〔薛〕 仲景先生治伤寒，有汗、吐、下三法；东垣先生治疮疡，有疏通、托里、和
荣卫三法，用之得宜，厥疾瘳矣。假如疮疡肿硬木闷，烦热便秘，脉沉而实，其邪在内，
当先疏其内以下之。 肿作痛，便利调和，脉浮而洪，其邪在表，当先托其里以汗之。《元
戎》云∶荣卫充满，抑遏而为痈者，当泄之以夺盛热之气；荣卫虚弱，壅滞而为痈者，当
补之以接虚怯之气。又东垣先生云∶疮疡虽面赤伏热，不得攻里，里虚则下利。仲景先
生云∶疮家虽身体疼痛，不可发汗，汗之则发痉。苟不详审，妄为汗下，以致血气亏损，
毒反延陷。少壮者难以溃敛，老弱者多致不救。
〔东垣〕 疮疡及诸病面赤，虽伏火热，禁不得攻里，为阳气怫郁，邪气在经，宜发
表以去之，故曰火郁则发之。虽大便数日不见，宜多攻其表，以发散阳气，少加润燥药
以润之，如见风脉风证，只用发表风药，便可以通利大便，若只干燥秘涩，尤宜润之，慎
不可下也，九窍不利，皆不可下，疮疡郁冒，俗呼昏迷是也，慎不可下，汗之则愈。
〔丹溪〕 《精要》云∶大黄治痈疽之要药，以其宣热拔毒。又云∶疮，始作，皆须
以大黄等汤，极转利之，且排日不废。继又自言，患痈疽者，每有泄泻，皆是恶候，此
是不能无疑者也？借曰，前用大黄，恐因病体实，而大腑秘结，有积热沉瘤之积者发也，
止可破结导滞，推令转动而已，岂可谓极转利之，而且排日不废乎！若下利之后，又与
利药，恐非防微杜渐之意。疮之始作，即《周礼》肿疡之时也，肿在肌肉，若非大满大
实坚之证，自当行仲景发表之法，借五香汤为例，散之于外，何必遽以峻下之药，以夺
其里，自取其祸乎。
《精要》云∶大凡痈疽不可舍五香汤，此又不能无言者也，开卷便于第一论中详言之。
吾不知良甫之时，有许多大腑坚秘，病气郁塞，若是之顽浓，可以骤散而大下者？若果
有之，亦当开陈时之先后，证之可否，庶乎后人不敢孟浪杀人也。或曰∶痈疽用大黄，走
泄以去毒，自孙真人行《千金方》已言之矣，良甫祖述其说，何吾子病之深也？曰∶大黄
除诸实热，而性峻急，孙以盛行奇术于公卿间，时在晚宋，民不知兵，交游于富贵之家，
肉食之辈，固皆捷效，今良甫不分贫富、苦乐、劳逸，一概用之，宁无孟浪之患乎！况
有房劳而虚者，忧怒而虚者，极意贪求而虚者，强力动劳而虚者，大醉过饱而虚者，皆
因气弱而涩，血少而浊，生疽固是难治之病，若大腑秘而稍安谷食，肯守戒律，甘心澹味
者，犹为可治，但费补工夫耳。苟因旬日、半
月，大便秘实，不知其气不降也，便以为实而行大黄，些少寒热，不知其血气不和也，便
以为有外感而行表散，如此害人甚速。
仲景云∶疮家虽身疼痛，不可发汗，汗之则痉。（发汗为大汗出，非谓诸托里之药，轻轻表
散也。）
〔丹〕 排脓内补十宣散，若用之于些少痈疽与冬月，尽可助内托之功，若于冬月肿
疡用之，亦可转重就轻，移深为浅，若溃疡与夏月用之，其桂朴之温散，佐以防风白芷，
吾恐虽有参 ，难为倚仗。比见世人用此方者，不分痈疽冬夏，无经络无先后，如盲人
骑瞎马，半夜临深池危哉！又云∶内补十宣散，泻卫燥血药太多，止可用于轻小证候，虚
之甚者，恐难倚仗。
《精要》云∶内托散一日至三日之内，进十数服，治毒瓦斯攻冲脏腑，名护心散，此方
专为服丹石而发疽者，若不因丹石而发，恐非必用之剂，若夫年老者，病深者，证备者，
体重者，绿豆虽补，将有不胜重任之患矣。
〔丹〕 夫外施敷贴，正与发表之意同。经曰∶发表不远热。大凡气得热则散，冷则
敛。向见郑经历，性嗜酒与煎爆，年五十余，忽春末夏初，在额丝竹空穴，涌出一角，长
短大小，如鸡距稍坚。求予治。予曰∶此非膏粱所致而何？宜断浓味，先解食毒。针灸
以开泄壅滞，未易治也，此少阳经所过，气多血少者。郑以惮烦，召他医以大黄、朴硝、
脑子等，冷药罨之。一夕，豁开如酱蚶，径三寸，一二日后，血自蚶中溅出，高数尺而
死。此冷药外逼，热郁不得发，宜其发之暴如此也。李世英∶疽不热不痛属阴，切不可
用冷药敷贴，恐逼毒瓦斯入内。
〔薛〕 《内经》云∶五脏不和，九窍不通，六腑不和，留结为痈。又云∶形伤痛，气
