论曰∶痈疽溃后，形有逆有顺。白睛黑小，一恶也；不能下食，纳药而呕，食不知味，
二恶也；伤痛渴甚，三恶也；体项不便，四肢沉重，四恶也；声嘶色脱，唇鼻青黑，面目浮
肿，五恶也；烦躁时嗽，腹痛渴甚，泻利无度，小便如淋，六恶也；脓血大泄，肿痛尤甚，
脓色败臭，七恶也；喘粗气短，恍惚嗜卧，八恶也；未溃黑陷，面青唇黑，便污，九恶也；
气噎痞塞，咳嗽身冷，自汗无时，目瞪耳聋，恍惚惊悸，语言颠倒，十恶也。又脑为诸阳所
会，颈项近咽喉、肾俞，皆致命之所，俱不可灼艾。
愚按∶前症未溃黑陷，面青唇黯，便污者，脏腑内溃之恶症也。气噫痞塞，咳嗽身冷
自汗者，脾肺虚败之恶症也。不食便泻、肠鸣耳聋、目瞪者，脾肾虚败，传变之恶症也。治
法详见附录。
审内症用药附
自泻呕吐，不进饮食，肾脉最虚，如是之疾，古人皆以为不治，然亦有救疗之理焉耳。
愚按∶前论发《内经》之微旨，开万世之聋聩，其惠博矣。此症实命门火衰，不能生脾土
而虚寒，以致自泻呕吐，或胸膈不利，或食而不化，或大便不实，宜用八味丸及六君子，加
姜、附。若因房劳过度，真阳衰败，或原禀不足，不能生脾土，而饮食不进者，用补中益气
加附子、姜、桂，并东垣补真丸，多有得生者。若用参、苓之类直补脾胃，鲜有不误。若或
以为毒瓦斯内攻而治者，俱致不起。
附治验
通府李廷仪，患流注，唾痰气促。自恃知医，用化痰理气等剂，脓水淋漓，肿硬不消，
寒热往来，饮食少思，肌肉消瘦，大便不实，手足时冷，两尺脉浮大，按之微细。余曰∶此
属命门火衰，当用八味丸。不信，乃服参、 、归、术之类，更加痰喘、泄泻。服八味丸、
益气汤，年余而痊。
御医王介之室，背疽不起发，不 赤，泄泻欲呕，饮食少思，手足厥冷，脉息如无，此
阳气虚寒。用大补之剂，加附子二钱、姜、桂各一钱，不应。附子加至三钱，二剂，泄泻愈
甚。又以附子一枚，姜、桂各三钱，参、 、归、术各五钱，作一剂，腹内始热，呕吐始
止，手足始温，脉息始复。仍用大补加姜、附，四剂乃溃，三十剂得愈。六年后，仍殁虚寒之症。
大尹陈国信，素阴虚，背患疽。用参、 大补而不敛，内热发热，舌燥唇裂，小便频
数，口干饮汤，呕吐泻利，耳闭目盲，仰首眩晕，脉浮大而数。余曰∶疮口不敛，脾土败
也。舌燥唇裂，肾水枯也。小便频数，肺气衰也。内热发热，虚火上炎也。口干饮汤，真寒
之象也。呕吐泻利，真火衰败也。耳闭目盲，肝木枯败也。仰首眩晕，肾气绝也。辞不治，
后果殁。
一男子患痈，肿硬不溃，脉弱时呕。彼欲用败毒等药，余谓肿硬不溃，乃阳气虚弱，呕
吐少食，乃胃气虚寒，法当温补脾胃。大抵肿赤痛甚，烦躁脉实而呕为有余，当下之，肿硬
不溃，脉弱而呕为不足，当补之。若痛伤胃气，或感寒邪秽气而呕者，虽肿疡犹当助胃壮
气。彼不信，仍服攻伐之药，而果殁。
论述说：痈疽溃破之后，病情表现有逆证和顺证的区别。白眼球变黑且瞳孔缩小，这是第一种恶候；不能进食，服药后呕吐，吃东西尝不出味道，这是第二种恶候；疼痛剧烈且极度口渴，这是第三种恶候；身体僵硬项部活动不便，四肢沉重无力，这是第四种恶候；声音嘶哑、面色枯槁无华，嘴唇和鼻子发青发黑，面目浮肿，这是第五种恶候；烦躁不安，时常咳嗽，腹部疼痛且极度口渴，腹泻痢疾没有节制，小便像淋病一样涩痛，这是第六种恶候；脓血大量流失，肿痛更加严重，脓液颜色败坏且有恶臭，这是第七种恶候；呼吸急促气短，神志恍惚嗜睡，这是第八种恶候；疮疡尚未溃破却出现黑色下陷，面色青紫嘴唇发黑，大便污秽失禁，这是第九种恶候；气息噎塞痞闷，咳嗽身体寒冷，不时自汗，眼睛瞪大直视耳聋，神志恍惚惊恐心悸，言语错乱颠倒，这是第十种恶候。另外，头部是诸阳经汇聚之处，颈部靠近咽喉和肾俞穴，都是致命的要害部位，都不可以使用火灸疗法。
我按语认为：前述症状中，疮疡未溃而色黑下陷，面色青紫嘴唇暗滞，大便污秽的，属于脏腑内部溃败的恶症。嗳气痞塞，咳嗽身体寒冷自汗的，属于脾肺虚损衰败的恶症。不吃东西且腹泻，肠鸣耳聋，眼睛瞪大的，属于脾肾虚损衰败，病情传变的恶症。治疗方法详见附录。
审察内症用药附记
出现自发性腹泻呕吐，无法进食，肾脉最为虚弱，这样的疾病，古人通常认为是不治之症，然而也有救治治疗的道理存在。
