（论一首脉证三条方五首）
诸浮数脉。应发热而反洒淅恶寒。若有痛处。当发其痈。
〔补注〕病之将发。脉必兆之。夫浮数、阳也。热也。浮数兼见。为阳中之阳。是其热必
尽显于外矣。而反洒淅恶寒。证实不应何哉。必其血有凝滞。气不得越。如经所
谓荣气不从。逆于肉理。乃生痈肿。阳气有余。荣气不行。乃发为痈是也。况其身
已有痛处乎。夫脉之见者阳也。其将发而痛者亦属阳。故曰当痈。
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。
〔补注〕邪客经络。则血必至于泣。泣则卫气归之。不得反复。于是寒郁则化热。热
胜则肉腐而为脓。欲知成脓与否。以手掩其上。热则透出。否则未也。师之所以
教知者。盖已成欲其溃。未成托之起也。
肠痈之病。其身错甲。腹皮急。按之濡。如肿状。腹无积聚。身无热。脉数。此为肠内有
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。杵为末。取方寸匕。以水二升顿服。小盒饭下。
〔补注〕血积于内。然后错甲于外。经所言也。肠痈何故亦然耶。痈成于内。血泣而
不流也。惟不流。气亦滞。遂使腹皮如肿。按之仍濡。虽其患在肠胃间。究非腹有
积聚也。外无热而见数脉者。其为痈脓在里可知矣。然大肠与肺相表里。腑病
而或上移于脏。正可虞也。故以保肺而下走者。使不上乘。附子辛散。以逐结。败
酱苦寒。以祛毒而排脓。务令脓化为水。仍从水道而出。将血病解而气亦开。抑何神乎。
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） 桃仁（五十个） 瓜子（半升） 芒硝（三合）
上五味。以水六升。煮取一升。去滓。内芒硝。再煎沸。顿服。有脓当下。如无脓。当下血。
〔补注〕肠痈而少腹不可按。阳邪下结。部位牵引也。按之如淋。形容痛状。情所必
至。夫血病而气不病。故小便自调。然阳邪已盛。卫气斯虚。遂发热汗出而畏寒
也。痈证如是。治之者。须以脓成未成为异。欲知之法。舍脉无由。脉迟紧。知未熟。
为血瘀于内。勿使成脓。下之须早。非桃仁承气汤乎。脉若洪数者。则已成矣。岂
复有瘀可下。此大黄丹皮以涤热排脓。势所必用也。然内经曰。肠痈为病不可
惊。惊则肠断而死。故患此者。坐卧转侧。理宜徐缓。少饮稀粥。毋失调养斯善。
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。
〔补注〕微则阳虚。涩为血虚。定理也。故涩则亡血。阳微当汗出。若不汗者云何。知
汗为血液。故汗多尚亡阳。况去血乎。然则骤为刀斧伤者。阴去而阳亦随衰。阳
虽衰而不能复汗者。亡血故也。
病金疮。王不留行散主之。
王不留行散方
王不留行（十分八月八日采取） 蒴 细叶（十分七月七日采）
桑东南根白皮（十分三月三日采） 川椒（三分除目及闭口者去汗）
甘草（十八分） 黄芩（二分） 干姜（二分） 浓朴（二分） 芍药（二分）
上九味。桑根皮以上三味。烧灰存性。勿令灰过。各别杵筛。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。
浸淫疮。从口流向四肢者可治。从四肢流来入口者不可治。
〔衍义〕从口向四肢。由上及下。由内及外。散也。火热散则易消。反聚则难治。因久
久愈热也。经云。夏脉太过。令人肤痛为浸淫。盖夏脉洪大。心主火。脉主心也。故
曰。三部洪数心家热。舌上生疮唇破裂。然必非其时有其气则然。若立夏得洪大脉。又非所论可知矣。
浸淫疮。黄连粉主之。（方未见）
〔衍义〕黄连泻手少阴之火。火去而气血自复矣。
（一篇论述，三条脉证，五个方剂）
凡是浮数脉。应当发热却反而感到阵阵恶寒。如果身体某处有疼痛感。这将会发生痈肿。
〔补注〕疾病将要发作时。脉象必定会预先显现征兆。所谓浮数脉。属于阳脉。主热证。浮脉与数脉同时出现。是阳中之阳。说明体内的热邪必然完全显露于体表。然而患者反而感到阵阵恶寒。症状表现与脉象不符。这是为什么呢？必然是因为血液运行凝滞。气机不能宣通发散。正如医经所说：营气不顺畅。逆乱于肌肉纹理之间。就会生成痈肿。阳气有余。营气运行不畅。就会发为痈肿。况且患者身上已经有疼痛的部位了。脉象显现的是阳证。即将发作且伴有疼痛的也属于阳证。所以说应当是痈肿。
老师说。对于各种痈肿。想要知道是否有脓液。可以用手按压在肿胀部位上方。感觉发热的就是有脓。感觉不发热的就是没有脓。
〔补注〕邪气客居于经络。血液必然会凝涩不通。凝涩则卫气汇聚于此。无法反复运行。于是寒气郁结转化为热邪。热邪亢盛则肌肉腐败化为脓液。想要知道是否已经成脓。用手按压其上方。感觉热气透出就是有脓。否则就是尚未形成。老师之所以教导这种判断方法。大概是因为脓已成者希望它溃破排出。脓未成者希望托毒外出使其消散。
