身重脉缓湿胜除湿 身热脉大心燥时肿乍来乍去遂热 诸痛眩晕动摇脉弦去风 气涩气
滞干燥亡津液脉涩泻气补血 寒胜则浮食不入便溺多恶寒脉紧细宜泻寒水
丹溪论相火能动为诸病疮疡亦然
详见火证门
丹溪云六阳经六阴经有多气少血者有多血少气者有多气多血者不可一概论也少阳经多气
少血
理宜预防肌肉难长驱毒利药亦难轻用予从叔多虑神劳年近五十左膊外侧红肿如栗予曰勿轻视
且先与人参浓汤得数升乃佳与数帖而止旬余值大风拔木疮上起一红线绕背抵右肋予曰大料人
参汤加芎术补剂与之两月而安李兄年三十连得忧患且好色又作劳左腿外侧 生红肿如栗一医
与承气两帖下之矣又一医教与解毒下之予视之脉大实后果死或曰生臀痈者何如予曰臀在少
腹
之后居其下此阴中之阴也其道远其位僻虽太阳多血气运虽及血亦罕来中年后生者须预补之若
无积补之功其祸多在疮成痂之后或半年以来乃病粗工不察或致失手慎之戒之病机机要云瘰
者结核是也或在耳后或在耳前或在耳下连及颐颔或在颈下连缺盆皆谓瘰 或在胸及胸之侧或
在两胁皆谓之马刀手足少阳主之
按此谓分经用药则不致有犯禁坏逆之失也然手少阳三焦少阴心太阴肺足少阳胆少阴肾太
阴脾
多气少血手厥阴心包络太阳小肠足太阳膀胱厥阴肝多血少气手阳明大肠足阳明胃多气多血也
故不可一概论治况以上病例不系膏粱丹毒火热之变因虚劳气郁所致止宜补形气调经脉其疮当
自消散盖不待汗之下之而已也其不详脉证经络受病之异者下之先犯病禁经禁故致失手如此丹
溪又曰才得肿痛参之脉证但有虚弱便与滋补血气无亏可保终吉若用寻常驱热拔毒及气药虚虚
之祸如指诸掌且夫火热为病亦有微甚所谓君火相火是也疮疡所发而有痈疽疖 轻重浅深或止
发于一经或兼二经者止当求责于一二经则不可干扰余经也若东垣处方用药是矣矧有兼风兼湿
兼痰兼气兼血兼阴虚等证者病本不同治当求责前论虽略比之世俗外科等书图人形疮样而不分
经络者此则大有径庭矣
身体沉重、脉象缓弱，是湿邪偏盛的表现，治疗应祛除湿邪。
身体发热、脉象洪大、心中烦燥、局部肿胀时现时隐、随即发热，这是心经有热的表现。
各种疼痛、眩晕、动摇不定，脉象弦紧，这是风邪为患，治疗应祛风。
气机涩滞、气机郁结、津液干燥耗损，脉象涩，这是气滞血虚，治疗应泻其壅滞之气，补益血液。
寒邪偏盛则脉象浮，饮食不入，大小便异常，多恶寒，脉象紧细，适宜泻除寒水之邪。
丹溪论述相火能够引发各种疾病，疮疡也是如此。
详见“火证”门类。
丹溪说：六阳经和六阴经中，有的经脉多气少血，有的多血少气，有的多气多血，不能一概而论。
其中，少阳经是多气少血的经脉。
理应当预防肌肉难以愈合，驱除毒邪的药物也难以轻易使用。
我的从叔父多虑（人名），神思劳倦，年龄近五十岁，左臂外侧红肿如栗子般大小。
我说：不要轻视此病，且先给予浓煎的人参汤，喝到数升才好，服用几帖后停止。
过了十几天，遇到大风拔起树木的恶劣天气，疮口上方出现一条红线，绕背抵达右肋部。
我说：用大剂量的人参汤，加入川芎、白术等补益药剂给他服用，两个月后才安稳。
李兄三十岁，接连遭受忧患，又好色又劳累，左腿外侧生发红肿如栗子般的疮疡。
一位医生给予承气汤两帖，使其泻下。
另一位医生教他使用解毒药并泻下。
我诊视他的脉象，发现脉大且实，结果最终死亡。
有人问：生臀痈的情况怎么样？
我说：臀部位于小腹之后，处于下方，这是阴中之阴的部位。
其路径遥远，位置偏僻，虽然太阳经多血气，气血运行虽能到达此处，但也很少能充分濡养。
中年以后发生此类疮疡，必须预先进行补益。
如果没有积累补益的功效，灾祸往往在疮疡结成痂皮之后才显现，或者经过半年之久。
这是由于粗疏的医生不加以考察，导致失误。谨慎啊，要引以为戒！
《病机机要》说：瘰疬就是结核性的肿块。
有的在耳后，有的在耳前，有的在耳下连及面颊和下颌，有的在颈下连及锁骨上窝，都称为瘰疬。
有的在胸部及胸侧，有的在两侧胁肋，都称为马刀。
这些病症由手足少阳经所主。
按语：这样区分经络用药，就不会犯禁忌而导致病情逆乱。
然而，手少阳三焦经、足少阴肾经、手太阴肺经、足少阴肾经（注：原文此处可能有误或特指，通常足少阴为肾，手少阴为心，原文列举稍显杂乱，依原文翻译）、手太阴肺经、足少阴肾经、手太阴脾经（注：脾属太阴，但通常言足太阴脾，原文列法特殊，依原文）……（此处原文列举经脉气血多少情况较为复杂，概括如下）：
手少阳三焦经、足少阴肾经、手太阴肺经、足少阴肾经、手太阴脾经等多气少血；
手厥阴心包络经、足太阳膀胱经、足太阳小肠经（注：小肠为手太阳，原文可能笔误或特指，依原文）、足太阳膀胱经、厥阴肝经等多血少气；
手阳明大肠经、足阳明胃经等多气多血。
所以不能一概而论地治疗。
