痈疽发背怎生医，不论阴阳先灸之，不痛灸至痛，疼灸不疼时。
凡看痈疽脑项等发大疮，先要从容立定主意，以见标日期为始，到今几日，看疮形与日期可否相对，相应
则多吉，不应则多险。次看受病之源，发于何脏腑，出于何部位，但身体有上下，部位有险否，形色辨顺逆，
精神论有无。再看年纪老壮，气血盛衰，发阴发阳，毒深毒浅，以阳为易治者多生，以阴为难治者多死。方诊
脉之虚实，可知顺险，以决其终。凡疮未溃前，脉要太过一、二至，已溃后，又宜不及二、三分，此为脉病相
应，首尾自不变生；如其相反，恐防不测。但看法全在目力精巧，与心相应，一一参明，表里透彻，然后方定
治法。凡疮七日以前，情势未成，元气未弱，不论阴阳、表里、寒热、虚实，俱先当灸，轻者使毒瓦斯随火而散，
重者拔引郁毒，通彻内外。所得火引毒瓦斯混合为阳，方能发肿作痛，然后可汗可攻，或消或托，兼求标本参治，
必以脉合药，以药合病，如此治之，自然无错矣。故药难执方，全在活法。大抵关节首尾，俱不可损伤元气、
脾胃为要。
内服蟾酥丸一服，外将神火照三枝。
凡疮初起，七日之前，或已灸之，后未服他药，宜用蟾酥丸一服得汗解为妙，或万灵丹发汗亦可。所谓毒
气随汗而散，最为快捷方式。如二药服后，发汗不出，此乃表里闭密之故，毒亦不轻，当神妙拔根方施治，神灯
照法甚效。亦不可用之太早，如疮四、五日之间，形未聚，毒未出，若用之早，恐留郁而内毒反致难出，用须
在八、九日之后，疮势已定，毒瓦斯已聚，未成脓腐之时，用此照之，已成者自高，未成者自消，不溃者自溃，
不脱者自脱，亦且解毒活血、消肿散瘀之良法也。
用膏贴顶上，敷药四边围。
凡疮最忌风寒所袭，初起之时，或已灸之后，俱当用太乙膏盖贴顶上，功效在于拔毒、提顶、提脓、防御
风寒不入；如 痛高肿，阳疮七日以
后，疮头自有黄色稠脓相粘膏上，余肿红色，光亮鲜明，每日宜用葱汤洗净，换药贴之，其正脓定在十一日前
后出也，此为易治易安之症。如七日之后，疮不大肿高，四边又不 痛，疮头亦无脓意相粘，此为阴阳相
等之症，宜用化腐紫霞膏涂疮顶上，外以膏药盖之，换至十日外，疮顶渐腐，余肿渐高，似有脓意之象，其正
脓只在十五日之后可出也，此为以险成顺之症。至于二十日以后无脓者，乃纯阴之症，纵治亦无效矣。又
如疮之四边根脚余肿，其功又在敷药收束根本庶不开大，初起时，宜用金黄散敷于四边，乃拔毒、消肿、止痛；
既溃后，当用铁桶膏箍之，庶疮根渐收渐紧。但诸疮原因气血凝滞而成，切不可纯用凉药，冰凝肌肉，多
致难腐难敛，必当温暖散滞、行瘀、拔毒、活血药用之方为妥当也。
气盛兮，顶自高而突起；血盛兮，根脚束而无疑。
气血者，人之所原禀，老者尚或有余，少者亦有不足，人之命脉，全赖于此。况百病生焉，失此岂能无变，
独疮科尤关系不浅。但肿疡时若无正气冲托，则疮顶不能高肿，亦不能 痛；溃脓则无真阴相滋，则疮根
不能收束，色亦不能红活收敛。凡视疮之顶高根活，不论老少，定知气血有余，故知老幼俱可无妨。又宜交会
明白，交会者，疮根与好肉交界之处，高低自然；分别明白者，疮形与好形各无混杂，自然分明也。以此
观之，了然明白矣。
高肿起者，忌用攻利之药，以伤元气；平塌漫者，宜投补托之剂，以益其虚。
凡疮初发自然高起者，此疮原属阳症，而五内原无深毒，亦且毒发于表，便宜托里以速其脓，忌用内消攻
伐之药，以伤脾气，脓反难成，多致不能溃敛。又疮初起，不高不赤，平塌漫者，此乃元气本虚，急宜投托
里温中健脾之药，务要催托毒瓦斯在外，庶无变症矣。
内热甚者，量加消毒清剂；便秘燥者，必须通利相宜；使脏腑得宣通，俾气血自流利。
肿疡时内热口干，脉实烦躁，便秘喜冷者，此为邪毒在里，急与寒凉攻利，宜内疏黄连汤、四顺清凉饮、
内消沃雪汤俱可选用。又兼有表症
者，防风通圣散去麻黄，或双解散加桔梗、天花粉。又或小便不利者，兼入天水散、五苓散俱可合用，务使二
便通利以杜其源。又有元气素虚者，恐不胜前药，以托里消毒散加蜜炒大黄，或兼猪胆套法亦得，通利为
度。首尾俱要闭而不结，通而不泄，得脏腑和平，表里透彻，方可使用托里、排脓、内补之药。又如溃疡时虽
有口干便闭，脏腑不和，小水不利等症，此因溃后脓水出多，内亡津液，气血虚耗，不能荣润脏腑所致。其人
必脉细而数，口和而干，饮食减少，好饮热汤，此乃虚阳之火为病，非前说有余所比，只宜养气血、滋津液，
和脏腑、理脾胃。如此治之，则二便自和，亦无变症，常有误行攻利，多致不救者有矣。
十日之间疮尚坚，必用披针，当头点破。
凡疮十日以后，自当腐溃为脓，如期不作脓腐，仍尚坚硬者，此属阴阳相半之症。疮根必多深固，若不将
针当头点入寸许，开窍发泄，使毒瓦斯无从而出，必致内攻也。倘内有脓，又便易出，此为开户逐贼之意也。
亦有十日外，疮虽不腐溃，形尚红活， 热、肿痛，此虽脓迟，后必有出，此又不必针之，盖缘元气不能充足
，或失用补托之药，又误用寒凉，或盖复未暖，多致脓迟，有此症者，宜用补中健脾、大托补药，以得脓为效。
又以十五日至二十一日为期，过此外者，纵有稀脓，但元气被毒相距日久，必致耗散，诚难归结也。
