丹溪曰精要云阳滞于阴脉浮洪弦数阴滞于阳脉沉细弱涩阳滞以寒治之阴滞以热治之切详
其意
阳滞阴滞当作热治寒治求之寒热固可作阴阳论于阴于阳分明是于气于血他无可言也热滞于气
固无寒滞耶寒滞于血固无热滞耶何寒不能伤气热不能伤血耶以予观之气为阳行脉外血为阴行
脉内相并分派周流循环一身无停止谓之脉一呼脉行三寸一吸脉行三寸呼吸定息共得六寸一身
通行八十一丈得热则行速而太过得寒则行迟而不及五味之偏七情之浓过气为滞津液稠浓积而
久也为饮为痰渗入脉内血为所乱因而凝浊营运冱泣或为沸腾此阴滞于阳也正血滞于气也气病
今人或以药助邪病上生病血之病日增溢出脉外坠道隘塞升降有妨运化失令此阳滞于阴也正气滞
于血也病分寒热者当是禀受之素偏虚邪之杂合岂可以阳为热阴为寒耶浮洪弦数气病之脉也岂
可遽此作热论沉细弱涩血病之脉岂可遽此作寒论此万病之根本岂止疥癣疮疡痈疽而已幸相评
其是否
明疮疡之本末
东垣曰生气通天论云营气不从逆于肉理乃生痈肿又云膏粱之变足生大疔受如持虚阴阳应
象论
云地之湿气感则害人皮肉筋脉是言湿气外伤则营气不行荣卫者皆营气之所经营也营气者胃气
也运气也荣气为本本逆不行为湿气所坏而为疮疡也膏粱之变亦是言浓滋味过度而使营气逆行
凝于经络为疮疡也此邪不在表亦不在里惟在其经中道病也以上内经所说俱言因营气逆而作也
遍看诸疮疡论中多言二热相搏热化为脓者有只言热化为脓者又言湿气主疮寒化为热而为脓者
此皆疮疽之源也宜于所见部分用引经药并兼见证中分阴证阳证先泻营气是其本本逆助火湿热
相合败坏肌肉而为脓血者此治次也宜远取诸物以比之一岁之中大热无过夏当时诸
物皆不坏烂坏烂者交秋湿令大行之际也近取诸身热病在
身止显热而不败坏肌肉此理明矣标本不得邪气不服言一而知百者可以为上工矣
营气不从逆于肉理乃生疮痈且营气者胃气也饮食入于胃先输于脾而朝于肺肺朝百脉次及
皮毛
先行阳道下归五脏六腑而气口成寸矣今富贵之人不知其节以饮食肥HT 之类杂以浓味日久太过
其气味俱浓之物乃阳中之阳不能走空窍先行阳道反行阴道逆于肉理则湿气大胜则子能令母实
火乃大旺热湿既盛必来克肾若杂以不顺又损其真水肾既受邪积久水乏水乏则从湿热之化而
上行其疮多出背出脑此为大疔之最重者也若毒瓦斯行于肺或脾胃之部分毒之次也若出于他经又
其次也湿热之毒所止处无不溃烂故经言膏粱之变足生大疔受如持虚如持虚器以受物物无不受
治大疔之法必当泻其营气以标本言之先受病为本非苦寒之剂为主为君不能除其苦楚疼痛也诸
疮疡有痛往往多以乳香没药杂以芳香之药止之必无少减之理若使经络流通脏腑中去其壅滞
必无痛矣苦寒之剂除其疼痛药下于咽则痛立已此神品药也
疮疡食肉乃自弃也疮疡者乃营气而作也今反补之而自弃何异虽用药施治而不能愈地之湿
气自
外而入内者疮疖当先服药而用针如疮疖小不欲饮药或婴儿之疮先当温衣覆盖令其凝泣壅滞血
脉温和则出血立已者不如此血脉凝滞便针则邪毒不泻反伤良肉又益其疮势也疮疡及诸病面赤
虽伏大热禁不得攻里为阳气怫郁邪气在经宜发表以去之故曰火郁则发之虽大便数日不见宜多
攻其表以发散阳气少加润燥之药以润之如见风脉风证只可用发表风药便可以通利得大便行也
若只干燥秘涩尤宜润之慎不可下也疮疡郁冒俗呼昏迷是也宜汗之则愈验疮名色治之当从素问
针经圣济总录易老疮论及诸家治疮用药法度此为紧要临病之际宜详审焉
谨按圣济总录能悉诸疮之名色但其用药则多主寒凉而无通变之法惟以上易老东垣等言深
撷针经之大法陈脉病治例之要学人能熟此等议论则临证处方便自胸中了然明白
Danxi stated in *Jingyao* (Essentials): When Yang Qi is stagnant in the Yin aspect, the pulse presents as Floating (Fu), Surging (Hong), Wiry (Xian), or Rapid (Shu); when Yin Qi is stagnant in the Yang aspect, the pulse presents as Deep (Chen), Fine (Xi), Weak (Ruo), or Choppy (Se). Stagnation of Yang should be treated with Cold (Han) methods, and stagnation of Yin should be treated with Heat (Re) methods. Upon careful examination of its meaning, "Yang stagnation" and "Yin stagnation" should actually be sought through the lens of "Heat treatment" and "Cold treatment." Although Cold and Heat can certainly be discussed in terms of Yin and Yang, the "Yin" and "Yang" mentioned here clearly refer to Qi and Blood. There is nothing else to say.
