郁，隧道阻滞，或溢或结，积久渗出脉外，气为之乱，此阳滞于阴也；百病皆由于此，
不止痈疽而已。故痈肿初起，便 痛肿大者，可治；不痛热肿大而陷者，不治也。
又曰∶衣浓仍寒，孤阴无济，衣薄仍热，孤阳独存，阳虚极宜补阳，阴虚极当益肾。
又曰∶腰背反张，颈项强直，为变 之兆；口噤作冷，寒战切牙，斯绝命之期。
窦太师曰∶发背之生，积毒于脏腑，正气盛，淹留停缓；元气虚，则朝轻夕重，如
发弓矢，外小内大；内托则生，败毒则毙，治法以参 为主，一定之论也，百世不易。
凡痈发于背，广一尺，深可一寸，虽溃至骨，不穿膜不死。（《经验全书》）
孙思邈曰∶疮之要害处，近虚处，怯薄处，当细心医治也。
喻嘉言曰∶夫疮毒已溃，治当大补气血。
又曰∶脓出反痛虚之过，脓多不敛弱之因。
王肯堂曰∶方书叙痈疽之源有五∶一天行时气，二七情内郁，三体虚外感，四
身热搏于风冷，五食炙 ，饮法酒，服丹石等热毒，总之不出于三因也。外因者，运
气痈疽有四∶一火热助心为疮。经云∶少阴所至为疮疹。又云∶少阴司天，热气下
临，肺气上从，甚则疮疡。又云∶少阴司天之政，初之气，寒乃始，阳气郁，炎暑
将起，中外疮疡。又云少阳所至为疮疡。又云∶少阳司天之政，风热参布，太阴横流，
寒乃时至，民病寒中，外发疮疡。初之气候，乃大温，其病肤腠中疮；二之气，火
反郁，其病热郁于上，疮发于中；三之气，炎暑至，民病脓疮。又云∶太阳司天之政，
初之气，气乃大温，肌腠疮疡，此皆常化病之浅也。又云∶少阴司天，热淫所胜，甚
则疮疡。又云∶少阴司天，客胜甚则疮疡。又曰∶少阴之复，病痱疹疮，疽痈痤痔。又
云∶火太过，曰赫羲，其病疮疽血流。又云∶火郁之发，民病疮疡痈肿，此是邪变
病之甚也。二曰寒邪伤心为疮疡。经曰∶太阳司天之政，三之气，寒气，民病寒反热
中，痈疽注下。又云∶太阳司天，寒淫所胜，血变于中，发为痈疡，病本于心。又
云∶阳明司天之政，四之气，寒雨降，民病痈肿疮疡是也。三曰燥邪伤肝为疮疡。经
曰∶木不及曰委和，上商与正商同其病，支发痈肿疮疡，邪伤肝也。又云∶阳明司天，
燥淫所胜，民病疡疮痤痈，病本于肝是也。四曰湿邪疮疡。经云∶太阴司天，湿气变
物，甚则身后痈。又云∶太阴之胜，火气内郁，疮疡于中，流散于外是也。此四条
所谓天行时气者也。《素问·脉要精微论》帝曰∶诸痈肿筋挛骨痛，此皆安生？岐伯
曰∶此寒气之肿，八风之变也。帝曰∶治之奈何？岐伯曰∶此四时之病，以其胜治之愈也。
《灵枢·痈疽篇》云∶血脉荣卫，周流不休，上应星宿，下应经数，寒邪客于经
络之中则血泣，血泣则不通，不通则卫气归之，不得复反，故痈肿。寒气化为热，热
甚则腐肉，腐肉则为脓，脓不泄则烂筋，筋烂则伤骨，骨伤则髓消，不当骨空，不得
泄泻，血枯空虚，则筋骨肌肉不相荣，经脉败漏，熏于五脏，脏伤故死矣。《生气通
天论》云∶劳汗当风，寒薄为 ，郁乃痤。又云∶阳气者，开阖不得，寒气从之，乃
生大偻。荣气不从，逆于肉里，乃生痈肿。是亦邪从劳汗之隙，及阳气开阖不得其理
之隙，久客之为痈肿也。所谓体虚外感，及身热搏于风冷者也。治法则《精要》十宣
散、五香汤、洁古苍术复煎散等发表之剂是也。内因者，陈无择云∶痈疽瘰 ，不
问虚实寒热，皆由气郁而成。经云∶气宿于经络，与血俱涩而不行，壅结为痈疽，不
言热之所作而后成痈者，此乃喜怒忧思有所郁而成也，治之以远志酒、独胜散，兼
以五志相胜之理，如怒胜思之类是也。不内外因者，经所谓膏粱之变，足生大疔，受
如持虚。又东方之域委盐之地，其民食委嗜咸，安其处，美其食，委热中，咸胜血，
故其民黑色疏理，其病为痈疽。又有服丹石法酒而致者，亦膏粱之类也。李东垣曰∶
膏粱之变，亦是滋味过度，荣气不从，逆于肉里。荣气者，胃气也，饮食入胃，先
输于脾，而朝于肺，肺朝百脉，次及皮毛，
先行阳道，下归五脏六腑，而气口成寸矣。今富贵之人，不知其节，法酒肥羊，杂以
浓味，积久太过，其气味俱浓之物，乃阳中之阳，不能走空窍而先行阳道，乃反行
阴道，则湿气大胜，子令母实，火乃大旺，热湿既盛，必来克肾，若不慎房事，损其
真水，水乏则从湿气之化而上行，其疮多出背上及脑，此为大疔之最重者。若毒瓦斯
出肺，或脾胃之部分，毒之次也，若出于他经，又其次也，湿热之毒，所止处无不
溃烂。故经言膏粱之变，足生大疔，受如持虚者，如持虚器以受物，则无不受矣。治
大疔之法，必当泻其荣气。以标本言之，先受病为本，非苦寒之剂为主为君，不能除
其苦楚痛疼也。如东垣治元好问，丹溪治老妇脑疽，皆因好酒，故以三黄大黄酒制
治之。又如排脓散、当归散之类是也。又有尽力房室，精虚气节之所致者，亦属不
内外因，当以补虚内托为主，亦忌用五香之药耗真阴而助邪热，治之之药，如内固
黄汤、神效托里散之类也。经云∶五脏菀热，痈发六腑。又云∶六腑不和，留结
为痈。又云∶诸痛痒疮，皆属于心，肺乘肝则为痈，肾移寒于肝，痈肿少气，脾移
寒于肝，痈肿筋挛，此皆脏腑之变亦属内因者也。东垣曰∶《生气通天论》云，荣气
不从，逆于肉理，乃生痈肿。又云，膏粱之变，足生大疔，受如持虚。《阴阳应象
论》云，地之湿气，感则害人皮肉筋脉，是言湿气外伤，则荣气不行，荣卫者，皆荣
气之所经营也，营气者胃气也，运气也，荣气为本，本逆不行，为湿气所坏而为疮疡
也。膏粱之变，亦是言浓滋味过度，而使荣气逆行，凝于经络为疮疡也。此邪不在
表亦不在里，唯在其经中道病也。以上《内经》所说，俱言因荣气逆而作也，遍看
诸疮疡论中，多言二热相搏，热化为脓者；有只言热化为脓者；有言湿气生疮，寒化
为热而为脓者；此皆痈疽之源也。宜于所见部分，用引经药，并兼见证中分阴证阳
证，先泻荣气是其本，本逆助火，湿热相合，败坏肌肉而为脓血者，此治次也。宜
远取诸物以比，一岁之中大热无过夏，当是时诸物皆不坏烂，坏烂者交秋湿令大行
