《内经》曰∶诸痛痒疮，皆属心火。又云∶营气不从，逆于肉理，乃生肿。又云∶膏粱
之变，足生大疔。又云∶热胜血则为痈脓。又云∶地之湿气，感则害人皮肉筋脉。东垣谓湿
气外伤，则营气不行。荣卫者，皆营气之所经营也。营气者，胃气也，运气也。营气为本，
本逆不行，为湿气所坏，而为疮疡也。但《疮疡论》中多言二热相搏，热化为脓。有言热化
为脓者，有言湿气生疮。寒化为热而为脓者，此皆疮疽之源也。当看是何部分所发，所用之
药，引经为先，兼见次之，以脉别之，是阴是阳，用药在乎主治，宜以先泻其荣，治疮之本
。若不次序，本逆而助火，湿热相合，败坏肌肉而为脓血者，当分而治之。且如一岁之中，
火热无过四五月之间，是时诸物皆不坏烂者，六七月之间，湿令大行之际，近取诸身，湿热
在身，岂不败坏肌肉，此理明矣。大抵疮疡之疾，经云∶六腑不和，流结为痈，要分脏腑之
属，经络之异，六阴六阳之经，有多气少血者，有多血少气者，有多气多血者，不可一概论
之。经言痈者，荣卫稽留于经脉之中，则涩而不行，则卫从之而不通，壅遏而不得行，故热
。大热不止，热胜则肉腐，肉腐则为脓。然此不能陷，骨髓不为焦枯，五脏不为伤，故曰痈
疽者，热气纯盛，下陷肌肤筋骨，髓枯肉运，五脏血气竭，其毒下陷筋骨及良肉，故云疽。
疽者皮坚，上如牛领之皮；痈者皮薄，上以泽之，是知痈者壅也，六腑不和之所生，浅而大
也，疽者沮也，五脏不调之所致，深而恶也。六腑主表，其气浅，故痈皮薄而肿高；五脏主
里，其气深，故疽皮浓而肿坚。皆根着脏腑，见于肌肉，营气不从，气血壅沮而生也。其所
出之道有异者耶，毒从虚而出也。假令太阳经虚从背出，少阳经虚从鬓出，阳明经虚从髭出，
督脉经虚从脑出，余者从经所出取焉。今富贵之人，不知其节，以饮食炙爆，高粱浓味，醇
酒辛辣之物，日久太过，其气味俱浓，乃阳中之阳不能走空窍先行，阳道反行，阴阳逆于肉
理，则湿气大胜，则令子母实，火乃大旺，相火一盛，必克肾水，肾既受邪，积久水乏，水
乏则从湿热之化而上行，其疮多出背出脑，此为大疔之最重者也。若毒瓦斯见于肺部之分，或
脾胃之分，次也，或见于他经，又其次也，或患湿毒流注，止处无不溃烂，故经曰∶高粱之
变，足生大疔，受如持虚。如持虚器以受物，物无不受。治大疔之法，必当泻其营气。以标
本言之，先受病为本，非苦寒之剂为多，则不能除其苦楚疼痛也。诸疮疡往往多以乳香没药
，加以热剂治之，此理未为稳当，若使经络流通，去其脏腑之壅滞，佐以寒凉之剂，其疮自
愈。是以河间论疮疡者火之属，须分内外以治其本，若其脉沉实，当先疏其内，以截其源也
；其脉浮大，当先托里，恐邪气入内也。有内外之中者，邪气至盛，遏截经络，故发痈肿，
此因失于托裹，及失疏通，又失和其荣卫。治疮之要，须以疏利为先，次以托里，和其荣卫
，此三法乃内外之攻也。若脉沉实，发热烦躁，外无KT 赤疼痛，其邪在内，气以深矣。
作疏其脏腑，以绝其源。又谓呕 心烦，脉沉而实，肿硬木闷，而皮肉不变，根深而病大，
邪亦在内。若脏腑秘涩，急当疏利，宜以黄连内疏汤，加大黄，服后以次序调理。若脉浮数
，KT 肿在外，形证外显，恐邪气极而内行，故先托里，宜以复煎散，此为治法。
一瘰疠马刀，经同证异，丹溪云∶夫瘰疠初发，必起于少阳经，不守禁戒，延及阳明经
。大抵食味之浓，郁气之积，曰毒曰风曰热，皆此三端，招引变换。治之须分虚实。若实者
根据法调治，远浓味发气之物，亦有愈者；虚者诚为可虑，以其属胆经，主决断，有相火，而
且气多血少。妇人若患此疾，月经不调，便作寒热，稍久变为潮热，其证渐危，自非断欲息
气，远滋味，神仙不能治。《本草》言夏枯草大治瘰 ，散结气，有补养厥阴血脉之功，能
退寒热，佐之以行散之药，加之以艾灸，取其随经之穴，自然取效。若河间之论∶瘰 者，
经谓结核者是也。或在耳前后连及颐颔，下连缺盆，皆为瘰 。或在胸及胸之侧，下连两胁
，皆为马刀。手足少阳主之，此经多气少血，故多坚而少软，脓白而稀，如米泔状。世俗治
马刀，求其水清者可治，殊不知此经多气少血之故，在乎诊其虚实，以调治之。是以东垣治
瘰马刀，以救苦化坚汤，或散肿溃坚汤主之，外以临泣穴灸二七壮。此证并属手足少阳经
也，惟瘰 延及阳明之经，故用药有出入加减不同耳，详载于《试效方》中。瘰 马刀，皆
形质发于部分而命名也。《巢氏病源》载之三十六种，《千金》、《圣惠》所论瘰 九漏，总论
说有风热气之三毒之异，瘰 结核寒热之殊，其本皆由恚怒气逆，忧思过甚，风热邪气，内
搏于肝，肝主筋，故令筋蓄结而肿，或见于是何部分，先以五香连翘汤，或牡蛎大黄汤，疏
下两三行后，服前药调治，外用十香膏、乌犀膏贴之。如或将痊求瘥，其将护忌慎治疗之法，
无造次焉。
一肺痈肺痿，内经云，肺之痈，喘而两 满。《金匮要略》又以肺痈肺痿并论辩之，所
谓热在上焦者，因咳为肺痿。肺痿之病，何从得之？或从汗出，或从呕吐，或从消渴，小便
利数，或从便难，又被疏利之药，重亡津液，故得之。若寸口脉数，其人咳，口中反有浊唾
涎沫者，为肺痿之病。若口中辟辟燥咳，又胸中隐隐痛，脉反滑数，此为肺痈。咳唾脓血，
脉数虚者为肺痿，数实者为肺痈。夫肺者，五脏之华盖也，处于胸中，主于气，候于皮毛，
劳伤血气，腠理虚而风邪乘之，内感于肺也，则汗出恶风，咳嗽短气，鼻塞项强，胸胁胀满
，久久不瘥，遂成前证，轻则痿，甚则痈。《圣惠》曰∶中府隐隐而微痛者，肺疽也。上肉
微起，肺疮也。中府者穴也，在云门下一寸六分乳肋间，动脉应手陷中也。是以候始萌则可
救，脓成则多死。若欲知有脓者，但诊其脉，若微紧而数者，未有脓也；紧甚而数者，已有
脓也。《内经》又曰∶血热则肉败，荣卫不行，必将为脓。大凡肺疮，当咳嗽短气胸满时，
唾脓血，久久如粳米粥者难治。若呕脓而不止者，亦不可治也。其呕脓而自止者自愈，其脉
