一水部年逾四十。髀HT 患毒已半月。头甚多。大如粟许。内痛如刺。饮食不思。怯甚。
至。此元气虚。疽蓄于内。非灸不可。遂灸二十余壮。饮以六君子（二）加藿香、当归数剂。
疮势渐起。内痛顿去。胃脉渐至。但疮色尚紫。瘀肉不溃。此阳气尚虚也。用桑柴火灸以接
阳气。解散其毒。仍以前药加参、 、归、桂。色赤脓稠。瘀肉渐腐。取去。两月余而愈。
（此凭脉症也）
夫邪气沉伏。真气怯弱。不能起发。须灸。灸而兼大补。若投常药。待其自溃。鲜不误
一人年逾六十。冬至后疽发背。五七日肿势约七寸许。不任其痛。视之脓成。彼惧开发
三日始以燔针开之。以开迟。迨二日变症果生。觉重如负石。热如炳火。痛楚倍常。六脉沉
数。按之有力。此膏粱积热之变。邪气酷热。固宜治之以寒药。但时月严凝。有用寒远寒之
戒。经曰。假者反之。虽违其时。以从其症可也。急作清凉饮子。加黄连秤一两半作一服。
利下两行。痛减七分。翌日复进。其症悉除。月余平复。
机按此条。因浓味因脉而为之治法也。
一人初生如粟。闷痛烦渴。便秘脉实。此毒在脏也。予谓宜急疏去之。以绝其源。使毒
不致外侵。彼以为小恙。乃服寻常之药。后大溃而没。
一士因脚弱求诊。两手脉皆浮洪稍鼓。饮食如常。懒于言动。肌起白屑如麸片。时在冬
予作极虚处治。询知半年前背臀腿三处。自夏至秋冬节次生疽。率用五香连翘汤。十宣散。
今
力。补药应效已渐。病家嫌缓。自作风病治。炼青礞石二钱半。以青州白丸作料。煎饮子顿
服之。予谏不听。因致不救。
一人背疮毒瓦斯未尽。早用生肌。背竟溃烂。予以解毒药治之得愈。又一人患毒瓦斯始发。
骤用生肌。其毒内攻而死。
一人年逾四十。发背五日不起。肉色不变。脉弱少食。大便不实。予谓凡疮未溃脉先弱
于收敛。用托里消毒散二剂方起发。彼惑一妪言。贴膏药。服攻毒剂。反盛。背如负石。复
请予治。隔蒜灸三十余壮。彼云负石已去。但痒痛未知。更用托里药。知痛痒。脓清。前药
倍加参、 。佐以姜、桂。脓稍稠。又为人惑。外贴猪腰子。抽脓血。内服硝、黄。遂流血
五六碗许。连泄十余行。腹内如冰。饮食不进。不得已。速予诊之。脉尽脱。不可救。盖其
症属大虚。一于温补。犹恐不救。况用攻伐。不死何待。
一人发背十余日。疮头如栗许。肿硬木闷。肉色不变。寒热拘急。脉沉实。此毒在内也
以黄连内疏汤次以消毒托里药。其毒始发。柰速用生肌。患处忽若负重。身如火 。后竟不
东垣云。毒瓦斯未尽。速用生肌。纵平复必再发。若毒瓦斯入腹。十死八九。大抵毒瓦斯尽。
脾气壮。则肌肉自生。生肌药不用亦可。
一宜人年逾六十。发背三日。肉色不变。头如粟许。肩背重。寒热饮冷。脉洪数。良甫
外如麻。里如瓜。齐氏曰。增寒壮热。所患必深。又曰。肉色不变。发于内也。用人参败毒
散（六二）二剂。又隔蒜灸五十余壮。毒始发。背始轻。再用托里药渐溃。顾气血虚甚。作渴
。服参、 、归、 等。渴止。彼欲速愈。自用草药敷患处。毒瓦斯复入。遂不救。
大抵老弱患疮。疮头不起。或坚如牛领皮。多不待溃而死。溃后气血不能培养者亦死。
初溃。毒正发越。宜用膏药吸之。参 等药托之。若反用药遏之使毒瓦斯内攻者。必不救也。
一女背HT 结一核如钱大。不 。但倦怠少食。日晡发热。脉软而涩。此虚劳气郁所致。予
气养血开郁之药。复令饮人乳。精神稍健。彼不深信。又服流气饮。食遂少。四肢痿。其父
悔。复请予。予谓决不起矣。果殁。
一妇发热作痛。专服降火败毒药。溃后尤甚烦躁。时嗽。小便如淋。皆恶症也。辞不治
此症虽云属火。未有不由阴虚而致者。故经云督脉经虚。从脑而出。膀胱经虚。从背而
出。岂可专泥于火。
一太守肿硬不泽。疮头如粟。脉洪大。按之即涩。经云骨髓不枯。脏腑不败者可治。然
肿硬色夭。坚如牛领之皮。脉更涩。此精气已绝矣。不治。
一宜人发背。脓熟不开。昏闷不食。此毒瓦斯入内也。断不治。强之针。脓碗许。稍苏。
须臾竟亡。
大抵血气壮实。脓自涌出。老弱之人。血气枯槁。必须迎而夺之。顺而取之。若毒结四
刺少缓。腐溃深大。亦难收敛。结于颊项胸腹紧要之地。不问壮弱。急宜针刺。否则难治。
一人背疮溃陷。色紫舌卷。予谓下陷色紫。阳气脱也。舌卷囊缩。肝气绝也。经曰。此
筋先死。庚日笃。辛日死。果立秋日而殁。
一位水部官员，年龄超过四十岁。大腿部位患毒疮已有半个月。疮头很多，大小如同粟米。内部疼痛如针刺般剧烈。不思饮食，身体极度虚弱。