之际也，近取诸身，热病在身，止显热而不败坏肌肉，此理明矣。标本不得，邪气
不服，言一而知百者，可以为上工矣。（《疡医准绳》）
又曰∶《灵枢经》云∶荣卫稽留于经脉之中，则血泣而不行，不行则卫气从之而
不通，壅遏而不得行，故热，大热不止，热胜则肉腐，肉腐则为脓，然不能陷肌肤，骨
髓不为焦枯，五脏不为伤，故名曰痈。热气淳盛，下陷肌肤，筋髓枯，内连五脏，血
气竭，当其痈下筋骨，良肉皆无余，故命曰疽。疽者上之皮夭以坚，上如牛领之皮。
痈者其皮上薄以泽，此其候也。
《鬼遗方》云∶痈之痛，只在皮肤之上，其发如火焚茅，初如黍米大，三两日如掌
面大，五七日如碗面大，即易治，如肿冷发渴发逆，治之难愈。疽发或如小疖，触
则彻心痛，四边微起，如橘皮，孔色红赤不全变，脓水不甚出，至七八日，疼闷喘
急不止，若始发肿，高五七日，忽平陷者，此内攻之候也。
又云∶痈疽有三等，毒瓦斯浮浅属腑，毒瓦斯深沉属脏，毒瓦斯猛烈而行经络，或浅或
深无定，五脏六腑皆受之毒，难为调理，唯宜急切于痈发诸处，不问虚实、高肿、起
盛、光泽、疼痛，只在皮肤之上，热急胀满，或有痒疼，别无恶候，初用温药平气，
次用排脓发穴。（治痈所谓平气者，犀角饮之类，其方用犀角、连翘、漏芦、甘草、当归、肉桂，皆发表之
药也。所谓发穴者，乃棘针之类，用皂角刺为君，甘草、川芎、乳香为佐使，亦托里之药也，然不若洁古、东
垣诸方发表托里为稳当。）
又曰∶疽发诸处，不拘大小，惟起在背，广一尺、二尺、三尺，皮浓而紫黑，高肿不常，内疼如锥刺，攻
击满闷，应四肢重疼，前心亦痛，余处发犹可，唯虚处及近筋骨处，若脓毒未溃，即伤烂筋骨，肉
损为疽者，属五脏毒瓦斯深沉，多气伏硬坚实而不宜缓慢，治之须内实五脏，外透皮
肤，令软匀和，即脓透，宜用内托实脏气之药，排脓匀气乃可，不比痈之毒瓦斯浮浅也，毋作一类治之。
又曰∶凡一切疮肿，始觉患起高肿，五七日忽平陷者，此是内攻之候也，急以内
托散及内补汤药补填脏腑令实，最怕透膜，膜穿十无一生矣。
娄全善曰∶痈之邪浅，其稽留壅遏，独在经络之中，而专攻于外。故初发时，自
表便发热，患处便如碗如盆，高肿而痛，甚者纵欲下陷，得正气内固，不肯受，故或
便秘，或发渴发逆以拒之，是以骨髓终不焦枯，五脏终不伤也。疽之邪深。其稽留
壅遏，内连五脏，而不专攻于外，故身体无热，患处或不肿痛，甚者声嘶气脱，眼
黑眼小，十指肿黑如墨，多死也。治之之法，痈之初发，当以洁古法为主，表者散
之，里者下之，火以灸之，药以敷之，脓未成者必消，脓已成者速溃也。疽之初发，
当以《鬼遗方》为主，补填脏腑令实，勿令下陷之邪蔓延，外以火灸，引邪透出，使
有穴归着而不乱，则可转死回生，变凶为吉。今世外科，不分痈疽，一例宣热拔毒，
外以五香耗其气，内以大黄竭其血，终不能自悟其用药之非，惜哉！
洁古云∶疮疡者，火之属，须分内外。若其脉沉实，当先疏其内绝其源也。其脉
浮大，当先托里，恐邪气入内也。有内外之中者，邪气至甚，遏绝经络，故发痈肿。
经曰∶荣气不从，逆于肉里，乃生痈肿，此因失托里，及失疏通，又失和荣卫也。治
疮之大要，须明托里、疏通、行荣卫三法∶托里者，治其外之内；疏通者，治其内之
外；行荣卫者，治其中也。内之外者，其脉沉实，发热烦躁，外无 赤痛甚，邪气
深于内也。故先疏通脏腑，以绝其源。（内疏黄连汤。）外之内者，其脉浮数， 肿在外，形
证外显，恐邪气极而内行，故先托里，以
防其干也。（内托复煎散。）内外之中者，外无 恶之气，内亦脏腑宣通，知其在经，当和
荣卫也。（当归黄 汤。）用此三法之后，虽未瘥，必无变证，亦可使邪气峻减而易痊也。
《三因》云∶痈疽瘰 ，不问虚实寒热，皆由气郁而成。经曰∶气宿于经络，与血
俱涩而不行，壅结为痈疽。不言热之所作而后成痈者，此乃因喜怒忧思，有所郁而成也。
《精要》云∶痈疽，愤郁不遂志欲之人，多犯此疾。
张景岳曰∶凡疮疡之患，所因虽多，其要惟内、外二字。证候虽多，其要惟阴、阳
二字。知此四者，则尽之矣。然内有由脏者，有由腑者，外有在皮肤者，有在筋骨
者，此又其浅深之辨也。至其为病，则无非血气壅滞，荣卫稽留之所致。盖凡以郁
怒忧思，或淫欲丹毒之逆者，其逆在肝、脾、肺、肾，此出于脏而为内病之最甚者也。凡
以饮食浓味，醇酒炙 之壅者，其壅在胃，此出于腑，而为内病之稍次者也。又如以
六气之外袭，寒暑之不调，侵入经络，伤人荣卫，则凡寒滞之毒，其来徐，来徐者，
其入深，多犯于筋骨之间，此表病之深者也。风热之毒，其来暴，来暴者，其入浅，
多犯于皮肉之间，此表病之浅者也。何也？盖在脏在骨者，多阴毒，阴毒其甚也；在
腑在肤者，多阳毒，阳毒其浅也。所以凡察疮疡者，当识痈疽之辨。痈者热壅于外，
阳毒之气也，其肿高，其色赤，其痛甚，其皮薄而泽，其脓易化，其口易敛，其来速
者，其愈亦速，此与脏腑无涉，故易治而易愈也。疽者结陷于内，阴毒之气也，其
肿不高，其痛不甚，其色沉黑，或如牛领之皮，其来不骤，其愈最难，或全不知痛
痒，甚有疮毒未形，而精神先困，七恶叠见者，此其毒将发而内先败，大危之候也。
知其阴阳内外，则痈疡之概可类见矣。然此以外见者言之，但痈疡之发，原无定所，
或在经络，或在脏腑，无不有阴阳之辨，若
元气强则正胜邪，正胜邪则毒在腑，在腑者便是阳毒，故易发易收而易治；元气弱
则邪胜正，邪胜正则毒在脏，在脏者便是阴毒，故难起难收而难治。此之难易，全
在虚实，实者易而虚者难也，速者易而迟者难也。所以凡察痈疽者，当先察元气，以
辨吉凶，故无论肿疡溃疡，但觉元气不足，必当先虑其何以收局，而不得不预为之地，
万一见病治病，且顾目前，则鲜不致害也。其有元气本亏，而邪盛不能容补者，是必
逆败之证，其有邪毒炽甚，而脉证俱实者，但当直攻其毒，则不得误补助邪，所当详辨也。（《全书》）