短而涩者自痊，浮大者难治。面色当白而反赤者，此火之克金，皆逆，为不治。治法∶此证
不得卧者，葶苈大枣泻肺汤，《千金方》黄 汤，并皆主之。全在脉理分之，若毫厘之差，
千里之远，慎之慎之。
一肠痈胃脘痈，孙真人云∶率得肠痈，而不晓其病候，愚医治之，错则杀人。肠痈之为
病，小腹肿，而强抑之则痛，小便涩似淋，时时汗出，复恶寒，其身皮甲耸然，腹皮急大如
肿状。其脉数者，小有脓也，其脉迟紧者，未有脓也。甚者腹胀大，转侧闻水声，或绕脐生
疮，或脓从脐中出，或大便如脓血，故治之以大黄牡丹皮之类，选而用之。或外以灸法，此
肠痈之形证，盖可知矣。胃脘痈者，何以别之？《内经》云∶人病胃脘痈者，诊当何如？当
胃脉沉细，沉细者气逆，逆者人迎反盛，则热聚于胃口而不行，故胃脘为痈也。诸书少论此
病，惟孙真人言此，后学以此论，乃胃热为邪治之，初以疏利为先，次以消毒托里退胃热，
此为良法。不识病者，误人不浅，可不慎之。
一乳核失治，必成痈疽。丹溪云∶乳房所属阳明，乳头厥阴所属。乳子之母，或忿怒，
或浓味，以致气不流行，窍不得通，汁不得出，则结为肿为痛。阳明之经血，热则化为脓。
又有儿之口气吹而 热，次结成核，初起时便须忍痛揉散令软，血脉通和，自然消散，失此
不治，则成痈疖。《精要》以神效栝蒌散治乳痈奶劳，固是妙捷，村落之处，药恐未易得。
用蒲公草，此草在处田野路侧有之，三月开花，黄似菊，味甘，解食毒，散滞气，入阳明太
阴二经，洗净细碾，以忍冬藤浓煎，入少酒佐之，服之即效。若疏厥阴之滞气，以青皮清阳
明之热，以石膏行泻火，以生甘草消肿毒，以栝蒌子或加青橘皮皂角刺金银花当归头，或汤
或随宜加减，佐以少酒，仍加艾火两三壮于肿处，甚效。切勿妄用针刀，引惹拙病。又有妇
人积忧，结成隐核，有如鳖棋子大，不痛不痒，或一年二年，三五年者，为疮破陷，名曰奶
癌，以其凹似癌穴也，不可治矣。若初起之时，便须消释病根，更宜清心远虑，薄滋味，全
要息怒调理，自有可安之理。若妇人经行得此轻，若六十岁左右，味浓郁结而形实，七情所
干，性急不调，结核前证，自觉神思不佳，不知食味，便可用人参汤调青皮甘草末等分，少
入生姜汁，细细呷之，一日夜五七次，其核自消。若不早治，隐至经年以后，如发不痛不痒
，必于乳下溃一穴出脓，或经三五年，虽饮食如旧，洞见五内乃死。惟无夫妇人生者多。若
有夫妇人生者，盖积气之所流滞也，故妇人夫乃妇之天，得夫则阴阳和。此证虽有而治自愈
，无夫妇人得其癌者，以其穴之嵌深，其可畏哉！患此者必须早治，必经岁月，九死一生。
有一初嫁之妇患此，只以青皮甘草煎汤常服，立安。又一妇人十八岁得此证者，性急脉实，
所难者姑且与青皮一味煎汤与之，间以加减四物汤服之，不月而安。学人前人用青皮乃厥阴
之药，四物汤行血分之功，信有理哉！又有五发及诸疮，十三疔痔漏阴疮时毒等证，《精义
》备载其详。今略痈疽治疗之法，条列于后。
《黄帝内经》说：各种疼痛、瘙痒和疮疡，都属于心火。又说：营气运行不畅，逆乱于肌肉纹理之间，就会发生肿疡。又说：长期食用肥甘厚味，会导致身体生出严重的疔疮。又说：热邪胜过血分，就会形成痈脓。又说：地之湿气侵袭人体，会伤害皮肉筋脉。李东垣认为，湿气从外部侵袭，会导致营气运行受阻。荣气和卫气，都是由营气所化生运行的。营气，就是胃气，也是运化的气。营气是根本，如果根本逆乱不能正常运行，被湿气破坏，就会形成疮疡。但是《疮疡论》中多讲两种热邪相互搏结，热转化为脓。有的说是热转化为脓，有的说是湿气生成疮疡，寒转化为热而化为脓，这些都是疮疽的根源所在。应当看是哪个部位发生的，用药以引经药为先，兼治次要症状为后，通过脉象来辨别是阴证还是阳证，用药在于主治，适宜先泻其营气，这是治疗疮疡的根本。如果不按次序，导致本已逆乱的营气助长火势，湿热相合，败坏肌肉化为脓血，就应当分别施治。况且在一年之中，火热之气没有超过四五月之间的，这个时候各种东西都不会腐烂；到了六七月之间，正是湿气大行的时候，就近取譬于人体，体内有湿热，难道不会败坏肌肉吗？这个道理是很明白的。大抵疮疡这类疾病，《内经》说：六腑不和，气血流注凝结而成痈，必须区分属于脏腑中的哪一类，经络的不同，六阴经和六阳经中，有多气少血的，有多血少气的，有多气多血的，不能一概而论。经文说痈，是营卫之气稽留在经脉之中，则涩滞而不行，卫气随之而不能通畅，壅塞遏阻而不能运行，所以发热。大热不止，热盛则肌肉腐败，肌肉腐败则化为脓。然而这种病不能陷入骨髓，骨髓不致焦枯，五脏不受损伤，所以叫痈。疽，是热气纯盛，向下陷入肌肤筋骨，骨髓枯焦，肌肉腐烂，五脏气血枯竭，毒气下陷至筋骨及健康肌肉，所以叫疽。疽的皮肤坚硬，上面像牛颈部的皮；痈的皮肤薄，上面湿润光泽，由此可知痈是壅滞的意思，是六腑不和所产生的，病位浅而范围大；疽是阻滞的意思，是五脏不调所导致的，病位深且性质恶劣。六腑主表，其气浅，所以痈皮肤薄而肿胀高起；五脏主里，其气深，所以疽皮肤厚而肿胀坚硬。都根源于脏腑，表现在肌肉，因营气不从，气血壅滞阻塞而生。它们排出的途径有什么不同呢？毒气是从虚处排出的。假如太阳经虚弱，毒气从背部排出；少阳经虚弱，从鬓角排出；阳明经虚弱，从胡须处排出；督脉经虚弱，从脑部排出，其余的从所属经络排出选取穴位。现在富贵之人，不懂得节制，饮食炙烤爆炒，高粱浓味，醇酒辛辣之物，日久太过，气味都浓厚，于是阳气中的阳气不能走空窍先行，阳道反而逆行，阴阳逆乱于肌肉纹理，则湿气大胜，导致子母俱实，火气大旺，相火一旦旺盛，必然克制肾水，肾既然受邪，积久肾水匮乏，肾水匮乏则随湿热之气上行，其疮疡多出现在背部和头部，这是大疔中最严重的。