程山龄曰∶或问痈疽五善七恶，何谓也？答曰∶五善者，饮食知味，一也；便
溺调匀，二也；脓溃肿消，脓水不臭，三也；神气清爽，动息自宁，四也；脉息有
神，不违时令，五也。七恶者，大渴发热，泄泻淋闭，一也；脓溃仍肿，脓水臭秽，二
也；目睛无神，语声不亮，三也；食少不化，服药作呕，四也；恍惚嗜卧，气短乏
力，背如负石，五也；唇青鼻黑，面目浮肿，六也；脉息无神，或躁动不和，七也。
古语云∶五善得三则吉，七恶得四则凶，不待四矣。然而急救之法，正不容以不讲，大
抵热渴淋闭，喘急内热，皆真阴受伤；宜用六味汤加麦冬、五味，如不应，用八珍
汤加麦冬、五味，更不应，用十全大补汤，兼服六味地黄丸，此补阳生阴之说也。若
气促倦怠，昏愦乏力，饮食不化，乃阳虚之候，宜用补中益气汤；若睡卧不宁，宜
用归脾汤；若饮食减少，面目浮肿，宜用香砂六君子汤；若兼脾胃虚寒，更用理中
汤；肾气虚寒，须用桂附八味丸，兼用十全大补汤加附子；此温补回阳之法也。若
痈疽溃后，脓血太多，变为角弓反张，手足搐搦，肢体振摇而发痈者，急宜用参、 、
归、术、附子等药以救之；如不应，用十全大补汤，间有可生者。当此时势，性命
急如悬缕，司命者，宜叮咛反复，熟思而审处之耳。（《十法》）
蒋示吉曰∶五善七恶，方书俱载，然亦不止于此也。如脓成不自出，失导引者
死。脓成不针烙，反敷药者死。热痛正甚，失治则毒内攻者死。毒内攻后，不服药，反
针烙者死。溃而至于透内膜者死。遗喉者死。未溃而陷，面青唇黑，便污者死。阴
入腹、入囊者死。高肿不托里，反用下药者死。漫肿不内托，反用寒凉攻利者死。溃
后，误用寒凉，致疮紫黑者死。溃后误用辛散，发 者死，穿膜穿腮者死。上蚀鼻
梁，下穿咽喉者死。故治者不可不早，亦不可不审也。（《说约》）
李东垣曰∶大抵证候，疮疽之后，虚中见恶证者，不可救也；实证无恶候者，自
愈。大凡脓溃之后，而烦疼尚未痊者，诊其脉，洪滑粗散者，难疗，微涩迟缓者，易
痊，此善恶之证于诊候之中，亦可知矣。发背脑疽及诸恶疮，则有五逆之证者，白睛
青黑而眼小，服药而呕，伤痛渴甚，膊项中不便，音嘶色败者是为五逆。其余热渴
痢呕，盖毒瓦斯入里，脏腑之伤也，当随证以治之。（《十书》）
薛立斋曰∶夫疮疡之证，有五善，有七恶，五善见三则瘥，七恶见四则危。夫
善者，动息自宁，饮食知味，二便调匀，脓溃肿消，脓鲜不臭，神彩精明，语声清朗，
体气和平是也；此属腑证，病微邪浅，更能慎起居，节饮食，勿药自愈。恶者，乃
五脏亏损之证，多因元气虚弱，或因脓水出多，气血亏损；或因汗下失宜，营卫消
烁；或因寒凉克伐，气血不足；或因峻厉之剂，胃气受伤；以致真气虚而邪气实，外
似有余而内实不足，法当纯补胃气，多有可生，不可因其恶，遂弃而不治。若大渴
发热，或泄泻淋闭者，邪火内淫，一恶也；竹叶黄 汤；气血俱虚，八珍汤加黄 、麦
冬、五味、山萸；如不应，佐以加减八味丸，煎服。脓血既泄，肿痛尤甚，脓色败
臭者，胃气虚而火盛，二恶也，人参黄 汤；如不应，用十全大补汤加麦冬、五味。
目视不正，黑睛紧小，白睛青赤，瞳子上视者，肝肾阴虚而目系急，三恶也，六味
丸料再加炒山栀、麦冬、五味；如不应，用八珍汤加炒山栀、麦冬、五味。喘粗短气，
恍惚嗜卧者，脾肺虚火，四恶也，六君子汤加大枣、生姜；如不应，用补中益气汤
加麦冬、五味；心火刑克肺金，人参平肺散；阴火伤肺，六味丸加五味，煎服。肩
背不便，四肢沉重者，脾肾亏损，五恶也，补中益气汤加山药、山萸、五味；如不应，
用十全大补汤加山茱萸、山药、五味。不能下食，服药而呕，食不知味者，胃气虚，
六恶也，六君子汤加木香、砂仁；如不应，急加附子。声嘶色败，唇鼻青赤，面目四
肢浮肿者，脾胃俱虚，七恶也，补中益气汤加大枣，生姜；如不应，用六君子汤加
炮姜；更不应，急加附子，或用十全大补汤加附子、炮姜。腹痛泄泻，咳逆昏愦者，
阳气虚，寒气内淫之恶证也，急用托里温中汤，后用六君子汤加附子，或加姜桂温
补，此七恶之治法也。此外，更有溃后发热恶寒，作渴或怔忡惊悸，寤寐不宁，牙
关紧急，或头目赤痛，自汗盗汗，寒战切牙，手撒身热，脉洪大，按之如无，或身
热恶衣，欲投于水，其脉浮大，按之微细，衣浓仍寒，此气血虚极传变之恶证也。若
手足逆冷，肚腹疼痛，泄利肠鸣，饮食不入，呃逆呕吐，此阳气虚，寒气所乘之恶
证也。若有汗而不恶寒，或无汗而恶寒，口禁足冷，腰背反张，颈项劲强，此血气虚
极变痉之恶候也，急用参、 、归、术、附子救之，间有可生者。大抵虚中见恶证者
难治，实证无恶候者易治。宋时齐院令虽尝纂其状，而未具其因；陶节庵虽各立一
方，亦简而未悉，余故补其缺云。
胡公弼曰∶痈有证合七恶，皮紧急而知善，气足而血未附也，疽有证合五善，皮
缓虚而知恶，血附而气未充也。
