诸浮数脉。应当发热。而反洒淅恶寒。若有痛处。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。
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。夫卫主行营气者也。而营过
实者。反能阻遏其卫。若有痛处。则营之实者已兆。故曰当发其痈。痈肿之候。脓不成。则毒不化。而
毒不聚。则脓必不成。故以手掩其肿上。热者毒已聚。则有脓。不热者毒不聚。则无脓也。
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。
甲错、肌皮干起。如鳞甲之交错。由营滞于中。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。营郁成热而何。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。
薏苡附子败酱散方
薏苡仁（十分） 附子（二分） 败酱（五分）
上三味。杵为散。取方寸匕。以水二升。煎减半。顿服。小盒饭下。
肿痈者。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。脉洪数者。脓已成。不可下也。大黄牡丹汤主之。
肿痈。疑即肠痈之在下者。盖前之痈在小肠。而此之痈在大肠也。大肠居小肠之下。逼处膀胱。
致小腹肿痞。按之即痛如淋。而实非膀胱为害。故仍小便自调也。小肠为心之合。而气通于血脉。大
肠为肺之合。而气通于皮毛。故彼脉数身无热。而此时时发热。自汗出。复恶寒也。脉迟紧者。邪暴
遏而营未变。云可下者。谓可下之令其消散也。脉洪数者。毒已聚而营气腐。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
大黄（四两） 牡丹（一两） 桃仁（五十个） 冬瓜仁（半升） 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。
问曰。寸口脉浮微而涩。法当亡血若汗出。设不汗出者云何。曰若身有疮。被刀斧所伤。亡血故
也。
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。
金疮。金刃所伤而成疮者。经脉斩绝。营卫沮弛。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） 甘草（十八分） 黄芩（二分）
桑东南根白皮（十分三月三日采） 川椒（三分） 浓朴（二分） 干姜（二分） 芍药（二分）
上九味。王不留行、蒴 、桑皮三味。烧灰存性。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。桑根勿取之。前三物阴干百日。
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。
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。
此亦行气血和营卫之剂。
浸淫疮。从口起流向四肢者可治。从四肢流来入口者不可治。浸淫疮。黄连粉主之。
浸淫疮。义如脏腑经络篇中。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。
For all floating and rapid pulses, fever should be present. However, if there is instead a sensation of shivering and aversion to cold, and if there is a painful area, an abscess (carbuncle) will likely develop. The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, place one's hand over the swollen area. If it feels hot, pus is present; if it does not feel hot, pus is absent.
Floating and rapid pulses both belong to Yang. Yang conditions typically manifest with fever. The presence of shivering and aversion to cold indicates that Wei Qi (Defensive Qi) is obstructed and unable to circulate outward. Although Wei Qi normally facilitates the circulation of Ying Qi (Nutritive Qi), excessive fullness in Ying Qi can reverse this and obstruct Wei Qi. If pain is present at a specific site, it signals that Ying Qi fullness has already manifested, hence the prediction of an impending abscess. In the progression of an abscess, if pus does not form, the pathogenic toxin cannot resolve; conversely, if the toxin does not gather, pus cannot form. Therefore, palpating the swelling reveals that heat indicates gathered toxin and thus the presence of pus, while lack of heat indicates scattered toxin and absence of pus.
Intestinal abscess presents with rough, scaly skin (jiacuo), tight abdominal skin that feels soft upon palpation, resembling swelling but without internal accumulation masses. The body temperature is normal, yet the pulse is rapid. This indicates pus within the intestines. Yi Yi Fu Zi Bai Jiang San (Coix Seed, Aconite, and Patrinia Decoction) is the primary formula.
"Jiacuo" refers to dry, scaly skin resembling overlapping scales, caused by stagnation of Ying blood internally leading to dryness externally. Tight abdominal skin that feels soft upon pressure suggests that although Qi is distending outward, the pathology is not in the superficial layers. Accumulations are the root of swelling, and a rapid pulse is a sign of fever. Here, the abdomen appears swollen but lacks internal accumulations, and the body is not febrile despite a rapid pulse. This must be due to intestinal abscess where Ying Qi stagnates and generates heat. Yi Yi Ren (Coix Seed) breaks down toxic swellings and benefits the intestines and stomach, serving as the Sovereign herb. Bai Jiang Cao (Patrinia Scabiosifolia Root), also known as Ku Cai, treats acute fire-toxin sores and promotes pus discharge and blood stasis resolution, serving as the Minister herb. Fu Zi (Aconite Lateralis Radix Praeparata) is used for its acrid and hot properties to move stagnant Qi.
**Yi Yi Fu Zi Bai Jiang San Formula**
* Yi Yi Ren (Coicis Semen): 10 parts
* Fu Zi (Aconiti Lateralis Radix Praeparata): 2 parts
* Bai Jiang Cao (Patriniae Herba): 5 parts
Pound the three ingredients into a powder. Take one cun-bi (approx. 9g) of the powder, add two sheng (approx. 400ml) of water, and decoct until half remains. Administer in one dose. Urination should be clear.
Chong Yong (Intestinal Abscess, specifically of the large intestine) manifests as swelling and fullness in the lower abdomen, pain upon pressure resembling strangury (lin syndrome), yet urination remains normal. There is intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not yet formed, and purgation may be used. If the pulse is surging and rapid, pus has formed, and purgation is contraindicated. Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) is indicated.
