脉因证治诸说 问曰∶官羽林妇病，医脉之，何以知妇人肠中有脓，为下之则愈？师曰∶寸口脉滑而
数，滑则为实，数则为热，滑则为荣，数则为卫，卫数下降，荣滑上升，荣卫相干，血为浊败，小腹痞坚，小
便或涩，或时汗出，或复恶寒，脓为已成，设脉迟紧，聚为瘀血，血下则
愈。（《脉经》）
痈之为病（按∶痈上盖脱肠字），诊小腹肿痞坚，按之则痛，或在膀胱左右，其色或赤或白，坚大如掌热，
小便欲调，时色色汗出，时复恶寒。（《鬼遗方》）
肠痈者，由寒温不适，喜怒无度，使邪气与荣卫相干，在于肠内，遇热加之，血气蕴积，结聚成痈，热积
不散，血肉腐坏，化而为脓。其病之伏，小腹重而微强，抑之即痛，小便数似淋，时时汗出，复恶寒，其身皮
皆甲错，腹皮急如肿状。诊其脉洪数者，已有脓也；其脉迟紧者，未有脓也。甚者腹胀大，转侧闻水声，或绕
脐生疮而穿（按∶一本作穿而）脓出，或脓自脐中出，或大便去脓血，惟宜急治之。又云∶大便脓血，似赤白
下而实非者，是肠痈也。卒得肠痈而不晓，治之错者杀人。（《病源论》）
凡肠痈，其状两耳叶文理甲错，初患腹中苦痛，或绕脐有疮如粟，皮热，便脓血出，似赤白下，不治必死。
（《千金》）
寸芤积血在胸中，关内逢芤肠里痈。（《脉诀》）
肠痈难知，滑数可推，数而不热，肠痈何疑。（《崔氏脉诀》）
肠痈肿结，活者脉浮，殂者脉沉。（《直指》）
其如五内生疮，亦止分阴阳利而已，不比外痈，须根据四节八事之次第也。（《三因》）
肠痛亦多端，若疼甚者乃肠痈，急宜服内补十全散等药。（《资生》）
夫肠痈者，皆湿热瘀血流入小肠而成也。又由来有三∶一、男子暴急奔走，以致肠胃传送不能舒利，败血
浊气壅遏而成者，一也。二、妇人产后，体虚多卧，未经起坐，又或
坐草艰难，用力太过，育后失逐败瘀，以致败血停积肠胃结滞而成者，二也。三、饥饱劳伤，担负重物，致伤肠
胃，又或醉饱房劳，过伤精力，或生冷并进，以致气血乖违，湿动痰生，多致肠胃痞塞，运化不通，气血凝滞
而成者，三也。总之，初起外症发热恶寒，脉芤而数，皮毛错纵，腹急渐肿，按之急痛，大便坠重，小便涩滞，
若淋甚者，脐突腹胀，转侧水声，此等并见，则内痈已成也。初起未成时，小腹殷殷作痛，俨似奔豚，小便淋
涩者，当大黄汤下之（即大黄牡丹汤用白芥子者），瘀血去尽自安。体虚脉细不敢下者，活血散瘀汤和利之。
已成腹中疼痛，胀满不食，便淋刺痛者，薏苡仁汤主之。腹濡而痛，小腹急胀，时时下脓者，毒未解也，用牡
丹皮汤治之（用参、牡、芍、茯、 、薏、桃、芷、归、芎、甘、桂、木香）。如脓从脐出，腹胀不除，饮食
减少，面白神劳，此皆气血俱虚，宜八珍汤加牡丹皮、肉桂、黄 、五味子，敛而补之。如积袭日久，因循不
识此症，误作胀病治之，以致毒攻五内，肠胃受伤，或致阴器攻烂，腐靥黑斑，色败无脓，每流污水，腹连阴痛，
烦躁不止，身热口干，衾帏多臭，卧房难进者。凡犯之俱为不治证，宜斟酌之。（《外科正宗》）
初起小腹疼痛，或软或硬，脉芤数者，瘀血也，宜下之。小腹作痛有块，大便秘涩，小便如淋者，宜和而
利之。已溃时时下脓，腹痛不止，饮食无味者，宜托而补之。产妇恶露不尽，流注小肠作痛，脉数者，宜和
而导之。腹胀日久，脐高突出，转侧响如水声，脓内蓄，急针之。（同上）
肠痈者，肠内生痈也，大肠小肠皆有之。大抵得之不节饮食，不适寒温，或积垢瘀凝，或败血留滞，壅塞不
行，久郁化热，久热腐脓，而痈斯成矣。（《续焰》）（按∶肠
痈，肠中痛不可忍，而大便从小便中出，见《医说》云母膏愈肠痈条，盖大肠痈也。）
肠痈下血，腹中 痛，其始发热恶寒，欲验其证，必小腹满痛，小便淋涩，反侧不便，即为肠痈之确候，
无论已成未成，俱用大黄牡丹汤加犀角急服之。小腹痛，若肿满不食，小便不利，脓壅滞也，用薏苡、丹皮、
桃仁、蒌仁煎服以排之。若至反侧作水声，此脓已成熟也，《千金》托里散下太乙膏。（《医通》）
胡公弼曰∶按脐下一寸三分，即肠之屈曲间，大肠左盘，小肠右曲。其生痈也，由冷毒积久，肠浓而不
能发越于外，故生于内，外视之无形，重按之痛甚。毒生于左，则左足不能伸；毒生于右，则右足不能伸。生
毒之处，肌肤微有皱纹，细观亦觉微肿。（《疡医大全》引《青囊》）（按∶《赤水》一染匠妇，腹痛三月，
左脚不可动，动即痛应于心，是以一步不能举，必肠痈，左脚莫能举，是其征也。）
肠痈属大肠实火，忌燥热，宜下、苦寒、解毒。（《本草经疏》）
难易看法 初起，小腹疼痛，小便不利，六脉微缓，不作寒热者轻。已成，小腹肿而坚硬，小便数而
不利，六脉洪数者险。已溃，时时下脓，里急后重，日夜无度，疼痛不减者重，溃后，脓腥臭秽，或流败水，
浊瘀虚热，更增不食者死。（《正宗》）
愈后却宜静养，若动作躁暴，或被惊恐，则肠断而死。凡痈生小肠分犹可，大肠分近肛门者难治，肛门破
者即死。（《入门》）
若脓从大便出者，为直肠痈，可治。若从脐中出者，为盘肠痈，多不治。经云∶肠痈为病不可惊，惊则肠
断而死。
（《医通》）
胃痈肠痈之别 胃痈亦生腹内，痛在心下脐上。其有红肿见于胸下者，此躯廓之伏梁痈，非胃痈也。
肠痈痛在下腹左右少腹间，以此为异。若红肿见于腹上者，乃肚角痈，亦躯廓之痈，非肠痈也。凡内痈脓未成，
皆宜从清导之；已成脓者，必溃脓。胃痈之脓。有呕出于口者，有下溃于肛者。肠痈之脓，有从下而溃于孔肛
者，有逆上而溃于脐中者。溃于肛者顺，顺则可生；溃于脐者逆，逆则多死。其下出孔肛者，自可并屎而出，
脓尽可冀愈也。（《医级》）
息积 更《内经》所载，有息积病，比见有得之二三年，遍身微肿，续乃大肠与脐连日出脓，遂致不
救，此亦肠痈之类也，不可不审。（《三因》）
初治方法 治肠痈汤方。
薏苡人（一升） 牡丹皮 桃仁（各三两） 瓜瓣仁（二升）
上四味 咀，以水六升，煮取二升，分再服。（《千金》）《医心》引《集验方》用冬瓜仁一升。《正宗》
薏苡仁汤，治肠痈，腹中疼痛，或胀满不食，小便涩滞，妇人产后多有此病，纵非痈，服之尤效。于本方去瓜
