薛立斋治上舍周一元，腹患痈，三月不愈，脓水清稀，朝寒暮热。服四物、知、柏之类，食少作
泻，痰涎上涌。服二陈、枳实之类，痰涎愈甚，胸膈痞闷。问故，曰∶朝寒暮热，血气虚也，食少作
泻，脾肾虚也，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。乃遂用六君子、
黄、当归，数剂诸症渐退。又用十全大补汤，肌肉渐敛，更用补中益气调理而愈。
从侄孙年十四而毕姻。乙巳春，年二十四，腹中作痛。用大黄等药二剂，下血甚多，胸腹胀满，
痰喘发热。又服破气降火药，一剂汗出如水，手足如冰。薛归诊之，左关洪数，右关尤甚，乃腹痈也。
虽能收敛，至夏必变而成瘵症。用参、 各一两，归、术各五钱，陈皮、茯苓各三钱，炙草、炮姜各
一钱，二剂诸症稍退，腹始微赤，按之觉痛。又二剂作痛，又二剂肿痛，脉滑数。针出脓瘀，更用大
补汤，精神饮食如故。因遗精，患处色黯，用前药加五味、山萸、山药、骨脂、吴萸等剂，疮口渐敛，
瘵症悉具。其脉非洪大而数，即微细如无，惟专服独参汤、人乳汁少复，良久仍脱。曰∶当备后事，
以俟火旺，乃祷鬼神。巫者历言往事如见，更示以方药，皆峻利之剂，且言保其必生。敬信服之，后
果殁。经曰∶拘于鬼神者，不可与言至德。而况又轻信方药于邪妄之人耶，书此以警后患。
薛立斋治一男子，腹患痈，肿硬不溃，乃阳气虚弱，呕吐少食，乃胃气虚寒，法当温补脾胃。假
如肿赤痛甚，烦躁脉实而呕，为有余，当下之；肿硬不溃，脉弱而呕，为不足，当补之。若痛伤胃气，
或感寒邪秽气而呕者，虽肿疡，犹当助胃壮气。彼信不真，仍服攻伐药而呕甚。复请治，脉微弱而发
热。曰∶热而脉反静，脱血脉反实，汗后脉反躁者，皆为逆也。辞不治，果殁。
秋官钱可容腹患痈， 肿烦渴作痛，饮冷，大便不通，脉沉数实，此热毒蕴于内。清热用消毒散
加大黄二钱，一剂诸症悉退。但形气顿虚，用托里消毒散去银花、白芷，倍加参、 、归、术而安。
毛砺安侧室，肚患痈月余矣，色黯不肿，内痛作呕，饮食不入，四肢逆冷，其脉或脱绝或浮大，
杂用定痛败毒之药。曰∶此气血俱虚而作痛，内决无脓，不治之症也。强用大温补之药，二剂痛止色
赤，饮食少进。谓但可延日而已。人皆以为有脓，复强针之，又用大补之剂，始生清脓少许。众仍以
为毒结于内，用攻脓保其必生，殊不知乃速其死耳。惜哉。
一男子腹患痈，肿硬木闷，烦热便秘，脉数而实，以黄连内疏汤，一剂少愈。以黄连解毒散，二
剂顿退。更以金银花散四剂，疮头出水而消。
一男年逾三十，患腹痈肿，脉数喜冷。齐氏云∶疮疡肿起坚硬，疮疽之实也。河间云∶肿硬木闷，
喜饮冷，邪气在内也。遂用清凉饮，倍用大黄，三剂稍缓。次以四物汤加芩、连、山栀、木通，四剂
而遂溃。更以十宣散去参、 、肉桂，加金银花、天花粉渐愈。彼欲速效，自服温补之剂，致腹俱肿，
小便不利。仍以清凉饮治之，脓溃数碗，再以托里药治之愈。东垣云∶疮疽之发，其受有内外之别，
治之有寒温之异。受之外者，法当托里以温剂，反用寒药，则是皮毛始受之邪，引入骨髓。受之内者，
法当疏利以寒剂，反用温补托里，则是骨髓之病，上彻毛皮，表里通溃，共为一疮，助邪为毒，苦楚
百倍，轻则几殆，重则死矣。
一男子素好酒色，小腹患毒，脉弱微痛，欲求内消。谓当助胃壮气，兼行经活血药佐之可消，不
宜用败毒等药。彼欲速效，乃自用之，病热果盛，疮亦不溃，饮食少思。迨两月余复请治，诊其脉愈
弱，盗汗不止，聚肿不溃，肌寒肉冷，自汗色脱。此气血俱虚也，故不能发肿成脓。以十全大补汤三
十余服，遂成脓。刺之反加烦躁脉，此亡阳也。以圣愈汤服二剂，仍用前药百帖愈。
刘贵患腹痈， 痛，烦躁作呕，脉实。河间云∶疮疡者，火之属，须分内外，以治其本。若脉沉
实者，先当疏其内，以绝其源。又曰∶呕哕以烦，脉沉而实，肿硬木闷，或皮肉不变，邪气在内，宜
内疏黄连汤治之。
今作呕脉实，毒在内也，遂用前汤通利二三行，诸症悉退。更以连翘消毒散而愈。
