诸浮数脉。应当发热。而反洒淅恶寒。若有痛处。当发其痈。（辨脉法。无
反字。处下。有饮食如常者五字。当发其痈。作蓄积有脓也。）
〔尤〕浮数脉。皆阳也。阳当发热。而反洒淅恶寒者。卫气有所遏。而不出也。夫卫主行荣气者也。
而荣过实者。反能阻遏其卫。若有痛处。则荣之实者已兆。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。（脓无间。脉经。有与字。）
〔程〕灵枢经曰。荣卫稽留于经脉之中。则血涩而不行。不行则卫气从之而不通。壅遏而不得行。故
热。大热不止。热胜则肉腐。腐则为脓。故知热聚者则作脓。热未聚者但肿。而未作脓也。皆以手掩知之。
巢源云。凡痈经久不复可消者。若按之都牢硬者。未有脓也。按之半硬半软者。有脓也。又以手掩
肿上不热者为无
脓。若热甚者为有脓。
陈氏三因方引原文云。此亦大略说也。若脉不数不热而疼者。盖发于阴也。不疼尤是恶证。不可不知。
陈氏外科精要云。伍氏方论曰。凡疮肿以手指从疮旁按。
至四畔上赤黑者。按之色不变。脓已结成。又按之随手赤色。此亦有脓。按之白。良久方赤。游毒已息。
陈氏外科正宗云。轻按热甚便痛者。有脓且浅且稠。重按微热方痛者。有脓且深且稀。按之陷而不起
者脓未成。按之软而复起者。脓已成。按之都硬不痛者无脓。非是脓。即
瘀血也。按之都软不痛者有脓。非是脓。即湿水也。
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。
〔尤〕甲错。肌皮干起。如鳞甲之交错。由荣滞于中。故血燥于外也。腹皮急按之濡。气虽外鼓。而
病不在皮间也。积聚为肿胀之根。脉数为身热之候。今腹如肿状。而中无积聚。身不发热。而脉反见数。
非肠内有痈。荣郁成热而何。薏苡。破毒肿利肠胃为君。败酱。一名苦菜。治暴热火疮。
排脓破血为臣。附子则假其辛热。以行郁滞之气尔。
巢源云。肠痈者。由寒温不适喜怒无度。使邪气与荣卫相干。在于肠内。遇热加之。血气蕴积。结聚
成痈。热积不散。血肉腐坏。化而为脓。其病之状。小腹重而微强。抑之即痛。小便数似淋。时时汗出。复
恶寒。其身皮肤甲错。腹皮急如肿状。诊其脉。洪数者已有脓也。其脉迟紧者。未有脓也。甚者腹胀大。转
侧闻水声。或绕脐生疮。穿而脓出。或脓自脐中出。或大便去脓血。惟宜急治之。又云。大便脓
血。似赤白下而实非者。是肠痈也。
薏苡附子败酱散方
薏苡仁（十分） 附子（二分） 败酱（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。
〔魏〕薏仁。下气则能泄脓。附子。微用。意在直走肠中屈曲之处可达。加以败酱之咸寒。以清积热。
服后以小便下为度者。小便者气化也。气通则痈脓结者可开。滞者可行。
而大便必泄污秽脓血。肠痈可已矣。顿服者。取其快捷之力也。
千金肠痈汤
薏苡仁（一升） 牡丹皮 桃仁（各三两） 瓜瓣仁（二升）
上四味 咀。以水六升。煮取二升。分再服。
张氏衍义云。即金匮薏苡附子败酱散之变方也。
圣惠方。治肠痈皮肉状如蛇皮。及如错。小腹坚。心腹急方。
即本方。用败酱二两。附子半两。薏苡仁二两半。
上捣粗罗为散。每服三钱。以水中盏。入生姜半分。煎
至六分。去滓温服。案本方。仅用方寸匕。似甚少。圣惠为是。
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。（肠。原
本。作肿。今据赵程沈金鉴。及脉经改之。脉经无痞字。巢源。作小便数如淋。无小便自调四字。）
〔程〕肿则形于外。痞则着于内。少腹既已痞肿。则肠痈已成。故按之即痛也。如淋者。以小腹为厥
阴经脉所过。厥阴脉循阴器。故按少腹而痛引阴茎。有如淋状。而小便则自
调也。灵枢经曰。有所结气归之。内既有痈。则荣卫稽留于内。而不卫外。故令有发热汗出恶寒也。脉迟紧
者。则热未聚。而肉未腐。故宜大黄牡丹汤下之。以消其肿疡。若脉洪数。则脓已成。将成溃疡。不可下也。
