绀珠丹 卫生散 贵金丸 托里消毒散 加减地黄丸 绛珠膏（俱见首卷） 黄连消毒饮（见头部）
蟾酥丸 蟾酥条（见疔门） 敷贴药（首卷参用） 灸法（见首卷灸门）
一人项疽十余日。势甚。根连耳项。红肿 热。脉浮而数。用黄连消毒饮二服。大势稍定。次用托里消毒
散数服。不能腐溃。脉浮无力。此为元气损伤。止能起发。不能为脓。易十全大补汤。加桔梗、白芷、倍参末
各三钱。外用桑柴烘法。早晚二次烘之。贴绀珠膏数日。患者头面俱肿。双目合缝。形状可畏。然后腐溃
并作。脓出日至数升。将及半月。加五心烦躁。饮食少思。此补力不及所致。虽变无妨。用圣愈汤一服。不
应。又进一服。加熟附子二钱方应。前症悉除。次以人参养荣汤。加麦冬、五味。参、术倍至三钱。月余后。腐
肉连发。片片脱下。野狼狈不堪。又恐补不及时。每日粥食中用人参三钱。几餐分入。同煮食之。后元气渐
醒。调理四月方瘥。
一人生偏疽。隔蒜灸十五壮。知痛乃住。失用内药。又四日。紫肿木痛。便秘脉实。以内疏黄连汤加玄明
粉二钱通之。次用消毒救苦汤二服。肿势仍甚。此内毒外发。不可再消。换托里消毒散。至二十日。因患
者体肥。外肉多紧。不作腐溃。欲行针开放。彼坚执强阻。后烦闷昏愦。人事不醒。乃变症出也。随用铍针。
左右耳边并顶中各开一窍。内有脓腐处剪割顽肉寸许。放出脓血碗许。服健脾养血大补之药。脓似
泉流。每朝夕药与食中共参六七钱。服至腐化新生。又四十日外。患者方得渐醒。始知人事。此症设若
禁用针刀。不加峻补。而得生者鲜矣。
一人项疽五六日。疮根平散。又至五日外。疮势坚硬。根脚开大。毒瓦斯已过两肩。流注前项。胸乳皆肿。呕
吐恶心。寒热不食。情势可畏。此时非药力可及也。先用葱汤洗去旧药。煮拔筒。拔提二处。出淤血碗许。
随用银针斜斜插入根脚。透通患底数处。以蟾酥条插入孔内。最能解毒为脓。总以膏盖之。其走散处。
以温药敷之。日渐日消。毒收原处。兼服内托降火化痰之药。三四日大势已退。内脓已通。换服十全大
补汤。凡坚而不化者照之。腐而不痛者取之。新肉生迟者培之。如是调理。三月方瘥。
一妇年六旬。素禀怯弱。疽头如粟。喜其形体不肥。虽发之逆。后必易溃。先隔蒜灸之。次以蟾酥饼贴灸
上。四边以吸毒散敷之。收其根。内服托里消毒散。数服疮势坚硬。苦于痛楚。予为脉细数而无力。此内
虚之故。不能解毒为脓。以痛为要。换益气养荣汤加角刺、白芷。三服肿亦渐起。用桑木烘法。坚亦渐软。
脓出稠而不多。前方去皂刺、白芷。加香附倍参 。又数服脓溃。溃后痛亦不止。再三日。腐肉将脱小半。
用乳香定疮散。一服疼痛退除。数十日完口。此法要在眼力精巧。量病易难。腐新迟速。补助有无。用
药合式。然后相量日数。并皆决之于前。发之必中。
一妇壮年体胖。项生疽。顶高根活。彼欲内消。予为药消不能。针消则可。取铍针当头针入六七分。至软
肉方住。去淤血。插蟾酥条。服蟾酥丸。得大汗而解。次日疮出微脓渐消。再服消毒清热之药。不出十日
而安。大凡欲消疮毒。先断根本。次泻毒瓦斯。使毒日衰。无致内攻为诀。
一人耳后生疽将半月。根脚渐大。疮头血水秽污。四边紫黑。软陷无脓。面惨鼻 。手冷气促。脉诊散大
无根。此内败症也。不治。果卒。但犯此症。虽山岳之躯。一败无不倾倒。
一妇对口。自灸念余壮。不痛。灸疤焦黑。平陷如故。诊之脉微数而无力。此内虚症也。若假药力。则误其
事。用铍针当顶刺入寸许。不知痛。亦无血。此毒滞而未发也。插蟾酥条。以膏盖之。每日一次。七日后。周
围裂缝出脓。内服补剂。至十四日根脱。搽绛珠膏。又半月。口平。掺珍珠散生皮而愈。此症不用针攻。专
假药力。虽不至死。岂能得其速愈哉。
一妇年四旬。肥甚。患项疽五六日。视之肉肿疮不肿。（乃顶陷也。）又兼口燥心烦。（此邪火内淫也。）
坚硬紫暗。（此血死毒滞故不作腐溃也。）根脚散平。（为真气内败不能束毒也。）六脉洪大。（为
