加减托里消毒散 治四肢逆冷，乃肾气虚寒也，去三味加桂附，仍佐以八味丸。
痈疽声嘶色败，唇鼻青赤，面目浮肿，宜调胃白术散。
调胃白术散
白术（炒） 茯苓（各二钱） 陈皮 白芍药（炒） 槟榔 泽泻（各一钱） 木香（五分）
作一剂。水二盅，姜三片，煎八分，食后服。如肿不退，加白术（炒） 枳实（麸炒，各一
钱）
〔薛〕 按∶前症乃七恶也用此方。若湿除气少退，用六君子汤、参苓白术散之类，大
便不实尤效。再用槟榔、木香，恐伤真气也，亦有真气虚而致前症者，尤不宜用二药。
〔薛〕 疮疡阳气脱陷，或因克伐之剂，或因脓血太泄，或因吐泻之后，或因误而入
房，若发热头痛，小便淋涩，或滑数便血，目赤烦喘，自汗发热，气短头晕，体倦热渴，意
欲饮水投水，恶寒憎寒，身热恶衣，扬手掷足，汗出如水，腰背反张，郑声不绝，此无
根虚火之假热症。若畏寒头痛，咳逆呕吐，耳聩目蒙，小便遗难，泻利肠鸣，里急腹痛，玉
茎短缩，冷汗时出，齿牙浮动，肢体麻痹，或厥冷身痛，或咬舌啮唇，舌根强硬，此阳气
脱陷之真寒证，皆勿论其脉，勿论其疮，但见一二，急用参附汤补之，多有复生者。大
凡溃后劳役，元气亏损，或梦遗精脱，或滑数便血，或外邪乘之，或误用寒凉，气血脱
陷而致斯症，治以前药，亦有复生者。内翰，杨皋湖，孟夏患背疽，服克伐之剂，二旬余
矣，漫肿坚硬，重如负石，隔蒜灸五十余壮，背遂轻，以六君加砂仁二剂，涎沫涌出，饮
食愈少，此脾虚阳气脱陷。剂用温补，反呕不食，仍用前药作大剂，加附子、姜桂。又
不应，遂以参 各一斤，归术、陈皮各半斤，附子一两，煎服，三日而尽，流涎顿止，腐
肉顿溃，饮食顿进，再用姜桂等药托里健脾，腐脱而疮愈矣。少参史南湖之内，夏患疽不
起发，脉大而无力，发热作渴，自汗盗汗，用参 大补之剂，益加手足逆冷，大便不宽，喘
促时呕，脉微细按之如无，惟太冲不绝，仍以参 、白术、当归、茯苓、陈皮计斤许，加
附子五钱，水煎两盅作一服，诸证顿退，脉息顿复，翌日疮起而溃，仍用前药四剂后，日
用托里药，调理两月余而消。一妇，卧床十三年矣。遭回禄，益加忧郁，明年三月，右
肩下发一块， 肿如瓯，中赤外白，先用凉药一剂，不解，次用十宣散四剂，加痛略红，
迎医视之，连投参 、丁桂、防芷之剂，脓溃云无恙矣，辞去。眩晕呕逆，恶寒战栗，顶
陷脓清。偶检《外科发挥》，发背门云∶若初起一头如黍，不肿不赤，烦躁便秘，四五日
间，生头不计其数，疮口各如含一粟，名曰莲房发云云。始骇为恶症，治法虽详，不谙
于行，迎薛至，诊云∶辛凉解散，气血两虚者忌之，连投参 、归术、地黄、姜附大剂，
肿高脓稠，兼 乌金膏数日，果腐落，筋如脂膜者数片，人参每服至八钱，日进二服，逾
两月平复。
附子理中汤 治疮疡脾胃虚寒，或误行攻伐，手足厥冷，饮食不入，或肠鸣腹痛，呕
逆吐泻。
附子 人参 茯苓 白芍药（各三钱） 白术（四钱）
上水煎服。
姜附汤 治疮疡真阳亏损，或误行汗下，或脓血出多失于补托，以致上气喘急，自汗
盗汗，气短头晕。
人参 附子（炮去皮脐各一两） 干姜（炮） 白术（各五钱）
上作二剂。水煎服。
参附汤 治失血过多，或脓瘀大泄，或寒凉汗下，真阳脱陷，上气喘急，自汗盗汗，
气短头晕等症，急服以救元气，缓则不治。
人参（一两） 附子（炮，去皮脐，五钱）
上姜五片，水煎服。不应，倍之。
加减托里消毒散：治疗四肢逆冷，这是肾气虚寒所致，去掉原方中的三味药，加入肉桂、附子，同时配合服用八味丸。
痈疽患者出现声音嘶哑、面色败坏，嘴唇和鼻子呈现青赤色，面目浮肿，适宜使用调胃白术散。
调胃白术散
配方：白术（炒制）、茯苓（各二钱），陈皮、白芍药（炒制）、槟榔、泽泻（各一钱），木香（五分）。
用法：作为一剂。加水两盅，生姜三片，煎煮至八分，饭后服用。如果肿胀不退，增加白术（炒制）和枳实（麸炒，各一钱）。
〔薛己按〕：上述症状属于“七恶”证候，使用此方。如果湿气去除、气机衰退消退，可改用六君子汤、参苓白术散之类药物，对于大便不成形者尤其有效。再次使用槟榔、木香，恐怕会损伤真气，也有因真气虚弱而导致前述症状的，更不宜使用这两味药。
