李氏云∶痈疽不服内托散，或失宣内毒，致咽喉口舌生疮，甚则生红黑菌，害人甚速，
当用琥珀犀角膏治之。向有患此症者，诸法不效，余用此药，一日而安。
愚按∶前症多因酒色过度，亏损肾水，虚火上炎，或五疳，元气消烁，虚火上攻而致。
治当滋其化源，最忌黄柏、知母之类，恐复伤胃气也。
附治验
大尹王汝邻，两足发热，吐痰如涌，左尺数而无力。余谓足三阴虚。彼反服四物、二
陈、黄柏、知母之类，喉舌作痛，又服清热败毒之剂，其舌如赤桃，脉洪数而无力。此脾肺
复伤，肾经亏甚，虚火上炎，水泛而为痰也。当滋化源以生肾水，遂用补中益气汤，六味地
黄丸而愈。
二守韩宗器，不慎起居，舌胀如菌，痰涌便秘，服芩连、二陈之类，脉浮而数，欲针出
血。余谓此足三阴亏损之症，且有形而不痛者，阴之类也，法当峻补其阴，毋损其血，况虚
浮之脉乎？遂朝补脾肺，夕滋肾肝而愈。后因大劳，面目俱赤，遍身搔痒，时已仲冬。余
曰∶大热而甚，寒之不寒，是无水也。乃用制火壮水之剂而愈。
摇城金允文，舌胀吐痰，反服降火化痰，针刺出血，便秘痰甚。余诊之，左尺关洪数，
右寸关弦数，用滋肾水生肝血益脾胃之剂，诸症少愈。因近火，顿面赤身痒，六脉弦数。余
谓此水竭火升之象，难免于春二月矣，于次年清明日果卒。
琥珀犀角膏
真琥珀（研） 犀角（镑各一钱） 辰砂（研极细） 茯神（去皮心各二钱） 片脑（研一字）
人参（三钱） 酸枣仁（去皮炒二钱）
上为末，炼蜜丸弹子大，每服一丸，麦门冬煎汤化下。
愚按∶前方虽有人参、茯神、酸枣仁安神补气，但琥珀等四品气味辛散，恐亏损真气，
须审症而用之可也。
李氏云∶痈疽之症，不服托里之药，热毒内攻，喉舌生疮，甚效黑烂，当服犀角散以解其毒。
犀角屑 玄参 升麻 黄 赤芍药 麦门冬（去心） 生粉草 当归（各一两） 大黄（微炒三两）
上为粗末，每服三钱，水煎。
愚按∶前方破血降火内 之剂也。若其脉沉实，大便秘结，发热作渴喜饮冷者，属热蓄
于内，方可用之。若其脉虚浮，大便不结，发热作渴，畏饮冷者，乃属血虚于外，可用当归
补血汤。若尺脉洪数而无力，发热作渴，小便频数者，属肾水不足，虚火上炎，宜用加减八
味丸。盖此症多因肾水亏损，虚火上炎，故也。
李氏说：患痈疽病如果不服用内托散，或者未能及时宣发体内的毒素，导致咽喉和口舌生出疮疡，严重时甚至长出红黑色的菌状物，危害生命非常快，应当使用琥珀犀角膏来治疗。过去有患这种病症的人，各种方法都不见效，我使用这个药，一天就痊愈了。
我认为：前面的病症大多是因为酒色过度，亏损了肾水，虚火上炎；或者是五疳（小儿五种疳积病），元气消减耗损，虚火上攻所致。治疗应当滋生化之源，最忌讳使用黄柏、知母这类药物，恐怕会再次损伤胃气。
附治验案例
大尹王汝邻，两脚发热，吐痰如涌出般多，左尺脉数而无力。我认为这是足三阴经虚损。他却反而服用了四物汤、二陈汤、黄柏、知母之类的药物，导致喉舌疼痛，又服用了清热败毒的药剂，舌头像赤桃一样红，脉象洪大而数且无力。这是脾肺再次受伤，肾经亏虚严重，虚火上炎，水液泛滥而成痰。应当滋生化之源以生养肾水，于是使用补中益气汤和六味地黄丸而痊愈。
二守韩宗器，不注意起居作息，舌头肿胀如菌状，痰多涌出，便秘，服用了黄芩、黄连、二陈汤之类的药物，脉象浮而数，想要针刺放血。我说这是足三阴经亏损的病症，而且是有形但不痛的，属于阴证一类，法度上应当峻补其阴，不要损耗其血，何况是虚浮的脉象呢？于是早晨补益脾肺，晚上滋补肾肝而痊愈。后来因为过度劳累，面目都发红，全身瘙痒，当时已是仲冬时节。我说：大热非常严重，用寒凉药不能退热，这是无水（肾阴枯竭）的表现。于是使用制火壮水的药剂而痊愈。
摇城金允文，舌头肿胀，吐痰，反而服用了降火化痰的药，针刺放血，便秘痰多。我诊察他的脉象，左尺、关脉洪数，右寸、关脉弦数，使用了滋肾水生肝血、益脾胃的药剂，各种症状稍微好转。因为靠近火源，顿时面红身痒，六脉弦数。我说这是水竭火升的现象，难免在春二月去世，果然在次年清明日逝世。
琥珀犀角膏配方
真琥珀（研碎） 犀角（镑片，各一钱） 辰砂（研极细） 茯神（去皮心，各二钱） 片脑（即冰片，研一字量）
人参（三钱） 酸枣仁（去皮炒，二钱）
以上药物研为末，用炼蜜制成弹子大小的丸剂，每次服用一丸，用麦门冬煎汤化开送下。
我认为：前面的方子虽然有人参、茯神、酸枣仁安神补气，但琥珀等四种药材气味辛散，恐怕会亏损真气，必须审察病情后使用才可以。
李氏说：痈疽这类病症，不服用托里（扶正祛邪）的药物，热毒内攻，喉舌生疮，严重时黑烂，应当服用犀角散来解除其毒性。
犀角屑 玄参 升麻 黄芪 赤芍药 麦门冬（去心） 生甘草 当归（各一两） 大黄（微炒三两）
以上药物制成粗末，每次服用三钱，用水煎煮。
我认为：前面的方子是破血降火、内泄的药剂。如果脉象沉实，大便秘结，发热口渴喜欢喝冷饮的，属于热蓄积于内，才可以使用它。如果脉象虚浮，大便不结，发热口渴，害怕喝冷饮的，属于血虚于外，可以使用当归补血汤。如果尺脉洪数而无力，发热口渴，小便频数的，属于肾水不足，虚火上炎，适宜使用加减八味丸。大概这个病症多因肾水亏损，虚火上炎所致。
