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Various discussions in *Mai Yin Zheng Zhi*: The ascending and descending of Yin and Yang allows the smooth circulation of Ying (Nutritive Qi) and Wei (Defensive Qi); if Qi rebellion occurs with obstruction, stagnation and knotting will form an abscess. Gastric epigastric abscess (an abscess occurring in the stomach region) arises from cold qi obstructing Yang, causing heat to gather at the gastric opening. Due to the disharmony of cold and heat, flesh and blood become corrupted and necrotic. Because Qi rebels in the stomach, the stomach pulse is deep and fine. Since Yang Qi cannot descend smoothly, the Renying (ST9) pulse at the neck becomes very vigorous, causing chills and fever resembling malaria, rough and scaly skin, or coughing, vomiting, or expectorating pus and blood. Observing the disease of Fuliang (a type of abdominal mass), there are cases where an internal abscess forms within the gastric epigastrium, because it wraps large amounts of pus and blood located outside the intestines and stomach. (From *Sheng Ji Zong Lu*)

Few books discuss this disease; only Sun Simiao mentioned it (Note: *Qian Jin Fang* has no other discussion on this, likely a misremembered reference). Later scholars treated this theory as gastric heat pathogen, using methods to clear heat, detoxify, and support the interior to reduce gastric heat, which is a good method. Misunderstanding the disease and treating incorrectly causes significant harm; one must be cautious. (From *Qi Xiao Liang Fang*)

Zhang Zhongjing said: For patients with vomiting accompanied by abscess pus, do not treat the vomiting directly; once the pus is exhausted, it will heal itself. This does not specify the location of the abscess but mentions vomiting pus; since he vomits without coughing, it is clear that this is not Lung Abscess but Gastric Epigastric Abscess. *Nei Jing* states: Heat gathering at the gastric opening without moving leads to gastric epigastric abscess. The gastric epigastrium belongs to the Yangming channel; Yangming Qi rebels, so pus does not come out via coughing like in Lung Abscess, but is expelled through vomiting. The pus also differs from Lung Abscess pus which resembles congee; this pus originates from the gastric epigastrium, transforms from dampness, gathers and knots into pus, containing condensed phlegm resembling clam meat. Saying "do not treat the vomiting" means one should not use acrid-aromatic warming stomach anti-emetic agents, because the turbid stasis of pus steams the grain Qi causing vomiting; if the pus exits, the vomiting heals naturally. This applies when the abscess is in the upper part of the gastric epigastrium. If it exceeds the middle, below the diaphragm, the pus exits via stool. Mild cases use Pai Nong Tang from *Jin Gui Yao Lue*; severe cases use Da Huang Mu Dan Tang or Liang Ge San. If pus is vomited from above, mild cases use Pai Nong Tang; severe cases use She Gan Tang, or Xi Jiao Di Huang Tang added with Jin Yin Hua and Lian Qiao. These are all methods of guiding according to the trend. After the pus becomes thin and vomiting stops, use Tai Yi Gao (see *Lung Abscess* section) made into pills. For deficient persons, use Ba Zhen Tang plus Huang Qi, Jin Yin Hua, Lian Qiao, etc., for tonification and regulation. Whenever tongue coating persists long-term, black and greasy, mouth feels sweet, breath is foul and turbid, these are signs of gastric epigastric abscess forming. Clear-eyed physicians should distinguish them early, not waiting until the abscess is formed and incurable. (From *Yi Tong*)

Gastric epigastric abscess has two types: excess and deficiency. Excess types are easy to resolve; if pus forms, healing requires vomiting large amounts of pus and blood. Deficiency types are mostly untreatable. Initially, there is pain and distension in the stomach; over time, the area below the heart gradually bulges, hard as stone, possibly with chills and fever, inability to eat, extreme tenderness upon pressure, and emaciation. This is a syndrome of spleen injury due to excessive thinking; death occurs before the abscess even forms. Therefore, anyone with fixed abdominal pain, aversion to cold, lethargy, and inability to eat should be carefully examined to prevent internal abscess formation. Do not delay treatment seeking unqualified practitioners, leading to late-stage pus rupture and self-harm. (From *Yuan Liu Lun*)