〔薛己〕：疮疡病中阳气脱陷，可能是因为使用了攻伐类药物，或者因为脓血流失过多，或者在呕吐腹泻之后，或者因为误入房事所致。如果出现发热头痛、小便淋沥涩痛，或滑数脉伴便血，眼睛红赤烦躁气喘，自汗发热，气短头晕，身体疲倦热渴，想喝水却怕水，恶寒憎寒，身热却厌恶衣物，扬手掷足，出汗如水，腰背反张，郑声（神志不清时的胡言乱语）不止，这些是无根虚火产生的假热症状。如果出现畏寒头痛，咳嗽气逆呕吐，耳聋目蒙，小便遗溺困难，腹泻肠鸣，里急后重腹痛，阴茎短缩，冷汗时常流出，牙齿浮动，肢体麻痹，或者四肢厥冷身痛，或者咬舌咬唇，舌根强硬，这些是阳气脱陷的真寒证候。对于这些情况，不要管它的脉象，也不要管疮疡的情况，只要见到其中一二种症状，就应立即使用参附汤进行补益，大多能起死回生。大凡溃烂后劳累过度，元气亏损，或者梦遗精脱，或者滑数脉伴便血，或者外邪侵袭，或者误用寒凉药物，导致气血脱陷而引发这些症状，治疗以上述药物，也有起死回生的案例。内翰杨皋湖，在孟夏时节患背疽，服用了攻伐类药物二十多天后，漫肿坚硬，沉重如负石，经过隔蒜灸五十多壮后，背部感觉轻松，服用加砂仁的六君子汤两剂，涎沫涌出，饮食减少，这是脾虚阳气脱陷。本应用温补药剂，反而呕吐不食，仍用前药加大剂量，加入附子、姜、桂。又无效，于是用人参各一斤，当归、白术、陈皮各半斤，附子一两，煎服，三天服完，流涎顿时停止，腐肉顿时溃破，饮食顿时增进，再用姜、桂等药物托里健脾，腐肉脱落而疮疡痊愈。少参史南湖的妻子，夏季患疽不起发，脉大而无力，发热口渴，自汗盗汗，使用人参大补之剂后，更加手足逆冷，大便不通畅，喘促时呕，脉微细按之如无，只有太冲脉不绝，仍以人参、白术、当归、茯苓、陈皮计斤许，加入附子五钱，水煎两盅作为一服，诸证顿时消退，脉息顿时恢复，第二天疮疡起发而溃破，仍用前药四剂后，每日使用托里药，调理两个多月而消散。一位妇女，卧床十三年了。遭遇火灾，更加忧郁，次年三月，右肩下长出一块肿块，肿如碗状，中间红外面白，先用凉药一剂，未解，接着用十宣散四剂，疼痛略减颜色稍红，请医生诊治，连续投予人参、丁香、肉桂、防风、白芷之剂，脓液溃破后声称无恙，医生离去。随后出现眩晕呕吐，恶寒战栗，顶部凹陷脓液清稀。偶然翻阅《外科发挥》，发背门记载：如果初起一个头如黍米大小，不肿不红，烦躁便秘，四五日间，生出无数个头，疮口各如含着粟米，名叫莲房发等等。开始惊骇认为是恶症，治法虽然详细，但不熟悉施行，请薛己诊治，诊察后说：辛凉解散之法，气血两虚者忌用，连续投予人参、当归、白术、地黄、姜、附子大剂，肿块高突脓液稠厚，兼用乌金膏数日，果然腐肉脱落，筋如脂膜般的组织脱落数片，人参每服至八钱，每日进服两次，超过两个月平复。
附子理中汤：治疗疮疡脾胃虚寒，或者误行攻伐，手足厥冷，饮食不入，或者肠鸣腹痛，呕吐腹泻。
配方：附子、人参、茯苓、白芍药（各三钱），白术（四钱）。
用法：上药加水煎服。
姜附汤：治疗疮疡真阳亏损，或者误行汗下，或者脓血出多失于补托，以致上气喘急，自汗盗汗，气短头晕。
配方：人参、附子（炮制去皮脐各一两）、干姜（炮制）、白术（各五钱）。
用法：上药作两剂。加水煎服。
参附汤：治疗失血过多，或者脓瘀大泄，或者寒凉汗下，真阳脱陷，上气喘急，自汗盗汗，气短头晕等症状，急服以救元气，缓则不治。
配方：人参（一两）、附子（炮制，去皮脐，五钱）。
用法：上药用生姜五片，加水煎服。若无效，加倍用量。
Jiajian Tuoli Xiaodu San (Modified Decoction for Supporting the Interior and Disinfecting): Treats cold extremities, which is caused by deficiency-cold of Kidney Qi. Remove three ingredients from the original formula, add Rougui (Cinnamon Twig) and Fuzi (Aconite Root), and simultaneously administer Bawei Wan (Eight-Ingredient Pill).
