身重脉缓。湿盛除湿。身热脉大。心燥热发肿。乍来乍去除热。诸痛。眩晕。动摇。脉
弦去风。
脉涩气滞。燥渴亡津液。脉涩。泻气补血。寒胜则浮。食不入。便溺多。恶寒。脉紧细
。泻寒水。
数脉不时见。当生恶疮。诸浮数脉应发热。反洒淅恶寒。
若有痛处。当发痈疽。脉滑而数。滑则为实。数则为热。
滑则为荣。数则为卫。荣卫相逢。则结为痈。热之所过。则为痈脓。
机按今之疡医多不诊脉。惟视疮形以施治法。盖疮有表里虚实之殊。兼有风寒暑湿之变
非脉以别之。安得而察识乎。东垣云。疮疡凭脉。此之谓也。因详列其脉之所主。揭之于首
。学人宜加意焉。
医疮概举七恶五善。此特谓肠胃之内。脏腑疮疽之证也。发背脑疽。别有善恶。载之于
七恶者。烦躁时嗽。腹痛渴甚。或泄利无度。或小便如淋。一恶也。脓血既泄。肿 尤
脓色败臭。痛不可近。二恶也。目视不正。黑睛紧小。白睛青赤。瞳子上看。三恶也。喘粗
短气。恍惚嗜卧。四恶也。肩背不便。四肢沉重。五恶也。不能下食。服药而呕。食不知味。
六恶也。声嘶色败。唇鼻青赤。面目四肢浮肿。七恶也。
五善者。动息自宁。饮食知味。一善。便利调匀。二善。脓溃肿消。水鲜不臭。三善。
神彩精明。语声清亮。四善。体气平和。五善。
五善之中。乍见一二善证。疮亦回也。七恶之内。忽见一二恶证。宜深惧之。又有证合
。皮急紧而知善。又或证合五善。皮缓虚而知恶。此又在人详审。大抵虚中见恶证者不可救
。实证无恶候者自愈。脓溃后尚烦疼。脉洪滑粗散者难治。微涩迟缓者易痊。
身体沉重，脉象缓弱。这是湿邪盛实，应当祛除湿气。身体发热，脉象洪大。这是心经燥热引发肿胀。症状时发时止，应当清热。各种疼痛、眩晕、肢体动摇。脉象弦紧，应当祛风。
脉象涩滞，是气机阻滞。伴有口干渴，是津液耗伤。脉象涩，应当泻其有余之气以补益血液。寒邪胜则脉浮。饮食难进，大小便次数多，怕冷。脉象紧细，应当泻去寒邪与水湿。
数脉不时出现，应当警惕发生恶疮。各种浮数脉象本应伴随发热，如果反而出现洒淅恶寒的感觉。
如果有疼痛的部位，应当会发生痈疽。脉象滑而数，滑脉主实证，数脉主热证。滑脉反映营气，数脉反映卫气。营卫二气相遇，就会凝结成痈。热邪所经过的地方，就会化生为痈脓。
汪机按语：现在的疡医大多不诊脉，只是观察疮疡的形状来施治法。大概疮疡有表里虚实的不同，兼有风寒暑湿的变化，如果不通过脉象来辨别，怎么能察觉识别呢？李东垣说：“治疗疮疡要凭借脉象”，说的就是这个道理。因此详细列出各种脉象所主应的病症，放在卷首。学习的人应当加以注意。
医生治疗疮疡通常列举七恶五善。这特指肠胃内部，脏腑生疮长疽的证候。发背疽和脑疽，另有善恶的判断标准。
属于“七恶”的情况有：烦躁且时时咳嗽，腹痛极度口渴，或者泄泻无度，或者小便像淋病一样涩痛，这是一恶。脓血已经排出，肿胀更加严重，脓色败坏发臭，疼痛剧烈不可触碰，这是二恶。眼睛视物不正，黑眼球紧缩变小，眼白部分呈现青赤色，瞳孔向上翻视，这是三恶。呼吸喘促粗重，气息短浅，神志恍惚嗜睡，这是四恶。肩背活动不便，四肢沉重，这是五恶。不能进食，服药后呕吐，吃东西不知道味道，这是六恶。声音嘶哑，面色败坏，嘴唇鼻子呈现青赤色，面目及四肢浮肿，这是七恶。
属于“五善”的情况有：动静休息自然安宁，饮食知道味道，是一善。大小便调匀，是二善。脓溃肿消，脓水新鲜不臭，是三善。神采精明，说话声音清亮，是四善。体质气息平和，是五善。
在五善之中，突然见到一两个善证，疮疡也有痊愈的希望。在七恶之内，忽然见到一两个恶证，应当深深恐惧警惕。又有证候相合的情况，皮肤紧急绷紧而知其为善证；又或证候符合五善，但皮肤松弛虚弱而知其为恶证。这又在医生仔细审察。大抵虚证中出现恶证的，难以救治。实证中没有恶候的，会自行痊愈。脓溃之后仍然烦疼，脉象洪大滑利粗散者，难治；脉象微涩迟缓者，容易痊愈。
The body feels heavy, and the pulse is slow. This indicates an excess of dampness; dispel the dampness. The body is hot, and the pulse is large. This indicates dry-heat in the Heart causing swelling. Symptoms that come and go intermittently require clearing heat. Various pains, vertigo, and tremors/shaking indicate a wiry pulse; expel wind.
