肿痛未作脓者。宜除湿消毒。黄连消毒饮之类。
大痛或不痛。或麻木者。毒甚也。隔蒜灸之。更用解毒药。
肿痛便秘者。邪在内也。泄之。
不甚痛。或不作脓者。虚也。托里为主。
脓成胀痛者。针之。更以托里。
不作脓。或不溃者。托里药为主。
脓溃或不敛。或多者。大补气血。
烦躁饮冷。脉实而痛。宜泻火。
一人素不慎起居饮食。 赤肿痛。尺脉洪数。以黄连消毒散一剂。湿热顿除。惟肿硬作
以仙方活命饮二剂。肿痛悉退。但疮头不消。投十宣。去桂。加金银花、 本、白术、茯
、陈皮。以托里排脓。彼欲全消。自制黄连解毒散二服。反肿硬不作脓。始悟。仍用十宣散
。加白术、茯苓、陈皮、半夏。肿少退。仍去桂。又四剂而脓成。肿势亦退。继以八珍汤加
黄、五味子、麦门。月余脓溃而愈。（此凭脉症也。）
夫苦寒之药虽治阳症。尤当分表里虚实次第时宜。岂可始末悉用之。然 肿赤痛。尺脉
按之则濡。乃膀胱经湿热壅盛也。故用黄连消毒散。以解毒除湿。顾肿硬作痛。乃气血凝滞
不行而作也。遂用仙方活命饮。以散结消毒破血也。其疮头不消。盖因热毒熏蒸。气血凝滞
而然也。宜用甘温之剂补益阳气。托里以腐溃之。况此症原属督脉经因虚火盛而出。若不审
其因。专用苦寒之药。胃气以伤。何以腐化收敛。几何不致于败耶。凡疮易消散。易腐溃。
易收敛。皆气血壮盛故也。
一人耳后漫肿作痛。肉色不变。脉微数。以小柴胡汤加芎、归、桔梗四剂。肿少起。更
里消毒散数剂。脉活数。此脓已成。宜针。彼畏不从。因痛极始针。出脓碗许以托里药两月
余始安。（此凭脉症也。）
一人脑疽。肿痛脉数。以黄连消毒散二剂少退。与仙方活命饮二剂而止。再以当归、川
芎、芍药、金银花、黄柏、知母而溃。又以托里药而愈。（此凭脉症也。）
一人头项俱痛。虽大溃。肿痛益甚。兼作泻。烦躁不睡。饮食少思。其势可畏。诊其
毒尚在。与仙方活命饮二剂。肿痛退半。与二神丸及六君子汤。加五味、麦门、酸枣仁四剂
。诸症少退。食颇进睡少得。及与参苓白术散数服。饮食颇进。又与十全大补汤。加金银花
、白芷、桔梗。月余瘥。
一老患此。色赤肿痛。脉数有力。与黄连消毒散二剂少退。更与清心莲子饮。四剂而消
。（此凭脉症也。）
一人肿硬不作脓。惟疮头出水。疼甚。以仙方活命饮二剂。痛止而脓成。针之。更以托
里药而愈。
一妇脑左肿痛。左鼻出脓。年余不愈。时或掉 如坐舟车。许叔微曰。肝虚风邪袭之然
以川芎一两。当归三钱。羌活、旋复花、细辛、防风、蔓荆子、石膏、 本、荆芥穗、半夏
曲、干地黄、甘草各半两。每服一两。姜水煎服。一料而愈。
机按此条认作肝虚风邪袭之。而治以去风清热养血祛痰之剂。因其掉 。痛偏于左也。
。诸风掉 。皆属肝木。又病偏左。乃肝胆所主。又曰。风从上受之。又曰。无痰不成 运
。又曰。肝藏血。又曰。风乃阳邪。故方以风热痰血为主治者。理也。
一人脑疽已十余日。面目肿闭。头 如斗。脉洪数。烦躁饮冷。此膀胱湿热所致。用黄
毒饮（百二一）二剂。次饮槐花酒二碗。顿退。以指按下。肿则复起。此脓已成。于颈额肩颊
各刺一孔。脓并涌出。口目始开。更以托里药。加金银花、连翘三十余帖而愈。（此凭脉症
一儿头患白疮。皮光且急。诸药不应。名曰脑疳疮。乃胎毒挟风热而成。服龙胆丸。（
百十五）及吹芦荟末鼻内。
兼搽解毒散 而愈。若重者。发结如穗。脑热如火。遍身出汗。腮肿胸高。尤宜此药。
机按龙胆丸芦荟末。皆凉肝胆杀虫之剂。盖肝胆主风。又风木自甚则生虫。故治疳多此
一人素饮酒。九月患脑之下项之上出小疮。后数日脑项麻木。肿势外 。疡医处五香连
且云不可速疗。俟脓出用药。或。砭刺。三月可平。四月如故。予曰。凡疮见脓。九死一生
。果如医言。则束手待毙矣。且膏粱之变。不当投五香。当先火攻。然后用药。以大艾炷如
两核许者。灸至百壮乃痛。次为处方。足太阳膀胱经其病逆。当反治。脉得弦紧。按之洪大
而数有力。必当伏其所主。而先其所因。其始则同。其终则异。以时言之。可收不可汗。经与
病禁下。法当结者散之。咸以 之。然寒受邪而又禁咸。遂以诸苦寒为君。甘寒为佐。酒热
为因。用大辛以解结为臣。三辛三甘。益元气而和血脉。淡渗以导酒湿。扶持秋令。益气泻
火。以入本经药通经为引用。故以羌活、独活、防风、 本、连翘以解结。黄连、芩、柏、
知母、酒制以泻火、生甘草泄肾火。补下焦元气。参、 、橘皮以补胃。但参、 、甘草配
诸苦寒药三之一。多则滋营气补土湿邪也。苏木、归尾去恶血。生地黄补血。酒防己除膀胱
留热。泽泻助秋去酒湿热。凡此诸药。必得桔梗为舟楫。乃不下沉。服之投床大鼾。日出乃
寤。以手扪疮。肿减七八。至疮痂敛。都十四日而已。
机按脉之紧弦主疮痛。按之洪数主内热。大阳寒水而受阳热。故曰其病逆寒水之经。而
用寒凉之药。
故曰反治。此因脉因经因其所嗜而制此方也。
一人患脑疽。势剧脉实。用黄连消毒散不应。以金银藤二两。水二钟。煎一钟。入酒半
服之势去三四。再服渐退。又加黄柏、知母、栝蒌、当归、甘草节。数剂而溃止。加黄 、
川芎、白芷、桔梗数剂而愈。（机按此条凭脉而治也。）
一人脑疽。其头数多。痛不可忍。服消毒药不应。更以金银花服之。即鼾睡。觉而势去
。再四剂而消。一人所患尤甚。亦令服之。肿痛顿退。但不能平。加黄 、当归、栝蒌仁、
白芷、桔梗、甘草节数剂而愈。
前条因治不应而变法。后条因症而处治。
一人脓将成。微痛兼渴。尺脉大而无力。此阴虚火动之症。彼谓心经热毒。自服清凉降
。愈炽。复求治。乃以四物汤加黄柏、知母、五味、麦门、黄 。及加减八味丸。渴止疮溃
。更以托里药兼前丸而愈。（此凭脉也。）
一妇脓成不溃。胀痛欲呕。饮食少思。急针之。与托里药而愈。（此凭症也。）
一妇脑疽不甚痛。作脓。以托里消毒。脓成针之。补以托里药亦愈。（此凭症也。）
一老人脓清兼作渴。脉软而涩。予以为气血俱虚。用八珍汤加黄 、五味。彼不信。乃
火之剂。果反作呕少食。始信。服香砂六君子汤四剂。呕止食进。仍投前汤。月余而愈。（
此脉凭症也。）
一人未溃兼作渴。尺脉大而无力。以四物汤加黄柏、知母、黄 、麦门四剂而渴减。又
与加减八味丸。渴止疮溃。更用托里药兼前丸而愈。（此凭症也。）
一夫人年逾八十。脑疽已溃。发背。继生头如粟许。脉大无力。此膀胱经湿热所致。脉