大黄牡丹汤。在当有血句下。以古人为文法所拘。故缀于条末。伤寒论中多有之。按上证痈在小肠。以小肠在
上。痈近于腹。则位深。但腹皮急而按之有如肿形。故用前汤。导其毒从小便而出。此证痈在大肠。以大肠
在下。痈隐少腹。其位浅则有痞肿之形。其迹易见。其按即痛。故用大黄牡丹汤。排其脓血从大便而下
也。
〔尤〕云不可下者。谓虽下之。而亦不能消之也。大黄牡丹汤。肠痈已成未成。皆得主之。故曰有脓
当下。无脓当下血。
大黄牡丹汤方（千金云。肘后名瓜子汤。案今本肘后无考。）
大黄（四两） 牡丹（一两○千金用三两） 桃仁（五十个） 瓜子（半斤○千金用一斤） 芒硝（三合）
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。
〔程〕诸疮疡痛皆属心火。大黄芒硝。用以下实热。血败肉腐。则为脓。牡丹桃仁。用以下脓血。瓜
子。（当是甜瓜子）味甘寒。神农经不载主治。考之雷公曰。血泛经过。饮调瓜子。则瓜子亦肠中血分药也。
故别录。主溃脓血。为脾胃肠中。内壅要药。想亦本诸此方。（案瓜子。沈以为冬瓜子。盖根据时珍治肠痈之
说。然古本草无所考。程注为是。）
张氏千金方衍义云。大黄下瘀血血闭。牡丹治瘀血留舍。芒硝治五脏积热。涤去蓄结。推陈致新之
功。较大黄尤锐。桃仁治疝瘕邪气。下瘀血血闭之功。亦与大黄不异。甜瓜瓣。
别录。治腹内结聚。破溃脓血。专于开痰利气。为内痈脉迟
紧脓未成之专药。
张氏医通云。肠痈下血。腹中 痛。其始发热恶寒。欲验其证。必小腹满痛。小便淋涩。反侧不便。即
为肠痈之确候。无论已成未成。俱用大黄牡丹汤。加犀角急服之。
刘涓子鬼遗方云。治肠痈大黄汤。痈之为病。诊小腹肿痞坚。按之则痛。或在膀胱左右。其色或赤或
白色。坚大如掌热。小便欲调。时白汗出。时复恶寒。其脉迟坚者。未成
脓也。可下之。当有血。脉数脓成。不可服此方。
即本方。唯不用瓜子。用芥子。（案千金。引刘涓子不用芥子。必后
世传写之讹。而圣济总录。及外科正宗等。亦用芥子。得效方。则用栝蒌子。并误。）
圣惠。牡丹散。治产后血运。腹满欲野狼狈。（出妇人产后门。）
即本方。不用瓜子。用冬瓜子。加生姜。产育宝庆集同。
云若口噤。则拗开灌之。必效。欲产先煎下。以备缓急。但不用生姜。
又牡丹散。治肠痈未成脓。腹中痛不可忍。（出肠痈门。下同。）
即本方。加木香芍药败酱。用甜瓜子。
又甜瓜子散。治肠痈肿痛。如闷气欲绝。
于本方中。加薏苡败酱当归槟榔。
又赤茯苓散。治肠痈小腹牢强。按之痛。小便不利。时有汗出恶寒。脉迟未成脓。
于本方中。加赤茯苓。
奇效良方。梅仁散。治肠痈。里急隐痛。大便闭涩。
于本方。桃仁。代梅仁。加犀角。
问曰。寸口脉浮微而涩。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。（脉经。无浮字。斧。作器。赵本。法。作然。）
〔尤〕血与汗皆阴也。阴亡则血流不行。而气亦无辅。故
脉浮微而涩也。经云夺血者无汗。夺汗者无血。兹不汗出。
而身有疮。则知其被刀斧所伤。而亡其血。与汗出不止者。迹虽异。而理则同也。
病金疮。王不留行散主之。
〔沈〕此金刃所伤。皮肉筋骨。故为金疮。乃属不内外因。
〔尤〕金疮金刃所伤。而成疮者。经脉斩绝。
荣卫沮弛。治之者必使经脉复行。营卫相贯而后已。王不留行散。则行气血和阴阳之良剂也。
王不留行散方
王不留行（十分八月八日采） 蒴 细叶（十分七月七日采） 桑东南根（白
皮十分三月三日采） 甘草（十八分○赵本无八字） 川椒（三分除目及闭口去汗） 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。
〔魏〕王不留行为君。专走血分。止血收痛。而且除风散痹。是收而兼行之药。于血分最宜也。佐
以蒴 叶。与王不留行。性共甘平。入血厘清火毒。祛恶气。倍用甘草。以益胃解毒。芍药黄芩。助清血热。
川椒干姜。助行血瘀。浓朴行中带破。惟恐血乃凝滞之物。故不惮周详也。桑根白皮。性寒。同王不留
