苏州章倚文夫人，体质本弱，平时饮食绝少，忽患项毒，平漫不肿，痛辄应心。医者谓大虚之证，投以峻补，毒伏神昏，奄奄一息，延余视之。余曰：毒无补理。疮口不高，则以围药束之，饮以清凉养血之品，托毒于外，兼服护心丸，痛定而疮根渐收。余暂归，转托一医代治。医者强作解事，曰围药不过金黄散之类，无益也，去之。用药亦意为改易，以炫己能。疮遂散大，血出不止，痛复甚而神疲。余再至大骇，询之，乃知其故。医者乃不复生议论，于是仍用前法，脓成食进，而后得安。盖外科病不治者绝少，皆由医之不得其道，所以动手辄误，病变日增，而药无一验，即束手无策矣。
白龙桥吴时臣，年七十余矣，患对口，痛欲绝。余视其外无围药，疮内反有插药五条，乃三品一条枪，此古方蚀顽肉之恶药，而近日医者，误以为必用之品，所以痛极昏迷。余悉拔去，掺以珠黄解毒散，其痛立除而神安。复用围药裹住其根，使疮头高而脓易出。或谓七旬之人，精力已衰，宜用温补。余曰：外证俱属火，苟非现证虚寒，从无用热药之理。进清凉开胃之剂，胃气开则肌肉自生，调养月余而愈，精神较胜前矣。
平湖徐抡斋，阴毒对口，颈项漫肿而色紫，有头如痘者百余，神烦志乱，医者束手，就治于余。余曰:此乃阴毒，兼似有祟。其家为述:患病之后，鬼声绕屋，鬼火不断。余曰：且敷药试之，色稍鲜，肿亦稍消。明晨视之，色转淡红，其如痘者，俱出微脓而低软，中聚一头，亦不甚大，势已消其十之三，神亦渐清，而思饮食。病虽属阴，亦不可用热药以增邪火，惟和血通气，使营卫充盈，使血中一点真阳诱出。则阴邪自退。若用热补，则反助毒火，而生机益绝。故冶外科之阴证，非若伤寒之阴证，为外感之寒邪，可专用桂附以驱之也。今之号外科者，惟拾内科之绪论，以为热可御寒，则贻害不小矣。
洞庭吴姓，从徐州经纪返棹，背起粟粒，深紫色而痛应心，周围肌肉皆不仁，知非轻证，未至家而就余治。余辞不能，再三恳求，姑用围药束之。稍定，病者谓我尚未到家，当归处分家事，求借一廛，如果不治，死无余憾。归二日而复来，其疮不甚大，顶微高而坚黑，当用刀挑破，方可上药。以洋刀点之，洋刀坚利非凡，竟不能人，用力挑之，刀头折，乃用金针四面刺之，以泄毒气。内托外敷，其方屡变，然后脓从四旁出，顽盖自落，约深半寸，脊骨隐露，其尖亦腐去，急以生肌散填补之，内服峻补之剂，两月而肉满皮完。此九死一生之证，不早为外束内托，则焦骨攻脏，无生理矣。
周庄陆姓，疽发背，周径尺余，一背尽肿，头以百计，毒气内攻，沉闷昏迷。医者以平塌无头，用桂附托之。余曰：此疮止宜收小，若欲加高，则根盘如此之大，而更加高，则背驮栲栳矣。此乃火毒，用热药必死。乃以束根提毒之药敷之，一夕而疮头俱平，皮肤亦润，止有大头如杯，高起于大椎骨之下，大三寸许，尚不思饮食，惟求食西瓜，医吓以入口即死。余令纵其所食，一日之内，连吃大西瓜两个。明日知饥，欲求肉饭，食肉四两，饭半碗，明日更加，始终用托毒清火之剂，而脓成口敛。余嘱曰：此疽初起盈背，背中脂膜皆空，非填补里膜，必有他变。有庸医献媚曰：病已全愈，为此说者，图厚谢也，我力能保之。病家利其省费，从之。至来年二月，忽旧疤中一细眼流血不止，放血斗余，两日而卒。盖其前一背尽肿，其中之脂膜俱化成脓，从大口出尽。庸医安知治法，贪利误人。富贵之家，往往最信此等人，可不省察耶。
郡中唐廷发，偶过余寓，时方暑，谓背上昨晚起一小瘰，搔之甚痒，先生肯一看否。余视之骇曰：此对心发也。唐不甚信，曰:姑与我药。余曰：君未信余言，一服药而毒大发，反疑我误君矣。含笑而去，明日已大如酒杯而痛甚，乃求医治。余曰：此非朝夕换方不可。我不能久留郡寓，奈何?因就医余家，旦暮易法，其中变迁不一，卒至收口。其收口前十日，忽头痛身热，神昏谵语，疮口黑陷，六脉参差。余适出门两日，归而大骇，疑为疮证变重，几无可药。细询其仆，乃贪凉当风而卧，疮口对风，膏药又落，风贯疮中，即所谓破伤风也。乃从外感治法，随用风药得汗而解，身凉神清，疮口复起，仍前治法而痊。若不审其故，又不明破伤风治法，则必无效，惟有相视莫解而已。
