一男子，溃而恶寒，用四君子汤，加桂，倍用黄 ，大料，四剂而止。脓水尚多，投
八珍汤，加桂数剂渐少。惟疮口不合，以附子饼，及十全大补汤，每剂加炮附子五分，数
剂乃去附子，又服月余而愈。一男子，溃后畏寒，脉虚，以四君子加炮姜，四剂而愈，以
十全大补汤月余而敛。仲景云∶脉虚则血虚。血虚生寒，阳气不足也，疮肿脉虚，宜托里
和养血。信夫！
丹溪治一老人，年七十（云云。见兼症呕条。）
五香白术散 宽中和气，滋益脾土，生肺金，进美饮食。（方见内痈门，肺痈条下。）
〔丹〕 五香汤，即五香连翘汤，去射干、大黄、升麻、连翘，加参、犀角。若用于肿
疡，犹可借其飞走，以攻散其毒，使不延蔓。若用于溃疡，虽多有参 、甘草之缓补，而
走泄太多，宁不犯仲景，已有得汗复汗，得下复下，重虚之戒！可不省乎。
《精要》云∶血气闻香则行，闻臭则逆。又言∶饮食调令香美，益其脾土，养其真气。
夫甘而淡者，可养脾土，若香美者，但能起火，经以热伤脾，热伤气为戒。今曰益脾养
气，若施之于肿疡者，似有畅达之理，溃疡后用香美，恐有发湿热，损真阴之患矣。
《精要》云∶热盛脉数，与漏芦汤，单煮大黄等汤，不甚热，脉缓弱，只投五香连翘
汤。夫热盛脉数，若肿疡时，脏腑秘而体实者，犹可与大黄。若溃疡后，脓血出多者，热
盛脉数，去死为近，其可下乎！缓弱之脉，古人皆以为邪毒已散，五香之飞走升散，其可
用乎。
《精要》云∶初成脓，宜用烙，得脓利为效，亦服神仙追毒丸，此又不能无疑者也。夫
追毒丸下积取丸之毒，决无取脓之效，今用烙而得脓，若在里之气血壮实，则脓自出如
推矣，何不以和气活血之药，佐参 补剂，使脓自托出乎。
《精要》云∶疮作渴甚，急与神仙追毒丸，取下恶毒，与清膻汤、万金散、五香连翘汤、
六味车螯散、千金漏芦汤，皆可选用。下利以后，渴尚未止，宜用生津补气药，则津液
生，气血完，渴自止矣。夫大渴而与利药，非明示脉症，何以知其当下？后又言下利后，渴
又不止，却用补药，又不明言脉症，恐是但有大渴必与峻下，下后尚渴方与补药，夫医
者治未病，如此用药可乎？况渴属上焦，当肿疡时犹或可用，若溃疡时渴，恐因血气之
虚，何以待下利后，方议其虚哉。
《精要》论疽疾，咽喉口舌生疮，归罪于不得内托，以致热毒冲心，与琥珀犀角膏。夫
于肿疡时用之，犹或近理，若于溃汤后用之，彼犀角、脑子之升散，宁不助病邪致虚，以
速其死也耶！后有犀角散，以大黄佐黄 ，用黄 则知其虚，用大黄又似疑其有实热，夫
疮溃体虚，纵有旧热，将自渐因脓血而消，何必以峻冷利动脏腑，若在秋冬，何异用刀剑
耶。
《精要》论痈疽，发寒热多汗，或先寒后热，或先热后寒，或连日作，或间日作，必
先呕痰，然后寒热，寒热解，大汗出，不可专以为有热，亦有气虚而得者，亦有因怒而
得者，又有先感寒邪，脾气不正而有此证者。夫气虚者，当以补气药补之。因怒者，当以
顺气药和之。脾气不正者，当以调脾药养之。今用不换金正气散，悉是温散泻卫之药，而
欲以一两人参，收拾十四两之泻卫可乎？若用于肿疡时感寒邪者，犹或庶几。彼气虚者，
因怒者，脾气不正者，此方能兼治乎？又未知用于肿疡耶，溃疡耶。
《鬼遗》穴有孔慎风，仍慎再合，如再合者，为风湿邪气，攻搏而再生脓，宜如前以
通和汤药，根据次第用，不可急性，恐伤气害人之命也。《三因》疮疡未合，风入，为破伤
风；湿入，为破伤湿，二者害人最急，仓卒不知其因，甚难认治，痈疽、瘰 ，溃后尤
宜谨之。
有一个男子，疮疡溃破后出现恶寒症状，使用四君子汤（由人参、白术、茯苓、甘草组成，具有益气健脾功效），加入桂枝，加倍使用黄芪，大剂量煎服，服用四剂后症状停止。脓水仍然较多，投予八珍汤（由四君子汤加四物汤组成，具有气血双补功效），加入桂枝，服用数剂后脓水逐渐减少。只有疮口不能愈合，采用附子饼敷贴，以及服用十全大补汤（由八珍汤加黄芪、肉桂组成，具有温补气血功效），每剂药中加入炮制过的附子五分，服用数剂后去掉附子，又继续服药一个多月才痊愈。
另一个男子，疮疡溃破后怕冷，脉象虚弱，使用四君子汤加入炮姜，服用四剂后痊愈，随后服用十全大补汤一个多月，疮口收敛愈合。张仲景说：脉象虚弱说明血虚。血虚会产生寒象，这是阳气不足的表现。疮肿若见脉虚，应当采用托里法调和血液、滋养血液。确实如此！
朱丹溪治疗一位老人，年龄七十岁（详见兼症呕吐条）。五香白术散能宽中和气，滋益脾土，生肺金，增进饮食。（方剂见于内痈门，肺痈条下。）
〔丹〕 五香汤，就是五香连翘汤，去掉射干、大黄、升麻、连翘，加入人参、犀角。如果用于肿疡（未溃破的疮疡），还可以借助其走窜之性，来攻散毒邪，使其不蔓延扩散。如果用于溃疡（已溃破的疮疡），虽然有很多人参、甘草的缓补作用，但药物走泄太过，难道不违背张仲景关于“已有汗出再用发汗法，已有泻下再用攻下法，会加重虚损”的告诫吗？怎能不醒悟呢？
《精要》说：气血闻到香味则运行通畅，闻到臭味则逆乱阻滞。又说：饮食调理得香甜美味，可以益助脾土，养护真气。甘淡的食物，可以养脾土；但所谓香甜美味的食物，只能引起火气，经典以“热伤脾，热伤气”为戒。现在说益脾养气，如果施用于肿疡患者，似乎有畅达之理；但在溃疡后用香甜美味的食物，恐怕会有引发湿热、损伤真阴的祸患啊。
《精要》说：热盛脉数，给予漏芦汤，单煮大黄等汤剂；热势不甚，脉象缓弱，只投予五香连翘汤。热盛脉数，如果在肿疡阶段，脏腑闭塞且体质实者，还可以与大黄。如果在溃疡之后，脓血流出很多，热盛脉数，离死亡已经很近了，怎么可以用攻下法呢！脉象缓弱，古人都认为是邪毒已经消散，五香汤那种走窜升散的药性，怎么还能用呢？
《精要》说：初成脓时，适宜用烙法，得到脓液排出为有效，也服用神仙追毒丸，这又不能不让人怀疑了。那追毒丸是通过泻下来积聚并取出体内的毒邪，绝对没有促使排脓的效果。现在用烙法而得到脓液，如果体内气血壮实，那么脓液自然会像被推挤出来一样，为什么不用调和气血的药物，佐以人参、黄芪的补剂，使脓液自然托举出来呢？
