黄帝曰。余闻肠胃受谷。上焦出气以温分肉。而养骨节。通腠理。中焦出气如露。上注 谷而
渗孙脉。津液和调。变化而赤为血。血和则孙脉先满溢。乃注于络脉皆盈。乃注于经脉。阴阳已
张。因息乃行。行有经纪。周有道理。与天协议。不得休止。切而调之。从虚去实。泻则不足。疾则
气减。留则先后。从实去虚。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 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。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。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。（泣涩同）
此篇归结首章之义。盖人之血气流行。与天地相参。与日月相应。昼夜环转之无端也。一息不运。
则留滞而为痈为痹。故圣人立九针之法。所以治未病也。若积久而成痈疽。则多不治之死证矣。夫营卫
血气之行。皆
从内而外。应寒暑往来。经水流行。皆从地而出。帝复论上焦出气。以温分肉而养骨节。通腠理。中
焦出气如露。上注 谷而渗孙脉。从孙脉而注于络脉经脉。是从气分而注于经脉之中。乃从外而内。
应天道之营运于外。而复通于经水之中。人与天地参也。故经脉流行不止。与天同度。与地合纪。天
宿失度。日月薄蚀。地经失纪。水道流溢。人之血气犹然。夫血脉营卫。周流不休。上应星宿。下应
经数。如寒邪客于经络之中。则血泣。血泣则不通。不通则卫气归之。归、还也。盖营行脉中。卫行
脉外。交相逆顺而行者也。营血留泣不行。则卫气亦还转而不得复反其故道。故痈肿也。骨空者。节
之交也。痈肿不当骨空之处。则骨中之邪热。不得泄泻矣。血枯而经脉空虚。则筋骨肌肉不相营矣。经
脉外络形身。内属脏腑。经脉败漏。则熏于五脏。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。三日而已。
夫皮脉肉筋骨。五脏之外合也。而脏腑之血
气循行。又各有部分。故有轻重死生之别焉。嗌乃呼吸出入之门。发于嗌中。其势甚猛。故名猛疽。若
脓不泻而塞嗌。则呼吸不通。不待半日而死矣。嗌乃肺之上管。肺肾上下交通。豕乃水畜。冷冻饮料豕膏者。
使热毒从下而出也。
发于颈名曰夭疽。其痈大以赤黑。不急治。则热气下入渊液。前伤任脉。内熏肝肺。
熏肝肺。十余日而死矣。颈乃手足少阳阳明血气循行之分部。故不急治。则热气下入渊液。渊液乃足少
阳胆经穴。在腋下三寸。盖从外而将入于内也。任脉居阳明少阳四脉之中。故前伤在脉。内熏肝肺。此
在外腑经之毒。内熏于脏。故至
十余日而死。经云。上工治皮肤。其次治经脉。其次治六腑。其次治五脏。治五脏者。半死半生。为
疡医者。不可不知也。
阳气大发。消脑留项。名曰脑烁。其色不乐。项痛而如刺以针。烦心者。死不可治。
阳气大发者。三阳之气并发也。三阳者。太阳也。太阳经脉入于脑。出于项。故阳气大发。留于项。
名曰脑烁。此纯阳之气。消烁脑髓也。夫心为阳中之太阳。心与太阳。标本相合。心气受郁。故其色
不乐。若烦心者。腑毒干脏。死不可治矣。
发于肩及 。名曰疵疽。其状赤黑。急治之。此令人汗出至足。不害五脏。痈发四五日逞
之。（ 热同）
肩 乃肺脏之部分。故令人汗出至足。此痈生浮浅。如疵之在皮毛。故名疵痈。而不害五脏。逞、
快也。速 治之。则毒随气而散矣。姚氏曰。火气能消肺金之毒。
发于腋下。赤坚者。名曰米疽。治之以砭石。欲细而长。疏砭之。涂以豕膏。六日已。勿裹之。
腋者。亦肺脏之部分。米者。言其小也。治之以砭石者。痈亦浮浅也。毒瓦斯在于皮肤之间。六日则气
已周而来复。故已。勿裹之者。使毒瓦斯外泄也。夫痈发于腑部者。反熏脏而死。发于脏部者易已。此
皆浅深内外之别。为疡医者。不可不知。
其痈坚而不 者。为马刀侠缨。急治之。（缨当作瘿）
其痈坚而不 者。承上文而言。痈在膺腋之间。坚而不溃者。此为马刀侠瘿。金匮要略曰。人年五
六十。其病脉大。痹挟背行。苦肠鸣。马刀侠瘿者。皆为劳得之。夫马刀侠瘿。足阳明之证也。四肢为诸阳之本。
劳其四体。
则伤阳明而有是证。故宜急治之。以保胃气。
发于胸。名曰井疽。其状如大豆。三四日起。不早治。下入腹。不治。七日死矣。
胸者。膻中之分。宗气之所居也。宗气出于阳明。故不早治。则下入于腹。而伤阳明胃气。胃气伤。则七
日死矣。
发于膺。名曰甘疽。色青。其状如谷实 KT 。常苦寒热。急治之。去其寒热。十岁死。死后出脓。
（音括KT 音楼）
膺乃足厥阴阳明之部分。故疽发于此。其名曰甘。其色青也。状如谷实 KT 者。如米谷如栝蒌之
子实也。阳明从太阴之化。厥阴从少阳之化。阴阳互交。故往来寒热也。急治之以去其寒热。此疽至
十年而后发乃死。死后出脓者。谓至将死之候。然后出脓而死。此即乳岩石痈之证也。夫寒热者。厥阴
阳明之气病也。如谷实 KT 者。肝脏胃腑之郁毒。留于脉络之间。即如窜 寒热之毒。其本在脏。其末
在脉。故不易消。而亦不即发也。至十年之久。脏腑之气将衰。则毒瓦斯发而溃烂死矣。
发于胁。名曰败疵。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。
锉翘草根各一升。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（ 同）
胁在腋之下。肺肝之部分也。此亦发于皮肤。故名曰败疵。夫肺主气。肝主血。女子之生。有余于
气。不足于血。此因气血不调而生。故为女子之病。其病大痈脓治之者。谓如治大痈之法以灸之也。其
中乃有生肉。大如赤小豆。是虽名败疽。而不至于腐肉烂筋伤骨矣。 乃水草。翘、连翘也。锉二草根各
一升煮之。强饮浓衣坐
于釜上。令汗出至足乃已。盖水草能清热发汗。翘能解毒者也。
发于股胫。名曰股胫疽。其状不甚变而痈脓搏骨。不急治之。三十日死矣。
发于股胫。足少阴之毒也。其状不甚变者。毒附于骨而不外发。故皮肤不甚变为痈毒之状也。
不急治之。三十日死。肾为水脏。月为阴而应水。故应月一周而死。
发于尻。名曰锐疽。其状赤坚大。急治之。不治。三十日死矣。
尻乃足太阳之部分。太阳之上。寒水主之。故亦应月而死。夫肾与膀胱。为水脏水腑。肾为
阴而主骨。故痈脓搏骨而不外发。腑为阳。而太阳之气。主于肤表。故其状赤坚而大。夫阳毒起
发于外。而亦致死者。太阳为诸阳主气也。噫。能知脏腑阴阳。营卫血气。表里标本。多能死中
