诸脉浮数。应当发热。而反洒淅恶寒。若有痛处。当发其痈。
疮者。怆也。伤也。风寒暑湿等之外因。客于经络。而其气血不和。有凄怆之象。因而 烂伤损者是也。痈者。壅
也。拥也。或七情之内火。或六淫之外邪。流于隧道。郁于经穴。以致气血不通。而壅塞拥起之象。故名痈。是疮
小痈大。疮浅痈深。且疮之所见。不拘十二经络。及任督两脉。痈即发于脏者。亦必移热于腑。而见三阳及任
督诸部者。以疮毒小而浅。故浮散而见各经之表。痈深而大。非阳经之热。不能成 肿溃烂之势故也。根深
而大。或见于阴经者。则肿而不痛。或痒。甚至三四月溃出。而无脓者。名疽。阴阳之别也 首条言诸痈初发
之脉症也。诸脉。指六部而言。浮为在表。数为热。浮脉见数。故症当发热。乃不发表热而反皮毛洒淅恶寒者。
是脉症不相对矣。若加上中下三部。或有一定之痛处。此为发痈之脉症。盖热毒之气外聚经络。故其脉见
浮数。又卫表之气。初得痈热。逼之而乍负。故洒淅恶寒也。痈处分上中下。而浮数。以寸关尺及左右分应
之。故曰。诸脉浮数也。
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。
肉腐皮薄。热毒外逼。故以手掩肿上。热者为有脓。不热则热在里而尚未透出。故无脓。又按肿上。跳动顶
指者为有脓。不顶指者为无脓。此法甚准。故并附于此。
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。此为腹内有痈脓。薏苡附子败酱散主之。
薏苡附子败酱散方 薏苡仁（十分） 附子（二分） 败酱（五分）
上三味。杵为散。取方寸匕。以水二升。煎减半。顿服。小盒饭下。
此及下文两条。就诸痈而抽言肠痈之病脉症治也。但本条为小肠痈。下条为大肠痈之别耳。小肠之痈。起
于阳虚。不能运水而聚湿。湿久则生虚热。湿热交蒸于小肠。则肠中之气血壅塞。而拥起成痈矣。大肠闭结。
而其气积热。气热而郁滞。则血不流行。故痈。此前后两方。一系责阳虚。而除湿热。一系责血热。而攻气滞之
不同也。小肠紧承胃之下口。其气虚寒。则不能胜湿而化热。小肠湿热。则上逼胃中。胃土外应肌肉。湿热
熏蒸。则血色不化。故身必甲错。湿热外浮。而腹与小肠为尤近。故其皮如急状。盖湿鼓而腾热之应也。然湿
热蒸腹皮。而痈肿在肠内。与皮内肠外之空处无涉。故按之濡。腹如肿状。而实非肿者。此也。夫腹中有积聚。
则气机之往来短促。而脉数于里者有之。身有表热。则阳浮气胜。而脉数于表者有之。若俱无此。而脉见数。
则数为气血不通。而热聚搏激之应。以症准之。则为腹内痈脓无疑矣。主本方者。湿为本病。故君甘寒之薏
苡以除湿。但除湿者。非扶真阳以呵导之。则其湿不能骤去。故佐以生阳之附子也。热为标病。故兼用苦寒
而攻暴热。及善破痈脓之败酱耳。为散、水煎而顿服。欲其少停胃中。所以并治身之甲错。及腹皮之急如肿
状也。小盒饭下。合未脓已脓而言。盖未脓而小便不通。则附子扶阳。薏苡、渗湿。败酱、泄痈脓于扶阳渗湿之
中。而痈自消散。已脓而小便下通。则败酱、破脓。薏苡、泄毒。而以生阳之附子。为内合疮口之助。仲景之方。真
海市蜃楼。顷刻万状者也。
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。
大黄牡丹汤方 大黄（四两） 牡丹皮（一两） 芒硝（三合） 桃仁（五十个） 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。（玩有脓当下四字。
知脓未成而可下者。非此汤矣。）
此言痈在大肠之病脉症治也。大肠承小肠之下口。而丽少腹。痈则气血壅塞而拥起。故少腹外肿而如痞。
大肠与膀胱之下口相贴。热势从邻近而逼溺管。故按之而肠痈自痛。溺管自急如淋状。所以知其非真淋
者。以小肠无病。而小便自调故也。小肠之痈为寒因。故不作表热。大肠之痈为热因。实热上蒸外被。故时时
发表热也。自汗与大承症之自汗同义。肠实者。胃亦实也。恶寒与白虎症之背恶寒同义。里热者。外反寒也。
