诸浮数脉，应当发热，而反洒浙恶寒，若有痛处，当发其痈。
【注】诸浮数脉，谓寸、关、尺六脉俱浮数也。浮脉主表，数脉主热，若是表邪，则
当发热而洒淅恶寒也。今非表邪，应当发热，不当恶寒，若有痛处，乃当发痈之诊，非表
邪之诊也。
【集注】周扬俊曰∶病之将发，脉必兆之。夫浮数阳也，热也，浮数兼见，为阳中之阳，
是其热必尽显于外矣。而反洒淅恶寒，证不相应，何哉？必其气血凝滞，营卫不和，如
经所谓营气不从，逆于肉理，乃生痈肿。阳气有余，营气不行，乃发为痈是也，况其身
已有痛处乎。夫脉之见者阳也。其将发而痛者亦属阳，故曰∶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。
【注】诸痈肿者，谓诸阴阳痈肿也。不论阴阳，凡诸痈肿，欲知有脓无脓，当以手掩
之肿上，热则能腐化成脓，故热者为有脓，不热者为无脓也。
【集注】周扬俊曰∶师之所以教人，知痈已成欲其溃，未成托之起也。
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。
【注】痈生于内，则气血为痈所夺，不能外营肌肤，故枯皱如甲错也。腹皮急似肿胀，
但按之软，询之腹无积聚，审之身无表热，诊之脉数，非有外证也。此为肠内有痈脓也，主
之薏苡附子败酱散，流通肠胃消痈肿也。
薏苡附子败酱散方，
薏苡仁（十分） 附子（二分） 败酱（一名苦菜，五分）
上三味，杵为末，取方寸匕，以水二升，煎减半，顿服，小盒饭下。
【集解】徐彬曰∶薏苡寒能除热，兼下气胜湿，利肠胃，破毒肿；败酱善排脓破血利，
结热毒瓦斯，故以为臣；附子导热行结，故为反佐。
肠痈者，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，当有血；脉洪数者，脓已成，不可下也，大黄牡丹汤主之。
【注】此承上条，详发其证，以明其治也。肠痈者，其证则少腹肿硬，按之即痛，可知
痈在内也；尿时如淋，尿色自调，可知肿碍之也。时时发热，汗出恶寒，似有表病，而
实非表病也。其脉迟紧，则阴盛血未化，其脓未成，可下之，大盒饭有血也。若其脉洪
数，则阳盛血已腐，其脓已成，不可下也。下之以大黄牡丹汤，消瘀泻热也。
大黄牡丹汤方
大黄（四两） 牡丹（一两） 桃仁（五十个） 芒硝（三合） 瓜子（半升）
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。
【集解】李 曰∶大黄、芒硝泄热，桃仁行瘀，丹皮逐血痹，去血分中伏火，瓜子主
溃脓血。
问曰∶寸口脉微而涩，法当亡血，若汗出，设不汗者云何？答曰∶若身有疮，被刀
斧所伤，亡血故也。
【注】脉微气夺也，脉涩血夺也，故曰∶法当亡血汗出也。设无亡血汗出等病，则必
身有疮被刀斧所伤，亡血故也。
【集注】李 曰∶汗出亡阳，则脉微；亡血伤阴，则脉涩。微与涩皆阴脉也，设不汗
而疮疡金疮，虽不亡阳而亡血，故亦见微涩之脉也，总是营卫虚衰之故。
病金疮，王不留行散主之。
【注】此承上条以明其治也。金疮，谓刀斧所伤之疮也。亡血过多，经络血虚，风寒
易得干之，故用王不留行散，一以止血出，一以防外邪也。小疮粉之，即外敷也。
王不留行散方
王不留行（八月八日采，十分） 蒴 细叶（七月七日采，十分） 桑东南根（白皮，三月
三日采，十分） 甘草（十八分） 川椒（除目及闭口、去汗，三分） 黄芩（二分） 干姜（
二分） 芍药（二分） 浓朴（二分）
上九味，桑根皮以上三味，烧灰存性，勿令灰过，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，桑东根勿取之，前三物皆阴干百日。
【集解】徐彬曰∶此乃概治金疮方也。盖王不留行，性苦平，能通利血脉，故反能止
金疮血、逐痛；蒴 亦通利气血，尤善开痹；周身肌肉肺主之，桑根白皮最利肺气，东南
根向阳，生气尤全，以复肌肉之主气，故以此三物，甚多为君。甘草解毒和荣，尤多为
臣，椒、姜以养其胸中之阳，浓朴以疏其内结之气，芩、芍以清其阴分之热为佐。若有
