或问∶十四椎旁，腰肾之间，发疽何如？曰∶此名连肾发，即下搭也。由房劳太过，致
伤肾水，令人口干，寒热大作，百节俱痛，急服胜金丹、黄 内托散、活命饮加羌活、黄
治之，稍缓溃烂透膜者死。若见咳嗽呕哕，腰间似折，不能俯仰，饮食不纳者死。溃而
脓水清稀，腐烂腥秽，迷闷不醒，厥逆者不治。 一妇年逾七十，腰生一 ，作痒异常，
疑虫虱所毒，诊脉浮数。齐氏曰∶脉浮数，反恶寒者，疮也。翌日复诊，脉乃弱。予谓∶未
溃而脉先弱，何以收敛？况大便不通，则真气已竭，治之无功。固请，不得已，用六君
子加藿香、神曲，饮食渐进，大便始通，更用峻补之剂，溃而脓清作渴，再用参、 、归、
、麦门、五味而渴止。喜曰∶可无虞矣！予曰∶不然。不能收敛先入之言也，彼疑。更
医，果殁。一人年十九，腰间肿一块无头，不痛色不变，三月不溃，饮食少思，肌肉日
瘦，此气搏腠理，荣气不行，郁而为肿。名曰湿毒流注。《元戎》曰∶若人饮食疏，精神
衰，气血弱，肌肉瘦，荣卫之气短促而涩滞，故寒搏腠理，闭郁为痈者当补，以接虚怯之
气。遂以十全大补汤，加香附、陈皮三十余剂，始针出白脓二碗许，仍用药倍加参 ，仍
灸以豆豉饼渐愈。彼乃惑于速效，内服败毒，外贴凉药，反致食少脓稀，患处色紫，复请
予治。喜得精气未衰，仍以前药，加远志、贝母、白蔹百剂而愈。此或久而不愈，或脓水
清稀，当服内塞散，及灸附子饼，然后可愈。一妇年逾二十，腰间突肿寸许，肉色不变，
微痛不溃，发热脉大，此七情所损，气血凝滞遂道而然。当益气血，开郁结，更以香附
饼熨之，使气血充畅，内自消散。若尔，虽溃亦无危。不听，乃服十宣流气之药，气血
愈虚，溃出清脓不敛而死。 一妇产后，腰间肿，两腿尤甚，此瘀血滞于经络而然，不
早治，必作痈。遂与桃仁汤二剂稍愈，更以没药丸数服而痊。亦有恶血未尽，脐腹刺痛，
或流注四肢，或注股内痛如锥刺，或两股肿痛，此由冷热不调，或思虑动作，气乃壅遏，
血蓄经络而然，宜没药丸治之。亦有或因水湿所触，经水不行而肿痛者，宜当归丸治之。
凡恶血停滞，为患匪轻，治之稍缓，则为流注，为骨疽，多致不救。 府庠彭碧溪，患
腰疽，服寒凉败毒之药，色黯不痛，疮头如铺黍，背重不能安寝，耳聩目白，面色无神，
小便频涩，作渴迷闷，气粗短促，脉浮数重按如无。余先用滋肾水之药一剂，少顷，便
利渴止，背即轻爽。乃砭去瘀血，以艾半斤许，明灸患处，外敷乌金膏，内服参、 、归、
术、肉桂等药至数剂，元气稍复。自疑肉桂辛热，一日不用。手足并冷，大便不禁，仍
加肉桂，及补骨脂二钱，肉豆蔻一钱，大便如常，其肉渐溃，更用当归膏以生肌肉，八
珍汤以补气血而愈。 举人顾东溪，久作渴，六月初腰患疽，不慎起居，疮溃尺许，色黯
败臭，小便如淋，唇裂舌刺，七月终请治。左尺洪数，左关浮涩，余谓∶先渴而患疽者，乃
肾水干涸，虚火上炎，多致不起。然脓水败臭，色黯不痛，疮口张大，乃脾气败而肌肉
死也。小便如淋，痰壅喘促，口干舌裂，乃脾肺败而肾水绝也。左尺洪数，肾无所生也。
左关浮涩，肺克脾也。况当金旺之际，危殆速矣！二日后果殁。盖此证既发于外，两月
方殁者，乃元气虚不能收敛也。若豫为调补，使气血无亏，亦有得生者。
或问∶一人患疽于腰胯之间，肉色不变，坚硬如石，经月不溃者何如？曰∶此名石疽。
属少阳 阳明二经积热所致，邪毒固结，元气不足，故不能起发。活命饮加独活、羌活、
柴胡、黄 ，及紫金丹汗之，壮实者，八阵散、一粒金丹下之。老弱者，十全大补汤、人
参养荣汤托之。若黑陷不起，麻木不痛，呕哕不食，精神昏乱，脉散或代者死。神清脉
和，服台阁紫微丸。