马益卿《痈疽论》曰∶人有四肢五脏，一觉一寐，呼吸吐纳，精气往来，流而为
营卫，畅而为气色，发而为声音，阳用其形，阴用其精，此人之常数所同也。至其
失也，蒸则生热，否则生寒，结则为瘤赘，陷则为痈疽。
郁结，是指经络隧道阻滞，气血或外溢或凝结，日久渗出脉外，导致气机紊乱，这是阳气滞留在阴分所致；百病皆由此引起，不仅仅是痈疽而已。所以痈肿初起时，如果疼痛且肿大，是可以治疗的；如果不痛、不热而肿大且下陷的，则难以治愈。
又说：衣着厚重却仍觉寒冷，是孤阴无阳来济助；衣着单薄却仍觉发热，是孤阳独自存在。阳气极度虚弱时应当补阳，阴液极度亏虚时应当滋补肾阴。
又说：腰背反张（角弓反张），颈项强直，是病情发生恶变的征兆；口噤不开、发冷、寒战咬牙，是生命终结的时期。
窦太师说：发背疮的发生，是因为毒邪积聚在脏腑。正气旺盛时，毒邪滞留停留进展缓慢；元气虚弱时，病情早晨轻晚上重，就像拉开弓射箭一样（形容病情发展迅速或力量集中），外表小内部大；采用内托法治疗就能生存，单纯败毒攻伐就会死亡，治疗方法以人参为主，这是一定的定论，百世不可改变。
凡是痈发于背部，宽度一尺，深度可达一寸，即使溃烂至骨头，只要不穿透膜就不会死亡。（出自《经验全书》）
孙思邈说：疮疡的关键部位，靠近虚损处、怯弱薄弱处，应当细心医治。
又说：脓液流出后反而疼痛，是正气虚弱的过错；脓液多但伤口不收敛，是体质虚弱的缘故。
王肯堂说：医书中叙述痈疽的成因有五种：一是天行时气（流行性疫病之气），二是七情内郁（情绪抑郁），三是体虚外感（身体虚弱感受外邪），四是身热与风冷搏结，五是食用炙烤食物、饮用烈酒、服用丹石等热毒之物。总之不出于三因（内因、外因、不内外因）。
外因方面，运气导致的痈疽有四种：
一是火热助心形成疮疡。经书说：少阴所至表现为疮疹。又说：少阴司天时，热气下行，肺气上从，严重时出现疮疡。又说：少阴司天之政，初之气阶段，寒气开始，阳气郁结，炎热暑气即将兴起，内外出现疮疡。又说：少阳所至表现为疮疡。又说：少阳司天之政，风热参杂分布，太阴湿气横流，寒气按时而至，民众患寒中病，外部发出疮疡。初之气候，是大温，其病在于肤腠中的疮；二之气，火气反而郁结，其病热郁于上部，疮发于中部；三之气，炎热暑气到来，民众患脓疮。又说：太阳司天之政，初之气，气乃大温，肌腠生疮疡，这些都是常化病的浅层表现。又说：少阴司天，热淫胜，严重时疮疡。又说：少阴司天，客胜严重时疮疡。又说：少阴之复，病发痱疹疮，疽痈痤痔。又说：火太过，称为赫羲，其病为疮疽血流。又说：火郁发作时，民众病发疮疡痈肿，这是邪变病的严重情况。
二是寒邪伤心形成疮疡。经书说：太阳司天之政，三之气，寒气盛，民众病发寒反热中，痈疽注下。又说：太阳司天，寒淫胜，血变于中，发为痈疡，病本在心。又说：阳明司天之政，四之气，寒雨降下，民众病发痈肿疮疡。
三是燥邪伤肝形成疮疡。经书说：木不及称为委和，上商与正商同其病，支节发痈肿疮疡，是邪气伤了肝。又说：阳明司天，燥淫胜，民众病发疡疮痤痈，病本在肝。
四是湿邪疮疡。经书说：太阴司天，湿气变化万物，严重时身后生痈。又说：太阴之胜，火气内郁，疮疡生于中，流散于外。这四条所谓的天行时气。
《素问·脉要精微论》中皇帝问：各种痈肿筋挛骨痛，这些是怎么产生的？岐伯说：这是寒气引起的肿胀，是八风变化的结果。皇帝问：怎么治疗？岐伯说：这是四时的病，用相克的方法治疗就能痊愈。
《灵枢·痈疽篇》说：血脉营卫，周流不息，上应星宿，下应经数。寒邪客居在经络之中，则血液凝涩，血液凝涩则不通，不通则卫气归附于此，不能返回，所以形成痈肿。寒气化为热，热甚则腐肉，腐肉则为脓，脓不排泄则烂筋，筋烂则伤骨，骨伤则髓消，如果不发生在骨空之处，不得泄泻，血枯空虚，则筋骨肌肉不相荣养，经脉败漏，熏灼五脏，脏伤故死。
《生气通天论》说：劳动出汗当风，寒气迫近成为疿㾦，郁结乃成痤疮。又说：阳气者，开阖功能失常，寒气随之侵入，于是产生大偻（脊背弯曲）。营气不顺，逆乱于肉理，于是产生痈肿。这也是邪气从劳动出汗的缝隙，以及阳气开阖失理的缝隙，久留而成痈肿。这就是所谓的体虚外感，及身热搏于风冷。治法则如《精要》中的十宣散、五香汤、洁古苍术复煎散等发表之剂。
内因方面，陈无择说：痈疽瘰疬，不问虚实寒热，皆由气郁而成。经书说：气停留于经络，与血一起涩滞而不行，壅结为痈疽。不说热所作而后成痈，这是因为喜怒忧思有所郁结而成，治疗用远志酒、独胜散，兼以五志相胜的道理，如怒胜思之类。
不内外因方面，经书所谓膏粱之变，足生大疔，受邪如持虚器。又东方之地多盐，其民食委嗜咸，安其处，美其食，湿热中阻，咸胜血，所以其民黑色疏理，其病为痈疽。又有服用丹石法酒而致的，也属于膏粱之类。
李东垣说：膏粱之变，也是滋味过度，营气不顺，逆乱于肉里。营气者，即胃气也，饮食入胃，先输于脾，而朝于肺，肺朝百脉，次及皮毛，先行阳道，下归五脏六腑，而气口成寸了。现在富贵之人，不知节制，法酒肥羊，杂以浓味，积久太过，其气味俱浓之物，乃阳中之阳，不能走空窍而先行阳道，乃反行阴道，则湿气大胜，子令母实，火乃大旺，热湿既盛，必来克肾，若不慎房事，损其真水，水乏则从湿气之化而上行，其疮多出背上及脑，此为大疔之最重者。若毒瓦斯出肺，或脾胃之部分，毒之次也，若出于他经，又其次也，湿热之毒，所止处无不溃烂。所以经言膏粱之变，足生大疔，受如持虚者，如持虚器以受物，则无不受矣。治大疔之法，必当泻其营气。以标本言之，先受病为本，非苦寒之剂为主为君，不能除其苦楚痛疼也。如东垣治元好问，丹溪治老妇脑疽，皆因好酒，故以三黄大黄酒制治之。又如排脓散、当归散之类是也。
又有尽力房室，精虚气节之所致者，亦属不内外因，当以补虚内托为主，亦忌用五香之药耗真阴而助邪热，治之之药，如内固黄汤、神效托里散之类也。