瓣，加栝蒌仁、白芍。
一幼妇产后月余，腹中渐痛，肿胀如蛊，内医纷纷认为蛊病，又月余沉重昏愦。彼家已弃不治，请予视童稚
疮恙，偶言此，予讨胗之。彼时人虽昏愦不苏，胗之其脉细数有力，此内痈脓病也，犹似不妨。彼家曰∶无生之
理。予曰∶腹肿上见而按之，一决其生何如？随视肿皮紧急光亮，脐下大热，此内痈不妨，乃万无一失之病，彼
家欢悦。分付先备净桶，用滚汤半桶盖之听用。先以薏苡仁汤加酒炒大黄二钱，徐徐灌服，待腹中觉痛，搭起患
者坐桶上，热气熏蒸，其脓下如涌泉，连
汤与脓，约共满桶，其患即苏。更服八珍汤加牡丹皮、五味子，调理月余而安。（《正宗》）
治肠痈，里急隐痛，大便秘涩，梅仁汤方。
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） 犀角（镑一两半）
芒硝（二两半）
上六味 咀，如麻豆大，每服五钱匕，水二盏，煎至一盏，去滓温服，以下脓血三两行为度。（《圣济》）
活血散瘀汤，治产后恶露不尽，或经后瘀血作痛，或暴急奔走，或男子杖后，瘀血流注肠胃作痛，渐成内
痈，及腹痛大便燥者，并宜服之。
川芎 归尾 赤芍 苏木 牡丹皮 枳壳 栝蒌仁（去壳） 桃仁（去皮尖合一钱） 槟榔（六分）
大黄（酒炒二钱）
水二钟，煎八分，空心服，渣再煎眼。（《正宗》）
东阳吕俊文，得潮热微似疟状，小腹右边有一块，大如鸡卵作痛，右脚不能伸缩。一医作 豚气治，十余
日不验。召余诊候，其脉左寸芤而带涩，右寸芤而洪实，两尺两关俱洪数。予曰∶此大小肠之间欲作痈耳，幸
脓未成，犹可治疗。与五香连翘汤加减与之，间以蜈蚣炙黄，酒调服，三日内平安。（《正传》）
会脓散，治腹中肿毒。
穿山甲（炙） 白僵蚕（炒去丝嘴） 白芷（各五钱） 大黄（三两） 乳香 没药 五灵脂（各五钱）
上末，每服五钱，酒服，脓从大便出，幼者用三钱。（《广笔记》）
中治方法 治肠痈汤方。
牡丹 甘草 败酱 生姜 茯苓（各二两） 薏苡人 桔梗 麦门冬（各三两） 丹参 芍药（各四两）
生地黄（五两）
上十一味 咀，以水一斗，煮取三升，分三服，日三。（《千金》）
四圣散，治肠痈、痈疽。便毒神效。
生黄栝蒌（一枚去皮） 粉草末（四钱） 没药末（三钱） 乳香末（一钱）
上件，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。
（《直指》）
保安散，福建兴化军官库刊行，治肠痈壮热恶寒，微汗气急，小腹疼痛，小便涩似淋，或大便难如刀刺，
及背胛疼痛，肠中已成脓，或大便下脓，脐中脓出。
上甜瓜子一枚，蛇蜕皮一尺，当归一两，锉微炒，以大盏水一盏，煎七分去滓，食前分作二服，前后温服，
以利下恶物效。（《经验良方》）
郡守李孝文妻母庞，病小腹痛，众医皆以为瘕聚，药之浃日弗愈，继命翁诊。翁循其少阴脉，如刀刃之切
手，胞门芤而数，知其阴中痛，痈结小肠也。即告之曰∶太夫人病在幽隐，不敢以闻，幸出侍人密语之。乃出
老妪。翁曰∶患者患小肠痈，以故脐下如瘕聚，今脓已成，肿迫于玉泉，当不得前后溲，溲则痛甚。妪拜曰∶
公神人也，所苦一如公所言。遂用国老、将军为向导，挟麒麟竭、琥珀之类以攻之，脓自小便溃，应手愈。
（《医史·沧州翁传》）
神仙蜡矾丸，治肠痈内托神妙。
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。（奇效》）（按∶
此本出《外科精要》，名神仙黄矾丸。）
末治方法《究原》排脓内补散，治脓痈冷证及痈疽等患。
人参 当归 浓朴（姜制） 防风 北梗（焙） 白芷 辣桂 黄 （炙） 甘草（炙） 白茯苓
上为末，每服三钱，温酒调下。如不饮酒，南木香煎汤下。（《直指》）（按∶此本《和剂》化毒排脓内补
十宜散，今去川芎，加茯苓。《资生经》曰∶胡权内补十全散，治肠痈神效。岂此方欤。又按∶此本《千金》内
补散，彼有川芎，无黄 、茯苓。）《得效》加味十奇散，治肺痈已散，于《千金》内补散加乳香、没药。
七贤散，治肠痈溃后疼痛，淋沥不已，或精神减少，饮食无味，面色痿黄，四肢无力，自汗盗汗，睡卧不
宁。
茯苓 山药 牡丹皮 山茱萸 熟地黄 人参（各一钱） 黄 （二钱）
水二钟，煨姜三片，大枣二枚，煎八分，食前服。（《正宗》）
童良辅子，年十二，患内痈，腹胀脐凸而颇锐。医欲刺脐出脓，其母靳不许，抱子独泣。童驰告翁，邀与俱。
及造卧内，见一野僧拥炉炽炭，燃铜筋一二枚烈火中，瞪目视翁曰∶此儿病痈发小肠，苟舍刺脐，无他法。翁喻
之曰∶脐，神阙也，针刺所当禁。矧痈舍于内，惟当以汤丸攻之。苟如君言，必杀是子矣。僧怒，趋而出。翁
投透脓散一匕，明日脓自气合溃，继以十奇汤下善应膏，凡浃旬瘥。（《沧洲翁传》）
一妇人腹胀如鼓，脐突寸许，小大水涩滞，转侧腹有水声。此内脓已成，用针刺脐上突顶，出脓盆许。以牡
丹皮散五六剂，其脓渐少。朝以八味丸，暮以八珍汤加泽泻、牡丹
皮、黄 、破故纸服之，月余而愈矣。（《正宗》）（按∶此二案，一禁针，一用针，盖各有所宜也。且其用针，
必得其法为佳，如野僧是妄术已。又《推求师意》有治验，与陈氏相似。）
