浮数之脉应发热,其不发热而反恶寒者,若有痛处,痈疽之证也。
洪大之脉,其主血实、积热、疮肿。凡洪大者,痈疽之病进也,脓未成者宜下之,脓溃
之后,脉见洪大则难治,若兼自利,尤为凶矣。
数脉主热,浮而数者为表热,沉而数者为里热,诸紧数之脉应发热,而反恶寒者痈疽也
。仲景曰∶数脉不时见,则生恶疮也。又曰∶肺脉数者,生疮也。凡诸疮脉至洪数,其内必
有脓也。
实脉主邪盛,邪气盛则实也。疮疽得此可下之。若久病虚人则最忌之,以正不胜邪也。
滑脉多阳,或为热,或为虚。疮疽得此,脓未成者可内消,脓已溃者宜托里,所谓始为
热,终为虚也。
散脉为血虚,有表无里也。凡疮毒脓溃之后,脉见洪滑粗散而烦痛不除者难治,以其正
气虚、邪气实也。又曰∶肢体沉得肺脉大则毙,谓其浮散而无根也。
长脉主阳气充实,伤寒得之,将欲汗解也。长而缓者胃脉也,百病得之皆愈。故曰∶长
则气治也。
芤脉主阴虚血虚,脓溃后得之为宜,以脉病相应也。
弦脉主肝邪,《疮疽论》曰∶弦洪相搏,内寒外热,欲发疮疽也。
肾脉主切痛积癖,凡疮疽得此,则气血留滞,邪结不散,多为痛也。
短脉主虚,《经》曰∶短则气病,以其乏胃气也。疮疡脉短,真气虚也。诸病见之皆为
难治,尤不可攻也。
涩脉主血虚气涩。疮疡溃后,得之无妨。
沉脉为阴,疮疡得之,邪气深也。
迟脉主阳气不足,疮疡得之,溃后自愈。
缓脉无邪,长而缓者,百病皆宜。疮疡得此则易愈,以其有胃气也。
弱脉主气血俱虚,形精不足,大抵疮家之脉,凡沉、迟、濡、弱者皆宜托里。
微脉主虚,真气复则生,邪气胜则死,疮疡溃后、微而和者,将愈也。
细脉主阳衰,疮肿脉细而沉者,里虚而欲变证也。
虚脉空而无力,脉虚则血虚,血虚生寒,阳气不足也,疮疡得之,只宜托里、补血、养
气也。
软脉少神,元气弱也。凡疮疡之脉,但见虚迟软弱者,悉宜补虚、排脓、托里。
牢脉坚强,阴之亏也。凡瘰 结核之类,诊得牢脉者,皆不可内消也。
结、促之脉,凡阴衰则促,阳衰则结。大抵结促之脉,由气血俱虚而断续者居多。疮疡
得之,多宜托里。然有素禀结、促者,又当以有力无力辨其虚实,实者可下,虚者不可不补
上痈疽脉二十二种,大都微、弱、虚、细、迟、缓、知、涩者,必气血皆虚,形精不足
,俱当用补用托,不可妄攻,无待言也。即如浮、滑、弦、洪、结、促等脉,此中最有疑似
,亦不得以全实论治。必须详审形症,或攻或补,庶无误也。
齐氏曰∶疮疡之证,若不论候,何以知阴阳勇怯,血气聚散。又曰∶脉洪大而数者,实
也。细微而数者,虚也。河间曰∶脉沉实者,其邪在脏。浮大者,其邪在表。立斋曰∶痈疽
未溃而脉先弱者,何以收敛。
部分毒见于背、见于脑,中属督脉,旁属足太阳经。见于鬓,属手足少阳经。见于眉,
属手足太少阳经。见于颐、见于髭,属手足阳明经。见于腮颔,属手阳明经。见于颧,属手
太阳经。见于穿裆,属督、冲、任三经。见于腿,外跗属足三阳,内跗属足三阴。见于臂,
从手背赤肉属手三阳,从手心白肉属手三阴。见于乳,内属阳明,外属少阳。
头属厥阴。逐部推求,治疗自验。诸经惟少阳、厥阴之疡,理宜预防。以其气多血少也
。其血本少,肌肉难长,少阳更有相火,递用驱毒之剂,祸不旋踵。诀曰∶多血多气君须记
,手经大肠足经胃。多气少血有六经,三焦胆肾心脾肺。多血少气心包络,膀胱小肠肝无异
。记此,则知气血多少之异矣。
五指经脉所属∶大指属肺,食指属大肠,中指属心包,无名指属三焦,小指内侧属心,
外侧属小肠。
浮数脉象应当表现为发热,如果不发热反而恶寒,若有疼痛部位,则是痈疽的证候。
