肿疡者,痈疽未见脓而肿者也。丹溪云∶肿疡内外皆壅,宜托里散为主,如用大黄,宜
戒猛浪之非。
溃疡者,痈疽之脓已溃出者也。丹溪云∶溃疡内外皆虚,宜以补接为主,欲用香燥,
宜戒虚虚之失。
肿高、 痛、脉浮者,邪在表也,宜托治之。(内托复煎散是也。)肿硬、痛深、脉
沉者,邪在内也,宜下之。(黄连内疏汤、仙方活命饮、苦参丸之类是也。)外无 肿,
内则便利调和者,邪在经络也,宜和荣卫。(托里养荣汤,白芷、升麻辈)。 痛烦躁,或咽
干作渴者,宜降火。(黄连解毒汤。) 痛发热,或拘急,或头痛者,邪在表也,宜
散之。(荆防败毒散、人参败毒散之类,汗之疮已是也。)大痛或不痛者,邪气实也,
宜隔蒜灸之,更用解毒剂。(仙方活命饮。)烦躁、饮冷、 痛、脉数者,邪在上也,宜
清之。(清凉饮、金银花散是也。)恶疮久而不溃者,气实兼寒邪也,宜宣而补之。(十
宣散是也。) 痛发热、汗多大渴、便秘谵语者,结阳证也,宜下之。(黄连内疏汤、
破棺丹是也。)不作脓,或熟而不溃者,虚也,宜补之。(补中益气汤、十全大补汤、八
珍汤是也。) 痛或不作脓者,邪气凝结也,宜解之。(仙方活命饮。)肿痛饮冷、发热
睡语者,火也,宜清之。(清心汤、防风通圣散加黄连)。不作脓或不溃,及不敛者,阳
气虚也,宜补之。(托里消毒散。)疮后当调养,若瘰 流注之证,尤当补益,否则更扶
不起,难以措治矣。
肿疡,是指痈疽尚未化脓但已经出现肿胀的病证。朱丹溪说:肿疡阶段,体内和体表的气血都壅滞不通,治疗应以托里散邪为主;如果必须使用大黄等泻下药,应当警惕并避免鲁莽猛烈的用药错误。
溃疡,是指痈疽的脓液已经溃破排出的病证。朱丹溪说:溃疡阶段,体内和体表的正气都已虚弱,治疗应以补益气血、促进愈合为主;如果想用香燥类药物,应当警惕并避免使虚者更虚的错误。
局部红肿高起、疼痛、脉象浮的,是邪气在肌表,适宜采用内托法治疗。(例如使用内托复煎散。)局部肿胀坚硬、疼痛位置深、脉象沉的,是邪气在体内,适宜采用攻下法治疗。(例如使用黄连内疏汤、仙方活命饮、苦参丸之类。)体表没有明显肿胀,但内部二便调和通畅的,是邪气在经络,适宜调和营卫。(例如使用托里养荣汤,或白芷、升麻这类药物。)疼痛伴烦躁,或者咽喉干燥、口渴的,适宜降火。(例如使用黄连解毒汤。)疼痛伴发热,或者肢体拘急抽搐、头痛的,是邪气在肌表,适宜发散解表。(例如使用荆防败毒散、人参败毒散之类,通过发汗使疮毒外透。)疼痛剧烈或不疼痛的,是邪气盛实,适宜隔蒜灸法,并配合使用解毒剂。(例如使用仙方活命饮。)烦躁、想喝冷水、疼痛、脉象数的,是邪气在上部,适宜清热。(例如使用清凉饮、金银花散。)恶疮日久不溃烂的,是正气尚实兼有寒邪,适宜宣通并补益。(例如使用十宣散。)疼痛伴发热、出汗多且极度口渴、便秘、胡言乱语的,是结阳证(热毒内结),适宜攻下。(例如使用黄连内疏汤、破棺丹。)不能化脓,或者脓成但不溃破的,是正气虚弱,适宜补益。(例如使用补中益气汤、十全大补汤、八珍汤。)疼痛或不化脓的,是邪气凝结,适宜消散解结。(例如使用仙方活命饮。)肿痛、想喝冷水、发热、睡中说胡话的,是火毒炽盛,适宜清热。(例如使用清心汤、防风通圣散加黄连。)不能化脓或不溃破,以及溃后不收敛的,是阳气虚弱,适宜补益。(例如使用托里消毒散。)疮疡后期应当调养,如果是瘰疬、流注这类病症,尤其应当注重补益,否则正气更加衰竭难以支撑,就难以进行治疗了。
A "Zhongyang" (swollen ulcer) refers to a carbuncle or furuncle that has swelled but has not yet suppurated. Zhu Danxi stated: In the stage of Zhongyang, both internal and external qi and blood are obstructed; treatment should primarily focus on supporting the interior and dispersing pathogens, such as using Tuoli San (Support Interior Powder). If Rhubarb (Dahuang, 大黄) is used, one must beware of the error of reckless and violent medication.
