寒热作痛，皮肤壮热，口渴烦躁，饮食如常，大便秘硬，小便赤涩，脓出稠粘，脓尽收敛，
为实证易治。气血虚弱者，塌而不起，虽肿不赤而软慢，肌寒肢冷，自汗色脱，食少懒言，小便
自利，大便滑泄，不起不腐，脓少而清，极难收敛。切忌攻伐，专宜温补，此虚寒证难治。小按
即痛者，脓浅为实；重按乃痛者，脓深为虚。按之不复起者无脓，乃清水也。按之即复者，有脓
也。脓出反痛者，虚也，宜补。有脓多者，亦气血虚而不能禁固也。有肿高而软者，此膀胱经络
从背起也。岂可概以为热而用凉药？
溃后脉涩迟缓者易愈，细而沉、时直者里虚。若痛尚未痊，脉洪滑粗散者难治，以正虚邪实也。
发热而渴，脉虚而大，乃真气虚、邪气盛，不治。凡肿坚硬而无光泽，皮浓疮头如粟，脉洪大，
按之涩，此精气已绝，不治。如未穿破，毒攻脏腑，一毫热药不可用；若已破溃，脏腑既伤，饮
食少进，一毫冷药不可用。此亦言其常也，变者又宜斟酌。如毒成脓管寸长深满，脓血胶粘易治
，臭秽清水，血败气衰，阳绝阴盛不治。
夫人之一身，本于五脏，五脏皆本于胃气。邪气郁于胃中，胃气盛而体实，则邪气相搏而流
注于经络。涩于所滞，血脉会聚，结而为痈。胃气弱而体虚，则邪气盛而宿于经络，阻于所行，
血脉凝留，结而为疽。故曰∶外如粟，内如 ；外如钱，内着拳。虽因荣卫不调，经络凝滞，致病
之由，非止于此。究其源有五∶一、天行时气。二、七情气郁。三、体虚外感。四、蕴热搏于风
冷。五、食膏粱浓味，腥膻热毒。又云∶一、天行。二、疲弱气滞。三、怒气。四、肾经虚，五
、服法酒，服丹药，食炙爆物，及大怒郁愤，尽力房劳，精虚气耗。皆能致发背、搭手、脑疽、
大疔、悬痈、脚发、乳痈诸般肿毒之证。
寒热交替并伴有疼痛，皮肤高热，口渴烦躁，饮食正常，大便秘结坚硬，小便短赤涩痛，脓液流出稠厚粘腻，待脓液排尽后伤口收敛，这属于实证，容易治疗。气血虚弱的人，疮口塌陷不起，虽然肿胀但不发红且质地软慢，肌肉寒冷四肢发冷，自汗出面色苍白无华，食欲减退懒于言语，小便清长自利，大便滑泄不禁，疮口不隆起也不化腐生肌，脓液少而清稀，极难收敛。此时切忌使用攻伐之法，专门适宜温补，这是虚寒证，难以治疗。轻轻按压即感到疼痛的，说明脓液位置浅，属实证；用力按压才感到疼痛的，说明脓液位置深，属虚证。按压后凹陷不复起的，没有脓液，只是清水罢了。按压后立即回弹的，是有脓液的表现。脓液排出后反而疼痛的，是虚证，应当补益。脓液多的，也是由于气血虚弱不能固摄所致。如果肿块高突但质地柔软，这是因为膀胱经络从背部起始的缘故。怎么能一概认为是热证而使用凉药呢？
溃破之后脉象涩滞迟缓的，容易痊愈；脉象细弱沉取、时而直硬的，是里气虚弱。如果疼痛尚未痊愈，脉象洪大滑数粗散乱的，难以治疗，因为正气虚弱邪气实盛。发热且口渴，脉象虚大而空的，是真气虚弱、邪气亢盛，属于不治之症。凡是肿块坚硬而无光泽，皮厚疮头像粟米一样，脉象洪大，按压时感觉涩滞的，这是精气已经枯竭，属于不治之症。如未穿破，毒邪攻冲脏腑，一毫热性药物不可用；如果已经破溃，脏腑既已受伤，饮食少量进服，一毫寒凉药物不可用。这也是说通常的情况，变化者又应当斟酌处理。如毒邪形成脓管寸许长深满，脓血胶粘容易治疗；若脓液臭秽如清水，血败气衰，阳绝阴盛，则属不治之症。
人的身体，根本在于五脏，五脏的根本在于胃气。邪气郁结在胃中，如果胃气旺盛而体质结实，那么邪气相互搏结而流注于经络。涩滞在停滞之处，血脉汇聚，凝结而成痈。如果胃气虚弱而体质亏虚，那么邪气亢盛而留宿于经络，阻遏于运行之道，血脉凝滞停留，凝结而成疽。所以说：外表像粟米一样小，内部却像谷子一样大；外表像铜钱一样大，内部却像拳头一样大。虽然是因为营卫不调，经络凝滞致病，但致病的缘由，不止于此。究其根源有五种：一、天行时气（流行性疫病之气）。二、七情气郁（情绪抑郁导致的气机阻滞）。三、体虚外感（体质虚弱感受外邪）。四、蕴热搏于风冷（体内蕴积的热邪与风寒相搏结）。五、食膏粱浓味，腥膻热毒（食用肥甘厚味、腥膻及热毒食物）。又有说法认为：一、天行（疫气）。二、疲弱气滞（疲劳虚弱导致气机阻滞）。三、怒气（愤怒情绪）。四、肾经虚（肾经虚弱）。五、服法酒，服丹药，食炙爆物，及大怒郁愤，尽力房劳，精虚气耗（服用烈酒，服用丹药，食用烤炸食物，以及大怒郁愤，过度房事，导致精亏气耗）。这些都能导致发背、搭手、脑疽、大疔、悬痈、脚发、乳痈等各种肿毒病症。
Alternating chills and fever accompanied by pain, high skin temperature, thirst with irritability, normal diet, constipation with hard stools, scanty dark and astringent urination, thick and sticky pus discharge, and wound contraction after pus exhaustion, indicate an Excess syndrome (Excess pattern) which is easy to treat. In cases of Qi and Blood deficiency, the sore collapses and does not rise; although swollen, it is not red and feels soft and slow; muscles are cold, limbs are chilly, spontaneous sweating occurs, complexion is pale and devoid of luster, appetite is poor, speech is reluctant, urination is clear and frequent, stool is slippery and incontinent, the sore does not elevate nor putrefy, pus is scanty and clear, making contraction extremely difficult. Attack and purging methods must be strictly avoided; warm tonification is specifically indicated. This is a Deficient-Cold syndrome (Deficient-Cold pattern) which is difficult to treat. Tenderness upon light palpation indicates shallow pus, signifying an Excess condition; tenderness only upon heavy pressure indicates deep pus, signifying a Deficiency condition. If depression persists after pressing, there is no pus, only clear fluid. If it rebounds immediately after pressing, pus is present. Pain that worsens after pus discharge indicates Deficiency, requiring tonification. Abundant pus may also result from Qi and Blood deficiency failing to secure and contain. If swelling is high but soft, this relates to the Bladder meridian originating from the back. How can one generally assume it is Heat and use cooling herbs?