洪大脉象,主要主血实、积热、疮肿。凡是洪大脉,表示痈疽病情进展,脓液未成时适宜用下法攻逐;脓液溃破之后,若脉见洪大则难以治疗,如果兼有自发性腹泻,尤为凶险。
数脉主热,浮而数的为表热,沉而数的为里热,各种紧数脉象应当发热,而反恶寒的是痈疽。张仲景说:数脉不时出现,就会生恶疮。又说:肺脉数,会生疮。凡是各种疮脉至洪数,内部必然有脓。
实脉主邪气盛,邪气盛就是实证。疮疽见到实脉可以攻下。如果是久病体虚的人则最忌讳此脉,因为正气不能胜邪气。
滑脉多属阳,或为热,或为虚。疮疽见到滑脉,脓未成时可以内消,脓已溃破则宜托里,所谓开始为热,最终为虚。
散脉主血虚,有表无里(指脉浮散无根)。凡是疮毒脓溃之后,脉见洪滑粗散且烦痛不除的难治,因为其正气虚、邪气实。又说:肢体沉取得肺脉大则死,是指其脉浮散而无根。
长脉主阳气充实,伤寒病见到长脉,将要汗出而解。长而缓的是胃脉,百病见到都痊愈。所以说:长则气治。
弦脉主肝邪,《疮疽论》说:弦洪相搏,内寒外热,将要发疮疽。
肾脉主切痛积癖,凡是疮疽见到此脉,则气血留滞,邪结不散,多为疼痛。
短脉主虚,《内经》说:短则气病,因为缺乏胃气。疮疡脉短,是真气虚。诸病见到都为难治,尤其不可攻下。
缓脉无邪,长而缓的,百病皆宜。疮疡见到缓脉则易愈,因为有胃气。
弱脉主气血俱虚,形精不足,大抵疮家的脉象,凡沉、迟、濡、弱的都适宜托里。
微脉主虚,真气恢复则生,邪气胜则死,疮疡溃后,微而和缓的,将要痊愈。
虚脉空而无力,脉虚则血虚,血虚生寒,阳气不足,疮疡见到虚脉,只宜托里、补血、养气。
软脉少神,元气弱。凡是疮疡之脉,但见虚迟软弱者,全宜补虚、排脓、托里。
牢脉坚强,是阴之亏。凡是瘰疬结核之类,诊得牢脉的,都不可内消。
结、促脉,凡是阴衰则促,阳衰则结。大抵结促脉,由气血俱虚而断续者居多。疮疡见到,多宜托里。然而有素禀结、促脉的,又当以有力无力辨别虚实,实者可下,虚者不可不补。
上痈疽脉二十二种,大都微、弱、虚、细、迟、缓、知、涩的,必气血皆虚,形精不足,俱当用补用托,不可妄攻,无需多言。即如浮、滑、弦、洪、结、促等脉,这其中最有疑似,也不得以全实论治。必须详审形症,或攻或补,才无误。
齐氏说:疮疡之证,若不论脉候,怎么知道阴阳勇怯,血气聚散。又说:脉洪大而数的,是实证。细微而数的,是虚证。河间说:脉沉实的,邪在脏。浮大的,邪在表。立斋说:痈疽未溃而脉先弱的,何以收敛。
部分毒见于背、见于脑,中属督脉,旁属足太阳经。见于鬓,属手足少阳经。见于眉,属手足太少阳经。见于颐、见于髭,属手足阳明经。见于腮颔,属手阳明经。见于颧,属手太阳经。见于穿裆,属督、冲、任三经。见于腿,外跗属足三阳,内跗属足三阴。见于臂,从手背赤肉属手三阳,从手心白肉属手三阴。见于乳,内属阳明,外属少阳。
头属厥阴。逐部推求,治疗自验。诸经惟少阳、厥阴之疡,理宜预防。因为其气多血少。其血本少,肌肉难长,少阳更有相火,递用驱毒之剂,祸不旋踵。诀曰:多血多气君须记,手经大肠足经胃。多气少血有六经,三焦胆肾心脾肺。多血少气心包络,膀胱小肠肝无异。记此,则知气血多少之异矣。
A floating and rapid pulse should correspond to fever; if there is no fever but rather aversion to cold, with a painful area, it indicates the syndrome of carbuncle and furuncle (Yongju).
