李氏云∶脑疽及颈项有疽，不可用隔蒜灸，恐引毒上攻，宜灸足三里穴五状，气海穴三
七壮，仍服凉血化毒之药，或以骑竹马穴法灸之。凡头项咽喉生疽，古法皆为不治，若用此
法，多有生者。如五香连翘漏芦等汤，国老膏、万金散，皆可选用。
愚按∶前症属膀胱经，或湿热上壅，或阴火上炎。若因湿热，则病气有余，元气不足，
当用黄连消毒散以除湿毒，用补中益气汤以滋化源。若因阴火，则元气病气俱不足，当用补
中益气汤及六味地黄丸，以滋肾水。若肾水干涸，中传末症，急用加减八味丸及补中益气
汤，以固根本，引火归源。若色黯不溃，或溃而不敛，名曰脑烁，不治。大凡肿 痛甚，宜
活命饮，隔蒜灸之，解散瘀血，拔引郁毒，但艾炷宜小而少。若欲其成脓腐溃，生肌收敛，
并用托里为主。
附治验
一妇人患头项俱肿，痛不可当，发热作渴，喜冷。内服清热，外敷寒凉，色黯不 ，胸
中气噎，此阳气虚寒。彼泥素有痰火，不受温补。余用参、 各五钱，姜、桂各二钱，一剂
肿顿起而溃，又用大补药而愈。凡疮疽肿高痛甚，烦渴饮冷，此病气元气俱有余，宜用清热
消毒散、仙方活命饮为主。若肿高痛甚，口干饮热，此病气有余，元气不足，宜用托里消毒
散、参 四补散为主。若漫肿微痛，食少体倦，此病气元气俱不足，宜用六君、补中二汤壮
其脾胃，则未成者消，已成者溃，已溃者敛矣。
儒者胡本中之内，冬患之，肿痛热渴，脉洪数实，用清热消毒之药，溃脓而愈。次年三
月，其舌肿大，遍身患紫疔如葡萄，不计其数，手足尤多，各刺出黑血，此脾胃受毒。先服
夺命丹七粒，出臭汗，疮热益甚，便秘。二日，与大黄、芩、连各三钱，升麻、白芷、山
栀、薄荷、连翘各二钱，生甘草一钱，水煎三五沸服之，大小便出臭血甚多，下体稍退。乃
磨入犀角汁再服，舌本及齿缝出臭血，诸毒顿消，更用犀角地黄汤而愈。
李氏说：脑疽以及颈项部发生的疽，不可以使用隔蒜灸法，恐怕会引动毒邪向上攻冲，适宜灸足三里穴五壮，气海穴三至七壮，同时服用凉血化毒的药物，或者采用骑竹马穴灸法。凡是头、项、咽喉部位生疽，古法都认为是无法治愈的，如果采用这种方法，大多能够存活。像五香连翘漏芦汤等方剂，国老膏、万金散，都可以酌情选用。
我按语认为：上述病症属于膀胱经病变，或者是湿热上壅，或者是阴火上炎。如果是由于湿热所致，则病气有余而元气不足，应当使用黄连消毒散来清除湿毒，使用补中益气汤以滋养化源。如果是由于阴火所致，则元气和病气都不足，应当使用补中益气汤及六味地黄丸，以滋补肾水。如果肾水枯竭，病情传变出现末症（危重症状），急需使用加减八味丸及补中益气汤，以固护根本，引火归源。如果疮色暗紫且不溃破，或者溃破后不能收敛，称为“脑烁”，属于不治之症。大凡肿痛剧烈的，适宜使用仙方活命饮，配合隔蒜灸法，以解散瘀血，拔引郁积之毒，但艾炷宜小且数量宜少。如果想要促使脓成腐溃、生肌收敛，均以托里法为主。
附治疗验案
一位妇女患头项部均肿胀，疼痛难忍，发热口渴，喜饮冷水。内服清热药，外敷寒凉药，导致疮色暗紫而不溃破，胸中气机阻塞，这是阳气虚寒的表现。患者拘泥于素有痰火的旧疾，拒绝接受温补治疗。我用人参、黄芪各五钱，干姜、肉桂各二钱，一剂药后，肿胀顿时隆起并溃破，随后又用大补药物而痊愈。凡是疮疽肿高疼痛剧烈，烦躁口渴喜冷饮，这是病气和元气都有余，适宜使用清热消毒散、仙方活命饮为主。如果肿高疼痛剧烈，口干想喝热水，这是病气有余，元气不足，适宜使用托里消毒散、参芪四补散为主。如果漫肿微痛，食少体倦，这是病气和元气都不足，适宜使用六君子汤、补中益气汤两方强壮脾胃，那么未形成的可消散，已形成的可溃破，已溃破的可收敛愈合。
儒生胡本中的妻子，冬季患病，肿痛发热口渴，脉象洪数有力，使用清热消毒类药物，溃脓后痊愈。次年三月，她的舌头肿大，全身患上紫色疔疮如葡萄状，数量不计其数，手足部位尤其多，分别针刺放出黑血，这是脾胃受毒。先服用夺命丹七粒，排出臭汗，疮热更加严重，便秘。两天后，给予大黄、黄芩、黄连各三钱，升麻、白芷、山栀、薄荷、连翘各二钱，生甘草一钱，水煎煮三五沸后服用，大小便排出大量臭血，下半身症状稍退。于是磨入犀角汁再次服用，舌根及齿缝排出臭血，各种毒邪顿时消除，最后再用犀角地黄汤而痊愈。
Li stated: For brain carbuncle (Nao Ju) and carbuncles occurring on the neck, moxibustion with garlic partition should not be used, as it may induce pathogenic toxins to attack upward. It is appropriate to apply moxibustion to Zusanli (ST36) for five cones (zhuang), Qihai (CV6) for three to seven cones, while simultaneously administering herbs that cool blood and resolve toxins. Alternatively, the "Riding Bamboo Horse" acupoint moxibustion method can be used. In ancient practice, carbuncles arising in the head, neck, or throat were considered incurable; however, if this method is employed, many patients survive. Formulas such as Wuxiang Lianqiao Loulu Decoction, Guolao Paste, and Wanjin Powder are all suitable options.
