《灵枢》云∶发于胸，名曰井疽。其状如大豆，三四日起，不早治，下入腹不治，七
日死矣。 或问∶心窝生疽何如？曰∶此证初起如黄痘，肉色不变，名曰井疽，又名穿
心冷 。若冷气攻心，精神恍惚，呕吐冷痰，恶闻食臭，毒瓦斯内陷，腹胀满者，不治。若
心躁如焚，肌热如火，不时盗汗，唇焦舌干黄色，渴饮冷水者，是正候也。急服活命饮
加黄连、桔梗。胜金丹、夺命丹汗之。壮实者，一粒金丹下之。恶证多，治稍迟，多致
颠危，宜服犀角解毒丸。
《灵枢》云∶发于膺，（膺胸两旁高处，亦谓之臆。）名曰甘疽。色青，其状如谷实栝蒌，常
苦寒热，急治之，去其寒热，不急治，十日死，死后出脓。
或问∶心窝上两乳间，生疽何如？曰∶此膻中发疽也。盖膻中为气之海，气所居焉，能
分布阴阳。若脏腑阴阳不和，七情不平，则发此证。宜活命饮加紫苏、薄荷叶汗之。夺
命丹、胜金丹、紫金丹选用。稍迟则溃烂，恶症多者难治。
或问∶心窝下旁，生疽何如？曰∶此名脾发疽。毒由多食煎爆，醉饱入房，以致毒
聚脾经而作，活命饮加桔梗、升麻。紫金丹、胜金丹汗之。壮实者，八阵散下之。老弱者，
十全大补汤。稍迟则溃伤脾膜，脓如蟹沫者死。服药而呕，饮食不进者死。
或问∶一人年三十，胸前肋上，坚硬如石者尺许，寒热大作，饮食不进，遍身疼痛，
烦躁不宁，胸膈填胀何如？曰∶凡在胸及胸之侧，或者肩前下延及胁，形长如蛤，皆为
马刀疮。属手少阳三焦经、足阳明胃经、手厥阴心包络，郁火怒气积痰所致。宜灸、宜
汗，攻补兼施则消，宜服胜金丹、乌金散。壮实者，一粒金丹下之。活命饮加柴胡。过时
则溃烂彻骨，久而不敛者死，未溃而谵语神昏，泄利呕吐者不治。
一夫人，性刚多怒，胸前作痛，肉色不变，脉数恶寒。经曰∶洪数脉，应发热，反
恶寒，疮疽也。今脉洪数，则脓已成。但体丰浓，故色不变，似乎无脓，以痛极始肯针，
入数寸脓数碗，以清肝消毒药，治之而愈。设泥其色而不用针，无可救之理。 一人年逾
四十，胸患疮成漏，日出脓碗许，喜饮食如常，用十全大补汤加远志、贝母、白蔹、续
断，灸以附子饼，脓渐少，调护岁余而愈。一少妇，胸膺间溃一窍，脓血与口中所咳，相
应而出。以参、 、当、归，加退热、排脓等药而愈。或曰∶此因肺痿所致。 一人胸
肿一块，半载不消，令灸百壮方溃，服大补药不敛，灸附子饼而愈。 一百户，胸患毒，
肿高 赤发热，脉数，大小便涩，饮食如常。齐氏曰∶肿起色赤，寒热疼痛，皮肤壮热，头
目昏重，气血实也。又曰∶大小便涩，饮食如故，肠满膨胀，胸膈痞闷，肢节疼痛。身
热脉大，精神昏塞，脏腑实也。进黄连内疏
汤二剂，诸证悉退，更以荆防败毒散加黄芩、山栀，四剂稍愈，再以四物加芩、连、白芷、
桔梗、甘草、金银花，数剂而消。（机按∶此项治治，虽因脉证皆实而用泄法，然泄法又有先后次
序，先攻里后发表，最后又用和解，前贤治病不肯猛浪和此；学人可不以此为法哉。）
《灵枢》记载：生于胸部的疽，名叫井疽。其形状像大豆，三四天起病，如果不及时医治，毒邪下行入腹则无法治愈，七日后死亡。有人问：心窝处生疽怎么样？回答说：此证初起时像黄疸，但肌肉颜色不变，名叫井疽，又叫做穿心冷痈。如果冷气攻心，精神恍惚，呕吐冷痰，厌恶食物气味，毒瓦斯内陷，腹部胀满的，属于不治之症。如果出现心中烦躁如火烧，肌肤发热如火，不时盗汗，嘴唇焦裂、舌头干燥且呈黄色，想喝冷水的，这是正常的证候。应立即服用活命饮，加黄连、桔梗。用胜金丹、夺命丹发汗。体质壮实者，用一粒金丹泻下。恶证多见的，治疗稍晚，容易导致危险，宜服用犀角解毒丸。