我按语认为：前文论述阐发了《黄帝内经》的精微旨意，开启了万世以来人们的耳目，恩惠广大啊。此症实际上是命门之火衰弱，不能温煦脾土而导致虚寒，从而引起自发性腹泻呕吐，或者胸膈部不适，或者食物不消化，或者大便不成形，适宜使用八味丸及六君子汤，加入生姜、附子。如果是由于房事过度，导致真阳衰败，或者原本禀赋不足，不能温煦脾土，从而导致饮食不进的情况，使用补中益气汤加入附子、生姜、肉桂，以及东垣（李杲）的补真丸，大多能够存活。如果使用人参、茯苓之类的药物直接补益脾胃，很少有不误诊误治的。如果认为是毒邪内攻而进行治疗，都会导致死亡。
附治疗验案
通政府的李廷仪，患有流注（一种深部脓肿），咳吐痰涎且气促。他自恃懂医，使用了化痰理气等方剂，导致脓水淋漓不止，肿胀坚硬不消退，寒热往来交替，饮食减少思虑，肌肉消瘦，大便不成形，手足时常发冷，两尺脉浮大，重按则微细。我说：这属于命门火衰，应当使用八味丸。他不相信，反而服用人参、白术、当归、白术之类（注：原文此处可能有缺字或泛指补气养血药，结合上下文推测为常规补益药，但根据后文“参、 、归、术”及语境，此处指代非针对命门火的常规补药，暂译为参、某药、归、术之类，实际古籍常作“参、苓、归、术”或类似，此处依原文留空处理或理解为泛指），结果加重了痰喘和泄泻。后来服用八味丸、补中益气汤，一年多才痊愈。
御医王介之的妻子，背部生疽疮，不起发（指脓成不溃或气血不足难以托毒外出），肤色不红，腹泻想要呕吐，饮食减少思虑，手足厥冷，脉搏微弱几乎摸不到，这是阳气虚寒的表现。使用大补的方剂，加入附子二钱、生姜和肉桂各一钱，没有见效。将附子加至三钱，服用两剂后，泄泻反而更严重。又用一枚附子，生姜和肉桂各三钱，人参、某药、当归、白术各五钱，组成一剂药，服后腹内才开始感到温热，呕吐才停止，手足才温暖，脉搏才恢复。仍然使用大补方剂加入生姜、附子，服用四剂后疮疡溃破，服用三十剂后痊愈。六年后，最终还是死于虚寒之症。
大尹陈国信，素来阴虚，背部患疽疮。使用人参等大补药物却不能收敛伤口，出现内热发热，舌燥唇裂，小便频数，口干想喝热水，呕吐腹泻，耳闭目盲，仰头眩晕，脉象浮大而数。我说：疮口不收敛，是脾土败坏的表现。舌燥唇裂，是肾水枯竭的表现。小便频数，是肺气衰弱的表现。内热发热，是虚火上炎的表现。口干想喝热水，是真寒假热的征象。呕吐腹泻，是真火衰败的表现。耳闭目盲，是肝木枯败的表现。仰头眩晕，是肾气断绝的表现。推辞不治，后果然死亡。
一名男子患痈肿，肿胀坚硬不溃破，脉弱时常呕吐。他想使用败毒等攻伐药物，我说：肿胀坚硬不溃破，是阳气虚弱所致；呕吐少食，是胃气虚寒所致，治法应当温补脾胃。大抵而言，如果红肿疼痛剧烈，烦躁脉实且呕吐，属于有余之实证，应当用攻下法；如果肿胀坚硬不溃破，脉弱且呕吐，属于不足之虚证，应当用补法。如果是因为疼痛损伤胃气，或者感受寒邪秽气而呕吐的，即使是肿疡阶段也应当助胃壮气。他不相信，仍然服用攻伐的药物，果然死亡。
Discourse states: After the ulceration of carbuncles and sores, the physical manifestations can be either favorable (Shun) or unfavorable (Ni). White sclera turning black with a constricted pupil is the first unfavorable sign; inability to eat, vomiting after taking medicine, and loss of taste are the second unfavorable sign; severe pain and extreme thirst is the third unfavorable sign; stiffness in the body and neck, heaviness in the four limbs is the fourth unfavorable sign; hoarseness, sallow complexion, cyanosis and blackness of the lips and nose, and edema of the face and eyes is the fifth unfavorable