肠痈病。患者身体皮肤紧绷如铠甲状。腹部皮肤紧张。按压时柔软。像是有肿胀的样子。但腹部没有积块。身体没有发热。脉象数。这是肠道内有痈脓。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。捣碎研成粉末。取一方寸匕的药量。用水二升。一次性服用。小便应当通畅下行。
〔补注〕血液积聚于体内。然后导致外部皮肤紧绷如铠甲。这是医经所说的道理。肠痈为什么也是这样呢？痈肿形成于内部。血液凝涩而不流动。正因为不流动。气机也随之停滞。从而导致腹部皮肤像肿胀一样。但按压时仍然柔软。虽然病变位于肠胃之间。终究不是腹中有积块。体表无发热而脉象数。可知痈脓在体内。但是大肠与肺相表里。腑病可能会向上影响脏。这正是令人担忧的地方。所以使用保护肺气并向下走泄的药物。使病邪不上乘于肺。附子辛温发散。用以驱逐凝结。败酱苦寒。用以祛除毒邪并排脓。务必让脓液化为水液。仍从水道排出。这样血病解除而气机也能开通。多么神奇啊。
肠痈病。少腹部肿胀痞硬。按压就疼痛如同淋病。小便正常。时常发热。自汗出。又伴有恶寒。脉象迟紧的。说明脓未形成。可以用攻下法治疗。应当会有瘀血排出。脉象洪数的。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） 桃仁（五十个） 瓜子（半升） 芒硝（三合）
以上五味药。用水六升。煮取一升药液。去渣。加入芒硝。再煎至沸腾。一次性服用。有脓液则排出脓液。如果没有脓液。则排出瘀血。
〔补注〕肠痈导致少腹部不可按压。是阳邪结聚于下部。病位牵引所致。按压时疼痛如同淋病。是对疼痛状态的形容。这是病情发展的必然结果。血分有病而气分无病。所以小便正常。然而阳邪已经亢盛。卫气因此虚弱。于是出现发热、出汗和畏寒的症状。痈证的诊治。必须以脓液是否形成作为区别。想知道的方法。除了诊脉别无他途。脉象迟紧。知道脓液未成熟。是因为血液瘀结在内部。不要让它形成脓液。攻下必须趁早。不就是桃核承气汤吗？如果脉象洪数。说明脓液已经形成。哪里还有瘀血可以攻下呢？这里使用大黄、丹皮来清除热邪并排脓。是形势所必需的。然而《内经》说。患肠痈病不可受惊吓。受惊会导致肠断而死。所以患有此病的人。坐卧转身。理应缓慢。少量饮用稀粥。不要失调养之道。这就好了。
问曰。寸口脉微而涩。按照医理应当是失血。如果是出汗。假设不出汗的情况是怎样的。回答说。如果身上有疮疡。被刀斧所伤。是因为失血的原因。
〔补注〕脉微则是阳虚。脉涩则是血虚。这是确定的定理。所以脉涩则亡血。阳微应当出汗。如果不出汗是怎么回事。要知道汗是由血液化生的。所以出汗多尚且会亡阳。何况是失血呢。然而突然被刀斧所伤者。阴血离去而阳气也随之衰微。阳气虽然衰微但不能再次出汗。是因为失血的原因。
患金疮（金属利器造成的创伤）。用王不留行散主治。
王不留行散方
王不留行（十分八月八日采取） 蒴藋细叶（十分七月七日采）
桑树东南方向的根白皮（十分三月三日采） 川椒（三分除去目及闭口者。炒去汗）
甘草（十八分） 黄芩（二分） 干姜（二分） 厚朴（二分） 芍药（二分）
以上九味药。桑根皮等前三味药。烧成灰保留药性。不要让灰过度烧焦。分别捣碎过筛。混合研磨成散剂。每次服用一方寸匕。小疮直接敷粉。大疮只内服。产后也可以服用。如果有风寒。不要用桑树东南根的白皮。前三味药都要阴干一百天。
浸淫疮。从口部流向四肢的可以治愈。从四肢流来进入口部的不可治愈。
〔衍义〕从口向四肢蔓延。是由上到下。由内到外。属于散发。火热之邪散发则容易消除。反之聚集则难治。因为时间久了会更加热盛。医经说。夏季脉象太过。使人皮肤疼痛成为浸淫疮。大概是因为夏季脉象洪大。心主火。脉象反映心的状况。所以说。三部脉象洪数是心家热盛。舌上生疮嘴唇破裂。但这必须是非其时而有其气才会这样。如果在立夏时节得到洪大的脉象。又不在此讨论范围内了。
浸淫疮。用黄连粉主治。（方剂未见）
〔衍义〕黄连泻手少阴心经之火。火邪去除而气血自然恢复。
(One treatise, three pulse and symptom patterns, five prescriptions)
Whenever the pulse is floating and rapid (Fushu Mai, a pulse indicating exterior heat or yang excess), fever should be present, yet the patient instead experiences chills (Saxi Ehan, feeling cold as if splashed by water). If there is a painful area on the body, an abscess (Yong, a localized purulent infection) will likely develop.