苏州钱君复庵，咳血不止，诸医以血证治之，病益剧。余往诊，见其吐血满地，细审之，中似有脓而腥臭者，余曰：此肺痈也，脓已成矣。《金匮》云:脓成则死，然有生者。余遂多方治之，钱亦始终相信，一月而愈。盖余平日因此证甚多，集唐人以来治肺痈之法，用甘凉之药以清其火，滋润之药以养其血，滑降之药以祛其痰，芳香之药以通其气，更以珠黄之药解其毒，金石之药填其空，兼数法而行之，屡试必效。今治钱君亦兼此数法而痊，强健逾旧。几二十年，至乾隆三年，家业日隆，因迁居大造，途中相值，邀余视其新居，坐谈良久，辞出，见其右额有豆大黑点，问之，钱对曰：昨此处生一瘰，颇痒，无他苦也。余谛审之曰：此毒发于内，治之失宜，可以伤命，非轻疾也。钱笑而腹非之。余曰：本当为君竭力，但君未信，若一用药而毒大发，则反以为病由药作，故不敢。但多年相好，不可不尽言，如五六日病势增重，当来相闻，勿为人误。越五日，遣人邀余山中，往则见其额肿目闭，哀号竟夕，方悔信余之不早，细视皮中有物，乃三品一条枪也。拔去五条。嗟乎!此乃腐烂死肌之恶药，好肉用上，其痛应心，况额上皮内即骨，横插皮中，所以痛极。余既不能久留，又坏证难治，力辞归山。易以他医，面目俱腐而卒。嗟乎!前何相信之深，后何不信之至，岂非命乎!
东洞庭刘某夫人，患乳疖，医者既不能消散，成脓之后，又用刀向乳头上寸余出毒，疮口向上，脓反下注，乳囊皆腐，寒热不食，将成乳劳，内外二科聚议无定，群以为不治矣。延余诊之，曰:此非恶证，治不如法耳。尚可愈也，但须百日耳。其家戚族皆少年喜事，闻余言欲塞群医之口，向病家曰:我辈公恳先生留山中百日，必求收功而后已。如欲归家，备快舟以迎送。余初不允，继勉承之，多方治之，至九十日而未见功。盖病者柔弱畏痛，既不敢于乳下别出一头，而脓水从上注下，颇难出尽，故有传囊之患。忽生一法，用药袋一个，放乳头之下，用帛束缚之，使脓不能下注;外以热茶壶熨之，使药气乘热人内;又服生肌托脓之丸散，于是脓从上泛，厚而且多，七日而脓尽生肌，果百日而全愈。后以此法治他证，无不神效。可知医之为术，全赖心思转变，刻舟求剑，终无一验也。
濮院沈维德，患下疳，前阴连根烂尽，溺从骨缝中出，沥灌肾囊中，哀号痛楚，肛门亦复烂深半寸，载至余家，止求得生为幸。余亦从未见此病，姑勉为治之。内服不过解毒养血之剂，而敷药则每用必痛，屡易其方，至不痛而后已。两月后结痂能行，惟阴茎仅留根耳。余偶阅秘本，有再长灵根一方，内用胎狗一个，适余家狗生三子，取其一，泥裹偎燥，合药付之。逾二年，忽生一子，举族大哗，谓人道已无，焉能生子?盖维德颇有家资，应继者怀觊觎之心也。其岳徐君密询之，沈曰：我服药后阳道已长，生子何疑?徐君乃集其族人共验之，阳道果全，但累生如有节而无总皮。再期又生一子，众始寂然。远近传之，以为奇事，今犹有述之以为异闻者。
附再长灵根方五十日复生效。
煅乳石三钱五分 琥珀七分 朱砂六分 人参一钱 真珠七分 牛黄四分 真水粉五分 胎狗一个 雄黄六分
用灵仙、首乌、大力子、寥草汁煮一昼夜，炒如银色。上为末，每服三厘，日进四服，卧又一服，俱以土茯苓半斤，阴阳水十二碗，煎五碗，连送五服，七日验。
雄按:煮一昼夜而炒如银色之药品，即上文煅乳石等九味也。详玩文义，似宜移上字于用字之上方顺。第胎狗煨燥必黑，全狗分两，又必数倍于诸药，同煮同炒，不知何以能如银色，是必煨时不令黑也。
苏州一小童，背上肿大如覆碗，俯不能仰，群谓驼疾也。或戏余曰:君能治奇疾，若愈此，则我辈服矣。其父母以余为果能治也，亦力求焉。余实不知其中何物，姑以腐药涂上，数日皮开肉烂，视其肉，如蚯蚓者盘结数条。细审之，乃背上之筋所聚也。余颇悔轻举，急以舒筋收口丸散，外敷内服，筋渐散，创渐平，肤完而身直矣。此筋瘤之一种也。哄传以余为能治驼疾，从此求治驼者云集，余俱谢不能，此乃幸而偶中。古人并无此治法。癸未人都，尚有人询及者，余谢无此事而已，存此以识异。
雄按:洄溪神于外科，读其所评《外科正宗》等书，已见一斑。是编列案仅十余条，然各大症治法略备，洵痈疽家赤文绿字之书也，可不奉为圭臬哉。
【背景信息】
书名：洄溪医案 章节：正文(6/6) 类别：医论
苏州章倚文夫人，体质本来虚弱，平时饮食极少，忽然患上颈部毒疮（项毒），疮面平漫不肿，疼痛放射至心脏部位。医生认为是极度虚弱的证候，投用峻猛的补益药，导致毒邪内伏、神志昏迷，气息微弱，生命垂危，请我去诊治。我说：毒邪没有通过补益来治疗的道理。疮口不高起，就用围药（外用药物，用于限制疮疡扩散）束紧患处，饮用清凉养血的药剂，将毒邪托举到体外，同时服用护心丸，疼痛停止后疮根逐渐收敛。我暂时回家，转托另一位医生代为治疗。那位医生自作聪明地说：围药不过是金黄散之类的东西，没有益处，把它去掉。用药也随意更改，以炫耀自己的能力。结果疮疡迅速扩大，出血不止，疼痛再次加剧且精神疲惫。我再去看时大为震惊，询问原因，才知道是这位医生的缘故。那位医生不再发表议论，于是仍沿用之前的方法，脓液形成，食欲恢复，之后才安稳下来。大概外科疾病不治好的情况极少，都是因为医生不得法，所以一动手就出错，病变日益增加，而药物毫无疗效，最终束手无策。
