大肠痈者，乃阴阳偏胜，喜怒无时，伏于脏腑之中，结在肠胃之内，血凝气滞，回旋失
度，不能通行，聚结成痈，致生肿痛。孙真人云，卒得肠痈而不晓其病候，庸医治之，错则
杀人。肠痈之为病，初起觉腹中微痛，小腹肿而强抑之则痛，小便涩似淋，时时汗出，复恶
寒，其身皮甲错，腹皮紧急如肿之状，而按之濡，或发热无汗，洒淅恶寒皆其候也。其脉洪
数者为有脓也，可下。其脉迟紧者，未有脓，不可下也。甚者腹肚胀大，转侧闻有水声，或
绕脐生疮，或脓从脐出，或大便下脓血，凡此皆为恶证。若夫胃脘痈者，何以别之。《内经
》云∶人病胃脘痈者，当论胃脉沉细，沉细者气逆，逆者人迎反盛，则热聚于胃口而不行，
故胃脘为痈也。治法亦与肠痈颇同。初以疏利之药导其滞，次用排脓消毒托里之药调之，此
其大法也。若夫痔 之疾，与肠痈不同，其状初起于肛门边，或如鼠乳，或结小核，痒痛注
闷，甚者身热恶寒，此证皆由酒色过度，久嗜肥甘，醉饱入房，劳扰血脉，肠 渗漏，冲注
下部，发于肛边，遂成痔疾。其名有五，一曰牝痔，二曰牡痔，三曰气痔，四曰血痔，五曰
酒痔。又曰肠风痔、脉痔、雌雄痔，皆五痔之别名也。日久不愈，遂成 疮则难治矣。具方
于后，审而用之。
大黄汤
治肠痈小腹坚硬，肿大如掌而热，按之则痛，其上色或赤或白，小便稠数，汗出憎寒，
其脉迟紧者未成脓，如脉数则脓已成。
大黄（锉炒） 牡丹皮 硝石（研） 芥子 桃仁（汤泡，去皮尖，双仁炒，各半两）
上锉碎，每服五钱，水二盏煎至一盏，去渣空心温服，以利下脓血为度。未利再服。
四圣散
（一名神效栝蒌散）
治肠痈痈疽，生于脑、髭、背、腋、乳，便毒服之神效。
生黄栝蒌（一枚，去皮） 粉草（研末，四钱） 没药（研末，三钱） 乳香（研末，一钱）
上用好红酒二大碗，慢火煎至一碗，分作两服，两日服尽。大便顺导恶物妙，若干栝蒌
则用两枚一方。若病在上，食后服；若病在下食前服。毒已结成即脓化为水，毒未成即于小
便中出。疾甚，再合服，以退为妙。
牡丹散
治肠痈冷证，腹濡而痛，时时利脓。
牡丹皮 人参 天麻 白茯苓 黄 木香 当归 川芎 官桂 桃仁（去皮尖，各三
分） 白芷 薏苡仁 甘草（炙，各二分）
上为细末，每服三钱，用水一盅煎至七分，食前温服。
梅仁汤
治肠痈里急隐痛，大便闭涩。
梅核仁（四十九个，去皮尖） 大黄（三两） 牡丹皮（一两三分） 冬瓜仁（四两） 芒硝（
二两半） 犀角（镑，一两半）
上锉如麻豆大，每服五钱，水二盏煎至一盏，去渣温服，以利下脓血三二行为度。
神仙蜡矾丸
治肠痈内托神妙。此药不问老幼皆可服之，无不作效。最止疼痛，不动脏腑。
黄蜡（半两，要黄色者，一方用七钱） 白矾（一两，要明者研细）
上熔化黄蜡，和矾为丸，如梧桐子大。每服二十丸，渐加至三十丸，食远用温白汤送下
薏苡仁汤
治肠痈腹中疠痛，烦躁不安，或胀满不食，小便涩，妇人产后虚热，多有此病，纵非痈
，但疑似间便可服。
薏苡仁 栝蒌仁（各三钱） 牡丹皮 桃仁（各二钱）
上作一服，水二盅煎至一盅，不拘时服。
秦艽白术丸
治痔疾并 有脓血，大便燥硬作疼，痛不可忍。
秦艽（去芦） 桃仁（去皮尖，另研） 皂角仁（烧存性，各一两） 枳实（麸炒） 当归尾（
酒制） 泽泻、白术（以上各半两） 地榆（三钱）
上为细末，与桃仁泥研匀，汤煮面糊和丸如梧桐子大，令药光滑，焙干。每服一百丸，
白汤空心送下。服待少时以美膳压之。忌生冷硬物、冷水菜之类，并湿面酒及五辛辣热大料
物之类，犯之则药无验矣。数服而愈。
秦艽防风汤
治痔 每日大便时发疼痛，如无疼痛非痔 也，此药主之。
秦艽 防风 当归 白术（各一钱半） 黄柏 橘皮 柴胡 大黄（煨） 泽泻（各一钱）
红花 桃仁 升麻（各五分） 甘草（炙六分）
上作一服，水二盅煎至一盅，空心服。避风寒，忌房事及酒湿面辛热之物。
地榆散
治痔疮肿痛。
地榆 黄 枳壳 槟榔 川芎 黄芩 槐花 赤芍药 羌活（各一钱） 白蔹 蜂房（
炒焦） 甘草（炙，各五分）
上作一服，水二盅煎至一盅，食前服。
槐角丸
治诸痔及肠风下血脱肛。
槐角（去梗，一两） 防风 地榆 枳壳（麸炒） 当归 黄芩（各半两）
上为细末，酒糊为丸，如梧桐子大。每服五十丸，空心用米饮送下。
钓肠丸
治久新诸痔，肛边肿痛或时疮痒有脓血。
栝蒌（二个，烧存性） 皮（二个，烧存性） 白矾（ ） 绿矾（ ） 白附子（生用） 天
南星 鸡冠花（锉炒） 半夏（各五两） 胡桃仁（十五个， 存性） 枳壳（炒） 附子（炮，去
皮脐） 诃子（去核，各二两）
上为细末，醋糊为丸，如梧桐子大。每服三五十丸，临卧用温酒送下。远年不瘥者服十
日效，久服除根。
皂角煎丸
治内痔 ，肠头里面生核，寒热往来。
满尺皂角（三挺，去弦核，醋炙） 白矾（ ） 刺 皮（炙黄） 薏苡仁 白芷（以上各一
两） 桃仁（去皮，炒） 甜葶苈（炒） 川芎 桔梗（以上各半两） 猪后蹄垂甲（十枚，烧存性
上为细末，炼蜜和丸，如梧桐子大。每服五十丸，空心用桑白皮煎汤送下。
神效散
治洗痔。凡富贵之人多因嗜欲酒色过度，喜怒不常，致生痔 。或如鼠乳连珠，或粪门
肠头肿，流脓漏血，其痛如割不可忍者。但是诸肿疮痔 及肠风漏血，此药治之。
苦参 川椒 苦葫芦 芫荽子 槐花 枳壳 荆芥 金银花 白芷 连翘 独活 小茴