My commentary: The aforementioned conditions belong to the Bladder Meridian, caused either by damp-heat obstructing upwards or by ministerial fire flaming upward. If due to damp-heat, there is an excess of pathogenic qi but a deficiency of healthy qi. One should use Huanglian Xiaodu San (Coptis Decoction for Clearing Toxins) to eliminate damp-toxin, and Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment Qi) to nourish the source of transformation. If due to ministerial fire, both healthy qi and pathogenic qi are deficient. One should use Buzhong Yiqi Tang combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney water. If Kidney water is exhausted and the disease progresses to terminal symptoms, Jiajian Bawei Wan (Modified Eight-Ingredient Pill) and Buzhong Yiqi Tang should be urgently administered to consolidate the root and guide fire back to its source. If the lesion is dark purple and does not suppurate, or suppurates but fails to heal, it is termed "Brain Scorched" (Nao Shuo) and is incurable. Generally, when swelling and pain are severe, Xianfang Huoming Yin (Immortal Formula for Preserving Life) should be used, combined with garlic-partitioned moxibustion to dissipate blood stasis and draw out stagnant toxins; however, the moxa cones should be small and few in number. To promote suppuration, necrosis discharge, flesh regeneration, and wound contraction, the primary approach should be tonifying the interior (Tuoli).
Attached Treatment Cases
A woman suffered from swelling in both the head and neck, unbearable pain, fever, thirst, and a preference for cold drinks. After taking internal heat-clearing medicines and applying external cooling agents, the lesion became dark purple without suppurating, and she experienced chest oppression. This indicated deficiency-cold of Yang qi. She adhered to her prior condition of phlegm-fire and refused warm-tonic treatment. I prescribed Ren Shen (Codonopsis Root / Ginseng Radix) and Huang Qi (Astragalus Root) at 5 qian each, Gan Jiang (Dried Ginger Rhizome) and Rou Gui (Cinnamon Bark) at 2 qian each. After one dose, the swelling rapidly rose and suppurated. Subsequently, she was treated with major tonic medicines and recovered. Generally, when sores and carbuncles present with high swelling, severe pain, irritability, thirst, and a desire for cold drinks, both pathogenic qi and healthy qi are in excess. Qingre Xiaodu San (Powder for Clearing Heat and Resolving Toxins) and Xianfang Huoming Yin should be the main treatments. If there is high swelling, severe pain, dry mouth, and a desire for hot drinks, pathogenic qi is in excess while healthy qi is deficient. Tuoli Xiaodu San (Powder for Supporting the Interior and Resolving Toxins) and Shenqi Sibusa San (Four-Tonic Powder with Ginseng and Astragalus) should be the main treatments. If there is diffuse swelling, slight pain, poor appetite, and physical fatigue, both pathogenic qi and healthy qi are deficient. Liujunzi Tang (Six-Gentlemen Decoction) and Buzhong Yiqi Tang should be used to strengthen the Spleen and Stomach. Thus, unformed lesions will dissipate, formed lesions will suppurate, and suppurated lesions will heal.
The wife of the Confucian scholar Hu Benzhong contracted the disease in winter, presenting with swelling, pain, heat, thirst, and a surging, rapid, and full pulse. She was treated with heat-clearing and toxin-resolving medicines, suppurated, and recovered. In March of the following year, her tongue swelled, and she developed numerous purple ding (hard nodules/boils) resembling grapes all over her body, especially on the hands and feet. Black blood was pricked out from each. This indicated toxicity affecting the Spleen and Stomach. First, Duoming Dan (Life-Snatching Pill) was administered, seven pills. Stinky sweat was excreted, but the sore heat intensified, accompanied by constipation. Two days later, Da Huang (Rhubarb Root), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome) at 3 qian each, Shengma (Cimicifuga Rhizome), Baizhi (Angelica Dahurica Root), Shanzhi (Gardenia Fruit), Bohe (Mint Herb), Lianqiao (Forsythia Fruit) at 2 qian each, and Sheng Gancao (Raw Licorice Root) at 1 qian were decocted in water, boiled for three to five boils, and taken orally. Large amounts of stinky blood were passed via urination and defecation, and symptoms in the lower body subsided slightly. Then, Xijiao (Rhinoceros Horn - *Note: Modern substitutes like Water Buffalo Horn are used*) juice was ground into the preparation and administered again. Stinky blood was discharged from the base of the tongue and gum margins. All toxins were instantly resolved, and she finally recovered after taking Xijiao Dihuang Tang (Rhino-Horn and Rehmannia Decoction).