小腹硬痛。脉迟紧者。瘀血也。宜下之。
小腹软痛。脉洪数者。脓成也。宜托之。
一产妇小腹痛。小便不利。以薏苡仁汤二剂痛止。更以四物加桃仁、红花。下瘀血升许
大抵此症、皆因荣卫不调。或瘀血停滞所致。若脉洪数。已有脓。脉但数。微有脓。脉
。乃瘀血。下之则愈。若患甚者。腹胀大转侧作水声。或脓从脐出。或从大便出。宜蜡矾丸
、太乙膏、及托里药。
一妇小腹肿痛。小便如淋。尺脉芤而迟。以神效栝蒌散二剂少愈。更以薏苡仁汤二剂而
愈。（此凭脉症也。）
一人脓已成。用云母膏一服。下脓升许。更以排脓托里药而愈。后因不守禁忌。以致不
救。（此凭症也。）
一人里急后重。时或下脓。胀痛。脉滑数。以排脓散及蜡矾丸而愈。（此凭症脉也。）
一妇小腹痛有块。脉芤而涩。以四物汤加玄胡、红花、桃仁、牛膝、木香而愈、（此凭
一妇小腹隐痛。大便秘涩。腹胀。转侧作水声。脉洪数。以梅仁汤一剂。诸症悉退。以
薏苡仁汤二剂而瘥。（此凭脉症也。）
一妇腹胀痛。皮毛错纵。小便不利。脉数滑。以太乙膏一服。脓下升许。胀痛顿退。以
神效栝蒌散二剂而全退更以蜡矾丸及托里药十余剂而安。（此凭脉症也。）
一妇因经水。多服涩药止之。致腹作痛。以失笑散（百九）二服而瘳。（此凭症也。）
一人小腹痛而坚硬。小便数。汗时出。脉迟紧。以大黄汤一剂。下瘀血合许。以薏苡仁
汤四剂而安。（此凭脉也。）
一妇小腹恶露不尽。小腹痛。以薏苡仁汤（二百十五）下瘀血而痊。（此凭症也。）凡瘀血
停涩。宜急治之。缓则腐为脓。最难治疗。若流满节骨。则患骨疽。失治多为败症。
肠痈。身甲错。腹皮急。按之濡。如肿状。腹无聚积。身无热。此久积冷所致。故金匮
附子温之。若小腹肿痞。按之痛如淋。小便自调发热身无汗。复恶寒。脉迟紧。肿未成可下
之。当有血。洪数者脓已成。不可下、此内结热所成。故金匮有用大黄利之甚者腹胀大。
转侧闻水声。或绕脐生疮。脓从疮出者。有出脐中者。不治必死。惟大便下脓血者自愈。
一妇病少腹痞坚。小便或涩。或时汗出。或复恶寒。此肠痈也。脉滑而数。为痈已成。
设脉迟紧。即为瘀血。惟血下则愈。（此凭症脉也。）
内经载有息积病。此得之二三年。遍身微肿。续乃大肠与脐连日出脓。遂至不救。此亦
肠痈之类。
肠痈作湿热积治。入风难治。千金谓妄治必杀人。要略以薏苡仁附子败毒散。千金以大
黄牡丹汤。三因以薏苡仁汤。千金又有灸法。曲两肘头正肘锐骨灸百壮。下脓血而安。
一人伤寒逾月。既下。内热未已。胁及小腹偏左肿满。肉色不变。俚医为风矢所中。以
之。月余。毒循宗筋流入睾丸。赤肿如瓠。翁诊关尺滑数且芤。曰。数脉不时见。当生恶
疮。关芤为肠痈。用保生膏。 更以乳香。用硝黄作汤下之。脓如糜者五升许。明日再圊。
余脓而瘥。（此凭脉症也。）
一妇肠中痛。大便自小便出。诊之芤脉见于关。此肠痈也。以云母膏（二百十六）作百十
丸。煎黄 汤吞之。利脓数升而安。
一女腹痛。百方不应。脉滑数。时作热。腹微急。曰。痛病脉沉细。今滑数。此肠痈也
云母膏一两。丸如梧桐子。以牛皮胶熔入酒中。并水吞之。饷时服尽。下脓血。愈（此凭脉
一人年逾五十。腹内隐痛。小便如淋。皮肤错纵而脉滑数。此肠痈也。滑数脓成。以广
东牛皮胶酒熔化送太乙膏。脓下升许。更以排脓托里药、及蜡矾丸而愈。（此凭脉也。）
一妇产后小腹作痛。诸药不应。其脉滑数。此瘀血内溃为脓也。服瓜子仁汤（五九）痛止
。更以太乙膏而愈。（此凭脉也。）
今人产后。多有此病。纵非痈毒。用之更效。有人脐出脓水。久而不愈。亦以前膏及蜡
矾丸而痊。
一儿年十二。患腹胀。脐突颇锐。医谓肠痈。舍针脐无他法。翁曰。脐神阙也。针刺当
况痈舍子内。惟当以汤丸攻之。进透脓散一剂。脓自溃。继以十奇汤下善应膏丸。渐瘥。（
此凭症也。）
The lower abdomen is hard and painful, with a slow and tight pulse; this indicates blood stasis. It is appropriate to use purgation.
