薛立斋治一膏粱之人。寒热作渴。不时咳吐。口内血腥。又五日。吐脓血。皮毛错纵。
用射干汤四剂。脓血已止。但气壅痰多。以甘桔汤而愈。其方乃射干、栀仁、升麻、白术、
赤苓、赤芍。水煎。加地黄汁、白蜜和服。
一男子用射干汤之类。乍愈。但气喘体倦。发热作渴。小便频数。用补中益气加山药、
山茱、麦冬、五味。时仲夏。更以生脉散代茶饮而愈。
江应宿治上舍汪中宇。患喉肿。不进饮食。腹中不饥。但日饮清茶数盏。江视之。诊得
气口紧数。此胃痈也。脓已成。宜引下行。投以凉膈散。稍稍利一二度。次早吐脓血。再服
射干汤一剂。即知饥索食。六剂全愈。
石顽治谈仲安。体肥善饮。初夏患壮热呕逆。胸膈左畔隐痛。手不可拊。便溺涩数。舌
上胎滑。食后痛呕稠痰。渐见血水。脉来涩涩不调。与凉膈散加石斛、连翘。下稠腻颇多。
先是疡医作肺痈治。不效。张曰。肺痈必咳嗽。吐腥秽痰。此但呕不嗽。洵为胃病无疑。下
后四五日。复呕如前。再以小剂调之。三下而势甫平。后以保元、苓、橘。平调二十日而痊
先时有李姓者患此。专以清热豁痰解毒为务。直至膈畔溃腐。脓水淋漓。缠绵匝月而毙。
良因见机不早。直至败坏。悔无及矣。
丹溪治一女子腹痛。百方不治。脉滑数。时作热。腹微急。曰。痛病脉当沉细。今滑数
此肠痈也。以云母膏一两。丸梧子大。以牛皮胶溶入酒中。并水下之。饷时服尽。下脓血
一盆而愈。
一妇以毒药去胎后。当脐右结块。块痛甚则寒热。块与脐高一寸。痛不可按。脉洪数。
谓曰。此瘀血流溢于肠外肓膜之间。聚结为痈也。遂用补气血行结滞排脓之剂。三日决一锋
针。脓血大出。内如粪状者臭甚。病妇恐。因谓气血生肌。则内外之窍自合。不旬日而愈。
虞恒德治一人。得潮热。微似疟状。小腹右边有一块。大如鸡卵。作痛。右脚不能伸缩
一医作奔豚气治。十余日不验。虞诊其脉。左寸芤而带涩。右寸芤而洪实。两尺两关俱洪
数。曰。此大小肠之间欲作痈耳。幸脓未成。犹可治。与五香连翘汤加减与之。间以蜈蚣炙
黄。酒调服之。三日愈。
儒医李生治一富家妇有疾。诊之曰。肠胃间有所苦耶。妇曰。肠中痛不可忍。而大便从
小便出。医皆谓古无此证。不可治。李曰。试为筹之。若服我之药。三日当瘳。下小丸子数
十粒。煎黄 汤下之。下脓血数升而愈。其家喜。问治法。李曰。始切脉时。觉芤脉见于肠
部。脉诀云。寸芤积血在胸中。关内逢芤肠里痈。此痈在内。所以致然。所服者。乃云母膏
为丸耳。切脉至此。可以言医矣。
立斋治一男子。里急后重。下脓胀痛。用排脓散、蜡矾丸而愈。后因劳。寒热体倦。用
补中益气而安。
一妇人小腹胀痛。小便如淋。此毒结于内。先以神效栝蒌散。二剂少愈。更以薏苡仁汤
而安。
一妇人小腹胀痛而有块。脉芤而涩。此瘀血为患。以四物加元胡索、红花、桃仁、牛膝
木香。二剂血下而愈。
一妇人小腹胀痛。大便秘涩。转侧有水声。脉洪数。以梅仁汤一剂。下瘀血。诸证悉退
再以薏苡仁汤而愈。
一妇人脓成胀痛。小便不利。脉洪数。服太乙膏三钱。下脓甚多。胀痛顿止。以栝蒌散
蜡矾丸及托里而安。
一妇人产后。恶露不尽。小腹作痛。服瓜子仁汤。下瘀血而瘥。凡瘀血停滞。宜急治之
缓则腐化为脓。最为难治。若流注关节。则为败证。
江汝洁治一男子病小肠痈。初起左小腹近胁下。一块如掌大。甚疼。江以峰蜜调大黄末
敷于痛处。再以生姜一大块。切片置于大黄之上。以火熨之四五度。逾半月而块自消。
一人胁破。肠出臭秽。急以香油抹肠送入。即不出。又以人参枸杞子煎汤淋之。皮自合
吃猪肾粥十日愈。
江应宿治汪上舍之内。当脐结痛。发热恶寒。脉洪数。此肠痈也。投以仙方活命饮、五
香连翘汤、栝蒌散。俱不应。过七日。小便间有脓血。乃制云母膏为丸。十数服而愈。可见
药之对病。其验如此。
震按云母膏其药三十九味。清油浸七日。文火熬膏。收贮。将水银弹上。用时。先刮去
水银。或服或贴。其功甚大。但熬一料。必用人参五钱。今亦难办也。其方即于疡科准绳可
查。
薛立斋治疗一位饮食肥甘厚味的人。出现寒热交替、口渴，不时咳嗽并吐出带有血腥味的痰液。又过了五天，吐出脓血，皮肤纹理粗糙交错。
