痈疽浮数，恶寒发热。若有痛处，痈疽所发。
脉数发热，而痛者阳。不数不热，不疼阴疮。
未溃痈疽，不怕洪大。已溃痈疽，洪大可怕。
痈者，壅也。疽者，阻也。荣卫气血，壅塞阻滞，郁热成脓之所致，有阴阳脏
腑之分。痈大而浅，疽小而深。大则气鼓发。鼓发，则向表而浅。小则气收敛。收
敛，则近里而深。浅则从腑从阳，故易消易溃。深则从脏从阴，故难消难溃。易溃
者，则毒从外泄。难溃者，则毒常内陷。此吉凶轻重之所由分也。方书谓其源有五，
一曰天行时气，二曰七情内郁，三曰体虚外感，四曰身热搏于风冷，五曰食炙 、
饮法酒、服丹石等热毒。虽分为五，然总不外三因也。三因者，一外因，如《素问》
运气等篇之太阳、少阴、阳明、太阴、少阳、厥阴之客气，以及所至所复，寒燥湿
邪，并热淫所胜，岁火太过之发为 疹疮疡，痈疽疮肿。又据脉要精微论，帝曰∶
诸痈肿筋挛骨痛，此皆安生？岐伯曰∶此寒气之肿，八风之变也。又生气通天论曰∶
劳汗当风，寒薄为 。郁乃痤。（薄之浅则为 ，郁之久则为痤。）又曰∶阳气者，开阖不得，
寒气从之，乃生大 。荣气不从，逆于肉理，乃生痈肿。（腠理之开阖，皆卫气主之。卫气失常，
则开阖亦不得如常矣。邪因乘隙而入，结于筋络，故成伛偻。邪若入陷于脉，则营亦不顺，逆于肉理之中，
久则结聚为痈肿也。）又《素问》气穴论曰∶邪溢气壅，脉热肉败，荣卫不行，即将为脓。内消骨髓，
外破大 ，留于节腠，必将为败。（邪留于节腠溪谷之间。节腠溪谷，神气所注，必大为败坏，岂仅
消髓破 而已？）又《灵枢》刺节真邪篇曰∶虚邪之中人也，搏于脉中，则为血闭。不通则为
痈。（亦荣气不从义。）又云∶热胜其寒，则烂肉腐肌为脓，内伤骨。内伤骨，为骨蚀。（热气
胜，久则良肉腐化为脓。不外泻而内入，入则烂及于骨。骨伤不易生新附骨，如虫之蚀也。）又曰∶邪气
中之，凝结日以易甚，连以聚居，为昔瘤。凝结之久，日渐增聚，则日渐长大矣。不腐而大，赘于形体，
其名曰瘤。昔者，夙昔之谓，言其久也。又曰∶骨与气并，日以益大，则为骨疽。（邪附于骨，久为
骨疽。）又曰∶有热则化为脓，无热则为肉疽（此邪结于肉者。有热，久则肉腐为脓，无热，久则肉化
为浆渣。今疽瘤内常有此类。）一内因，如《素问》阴阳别论曰∶三阳为病，发寒热，下为痈肿。（
三阳者，太阳也。
太阳主表，故发寒热。太阳走足，故下为痈肿。）又《素问》气厥论曰∶肾移寒于脾，痈肿少气。脾
移寒于肝，痈肿筋挛（肾水寒气反移，凌于脾土，是为逆。逆则气壅肌肉而为肿，以脾主肌肉故。脾以
寒气反移凌于肝木，亦为逆。逆则气不独壅肌肉，而筋亦挛肿，以肝主筋故。）又《素问》厥论曰∶少阳
厥逆，发肠痈，不可治。惊者死。（此言少阳游行之火。若厥逆结聚，为毒最甚，故不可治。若发惊，
是为入脏，主死。以惊属心，脏则指厥阴心包络也。）又《灵枢》脉度篇曰∶六腑不和，则留结为痈。（腑为
阳，阳主卫。卫气不和，则留结于肌腠而痈肿矣。）又玉版论，黄帝曰∶病之生时，有喜怒不测，饮食不节。阴
气不足，阳气有余，营气不行，乃发为痈疽。阴阳不通，两热相搏，乃化为脓。（喜
怒伤气，饮食伤脏。不测者，暴发之谓。暴则气壅逆而阳有余。不节者，纵食偏嗜之谓。不节则五宫伤而阴
不足。阳有余则气聚而热胜，阴不足则荣不行而热亦胜。两热相搏，营卫不行，故化脓而成痈疽也。）
又陈无择亦云∶痈疽瘰 ，不问虚实寒热，皆由气郁而成，盖言喜怒忧思久郁所致。治以远志酒、独胜散，兼
以五志相胜之理，乃善。（如恐胜思，思胜恐之类。）不内外因，如《素问》生气通天论曰∶
膏粱之变，足生大丁，受如持虚。（足生者，必生也。）又异法方宜论曰∶东方之域，天地
之所生也。鱼盐之地，海滨傍水。其民食鱼而嗜咸，皆安其处，美其食。鱼者，使
人热中。盐者，胜血，故其民皆黑色疏理，其病皆为痈疡，其治宜砭石。（鱼生于水，外
阴而内阳，水之体也。动而不息，火之象也。火显于外，阳蓄于内，美食久久，使人热中。痈疡之病，
乃其常耳。）又有久服丹石法酒，热毒蓄中，发为痈疽疔肿，亦同膏粱之类。其脉浮数者，以血泣而
气复从之。邪与正郁，郁则化热，故数也。在表在阳，故浮也。正为邪搏，则宣畅
外卫之力薄，故复恶寒。据脉证，似与伤寒表证无异。但伤寒虽有痛，或在头，或
在身体，或在骨节，未有痛止于一处者。今痛止一处而脉数，此处必化热为脓，正
痈疽所发之处也。即《伤寒论》辨脉法所谓诸脉浮数，当发热而洒淅恶寒。若有痛
处，饮食如常者，蓄积有脓是也。如此者，乃为阳毒。若脉不数，身不热，所患之
处不疼，是邪客阴分，不能鼓发，多致内陷。然必兼有烦懊呕逆，胸膈不安等证。
否则不热不疼，脉又不数，是一不病患也，何得谓之阴疮而反重于阳证耶？方痈疽
之未溃也，无论成脓与否，热邪郁蓄，外不疏通，脉之鼓涌洪大，是其宜也。至于
已溃，则热泄邪解，而洪大之脉宜衰矣。溃而不衰，一派热邪，正从何复，诚为大
可惧者。与《素问》评热病论所谓病温者，汗出辄复热，而脉躁疾，不为汗衰，病
名阴阳交者，同一义也。凡此痈疽疡肿，自有专书，注固不能毕述，然《灵枢》痈
疽一篇，穷源别流，包括殆尽，恐业外医者，不能出其范围也，故备录于下。黄帝
曰∶余闻肠胃受谷，上焦出气以温分肉而养骨节，通腠理。（卫气源流。）中焦出气如露，
上注溪谷而渗孙脉，津液和调，变化而赤为血。血和，则孙络先满溢，乃注于络脉。
皆盈，乃注于经脉。阴阳以张，因息乃行。（荣气源流。）行有经纪，周有道理，与天合
同，不得休止。切而调之，从虚去实。泻则不足，疾则气减，留则先后，从虚去虚，
补则有余。血气已调，形气乃持。余已知血气之平与不平，未知痈疽之所从生。成
败之时，死生之期，有远近，何以度之，可得闻乎？岐伯曰∶经脉流行不止，与天
同度，与地合纪。故天宿失度，日月薄蚀。地经失纪，水道流溢，草萱不成，五谷
不殖，径路不通，民不往来，巷聚邑居，则别离异处。血气犹然，请言其故。夫血
脉营卫，周流不休，上应星宿，下应经数。寒邪客于经络之中则血泣。血泣则不通。
不通，则卫气归之，不得复反，故痈肿。（言卫气因以留聚，而不得复返于平常流行之故道也。）寒气
化为热，热胜则腐肉，肉腐则为脓。脓不泻则烂筋，筋烂则伤骨，骨伤则髓消，不
当骨空，（骨空，骨中之细孔，如鬃眼者，所以通血液之渗灌。）不得泄泻，血枯空虚，则筋骨肌肉不
相营。经脉败漏，熏于五脏，脏伤故死矣。黄帝曰∶愿尽闻痈疽之形，与忌曰名。
岐伯曰∶痈发于嗌中，名曰猛疽。（猛者猛烈急速之谓。）猛疽不治，化为脓。脓不泻，塞咽
半日死。其化为脓者，泻则合豕膏冷食，三日已。发于颈，名曰夭疽，（外在颈而内则入腋熏
肺。以其最上，故曰夭。）其痈大以赤黑。不急治，则热气下入渊腋，前伤任脉，内熏肝肺，
