夫 渍疮肿之法,宣通行表、发散邪气,使疮内消也。盖汤水有荡涤之功。古人有论∶
初生,经一二日不退,即须用汤水淋射之;其在四肢者 渍之,其在腰腹背者淋射之,其在
下部委曲者浴渍之。此谓疏导腠理,通调血脉,使无凝滞也。且如药二两,用水二升为则,
煎取一升半,以净帛或新绵蘸药水,稍热 其患处,渐渐喜 淋浴之,稍凉则急令再换,慎
勿冷用。夫血气得寒则凝涩,得热则淖泽,日用五七次,病甚者日夜不住,或十数次,肿消
痛止为验也。治疮肿神良之法也。
夫疮疽之疾,证候不一;针烙之法,实非小端。盖有浅有深,有迟有速,宜与不宜,不
辨。盖疽肿皮浓口小肿多,脓水出不快者,宜用针烙。如有未成脓以前,不可以诸药贴
渍救疗,以待自消;久入不消,内溃成脓,即当弃药,从其针烙,当用火针,如似火箸磨令
头尖如枣核样圆满,用灯焰烧须臾,作炬数 ,油烧令赤,于疮头近下烙之,一烙不透,即
须再烙,令透,要在脓水易出,不假按抑。近代良医,仓卒之际,但以金银铁铤,其样如针
者,可通用之,实在泄其毒也;或只以木炭熟火猛烧通赤,蘸油烙之尤妙。烙后实者捻发为
,虚者以纸为 ,于 上醮药 之,上以帛摊温热软粘膏药贴之,常令滋润,勿令燥也。
夫疮疽既作,毒热聚攻蚀其膏膜肌肉腐烂,若不针烙,毒瓦斯无从而解,脓淤无从而泄,过时
不烙,反攻其内,内既消散,欲望其生,岂可得乎?嗟乎!此疾针烙取瘥,实为当理,然忌太
早,亦忌稍迟。尝见粗工不审其证浅深,妄施针烙之法,或疮深针浅烙,毒瓦斯不得泄,以
致内溃;或疮浅烙深,误伤良肉,筋骨腐烂,或抑擦掀动,加益烦痛;或针之不当,别处作
头,或实时无脓,经久方溃,遂使痛中加痛,真气转伤。详其所由,不遇良医也。以此推之
,凡用医者,不可不择,纵常医疗之得痊者幸矣!
治疗疮肿的渍洗法,旨在宣通体表气机、发散邪气,使疮毒在体内消散。因为汤水具有荡涤污垢的功效。古人曾有论述:疮肿初起,经过一两天仍未消退,就必须用汤水淋洗或喷射患处;位于四肢的疮肿进行浸泡,位于腰腹背部的进行淋射,位于下身隐蔽曲折部位的进行沐浴浸泡。这叫做疏通腠理(皮肤纹理及汗孔),调畅血脉,使气血没有凝滞阻塞。一般以药物二两、水二升为标准,煎煮取药液一升半,用干净的布或新棉蘸取药水,趁稍热时熨敷患处,然后逐渐喜欢地淋浴冲洗,药液稍凉就立即更换,千万不要冷用。因为气血遇到寒冷就会凝涩不通,遇到温热就会滋润流畅。每天使用五到七次,病情严重的日夜不停使用,或者十几次,直到肿胀消退、疼痛停止作为见效的标准。这是治疗疮肿非常灵验的方法。
疮疽这类疾病,症状表现各不相同;针烙(针刺和火灸)的治疗方法,确实不是小事。因为其中有浅有深,有快有慢,适宜与不适宜的情况,如果不仔细辨别,很容易出错。比如疽肿皮厚、开口小但脓多,脓水流出不畅的,适宜使用针烙法。如果在脓液尚未形成之前,不能用各种药物贴敷浸泡来救治,而指望它自行消散;如果长时间不消散,内部溃烂成脓,就应当放弃药物治疗,改用针烙法。应当使用火针,将针头磨得像枣核一样圆润饱满,在灯焰上烧片刻,做成火炬状,涂上油烧至通红,在疮口下方近处进行烙烫。如果一次烙透不了,就必须再次烙烫,直到穿透为止,关键在于让脓水容易排出,不需要用手按压挤压。近代的好医生,在匆忙之际,直接用金银铁条,形状像针一样的,可以通用,这实在能起到泄出毒邪的作用;或者只用木炭烧红的烈火,烧得通红,蘸油进行烙烫,尤其妙好。烙烫之后,体质实壮的用手指捻开创口,体虚的用纸做成引流物,在引流物上蘸取药液涂抹,上面用布摊开温热的软粘膏药贴敷,经常保持滋润,不要让伤口干燥。
既然疮疽已经发作,毒热聚集攻蚀,导致膏膜肌肉腐烂,如果不进行针烙,毒邪就没有途径解除,脓血淤积就没有途径排泄。过了时间不进行烙治,毒邪反而向内攻陷,内部既已消散破坏,想要希望患者存活,怎么可能呢?唉!这种疾病的针烙治愈,确实是合乎道理的,然而忌讳太早,也忌讳稍微延迟。曾经见到粗劣的工匠不审察病证的深浅,胡乱施用针烙之法,有的疮深而针浅烙浅,毒邪无法排泄,导致内部溃烂;有的疮浅而烙深,误伤好肉,导致筋骨腐烂;或者按压摩擦触动患处,增加烦闷痛苦;或者针刺不当,在其他地方形成新的疮头,或者当时没有脓,时间久了才溃破,于是使得疼痛中再加疼痛,真气更加受损。详细探究其原因,是因为没有遇到良医。由此推断,凡是求医治病的人,不可不慎重选择医生,即使平时医疗得当得以痊愈,也是幸运的了!
