曾氏云∶凡痈疽其脉浮数洪紧，肿 作痛，身热烦渴，饮食如常，此六腑不和，毒发于
外而为痈。其势虽急，投以凉剂，多保全生。其脉沉细伏紧，初发甚微，或无疮头，身不热
而内躁，体重烦疼，情绪不乐，胸膈痞闷，饮食无味，此五脏不和，毒蓄于内而为疽。急投
五香连翘汤，甚者转毒散、神仙截法、黄矾丸、国老膏，防托毒瓦斯，免致变症内攻，尤宜当
头隔蒜灸。若涂毒药，迷其腠理；投诸凉药，虚其真气。故其善恶之症，在乎医之工拙耳。
或气噫痞塞，咳逆身冷，自汗，目瞪耳聋，恍惚惊悸，语言颠倒，皆恶症也。五善见三则
瘥，七恶见四则危，五善并至则善无以加，七恶并臻则恶之剧矣。
愚按∶前症善者乃五脏未伤，病微邪浅，使能慎起居，节饮食，勿药自愈。恶者乃五
脏亏损之症，前哲虽云不治，若能补其脾胃，固其根本，多有可生者，岂可以其恶而遂弃
之耶。
附治验
邻人苏子遇之内，左手指患疔，麻痒，寒热恶心，左半体皆麻，脉数不时见。余曰∶凡
疮不宜不痛，不可大痛，烦闷者不治，今作麻痒，尤其恶也。用夺命丹二服，不应，又用解
毒之剂，麻痒始去，乃作肿痛。余曰∶势虽危，所喜作痛，但毒瓦斯无从而泄。欲针之，适值
望日，其家俱言尻神，不从，势愈肿甚。余强针之，诸症顿退，又用解毒之剂，其疮全愈。
辛丑孟夏，余至四明，有屠寿卿氏，当门齿忽如所击，痛不可忍，脉洪大而弦。余曰∶
弦洪相搏，将发疮毒也。先用清胃散，加白芷、银花、连翘一剂，痛即止。至晚，鼻上发一
疮，面肿黯痛，用前药加犀角一剂，肿至两额，口出秽气，脉益洪大，恶寒内热，此毒炽血
瘀，药力不能敌也。乃数砭患处出紫血，服犀角解毒之剂，翌日肿痛尤甚，乃砭患处与唇上，
并刺口内赤脉，各出毒血，再服前药至数剂而愈。
一妇人背患流注，内溃胀痛，服流气化痰之剂，自汗盗汗，脉大而弱，此元气亏损之症
也。与参、 各一两，归、术各五钱，肉桂二钱，服而针之。至夜半，始出稀脓二碗许。翌
日大汗倦甚，烦热作渴，扬手气促，脉洪大而数。仍用前药加附子一钱，炙甘草二钱，二
剂，脉症悉退。又以六君加姜、桂二十余剂，始离床褥。后因劳复，寒热作渴，汗出，时仲
冬，寝帏气出如雾，用十全大补加桂、附，二剂而痊。
中翰郑朝用，疽溃发热吐痰，饮食无味，肌肉不生，疮出鲜血。余曰∶此脾气亏损，不
能摄血归源也，法当补脾。彼不信，用消毒凉血之剂，加恶寒呕吐，始悟余言，用六君加炮
姜、半夏、茯苓，数剂诸症悉退。又用十全大补，疮口渐敛。后因饮食稍多，泄泻成痢，此
脾胃虚寒下陷，用补中益气，送四神丸，而痢止，继以六君子汤而疮愈。
一妇人，癸卯冬，失物发怒，缺盆内微肿。甲辰春，大如覆碗，左肩胛亦肿，肉色如
故。或针出鲜血三碗许，腹痛如锥，泄泻不止，四肢逆冷，呕吐恶寒，或时发热，绝食已七
日矣，其脉洪大，时或微细，此阳气脱陷也。用六君加炮姜三钱、附子二钱，早服，至午不
应，再剂加附子五钱，熟睡觉来，诸症顿退六七，少进稀粥。再四剂，诸症悉退，饮食如
故，缺盆始痛。针出清脓二碗许，诸症复至，此虚极也。以十全大补加姜、桂、附各一钱，
三剂而安。后减干姜、桂、附各五分，与归脾汤，兼服五十余剂而愈。
一男子，背疮漫肿微痛，食少体倦。余曰∶症属形病俱虚，法当补元气为主。彼不信，
乃用攻毒之剂，中央肉黯五寸许，恶症悉具，复求治。余曰∶此胃气虚寒，而变症作矣，当
急温补脾胃，则恶症自退，黯肉自生。仍不信，乃割死肉，祛恶症，遂致不起。
毛砺庵侧室，肚患痈月余矣，色黯不肿，内痛作呕，饮食不入，四肢逆冷，其脉或脱绝
或浮大，杂用定痛败毒之剂。余曰∶此气血俱虚而作痛，内决无脓，不治之症也。强用大温
补之药二剂，痛止，色赤，饮食少进。余谓但可延日而已。人皆以为有脓，复强针之，又
用大补之剂，始出清脓少许。众仍以为毒结于内，用攻脓保其必生，殊不知乃速其死耳，惜哉！
