凡痈疽脓已成。十死一生。故圣人弗使已成。已成脓血。砭石锋针取之也。但病者多喜
。而医者即用十宣散、败毒散、流气饮之类。殊不知十宣散虽有参、 。然防风、白芷、浓
朴、桔梗皆足以耗气。况不分经络时令。气血多少。安可概用。败毒散乃表散药也。虽有表
证。不过一二服。况非表证。宁用之乎。流气饮乃行气散血之剂。服之过度。则气血虚耗。
何以为脓。此三药不可轻用明矣。若脓既成。昧者待其自穿。殊不知少壮充实者。或能自破
。若老弱之人又有攻发太过。不行针刺。脓毒乘虚内攻。穿肠腐膜。鲜不误事。一妇乳痈脓
成。针刺及时。不月而愈。一人腿痈脓成。畏针几殆。后为针之。大补三月而平。一人腿痈
。脉症俱弱。亦危症也。治以托里得脓。不急针刺。后脓水开泄不敛而死。一妇发背。待自
破。毒内攻。一人腹痈溃透。秽从疮口出。皆由畏针而毙。
恶肉者。腐肉也。痈疽溃后。腐肉凝滞。必须去之。推陈致新之意。若壮者筋骨强盛。
充溢。真能胜邪。或自去或自平。不能为害。若年高及怯弱之人。血液少。肌肉涩。设或留
而不去。则有烂筋腐肉之患。一夫人取之及时。而新肉早生。得以全愈。一人去之稍迟。几
致不救。一人取之失期。大溃而毙。尝见腐肉既去。虽少壮者不补其气血。亦不能收敛。若
怯弱者不取恶肉。不补养气血。未见其生也。
腐肉可用手法去之。或用雄黄、轻粉敷之。蠹肉努出。用远志末酒调涂之。（又法）息肉
。乌头五钱。苦酒三升。浸渍三日洗之。日夜三四次。诸疮 肉。如蛇出数寸。硫黄末敷之
即缩。脓溃后蠹肉不腐。亦用硫黄、轻粉敷之。四围仍有肿 处。用毫针烧赤刺之。约一米
深。红肿则缩。
凡是痈疽脓液已经形成，死亡率极高（十死一生），所以高明的医生会防止病情发展到化脓阶段。如果脓血已经形成，应当用砭石或锋针进行刺破排脓。但是患者往往因为害怕疼痛而抗拒治疗，医生就立即使用十宣散、败毒散、流气饮等方剂。殊不知十宣散虽然含有人参、黄芪，但其中的防风、白芷、厚朴、桔梗都足以耗伤正气。况且如果不分经络归属和时令季节的气血盛衰情况，一概使用这些药物，怎么行呢？败毒散属于发散表邪的药物，即使有表证，也不过服用一两剂即可，何况并没有表证，怎么能用它呢？流气饮是行气散血的药剂，服用过度会导致气血虚耗，那么靠什么来化生脓液呢？这三种药不可轻易使用，这是很明显的道理。
如果脓液已经形成，无知的医生等待它自行穿破。殊不知身体强壮、气血充实的人，或许能自行破溃；但对于年老体弱的人，如果之前的攻伐发散太过，又不及时针刺排脓，脓毒就会乘虚内陷攻里，腐蚀肠膜，很少有不误事的。有一位妇女患乳痈，脓成后及时针刺，不到一个月就痊愈了。有一人患腿痈，脓成后因害怕针刺几乎丧命，后来经过针刺，再大补气血三个月才平复。有一人患腿痈，脉象和症状都虚弱，也是危重病症，治疗时用托里法促使化脓，但没有及时针刺，后来脓水流出后疮口不收敛而死。有一位妇女患发背（背部痈疽），等待自行破溃，导致毒邪内攻致死。还有一人腹痈溃烂穿透，秽物从疮口流出，也都是因为畏惧针刺而死。
所谓“恶肉”，就是腐肉。痈疽溃烂之后，腐肉凝滞不去，必须将其去除，这是推陈出新的意思。如果身体强壮、筋骨强盛、气血充溢的人，真正能够抵御邪气，腐肉或许能自行脱落或平复，不会造成危害。但如果年纪大以及体质怯弱的人，血液少，肌肉枯涩，如果留下腐肉不去除，就会有烂筋腐肉的祸患。有一位夫人及时去除了腐肉，新肉早早生长，得以完全痊愈。有一人去除腐肉稍迟，差点导致不治。有一人去除腐肉错过了时机，导致大溃烂而死。我曾见过腐肉既已去除，即使是身体强壮的人，如果不补益其气血，也不能使疮口收敛。如果是体质怯弱的人，既不去除恶肉，又不补养气血，没有见到能存活的。
去除腐肉可以用手法操作，或者用雄黄、轻粉外敷，使蛀蚀的肉突起，然后用远志末用酒调匀涂抹。（另一种方法）对于息肉，用乌头五钱，苦酒三升，浸泡三天后清洗患处，每天早晚三四次。各种疮疡中如有像蛇一样伸出数寸的赘肉，用硫黄末外敷即刻收缩。脓溃后如果有蛀肉但不腐烂，也用硫黄、轻粉外敷。如果四周仍有肿胀的地方，用毫针烧红后刺入，约一米深（此处原文可能有误，通常指浅刺或特定深度，依文意译为刺入一定深度），红肿就会消退。
When the pus of any carbuncle or ulcer (Yongju, 痈疽) has already formed, the mortality rate is extremely high (ten deaths for one survival). Therefore, wise physicians prevent the condition from progressing to suppuration. If pus and blood have already formed, they should be drained using Bian stones (砭石, stone knives for surgical incision) or Fengzhen (锋针, sharp needles for pricking). However, patients often fear pain and resist treatment, leading physicians to immediately administer formulas such as Shixuan San (Ten-Acun Powder), Baidu San (Resist Toxin Powder), or Liuqi Yin (Flowing Qi Decoction). Little do they know that although Shixuan San contains Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), ingredients like Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Houpo (Magnoliae Officinalis Cortex), and Jiegeng (Platycodonis Radix) are sufficient to consume healthy Qi. Moreover, without distinguishing the meridians involved and the seasonal variations in the abundance or deficiency of Qi and Blood, how can these drugs be used indiscriminately? Baidu San is a formula for dispersing exterior pathogens. Even if there are exterior symptoms, it should only be taken for one or two doses; furthermore, if there are no exterior symptoms, how can it be used? Liuqi Yin is a preparation for moving Qi and dissipating Blood. Overconsumption leads to the depletion of Qi and Blood, leaving nothing to generate pus. It is evident that these three formulas must not be used lightly.