行蒴 细叶。烧灰存性者。灰能入血分止血也。为金疮血流不止者设也。小疮则合诸药为粉。以敷之。
大疮则服之。治内以安外也。产后亦可服者。行瘀血也。风寒之日。桑根勿取者。恐过于寒也。前三物皆阴
干百日。存其阴性。不可日曝及火炙也。此金疮家之圣方。奏效如神者也。
〔沈〕金疮。当取生气为本。故
用桑东南根。乃得生气而生气血。烧灰存性。取黑色而能止血。
案徐云。若风寒。此属经络邪。桑皮止利肺气。不能逐外邪。故勿取。沈及金鉴义同。此解似不允当。
王不留行。本经云。治金疮。止血逐痛。蒴 。本草不载治金疮。而接骨木一名木蒴 。唐本草云。治折伤
续筋骨。盖其功亦同。桑根白皮。本经云。治绝脉。别录云。可以缝金疮。知是三物为金疮之要药。
排脓散方
枳实（十六枚） 芍药（六分） 桔梗（二分）
上三味。杵为散。取鸡子黄一枚。以药散。与鸡黄相等。揉和令相得。饮和服之。日一服。
〔尤〕枳实。苦寒除热破滞为君。得芍药则通血。得桔梗
则利气。而尤赖鸡子黄之甘润。以为排脓化毒之本也。
排脓汤方
甘草（二两） 桔梗（三两） 生姜（一两） 大枣（十枚）
上四味。以水三升。煮取一升。温服五合。日再服。
〔尤〕此亦行气血和营卫之剂。
案以上二方。徐注为疮痈概治之方。沈云。此两方。专治躯壳之内肠胃之痈而设。魏云。排脓散。为疮
痈将成未成治理之法也。排脓汤。甘草桔梗。即桔梗汤。盖上部胸喉之
间。有欲成疮痈之机。即当急服也。数说未知孰是。程本。金鉴。并不载此两方。似有所见矣。
浸淫疮。从口流向四肢者可治。从四肢流来入口者。不可治。
〔鉴〕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。
〔魏〕不可治者。难治之义。非当委之不治也。
案玉机真脏论。身热肤痛而为浸淫。汉书五王传。师古注。浸淫犹渐染也。巢源浸淫疮候云。浸淫疮。
是心家有风热。发于肌肤。初生甚小。先痒后痛。而成疮汁出。侵溃肌肉。浸淫渐阔。乃遍体。其疮若从口
出。流散四肢者轻。若从四肢生。然后入口者则重。以其渐渐增长。因名浸淫也。千金云。浸淫疮者。浅搔之
蔓延长不止。瘙痒者初如疥。搔之转生汁相连着是也。又云。疮表里相当。名浸淫疮。乃知
此疥湿疮之属。沈云。脱疽游丹之类。金鉴云。犹今之癞疠之类。皆非。（外台。载七方。可参考。）
浸淫疮。黄连粉主之。（〔原注〕方未见。）
〔尤〕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。
〔魏〕按外科精义。以一味黄柏散调涂。本此。（徐沈并为黄连一味为粉之方。）
千金。黄连胡粉散
黄连（二两） 胡粉（十分） 水银（一两）
上三味。黄连为末相和。软皮裹熟 之。自能和合。纵不得成。一家亦得水银。细散入粉中也。以傅乳疮
诸湿疮黄烂肥疮等。若干着甲。煎为膏。案外台删繁。疗 疮多汁方同。黄连粉盖此类也。
Whenever the pulse is floating and rapid, fever should occur, yet the patient instead feels chilly and shivering. If there is a painful area, an abscess (abscess) will likely develop. (In the *Bian Mai Fa* chapter, the character "fan" (instead/reversely) is absent, and below "chu" (area), there are five additional characters: "you yin shi ru chang zhe" (those whose diet and thirst remain normal). "Dang fa qi yong" means that pus has accumulated.)