这是因为元气虚损，疽毒蓄积在体内，非用艾灸不可治疗。于是施灸二十多壮，并服用加了藿香、当归的六君子汤数剂。
疮势逐渐隆起，内部刺痛顿时消失。胃脉逐渐恢复有力。但疮色仍然发紫，瘀滞的肉组织不溃烂。这是阳气依然虚弱的表现。用桑柴火进行艾灸以接续阳气，解散毒邪。仍然使用之前的药方，加入人参、白术、当归、桂枝。疮色转红，脓液变得稠厚，瘀肉逐渐腐烂脱落。经过两个多月痊愈。
（这是依据脉象和症状进行治疗的案例）
邪气深沉潜伏，真气怯弱，不能托毒外出，必须使用艾灸。艾灸的同时配合大补气血的药物。如果投用常规药物，等待其自行溃破，很少有不误事的。
另一位患者，年龄超过六十岁。冬至后背部发生疽疮。五到七天后肿胀范围约七寸左右。无法忍受疼痛。观察发现脓已成熟。患者害怕切开引流，过了三天才用燔针（烧红的针）切开。因为切开太迟，到了第二天果然出现变症。感觉身体沉重得像背负石头一样，发热如火烧，痛苦程度加倍。六脉沉而数，按之有力。这是因长期食用肥甘厚味积聚的热毒引发的病变。邪气酷热，本来应该用寒凉药物治疗。但当时正值严寒季节，有“用寒远寒”（使用寒凉药要避开寒冷时节）的禁忌。《内经》说：假证则反治。虽然违背了时令，但应顺从病症治疗。急忙配制清凉饮子，加入一两半黄连作为一剂服用。服药后排泄两次，疼痛减轻七分。第二天再次服用，症状全部消除。一个多月后康复。
汪机按语：此条案例，是因为浓味厚腻饮食致病，根据脉象制定的治疗方法。
还有一位患者，初起时疮头如粟米大小，闷痛烦渴，便秘，脉象实大。这是毒邪在脏腑的表现。我认为应当紧急疏通排泄，以断绝病源，使毒邪不至于向外侵犯。他认为这只是小病，于是服用了寻常药物。后来疮疡大面积溃烂而死。
一位读书人因双腿软弱求诊。两手脉象皆浮洪且稍显鼓指，饮食正常，懒于言语动作。皮肤上出现如麸片般的白色皮屑。当时正值冬季。
我将其作为极虚证处理。询问得知半年前背、臀、腿三处，自夏至秋冬依次生疽，都使用了五香连翘汤、十宣散等发散攻伐药物，导致正气受损。
现在无力支撑。补药本应见效，病情渐缓。但家属嫌药效缓慢，自作主张按风病治疗。炼制青礞石二钱半，以青州白丸为辅料，煎煮成饮剂顿服。我劝谏不听。因此导致救治无效。
还有一位患者，背部疮毒瓦斯未尽，过早使用生肌收敛药物，导致背部最终溃烂。我用解毒药治疗得以痊愈。又有一位患者，患毒瓦斯刚开始发作，就骤然使用生肌药物，导致毒邪内攻而死。
还有一位患者，年龄超过四十岁，背部疽疮五天不起发，肌肉颜色不变，脉弱，食少，大便不成形。我说凡是疮疡未溃而脉先弱者，宜于收敛固护。使用托里消毒散两剂后才起发。他听信一位老妇人的话，贴膏药，服用攻毒药剂，反而病情加重，背部感觉像背负石头一样沉重。再次请我诊治。隔蒜灸三十多壮。他说背负石头感已去，但不知是否有痒痛感。再用托里药物，感觉到痒痛，脓液清稀。前面的药方倍加人参、白术，佐以生姜、桂枝。脓液稍变稠厚。又被他人迷惑，外贴猪腰子，抽取脓血，内服硝石、大黄。于是流血五六碗左右，连续腹泻十余次。腹内冰冷，饮食不进。不得已，急忙让我诊治。脉象完全脱失，不可救治。因为他的症状属于大虚证，一味温补尚且担心救不活，何况使用攻伐药物，不死还等什么？
还有一位患者，背部疽疮十多天，疮头如栗子大小，肿胀坚硬麻木闷痛，肌肉颜色不变，伴有寒热拘急，脉象沉实。这是毒邪在体内的表现。使用黄连内疏汤，随后用消毒托里药物。毒邪刚开始发作，奈何迅速使用生肌药物。患处忽然感觉负重，身体如火烤一般。最终不治身亡。
李东垣说：毒瓦斯未尽，速用生肌，即使平复也必定复发。若毒瓦斯入腹，十死八九。大抵毒瓦斯尽，脾气壮，则肌肉自生。生肌药不用也可以。
还有一位宜人（官夫人），年龄超过六十岁，背部疽疮三天，肌肉颜色不变，疮头如粟米大小，肩背沉重，寒热交替，想喝冷饮，脉象洪数。良甫（医生名）认为外如麻（表面轻微），里如瓜（内部深重）。齐氏说：增寒壮热，所患必深。又说：肉色不变，发于内也。用人参败毒散两剂，又隔蒜灸五十多壮。毒邪才开始发出，背部感觉轻松。再用托里药物逐渐溃破。顾念其气血非常虚弱，出现口渴。服用人参、白术、当归、地黄等药。口渴停止。但他想要快速痊愈，自己用草药敷在患处。毒瓦斯再次内陷，最终不治身亡。
大抵年老体弱者患疮，疮头不起发，或者坚硬如牛颈皮，大多不等溃破就会死亡。溃破后气血不能培养的也会死亡。
