脓者血之变也。血不阻气。气不战血。则血气调和。疮疖不生。血滞气则凝结为痛。气蒸血则腐化成脓。躯
壳外者易治。至于吐脓。则出于脏腑之内。其证最危。在中焦以下。则便脓。在中焦以上。则吐脓。夫人身之
气。乃水所化。气即水也。故血得气之变蒸。亦化而为水。不名曰水。而名曰脓者。以其本系血质。虽化为水。
而较水更浓也。当其未化。则仍是血。消瘀则脓自不生。及其既化。则同于水。逐水则脓自排去。
一肺痈。乳上第三根肋骨间。名肺募穴。隐隐疼痛。食豆而香。是痈将成。仲景云。风舍于肺。其人则咳。口干
喘满。咽燥不渴。时时吐浊沫。时时振寒。热之所过。血为之凝滞。蓄结痈脓。吐如米粥。始萌可救。脓成则死。
谓重者肺坏而死。若肺不坏。亦有可救。故仲景又曰。口中辟辟燥咳。胸中隐隐作痛。脉数而实。喘不得卧。
鼻塞不闻香臭者。葶苈大枣泻肺汤主之。吐脓如米粥者。甘桔汤主之。仲景此论。非谓除此二方。别无治
法。不过分别未成脓者。当泻实。已成脓者。当开结。指示两条门径。使人知所从事。且曰。以此汤主之。明明
有加减之法。见于言外。余因即泻实开结二义。推而广之。其成脓者。用通窍活血汤。加麻黄杏仁石膏甘
草。从表以泻之。无表证者。用人参泻肺汤。加葶苈大枣。从里以泻之。如病势猛勇。急须外攘内除。则用防
风通圣散。三方力量。雄浓于仲景泻实之法。庶尽其量。如识力不及。只用甘桔汤。加荆芥薄荷杏仁黄芩。
亦许免疚。然而无功。其已成脓者。急须将脓除去。高者越之。使从口出。用千金韦茎汤。或用瓜蒂散。加冬
瓜仁桃仁苡仁栀子。或用泻白散。加黄连栝蒌。皆取在膈上则吐。使脓远去。以免久延为患。白散尤能吐
能下。加升麻郁金。以助其吐下之机。再加黄芩栝蒌。以解其火更善。如只须下泻。不宜涌吐。则合甘桔泻
肺二汤。再加赤豆芽苡仁防己栝蒌杏仁知母枳壳。使从下降。或用桔梗宁肺汤。补泻兼行。如此则于仲
景开结之法。庶尽其妙。惟收口之法。仲景未言。然亦可以义例求也。诸疮生肌。皆用温补。肺是金脏。温则
助火刑金。只宜清敛以助金令。使金气足。而肺自生。人参清肺汤治之。后服清燥救肺汤以收功。
一脾胃痈。与肺痈治法略同。但肺痈多由外感风邪而成。故有发表之法。脾胃痈。则由湿热酒毒。七情之
火内蕴而成。故无发表之法。胃痈初起。中脘穴在脐上四寸。必隐隐作痛。脾痈初起。章门穴在脐上二寸。
旁开六寸。必隐隐作痛。二病皆食豆而香。其证寒热如疟。皮肤甲错。腹满咽干。治宜攻热下血。热去而血
不停。更自何地酿为痈脓哉。故凡内痈脓未成者。以夺去瘀热为主。丹皮汤治之。脓已成者。以排为主。脓
即水也。逐水即是排脓。赤豆苡仁汤治之。脓血既去之后。则脏腑空虚。见火象者。人参固本汤。加黄 茯
苓。以清补之。若现虚寒之象。则用六君子汤。加黄 当归煨姜。以温补之。方外有方。视其所兼之证。随宜
用之。笔楮难尽。
此外。如胸背腰胁肝膈。大小肠。凡有瘀热壅血。均能成痈。总以丹皮汤主之。近上焦者。去芒硝。加葶苈黄
桔梗荆芥甘草。中下焦者。加姜黄。余详便脓门。
此书原专论血证。所以兼及内痈者。以痈脓之病。皆由血积而成。知血之变痈脓。即可知血之能为干血。
能变痨虫。知内痈之生寒热。即可知血证之郁热矣。但痈脓之证。系血家实积。与失血虚证有异。然不以
此反观合勘。亦无以尽血证之情伪。
Pus is a transformation of blood. If blood does not obstruct qi, and qi does not contend with blood, then blood and qi will be harmonious, and sores and boils will not arise. When blood stagnates and qi becomes constrained, it condenses into pain; when qi steams and blood putrefies, pus is formed. Pus on the exterior of the body is easy to treat. However, vomiting pus originates from within the zang-fu organs, making the condition most critical. If the pathology is below the middle jiao (middle energizer), there is pus in the stool; if above the middle jiao, there is vomiting of pus. The qi of the human body is transformed from water; thus, qi is essentially water. Therefore, when blood undergoes the steaming and transforming action of qi, it also transforms into water. It is not called water but pus because its original substance is blood; although transformed into water, it is thicker than water. Before it transforms, it remains blood; eliminating blood stasis prevents pus formation. Once it has transformed, it is equivalent to water; promoting diuresis expels the pus.
