凡痈疽之疾,比他病最酷,圣人推为杂病之先。自古虽有疡医一科,及鬼遗等论,后人不能深究,于是此方沦没,
转乖迷涂。今乡井多是下甲人,专攻此科。然沾此疾,又多富贵者。《内经》云;大凡痈疮,多失于膏粱之人。仆家世大
方脉,每见沾此疾者十存一二,盖医者少有精妙能究方论者。闻读其书,又不能探赜素隐,及至临病之际,仓卒之间,
无非对病阅方,遍试诸药。况能疗痈疽、持补割、理折伤、攻牙疗痔,多是庸俗不通文理之人,一见文繁,即使厌弃。
病家又执方论,以诘难之,遂使医者鼯鼠技穷,中心惶惑,当下不下,悠悠弗决,迁延日久,遂令轻者重,重者死。又
多见生疽之人,隐讳者众,不喜人言是痈疽发疾,但喜云只是小小疖毒而已,及至孔洪,遂致不救。又有病家猜鄙,吝
其所费浩瀚,不肯请明了之医,而甘心委命于庸俗之手。或有医者,用心不臧,贪人财利,不肯便投的当伐病
之剂,惟恐效速而无所得,是祸不极,则功不大矣。又有确执一二药方,而全无变通者。又有当先用而后下者;当后用
而先下者。多见一得疾之初,便令多服排脓内补十宣散,而及增其疾。此药是破后排脓内补之药,而洪内翰未解用药之
意,而妄为序跋,以误天下后世者众矣。陈无择云∶当在第四节用之是也。又有得一二方子,以为秘传,惟恐人知之,
穷贵之人不见药味而不肯信服者多矣。又有自知众人尝用已效之方,而改易其名,而为秘方,或妄增
药味以惑众听,而返无效者,亦多矣。此等之徒,皆含灵之巨贼,何足相向!又有道听涂说之人,远来问病,自逞了了,
诈作明能,谈说异端,或云是虚,或云是实,出示一方,力言奇效,奏于某处。此等之人,皆是贡谀。其实皆未曾经历
一病,初无寸长,病家无主,易于摇惑,欲于速效,又喜不费资财,更不待医者商议,可服不可服,即欲投之,倏然至
祸,各自走散。古人云∶贫无达士将金赠,病有闲人说药方,此世之通患,历代不能革。
凡痈疽之疾,真如草寇,不守律法,出意凶暴,待之稍宽,杀人纵火,无可疑者。凡疗斯疾,不可以礼法待之,仍
要便服一二紧要经效之药,把定脏腑,外施针灸,以泄毒瓦斯。其势稍定,却乃详观方论,或命医者,详察定名。是痈是
疽,是虚是实,是冷是热,或重或轻,对证用药,毋失先后次序。病者不必忧惶,医者确执己见,不可妄立名色,怆惶
惑乱,收效必矣。如近代名医李嗣之、伍起予、曾孚先辈,编集上古得效方论要诀,愚因暇日,采摭群言,自立要领,
或先或后,不失次序。其中重复繁文者削之,取其言简意尽,纲领节目,整然不紊。庶几览者,如指诸掌,虽不能尽圣
人之万一,使临病之际,便有所主,毋致渴而穿井,斗而铸兵者乎!
