浮数之脉，应发热，其不发热而反恶寒者，若有痛处，痈疽之谓也。
洪大之脉，其主血实，积热疮肿。凡洪大者，痈疽之病进也。脓未成者，宜下之。脓溃
之后，脉见洪大，则难治。若兼自利，尤有凶候。
数脉主热，浮而数者，为表热。沉而数者，为里热。诸紧数之脉，应发热而反恶寒者，
痈疽也。仲景曰，数脉不时见，则生恶疮也。又曰，肺脉数者，生疮也。凡诸疮，脉至洪数
，其内必有脓也。
实脉，主邪盛，邪气盛则实也。痈疽得此，可下之。若久病虚人，则最忌之，以正不胜邪也。
滑脉，多阳，或为热，或为虚。疮疡得此，脓未成者，可内消脓。已溃者，宜托里。所谓始为热，终为虚也。
散脉，为血虚有表无里也。凡疮毒脓溃之后，脉见洪滑粗散，而烦痛不除者，难治，以
其正气虚，邪气实也。又曰，肢体沉重，肺脉大则毙，谓其浮散无根也。
长脉，主阳气充实。伤寒得之，将欲汗解也。长而缓者，胃脉也，百病得之皆愈。故曰长则气治也。
芤脉，主阴虚血虚，脓溃后得之为宜，以脉病相应也。
弦脉，主肝邪。《疮疽论》曰，弦洪相搏，内寒外热，欲发疮疽也。
紧脉，主切痛积癖。凡疮疽得此，则气血留滞，邪结不散，多为痛也。
短脉，主虚。经曰，短则气病，以其乏胃气也。疮疡脉短，真气虚也。诸病见之，皆为难治，尤不可攻也。
涩脉，主血虚气涩。疮疡溃后得之无妨。
沉脉，为阴。疮疡得之，邪气深也。
迟脉，主阳气不足。疮疡得之，溃后自愈。
缓脉，无邪。长而缓者，百病皆宜。疮疡得此，则易愈，以其有胃气也。
弱脉，主气血俱虚，形精不足。大抵疮家之脉，凡沉迟濡弱者，皆宜托里。
微脉，主虚。真气复则生，邪气胜则死。疮疡溃后，微而和者，将愈也。
脉细，主阳衰。疮疡脉细而沉者，里虚而欲变证也。
虚脉，空而无力。脉虚则血虚，血虚生寒，阳气不足也。疮疡得之，只宜托里养血补气也。
软脉，少神元气弱也。凡疮疡之脉，但见虚迟软弱者，悉宜补虚排脓托里。
牢脉，坚强，阴之亏也。凡瘰 结肿之类，诊得牢脉者，皆不可内消也。
结促之脉，凡阴衰则促，阳衰则结。大抵结促之脉，由气血俱虚而断续者居多。疮疡得
之，多宜托里。然有素禀结促者，又当以有力无力，辨其虚实。实者可下，虚者不可不补。
右痈疽脉二十二种，大都微弱虚细迟缓短涩者，必气血皆虚，形精不足，俱当用补用托
，不可妄攻，无待言也。即如浮滑弦洪结促等脉，此中最有疑似，亦不得以全实论治，必须
详审形证，或攻或补，庶无误也。
齐氏曰∶疮疡之证，若不诊候，何以知阴阳勇怯，血气聚散。又曰∶脉洪大而数者，实
也。细微而数者，虚也。
河间曰∶脉沉实者，其邪在脏。浮大者，其邪在表。
立斋曰∶痈疽未溃，而脉先弱者，何以收敛。
The floating and rapid pulse should be accompanied by fever; if there is no fever but rather aversion to cold, and there is a painful area, this indicates carbuncle and ulcer (Yong Ju).
The surging and large pulse indicates blood excess, often associated with accumulated heat causing sores and swelling. Whenever the pulse is surging and large, it signifies the progression of carbuncle and ulcer. If pus has not yet formed, purgation is appropriate. After the pus has drained, if the pulse remains surging and large, the condition is difficult to treat. If accompanied by spontaneous diarrhea, it is an ominous sign.
The rapid pulse indicates heat. A floating and rapid pulse indicates exterior heat; a deep and rapid pulse indicates interior heat. Various tight and rapid pulses, where fever is expected but aversion to cold occurs instead, indicate carbuncle and ulcer. Zhang Zhongjing stated that if the rapid pulse appears intermittently, malignant sores will arise. He also said that a rapid lung pulse indicates the development of sores. In all cases of sores, if the pulse becomes surging and rapid, pus must have formed internally.
The full pulse indicates pathogenic excess; when pathogenic qi is excessive, it is termed excess. For carbuncle and ulcer presenting with a full pulse, purgation may be used. However, for patients with chronic illness and deficiency, this pulse is most contraindicated because healthy qi cannot overcome pathogenic factors.