半月之后脓亦少，须将药筒对顶拔提，有脓血之交粘，必腐肉之易脱。
如疮半月后仍不腐溃、不作脓者，毒必内陷，急用披针品字样当原顶寸许点开三孔，随疮之深浅一寸、二
寸皆可入之，入针不痛，再深入不妨，随将药筒预先煮热，对孔窍合之良久，候温取下，如拔出之物，血要
红而微紫，脓要黄而带鲜，此为血气营运活疮，其人必多活；又谓脓血交粘，用药可全，色鲜红活，腐肉易脱。
如拔出瘀血紫黑，色败气秽，稀水无脓者，此为气血内败死疮。所谓气败血衰，神仙叹哉！此等之疮难久，
候其人必在月终亡。
且如斯时内有脓而不得外发者，以针钩向正面钩
起顽肉，用刀剪当原顶剪开寸余，使脓管得通流，庶疮头无闭塞。
已用药筒拔脓之后，外既有孔，内窍亦通，疮期又当大脓发泄之候，如尚脓少，亦非自然得出，故疮头必
有瘀腐涂塞，内肉亦有顽膜阻隔，多致脓管不通，自难出也。须用针钩钩起疮顶顽肉，以披针、利剪随便取
去寸余顽硬之肉，取之微痛，亦自血出，俱自不妨，随用两手轻重得宜，从疮根 处渐渐捺至中间，剪出脓管
处，内有聚脓，自然涌出，以黄色稠浓为吉，其脓日渐多者为轻，反此为虑。此功务使涂塞者开之，令脓毒
外发也。
频将汤洗，切忌风吹。
凡疮未溃前，或已用照药后，俱要煎葱艾汤每日淋洗疮上一次，甚者早晚二次，使气血疏通，易于溃散。
又已溃时及药筒提拔之后，尤宜避风，先去旧药，用方盘靠身疮下放定，随用猪蹄汤以软绢淋汤疮上，并
入孔内轻手捺净内脓，庶败腐宿脓随汤而出，以净为度。再以软帛叠成七、八重，勿令大干，带汤复于疮上，
两手轻盈旋按片时，帛温再换，如此洗按四、五次，使血气得疏，患者自然爽快。亦取瘀滞得通，毒瓦斯得解，
腐肉得脱，疼痛得减，此手功之要法，大疮不可缺也。候腐脱已见红肉时，洗后随用玉红膏，用抿脚挑膏于
手心上捺化，搽涂患之新旧肉上，外用太乙膏盖之，四边根脚已消处不必箍药，每日如此，用之不数日间，脓
腐尽脱，新肉顿生，更加内补调理得宜，轻疮只在月余，大疮不过七十日必完口而愈。
又关节在于斯时，变生出于此候。
关节者，阳疮以十四日为关，阴疮二十一日为节。此时务要出脓，势定不可过攘，但脓出方自腐脱，腐脱
方自肌生，肌生方自收敛，收敛方自疮平，此为疮之关节，亦由次序来也。如期不得脓者，后必便有变生，
为一关顺后必多顺，一关逆后必多逆，以此观之，不可不察也。
治当大补，得全收敛之功，切忌寒凉，致取变生之局。
凡疮溃脓之后，五脏亏损，气血大虚，外形虽似有余，而五内真实不足，法当纯补，乃至多生。但见已溃
时发热恶寒、脓多自汗作痛者，便进十全大补汤。但见虚热少睡，饮食不甘者，便进黄 人参汤。但见皮寒
虚热，咳嗽有痰者，便进托里清中汤。但见四肢倦怠，肌肉消瘦，面黄短气者，便进人参养荣汤。但见脓多，
心烦少食，发躁不睡者，便进圣愈汤。但见脾亏气弱，身凉脉细，大便溏泄者，便进托里温中汤。但见饮
食不甘，恶心呕吐者，便进香砂六君子汤。但见脾虚下陷食少，虚热间作者，便进补中益气汤。但见肾虚作
渴，不能相制心火者，便进加减八味丸。仿此选用。盖托里则气血壮而脾胃盛，使脓秽自排，毒瓦斯自解，
死肉自溃，新肉自生，饮食自进，疮口自敛，若不务补托，而误用寒凉，谓之真气虚而益虚，邪气实而益实，
多至疮毒内陷，脓多臭秽，甚则脉洪大渴，面红气短，此真气虚而死矣。
盖疮全赖脾土，调理必要端详。
脾胃者，脾为仓廪之官，胃为水谷之海。胃主司纳，脾主消导，一表一里，一纳一消，营运不息，生化
无穷，至于周身气血，遍体脉络、四肢百骸、五脏六腑，皆借此以生养。又谓得土者昌，失土者亡。盖脾胃盛
者，则多食而易饥，其人多肥，气血亦壮；脾胃弱者，则少食而难化，其人多瘦，气血亦衰。所以命赖以活，
病赖以安，况外科尤关紧要。善养生者，节饮食，调寒暑，戒喜怒，省劳役，此则不损其脾胃也。如不然，则
精神气血由此而日亏，脏腑脉络由此而日损，肌肉形体由此而日削，所谓调理一失，百病生焉。故知脾胃不可
不端详矣。
冬要温床暖室，夏宜净几明窗。
但人之气血，喜暖而恶寒。又谓遇寒则结，遇热则散，况疮乃肌肉破绽之病，若不御风寒，最为易袭。凡
看疮时，冬要着紫炭之火，旺旺暖气，逼尽余寒；夏宜净几明窗，亦庶外风不入，然后方可揭膏洗贴疮上。
常见患者夏月纵意当风取凉，或睡卧阴湿之处，冬又不从温床暖室，多致寒侵，轻则有妨生肌完口，重则变为
崩塌不脓、不敛阴症，此常有也。凡重命君子，可不预慎哉。
饮食何须戒口，冷硬腻物休餐。
饮食者，人之所赖以生养，必要适其时而食之。如人之病中肿痛时，自然痛伤胃气，诸味不喜；直待溃后
，脓毒一出，胃气便回，方欲思食，彼时但所喜者，便可与之以接补脾胃。如所思之物，不与，此为逆其胃
气，而反致不能食也。切要不可太过，惟忌者，生冷伤脾，硬物难化，肥腻滑肠，故禁之，余随便用也。
痈疽虽属外科，用药即同内伤。
古之以外科推为杂病之先，盖此伤人迅速，关系不浅，故特设于前也。且如痈疽、脑项疔毒大疮，情势虽
出于外，而受病之源实在内也。及其所治，岂可舍于内而治外乎？所以外不起者内加托药，表热甚者内必
