俗传疡科诸书，鲜不谓痈疽大证，利用补托。所以举世之治疡者，凡见证候较巨，无不
参、术、 、苓，唯补是尚，而素习景岳者无论矣。不知疮疡大毒，气血壅滞，窒而不行，
留而不去，一经补托，其象何若。清夜扪心，亦当觉悟。而暑热之互阻，寒湿之痹着者，
蛮补之变，又当何若。寿颐治疡秉承先师朱氏家学，每谓除虚损流痰、腰疽、肾俞、附骨环
跳数者以外，绝少虚证。而世之习于补托者，每引《本草经》黄 主治痈疽久败疮，排脓止
痛之说，且谓金元以后，皆称黄 为疮家圣药，宜乎一遇疡证，无论痈肿 赤，风火暑
自始至终辄以黄 从事。而肿者越托越高，溃者且补且腐。古人所谓养痈贻害者，真是为此
等补药写照。而病家医家彼此不悟，其故安在。盖即误读《本草经》黄 一条之害也。绎《
本经》之意，所谓治痈疽之久败者，黄 是固表实表之主药。表虚之病，独擅胜场。凡病痈
疽而至于久败，则脓水淋漓，津液耗竭，其虚在表，惟黄 能补其耗伤，固其元气。《本经
》大旨，极易明晓，非谓大毒乍发，邪势方张者，而亦必一例用固表法也。不谓浅者读之，
只见其治痈疽云云，而置久败疮三字于不问，且更为之申一解曰， 是痈疽圣药。一若凡是
痈疽，不论虚实寒热，有毒无毒，非用黄 不可者。于是立斋景岳之书盛行，而欲排脓者，
越排则脓越多；欲止痛者，越止则痛越剧。教猱升木，为虎附翼。贾生所谓一胫之大几如腰
，一指之大几如股者，于是实践其说，而不知即其排脓止痛，有以玉成之。甚矣，古书之不
易读也。寿颐治疡，非不知自有当补之法，如虚损流痰及腰疽、肾俞、流注等证，皆为气血
俱衰，运化不健，痹着不行。非得补益之力流动其气机，则留者不行，着者不去。然必非专
恃参、 数味，可以幸中。若脑疽、背疽即经腐化而脓毒不畅，恶肉不脱，无非气血不充，
不能托毒外泄，亦非补剂不为功。而老人虚人，尤须温补。更有疡毒即溃，脓水较多，而其
人顿形 瘠者，亦宜参用补法。然一二剂后，胃纳既苏，精神既振，即当撤去补药，仍与清
理。盖余毒未清，终防死灰复燃，补而益炽。亦如治时证者，大势乍平，必不当骤然蛮补，
反以留恋余邪，酿成变幻。总之医以治病，非以治虚，有病则惟以去病为主，补养二字决非
通治百病之法。内外二科，皆此一理。而举世之习于立斋景岳者不知也，而富贵家之知有虚
不知有病者，不悟也。然则补药疗病，殆专为迎合富家心理之作用乎。而医学从此扫地尽矣
。若其人果有虚证必当补养者，则自有内科理法在，非疡医界内之事，兹亦不赘。
民间流传的外科书籍，几乎没有不认为痈疽这类重症，适宜使用补益托毒的方法。因此，天下治疗外科疾病的医生，凡是见到证候较为严重的，无不加入人参、白术、茯苓等药物，只崇尚补法，那些素来学习张景岳学说的医生更是不用说了。他们不知道疮疡大毒，会导致气血壅滞，阻塞而不运行，停留而不去除，一旦使用补托之法，病情会呈现什么样子呢？深夜扪心自问，也应当觉悟。至于暑热相互阻滞，寒湿痹阻留着的病症，蛮补带来的变证，又该是怎样的结果呢？
我（寿颐）治疗外科疾病秉承先师朱氏的家学，常常说除了虚损流痰、腰疽、肾俞发、附骨疽、环跳疽这几种情况以外，极少有真正的虚证。然而世上习惯于补托的医生，常常引用《本草经》中关于黄芪主治痈疽久败疮、排脓止痛的说法，并且说金元以后，都称黄芪为“疮家圣药”，所以一遇到外科疾病，无论痈肿是否红赤，无论是风火还是暑邪，自始至终辄以黄芪为主进行治疗。结果导致肿胀者越托越高，溃破者边补边腐烂。古人所说的“养痈贻害”，真是为这些补药写的写照。而病人和医生彼此都不醒悟，这是什么原因呢？大概就是因为误读了《本草经》中关于黄芪这一条的危害。
推究《本经》的本意，所谓治疗痈疽的“久败”者，黄芪确实是固表实表的主药。对于表虚的病证，它独擅胜场。凡是患痈疽到了“久败”阶段，脓水淋漓，津液耗竭，其虚弱在于体表，只有黄芪能补益其耗伤，巩固其元气。《本经》的大旨，很容易明白，并不是说大毒刚刚发作，邪气势力正盛的时候，也必须一律使用固表法。没想到浅薄的人阅读时，只看它说治痈疽云云，而把“久败疮”这三个字置之不问，并且还进一步申解说：黄芪是痈疽的圣药。好像凡是痈疽，不论虚实寒热，有毒无毒，非用黄芪不可。于是薛立斋、张景岳的书盛行，想要排脓的，越排脓越多；想要止痛的，越止疼痛越剧烈。这简直是教猱升木，为虎作伥。正如贾谊所说“一条腿粗得像腰，一个手指粗得像大腿”，这些人实践了这种说法，却不知道自己所谓的“排脓止痛”，反而成就了这种恶果。古书真是不容易读懂啊！