求生。为疡医者。可不知内经乎。
发于股阴。名曰赤施。不急治。六十日死。在两股之内。不治。十日而当死。
股阴者。足三阴之部分也。以火毒而施于阴部。故名曰赤施。六十者。水之成数也。十日者。
阴数之终也。闵士先曰。股阴者。足少阴之分也。两股之内者。足太阴厥阴之分也。
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。
膝者筋之会。足少阳之分也。色不变者。色与皮肤相同而不赤也。其状如大痈而色不变者。毒
在外内之间也。盖少阳主枢。故其色状如此。而为寒为热也。如坚石者。勿砭石之。石之则死。毒
气入于内也。须其柔软而石之者生。毒瓦斯出于外也。盖少阳主枢。可内而可外也。余伯荣曰。坚石
者。毒瓦斯尚未透发。柔则发于外矣。故有外内死生之分焉。
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。
此论痈疽之发于背也。节者。脊之二十一椎。每椎有节之交。神气之所游行出入者也。相应者。
内应于五脏也。发于阳者。发于三椎。而内应于肺脏。发于四椎。而内应于心主包络。发于五椎。
而内应于心脏也。发于阴者。发于七椎。而内应于肝脏。发于十一椎。而内应于脾脏。发于十四椎。
而内应于肾脏也。百日死者。日之终也。三十日者。月之终也。余伯荣曰。痈疽发于背而偏者。或
伤及脏腑之俞。犹有可生之机。正中者。伤及督脉。而况相应于五脏乎。闵士先曰。痈者。壅也。疽者。
阻也。毒者。痈疽之总名也。上古以痈疽所发之处。分阴阳而命名。后世以发于背者。即名曰发背。
发于臂者。即名曰臂痈。是以古今之命名。各不同焉。姚士因曰。节之交。骨空处也。周身三百六十
五节。而四肢有十二大节。皆髓孔易髓之处。上文曰。不当骨空。不得泄泻。谓痈不当于骨空之处。
其伤骨消髓之热邪。无从而出。若诸痈疽之发于节者。正当邪热所出之空。非死征也。马氏云。其节之外
廉为阳。内廉为阴。是发于四肢之内外廉者。皆不治之死证耶。噫。经义渊微。不易阐发。岂可以
粗疏之学。贻误后人。
发于胫。名曰兔啮。其状赤至骨。急治之。不治。害人也。
兔乃阴类。发于胫。名曰兔啮者。发于阴胫也。其状赤至骨者。从外而内也。故曰急治之。不治
害人也。犹言外贼之来害人也。夫冲脉者。十二经之海也。与少阴之大络起于肾。下出于气街。循阴
股内廉。邪入 中。循胫
骨内廉。下入内踝之后。此邪客于冲脉之中。则血泣不通。有如兔啮之微肿也。
发于内踝。名曰走缓。其状痈也。色不变。数石其输。而止其寒热。不死。
此邪客于足少阴之脉而为肿也。夫痈疽之变。有病因于内。而毒瓦斯走于外者。有肿见于外。而
毒瓦斯走于内者。此邪留于脉而不行。故名曰走缓。其状若痈而色不赤也。足少阴之脉。起于小趾之
下。邪越足心。出然谷之下。循内踝之后。以上端内。故当数石其输。去其邪而止其寒热。盖足少
阴秉先天之水火。故能为寒为热也。余伯荣曰。鼠 。寒热病也。发于少阴。
发于足上下。名曰四淫。其状大痈。急治之。百日死。
四淫者。邪气行于左右之太少也。少阳主初阳之生气。而发于肾脏。太阳乃肾之腑。而为诸阳主
气。故当急治之。不则阳气伤而百日死矣。
发于足旁。名曰厉痈。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。
此寒邪客于足阳明之脉而为痈也。足阳明之脉。起于足大趾次趾之厉兑。故发于足旁。名曰厉痈。
夫在地为水。在天为寒。黑者。水之气色也。不急治之以去其黑。则寒淫而土败矣。姚士英曰。少阳
太阳之气。生于下焦。故邪客于下。其状大痈。阳明之气。生于中焦。故邪客于下。其状不大。盖经络
伤而气未伤也。闵士先曰。初如小指发者。谓初发如小指。其状肿而长。乃邪在经络之形也。卫气归
之。则圆而坟起矣。
发于足趾。名曰脱痈。其状赤黑。死不治。不赤黑不死。不衰。急斩之。不则死矣。
此足少阴之毒。从内而发于外。故曰脱痈。谓从阴而脱出于阳也。发于足趾者。发于足大趾也。
动输篇曰。足少阴之经。下入内踝之后。入足下。其别者。邪入踝。出属跗上。入大趾之间。注
诸络。夫足少阴。秉先天之水火。其状赤黑者。水火之淫毒太盛。故为不治之死证。不赤黑者。其毒
气少衰。故为不死。如痈肿不衰。急斩去其趾。不则毒瓦斯注于诸经之络而死矣。
黄帝曰。夫子言痈疽。何以别之。岐伯曰。营卫稽留于经脉之中。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。肉腐则为脓。然不能陷骨髓。不为焦
枯。五脏不为伤。故命曰痈。黄帝曰。何谓疽。岐伯曰。热气淳盛。下陷肌肉。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。痈者。其皮
上薄以泽。此其候也。
上文分别部位之阴阳死生。此总论痈疽之浅深轻重。盖人之血气流行。环转出入。而淫邪泮衍。
变易无常。且气秉有浓薄。邪客有微甚。是以死生成败。各不同焉。按内经论痈疽所发。有因于喜怒不
测。饮食不节。脏腑不和。则留积而为痈者。有因于脏腑之寒热相移而成痈者。本篇只论外因之邪。
盖以人之血气流行。与天同度。与地合纪。因息乃行。不得休止。少有留滞。则为痈为痹矣。是以圣人
黄帝说：我听说肠胃受纳水谷，上焦宣发阳气以温煦肌肉、滋养骨节、疏通腠理；中焦化生之气如露水般滋润，向上灌注于血脉，渗入孙脉（最细小的脉络），使津液调和，变化而成红色的血液。血液调和则孙脉先充盈，进而注入络脉，络脉充满后，再注入经脉。阴阳之气已充盛，随着呼吸运行，运行有常道，循环有规律，与天地自然相合，永不停息。诊察调理时，应从虚证转向实证（注：此处原文逻辑似有倒置或特定语境，通常泻实补虚，但依原文直译），实则用泻法则气减，留针不当则先后有序；从实证转向虚证，实则用补法则有余。血气已经调和，形体与正气才能稳固。我已经了解了血气的平和与不平和，但还不知道痈疽是如何产生的，其成败的时机，以及死生的期限远近，如何判断？可以讲给我听吗？
岐伯说：经脉中的气血流行不止，与天体的运行度数相同，与大地的纪纲相合。所以天上的星宿失去常态，日月就会发生亏蚀；大地的经路失去规律，水道就会泛滥，草木不能生长，五谷不能种植，道路不通，百姓无法往来，村落城邑分离孤立。人体气血的运行也是如此。请让我说明其中的道理。血脉和营卫之气，周流不息，上应星宿，下应地里的沟渠数目。寒邪侵入经络之中，血液就会凝涩；血液凝涩就不通畅；不通畅则卫气聚集于此，无法再返回原来的轨道，所以形成痈肿。寒气转化为热，热盛则腐蚀肌肉，肌肉腐烂则化为脓。脓液如果不排出，就会烂筋；筋腐烂则伤骨；骨受伤则骨髓消减。如果不在骨空处（关节空隙）泄泻毒邪，血液就会枯竭空虚，导致筋骨肌肉相互失养。经脉败坏渗漏，毒气熏蒸五脏，脏腑受损就会死亡。（“泣”通“涩”，意为凝涩）。
