九江黄父问于岐伯曰∶余闻肠胃受谷,上焦出气,以温分HT 而养骨节、通腠理,中焦出气如露,注溪谷而燥经脉,
津液和调而变化赤为血,血和则乘脉先满,乃注经络,经络皆盈,乃注于经络(句有脱误)。阴阳已张,因息乃行,行有
经纪,周有道理,与天协议,不得休止,切而谓之,从虚去实,泻则不足,疾则气留,去虚补实则有余,血气已调,形
神乃持。余已知血气平与不平,未知痈疽之所从生,成败之时、死生之期,期有远近,何以度之,可知闻乎。
岐伯曰∶经脉流行不止,与天同度,与地同纪,故大宿失度,日月薄蚀也。经始纪冰道流溢,草薷不成,五谷不植,
经路不通,民不往来,庵聚邑居,别离异处,血气犹然,则言其故。
夫血脉荣卫周流不休,上应星宿,下应经数,寒客于经络之中则血泣,泣则不通,不通则归之不得复,及故痈肿与
寒气化为热,热胜则肉腐,肉腐则为脓,脓不泻则烂筋,筋烂则伤骨,骨伤则水髓消不当骨肉不泻,筋枯空虚,筋骨肌
肉不得相亲,经脉败漏,熏于五脏,五脏伤故死矣。
黄父曰∶愿闻于痈疽之形与其期日。
岐伯曰∶略说痈疽极者一十八种。痈发于嗌,名曰猛疽,猛疽不治则化为脓,脓塞其咽半日死。其为者写则已,含
豕膏无冷,写三日而已(一方无冷食)。发于颈者名曰夭疽,其状痈大而赤黑,不急则热气不入渊脉腋前,伤任脉,内熏
肝脉十余日死,阳气大发,消脑,名曰脑漯,其色不乐,项痛如 ,以藏头乘心者,不治(本作留字)。发于肩及 者名
曰雌痈,其状赤黑,急治之,此令大汗出至足,不害五脏。
发于腋下赤坚者名曰米疽,治之HT 石欲细长疏,或云涂豕六膏,日以勿裹,其痈坚而不溃者,马刀夹缨乃治之。
发于胸者名曰并疽,其状如大豆,三四日起,不早治,下入腹不治,十日死。
发于臆者名曰甘疽,其状如谷实萎瓜,常寒热,急治之去其寒,十岁(似误)死,死后脓自出。
发于胁者名曰改訾,改訾者女子之病也。久之其疾大痈脓,治之,其中乃有生肉大如赤小豆,锉陵翘草、陵根各一
升,水六升,煮之竭为三升,即强饮浓衣坐釜上,令汗出至足已。
发于股阳明名曰股瓮疽,其状不甚变而痈脓附骨,不急治四十日死。
发于股阴名曰赤施疽,不急治六日死。在两股之内,不治六日死(一方云十六日死)。发于尻名曰兑疽,其状赤坚大
急,急治之,不速治三十日死。
发于膝名曰雌疽,其状痈色不寒热而坚,勿破,破之死。须以手缓柔之,乃破。诸疽发于节而相应之者,不可治之
也。
发于阳者百日死。
发于阴者四十日死。
发于脑名曰菟啮,其状疾赤至胃,急治之,不治煞人。
发于踝名曰走援,其状痈也,急不变,灸而止其寒热,不死。
发于足上名曰四淫,其状如痈,不急治之百日死。
发于足名曰疠疽,其状初小指发,急治之,去其黑者,不辄益不治,百日死。
发于足指名曰脱疽,其状赤黑不死,治之不衰,急渐去之,治不去,必死矣。
夫痈疽者,初发始微,多不为急,此实奇患,惟宜速治之,急治不苦速,成病难救,以此致祸能不痛哉!具述所怀,
以悟后贤。谨按∶黄父痈疽论所着缓急之处,生死之期,如有别痈之形色、难易之治如左僧纳私撰是用,非是先贤恐后
高雅,故记之名字,令惑之耳。
发皮HT 浅肿,高之赤即消,不治亦愈。
发筋HT 深肿,下之坚其色,或青或黄白黑,或复微热而赤,宜急治之。成消中半发附骨者,或未觉肉HT ,
肉HT 已殃
者,痈疽之甚也(肉HT 似误,按HT 即肉字也)。
凡发背,外皮薄为痈,皮坚为疽,如此者多现先兆,宜急治之。皮坚甚,大多致祸矣。
夫痈坏后有恶HT 当者,以猪蹄汤洗其秽,次敷饮HT 膏散恶HT 尽,乃敷生肌膏散,乃摩四边令善HT
速生,当须绝房室、
慎风冷,勿自劳动,须筋脉复常,乃可自劳耳。不尔,新HT 易伤则重发,便益溃烂,慎之慎之。
九江的黄父向岐伯问道:我听说肠胃消化食物后,上焦发出气,用来温煦体表、滋养骨节、疏通腠理;中焦发出的气像露水一样,注入溪谷(指肌肉间的空隙)以干燥经脉。津液调和变化成红色的血,血液调和则先充满脉管,然后注入经络,当经络都充盈时,再注入其他经络(此处原文可能有脱漏或错误)。阴阳之气已经张开,随着呼吸而运行,运行有规律,循环有条理,与天地自然相合,不停止。切脉诊断可知,从虚证转为实证是泻法,导致不足;如果疾速则气会滞留;去除虚证补益实证会导致有余。气血已经调和,形体和精神才能维持平衡。我已经知道气血是否平和,但还不知道痈疽是如何产生的,以及它们的预后、生死期限,期限有远近,如何判断它,可以告诉我吗?