曾氏说：凡是痈疽，如果脉象浮数洪紧，局部肿胀疼痛，身体发热且烦躁口渴，饮食如常，这是六腑不和，毒邪发于体表而形成的痈。虽然病势急迫，但投用凉性药剂，大多能保全生命。如果脉象沉细伏紧，初起时症状很轻微，或者没有疮头，身体不发热但内心烦躁，身体沉重且烦痛，情绪低落不乐，胸膈部痞闷不适，饮食无味，这是五脏不和，毒邪蓄积于体内而形成的疽。此时应紧急投用五香连翘汤，病情严重的使用转毒散、神仙截法、黄矾丸、国老膏，以防范托举毒气，避免导致变症内攻入里，尤其适宜在疮顶进行隔蒜灸。如果涂抹毒药，会闭塞腠理；投用各种凉药，会损伤真气。所以判断病症的吉凶，关键在于医生的医术高低。
如果出现嗳气痞塞、咳嗽气逆、身体发冷、自汗、眼睛直视、耳聋、神志恍惚惊悸、言语错乱颠倒等症状，都是恶症。五善证见到三个则疾病可愈，七恶证见到四个则病情危重，五善证全部出现则善到了极点，七恶证全部出现则恶到了极致。
我按语：上述所谓的“善”症，是因为五脏未受损伤，病邪轻微且浅表，如果能谨慎起居，节制饮食，甚至不服药也能自愈。所谓的“恶”症，是五脏亏损的表现，前代哲人虽然说不治，但如果能补益脾胃，巩固根本，大多有存活的可能，怎么能因为它是恶症就放弃治疗呢？
附治疗验案：
邻居苏子遇的内人，左手手指患疔疮，感到麻木瘙痒，伴有寒热恶心，左半身都麻木，脉数且不时出现。我说：凡是疮疡不宜完全不痛，也不宜剧烈疼痛，若伴有心烦闷者属不治之症，现在表现为麻木瘙痒，这更是恶症。服用两服夺命丹，无效，又使用解毒药剂，麻木瘙痒才去除，随后转为肿痛。我说：病势虽然危险，可喜的是出现了疼痛，只是毒气没有排泄的途径。想要针刺排脓，恰逢望日（农历十五），其家人都说这天忌讳动刀针，不听从我，病势更加肿胀严重。我强行针刺，各种症状顿时消退，又使用解毒药剂，疮疡完全痊愈。
辛丑年孟夏（初夏），我到达四明，有一位屠寿卿先生，门牙突然像被击打一样，疼痛难忍，脉象洪大而弦。我说：弦脉与洪脉相搏结，将要发作疮毒。先用清胃散，加入白芷、金银花、连翘，一剂后疼痛即止。到了晚上，鼻子上长出一个疮，面部肿胀颜色暗黑且疼痛，用前面的药方加入犀角，一剂后肿胀蔓延至两额，口中呼出秽气，脉象更加洪大，恶寒内热，这是毒气炽盛血行瘀滞，药力不能对抗。于是多次砭刺患处放出紫黑色血液，服用犀角解毒药剂，第二天肿痛更加严重，于是再次砭刺患处和嘴唇上，并刺破口腔内的赤色脉络，各放出毒血，再服用前面的药物几剂后痊愈。
一位妇人背部患流注，内部溃烂胀痛，服用流气化痰药剂，出现自汗盗汗，脉象大而弱，这是元气亏损的病证。给予人参、黄芪各一两，当归、白术各五钱，肉桂二钱，服药后针刺。到半夜，才流出稀脓约两碗。第二天大汗淋漓非常疲倦，烦躁发热作渴，扬手呼吸急促，脉象洪大而数。仍然用前面的药方加入附子一钱，炙甘草二钱，两剂后，脉象症状全部消退。又用六君子汤加生姜、肉桂二十多剂，才离开床铺。后来因劳累复发，寒热作渴，出汗，当时正值仲冬，睡觉时帷帐内气息如雾般冒出，用十全大补汤加肉桂、附子，两剂后痊愈。
中翰郑朝用，疽疮溃破后发热吐痰，饮食无味，肌肉不生，疮口流出鲜血。我说：这是脾气亏损，不能摄血归源，治法应当补脾。他不相信，使用消毒凉血的药剂，加上恶寒呕吐，才明白我的话，使用六君子汤加炮姜、半夏、茯苓，几剂后各种症状全部消退。又用十全大补汤，疮口逐渐收敛。后来因为饮食稍多，泄泻变成痢疾，这是脾胃虚寒下陷，用补中益气汤送服四神丸，痢疾停止，继以六君子汤而疮疡痊愈。
一位妇人，癸卯年冬天，因丢失物品发怒，锁骨窝内微肿。甲辰年春天，肿大如倒扣的碗，左肩胛骨也肿，皮肤颜色如故。有人针刺放出鲜血约三碗，腹痛如锥刺，泄泻不止，四肢厥冷，呕吐恶寒，有时发热，已经七天绝食了，脉象洪大，时而微细，这是阳气脱陷。用六君子汤加炮姜三钱、附子二钱，早上服用，到中午没反应，第二剂增加附子五钱，熟睡醒来后，各种症状顿时消退六七成，少量进食稀粥。再服四剂，各种症状全部消退，饮食如常，锁骨窝才开始疼痛。针刺流出清脓约两碗，各种症状又出现，这是极度虚弱。用十全大补汤加干姜、肉桂、附子各一钱，三剂后安稳。后来减少干姜、肉桂、附子各五分，给予归脾汤，兼服五十多剂后痊愈。
一名男子，背部疮疡漫肿微痛，食少体倦。我说：症状属于形体与病气俱虚，治法应当以补元气为主。他不相信，于是使用攻毒药剂，中央肌肉变黑暗约五寸，恶症全部具备，又来求治。我说：这是胃气虚寒，变症发作，应当紧急温补脾胃，则恶症自然消退，黑肉自然生长。仍然不相信，于是割除死肉，祛除恶症，最终导致死亡。
