李氏云∶疽初发一粒如麻豆，发热肿高，热痛色赤，此为外发。势虽炽盛，治得其法，
可保其生。若初时不发热，体倦怠，患处如故，数日不肿痛，五内已坏，虽有卢扁之药，亦
未如之何矣。
愚按∶前症，有因元气虚而不能发出者，有因敷贴寒药而不能发出者，有因攻伐过伤气
血而不能发出者，有因热毒内蕴而失疏托者，审而治之，多有生者。
附治验
进士申天益，臂患痈，寒热头痛，形气虚弱，此手足阳明经风邪之症。用桔梗升麻汤二
剂，外邪顿散。用托里消毒散二剂，肿痛顿退。乃用补中益气汤调理，形气渐复而愈。
秋官钱可容，腹患痈， 肿作痛，烦渴饮冷，大便不通，脉沉数实，此热毒蕴于内。用
清热消毒散加大黄二钱一剂，诸症悉退。但形气顿虚，用托里消毒散去金银花、白芷，倍加
参、 、归、术而安。
一男子股内患毒，欲求内消。其脉滑数，脓已成矣，因气血虚而不溃，遂刺之，脓出作
痛。以八珍汤治之，渐可。但脓水清稀，更以十全大补汤加炮附子五分，数剂渐愈，乃去附
子，又三十余剂而愈。
一童子腋下患痈，久不敛，脓清脉大，怠倦懒食，自汗口干。用内补黄 汤及豆豉饼，
两月而愈。凡疮溃而脓清，或疮口不合，或聚肿不溃，肌寒肉冷，自汗色脱者，皆气血虚极
也，非大温补不可。
一男子肩患毒， 痛饮冷，烦躁便秘，脉数而实。以清凉饮二剂，少愈；以金银花散四
剂，悉退；又以十宣散去桂加天花粉、金银花数剂，疮溃而痊。此脉与症皆属有余也。
一男子背疮溃而瘀血不散，此阳气虚弱也。用参、 、归、术峻补，更以桑枝灸，又用
托里散加肉桂，疮口自敛。此补接阳气之法也。
上舍毛体仁，素阴虚，春初咳嗽，胸中隐痛，肾脉洪数，肺脉数而时不见。余曰∶内当
结痈，先用六味地黄丸料一剂服之。翌早来谓余曰∶昨得良剂，嗽愈六七，务求一方，到监
调理。余曰∶此阴火上炎，患痈之症，第因元气虚弱，未能发出。因其易忽，余辞不能。乃
别用降火化痰等剂，愈甚。月余复请诊之，脉洪滑而数。余曰∶脓已成矣，当请常治者同议
针之，且免内溃之患。仍不决。又月余请视，他医已先开疮孔偏上，兜脓不出，仍内溃，脉
愈洪大。余曰∶脉洪滑而数，视其舌青黯，五内已坏，无能为矣。后果然。
李氏说：疽病初发时，如果像麻豆一样的一粒，伴有发热、肿胀高起、灼热疼痛且颜色发红，这属于外发性疽。虽然病情看似炽盛，但只要治疗方法得当，就可以保全生命。如果在初发时不发热，身体倦怠乏力，患处没有变化，几天后也不肿痛，这说明五脏内部已经败坏，即使有卢医和扁鹊那样的神医良药，也无能为力了。
我按语认为：上述前一种病症（指内陷或难发之症），有的是因为元气虚弱而不能透发出来的，有的是因为敷贴寒凉药物导致阳气被遏而不能透发的，有的是因为攻伐太过损伤气血而不能透发的，有的是因为热毒内蕴而未能及时疏泄托毒的。仔细辨证施治，大多可以治愈。
附治疗验案
进士申天益，手臂患痈，出现恶寒发热、头痛，形体气息虚弱，这是手足阳明经受风邪侵袭的病症。服用桔梗升麻汤两剂，外邪顿时消散。再服用托里消毒散两剂，肿痛顿时消退。接着用补中益气汤调理，形体气息逐渐恢复而痊愈。
秋官钱可容，腹部患痈，局部肿胀疼痛，心烦口渴想喝冷水，大便不通，脉象沉数而实，这是热毒蕴结于体内。使用清热消毒散加大黄二钱，一剂药后，各种症状全部消退。但此时形体气息突然变得虚弱，于是改用托里消毒散，去掉金银花、白芷，加倍加入人参、[此处原文缺字，据方义推测为黄芪]、当归、白术，从而安定病情。
有一个男子大腿内侧患毒疮，想要通过内服药物使其消散。其脉象滑数，说明脓液已经形成，但因为气血虚弱而不能溃破，于是针刺排脓，脓出后感到疼痛。用八珍汤治疗，逐渐好转。但脓水清稀，又改用十全大补汤加炮附子五分，服用几剂后逐渐痊愈，然后去掉附子，又服用三十多剂才完全康复。
有一个少年腋下患痈，长久不能愈合，脓液清稀，脉象大而无力，精神怠倦，食欲不振，自汗，口干。使用内补黄耆汤及豆豉饼灸法，两个月后痊愈。凡是疮疡溃破后脓液清稀，或者疮口不合拢，或者聚集肿胀却不溃破，肌肉寒冷，皮肤苍白，自汗，面色脱失的，都是气血极度虚弱的表现，非用大温大补的方法不可。
有一个男子肩部患毒疮，怕冷想喝冷饮，烦躁不安，便秘，脉象数而实。用清凉饮两剂，稍见好转；用金银花散四剂，症状全部消退；又用十宣散去桂枝，加天花粉、金银花，服用几剂后，疮疡溃破而痊愈。这种脉象与症状都属于实证（有余）。
有一个男子背部疮疡溃破后瘀血不散，这是阳气虚弱所致。用人参、[此处原文缺字，据方义推测为黄芪]、当归、白术峻补元气，再用桑树枝灸，以及托里散加肉桂，疮口自然收敛。这是补接阳气的方法。