毒瓦斯胜正气也。）此太过之症。后必无脓软陷。内攻而死。辞不治。后果殁。
绀珠丹、卫生散、贵金丸、托里消毒散（托里消毒汤，用于补益气血、托毒外出）、加减地黄丸、绛珠膏（以上方药均见于本书首卷）。黄连消毒饮（见头部章节）。蟾酥丸、蟾酥条（见疔疮门）。敷贴药（参考首卷使用）。灸法（见首卷灸法门）。
有一人患颈项部疽证十余日。病情严重，病灶根部牵连耳部和颈部，局部红肿、发热，脉象浮而数。服用黄连消毒饮两剂后，大势稍定。接着服用托里消毒散数剂，但疮口不能腐溃化脓，脉象浮而无力。这是元气受损的表现，只能促使疮顶起发，却无法化生脓液。于是改用十全大补汤（十全大补汤，具有温补气血功效的方剂），加入桔梗、白芷，人参和黄芪粉末各增加三钱。外用桑柴火烘法，早晚各烘烤两次。贴上绀珠膏数日。此时患者头面部全部肿胀，双眼紧闭无法睁开，形态令人畏惧。随后疮口腐烂溃破，脓液每日流出达数升。将近半个月时，出现五心烦热、烦躁不安、饮食减少思虑的症状。这是由于补益之力不足以应对病势所致。虽然病情发生变化也无妨，但仍需治疗。服用圣愈汤一剂，未见效果；再服一剂，加入熟附子二钱，方才见效。之前的症状全部消除。接着用人参养荣汤（人参养荣汤，益气补血、养心安神的方剂），加入麦冬、五味子，人参和白术加倍至三钱。一个多月后，腐肉连着毛发，成片脱落，景象狼狈不堪。又担心补益不及时，每天在粥食中加入人参三钱，分几餐同煮食用。后来元气逐渐恢复，经过四个月的调理才痊愈。
有一人生偏侧疽证。先隔蒜灸十五壮，感到疼痛便停止。之后未能及时使用内服药物。又过了四天，患处紫肿、麻木疼痛，便秘，脉象实。用内疏黄连汤（内疏黄连汤，清热解毒、通腑泄热的方剂）加入玄明粉二钱以通便泻热。接着服用消毒救苦汤两剂，肿胀之势仍然很严重。这是体内毒素向外发散的表现，不可再用消法。换用托里消毒散。到了第二十天，因为患者身体肥胖，外部肌肉紧绷，导致不能腐溃化脓。想要进行针刺开放引流，患者坚决强烈地阻止。后来出现烦闷、昏愦、人事不省的情况，这是变症发生。随即用铍针（一种外科针具），在左右耳边及头顶正中各开一个孔窍。对内有脓腐的地方剪割顽肉约一寸长，放出脓血约一碗。服用健脾养血的大补药物。脓液像泉水一样流出，每早晚餐时与药物一起摄入六七钱。服药直到腐肉化解、新肉生长。又过了四十多天，患者才逐渐苏醒，开始知晓人事。此症如果禁用针刀，不加峻猛补益，能存活的人极少。
有一人患颈项部疽证五六天，疮根平散。又过了五天，疮势坚硬，根部扩大，毒气已过双肩，流注到前颈部，胸部和乳房都肿胀，呕吐恶心，寒热交替，不能进食，情势令人畏惧。此时单靠药力已难以奏效。先用葱汤洗去旧药，煮拔筒，在两个部位进行拔罐提毒，引出淤血约一碗。随即用银针斜插入疮根底部，透通患部底部多处，将蟾酥条插入孔内。蟾酥条最能解毒并促进化脓。总之以膏药覆盖。对于毒气走散的部位，用温性药物敷贴。日渐消退，毒气收敛回原处。兼服内托降火化痰的药物。三四天后大势已退，内部脓液已通畅。换服十全大补汤。凡是坚硬而不化脓的照此处理，腐烂而不痛的取此法，新肉生长迟缓的培补正气。如此调理，三个月才痊愈。
有一位六十岁的妇人，素来体质怯弱。疽头如粟米大小。庆幸她形体不肥胖，虽然发病属于逆证，但后来容易溃破。先进行隔蒜灸，然后在灸处贴上蟾酥饼，四周用吸毒散敷贴，以收束疮根。内服托里消毒散。服用数剂后疮势坚硬，痛苦于疼痛。我为其诊脉，脉细数而无力，这是内虚的缘故，不能解毒化脓，以疼痛为主要表现。换用益气养荣汤（即人参养荣汤，此处指代同类补益方义，或为笔误，依上下文应为补气养血之剂，原文作“益气养荣汤”，通常指人参养荣汤或类似方，此处保留原名或理解为补益气血之剂，结合后文加角刺白芷，仍属补托范畴。注：中医古籍中“益气养荣”常作为治法描述，若作方名，多指人参养荣汤加减。此处依原文提取实体，翻译时意译为补益气血之剂或保留方名概念），加入皂角刺、白芷。服用三剂后肿胀也逐渐起发。用桑木烘烤法，坚硬之处也逐渐变软。脓液流出稠厚但不多。前方去掉皂角刺、白芷，加入香附，人参加倍。又服用数剂后脓液溃出。溃破后疼痛仍未停止。再过三天，腐肉即将脱落一半。用乳香定疮散，服用一剂后疼痛消除。数十日后疮口愈合。这种方法关键在于医生眼力精巧，衡量病情的难易，判断腐肉与新肉生长的迟速，补充正气之有无，用药合乎法度，然后相应推算天数，并且都在事前决断，发必中的。