前后两脉字。当指右尺而言。以内经之候大肠者。在此也。脉迟。为气阻之诊。脉紧。为聚痛之应。气方阻而尚
在聚痛。故知脓未成耳。可下不可下。非谓下文之大黄牡丹汤。当指大承及桃核承气。或抵当丸而言。盖初
起而痈势未成。大承下之。则实去热消。而痈固可散。即痈成而未脓者。犹可以桃核、抵当等方下之。泻血以
泻气。而痈亦可除故也。若夫洪为阴虚。数为火炽。痈脉阴虚。非营血内溃而何。痈脉火炽。非热毒外搏而何。
内溃之势已欲外搏。故知脓已成矣。脓已成者。不特大承之徒下实热不可任。即桃核、抵当之单下瘀血。亦
不可任。故曰不可下。犹言此不得以寻常之例下之耳。主大黄牡丹汤者。妙在用瓜子一味。盖瓜子生在瓜
穣中。而其仁则饱具生阳。常有努芽欲出之势。故能善入痈中。而主透痈溃毒之用。佐气窜性行之桃仁。以
破瘀逐血。味咸润下之芒硝。以软坚消肿也。牡丹皮详肾气丸注。本方取以为使。却又另是一番妙义。盖牡
丹之皮。固为升降生阳之品。入肾气丸之桂附阳药中者。取其升性而正用之。所以使之上补心气。而蒸填
虚悸。入于本方之硝黄阴药中者。又取其降性而倒用之。所以使之外摄寒热。而下趋大肠也。然后统以苦
寒沉雄之大黄。扫除涤荡之。则实热脓血俱去矣。名之曰大黄牡丹汤。而三物不与者。是以芒硝桃仁。建左
攻右取之勋。瓜子、奏诈降内应之捷。及其成功。元戎之外。惟檄文露布之参谋。转得同垂史册之道也。李
氏旧注。谓本方当在脓未成可下之之下。误。如果为下未脓之方。则成脓者。将死不治乎。抑别有方未传。或
传而残缺耶。且方后不得曰有脓当下矣。
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。
此合下条。言金疮之病脉症治也。左寸、心与膻中。为血液之宗主。右寸、肺与胸中。为阳气之根蒂。其脉微涩。
微为阳气虚。涩。为血液短可知。但阳附于阴。气根于血。是此脉以责涩为首。责微为从。故诊法为吐衄等之
亡血。并若发汗而汗出之脉。以亡血汗出致阴虚故涩。遂因阴虚而阳亦虚。故微也。设不汗出句。并亡血亦
互在内。犹云设若不曾汗出。及吐衄等亡血。则此脉当云因何而见也。答曰。此必身有疮。且此疮为刀斧所
伤之金疮。先经血气暴亡。故其脉。与吐衄及汗出者。同也。
病金疮。王不留行散主之。
王不留行散方
王不留行（十分八月八日采） 蒴 细叶（十分七月七日采） 桑东南根白皮（十分三月三日采）
黄芩 芍药 浓朴 干姜（各二分） 甘草（十八分） 川椒（三分除目及闭口者妙去汗）
上九味。桑根皮以上三味。烧灰存性。勿令灰过。各别捣筛。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。
金疮。即上条刀斧所伤。并跌扑亦在内。首卷所谓不内外因是也。其与疮痈之疮不同者。血液暴亡。气奔伤
处而多热。热则血液宣流。而轻易不可止遏者。一也。故用苦寒之黄芩。酸敛之芍药。所以清其热而敛其血
也。又血液暴亡。血奔伤处。而经络以血去而气虚。气虚则寒。寒则其气不贯不密。而疮口不能完合者。又一
也。故用辛温而生气之干姜。辛温而固气之川椒者。所以充贯其气。而且使固密之也。王不留行。行血中之
气。蒴 细叶。主绝伤而续筋骨。桑根白皮。形如丝麻。象同肌肉。具续绝完合之性。烧灰则色黑味咸。黑则入
血而止敛之。咸则消肿而降润之。茎叶取其秋成。故采于七八两月。根皮取其生气。故采于三月。而且择向
东南也。时日风寒。则生气缩伏而不全。故以取为戒耳。三物皆阴干百日。勿欲以烘晒及朽烂伤其药性也。
君甘草而佐以浓朴。且为散而连服渣质者。以气血生于胃中之精悍。重用甘草。使全药从其性而停留胃
腑。配浓朴以宽展胸膈。并使营运伤处也。此王不留行一散。为金疮之圣药也。小疮伤气血者尚浅。故可
就近末之。以取完合。大疮伤经络之气血以掣脏腑。故必服之。从内外托。而递及伤处也。产妇宜生新逐瘀。
与金疮同义。故亦可服。
浸淫疮。从口流向四肢者可治。从四肢流来入口者不可治。
