肥人脓多如少。是肉未腐。瘦人脓少如多。是肉败坏也。脓出多。身大热不休者。难治。盖毒之得脓。如伤
寒之得汗。汗已而反大热者。为坏伤寒矣。脓成体弱者。必先补之。如出脓一碗。须服参三钱。元气虚弱。
更须大补。若损大补小。尚生变症。况无补乎。故云。若无补养之功。其祸多在结痂之后。先出稠白脓。次
流桃花脓。再次流淡红水。方为脓尽生肌之兆。脓腐作臭者惟补气血。腐尽则臭自止。忌用止臭药。
疮口出血。或渐大而不敛者。气不守血也。故云溃而出血不作脓者死。
肉赤而不敛。及脓多而带赤者。为血虚有热。宜八珍汤加丹皮。肉黯而不敛者。为阳气虚寒。宜十全大
补汤加白蔹。疮口皮白。绽而不收者。及久不合口。肉多脓少者。再、疮无血色。四围血晕不散者。皆由风
寒外袭。或凉药太过。致使气血不潮。俱用参、 补之。桂、附温之。艾汤涤之。神灯照之。桑柴烘之。疮口开
大脓清不生肌者。里虚也。峻补之。恐生变症。再疮口开大由七情房劳秽气所致者。用白盐、皂角烧存
性为末。发热。茶清调敷。不发热。姜、醋调敷四围。立效。由砒、 蚀药所致者。用皮硝、靛花水敷。疮口紧硬。
贴膏无脓者。风毒也。蝎蚣散掺之。(见去腐门)疮口发痒。用细茶、食盐汤洗之。或以细盐摩口四围自止。肉
虽长。其色紫者遗毒也。地榆汤、活血散敷之。疮口已合。误犯房劳。或暴怒复崩溃者。仍助气血。疮口易
收。乃热毒所致。必防流注之患。
身体肥胖的人,脓液多而稀薄,说明肌肉尚未腐烂;身体消瘦的人,脓液少而稠厚,说明肌肉已经败坏。脓液排出后,如果身体高热不退,属于难治之症。这是因为毒邪化脓,就像伤寒病出汗一样,汗出之后反而出现大热的,就是“坏伤寒”(病情恶化)。脓成但体质虚弱者,必须先进行补益治疗。例如,每排出一碗脓液,就需要服用三钱人参。如果元气特别虚弱,更需要大力补益。如果损伤严重却只轻微补益,尚且会产生变证,何况完全不补呢?所以说,如果没有补养的功效,祸患大多出现在结痂之后。正常的脓液变化过程是:先流出稠厚的白色脓液,接着流出像桃花色一样的脓液,最后流出淡红色的水样液体,这才是脓毒排尽、新肉生长的征兆。脓液腐败发臭的,只能通过补益气血来治疗,腐肉排尽后臭味自然停止,切忌使用止臭的药物。
疮口出血,或者逐渐扩大而不能愈合的,是气不能固摄血液所致。所以说,溃破后出血而不化脓的,预后不良(主死)。
疮面肌肉鲜红而不能愈合,以及脓液多且带红色的,是血虚有热,适宜用八珍汤加牡丹皮。疮面肌肉暗滞而不能愈合的,是阳气虚寒,适宜用十全大补汤加白蔹。疮口周围皮肤发白,裂开而不能收敛的,以及久不愈合、肉多脓少的,还有疮口没有血色、四周血晕不散的,都是由风寒外袭,或者寒凉药物使用过度,导致气血不能充盈所致,均用人参、桂枝、附子来补益和温通,用艾叶煎汤清洗,用神灯照射,用桑木柴烘烤。疮口开张很大、脓液清稀不生肌的,是里虚,必须峻补,以防产生变证。另外,疮口开张很大是由七情内伤、房劳过度或秽气侵袭所致的,用白盐、皂角烧存性研末,发热时用茶汁调敷,不发热时用姜汁、醋调敷于四周,立即见效。由砒霜等腐蚀性药物引起的,用皮硝、靛花水外敷。疮口紧硬、贴膏药无脓流出的,是风毒,用蝎蚣散掺敷。(见去腐门)疮口发痒的,用细茶、食盐汤清洗,或者用细盐摩擦疮口四周,瘙痒自止。肌肉虽然生长,但颜色紫暗的,是遗留毒邪,用地榆汤、活血散外敷。疮口已经愈合,误犯房事,或因暴怒再次溃破的,仍要助益气血,疮口容易收敛。这是热毒所致,必须防止发生流注(毒邪走窜)的祸患。
In obese individuals, copious and thin pus indicates that the flesh has not yet necrosed; in emaciated individuals, scanty and thick pus indicates that the flesh has already degenerated. If copious pus is discharged accompanied by persistent high fever, the condition is difficult to treat. This is because the formation of pus from toxic heat is analogous to sweating in Cold Damage (Shanghan) disease; if high fever persists after sweating, it constitutes "ruined Cold Damage" (a deteriorated state). For patients with formed pus but weak constitution, tonification must be administered first. For instance, for every bowl of pus discharged, three qian of Ginseng Radix et Rhizoma (Renshen) should be taken. If the Yuan Qi (Original Qi) is particularly deficient, vigorous tonification is required. Even slight tonification may cause complications when the damage is severe, let alone no tonification at all. Therefore, it is said that without the efficacy of nourishment and tonification, misfortune often occurs after scabbing. The normal progression of pus resolution is: first, thick white pus flows; second, peach-blossom-colored pus flows; third, pale red watery fluid flows. This signifies that the pus and toxins have been exhausted and new tissue is growing. When pus becomes putrid and foul-smelling, treatment should focus on tonifying Qi and Blood; once the necrotic tissue is eliminated, the odor will cease naturally. It is contraindicated to use drugs specifically to stop the odor.