香麻黄 牡蛎（ ） 威灵仙 椿树皮（各二两）
上 咀，每用五钱，水六七碗，葱白二茎煎五七沸，去渣以盆盛，药水上坐，先蒸后洗
，甚验。加黄老茄子二个尤妙。
蜗牛膏
敷痔疮极效。
蜗牛（一枚） 片脑 麝香（各少许）
上同研烂，用瓷盒盛，次早取汁敷疮上。
拔毒散
敷痔肿毒处。
大黄 黄柏 白芨 石膏 黄芩 黄连 白蔹 栀子 朴硝（各等分）
上为末，用井华水调涂。
鸡峰乌金散
治痔 。
黄牛角心 猪牙皂角 刺 皮 穿山甲（以上，同炒焦黑） 皂荚刺 槐子 枳壳 贯众
阿胶（炒，各等分）
上为细末，每服一钱半，用胡桃肉研烂并酒调，食前服。大肠有热，荆芥泡汤调下；漏
血不止，当归煎汤调下。
枳壳散
熏洗痔 。
枳壳 贯众（各二两） 荆芥 大柏皮（各一两） 黄连 蛇床子 地骨皮 无名异 干姜
（炮，各半两） 苍耳根 冬青叶 薤头 柏枝（各一把） 黑豆（半升）
上 咀，每用一大合，用水三大碗，煎至二碗，先熏后洗，日三五次。
结阴丹
治肠风脏毒，大便下血。
枳壳（去穣，麸炒） 威灵仙 何首乌 椿根白皮 陈皮（去白） 荆芥穗 黄 （各等分）
上为细末，酒煮糊同蜜少许和丸，如梧桐子大。每服五十丸至七十丸，食前用米饮送下
。一方不用蜜，以醋少许同陈米饮煎汤下。
猪脏丸
治大人小儿大便下血日久，多食易饥，腹不痛，里不急。先用海螵蛸炙黄去皮，白者为
末，以木贼煎汤调下服之，三日后效。
黄连（二两，锉碎） 嫩猪脏（二尺，去肥）
上以黄连塞满猪脏，系两头煮十分烂，研细添糕糊丸，如梧桐子大。每服三五十丸，米
[Background Information]
Book: Waike Jiyan Fang (Collected Effective Formulas for Surgery)
Author: Zhao Yizhen
Dynasty: Ming Dynasty, Hongwu Wuwu Year
Chapter: Lun Changyong Zhi (Discussion on Intestinal Carbuncle and Hemorrhoids)
Category: Formula
[Intestinal Carbuncle]
Intestinal carbuncle (nongpurulent inflammation of the intestine) arises from an imbalance of yin and yang, irregular emotions such as anger and joy, where pathogenic factors lie dormant within the zang-fu organs and accumulate inside the intestines and stomach. This leads to blood stasis and qi stagnation, disrupting normal circulation and causing accumulation that forms a carbuncle, resulting in swelling and pain. Sun Simiao stated that if one suddenly suffers from intestinal carbuncle without understanding its symptoms, and a mediocre physician treats it incorrectly, death may result. In the early stage of intestinal carbuncle, there is slight abdominal pain, swelling in the lower abdomen, and pain upon firm pressure. Urination is difficult and painful, resembling strangury. There is frequent sweating accompanied by aversion to cold. The skin becomes rough like scales, and the abdominal wall feels tense as if swollen, yet soft upon palpation. Alternatively, there may be fever without sweat, or chills and shivering. These are all characteristic signs. A surging and rapid pulse indicates the presence of pus, suggesting the use of purgative methods. A slow and tight pulse indicates that pus has not yet formed, and purgatives should not be used. In severe cases, the abdomen distends significantly, and water sounds can be heard when turning over. Sores may appear around the umbilicus, pus may discharge from the navel, or bloody pus may pass in the stool. All these constitute ominous signs.
