初起之形，阔大平塌，根盘散漫，不肿不痛，色不明亮，此疽中最险之症，倘误服寒凉
，其
色变如隔宿猪肝，毒攻内腑，神昏即死。夫色之不明而散漫者，乃气血两虚也；患之不痛而
平塌者，毒痰凝结也。治之之法，非麻黄不能开其腠理，非肉桂、炮姜不能解其寒凝。此三
味虽酷暑，不可缺一也。腠理一开，寒凝一解，气血乃行，毒亦随之消矣。学人照方根据治，
自无不愈，倘有加减，定难奏效。
马曰∶治法极是。
又曰∶麻黄未溃可用，已溃之后，断不可重开其腠理。
此症色白肿痛，毒发阴分，盖因痰塞清道，气血虚寒凝结，一曰寒痰，一曰气毒。其初
起皮
色不异，惟肿惟疼，体虽发热，内未成脓，以二陈汤加阳和丸同煎，数服全消。消后接服小
金丹七丸，杜其续发。如皮色稍变，极痛难忍，须服阳和汤以止其痛，消其未成脓之余地。
使其已成脓者，渐至不痛而溃，此乃以大疽变小之法。如患顶软，即为穿之，脓多白色，以
阳和膏日贴。但此症溃后，定增毒痰流走，患生不一，故初溃之后，五日内仍服小金丹十丸
，以杜后患。接用犀黄丸、阳和汤，每日早晚轮服，使毒痰消尽，不补亦可收功。
倘孩子不能服煎剂者，初起以小金丹化服，至消乃止。成脓者，亦服小金丹，消其余硬
之地
，使患不痛，即为穿之。俟其毒尽，用保元汤， 、草宜生忌炙，加入肉桂五分，日服收功
。
如孕妇患之，当问怀胎月数，倘未满六个月，犀黄丸有麝香，不可服，当以阳和汤愈之
。愈后再服三四剂，以代小金丹，杜其流走。
马曰∶此症湿痰凝滞者，固当温散，其有动劳之辈，不受外寒，内伤脾土，脾气滞而不
行，湿痰因之停滞，治当流气行痰，可望消散。
又曰∶流注生于夏令，太阴司天在泉之岁最多。曝日躬耕，夜天露卧，暑为寒束，气道
不行
，随处结肿。初起宜从汗解，万灵丹最妙。数服后不应，再进阳和。若壮热烦渴引饮，全是
暑热内蕴，小金、阳和，岂可沾唇？
马曰∶阳和汤孕妇忌服，即小金丹亦非所宜。
初起时的形态，范围宽大且平坦下陷，根基散漫不聚，既不肿胀也不疼痛，颜色晦暗不明亮，这是疽病中最危险的证候。如果误服寒凉药物，其颜色会变成像隔夜的猪肝一样，毒邪攻入内脏，导致神志昏迷随即死亡。肤色晦暗且散漫，是因为气血两虚；患处不痛且平坦下陷，是因为毒邪与痰浊凝结。治疗的方法，非用麻黄不能打开腠理（皮肤毛孔及汗腺），非用肉桂、炮姜不能解除寒凝。这三味药即使在酷暑季节，也不可缺少。一旦腠理开通，寒凝解除，气血得以运行，毒邪也随之消散。学习者按照此方根据病情治疗，自然没有不痊愈的，如果有加减改动，一定难以奏效。
马曰：治法非常正确。
又说：麻黄在未溃破时可以使用，已经溃破之后，绝对不可以再次强行打开腠理。
这种病症表现为肤色白而肿痛，毒邪发于阴分，大概是因为痰浊阻塞了清道（指呼吸道或上部经络通道），加上气血虚寒凝结，分为“寒痰”和“气毒”两种情况。初起时皮色没有变化，只有肿胀和疼痛，身体虽然发热，但内部尚未成脓。用二陈汤加阳和丸同煎，服用几剂后完全消散。消散后接着服用小金丹七丸，以杜绝其再次发作。如果皮色稍有改变，极度疼痛难以忍受，必须服用阳和汤来止痛，并消除未成脓部分的余毒。使已经成脓的部分，逐渐变得不痛而溃破，这是将大疽转化为小疽的方法。如果患部顶部变软，就进行穿刺，脓液多为白色，每天外贴阳和膏。但这种病症在溃破后，一定会增加毒痰流窜的情况，患处位置不一，所以在初次溃破后的五天内，仍然要服用小金丹十丸，以杜绝后患。接着使用犀黄丸、阳和汤，每日早晚轮流服用，使毒痰彻底消除，即使不进行补益治疗也可以收到疗效。
如果孩子不能服用煎剂，初起时用小金丹化开服用，直到病灶消散为止。已经成脓的，也服用小金丹，以消散剩余的硬结部分，使患处不再疼痛，就可以进行穿刺。等到毒邪排尽，使用保元汤，甘草宜生用忌用炙过的，加入肉桂五分，每日服用以收功。
如果是孕妇患病，应当询问怀孕几个月，如果未满六个月，因为犀黄丸含有麝香，不可服用，应当用阳和汤治愈它。治愈后再服用三四剂，用来代替小金丹，以杜绝毒邪流窜。
马曰：这种病症如果是湿痰凝滞造成的，固然应当温散，但对于那些从事体力劳动的人，他们不受外寒侵袭，而是内伤脾土，脾气阻滞而不运行，湿痰因此停滞，治疗应当行气化痰，有望消散。
又说：流注生于夏季，在太阴司天在泉的年份最多。烈日下躬身耕作，夜晚露天睡觉，暑气被寒气束缚，气道不通，随处结肿。初起适宜从汗解，万灵丹最为巧妙。服用几剂后如果不见效，再进服阳和汤。如果出现高热、烦躁、口渴想喝水，全是暑热内蕴，小金丹、阳和汤怎么可以沾唇？
The initial appearance is broad, flat, and sunken, with a diffuse root that does not gather. There is no swelling or pain, and the color is dull and not bright. This is the most dangerous syndrome among carbuncles (deep-seated suppurative infections). If cold-natured medicines are mistakenly taken, the color will change to resemble overnight pork liver; if the toxin attacks the internal organs, causing coma, death will follow immediately. The dull and diffuse color indicates deficiency of both Qi and Blood; the lack of pain and sunken appearance indicates condensation of toxin and phlegm. The treatment method requires Ephedrae Herba (Mahuang, 麻黄) to open the Couli (skin pores and interstices), and Cinnamon Twig (Rougui, 肉桂) and Prepared Ginger (Paoyang, 炮姜) to resolve cold condensation. These three herbs are indispensable even in the height of summer. Once the Couli are opened and cold condensation resolved, Qi and Blood can circulate, and the toxin will dissipate accordingly. Practitioners who treat according to this prescription without alteration will find all cases curable; any modification will likely fail to produce results.
Ma said: The treatment method is extremely correct.
He also said: Mahuang can be used before ulceration, but after ulceration has occurred, it must absolutely not be used to forcibly reopen the Couli.
