【方歌】多气多血惟阳明，少气太阳厥阴经，二少太阴常少血，
血亏行气补其荣。气少破血宜补气，气血两充功易成，
厥阴少阳多相火，若发痈疽最难平。
【注】人之十二经，有气血多少之分，多则易愈，少则难痊，
疡医明此，临证可豫知痈疽、疮疡之始终难易，而用药
消补之法始当也。如手阳明大肠、足阳明胃，此二经常
多气多血；手太阳小肠、足太阳膀胱、手厥阴包络、足
厥阴肝，此四经常多血少气；手少阳三焦、足少阳胆、
手少阴心、足少阴肾、手太阴肺、足太阴脾，此六经常
多气少血。大法血多者则破其血；气多者则行其气。气
少者难于起发，宜托补之；血少者难于收敛，宜滋养之
；气血两充，则易于起发，易于收敛。惟手足厥阴、少
阳四经，倍多相火，此四经若发痈疽，肌肉难长，疮口
难合，倘过用驱毒峻利之药，以伐其气，以消其血，必
难收功。故明其经之气血多少，则用药不致有妄汗妄下
之弊矣。
【方歌】痈疽原是火毒生，经络阻膈气血凝。外因六淫八风感，
内因六欲共七情，饮食起居不内外，负挑趺扑损身形，
膏梁之变荣卫过，藜藿之亏气血穷。疽由筋骨阴分发，
肉脉阳分发曰痈，疡起皮里肉之外，疮发皮肤疖通名。
阳盛焮肿赤痛易，阴盛色黯陷不疼，半阴半阳不高肿，
微痛微焮不甚红。五善为顺七恶逆，见三见四死生明。
临证色脉须详察，取法温凉补汗攻。善治伤寒杂证易，
能疗痈疽肿毒精。
【注】经云，诸痛痒疮疡，皆属心火，故曰痈疽原是火毒生也
。痈疽皆因荣卫不足，气血凝结，经络阻隔而生。故曰
经络阻隔气血凝也。其因有三：外因、内因、不内外因
也。外因者，由于春之风，夏之热暑，长夏之湿，秋之
燥，冬之寒也。当其时而至，则为正气；非其时而至，
或过盛，则为淫邪。凡此六淫为病，皆属外因。亦有因
于八风相感，如冬至日，正北大刚风；立春日，东北凶
风；春分日，正东婴儿风；立夏日，东南弱风；夏至日
，正南大弱风；立秋日，西南谋风；秋分日，正西刚风
；立冬日，西北折风。应时而至，主生养万物；不应时
而至，主杀害万物。若人感受，内生重病，外生痈肿。
凡此八风为病，亦属外因。故曰外因六淫八风感也。内
因者，起于耳听淫声，眼观邪色，鼻闻过臭，舌贪滋味
，心思过度，意含妄生，皆损人神气，凡此六欲为病，
皆属内因。又有喜过伤心，怒过伤肝，思过伤脾，悲过
伤肺，恐过伤肾，忧久则气结，卒惊则气缩。凡此七情
为病，亦属内因。故曰内因六欲共七情也。不内外因者
，由于饮食不节，起居不慎。过饮醇酒，则生火，消灼
阴液；过饮茶水，则生湿停饮；过食五辛，则损气血；
伤饥失饱，则伤脾胃，凡此皆饮食之致病也。昼日过劳
，挑轻负重，跌扑闪坠等类，损其身形；夜不静息，强
力入房，劳伤精气，凡此皆起居之致病也。其起于膏梁
厚味者，多令人荣卫不从，火毒内结；起于藜藿薄食者
，多令人胃气不充，气血亏少，凡此亦属不内外因也。
人之身体，计有五层：皮、脉、肉、筋、骨也。发于筋
骨间者，名疽，属阴；发于肉脉之间者，名痈，属阳；
发于皮里肉外者，名曰疡毒；只发于皮肤之上者，名曰
疮疖。凡痈疽阳盛者，初起焮肿，色赤疼痛，则易溃易
敛，顺而易治，以其为阳证也。阴盛者，初起色黯不红
，塌陷不肿，木硬不疼，则难溃难敛，逆而难治，以其
为阴证也。半阴半阳者，漫肿不高，微痛不甚，微焮不
热，色不甚红，此证属险。若能随证施治，不失其宜，
则转险为顺，否则逆矣。五善者，五善之证也，诸疮见
之为顺，则易治。七恶者，七恶之证也，诸疮见之为逆
，则难治。凡患痈疽者，五善为顺，七恶为逆。见三善
者，则必生；见四恶者，则必死也。医者于临证之时，
须详察色脉，宜温者温之，宜凉者凉之，宜补者补之，
宜汗者汗之，宜攻者攻之，庶有济也。然外证痈疽，犹
如内证伤寒。善治伤寒，则杂病无不易治；能疗痈疽，
则诸疮无不精妙。盖以能辨表里、阴阳、虚实、寒热也
。
【方歌】十二经中，气血充盛的唯有阳明经；太阳经和厥阴经则是气少血多（注：原文此处“少气”结合下文注释及中医常识，实指气相对不足或特定语境下的少气状态，但根据《医宗金鉴》原文逻辑及后世解读，通常表述为太阳、厥阴多血少气，此处依原文字面翻译为“少气”，但在注释中会澄清）；少阳经、太阴经以及少阴经常表现为血少；当血虚时，应通过调理气机来补益营血。当气虚时，破血疗法需谨慎，宜先补气；若气血两旺，治疗效果便容易成功。厥阴经和少阳经含有较多的相火，如果这些经络发生痈疽，最难治愈和平复。
【注】人的十二经脉，有气血多少的区别。气血多则疾病容易痊愈，气血少则难以康复。外科医生明白这个道理，在临证时可以预先判断痈疽、疮疡的起始、发展难易程度，从而制定恰当的用药消散或补益方法。例如手阳明大肠经和足阳明胃经，这两条经脉通常气血都充足；手太阳小肠经、足太阳膀胱经、手厥阴心包络经、足厥阴肝经，这四条经脉通常血多气少；手少阳三焦经、足少阳胆经、手少阴心经、足少阴肾经、手太阴肺经、足太阴脾经，这六条经脉通常气多血少。基本法则是：血多的，就破除瘀血；气多的，就行气导滞。气少的，疮疡难以起发（隆起），宜用托毒补益的方法；血少的，疮口难以收敛，宜用滋养的方法。如果气血两充，则易于起发，也易于收敛。只有手足厥阴经和手足少阳经这四条经脉，相火特别旺盛，这四条经脉如果发生痈疽，肌肉难以生长，疮口难以愈合。倘若过度使用驱除毒素、峻猛利下的药物，以损伤其气，以消耗其血，必定难以取得疗效。因此，明了各经脉气血的多少，用药就不会出现妄用发汗或攻下法的弊端了。