First, Lung Abscess. There is a hidden pain between the third rib on the chest, known as the Front-Mu point of the Lung (Yufu area). A pleasant smell of beans indicates that the abscess is about to form. Zhang Zhongjing stated: "When wind lodges in the lung, the person coughs, has a dry mouth, wheezing and chest fullness, dry throat without thirst, frequently spits turbid froth, and experiences frequent chills. Where heat passes, blood coagulates and stagnates, accumulating to form an abscess and pus, which is vomited like congee. In the early stage, it can be saved; once pus forms, death ensues." This refers to severe cases where the lung is destroyed leading to death. If the lung is not destroyed, it may still be salvageable. Thus, Zhang Zhongjing also said: "If the mouth is parched, coughing occurs, there is hidden pain in the chest, the pulse is rapid and excess, wheezing prevents lying down, and nasal congestion causes loss of smell, Tingli Dazao Xiefei Tang (Thladiantha and Jujube Decoction to Drain the Lung) is indicated. If pus is vomited like congee, Ganjie Tang (Licorice and Platycodon Decoction) is indicated." Zhang Zhongjing's discussion does not imply that no other treatments exist besides these two formulas. Rather, it distinguishes between those where pus has not yet formed, requiring draining of excess, and those where pus has formed, requiring opening blockages and draining pus. It points out two pathways for treatment. The phrase "indicated by this decoction" clearly implies methods of modification beyond the literal text. I have therefore extrapolated and expanded upon the principles of draining excess and opening blockages. For those with formed pus, Tongqiao Huoxue Tang (Unblocking Orifices and Invigorating Blood Decoction) is used, added with Mahuang, Xingren, Shigao, and Gancao (Ephedra, Apricot Seed, Gypsum, and Licorice), to drain via the exterior. For those without exterior symptoms, Renshen Xiefei Tang (Ginseng Decoction to Drain the Lung) is used, added with Tingli and Dazao (Thladiantha and Jujube), to drain via the interior. If the disease momentum is fierce and urgent external release and internal removal are needed, Fangfeng Tongsheng San (Saposhnikovia Universal Salvation Powder) is used. These three formulas possess greater potency than Zhang Zhongjing's method of draining excess, thereby fully utilizing their strength. If diagnostic acumen is insufficient, using only Ganjie Tang added with Jingjie, Bohe, Xingren, and Huangqin (Schizonepeta, Mint, Apricot Seed, and Scutellaria) might avoid error, though efficacy may be poor. For those with formed pus, it is urgent to remove the pus. For high-located pathogens, induce vomiting to expel pus from the mouth, using Qianjin Weijing Tang (Millennium Reed Stem Decoction) or Guiti San (Melon Seed Powder) added with Dongguaren, Taoren, Yiren, and Zhizi (Winter Melon Seed, Peach Kernel, Coix Seed, and Gardenia); or use Xiebai San (Drain White Powder) added with Huanglian and Gualou (Coptis and Trichosanthes Fruit), aiming to expel via vomiting since the pathogen is above the diaphragm, keeping the pus distant to prevent prolonged suffering. Baisan (White Powder) is particularly effective in inducing both vomiting and purgation; adding Shengma and Yujin (Cimicifuga and Curcuma Rhizome) assists this mechanism; further adding Huangqin and Gualou better resolves fire-toxin. If only purgation is needed and vomiting is contraindicated, combine Ganjie Tang and Xiefei Tang, adding Chidouya, Yiren, Fangji, Gualou, Xingren, Zhimu, and Zhike (Red Bean Sprout, Coix Seed, Stephania Root, Trichosanthes Fruit, Apricot Seed, Anemarrhena Rhizome, and Aurantium Peel), to direct downward expulsion; or use Jiegeng