身重脉缓。湿盛除湿。身热脉大。心燥热发肿。乍来乍去除热。诸痛。眩晕。动摇。脉
弦去风。
脉涩气滞。燥渴亡津液。脉涩。泻气补血。寒胜则浮。食不入。便溺多。恶寒。脉紧细
。泻寒水。
数脉不时见。当生恶疮。诸浮数脉应发热。反洒淅恶寒。
若有痛处。当发痈疽。脉滑而数。滑则为实。数则为热。
滑则为荣。数则为卫。荣卫相逢。则结为痈。热之所过。则为痈脓。
机按今之疡医多不诊脉。惟视疮形以施治法。盖疮有表里虚实之殊。兼有风寒暑湿之变
非脉以别之。安得而察识乎。东垣云。疮疡凭脉。此之谓也。因详列其脉之所主。揭之于首
。学人宜加意焉。
医疮概举七恶五善。此特谓肠胃之内。脏腑疮疽之证也。发背脑疽。别有善恶。载之于
七恶者。烦躁时嗽。腹痛渴甚。或泄利无度。或小便如淋。一恶也。脓血既泄。肿 尤
脓色败臭。痛不可近。二恶也。目视不正。黑睛紧小。白睛青赤。瞳子上看。三恶也。喘粗
短气。恍惚嗜卧。四恶也。肩背不便。四肢沉重。五恶也。不能下食。服药而呕。食不知味。
六恶也。声嘶色败。唇鼻青赤。面目四肢浮肿。七恶也。
五善者。动息自宁。饮食知味。一善。便利调匀。二善。脓溃肿消。水鲜不臭。三善。
神彩精明。语声清亮。四善。体气平和。五善。
五善之中。乍见一二善证。疮亦回也。七恶之内。忽见一二恶证。宜深惧之。又有证合
。皮急紧而知善。又或证合五善。皮缓虚而知恶。此又在人详审。大抵虚中见恶证者不可救
。实证无恶候者自愈。脓溃后尚烦疼。脉洪滑粗散者难治。微涩迟缓者易痊。
The body feels heavy, and the pulse is slow. This indicates an excess of dampness; dispel the dampness. The body is hot, and the pulse is large. This indicates dry-heat in the Heart causing swelling. Symptoms that come and go intermittently require clearing heat. Various pains, vertigo, and tremors/shaking indicate a wiry pulse; expel wind.
A choppy pulse indicates Qi stagnation. Dryness and thirst indicate the loss of body fluids. A choppy pulse requires draining excess Qi to nourish Blood. Excess Cold causes floating [pulse]. Inability to eat, frequent urination and defecation, and aversion to cold with a tight and fine pulse require draining Cold and water retention.
An intermittent rapid pulse suggests the potential development of malignant sores. Floating and rapid pulses should be accompanied by fever; if instead there is shivering and aversion to cold, it indicates a different pathology.
If there is a painful area, a carbuncle or furuncle (Yong Ju) will likely develop. A slippery and rapid pulse: slippery indicates excess, rapid indicates heat. Slippery relates to Ying (Nutrient) Qi, and rapid relates to Wei (Defensive) Qi. When Ying and Wei meet, they congeal to form a carbuncle. Where heat passes, pus and blood are generated.
Wang Ji’s commentary: Contemporary surgeons often do not palpate the pulse, relying solely on the appearance of the sore to determine treatment. However, sores differ in exterior/interior, deficiency/excess, and are complicated by variations of Wind, Cold, Summer-heat, and Dampness. Without distinguishing via the pulse, how can one perceive and identify them? Li Dongyuan stated, "Treating sores relies on the pulse," which refers to this principle. Therefore, I have detailed the indications of various pulses and placed them at the beginning. Students should pay close attention.
Surgeons generally cite the Seven Evils and Five Goods. This specifically refers to sores and carbuncles within the intestines and stomach, involving the Zang-Fu organs. For back carbuncles and brain abscesses, the criteria for good and evil signs differ.
The Seven Evils are as follows:
1. Restlessness, frequent coughing, abdominal pain, extreme thirst, uncontrolled diarrhea, or dysuria resembling strangury.
2. After pus and blood are discharged, swelling increases further; the pus is foul-smelling and discolored; pain is severe and cannot be touched.
3. Vision is abnormal; the pupil is tightly contracted and small; the sclera is greenish-red; the pupil looks upward.
4. Rapid, coarse breathing; shortness of breath; mental confusion and drowsiness.
5. Inconvenience in the shoulders and back; heaviness in the four limbs.
6. Inability to eat; vomiting after taking medicine; loss of taste.
7. Hoarseness; deterioration of complexion; lips and nose are greenish-red; edema of the face, eyes, and four limbs.
The Five Goods are as follows:
1. Calm movement and rest; appetite and sense of taste are normal.
2. Regular bowel movements and urination.
3. Pus drains, swelling subsides; the discharge is fresh and odorless.
4. Bright spirit and clear eyes; clear and resonant voice.
5. Harmonious constitution and balanced Qi.
Among the Five Goods, even if only one or two good signs appear initially, the sore may still heal. Among the Seven Evils, if even one or two evil signs suddenly appear, one should be deeply alarmed. There are also cases where symptoms align with the skin being tight and tense (indicating Good), or where symptoms align with the Five Goods but the skin is loose and flaccid (indicating Evil). These require careful examination by the physician. Generally, deficiency patterns presenting with evil signs are incurable. Excess patterns without evil signs will heal spontaneously. After pus drainage, if there is still烦 (vexatious) pain and the pulse is surging, slippery, and coarse/disorganized, it is difficult to treat. If the pulse is slightly choppy and slow, recovery is easy.