如果毒气出现在肺部分野，或脾胃分野，算是次一等，或者出现在其他经络，又更次一等，或者患湿毒流注，停留之处无不溃烂，所以经文说：肥甘厚味的变化，足以生出大疔，接受毒气就像拿着空的容器装东西一样，没有不接受的。治疗大疔的方法，必须泻其营气。从标本来说，先受病为本，如果不是用苦寒的药物居多，就不能消除其痛苦疼痛。各种疮疡往往多用乳香、没药，加上热性药物治疗，这个理法并不稳妥，如果能使经络流通，去除脏腑的壅滞，佐以寒凉药物，疮疡自然痊愈。所以刘河间论述疮疡属于火的一类，必须区分内外以治其本，如果脉象沉实，应当先疏通内部，以截断源头；如果脉象浮大，应当先托里，防止邪气入内。有内外兼病的，邪气极盛，遏制经络，所以发为痈肿，这是因为失于托裹，以及失于疏通，又失于调和营卫。治疗疮疡的要领，必须以疏利为先，其次以托里，调和营卫，这三法是内治和外治的方法。如果脉象沉实，发热烦躁，体表无红肿疼痛，邪气在内，气机深沉。应当疏利脏腑，以绝其源。又说呕吐心烦，脉沉而实，肿硬木闷，而皮肉颜色不变，根深且病情重，邪气也在内。如果脏腑秘涩，急当疏利，适宜用黄连内疏汤，加大黄，服用后按次序调理。如果脉象浮数，红肿在外，形证外显，恐怕邪气极盛而向内传变，所以先托里，适宜用复煎散，这是治疗方法。
瘰疬和马刀，经络相同但证候不同，朱丹溪说：瘰疬初发，一定起于少阳经，如果不遵守禁忌戒律，会延及阳明经。大抵口味浓厚，郁结之气积聚，称为毒、称为风、称为热，都是这三个方面，招引变换。治疗必须区分虚实。如果是实证，根据法则调治，远离浓厚味道和发散气机的食物，也有痊愈的；虚证确实值得忧虑，因为它属于胆经，主决断，有相火，而且多气少血。妇人如果患此病，月经不调，便出现寒热，稍久变为潮热，证候逐渐危险，如果不是断绝性欲、平息心气，远离滋味，神仙也不能治愈。《本草》说夏枯草大治瘰疬，散结气，有补养厥阴血脉的功效，能退寒热，佐以行散的药物，加上艾灸，选取随经的穴位，自然见效。如果按照刘河间的论述：瘰疬，经文指的就是结核。有的在耳前后连及颐颔，下连缺盆，都称为瘰疬。有的在胸部及胸侧，下连两胁，都称为马刀。由手足少阳经主司，此经多气少血，所以肿块多坚硬而少柔软，脓液白而稀，像米泔水状。世俗治疗马刀，认为水流清澈的可以治愈，殊不知这是此经多气少血的原因，关键在于诊察其虚实，来调治它。所以李东垣治疗瘰疬马刀，用救苦化坚汤，或散肿溃坚汤为主方，外用临泣穴灸七壮。此证并属于手足少阳经，只有瘰疬延及阳明经，所以用药有出入加减的不同，详细记载在《试效方》中。瘰疬马刀，都是根据形态部位而命名的。《诸病源候论》记载了三十六种，《千金方》、《太平圣惠方》所论述的瘰疬九漏，总论说有风、热、气三毒的差异，瘰疬结核有寒热的不同，其根本都是由愤怒气逆，忧思过度，风热邪气，内搏于肝，肝主筋，所以令筋蓄结而肿，或者出现在哪个部位，先用五香连翘汤，或牡蛎大黄汤，疏下两三行后，服用前面的药物调治，外用十香膏、乌犀膏贴敷。如果即将痊愈求好转，其护理忌慎治疗的方法，不可草率。
肺痈和肺痿，《内经》说，肺的痈，气喘且两胁满闷。《金匮要略》又将肺痈肺痿一起讨论辨析，所谓热在上焦的，因咳嗽成为肺痿。肺痿的病，是怎么得的呢？有的因为汗出，有的因为呕吐，有的因为消渴，小便频数，有的因为大便困难，又被疏利的药物，再次亡失津液，所以得此病。如果寸口脉数，其人咳嗽，口中反而有浊唾涎沫的，是肺痿的病。如果口中干燥咳声连连，又胸中隐隐作痛，脉反滑数，这是肺痈。咳吐脓血，脉数虚的是肺痿，数实的是肺痈。肺，是五脏的华盖，处于胸中，主气，候于皮毛，劳伤血气，腠理虚而风邪乘虚而入，内感于肺，则汗出恶风，咳嗽短气，鼻塞项强，胸胁胀满，久久不愈，遂成前证，轻则肺痿，重则肺痈。《太平圣惠方》说：中府穴隐隐微痛的，是肺疽。上肉微微隆起的，是肺疮。中府是穴位，在云门下一寸六分乳肋间，动脉应手陷中。所以候察在始发时可救，脓成则大多死亡。如果想知有脓与否，只要诊察其脉，如果微紧而数的，还没有脓；紧甚而数的，已有脓了。《内经》又说：血热则肌肉败坏，营卫不行，必将化为脓。大凡肺疮，当咳嗽短气胸满时，唾脓血，久久像粳米粥样的难治。如果呕脓而不止的，也不可治。其呕脓而自止的自愈，其脉短而涩的自痊，浮大的难治。面色应当白而反赤的，这是火克金，都是逆证，为不治。治法：此证不得卧的，葶苈大枣泻肺汤，《千金方》的黄耆汤，都主治。全在脉理分辨，如果毫厘之差，千里之远，谨慎啊谨慎啊。
肠痈和胃脘痈，孙真人说：大概得到肠痈，却不了解其病候，愚医治疗，错误则会杀人。肠痈这个病，小腹肿，强行按压则痛，小便涩似淋病，时时汗出，又恶寒，其身皮肤耸然如鸡皮，腹皮急大如肿状。其脉数的，小有脓；其脉迟紧的，未有脓。严重的腹胀大，转侧听到水声，或绕脐生疮，或脓从脐中出，或大便如脓血，所以治疗用大黄牡丹皮之类，选择使用。或外用灸法，这肠痈的形证，大概可以知道了。胃脘痈，怎么区别它？《内经》说：人患胃脘痈，诊察应当如何？当胃脉沉细，沉细者气逆，逆者人迎脉反盛，则热聚于胃口而不行，所以胃脘为痈。各书很少论述此病，只有孙真人提到此病，后学以此论，认为是胃热为邪治疗它，初以疏利为先，其次以消毒托里退胃热，这是良法。不识病的人，误人不浅，可不谨慎吗？