。血气衰。进托里药消毒数服。稍可。更加参 。虽起而渴。此血气虚甚。以参、 各一两
。归、 各五钱。麦门、五味各一钱。数服渴止不溃。加肉桂十余剂。脓成针之。瘀肉渐腐
。徐徐取去。而脓清不敛。投十全大补汤。（十三）加白蔹、贝母、远志三十余剂。脓稠而
愈。设不峻补。不去腐肉。以渴为火。投以凉药。宁免死哉。疮疽之症。虽属心火。当分表
里虚实。果元气充实。内有实火。寒剂或可责效。若寒凉过度。使胃寒脾弱。阳症变阴。或
结而不溃。或溃而不敛。阴阳乖戾。水火交争。死无日矣。（机按此凭形凭脉凭症而治之也
一人肿痛。脉数。以荆防败毒散二剂而痛止。更以托里消毒药而消。（此凭脉也。）
一人 肿。疼痛发热。饮冷。脉洪数。与凉膈散二剂而止。以金银花四剂而溃。更以托
里药而愈。（此凭症脉也。）
一老妇禀实。溃而痛不止。脉实便秘。以清凉二剂而止。更以托里消毒药而愈。（此凭脉
一妇年逾七十。冬至后脑出疽如瓯面大。疡医诊视。候熟以针出脓。因怒笞婢。疽辄凹
韭叶许。面色青黄不泽。四肢逆冷。汗出身清。时呕吐。脉极沉细而迟。盖缘衰老之年。严
寒之时。病中苦楚。饮食淡薄。肥脓之气色涤。瘦悴之形独存。加之暴怒。精神愈损。故有
此寒变也。病与时同速。制五香汤一剂。加丁香附子各五钱。剂尽疽复大发。随症调理而愈
经曰。治病必察其下。谓察时下之宜。诸痛疮疡皆属心火。言其常也。如疮盛形羸。邪
高痛下。始热终寒。此反常也。固当察时下之宜而权治之。不可执一。
机按此条年老冬寒。理宜温补。兹用五香汤加丁附以辛散。何也。盖因其怒气郁结。阻
气。不得营运。致疽凹陷。且脉极沉细而迟。其为气郁可知矣。故用五香以开结。丁、附以
助阳。则郁散阳复。疽乃大发。此亦因其性因其脉而为治也。
一人脑疽作渴。脉虽洪。按之无力。予 咀加减八味丸与之。彼不信。自用滋阴等药。
并至而殁。精要曰。患疽虽云有热。皆因虚而得之。愈后作渴。或先渴后疽。非加减八味丸
一妇年将七十形实性急。好酒。脑疽才五日。脉紧急又涩。急用大黄酒煨细切。酒拌炒
末。又酒拌人参炒。入姜煎调一钱服。过两时再与。得卧而上半身汗。睡觉病已失。此亦内
托之意。
机按此治。因性急。因好酒。兼因其脉而制此方。脉紧急且涩。由其性急嗜酒。以伤其
血而然。故用大黄以泄酒热。人参以养气血也。
一人便血数年。舌下筋紫。午后唇下赤。胃肺脉洪。予谓大肠脉散舌下。大肠有热。故
筋紫而又便血。胃脉环承浆。唇下即承浆。午后因火旺。故承浆发赤。盖胃为本。肺为标。
乃标本有热也。用防风通圣散（六）为丸治之而愈。后每睡觉惊跳而起。不自知其故。如是者
年余。脑发一毒。 痛。左尺脉数。此膀胱经热。而然。服黄连消毒散数剂少愈。次服金银
花、栝蒌、甘草节、当归。月余而平。
机按便血之后。睡觉惊跳者。由失血阴虚。心失所养而然。阴虚阳必亢。头为诸阳之首
。故亢阳上从于阳。疽发于脑。此条治法。因经因脉而制方也。
杜清碧病脑疽。疗之不愈。丹溪往视之。曰。何不服防风通圣散。（四十）曰。已服数剂
。丹溪曰。合以酒制之。清碧乃自悟以为不及。（此因症也。）
一举人年逾四十。患脑疽肿 。其脉沉静。此阳症阴脉。断不起。果殁。
脑疽出现肿胀疼痛但尚未化脓的，适宜采用除湿解毒的方法。可用黄连消毒饮之类的方剂。
如果疼痛剧烈或者完全不痛，或者感觉麻木的，说明毒邪很盛。应当隔蒜灸治疗，同时配合使用解毒药物。
如果肿胀疼痛且伴有便秘的，说明邪气在体内（里证）。应当采用泻下的方法。
如果疼痛不严重，或者不能化脓的，属于虚证。应当以托里透脓为主。
如果脓液已经形成，感到胀痛，应当针刺排脓，随后再用托里药物调理。
如果不能化脓，或者溃破后难以愈合的，应以托里药物为主。
如果脓液已溃破但伤口不收敛，或者脓液过多的，应当大补气血。
有一人平时不注意起居饮食，患处红肿疼痛，尺脉洪数。服用一剂黄连消毒散，湿热顿时消除。只是肿块坚硬作痛，又服用两剂仙方活命饮，肿痛全部消退。但是疮头没有消散，于是投用十宣散，去掉桂枝，加入金银花、藁本、白术、茯苓、陈皮，用来托里排脓。患者想要完全消散，自行服用了两剂黄连解毒散，反而导致肿块坚硬不再化脓。这才醒悟，仍然使用十宣散，加入白术、茯苓、陈皮、半夏。肿块稍微消退，仍然去掉桂枝，又服四剂后脓液形成，肿势也消退了。接着用八珍汤加黄芪、五味子、麦冬，一个多月后脓液溃破而痊愈。（这是根据脉象和症状判断的。）
苦寒的药物虽然能治疗阳证，尤其应当分清表里、虚实以及治疗的先后次序和时机，怎么可以一开始到最后都使用呢？然而，如果患处红肿疼痛，尺脉按之柔软，这是膀胱经湿热壅盛所致。所以使用黄连消毒散，来解毒除湿。考虑到肿块坚硬作痛，这是气血凝滞不通所致。于是使用仙方活命饮，来散结、消毒、破血。那个疮头不消散，大概是因为热毒熏蒸，气血凝滞造成的。适宜使用甘温的药剂补益阳气，托里以使脓液腐熟溃破。况且这个病症原本属于督脉经因虚火旺盛而出，如果不审察病因，专门使用苦寒药物，会损伤胃气，靠什么来腐化和收敛呢？不久难道不会导致败症吗？凡是疮疡容易消散、容易腐溃、容易收敛，都是因为气血壮盛的缘故。
有一人耳后漫肿作痛，肤色不变，脉微数。用小柴胡汤加川芎、当归、桔梗，服四剂后，肿块稍微隆起。再服用几剂托里消毒散，脉象活跃且数，这说明脓已经形成，应当针刺。患者害怕而不肯听从，因为疼痛极度剧烈才同意针刺，流出约一碗脓液，再用托里药物治疗两个多月才安定。（这是根据脉象和症状判断的。）
有一人患脑疽，肿痛且脉数。服用两剂黄连消毒散后症状稍退。给予两剂仙方活命饮后停止进展。再以当归、川芎、芍药、金银花、黄柏、知母等药治疗后溃破。又以托里药物治愈。（这是根据脉象和症状判断的。）
有一人头项俱痛，虽然已经大面积溃烂，但肿痛更加严重，兼有腹泻，烦躁失眠，饮食减少，病势令人畏惧。诊察发现毒邪尚在。给予两剂仙方活命饮，肿痛退去一半。给予二神丸及六君子汤，加五味子、麦冬、酸枣仁，服四剂，各种症状稍退，饮食颇进，睡眠稍得安稳。后来服用几服参苓白术散，饮食颇进。又给予十全大补汤，加金银花、白芷、桔梗，一个月多后痊愈。
一位老人患此病，色赤肿痛，脉数有力。给予两剂黄连消毒散后稍退。再给予清心莲子饮，四剂后消散。（这是根据脉象和症状判断的。）