程山龄说：有人问，痈疽病的“五善”和“七恶”，具体指什么？回答说：“五善”是指：饮食能知滋味，这是第一善；大小便调和均匀，这是第二善；脓液排出后肿胀消退，脓水没有臭味，这是第三善；精神清爽，动静休息自然安宁，这是第四善；脉搏有神气，不违背时令规律，这是第五善。“七恶”是指：极度口渴、发热、腹泻、小便淋沥或闭塞不通，这是第一恶；脓液排出后肿胀依然不退，脓水臭秽，这是第二恶；眼睛目光无神，说话声音不响亮，这是第三恶；进食少且消化不良，服药后发生呕吐，这是第四恶；神情恍惚、嗜睡懒卧，气短乏力，背部感觉像背着石头一样沉重，这是第五恶；嘴唇发青、鼻头发黑，面部和眼部浮肿，这是第六恶；脉搏无神气，或者躁动不安、节律不和，这是第七恶。古语说：“五善”证候中出现三条就算吉利，“七恶”证候中出现四条就算凶险，不需要等到全部出现。然而急救的方法，正是不容许不去研究的。大抵上，热渴、小便淋闭、气喘急促、体内发热，都是真阴受损的表现；适宜使用六味地黄汤（六味丸组成的汤剂）加入麦冬、五味子，如果无效，使用八珍汤加入麦冬、五味子，再无效，使用十全大补汤，同时服用六味地黄丸，这是通过补益阳气以滋生阴液的学说。如果是气促倦怠、昏沉困倦、乏力、饮食不消化，这是阳虚的征候，适宜使用补中益气汤；如果是睡眠卧躺不安宁，适宜使用归脾汤；如果是饮食减少、面部和眼部浮肿，适宜使用香砂六君子汤；如果兼有脾胃虚寒，更要使用理中汤；肾气虚寒，必须使用桂附八味丸，同时服用十全大补汤加入附子；这是温补回阳的方法。如果是痈疽溃破后，脓血太多，转变为角弓反张（身体向后弯曲如弓状）、手足抽搐、肢体震颤摇动而发作痈疽的，急需用人参、黄芪、当归、白术、附子等药物来抢救；如果无效，使用十全大补汤，偶尔有能够存活的。正当这个时候，性命危急如同悬挂在细线上，掌握人命的主治医生，应该反复叮咛，深思熟虑并审慎处理。（出自《十法》）
蒋示吉说：“五善”和“七恶”，医方书籍中都记载了，但也不仅仅只有这些情况。例如：脓已形成但不自行流出，失去导引排脓机会的会死。脓已成但不进行针刺烙烫，反而敷贴药物的会死。热痛正剧烈时，失于治疗导致毒邪内攻的会死。毒邪内攻之后，不服药，反而进行针刺烙烫的会死。溃烂以至于穿透内膜的会死。疮毒遗留在喉部的会死。未溃破而陷伏在内，面色青、嘴唇黑，大便污浊的会死。阴部疮毒侵入腹部、阴囊的会死。高肿而不使用托里透脓法，反而使用泻下药物的会死。漫肿而不使用内托法，反而使用寒凉攻下利导药物的会死。溃破后，误用寒凉药物，导致疮面紫黑色的会死。溃破后误用辛散药物，导致发出斑疹的会死，穿透肌肉脸颊的会死。向上侵蚀鼻梁，向下穿透咽喉的会死。所以治疗者不可不早做打算，也不可不用心审慎。（出自《说约》）
李东垣说：大抵病情证候，在疮疽之后，虚证中见到恶证的，无法救治；实证中没有恶候的，自然会痊愈。大凡脓液溃破之后，烦痛尚未痊愈的，诊察其脉象，洪大滑数粗散乱的，难治，微涩迟缓的，容易痊愈，这善恶的证候在诊察脉候之中，也可以知道了。发背疽、脑疽以及各种恶疮，如果有“五逆”的证候，即白眼球部分呈现青黑色且眼裂变小，服药后呕吐，伤痛严重且极度口渴，肩膊颈部活动不便，声音嘶哑、面色败坏的，这就称为“五逆”。其余的热渴、痢疾、呕吐，大概是毒瓦斯进入体内，损伤脏腑，应当根据证候来治疗。（出自《十书》）
薛立斋说：疮疡的病证，有“五善”，有“七恶”，“五善”见到三条就会痊愈，“七恶”见到四条就会危险。所谓“善”，是指动静休息自然安宁，饮食能知滋味，二便调和均匀，脓液排出后肿胀消退，脓液新鲜没有臭味，神采精明，说话声音清朗，体质气息平和；这属于腑证，病邪轻微浅表，如果能谨慎起居，节制饮食，甚至不用药也能自愈。“恶”，乃是五脏亏损的证候，多因为元气虚弱，或者因为脓水流出过多，气血亏损；或者因为发汗、泻下不当，营卫之气消减耗损；或者因为寒凉药物克伐损伤，气血不足；或者因为峻猛严厉的药剂，胃气受伤；导致真气虚弱而邪气实盛，外表看似有余而内部实在不足，治法应当纯粹补益胃气，大多有存活的可能，不能因为其表现为恶证，就放弃不治疗。如果是极度口渴发热，或者腹泻、小便淋闭的，是邪火内淫，属于第一恶，用竹叶黄芪汤；气血俱虚的，用八珍汤加入黄芪、麦冬、五味子、山茱萸；如果无效，佐以加减八味丸，煎服。脓血已经排泄，肿痛尤其严重，脓色败坏发臭的，是胃气虚而火气盛，属于第二恶，用人参黄芪汤；如果无效，用十全大补汤加入麦冬、五味子。眼睛注视不正，黑眼球紧缩变小，白眼球青赤色，瞳仁向上看的，是肝肾阴虚而目系紧急，属于第三恶，用六味地黄丸的药料再加炒山栀、麦冬、五味子；如果无效，用八珍汤加入炒山栀、麦冬、五味子。呼吸喘促粗重、气短，神情恍惚、嗜睡的，是脾肺虚火，属于第四恶，用六君子汤加大枣、生姜；如果无效，用补中益气汤加入麦冬、五味子；如果是心火刑克肺金，用人参平肺散；如果是阴火伤肺，用六味地黄丸加五味子，煎服。肩背不便、四肢沉重的，是脾肾亏损，属于第五恶，用补中益气汤加入山药、山茱萸、五味子；如果无效，用十全大补汤加入山茱萸、山药、五味子。不能进食，服药后呕吐，吃东西不知滋味的，是胃气虚，属于第六恶，用六君子汤加入木香、砂仁；如果无效，急加附子。声音嘶哑、面色败坏、嘴唇鼻子青赤、面部四肢浮肿的，是脾胃俱虚，属于第七恶，用补中益气汤加大枣、生姜；如果无效，用六君子汤加入炮姜；再无效，急加附子，或者用十全大补汤加入附子、炮姜。腹痛腹泻、咳嗽气逆、昏沉困倦的，是阳气虚，寒气内侵的恶证，急用托里温中汤，后用六君子汤加入附子，或者加入干姜、肉桂温补，这是七恶的治疗方法。此外，更有溃破后发热恶寒，口渴或者心悸惊悸，醒着睡着都不安宁，牙关紧急，或者头目红赤疼痛，自汗盗汗，寒战咬牙，手撒开身体发热，脉象洪大，按下去却好像没有，或者身体热厌恶穿衣，想要投入水中，脉象浮大，按下去微细，衣服穿得厚仍然觉得寒冷，这是气血极度虚弱传变而成的恶证。如果是手脚逆冷，肚腹疼痛，腹泻肠鸣，饮食不进，呃逆呕吐，这是阳气虚，寒气乘袭的恶证。如果有汗但不恶寒，或者无汗而恶寒，口噤脚冷，腰背反张，颈项僵硬强直，这是血气极度虚弱变为痉病的恶候，急用人参、黄芪、当归、白术、附子来抢救，偶尔有存活的可能。大抵虚证中见到恶证的难治，实证中没有恶候的易治。宋代齐院令虽然曾经编纂了这些症状，但没有详尽其原因；陶节庵虽然各自设立一方，也简略而不详尽，所以我补充其中的缺漏。（出自《薛氏医案》相关论述）