Ningfei Tang (Platycodon Decoction to Calm the Lung), combining tonification and draining. This way, the subtlety of Zhang Zhongjing's method of opening blockages is fully realized. Only the method for closing wounds was not mentioned by Zhang Zhongjing, but it can be deduced by analogy. All sores generating flesh use warm tonification. The Lung is a Metal organ; warm tonification aids fire to damage metal. Only clear, astringent methods should be used to assist Metal, ensuring sufficient Metal Qi so the Lung regenerates naturally. Renshen Qingfei Tang (Ginseng Decoction to Clear the Lung) treats it, followed by Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) to conclude treatment.
Second, Spleen and Stomach Abscess. The treatment is slightly similar to Lung Abscess. However, Lung Abscess often arises from external wind pathogens, hence methods for releasing the exterior are used. Spleen and Stomach Abscess arises from internal accumulation of damp-heat, alcohol toxins, and fire from the seven emotions, hence no exterior-releasing methods are used. At the onset of Stomach Abscess, the Zhongwan point (4 cun above the umbilicus) must have hidden pain. At the onset of Spleen Abscess, the Zhangmen point (2 cun above the umbilicus, 6 cun lateral) must have hidden pain. Both conditions present with a pleasant smell of beans, symptoms resembling malaria (alternating chills and fever), skin roughness like scales, abdominal fullness, and dry throat. Treatment should attack heat and purge blood stasis. If heat is removed and blood stasis persists, where else could pus be brewed? Therefore, for all internal abscesses before pus formation, the main strategy is to seize and eliminate stasis-heat, treated with Danpi Tang (Moutan Decoction). For those with formed pus, the main strategy is drainage. Pus is water; draining water is draining pus, treated with Chidou Yiren Tang (Adzuki Bean and Coix Seed Decoction). After pus and blood are expelled, the zang-fu organs are empty. If signs of fire appear, Renshen Guben Tang (Ginseng Decoction to Secure the Root) added with Huangqi and Fuling (Astragalus and Poria) is used for clear tonification. If signs of deficiency-cold appear, Liujunzi Tang (Six Gentlemen Decoction) added with Huangqi, Danggui, and Wei Jiang (Astragalus, Angelica Sinensis, and Roasted Ginger) is used for warm tonification. Beyond these formulas, variations depend on accompanying symptoms, applied flexibly. Writing cannot exhaustively list them.
Furthermore, areas such as the chest, back, waist, flanks, Liver, Diaphragm, Large Intestine, and Small Intestine, where stasis-heat and blood congestion occur, can all form abscesses. Danpi Tang is generally indicated. For locations near the Upper Jiao, remove Mangxiao and add Tingli, Huangqin, Jiegeng, Jingjie, and Gancao (Thladiantha, Scutellaria, Platycodon, Schizonepeta, and Licorice). For Middle and Lower Jiao locations, add Jianghuang (Turmeric). Details are found in the "Pus in Stool" section.
This book originally focused specifically on blood disorders, so it mentions internal abscesses because abscess and pus diseases all result from blood accumulation. Understanding how blood transforms into abscess and pus allows one to understand how blood can become dried blood or transform into consumption parasites. Understanding the chills and fever generated by internal abscesses allows one to understand the stagnant heat in blood disorders. However, abscess and pus conditions belong to excess accumulation in the blood level, differing from deficiency syndromes caused by blood loss. Nevertheless, without reflecting and cross-examining through this perspective, one cannot fully grasp the true and false aspects of blood disorders.