乳核如果失治，必成痈疽。丹溪说：乳房所属阳明经，乳头所属厥阴经。哺乳期的母亲，或因忿怒，或因浓味，以致气不流行，窍不得通，乳汁不得出，则结为肿为痛。阳明经的血，热则化为脓。又有婴儿的口气吹而受热，次结成核，初起时便须忍痛揉散令软，血脉通和，自然消散，失此不治，则成痈疖。《精要》用神效栝蒌散治乳痈奶劳，固然是妙捷，村落之处，药恐不容易得到。用蒲公英草，此草到处田野路侧都有，三月开花，黄似菊，味甘，解食毒，散滞气，入阳明太阴二经，洗净细碾，以忍冬藤浓煎，入少许酒佐之，服之即效。如果疏厥阴的滞气，用青皮清阳明的热，用石膏行泻火，用生甘草消肿毒，用栝蒌子或加青橘皮皂角刺金银花当归头，或汤剂或随宜加减，佐以少许酒，仍加艾火两三壮于肿处，很有效。切勿妄用针刀，引惹拙病。又有妇人积忧，结成隐核，有如鳖棋子大，不痛不痒，或一年二年，三五年者，为疮破陷，名叫奶癌，以其凹似癌穴也，不可治了。如果初起之时，便须消释病根，更宜清心远虑，薄滋味，全要息怒调理，自有可安之理。如果妇人在经期得此较轻，如果六十岁左右，味浓郁结而形实，七情所干，性急不调，结核前证，自觉神思不佳，不知食味，便可用人参汤调青皮甘草末等分，少入生姜汁，细细呷之，一日夜五七次，其核自消。如果不早治，隐至经年以后，如发不痛不痒，必于乳下溃一穴出脓，或经三五年，虽饮食如旧，洞见五内乃死。只有无夫妇女人多。如果有夫妇人生者，盖积气之所流滞也，所以丈夫是妇女的天，得夫则阴阳和。此证虽有而治自愈，无夫妇人得其癌的，以其穴之嵌深，其可畏哉！患此者必须早治，必经岁月，九死一生。有一个刚出嫁的妇人患此，只以青皮甘草煎汤常服，立刻安宁。又一个妇人十八岁得此证的，性急脉实，所难的是姑且与青皮一味煎汤与之，间以加减四物汤服之，不到一个月而安宁。学者前人用青皮乃是厥阴的药，四物汤行血分的功效，信是有理啊！又有五发及诸疮，十三疔痔漏阴疮时毒等证，《精义》备载其详。现略述痈疽治疗之法，条列于后。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All pain, itching, and sores belong to Heart Fire. It further says: When Ying Qi (Nutritive Qi) does not flow smoothly and reverses into the muscle tissue, swelling occurs. It also says: Changes caused by rich and greasy food can lead to the emergence of severe Ding Sores (deep-seated infections). It states: When heat overcomes blood, it forms carbuncle pus. It also says: Dampness from the earth, when pathogenic, harms the skin, flesh, sinews, and vessels. Li Dongyuan stated that external dampness invasion causes Ying Qi to fail to circulate. Ying Qi and Wei Qi (Defensive Qi) are both managed and operated by Ying Qi. Ying Qi is Stomach Qi, which is also the qi of transportation and transformation. Ying Qi is the root; if the root reverses and fails to circulate, damaged by dampness, sores and ulcers arise. However, in the *Sore and Ulcer Treatise*, it is often said that two types of heat clashing transform into pus. Some say heat transforms into pus, some say dampness generates sores, cold transforming into heat and then into pus—these are all the sources of sores and deep abscesses (Ju). One must examine which part of the body is affected. In medication, channel-specific guiding herbs come first, followed by secondary symptoms. Pulse diagnosis distinguishes Yin from Yang syndromes. Medication depends on the primary treatment, ideally starting by draining Ying Qi, which addresses the root of sore treatment. If order is disregarded, the reversed root aids fire, damp-heat combines, corrupts muscle into pus and blood, and treatment must be differentiated. Generally, within a year, heat is most intense between the fourth and fifth lunar months, yet things do not rot at this time. Between the