外科精要云热发于皮肤之间浮肿根小至大不过三二寸者为疖六腑积热腾出于外肌肉之间
其发
暴盛肿皮光软侵展广大为痈五脏风毒积热攻 肉骨风毒猛暴初生一如蓓蕾形自焦枯触之应者
乃疽也
夫五善七恶者动息自宁饮食知味一善也便利调匀二善也脓清肿消不臭三善也神采精明语
声清
爽四善也体气和平五善也烦躁时嗽腹痛渴甚或泄痢无度小便如淋一恶也脓血大泄肿 尤甚脓
色败臭痛不可近者二恶也喘粗短气恍惚嗜卧三恶也目视不正黑睛紧小白睛青赤瞳子上看者四
恶也肩背不便四肢沉重五恶也饮食不下服药而呕食不知味六恶也声嘶色败鼻青赤面目四肢浮
肿七恶也五善见三则瘥七恶见四则危然则病有源同七恶者乃皮紧急而知善也病有源同五善者
乃皮缓虚而知恶也知是者岂凡医之所知哉
此事难知论中定痈疽死之地分
一伏菟 二腓 三背 四五脏俞 五项上 六脑 七髭 八 九颐
谨按素问灵枢诸篇具疮疡之由生死之要针治之法甚详宜玩本文大抵以上所言地分皆脉络
所会
内系腑脏然患者得而早言医者审证按法治之则皆为不死矣设不早治治不对证虽发于不死之地
分乃恐亦致死矣
元戎云陷脉为 留连肉腠营气不从逆于肉理乃生痈肿荣逆血郁血郁则热聚为脓正理论曰
热之
所过则为痈肿营气不从亦有不热者乎答曰膏粱之变芳草之美金石之过气血不盛荣卫之气充满
而抑遏不能行故闭塞血气腐而为痈也当泄之以夺盛热之气若其人饮食疏精神衰气血弱肌肉消
薄荣卫之气短促而涩滞故寒薄腠理闭郁而为痈肿也当补之以接虚怯之气亦当以脉浮沉别之既
得盛衰泄之则连翘大黄补之则内托之类是也
按此辨疮疡因热因寒及气血郁而成当攻补之法不同宜与前后诸篇兼看殆无余蕴矣但世俗
昧此
理而云是疮不是疮且服五香连翘汤然或中或否致误者多盖不审形气虚实疮毒浅深发表攻里所
因不同故也今以丹溪先生外科精要发挥诸法之义附于后方例之下庶学人幸有所鉴焉
*Waike Jingyao* (Essentials of External Medicine) states: When heat pathogen manifests between the skin, presenting as edema with a small root and a diameter not exceeding two or three *cun*, it is termed **Jie** (Furuncle). This results from accumulated heat in the six fu organs steaming outward into the muscles. If the onset is sudden, with severe swelling, shiny and soft skin, and extensive spread, it is termed **Yong** (Carbuncle/Abscess). This occurs when wind-toxin and accumulated heat of the five zang organs attack the flesh and bones; the wind-toxin is fierce and violent. Initially resembling a bud, it subsequently becomes scorched and dry, and if tender to touch, it is termed **Ju** (Deep-seated Abscess/Necrosis).
Regarding the Five Auspicious Signs and Seven Inauspicious Signs:
1. Calm breathing and appetite are the first auspicious sign.
2. Regular bowel movements and urination are the second auspicious sign.
3. Clear pus, subsiding swelling, and lack of foul odor are the third auspicious sign.
4. Bright spirit and clear voice are the fourth auspicious sign.
5. Harmonious body constitution is the fifth auspicious sign.
Conversely:
1. Restlessness, frequent coughing, abdominal pain, extreme thirst, or uncontrolled diarrhea/dysentery, and dysuria constitute the first inauspicious sign.
2. Profuse discharge of pus and blood, worsening swelling, foul-smelling敗 pus, and unbearable pain constitute the second inauspicious sign.
3. Rapid and coarse breathing, shortness of breath, mental confusion, and lethargy constitute the third inauspicious sign.
4. Abnormal gaze, tight black pupils, tight white sclera, greenish-red discoloration of the sclera, and upward deviation of the pupil constitute the fourth inauspicious sign.
5. Stiffness in the shoulders and back, and heaviness in the four limbs constitute the fifth inauspicious sign.
6. Inability to eat, vomiting after taking medicine, and loss of taste constitute the sixth inauspicious sign.
7. Hoarse voice, deteriorated complexion, cyanotic and red nose, and edema of the face, eyes, and limbs constitute the seventh inauspicious sign.
If three of the five auspicious signs appear, recovery is expected; if four of the seven inauspicious signs appear, the condition is critical. However, the text notes that when sources are identical but seven inauspicious signs manifest, the skin is tense, indicating a specific pathological state; when five auspicious signs manifest, the skin is lax and weak, indicating another state. Understanding these distinctions is beyond the capacity of ordinary physicians.
*Lishi Nan Zhi Lun* (Discussion on the Difficulties of This Matter) identifies locations where carbuncles and necrosis are fatal: 1. Fubao area (anterior thigh); 2. Calf region; 3. Back; 4. Shu points of the five zang organs; 5. Upper neck; 6. Brain; 7. Mustache area; 8. [Text missing]; 9. Chin/Jaw area.
According to *Suwen* and *Lingshu*, the causes of sores, keys to life and death, and acupuncture treatments are detailed. One should study the original texts carefully. Generally, the aforementioned fatal locations are intersections of meridians and collaterals, internally connected to the zang-fu organs. If patients report symptoms early and physicians diagnose and treat according to principles, death can be avoided. Conversely, delayed treatment or incorrect diagnosis may lead to death even if the lesion arises in non-fatal locations.
Yuan Rong stated: Pathogens sinking into meridians linger, obstructing the muscle layers. When Ying Qi does not flow smoothly and rebels within the muscle texture, abscesses form. Ying Qi rebellion leads to blood stasis; blood stasis generates heat, which condenses into pus. *Zhengli Lun* states: Wherever heat passes, abscesses form. Can Ying Qi rebellion occur without heat? The answer is: Changes due to rich foods, delicacies, or overuse of mineral drugs can cause deficient Qi and Blood. Although Ying and Wei Qi are abundant, they are suppressed and cannot circulate, leading to obstruction, putrefaction, and abscess formation. Such cases require purgation to drain excess heat. However, in individuals with bland diets, depleted spirit, weak Qi and Blood, and thin muscles, Ying and Wei Qi are short, sluggish, and stagnant. Cold constrains the interstices, causing closure and abscess formation. These cases require tonification to support deficiency. Pulse floating or deep helps distinguish these. For excess, use purgatives like *Qiaoliao* (Forsythiae Fructus) and *Dahuang* (Rhei Radix et Rhizoma); for deficiency, use tonics like Neituo San (Internal Support Powder).
This analysis distinguishes sores caused by heat, cold, or Qi-Blood stagnation, prescribing different attacking or tonifying methods. It should be read alongside preceding and following chapters for comprehensive understanding. Unfortunately, laypeople often misunderstand this, confusing types of sores and indiscriminately administering *Wuxiang Liaoqiao Tang* (Five-Scent Forsythia Decoction), leading to variable results and errors. This stems from failing to assess constitutional excess/deficiency, depth of toxin, and whether to release the exterior or purge the interior. Here, the interpretations of methods from Danxi’s *Waike Jingyao Fahui* are appended below for the benefit of students.