肿痛未作脓者，宜除湿消毒。大痛或不痛，或麻木者，毒甚也。隔蒜灸之，更用解毒
药。
，更以托里。上部脉数实而痛者，宜降火。上部脉数虚而痛者，宜滋阴降火为主。尺部脉数
而作渴者，滋阴降火。不作脓，或不溃者，托里药主之。脓清或多者，大补气血。烦躁饮冷
，脉实而痛者，宜泻火。
一男子患之，肿痛脉数。以黄连消毒散，二剂少退，与仙方活命饮，二剂而止，再以当
归、川芎、芍药、金银花、黄柏、知母而溃，又以托里药而愈。
一男子头项俱肿，虽大溃，肿痛益甚，兼作泻烦躁不睡，饮食少思，其势可畏，诊其脉
，毒
，诸证少退，饮食少进，睡亦少得。及与参苓白术散数服，饮食顿进。又与十全大补汤，加
金银花、白芷、桔梗，月余而瘥。
一老人色赤肿痛，脉数而有力。与黄连消毒散，二剂少退。更与清心莲子饮，四剂而消
。
一妇人脓熟不溃，胀痛欲呕，饮食少思。急针之，与托里药而愈。
一妇人患之，不甚痛，不作脓。以托里消毒散，脓成，针之，补以托里药亦愈。
一老人脓清，兼作渴，脉软而涩，余以为气血俱虚，用八珍汤，加黄 、五味子，彼不
信，
而愈。
一男子未溃，兼作渴，尺脉大而无力。以四物汤，加黄柏、知母、麦门冬、黄 ，四剂
而渴减，又与加减八味丸，渴止疮溃。更用托里药，兼前丸而愈。
一男子肿痛脉数。以荆防败毒散，二剂而痛止，更以托里消毒药而消。
一男子 肿疼痛，发热饮冷，脉洪数。与凉膈散，二剂而止，以金银花散，四剂而溃，
更以托里药而愈。
一老妇禀实，溃而痛不止，脉实便秘。以清凉饮二剂而止，更以托里消毒药而愈。
一男子肿硬，不作脓，惟疮头出水，痛甚。以仙方活命饮二剂，痛止而脓成，针之；更
以托里药而愈。常治脓清补而不应，及不痛或木闷坚硬者，俱不治。
一男子脓将成，微痛兼渴，尺脉大而无力，此阴虚火动之证。彼谓心经热毒，自服清凉
降火
渴止疮溃；更以托里药，兼前丸而愈。《中藏经》云∶痈疽疮肿之作，皆五脏六腑蓄毒不流
，非独荣卫壅塞而发，其行也有处，其主也有归。假令发于喉舌者，心之毒；皮毛者，肺之
毒；肌肉者，脾之毒；骨髓者，肾之毒；发于下者，阴中之毒；发于上者，阳中之毒；外者
六腑之毒，内者五脏之毒。故内曰坏，外曰溃，上曰从，下曰逆。发于上者，得之速；发于
下者，得之缓。感于六腑者，易治；感于五脏者，则难治也。观此，则疽发于脑者，乃膀胱
督脉，阴气不足，阳火炽甚而出也。岂可专泥于心火，而不滋益阴气耶。
一男子耳后漫肿作痛，肉色不变，脉微数。以小柴胡汤，加芎、归、桔梗，四剂肿少起
，更
碗许，以托里药，两月余而始愈。凡疮不起者，托而起之；不成脓者，补而成之，使不内攻
。脓成，而及时针之，不数日即愈矣。常见患者，皆畏针痛而不肯用，又有恐伤良肉而不肯
用。殊不知疮虽发于肉薄之所，若脓成，其肿亦高寸余，疮皮又浓分许，用针深不过二分。
若发于背，肿高必有三四寸，入针止于寸许。况患处肉已坏矣，何痛之有，何伤之虑。怯弱
之人，及患附骨疽，待脓自通，以致大溃，不能收敛，气血沥尽而亡者为多矣。
一男子素不慎起居饮食， 赤肿痛，尺脉洪数。以黄连消毒散二剂，湿热顿退，惟肿硬
作痛
、陈皮，以托里排脓。彼欲全消，自制黄连消毒散二服，反肿硬不作脓，始悟。仍用十宣散
加白术、茯苓、陈皮、半夏，肿少退，乃去桂，又四剂而脓成，肿势亦退。继以八珍散加黄
、五味、麦门冬，月余脓溃而愈。夫苦寒之药，虽治阳证，尤当分表里虚实，次第时宜，
岂可始末悉用之。然 肿赤痛，尺脉数，按之则濡，乃膀胱湿热壅盛也。故用黄连消毒散，
以
头不消，盖因热毒熏蒸，气血凝滞而然也。宜用甘温之剂，补益阳气，托里以腐溃之。况此
证元属督脉，经阴虚火盛而出，若不审其因，专用寒苦之剂，使胃寒气弱，何以腐化收敛，
几何不至于败耶。凡疮之易消散、易腐溃、易收敛，皆气血壮盛故也。
附方
黄连消毒散 治脑疽，或背疽。肿势外散，疼痛发 ，或不痛麻木，服此。更宜
隔蒜灸之。
黄连（酒拌） 羌活 黄柏 黄芩（酒拌） 生地黄 知母 独活 防风 当归尾（酒拌）
连
甘草（炒，各五分） 作一剂，水二钟，姜三片，煎八分，食后服。
仙方活命饮（方见发背门）
隔蒜灸法（方见发背门）
槐花酒（方见发背门）
清凉饮（方见发背门）
四物汤（方见瘰 门）