伤肿。此则脏腑不和，疮发于外也明矣。涂贴寒凉，岂能调和脏腑，宣通气血耶！设使
肿痛热渴，脉滑数而有力属纯阳，宜内用济阴丹，外用益阳散，则热毒自解，瘀滞自散。
若似肿非肿，似痛非痛，似溃不溃，似赤不赤，脉洪数而无力，属半阳半阴，宜内用冲
和汤，外用阴阳散，则气血自和，瘀滞自消。若微肿微痛，或色黯不痛，或坚硬不溃，脉
洪大按之微细软弱，属纯阴，宜内服回阳汤，外敷抑阴散，则脾胃自健，阳气自回。丹溪
先生云∶敷贴之剂，应酬轻小热证耳，若不辨其阴证、阳证之所由分，而妄敷寒凉之剂，
迷塞腠理，凝滞气血，毒反内攻，而肉反死矣。况运气得寒而不健，瘀血得寒而不散，瘀
肉得寒而不溃，新肉得寒而不生，治者审焉。
蜞针法∶谓开门放毒以为要捷，恐可施于轻小证候耳。愚谓蜞之所吮，止肤间恶血，
若积毒于脏腑者，徒竭之于外，而不及于里，恐未为得。往见张兄之子，甫二岁，遍身赤
疹如霞片，予向见其母久病 ，谓毒热在血所成者。张曰∶谁不因母血所成，何谓毒热
之血？予曰∶其母虽 ，食肉如平时，肉性热与宿痰之热相搏，非毒欤？张不之信，自
取五六大蜞，吮其血，疹顿消，乳食起居如旧，予曰∶非其治也，未可以为喜！张怒，越
二三日，大发热而暴死，非竭之于外，血去而气不能独居乎。
薛氏论，见前内消条。
〔薛〕 用药之法如执权衡，当察病势轻重，邪蓄表里，疮毒肿溃，元气虚实，若不
详究其因，率尔投治，实实虚虚，七恶之祸，不能免矣，治者审之。 吴庠，盛原博，掌
后患疔，红丝至腕，恶寒发热，势属表证，与夺命丹一服，红丝顿消，又用和解之剂，大
势已退，彼别服败毒药，发热口干，红丝仍见，脉浮大而虚，此气血受伤而然，以补中
益气汤主之而愈。盖夺命败毒性尤猛烈，疮邪已散而复用之，是诛伐太过，失《内经》之
旨矣。 一儒者，元气素弱，予补其气血出脓而愈，后因劳役疮痕作痒，乃别服败毒药
一剂，以致口噤舌强，手足搐溺，痰涎上涌，
自汗不止，此气血伤而发痉也，用十全大补加附子一钱，灌服而苏。 一男子患疔，
服夺命丹，汗不止而疮不痛，热不止而便不利，此汗多亡阳，毒瓦斯盛而真气伤矣。用参 、归
术、芍药、防风、五味二剂，诸证悉愈，惟以小便不利为忧。予曰∶汗出不宜利小便，汗
既止阳气复而自利矣。仍用前药去防风，加麦门，倍用当归、黄 四剂，便行疮溃而愈。
东垣曰∶疮疡食肉，乃自弃也。疮疡乃营气而作，今反补之，自弃何异，虽用药治，
不能愈也。《精要》曰∶羊、鸡、牛、鹅、鱼、面，煎爆炒炙，酒等味，犯之必发热，用栀
子黄芩汤最效。丹溪曰∶栀芩、苦参、犀角，佐辅人参，固可解食毒之热，若寒月与虚人，
宁无加减乎！《内经》谓，膏粱之变，足生大疔，此言疮疽之因也，禁戒浓味，恐其引起
宿火之热，此诚富贵豢养口腹者，所当谨。若素贫者大不然矣。予治一人，背痈径尺，穴
深而黑，家贫得此，急作参 归术膏，多肉馄饨与之而安，多肉馄饨，补气之有益者也。
【薛己】张仲景先生治疗伤寒，采用汗、吐、下三种治法；李东垣先生治疗疮疡，采用疏通、托里、调和营卫三种治法。运用得当，疾病即可痊愈。假如疮疡肿胀坚硬、麻木闷痛，伴有烦热、便秘，脉象沉而有力，说明邪气在体内，应当先疏通内部以泻下之法治疗。若肿胀处开始疼痛，二便调和，脉象浮而洪大，说明邪气在体表，应当先托补里气以发汗之法治疗。《元戎》说：营卫之气充满，被郁遏而形成痈肿的，应当用泄法以消除盛热之气；营卫之气虚弱，壅滞而形成痈肿的，应当用补法以接续虚怯之气。另外李东垣先生说：疮疡患者虽然面赤且有伏热，不可攻伐里实，因为里气虚弱会导致腹泻。张仲景先生说：患有疮疡的人虽然身体疼痛，不可发汗，发汗会导致痉病（肌肉痉挛）。如果不详细审察病情，妄用汗法或下法，导致气血亏损，毒邪反而内陷深入。年轻力壮者难以溃破收口，年老体弱者多导致死亡。
【李东垣】疮疡及其他疾病出现面赤，虽然有伏火和热邪，禁止攻伐里实，这是因为阳气郁结，邪气在经络，适宜用发表法去除它，所以说“火郁则发之”。即使大便几天不通，也应当多从表证论治，发散阳气，少加润燥药来滋润肠道。如果见到风脉和风证，只用发表祛风的药物，就可以使大便通利；如果只是干燥秘涩，尤其适宜滋润，千万不可使用泻下药。九窍不利，都不可使用泻下药。疮疡引起的昏冒（俗称昏迷），千万不可使用泻下药，发汗治疗即可痊愈。