有一人肿块坚硬不化脓，只有疮头出水，疼痛剧烈。服用两剂仙方活命饮，疼痛停止且脓液形成。针刺后，再用托里药物治愈。
一位妇女左侧脑部肿痛，左侧鼻孔流脓，一年多不愈。时常身体颤抖，像坐在车船上一样摇晃。许叔微说：这是肝虚风邪侵袭所致。用川芎一两，当归三钱，羌活、旋复花、细辛、防风、蔓荆子、石膏、藁本、荆芥穗、半夏曲、干地黄、甘草各半两。每服一两，姜水煎服。一料药后痊愈。
汪机按语：这一条将病症认定为肝虚风邪侵袭，而治疗使用祛风清热、养血祛痰的药剂。因为患者有颤抖、疼痛偏于左侧的症状。诸风引起的颤抖，都属于肝木。而且病偏于左侧，是肝胆所主。又说：风从上部受邪。又说：无痰不成眩晕。又说：肝藏血。又说：风是阳邪。所以方剂以风、热、痰、血为主要治疗对象，这是合理的。
有一人患脑疽已经十多天，面目肿胀闭合，头部肿大如斗，脉洪数，烦躁想喝冷饮。这是膀胱湿热所致。用黄连消毒散（见百二十一页）两剂，随后饮用槐花酒两碗，症状顿退。用手指按压，松开后肿块立即复原，这说明脓已经形成。在颈部、额头、肩部、脸颊各刺一个孔，脓液一起涌出，口眼才张开。再用托里药物，加金银花、连翘三十多帖而痊愈。（这是根据脉象和症状判断的。）
一个婴儿头部患白色疮疡，皮肤光亮且紧绷，各种药物无效，名叫脑疳疮。这是胎毒挟带风热而成。服用龙胆丸（见百十五页）以及向鼻内吹芦荟末，兼搽解毒散而痊愈。如果病情严重的，头发结成穗状，头脑热如火，全身出汗，腮部肿胀胸部高耸，尤其适宜使用这些药物。
汪机按语：龙胆丸和芦荟末，都是清凉肝胆、杀虫的药剂。大概因为肝胆主风，风气过盛会生虫，所以治疗疳积多用此类药物。
有一人平时爱喝酒，九月时在脑后下方、颈项上方长出小疮。几天后脑项麻木，肿势向外扩散。外科医生开出处方五香连翘汤，并且说不可快速治疗，等到脓出来后用药，或者砭石刺破，三个月可以平复，四个月恢复正常。我说：凡是疮疡见到脓液，九死一生。如果真的像医生说的，那就束手待毙了。况且膏粱厚味之变，不应当投用五香类药物。应当先进行火攻，然后再用药。用大艾炷如核桃大小的，灸至一百壮直到感到疼痛。其次开具处方。足太阳膀胱经的病逆乱，应当反治。脉象弦紧，按之洪大而数有力，必须伏其所主，而先治其因。开始时症状相同，最终结果不同。从时令来说，可收不可汗。经典与疾病禁忌中提到下法，法则应当是结者散之，咸味软坚。然而受寒邪又禁止咸味，于是以各种苦寒药为君药，甘寒药为佐药，酒热为病因，用大辛味药解结为臣药。三辛三甘，益元气而和血脉，淡渗药引导酒湿，扶持秋令，益气泻火，以入本经的药作为引经药。所以用羌活、独活、防风、藁本、连翘来解结。黄连、黄芩、黄柏、知母，酒制以泻火，生甘草泄肾火，补下焦元气。人参、黄芪、橘皮来补胃。但人参、黄芪、甘草配伍各种苦寒药的三分之一，多了则会滋腻营气、补土湿邪。苏木、归尾去除恶血，生地黄补血，酒防己清除膀胱留热，泽泻帮助秋季去除酒湿热。所有这些药物，必须得到桔梗作为舟楫，才不会下沉。服药后倒在床上大声打鼾，日出才醒来。用手摸疮，肿减去了七八成。直到疮痂收敛，总共十四天就好了。
汪机按语：脉紧弦主疮痛，按之洪数主内热。太阳寒水经受阳热侵袭，所以说它的病是逆乱的，寒水之经却用寒凉药物，所以说反治。这是根据脉象、经络和患者的嗜好来制定这个方剂的。
有一人患脑疽，病势剧烈脉实。用黄连消毒散无效。用金银藤二两，水两钟，煎成一钟，加入半钟酒，分次服用，病势去除了三四成。再服用逐渐消退。又加黄柏、知母、栝蒌、当归、甘草节，数剂后溃破止住。加黄芪、川芎、白芷、桔梗数剂而痊愈。（汪机按语：这一条是根据脉象治疗的。）
有一人患脑疽，疮头很多，疼痛难忍。服用消毒药无效。改用金银花服用，随即酣睡。醒来后病势减退。再服四剂而消散。另一人所患更严重，也让他服用，肿痛顿时消退。但不能平卧，加黄芪、当归、栝蒌仁、白芷、桔梗、甘草节数剂而痊愈。
前一条是因为治疗无效而改变方法，后一条是根据症状进行治疗。
有一人脓即将形成，轻微疼痛兼口渴，尺脉大而无力。这是阴虚火动的症状。患者认为是心经热毒，自行服用清凉降火药，火势更旺。再次求治，我用四物汤加黄柏、知母、五味子、麦冬、黄芪，以及加减八味丸，口渴停止，疮疡溃破。再用托里药物兼服前面的丸药而痊愈。（这是根据脉象判断的。）
一位妇女脓成不溃，胀痛欲呕，饮食少思。紧急针刺，给予托里药物而痊愈。（这是根据症状判断的。）
一位妇女脑疽疼痛不重，正在化脓。用托里消毒法，脓成后针刺，补以托里药物也痊愈。（这是根据症状判断的。）
一位老人脓液清稀兼口渴，脉软而涩。我认为气血俱虚，用八珍汤加黄芪、五味子。他不相信，乃用火燥之剂，果然反而呕吐少食，这才相信。服用香砂六君子汤四剂，呕吐停止，饮食增进，仍投前汤，一个月多而痊愈。（这是根据脉象和症状判断的。）
有一人未溃破兼口渴，尺脉大而无力。用四物汤加黄柏、知母、黄芪、麦冬，四剂后口渴减轻。又给予加减八味丸，口渴停止，疮疡溃破。再用托里药物兼服前面的丸药而痊愈。（这是根据症状判断的。）
一位夫人年过八十，脑疽已溃，发背继生粟米大小的疮头，脉大无力。这是膀胱经湿热所致，脉象显示血气衰败。进服托里消毒药数服，稍有好转。再加人参、黄芪。虽然好转但仍有口渴，这是血气非常虚弱。用人参、黄芪各一两，当归、白芍各五钱，麦冬、五味子各一钱，数服后口渴停止但不溃破。加肉桂十余剂，脓成后针刺，瘀肉逐渐腐烂，徐徐去除，而脓液清稀不收敛。投用十全大补汤（见十三页），加白蔹、贝母、远志三十多剂，脓液变稠而痊愈。如果不峻补，不去腐肉，把口渴当作火邪，投用凉药，难道能避免死亡吗？疮疽之症，虽然属于心火，应当分表里虚实。如果元气充实，内有实火，寒剂或许可以见效。如果寒凉过度，使胃寒脾弱，阳症变阴，或者结而不溃，或者溃而不敛，阴阳乖戾，水火交争，死期不远了。（汪机按语：这一条是根据形体、脉象、症状来治疗的。）
有一人肿痛，脉数。用荆防败毒散两剂后疼痛停止。再用托里消毒药而消散。（这是根据脉象判断的。）
有一人局部肿胀，疼痛发热，想喝冷饮，脉洪数。给予凉膈散两剂后停止。用金银花四剂后溃破。再用托里药物而痊愈。（这是根据症状和脉象判断的。）