You Zaijing's commentary: Floating and rapid pulses both belong to Yang. Yang excess should cause fever, yet the patient feels chilly and shivering; this indicates that Wei Qi (Defensive Qi) is obstructed and cannot disperse. Wei Qi's function is to circulate Ying Qi (Nutritive Qi). If Ying Qi becomes overly full, it can actually impede the movement of Wei Qi. If there is pain in a specific area, it signals that Ying Qi stagnation has manifested, hence it is said that an abscess will develop.
The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, one may press the swollen area with the hand. If it feels hot, pus is present; if not hot, pus is absent. (In *Mai Jing*, there is a "wu" (no/not) after "nong" (pus), and a "yu" (and/with) character exists in *Mai Jing*.)
Cheng Zhi's commentary: The *Ling Shu* states: When Ying and Wei Qi stagnate within the meridians, blood flow becomes sluggish and ceases. When blood does not flow, Wei Qi follows but becomes blocked, leading to congestion and obstruction, which generates heat. If intense heat persists, heat excess causes flesh to rot, and rotting flesh transforms into pus. Therefore, where heat gathers, pus forms; where heat has not gathered, there is only swelling without pus formation. This is determined by pressing with the hand. Chao Yuanfang states: For abscesses that do not resolve over time, if the entire area is hard upon pressure, no pus has formed; if half-hard and half-soft, pus is present. Additionally, pressing the swollen area: if not hot, no pus; if very hot, pus is present.
Chen Shi's *San Yin Fang* quotes the original text: This is a general statement. If the pulse is not rapid, there is no fever, but there is pain, this indicates a manifestation in the Yin aspect. If there is no pain, it is even more ominous and must be known.
Chen Shi's *Wai Ke Jing Yao* cites Wu Shi's formula discussion: For any sores or swellings, press from the side of the sore towards the periphery. If the skin turns red-black at the edges, but color does not change upon pressing, pus has consolidated. If pressing causes immediate redness, pus is also present. If pressing turns white and only reddens after a long time, wandering toxic heat has subsided.
Chen Shi's *Wai Ke Zheng Zong* states: Light pressure causing significant heat and pain indicates pus that is superficial and thick. Heavy pressure causing slight heat and pain indicates pus that is deep and thin. Pressing leaving an indentation that does not rebound indicates unformed pus. Pressing soft tissue that rebounds immediately indicates formed pus. Pressing the entire area hard without pain indicates no pus; if not pus, it is blood stasis. Pressing the entire area soft without pain indicates pus; if not pus, it is damp fluid.
Intestinal abscess (intestinal carbuncle) presents with dry, scaly skin resembling fish scales, tense abdominal skin that is soft upon pressure, appearing swollen but without abdominal masses, no body fever but a rapid pulse. This indicates intestinal pus, treated with Yiyi Fuzi Baijiang San (Coix Seed and Aconite Decoction).
You Zaijing's commentary: "Jiacuo" refers to dry, scaling skin like interlaced scales, caused by Ying blood stagnating internally, leading to blood dryness externally. Tense abdominal skin that is soft upon pressure indicates Qi bulging outward, but the disease is not in the skin/subcutaneous layer. Accumulations are the root of swelling; rapid pulse indicates body heat. Now, the abdomen appears swollen but lacks internal accumulation; the body has no fever but the pulse is rapid. Unless there is an intestinal abscess with Ying stagnation generating heat, what else could it be? Coix seed is the Sovereign herb, breaking toxic swelling and benefiting the intestines/stomach. Baijiangcao (Patrinia) is the Minister herb, treating acute fire-toxic sores, expelling pus and breaking blood stasis. Fuzi (Aconite) is used for its acrid-hot nature to move stagnant Qi.