【朱丹溪】《精要》说：大黄是治疗痈疽的重要药物，因为它能宣散热邪、拔除毒邪。又说：疮疡初起，都必须用大黄等汤剂，极力使其通便泻下，并且每天不停止服用。后来又自己说，患痈疽的人，常常有腹泻症状，这都是恶候，这不能不让人怀疑？假设之前使用大黄，恐怕是因为病人身体实证，大肠腑气秘结，有积热沉瘤积聚所致，只可破除结滞、导引积滞，推动其转动而已，怎么能说是极力使其极度泻下，而且每天不停止呢！如果在已经腹泻之后，又给予泻下药物，恐怕不符合防微杜渐的本意。疮疡初起，就是《周礼》中提到的“肿疡”阶段，肿在肌肉之间，如果不是大满、大实、坚硬的证候，自然应当采用张仲景的发表法，借五香汤为例，从外部消散它，何必急于使用峻猛的泻下药，去攻伐内部，自取祸患呢？
《精要》说：凡是痈疽不可舍弃五香汤，对此我又不能不说话。在开篇第一论中已详细说明。我不知道良甫那个时代，有多少人大肠腑气坚硬秘结，病气郁塞，如此顽固浓重，可以突然发散并大力泻下的？如果果真有这种情况，也应当陈述时间的先后，证候的可否，这样后人就不敢鲁莽杀人了。有人说：痈疽使用大黄，通过走泄作用去除毒邪，自从孙思邈的《千金方》以来就已经说过了，良甫继承他的学说，为什么您批评得这么深呢？我说：大黄清除各种实热，性质峻猛急迫。孙思邈当时在公卿贵族间盛行奇术，时值晚宋，百姓不知战争，交往于富贵之家，都是吃肉的人，所以确实见效快。现在良甫不分贫富、苦乐、劳逸，一概使用大黄，难道没有鲁莽害人的隐患吗？何况有因房劳而虚损的，因忧怒而虚损的，因过度贪求而虚损的，因强力劳作而虚损的，因大醉过饱而虚损的，都是因为气弱而涩滞，血少而浑浊。生疽固然是难治的病，如果大肠腑气秘结但稍微能进食安养，肯遵守戒律，甘心吃清淡食物的人，还可以治疗，只是需要花费补益的功夫罢了。如果因为十天半月大便干结坚实，不知道这是气不下降，就认为是实证而使用大黄；有些许寒热，不知道这是气血不和，就认为有外感而使用解表散邪药，这样害人非常快。
张仲景说：患有疮疡的人虽然身体疼痛，不可发汗，发汗会导致痉病。（注：发汗是指大汗出，并非指各种托里药轻微的表散。）
【朱丹溪】排脓内补十宣散，如果用于轻微的痈疽或在冬季使用，完全可以助益内托的功效；如果在冬季用于肿疡，也可以使病情由重转轻，由深变浅；但如果用于溃疡或在夏季使用，其中桂皮、厚朴的温散作用，配合防风、白芷，我担心虽然有参、芪，也难以倚仗。近来见世人使用此方，不分痈疽发生在冬夏，不分经络和先后次序，如同盲人骑瞎马，半夜面临深池，危险啊！又说：内补十宣散，泻卫气、燥血的药物太多，只可用于轻微小的证候，虚损严重的，恐怕难以倚仗。
《精要》说：内托散在一至三天内，服用十几服，治疗毒瓦斯攻冲脏腑，名为护心散，此方专为服用丹石后引发疽症的人设计，如果不是因服用丹石而发病，恐怕不是必用的药剂。至于年老的人，病深的人，证候完备的人，体重的人，绿豆虽然补益，将有不胜重任的隐患。
【朱丹溪】外用敷贴，正与发表的意思相同。经书说：发表不远热。一般来说，气受热则发散，遇冷则收敛。以前见过郑经历，性格嗜好饮酒和煎炸爆炒食物，五十多岁，忽然在春末夏初，额头的丝竹空穴涌出一个角状物，长短大小像鸡距一样稍硬。请求我治疗。我说：这不是膏粱厚味导致的还能是什么？应当断绝浓味食物，先解除食毒。针灸以开泄壅滞，不容易治疗，这是少阳经经过的地方，气多血少的经脉。郑经历因为怕麻烦，请其他医生用大黄、朴硝、冰片等冷药外敷。一夜之间，患处豁然溃开如酱蚶，直径三寸，一两天后，血液从蚶中溅出，高达数尺而死。这是冷药从外部逼迫，热邪郁结不得发散，应该发作得如此猛烈。李世英说：疽症不热不痛属于阴证，千万不可用冷药敷贴，恐怕逼迫毒瓦斯进入体内。