[Supplementary Note] When a disease is about to manifest, the pulse invariably provides an early sign. The floating and rapid pulse belongs to Yang and indicates Heat. Their simultaneous appearance represents "Yang within Yang," suggesting that the internal Heat must fully manifest externally. However, the patient experiences chills, which contradicts the typical presentation of such a pulse. Why? This is due to blood stagnation (Xue You Ningzhi) where Qi cannot disperse freely. As stated in the classics: when Ying Qi (Nutritive Qi) fails to flow smoothly and reverses into the muscle tissue, swelling and abscesses arise; when Yang Qi is excessive and Ying Qi does not circulate, an abscess develops. Moreover, the patient already has a specific painful area. The visible pulse indicates Yang, and the impending pain also belongs to Yang pathology. Therefore, it is said that an abscess is indicated.
The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, place your hand over the swollen area. If it feels hot, pus is present; if it does not feel hot, pus is absent.
[Supplementary Note] When pathogenic factors invade the meridians, blood circulation becomes sluggish (Qi). Consequently, Wei Qi (Defensive Qi) gathers there and cannot circulate freely. Cold stagnates and transforms into Heat. When Heat prevails, flesh rots and turns into pus. To ascertain if pus has formed, one presses the area with the hand. Heat radiating outward indicates pus formation; otherwise, it has not yet formed. The reason the Master taught this method is to guide treatment: for established abscesses, promote suppuration and drainage; for unformed ones, support the body's resistance to expel toxins.
Intestinal abscess (Chang Yong) presents with the skin feeling tight like armor (Cuojia), abdominal wall tension, softness upon palpation despite appearing swollen, no abdominal masses (Jiju), no systemic fever, and a rapid pulse. This indicates pus forming within the intestines. Treat with Yiyi Fuzi Baijiang San (Coix Seed and Aconite Decoction with Patrinia).
Prescription: Yiyi Fuzi Baijiang San
Coix Seed (Yiyiren, 10 parts) / Aconite Root (Fuzi, 2 parts) / Patrinia Herb (Baijiangcao, 5 parts)
Grind the above three ingredients into powder. Take one cun-bi (a square-inch measure) of the powder. Boil in two sheng of water and take orally at once. Urination should be clear and smooth.
[Supplementary Note] Blood accumulation internally leads to external skin tightening, as described in the classics. Why does intestinal abscess present similarly? The abscess forms internally, causing blood stagnation and immobility. Due to this immobility, Qi also stagnates, making the abdominal wall appear swollen but remain soft upon palpation. Although the lesion is in the intestines/stomach, it is not an abdominal mass. The absence of external fever combined with a rapid pulse confirms internal abscess/pus. However, the Large Intestine and Lung are interior-exteriorly related. Pathology in the Fu organ may ascend to affect the Zang organ, which is concerning. Therefore, use herbs that protect the Lung and direct downward, preventing upward invasion. Aconite is acrid and warm to disperse stagnation; Patrinia is bitter and cold to detoxify and drain pus. The goal is to transform pus into fluid, which then exits via the urinary pathway. Thus, blood pathology resolves and Qi circulation opens. How miraculous!
Intestinal abscess presents with swelling and fullness in the lower abdomen, pain upon pressure resembling strangury (Lin), normal urination, intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight (Chi Jin), pus has not yet formed; purgation can be used, and bloody stool may pass. If the pulse is surging and rapid (Hong Shu), pus has formed; purgation is contraindicated. Treat with Dahuang Mudan Tang (Rhubarb and Moutan Decoction).