Chao Yuanfang states: Intestinal abscess arises from improper cold/warmth regulation and excessive anger, allowing pathogenic factors to interfere with Ying and Wei Qi in the intestines. Upon encountering heat, blood and Qi accumulate, forming an abscess. Persistent heat causes flesh and blood to rot, transforming into pus. Symptoms include heaviness and slight stiffness in the lower abdomen, pain upon pressure, frequent urination resembling strangury, occasional sweating, and aversion to cold. Skin is dry and scaly, abdominal skin tense like a mass. Pulse:洪数 (surging and rapid) indicates formed pus; 迟紧 (slow and tight) indicates unformed pus. Severe cases show abdominal distension, water sounds when turning, ulcers around the navel, pus discharge from the navel or stool. Urgent treatment is required. Also, stool containing pus/blood resembling dysentery but actually different indicates intestinal abscess.
Yiyi Fuzi Baijiang San Formula
Yiyiren (Coicis Semen, 10 parts) Fuzi (Aconiti Lateralis Radix Praeparata, 2 parts) Baijiangcao (Patriniae Herba, 5 parts)
Crush the three herbs into powder. Take one cun-bi (measure) with two sheng (liters) of water, decoct until half remains, and take once. After urination flows smoothly, stool will inevitably discharge foul pus and blood, curing the intestinal abscess.
Wei Nianting's commentary: Yiyiren descends Qi to drain pus. Fuzi is used minimally to reach the tortuous parts of the intestine, combined with the salty-cold nature of Baijiangcao to clear accumulated heat. Taking until urination flows freely relies on Qi transformation; when Qi flows, accumulated pus opens and stagnation moves. Stool will discharge filth and pus/blood, curing the abscess. Taking it all at once seeks rapid efficacy.
Qianjin Changyong Tang (Thousand Gold Intestinal Abscess Decoction)
Yiyiren (Coicis Semen, 1 sheng) Mudanpi (Moutan Cortex, 3 liang) Taoren (Persicae Semen, 3 liang) Gubabanren (Benincasae Semen, 2 sheng)
Chop the four herbs. Decoct in six sheng (liters) of water to obtain two sheng. Divide into two doses.
Zhang Shi's *Yanyi* states: This is a variation of the *Jinkui* Yiyi Fuzi Baijiang San.
*Shenghui Fang* treats intestinal abscess with skin resembling snake scales or interlaced patterns, hard lower abdomen, and urgent heart/abdominal pain.
This is the base formula: Baijiangcao (2 liang), Fuzi (0.5 liang), Yiyiren (2.5 liang).
Pulverize coarsely. Take 3 qian per dose with one cup of water and 0.5 fen of fresh ginger, decoct to 0.6 cup, strain, and take warm. Note: The original formula uses only one cun-bi, which seems too little; *Shenghui Fang*'s dosage is more appropriate.
Intestinal abscess presents with lower abdominal swelling and fullness, pain upon pressure resembling strangury, normal urination, intermittent fever, spontaneous sweating, and aversion to cold. Pulse slow and tight indicates unformed pus; purgation is indicated, expecting blood discharge. Pulse surging and rapid indicates formed pus; purgation is contraindicated. Treat with Dahuang Mudan Tang (Rhubarb and Moutan Decoction). ("Chang" [intestine] was originally "Zhong" [swollen]; corrected here based on Zhao Xianke, Cheng Zhi, Shen Jinjian, and *Mai Jing*. *Mai Jing* lacks "Pi"; *Chaoyuan* says "urine frequency like strangury," lacking "normal urination.")