使用射干汤服用四剂后，脓血停止。但仍有气机壅滞、痰多症状，改用甘桔汤而痊愈。该方由射干、栀子仁、升麻、白术、赤茯苓、赤芍组成，水煎，加入地黄汁和白蜜调和服用。
一名男子使用射干汤之类的方药，病情暂时好转，但出现气喘、身体疲倦、发热口渴、小便频数。使用补中益气汤加山药、山茱萸、麦冬、五味子治疗。当时正值仲夏，另外用生脉散代替茶饮而痊愈。
江应宿治疗上舍汪中宇。患有咽喉肿痛，无法进食，腹部没有饥饿感，只是每天喝几盏清茶。江应宿诊察，发现气口脉紧数，判断这是胃痈（胃部化脓性炎症）。脓液已经形成，应当引导其向下排出。投以凉膈散，稍微通利大便一两次。第二天早上吐出脓血，再服用一剂射干汤，便知道饥饿想要进食，服用六剂后完全痊愈。
石顽治疗谈仲安。身体肥胖且喜欢饮酒，初夏患高热呕吐逆气，胸膈左侧隐痛，手不能触碰，大小便涩滞频数，舌苔滑腻，饭后疼痛呕吐稠痰，逐渐见血水，脉象涩滞不调。给予凉膈散加石斛、连翘，排出大量稠腻粪便。
起初疡医按肺痈治疗，无效。张石顽说：“肺痈必定有咳嗽，吐出腥臭的痰，此患者只呕吐不咳嗽，确实是胃病无疑。”通便后四五日，再次呕吐如前，再用小剂量药物调理。经过三次通便，病势才平息。后来用保元汤、苓橘汤平和调理二十天而痊愈。
先前有个姓李的患者患此病，专门以清热豁痰解毒为务，直到膈膜边缘溃烂腐败，脓水淋漓，缠绵一个月而死。实在是因为见机不早，直到病情败坏，后悔也来不及了。
丹溪治疗一名女子腹痛，多种方法治疗无效，脉象滑数，时常发热，腹部微急。丹溪说：“痛病的脉象应当沉细，现在滑数，这是肠痈（肠道化脓性炎症）。”使用云母膏一两，制成梧桐子大小的丸药，将牛皮胶溶入酒中，送服。一顿饭的时间服完，排出一盆脓血而痊愈。
一名妇女在服用毒药堕胎后，肚脐右侧结块，块状物疼痛剧烈时伴有寒热，肿块与肚脐平齐高一寸，疼痛不可按压，脉象洪数。丹溪说：“这是瘀血流溢到肠外肓膜之间，聚结形成痈肿。”于是使用补气血、行结滞、排脓的药剂。三天后用锋针刺破，脓血大量流出，内部物质像粪便一样气味极臭。患病妇女害怕，丹溪说：“气血生成肌肉，则内外的孔窍自然会闭合。”不到十天就痊愈了。
虞恒德治疗一人。出现潮热，轻微类似疟疾的症状，小腹右边有一块肿块，大如鸡蛋，疼痛，右脚不能伸缩。一名医生按奔豚气治疗，十多天不见效。虞恒德诊脉，左寸脉芤带涩，右寸脉芤而洪实，两尺两关脉俱洪数。说：“这是大小肠之间将要发生痈肿。幸好脓未形成，还可以治疗。”给予五香连翘汤加减服用，间或服用炙蜈蚣粉，用酒调服。三天痊愈。
儒医李生治疗一富家妇人有病。诊察后说：“肠胃间有什么痛苦吗？”妇人回答说：“肠中疼痛难忍，而且大便从小便中排出。”医生们都认为古无此证，不可治。李生说：“让我试着为您筹划。如果服用我的药，三天应当好转。”给予小丸子数十粒，煎黄柏汤送下。排出脓血数升而痊愈。家属高兴，询问治疗方法。李生说：“开始切脉时，感觉芤脉出现在肠部。《脉诀》说：‘寸口芤脉积血在胸中，关内逢芤肠里痈。’这是痈肿在内，所以导致这种情况。所服的药，乃是云母膏制成的丸药罢了。能这样切脉，才可以谈论医术了。”
薛立斋治疗一名男子。里急后重，下脓胀痛，使用排脓散、蜡矾丸而痊愈。后来因劳累，出现寒热、身体疲倦，使用补中益气汤而安定。
一名妇女小腹胀痛，小便像淋证一样，这是毒邪结于体内。先用神效栝蒌散，两剂后稍有好转，再用薏苡仁汤而安定。
一名妇女小腹胀痛且有肿块，脉象芤而涩，这是瘀血为患。使用四物汤加延胡索、红花、桃仁、牛膝、木香，两剂后血下行而痊愈。
一名妇女小腹胀痛，大便秘涩，转身时有水声，脉象洪数。使用梅仁汤一剂，排出瘀血，所有症状全部消退，再用薏苡仁汤而痊愈。
一名妇女脓成胀痛，小便不利，脉象洪数。服用太乙膏三钱，排出大量脓液，胀痛立刻停止，用栝蒌散、蜡矾丸及托里透脓法而安定。
一名妇女产后，恶露不尽，小腹作痛，服用瓜子仁汤，排出瘀血而病愈。凡是瘀血停滞，应当紧急治疗，迟缓则会腐化为脓，最为难治。如果流注关节，则为败证。
江汝洁治疗一名男子患小肠痈。初起时左小腹近胁下，有一块如手掌大的肿块，非常疼痛。江汝洁用蜂密调大黄末敷在疼痛处，再用生姜一大块切片置于大黄之上，用火熨烫四五次。过了半个月肿块自然消散。