For carbuncles and sores presenting with hoarseness, deteriorated complexion, cyanotic-red lips and nose, and edema of the face and eyes, Diaowei Baizhu San (Stomach-Regulating Atractylodes Macrocephala Powder) is appropriate.
Diaowei Baizhu San (Stomach-Regulating Atractylodes Macrocephala Powder)
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria, two qian each); Chenpi (Citri Reticulatae Pericarpium), Shaoyaoyao (Paeoniae Radix Alba, stir-fried), Binglang (Arecae Semen), Zexie (Alismatis Rhizoma, one qian each); Muxiang (Aucklandiae Radix, five fen).
Usage: As one dose. Add two zhong of water and three slices of Shengjiang (Zingiberis Rhizoma Recens), decoct to obtain eight fen of liquid, take after meals. If swelling does not subside, increase the dosage of Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried) and Zhishi (Immature Bitter Orange Fruit, bran-fried, one qian each).
[Xue Ji's Commentary]: The aforementioned symptoms belong to the "Seven Evils" syndrome; this formula should be used. If dampness is eliminated and qi deficiency recedes, formulas such as Liujunzi Tang (Six Gentlemen Decoction) or Shenling Baizhu San (Ginseng and Poria with Atractylodes Macrocephala Powder) may be employed, which are particularly effective for loose stools. Reusing Binglang (Arecae Semen) and Muxiang (Aucklandiae Radix) may damage true qi. There are also cases where the aforementioned symptoms are caused by deficiency of true qi, in which case these two herbs are especially contraindicated.
[Xue Ji]: In sores and ulcers, collapse of yang qi may result from the use of purgative/attacking agents, excessive loss of pus and blood, post-emesis/diarrhea states, or improper sexual activity. If fever, headache, dysuria, or a slippery-rapid pulse with hematochezia occurs, accompanied by red eyes, restlessness, panting, spontaneous sweating, fever, shortness of breath, dizziness, fatigue, heat-thirst, desire to drink but aversion to cold water, aversion to cold, feeling hot yet disliking clothing, tossing and turning, profuse sweating like water, opisthotonos, and delirious speech, these are false-heat symptoms arising from rootless deficient fire. If chills, headache, cough with vomiting, deafness, blurred vision, urinary incontinence or difficulty, diarrhea with borborygmus, tenesmus and abdominal pain, retraction of the penis, intermittent cold sweat, floating teeth, limb numbness, cold extremities with body pain, biting tongue/lips, or stiff tongue root occur, these are true-cold syndromes of collapsed yang qi. Regardless of the pulse or the nature of the sore, if any one or two of these signs are present, immediately administer Shenfu Tang (Ginseng and Aconite Decoction) to tonify; many patients recover. Generally, after ulceration, overwork causing yuanqi (primordial qi) deficiency, seminal emission, slippery-rapid pulse with hematochezia, external pathogen invasion, or misuse of cold-cooling herbs can lead to collapse of qi and blood causing these symptoms. Treatment with the aforementioned drugs has resulted in recovery. Yang Gaohu, an Hanlin Academician, suffered from a back carbuncle in early summer. After taking attacking herbs for over twenty days, he presented with diffuse swelling and hardness, feeling heavy as if carrying a stone. After fifty moxa cones applied via garlic partition on the back, the heaviness lightened. He took Liujunzi Tang (Six Gentlemen Decoction) with Sharen (Amomi Fructus) for two doses, resulting in profuse salivation and reduced appetite, indicating spleen deficiency with collapsed yang qi. Although warm-tonifying agents were indicated, he vomited and refused food. The previous formula was used in a large dose with added Fuzi (Aconiti Lateralis Radix Praeparata), Jiang (Zingiberis Rhizoma), and Guizhi (Cinnamomi Ramulus). When this failed, one jin of Renshen (Ginseng Radix et Rhizoma) each, half jin of Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), plus Chenpi (Citri Reticulatae Pericarpium), and one liang of Fuzi (Aconiti Lateralis Radix Praeparata) were decocted and taken over three days. Salivation stopped instantly, necrotic tissue sloughed off immediately, and appetite returned. Subsequently, herbs like Jiang (Zingiberis Rhizoma) and Guizhi (Cinnamomi Ramulus) were used to support the interior and strengthen the spleen; upon sloughing of necrotic tissue, the sore healed. The wife of Shi Nanhu, Vice Minister, developed a