万绪，一病必有一病之主方。外科不过托毒清火，及生肌长肉等数法耳。即有加减，亦惟随症选择几
味，无多法也。学人果能将药性细细参考，自能随症施治，投无不利。
缪仲淳治疔疽及一切肿毒方∶生甘菊连根打碎，一两五钱；紫花地丁五钱；甘草用水炙，三钱；
鼠粘子炒
研，一钱五分；栝蒌根二钱；贝母三钱；金银花五钱；白芷一钱五分；生地三钱；白芨三钱；连翘二
钱五分；五爪龙（即茜根）五钱。先用夏枯草六两，河水六碗，煎三大碗，去渣，入煎药一碗，不
拘时服。溃后，加盐水炒黄 五钱，麦冬五钱。
又围阴症疮疡方∶红药子四两，白芨一两五钱，白蔹一两五钱，乳香六钱，没药六钱，朱砂三钱，
雄黄三钱，麝香一钱，冰片一钱，黑狗下颏一个， 存性，豌豆粉一两。各另研极细末和匀，以醋蜜
调敷四围，以极滚热醋蘸润。亦可服。
薛立斋治一男子，患脑疽，其头数多，痛不可忍，先服黄连消毒散不应。更以忍冬酒服之即酣睡，
觉而势去六七，再四剂而消。又一男子所患尤甚，亦令服之，肿痛顿退。但不能平，加以黄 、当归、
栝蒌、白芷、甘草节、桔梗，数剂而愈。
举人潘光甫，年四十，患脑疽 肿。诊其脉沉静，谓阳症阴脉，断不起，已而果然。盖疮疡之症，
虽属心火，尤当分表里虚实。果元气充实，内有实火者，寒剂或可责效。若寒凉过度，使胃寒脾弱，
阳变阴，或结而不溃，溃而不敛，阴阳乖戾，水火交争，死无日矣。
一老妇患脑疽，禀壮实，溃而痛不止，脉实便秘，与清凉饮二剂而痛止，更以消毒托里药而愈。
一老人患此症，色赤肿痛，脉数而有力，与黄连消毒散，二剂少愈。更以清心莲子饮，四剂而愈。
一男子患此症，肿痛脉数，以黄连消毒散，二剂少退。以仙方活命饮，二剂而止。更以芎、归、
白芍、银花、知、柏而溃。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，毒尚
在。与仙方活命饮二剂，肿痛退半。与二神丸及六君子汤加五味、麦冬、枣仁，四剂诸症少退，饮食
少进，睡亦少得。
又与 芩白术散，数服饮食少进。又与十全大补汤加银花、白芷、桔梗，月余而瘥。
一老人面赤肿痛，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。
一妇人患此症，脓熟不溃，胀痛欲呕，饮食少思，急针之，与托里药而愈。又一妇人患之，不甚
痛，不作脓，以托里消毒散，脓成针之，补以托里药而愈。
一老人患此症，脓清兼作渴，脉软而涩，以为气血俱虚，用八珍汤加黄 、五味子。彼不信，及
服降火之剂，果反作呕，少食。始信，服香砂六君子汤四剂，呕止食进，仍投前汤四剂而愈。
一男子患此症，脓成未溃，兼作渴，尺脉大而无力，以四物汤加知、柏、麦冬、黄 ，四剂而渴
减。又与加味八味丸，渴止疮溃。更用托里药兼前丸而愈。
一男子患此症，肿痛脉数，以荆防败毒散，二剂而痛止。更以托里消毒药而消。
一男子患此症， 肿疼痛，发热饮冷，脉洪数，与凉膈散二剂而止。以金银花四剂，散而溃，更
以托里药而愈。
一老妇患此症，禀实，溃而痛不止，脉实便秘，服清凉饮二剂而止，更以托里消毒药而愈。
一男子患此症，肿硬不作脓，惟疮口出水，痛甚，以仙方活命饮，二剂痛止。而脓成针之，更以
托里药而愈。常见脓清而补不应，及不痛或木闷坚硬者，俱不治。
一男子患此症，脓将成，微痛兼渴，尺脉大而无力。此阴虚火动之症。彼谓心经热毒，自服清凉
降火药愈炽。复求治，乃以四物汤加知、柏、五味、麦冬、黄 ，及加减八味丸，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，乃膀胱肾脉阴气不足，阳火炽盛而出
也。岂可专泥于火，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。更以托里
消毒散数剂，脉滑数，此脓已成矣，宜针之。彼畏而不肯用，因痛极始针之，出脓碗许。以托里药，
两月余始愈。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，入针止寸许，况患处肉
已坏矣，何痛之有？何伤之虑？怯弱之人，又患附骨疽，待脓自通，以致大溃，不能收敛，气血沥尽
而亡者多矣。（用针之法。）