Regarding gastric carbuncle (nongpurulent inflammation of the stomach), how can it be distinguished? The *Neijing* states: "When a person suffers from gastric carbuncle, the stomach pulse should be examined. If the pulse is deep and fine, it indicates rebellious qi. Rebellious qi causes the Renying pulse (carotid artery) to become excessively full. Heat gathers at the stomach opening but cannot circulate, thus forming a gastric carbuncle." The treatment method is similar to that of intestinal carbuncle. Initially, herbs that unblock and guide stagnation are used to clear obstructions. Subsequently, herbs that drain pus, detoxify, and support the interior are employed for regulation. This is the general principle.
[Hemorrhoids]
Hemorrhoidal disease differs from intestinal carbuncle. Its initial presentation occurs at the anal margin, appearing either like a mouse's teat or as small nodules, with itching, pain, and a sensation of heaviness and distress. Severe cases involve fever and aversion to cold. These conditions are caused by excesses in alcohol and sexual activity, long-term consumption of rich and sweet foods, intercourse while intoxicated or after heavy meals, which damage and disturb the blood vessels. Damp-heat leaks from the intestines and rushes downward, manifesting at the anal region, thereby forming hemorrhoids. There are five types: Pin-zhi (Yin Hemorrhoid), Mu-zhi (Yang Hemorrhoid), Qi-zhi (Qi Hemorrhoid), Xue-zhi (Blood Hemorrhoid), and Jiu-zhi (Alcohol Hemorrhoid). Other names include Changfeng-zhi (Wind-intestinal Hemorrhoid), Mai-zhi (Vessel Hemorrhoid), and Cixiong-zhi (Female-Male Hemorrhoid); these are all aliases for the five types. If left untreated for a long time, they may develop into fistulas or ulcers, becoming difficult to cure. Specific formulas are listed below; please examine them carefully before use.