《精要》说：疮疡发作口渴严重，急忙给予神仙追毒丸，取下恶毒，与清膻汤、万金散、五香连翘汤、六味车螯散、千金漏芦汤，都可以选用。泻利之后，口渴仍未停止，应该使用生津补气的药物，这样津液生成，气血完善，口渴自然停止。大渴却给予泻下药，如果不明确显示脉象和症状，怎么知道该用攻下法？后又说泻利后，口渴仍不止，却用补药，又不明确说明脉象和症状，恐怕只是认为有大渴就必须用峻猛攻下，泻利后仍然口渴才给予补药。医生治理未病，这样用药可以吗？况且口渴属于上焦，在肿疡阶段或许还可以用，若在溃疡时口渴，恐怕是因为气血虚弱，为什么要等到泻利之后，才议论其虚损呢？
《精要》论述疽疾，咽喉口舌生疮，归咎于未能及时内托，导致热毒冲心，给予琥珀犀角膏。如果在肿疡时使用，或许还接近事理；如果在溃疡后用这种药，那些犀角、冰片的升散之性，难道不是帮助病邪导致虚损，从而加速死亡吗！后面又有犀角散，用大黄佐助黄芪，用黄芪就知道患者体虚，用大黄又似乎怀疑有实热。疮疡溃破身体虚弱，纵然有旧有的热邪，也将自然随着脓血的排出而消退，何必用峻猛寒凉的泻下药动摇脏腑？如果在秋冬季节使用，这与用刀剑伤害人有什么区别呢？
《精要》论述痈疽，出现寒热多汗，或先寒后热，或先热后寒，或连续几日发作，或隔日发作，必定先呕吐痰涎，然后才出现寒热，寒热解除，大汗出，不能专门认为是因为有热，也有因气虚而得的，也有因愤怒而得的，又有先感受寒邪，脾气不正而有此证的。气虚者，应当用补气药补益。因愤怒所致者，应当用顺气药调和。脾气不正者，应当用调脾药养护。现在使用不换金正气散，全是温散泻卫气的药物，而想靠一两的人参，收拾十四两的泻卫之气，可能吗？如果用于肿疡时感受寒邪者，或许还可以。那些气虚者、因怒者、脾气不正者，这个方子能兼治吗？又不知道是用于肿疡还是溃疡。
《鬼遗科》说：穴位有孔洞时要慎防风邪，仍要谨慎防止再次闭合，如果再闭合，会导致风湿邪气攻搏而生脓，应当像以前那样用通和汤药，按照次序使用，不可急躁，恐怕伤气害人性命。《三因方》说：疮疡未愈合，风邪侵入，成为破伤风；湿邪侵入，成为破伤湿，这两种情况害人最急迫，仓促间不知其原因，很难辨认和治疗，痈疽、瘰疬，溃破后尤其应该谨慎。
A male patient, after the ulceration of a sore, experienced aversion to cold. He was treated with Sijunzi Tang (Four Gentlemen Decoction), with Guizhi (Cinnamon Twig) added, and Huangqi (Astragalus Root) doubled in dosage, administered in a large decoction. After four doses, the symptom ceased. There was still much pus and fluid, so Bazhen Tang (Eight Treasures Decoction) was administered with several doses of Guizhi (Cinnamon Twig), after which the discharge gradually decreased. Only the wound failed to close. A moxa cone made of Fuzi (Prepared Aconite Root) cake was applied, and Shiquan Dabu Tang (Ten Significant Tonifying Decoction) was taken, with five fen of Pao Fuzi (Prepared Aconite Root) added to each dose. After several doses, Fuzi was removed, and he continued taking medicine for over a month until he recovered.
Another male patient, after ulceration, feared cold, and his pulse was deficient. He was treated with Sijunzi Tang (Four Gentlemen Decoction) plus Pao Jiang (Prepared Ginger Rhizome). After four doses, he recovered, and subsequently took Shiquan Dabu Tang (Ten Significant Tonifying Decoction) for over a month until the wound healed. Zhang Zhongjing said: "A deficient pulse indicates blood deficiency." Blood deficiency generates cold; this is insufficient Yang Qi. For sores and swellings with a deficient pulse, one should employ the interior-supporting method to harmonize and nourish the blood. Truly so!