风寒，此属经络客邪，桑皮止利肺气，不能逐外邪，故勿取。
浸淫疮，从口流向四肢者可治，从四肢流来入口者，不可治。
【注】浸淫疮者，浸谓浸浸，淫谓不已，谓此疮浸淫留连不已也。从口流向四肢者轻，
以从内走外也，故曰可治；从四肢流走入口者重，以从外走内也，故曰不可治，浸淫者，
犹今之癞疠之类。
浸淫疮，黄连粉主之。
【按】此承上条以明其治，黄连粉方脱简。
【集解】尤怡曰∶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。
【原文】
凡是浮数脉，通常应当出现发热症状，反而却感到怕冷战栗，如果身体某处有疼痛感，说明将要发生痈肿。
【注释】所谓的浮数脉，是指寸、关、尺三部六脉都呈现浮数之象。浮脉主表证，数脉主热证，如果是外感表邪，就应当发热并伴有怕冷战栗的症状。现在并非表邪致病，按理应当发热而不应当恶寒，如果有疼痛的部位，这是即将发生痈肿的诊断依据，而非表邪致病的诊断。
【集注】周扬俊说：疾病即将发作时，脉象必定会有先兆。浮数和数脉都属于阳脉，代表热证，浮数脉同时出现，是阳中之阳，其热势必然完全显露于体表。然而反而出现怕冷战栗的症状，证候与脉象不相符合，为什么呢？一定是气血凝滞，营卫不和，正如《内经》所说：“营气运行不畅，逆乱于肌肉纹理之间，就会生成痈肿。”阳气有余，营气运行受阻，就会发为痈肿，况且患者身上已经有疼痛之处了。脉象显现的是阳热之气，即将发作且伴有疼痛的也属于阳证，所以说：“将要发生痈肿。”
老师说：对于各种痈肿，想要知道是否有脓液，可以用手按压在肿胀部位，感觉发热的就是有脓，不发热就是没有脓。
【注释】所谓的各种痈肿，是指阴阳各类痈肿。不论属于阴证还是阳证，凡是有痈肿，想要知道是否有脓，应当用手按压在肿胀处，如果发热说明能腐化成脓，所以发热的是有脓，不发热的是无脓。
【集注】周扬俊说：老师教导人们判断痈肿是否已成脓，是为了让已经成脓的可以溃破排脓，尚未成脓的可以托毒外出。
肠痈这种病，患者皮肤干枯如鳞甲交错，腹部皮肤紧绷，按压时感觉柔软像是有肿胀，但腹部没有积块，身体没有发热，脉象数，这是肠内有痈脓的表现，用薏苡附子败酱散主治。
【注释】痈生于体内，气血被痈邪所夺，不能外达滋养肌肤，所以皮肤枯皱如鳞甲交错。腹部皮肤紧绷看似肿胀，但按压时柔软，询问得知腹部没有积块，仔细检查发现身体没有表热，诊察脉象数，这说明没有外在的表证。这是肠内有痈脓，主治方剂为薏苡附子败酱散，旨在疏通肠胃、消除痈肿。
薏苡附子败酱散方：
薏苡仁（十分） 附子（二分） 败酱（一名苦菜，五分）
以上三味药，捣碎研成末，取一方寸匕的药量，用水二升，煎至减半，一次性服用，小便应当通畅排出。
【集解】徐彬说：薏苡仁性寒能除热，兼能下气胜湿，利肠胃，破除毒肿；败酱善于排脓破血，利结热毒气，所以作为臣药；附子引导热邪运行以解散结滞，所以作为反佐药。
肠痈的病证，表现为小腹肿胀痞硬，按压即痛，排尿时有淋沥感但小便自调，时常发热，自汗出，又伴有恶寒。如果脉象迟紧，说明脓未形成，可以用攻下法治疗，应当排出瘀血；如果脉象洪数，说明脓已形成，不可用攻下法，用大黄牡丹汤主治。
【注释】此条承接上一条，详细阐述其证候，以明确治疗方法。肠痈的病证是小腹肿胀坚硬，按压即痛，可知痈肿在体内；排尿时感觉像淋病，但尿色正常，可知是肿胀阻碍所致。时常发热，汗出恶寒，看似有表证，但实际上不是表证。如果脉象迟紧，说明阴盛血未化脓，脓未形成，可以用攻下法，应当会排出瘀血。如果脉象洪数，说明阳盛血已腐败，脓已形成，不可用攻下法。用大黄牡丹汤攻下，以消除瘀血、泻除热毒。
大黄牡丹汤方：
大黄（四两） 牡丹皮（一两） 桃仁（五十个） 芒硝（三合） 瓜子（半升）
以上五味药，用水六升，煮取一升药液，去渣，加入芒硝再煮沸，一次性服用。有脓则排出脓液，如无脓则排出瘀血。
【集解】李中梓说：大黄、芒硝泄热，桃仁行瘀，丹皮逐除血痹，清除血分中的伏火，瓜子主要促使脓血溃破排出。
问：寸口脉微而涩，按常理应当是失血或汗出过多，如果不汗出是怎么回事？答：如果身上有疮疡，被刀斧等利器所伤，是因为失血导致的。