有人问：在第十四椎骨旁侧，腰与肾之间的部位，发生疽病是怎么回事？回答说：这叫做“连肾发”，也就是俗称的“下搭”。这是由于房事过度，损伤了肾阴（肾水），导致人口干，寒热症状剧烈发作，全身关节都疼痛。应当立即服用胜金丹、黄芪内托散，或在活命饮中加入羌活、黄芪来治疗。如果病情稍微拖延，出现溃烂且穿透筋膜的情况，就会死亡。如果出现咳嗽、呕吐呃逆，腰部感觉像折断一样，不能弯腰或直立，饮食无法吞咽的情况，也会死亡。如果已经溃破，但脓液清稀，腐烂且有腥臭味，神志昏迷不醒，四肢厥冷的，属于难治之症。
有一位七十多岁的妇女，腰部生了一个疮疡，瘙痒异常，怀疑是被虫虱叮咬中毒所致。诊脉见浮数脉。齐氏说：脉象浮数，反而恶寒的，是疮疡的表现。第二天再次诊脉，脉象变得微弱。我说：疮疡尚未溃破而脉象先变弱，如何能促使疮口收敛愈合？况且大便不通，说明真气已经衰竭，治疗也不会有效果。病人家属坚决请求治疗，不得已，使用了六君子汤加入藿香、神曲，病人的饮食逐渐增加，大便开始通畅。随后又使用峻补的药物，溃破后脓液清澈并感到口渴，再用人参、白术、当归、熟地黄、麦门冬、五味子等药，口渴停止。家属高兴地说：可以没有忧虑了！我说：不是这样。这是不能收敛疮口的先兆，他们对此表示怀疑。后来换了医生，果然去世了。
有一个十九岁的年轻人，腰间肿起一块，没有脓头，不痛，肤色不变，三个月不溃破，饮食减少，思食无力，肌肉日渐消瘦。这是气机搏结于腠理，营气运行不畅，郁滞而形成肿胀。名叫“湿毒流注”。《元戎》说：如果一个人饮食粗疏，精神衰弱，气血虚弱，肌肉消瘦，营卫之气短促而涩滞，所以寒气搏结于腠理，闭塞郁积而成痈肿的，应当采用补法，以接续虚怯的气血。于是使用十全大补汤，加入香附、陈皮，服用三十多剂后，才针刺出约两碗白色的脓液。仍然加倍使用人参、黄芪，并用豆豉饼灸患处，逐渐痊愈。那人被追求速效迷惑，内服败毒药物，外贴凉性药物，反而导致食欲减少，脓液稀薄，患处颜色紫暗，再次请求我治疗。我发现他精气尚未衰败，仍然用前面的药物，加入远志、贝母、白蔹，服用一百剂后痊愈。这种情况如果是久治不愈，或者脓水清稀，应当服用内塞散，以及灸附子饼，然后才可以痊愈。
有一位二十多岁的妇女，腰间突然肿起一寸左右，肤色不变，微痛不溃，发热，脉象大。这是七情（喜、怒、忧、思、悲、恐、惊）所损伤，气血凝滞，经络阻塞所致。应当补益气血，开通郁结，再用香附饼熨烫患处，使气血充盛通畅，内部自然消散。如果是这样，即使溃破也没有危险。她不听劝告，反而服用十宣流气的药物，导致气血更加虚弱，溃破后流出清脓，不能收敛而死亡。
一位产妇产后，腰部肿胀，两条腿尤其严重，这是瘀血停滞在经络中造成的。如果不早治疗，必定会形成痈肿。于是给予桃仁汤两剂，稍有好转，再服用几剂没药丸而痊愈。也有因为恶露未尽，脐腹部刺痛，或者流注到四肢，或者注入大腿内侧，疼痛如锥刺，或者双腿肿痛，这是由于冷热不调，或者思虑劳倦，气机壅遏，血液蓄积在经络中造成的，适宜用没药丸治疗。也有因为接触水湿，月经不行而导致肿痛的，适宜用当归丸治疗。凡是恶血停滞，为害不小，治疗稍微迟缓，就会变成流注，或者骨疽，大多导致无法救治。
府学生彭碧溪，患腰疽，服用寒凉败毒的药物，疮色黯黑且不痛，疮头像铺开的黍米，背部沉重不能安睡，耳聋目眩，面色无神，小便频急涩痛，口渴神志昏闷，呼吸粗重短促，脉象浮数但重按似乎没有。我先用滋补肾水的药物一剂，不久，大小便通利，口渴停止，背部立刻轻松爽快。然后用砭石刺去瘀血，用艾绒半斤左右，直接灸患处，外敷乌金膏，内服人参、白术、当归、肉桂等药物，服用数剂后，元气稍微恢复。他自己怀疑肉桂辛热，有一天没有服用。结果手足冰冷，大便失禁，仍然加上肉桂，以及补骨脂二钱，肉豆蔻一钱，大便恢复正常，肌肉逐渐溃破，再用当归膏生肌，八珍汤补益气血而痊愈。
