外疡情势皮相者，恒以发肿之大小缓急辨别轻重而已。然其实不可以外形论也。要在视
其病源之浅深缓急及部位之虚实险夷为主义。故有发肿甚巨，其势可畏，而治疗得宜，功成
反掌者。亦有坚块尚小，貌若易疗，而费尽手续，始终不应者。此非医家之技术有良莠，诚
以受病之源，万有不齐，切不可以一例观也。若但以外形论之，大率肿在皮肤之表，肌肉之
中，虽有大疡，尚多易治。若在筋骨之间，大节之界，起病虽微，亦多难疗。凡外疡之浅者
，肿必高突而根围收束，不甚平塌者，最是佳象。若散漫不聚，毫无畔岸者，则多棘手。而
其深者，初发时，但酸痛不仁，甚者且微酸而不痛，然皮肉如故，无所谓肿硬坚块也。至数
日而重按之，始觉其中有僵硬之处，然后渐以延开，其势日巨，而尚无高突形象。其皮肤之
色泽如故，其肤表之肌肉亦如故，此附骨大疽发肿之次序，病家恒不自知为疡证者也。若以
肿势之已发现者言之，则坚肿而四围分明者，其证顺；坚硬而畔岸散漫者，其证重。非毒势
之不聚，即元气之不充也。若坚肿大痛，按之四围皆硬，而其中有一点独软者，则内已成脓
矣。亦有软肿散漫，杳无边际，其人但苦其重而不作痛，则气血大衰，断非佳状。此证甚有
成脓而始终不痛者，盖其人正不胜邪，神经之知觉不灵，邪正已不能相争，所以毫不知痛，
最为败象。又有病起皮肤间，一粒如黍上有白头（吾吴俗语，谓之毒 子。其形如暑天痱
之
觉
化，必不甚小，此脑疽、背疽、腹皮痈及疔毒等诸大疡之肿势也。若头面额颅，颐颊口唇间
见此黍粒，而或为麻木，或为痒痛者，则尤为疔毒之重候。初起亦不肿，至其渐形肿硬，而
大波轩然作矣。若头面漫肿，无此黍粒，其肿或坚或软，或亦作痛作痒，顷刻而起，其势甚
速。或有寒热，或无寒热，则大头疫也。此证病家必以为外疡，而疡科或且不识，妄用刀针
敷药，误人最多。实则风邪袭六阳之络，疏表立验。古所谓头面肿为风者，此病是也。又古
有脚肿为湿之语，亦是确论。但辨其寒湿与湿热而已。如其红肿光亮，皆属湿火。若但肿而
不红，则湿盛也。果属寒湿，肿必不坚，脉必迟涩，舌必白腻。古人之治香港脚，恒用温燥，
皆专为寒湿立法。然大江以南，湿与热并，凡肿处坚硬者，其湿最易化热，非可与古书作一
例论矣。肿疡大旨，不过如斯。
若至溃后，则脓毒必求其爽利，自然肿处渐消，庶为顺境。脓不爽，则肿不能退。若脓
已畅达，而肿犹坚硬，则脓水浓浓者，为毒未净，为实证；脓水清澈者，为正不足，为虚证
。辨别治之，无余蕴也。
外科疾病的病情，通常通过观察肿胀的大小和急缓来辨别轻重。然而，实际上不能仅凭外形来判断。关键在于视其病源的浅深、急缓以及发病部位的虚实、险夷（平坦或危险）作为主要依据。因此，有的肿胀非常巨大，形势令人畏惧，但治疗得当，成功就在反掌之间；也有坚硬的肿块尚小，看似容易治疗，却费尽手续，始终无效。这并非医生技术有高下之分，实在是因为致病之源千差万别，绝不能一概而论。如果仅以外形论断，大体上，肿胀在皮肤表面、肌肉之中的，即使是大疮疡，大多容易治疗。如果在筋骨之间、大关节的界限处，起病虽然轻微，也大多难以治疗。凡是外疡较浅的，肿胀必然高突，且根部周围收束，不十分平塌的，是最为吉利的征象。如果散漫不聚，毫无边界，则大多棘手。而病位深的，初发时，只是酸痛麻木，严重的甚至微酸而不痛，然而皮肉如故，无所谓肿硬坚块。到了数日后，重按时，才觉得其中有僵硬之处，然后逐渐蔓延扩大，其势日益增大，但仍然没有高突的形象。其皮肤的色泽如故，其肤表的肌肉也如故，这是附骨大疽发肿的次序，病人往往自己不知道是疮疡证。如果以已发现的肿势而言，则坚硬肿胀且四周分明的，其证顺；坚硬而边缘散漫的，其证重。这不是毒势不聚，就是元气不充。如果坚肿大痛，按压四周皆硬，而其中有一点特别软的，则内部已成脓了。也有软肿散漫，完全没有边际，病人只苦于沉重而不作痛，则是气血大衰，绝非佳状。此证很有成脓而始终不痛的，大概是因为正气不胜邪气，神经知觉不灵敏，邪正已不能相争，所以毫不知痛，最为败象。又有病起于皮肤间，一粒如黍米上有白头（我们吴地的俗语，称为毒子。其形像暑天痱子的化脓，必不甚小），这是脑疽、背疽、腹皮痈及疔毒等诸大疮疡的肿势。如果在头面额颅、颐颊口唇间见此黍粒，或者麻木，或者痒痛，则更是疔毒的重症。初起也不肿，等到逐渐形成肿硬，而大波轩然兴起。如果头面漫肿，没有这种黍粒，其肿或坚或软，或者也作痛作痒，顷刻而起，其势很快。或有寒热，或无寒热，则是大头疫。此证病人一定以为是外疡，而疡科医生或许也不识，妄用刀针敷药，误人最多。实际上是风邪侵袭六阳之络，疏解表邪立见疗效。古所谓头面肿为风者，此病即是。又古有脚肿为湿的说法，也是确论。但需辨别是寒湿还是湿热而已。如其红肿光亮，都属于湿火。如果只肿而不红，则是湿盛。果属寒湿，肿必不坚，脉必迟涩，舌必白腻。古人治疗香港脚，常用温燥之法，都是专为寒湿立法。然而大江以南，湿与热并见，凡肿处坚硬者，其湿最容易化热，不可与古书作一例论矣。肿疡的大旨，不过如此。
至于溃破之后，则脓毒必须力求排出通畅顺利，自然肿胀处逐渐消退，这才是顺境。脓排不畅，则肿不能退。如果脓已畅达，而肿仍然坚硬，则脓水浓稠的，为毒未净，属实证；脓水清澈的，为正不足，属虚证。辨别后治疗，就没有遗漏了。
The condition of external sores is generally distinguished by the size and urgency of swelling to determine severity. However, it cannot be judged solely by external appearance. The key lies in taking as the primary principle the depth and urgency of the disease source, as well as the deficiency or excess and safety or danger of the affected site. Therefore, there are cases where the swelling is extremely large and the situation appears formidable, yet with appropriate treatment, success is achieved readily; conversely, there are cases where a hard nodule is still small and seems easy to treat, yet despite exhaustive procedures, it remains unresponsive. This is not due to differences in medical skill, but rather because the sources of disease vary infinitely, and one must not view them all under a single category. Generally speaking, if the swelling is superficial in the skin or within the muscles, even major sores are often easy to treat. If located between tendons and bones or at the boundaries of major joints, even if the onset is mild, it is often difficult to cure. For shallow external sores, the swelling must be prominent with a constricted base and not overly flat, which is the most auspicious sign. If the swelling is diffuse and scattered without clear boundaries, it is often troublesome. For deep lesions, initially, there may only be soreness, numbness, or in severe cases, slight soreness without pain, while the skin and flesh appear normal, with no obvious swollen, hard