紫参半筋 甘草三两
右二味,以水五升,先煮紫参,取二升,内甘草,煮取一升半,分温三服。
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诸浮数脉,应当发热,而反洒淅恶寒,若有痛处,当发其痈。
【注】
诸浮数脉,谓寸、关、尺六脉俱浮数也。浮脉主表,数脉主热,若是表邪,则当发热
而洒淅恶寒也。今非表邪,应当发热,不当恶寒,若有痛处,乃当发痈之诊,非表邪
之诊也。
【集注】
周扬俊曰:病之将发,脉必兆之。夫浮数阳也,热也,浮数兼见,为阳中之阳,是其
热必尽显于外矣。而反洒淅恶寒,证不相应,何哉?必其气血凝滞,荣卫不和,如经
所谓荣气不从,逆于肉理,乃生痈肿,阳气有余,荣气不行,乃发为痈是也,况其身
已有痛处乎。夫脉之见者阳也,其将发而痛者亦属阳,故曰:当发其痈。
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师曰:诸痈肿,欲知有脓无脓,以手掩肿上,热者为有脓,不热者为无脓。
【注】
诸痈肿者,谓诸阴阳痈肿也。不论阴阳,凡诸痈肿,欲知有脓无脓,当以手掩之肿上
,热则能腐化成脓。故热者为有脓,不热者为无脓也。
【集注】
周扬俊曰:师之所以教人,知痈已成欲其溃,未成托之起也。
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肠痈之为病,其身甲错,腹皮急,按之濡如肿状,腹无积聚,身无热,脉数,此为肠
内有痈脓,薏苡附子败酱散主之。
【注】
痈生于内,则气血为痈所夺,不能外营肌肤,故枯皱如甲错也。腹皮急似肿胀,但按
之软,询之腹无积聚,审之身无表热,诊之脉数,非有外证也。此为肠内有痈脓也,
主之薏苡附子败酱散,流通肠胃,消痈肿也。
Banjin of Zishen (Scutellaria Barbatae Herba), 3 liang of Gancao (Glycyrrhizae Radix et Rhizoma).
These two ingredients are boiled in five sheng of water. First, boil Zishen until the liquid reduces to two sheng. Then add Gancao and continue boiling until the liquid reduces to one and a half sheng. Divide into three doses and take warm.
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In cases of floating and rapid pulse (Fushu Mai, 浮数脉), fever should be present, yet the patient instead experiences chills as if cold water is being sprinkled on them. If there is a specific painful area, an abscess (Yong, 痈) is likely to develop.
[Annotation]
"Floating and rapid pulse" refers to the pulse at the Cun, Guan, and Chi positions on both wrists all presenting as floating and rapid. A floating pulse indicates exterior syndrome, while a rapid pulse indicates heat. If caused by exterior pathogenic factors, fever accompanied by chills would be expected. However, this is not an exterior pathogenic condition; fever should occur without chills. The presence of localized pain indicates a diagnosis of impending abscess formation, rather than an exterior pathogenic diagnosis.
[Collected Notes]
Zhou Yangjun stated: When a disease is about to manifest, the pulse will show signs beforehand. Floating and rapid pulses belong to Yang and represent heat. Their simultaneous appearance signifies "Yang within Yang," suggesting that heat will fully manifest externally. Yet, the patient experiences chills, which contradicts the pulse presentation. Why? This is due to stagnation of Qi and Blood and disharmony of Ying (Nutritive) and Wei (Defensive) Qi. As the classics state, "When Ying Qi does not flow smoothly and reverses into the muscle tissue, abscesses and swellings arise; when Yang Qi is excessive and Ying Qi fails to circulate, abscesses develop." Furthermore, the patient already has a painful area. Since the visible pulse indicates Yang, and the impending pain also belongs to Yang, it is said: "An abscess is likely to develop."
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The Master said: Regarding various abscesses and swellings, to determine whether pus has formed, press your hand over the swollen area. If it feels hot, pus is present; if not hot, pus is absent.
[Annotation]
"Various abscesses and swellings" refers to abscesses and swellings of any Yin or Yang nature. Regardless of Yin or Yang classification, to determine the presence of pus in any abscess, one should press the swollen area. Heat indicates that tissue necrosis and pus formation have occurred. Therefore, heat signifies the presence of pus, while lack of heat signifies its absence.
[Collected Notes]
Zhou Yangjun stated: The Master's teaching aims to help practitioners determine if an abscess has matured and is ready to rupture, or if it is immature and requires treatment to promote suppuration and discharge.
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Intestinal abscess (Chang Yong, 肠痈) presents with rough, scaly skin (Jiacuo, 甲错), tense abdominal wall, softness upon palpation resembling swelling, but no abdominal masses, no body fever, and a rapid pulse. This indicates pus within the intestines, and Yiyi Fuzi Baijiang San (Coix Seed, Aconite, and Patrinia Powder) is the primary formula.
[Annotation]
When an abscess forms internally, Qi and Blood are consumed by the pathogenic factor and cannot nourish the skin and muscles externally, resulting in dry, rough, scaly skin. The abdominal wall appears tense like swelling, but is soft to the touch. Inquiry reveals no abdominal masses, observation confirms no exterior fever, and pulse diagnosis shows rapidity, indicating no external symptoms. This points to pus accumulation within the intestines. The indicated formula is Yiyi Fuzi Baijiang San, which promotes circulation in the intestines and eliminates abscesses.