一位老妇人禀赋实证，溃破后疼痛不止，脉实便秘。用清凉药两剂后停止。再用托里消毒药而痊愈。（这是根据脉象判断的。）
一位妇人年过七十，冬至后脑后长出如碗面大的疽。外科医生诊视，等待成熟后用针出脓。因为愤怒鞭打婢女，疽突然凹陷如韭菜叶大小，面色青黄无光泽，四肢逆冷，出汗身凉，时而呕吐，脉极沉细而迟。大概因为年老体衰，正值严寒之时，病中痛苦，饮食淡薄，肥浓之气色涤除，瘦悴之形独存。加之暴怒，精神更加受损，所以有此寒变。病情与时令变化同样迅速。配制五香汤一剂，加丁香、附子各五钱。药尽后疽复发大发。随症调理而痊愈。
《内经》说：治病必察其下，谓察时下之宜。诸痛疮疡皆属心火，说的是常理。如疮盛形羸，邪高痛下，始热终寒，这是反常情况。固当察时下之宜而权变治疗，不可固执一端。
汪机按语：这一条年老冬季寒冷，理应温补。这里用五香汤加丁香、附子以辛散，为什么呢？大概因为怒气郁结，阻滞气机，不得营运，导致疽凹陷。且脉极沉细而迟，其为气郁可知矣。所以用五香以开结，丁香、附子以助阳，则郁散阳复，疽乃大发。这也是因其性情、因其脉象而为治。
有一人患脑疽作渴，脉虽洪大，按之无力。我给他咀碎加减八味丸服用。他不相信，自用滋阴等药，结果病势并至而死。《精要》说：患疽虽云有热，皆因虚而得之。愈后作渴，或先渴后疽，非加减八味丸不能治。
一位妇人将近七十岁，形体实性急，好酒。脑疽才五日，脉紧急又涩。紧急用大黄酒煨细切，酒拌炒末，又酒拌人参炒，入姜煎调一钱服。过了两时再给。得卧而上半身出汗，睡觉醒来病已消失。这也是内托之意。
汪机按语：此治疗，因为性情急躁，因为好酒，兼因其脉象而制此方。脉紧急且涩，由其性急嗜酒，伤其血所致。故用大黄以泄酒热，人参以养气血。
有一人便血数年，舌下筋紫，午后唇下赤。胃肺脉洪。我说大肠脉散舌下，大肠有热，故舌下筋紫而又便血。胃脉环承浆，唇下即承浆，午后因火旺，故承浆发赤。盖胃为本，肺为标，乃标本有热也。用防风通圣散（见六页）为丸治之而愈。后来每次睡觉惊跳而起，不自知其故。如是者一年余。脑中发一毒，疼痛。左尺脉数，这是膀胱经热所致。服黄连消毒散数剂稍愈。次服金银花、栝蒌、甘草节、当归，月余而平。
汪机按语：便血之后，睡觉惊跳者，由失血阴虚，心失所养所致。阴虚阳必亢，头为诸阳之首，故亢阳上从于阳，疽发于脑。此条治法，因经因脉而制方。
杜清碧患脑疽，治疗不愈。丹溪前往查看，说：为何不服防风通圣散？（见四十页）他说：已服数剂。丹溪说：合以酒制之。清碧于是自悟以为不及。（这是根据症状判断的。）
For brain carbuncle presenting with swelling and pain but without suppuration, it is appropriate to employ methods for removing dampness and detoxifying. Formulas such as Huanglian Xiaodu Yin (Coptis Decoction for Detoxification) may be used.
If the pain is severe or absent, or if there is numbness, the toxin is profound. Moxibustion with garlic partition should be applied, along with the use of detoxifying medicines.
If there is swelling, pain, and constipation, the pathogenic factor is in the interior. Purging methods should be employed.
If the pain is not severe, or if suppuration does not occur, it indicates deficiency. The treatment should focus on supporting the interior (boosting Qi to expel toxins).
If pus has formed causing distending pain, puncture should be performed, followed by medicine to support the interior.
If suppuration does not occur, or if the ulcer fails to heal, medicine to support the interior should be the primary treatment.
If the pus has drained but the wound fails to close, or if there is excessive discharge, substantial tonification of Qi and Blood is required.
If restlessness and a desire for cold drinks are present, accompanied by a full pulse and pain, clearing fire is appropriate.