岐伯说:经脉中的气血流行不止,与天体的度数相同,与大地的纪限相应。所以如果大星宿失去常态,就会出现日月蚀的现象。经脉开始记录冰道(此处疑为衍文或误字,意指经脉运行之道)的流溢,就像草木不生长,五谷不种植,道路不通,人们不往来,聚集在城邑居住,分离在不同地方,气血也是如此,所以要说明其中的缘故。
血脉和营卫之气周流不息,上对应星宿,下对应经数。寒气客居在经络之中,血液就会凝涩;凝涩就不通;不通则气血归聚不得复行,于是形成痈肿,并与寒气化为热邪。热邪胜则肌肉腐烂,肌肉腐烂则化为脓。脓液如果不排出,就会烂筋;筋烂则伤骨;骨伤则骨髓消耗,不能与骨肉相亲附;筋枯空虚,筋骨肌肉不能相互亲近,经脉败坏渗漏,热气熏蒸五脏,五脏受伤所以死亡。
岐伯说:简略地说,痈疽极端的种类有十八种。痈发于咽喉,名叫猛疽,猛疽如果不治疗就会化为脓,脓堵塞咽喉,半天内死亡。如果是实证则用泻法即可痊愈,含服猪膏不要冷食,三天后痊愈(另一版本说不吃冷食)。痈发于颈部,名叫夭疽,其形状痈大而色赤黑,如果不紧急治疗,热气就会侵入渊脉和腋前,损伤任脉,向内熏蒸肝脉,十多天后死亡。阳气大发,消烁脑髓,名叫脑漯,神色不乐,项部疼痛如……(原文缺失),以藏头乘心者,无法治疗(原本作“留”字)。痈发于肩部及……(原文缺失),名叫雌痕,其形状赤黑,紧急治疗它,使患者大汗出直到脚部,不伤害五脏。
痈发于腋下且色赤坚硬,名叫米疽,治疗时用石针想要细长稀疏,或者说涂抹猪膏,每天不要包扎,如果痈坚硬而不溃破,用马刀夹缨(一种治疗方法或工具)来治疗。
痈发于胸部,名叫并疽,其形状像大豆,三四天起病,不早治疗,向下进入腹部则无法治疗,十天后死亡。
痈发于胸胁部位,名叫甘疽,其形状像谷实萎瓜,经常寒热,紧急治疗以去除寒邪,十年后(似有误)死亡,死后脓液自行流出。
痈发于胁部,名叫改訾,改訾是女子的病。时间久了,疾病变成大痈脓,治疗时,其中会有生肉大如赤小豆,锉碎陵翘草、陵根各一升,用水六升,煮至剩余三升,立即让病人强饮,穿厚衣坐在锅上,令汗出直到脚部为止。
痈发于大腿阳明经部位,名叫股瓮疽,其形状变化不明显但痈脓附着在骨头上,不紧急治疗四十天后死亡。
痈发于大腿内侧阴经部位,名叫赤施疽,不紧急治疗六天后死亡。在两腿之间,不治疗六天后死亡(另一版本说十六天死亡)。痈发于尾骶部,名叫兑疽,其形状赤坚大且急迫,紧急治疗它,不快速治疗三十天后死亡。
痈发于膝盖,名叫雌疽,其形状痈色不寒不热而且坚硬,不要刺破,刺破就会死亡。必须用手轻轻揉按使之缓和,然后才能刺破。各种痈疽发于关节且相互对应的,不可治疗。
发于阳分的,一百天后死亡。
发于阴分的,四十天后死亡。
痈发于脑部,名叫菟啮,其形状急赤直至胃部,紧急治疗它,不治疗会杀人。
痈发于脚踝,名叫走援,其形状是痈,紧急不变,灸治以停止寒热,不会死亡。
痈发于足背上,名叫四淫,其形状像痈,不紧急治疗一百天后死亡。
痈发于足部,名叫疠疽,其形状初起于小趾,紧急治疗它,去除黑色的部分,不立刻增加且不治疗,一百天后死亡。
痈发于足趾,名叫脱疽,其形状赤黑但不死,治疗无效,逐渐去除坏死组织,治疗不去除,必定死亡。
那些痈疽,初发时很微小,大多不被重视,这其实是奇患,只宜迅速治疗,紧急治疗不觉得苦,一旦成病难以救治,因此招致祸患能不痛惜吗!详细陈述我的想法,以启发后来的贤者。谨按:黄父痈疽论所记载的缓急之处,生死之期,如果有其他的痈疽形色、难易治疗如左列僧纳私撰所用,并非先贤恐后世高雅之人困惑,所以记录名字,让他们迷惑罢了。
痈发于筋深层肿胀,下部坚硬其色,或青或黄白黑,或者又微热而赤,宜紧急治疗。成消中半发附骨者,或者未觉察肉……(原文缺失),肉……已殃者,是严重的痈疽(肉……似误,按……即肉字也)。
凡是发背,外皮薄的是痈,皮坚硬的是疽,这样的多现先兆,宜紧急治疗。皮非常坚硬,大多会导致祸患。
痈疽溃坏后有恶腐物应当清除,用猪蹄汤清洗秽物,其次敷上饮膏散,恶腐尽去,再敷上生肌膏散,然后按摩四周令好肉迅速生长,应当禁止房事,慎防风冷,不要自我劳累,须等筋脉恢复正常,才可以自我劳作。不然,新肉容易受伤则再次发作,便更加溃烂,务必谨慎。
Huangfu of Jiujiang asked Qibo: I have heard that after the intestines and stomach digest food, the Upper Jiao (Upper Burner) emits Qi to warm the body surface, nourish the bone joints, and unblock the Cou Li (interstitial spaces). The Qi emitted by the Middle Jiao (Middle Burner) is like dew, pouring into the Xi Gu (valleys between muscles) to dry the meridians. When Jing Ye (Body Fluids) are harmonized, they transform into red Blood. Harmonized Blood first fills the Mai (Vessels), then pours into the Jing Luo (Meridians and Collaterals); when the Jing Luo are full, it pours into other collaterals (the sentence here may have omissions or errors). Yin and Yang Qi are already