岁景定癸亥孟秋宝唐习医陈自明良甫序
凡是痈疽这类疾病,比其他疾病最为惨酷,圣人将其列为杂病之首。自古以来虽然设有疡医这一科,以及《鬼遗方》等论述,但后人不能深入探究,于是这方面的医术逐渐沦落埋没,转而偏离了正确的道路。如今乡间多是地位低下的人,专门从事这一科的治疗。然而染上这种疾病的,又大多是富贵人家。《内经》说:大凡痈疮,多发生在食用膏粱厚味(油腻精细食物)的人身上。我家世代行医于大方脉(内科),经常见到染上这种病的病人,十人中仅存一二,大概是因为医生中少有精妙且能深入研究方论的人。即使有人阅读相关书籍,又不能探求深奥隐微的道理,等到面对病人的时候,仓促之间,无非是对着病症翻阅药方,遍试各种药物。况且能够治疗痈疽、掌握补法与割治法、处理骨折损伤、攻治牙病痔疮的,多是庸俗不通文理的人,一见文字繁多,就产生厌恶而抛弃。病人家属又拿着方论来诘问刁难,致使医者像鼯鼠一样技穷,心中惶恐困惑,该下针不下针,犹豫不决,拖延日久,遂使轻病转重,重病致死。又常见患疽的人,隐瞒忌讳者众多,不喜欢别人说这是痈疽发作的疾病,只喜欢说是小小的疖毒而已,等到病情严重到不可收拾时,便导致无法救治。又有病人家属猜忌鄙陋,吝惜浩大的费用,不肯聘请明白晓畅的医生,而甘心将性命托付给庸俗之人。有的医者用心不良,贪图钱财利益,不肯立即投用确切有效的攻伐病邪的药物,唯恐见效太快而无利可图,认为祸患不极深,功劳就不大。又有固执于一两个药方,完全不知变通的。还有应当先用攻下药却后用的;应当后用药却先下的。多见一得病之初,便令病人多服排脓内补十宣散,反而加重了病情。这药是破溃后排脓内补的药,而洪内翰不理解用药的本意,却妄作序跋,误导天下后世的人太多了。陈无择说:应当在第四节使用它,这才是对的。又有得到一两个方子,视为秘传,惟恐别人知道,很多权贵有钱的人不见药味就不肯信服。又有自知众人常用已验证有效的方子,却改易其名称,称为秘方,或者妄增药味以迷惑大众听闻,反而无效的,也多了。这类人,都是伤害生灵的大贼,哪里值得与之交谈!又有道听途说的人,远道而来问病,自逞高明,假装明察能干,谈论异端邪说,有的说是虚证,有的说是实证,出示一个方子,极力宣称有奇效,声称在某处奏效。这类人,都是阿谀奉承之徒。其实他们都未曾亲身经历诊治过疾病,起初毫无特长,病人家属没有主见,容易动摇疑惑,想要速效,又喜欢不花费资财,更不与医者商议,不管可服不可服,就想服用,忽然招致祸患,各自走散。古人说:贫穷时没有达士赠送金银,生病时有闲人说药方,这是世间的通病,历代都不能革除。
凡是痈疽这类疾病,真像草寇一样,不守律法,出人意料的凶暴,对待它们稍微宽松一点,就会杀人纵火,这是毫无疑问的。凡是治疗这类疾病,不可以礼法来对待它,仍然要方便地服用一两种紧要经过验证有效的药物,把定脏腑,外用针灸,以泄解毒瓦斯。病情势头稍定之后,再详细观察方论,或者命令医者,详细察辨确定病名。是痈还是疽,是虚还是实,是冷还是热,或重或轻,对证用药,不要失去先后次序。病人不必忧愁惶惑,医者确坚持己见,不可妄立名目,惊慌惑乱,收效必定成功。如近代名医李嗣之、伍起予、曾孚等先辈,编集上古得效方论的要诀,我趁着闲暇之日,采摭各家言论,自立要领,或先或后,不失次序。其中重复繁冗的文字予以删削,取其语言简练意思完备,纲领条目,整齐不乱。希望阅览的人,如同指掌般清楚,虽然不能完全达到圣人的万分之一,但能使面临疾病时,便有所主张,不至于口渴才挖井,战斗时才铸造兵器吧!
