诸浮数脉。应当发热。而反洒淅恶寒。若有痛处。当发其痈。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。
浮数脉皆阳也。阳当发热。而反洒淅恶寒者。卫气有所遏而不出也。夫卫主行营气者也。而营过
实者。反能阻遏其卫。若有痛处。则营之实者已兆。故曰当发其痈。痈肿之候。脓不成。则毒不化。而
毒不聚。则脓必不成。故以手掩其肿上。热者毒已聚。则有脓。不热者毒不聚。则无脓也。
肠痈之为病。其身甲错。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。
甲错、肌皮干起。如鳞甲之交错。由营滞于中。故血燥于外也。腹皮急。按之濡。气虽外鼓。而
病不在皮间也。积聚为肿胀之根。脉数为身热之候。今腹如肿状而中无积聚。身不发热而脉反见数。
非肠内有痈。营郁成热而何。薏苡破毒肿。利肠胃为君。败酱一名苦菜。治暴热火疮。排脓破血为臣。
附子则假其辛热以行郁滞之气尔。
薏苡附子败酱散方
薏苡仁（十分） 附子（二分） 败酱（五分）
上三味。杵为散。取方寸匕。以水二升。煎减半。顿服。小盒饭下。
肿痈者。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。脉洪数者。脓已成。不可下也。大黄牡丹汤主之。
肿痈。疑即肠痈之在下者。盖前之痈在小肠。而此之痈在大肠也。大肠居小肠之下。逼处膀胱。
致小腹肿痞。按之即痛如淋。而实非膀胱为害。故仍小便自调也。小肠为心之合。而气通于血脉。大
肠为肺之合。而气通于皮毛。故彼脉数身无热。而此时时发热。自汗出。复恶寒也。脉迟紧者。邪暴
遏而营未变。云可下者。谓可下之令其消散也。脉洪数者。毒已聚而营气腐。云不可下者。谓虽下之
而亦不能消之也。大黄牡丹汤。肠痈已成未成。皆得主之。故曰有脓当下。无脓当下血。
大黄牡丹汤方
大黄（四两） 牡丹（一两） 桃仁（五十个） 冬瓜仁（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。顿服之。有脓当下。如无脓当下血。
问曰。寸口脉浮微而涩。法当亡血若汗出。设不汗出者云何。曰若身有疮。被刀斧所伤。亡血故
也。
血与汗皆阴也。阴亡。则血流不行。而气亦无辅。故脉浮微而涩也。经云。夺血者无汗。夺汗者
无血。兹不汗出而身有疮。则知其被刀斧所伤而亡其血。与汗出不止者。迹虽异而理则同也。
病金疮。王不留行散主之。
金疮。金刃所伤而成疮者。经脉斩绝。营卫沮弛。治之者必使经脉复行。营卫相贯而后已。王不
留行散。则行气血和阴阳之良剂也。
王不留行散方
王不留行（十分八月八日采） 蒴 细叶（十分七月七日采） 甘草（十八分） 黄芩（二分）
桑东南根白皮（十分三月三日采） 川椒（三分） 浓朴（二分） 干姜（二分） 芍药（二分）
上九味。王不留行、蒴 、桑皮三味。烧灰存性。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。桑根勿取之。前三物阴干百日。
排脓散方
枳实（十六枚） 芍药（六分） 桔梗（二分）
上三味。杵为散。取鸡子黄一枚。以药散与鸡黄相等。揉和令相得。饮和服之。日一服。
枳实苦寒。除热破滞为君。得芍药则通血。得桔梗则利气。而尤赖鸡子黄之甘润。以为排脓化毒
之本也。
排脓汤方
甘草（二两） 桔梗（三两） 生姜（一两） 大枣（十枚）
上四味。以水三升。煮取一升。温服五合。日再服。
此亦行气血和营卫之剂。
浸淫疮。从口起流向四肢者可治。从四肢流来入口者不可治。浸淫疮。黄连粉主之。
浸淫疮。义如脏腑经络篇中。黄连粉方未见。大意以此为湿热浸淫之病。故取黄连一味为粉粉之。
苦以燥湿。寒以除热也。
凡是脉象浮数，本应当出现发热症状，却反而感到阵阵恶寒。如果身体某处有疼痛感，说明将要发生痈肿。老师说：对于各种痈肿，想要知道是否有脓液形成，可以用手按压在肿胀部位上方。感觉发热的，说明有脓；不感觉发热的，说明没有脓。