一人患腹痈，脓熟开迟，脉微细。脓出后，疮口微脓如蟹吐沫，此内溃透膜也。凡疮疡透膜，十
无一生，虽以大补药治之，亦不能救。此可为待脓自出之戒也。
黄师文云∶男子服建中汤，妇人服四物汤，往往十七八得，但时为之损益耳。有男病小腹一大痈，
其诸弟侮之曰∶今日用建中汤否？师文曰∶服建中汤。俄而痈溃。盖小腹痈本虚，其热毒乘虚而入，
建中汤既补虚，而黄 且溃脓也。（《北窗炙 》）
Xue Lizhai treated Zhou Yiyuan, a Shangshe (official title), who suffered from an abdominal carbuncle that had not healed for three months. The pus was clear and thin, with chills in the morning and fever in the evening. After taking herbs such as Siwu Tang (Four Substances Decoction), Zhimu (Anemarrhenae Rhizoma), and Baipiao (Phellodendri Cortex), his appetite decreased, he experienced diarrhea, and phlegm-saliva surged upward. He then took Erchen Tang (Two-Aged Decoction) and Zhishi (Aurantii Fructus), but the phlegm-saliva became worse, causing fullness and oppression in the chest and diaphragm. Upon inquiry, it was explained: "Chills in the morning and fever in the evening indicate deficiency of blood and Qi; decreased appetite leading to diarrhea indicates deficiency of Spleen and Kidney; all are due to deficiency of True Qi and excess of pathogenic factors." The treatment should first strengthen Stomach Qi so that the Zang-Fu organs receive nourishment and pathogens recede spontaneously. Thus, Liujunzi Tang (Six Gentlemen Decoction) combined with Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix) was used. After several doses, symptoms gradually subsided. Then, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was administered, allowing muscles to gradually heal. Finally, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) was used for regulation until recovery.