[On Pulse, Etiology, Symptoms, and Treatment] A question was asked: "A woman, the wife of a Yulin official, was ill. The physician palpated her pulse and knew that there was pus in her intestines, believing that purgation would cure her. How did he know?" The Master said: "The pulse at Cun Kou (radial artery) is slippery and rapid. Slippery indicates excess; rapid indicates heat. Slippery relates to Ying (Nutritive Qi); rapid relates to Wei (Defensive Qi). The rapidity of Wei descends, while the slipperiness of Ying ascends. Ying and Wei interfere with each other, causing the blood to become turbid and degenerated. Symptoms include a痞 (fullness/hardness) and firmness in the lower abdomen, occasional difficulty in urination, intermittent sweating, and recurrent aversion to cold. If the pulse is洪 (surging) and 数 (rapid), pus has already formed; if the pulse is 迟 (slow) and 紧 (tight), it is an accumulation of blood stasis. Purging will expel the stasis and cure the condition." (From *Mai Jing*)
Regarding carbuncles (Note: The character 'carbuncle' here should be preceded by 'intestinal', i.e., intestinal carbuncle): Diagnosis reveals swelling, fullness, and firmness in the lower abdomen, which is painful upon pressure. It may be located on either side of the bladder. The skin color may be red or white, hard and palm-sized, and hot. Urination may be difficult, with intermittent sweating and recurrent aversion to cold. (From *Gui Yi Fang*)
Intestinal carbuncle arises from improper adaptation to cold and heat, and excessive anger or joy, causing pathogenic factors to interfere with Ying and Wei, lodging in the intestines. When aggravated by heat, Qi and Blood accumulate and condense into a carbuncle. Prolonged heat retention causes flesh and blood to rot and transform into pus. During the latent stage, the lower abdomen feels heavy and slightly stiff, painful upon pressure. Urination is frequent, resembling strangury. There is intermittent sweating and recurrent aversion to cold. The skin throughout the body becomes rough like fish scales (jia cuo). The abdominal skin is tight as if swollen. Palpating a 洪 (surging) and 数 (rapid) pulse indicates pus has formed; a 迟 (slow) and 紧 (tight) pulse indicates no pus yet. Severe cases present with abdominal distension and enlargement, where water sounds can be heard when turning over. Sores may form around the umbilicus and rupture (Note: one version reads 'chuan er'), discharging pus, or pus may discharge from the umbilicus itself, or stool may contain pus and blood. Urgent treatment is required. It is also stated: Stool containing pus and blood, resembling dysentery but actually not dysentery, is intestinal carbuncle. Sudden onset of intestinal carbuncle unrecognized and treated incorrectly can be fatal. (From *Bing Yuan Lun*)