After ulceration, if the pulse is choppy and slow, recovery is easy; if fine and deep, occasionally straight and rigid, it indicates Interior Deficiency. If pain has not yet resolved, and the pulse is surging, slippery, coarse, and scattered, treatment is difficult due to Deficient Zheng Qi (Upright Qi) and Excess Xie Qi (Pathogenic Qi). Fever with thirst, and a pulse that is deficient and large/empty, indicates True Qi deficiency and Pathogenic Qi excess, constituting an untreatable condition. Whenever swelling is hard without luster, skin is thick with pustules like millet grains, and the pulse is surging and large but choppy upon pressure, Essence and Qi have exhausted, constituting an untreatable condition. If not yet broken, and toxic heat attacks the Zang-Fu organs, no hot herbs should be used at all; if already ulcerated, and Zang-Fu organs are injured with minimal food intake, no cold herbs should be used at all. This describes the general rule; variations require careful consideration. If toxic heat forms a pus tube inch-deep and full, with sticky pus and blood, it is easy to treat; if pus is foul-smelling like clear water, blood fails, Qi declines, Yang is exhausted and Yin is excessive, it is untreatable.
The human body is rooted in the Five Zang organs, and the Five Zang organs are rooted in Stomach Qi. When pathogenic factors stagnate in the Stomach, if Stomach Qi is robust and the constitution solid, pathogenic factors contend and flow into the meridians. Stagnating where blocked, blood vessels converge, knotting to form a carbuncle (Yong). If Stomach Qi is weak and the constitution deficient, pathogenic factors become excessive and lodge in the meridians, obstructing their course, causing blood vessels to coagulate and remain, knotting to form a deep abscess (Ju). Thus it is said: externally like millet, internally like grain; externally like a coin, internally like a fist. Although caused by disharmony of Ying and Wei (Nutritive and Defensive Qi) and meridian stagnation, the causes of disease are not limited to this. Investigating the source, there are five: 1. Seasonal epidemic qi (Tianxing Shiqi); 2. Emotional Qi stagnation (Seven Emotions Qi Yu); 3. Constitutionally deficient with external invasion (Ti Xu Wai Gan); 4. Accumulated heat contending with wind-cold (Yun Re Bo Feng Leng); 5. Consumption of rich, greasy, strong-flavored foods, fishy, mutton-like, and heat-toxic substances. Another view states: 1. Epidemic qi (Tianxing); 2. Fatigue and weakness leading to Qi stagnation (Pi Ruo Qi Zhi); 3. Anger (Nu Qi); 4. Kidney Meridian deficiency (Shen Jing Xu); 5. Consuming strong wine, taking elixirs, eating roasted/fried foods, along with great anger, depression, resentment, excessive sexual activity, leading to Essence deficiency and Qi consumption. All these can lead to various swelling and toxicity conditions such as Back Carbuncle (Fa Bei), Hand-Reach Abscess (Da Shou), Brain Carbuncle (Nao Ju), Large Ding (Da Ding), Suspended Carbuncle (Xuan Yong), Leg Outbreak (Jiao Fa), and Breast Carbuncle (Ru Yong).