举人顾东溪，长期口渴，六月初腰部患疽，起居不慎，疮溃破有一寸多，颜色黯黑腐败发臭，小便像淋证一样，嘴唇开裂，舌有刺状突起，七月末请我治疗。左尺脉洪数，左关脉浮涩。我说：先口渴而后患疽的，是肾水干涸，虚火上炎，大多导致死亡。然而脓水腐败发臭，颜色黯黑不痛，疮口张大，这是脾气败坏而肌肉坏死。小便像淋证，痰多气喘急促，口干舌裂，这是脾肺败坏而肾水枯竭。左尺脉洪数，说明肾无所生。左关脉浮涩，说明肺金克伐脾土。况且正值金气旺盛的时候，危险迫在眉睫！两天后果然去世。这个病症既然发于外部，两个月后才死亡的，是因为元气虚弱不能收敛。如果预先进行调补，使气血不亏损，也有能够存活的人。
有人问：一个人患疽在腰胯之间，肤色不变，坚硬如石头，经过一个月不溃破，是怎么回事？回答说：这叫做“石疽”。属于少阳经和阳明经积热所致，邪毒固结，元气不足，所以不能起发化脓。用活命饮加入独活、羌活、柴胡、黄芪，以及紫金丹发汗；体质壮实的，用八阵散、一粒金丹攻下；年老体弱的，用十全大补汤、人参养荣汤托毒外出。如果疮色黑陷不起，麻木不痛，呕吐呃逆不能进食，精神昏乱，脉象散乱或代脉的，会死亡。如果神志清醒，脉象平和，服用台阁紫微丸。
A person asked: What is the condition of a carbuncle (ju, 疽) occurring between the fourth lumbar vertebra and the kidneys? The answer was: This is called "Lian Shen Fa" (Continuous Kidney Eruption), also known as "Xia Da". It is caused by excessive sexual activity, which injures the Kidney Yin (Kidney Water), leading to dry mouth, severe alternating chills and fever, and pain in all joints. One should immediately administer Sheng Jin Dan (Victory Gold Pill), Huangqi Neituo San (Astragalus Interior-Supporting Powder), or Huoming Yin (Life-Saving Decoction) with added Qianghuo (Notopterygii Rhizoma et Radix) and Huangqi (Astragali Radix). If treatment is delayed slightly and ulceration penetrates the fascia, death will ensue. If cough, vomiting, and hiccups appear, the waist feels as if broken, inability to bend or straighten, and inability to swallow food occur, death will also result. If already ulcerated but the pus is clear and thin, rotting with a fishy and foul odor, accompanied by coma and cold extremities, it is incurable.