Danxi treated an elderly man, aged seventy (see the section on vomiting as a concomitant symptom). Wuxiang Baizhu San (Five-Aromatic Atractylodes Powder) broadens and harmonizes Qi, nourishes the Spleen Earth, generates Lung Metal, and promotes appetite. (The formula is found in the Internal Abscess section, under Lung Abscess.)
[Dan] Wuxiang Tang is essentially Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction), with Shegan (Belamcanda Rhizome), Dahuang (Rhubarb Root), Shengma (Cimicifuga Rhizome), and Liaoqiao (Forsythia Fruit) removed, and Renshen (Ginseng Root) and Xijiao (Rhinoceros Horn) added. If used for a swelling (undecayed sore), its penetrating nature can still be borrowed to attack and disperse toxicity, preventing it from spreading. However, if used for an ulcer (decayed sore), although there is much slow tonification from Renshen (Ginseng Root) and Gancao (Licorice Root), the dispersing action is too excessive. Does this not violate Zhongjing's warning against "sweating again after sweating has occurred, or purging again after purging has occurred," which leads to severe deficiency? One must awaken to this truth.
*Jingyao* states: "Qi and Blood move freely upon smelling fragrance but reverse upon smelling foul odors." It also says: "Diet should be regulated to be fragrant and delicious to benefit Spleen Earth and nourish True Qi." Sweet and bland substances can nourish Spleen Earth, but so-called fragrant and delicious foods only generate fire. The Classics warn against "heat injuring the Spleen and heat injuring Qi." Now, saying it benefits the Spleen and nourishes Qi seems reasonable when applied to patients with swellings, as it may facilitate circulation. But applying fragrant and delicious foods after ulceration may cause damp-heat to arise and damage True Yin.
*Jingyao* states: "When heat is abundant and the pulse is rapid, administer Loulu Tang (Euphorbia Decoction) or decoct Dahuang (Rhubarb Root) alone. When heat is not severe and the pulse is slow and weak, administer only Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction)." If heat is abundant and the pulse is rapid during the swelling stage, and the Zang-Fu organs are blocked while the constitution is excess, Dahuang (Rhubarb Root) may still be given. However, after ulceration, with significant loss of pus and blood, if heat is abundant and the pulse is rapid, death is near; how can purgatives be used? An ancient view holds that a slow and weak pulse indicates the dissipation of pathogenic toxins; thus, the penetrating and ascending nature of Wuxiang Tang (Five-Aromatic Decoction) should not be used.