【薛己】《内经》说：五脏不和，九窍不通；六腑不和，留结形成痈肿。又说：形伤则痛，气伤则肿。这说明脏腑不和，疮疡发于外部是很明显的。涂抹寒凉药物，怎么能调和脏腑，宣通气血呢！假使肿痛热渴，脉滑数而有力，属于纯阳证，适宜内用济阴丹，外用益阳散，则热毒自然解除，瘀滞自然消散。如果似肿非肿，似痛非痛，似溃不溃，似赤不赤，脉洪数而无力，属于半阳半阴证，适宜内用冲和汤，外用阴阳散，则气血自然调和，瘀滞自然消除。如果微肿微痛，或者颜色暗而不痛，或者坚硬不溃，脉洪大按之微细软弱，属于纯阴证，适宜内服回阳汤，外敷抑阴散，则脾胃自然强健，阳气自然恢复。丹溪先生说：敷贴的药剂，只是应酬轻微小的热证罢了，如果不辨别阴证、阳证的由来，而妄用寒凉药剂，迷塞腠理，凝滞气血，毒邪反而内攻，肌肉反而坏死。况且运气遇到寒冷就不健康，瘀血遇到寒冷就不消散，瘀肉遇到寒冷就不溃破，新肉遇到寒冷就不生长，治疗者务必审慎。
蜞针法：说是开门放毒作为主要捷径，恐怕只适用于轻微小的证候。我认为蜞所吮吸的，只是皮肤间的恶血，如果毒素积聚在脏腑，只在外部竭尽，而不能顾及内部，恐怕不得当。过去见过张兄的儿子，刚两岁，遍身赤疹如霞片，我以前见过他母亲久病，说是毒热在血分形成的。张兄说：谁不是因为母血形成的，为什么说毒热之血？我说：他母亲虽然患病，吃肉如平时，肉性热与宿痰之热相搏，不是毒吗？张兄不信，自己取五六只蜞，吮吸其血，疹子顿时消退，乳食起居如旧，我说：这不是正确的治疗，不可以为此高兴！张兄生气，过了两三天，大发热而暴死，这不是因为在外部竭尽，血去而气不能独存吗？
薛氏的论述，见前文内消条。
【薛己】用药的方法如同执掌秤锤，应当考察病势轻重，邪气蓄积在表在里，疮毒肿胀溃破情况，元气虚实。如果不详细探究病因，草率投药治疗，造成实证实治、虚证虚治的错误，七恶的灾祸就不能避免，治疗者务必审慎。吴庠，盛原博，手掌后患疔疮，红丝蔓延至手腕，恶寒发热，病势属于表证，给他服用夺命丹一次，红丝顿时消退，又用和解的药剂，大势已退，他却另外服用败毒药，导致发热口干，红丝仍然出现，脉象浮大而虚，这是气血受伤所致，用补中益气汤主治而痊愈。大概夺命丹、败毒性尤猛烈，疮邪已散而再用之，是诛伐太过，违背了《内经》的宗旨。一位儒者，元气素来虚弱，我补益其气血，出脓而愈，后来因为劳役导致疮痕作痒，于是另外服用一剂败毒药，导致口噤舌强，手足抽搐，痰涎上涌，自汗不止，这是气血受伤而引发的痉病，用十全大补汤加附子一钱，灌服后苏醒。一个男子患疔疮，服用夺命丹，汗不止而疮不痛，热不止而大便不通利，这是汗多亡阳，毒瓦斯盛而真气受伤。用人参、当归、白术、芍药、防风，两剂后，诸证悉愈，惟独为小便不利而担忧。我说：出汗后不宜利小便，汗既停止阳气恢复而小便自然通利。仍用前药去掉防风，加麦门冬，倍用当归、黄芪，四剂后，小便行，疮溃而愈。
李东垣说：疮疡患者吃肉，是自弃生命。疮疡是由营气运行不畅而作，现在反而进补肉食，自弃与什么不同，虽然用药治疗，也不能痊愈。《精要》说：羊、鸡、牛、鹅、鱼、面，煎爆炒炙，酒等味道，犯了这些必然发热，用栀子黄芩汤最有效。丹溪说：栀芩、苦参、犀角，佐辅人参，固然可以解除食毒之热，如果在寒冬或对于虚人，难道不需要加减吗！《内经》说，膏粱之变，足生大疔，这是说疮疽的原因，禁戒浓味，恐怕引起宿火之热，这确实是富贵人家豢养口腹者所应当谨慎的。如果是向来贫穷的人则完全不然。我治疗一个人，背痈直径一尺，穴位深而黑，家境贫寒得了这个病，急忙制作参、归、术膏，给他吃多肉馄饨而安宁，多肉馄饨，是对补气有益的。
[Xue Ji] Master Zhang Zhongjing treated Shaoyang disease (Shaoyang disease, a syndrome caused by pathogenic factors affecting the Shaoyang channel) using three methods: sweating (sweating method), vomiting (vomiting method), and purging (purging method). Master