痈发于六腑。为表为阳。为热为实。其发迅暴。如燎原之火。故热痛高肿。侵长广大。皮薄光软以泽。多有
椒眼。或作便闭。发渴发逆以拒之。由正气内固。不能下陷。是以五脏终不伤也。
疽之发于五脏。为里为阴。为冷为虚。其发停蓄。如陶室之火。内消骨髓。故无热、无肿、无痛。形如 。色
淡而坚。甚则如牛领之皮。见七恶逆症者死。(七恶逆症歌见后)阳中之阴者。似热非热。虽肿而虚。赤而不燥。痛而
不脓。浮而复消。外盛而内腐。其人多肥。肉紧而内虚也。阴中之阳者。似冷非冷。不肿而实。赤微而燥。痛
而有脓。外不盛而内烦闷。其人多瘦。肉缓而内实也。
阳症变而为阴者。草医凉剂之过也。阴症变而为阳者。大方热药之骤也。然阳变为阴。为犹可返于阳
也。其症多生。阴变为阳。为不久复归于阴矣。其症多死。阳症有热。则气血行而生肌。阴症无热。则气血
滞而不敛。故云。有热无热为生死之诀。观此。则知痈疽有阴阳表里虚实之分。而无大小之别也。第恐
犹有未悉者。再续阴阳、善恶、生死、顺逆、等歌。内消、内托、虚实等治。使一见了然。庶无舛误。
痈疽不论上中下。惟在阴阳二症推。发背虽有正与偏。要取高低两样看。纯阳初起必 肿。更兼身热
有微寒。顶如尖字高突起。肿似弯弓根有盘。七日之间多 痛。二七之期脓渐漫。动息自宁食知味。二
便调匀无泻干。肿消脓溃精神爽。脱腐生新气血完。五善自然臻并至。七恶全无半点干。痛便随脓减。
肿退自肌宽。新肉已生红艳艳。腐皮自敛白漫漫。一身多爽快。五脏尽和欢。此属纯阳俱易治。百人百
可保全安。
痈发生于六腑。属于表证、阳证。表现为热象和实证。发病迅速猛烈,如同原野上燃烧的大火。因此出现热痛、高肿,病灶蔓延扩大。皮肤薄而光亮柔软润泽,多有类似椒眼的脓头,或者伴有便秘。出现口渴、呃逆等症状以抗拒邪气。这是因为正气在内固守,病邪不能内陷深入。所以五脏最终不会受到损伤。
疽发生于五脏。属于里证、阴证。表现为寒象和虚证。发病缓慢停滞,如同陶窑中的火,向内消耗骨髓。因此没有发热、没有肿胀、没有疼痛。形状像凹陷的坑,颜色淡而坚硬,严重时像牛颈部的皮。出现七恶逆症(严重的危重症状)的会死亡。(七恶逆症歌诀见后文)
阳证中夹杂阴证的,看似有热其实无热,虽然肿胀但本质是虚,颜色红但不干燥,疼痛但不化脓,浮肿后又消退,外表盛大内部却腐烂。这类患者多肥胖,肌肉紧实但内部虚弱。
阴证中夹杂阳证的,看似寒冷其实不冷,不肿胀但本质是实,颜色微红且干燥,疼痛且能化脓,外表不盛大但内部烦闷。这类患者多消瘦,肌肉松弛但内部充实。
阳证转变为阴证的,是由于草医使用寒凉方剂过度的缘故。阴证转变为阳证的,是大剂量使用温热药物突然起效的缘故。然而,阳证变为阴证,还有可能重新转为阳证,这种病症大多能生还。阴证变为阳证,不久又会回归到阴证,这种病症大多死亡。阳证有热,气血运行从而生成新肉;阴证无热,气血停滞而不能收敛愈合。所以说,有无发热是判断生死的关键。观察这一点,就知道痈疽有阴阳、表里、虚实之分,而没有大小之别。只是担心读者仍有不明白的地方,再续写关于阴阳、善恶、生死、顺逆等的歌诀,以及内消、内托、虚实等治疗方法,使人们一见就能明白,从而避免错误。
痈疽不论发生在身体上部、中部还是下部,关键在于推求阴阳二证。发背虽然有正中和偏侧之分,但要分别从高和低两种情况来观察。纯阳证初起必然红肿,同时伴有身体发热和轻微恶寒。疮顶像“尖”字一样高高突起,肿胀像弯弓一样,根部有盘绕扩散。七天之内多有剧烈疼痛,十四天左右脓液逐渐漫溢。此时患者呼吸平稳,饮食知味,大小便调匀,没有腹泻或干结。肿胀消退,脓液溃破,精神清爽,腐肉脱落,新肉生长,气血完备。五善(五种吉兆)自然全部到来,七恶(七种凶兆)完全没有沾染。疼痛随着脓液排出而减轻,肿胀退去后肌肤自然宽松。新长出的肉红艳鲜艳,腐皮自行收敛变白。全身感觉爽快,五脏调和欢悦。这属于纯阳证,都容易治疗,百人之中百人都可以保全性命。
Carbuncles (Yong) occur in the six fu organs. They are exterior and yang, characterized by heat and excess. Their onset is rapid and violent, like a fire spreading across a prairie. Therefore, they present with hot pain and high swelling, invading and expanding widely. The skin is thin, smooth, soft, and lustrous, often having pustules resembling pepper eyes, or accompanied by constipation. Symptoms such as thirst and hiccups arise as the body resists the pathogen. This is because the healthy qi is solidified internally, preventing the pathogen from sinking inward. Thus, the five zang organs are ultimately not injured.