湿热之毒。发于皮肤肌肉。其浸淫沿染。如淫佚之波靡者。故曰浸淫疮。四肢于人身。有边远之象。譬之么魔
小寇。不足为社稷之害。口为饮食之所从入。其象如粮饷要路。且阳明之经气。终于唇口。故从口流向四肢。
而自内外散者。为可治。从四肢流来入口。而自外内犯者。为不可治。然言四肢与口。而内外可知。言浸淫疮。
而诸病可知矣。
浸淫疮。黄连粉主之。
黄连粉方缺。或即黄连而独为粉耶。浸淫疮。为湿热流浸。而使营气缓散之症。黄连苦寒。而形性拘结。苦以
燥湿。寒以清热。而形性拘结者。尤能坚其缓散之气故主之。
所有的脉象浮而数，本应当出现发热症状，反而却感到怕冷、战栗。如果身体某处有固定疼痛点，说明即将发生痈肿。
“疮”，是指怆痛、损伤。风寒暑湿等外邪侵袭经络，导致气血不和，呈现出凄怆的状态，进而腐烂损伤肌肤，这就是疮。“痈”，是指壅塞、拥聚。无论是七情内生的火热，还是六淫外来的邪气，流注于经络隧道，郁结在经穴，导致气血不通，呈现壅塞隆起的形态，所以称为痈。一般来说，疮小痈大，疮浅痈深。而且疮的表现不局限于十二正经及任督二脉；即使是发生在脏腑内部的痈，其热毒也必然转移至腑，并在三阳经及任督各部位表现出来。这是因为疮的毒邪小而浅，所以脉象浮散，表现在各经的体表；而痈根深且大，如果不是阳经的热毒，就不能形成肿胀溃烂的态势。如果病根深且大，出现在阴经上，则表现为肿胀但不痛，或者发痒，甚至经过三四个月才溃破，且没有脓液流出，这叫做“疽”，这是阴阳性质的区别。第一条论述了各种痈初发时的脉象和症状。所谓的“诸脉”，指的是寸关尺六部脉象。浮脉主表，数脉主热，脉象浮而数，所以症状应当是发热。如果不表现为表证的发热，反而皮肤感觉怕冷、战栗，这就是脉象与症状不相符合。如果在寸关尺三部或上下中焦有固定的疼痛部位，这就是发痈的脉症。因为热毒之气聚集在经络外部，所以脉象见浮数。另外，卫表之气初次受到痈热的逼迫，正气与之抗争，所以会出现忽冷忽热的恶寒感。痈的部位有上中下之分，脉象的浮数可以通过寸关尺及左右手来对应判断，所以说“诸脉浮数”。
老师说：对于各种痈肿，想要知道是否有脓，可以用手按压肿块上方。感觉发热的，说明有脓；不感觉发热的，说明无脓。
肌肉腐败、皮肤变薄，热毒向外逼迫，所以用手按压肿块上方，感觉发热的就是有脓。如果不发热，说明热邪在体内尚未透出，所以没有脓。另外，按压肿块时，如果感觉到跳动顶指，说明有脓；不顶指的说明无脓。这种方法非常准确，所以一并附在这里。
肠痈这种病，患者身体皮肤粗糙如鳞甲交错（肌肤甲错），腹部皮肤紧张，但按之柔软，看起来像是有肿物，但腹内并没有积聚块状物，身体没有发热，脉象数，这是腹内有痈脓的表现，用薏苡附子败酱散主治。
薏苡附子败酱散方：薏苡仁（十分）、附子（二分）、败酱（五分）。
以上三味药，捣碎成散剂。每次取一方寸匕的药量，用水二升，煎煮至剩下一升，一次性服用。服药后小便应当通畅。
这一条以及下面两条，是从各种痈中专门论述肠痈的病脉症治。但是本条说的是小肠痈，下一条说的是大肠痈的区别罢了。小肠的痈，起因于阳气虚弱，不能运化水湿而导致湿气积聚，湿气久了则产生虚热，湿热交蒸于小肠，导致肠中的气血壅塞，从而拥起形成痈。大肠闭结，其气积热，气热而郁滞，导致血液运行不畅，所以形成痈。前面的方子和后面的方子，一个是因为责求阳气虚弱而去除湿热，一个是因为责求血热而攻逐气滞，这是不同的。小肠紧接在胃的下口，其气虚寒，就不能胜湿而化热。小肠湿热，就会向上逼迫胃中。胃土在外部对应肌肉，湿热熏蒸，导致血色无法正常化生，所以身体必定出现肌肤甲错。湿热向外浮越，而腹部与小肠最为接近，所以腹部皮肤呈现紧张状态。这是湿气鼓动而腾起热气的反应。然而湿热蒸腾的是腹皮，而痈肿在肠内，与皮内肠外的空隙无关，所以按之柔软，腹部看起来像肿状，但实际上并不是肿。如果腹中有积聚，那么气机往来短促，脉象在里部会数；身体有表热，那么阳气浮盛，脉象在表部会数。如果都没有这些情况，而脉象见数，那么数脉就是气血不通、热邪聚集搏击的反应。