expanded, moving with respiration; movement has its order, circulation has its principles, aligning with Heaven and Earth, never ceasing. Pulse diagnosis reveals that transforming from Deficiency to Excess is a Draining method, leading to insufficiency; if too rapid, Qi stagnates; removing Deficiency and tonifying Excess leads to excess. Once Qi and Blood are harmonized, the Form and Spirit can be maintained. I already know whether Qi and Blood are balanced or not, but I do not yet know how Yong Ju (Carbuncles and Ulcers) arise, nor their prognosis, timing of death or survival. The timelines vary in length; how can we estimate them? Can you tell me?
Qibo replied: The flow of Qi and Blood in the meridians never stops, corresponding to the degrees of Heaven and the records of Earth. Thus, if major stars lose their regularity, solar and lunar eclipses occur. The meridians begin to record the overflow of paths (text likely erroneous, referring to meridian flow), similar to grass and reeds failing to grow, grains failing to plant, roads blocked, people not traveling, gathering in towns, separated in different places; Qi and Blood behave similarly, hence the need to explain the causes.
Blood vessels and Ying Wei (Nutritive and Defensive Qi) circulate ceaselessly, corresponding to stars above and meridian numbers below. When Cold pathogens lodge in the meridians, Blood becomes viscous and stagnant; stagnation leads to blockage; blockage prevents return, causing Qi and Blood to gather, forming swelling. This swelling combines with Cold to generate Heat. Excessive Heat rots flesh, and rotted flesh turns into Pus. If Pus is not drained, tendons rot; rotten tendons damage bones; damaged bones cause Marrow to diminish, unable to support flesh and bone; tendons become withered and empty, so bones, tendons, flesh, and muscles cannot adhere to each other. Meridians fail and leak, Heat steams the Zang Organs, damaging them, leading to death.
Huangfu said: I wish to hear about the forms of Yong Ju and their prognostic timelines.
Qibo said: Briefly speaking, there are eighteen extreme types of Yong Ju.
1. Yong arising in the throat is called Meng Ju (Fierce Carbuncle). If untreated, it turns to Pus, blocking the throat, causing death within half a day. For Excess patterns, draining therapy cures it; swallowing Pig Fat without cold food cures it in three days (another version says avoid cold food).
