疮疡在外者引而拔之。在内者疏而下之。灼艾之功甚大。若毒瓦斯郁结。气血凝聚。轻者
药散。重者药无全功。东垣云。若不针烙。则毒瓦斯无从而散。脓瘀无从而泄。过时不烙。反
攻于内。故治毒者必用隔蒜灸。舍是而用苦寒之剂。其壮实内有火者或可。彼怯弱气寒。未
有不败者也。又有毒瓦斯沉伏。或年高气弱。若服克伐之剂。气血愈虚。脓因不溃。必假火力
以成功。
一人足患疔已十一日。气短。灸五十余壮。更以托里药而愈。黄君腿痈。脓清脉弱。一
结一块。溃不收敛。各灸以豆豉饼。更饮托里药而愈。一人胸肿一块。半载不消。明灸百壮
方溃。与大补药不敛。复灸以附子饼而愈。一人发背 痛如灼。隔蒜灸三十余壮。肿痛悉退
。更服托里消毒而愈。一人发背疮。头甚多。肿硬。色紫。不甚痛。不腐溃。以艾铺患处灸
之。更服大补药。数日死肉脱去而愈。一人发背已四五日。疮头虽小。根畔颇大。隔蒜灸三
十余壮。其根内消。惟疮头作脓而愈。精要。曰。灸法有回生之功。信矣。大凡蒸灸。若未
溃则拔引郁毒。已溃则补接阳气。祛散寒邪疮口自合。其功甚大。尝治四肢疮疡气血不足者
。只以前法灸之皆愈。疔毒甚者。痛则灸至不痛。不痛则灸至痛。亦无不愈。若中虚者。不
服败毒药。则疮毒未除。中气先伤。未有不败者也。李氏云。治疽之法。着艾胜于用药。缘
热毒中隔。外内不通。不发泄则不解散。又有处贫居僻。一时无药。用灸尤便。大概蒜用大者。取其散
毒有力。用着艾炷多者。取其火力透也。如法灸之。疮发脓溃。继以神异膏贴之。不日而安
。一则疮不开大。二则内肉不溃。三则疮口易合。见效甚神。
辨精要曰。始发时用针灸。十死八九。丹溪曰。火以畅达。拔引郁毒。此从治之意。因
死者。盖虚甚孤阴将绝。脉必浮数而大且鼓。精神必短而昏。无以抵当火气故也。岂可泛言
始发不可灸以误人。精要又谓头上有毒不得灸。恐火拔起热毒而加病。丹溪曰。头为诸阳所
聚。艾炷宜小而少。小者如椒粒。少者三五壮而已。若猛浪如灸腹背。炷大数多。斯为误矣
。按东垣灸元好问脑疽。以大艾炷如两核许。灸百壮。始觉痛而安。由是推之。则头上发毒
。灸之痛则炷宜小。数宜少。不痛者。炷大数多亦无妨也。
经曰。陷者灸之。如外微觉木硬不痛者。是邪气深陷也。急灸之。浅者不可灸。又曰。
浅者有数头肿痛。亦灸之无妨。
疮疡生在体表的，用引提的方法将其拔出；生在体内的，用疏通下行的方法将其排出。艾灸的功效非常大。如果毒邪郁结，气血凝聚，病情轻的，用药即可消散；病情重的，单靠药物难以取得全效。李东垣说：如果不使用针烙（针刺和火烙），那么毒邪就没有途径散发，脓血瘀滞就没有途径排泄。错过时机不进行火烙，毒邪反而会向内攻陷。因此，治疗毒疮必须使用隔蒜灸。舍弃这种方法而使用苦寒的药物，对于体质壮实、体内有火的人或许可以；但对于怯弱、气虚偏寒的人，没有不导致病情败坏失败的。又有毒邪沉伏隐匿，或者年老气弱的人，如果服用克伐（攻伐）的药物，气血会更加虚弱，脓液因此无法溃破，必须借助艾火的火力才能成功治愈。
有一人足部患疔疮已经十一日，气息短促，艾灸五十多壮，再服用托里药而痊愈。黄先生的腿部痈肿，脓液清稀，脉象微弱，结成一块肿块，溃破后不收敛，分别用豆豉饼隔灸，再饮用托里药而痊愈。有一人胸部肿胀一块，半年不消退，直接艾灸一百壮后才溃破，服用大补药后伤口不收敛，再次用附子饼隔灸而痊愈。有一人背部发背疮，疼痛如灼烧感，隔蒜灸三十多壮，肿痛全部消退，再服用托里消毒药而痊愈。有一人发背疮，疮头很多，肿胀坚硬，颜色紫暗，疼痛不明显，不腐烂溃破，用艾绒铺在患处施灸，再服用大补药，几天后死肉脱落而痊愈。有一人发背疮已四五天，疮头虽然小，但根部周围颇大，隔蒜灸三十多壮，其根部内部消散，只有疮头化脓而痊愈。《精要》说：灸法有起死回生的功效，确实如此。大凡蒸灸，如果疮疡未溃破，则能拔引郁结之毒；如果已溃破，则能补接阳气，驱散寒邪，疮口自然愈合，其功效很大。我曾经治疗四肢疮疡气血不足的患者，只用上述灸法都治愈了。疔毒严重的，痛的就灸到不痛为止，不痛的灸到有感觉为止，也没有不愈的。如果是中气虚弱的人，不服用败毒药物，那么疮毒未除，中气先被损伤，没有不导致病情败坏的。李氏说：治疗疽病的方法，使用艾灸胜过使用药物。因为热毒阻隔于内，内外不通，不通过发泄（艾灸）就不能解散。又有地处贫寒偏僻，一时没有药物的情况，使用艾灸尤其方便。大概大蒜要用大的，取其发散毒邪有力；使用的艾炷要多，取其火力透达深入。按照这种方法施灸，疮头发脓溃破，继以神异膏贴敷，不久就能安宁。这样一则疮口不会开得过大，二则内部肌肉不会过度溃烂，三则疮口容易愈合，见效非常神奇。
