汪太夫人，年逾八十，脑疽已溃，发背继生，头如粟米，脉大无力。此膀胱经湿热所致
，然脉大无力，乃血气衰也。遂以托里消毒散数服，稍可。更加参 之剂。虽疮起而作渴，
此气血虚甚，以人参、黄 各一两，当归、熟地各五钱，麦冬、五味各一钱，数服渴止而愈
。此不有脏腑能言，气血能告，岂能省悟。病者至死，皆归于命，深可哀也。又有患者，气
质素实，或有痰不服补剂，然不知脓血内溃，气血并虚，岂不宜补。余常治疮，阴用参 大
补之剂，阳书败毒之名，与服之，俱不中满，疮亦随效。虚甚者，尚加姜桂，甚至附子，未
尝有不效也。（薛按）
立斋曰∶脓熟不溃者，阳气虚也，宜补之。瘀血不腐者，宜大补阳气，更以桑木灸之。
脓清不敛者，气血俱虚，宜大补。脓后食少无睡，或发热者，虚也，宜补之。倦怠懒言，
食少不睡者，虚也，宜补之。寒气袭于疮口，不能收敛或陷下不敛者，温补之。脉大无力，或涩
微者，气血俱虚也，峻补之。出血或脓多，烦躁不眠者，乃亡阳也，急补之。
凡脓溃而清，或疮口不合，或聚肿不赤，肌寒肉冷，自汗色脱者，皆气血俱虚也，非补
不可。
凡脓血去多，疮口虽合，尤当补益。务使气血平复，否则更患他证，必难治疗也。
又曰∶大抵脓血大泄，当大补血气为先，虽有他证，以未治之。凡痈疽大溃，发热恶寒
，皆属气血虚甚。若左手脉不足者，补血药当多于补气药；右手脉不足者，补气药当多于补
血药，切不可发表。
大凡痈疽，全藉血气为主，若患而不起，或溃而不腐，或不收敛，及脓少或清，皆血气
之虚也，俱宜大补之，最忌攻伐之剂。亦有脓反多者，乃气血虚而不能禁止也。常见血气充实
之人患疮者，必肿高色赤，易腐溃而脓且稠，又易于收敛。怯弱之人，多不起发，不腐溃，
及难于收敛。若不审察而妄投攻剂，虚虚之祸不免矣。及患后，更当调养。若瘰 流注之属
，尤当补益也。否则更患他证，必难措治。慎之。
又曰∶溃疡若属气血俱虚，固所当补，若患肿疡而气血虚弱者，尤宜预补。否则虽溃而不
敛矣。又凡大病之后，气血未复，多致再发，若不调补，必变为他证而危，或误以疮毒复发
，反行攻伐，则速其不起，深可为戒也。
又曰∶若疮疡肿 痛甚，烦躁脉大，则辛热之剂，不但肿疡不可用，即溃疡亦不可用也。
《太平圣惠方》云∶凡痈疽脓溃之后，脉微涩迟缓者，邪气去而真气将复也，为易愈。
若脉来沉细而直者，里虚而欲变证也。若脓血既去，则当脉静身凉，肿消痛息，如伤寒表
证之得汗也。若反发热作渴，脉洪数者，此真气虚而邪气实也，死无疑矣。
汪太夫人，年龄超过八十岁，脑疽已经溃破，随后发背又生出新疮，疮头像粟米一样小，脉象大而无力。这是膀胱经湿热所致，然而脉象大而无力，说明血气衰败。于是服用托里消毒散几剂，病情稍有好转。再增加人参的剂量。虽然疮疡隆起但出现口渴，这是因为气血极度虚弱，使用人参、黄芪各一两，当归、熟地黄各五钱，麦冬、五味子各一钱，服用数剂后口渴停止而痊愈。如果不是脏腑能言说，气血能告警，怎么能醒悟呢？病人直到死亡，都归结为命运，实在令人悲哀。又有患者，体质素来壮实，或者有痰湿不服用补剂，然而不知道脓血内溃后，气血并皆虚弱，难道不应该补益吗？我常治疗疮疡，阴分用参芪大补之剂，阳分书写败毒之名，让患者服用，都不导致中焦胀满，疮疡也随即见效。虚损严重的，还加用干姜、肉桂，甚至附子，未曾有不奏效的。（薛己按语）
薛立斋说：脓液成熟但不溃破的，是阳气虚弱，应当补益。瘀血不腐烂的，应当大补阳气，并用桑木进行艾灸。脓液清稀不收敛的，是气血俱虚，应当大补。出脓后饮食减少且失眠，或者发热的，是虚证，应当补益。倦怠懒言，饮食减少且失眠的，是虚证，应当补益。寒气侵袭疮口，不能收敛或下陷不收敛的，应当温补。脉象大而无力，或者涩微的，是气血俱虚，应当峻补。出血或脓液过多，烦躁不眠的，是亡阳，应当急补。
凡是脓液溃破后清稀，或者疮口不合拢，或者聚集肿胀但不发红，肌肉寒冷，自汗面色脱色的，都是气血俱虚，非补不可。
凡是脓血流失过多，疮口虽然合拢，尤其应当补益。务必使气血平复，否则更患其他病证，必定难以治疗。
又说：大概脓血大量泄出时，应当以大补血气为先，即使有其他病证，暂且不治。凡是痈疽大溃，发热恶寒，都属于气血极度虚弱。如果左手脉不足，补血药应当多于补气药；右手脉不足，补气药应当多于补血药，切不可使用发表（解表）法。
大凡痈疽，完全依赖血气作为根本，如果患病后不起发，或者溃破后不腐烂，或者不收敛，以及脓少或清稀，都是血气的虚损，都应当大补，最忌讳攻伐之剂。也有脓反而多的，是气血虚弱而不能固摄的缘故。常见血气充实的人患疮，一定肿胀高突、颜色红赤，容易腐烂溃破且脓液稠厚，又易于收敛。怯弱的人，多不起发，不腐烂溃破，以及难于收敛。如果不审察而妄投攻剂，造成“虚虚”（使虚者更虚）的祸害是不可避免的。患病之后，更应当调养。如果是瘰疬、流注之类的病症，尤其应当补益。否则更患其他病证，必定难以处置。要谨慎。
又说：溃疡如果属于气血俱虚，固然应当补益，如果患肿疡而气血虚弱，尤其应当预先补益。否则虽然溃破也不收敛了。又凡是重病之后，气血未恢复，多导致复发，如果不调补，必定变为其他病证而危险，或者误认为是疮毒复发，反而行攻伐之法，则加速其不起发，深以为戒。
又说：如果疮疡肿痛严重，烦躁脉大，那么辛热之剂，不但肿疡不可用，即溃疡亦不可用。
《太平圣惠方》说：凡是痈疽脓溃之后，脉象微涩迟缓的，是邪气去而真气将复，为易愈。如果脉象沉细而直的，是里虚而欲变证。如果脓血既去，则应当脉静身凉，肿消痛息，如同伤寒表证得汗一样。如果反而发热作渴，脉洪数的，这是真气虚而邪气实，死无疑矣。
