伍氏曰∶痈溃之后，败肉渐去，新肉渐生，日见堆阜，方成白膜新肉，当滋养平复无
虞。大凡疮口未可速合，日用猪蹄汤洗去恶浊，外敷生肌膏、神异膏，毒脓出尽，可用圣效
散以合疮口，更慎起居，节饮食，戒七情，否则虚症蜂起，多致不救。慎之！
愚按∶前症，败肉去而新肉生者，须先微赤，四沿渐生白膜者，此胃中生气也，用四君
子汤以培补之。若赤甚者，血虚而有火也，用四物加参、 、白术以调补之，若赤而不生膜
者，气虚也，用四君加当归、黄 ，若色白而无神者，气血俱虚也，用十全大补加姜、桂。
如不应，急加附子。大凡疮疽溃后，败肉渐去，新肉渐生，此乃脾胃之气充实也。若恶浊已一
去，宜用当归膏。
伍氏曰∶痈疽一症，病患当自体察。凡初作，先以墨围患处，却视浮沉聚散，脓出视其
多少，肉生视其阔狭，饮食视其美恶，脏腑防其秘泄，疮口防其奢裂。宜戒怒节劳，调补元
气，保爱体察，慎不可忽。
愚按∶前论，即丹溪先生所云，痈疽当先助胃壮气，使根本坚固。东垣先生教人以饮食
有节，起居有时。素问反复言之，可不慎哉。太凡泄泻，易损元气，肿疡犯之，不能成脓，
溃疡犯之，不能生肌，患者慎之。
附治验
太守朱阳山之内，年五十二，四月四日，背当心生疽如栗，三日渐大，根盘五寸许，不
肿痛，不寒热，脉微而沉。余曰∶实则痛，虚则痒，不发不治，溃而不敛亦不治。乃与大补
阳气之剂，色白而黯，疮势如故，神疲食减，小便淋涩。乃与大补气血，加姜、桂二剂，疮
亦不起。十五日涉怒呕泻并作，复与大补药一剂，疮仍不起，留前药二剂，昏愦不服。或劝
之，省悟，根据方连进七剂，十六日疮起而溃，色红而淡。十九日与大补二十余剂，后因劳自
汗，口干舌强，太阳发际、脑顶俱胀，此血气俱虚，肝胆火上炎，用补中益气加山栀、芍
药，顿愈。但内热少睡，手足发热，不时霍热，用逍遥散加山栀，热退，复用归脾汤，疮亦
愈。计疮发及敛，凡四十二日，未尝一用攻疮之药。
江阴举人陈鸣岐，寓京患背疽，用大补之剂而愈。翌日欲回，先期设席作谢，对谈如
常。是晚得家信，大拂其意，恼怒发热作渴，食梨子少许，至夜连泻数次，早促余视，脉已
脱矣，竟至不起。夫梨者，利也， 利下行之物，凡脾胃虚寒，产妇金疮者，皆当忌之。
伍氏说：痈疽溃破之后，腐败的肌肉逐渐脱落，新生的肌肉逐渐生长，每天都能看到肉芽隆起，形成白色的薄膜和新肉，此时应当注意滋养调理，使疮口平复，就没有危险了。大凡疮口不可以急于求成使其快速愈合，每日应用猪蹄汤清洗以去除污秽恶浊之物，外部敷贴生肌膏、神异膏；待毒脓排尽后，可用圣效散来促进疮口愈合。更要谨慎起居生活，节制饮食，戒除七情（喜、怒、忧、思、悲、恐、惊）的过度波动，否则虚证会蜂拥而起，多导致无法救治。务必谨慎！
我按语认为：前述病症中，腐败肌肉去除而新肉生长的情况，必须先见微红，四周逐渐生出白色薄膜，这是胃气中生发之气的表现，应使用四君子汤（人参、白术、茯苓、甘草组成的补气方剂）来培补脾胃之气。如果红肿严重的，是血虚而有火邪，应使用四物汤（熟地黄、当归、白芍、川芎组成的补血方剂）加入人参、[此处原文缺字，通常指黄芪或类似补气药]、白术来调和补益；如果发红但不生白膜的，是气虚，应使用四君子汤加入当归、[此处原文缺字，通常指黄芪]；如果颜色苍白且无神采的，是气血俱虚，应使用十全大补汤（四君子汤加四物汤再加黄芪、肉桂组成的大补气血方剂）加入生姜、肉桂。如果不见效，紧急情况下加入附子。大凡疮疽溃破后，腐败肌肉渐去，新肉渐生，这是脾胃之气充实的表现。如果污秽恶浊已清除，宜使用当归膏。
伍氏说：痈疽这一病症，患者应当自己体察病情。凡是初起时，先用墨汁在患处周围画圈标记，然后观察肿势的浮沉、聚散情况；脓液流出时观察其多少；肌肉生长时观察其宽窄；饮食状况观察其好坏；脏腑要防止便秘或泄泻；疮口要防止过度裂开。应当戒除愤怒，节制劳累，调养补益元气，保重爱护并仔细体察，切不可疏忽大意。
