王海藏曰∶疮疡自外而入者,不宜灸,自内而出者宜灸。外入者托之而不内,内出者
接之而令外。故经曰∶陷者灸之。灸而不痛,痛而后止其灸。灸而不痛者,先及其溃,所以
不痛,而后及良肉,所以痛也。灸而痛,不痛而后止其灸。灸而痛者,先及其未溃,所以
痛,而次及将溃,所以不痛也。
李氏云∶治疽之法,灼艾之功胜于用药,盖使毒瓦斯外泄。譬诸盗入人家,当开门逐之,
不然则入室为害矣。凡疮初发一二日,须用大颗独蒜切片三分浓,贴疽顶,以艾隔蒜灸之。
每三壮易蒜,疮溃则贴神异膏,如此则疮不开大,肉不坏,疮口易敛,一举三得。此法之妙
,人所罕知。若头顶见疽,则不可用此法。(《五府极观碑》载。)
又曰∶凡患背疽,漫肿无头者,用湿纸贴肿处,但一点先干处,乃是疮头。可用大蒜十
颗、淡豆豉半合、乳香钱许,研烂置疮上,铺艾灸之。痛否,皆以前法为度。
陈氏曰∶脑为诸阳之会,颈项近咽喉,肾俞乃致命之所,皆不可灼艾。
伍氏曰∶凡用蒜饼灸者,盖蒜味辛温有毒,主散痈疽,假火势以行药力也。只有用艾炷
灸者,此可施于顽疽痼发之类。凡赤肿紫黑毒甚者,须以蒜艾同灸为妙。又曰∶凡治疽痈,
发背、疔疮,若初灸即痛者,由毒瓦斯轻浅,灸而不痛者,乃毒瓦斯深重,悉宜内服追毒排脓,
外敷消毒之药。大抵痈疽不可不痛,又不可大痛,闷乱不知痛者,难治。又曰∶凡隔蒜灸者
,不论壮数,则邪无所容,而真气不损。但头项见疮,宜用骑竹马法,及足三里灸之。
《千金》云∶痈疽始作,或大痛,或小痛,或发如米粒,既便出脓,宜急断口味,利去
其毒,用骑竹马灸法,或就患处灼艾。重者四面,中央总灸一二百壮,更用敷药,其效甚速。
立斋云∶夫疮疡之证,有诸中,必形诸外。在外者,引而拔之。在内者,疏而下之。灼
艾之功甚大。若毒瓦斯郁结,瘀血凝滞轻者,或可药散,重者药无全功矣。东垣曰∶若不针烙
则毒瓦斯无从而解。是故善治毒者,必用隔蒜灸。舍是而用苦寒败毒等剂,其壮实内热者,或
可,彼怯弱气虚者,未有不败者也。又有毒瓦斯沉伏,或年高气弱,或服克伐之剂,气益以虚
,脓因不溃者,必假火力以成功。大凡蒸灸,若未溃则拔引郁毒,已溃则接补阳气,祛散寒
邪,疮口自合,其功甚大。尝治四肢疮疡气血不足者,祗以前法灸之,皆愈。疔毒甚者,尤
宜灸。盖热毒中隔,内外不通,不发泄则不解散。若处贫居僻,一时无药,则用隔蒜灸法尤
便。每三壮一易蒜片,大概以百壮为度。用大蒜,取其辛而能散。用艾炷,取其火力能透。
如法灸之,必疮发脓溃。继以神异膏贴之,不日自愈。一能使疮不开大,二内肉不坏,三疮
口易合,见效甚神。丹溪云∶惟头为诸阳所聚,艾壮宜小,而少。
曹工部,发背已十八日,疮头如粟,疮内如锥,痛极时有闷瞀,饮食不思,气则益虚,
以大艾隔蒜灸十余壮,尚不知,而痛不减,遂明灸二十余壮,内疮悉去,毒瓦斯大发,饮食渐
进。更以大补药及桑木燃灸,瘀肉渐溃。
刘贯卿,足患疔疮已十一日,气弱,亦灸五十余壮,更以托里药而愈。
黄君,腿痈,脓清脉弱。一妇,臂结一块已溃。俱不收敛。各灸以豆豉饼,更饮托里药而愈。
一男子,胸肿一块,半载不消。令明灸百壮方溃。与大补药不敛,复灸以附子饼而愈。
一男子,患发背,疮头甚多,肿硬色紫,不甚痛,不腐溃,以艾铺患处灸之,更以大补
药数日,死肉脱去而愈。陈工部,患发背已四五日,疮头虽小,根畔颇大,以隔蒜灸三十余
壮,其根内消。惟疮头作脓,数日而愈。
余丙子年忽恶心,大锥骨甚痒,须臾,臂不能举,神思甚倦,此夭疽危病也。急隔蒜灸
之,痒愈甚。又明灸五十余壮,痒遂止,旬日而愈。《精要》云,灸法有四生之功,信矣。(薛按)
史氏引证曰∶疡医常器之,于甲戌年,诊太学史氏之母,云内有蓄热,防其作疽。至辛
巳六月,果背胛微痒,疮粒如黍,灼艾即消,隔宿复作,用膏药覆之,晕开六寸许,痛不可
胜,归咎于艾。适遇一僧,自云病疮甚危,尝灸八百余壮方苏。遂用大艾壮如银杏者,灸疮
头及四傍各数壮,痛止。至三十余壮,赤晕悉退。又以艾作团,如梅杏大者四十壮,乃食粥
安寝,疮实四寸,小窍百许,患肉俱坏而愈。立斋曰∶灼艾之法,必使痛者灸至不痛,不痛
者灸至痛,则毒必随火而散。否则非徒无益,而反害之。
愚意,痈疽为患,无非血气壅滞留结不行之所致,凡大结大滞者最不易散,必欲散之,非