十余日而死矣。阳气大发，消脑留项，名曰脑烁。（烁，消烁也。烈火熔金之谓。脑被其热，烁亦如
之。烦心者，肾毒传心也。）其色不乐，项痛而如刺以针。烦心者，死不可治。发于肩及 ，
名曰疵疽，其状赤黑。急治之，令人汗出至足，不害五脏。痈发四五日，逞（速也。）
之。发于腋下，赤坚者，名曰米疽。（言其小如粟米也。）治之以砭石。欲细而长，疏砭之，
涂以豕膏，六日已，勿裹之。其痈坚而不溃者，为马刀侠缨，急治之。（马刀蛤蛎之属，
痈形似之。侠缨者，发于结缨之处，人迎之下颈侧也。二痈一在腋，一在颈，常相联系，故俗名历
串。）发于胸，名曰井疽。（言其深也。）其状如大豆。三四日起。不早治，下入腹。不治，七日死矣。
发于膺，名曰甘疽。色青，其状如谷实栝蒌，常苦寒热。急治之，去其寒热，十岁死。死后出脓。（甘属土。
此疽发于阳明胃经，隐名也。即乳痈之类。内累累如谷食之蓓 ，如栝蒌之包子。虽不即死，亦
不即愈。）发于胁，名曰败疵。（亦乳串之类。）败疵者，女子之病也。灸之。其病大痈脓，治
之。其中乃有生肉，大如赤小豆。锉 草根各一升，以水一斗六升，煮之竭，为
取三升，则强饮浓衣，坐于釜上，令汗出至足已。发于股胫，名曰股胫疽。其状不
甚变而痈脓搏骨。不急治，三十日死矣。发于尻，名曰锐疽。（尾骨尽处而尖锐，故名。）其
状赤坚大。急治之。不治，三十日死矣。发于股阴，名曰赤施。（股阴，足太阴、厥阴二经所
过之处。火毒伤阴之甚则发。此曰赤施者，谓赤火之施发耳。）不急治，六十日死。在两股之内，不治。
十日而当死。发于膝，名曰疵痈。其状大，痈色不变，寒热，如坚石。勿石，石之
者死。须其柔，乃石之者生。诸痈疽之发于节而相应者，不可治也。发于阳者百日
死，发于阴者三十日死。（节为神气之所游行出入。若上下左右相应而发者必死。）发于胫，名曰兔啮。
（如兔之啮伤，故在胫。）其状赤至骨。急治之，不治害人也。发于内踝，名曰走缓。（毒害于足，
则走缓而不能疾。）其状痈也，色不变，数石其输而止其寒热，不死。发于足上下，名曰
四淫。（毒淫其末，诸阳之本败矣。亦上下相应者。）其状大痈。急治之，百日死。发于足旁，名曰
厉痈。（厉，恶也。）其状不大，初如小指发。急治之。去其黑者，不消辄益。不治，百
日死。（急挑去其黑者，不尔则增多。）发于足指，名脱痈。其状赤黑，死不治。不赤黑，不死。
不衰，急斩之，否则死矣。（不赤黑者，虽不死，亦欲其即衰去。不衰则急斩其指。不然则毒入指脱
而死。）黄帝曰∶夫子言痈疽，何以别之？岐伯曰∶荣卫稽留于经脉之中，则血泣而不行。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。
然不能陷，骨髓不能焦枯，五脏不为伤，故命曰痈。黄帝曰∶何谓疽？岐伯曰∶热
气淳盛，下陷肌肤，筋髓枯；内连五脏，血气竭。当其痈下，筋骨良肉皆无余，故命曰疽。疽者，上之
皮夭以坚，上如牛领之皮。（皮夭白，如牛脊皮之坚浓也。）痈者，其皮上薄以泽，此其候也。
痈疽脉象浮数，伴有恶寒发热。如果有疼痛的部位，那就是痈疽发生的地方。
脉象数且发热，并有疼痛的是阳证（阳疮）。脉象不数、不发热、也不疼痛的是阴疮。
痈疽尚未溃破时，不怕脉象洪大；痈疽已经溃破后，脉象洪大则令人担忧。
“痈”字意为壅塞，“疽”字意为阻隔。这是由于营卫气血壅塞阻滞，郁积化热而成脓所致，有阴阳、脏腑之分。痈的特点是范围大而位置浅，疽的特点是范围小而位置深。范围大说明气机鼓动外发，气机向外鼓动，病位就趋向体表而较浅；范围小说明气机收敛内聚，气机向内收敛，病位就趋向体内而较深。病位浅的属于腑、属阳，所以容易消散、容易溃破；病位深的属于脏、属阴，所以难以消散、难以溃破。容易溃破的，毒邪就从外部排出；难以溃破的，毒邪就会向内部陷落。这就是判断病情吉凶轻重的依据。医书说其病因主要有五种：一是天行时气（流行性疫病之气），二是七情内郁（情绪抑郁），三是体质虚弱感受外邪，四是身体发热与风冷相搏结，五是食用炙烤食物、饮用烈酒、服用丹石类药物等引起的热毒。虽然分为五类，但总括起来不外乎“三因”（三种病因）。所谓三因，一是外因，如《素问》运气等篇中提到的太阳、少阴、阳明、太阴、少阳、厥阴的客气，以及所至所复的寒、燥、湿邪，还有热淫所胜、岁火太过引发的疹疮疡、痈疽疮肿。又根据《脉要精微论》，黄帝问：各种痈肿、筋挛、骨痛，这是怎么产生的？岐伯回答：这是寒气导致的肿胀，是八风变化引起的。又《生气通天论》说：劳动出汗后当风，寒气迫入肌肤则为疿（一种皮肤疾患），郁久则成为痤（痤疮）。（寒气轻微则为疿，郁积日久则为痤。）又说：阳气如果开阖功能失常，寒气乘虚而入，就会生成大痈。营气运行不畅，逆乱于肌肉纹理之间，就会生痈肿。（腠理的开阖都由卫气主导。卫气失常，开阖就不能正常进行。邪气趁机侵入，结聚在筋络，所以形成伛偻；邪气如果深入血脉，营气就不顺，逆乱在肌肉纹理中，日久结聚就成为痈肿。）又《素问·气穴论》说：邪气溢满，气机壅滞，脉热肉败，营卫不通，即将化为脓液。如果在体内消耗骨髓，在体外破溃大痈，留存在节腠之间，必将造成严重的败坏。（邪气停留在节腠溪谷之间。节腠溪谷是神气灌注的地方，一旦受邪必大为败坏，岂止是消髓破皮而已？）又《灵枢·刺节真邪篇》说：虚邪侵袭人体，搏结于脉中，就会导致血闭。血闭不通就会生痈。（这也是营气运行不畅的意思。）又说：热胜过寒，就会烂肉腐肌化为脓，内伤骨骼。内伤骨骼，称为骨蚀。（热气胜久，良肉腐化为脓。如果不向外排泻而向内侵入，就会烂及骨骼。骨头受伤不易长出新骨附着，就像被虫蛀蚀一样。）又说：邪气侵入，凝结日益严重，连片聚居，形成昔瘤（陈旧性的肿瘤）。凝结时间久，日渐增聚，就会日渐长大。不腐烂而变大，赘生于形体之上，名叫瘤。“昔”指往昔，表示时间长久。又说：骨与气并结，日渐增大，就称为骨疽。（邪气附着于骨，日久成为骨疽。）又说：有热就会化为脓，无热就称为肉疽（这是邪气结聚在肌肉里。有热，日久肉腐为脓；无热，日久肉化为浆渣。现在有些疽瘤内部常有这类情况）。二是内因，如《素问·阴阳别论》说：三阳经发病，出现寒热，下部发生痈肿。（三阳指太阳经。太阳主表，所以发寒热；太阳经脉下行足部，所以下部发生痈肿。）又《素问·气厥论》说：肾将寒气移传给脾，会发生痈肿、少气。脾将寒气移传给肝，会发生痈肿、筋挛。（肾水寒气反常移传，凌犯脾土，这叫逆。逆则气壅滞于肌肉而肿胀，因为脾主肌肉的缘故。脾以寒气反常移传凌犯肝木，也叫逆。逆则气不仅壅滞于肌肉，筋也会挛缩肿胀，因为肝主筋的缘故。）又《素问·厥论》说：少阳经气厥逆，发生肠痈，不可治。如果出现惊悸症状就会死亡。（这里说的是少阳游行之火。如果厥逆结聚，毒性最甚，所以不可治。如果发生惊悸，说明病邪入脏，主死。