这一篇归结了首章的意义。大概人体的气血流行，与天地相参验，与日月相应和，昼夜循环运转没有尽头。只要有一息不运，就会留滞而形成痈或痹证。所以圣人创立九针的方法，是用来治疗未病之病的。如果积久形成痈疽，就大多是不治的死证了。营卫血气的运行，都是从内向外，顺应寒暑的往来；经水的流行，都是从地下涌出。黄帝又论述上焦宣发阳气，以温煦肌肉、滋养骨节、疏通腠理；中焦化生之气如露水，向上灌注于血脉而渗入孙脉，从孙脉注入络脉、经脉。这是从气分注入到经脉之中，是从外向内，顺应天道在外的营运，而又通达于经水之中。人与天地是相参应的。所以经脉气血流行不止，与天同度，与地合纪。天体星宿失常，日月亏蚀；大地经路失序，水道泛滥。人体气血也是这样。血脉营卫，周流不休，上应星宿，下应经数。如果寒邪客居在经络之中，血液就会凝涩；血液凝涩就不通；不通则卫气归附于此。“归”就是“还”。一般来说，营气行于脉中，卫气行于脉外，二者交错逆顺而行。营血留滞不行，卫气也就回转而不能恢复原来的轨道，所以形成痈肿。骨空，是指关节的连接处。痈肿如果不生在骨空之处，那么骨中的邪热就无法泄泻。血液枯竭而经脉空虚，筋骨肌肉就不能相互濡养。经脉外连形体，内属脏腑，经脉败坏渗漏，毒气就会熏蒸五脏，脏腑受损就会死亡。
岐伯说：痈发生在咽喉中间，名叫猛疽。猛疽如果不治疗，会化为脓；脓如果不排出，堵塞咽喉，半天就会死亡。如果已经化为脓，排出脓液后，配合食用冷的猪脂膏，三天就能痊愈。
皮、脉、肉、筋、骨，是五脏的外合部分，而脏腑的血气循行，又各有分部，所以有轻重死生的区别。咽喉是呼吸出入的门，发生在咽喉中间，势头很猛烈，所以叫猛疽。如果脓不排出而堵塞咽喉，呼吸就不通，不到半天就会死亡。咽喉是肺的上管，肺肾上下交通。猪是水畜，冷冻饮料猪脂膏，是为了使热毒从下面排出。
发生在颈部，名叫夭疽。它的痈很大，颜色赤黑，如果不及时治疗，热气就会向下进入渊液穴，向前损伤任脉，向内熏蒸肝肺。熏蒸肝肺，十多天后就会死亡。颈部是手足少阳、阳明经血气循行的分部，所以如果不及时治疗，热气就会向下进入渊液穴。渊液是足少阳胆经的穴位，在腋下三寸，这是从外部将要进入内部。任脉位于阳明、少阳四脉之中，所以向前损伤的是经脉，向内熏蒸肝肺。这是在外腑经的毒邪，向内熏蒸于脏，所以到了十多天就会死亡。经文说：上工治疗皮肤，其次治疗经脉，其次治疗六腑，其次治疗五脏。治疗五脏的病，一半能活一半会死。做外科医生的人，不可不知道这些。
阳气大发，消耗脑髓并停留在项部，名叫脑烁。患者面色不乐，项痛像被针刺一样，心烦意乱的，是死证，不可治疗。
阳气大发，是三阳之气并发。三阳，指太阳经。太阳经脉入于脑，出于项，所以阳气大发，停留在项部，名叫脑烁。这是纯阳之气，消烁脑髓。心为阳中之太阳，心与太阳经标本相合，心气受郁，所以面色不乐。如果心烦意乱，是腑毒干扰脏气，属于死证，不可治疗。
发生在肩部和髆（音bó，肩胛骨）之间，名叫疵疽。它的形状赤黑，要紧急治疗。这会导致人出汗直到脚部，但不伤害五脏。痈发生四五天后，要迅速切开排脓。（“ ”同“热”）。
肩髆是肺脏的分部，所以会导致人出汗直到脚部。这个痈生得浮浅，像瑕疵在皮毛一样，所以名叫疵痈，而不伤害五脏。“逞”是快的意思。迅速治疗，毒邪就会随气消散。姚氏说：火气能消除肺金的毒邪。
发生在腋下，颜色赤硬，名叫米疽。用砭石治疗，砭石要细而长，稀疏地刺破，涂上猪脂膏，六天痊愈，不要包扎。
腋下也是肺脏的分部。“米”是说它小。用砭石治疗，是因为痈也浮浅。毒邪在皮肤之间，六天气机已经周流而复来，所以痊愈。不要包扎，是为了让毒邪外泄。痈发生在腑部，反而熏蒸内脏而死；发生在脏部，容易痊愈。这都是深浅内外的区别，做外科医生的人，不可不知道。
痈坚硬而不溃破的，叫做马刀侠瘿，要紧急治疗。（“缨”当作“瘿”）。
痈坚硬而不溃破的，是承接上文而言。痈在胸膺腋间，坚硬而不溃破的，这就是马刀侠瘿。《金匮要略》说：人五六十岁，病脉大，痹症夹背而行，苦于肠鸣，马刀侠瘿，都是因为劳损引起的。马刀侠瘿，是足阳明经的证候。四肢是诸阳之本，劳损四肢，就会损伤阳明而产生这种证候，所以应该紧急治疗，以保护胃气。
发生在胸部，名叫井疽。形状像大豆，三四天起病，不早治疗，毒邪会向下进入腹部，不治疗七天就会死亡。
胸部是膻中的分部，是宗气居住的地方。宗气出于阳明，所以不早治疗，毒邪就会向下进入腹部，损伤阳明胃气。胃气受伤，七天就会死亡。
发生在胸膺部，名叫甘疽。颜色青，形状像谷实栝蒌子，常常苦于寒热交替，要紧急治疗，去除寒热症状，十年后会死，死后出脓。
胸膺是足厥阴、阳明经的分部，所以疽发生在这里，名字叫甘，颜色青。形状像谷实栝蒌子的，就像米谷如栝蒌的子实。阳明从太阴化，厥阴从少阳化，阴阳互交，所以往来寒热。紧急治疗以去除寒热，这个疽要到十年后才发作致死。死后出脓，是说到了将死的时候，然后出脓而死。这就是乳岩石痈的证候。寒热，是厥阴、阳明之气生病。像谷实栝蒌子，是肝脏胃腑的郁毒，留在脉络之间，就像窜动寒热的毒邪，根本在脏，末梢在脉，所以不容易消散，也不立即发作。到了十年之久，脏腑之气将衰，毒邪发作而溃烂死亡。
发生在胁部，名叫败疵。败疵是女子的病。灸治它，病变成大痈脓，治疗它，其中会有像赤小豆大小的生肉。锉取水草根和翘草根各一升，用水一斗六升，煮至水干，取汁三升，用力喝下，穿厚衣服，坐在锅上，令出汗直到脚部为止。（“ ”同“薤”）。
胁在腋下，是肺肝的分部。这也发生在皮肤，所以名叫败疵。肺主气，肝主血，女子生成时，气有余而血不足，这是因为气血不调而产生的，所以是女子的病。所谓“其病大痈脓治之”，是说像治疗大痈的方法去灸治它。其中会有像赤小豆大小的生肉，虽然名叫败疽，但不至于腐肉烂筋伤骨。“ ”是水草，“翘”是连翘。锉这两种草根各一升煮汤，强饮，穿厚衣坐在锅上，令出汗直到脚部才停止。大概水草能清热发汗，翘能解毒。
发生在股部和胫部，名叫股胫疽。形状变化不明显，但痈脓附着在骨头上，不紧急治疗，三十天就会死亡。
发生在股胫，是足少阴经的毒邪。形状变化不明显，是因为毒邪附着在骨头而不向外发散，所以皮肤不呈现明显的痈毒形状。不紧急治疗，三十天死亡。肾是水脏，月是阴而应水，所以对应月亮的一个周期（三十天）而死。