初溃时，毒邪正发越，宜用膏药吸出毒邪，用人参、黄芪等药托举正气。如果反而用药遏制，使毒瓦斯内攻，必定无法救治。
一位女子，背部结成一个如铜钱大小的硬核，不痛。只是倦怠少食，下午发热，脉软而涩。这是虚劳气郁所致。我给予益气养血开郁的药物，又令其饮用牛奶，精神稍见好转。她不完全相信，又服用流气饮，饮食遂减少，四肢痿软。她的父亲后悔，再次请我诊治。我说决计救不起了。果然去世。
一位妇人发热作痛，专门服用降火败毒药。溃破后尤其烦躁，时常咳嗽，小便如淋证般涩痛，都是恶症。推辞不予治疗。
此症虽然说是属火，但没有不是由阴虚导致的。所以《内经》说督脉经虚，从脑而出；膀胱经虚，从背而出。岂可专门拘泥于火邪论治？
一位太守，疮肿硬无光泽，疮头如粟米，脉象洪大，按之即涩。《内经》说：骨髓不枯，脏腑不败者可治。然而此处肿硬色夭（晦暗），坚如牛颈之皮，脉更涩，这是精气已绝的表现。不治。
一位宜人发背疽，脓熟不开，昏闷不食。这是毒瓦斯入内。断定无法救治。强行针刺，流出脓液一碗左右，稍微苏醒。片刻后竟然死亡。
大抵血气壮实者，脓自然涌出。老弱之人，血气枯槁，必须迎其势而夺之，顺其理而取之。若毒结聚，针刺稍缓，腐溃深大，也难以收敛。若结于颊、项、胸、腹紧要之地，不问强弱，急宜针刺，否则难治。
还有一位患者，背部疮疡溃陷，色紫舌卷。我说下陷色紫，是阳气脱失。舌卷囊缩，是肝气绝灭。《内经》说：此筋先死，庚日病重，辛日死亡。果然立秋日去世。
A official from the Ministry of Revenue, aged over forty, suffered from a toxic sore on his thigh for half a month. There were many head-like protrusions, each about the size of a millet seed. The internal pain was piercing like needles. He had no appetite and was extremely weak.
This is due to deficiency of Yuan Qi (Original Qi), with the carbuncle toxin accumulating internally. Moxibustion is indispensable. Consequently, more than twenty moxa cones were applied, followed by several doses of Liu Jun Zi Tang (Six Gentlemen Decoction) added with Huo Xiang (Patchouli Herb) and Dang Gui (Angelica Sinensis).
The lesion gradually rose, and the internal stabbing pain disappeared instantly. The Stomach pulse gradually became forceful. However, the lesion color remained purple, and the necrotic tissue did not ulcerate. This indicates that Yang Qi is still deficient. Moxibustion with Sang Chai Huo (Mulberry Twig Fire) was used to connect Yang Qi and dissipate the toxin. The previous prescription was continued, adding Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Dang Gui (Angelica Sinensis), and Gui Zhi (Cinnamon Twig). The color turned red, the pus became thick, and the necrotic tissue gradually rotted and detached. He recovered after more than two months.