有一位壮年妇女，身体肥胖，颈部生疽。疮顶高突，根部活动。她想通过内服药物消除疮毒。我用药内消无效，针刺则可。取铍针当头直入六七分，到达柔软肌肉处停止。去除淤血，插入蟾酥条，服用蟾酥丸。得大汗而解。第二天疮口流出少量脓液，逐渐消退。再服用消毒清热的药物，不出十日而安宁。大凡想要消除疮毒，先断绝根本，其次泻排毒气，使毒气日渐衰减，不致使之内攻，这是诀窍。
有一人耳后生疽将近半个月，根部逐渐变大，疮头血水秽污，四周紫黑，软陷无脓，面色惨白，鼻准色青黑（注：原文“鼻 ”可能缺字，结合语境多为鼻准黑或类似危候，此处依常见危候推断或仅译可见部分，通常指鼻准黑为脾败），手脚冷，气促，脉象散大无根。这是内脏败坏的症状。不治。果然去世。但犯此症的人，即使有山岳般强壮的身体，一旦败坏无不倾倒死亡。
有一位患对口疽（生于项后正中者）的妇人，自己灸了二十余壮，不痛，灸后的疤痕焦黑，平陷如故。诊脉微数而无力，这是内虚症。如果假借药力（指单纯依赖药物而不行手术引流），则会耽误病情。用铍针当顶刺入寸许，不知疼痛，也没有血液流出，这是毒气停滞而未发散。插入蟾酥条，用膏药覆盖。每天一次。七日后，周围裂缝出脓。内服补剂。到了第十四天，疮根脱落。搽涂绛珠膏。又过半个月，疮口平复。掺撒珍珠散生肌长皮而痊愈。此症如果不使用针刀攻伐，专门依靠药力，虽然不至于死亡，难道能求得快速痊愈吗？
有一位四十岁的妇人，非常肥胖，患颈项部疽证五六天。观察发现肌肉肿胀但疮面不肿（这是疮顶下陷）。又兼口燥心烦（这是邪火内侵）。坚硬紫暗（这是血死毒滞所以不能腐溃）。根部散平（这是真气内败不能束毒）。六脉洪大（这是毒气胜过正气）。这是太过之症，后来必然无脓、软陷，毒气内攻而死。辞谢不予治疗。后果然死亡。
Ganzhu Dan (Cinnabar Pearl Pill), Weisheng San (Health-Preserving Powder), Guijin Wan (Noble Gold Pill), Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder, a formula to tonify qi and blood and expel toxins), Jiadi Dihuang Wan (Modified Rehmannia Pill), Jiangzhu Gao (Crimson Pearl Ointment) (all formulas mentioned in the first volume). Huanglian Xiaodu Yin (Coptis Decoction for Detoxification) (see Head section). Chansu Wan (Toad Venom Pill), Chansu Tiao (Toad Venom Strip) (see Ding [Carbuncle] section). Futie Yao (External Application Paste) (refer to first volume for use). Jiu Fa (Moxibustion Method) (see Moxibustion section in the first volume).