藉火力不能速也,所以极宜用灸。然又有孙道人神仙熏照方,其法尤精尤妙。若毒邪稍缓,
邪深经远,而气有不达,灸之为良。若毒邪炽盛,其势猛急,而垂危者,则宜用熏照方,更胜于灸。
王海藏说:疮疡如果是从外部侵入体内的,不宜使用灸法;如果是从内部发出来的,适宜使用灸法。对于外入的邪毒,要通过托毒外出使其不向内深入;对于内出的邪毒,要引导它向外发散。所以医经上说:下陷的病症要用灸法治疗。施灸时如果不痛,等到感到疼痛时就停止施灸。施灸时不痛,是因为艾火先接触到了已经溃烂的部位,所以不痛;后来才接触到健康的肌肉,所以会痛。施灸时如果痛,等到不痛时就停止施灸。施灸时痛,是因为艾火先接触到了尚未溃烂的部位,所以痛;后来才接触到即将溃烂的部位,所以不痛。
李氏说:治疗疽的方法中,灼烧艾草的功效胜过用药,这是因为能使毒气向外排泄。这就好比强盗进入人家,应当开门将其驱逐出去,否则强盗就会入室为害。凡是疮疡初发的一两天,必须用大颗独蒜切成三分厚的片,贴在疽的顶部,隔着蒜片进行艾灸。每灸三壮更换一次蒜片,疮疡溃烂后贴上神异膏,这样疮口就不会扩大,肌肉不会坏死,疮口容易愈合,一举三得。这个方法的奥妙,人们很少知道。如果头顶出现疽,则不可使用这种方法。(记载于《五府极观碑》)
又说:凡是患有背疽,漫肿没有头部的,用湿纸贴在肿胀处,最先干燥的一点,就是疮头。可以用大蒜十颗、淡豆豉半合、乳香少许,研烂后敷在疮上,铺上艾绒进行艾灸。无论痛还是不痛,都以前面提到的方法为标准。
陈氏说:头部是诸阳经汇聚的地方,颈部靠近咽喉,肾俞穴是致命的关键部位,都不可以灼烧艾草。
伍氏说:凡是使用蒜饼灸的,大概是因为蒜味辛温有毒,主要作用是消散痈疽,借助火势来运行药力。只有使用艾炷直接灸的,这可以应用于顽固性疽疮和慢性发作等疾病。凡是红肿紫黑、毒气严重的,必须用蒜和艾一起灸才好。又说:凡是治疗疽痈、发背、疔疮,如果刚开始灸就感到痛的,说明毒气轻浅;灸了却不痛的,说明毒气深重,都应该内服追毒排脓的药物,外敷消毒的药。大抵痈疽不可以完全不痛,也不可以剧烈疼痛,如果神志昏乱感觉不到痛的,很难治疗。又说:凡是隔蒜灸的,不论灸多少壮,邪气就没有容身之地,而真气也不会受损。但是头项部出现疮疡,适宜使用骑竹马灸法,以及灸足三里穴。
《千金方》说:痈疽刚开始发作时,或者剧痛,或者微痛,或者像米粒一样发出,随即流出脓液,应该立即节制饮食口味,利导排出毒气,使用骑竹马灸法,或者就在患处灼烧艾草。病情重的,在四周及中央总共灸一二百壮,再配合敷药,疗效非常迅速。
立斋说:疮疡的病症,有内在的原因,必然表现在外部。在外部的,引导并拔除它;在内部的,疏通并泻下它。灼烧艾草的功效很大。如果毒气郁结,瘀血凝滞较轻的,或许可以用药物散除;重的话,药物就不能完全奏效了。东垣说:如果不使用针烙,毒气就没有途径解除。所以善于治疗毒疮的人,一定使用隔蒜灸。舍弃这个方法而使用苦寒败毒等药剂,对于那些体质壮实内有热的人,或许可以;但对于那些虚弱气虚的人,没有不导致病情恶化的。又有毒气沉伏,或者年老气弱,或者服用克伐药物的,气更加虚弱,脓液因此不能溃破的,必须借助火力来取得成功。大凡蒸灸,如果疮未溃破,就能拔引郁积的毒气;如果已溃破,就能接补阳气,驱散寒邪,疮口自然愈合,功效很大。我曾经治疗四肢疮疡气血不足的病人,只采用前面的方法灸治,都痊愈了。疔毒严重的,尤其适宜灸治。因为热毒阻隔,内外不通,不发泄就不能解散。如果居住在贫困偏僻的地方,一时没有药物,那么使用隔蒜灸法尤其方便。每三壮更换一片蒜片,大概以一百壮为限度。使用大蒜,是取其辛味能发散;使用艾炷,是取其火力能穿透。按照这种方法灸治,必定会使疮头发脓溃破。接着贴上神异膏,不久就能自愈。一能使疮口不扩大,二使内部肌肉不坏死,三使疮口容易愈合,见效非常神奇。丹溪说:只有头部是诸阳经聚集的地方,艾壮宜小且少。
曹工部,患发背已经十八天,疮头像粟米大小,疮内感觉像锥子刺一样,疼痛剧烈时常伴有神志昏蒙,不想饮食,气越来越虚,用大艾柱隔蒜灸了十余壮,还不知疼痛,而且痛感不减,于是直接灸了二十多壮,内部疮毒全部去除,毒气大发,饮食逐渐恢复。再用大补药以及桑木燃烧灸,瘀肉逐渐溃破。