经云：五脏菀热，痈发六腑。又云：六腑不和，留结为痈。又云：诸痛痒疮，皆属于心，肺乘肝则为痈，肾移寒于肝，痈肿少气，脾移寒于肝，痈肿筋挛，此皆脏腑之变亦属内因者也。
东垣说：《生气通天论》云，营气不从，逆于肉理，乃生痈肿。又云，膏粱之变，足生大疔，受如持虚。《阴阳应象论》云，地之湿气，感则害人皮肉筋脉，是言湿气外伤，则营气不行，营卫者，皆营气之所经营也，营气者胃气也，运气也，营气为本，本逆不行，为湿气所坏而为疮疡也。膏粱之变，亦是言浓滋味过度，而使营气逆行，凝于经络为疮疡也。此邪不在表亦不在里，唯在其经中道病也。以上《内经》所说，俱言因营气逆而作也，遍看诸疮疡论中，多言二热相搏，热化为脓者；有只言热化为脓者；有言湿气生疮，寒化为热而为脓者；此皆痈疽之源也。宜于所见部分，用引经药，并兼见证中分阴证阳证，先泻营气是其本，本逆助火，湿热相合，败坏肌肉而为脓血者，此治次也。宜远取诸物以比，一岁之中大热无过夏，当是时诸物皆不坏烂，坏烂者交秋湿令大行之时也，近取诸身，热病在身，止显热而不败坏肌肉，此理明矣。标本不得，邪气不服，言一而知百者，可以为上工矣。（《疡医准绳》）
又说：《灵枢经》云：营卫稽留于经脉之中，则血泣而不行，不行则卫气从之而不通，壅遏而不得行，故热，大热不止，热胜则肉腐，肉腐则为脓，然不能陷肌肤，骨髓不为焦枯，五脏不为伤，故名曰痈。热气淳盛，下陷肌肤，筋髓枯，内连五脏，血气竭，当其痈下筋骨，良肉皆无余，故命曰疽。疽者上之皮夭以坚，上如牛领之皮。痈者其皮上薄以泽，此其候也。
《鬼遗方》云：痈之痛，只在皮肤之上，其发如火焚茅，初如黍米大，三两日如掌面大，五七日如碗面大，即易治，如肿冷发渴发逆，治之难愈。疽发或如小疖，触则彻心痛，四边微起，如橘皮，孔色红赤不全变，脓水不甚出，至七八日，疼闷喘急不止，若始发肿，高五七日，忽平陷者，此内攻之候也。
又说：痈疽有三等，毒瓦斯浮浅属腑，毒瓦斯深沉属脏，毒瓦斯猛烈而行经络，或浅或深无定，五脏六腑皆受之毒，难为调理，唯宜急切于痈发诸处，不问虚实、高肿、起盛、光泽、疼痛，只在皮肤之上，热急胀满，或有痒疼，别无恶候，初用温药平气，次用排脓发穴。（治痈所谓平气者，犀角饮之类，其方用犀角、连翘、漏芦、甘草、当归、肉桂，皆发表之药也。所谓发穴者，乃棘针之类，用皂角刺为君，甘草、川芎、乳香为佐使，亦托里之药也，然不若洁古、东垣诸方发表托里为稳当。）
又说：疽发诸处，不拘大小，惟起在背，广一尺、二尺、三尺，皮浓而紫黑，高肿不常，内疼如锥刺，攻击满闷，应四肢重疼，前心亦痛，余处发犹可，唯虚处及近筋骨处，若脓毒未溃，即伤烂筋骨，肉损为疽者，属五脏毒瓦斯深沉，多气伏硬坚实而不宜缓慢，治之须内实五脏，外透皮肤，令软匀和，即脓透，宜用内托实脏气之药，排脓匀气乃可，不比痈之毒瓦斯浮浅也，毋作一类治之。
又说：凡一切疮肿，始觉患起高肿，五七日忽平陷者，此是内攻之候也，急以内托散及内补汤药补填脏腑令实，最怕透膜，膜穿十无一生矣。
娄全善说：痈之邪浅，其稽留壅遏，独在经络之中，而专攻于外。故初发时，自表便发热，患处便如碗如盆，高肿而痛，甚者纵欲下陷，得正气内固，不肯受，故或便秘，或发渴发逆以拒之，是以骨髓终不焦枯，五脏终不伤也。疽之邪深。其稽留壅遏，内连五脏，而不专攻于外，故身体无热，患处或不肿痛，甚者声嘶气脱，眼黑眼小，十指肿黑如墨，多死也。治之之法，痈之初发，当以洁古法为主，表者散之，里者下之，火以灸之，药以敷之，脓未成者必消，脓已成者速溃也。疽之初发，当以《鬼遗方》为主，补填脏腑令实，勿令下陷之邪蔓延，外以火灸，引邪透出，使有穴归着而不乱，则可转死回生，变凶为吉。今世外科，不分痈疽，一例宣热拔毒，外以五香耗其气，内以大黄竭其血，终不能自悟其用药之非，惜哉！
洁古说：疮疡者，火之属，须分内外。若其脉沉实，当先疏其内绝其源也。其脉浮大，当先托里，恐邪气入内也。有内外之中者，邪气至甚，遏绝经络，故发痈肿。经曰：营气不从，逆于肉里，乃生痈肿，此因失托里，及失疏通，又失和营卫也。治疮之大要，须明托里、疏通、行营卫三法：托里者，治其外之内；疏通者，治其内之外；行营卫者，治其中也。内之外者，其脉沉实，发热烦躁，外无赤痛甚，邪气深于内也。故先疏通脏腑，以绝其源。（内疏黄连汤。）外之内者，其脉浮数，肿在外，形证外显，恐邪气极而内行，故先托里，以防其干也。（内托复煎散。）内外之中者，外无恶之气，内亦脏腑宣通，知其在经，当和营卫也。（当归黄芪汤。）用此三法之后，虽未瘥，必无变证，亦可使邪气峻减而易痊也。
《三因》云：痈疽瘰疬，不问虚实寒热，皆由气郁而成。经曰：气宿于经络，与血俱涩而不行，壅结为痈疽。不言热之所作而后成痈者，此乃因喜怒忧思，有所郁而成也。《精要》云：痈疽，愤郁不遂志欲之人，多犯此疾。
张景岳说：凡疮疡之患，所因虽多，其要惟内、外二字。证候虽多，其要惟阴、阳二字。知此四者，则尽之矣。然内有由脏者，有由腑者，外有在皮肤者，有在筋骨者，此又其浅深之辨也。至其为病，则无非血气壅滞，营卫稽留之所致。盖凡以郁怒忧思，或淫欲丹毒之逆者，其逆在肝、脾、肺、肾，此出于脏而为内病之最甚者也。凡以饮食浓味，醇酒炙臛之壅者，其壅在胃，此出于腑，而为内病之稍次者也。又如以六气之外袭，寒暑之不调，侵入经络，伤人营卫，则凡寒滞之毒，其来徐，来徐者，其入深，多犯于筋骨之间，此表病之深者也。风热之毒，其来暴，来暴者，其入浅，多犯于皮肉之间，此表病之浅者也。何也？盖在脏在骨者，多阴毒，阴毒其甚也；在腑在肤者，多阳毒，阳毒其浅也。所以凡察疮疡者，当识痈疽之辨。痈者热壅于外，阳毒之气也，其肿高，其色赤，其痛甚，其皮薄而泽，其脓易化，其口易敛，其来速者，其愈亦速，此与脏腑无涉，故易治而易愈也。