In all cases of intestinal carbuncle, signs include rough textures on the earlobes resembling fish scales. Initially, there is severe abdominal pain, or sores the size of millet grains around the umbilicus, with hot skin, and discharge of pus and blood resembling dysentery. Without treatment, death is inevitable. (From *Qian Jin*)
A 芤 (hollow) pulse at Cun indicates accumulated blood in the chest; a 芤 (hollow) pulse at Guan indicates a carbuncle in the intestines. (From *Mai Jue*)
Intestinal carbuncle is difficult to diagnose, but can be inferred from a slippery and rapid pulse. A rapid pulse without fever strongly suggests intestinal carbuncle. (From *Cui Shi Mai Jue*)
For intestinal carbuncle swelling and knotting, a floating pulse indicates survival, while a deep pulse indicates death. (From *Zhi Zhi*)
If sores occur within the five Zang organs, treatment only involves differentiating Yin and Yang and promoting drainage, unlike external carbuncles which must follow the sequence of Si Jie Ba Shi. (From *San Yin*)
Intestinal carbuncle presents in many ways. If pain is severe, it is intestinal carbuncle, and one should urgently administer formulas such as Nei Bu Shi Quan San. (From *Zi Sheng*)
Intestinal carbuncle is caused by damp-heat and blood stasis flowing into the Small Intestine. There are three main origins: First, men running violently cause gastrointestinal transport to fail, leading to stagnation of degenerated blood and turbid Qi. Second, postpartum women, being weak and bedridden, or those who exerted too much effort during difficult childbirth, fail to expel lochia/stasis, leading to stagnation in the intestines. Third, injury from hunger/fullness, labor, carrying heavy loads, sexual indulgence after drunkenness, or consuming raw/cold foods causes Qi and Blood disharmony, generating dampness and phlegm, blocking the intestines and causing Qi/Blood stasis. In summary, early symptoms include fever, aversion to cold, hollow and rapid pulse, rough skin, abdominal tightness and gradual swelling, acute pain on pressure, feeling of heaviness in defecation, and stagnant urination resembling strangury. If the umbilicus protrudes, abdomen distends, and water sounds are heard upon turning, internal carbuncle has formed. Early stage before pus formation, with dull lower abdominal pain resembling Ben Tun (running piglet), and strangury, should be purged with Da Huang Tang (i.e., Da Huang Mu Dan Tang with Bai Jie Zi) to expel stasis. For those too weak for purgation, Huo Xue San Yu Tang harmonizes and drains. Once pus forms, with abdominal pain, distension, anorexia, and painful urination, Yi Yi Ren Tang is indicated. If the abdomen is soft but painful, lower abdomen is tense/distended, and pus is intermittently discharged, toxins remain unresolved; use Mu Dan Pi Tang (with Ren Shen, Mu Dan Pi, Shao Yao, Fu Ling, [missing char], Yi Yi Ren, Tao Ren, Bai Zhi, Dang Gui, Chuan Xiong, Gan Cao, Rou Gui, Mu Xiang). If pus discharges from the umbilicus, abdominal distension persists, appetite decreases, complexion is pale, and spirit is fatigued, this indicates dual deficiency of Qi and Blood; use Ba Zhen Tang plus Mu Dan Pi, Rou Gui, Huang Qi, Wu Wei Zi to astringe and tonify. If neglected for a long time and misdiagnosed as distension, toxins attack the Zang organs, damaging the intestines/stomach. This may lead to ulceration of the genitalia, black spots, lack of pus, continuous flow of foul fluid, abdominal pain radiating to the yin, restlessness, fever, dry mouth, and foul odor in bedding. Such cases are generally incurable and require careful judgment. (From *Wai Ke Zheng Zong*)
Early stage: Lower abdominal pain, soft or hard, hollow/rapid pulse indicates blood stasis; purge it. Lower abdominal pain with mass, constipation, and strangury-like urination; harmonize and drain. Post-ulceration with intermittent pus discharge, unceasing pain, and anorexia; support and tonify. Postpartum lochia not clearing, flowing into Small Intestine causing pain with rapid pulse; harmonize and guide. Long-standing abdominal distension, high/protruding umbilicus, water sounds upon turning, internal pus accumulation; urgent acupuncture. (Same source)
Intestinal carbuncle is a carbuncle inside the intestine, occurring in both Large and Small Intestines. Generally caused by irregular diet, failure to adapt to cold/heat, accumulation of filth and stasis, or lingering degenerated blood causing blockage. Long-term stagnation generates heat, prolonged heat rots tissue into pus, forming the carbuncle. (From *Xu Yan*) (Note: Intestinal carbuncle involves unbearable intestinal pain, with stool passing through urine, as seen in Yun Mu Gao curing intestinal carbuncle case in *Yi Shuo*, likely Large Intestine carbuncle.)