sixth and seventh months, when dampness prevails, taking the human body as an analogy, internal damp-heat would surely corrupt muscle; this logic is clear. Broadly speaking, regarding sores and ulcers, the *Neijing* states: Disharmony of the Six Fu Organs leads to flow and stagnation forming carbuncles. One must distinguish the organ affiliation and meridian differences. Among the Six Yin and Six Yang channels, there are those with abundant Qi and scarce Blood, those with scarce Qi and abundant Blood, and those with abundant Qi and abundant Blood; they cannot be generalized. The classics state that a Carbuncle (Yong) occurs when Ying and Wei Qi stagnate in the meridians, becoming stagnant and obstructed, preventing Wei Qi from circulating freely, causing heat. Unrelenting high heat rots flesh, which turns to pus. However, this condition does not sink into the marrow, the marrow does not dry up, and the Zang organs are not injured, hence it is called a Carbuncle. A Deep Abscess (Ju) involves pure excess heat sinking into skin, muscle, sinew, and bone, drying the marrow, rotting flesh, exhausting Zang organ Qi and Blood, with toxins sinking into sinew, bone, and healthy flesh. Ju presents with hard skin, resembling ox neck skin; Yong presents with thin, moist skin. Thus, Yong means obstruction, arising from Fu organ disharmony, superficial and large; Ju means blockage, resulting from Zang organ dysfunction, deep and malignant. Fu organs govern the exterior, their Qi is shallow, so Yong has thin skin and high swelling; Zang organs govern the interior, their Qi is deep, so Ju has thick skin and firm swelling. Both originate from Zang-Fu, manifest in muscle, and arise from Ying Qi stagnation and Qi-Blood obstruction. Their exit paths differ? Toxins exit through deficiency points. For instance, if the Taiyang Channel is deficient, toxins exit from the back; Shaoyang deficiency, from the temples; Yangming deficiency, from the beard area; Du Mai deficiency, from the brain; others follow their respective channels. Now, wealthy people lack moderation, consuming roasted, fried, rich, spicy foods, and strong alcohol for long periods. These flavors are dense; Yang within Yang cannot move through orifices first, the Yang pathway reverses, Yin and Yang reverse in muscle tissue, dampness dominates, leading to excess in mother and child