刘贯卿,脚上患疔疮已经十一日,气弱,也灸了五十多壮,再用托里药而痊愈。
黄君,腿部患痈,脓液清稀脉象微弱。一位妇女,手臂结块已经溃破。都不能收敛。各自用豆豉饼灸治,再饮用托里药而痊愈。
一个男子,胸部肿块,半年不消。命令直接灸一百壮才溃破。给以大补药但不收敛,又用附子饼灸治而痊愈。
一个男子,患发背,疮头很多,肿胀坚硬颜色紫暗,不太痛,不腐溃,用艾绒铺在患处灸治,再用大补药数日,死肉脱落而痊愈。陈工部,患发背已经四五日,疮头虽然小,根部周围颇大,用隔蒜灸三十多壮,其根部内部消退。只有疮头化脓,数日后痊愈。
我在丙子年忽然恶心,大椎骨非常痒,一会儿,手臂不能抬起,精神非常疲倦,这是夭疽这种危重疾病。急忙隔蒜灸治,痒得更厉害。又直接灸了五十多壮,痒才停止,十天痊愈。《精要》说,灸法有四生之功,确实如此。(薛己按语)
史氏引用论证说:疡医常器之,在甲戌年,诊治太学史氏的母亲,说体内有蓄热,担心她发作疽病。到辛巳年六月,果然背部肩胛处微痒,疮粒像黍米大小,灼烧艾草后立即消除,过了一夜又发作,用膏药覆盖,晕开约六寸,痛得受不了,归咎于艾草。恰好遇到一个僧人,自称患疮很危险,曾经灸了八百多壮才苏醒。于是用像银杏大小的巨大艾壮,灸疮头及四周各几壮,痛止。灸到三十多壮,红晕全部消退。又用艾做成团,像梅杏大小的四十壮,然后吃粥安睡,疮实际有四处,小孔百余,患病肌肉都坏死而痊愈。立斋说:灼烧艾草的方法,一定要让痛的灸到不痛,不痛的灸到痛,那么毒气必定随着火气而消散。否则不仅无益,反而有害。
我的意见,痈疽为患,无非是血气壅滞留结不行的结果,凡是大的结滞最不容易消散,一定要消散它,不借助火力就不能快速做到,所以极适宜使用灸法。然而又有孙道人的神仙熏照方,这种方法尤其精妙。如果毒邪稍缓,邪气深且在经络远端,而气机不达,灸法是好的。如果毒邪炽盛,势头猛急,且处于垂危状态,则适宜使用熏照方,比灸法更好。
Wang Haicang stated: For sores and ulcers caused by external pathogens invading the body, moxibustion is not suitable; for those originating from within the body, moxibustion is appropriate. For externally invading pathogens, one should use methods to push them out without letting them go inward; for internally emerging pathogens, one should guide them outward. Therefore, the classics state: For sinking conditions, apply moxibustion. When applying moxibustion, if there is no pain, stop when pain occurs. If there is no pain during moxibustion, it is because the heat first contacts the ulcerated area, hence no pain; later it contacts healthy flesh, hence pain. If there is pain during moxibustion, stop when pain ceases. If there is pain, it is because the heat first contacts the non-ulcerated area, hence pain; subsequently it contacts the impending ulcerated area, hence no pain.