A woman over seventy years old developed a sore on her waist with extreme itching, suspected to be poisoned by insects or lice. Her pulse was floating and rapid. Qi stated: A floating and rapid pulse with aversion to cold indicates a sore. On the second day, upon re-examination, the pulse became weak. I said: If the pulse becomes weak before ulceration, how can the sore heal and close? Moreover, constipation indicates that the True Qi is exhausted; treatment will be ineffective. Despite strong requests, I reluctantly used Liujunzi Tang (Six Gentlemen Decoction) with added Huoxiang (Pogostemonis Herba) and Shenqu (Massa Medicata Fermentata). Her diet gradually improved, and bowel movements resumed. Subsequently, potent tonifying agents were used. After ulceration, the pus was clear and thirst appeared. Ren Shen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Shudihuang (Rehmanniae Radix Praeparata), Maidong (Ophiopogonis Tuber), and Wuweizi (Schisandrae Fructus) were then administered, stopping the thirst. The family rejoiced, saying, "We are safe!" I replied, "Not so. This is a precursor to the failure of the sore to close." They doubted me. Later, they changed doctors, and indeed, she died.
A nineteen-year-old man had a swelling on his waist without a head, non-painful, with unchanged skin color, which did not ulcerate for three months. His appetite decreased, he lacked desire for food, and his muscles wasted daily. This was due to Qi stagnating in the interstices (Couli, 腠理), causing Ying Qi (Nutritive Qi) to fail to circulate, leading to swelling from depression. It is named "Shidu Liuzhu" (Damp-Toxin Flowing Deposit). *Yuanrong* states: If a person has coarse diet, depleted spirit, weak Qi and Blood, and emaciated muscles, their Ying and Wei (Defensive) Qi are short and stagnant. Thus, when cold stagnates in the interstices, closing and depressing to form an abscess, tonification should be used to support deficient and frail Qi. Therefore, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with Xiangfu (Cyperi Rhizoma) and Chenpi (Citri Reticulatae Pericarpium) was prescribed for over thirty doses. Only then was white pus expressed via needle puncture, amounting to about two bowls. Ren Shen and Huangqi were doubled in the prescription, and moxibustion with fermented soybean cakes was applied to the affected area, leading to gradual recovery. Confused by the desire for quick results, he took internal detoxifying drugs and applied cooling external medicines. This worsened his condition, causing poor appetite, thin pus, and purple discoloration at the site. He requested my treatment again. Finding his Essence and Qi still intact, I continued with the previous formula, adding Yuanzhi (Polygalae Radix), Beimu (Fritillariae Cirrhosae Bulbus), and Bailian (Tinosporae Caulis). After one hundred doses, he recovered. In cases where healing is prolonged or pus is clear and thin, Naise San (Internal-Sealing Powder) and moxibustion with Aconite cakes should be used before recovery is possible.
A woman over twenty years old had a sudden swelling of about one cun on her waist, with unchanged skin color, slight pain, no ulceration, fever, and a large pulse. This was caused by damage from the Seven Emotions (Seven Affects), leading to Qi and Blood stagnation and meridian obstruction. Treatment should tonify Qi and Blood, resolve depression, and apply Xiangfu cake compresses to the area to ensure abundant and smooth Qi and Blood circulation, allowing internal resolution. In such cases, even if ulceration occurs, there is no danger. She did not listen and instead took Shixuan Liuqi drugs, further depleting Qi and Blood. She ulcerated, discharged clear pus, failed to heal, and died.
A postpartum woman had swelling in her waist, worse in both legs. This was due to lochia stasis in the meridians. If not treated early, it would become an abscess. Two doses of Taoren Tang (Peach Kernel Decoction) provided slight relief, followed by several doses of Moyao Wan (Myrrh Pill) for full recovery. There are also cases where residual lochia causes stabbing pain in the umbilical and abdominal regions, or flows to the limbs, or injects into the inner thighs with pain like needle pricks, or causes bilateral thigh swelling. These result from imbalance of cold and heat, or mental worry and physical exertion, causing Qi obstruction and Blood accumulation in the meridians. Moyao Wan is suitable. There are also cases of swelling and pain due to water-dampness exposure and amenorrhea, treatable with Danggui Wan (Angelica Pill). Any stasis of evil blood is serious; if treatment is delayed, it becomes a flowing deposit or bone carbuncle, often proving fatal.