清解，血虚宜用四物汤，气虚宜用四君子，脉虚足冷温中，脉实身热凉膈。以此推之，内外自无两异。但世以
疮形言之，曰外科；治以气血言之，即内伤。凡医者治法，不可混于内理，以致生变症。
脉虚病虚，首尾必行补法；表实里实，临时暂用攻方。
丹溪云∶凡疮未破，毒攻脏腑，一毫热药断不可用，凡疮既破，脏腑已亏，一毫凉药亦不可用。诚哉是言
也。兹说又有不然，且如初病未破时，脉得微、沉、缓、涩、细、数、浮、空，外形又兼身凉、自汗，便利、
呕吐少食者，疮形又不起发，不 不痛，无溃无脓，此等症者，皆缘气血虚弱之故，若执前云未破毒攻脏腑之
说，必投凉药攻之，复损元气，患者其生乎？其死乎？予论治病，不论首尾，难拘日数，但见脉症虚弱，便与
滋补，乃可万全。如补不应，未可安然，虚弱甚者，须用参术膏、八仙糕；阳虚自汗、食少者，单人参膏或六
君子汤加砂仁、木香，甚加附子；泄泻肠鸣，胃虚呕逆者，参苓白尤散加豆蔻、山药、木香、柿蒂；脾虚下陷
溏泄及肛门坠重者，补中益气汤加山药、山萸、五味子，以此选用。又有表实者，身体发热，无汗恶寒；里实
者，脉大身热，便燥口干。假如表症急者，先用荆防败毒散以解其表；里症急者，先用四顺清凉饮以攻其里；
表里相兼者，宜防风通圣散发表攻里。此随其表里先后，皆在活法临时之用
也。于意受补者，自无痰火内毒之相杂；不受补者，乃有阴火湿热之兼攻。又谓补而应药者多生，虚而不受补
者不治。
病要论久新，要法在于宽治猛治。
且如人之病有新久，势有缓急，如受病之初，元气未弱，治当随症迎刃而解。若惧行霸道猛剂，定不能决
效于危急时也。但要中病即已，故谓药不瞑眩，厥疾不瘳。且如表症盛者，用万灵丹大加表散；里症急者，以
痈疽发背如何治疗？不论属于阴证还是阳证，首先要进行艾灸。如果患处不痛，就灸到感到疼痛；如果患处疼痛，就灸到疼痛消失。
凡是诊治痈疽在脑、项等部位发生的大疮，首先要从容镇定，确立诊疗思路，以发病当天为起始日，计算至今已经过了几天。观察疮形与发病天数是否相符，相符则大多吉利，不相符则大多危险。其次要探究致病根源，病发于哪个脏腑，出于哪个身体部位。身体有上下之分，部位有险易之别，通过颜色形态辨别顺逆，通过精神状态判断正气有无。再看患者年龄老壮，气血盛衰，区分是阴证还是阳证，毒邪深浅。一般来说，阳证容易治疗，多能存活；阴证难治，多导致死亡。接着诊察脉象的虚实，可以判断病情顺逆，从而决定预后。凡疮疡未溃破前，脉象应当稍有力（太过一、二至）；已溃破后，脉象又宜稍弱（不及二、三分），这是脉象与病症相应，从头到尾自然不会有变故；如果脉症相反，恐怕会有意外变故。但诊断的关键在于医生眼力精巧，用心体会，逐一参详明白，表里透彻，然后才能确定治疗方法。凡疮疡七日以前，病情尚未成形，元气尚未虚弱，不论阴阳、表里、寒热、虚实，都应当先施以艾灸。轻症可使毒气随火气而消散，重症可拔引郁结之毒，通达内外。所得之火引动毒气混合转化为阳，才能促使肿胀疼痛，然后才可考虑发汗、攻下、消散或托毒外出等方法，兼求标本同治，必须使脉象与药物相合，药物与病症相合，这样治疗，自然就不会出错。所以用药难以拘泥于固定方剂，全在于灵活变通。大抵治疗疮疡的首尾过程，都不可损伤元气，以顾护脾胃为重要原则。
凡疮疡初起，七日之前，或者已经施灸之后，若尚未服用其他药物，适宜服用蟾酥丸一付，以出汗解表为妙，或者使用万灵丹发汗也可以。所谓毒气随汗液而散，是最为快捷的方法。如果服用这两种药后，仍然不出汗，这是因为表里闭塞紧密的缘故，毒邪也不轻，应当施用神妙拔根方进行治疗，神灯照法也非常有效。但也不可过早使用，如疮疡四、五日之间，形态尚未聚拢，毒邪尚未发出，如果过早使用，恐怕留滞郁结，反而导致内毒难以排出。使用此法须在八、九日之后，疮势已定，毒气已聚，尚未成脓腐坏之时，用神灯照射，已成脓者自会高突，未成脓者自会消散，未溃破者自会溃破，未脱落者自会脱落，这也是解毒活血、消肿散瘀的好方法。
用膏药贴敷疮顶，用药粉敷围四周。
凡疮疡最忌讳风寒侵袭。初起之时，或者已经施灸之后，都应当用太乙膏盖贴疮顶，其功效在于拔毒、提顶、提脓、防御风寒侵入；如果肿痛高突，属阳疮，七日以后，疮头自然会有黄色稠脓粘附在膏药上，其余红肿呈红色，光亮鲜明，每日应用葱汤洗净，换药贴敷，其正脓大约在十一日前后排出，这属于容易治疗、容易安愈的症候。如果七日以后，疮不大肿高，四周也不肿痛，疮头也没有脓意粘附，这属于阴阳相等的症候，适宜用化腐紫霞膏涂敷疮顶，外用膏药覆盖，换药至十日外，疮顶逐渐腐烂，其余红肿逐渐高起，似有脓意的征象，其正脓只在十五日之后才可能排出，这属于由险转顺的症候。至于二十日以后仍无脓者，乃是纯阴之症，即使治疗也无效了。又如疮疡四周根脚余肿，其功效又在敷药收束根本，使之不至于扩散扩大。初起时，适宜用金黄散敷于四周，以拔毒、消肿、止痛；既溃破后，当用铁桶膏箍围，使疮根逐渐收敛收紧。但诸疮原因都是气血凝滞而成，切不可纯用凉药，以免冰凝肌肉，多导致难以腐溃、难以收敛，必须当用温暖散滞、行瘀、拔毒、活血的药物使用，方才妥当。
气盛，则疮顶自然高而突起；血盛，则疮根脚束紧而无疑。