因为惊悸属心，这里的脏指厥阴心包络。）又《灵枢·脉度篇》说：六腑不和，就会留结为痈。（腑属阳，阳主卫气。卫气不和，就会留结于肌腠而生痈肿。）又《玉版论》中，黄帝说：疾病产生时，有喜怒无常、饮食不节。阴气不足，阳气有余，营气运行不畅，于是发为痈疽。阴阳不通，两热相搏结，就化为脓。（喜怒伤气，饮食伤脏。不测指暴发。暴则气壅逆而阳有余。不节指放纵饮食偏嗜。不节则五脏伤而阴不足。阳有余则气聚而热胜，阴不足则营不行而热也胜。两热相搏，营卫不通，所以化脓而成痈疽。）陈无择也说：痈疽瘰疬，不问虚实寒热，都是由气郁而成，大概是指喜怒忧思久郁所致。治疗用远志酒、独胜散，兼用五志相胜的道理，才是好的方法。（比如恐胜思，思胜恐之类。）三是不内外因，如《素问·生气通天论》说：膏粱厚味的变害，足以生出大疔，接受这种病就像拿着空容器接东西一样容易。（足生者，是一定会产生之意。）又《异法方宜论》说：东方地域，是天地生长的地方。鱼盐之地，靠近海滨有水。那里的百姓吃鱼而嗜好咸味，都安于那里，喜爱那里的食物。吃鱼使人热积于中。咸味耗伤血液，所以那里的百姓肤色黑、皮肤纹理疏松，他们的病多为痈疡，治疗适宜用砭石。（鱼生于水，外表阴而内里阳，是水体的特性。鱼动而不息，是火的象征。火显于外，阳蓄于内，长期食用美食，使人热积于中。痈疡之病，就是那里的常见病。）又有长期服用丹石、法酒，热毒蓄积在中焦，发为痈疽疔肿，也与膏粱厚味同类。其脉象浮数的，是因为血液凝涩而气又随之郁结。邪气与正气郁结，郁结则化热，所以脉数。病在表、在阳，所以脉浮。正气被邪气搏击，宣畅外卫的力量薄弱，所以又感到恶寒。根据脉证，似乎与伤寒表证没有不同。但是伤寒虽然有痛，或在头部，或在身体，或在骨节，没有疼痛只局限在一处的。现在疼痛只局限在一处且脉数，此处必然化热成脓，这正是痈疽发生的地方。即《伤寒论·辨脉法》所说的诸脉浮数，应当发热而洒淅恶寒。如果有疼痛之处，饮食如常的，是蓄积有脓。像这种情况，属于阳毒。如果脉不数，身不热，患病部位不疼，这是邪气客居阴分，不能鼓动外发，多导致毒邪内陷。然而必定兼有烦懊、呕逆、胸膈不安等症状。否则不热不疼，脉又不数，那就不是病人了，怎么能说是阴疮反而比阳证重呢？在痈疽未溃破时，无论是否成脓，热邪郁蓄，外部不得疏通，脉象鼓涌洪大，是适宜的现象。至于已经溃破，热泄邪解，洪大的脉象应该衰退。溃破后脉象不衰，一派热邪，正气从何恢复，这确实是非常可怕的。这与《素问·评热病论》所说的患温病的人，汗出后立即又发热，脉象躁疾，不因汗出而衰退，病名阴阳交的，意义相同。凡此痈疽疡肿，自有专门书籍论述，注释固然不能详尽叙述，但《灵枢·痈疽》一篇，穷究本源辨别流派，几乎全部包括在内，恐怕非专业医者不能超出这个范围，所以完整记录在下面。黄帝说：我听说肠胃受纳谷物，上焦发出气来温煦分肉并滋养骨节，通达腠理。（这是卫气的源流。）中焦发出气像露水一样，向上注入溪谷并渗入孙脉，津液调和，变化而成为赤色的血。血调和，则孙络先充满，然后注入络脉。络脉都充盈，然后注入经脉。阴阳张开，随着呼吸而行。（这是营气的源流。）运行有经纪，周流有条理，与天道相合，不得休止。切脉调治，从虚去实。泻法则不足，疾则气减，留针则先后有序，从虚去虚，补法则有余。血气已调和，形气乃能维持。我已经知道血气的平与不平，还不知道痈疽是从哪里产生的。成败的时间，死生的期限，有远有近，如何度量它，可以听我说吗？岐伯说：经脉流行不止，与天同度，与地合纪。所以天上的星宿失去度数，日月就会遭受侵蚀。地上的经水失去规律，水道就会泛滥，草木萱草不能长成，五谷不能种植，道路不通，民众不能往来，村落城邑聚集，就会别离异处。血气也是这样，请让我说说其中的缘故。夫血脉营卫，周流不休，上应星宿，下应经数。寒邪客于经络之中则血泣（涩）。血泣则不通。不通，则卫气归之，不得复返，所以生痈肿。（意思是卫气因此留聚，而不能返回平常流行的故道。）寒气化为热，热胜则腐肉，肉腐则为脓。脓不泻则烂筋，筋烂则伤骨，骨伤则髓消，如果不当骨空（骨空，指骨中的细孔，如鬃眼者，用来通血液的渗灌），不得泄泻，血枯空虚，则筋骨肌肉不相营养。经脉败漏，熏灼五脏，脏伤所以死。黄帝说：愿听尽痈疽的形状，以及禁忌日和名称。岐伯说：痈发于咽喉中间，名叫猛疽。（猛，指猛烈急速之意。）猛疽不治疗，会化为脓。脓不排出，堵塞咽喉半天就会死。那些已经化为脓的，排出后用猪脂膏冷服，三天痊愈。发于颈部，名叫夭疽，（外在颈部而内则入腋熏肺。因为它位置最高，所以叫夭。）它的痈大而色赤黑。不紧急治疗，则热气下入渊腋，前伤任脉，内熏肝肺，十多天后就会死。阳气大发，消烁脑髓留于项部，名叫脑烁。（烁，消烁之意。像烈火熔金一样。脑被热邪灼烁也是如此。心烦意乱，是肾毒传心的表现。）面色不乐，项痛如针刺。心烦意乱的，死不可治。发于肩部及腋下，名叫疵疽，它的形状赤黑。紧急治疗，让人汗出至足，不伤害五脏。痈发四五日，速治之。发于腋下，色赤坚硬的，名叫米疽。（说它小如粟米。）用砭石治疗。砭石要细而长，疏刺患处，涂上猪脂膏，六天痊愈，不要包扎。那些痈坚硬而不溃破的，称为马刀侠缨，紧急治疗。（马刀蛤蛎之类，痈形似之。侠缨者，发于结缨之处，人迎之下颈侧也。这两个痈一个在腋，一个在颈，常相联系，所以俗名历串。）发于胸部，名叫井疽。（说它位置深。）形状像大豆。三四天起病。不早治疗，向下传入腹部。不治疗，七天就会死。发于胸前，名叫甘疽。色青，形状像谷实栝蒌，常常苦于寒热。紧急治疗，去除寒热，十年后死。死后出脓。（甘属土。此疽发于阳明胃经，隐名也。即乳痈之类。内部累累如谷食之蓓蕾，如栝蒌之包子。虽然不立即死，也不立即愈。）发于胁部，名叫败疵。（也是乳串之类。）败疵，是女子的病。灸治它。如果变成大痈脓，治疗它。其中会有生肉，大如赤小豆。锉葛根草根各一升，用水一斗六升，煮至水干，取汁三升，则强饮，盖厚衣，坐在锅上，令汗出至足痊愈。发于大腿和小腿，名叫股胫疽。形状变化不明显但痈脓搏结于骨。不紧急治疗，三十天死。发于尾椎，名叫锐疽。（尾骨尽头处尖锐，所以得名。）形状赤坚大。紧急治疗。不治疗，三十天死。发于大腿内侧，名叫赤施。（股阴，是足太阴、厥阴二经经过的地方。火毒伤阴严重就会发生。这里叫赤施，是说赤火之施发罢了。）不紧急治疗，六十天死。在两腿内侧，不治疗，十天就会死。发于膝盖，名叫疵痈。形状大，痈色不变，有寒热，像坚石。不要用石针刺，刺的会死。等到它变软，再用石针刺的才会生。所有痈疽发于关节且上下相应的，不可治。发于阳经的百日死，发于阴经的三十天死。（关节是神气游行出入的地方。如果上下左右相应而发的必死。）发于小腿，名叫兔啮。（像兔子咬伤，所以在小腿。）形状赤至骨。