上舍毛体仁，平素阴虚，春初咳嗽，胸中隐痛，肾脉洪数，肺脉数而时常摸不到。我说：体内应当结痈，先用六味地黄丸料一剂服用。第二天早上他来对我说：昨天用了有效的药方，咳嗽好了六七成，务必求一方，到监狱去调理。我说：这是阴火上炎，患痈的病症，只是因为元气虚弱，未能透发出来。因为容易被忽视，我推辞不能诊治。于是另用降火化痰等药剂，病情反而加重。一个多月后再次请诊，脉象洪滑而数。我说：脓液已经形成了，应当请常规治疗的医生共同商议针刺排脓，以免发生内溃的危险。他仍然不决定。又过一个月请我看，其他医生已经先在偏上方开了疮孔，兜住脓液排不出来，仍然发生内溃，脉象更加洪大。我说：脉象洪滑而数，看他的舌色青黯，五脏内部已经败坏，无能为力了。后果然如此。
Li stated: When a ju (deep-seated abscess) first appears, if it presents as a single grain the size of a hemp seed or bean, accompanied by fever, swelling, elevation, burning pain, and redness, this is an external manifestation. Although the condition may appear vigorous, if treated with appropriate methods, life can be preserved. However, if there is no fever at the onset, the body feels fatigued and weak, the affected area remains unchanged, and after several days there is neither swelling nor pain, this indicates that the internal organs have already deteriorated. Even with the medicines of Lu [Yi] and Bian [Que], nothing can be done.
My commentary: Regarding the aforementioned conditions where the disease fails to manifest externally, some cases are due to deficiency of Yuan Qi (Original Qi) preventing eruption; some are due to the application of cold-natured topical medications inhibiting eruption; some are due to excessive purgation damaging Qi and Blood, preventing eruption; and some are due to internal accumulation of heat-toxin without timely venting and pushing out. Upon careful differentiation and treatment, many patients survive.
Attached Treatment Cases
Shen Tianyi, a Jinshi degree holder, suffered from a carbuncle on his arm, presenting with aversion to cold, fever, headache, and weakness in form and Qi. This was a syndrome of Wind pathogen affecting the Hand and Foot Yangming meridians. After two doses of Jiegeng Shengma Tang (Platycodon and Cimicifuga Decoction), the exterior pathogens dispersed instantly. Two doses of Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder) caused the swelling and pain to subside immediately. Subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used for regulation, leading to gradual recovery of form and Qi until cure.