【注释】脉微是气虚被夺，脉涩是血虚被夺，所以说：按常理应当是失血或汗出。如果没有失血汗出等疾病，那么一定是身上有疮疡被刀斧所伤，导致失血的原因。
【集注】李中梓说：汗出导致亡阳，则脉微；失血损伤阴液，则脉涩。微脉和涩脉都是阴脉，假设不出汗而是疮疡金创，虽然不会亡阳但会亡血，所以也会出现微涩的脉象，这总是因为营卫虚衰的缘故。
【注释】此条承接上一条以明确治疗方法。金疮，是指被刀斧等利器所伤的创伤。失血过多，经络血液亏虚，风寒容易侵袭，所以用王不留行散，一方面止血，一方面防止外邪入侵。小伤口可以撒药粉，即外敷；大伤口仅内服即可。
王不留行散方：
王不留行（八月八日采集，十分） 蒴藋细叶（七月七日采集，十分） 桑树东南方向的根白皮（三月三日采集，十分） 甘草（十八分） 川椒（去除椒目及闭口者，去汗，三分） 黄芩（二分） 干姜（二分） 芍药（二分） 浓朴（二分）
以上九味药，将桑根皮及前三味药烧成灰存性，不要烧成纯灰，分别捣碎过筛，混合制成散剂，每次服用一方寸匕。小伤口直接撒粉外敷，大伤口只内服，产后妇女也可以服用。如果有风寒邪气，不要用桑树东南根的白皮，前三味药都要阴干一百天。
【集解】徐彬说：这是概治金疮的方子。王不留行性味苦平，能通利血脉，所以反而能止金疮出血、驱除疼痛；蒴藋也能通利气血，尤其善于开通痹阻；周身肌肉由肺所主，桑根白皮最利于肺气，东南方向的根向阳，生气尤为完备，用来恢复肌肉的主气，所以这三味药用量最大作为君药。甘草解毒调和营血，用量也多作为臣药，花椒、生姜以温养胸中之阳，浓朴以疏解内部郁结之气，黄芩、芍药以清阴分之热作为佐药。如果有风寒，这属于经络客邪，桑皮只能利肺气，不能驱逐外邪，所以不用。
浸淫疮，从口部流向四肢的可以治疗，从四肢流入口部的，不可以治疗。
【注释】浸淫疮，“浸”指浸润，“淫”指不止，意思是这种疮疡浸润蔓延、连绵不断。从口部流向四肢的病情较轻，因为是从内脏走向体表，所以说可治；从四肢流走进入口部的病情较重，因为是从体表走向内脏，所以说不可治。浸淫疮，类似于现在的癞疠之类疾病。
【按语】此条承接上一条以明确治疗方法，黄连粉方已脱简遗失。
[Original Text]
When the pulse is floating and rapid, fever should typically manifest. However, if there is instead a sensation of chills and shivering (sazhe), and there is a painful area, an abscess (yong) is likely to develop.
[Annotation] "Floating and rapid pulse" refers to the pulse at the Cun, Guan, and Chi positions on both wrists being simultaneously floating and rapid. A floating pulse indicates exterior syndrome, while a rapid pulse indicates heat. If this were an exterior pathogenic factor, one would expect fever accompanied by chills and shivering. Since it is not an exterior pathogen, fever should occur without chills. The presence of a specific painful area indicates a diagnosis of impending abscess formation, rather than an exterior pathogenic condition.
