疮疡之治，有宜泻者，有宜补者，有宜发散者，有宜调营解毒者，因证用药，各有所主
。经曰∶形气有余，病气有余，当泻不当补；形气不足，病气不足，当补不当泻。此其大纲
也。故凡察病之法，若其脉见滑实洪数，而 肿痛甚，烦热痞结，内外俱壅者，方是大实之
证。此其毒在脏腑，非用硝黄猛峻等剂，荡而逐之，则毒终不解。故不得不下，然非有真实
滞者不可下，此下之不可轻用也。其有脉见微细，血气素弱，或肿而不溃，溃而不敛，或饮
食不加，精神疲倦，或呕吐泄泻，手足常冷，脓水清稀，是皆大虚之候。此当全用温补，固
无疑矣。然不独此也。即凡见脉无洪数，外无烦热，内无壅滞，而毒有可虑者，此虽非大虚
之证，然察其但无实邪，盒饭托里养营，预顾元气。何也。盖恐困苦日久，或脓溃之后，不
待损而自虚矣。及其危败，临期何能及哉。故丹溪云∶痈疽因积毒在脏腑，宜先助胃壮气，以
固其本。夫然则气血，凝结者自散，脓瘀已成者自溃，肌肉欲死者自生肌肉，已死者自腐肌
肉，已溃者自敛。若独攻其疮，则脾胃一虚，七恶蜂起，其不死者幸矣，即此谓也。其有脉
见紧数，发热憎寒，或头痛，或身痛，或四肢拘急无汗，是必时气之不正，外闭皮毛，风热
壅盛而为痈肿，此表邪之宜散者也。如无表证，则不宜妄用发散，以致亡阳损卫。故仲景曰
∶疮家不可汗，此之谓也。其有营卫失调，气血留滞而偶生痈肿，但元气无损，饮食如常，
脉无凶候，证无七恶，此其在腑不在脏，在表不在里。有热者清其热，有毒者解其毒，有滞
者行其气，所当调营和卫而从平治者也。大都疮疡一证，得阳证而病气形气俱有余者轻，得
阴证而形气病气俱不足者重。若正气不足而邪毒有余，补之不可，攻之又不可者危。若毒虽
尽去，而脾肾已败，血气难复者，总皆不治之证。故临证者，当详察虚实，审邪正，辨表里
，明权衡。尚举措略乖，必遗人大害。斯任非轻，不可苟也。
王海藏《元戎》曰∶若人气血壅盛，营卫充满，抑遏不行，腐化而为痈者，当泄之，以
夺其盛热之气。若人饮食少思，精神衰弱，营卫短涩，寒搏而为痈者，当补之，以接其虚怯之气。
丹溪亦曰∶肿疡内外皆虚，宜以补接行散为主。
东垣曰∶疮疽之发，其受之有内外之别，治之有寒热之异。受之外者，法当托里以温剂
。反用寒药，则使皮毛始受之邪引入骨髓。受之内者，法当疏利以寒剂。反用温药托里，则
使骨髓之病上彻皮毛，表里通溃，共为一疮，助邪为毒，苦楚百倍，轻则危殆，重则死矣。
《病机机要》云∶内之外者，其脉沉实，发热烦躁，外无 赤痛，深于内其邪气深，故宜疏
通脏腑以绝其源。外之内者，其脉浮数， 肿在外，形证外显，恐邪气极而内行，故先宜托
里也。内外之中者，外无 恶之气，内亦脏腑宣通，知其在经，当和营卫也。用此三法之后
，虽未即瘥，必无变证，亦可使邪气峻减，而易愈。故治疮大要，须明此托里、疏通、和营卫之三法。
陈良甫曰∶诸痛痒疮疡，皆属心火。前辈云痈疽多生于丹石房劳之人。凡人年四十以上，
宜先用内托散，次用五香连翘汤，更以骑竹马法，或隔蒜并明灸足三里，以发泄其毒。盖邪
之所凑，其气必虚；留而不去，其病乃实。故痈疽未溃，则一毫热药断不可用。痈疽已溃，
脏腑既亏，一毫冷药亦不可用。犹忌敷贴之药，闭其毫孔。若热渴便闭，脉沉实洪数者，宜
用大黄等药，以泄其毒，后以国老膏、万金散、黄矾丸、远志酒之类，选而用之。
立斋曰∶按前证，若热毒蕴于内，大便秘结，元气无亏者，宜用大黄等药泄其热毒。若
阴虚阳凑，精虚气怯，脾胃虚弱者，宜用甘温之剂，培其本源。若疮不 肿，不作脓者，