Qian Kerong, a magistrate of the Ministry of Justice, suffered from a carbuncle on his abdomen, presenting with local swelling and pain, irritability, thirst with a desire for cold drinks, and constipation. His pulse was deep, rapid, and full. This indicated heat-toxin accumulating internally. Qingre Xiaodu San (Clear Heat and Eliminate Toxin Powder) with added 2 qian of Dahuang (Rhubarb Rhizome) was administered for one dose, causing all symptoms to retreat. However, his form and Qi suddenly became deficient. Therefore, Tuoli Xiaodu San was modified by removing Jinyinhua (Lonicerae Flos) and Baizhi (Angelicae Dahuricae Radix), and doubling the dosage of Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), which stabilized the condition.
A man suffered from a toxic sore on the inner thigh, seeking internal resolution. His pulse was slippery and rapid, indicating that pus had already formed. Due to deficiency of Qi and Blood, it failed to ulcerate spontaneously. It was then punctured, releasing pus and causing pain. Bazhen Tang (Eight Treasures Decoction) was used for treatment, leading to gradual improvement. However, the discharge was clear and thin. Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with 5 fen of Paofuzi (Prepared Aconiti Lateralis Radix) was added. After several doses, he gradually improved. The Fuzi was then removed, and after more than thirty additional doses, he fully recovered.
A young boy suffered from a carbuncle in the axilla that failed to heal for a long time. The pus was clear, the pulse was large and empty, he felt lethargic and lazy to eat, sweated spontaneously, and had a dry mouth. Neibu Huangqi Tang (Internal Supplement Huangqi Decoction) and fermented soybean cakes were applied. He healed after two months. Generally, when sores ulcerate with clear pus, or the wound does not close, or swelling aggregates without ulcerating, accompanied by cold muscles and flesh, spontaneous sweating, and pallor, these are signs of extreme deficiency of Qi and Blood. Only strong warming and tonification will suffice.
A man suffered from a toxic sore on his shoulder, presenting with aversion to cold, desire for cold drinks, irritability, constipation, and a rapid, full pulse. These symptoms and pulse belong to excess patterns. Qingliang Yin (Cooling Drink) was given for two doses, resulting in slight improvement. Jinyinhua San (Honeysuckle Powder) was given for four doses, causing all symptoms to retreat. Then, Shixuan San (Ten Acupoints Powder) was modified by removing Guizhi (Cinnamon Twig) and adding Tianguafen (Trichosanthis Radix) and Jinyinhua (Lonicerae Flos). After several doses, the sore ulcerated and healed.
A man’s back sore ulcerated, but blood stasis did not dissipate. This was due to deficiency of Yang Qi. Strong tonification with Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) was used, along with moxibustion using mulberry branches. Tuoli San (Support Interior Powder) with Rougui (Cinnamomi Cortex) was also applied, leading to natural contraction of the wound. This is the method of supplementing and connecting Yang Qi.
Mao Tiren, a student of the Imperial Academy, had chronic Yin deficiency. In early spring, he suffered from cough and dull pain in the chest. His Kidney pulse was surging and rapid, while his Lung pulse was rapid and occasionally imperceptible. I said: There should be an internal abscess forming. First, administer one dose of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) material. The next morning, he reported: "Yesterday I took the effective prescription; my cough improved by six or seven tenths. I earnestly request a formula to take to the prison for regulation." I replied: "This is Flaming Fire rising due to Yin deficiency, a symptom of impending abscess. It is merely because Yuan Qi is weak and unable to erupt. Because it is easily overlooked, I decline to treat." Consequently, other physicians used prescriptions for descending fire and resolving phlegm, which worsened the condition. Over a month later, upon re-examination, the pulse was surging, slippery, and rapid. I said: "The pus has formed. You should consult regular practitioners to discuss needle drainage to avoid internal rupture." He still hesitated. Another month passed. Other physicians had already opened a hole slightly above the center, trapping the pus, which failed to drain, leading to internal rupture. The pulse became even more surging and large. I said: "With a surging, slippery, and rapid pulse, and observing his dark blue tongue, the internal organs have already deteriorated. Nothing can be done." This proved true eventually.