【方歌】痈疽原本是由火毒产生的，导致经络阻滞、气血凝结。外因是感受六淫邪气和八风侵袭；内因是六欲过度和七情失调；饮食起居不当属于不内外因；负重挑担、跌倒扑伤损伤身形；食用膏粱厚味导致荣卫失调，食用粗茶淡饭导致气血亏虚。疽生于筋骨之间属阴分，生于肉脉之间属阳分称为痈，发生于皮里肉外的称为疡，发生于皮肤表面的疖子通称为疮。阳证盛者，红肿热痛明显，容易治疗；阴证盛者，颜色暗紫，凹陷不肿，不疼痛，难以治疗；半阴半阳证，不高肿，微痛微热，红色不明显。五善证为顺证，七恶证为逆证，见到三种善证或四种恶证，生死预后便明确了。临证时必须详细观察面色和脉象，采取温、凉、补、汗、攻等治法。善于治疗伤寒杂病的人容易，能精通治疗痈疽肿毒的人更见功力。
【注】经文说：“各种疼痛、瘙痒、疮疡，都属于心火。”所以说痈疽原本是由火毒产生的。痈疽都是因为荣卫不足、气血凝结、经络阻隔而产生的。所以说“经络阻隔，气血凝结”。其原因有三类：外因、内因、不内外因。外因，是由于春季的风、夏季的热暑、长夏的湿、秋季的燥、冬季的寒。在相应的季节到来，这叫正气；不在相应季节到来，或者过于强盛，这就叫淫邪。凡是这六淫致病，都属于外因。也有因为感受八风引起的，比如冬至日，来自正北的刚风；立春日，来自东北的凶风；春分日，来自正东的婴儿风；立夏日，来自东南的弱风；夏至日，来自正南的大弱风；立秋日，来自西南的谋风；秋分日，来自正西的刚风；立冬日，来自西北的折风。顺应时节而来，主掌生养万物；不顺应时节而来，主掌杀害万物。如果人感受了这些邪气，内生重病，外生痈肿。凡是这八风致病，也属于外因。所以说是“外因六淫八风感”。内因，起因于耳朵听淫靡之声，眼睛看邪僻之色，鼻子闻过分的气味，舌头贪恋美味，心思过度劳累，意念产生妄想，这些都损害人的神气，凡是这六欲致病，都属于内因。又有欢喜过度伤心，愤怒过度伤肝，思虑过度伤脾，悲伤过度伤肺，恐惧过度伤肾，忧愁久了则气机郁结，突然受惊则气机收缩。凡是这七情致病，也属于内因。所以说是“内因六欲共七情”。不内外因，由于饮食不节制，起居不慎。过量饮用美酒，则生火，消灼阴液；过量饮茶，则生湿停饮；过量食用五辛（葱、蒜、韭、薤、兴渠），则损伤气血；饥饱失常，则损伤脾胃，这些都是饮食导致的疾病。白天过度劳累，挑轻物却背重物，跌打闪挫坠落等，损伤身形；夜晚不能安静休息，强行房事，劳伤精气，这些都是起居导致的疾病。那些源于膏粱厚味的人，多让人荣卫不和，火毒内结；源于藜藿薄食的人，多让人胃气不充，气血亏少，这些也属于不内外因。人的身体，共有五层：皮、脉、肉、筋、骨。发生在筋骨之间的，名叫疽，属阴；发生在肉脉之间的，名叫痈，属阳；发生在皮里肉外的，名叫疡毒；只发生在皮肤之上的，名叫疮疖。凡是痈疽中阳盛者，初起时红肿热痛，则容易溃破也容易收敛，顺而易治，因为这是阳证。阴盛者，初起颜色暗紫不红，塌陷不肿，木硬不疼，则难溃难敛，逆而难治，因为这是阴证。半阴半阳者，漫肿不高，微痛不甚，微热不烫，颜色不太红，这个证候属于险证。如果能随证施治，不失适宜，则转险为顺，否则就是逆证。五善，是指五种善证，各种疮疡见到这些症状为顺证，则容易治疗。七恶，是指七种恶证，各种疮疡见到这些症状为逆证，则难治。凡是患痈疽的人，五善为顺，七恶为逆。见到三种善证，则必然生存；见到四种恶证，则必然死亡。医生在临证之时，必须详细察看病色和脉象，该温的就温之，该凉的就凉之，该补的就补之，该发汗的发汗，该攻下的攻下，这样才会有帮助。然而外证的痈疽，犹如内证的伤寒。善于治疗伤寒，那么杂病就没有不易治疗的；能治疗痈疽，那么各种疮疡没有不精妙的。大概是因为能够辨别表里、阴阳、虚实、寒热罢了。
[Song] Among the twelve meridians, only the Yangming (Yang Brightness) meridian is abundant in both Qi and Blood. The Taiyang (Greater Yang) and Jueyin (Terminal Yin) meridians have less Qi [Note: Contextually implies relative Qi deficiency or specific pattern; literal translation "less Qi"]. Shaoyang (Lesser Yang), Taiyin (Greater Yin), and Shaoyin (Lesser Yin) meridians often have less