Li Shi said: In treating carbuncles (Ju), the efficacy of burning mugwort surpasses that of medication, as it allows toxic factors to discharge outward. This is like a thief entering a house; one should open the door to drive him out, otherwise he will enter the room and cause harm. For sores and ulcers in their initial stage (one or two days after onset), one must slice a large single-clove garlic into three fen thickness, place it on the top of the carbuncle, and perform moxibustion through the garlic slice. Replace the garlic slice every three moxa cones (Zhuang). Once the sore ulcerates, apply Shenyi Gao (Miraculous Ointment). This prevents the sore from enlarging, preserves the flesh, and facilitates healing, achieving three benefits at once. The subtlety of this method is rarely known. However, if a carbuncle appears on the head, this method should not be used. (Recorded in *Wu Fu Ji Guan Bei*).
He further stated: For patients with back carbuncles presenting as diffuse swelling without a distinct head, paste wet paper onto the swollen area; the point where the paper dries first indicates the head of the sore. Use ten cloves of garlic, half he of fermented soybeans (Dan Dou Chi), and a small amount of frankincense (Ruxiang), grind them into a paste, apply to the sore, and perform moxibustion. Whether painful or not, follow the previously described method as the standard.
Chen Shi said: The head is the convergence point of all Yang meridians; the neck is near the throat; the Shenshu (BL23) acupoint is a critical vital area. None of these locations should undergo burning moxibustion.
Wu Shi said: The use of garlic cake moxibustion relies on the pungent, warm, and slightly toxic nature of garlic, which primarily disperses carbuncles and ulcers, utilizing the fire's power to propagate the medicinal effect. Direct moxibustion with moxa cones alone can be applied to stubborn carbuncles and chronic eruptions. For cases with severe redness, swelling, purple-black discoloration, and intense toxicity, simultaneous moxibustion with garlic and mugwort is optimal. He also stated: In treating carbuncles, ulcers, back eruptions, and carbuncles (Ding), if pain occurs immediately upon starting moxibustion, the toxic factor is light and superficial; if there is no pain, the toxic factor is deep and heavy. In both cases, internal administration of drugs to chase toxins and drain pus, along with external application of detoxifying medicines, is indicated. Generally, carbuncles and ulcers should not be completely painless, nor should they be excessively painful. Cases with confusion and lack of sensation are difficult to treat. Furthermore, regarding garlic-interposed moxibustion, regardless of the number of moxa cones, the pathogenic factor has no place to reside, and the healthy Qi remains undamaged. However, for sores on the head and neck, the "Bamboo Horse" moxibustion method and moxibustion on Zusanli (ST36) are appropriate.
*Qianjin Fang* states: At the onset of carbuncles and ulcers, whether characterized by severe pain, mild pain, or eruption like millet grains followed by pus discharge, one should immediately restrict diet, promote the discharge of toxins, and use the "Bamboo Horse" moxibustion method or direct moxibustion on the affected area. For severe cases, apply a total of 100-200 moxa cones around the four sides and center, combined with topical applications, yielding very rapid results.
