痈之发也。上下内外。无处不有。然发于清阳之分。危者十之八九。发于浊阴之分。危者十
之一二。头为诸阳之会。背隶心肺之野。以阴乘阳则逆。腹乃肠胃之司。足为筋骨之用。以阳乘
阴则从。盖因膏粱之子。过服丹石暴烈之性。灼耗真阴。则水不足以制火。直乾清分。脑项肩背。
任其糜烂。多至于不救者有之。辛勤之人。疲乏筋骨。四气交侵。凝滞经络。则血不足以辅气。
流于肢节尻股腰膝。随其阻逆。每至于缠绵者有之。要之发于肾元者至重。以丹石烁脑髓也。发
于心脾者次之。以抑郁滞经络也。发于筋骨皮肉者又次之。以六淫侵肌肤也。此毒之有轻重。主
客之势使然。又何疑哉。余因论列诸症。而旁及疡科。偶举一二言之。缘不明乎外。不足以知内。
不别其症。不足以为治。使非熟识而详辨之。其遗害可胜道耶。
腹为阴。大小肠与之俱。乃传导化物之司。何为而成痈。良由醉饱入房。或过啖生冷。劳顿
所伤。凝而不化。
因遂发焉。其症身皮甲错。汗出恶风。小腹满。脉数疾。薏苡仁汤牡丹皮、栝蒌、桃仁破血排脓。
脓血大下即安。若溃而不敛。蜡矾丸护膜化毒。兼以补剂。鲜不愈者。
治验
一男子岁除过啖荸荠。远行疾走。内伤于肾。至新节遂发寒振振然。其家以伤寒召诊。往候
其脉。手不敢出衣被。汗泄脉数。小腹胀疼。余曰。此肠痈。非伤寒也。故头不疼而汗出。脉不
紧而腹满耳。投薏苡仁汤。果得脓盂许。寒热顿止。然未透也。翌日复欲下之。会伊芳戚延他医。
反用消食作外感治。增剧。复进以人参。遂致不起。
一女子新产过劳。积血未除。而成肠痈。少腹疼。下脓血。经月不止。有进龙胆泻肝汤。弥
甚。后以八珍入阿胶。用蜡矾丸稍缓。服参至二三斤。兼地黄丸而愈。
薏苡仁汤 治初起。
薏苡仁 栝蒌仁（各三钱） 牡丹皮 桃仁（去皮尖各二钱） 白芍药（一钱）
水煎。
蜡矾丸
白矾（一两生研） 黄蜡（七钱）
上将蜡溶化和丸。梧子大。每服十丸。渐加至二十丸。熟水送下。未破者内消。已破者便合。
每日中服近百粒则有效。不惟止痛生肌。能防毒瓦斯内攻。护膜止泻。托里化脓之功甚大。服至半斤。尤佳。
七贤散 治肠痈溃后疼痛。淋沥不已。
人参 茯苓 熟地黄 山药 山茱肉 牡丹皮（各一钱） 黄 （二钱）
大枣二枚。煨姜三片。水煎。
痈的发生，无论上下内外，无处不有。然而，发于清阳部位（头面、背部等阳气汇聚之处）的，十分之八九是危重证；发于浊阴部位（腹部、下肢等阴气汇聚之处）的，十分之一二是危重证。头部是诸阳经交会之处，背部属于心肺所主的区域，若阴邪侵犯阳位则病势逆乱；腹部是肠胃主管消化的地方，足部是筋骨发挥作用的部位，若阳邪侵犯阴位则病势顺从。
大概是因为那些生活优渥的人，过度服用丹石类药物（古代炼丹术士制作的具有暴烈性质的矿物药），其暴烈的药性灼伤耗损了真阴，导致肾水不足以制约心火，火热之邪直接干犯清阳之分，致使脑项、肩背等处任其糜烂，多有因此无法救治而死亡的。而那些辛勤劳作的人，筋骨疲乏，受风、寒、暑、湿四时邪气交相侵袭，导致气血凝滞于经络，使得血液不足以辅助运行气机，邪气流注于肢节、尻股、腰膝等处，随着其阻滞逆乱的情况发展，多有因此缠绵难愈的。
总之，发源于肾元的病情最重，因为丹石之火灼烧脑髓；发源于心脾的病情次之，因为情志抑郁导致经络阻滞；发源于筋骨皮肉的病情又次之，因为六淫邪气侵袭肌肤。这种毒邪有轻重之分，是由主客之势（正气与邪气的强弱对比及发病部位的主客关系）决定的，这有什么可怀疑的呢？我因此论述列举各种病症，并旁涉外科疡科知识，偶尔举出几个例子来说明。因为如果不明了外在的表现，就不足以了解内在的病机；如果不辨别具体的症状，就无法进行有效的治疗。如果不是熟悉并详细辨析这些病症，其遗留的危害怎能说得完呢？
腹部属阴，大小肠与之同属腹部，是传导食物和化生糟粕的器官。为什么会形成痈呢？确实是由于醉酒后行房事，或者过食生冷之物，以及劳顿损伤，导致气机凝滞而不能运化，于是便发作成痈。其症状表现为皮肤粗糙如鳞甲交错，出汗怕风，小腹胀满，脉象数且急疾。可用薏苡仁汤（Yiyiren Tang, Coix Seed Decoction），方中含牡丹皮（Mudanpi, Moutan Cortex）、栝蒌（Gualou, Trichosanthes Fruit）、桃仁（Taoren, Persicae Semen）以破血排脓。脓血大量排出后病情即安定。如果溃烂后不能收敛，可用蜡矾丸（Lafan Wan, Beeswax and Alum Pill）保护黏膜、化解毒邪，兼用补益剂，很少有不痊愈的。
治验案例：
有一个男子在除夕那天过量食用荸荠，又长途跋涉疾走，内伤肾脏，到了新年节日便发作寒战颤抖。他的家人以为是伤寒请医生诊治。我去诊察时，发现他手不敢伸出衣被之外，汗出脉数，小腹胀痛。我说：“这是肠痈（Intestinal Abscess），不是伤寒。所以头不疼而出汗，脉不紧而腹满。”投予薏苡仁汤，果然排出约一盂的脓液，寒热顿时停止。但是脓毒尚未完全透发。第二天打算继续攻下排毒，恰逢他的亲戚延请其他医生，反而用消食和解表的方法治疗，导致病情加重。后来再用参类补气药，最终导致死亡。
有一个女子新产后过度劳累，恶露积血未除，从而形成肠痈。少腹疼痛，下脓血，持续一个月不止。有人进用龙胆泻肝汤（Longdan Xiegan Tang, Gentiana Liver-Draining Decoction），病情更加严重。后来用八珍汤（Bazhen Tang, Eight-Treasure Decoction）加入阿胶（Ejiao, Donkey-Hide Glue），并用蜡矾丸稍作缓解，服用人参二三斤，兼服地黄丸（Dihuang Wan, Rehmannia Pill）而痊愈。