The lower abdomen is soft and painful, with a surging and rapid pulse; this indicates that pus has formed. It is appropriate to use the method of supporting the healthy qi to expel toxins.
A postpartum woman suffered from lower abdominal pain and difficulty in urination. After taking two doses of Yiyiren Decoction (Coix Seed Decoction), the pain ceased. Subsequently, she took Siwu Tang (Four Substances Decoction) added with Taoren (Peach Kernel) and Honghua (Safflower), which expelled more than one sheng of blood stasis.
Generally, this condition is caused by disharmony of Ying and Wei (nutritive and defensive qi) or stagnation of blood stasis. If the pulse is surging and rapid, pus has already formed; if the pulse is merely rapid, there is slight pus; if the pulse is slow and tight, it is blood stasis. Purging will lead to recovery. In severe cases, the abdomen becomes distended and large, producing a water-sloshing sound when turning over, or pus discharges from the umbilicus or through the stool. One should use Lafan Pill (Beeswax and Alum Pill), Taiyi Paste, and formulas for supporting the interior (tonifying qi and blood to expel toxins).
A woman suffered from swelling and pain in the lower abdomen and urinary symptoms resembling strangury. Her chi (cun-kou position at the wrist) pulse was hollow and slow. After taking two doses of Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder), her condition improved slightly. She then took two doses of Yiyiren Decoction and recovered. (This diagnosis relied on pulse and symptoms.)
A man had already formed pus. He took one dose of Yunmu Paste (Cloud Mother Paste) and discharged more than one sheng of pus. He subsequently took formulas for draining pus and supporting the interior and recovered. However, due to failing to observe dietary and lifestyle taboos, he eventually died. (This diagnosis relied on symptoms.)
A man experienced tenesmus and occasional discharge of pus, accompanied by distending pain. His pulse was slippery and rapid. He recovered after taking Painong San (Drain Pus Powder) and Lafan Pill. (This diagnosis relied on symptoms and pulse.)
A woman suffered from lower abdominal pain with a palpable mass. Her pulse was hollow and choppy. She recovered after taking Siwu Tang (Four Substances Decoction) added with Yuanhusuo (Corydalis Rhizome), Honghua (Safflower), Taoren (Peach Kernel), Niuxi (Achyranthes Root), and Muxiang (Aucklandia Root). (This diagnosis relied on...)
A woman suffered from dull pain in the lower abdomen, constipation with dry stools, abdominal distension, and a water-sloshing sound when turning over. Her pulse was surging and rapid. After taking one dose of Meiren Tang (Apricot Kernel Decoction), all symptoms subsided. She then took two doses of Yiyiren Decoction and healed. (This diagnosis relied on pulse and symptoms.)
A woman suffered from abdominal distension and pain, rough and crisscrossed skin texture, and difficulty in urination. Her pulse was rapid and slippery. After taking one dose of Taiyi Paste, she discharged more than one sheng of pus, and the distending pain instantly receded. She then took two doses of Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder) until complete resolution, followed by more than ten doses of Lafan Pill and formulas for supporting the interior, leading to stability. (This diagnosis relied on pulse and symptoms.)
A woman took excessive amounts of astringent medicines to stop menstruation, resulting in abdominal pain. She recovered after taking two doses of Shixiao San (Instant Satisfaction Powder). (This diagnosis relied on symptoms.)
A man suffered from hard and painful lower abdomen, frequent urination, spontaneous sweating, and a slow and tight pulse. After taking one dose of Dahuang Tang (Rhubarb Decoction), he discharged about one he of blood stasis. He then took four doses of Yiyiren Decoction and stabilized. (This diagnosis relied on pulse.)
A woman suffered from incomplete expulsion of lochia postpartum and lower abdominal pain. She recovered after taking Yiyiren Decoction to expel blood stasis. (This diagnosis relied on symptoms.) Whenever blood stasis stagnates and obstructs, it should be treated urgently. Delay allows it to rot into pus, making it very difficult to treat. If it flows into the joints and bones, it results in bone abscess; neglect often leads to critical conditions.
Intestinal carbuncle presents with rough, scaly skin on the body, tense abdominal wall, and a soft feeling upon pressure, resembling a swelling but without accumulated masses in the abdomen. The body has no fever. This is caused by long-standing accumulation of cold. Therefore, Fuzi (Aconite Lateralis Radix Preparata) is used to warm, as per the *Jinkui Yaolue*. If the lower abdomen is swollen and痞 (fullness/hardness), painful upon pressure like strangury, with normal urination, fever, no sweat, aversion to cold, and a slow and tight pulse, the swelling has not yet formed pus and can be purged; blood stasis should be expected. If the pulse is surging and rapid, pus has formed, and purging is contraindicated; this is caused by internal heat binding. Thus, Dahuang (Rhubarb Radix et Rhizoma) is used to purge, as per the *Jinkui Yaolue*. In severe cases, the abdomen is distended and large, producing a water-sloshing sound when turning over, or sores appear around the umbilicus with pus discharging from them, or pus discharges from the umbilicus itself. Untreated, this is fatal. Only those who discharge pus and blood via the stool may heal spontaneously.
