一男子溃后，发热头痛，脉浮紧，虚而兼表邪也，以补中益气汤，加川芎、白芷二
剂而止，更以托里药而愈。一男子风袭疮口，牙关紧急，腰背反张，以玉真散一服而愈，仍
以托里药而敛。一男子患痈将敛，遍身作痒，脉浮，以消风散二服而止，更以托里药而愈。
〔薛〕 一人胸患痈， 痛烦躁，发热作渴，脉数而实，时季冬。予谓∶此热毒内蓄，
须舍时从证，欲治以内疏黄连汤，彼以时当隆寒，乃杂用败毒药愈炽。仍求治，投前汤
二剂，后去二次，诸证悉退，以金银花散加连翘、山栀，四剂出水而消。罗谦甫，治贾
仓使父，（见发背。）
一男子患痈，溃而饮酒， 痛发热，服黄连解毒汤二剂而止，更以托里消毒散而愈。
常治痛而大便秘，脉实者，用清凉饮治之。
〔罗〕 至元壬午，有王伯禄者，年五十七，右臂膊肿盛，上至肩，下至手指色变，皮
肤凉，六脉沉细而微，脉症俱寒，举疡医彦和视之，曰∶此乃附骨痈，开发已迟，以燔
起之，脓清稀解，待日再开之，加吃逆不绝，彦和与丁香柿蒂汤两服，稍缓，待日吃逆尤
甚，自利脐腹冷痛，腹满饮食减少，时发昏愦，于左乳下黑尽处，灸二七壮，又处以干
姜、附子、木香、沉香、茴香、羌活类药， 咀一两半，欲与服。或者曰∶诸痛痒疮，皆
属心火，又当盛暑之时，用干姜，附子可乎？予应之曰∶理所当然，不得不然。《内经》曰∶
脉细皮寒，泻利前后，饮食不入，此谓五虚。吃逆者，胃中虚极也，诸肿疮疡，皆属心火，
是定理也，此症内外相反，须当舍时从症，非大方辛热之剂急治之，则不能愈也，遂投之。
诸症悉去，饮食进，疮势温，脓色正，彦和又与五香汤数服，月余平复。噫！守常者众
人之见，知变者大人之事，知常而不知变，细事因而取败者亦多矣，况医乎。守常知变岂
可同日而语哉，陈录判母治案，（见脑疽。）
托里温中汤 治疮为寒变而内陷者，脓出清解，皮肤凉，心下痞满，肠鸣切痛，大
便微溏，食则呕气短促，吃逆不绝，不得安卧，时有昏愦。
丁香 沉香 茴香 益智仁 陈皮（各一钱） 木香（各一钱半） 羌活 干姜（炮，各三钱）
甘草（炙，二钱） 黑附子（炮去皮脐，四钱）
《内经》曰∶寒淫于内，治以辛热，佐以苦温。以附子、干姜大辛热，温中外发，阳
气自里之表，以为君。羌活苦辛温，透关节；炙甘草甘温，补脾胃，行经络，通血脉；胃
寒则呕吐吃逆，不下食，益智仁，丁香、沉香大辛热，以散寒为佐；疮气内攻，气聚而
为满，木香、茴香、陈皮苦辛温，治痞散满，为使也。
上 咀作一服。水三盏，生姜五片，煎至一盅，去滓。不拘时，温服。忌一切冷物。
一个男子在疮疡溃破后，出现发热、头痛的症状，脉象浮紧，这是正气虚弱兼有表邪的表现。使用补中益气汤，加入川芎、白芷，服用两剂后症状停止，随后再用托里药治疗而痊愈。
另一个男子因风邪侵袭疮口，出现牙关紧闭、腰背反张（角弓反张）的症状，服用一剂玉真散后痊愈，随后仍用托里药使疮口收敛。
还有一个男子患痈疽即将愈合时，全身发痒，脉象浮，服用两剂消风散后症状停止，随后再用托里药治疗而痊愈。
〔薛己〕有一人胸部患痈，疼痛烦躁，发热口渴，脉象数而有力，当时正值隆冬季节。我认为：这是热毒内蕴蓄积，必须舍弃时令因素而从证候论治，打算用内疏黄连汤治疗，但他因为当时正值严寒，反而杂用败毒药，导致病情更加严重。后来再次求治，投予前述汤剂两剂，之后去掉两次用药，所有症状全部消退，改用金银花散加连翘、山栀，服用四剂后脓出而消散。罗谦甫治疗贾仓使的父亲（见发背案）。
有一个男子患痈疽，溃破后饮酒，导致疼痛发热，服用黄连解毒汤两剂后症状停止，随后用托里消毒散治疗而痊愈。
〔罗谦甫〕至元壬午年，有个叫王伯禄的人，五十七岁，右臂肿胀严重，上至肩部，下至手指颜色改变，皮肤发凉，六脉沉细而微弱，脉象与症状均表现为寒证。请疡医彦和诊治，他说：这是附骨痈，发现已晚，用火燔法处理，脓液清稀，待时日再切开排脓，但出现呃逆不止的情况。彦和给予丁香柿蒂汤服用两剂，稍有好转，待时日呃逆更加严重，伴有自发性腹泻、脐腹冷痛、腹胀、饮食减少，时常发生昏厥。在左乳下黑色尽处，施灸十四壮，又处方干姜、附子、木香、沉香、茴香、羌活等药物，切碎一两半，准备给患者服用。有人问：各种疼痛、瘙痒、疮疡，都归属于心火，又正值盛夏酷暑之时，使用干姜、附子可以吗？我回答说：理所当然，不得不如此。《内经》说：脉细、皮寒、前后二便泄利、饮食不入，这称为五虚。呃逆，是胃气极度虚弱的表现。各种肿疡疮疡，都归属于心火，这是确定的定理，此症内外表现相反，必须舍弃时令而从证候论治，不用大剂量辛热之剂紧急治疗，就不能痊愈，于是投药。所有症状全部消除，饮食恢复，疮势转温，脓色正常，彦和又给予五香汤服用数次，一个多月后康复。唉！墨守成规是普通人的见识，懂得变通是君子的作为，只知道常规而不知道变通，因小事而失败的人也很多，何况是医学呢？墨守成规与懂得变通岂能相提并论？陈录判母亲的医案（见脑疽案）。
托里温中汤：治疗疮疡因寒邪变化而内陷的病症，脓液清稀，皮肤发凉，心下痞满，肠鸣切痛，大便微溏，进食则呕吐、气短促，呃逆不止，无法安卧，时常昏厥。
配方：丁香、沉香、茴香、益智仁、陈皮（各一钱），木香（各一钱半），羌活、干姜（炮制，各三钱），甘草（炙，二钱），黑附子（炮制，去皮去脐，四钱）。
《内经》说：寒邪淫溢于内，用辛热药物治疗，以苦温药物为辅佐。用附子、干姜大辛大热，温补中外，使阳气从里达表，作为君药。羌活苦辛温，透达关节；炙甘草甘温，补益脾胃，通行经络，通畅血脉；胃寒则呕吐呃逆，不能进食，益智仁、丁香、沉香大辛大热，用来散寒作为臣药；疮气内攻，气聚而成痞满，木香、茴香、陈皮苦辛温，治疗痞满散结，作为使药。
