齐德之曰∶夫疮疡生于外，皆由积热蕴于内。《内经》谓血热肉败，荣卫不行，必将为
脓，留于节腠，必将为败。盖疮疽脓溃之时，头小未破，疮口未开，或毒瓦斯未出，疼痛难忍
，所以立追蚀腐溃之法，使毒瓦斯外泄而不内攻，恶肉易去，好肉易生也。若 其疮血出不止
者，则未可 ，于疮上掺追蚀之药，待其熟，可 方 。若 其疮而痛应心根者，亦不可强
之。误触其疮， 痛必倍，变证不测，不可不慎也。若疮疖脓成未破，于上薄皮剥起者，
即当用破头代针之剂安其上，以膏贴之。脓出之后，用搜脓化毒之药，取效如神矣。若脓血
未尽，便用生肌敛疮之剂，欲其早愈，殊不知恶肉未尽，其疮早合，后必再发。不可不慎也。
立斋曰∶疮疡之证，脓成者，当辨其生熟浅深。肉死者，当验其腐溃连脱。余尝治脉证
虚弱者，用托里之药，则气血壮而肉不死。脉证实热者，用清热之剂，则毒瓦斯退而肉自生。
凡疮聚于筋骨之间，肌肉之内，皆因血气虚弱，用十全大补汤壮其脾胃，则未成者自解，已
成者自溃，又何死肉之有。若不大痛，或大痛，或不赤，或内脓不溃，或外肉不腐，乃血气
虚弱，宜用桑枝灸，及十全大补加姜桂，壮其阳气，则四畔即消，疮头即腐，其毒自散，又
何待于针割。若脾胃虚弱，饮食少思，用六君倍加白术，壮其营气，则肌肉受毒者自溃，已
死者自活，已溃者自敛。若初起或因克伐，或犯房事，以致色黯而不痛者，乃阳气脱陷，
变为阴证也。急用参附汤，温补回阳，亦有可生。
又曰∶夫腐肉者，恶肉也。大凡痈疽疮肿溃后，若有腐肉凝滞者，必取之，乃推陈致新
之意。若壮者筋骨强盛，气血充溢，真能胜邪，或自去，或自平，不能为害。若年高怯弱之
人，血液少，肌肉涩，必迎而夺之，顺而取之，是谓定祸乱以致太平。设或留而不去，则有
烂筋腐肉之患。如刘大尹、汪夫人，收之及时，而新肉即生，得以全愈；金工部、郑挥使
，取之失期，大溃而毙。予尝见腐肉既去，虽少壮者，不补其气血，尚不能收敛；若怯弱者
，不取恶肉，不补血气，未见其生也。故古人曰∶坏肉恶于野狼虎，毒于蜂虿，缓去之则戕
贼性命。信哉。
又曰∶疮疡之证，若毒瓦斯已结，肿赤炽盛，中央肉死黯黑者，内用托里健脾之剂，外用
乌金膏涂之，则黯处渐低，赤处渐起。至六七日间，赤黯之界自有裂纹，如刀划状，其黯渐
溃。若用铍针利剪徐去犹好。须使不知疼痛，不见鲜血为善。若脓未流利，宜用针于纹中引
之。若脓水已出，肿痛仍作，乃内筋间隔，亦用针引之。若元气虚弱，误服克伐之剂，患处
不痛，或肉死不溃者，急温补脾胃，亦有复生者。后须纯补脾胃，庶能收敛。此则不可妄用
针刀，若误用之以去肉出血，使阳随阴败，是速其危也。
齐德之说：疮疡生于体表，都是由体内积热蕴结所致。《黄帝内经》说血热则肌肉败坏，营卫之气运行不畅，必然化为脓液；若脓液滞留于关节腠理之间，必然导致组织败坏。大概疮疽在脓液溃破之时，如果疮头小而未破，疮口未开，或者毒邪未能排出，疼痛难以忍受，所以必须立即采用追蚀腐肉、促使溃烂的方法，使毒邪向外排泄而不向内攻陷，让恶肉容易去除，好肉容易生长。如果疮口出血不止，则不可立即在疮上撒布追蚀的药物，待其成熟后，方可使用。如果触碰疮口时疼痛牵连心根（指疼痛剧烈，令人心悸），也不可以强行处理。误触疮口，疼痛必定加倍，变证不可预测，不可不谨慎。如果疖肿脓成但未破，表面薄皮剥起者，应当立即使用破头代针的药剂敷在上面，再用膏药贴敷。脓液流出之后，使用搜脓化毒的药物，疗效神奇。如果脓血未尽，就使用生肌敛疮的药物，想要它早日愈合，却不知道恶肉未尽，疮口过早闭合，日后必然复发。不可不谨慎。
薛己（立斋）说：疮疡的病证，脓已成者，应当辨别其生熟、浅深。肌肉坏死死者，应当检验其腐溃脱落的情况。我曾经治疗脉象和证候虚弱的人，使用托里透脓的药物，则气血壮盛而肌肉不死。脉象证实热者，使用清热泻火的药剂，则毒邪退去而肌肉自然生长。凡是疮毒聚集在筋骨之间、肌肉之内，都是因为气血虚弱，使用十全大补汤来强壮脾胃，则未成脓的自行消散，已成脓的自行溃破，哪里还有死肉呢？如果不怎么痛，或者剧痛，或者不红肿，或者内部脓液不溃破，或者外部肌肉不腐烂，这是气血虚弱，适宜用桑枝灸法，以及十全大补汤加入干姜、肉桂，以壮阳气，则四周肿胀即消，疮头即腐，毒邪自然消散，又何须等待针割呢？如果脾胃虚弱，饮食减少思虑不足，使用六君子汤加倍白术，以壮营气，则受毒的肌肉自行溃破，已死的肌肉自行复活，已溃破的疮口自行收敛。如果初起时因为误用攻伐药物，或犯房事，导致颜色暗紫且不痛，这是阳气脱陷，变为阴证。急用参附汤，温补回阳，也有可救活的希望。
又说：所谓腐肉，就是恶肉。大凡痈疽疮肿溃破后，如果有腐肉凝滞，必须去除，这是推陈出新的意思。如果身体强壮、筋骨强盛、气血充溢的人，真能胜邪，腐肉或许自行脱落，或许自行平复，不能为害。如果是年老体弱之人，血液少，肌肉涩滞，必须迎其势而夺之，顺其理而取之，这叫做平定祸乱以致太平。假如留下而不除去，则有烂筋腐肉的祸患。比如刘大尹、汪夫人，及时清除，新肉随即生长，得以痊愈；金工部、郑挥使，去除时机不当，导致大溃而死。我曾见过腐肉既去，即使是强壮的人，如果不补益气血，尚且不能收敛；如果是体弱者，不除去恶肉，不补血气，未见有能活命的。所以古人说：坏肉比野狼老虎更坏，比蜂蝎更毒，缓慢去除则会戕害性命。确实如此。