虽其未溃，仍须温补。若疮已溃，而肿不退，痛不止者，仍宜清凉之剂治之。若病急而元气实
者，先治其标。病缓而元气虚者，先治其本。或病急而元气更虚者，必先治本而兼以治标。
大抵肿高 痛，脓水稠粘者，元气未损也，治之则易。漫肿微痛，脓水清稀者，元气虚弱
也，治之则难。不肿不痛，或漫肿色黯，不溃者，发于阴也，元气虚甚，理所不治。若肿高
痛者，先用仙方活命饮，后用托里消毒散。漫肿微痛者，宜托里散；如不应，加姜、桂。若
脓出而反痛，气血虚也，八珍汤。不作脓，不腐溃，阳气虚也，四君加归、 、肉桂。不生
肌，不收敛，脾气虚也，十全大补加姜、桂。晡热内热，阴血虚也，四物加参、术。欲呕作
呕，胃气虚也，六君加炮姜。自汗盗汗，五脏虚也，六味丸加五味子。食少体倦，脾气虚也
，补中益气加茯苓、半夏。喘促咳嗽，脾肺虚也，前汤加麦冬、五味。欲呕少食，脾胃虚也
，人参理中汤。腹痛泄泻，脾胃虚寒也，附子理中汤。小腹痞，足胫肿，脾肾虚弱也，十全
大补加山萸、山药、肉桂。泄泻足冷，脾肾虚寒也，前药加桂、附。热渴淋闭，肾虚阴火也
，加减八味丸。喘嗽淋闭，肺肾虚火也，补中益气汤加减八味丸。凡此变证，皆因元气亏损
，失于预补所致。又曰∶凡疮疡用药，当审其经络受证，标本虚实，以治之。不可泥于热毒
内攻，专用寒凉克伐之剂，亏损脾胃气血，多致有误。且以虚弱之人，用峻利之药，则药力
未到，胃气先伤，虚虚之祸，有所不免。故凡元气不足者，既治其初患，更当内用参 归术
温补脾胃，外用桑枝葱熨接补阳气，使自消散。又曰，凡痈疽肿痛，初生便觉脉沉细而烦闷
，脏腑弱而皮寒，邪毒猛暴，恍惚不宁，外证深沉者，亦当即用托里散及温热之剂，以从治
之。又曰∶前证若发热烦渴，大便秘结者，由邪蓄于内，宜内疏黄连汤，以泄内毒。若头痛
拘急，发热恶寒者，由邪客于外，宜人参败毒散，以散表邪。若肿痛 赤，发热作渴，此
毒瓦斯凝于肉里，宜仙方活命饮，解散其毒。若食少体倦，发热恶寒，此中气虚弱，宜六君子汤
，以补脾胃。又曰∶大抵证有本末，治有权宜。治其主，则末病自退。用其权，则不拘于时。
泥于守常，必致病势危甚。况杂用攻剂，动损各经乎。罗谦甫云∶守常者众人之见，知变者
智者之事。知常而不知变，因细事而取败者多矣。
凡痈疽，实证不可温补，虚证不可凉泄，此大法也。观前条陈良甫曰∶凡疮疡未溃，一
毫热药断不可用。痈疽已溃，脏腑已亏，一毫冷药亦不可用。又立斋云，若肿 痛甚，烦躁
脉大，寒热往来，大便秘结，小便涩痛，心神愦闷，皆邪热之证。凡辛热之剂，不但肿疡不
可用，虽溃疡亦不可用也。此固然矣。然二公已道其半，犹未尽也。余读之曰，凡痈疽阴盛
阳衰者，但见体虚脉弱，阳气无权等证，则凡苦寒之剂，非为溃疡不可用，即肿疡亦不可用
也。又若阴邪凝结之毒，非用温热，何以营运。而陈氏谓肿疡不可用热药，恐不可以概言也。
疮疡的治疗，有适宜用泻法的，有适宜用补法的，有适宜用发散法的，有适宜用调和营血、解除毒邪的，应当根据证候选用药物，各有其主治原则。《内经》说：形体正气有余，病邪气也有余，应当用泻法而不应当用补法；形体正气不足，病邪气也不足，应当用补法而不应当用泻法。这是治疗的大纲。所以凡是诊察疾病的方法，如果脉象呈现滑、实、洪、数，而肿痛剧烈，烦热痞塞结聚，内外都壅滞不通的，这才是大实证。这种毒邪在脏腑，如果不使用芒硝、大黄等猛峻的药剂，荡涤攻逐毒邪，那么毒邪终究不能解除。