发生在尻部（尾椎），名叫锐疽。形状赤黑坚硬大，要紧急治疗。不治疗，三十天就会死亡。
尻部是足太阳经的分部，太阳之上，寒水主事，所以也对应月亮而死。肾与膀胱，是水脏水腑。肾为阴而主骨，所以痈脓附着骨头而不向外发散。腑为阳，而太阳之气，主管肤表，所以形状赤黑坚硬大。阳毒起发于外部，也会导致死亡，因为太阳是诸阳主气。唉，能知道脏腑阴阳、营卫血气、表里标本，大多能在死中求生，做外科医生的人，能不学习《内经》吗？
发生在股内侧，名叫赤施。不紧急治疗，六十天死亡。如果在两腿内侧，不治疗十天就会死亡。
股内侧是足三阴经的分部。用火毒施于阴部，所以名叫赤施。六十是水成之数。十是阴数之终。闵士先说：股内侧，是足少阴的分部。两腿内侧，是足太阴、厥阴的分部。
发生在膝盖，名叫疵痈。形状是大痈，颜色不变，有寒热，像坚硬的石头。不要用砭石刺。用砭石刺的会死，必须等它变柔软，再用砭石刺的才会生。
膝盖是筋的聚会处，是足少阳经的分部。颜色不变，是指颜色与皮肤相同而不红。形状像大痈而颜色不变，说明毒邪在内外之间。少阳主枢机，所以颜色和形状如此，表现为寒热。像坚硬石头，不要用砭石刺。刺了就会死，因为毒气会陷入内部。必须等它柔软再用砭石刺，这样才会生，因为毒邪会出于外部。少阳主枢机，可内可外。余伯荣说：坚硬石头，说明毒邪尚未透发；柔软则发于外部，所以有内外死生的区别。
各种痈疽发生在关节且与内脏相应的，不可治疗。发生在阳经的，一百天死；发生在阴经的，三十天死。
这是论述痈疽发生在背部。关节，是指脊柱的二十一椎，每椎有关节的连接，是神气游行出入的地方。相应，是指内应于五脏。发生在阳经，是指发生在第三椎，内应于肺脏；发生在第四椎，内应于心包络；发生在第五椎，内应于心脏。发生在阴经，是指发生在第七椎，内应于肝脏；发生在第十一椎，内应于脾脏；发生在第十四椎，内应于肾脏。一百天死，是一年的终结（日之终）；三十天死，是一个月的终结（月之终）。余伯荣说：痈疽发生在背部偏侧的，或者伤及脏腑的俞穴，还有可生的机会；正中发生的，伤及督脉，何况相应于五脏呢？闵士先说：痈，是壅塞；疽，是阻隔；毒，是痈疽的总名。上古根据痈疽发生的地方分阴阳命名，后世把发生在背部的就叫发背，发生在手臂的就叫臂痈，所以古今命名各不相同。姚士因说：关节的连接处，就是骨空处。周身三百六十五节，四肢有十二个大节，都是髓孔易髓的地方。上文说：不当骨空，不得泄泻。意思是痈如果不生在骨空之处，伤骨消髓的热邪就没有出路。如果各种痈疽发生在关节，正当邪热排出的空处，就不是死征。马氏说：关节的外侧为阳，内侧为阴，这是说发生在四肢内外侧的，都是不治的死证吗？唉，经义深奥微妙，不易阐发，岂可以用粗疏的学问贻误后人。
发生在小腿，名叫兔啮。形状红色直达骨头，要紧急治疗。不治疗，会害人。
兔子是阴类，发生在小腿，名叫兔啮，是发生在阴胫。形状红色直达骨头，是从外向内。所以说紧急治疗。不治疗会害人，就像外贼来害人一样。冲脉是十二经之海，与少阴的大络起于肾，向下出于气街，沿着阴股内侧，邪气侵入其中，沿着胫骨内侧，向下进入内踝之后。这是邪气客居在冲脉之中，血液凝涩不通，就像兔啮一样的微肿。
发生在内踝，名叫走缓。形状是痈，颜色不变，多次针刺其输穴，以止住寒热，不会死。
这是邪气客居在足少阴脉而导致肿胀。痈疽的变化，有病因在内而毒邪走于外的，有肿见于外而毒邪走于内的。这里邪气留在脉中不行，所以名叫走缓。形状像痈但颜色不红。足少阴脉，起于小趾之下，邪气越过足心，出于然谷之下，沿着内踝之后，向上端内。所以应当多次针刺其输穴，去除邪气而止住寒热。足少阴秉承先天的水火，所以能表现为寒或热。余伯荣说：鼠瘰，是寒热病。发生在少阴经。
发生在足上下，名叫四淫。形状是大痈，要紧急治疗，一百天死亡。
四淫，是邪气行于左右的大小肠（或少阳太阳）。少阳主初阳的生气，而发于肾脏；太阳是肾的腑，而为诸阳主气，所以应当紧急治疗。否则阳气受伤，一百天死亡。
发生在足旁，名叫厉痈。形状不大，起初像小指肿大，要紧急治疗，去掉黑色的部分。如果不消退反而增加，不治疗，一百天死亡。
这是寒邪客居在足阳明脉而形成的痈。足阳明脉，起于足大趾次趾的厉兑穴，所以发生在足旁，名叫厉痈。在地为水，在天为寒，黑色是水的气色。不紧急治疗以去除黑色，就会寒邪肆虐而土气败坏。姚士英说：少阳太阳之气，生于下焦，所以邪气客居在下，形状是大痈。阳明之气，生于中焦，所以邪气客居在下，形状不大。大概是经络受伤而气未伤。闵士先说：起初像小指肿大，是说初发时像小指，形状肿而长，是邪气在经络的形态。卫气归附于此，就会圆而坟起。
发生在足趾，名叫脱痈。形状赤黑，死证不可治。如果不赤黑就不会死。如果不衰退，要紧急截肢，否则就会死亡。
这是足少阴的毒邪，从内发于外，所以叫脱痈，意思是阴毒脱出于阳。发生在足趾，是发生在足大趾。《动输篇》说：足少阴经，向下进入内踝之后，入足下。其别支，邪气入踝，出属跗上，入大趾之间，注入诸络。足少阴秉承先天的水火，形状赤黑的，是水火淫毒太盛，所以是不治的死证。不赤黑的，毒气稍衰，所以不死。如果痈肿不衰退，紧急截去脚趾，否则毒邪注入诸经之络就会死亡。
岐伯说：营卫稽留在经脉之中，血液凝涩而不行，不行则卫气随之而不通，壅遏而不能运行，所以发热。大热不止，热盛则肉腐，肉腐则为脓。但是不能陷进骨髓，不为焦枯，五脏不受伤，所以名叫痈。
岐伯说：热气淳盛，向下陷入肌肉，筋髓枯槁，内连五脏，血气竭尽。当痈发生时，筋骨良肉都没有剩余，所以名叫疽。疽，上面的皮肤枯夭而且坚硬，上面像牛颈的皮肤；痈，上面的皮肤薄而有光泽。这是它们的征候。
上文分别论述了部位阴阳的死生，这里总论痈疽的浅深轻重。大概人体的气血流行，环转出入，而淫邪泮衍，变易无常。而且禀气有浓薄，邪客有微甚，所以死生成败，各不相同。按《内经》论述痈疽的发生，有因喜怒不测、饮食不节、脏腑不和，导致留积而为痈的；有因脏腑寒热相移而成痈的。本篇只论外因之邪，大概因为人体的气血流行，与天同度，与地合纪，随着呼吸运行，不得休止，稍有留滞，就会成为痈或痹证。所以圣人……