Xue Lizhai’s nephew married at age fourteen. In the spring of the Yisi year, at age twenty-four, he suffered from abdominal pain. After taking two doses of Da Huang (Rhei Radix et Rhizoma) and other drugs, he passed a large amount of blood, resulting in chest and abdominal distension, phlegm-wheezing, and fever. He then took Qi-po Jiehuo Yao (Qi-breaking and Fire-descending medicines). After one dose, he sweated profusely like water, and his hands and feet became ice-cold. Xue examined the pulse: the Left Guan position was surging and rapid, especially the Right Guan position, diagnosing an abdominal carbuncle. Although it could be收敛 (astringed/healed), by summer it would inevitably transform into a consumptive disease (Zhai Syndrome). A prescription of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) each 1 liang, Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) each 5 qian, Chenpi (Citri Reticulatae Pericarpium) and Fuling (Poria) each 3 qian, Zhigancao (Prepared Licorice Root) and Paojiang (Prepared Ginger) each 1 qian was given. After two doses, symptoms slightly receded, and the abdomen became slightly red, painful upon pressure. After two more doses, pain occurred; after two further doses, swelling and pain appeared, with a slippery and rapid pulse. Needling drained pus and stasis. Using Dabu Tang (Great Tonifying Decoction), spirit and diet returned to normal. Due to spermatorrhea, the lesion turned dark. The previous formula was modified with Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gubuli (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus). The wound gradually closed, but signs of consumptive disease fully manifested. His pulse was either surging, large, and rapid, or minute and fine as if absent. Only Du Shen Tang (Single Ginseng Decoction) and human milk were taken, providing slight recovery before relapsing into collapse. It was said: "Prepare for death, wait for the Fire phase to peak, and pray to ghosts and gods." A shaman recounted past events as if seeing them, prescribing harsh purgatives, guaranteeing survival. Trusting this, he eventually died. The Classic states: "One bound by ghosts and gods cannot be spoken to regarding the highest Virtue." How much less can one trust prescriptions from deceitful persons? This is recorded to warn future generations.
Xue Lizhai treated a man with an abdominal carbuncle that was swollen, hard, and unruptured, indicating Yang Qi deficiency. Vomiting and poor appetite indicated deficiency-cold of Stomach Qi. The method should be to warm and tonify Spleen and Stomach. If the swelling were red and painfully hot, with irritability, a full pulse, and vomiting, it would be Excess, requiring purgation. Since it was hard and unruptured with a weak pulse and vomiting, it was Deficiency, requiring tonification. If pain injured Stomach Qi, or cold/dirty pathogens caused vomiting, even with a superficial abscess, one must assist Stomach Qi and strengthen Wei Qi. The patient lacked conviction, continued taking attacking drugs, and vomiting worsened. Upon re-consultation, the pulse was minute and weak with fever. Xue stated: "Fever with a calm pulse, collapse with a full pulse, agitation after sweating—all are adverse signs." He refused treatment, and the patient died.
Qian Kerong, a magistrate, suffered from an abdominal carbuncle with swelling, irritability, thirst, pain, desire for cold drinks, and constipation. The pulse was deep, rapid, and full, indicating heat-toxin accumulation internally. To clear heat, Xiaodu San (Detoxication Powder) plus 2 qian of Da Huang (Rhei Radix et Rhizoma) was used. One dose cleared all symptoms. However, form and Qi suddenly weakened. Tuoli Xiaodu San (Interior-Supporting Detoxication Powder) without Jinyinhua (Lonicerae Japonicae Flos) and Baizhi (Angelicae Dahuricae Radix), with doubled Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baishao (Paeoniae Radix Alba), stabilized him.
Mao Li'an's concubine had an abdominal carbuncle for over a month. The color was dark without swelling, internal pain with vomiting, inability to eat, cold limbs, and pulses alternating between absent and floating-large. Various pain-relieving and detoxifying herbs were used. Xue said: "This is pain due to dual deficiency of Qi and Blood. There is absolutely no pus internally; it is an untreatable condition." Forcing strong warming-tonics for two doses stopped pain and reddened the area, allowing slight food intake. It was noted that life could only be prolonged. Others believed there was pus and forced needling, followed by strong tonics, producing only a little clear pus. Believing toxin remained inside, they attempted to drain pus to ensure survival, unknowingly hastening death. Regrettable.
A man suffered from an abdominal carbuncle, swollen, hard, numb, with irritability, fever, and constipation. The pulse was rapid and full. Huanglian Neishu Tang (Coptis Internal-Draining Decoction) improved him slightly after one dose. Huanglian Jiedu San (Coptis Detoxication Powder) resolved symptoms after two doses. Jinyinhua San (Lonicera Powder) for four doses allowed the sore head to discharge water and resolve.
