大凡疮疾有五善七恶之证。不可不察也。烦躁时嗽。腹痛渴甚。或泄利无度。或小便如淋。一
恶也。脓血大泄。肿 尤甚。脓血败臭。痛不可近。二恶也。喘粗短气。恍惚嗜卧。三恶也。目视
不正。黑睛紧小。白睛反青。瞳子上看。四恶也。肩项不便。四肢沉重。五恶也。不能下食。服药
则呕。食不知味。六恶也。声嘶色败。口鼻青赤。面目四肢浮肿。七恶也。动息自宁。饮食知味。
一善也。便利调匀。二善也。脓溃肿消。色鲜不臭。三善也。神彩精明。语言清爽。四善也。体气
和平。五善也。若五善见三则瘥。七恶见四则危。然则病有源同七恶。皮紧急者如善。病有源同五
善。皮缓虚者如恶。夫如是者岂凡医之所知哉。若五善病至。则妙无以加也。如七恶并臻。则恶之
剧矣。
丁巳岁。予从军回。住冬于曹州界。以事至州。有赵同知谓予曰。家舅牛经历。病头面赤肿。
耳前后尤甚。疼
痛不可忍。发热恶寒。牙关紧急。涕唾稠粘。饮食难下。不得安卧。一疡医于肿上砭刺四五百余针
。肿赤不减。其痛益甚。不知所由然。愿请君一见。予遂往诊。视其脉浮紧。按之洪缓。此证乃寒
覆皮毛。郁遏经络。热不得升。聚而赤肿。经云。天寒则地冻水冰。人气在身中。皮肤致密。腠理
闭。汗不出。血气强。内坚涩。当是之时。善行水者不能注冰。善穿地者不能凿冻。善用针者亦不
得取四厥。必待天温冰释冻解。而后水可行。地可穿。人脉亦犹是也。又云。冬月闭藏。用药多而
少针石也。宜以苦温之剂。温经散寒则已。所谓寒致腠理。以苦发之。以辛散之。宜以托里温经汤
。麻黄苦温。发之者也。故以为君。防风辛温。散之者也。升麻苦辛。葛根甘平。解肌出汗。专治
阳明经中之邪。故以为臣。血留而不行者则痛。以香白芷、当归身辛温以和血散滞。湿热则肿。苍
术苦甘温。体轻浮。力雄壮。能泄肤腠间湿热。人参、甘草甘温。白芍药酸微寒、调中益气。使托
其里。故以为佐。根据方饵之。以薄衣覆其首。以浓被覆其身。卧于暖处。使经血温。腠理开。寒乃
散。阳气伸。大汗出。后肿减八九分。再服去麻黄、防风。加连翘、黍粘子。肿痛悉去。经言汗之
则疮已。信哉斯言。或人以仲景言。疮家虽身肿痛。不可发汗。其理何也。予曰。此说乃营气不从
。逆于肉理而患疮肿。作身疼痛。非外感寒邪而作疼痛。故戒之以不可发汗。若汗之则成 也。又
问仲景言鼻衄者不可发汗。复言脉浮紧者。当以麻黄汤发之。衄血自止。所说不同。其故何也。愿
闻其说。予曰。此议论血正与疮家概同。且夫人身血之与汗。异名而同类。夺汗者无血。夺血者无
汗。今衄血妄行。为热所逼。更发其汗。反助邪热。重竭津液。必变凶证。故不可汗。若脉浮则为
在表。脉紧则为寒。寒邪郁遏。阳不得伸。热伏荣中。迫血妄行。上出于鼻。
则当麻黄汤散其寒邪。使阳气得舒。其衄自止。又何疑焉。或者叹曰。知其要者。一言而终。不知
其要。流弊无穷。洁古之学。可谓知其要者矣。
【托里温经汤】治寒覆毛皮。郁遏经络。不得伸越。热伏荣中。聚而为赤肿。痛不可忍。
恶寒发热。或相引肢体疼痛。
人参（去芦） 苍术（各一钱） 白芍药 甘草（炙。各一钱半）
白芷 当归身 麻黄（去根节。各二钱） 防风（去芦）
葛根（各三钱） 新升麻（四钱）
上 咀。每服一两重。水三盏。先煎麻黄令沸。去沫。再下余药同煎。至一盏。去渣。大温服
讫。卧于暖处。以绵衣覆之。得汗而散。
大凡疮疡疾病都有五善七恶的证候。不可不仔细考察。
烦躁且时时咳嗽，腹痛且极度口渴，或者泄泻无度，或者小便像淋病一样涩痛难忍，这是一恶。
脓血大量流出，肿胀更加严重，脓血腐败发臭，疼痛剧烈到无法触碰，这是二恶。
呼吸急促短浅，神志恍惚嗜睡，这是三恶。
目光不正，黑眼球紧缩变小，眼白反现青色，瞳孔向上翻视，这是四恶。
肩颈部位活动不便，四肢沉重无力，这是五恶。
不能进食，服药则呕吐，吃东西不知道味道，这是六恶。
声音嘶哑，面色败坏，口鼻呈现青赤色，面目及四肢浮肿，这是七恶。
呼吸平稳安宁，饮食知道味道，是一善。
大小便调匀，是二善。
脓溃后肿胀消退，颜色鲜红且不臭，是三善。
神采精明，语言清爽，是四善。
