诸浮数脉，应当发热，而反洒浙恶寒，若有痛处，当发其痈。
【注】诸浮数脉，谓寸、关、尺六脉俱浮数也。浮脉主表，数脉主热，若是表邪，则
当发热而洒淅恶寒也。今非表邪，应当发热，不当恶寒，若有痛处，乃当发痈之诊，非表
邪之诊也。
【集注】周扬俊曰∶病之将发，脉必兆之。夫浮数阳也，热也，浮数兼见，为阳中之阳，
是其热必尽显于外矣。而反洒淅恶寒，证不相应，何哉？必其气血凝滞，营卫不和，如
经所谓营气不从，逆于肉理，乃生痈肿。阳气有余，营气不行，乃发为痈是也，况其身
已有痛处乎。夫脉之见者阳也。其将发而痛者亦属阳，故曰∶当发其痈。
师曰∶诸痈肿，欲知有脓无脓，以手掩肿上，热者为有脓，不热者为无脓。
【注】诸痈肿者，谓诸阴阳痈肿也。不论阴阳，凡诸痈肿，欲知有脓无脓，当以手掩
之肿上，热则能腐化成脓，故热者为有脓，不热者为无脓也。
【集注】周扬俊曰∶师之所以教人，知痈已成欲其溃，未成托之起也。
肠痈之为病，其身甲错，腹皮急，按之濡如肿状，腹无积聚，身无热，脉数，此为
肠内有痈脓，薏苡附子败酱散主之。
【注】痈生于内，则气血为痈所夺，不能外营肌肤，故枯皱如甲错也。腹皮急似肿胀，
但按之软，询之腹无积聚，审之身无表热，诊之脉数，非有外证也。此为肠内有痈脓也，主
之薏苡附子败酱散，流通肠胃消痈肿也。
薏苡附子败酱散方，
薏苡仁（十分） 附子（二分） 败酱（一名苦菜，五分）
上三味，杵为末，取方寸匕，以水二升，煎减半，顿服，小盒饭下。
【集解】徐彬曰∶薏苡寒能除热，兼下气胜湿，利肠胃，破毒肿；败酱善排脓破血利，
结热毒瓦斯，故以为臣；附子导热行结，故为反佐。
肠痈者，少腹肿痞，按之即痛，如淋，小便自调，时时发热，自汗出，复恶寒。其脉
迟紧者，脓未成，可下之，当有血；脉洪数者，脓已成，不可下也，大黄牡丹汤主之。
【注】此承上条，详发其证，以明其治也。肠痈者，其证则少腹肿硬，按之即痛，可知
痈在内也；尿时如淋，尿色自调，可知肿碍之也。时时发热，汗出恶寒，似有表病，而
实非表病也。其脉迟紧，则阴盛血未化，其脓未成，可下之，大盒饭有血也。若其脉洪
数，则阳盛血已腐，其脓已成，不可下也。下之以大黄牡丹汤，消瘀泻热也。
大黄牡丹汤方
大黄（四两） 牡丹（一两） 桃仁（五十个） 芒硝（三合） 瓜子（半升）
上五味，以水六升，煮取一升，去滓，内芒硝再煎沸，顿服之。有脓当下，如无脓当
下血。
【集解】李 曰∶大黄、芒硝泄热，桃仁行瘀，丹皮逐血痹，去血分中伏火，瓜子主
溃脓血。
问曰∶寸口脉微而涩，法当亡血，若汗出，设不汗者云何？答曰∶若身有疮，被刀
斧所伤，亡血故也。
【注】脉微气夺也，脉涩血夺也，故曰∶法当亡血汗出也。设无亡血汗出等病，则必
身有疮被刀斧所伤，亡血故也。
【集注】李 曰∶汗出亡阳，则脉微；亡血伤阴，则脉涩。微与涩皆阴脉也，设不汗
而疮疡金疮，虽不亡阳而亡血，故亦见微涩之脉也，总是营卫虚衰之故。
病金疮，王不留行散主之。
【注】此承上条以明其治也。金疮，谓刀斧所伤之疮也。亡血过多，经络血虚，风寒
易得干之，故用王不留行散，一以止血出，一以防外邪也。小疮粉之，即外敷也。
王不留行散方
王不留行（八月八日采，十分） 蒴 细叶（七月七日采，十分） 桑东南根（白皮，三月
三日采，十分） 甘草（十八分） 川椒（除目及闭口、去汗，三分） 黄芩（二分） 干姜（
二分） 芍药（二分） 浓朴（二分）
上九味，桑根皮以上三味，烧灰存性，勿令灰过，各别杵筛，合治之为散，服方寸匕。
小疮即粉之，大疮但服之，产后亦可服。如风寒，桑东根勿取之，前三物皆阴干百日。
【集解】徐彬曰∶此乃概治金疮方也。盖王不留行，性苦平，能通利血脉，故反能止
金疮血、逐痛；蒴 亦通利气血，尤善开痹；周身肌肉肺主之，桑根白皮最利肺气，东南
根向阳，生气尤全，以复肌肉之主气，故以此三物，甚多为君。甘草解毒和荣，尤多为
臣，椒、姜以养其胸中之阳，浓朴以疏其内结之气，芩、芍以清其阴分之热为佐。若有
风寒，此属经络客邪，桑皮止利肺气，不能逐外邪，故勿取。
浸淫疮，从口流向四肢者可治，从四肢流来入口者，不可治。
【注】浸淫疮者，浸谓浸浸，淫谓不已，谓此疮浸淫留连不已也。从口流向四肢者轻，
以从内走外也，故曰可治；从四肢流走入口者重，以从外走内也，故曰不可治，浸淫者，
犹今之癞疠之类。
浸淫疮，黄连粉主之。
【按】此承上条以明其治，黄连粉方脱简。
【集解】尤怡曰∶黄连粉方未见大意，以此为湿热浸淫之病，故取黄连一味为粉，粉
之，苦以燥湿，寒以除热也。
[Original Text]
When the pulse is floating and rapid, fever should typically manifest. However, if there is instead a sensation of chills and shivering (sazhe), and there is a painful area, an abscess (yong) is likely to develop.