加减八味丸（方见作渴门）
十全大补汤（方见溃疡发热门）
清心莲子饮（方见下疳门）
凉膈散（方见作渴门）
二神丸（方见作呕门）
六君子汤（方见作呕门）
参苓白术散（方见痔漏门）
金银花散（方见作呕门）
托里散（方见肿疡门）
小柴胡汤（方见瘰 门）
托里消毒散（方见肿疡门）
荆防败毒散（方见溃疡发热门）
十宣散（方见发背门）
八珍汤（方见溃疡发热门）
香砂六君子汤（方见作呕门）
脑疽肿痛但尚未化脓的，适宜采用除湿解毒的方法。如果疼痛剧烈或者完全不痛，甚至出现麻木感的，说明毒邪深重。此时应用隔蒜灸法治疗，并配合使用解毒药物。若脓液未能形成或疮口不能溃破的，应以托里透脓的药物为主进行治疗。
对于上部脉象数而有力且伴有疼痛的，适宜清降火邪；上部脉象数而无力且伴有疼痛的，应以滋阴降火为主要治法。尺部脉象数且伴有口渴的，也采用滋阴降火的方法。若脓液稀薄或流出量多的，应大补气血。若患者烦躁、想喝冷饮，脉象实且疼痛的，适宜泻火。
有一个男子患此病，表现为肿痛、脉数。服用黄连消毒散两剂后症状稍减，接着服用仙方活命饮两剂后疼痛停止，再服用当归、川芎、芍药、金银花、黄柏、知母等药后疮口溃破，最后用托里药调理而痊愈。
另一个男子头颈部都肿胀，虽然已经大面积溃烂，但肿痛反而更加严重，兼有腹泻、烦躁、失眠，饮食减少，病情看起来很危险。诊察其脉象，发现毒邪已退，诸证稍有缓解，饮食略进，睡眠也稍好。随后服用参苓白术散几服，饮食突然增加。又服用十全大补汤，加入金银花、白芷、桔梗，一个月多月后痊愈。
一个老人面色红赤，肿痛，脉数而有力。给予黄连消毒散，两剂后症状稍减。再给予清心莲子饮，四剂后肿块消散。
一个妇人脓液成熟但不溃破，胀痛欲呕，饮食减少。紧急针刺排脓，并给予托里药而痊愈。
另一个妇人患此病，疼痛不剧烈，也不化脓。服用托里消毒散后脓液形成，针刺排脓，再用托里药补益而痊愈。
一个老人脓液稀薄，兼有口渴，脉象软而涩。我认为这是气血俱虚，使用八珍汤，加入黄芪、五味子，但他不相信我的诊断，最终（自行处理或延误）而痊愈。（注：原文此处可能有脱漏或语意转折，按字面翻译为“彼不信...而愈”，通常语境下可能指未遵医嘱导致不良后果或自行服药，但根据“而愈”二字，暂译为最终痊愈，保留原文逻辑）。
一个男子疮口未溃，兼有口渴，尺脉大而无力。这是阴虚火动的证候。他认为自己是心经热毒，自行服用清凉降火药，结果口渴停止、疮口溃破；再用托里药，配合前面的丸药而痊愈。《中藏经》说：痈疽疮肿的发生，都是五脏六腑蓄积毒邪不得流通所致，不仅仅是营卫壅塞而发病。它有发生的部位，也有归属的脏腑。例如发于喉舌的，是心的毒；发于皮毛的，是肺的毒；发于肌肉的，是脾的毒；发于骨髓的，是肾的毒；发于身体下部的，是阴中之毒；发于身体上部的，是阳中之毒；发于外部的，是六腑之毒；发于内部的，是五脏之毒。所以内部称为坏，外部称为溃，上部称为顺证，下部称为逆证。发于上部的，发病迅速；发于下部的，发病缓慢。感于六腑的，容易治疗；感于五脏的，则难治疗。观察这一点，那么脑疽发于脑部，乃是膀胱督脉阴气不足，阳火炽盛而发出的。怎么能专门拘泥于心火，而不滋益阴气呢？
一个男子耳后漫肿作痛，肤色不变，脉微数。用小柴胡汤，加入川芎、当归、桔梗，四剂后肿块稍起，再服用一碗左右，用托里药，两个多月才痊愈。凡是疮疡不起发的，用托法使其起发；不化脓的，用补法使其化脓，使毒邪不向内攻陷。脓液形成后，及时针刺，不出几天就痊愈了。常见患者，都害怕针刺疼痛而不肯使用，又有担心损伤好肉而不肯使用的。殊不知疮虽然发在肉薄的地方，但如果脓已形成，肿胀也会高出一寸多，疮皮又厚一分多，用针刺深度不超过二分。如果发于背部，肿胀高三四寸，入针也只到一寸左右。况且患处肉已经坏死，有什么疼痛呢？有什么损伤的顾虑呢？怯弱的人，以及患附骨疽的患者，等待脓液自然通畅，以致大面积溃烂，不能收敛，气血耗尽而死亡的很多。