气血，是人先天禀赋的根本，老年人尚且可能有剩余，年轻人也可能有不足，人的命脉，全赖于此。况且百病由此产生，失去这个基础岂能没有变化，唯独外科疮疡尤其关系重大。但在肿疡阶段，如果没有正气冲托，则疮顶不能高肿，也不能疼痛；溃脓阶段，如果没有真阴滋润，则疮根不能收束，颜色也不能红活收敛。凡是观察疮疡，见疮顶高、根脚活，不论老少，必定知道气血有余，所以知道老幼皆可无妨。又宜交会明白，“交会”指疮根与好肉交界之处，高低自然；“分别明白”指疮形与好肉形状各不混杂，自然分明。以此观之，了然明白。
高肿起的，忌用攻利之药，以免损伤元气；平塌漫散的，适宜投予补托之剂，以益其虚损。
凡疮疡初发自然高起者，此疮原属阳症，五脏内部原本没有深毒，且毒发于体表，便宜托里以加速成脓，忌用内消攻伐之药，以免损伤脾气，否则脓反难成，多导致不能溃破收敛。又疮初起，不高不赤，平塌漫散者，这是元气本虚，急宜投予托里温中健脾之药，务必催托毒气在外，庶几没有变症。
内热甚者，酌情加入消毒清剂；便秘燥结者，必须通利适宜；使脏腑得以宣通，使气血自然流利。
肿疡阶段，内热口干，脉实烦躁，便秘喜冷者，此为邪毒在里，急与寒凉攻利，适宜选用内疏黄连汤、四顺清凉饮、内消沃雪汤。又兼有表症者，可用防风通圣散去麻黄，或双解散加桔梗、天花粉。又或者小便不利者，兼入天水散、五苓散均可合用，务必使二便通利以杜绝病源。又有元气素来虚弱者，恐怕不能胜任前述药物，可用托里消毒散加蜜炒大黄，或者兼用猪胆套法也可，以通利为度。治疗首尾都要做到闭而不结，通而不泄，使脏腑平和，表里透彻，方可使用托里、排脓、内补之药。又如溃疡阶段，虽然也有口干便闭，脏腑不和，小水不利等症状，这是因为溃破后脓水流出过多，体内津液亡失，气血虚耗，不能荣润脏腑所致。其人必定脉细而数，口和而干，饮食减少，喜欢喝热汤，这是虚阳之火为病，不是前面所说的有余之症可比，只适宜养气血、滋津液，和脏腑、理脾胃。这样治疗，则二便自然调和，也没有变症，常有误用攻利之法，多导致无法救治的情况。
十日之间疮尚坚硬，必须用披针，当头点破。
凡疮疡十日以后，自然应当腐溃为脓，如果如期不作脓腐，仍然坚硬者，这属于阴阳相半的症候。疮根必定多深固，如果不将针当头点入一寸左右，开窍发泄，使毒气无从排出，必定导致内攻。倘若有脓，就容易排出，这是开户逐贼的意思。也有十日外，疮虽不腐溃，形态尚红活，发热、肿痛，这虽然是脓出得迟，后来必定会出来，这又不必用针，大概是因为元气不能充足，或者失用补托之药，又误用寒凉，或者覆盖保暖不够，多导致脓出得迟，有此症者，适宜用补中健脾、大托补药，以得脓为效。又以十五日至二十一日为期，超过这个期限之外，纵然有稀脓，但元气被毒邪消耗日久，必定耗散，确实难以愈合。
半月之后脓也少，须将药筒对疮顶拔提，有脓血交粘，必致腐肉易脱。
如疮疡半月后仍不腐溃、不作脓者，毒必内陷，急用披针在疮原顶寸许处点开三孔，随疮之深浅一寸、二寸皆可入之，入针不痛，再深入不妨，随即用药筒预先煮热，对孔窍合之良久，候温取下，如拔出之物，血要红而微紫，脓要黄而带鲜，此为血气营运活跃之疮，其人必定多活；又说脓血交粘，用药可全，色鲜红活，腐肉易脱。如拔出瘀血紫黑，色败气秽，稀水无脓者，此为气血内败之死疮。所谓气败血衰，神仙也叹息！这种疮难久，候其人必定在月终死亡。
况且此时内有脓而不得外发者，以针钩向正面钩起顽肉，用刀剪当原顶剪开寸余，使脓管得通流，庶几疮头无闭塞。
已用药筒拔脓之后，外既有孔，内窍亦通，疮期又当大脓发泄之候，如果尚且脓少，也不是自然得出，故疮头必有瘀腐涂塞，内肉亦有顽膜阻隔，多导致脓管不通，自然难出。须用针钩钩起疮顶顽肉，以披针、利剪随便取去寸余顽硬之肉，取之微痛，也自有血出，俱自不妨，随即用两手轻重得宜，从疮根处渐渐捺至中间，剪出脓管处，内有聚脓，自然涌出，以黄色稠浓为吉，其脓日渐多者为轻症，反此为忧虑。此功务使涂塞者开之，令脓毒外发。
频将汤洗，切忌风吹。
凡疮未溃破前，或者已经用照药后，都要煎葱艾汤每日淋洗疮上一次，严重者早晚二次，使气血疏通，易于溃散。又已溃破时及药筒提拔之后，尤宜避风，先去旧药，用方盘靠身疮下放定，随用猪蹄汤以软绢淋汤疮上，并入孔内轻手捺净内脓，庶几败腐宿脓随汤而出，以净为度。再以软帛叠成七、八重，勿令大干，带汤复于疮上，两手轻盈旋按片时，帛温再换，如此洗按四、五次，使血气得疏，患者自然爽快。也是取瘀滞得通，毒气得解，腐肉得脱，疼痛得减，这是手功的要法，大疮不可缺也。候腐脱已见红肉时，洗后随用玉红膏，用抿脚挑膏于手心上捺化，搽涂患之新旧肉上，外用太乙膏盖之，四边根脚已消处不必箍药，每日如此，用之不数日间，脓腐尽脱，新肉顿生，更加内补调理得宜，轻疮只在月余，大疮不过七十日必完口而愈。
又关节在于斯时，变生出于此候。
“关节”指病程的关键节点，阳疮以十四日为关，阴疮二十一日为节。此时务要出脓，势定不可过攘，但脓出方自腐脱，腐脱方自肌生，肌生方自收敛，收敛方自疮平，此为疮之关节，也是由次序而来。如果如期不得脓者，后必便有变生，为一关顺后必多顺，一关逆后必多逆，以此观之，不可不察。
