齐氏曰∶疮疽之证，有脏腑气血上下，真邪虚实不同也，不可不辨∶如肿起坚硬，脓
稠者，疮疽之实也；肿下软慢，脓稀者，疮疽之虚也；大便硬，小便涩，饮食如故，肠满膨
胀，胸膈痞闷，肢节疼痛，口苦咽干，烦躁多渴，身热脉大，精神闷塞者，悉脏腑之实也；
泻利肠鸣，饮食不入，呕吐无时，手足厥冷，脉弱皮寒，小便自利，或小便短少，大便滑利
，声音不振，精神困倦，悉脏腑之虚也。凡疮疽，肿起色赤，寒热疼痛，皮肤壮热，脓水稠
粘，头目昏重者，血气之实也。凡脓水清稀，疮口不合，聚肿不赤，不堪热痛，肌寒肉冷，
自汗色夭者，气血之虚也。头痛鼻塞，目赤心惊，咽喉不利，口舌生疮，烦渴引冷，睡语咬
牙者，上实也。精滑不禁，大便自利，腰脚沉重，睡卧不宁者，下虚也。肿 尤甚，痛不
可近，寒热往来，大便秘涩，小便如淋，心神烦闷，恍惚不宁者，邪气之实也。肩项不便，四
肢沉重，目视不正，睛不了了，食不知味，音嘶色败，四肢浮肿，多日不溃者，真气之虚也
。又曰∶邪气胜则实，真气夺则虚。又曰∶诸痛为实，诸痒为虚也。又曰∶诊其脉洪大而数
者实也，细微而软者虚也。虚则补之，和其气以托里也。实则泻之，疏利而导其滞也。《内
经》曰∶血实则决之，气虚则掣引之。又曰∶形伤痛，气伤肿。先肿而后痛者，形伤气也；
先痛而后肿者，气伤形也。
《精要》曰∶凡疮疽肿高痛甚，烦渴饮冷，此病气元气俱有余，宜用清热消毒散、仙方
活命饮为主。若肿高痛甚，口干饮热，此病气有余，元气不足，宜用托里消毒散为主。若漫
肿微痛，食少体倦，此病气元气俱不足，宜用六君、补中二汤，壮其脾胃，则未成者消，已
成者溃，已溃者敛矣。
《心法》曰∶凡疮口不合，脓水清稀，气血俱虚也。饮食少而难化，脾胃虚寒也。肌体
瘦弱，面色痿黄，胆气不行也，非参 归术之类不能补，非附子不能助其功。今饮食进少，
且难消化，属脾胃虚寒。盖脾胃属土，乃命门火虚不能生土而然。不宜直补脾胃，当服八味
丸补火以生土也。
立斋曰∶疮疡之作，当审其标本虚实，邪正缓急而治之。若病急而元气实者，先治其标
；病缓而元气虚者，先治其本；或病急而元气又虚者，必先于治本而兼以治标。大要肿高
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，或漫肿黯黑不溃者，元气虚甚，治之尤难也。主治之法，若肿高 痛者，先用
仙方活命饮解之，后用托里消毒散。漫肿微痛者，用托里散；如不应，加姜、桂。若脓出而
反痛者，气血虚也，八珍汤。不作脓，不腐溃，阳气虚也，四君子加归、 、肉桂。不生肌
，不收敛，脾气虚也，四君加地黄、木香。恶寒憎寒，阳气虚也，十全大补加姜、附。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
，六味丸料加五味子。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，脾肾虚也，十全大补汤加山茱、山药、肉桂。泄泻足冷，脾肾虚寒
也，前药加桂附。热渴淋秘，肾虚阴火也，加减八味丸。喘嗽淋秘，肺肾虚火也，补中益气
汤加减八味丸。
又曰∶大凡虚怯之人，不必分其肿溃，惟当先补胃气。或疑参 满中，间有用者，又加
发散败毒，所补不偿，所损又有，泥于气质素实。或有痰不服补剂者，多致有误。殊不知疮
疡之作，缘阴阳亏损，其脓既泄，则气血愈虚，岂有不宜补者哉。故丹溪曰∶但见肿痛，参
之脉证，虚弱便与滋补气血，无亏，可保终吉。旨哉斯言。
又曰∶气无补法，俗论也。以其为病，痞满壅塞，似难于补，不知正气虚，而不能营运
，则邪气滞而为病。经云∶壮者气行则愈，怯者弱者则着而为病。苟不用补气，何由而行乎。
齐氏说：疮疽这类病症，有脏腑、气血、上下部位以及真邪、虚实的不同，不可不加以辨别。例如：肿胀隆起且坚硬，脓液稠厚的，属于疮疽的实证；肿胀下陷且松软缓慢，脓液稀薄的，属于疮疽的虚证。大便干硬，小便涩滞，饮食正常，腹部胀满膨隆，胸膈部痞闷不适，肢体关节疼痛，口苦咽干，烦躁多渴，身体发热，脉象洪大，精神沉闷闭塞的，全都是脏腑的实证。腹泻痢疾，肠鸣音亢进，饮食无法入口，频繁呕吐，手足冰冷，脉象微弱，皮肤寒冷，小便自利（通畅），或者小便短少，大便滑泄失禁，声音低微不振，精神困倦乏力的，全都是脏腑的虚证。凡是疮疽，肿胀隆起且颜色红赤，伴有寒热往来和疼痛，皮肤灼热，脓水稠粘，头目昏沉沉重的，属于血气的实证。凡是脓水清稀，疮口难以愈合，肿胀聚集但不红赤，不耐受热痛，肌肉寒冷，自汗出且面色枯槁无华的，属于气血的虚证。头痛鼻塞，眼睛红赤，心惊不安，咽喉不利，口舌生疮，烦躁口渴想喝冷饮，睡梦中说胡话甚至咬紧牙关的，属于上部的实证。精关不固导致遗精滑泄，大便自利（通畅或失禁），腰脚沉重，睡眠卧不安宁的，属于下部的虚证。肿胀特别严重，疼痛剧烈到不能触碰，寒热往来，大便秘结涩滞，小便像淋证一样频急涩痛，心神烦闷，恍惚不安的，属于邪气的实证。肩颈部活动不便，四肢沉重，视物不正，眼神浑浊不清，吃东西不知味道，声音嘶哑，气色败坏，四肢浮肿，多日不溃烂的，属于正气的虚证。又说：邪气盛则表现为实证，真气耗夺则表现为虚证。又说：各种疼痛多为实证，各种瘙痒多为虚证。又说：诊察其脉象洪大而数动的，是实证；脉象细微而柔软的，是虚证。虚证就要用补法，调和其气以托毒外出、扶助里气。实证就要用泻法，疏通导利以引导其积滞。《黄帝内经》说：血实就要决破它（如刺络放血），气虚就要牵引它（如针灸补法）。又说：形体受伤则疼痛，气机受伤则肿胀。先肿胀后疼痛的，是形伤及气；先疼痛后肿胀的，是气伤及形。
《外科精要》说：凡是疮疽肿胀高突，疼痛剧烈，烦躁口渴想喝冷饮的，这是病气和元气都有余（实），适宜使用清热消毒散、仙方活命饮为主方。如果肿胀高突，疼痛剧烈，口干但想喝热水的，这是病气有余，元气不足，适宜使用托里消毒散为主方。如果是漫肿（平塌不起）且微痛，食量减少，身体疲倦的，这是病气和元气都不足，适宜使用六君子汤、补中益气汤两方，强壮其脾胃，那么未成脓的可以消散，已成脓的可以溃破，已溃破的可以收敛愈合。