A man suffered from a neck carbuncle for more than ten days. The condition was severe, with the root of the lesion extending to the ear and neck, presenting with redness, swelling, heat, and a floating, rapid pulse. After taking two doses of Huanglian Xiaodu Yin, the major symptoms subsided slightly. Subsequently, several doses of Tuoli Xiaodu San were administered, but the wound failed to suppurate and ulcerate. The pulse remained floating and weak, indicating damage to the primordial qi. The treatment could only promote the elevation of the abscess head but failed to generate pus. Therefore, Shiquan Dabu Tang (Ten Great Tonifying Decoction) was prescribed with added Jiegeng (Platycodon Root), Baizhi (Angelica Dahurica), and increased amounts of Renshen (Ginseng) and Huangqi (Astragalus) powders by three qian each. Externally, the Sangchai Hong Fa (Mulberry Wood Fire Roasting Method) was applied twice daily, morning and evening. Jiangzhu Gao was applied for several days. At this stage, the patient's head and face became severely swollen, eyes tightly shut, creating a terrifying appearance. Eventually, the tissue necrosed and ulcerated simultaneously, discharging several sheng of pus daily. Nearly half a month later, the patient developed five-palm heat, irritability, and loss of appetite due to insufficient tonic efficacy. Although the pathology changed, it did not preclude further treatment. One dose of Shengyu Tang (Holy to Save Decoction) was given without effect. A second dose was administered with the addition of Shu Fuzi (Prepared Aconite Root) by two qian, which finally took effect, resolving all previous symptoms. Then, Renshen Yangrong Tang (Ginseng Nourishing Harmony Decoction) was prescribed with added Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), doubling the dosage of Renshen and Baizhu (Atractylodes Macrocephala Rhizome) to three qian each. Over a month later, necrotic tissue and hair detached in sheets, leaving a messy state. To prevent delayed tonification, three qian of Renshen were added to his daily porridge, divided into several meals and cooked together. Gradually, the primordial qi recovered, and after four months of regulation, he healed.
Another man developed a lateral neck carbuncle. He underwent moxibustion with garlic slices for fifteen moxa cones, stopping when pain was felt. However, internal medication was neglected. Four days later, the area became purple, swollen, numb, and painful, accompanied by constipation and a solid pulse. Neishu Huanglian Tang (Internal Draining Coptis Decoction) with two qian of Xuanmingfen (Mirabilite) was used to unblock bowels and drain heat. Two doses of Xiaodu Jiuku Tang (Detoxifying and Suffering-Relieving Decoction) followed, but swelling persisted. This indicated that internal toxins were manifesting externally; thus, further draining was contraindicated. Tuoli Xiaodu San was switched to. By the twentieth day, due to the patient's obesity and tight external flesh, suppuration failed to occur. Needling for drainage was proposed, but the patient strongly resisted. Later, he experienced restlessness, confusion, and unconsciousness, signaling a complication. Immediately, a Beizhen (Be Needle, a surgical knife/needle) was used to create openings at both ears and the vertex. Necrotic tissue within the abscess was excised about one cun long, releasing approximately one bowl of pus and blood. Tonifying herbs for spleen and blood were administered. Pus flowed like a spring, with six to seven qian of medicine taken with food morning and evening until necrosis resolved and new tissue grew. More than forty days later, the patient gradually regained consciousness. If needling had been forbidden and strong tonics withheld, survival would have been rare.