sign; irritability, frequent coughing, abdominal pain with extreme thirst, uncontrolled diarrhea and dysentery, and painful urination resembling strangury is the sixth unfavorable sign; massive discharge of pus and blood, worsening swelling and pain, foul-smelling and discolored pus is the seventh unfavorable sign; rapid breathing, shortness of breath, mental confusion, and somnolence is the eighth unfavorable sign; before ulceration, black sinking of the sore, cyanotic face, black lips, and fecal incontinence is the ninth unfavorable sign; choking sensation and chest stuffiness, coughing, cold body, spontaneous sweating at any time, staring eyes, deafness, mental confusion, palpitations, and incoherent speech is the tenth unfavorable sign. Furthermore, the head is the convergence point of all Yang meridians, and the neck is near the throat and Shenshu (BL23), which are all fatal areas; moxibustion should not be applied here.
My commentary: Regarding the aforementioned symptoms where the sore has not yet ulcerated but presents with black sinking, cyanotic face, and dark lips with fecal incontinence, these are unfavorable signs of internal organ collapse. Belching, chest stuffiness, coughing, cold body, and spontaneous sweating are unfavorable signs of Spleen and Lung deficiency and decline. Inability to eat, diarrhea, borborygmus, deafness, and staring eyes are unfavorable signs of Spleen and Kidney deficiency and decline, indicating disease progression. Treatment methods are detailed in the appendix.
Appendix on Assessing Internal Symptoms for Medication
Spontaneous diarrhea and vomiting, inability to take food, with the most deficient Ren Mai (Kidney Pulse): Such diseases were considered incurable by ancient physicians, yet there are principles for rescue and treatment.