《外科心法》说：凡是疮口不合拢，脓水清稀的，是气血俱虚。饮食量少且难以消化，是脾胃虚寒。肌体瘦弱，面色萎黄，胆气运行不畅的，非人参、当归、白术之类的药物不能补益，非附子不能助其功效。如今饮食摄入少，且难以消化，属于脾胃虚寒。因为脾胃属土，这是由于命门火虚不能生土所致。不宜直接补益脾胃，应当服用八味丸（金匮肾气丸）补火以生土。
薛立斋说：疮疡的发生，应当审察其标本虚实，根据邪正的缓急来治疗。如果病情急迫而元气充实的，先治其标；病情缓和而元气虚弱的，先治其本；或者病情急迫而元气又虚弱的，必须先治其本兼以治标。大抵而言，肿胀高突疼痛，脓水稠粘的，元气未受损，治疗起来容易。漫肿微痛，脓水清稀的，元气虚弱，治疗起来难。不肿不痛，或者漫肿黯黑不溃烂的，元气极虚，治疗尤其难。主治的方法：如果肿胀高突疼痛的，先用仙方活命饮解表解毒，后用托里消毒散。漫肿微痛的，用托里散；如果无效，加生姜、肉桂。如果脓出之后反而疼痛的，是气血虚，用八珍汤。如果不化脓，不腐溃，是阳气虚，用四君子汤加当归、黄芪、肉桂。如果不生肌，不收敛，是脾气虚，用四君子汤加地黄、木香。恶寒憎寒，是阳气虚，用十全大补汤加生姜、附子。午后潮热内热，是阴血虚，用四物汤加人参、白术。想要呕吐或已经呕吐，是胃气虚，用六君子汤加炮姜。自汗盗汗，是五脏虚，用六味地黄丸料加五味子。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，用前方加麦冬、五味子。想要呕吐且食少，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。小腹部痞满，足胫肿胀，是脾肾虚，用十全大补汤加山茱萸、山药、肉桂。泄泻且足冷，是脾肾虚寒，用前方加桂枝、附子。热渴淋秘（小便热、渴、淋、闭），是肾虚阴火，用加减八味丸。喘嗽淋秘，是肺肾虚火，用补中益气汤合加减八味丸。
又说：大凡虚怯之人，不必区分是否肿胀或溃破，只应当先补胃气。有人怀疑人参、黄芪充满中焦，间或有使用的，又加入发散败毒的药物，所补的不抵所损，又有新的损伤，这是因为拘泥于体质素来壮实。或者有痰湿不服用补剂的，多导致误治。殊不知疮疡的发生，是因为阴阳亏损，脓液既已排出，则气血更加虚弱，哪里有不宜补益的呢？所以朱丹溪说：只要见到肿痛，参合脉证，若虚弱便给予滋补气血，无亏损之虞，可保最终吉利。这话真是深刻啊。
又说：“气没有补法”，这是世俗的论调。因为气病出现痞满壅塞，似乎难以补益，却不知道正气虚，不能营运流通，则邪气停滞而致病。经书说：壮健的人气行则痊愈，怯弱的人气滞则留着而致病。如果不使用补气法，气如何能运行呢？
Qi stated: In conditions of sores and carbuncles, there are differences in the zang-fu organs, qi and blood, upper and lower regions, as well as true versus pathogenic factors, and deficiency versus excess. These must not fail to be distinguished. For instance: swelling that is elevated and hard, with thick pus, indicates an Excess condition of sores and carbuncles; swelling that is depressed and soft/slow, with thin pus, indicates a Deficiency condition. Hard stools, astringent urination, normal diet, abdominal fullness and distension, chest and diaphragm stuffiness, pain in limbs and joints, bitter taste in the mouth, dry throat, irritability, excessive thirst, fever, a large pulse, and mental depression/closure all constitute Zang-Fu Excess. Diarrhea or dysentery, borborygmus (intestinal rumbling), inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, spontaneous free urination, or conversely, scanty urine, loose stools, low voice, and mental fatigue all constitute Zang-Fu Deficiency. Regarding any sore or carbuncle: swelling that is elevated and red, accompanied by aversion to cold and fever, pain, hot skin, thick and sticky pus, and heavy/dizzy head and eyes, constitutes Blood and Qi Excess. Pus that is clear and thin, wound edges failing to close, swelling gathered but not red, intolerance to heat/pain, cold muscles and flesh, spontaneous sweating, and sallow/lusterless complexion constitute Blood and Qi Deficiency. Headache, nasal