天泡疮属元气不足，邪气所乘，亦有传染而患。受症在肝肾二经，故多在下体发起。有
先筋骨痛而后患者；有先患而后痛者。初起脉浮数，邪在脾肺经也，先用荆防败毒散解散之；
脉弦数，邪在肝胆经也，先用龙胆泻肝汤清解之；脉沉数，邪在脏腑也，先用内疏黄连汤通导
之；后用换肌消毒散为主，愈后再无筋骨疼痛之患。若疮凸赤作痛，热毒炽甚也。疮微作痛
，毒将杀也。疮色白而不结痂，阳气虚也。色赤而不结痂，阴血虚也。搔痒脉虚浮，气不能
相荣也。搔痒脉浮数，血不能相荣也。臀背间或颈间作痒，膀胱阴虚也。阴囊间或股内痒，
肝经血虚也。阴囊作痒重坠，肝经阴虚湿热也。小便频数，短少色赤，肝经阴虚也。小便频
数，色白短少，脾肺气虚也。面目搔痒，或搔变赤，外邪相搏也。眉间痒，或毛落，肝胆血
燥也。饮食少思，口干饮汤，胃气虚也。饮食不化，大便不实，脾气虚也。侵晨或夜间泄泻
，脾肾虚也。若治失其法，有蚀伤眼目，腐烂玉茎，拳挛肢体者，但用九味芦荟丸，以清肝
火；六味丸，以生肾水；蠲痹解毒散，以养血祛邪，亦有可生者。若误用轻粉等剂，反为难
治验
一儒者患前症，先玉茎作痒出水，后阴囊股内、小腹胁臂，发小 ，或干脓窠，误服祛
风等
弦。余曰∶此患属肝胆经也。左关脉弦，左尺脉浮数者，肾水少而虚热传于肝也。右关脉浮
缓，脾胃之气弱也。按之而弦者，肝木乘脾土也。用六味地黄丸、补中益气汤为主，佐以换
一儒者患前症，色 赤作痛，大便秘而不实，服祛风败毒等药。舌痛口干、脉浮而数，
此邪
色渐白；后用四君加归、 而愈。
一人患此，服攻毒等药，患处凸而色赤作痛，肢体倦怠恶寒发热，脉浮而虚，此元气复
伤而邪气实也。用补中益气，二剂而痊。
一儒者患之，误服祛风消毒之药，复伤元气。因劳役过度，内热口干，齿龈作痛，右关
脉洪数而虚，此脾胃受伤而火动，用清胃散之类而愈。
进士刘华甫患之数月。用轻粉、朱砂等药，头面背臀，各结一块，二寸许，溃而形气消
弱，寒热口干，舌燥唇裂，小便淋漓，痰涎上涌，饮食少思，此脾胃伤，诸脏弱，而虚火动也。
先
小便未清，痰涎未止，用加减八味丸而痊。
一儒者患之，头面搔痒，或成粒，或成片，或出水，脾肺脉俱洪数，此风邪所伤。先用
荆防败
愈。后遍身搔痒，内热口干，佐以六味丸而痊。
一商人每劳役、饮食后则遍身生疮，服祛风败毒之剂，面目胸背臂胁，结一块，如桃栗
，凹
敷当归膏，内用补阴八珍加萆 五钱，并换肌消毒散加干葛、钩藤钩各一钱，二十余剂，诸
症渐退。仍以前药为主，佐以调理之剂，两月余，血气复而疮愈。
天泡疮属于元气不足，邪气乘虚而入所致，也有因传染而患病的。病症主要涉及肝肾二经，因此多在下半身发起。有的先出现筋骨疼痛而后发病；有的先发病而后出现疼痛。初起时脉象浮数，说明邪气在脾肺经，先用荆防败毒散来解散表邪；脉象弦数，说明邪气在肝胆经，先用龙胆泻肝汤来清解热毒；脉象沉数，说明邪气在脏腑内部，先用内疏黄连汤来通导泄热；之后以换肌消毒散为主方治疗，痊愈后便不再有筋骨疼痛的隐患。如果疮疡凸起、色红且疼痛剧烈，是热毒炽盛的表现。如果疮疡轻微疼痛，说明毒势将衰。如果疮色发白且不结痂，是阳气虚弱所致。如果疮色发红却不结痂，是阴血虚弱所致。如果瘙痒且脉象虚浮，是气不能相互荣养；如果瘙痒且脉象浮数，是血不能相互荣养。臀部背部或颈部瘙痒，是膀胱阴虚所致。阴囊间或大腿内侧瘙痒，是肝经血虚所致。阴囊瘙痒且伴有沉重下坠感，是肝经阴虚兼有湿热所致。小便频数、短少且颜色赤红，是肝经阴虚所致。小便频数、颜色白且短少，是脾肺气虚所致。面部和眼部瘙痒，或者抓挠后变红，是外邪相搏所致。眉间瘙痒，或者眉毛脱落，是肝胆血燥所致。饮食减少、思食欲望低，口干想喝热汤，是胃气虚弱所致。饮食不消化，大便不成形，是脾气虚弱所致。清晨或夜间发生腹泻，是脾肾两虚所致。如果治疗失当，会导致眼睛受损失明，阴茎腐烂，肢体蜷曲挛缩等严重后果。此时仅用九味芦荟丸以清泻肝火；六味地黄丸以滋补肾水；蠲痹解毒散以养血祛邪，也还有治愈的可能。如果误用轻粉等药物，反而难以治疗验证。
一位儒生患有上述病症，先是阴茎瘙痒流水，随后阴囊、大腿内侧、小腹、胁部及手臂发出小疮，有的干燥呈脓窠状，误服了祛风类药物。我说：此病属于肝胆经病变。左关脉弦，左尺脉浮数，这是肾水不足导致虚热传于肝脏。右关脉浮缓，说明脾胃之气虚弱。按压脉象呈弦象，是肝木克制脾土所致。使用六味地黄丸、补中益气汤为主方，佐以换肌消毒散治疗而愈。
另一位儒生患有前述病症，疮色赤红且疼痛，大便秘结但质地不实，服用祛风败毒等药物后，出现舌痛、口干，脉象浮而数，这是邪气未解的表现。后来疮色逐渐变白；之后使用四君子汤加当归、黄芪等药而痊愈。
还有一人患此病，服用攻毒类药物后，患处凸起、色赤且疼痛，肢体倦怠、恶寒发热，脉象浮而虚，这是元气再次受伤而邪气实盛所致。使用补中益气汤，两剂后痊愈。
一位儒生患病，误服祛风消毒药物，再次损伤元气。因过度劳累，出现内热、口干、齿龈疼痛，右关脉洪数而虚，这是脾胃受伤而虚火妄动所致，使用清胃散之类药物而痊愈。
进士刘华甫患病数月，使用轻粉、朱砂等药物，导致头面背臀各处结块，约二寸大小，溃烂后形体和气力都消耗减弱，出现寒热、口干、舌燥唇裂、小便淋漓不尽、痰涎上涌、饮食减少等症状，这是脾胃受伤，诸脏虚弱，虚火妄动所致。起初小便未清，痰涎未止，使用加减八味丸而痊愈。
一位儒生患病，头面部瘙痒，有时形成颗粒，有时成片，有时流出水液，脾肺脉象均洪数，这是风邪所伤。先用荆防败毒散治疗而愈。后来全身瘙痒，伴有内热、口干，佐以六味地黄丸而痊愈。
一位商人每次劳累或饮食后，全身生出疮疡，服用祛风败毒药剂，导致面目胸背臂胁处结块，如桃栗般大小，凹陷不平。外用当归膏敷贴，内服补阴八珍汤加萆薢五钱，并配合换肌消毒散加干葛、钩藤各一钱，二十余剂后，各种症状逐渐消退。仍以原药为主，佐以调理之剂，两个多月后，气血恢复，疮疡痊愈。