一人胁部破裂，肠子流出且气味臭秽。急忙用香油涂抹肠子送入腹腔，即不再脱出。又用人参枸杞子煎汤淋洗伤口，皮肤自然愈合，吃猪肾粥十天痊愈。
江应宿治疗汪上舍的妻子。肚脐周围结聚疼痛，发热恶寒，脉象洪数。这是肠痈。投以仙方活命饮、五香连翘汤、栝蒌散，都不见效。过了七天，小便间断有脓血，于是制作云母膏为丸，服用十几次而痊愈。可见药物对病，疗效如此显著。
俞震按语：云母膏的药物有三十九味。用清油浸泡七天，文火熬膏，收藏备用。使用时，先将表面的水银刮去。或者内服或者外贴，功效很大。但是熬制一料药，必须用人参五钱，现在也很难办到。该方可以在《疡科准绳》中查到。
Xue Lizhai treated a person who consumed rich and fatty foods. The patient presented with alternating chills and fever, thirst, occasional coughing with sputum containing a bloody taste, and five days later, expectoration of pus and blood. The skin texture became rough and interlaced.
Shiyegao Tang (Kadsura Decoction) was administered for four doses, after which the discharge of pus and blood ceased. However, qi stagnation and excessive phlegm remained. Ganjie Tang (Licorice and Platycodon Decoction) was then used to effect a cure. The formula consists of Shenggan (Belamcandae Rhizoma), Zhiren (Gardeniae Semen), Shengma (Cimicifugae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chifuling (Poria with Red Mycelium), and Chishao (Paeoniae Radix Rubra). It is decocted in water, mixed with Dihuang Zhi (Juice of Rehmanniae Radix Preparata) and Baimi (White Honey), and taken orally.
A male patient used Shiyegao Tang or similar formulas. His condition temporarily improved, but he developed panting, physical fatigue, fever, thirst, and frequent urination. Butuzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) plus Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), Maidong (Ophiopogonis Tuber), and Wuweizi (Schisandrae Fructus) were prescribed. At that time, it was mid-summer, and Shengmai San (Generating the Pulse Powder) was also used as a tea substitute to achieve recovery.