congestion, red eyes, palpitations, pharyngeal obstruction, sores on the mouth and tongue, irritability/thirst for cold drinks, somnolence with muttering, and teeth grinding constitute Upper Excess. Involuntary seminal emission, spontaneous loose stools, heavy waist and legs, and restless sleep constitute Lower Deficiency. Swelling that is particularly severe, pain so intense it cannot be touched, alternating chills and fever, constipation, urinary frequency/urgency resembling strangury, mental restlessness, and confusion constitute Pathogenic Factor Excess. Stiffness in shoulders and neck, heaviness in limbs, abnormal vision, cloudy eyes, loss of taste, hoarse voice, deteriorated complexion, edema in limbs, and failure to ulcerate after many days constitute True Qi Deficiency. It is also said: When pathogenic factors prevail, it is Excess; when true qi is depleted, it is Deficiency. It is also said: All pains are Excess; all itching is Deficiency. It is also said: A洪大 (Hongda, surging and rapid) and numerous pulse indicates Excess; a 细微 (Xixi, fine and soft) pulse indicates Deficiency. For Deficiency, apply tonification; harmonize the qi to support the interior and expel toxins. For Excess, apply purgation/draining; unblock and guide stagnation. The *Neijing* states: For blood excess, resolve it (e.g., via pricking); for qi deficiency, draw it (e.g., via acupuncture tonification). It also states: Injury to form causes pain; injury to qi causes swelling. Swelling preceding pain indicates form injuring qi; pain preceding swelling indicates qi injuring form.
The *Jingyao* (Essentials) states: For sores and carbuncles with high swelling, severe pain, irritability, thirst, and desire for cold drinks, this indicates both disease qi and yuan qi are in excess. One should primarily use Qingre Xiaodu San (Clear Heat and Detoxify Powder) or Xianfang Huoming Yin (Immortal Life Elixir Decoction). If swelling is high and painful, with dry mouth but desire for hot drinks, this indicates disease qi is in excess while yuan qi is deficient. One should primarily use Tuoli Xiaodu San (Support Interior and Detoxify Powder). If swelling is flat/spreading with slight pain, reduced appetite, and body fatigue, this indicates both disease qi and yuan qi are deficient. One should use Liujunzi Tang (Six Gentlemen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to strengthen the spleen and stomach. This will cause unformed abscesses to dissipate, formed abscesses to ulcerate, and open wounds to heal.