Li Dongyuan treated sores and ulcers (sores and ulcers, external skin lesions) using three methods: unblocking and draining (unblocking and draining method), supporting the interior (supporting the interior method), and harmonizing Ying and Wei (harmonizing Ying and Wei method). When applied appropriately, the serious illness would be cured. For instance, if a sore or ulcer is swollen, hard, numb, and stifling, accompanied by irritability, heat, constipation, and a deep, forceful pulse, the pathogen is in the interior; one should first unblock the interior and use purging. If the swelling becomes painful, bowel movements and urination are regulated, and the pulse is floating and surging, the pathogen is in the exterior; one should first support the interior and use sweating. The *Yuan Rong* states: When Ying and Wei Qi are full and obstructed, causing an abscess, one should use draining to remove excessive heat; when Ying and Wei Qi are weak and stagnant, causing an abscess, one should use tonification to replenish deficient Qi. Furthermore, Master Li Dongyuan stated: Although a patient with a sore or ulcer may have a red face and latent heat, one must not attack the interior, as interior deficiency leads to diarrhea. Master Zhang Zhongjing stated: Although a patient with a sore or ulcer may have body pain, one must not induce sweating, as doing so will lead to tetanus (tetanus, characterized by muscle spasms). If one fails to examine carefully and recklessly uses sweating or purging, it will deplete Qi and Blood, causing the toxin to sink deeper. Young and strong individuals may fail to suppurate and heal, while the old and weak often die.
