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All pulse positions are floating and rapid. Fever should be present, yet the patient instead experiences chills and shivering (saxi). If there is a fixed area of pain, an abscess (yong) is about to develop.

"Cang" (sores/ulcers) refers to distress and injury. External pathogens such as wind, cold, summer-heat, and dampness invade the meridians, causing disharmony of Qi and blood, presenting with a distressed appearance, leading to rotting and damaging the skin. This is what is called "cang". "Yong" (carbuncles) refers to obstruction and congestion. Whether caused by internal fire from the seven emotions or external evil from the six climatic factors, when these flow into the collaterals and accumulate in the acupoints, they cause blockage of Qi and blood, resulting in a congested and raised swelling. Hence it is named "yong". Generally, cang is small and shallow, while yong is large and deep. Furthermore, cang can manifest in any of the twelve regular meridians as well as the Ren and Du vessels. Even if a yong originates in the zang organs, its heat must transfer to the fu organs and manifest in the three Yang meridians and the Ren and Du vessels. This is because the pathogenic factor of cang is small and shallow, so the pulse is floating and scattered, appearing on the exterior of various meridians. Yong is deep and large; without the heat of the Yang meridians, it cannot form the momentum of swelling and ulceration. If the root is deep and large, appearing in the Yin meridians, it presents as swelling without pain, or itching, even ulcerating after three or four months without pus discharge. This is called "ju" (deep-seated abscess), representing the distinction between Yin and Yang. The first clause describes the initial pulse and symptoms of various yongs. "Zhu mai" (all pulses) refers to the six pulse positions (cun, guan, chi on both hands). Floating indicates the exterior, and rapid indicates heat. With a floating and rapid pulse, the symptom should be fever. However, if instead of exterior fever, the skin feels chilly and shivering occurs, this is a mismatch between pulse and symptoms. If there is fixed pain in the upper, middle, or lower jiao, or at specific locations, this constitutes the pulse and symptoms of developing a yong. This is because the heat-toxin gathers externally in the meridians, hence the floating and rapid pulse. Additionally, the defensive Qi at the exterior, initially pressured by the heat of the yong, struggles against it, causing alternating chills and fever (saxi ehan). The location of the yong varies in the upper, middle, and lower sections, and the floating and rapid nature of the pulse corresponds to the cun, guan, chi positions and left/right hands. Thus it says, "All pulses are floating and rapid."

The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, press the hand over the swelling. If it feels hot, pus is present; if not hot, no pus is present.

When muscle rots and skin becomes thin, heat-toxin forces outward. Therefore, pressing the hand over the swelling, heat indicates pus. Lack of heat means the heat is internal and has not yet emerged, indicating no pus. Additionally, if pressing the swelling causes a pulsating sensation against the finger, pus is present; if it does not push against the finger, no pus is present. This method is very accurate, so it is appended here.

Intestinal yong (intestinal abscess) presents with rough, scaly skin (jiacuo), tense abdominal skin that feels soft upon palpation but appears swollen, without abdominal accumulations, body fever, but with a rapid pulse. This indicates intestinal abscess with pus, treated with Yiyi Fuzi Baijiang San.

Formula: Yiyi Ren (Coix Seed, 10 parts), Fuzi (Prepared Aconite Root, 2 parts), Baijiang Cao (Patrinia Herb, 5 parts).
Crush the three herbs into a powder. Take one fangcun bi (a measure approx. 2-3 grams) of powder, boil in two sheng of water until reduced by half, and take in one dose. Urination should follow shortly.

These two clauses below specifically discuss the pulse, symptoms, and treatment of intestinal yong among various abscesses. The current clause refers to Small Intestine yong, while the next refers to Large Intestine yong. Small Intestine yong arises from Yang deficiency, failing to transform water and accumulating dampness. Long-standing dampness generates deficient heat. Damp-heat steams in the Small Intestine, blocking Qi and blood, leading to congestion and formation of yong. Large Intestine constipation leads to accumulated heat in Qi. Qi heat and stagnation prevent blood circulation, causing yong. The former formula addresses Yang deficiency to remove damp-heat; the latter addresses blood heat to attack Qi stagnation. The Small Intestine connects to the lower opening of the Stomach. Its Qi deficiency and cold prevent it from overcoming dampness and transforming heat. Small Intestine damp-heat presses upward on the Stomach. Stomach Earth corresponds to muscles externally. Damp-heat steaming prevents normal blood transformation, causing jiacuo (rough skin). Damp-heat floats outward, and since the abdomen is close to the Small Intestine, the abdominal skin feels tense. This is the response of dampness鼓动 (bulging) and rising heat. However, the damp-heat steams the abdominal skin, while the abscess is inside the intestine, unrelated to the space between the skin and intestine. Thus, palpation feels soft, and although it looks swollen, it is not truly swollen. If there were abdominal accumulations, Qi mechanism would be short, and the pulse might be rapid internally. If there were exterior heat, Yang Qi would float, and the pulse might be rapid externally. Without these, a rapid pulse indicates blocked Qi and blood and gathered heat-toxin. Based on symptoms, this is undoubtedly intestinal abscess with pus. The formula uses Yiyi Ren (sweet and cold) as the sovereign herb to remove dampness, as dampness is the root disease. However, removing dampness requires supporting True Yang to guide it, otherwise dampness cannot be quickly removed; thus, Fuzi (generating Yang) is used as an assistant. Heat is the branch disease, so bitter-cold Baijiang Cao is used to attack violent heat and break down abscess pus. Made into powder and boiled in water for single dosing allows the medicine to stay in the Stomach longer, treating both jiacuo and tense abdominal skin. "Urination should follow" applies to both pre-pus and post-pus stages. If unformed pus and urination is blocked, Fuzi supports Yang, Yiyi Ren leaches dampness, and Baijiang Cao drains pus within the context of supporting Yang and leaching dampness, allowing the abscess to dissipate. If pus is formed and urination flows freely, Baijiang Cao breaks the pus, Yiyi Ren drains toxins, and Yang-generating Fuzi aids in closing the wound. Zhang Zhongjing's formulas are truly miraculous and ever-changing.