一男子素不慎起居饮食，脑忽 赤肿痛，尺脉洪数，以黄连消毒散二帖，湿热顿退。惟肿硬作痛，
以仙方活命饮二帖，肿痛悉退。但疮头不消，投十宣去桂，加银花、 本、白术、茯苓、陈皮，以托
里排脓。彼欲全消，自制黄连消毒散二帖，反肿硬不作脓，始悟。仍用十宣加白术、茯苓、半夏，肿
少退，乃去桂，又四剂而脓成，脓势亦退。继以八珍散加黄 、五味、麦冬，月余脓溃而愈。夫苦寒
之药，虽治阳症，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，以解毒除湿。肿硬作痛，乃气血凝滞不行而作也，遂用仙方活
命饮，以散结消毒破血。其疮头不消，盖因热毒熏蒸，气血凝滞而然也，宜用甘温之剂，补益阳气，
托里以腐之。况此症原属督脉经阴虚火盛而出，若不审其因，专用苦寒之剂，使胃气弱，何以腐化收
敛，何不致于败耶？凡疮之易消散，易腐溃，易收敛，皆气血壮盛故也。
汪太常太夫人，年逾八十，脑疽已溃，发背继生，头如粟许，脉大无力，此膀胱经湿热所致。夫
脉无力，乃血气衰也，遂以托里消毒药数服，稍可。更加参、 之剂，虽起而作渴。此气血虚甚，以
人参、黄 各一两，当归、熟地各五钱，麦冬、五味各一钱，数服渴止而不溃。以前药加肉桂，十余
剂，脓成针之，瘀肉渐腐，徐
徐取去。而脓犹清不敛，投以大剂十全大补汤加白蔹、贝母、远志，三十余剂，脓稠而愈。凡患者气
质素实，或有痰，不服补剂，不知脓血出多，气血并虚，岂不宜补？尝治疮，阴用参、 大补之剂，
阳用败毒之方与服之，服不中满，疮亦有效。虚甚者，尚加姜、桂及附子也。
一男子患脑疽，肿高作痛，肿处敷药，痛虽止，而色变黯。肿外作痛，仍敷之，肉色亦黯，喉肉
不痛不肿。此为凉药所误，及尽颈敷之，其颈皆溃而死。
朱丹溪治元杜清碧，学道武夷，至婺源病脑疽，自治不愈。朱往视之，曰∶何不服防风通圣散？
清碧曰∶服数次矣。朱曰∶盍以酒制之？清碧乃悟，服不尽剂而愈。自此心服丹溪。（《续医说》。）
窦材治一人，病脑疽，六日危笃，不进饮食。窦曰∶年高肾虚，邪气滞经也。令服救生汤，即刻
减半，夜间再进一服全安。
一老妇脑后作痛，筋拘急。窦曰∶此欲发脑疽也。急服救生汤，三服全愈。
万病之理，一种疾病必然有一个针对该病的主治方剂。外科治疗不过是用托毒、清火以及生肌长肉等几种方法罢了。即使有加减变化，也只是根据症状选择几味药物，并没有太多复杂的方法。医者如果能够将药性细细参考研究，自然能够随症施治，投药无不奏效。
缪仲淳治疗疔疽及一切肿毒的方子：生甘菊连根打碎，一两五钱；紫花地丁五钱；甘草用水炙过，三钱；鼠粘子（牛蒡子）炒后研碎，一钱五分；栝蒌根二钱；贝母三钱；金银花五钱；白芷一钱五分；生地三钱；白芨三钱；连翘二钱五分；五爪龙（即茜草根）五钱。先用夏枯草六两，河水六碗，煎煮成三大碗，去渣，取其中一碗药汁加入上述煎好的药液中，不拘时间服用。溃烂后，加盐水炒过的黄芪五钱，麦冬五钱。
又一方用于治疗阴证疮疡：红药子四两，白芨一两五钱，白蔹一两五钱，乳香六钱，没药六钱，朱砂三钱，雄黄三钱，麝香一钱，冰片一钱，黑狗下颏一个（煅存性），豌豆粉一两。各药分别研成极细末并混合均匀，用醋和蜜调匀敷在疮口四周，并用极滚热的醋蘸湿润敷。此方也可以内服。
薛立斋治疗一名男子，患脑疽，疮头很多，疼痛难忍，先服用黄连消毒散无效。改用忍冬酒服用后即酣睡，醒来后病情去除了六七成，再服四剂而痊愈。另一名男子患病更重，也让他服用此药，肿痛顿时消退。但未能完全平复，于是加上黄芪、当归、栝蒌、白芷、甘草节、桔梗，数剂后痊愈。
举人潘光甫，四十岁，患脑疽肿胀。诊其脉象沉静，认为是阳证见阴脉，断定无法治愈，后来果然如此。大概疮疡之症，虽然属于心火，尤其应当分辨表里虚实。如果元气充实，内有实火的，寒凉药剂或许可以见效。若寒凉过度，导致胃寒脾弱，阳气变为阴气，或者结聚而不溃破，溃破而不收敛，阴阳乖戾，水火交争，离死就不远了。
一位老妇人患脑疽，体质壮实，溃烂后疼痛不止，脉象实大且便秘，给予清凉饮两剂后疼痛停止，再用消毒托里药而痊愈。
一位老人患此症，面色红赤，肿痛，脉数而有力，给予黄连消毒散，两剂后稍有好转。再用清心莲子饮，四剂后痊愈。