对口疽（生于颈后正中线的痈疽）
白龙桥吴时臣，七十多岁，患对口疽，疼痛难忍。我看他外部没有使用围药，疮内反而插入了五条药线，那是“三品一条枪”（一种含砷的腐蚀性强药），这是古代用来蚀除顽固腐肉的恶药，而近日的医生误以为这是必用的药品，所以导致疼痛剧烈甚至昏迷。我将这些药全部拔出，掺入珠黄解毒散（具有清热解毒功效的散剂），疼痛立即消除，神志安定。再用围药包裹住疮根，使疮头高起以便脓液容易排出。有人说七旬老人精力已衰，应该用温补法。我说：外部疮证都属于火毒，如果不是现症表现为虚寒，绝没有使用热药的道理。进服清凉开胃的药剂，胃气开通则肌肉自然生长，调养一个多月痊愈，精神状态比之前更好。
平湖徐抡斋，患阴毒对口疽，颈项漫肿且颜色紫暗，有像痘疹一样的头百余颗，心神烦躁、意识混乱，医生束手无策，前来找我治疗。我说：这是阴毒，兼似有邪祟作怪。他的家人叙述：患病之后，鬼声在屋中环绕，鬼火不断。我说：先敷药试试，颜色稍变鲜红，肿胀也稍消退。第二天早晨看时，颜色转为淡红色，那些像痘疹一样的头，都流出少量脓液且低软，中间聚集成一个头，也不甚大，病势已消退十分之三，神志也逐渐清醒，开始想吃东西。病虽然属于阴证，但也不可滥用热药以增加邪火，只有调和气血、疏通经络，使营卫充盈，引导血中的真阳之气透出。那么阴邪自然退去。如果用热补法，反而会助长毒火，使生机断绝。所以治疗外科的阴证，不像伤寒病的阴证，那是外感寒邪，可以专用桂枝、附子等温热药来驱散。现在的号称外科医生的人，只是拾取内科理论的余绪，认为热药可以抵御寒邪，这就造成了不小的危害。
洞庭吴姓人，从徐州经商返回，背上长出粟米大小的疙瘩，深紫色且疼痛放射至心脏，周围肌肉皆麻木无知觉，知道不是轻症，还没到家就来找我治疗。我推辞说不能治，再三恳求，姑且用围药束紧患处。病情稍定，病人说我还没到家，当归家处理家事，请求借住一处，如果不治好，死也无憾。回去两天后又来了，疮不算很大，顶部微高且坚硬发黑，应当用刀挑破，才能上药。用洋刀点刺，洋刀坚利非凡，竟然刺不进去，用力挑时，刀头折断，于是用金针四面刺之，以泄出毒气。内服托里透脓药，外敷药物，方剂多次变化，然后脓液从四周流出，顽腐的死皮自行脱落，约深半寸，脊骨隐约露出，尖端也腐烂去除，急忙用生肌散填补，内服峻猛补益药剂，两个月后肌肉丰满、皮肤愈合。这是九死一生的重症，不早为之外束内托，就会焦骨攻脏，没有生机了。
周庄陆姓人，发背疽，周长一尺多，整个背部尽肿，疮头数以百计，毒气内攻，胸闷昏迷。医生因为疮面平塌无头，用桂枝、附子托毒。我说：此疮只宜收小，如果想加高，疮根盘如此之大，再加高，那背部就像背着筐篓一样了。这是火毒，用热药必死。于是用束根提毒的药物敷之，一晚之后疮头全部平复，皮肤也滋润，只剩一个大头如杯状，高起于大椎骨之下，直径约三寸，尚不思饮食，只求吃西瓜。医生吓唬他说入口即死。我让他放纵食用，一天之内连吃两个大西瓜。第二天知道饿了，想要吃肉饭，吃了四两肉，半碗饭，第二天更多，始终用托毒清火的药剂，脓成口敛。我嘱咐说：此疽初起布满背部，背中的脂膜都已空虚，如果不填补里膜，必有其他变故。有个庸医献媚说：病已经完全好了，说这话的人是想图厚谢，我能保证。病家贪图省钱，听从了他。到了第二年二月，忽然旧疤中一个细眼流血不止，放血一斗多，两天后死亡。大概之前整个背部尽肿，其中的脂膜都化成脓，从大口排出殆尽。庸医哪里懂治疗方法，贪利误人。富贵人家，往往最相信这种人，可不省察吗？
郡城中唐廷发，偶然经过我的住所，当时正值暑天，他说背上昨晚起了一个小疙瘩，搔抓很痒，先生肯看一眼吗。我看后惊骇地说：这是对心发。唐不太相信，说：姑且给我药。我说：您不相信我的话，一服药而毒大发，反而怀疑我误了您。含笑而去，第二天已经大如酒杯且疼痛剧烈，才求医治。我说：这不是朝夕换方能解决的。我不能久留郡城住所，怎么办？于是就医于我家，早晚更换疗法，其中变化不一，最终收口。在收口前十天，忽然头痛身热，神志昏迷胡言乱语，疮口黑陷，六脉参差不齐。我恰好出门两天，回来时大为震惊，怀疑是疮证变重，几乎无可救药。仔细询问其仆人，是因为贪凉当风而卧，疮口对着风，膏药又掉落，风邪侵入疮中，这就是所谓的破伤风。于是按外感治法，随用祛风药得汗而解，身凉神清，疮口复起，仍用前法治愈。如果不审察其原因，又不明破伤风的治法，那就必然无效，只有相对无言罢了。