*Jingyao* states: "When pus is initially formed, cauterization is appropriate; effective results are seen when pus drains freely. Also, Shenxian Zhuidu Wan (Immortal Poison-Expelling Pill) can be taken." This raises doubts. Zhuidu Wan (Poison-Expelling Pill) works by purging to accumulate and expel internal toxins; it certainly does not promote pus drainage. Now, using cauterization to obtain pus: if the internal Qi and Blood are strong, pus will naturally emerge as if pushed out. Why not use herbs that harmonize Qi and invigorate Blood, assisted by tonics like Renshen (Ginseng Root) and Huangqi (Astragalus Root), to naturally support the expulsion of pus?
*Jingyao* states: "If a sore causes severe thirst, urgently administer Shenxian Zhuidu Wan (Immortal Poison-Expelling Pill) to purge evil toxins. Qingdan Tang (Clear Diaphragm Decoction), Wanjin San (Myriad Gold Powder), Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction), Liuwei Che'ao San (Six-Clam Powder), and Qianjin Loulu Tang (Thousand-Gold Euphorbia Decoction) can all be selected." After purgation, if thirst persists, fluids-generating and Qi-tonifying medicines should be used. Then fluids will be generated, Qi and Blood will be complete, and thirst will cease. Giving purgatives for severe thirst without clearly indicating the pulse and symptoms—how can one know purgation is indicated? Later, it says after purgation, if thirst continues, tonics are used, yet without specifying pulse and symptoms. It seems to imply that severe thirst always requires harsh purgation, and tonics are only considered if thirst persists after purgation. Is this appropriate for a physician treating disease before it arises? Moreover, thirst belongs to the Upper Jiao. It might be usable during the swelling stage, but if thirst occurs during ulceration, it is likely due to Qi and Blood deficiency. Why wait until after purgation to discuss deficiency?
*Jingyao* discusses Ju diseases (deep-seated abscesses), where sores appear in the throat, mouth, and tongue, attributing them to the failure of interior support, leading to toxic heat rushing to the Heart, and prescribes Hupo Xijiao Gao (Amber and Rhinoceros Horn Paste). Using this during the swelling stage might be somewhat logical, but using it after ulceration: won't the ascending and dispersing nature of Xijiao (Rinoceros Horn) and Naozi (Borneol) assist the pathogen and cause deficiency, thereby hastening death? Later, there is Xijiao San (Rhinoceros Horn Powder), which uses Dahuang (Rhubarb Root) to assist Huangqi (Astragalus Root). Using Huangqi (Astragalus Root) indicates deficiency, but using Dahuang (Rhubarb Root) suggests suspicion of excess heat. With an ulcerated sore and a deficient body, even old heat will gradually dissipate with the discharge of pus and blood. Why use harsh cold purgatives to disturb the Zang-Fu organs? Using them in autumn or winter is akin to using swords and knives to harm people.
*Jingyao* discusses Yongju (boils and carbuncles) presenting with chills, fever, and profuse sweating, or alternating chills and fever, occurring daily or every other day. There is often vomiting of phlegm before the chills and fever appear. After the chills and fever resolve, profuse sweating occurs. This cannot be solely attributed to heat; it can also result from Qi deficiency, anger, or initial exposure to cold pathogens causing improper Spleen Qi function. For Qi deficiency, tonify with Qi-tonifying herbs. For cases caused by anger, harmonize with Qi-regulating herbs. For improper Spleen Qi function, nourish with Spleen-regulating herbs. Now, using Buhuanjin Zhengqi San (Golden-Exchange Upright Qi Powder), which consists entirely of warming and dispersing herbs that leak Wei Qi, hoping that one or two qian of Renshen (Ginseng Root) can counteract the leakage of fourteen liang of Wei Qi—is this feasible? If used for cold-pathogen invasion during the swelling stage, it might be acceptable. But can this formula treat Qi deficiency, anger-induced cases, and Spleen dysfunction simultaneously? Furthermore, it is unknown whether this applies to swelling or ulceration.
*Guiyi* states: "When there is a hole in an acupoint, guard against wind carefully, and still prevent re-closure. If it re-closes, Wind-Dampness pathogens will attack and generate pus again. Treat as before with Tonghe Tang (Harmonizing Decoction), following the sequence step-by-step. Do not act hastily, lest you injure Qi and endanger life." *Sanyin* states: "For unhealed sores, Wind invasion causes Broken-Wind Trauma (Tetanus); Dampness invasion causes Broken-Water Trauma. These two are most urgent in harming people. In haste, without knowing the cause, recognition and treatment are very difficult. For Yongju (boils/carbuncles) and Luoli (scrofula), caution is especially required after ulceration."