内消 消者、减也。于初起红肿结聚之际。施行气、活血、解毒消肿之剂。必分之以虚实。如脉症俱实者。
汗利之。脉症俱虚者。滋补之。次分部位。佐以引经消毒之药。使气血各得其常。则可内消也。再如热渴
便闭。邪在里也。则疏导之。寒热 痛。邪在表也。则发散之。无表里症。邪在经也。则和解之。
内托 托者、起也。已成之时。不能突起。亦难溃脓。或坚肿不赤。或不痛大痛。或得脓根散。
或脓少脓清。或疮口不合者。皆气血虚也。主以大补。佐以活血祛毒之品。或加以芳香。行其郁滞。或加以温热。御其
风寒。如托里消毒散。随时加减之。候脓出肿消腐净。用参、 、归、术、大补之。甚加附子。使气血滋茂。则新
肉易生。是为内托也。又云。治痈以寒。是为内消。治疽以热。是为内托。内消内托。乃正治从治之义也。
肿溃诸症。须辨虚实。随行补泻。若或稍差。关系甚大。假如肿起坚硬脓稠者。疮疽之实也。肿下软慢脓
稀者。疮疽之虚也。泻利肠鸣。食少呕吐。手足并冷。脉弱皮寒。小便自利。或小便时难。大便滑利。声音
不出。精神不爽者。悉脏腑之虚也。大便硬。小便涩。饮食如故。肠满胀闷。肢节疼痛。口苦咽干。烦渴身热。
脉大神昏者。悉脏腑之实也。脓水清稀。疮口不合。聚肿不赤。肌寒肉冷。自汗色脱者。气血之虚也。肿
高色赤。寒热疼痛。脓稠壮热。头目昏重者。气血之实也。头痛鼻塞。目赤心惊。喉舌生疮。烦渴饮冷。睡
语切牙者。上实也。精滑便利。腰脚沉重。睡卧不宁者。下虚也。肩项不便。四肢沉重。目视不正。睛不了
了。食不知味。音嘶声败。四肢浮肿者。真气虚也。 肿痛甚。日久不溃。寒热往来。二便淋秘。心神烦闷者。
邪气虚也。又曰。真气夺则虚。邪气盛则实。诸庠为虚。诸痛为实。脉微细软者为虚。洪大而数者为实
也。脉症俱虚。虚则补之。和其气。托里也。脉症俱实。实则泻之。导其气。疏利也。脉症俱缓。缓则治本。用
平和之药。徐治之也。
主治之法。如肿高 痛者。神授卫生散解之。次用托里消毒散。漫肿微痛者。用托里散。如不应。加姜桂。
脓出反痛。气血虚也。宜八珍汤。不作脓。不腐溃。阳气虚也。宜四君子汤。加归、 、肉桂。不生肌。不收
敛。脾气虚也。宜四君子汤。加芍药、木香。恶寒憎寒。阳气虚也。宜十全大补汤。加姜、附。晡热内热。阴
血虚也。宜四物汤。加参、术。欲呕作呕。胃气虚也。宜六君子汤。加炮姜。自汗盗汗。五脏虚也。宜六味
丸。加五味子。食少体倦。脾气虚也。宜补中益气汤。加茯苓、半夏。喘促咳嗽。脾肺虚也。宜补中益气
汤。加五味、麦冬。欲呕食少。脾胃虚也。宜人参理中汤。腹痛泄泻。脾胃虚寒也。宜附子理中汤。小腹
痞。足胫肿。脾肾虚也。宜十全大补汤。加山药、山茱萸。泄泻足冷。脾肾虚寒也。宜十全大补汤。加附子。
热渴淋秘。肾虚阴火也。宜加减八味丸。喘嗽淋秘。肺肾虚火也。宜补中益气汤、加减八味丸。
大凡怯弱之人。不必分其肿溃。惟宜先补胃气。或疑参、 满中。或泥于气质素实。或为有痰勿服补剂。
或间有用者又加发散败毒等药。致使听补不偿听损。多致有误。殊不究疮疡之作。缘阴阳已亏。脓血
既泻。元气已惫。斯时也。不行温补。将何以恃。书云。才得肿痛。参之脉症。见有虚弱。便与滋补。气血无亏。
可保终吉。此古今不易之确论也。
内消法：所谓“消”，即减少、消散之意。在疾病初起，出现红肿结聚的时候，施行行气、活血、解毒消肿的方剂。必须辨别病证的虚实。如果脉象和症状都表现为实证，则采用发汗或攻下的方法；如果脉象和症状都表现为虚证，则采用滋补的方法。其次要辨别病变部位，辅以引导药力到达该经络并消毒的药物，使气血各归其常道，这样就可以实现内消。再如出现发热、口渴、大便闭结的症状，说明邪气在里，则采用疏导通里的方法；出现寒热往来、疼痛的症状，说明邪气在表，则采用发散解表的方法；没有表证也没有里证，说明邪气在经络，则采用和解的方法。
内托法：所谓“托”，即提起、托毒外出之意。当疮疡已经形成，但不能突起，也难以溃破排脓时；或者肿胀坚硬但颜色不红，或者不痛却剧烈疼痛；或者脓液稀薄散漫；或者脓液少且清稀；或者疮口久不愈合的情况，这些都是气血虚弱所致。治疗以大量补益为主，辅以活血祛毒的药物。或者加入芳香类药物，以疏通郁滞的气机；或者加入温热类药物，以抵御风寒侵袭。例如使用托里消毒散，根据情况随时加减药物。等到脓液排出、肿胀消退、腐肉净化后，用人参、（此处原文缺字，通常指黄芪）、当归、白术等大补气血的药物进行调理，严重时加入附子，使气血滋长茂盛，那么新肉就容易生长，这就是内托法。又有人说：治疗痈肿用寒凉药，这属于内消法；治疗疽症用温热药，这属于内托法。内消和内托，正是正治法和从治法的含义。