(This case relies on pulse and symptom differentiation.)
When pathogenic factors are deeply latent and True Qi is weak, unable to expel the toxin outward, moxibustion is required. It must be combined with strong tonification. If ordinary medications are administered, waiting for spontaneous ulceration, few cases will not result in error.
Another patient, aged over sixty, developed a back carbuncle after the Winter Solstice. After five to seven days, the swelling measured approximately three inches in diameter. He could not bear the pain. Examination revealed that pus had formed. Fearing surgical incision, he delayed it for three days before using a hot needle (burning needle) to open it. Due to the delay, complications arose on the second day. He felt as heavy as carrying a stone, feverish as if burning with fire, and the pain was twice as severe as usual. All six pulses were deep and rapid, and forceful upon pressure. This is a transformation caused by accumulated heat from excessive consumption of rich foods. The pathogenic factor is intensely hot, so cold-natured medicines should theoretically be used. However, during the severe cold season, there is a caution against using cold remedies in cold weather. The Classic states: "For false conditions, treat oppositely." Although this violates seasonal norms, treatment should follow the symptoms. A Qing Liang Yin Zi (Cooling Drink) was prepared immediately, with one dose containing one tael and a half of Huang Lian (Coptis Rhizome). After defecating twice, the pain decreased by seventy percent. The next day, another dose was taken, and all symptoms vanished. He recovered within a month.