A "Kuangyang" (ulcerated sore) refers to a carbuncle or furuncle where pus has already ruptured and drained. Zhu Danxi stated: In the stage of Kuangyang, both internal and external righteousness (zheng qi, 正气) are deficient; treatment should primarily focus on tonifying and reconnecting tissues. If aromatic and drying herbs are desired, one must beware of the error of further depleting the deficiency.
When the swelling is high, painful, and the pulse is floating, the pathogen is in the exterior; it is appropriate to use internal support therapy (e.g., Neituo Fujian San). When the swelling is hard, the pain is deep, and the pulse is sinking, the pathogen is in the interior; it is appropriate to use purgation (e.g., Huanglian Neishu Tang, Xianfang Huoming Yin, Kushen Wan). When there is no external swelling, but internal bowel movements and urination are harmonious, the pathogen is in the meridians; it is appropriate to harmonize Ying and Wei (nutritive and defensive qi) (e.g., Tuoli Yangrong Tang, or herbs like Baizhi and Shengma). When there is pain accompanied by irritability, or dry throat and thirst, it is appropriate to descend fire (e.g., Huanglian Jiedu Tang). When there is pain accompanied by fever, stiffness/spasms, or headache, the pathogen is in the exterior; it is appropriate to disperse it (e.g., Jingfang Baidu San, Renshen Baidu San), inducing sweating to vent the sores. When the pain is severe or absent, the pathogenic factor is excess; it is appropriate to apply garlic-separated moxibustion and use detoxifying agents (e.g., Xianfang Huoming Yin). When there is irritability, desire for cold drinks, pain, and a rapid pulse, the pathogen is in the upper jiao; it is appropriate to clear heat (e.g., Qingliang Yin, Jinyinhua San). When a malignant sore persists without ulcerating over a long period, it indicates excess qi combined with cold pathogen; it is appropriate to ventilate and tonify (e.g., Shixuan San). When there is pain, fever, profuse sweating, extreme thirst, constipation, and delirium, it is a Jieyang syndrome (accumulation of yang/heat); it is appropriate to purge (e.g., Huanglian Neishu Tang, Po Guan Dan). When pus does not form, or forms but does not rupture, it indicates deficiency; it is appropriate to tonify (e.g., Buzhong Yiqi Tang, Shiquan Dabu Tang, Bazhen Tang). When there is pain or failure to suppurate, it indicates pathogenic condensation; it is appropriate to resolve/dissipate it (e.g., Xianfang Huoming Yin). When there is swelling, pain, desire for cold drinks, fever, and somniloquy (talking in sleep), it is fire/toxin; it is appropriate to clear it (e.g., Qingxin Tang, Fangfeng Tongsheng San added with Huanglian). When there is failure to suppurate, failure to ulcerate, or failure to heal after ulceration, it indicates deficiency of Yang qi; it is appropriate to tonify (e.g., Tuoli Xiaodu San). After the sore heals, recuperation is necessary. For conditions like Luoli (scrofula) and Liuzhu (flowing abscesses), tonification is especially crucial; otherwise, the righteous qi will be too weak to sustain itself, making treatment difficult.