Bleeding from a sore or ulcer that gradually enlarges and fails to heal indicates that Qi fails to control the Blood. Hence, it is stated that an ulcer that bleeds upon rupture but does not form pus carries a fatal prognosis.
Reddish flesh that fails to heal, and pus that is abundant and tinged with blood, indicate Blood deficiency with Heat. Ba Zhen Tang (Eight Treasure Decoction) combined with Cortex Moutan (Mudanpi) is appropriate. Darkened flesh that fails to heal indicates Yang Qi deficiency with Cold. Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) combined with Rhizoma Belamcandae (Bailian) is appropriate. White skin around the sore, fissured and unable to contract, as well as long-standing non-healing sores with excessive flesh and scanty pus, and sores lacking color with dispersed peripheral erythema, are all caused by external invasion of Wind-Cold or the excessive use of cold-natured herbs, resulting in insufficient flow of Qi and Blood. All such cases should be treated with Ginseng Radix et Rhizoma (Renshen), Cinnamon Twig (Guizhi), and Prepared Root of Aconite (Fuzi) to tonify and warm, washed with Mugwort Leaf Decoction (Aitang), illuminated with Divine Lamp (Shendeng), and dried with mulberry wood fire (Sangchaihong). Large open sores with clear pus failing to generate tissue indicate interior deficiency; vigorous tonification is required to prevent complications. Additionally, large open sores caused by emotional stress, sexual exhaustion, or foul pathogens should be treated with powdered Burnt White Salt (Ba Yan) and Burnt Gleditsia Sinensis Fruit (Zaojiao). Apply mixed with tea liquor if fever is present, or mixed with ginger juice and vinegar around the periphery if no fever is present, yielding immediate results. Sores caused by Arsenic (Pi) or corrosive agents should be treated with application of Mirabilite (Piaoxiao) and Indigofera Tinctoria Leaf Water (Dianhua Shui). Tight and hard sores with no pus under plasters indicate Wind-Toxin; apply Xie Gong San (Scorpion and Centipede Powder) (see section on Removing Necrosis). Itchy sores should be washed with fine tea and salt water, or rubbed with fine salt around the periphery to stop itching. Flesh that grows but appears purple indicates residual toxin; apply Sanguisorba Officinalis Decoction (Diyu Tang) and Huoxue San (Blood-Invigorating Powder). If a healed sore ruptures again due to sexual indiscretion or violent anger, tonifying Qi and Blood will facilitate healing. However, if the rupture is caused by Heat-Toxin, one must guard against the risk of Metastatic Abscess (Liuzhu).