[Dahuang Tang (Rhubarb Decoction)]
Treats intestinal carbuncle with hardness and swelling in the lower abdomen, large as a palm, hot to touch, painful upon pressure, with redness or pallor of the face, thick and frequent urination, sweating, and aversion to cold. A slow and tight pulse indicates unformed pus; a rapid pulse indicates formed pus.
Ingredients: Rhubarb (cut and stir-fried), Moutan Cortex (Peony Root Bark), Niter (ground), Mustard Seed, Peach Kernel (soaked in water, skin and tip removed, fried, each half tael).
Cut the ingredients finely. Take 5 qian per dose, decoct in two cups of water until one cup remains. Strain and take warm on an empty stomach. Continue until pus and blood are discharged. If not discharged, repeat the dose.
[Sisheng San (Four Sages Powder)]
(Also known as Shenxiao Gualou San)
Treats intestinal carbuncles and sores occurring on the head, beard area, back, axilla, and breasts, as well as inguinal abscesses. It is highly effective.
Ingredients: Fresh Trichosanthes Fruit (one piece, peeled), Licorice Root (ground, 4 qian), Myrrh (ground, 3 qian), Frankincense (ground, 1 qian).
Decoct in two large bowls of high-quality red wine over low heat until one bowl remains. Divide into two doses and finish within two days. Passage of foul matter via stool is desirable. If dried Trichosanthes is used, use two pieces. For upper body ailments, take after meals; for lower body ailments, take before meals. If pus has formed, it will liquefy; if not formed, it will exit via urine. For severe cases, prepare another batch to continue treatment until symptoms subside.
[Mudan San (Moutan Powder)]
Treats cold-type intestinal carbuncle with soft abdomen, pain, and frequent discharge of pus.
Ingredients: Moutan Cortex, Ginseng Root, Gastrodia Tuber, Poria, Astragalus Root, Costus Root, Angelica Sinensis, Ligusticum Chuanxiong, Cinnamon Twig, Peach Kernel (skin and tip removed, each 3 fen), Angelica Dahurica, Coix Seed, Licorice Root (roasted, each 2 fen).
Grind into fine powder. Take 3 qian per dose, decoct in one cup of water until 0.7 cup remains. Take warm before meals.
[Meiren Tang (Plum Kernel Decoction)]
Treats intestinal carbuncle with tenesmus, dull pain, and constipation.
Ingredients: Plum Kernels (49 pieces, skin and tip removed), Rhubarb (3 liang), Moutan Cortex (1.3 liang), Winter Melon Seeds (4 liang), Mirabilite (2.5 liang), Rhino Horn (shaved, 1.5 liang).
Cut into sizes similar to hemp seeds. Take 5 qian per dose, decoct in two cups of water until one cup remains. Strain and take warm. Continue until 2-3 passages of pus and blood occur.
[Shenxian Lafan Wan (Immortal Wax and Alum Pills)]
Treats intestinal carbuncle with internal expulsion effects. Suitable for all ages, universally effective. Best for stopping pain without damaging the zang-fu organs.
Ingredients: Yellow Beeswax (half tael, yellow variety preferred, alternative recipe uses 7 qian), White Alum (1 tael, transparent variety, finely ground).
Melt the beeswax and mix with alum to form pills the size of paulownia seeds. Take 20 pills initially, gradually increasing to 30 pills. Take with warm plain water far from meals.
[Yiyi Ren Tang (Coix Seed Decoction)]
Treats intestinal carbuncle with abdominal colic, restlessness, bloating, loss of appetite, and difficult urination. Common in postpartum women with deficiency-heat. Can be taken even if the diagnosis is uncertain.
Ingredients: Coix Seed, Trichosanthes Kernel (each 3 qian), Moutan Cortex, Peach Kernel (each 2 qian).
Take as one dose, decoct in two cups of water until one cup remains. Take at any time.
[Qinjiao Baizhu Wan (Gentian and Atractylodes Macrocephala Pills)]
Treats hemorrhoids with pus and blood, dry and hard stools causing unbearable pain.