浮脉和数脉都属于阳脉。属阳的脉象本应伴随发热，但反而出现阵阵恶寒，这是因为卫气受到遏制而不能外达所致。卫气原本负责运行营气，但如果营气过于壅实，反而会阻碍卫气的运行。如果身体某处有疼痛，说明营气壅实的征象已经显现，所以说将会发生痈肿。痈肿的症状中，脓液如果不形成，毒邪就不能化解；而毒邪如果不聚集，脓液就一定无法形成。因此用手按压肿胀处，感觉发热的，说明毒邪已经聚集，所以有脓；不感觉发热的，说明毒邪未聚集，所以没有脓。
肠痈这种病，患者皮肤干燥粗糙如鳞甲交错，腹部皮肤紧绷，但按压时感觉柔软，看起来像是有肿胀，但腹内并无积聚块状物，身体无发热，脉象数。这是肠道内有痈脓的表现，用薏苡附子败酱散主治。
“甲错”是指肌肤干燥起屑，像鳞甲一样交错，这是由于营血阻滞于体内，导致血液干枯于体表所致。腹部皮肤紧绷，按压却感觉柔软，说明气机虽然向外鼓胀，但病位不在皮肉之间。“积聚”是产生肿胀的根本原因，“脉数”是身体发热的征候。现在腹部像是有肿胀但中间没有积聚，身体不发热度脉搏却见数，如果不是肠道内有痈肿，营气郁结化热，还能是什么呢？薏苡仁能破除毒肿，通利肠胃，作为君药；败酱又名苦菜，能治疗暴热火疮，排脓破血，作为臣药；附子是借其辛热之性来运行郁滞的气机罢了。
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，捣碎成散剂。取一方寸匕的药量，用水二升，煎煮至剩下一升，一次性服用。小便应当通畅。
肠痈（此处指大肠痈），表现为小腹部肿胀痞满，按压时就疼痛如同淋证，但小便正常。时常发热，自汗出，又伴有恶寒。脉象迟紧的，说明脓液尚未形成，可以使用攻下法；脉象洪数的，说明脓液已经形成，不可使用攻下法。用大黄牡丹汤主治。
肠痈，怀疑就是发生在下部的肠痈。前面的肠痈是在小肠，而这个肠痈是在大肠。大肠位于小肠之下，紧邻膀胱，导致小腹肿胀痞满，按压就痛得像淋证，但实际上并非膀胱受累，所以小便依然正常。小肠与心相合，气脉相通于血脉；大肠与肺相合，气脉相通于皮毛。所以前一种情况脉数身无热，而这一种情况时时发热，自汗出，又恶寒。脉象迟紧，说明邪气突然遏制而营血尚未变化，说“可下”，意思是可以通过攻下使其消散。脉象洪数，说明毒邪已聚集且营气腐败，说“不可下”，意思是即使攻下也不能消除它。大黄牡丹汤，无论肠痈脓液已成或未成，都可以主治。所以说有脓可以攻下，无脓也可以攻下以排出瘀血。
大黄牡丹汤方
大黄（四两） 牡丹皮（一两） 桃仁（五十个） 冬瓜仁（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，再煮沸，一次性服用。有脓液则排出脓液，如无脓液则排出瘀血。
问：寸口脉象浮微而涩，按照医理应当是失血或者汗出的表现。假设没有汗出，是怎么回事呢？回答说：如果身上有疮伤，被刀斧所伤，是因为失血的原因。
血和汗都属阴。阴液亡失，则血液运行不畅，气也失去依附，所以脉象浮微而涩。经书说：夺血者无汗，夺汗者无血。这里没有汗出而身上有疮，就知道是被刀斧所伤而失血。这与汗出不止的情况，表象虽然不同，但道理是一样的。
金疮（金属利器造成的创伤），用王不留行散主治。
金疮，是由金属利器损伤形成的疮口，导致经脉断裂，营卫之气松弛败坏。治疗时必须使经脉重新通行，营卫之气相互贯通才能痊愈。王不留行散，是行气血、和阴阳的良好方剂。
王不留行散方
王不留行（十分，八月八日采集） 蒴藋细叶（十分，七月七日采集） 甘草（十八分） 黄芩（二分）
桑树东南方向的根白皮（十分，三月三日采集） 川椒（三分） 厚朴（二分） 干姜（二分） 芍药（二分）
以上九味药，将王不留行、蒴藋细叶、桑皮这三味药烧成灰但保留药性，分别捣碎过筛，混合制成散剂。每次服用一方寸匕。小疮可以直接用药粉敷撒；大疮只内服。产后妇女也可以服用。如果有风寒，不要取用桑根。前三味药需阴干一百天。
排脓散方
枳实（十六枚） 芍药（六分） 桔梗（二分）
以上三味药，捣碎成散剂。取一个鸡蛋黄，用药散与蛋黄等量，揉和均匀。用水送服，每天一次。
枳实味苦性寒，能清热破滞，作为君药；得到芍药就能通血；得到桔梗就能利气；尤其依赖鸡蛋黄的甘润，作为排脓解毒的根本。
排脓汤方
甘草（二两） 桔梗（三两） 生姜（一两） 大枣（十枚）
以上四味药，用水三升，煮取一升药液，温服五合，每天两次。
这也是行气血、和营卫的方剂。