If Heat pathogen stagnates in the Qi level, does it imply there is no Cold stagnation? If Cold pathogen stagnates in the Blood level, does it imply there is no Heat stagnation? Why assume that Cold cannot injure Qi and Heat cannot injure Blood? In my view, Qi belongs to Yang and circulates outside the vessels; Blood belongs to Yin and circulates inside the vessels. They move together, distribute throughout the body, circulate endlessly without stopping, which is called the Pulse. During one exhalation, the pulse moves three cun; during one inhalation, it moves three cun. Together in one respiratory cycle, it covers six cun. The entire body's meridians total eighty-one zhang. When encountering Heat, movement accelerates and becomes excessive; when encountering Cold, movement slows down and falls short. Bias from the Five Flavors (Wu Wei) and intensity of the Seven Emotions (Qi Qing) cause Qi stagnation. Body fluids become thick, accumulate over time, and transform into Fluid Retention (Yin) or Phlegm (Tan), seeping into the vessels, disturbing the Blood, causing turbidity, obstructing circulation, or becoming turbulent like boiling water. This is what is meant by "Yin stagnating in Yang," which is essentially "Blood stagnating in Qi," a disease of the Qi level.
Today, people sometimes use medicines that assist the pathogen, adding illness upon illness. Blood disorders increase daily, overflowing from the vessels, blocking channels, hindering ascending and descending functions, and disrupting transformation and transportation. This is what is meant by "Yang stagnating in Yin," which is essentially "Healthy Qi stagnating in Blood." Diseases are divided into Cold and Heat types, which should be attributed to constitutional deficiency and mixed pathogenic factors. How can one simply equate Yang with Heat and Yin with Cold? Floating, Surging, Wiry, and Rapid pulses are signs of Qi diseases; how can they be hastily diagnosed as Heat syndromes? Deep, Fine, Weak, and Choppy pulses are signs of Blood diseases; how can they be hastily diagnosed as Cold syndromes? These are the root causes of ten thousand diseases, extending far beyond just scabies, sores, ulcers, carbuncles, and gangrene. I hope everyone will evaluate whether this is correct.
[Clarifying the Origin and Progression of Sores and Ulcers]
Dongyuan stated: *Shengqi Tongtian Lun* records: "When Ying Qi does not follow its course and reverses within the flesh and tissue, abscesses and swellings arise." It also says: "Changes due to rich food and drink lead to large carbuncles; susceptibility is like holding an empty vessel." *Yinyang Yingxiang Lun* records: "The dampness of the earth, when contracted, harms the skin, flesh, sinews, and vessels." This indicates that external Dampness impairs the flow of Ying Qi. Both Ying and Wei Qi originate from Ying Qi. Ying Qi is Stomach Qi and Transporting Qi. Ying Qi is the root; if the root reverses and fails to function normally, damaged by Dampness, sores and ulcers form. "Changes due to rich food and drink" also refers to excessive consumption of rich flavors causing Ying Qi to reverse and condense in the meridians, forming sores and ulcers. This pathogen is neither in the exterior nor the interior, but resides in the middle of the meridians. All statements in *Neijing* mention that these conditions arise from the reversal of Ying Qi.