A surging and large pulse primarily indicates blood excess, accumulated heat, and swelling sores. Whenever the pulse is surging and large, it signifies the progression of carbuncle and furuncle disease. If pus has not yet formed, purgation is appropriate; if pus has already ruptured and the pulse remains surging and large, treatment is difficult. If accompanied by spontaneous diarrhea, the prognosis is particularly ominous.
The rapid pulse indicates heat. A floating and rapid pulse indicates exterior heat, while a deep and rapid pulse indicates interior heat. Various tight and rapid pulses should correspond to fever, but if aversion to cold occurs instead, it indicates carbuncle and furuncle. Zhang Zhongjing stated: "If a rapid pulse appears intermittently, malignant sores will arise." He also said: "A rapid lung pulse indicates the development of sores." Generally, when the pulse of any sore becomes surging and rapid, pus must be present internally.
The full pulse indicates an abundance of pathogenic factors; abundance of qi and pathogens constitutes excess. Carbuncles and furuncles presenting with a full pulse can be treated with purgation. However, for patients with chronic illness and deficiency, this pulse is most contraindicated because healthy qi cannot overcome the pathogen.
The slippery pulse is predominantly yang, indicating either heat or deficiency. In cases of carbuncles and furuncles, if pus has not formed, internal resolution is suitable; if pus has ruptured, supporting the interior is appropriate. This reflects the principle that the condition begins as heat and ends as deficiency.
The scattered pulse indicates blood deficiency and lack of root (superficial presence without depth). After the rupture of toxic sores and pus discharge, if the pulse is surging, slippery, coarse, and scattered, accompanied by persistent restlessness and pain, treatment is difficult due to deficiency of healthy qi and excess of pathogens. It is also stated: "If the lung pulse is large upon deep palpation of the limbs, death ensues," referring to the pulse being superficially scattered without root.
The long pulse indicates substantial yang qi. In cold damage diseases, encountering a long pulse suggests impending resolution through sweating. A long and moderate pulse is the stomach pulse; encountering it in various diseases indicates recovery. Thus, it is said: "Long indicates regulated qi."
The knotted (hollow) pulse indicates yin and blood deficiency. It is favorable after pus rupture, as the pulse corresponds to the disease state.
The wiry pulse indicates liver pathogenic factors. The *Treatise on Carbuncles and Furuncles* states: "When wiry and surging pulses interact, there is interior cold and exterior heat, indicating the impending onset of carbuncles and furuncles."
The kidney pulse indicates cutting pain and accumulations. When carbuncles and furuncles present with this pulse, qi and blood stagnate, pathogens knot and do not disperse, resulting in significant pain.
The short pulse indicates deficiency. The *Classic* states: "Short indicates qi pathology," due to a lack of stomach qi. A short pulse in sores indicates deficiency of true qi. Encountering this in various diseases makes them difficult to treat, especially contraindicating aggressive purgation.
The choppy pulse indicates blood deficiency and qi stagnation. After the rupture of sores, encountering this pulse is acceptable.
The deep pulse is yin. In sores, a deep pulse indicates that pathogens are deep-seated.
The slow pulse indicates insufficient yang qi. In sores, encountering a slow pulse suggests self-healing after rupture.
The moderate pulse indicates absence of pathogens. Long and moderate pulses are suitable for all diseases. In sores, a moderate pulse indicates easy recovery due to the presence of stomach qi.
The weak pulse indicates simultaneous deficiency of qi and blood, and insufficiency of form and essence. Generally, for patients with sores, deep, slow, soggy, and weak pulses all indicate the need to support the interior.
The minute pulse indicates deficiency. Recovery of true qi leads to survival; dominance of pathogens leads to death. After the rupture of sores, a minute and harmonious pulse indicates impending recovery.