一名男子患此症，肿痛且脉数，用黄连消毒散，两剂后稍退。用仙方活命饮，两剂后疼痛停止。再用川芎、当归、白芍、金银花、知母、黄柏使疮溃破。后用托里药而痊愈。
一名男子头项俱肿，虽然已大溃，但肿痛反而加重，兼有腹泻，烦躁不眠，饮食减少，形势可畏。诊其脉，认为毒邪尚在。给予仙方活命饮两剂，肿痛退去一半。给予二神丸及六君子汤加五味子、麦冬、枣仁，四剂后诸症稍退，饮食稍进，睡眠也稍得改善。
又给予黄芩白术散，数服后饮食稍进。又给予十全大补汤加金银花、白芷、桔梗，月余后痊愈。
一位老人面赤肿痛，脉数而有力，给予黄连消毒散，两剂后稍退。再用清心莲子饮，四剂后消散。
一名妇人患此症，脓熟但不溃破，胀痛欲呕，饮食少思，急行针刺，给予托里药而痊愈。另一名妇人患此症，疼痛不剧烈，不生脓，用托里消毒散，脓成后针刺，再用托里药补益而痊愈。
一位老人患此症，脓液清稀且口渴，脉软而涩，认为是气血俱虚，用八珍汤加黄芪、五味子。患者不信，自行服用降火药剂，果然反作呕吐，食量减少。始信医言，服用香砂六君子汤四剂，呕吐止而进食增加，仍投前药八珍汤四剂而痊愈。
一名男子患此症，脓成未溃，兼有口渴，尺脉大而无力，以四物汤加知母、黄柏、麦冬、黄芪，四剂后口渴减轻。又给予加味八味丸，口渴止而疮溃。再用托里药兼服前丸而痊愈。
一名男子患此症，肿痛脉数，用荆防败毒散，两剂后疼痛停止。再用托里消毒药而消散。
一名男子患此症，红肿疼痛，发热喜冷饮，脉洪数，给予凉膈散两剂后停止。用金银花四剂，消散而溃破，再用托里药而痊愈。
一位老妇人患此症，体质壮实，溃烂后疼痛不止，脉实便秘，服用清凉饮两剂后停止，再用托里消毒药而痊愈。
一名男子患此症，肿硬不生脓，仅疮口出水，疼痛剧烈，用仙方活命饮，两剂后疼痛停止。脓成后针刺，再用托里药而痊愈。常见脓液清稀而补益无效，以及不痛或麻木闷胀坚硬者，均属不治之症。
一名男子患此症，脓将成，微痛兼渴，尺脉大而无力。这是阴虚火动之症。患者自认为是心经热毒，自行服用清凉降火药使病情加剧。复求治疗，乃以四物汤加知母、黄柏、五味子、麦冬、黄芪，及加减八味丸，口渴止而疮溃，再用托里药兼服前丸而痊愈。《中藏经》说：痈疽疮肿的发生，都是五脏六腑蓄积毒邪不能流通所致，并非仅仅是营卫壅塞而发。其发病部位有定处，主治也有归属。例如发于喉舌的，是心之毒；发于皮毛的，是肺之毒；发于肌肉的，是脾之毒；发于骨髓的，是肾之毒；发于下方的，是阴中之毒；发于上方的，是阳中之毒；发于外的，是六腑之毒；发于内的，是五脏之毒。所以内陷叫坏，外溃叫溃，向上发展的叫从，向下发展的叫逆。发于上方的病来得快，发于下方的病来得慢。感于六腑的容易治，感于五脏的则难治。看这一点，则脑疽发作，乃是膀胱肾脉阴气不足，阳火炽盛而出。岂可专泥于火，而不滋益阴气呢？
一名男子耳后漫肿作痛，肉色不变，脉微数，用小柴胡汤加川芎、当归、桔梗，四剂后肿势稍起。再用托里消毒散数剂，脉滑数，这是脓已成，宜针刺。患者畏惧不肯用，因疼痛极甚才针刺，流出脓液约一碗。用托里药，两个多月才痊愈。凡疮不起发的，用托法使其起发，不成脓的，用补法使其成脓，使毒邪不内攻。脓成而及时针刺，不数日即愈了。常见患者都畏惧针痛而不肯用，又有恐伤良肉而不肯用。殊不知疮虽发于肉薄之处，若脓成，其肿亦高寸余，疮皮又厚分许，用针深不过二分。若发于背部肿，高必有三四寸，入针只一寸许，何况患处肉已坏死，有什么痛楚？有什么损伤的顾虑？怯弱之人，又患附骨疽，等待脓液自通，以致大溃，不能收敛，气血沥尽而亡者多矣。（这是关于用针的方法。）
一名男子平时不注意起居饮食，头部忽然红肿疼痛，尺脉洪数，用黄连消毒散两帖，湿热顿退。惟独肿硬作痛，用仙方活命饮两帖，肿痛悉退。但疮头不消，投十宣散去桂枝，加金银花、藁本、白术、茯苓、陈皮，以托里排脓。患者想要完全消散，自制黄连消毒散两帖，反而肿硬不作脓，这才醒悟。仍用十宣散加白术、茯苓、半夏，肿势稍退，乃去桂枝，又四剂后脓成，脓势亦退。继以八珍散加黄芪、五味子、麦冬，月余后脓溃而痊愈。苦寒之药，虽治阳证，尤其应当分表里虚实，次第时宜，岂可始终都用它？然而红肿赤痛，尺脉数，按之则濡，是膀胱湿热壅盛也，故用黄连消毒散，以解毒除湿。肿硬作痛，是气血凝滞不行而作也，遂用仙方活命饮，以散结消毒破血。其疮头不消，盖因热毒熏蒸，气血凝滞而然也，宜用甘温之剂，补益阳气，托里以腐之。况且此症原属督脉经阴虚火盛而出，若不审其因，专用苦寒之剂，使胃气弱，何以腐化收敛，何不致于败耶？凡疮之易消散，易腐溃，易收敛，皆气血壮盛故也。