紧急治疗，不治疗害人。发于内踝，名叫走缓。（毒害于足，则行走缓慢而不能快。）形状是痈，色不变，多次用石针刺其输穴以止寒热，不死。发于足上下，名叫四淫。（毒淫其末，诸阳之本败矣。也是上下相应者。）形状是大痈。紧急治疗，百日死。发于足旁，名叫厉痈。（厉，恶也。）形状不大，初起如小指大小。紧急治疗。去掉黑色部分，不消退则增多。不治疗，百日死。（急挑去其黑者，不然则增多。）发于足趾，名叫脱痈。形状赤黑，死不治。不赤黑，不死。不衰退，急斩除脚趾，否则死。（不赤黑的，虽然不死，也希望它立即衰退。不衰退则急斩其趾。不然则毒入指脱而死。）黄帝说：先生讲痈疽，如何区别它们？岐伯说：营卫稽留在经脉之中，则血涩而不行。不行，则卫气随之而不通，壅遏而不得行，所以热。大热不止，热胜则肉腐，腐则为脓。然而不能深陷，骨髓不能焦枯，五脏不为伤，所以名叫痈。黄帝说：什么叫疽？岐伯说：热气淳盛，下陷肌肤，筋髓枯；内连五脏，血气竭。当其痈下，筋骨良肉皆无余，所以名叫疽。疽，上面的皮肤苍白而坚硬，上面像牛颈的皮肤。（皮苍白，像牛脊皮之坚浓也。）痈，它的皮肤薄而有光泽，这是它们的征候。
Boils and carbuncles present with a floating and rapid pulse, accompanied by aversion to cold and fever. If there is a painful area, this is where the boil or carbuncle has developed.
A rapid pulse with fever and pain indicates a Yang condition (Yang sore). A non-rapid pulse, no fever, and no pain indicate a Yin sore.
For boils and carbuncles that have not yet ulcerated, a flooding and large pulse is not feared. For those that have already ulcerated, a flooding and large pulse is alarming.
"Boil" (Yong) implies obstruction; "carbuncle" (Ju) implies blockage. These are caused by the obstruction and stagnation of Ying and Wei Qi and blood and qi, leading to郁 heat and pus formation. They can be distinguished by Yin/Yang and Zang/Fu organs. Boils are large and superficial; carbuncles are small and deep. Large size indicates Qi bubbling outward; outward bubbling means the lesion tends toward the surface and is shallow. Small size indicates Qi converging inward; inward convergence means the lesion tends toward the interior and is deep. Superficial lesions belong to Fu organs and Yang, so they are easy to resolve and ulcerate. Deep lesions belong to Zang organs and Yin, so they are difficult to resolve and ulcerate. Easy ulceration allows toxins to drain externally; difficult ulceration allows toxins to sink internally. This distinction determines the severity and prognosis. Medical texts state five sources: 1. Epidemic pathogens (Tianxing Shiqi); 2. Internal emotional depression (Seven Emotions); 3. Deficiency with external pathogen invasion; 4. Body heat combing with wind-cold; 5. Heat toxins from roasted foods, strong wine, or cinnabar/stone medicines. Although divided into five, they ultimately fall under the "Three Causes." The first cause is External: as mentioned in *Suwen* chapters on Six Qi, such as the guest Qi of Taiyang, Shaoyin, Yangming, Taiyin, Shaoyang, and Jueyin, and variations like cold, dryness, dampness, excessive heat, or excessive fire causing rashes, sores, boils, and carbuncles. According to *Maiyao Jingwei Lun*, Huangdi asked: How do various swellings, tendon spasms, and bone pains arise? Qibo answered: These are swellings due to cold Qi and changes from the Eight Winds. *Shengqi Tongtian Lun* states: Sweat from labor