又说：疮疡的病证，如果毒邪已经凝结，红肿炽盛，中央肌肉坏死呈暗黑色，内服托里健脾的药剂，外用乌金膏涂抹，则暗色处逐渐降低，红色处逐渐隆起。到了六七日间，红暗交界处自然出现裂纹，像刀划一样，暗色部分逐渐溃破。如果用铍针利剪慢慢去除更好。必须做到不知疼痛，不见鲜血才好。如果脓液未流利，适宜用针在裂纹中引导。如果脓水已出，肿痛仍然发作，是内部筋膜间隔，也用针引导。如果元气虚弱，误服攻伐药剂，患处不痛，或者肌肉坏死不溃破，急当温补脾胃，也有复生的可能。之后必须纯补脾胃，才能收敛。这就不可妄用针刀，如果误用针刀去除肌肉出血，使阳气随阴邪败亡，这是加速其死亡。
Qi Dezhi stated: Sores and ulcers appearing on the exterior are all caused by accumulated heat harbored within. The *Neijing* (Inner Canon) states that when blood is hot, flesh rots; when Ying and Wei Qi (Nutritive and Defensive Qi) fail to circulate, pus will inevitably form. If retained in the joints and interstices, it will lead to tissue necrosis. Generally, when a carbuncle or furuncle is about to suppurate, if the head is small and unruptured, the sore opening not yet open, or the pathogenic factors not yet expelled, causing unbearable pain, one must immediately employ methods to cauterize and expel necrotic tissue. This allows the pathogenic factors to discharge outward rather than attacking inward, facilitating the removal of foul flesh and the regeneration of healthy flesh. If the sore bleeds incessantly, one should not immediately apply cauterizing powders to the wound; wait until it is mature before applying them. If touching the sore causes pain radiating to the heart root (indicating severe pain affecting the heart), one should not force treatment. Accidental contact with the sore will double the pain, leading to unpredictable complications; caution is essential. If a boil has formed pus but remains unruptured, with the superficial skin peeling up, one should immediately apply a formula for lancing to the top and cover it with a plaster. After the pus drains, use herbs to search out pus and resolve toxins, yielding miraculous results. If pus and blood are not fully discharged, using formulas to generate muscle and close sores in an attempt to hasten healing is misguided. One fails to realize that if foul flesh remains and the sore closes early, it will inevitably recur later. Caution is paramount.