A certain person who had been negligent in diet and lifestyle presented with red, swollen, and painful lesions, and a surging and rapid radial pulse at the cun position. After one dose of Huanglian Xiaodu San (Coptis Powder for Detoxification), the damp-heat was suddenly eliminated. However, the swelling remained hard and painful. Two doses of Xianfang Huoming Yin (Immortal Formula for Preserving Life) were administered, after which the swelling and pain completely subsided. Yet the head of the sore did not resolve. Shixuan San (Ten Acupoints Powder) was prescribed, with Guizhi (Cinnamon Twig) removed, and Jinyinhua (Honeysuckle Flower), Bencao (Ligusticum Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), and Chenpi (Tangerine Peel) added, to support the interior and expel pus. The patient desired complete resolution and self-administered two doses of Huanglian Jiedu San (Coptis Powder for Resolving Toxins), which resulted in the swelling becoming hard and preventing suppuration. Only then did he realize his error. Shixuan San was resumed, with Baizhu, Fuling, Chenpi, and Banxia (Pinellia Tuber) added. The swelling decreased slightly. Guizhi was again removed, and after four more doses, pus formed, and the swelling subsided. Subsequently, Bazhen Tang (Eight Treasures Decoction) was given with Huangqi (Astragalus Root), Wuweizi (Schisandra Fruit), and Maidong (Ophiopogon Tuber). Over a month later, the pus drained, and the patient recovered. (This diagnosis was based on pulse and symptoms.)
Although bitter-cold medicines treat Yang syndromes, one must carefully distinguish the layers (exterior/interior), excess/deficiency, and the sequence and timing of treatment. How can they be used indiscriminately from start to finish? However, if the lesion is red, swollen, and painful, and the radial pulse at the chi position feels soft upon pressure, this indicates abundant damp-heat in the Bladder Meridian. Therefore, Huanglian Xiaodu San was used to resolve toxicity and remove dampness. Considering the hardness and pain of the swelling, which results from stagnation of Qi and Blood, Xianfang Huoming Yin was subsequently used to dissipate nodules, detoxify, and break blood stasis. The failure of the sore head to resolve was likely due to steaming by heat-toxin causing Qi and Blood stagnation. It was appropriate to use sweet-warm agents to tonify Yang Qi and support the interior to facilitate suppuration and rupture. Moreover, this condition originally arose from the Du Meridian due to deficient fire. If the cause is not examined and only bitter-cold medicines are used, the Stomach Qi will be damaged. How can suppuration and healing occur? Would it not lead to collapse? Generally, sores that easily dissipate, suppurate, and heal do so because Qi and Blood are robust.