elements, fire flares up. Once Ministerial Fire thrives, it conquers Kidney Water. With Kidney pathogen accumulation and water depletion, damp-heat rises upward. Sores often appear on the back and head, representing the most severe type of Ding Sore. If toxins appear in Lung or Spleen-Stomach regions, it is less severe; appearing in other channels is even less so. Or suffering from damp-toxin flowing and depositing, where stagnation always ulcerates. Hence the classic says: Rich food changes suffice to produce major Ding Sores; accepting toxins is like holding an empty vessel—nothing is refused. Treating major Ding Sores requires draining Ying Qi. From the perspective of Root and Branch, the initial pathogenesis is the Root. Without predominantly bitter-cold agents, one cannot remove the painful suffering. Many treat various sores with Frankincense (Ruxiang) and Myrrh (Moyao) plus hot-natured drugs, which is not secure reasoning. If meridians circulate freely, removing Zang-Fu stagnation, aided by cool-cold agents, sores heal naturally. Liu Hejian argued sores belong to Fire, requiring differentiation of interior/exterior to treat the root. If the pulse is deep and solid, first unblock the interior to cut off the source; if floating and large, first support the interior to prevent pathogen entry. For mixed interior-exterior cases, excessive pathogen blocks meridians, causing swelling, due to failure to support, unblock, and harmonize Ying-Wei. The key to treating sores is prioritizing unblocking, then supporting the interior, and harmonizing Ying-Wei; these three methods constitute internal and external attacks. If the pulse is deep and solid, with fever, irritability, but no external redness/pain, the pathogen is interior and deep. One should unblock Zang-Fu to cut off the source. Vomiting, irritability, deep-solid pulse, hard/swollen numbness, unchanged skin color, deep-rooted severe disease indicate interior pathogen. If Zang-Fu constipation exists, urgently unblock using Huanglian Neishu Tang (Coptis Internal Unblocking Decoction), adding Rhubarb (Dahuang), followed by sequential regulation. If the pulse is floating and rapid, with external redness/swelling and obvious exterior signs, fearing extreme pathogen sinking inward, first support the interior using Fujian San (Double-Boiled Powder). This is the treatment method.
