立斋引《圣济总录》云∶胃脘痈，由寒气隔阳，热聚胃口，寒热不调，故血肉腐坏。以
气逆于胃，故胃脉沉细，以阳气不得上升，故人迎热甚，令人寒热如疟，身皮甲错，或咳嗽
，或呕脓唾血。若脉见洪数，脓已成也，急宜排之。设脉迟紧，其脓未就，有瘀血也，急下
之。否则邪毒内攻，腐烂肠胃矣。丹溪云∶内疽者，因饮食之毒，七情之火，相郁而发，用
射干汤主之。愚常以薏苡仁汤、牡丹皮散、太乙膏选用之，亦效。若吐脓血，饮食少思，宜
助胃壮气为主，而佐以前法，不可专治其疮。
立斋曰∶腹痈，谓疮生于肚腹，或生于皮里膜外，属膏粱浓味，七情郁火所致。若漫肿
坚硬，肉色不变，或脉迟紧，未成脓也，四君加芎、归、白芷、枳壳，或托里散。肿软色赤
，或脉洪数，已成脓也，托里消毒散。脓成而不外溃者，气血虚也，卧针而刺之。 肿作
痛者，邪气实也，先用仙方活命饮，隔蒜灸，以杀其毒，后用托里以补其气。若初起，欲其内
消，当助胃壮气，使根本坚固，而以行经活血之药佐之。若用克伐之剂，欲其消散，则肿者
不能溃，溃者不能敛。若用疏利之药，
下其脓血，则少壮者，多为难治，老弱者，立见危亡。若有食积疝气类此者，当辨而治之。
进士边云庄，腹痛、恶寒，脉浮数。余曰∶浮数之脉而反恶寒，疮疽之证也。不信。数
日后，复请视之，左尺洪数。余曰∶内有脓矣。仍不信。至小腹痛胀，连及两臀，始悟
。余曰∶脓溃臀矣，气血俱虚，何以收敛。急服活命饮一钟，臀溃一孔，出脓斗许，气息奄
奄。用大补药一剂，神思方醒。每去后，粪从疮出，痛不可当，小腹间如有物上挺，即发痉
不省人事，烦躁，脉大，举按皆实。省而细察之，脉虽洪大，按之如无，以十全大补，倍加参、
至四斤，更加附子二枚，煎膏服之而痉止。又用十全大补汤，五十余剂而疮敛。
上舍周一元，患腹痈三月不愈，脓水清稀，朝寒暮热，服四物、黄柏、知母之类，食少
作泻，痰涎上涌。服二陈、枳实之类，痰涎愈甚，胸膈痞闷。谓余曰∶何也。余曰∶朝寒暮
热，血气虚也。食少作泻，脾肾虚也。痰涌胸痞，脾肺虚也。悉因真气虚，而邪气实也。当
先壮其胃气，使诸脏有所禀，而邪自退矣。遂用六君加黄 、当归，数剂诸证渐退。又用十
全大补汤，肌肉渐敛。更用补中益气汤，调理而愈。（薛按）
Xue Lizhai quoted from *Shengji Zonglu*: Wei-wan abscess (abscess of the stomach region) is caused by cold qi obstructing yang qi, with heat gathering at the stomach opening. The disharmony between cold and heat leads to the putrefaction of flesh and blood. Because qi rebels in the stomach, the stomach pulse appears deep and fine. Because yang qi cannot ascend, there is excessive heat at the Renying (ST 9) acupoint, causing chills and fever resembling malaria, rough skin resembling fish scales, cough, or vomiting of pus and blood. If the pulse is surging and rapid, the pus has formed; it should be drained urgently. If the pulse is slow and tight, the pus has not yet formed, indicating blood stasis; purgation should be performed urgently. Otherwise, pathogenic toxins will attack internally, corroding the intestines and stomach. Zhu Danxi stated: Internal carbuncles arise from food toxicity combined with fire generated by emotional stagnation. They are treated primarily with Shegan Tang (Belamcanda Decoction). I frequently selected Yiyiren Tang (Coix Seed Decoction), Mudanpi San (Moutan Powder), or Taiyi Gao (Great One Plaster) for treatment, with good efficacy. If there is vomiting of pus and blood, loss of appetite, the primary approach should be to support the stomach qi and strengthen righteous qi, assisted by the aforementioned methods, rather than treating the sore exclusively.