[Collected Notes] Zhou Yangjun stated: Before a disease manifests, the pulse will show signs. Floating and rapid pulses are yang and indicate heat. Their simultaneous appearance represents "yang within yang," suggesting that the heat will fully manifest externally. Yet, the patient experiences chills and shivering, which contradicts the pulse. Why? This is due to qi and blood stagnation and disharmony between Ying (Nutritive) and Wei (Defensive) qi. As the Classics state: "If Ying qi does not flow smoothly and reverses in the muscle tissue, abscesses and swellings arise." When yang qi is excessive and Ying qi cannot circulate, an abscess develops. Furthermore, the patient already has a painful area. The manifestation of the pulse reflects yang; the impending pain also belongs to yang. Therefore, it is said: "An abscess will develop."
The Master said: Regarding various abscesses and swellings, to determine whether pus has formed, press your hand over the swollen area. If it feels hot, pus is present; if not hot, pus is absent.
[Annotation] "Various abscesses and swellings" refers to both yin and yang types. Regardless of yin or yang classification, to determine the presence of pus in any abscess, press the hand over the swelling. Heat indicates the tissue is rotting and transforming into pus; thus, heat signifies pus, while lack of heat signifies no pus.
[Collected Notes] Zhou Yangjun stated: The Master's teaching aims to help practitioners determine if an abscess is ready to rupture or needs support to bring it to the surface.
Intestinal abscess presents with dry, scaly skin resembling fish scales (jiacuo), tight abdominal skin, and softness upon palpation despite the appearance of swelling. There are no accumulations in the abdomen, no body fever, but a rapid pulse. This indicates pus within the intestines, treated with Yiyi Fuzi Baijiang San.
[Annotation] When an abscess forms internally, qi and blood are consumed by the pathogen and cannot nourish the skin externally, resulting in dry, scaly skin like armor plates. The abdominal skin appears tight and swollen, but is soft to touch. Inquiry reveals no abdominal masses, examination shows no exterior heat, and the pulse is rapid. These findings exclude exterior symptoms and confirm intestinal abscess with pus. The treatment is Yiyi Fuzi Baijiang San, which promotes intestinal circulation and resolves abscesses.
Formula for Yiyi Fuzi Baijiang San:
Yiyiren (Coix Seed) - 10 parts
Fuzi (Prepared Aconite Root) - 2 parts
Baijiangcao (Patrinia Herb) - 5 parts (also known as Kucail)
Grind these three herbs into powder. Take one fangcun bi (a square-inch measure) of the powder, add two sheng of water, boil until reduced by half, and take orally in one dose. Urination should be clear and smooth afterward.
[Collected Explanations] Xu Bin stated: Yiyiren is cold and clears heat, descends qi, overcomes dampness, benefits the intestines and stomach, and breaks toxic swellings. Baijiangcao effectively drains pus, breaks blood stasis, and clears heat-toxic qi, serving as the Deputy Minister herb. Fuzi guides heat to resolve stagnation, acting as an antagonistic assistant (fan zuo).
Intestinal abscess presents with swelling and hardness in the lower abdomen, pain upon pressure, a sensation similar to strangury (lin) during urination, but normal urine output. There is intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not yet formed; purgation may be used, and bloody stool is expected. If the pulse is surging and rapid, pus has formed; purgation is contraindicated. Treat with Dahuang Mudan Tang.
[Annotation] This clause elaborates on the previous one to clarify symptoms and treatment. Intestinal abscess involves lower abdominal swelling and hardness with pain on pressure, indicating internal pathology. The sensation resembles strangury, but urine color is normal, indicating obstruction by swelling. Intermittent fever, sweating, and chills mimic exterior syndrome but are not exterior. A slow and tight pulse indicates yin excess and unformed pus; purgation can be used, likely expelling blood. A surging and rapid pulse indicates yang excess and putrefied blood (formed pus); purgation is contraindicated. Dahuang Mudan Tang is used to purge, eliminate blood stasis, and clear heat.
Formula for Dahuang Mudan Tang:
Dahuang (Rhubarb Root and Rhizome) - 4 liang
Mudanpi (Tree Peony Bark) - 1 liang
Taoren (Peach Kernel) - 50 pieces
Mangxiao (Mirabilite) - 3 he
Gua Zi (Melon Seeds) - 0.5 sheng
Boil the first five ingredients in six sheng of water until one sheng remains. Strain, add Mangxiao, boil again until boiling, and take orally in one dose. Pus will be discharged if present; otherwise, blood stasis will be expelled.
[Collected Explanations] Li Zhongzi stated: Dahuang and Mangxiao purge heat; Taoren moves blood stasis; Mudanpi removes blood stasis and clears latent fire in the blood level; Gua Zi facilitates the discharge of pus and blood.