毛砺庵的侧室，腹部患痈一个多月了，颜色暗黑不肿，内部疼痛作呕，饮食不进，四肢厥冷，脉象或断绝或浮大，杂用定痛败毒药剂。我说：这是气血俱虚而疼痛，内部决不会有脓，是不治之症。强行使用大温补药剂两剂，疼痛停止，颜色变红，饮食稍微进一点。我认为只能延缓时日而已。人们都认为有脓，又强行针刺，又用大补药剂，才流出少许清脓。众人仍认为毒结于内，用攻脓的方法保证必生，殊不知这是加速死亡，可惜啊！
Zeng Shi stated: In all cases of carbuncles and ulcers (Yong Ju), if the pulse is floating, rapid, full, and tight, with local swelling and pain, fever, restlessness, thirst, and normal appetite, this indicates disharmony of the Six Fu organs, with toxic heat erupting on the exterior forming a carbuncle. Although the condition may be acute, administering cooling formulas often preserves life. If the pulse is deep, fine, hidden, and tight, with initial symptoms being very mild or lacking a pustule, no fever but internal restlessness, heavy body, painful distress, low mood, chest and diaphragm stuffiness, and loss of taste, this indicates disharmony of the Five Zang organs, with toxin accumulating internally forming an ulcer. In such cases, urgently administer Wuxiang Liaoqiao Tang (Five-Spice Forsythia Decoction). For severe cases, use Zhuan Du San (Toxin-Transforming Powder), Shenxian Jie Fa (Immortal's Method of Interception), Huangfan Wan (Yellow Alum Pill), or Guolao Gao (Old Man's Paste) to prevent and support the expulsion of toxic qi, avoiding internal invasion by transformed pathogens. It is especially appropriate to perform garlic-partitioned moxibustion directly on the lesion. Applying toxic ointments can block the cou li (skin pores and interstices); administering various cooling medicines can deplete true qi. Therefore, determining whether a condition is favorable or unfavorable depends on the skill of the physician.
