夫疮疽脓溃，肿毒浸展，证候危恶者，须辨虚实。况无虚者难补，实者易泻，补泻之法
不可轻用，若或少差，利害甚大。然而虚实证多端，不可不辨。有疮之虚实，有脏腑气血、
下真邪各有虚实，故不同也。分而言之，则肿起坚硬脓稠者，疮疽之实也；肿下软慢脓稀者
，疮疽之虚也；泻痢肠鸣，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，精神不爽者，悉脏腑之虚也；大便硬，小便涩，饮食如故，肠
满膨胀，胸膈痞闷，肢节疼痛，口苦咽干，烦躁多渴，身热脉大，精神昏塞者，悉脏腑之实
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，气血之虚也；肿起
色赤，寒热疼痛，皮肤壮热，脓水稠粘，头目昏重者，气血之实也；头疼鼻塞，目赤心惊，
咽喉不利，口舌生疮，烦渴饮冷，睡语切牙者，上实也；精滑不滞，大便自利，腰脚沉重，
睡卧而不宁者，下虚也；肩项不便，四肢沉重，目视不正，睛不了了，食不知味，音嘶色败
，四肢浮肿者，真气之虚也；肿 尤甚，痛不可近，积日不溃，寒热往来，大便秘涩，小便
如淋，心神烦闷，恍惚不宁者，邪气之实也。又曰∶真气夺则虚，邪气胜则实。又曰∶诸痛
为实，痒为虚也。又曰∶诊其脉洪大而数者实也；微细而软者虚也。虚则补之，和其气托里
也；实则泻之，疏利而自导其气。《内经》谓∶血实则决之，气虚则掣引之。
疮疽化脓溃破，肿毒蔓延扩散，病情危重险恶的，必须辨别虚实。况且没有虚证的就难以补益，实证的就容易泻下，补法和泻法不可轻易使用，如果稍有差错，利害非常大。然而虚实证的类型很多，不能不仔细辨别。有疮疡本身的虚实，有脏腑气血的虚实，有正气与邪气的虚实，所以各不相同。分别来说，那么肿胀隆起、坚硬、脓液稠厚的，是疮疽的实证；肿胀平坦、松软缓慢、脓液稀薄的，是疮疽的虚证；腹泻痢疾、肠鸣、饮食无法进入、呕吐无常、手足冰冷、脉象微弱、皮肤寒冷、小便自利（通畅），或者小便困难、大便滑泄失禁、声音不出、精神不清爽的，都是脏腑的虚证；大便秘结、小便涩滞、饮食正常、腹部胀满膨胀、胸膈痞闷堵塞、肢体关节疼痛、口苦咽干、烦躁多渴、身体发热、脉象洪大、精神昏沉窒塞的，都是脏腑的实证。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、面色苍白脱色的，是气血的虚证；肿胀隆起、颜色红赤、寒热交替疼痛、皮肤灼热、脓液稠粘、头目昏重沉重的，是气血的实证；头痛鼻塞、眼睛红赤、心惊不安、咽喉不利、口舌生疮、烦渴想喝冷水、睡梦中说胡话咬牙齿的，是上部的实证；精液滑泄不禁、大便自利（通畅）、腰脚沉重、睡眠卧而不安宁的，是下部的虚证；肩颈项部不便、四肢沉重、视物不正、眼神模糊不清、吃东西不知道味道、声音嘶哑、气色败坏、四肢浮肿的，是真气（元气）的虚证；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，是邪气的实证。又说：真气耗夺就是虚，邪气亢胜就是实。又说：各种疼痛属于实证，瘙痒属于虚证。又说：诊察其脉象洪大而数的，是实证；脉象微细而软的，是虚证。虚证就用补法，调和其气并托里扶正；实证就用泻法，疏通利导并自行引导其气机。《内经》说：血实就要决破它（放血或攻逐），气虚就要牵引它（升提或引导）。
When sores and carbuncles have suppurated and ulcerated, and the swelling and toxicity are spreading, with a critical and malignant presentation, it is imperative to differentiate between deficiency (Xu) and excess (Shi). For those without deficiency, tonification is difficult; for those with excess, purgation is easier. The methods of tonification and purgation must not be used lightly; even a slight error can lead to significant harm. However, there are many manifestations of deficiency and excess syndromes, which cannot fail to be distinguished. There are deficiencies and excesses in the sores themselves, in the Zang-Fu organs and Qi and Blood, and in the true Qi versus pathogenic factors, hence they differ. Speaking separately: if the swelling is raised, hard, and the pus is thick, it is an excess syndrome of the sore or carbuncle; if the swelling is flat, soft, slow to rise, and the pus is thin, it is a deficiency syndrome of the sore or carbuncle. If there is diarrhea or dysentery, borborygmus (intestinal rumbling), inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, free urination, or difficulty in urination combined with loose stools, loss of voice, and unclear spirit, these are all deficiency syndromes of the Zang-Fu organs. If there is hard stool, obstructed urination, normal appetite, abdominal fullness and distension, chest and diaphragm oppression, pain in limbs and joints, bitter taste in the mouth and dry throat, irritability with excessive thirst, fever, large pulse, and confused or blocked spirit, these are all excess syndromes of the Zang-Fu organs. Whenever various sores and carbuncles have clear and thin pus, open wounds that do not close, swollen masses that are not red, cold muscles and flesh, spontaneous sweating, and sallow complexion, this is a deficiency of Qi and Blood. If the swelling is raised and red, accompanied by alternating chills and fever, pain, hot skin, thick and sticky pus, and heavy or confused head and eyes, this is an excess of Qi and Blood. Headache and nasal congestion, red eyes, fright, pharyngeal obstruction, sores on the mouth and tongue, vexatious thirst for cold drinks, somnolence with teeth grinding, constitute an upper excess. Slippery seminal emission, unobstructed bowel movements, heavy waist and legs, and restless sleep constitute a lower deficiency. Inconvenience in the shoulders, neck, and nape, heaviness in the four limbs, abnormal vision, unclear gaze, loss of taste, hoarse voice, deteriorated complexion, and edema of the four limbs constitute a deficiency of True Qi (Zhen Qi). Severe swelling, unbearable pain, failure to ulcerate after many days, alternating chills and fever, constipation, urinary frequency and dysuria resembling strangury, mental restlessness, and confusion constitute an excess of Pathogenic Factors (Xie Qi). It is said: depletion of True Qi results in deficiency; victory of Pathogenic Factors results in excess. It is also said: all pain indicates excess, while itching indicates deficiency. It is further stated: a pulse that is surging, large, and rapid indicates excess; a pulse that is faint, fine, and soft indicates deficiency. For deficiency, one tonifies and harmonizes the Qi to support the interior; for excess, one purges, unblocks, and guides the Qi naturally. The *Neijing* states: "If Blood is excess, resolve it [by draining]; if Qi is deficient, draw it up [or guide it]."