苏州钱君复庵，咳血不止，众医生以血证治疗，病情加重。我去诊视，见其吐血满地，仔细审视，中间似乎有脓液且腥臭，我说：这是肺痈，脓已成。《金匮要略》说：脓成则死，然而也有活的。我遂多方治疗，钱君也始终相信，一个月痊愈。大概我平日因此证很多，集唐人以来治肺痈之法，用甘凉药以清其火，滋润药以养其血，滑降药以祛其痰，芳香药以通其气，再以珠黄药解其毒，金石药填其空，兼数法而行，屡试必效。今治钱君亦兼此数法而痊愈，强健超过以前。将近二十年，到乾隆三年，家业日隆，因迁居大造，途中相遇，邀我参观新居，坐谈良久，辞出，见他右额有豆大黑点，问之，钱回答说：昨天此处生一小疙瘩，颇痒，无其他痛苦。我仔细审视说：此毒发于内，治疗失宜，可以伤命，不是轻疾。钱笑而腹非之（心中不以为然）。我说：本当为君竭力，但君未信，若一用药而毒大发，则反以为病由药作，故不敢。但多年相好，不可不尽言，如五六日病势增重，当来相闻，勿为人误。越五日，派人邀我山中，前往则见其额肿目闭，哀号整夜，方才后悔信我不早，细视皮中有物，乃是“三品一条枪”。拔出五条。唉！这是腐烂死肌的恶药，好肉用上，其痛应心，何况额上皮内即是骨头，横插皮中，所以痛极。我既不能久留，又是坏证难治，力辞归山。易以他医，面目俱腐而死。唉！前何相信之深，后何不信之至，岂非命乎！
东洞庭刘某夫人，患乳疖，医生既不能消散，成脓之后，又用刀向乳头上一寸多处排毒，疮口向上，脓液反而向下流注，乳囊皆腐烂，寒热不食，将成乳劳（慢性乳房疾病），内外二科聚议无定论，群以为不治矣。延请我诊治，说：这不是恶证，治疗不如法罢了。还可以痊愈，但须百日。其家戚族皆少年喜事，听我言欲塞群医之口，向病家说：我们公恳先生留山中百日，必求收功而后已。如果想回家，备快舟以迎送。我起初不允，继勉承之，多方治疗，至九十日而未见功。大概病者柔弱畏痛，既不敢于乳下别出一头，而脓水从上注下，颇难出尽，故有传囊之患（脓液流入相邻乳络形成新脓肿）。忽生一法，用药袋一个，放乳头之下，用帛束缚之，使脓不能下注；外以热茶壶熨之，使药气乘热入内；又服生肌托脓之丸散，于是脓从上泛，厚而且多，七日而脓尽生肌，果百日而全愈。后以此法治他证，无不神效。可知医之为术，全赖心思转变，刻舟求剑，终无一验也。
下疳（生殖器溃疡）
濮院沈维德，患下疳，前阴连根烂尽，小便从骨缝中出，沥灌肾囊中，哀号痛楚，肛门亦复烂深半寸，载至余家，只求求得生存为幸。我也从未见此病，姑勉为治之。内服不过解毒养血之剂，而敷药则每用必痛，屡易其方，至不痛而后已。两月后结痂能行，惟阴茎仅留根耳。我偶阅秘本，有再长灵根一方，内用胎狗一个，适余家狗生三子，取其一，泥裹偎燥，合药付之。逾二年，忽生一子，举族大哗，谓人道已无，焉能生子？盖维德颇有家资，应继者怀觊觎之心也。其岳徐君密询之，沈曰：我服药后阳道已长，生子何疑？徐君乃集其族人共验之，阳道果全，但累生如有节而无总皮。再期又生一子，众始寂然。远近传之，以为奇事，今犹有述之以为异闻者。
附再长灵根方五十日复生效。
煅乳石三钱五分 琥珀七分 朱砂六分 人参一钱 真珠七分 牛黄四分 真水粉五分 胎狗一个 雄黄六分
用灵仙、首乌、大力子、寥草汁煮一昼夜，炒如银色。上为末，每服三厘，日进四服，卧又一服，俱以土茯苓半斤，阴阳水十二碗，煎五碗，连送五服，七日验。
雄按：煮一昼夜而炒如银色之药品，即上文煅乳石等九味也。详玩文义，似宜移上字于用字之上方顺。第胎狗煨燥必黑，全狗分两，又必数倍于诸药，同煮同炒，不知何以能如银色，是必煨时不令黑也。
苏州一小童，背上肿大如覆碗，俯不能仰，群谓驼疾也。或戏余曰：君能治奇疾，若愈此，则我辈服矣。其父母以余为果能治也，亦力求焉。余实不知其中何物，姑以腐药涂上，数日皮开肉烂，视其肉，如蚯蚓者盘结数条。细审之，乃背上之筋所聚也。余颇悔轻举，急以舒筋收口丸散，外敷内服，筋渐散，创渐平，肤完而身直矣。此筋瘤之一种也。哄传以余为能治驼疾，从此求治驼者云集，余俱谢不能，此乃幸而偶中。古人并无此治法。癸未人都，尚有人询及者，余谢无此事而已，存此以识异。
雄按：洄溪神于外科，读其所评《外科正宗》等书，已见一斑。是编列案仅十余条，然各大症治法略备，洵痈疽家赤文绿字之书也，可不奉为圭臬哉。
[Background Information]