疽者结陷于内，阴毒之气也，其肿不高，其痛不甚，其色沉黑，或如牛领之皮，其来不骤，其愈最难，或全不知痛痒，甚有疮毒未形，而精神先困，七恶叠见者，此其毒将发而内先败，大危之候也。知其阴阳内外，则痈疡之概可类见矣。然此以外见者言之，但痈疡之发，原无定所，或在经络，或在脏腑，无不有阴阳之辨，若元气强则正胜邪，正胜邪则毒在腑，在腑者便是阳毒，故易发易收而易治；元气弱则邪胜正，邪胜正则毒在脏，在脏者便是阴毒，故难起难收而难治。此之难易，全在虚实，实者易而虚者难也，速者易而迟者难也。所以凡察痈疽者，当先察元气，以辨吉凶，故无论肿疡溃疡，但觉元气不足，必当先虑其何以收局，而不得不预为之地，万一见病治病，且顾目前，则鲜不致害也。其有元气本亏，而邪盛不能容补者，是必逆败之证，其有邪毒炽甚，而脉证俱实者，但当直攻其毒，则不得误补助邪，所当详辨也。（《全书》）
马益卿《痈疽论》说：人有四肢五脏，一觉一寐，呼吸吐纳，精气往来，流而为营卫，畅而为气色，发而为声音，阳用其形，阴用其精，此人之常数所同也。至其失也，蒸则生热，否则生寒，结则为瘤赘，陷则为痈疽。
Stagnation refers to the blockage of the meridians and collaterals, where Qi and Blood either overflow or condense. Over time, they seep out of the vessels, causing chaotic Qi movement; this is Yang stagnating in Yin. All diseases arise from this, not just carbuncles and ulcers. Therefore, when a carbuncle first appears, if it is painful and swollen, it is treatable; if it is painless, non-hot, swollen yet sunken, it is untreatable.
It is also said: Wearing heavy clothes but still feeling cold indicates solitary Yin without Yang to assist; wearing thin clothes but still feeling hot indicates solitary Yang existing alone. When Yang deficiency is extreme, Yang should be tonified; when Yin fluid deficiency is extreme, the Kidney should be nourished.
It is also said: Opisthotonos (back arching) and neck stiffness are signs of disease deterioration; trismus (lockjaw), chills, and teeth grinding indicate the approach of death.
Grand Master Dou said: The occurrence of back carbuncles results from toxic accumulation in the Zang and Fu organs. When Zheng Qi (Upright Qi) is strong, the toxin lingers and progresses slowly; when Yuan Qi (Original Qi) is deficient, the condition is lighter in the morning and heavier in the evening, like drawing a bowstring—small externally but large internally. Internal support therapy leads to survival, while merely draining toxicity leads to death. The treatment method centers on Ginseng Radix et Rhizoma (Renshen, 人参); this is an unchanging principle for all generations.
Whenever a carbuncle arises on the back, spanning one chi in width and reaching one cun in depth, even if it ulcerates to the bone, as long as it does not penetrate the membrane, death will not occur. (From *Quan Shu Jing Yan*)
Sun Simiao said: At critical sites of sores, especially near deficient areas or weak/thin tissues, careful medical treatment is required.