This syndrome presents with white skin, swelling, and pain, with toxin emerging from the Yin aspect. It is generally due to phlegm obstructing the clear pathways (respiratory tract or upper meridians) and condensation of deficient Qi and Cold Blood, categorized as either "Cold Phlegm" or "Qi Toxin." Initially, the skin color remains unchanged, with only swelling and pain. Although the body may have fever, pus has not yet formed internally. Decocting Erchen Tang (Two-Aged Powder) together with Yanghe Wan (Yanghe Pill) and taking several doses will completely eliminate the condition. After resolution, continue administering Xiaojin Dan (Xiaojin Pill), seven pills at a time, to prevent recurrence. If the skin color changes slightly and extreme pain becomes unbearable, Yanghe Tang (Yanghe Decoction) must be taken to stop the pain and eliminate residual toxin in areas where pus has not yet formed. This allows already formed pus to gradually become painless and ulcerate, which is a method of transforming a large carbuncle into a small one. If the apex of the lesion becomes soft, puncture it. The pus is mostly white; apply Yanghe Gao (Yanghe Plaster) daily. However, after ulceration, this syndrome inevitably leads to the wandering of toxin and phlegm, with lesions appearing in various locations. Therefore, within five days after initial ulceration, administer ten pills of Xiaojin Dan to prevent future complications. Subsequently, use Xihuang Wan (Xihuang Pill) and Yanghe Tang, alternating morning and evening, to completely eliminate toxin and phlegm. Even without tonification, therapeutic success can be achieved.
If children cannot take decoctions, dissolve Xiaojin Dan for oral administration during the initial stage until the lesion resolves. For those with formed pus, also administer Xiaojin Dan to dissipate remaining indurations, rendering the lesion painless so that it can be punctured. Once the toxin is exhausted, use Baoyuan Tang (Baoyuan Decoction). Licorice Root (Gancao, 甘草) should be used raw, not honey-fried, with added Cinnamon Bark (Rougui, 肉桂) 5 fen, taken daily to achieve recovery.
If pregnant women suffer from this, inquire about the number of months of gestation. If less than six months, Xihuang Wan contains Moschus (Shexiang, 麝香) and must not be taken; instead, cure it with Yanghe Tang. After healing, take three or four additional doses to substitute for Xiaojin Dan and prevent the wandering of toxin.
Ma said: For this syndrome caused by stagnation of damp-phlegm, warming and dispersing methods are indeed appropriate. However, for those engaged in strenuous labor who do not suffer from external cold but instead damage the Spleen Earth internally, leading to stagnant and non-circulating Spleen Qi, which causes damp-phlegm to stagnate, the treatment should focus on moving Qi and resolving phlegm, with hope for resolution.
He also said: Liuzhu (Flowing Abscesses) occur in summer, most frequently in years governed by Taiyin (Too-Yang) influencing the Heaven and Earth. Working under the scorching sun and sleeping outdoors at night, the summer heat is constrained by cold, causing the Qi mechanism to cease functioning, resulting in localized swellings anywhere. Initially, resolution through sweating is suitable; Wanling Dan (Wanling Pill) is excellent. If there is no response after several doses, proceed with Yanghe Tang. If high fever, restlessness, and thirst with desire to drink occur, indicating pure internal accumulation of summer-heat toxin, how could Xiaojin Dan or Yanghe Tang be touched?
Ma said: Yanghe Tang is contraindicated for pregnant women, and even Xiaojin Dan is not suitable.