Tianpao Chuang (Blistering Eruption) is attributed to a deficiency of Yuan Qi (Original Qi), allowing pathogenic factors to invade; it can also be contracted through transmission. The pathology primarily involves the Liver and Kidney meridians, hence lesions often manifest on the lower body. Some patients experience bone and joint pain prior to onset, while others develop lesions first followed by pain. In the initial stage, if the pulse is floating and rapid, the pathogen is in the Spleen and Lung meridians; treat initially with Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxins) to release the exterior. If the pulse is wiry and rapid, the pathogen is in the Liver and Gallbladder meridians; treat initially with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) to clear and resolve heat. If the pulse is deep and rapid, the pathogen is in the Zang-Fu organs; treat initially with Neishu Huanglian Tang (Internal-Draining Coptis Decoction) to unblock and guide out pathogens. Subsequently, use Huanji Xiaodu San (Skin-Rejuvenating Toxin-Resolving Powder) as the main formula. After recovery, there will be no further risk of bone and joint pain. If the sores are convex, red, and painful, it indicates intense heat-toxin. If the sores are slightly painful, the toxin is subsiding. If the sores are white and do not form scabs, it indicates Yang Qi deficiency. If the sores are red but do not form scabs, it indicates Yin Blood deficiency. If itching occurs with a floating and deficient pulse, it signifies that Qi cannot nourish mutually; if itching occurs with a floating and rapid pulse, it signifies that Blood cannot nourish mutually. Itching between the buttocks and back or in the neck indicates Bladder Yin deficiency. Itching in the scrotum or inner thighs indicates Liver meridian Blood deficiency. Itching in the scrotum accompanied by a heavy, dragging sensation indicates Liver meridian Yin deficiency with damp-heat. Frequent urination with scanty, reddish urine indicates Liver meridian Yin deficiency. Frequent urination with scanty, whitish urine indicates Spleen and Lung Qi deficiency. Itching in the face and eyes, or redness after scratching, indicates conflict with external pathogens. Itching in the glabella or hair loss indicates dryness of Liver and Gallbladder Blood. Reduced appetite and desire for food, dry mouth desiring warm drinks indicate Stomach Qi deficiency. Indigestion and loose stools indicate Spleen Qi deficiency. Diarrhea occurring in the early morning or at night indicates Spleen and Kidney deficiency. If treatment is incorrect, complications such as eye damage leading to blindness, rotting of the penis, and limb contracture may occur. In such cases, use Jiwei Lushan Wan (Nine-Ingredient Aloe Pill) to clear Liver fire; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to generate Kidney water; Juanbi Jiedu San (Bi-Syndrome-Removing Toxin-Resolving Powder) to nourish Blood and dispel pathogens; recovery is still possible. However, if mercury-containing powders (Qingfen) etc. are mistakenly used, the condition becomes difficult to treat.