Peng Bixi, a government student, suffered from a lumbar carbuncle after taking cold-natured detoxifying drugs. The lesion was dark and painless, the head resembled spread millet seeds, his back felt heavy preventing sleep, he had deafness and cloudy vision, lackluster complexion, frequent and difficult urination, thirst, confusion, coarse and short breathing, and a floating-rapid pulse that vanished under heavy pressure. I first administered one dose of medicine to nourish Kidney Water. Soon, urination and defecation normalized, thirst ceased, and his back felt light. Then, bloodletting with a stone needle removed stasis. Half a jin of moxa was applied directly to the lesion. Wujin Gao (Black Gold Ointment) was applied externally, and internally, Ren Shen, Baizhu, Danggui, Renshen (Note: likely Baizhu repeated or similar root, context implies tonics), Rougui (Cinnamomi Cortex), etc., were taken for several doses, slightly restoring Yuan Qi (Primal Qi). Suspecting Rougui's pungent heat, he omitted it for one day. Consequently, his hands and feet became cold, and he suffered fecal incontinence. Rougui was reinstated, along with Buguzhi (Psoraleae Fructus, 2 qian) and Roudoukou (Myristicae Semen, 1 qian). Bowel movements normalized, the flesh gradually ulcerated, Danggui Gao (Angelica Ointment) was used to generate flesh, and Bazhen Tang (Eight Treasures Decoction) tonified Qi and Blood, leading to recovery.
Gu Dongxi, a licentiate, suffered from chronic thirst. In early June, he developed a lumbar carbuncle. Neglecting his lifestyle, the sore ulcerated to an inch wide, appearing dark, rotten, and foul-smelling. His urine resembled strangury, lips cracked, and tongue had prickles. He sought treatment at the end of July. The left Chi pulse was flooding and rapid; the left Guan pulse was floating and choppy. I said: Thirst preceding carbuncle indicates dried-up Kidney Water and flaming deficiency fire, usually resulting in death. However, rotten pus, dark color, painlessness, and gaping wound indicate Spleen Qi failure and muscle necrosis. Strangury-like urine, phlegm congestion, panting, dry mouth, and cracked tongue indicate Spleen-Lung failure and exhaustion of Kidney Water. Flooding Chi pulse shows Kidney has nothing to generate. Floating-choppy Guan pulse shows Lung Metal overcoming Spleen Earth. Moreover, during the peak of Metal energy, danger is imminent! Indeed, he died two days later. This disease manifested externally and lasted two months until death because Yuan Qi was too weak to close the sore. If regulated and tonified beforehand to prevent Qi and Blood deficiency, survival was possible.
A person asked: What is the condition of a carbuncle between the waist and hip, with unchanged skin color, hardness like stone, failing to ulcerate after a month? The answer was: This is called "Shi Ju" (Stone Carbuncle). It is caused by accumulated heat in the Shaoyang and Yangming meridians. Pathogenic toxins are firmly knotted, and Yuan Qi is insufficient, so it cannot rise and suppurate. Huoming Yin with Duohuo (Saussureae Radix), Qianghuo, Chaihu (Bupleuri Radix), and Huangqi, along with Zijin Dan (Purple Gold Pill), should be used to induce sweating. For robust individuals, Bazhen San (Eight Patterns Powder) or Yili Jindan (One Grain Golden Pill) should be used to purge. For the elderly and weak, Shiquan Dabu Tang and Renshen Yangrong Tang should be used to support and expel toxins. If the lesion turns black, sinks, does not rise, is numb and painless, accompanied by vomiting, inability to eat, mental confusion, and scattered or intermittent pulses, death will occur. If spirit is clear and pulse is harmonious, Taige Ziwei Wan (Imperial Purple Micro Pill) should be administered.