The slippery pulse is predominantly yang, indicating either heat or deficiency. In sores and ulcers, if pus has not formed, internal resolution can be attempted; if already ulcerated, supporting the interior is indicated. This reflects the principle that the condition begins as heat and ultimately transforms into deficiency.
The scattered pulse indicates blood deficiency and a state where only the exterior is involved while the interior is depleted (healthy qi is dissipated). After the pus of toxic sores has drained, if the pulse is surging, slippery, coarse, and scattered, and pain and irritability persist, the condition is difficult to treat due to deficiency of healthy qi and excess of pathogenic factors. It is also stated that heavy limbs combined with a large lung pulse indicate death, as the pulse lacks root.
The long pulse indicates abundant healthy yang qi. In cold damage diseases, its appearance suggests that sweating and resolution are imminent. A long and moderate pulse represents stomach qi; its presence in various diseases indicates recovery. Thus, it is said, "Long means qi is regulated."
The boggy pulse indicates yin deficiency and blood deficiency. Its appearance after pus drainage is favorable, as the pulse corresponds to the disease state.
The wiry pulse indicates liver pathogenic factors. The *Treatise on Carbuncles and Ulcers* states that the combination of wiry and surging pulses, manifesting as internal cold and external heat, indicates the impending onset of carbuncle and ulcer.
The tight pulse indicates severe pain and accumulations. In carbuncle and ulcer, its presence indicates stagnation of qi and blood and unresolved pathogenic binding, typically resulting in pain.
The short pulse indicates deficiency. The classics state, "Short indicates qi pathology," due to a lack of stomach qi. A short pulse in sores and ulcers indicates deficiency of true qi. Its presence in various diseases makes them difficult to treat, especially contraindicating purgation.
The choppy pulse indicates blood deficiency and qi stagnation. Its appearance after the ulceration of sores is acceptable.
The deep pulse is yin. In sores and ulcers, it indicates that pathogenic factors are deep-seated.
The slow pulse indicates insufficient healthy yang qi. In sores and ulcers, if the pulse is slow, spontaneous healing may occur after ulceration.
The moderate pulse indicates absence of pathogenic factors. A long and moderate pulse is suitable for all diseases. In sores and ulcers, it indicates easy recovery due to the presence of stomach qi.
The weak pulse indicates dual deficiency of qi and blood, and insufficiency of form and spirit. Generally, for sores and ulcers, pulses that are deep, slow, soggy, or weak indicate the need for supporting the interior.
The minute pulse indicates deficiency. Recovery depends on the restoration of true qi; death results from the dominance of pathogenic factors. After ulceration of sores, a minute and harmonious pulse indicates impending recovery.
A fine pulse indicates decline of healthy yang. In sores and ulcers, a fine and deep pulse indicates interior deficiency and potential transformation of the disease.
The empty pulse is hollow and forceless. An empty pulse indicates blood deficiency; blood deficiency generates cold, leading to insufficient healthy yang. For sores and ulcers presenting with this pulse, only methods to support the interior, nourish blood, and tonify qi are appropriate.
The soft pulse indicates a lack of spirit and weak primordial qi. For any pulse in sores and ulcers that is deficient, slow, soft, or weak, methods to tonify deficiency, drain pus, and support the interior should be employed.
The firm pulse is strong and hard, indicating deficiency of yin essence. In conditions such as scrofula and nodular swellings, the presence of a firm pulse contraindicates internal resolution methods.
The knotted and hurried pulses: deficiency of yin leads to a hurried pulse, while deficiency of yang leads to a knotted pulse. Generally, these pulses result mostly from dual deficiency of qi and blood causing intermittent interruptions. In sores and ulcers, they usually require supporting the interior. However, in individuals with a constitutional tendency toward knotted or hurried pulses, one must distinguish between excess and deficiency based on the strength of the pulse. Excess conditions may be purged, while deficiency conditions must be tonified.
Of the twenty-two types of pulses described for carbuncle and ulcer, those that are weak, minute, deficient, fine, slow, short, or choppy definitely indicate dual deficiency of qi and blood and insufficiency of form and spirit. Tonification and supporting the interior are mandatory; reckless use of purgation is strictly forbidden. Even for pulses such as floating, slippery, wiry, surging, knotted, or hurried, which are easily confused, treatment cannot be solely based on excess patterns. One must carefully examine symptoms and signs, deciding whether to purge or tonify, to avoid error.
Qi stated: In the presentation of sores and ulcers, without pulse diagnosis, how can one discern the courage or timidity of yin and yang, and the gathering or dispersal of blood and qi? He further stated that a surging, large, and rapid pulse indicates excess, while a fine, small, and rapid pulse indicates deficiency.
Hejian stated: A deep and full pulse indicates pathogenic factors in the zang organs; a floating and large pulse indicates pathogenic factors in the exterior.
Lizhai stated: If the pulse is weak before the ulceration of carbuncle and ulcer, how can healing and contraction be expected?