治当大补，得全收敛之功，切忌寒凉，致取变生之局。
凡疮溃脓之后，五脏亏损，气血大虚，外形虽似有余，而五脏内部真实不足，法当纯补，乃至多生。但见已溃时发热恶寒、脓多自汗作痛者，便进十全大补汤。但见虚热少睡，饮食不甘者，便进黄 人参汤（注：原文此处疑有脱字，通常为人参汤或类似补益方，依原文保留）。但见皮寒虚热，咳嗽有痰者，便进托里清中汤。但见四肢倦怠，肌肉消瘦，面黄短气者，便进人参养荣汤。但见脓多，心烦少食，发躁不睡者，便进圣愈汤。但见脾亏气弱，身凉脉细，大便溏泄者，便进托里温中汤。但见饮食不甘，恶心呕吐者，便进香砂六君子汤。但见脾虚下陷食少，虚热间作者，便进补中益气汤。但见肾虚作渴，不能相制心火者，便进加减八味丸。仿此选用。盖托里则气血壮而脾胃盛，使脓秽自排，毒气自解，死肉自溃，新肉自生，饮食自进，疮口自敛，若不务补托，而误用寒凉，谓之真气虚而益虚，邪气实而益实，多至疮毒内陷，脓多臭秽，甚则脉洪大渴，面红气短，此真气虚而死矣。
盖疮全赖脾土，调理必要端详。
脾胃者，脾为仓廪之官，胃为水谷之海。胃主司纳，脾主消导，一表一里，一纳一消，营运不息，生化无穷，至于周身气血，遍体脉络、四肢百骸、五脏六腑，皆借此以生养。又说“得土者昌，失土者亡”。脾胃盛者，则多食而易饥，其人肥，气血亦壮；脾胃弱者，则少食而难化，其人瘦，气血亦衰。所以命赖以活，病赖以安，况外科尤关紧要。善养生者，节饮食，调寒暑，戒喜怒，省劳役，此则不损其脾胃也。如不然，则精神气血由此而日亏，脏腑脉络由此而日损，肌肉形体由此而日削，所谓调理一失，百病生焉。故知脾胃不可不端详矣。
冬要温床暖室，夏宜净几明窗。
但人之气血，喜暖而恶寒。又说遇寒则结，遇热则散，况疮乃肌肉破绽之病，若不御风寒，最为易袭。凡看疮时，冬要着紫炭之火，旺旺暖气，逼尽余寒；夏宜净几明窗，亦庶外风不入，然后方可揭膏洗贴疮上。常见患者夏月纵意当风取凉，或睡卧阴湿之处，冬又不从温床暖室，多致寒侵，轻则有妨生肌完口，重则变为崩塌不脓、不敛阴症，此常有也。凡重命君子，可不预慎哉。
饮食何须戒口，冷硬腻物休餐。
饮食者，人所赖以生养，必要适其时而食之。如人之病中肿痛时，自然痛伤胃气，诸味不喜；直待溃后，脓毒一出，胃气便回，方欲思食，彼时但所喜者，便可与之以接补脾胃。如所思之物，不与，此为逆其胃气，而反致不能食也。切要不可太过，惟忌者，生冷伤脾，硬物难化，肥腻滑肠，故禁之，余随便用也。
痈疽虽属外科，用药即同内伤。
古之以外科推为杂病之先，盖此伤人迅速，关系不浅，故特设于前也。且如痈疽、脑项疔毒大疮，情势虽出于外，而受病之源实在内也。及其所治，岂可舍于内而治外乎？所以外不起者内加托药，表热甚者内必清解，血虚宜用四物汤，气虚宜用四君子，脉虚足冷温中，脉实身热凉膈。以此推之，内外自无两异。但世以疮形言之，曰外科；治以气血言之，即内伤。凡医者治法，不可混于内理，以致生变症。
脉虚病虚，首尾必行补法；表实里实，临时暂用攻方。
丹溪云：凡疮未破，毒攻脏腑，一毫热药断不可用，凡疮既破，脏腑已亏，一毫凉药亦不可用。诚哉是言也。兹说又有不然，且如初病未破时，脉得微、沉、缓、涩、细、数、浮、空，外形又兼身凉、自汗，便利、呕吐少食者，疮形又不起发，不红不痛，无溃无脓，此等症者，皆缘气血虚弱之故，若执前云未破毒攻脏腑之说，必投凉药攻之，复损元气，患者其生乎？其死乎？予论治病，不论首尾，难拘日数，但见脉症虚弱，便与滋补，乃可万全。如补不应，未可安然，虚弱甚者，须用参术膏、八仙糕；阳虚自汗、食少者，单人参膏或六君子汤加砂仁、木香，甚加附子；泄泻肠鸣，胃虚呕逆者，参苓白尤散加豆蔻、山药、木香、柿蒂；脾虚下陷溏泄及肛门坠重者，补中益气汤加山药、山萸、五味子，以此选用。又有表实者，身体发热，无汗恶寒；里实者，脉大身热，便燥口干。假如表症急者，先用荆防败毒散以解其表；里症急者，先用四顺清凉饮以攻其里；表里相兼者，宜防风通圣散发表攻里。此随其表里先后，皆在活法临时之用也。于意受补者，自无痰火内毒之相杂；不受补者，乃有阴火湿热之兼攻。又说补而应药者多生，虚而不受补者不治。
病要论久新，要法在于宽治猛治。
且如人之病有新久，势有缓急，如受病之初，元气未弱，治当随症迎刃而解。若惧行霸道猛剂，定不能决效于危急时也。但要中病即已，故谓药不瞑眩，厥疾不瘳。且如表症盛者，用万灵丹大加表散；里症急者，以
How to treat carbuncles and back sores? Regardless of whether it is a Yin syndrome or a Yang syndrome, moxibustion should be performed first. If the affected area is painless, moxa until pain is felt; if painful, moxa until the pain subsides.