我按语认为：上述论述，就是丹溪先生所说的，治疗痈疽应当先助益胃气、壮大元气，使根本坚固。东垣先生教导人们饮食要有节制，起居要有规律。《素问》中反复强调这一点，能不谨慎吗？大凡泄泻，容易损伤元气，如果在肿疡阶段发生泄泻，不能化脓；在溃疡阶段发生泄泻，不能生肌，患者务必谨慎。
附治疗验案：
太守朱阳山的夫人，五十二岁，四月四日，背部心俞穴附近长出如栗子大小的疽，三天后变大，根盘直径约五寸，不肿痛，没有寒热症状，脉象微而沉。我说：“实证则痛，虚证则痒，不发出来不治，溃破后不收敛也不治。”于是给予大补阳气的药剂，但疮色白而暗，疮势如故，精神疲倦，食欲减退，小便淋漓涩痛。于是给予大补气血的药剂，加入生姜、肉桂，服用两剂后，疮仍未起发。十五日因恼怒导致呕吐泄泻并作，又给予大补药剂一剂，疮仍不起，留下前药两剂，患者昏迷困倦不愿服用。有人劝解，患者醒悟，根据处方连续进服七剂，十六日疮起并溃破，颜色红而淡。十九日给予大补药剂二十余剂，后来因劳累导致自汗，口干舌强，太阳经发际处、头顶均感胀痛，这是气血俱虚，肝胆之火上炎，使用补中益气汤（黄芪、人参、白术、甘草、当归、陈皮、升麻、柴胡组成的补气升阳方剂）加入山栀、芍药，顿时痊愈。但仍有内热、少睡、手足发热、不时阵发性燥热，使用逍遥散（柴胡、当归、白芍、白术、茯苓、甘草、薄荷、生姜组成的疏肝健脾养血方剂）加入山栀，热退后，复用归脾汤（党参、龙眼肉、酸枣仁、白术、茯苓、黄芪、当归、远志、木香、甘草、大枣组成的益气补血、健脾养心方剂），疮也痊愈了。计算从发病到收敛，共四十二天，未曾使用过一味攻伐疮毒的药物。
江阴举人陈鸣岐，寓居京城时患背疽，使用大补药剂而痊愈。第二天准备返回，提前设宴答谢，交谈如常。当晚收到家信，非常违背心意，恼怒发热口渴，吃了几片梨子，到了夜里连泻数次，早晨急忙让我诊治，脉象已经散脱，最终未能挽救。梨性滑利，是向下通利的食物，凡是脾胃虚寒、产妇、金疮患者，都应当忌食。
Wu said: After the abscess ulcerates, the necrotic flesh gradually disappears, and new flesh gradually grows. Daily observation reveals raised granulation tissue, forming a white membrane and new flesh. At this stage, nourishment and regulation are required to ensure flat healing without danger. Generally, wound closure should not be rushed. The area should be washed daily with Pig Trotter Decoction (Zhuti Tang) to remove foul impurities, and externally applied with Flesh-Generating Ointment (Shengji Gao) or Miraculous Ointment (Shenyi Gao). Once all toxic pus is discharged, Sacred Efficacy Powder (Shengxiao San) can be used to promote wound closure. One must also be cautious with daily routine, regulate diet, and guard against excessive emotional fluctuations (Seven Emotions); otherwise, deficiency syndromes will arise in swarms, often leading to untreatable conditions. Be extremely cautious!