况且以上病例并非由于膏粱厚味、丹毒火热引起的病变，而是由于虚劳、气郁所致。
只宜补益形体正气，调理经脉，疮疡自然会消散。
根本不需要使用发汗或泻下的方法。
那些不详察脉证、经络受病差异的人，先用泻下法，首先违反了病禁和经禁，所以导致失误如此。
丹溪又说：刚出现肿痛，参合脉证，只要有虚弱表现，就给予滋补气血的药物，使血气不亏损，可以保全最终吉利。
如果使用常规的清热拔毒及行气药物，造成虚上加虚的祸害，就像看手掌一样清楚。
而且火热致病也有轻微和严重的区别，所谓君火、相火就是如此。
疮疡发作而有痈疽疖肿，轻重浅深不同，有的只发于一经，有的兼及二经，只应当追究责任在一二条经脉上，不可干扰其他经脉。
像东垣那样处方用药是正确的。
何况还有兼夹风、湿、痰、气、血、阴虚等证候的，病本不同，治疗应当追究前面的理论依据。
虽然上述论述简略，但与世俗的外科书籍相比，那些只画人体外形、疮疡样式而不分经络的书，这其中的差别大有径庭了。
The body feels heavy and the pulse is slow, indicating an excess of dampness; treatment should focus on eliminating dampness.
Body heat, a large pulse, mental restlessness, intermittent swelling that appears and disappears followed by fever, indicates heat in the Heart channel.
Various pains, dizziness, and tremors with a wiry pulse indicate wind pathogen; treatment should focus on dispelling wind.
Qi stagnation, Qi obstruction, dryness, and loss of body fluids with a choppy pulse indicate Qi stagnation and blood deficiency; treatment should drain stagnant Qi and tonify blood.
Cold excess manifests as a floating pulse, inability to eat, abnormal urination and defecation, aversion to cold, and a tight, thin pulse; treatment should drain cold and water retention.
Danxi discussed how Ministerial Fire (Xiang Huo) can trigger various diseases, and sores and ulcers are no exception.
For details, see the section on "Fire Patterns".
Danxi stated: Among the six Yang channels and six Yin channels, some have abundant Qi and little Blood, some have abundant Blood and little Qi, and some have both abundant Qi and Blood. They cannot be generalized.
Specifically, the Shaoyang channel has abundant Qi and little Blood.
Therefore, one should anticipate difficulty in muscle regeneration, and drugs that drive out toxins are difficult to use lightly.
My uncle, Duo Lu, suffered from mental fatigue. At nearly fifty years old, he developed a red and swollen lump like a chestnut on the lateral aspect of his left upper arm.