Cheng Zhi's commentary: Swelling is external; fullness is internal. Lower abdominal fullness/swelling indicates established intestinal abscess, hence pain on pressure. "Like strangury" occurs because the lower abdomen is traversed by the Jueyin meridian, which circles the genitalia; thus, pressing the lower abdomen causes pain radiating to the penis, mimicking strangury, while urination remains normal. The *Ling Shu* states: Qi accumulates there. Internally, Ying and Wei Qi stagnate and fail to protect the exterior, causing fever, sweating, and aversion to cold. Slow/tight pulse means heat has not gathered and flesh has not rotted; thus, Dahuang Mudan Tang is suitable to purge and reduce swelling. Surging/rapid pulse means pus is formed and ulceration is imminent; purgation is contraindicated. Dahuang Mudan Tang is placed after "expect blood" due to classical literary constraints. Regarding location: Small intestine abscess is deeper, presenting as tense skin with swelling shape, treated by the previous formula to drain toxins via urine. Large intestine abscess is shallower, presenting as palpable fullness/swelling, treated by Dahuang Mudan Tang to drain pus/blood via stool.
You Zaijing's commentary: "Cannot purge" means purgation cannot eliminate it. However, Dahuang Mudan Tang treats intestinal abscess whether formed or unformed. Thus, "if pus, purge pus; if no pus, purge blood."
Dahuang Mudan Tang Formula (*Qianjin* notes *Zhouhou* calls it Guazi Tang; current *Zhouhou* text unavailable).
Dahuang (Rhei Rhizoma, 4 liang) Mudan (Moutan Cortex, 1 liang; *Qianjin* uses 3 liang) Taoren (Persicae Semen, 50 seeds) Guazi (Cucumeris Semen, 0.5 jin; *Qianjin* uses 1 jin) Mangxiao (Natrii Sulfas, 3 he)
Decoct the first five herbs in six sheng (liters) of water to obtain one sheng. Strain, add Mangxiao, boil again, and take once. Pus will be discharged if present; if not, blood will be discharged.
Cheng Zhi's commentary: All sores/pain belong to Heart Fire. Dahuang and Mangxiao purge solid heat. Rotting flesh becomes pus. Mudan and Taoren purge pus/blood. Guazi (likely Tian Guazi/Sweet Melon Seed) is sweet and cold. Though not in *Shennong Ben Cao Jing*, Lei Gong notes it treats blood flooding, indicating it acts on blood in the intestines. *Bielu* states it treats discharging pus/blood, making it a key herb for spleen/intestine/stomach internal blockage. Zhang Shi's *Qianjin Fang Yanyi* states: Dahuang purges blood stasis/closure; Mudan treats retained blood stasis; Mangxiao clears five-viscera accumulated heat, scouring accumulations, pushing out the old and bringing in the new, sharper than Dahuang. Taoren treats hernia/masses and purges blood stasis. Sweet melon seed treats abdominal accumulations, breaks pus/blood, opens phlegm, and moves Qi, specifically for intestinal abscess with slow/tight pulse and unformed pus.
Zhang Shi's *Yitong* states: Intestinal abscess with bloody stool and abdominal pain, initially fever/aversion to cold. To verify, check for lower abdominal fullness/pain, difficult urination, and inability to turn easily. These are definitive signs. Whether pus is formed or not, use Dahuang Mudan Tang with Xijiao (Rhinoceros Horn) urgently.
Liu Juanzi's *Guiyi Fang* describes Da Huang Tang for intestinal abscess: Hard lower abdominal swelling/pain, possibly left/right of bladder, red or white, hard/large like palm and hot, normal urination, sweating, aversion to cold. Slow/firm pulse indicates unformed pus; purge, expect blood. Rapid pulse indicates formed pus; do not take this formula.
This is the base formula, replacing Guazi with Jiezi (Mustard Seed). (*Note*: *Qianjin* cites Liu Juanzi not using Jiezi; this is likely a transcription error. *Shengji Zonglu* and *Waike Zhengzong* also use Jiezi; *De Xiao Fang* uses Gualouzi, all errors.)
*Shenghui Fang* Mudan San treats postpartum blood shock with abdominal fullness/distress.
Base formula, replace Guazi with Donggua Zi (Winter Melon Seed), add Shengjiang (Fresh Ginger). Same as *Chanyu Baoqing Ji*.
If jaw is locked, pry open and administer. Effective. Prepare beforehand for emergencies, but omit Shengjiang.
Another Mudan San treats intestinal abscess unformed pus with unbearable abdominal pain.
Base formula, add Muxiang (Costus Root), Shaoyao (Peony Root), Baijiangcao, use Tian Guazi.