nodules. After several days, upon deep pressure, hardness is felt within, which then gradually spreads, increasing in magnitude daily, yet still lacking a prominent shape. The skin color and subcutaneous muscles remain unchanged. This is the sequence of swelling in deep bone-abscessing carbuncles (Fugu Daju), conditions that patients often do not recognize as sores. Regarding observed swelling patterns: firm swelling with distinct margins indicates a favorable prognosis; firm swelling with diffuse margins indicates a severe condition, reflecting either dispersed pathogenic factors or insufficient healthy Qi. If the swelling is firm, large, and painful, with hardness around the periphery upon palpation but a soft spot in the center, pus has formed internally. Conversely, soft, diffuse swelling without boundaries, accompanied by heaviness but no pain, indicates severe depletion of Qi and Blood, which is unfavorable. Some cases involve pus formation without pain throughout, likely because healthy Qi fails to overcome pathogenic factors, nerve perception becomes dull, and the struggle between healthy Qi and pathogens ceases, resulting in no pain sensation; this is a sign of defeat. Another type begins in the skin as a grain-sized bump with a white head (colloquially known as "toxic seed" in our region, resembling pustular heat rash in summer, though not necessarily small); this characterizes the swelling of major sores such as occipital carbuncle (Naoju), dorsal carbuncle (Beiju), abdominal furuncle, and carbuncle-poison (Dingdu). If such grain-like bumps appear on the forehead, temples, cheeks, or lips, accompanied by numbness or itching/pain, it indicates a severe case of Dingdu. Initially non-swollen, it gradually becomes hard and swollen, rising prominently. If the face swells diffusely without such grains, with variable hardness or softness, possibly accompanied by pain or itching, arising suddenly and rapidly, with or without chills and fever, it is identified as Big Head Plague (Datouyi). Patients often mistake this for an external sore, and some specialists in sores may fail to recognize it, mistakenly using knives, needles, or topical applications, causing much harm. In reality, it is caused by Wind pathogen invading the meridians of the Six Yang, and resolving the exterior yields immediate results. As ancient texts state, facial swelling is attributed to Wind, referring to this disease. Similarly, leg swelling is attributed to Dampness, which is also accurate, provided one distinguishes between Cold-Damp and Damp-Heat. Red, swollen, and shiny areas indicate Damp-Fire. Swelling without redness indicates excessive Dampness. If truly Cold-Damp, the swelling will not be hard, the pulse will be slow and choppy, and the tongue coating will be white and greasy. Ancient treatments for Hong Kong Foot (Gangjiao) often used warming and drying methods, specifically legislated for Cold-Damp. However, south of the Yangtze River, Dampness and Heat coexist; where swelling is hard, Dampness easily transforms into Heat, and thus cannot be treated uniformly with ancient texts. The general principles of pre-ulcerative swelling are as above.
After ulceration, purulent toxins must be discharged smoothly and thoroughly; naturally, the swelling will gradually subside, indicating a favorable course. If pus discharge is obstructed, swelling cannot recede. If pus drains freely but swelling remains hard, thick pus indicates incomplete clearance of toxins (Excess pattern); clear pus indicates insufficiency of Healthy Qi (Deficiency pattern). Treatment should be differentiated accordingly, leaving no room for oversight.