If symptoms include belching with obstruction, coughing with counterflow qi, cold body, spontaneous sweating, fixed gaze, deafness, mental confusion with palpitations, and incoherent speech, these are all malignant signs. If three of the Five Favorable signs appear, recovery is expected; if four of the Seven Unfavorable signs appear, the condition is critical. If all Five Favorable signs manifest, goodness cannot be added to; if all Seven Unfavorable signs manifest, evil has reached its extreme.
My commentary: The aforementioned "favorable" conditions indicate that the Five Zang organs are undamaged, the pathogen is mild and superficial. With careful daily routine and dietary restraint, self-healing can occur even without medicine. The "unfavorable" conditions indicate deficiency of the Five Zang organs. Although ancient sages claimed they were untreatable, if one tonifies the Spleen and Stomach and consolidates the root, survival is often possible. How can one abandon treatment simply because it is unfavorable?
Attached Treatment Cases:
The wife of my neighbor Su Ziyu suffered from a carbuncle on her left index finger, experiencing numbness and itching, accompanied by aversion to cold, fever, and nausea. Her entire left half-body was numb, and her pulse was rapid with intermittent irregularities. I said: Generally, sores should not be completely painless, nor should they cause severe pain. Conditions with restlessness and oppression are untreatable. Numbness and itching now indicate a particularly malignant sign. She took two doses of Duoming Dan (Life-Seizing Pill) without effect. Then, detoxifying agents were used, after which the numbness and itching subsided, transforming into swelling and pain. I said: Although the situation is dangerous, it is fortunate that pain has appeared, indicating the toxin has a pathway to exit. I wished to puncture it, but it happened to be the Full Moon day. Her family refused, citing taboos against surgery on this day. The swelling worsened. I forcibly punctured it, and all symptoms immediately receded. After administering detoxifying agents, the sore healed completely.
In early summer of the Xinchui year, I arrived at Siming. Mr. Tu Shouqing experienced sudden, unbearable pain in his front teeth, as if struck. His pulse was full and large, yet wiry. I said: The combination of wiry and full pulses suggests impending carbuncle toxicity. I first prescribed Qingwei San (Stomach-Clearing Powder) with Bai Zhi (Angelicae Dahuricae Radix), Yin Hua (Lonicerae Japonicae Flos), and Liao Qiao (Forsythiae Fructus). One dose stopped the pain. That evening, a sore erupted on his nose, with dark, swollen, and painful facial features. I added Xi Jiao (Rhinocerotis Cornu) to the previous formula. One dose caused swelling to spread to both temples, foul breath exhaled, and the pulse became even fuller and larger, with aversion to cold and internal heat. This indicated blazing toxin and blood stasis, where medicinal power could not contend. I repeatedly scarified the affected areas to release purple-black blood, administered Xi Jiao Jiedu agents, but the next day swelling and pain intensified. I scarified the affected areas and lips again, pricked red vessels inside the mouth to release toxic blood, and continued the previous medication for several doses until cure.
A woman suffered from a flowing abscess (Liuzhu) on her back, with internal ulceration, distension, and pain. After taking Liqi Huatan agents (Qi-Regulating Phlegm-Resolving formulas), she developed spontaneous and night sweats. Her pulse was large and weak, indicating Yuan Qi (Original Qi) deficiency. I prescribed Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) each 1 liang, Dang Gui (Angelicae Sinensis Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 5 qian, and Rou Gui (Cinnamomi Cortex) 2 qian. After administration, I punctured the lesion. By midnight, approximately two bowls of thin pus were discharged. The next day, she sweated profusely, felt extremely fatigued, restless, hot, thirsty, waved her hands, breathed rapidly, and her pulse was full, large, and rapid. I used the previous formula adding Fu Zi (Aconiti Lateralis Radix Praeparata) 1 qian and Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 2 qian. Two doses resolved the pulse and symptoms. Subsequently, she took Liu Jun Zi Tang (Six-Gentlemen Decoction) with Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui for over twenty doses before getting out of bed. Later, due to overexertion, relapse occurred with chills, fever, thirst, and sweating. It was mid-winter, and her breath fogged the curtains. I prescribed Shiquan Dabu Tang (Perfect Great Tonifying Decoction) with Rou Gui and Fu Zi. Two doses resulted in recovery.