薏苡仁汤 治疗初起阶段。
薏苡仁（Coicis Semen, Coix Seed）三钱，栝蒌仁（Trichosanthis Semen, Trichosanthes Seed）三钱，牡丹皮二钱，桃仁去皮尖二钱，白芍药（Baishao, White Peony Root）一钱。
用水煎服。
蜡矾丸
白矾（Alumen, Alum）一两，生研；黄蜡（Cera Flava, Yellow Beeswax）七钱。
先将黄蜡溶化，与白矾末混合制成丸药，梧桐子大小。每次服用十丸，逐渐增加至二十丸，用熟水送下。未破溃的可使之内消，已破溃的可使其愈合。每天中午服用近一百粒则有效。不仅止痛生肌，还能防止毒瓦斯内攻，保护黏膜止泻，托里排脓的功效很大。服用至半斤，效果更佳。
七贤散 治疗肠痈溃后疼痛，淋漓不尽。
人参（Renshen, Ginseng Root）一钱，茯苓（Fuling, Poria）一钱，熟地黄（Shudihuang, Prepared Rehmannia Root）一钱，山药（Shanyao, Dioscoreae Rhizoma）一钱，山茱肉（Shanzhuyu, Cornus Officinalis Fruit）一钱，牡丹皮一钱，黄芪（Huangqi, Astragali Radix）二钱。
大枣二枚，煨姜三片，用水煎服。
The occurrence of carbuncle (Yong, a type of suppurative infection) is ubiquitous, occurring anywhere in the upper, lower, interior, or exterior. However, those arising in the clear yang regions (areas where yang qi converges, such as the head and back) are critical in eight or nine out of ten cases; those arising in the turbid yin regions (areas where yin qi converges, such as the abdomen and lower limbs) are critical in only one or two out of ten cases. The head is the confluence of all yang meridians, and the back belongs to the territory governed by the Heart and Lung. If yin pathogens invade yang positions, the disease progression is adverse/rebellious. The abdomen is the domain of the Intestines and Stomach responsible for digestion, and the feet are used by the sinews and bones. If yang pathogens invade yin positions, the disease progression is compliant/favorable.
Generally, this arises because individuals living in luxury overconsume cinnabar and stone minerals (Dan Shi, mineral-based alchemical preparations with violent properties). Their violent nature scorches and depletes true yin, causing kidney water to be insufficient to control fire. The fire directly invades the clear yang regions, leading to the erosion and ulceration of the brain, nape, shoulders, and back, often resulting in untreatable death. Conversely, hardworking individuals suffer from exhausted sinews and bones due to invasion by the four climatic factors (Wind, Cold, Summerheat, Dampness), causing stagnation in the meridians. This results in blood being insufficient to assist qi movement, allowing pathogens to flow into the joints, buttocks, thighs, waist, and knees. Depending on the obstruction and rebellion, these conditions often become chronic and lingering.
