疮疡之症。五善之中见一二善症者可治。七恶之内见一二恶症者难治。若虚中见恶症者
。实中无恶者自愈。此症虽云属火。未有不由阴虚而致者。故经云督经虚从脑出。膀胱经
虚从背出。岂可专泥于火而用苦寒药治。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。
凡疮肿坚而不泽。（不泽。不光泽而色夭）坚如牛领之皮。疮头如粟。脉洪大。按之则涩
。此精气已绝。不治亦死。
凡痈疽之作。皆五脏六腑蓄毒不流。非独荣气壅塞而发。其行也有处。其主也有归。假
于喉舌者心之毒。皮毛者肺之毒。肌肉者脾之毒。骨髓者肾之毒。发于下者阴中之毒。发于上
者阳中之毒。外者六腑之毒。内者五脏之毒。故内曰坏。外曰溃。上曰从。下曰逆。发于上
者得之速。发于下者得之缓。感于六腑者易治。感于五脏者则难治也。
发背、脑疽、大疔、悬痈、脱疽、脚发之类。皆由膏粱浓味。尽力房劳。七情六淫。或
补药。精虚气耗所致。非独因荣卫凝滞而生也。必灸之以拔其毒。更辨其因。及察邪在脏腑之
异、虚实之殊而治之。庶无误也。凡大痈疽。藉气血为主。若塌而不起。或溃而不腐。或不
收敛。及脓少。或清。皆气血虚也。宜大补之。最忌攻伐之剂。亦有脓反多者。乃气血虚不
能禁止也。若溃后发热作渴。脉大而脓愈多。属真气虚邪气实也。俱不治。常见气血充实之
人。患疮皆肿高。色赤。易腐溃而脓且稠。又易收敛。怯弱之人多不起。发不腐溃。及难收
敛。若不审察。妄投攻剂。虚虚之祸不免矣。
大抵疮之始作。先发为肿。气血郁积。蒸肉为脓。故多痛。脓溃之后。脓退肌宽。痛必渐
减。
元太医令。）疮疽之症。有脏腑气血。上下真邪。虚实不同也。不可不辨。如肿起坚硬脓稠
者实也。肿下软慢脓稀者虚也。泻利肠鸣。饮食不入。呕吐无时。手足并冷。脉弱皮寒。小
便自利。或小便时难。大便滑利。声音不出。精神不爽。悉脏腑虚也。大便硬。小便涩。饮
食如故。腹满膨胀。胸膈痞闷。肢节疼痛。口苦咽干。烦躁多渴。身热脉大。精神昏塞。悉
脏腑实也。凡诸疮疽。脓水清稀。疮口不合。聚肿不赤。肌寒肉冷。自汗色脱者。气血虚也
。肿起色赤。寒热疼痛。皮肤壮热。脓水稠粘。头目昏重。气血实也。头痛鼻塞。目赤心惊
。咽喉不利。口舌生疮。烦渴饮冷。睡语切牙者。上实也。精滑不禁。大便自利。腰脚沉重
。睡卧不能者。下虚也。肩头不便。四肢沉重。目视不正。睛不 。食不知味。音嘶色
。四肢浮肿者。真气虚也。肿 尤甚。痛不可近。多日不溃。寒热往来。大便秘涩。小便如
淋。心神烦闷。惚恍不宁者。邪气实也。又曰。诸痛为实。诸痒为虚。又曰。其脉洪大而数
者实也。微细而软者虚也。虚则补之。和其气血托里也。实则泻之。疏利而导其气。内经谓
血实则决之。气虚则掣引之。
溃疡虽有表症。发热宜以托里药为主。佐以表散之剂。
疮疡这类疾病，如果在“五善”的症状中见到一两个善症，就可以治疗。如果在“七恶”的症状中见到一两个恶症，就难以治疗。如果是虚证中出现恶症，或者实证中没有恶症，则可能自愈。虽然这些病症常说属于火邪，但没有不是由阴虚导致的。所以医经说：督脉虚弱，病邪从脑部发出；膀胱经虚弱，病邪从背部发出。怎么可以专门拘泥于火邪而使用苦寒药物治疗呢？苦寒的药物，虽然能治疗阳证，但也应当区分表里、虚实、治疗的先后次序以及是否适宜当时的气候时令。怎么可以一开始到最后都全部使用苦寒药呢？
凡是疮肿坚硬且不润泽的（不润泽，指没有光泽且颜色枯槁），坚硬得像牛颈部的皮一样，疮头像粟米一样小，脉象洪大，但重按下去却感觉涩滞。这是精气已经枯竭的表现，无法治疗，最终也会死亡。
凡是痈疽的发生，都是五脏六腑蓄积毒素不能流通所致，不仅仅是营气壅塞才发病。毒邪行走有它的部位，主治也有它的归属。假使发于喉舌的，是心的毒邪；发于皮毛的，是肺的毒邪；发于肌肉的，是脾的毒邪；发于骨髓的，是肾的毒邪。发于身体下部的，是阴中的毒邪；发于身体上部的，是阳中的毒邪。发于体表的，是六腑的毒邪；发于体内的，是五脏的毒邪。所以在体内称为“坏”，在体表称为“溃”。发于上部称为“顺证”（从），发于下部称为“逆证”（逆）。发在上部的，病情发展迅速；发在下部的，病情发展缓慢。感受六腑之毒的容易治疗，感受五脏之毒的就难治疗。
