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The *Yellow Emperor's Inner Canon* states: Dull pain at the Guanyuan (CV-4) acupoint indicates Small Intestine Ju (Small Intestine Carbuncle); if the flesh in this area is slightly elevated, it is Small Intestine Yong (Small Intestine Abscess). (Guanyuan, also known as the Front-Mu point of the Small Intestine, is located 3 cun below the umbilicus.)

The *Qianjin Fang* (Prescriptions Worth a Thousand Gold) states: In cases of Chang Yong (Intestinal Abscess), there is swelling in the lower abdomen; severe tenderness upon deep palpation; and frequent urination resembling Lin Syndrome (Dysuria).

The *Jue Lun* (Treatise on Jue Syndromes) states: When Shaoyang Qi rebels, joint movement becomes impaired. Those with impaired joint movement cannot walk with their waist or look back with their neck. If Chang Yong occurs, it is incurable, and death ensues if the patient is startled.

Wang Kentang states: The *Qianjin Fang* warns that mismanagement will certainly kill. In Chang Yong, the lower abdomen feels heavy and painful upon deep pressure; urination is frequent and resembles dysuria; sweating occurs frequently accompanied by aversion to cold; the skin is rough like fish scales (Jia Cuo); the abdominal wall is tense as if swollen; and a rapid pulse indicates pus formation in the Small Intestine. (From *Yixue Zhunsheng*)

Chen Wuyue states: In Chang Yong, the body skin is rough like fish scales, the abdominal wall is tense but soft upon palpation, resembling a swelling, yet there are no accumulations in the abdomen and no fever. A rapid pulse indicates pus within the intestine, formed by long-standing accumulation of Yin-Cold. Therefore, the *Jingui Yaolue* uses Fuzi (Aconite Lateralis Radix Preparata) to warm. If the pulse is slow and tight, pus has not yet formed; purgatives may be used, and blood should be expelled. If the pulse is surging and rapid, pus has formed; purgatives are contraindicated, as this is caused by internal heat binding. Thus, the *Jingui Yaolue* uses Dahuang (Rhei Radix et Rhizoma) to promote drainage.

Zhang Zhongjing states: Chang Yong presents with stuffiness and hardness in the lower abdomen, characterized by lower abdominal pain and fullness, and frequent urination resembling dysuria. Chang Yong belongs to the same category as Fei Yong (Lung Abscess) and Gan Yong (Liver Abscess).

Chao Yuanfang states: A surging and rapid pulse indicates existing pus; a slow and tight pulse indicates no pus. In severe cases, the abdomen distends significantly, producing a splashing sound when turning over; sores may appear around the umbilicus; pus may discharge from the umbilicus; or pus and blood may pass through the stool.

Zhang Jingyue states: The classic text says that Chang Yong must not be startled; startling causes intestinal rupture and death. Therefore, patients should move slowly when sitting, lying down, or turning over. They should occasionally drink thin rice gruel and take Bazhen Tang (Eight-Treasure Decoction) to consolidate Yuan Qi, resting quietly and regulating their condition to preserve life. (From *Jingyue Quanshu*)

Xue Lizhai states: This syndrome is caused by emotional disturbances and dietary irregularities.

He further states: If pus discharges from the umbilicus, it is an untreatable condition.

Sun Simiao states: In Chang Yong, the lower abdomen is heavy and tender upon pressure; urination resembles dysuria; sweating occurs frequently accompanied by aversion to cold; the skin is rough like fish scales; the abdominal wall is tense; in severe cases with significant swelling, the abdomen distends with a splashing sound upon turning; sores may appear around the umbilicus; pus may discharge from the umbilicus or via the stool. These are caused by emotional disturbances and dietary irregularities. A slow and tight pulse indicates no pus; treat with Dahuang Tang (Rhubarb Decoction) to purge. A surging and rapid pulse indicates existing pus; treat with Yiyi Ren Tang (Coix Seed Decoction) to drain pus. Lower abdominal pain with difficult urination indicates pus obstruction; treat primarily with Mudanpi San (Moutan Powder).