2. Yong arising in the neck is called Yao Ju (Premature Death Carbuncle). It appears large, red, and black. If not treated urgently, Heat enters the Yuan Mai and anterior axilla, damaging the Ren Mai (Conception Vessel), internally steaming the Liver Meridian, causing death in ten-plus days. If Yang Qi overflows excessively, consuming brain marrow, it is called Nao Luo. The complexion is unhappy, neck pain is severe... (text missing), involving the head and heart, it is incurable (original text uses "Liu").
3. Yong arising in the shoulder and [missing part] is called Ci Yong (Female Carbuncle). It is red and black. Treat urgently to induce profuse sweating down to the feet; this does not harm the Zang Organs.
4. Yong arising in the axilla, red and hard, is called Mi Ju (Rice Carbuncle). Treat with thin, long, sparse stone needles, or apply Pig Fat daily without bandaging. If the Yong is hard and does not suppurate, treat with Ma Dao Jia Ying (a specific technique/tool).
5. Yong arising in the chest is called Bing Ju (Combined Carbuncle). It looks like a soybean. Onset in 3-4 days. If not treated early, spreading downward to the abdomen is incurable, causing death in ten days.
6. Yong arising in the hypochondrium/chest area is called Gan Ju (Sweet Carbuncle). It resembles a withered melon seed. Accompanied by frequent chills and fever. Treat urgently to remove Cold. Death occurs in ten years (likely an error), with spontaneous Pus discharge after death.
7. Yong arising in the flank is called Gai Zi. Gai Zi is a disease of women. After a long time, it becomes a large abscess. Treatment reveals raw flesh the size of a red bean. Decoct Ling Qiao Cao and Ling Gen (each 1 Sheng) in 6 Sheng of water until reduced to 3 Sheng. Drink strongly while wrapped in thick clothes, sitting on a pot to induce sweating down to the feet.
8. Yong arising in the thigh along the Yangming Meridian is called Gu Weng Ju. The appearance changes little, but pus adheres to the bone. Untreated, death occurs in forty days.
9. Yong arising in the thigh along the Yin Meridian is called Chi Shi Ju. Untreated, death occurs in six days. Between the thighs, untreated death in six days (another version says sixteen days).
10. Yong arising in the sacrum is called Dui Ju. It is red, hard, large, and urgent. Treat urgently; if not treated quickly, death occurs in thirty days.
11. Yong arising in the knee is called Ci Ju. The color is neither hot nor cold, and it is hard. Do not pierce; piercing causes death. Gently massage to soften before piercing. Yong Ju arising at joints with corresponding symptoms are incurable.
12. Arising in Yang aspects: death in one hundred days.
13. Arising in Yin aspects: death in forty days.
14. Yong arising in the brain is called Tu Nie. It spreads rapidly and redness reaches the stomach. Treat urgently; untreated, it kills.
15. Yong arising in the ankle is called Zou Yuan. It is a Yong. Urgent treatment prevents change; moxibustion stops chills/fever; no death.
16. Yong arising on the dorsum of the foot is called Si Yin. It resembles a Yong. Untreated, death in one hundred days.
17. Yong arising on the foot is called Li Ju. Starts at the little toe. Treat urgently, remove blackened tissue. If not treated immediately, it worsens; death in one hundred days.
18. Yong arising on the toe is called Tuo Ju. Red/black but not fatal initially. If treatment fails, gradually remove necrotic tissue. If not removed, death is certain.
Yong Ju start small and are often ignored, which is a grave danger. They must be treated quickly. Delay makes them hard to save. This brings tragedy! I detail these thoughts to enlighten future scholars. Note: Huangfu's discussion on urgency and timelines, along with other Yong forms and treatments as noted by Seng Na, are recorded here not to confuse later generations, but for reference.
Superficial skin swelling, high and red, resolves spontaneously or with treatment.
Deep muscle swelling, hard, colored blue, yellow, white, black, or slightly hot/red, requires urgent treatment. If it involves bone or deep tissue, it is severe.
Back sores: Thin skin indicates Yong; hard skin indicates Ju. These often show warning signs; treat urgently. Very hard skin leads to disaster.
After Yong/Ju ulcerates, clean foul matter with Pork Trotter Soup. Apply Yin Gao San to remove all foul matter, then apply Sheng Ji Gao San. Massage edges to promote healing. Avoid sexual activity, wind/cold, and overexertion. Wait for meridians/tendons to recover before working. Otherwise, new tissue will be injured, causing recurrence and worsening ulceration. Be very careful.