痈从六腑生，疽从五脏生。营气不循，逆于肉理，乃生痈肿。此先圣论痈疽之大端，疡
科之
纲领也。证起月余，毒发于背，始初平塌不痛，药服温补内托，得以由阴转阳，掀肿溃脓腐
化，新生疮口渐敛。无如一波未平，一波又起，日前龈微肿痛，渐次肿甚流血，病中饮食本
少，兹因龈肿，米汁难啜，人以胃气为本，疡溃之后，胃气空虚，全藉饮食精华，资其生气
。既不安谷，仓廪必倾，何恃不恐。且疡后与产后同，理应培养气血，现下龈肿咽干，下利
粪色如酱，利下龈肿稍松，利止肿痛复剧。详审病机，似乎余毒未清，奈病久困顿如斯，固
正则火势不平，清火则正气不守。如何借箸，姑仿少阴不足阳明有余之例，宗玉女煎方法。
盖肾主骨，齿者骨之余，上龈属手阳明，下龈属足阳明。据理推详，冀图侥幸。
安波按∶拟于玉女煎外，再参入清胃散意方，有升麻使清升浊降，丹皮以疏其下滞，
则斯候之上下处病，厥义无遗漏矣。
经云∶呼出心与肺，吸入肾与肝。是肺主出气，肾主纳气。肺为气之主，肾乃气之根。
母藏
子宫，子隐母胎，金水相生之义也。前商保金生水，纳气归根，正本澄源，治不为谬。据述
服药脘中微觉痞闷，心疑药补，即不敢尝。此由胃虚不能传送药力之故，与补无干。如果补
之为害，何喘不见增，病不见甚耶?经曰∶能合脉色，可以万全。岂色悴神疲，喝喝不继者
如是，而能以耗散收功者乎。先哲有云∶喘生毋耗气，气本弱而复耗之，元本亏而复竭之，
抱薪救火，入井下石，离线甚速。勿怪言之不祥。
安波按∶读至斯案，不觉浩叹。虽有回生妙术，奈不见信何。近来见夭枉者甚多，大
抵彼寿固止于此，而吾之道终于不行，岂非命耶?
痈疮生于六腑，疽疮生于五脏。营气运行失常，逆乱于肌肉纹理之间，从而产生痈肿。这是古代圣人对痈疽病机的大致论述，也是外科疾病的纲领。
患者病程已有一个多月，毒邪发于背部，起初疮形平塌且不疼痛，服用温补及内托的药物后，病情得以由阴证转为阳证，出现红肿、化脓、腐肉脱落，新生的疮口逐渐收敛。无奈一波未平一波又起，日前牙龈轻微肿痛，随后肿胀加剧并出血。患者在患病期间饮食本就很少，现在因为牙龈肿胀，连米汤都难以吞咽。人以胃气为本，溃疡之后，胃气空虚，完全依赖饮食的精微物质来滋养生机。既然不能进食，仓廪（脾胃）必然倾覆，还有什么可依靠而不感到恐惧的呢？况且疮疡溃后与产后情况相同，理应培养气血。现下牙龈肿胀、咽喉干燥，腹泻且粪便颜色如酱色；腹泻时牙龈肿痛稍缓，腹泻停止后肿痛反而加剧。仔细审察病机，似乎是余毒未清，但病久身体困顿如此，若固护正气则火势不平，若清泻火毒则正气不守。该如何应对呢？暂且模仿“少阴不足、阳明有余”的治法，遵循玉女煎的方法。盖因肾主骨，牙齿是骨的余气所生，上牙龈属于手阳明大肠经，下牙龈属于足阳明胃经。根据医理推详，希望侥幸获效。
安波按语：建议在玉女煎之外，再参入清胃散的意思，方中有升麻使清气上升、浊气下降，丹皮以疏解下部的瘀滞，那么这种上下同病的证候，其义理就没有遗漏了。
《内经》说：呼出之气由心与肺主管，吸入之气由肾与肝主管。因此肺主呼气，肾主纳气。肺是气的主宰，肾是气的根本。母脏藏于子宫，子脏隐于母胎，体现了金水相生的道理。之前商讨用保金生水、纳气归根、正本澄源的方法治疗，这并非谬误。据描述服药后胃脘中微微觉得痞闷，心里怀疑是药物滋补所致，便不敢再喝。这是由于胃气虚弱不能传送药力造成的，与药物是否滋补无关。如果滋补真的有害，为什么气喘没有加重，病情没有恶化呢？《内经》说：能结合脉象和面色诊断，就可以万无一失。难道面色憔悴、精神疲乏、气息微弱接续不上的人，能通过耗散收功吗？先哲有话说：喘证产生时不要耗损正气，本已气弱又去耗损它，元气亏损又去竭尽它，如同抱柴救火、往井下扔石头，离死亡就非常快了。不要怪我说话不吉利。
安波按语：读到这个医案，不禁长叹。虽然有起死回生的妙术，无奈病人不信从啊。近来见到夭折枉死者很多，大抵他们的寿命本来只到此为止，而我的医术终究无法施行，这难道不是命运吗？
Carbuncles (Yong) arise from the Six Fu organs, while deep abscesses (Ju) arise from the Five Zang organs. When Ying Qi (Nutritive Energy) fails to circulate properly and reverses within the muscle tissue, carbuncles and swellings are generated. This is the general principle of carbuncles and abscesses discussed by ancient sages, serving as the guiding outline for surgical diseases.