The fine pulse indicates decline of yang. In swellings and sores, a fine and deep pulse indicates interior deficiency and potential transformation of the syndrome.
The empty pulse is hollow and forceless. An empty pulse indicates blood deficiency; blood deficiency generates cold, leading to insufficient yang qi. In sores, only supporting the interior, nourishing blood, and tonifying qi are appropriate.
The soft pulse lacks spirit and indicates weak primordial qi. For pulses in sores, whenever deficiency, slowness, softness, and weakness are observed, tonifying deficiency, draining pus, and supporting the interior are all indicated.
The firm pulse is hard and strong, indicating deficiency of yin. In conditions such as scrofula and nodules, encountering a firm pulse contraindicates internal resolution.
The knotted and intermittent pulses: deficiency of yin leads to intermittent pulses, while deficiency of yang leads to knotted pulses. Generally, these pulses result from simultaneous deficiency of qi and blood causing irregularity. In sores, supporting the interior is mostly indicated. However, for individuals constitutionally possessing knotted or intermittent pulses, strength and forcefulness must be assessed to distinguish excess from deficiency; excess can be purged, while deficiency requires supplementation.
Regarding the twenty-two types of pulses in carbuncles and furuncles, those that are minute, weak, empty, fine, slow, moderate, known, or choppy necessarily indicate deficiency of both qi and blood, and insufficiency of form and essence. Tonification and support are mandatory; reckless aggression is forbidden, which needs no further elaboration. Even for floating, slippery, wiry, surging, knotted, and intermittent pulses, which are often ambiguous, one must not treat them solely as excess. One must carefully examine symptoms and signs, choosing between aggression and tonification accordingly to avoid error.
Qi stated: "In sores and ulcers, without examining the pulse, how can one discern the courage or timidity of yin and yang, and the gathering or dispersal of blood and qi?" He further stated: "A surging, large, and rapid pulse indicates excess; a fine, small, and rapid pulse indicates deficiency." He Jian stated: "A deep and full pulse indicates the pathogen is in the zang organs; a floating and large pulse indicates the pathogen is in the exterior." Li Zhai stated: "If the pulse is weak before the rupture of carbuncles and furuncles, how can healing occur?"
Toxins appearing on the back or head belong centrally to the Du vessel and laterally to the Foot-Taiyang channel. Those appearing on the temples belong to the Hand and Foot-Shaoyang channels. Those appearing on the eyebrows belong to the Hand and Foot-Taiyin and Shaoyang channels. Those appearing on the chin or beard belong to the Hand and Foot-Yangming channels. Those appearing on the cheeks and jaw belong to the Hand-Yangming channel. Those appearing on the cheekbones belong to the Hand-Taiyang channel. Those appearing in the perineum belong to the Du, Chong, and Ren vessels. Those appearing on the legs: the outer ankle belongs to the Foot-Yangming channels, and the inner ankle belongs to the Foot-Yin channels. Those appearing on the arms: the dorsal aspect (red flesh) belongs to the Hand-Yang channels, and the palmar aspect (white flesh) belongs to the Hand-Yin channels. Those appearing on the breasts: the medial aspect belongs to Yangming, and the lateral aspect belongs to Shaoyang.
The head belongs to Jueyin. Investigating each region systematically ensures effective treatment. Among the channels, sores of Shaoyang and Jueyin require particular prevention due to their characteristic of abundant qi and scarce blood. Since blood is inherently scant, muscle growth is difficult. Furthermore, Shaoyang possesses ministerial fire; successive use of detoxifying agents may lead to swift disaster. The maxim states: "Remember those with abundant blood and qi: the Hand-Large Intestine and Foot-Stomach channels. There are six channels with abundant qi and scarce blood: Sanjiao, Gallbladder, Kidney, Heart, Spleen, and Lung. The Pericardium has abundant blood and scarce qi, while the Bladder, Small Intestine, and Liver are similar [to the Pericardium in terms of blood/qi distribution? Note: Text implies specific classification]. Memorizing this reveals the differences in the abundance and scarcity of qi and blood."
Meridian associations of the five fingers: The thumb belongs to the Lung; the index finger to the Large Intestine; the middle finger to the Pericardium; the ring finger to the Sanjiao; the medial side of the little finger to the Heart; and the lateral side of the little finger to the Small Intestine.