一个男子平时不注意起居饮食，局部红肿疼痛，尺脉洪数。服用黄连消毒散两剂，湿热顿退，只剩下肿硬作痛。又用香砂六君子汤加陈皮，以托里排脓。他想让肿块完全消散，自制黄连消毒散服用两服，反而肿硬不化脓，这才醒悟。仍然用十宣散加白术、茯苓、陈皮、半夏，肿块稍退，于是去掉桂枝，又四剂后脓成，肿势也退。继以八珍散加黄芪、五味子、麦门冬，一个多月后脓溃而愈。苦寒的药物，虽然治疗阳证，尤其应当分辨表里虚实，讲究次第和时机，怎么可以始终全部使用呢？然而局部红肿疼痛，尺脉数，按之濡软，这是膀胱湿热壅盛。所以用黄连消毒散，以清热燥湿。头部肿块不消，是因为热毒熏蒸，气血凝滞造成的。适宜用甘温的药剂，补益阳气，托里以促使腐溃。况且这个证原本属于督脉，因经阴虚火盛而出，如果不审察病因，专用寒苦药剂，使胃气寒冷虚弱，凭什么来腐化和收敛呢？不久就会败坏吗？凡是疮疡容易消散、容易腐溃、容易收敛的，都是因为气血壮盛的缘故。
附方：
黄连消毒散：治疗脑疽，或背疽。肿势向外扩散，疼痛发作，或不痛麻木，服用此方。更宜配合隔蒜灸法。
黄连（酒拌）、羌活、黄柏、黄芩（酒拌）、生地黄、知母、独活、防风、当归尾（酒拌）、甘草（炒），各五分。作一剂，水二钟，姜三片，煎至八分，食后服用。
仙方活命饮（方见发背门）
隔蒜灸法（方见发背门）
槐花酒（方见发背门）
清凉饮（方见发背门）
四物汤（方见瘰疬门）
加减八味丸（方见作渴门）
十全大补汤（方见溃疡发热门）
清心莲子饮（方见下疳门）
凉膈散（方见作渴门）
二神丸（方见作呕门）
六君子汤（方见作呕门）
参苓白术散（方见痔漏门）
金银花散（方见作呕门）
托里散（方见肿疡门）
小柴胡汤（方见瘰疬门）
托里消毒散（方见肿疡门）
荆防败毒散（方见溃疡发热门）
十宣散（方见发背门）
八珍汤（方见溃疡发热门）
香砂六君子汤（方见作呕门）
If there is swelling and pain but no pus formation in the brain carbuncle, it is appropriate to employ dampness-dispelling and detoxification methods. If the pain is severe or absent, or if there is numbness, the toxin is profound. In such cases, garlic-separated moxibustion should be applied, along with detoxifying herbs. If pus does not form or the sore does not ulcerate, tonic herbs for supporting the interior (Tuoli) should be the primary treatment.
For those with a rapid and full pulse on the upper position accompanied by pain, clearing and descending fire is appropriate. For those with a rapid and deficient pulse on the upper position accompanied by pain, nourishing yin and descending fire should be the main approach. For those with a rapid pulse on the chi (cun-guan-chi) position accompanied by thirst, nourishing yin and descending fire is also indicated. If the pus is thin or excessive, major tonification of qi and blood is required. For patients who are irritable, desire cold drinks, have a full pulse, and experience pain, purging fire is appropriate.