[Annotation] "Floating and rapid pulse" refers to the pulse at the Cun, Guan, and Chi positions on both wrists being simultaneously floating and rapid. A floating pulse indicates exterior syndrome, while a rapid pulse indicates heat. If this were an exterior pathogenic factor, one would expect fever accompanied by chills and shivering. Since it is not an exterior pathogen, fever should occur without chills. The presence of a specific painful area indicates a diagnosis of impending abscess formation, rather than an exterior pathogenic condition.
[Collected Notes] Zhou Yangjun stated: Before a disease manifests, the pulse will show signs. Floating and rapid pulses are yang and indicate heat. Their simultaneous appearance represents "yang within yang," suggesting that the heat will fully manifest externally. Yet, the patient experiences chills and shivering, which contradicts the pulse. Why? This is due to qi and blood stagnation and disharmony between Ying (Nutritive) and Wei (Defensive) qi. As the Classics state: "If Ying qi does not flow smoothly and reverses in the muscle tissue, abscesses and swellings arise." When yang qi is excessive and Ying qi cannot circulate, an abscess develops. Furthermore, the patient already has a painful area. The manifestation of the pulse reflects yang; the impending pain also belongs to yang. Therefore, it is said: "An abscess will develop."
The Master said: Regarding various abscesses and swellings, to determine whether pus has formed, press your hand over the swollen area. If it feels hot, pus is present; if not hot, pus is absent.
[Annotation] "Various abscesses and swellings" refers to both yin and yang types. Regardless of yin or yang classification, to determine the presence of pus in any abscess, press the hand over the swelling. Heat indicates the tissue is rotting and transforming into pus; thus, heat signifies pus, while lack of heat signifies no pus.