Huangdi said: I have heard that the intestines and stomach receive grain. The Upper Jiao (Upper Burner) emits Qi to warm the muscles, nourish the bone joints, and open the interstices (cou li). The Middle Jiao (Middle Burner) produces Qi like dew, which flows upward into the blood vessels and seeps into the Sun vessels (the finest branches of the collaterals). When the body fluids are harmonized, they transform and turn red to become blood. When the blood is harmonized, the Sun vessels fill first, then flow into the Luo vessels (collaterals); when the Luo vessels are full, they flow into the Jing vessels (main meridians). Yin and Yang Qi are fully distended, and movement occurs with respiration. Movement has its order, and circulation has its principles, conforming to the Heavenly Dao, never ceasing. Palpating and regulating it: from deficiency, go to excess; using reduction (sedation) leads to insufficiency; rapid manipulation reduces Qi, while retention affects the sequence. From excess, go to deficiency; using reinforcement leads to surplus. Once Blood and Qi are regulated, Form and Zheng Qi are maintained. I already know the balance and imbalance of Blood and Qi, but I do not yet know the origin of carbuncles and ulcers, the timing of their success or failure, and the proximity or remoteness of death and life periods. How can we measure this? May I hear about it?
Qibo said: The flow of Qi and Blood in the meridians never stops, corresponding to the degrees of Heaven and the measures of Earth. Therefore, if the stars in Heaven lose their order, the sun and moon will be eclipsed; if the channels on Earth lose their records, waterways will overflow, grass and trees will fail to grow, and grains will not be cultivated. Paths will be blocked, and people will not travel; villages and towns will be separated and isolated. The same applies to human Qi and Blood. Let me explain the reason. Blood vessels, Ying (Nutritive) Qi, and Wei (Defensive) Qi circulate without rest, responding above to the constellations and below to the number of earthly channels. If Cold Evil lodges in the meridians, Blood becomes stagnant (si). Stagnant Blood causes obstruction. Obstruction causes Wei Qi to gather there and prevents it from returning to its original path, thus forming a swelling (carbuncle). Cold Qi transforms into Heat. Excessive Heat rots the flesh, and rotted flesh becomes pus. If pus is not drained, tendons rot; rotten tendons damage bones; damaged bones cause marrow depletion. If not drained at the bone voids (joint spaces), Blood becomes dry and empty, causing bones, tendons, muscles, and flesh to fail to nourish each other. Meridians deteriorate and leak, fuming upon the Zang Organs. Damage to the Zang Organs leads to death. ("Qi" here is synonymous with "Se", meaning stagnation).
