治痈疽初作，先以笔管一个，入蚂蜞一条，以管口对疮头，使蜞吮疮脓血，其毒即散，
加疮大须换三四条，若吮正穴，蜞必死矣，累试累效。若血不止，以藕节上泥涂之。若疮头
未明，以井边泥涂上，先干处即是。
愚按∶痈疽既成，毒血凝聚于外，可用此法吮去固善，但能治其末耳。又当审其邪在表
里，并元气虚实而药之，斯内外合一而为万全也。
经验方 治金石发痈。
黑铅（一斤） 甘草（三两）
上用酒一斗置瓷器内，先以甘草置在一边，另将铅熔投酒一边，取铅再熔，仍投九度，
取酒饮醉寝，即愈。
愚按∶前方治金石发疽之良法也。气血亏损者，仍当补托可也。
肘后方 治发背欲死，取冬瓜切去一头，合疮上；瓜烂仍切，复合之，瓜未尽用而疮已
安，仍用膏药贴之。
愚按∶此方若 肿痛甚，其邪在表者，最宜用此法宣热拔毒以通其滞。若肿痛发渴，大
便秘结，其邪在里者，须佐以内 黄连汤通利脏腑以泄其毒。在经络者，当佐以托里荣卫汤
以调气血。斯善。
张文仲治耳下石痈不作脓，用商陆根杵烂频搽之。
愚按∶商陆破气软坚，果系石痈，宜用此方治之。若怒动肝火而肿硬，或发寒发热，宜
用柴胡清肝散加钩藤、山栀，以养血气清肝火。肉色不变，晡热内热，宜用逍遥散加龙胆
草，以养肝血清肝火。若肝火血燥筋挛，或如贯珠，宜用柴芍参苓散加钩藤，以养血气，佐
以六味丸以生肾水。若时消时作，此脾肺之气滞而痰结也，须用归脾、六君二汤以和之。若
前药不应，当佐以海藻丸以散坚。经云∶形伤则痛，气伤则肿。不可轻用行气破血之剂（以
上治症见《外科枢要》）。
治痈疽疖，用生鹿角尖，于砂石器内同米醋磨脓，涂患处四围，涂一二日，内消。
愚按∶前方内消之法，如未应，须审其邪在表里、人之虚实而治之，不可治外而忘内也。
治痈疽，用生甘草为末，酒调二钱服，连进数服，自消。
愚按∶前方乃清热消毒之剂。若因膏粱积热，金石蓄毒，血气壅滞者，最宜用。如脾胃
虚弱，血气痞滞者，不宜概用，恐反寒胃气故也。
升麻汤 治肺痈，胸乳间作痛，呕吐脓血腥秽。
川升麻 苦梗 薏苡仁 地榆 黄芩 赤芍药 牡丹皮 甘草（各等分）
上为散，每服一两，水煎服。
愚按∶前方乃消毒清热排脓之良剂。如未应，用桔梗汤。咳嗽短气，小便短少者，佐以
参、 补肺汤。体倦食少，或咳嗽短气者佐以参术补胃汤。咳嗽痰涌者，肾虚水泛也，佐以
六味丸。口干咽燥，虚火上炎者，佐以加减八味丸。若发热喘唾脓血，饮食不入，为败症。
皆为脾土亏损不能生肺金，肺金不能生肾水；能补脾肺滋肾水，多有得生者。若面赤脉大
者，难治；面黄白脉浮涩者，易治。若呕脓不止，不治。呕脓自止，自愈（治验见《妇人良
方》、《外科枢要》）。
治谷道前后生痈，谓之悬痈。用粉草一两，截断，以涧水浸润，炙令透内，细锉，用无
灰酒煎服。有人患此已破，服两剂，疮即合。
愚按∶前症患于阴茎之后，谷道之前，属足三阴亏损之症。轻则为漏，沥尽气血而亡；
重则内溃而即殒。常治初起，湿热壅滞，未成脓作痛，或小便涩滞者，用龙胆泻肝汤。肿痛
盛，仙方活命饮，并以制甘草佐之。若不能成脓或不溃者，用八珍散主之。若脓已成者，
急针之，欲其生肌收敛。肾虚者，六味地黄丸。血虚者，四物加参、术。气虚者，四君加
芎、归。脾虚者，补中益气汤。气血俱虚者，八珍汤、大补汤。若用寒凉消毒则误矣（治验
见《外科枢要》）。
【背景信息】
书名：外科精要 作者：陈自明 朝代：宋 章节：洪丞相方用蜞针法第五十五 / 痈疽经验杂方 类别：外科
治疗痈疽（皮肤及皮下组织的化脓性感染）初起时，先取一支笔管，放入一条蚂蜞（水蛭的一种），将管口对准疮头，让蚂蜞吮吸疮口的脓血，毒气随即消散。如果疮口变大，需要更换三四条蚂蜞。如果蚂蜞吸到了正穴（关键穴位），蚂蜞必定死亡。此法屡试屡效。如果出血不止，用藕节上的泥土涂抹患处。如果疮头不明显，用井边的泥土涂抹，先变干的地方就是疮头所在。
我按语∶痈疽形成后，毒血凝聚于体表，可以用这种方法吸除，固然很好，但这只能治其标。还应当审察病邪是在表还是在里，以及元气是虚还是实，然后用药治疗，这样内外结合才能万无一失。
经验方 治疗金石发痈（因服用金石类药物引发的痈肿）。
黑铅（一斤） 甘草（三两）
以上药材用一斗酒放在瓷器内，先将甘草放在一边，另外将铅熔化倒入酒的另一边，取出铅再次熔化，仍然倒入，重复九次。取药酒喝到醉倒睡觉，即可痊愈。
我按语∶前方是治疗金石发疽的良好方法。气血亏损的患者，仍然应当采用补益托毒的方法治疗。
肘后方 治疗发背欲死（背部严重痈疽，病情危重），取冬瓜切去一头，盖在疮上；冬瓜烂了再切新的，继续盖上，冬瓜没用完而疮已安定，再用膏药贴敷。
我按语∶此方如果肿痛非常严重，病邪在表的，最适合用此法宣散热毒以疏通阻滞。如果肿痛且口渴，大便秘结，病邪在里的，必须配合使用黄连汤通利脏腑以泄出毒气。病邪在经络的，应当配合使用托里荣卫汤来调和气血。这样就很好了。
张文仲治疗耳下石痈（质地坚硬的痈肿）不化脓，用商陆根捣烂频繁涂抹。
我按语∶商陆能破气软坚，如果是石痈，适宜用此方治疗。如果是因愤怒引发肝火导致肿胀坚硬，或伴有发冷发热，适宜使用柴胡清肝散加钩藤、山栀，以养血气、清肝火。如果肤色不变，傍晚发热、内部发热，适宜使用逍遥散加龙胆草，以养肝血、清肝火。如果是肝火血燥导致筋脉拘挛，或肿块如串珠状，适宜使用柴芍参苓散加钩藤，以养血气，配合六味丸以滋补肾水。如果症状时好时坏，这是脾肺之气滞涩而痰凝结所致，必须使用归脾汤、六君子汤两方合用以调和之。如果前面的药物无效，应当配合海藻丸以消散硬结。经书说∶形体受伤则疼痛，气机受伤则肿胀。不可轻易使用行气破血的药剂（以上治疗症候见《外科枢要》）。
治疗痈疽疖（小型化脓性感染），用生鹿角尖，在砂石器内同米醋磨成浆，涂在患处四周，涂一两天，可使内消。
我按语∶前方是内消的方法，如果无效，必须审察病邪在表在里、人体虚实情况来治疗，不可只治外部而忘记内部。
治疗痈疽，用生甘草研为粉末，用酒调服二钱，连续服用几次，可自行消散。
我按语∶前方是清热消毒的药剂。如果是因饮食肥甘厚味积热，或金石蓄毒，导致血气壅滞的，最适宜使用。如果脾胃虚弱，血气痞滞的，不宜一概使用，恐怕反而寒伤胃气。
升麻汤 治疗肺痈（肺部化脓性疾病），胸乳间作痛，呕吐脓血腥秽之物。