胡公弼说：痈证符合七恶表现，但皮肤紧张而知道预后尚好，是因为气足而血尚未依附；疽证符合五善表现，但皮肤松弛虚弱而知道预后不良，是因为血已依附而气尚未充盈。
Cheng Shanling said: Someone asked, what are the "Five Goods" and "Seven Evils" in carbuncles and sores? The answer is: The "Five Goods" refer to: being able to taste food and drink, which is the first good; regular and balanced urination and defecation, which is the second good; after pus drains and swelling subsides, with no foul odor in the discharge, which is the third good; clear spirit, with natural calmness in movement and rest, which is the fourth good; a pulse that shows vitality and does not contradict the seasonal patterns, which is the fifth good. The "Seven Evils" refer to: extreme thirst, fever, diarrhea, and dysuria or urinary retention, which is the first evil; swelling persists despite pus drainage, with foul-smelling discharge, which is the second evil; eyes lack spirit, voice is hoarse or weak, which is the third evil; poor appetite with indigestion, vomiting after taking medicine, which is the fourth evil; mental confusion, drowsiness, shortness of breath, fatigue, and a sensation of heaviness on the back as if carrying a stone, which is the fifth evil; cyanotic lips, black nose, and edema of the face and eyes, which is the sixth evil; a pulse lacking vitality, or restless and irregular, which is the seventh evil. Ancient sayings state: "If three of the Five Goods are present, it is auspicious; if four of the Seven Evils are present, it is ominous," without needing all signs to appear. However, emergency rescue methods must be studied. Generally, heat-thirst, dysuria, rapid breathing, and internal heat indicate damage to True Yin (Zhen Yin); Liuwei Tang (Six-Ingredient Decoction) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) is suitable. If ineffective, Bazhen Tang (Eight-Treasure Decoction) added with Maidong and Wuweizi should be used. If still ineffective, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be used, along with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). This follows the theory of tonifying Yang to generate Yin. If there is shortness of