经曰∶汗之则疮已。又曰∶发表不远热。故疮疡初感,必以消散为最胜。内服发汗之剂,外
用蒜灸之法,靡不奏功。惟当审经络处所,形脉虚实,深浅大小,而兼引经之药。如脑、背、腰
、项、臀、 、
皆太阳经,宜黄连、羌活。脊背连胁处,为近少阳,宜败毒散。形实脉实者,宜漏芦汤、五利大
黄汤等疏利之。气虚,参、 为主;血虚,参、归为主。佐以消毒,加以引经,而行补泻。惟少
阳一经,与气血虚同法治。凡栝蒌、射干、山甲、蟾酥、连翘、地丁、牛蒡子、金银花、木鳖之
类,皆内消之药。
凡痈疽血气虚者,则邪气入深而散漫不能突起,亦难溃脓。或溃后脓少,或脓清稀,或坚硬
不软,或根脚虽红而脓不开大者,皆气血两虚。必用内托,以补药为君,活血驱邪为臣,辛香行
滞为佐,加温药以御虚寒。亦有一、二日便觉,脉沉细而烦闷,脏腑弱而皮寒,恍惚不宁。外证
深沉者,即当用托里诸方采择,兼温热之剂从治之。
疮疡穿破,脓血溃出,则重者亦觉轻可,甚不得已乃用刀针。若势缓证轻,以药饵破之。后
有替针丸之类,皆可用以咬头出脓。
经曰∶诸痛痒疮疡,皆属心火。后有止痛诸方。痛甚者,必宜苦寒药为主。虚弱者,补中益
气汤加
苦寒药,量轻重用。血热者,四物汤加牛蒡、黄芩、连翘、在下加黄柏。肥人加羌、防、荆、芷
。大便秘加大黄。诸药中兼乳香、没药,痛可定矣。
《黄帝内经》说:发汗治疗,疮疡即可痊愈。又说:发表解表不宜远离热性药物。因此,疮疡初起时,以消散为最佳疗法。内服发汗的药剂,外用蒜灸的方法,没有不奏效的。只是应当审察病变所在的经络部位、形体与脉象的虚实、病灶的深浅大小,并配合使用引经药。如脑、背、腰、项、臀、大腿后侧等部位,都属于太阳经,适宜使用黄连、羌活。脊背连接胁肋处,靠近少阳经,适宜使用败毒散。形体壮实、脉象有力者,适宜使用漏芦汤、五利大黄汤等具有疏泄通利作用的方剂。气虚者,以人参、白术为主;血虚者,以人参、当归为主。辅以消毒药物,加入引经药,从而实施补泻之法。只有少阳一经,按照气血两虚的方法同治。凡是栝蒌、射干、穿山甲、蟾酥、连翘、地丁、牛蒡子、金银花、木鳖子之类的药物,都是内消(通过内服药物使疮疡消散)的药。
凡是痈疽患者若气血虚弱,则邪气深入且扩散漫延,不能突起成脓,也难以溃破排脓。或者溃破后脓液稀少,或脓液清稀,或患处坚硬不软,或根部虽红但脓头不开大者,都是气血两虚的表现。必须使用内托法,以补益药为君药,活血驱邪药为臣药,辛香行滞药为佐药,加入温热药以抵御虚寒。也有一两天就出现感觉,脉象沉细而烦闷,脏腑虚弱而皮肤寒冷,神志恍惚不安的情况。外证表现深沉者,就应当选用托里诸方,并配合温热药剂进行从治(顺从病势假象而治)。
疮疡穿破,脓血流出,那么病情重的也会觉得减轻,实在不得已才用刀针切开。如果病势缓慢、症状轻微,用药物饵剂来破除。后来有替针丸之类,都可以用来腐蚀疮头排出脓液。
《黄帝内经》说:各种疼痛、瘙痒、疮疡,都归属于心火。后世有止痛的各种方剂。疼痛剧烈的,必须以苦寒药物为主。体质虚弱者,用补中益气汤加入苦寒药物,根据轻重程度用量。血热者,用四物汤加入牛蒡子、黄芩、连翘,病位在下部加黄柏。肥胖的人加羌活、防风、荆芥、白芷。大便秘结加大黄。在这些药物中兼用乳香、没药,疼痛就可以止住了。
The *Classic of Medicine* (Huangdi Neijing) states: "Sweating therapy will cure sores." It also states: "Releasing the exterior should not avoid hot-natured herbs." Therefore, in the initial stage of sores and ulcers, resolution through dispersion is considered the most superior approach. Internally administering diaphoretic formulas and externally applying garlic moxibustion are both effective methods. However, one must carefully examine the meridian location of the lesion, the deficiency or excess of the physical constitution and pulse, as well as the depth and size of the lesion, while incorporating guiding herbs. For areas such as the head, back, waist, neck, buttocks, and posterior thighs, which belong to the Taiyang Meridian (Greater Yang Meridian), Huanglian (Coptis Rhizome) and Qianghuo (Notopterygium Rhizome) are appropriate. The area connecting the spine and ribs is close to the Shaoyang Meridian (Lesser Yang Meridian), where Baidu San (Decoction for Resolving Toxins) is suitable. For patients with a robust physique and a forceful pulse, formulas with draining and purgative properties such as Loulu Tang (Loulu Decoction) and Wuli Dahuang Tang (Five Benefits Rhubarb Decoction) are appropriate. In cases of Qi deficiency, Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) serve as the main agents; in cases of Blood deficiency, Renshen (Ginseng Root) and Danggui (Angelica Sinensis Root) are primary. These are supplemented by detoxifying herbs and guiding herbs to implement tonification