A scholar suffered from the aforementioned condition, initially experiencing itching and discharge from the penis, followed by small eruptions in the scrotum, inner thighs, lower abdomen, hypochondrium, and arms, some dry with pus-filled crusts. He had mistakenly taken wind-dispelling medicines. I stated: This condition belongs to the Liver and Gallbladder meridians. The left Guan position pulse is wiry, and the left Chi position pulse is floating and rapid, indicating insufficient Kidney Water causing deficient heat to transmit to the Liver. The right Guan position pulse is floating and slow, indicating weak Spleen and Stomach Qi. A wiry sensation upon palpation indicates Liver Wood overacting on Spleen Earth. Treatment was based on Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), supplemented with Huanji Xiaodu San (Skin-Rejuvenating Toxin-Resolving Powder), resulting in recovery.
Another scholar suffered from the aforementioned condition with red, painful sores and constipation with hard stool. After taking wind-dispelling and toxin-resolving medicines, he developed tongue pain, dry mouth, and a floating, rapid pulse, indicating unresolved pathogenic factors. Later, the sores gradually turned white; subsequently, he recovered using Sijunzi Tang (Four Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix).
Another patient took toxin-attacking medicines, resulting in convex, red, painful sores, limb fatigue, aversion to cold, fever, and a floating, deficient pulse. This indicated that Yuan Qi (Original Qi) was re-injured while pathogens remained excess. Treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) resulted in recovery after two doses.
A scholar mistakenly took wind-dispelling and toxin-resolving medicines, further injuring his Yuan Qi (Original Qi). Due to excessive labor, he experienced internal heat, dry mouth, and gum pain. The right Guan position pulse was surging, rapid, and deficient, indicating Spleen and Stomach injury with stirring of fire. He recovered using Qingwei San (Stomach-Clearing Powder) and similar formulas.
Jinshi Liu Huafu suffered from this condition for several months. Using Qingfen (Calomel) and Zhusha (Cinnabar) caused nodules about two inches in size to form on the head, face, back, and buttocks. After ulceration, his physical form and Qi became depleted, presenting with alternating chills and fever, dry mouth, dry tongue, cracked lips, dribbling urination, surping phlegm-saliva, and reduced appetite. This indicated Spleen and Stomach injury, weakness of all Zang-Fu organs, and stirring of deficient fire. Initially, when urination was not clear and phlegm-saliva did not stop, he recovered using Jiawei Bawei Wan (Modified Eight-Ingredient Pill).
A scholar suffered from this condition with facial itching, forming either granules or patches, sometimes with discharge. Both Spleen and Lung pulses were surging and rapid, indicating injury by Wind pathogens. He initially recovered using Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxins). Later, he experienced whole-body itching with internal heat and dry mouth, recovering with the addition of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
A merchant developed whole-body eruptions after every instance of labor or eating. After taking wind-dispelling and toxin-resolving agents, nodules like peaches or chestnuts formed on the face, chest, back, arms, and hypochondrium, appearing concave. External application of Danggui Gao (Angelica Ointment) was used. Internally, he took Buyin Bazhen Tang (Nourish Yin Eight-Treasures Decoction) with Bibai (Dioscoreae Hypoglaucae Rhizoma) 5 qian, combined with Huanji Xiaodu San (Skin-Rejuvenating Toxin-Resolving Powder) added with Gegen (Puerariae Lobatae Radix) and Goutenggou (Uncariae Ramulus cum Uncis) each 1 qian. After more than twenty doses, various symptoms gradually receded. Continuing with the previous medicines as the main regimen and supplementing with regulatory agents, his Qi and Blood recovered, and the sores healed after more than two months.