Intestinal carbuncle with bleeding and colicky abdominal pain, starting with fever and aversion to cold. To verify, look for lower abdominal fullness/pain, strangury, and difficulty turning over; these are definitive signs. Regardless of pus formation status, take Da Huang Mu Dan Tang plus Xi Jiao urgently. Lower abdominal pain with swelling/anorexia and difficult urination indicates pus obstruction; use Yi Yi Ren, Mu Dan Pi, Tao Ren, Gua Lou Ren decoction to drain. If water sounds are heard upon turning, pus is mature; use Qian Jin Tuo Li San with Tai Yi Gao. (From *Yi Tong*)
Hu Gongbi states: Pressing 1.3 cun below the umbilicus locates the intestinal curvature, with Large Intestine coiling left and Small Intestine curving right. Carbuncle here arises from cold toxin accumulating long-term, becoming thick in the intestine but unable to vent externally, thus forming internally. Externally invisible, but severely painful on deep pressure. Toxin on the left prevents left leg extension; toxin on the right prevents right leg extension. At the site of toxin, skin shows slight wrinkles and subtle swelling. (From *Yang Yi Da Quan* citing *Qing Nang*) (Note: In *Chi Shui*, a dyer's wife had abdominal pain for three months, left leg immobile, pain radiating to heart upon movement, unable to step. This is intestinal carbuncle; inability to lift left leg is the sign.)
Intestinal carbuncle belongs to Excess Fire of the Large Intestine. Avoid drying/hot herbs; use purgative, bitter-cold, and detoxifying methods. (From *Ben Cao Jing Shu*)
Difficulty and Prognosis: Early stage, lower abdominal pain, difficult urination, faint/slow six pulses, no chills/fever is mild. Pus formed, lower abdominal swelling/firmness, frequent/difficult urination, surging/rapid six pulses is dangerous. Ulcerated, intermittent pus, tenesmus, day/night frequency, unrelenting pain is severe. Post-ulceration, foul-smelling pus or foul water, turbid stasis, false heat, and anorexia indicate death. (From *Zheng Zong*)
After recovery, quiet rest is essential. Violent movement or fright can cause intestinal rupture and death. Carbuncles in the Small Intestine are treatable; those in the Large Intestine near the anus are difficult; rupture of the anus is fatal. (From *Ru Men*)
Pus discharging via stool indicates Rectal Carbuncle, treatable. Pus discharging from the umbilicus indicates Coiled Intestine Carbuncle, mostly untreatable. Classics state: Intestinal carbuncle patients must not be frightened, as fright causes intestinal rupture and death. (From *Yi Tong*)
Difference between Gastric and Intestinal Carbuncle: Gastric carbuncle occurs in the abdomen, pain below the heart/xiphoid. Redness/swelling below the chest is Fu Liang Carbuncle of the torso, not gastric. Intestinal carbuncle pain is in the lower/lateral abdomen. Redness/swelling above the abdomen is Du Jiao Carbuncle, also torso-related, not intestinal. Internal carbuncles without pus should be cleared/guided; with pus, they must ulcerate. Gastric carbuncle pus vomits out or discharges via anus. Intestinal carbuncle pus discharges via anus or retrogrades to umbilicus. Discharge via anus is favorable (Shun) and survivable; discharge via umbilicus is unfavorable (Ni) and often fatal. Anus discharge mixes with stool; once pus clears, recovery is expected. (From *Yi Ji*)
Xi Ji: According to *Nei Jing*, Xi Ji disease involves two-three years of mild whole-body swelling, followed by daily pus discharge from the connection between Large Intestine and umbilicus, leading to death. This is also a type of intestinal carbuncle and requires careful examination. (From *San Yin*)
Initial Treatment Methods: Formula for Treating Intestinal Carbuncle.
Yi Yi Ren (1 sheng), Mu Dan Pi, Tao Ren (each 3 liang), Gua Ban Ren (2 sheng).
These four ingredients are crushed, boiled in 6 sheng of water to yield 2 sheng, divided into two doses. (From *Qian Jin*) *Yi Xin Fang* cites *Ji Yan Fang* using Dong Gua Ren 1 sheng. *Wai Ke Zheng Zong* Yi Yi Ren Tang treats intestinal carbuncle with abdominal pain, distension/anorexia, and stagnant urination, common postpartum. Effective even if not carbuncle. Modify base formula by removing Gua Ban, adding Gua Lou Ren and Bai Shao.