川升麻 苦梗 薏苡仁 地榆 黄芩 赤芍药 牡丹皮 甘草（各等分）
以上药材研为散剂，每次服用一两，用水煎服。
我按语∶前方是消毒清热排脓的良好药剂。如果无效，使用桔梗汤。咳嗽短气，小便短少的，配合人参、黄芪补肺汤。身体疲倦食量减少，或咳嗽短气的，配合参术补胃汤。咳嗽痰多涌出的，是肾虚水泛所致，配合六味丸。口干咽燥，虚火上炎的，配合加减八味丸。如果发热喘息唾脓血，饮食不入，属于败症。这都是因为脾土亏损不能生肺金，肺金不能生肾水；如果能补脾肺、滋肾水，大多能够存活。如果面赤脉大的，难治；面黄白脉浮涩的，易治。如果呕脓不止，不治。呕脓自止，自愈（治疗验案见《妇人良方》、《外科枢要》）。
治疗肛门前后生痈，称为悬痈。用粉草一两，截断，用涧水浸润，炙烤至透内，细切，用无灰酒煎服。有人患此症已经破溃，服用两剂，疮口即愈合。
我按语∶前症发生在阴茎之后，肛门之前，属于足三阴经亏损的病症。轻则为漏，沥尽气血而死；重则内部溃烂立即死亡。通常治疗初起，湿热壅滞，未成脓作痛，或小便涩滞的，使用龙胆泻肝汤。肿痛严重的，使用仙方活命饮，并配合制甘草辅助治疗。如果不能成脓或不溃破的，使用八珍散主治。如果脓已成形的，急刺排脓，使其生肌收敛。肾虚的，使用六味地黄丸。血虚的，四物汤加人参、白术。气虚的，四君子汤加川芎、当归。脾虚的，使用补中益气汤。气血俱虚的，使用八珍汤、大补汤。如果使用寒凉消毒的方法就错了（治疗验案见《外科枢要》）。
[Background Information]
Book: *Waike Jingyao* (Essentials of Surgery)
Author: Chen Ziming
Dynasty: Song
Chapter: Chapter 55, Hong Chengxiang's Method Using Leeches / Empirical Miscellaneous Formulas for Carbuncles and Ulcers
Category: Surgery
**Treatment for Early-Stage Carbuncles and Ulcers (Skin and subcutaneous purulent infections)**
When treating early-stage carbuncles and ulcers, first take a pen tube, insert one leech (a type of aquatic worm), align the tube opening with the head of the sore, and allow the leech to suck the pus and blood from the wound. The toxicity will then dissipate. If the sore enlarges, replace three or four leeches. If a leech sucks at an acupoint, it will inevitably die. This method has been tested repeatedly with consistent efficacy. If bleeding does not stop, apply mud from lotus rhizomes to the affected area. If the head of the sore is indistinct, apply mud from beside a well; the area that dries first indicates the location of the sore head.
**My Commentary:** Once a carbuncle or ulcer has formed, toxic blood accumulates on the exterior. Using this method to suction it out is indeed beneficial, but it only treats the branch (symptoms). One must also examine whether the pathogenic factor is in the exterior or interior, and assess the deficiency or excess of Yuan Qi (Original Qi), then administer medication accordingly. Integrating internal and external treatments ensures complete safety.
**Empirical Formula for Treating Carbuncles Caused by Mineral Drugs**
Black Lead (1 jin / approx. 600g)
Licorice Root (3 liang / approx. 90g)
Place one dou (approx. 10 liters) of wine in a porcelain vessel. Place the Licorice Root on one side. Separately, melt the lead and pour it into the wine on the other side. Retrieve the lead, remelt it, and pour it back in again. Repeat this process nine times. Drink the medicinal wine until intoxicated and sleep; the condition will be cured.