Book: Huixi Medical Cases Chapter: Main Text (6/6) Category: Medical Discussion
Madam Zhang Yiwen of Suzhou, whose constitution was originally weak and who ate very little in daily life, suddenly developed a toxic carbuncle on the neck (Xiangdu). The lesion was flat and spreading without swelling, with pain radiating to the heart. Physicians considered it a severe deficiency syndrome and administered potent tonics, causing the toxin to become latent and leading to coma and critical breathing. She was referred to me for consultation. I stated that toxins are not treated by tonification. Since the wound did not protrude, I applied external encircling medicines (Weiyao, topical agents used to confine the spread of sores) to bind the area, prescribed cooling blood-nourishing decoctions to lift the toxin outward, and administered Huxin Wan (Heart-Protecting Pill) concurrently. Once the pain subsided, the base of the sore gradually receded. I temporarily returned home and entrusted another physician to continue treatment. That physician, acting presumptuously, claimed that encircling medicines were merely like Jinhuang San (Golden Yellow Powder) and were useless, so he removed them. He arbitrarily altered the herbal prescriptions to display his own skill. Consequently, the sore expanded rapidly, bleeding ceased not, pain intensified, and mental fatigue set in. Upon my second visit, I was greatly alarmed. After inquiry, I learned the cause. The physician ceased further discussion, and we reverted to the previous method. Pus formed, appetite returned, and she eventually stabilized. Generally, untreatable cases in surgery are rare; most failures stem from physicians lacking proper methodology, leading to errors upon intervention, worsening conditions, ineffective medications, and ultimately, helplessness.