Intestinal yong presents with swelling and fullness in the lower abdomen, pain upon pressure resembling strangury (lin), but normal urination, frequent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus is not yet formed; purgation may be used, and bloody stool will likely pass. If the pulse is surging and rapid, pus is formed; purgation is contraindicated. Treat with Dahuang Mudan Tang.

Formula: Dahuang (Rhubarb Root, 4 liang), Mudan Pi (Moutan Cortex, 1 liang), Mangxiao (Mirabilite, 3 he), Taoren (Peach Kernel, 50 pieces), Guazi (Melon Seeds, 0.5 sheng).
Boil the five herbs in six sheng of water to obtain one sheng. Strain, add Mangxiao, boil again, and take in one dose. If pus exists, it will be discharged; if no pus, bloody stool will be discharged. (Carefully consider the phrase "if pus exists, it will be discharged"; this implies that for unformed pus requiring purgation, this formula is not appropriate.)

This discusses the pulse, symptoms, and treatment of Large Intestine yong. The Large Intestine follows the Small Intestine and resides in the lower abdomen. Abscess formation blocks Qi and blood, causing swelling and fullness in the lower abdomen. The Large Intestine adheres to the lower opening of the Bladder. Heat forces the urinary tract due to proximity, causing pain upon pressure resembling strangury. It is not true strangury because the Small Intestine is unaffected and urination is normal. Small Intestine yong is caused by cold, so no exterior heat occurs. Large Intestine yong is caused by heat; excess heat steams upward and covers outward, causing frequent exterior heat. Spontaneous sweating here shares the same meaning as in Da Chengqi Tang syndrome (excess in intestines implies excess in Stomach). Aversion to cold here shares the same meaning as back-chill in Baihu Jia Renshen Tang syndrome (interior heat causes exterior cold). The "pulse" mentioned twice refers to the right Chi position, as per Neijing, where the Large Intestine is inspected. Slow pulse indicates Qi obstruction; tight pulse indicates gathering pain. Since Qi is just obstructed and pain is gathering, pus is not yet formed. "May purge" vs "may not purge" does not refer solely to Dahuang Mudan Tang, but also to Da Chengqi Tang, Taohe Chengqi Tang, or Didang Wan. In early stages before abscess formation, Da Chengqi Tang purges excess and clears heat, dispersing the abscess. Even if abscess forms but pus is not yet ready, Taohe or Didang formulas can purge blood to drain Qi, eliminating the abscess. Surging pulse indicates Yin deficiency; rapid pulse indicates blazing fire. An abscess pulse showing Yin deficiency suggests internal collapse of Ying blood. An abscess pulse showing blazing fire suggests external combat of heat-toxin. Internal collapse turning outward indicates pus is formed. Once pus is formed, neither simple purging of excess heat (Da Chengqi) nor simple purging of stasis (Taohe/Didang) is suitable. Thus, "purge is contraindicated" means standard purging methods cannot be applied. The brilliance of Dahuang Mudan Tang lies in the use of Guazi. Growing in melon pulp, its kernel possesses vigorous generating Yang Qi, often showing a tendency to sprout. Thus, it enters the abscess to penetrate and drain toxin. Taoren, with its penetrating and moving nature, breaks stasis and drives out bad blood. Mangxiao, salty and lubricating, softens hardness and reduces swelling. Mudan Pi (discussed in Shenqi Wan commentary) acts as the envoy. In Shenqi Wan's warming Yang herbs, its ascending nature is used positively to nourish Heart Qi. In this formula's cooling Yin herbs (Mangxiao, Dahuang), its descending nature is used inversely to regulate exterior cold/heat and descend to the Large Intestine. Finally, Dahuang, bitter-cold and majestic, sweeps away excess heat, pus, and blood. Named Dahuang Mudan Tang, the other three herbs serve as assistants: Mangxiao and Taoren establish merit through auxiliary action; Guazi achieves success through internal correspondence. Like strategists in history books, they share the glory. Li's old annotation placing this formula under "unformed pus, may purge" is incorrect. If it were for unformed pus, how would formed pus be treated? Would it be fatal? Or is another formula missing? Moreover, the formula instructions say "if pus exists, it will be discharged."