浸淫疮，从口部开始流向四肢的可以治愈；从四肢流回入口部的不可治愈。浸淫疮，用黄连粉主治。
浸淫疮，含义如脏腑经络篇所述。黄连粉的方子未见记载。大意认为这是湿热浸淫的病证，所以只用黄连一味药研成粉末外敷。苦味能燥湿，寒性能除热。
For all floating and rapid pulses, fever should be present. However, if there is instead a sensation of shivering and aversion to cold, and if there is a painful area, an abscess (carbuncle) will likely develop. The Master said: Regarding various swellings and abscesses, to determine whether pus has formed, place one's hand over the swollen area. If it feels hot, pus is present; if it does not feel hot, pus is absent.
Floating and rapid pulses both belong to Yang. Yang conditions typically manifest with fever. The presence of shivering and aversion to cold indicates that Wei Qi (Defensive Qi) is obstructed and unable to circulate outward. Although Wei Qi normally facilitates the circulation of Ying Qi (Nutritive Qi), excessive fullness in Ying Qi can reverse this and obstruct Wei Qi. If pain is present at a specific site, it signals that Ying Qi fullness has already manifested, hence the prediction of an impending abscess. In the progression of an abscess, if pus does not form, the pathogenic toxin cannot resolve; conversely, if the toxin does not gather, pus cannot form. Therefore, palpating the swelling reveals that heat indicates gathered toxin and thus the presence of pus, while lack of heat indicates scattered toxin and absence of pus.
Intestinal abscess presents with rough, scaly skin (jiacuo), tight abdominal skin that feels soft upon palpation, resembling swelling but without internal accumulation masses. The body temperature is normal, yet the pulse is rapid. This indicates pus within the intestines. Yi Yi Fu Zi Bai Jiang San (Coix Seed, Aconite, and Patrinia Decoction) is the primary formula.