exposed to wind causes cold to press into the skin, resulting in 'Fei' (a skin disorder); prolonged stagnation results in 'Cuo' (acne). It also states: If Yang Qi's opening and closing fail, cold Qi enters, causing major boils. If Ying Qi does not flow smoothly and rebels within the muscle tissue, boils and swellings arise. (The opening and closing of Couli are governed by Wei Qi. If Wei Qi is abnormal, opening and closing are disrupted. Pathogens enter through gaps, knotting in meridians causing stooping; if pathogens sink into vessels, Ying Qi becomes unsmooth, rebelling in muscle tissue, eventually knotting into boils.) *Suwen·Qixue Lun* says: Excess pathogens and stagnant Qi, hot pulses and decaying flesh, blocked Ying and Wei Qi will soon turn to pus. Internally consuming marrow, externally breaking large sores, remaining in joints and Couli will lead to severe decay. *Lingshu·Cijie Zhenxie Pian* says: Empty pathogens invading humans, combing in vessels, cause blood closure. Blockage leads to boils. (This aligns with Ying Qi stagnation.) It also says: If heat overcomes cold, flesh rots and muscles decay into pus, damaging bones internally. Bone damage is called bone erosion. (Prolonged heat rots good flesh into pus. If it doesn't drain but sinks in, it rots bones. Bones damaged don't regenerate easily, like insect erosion.) It further says: Pathogens invade, condensing daily, gathering together, forming 'Xi Liu' (chronic tumors). Prolonged condensation grows larger. Non-decaying growths on the body are called tumors. "Xi" means past, indicating duration. It says: Bone and Qi combining, growing daily, becomes bone Ju. (Pathogens attaching to bone become bone Ju over time.) It says: With heat, it turns to pus; without heat, it becomes flesh Ju. (Pathogens knotting in flesh. With heat, flesh rots to pus; without heat, flesh turns to sludge. Common in some Ju tumors.) The second cause is Internal: *Suwen·Yinyang Bie Lun* says: Disease of the Three Yang channels presents with chills and fever, and lower-body boils. (Three Yang refers to Taiyang. Taiyang governs the exterior, hence chills and fever; its meridian runs down the leg, hence lower-body boils.) *Suwen·Qi Jue Lun* says: Kidney transferring cold to Spleen causes boils and shortness of breath. Spleen transferring cold to Liver causes boils and tendon spasms. (Kidney water cold reversing to Spleen earth is adverse. Adversity causes Qi stagnation in muscles swelling, as Spleen governs muscles. Spleen cold reversing to Liver wood is also adverse. Adversity causes Qi not only to stagnate in muscles but also tendons to spasm and swell, as Liver governs tendons.) *Suwen·Jue Lun* says: Shaoyang Qi reversal causes intestinal abscesses, untreatable. If convulsions