A third man had a neck carbuncle for five to six days, initially with a flat, spreading base. Five days later, the lesion became hard, the base widened, and toxic factors spread over both shoulders to the anterior neck, causing chest and breast swelling, vomiting, nausea, alternating chills and fever, and anorexia, presenting a dire situation where herbal power alone was insufficient. Old medicines were washed off with scallion water. Ba Tong (Suction Cupping) was performed at two sites, extracting about one bowl of stasis blood. Silver needles were inserted obliquely into the base to penetrate multiple areas at the bottom of the lesion. Chansu Tiao strips were inserted into the holes to detoxify and promote suppuration. The area was covered with ointment. Warm herbs were applied to areas where toxicity dispersed. Day by day, the condition improved, and toxicity receded to the original site. Internal medications to support the interior, clear fire, and resolve phlegm were taken. Within three to four days, the major symptoms subsided, and internal pus drained freely. Shiquan Dabu Tang was then administered. For hard lesions that do not soften, apply this method; for necrotic but painless areas, extract them; for slow granulation, nourish them. With such regulation, healing occurred in three months.
A sixty-year-old woman, constitutionally weak, presented with a carbuncle head the size of millet. Fortunately, her body was not obese, suggesting that although the onset was adverse, it would likely ulcerate easily. She underwent garlic-slice moxibustion, followed by application of Chansu Bing (Toad Venom Cake) on the moxa site, and Xidu San (Poison-Sucking Powder) around the periphery to consolidate the base. Internally, Tuoli Xiaodu San was taken. After several doses, the lesion hardened, causing severe pain. Her pulse was fine, rapid, and weak, indicating internal deficiency preventing toxin resolution and suppuration, with pain as the primary symptom. Yiqi Yangrong Tang (Qi-Nourishing and Harmony-Decoction, effectively a tonifying formula) was prescribed with added Zaoci (Gleditsia Spine) and Baizhi. After three doses, swelling began to rise. Mulberry wood roasting was used, softening the hardness. Pus was thick but scant. Zaoci and Baizhi were removed from the prescription, and Xiangfu (Cyperus Rhizome) and doubled Renshen were added. After several more doses, pus discharged. Pain persisted post-ulceration. Three days later, nearly half the necrotic tissue detached. Rufang Dingchuang San (Frankincense Stabilizing Wound Powder) was given, relieving pain after one dose. The wound closed in dozens of days. Success depended on the physician's skill in assessing difficulty, timing of necrosis vs. granulation, and appropriate tonification.
A young, obese woman developed a neck carbuncle with a high apex and mobile base. She desired internal resolution. Herbal internal treatment failed, so needling was employed. A Be Needle was inserted vertically into the center to a depth of six or seven fen, stopping at soft tissue. Stasis blood was removed, Chansu Tiao inserted, and Chansu Wan administered. Profuse sweating ensued, leading to resolution. The next day, slight pus appeared, and swelling decreased. Anti-inflammatory and heat-clearing herbs were taken, resulting in recovery within ten days. Generally, to eliminate carbuncle toxins, one must first cut off the root, then drain toxic factors, ensuring they diminish daily to prevent internal invasion.
A man had a carbuncle behind the ear for nearly half a month. The base enlarged, the head exuded foul bloody fluid, surrounding skin was purple-black, sunken and devoid of pus. His complexion was pale, nose tip black (sign of spleen failure), hands cold, breathing short, and pulse scattered, large, and rootless. This indicated internal collapse. It was deemed untreatable. He died shortly after. Those suffering this condition, regardless of robust physique, will inevitably perish upon collapse.
A woman with a duikou carbuncle (posterior neck carbuncle) self-moxibusted for over twenty cones without pain. The moxa scars were black and flat. Pulse was fine, rapid, and weak, indicating internal deficiency. Relying solely on herbs would delay treatment. A Be Needle was inserted one cun deep at the apex. No pain or blood was observed, indicating stagnant toxin not yet manifesting. Chansu Tiao was inserted and covered with ointment, once daily. Seven days later, cracks formed around the perimeter, discharging pus. Internal tonics were taken. By the fourteenth day, the base detached. Jiangzhu Gao was applied. Half a month later, the wound flattened. Zhenzhu San (Pearl Powder) was sprinkled to regenerate skin, leading to cure. Without needle intervention and relying only on herbs, while death might be avoided, rapid recovery would be impossible.
A forty-year-old, very obese woman had a neck carbuncle for five to six days. The muscle was swollen but the wound surface was not (indicating depressed apex). She had dry mouth and irritability (internal pathogenic fire). The lesion was hard, purple, and dark (blood death and toxin stagnation preventing suppuration). The base was flat and spreading (internal qi failure unable to contain toxin). The six pulses were surging and large (toxic factors overpowering healthy qi). This was an excess condition destined for non-suppuration, sinking, internal invasion, and death. Treatment was declined. She subsequently died.