A man over thirty suffered from an abdominal carbuncle with swelling, rapid pulse, and preference for cold drinks. Qi Shi stated: "Swollen, hard sores indicate Excess in carbuncles." He Jianwei stated: "Swelling, hardness, numbness, and preference for cold drinks indicate pathogens inside." Qingliang Yin (Cooling Drink) with extra Da Huang (Rhei Radix et Rhizoma) relieved symptoms after three doses. Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), and Mutong (Akebiae Caulis) caused rupture after four doses. Shixuan San (Ten-Vitality Powder) without Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Rougui (Cinnamomi Cortex), plus Jinyinhua (Lonicerae Japonicae Flos) and Tianhuafen (Trichosanthis Radix), gradually healed him. Wanting quick results, he self-administered warming-tonics, causing total abdominal swelling and difficult urination. Qingliang Yin (Cooling Drink) was used again, draining several bowls of pus. Tuoli medicines (Interior-Supporting Drugs) cured him. Dong Yuan stated: "Carbuncles have external and internal origins, requiring warm or cold treatments respectively. External pathogens require warming interior-supporters; using cold herbs draws pathogens to the marrow. Internal pathogens require cold draining herbs; using warming tonics draws marrow pathology to the skin, causing systemic ulceration, aiding toxins, increasing suffering tenfold—light cases nearly die, heavy cases die."
A man fond of alcohol and sex suffered from a toxic lump in the lower abdomen with a weak pulse and mild pain, seeking internal resolution. Xue advised assisting Stomach Qi and strengthening Wei Qi, aided by blood-invigorating herbs, avoiding detoxifying drugs. Seeking quick results, he self-medicated, worsening heat, preventing rupture, and reducing appetite. Two months later, the pulse was weaker, with night sweats, clustered swelling without rupture, cold skin and flesh, spontaneous sweating, and pale complexion. This was dual deficiency of Qi and Blood, preventing pus formation. Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) for over thirty doses produced pus. Needling increased irritability and pulse agitation, indicating Yang collapse. Shengyu Tang (Sage Preservation Decoction) for two doses, followed by the previous hundred doses, cured him.
Liu Gui suffered from an abdominal carbuncle with pain, irritability, vomiting, and a full pulse. He Jianwei stated: "Carbuncles belong to Fire; distinguish internal/external to treat the root. Deep-full pulses require internal draining to cut off the source." Also: "Vomiting with irritability, deep-full pulse, hard swelling/numbness, or unchanged skin/flesh indicate internal pathogens; use Neishu Huanglian Tang (Internal-Draining Coptis Decoction)."
Now, vomiting with a full pulse indicates internal toxin. The previous decoction was used to promote defecation two or three times, clearing all symptoms. Lianqiao Xiaodu San (Forsythia Detoxication Powder) cured him.
A man with an abdominal carbuncle had delayed rupture despite mature pus, with a minute-fine pulse. After drainage, the wound oozed pus like crab bubbles, indicating internal rupture through the membrane. Carbuncles penetrating the membrane are almost invariably fatal; even strong tonics cannot save them. This serves as a warning against waiting for spontaneous rupture.
Huang Shiwen stated: "Men taking Jianzhong Tang (Middle-Building Decoction) and women taking Siwu Tang (Four Substances Decoction) often succeed, adjusting for timing." A man had a large lower abdominal carbuncle. His brothers mocked him: "Are you taking Jianzhong Tang today?" Shiwen said: "Take Jianzhong Tang." Soon, the carbuncle ruptured. Lower abdominal carbuncles are essentially deficient; heat-toxins enter via deficiency. Jianzhong Tang tonifies deficiency, and Huangqi (Astragali Radix) promotes pus rupture. (From *Beichuang Zhigelu*)