A male patient suffered from this condition, presenting with swelling, pain, and a rapid pulse. After taking two doses of Huanglian Xiaodu San (Coptis Decoction for Detoxification), symptoms slightly subsided. He then took two doses of Xianfang Huoming Yin (Immortal Life Elixir), which stopped the pain. Subsequently, he took Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix), Jinyinhua (Lonicerae Japonicae Flos), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), leading to ulceration. Finally, he was cured with Tuoli (interior-supporting) herbs.
Another male patient had swelling in both the head and neck. Although the sore had extensively ulcerated, the swelling and pain worsened. He also suffered from diarrhea, irritability, insomnia, and poor appetite, indicating a dangerous condition. Upon pulse diagnosis, it was found that the toxin had receded, symptoms slightly improved, appetite increased slightly, and sleep improved somewhat. He then took Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for several doses, after which his appetite suddenly improved. Next, he took Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with added Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Jiegeng (Platycodonis Radix), and recovered after more than a month.
An elderly male patient presented with a red complexion, swelling, pain, and a rapid, forceful pulse. He was given Huanglian Xiaodu San (Coptis Decoction for Detoxification); after two doses, symptoms slightly subsided. Then, Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) was administered; after four doses, the swelling resolved.
A female patient had mature pus that did not ulcerate, accompanied by distending pain, nausea, and poor appetite. Urgent acupuncture was performed to drain the pus, followed by Tuoli (interior-supporting) herbs, resulting in recovery.
Another female patient suffered from this condition with mild pain and no pus formation. She took Tuoli Xiaodu San (Interior-Supporting and Detoxifying Decoction); once pus formed, it was drained via acupuncture, and she recovered with further Tuoli (interior-supporting) tonification.
An elderly male patient had thin pus and thirst, with a soft and choppy pulse. I diagnosed this as deficiency of both qi and blood and prescribed Bazhen Tang (Eight-Treasure Decoction) with added Huangqi (Astragali Radix) and Wuweizi (Schisandrae Fructus). However, he did not trust my diagnosis, yet eventually recovered.
A male patient had an un-ulcerated sore with thirst and a large, weak chi pulse. This indicated yin deficiency with hyperactive fire. He believed it was heat-toxin in the Heart channel and self-medicated with cooling and fire-descending herbs. Consequently, his thirst ceased and the sore ulcerated; combined with Tuoli (interior-supporting) herbs and the previous pill formula, he recovered. The *Zhongzang Jing* states: "The occurrence of sores and ulcers results from the accumulation of toxins in the five zang and six fu organs that fail to circulate, not merely from the obstruction of Ying and Wei. There is a specific location for their manifestation and a specific organ they belong to. For instance, those appearing on the throat and tongue stem from Heart toxicity; those on the skin and hair from Lung toxicity; those on muscles from Spleen toxicity; those in the bone marrow from Kidney toxicity; those appearing on the lower body from yin toxicity; those on the upper body from yang toxicity; external ones from fu-organ toxicity; internal ones from zang-organ toxicity. Therefore, internal lesions are termed 'huai' (decay), external ones 'kui' (ulceration), upper ones 'cong' (favorable prognosis), and lower ones 'ni' (adverse prognosis). Lesions on the upper body develop rapidly; those on the lower body develop slowly. Those affecting the fu organs are easy to treat; those affecting the zang organs are difficult." Observing this, a carbuncle on the brain arises from insufficiency of yin qi in the Bladder and Du vessels, with intense yang fire erupting. How can one rigidly adhere to Heart fire without nourishing yin qi?
A male patient had diffuse swelling and pain behind the ear, with unchanged skin color and a slightly rapid pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) with added Xiong (Chuanxiong Rhizoma), Gui (Danggui, Angelicae Sinensis Radix), and Jiegeng (Platycodonis Radix) was prescribed. After four doses, the swelling slightly subsided. Following this, with Tuoli (interior-supporting) herbs, he recovered after over two months. Generally, for sores that do not rise, use support methods to raise them; for those that do not suppurate, use tonification to induce suppuration, preventing internal invasion. Once pus forms, timely acupuncture leads to recovery within days. Often, patients fear the pain of acupuncture and refuse it, or worry about damaging healthy flesh. They do not realize that although the sore may appear on thin flesh, if pus has formed, the swelling may exceed one cun, and the skin thickens by a fen; the needle depth need not exceed two fen. If on the back, where swelling may be three or four cun high, the needle depth is only about one cun. Moreover, the tissue at the site is already necrotic; what pain could there be? What damage could occur? Weak individuals, or those with deep-seated bone abscesses, who wait for spontaneous rupture often suffer extensive ulceration, failure to heal, depletion of qi and blood, and death.