所以不得不使用下法，然而如果没有真实的积滞不可轻易使用下法，这就是下法不可轻用的原因。那些脉象微细，气血素来虚弱，或者肿胀但不溃破，溃破后但不愈合，或者饮食减少，精神疲倦，或者呕吐泄泻，手足经常发冷，脓水清稀，这些都是大虚证的征候。这应当完全使用温补法，毫无疑问了。然而不仅仅如此。即使凡是见到脉象没有洪数，体表没有烦热，体内没有壅滞，但毒邪有可忧虑的情况，这虽然不是大虚证，然而审察发现没有实邪，就应当使用托里养营的方法，预先顾护元气。为什么呢？大概担心困苦日久，或者脓液溃破之后，不待损伤而自然虚弱了。等到病情危重败坏时，临时怎么来得及救治呢？所以朱丹溪说：痈疽是因为积毒在脏腑，应当先助胃壮气，以巩固根本。既然这样，那么气血凝结的自然会消散，脓瘀已经形成的自然会溃破，肌肉将要坏死的自然会生出新肉，已经坏死的自然会腐脱，已经溃破的自然会愈合。如果只攻伐疮疡，那么脾胃一旦虚弱，七恶证（中医外科危重证候）蜂拥而起，不死也是侥幸了，说的就是这个道理。那些脉象紧数，发热怕冷，或者头痛，或者身痛，或者四肢拘急无汗，这一定是时行不正之气，外闭皮毛，风热壅盛而成为痈肿，这是表邪适宜用发散法的情况。如果没有表证，就不应当妄用发散法，以致导致亡阳损卫。所以张仲景说：患疮疡的人不可发汗，说的就是这个意思。那些营卫失调，气血留滞而偶然发生痈肿，只要元气没有亏损，饮食如常，脉象没有凶险征候，证候没有七恶表现，这说明病在腑不在脏，在表不在里。有热的清除其热，有毒的解除其毒，有滞的通行其气，应当调和营卫而按平和之法治疗。大抵疮疡这一类证候，得到阳证且病气、形气都有余的较轻，得到阴证且形气、病气都不足的较重。如果正气不足而邪毒有余，补它不可以，攻它也不可以的，属于危重证。如果毒邪虽然尽去，但脾肾已经败坏，血气难以恢复的，总都是不治之证。所以临证时，应当详细审察虚实，审视邪正，辨别表里，明确权衡利弊。如果举措稍微违背常理，必定遗给人大的祸害。这个责任不轻，不可草率马虎。
王海藏在《元戎》中说：如果人气血壅盛，营卫充满，郁遏不行，腐败化而为痈的，应当用泻法，以剥夺其盛热之气。如果人饮食少思，精神衰弱，营卫短涩，寒邪搏结而为痈的，应当用补法，以接续其虚怯之气。朱丹溪也说：肿疡（未溃之疮）内外皆虚，应当以补接、行散为主。
李东垣说：疮疽的发生，其受邪有内外的区别，治疗有寒热的不同。受于外部的，治法应当用托里法配合温剂。反而使用寒药，则会使皮毛初受的邪气引入骨髓。受于内部的，治法应当用疏利法配合寒剂。反而使用温药托里，则会使骨髓的病上彻皮毛，表里贯通溃烂，共成一疮，助长邪气为毒，痛苦百倍，轻则危殆，重则死亡。《机要》说：内之外者（病起于内而发于外），其脉沉实，发热烦躁，体表无赤痛，因为邪气深在于内，所以应当疏通脏腑以断绝其源头。外之内者（病起于外而入于内），其脉浮数，肿胀在外，形证显现于外，恐怕邪气极盛而内行入里，所以先应当用托里法。内外之中者，外表没有恶气，内部脏腑宣通，知道病在经络，应当调和营卫。使用这三种方法之后，虽然不能立即痊愈，但必定不会有变证，也可以使邪气大幅减少，而容易痊愈。所以治疗疮疡的大要，必须明白托里、疏通、和营卫这三种方法。