发背、脑疽、大疔、悬痈、脱疽、脚发等类似病症，都是由食用膏粱厚味（油腻精细的食物）、过度房劳、七情内伤或六淫外感，或者误用补药，导致精亏气耗所引起的，并不仅仅是因为营卫之气凝滞而生成的。必须用艾灸的方法来拔除毒邪，更要辨别病因，并观察邪气在脏腑的不同、虚实的差异来进行治疗，这样才不至于出错。凡是大的痈疽，都以气血为主干。如果疮形塌陷不起，或者溃破后不腐烂化脓，或者伤口不收敛，以及脓液少，或者脓液清稀，这都是气血虚弱的表现。应当用大补的方法治疗。最忌讳使用攻伐的药物。也有脓液反而多的情况，那是气血虚弱不能固摄津液造成的。如果溃破后发热口渴，脉象大而脓液越来越多，这属于真气虚弱而邪气实盛的情况，都属于不治之症。常见气血充实的人，患疮疡时都会肿胀高起，颜色红赤，容易腐烂溃破且脓液稠厚，又容易收敛愈合。怯弱的人大多疮形不起，不腐烂溃破，且难以收敛。如果不仔细审察，妄投攻伐药剂，造成“虚虚”（使虚者更虚）的祸害是不可避免的。
大抵疮疡刚开始发作时，先发为肿胀，这是因为气血郁积，蒸灼肌肉化为脓液，所以多伴有疼痛。脓液溃破之后，脓液消退，肌肉松弛，疼痛必然逐渐减轻。
（出自《元太医令》注疏/引用）：疮疽这类病症，涉及脏腑气血、上下部位、真邪性质、虚实情况等不同方面，不可不加以辨别。例如：肿胀高耸、坚硬、脓液稠厚的，属于实证；肿胀低平、柔软缓慢、脓液稀薄的，属于虚证。腹泻痢疾、肠鸣、饮食无法入口、呕吐无定时、手足冰冷、脉象微弱、皮肤寒冷、小便自利（通畅），或者小便排尿困难、大便滑泄不禁、声音不出、精神不振，这些都是脏腑虚证的表现。大便干硬、小便涩滞、饮食如常、腹部胀满膨胀、胸膈痞闷堵塞、肢节疼痛、口苦咽干、烦躁多渴、身体发热、脉象洪大、精神昏沉闭塞，这些都是脏腑实证的表现。凡是各种疮疽，脓水清稀，疮口不合拢，聚集肿胀但不红赤，肌肉寒冷，自汗出，面色苍白脱失的，属于气血虚证。肿胀高耸、颜色红赤、恶寒发热、疼痛、皮肤壮热、脓水稠粘、头目昏重，属于气血实证。头痛鼻塞、眼睛红赤、心惊、咽喉不利、口舌生疮、烦渴想喝冷水、睡梦中说胡话、磨牙的，属于上焦实证。精关不固滑精、大便自利（滑泄）、腰脚沉重、睡眠卧倒困难的，属于下焦虚证。肩头活动不便、四肢沉重、视物不正、眼睛不明亮、吃东西不知道味道、声音嘶哑、面色晦暗、四肢浮肿的，属于真气虚证。肿胀特别严重，疼痛剧烈不可触碰，多日不溃破，寒热往来，大便秘结涩滞，小便像淋证一样频急涩痛，心神烦闷，恍惚不安的，属于邪气实证。又说：所有的疼痛属于实证，所有的瘙痒属于虚证。又说：脉象洪大且数的，属于实证；脉象微细且软的，属于虚证。虚证就用补法，调和气血，托毒外出；实证就用泻法，疏通利导，引导气机。《内经》说：血实则决破它（放血或排脓），气虚则牵引它（补气升提）。
溃疡虽然有表证，出现发热时，应以托里药为主，辅以解表散邪的药剂。
In diseases of sores and ulcers, if one or two of the "Five Auspicious" signs are present among the symptoms, it is treatable. If one or two of the "Seven Malignant" signs appear within the "Seven Evils," it is difficult to treat. If malignant signs appear in a deficiency pattern, or if no malignant signs appear in an excess pattern, the condition may resolve spontaneously. Although these conditions are often attributed to Fire pathogen, none arise without Yin deficiency as the root cause. Thus, the classics state: when the Du Meridian (Governing Vessel) is deficient, pathogens emerge from the brain; when the Bladder Meridian is deficient, pathogens emerge from the back. How can one rigidly adhere to the concept