对于肿胀和溃破的各种症状，必须辨别虚实，随即采取补法或泻法。如果稍有差错，关系非常重大。假如肿胀高起、坚硬、脓液稠厚，这是疮疽的实证；如果肿胀平塌、软慢、脓液稀薄，这是疮疽的虚证。如果出现腹泻、肠鸣、食欲减退、呕吐、手脚冰冷、脉弱皮肤寒冷、小便自利或排尿困难、大便滑泄失禁、声音不出、精神萎靡不振等症状，都是脏腑的虚证。如果出现大便干硬、小便涩滞、饮食正常、腹部胀满闷痛、关节疼痛、口苦咽干、烦躁口渴、身体发热、脉象洪大、神志昏沉等症状，都是脏腑的实证。如果脓水清稀、疮口不合、聚集性肿胀但不发红、肌肉寒冷、自汗、面色苍白无华，这是气血的虚证。如果肿胀高起、颜色红赤、伴有寒热疼痛、脓液稠厚、壮热、头目昏重，这是气血的实证。如果出现头痛鼻塞、眼睛红赤、心惊、咽喉舌头生疮、烦躁口渴想喝冷水、说梦话、磨牙等症状，这是上部的实证。如果出现遗精滑泄、大小便通畅、腰脚沉重、睡眠不安稳，这是下部的虚证。如果出现肩颈僵硬不便、四肢沉重、视物不正、目光呆滞、吃东西不知道味道、声音嘶哑、四肢浮肿，这是真气的虚证。如果出现肿痛严重、日久不溃破、寒热往来、大小便淋沥闭塞、心神烦闷，这是邪气的虚证（注：此处原文“邪气虚”疑为笔误或特定语境，通常邪盛为实，但依原文翻译）。又说：真气耗夺则为虚，邪气亢盛则为实。所有的瘙痒都属于虚证，所有的疼痛都属于实证。脉象微细柔软的属于虚证，脉象洪大而数急的属于实证。如果脉象和症状都表现为虚，虚证就用补法，调和其气，起到托里的作用；如果脉象和症状都表现为实，实证就用泻法，疏导其气，起到疏利的效果；如果脉象和症状都表现为缓，缓证则治其根本，使用平和的药物，慢慢治疗。
主治的方法：如果肿胀高起、疼痛明显的，用神授卫生散来解散它，其次再用托里消毒散。如果漫肿且轻微疼痛的，用托里散。如果无效，加入生姜、肉桂。如果脓出后反而疼痛，是气血虚弱，适宜用八珍汤。如果不化脓、不腐溃，是阳气虚弱，适宜用四君子汤，加入当归、（此处原文缺字，通常指黄芪）、肉桂。如果不生肌、不收敛，是脾气虚弱，适宜用四君子汤，加入芍药、木香。如果恶寒、憎寒，是阳气虚弱，适宜用十全大补汤，加入生姜、附子。如果下午发热、内部发热，是阴血虚弱，适宜用四物汤，加入人参、白术。如果想吐、呕吐，是胃气虚弱，适宜用六君子汤，加入炮姜。如果自汗、盗汗，是五脏虚弱，适宜用六味丸，加入五味子。如果食欲少、身体疲倦，是脾气虚弱，适宜用补中益气汤，加入茯苓、半夏。如果气喘急促、咳嗽，是脾肺虚弱，适宜用补中益气汤，加入五味子、麦冬。如果想吐、食欲少，是脾胃虚弱，适宜用人参理中汤。如果腹痛、泄泻，是脾胃虚寒，适宜用附子理中汤。如果小腹部痞块、足胫肿胀，是脾肾虚弱，适宜用十全大补汤，加入山药、山茱萸。如果泄泻、脚冷，是脾肾虚寒，适宜用十全大补汤，加入附子。如果发热、口渴、小便淋沥闭塞，是肾虚导致的阴火，适宜用加减八味丸。如果气喘咳嗽、小便淋沥闭塞，是肺肾虚火，适宜用补中益气汤、加减八味丸。
大凡体质怯弱的人，不必区分是肿胀期还是溃破期，只适宜先补益胃气。有人怀疑人参、（黄芪）会充满中焦阻碍气机，或者拘泥于患者平时体质强壮，或者有痰湿就不服用补剂，或者偶尔用了补剂又加上发散败毒等药物，导致补益的效果抵不过损耗，大多导致误治。这些人根本不探究疮疡的发生，是因为阴阳已经亏损，脓血既已排泄，元气已经疲惫。在这个时候，如果不进行温补，还能依靠什么呢？书上说：刚出现肿痛，诊察脉象和症状，见到有虚弱的表现，就给予滋补。只要气血没有亏损，就可以保证最终吉利。这是古今不变的确切理论。
Internal Resolution (Neixiao): "Resolution" refers to reduction and dissipation. When the disease first begins, presenting with redness, swelling, and aggregation, administer formulas that regulate Qi, invigorate blood, resolve toxicity, and reduce swelling. One must differentiate between deficiency and excess syndromes. If both the pulse and symptoms indicate excess, employ sweating or purging methods. If both the pulse and symptoms indicate deficiency, employ tonifying methods. Secondly, differentiate by anatomical location, assisting with herbs that guide the medicinal action to the relevant meridian