A woman suffered from hardness and fullness in the lower abdomen, intermittent difficulty in urination, occasional sweating, and intermittent aversion to cold. This is intestinal carbuncle. A slippery and rapid pulse indicates that the abscess has formed; if the pulse were slow and tight, it would indicate blood stasis, which must be discharged for recovery. (This diagnosis relied on symptoms and pulse.)
The *Neijing* records a disease called Xiji (Accumulation Disease). Contracted over two or three years, it presents with slight swelling throughout the body, followed by daily discharge of pus from the connection between the large intestine and the umbilicus, eventually leading to death. This is also a type of intestinal carbuncle.
Intestinal carbuncle should be treated as damp-heat accumulation. If complicated by wind pathogens, it is difficult to treat. The *Qianjin Fang* states that mistaken treatment kills. The *Jinkui Yaolue* uses Yiyiren Fuzi Baidu San (Coix Seed and Aconite Toxin-Expelling Powder); the *Qianjin Fang* uses Dahuang Mudan Tang (Rhubarb and Moutan Decoction); the *San Yin Fang* uses Yiyiren Tang (Coix Seed Decoction). The *Qianjin Fang* also mentions moxibustion: moxa is applied 100 cones to the sharp bone at the center of both elbows. Discharge of pus and blood leads to peace.
A man suffered from typhoid fever for over a month. After purgation, internal heat remained. The hypochondrium and left side of the lower abdomen became swollen and full, with unchanged skin color. Quacks attributed it to wind attack. Over a month later, the toxin flowed along the Zongjin (Vessel of Genitals) into the testicles, causing red and swollen lumps like gourds. Wang Ji diagnosed the guan and chi pulses as slippery, rapid, and hollow. He said, "The intermittent appearance of a rapid pulse suggests an impending malignant sore; the hollow guan pulse indicates intestinal carbuncle." He used Baosheng Paste, and additionally used Ruxiang (Frankincense Resin) administered with a decoction of Xiaoshihuang (Natrii Sulfas) and Dahuang (Rhubarb Radix et Rhizoma). He discharged five sheng of pus resembling gruel. The next day, after another bowel movement, the remaining pus was discharged, and he recovered. (This diagnosis relied on pulse and symptoms.)
A woman suffered from intestinal pain, with feces discharging through the vagina. Diagnosis revealed a hollow pulse at the guan position. This is intestinal carbuncle. She took Yunmu Paste (Cloud Mother Paste) made into over one hundred pills, swallowed with Huangqi (Astragalus Root) decoction, and discharged several sheng of pus, achieving peace.
A young woman suffered from abdominal pain unresponsive to various treatments. Her pulse was slippery and rapid, with intermittent fever and slight abdominal tension. I stated, "Painful diseases typically present with deep and fine pulses; the current slippery and rapid pulse indicates intestinal carbuncle." She took one liang of Yunmu Paste (Cloud Mother Paste), formed into pills the size of paulownia seeds, melted with NiuPi Jiao (Ox Hide Glue) in wine, and taken with water within the time of a meal. She discharged pus and blood and healed. (This diagnosis relied on pulse...)
A man over fifty years old suffered from dull internal abdominal pain, urinary symptoms resembling strangury, rough and crisscrossed skin, and a slippery and rapid pulse. This is intestinal carbuncle. The slippery and rapid pulse indicates pus formation. He took Guangdong NiuPi Jiao (Ox Hide Glue) melted in wine to swallow Taiyi Paste. He discharged more than one sheng of pus, then took formulas for draining pus and supporting the interior, along with Lafan Pill, and recovered. (This diagnosis relied on pulse.)
A postpartum woman suffered from lower abdominal pain unresponsive to various medicines. Her pulse was slippery and rapid, indicating that blood stasis had internally ulcerated into pus. She took Guazi Ren Tang (Melon Seed Decoction), and the pain stopped. She then took Taiyi Paste and recovered. (This diagnosis relied on pulse.)
Currently, many postpartum women suffer from this condition. Even if it is not a carbuncle or toxin, using these methods is even more effective. Some people have chronic pus discharge from the umbilicus that does not heal; they also recover using the aforementioned paste and Lafan Pill.
A twelve-year-old child suffered from abdominal distension with a prominent and sharp umbilicus. Physicians diagnosed intestinal carbuncle and suggested needle puncture of the umbilicus as the only method. Wang Ji said, "The umbilicus is Shenque (CV8). Needle puncture should..." Moreover, since the carbuncle is located internally, it should only be treated with decoctions and pills. After taking one dose of Tou Nong San (Penetrate Pus Powder), the pus ruptured spontaneously. Subsequently, he took Shiqi Tang (Ten Wonders Decoction) to swallow Shanying Gao Wan (Excellent Response Paste Pills), gradually recovering. (This diagnosis relied on symptoms.)