[Collected Notes] Zhou Yangjun stated: The Master's teaching aims to help practitioners determine if an abscess is ready to rupture or needs support to bring it to the surface.
Intestinal abscess presents with dry, scaly skin resembling fish scales (jiacuo), tight abdominal skin, and softness upon palpation despite the appearance of swelling. There are no accumulations in the abdomen, no body fever, but a rapid pulse. This indicates pus within the intestines, treated with Yiyi Fuzi Baijiang San.
[Annotation] When an abscess forms internally, qi and blood are consumed by the pathogen and cannot nourish the skin externally, resulting in dry, scaly skin like armor plates. The abdominal skin appears tight and swollen, but is soft to touch. Inquiry reveals no abdominal masses, examination shows no exterior heat, and the pulse is rapid. These findings exclude exterior symptoms and confirm intestinal abscess with pus. The treatment is Yiyi Fuzi Baijiang San, which promotes intestinal circulation and resolves abscesses.
Formula for Yiyi Fuzi Baijiang San:
Yiyiren (Coix Seed) - 10 parts
Fuzi (Prepared Aconite Root) - 2 parts
Baijiangcao (Patrinia Herb) - 5 parts (also known as Kucail)
Grind these three herbs into powder. Take one fangcun bi (a square-inch measure) of the powder, add two sheng of water, boil until reduced by half, and take orally in one dose. Urination should be clear and smooth afterward.
[Collected Explanations] Xu Bin stated: Yiyiren is cold and clears heat, descends qi, overcomes dampness, benefits the intestines and stomach, and breaks toxic swellings. Baijiangcao effectively drains pus, breaks blood stasis, and clears heat-toxic qi, serving as the Deputy Minister herb. Fuzi guides heat to resolve stagnation, acting as an antagonistic assistant (fan zuo).
Intestinal abscess presents with swelling and hardness in the lower abdomen, pain upon pressure, a sensation similar to strangury (lin) during urination, but normal urine output. There is intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not yet formed; purgation may be used, and bloody stool is expected. If the pulse is surging and rapid, pus has formed; purgation is contraindicated. Treat with Dahuang Mudan Tang.
[Annotation] This clause elaborates on the previous one to clarify symptoms and treatment. Intestinal abscess involves lower abdominal swelling and hardness with pain on pressure, indicating internal pathology. The sensation resembles strangury, but urine color is normal, indicating obstruction by swelling. Intermittent fever, sweating, and chills mimic exterior syndrome but are not exterior. A slow and tight pulse indicates yin excess and unformed pus; purgation can be used, likely expelling blood. A surging and rapid pulse indicates yang excess and putrefied blood (formed pus); purgation is contraindicated. Dahuang Mudan Tang is used to purge, eliminate blood stasis, and clear heat.
Formula for Dahuang Mudan Tang:
Dahuang (Rhubarb Root and Rhizome) - 4 liang
Mudanpi (Tree Peony Bark) - 1 liang
Taoren (Peach Kernel) - 50 pieces
Mangxiao (Mirabilite) - 3 he
Gua Zi (Melon Seeds) - 0.5 sheng
Boil the first five ingredients in six sheng of water until one sheng remains. Strain, add Mangxiao, boil again until boiling, and take orally in one dose. Pus will be discharged if present; otherwise, blood stasis will be expelled.
[Collected Explanations] Li Zhongzi stated: Dahuang and Mangxiao purge heat; Taoren moves blood stasis; Mudanpi removes blood stasis and clears latent fire in the blood level; Gua Zi facilitates the discharge of pus and blood.
Question: If the Cun Kou pulse is faint and choppy, according to standard theory, this indicates blood loss or excessive sweating. What if there is no sweating?
Answer: If the patient has wounds caused by knives or axes, the faint and choppy pulse is due to blood loss.
[Annotation] A faint pulse indicates qi depletion; a choppy pulse indicates blood depletion. Thus, standard theory suggests blood loss or sweating. If neither occurred, the cause must be trauma from sharp instruments leading to blood loss.