A certain person presented with diffuse swelling and pain behind the ear, with unchanged skin color and a slightly rapid pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Szechwan Lovage Rhizome), Danggui (Angelica Sinensis Root), and Jiegeng (Platycodon Root) was administered for four doses, resulting in slight elevation of the swelling. Several doses of Tuoli Xiaodu San (Interior-Supporting Detoxification Powder) were then given. The pulse became active and rapid, indicating that pus had formed. Puncture was indicated. The patient feared it and refused, only agreeing when the pain became extreme. Approximately one bowl of pus was drained, and the patient stabilized after two months of interior-supporting medication. (This diagnosis was based on pulse and symptoms.)
A certain person with brain carbuncle presented with swelling, pain, and a rapid pulse. Two doses of Huanglian Xiaodu San reduced symptoms slightly. Two doses of Xianfang Huoming Yin halted progression. Subsequent treatment with Danggui, Chuanxiong, Shaoyao (Peony Root), Jinyinhua, Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) led to suppuration. The patient recovered with interior-supporting medicine. (This diagnosis was based on pulse and symptoms.)
A certain person suffered from pain in both the head and neck. Although extensive ulceration had occurred, swelling and pain worsened, accompanied by diarrhea, restlessness, insomnia, and poor appetite. The condition was alarming. Examination revealed that the toxin remained. Two doses of Xianfang Huoming Yin reduced swelling and pain by half. Ershen Wan (Two Spirit Pill) and Liujunzi Tang (Six Gentlemen Decoction) plus Wuweizi, Maidong, and Suanzaoren (Ziziphus Seed) were administered for four doses, leading to slight improvement in all symptoms, better appetite, and improved sleep. Several doses of Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) further improved appetite. Subsequently, Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) plus Jinyinhua, Baizhi (Angelica Dahurica Root), and Jiegeng was given. The patient recovered after over a month.
An elderly patient presented with red, swollen, and painful lesions and a rapid, forceful pulse. Two doses of Huanglian Xiaodu San reduced symptoms slightly. Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) was then administered for four doses, resulting in resolution. (This diagnosis was based on pulse and symptoms.)
A certain person presented with hard, non-suppurating swelling, with only fluid exuding from the sore head and severe pain. Two doses of Xianfang Huoming Yin stopped the pain and promoted suppuration. After puncture, interior-supporting medicine cured the condition.
A female patient presented with swelling and pain on the left side of the brain, purulent discharge from the left nostril, lasting over a year. She occasionally experienced tremors, feeling as if rocking in a boat or carriage. Xu Shuwei stated: "This is liver deficiency with wind-pathogen invasion." The prescription contained Chuanxiong 1 liang, Danggui 3 qian, Qianghuo (Notopterygium Rhizome), Xuanfuhua (Inula Flower), Xixin (Asarum Root), Fangfeng (Saposhnikovia Root), Manjingzi (Vernonia Fruit), Shigao (Gypsum Fibrosum), Bencao, Jingjiesui (Perilla Leaf with Stem), Banqu (Medicated Leaven), Dihuang (Rehmannia Root), and Gancao (Licorice Root) each 0.5 liang. One liang was taken per dose, decocted with ginger water. One course cured the condition.
Wang Ji commented: This case was identified as liver deficiency with wind-pathogen invasion, treated with wind-dispelling, heat-clearing, blood-nourishing, and phlegm-resolving agents. Because of the tremors and pain localized to the left side. All wind-induced tremors belong to Liver Wood. Furthermore, pathology on the left side is governed by the Liver and Gallbladder. It is said that wind enters from above. It is also said that "no phlegm, no dizziness." It is said that the Liver stores Blood. It is said that wind is a Yang pathogen. Therefore, treating wind, heat, phlegm, and blood as the main targets is logical.
A certain person with brain carbuncle for over ten days presented with swollen and closed eyes and face, and a head swollen like a bucket. The pulse was surging and rapid, with restlessness and a desire for cold drinks. This was caused by damp-heat in the Bladder. Two doses of Huanglian Xiaodu Yin (see page 121) were given, followed by drinking two bowls of Huaihua Jiu (Sophora Flower Wine), resulting in sudden relief. Pressing with a finger caused the swelling to rebound immediately, indicating pus formation. Holes were punctured in the neck, forehead, shoulder, and cheeks, allowing pus to gush out, opening the mouth and eyes. Interior-supporting medicine plus Jinyinhua and Lianqiao (Forsythia Fruit) for over thirty doses cured the condition. (This diagnosis was based on pulse and symptoms.)
An infant presented with a white sore on the head, with smooth and tight skin, unresponsive to various medicines. This is called Brain Gan Sore, caused by fetal toxin combined with wind-heat. Longdan Wan (Gentian Pill) (see page 115) was administered, and Luben powder (Aloe) was blown into the nose, combined with external application of Jiedu San (Detoxification Powder), resulting in recovery. For severe cases, where hair mats into tufts, the head feels hot like fire, the whole body sweats, the cheeks swell, and the chest protrudes, these medicines are especially suitable.
Wang Ji commented: Longdan Wan and Luben powder are cooling agents for the Liver and Gallbladder that kill parasites. Since the Liver and Gallbladder govern wind, and excessive wind generates parasites, such medicines are often used to treat Gan conditions.