**My Commentary:** The above formula is an excellent method for treating ulcers caused by mineral drugs. For patients with Qi and Blood deficiency, supplementation and support methods should still be employed.
**From *Zhouhou Fang* (Handbook of Prescriptions for Emergencies): Treatment for Severe Back Carbuncles (Life-Threatening Back Abscess)**
Take a winter melon, cut off one end, and place it over the sore. When the melon rots, cut a new piece and place it again. Continue until the melon is exhausted but the sore has stabilized, then apply a plaster.
**My Commentary:** If swelling and pain are severe and the pathogen is in the exterior, this method is most suitable for dispersing heat and extracting toxicity to unblock stagnation. If there is swelling, pain, thirst, and constipation, the pathogen is in the interior; one must assist with Huanglian Tang (Coptis Decoction) to unblock the fu organs and drain toxicity. If the pathogen is in the meridians, assist with Tuoli Rongwei Tang (Support Interior and Nourish Wei Decoction) to regulate Qi and Blood. This is optimal.
**Zhang Wenzhong’s Treatment for Stone Carbuncles Below the Ear (Hard Abscess) Not Suppurating**
Use Phytolacca radix (Shanglu Gen), pound it until soft, and apply frequently.
**My Commentary:** Phytolacca breaks Qi stagnation and softens hardness. If it is indeed a stone carbuncle, this formula is appropriate. If swelling and hardness are caused by anger stirring Liver Fire, accompanied by chills and fever, use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) plus Gouteng (Uncaria) and Zhizi (Gardenia Fruit) to nourish Qi and Blood and clear Liver Fire. If skin color remains unchanged with afternoon tidal fever and internal heat, use Xiaoyao San (Free and Easy Wanderer Powder) plus Longdancao (Gentian Root) to nourish Liver Blood and clear Liver Fire. If Liver Fire and Blood dryness cause tendon spasms or nodules like beads, use Chaishao Shenling San (Bupleurum and Peony with Ginseng and Poria Powder) plus Gouteng to nourish Qi and Blood, assisted by Liuwei Wan (Six-Ingredient Pill with Rehmannia) to generate Kidney Water. If symptoms fluctuate, this is due to Qi stagnation in Spleen and Lung with phlegm knotting; use Guipi Tang (Restore the Spleen Decoction) and Liujun Zi Tang (Six-Gentlemen Decoction) harmoniously. If previous medicines fail, assist with Haizao Wan (Seaweed Pill) to dissipate hardness. The Classics state: "Injury to form causes pain; injury to Qi causes swelling." Do not lightly use formulas that move Qi and break Blood (Symptom management seen in *Waike Shuyao*).