breath, fatigue, lethargy, weakness, and indigestion, this indicates Yang Deficiency (Yang Xu); Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable. If sleep is restless, Guipi Tang (Restore the Spleen Decoction) is suitable. If appetite is reduced with facial and ocular edema, Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) is suitable. If accompanied by Spleen-Stomach Cold-Deficiency (Pi Wei Xu Han), Lizhong Tang (Regulate the Middle Decoction) should be used. For Kidney Qi Cold-Deficiency (Shen Qi Xu Han), Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill) is required, along with Shiquan Dabu Tang added with Fuzi (Aconiti Lateralis Radix Praeparata); this is the method of warming and tonifying to restore Yang. If after carbuncle/sores ulcerate, excessive pus and blood lead to opisthotonos (body bent backward like a bow), convulsions of hands and feet, and trembling limbs, Shen (Ginseng), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuzi should be urgently used for rescue. If ineffective, Shiquan Dabu Tang may be tried, with occasional survival. At such critical moments, when life hangs by a thread, physicians must deliberate carefully and handle the case prudently. (From *Shifa*)
Jiang Shiji said: The "Five Goods" and "Seven Evils" are recorded in medical texts, but they do not cover all cases. For instance: death occurs if pus forms but does not drain spontaneously due to missed guidance/drainage; death occurs if puncture/cauterization is not performed for formed pus, but only topical applications are used; death occurs if severe heat and pain are untreated, leading to internal attack of toxins; death occurs if, after internal toxin attack, medicine is not taken but puncture/cauterization is used instead; death occurs if ulceration penetrates internal membranes; death occurs if the sore remains in the throat; death occurs if un-ulcerated sores sink inward with cyanotic face, black lips, and foul stool; death occurs if yin-area sores invade the abdomen or scrotum; death occurs if high swelling is treated with purgatives instead of interior-supporting methods; death occurs if diffuse swelling is treated with cold-cooling purgatives instead of interior-supporting methods; death occurs