and resolve toxicity, thereby allowing Qi and Blood to return to their normal state, achieving internal resolution. Furthermore, if there is fever, thirst, and constipation, the pathogen is in the interior; thus, employ draining and guiding methods. If there are alternating chills and fever with pain, the pathogen is in the exterior; thus, employ dispersing and releasing methods. If there are neither exterior nor interior symptoms, the pathogen is in the meridians; thus, employ harmonizing methods.
Internal Support (Naituo): "Support" refers to lifting and pushing out. When a sore has formed but fails to rise prominently, making it difficult to suppurate and drain pus, or when the swelling is hard but not red, or painless yet severely painful, or when the pus root is scattered, or when there is little pus with clear consistency, or when the wound fails to close, these are all due to Qi and Blood deficiency. The primary treatment is massive tonification, assisted by herbs that invigorate blood and dispel toxicity. Aromatic herbs may be added to move stagnant Qi, or warming herbs may be added to ward off wind-cold. For example, use Tuoli Xiaodu San (Support Interior and Dispel Toxin Decoction), adjusting it according to circumstances. Once pus is discharged, swelling subsides, and necrotic tissue is cleared, use Ren Shen (Ginseng Radix), [missing character, likely Huangqi], Dang Gui (Angelicae Sinensis Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) for major tonification. In severe cases, add Fu Zi (Aconiti Lateralis Radix Praeparata) to nourish and flourish Qi and Blood, facilitating the easy growth of new flesh. This is called internal support. It is also said: treating carbuncles (Yong) with cold-natured herbs constitutes internal resolution; treating ulcers (Ju) with warm-natured herbs constitutes internal support. Internal resolution and internal support represent the principles of direct treatment (Zhengzhi) and indirect treatment (Congzhi).