根据症状来判断，这肯定是腹内有痈脓无疑了。使用本方的原因，是因为湿是本病的根本，所以用味甘性寒的薏苡仁作为君药以除湿。但是，单纯除湿，如果不扶持真阳来引导，湿气就不能迅速去除，所以佐以能生发阳气的附子。热是标病，所以兼用苦寒且善于破除痈脓的败酱来攻逐暴热。制成散剂，用水煎煮后一次性服用，是想让药力在胃中稍作停留，从而同时治疗身体的肌肤甲错以及腹部皮肤紧张如肿状的情况。“小便应当通畅”，是针对未成脓和已成脓两种情况而言的。如果没有成脓而小便不通，那么附子扶助阳气，薏苡仁渗利湿气，败酱泄除痈脓，在扶阳渗湿的过程中，痈自然消散。如果已经成脓而小便通利，那么败酱破除脓液，薏苡仁泄除毒邪，而生发阳气的附子则起到帮助疮口愈合的作用。仲景的方子，真是变幻莫测、瞬息万状的杰作啊。
肠痈的症状是：少腹部肿胀痞硬，按压时就疼痛，感觉像淋病一样，但小便自调正常，时常发热，自汗出，又伴有恶寒。脉象迟而紧的，说明脓未形成，可以用攻下法。应当会有瘀血排出。脉象洪而数的，说明脓已形成，不可用攻下法。用大黄牡丹汤主治。
大黄牡丹汤方：大黄（四两）、牡丹皮（一两）、芒硝（三合）、桃仁（五十个）、瓜子（半升）。
以上五味药，用水六升，煮取一升，去渣，加入芒硝，再煮沸后一次性服用。如果有脓，应当排出脓液；如果没有脓，应当排出瘀血。（仔细玩味“有脓当下”这四个字，就知道脓未成而可用攻下法的，不是这个方子了。）
这里论述的是大肠痈的病脉症治。大肠承接在小肠的下口，位于少腹部。发生痈时，气血壅塞而隆起，所以少腹部外部肿胀而像痞块。大肠与膀胱的下口相邻，热势从邻近部位逼迫尿道，所以按压时肠痈自痛，尿道紧急如同淋病状。之所以知道这不是真正的淋病，是因为小肠没有病变，而小便自调正常。小肠的痈是由于寒邪引起的，所以不产生表热；大肠的痈是由于热邪引起的，实热向上蒸腾并向外覆盖，所以时常表现出表热。自汗与大承气汤证中的自汗意义相同。肠腑实证，胃腑也是实的。恶寒与白虎加人参汤证中的背恶寒意义相同。里有热，体表反而寒冷。前后两个“脉”字，应当指的是右尺脉，因为《内经》中候察大肠的脉位就在这里。脉迟，是气机阻滞的诊断；脉紧，是聚痛的反应。气机刚刚阻滞且尚在聚痛阶段，所以知道脓未形成。可下与不可下，并非指下文的大黄牡丹汤，而是指大承气汤、桃核承气汤或抵当丸等。大概是在初起而痈势未成时，用大承气汤攻下，实邪去则热消，痈固可以消散；即使痈已成但未成脓，仍然可以用桃仁、抵当等方攻下，通过泻血来泻气，痈也可以消除。至于洪脉主阴虚，数脉主火炽，痈脉见阴虚，难道不是营血在内溃烂吗？痈脉见火炽，难道不是热毒在外搏击吗？内溃的趋势正要向外搏击，所以知道脓已形成了。脓已成，不仅大承气汤那种单纯攻下实热的方法不能用，就是桃仁、抵当那种单纯攻下瘀血的方法也不能用，所以说不可下。这里说的“不可下”，意思是此症不能用寻常的攻下方法来处理。使用大黄牡丹汤的原因，妙在用瓜子一味药。瓜子生长在瓜瓤中，而其仁则饱满具备生发的阳气，常有萌芽欲出的态势，所以能善于进入痈中，主要发挥透痈溃毒的作用。佐以气窜性行的桃仁，以破除瘀血、驱逐败血；味咸润下的芒硝，以软坚消肿。牡丹皮在肾气丸的注释中已有详述，本方取其作为使药，却又有一番新的妙义。牡丹皮本是升降生阳的药物，在肾气丸的桂附阳药中，是取其升性而正用，以便上补心气，蒸填虚悸；在本方的硝黄阴药中，又是取其降性而倒用，以便外摄寒热，下趋大肠。然后用苦寒沉雄的大黄统率，扫除涤荡，那么实热脓血就都去除了。命名为大黄牡丹汤，而不把其他三物列入主要地位，是因为芒硝、桃仁建立了左辅右弼的功勋，瓜子奏响了诈降内应的捷报，等到成功之后，在大将之外，只有檄文露布的参谋，反而得以一同载入史册的道理。李氏旧注认为本方应当在“脓未成可下”的下面，是错误的。如果这是攻下未成脓的方子，那么已成脓的，难道会死掉无法治疗吗？还是有别的方子没有流传下来，或者流传下来残缺不全呢？况且方后不得说“有脓当下”啊。