Duikou Carbuncle (Carbuncle located at the center of the posterior neck)
Wu Shichen from Bailongqiao, over seventy years old, suffered from Duikou carbuncle with excruciating pain. I observed that no encircling medicine was applied externally, while five threads of "Sanpin Yitiao Qiang" (a caustic arsenic-containing preparation) were inserted internally. This is an ancient harsh medication used to escharose stubborn necrotic flesh, but contemporary physicians mistakenly regarded it as essential, resulting in extreme pain and coma. I extracted all the threads and applied Zhuhang Jiedu San (Pearl and Realgar Detoxifying Powder), which immediately relieved the pain and calmed the spirit. Subsequently, encircling medicine was used to bind the root, elevating the head of the sore to facilitate pus discharge. Some argued that a septuagenarian has declining vitality and should receive warm tonification. I replied: External lesions generally belong to fire-toxin syndromes. Unless there are current signs of deficiency-cold, there is no rationale for using hot/warm medicines. Administering cooling stomach-appetizing agents opened the stomach qi, allowing muscles to regenerate naturally. After more than a month of recuperation, she recovered, with her spirit superior to before.
Xu Lunzhai from Pinghu suffered from Yin-Du Duikou carbuncle. His neck and nape were diffusely swollen with a purplish hue, presenting with over a hundred pustule-like heads. He was mentally restless and confused. Physicians were helpless, and he sought my treatment. I said: This is Yin-Toxin, possibly accompanied by malevolent influences. His family recounted that after the onset of illness, ghostly sounds echoed around the house and ghostly fires appeared continuously. I said: Let us try applying medicine first. The color became slightly brighter, and the swelling reduced somewhat. The next morning, the color turned pale red. The pustule-like heads exuded slight pus and felt soft. They coalesced into one central head, which was not large. The condition had improved by three-tenths, his spirit cleared, and he desired food. Although the disease belongs to Yin syndromes, hot medicines must not be used to exacerbate pathogenic fire. Only by harmonizing blood and qi, unblocking collaterals, and replenishing Ying and Wei (Nutritive and Defensive Qi) can the true Yang within the blood be induced to emerge, causing Yin pathogens to retreat spontaneously. Using hot tonification would assist the toxic fire and extinguish vital energy. Therefore, treating Yin syndromes in surgery differs from Yin syndromes in Shanghan (Cold Damage) diseases caused by external cold pathogens, where Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) can be exclusively used to dispel cold. Contemporary self-proclaimed surgical physicians merely borrow internal medicine theories, believing warm medicines can counteract cold, thereby causing significant harm.
Faback Carbuncle (Carbuncle on the back)
A man surnamed Wu from Dongting returned from business in Xuzhou when a millet-grain-sized nodule appeared on his back. It was deep purple, painful radiating to the heart, and surrounded by insensate muscle tissue. Recognizing it as a serious condition, he sought my treatment before reaching home. I declined, citing inability to treat, but after persistent pleading, I tentatively applied encircling medicine. The condition stabilized slightly. The patient stated he needed to return home to settle affairs and requested lodging. If untreated, he accepted death without regret. Two days later, he returned. The sore was not very large, with a slightly elevated, hard, and black apex. It required incision before applying medication. An imported knife was too sharp and stiff to penetrate; forcing it broke the blade. I then used gold needles to puncture the four sides to drain toxic qi. Internal supportive therapies and external applications were adjusted frequently. Eventually, pus drained from the periphery, necrotic slough fell off, revealing the spine at a depth of approximately half cun, with the tip also necrotic. Urgently, Shengji San (Flesh-Generating Powder) was applied to fill the defect, and potent internal tonics were given. After two months, flesh filled the wound and skin healed. This was a case of nine deaths and one life. Had external binding and internal support not been employed early, the bone would have been scorched and viscera attacked, leaving no hope for survival.
A man surnamed Lu from Zhouzhuang suffered from Faback carbuncle with a circumference of over one chi. The entire back was swollen with hundreds of heads, and toxic qi invaded internally, causing chest oppression and coma. Because the lesion was flat without heads, physicians used Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to support. I said: This sore should only be constricted. If one attempts to elevate it given such a broad base, the back would resemble a carrying basket. This is Fire-Toxin; using hot medicines will certainly cause death. I applied medicines to bind the root and lift the toxin. Overnight, all heads flattened, and the skin became moist. Only one large head, cup-shaped and rising below the Dazhui point (GV14), remained about three cun in diameter. He had no appetite but craved watermelon. Physicians warned that eating it would cause immediate death. I allowed him to eat freely. Within one day, he consumed two large watermelons. The next day, he felt hungry and requested meat and rice, consuming four liang of meat and half a bowl of rice, increasing the amount the following day. Consistently using toxin-supporting and fire-clearing agents led to pus formation and wound closure. I advised: Since the initial carbuncle covered the entire back, the subcutaneous fat membranes were emptied. Without filling these inner membranes, other complications would arise. A quack flatteringly claimed the patient was fully cured and accused anyone suggesting otherwise of seeking bribes, guaranteeing recovery. The family, wishing to save costs, agreed. In February of the following year, a small opening in the old scar began bleeding profusely. After losing over one dou of blood, he died within two days. Previously, the entire back was swollen, and the fat membranes had turned to pus, draining out through the large openings. How could a quack know the correct treatment? Greed for profit misled people. Wealthy families often trust such individuals most; one must reflect on this carefully.