if cold-cooling herbs are mistakenly used after ulceration, turning the sore purple-black; death occurs if acrid-dispersing herbs are mistakenly used after ulceration, causing rashes or perforation of flesh/cheeks; death occurs if erosion goes up to the nasal bridge or down through the pharynx. Therefore, treatment must be timely and prudent. (From *Shuoyue*)
Li Dongyuan said: Generally, post-carbuncle/sores conditions showing Evil signs within Deficiency patterns are incurable; Excess patterns without Evil signs will heal spontaneously. After pus drainage, if pain and vexation persist, a Hong-Hua-Cu-San (surging, slippery, coarse, scattered) pulse indicates difficult treatment, while a Wei-Se-Chi-Huan (slight, choppy, slow, delayed) pulse indicates easy recovery. Thus, Good/Evil signs can be known through pulse diagnosis. For Back Carbuncles, Brain Sores, and other malignant sores, the "Five Reversals" include: white sclera appearing blue/black with small palpebral fissures, vomiting after taking medicine, severe pain with extreme thirst, stiffness/inconvenience in shoulders/neck, hoarseness, and deteriorated complexion. Other symptoms like heat-thirst, dysentery, and vomiting suggest toxins entering the interior and damaging Zang-Fu organs, requiring treatment based on specific signs. (From *Shishu*)
Xue Lizhai said: Carbuncle/sores conditions have "Five Goods" and "Seven Evils." Three Goods indicate recovery; four Evils indicate danger. "Goods" include: calm movement/rest, tasty appetite, balanced excretion, resolved swelling after pus drainage, fresh non-foul pus, bright spirit, clear voice, and harmonious constitution. These belong to Fu-organ patterns, with mild/shallow pathogens; with careful lifestyle and diet, self-healing may occur without medicine. "Evils" are Zang-organ deficiency patterns, often due to Yuan Qi weakness, excessive pus loss depleting Qi/Blood, improper sweating/purging damaging Ying-Wei, cold herbs injuring Qi/Blood, or harsh drugs damaging Stomach Qi. This results in True Qi deficiency and Pathogenic Excess, appearing externally full but internally empty. Treatment should purely tonify Stomach Qi, offering hope for survival; one should not abandon treatment due to Evil signs.