汪太常太夫人，年逾八十，脑疽已溃，发背继生，头如粟米大小，脉大无力，这是膀胱经湿热所致。脉无力，是血气衰也，遂以托里消毒药数服，稍可。更加人参、黄芪之剂，虽起而作渴。这是气血虚甚，以人参、黄芪各一两，当归、熟地各五钱，麦冬、五味子各一钱，数服后渴止而不溃。以前药加肉桂，十余剂，脓成针刺，瘀肉渐腐，徐徐取去。而脓犹清不敛，投以大剂十全大补汤加白蔹、贝母、远志，三十余剂，脓稠而愈。凡患者气质素实，或有痰，不服补剂，不知脓血出多，气血并虚，岂不宜补？尝治疮，阴用参、芪大补之剂，阳用败毒之方与服之，服不中满，疮亦有效。虚甚者，尚加姜、桂及附子也。
一名男子患脑疽，肿高作痛，肿处敷药，痛虽止，而色变黯。肿外作痛，仍敷之，肉色亦黯，喉肉不痛不肿。此为凉药所误，及尽颈敷之，其颈皆溃而死。
朱丹溪治疗元朝杜清碧，学道武夷，到婺源患脑疽，自治不愈。朱丹溪前往探望，说：为何不服防风通圣散？杜清碧说：服数次了。朱丹溪说：何不加以酒制？杜清碧才领悟，服不尽剂而痊愈。从此心服丹溪。（《续医说》。）
The principle of myriad diseases is that every disease must have a primary prescription for its treatment. Surgical medicine merely employs a few methods such as expelling toxins, clearing fire, and generating flesh to promote healing. Even with modifications, one only selects a few herbs based on symptoms; there are not many complex methods. If practitioners can carefully study the properties of medicines, they will naturally be able to treat according to symptoms, and their prescriptions will invariably be effective.
Miao Zhongchun's prescription for treating ding carbuncles (malignant furuncles) and all kinds of swelling and toxicity: Raw Chrysanthemum Indicum (Gan Ju) with roots, crushed, 1.5 liang; Purple Flower Siegesbeckia Orientalis (Zi Hua Di Ding), 5 qian; Licorice Root (Gan Cao) honey-fried, 3 qian; Burdock Fruit (Niu Bang Zi) fried and ground, 1.5 qian; Trichosanthes Root (Gua Lou Gen), 2 qian; Fritillaria Bulb (Bei Mu), 3 qian; Honeysuckle Flower (Jin Yin Hua), 5 qian; Angelica Dahurica (Bai Zhi), 1.5 qian; Rehmannia Root (Sheng Di), 3 qian; Bletilla Rhizome (Bai Ji), 3 qian; Forsythia Fruit (Lian Qiao), 2.5 qian; Five-claw Dragon (Wu Zhao Long, i.e., Rubia Cordifolia root / Qian Gen), 5 qian. First, decoct six liang of Prunella Vulgaris (Xia Ku Cao) in six bowls of river water until reduced to three bowls, strain, take one bowl of this decoction and mix it with the previously prepared herbal mixture. Take at any time. After ulceration, add Astragalus Root (Huang Qi) stir-fried with salt water, 5 qian, and Ophiopogon Tuber (Mai Dong), 5 qian.
Another prescription for treating yin-pattern sores and ulcers: Polygonum Multiflorum Vine (Hong Yao Zi), 4 liang; Bletilla Rhizome (Bai Ji), 1.5 liang; Ampelopsis Rhizome (Bai Lian), 1.5 liang; Frankincense (Ru Xiang), 6 qian; Myrrh (Mo Yao), 6 qian; Cinnabar (Zhu Sha), 3 qian; Realgar (Xiong Huang), 3 qian; Musk (She Xiang), 1 qian; Borneol (Bing Pian), 1 qian; One lower jaw of a black dog (preserved by calcination), Pea Flour (Wan Dou Fen), 1 liang. Grind each herb into an extremely fine powder and mix evenly. Apply around the sore using vinegar and honey as a vehicle, moistening with very hot vinegar. This can also be taken internally.
Xue Lizhai treated a man suffering from a brain carbuncle (Nao Ju) with numerous heads, unbearable pain. He first took Huanglian Xiaodu San (Coptis Decoction for Disinfecting Toxins) without effect. He then took honeysuckle wine and fell into a deep sleep. Upon waking, the condition had improved by sixty or seventy percent. After four more doses, he recovered. Another man suffered even more severely; upon taking the same remedy, his swelling and pain subsided instantly. However, it did not completely resolve, so Huang Qi (Astragalus), Dang Gui (Angelica Sinensis), Gua Lou (Trichosanthes), Bai Zhi (Angelica Dahurica), Gan Cao Jie (Licorice Knots), and Jie Geng (Platycodon) were added. After several doses, he healed.