A person who frequently drank alcohol developed a small sore below the back of the head and above the neck in September. Days later, the head and neck became numb, and the swelling spread outward. The surgeon prescribed Wuxiang Lianqiao Tang (Five Fragrant Forsythia Decoction), stating that rapid cure was impossible; one must wait for pus to form before medicating, or use cupping/lancing, expecting resolution in three months and normalization in four. I said: Once pus appears in a sore, nine out of ten die. If we follow the doctor's advice, we would simply wait to die. Moreover, changes due to rich food and drink should not be treated with Five Fragrants. Fire therapy should be applied first, followed by medicine. Large moxa cones, sized like walnut kernels, were moxa-burned until the patient felt pain, totaling one hundred burns. Then a prescription was formulated. The disease of the Foot-Taiyang Bladder Meridian is rebellious and requires contrary treatment. The pulse was wiry and tight, surging and rapid upon pressure, forceful. One must subdue the dominant pathogen and address the root cause. Initially similar, finally different. In terms of season, consolidation is preferred over sweating. Classics and disease contraindications mention purging; the method should be to disperse congealed pathogens and soften hardness with salty flavors. However, since cold pathogen is involved, salty flavors are contraindicated. Thus, various bitter-cold herbs were used as Sovereign, sweet-cold herbs as Ministers, and wine-heat as the etiology. Great acrid herbs were used as Deputy to resolve congealment. Three acrid and three sweet herbs tonify Yuan Qi and harmonize blood vessels. Bland-draining herbs guide wine-dampness. Supporting the Autumn season, tonifying Qi and draining fire, with meridian-guiding herbs as Guides. Therefore, Qianghuo, Duhuo (Angelica Pubescens Root), Fangfeng, Bencao, and Lianqiao were used to resolve congealment. Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Huangbai, and Zhimu, prepared with wine, drain fire. Shenggancao (Raw Licorice Root) drains Kidney fire and tonifies Lower Jiao Yuan Qi. Renshen (Ginseng Root), Huangqi, and Jupi (Tangerine Peel) tonify the Stomach. However, Renshen, Huangqi, and Gancao are combined with bitter-cold herbs in a ratio of one-third; too much would cloy Ying Qi and generate Earth-dampness. Sumu (Sappan Wood) and Guiwei (Angelica Sinensis Root Tail) remove bad blood. Shengdihuang (Rehmannia Root) nourishes blood. Jiu Fangji (Stephania Tetrandra prepared with wine) removes residual heat in the Bladder. Zexie (Alisma Rhizome) assists in removing wine-damp-heat in Autumn. All these herbs require Jiegeng as a boat and oar to prevent sinking. After administration, the patient fell into bed snoring loudly, waking at sunrise. Palpation of the sore showed 70-80% reduction in swelling. By the time the scab healed, fourteen days had passed.
Wang Ji commented: A wiry-tight pulse indicates sore pain; surging-rapid upon pressure indicates internal heat. The Taiyang Cold Water Meridian receives Yang Heat, hence its rebellion. Using cold-cooling medicines on the Cold Water Meridian constitutes contrary treatment. This formula was created based on the pulse, meridian, and patient's habits.
A person with brain carbuncle presented with severe condition and full pulse. Huanglian Xiaodu San was ineffective. Jin Yin Teng (Honeysuckle Stem) 2 liang was decocted in 2 zhong of water to yield 1 zhong, mixed with half a zhong of wine, and taken in divided doses. The condition improved by 30-40%. Continued dosing led to gradual resolution. Huangbai, Zhimu, Gualou (Trichosanthes Fruit), Danggui, and Gancaojie (Licorice Joint) were added. After several doses, suppuration stopped. Huangqi, Chuanxiong, Baizhi, and Jiegeng were added for several doses, resulting in recovery. (Wang Ji commented: This case was treated based on pulse.)
A person with brain carbuncle presented with multiple sore heads and unbearable pain. Detoxifying medicines were ineffective. Jin Yinhua (Honeysuckle Flower) was administered, leading to deep sleep. Upon waking, the condition had receded. Four more doses led to resolution. Another patient with a more severe condition also took it, resulting in immediate reduction of swelling and pain, though unable to lie flat. Huangqi, Danggui, Gualouren (Trichosanthes Seed), Baizhi, Jiegeng, and Gancaojie were added for several doses, resulting in recovery.
The previous case changed methods due to treatment failure; this case treated based on symptoms.
A person near suppuration presented with slight pain and thirst, and a large, empty chi pulse. This is a Yin deficiency with fire hyperactivity syndrome. The patient believed it was Heart channel heat-toxin and self-medicated with cooling and descending agents, worsening the fire. Seeking treatment again, Siwu Tang (Four Substances Decoction) plus Huangbai, Zhimu, Wuweizi, Maidong, and Huangqi, along with Jiajian Bawei Wan (Modified Eight-Ingredient Pill), was prescribed. Thirst stopped, and the sore suppurated. Interior-supporting medicine combined with the pill cured the condition. (Diagnosed based on pulse.)
A woman with formed but unruptured pus presented with distending pain, nausea, and poor appetite. Emergency puncture was performed, and interior-supporting medicine cured her. (Diagnosed based on symptoms.)
A woman with mild pain in brain carbuncle during suppuration was treated with interior-supporting detoxification. After puncture upon pus formation, interior-supporting tonification cured her. (Diagnosed based on symptoms.)
An elderly man with clear pus and thirst presented with a soft and choppy pulse. I diagnosed dual Qi and Blood deficiency and prescribed Bazhen Tang plus Huangqi and Wuweizi. He did not believe it and used heating/drying agents, resulting in vomiting and poor intake, which convinced him. Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction) for four doses stopped vomiting and improved appetite. Returning to the previous decoction, he recovered after a month. (Diagnosed based on pulse and symptoms.)
A person with unruptured sore and thirst presented with a large, empty chi pulse. Siwu Tang plus Huangbai, Zhimu, Huangqi, and Maidong for four doses reduced thirst. Jiajian Bawei Wan was then given, stopping thirst and promoting suppuration. Interior-supporting medicine combined with the pill cured the condition. (Diagnosed based on symptoms.)