Xue Lizhai stated: Abdominal abscess refers to sores occurring on the abdomen or between the skin and fascia, caused by rich, greasy foods and fire from emotional stagnation. If the swelling is diffuse and hard, with unchanged skin color, or if the pulse is slow and tight, the pus has not formed; treat with Sijunzi Tang (Four Gentlemen Decoction) added with Chuanxiong Danggui Baizhi Zhike (Atractylodes Macrocephala, Angelica Sinensis, Angelica Dahurica, Aurantium), or Tuoli San (Support Interior Powder). If the swelling becomes soft and red, or the pulse is surging and rapid, the pus has formed; treat with Tuoli Xiaodu San (Support Interior and Detoxify Powder). If pus has formed but fails to ulcerate externally, it indicates deficiency of qi and blood; use shallow needle insertion. If swelling and pain are severe, it indicates excess pathogenic qi; first use Xianfang Huoming Yin (Immortal Formula for Preserving Life Decoction) and garlic-separated moxibustion to neutralize toxicity, followed by interior-supporting methods to tonify qi. In the initial stage, if the goal is internal resolution, one must support stomach qi and strengthen the root, assisting with herbs that unblock meridians and invigorate blood. If harsh draining agents are used to resolve the swelling, the swollen area will fail to ulcerate, and the ulcerated area will fail to heal. If purgative herbs are used to drain pus and blood, young and strong patients may become difficult to treat, while old and weak patients may face immediate danger. Cases resembling food stagnation or hernia should be differentiated and treated accordingly.
The Jinshi Bian Yunzhuang suffered from abdominal pain and aversion to cold, with a floating and rapid pulse. I said: A floating and rapid pulse accompanied by aversion to cold is a sign of carbuncle or furuncle. He did not believe me. Several days later, he requested another consultation; the left Chi pulse was surging and rapid. I said: Pus has formed internally. He still did not believe me. Until the lower abdomen became distended and painful, radiating to both buttocks, he finally realized [my diagnosis]. I said: The pus has ulcerated through the buttock. Qi and blood are both deficient; how can the wound close? Urgently administer one cup of Huoming Yin. The buttock ulcerated one hole, discharging approximately one dou of pus. His breath was faint. After one dose of major tonic medicine, his consciousness returned. Each time he defecated, feces exited through the wound, causing unbearable pain. A sensation of something rising in the lower abdomen triggered spasms, unconsciousness, irritability, and a large pulse that felt solid upon both light and heavy pressure. Upon regaining consciousness and careful examination, although the pulse appeared surging and large, it felt empty upon heavy pressure. Therefore, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was used, with doubled Ginseng and Astragalus, up to four jin in total, plus two pieces of Aconite, decocted into a paste and administered. The spasms ceased. Subsequently, using Shiquan Dabu Tang for over fifty doses, the wound healed.
Shangshe Zhou Yi-yuan suffered from an abdominal abscess for three months without healing. The pus was clear and thin; he experienced morning chills and evening fevers. After taking Siwu Tang (Four Substances Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome), he had poor appetite and diarrhea, with phlegm-saliva surging upward. After taking Erchen Tang (Two Aged Herbs Decoction) and Zhishi (Bitter Orange Fruit), the phlegm-saliva worsened, causing chest and diaphragm stuffiness. He asked me: Why? I said: Morning chills and evening fevers indicate deficiency of blood and qi. Poor appetite and diarrhea indicate deficiency of spleen and kidney. Surging phlegm and chest stuffiness indicate deficiency of spleen and lung. All result from deficiency of true qi and excess of pathogenic qi. We must first strengthen stomach qi so that the zang-fu organs receive nourishment, allowing pathogenic qi to retreat naturally. Thus, Liujunzi Tang (Six Gentlemen Decoction) was used with added Huangqi (Astragalus Root) and Danggui (Angelica Sinensis Root). After several doses, symptoms gradually receded. Then, Shiquan Dabu Tang was used, and muscle tissue gradually closed. Finally, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used for regulation, leading to recovery. (Note by Xue Ji)