陈良甫说：各种痛痒疮疡，都属于心火。前辈说痈疽多生于服用丹石、房劳过度的人。凡人年四十以上，应当先用内托散，次用五香连翘汤，再用骑竹马灸法，或者隔蒜灸并直接灸足三里穴，以发泄其毒邪。大概邪气所凑集的地方，正气必然虚弱；邪气停留不去，病邪乃成实邪。所以痈疽未溃破时，一毫热药绝对不可用。痈疽已溃破，脏腑既已亏虚，一毫冷药也不可再用。还要忌用敷贴的药物，以免闭塞毛孔。如果有热渴、便秘，脉象沉实洪数的，应当使用大黄等药，以泄其毒，随后选用国老膏、万金散、黄矾丸、远志酒之类。
薛立斋说：按照前面的证候，如果热毒蕴结于内，大便秘结，元气没有亏损的，应当使用大黄等药泄其热毒。如果阴虚阳凑，精虚气怯，脾胃虚弱的，应当使用甘温的药剂，培补其本源。如果疮不肿，不作脓的，虽然未溃破，仍须温补。如果疮已溃破，而肿不退，痛不止的，仍宜用清凉的药剂治疗。如果病势急而元气实的，先治其标。病势缓而元气虚的，先治其本。或者病势急而元气更虚的，必须先治本而兼以治标。大抵肿胀高突疼痛，脓水稠粘的，元气没有受损，治疗则容易。漫肿微痛，脓水清稀的，元气虚弱，治疗则难。不肿不痛，或者漫肿色黯，不溃破的，发于阴分，元气虚甚，按理是不治之证。如果肿高疼痛的，先用仙方活命饮，后用托里消毒散。漫肿微痛的，宜用托里散；如果无效，加生姜、肉桂。如果脓出而反痛，是气血虚，用八珍汤。不作脓，不腐溃，是阳气虚，用四君子汤加当归、黄芪、肉桂。不生肌，不收敛，是脾气虚，用十全大补汤加生姜、肉桂。傍晚发热、内热，是阴血虚，用四物汤加人参、白术。想呕吐或作呕，是胃气虚，用六君子汤加炮姜。自汗盗汗，是五脏虚，用六味地黄丸加五味子。食少体倦，是脾气虚，用补中益气汤加茯苓、半夏。喘促咳嗽，是脾肺虚，用前汤加麦冬、五味子。想呕吐少食，是脾胃虚，用人参理中汤。腹痛泄泻，是脾胃虚寒，用附子理中汤。小腹痞满，足胫肿，是脾肾虚弱，用十全大补汤加山茱萸、山药、肉桂。泄泻足冷，是脾肾虚寒，用前药加肉桂、附子。热渴淋闭，是肾虚阴火，用加减八味丸。喘嗽淋闭，是肺肾虚火，用补中益气汤合加减八味丸。凡此变证，都是因为元气亏损，失于预先补益所致。又说：凡疮疡用药，应当审察其经络受证，标本虚实，然后治疗。不可拘泥于热毒内攻，专用寒凉克伐的药剂，亏损脾胃气血，多会导致错误。况且对于虚弱之人，使用峻利的药物，则药力未到，胃气先伤，造成虚上加虚的祸患，在所难免。所以凡元气不足的，既治其初患，更应当内服人参、当归、白术温补脾胃，外用桑枝葱熨法接补阳气，使其自行消散。又说，凡痈疽肿痛，初生便觉得脉沉细而烦闷，脏腑弱而皮肤寒冷，邪毒猛暴，恍惚不宁，外证深沉的，也应当立即使用托里散及温热药剂，以从治法应对。又说，前面的证候如果发热烦渴，大便秘结的，是由于邪气蓄积于内，宜用内疏黄连汤，以泄内毒。如果头痛拘急，发热恶寒的，是由于邪气客于体外，宜用人参败毒散，以散表邪。如果肿痛红赤，发热作渴的，这是毒瓦斯凝于肉里，宜用仙方活命饮，解散其毒。如果食少体倦，发热恶寒的，这是中气虚弱，宜用六君子汤，以补脾胃。又说：大抵证候有本末，治疗有权宜。治其主证，则末病自然退却。运用权宜之法，则不拘泥于常规。拘泥于守常，必定导致病势危重。何况杂用攻剂，动辄损伤各经吗？罗谦甫说：守常是众人的见解，知变是智者的行事。知常而不知变，因小事而失败的很多。
凡痈疽，实证不可温补，虚证不可凉泄，这是大法。看前面陈良甫说：凡疮疡未溃破，一毫热药绝对不可用。痈疽已溃破，脏腑已亏，一毫冷药也不可再用。又薛立斋说，如果肿痛甚，烦躁脉大，寒热往来，大便秘结，小便涩痛，心神愦闷，都是邪热之证。凡辛热药剂，不但肿疡不可用，虽溃疡也不可用。这固然正确。然而这两位先生只说对了一半，还没有说完。我读后认为，凡痈疽阴盛阳衰的，只要见到体虚脉弱，阳气无权等证候，那么凡苦寒药剂，不仅溃疡不可用，即肿疡也不可用。另外如果是阴邪凝结的毒，不用温热药，怎么能营运气血。而陈氏说肿疡不可用热药，恐怕不可以一概而论。
The treatment of sores and ulcers includes methods suitable for purging (Purging), those suitable for tonifying (Tonifying), those suitable for dispersing (Dispersing), and those suitable for regulating Ying (Nutrient) blood and resolving toxins. Medications should be selected according to the syndrome, each with its specific indication. The *Classic of Medicine* states: "When both physical constitution and pathogenic factors are in excess, purging is indicated rather than tonifying; when both physical constitution and pathogenic factors are deficient, tonifying is indicated rather than purging." This constitutes the general principle. Therefore, in diagnosing diseases, if the pulse is slippery, full, flooding, or rapid, accompanied by severe swelling and pain, irritability, heat, epigastric fullness and stagnation, and blockage both internally and externally, this represents a true Excess syndrome. Here, the toxin resides within the Zang-Fu organs. Without using potent agents such as Mirabilite (Natrii Sulfas) and Rhubarb (Rhei Radix et Rhizoma) to purge and drive out the toxin, the toxin will never be resolved. Thus, purgative methods must be employed; however, they should not be used lightly unless there is genuine accumulation. This explains why purgatives are not to be used casually.