Luo Li (Scrofula) and Ma Dao (Horse Knife) share the same channel but different presentations. Zhu Danxi stated: Luo Li initially arises in the Shaoyang Channel. Ignoring taboos allows it to extend to the Yangming Channel. Generally, rich flavors and accumulated stagnant Qi become toxins, wind, or heat, inducing transformation. Treatment must distinguish deficiency/excess. Excess cases follow standard regulation, avoiding rich/flavorful and Qi-dispersing foods, potentially healing. Deficiency cases are concerning as they involve the Gallbladder Channel, governing decision-making, containing Ministerial Fire, and having abundant Qi but scarce Blood. Women suffering menstruation irregularities develop chills/fever, progressing to tidal fever, becoming critical. Only celibacy, calming the mind, and avoiding rich flavors allow divine healing. The *Bencao* states Prunellae Spica (Xiakucao) treats Luo Li effectively, dissipating nodules, nourishing Jueyin blood vessels, and relieving chills/fever. Aid with dispersing herbs, moxibustion on channel-specific acupoints for natural efficacy. Liu Hejian’s theory: Luo Li refers to tubercles. Those around ears/jaw connecting to clavicle are Luo Li. Those on chest/sides connecting to hypochondrium are Ma Dao. Governed by Hand/Foot Shaoyang channels, which have abundant Qi and scarce Blood, hence tumors are hard, softness rare, pus white/thin like rice wash water. Laypeople treat Ma Dao seeking clear fluid, unaware of the Qi/Blood imbalance; diagnosis of deficiency/excess guides treatment. Li Dongyuan treated Luo Li/Ma Dao with Jiuku Huajian Tang (Bitter Rescue Hardening Dissolution Decoction) or Sanzhong Kuijian Tang (Swelling Reduction Hardening Dissolution Decoction), externally applying moxibustion to Linqi (GB15) for 14 moxa cones. This syndrome belongs to Hand/Foot Shaoyang; only Luo Li extending to Yangming alters prescription nuances, detailed in *Shixiao Fang*. Luo Li and Ma Dao are named by morphology/location. *Chushi Bingyuan* records 36 types; *Qianjin* and *Shenghui* discuss nine leaks. General theory cites Wind, Heat, Qi as three toxins; Luo Li tubercles vary by cold/heat. Root cause: anger reversing Qi, excessive worry, wind-heat pathogens attacking Liver. Liver governs sinews, causing sinus accumulation/swelling anywhere. Initially use Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction) or Muli Dahuang Tang (Oyster Shell Rhubarb Decoction), purging 2-3 times, then regulating with previous meds. Externally apply Shixiang Gao (Ten-Fragrance Plaster) or Wuxi Gao (Black Rhinoceros Horn Plaster). Near recovery, care must be meticulous.