Madam Wang, over eighty years old, had a carbuncle on the head that had already ulcerated, followed by the emergence of a back carbuncle; the pustules were as small as millet seeds, and the pulse was large but powerless. This was caused by damp-heat in the Bladder Meridian (Taiyang Bladder Channel), yet a large and powerless pulse indicates a decline in Blood and Qi. Consequently, she took Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction) for several doses, with slight improvement. The dosage of Ren Shen (Ginseng Radix et Rhizoma) was then increased. Although the sore raised up, thirst ensued, indicating extreme deficiency of Blood and Qi. A prescription containing one liang each of Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix), five qian each of Dang Gui (Angelicae Sinensis Radix) and Shu Di Huang (Rehmanniae Radix Preparata), and one qian each of Mai Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus) was administered for several doses, after which the thirst ceased and she recovered. If the Zang-Fu organs could speak and Blood and Qi could report their condition, how could one not realize this? Patients often attribute their death to fate, which is deeply lamentable. There was another patient who was constitutionally robust or had phlegm-dampness and refused tonifying agents. However, they did not realize that after internal ulceration of pus and blood, both Blood and Qi become deficient; should they not be tonified? In my frequent treatment of sores, I used Yin-tonifying formulas with heavy doses of Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix), while labeling them with names implying detoxification, and patients took them without experiencing abdominal fullness, and the sores responded promptly. In cases of severe deficiency, I even added Gan Jiang (Zingiberis Rhizoma) and Rou Gui (Cinnamomi Cortex), or even Fu Zi (Aconiti Lateralis Radix Preparata), and there was never a case where it failed. (Commentary by Xue Ji)
Xue Lizhai said: When pus has matured but does not ulcerate, it is due to deficiency of Yang Qi, and tonification is indicated. When stagnant blood does not putrefy, one should greatly tonify Yang Qi and apply moxibustion with mulberry wood. When pus is clear and does not heal, it indicates deficiency of both Blood and Qi, requiring great tonification. After pus discharge, if appetite is poor and sleep is absent, or fever occurs, it is deficiency, and tonification is indicated. If fatigue, reluctance to speak, poor appetite, and insomnia are present, it is deficiency, and tonification is indicated. If cold pathogen invades the sore opening, preventing healing or causing sinking without healing, warm tonification is indicated. If the pulse is large and powerless, or choppy and minute, it indicates deficiency of both Blood and Qi, requiring vigorous tonification. If bleeding or excessive pus discharge occurs with irritability and insomnia, it indicates collapse of Yang, requiring urgent tonification.