《灵枢》记载：生于膺部（膺指胸两旁高处，也称为臆），名叫甘疽。颜色发青，形状像谷实栝蒌，常苦于寒热往来，应紧急治疗，去除寒热症状；若不紧急治疗，十日后死亡，死后出脓。
有人问：心窝上方两乳之间生疽怎么样？回答说：这是膻中发疽。因为膻中是气之海，是气居住的地方，能够分布阴阳。如果脏腑阴阳不和，七情不平，就会发生此证。宜用活命饮加紫苏、薄荷叶发汗。选用夺命丹、胜金丹、紫金丹。治疗稍迟则会溃烂，恶证多的难以治愈。
有人问：心窝下方旁边生疽怎么样？回答说：这名叫脾发疽。毒邪因过多食用煎炸爆炒食物，醉酒后行房事，导致毒聚积在脾经而发作。用活命饮加桔梗、升麻。用紫金丹、胜金丹发汗。体质壮实者，用八阵散泻下。年老体弱者，用十全大补汤。治疗稍迟则会溃伤脾膜，脓液像蟹沫一样的会死亡。服药后呕吐，饮食不能进服的会死亡。
有人问：一人三十岁，胸前肋上，坚硬如石有一尺多长，寒热大作，饮食不进，遍身疼痛，烦躁不宁，胸膈填胀怎么样？回答说：凡是生在胸部及胸侧，或者肩前下延及胁部，形状长如蛤蜊的，都叫马刀疮。属于手少阳三焦经、足阳明胃经、手厥阴心包络，由郁火、怒气积痰所致。宜灸法、宜发汗，攻补兼施则可以消散，宜服用胜金丹、乌金散。体质壮实者，用一粒金丹泻下。用活命饮加柴胡。过时则溃烂彻骨，久不愈合的会死亡，未溃烂而出现谵语神昏、泄利呕吐的属于不治之症。
一位夫人，性格刚强易怒，胸前作痛，肉色不变，脉数且恶寒。医经说：洪数脉应当对应发热，反而恶寒，这是疮疽。现在脉象洪数，说明脓已成。只是身体肥胖丰浓，所以颜色不变，看似无脓，直到疼痛极度剧烈时才肯针刺，刺入数寸，流出脓液数碗，用清肝消毒药治疗而痊愈。如果拘泥于颜色而不用针，就没有可救的道理。
一人年过四十，胸部患疮形成漏管，每天流出脓液约一碗，喜欢饮食如常，用十全大补汤加远志、贝母、白蔹、续断，用附子饼灸，脓液逐渐减少，调养护理一年多而痊愈。
一位少妇，胸膺间溃破一个孔窍，脓血与口中咳出的东西相应而出。用人参、[原文缺字]、当归，加退热、排脓等药而痊愈。有人说：这是因为肺痿所致。
一人胸部肿起一块，半年不消，令灸一百壮才溃破，服用大补药不收敛，用附子饼灸而痊愈。
一位百户官，胸部患毒，肿高赤红发热，脉数，大小便涩滞，饮食如常。齐氏说：肿起色赤，寒热疼痛，皮肤壮热，头目昏重，这是气血实证。又说：大小便涩滞，饮食如故，肠满膨胀，胸膈痞闷，肢节疼痛。身热脉大，精神昏塞，这是脏腑实证。进服黄连内疏汤二剂，各种症状全部消退，再用荆防败毒散加黄芩、山栀，四剂后稍见好转，再用四物汤加黄芩、黄连、白芷、桔梗、甘草、金银花，数剂后消散。（王肯堂按：这种治疗方法，虽然是因为脉证皆实而用泻法，但泻法又有先后次序，先攻里后发表，最后又用和解之法，前贤治病不肯鲁莽轻率，学习的人怎能不以此为法则呢？）
The *Ling Shu* states: A carbuncle arising in the chest is named Jing Ju (Well Carbuncle). Its appearance is like a soybean. If not treated promptly within three to four days, the pathogenic factor descends into the abdomen, leading to an incurable condition and death within seven days.