身体气息平和，是五善。
如果见到五善中的三项，病情就会痊愈；如果见到七恶中的四项，病情就危险了。然而，有的病根源相同却表现为七恶，但皮肤紧急的反而像善证；有的病根源相同却表现为五善，但皮肤松弛虚软的反而像恶证。像这样的情况，难道是普通医生所能知晓的吗？如果五善的病证出现，那就再好不过了；如果七恶同时到来，那就是恶证到了极点。
丁巳年，我随军返回，冬天住在曹州地界。因为有事到州城，有一位赵同知对我说：“我的舅舅牛经历，头面部红肿发热，耳朵前后尤其严重，疼痛难以忍受，伴有发热恶寒，牙关紧闭，鼻涕唾液稠粘，饮食难以下咽，无法安卧。一位疡医在肿处砭刺了四五百针，红肿没有减退，疼痛反而加剧，不知道原因所在，希望您能去诊治。”我便前往诊视，看到他的脉象浮紧，重按洪缓。这个证候是因为寒邪覆盖皮毛，郁遏经络，热气不得升发，聚集而致红肿。经书说：“天气寒冷，地面冻结水冰，人体在体内，皮肤致密，腠理闭合，汗不出，血气强盛，内部坚涩。在这个时候，善于治水的人也不能让冰水流淌，善于掘地的人也不能凿开冻土，善于用针的人也治不好四肢厥逆。必须等到天气温暖，冰融冻解，然后水才能流动，地才能挖掘，人的经脉也是如此。”又说：“冬季闭藏，用药多而少用针石。”适宜用苦温的药剂，温经散寒就好了。所谓寒邪导致腠理闭塞，要用苦味药发散它，用辛味药疏散它。适宜使用托里温经汤。麻黄味苦性温，是发散的药物，所以作为君药。防风味辛性温，是疏散的药物。升麻味苦辛，葛根味甘平，解除肌表之邪并出汗，专门治疗阳明经中的邪气，所以作为臣药。血液停留而不运行就会疼痛，用香白芷、当归身味辛性温来调和血液消散滞结。湿热就会导致肿胀，苍术味苦甘性温，质地轻浮，力量雄壮，能泄除肤腠间的湿热。人参、甘草味甘性温，白芍药味酸微寒，调理中气益气，支撑其里，所以作为佐药。按照方剂服用，用薄衣覆盖头部，用厚被覆盖身体，躺在暖和的地方，使经脉血液温暖，腠理开放，寒邪乃散，阳气伸展，大汗出后，肿痛减轻八九分。再服用时去掉麻黄、防风，加入连翘、黍粘子（牛蒡子），肿痛完全消除。经书说“发汗则疮愈”，这话确实可信啊。有人问张仲景说：“患疮疡的人即使身体肿痛，也不可发汗”，这是什么道理呢？我说：“这种说法是指营气不顺，逆乱于肌肉纹理而患疮肿，引起身体疼痛，并非外感寒邪引起的疼痛，所以告诫不可发汗。如果发汗就会造成变证。”又问张仲景说：“鼻出血的人不可发汗”，又说“脉浮紧的，应当用麻黄汤发汗”，结果鼻衄自止。说法不同，原因是什么呢？希望听听您的解释。我说：“这议论的血证与疮家概略相同。况且人身上的血与汗，名称不同但同类。夺汗者无血，夺血者无汗。现在鼻血妄行，是被热邪逼迫所致，如果再发汗，反而助长邪热，重新竭尽津液，必然变成凶险证候，所以不可发汗。如果脉浮说明病在表，脉紧说明有寒。寒邪郁遏，阳气不得伸展，热伏于营分中，逼迫血液妄行，向上从鼻子流出，这时应当用麻黄汤散发寒邪，使阳气得以舒展，鼻衄自然停止，又有什么可疑的呢？”那人感叹道：“懂得要领的人，一句话就能终结问题；不懂要领的人，流弊无穷无尽。洁古（张元素）的学问，可以说是懂得要领的人了。”
【托里温经汤】治疗寒邪覆盖皮毛，郁遏经络，不得伸展越出，热伏于营分中，聚集而为红肿，疼痛难以忍受，恶寒发热，或者牵引肢体疼痛。
人参（去芦头） 苍术（各一钱） 白芍药 甘草（炙，各一钱半）
白芷 当归身 麻黄（去根节，各二钱） 防风（去芦头）
葛根（各三钱） 新升麻（四钱）
以上药物切碎，每次服用一两重，用水三盏，先煎麻黄令其沸腾，去掉浮沫，再放入其余药物共同煎煮，至剩一盏，去渣滓，大温服下。服后躺在暖和的地方，用绵衣覆盖，得汗而病散。
Generally, sores and ulcers present with five favorable (Shan) and seven unfavorable (E) syndromes. These must be carefully examined.