occur, death ensues. (Refers to Shaoyang wandering fire. Reversal and knotting create severe toxicity, hence untreatable. Convulsions indicate pathogen entering Zang, specifically Jueyin Pericardium, hence death.) *Lingshu·Maidu Pian* says: Disharmony of the Six Fu organs leads to knotting and boils. (Fu organs are Yang, governing Wei Qi. Wei Qi disharmony knots in muscle-Couli, causing boils.) *Yuban Lun* records Huangdi saying: Diseases arise from unpredictable joy/anger and irregular diet. Yin Qi deficiency and Yang Qi excess, with blocked Ying Qi, lead to boils and carbuncles. Yin-Yang blockage and combing of two heats transform into pus. (Joy/anger damage Qi; diet damages Zang. Unpredictable means sudden onset, causing Qi stagnation and Yang excess. Irregular diet means indulgence, damaging Five Zang and Yin deficiency. Yang excess causes Qi gathering and heat victory; Yin deficiency causes Ying stagnation and heat victory. Two heats comb, blocking Ying-Wei, transforming to pus.) Chen Wuyue also stated: Boils, carbuncles, and scrofula, regardless of deficiency/excess or cold/heat, are all caused by Qi depression, likely from long-term emotional stagnation. Treatment uses Yuanzhi Wine and Dusheng Powder, combined with the theory of Five Emotions overcoming each other (e.g., fear overcomes thought). The third cause is Neither Internal nor External: *Shengqi Tongtian Lun* says: Changes from rich/greasy foods suffice to generate major Ding (carbuncles), accepted as easily as holding an empty vessel. (*Yifang Fangyi Lun* says: Eastern regions produce fish and salt. People eat fish and love salt, settling there. Fish causes internal heat. Salt consumes blood, so people have dark skin and loose texture, prone to sores, treated with Bian stones. Fish is Yin outside, Yang inside, moving constantly like Fire. Long-term consumption causes internal heat, making sores common.) Long-term use of cinnabar/stone medicines and strong wine accumulates heat toxins, causing boils/carbuncles similar to rich food effects. Pulses floating and rapid indicate blood stagnation with Qi following. Pathogen-Qi depression transforms to heat, hence rapid pulse. Surface/Yang location makes pulse float. Zheng Qi battling pathogens weakens exterior defense, causing aversion to cold. Symptoms resemble Taiyang syndrome. However, Shanghan pain varies (head, body, joints), never localized. Localized pain with rapid pulse indicates heat turning to pus at the specific site, characteristic of boils/carbuncles. As *Shanghan Lun·Bian Mai Fa* states: Floating-rapid pulses with fever/chills and localized pain with normal appetite indicate accumulated pus. This is Yang Du. If pulse is not rapid, no fever, no pain, pathogen is in Yin division, unable to push