以上药材切碎为一服量。用水三盏，生姜五片，煎煮至一盏，去渣。不拘时间，温服。忌食一切生冷食物。
A male patient, after the ulceration of a sore, presented with fever and headache. The pulse was floating and tight, indicating deficiency combined with exterior pathogenic factors. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) supplemented with Chuanxiong Rhizoma (Chuanxiong) and Baizhi Radix Angelicae Dahuricae (Baizhi). After two doses, the symptoms ceased, and he was subsequently cured using Tuo Li Yao (Supporting Interior Medicines).
Another male patient suffered from wind pathogen invading the wound, resulting in trismus (lockjaw) and opisthotonos (backward arching of the back). One dose of Yuzhen San (Jade True Powder) cured him, and he was then treated with Tuo Li Yao to promote healing.
A third male patient had a carbuncle that was about to heal but experienced generalized pruritus with a floating pulse. Two doses of Xiaofeng San (Eliminate Wind Powder) stopped the itching, and he was subsequently cured with Tuo Li Yao.
[Xue Ji] A man developed a carbuncle on his chest, presenting with painful irritability, fever, thirst, and a rapid, full pulse. It was late winter. I stated: This is internal accumulation of heat toxin; one must disregard the season and treat according to the syndrome. I intended to use Neishu Huanglian Tang (Internal Draining Coptis Decoction), but because it was severe cold, he mistakenly used cooling and detoxifying drugs, which exacerbated the condition. Upon seeking treatment again, I administered the aforementioned decoction for two doses. Later, adjusting the prescription twice, all symptoms subsided. He was then given Jinyinhua San (Honeysuckle Powder) plus Lqiao Fructus Forsythiae (Liqiao) and Zhizi Gardenia Fruit (Zhizi) for four doses, leading to pus discharge and resolution.
Luo Qianfu treated the father of Clerk Jia (see "Fabei" case).
A male patient developed a carbuncle, drank alcohol after ulceration, and suffered pain and fever. Two doses of Huanglian Jiedu Tang (Coptis Decoction for Detoxification) stopped the symptoms, and he was subsequently cured with Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder).
Chang treated patients with painful sores accompanied by constipation and a full pulse using Qingliang Yin (Cooling Drink).