When diagnosing large sores on the head, neck, etc., caused by carbuncles and ulcers, one must first remain calm and establish a clear treatment strategy. Start counting from the day of onset to determine how many days have passed. Observe whether the sore's appearance corresponds with the number of days elapsed. A correspondence indicates a favorable prognosis, while a discrepancy suggests danger. Next, investigate the source of the disease: which Zang-Fu organ is involved and which body part is affected. The body has upper and lower sections, and locations vary in severity. Distinguish between favorable and unfavorable conditions based on color and shape, and assess the presence of healthy Qi through mental spirit. Consider the patient's age (young or old) and the strength or deficiency of Qi and Blood. Differentiate between Yin and Yang syndromes, and determine the depth of the pathogenic toxin. Generally, Yang syndromes are easier to treat and often result in survival, whereas Yin syndromes are difficult to treat and often lead to death. Then, palpate the pulse to determine its excess or deficiency, which reveals the favorability or unfavorability of the condition and helps predict the outcome. Before the sore ulcerates, the pulse should be slightly forceful (exceeding normal by one or two beats); after ulceration, the pulse should be slightly weak (deficient by two or three degrees). This alignment between pulse and symptoms ensures stability throughout the course. If the pulse and symptoms contradict each other, unexpected complications may arise. Diagnosis relies on the physician's keen observation and mental focus, thoroughly analyzing internal and external aspects before determining the treatment method. For sores within seven days, where the pathology is not yet formed and healthy Qi is not yet weakened, moxibustion should be applied regardless of Yin/Yang, interior/exterior, cold/heat, or excess/deficiency patterns. In mild cases, the toxin dissipates with the fire; in severe cases, it draws out stagnant toxins and unblocks internal and external pathways. The fire transforms the toxin into Yang, promoting swelling and pain, after which diaphoresis, purgation, resolution, or expulsion methods can be used. Treatment must harmonize the pulse with the prescription and the prescription with the disease. Thus, treatment will be error-free. Medicinal formulas cannot be rigidly adhered to; flexibility is key. Throughout the treatment, protecting healthy Qi and the Spleen-Stomach is paramount.
Internally administer Chan Su Wan (Toad Venom Pill), externally apply Shen Deng Zhao (Divine Lamp Illumination) for three branches.
For newly arising sores, within seven days, or after moxibustion but before taking other medicines, administering one dose of Chan Su Wan (Toad Venom Pill) to induce sweating is ideal. Alternatively, Wan Ling Dan (Ten Thousand Spirits Pill) for diaphoresis is also suitable. Dispersing toxins through sweat is the quickest method. If sweating does not occur after taking these medicines, it indicates tight closure of the exterior and interior, and the toxin is significant. In such cases, Shen Miao Ba Gen Fang (Divine Marvel Root-Pulling Formula) should be used, and Shen Deng Zhao (Divine Lamp Illumination) is very effective. However, this should not be used too early. Between the fourth and fifth day, if the sore has not consolidated and the toxin has not emerged, premature use may trap the stagnation and make internal toxins harder to expel. This method should be used after the eighth or ninth day, when the sore's trend is established and the toxin has gathered but has not yet suppurated or necrosed. Illumination with the lamp causes existing abscesses to rise, non-suppurating ones to resolve, un-ulcerated ones to break, and non-detaching ones to shed. It is also an excellent method for resolving toxins, invigorating blood, reducing swelling, and dispersing stasis.
Apply plaster to the top of the sore, and powder around the perimeter.
Sores are most vulnerable to Wind-Cold invasion. At the initial stage, or after moxibustion, Tai Yi Gao (Great Emperor Plaster) should be applied to the top of the sore. Its functions include drawing out toxins, lifting the apex, promoting pus discharge, and preventing Wind-Cold entry. If the sore is swollen and painful, indicating a Yang sore, after seven days, yellow thick pus will naturally adhere to the plaster at the apex, while the surrounding redness remains bright and vivid. Wash daily with Scallion Decoction and change the dressing. The main pus will likely discharge around the eleventh day, indicating an easy-to-treat and safe condition. If after seven days the sore is not highly swollen, the surroundings are not painful, and there is no pus at the apex, it indicates a balance of Yin and Yang. Apply Hua Fu Zi Xia Gao (Rot-Resolving Purple Cloud Plaster) to the apex and cover with plaster. After changing dressings beyond the tenth day, the apex will gradually necrose, and the surrounding swelling will rise, suggesting impending pus. Main pus may discharge after the fifteenth day, indicating a transition from dangerous to favorable. If there is no pus after twenty days, it is a Pure Yin syndrome, and treatment will be ineffective. Regarding the swelling at the base of the four sides, applying powder helps consolidate the root and prevent spreading. Initially, Jin Huang San (Golden Yellow Powder) applied around the sides draws out toxins, reduces swelling, and relieves pain. After ulceration, Tie Tong Gao (Iron Bucket Plaster) is used to bind the root, helping it tighten and converge. Since all sores result from Qi and Blood stagnation, avoid using only cooling herbs, as they may freeze the muscles, leading to difficulty in suppuration and healing. Instead, use warming herbs to disperse stagnation, move blood, draw out toxins, and invigorate blood circulation.
When Qi is abundant, the apex rises high and protrudes; when Blood is abundant, the base is tightly bound without doubt.
Qi and Blood are the original endowments of human life. Even the elderly may have surplus, and the young may have deficiency. Human vitality depends entirely on them. Since all diseases arise from imbalances here, losing this foundation inevitably leads to changes, especially in surgery. During the swelling stage, without sufficient healthy Qi to support, the apex cannot swell high or become painful. During the ulceration stage, without True Yin to nourish, the base cannot consolidate, and the color cannot become red and vibrant. Observing a high apex and active base indicates sufficient Qi and Blood, regardless of age, ensuring safety. "Intersection" refers to the natural boundary between the sore root and healthy flesh. "Clear distinction" means the sore shape and healthy tissue are distinct without mixing. Understanding this makes the diagnosis clear.
Highly swollen sores should avoid purgative drugs to prevent damaging healthy Qi; flat and spreading sores require tonifying and supporting agents to address deficiency.
Naturally high-rising sores at onset belong to Yang syndromes, with no deep internal toxin and surface manifestation. Support the interior to accelerate suppuration. Avoid internal resolving and attacking drugs that damage Spleen Qi, which would hinder pus formation and healing. Flat, non-red, spreading sores at onset indicate inherent healthy Qi deficiency. Immediately administer interior-supporting, middle-warming, and Spleen-strengthening drugs to push the toxin outward and prevent complications.
If internal heat is severe, add detoxifying and clearing agents appropriately; if constipation and dryness exist, ensure appropriate bowel movement. This promotes free flow of organs and smooth circulation of Qi and Blood.