Yu Jiayan said: Once a sore has ulcerated, treatment should focus on greatly tonifying Qi and Blood.
He also said: Pain persisting after pus discharge is due to deficiency; excessive pus with failure to heal is due to weakness.
Wang Kentang said: Medical texts describe five sources of carbuncles and ulcers: 1. Epidemic Qi (Tian Xing Shi Qi); 2. Internal emotional stagnation (Qi Qing Nei Yu); 3. Exterior contraction due to body deficiency (Ti Xu Wai Gan); 4. Body heat clashing with wind-cold (Shen Re Bo Yu Feng Leng); 5. Heat toxins from consuming roasted foods, strong wine, or Dan Shi (cinnabar/stone pills). In summary, these fall under the Three Causes (San Yin).
Regarding exterior causes related to climatic factors (Yun Qi), there are four types:
First, Fire-Heat assisting the Heart to form sores. The Classics state: "What arrives at Shaoyin manifests as sores and rashes." Also: "When Shaoyin governs the year, Heat Qi descends, Lung Qi ascends in response; severely, sores and ulcers appear." Also: "In the political phase of Shaoyin governing, during the First Qi period, Cold begins, Yang Qi stagnates, and summer heat rises, causing internal and external sores." Also: "What arrives at Shaoyang manifests as sores." Also: "When Shaoyang governs, Wind-Heat distributes mixedly, Taiyin Dampness flows horizontally, Cold arrives on time, people suffer from interior cold and exterior sores." During the First Qi climate, it is very warm, causing sores in skin and pores; during the Second Qi, Fire reverses and stagnates, causing heat stagnation above and sores in the middle; during the Third Qi, summer heat arrives, causing people to suffer from pustular sores. Also: "When Taiyang governs, during the First Qi, the air becomes very warm, causing sores in muscles and pores." These are all shallow manifestations of normal transformations. Also: "When Shaoyin governs, if Heat dominates excessively, severely sores appear." Also: "When Shaoyin governs, if invading pathogens dominate severely, sores appear." Also: "The return of Shaoyin causes fei zhen sores, jiong yong acne, and hemorrhoids." Also: "Excessive Fire is called He Xi, causing sores, ulcers, and blood flow disorders." Also: "When Fire stagnates and erupts, people suffer from sores, ulcers, and swelling." This represents severe pathological changes.
Second, Cold Evil injuring the Heart to form sores. The Classics say: "During the Third Qi of Taiyang governance, Cold is prevalent, causing people to suffer from interior cold manifesting as heat, leading to carbuncles, ulcers, and diarrhea." Also: "When Taiyang governs, if Cold dominates excessively, blood changes within, leading to sores and ulcers, with the root in the Heart." Also: "During the Fourth Qi of Yangming governance, cold rain falls, causing people to suffer from carbuncles, swelling, and sores."
Third, Dryness Evil injuring the Liver to form sores. The Classics say: "Wood deficiency is called Wei He... branches develop carbuncles, swelling, and sores; this is evil injuring the Liver." Also: "When Yangming governs, if Dryness dominates excessively, people suffer from ulcers, acne, and sores, with the root in the Liver."
Fourth, Dampness Evil sores. The Classics say: "When Taiyin governs, Dampness transforms things; severely, sores appear on the posterior body." Also: "When Taiyin prevails, Fire Qi stagnates internally, causing sores within that spread outward." These four points refer to epidemic Qi.
In *Su Wen: Mai Yao Jing Wei Lun*, the Emperor asked: "How do various carbuncles, swelling, tendon spasms, and bone pain arise?" Qibo replied: "These are swellings caused by Cold Evil and variations of the Eight Winds." The Emperor asked: "How to treat them?" Qibo replied: "These are diseases of the four seasons; treat them using the controlling cycle to achieve cure."
*Ling Shu: Yong Ju Pian* states: Blood vessels, Ying Qi, and Wei Qi circulate ceaselessly, corresponding to stars above and numbers below. When Cold Evil lodges in the meridians, blood becomes viscous and stops flowing. Stagnation causes Wei Qi to gather there and not return, resulting in carbuncles. Cold transforms into Heat; excessive Heat rots flesh, which becomes pus. If pus is not drained, tendons rot; rotten tendons injure bones; injured bones cause marrow depletion. If not draining through bone apertures, blood dries up and empties, causing tendons, bones, muscles, and flesh to lose mutual nourishment. Meridians fail and leak, fuming into the Five Zang organs; organ injury leads to death.
*Sheng Qi Tong Tian Lun* states: Sweat from labor exposed to wind, with Cold pressing against it, forms fei hui (heat rash); stagnation leads to acne. It also states: "When Yang Qi's opening and closing functions fail, Cold enters, causing severe curvature (Da Lou)." When Ying Qi does not follow its course and rebels in the muscle tissue, carbuncles and swelling arise. This occurs because evil enters through gaps left by sweat and failed Yang Qi regulation, lingering to form carbuncles. This corresponds to body deficiency with exterior contraction, and body heat clashing with wind-cold. Treatment methods include releasing the exterior with formulas such as *Shi Xuan San*, *Wu Xiang Tang*, and Jiegu's *Cang Zhu Fu Jian San*.
Regarding internal causes, Chen Wuyue stated: Carbuncles, ulcers, and scrofula, regardless of deficiency/excess or cold/heat, all result from Qi stagnation. The Classics say: "Qi lodges in the meridians, moving sluggishly with blood, obstructing and knotting to form carbuncles and ulcers." It does not attribute them solely to Heat, but rather to emotional stagnation from anger, joy, worry, and thought. Treatment uses *Yuan Zhi Jiu* and *Du Sheng San*, incorporating the theory of the Five Emotions overcoming each other, such as Anger overcoming Thought.
Regarding non-interior/non-exterior causes, the Classics mention that dietary excesses lead to major ding sores, receiving evil as easily as holding an empty vessel. In eastern regions rich in salt, people consume salty foods, enjoying their dwellings and food, leading to interior heat and Salt overpowering Blood. Thus, their skin is dark and pores loose, prone to carbuncles and ulcers. Using Dan Shi and strong wine also falls into this category.
