. Boiling Sang Zhi (Mori Ramulus) with Wu Wei Tang (Five-Flavor Decoction) to nourish yin water is an excellent prescription." However, it does not mention fire generated by dietary tastes, anger, or sexual exhaustion. I fear thirst will not be easily resolved.
The *Jingyao* states: "For hair-bearing sores on the head, moxibustion is forbidden, fearing that fire qi will draw up heat toxins, aggravating the pathogen and worsening the disease." I consider this statement excessive. Fire is meant to promote circulation and draw out constrained toxins, following the principle of contrary treatment. The head is the gathering place of all yang meridians; moxa cones should be small, and the number of moxibustions few—small as peppercorns, three to five cones. Recklessly applying the rule of "moxa until pain stops, or stop moxa until pain starts" as seen in abdominal/back treatments would be erroneous.
According to Li Dongyuan, when treating Yuan Haowen's brain carbuncle, large moxa cones the size of two kernels were used, totaling one hundred cones, until pain was felt and recovery ensued. From this, we infer: for hair-bearing sores on the head, if painful, use small cones and few moxibustions; if painless, use larger cones and more moxibustions, which is also acceptable. Citing Chen Rihua, who claimed that acupuncture and moxibustion at the onset result in eight or nine deaths out of ten, shows a lack of deep thought. Careful examination reveals that those who died from moxibustion were likely blood-deficient, with isolated yin nearing extinction, unable to withstand fire qi; their pulses were floating, rapid, and large, and their spirit was short and confused. How can one generally forbid moxibustion at the onset and mislead others?
*[Baoming Ji]* When a sore feels slightly swollen, hard, with unchanged skin color, sinking pulse, and no pain, external moxibustion should be applied to guide pathogenic factors out. The Classics state: "Sunken conditions require moxibustion." If there is slight wood-like hardness without pain, urgent moxibustion is needed, indicating deep pathogen invasion. Superficial conditions should not be moxed; exercise caution. If pus and fluid are present, do not moxa; puncture instead.
Analysis: After puncturing, if pus drains and pain/swelling cease, the pathogen is gone; moxibustion is unnecessary. If pus drains but pain/swelling persist, moxibustion on the swelling is acceptable. Even if the toxin is shallow but presents with multiple painful heads, moxibustion is acceptable.
[Wang Juan] Once a carbuncle, sore, or boil appears, one must follow the seasons. Spring and summer are the correct times, making management easier. Because the weather is mild, muscles are slow and warm, treatment is easier. If the flesh is cold, it is due to the patient's qi deficiency; use warm medicines to regulate qi and blood, and apply warm pus-draining plasters externally. Wait for the pore to form and drain completely, then urgently use flesh-regenerating medicines to fill the wound. Do not delay, lest it become a fistula in autumn/winter. If it erupts in autumn/winter, it stems from steaming heat-toxin accumulated internally during spring/summer, combined with latent toxin after the arrival of yin, triggered by toxic foods, alcohol, wheat products, or sexual indulgence. Initially appearing tiny, it swells and becomes unbearably painful within days. Initial signs include constipation for five to seven days and dribbling urination. First, strengthen spleen qi, then administer medicines to open pores, drain pus, detoxify, and remove accumulation. Internal support should be warm and neutral; avoid overly hot/astringent herbs. The spleen organ needs warmth; hot herbs may cause qi stagnation and disrupt Ying and Wei. External applications should be warm-cool, not cold, to avoid forcing toxins inward. Pus must be guided outward for gradual peace.
[Zhang Zhongjing] Floating and rapid pulses usually indicate fever; if accompanied by shivering aversion to cold and a painful area, a carbuncle is developing.
*[Jingyi]* Yin stagnating in Yang causes carbuncles; Yang stagnating in Yin causes gangrenous sores. These two toxins appear in不定 locations and should be distinguished by pulse: floating, surging, slippery, and rapid indicate Yang; fine, sinking, moderate, and choppy indicate Yin. Yin syndromes are treated with heat; Yang syndromes with cold.
However, Yang pulses should be treated according to carbuncle protocols, and Yin pulses according to gangrene protocols; one need not rigidly adhere to heat or cold treatments.
[Li Dongyuan] Heavy body with moderate pulse indicates dampness excess; resolve dampness. Fever with large pulse, restlessness, intermittent swelling, coming and going indicates heat; clear heat. Pain, vertigo, tremors with wiry pulse indicate wind; dispel wind.
Sluggish/stagnant qi, dryness, loss of body fluids, and choppy pulse indicate qi stagnation and blood deficiency; purge qi and tonify blood. Excess cold with floating pulse, inability to eat, frequent urination/defecation, aversion to cold, and tight pulse indicate cold-water excess; purge cold-water. Very choppy kidney pulse indicates major carbuncle. (See Fullness-Emptiness Methods for full text.)
[Wang Juan] The most worrying condition in humans is Back Carbuncle (Fā Bèi), which has five types:
1. Yang Toxin: Caused by wind-heat, or resulting from heat-toxin diabetes, or residual yang toxin accumulating after typhoid fever. It arises between the spine ribs, starting from both sides of the spine up to the waist. The entire back feels hot like cooking, red-purple or flame-red. Pus and toxin are hard to form; if formed, discharge continues, pain persists. Suddenly, within days, it flattens as if healed, but this indicates internal attack and muscle collapse, untreatable.