Dui Xin Fa (Carbuncle on the back corresponding to the heart)
Tang Tingfa from the prefecture visited my residence during summer. He reported a small lump on his back that started the previous night, itching severely, and asked for my opinion. I examined it and exclaimed in alarm: This is Dui Xin Fa. Tang was skeptical, saying: Give me some medicine anyway. I replied: If you do not believe me, one dose may cause the toxin to flare up violently, and you might blame me for error. He left smiling. The next day, the sore enlarged to the size of a wine cup with severe pain, and he sought treatment. I said: This requires frequent changes in prescription. I cannot stay in the prefecture long. What shall we do? He came to my home for treatment. We changed methods morning and evening, adapting constantly, until the wound closed. Ten days before closure, he suddenly developed headache, fever, coma, delirium, black sunken wounds, and irregular pulses. I had been away for two days. Returning, I was shocked, fearing the condition had worsened beyond remedy. Questioning his servant, I learned he had slept facing the wind due to heat, the wound was exposed, and the plaster had fallen off. Wind penetrated the wound, causing what is known as Poshang Feng (Wind Injury/Tetanus). Treating it as an external contraction, I used wind-dispelling medicines to induce sweating, resolving the fever and clearing the spirit. The wound rose again, and he recovered with the previous regimen. Without investigating the cause or understanding Poshang Feng treatment, efficacy would be impossible, leaving only confusion.
Fei Yong (Lung Abscess)
Qian Fuan of Suzhou suffered from incessant hemoptysis. Other physicians treated it as a bleeding disorder, worsening the condition. Upon examination, I saw blood covering the floor. Careful inspection revealed pus mixed with the blood, smelling foul. I diagnosed Fei Yong (Lung Abscess), stating the pus was already formed. The *Jinkui Yaolue* states: When pus forms, death ensues, yet survival is possible. I employed various treatments. Qian trusted me completely, and he recovered in one month. Having encountered many such cases, I synthesized methods since the Tang Dynasty: using sweet-cool herbs to clear fire, moistening herbs to nourish blood, slippery-descending herbs to expel phlegm, aromatic herbs to unblock qi, Pearl and Realgar preparations to detoxify, and mineral substances to fill cavities. Combining these methods proved consistently effective. Applying this combination cured Qian, restoring his health better than before. Nearly twenty years later, in the third year of Qianlong, his family fortune prospered. Moving to Dazao, we met on the road. He invited me to view his new home. After a long conversation, as I departed, I noticed a bean-sized black spot on his right forehead. Asking about it, Qian replied: A small lump appeared here yesterday, quite itchy, with no other discomfort. Examining it closely, I said: This toxin originates internally. Improper treatment can be fatal; it is not a minor ailment. Qian smiled and dismissed my concern internally. I said: I ought to strive to help you, but since you do not believe me, if the toxin flares up after medication, you might blame the medicine. Thus, I dare not intervene. However, given our long friendship, I must speak frankly. If the condition worsens in five or six days, come find me; do not let others mislead you. Five days later, he sent someone to invite me to the mountains. Arriving, I found his forehead swollen, eyes closed, wailing throughout the night. He regretted not trusting me earlier. Inspecting the skin, I found "Sanpin Yitiao Qiang" threads embedded. I extracted five. Alas! This is a harsh medication that rotting dead flesh. Applied to healthy flesh, it causes pain radiating to the heart. Moreover, the skin on the forehead lies directly over bone; inserting it horizontally causes extreme pain. Unable to stay long and facing a difficult, damaged case, I declined and returned to the mountains. Another physician took over, and the patient’s face and features rotted before he died. Alas! Why such deep trust initially, and such complete disbelief later? Is it not fate?
Ru Ji (Breast Furuncle)
Madam Liu of East Dongting suffered from Ru Ji. Physicians failed to resolve it. After suppuration, a physician cut above the nipple to drain pus. The wound faced upward, causing pus to flow downward, rotting the mammary glands. She experienced chills, fever, and loss of appetite, progressing toward Ru Lao (Chronic Breast Disease). Internal and external specialists debated without consensus, deeming it untreatable. I consulted and said: This is not a malignant syndrome; the treatment was improper. It is curable, but will take one hundred days. Her young relatives, fond of drama, wished to silence the other physicians. They urged me to stay in the mountains for a hundred days to ensure success, offering fast boats for travel if I wished to return. I initially refused but eventually agreed. I tried various methods, but after ninety days, no progress was seen. The patient was frail and feared pain, refusing to create a secondary drainage site below the breast. With pus flowing down from above, it was difficult to drain completely, risking transmission to adjacent lobules (Chuang Nang). I devised a new method: placing a medicinal bag under the nipple and binding it with cloth to prevent downward flow; externally applying a hot teapot to warm the area and drive medicinal qi inward; and administering pills and powders to generate flesh and support pus expulsion. Pus then flowed upward, becoming thick and abundant. In seven days, pus ceased and flesh regenerated. Indeed, full recovery occurred in one hundred days. Later, applying this method to other cases yielded miraculous results. This demonstrates that medical art relies entirely on flexible thinking. Rigid adherence to precedent yields no efficacy.