The *Xinfa* (Core Methods) states: Wounds that fail to close with clear, thin pus indicate dual deficiency of qi and blood. Reduced intake and difficult digestion indicate spleen-stomach deficiency-cold. Emaciation and sallow complexion indicate stagnant gallbladder qi. Such conditions cannot be tonified without herbs like Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), nor can efficacy be assisted without Fuzi (Aconiti Lateralis Radix Praeparata). Current symptoms of poor intake and indigestion belong to spleen-stomach deficiency-cold. Since spleen and stomach belong to Earth, this results from Mingmen fire deficiency failing to generate Earth. Direct tonification of the spleen and stomach is inappropriate; instead, one should administer Bawei Wan (Eight-Ingredient Pill) to tonify fire to generate earth.
Li Zhang (Xue Ji) stated: The onset of sores and ulcers requires assessing the root and branch, deficiency and excess, and treating according to the urgency of pathogenic factors and righteous qi. If the disease is acute but yuan qi is solid, treat the branch first; if the disease is chronic but yuan qi is deficient, treat the root first; if the disease is acute and yuan qi is also deficient, prioritize treating the root while concurrently addressing the branch. Generally, high swelling with pain and thick, sticky pus indicates yuan qi is undamaged, making treatment easy. Flat swelling with slight pain and thin pus indicates yuan qi weakness, making treatment difficult. No swelling or pain, or flat, dark, non-ulcerating lesions, indicate extreme yuan qi deficiency, making treatment especially difficult. Treatment methods: For high swelling and pain, first use Xianfang Huoming Yin to resolve, followed by Tuoli Xiaodu San. For flat swelling and slight pain, use Tuoli San; if ineffective, add Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). If pain persists after pus discharge, it is qi-blood deficiency; use Bazhen Tang (Eight Treasure Decoction). Failure to suppurate or ulcerate indicates yang qi deficiency; use Sijunzi Tang plus Danggui, Huangqi, and Rougui. Failure to generate flesh or contract indicates spleen qi deficiency; use Sijunzi Tang plus Dihuang and Muxiang. Aversion to cold and fear of cold indicate yang qi deficiency; use Shiquan Dabu Tang plus Shengjiang and Fuzi. Afternoon tidal fever and internal heat indicate yin-blood deficiency; use Siwu Tang plus Renshen and Baizhu. Nausea and vomiting indicate stomach qi deficiency; use Liujunzi Tang plus Paojiang (Prepared Ginger). Spontaneous and night sweats indicate five-zang deficiency; use Liuwei Dihuang Wan material plus Wuweizi. Reduced food intake and fatigue indicate spleen qi deficiency; use Buzhong Yiqi Tang plus Fuling and Banxia. Panting and cough indicate spleen-lung deficiency; add Maidong and Wuweizi to the previous formula. Nausea and poor appetite indicate spleen-stomach deficiency; use Renshen Lizhong Tang. Abdominal pain and diarrhea indicate spleen-stomach deficiency-cold; use Fuzi Lizhong Tang. Hypogastric stuffiness and leg/shin edema indicate spleen-kidney deficiency; use Shiquan Dabu Tang plus Shanzhuyu, Shanyao, and Rougui. Diarrhea with cold feet indicates spleen-kidney deficiency-cold; add Guizhi and Fuzi to the previous medicine. Heat, thirst, strangury, and retention indicate kidney deficiency with yin-fire; use Jiajian Bawei Wan. Panting, cough, strangury, and retention indicate lung-kidney deficiency with false fire; combine Buzhong Yiqi Tang with Jiajian Bawei Wan.
It is also said: For generally frail individuals, regardless of swelling or ulceration, one must first tonify stomach qi. Some doubt the use of Renshen and Huangqi due to their potential to cause middle-jiao stagnation, and adding dispersing/detoxifying agents may result in more harm than benefit, often due to adherence to constitutions that were originally robust. Those with phlegm who cannot tolerate tonics are often misled. One must not realize that sores and ulcers arise from yin-yang depletion; once pus is discharged, qi and blood become even more deficient. Is there any reason not to tonify? Thus, Danxi stated: Whenever swelling and pain are seen, examine the pulse and signs; if deficient, immediately provide qi and blood tonification. Without depletion, ultimate auspiciousness can be ensured. How profound these words are.
It is also said: "There is no method to tonify qi" is a vulgar theory. Because qi pathology presents with stuffiness and obstruction, it seems difficult to tonify. However, one does not know that when righteous qi is deficient and fails to circulate, pathogenic factors stagnate and cause disease. The Classics state: The vigorous recover as qi moves; the weak have pathogenic factors adhere and cause disease. If one does not use qi-tonifying methods, how can qi move?