我治疗外科疾病，并非不知道自有应当补益的方法，比如虚损流痰以及腰疽、肾俞发、流注等证候，都是气血俱衰，运化功能不健，痹阻留滞不行。如果不借助补益之力来流动其气机，那么留滞的就不能运行，痹着的就不能去除。但是，绝不能专门依赖人参、黄芪这几味药，就可以侥幸奏效。如果是脑疽、背疽，即使经过腐化而脓毒不畅，恶肉不脱，无非是因为气血不充，不能托毒外泄，也不是补剂不能建功。而且老人、体虚之人，尤其需要温补。更有疮毒已经溃破，脓水较多，而其人突然变得消瘦羸弱的，也适宜参用补法。但是一两剂之后，如果胃纳恢复，精神振奋，就应当撤去补药，仍然给予清解清理。因为余毒未清，终究要防止死灰复燃，补益反而会使邪气更炽盛。这也如同治疗时令病一样，大势刚平定，必定不应当骤然蛮补，否则反而会留恋余邪，酿成变幻莫测的后果。总之，医生是用来治病的，不是用来治虚的，有病则只以去病为主，“补养”二字决不是通治百病的方法。内科和外科，都是这个道理。然而世上习惯于薛立斋、张景岳学说的人却不知道，富贵人家只知道有虚证而不知道有病的人，也不醒悟。那么，补药治病，难道仅仅是为了迎合富家人心理的作用吗？医学从此也就扫地尽了。如果那人果真有虚证必须补养的，那自有内科的道理和方法在，不属于外科医生的职责范围，这里也不再赘述。
The folk-heralded surgical texts rarely fail to assert that for major conditions such as carbuncles and sores (Yong Ju, 痈疽), the utilization of tonification and expulsion methods is beneficial. Consequently, all practitioners treating external sores, upon observing more severe manifestations, invariably incorporate Codonopsis Radix (Dangshen, 党参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Poria (Fuling, 茯苓), etc., holding tonification in the highest regard; this is especially true for those versed in the school of Zhang Jingyue. They are unaware that the great toxicity of sores leads to qi and blood stagnation, obstruction without flow, retention without elimination. Once tonification and expulsion methods are applied, what would the clinical picture be? One should awaken to this truth upon quiet self-reflection. Furthermore, regarding cases where summer-heat and dampness mutually obstruct, or cold-dampness causes bi-syndrome with fixed pain, what would be the consequences of reckless tonification?
