疮疡有痈疽。疖 。轻重浅深。或止发于一经。或兼二经者。止当求责于一二经。不可
余经也。若东垣用药处方是矣。矧有兼风。兼湿。兼痰。兼气。兼血。兼阴虚等证者。病本
不同。治当求责。疮疡郁冒。俗呼昏迷是也。宜汗之则愈。
若发肿都软不痛者。血瘤。虚肿而黄者水也。发肿日渐增长而不大热。时时牵痛者。气
气结微肿。久而不消。后亦成脓。诸癃。瘤。疣。赘等。至年衰皆自内溃。治于壮年。可无
后忧。
疮疽痛息自宁。饮食知味。脉证俱缓。缓则治本。故可以王道平和之药徐而治之。亦无
。若脉实 肿，烦躁。寒热。脉证俱实。非硝黄猛烈之剂不能除。投以王道之剂则非也。若
疮疡聚肿不溃。溃而脓水清稀。或泄利肠鸣。饮食不入。呕吐无时。或手足并冷。此脉证俱
虚。非大补之。药不能平。投以硝黄攻伐之剂亦非也。故治其证者。当辨表里虚实。随宜治
之。庶得万全。
东垣云。疮疽受之有内外之别。治之有寒温之异。受之外者。法当托里以温剂。反用寒
则是皮毛之邪引入骨髓矣。受之内者。法当疏利以寒剂。反用温剂托里。则是骨髓之病。上
彻皮毛矣。殆必表里通溃。共通为一疮。助邪为毒。苦楚百倍。轻则危。重则死矣。
男妇痈疽。精要谓治法无异。丹溪曰。妇人情性执着。比之男子。其难何止十倍。虽有
宜补。亦当以执着为虑。向见一妇早寡。善饮啖。形肥伟。性沉毒。年六十六。七月间背疽
近正脊。医乃横直裂开取血。杂以五香十宣散。酒饮月余。未尝及其寡居之郁。酒肉之毒。
执着之滞。时令之热。竟至平陷。淹延两三月不愈。
疮疡疾病包括痈、疽和疖。病情有轻重、病位有浅深之分，有的仅发于一经，有的兼涉两经，治疗时只需在相关的一两经中寻求病因，不可去追究其他无关的经络。如果像李东垣那样用药处方，就是正确的了。况且还有兼夹风邪、湿邪、痰浊、气滞、血瘀、阴虚等证候的情况，疾病的根本原因不同，治疗应当针对具体病因进行辨析。
疮疡患者出现的郁冒症状，俗称昏迷，适宜采用发汗法治疗即可痊愈。
如果患处肿胀但质地柔软且不疼痛，这是血瘤；虚性肿胀且颜色发黄的是水湿停滞；肿胀逐渐增大但热度不高，时常牵引作痛的，是气结微肿，日久也会化脓。各种癃闭、瘤、疣、赘生物等，到了年老体衰时往往自行从内部溃破，如果在壮年时期进行治疗，就可以避免日后的忧患。
疮疽疼痛停止，身体安宁，饮食知味，脉象和症状都表现为缓象，缓则说明正气未衰或病势缓和，应当治本，因此可以用王道（平和）的药物慢慢调理治疗，这样就不会有后患。如果脉象实大，伴有肿胀、烦躁、寒热往来，脉证都表现为实证，非用芒硝、大黄等猛烈攻下的药物不能祛除病邪，此时投以王道的平和药物就是错误的。
如果疮疡聚集成肿但不溃破，或者溃破后脓水清稀，或者出现腹泻肠鸣、饮食不进、时时呕吐，或者手足冰冷，这些脉证都表现为虚证，非用大补的药物不能平复病情，此时投以芒硝、大黄等攻伐的药物也是错误的。所以治疗这类病症，应当辨别表里、虚实，根据具体情况灵活施治，这样才能确保万无一失。
李东垣说：疮疽的致病有内因和外因的区别，治疗有寒法和温法的不同。感受外邪的，依法应当用温剂托毒外出，如果反而使用寒凉药，就会把皮毛之邪引入骨髓深处。感受内伤的，依法应当用寒凉药疏通利导，如果反而用温剂托里，就会使骨髓中的病邪上透至皮毛。这必然导致表里同时溃烂，合为一个大的疮口，助长邪气成为剧毒，痛苦百倍，轻则危及生命，重则死亡。
男女患痈疽，《外科精要》认为治疗方法没有区别。朱丹溪说：妇女性情执着，比起男子来，治疗的难度何止十倍。虽然也有需要补益的情况，但也应当顾虑到她们性情执着这一因素。曾见过一位早寡的妇女，喜欢饮酒吃肉，形体肥胖高大，性格深沉狠毒，六十六岁时背部靠近脊柱处生疽。医生采取横直切开排血的方法，并混入五香十宣散，用酒送服，持续了一个多月。医生未曾考虑到她寡居的抑郁情绪、酒肉产生的毒素、性情执着导致的滞涩以及当时季节的热邪，最终导致疮面平塌下陷，拖延了两三个月都不愈合。
Sores and ulcers include carbuncles (Yong), gangrenes (Ju), and boils (Jie). The severity varies, and the depth of the lesion differs; some occur in a single meridian, while others involve two meridians. Treatment should focus on identifying the cause within one or two relevant meridians, rather than seeking causes in other unrelated meridians. Prescribing medications as Li Dongyuan did is correct. Furthermore, there are cases complicated by wind, dampness, phlegm, qi stagnation, blood stasis, yin deficiency, and other syndromes. Since the root causes of the diseases differ, treatment must be targeted at specific etiologies.