Generally, when pus discharges and is clear, or the sore opening fails to close, or swelling gathers without redness, muscles are cold, flesh is cold, spontaneous sweating occurs, and complexion is pale, all indicate deficiency of both Blood and Qi, and tonification is indispensable.
When much pus and blood have been lost, even if the sore opening has closed, tonification is still crucial. One must ensure the restoration of Blood and Qi; otherwise, other syndromes may arise, making treatment difficult.
He also said: Generally, when pus and blood are heavily discharged, replenishing Blood and Qi should be the priority. Even if other syndromes exist, they should be left untreated for the time being. For major ulceration of carbuncles and sores, fever and aversion to cold belong to extreme deficiency of Blood and Qi. If the Left Hand pulse is insufficient, Blood-tonifying herbs should outweigh Qi-tonifying herbs; if the Right Hand pulse is insufficient, Qi-tonifying herbs should outweigh Blood-tonifying herbs. One must absolutely avoid releasing the exterior (diaphoresis).
Generally, carbuncles and sores rely entirely on Blood and Qi as the foundation. If the lesion fails to rise, or ulcerates without puttingrefying, or fails to heal, or if pus is scant or clear, all indicate deficiency of Blood and Qi, and great tonification is appropriate. Formulas that attack and drain are most contraindicated. There are cases where pus increases instead, which is due to deficiency of Blood and Qi failing to contain it. It is common to see that individuals with substantial Blood and Qi who suffer from sores will have high, swollen, red lesions that easily putrefy and ulcerate, producing thick pus, and heal readily. Weak individuals often fail to rise, do not putrefy, and find healing difficult. If one fails to examine carefully and recklessly administers attacking formulas, the disaster of "deficiency inducing further deficiency" is unavoidable. Post-illness, nourishment and regulation are essential. For conditions such as scrofula (Luo Li) and flowing abscesses (Liu Zhu), tonification is especially important. Otherwise, other syndromes may arise, making management difficult. Be cautious.
He also said: If an ulcer belongs to deficiency of both Blood and Qi, tonification is certainly indicated. If a pre-ulcerative sore (swelling) presents with weak Blood and Qi, preventive tonification is especially advisable. Otherwise, even if it ulcerates, it will not heal. Furthermore, after serious illness, when Blood and Qi have not recovered, recurrence is common. Without regulation and tonification, it will surely transform into other critical syndromes. Or, mistaking recurrence for toxic flare-up and administering attacking formulas, one accelerates the failure to recover; this is a profound warning.
He also said: If the sore swelling and pain are severe, accompanied by irritability and a large pulse, then acrid-hot formulas are contraindicated, not only for pre-ulcerative sores but also for ulcers.
The *Taiping Shenghui Fang* states: After pus has discharged from a carbuncle or sore, if the pulse is faint, choppy, slow, and delayed, it indicates that the pathogenic factor has departed and the True Qi is recovering, signifying easy recovery. If the pulse comes deep, fine, and straight, it indicates interior deficiency and impending transformation of the syndrome. Once pus and blood have gone, the pulse should be calm, the body cool, swelling reduced, and pain ceased, similar to the resolution of a Taiyang Exterior Syndrome after sweating. If, conversely, fever and thirst occur with a flooding and rapid pulse, this indicates deficiency of True Qi and excess of pathogenic factors, and death is certain.