Xia Gan (Genital Chancre/Ulcer)
Shen Weide from Puyuan suffered from Xia Gan. The external genitalia and root were completely ulcerated. Urine exited through bone fissures, dripping into the scrotum. He wailed in agony. The anus was also ulcerated deeply by half a cun. Brought to my home, he prayed only for survival. I had never seen such a case but attempted treatment. Internally, I used only detoxifying and blood-nourishing agents. Externally, every application caused pain. I frequently changed formulas until pain subsided. After two months, scabs formed, and he could walk, though only the root of the penis remained. While reading a secret manuscript, I found a formula for regenerating the "spiritual root" (penis), using one fetal dog. My dog had recently given birth to three pups. I took one, wrapped it in mud, roasted it, and combined it with the other herbs. Over two years later, he unexpectedly fathered a child. The clan erupted in uproar, claiming humanity was ended and questioning how he could sire a child. Shen possessed considerable wealth, and heirs harbored greedy intentions. His father-in-law, Mr. Xu, secretly questioned him. Shen replied: After taking the medicine, my organ grew; how could I not sire children? Mr. Xu gathered the clan to verify. The organ was indeed whole, though segmented without a prepuce. Two years later, he sired another child, and the crowd fell silent. Word spread far and wide as a marvel, still recounted as a strange tale today.
Appendix: Regenerate Spiritual Root Formula (Effective after fifty days)
Calcined Gypsum (Duan Rushi) 3 qian 5 fen; Amber (Hupo) 7 fen; Cinnabar (Zhusha) 6 fen; Ginseng (Renshen) 1 qian; True Pearl (Zhenzhu) 7 fen; Realgar (Niuhuang - *Note: Niuhuang usually refers to Calculus Bovis, likely a typo in original or specific preparation*) 4 fen; True Water Powder (Zhen Shuifen) 5 fen; One Fetal Dog; Realgar (Xionghuang) 6 fen.
Boil with Dioscorea Hypoglauca Lingxian (Dioscorea hypoglauca), Polygonum Multiflorum (He Shouwu), Arctium Fruit (Niu Bang Zi), and Artemisia Annua juice (Liao Cao) for one day and night. Stir-fry until silver-colored. Grind to powder. Take 3 liang per dose, four times daily, plus one dose before bed. All doses are washed down with a decoction of half jin of Smilax Glabra (Tu Fuling) and twelve bowls of Yin-Yang Water, boiled down to five bowls. Consume five doses consecutively. Verify effects in seven days.
Commentary by Xiong: The drugs boiled for a day and night and stir-fried until silver-colored refer to the nine ingredients listed above (Calcined Gypsum, etc.). Carefully analyzing the text, the character "Shang" (Above) seems misplaced and should precede "Yong" (Use) for logical flow. However, the roasted fetal dog must turn black. Its weight would be several times that of the other herbs. Boiling and frying them together makes it unclear how they achieve a silver color. It is likely the dog was roasted without turning black.
Jin Liu (Tendon Tumor/Venous Varix)
A young boy in Suzhou had a back swelling the size of an inverted bowl, unable to bend forward or look up. Many called it hunchback disease. Someone joked with me: You can treat strange diseases; if you cure this, we will submit to you. His parents, believing I could truly cure it, also pleaded earnestly. I did not know what lay inside but applied caustic medication topically. After a few days, the skin opened and flesh rotted. Looking at the tissue, several earthworm-like structures were coiled. Careful examination revealed these were aggregated tendons on the back. I regretted my rash action and urgently applied Shujin Shukou Wan/San (Tendon-Relaxing and Wound-Closing Pills/Powder), both internally and externally. The tendons gradually dispersed, the wound flattened, skin healed, and his posture straightened. This was a type of Jin Liu. Rumors spread that I could cure hunchbacks, and seekers flocked to me. I declined all, attributing the success to luck. Ancient texts contain no such treatment method. In Guiwei year, arriving in the capital, people still asked about it. I denied the incident, preserving this record to note the anomaly.
Commentary by Xiong: Huixi was divine in surgery. Reading his critiques of books like *Waike Zhengzong* reveals glimpses of his expertise. This collection contains only over ten cases, yet covers major surgical treatments comprehensively. It is truly a precious gem for surgeons; should it not be revered as a standard?