Case: A young woman, one month postpartum, developed gradual abdominal pain and distension resembling Gu disease. Physicians diagnosed Gu. After another month, she became heavy and comatose. Family gave up. I examined her while treating children's sores. Though comatose, her pulse was fine, rapid, and forceful, indicating internal carbuncle with pus, seemingly not immediately fatal. Family despaired. I felt the swollen abdomen; skin was tight and shiny, lower abdomen very hot. I assured them it was safe. Prepared a clean bucket covered with boiling water. Administered Yi Yi Ren Tang plus 2 qian of wine-fried Da Huang slowly. When abdominal pain started, sat patient on bucket. Steam vaporized pus gushing out like a spring, filling the bucket with soup and pus. Patient revived. Then administered Ba Zhen Tang plus Mu Dan Pi and Wu Wei Zi, regulated for over a month until recovered. (From *Wai Ke Zheng Zong*)
Mei Ren Tang for Intestinal Carbuncle with tenesmus, dull pain, constipation.
Mei He Ren (49, peeled/cored), Da Huang (3 liang), Mu Dan Pi (1.3 liang), Dong Gua Ren (4 liang), Xi Jiao (sliced 1.5 liang), Mang Xiao (2.5 liang).
Crush to hemp seed size. Take 5 qian bi per dose, boil in 2 zhan water to 1 zhan, strain, warm drink. Continue until 2-3 passages of pus/blood occur. (From *Sheng Ji*)
Huo Xue San Yu Tang treats postpartum lochia retention, post-menstrual stasis pain, violent running, or beating injuries causing stasis flowing into intestines, gradually forming internal carbuncle, and abdominal pain with dry stool.
Chuan Xiong, Gui Wei, Chi Shao, Su Mu, Mu Dan Pi, Zhi Ke, Gua Lou Ren (shelled), Tao Ren (peeled/cored, total 1 qian), Bing Lang (6 fen), Da Huang (wine-fried 2 qian).
Boil in 2 zhong water to 8 fen, take empty stomach, dregs re-boiled and drunk. (From *Wai Ke Zheng Zong*)
Lu Junwen of Dongyang had tidal fever resembling malaria, a chicken-egg-sized painful mass in right lower abdomen, right leg immobility. Physician treated as Ben Tun Qi for 10+ days without effect. My pulse diagnosis: Left Cun hollow/slippery, Right Cun hollow/surging-solid, both Chi and Guan surging/rapid. I said: "Carbuncle forming between Large/Small Intestines, fortunately pus not yet formed, still treatable." Gave modified Wu Xiang Lian Qiao Tang, occasionally roasted centipede with wine. Safe within 3 days. (From *Zheng Zhuan*)
Hui Nong San treats abdominal swelling/toxins.
Chuan Shan Jia (roasted), Bai Jiang Can (fried, silk removed), Bai Zhi (each 5 qian), Da Huang (3 liang), Ru Xiang, Mo Yao, Wu Ling Zhi (each 5 qian).
Powder. Take 5 qian with wine. Pus discharges via stool. Children take 3 qian. (From *Guang Bi Ji*)
Intermediate Treatment Methods: Formula for Treating Intestinal Carbuncle.
Mu Dan, Gan Cao, Bai Jiang Cao, Sheng Jiang, Fu Ling (each 2 liang), Yi Yi Ren, Jie Geng, Mai Men Dong (each 3 liang), Dan Shen, Shao Yao (each 4 liang), Sheng Di Huang (5 liang).
Eleven ingredients crushed, boiled in 1 dou water to 3 sheng, divide into 3 doses, taken 3 times daily. (From *Qian Jin*)
Si Sheng San treats intestinal carbuncle, carbuncles/furuncles. Miraculous for perianal abscess.
Sheng Huang Gua Lou (1, peeled), Fen Cao powder (4 qian), Mo Yao powder (3 qian), Ru Xiang powder (1 qian).
Decoct in 2 large bowls of good red wine over slow fire to 1 bowl. Divide into 2 doses, finish in 2 days. Promotes smooth bowel movement of evil substances. Use 2 gourds if dried. (From *Zhi Zhi*)
Bao An San, published by Fujian Xinghua Military Officer Treasury, treats intestinal carbuncle with high fever, aversion to cold, slight sweating, shortness of breath, lower abdominal pain, stagnant urination resembling strangury, or painful defecation like knife stabbing, back/scapula pain, internal pus formation, pus in stool, or pus from umbilicus.