Zheng Chaoyong, a Hanlin Academician, had an ulcer that ulcerated with fever, expectoration, loss of taste, lack of muscle regeneration, and fresh blood from the wound. I said: This is Spleen Qi deficiency failing to control blood return to its source. The method should be to tonify the Spleen. He did not believe me and used detoxifying and blood-cooling agents, which led to aversion to cold and vomiting. Only then did he realize my words. I prescribed Liu Jun Zi Tang with Pao Jiang (Zingiberis Rhizoma Preparatum) and Ban Xia (Pinelliae Tuber), along with Fu Ling (Poria). Several doses resolved all symptoms. Then, Shiquan Dabu Tang was used, and the wound gradually closed. Later, due to slight overeating, diarrhea turned into dysentery. This was Spleen and Stomach deficiency-cold with sinking. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) delivered with Sishen Wan (Four-Spirit Pill), stopping the dysentery. Subsequently, Liujunzi Tang cured the ulcer.
A woman, in winter of the Guimao year, became angry over lost items, resulting in slight swelling in the supraclavicular fossa. In spring of the Jiachen year, it swelled like an inverted bowl, and her left scapula also swelled, though skin color remained normal. Someone punctured it, releasing about three bowls of fresh blood. She then suffered abdominal pain like needle insertion, incessant diarrhea, cold limbs, vomiting, aversion to cold, occasional fever, and had been fasting for seven days. Her pulse was full and large, sometimes fine and subtle, indicating collapse and sinking of Yang Qi. I prescribed Liu Jun Zi Tang with Pao Jiang 3 qian and Fu Zi 2 qian, taken in the morning. By noon, there was no response. In the second dose, I increased Fu Zi to 5 qian. Upon waking from sleep, her symptoms receded by six or seven parts, and she ate a little thin porridge. After four more doses, all symptoms receded, diet returned to normal, and only then did the supraclavicular area become painful. Puncture released about two bowls of clear pus, but symptoms returned, indicating extreme deficiency. I prescribed Shiquan Dabu Tang with Gan Jiang (Zingiberis Rhizoma), Rou Gui, and Fu Zi each 1 qian. Three doses brought stability. Later, I reduced Gan Jiang, Rou Gui, and Fu Zi to 0.5 qian each, and prescribed Guilpi Tang (Restore the Spleen Decoction). Combined administration for over fifty doses resulted in cure.
A man suffered from a diffuse, slightly painful back sore, with poor appetite and fatigue. I said: The condition belongs to deficiency of both form and disease energy. The method should primarily tonify Yuan Qi. He did not believe me and used attacking-toxin agents. The central flesh turned dark over an area of five cun, exhibiting all malignant signs. He sought treatment again. I said: This is Stomach Qi deficiency-cold with transformed pathology. Urgently warm and tonify the Spleen and Stomach, and the malignant signs will retreat, and healthy flesh will grow. He still did not believe me, cut away dead flesh, and removed the malignant tissue, ultimately leading to death.
Mr. Mao Li'an's concubine had suffered from an abdominal carbuncle for over a month. The color was dark, not swollen, with internal pain and vomiting, inability to eat, cold limbs, and a pulse that was either absent or floating and large. Various pain-relieving and toxin-defeating agents were used. I said: This is pain caused by joint deficiency of Qi and Blood. There is absolutely no pus internally; it is an untreatable condition. I forced the use of strong warming and tonifying agents for two doses. Pain stopped, color turned red, and food intake slightly improved. I believed it could only prolong life. People thought there was pus and forcibly punctured it. Using strong tonifying agents again, only a small amount of clear pus was discharged. The crowd still believed the toxin was trapped internally and used methods to drain pus, believing this guaranteed survival. Little did they know this accelerated death. What a pity!