This chapter summarizes the meaning of the first chapter. Essentially, human Qi and Blood circulation corresponds with Heaven and Earth and resonates with the sun and moon, rotating day and night without end. If even one breath fails to move, stagnation occurs, leading to carbuncles or bi-syndrome. Thus, the Sages established the method of the Nine Needles to treat disease before it arises. If accumulation persists and forms carbuncles and ulcers, they are mostly untreatable fatal conditions. The movement of Ying, Wei, Blood, and Qi all proceeds from the interior to the exterior, responding to the alternation of cold and heat. Water in rivers flows out from the ground. Huangdi further discussed how the Upper Jiao emits Qi to warm muscles, nourish bones, and open interstices, and how the Middle Jiao produces Qi like dew, flowing upward into grain/blood and seeping into Sun vessels, then from Sun vessels into Luo and Jing vessels. This is moving from the Qi level into the meridians, from the exterior to the interior, responding to the heavenly operation outside and connecting with the water channels. Humans correspond with Heaven and Earth. Thus, the flow of Qi and Blood in the meridians never stops, corresponding to the degrees of Heaven and the measures of Earth. If celestial bodies lose order and sun/moon are eclipsed, or earthly channels lose regulation and waters overflow, human Qi and Blood behave similarly. Blood vessels, Ying, and Wei circulate incessantly, responding above to stars and below to channel numbers. If Cold Evil lodges in the meridians, Blood stagnates; stagnant Blood obstructs; obstruction causes Wei Qi to return and not revert to its original path, hence swelling. Bone voids refer to joint intersections. If a swelling does not occur at a bone void, the heat evil in the bone cannot be drained. Dry Blood and empty meridians cause bones, tendons, muscles, and flesh to lack mutual nourishment. Meridians connect externally to the form and internally to the organs. Deteriorated and leaking meridials fumigate the five Zang organs, causing organ damage and death.
Huangdi said: I wish to hear completely about the manifestations of carbuncles and ulcers, and the names related to taboo days.
Qibo said: A carbuncle occurring in the throat is called Meng Ju (Fierce Ulcer). If Meng Ju is not treated, it turns to pus. If pus is not drained, blocking the throat, death occurs within half a day. For those who have turned to pus, draining it and consuming cold pig fat ointment results in recovery within three days.
Skin, vessels, muscle, sinews, and bones are the external combinations of the five Zang organs. The circulation of Qi and Blood in the organs and bowels has specific distributions, leading to differences in severity, death, and life. The throat is the gate for respiration. Occurring in the throat, the condition is fierce, hence named Meng Ju. If pus blocks the throat without drainage, respiration is blocked, and death occurs before half a day passes. The throat is the upper tube of the Lung. Lung and Kidney communicate vertically. Pigs are aquatic animals. Consuming chilled pig fat ointment allows heat toxins to exit downward.
A carbuncle occurring on the neck is called Yao Ju (Premature Death Ulcer). The swelling is large and red-black. If not treated urgently, heat qi descends into Yuan Ye (Gallbladder meridian point, 3 cun below the axilla), damages the Ren Mai (Conception Vessel) anteriorly, and internally fumigates the Liver and Lung. Fumigating the Liver and Lung leads to death in ten-plus days. The neck is the distribution area for the Qi and Blood of the Hand and Foot Shaoyang and Yangming meridians. Without urgent treatment, heat descends into Yuan Ye. The Ren Mai lies among the Yangming and Shaoyang four meridians, so anterior damage affects the vessel, and internal fumigation affects the Liver and Lung. This is toxin from external bowels and meridians fumigating the zang organs, leading to death in ten-plus days. The Classic states: Superior physicians treat the skin; next, the meridians; next, the six bowels; next, the five zang organs. Treating zang organ diseases results in half survival and half death. Surgeons must know this.
Excessive emission of Yang Qi, consuming brain marrow and remaining in the nape, is called Nao Shuo (Brain Melting). The complexion is unhappy, the nape hurts as if pierced by a needle, and there is mental distress. This is a fatal, untreatable condition.
Excessive Yang Qi refers to the concurrent emission of the Three Yang Qi. The Three Yang refers to the Taiyang (Greater Yang) meridian. The Taiyang meridian enters the brain and emerges from the nape. Thus, excessive Yang Qi remains in the nape, called Nao Shuo. This pure Yang Qi consumes brain marrow. The Heart is the Greater Yang within the Yang. The Heart and Taiyang meridian share root and branch. Heart Qi is depressed, hence the unhappy complexion. If accompanied by mental distress, bowel toxin interferes with zang organs, making it fatal and untreatable.
A carbuncle occurring between the shoulder and scapula is called Ci Ju (Flaw Ulcer). Its appearance is red-black. It requires urgent treatment. This causes sweating down to the feet but does not harm the five zang organs. The carbuncle should be opened quickly after four or five days.
The shoulder and scapula are the distribution of the Lung organ. Hence, it causes sweating down to the feet. This carbuncle is superficial, like a flaw on the skin/hair, hence named Ci Ju, and does not harm the zang organs. "Cheng" means fast. Rapid treatment disperses the toxin with the Qi. Master Yao stated: Fire Qi can eliminate Lung Metal toxin.
A carbuncle occurring in the armpit, red and hard, is called Mi Ju (Rice Ulcer). Treat with bian stones (lithotripsy/stone knives). The stones should be fine and long, pricking sparsely. Apply pig fat ointment. Recovery in six days. Do not bandage.
The armpit is also the distribution of the Lung organ. "Mi" indicates smallness. Treatment with bian stones indicates the carbuncle is superficial. Toxin resides between the skin. In six days, Qi cycles and returns, leading to recovery. Not bandaging allows toxin to vent externally. Carbuncles arising in bowel areas fumigate zang organs leading to death; those arising in zang areas heal easily. These are distinctions of depth and interior/exterior. Surgeons must know this.
A carbuncle that is hard and does not suppurate is called Ma Dao Xia Ying (Horse Knife and Companion Goiter). Urgent treatment is required. ("Ying" should be "Ying" - goiter).
Hard and non-suppurating continues the previous context. A carbuncle between the chest and armpit that is hard and does not ulcerate is Ma Dao Xia Ying. *Jin Gui Yao Lue* states: People aged fifty or sixty, with large pulse, bi syndrome affecting the back, intestinal murmurs, Ma Dao Xia Ying, are all caused by consumption/labor. Ma Dao Xia Ying is a symptom of the Foot Yangming meridian. The four limbs are the root of all Yang. Labor on the four limbs damages Yangming, causing these symptoms. Urgent treatment is needed to preserve Stomach Qi.