Irritability accompanied by occasional coughing, abdominal pain with extreme thirst, or uncontrolled diarrhea, or dysuria resembling strangury—this is the first unfavorable sign.
Profuse discharge of pus and blood, worsening swelling, foul-smelling putrid pus and blood, and severe pain that cannot be tolerated to touch—this is the second unfavorable sign.
Rapid and short breathing, mental confusion, and excessive drowsiness—this is the third unfavorable sign.
Abnormal gaze, tight and small black pupils, greenish hue in the whites of the eyes, and upward deviation of the pupils—this is the fourth unfavorable sign.
Stiffness and inconvenience in the shoulders and neck, and heaviness in the four limbs—this is the fifth unfavorable sign.
Inability to eat, vomiting after taking medicine, and loss of taste—this is the sixth unfavorable sign.
Hoarseness, deteriorated complexion, bluish-red color around the mouth and nose, and edema of the face, eyes, and four limbs—this is the seventh unfavorable sign.
Calm breathing and awareness of taste—this is the first favorable sign.
Regular bowel movements and urination—this is the second favorable sign.
After pus discharges, swelling subsides, the color is fresh, and there is no foul odor—this is the third favorable sign.
Bright spirit and clear speech—this is the fourth favorable sign.
Harmonious body qi—this is the fifth favorable sign.
If three of the five favorable signs are present, the disease will heal. If four of the seven unfavorable signs appear, the condition is critical. However, diseases with the same origin may present as seven unfavorable signs, yet if the skin is tense, it resembles a favorable sign; diseases with the same origin may present as five favorable signs, yet if the skin is loose and deficient, it resembles an unfavorable sign. Such cases, can they be known by ordinary physicians? If the five favorable signs manifest, nothing could be better. If all seven unfavorable signs converge, the evil pathogen is at its most severe.
In the Ding Si year, I returned from military service and stayed in winter within the jurisdiction of Caozhou. Due to some matters, I went to the prefecture. A Zhao Tongzhi said to me: "My uncle, Niu Jingli, suffers from red and swollen head and face, especially severe around the ears. The pain is unbearable, accompanied by fever and aversion to cold, trismus (lockjaw), thick and sticky sputum and nasal discharge, difficulty swallowing food, and inability to lie down peacefully. A surgeon applied cupping-needle therapy (Bianci) with over four or five hundred punctures on the swelling, but the redness and swelling did not decrease, and the pain increased. We do not know the cause. We wish for you to examine him." I then went to diagnose. His pulse was floating and tight, but deep pressing revealed it to be surging and slow. This syndrome is caused by cold covering the hair and skin, obstructing the meridians, preventing heat from ascending, causing it to gather and result in redness and swelling. The Classics state: "When heaven is cold, the earth freezes and water turns to ice. In the human body, the skin becomes dense, the cou-li (pores) close, sweat does not emerge, blood and qi become strong, and the interior becomes firm and stagnant. At this time, even those skilled in managing water cannot make ice flow, and those skilled in digging cannot pierce frozen ground. Even those skilled in acupuncture cannot treat tetanus (Si Jue). One must wait for warm weather, melting ice, and thawing ground before water can flow and earth can be dug. Human meridians are similar." It also states: "In winter, when storage prevails, medicines are used more frequently than needles and stones." It is appropriate to use bitter-warm agents to warm the meridians and dispel cold. As stated, cold causes the closure of cou-li; it should be dispersed with bitter agents and scattered with pungent agents. Toli Wenjing Tang (Support Interior and Warm Meridian Decoction) is suitable. Mahuang (Ephedrae Herba) is bitter and warm, serving as a dispersing agent, thus acting as the Sovereign herb. Fangfeng (Saposhnikoviae Radix) is pungent and warm, serving as a scattering agent. Shengma (Cimicifugae Rhizoma) is bitter