Jie (deep abscesses) occur in the five zang organs. They are interior and yin, characterized by cold and deficiency. Their onset is stagnant and slow, like fire in a pottery kiln, consuming the bone marrow from within. Therefore, there is no heat, no swelling, and no pain. The shape resembles a depression, the color is pale yet firm, and in severe cases, it resembles the skin of an ox's neck. Death occurs if the seven evils (qi e, severe adverse syndromes) appear. (The song for the seven evils is found later.)
Yang containing Yin appears to have heat but does not truly have heat; although swollen, it is deficient; red but not dry; painful but without suppuration; fluctuating and then subsiding; appearing vigorous externally but rotting internally. Patients with this condition are often obese, with tight flesh but internal deficiency.
Yin containing Yang appears to be cold but is not truly cold; not swollen but substantial; slightly red and dry; painful with suppuration; not vigorous externally but internally restless. Patients with this condition are often emaciated, with loose flesh but internal excess.
When a Yang syndrome transforms into a Yin syndrome, it is due to the excessive use of cooling formulas by unskilled practitioners. When a Yin syndrome transforms into a Yang syndrome, it is due to the sudden effect of large doses of warming medicines. However, when Yang transforms into Yin, it can still revert to Yang, and such cases mostly survive. When Yin transforms into Yang, it soon returns to Yin, and such cases mostly die. Yang syndromes have heat, allowing qi and blood to circulate and generate tissue; Yin syndromes lack heat, causing qi and blood to stagnate and fail to heal. Thus, it is said that the presence or absence of heat is the key to life and death. Observing this, one knows that carbuncles and deep abscesses are distinguished by yin/yang, exterior/interior, and excess/deficiency, but not by size. Fearing that some details may still be unclear, I continue with songs on yin/yang, good/bad omens, life/death, and favorable/unfavorable courses, along with treatments for internal resolution, internal support, and excess/deficiency, so that everything becomes clear at a glance, thereby avoiding errors.
Carbuncles and deep abscesses, whether located in the upper, middle, or lower parts of the body, must be deduced through the two syndromes of yin and yang. Back carbuncles (Fa Bei), though occurring in central or lateral positions, must be observed from both high and low perspectives. Pure Yang syndromes initially present with definite swelling, accompanied by fever and slight aversion to cold. The apex rises sharply like the character "Jian" (pointed), and the swelling arches like a bow with a spreading base. Within seven days, there is often intense pain; by fourteen days, pus gradually spreads. At this stage, breathing is calm, appetite is normal, and bowel movements are regular without diarrhea or constipation. As swelling subsides and pus drains, spirit refreshes, necrotic tissue sheds, new tissue grows, and qi and blood are restored. The five goods (wu shan, five auspicious signs) naturally converge, while the seven evils are completely absent. Pain decreases with pus discharge, and swelling recedes with muscle relaxation. New flesh appears bright red, and necrotic skin heals over white. The whole body feels comfortable, and the five zang organs are harmonious. These pure Yang cases are all easy to treat, and virtually all patients can be saved.