[Luo Qianfu] In the Renwu year of the Zhiyuan era, a man named Wang Bolu, aged 57, presented with severe swelling of the right arm extending from the shoulder to the fingers, with color changes in the skin and coldness of the skin. The six pulses were deep, fine, and faint. Both pulse and symptoms indicated cold. Surgeon Yanhe examined him and said: This is Gujue Yong (Bone-Adhering Carbuncle), detected too late. He applied fire cautery. The pus was clear and thin. He advised waiting before incision again. However, the patient developed persistent hiccups. Yanhe prescribed Dingxiang Shidi Tang (Clove and Persimmon Calyx Decoction) for two doses, providing slight relief. When seen again, the hiccups worsened significantly, accompanied by spontaneous diarrhea, cold pain in the umbilical and abdominal region, abdominal distension, reduced food intake, and occasional syncope. Seventeen moxa cones were applied at the point where black discoloration ended under the left breast. A prescription of Ganjiang Dried Ginger (Ganjiang), Fuzi Prepared Aconite Root (Fuzi), Muxiang Aucklandia Root (Muxiang), Chenxiang Aquilaria Wood (Chenxiang), Huixiang Fennel Fruit (Huixiang), and Qianghuo Notopterygium Rhizome (Qianghuo) was prepared, chopped to 1.5 qian, and intended for administration. Someone asked: "All pain, itching, and sores belong to Heart Fire. Moreover, it is midsummer. Is it appropriate to use Ganjiang and Fuzi?" I replied: "It is logically necessary and unavoidable. The *Neijing* states: Fine pulse, cold skin, diarrhea of both bowels, and inability to eat constitute 'Five Deficiencies.' Hiccups indicate extreme deficiency of Stomach Qi. Although it is a general principle that all swellings and sores belong to Heart Fire, this case presents contradictory internal and external signs. One must disregard the season and treat the syndrome. Without urgent treatment using large doses of acrid-hot medicines, recovery is impossible." Thus, the medicine was administered. All symptoms disappeared, food intake resumed, the sore became warm, and the pus color normalized. Yanhe then administered Wuxiang Tang (Five Fragrances Decoction) several times, and the patient recovered after more than a month. Alas! Adhering to convention is the view of the masses; knowing how to adapt is the task of the superior person. Many fail due to small matters because they know the constant but not the variable, let alone in medicine. Can adhering to convention be compared with knowing how to adapt? (See the case of Chancellor Chen's mother for "Naoju").
Tuoli Wenzhong Tang (Interior-Supporting and Middle-Warming Decoction): Treats sores that have collapsed inward due to cold transformation. Symptoms include clear and thin pus, cold skin, epigastric stuffiness and fullness, borborygmus with cutting pain, slightly loose stools, vomiting and shortness of breath after eating, persistent hiccups, inability to lie down peacefully, and occasional syncope.
Ingredients: Dingxiang Flos Caryophylli (Dingxiang), Chenxiang Lignum Aquilariae Resinatum (Chenxiang), Huixiang Fructus Foeniculi (Huixiang), Yizhiren Semen Alpiniae Oxyphyllae (Yizhiren), Chenpi Pericarpium Citri Reticulatae (Chenpi) (each 1 qian); Muxiang Radix Aucklandiae (Muxiang) (1.5 qian each); Qianghuo Rhizoma et Radix Notopterygii (Qianghuo), Ganjiang Rhizoma Zingiberis Recens (prepared) (each 3 qian); Gancao Radix Glycyrrhizae (prepared with honey) (2 qian); Heifuzi Radix Aconiti Lateralis Preparata (prepared, peeled, de-navel) (4 qian).
The *Neijing* states: "When cold invades internally, treat with acrid-hot substances, assisted by bitter-warm ones." Using Fuzi and Ganjiang, which are greatly acrid and hot, to warm the interior and exterior, allowing Yang Qi to move from the interior to the exterior, serves as the Sovereign drug. Qianghuo, bitter and acrid-warm, penetrates the joints; Gancao (prepared), sweet and warm, tonifies the Spleen and Stomach, unblocks meridians, and unifies blood vessels. Since Stomach cold causes vomiting and hiccups with inability to eat, Yizhiren, Dingxiang, and Chenxiang, being greatly acrid and hot, serve as Assistant drugs to dispel cold. Because pathogenic qi of the sore attacks inward, causing Qi stagnation and fullness, Muxiang, Huixiang, and Chenpi, bitter and acrid-warm, treat stuffiness and dissipate fullness, serving as Envoy drugs.
Chop the above ingredients into one dose. Add three cups of water and five slices of Shengjiang Fresh Ginger (Shengjiang). Decoct until one cup remains, then strain. Take warm at any time. Avoid all cold foods.