A question was raised: How about a carbuncle arising in the epigastric region? The answer is: This condition initially resembles jaundice, but the skin color remains unchanged; it is named Jing Ju, also known as Chuan Xin Leng Yong (Penetrating Heart Cold Abscess). If cold pathogenic factors attack the heart, causing mental confusion, vomiting of cold phlegm, aversion to food odors, internal sinking of toxic heat, and abdominal distension, it is incurable. However, if there is irritability as if burning, skin fever as if on fire, spontaneous night sweats, dry and yellow tongue with cracked lips, and thirst for cold water, this represents the typical presentation. Immediately administer Huo Ming Yin (Life-Saving Decoction) with added Huang Lian (Coptidis Rhizoma) and Jie Geng (Platycodonis Radix). Use Sheng Jin Dan (Golden Pill of Victory) or Duo Ming Dan (Life-Extending Pill) to induce sweating. For those with robust constitution, use Yi Li Jin Dan (One-Pill Golden Pill) to purge downward. If severe symptoms are prevalent and treatment is delayed, danger may ensue; Xi Jiao Jie Du Wan (Rhinoceros Horn Detoxification Pill) should be taken.
The *Ling Shu* states: A carbuncle arising in the Ying region (the upper lateral part of the chest, also called Yi) is named Gan Ju (Sweet Carbuncle). It appears blue-green in color and resembles the fruit of Trichosanthes kirilowii. The patient often suffers from alternating chills and fever. Urgent treatment is required to resolve the chills and fever; if neglected, death occurs within ten days, followed by pus discharge.
A question was raised: How about a carbuncle arising between the two breasts above the epigastrium? The answer is: This is Tan Zhong Fa Ju (Carbuncle of the Tanzhong Region). Tanzhong is the Sea of Qi, where Qi resides and distributes Yin and Yang. If the Yin and Yang of the Zang-Fu organs are disharmonious, or if the Seven Emotions are unbalanced, this condition arises. Huo Ming Yin (Life-Saving Decoction) with added Zi Su (Perillae Folium) and Bo He Ye (Menthae Haplocalycis Folium) should be used to induce sweating. Choose from Duo Ming Dan (Life-Extending Pill), Sheng Jin Dan (Golden Pill of Victory), or Zi Jin Dan (Purple Gold Pill). If treatment is delayed, ulceration will occur, and cases with severe symptoms are difficult to treat.
A question was raised: How about a carbuncle arising beside the lower epigastrium? The answer is: This is named Pi Fa Ju (Spleen-Originating Carbuncle). Toxicity accumulates in the Spleen Meridian due to excessive consumption of fried and roasted foods, or sexual activity after drunkenness and overeating. Huo Ming Yin (Life-Saving Decoction) with added Jie Geng (Platycodonis Radix) and Sheng Ma (Cimicifugae Rhizoma) is indicated. Zi Jin Dan (Purple Gold Pill) or Sheng Jin Dan (Golden Pill of Victory) can be used to induce sweating. For those with robust constitution, Ba Zhen San (Eight Arrays Powder) is used to purge downward. For the elderly or weak, Shi Quan Da Bu Tang (Decoction for Ten Thousand Benefits) is prescribed. If treatment is delayed, the spleen membrane may be damaged; if the pus resembles crab foam, death ensues. If vomiting occurs after taking medicine and food intake is impossible, death ensues.