[Li Dongyuan] In sores, ulcers, and other diseases presenting with facial redness, although there is latent fire and heat, attacking the interior is prohibited because Yang Qi is constrained and the pathogen is in the channels; it is appropriate to release the exterior to eliminate it, hence the saying "when fire is constrained, release it." Even if stool has not passed for several days, one should focus on releasing the exterior, dispersing Yang Qi, and adding a small amount of moistening drugs to lubricate the intestines. If wind pulse or wind symptoms are present, only exterior-releasing wind-dispelling herbs are needed to facilitate bowel movement; if it is merely dryness and constipation, moistening is especially appropriate, and purgatives must strictly be avoided. Any condition involving dysfunction of the nine orifices should not be treated with purgatives. Coma induced by sores and ulcers (commonly called coma) must not be treated with purgatives; sweating therapy will cure it.
[Zhu Danxi] The *Jing Yao* states: Rhubarb (*Rhei Radix et Rhizoma*) is a key drug for treating carbuncles and malignant sores because it disseminates heat and extracts toxins. It also states: At the onset of a sore, one must use decoctions containing Rhubarb etc., to induce strong purgation, continuing daily without interruption. Later, Zhu himself remarked that patients with carbuncles and malignant sores often experience diarrhea, which is a bad omen; this raises doubts. Perhaps the previous use of Rhubarb was intended for patients with excess syndromes, fecal impaction, and accumulated deep heat; it could only break stagnation and guide it out, but certainly not to induce extreme purgation daily! If purgatives are given after diarrhea has already occurred, it contradicts the principle of preventing minor issues from becoming major ones. The initial stage of a sore corresponds to the "swollen ulcer" stage in the *Zhou Li*. If the swelling is in the muscles and does not present as fullness, excess, or hardness, one should naturally follow Zhang Zhongjing’s method of releasing the exterior, taking Wuxiang Tang (Five Fragrances Decoction) as an example, to disperse externally. Why rush to use harsh purgatives to attack the interior and invite disaster?
The *Jing Yao* states: Generally, carbuncles and malignant sores should not discard Wuxiang Tang. Regarding this, I must speak. As detailed in the first chapter. I do not know how many people in Liangfu’s time had such stubborn and severe fecal impaction and Qi stagnation that they could be suddenly dispersed and heavily purged? If such cases existed, the timing and appropriateness of the syndrome should have been clearly explained, so later generations would not dare to kill rashly. Some say: Using Rhubarb for carbuncles to drain and remove toxins was stated since Sun Simiao’s *Qianjin Fang*; Liangfu followed this theory, why do you criticize it so deeply? I reply: Rhubarb clears various excess heats and is harsh and urgent. Sun Simiao practiced his unique arts among nobles in the late Song Dynasty, when people were unfamiliar with war and socialized with wealthy meat-eaters, so quick effects were indeed common. Now, Liangfu uses it indiscriminately regardless of wealth, hardship, leisure, or labor. Could this not lead to rash harm? Moreover, those deficient due to sexual exhaustion, worry and anger, excessive greed, forced labor, or drunkenness overeating all suffer from weak Qi causing stagnation and scanty blood causing turbidity. Carbuncles are indeed difficult to treat; however, if the bowels are constipated but the patient can eat slightly and rest, abiding by dietary restrictions and accepting bland food, treatment is possible, though it requires tonifying efforts. If one assumes constipation for ten days or half a month indicates excess and uses Rhubarb, or attributes slight chills and fever to external contraction and uses diaphoretics without recognizing Qi non-descent or Qi-Blood disharmony, such practices harm people rapidly.
Zhang Zhongjing said: Although a patient with a sore has body pain, one must not sweat them, as sweating causes tetanus. (Note: Sweating refers to profuse sweating, not mild exterior dispersion via supporting interior herbs.)