Ingredients: Gentiana Scabra (rhizome removed), Peach Kernel (skin and tip removed, separately ground), Gleditsia Sinensis Pod (charred, each 1 liang), Immature Bitter Orange (bran-fried), Angelica Sinensis Tail (wine-processed), Alisma, Atractylodes Macrocephala (each half tael), Sanguisorba Officinalis (3 qian).
Grind into fine powder, mix with peach kernel paste, and bind with cooked flour paste to form pills the size of paulownia seeds. Dry thoroughly. Take 100 pills on an empty stomach with white water. Follow with a light meal. Avoid raw, cold, hard foods, cold water vegetables, damp noodles, alcohol, and pungent/spicy/hot spices. Failure to observe these restrictions renders the medicine ineffective. Cure usually occurs after several doses.
[Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction)]
Treats hemorrhoids causing pain during daily bowel movements. If there is no pain, it is not hemorrhoids.
Ingredients: Gentiana Scabra, Saposhnikovia Root, Angelica Sinensis, Atractylodes Macrocephala (each 1.5 qian), Phellodendron Bark, Tangerine Peel, Bupleurum, Rhubarb (stir-baked), Alisma (each 1 qian), Safflower, Peach Kernel, Cimicifuga Rhizome (each 5 fen), Licorice Root (roasted, 6 fen).
Take as one dose, decoct in two cups of water until one cup remains. Take on an empty stomach. Avoid wind and cold, sexual activity, alcohol, damp noodles, and spicy/hot foods.
[Diyu San (Sanguisorba Powder)]
Treats hemorrhoidal swelling and pain.
Ingredients: Sanguisorba Officinalis, Astragalus Root, Immature Bitter Orange, Areca Seed, Ligusticum Chuanxiong, Scutellaria Baicalensis, Sophora Flower, Red Peony Root, Notopterygium Root, Ampelopsis Radix, Honeycomb (fried until charred), Licorice Root (roasted, each 5 fen).
Take as one dose, decoct in two cups of water until one cup remains. Take before meals.
[Huaijiao Wan (Sophora Fruit Pills)]
Treats various hemorrhoids, intestinal wind with bleeding, and rectal prolapse.
Ingredients: Sophora Fruit (stalks removed, 1 liang), Saposhnikovia Root, Sanguisorba Officinalis, Immature Bitter Orange (bran-fried), Angelica Sinensis, Scutellaria Baicalensis (each half tael).
Grind into fine powder, bind with wine paste to form pills the size of paulownia seeds. Take 50 pills on an empty stomach with rice drink.
[Diaochang Wan (Hooking Intestine Pills)]
Treats chronic and acute hemorrhoids, swelling and pain at the anal margin, or intermittent itching with pus and blood.
Ingredients: Trichosanthes Fruit (two pieces, charred), Thistle Bark (two pieces, charred), White Alum (appropriate amount), Green Vitriol (appropriate amount), Baeckea Frutescens (raw), Arisaema Cum Bile, Celosia Cristata (cut and fried), Pinellia Ternata (each 5 liang), Walnut Kernel (15 pieces, charred), Immature Bitter Orange (fried), Aconitum Carmichaelii (processed, skin and navel removed), Chebula Terminalia (pitted, each 2 liang).
Grind into fine powder, bind with vinegar paste to form pills the size of paulownia seeds. Take 30-50 pills before bed with warm wine. Ten days of use shows effect for long-standing cases; long-term use eliminates the root cause.
[Zaojiao Jian Wan (Gleditsia Decoction Pills)]
Treats internal hemorrhoids, nodules inside the anal canal, alternating chills and fever.
Ingredients: Gleditsia Sinensis Pod (full foot-length, three stalks, strings and seeds removed, vinegar-roasted), White Alum (appropriate amount), Thistle Bark (roasted yellow), Coix Seed, Angelica Dahurica (each 1 liang), Peach Kernel (skin removed, fried), Descurainia Sophia Seed (fried), Ligusticum Chuanxiong, Platycodon Grandiflorus (each half tael), Pig Hind Hoof Nail (ten pieces, charred).
Grind into fine powder, bind with refined honey to form pills the size of paulownia seeds. Take 50 pills on an empty stomach with decoction of Mulberry Root Bark.