Xue Ji (Li Zhai) stated: In cases of sores and ulcers, when pus has formed, one must distinguish between its maturity and depth. Regarding dead flesh, one must verify the extent of rotting and detachment. I have treated patients with weak pulses and deficient syndromes by using formulas to support the interior and promote suppuration; this strengthens Qi and Blood, preventing flesh from dying. For patients with excess-heat syndromes indicated by strong pulses, using heat-clearing formulas allows the pathogenic factors to recede and flesh to regenerate naturally. When sores gather between bones and tendons or within muscles, it is due to deficiency of Qi and Blood. Using Shiquan Dabu Tang (Complete and Great Tonifying Decoction) to strengthen the Spleen and Stomach allows unformed abscesses to resolve spontaneously and formed abscesses to rupture naturally, leaving no dead flesh. If there is little pain or severe pain, lack of redness, internal pus not rupturing, or external flesh not rotting, this indicates Qi and Blood deficiency. It is appropriate to use moxibustion with mulberry branches, or Shiquan Dabu Tang added with Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark) to strengthen Yang Qi. Then swelling around the periphery will subside, the sore head will rot, and toxins will dissipate naturally, without waiting for needle cutting. If the Spleen and Stomach are weak, with poor appetite and lack of desire for food, use Liujunzi Tang (Six Gentlemen Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) to strengthen Ying Qi. Then flesh affected by toxins will rupture spontaneously, dead flesh will revive, and open sores will heal. If at the onset, due to mistaken use of purgatives or sexual indiscretion, the area becomes dark purple and painless, this indicates collapse of Yang Qi, transforming into a Yin syndrome. Urgently use Shenfu Tang (Ginseng and Aconite Decoction) to warm, tonify, and restore Yang; survival is possible.
He further stated: Necrotic flesh is foul flesh. Generally, after an abscess or ulcer ruptures, if necrotic tissue remains stagnant, it must be removed, embodying the principle of eliminating the old to bring forth the new. In robust individuals with strong sinews and bones, abundant Qi and Blood, who can truly overcome pathogens, the necrotic tissue may fall off naturally or level out, causing no harm. However, in elderly or frail individuals with scant blood and dry flesh, one must intercept and remove it according to the situation, which is likened to quelling chaos to establish peace. If left untreated, it leads to rotting sinews and foul flesh. For example, Liu Dayin and Lady Wang had timely removal, allowing new flesh to grow and full recovery; whereas Jin Gongbu and Zheng Huishi delayed removal, leading to massive溃破 (rupture) and death. I have observed that even in robust individuals, if necrotic tissue is removed but Qi and Blood are not supplemented, healing cannot occur; in frail individuals, if foul flesh is not removed and Qi and Blood are not replenished, survival is unlikely. Thus, the ancients said: Foul flesh is worse than wild wolves and tigers, more toxic than bees and scorpions; delaying its removal endangers life. This is true.
He also stated: In sores and ulcers, if toxins have consolidated, with intense redness and swelling, and the central flesh is necrotic and dark black, internally administer formulas to support the interior and strengthen the Spleen and Stomach, and externally apply Wujin Gao (Black Gold Ointment). The dark areas will gradually recede, and red areas will rise. By the sixth or seventh day, cracks will naturally appear at the boundary between red and dark areas, resembling knife marks, and the dark areas will gradually suppurate. It is good to slowly remove them with a bi needle (lancet) or sharp scissors. Ideally, this should be done without causing pain or visible bleeding. If pus flow is not smooth, use a needle to guide drainage through the cracks. If pus has drained but swelling and pain persist, it indicates internal fascial separation; use a needle to guide drainage. If Yuan Qi (Primal Qi) is weak, and purgatives were mistakenly taken, resulting in painless lesions or non-suppurating necrotic flesh, urgently warm and tonify the Spleen and Stomach; recovery is possible. Subsequently, purely tonify the Spleen and Stomach to facilitate healing. In such cases, do not recklessly use needles or knives. Mistakenly using them to remove flesh and cause bleeding makes Yang follow Yin into defeat, accelerating danger.