问：寸口脉微而涩，按照医理应当是失血或汗出过多。假设没有汗出，那是什么原因呢？答：如果是身上有疮，被刀斧所伤，导致失血，就是这个原因。
这一条结合下一条，论述金疮（金属利器造成的创伤）的病脉症治。左寸部，心与膻中，是血液的主宰；右寸部，肺与胸中，是阳气的根基。脉象微涩，微表示阳气虚，涩表示血液不足，这是显而易见的。但是阳气依附于阴血，气根源于血，所以对此脉象的分析，以责求涩（血虚）为首要，责求微（气虚）为次要。因此诊法认为这是吐衄等导致的亡血，或者是发汗导致汗出过多的脉象。因为亡血汗出导致阴虚，遂因阴虚而导致阳亦虚，所以脉微。设若不出汗一句，同时也包含了亡血的意思，就像说假如不曾汗出，以及吐衄等亡血，那么这个脉象是因为什么原因出现的呢？回答说：这一定是身上有疮，而且是刀斧所伤的金疮，先经历了气血暴亡，所以其脉象与吐衄及汗出者相同。
王不留行散方：王不留行（十分，八月八日采集）、蒴藋细叶（十分，七月七日采集）、桑树东南方向的根白皮（十分，三月三日采集）、黄芩、芍药、浓朴、干姜（各二分）、甘草（十八分）、川椒（三分，去掉目及闭口的，炒去汗）。
以上九味药，桑根皮以上的三味药，烧成灰但要保留药性，不要让灰过量。分别捣碎筛过，混合在一起制成散剂。每次服用一方寸匕。小伤口可以直接撒粉，大伤口只要服用即可。产后妇女也可以服用。如果遇到风寒天气，不要取用桑东根。前三味药都要阴干一百天。
金疮，就是上一条所说的刀斧所伤，跌打损伤也包括在内。属于首卷所说的“不内外因”。它与疮痈的“疮”不同之处在于：血液暴亡，气奔涌到受伤处而产生多热，热则血液宣散流动，轻易难以止遏，这是一点。所以用苦寒的黄芩、酸敛的芍药，来清热而收敛血液。另外，血液暴亡，血奔涌到受伤处，经络因失血而气虚，气虚则寒，寒则气不贯通不紧密，而疮口不能愈合，这是另一点。所以用辛温而生气的干姜、辛温而固气的川椒，来充实贯通其气，并且使其固密。王不留行，行血中之气；蒴藋细叶，主治绝伤而续接筋骨；桑根白皮，形状如丝麻，形象同肌肉，具有续绝完合的性质。烧成灰后色黑味咸，黑色入血而止敛，咸味消肿而降润。茎叶取其秋成，所以在七八月采集；根皮取其生气，所以在三月采集，而且选择朝向东南的方向。时日气候寒冷或有风，则生气缩伏而不全，所以以此为戒。这三味药都要阴干一百天，不要用烘烤日晒以免朽烂损伤药性。
以甘草为君药，佐以浓朴，且制成散剂连渣服用，是因为气血生于胃中的精悍之气。重用甘草，使全药顺着它的性质停留在胃腑，配合浓朴以宽展胸膈，并使营运到达受伤处。这王不留行散，是治疗金疮的神药。小伤口伤及气血尚浅，所以可以就近撒粉，以求愈合。大伤口伤及经络气血并牵涉脏腑，所以必须服用，从内外托举，依次到达受伤处。产妇宜生新逐瘀，与金疮的治疗原理相同，所以也可以服用。
浸淫疮，从口流向四肢的可以治愈，从四肢流来入口的不可治愈。
湿热之毒，发于皮肤肌肉，其浸淫蔓延，像淫佚的波浪漫延一样，所以叫浸淫疮。四肢在人身，有边远之象，譬如有微小寇贼，不足以危害社稷。口是饮食进入的地方，其象如同粮饷的要路，而且阳明经的气气终于唇口。所以从口流向四肢，由内向外发散，是可以治愈的。从四肢流来入口，由外向内侵犯，是不可治愈的。然而提到四肢与口，内外的道理就知道了；提到浸淫疮，其他疾病的道理也就知道了。
黄连粉方缺失。或许是单用黄连研为粉吧。浸淫疮，是湿热流浸，导致营气缓散的病症。黄连苦寒，且形性拘结，苦能燥湿，寒能清热，而其形性拘结的特点，尤其能坚固其缓散之气，所以用它为主药。
All pulse positions are floating and rapid. Fever should be present, yet the patient instead experiences chills and shivering (saxi). If there is a fixed area of pain, an abscess (yong) is about to develop.