and purgation techniques. The Shaoyang Meridian alone is treated according to the same principles as Qi and Blood deficiency. Herbs such as Gualou (Trichosanthes Fruit), Shegan (Belamcanda Rhizome), Shanjia (Pangolin Scales), Chansu (Toad Venom), Lianqiao (Forsythia Fruit), Dingdu (Scutellaria Barbata Herb), Niubangzi (Arctium Fruit), Jinyinhua (Lonicera Flower), and Miebiezi (Momordica Seed) are all internal resolution (dispersing sores via internal medication) herbs.
In cases of carbuncles and malignant sores where Qi and Blood are deficient, pathogenic factors penetrate deeply and spread diffusely without forming distinct protrusions, making it difficult to suppurate. Alternatively, after ulceration, there may be scant pus, thin and clear pus, hardness without softening, or redness at the base without a large opening for pus discharge; these are all signs of dual deficiency of Qi and Blood. One must employ internal support (Neituo) methods, using tonifying herbs as the sovereign agent, blood-activating and pathogen-expelling herbs as the minister agents, acrid-aromatic qi-moving herbs as the assistant agents, and adding warm-natured herbs to counteract deficiency-cold. There are also cases presenting within one or two days with deep and fine pulses accompanied by restlessness, weak viscera, cold skin, and mental agitation. When external manifestations appear deep-seated, one should select from various internal support formulas and combine them with warm-natured decoctions for treating following the apparent syndrome.
When a sore or ulcer penetrates and pus and blood discharge, even severe cases may feel relief. Only when absolutely necessary should knife and needle incisions be used. If the condition is mild and slow-progressing, medicinal pastes or pills can be used to break the abscess. Later formulations such as Tizhen Wan (Needle-Replacement Pill) can be used to cauterize the head of the sore and expel pus.
The *Classic of Medicine* states: "All pain, itching, sores, and ulcers belong to Heart Fire." Subsequent texts provide various formulas for pain relief. In cases of severe pain, bitter-cold herbs should be the primary choice. For those with weakness, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Enrich the Qi) combined with bitter-cold herbs should be used, dosed according to severity. For Blood heat, Siwu Tang (Four Substance Decoction) combined with Niubangzi (Arctium Fruit), Huangqin (Scutellaria Root), and Lianqiao (Forsythia Fruit) is indicated; if the pathology is located below, add Huangbai (Phellodendron Bark). For obese individuals, add Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), and Baizhi (Angelica Dahurica Root). If constipation is present, add Dahuang (Rhubarb Root and Rhizome). Adding Xiangru (Frankincense) and Moyao (Myrrh) to these prescriptions will alleviate pain.