Fei Yong (Lung Carbuncle) and Fei Wei (Lung Flaccidity): *Neijing* states Lung Yong causes panting and bilateral fullness. *Jingui Yaolue* discusses Yong and Wei together. Heat in Upper Jiao causes coughing into Lung Wei. How is Wei acquired? Via sweating, vomiting, Xiao Ke (Wasting-Thirst), frequent urination, or constipation compounded by purgatives losing fluids. Cun Kou pulse rapid, coughing, turbid saliva/phlegm indicates Wei. Dry cough, chest pain, slippery-rapid pulse indicates Yong. Coughing pus-blood, rapid-deficient pulse is Wei; rapid-solid is Yong. Lung is the canopy of Zang organs, located in chest, governs Qi, reflects on skin/hair. Labor/injury damages Qi-Blood, pores open, wind-pathogen enters Lung, causing sweating/aversion to wind, cough/shortness of breath, nasal congestion/stiff neck, chest/hypochondriac fullness. Chronicity leads to Wei (mild) or Yong (severe). *Shenghui* states: Tenderness at Zhongfu (LU1) indicates Lung Ju; slight elevation indicates Lung Chuang. Zhongfu is an acupoint, 1.5 cun below Yunmen (LU2), intercostal space, pulsating depression. Early detection saves; suppuration kills. Pulse check: slightly tight-rapid means no pus; very tight-rapid means pus exists. *Neijing*: Blood heat rots flesh, Ying-Wei stagnation forms pus. Lung Chuang with cough/shortness of breath/chest fullness, spitting pus-blood like rice gruel porridge is difficult to treat. Continuous vomiting of pus is incurable. Self-stopping vomiting heals. Short-choppy pulse heals; floating-large is difficult. Pale face turning red indicates Fire overcoming Metal, a reversal, incurable. Treatment: Inability to lie flat uses Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Lung-Draining Decoction) or Qianjin Fang Huangqi Tang (Astragalus Decoction). Precision in pulse differentiation is vital; slight error leads to vast consequences.
Chang Yong (Intestinal Carbuncle) and Weiwuan Yong (Stomach Carbuncle): Sun Simiao warned: Misidentifying Intestinal Carbuncle symptoms leads to fatal errors. Symptoms: Lower abdominal swelling, pain on pressure, dysuria resembling strangury, sweating, aversion to cold, gooseflesh, tense abdomen like swelling. Rapid pulse indicates small amount of pus; slow-tight pulse indicates no pus. Severe cases: abdominal distension, splashing sound on turning, periumbilical sores, umbilical pus discharge, bloody-purulent stool. Treat with Dahuang Mudanpi Tang (Rhubarb and Moutan Decoction) variants or external moxibustion. Weiwuan Yong differentiation: *Nejing* asks how to diagnose? Stomach pulse deep-thin indicates Qi reversal. Reversal makes Renying (ST9) pulse vigorous. Heat gathers at stomach opening, causing Weiwuan Yong. Rarely discussed except by Sun Simiao. Post-Sun scholars treat Stomach Heat pathogen: first unblock, then detoxify/support interior/reduce heat. Good method. Ignorance harms greatly; be cautious.
Ru He (Breast Nodule) untreated becomes Yong/Ju. Danxi stated: Breasts belong to Yangming, nipples to Jueyin. Nursing mothers, via anger or rich diet, cause Qi stagnation, duct blockage, milk retention, forming swelling/pain. Yangming blood heat turns to pus. Infant breath blowing heat forms nodules. Initial stage: endure pain, massage until soft, promote circulation for resolution. Neglect leads to carbuncle/furuncle. *Jingyao* uses Shenxiao Gualou San (Miraculous Trichosanthes Powder) for Ru Yong/Ru Lao. Effective but rare in villages. Use Dandelion (Pugongying), found everywhere, blooms March, yellow like chrysanthemum, sweet taste, resolves toxicity, moves stagnation, enters Yangming/Taiyin. Clean, grind, decoct with Honeysuckle Vine (Jinyinhua Teng), add wine. Effective. To disperse Jueyin stagnation, use Qingpi (Green Tangerine Peel); clear Yangming heat, use Shigao (Gypsum); drain fire, use Gancao (Licorice); reduce toxicity, use Gualouzi (Trichosanthes Seed); add Qingpi, Zaocoris (Gleditsia Spine), Jinnyinhua (Honeysuckle Flower), Danggui (Angelica Head). Decoction varies with wine. Add 2-3 moxa cones to swelling. Do not use needles/knives rashly. Women with accumulated sorrow form hidden nodules, turtle-shell sized, painless/itchless, lasting years, eventually ulcerating into "Nai Ai" (Breast Cancer) due to concave appearance. Incurable. Early resolution, mental clarity, bland diet, anger management ensure safety. Menstruating women have milder cases. Around age 60, rich diet/nodules/solid shape, emotional interference, irritability, tubercles, poor spirit/appetite: use Renshen Tang (Ginseng Decoction) adjusting Qingpi/Gancao powder equally, add ginger juice, sip frequently. Nodules resolve. Delayed treatment leads to painless ulceration under breast, death after 3-5 years despite normal eating. Widows/orphans suffer more. Married women benefit from husband's presence balancing Yin-Yang. Treated cases heal; untreated widows' deep lesions are feared. Early treatment essential; prolonged course, low survival rate. Newlywed woman healed by Qingpi/Gancao tea. 18-year-old woman with rapid-solid pulse treated with Qingpi tea and Siwu Tang variations, healed in one month. Scholars note Qingpi acts on Jueyin, Siwu Tang moves Blood; reasoning holds. Other eruptions, Ding, hemorrhoids, fistulas, genital sores, seasonal toxins detailed in *Jingyi*. Below lists Carbuncle/Abscess treatments.