[Collected Notes] Li Zhongzi stated: Sweating leads to collapse of yang, causing a faint pulse; blood loss damages yin, causing a choppy pulse. Both are yin pulses. In cases of traumatic wounds without sweating, although yang is not collapsed, blood is lost, resulting in a faint and choppy pulse. This is always due to deficiency and decline of Ying and Wei qi.
For traumatic wounds (Jinchuang) caused by metal weapons, Wangbuliu Xing San is indicated.
[Annotation] This follows the previous clause to specify treatment. Jinchuang refers to wounds from knives or axes. Excessive blood loss leads to deficiency in meridians and vessels, making the body susceptible to wind-cold invasion. Wangbuliu Xing San stops bleeding and prevents external pathogens. For minor wounds, apply the powder externally; for major wounds, administer orally. It can also be used postpartum.
Formula for Wangbuliu Xing San:
Wangbuliu Xing (Vaccaria Seed) - 10 parts (harvested on the 8th day of the 8th lunar month)
Shuodai Xiye (Leaves of Tripterospermum) - 10 parts (harvested on the 7th day of the 7th lunar month)
Sanggen Dongnan Pi (White bark of the southeast root of Mulberry) - 10 parts (harvested on the 3rd day of the 3rd lunar month)
Gancao (Licorice Root) - 18 parts
Chuanjiao (Sichuan Pepper) - 3 parts (remove seeds and closed pods, remove sweat/moisture)
Huangqin (Scutellaria Root) - 2 parts
Ganjiang (Dried Ginger) - 2 parts
Shaoyao (Peony Root) - 2 parts
Houpo (Magnolia Bark) - 2 parts
Take the first three ingredients (Mulberry bark and the two leaves mentioned above), burn them to ash while retaining their properties (do not burn completely to white ash). Grind each separately and sieve. Mix thoroughly to make a powder. Take one fangcun bi per dose. Apply powder externally for minor wounds; take orally for major wounds. Safe for postpartum use. If wind-cold is present, do not use the southeast mulberry root. The first three ingredients should be dried in the shade for 100 days.
[Collected Explanations] Xu Bin stated: This is a general formula for traumatic wounds. Wangbuliu Xing is bitter and neutral, promoting blood circulation; paradoxically, it stops bleeding and relieves pain in trauma. Shuodai also promotes qi and blood circulation and opens blockages. The muscles are governed by the Lung. Mulberry bark benefits Lung qi. The southeast root faces the sun, possessing abundant vital energy to restore the Qi governing muscles. Hence, these three are used in large quantities as Sovereign herbs. Gancao detoxifies and harmonizes Ying, used in larger amounts as Deputy Minister. Chuanjiao and Ganjiang warm and nourish the Yang in the chest. Houpo disperses internal stagnation. Huangqin and Shaoyao clear heat in the Yin level as Assistant herbs. If wind-cold is present, it is an external pathogen in the meridians. Mulberry bark only benefits Lung qi and cannot expel external pathogens, so it is omitted.
Jinyin Chuang (oozing dermatitis) flowing from the mouth to the limbs is treatable; flowing from the limbs to the mouth is untreatable.
[Annotation] "Jinyin" means oozing and spreading incessantly. Flowing from the mouth (internal center) to the limbs (exterior) is mild because the pathogen moves outward; hence, it is treatable. Flowing from the limbs to the mouth is severe because the pathogen moves inward; hence, it is untreatable. Jinyin Chuang resembles modern leprosy or similar chronic skin diseases.
Jinyin Chuang is treated with Huanglian Fen (Coptis Powder).
[Note] This clause follows the previous one to specify treatment. The formula for Huanglian Fen is missing in the text.
[Collected Explanations] You Yi stated: Although the formula is missing, the intent is clear. This is a disease of damp-heat oozing. Therefore, Coptis (Huanglian) alone is ground into powder and applied topically. Its bitterness dries dampness, and its cold nature clears heat.