Chen Shigong states: At the onset of Chang Yong, there is fever and aversion to cold; the pulse is hollow and rapid; the skin and hair are rough and crisscrossed; the abdominal wall becomes tense and gradually swollen, extremely painful upon pressure; the stool feels heavy; urination is obstructed and resembles dysuria. In severe cases, the umbilicus protrudes, the abdomen distends, and there is a splashing sound upon turning. All these result from Damp-Heat and Stasis entering the Small Intestine to form an abscess. (From *Waike Zhengzong*)

He further states: In men, sudden and urgent running leads to impaired gastrointestinal transport and unsmooth flow, causing败血 (defective blood) and turbid Qi to stagnate and form the disease. In women, postpartum deficiency with prolonged bed rest without rising can cause it. Women experiencing difficult labor exerting excessive force can develop it. Postpartum failure to expel stasis leads to defective blood accumulating in the intestines and forming knots. Hunger, satiety, and overwork, or carrying heavy loads, damage the intestines and stomach. Intoxication, overeating, or sexual fatigue excessively injure essence and vitality; consuming raw and cold foods together causes Qi and Blood disharmony, generating Dampness and Phlegm, leading to intestinal stuffiness, impaired transformation, and Qi-Blood stagnation, all of which can cause this condition.

He further states: In the early stage before pus formation, if the lower abdomen aches deeply, resembling Ben Tun (Running Piglet) syndrome, with dribbling urination, use Dahuang Tang to purge; once stasis is cleared, peace returns. If the constitution is weak with a fine pulse and purgatives are contraindicated, use Huoxue Sanyu Tang (Invigorate Blood and Resolve Stasis Decoction) to harmonize and promote flow.

He further states: If the abdomen is soft yet painful, the lower abdomen is urgently distended, and pus is frequently discharged, the toxin is unresolved; treat with Mudanpi Tang.

He further states: Once pus has formed, presenting with abdominal pain, distension, anorexia, and painful dribbling urination, treat primarily with Yiyiren Tang.

He further states: If pus discharges from the umbilicus, abdominal distension persists, appetite decreases, the complexion is pale, and spirit is fatigued, this indicates dual deficiency of Qi and Blood. Use Bazhen Tang added with Mudanpi (Moutan Cortex), Rougui (Cinnamon Bark), and Bei Wuwei Zi (Schisandra Fruit) to astringe and tonify.

He further states: If the condition lingers for a long time due to neglect and is mistaken for a distension disorder, treating it wrongly allows toxins to attack the five Zang organs and damage the intestines and stomach. This may lead to ulceration of the external genitalia, black spots, loss of luster, absence of pus, continuous discharge of foul fluid, abdominal pain radiating to the yin, incessant irritability, fever, dry mouth, and offensive odors in bedding and rooms. Such cases are untreatable.

Feng Luzhan states: In Small Intestine Yong causing pain, the skin is rough like fish scales, the abdominal wall is tight, soft upon palpation resembling a swelling, with frequent abdominal pain or sores around the umbilicus. Urgent purgation is required. (From *Waike Jinang*)

He further states: A maiden suffered recurrent abdominal pain, poor appetite, sallow complexion, and emaciation. Pediatric treatment focused on clearing heat and resolving accumulation; gynecological treatment focused on unblocking menses and moving blood; and general prescriptions based on deficiency attempted tonification, all without effect. Later, a knowledgeable physician noted: The pulse is large, but the Chi position is exclusively rapid; the skin is rough like fish scales. This indicates Small Intestine Yong, with pus formed and about to rupture. Immediately administer Kuigen (Hibiscus Root) 1 liang, Jinyinhua (Lonicerae Japonicae Flos) 3 qian, Gancao Jie (Licorice Joint) 1 qian, Zaogelaci (Gleditsiae Spina) and Chenpi (Citri Reticulatae Pericarpium) 2 qian each. After two doses, pus and blood discharged profusely. Subsequently, treat with Taiyi Gao (Taiyi Plaster) combined with Renshen (Ginseng Radix et Rhizoma). Stability was achieved after one month.

He further states: Chang Yong is caused by accumulated heat from rich and greasy foods. Symptoms include rough skin, tense abdominal wall, soft upon palpation resembling swelling, sores around the umbilicus, tenderness upon pressing the lower abdomen, frequent urination resembling dysuria, abdominal distension with aversion to cold, fever, and spontaneous sweating. If the pulse is deep and tight with no pus, urgently resolve toxicity. If the pulse is surging and rapid with pus, urgently drain pus. If there is lower abdominal pain with urinary retention, pus is obstructed. However, in Chang Yong, one must never startle the patient; startling causes intestinal rupture. Movements should be slow. Drink thin gruel and take Bazhen Tang to consolidate Yuan Qi, rest quietly, and regulate to ensure survival.

