问曰∶痈疽何为而发也。答曰∶人之一身，气血而已，非气不生，非血不行。气血者，
阴阳之属也。阴阳调和，百骸畅适，苟六淫外伤，七情内贼，饮食不节，起居不慎，以致脏腑乖
变，经络滞隔，气血凝结，随其阴阳之所属，而攻发于肌肤筋脉之间，此痈疽之所以发也。
曰∶然则痈疽有别乎？曰∶痈者，壅也，邪热壅聚，气血不宣，其为证也为阳，属六腑，高
肿
其为证也为阴，属五脏，漫肿色白，坚硬木痛，而其发也必缓，故所患深沉而难疗。此痈疽
之所以别者然也。曰∶然则其治之也当若何？曰∶初起者，审其证而消之；成脓者，因其势
而逐之；毒尽者，益其所不足而敛之，此治痈之大旨也。于是乎未出脓前，痈则宣其阳毒之
滞，疽则解其阴寒之凝；已出脓后，痈则毒滞未尽宜托，疽有寒凝未解宜温。即患阴疽，虽在
盛暑之时，必用辛热之剂，以助阳气；如生阳痈，虽在严寒之时，必用寒凉之剂，以泻火邪
，不拘盛暑严寒，但当舍时而从证也。曰∶然则视其外即可知其内欤？曰∶吾闻之，医者意
也，有诸内则形诸外，故四诊为医家辨证之筌蹄，而望居其一。是以外科之证，形色可凭，
善恶可准，一定而不移，显然而易见，非若伤寒证有传经之变也。盖色红 痛者，实热壅聚
也；色白阴痛者，虚寒沮逆也；憎寒发热者，表邪未解也；口渴便秘者，里邪未通也；红活
高肿者，气血拘毒于外也；白塌漫肿者，气血冰结于内也；根红散漫者，气虚不能摄血紧附
也；不痛坚硬者，血凝不能附气流行也；外红里黑者，毒滞不化也；紫暗不明者，胃气大伤
而肌肉死败也；按之陷而不即高，顶虽温而不甚热者，脓尚未成也；按之随指而起，顶已软
而热甚者，脓已灌足也；脓色浓浓者，气血强旺也；脓色清淡者，气血衰弱也。诸如此类，
审其外，悉其内，按其委，溯其源，此所谓望而知之者也。曰∶然则疮疥之与痈疽同乎否，
有不发为痈疽而发为疮疥者何也？曰∶人之躯壳，计有五层，皮脉肉筋骨也。发于筋骨间者
，疽是也；发于脉肉间者，痈是也；发于皮腠间者，疮疥之属是也。大抵营卫不足，湿热邪
风，肥甘浊气，淫于肌肤，留滞不散，则疮疥所由生。或痒或痛或脓或水，名类颇多，治法不
一。热则凉之，湿则利之，虫则杀之，风则散之，燥则润之滋之。更宜戒沐浴，以避湿气，忌
浓味以清营卫，而疮瘥矣。此所以较痈疽之证治，有大同而小异者焉。噫！人能慎养，气畅血
盈，不使形体有衰，则痈疽疮疥从何而发？苟或不然，百病丛生，又岂惟痈疽疮疥而已哉。古
人不治已病治未病，非虚
问：痈疽是如何发生的？
答：人的身体，不过是气血罢了。没有气就不能生化，没有血就不能运行。气血，属于阴阳的范畴。如果阴阳调和，全身骨骼关节就会通畅舒适；倘若六淫（风、寒、暑、湿、燥、火）从外部侵袭，七情（喜、怒、忧、思、悲、恐、惊）从内部伤害，饮食没有节制，起居不慎，导致脏腑功能变异，经络阻滞不通，气血凝结，随着它们所属的阴阳属性，在肌肤筋脉之间发作，这就是痈疽发生的原因。
问：那么痈和疽有区别吗？
答：痈，就是壅塞的意思。邪热壅聚，气血不能宣通，它的证候表现为阳证，归属于六腑，特点是高肿；疽，它的证候表现为阴证，归属于五脏，特点是漫肿色白，坚硬且麻木疼痛，而且它的发生必然缓慢，所以患病部位深沉而难以治疗。这就是痈和疽的区别所在。
问：那么治疗它们应该怎么做呢？
答：初起时，审察其证候而用消散法；成脓时，顺应其势而用排脓法；毒尽时，补益其不足而用收敛法，这是治疗痈疽的大致原则。因此在未出脓之前，痈要宣散其阳毒的滞结，疽要解除其阴寒的凝滞；已出脓之后，痈若毒滞未尽宜用托毒法，疽若有寒凝未解宜用温法。即使是患阴疽，虽然在盛夏之时，也必须使用辛热性质的药剂，以助长阳气；如果是生阳痈，虽然在严寒之时，也必须使用寒凉性质的药剂，以泻除火邪。不拘泥于盛夏或严寒的季节，只应当舍弃季节因素而顺从证候特点。
问：那么观察外表就可以知道内部情况吗？