Reviewing various discussions on sores and ulcers, many state that two Heats clashing transform into pus; some only mention Heat transforming into pus; others say Dampness governs sores, where Cold transforms into Heat to form pus. These are all sources of sores and ulcers. One should use channel-guiding herbs at the affected site and differentiate between Yin and Yang syndromes based on manifestations. Draining Ying Qi addresses the root, as the primary issue is the reversal of Ying Qi. If Fire, Dampness, and Heat combine to destroy muscle and form pus and blood, this is secondary treatment.
One should observe nature for analogy: In a year, summer heat is the greatest, yet things do not rot then. Rotting occurs when Autumn Dampness prevails. Observing the human body: In febrile diseases, Heat manifests but does not destroy muscle. This logic is clear. "When the root and branch do not correspond, the pathogen cannot be subdued." One who knows one thing and understands a hundred can be considered a superior physician.
"When Ying Qi does not follow its course and reverses within the flesh and tissue, sores and ulcers arise." Moreover, Ying Qi is Stomach Qi. Food enters the Stomach, first transmits to the Spleen, then ascends to the Lung. The Lung directs Qi to all vessels, reaching the skin and hair, moving along the Yang pathways, descending to the Zang-Fu organs, and manifesting at the Cun Kou (radial artery). Today, wealthy individuals lack moderation, consuming fatty and sweet foods mixed with rich flavors. Over time, these strong-smelling and tasting substances, being Yang within Yang, fail to enter the orifices. Instead of moving along Yang pathways, they reverse into Yin pathways, stagnating in the flesh. Dampness becomes dominant. According to the generating cycle, "the child can strengthen the mother," leading to excessive Fire. With Heat and Dampness prevalent, Kidney Water is attacked. If irregularities further damage True Water, the Kidneys suffer. Prolonged deficiency leads to transformation into Heat and Dampness rising upward. Such sores often appear on the back or head, representing the most severe type of large carbuncle. If toxic vapors affect the Lungs or Spleen/Stomach regions, the toxicity is moderate. If affecting other meridians, it is less severe. Wherever Heat-Damp toxins settle, ulceration occurs. Thus, the classic states: "Rich food changes lead to large carbuncles; susceptibility is like holding an empty vessel." Just as an empty vessel accepts anything, the body accepts the toxin easily.
The treatment for large carbuncles must drain Ying Qi. From the perspective of root and branch, the initial injury is the root. Without using Bitter-Cold agents as the principal herb, pain and suffering cannot be relieved. For painful sores, using aromatic herbs like Frankincense (Ruxiang) and Myrrh (Moyao) for pain relief rarely reduces pain. If meridians are unblocked and internal stagnation removed, pain will cease. Bitter-Cold agents relieve pain; once swallowed, pain stops immediately. This is a divine medicine.
Eating meat during sores and ulcers is self-sabotage. Sores and ulcers arise from Ying Qi disorders; supplementing them now is akin to giving up. Even with medication, healing is impossible. For Dampness entering from outside causing boils, one should take medicine and use acupuncture. For small boils or infant sores, if oral medication is refused, cover the infant with warm clothing to warm the blood vessels; bleeding will stop immediately. Otherwise, if vessels are stagnant and needling is performed, pathogens will not be expelled, healthy flesh will be injured, and the sore will worsen.
For sores and ulcers presenting with facial redness, despite latent severe Heat, purgatives for the interior are forbidden because Yang Qi is constrained and pathogens reside in the meridians. One should release the exterior. Thus, it is said: "Fire constraint requires dispersal." Even if constipation persists for days, focus on releasing the exterior to disperse Yang Qi, adding mild moistening herbs. If Wind pulse or Wind syndrome is present, exterior-releasing Wind herbs facilitate bowel movement. If dryness and constipation prevail, moistening is essential; avoid purgatives.
Sore-related syncope, commonly called coma, should be treated with sweating to achieve recovery. Regarding diagnosis and treatment of sores, one must follow *Suwen*, *Zhenjing*, *Shengji Zonglu*, Yilao’s treatise on sores, and methods from various schools. This is crucial. At the bedside, careful examination is required.
In summary: *Shengji Zonglu* details names and appearances of sores but relies heavily on Cold-Cooling herbs without flexible adaptation. Only the theories of Yilao and Dongyuan deeply extract the principles of *Zhenjing* and summarize key pulse-disease-treatment examples. Scholars who master these discussions will have clear understanding when treating patients clinically.