Stomach abscess is a disease where Stomach Yang is suppressed. (Original text cites *Sheng Ji*). If the pulse is surging and rapid, pus has formed; urgently use pus-draining formulas. If the pulse is slow and tight, it belongs to blood stasis; urgently consider purgative methods. Otherwise, toxic factors attack internally, rotting the intestines and stomach, causing great harm. However, this condition is not as recognizable as Lung Abscess; if pus and blood are not vomited, misdiagnosis is inevitable. Surgeons must understand pulse diagnosis principles. Thus, we know the symptoms of stomach abscess stem from the suppression of Stomach Yang. The cause of this suppression is not merely cold. It often involves prior food accumulation, preference for rich wine, or consumption of fried/spicy foods, accumulating heat-toxic qi in the center; or emotional fire stagnating for a long time, compounded by wind-cold invasion, filling the gastric epigastrium with heat-toxic qi. Clear Qi of the stomach sinks downward, making the stomach pulse deep and fine; blocked by wind-cold, the Renying pulse becomes tight and vigorous. With these two pulses, what else could it be but stomach abscess? However, the formation of symptoms is gradual, and treatment methods must not be applied indiscriminately. (From *Zun Sheng Shu*)

Stomach abscess also grows inside the abdomen, with pain between the epigastrium and umbilicus. If redness and swelling appear below the chest, this is Fuliang abscess within the torso cavity, not stomach abscess. Intestinal abscess pain is located in the lower abdomen, left and right lower quadrants, distinguishing it thus. For all internal abscesses where pus has not yet formed, clearing and guiding is appropriate. Once pus has formed, it must be drained. Pus from stomach abscess may exit via vomiting from the mouth or via defecation from the anus. (From *Yi Ji*)

Treatment Case: Jiang Yingsu treated Wang Zhongyu, a scholar-official, who suffered from throat swelling preventing food intake, no sensation of hunger in the abdomen, drinking only several cups of clear tea daily. Upon examination, the Qi Kou pulse was tight and rapid, indicating stomach abscess. Pus had formed; it was appropriate to guide it downward. Administered Liang Ge San, resulting in slight bowel movements one or two times. The next morning, he vomited pus and blood. After taking one dose of She Gan Tang, he felt hungry and sought food. Six doses led to complete recovery. (From *Lei An*)

Shi Wan treated Tan Zhong'an, a fat man who drank heavily. In early summer, he suffered from high fever, vomiting, and reflux, with dull pain on the left side of the chest and diaphragm, intolerable to touch, scanty and frequent urination, slippery tongue coating, pain after eating, vomiting thick phlegm, gradually seeing bloody fluid, and a choppy, irregular pulse. Prescribed Liang Ge San plus Shi Hu and Lian Qiao, expelling much thick greasy material. Previously, a surgeon treated him as Lung Abscess without effect. I stated: "Lung Abscess must involve coughing and expectoration of foul-smelling sputum. This patient only vomits without coughing; undeniably a stomach disease." Four or five days after purgation, vomiting recurred. Treated again with small doses; after three purgations, the condition stabilized. Then regulated with Bao Yuan Ling Ju Tang, recovering in twenty days. Previously, a Mr. Li suffered from this, focusing solely on clearing heat, resolving phlegm, and detoxifying. Until the diaphragm edge ulcerated and pus flowed profusely, lingering for a month until death. Truly due to delayed intervention, until the condition became hopeless, regretting too late. (From *Yi Tong*)

Prescriptions: To treat heat gathering in the gastric epigastrium, stagnating and knotting to form an abscess, Lian Qiao Sheng Ma Tang formula. (From *Sheng Ji*) (Note: i.e., Wu Xiang Lian Qiao Tang.)

To treat excess heat in the stomach fu, stagnating and knotting to form an abscess, Yang Qi unable to descend, stomach pulse deep and fine, Xi Jiao Tang formula.
Xi Jiao (sliced) Zhi Zi Ren Chi Shao Yao Chi Fu Ling (remove black skin) Huang Qin (remove black heart) She Gan (remove hairs) Da Huang (crushed and stir-fried, each 1 liang)
Coarsely grind the seven herbs into a powder. Take 5 qian bi per dose, add 1.5 sheng of water, decoct to 1 sheng, remove dregs, add 1 spoonful of honey, mix well, boil briefly, take warm after meals. (Same source)

To treat Ying and Wei non-circulation, heat gathering at the gastric opening, flesh and blood corruption, forming gastric epigastric abscess, She Gan Tang formula.
She Gan (remove hairs) Zhi Zi Ren Chi Fu Ling (remove black skin) Sheng Ma (each 1 liang) Chi Shao Yao Bai Zhu (each 1.5 liang)
Chop the six herbs to the size of hemp seeds. Take 5 qian bi per dose, add 1.5 sheng of water, decoct to 0.8 sheng, remove dregs, add 1 he of fresh Sheng Di Huang juice and 0.5 he of honey, boil three times, take warm at any time, twice daily. (Same source)