A choppy pulse indicates Qi stagnation. Dryness and thirst indicate the loss of body fluids. A choppy pulse requires draining excess Qi to nourish Blood. Excess Cold causes floating [pulse]. Inability to eat, frequent urination and defecation, and aversion to cold with a tight and fine pulse require draining Cold and water retention.
An intermittent rapid pulse suggests the potential development of malignant sores. Floating and rapid pulses should be accompanied by fever; if instead there is shivering and aversion to cold, it indicates a different pathology.
If there is a painful area, a carbuncle or furuncle (Yong Ju) will likely develop. A slippery and rapid pulse: slippery indicates excess, rapid indicates heat. Slippery relates to Ying (Nutrient) Qi, and rapid relates to Wei (Defensive) Qi. When Ying and Wei meet, they congeal to form a carbuncle. Where heat passes, pus and blood are generated.
Wang Ji’s commentary: Contemporary surgeons often do not palpate the pulse, relying solely on the appearance of the sore to determine treatment. However, sores differ in exterior/interior, deficiency/excess, and are complicated by variations of Wind, Cold, Summer-heat, and Dampness. Without distinguishing via the pulse, how can one perceive and identify them? Li Dongyuan stated, "Treating sores relies on the pulse," which refers to this principle. Therefore, I have detailed the indications of various pulses and placed them at the beginning. Students should pay close attention.
Surgeons generally cite the Seven Evils and Five Goods. This specifically refers to sores and carbuncles within the intestines and stomach, involving the Zang-Fu organs. For back carbuncles and brain abscesses, the criteria for good and evil signs differ.
The Seven Evils are as follows:
1. Restlessness, frequent coughing, abdominal pain, extreme thirst, uncontrolled diarrhea, or dysuria resembling strangury.
2. After pus and blood are discharged, swelling increases further; the pus is foul-smelling and discolored; pain is severe and cannot be touched.
3. Vision is abnormal; the pupil is tightly contracted and small; the sclera is greenish-red; the pupil looks upward.
4. Rapid, coarse breathing; shortness of breath; mental confusion and drowsiness.
5. Inconvenience in the shoulders and back; heaviness in the four limbs.
6. Inability to eat; vomiting after taking medicine; loss of taste.
7. Hoarseness; deterioration of complexion; lips and nose are greenish-red; edema of the face, eyes, and four limbs.
The Five Goods are as follows:
1. Calm movement and rest; appetite and sense of taste are normal.
2. Regular bowel movements and urination.
3. Pus drains, swelling subsides; the discharge is fresh and odorless.
4. Bright spirit and clear eyes; clear and resonant voice.
5. Harmonious constitution and balanced Qi.
Among the Five Goods, even if only one or two good signs appear initially, the sore may still heal. Among the Seven Evils, if even one or two evil signs suddenly appear, one should be deeply alarmed. There are also cases where symptoms align with the skin being tight and tense (indicating Good), or where symptoms align with the Five Goods but the skin is loose and flaccid (indicating Evil). These require careful examination by the physician. Generally, deficiency patterns presenting with evil signs are incurable. Excess patterns without evil signs will heal spontaneously. After pus drainage, if there is still烦 (vexatious) pain and the pulse is surging, slippery, and coarse/disorganized, it is difficult to treat. If the pulse is slightly choppy and slow, recovery is easy.