non-suppurating carbuncle in summer with a large but forceless pulse, fever, thirst, spontaneous and night sweats. After administering a large tonic containing Renshen (Ginseng Radix et Rhizoma), her cold extremities worsened, bowel movement became difficult, she experienced panting and occasional vomiting, and her pulse became minute and fine, imperceptible on pressure, except for the Taichong (LR3) pulse. She was given Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Fuling (Poria), and Chenpi (Citri Reticulatae Pericarpium) totaling about one jin, plus five qian of Fuzi (Aconiti Lateralis Radix Praeparata), decocted in two zhong of water as a single dose. Symptoms subsided instantly, and the pulse recovered. The next day, the sore rose and suppurated. Four doses of the previous formula were continued, followed by daily use of interior-supporting herbs for over two months until resolution. A woman bedridden for thirteen years suffered increased depression after a house fire. In March of the following year, a lump appeared under her right shoulder, swollen like a bowl, red in the center and white on the periphery. One dose of cooling herbs failed. Four doses of Shixuan San (Ten Acupoints Powder) slightly reduced pain and redness. A physician was consulted and administered continuous doses of Renshen (Ginseng Radix et Rhizoma), Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Fangfeng (Saposhnikoviae Radix), and Baizhi (Angelicae Dahuricae Radix). After suppuration, the physician declared her safe and left. She then developed dizziness, vomiting, aversion to cold, and shivering, with sunken apex and clear pus. Consulting *Waike Fahui* (Explication of External Medicine), the section on Back Carbuncles stated: If initially appearing as a millet-grain-sized head without swelling or redness, accompanied by restlessness and constipation, numerous heads may emerge within four to five days, each sore mouth resembling a grain of millet, named Lotus-Pad Carbuncle. Initially alarmed by this malignant sign, though treatment methods were detailed, I was unfamiliar with their application. Xue Ji was summoned. Diagnosis indicated that acrid-cool dispersing methods are contraindicated for qi-blood deficiency. Large doses of Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Dihuang (Rehmanniae Radix), Jiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) were continuously administered. The swelling rose, pus became thick, and Wujin Gao (Black Gold Ointment) was applied for several days. Necrotic tissue sloughed off, including several pieces of fascia-like tissue. Renshen (Ginseng Radix et Rhizoma) was taken up to eight qian per dose, twice daily. Recovery occurred after more than two months.
Fuzi Lizhong Tang (Aconite and Poria Regulating the Middle Decoction): Treats spleen-stomach deficiency-cold in sores and ulcers, or injury from mistaken purgation, presenting with cold extremities, inability to eat, borborygmus, abdominal pain, vomiting, and diarrhea.
Ingredients: Fuzi (Aconiti Lateralis Radix Praeparata), Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Shaoyaoyao (Paeoniae Radix Alba) (three qian each); Baizhu (Atractylodis Macrocephalae Rhizoma, four qian).
Usage: Decoct in water and take orally.
Jiangfu Tang (Ginger and Aconite Decoction): Treats depletion of true yang in sores and ulcers due to mistaken sweating/purgation or excessive loss of pus/blood without adequate support, leading to panting, spontaneous and night sweats, shortness of breath, and dizziness.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata, processed, skin and umbilicus removed, one liang each), Ganjiang (Zingiberis Rhizoma, processed), Baizhu (Atractylodis Macrocephalae Rhizoma, five qian each).
Usage: Prepare as two doses. Decoct in water and take orally.
Shenfu Tang (Ginseng and Aconite Decoction): Treats conditions such as excessive blood loss, massive discharge of pus and stasis, or collapse of true yang due to mistaken cold-cooling/sweating/purgation, presenting with panting, spontaneous and night sweats, shortness of breath, and dizziness. Take urgently to rescue primordial qi; delay leads to untreatability.
Ingredients: Renshen (Ginseng Radix et Rhizoma, one liang); Fuzi (Aconiti Lateralis Radix Praeparata, processed, skin and umbilicus removed, five qian).
Usage: Add five slices of Shengjiang (Zingiberis Rhizoma Recens), decoct in water and take. If ineffective, double the dosage.