The symptom of "Yu Mao" (depression and dizziness/coma) in sores and ulcers, commonly referred to as coma, can be cured by inducing sweating.
If swelling occurs but is soft and painless, it is a Blood Tumor (Xue Liu). If the swelling is deficient in nature and yellowish, it is due to water retention. If swelling increases gradually without significant heat, accompanied by occasional pulling pain, it is Qi Stagnation with slight swelling, which will eventually suppurate after a long time. Various conditions such as strangury (Long), tumors (Liu), warts (You), and skin tags (Zhui) often spontaneously ulcerate internally when patients reach old age. Treating them in youth can prevent future worries.
When pain from a carbuncle or gangrene ceases, the body feels calm, appetite returns, and both pulse and symptoms indicate slowness (Huan), it indicates that the root should be treated. Therefore, mild and harmonious medicines (Wang Dao herbs) can be used for gradual treatment without adverse consequences. However, if the pulse is excess (Shi), accompanied by swelling, irritability, aversion to cold and fever, and all signs indicate an excess syndrome, only potent purgatives like Mangxiao (Natrii Sulfas) and Huanglian (Coptidis Rhizoma) [Note: Text says Huang, likely Dahuang/Rhei Radix] can eliminate the pathogen. Using mild medicines in this case is incorrect.
If a sore or ulcer forms a lump but does not suppurate, or if it suppurates with thin and clear pus, or if there is diarrhea with borborygmus, inability to eat, frequent vomiting, or cold hands and feet, these pulse and symptom patterns indicate deficiency. Only strong tonifying medicines can resolve this; using purgatives like Mangxiao and Huang would be inappropriate. Therefore, when treating such conditions, one must differentiate between exterior/interior and deficiency/excess, and treat according to circumstances to ensure complete safety.
Li Dongyuan stated that sores and ulcers have external and internal origins, and their treatments differ in cold and warmth. For externally acquired pathogens, the method should be to support the interior with warm agents. Conversely using cold agents would drive the pathogen from the skin and hair into the bone marrow. For internally acquired diseases, the method should be to dredge and drain with cold agents. Conversely using warm agents to support the interior would cause the disease from the bone marrow to penetrate outward to the skin and hair. This inevitably leads to simultaneous ulceration of the interior and exterior, merging into one large sore, assisting the pathogen to become toxic, causing hundreds of times more suffering. Mild cases become critical, and severe cases result in death.
Regarding male and female carbuncles and gangrenes, *Waike Jingyao* states that the treatment methods are no different. Zhu Danxi said: Women's temperaments are stubborn and fixed; compared to men, the difficulty of treatment is more than tenfold. Even when supplementation is indicated, one must consider their stubborn temperament. I once saw a woman who had been widowed early, enjoyed drinking and eating rich food, was fat and tall, and had a deep, vicious character. At sixty-six, she developed a back carbuncle near the spine. The physician made horizontal and vertical incisions to drain blood, mixed it with Wuxiang Shixuan San (Five-Aromatic Ten-Acun Powder), and administered it with wine for over a month. The physician failed to account for her depression from widowhood, toxicity from alcohol and meat, stagnation from her stubborn nature, and the seasonal heat. Consequently, the sore collapsed flat, lingering for two or three months without healing.