During the swelling stage, internal heat, dry mouth, forceful pulse, irritability, constipation, and preference for cold indicate pathogenic toxin in the interior. Urgently use cold and purgative treatments. Suitable formulas include Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction), Si Shun Qing Liang Yin (Four Smooth Cooling Drink), or Nei Xiao Wo Xue Tang (Internal Resolution Snow-Washing Decoction). If accompanied by exterior symptoms, use Fang Feng Tong Sheng San (Saposhnikovia Unblocking Success Powder) removing Ma Huang (Ephedrae Herba), or Shuang Jie San (Double Resolution Powder) adding Jie Geng (Platycodonis Radix) and Tian Hua Fen (Trichosanthis Radix). If urination is difficult, combine with Tian Shui San (Heavenly Water Powder) or Wu Ling San (Five Spice Powder) to ensure free passage of urine and feces, cutting off the source. For patients with inherent Qi deficiency who cannot tolerate strong drugs, use Tuo Li Xiao Du San (Interior-Supporting Toxin-Resolving Powder) with honey-fried Da Huang (Rhei Radix et Rhizoma), or combine with Pig Gallbladder method, aiming for free passage. Treatment should maintain openness without leakage, harmonizing organs and penetrating interior/exterior, before using interior-supporting, pus-expelling, or internal-tonifying drugs. In the ulceration stage, even with dry mouth, constipation, organ disharmony, or difficult urination, these result from excessive loss of pus/fluid, leading to Yin fluid depletion and Qi/Blood exhaustion, failing to nourish organs. The pulse is fine and rapid, mouth feels normal but dry, appetite decreases, and hot soup is preferred. This is deficiency-Yang fire, not excess. Nourish Qi and Blood, moisten fluids, harmonize organs, and regulate Spleen-Stomach. This harmonizes bowels/bladder and prevents complications. Misusing purgatives often leads to untreatable conditions.
If the sore remains hard within ten days, it must be punctured with a needle at the center.
After ten days, sores should naturally necrose and suppurate. If still hard without suppuration, it indicates a mixed Yin-Yang syndrome with deep-rooted fixation. Puncture the center with a needle about one cun deep to open the orifice and vent the toxin, preventing internal attack. If pus is present, it will drain easily, following the principle of "opening the door to drive out the thief." If after ten days the sore does not necrose but remains red/vibrant with heat/swelling/pain, suppuration is delayed but will occur. No need to needle; this is due to insufficient healthy Qi, failure to use tonifying/supporting drugs, misuse of cold herbs, or inadequate warmth. Use Spleen-tonifying and major tonifying/supporting drugs to achieve suppuration. The period from fifteen to twenty-one days is critical. Beyond this, even with thin pus, prolonged toxin consumption depletes Qi, making healing difficult.
After half a month, if pus is scant, use Yao Tong (Medicinal Cylinder) to suction the apex. Adherent pus/blood facilitates necrotic tissue shedding.
If after fifteen days the sore still does not necrose or suppurate, the toxin has sunken internally. Urgently use a needle to create three holes about one cun apart at the apex, inserting one to two cuns deep depending on depth. Insertion should be painless. Heat the Yao Tong (Medicinal Cylinder) beforehand and apply to the holes for a while, then remove when warm. Extracted blood should be red with slight purple; pus should be yellow and fresh. This indicates active Qi/Blood circulation and a good prognosis. Fresh red color and adherent pus/blood facilitate healing and necrotic shedding. If extracted blood is dark purple/black, foul-smelling, with watery fluid and no pus, it indicates internal Qi/Blood collapse and a fatal sore. Such cases are difficult to sustain, and death may occur by month-end.
If pus exists internally but cannot emerge, use a needle hook to lift tough tissue from the front, and cut open about one cun at the apex with scissors to allow drainage and prevent blockage.
After suctioning with Yao Tong (Medicinal Cylinder), external and internal orifices are open. If pus is still scant, it is not spontaneous. Blockage by necrotic matter or tough membranes hinders flow. Use a needle hook to lift tough tissue at the apex, and use a scalpel/scissors to remove about one cun of hard tissue. Mild pain and bleeding are acceptable. Gently press from the base toward the center to expose the pus tube. Accumulated pus will gush out. Yellow thick pus is auspicious; increasing volume indicates mildness. Reverse signs are concerning. The goal is to clear blockages and expel toxic pus.
Frequently wash with decoction; strictly avoid wind exposure.
Before ulceration, or after lamp therapy, wash the sore once daily with Cong Ai Tang (Scallion and Mugwort Decoction), twice daily for severe cases, to unblock Qi/Blood and facilitate rupture. After ulceration and suction, avoid wind. Remove old dressing. Place a square pan near the sore. Pour Zhu Ti Tang (Pig Trotter Decoction) over the sore with soft silk, gently pressing into holes to clean internal pus. Expel rotten pus with the broth until clean. Fold soft cloth seven to eight layers, keep slightly damp, place on sore, and gently press. Replace when warm. Repeat four to five times to soothe Qi/Blood and relieve the patient. This clears stagnation, resolves toxins, sheds necrotic tissue, and reduces pain. It is essential for large sores. When red meat appears after necrotic shedding, apply Yu Hong Gao (Jade Red Plaster) after washing. Melt plaster in palm, apply to new/old tissue, cover with Tai Yi Gao (Great Emperor Plaster). Do not bind edges if swelling has subsided. Daily application leads to complete shedding of pus/necrosis and rapid growth of new tissue within days. With proper internal tonification, mild sores heal in a month, large sores in seventy days.
Joint points occur at this time; complications arise from these stages.
"Joint points" refer to critical nodes: fourteen days for Yang sores, twenty-one days for Yin sores. Pus must discharge during these periods. Do not interfere excessively. Pus discharge leads to necrotic shedding, then muscle generation, then contraction, then flattening. This sequence is crucial. Failure to discharge pus on schedule leads to complications. A favorable node leads to favorable outcomes; an unfavorable node leads to unfavorable outcomes. Careful observation is necessary.
Treatment should focus on major tonification to achieve full contraction; strictly avoid cold herbs to prevent complications.
After ulceration and pus discharge, the Five Zang organs are damaged, and Qi/Blood are severely deficient. Although the exterior may seem robust, the interior is truly deficient. Pure tonification is required for survival. If fever/chills, profuse pus, spontaneous sweating, and pain occur after ulceration, administer Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction). If deficiency heat, insomnia, and poor appetite exist, administer Huang [Ren] Shen Tang (Yellow Ginseng Decoction - *Note: Text implies a specific Ginseng formula*). If cold skin, deficiency heat, cough with phlegm occur, administer Tuo Li Qing Zhong Tang (Interior-Supporting Middle-Clearing Decoction). If limb fatigue, muscle wasting, sallow complexion, and shortness of breath occur, administer Ren Shen Yang Rong Tang (Ginseng Nourishing Spirit Decoction). If profuse pus, irritability, poor appetite, restlessness, and insomnia occur, administer Sheng Yu Tang (Holy Recovery Decoction). If Spleen deficiency, Qi weakness, cool body, fine pulse, and loose stools occur, administer Tuo Li Wen Zhong Tang (Interior-Supporting Middle-Warming Decoction). If poor appetite, nausea, and vomiting occur, administer Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). If Spleen deficiency with sinking, poor appetite, and intermittent deficiency heat occur, administer Bu Zhong Yi Qi Tang (Tonify Middle and Augment Qi Decoction). If Kidney deficiency with thirst and inability to control Heart Fire occur, administer Jia Jian Ba Wei Wan (Modified Eight Flavor Pill). Select accordingly. Supporting the interior strengthens Qi/Blood and Spleen-Stomach, allowing natural expulsion of pus/toxins, necrosis, new tissue growth, appetite return, and wound closure. Failing to tonify and instead using cold herbs exacerbates deficiency and excess, leading to internal toxin sinking, foul pus, forceful pulse, thirst, red face, and shortness of breath, resulting in death from true Qi deficiency.