[Shenxiao San (Miraculous Powder)]
For washing hemorrhoids. Often caused by excessive desires, alcohol, and sexual indulgence among the wealthy, along with emotional instability. Symptoms include nodules like beads, swelling of the anus/intestine, pus leakage, bleeding, and excruciating pain. Effective for all swellings, sores, hemorrhoids, and intestinal wind with leakage.
Ingredients: Sophora Root, Sichuan Pepper, Bitter Gourd, Coriander Seed, Sophora Flower, Immature Bitter Orange, Schizonepeta, Honeysuckle, Angelica Dahurica, Forsythia, Angelica Pubescens, Fennel, Ephedra, Oyster Shell (appropriate amount), Clematis Root, Chinese Toon Bark (each 2 liang).
Chop the herbs. Use 5 qian per dose with 6-7 bowls of water and two stalks of green onion. Boil for 5-7 boils. Strain. Sit in a basin over the steam, then wash. Very effective. Adding two old yellow eggplants is especially good.
[Woniu Gao (Snail Ointment)]
Highly effective for applying to hemorrhoids.
Ingredients: Snail (one piece), Borneol, Musk (small amounts).
Grind together until smooth. Store in a porcelain box. Apply the juice to the sore the next morning.
[Badu San (Detoxifying Powder)]
Apply to swollen and toxic hemorrhoidal areas.
Ingredients: Rhubarb, Phellodendron Bark, Bletilla Striata, Gypsum Fibrosum, Scutellaria Baicalensis, Coptis Chinensis, Ampelopsis Radix, Gardenia Jasminoides, Glauber Salt (equal parts).
Grind into powder. Mix with well water and apply.
[Jifeng Wujin San (Jifeng Black Gold Powder)]
Treats hemorrhoids.
Ingredients: Yellow Ox Horn Heart, Pig Tooth Gleditsia, Thistle Bark, Pangolin Scales (all stir-fried until black), Gleditsia Spine, Sophora Seed, Immature Bitter Orange, Cyathula Root, Donkey-hide Gelatin (fried, equal parts).
Grind into fine powder. Take 1.5 qian per dose. Mix with crushed walnut meat and wine. Take before meals. For heat in the large intestine, take with Schizonepeta tea. For persistent bleeding, take with Angelica Sinensis decoction.
[Zhiqiao San (Immature Bitter Orange Powder)]
For fumigation and washing of hemorrhoids.
Ingredients: Immature Bitter Orange, Cyathula Root (each 2 liang), Schizonepeta, Large Phellodendron Bark (each 1 liang), Coptis Chinensis, Cnidium Monierii, Dogwood Root Bark, Hematite, Ginger (processed, each half tael), Xanthium Root, Ilex Aquifolium Leaf, Shallot, Cypress Branch (each one handful), Black Soybean (half sheng).
Chop the herbs. Use one large measure per dose with three large bowls of water. Decoct until two bowls remain. Fumigate first, then wash. Do this 3-5 times daily.
[Jieyin Dan (Binding Yin Pellets)]
Treats intestinal wind and visceral toxin with blood in the stool.
Ingredients: Immature Bitter Orange (pulp removed, bran-fried), Clematis Root, Polygonum Multiflorum, Chinese Toon Root Bark, Tangerine Peel (white part removed), Schizonepeta Spike, Astragalus Root (equal parts).
Grind into fine powder. Bind with wine-cooked paste and a little honey to form pills the size of paulownia seeds. Take 50-70 pills before meals with rice drink. Alternative: omit honey, use a little vinegar with aged rice drink decoction.
[Zhu Zang Wan (Pig Intestine Pills)]
Treats prolonged blood in stool in adults and children, increased appetite with easy hunger, no abdominal pain, and no tenesmus. First, roast Cuttlefish Bone until yellow, remove skin, grind to white powder, and take with Equisetum Decoction. Effect seen after three days.
Ingredients: Coptis Chinensis (2 liang, chopped), Tender Pig Intestine (2 chi, fat removed).
Stuff the Coptis into the pig intestine, tie both ends, and boil until very soft. Grind finely, add cake paste, and form pills the size of paulownia seeds. Take 30-50 pills with rice...