《辨精要》说：疾病初起时使用针灸，十个人中有八九个死亡。朱丹溪说：火能够畅达气机，拔引郁结之毒，这是“从治”的意思。那些因灸致死的，是因为正气极度虚弱，孤阴即将绝灭，脉象必然浮数且大而鼓动，精神必然短少而昏沉，无法承受火气的缘故。怎么能笼统地说初起不可灸从而误导人呢？《精要》又说头上有毒不得灸，担心火性拔起热毒而加重病情。朱丹溪说：头部是诸阳经汇聚的地方，艾炷应该小而少，小的像花椒粒那么大，少的三五壮而已。如果猛烈鲁莽地像灸腹部背部那样，艾炷大数量多，这就是错误了。按李东垣为元好问灸疗脑疽的案例，使用大艾炷如两个核大小，灸一百壮，开始觉得痛然后安定下来。由此推断，那么头上发毒，灸的时候痛的就用小艾炷，数量要少；不痛的，用大艾炷数量多也没有妨碍。
《内经》说：凹陷的病证用灸法。如外部微微感觉麻木坚硬且不痛的，是邪气深陷的表现，应当急灸。浅表的病证不可灸。又说：浅表的病证如果有几个头肿痛，灸它也没有妨碍。
For sores and ulcers located on the exterior, employ the method of drawing and pulling them out; for those located in the interior, employ the method of dispersing and purging them downward. The efficacy of moxibustion is profound. If toxic pathogens are constrained and stagnant, and qi and blood coagulate, mild cases can be resolved with herbs alone; severe cases cannot achieve complete cure with herbs alone. Li Dongyuan stated: "If acupuncture and cauterization (needle and fire) are not employed, there is no pathway for toxic pathogens to dissipate, and no outlet for pus and stasis to drain. If cauterization is delayed, the pathogenic factors will counter-attack inward." Therefore, when treating toxic sores, garlic-separated moxibustion must be used. Abandoning this method in favor of bitter-cold formulas may be acceptable for individuals with robust constitutions and internal heat, but for those who are frail, deficient, and cold in constitution, it invariably leads to deterioration. Furthermore, if toxic pathogens are deeply latent, or if the patient is elderly and weak, administering harsh purgative or attacking herbs will further deplete qi and blood, preventing the formation and rupture of pus; one must rely on the thermal power of moxibustion to achieve success.