"Cang" (sores/ulcers) refers to distress and injury. External pathogens such as wind, cold, summer-heat, and dampness invade the meridians, causing disharmony of Qi and blood, presenting with a distressed appearance, leading to rotting and damaging the skin. This is what is called "cang". "Yong" (carbuncles) refers to obstruction and congestion. Whether caused by internal fire from the seven emotions or external evil from the six climatic factors, when these flow into the collaterals and accumulate in the acupoints, they cause blockage of Qi and blood, resulting in a congested and raised swelling. Hence it is named "yong". Generally, cang is small and shallow, while yong is large and deep. Furthermore, cang can manifest in any of the twelve regular meridians as well as the Ren and Du vessels. Even if a yong originates in the zang organs, its heat must transfer to the fu organs and manifest in the three Yang meridians and the Ren and Du vessels. This is because the pathogenic factor of cang is small and shallow, so the pulse is floating and scattered, appearing on the exterior of various meridians. Yong is deep and large; without the heat of the Yang meridians, it cannot form the momentum of swelling and ulceration. If the root is deep and large, appearing in the Yin meridians, it presents as swelling without pain, or itching, even ulcerating after three or four months without pus discharge. This is called "ju" (deep-seated abscess), representing the distinction between Yin and Yang. The first clause describes the initial pulse and symptoms of various yongs. "Zhu mai" (all pulses) refers to the six pulse positions (cun, guan, chi on both hands). Floating indicates the exterior, and rapid indicates heat. With a floating and rapid pulse, the symptom should be fever. However, if instead of exterior fever, the skin feels chilly and shivering occurs, this is a mismatch between pulse and symptoms. If there is fixed pain in the upper, middle, or lower jiao, or at specific locations, this constitutes the pulse and symptoms of developing a yong. This is because the heat-toxin gathers externally in the meridians, hence the floating and rapid pulse. Additionally, the defensive Qi at the exterior, initially pressured by the heat of the yong, struggles against it, causing alternating chills and fever (saxi ehan). The location of the yong varies in the upper, middle, and lower sections, and the floating and rapid nature of the pulse corresponds to the cun, guan, chi positions and left/right hands. Thus it says, "All pulses are floating and rapid."
The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, press the hand over the swelling. If it feels hot, pus is present; if not hot, no pus is present.
When muscle rots and skin becomes thin, heat-toxin forces outward. Therefore, pressing the hand over the swelling, heat indicates pus. Lack of heat means the heat is internal and has not yet emerged, indicating no pus. Additionally, if pressing the swelling causes a pulsating sensation against the finger, pus is present; if it does not push against the finger, no pus is present. This method is very accurate, so it is appended here.
Intestinal yong (intestinal abscess) presents with rough, scaly skin (jiacuo), tense abdominal skin that feels soft upon palpation but appears swollen, without abdominal accumulations, body fever, but with a rapid pulse. This indicates intestinal abscess with pus, treated with Yiyi Fuzi Baijiang San.
Formula: Yiyi Ren (Coix Seed, 10 parts), Fuzi (Prepared Aconite Root, 2 parts), Baijiang Cao (Patrinia Herb, 5 parts).
Crush the three herbs into a powder. Take one fangcun bi (a measure approx. 2-3 grams) of powder, boil in two sheng of water until reduced by half, and take in one dose. Urination should follow shortly.
These two clauses below specifically discuss the pulse, symptoms, and treatment of intestinal yong among various abscesses. The current clause refers to Small Intestine yong, while the next refers to Large Intestine yong. Small Intestine yong arises from Yang deficiency, failing to transform water and accumulating dampness. Long-standing dampness generates deficient heat. Damp-heat steams in the Small Intestine, blocking Qi and blood, leading to congestion and formation of yong. Large Intestine constipation leads to accumulated heat in Qi. Qi heat and stagnation prevent blood circulation, causing yong. The former formula addresses Yang deficiency to remove damp-heat; the latter addresses blood heat to attack Qi stagnation. The Small Intestine connects to the lower opening of the Stomach. Its Qi deficiency and cold prevent it from overcoming dampness and transforming heat. Small Intestine damp-heat presses upward on the Stomach. Stomach Earth corresponds to muscles externally. Damp-heat steaming prevents normal blood transformation, causing jiacuo (rough skin). Damp-heat floats outward, and since the abdomen is close to the Small Intestine, the abdominal skin feels tense. This is the response of dampness鼓动 (bulging) and rising heat. However, the damp-heat steams the abdominal skin, while the abscess is inside the intestine, unrelated to the space between the skin and intestine. Thus, palpation feels soft, and although it looks swollen, it is not truly swollen. If there were abdominal accumulations, Qi mechanism would be short, and the pulse might be rapid internally. If there were exterior heat, Yang Qi would float, and the pulse might be rapid externally. Without these, a rapid pulse indicates blocked Qi and blood and gathered heat-toxin. Based on symptoms, this is undoubtedly intestinal abscess with pus. The formula uses Yiyi Ren (sweet and cold) as the sovereign herb to remove dampness, as dampness is the root disease. However, removing dampness requires supporting True Yang to guide it, otherwise dampness cannot be quickly removed; thus, Fuzi (generating Yang) is used as an assistant. Heat is the branch disease, so bitter-cold Baijiang Cao is used to attack violent heat and break down abscess pus. Made into powder and boiled in water for single dosing allows the medicine to stay in the Stomach longer, treating both jiacuo and tense abdominal skin. "Urination should follow" applies to both pre-pus and post-pus stages. If unformed pus and urination is blocked, Fuzi supports Yang, Yiyi Ren leaches dampness, and Baijiang Cao drains pus within the context of supporting Yang and leaching dampness, allowing the abscess to dissipate. If pus is formed and urination flows freely, Baijiang Cao breaks the pus, Yiyi Ren drains toxins, and Yang-generating Fuzi aids in closing the wound. Zhang Zhongjing's formulas are truly miraculous and ever-changing.