[Zhu Danxi] Paining Neibu Shixuan San (Ten-Expanse Internal-Supplementing Pus-Draining Powder) can assist internal support when used for minor carbuncles or in winter. Used in winter for swollen ulcers, it can turn heavy conditions light and deep conditions superficial. However, if used for open ulcers or in summer, the warming and dispersing nature of Cinnamon Twig (*Cinnamomi Ramulus*) and Phellodendron Bark (*Phellodendri Cortex*), assisted by Saposhnikovia Root (*Saposhnikoviae Radix*) and Angelica Dahurica Root (*Angelicae Dahuricae Radix*), makes me fear that even with Ginseng (*Ginseng Radix*) and Astragalus Root (*Astragali Radix*), reliance is precarious. I have seen people using this formula regardless of season or meridian sequence, like a blind man riding a blind horse facing a deep pool at midnight—dangerous! Also, Paining Neibu Shixuan San contains too many herbs that drain Wei Qi and dry Blood; it is only suitable for mild cases. In severe deficiency, it cannot be relied upon.
The *Jing Yao* states: Neituo San, taken in large doses within one to three days, treats toxic qi attacking the zang-fu organs, named Huxin San (Heart-Protecting Powder). This formula is specifically for carbuncles caused by taking mineral pills (Dan Shi). If not caused by mineral pills, it may not be essential. For the elderly, those with deep disease, complete syndromes, or heavy bodies, although Mung Bean (*Vigna mungo*) is nourishing, there is a risk of failing to bear the burden.
[Zhu Danxi] External application is similar in intent to releasing the exterior. The Classics state: Releasing the exterior does not avoid heat. Generally, Qi disperses when warm and contracts when cold. I once treated Zheng Jingli, who loved alcohol and fried foods. In late spring/early summer, at age fifty-plus, a horn-like swelling appeared at Sizhukong (EX-HN4), hard like a chicken spur. I said: Is this not caused by rich food? Stop rich foods, resolve food toxicity. Acupuncture and moxibustion to open stagnation are not easy to treat; this is the Shaoyang channel, where Qi is abundant and Blood is scarce. Fearful of trouble, Zheng hired another doctor who applied cold herbs like Rhubarb, Mirabilite (*Natrii Sulfas*), and Borneol (*Borneolum Syntheticum*). Overnight, it burst open like a sauce clam, three inches in diameter. One or two days later, blood sprayed from the wound, reaching several feet high, and he died. This was caused by cold herbs forcing from outside, trapping heat internally, leading to violent eruption. Li Shiy ing said: Yin-type carbuncles are neither hot nor painful; cold applications must strictly be avoided to prevent forcing toxins inward.
[Xue Ji] The *Neijing* states: Disharmony of the five zang organs leads to blockage of the nine orifices; disharmony of the six fu organs leads to accumulation and formation of abscesses. It also states: Injury to form causes pain; injury to Qi causes swelling. Thus, it is clear that zang-fu disharmony manifests as external sores. Applying cold pastes cannot harmonize zang-fu or promote Qi and Blood circulation. If swelling, pain, heat, and thirst are present, with a slippery, rapid, and forceful pulse indicating pure Yang excess, one should internally use Jiyin Dan (Nourish-Yin Pill) and externally use Yiyang San (Benefit-Yang Powder); heat toxins will resolve, and stasis will dissipate. If swelling and pain are ambiguous, with a surging, rapid, but forceless pulse indicating half-Yang half-Yin, one should internally use Chonghe Tang (Harmonizing Decoction) and externally use Yinyang San (Yin-Yang Powder); Qi and Blood will harmonize, and stasis will消. If swelling and pain are slight, color is dark, hardness persists without suppuration, and the pulse is surging and large but fine, weak, and soft upon pressure, indicating pure Yin, one should internally use Guiyang Tang (Restore-Yang Decoction) and externally apply Yi Yin San (Suppress-Yin Powder); Spleen and Stomach will strengthen, and Yang Qi will return. Mr. Danxi said: Pastes are only for responding to mild, small heat syndromes. If one fails to distinguish between Yin and Yang syndromes and recklessly applies cold pastes, it blocks pores, stagnates Qi and Blood, causes toxins to attack inward, and leads to tissue necrosis. Furthermore, cold prevents healthy Qi movement, prevents blood stasis resolution, prevents necrotic tissue suppuration, and prevents new flesh growth. Practitioners must be cautious.