out, likely sinking internally. Accompanied by irritability, vomiting, chest discomfort. Otherwise, no heat/pain/rapid pulse implies no disease, so calling it Yin sore worse than Yang is incorrect. Before ulceration, whether pus forms or not, heat stagnation without external release makes flooding-large pulses appropriate. After ulceration, heat drains, pathogen resolves, so flooding-large pulses should subside. Persistent flooding-large pulse after ulceration indicates unchecked heat, threatening Zheng Qi recovery, akin to *Ping Re Bing Lun*'s Yin-Yang Jiao (fever returning after sweat, rapid pulse unsubsided). Specifics of boils/carbuncles are in dedicated texts, but *Lingshu·Yong Ju* covers origins thoroughly. Huangdi asked: I hear Stomach/Intestines receive grain, Upper Jiao emits Qi to warm muscles/joints/open Couli (Wei Qi source). Middle Jiao emits Qi like dew, pouring into Xigu, penetrating Sun vessels, harmonizing fluids into red blood. Blood harmonizes, filling Sun vessels, then Luo vessels, then Jing vessels. Yin-Yang expand, moving with breath (Ying Qi source). Movement has order, circling matches Heaven, ceaseless. Pulse diagnosis regulates, reducing excess, tonifying deficiency. Discharging reduces excess, quick needle reduces Qi, retaining adjusts timing, tonifying fills deficiency. Once Qi-blood harmonized, form-Qi sustains. I know Qi-blood balance but not boil/carbuncle origins, timing, or prognosis. Please explain. Qibo replied: Meridians flow endlessly, matching Heaven/Earth. Star deviations cause eclipses; river deviations cause floods/barren land/isolation. Qi-blood behaves similarly. Blood-Qi-Ying-Wei flow continuously, mirroring stars/numbers. Cold pathogens in meridians cause blood stagnation. Stagnation blocks Wei Qi return, causing boils. (Wei Qi stays, failing to return to normal flow.) Cold turns to heat; heat rots flesh to pus. Undrained pus rots tendons, damaging bones, consuming marrow. If not draining through bone holes, blood empties, muscles/tendons lose nourishment. Meridian leakage fumes on Five Zang, causing death. Huangdi asked for shapes, forbidden days/names. Qibo said: Boil in throat is Meng Ju (Fierce Ju). Untreated, it pus. Undrained pus blocks throat, death in half a day. Drained pus treated with cold pig fat, cured in three days. Neck boil is Yao Ju. (Extends to armpit/lungs. Highest point, hence Yao.) Large, red-black. Untreated, heat sinks to Yuanye, damages Ren Mai, steams Liver/Lungs, death in ten days. Excessive Yang Qi melting brain/neck is Nao Shuo. (Melting like gold. Brain scorched. Irritability is Kidney toxin transmitting to Heart.) Unhappy expression, neck pain like needle stick, irritability: fatal. Shoulder/armpit boil is Ci Ju. Red-black. Treat urgently