Intestinal yong presents with swelling and fullness in the lower abdomen, pain upon pressure resembling strangury (lin), but normal urination, frequent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus is not yet formed; purgation may be used, and bloody stool will likely pass. If the pulse is surging and rapid, pus is formed; purgation is contraindicated. Treat with Dahuang Mudan Tang.
Formula: Dahuang (Rhubarb Root, 4 liang), Mudan Pi (Moutan Cortex, 1 liang), Mangxiao (Mirabilite, 3 he), Taoren (Peach Kernel, 50 pieces), Guazi (Melon Seeds, 0.5 sheng).
Boil the five herbs in six sheng of water to obtain one sheng. Strain, add Mangxiao, boil again, and take in one dose. If pus exists, it will be discharged; if no pus, bloody stool will be discharged. (Carefully consider the phrase "if pus exists, it will be discharged"; this implies that for unformed pus requiring purgation, this formula is not appropriate.)
This discusses the pulse, symptoms, and treatment of Large Intestine yong. The Large Intestine follows the Small Intestine and resides in the lower abdomen. Abscess formation blocks Qi and blood, causing swelling and fullness in the lower abdomen. The Large Intestine adheres to the lower opening of the Bladder. Heat forces the urinary tract due to proximity, causing pain upon pressure resembling strangury. It is not true strangury because the Small Intestine is unaffected and urination is normal. Small Intestine yong is caused by cold, so no exterior heat occurs. Large Intestine yong is caused by heat; excess heat steams upward and covers outward, causing frequent exterior heat. Spontaneous sweating here shares the same meaning as in Da Chengqi Tang syndrome (excess in intestines implies excess in Stomach). Aversion to cold here shares the same meaning as back-chill in Baihu Jia Renshen Tang syndrome (interior heat causes exterior cold). The "pulse" mentioned twice refers to the right Chi position, as per Neijing, where the Large Intestine is inspected. Slow pulse indicates Qi obstruction; tight pulse indicates gathering pain. Since Qi is just obstructed and pain is gathering, pus is not yet formed. "May purge" vs "may not purge" does not refer solely to Dahuang Mudan Tang, but also to Da Chengqi Tang, Taohe Chengqi Tang, or Didang Wan. In early stages before abscess formation, Da Chengqi Tang purges excess and clears heat, dispersing the abscess. Even if abscess forms but pus is not yet ready, Taohe or Didang formulas can purge blood to drain Qi, eliminating the abscess. Surging pulse indicates Yin deficiency; rapid pulse indicates blazing fire. An abscess pulse showing Yin deficiency suggests internal collapse of Ying blood. An abscess pulse showing blazing fire suggests external combat of heat-toxin. Internal collapse turning outward indicates pus is formed. Once pus is formed, neither simple purging of excess heat (Da Chengqi) nor simple purging of stasis (Taohe/Didang) is suitable. Thus, "purge is contraindicated" means standard purging methods cannot be applied. The brilliance of Dahuang Mudan Tang lies in the use of Guazi. Growing in melon pulp, its kernel possesses vigorous generating Yang Qi, often showing a tendency to sprout. Thus, it enters the abscess to penetrate and drain toxin. Taoren, with its penetrating and moving nature, breaks stasis and drives out bad blood. Mangxiao, salty and lubricating, softens hardness and reduces swelling. Mudan Pi (discussed in Shenqi Wan commentary) acts as the envoy. In Shenqi Wan's warming Yang herbs, its ascending nature is used positively to nourish Heart Qi. In this formula's cooling Yin herbs (Mangxiao, Dahuang), its descending nature is used inversely to regulate exterior cold/heat and descend to the Large Intestine. Finally, Dahuang, bitter-cold and majestic, sweeps away excess heat, pus, and blood. Named Dahuang Mudan Tang, the other three herbs serve as assistants: Mangxiao and Taoren establish merit through auxiliary action; Guazi achieves success through internal correspondence. Like strategists in history books, they share the glory. Li's old annotation placing this formula under "unformed pus, may purge" is incorrect. If it were for unformed pus, how would formed pus be treated? Would it be fatal? Or is another formula missing? Moreover, the formula instructions say "if pus exists, it will be discharged."