Various symptoms of swelling and ulceration must be differentiated as deficiency or excess, followed by appropriate tonification or purgation. Any slight error can have significant consequences. For instance, if the swelling is high, hard, and the pus is thick, this indicates an excess syndrome of sores and ulcers. If the swelling is flat, soft, slow-rising, and the pus is thin, this indicates a deficiency syndrome. Symptoms such as diarrhea, borborygmus, poor appetite, vomiting, cold hands and feet, weak pulse, cold skin, free urination or difficulty urinating, loose stools, loss of voice, and mental fatigue all indicate deficiency of the Zang-Fu organs. Symptoms such as hard stool, scanty urine, normal diet, abdominal fullness and distension, limb pain, bitter taste in the mouth, dry throat, irritability, thirst, body heat, large pulse, and confusion all indicate excess of the Zang-Fu organs. Clear and thin pus, non-healing wounds, aggregated swelling without redness, cold muscles and flesh, spontaneous sweating, and sallow complexion indicate deficiency of Qi and Blood. High swelling, red color, chills and fever with pain, thick pus, high fever, and heavy/dizzy head and eyes indicate excess of Qi and Blood. Headache, nasal congestion, red eyes, palpitations, sores on the throat and tongue, irritability, thirst for cold drinks, somniloquy, and teeth grinding indicate excess in the upper jiao. Spermatorrhea, free bowel movements, heavy waist and legs, and restless sleep indicate deficiency in the lower jiao. Stiffness in shoulders and neck, heavy limbs, abnormal vision, dull gaze, loss of taste, hoarse voice, and edema of the four limbs indicate deficiency of True Qi. Severe pain and swelling, failure to ulcerate after a long time, alternating chills and fever, strangury and retention of urine and feces, and mental restlessness indicate deficiency of Pathogenic Qi (Note: Text says "Xieqi Xu", typically pathogens cause excess, but translated literally here). It is said: depletion of True Qi results in deficiency; flourishing of Pathogenic Qi results in excess. All itching belongs to deficiency; all pain belongs to excess. A fine, small, and soft pulse indicates deficiency; a surging, large, and rapid pulse indicates excess. If pulse and symptoms both indicate deficiency, apply tonification to harmonize Qi and support the interior. If pulse and symptoms both indicate excess, apply purgation to guide Qi and promote drainage. If pulse and symptoms both indicate slackness, treat the root cause with mild and balanced herbs, managing the condition gradually.
Specific treatments include: For high swelling and severe pain, use Shenshou Weisheng San (Divine Grant Hygiene Powder) to resolve it, followed by Tuoli Xiaodu San. For diffuse swelling with slight pain, use Tuoli San. If ineffective, add Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex). If pain increases after pus discharge, it is Qi and Blood deficiency; use Bazhen Tang (Eight Treasure Decoction). If no pus forms and no ulceration occurs, it is Yang Qi deficiency; use Sijunzi Tang (Four Gentlemen Decoction) plus Dang Gui, [missing character, likely Huangqi], and Rou Gui. If granulation tissue does not form and the wound does not contract, it is Spleen Qi deficiency; use Sijunzi Tang plus Shaoyao (Paeoniae Radix Alba) and Muxiang (Aucklandiae Radix). If aversion to cold and fear of cold occur, it is Yang Qi deficiency; use Shiquan Dabu Tang (Ten Significant Tonifying Decoction) plus Sheng Jiang and Fu Zi. If afternoon fever and internal heat occur, it is Yin Blood deficiency; use Siwu Tang (Four Substance Decoction) plus Ren Shen and Bai Zhu. If nausea and vomiting occur, it is Stomach Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum). If spontaneous sweating and night sweats occur, it is Five Zang deficiency; use Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Wuweizi (Schisandrae Fructus). If poor appetite and physical fatigue occur, it is Spleen Qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fuling (Poria) and Banxia (Pinelliae Rhizoma). If panting, coughing, and wheezing occur, it is Spleen and Lung deficiency; use Buzhong Yiqi Tang plus Wuweizi and Maidong (Ophiopogonis Radix). If nausea and poor appetite occur, it is Spleen and Stomach deficiency; use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If abdominal pain and diarrhea occur, it is Spleen and Stomach deficiency-cold; use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). If epigastric stuffiness and leg/ankle edema occur, it is Spleen and Kidney deficiency; use Shiquan Dabu Tang plus Shanyao (Dioscoreae Rhizoma) and Shanzhuyu (Corni Fructus). If diarrhea and cold feet occur, it is Spleen and Kidney deficiency-cold; use Shiquan Dabu Tang plus Fu Zi. If fever, thirst, and strangury/retention occur, it is Kidney deficiency with deficient fire; use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). If panting, coughing, and strangury/retention occur, it is Lung and Kidney deficiency-fire; use Buzhong Yiqi Tang and Jiajian Bawei Wan.
Generally, for frail individuals, one need not distinguish between the swelling stage and the ulceration stage; it is best to first tonify Stomach Qi. Some doubt that Ren Shen and [Huangqi] fill the middle and obstruct Qi, or cling to the idea that constitutions are naturally robust, or refuse tonics due to phlegm, or even when using tonics, add dispersing and detoxifying herbs, causing the benefit of tonification to be outweighed by the damage. This leads to many errors. They fail to investigate that sores and ulcers arise because Yin and Yang are already depleted, and after pus and blood are discharged, Yuan Qi is exhausted. At this time, if warming and tonifying are not performed, what can one rely upon? The text states: As soon as swelling and pain appear, examine the pulse and symptoms; if weakness is seen, immediately provide tonification. As long as Qi and Blood are not depleted, ultimate auspiciousness can be guaranteed. This is an unchanging truth from ancient to modern times.