Jiang Yingsu treated Wang Zhongyu, an Shangshe (a title for scholars serving in the Hanlin Academy). He suffered from throat swelling, inability to eat, lack of hunger in the abdomen, and only drank several cups of clear tea daily. Jiang examined him and found the Qi Kou (radial artery at the wrist) pulse tight and rapid. He diagnosed this as Weiyong (Stomach Abscess). Since the pus had already formed, he decided to guide it downward. Liangge San (Cooling the Diaphragm Powder) was administered, resulting in slight bowel movements one or two times. The next morning, pus and blood were vomited. After taking one more dose of Shiyegao Tang, the patient felt hungry and desired food. After six doses, he was completely cured.
Shi Wan treated Tan Zhongan. The patient was obese and fond of drinking alcohol. In early summer, he suffered from high fever, vomiting, and regurgitation, with dull pain on the left side of the chest and diaphragm, tenderness to touch, scanty and painful urination, slippery tongue coating, and vomiting of thick phlegm followed by bloody fluid after eating. The pulse was choppy and irregular. Liangge San plus Shihu (Dendrobii Caulis) and Lianqiao (Forsythiae Fructus) were given, resulting in the passage of much thick and greasy stool.
Initially, a surgeon treated him as Feiyong (Lung Abscess) without success. Zhang Shiwan said, "Feiyong must involve coughing and expectoration of foul-smelling sputum. This patient only vomits and does not cough; it is undoubtedly a stomach disease." After purgation, four or five days later, vomiting recurred. A small dose of medication was used to regulate the condition. After three courses of purgation, the condition stabilized. Later, Baoyuan Tang (Preserve the Origin Decoction) and Lingju Tang (Poria and Tangerine Peel Decoction) were used for gentle regulation over twenty days until recovery.
Previously, a man surnamed Li suffered from this condition, focusing solely on clearing heat, resolving phlegm, and detoxifying. Until the diaphragmatic area ulcerated and necrotized, with dripping pus, he lingered for a month before dying. This was truly due to failing to recognize the opportunity early, leading to a deteriorated state where regret came too late.
Danxi treated a female patient with abdominal pain, unresponsive to various treatments. The pulse was slippery and rapid, with intermittent fever and mild abdominal tension. Danxi said, "Painful conditions typically present with deep and fine pulses. The current slippery and rapid pulse indicates Changyong (Intestinal Abscess)." Yunmu Gao (Cloud Mother Ointment), one liang, was made into pills the size of wutong seeds. Niujiao (Bovis Corneum) was dissolved in wine, and the pills were taken with this mixture. Within the time it takes to eat a meal, the entire dose was consumed, and the patient recovered after passing a basin of pus and blood.
A woman developed a mass on the right side of her umbilicus after using toxic drugs to abort a fetus. When the mass hurt severely, she experienced chills and fever. The mass was one cun higher than the umbilicus, and the pain was intolerable to pressure. The pulse was surging and rapid. Danxi said, "This is stasis flowing out into the huangmo (membrane between the intestines and peritoneum), gathering to form an abscess." Therefore, a formula to tonify qi and blood, resolve stagnation, and drain pus was used. Three days later, a sharp needle was used to lance it, releasing a large amount of pus and blood. The internal material resembled feces and smelled extremely foul. The patient was frightened. Danxi said, "As qi and blood generate flesh, the internal and external orifices will naturally close." She recovered within ten days.
Yu Hengde treated a man who developed tidal fever, slightly resembling malaria, with a mass on the right lower abdomen the size of a chicken egg, causing pain and immobility of the right foot. A physician treated him as Bentunqi (Rushing Pig Gas) for over ten days without effect. Yu palpated the pulse: the left Cun position was hollow and choppy, the right Cun position was hollow and surging-solid, and both Chi and Guan positions were surging and rapid. Yu said, "This is an impending abscess between the large and small intestines. Fortunately, the pus has not yet formed, so it is still treatable." Wuxiang Lianqiao Tang (Five Fragrances and Forsythia Decoction) was modified and administered. Intermittently, roasted centipede powder was taken with wine. Recovery occurred in three days.