Li Dongyuan said: Dietary excesses also cause Ying Qi to stagnate and rebel in the muscle tissue. Ying Qi is Stomach Qi. Food entering the stomach is first transported to the Spleen, then directed to the Lungs. The Lungs direct Qi to all vessels, extending to skin and hair, proceeding via Yang pathways before returning to the Five Zang and Six Fu organs, forming the Cun position at the radial artery. Now, wealthy people lack moderation, consuming strong wine, fatty mutton, and rich flavors. Accumulated over time, these dense, pungent substances are "Yang within Yang." Instead of moving through orifices and Yang pathways, they move via Yin pathways, causing excessive Dampness. Following the generating cycle (Son strengthening Mother), Fire becomes vigorous. Excessive Heat and Dampness attack the Kidney. If sexual activity is not regulated, True Water is damaged. With insufficient Water, Dampness transforms and rises upward. Sores often appear on the back and head, constituting the most severe type of major Ding. If toxins exit via the Lungs or Spleen/Stomach regions, it is less severe; if via other channels, even less so. Wherever Heat-Damp toxins stop, ulceration occurs. Thus, the Classics say dietary excesses lead to major Ding, receiving evil like an empty vessel. To treat major Ding, one must drain Ying Qi. From the perspective of Root and Branch, the initial pathogenesis is the Root. Without bitter-cold agents as the sovereign drug, the painful suffering cannot be removed. For example, Li Dongyuan treated Yuan Haowen, and Danxi treated an old woman's brain carbuncle, both due to alcohol consumption, treating them with *San Huang Da Huang* prepared with wine. Similarly, *Pai Nong San* and *Dang Gui San* are used.
Another cause is excessive sexual activity leading to Essence deficiency and Qi exhaustion, belonging to non-interior/non-exterior causes. Treatment should focus on tonifying deficiency and internal support. Avoid *Wu Xiang* drugs that consume True Yin and aid pathogenic Heat. Medicines include *Nei Gu Huang Tang* and *Shen Xiao Tuo Li San*.
The Classics state: "Stagnant Heat in the Five Zang causes sores in the Six Fu organs." Also: "Disorder in the Six Fu organs leads to retention and knotting, forming sores." Also: "All pain, itching, and sores belong to the Heart." "Lung overcoming Liver causes sores; Kidney transferring Cold to Liver causes swelling and shortness of breath; Spleen transferring Cold to Liver causes swelling and tendon spasms." These are all Zang-Fu transformations belonging to internal causes.
Li Dongyuan cited *Sheng Qi Tong Tian Lun*: "Ying Qi not following its course, rebelling in muscle tissue, causes carbuncles." And "Dietary excesses lead to major Ding." And *Yin Yang Ying Xiang Lun*: "Earth's Dampness, when contracted, harms skin, flesh, tendons, and vessels." This means external Dampness impedes Ying Qi. Ying and Wei Qi are managed by Ying Qi. Ying Qi is Stomach Qi and transport Qi. Ying Qi is the Root. If the Root rebels and fails to move, damaged by Dampness, sores arise. Dietary excesses also cause Ying Qi to reverse and congeal in meridians, forming sores. This evil is neither in the exterior nor the interior, but in the middle of the meridians. All statements in *Nei Jing* attribute this to reversed Ying Qi. Reviewing various discussions on sores, some mention two heats clashing transforming into pus; some mention only Heat transforming into pus; some mention Dampness generating sores and Cold transforming into Heat to form pus. These are all sources of carbuncles and ulcers. One should use channel-guiding herbs for the affected area and distinguish Yin/Yang patterns. Draining Ying Qi is the primary treatment. If rebellion aids Fire, combining with Heat-Damp to destroy muscle into pus-blood, this is secondary treatment. Consider nature: Summer is the hottest, yet things do not rot then; rotting occurs when Autumn Dampness prevails. Considering the body: Heat diseases show heat but do not destroy muscle. This logic is clear. If Root and Branch do not match, evil will not subdue. One who knows one thing and understands a hundred can be a superior physician. (From *Yang Yi Zhun Sheng*)
It is also said: *Ling Shu Jing* states: "When Ying and Wei Qi linger in the meridians, blood becomes viscous and stops flowing. Stagnation causes Wei Qi to gather and obstruct, generating Heat. Persistent high Heat wins over flesh, rotting it into pus. However, if it cannot sink into muscles, scorch marrow, or injure the Five Zang, it is named 'Yong' (Carbuncle). If Heat Qi is pure and abundant, sinking into muscles, drying tendons and marrow, connecting internally to the Five Zang, exhausting Qi and Blood, destroying tendons, bones, and good flesh beneath the carbuncle, it is named 'Ju' (Ulcer/Gangrene). On Ju, the skin is dull and hard, resembling ox neck skin. On Yong, the skin is thin and glossy. These are their signs."
*Gui Yi Fang* states: Carbuncle pain is only on the skin surface. Its eruption is like burning thatch, starting like a millet grain, growing to palm size in 2-3 days, and bowl size in 5-7 days; thus easy to treat. If cold swelling, thirst, and rebellious Qi occur, it is difficult to cure. Ulcers may start like small boils; touching causes heart-piercing pain, edges slightly raised like orange peel, pore color red but incomplete, pus not much. By day 7-8, pain, oppression, and rapid breathing persist. If initially swollen and high, suddenly flattening by day 5-7, this is a sign of internal attack.
It also says: There are three grades of carbuncles and ulcers. Superficial toxins belong to Fu organs; deep toxins belong to Zang organs; fierce toxins travel through meridians, varying in depth, affecting all Zang and Fu. These are difficult to regulate. Urgently treat carbuncles appearing on the skin, regardless of deficiency/excess, high swelling, brightness, or pain, provided they are superficial, hot, distended, or itchy/painful without malignant signs. Initially use warm herbs to calm Qi, then use pus-draining and acupoint-opening methods. (Calming Qi for carbuncles involves *Xi Jiao Yin* using Rhino Horn, Forsythia, Agrimonia, Licorice, Angelica, and Cinnamon Twig—all releasing exterior herbs. Opening acupoints involves thorns, using Gleditsia Spine as sovereign, Licorice, Ligusticum, and Frankincense as assistants—also supporting interior herbs, though Jiegu and Li Dongyuan's releasing/supporting formulas are more stable.)
It also says: Ulcers arising anywhere, regardless of size, especially on the back spanning 1-3 chi, with thick purple-black skin, irregular high swelling, internal stabbing pain, chest oppression, heavy limb pain, and anterior chest pain. Eruptions elsewhere are tolerable, but those in deficient areas or near tendons/bones, if pus-toxin has not ulcerated, will damage tendons and bones. Muscle loss defines Ju, belonging to deep Zang toxins. Qi lies hidden, hard and firm; slowness is inadvisable. Treatment must solidify the Five Zang internally and penetrate the skin externally, making it soft and even, allowing pus to emerge. Use internal support herbs to solidify Zang Qi and harmonize Qi to drain pus. This differs from superficial carbuncle toxins; do not treat them identically.
It also says: For all swellings, if initially high and swollen but suddenly flattening by day 5-7, this is a sign of internal attack. Urgently use *Nei Tuo San* and internal tonifying decoctions to fill and solidify the Zang and Fu organs. Penetrating the membrane is most feared; once penetrated, ten cases yield no survivors.