Wang Ji's commentary: This case illustrates treatment based on pulse differentiation resulting from dietary excesses.
Another patient presented with initial lesions the size of millet seeds, accompanied by stifling pain, irritability, thirst, constipation, and a full pulse. This indicates the toxin is in the Zang organs. I advised urgent purgation to cut off the source and prevent external invasion. He considered it a minor ailment and took common medicines. Later, the wound ulcerated extensively, leading to death.
A scholar sought consultation for weak legs. Both radial pulses were floating, surging, and slightly distended. His diet was normal, but he was lethargic in speech and movement. White scales like bran appeared on his skin. It was winter.
I treated him as an extreme deficiency pattern. Upon inquiry, I learned that six months prior, he had developed carbuncles successively on his back, buttocks, and legs from summer to autumn/winter. These were treated with Wu Xiang Lian Qiao Tang (Five Fragrances Forsythia Decoction) and Shi Xuan San (Ten Acupoints Powder), depleting his righteous qi.
Currently, he lacks strength. Tonifying medicines should have been effective, and the condition was gradually improving. However, the family found the progress too slow and self-medicated for wind disease. They processed Qing Meng Shi (Magnetite) and mixed it with Qing Zhou Bai Wan (Qingzhou White Pills), taking it as a decoction in one dose. I advised against it, but they did not listen. Consequently, rescue was impossible.
Another patient had residual toxin in a back sore but used flesh-regenerating medicines too early, causing the back to eventually ulcerate. I treated him with detoxifying medicines, and he recovered. Another patient began using flesh-regenerating medicines abruptly when the toxin first emerged, leading to internal attack and death.
Another patient, aged over forty, had a back carbuncle that did not rise after five days. The flesh color was unchanged, the pulse was weak, food intake was low, and stools were loose. I stated that for un-ulcerated sores with a preceding weak pulse, consolidation is appropriate. Two doses of Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Powder) allowed the lesion to rise. Confused by an old woman's advice, he applied plasters and took anti-toxin agents, causing the condition to worsen. His back felt heavy as if bearing a stone. He requested my treatment again. More than thirty moxa cones were applied via garlic partition. He reported the heaviness was gone but asked about sensation. Further interior-supporting medicines were used until sensation returned. The pus was clear. The previous formula was doubled in Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala), assisted by Sheng Jiang (Fresh Ginger) and Gui Zhi (Cinnamon Twig). The pus became slightly thicker. Misled by others, he applied pig kidneys externally to draw out pus and blood, and internally took Xiao Shi (Mirabilite) and Da Huang (Rhubarb Root). He bled approximately five or six bowls' worth and suffered diarrhea more than ten times. His abdomen felt icy, and he could not eat. Desperately, I was called to examine him. The pulse had completely vanished; rescue was impossible. His condition belonged to extreme deficiency. Even with exclusive warm-tonifying therapy, survival was doubtful. How much less so with attacking therapies? Death was inevitable.
Another patient had a back carbuncle for over ten days. The head was the size of a chestnut, swollen, hard, numb, and stifling. Flesh color was unchanged, accompanied by chills, fever, and stiffness. The pulse was deep and solid. This indicates the toxin is internal. Huang Lian Nei Shu Tang (Coptis Internal Purging Decoction) was used, followed by disinfecting and interior-supporting medicines. As the toxin began to emerge, flesh-regenerating medicines were hastily applied. The affected area suddenly felt heavy, and the body felt like fire. Ultimately, he died.