Li Dongyuan states: In Chang Yong with sores around the umbilicus discharging pus, some discharge from the umbilicus itself. Only those passing pus and blood via the stool will heal spontaneously. (From *Shi Shu*)

Shen Douyuan states: For internal intestinal abscesses, verify the diagnosis clearly; do not treat recklessly, as reckless treatment kills. Symptoms include heavy lower abdomen, tenderness upon pressure, urination resembling dysuria, frequent sweating with aversion to cold, rough skin, tense abdominal wall, sores around the umbilicus, pus from the umbilicus, or pus and blood in stool. If swelling is severe on the left and the Cun position of the left wrist is surging and rapid, it is Small Intestine Yong. If swelling is severe on the right and the Cun position of the right wrist is surging and rapid, it is Large Intestine Yong. (From *Yanke Qixuan*)

Zhu Danxi states: Rough skin like fish scales, tight and small abdominal wall, abdominal pain with dribbling urination, frequent sweating or牵引 (pulling) pain to the large abdomen, soft upon palpation resembling swelling, no abdominal masses, no fever, and non-wiry/non-rapid pulse indicate intestinal Yong caused by long-standing Yin-Cold. Use hot and warm agents to warm and disperse. Thus, the *Jingui Yaolue* uses Fuzi to warm.

He Shi states: In Chang Yong, men present with symptoms on the left and women on the right, with legs bent and unable to extend. Mistaking this for Yin Hernia or Cold Damage causes great harm. (From *Jisheng Fang*)

Hu Gongbi states: Pressing 1.3 cun below the umbilicus reaches the curvature of the intestines; the Large Intestine coils on the left, and the Small Intestine curves on the right. Abscess formation results from long-standing cold toxin, where intestinal pus cannot vent outward, thus forming internally. Externally, there is no visible shape, but deep pressure causes severe pain. Toxin on the left prevents left leg extension; toxin on the right prevents right leg extension. The skin outside the toxin shows slight wrinkles and mild swelling upon close observation. This condition requires Niujiao Jiu (Ox Horn Gelatin Wine) taken with Taiyi Gao Wan (Taiyi Pill) to pursue pus and resolve toxicity. Poor management renders it incurable. (From *Qingnang*)

Dou Hanqing states: Heat in the Bladder with accumulated toxin failing to flow results in this syndrome, causing hard nodules at the umbilicus, painful urination, and relentless diarrhea day and night. Externally, apply ten scallions with roots, mashed, to the umbilicus.

He further states: Female Chang Yong differs from males; it arises from Heart channel toxin flowing into the Small Intestine channel, manifesting at the umbilicus as hard as stone. This is a malignant sign; use internal support methods.

He further states: In Chang Yong, if pus discharges via stool or umbilicus, it is untreatable.

The *Neijing* states: Chang Yong must not be startled; startling causes intestinal rupture and death. Patients must move slowly when sitting, lying, or turning. Occasionally drink thin gruel and take Bazhen Tang to consolidate Yuan Qi, rest quietly, and regulate to preserve life. (From *Jingyue Quanshu*)

*Millejin Fang* Moxibustion method: Bend both elbows, align the sharp bone of the elbow tip, and moxa 100 Zhuans. Pus and blood discharge, and the patient stabilizes.

*Mai Jing* asks: How does one know if a woman of the Yulin guard has an intestinal abscess? The Master answers: The pulse is slippery and rapid. Slippery indicates excess; rapid indicates heat. Slippery relates to Ying (Nutrient) Qi; rapid relates to Wei (Defensive) Qi. Wei Qi descends rapidly, Ying Qi rises slipperily; their conflict creates turbid敗浊 (defective turbidity), causing lower abdominal stuffiness and hardness, difficult or spontaneous urination, spontaneous sweating, or aversion to cold. Pus has formed. If the pulse is slow and tight, it indicates blood stasis; expulsion of blood brings relief.

Chen Yuangong states: Some present with severe abdominal pain, thirst, inability to extend the left leg (pain worsens upon extension), and unbearable tenderness upon pressure. People assume intestinal abscess. However, intestinal abscesses differ between Large and Small Intestines. Bending the right leg indicates Large Intestine Yong; bending the left leg indicates Small Intestine Yong. Current left leg flexion confirms Small Intestine Yong. Large Intestine Yong is easier to treat; Small Intestine Yong is harder because the Large Intestine can be purged, while the Small Intestine is difficult to purge. Yet, with proper method, why not purge? Fire from the Large Intestine exits via feces; fire from the Small Intestine exits via urine. Xiedu Zhishen Tang: Jinyinhua 3 liang, Fuling (Poria) and Yiyiren (Coix Semen) 1 liang each, Gancao (Licorice), Cheqianzi (Plantaginis Semen), Liuji Nu (Lysimachiae Herba), Zexie (Alismatis Rhizoma) 3 qian each, Rougui (Cinnamon Bark) 1 fen. Decoct in water. After one dose, watery discharge flows heavily; after two doses, pain greatly reduces; after three doses, complete recovery. This formula consists mainly of diuretics, with only Jinyinhua resolving toxicity. Why such efficacy? Small Intestine toxin must be resolved internally. Among internal-resolving herbs, none replace Jinyinhua, as others damage healthy Qi, which must not be injured in the Small Intestine. Thus, Jinyinhua is the sovereign herb. Although it does not enter the Small Intestine directly, combined with Fuling, Yiyiren, Cheqianzi, and Zexie, it guides the action to the Small Intestine. A little Rougui guides it to the Bladder for excretion via urine. To prevent overwhelming fire toxin, Liuji Nu accelerates removal, and Gancao moderates. This avoids stagnation and harshness, allowing fire toxin to exit via the Bladder and Small Intestine. (From *Bianzheng Lu*)

