外疡为病，血凝气滞实证为多，泄之化之消之散之通之行之犹恐不及，初无所用其托里
之法也。自浅者误读洁古黄 为疮家圣药一句，而疡医家竟以托里为能事，开口黄 ，动乎
参、术，纵能迎合富贵家嗜好，而养痈贻祸之说，于以实践。岂以其腐烂不巨，不足以显医
者之绝技，必补之托之使痛苦既深，而痛者之呼号益切，然后托孤寄命而可以邀大功耶。寿
颐治疡，恒谓自肾俞、腰疽、虚损、流痰外无虚证。然即对此虚证，亦必以宣络行气为先务
，初非全恃蛮补而可有消散之希望。若误认托里为必要之诀，则外证越巨，而元气越伤，未
有不速其成脓而殒其生命。此补中托毒一层最为颐之所腐心切齿者也。惟附骨大疽脓成于里
，不能透达外泄，一时未便奏刀，则不得不投透脓之剂速其外达，庶几脓毒可泄。不然者内
攻益剧，蚀骨腐筋为害越厉。此则皂刺，甲片固亦有时而偶为借重。若漫肿无脓之时，万万
不敢轻投此物。盖甲片攻坚，皂刺锐利，皆有酿脓速溃之能力。苟其证尚可消，而轻率用之
，则不能内消而令外溃，则无坚不破无孔不穿矣。至如脑疽、背疽两证，以有脓外达为顺，
无脓内陷为危，非用透脓之法不可。然不过宣通气机，疏达腠理而已。川芎归断足以了之，
非皂刺、穿山之任也。又疔毒为疡家大证，毒聚脓流，虽困无害；毒败无脓，虽小必险。则
以解毒清热大剂，消其余肿而脓毒自回；必不可杂以透脓之药，而脓自无不透者。凡此皆以
透脓为主义，而所以使之得脓者，又各有其理。以此知一证自有一证之治法，必不能执一板
方而谓某方可有若何之妙用者也。
外疡（体表疮疡）这类疾病，大多属于血凝气滞的实证，采用泻下、化解、消散、疏通、行气等方法尚且担心力度不够，起初根本不需要使用托里（扶助正气以托毒外出）的方法。自从有人误读了洁古先生“黄耆为疮家圣药”这句话后，外科医生竟然把托里法当作主要本事，开口就是黄耆，动不动就加入人参、白术，虽然这能迎合富贵人家的喜好，但“养痈遗患”的说法也就在实践中得到了验证。难道是因为疮口腐烂得不够巨大，不足以显示医生的绝技，必须通过补益和托举使患者痛苦加深，让患者呼号更切，然后才能像托付孤幼、寄託性命那样来邀取大功吗？
寿颐（作者自指）治疗外疡，常说除了肾俞疽、腰疽、虚损、流痰之外，没有虚证。即使面对这些虚证，也必须以宣通经络、行气为首要任务，绝不是完全依赖蛮力进补就能有消散的希望。如果错误地认为托里法是必要的诀窍，那么外部疮证越严重，元气就越受损伤，没有不加速化脓并导致死亡的。这种“补中托毒”的做法，是最让我痛心疾首的。
只有那种附骨大疽，脓液在体内形成却无法向外透达排泄，一时不便动刀手术的情况下，才不得不投用透脓剂以加速其向外排出，这样脓毒才能得以泄出。否则，毒邪内攻会更加剧烈，腐蚀骨骼、烂坏筋脉，危害更加厉害。这种情况下，皂角刺、穿山甲片固然有时会被偶尔重用。但在漫肿无脓的时候，万万不敢轻易投用这些药物。因为穿山甲片攻坚破结，皂角刺锐利穿透，都有酿脓速溃的能力。如果病情还可以内消，却轻率地使用它们，就不能使病邪从内部消除，反而导致从外部溃破，那就变得无坚不摧、无孔不入了。
至于脑疽、背疽这两种病症，以脓液能够向外透达为顺证，脓液内陷则为危证，非用透脓法不可。但这不过是宣通气机、疏达腠理罢了。川芎、当归断然足以处理，并不需要皂角刺、穿山甲。另外，疔毒是外科的大证，毒聚脓流，虽然症状严重但无害；若毒败无脓，虽然病灶小但也必定危险。这时应用大剂量的解毒清热药，消除其余下的肿胀，脓毒自然就会回转；绝不可混杂透脓的药物，而脓自然会透出。凡此种种，都是以透脓为主导思想，但使之得脓的原因，又各有其道理。由此可知，一种病症自有一种病症的治疗方法，绝不能拘泥于一个死板的方子，就说某个方子有什么样的妙用。
External sores (external ulcers) are mostly characterized by blood stasis and qi stagnation, which are excess syndromes. Even with purgation, resolution, dispersion, unblocking, and promoting circulation, one might still fear that the treatment is insufficient; initially, there is no need to employ the method of supporting the interior (supporting healthy qi to push out toxins). Since some misread Jiegu’s statement that "Huangqi (Astragali Radix) is the sacred medicine for sores," surgeons have actually taken supporting the interior as their primary skill. They open with Huangqi and frequently add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). Although this may cater to the preferences of the wealthy, it practically validates the saying that "nurturing an abscess leads to disaster." Is it because the ulceration is not severe enough to display the physician's supreme skill? Must they use tonification and support to deepen the patient's suffering, making them cry out more intensely, so that they can claim great merit as if entrusting an orphan or a life?
