脓出而反痛者。虚也。宜补之。
凡脓溃之后。脉涩迟缓者易愈。以其有胃气故也。脉细而沉时直者。里虚欲变症也。若
痛尚未痊。洪滑粗散者难疗。以正气虚邪气实也。
脉数虚而痛者属虚火。宜滋阴。如托里散加生地黄。
脉数实而痛者。邪气实也。宜泄之。
脉实便秘而痛者。邪在内也。宜下之。如清凉饮。
脉涩而痛者。气血虚寒也。温补之。如定痛托里散。
若有脓为脂膜间隔不出。或作胀痛者。宜用针引之。或用利刀。剪之。腐肉堵塞者去之
脉浮或弱。而热或恶寒者。阳气虚也。宜补气。如补中益气汤。
脉涩而热者。血虚也。宜补血。如四物汤。人参养荣汤。
午前热补气为主。如四君子汤。
午后热者补血为主，如四物汤。
脉浮数发热而痛者。邪在表也。宜散之。如补中益气汤。
脉沉数发热而痛者。邪在内也。宜下之。
东垣云。发热恶热。不渴不止。烦躁肌热。不欲近衣。脉洪大。按之无力。或目痛鼻干
非白虎汤症也。此血虚发热。宜用当归补血汤。又有火郁而热者。如不能食而热。自汗气
短者。虚也。以甘寒之剂泻热补气。如能食而热。口舌干燥。大便难者。以辛苦大寒之剂下
之。以泄火补水。
脓血大泄。当大补气血为先。虽有他症。以末治之。
凡痈大溃发热恶寒。皆属气血虚甚。若左手脉不足者。补血药当多于补气药。右手脉不
足者。补气药当多于补血药。切不可发表。
附余诸症十五条。
When pain persists or worsens after the discharge of pus, it indicates deficiency. Tonification should be applied.
After the abscess has ruptured and pus has drained, a choppy (Se) and slow pulse indicates an easy recovery due to the presence of Stomach Qi. A fine (Xi), deep pulse that is rigid suggests interior deficiency with a tendency toward transformation into complicated syndromes. If pain has not yet subsided and the pulse is surging (Hong), slippery (Hua), coarse, or scattered (San), the condition is difficult to treat because it represents deficiency of healthy Qi and excess of pathogenic factors.
A rapid (Shuo) but deficient pulse accompanied by pain belongs to deficiency fire. Nourishing Yin is indicated, such as using Tuoli San (Supporting Interior Powder) with added Sheng Di Huang (Rehmanniae Radix).
A rapid (Shuo) and excess pulse accompanied by pain indicates excess of pathogenic factors. Draining (Xie) is indicated.
An excess pulse accompanied by constipation and pain indicates pathogens in the interior. Purging (Xia) is indicated, such as using Qingliang Yin (Cooling Drink).
A choppy (Se) pulse accompanied by pain indicates deficiency of Qi and Blood with cold. Warming and tonifying are indicated, such as using Dingtong Tuoli San (Pain-Relieving Supporting Interior Powder).
If pus is present but separated by fatty membranes preventing its discharge, or if distending pain occurs, it is appropriate to use a needle to drain it, or a sharp knife to cut it open. If putrid flesh blocks the opening, it should be removed.
A floating (Fu) or weak (Ruo) pulse accompanied by fever or aversion to cold indicates deficiency of Yang Qi. Tonifying Qi is indicated, such as using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
A choppy (Se) pulse accompanied by fever indicates Blood deficiency. Nourishing Blood is indicated, such as using Siwu Tang (Four Substances Decoction) or Renshen Yangrong Tang (Ginseng Nourishing Glory Decoction).
Fever occurring before noon is primarily treated by tonifying Qi, such as using Sijunzi Tang (Four Gentlemen Decoction).
Fever occurring after noon is primarily treated by nourishing Blood, such as using Siwu Tang (Four Substances Decoction).
A floating (Fu) and rapid (Shuo) pulse accompanied by fever and pain indicates pathogens in the exterior. Dispersing (San) is indicated, such as using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
A deep (Chen) and rapid (Shuo) pulse accompanied by fever and pain indicates pathogens in the interior. Purging (Xia) is indicated.
Li Dongyuan stated: Fever with aversion to heat, unquenchable thirst, irritability, sensation of heat in the muscles, reluctance to remove clothing, a surging (Hong) pulse that feels empty upon pressure, or eye pain and dry nose, do not constitute Baihu Tang syndrome. This is fever due to Blood deficiency, and Danggui Buxue Tang (Danggui Tonifies Blood Decoction) is indicated. There is also fever due to constrained Fire. For example, inability to eat with fever, spontaneous sweating, and shortness of breath indicate deficiency; sweet and cold agents should be used to drain heat and tonify Qi. If one can eat with fever, dry mouth and tongue, and difficulty defecating, bitter and pungent, greatly cold agents should be used to purge downward, thereby draining Fire and supplementing Water.
When there is massive loss of pus and blood, major tonification of Qi and Blood must be prioritized. Even if other symptoms exist, they should be treated subsequently.
In all cases where large carbuncles have ulcerated and are accompanied by fever and aversion to cold, it belongs to severe deficiency of Qi and Blood. If the pulse at the left position is insufficient, Blood-nourishing herbs should outweigh Qi-tonifying herbs. If the pulse at the right position is insufficient, Qi-tonifying herbs should outweigh Blood-nourishing herbs. One must absolutely avoid using exterior-releasing methods.
Fifteen additional syndromes are appended.