Another Tian Guazi San treats intestinal abscess swelling/pain with suffocating sensation.
Base formula, add Yiyi, Baijiang, Danggui (Angelica Sinensis), Binglang (Areca Seed).
Another Chi Fuling San treats intestinal abscess with hard lower abdomen, pain on pressure, difficult urination, sweating/aversion to cold, slow pulse unformed pus.
Base formula, add Chi Fuling (Red Poria).
*Qixiao Liangfang* Meiren San treats intestinal abscess with tenesmus, dull pain, constipation.
Base formula, replace Taoren with Meiren (Apricot Kernel), add Xijiao.
Question: Floating, faint, and choppy pulse at Cun Kou suggests blood loss or excessive sweating. If there is no sweating, what is the cause? Answer: If there is a wound caused by knife/axe injury leading to blood loss. (*Mai Jing* lacks "floating"; "fu" is "qi". Zhao edition, "fa" is "ran".)
You Zaijing's commentary: Blood and sweat are both Yin. Loss of Yin leads to stagnant blood and unsupported Qi, resulting in floating/faint/choppy pulse. Classics state: Those who lose blood do not sweat; those who lose sweat do not lose blood. Here, no sweating but presence of wound indicates knife/axe injury causing blood loss. Though manifestations differ from profuse sweating, the principle is the same.
For Jin Chuang (metal weapon injuries), Wangbuliuxing San (Imperata Decoction) is prescribed.
Shen Mingzong's commentary: Injury from metal weapons damaging skin, flesh, tendons, and bones is called Jin Chuang, belonging to non-internal/non-external causes.
You Zaijing's commentary: Metal weapon injuries sever meridians and relax Ying/Wei Qi. Treatment must restore meridian flow and reconnect Ying/Wei. Wangbuliuxing San is an excellent formula for harmonizing Qi/Blood and Yin/Yang.
Wangbuliuxing San Formula
Wangbuliuxing (Vaccariae Semen, 10 parts, harvested Aug 8) Shuodie Xiye (Adenophorae Folium, 10 parts, harvested Jul 7) Sanggen Dongnan Pi (Mori Cortex, 10 parts, harvested Mar 3) Gancao (Glycyrrhizae Radix, 18 parts; Zhao ed. lacks "8") Chuanjiao (Zanthoxyli Pericarpium, 3 parts, remove eyes/closed ones/sweat) Huangqin (Scutellariae Radix, 2 parts) Ganjiang (Zingiberis Rhizoma, 2 parts) Shaoyao (Paeoniae Radix, 2 parts) Houpo (Magnoliae Cortex, 2 parts)
Burn the first three herbs (Sanggen, etc.) to ash retaining nature. Do not over-burn. Pound and sieve separately, then mix into powder. Take one cun-bi. For small wounds, apply powder topically. For large wounds, take orally. Safe for postpartum. Avoid Sanggen Dongnan Pi on windy/cold days. The first three herbs must be dried in shade for 100 days.
Wei Nianting's commentary: Wangbuliuxing is Sovereign, entering Blood level to stop bleeding and relieve pain, dispersing wind and bi-syndrome. It combines astringency and movement, ideal for Blood disorders. Shuodie leaf assists, sharing sweet/flat nature, clearing fire-toxicity and evil Qi in Blood. Double Gancao benefits Stomach and detoxifies. Shaoyao and Huangqin assist clearing Blood heat. Chuanjiao and Ganjiang assist moving Blood stasis. Houpo moves and breaks, preventing Blood stagnation. Sanggen Baipi is cold; burned to ash with the first two herbs enters Blood level to stop bleeding, set for uncontrollable hemorrhage. Small wounds get topical powder; large wounds get oral administration to treat interior and stabilize exterior. Postpartum use moves Blood stasis. Avoid Sanggen on cold days to prevent excessive cold. Shade-drying preserves Yin nature; avoid sun/fire. This is a sacred formula for metal injuries, effective as spirit.
Shen Mingzong's commentary: Jin Chuang requires restoring vital energy; thus, Southeast Mulberry Root obtains vital energy to generate Qi/Blood. Ash retains black color to stop bleeding.