Blood. When Blood is deficient, regulate Qi to nourish Ying (Nutritive) Blood. When Qi is deficient, breaking Blood should be avoided; instead, tonify Qi. If both Qi and Blood are充盈 (abundant), therapeutic efficacy is easily achieved. The Jueyin and Shaoyang meridians contain excessive Xianghuo (Ministerial Fire); if carbuncles and sores occur in these meridians, they are the most difficult to heal and pacify.
[Annotation] In the human body's twelve meridians, there are distinctions in the abundance of Qi and Blood. Abundance facilitates recovery, while deficiency makes healing difficult. Surgeons who understand this can predict the onset, progression, and difficulty of carbuncles, sores, and ulcers, thereby employing appropriate methods of medication for dissipation or tonification. For instance, the Hand-Yangming Large Intestine meridian and Foot-Yangming Stomach meridian typically possess abundant Qi and Blood. The Hand-Taiyang Small Intestine, Foot-Taiyang Bladder, Hand-Jueyin Pericardium, and Foot-Jueyin Liver meridians typically possess abundant Blood but less Qi. The Hand-Shaoyang Sanjiao (Triple Burner), Foot-Shaoyang Gallbladder, Hand-Shaoyin Heart, Foot-Shaoyin Kidney, Hand-Taiyin Lung, and Foot-Taiyin Spleen meridians typically possess abundant Qi but less Blood. The general principle is: where Blood is abundant, break stasis; where Qi is abundant, move Qi. Where Qi is deficient, lesions are difficult to elevate (rise), requiring supportive and tonifying methods; where Blood is deficient, wounds are difficult to close, requiring nourishing methods. If both Qi and Blood are abundant, elevation and closure are easy. Only the four meridians of Hand-Foot Jueyin and Hand-Foot Shaoyang have doubled Ministerial Fire. If carbuncles and sores arise in these four meridians, muscle growth is difficult, and wound closure is hard. Overuse of harsh drugs to expel toxins and drain will damage Qi and consume Blood, making success unlikely. Thus, understanding the Qi and Blood status of each meridian prevents the misuse of sweating or purging therapies.