One case involved a patient with a carbuncle on the foot for eleven days, presenting with shortness of breath. After receiving over fifty moxa cones, followed by administration of *Tuoli* (Supporting the Interior) medicine, he recovered. Another case involved Mr. Huang, who suffered from a thigh abscess with thin pus and a weak pulse, presenting as a single hardened lump that failed to heal after rupture. He was treated with fermented soybean cake-separated moxibustion and administered *Tuoli* medicine, resulting in recovery. A third case involved a swelling on the chest that persisted for half a year without resolution. After direct moxibustion of one hundred cones, the lesion ruptured. Although large tonifying herbs were given, the wound failed to close; subsequent treatment with ginger-attached moxibustion led to healing. A fourth case involved a back carbuncle with burning pain. Thirty-plus garlic-separated moxa cones were applied, causing the swelling and pain to subside completely, followed by administration of *Tuoli* detoxification medicine, leading to recovery. A fifth case involved a back carbuncle with numerous heads, hard swelling, purple discoloration, minimal pain, and lack of suppuration. Moxa was spread directly on the affected area for moxibustion, followed by large tonifying herbs; dead tissue sloughed off within several days, and the patient recovered. A sixth case involved a back carbuncle present for four to five days, with small heads but a wide base. Garlic-separated moxibustion of thirty-plus cones caused the base to resolve internally, leaving only the head to suppurate, leading to recovery. *Jingyao* states: "Moxibustion possesses the power to restore life," which is indeed true. Generally, steaming moxibustion, if applied before rupture, draws out constrained toxins; if applied after rupture, it supplements yang qi and dispels cold pathogens, allowing the wound to heal naturally. Its efficacy is significant. I once treated patients with sores and ulcers on the limbs due to qi and blood deficiency, using only the aforementioned moxibustion methods, all of whom recovered. For severe carbuncles, if painful, moxibustion should continue until pain ceases; if painless, until sensation returns. There are no failures in such cases. However, for those with middle-jiao deficiency, failing to administer detoxifying herbs means the toxin remains while the middle qi is damaged first, inevitably leading to deterioration. Li Shi stated: "In treating carbuncles, moxibustion surpasses herbal medicine." This is because heat toxins are blocked internally, preventing communication between the interior and exterior; without venting via moxibustion, they cannot disperse. Additionally, for those living in poverty or remote areas lacking immediate access to medicine, moxibustion is particularly convenient. Large garlic cloves should be used for their strong toxin-dispersing capability; numerous moxa cones should be used to ensure deep penetration of thermal energy. Following this method, the sore suppurates and ruptures, followed by application of *Shenyi Gao* (Miraculous Ointment), leading to rapid peace and stability. This ensures three benefits: the wound does not open excessively, internal flesh is not overly destroyed, and the wound closes easily. The results are remarkably effective.
*Bian Jingyao* states: "Using acupuncture and moxibustion at the onset of disease results in eight or nine deaths out of ten." Zhu Danxi stated: "Fire promotes free flow and draws out constrained toxins, embodying the principle of 'treating according to the nature of the disease' (Cong Zhi)." Those who died after moxibustion did so because their deficiency was extreme, with isolated yin nearing extinction. Their pulses were floating, rapid, large, and forceful; their spirit was diminished and confused, unable to withstand the fire energy. How can one broadly state that moxibustion is contraindicated at the onset, thereby misleading people? *Jingyao* also claims that toxic lesions on the head must not be moxibusted, fearing that fire will draw up heat toxins and worsen the condition. Zhu Danxi stated: "The head is the gathering point of all yang meridians. Moxa cones should be small and few in number—small like peppercorns, and few, only three to five cones. Acting recklessly as one would on the abdomen or back, using large cones and high numbers, constitutes an error." According to Li Dongyuan’s treatment of Yuan Haowen’s brain carbuncle, large moxa cones the size of two nuts were used, applying one hundred cones. Pain was felt initially, then relief ensued. From this, we deduce that for toxic lesions on the head, if painful, use small cones and few applications; if painless, large cones and many applications are permissible.
The *Classic* states: "For sinking conditions, use moxibustion." If the exterior feels slightly numb, hard, and painless, it indicates deep invasion of pathogenic factors; urgent moxibustion is required. Superficial conditions should not be moxibusted. It also states: "Superficial conditions with multiple swollen and painful heads can also be moxibusted without harm."