"Jiacuo" refers to dry, scaly skin resembling overlapping scales, caused by stagnation of Ying blood internally leading to dryness externally. Tight abdominal skin that feels soft upon pressure suggests that although Qi is distending outward, the pathology is not in the superficial layers. Accumulations are the root of swelling, and a rapid pulse is a sign of fever. Here, the abdomen appears swollen but lacks internal accumulations, and the body is not febrile despite a rapid pulse. This must be due to intestinal abscess where Ying Qi stagnates and generates heat. Yi Yi Ren (Coix Seed) breaks down toxic swellings and benefits the intestines and stomach, serving as the Sovereign herb. Bai Jiang Cao (Patrinia Scabiosifolia Root), also known as Ku Cai, treats acute fire-toxin sores and promotes pus discharge and blood stasis resolution, serving as the Minister herb. Fu Zi (Aconite Lateralis Radix Praeparata) is used for its acrid and hot properties to move stagnant Qi.
**Yi Yi Fu Zi Bai Jiang San Formula**
* Yi Yi Ren (Coicis Semen): 10 parts
* Fu Zi (Aconiti Lateralis Radix Praeparata): 2 parts
* Bai Jiang Cao (Patriniae Herba): 5 parts
Pound the three ingredients into a powder. Take one cun-bi (approx. 9g) of the powder, add two sheng (approx. 400ml) of water, and decoct until half remains. Administer in one dose. Urination should be clear.
Chong Yong (Intestinal Abscess, specifically of the large intestine) manifests as swelling and fullness in the lower abdomen, pain upon pressure resembling strangury (lin syndrome), yet urination remains normal. There is intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not yet formed, and purgation may be used. If the pulse is surging and rapid, pus has formed, and purgation is contraindicated. Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) is indicated.
Chong Yong is suspected to be intestinal abscess located in the lower region. The previous description referred to the small intestine, whereas this refers to the large intestine. The large intestine lies below the small intestine and adjacent to the bladder, causing lower abdominal swelling and pain upon pressure mimicking strangury, though the bladder is not actually affected, hence normal urination. The Small Intestine pairs with the Heart, connecting via blood vessels; the Large Intestine pairs with the Lung, connecting via the skin and hair. Thus, while the former presents with rapid pulse and no fever, this condition presents with intermittent fever, sweating, and aversion to cold. A slow and tight pulse indicates sudden obstruction of pathogens without alteration of Ying Qi; "purgation may be used" means purgation can cause resolution. A surging and rapid pulse indicates gathered toxin and putrefaction of Ying Qi; "purgation is contraindicated" means purgation cannot eliminate the condition even if attempted. Da Huang Mu Dan Tang is effective for intestinal abscess whether pus has formed or not. Hence, it is said: if pus exists, purge it; if no pus, purge the blood stasis.
**Da Huang Mu Dan Tang Formula**
* Da Huang (Rhei Radix et Rhizoma): 4 liang
* Mu Dan Pi (Moutan Cortex): 1 liang
* Tao Ren (Persicae Semen): 50 kernels
* Dong Gua Ren (Benincasae Semen): 0.5 sheng
* Mang Xiao (Natrii Sulfas): 3 he
Decoct the five ingredients in six sheng (approx. 1200ml) of water until one sheng (approx. 200ml) remains. Strain, add Mang Xiao, boil again until boiling, and administer in one dose. Pus will be discharged if present; if not, blood stasis will be discharged.
Question: What if the Cun Kou (inch position) pulse is floating, fine, and choppy? According to principles, this indicates blood loss or excessive sweating. If there is no sweating, what is the explanation?
Answer: If there are wounds on the body caused by knives or axes, it is due to blood loss.
Blood and sweat both belong to Yin. Loss of Yin leads to stagnant blood flow and Qi lacking support, resulting in a floating, fine, and choppy pulse. The Classics state: "Those who lose blood do not sweat; those who lose sweat do not lose blood." Here, the absence of sweating combined with wounds indicates trauma from sharp instruments causing blood loss. Although the manifestation differs from profuse sweating, the underlying principle is the same.