Pan Guangfu, a Juren degree holder, aged forty, suffered from a swollen brain carbuncle. His pulse was calm and still. Xue diagnosed this as a yang-pattern disease presenting with a yin-pulse, predicting death, which subsequently proved true. Generally, sores and ulcers, although belonging to heart-fire, require differentiation between exterior/interior and deficiency/excess. If vital qi is substantial and there is internal excess heat, cold-natured medicines may be effective. However, excessive use of cold and cooling agents causes stomach cold and spleen weakness, transforming yang into yin, leading to condensation without ulceration, or ulceration without healing. With yin-yang disharmony and conflict between water and fire, death is imminent.
An elderly woman with a robust constitution suffered from a brain carbuncle. After ulceration, pain persisted. Her pulse was excess-type, accompanied by constipation. She was given Qingliang Yin (Cooling Drink) for two doses, after which the pain stopped. She was then treated with disinfecting and supporting interior medicines and recovered.
An elderly man presented with redness, swelling, and pain, with a rapid and forceful pulse. He was given Huanglian Xiaodu San for two doses, showing slight improvement. He was then given Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) for four doses and recovered.
A man presented with swelling, pain, and a rapid pulse. Huanglian Xiaodu San was administered for two doses, resulting in slight reduction. Xianfang Huoming Yin (Immortal Life Preserving Powder) was given for two doses, stopping the pain. Then Chuan Xiong (Szechwan Lovage Rhizome), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Jin Yin Hua (Honeysuckle), Zhi Mu (Anemarrhena Rhizome), and Huang Bo (Phellodendron Bark) were used to induce ulceration. Finally, interior-supporting medicines were used for recovery.
A man presented with swelling of the head and neck. Although large ulcers had formed, swelling and pain worsened, accompanied by diarrhea, irritability, insomnia, and poor appetite. The situation was alarming. Pulse diagnosis indicated the toxin remained. Xianfang Huoming Yin was given for two doses, reducing swelling and pain by half. Er Shen Wan (Two Spirit Pill) and Liu Jun Zi Tang (Six Gentlemen Decoction) plus Wu Wei Zi (Schisandra), Mai Dong (Ophiopogon), and Zao Ren (Ziziphus Seed) were given for four doses. Symptoms slightly improved, appetite increased slightly, and sleep improved.
Huang Qin Bai Zhu San (Scutellaria and Atractylodes Macrocephala Powder) was then given for several doses, further improving appetite. Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) plus Jin Yin Hua, Bai Zhi, and Jie Geng was given for over a month until recovery.
An elderly man presented with facial redness, swelling, and pain, with a rapid and forceful pulse. Huanglian Xiaodu San was given for two doses, showing slight improvement. Qingxin Lianzi Yin was then given for four doses, resolving the condition.
A woman presented with ripe pus but no ulceration, distending pain, nausea, and poor appetite. Acupuncture was performed urgently, followed by interior-supporting medicines, leading to recovery. Another woman presented with mild pain and no pus formation. Tuoli Xiaodu San (Support Interior and Disinfect Toxin Powder) was given. Once pus formed, she was needled and treated with interior-supporting tonics for recovery.
An elderly man presented with clear thin pus and thirst, with a soft and choppy pulse. This was diagnosed as dual deficiency of qi and blood. Bazhen Tang (Eight Treasures Decoction) plus Huang Qi and Wu Wei Zi was prescribed. The patient disbelieved and took fire-clearing herbs instead, resulting in vomiting and reduced food intake. Believing the doctor finally, he took Xiang Sha Liu Jun Zi Tang (Amomum and Aucklandia Six Gentlemen Decoction) for four doses, stopping vomiting and improving appetite. He then took the previous Bazhen Tang for four more doses and recovered.
A man presented with formed but un-ulcerated pus and thirst, with a large and weak chi pulse. Si Wu Tang (Four Substances Decoction) plus Zhi Mu, Huang Bo, Mai Dong, and Huang Qi was given for four doses, reducing thirst. Jiawei Bawei Wan (Modified Eight-Ingredient Pill) was then given, stopping thirst and inducing ulceration. Interior-supporting medicines combined with the previous pill led to recovery.