He further states: Someone cries out in pain in the left abdomen, unbearable upon pressure. People assume food stagnation in the Large Intestine, but it is actually Small Intestine Yong! All intestinal abscesses involve leg flexion. Here, the leg is not flexed, seemingly contradicting intestinal abscess. However, abscesses inside the intestine cause leg flexion: Large Intestine abscess bends the right leg; Small Intestine abscess bends the left leg. Abscesses outside the intestine do not cause leg flexion. Pain on the left indicates Small Intestine Yong; pain on the right indicates Large Intestine Yong. Food stagnation pain comes and goes; abscess pain is fixed and unceasing. Thus, left-sided pain indicates an abscess outside the Small Intestine. Abscesses inside the intestines can be ruptured/drained; those outside cannot, as there is no exit path, leading to death. Small Intestine cases are especially critical and require early treatment. Neihua Dan: Jinyinhua 4 liang, Cheqianzi 5 qian, Baifuling (Poria) and Yiren (Coix Semen) 1 liang each, Sheng Gancao (Raw Licorice) 3 qian. Decoct in water. Three doses stop pain; four doses cure. (This is a variation of the previous formula. The previous formula promotes diuresis while resolving toxicity. This formula adds Danggui (Angelicae Sinensis Radix) 2 liang to nourish blood while promoting diuresis and resolving toxicity. When the abscess ruptures, diuresis helps expel toxin easily. Before rupture, without nourishing blood, diuresis depletes blood, making digestion difficult. Note this distinction. Early treatment is essential; otherwise, even if healed, stasis flows outside the intestine, causing lifelong abdominal pain. Be cautious.)

He further states: Someone experiences sudden severe abdominal pain, hematuria, and inability to extend the left leg. People assume Small Intestine Yong, but it is actually Small Intestine Fire Excess! Small Intestine Yong always involves bending the left leg. Now the leg is extended, clearly indicating Yong, yet why "Fire Excess"? Abscesses have signs; they do not suddenly bleed immediately. Long-standing abscesses generate pus; bleeding occurs only when pus is nearly exhausted. How could bleeding occur before rupture? Why is the leg not extended? The Small Intestine is narrow, while the Large Intestine is wide. Wide channels accommodate pathogens; narrow ones do not. The Small Intestine suffers from fire roasting, internal pressure prevents relaxation, causing temporary left leg flexion, unlike the sustained flexion in Yong. Do not assume Yong solely based on leg extension and prescribe detoxifiers blindly. How to differentiate? Check for blood in urine at onset. Initial pain with leg flexion and no blood in urine indicates Yong. Initial pain with leg flexion and blood in urine indicates Fire Pain. Treatment: Purge fire; detoxification is unnecessary. Pain stops, and leg extends. Modified Xiaochaihu Tang: Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma), Gancao (Licorice) 1 qian each, Renshen (Ginseng) 2 qian, Fuling (Poria) 5 qian, Huangqin (Scutellariae Radix) 3 qian. Decoct in water. One dose extends the leg; two doses stop bleeding and pain. (Note: Xiaochaihu Tang is not typically for the Small Intestine. Why such swift effect? Small Intestine Fire Excess originates from Liver-Gallbladder depression. Wood depression generates fire; fearing the Heart, it attacks the Small Intestine. Fire naturally rises; here it blazes downward, violating its nature, causing Small Intestine pain. Hematuria occurs because fire forces Small Intestine blood out, fearing desiccation, it bypasses the Small Intestine, enters the Bladder, obstructs water pathways, and causes bleeding. Xiaochaihu soothes Liver Qi, allowing fire to rise normally. With Fuling clearing dampness, water flows, and blood returns to its vessels. This explains the formula's miracle.)