Question: Cun Kou pulse is micro and choppy. Medically, this indicates loss of blood or excessive sweating. If there is no sweating, what is the cause? Answer: If the body has sores injured by knives or axes, causing blood loss, this is the reason.

This clause combined with the next discusses Jin Chuang (metal weapon injuries) pulse, symptoms, and treatment. Left Cun governs Heart and Danzhong, masters Blood. Right Cun governs Lung and Xiongzhong, roots Yang Qi. Micro pulse indicates Yang deficiency; choppy pulse indicates Blood insufficiency. However, Yang attaches to Yin, and Qi roots in Blood. Therefore, analyzing this pulse prioritizes choppy (Blood deficiency) over micro (Yang deficiency). Thus, diagnosis attributes this to blood loss from vomiting/epistaxis or sweating. Blood loss/sweating causes Yin deficiency, leading to Yang deficiency (micro pulse). The phrase "if no sweating" also encompasses blood loss scenarios like vomiting/epistaxis. Why does this pulse appear? Answer: Due to Jin Chuang (knife/axe wounds) causing sudden loss of Qi and Blood, making the pulse identical to that of vomiting/epistaxis or sweating.

For Jin Chuang, Wangbuliuxing San is indicated.

Formula: Wangbuliuxing (Polygonatum Kingii Rhizome, 10 parts, harvested Aug 8), Shuoxi Xiye (Dioscorea Hypoglauca Leaves, 10 parts, harvested Jul 7), Sanggen Baipi (Mulberry Root Bark, SE direction, 10 parts, harvested Mar 3), Huangqin (Scutellaria Root, 2 parts), Shaoyao (Peony Root, 2 parts), Nongpu (Magnolia Bark, 2 parts), Ganjiang (Dried Ginger, 2 parts), Gancao (Licorice Root, 18 parts), Chuanjiao (Sichuan Pepper, 3 parts, remove eyes and closed ones, stir-fry to remove moisture).
Burn the first three herbs (Mulberry bark, etc.) to ash retaining medicinal properties, avoiding excessive ash. Grind and sieve separately, then mix into powder. Take one fangcun bi. For small wounds, apply powder topically. For large wounds, take orally. Postpartum women may also take it. Avoid Mulberry SE root during wind-cold weather. The first three herbs must be air-dried for 100 days.

Jin Chuang refers to knife/axe wounds and falls, categorized as "neither internal nor external" causes. Unlike typical sores, sudden blood loss causes Qi to rush to the wound, generating heat. Heat causes blood to flow freely and be hard to stop. Thus, bitter-cold Huangqin and sour-astringent Shaoyao clear heat and consolidate blood. Sudden blood loss leaves Qi deficient in the meridians. Deficient Qi becomes cold, preventing closure of the wound. Thus, warm-acrid Ganjiang and Chuanjiao generate and secure Qi to promote healing. Wangbuliuxing moves Qi in Blood. Shuoxi Xiye heals severe injuries and reconnects bones/tendons. Mulberry root bark resembles silk/hemp and muscle tissue, possessing properties to heal and close wounds. Ashed, it turns black and salty; black enters Blood to stop bleeding, salty reduces swelling and moistens. Leaves/stems harvested in autumn (Jul/Aug) for maturity; root bark harvested in spring (Mar) for vitality, choosing SE direction for optimal Qi. Cold/windy weather shrinks vital Qi, so harvesting is avoided. Air-drying for 100 days preserves potency, avoiding heat damage. Gancao is sovereign, harmonizing and staying in the Stomach to distribute the formula. Nongpu expands the chest/diaphragm and directs Qi to the wound. Wangbuliuxing San is the sacred medicine for Jin Chuang. Small wounds affect Qi/Blood superficially; topical powder suffices. Large wounds affect meridians/organs; oral administration is needed to support from inside/outside. Postpartum treatment aims to generate new blood and expel stasis, similar to Jin Chuang principles, so it is applicable.

Jinyin Chuang (oozing sore) flowing from mouth to limbs is treatable; flowing from limbs to mouth is untreatable.

Damp-heat toxin erupts in skin/muscle, spreading like waves, hence "Jinyin" (oozing/spreading). Limbs represent distant areas, like minor bandits harmless to the state. The mouth is the entry for food, like a supply route. Yangming Meridian Qi ends at the lips/mouth. Flowing from mouth to limbs disperses outward from inside, making it treatable. Flowing from limbs to mouth invades inward from outside, making it untreatable. Mentioning limbs and mouth clarifies interior/exterior dynamics; mentioning Jinyin Chuang illustrates principles for other diseases.

Jinyin Chuang is treated with Huanglian Fen.

Huanglian Fen formula is missing. Perhaps it is simply Huanglian ground into powder. Jinyin Chuang involves damp-heat spreading, causing Ying Qi to loosen and scatter. Huanglian is bitter and cold, with a constrained nature. Bitter dries dampness, cold clears heat. Its constrained nature particularly strengthens the loosened/scattered Qi, making it the primary herb.