1. Extreme thirst/fever or diarrhea/dysuria indicates Internal Flaming Fire (First Evil): Zhuye Huangqi Tang. For Qi/Blood dual deficiency, Bazhen Tang added with Huangqi, Maidong, Wuweizi, Shanzhuyu. If ineffective, Jiajian Bawei Wan.
2. Severe swelling/pain after pus/blood drainage, foul敗 pus indicates Stomach Qi deficiency with Fire Excess (Second Evil): Renshen Huangqi Tang. If ineffective, Shiquan Dabu Tang added with Maidong, Wuweizi.
3. Misaligned gaze, constricted pupil, blue/red sclera, upward-looking pupil indicates Liver/Kidney Yin Deficiency with tight eye meridians (Third Evil): Liuwei Wan material added with Chao Zhizi, Maidong, Wuweizi. If ineffective, Bazhen Tang added with Chao Zhizi, Maidong, Wuweizi.
4. Rapid breathing, shortness of breath, confusion, drowsiness indicates Spleen/Lung Deficient Fire (Fourth Evil): Liujunzi Tang added with Dazao, Shengjiang. If ineffective, Buzhong Yiqi Tang added with Maidong, Wuweizi. For Heart Fire attacking Lung Metal, Renping Feisan; for Yin Fire damaging Lung, Liuwei Wan added with Wuweizi.
5. Shoulder/back stiffness, heavy limbs indicates Spleen/Kidney Deficiency (Fifth Evil): Buzhong Yiqi Tang added with Shanyao, Shanzhuyu, Wuweizi. If ineffective, Shiquan Dabu Tang added with Shanzhuyu, Shanyao, Wuweizi.
6. Inability to eat, vomiting after medicine, loss of taste indicates Stomach Qi Deficiency (Sixth Evil): Liujunzi Tang added with Muxiang, Sharen. If ineffective, urgently add Fuzi.
7. Hoarse voice, deteriorated complexion, cyanotic/red lips/nose, edema of face/limbs indicates Spleen/Stomach Dual Deficiency (Seventh Evil): Buzhong Yiqi Tang added with Dazao, Shengjiang. If ineffective, Liujunzi Tang added with Paojiang. If still ineffective, urgently add Fuzi, or use Shiquan Dabu Tang added with Fuzi, Paojiang. Abdominal pain, diarrhea, cough, reversal of Qi, lethargy indicates Yang Qi Deficiency with Internal Cold Invasion (Evil Syndrome): Urgently use Tuoli Wenzhong Tang, followed by Liujunzi Tang added with Fuzi, or Jiang/Gui for warming tonification. This covers the treatment of the Seven Evils.
Additionally, post-ulceration fever/chills, thirst, palpitations, insomnia, trismus, red/painful head/eyes, spontaneous/night sweats, chattering teeth, flaccid hands, body heat with surging-but-empty pulse, or aversion to clothing/thirst for water with floating-large-but-microscopic pulse, or feeling cold despite thick clothing, indicates extreme Qi/Blood deficiency transforming into Evil. Cold extremities, abdominal pain, diarrhea/borborygmus, inability to eat, hiccups/vomiting indicate Yang Deficiency with Cold invasion. Sweating without chills, or no sweating with chills, locked jaw, cold feet, opisthotonos, stiff neck indicate extreme Qi/Blood deficiency transforming into Spasm (Jing). Urgently use Shen, Huangqi, Danggui, Baizhu, Fuzi for rescue; occasional survival is possible. Generally, Evil signs in Deficiency are hard to treat; Excess without Evil signs are easy. Song dynasty Qi Yuanling compiled symptoms but lacked causes; Tao Jian'an set formulas but was incomplete. I thus supplement these deficiencies.
Hu Gongbi said: Carbuncles matching Seven Evils but with tight skin indicate Good prognosis because Qi is sufficient though Blood has not yet attached. Sores matching Five Goods but with loose/weak skin indicate Evil prognosis because Blood has attached but Qi is insufficient.