Li stated: If patients with carbuncles and sores (Yong Ju, 痈疽) do not take Neituo San (Internal Support Powder), or fail to properly disperse internal toxins, it may lead to sores in the throat and tongue. In severe cases, red and black fungal-like growths may appear, causing rapid death. One should use Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment) for treatment. Previously, there was a patient with this condition who did not respond to various methods. I used this medicine, and he recovered within one day.
I observe: The aforementioned conditions are mostly caused by excessive indulgence in alcohol and sex, leading to depletion of Kidney Water (Kidney Yin). This results in Deficient Fire flaming upward, or it may be due to Wugan (Five types of childhood malnutrition syndromes), where Yuan Qi (Original Qi) is consumed and depleted, causing Deficient Fire to attack upwards. Treatment should focus on nourishing the source of transformation (Spleen and Stomach). It is most taboo to use herbs like Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), as they may further damage Stomach Qi.
Attached Clinical Cases
Wang Rulin, Grand Secretary, experienced heat in both feet and profuse expectoration of phlegm. His left Chi (Cun-Guan-Chi pulse position at the wrist) pulse was rapid but forceless. I diagnosed this as deficiency of the three Yin meridians of the foot. However, he took medicines such as Siwu Tang (Four Substance Decoction), Erchen Tang (Two Aged Things Decoction), Huangbai, and Zhimu. Consequently, his throat and tongue became painful. He then took heat-clearing and detoxifying agents. His tongue turned red like a peach, and his pulse became surging, rapid, yet forceless. This indicated that the Spleen and Lung were injured again, and the Kidney meridian was severely deficient. Deficient fire flared upward, and water overflowed to form phlegm. I treated him by nourishing the source of transformation to generate Kidney Water, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). He recovered.
