申斗垣曰∶首疽，生于耳傍 脉、翳风二穴，乃手少阳三焦经多气少血，憎寒
壮热发渴。七八日可刺。脓水黄白色可治；如黑稀水发渴及两左右双疽者死。此毒之
甚者也。（《启玄》）
\r首疽\p04-a41a80.bmp\r
\r杼疽\p04-a41a81.bmp\r
《鬼遗方》曰∶杼疽发发中须内及两耳。不穴十五日死；可刺其脓，色黑如豆豉，或见血者死。
王肯堂曰∶杼疽生颈上两耳后，初不甚肿，但痛痒不时，而出清水，渐渐长大
如玳瑁斑点者是也。亦名化骨疮。若过时溃烂，日久出骨者大恶之证。此证多生于
积郁之人，七恶多见，犯禁者不治。（《准绳》）
申斗垣曰∶杼疽，乃手少阳三焦经多气少血，生于耳下天牖、翳风二穴之旁，六
七日可刺。若对脐有疮，初出不肿，俱有燎浆，泡渐长大，蚀肉溃脓，先从脚后跟
如玳瑁斑点，名曰羡疮，又名化骨疮。有骨出，乃肺败也，甚恶。（《启玄》）
王肯堂曰∶月蚀疳疮，生小儿耳窍之旁，虽曰指月而生，恐未必然。大抵风湿
热毒成疳耳。（《准绳》）
冯鲁瞻曰∶若风湿相搏则生耳疮。更有以手指月，遂使两耳之后生疮者，名曰
月蚀疮。及冻耳、虫伤、拨损之类外因者，并从外治。（《锦囊》）
周文采曰∶月蚀疮生于两耳鼻面，烂及下部诸窍，浸入筋络。月中则疮盛，月
末则疮衰，以其随月盈亏故名。（《集验》）
《心法》曰∶月蚀疮，又名旋耳疮，生于耳后缝间，延及耳折上下，如刀裂之状，
色红时流津黄水。由胆脾湿热所致。
\r月蚀疳疮\p04-a41a82.bmp\r
申斗垣说：首疽，生长在耳旁的脉门穴和翳风穴处，属于手少阳三焦经（多气少血之经），症状表现为憎寒、壮热、口渴。发病七八天可以刺破排脓；如果脓水呈黄白色，尚可治疗；如果是黑色稀水、口渴严重以及左右两侧同时生疽的，则预后不良，属死证。这是毒邪极盛的表现。（出自《启玄》）
杼疽
《鬼遗方》说：杼疽发生在发际内部及两耳后方。如果不进行针刺放脓，十五天后会死亡；如果能刺出脓液，但颜色黑如豆豉，或者流出血液的，也是死证。
王肯堂说：杼疽生在颈上部两耳后方，起初肿胀不明显，只是不时感到疼痛和瘙痒，流出清水，逐渐长大，像玳瑁斑点一样的就是此病。也叫做化骨疮。如果过时溃烂，日久排出骨头的，是大凶恶的证候。这种证候多生于长期情绪抑郁的人身上，容易出现“七恶”（中医外科危重征象），如果违反禁忌治疗的，无法治愈。（出自《准绳》）
申斗垣说：杼疽，属于手少阳三焦经（多气少血之经），生长在耳下天牖穴、翳风穴旁边的位置，六七天可以刺破排脓。如果对脐部也有疮疡，初起不肿，都伴有燎浆水泡，逐渐长大，腐蚀肌肉溃烂流脓，先从脚后跟出现像玳瑁斑点的，名叫羡疮，也叫化骨疮。如果有骨头排出，说明肺脏败坏，非常凶险。（出自《启玄》）
王肯堂说：月蚀疳疮，生长在小儿耳窍旁边，虽然说是随着月亮盈亏而生，恐怕未必如此。大抵是由于风湿热毒积聚而成疳疮罢了。（出自《准绳》）
冯鲁瞻说：如果是风湿相互搏结，就会生耳疮。更有因为用手指指月亮，导致两耳后面生疮的，名叫月蚀疮。还有冻伤耳朵、虫咬损伤、拨弄损伤等外因引起的，都从外部进行治疗。（出自《锦囊》）
周文采说：月蚀疮生在两耳、鼻子和面部，腐烂波及下部各个孔窍，侵入筋络。在月中时疮势旺盛，月末时疮势衰退，因为它随着月亮的盈亏变化而得名。（出自《集验》）
《心法》说：月蚀疮，又名旋耳疮，生在耳后缝隙间，蔓延到耳折上下，像刀裂一样的形状，颜色发红，时常流出黄色津液。这是由于胆脾湿热所致。
Shen Douyuan stated: Shu Ju (First Carbuncle) arises at the Mai Men and Yifeng acupoints beside the ear. These points belong to the Shaoyang Sanjiao Meridian of Hand-Taiyang, which is characterized by abundant Qi and scarce Blood. Symptoms include aversion to cold, high fever, and thirst. It can be punctured after seven or eight days. If the pus and discharge are yellowish-white, it is treatable; if there is black, thin discharge accompanied by severe thirst, or if carbuncles appear on both sides simultaneously, the prognosis is fatal. This represents an extreme severity of toxin. (From *Qixuan*)
[Image: Shu Ju]
Zhu Ju (Second Carbuncle)
*Gui Yi Fang* stated: Zhu Ju occurs within the hairline and behind both ears. If not punctured to drain pus, death will occur within fifteen days; if pus can be punctured but is black like fermented soybeans, or if blood appears, it is also a fatal condition.