In summary, abscesses originating from the Kidney essence are the most severe, as the fire from minerals scorches the brain marrow. Those originating from the Heart and Spleen are next in severity, caused by emotional depression leading to meridian stagnation. Those originating from the sinews, bones, skin, and flesh are less severe, caused by the six excess pathogenic factors invading the body surface. The difference in toxicity severity is determined by the dynamic relationship between the host and the pathogen, which leaves no room for doubt. Therefore, I discuss various symptoms and briefly touch upon surgical diseases, citing a few examples. Without understanding external manifestations, one cannot comprehend internal pathology; without distinguishing specific symptoms, effective treatment is impossible. If one does not thoroughly understand and differentiate these conditions, the resulting harm would be incalculable.
The abdomen belongs to yin, including the Large and Small Intestines, which are responsible for transportation and transformation. How can an abscess form here? It is indeed due to sexual activity after heavy eating or drinking, excessive consumption of raw and cold foods, or injury from overexertion. These cause qi stagnation and failure to transform, leading to the formation of an abscess. Symptoms include skin roughness resembling scales (skin jia cuo), sweating with aversion to wind, fullness in the lower abdomen, and a rapid, urgent pulse. Yi Yi Ren Tang (Coix Seed Decoction) should be used, containing Mu Dan Pi (Moutan Cortex), Gua Lou (Trichosanthes Fruit), and Tao Ren (Persicae Semen) to break blood stasis and expel pus. When large amounts of pus and blood are discharged, the condition stabilizes. If the ulcer fails to heal, La Fan Wan (Beeswax and Alum Pill) should be used to protect the mucosa and resolve toxicity, combined with tonifying agents. Few cases fail to recover.
Clinical Case 1: A man consumed too many water chestnuts on New Year's Eve and walked rapidly over a long distance, injuring his Kidneys internally. By the New Year festival, he developed chills and trembling. His family summoned a physician suspecting Taiyang Disease (Shanghan, common cold/flu). Upon examination, he dared not extend his hands outside his blankets, had sweating, a rapid pulse, and lower abdominal distension and pain. I stated, "This is Chang Yong (Intestinal Abscess), not Shanghan. Hence, there is no headache but there is sweating, and the pulse is not tight but the abdomen is full." I administered Yi Yi Ren Tang. Indeed, about a bowl of pus was discharged, and the chills and fever stopped immediately. However, the toxin had not fully expelled. The next day, I intended to use purgatives again, but his relative had invited another physician who treated it as indigestion and external contraction, worsening the condition. Subsequent administration of Ginseng led to his death.
Clinical Case 2: A woman suffered excessive fatigue after childbirth, leaving accumulated blood unremoved, which formed an intestinal abscess. She experienced lower abdominal pain and discharge of pus and blood for over a month. A physician prescribed Long Dan Xie Gan Tang (Gentiana Liver-Draining Decoction), which aggravated the condition. Later, she was treated with Ba Zhen Tang (Eight-Treasure Decoction) added with Ejiao (Donkey-Hide Glue), along with La Fan Wan for slight relief. After consuming two to three jin of Renshen (Ginseng Root) and taking Di Huang Wan (Rehmannia Pill), she recovered.
Yi Yi Ren Tang: For early-stage treatment.
Yi Yi Ren (Coix Seed) 3 qian, Gua Lou Ren (Trichosanthes Seed) 3 qian, Mu Dan Pi 2 qian, Tao Ren (de-skinned and de-pitted) 2 qian, Bai Shao Yao (White Peony Root) 1 qian.
Decoct in water and drink.
La Fan Wan:
Bai Fan (Alum) 1 liang, ground raw; Huang La (Yellow Beeswax) 7 qian.
Melt the beeswax and mix with the alum powder to form pills the size of a Chinese quince seed. Take 10 pills per dose, gradually increasing to 20 pills, taken with warm water. For unruptured abscesses, it promotes internal resolution; for ruptured ones, it aids healing. Taking nearly 100 pills at midday daily is effective. It not only stops pain and generates flesh but also prevents toxic heat from attacking inward, protects the mucosa, stops diarrhea, and has significant effects in supporting the interior and expelling pus. Taking up to half a jin is particularly beneficial.
Qi Xian San (Seven-Sage Powder): For pain and continuous discharge after the rupture of intestinal abscess.
Renshen (Ginseng Root) 1 qian, Fu Ling (Poria) 1 qian, Shu Di Huang (Prepared Rehmannia Root) 1 qian, Shan Yao (Dioscorea Rhizome) 1 qian, Shan Zhu Rou (Cornus Fruit) 1 qian, Mu Dan Pi 1 qian, Huang Qi (Astragalus Root) 2 qian.
Add 2 Jujubes and 3 slices of roasted ginger. Decoct in water and drink.