Tian Gua Zi (1 piece), She Tui Pi (1 chi), Dang Gui (1 liang). Finely chop, lightly stir-fry. Decoct in 1 large cup water to 7 fen, strain. Take 2 doses before meals, warm. Effective when evacuating evil substances. (From *Jing Yan Liang Fang*)
Lady Pang, mother-in-law of Prefect Li Xiaowen, suffered lower abdominal pain. Physicians diagnosed Jia Ju (masses). Medication failed after a day. Weng was summoned. Palpating Shao Yin pulse, felt sharp like a blade. Bao Men pulse was hollow/rapid. Knew of yin pain, carbuncle knotting in Small Intestine. Said: "Madam's illness is hidden, dare not speak aloud. Please have attendants leave." Old maid left. Weng said: "Patient has Small Intestine Carbuncle, hence lower abdomen resembles mass. Pus now formed, swelling presses on Yu Quan (urethra/bladder outlet), preventing urination/defecation. Urination causes severe pain." Maid bowed: "You are divine! Symptoms match exactly." Used Guo Lao (Gan Cao) and Jiang Jun (Da Huang) as guides, combined with Qi Lin Jie, Hu Po etc. to attack. Pus discharged via urine, cured instantly. (From *Yi Shi · Cang Zhou Weng Zhuan*)
Shen Xian La Fan Wan treats intestinal carbuncle, miraculous for internal support.
Huang La (half liang, yellow preferred, some use 7 qian), Bai Fan (1 liang, clear, finely ground).
Melt wax, mix with alum, make pills like paulownia seeds. Take 20 pills, gradually increase to 30. Swallow with warm plain water far from meals. (From *Qi Xiao*) (Note: Originally from *Wai Ke Jing Yao*, named Shen Xian Huang Fan Wan.)
Late-stage Treatment Methods: *Jiu Yuan* Pai Nong Nei Bu San treats cold-type suppurative carbuncles and furuncles.
Ren Shen, Dang Gui, Hou Po (ginger-processed), Fang Feng, Bei Geng (roasted), Bai Zhi, La Gui, Huang Qi (roasted), Gan Cao (roasted), Bai Fu Ling.
Powder. Take 3 qian, mix with warm wine. If non-drinker, use Nan Mu Xiang decoction. (From *Zhi Zhi*) (Note: Originally *He Ji Ju Fang* Hua Du Pai Nong Nei Bu Shi Yi San, now removes Chuan Xiong, adds Fu Ling. *Zi Sheng Jing* says Hu Quan's Nei Bu Shi Quan San is miraculous for intestinal carbuncle. Could this be it? Also, originally *Qian Jin* Nei Bu San, which has Chuan Xiong but no Huang Qi/Fu Ling.) *De Xiao Fang* Jia Wei Shi Qi San treats resolved Lung Carbuncle, modifies *Qian Jin* Nei Bu San with Ru Xiang, Mo Yao.
Qi Xian San treats post-ulceration pain from intestinal carbuncle, continuous dripping, reduced spirit, anorexia, sallow complexion, limb weakness, spontaneous/night sweats, restless sleep.
Fu Ling, Shan Yao, Mu Dan Pi, Shan Zhu Yu, Shu Di Huang, Ren Shen (each 1 qian), Huang Qi (2 qian).
Boil in 2 zhong water with 3 slices ginger, 2 dates to 8 fen. Take before meals. (From *Wai Ke Zheng Zong*)
Tong Liangfu's son, age 12, had internal carbuncle, abdominal distension, sharp/protruding umbilicus. Doctor wanted to puncture umbilicus to drain pus. Mother refused, weeping. Tong reported to Weng. Weng went, saw a wild monk heating copper rods in fire, staring at Weng saying: "This boy has Small Intestine Carbuncle. If not puncturing umbilicus, no other method." Weng explained: "Umbilicus is Shen Que, forbidden for acupuncture. Moreover, carbuncle is internal, should be attacked with decoctions/pills. Following your advice would kill the child." Monk angry, left. Weng administered Tou Nong San. Next day, pus ulcerated from Qi He point. Followed with Shi Qi Tang and Shan Ying Gao. Recovered in 10 days. (From *Cang Zhou Weng Zhuan*)
Woman with drum-like abdominal distension, umbilicus protruding 1 cun, difficult urination/defecation, water sounds upon turning. Internal pus formed. Puncture top of protruding umbilicus, drained basin-full of pus. Given Mu Dan Pi San 5-6 doses, pus decreased. Morning: Ba Wei Wan; Evening: Ba Zhen Tang plus Ze Xie, Mu Dan Pi, Huang Qi, Po Gu Zhi. Recovered in over a month. (From *Wai Ke Zheng Zong*) (Note: These two cases, one forbids needle, one uses needle, each appropriate. Needle use must be skilled; wild monk's method was reckless. *Tui Qiu Shi Yi* has similar successful case.)