of Fire and use Bitter-Cold herbs for treatment? Although Bitter-Cold herbs can treat Yang patterns, one must distinguish between Exterior/Interior, Deficiency/Excess, the sequence of treatment, and seasonal appropriateness. One cannot use them exclusively from beginning to end.
When a sore or swelling is hard and lacks luster (luster refers to lacking shine and appearing withered), hard like the skin of an ox's neck, with a head resembling millet grains, and the pulse is Surging (Hong) but feels Choppy (Se) upon deep pressure, this indicates that Essence and Qi have been exhausted. This is untreatable and will lead to death.
The occurrence of carbuncles and ulcers results from the accumulation of toxins in the Five Zang and Six Fu organs that fail to circulate freely; it is not merely due to the stagnation of Ying (Nutrient) Qi. The movement of toxins has specific locations, and their governance has specific origins. For instance, toxins manifesting in the throat and tongue belong to the Heart; those on the skin and hair belong to the Lung; those in the muscles belong to the Spleen; those in the bone marrow belong to the Kidney. Those manifesting in the lower body are toxins of Yin; those in the upper body are toxins of Yang. Those on the exterior are toxins of the Six Fu organs; those on the interior are toxins of the Five Zang organs. Therefore, internal lesions are termed "Huai" (destruction/collapse), while external ones are termed "Kui" (ulceration). Manifestations in the upper part are considered "Cong" (favorable/compliant); those in the lower part are "Ni" (adverse/rebellious). Lesions in the upper body develop rapidly; those in the lower body develop slowly. Infections involving the Six Fu organs are easier to treat, whereas those involving the Five Zang organs are difficult to treat.