A man presented with swelling, pain, and a rapid pulse. Jingfang Baidu San (Aucklandia and Saposhnikovia Decoction to Overcome Toxicity) was given for two doses, stopping pain. Tuoli Xiaodu medicines were then used to resolve the condition.
A man presented with red swelling, pain, fever, desire for cold drinks, and a surging rapid pulse. Liangge San (Cooling Chest Powder) was given for two doses, stopping symptoms. Jin Yin Hua was given for four doses, causing resolution and ulceration. Interior-supporting medicines completed the cure.
An elderly woman with a robust constitution presented with persistent pain after ulceration, excess pulse, and constipation. Qingliang Yin was given for two doses, stopping pain. Tuoli Xiaodu medicines completed the cure.
A man presented with hard swelling, no pus formation, only weeping from the wound, and severe pain. Xianfang Huoming Yin was given for two doses, stopping pain. Once pus formed, he was needled and treated with interior-supporting medicines for recovery. It is commonly seen that clear pus unresponsive to tonification, or non-painful, numb, stiff, and hard sores, are untreatable.
A man presented with impending pus formation, slight pain, and thirst, with a large and weak chi pulse. This was diagnosed as yin deficiency with hyperactive fire. The patient believed it was heart meridian heat-toxin and self-medicated with cooling fire-reducing herbs, worsening the condition. Seeking treatment again, Si Wu Tang plus Zhi Mu, Huang Bo, Wu Wei Zi, Mai Dong, and Huang Qi, along with Jiawei Bawei Wan, was prescribed. Thirst stopped, pus ulcerated, and interior-supporting medicines combined with the previous pill led to recovery. *Zhong Zang Jing* states: The occurrence of carbuncles, sores, and swellings is due to accumulated toxins in the five zang and six fu organs failing to circulate, not merely congestion of ying and wei. Their movement has specific locations, and their management has specific归 (orientations). For example, those appearing on the throat and tongue are toxins of the heart; on skin and hair, lung toxins; on muscles, spleen toxins; on bone marrow, kidney toxins; appearing below are yin toxins; appearing above are yang toxins; appearing externally are fu organ toxins; appearing internally are zang organ toxins. Therefore, internal sinking is called "huai" (ruin), external ulceration is "kui", upward progression is "cong" (following), and downward progression is "ni" (rebellious). Those appearing above develop quickly; those below develop slowly. Those affecting fu organs are easy to treat; those affecting zang organs are difficult. Observing this, a brain carbuncle arises from insufficiency of yin qi in the bladder and kidney meridians, with blazing yang fire. How can one focus solely on clearing fire without nourishing yin qi?
A man presented with diffuse swelling and pain behind the ear, unchanged skin color, and a slightly rapid pulse. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Chuan Xiong, Dang Gui, and Jie Geng was given for four doses, raising the swelling slightly. Tuoli Xiaodu San was given for several doses. The pulse became slippery and rapid, indicating pus formation, requiring acupuncture. Fearful, the patient refused until extreme pain forced him to undergo needling, yielding about a bowl of pus. Interior-supporting medicines were used, and he recovered after over two months. For sores that do not rise, use support to raise them; for those not forming pus, use tonification to generate them, preventing internal attack. Timely needling of formed pus leads to quick recovery. Patients often fear needle pain or damage to healthy flesh. However, even if the sore is on thin flesh, once pus forms, the swelling rises over an inch, and the skin thickens slightly. Needling depth should not exceed two fen. On the back, where swelling may be three or four inches high, needling depth is only about one cun. Since the tissue is already necrotic, why would it hurt? Why worry about damage? Weak individuals with osteomyelitis (Fu Gu Ju) waiting for spontaneous drainage often suffer massive ulceration, failure to heal, exhaustion of qi and blood, and death. (This concerns acupuncture techniques.)