Question: If the Cun Kou pulse is faint and choppy, according to standard theory, this indicates blood loss or excessive sweating. What if there is no sweating?
Answer: If the patient has wounds caused by knives or axes, the faint and choppy pulse is due to blood loss.
[Annotation] A faint pulse indicates qi depletion; a choppy pulse indicates blood depletion. Thus, standard theory suggests blood loss or sweating. If neither occurred, the cause must be trauma from sharp instruments leading to blood loss.
[Collected Notes] Li Zhongzi stated: Sweating leads to collapse of yang, causing a faint pulse; blood loss damages yin, causing a choppy pulse. Both are yin pulses. In cases of traumatic wounds without sweating, although yang is not collapsed, blood is lost, resulting in a faint and choppy pulse. This is always due to deficiency and decline of Ying and Wei qi.
For traumatic wounds (Jinchuang) caused by metal weapons, Wangbuliu Xing San is indicated.
[Annotation] This follows the previous clause to specify treatment. Jinchuang refers to wounds from knives or axes. Excessive blood loss leads to deficiency in meridians and vessels, making the body susceptible to wind-cold invasion. Wangbuliu Xing San stops bleeding and prevents external pathogens. For minor wounds, apply the powder externally; for major wounds, administer orally. It can also be used postpartum.
Formula for Wangbuliu Xing San:
Wangbuliu Xing (Vaccaria Seed) - 10 parts (harvested on the 8th day of the 8th lunar month)
Shuodai Xiye (Leaves of Tripterospermum) - 10 parts (harvested on the 7th day of the 7th lunar month)
Sanggen Dongnan Pi (White bark of the southeast root of Mulberry) - 10 parts (harvested on the 3rd day of the 3rd lunar month)
Gancao (Licorice Root) - 18 parts
Chuanjiao (Sichuan Pepper) - 3 parts (remove seeds and closed pods, remove sweat/moisture)
Huangqin (Scutellaria Root) - 2 parts
Ganjiang (Dried Ginger) - 2 parts
Shaoyao (Peony Root) - 2 parts
Houpo (Magnolia Bark) - 2 parts
Take the first three ingredients (Mulberry bark and the two leaves mentioned above), burn them to ash while retaining their properties (do not burn completely to white ash). Grind each separately and sieve. Mix thoroughly to make a powder. Take one fangcun bi per dose. Apply powder externally for minor wounds; take orally for major wounds. Safe for postpartum use. If wind-cold is present, do not use the southeast mulberry root. The first three ingredients should be dried in the shade for 100 days.
[Collected Explanations] Xu Bin stated: This is a general formula for traumatic wounds. Wangbuliu Xing is bitter and neutral, promoting blood circulation; paradoxically, it stops bleeding and relieves pain in trauma. Shuodai also promotes qi and blood circulation and opens blockages. The muscles are governed by the Lung. Mulberry bark benefits Lung qi. The southeast root faces the sun, possessing abundant vital energy to restore the Qi governing muscles. Hence, these three are used in large quantities as Sovereign herbs. Gancao detoxifies and harmonizes Ying, used in larger amounts as Deputy Minister. Chuanjiao and Ganjiang warm and nourish the Yang in the chest. Houpo disperses internal stagnation. Huangqin and Shaoyao clear heat in the Yin level as Assistant herbs. If wind-cold is present, it is an external pathogen in the meridians. Mulberry bark only benefits Lung qi and cannot expel external pathogens, so it is omitted.
Jinyin Chuang (oozing dermatitis) flowing from the mouth to the limbs is treatable; flowing from the limbs to the mouth is untreatable.
[Annotation] "Jinyin" means oozing and spreading incessantly. Flowing from the mouth (internal center) to the limbs (exterior) is mild because the pathogen moves outward; hence, it is treatable. Flowing from the limbs to the mouth is severe because the pathogen moves inward; hence, it is untreatable. Jinyin Chuang resembles modern leprosy or similar chronic skin diseases.
Jinyin Chuang is treated with Huanglian Fen (Coptis Powder).
[Note] This clause follows the previous one to specify treatment. The formula for Huanglian Fen is missing in the text.
[Collected Explanations] You Yi stated: Although the formula is missing, the intent is clear. This is a disease of damp-heat oozing. Therefore, Coptis (Huanglian) alone is ground into powder and applied topically. Its bitterness dries dampness, and its cold nature clears heat.