Prescription: Dahuang Mudan Tang
Rhubarb Root (Dahuang, 4 liang) / Moutan Bark (Mudanpi, 1 liang) / Peach Kernel (Taoren, 50 pieces) / Melon Seeds (Gua Zi, 0.5 sheng) / Mirabilite (Mangxiao, 3 he)
Boil the above five ingredients in six sheng of water until reduced to one sheng. Strain. Add Mangxiao. Boil again until boiling. Take orally at once. Pus will be discharged if present; if no pus, blood will be discharged.
[Supplementary Note] In intestinal abscess, the lower abdomen is tender to touch because Yang pathogens are bound below, causing referred pain. Pain resembling strangury describes the severity. Since only blood is affected and not Qi, urination remains normal. However, Yang pathogens are abundant, weakening Wei Qi, leading to fever, sweating, and chills. Treatment depends on whether pus has formed. Pulse diagnosis is key. A slow, tight pulse indicates immaturity and blood stasis; purgation should be administered early to prevent pus formation, similar to Taohe Chengqi Tang. A surging, rapid pulse indicates mature pus; there is no stasis to purge. Here, Dahuang and Mudanpi are used to clear Heat and drain pus, which is necessary. However, the Neijing states: "In intestinal abscess, do not startle the patient; startling may cause intestinal rupture and death." Therefore, patients should move slowly when sitting, lying, or turning, consume small amounts of thin porridge, and maintain proper care.
Question: If the Cun Kou (radial artery) pulse is minute and choppy (Wei Se), according to theory, this indicates blood loss. If it were due to sweating, what if there is no sweating? Answer: If the patient has sores or wounds from knife/axe injuries, the minute and choppy pulse is due to blood loss.
[Supplementary Note] Minute pulse indicates Yang deficiency; choppy pulse indicates blood deficiency. This is a fixed principle. Choppy pulse implies blood loss. Minute pulse suggests sweating should occur. If no sweating occurs, consider that sweat is derived from blood. Excessive sweating depletes Yang; how much more so does blood loss deplete Yin and Yang? Sudden trauma from knives/axes causes Yin (blood) loss, causing Yang to decline with it. Although Yang declines, the inability to sweat further is due to the prior blood loss.
For metal weapon wounds (Jinchuang), treat with Wangbuliuxing San (Imperata Rhizome Powder).
Prescription: Wangbuliuxing San
Imperata Rhizome (Wangbuliuxing, 10 parts, harvested Aug 8) / Smartweed Leaves (Shuodi Xiye, 10 parts, harvested Jul 7) / White bark of mulberry root from the southeast side (Sang Dongnan Gen Baipi, 10 parts, harvested Mar 3) / Sichuan Pepper (Chuanjiao, 3 parts, remove eyes and closed ones, stir-fry until moisture evaporates) / Licorice Root (Gancao, 18 parts) / Scutellaria Root (Huangqin, 2 parts) / Dried Ginger (Ganjiang, 2 parts) / Magnolia Bark (Houpo, 2 parts) / Peony Root (Shaoyao, 2 parts)
Take the first three ingredients (mulberry bark, etc.), burn them to ash while preserving their medicinal properties (do not burn completely to charcoal). Grind each separately and sieve. Mix and grind into a powder. Take one cun-bi orally. For minor wounds, apply the powder topically. For major wounds, take orally. It can also be taken postpartum. If wind-cold is present, do not use the southeast mulberry root. The first three ingredients must be dried in the shade for 100 days.
For Jingyin Chuang (oozing dermatitis/crusted sores): If the lesion spreads from the mouth/trunk to the limbs, it is treatable. If it spreads from the limbs to the mouth/trunk, it is difficult to treat.
[Extended Meaning] Spreading from the center to the limbs is dispersal (from inside out, top to bottom). Fire-Heat dispersing is easy to resolve; aggregation is hard to treat as heat accumulates over time. The classics state: Excessive Summer pulse causes skin pain known as Jingyin. This is because the Summer pulse is surging and large, reflecting Heart Fire (Heart governs the pulse). Thus, "Surging and rapid pulses in all three positions indicate Heart Heat; ulcers on the tongue and cracked lips follow." However, this applies only when abnormal weather occurs at the wrong time. If a surging-large pulse appears at the beginning of Summer, it is normal and not discussed here.
For Jingyin Chuang, treat with Huanglian Fen (Coptis Powder). (Formula not recorded)
[Extended Meaning] Huanglian clears Fire from the Hand-Shaoyin (Heart) meridian. Once Fire is eliminated, Qi and Blood naturally recover.