Chong Yong is suspected to be intestinal abscess located in the lower region. The previous description referred to the small intestine, whereas this refers to the large intestine. The large intestine lies below the small intestine and adjacent to the bladder, causing lower abdominal swelling and pain upon pressure mimicking strangury, though the bladder is not actually affected, hence normal urination. The Small Intestine pairs with the Heart, connecting via blood vessels; the Large Intestine pairs with the Lung, connecting via the skin and hair. Thus, while the former presents with rapid pulse and no fever, this condition presents with intermittent fever, sweating, and aversion to cold. A slow and tight pulse indicates sudden obstruction of pathogens without alteration of Ying Qi; "purgation may be used" means purgation can cause resolution. A surging and rapid pulse indicates gathered toxin and putrefaction of Ying Qi; "purgation is contraindicated" means purgation cannot eliminate the condition even if attempted. Da Huang Mu Dan Tang is effective for intestinal abscess whether pus has formed or not. Hence, it is said: if pus exists, purge it; if no pus, purge the blood stasis.
**Da Huang Mu Dan Tang Formula**
* Da Huang (Rhei Radix et Rhizoma): 4 liang
* Mu Dan Pi (Moutan Cortex): 1 liang
* Tao Ren (Persicae Semen): 50 kernels
* Dong Gua Ren (Benincasae Semen): 0.5 sheng
* Mang Xiao (Natrii Sulfas): 3 he
Decoct the five ingredients in six sheng (approx. 1200ml) of water until one sheng (approx. 200ml) remains. Strain, add Mang Xiao, boil again until boiling, and administer in one dose. Pus will be discharged if present; if not, blood stasis will be discharged.
Question: What if the Cun Kou (inch position) pulse is floating, fine, and choppy? According to principles, this indicates blood loss or excessive sweating. If there is no sweating, what is the explanation?
Answer: If there are wounds on the body caused by knives or axes, it is due to blood loss.
Blood and sweat both belong to Yin. Loss of Yin leads to stagnant blood flow and Qi lacking support, resulting in a floating, fine, and choppy pulse. The Classics state: "Those who lose blood do not sweat; those who lose sweat do not lose blood." Here, the absence of sweating combined with wounds indicates trauma from sharp instruments causing blood loss. Although the manifestation differs from profuse sweating, the underlying principle is the same.
For Jin Chuang (metal weapon injuries), Wang Bu Liu Xing San (Polygoni Multiflori Caulis Powder) is indicated.
Jin Chuang results from injury by metal blades, severing meridians and causing Ying and Wei Qi to become slack. Treatment must restore meridian flow and reunite Ying and Wei Qi. Wang Bu Liu Xing San is an excellent formula for promoting Qi and Blood circulation and harmonizing Yin and Yang.
**Wang Bu Liu Xing San Formula**
* Wang Bu Liu Xing (Polygoni Multiflori Caulis): 10 parts (harvested on the 8th day of the 8th lunar month)
* Shuoxie Ye (Commelinae Herba / Commelina communis leaves): 10 parts (harvested on the 7th day of the 7th lunar month)
* Gan Cao (Glycyrrhizae Radix et Rhizoma): 18 parts
* Huang Qin (Scutellariae Radix): 2 parts
* Sang Zhi Dong Nan Gen Bai Pi (Mori Cortex from Southeastern branch): 10 parts (harvested on the 3rd day of the 3rd lunar month)
* Chuan Jiao (Zanthoxyli Pericarpium): 3 parts
* Hou Po (Magnoliae Officinalis Cortex): 2 parts
* Gan Jiang (Zingiberis Rhizoma): 2 parts
* Shao Yao (Paeoniae Radix Alba): 2 parts
Take the nine ingredients. Burn Wang Bu Liu Xing, Shuoxie Ye, and Sang Pi to ash while retaining their medicinal properties. Pound and sieve each separately, then mix into a powder. Take one cun-bi per dose. For minor wounds, apply the powder topically; for major wounds, take orally. It may also be taken postpartum. If Wind-Cold is present, do not use Sang Gen. The first three ingredients should be dried in the shade for 100 days.
**Pai Nong San Formula (Pus-Discharging Powder)**
* Zhi Shi (Aurantii Fructus Immaturus): 16 pieces
* Shao Yao (Paeoniae Radix Alba): 6 fen
* Jie Geng (Platycodonis Radix): 2 fen
Pound the three ingredients into a powder. Take one chicken egg yolk. Mix equal amounts of the powder and egg yolk, knead until uniform, and take with water once daily.
Zhi Shi is bitter and cold, clearing heat and breaking stagnation, serving as the Sovereign herb. Combined with Shao Yao, it unblocks blood; combined with Jie Geng, it promotes Qi movement. Crucially, it relies on the sweet and moistening nature of the chicken egg yolk as the foundation for discharging pus and resolving toxicity.
**Pai Nong Tang Formula (Pus-Discharging Decoction)**
* Gan Cao (Glycyrrhizae Radix et Rhizoma): 2 liang
* Jie Geng (Platycodonis Radix): 3 liang
* Sheng Jiang (Zingiberis Rhizoma Recens): 1 liang
* Da Zao (Jujubae Fructus): 10 pieces
Decoct the four ingredients in three sheng (approx. 600ml) of water until one sheng (approx. 200ml) remains. Take five he (approx. 100ml) warm, twice daily.
This is also a formula for circulating Qi and Blood and harmonizing Ying and Wei Qi.
Jin Yin Chuang (oozing sore) starting from the mouth and flowing to the limbs is treatable; flowing from the limbs back to the mouth is untreatable. For Jin Yin Chuang, Huang Lian Fen (Coptidis Powder) is indicated.
The term "Jin Yin Chuang" is defined in the Chapter on Zang-Fu and Meridians. The formula for Huang Lian Fen is not recorded here. The general understanding is that this is a disease of damp-heat oozing. Therefore, only Huang Lian (Coptidis Rhizoma) is used, powdered and applied topically. Its bitterness dries dampness, and its coldness clears heat.