My treatment of external sores inherits the family learning of my late teacher, Mr. Zhu. I often state that except for a few specific conditions such as deficiency-type flowing phlegm (Liutan, 流痰), lumbar carbuncle (Yaoju, 腰疽), Shenshu abscess (Shenshufa, 肾俞发), deep-rooted bone abscess (Fugu huan tiao, 附骨环跳 - referring to abscesses around the hip/bone), there are rarely true deficiency syndromes. However, practitioners accustomed to tonification often cite the *Shennong Bencao Jing* stating that Astragali Radix (Huangqi, 黄芪) treats chronic, deteriorating sores of carbuncles and expels pus while stopping pain. They claim that since the Jin and Yuan dynasties, Huangqi has been called the "sage medicine for sores." Thus, upon encountering any surgical condition, regardless of whether the swelling is red, or whether it involves wind-fire or summer-heat, they consistently rely on Huangqi from start to finish. The result is that swollen areas become higher with each tonification attempt, and ulcerated wounds continue to fester despite supplementation. What the ancients described as "nourishing the carbuncle leads to harm" is truly a portrait of these tonifying medicines. Neither patients nor doctors realize this; why is this so? It is precisely the harm caused by misreading the entry on Huangqi in the *Bencao Jing*.
Examining the intent of the *Bencao Jing*, the phrase "treating chronic, deteriorating sores of carbuncles" indicates that Huangqi is indeed the primary herb for consolidating the exterior and strengthening the surface. For diseases characterized by exterior deficiency, it excels. When a carbuncle reaches the stage of "chronic deterioration," with profuse discharge of pus and fluid, leading to exhaustion of body fluids, the deficiency lies at the exterior level. Only Huangqi can replenish this consumption and consolidate the original qi. The main purport of the *Bencao Jing* is easy to understand: it does not imply that when great toxicity first erupts and pathogenic factors are strong, one must uniformly apply exterior-consolidating methods. Regrettably, superficial readers see only "treats carbuncles" and ignore the three characters "chronic deteriorating sores" (Jiu Bai Chuang, 久败疮). They further interpret it as "Huangqi is the sage medicine for carbuncles," implying that for any carbuncle, regardless of deficiency/excess, cold/heat, or presence/absence of toxicity, Huangqi is indispensable. With the prevalence of works by Xue Lizhai and Zhang Jingyue, those seeking to expel pus find that the more they expel, the more pus appears; those seeking to stop pain find that the more they treat, the worse the pain becomes. This is like teaching a monkey to climb a tree or adding wings to a tiger. As Jia Yi said, "A leg as thick as a waist, a finger as thick as a thigh," these practitioners implement this theory, unaware that their so-called "expelling pus and stopping pain" actually facilitates this disaster. How difficult it is to read ancient books!
In treating external sores, I am not unaware of appropriate methods for tonification. Conditions such as deficiency-type flowing phlegm, lumbar carbuncle, Shenshu abscess, and flowing abscess (Liuzhu, 流注) involve depletion of both qi and blood, poor transformation and transportation, and bi-obstruction without movement. Without the power of tonification to mobilize qi mechanism, retained pathogens will not move, and fixed pathogens will not leave. However, one cannot rely solely on herbs like Codonopsis Radix (Dangshen, 党参) and Astragali Radix (Huangqi, 黄芪) to achieve success by chance. For nuchal carbuncle (Naoju, 脑疽) or back carbuncle (Beiju, 背疽), even if necrotic tissue has formed but pus/toxin drainage is poor and foul flesh does not detach, it is due to insufficient qi and blood failing to expel toxin outward; tonifying formulas are necessary for efficacy. Especially for the elderly and debilitated, warm tonification is required. Additionally, if a sore has ulcerated with abundant pus, and the patient suddenly becomes emaciated and thin, tonification may also be appropriate. However, after one or two doses, once appetite returns and spirit revitalizes, tonifying medicines should be withdrawn, and clearing/cleaning methods resumed. Because residual toxins remain, one must prevent the ashes from reigniting; tonification might otherwise intensify the pathogenic heat. Similarly, in treating seasonal diseases, once the major symptoms subside, one must not recklessly tonify, lest lingering pathogens be retained and cause complex transformations. In summary, medicine is for treating disease, not for treating deficiency. When disease exists, the priority is eliminating the pathogen; "tonification and nourishment" are certainly not universal cures for all diseases. This principle applies equally to internal and external medicine. Yet, those in the world adhering to Xue Lizhai and Zhang Jingyue do not understand, and wealthy families who recognize only deficiency but not disease do not awaken. Does the use of tonifying medicines for illness merely serve to cater to the psychology of the rich? Medicine is thus brought to ruin. If a person truly has a deficiency syndrome requiring tonification, there are internal medicine principles and methods for that; it is not within the scope of surgical practice, so I will not elaborate further.