The method of soaking (Zi) for treating carbuncles and swellings aims to diffuse the exterior, disperse pathogenic factors, and cause the lesion to resolve internally. This is because hot water possesses the efficacy of cleansing and scouring. Ancient texts state: When a carbuncle or swelling first appears and does not recede after one or two days, it is necessary to use hot water for irrigation or spraying; lesions on the limbs should be soaked, those on the waist, abdomen, and back should be irrigated/sprayed, and those in the lower body or hidden/cramped areas should be bathed/soaked. This is referred to as dredging the *Couli* (pores and interstices), regulating the blood vessels, and ensuring no stagnation occurs. Generally, the ratio is two liang of herbs to two sheng of water; decoct until one and a half sheng remains. Dip clean cloth or new cotton into the herbal liquid, apply warm compresses to the affected area, and gradually proceed with gentle irrigation/washing. Replace immediately when the liquid cools slightly; do not use cold liquids. Qi and Blood become stagnant and sluggish when exposed to cold, but become moist and fluid when exposed to heat. Use five to seven times daily; for severe cases, use continuously day and night, or up to ten-plus times. The resolution of swelling and cessation of pain serve as indicators of efficacy. This is an excellent method for treating carbuncles and swellings.
Diseases such as carbuncles and deep abscesses present various syndromes; the methods of acupuncture and cauterization are indeed significant matters. There are variations in depth and speed, and distinguishing between appropriate and inappropriate applications requires careful discernment. For instance, in cases of deep abscesses where the skin is thick, the opening is small, but there is much pus that drains slowly, the needle-cautery method is indicated. If the pus has not yet formed, one should not rely solely on topical applications or soaks expecting spontaneous resolution; if it persists without resolving and internal suppuration occurs, medication should be abandoned in favor of needle-cautery. A fire-needle should be used, sharpened to a round tip resembling a jujube pit. Heat it briefly over a lamp flame, shape it like a torch, coat it with oil, and burn it until red-hot. Apply the cautery near the base of the wound. If penetration is not achieved in one application, repeat until fully penetrated. The goal is to facilitate easy drainage of pus without manual pressure. In modern times, skilled physicians may, in urgent situations, use silver, gold, or iron rods shaped like needles as a general substitute, which effectively helps drain toxicity. Alternatively, heating charcoal until red-hot and using it to cauterize with oil is particularly effective. After cauterization, for patients with robust constitution, the wound can be gently opened by finger manipulation; for those with deficiency, paper wicks can be used. Apply medicated liquid to the wick, then cover with a warm, soft, adhesive plaster spread on cloth. Keep the area moist and prevent drying.
Once a carbuncle or deep abscess has developed, toxic heat gathers and attacks, rotting the fascia and muscles. Without needle-cautery, the toxic pathogens have no outlet to dissipate, and purulent stasis has no route to drain. If cauterization is delayed, the toxin may invade inward. Once the interior is compromised, hoping for survival is impossible. Alas! While needle-cautery is indeed the rational treatment for these diseases, caution must be exercised against both premature and delayed application. I have observed unskilled practitioners who fail to assess the depth of the syndrome and recklessly apply needle-cautery. Some treat deep wounds with shallow needling/cauterization, preventing toxin drainage and causing internal rupture; others treat superficial wounds with deep cauterization, damaging healthy tissue and causing bone and muscle decay. Others press or rub the area, exacerbating pain and distress; improper needling may create new focal points elsewhere, or delay suppuration until long after onset, compounding pain and further injuring the True Qi (*Zhen Qi*). Investigating the causes, this stems from failing to encounter a skilled physician. Therefore, one must carefully select a physician when seeking medical treatment. Even if recovery occurs through routine care, it is merely fortunate.