Question: Cun Kou pulse is micro and choppy. Medically, this indicates loss of blood or excessive sweating. If there is no sweating, what is the cause? Answer: If the body has sores injured by knives or axes, causing blood loss, this is the reason.
This clause combined with the next discusses Jin Chuang (metal weapon injuries) pulse, symptoms, and treatment. Left Cun governs Heart and Danzhong, masters Blood. Right Cun governs Lung and Xiongzhong, roots Yang Qi. Micro pulse indicates Yang deficiency; choppy pulse indicates Blood insufficiency. However, Yang attaches to Yin, and Qi roots in Blood. Therefore, analyzing this pulse prioritizes choppy (Blood deficiency) over micro (Yang deficiency). Thus, diagnosis attributes this to blood loss from vomiting/epistaxis or sweating. Blood loss/sweating causes Yin deficiency, leading to Yang deficiency (micro pulse). The phrase "if no sweating" also encompasses blood loss scenarios like vomiting/epistaxis. Why does this pulse appear? Answer: Due to Jin Chuang (knife/axe wounds) causing sudden loss of Qi and Blood, making the pulse identical to that of vomiting/epistaxis or sweating.
For Jin Chuang, Wangbuliuxing San is indicated.
Formula: Wangbuliuxing (Polygonatum Kingii Rhizome, 10 parts, harvested Aug 8), Shuoxi Xiye (Dioscorea Hypoglauca Leaves, 10 parts, harvested Jul 7), Sanggen Baipi (Mulberry Root Bark, SE direction, 10 parts, harvested Mar 3), Huangqin (Scutellaria Root, 2 parts), Shaoyao (Peony Root, 2 parts), Nongpu (Magnolia Bark, 2 parts), Ganjiang (Dried Ginger, 2 parts), Gancao (Licorice Root, 18 parts), Chuanjiao (Sichuan Pepper, 3 parts, remove eyes and closed ones, stir-fry to remove moisture).
Burn the first three herbs (Mulberry bark, etc.) to ash retaining medicinal properties, avoiding excessive ash. Grind and sieve separately, then mix into powder. Take one fangcun bi. For small wounds, apply powder topically. For large wounds, take orally. Postpartum women may also take it. Avoid Mulberry SE root during wind-cold weather. The first three herbs must be air-dried for 100 days.
Jin Chuang refers to knife/axe wounds and falls, categorized as "neither internal nor external" causes. Unlike typical sores, sudden blood loss causes Qi to rush to the wound, generating heat. Heat causes blood to flow freely and be hard to stop. Thus, bitter-cold Huangqin and sour-astringent Shaoyao clear heat and consolidate blood. Sudden blood loss leaves Qi deficient in the meridians. Deficient Qi becomes cold, preventing closure of the wound. Thus, warm-acrid Ganjiang and Chuanjiao generate and secure Qi to promote healing. Wangbuliuxing moves Qi in Blood. Shuoxi Xiye heals severe injuries and reconnects bones/tendons. Mulberry root bark resembles silk/hemp and muscle tissue, possessing properties to heal and close wounds. Ashed, it turns black and salty; black enters Blood to stop bleeding, salty reduces swelling and moistens. Leaves/stems harvested in autumn (Jul/Aug) for maturity; root bark harvested in spring (Mar) for vitality, choosing SE direction for optimal Qi. Cold/windy weather shrinks vital Qi, so harvesting is avoided. Air-drying for 100 days preserves potency, avoiding heat damage. Gancao is sovereign, harmonizing and staying in the Stomach to distribute the formula. Nongpu expands the chest/diaphragm and directs Qi to the wound. Wangbuliuxing San is the sacred medicine for Jin Chuang. Small wounds affect Qi/Blood superficially; topical powder suffices. Large wounds affect meridians/organs; oral administration is needed to support from inside/outside. Postpartum treatment aims to generate new blood and expel stasis, similar to Jin Chuang principles, so it is applicable.
Jinyin Chuang (oozing sore) flowing from mouth to limbs is treatable; flowing from limbs to mouth is untreatable.
Damp-heat toxin erupts in skin/muscle, spreading like waves, hence "Jinyin" (oozing/spreading). Limbs represent distant areas, like minor bandits harmless to the state. The mouth is the entry for food, like a supply route. Yangming Meridian Qi ends at the lips/mouth. Flowing from mouth to limbs disperses outward from inside, making it treatable. Flowing from limbs to mouth invades inward from outside, making it untreatable. Mentioning limbs and mouth clarifies interior/exterior dynamics; mentioning Jinyin Chuang illustrates principles for other diseases.
Jinyin Chuang is treated with Huanglian Fen.
Huanglian Fen formula is missing. Perhaps it is simply Huanglian ground into powder. Jinyin Chuang involves damp-heat spreading, causing Ying Qi to loosen and scatter. Huanglian is bitter and cold, with a constrained nature. Bitter dries dampness, cold clears heat. Its constrained nature particularly strengthens the loosened/scattered Qi, making it the primary herb.