2. Yin Toxin Back Carbuncle: Caused by cold qi. Starts like a millet grain, with bad mood, stifling pain radiating to the front heart, palpitations, heavy head/eyes, and malaria-like chills/fever. After five to seven days, swelling spreads, hard to contain, with deep, slow, unruptured pus inside. Urgently use Qi-Bu Tang (Tonify-Qi Decoction) for internal support and pus-draining plasters externally. Pus should appear quickly; without it, healing is uncertain.
3. Those who take excessive mineral/cinnabar pills may develop Back Carbuncle from toxic stagnation. Starts like erysipelas, spreading like burn wounds, face red like vermilion, chest irritability, excessive thirst for cold drinks. The sore is hard to rise; if it rises, it is alarming. Better than Yin/Yang toxins because internal mineral-detoxifying decoctions can be used. With clear root cause, urgent treatment brings peace.
4. Alcohol/Food-Toxin Back Carbuncle: Not recent, but accumulated in zang-fu over time. Triggered by hunger/fatigue, eating while lying down, excessive alcohol/meat, sticky/greasy foods, unrestrained sexual activity, and exposure to wind. Spleen qi deficiency cannot handle it; toxin attacks the back between spine ribs. Starts like a small marble, grows to fist-sized, hard as stone, pain throughout limbs, stiffness, bitter taste, dry tongue, abdominal urgency, constipation/difficult urination. After ten+ days, puffiness of head/face/extremities, diarrhea, internal urgency/pain. Urgently use Swelling-Resolving/Pore-Opening/Pus-Draining decoctions to solidify internally and drain externally. Pus must not be allowed to flow freely; delay leads to rotting flesh, bone damage, tendon decay, and death from internal failure.
5. Mountain Miasma Back Carbuncle: Toxic factors in zang-fu for years, depleting qi/blood. Starts with blue-black swelling like boots, numb/painful skin, deep attachment to bones/marrow, hard as wood/stone, pain only when pressed deeply. After five-seven days, toxin surfaces, swelling rises turning blue-white, like a punch mark, chills like malaria, wind symptoms, head tilting, limb reversal, small pupils with white dominance. Internal pathogen struggle requires urgent lancing to release 3-5 sheng of clear blood, followed by yellow/white pus discharge. Skin tension and pain persist until color fades and heat/pain cease. Urgently guide pus/toxin outward.
Survival indicators: Moxa within 3 days of onset; needle/cautery/guidance within 8 days when pus forms; avoid labor if not cured; strict diet; control emotions; treat aggressively; do not deny the disease.
Death indicators: Waiting for spontaneous pus without guidance; needle/cautery after internal attack; treatment after peak heat/pain if internal attack has occurred; pus formed but not drained, only topical application; dysentery with急促 breathing (internal attack, futile); untreated gangrene always fatal; fear of pain in mild swelling fatal; no good prescription fatal; ignoring seasonal laws fatal; reckless lifestyle fatal.
Back Carbuncle Sores vs. Gangrenous Sores: If toxin erupts violently like fire burning thatch, it deteriorates easily. Starts millet-grain sized, grows palm-sized in 2-3 days, bowl-sized in 5-7 days, easy to attack. Red/hot like burning, surface ulcerates, internal swelling like cooking, external flesh sloughs off, purple stasis/pus abundant, swelling/pain persist, thirst/reversal, inability to eat/vomit/shortness of breath, superficial/open: especially suitable for Fa Nong Tuo Du Decoction (Pus-Releasing Toxin-Supporting Decoction);必 recover. (Yang Syndrome, Excess.) Sometimes only cup-sized; not small, but toxin is deep, internal deficiency, toxin near membrane. Must attack internally, entering zang-fu, then extremities. First head/face puffiness, then hands, then feet swelling, named "Toxin Scattering to Four Limbs." Hoarse voice, qi depletion, black/small eyes, black/dry fingers: untreatable. (Yin Syndrome, Deficiency.)
*[Jingyi]* Early carbuncles with high/hard swelling but shallow toxin are Six-Fu disharmony, Yang syndrome, urgent but easy to treat. Early gangrenous sores like millet/bean, flat with flesh, red, itchy/painful, do not scratch: Five-Zang disharmony, Yin syndrome, deep toxin, slow but hard to treat.
Starting as hemp/bean sized, body fever, local swelling/heat/pain: Erupts externally, even basin-sized, 100% curable. (Yang Syndrome, Excess.) No body fever, fatigue, local non-hot, growing slowly, painless, sunken/rotten: Erupts internally, incurable even by immortals. (Yin Syndrome, Deficiency.)
*[Baoming Ji]* Muxiang San treats post-smallpox carbuncles in children miraculously. (From Children's Section.)
Digut皮的 (One liang), Muxiang (Half liang), Chuanshan Jia (Roasted yellow, 2.5 qian), Shexiang (One zi).
Grind to powder, take 3 qian with rice water.