to induce sweating to feet, sparing Zang. Treat within 4-5 days. Armpit small red-hard boil is Mi Ju (Rice Ju). Treat with Bian stone (fine/long), puncture lightly, apply pig fat, cure in six days, do not bandage. Hard non-ulcerating armpit/neck lumps are Ma Dao Xia Ying. Treat urgently. Chest deep boil is Jing Ju. Bean-sized. Starts in 3-4 days. Untreated, spreads to abdomen, death in seven days. Anterior chest green boil is Gan Ju. Gourd-seed shaped, chills/fever. Treat urgently to remove chills/fever, death in ten years (post-pus discharge). Rib-side female boil is Bai Ci. Moxibustion. If large pus forms, treat. Contains meat like adzuki bean. Decoct Ge Gen root, drink strong, sit over pot, sweat to feet, cure. Thigh/calf boil is Gu Ting Ju. Minimal change, pus binds bone. Untreated, death in thirty days. Tailbone sharp boil is Rui Ju. Red-hard-large. Urgent treatment. Untreated, death in thirty days. Inner thigh red spread is Chi Shi. (Taiyin/Jueyin pathway. Severe Yin-damaging fire. "Chi Shi" means red fire spreading.) Untreated, death in sixty days. Both inner thighs untreated, death in ten days. Knee boil is Ci Yong. Large, color unchanged, chills/fever, hard stone. Do not pierce; piercing kills. Wait for softness, then pierce for survival. Joint boils with corresponding points above/below are untreatable. Yang channel boils die in 100 days; Yin channel boils die in 30 days. (Joints are spirit pathways. Corresponding outbreaks are fatal.) Calf rabbit-bite boil is Tu Nie. Red to bone. Urgent treatment prevents harm. Inner ankle slow-walk boil is Zou Huan. (Foot poison slows gait.) Boil shape, color unchanged. Pierce acupoints repeatedly to stop chills/fever, survival. Foot upper-lower four-fluency boil is Si Yin. (Poison in extremities, Yang roots failed. Corresponding.) Large boil. Urgent treatment, death in 100 days. Foot-side malignant boil is Li Yong. (Li means evil.) Small, finger-sized start. Urgent treatment. Remove black parts; otherwise increases. Untreated, death in 100 days. Toe shedding boil is Tuo Yong. Red-black, fatal. Not red-black, survivable. If no regression, amputate toe immediately, else death. Huangdi asked how to distinguish boils/carbuncles. Qibo said: Ying-Wei stagnation in meridians causes blood stagnation. Wei Qi follows but cannot pass, knotting causes heat. Unchecked heat rots flesh to pus. But it doesn't sink deeply, marrow doesn't dry, Zang aren't harmed, so it's called Boil. Huangdi asked about Carbuncle. Qibo said: Intense heat sinks into skin, drying tendons/marrow; connects to Zang, exhausting Qi-blood. Under the lesion, bone/tendon/flesh are destroyed, so it's called Carbuncle. Carbuncle skin is pale/hard, like cow neck skin. Boil skin is thin/shiny. These are the signs.