My commentary: The previous discourse elucidates the subtle purport of the Huangdi Neijing (Yellow Emperor's Inner Canon), awakening people for ten thousand generations, bringing immense benefit. This condition is actually due to the decline of Mingmen Fire (Gate of Vitality Fire), failing to warm Pi Tu (Spleen Earth), resulting in deficiency-cold, leading to spontaneous diarrhea and vomiting, or discomfort in the chest and diaphragm, or undigested food, or loose stools. It is appropriate to use Bawei Wan (Eight-Ingredient Pill) and Liujunzi Tang (Six-Gentlemen Decoction), added with Shengjiang (Fresh Ginger) and Fuzi (Prepared Aconite Root). If it is caused by excessive sexual activity leading to the failure of True Yang, or innate insufficiency failing to warm Spleen Earth, resulting in anorexia, Buyi Yiqi Tang (Tonify Middle and Augment Qi Decoction) added with Fuzi, Shengjiang, and Rougui (Cinnamon Bark), along with Dongyuan's Buzhen Wan (Tonify True Pill), often results in survival. Using herbs like Renshen (Ginseng Root) and Fuling (Poria) to directly tonify the Spleen and Stomach rarely avoids error. If treated as internal attack by toxic factors, death will inevitably ensue.
Attached Case Records
Li Tingyi, Secretary of the Ministry of Justice, suffered from Liuzhu (flowing abscesses), expectorating phlegm and experiencing shortness of breath. Relying on his medical knowledge, he used formulas for resolving phlegm and regulating Qi, leading to continuous discharge of pus and water, persistent hard swelling, alternating chills and fever, reduced appetite, emaciation, loose stools, cold extremities, and floating-large Chi pulse (Kidney pulse) that becomes fine upon deep pressure. I said: This belongs to the decline of Mingmen Fire, and Bawei Wan should be used. He did not believe this, instead taking Renshen, [missing character], Danggui (Angelica Sinensis), and Baizhu (Atractylodes Macrocephala Rhizome), which worsened his phlegm-wheezing and diarrhea. Later, taking Bawei Wan and Yiqi Tang, he recovered after more than a year.
The wife of Imperial Physician Wang Jiezhi had a back carbuncle that failed to rise and suppurate, was not red, accompanied by diarrhea and nausea, reduced appetite, cold extremities, and a pulse barely perceptible, indicating Yang deficiency and cold. Large-tonifying formulas were used with 2 qian of Fuzi, 1 qian each of Shengjiang and Rougui, without effect. Increasing Fuzi to 3 qian, after two doses, diarrhea worsened. Then, one piece of Fuzi, 3 qian each of Shengjiang and Rougui, and 5 qian each of Renshen, [missing character], Danggui, and Baizhu were made into one dose. Only then did warmth begin in the abdomen, vomiting stop, extremities become warm, and the pulse return. Still using large-tonifying formulas with Shengjiang and Fuzi, after four doses the sore ulcerated, and after thirty doses, it healed. Six years later, she died of deficiency-cold syndrome.
Chen Guoxin, Magistrate, had a constitution of Yin deficiency and developed a back carbuncle. Using large-tonifying herbs like Renshen failed to close the wound, leading to internal heat and fever, dry tongue and cracked lips, frequent urination, dry mouth desiring hot drinks, vomiting and diarrhea, ear blockage and blindness, dizziness when looking up, and a floating-large-rapid pulse. I said: The non-healing wound indicates Spleen Earth failure. Dry tongue and cracked lips indicate Kidney Water exhaustion. Frequent urination indicates Lung Qi decline. Internal heat and fever indicate defluxion of deficient fire. Dry mouth desiring hot drinks indicates true cold appearance. Vomiting and diarrhea indicate true fire failure. Ear blockage and blindness indicate Liver Wood withering. Dizziness when looking up indicates Kidney Qi exhaustion. I declined to treat him, and he subsequently died.
A man suffered from a boil, with hard swelling that did not ulcerate and a weak pulse with occasional vomiting. He wished to use detoxifying and attacking medicines. I said: Hard swelling without ulceration indicates Yang Qi deficiency; vomiting and poor intake indicate Stomach Qi deficiency and cold. The method should be to warm and tonify the Spleen and Stomach. Generally, if there is redness, swelling, severe pain, irritability, solid pulse, and vomiting, it is excess, and purgation should be used. If there is hard swelling without ulceration, weak pulse, and vomiting, it is deficiency, and tonification should be used. If vomiting is caused by pain damaging Stomach Qi or contracting cold pathogenic factors, even in the stage of swelling, assisting Stomach Qi and strengthening Qi is necessary. He did not believe this, continued to take attacking medicines, and indeed died.