A woman over eighty years old presented with an ulcerated brain carbuncle and subsequent back carbuncle, with millet-sized pustules on the head. The pulse was large and empty. This was caused by damp-heat in the Bladder Meridian, with declining Qi and Blood. Several doses of interior-supporting detoxification provided slight relief. Ren Shen and Huangqi were added. Although improving, thirst persisted, indicating severe Qi and Blood deficiency. Ren Shen and Huangqi 1 liang each, Danggui and Baishao (White Peony Root) 5 qian each, Maidong and Wuweizi 1 qian each were administered for several doses, stopping thirst but failing to suppurate. Rougui (Cinnamon Bark) was added for over ten doses. Upon pus formation, puncture was performed. Necrotic tissue gradually sloughed off. Clear pus failed to heal. Shiquan Dabu Tang (see page 13) plus Bailian (Tiger Lily Bulb), Beimu (Fritillaria Bulb), and Yuanzhi (Polygala Root) for over thirty doses thickened the pus and cured the condition. Without vigorous tonification and debridement, mistaking thirst for fire and using cooling medicines would surely lead to death. Carbuncles, though related to Heart Fire, must be distinguished by exterior/interior and excess/deficiency. If Yuan Qi is solid and internal fire is excess, cold medicines may work. However, excessive cold-cooling damages Stomach and Spleen, transforming Yang syndromes into Yin. If nodules fail to suppurate or ulcers fail to heal, Yin-Yang disharmony and Water-Fire conflict ensue, leading to imminent death. (Wang Ji commented: This case was treated based on morphology, pulse, and symptoms.)
A person with swelling and pain presented with a rapid pulse. Jingfang Baidu San (Ephedra, Saposhnikovia, and Imperata Decoction) for two doses stopped pain. Interior-supporting detoxification resolved the swelling. (Diagnosed based on pulse.)
A person with localized swelling, pain, fever, desire for cold drinks, and surging-rapid pulse was given Liangge San (Cooling Chest Powder) for two doses, stopping symptoms. Jinyinhua for four doses promoted suppuration. Interior-supporting medicine cured the condition. (Diagnosed based on symptoms and pulse.)
An elderly woman with excess constitution presented with persistent pain after ulceration, full pulse, and constipation. Cooling medicines for two doses stopped pain. Interior-supporting detoxification cured her. (Diagnosed based on pulse.)
A woman over seventy developed a bowl-sized carbuncle on the back of the head after Winter Solstice. The surgeon waited for maturation to lance it. Angered by whipping a maid, the carbuncle suddenly depressed like a leek leaf. Her complexion was sallow and lusterless, limbs cold, sweating with cool body, occasional vomiting. The pulse was extremely deep, fine, and slow. Due to old age, severe cold, illness suffering, bland diet, loss of robust qi, emaciation, and sudden anger damaging spirit, this cold transformation occurred. Disease progresses rapidly with the season. Wuxiang Tang (Five Fragrant Decoction) one dose plus Dingxiang (Clove) and Fuzi (Prepared Aconite Root) 5 qian each was prepared. After finishing the dose, the carbuncle flared up significantly. Symptomatic regulation led to recovery.
The Classic says: Treat diseases by observing the lower [signs], meaning observing the appropriateness of the time. All pains and sores belong to Heart Fire, describing the norm. Cases of full sores with emaciated bodies, high pathogen with low pain, starting hot ending cold are abnormalities. One must observe seasonal appropriateness and adapt treatment, not adhere rigidly.
Wang Ji commented: In old age and winter cold, warming tonification is appropriate. Here, Wuxiang Tang plus Dingxiang and Fuzi uses acrid dispersal. Why? Because anger caused Qi stagnation, blocking circulation, leading to depression. The extremely deep, fine, slow pulse confirms Qi stagnation. Thus, Wuxiang opens congealment, Ding and Fu assist Yang. Stagnation disperses, Yang returns, and the carbuncle flares. This treatment adapts to temperament and pulse.
A person with brain carbuncle and thirst presented with a surging pulse, empty upon pressure. I prescribed Jiajian Bawei Wan. He did not believe it, used self-prescribed Yin-nourishing medicines, and died as symptoms converged. *Jingyao* states: Carbuncles虽有热 (though having heat) are caused by deficiency. Thirst after recovery or preceding carbuncle requires Jiajian Bawei Wan.
A woman nearly seventy, robust in body but impatient, fond of wine, developed brain carbuncle after five days. Pulse was urgent and choppy. Da Huang (Rhubarb Root) was quickly wine-steamed, finely cut, wine-fried to powder. Renshen was wine-fried. Ginger decoction was mixed with one qian of powder and administered. Repeated after two hours. The patient slept, sweating on the upper half. Upon waking, the disease had vanished. This embodies the principle of interior support.
Wang Ji commented: This treatment adapted to impatience, wine habit, and pulse. Urgent and choppy pulse results from impatience and wine damaging blood. Da Huang drains wine-heat; Renshen nourishes Qi and Blood.
A person with hematochezia for years presented with purple veins under the tongue and redness below the lips in the afternoon. Stomach and Lung pulses were surging. I explained: Large Intestine pulses scatter under the tongue; Large Intestine heat causes purple veins and hematochezia. Stomach pulse circles Chengjiang; below the lips is Chengjiang. Afternoon fire prosperity causes Chengjiang redness. Stomach is Root, Lung is Branch; thus Root and Branch have heat. Fangfeng Tongsheng San (Wind-Barrier Unblocking Supreme Defense Powder) (see page 6) pills cured him. Later, he woke with startles for over a year, unaware why. A toxic sore developed in the brain, painful. Left chi pulse was rapid, indicating Bladder Meridian heat. Huanglian Xiaodu San for several doses improved it slightly. Subsequently, Jinyinhua, Gualou, Gancaojie, and Danggui were taken, resolving after a month.
Wang Ji commented: Startles after hematochezia result from blood loss, Yin deficiency, and Heart malnourishment. Yin deficiency leads to Yang hyperactivity. The head is the summit of all Yang; thus hyperactive Yang ascends, causing brain carbuncle. This treatment was formulated based on meridian and pulse.
Du Qingbi suffered from brain carbuncle, unresponsive to treatment. Danxi visited and asked: Why not take Fangfeng Tongsheng San? (See page 40) He replied: I have taken several doses. Danxi said: Prepare it with wine. Qingbi realized his inadequacy. (Diagnosed based on symptoms.)
A scholar over forty developed brain carbuncle swelling. His pulse was calm and still. This is a Yang syndrome with Yin pulse, predicted fatal. He indeed died.