岁在景定癸亥年孟秋,宝唐习医陈自明良甫序
Any disease of carbuncle and ulcer (Yongju, a severe skin infection) is the most cruel compared to other diseases, and the Sages ranked it as the foremost among miscellaneous diseases. Since ancient times, although there has been a department of surgeons (Yangyi), as well as discussions such as *Gui Yi Fang*, later generations failed to investigate deeply, causing this medical art to fall into obscurity and deviate from the correct path. Nowadays, in the countryside, many are people of low status who specialize in this field. However, those who contract this disease are mostly wealthy individuals. *Neijing* states: "Generally speaking, carbuncles and sores often occur in people who consume rich and greasy foods." My family has practiced internal medicine (Dafangmai) for generations, and I have often seen that among those contracting this disease, only one or two out of ten survive. This is likely because few doctors are skilled enough to thoroughly study formulas and theories. Even if some read the books, they fail to explore profound and hidden principles. When facing patients, in haste, they merely consult prescriptions against symptoms and try various medicines indiscriminately. Moreover, those who can treat carbuncles and ulcers, master tonification and surgical excision, manage fractures, and treat dental and hemorrhoidal conditions are mostly vulgar people unversed in literature. Upon seeing lengthy texts, they become disgusted and discard them. Patients' families then use theoretical texts to question and challenge the doctors, leaving the physicians helpless like flying squirrels, confused and panicked. They hesitate when action is needed, delaying treatment for long periods, thus turning mild cases severe and severe cases fatal. It is also common for those suffering from ulcers to hide their condition, disliking others to call it carbuncle or ulcer, preferring to say it is merely a small boil. By the time the condition becomes critical, it leads to untreatable situations. Some families are suspicious and stingy about the high costs, refusing to hire competent doctors, and instead willingly entrust their lives to mediocre practitioners. Some doctors act with bad intentions, greedy for profit, unwilling to immediately administer effective attacking remedies, fearing that quick recovery would yield no gain, believing that greater disaster brings greater merit. Others rigidly adhere to one or two formulas without flexibility. Some apply treatments in the wrong order: using purgatives too late when they should be used first, or vice versa. It is frequently observed that at the onset of the disease, patients are made to take large amounts of *Paion Neibu Shixuan San* (Ten-Pure Powder for Draining Pus and Tonifying Internally), which aggravates the illness. This formula is intended for draining pus and tonifying internally after the abscess has ruptured, yet Hong Nei Han misunderstood its purpose and wrote prefaces and postscripts recklessly, misleading countless people in the world and future generations. Chen Wuyue said: "It should be used in the fourth section," which is correct. Some obtain one or two formulas, treating them as secret transmissions, fearing others will know them; many wealthy nobles refuse to believe in them unless they see the ingredients. Others, knowing that commonly used formulas have proven effective, change their names to claim them as secrets, or recklessly add herbs to confuse the public, resulting in ineffectiveness. Such people are great thieves harming living beings; what reason is there to converse with them! There are also those who spread hearsay, travel far to inquire about illnesses, pretending to be knowledgeable and capable, discussing heterodox views, claiming either deficiency or excess, presenting a single formula, and vigorously asserting its miraculous efficacy achieved somewhere else. These people are all flatterers. In reality, none have experienced diagnosing or treating a disease themselves, possessing no real skill. Patients' families lack judgment and are easily swayed, desiring quick results while wanting to save money, without consulting doctors, deciding whether to take the medicine or not, and suddenly inviting disaster before scattering away. The ancients said: "When poor, no noble person gives gold; when sick, idle people offer prescriptions." This is a universal ailment of the world, unreformed through dynasties.
The disease of carbuncle and ulcer is truly like bandits, disregarding laws, acting with unexpected ferocity. If treated too leniently, they kill and burn, which is undeniable. To treat such diseases, one cannot rely on etiquette and law alone; one must conveniently administer one or two crucial, clinically effective medicines to stabilize the Zang-Fu organs, and apply external acupuncture to vent toxic vapors. Once the condition stabilizes slightly, then carefully observe the formulas and theories, or instruct the doctor to meticulously examine and determine the diagnosis. Whether it is a carbuncle or an ulcer, deficiency or excess, cold or heat, heavy or light, one must prescribe medication according to the syndrome, maintaining the correct sequence. The patient need not be anxious or panicked; if the doctor firmly holds their ground and does not create confusing diagnoses, success is certain. Modern famous doctors such as Li Sizhi, Wu Qiyu, and senior expert Zeng Fu compiled essential keys from effective ancient formulas. Taking advantage of my leisure time, I collected various opinions, established main principles, arranged them in order, neither preceding nor following incorrectly. Redundant and verbose parts were removed, retaining concise language and complete meaning, with clear guidelines and items, orderly and unconfused. May readers understand it as clearly as pointing to their palm. Although I cannot achieve even a fraction of the Sages' wisdom, I hope that when facing illness, there will be a basis for decision-making, avoiding the folly of digging a well only when thirsty or forging weapons only when fighting!
Preface by Chen Ziming, courtesy name Liangfu, a physician from Baotang, in the early autumn of the Guihai year of Jingding.