Lizhai stated: Sores and ulcers have internal causes that manifest externally. For external manifestations, draw them out; for internal issues, unblock and purge them. The efficacy of moxibustion is significant. For mild cases of stagnant toxic factors and coagulated blood, herbal dispersants may suffice; for severe cases, herbs alone cannot achieve complete success. Dongyuan stated: Without acupuncture or cauterization, toxic factors have no pathway to resolve. Therefore, skilled practitioners always use garlic-interposed moxibustion. Abandoning this for bitter-cold detoxifying formulas may work for robust individuals with internal heat, but for those who are weak and deficient in Qi, it invariably leads to deterioration. In cases where toxic factors are latent, or the patient is elderly and weak, or has taken harsh purgative drugs leading to further Qi deficiency and failure of pus to form, fire therapy is necessary to succeed. Generally, steaming moxibustion draws out stagnant toxins before ulceration and tonifies Yang Qi, dispels cold pathogens, and promotes healing after ulceration, demonstrating great efficacy. I once treated patients with limb sores due to Qi and Blood deficiency using only this method, and all recovered. Severe Ding toxins are particularly suitable for moxibustion because heat toxins block internal and external communication; without venting, they cannot disperse. In poor or remote areas lacking medicine, garlic-interposed moxibustion is especially convenient. Replace the garlic slice every three moxa cones, generally aiming for 100 cones. Garlic is used for its pungency to disperse; moxa cones are used for their penetrating heat. Following this method ensures suppuration and ulceration. Subsequent application of Shenyi Gao leads to spontaneous healing within days. It prevents enlargement, preserves internal flesh, and facilitates closure, showing miraculous results. Danxi stated: Since the head is the gathering point of all Yang meridians, moxa cones should be small and few in number.
Official Cao suffered from a back eruption for eighteen days. The sore head was like millet, feeling like a needle prick inside, with extreme pain accompanied by occasional fainting and loss of appetite. His Qi became increasingly deficient. After more than ten moxa cones of large moxa via garlic interposition, he felt no relief and pain persisted. Subsequently, direct moxibustion was applied for over twenty cones. Internal toxins were expelled, toxic factors erupted, and appetite gradually returned. Further treatment with major tonics and burning mulberry wood led to gradual necrosis of dead flesh.
Liu Guanqing suffered from a Ding carbuncle on the foot for eleven days. Due to weak Qi, he underwent over fifty moxa cones and recovered with interior-supporting medicines.
Mr. Huang had a leg abscess with clear pus and a weak pulse. A female patient had an arm lump that had ulcerated. Neither wound would close. Both were treated with fermented soybean cake moxibustion and administered interior-supporting medicines, resulting in recovery.
A male patient had a chest lump persisting for half a year without resolution. He was ordered to undergo direct moxibustion for one hundred cones until ulceration occurred. Major tonics failed to promote closure, but application of Aconite Cake moxibustion led to recovery.
A male patient suffered from a back eruption with many sore heads, hard purple swelling, minimal pain, and no necrosis/ulceration. Mugwort was spread on the affected area for moxibustion, followed by several days of major tonics. Dead flesh detached, and he recovered. Official Chen suffered from a back eruption for four to five days. Although the sore head was small, the base was wide. Garlic-interposed moxibustion of thirty-plus cones caused the base to subside internally. Only the sore head suppurated, and he recovered in a few days.
In the Bingzi year, I suddenly experienced nausea, intense itching at the Dazhui (GV14) bone, inability to lift my arm shortly after, and extreme mental fatigue. This was a critical condition known as Tian Ju (Early Mortality Carbuncle). I urgently applied garlic-interposed moxibustion, which intensified the itching. Direct moxibustion of fifty-plus cones stopped the itching, and I recovered within ten days. *Jing Yao* states that moxibustion possesses the merit of generating life in four ways; this is true. (Commentary by Xue Ji)
Shi Shi cited evidence: The surgeon Chang Qizhi diagnosed the mother of Tai Shi in the Jiaxu year, noting internal accumulated heat and warning of potential carbuncle formation. In June of the Xin Si year, she indeed experienced slight itching on her back and shoulder blades, with grain-like eruptions. Moxibustion cleared them temporarily, but they recurred overnight. Topical plasters widened the redness to about six cun, causing unbearable pain, leading to blame being placed on moxibustion. An encounter with a monk, who claimed to have survived a critical sore after 800+ moxa cones, prompted the use of large moxa cones the size of ginkgo nuts on the sore head and surrounding areas. Pain ceased. After 30+ cones, the red halo disappeared. Forty moxa balls the size of plum/apricots were then applied, allowing him to eat congee and sleep. The actual sore covered four areas with over a hundred small openings; necrotic tissue sloughed off, and he recovered. Lizhai stated: The method of moxibustion requires making painful areas become painless and painless areas become painful; thus, toxins disperse with the fire. Otherwise, it is not only ineffective but harmful.
My opinion is that carbuncles and ulcers result from stagnation and accumulation of Qi and Blood. Large accumulations are hardest to disperse and require fire therapy for rapid resolution, making moxibustion highly suitable. However, Sun Daoren’s Shenxian Xunzhao Formula is even more exquisite. For mild pathogens, deep-seated pathogens in distant meridians, or blocked Qi flow, moxibustion is good. For intense, rapidly progressing pathogens in critical conditions, the Xunzhao formula is superior to moxibustion.