and pungent, Gegen (Puerariae Lobatae Radix) is sweet and neutral; they resolve the muscle layer and induce sweating, specifically treating pathogens in the Yangming meridian, thus acting as Ministers. Stagnant blood causes pain; Xiang Baizhi (Angelicae Dahuricae Radix) and Danggui Shen (Angelicae Sinensis Radix - root body) are pungent and warm to harmonize blood and dissipate stagnation. Damp-heat causes swelling; Cangzhu (Atractylodis Rhizoma) is bitter, sweet, and warm, light in texture, and powerful in action, capable of draining damp-heat from the cou-li. Renshen (Ginseng Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) are sweet and warm; Shaoyao (Paeoniae Radix Alba) is sour and slightly cold; they regulate the middle and boost qi, supporting the interior, thus acting as Assistants. Following this prescription, cover the head with thin clothing and the body with thick blankets, lie in a warm place to warm the meridians and blood, open the cou-li, scatter the cold, extend the yang qi, and induce profuse sweating. Afterward, the swelling and pain reduced by eight or nine parts. For the next dose, remove Mahuang and Fangfeng, add Lianqiao (Forsythiae Fructus) and Niu Bang Zi (Arctii Fructus), and the swelling and pain completely disappeared. The Classics say, "Inducing sweating cures sores," truly these words are credible. Someone asked: "Zhang Zhongjing stated that although patients with sores have body pain and swelling, they should not be induced to sweat. What is the rationale?" I replied: "This statement refers to Ying Qi (Nutritive Qi) failing to follow its course, reversing in the muscle tissue causing sores and swelling, resulting in body pain, not pain caused by external cold pathogens. Therefore, it warns against sweating. If sweating is induced, it leads to complications." He further asked: "Zhang Zhongjing stated that those with epistaxis should not be induced to sweat, yet also stated that those with a floating and tight pulse should be treated with Mahuang Tang to induce sweating, after which the epistaxis stops naturally. The statements differ; what is the reason?" I replied: "The discussion on blood conditions is similar to that of sore patients. Blood and sweat in the human body have different names but are of the same category. Depriving sweat results in lack of blood; depriving blood results in lack of sweat. Now, spontaneous epistaxis is forced by heat. Inducing sweat again would further assist the pathogenic heat and deplete fluids, inevitably leading to ominous signs. Hence, sweating is contraindicated. If the pulse is floating, the pathogen is in the exterior; if tight, it indicates cold. Cold pathogens obstruct, preventing Yang Qi from extending. Heat hides in the Ying level, forcing blood to move recklessly and exit through the nose. In this case, Mahuang Tang should be used to scatter the cold pathogen, allowing Yang Qi to relax, and the epistaxis will stop naturally. Is there any doubt?" The person sighed and said: "Those who understand the essentials need only one word to conclude; those who do not understand face endless complications. Jiegu's (Zhang Yuansu's) learning can be said to understand the essentials."
[Toli Wenjing Tang] Treats cold covering the hair and skin, obstructing the meridians, preventing extension and transcendence, heat hiding in the Ying level, gathering to form redness and swelling, unbearable pain, aversion to cold and fever, or pain radiating to the limbs.
Renshen (Ginseng Radix) (remove rhizome) 1 qian
Cangzhu (Atractylodis Rhizoma) 1 qian
Shaoyao (Paeoniae Radix Alba)
Gancao (Glycyrrhizae Radix et Rhizoma) (roasted) 1.5 qian
Baizhi (Angelicae Dahuricae Radix)
Danggui Shen (Angelicae Sinensis Radix - root body)
Mahuang (Ephedrae Herba) (remove roots and joints) 2 qian
Fangfeng (Saposhnikoviae Radix) (remove rhizome)
Gegen (Puerariae Lobatae Radix) 3 qian
Xin Shengma (Cimicifugae Rhizoma) 4 qian
Cut the herbs into pieces. Take 1 liang per dose. Add 3 cups of water. First decoct Mahuang until boiling, skim off the foam. Then add the remaining herbs and decoct together until 1 cup remains. Strain. Drink warm. Lie in a warm place and cover with cotton clothes. Obtain sweating to resolve the condition.