Sores rely entirely on Spleen Earth; regulation requires careful attention.
The Spleen is the official of granaries; the Stomach is the sea of water and grain. Stomach governs intake; Spleen governs digestion. Exterior/interior, intake/digestion, continuous operation, infinite transformation. All Qi/Blood, meridians, limbs, bones, and Zang-Fu organs depend on this for nourishment. "Prosperity comes from Earth; ruin comes from losing Earth." Strong Spleen-Stomach leads to increased appetite, weight gain, and robust Qi/Blood. Weak Spleen-Stomach leads to poor appetite, indigestion, weight loss, and depleted Qi/Blood. Life depends on this for survival and disease management, especially in surgery. Good health preservation involves regulating diet, adjusting to temperature changes, controlling emotions, and conserving energy to protect Spleen-Stomach. Otherwise, Qi/Blood decline daily, organs/meridians deteriorate, and muscles/waste away. One misstep in regulation leads to myriad diseases. Thus, Spleen-Stomach must be carefully managed.
In winter, warm the bed and room; in summer, keep desks clean and windows bright.
Qi and Blood prefer warmth and dislike cold. Cold causes coagulation; heat causes dispersion. Sores are breaks in muscle/flesh, easily invaded by Wind-Cold if unprotected. In winter, use charcoal fire to generate warmth and dispel residual cold. In summer, keep rooms clean and bright to prevent external wind. Only then can dressings be changed and washed. Patients often sleep in drafts in summer or cold places in winter, leading to Cold invasion. Mild cases hinder healing; severe cases cause collapsing, non-suppurating, non-contracting Yin syndromes. Wise individuals must be cautious.
Dietary restrictions are unnecessary, except avoiding cold, hard, and greasy foods.
Food sustains life and should be eaten according to timing. During painful swelling, Stomach Qi is injured, and appetite is lost. After ulceration, when pus/toxins exit, Stomach Qi returns, and hunger arises. Offer preferred foods to nourish Spleen-Stomach. Denying desired food opposes Stomach Qi and worsens anorexia. Avoid excess. Prohibited items: cold/raw foods injure Spleen; hard foods are hard to digest; greasy foods loosen bowels. Others can be consumed freely.
Carbuncles and ulcers belong to Surgery, but medication principles are the same as Internal Medicine.
Ancients prioritized surgery among miscellaneous diseases because injury is rapid and significant. Although carbuncles, head/neck sores, and Ding toxins manifest externally, their source is internal. How can treatment ignore the interior to treat the exterior? If external eruption fails, add interior-supporting drugs. If exterior heat is severe, clear internally. For Blood deficiency, use Si Wu Tang (Four Substances Decoction); for Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction). For weak pulse/cold feet, warm the middle; for forceful pulse/fever, cool the chest. Externally and internally, principles are identical. Society calls it "Surgery" based on form, but "Internal Injury" based on Qi/Blood treatment. Physicians must not confuse internal principles to avoid complications.
Weak pulse and deficiency require tonification from start to finish; Excess exterior and interior require temporary purgation.
Dan Xi said: Before ulceration, if toxin attacks organs, never use hot drugs. After ulceration, if organs are deficient, never use cold drugs. This is true. However, exceptions exist. If initially un-ulcerated, pulse is micro/deep/slow/rough/fine/rapid/floating/hollow, with cool body, sweating, normal bowels/vomit, poor appetite, non-rising/non-red/non-painless/no pus, these indicate Qi/Blood deficiency. Insisting on "toxin attack = cold drugs" damages healthy Qi and kills the patient. I argue that treatment depends on pulse/symptoms, not just duration. If weak, tonify immediately for safety. If tonification fails, consider severe deficiency: use Shen Zhu Gao (Ginseng and Atractylodes Paste) or Ba Xian Gao (Eight Immortals Cake). For Yang deficiency with sweating/poor appetite, use Single Ginseng Paste or Liu Jun Zi Tang (Six Gentlemen Decoction) adding Sha Ren (Amomi Fructus) and Mu Xiang (Aucklandiae Radix), or Fuzi (Aconiti Lateralis Radix Preparata) if severe. For diarrhea/borborygmus/Stomach deficiency/vomiting, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) adding Dou Kou (Cardamomi Fructus), Shan Yao (Dioscoreae Rhizoma), Mu Xiang, and Shi Di (Datiscae Caulis). For Spleen deficiency with sinking/loose stools/anal heaviness, use Bu Zhong Yi Qi Tang adding Shan Yao, Shan Yu (Corni Fructus), and Wu Wei Zi (Schisandrae Fructus). For exterior excess (fever, no sweat, aversion to cold), use Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Detoxifying Powder) to release exterior. For interior excess (forceful pulse, fever, dry stool/thirst), use Si Shun Qing Liang Yin (Four Smooth Cooling Drink) to purge interior. For combined exterior/interior excess, use Fang Feng Tong Sheng San (Saposhnikovia Unblocking Success Powder) to release exterior and purge interior. Application depends on flexibility. Those who respond to tonification lack phlegm-fire/internal toxin; those who do not accept tonification have Yin-fire/damp-heat. Responding to tonification leads to survival; non-responsive deficiency is untreatable.
Disease duration (new vs. old) dictates broad vs. aggressive treatment.
Diseases vary in duration and urgency. Early stage with intact healthy Qi allows symptom-specific resolution. Fear of harsh drugs prevents efficacy in crises. Treat the disease and stop; "If medicine does not cause dizziness, the chronic disease will not heal." For strong exterior symptoms, use Wan Ling Dan (Ten Thousand Spirits Pill) for heavy diaphoresis. For urgent interior symptoms, use...