A man who neglected diet and lifestyle suddenly developed red, swollen, painful head with a surging rapid chi pulse. Huanglian Xiaodu San for two doses cleared damp-heat. Hard swelling and pain remained. Xianfang Huoming Yin for two doses resolved swelling and pain. However, the sore head persisted. Shixuan San minus Gui Zhi, plus Jin Yin Hua, Gao Ben, Bai Zhu, Fu Ling, and Chen Pi was given to support interior and drain pus. Desiring complete resolution, the patient self-prescribed Huanglian Xiaodu San for two doses, causing re-hardening and lack of pus formation. Realizing his error, he returned to Shixuan San plus Bai Zhu, Fu Ling, and Ban Xia. Swelling subsided slightly. Gui Zhi was removed, and after four more doses, pus formed and subsided. Bajen San plus Huang Qi, Wu Wei Zi, and Mai Dong was given for over a month until pus drained and he recovered. Bitter-cold herbs treat yang patterns but require differentiation of exterior/interior and deficiency/excess, applied sequentially and appropriately. Can they be used throughout? Red, swollen, painful presentation with a rapid chi pulse that feels soft upon pressure indicates damp-heat stagnation in the bladder meridian, hence Huanglian Xiaodu San was used to detoxify and remove dampness. Hard swelling and pain indicate qi and blood stagnation, hence Xianfang Huoming Yin was used to dissipate nodules, detoxify, and break blood stasis. The persistent sore head was due to heat-toxin steaming and qi/blood stagnation, requiring sweet-warm herbs to tonify yang qi, support interior, and promote suppuration. This condition originally arose from yin deficiency and fire excess in the Du meridian. Without investigating the cause and using only bitter-cold herbs, stomach qi weakens, hindering suppuration and healing, leading to failure. Sores that easily dissipate, suppurate, and heal are due to strong qi and blood.
Madam Wang, Grand Secretary's mother, over eighty years old, had an ulcerated brain carbuncle followed by a back carbuncle, sized like millet grains. Pulse was large and weak, indicating damp-heat in the bladder meridian. Weak pulse indicates qi and blood decline. Tuoli Xiaodu medicines were given for several doses, providing slight relief. Ginseng and Astragalus were added. Although she rose, she became thirsty. This indicated severe qi and blood deficiency. Ren Shen (Ginseng) and Huang Qi (Astragalus) 1 liang each, Dang Gui (Angelica) and Shu Di (Prepared Rehmannia) 5 qian each, Mai Dong and Wu Wei Zi 1 qian each were given for several doses. Thirst stopped, but no ulceration. Rou Gui (Cinnamon Bark) was added to the previous formula. After ten-plus doses, pus formed and was needled. Necrotic tissue gradually rotted and was removed. Pus remained clear and failed to heal. Large doses of Shi Quan Da Bu Tang plus Bai Lian, Bei Mu, and Yuan Zhi were given for thirty-plus doses. Pus became thick, and she recovered. Patients with robust constitutions or phlegm often refuse tonics, unaware that profuse pus and blood loss lead to dual qi and blood deficiency, necessitating tonification. In treating sores, I use Yin-style major tonics (Ginseng, Astragalus) and Yang-style detoxifying formulas together. They do not cause fullness and are effective. For severe deficiency, Ginger, Cinnamon, and Aconite are added.
A man presented with a high, painful brain carbuncle. Topical application stopped pain but darkened the color. Pain outside the swelling persisted despite topical application, and flesh color turned dark. Throat flesh was neither painful nor swollen. This was a mistake caused by cooling herbs. Applying them over the entire neck led to widespread ulceration and death.
Zhu Danxi treated Du Qingbi, a Daoist scholar from Wuyi, who developed a brain carbuncle in Wuyuan and failed to heal himself. Zhu visited and asked, "Why not take Fangfeng Tongsheng San?" Du replied, "I have taken it several times." Zhu said, "Why not process it with wine?" Du understood, took the modified preparation, and recovered before finishing the dose. He thereafter deeply respected Danxi. (*Xu Yi Shuo*.)
Dou Cai treated a man with a brain carbuncle, critically ill on the sixth day, unable to eat. Dou said, "Advanced age, kidney deficiency, pathogenic qi stagnating in meridians." He prescribed Jiusheng Tang. Symptoms halved immediately. A second dose at night brought complete recovery.
An elderly woman presented with pain behind the ear and muscle spasms. Dou said, "This is about to become a brain carbuncle." Urgently prescribe Jiusheng Tang. Three doses led to complete recovery.