Shouyi (the author referring to himself) treats external sores and often states that except for Shenshu Ju (abscess at the Shenshu acupoint), Yao Ju (lumbar abscess), Xu Sun (deficiency consumption), and Liu Tan (scrofula/tuberculous lymphadenitis), there are no deficiency syndromes. Even when facing these deficiency syndromes, one must prioritize unblocking collaterals and promoting qi circulation; it is certainly not possible to hope for resolution by relying solely on brute-force tonification. If one mistakenly believes that supporting the interior is an essential principle, the more severe the external lesion, the more the healthy qi will be damaged, inevitably accelerating suppuration and leading to death. This approach of "tonifying while supporting toxins" is what causes me the most heartache and indignation.
However, in cases of deep-seated bone-abscesses where pus forms internally but cannot penetrate outward for drainage, and surgery is temporarily impractical, one must administer formulas to promote pus discharge to accelerate its outward expulsion, thereby allowing pus and toxins to be drained. Otherwise, internal attack by pathogens will intensify, corroding bones and rotting tendons, causing even greater harm. In such instances, Zaocis (Saposhnikoviae Radix - *Note: Context implies Zao Ci/Gleditsiae Spina* -> Gleditsiae Spina) and Chuanshanjia (Pangolin Scales) may occasionally be relied upon. But during periods of diffuse swelling without pus, these substances must never be lightly administered. For Chuanshanjia breaks through hardness, and Zaocis is sharp and penetrating; both possess the ability to generate pus and cause rapid溃破 (ulceration). If the condition can still be resolved internally, but these are used rashly, internal resolution will fail, leading to external ulceration, resulting in a state where nothing remains unbroken and no hole is left unpenetrated.
Regarding Nao Ju (carbuncle of the head/neck) and Bei Ju (dorsal carbuncle), these conditions are favorable when pus reaches the exterior and dangerous when pus sinks inward; thus, methods to promote pus discharge are indispensable. However, this merely involves venting qi mechanisms and opening the interstices (couli). Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) are sufficient to handle this; there is no need for Zaocis or Chuanshanjia. Furthermore, Ding Du (carcinogenic toxin/fixed carbuncle) is a major syndrome in surgery. If toxins gather and pus flows, it is serious but harmless; if toxins fail and no pus forms, even a small lesion is dangerous. In such cases, large doses of detoxifying and clearing-heat herbs should be used to reduce residual swelling, after which pus and toxins will naturally resolve. One must absolutely not mix in herbs that promote pus discharge, yet the pus will naturally emerge. All these examples take promoting pus discharge as the guiding principle, yet the reasons for achieving pus vary according to each case. From this, we know that each syndrome has its own specific treatment method; one cannot rigidly adhere to a single fixed formula and claim that a specific formula possesses certain miraculous effects.