Xu Zhongke notes: Wind/cold belongs to meridian pathogens; Sangpi benefits Lung Qi but does not expel exterior pathogens, hence avoided. Shen and Jinjian agree. This explanation seems inadequate. *Benjing* states Wangbuliuxing treats Jin Chuang, stops bleeding, relieves pain. *Bencao* does not list Shuodie for Jin Chuang, but Jiegumu (Adenophora) is named Mu Shuodie; *Tang Bencao* says it treats fractures and knits bones, implying similar efficacy. *Benjing* says Sanggen Baipi treats severed pulses; *Bielu* says it sutures Jin Chuang. These three are key herbs for Jin Chuang.
Painong San (Pus-Expelling Powder)
Zhishi (Aurantii Fructus, 16 pieces) Shaoyao (Paeoniae Radix, 6 fen) Jiegeng (Platycodonis Radix, 2 fen)
Pound into powder. Mix with one chicken egg yolk (equal amount to powder), knead well. Take with water, once daily.
You Zaijing's commentary: Zhishi is bitter/cold, clearing heat and breaking stagnation (Sovereign). With Shaoyao, it unblocks Blood; with Jiegeng, it benefits Qi. Crucially, it relies on Chicken Egg Yolk's sweet/moistening properties as the basis for expelling pus and resolving toxicity.
Painong Tang (Pus-Expelling Decoction)
Gancao (Glycyrrhizae Radix, 2 liang) Jiegeng (Platycodonis Radix, 3 liang) Shengjiang (Zingiberis Rhizoma Recens, 1 liang) Dazao (Jujubae Fructus, 10 pieces)
Decoct in three sheng (liters) of water to obtain one sheng. Take five he (approx. 100ml) warm, twice daily.
You Zaijing's commentary: This is also a formula to move Qi/Blood and harmonize Ying/Wei.
Note: Xu comments these are general formulas for sores/abscesses. Shen says they specifically treat internal gastrointestinal abscesses. Wei says Painong San treats sores/abscesses before/during formation. Painong Tang (Gancao/Jiegeng = Jiegeng Tang) is for impending sores/abscesses in upper chest/throat. Uncertainty remains. Cheng edition and Jinjian omit these two formulas, suggesting insight.
Jinyin Chuang (Spreading Eczema/Herpes Zoster-like condition): Spreading from mouth to limbs is treatable; spreading from limbs to mouth is untreatable.
Shen Jinjian's commentary: "Jinyin" means spreading continuously. Mouth-to-limb spread is mild (exteriorizing), hence treatable. Limb-to-mouth spread is severe (interiorizing), hence untreatable.
Wei Nianting's commentary: "Untreatable" means difficult to treat, not hopeless.
Note: *Yuji Zhenzang Lun* mentions body heat and skin pain as Jinyin. *Han Shu* commentary defines Jinyin as gradual infection. *Chaoyuan* states Jinyin Chuang results from Heart wind-heat manifesting on skin, starting small, itching then hurting, oozing, spreading muscles, covering body. Mouth-to-limb is mild; limb-to-mouth is severe due to progression. *Qianjin* describes it as shallow scratching leading to continuous spreading, initial like scabies, scratching produces fluid. It is a type of scabies/damp sore. Shen compares it to gangrene/erysipelas. Jinjian compares it to leprosy; both incorrect. (*Waitai Miyao* records seven formulas for reference.)
Jinyin Chuang is treated with Huanglian Fen (Coptis Powder). ([Original note: Formula not found.])
You Zaijing's commentary: Formula not found. Likely treats damp-heat spreading disease. Coptis alone powdered is applied. Bitter dries dampness, cold clears heat.
Wei Nianting's commentary: *Waike Jingyi* uses single Herb Baie Powder mixed and applied, based on this. (Xu and Shen interpret as single Coptis powder.)
*Qianjin Fang* Huanglian Hufen San
Huanglian (Coptidis Rhizoma, 2 liang) Hufen (Cerussa, 10 parts) Shuiyin (Hydrargyrum, 1 liang)
Grind Huanglian into powder, mix. Wrap in soft skin and steam until blended. If not fully blended, finely scatter mercury into powder. Apply to breast sores, damp sores, yellow/rotten/fatty sores. If adhering to nails, decoct into ointment. *Waitai Shanfan* matches the formula for sores with much discharge. Huanglian Fen belongs to this category.