Lee Needle Method (Leeching Therapy): Claiming to open the gate to release toxins as a shortcut, this may only be suitable for mild cases. I believe leeches only suck evil blood from the skin surface. If toxins accumulate in the zang-fu, exhausting them externally without addressing the interior is inappropriate. I once saw Brother Zhang’s son, aged two, covered in red rashes like clouds. His mother had a long-term illness, which I attributed to heat-toxin in the blood. Zhang asked: Isn’t everyone formed by maternal blood? Why call it heat-toxin? I said: Although ill, she ate meat as usual. Meat is hot; combined with phlegm-heat, is it not toxic? Zhang did not believe me, took five or six leeches, and sucked the blood. Rashes vanished, feeding and activity resumed. I said: This is not proper treatment; do not rejoice. Zhang became angry. Two or three days later, the child developed high fever and died suddenly. Was this not due to exhausting externally, leaving Qi unable to stand alone?
Xue’s discussion is found in the preceding section on internal resolution.
[Xue Ji] Medication usage is like holding a balance scale; one must assess the severity of the disease, the location of pathogens (exterior/interior), the state of sores (swollen/suppurated), and the strength of Yuan Qi. Without investigating the cause and prescribing hastily, one risks exacerbating excess and depleting deficiency, leading to the "Seven Evils" disasters. Practitioners must be cautious. Wu Xiang, Sheng Yuanbo, suffered a carbuncle behind the palm with red streaks extending to the wrist, accompanied by aversion to cold and fever, indicating an exterior syndrome. One dose of Mingdan (Life-Saving Pill) cleared the red streaks immediately. A harmonizing formula reduced the main symptoms. However, he took detoxifying/purging herbs, leading to fever, dry mouth, and recurring red streaks with a floating, large, and empty pulse, indicating Qi and Blood injury. He was cured with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Mingdan and detoxifying herbs are extremely potent; using them after the pathogen has dispersed constitutes excessive attack, violating the *Neijing*. A scholar with inherent weak Qi was cured by tonifying Qi and Blood to promote suppuration. Later, itching at the scar site due to labor led him to take a dose of detoxifying herbs, resulting in trismus, stiff tongue, convulsions, upward rushing of phlegm-saliva, and spontaneous sweating—tetanus due to Qi and Blood injury. He revived after administering Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with one qian of Aconite Root (*Aconiti Lateralis Radix Praeparata*). A man with a carbuncle took Mingdan, resulting in continuous sweating without sore pain, persistent fever without bowel movement. This indicated Yang loss from excessive sweating, with strong toxins injuring true Qi. Two doses of Ginseng (*Ginseng Radix*), Angelica Sinensis Root (*Angelicae Sinensis Radix*), Atractylodes Macrocephala Rhizome (*Atractylodis Macrocephalae Rhizoma*), Peony Root (*Paeoniae Radix Alba*), and Saposhnikovia Root resolved all symptoms except difficulty urinating. I said: After sweating, diuresis is contraindicated; once sweating stops and Yang recovers, urination will normalize. The same formula minus Saposhnikovia Root, plus Ophiopogon Tuber (*Ophiopogonis Tuber*), with doubled Angelica Sinensis Root and Astragalus Root (*Astragali Radix*), administered for four doses, resulted in normal urination, suppuration, and cure.
Li Dongyuan said: Eating meat for sores is self-abandonment. Sores arise from impaired Ying Qi; supplementing with meat is self-abandonment. Even with medication, it cannot be cured. The *Jing Yao* states: Lamb, chicken, beef, goose, fish, wheat noodles, fried/grilled foods, and alcohol will cause fever if consumed; Zhi Zi Huang Qin Tang (Gardenia and Scutellaria Decoction) is most effective. Danxi said: Gardenia, Scutellaria, Sophora Root (*Sophorae Flavescentis Radix*), and Rhinoceros Horn (*Rhinocerotis Cornu* - note: now substituted), assisted by Ginseng, can resolve food-toxin heat, but adjustments are necessary in winter or for deficient persons. The *Neijing* states: Changes from rich food give rise to large carbuncles, explaining the cause of sores. Avoiding rich flavors prevents reigniting latent heat, a caution for the wealthy. This does not apply to the poor. I treated a man with a back carbuncle one chi in diameter, deep and black. Poor, he was given a paste of Ginseng, Angelica, and Atractylodes, and fed wontons with plenty of meat, which stabilized him. Meat-filled wontons benefit Qi tonification.