Conditions such as Back Carbuncle (Fabei), Brain Carbuncle (Naoju), Large Ding (Dingchuang), Xuan Yong (Hanging Abscess), Tuo Ju (Devitalized Gangrene), and Jiao Fa (Leg Erysipelas) are caused by consuming rich and greasy foods (Gao Liang Hou Wei), excessive sexual activity, emotional disturbances (Seven Emotions), exogenous pathogens (Six Evils), or improper use of tonifying herbs, leading to depletion of Essence and exhaustion of Qi. They do not arise solely from the stagnation of Ying and Wei (Defensive) Qi. Moxibustion must be used to draw out toxins, and the etiology must be differentiated. Treatment should be based on observing the differences in pathogens affecting the Zang/Fu organs and distinguishing between Deficiency and Excess patterns to avoid errors. Major carbuncles and ulcers rely primarily on Qi and Blood. If the lesion collapses and fails to rise, or ulcerates without putrefaction (draining pus), or fails to heal, or if there is little pus or the pus is clear/thin, these indicate Qi and Blood deficiency. Great tonification is indicated. Aggressive draining/purgative formulas are strictly contraindicated. There are cases where pus is excessive; this is due to Qi and Blood deficiency failing to secure fluids. If fever and thirst occur after ulceration, with a Surging pulse and increasing pus volume, this indicates True Qi deficiency and Pathogenic Excess; such cases are untreatable. It is commonly observed that individuals with robust Qi and Blood present with high, swollen, red lesions that easily putrefy and drain thick pus, and heal quickly. Weak individuals often fail to raise the lesion, lack putrefaction/drainage, and heal slowly. Failure to examine carefully and administering aggressive draining formulas blindly will inevitably result in the harm of "making deficiency more deficient."
Generally, when a sore first appears, it presents as swelling due to the stagnation and accumulation of Qi and Blood, which steams the flesh into pus, causing pain. After the pus drains, as the pus recedes and the tissue relaxes, the pain gradually decreases.
(Referencing *Yuan Tai Yi Ling*): Sores and ulcers involve differentiations in Zang/Fu organs, Qi/Blood, Upper/Lower regions, True/Pathogenic nature, and Deficiency/Excess states; these must not be ignored. For example: swelling that is elevated, hard, with thick pus indicates Excess; swelling that is flat, soft/slow, with thin pus indicates Deficiency. Diarrhea, borborygmus, inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, free urination, or difficulty urinating, loose stools, loss of voice, and poor spirit all indicate Zang/Fu Deficiency. Hard stools, scanty/difficult urination, normal appetite, abdominal distension, chest/epigastric oppression, limb/joint pain, bitter taste, dry throat, irritability, polydipsia, fever, Surging pulse, and mental confusion all indicate Zang/Fu Excess. For various sores and ulcers, if the discharge is clear and thin, the wound fails to close, swelling is aggregated but not red, muscles are cold, spontaneous sweating occurs, and the complexion is pale/washed-out, this indicates Qi and Blood Deficiency. Elevated swelling, redness, aversion to cold/fever, pain, hot skin, sticky/thick pus, and heavy/dizzy head indicate Qi and Blood Excess. Headache, nasal congestion, red eyes, palpitations, pharyngeal obstruction, mouth/tongue sores, irritability with craving for cold drinks, somniloquy, and teeth grinding indicate Upper Excess. Involuntary seminal emission, loose stools, heavy waist/legs, and inability to lie down comfortably indicate Lower Deficiency. Stiff shoulders, heavy limbs, abnormal vision, unclear eyes, loss of taste, hoarse voice, dull complexion, and edema of limbs indicate True Qi Deficiency. Severe swelling, unbearable pain, failure to ulcerate after many days, alternating chills/fever, constipation, dysuria resembling strangury, mental restlessness, and agitation indicate Pathogenic Excess. It is said: All pain belongs to Excess; all itching belongs to Deficiency. It is also said: A Surging and rapid pulse indicates Excess; a fine, thready, and soft pulse indicates Deficiency. For Deficiency, apply Tonification to harmonize Qi and Blood and support the Interior to expel pathogens. For Excess, apply Purging/Draining to unblock and guide Qi. The *Neijing* states: For Blood Excess, pierce/drained it; for Qi Deficiency, lift/support it.
Although ulcerated sores may present with Exterior signs, if fever is present, the primary treatment should be Interior-Supporting (Tuo Li) herbs, assisted by Exterior-Dispersing agents.