I said: Do not underestimate this condition. First, administer a concentrated decoction of Renshen (Ginseng Radix et Rhizoma). It is best if he drinks several sheng (a unit of volume), and stop after a few doses.
Ten days later, during a storm strong enough to uproot trees, a red line appeared above the sore, encircling the back and reaching the right hypochondrium.
I said: Use a large dose of Renshen Tang (Ginseng Decoction) added with Xiong (Ligusticum Chuanxiong Rhizome) and Zhu (Atractylodis Macrocephalae Rhizoma) tonics. He recovered peacefully after two months.
Brother Li was thirty years old, had recently suffered from worry and grief, indulged in sexual activity, and overworked himself. He developed a red and swollen lump like a chestnut on the lateral aspect of his left thigh.
One physician administered Erchen Tang (Two-Aged Decoction) or Chengqi Tang (likely referring to a purgative formula like Dachengqi Tang given the context of purging) for two doses to induce purgation.
Another physician advised using detoxifying drugs and purgatives.
Upon examination, I found his pulse to be large and excess/solid. He eventually died.
Someone asked: What about gangrene of the buttocks?
I said: The buttock is located posterior to the lower abdomen and inferiorly, representing Yin within Yin.
The pathway is distant and the location remote. Although the Taiyang channel has abundant Qi and Blood, the circulation rarely reaches here sufficiently.
When such sores occur after middle age, preventive tonification is necessary.
If there is no foundation of tonification, disaster often strikes after the sore forms a scab, or even after half a year.
This is due to incompetent physicians failing to examine properly, leading to errors. Be cautious and take warning!
*Bingji Jiyao* states: Luoli (scrofula) refers to tubercular nodules.
They may appear behind the ear, in front of the ear, below the ear extending to the jaw and chin, or below the neck extending to the supraclavicular fossa; all are called Luoli.
They may also appear in the chest and its sides, or in the bilateral hypochondrium, called Machdao (horse knife/chain scrofula).
These conditions are governed by the Hand-Shaoyang and Foot-Shaoyang channels.
Commentary: By prescribing medication according to specific channels, one avoids violating contraindications and causing adverse reversals.
However, the Hand-Shaoyang Sanjiao channel, Foot-Shaoyin Kidney channel, Hand-Taiyin Lung channel, Foot-Shaoyin Kidney channel, Hand-Taiyin Spleen channel... [Note: The original text lists channels with abundant Qi and little Blood, abundant Blood and little Qi, and abundant Qi and Blood in a complex manner].
Generally, the Hand-Shaoyang Sanjiao, Foot-Shaoyin Kidney, Hand-Taiyin Lung, etc., have abundant Qi and little Blood;
The Hand-Jueyin Pericardium, Foot-Taiyang Bladder, Foot-Yangming Stomach, etc., have abundant Blood and little Qi;
The Hand-Yangming Large Intestine and Foot-Yangming Stomach have abundant Qi and abundant Blood.
Thus, treatment cannot be generalized.
Moreover, the aforementioned cases were not caused by rich food, Dan Du (red skin disease), or fire-heat transformations, but by deficiency-fatigue and Qi depression.
Treatment should only focus on tonifying the form and Qi, regulating the meridians, and the sores will dissipate naturally.
There is no need for sweating or purging methods.
Those who fail to carefully distinguish the pulse, symptoms, and meridian involvement, and instead use purgatives first, violate disease and meridian contraindications, leading to such errors.
Danxi further stated: When swelling and pain first appear, if combined with pulse and symptom analysis showing deficiency, one should immediately provide tonics for Qi and Blood. If Qi and Blood are preserved, ultimate safety can be guaranteed.
Using routine heat-clearing, toxin-draining, or Qi-moving drugs would cause a "deficiency upon deficiency" disaster, which is as clear as looking at one's palm.
Furthermore, fire-heat diseases vary in severity, known as Monarch Fire and Ministerial Fire.
Sores and ulcers manifest as carbuncles, furuncles, or boils, varying in severity and depth. Some affect only one channel, others two. Treatment should target only the involved one or two channels and must not interfere with other channels.
Prescribing as Dongyuan did is correct.
Especially when complicated by wind, dampness, phlegm, Qi, Blood, or Yin deficiency patterns, the root causes differ, and treatment must seek the principles discussed earlier.
Although the above discussion is brief, it differs vastly from secular surgical texts that merely illustrate human figures and sore shapes without distinguishing meridians.