答：我听说，医者的关键在于意会，内部有病则会在外部显现形迹，所以望、闻、问、切四诊是医生辨证的关键工具，而望诊是其中之一。因此外科的证候，颜色和形态可以作为依据，预后善恶可以准确判断，规律固定不变，明显而易见，不像伤寒证那样有传经的变化。一般来说，颜色红且疼痛的，是实热壅聚；颜色白且隐痛的，是虚寒沮逆；怕冷发热的，是表邪未解；口渴便秘的，是里邪未通；颜色红活、高肿的，是气血将毒邪拘束于外部；颜色苍白、塌陷漫肿的，是气血在内部冰结；根部发红、散漫无根的，是气虚不能摄血紧附；不痛且坚硬的，是血凝不能依附气机流行；外部红内部黑的，是毒滞不化；紫暗不明的，是胃气大伤而肌肉死败；按压后凹陷不能立即弹起，顶部虽然温热但不甚热的，说明脓尚未形成；按压后随手指抬起而回弹，顶部已经变软且热势严重的，说明脓已成熟充足；脓液浓稠的，说明气血强旺；脓液清淡的，说明气血衰弱。诸如此类，审察外部，推知内部，按察病位，追溯源头，这就是所谓的“望而知之”。
问：那么疮疥与痈疽相同吗？有没有不发为痈疽而发为疮疥的情况，原因是什么？
答：人的躯壳，共有五层，即皮、脉、肉、筋、骨。发于筋骨之间的，是疽；发于脉肉之间的，是痈；发于皮腠（皮肤纹理间隙）之间的，是疮疥之类。大抵由于营卫不足，湿热邪风，以及肥甘厚味产生的浊气，淫溢于肌肤，留滞不散，这就产生了疮疥。或者痒、或者痛、或者流脓、或者流水，名称类别很多，治疗方法不一。热则用凉法，湿则用利法，虫则用杀虫法，风则用散法，燥则用润法和滋法。更应当禁止沐浴，以避开湿气，忌食浓味食物以清养营卫，这样疮疡就能痊愈。这就是说，相较于痈疽的证治，疮疥是大同小异的。唉！人们如果能谨慎调养，使气畅血盈，不让形体衰败，那么痈疽疮疥从哪里发作呢？如果不这样做，百病丛生，又岂止是痈疽疮疥而已呢。古人主张不治已病治未病，这不是空话。
Q: How do carbuncles and ulcers (yongju) arise?
A: The human body consists merely of Qi and Blood. Without Qi, there is no generation; without Blood, there is no circulation. Qi and Blood belong to the category of Yin and Yang. When Yin and Yang are harmonious, the bones and joints are smooth and comfortable. However, if the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade from outside, or the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) harm from inside, coupled with unregulated diet and careless living habits, it leads to dysfunction of the Zang-Fu organs and obstruction of the meridians. Consequently, Qi and Blood coagulate. Depending on their Yin or Yang attributes, they erupt between the skin, muscles, sinews, and vessels. This is the cause of carbuncles and ulcers.