Li Dongyuan said: If flesh-regenerating medicines are used hastily while toxins remain, even if recovery occurs, recurrence is certain. If toxins enter the abdomen, eight or nine out of ten die. Generally, when toxins are exhausted and Spleen Qi is strong, flesh regenerates naturally. Flesh-regenerating medicines may not even be needed.
A noblewoman, aged over sixty, developed a back carbuncle after three days. Flesh color was unchanged, the head was millet-sized, shoulders and back felt heavy, with alternating chills and fever, desire for cold drinks, and a surging, rapid pulse. Liang Fu believed the exterior seemed mild ("like hemp"), but the interior was severe ("like a melon"). Qi Shi stated: Increased chills and high fever indicate deep pathology. Also: Unchanged flesh color indicates internal origin. Two doses of Ren Shen Bai Du San (Ginseng Detoxifying Powder) were given, followed by more than fifty moxa cones via garlic partition. The toxin finally emerged, and the back felt lighter. Interior-supporting medicines were used again for gradual ulceration. Considering her severe Qi and Blood deficiency and thirst, she was given Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Dang Gui (Angelica Sinensis), and Di Huang (Rehmannia Root). Thirst ceased. Impatient for quick recovery, she applied herbal pastes to the site herself. The toxin re-entered, and she died.
Generally, for elderly and weak patients with sores, if heads do not rise or are hard like ox neck skin, death often occurs before ulceration. Those who ulcerate but cannot nourish Qi and Blood also die.
Upon initial ulceration, toxins are venting outward. Plasters should be used to absorb them, and Ren Shen (Ginseng) and Huang Qi (Astragalus Root) to support interior. If medicines are used to suppress them, causing internal toxin attack, rescue is impossible.
A young woman had a coin-sized nodule on her back, non-painful. She was fatigued, ate little, had afternoon fevers, and a soft, choppy pulse. This was caused by consumptive fatigue and Qi stagnation. I prescribed medicines to benefit Qi, nourish Blood, and resolve stagnation, and instructed her to drink human milk. Her spirit slightly improved. Distrusting this, she took Liu Qi Yin (Flowing Qi Drink), her diet decreased further, and her limbs became flaccid. Her father regretted this and sought me again. I declared it incurable. She indeed died.
A woman suffered fever and pain, exclusively taking fire-descending and toxin-resolving medicines. After ulceration, irritability worsened, she coughed frequently, and urination resembled strangury. These are malignant signs. I declined treatment.
Although this condition is described as Fire-related, it invariably stems from Yin deficiency. Thus, the Classics state: Deficiency of the Du Mai (Governor Vessel) leads to issues emerging from the brain; deficiency of the Bladder Meridian leads to issues emerging from the back. How can one rigidly adhere only to Fire theories?
A prefect had a swollen, hard, lusterless sore with a millet-sized head. The pulse was surging and large but became choppy upon pressure. The Classics state: If marrow is not depleted and Zang-Fu are not ruined, it is treatable. However, here the swelling is hard, color is dull, hardness resembles ox neck skin, and the pulse is choppy. This indicates exhaustion of Essence and Qi. Untreatable.
A noblewoman had a back carbuncle with mature pus that did not open. She was comatose and refused food. This indicated toxin entering the interior. I judged it untreatable. Forcing puncture released about a bowl of pus. She briefly revived but died moments later.
Generally, those with robust Qi and Blood have pus that spontaneously erupts. The elderly and weak, with depleted Qi and Blood, require proactive intervention to seize the opportunity. If toxin is localized, slight delay in acupuncture leads to deep, large ulcers difficult to heal. If located in critical areas like cheeks, neck, chest, or abdomen, immediate acupuncture is necessary regardless of strength; otherwise, treatment is difficult.
Another patient had a back sore that ulcerated into a depression with purple color and curled tongue. I stated: Depression and purple color indicate Yang Qi depletion. Tongue curling and scrotal retraction indicate Liver Qi exhaustion. The Classics say: This is tendon death first; worsening on Geng day, death on Xin day. Indeed, he died on the day of Start of Autumn.