For Jin Chuang (metal weapon injuries), Wang Bu Liu Xing San (Polygoni Multiflori Caulis Powder) is indicated.
Jin Chuang results from injury by metal blades, severing meridians and causing Ying and Wei Qi to become slack. Treatment must restore meridian flow and reunite Ying and Wei Qi. Wang Bu Liu Xing San is an excellent formula for promoting Qi and Blood circulation and harmonizing Yin and Yang.
**Wang Bu Liu Xing San Formula**
* Wang Bu Liu Xing (Polygoni Multiflori Caulis): 10 parts (harvested on the 8th day of the 8th lunar month)
* Shuoxie Ye (Commelinae Herba / Commelina communis leaves): 10 parts (harvested on the 7th day of the 7th lunar month)
* Gan Cao (Glycyrrhizae Radix et Rhizoma): 18 parts
* Huang Qin (Scutellariae Radix): 2 parts
* Sang Zhi Dong Nan Gen Bai Pi (Mori Cortex from Southeastern branch): 10 parts (harvested on the 3rd day of the 3rd lunar month)
* Chuan Jiao (Zanthoxyli Pericarpium): 3 parts
* Hou Po (Magnoliae Officinalis Cortex): 2 parts
* Gan Jiang (Zingiberis Rhizoma): 2 parts
* Shao Yao (Paeoniae Radix Alba): 2 parts
Take the nine ingredients. Burn Wang Bu Liu Xing, Shuoxie Ye, and Sang Pi to ash while retaining their medicinal properties. Pound and sieve each separately, then mix into a powder. Take one cun-bi per dose. For minor wounds, apply the powder topically; for major wounds, take orally. It may also be taken postpartum. If Wind-Cold is present, do not use Sang Gen. The first three ingredients should be dried in the shade for 100 days.
**Pai Nong San Formula (Pus-Discharging Powder)**
* Zhi Shi (Aurantii Fructus Immaturus): 16 pieces
* Shao Yao (Paeoniae Radix Alba): 6 fen
* Jie Geng (Platycodonis Radix): 2 fen
Pound the three ingredients into a powder. Take one chicken egg yolk. Mix equal amounts of the powder and egg yolk, knead until uniform, and take with water once daily.
Zhi Shi is bitter and cold, clearing heat and breaking stagnation, serving as the Sovereign herb. Combined with Shao Yao, it unblocks blood; combined with Jie Geng, it promotes Qi movement. Crucially, it relies on the sweet and moistening nature of the chicken egg yolk as the foundation for discharging pus and resolving toxicity.
**Pai Nong Tang Formula (Pus-Discharging Decoction)**
* Gan Cao (Glycyrrhizae Radix et Rhizoma): 2 liang
* Jie Geng (Platycodonis Radix): 3 liang
* Sheng Jiang (Zingiberis Rhizoma Recens): 1 liang
* Da Zao (Jujubae Fructus): 10 pieces
Decoct the four ingredients in three sheng (approx. 600ml) of water until one sheng (approx. 200ml) remains. Take five he (approx. 100ml) warm, twice daily.
This is also a formula for circulating Qi and Blood and harmonizing Ying and Wei Qi.
Jin Yin Chuang (oozing sore) starting from the mouth and flowing to the limbs is treatable; flowing from the limbs back to the mouth is untreatable. For Jin Yin Chuang, Huang Lian Fen (Coptidis Powder) is indicated.
The term "Jin Yin Chuang" is defined in the Chapter on Zang-Fu and Meridians. The formula for Huang Lian Fen is not recorded here. The general understanding is that this is a disease of damp-heat oozing. Therefore, only Huang Lian (Coptidis Rhizoma) is used, powdered and applied topically. Its bitterness dries dampness, and its coldness clears heat.