Q: Are there distinctions between carbuncles (yong) and ulcers (ju)?
A: "Yong" implies obstruction. Pathogenic heat obstructs and gathers, preventing the free flow of Qi and Blood. Its clinical manifestation is a Yang syndrome, associated with the Fu organs, characterized by high swelling. "Ju" manifests as a Yin syndrome, associated with the Zang organs, characterized by diffuse swelling, pale color, hardness, and numb pain. Its onset is necessarily slow, making the lesion deep-seated and difficult to treat. These are the distinctions between Yong and Ju.
Q: How should they be treated?
A: In the initial stage, observe the syndrome and apply resolution methods; when pus forms, follow the momentum and apply drainage methods; when toxins are exhausted, tonify deficiencies and apply astringent methods. This is the general principle for treating Yong and Ju. Before pus formation, Yong requires dispersing Yang toxin stagnation, while Ju requires resolving Yin cold coagulation. After pus discharge, if toxin stagnation remains in Yong, supportive methods (Tuo) should be used; if cold coagulation persists in Ju, warming methods should be applied. Even if suffering from a Yin Ju during midsummer, acrid-hot formulas must be used to assist Yang Qi. Conversely, if developing a Yang Yong during severe winter, cooling formulas must be used to drain Fire pathogens. One should not be bound by seasonal considerations but rather adhere strictly to the syndrome differentiation.
Q: Can internal conditions be known by observing external signs?
A: I have heard that medicine relies on intuitive understanding; internal pathology manifests externally. Therefore, the Four Diagnostic Methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation) are essential for syndrome differentiation, with Inspection being one of them. Thus, in surgery, color and shape provide reliable evidence for determining prognosis. These signs are fixed and obvious, unlike the meridian transmission variations seen in Cold Damage syndromes. Generally, redness and pain indicate excess heat accumulation; pallor and dull pain indicate deficiency cold; aversion to cold and fever indicate unresolved exterior pathogens; thirst and constipation indicate unpassed interior pathogens; bright red, high swelling indicates Qi and Blood constraining toxins externally; pale, collapsed, diffuse swelling indicates Qi and Blood freezing internally; a red, spreading base indicates Qi deficiency failing to secure blood; painless hardness indicates Blood stasis failing to support Qi movement; red exterior with black interior indicates untransformed toxin stagnation; purple-dark indistinctness indicates severe damage to Stomach Qi and muscle necrosis; indentation upon pressure that does not rebound immediately, with a warm but not hot apex, indicates pus has not yet formed; rebound upon pressure, with a soft and hot apex, indicates pus is fully formed; thick pus indicates strong Qi and Blood; thin pus indicates weak Qi and Blood. By examining the exterior to understand the interior, palpating the site, and tracing the source, one achieves "knowing through inspection."
Q: Are sores and scabies (chuangjie) the same as carbuncles and ulcers? What causes some to manifest as sores and scabies instead?
A: The human body has five layers: skin, vessels, flesh, sinews, and bones. Lesions arising between sinews and bones are Ju; those between vessels and flesh are Yong; those between the skin and interstices are Chuangjie. Generally, due to insufficiency of Ying and Wei, damp-heat, pathogenic wind, and turbid qi from rich foods invading the skin and lingering without dispersal, sores and scabies arise. They may present as itching, pain, suppuration, or weeping, with various names and treatments. Heat is cooled, dampness is drained, parasites are killed, wind is dispersed, and dryness is moistened and nourished. One should also avoid bathing to prevent dampness exposure and avoid rich flavors to clear Ying and Wei, leading to recovery. Thus, compared to Yong and Ju, Chuangjie shares similarities but has minor differences. Alas! If people cultivate carefully, ensuring smooth Qi and abundant Blood, preventing physical decline, where would Yong, Ju, Chuangjie, and Scabies arise? If not, myriad diseases will emerge, far exceeding just these dermatological conditions. The ancients advocated treating disease before it arises, which is not an empty phrase.