The Confucian physician Li Sheng treated a wealthy woman. Upon examination, he asked, "Is there discomfort in the intestines and stomach?" The woman replied, "The pain in my intestines is unbearable, and stool passes through the urine." Physicians claimed this condition did not exist in ancient texts and was untreatable. Li Sheng said, "Let me try. If you take my medicine, you should improve in three days." Dozens of small pills were given, taken with Huangbo Tang (Phellodendron Decoction). Several sheng of pus and blood were discharged, and she recovered. Her family was pleased and asked for the treatment method. Li Sheng said, "When I first palpated the pulse, I felt a hollow pulse in the intestinal region. The Maijue (Pulse Classic) states: 'Hollow pulse at Cun indicates blood accumulation in the chest; hollow pulse at Guan indicates intestinal abscess.' This abscess is internal, hence these symptoms. The medicine taken was Yunmu Gao made into pills. Only when one can palpate the pulse like this can one speak of medicine."
Xue Lizhai treated a man with tenesmus, discharge of pus, abdominal distension, and pain. Painong San (Draining Pus Powder) and Lafan Wan (Beeswax and Alum Pill) were used to effect a cure. Later, due to overwork, he experienced chills, fever, and fatigue, which were resolved with Butuzhong Yiqi Tang.
A woman suffered from lower abdominal distending pain and urinary symptoms resembling strangury. This was toxin knotting internally. Shenxiao Gualou San (Miraculous Trichosanthes Powder) was given for two doses, bringing slight improvement, followed by Yiyiren Tang (Coix Seed Decoction) to stabilize the condition.
A woman had lower abdominal distending pain and a mass. The pulse was hollow and choppy, indicating blood stasis. Siwu Tang (Four Substances Decoction) plus Yuanhusuo (Cyperi Rhizoma), Honghua (Carthami Flos), Taoren (Persicae Semen), Niuxi (Achyranthis Bidentatae Radix), and Muxiang (Aucklandiae Radix) were administered. Blood was discharged after two doses, and she recovered.
A woman had lower abdominal distending pain, constipation, and a sound of water shifting when turning. The pulse was surging and rapid. Meiren Tang (Apricot Kernel Decoction) was given for one dose to expel blood stasis. All symptoms subsided, and Yiyiren Tang was used to complete the recovery.
A woman had abdominal distension and pain due to formed pus, with difficult urination. The pulse was surging and rapid. Taiyi Gao (Great One Ointment), three qian, was taken, discharging a large amount of pus. Distension and pain stopped immediately. Gualou San (Trichosanthes Powder), Lafan Wan, and Tuoli methods (supporting the interior) were used to stabilize the condition.
A postpartum woman had lochia不尽 (prolonged lochia) and lower abdominal pain. Gua Zi Ren Tang (Melon Seed Decoction) was taken, discharging blood stasis and curing the illness. Whenever blood stasis stagnates, urgent treatment is required. Delay allows it to rot and turn into pus, which is very difficult to treat. If it flows into the joints, it becomes a hopeless condition.
Jiang Rujie treated a man with Xiao Changyong (Small Intestine Abscess). Initially, a palm-sized mass appeared near the left lower abdomen and hypochondrium, causing severe pain. Jiang applied Dahuang (Rhei Radix et Rhizoma) powder mixed with fengmi (honey) to the painful area. Then, a large piece of fresh ginger was sliced and placed on top of the Dahuang. The area was heated with fire ironization four or five times. After half a month, the mass disappeared spontaneously.
A man suffered a rib injury with evisceration of foul-smelling intestines. Immediately, xiangyou (sesame oil) was applied to the intestines, and they were pushed back in, stopping further prolapse. Ginseng and Gouqizi (Lycii Fructus) decoction was poured over the wound. The skin healed naturally, and eating pig kidney porridge for ten days led to recovery.
Jiang Yingsu treated the wife of Shangshe Wang. She had pain and knotting around the umbilicus, fever, chills, and a surging, rapid pulse. This was Changyong. Xianfang Huoming Yin (Immortal Life Preserving Decoction), Wuxiang Lianqiao Tang, and Gualou San were administered but ineffective. Seven days later, pus and blood appeared intermittently in the urine. Yunmu Gao pills were prepared. After taking more than ten doses, she recovered. This shows how effective medicine is when correctly matched to the disease.
Zhen An (Commentary by Yu Zhen): Yunmu Gao contains thirty-nine ingredients. It is soaked in refined oil for seven days, simmered over low heat to make a paste, and stored. When used, the surface mercury is scraped off first. It can be taken orally or applied externally. Its efficacy is great. However, preparing one batch requires five qian of Renshen (Ginseng Radix et Rhizoma), which is difficult to obtain nowadays. The formula can be found in Yangke Zhunsheng (Standard Guidelines for Surgeons).