Lou Quanshan said: Carbuncle evil is shallow, lingering and obstructing only in the meridians, attacking exclusively outward. Thus, upon onset, fever appears from the exterior, and the site swells high like a bowl or basin, painful. Even if tending to sink, upright Qi secures the interior, refusing acceptance, causing constipation, thirst, or rebellious Qi to resist. Thus, marrow never scorches, and Zang organs remain uninjured. Ulcer evil is deep, lingering and obstructing, connecting internally to the Five Zang, not attacking exclusively outward. Thus, the body has no fever, the site may not be painful or swollen; severely, hoarseness, Qi collapse, black/small eyes, and black swollen fingers occur, often leading to death. Treatment for early carbuncles follows Jiegu's method: release the exterior to scatter, purge the interior to descend, moxa to burn, apply herbs to cover. Unformed pus must resolve; formed pus must quickly rupture. Early ulcer treatment follows *Gui Yi Fang*: fill and solidify Zang and Fu, prevent sinking evil from spreading, moxa externally to draw evil out, providing a pathway for expulsion, turning death to life and disaster to auspiciousness. Modern surgeons fail to distinguish carbuncles from ulcers, uniformly clearing heat and extracting toxins, depleting Qi with external *Wu Xiang*, and exhausting Blood with internal Rhubarb. They never realize their error; what a pity!
Jiegu said: Sores and ulcers belong to Fire and must be distinguished internally and externally. If the pulse is deep and solid, first dredge the interior to cut off the source. If the pulse is floating and large, first support the interior to fear evil entering inward. For those in between, evil is extreme, blocking meridians, causing carbuncles. The Classics state: "Ying Qi not following its course, rebelling in muscle tissue, causes carbuncles." This results from failing to support the interior, failing to dredge, and failing to harmonize Ying and Wei. The key to treating sores requires understanding three methods: Supporting Interior, Dredging, and Moving Ying-Wei. Supporting Interior treats exterior-to-interior; Dredging treats interior-to-exterior; Moving Ying-Wei treats the middle. Interior-to-exterior presents with deep-solid pulse, fever, irritability, no severe exterior redness/pain, indicating deep interior evil. Thus, first dredge Zang-Fu to cut the source (*Nei Shu Huang Lian Tang*). Exterior-to-interior presents with floating-rapid pulse, swelling outside, obvious exterior signs, fearing extreme evil moving inward. Thus, first support interior to prevent invasion (*Nei Tuo Fu Jian San*). Middle-of-interior-and-exterior presents with no malignant exterior Qi and smooth interior Zang-Fu, knowing the evil is in the meridians, requiring harmonizing Ying-Wei (*Dang Gui Huang Qi Tang*). After using these three methods, even if not cured, complications will not arise, and evil will diminish significantly for easier recovery.
*San Yin Fang Lun* states: Carbuncles, ulcers, and scrofula, regardless of deficiency/excess or cold/heat, all result from Qi stagnation. The Classics say: "Qi lodges in meridians, moving sluggishly with blood, obstructing and knotting to form carbuncles and ulcers." It does not attribute them solely to Heat, but to emotional stagnation from anger, joy, worry, and thought. *Jing Yao* states: People frustrated and unfulfilled in desires often suffer from carbuncles and ulcers.
Zhang Jingyue said: Although causes of sores are many, the essence lies in Interior and Exterior. Although symptoms are many, the essence lies in Yin and Yang. Knowing these four covers everything. Internally, some arise from Zang, some from Fu. Externally, some are in skin, some in tendons/bones; this distinguishes depth. Pathologically, all result from Qi-Blood obstruction and Ying-Wei lingering. Emotional anger/worry or lust/Dan Du rebellion affects Liver, Spleen, Lung, Kidney—originating from Zang, being the most severe internal disease. Dietary rich flavors, strong wine, and roasted meats obstruct the Stomach—originating from Fu, being slightly less severe internal disease. External invasion of Six Qi, imbalance of Cold/Heat, penetrating meridians and harming Ying-Wei: Cold stagnation comes slowly, entering deeply, often affecting tendons/bones (deep exterior disease). Wind-Heat comes violently, entering shallowly, often affecting skin/flesh (shallow exterior disease). Why? Zang/Bone involve mostly Yin-Toxin (severe); Fu/Skin involve mostly Yang-Toxin (shallow). Thus, examining sores requires distinguishing carbuncles from ulcers. Carbuncles: Heat obstructed externally, Yang-Toxin Qi. Swelling is high, color red, pain severe, skin thin and glossy, pus easy to liquefy, wound easy to close, onset fast, healing fast. Unrelated to Zang-Fu, thus easy to treat and heal. Ulcers: Knotting and sinking internally, Yin-Toxin Qi. Swelling not high, pain not severe, color dark/black, skin like ox neck, onset not sudden, healing hardest. May feel no pain/itching; even before toxin forms, spirit is exhausted, Seven Evils appear. This indicates toxin emerging while interior fails first—a critical danger. Knowing Yin/Yang and Interior/Exterior allows categorizing sores. Speaking of external manifestations, sores have no fixed location, possibly in meridians or Zang-Fu, all having Yin/Yang distinction. If Original Qi is strong, Upright defeats Evil; Evil in Fu is Yang-Toxin, easy to emit, collect, and treat. If Original Qi is weak, Evil defeats Upright; Evil in Zang is Yin-Toxin, hard to rise, collect, and treat. Difficulty depends on Deficiency/Excess: Excess is easy, Deficiency is hard; Fast is easy, Slow is hard. Thus, examining carbuncles/ulcers requires assessing Original Qi to judge fortune/misfortune. Regardless of pre-ulcer or post-ulcer stages, if Original Qi feels insufficient, one must anticipate the outcome and prepare in advance. Treating disease only when seen, focusing only on the present, rarely avoids harm. If Original Qi is fundamentally deficient but Evil is too strong to tolerate tonification, it is a rebellious/destructive pattern. If Evil-Toxin is blazing and pulse/symptoms are full, directly attack the toxin, avoiding mistakenly aiding Evil with tonification. Careful differentiation is required. (From *Quan Shu*)
Ma Yiqing's *Yong Ju Lun* states: Humans have four limbs and five Zang organs, waking and sleeping, breathing and exchanging Qi, Jing-Qi flowing as Ying-Wei, flourishing as Qi-color, emitting as voice. Yang uses Form, Yin uses Essence; this is the constant shared by humans. When deviation occurs, steaming generates Heat, cooling generates Cold. Knotting forms tumors/lumps, sinking forms carbuncles and ulcers.