A carbuncle occurring in the chest is called Jing Ju (Well Ulcer). Its shape is like a soybean. It appears in three to four days. If not treated early, it descends into the abdomen. Untreated, death occurs in seven days.
The chest is the distribution of Dan Zhong (Chest Center), where Zong Qi (Gathering Qi) resides. Zong Qi originates from Yangming. If not treated early, it descends into the abdomen, damaging Yangming Stomach Qi. Damage to Stomach Qi leads to death in seven days.
A carbuncle occurring in the pectoral region is called Gan Ju (Sweet Ulcer). The color is green. The shape is like grain seeds or trichosanthes fruit. Patients often suffer from alternating chills and fever. Urgent treatment is required to remove chills and fever. Death occurs after ten years, with pus discharge post-mortem.
The pectoral region is the distribution of the Foot Jueyin and Yangming meridians. Hence, the ulcer is named Gan (Sweet) and is green. The shape resembles grain/trichosanthes seeds. Yangming transforms from Taiyin; Jueyin transforms from Shaoyang. Yin and Yang interact, causing alternating chills and fever. Urgent treatment removes chills and fever. This ulcer manifests death only after ten years. Pus discharge post-mortem means pus appears at the moment of death. This is the syndrome of breast rock tumor. Chills and fever indicate pathology of Jueyin and Yangming Qi. Resembling grain seeds indicates郁毒 (depressed toxin) of the Liver and Stomach lodged in the collaterals, similar to migrating chills/fever toxin. The root is in the zang, the branch in the vessels, making it hard to resolve and slow to manifest. After ten years, zang-fu Qi declines, toxin erupts, ulcerates, and causes death.
A carbuncle occurring in the hypochondrium is called Bai Ci (Decayed Flaw). Bai Ci is a disease of women. Moxibustion is applied. The condition becomes a large carbuncle with pus. Treatment reveals flesh growth inside, the size of a adzuki bean. Decoct one sheng each of waterweed root and Forsythia root in one dou six sheng of water until reduced to three sheng. Drink strongly, wear thick clothes, sit over a pot to induce sweating down to the feet.
The hypochondrium, below the axilla, is the distribution of the Lung and Liver. This also occurs on the skin, hence named Bai Ci. The Lung governs Qi, the Liver governs Blood. Women are born with excess Qi and deficient Blood. This arises from Qi-Blood disharmony, hence a female disease. "Treating the large carbuncle with pus" means applying moxibustion as for a large carbuncle. The flesh growth resembling an adzuki bean indicates that although named Bai Ju, it does not rot flesh, damage tendons, or injure bones. "Shui Cao" is waterweed; "Qiao" is Forsythia. Decocting these roots, drinking strongly, wearing thick clothes, and sitting over a pot induces sweating. Waterweed clears heat and induces sweating; Forsythia resolves toxicity.
A carbuncle occurring in the thigh and shin is called Gu Ting Ju (Thigh-Shin Ulcer). The appearance changes little, but pus binds to the bone. If not treated urgently, death occurs in thirty days.
Occurrence in the thigh/shin is toxin of the Foot Shaoyin meridian. Little change in appearance occurs because toxin adheres to the bone without external eruption, so the skin does not show obvious carbuncle signs. Lack of urgent treatment leads to death in thirty days. The Kidney is the Water Organ. The Moon is Yin and corresponds to Water, hence death corresponds to the lunar cycle (thirty days).
A carbuncle occurring in the sacrum is called Rui Ju (Sharp Ulcer). The appearance is red, hard, and large. Urgent treatment is required. Untreated, death occurs in thirty days.
The sacrum is the distribution of the Foot Taiyang meridian. Above Taiyang, Cold Water dominates, hence it also corresponds to the moon. Kidney and Bladder are Water Zang and Fu. Kidney is Yin and governs bone, so pus binds to bone without external eruption. The Fu is Yang, and Taiyang Qi governs the surface, hence the red, hard, large appearance. Yang toxin erupts externally but can still cause death because Taiyang is the master of all Yang Qi. Alas, knowing zang-fu Yin-Yang, Ying-Wei Blood-Qi, interior-exterior root-branch allows one to seek life in death. Surgeons must study the *Neijing*.
A carbuncle occurring in the medial thigh is called Chi Shi (Red Spread). If not treated urgently, death occurs in sixty days. If in both inner thighs, untreated death occurs in ten days.
The medial thigh is the distribution of the Foot Three Yin meridians. Fire toxin spreads to the Yin area, hence named Chi Shi. Sixty is the completion number of Water. Ten is the end of Yin numbers. Min Shixian stated: The medial thigh is the Foot Shaoyin distribution. Both inner thighs are the Foot Taiyin and Jueyin distributions.
A carbuncle occurring on the knee is called Ci Yong (Flaw Swelling). The appearance is a large carbuncle, color unchanged, with chills and fever, hard as stone. Do not use stone needles. Using stone needles causes death. Wait for softness, then use stone needles for survival.
The knee is the meeting of sinews and the distribution of the Foot Shaoyang meridian. Unchanged color means it matches the skin and is not red. Large carbuncle with unchanged color indicates toxin is between interior and exterior. Shaoyang governs the pivot, hence this appearance and chills/fever. Hard as stone: do not pierce with stone needles. Piercing causes death as toxin enters inward. Waiting for softness and then piercing allows survival as toxin vents outward. Shaoyang governs the pivot, capable of interior or exterior movement. Yu Borong stated: Hard stone means toxin has not yet erupted; softness means eruption outward, creating the distinction between interior/exterior and death/life.
Carbuncles and ulcers occurring at joints and corresponding to internal organs are untreatable. Those occurring in Yang [meridians] die in one hundred days; those in Yin [meridians] die in thirty days.