My commentary: Regarding the aforementioned condition, when necrotic flesh is removed and new flesh grows, it must first appear slightly red, with a white membrane gradually forming around the edges. This indicates the generation of Qi from the Stomach. Use Four Gentlemen Decoction (Sijunzi Tang) to cultivate and tonify Qi. If redness is severe, it indicates Blood deficiency with Fire; use Four Substances Decoction (Siwu Tang) added with Ginseng, [missing character, likely Astragalus], and Atractylodes Macrocephala Rhizome (Baizhu) to harmonize and tonify. If red but no membrane forms, it indicates Qi deficiency; use Four Gentlemen Decoction added with Angelica Sinensis Radix (Danggui) and [missing character, likely Astragalus]. If the color is pale and lacks luster, it indicates dual deficiency of Qi and Blood; use Ten Great Tonifying Decoction (Shiquan Dabujun Wan/Tang) added with Ginger and Cinnamon Twig (Guizhi). If there is no response, add Aconite Lateralis Radix Preparata (Fuzi) urgently. Generally, after an abscess or carbuncle ulcerates, the gradual disappearance of necrotic flesh and growth of new flesh indicates the sufficiency of Spleen and Stomach Qi. Once foul impurities are cleared, Angelica Sinensis Radix Ointment (Danggui Gao) should be used.
Wu said: For the syndrome of abscess and carbuncle, the patient must self-monitor. When it first appears, mark the affected area with ink, then observe the floating/sunken nature and aggregation/dispersion of the swelling. Observe the amount of pus discharge, the width/narrowness of flesh regeneration, and the quality of diet. Prevent constipation or diarrhea of the Zang-Fu organs, and prevent excessive splitting of the wound. One should avoid anger, conserve energy, regulate and tonify Yuan Qi, and protect oneself with careful observation. Do not neglect this.
My commentary: The above discussion aligns with what Master Danxi stated: treating abscesses and carbuncles requires first assisting Stomach Qi and strengthening Yuan Qi to solidify the root. Master Dongyuan taught that diet should be regulated and daily routine regular. The *Suwen* repeatedly emphasizes this; how can one be careless? Generally, diarrhea easily damages Yuan Qi. If it occurs during the tumorous stage (swelling), pus cannot form; if it occurs during the ulcerated stage, flesh cannot regenerate. Patients must be cautious.
Attached Treatment Case:
The wife of Prefect Zhu Yangshan, aged 52, developed a carbuncle on her back at the Xinshu acupoint region on April 4th, resembling a chestnut. Within three days, it enlarged to a base diameter of about five cun. It was neither painful nor swollen, with no chills or fever, and the pulse was faint and deep. I said: "Excess causes pain, deficiency causes itching. If it does not erupt, it is untreatable; if it ulcerates and does not heal, it is also untreatable." Therefore, I administered a formula to greatly tonify Yang Qi. However, the lesion remained white and dull, the condition unchanged, with mental fatigue, reduced appetite, and dysuria. Subsequently, I administered a formula to greatly tonify Qi and Blood, added with Ginger and Cinnamon Twig. After two doses, the lesion still did not erupt. On the 15th day, due to anger, vomiting and diarrhea occurred simultaneously. Another dose of the great tonifying formula was given, but the lesion still did not erupt. Two doses of the previous formula were left, but the patient was confused and refused to take them. Persuaded by others, she regained clarity and continued taking the prescription for seven doses. On the 16th day, the lesion erupted and ulcerated, appearing red and pale. On the 19th day, over twenty doses of the great tonifying formula were given. Later, due to exertion, spontaneous sweating occurred, accompanied by dry mouth, stiff tongue, and distension/pain at the hairline of the Taiyang channel and the vertex of the head. This indicated dual deficiency of Qi and Blood, with Liver-Gallbladder Fire flaming upward. I used Tonifying the Middle and Augmenting Qi Decoction (Buzhong Yiqi Tang) added with Gardenia Fruit (Shanzhi) and White Peony Root (Shaoyao), resulting in immediate recovery. However, internal heat, insomnia, hot sensations in hands and feet, and intermittent paroxysmal heat persisted. I used Free and Easy Wanderer Powder (Xiaoyao San) added with Gardenia Fruit. After the heat subsided, I used Gui Pi Decoction (Guipi Tang), and the wound healed. From onset to healing, it took 42 days, without using a single herb for attacking/toxicity-clearing purposes.
Chen Mingqi, a Juren (degree holder) from Jiangyin, suffered from a back carbuncle while residing in the capital. He recovered using great tonifying formulas. The next day, he intended to return home and held a banquet in advance to express gratitude. His conversation was normal. That evening, he received a family letter that greatly displeased him. Anger led to fever and thirst. He ate a few slices of pear. By night, he suffered multiple episodes of diarrhea. In the morning, he urgently summoned me. His pulse had scattered/disappeared, and he ultimately died. Pears are slippery and promoting downward movement. They should be avoided by those with Spleen-Stomach deficiency-cold, postpartum women, and patients with traumatic injuries.