Han Zongqi, Prefectural Governor, neglected his daily routine. His tongue swelled like a fungus, accompanied by profuse phlegm and constipation. He had taken Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Erchen Tang. His pulse was floating and rapid. He desired acupuncture bloodletting. I said this is a syndrome of deficiency in the three Yin meridians of the foot. Moreover, what is有形 (having form) but painless belongs to the Yin category. The method should be to vigorously tonify Yin without damaging Blood, especially given the floating and deficient pulse. Thus, I tonified the Spleen and Lung in the morning and nourished the Kidney and Liver in the evening. He recovered. Later, due to overexertion, his face and eyes turned red, and his whole body itched. It was already mid-winter. I said: "The heat is extreme, and cold treatments cannot cool it; this indicates a lack of Water (Kidney Yin)." I used formulas to control fire and strengthen water, and he recovered.
Jin Yunwen from Yaocheng had a swollen tongue and expectorated phlegm. He mistakenly took fire-descending and phlegm-resolving medicines and underwent acupuncture bloodletting. He suffered from constipation and severe phlegm. Upon diagnosis, his left Chi and Guan positions were surging and rapid, while the right Cun and Guan positions were wiry and rapid. I used agents to nourish Kidney Water, generate Liver Blood, and benefit the Spleen and Stomach. His symptoms improved slightly. Due to proximity to fire, his face suddenly turned red and his body itched; all six pulses became wiry and rapid. I said this is a sign of exhaustion of Water and rising Fire. He would likely not survive until the second month of spring. Indeed, he died on Qingming Festival the following year.
Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment)
Zhen Hupo (True Amber, ground) - 1 qian
Xijiao (Rhinoceros Horn, shaved) - 1 qian
Chensha (Cinnabar, ground extremely fine) - quantity not specified in text snippet, implied part of formula
Fushen (Poria with Hostwood, peeled and cored) - 2 qian
Pian Nao (Borneol, ground, amount equivalent to 'yi zi') - quantity not specified
Renshen (Ginseng Radix et Rhizoma) - 3 qian
Suanzaoren (Ziziphi Spinosae Semen, peeled and stir-fried) - 2 qian
Grind the above into powder. Make pills the size of a mustard seed using refined honey. Take one pill per dose, dissolved in decoction of Ophiopogonis Radix (Maidong).
I observe: Although the previous formula contains Renshen, Fushen, and Suanzaoren to calm the spirit and tonify Qi, the four items including Amber have acrid and dispersing properties, which may deplete True Qi. They must be used only after careful syndrome differentiation.
Li stated: For carbuncles and sores, if supportive interior-tonifying medicines are not taken, heat-toxins attack inward, causing sores in the throat and tongue. In severe cases, black rot occurs. One should take Xijiao San (Rhinoceros Horn Powder) to resolve the toxicity.
Xijiao Xie (Rhinoceros Horn shavings) - 1 liang
Xuanshen (Scrophulariae Radix) - 1 liang
Shengma (Cimicifugae Rhizoma) - 1 liang
Huangqi (Astragali Radix) - 1 liang
Chishaoyao (Red Peony Root) - 1 liang
Maidong (Ophiopogonis Radix, cored) - 1 liang
Sheng Gancao (Raw Licorice Root) - 1 liang
Danggui (Angelicae Sinensis Radix) - 1 liang
Dahuang (Rhei Radix et Rhizoma, lightly stir-fried) - 3 liang
Make into coarse powder. Take 3 qian per dose, decoct in water.
I observe: The previous formula is an agent that breaks blood, descends fire, and purges internally. If the pulse is deep and solid, with constipation, fever, thirst, and a preference for cold drinks, it belongs to heat accumulation inside, and this formula can be used. If the pulse is deficient and floating, with no constipation, fever, thirst, and aversion to cold drinks, it belongs to blood deficiency on the exterior, and Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) can be used. If the Chi pulse is surging and rapid but forceless, with fever, thirst, and frequent urination, it belongs to insufficiency of Kidney Water with Deficient Fire flaming upward. Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is appropriate. Generally, this syndrome is caused by depletion of Kidney Water and flaming of Deficient Fire.