This discusses carbuncles occurring on the back. Joints refer to the twenty-one vertebrae of the spine, where joints intersect, allowing the passage of Shen Qi. Corresponding means internal resonance with the five Zang organs. Occurrence in Yang refers to the third vertebra corresponding to the Lung; fourth vertebra corresponding to the Pericardium; fifth vertebra corresponding to the Heart. Occurrence in Yin refers to the seventh vertebra corresponding to the Liver; eleventh vertebra corresponding to the Spleen; fourteenth vertebra corresponding to the Kidney. One hundred days represents the end of the solar year (days); thirty days represents the end of the lunar month. Yu Borong stated: Carbuncles on the back, if lateral, may injure Shu points of zang-fu and have a chance of survival; if central, they injure the Du Mai, let alone correspond to the five zang organs. Min Shixian stated: Yong (carbuncle) means blockage; Ju (ulcer) means obstruction; Du (toxin) is the general name for Yong and Ju. Ancient times named based on location Yin/Yang; later times named Back Carbuncle or Arm Carbuncle based on location, hence different naming conventions. Yao Shiyin stated: Joint intersections are bone voids. The body has 365 joints, twelve major joints in the four limbs, places where marrow pores exchange marrow. As stated earlier: Not at bone voids, no drainage. Meaning if carbuncle is not at bone voids, heat evil damaging bone/marrow has no exit. If carbuncles occur at joints, they are at the empty spaces for heat evil exit, not necessarily fatal signs. Master Ma stated: The outer edge of joints is Yang, inner edge is Yin. Does this mean occurrences on the outer/inner edges of the four limbs are all fatal? Alas, the Classic's meaning is profound and subtle, difficult to elucidate. How can rough scholarship mislead future generations?
A carbuncle occurring in the shin is called Tu Nie (Rabbit Bite). The redness extends to the bone. Urgent treatment is required. Untreated, it harms people.
Rabbits are Yin creatures. Occurrence in the shin is named Tu Nie, indicating the Yin shin. Redness extending to bone indicates progression from exterior to interior. Hence, urgent treatment. Untreated, it harms like an external thief. The Chong Mai (Penetrating Vessel) is the Sea of Twelve Meridians. It originates with the Great Collateral of Shaoyin from the Kidney, descends to Qi Chuan, follows the medial thigh, enters the middle, follows the medial shin bone, and descends behind the medial malleolus. This evil lodging in the Chong Mai causes blood stagnation and obstruction, resembling the slight swelling of a rabbit bite.
A carbuncle occurring at the medial malleolus is called Zou Huan (Slow Wander). The appearance is a carbuncle, color unchanged. Frequent needling of the Shu points stops chills and fever; death does not occur.
This is evil lodging in the Foot Shaoyin meridian causing swelling. Carbuncle changes include internal etiology with external toxin movement, or external swelling with internal toxin movement. Here, evil stays in the vessel without moving, hence named Zou Huan. Appearance resembles carbuncle but is not red. The Foot Shaoyin meridian starts below the little toe, crosses the sole, exits below Ran Gu, follows behind the medial malleolus, and ascends internally. Therefore, frequent needling of Shu points is needed to remove evil and stop chills/fever. Foot Shaoyin embodies primordial Water and Fire, hence manifesting as cold or heat. Yu Borong stated: Shu Lou is a chills/fever disease occurring in Shaoyin.
A carbuncle occurring on the top and bottom of the foot is called Si Yin (Four Licentiousnesses). The appearance is a large carbuncle. Urgent treatment is required; death occurs in one hundred days.
Si Yin refers to evil moving between left and right Shaoyang/Taiyang. Shaoyang governs the initial Yang vital Qi and originates in the Kidney; Taiyang is the Fu of the Kidney and master of all Yang Qi. Urgent treatment is required. Otherwise, Yang Qi is damaged, leading to death in one hundred days.
A carbuncle occurring on the side of the foot is called Li Yong (Fierce Carbuncle). The appearance is not large, initially like a swollen little finger. Urgent treatment is required to remove black discoloration. If it does not subside but increases, and is untreated, death occurs in one hundred days.
This is Cold Evil lodging in the Foot Yangming meridian causing carbuncle. The Foot Yangming meridian starts at Lidui on the second toe, hence occurrence on the side of the foot, named Li Yong. On earth is Water, in heaven is Cold. Black is the color of Water Qi. Without urgent treatment to remove black, Cold overwhelms and Earth fails. Yao Shiyin stated: Shaoyang/Taiyang Qi originates in the Lower Jiao, so evil in the lower part presents as large carbuncle. Yangming Qi originates in the Middle Jiao, so evil in the lower part presents as small carbuncle. This implies meridian injury without Qi injury. Min Shixian stated: Initially like a swollen little finger means the initial swelling is elongated, the form of evil in meridians. Wei Qi gathering there causes round elevation.
A carbuncle occurring on the toes is called Tuo Yong (Fall-off Carbuncle). The appearance is red-black; fatal and untreatable. If not red-black, not fatal. If not subsiding, urgent amputation is required; otherwise, death occurs.
This is Foot Shaoyin toxin erupting from interior to exterior, hence Tuo Yong, meaning Yin toxin escaping to Yang. Occurrence on toes refers to the big toe. *Dong Shu Pian* states: Foot Shaoyin meridian descends behind the medial malleolus, enters the sole. Its branch enters the ankle, emerges on the dorsum, enters between the big toe, and injects into collaterals. Foot Shaoyin embodies primordial Water and Fire. Red-black appearance indicates excessive Water/Fire淫毒 (licentious toxin), making it fatal and untreatable. Non-red-black indicates less toxic Qi, hence not fatal. If swelling does not subside, urgent amputation of the toe is required; otherwise, toxin injects into collateral networks of various meridians, causing death.
Huangdi said: You speak of carbuncles and ulcers; how do we distinguish them?
Qibo said: When Ying and Wei Qi stagnate in the meridians, Blood stagnates and does not flow. Non-flow causes Wei Qi to follow but become obstructed, blocking movement, hence Heat. Persistent severe Heat, excessive Heat rots flesh, rotted flesh becomes pus. However, it cannot sink into bone marrow, does not cause burning/drying, and does not damage the five Zang organs. Hence, it is named Carbuncle (Yong).
Huangdi said: What is Ju (Ulcer)?
Qibo said: Pure Heat Qi is abundant, sinking downward into muscles, drying sinews and marrow, connecting internally to five Zang organs, exhausting Blood and Qi. At the site of the ulcer, bones, sinews, and good flesh are entirely destroyed. Hence, it is named Ju. Ju presents with skin that is withered and hard, resembling ox neck skin. Carbuncle presents with thin, glossy skin. These are their signs.
The above distinguished the Yin/Yang and death/life of locations; this generally discusses the depth and severity of carbuncles and ulcers. Human Qi and Blood circulate continuously, and pathogenic factors diffuse and change unpredictably. Constitution varies in density/thinness, and evil invasion varies in mildness/severity, leading to different outcomes of death, life, success, and failure. According to the *Neijing*, carbuncles arise from unmeasured anger/joy, irregular diet, or zang-fu disharmony causing accumulation; or from shifting cold/heat between zang-fu. This chapter only discusses external pathogenic evils. Since human Qi and Blood circulation corresponds to Heaven and Earth, moves with respiration, and never ceases, any slight stagnation leads to carbuncle or bi-syndrome. Thus, the Sages...