The condition has persisted for over a month, with toxicity erupting on the back. Initially, the lesion was flat and painless. After administering warming and tonifying internal-supporting medicines, the condition transformed from a Yin syndrome to a Yang syndrome, presenting with redness, swelling, suppuration, and sloughing of necrotic tissue, with new granulation tissue gradually closing the wound. However, just as one wave subsides, another rises. A few days ago, the gums swelled slightly and became painful, progressing to severe swelling and bleeding. The patient had already consumed little food during the illness; now, due to gum swelling, even rice gruel is difficult to swallow. Humans rely on Stomach Qi (Wei Qi) as their foundation. After ulceration, Stomach Qi is empty and entirely depends on the essence derived from dietary intake to nourish vital life force. If one cannot accept grain and food, the granaries (Spleen and Stomach) will surely collapse; what reliance can there be without fear? Moreover, post-ulceration is similar to postpartum conditions, where cultivating Qi and Blood is the proper approach. Currently, the gums are swollen and the throat dry, accompanied by diarrhea with feces resembling dark sauce color. The gum swelling and pain ease slightly during diarrhea but intensify again when the diarrhea stops. Carefully examining the pathogenesis, it seems residual toxicity remains unclarified. Yet, given the prolonged debilitation, reinforcing the healthy Qi would leave the fire unchecked, while clearing the fire would fail to preserve the healthy Qi. How should one proceed? Tentatively imitating the pattern of "Shao Yin insufficiency and Yang Ming excess," I follow the method of Yü Nü Jian (Jade Woman Decoction). The Kidney governs the bones, and teeth are considered the surplus of bones. The upper gums belong to the Hand-Yangming Large Intestine channel, and the lower gums belong to the Foot-Yangming Stomach channel. Based on theoretical deduction, I hope for a fortunate outcome.
Commentary by Anbo: It is suggested to incorporate the intent of Qing Wei San (Stomach-Clearing Powder) alongside Yü Nü Jian. The inclusion of Sheng Ma (Cimicifugae Rhizoma) facilitates the ascending of clear Qi and descending of turbid Qi, while Dan Pi (Moutan Cortex) disperses stagnation in the lower aspect. Thus, the treatment of this simultaneous upper and lower pathology would be comprehensive without omission.
The Classic states: Exhalation is governed by the Heart and Lungs, while inhalation is governed by the Kidneys and Liver. Therefore, the Lung governs exhalation, and the Kidney governs inhalation. The Lung is the master of Qi, and the Kidney is the root of Qi. The Mother organ resides in the Palace of the Child, and the Child organ hides within the Mother's womb, illustrating the principle of Metal and Water generating each other. Previously, we discussed preserving Metal to generate Water, grasping Qi to return it to its root, and purifying the source to rectify the origin; this treatment was not erroneous. According to the report, after taking the medicine, there was slight fullness in the epigastrium. Suspecting that the tonic nature of the medicine caused this, the patient dared not consume it further. This is due to the Spleen and Stomach's deficiency failing to transport the medicinal power, unrelated to whether the medicine is tonifying. If tonification were truly harmful, why would the asthma not increase and the disease not worsen? The Classic says: "If one can combine pulse and complexion diagnosis, one can achieve perfection." Does the complexion appear haggard and spirit exhausted, with panting breath that cannot continue? Can such a state be resolved through depletion? Ancient sages said: "When asthma arises, do not deplete Qi." If Qi is already weak and then depleted, and Yuan Ben (Primal Foundation) is already deficient and then exhausted, it is like carrying firewood to save a fire or throwing stones into a well; death will be near very quickly. Do not blame me for speaking ill omens.
Commentary by Anbo: Reading this case, I cannot help but sigh deeply. Although there are miraculous arts capable of reviving the dead, what can be done if they are not believed? Recently, I have seen many premature deaths. Generally, their lifespan was destined to end thus, and my medical principles ultimately could not be implemented. Is this not fate?