**Treatment for Carbuncles, Ulcers, and Furuncles**
Use raw Deer Antler Tip. Grind it with rice vinegar in a stone mortar until it forms a paste. Apply around the periphery of the affected area. After one or two days, the lesion may resolve internally.
**My Commentary:** The above method promotes internal resolution. If ineffective, one must examine whether the pathogen is in the exterior or interior and assess the patient's deficiency or excess before treating. Do not treat the exterior while neglecting the interior.
**Treatment for Carbuncles and Ulcers**
Use raw Licorice Root ground into powder. Mix with wine and take 2 qian (approx. 6g). Take several doses consecutively; the lesion will spontaneously resolve.
**My Commentary:** The above formula is a heat-clearing and detoxifying agent. It is most suitable for cases caused by accumulation of heat from rich foods or toxicity from minerals, leading to Qi and Blood stagnation. However, for those with weak Spleen and Stomach and stagnant Qi and Blood, it should not be used indiscriminately, as it may cold-injure the Stomach Qi.
**Shengma Tang (Cimicifuga Decoction): Treatment for Lung Carbuncle**
Symptoms: Pain between chest and breast, vomiting of foul-smelling purulent blood.
Ingredients:
Chuan Shengma (Rhizoma Cimicifugae)
Kugen (Radix Platycodi)
Yiyiren (Semen Coicis)
Diyu (Radix Sanguisorbae)
Huangqin (Radix Scutellariae)
Chi Shaoyao (Radix Paeoniae Rubra)
Mudanpi (Cortex Moutan)
Gancao (Radix Glycyrrhizae)
(All in equal parts)
Grind into powder. Take 1 liang (approx. 30g) per dose, decoct in water, and drink.
**My Commentary:** The above formula is an excellent agent for detoxification, heat-clearing, and pus-draining. If ineffective, use Jiegeng Tang (Platycodon Decoction). For cough, shortness of breath, and scanty urination, assist with Renshen Bufeitang (Ginseng Lung-Supporting Decoction). For fatigue, poor appetite, cough, or shortness of breath, assist with Shen Zhu Buweitang (Ginseng and Atractylodes Stomach-Supporting Decoction). For profuse coughing with phlegm, this indicates Kidney deficiency with overflowing water; assist with Liuwei Wan (Six-Ingredient Pill with Rehmannia). For dry mouth and throat with defying deficient fire, assist with Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If fever, wheezing, expectoration of pus and blood occur, and food intake is impossible, it is a critical failure syndrome. This results from Spleen Earth deficiency failing to generate Lung Metal, and Lung Metal failing to generate Kidney Water. By tonifying Spleen and Lung and nourishing Kidney Water, many can survive. If the face is red and pulse large, it is difficult to treat; if the face is yellow-white and pulse floating and choppy, it is easy to treat. If vomiting of pus does not cease, it is untreatable. If vomiting of pus stops spontaneously, recovery occurs (Clinical cases seen in *Furen Liangfang* and *Waike Shuyao*).
**Treatment for Carbuncles Before and After the Anus, Known as Xuan Yong (Hanging Carbuncle)**
Use 1 liang (approx. 30g) of Fencacao (Licorice Root). Cut it, soak in spring water, roast thoroughly until permeated, finely chop, decoct in pure wine (without ash), and drink. Someone suffering from this who had already ruptured healed after taking two doses.
**My Commentary:** The aforementioned condition occurs behind the penis and in front of the anus, belonging to deficiency syndromes of the Three Yin Meridians of Foot. Mild cases become fistulas, draining all Qi and Blood leading to death; severe cases involve internal rupture and immediate demise. Typically, for early stages with damp-heat stagnation, pain without suppuration, or dysuria, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). For severe swelling and pain, use Xianfang Huoming Yin (Immortal Life Saving Decoction), assisted by processed Licorice. If suppuration cannot form or does not rupture, use Bazhen San (Eight-Treasure Powder) as the main treatment. If pus has formed, urgently puncture to drain, aiming for tissue regeneration and contraction. For Kidney deficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For Blood deficiency, use Siwu Tang (Four-Substance Decoction) plus Ren Shen and Bai Zhu. For Qi deficiency, use Sijun Zi Tang (Four-Gentlemen Decoction) plus Chuan Xiong and Dang Gui. For Spleen deficiency, use Buzhong Yiqi Tang (Center-Supplementing Qi-Augmenting Decoction). For combined Qi and Blood deficiency, use Bazhen Tang (Eight-Treasures Decoction) or Dabu Tang (Great Tonifying Decoction). Using cold-cooling detoxifying agents would be a mistake (Clinical cases seen in *Waike Shuyao*).