In cases where the pulse is faint and fine, and the Qi and Blood have always been weak, or where there is swelling without ulceration, or ulceration without healing, or reduced appetite, mental fatigue, vomiting and diarrhea, cold hands and feet, and thin, clear pus, these are all signs of severe Deficiency. Such cases require complete use of warming and tonifying methods, which is beyond doubt. However, it is not limited to this. Even if the pulse lacks flooding or rapid qualities, there is no external irritability or heat, and no internal stagnation, yet the toxin remains a concern, although this is not a severe Deficiency syndrome, one should observe that since there is no Excess pathogen, methods to support the interior and nourish Ying (Nutrient) blood should be used to protect Yuan Qi (Original Qi) in advance. Why? Because prolonged suffering may lead to spontaneous deficiency after the pus drains, before any further damage occurs. When the condition becomes critical, it is too late to act. Therefore, Zhu Danxi stated: "Carbuncles and sores result from accumulated toxins in the Zang-Fu organs; one should first strengthen the Stomach and boost Qi to consolidate the root." In this way,凝结 (coagulated) Qi and Blood will naturally disperse, formed pus and stasis will naturally ulcerate, necrotic muscle will regenerate, dead tissue will slough off, and open wounds will heal. If one only attacks the sore, the Spleen and Stomach will weaken, leading to the emergence of the Seven Evil syndromes (Seven Evil Syndromes); survival would be merely fortunate. This is the point being made.
In cases where the pulse is tight and rapid, with fever and aversion to cold, headache, body pain, or limb stiffness without sweating, this indicates invasion by abnormal seasonal pathogens closing the skin and hair, with excessive Wind-Heat causing swelling and carbuncles. This is an Exterior pathogen suitable for dispersing. If there are no Exterior symptoms, dispersing methods should not be used recklessly, to avoid damaging Yang and Wei (Defensive) Qi. Thus, Zhang Zhongjing said: "Patients with sores should not be induced to sweat," referring to this principle.
In cases where Ying (Nutrient) and Wei (Defensive) Qi are disharmonious, and Qi and Blood stagnate, causing occasional carbuncles, provided Yuan Qi is intact, diet is normal, the pulse shows no ominous signs, and there are no Seven Evil syndromes, the disease is in the Fu (Hollow) organs rather than Zang (Solid) organs, and in the Exterior rather than the Interior. Heat should be cleared, toxins resolved, and stagnation moved. One should regulate Ying and Wei and treat according to peaceful methods. Generally, for sores and ulcers, Yang syndromes with Excess in both pathological and constitutional Qi are mild; Yin syndromes with Deficiency in both are severe. If Righteous Qi is insufficient while Pathogenic Toxin is excessive, neither tonification nor attack is appropriate, indicating a critical condition. If the toxin is gone but the Spleen and Kidney are ruined and Qi and Blood cannot recover, it is incurable. Therefore, clinicians must carefully examine Excess and Deficiency, assess Pathogen and Righteous Qi, distinguish Exterior and Interior, and weigh the pros and cons. Any slight deviation in management will cause great harm. The responsibility is heavy and must not be taken lightly.
Wang Haizang in *Yuan Rong* stated: "If a person has abundant and obstructed Qi and Blood, with充盈 (full) Ying and Wei Qi that cannot circulate, leading to putrefaction and carbuncle formation, purging should be used to drain the excessive heat. If a person has poor appetite, weak spirit, short and stagnant Ying and Wei Qi, with Cold binding causing carbuncle, tonifying should be used to replenish the deficient and timid Qi." Zhu Danxi also said: "For early-stage sores (Swollen Ulcer) with internal and external deficiency, the main approach should be tonification, connection, and dispersion."
Li Dongyuan stated: "The onset of sores and carbuncles differs in origin (internal vs. external) and treatment (cold vs. hot). External origins should be treated with interior-supporting warm formulas. Using cold herbs instead draws the pathogen from the skin into the bone marrow. Internal origins should be treated with draining and promoting cold formulas. Using warm interior-supporting herbs instead causes bone marrow pathology to penetrate to the skin, resulting in systemic ulceration, aiding the pathogen's toxicity, causing immense suffering, danger, or death." *Ji Yao* states: "Internal-originating external lesions present with deep, full pulses, fever, irritability, and no superficial redness/pain; because the pathogen is deep inside, one should unblock the Zang-Fu to cut off the source. External-originating internal lesions present with floating, rapid pulses, superficial swelling, and visible exterior signs; fearing extreme pathogen penetration inward, one should first support the interior. Lesions between internal and external show no evil signs externally and smooth Zang-Fu function internally, indicating involvement of the meridians; one should harmonize Ying and Wei. After applying these three methods, even if not immediately cured, complications are avoided, the pathogen is significantly reduced, and recovery is facilitated. Thus, the key to treating sores is understanding these three methods: supporting the interior, unblocking/dredging, and harmonizing Ying and Wei."