If pus has already formed, ignorant physicians wait for it to rupture spontaneously. They fail to realize that while young and robust individuals with sufficient Qi and Blood might rupture on their own, elderly or weak individuals who have undergone excessive purgative or diaphoretic treatments will suffer internal invasion of pus toxins if not promptly needle-drained. The toxins may penetrate intestines and corrode membranes, rarely resulting in success. A woman with breast abscess (Ruyong, 乳痈) was needled promptly when pus formed and recovered within a month. A man with leg abscess feared needling and nearly died; after being needled and treated with substantial tonification for three months, he recovered. Another man with leg abscess presented with weak pulse and symptoms, a critical condition. He was treated with Tuo Li (Supporting Interior) methods to promote suppuration but was not needled urgently; subsequently, his wound failed to heal after drainage, leading to death. A woman with Back Carbuncle (Fabei, 发背) waited for spontaneous rupture, causing toxic invasion and death. Another man with abdominal abscess had his wound perforate, discharging foul matter; he also died due to fear of needling.
"Evil flesh" (Erou, 恶肉) refers to necrotic tissue. After an abscess or ulcer ruptures, necrotic tissue stagnates and must be removed to eliminate the old and promote the new. Robust individuals with strong sinews and bones and abundant Qi and Blood can resist pathogens effectively; necrotic tissue may detach or resolve spontaneously without harm. However, in the elderly or frail, where blood is scant and muscles are dry, retaining necrotic tissue risks rotting sinews and flesh. A lady had her necrotic tissue removed promptly, allowing new flesh to grow early and achieve full recovery. One person delayed removal and nearly died. Another missed the timing, leading to massive ulceration and death. I have observed that even in robust individuals, if Qi and Blood are not tonified after removing necrotic tissue, healing cannot occur. In frail individuals, failing to remove evil flesh and failing to tonify Qi and Blood results in death.
Necrotic tissue can be removed manually or by applying Xionghuang (Realgar) and Qingfen (Calomel) to cause the decayed flesh to protrude, then applying Yuanzhi powder mixed with wine. (Another method) For polyps, soak Wutou (Aconiti Lateralis Radix Praeparata) five qian in Kujiu (bitter wine) three sheng for three days, then wash the area three to four times daily. For various sores with fleshy protrusions resembling snakes extending several inches, apply Sulfur powder to shrink them immediately. If necrotic tissue remains after pus drainage but does not decay, apply Sulfur and Calomel. If swelling persists around the periphery, insert heated Filiform Needles (Haozhen, 毫针) to a depth of approximately one cun (note: original text says "one mi", likely a textual error for "cun" or shallow depth); redness and swelling will subside.