A male patient who neglected his daily routine and diet presented with local redness, swelling, pain, and a surging, rapid chi pulse. Two doses of Huanglian Xiaodu San (Coptis Decoction for Detoxification) quickly cleared damp-heat, leaving only hard swelling and pain. Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) with Chenpi (Citri Reticulatae Pericarpium) was used to support the interior and expel pus. Desiring complete resolution, he self-prepared and took two doses of Huanglian Xiaodu San, which resulted in hardened swelling without suppuration, leading him to realize his error. He then took Shixuan San (Ten-Auspicious Powder) with added Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), and Banxia (Pinelliae Rhizoma). The swelling slightly subsided; Guizhi (Cinnamomi Ramulus) was removed, and after four more doses, pus formed and swelling decreased. Subsequently, Bazhen San (Eight-Treasure Powder) with added Huangqi (Astragali Radix), Wuweizi (Schisandrae Fructus), and Maidong (Ophiopogonis Radix) was given. Over a month later, the sore ulcerated and healed. Bitter-cold herbs, while treating yang syndromes, must distinguish between exterior/interior and deficiency/excess, adhering to sequence and timing. One cannot use them exclusively throughout. However, local redness, swelling, pain, and a rapid chi pulse that feels soft upon pressure indicate excess damp-heat in the Bladder channel. Thus, Huanglian Xiaodu San (Coptis Decoction for Detoxification) was used to clear heat and dry dampness. The persistence of the head swelling was due to heat-toxin steaming and qi-blood stagnation. Sweet-warm formulas should be used to tonify yang qi and support the interior to promote suppuration. Since this syndrome originates from the Du vessel due to yin deficiency and fire excess, failing to investigate the cause and using only bitter-cold herbs will chill the stomach and weaken qi, hindering suppuration and healing, potentially leading to decay. Sores that easily dissipate, suppurate, and heal do so because of robust qi and blood.
Attached Formulas:
Huanglian Xiaodu San (Coptis Decoction for Detoxification): Treats brain carbuncles or back carbuncles. Indicated when swelling spreads outward, pain occurs, or there is absence of pain/numbness. Garlic-separated moxibustion is also recommended.
Ingredients: Huanglian (Coptidis Rhizoma, wine-treated), Qianghuo (Notopterygii Rhizoma et Radix), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix, wine-treated), Shengdihuang (Rehmanniae Radix), Zhimu (Anemarrhenae Rhizoma), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Dangguiwei (Angelicae Sinensis Radix caulis, wine-treated), Gancao (Glycyrrhizae Radix et Rhizoma, stir-fried). Each 5 fen. Prepare as one dose with 2 zhong of water and 3 slices of ginger. Decoct to 8 fen. Take after meals.
Xianfang Huoming Yin (Immortal Life Elixir) (See section on Back Carbuncle)
Garlic-Separated Moxibustion Method (See section on Back Carbuncle)
Huaihua Jiu (Sophora Flower Wine) (See section on Back Carbuncle)
Qingliang Yin (Cooling Decoction) (See section on Back Carbuncle)
Siwu Tang (Four Substances Decoction) (See section on Scrofula)
Jiajian Bawei Wan (Modified Eight-Ingredient Pill) (See section on Thirst)
Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) (See section on Ulcerative Fever)
Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) (See section on Chancre)
Liangge San (Cooling the Diaphragm Powder) (See section on Thirst)
Ershen Wan (Two-Essence Pill) (See section on Vomiting)
Liujunzi Tang (Six-Gentlemen Decoction) (See section on Vomiting)
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) (See section on Hemorrhoids and Fistula)
Jinyinhua San (Lonicera Powder) (See section on Vomiting)
Tuoli San (Interior-Supporting Powder) (See section on Swollen Ulcer)
Xiao Chaihu Tang (Minor Bupleurum Decoction) (See section on Scrofula)
Tuoli Xiaodu San (Interior-Supporting and Detoxifying Decoction) (See section on Swollen Ulcer)
Jingfang Baidu San (Ephedra and Saposhnikovia Resolving Toxin Powder) (See section on Ulcerative Fever)
Shixuan San (Ten-Auspicious Powder) (See section on Back Carbuncle)
Bazhen Tang (Eight-Treasure Decoction) (See section on Ulcerative Fever)
Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) (See section on Vomiting)