Chen Liangfu stated: "All painful, itching sores and ulcers belong to Heart Fire." Seniors noted that carbuncles often occur in people taking mineral drugs or engaging in excessive sexual activity. People over forty should first use Neituo San (Interior-Supporting Powder), then Wuxiang Liaoqiao Tang (Five-Aromatic and Forsythia Decoction), along with Qizhuma moxibustion, garlic-separated moxibustion, and direct moxibustion on Zusanli (ST 36) to vent the toxin. Wherever pathogen gathers, Qi is deficient; where it lingers, it becomes Excess. Thus, before ulceration, no hot herbs should be used. After ulceration, when Zang-Fu are depleted, no cold herbs should be used. Also, avoid topical applications that close pores. For heat, thirst, constipation, and deep, full, flooding, rapid pulses, use Rhubarb (Rhei Radix et Rhizoma) to purge toxins, followed by Guolao Gao, Wanjing San, Huangfan Wan, or Yuanzhi Jiu.
Xue Ji stated: "Regarding previous syndromes: If heat-toxin is trapped internally with constipation and intact Yuan Qi, use Rhubarb (Rhei Radix et Rhizoma) to purge heat-toxin. If Yin deficiency with Yang encroachment, essence deficiency, timid Qi, and weak Spleen-Stomach, use sweet-warm agents to cultivate the root. If the sore does not swell or suppurate, even before ulceration, warming and tonifying are still required. If ulcerated but swelling and pain persist, cool agents are still appropriate. If acute and Yuan Qi is strong, treat the branch first. If chronic and Yuan Qi is weak, treat the root first. If acute and Yuan Qi is very weak, treat the root primarily while addressing the branch. Generally, high, swollen, painful sores with thick pus indicate intact Yuan Qi and easy treatment. Flat, mildly painful sores with thin pus indicate weak Yuan Qi and difficult treatment. Non-swollen, non-painful, or flat dark sores not ulcerating indicate Yin onset, severe Yuan Qi deficiency, and likely incurability. For high, swollen, painful sores, use Xianfang Huoming Yin (Immortal Life Elixir) first, then Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) later. For flat, mildly painful sores, use Tuoli San (Interior-Supporting Powder); if ineffective, add Ginger (Zingiberis Rhizoma Recens) and Cinnamon Twig (Cinnamomi Ramulus). If pain increases after pus drainage, it is Qi and Blood deficiency; use Bazhen Tang (Eight-Treasure Decoction). If no suppuration or sloughing, it is Yang Qi deficiency; use Sijunzi Tang (Four-Gentlemen Decoction) plus Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), and Cinnamon Twig (Cinnamomi Ramulus). If no granulation or healing, it is Spleen Qi deficiency; use Shiquan Dabu Tang (Perfect Great Tonifying Decoction) plus Ginger and Cinnamon Twig. If afternoon fever or internal heat, it is Yin Blood deficiency; use Siwu Tang (Four-Materials Decoction) plus Ginseng (Ren Shen) and Atractylodis Macrocephalae Rhizoma (Baizhu). If nausea or vomiting, it is Stomach Qi deficiency; use Liujunzi Tang (Six-Gentlemen Decoction) plus roasted Ginger (Shengjiang Pao). If spontaneous or night sweats, it is Five Zang deficiency; use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Schisandrae Fructus (Wuweizi). If poor appetite and fatigue, it is Spleen Qi deficiency; use Buzhong Yiqi Tang (Middle-Warming and Qi-Boosting Decoction) plus Poria (Fuling) and Pinelliae Rhizoma (Banxia). If panting and cough, it is Spleen-Lung deficiency; use the previous decoction plus Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi). If nausea and poor intake, it is Spleen-Stomach deficiency; use Renshen Lizhong Tang (Ginseng and Magnolia Bark Decoction). If abdominal pain and diarrhea, it is Spleen-Stomach deficiency-cold; use Fuzi Lizhong Tang (Aconite and Magnolia