A question was raised: A thirty-year-old man has a hard, stone-like swelling extending one chi on the chest and ribs, accompanied by severe chills and fever, inability to eat, generalized body pain, restlessness, and fullness/distension in the chest and diaphragm. What is the prognosis? The answer is: Any swelling located on the chest, its sides, or extending from the anterior shoulder to the hypochondrium, shaped like a clam, is called Ma Dao Chuang (Horse Knife Sores). These belong to the Hand-Shaoyang Sanjiao Meridian, Foot-Yangming Stomach Meridian, and Hand-Jueyin Pericardium Meridian, caused by accumulated phlegm due to constrained fire and anger. Moxibustion and sweating methods are appropriate. Combining attacking and tonifying methods can lead to resolution. Sheng Jin Dan (Golden Pill of Victory) and Wu Jin San (Black Gold Powder) are indicated. For robust constitutions, Yi Li Jin Dan (One-Pill Golden Pill) purges downward. Huo Ming Yin (Life-Saving Decoction) with added Chai Hu (Bupleuri Radix) is used. If treatment is delayed, ulceration penetrating the bone occurs, and non-healing lesions result in death. Delirium, coma, diarrhea, and vomiting before ulceration indicate an incurable condition.
A woman with a rigid and irritable temperament experienced chest pain with unchanged skin color and a rapid pulse accompanied by aversion to cold. The Classics state: A洪数 (Hong-Shu / Surging-Rapid) pulse typically corresponds to fever; if aversion to cold occurs instead, it indicates a carbuncle. Since the pulse is Hong-Shu, pus has already formed. However, due to her obese physique, the skin color did not change, appearing as if no pus were present. Only when the pain became extreme was acupuncture performed; several cun deep, several bowls of pus were drained. She was cured using Liver-Clearing and Toxin-Detoxifying herbs. Had one relied solely on the skin color and avoided acupuncture, there would have been no hope for rescue.
A man over forty suffered from a chest sore that developed into a fistula, draining about one bowl of pus daily. His appetite remained normal. He was treated with Shi Quan Da Bu Tang (Decoction for Ten Thousand Benefits) plus Yuan Zhi (Polygalae Radix), Bei Mu (Fritillariae Cirrhosae Bulbus), Bai Lian (Ampelopsis Radix), and Xu Duan (Dipsaci Radix), along with moxibustion using Fu Zi Bing (Aconite Cake). Pus secretion gradually decreased, and he recovered after more than a year of care.
A young woman had an opening ulcerated in the chest and pectoral region, discharging pus and blood simultaneously with coughed-up material. She was cured using Ren Shen (Ginseng Radix), [Text Missing], Dang Gui (Angelicae Sinensis Radix), along with antipyretic and pus-draining herbs. Some stated this was caused by Fei Wei (Lung Atrophy).
A man had a chest swelling that persisted for half a year without resolving. After moxibustion for one hundred Zhu units until ulceration occurred, large-tonifying herbs failed to promote healing. Healing was achieved using moxibustion with Fu Zi Bing (Aconite Cake).
A military officer (Bai Hu) suffered from a chest toxin characterized by high, red, hot swelling, rapid pulse, difficulty in urination and defecation, but normal diet. Qi Shi stated: Swelling that is red, accompanied by chills, fever, pain, hot skin, and heavy/dizzy head and eyes, indicates an Excess pattern of Qi and Blood. Furthermore: Difficulty in urination/defecation, normal diet, intestinal fullness/distension, chest/diaphragm oppression, and limb/joint pain, combined with fever, large pulse, and mental cloudiness, indicate an Excess pattern of the Zang-Fu organs. Two doses of Huang Lian Nei Shu Tang (Coptis Internal Purging Decoction) were administered, resolving all symptoms. Subsequently, Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Detoxifying Powder) with added Huang Qin (Scutellariae Radix) and Shan Zhi (Gardeniae Fructus) was given for four doses, resulting in slight improvement. Finally, Si Wu Tang (Four Substance Decoction) with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Jie Geng (Platycodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Jin Yin Hua (Lonicerae Japonicae Flos) was used for several doses, leading to resolution. (Wang Kentang’s Note: Although this treatment employs purgative methods because both pulse and symptoms indicate Excess, purgation follows a specific sequence: first attacking the interior, then releasing the exterior, and finally harmonizing. Ancients did not act rashly in treating diseases. Should not students take this as a standard?)