Wang Kentang stated: Zhu Ju arises above the neck, behind both ears. Initially, swelling is not significant, but there is intermittent pain and itching with clear fluid discharge. It gradually enlarges, resembling tortoiseshell spots. It is also known as Hua Gu Chuang (Bone-Dissolving Ulcer). If left untreated until ulceration, and bones are discharged after a long period, it is a grave and malignant syndrome. This condition often occurs in individuals with chronic emotional depression, frequently presenting with the "Seven Evils" (seven critical signs in TCM surgery). If contraindications are violated, it is incurable. (From *Zhunsheng*)
Shen Douyuan stated: Zhu Ju belongs to the Shaoyang Sanjiao Meridian of Hand-Taiyang (abundant Qi, scarce Blood), arising beside the Tianyou and Yifeng acupoints below the ear. It can be punctured after six or seven days. If there is also a sore opposite the umbilicus, initially without swelling but accompanied by blistering that gradually enlarges, eroding flesh and discharging pus, starting from the heel with tortoiseshell-like spots, it is called Xian Chuang, also known as Hua Gu Chuang. The discharge of bone indicates failure of the Lung organ, which is extremely malignant. (From *Qixuan*)
Wang Kentang stated: Yue Shi Gan Chuang (Moon-Eclipse Chan Ulcer) arises beside the auditory meatus of infants. Although it is said to arise in correlation with the moon's phases, this may not necessarily be true. Generally, it is caused by the accumulation of wind-dampness and heat-toxin forming Chan sores. (From *Zhunsheng*)
Feng Luzhan stated: If wind and dampness interact and bind, ear sores arise. Furthermore, some cases where pointing at the moon leads to sores appearing behind both ears are named Yue Shi Chuang. Other external causes such as frostbite, insect bites, or mechanical injury should be treated externally. (From *Jinnang*)
Zhou Wencai stated: Yue Shi Chuang arises around both ears, the nose, and the face, rotting and spreading to the lower orifices, penetrating into the sinews and collaterals. The sore intensifies during the middle of the lunar month and subsides at the end of the month, hence its name derived from the waxing and waning of the moon. (From *Jiyan*)
*Xin Fa* stated: Yue Shi Chuang, also known as Xuan Er Chuang (Rotating Ear Ulcer), arises in the folds behind the ear, extending up and down the auricle, resembling a knife cut. The color is red, and it frequently exudes yellow fluid. It is caused by damp-heat in the Gallbladder and Spleen.
[Image: Yue Shi Gan Chuang]