Bark Decoction). If lower abdominal fullness and leg edema, it is Spleen-Kidney weakness; use Shiquan Dabu Tang plus Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), and Cinnamon Twig. If diarrhea and cold feet, it is Spleen-Kidney deficiency-cold; add Cinnamon and Aconite to the previous medicine. For heat, thirst, and dysuria due to Kidney deficiency and deficient fire, use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). For panting, cough, and dysuria due to Lung-Kidney deficiency-fire, combine Buzhong Yiqi Tang with Jiajian Bawei Wan. All these variations result from Yuan Qi depletion and failure to tonify in advance. Furthermore, when medicating sores, one must examine meridian involvement, root and branch, and Excess/Deficiency. Do not rigidly adhere to 'heat-toxin attacking inward' using only cold-draining agents that damage Spleen-Stomach Qi and Blood, leading to errors. Especially for weak patients, harsh purgatives injure Stomach Qi before reaching the target, causing 'deficiency upon deficiency.' Thus, for insufficient Yuan Qi, besides treating the initial complaint, internally use Ginseng (Ren Shen), Angelica (Danggui), and Atractylodes (Baizhu) to warm-tonify Spleen-Stomach, and externally use Mulberry Branch and Scallion moxibustion to connect and supplement Yang Qi for natural resolution. Also, if early-stage carbuncles present with deep-fine pulse, irritability, weak viscera, cold skin, fierce toxin, restlessness, and deep exterior signs, immediately use Tuoli San and warm-hot agents to treat from the side. If fever, thirst, and constipation exist due to internal pathogen accumulation, use Nishu Huanglian Tang (Internal-Draining Coptis Decoction) to purge internal toxin. If headache, stiffness, fever, and aversion to cold exist due to external pathogen invasion, use Renshen Baidu San (Ginseng and Rescue the Extremities Powder) to disperse exterior pathogen. If swelling, pain, redness, fever, and thirst exist due to toxin condensing in flesh, use Xianfang Huoming Yin to resolve the toxin. If poor appetite, fatigue, fever, and aversion to cold exist due to Middle Qi weakness, use Liujunzi Tang to tonify Spleen-Stomach. Generally, syndromes have root and branch; treatments allow flexibility. Treating the main issue resolves secondary issues. Using flexibility avoids rigid adherence to time or convention. Rigid adherence leads to critical conditions. Moreover, indiscriminate use of attacking agents damages various meridians. Luo Qianfu said: 'Adhering to convention is the view of the masses; knowing change is the act of the wise. Knowing convention but not change leads to many failures over minor matters.'"
For all carbuncles and sores, Excess syndromes should not be warmed-tonified, and Deficiency syndromes should not be cooled-purged; this is the general rule. As Chen Liangfu stated: "Before ulceration, no hot herbs should be used. After ulceration, when Zang-Fu are depleted, no cold herbs should be used." Xue Ji added: "Severe swelling/pain, irritability, large pulse, alternating chills/fever, constipation, painful urination, and mental confusion indicate pathogenic heat. Hot agents are contraindicated for both early-stage and ulcerated sores." This is correct. However, these masters only addressed half the truth. I argue that for Yin-excess/Yang-deficiency sores, presenting with weak constitution, faint pulse, and powerless Yang, even bitter-cold agents are contraindicated for both early-stage and ulcerated sores. Conversely, for toxins caused by Yin-Cold coagulation, how can circulation be maintained without warm-hot agents? Therefore, Chen's statement that hot herbs are universally contraindicated for early-stage sores cannot be generalized.