[Song] Carbuncles and sores originate from Fire-Toxin, causing obstruction in meridians and coagulation of Qi and Blood. External causes include invasion by Six Excesses (Six Evils) and Eight Winds; internal causes involve excess of Six Desires and Seven Emotions; improper diet and lifestyle constitute neither-internal-nor-external causes; carrying loads or falling injures the body form; rich food leads to disharmony of Ying and Wei, while poor food leads to exhaustion of Qi and Blood. Sores arising between sinews and bones belong to the Yin aspect; those between flesh and vessels belonging to the Yang aspect are called Carbuncles (Yong); lesions outside the skin but inside the flesh are called Ulcers (Yang); boils on the skin surface are generally called Chuang-Jie. Yang-excess presents with red, swollen, hot, painful symptoms, which are easy to treat; Yin-excess presents with dark, depressed, non-painful symptoms, which are difficult to treat; Half-Yin-Half-Yang presents with slight swelling, mild pain, slight heat, and pale redness. Five Good signs indicate favorable prognosis; Seven Evil signs indicate adverse prognosis. Observing three Goods or Four Evils clarifies survival or death. Clinically, one must carefully inspect complexion and pulse, applying warming, cooling, tonifying, sweating, or purging methods as appropriate. Mastering the treatment of Cold Damage and miscellaneous diseases is proficient; mastering the treatment of carbuncles and toxic swellings demonstrates exquisite skill.
[Annotation] The Classic states: "All pain, itching, and sores belong to Heart Fire." Hence, it is said that carbuncles and sores originate from Fire-Toxin. They arise due to deficiency of Ying and Wei, coagulation of Qi and Blood, and obstruction of meridians. There are three categories of causes: external, internal, and neither-internal-nor-external. External causes stem from Wind in Spring, Heat/Summerheat in Summer, Dampness in Late Summer, Dryness in Autumn, and Cold in Winter. Arriving in their proper season, they are Righteous Qi; arriving out of season or excessively, they become Pathogenic Excesses. All diseases caused by the Six Excesses are external. Also included are invasions by the Eight Winds: Gangfeng (Rigid Wind) from North at Winter Solstice; Xiongfeng (Auspicious/Bad Wind - *Note: 'Xiong' usually means bad/malevolent here*) from Northeast at Start of Spring; Ying'erfeng (Infant Wind) from East at Spring Equinox; Ruofeng (Weak Wind) from Southeast at Start of Summer; Daweifeng (Great Weak Wind) from South at Summer Solstice; Mofeng (Plotting Wind) from Southwest at Start of Autumn; Gangfeng (Rigid Wind) from West at Autumn Equinox; Zhefeng (Folding Wind) from Northwest at Start of Winter. Arriving in season, they nurture all things; arriving out of season, they harm all things. Human exposure leads to internal severe disease and external carbuncles/swellings. These Eight Winds are also external causes. Internal causes arise from hearing obscene sounds, viewing lewd sights, smelling foul odors, craving flavors, mental overexertion, and delusional thoughts, which damage Shen (Spirit) and Qi. Joy over-injures the Heart, Anger over-injures the Liver, Pondering over-injures the Spleen, Grief over-injures the Lung, Fear over-injures the Kidney, prolonged sorrow knots Qi, sudden fright shrinks Qi. These Seven Emotions are internal causes. Neither-internal-nor-external causes include irregular diet and lifestyle. Excessive alcohol generates Fire and consumes Yin fluids; excessive tea generates Dampness and fluid retention; excessive pungent spices (Five Pungents) damages Qi and Blood; irregular meals injure the Spleen and Stomach. Daytime overwork, carrying heavy loads, falls, and sprains injure the body form; nighttime lack of rest and forced sexual activity exhaust Jing (Essence) and Qi. Rich foods cause Ying-Wei disharmony and internal Fire-Toxin binding; poor foods cause Spleen-Stomach Qi deficiency and Qi-Blood depletion. The human body has five layers: Skin, Vessels, Flesh, Sinews, Bones. Lesions between sinews and bones are Ju (Deep Sores/Yin); between flesh and vessels are Yong (Carbuncles/Yang); outside skin but inside flesh are Yangdu (Ulcer Toxins); on the skin surface are Chuangjie (Boils). Yang-excess Yong/Ju starts with red, swollen, hot, painful lesions, easy to suppurate and heal (Favorable). Yin-excess starts with dark, depressed, hard, painless lesions, difficult to suppurate and heal (Adverse). Half-Yin-Half-Yang presents with diffuse swelling, mild pain/heat/color, representing a dangerous condition. Proper treatment can turn danger into favor; otherwise, it becomes adverse. Five Good signs indicate favorable prognosis; Seven Evil signs indicate adverse prognosis. Seeing three Goods suggests survival; seeing four Evils suggests death. Clinicians must examine complexion and pulse, applying warming, cooling, tonifying, sweating, or purging treatments appropriately. Treating external carbuncles is akin to treating internal Cold Damage. One who masters Cold Damage can treat miscellaneous diseases easily; one who masters carbuncles treats all sores with precision, primarily by distinguishing Exterior/Interior, Yin/Yang, Deficiency/Excess, and Cold/Heat.