《圣济总录》云∶胃脘痈，由寒气隔阳，热聚胃口，寒热不调，故血肉腐坏。以气逆于
胃，故胃脉沉细；以阳气不得上升，故人迎热甚，令人寒热如疟，身皮甲错或咳嗽，或呕脓唾血
。若脉洪数，脓成也，急排之。脉迟紧，瘀血也，急下之。否则其毒内攻，腐烂肠胃矣。丹
溪先生云∶内疽者，因饮食之毒，七情之火，相郁而发，用射干汤主之。愚常以薏苡仁汤、
牡丹皮散、太乙膏选用之亦效。若吐脓血，饮食少思，助胃壮气为主，而佐以前法，不可专
治其疮。
治验
一男子寒热作渴，不时咳吐，口内血腥，又五日，吐脓，身皮甲错。用射干汤四剂，脓
血已止，但气壅痰多，以甘桔汤而愈。
一男子用射干汤之类将愈，但气喘体倦，发热作渴，小便频数。此肺气不足，用补中益
气、山药、山茱、麦门、五味。时仲夏，更以生脉散代茶饮而愈。
一妇人素食浓味，吐脓已愈，但小便淋沥，此肺肾气虚。用补中益气，加麦门、五味，
及加减八味丸，而愈。若膏粱之人，初起宜用清胃散。
孙真人云∶肠痈为病，小腹重，强按之则痛，小便如淋，时时汗出，复恶寒，身皮甲错
，腹皮急如肿，甚者腹胀大，转侧有水声，或绕脐生疮，或脓从脐出，或从大便下，盖因七
情饮食所致。治法∶脉迟紧者，未有脓也，用大黄汤下之。脉洪数者，已有脓也，用薏苡仁
汤排之。小腹疼痛，小便不利，脓壅滞也，牡丹皮散主之。若大便或脐间出脓者，不治。《
内经》云∶肠痈为病，不可惊，惊则肠断而死。故患是者，其坐卧转侧，理宜徐缓，时少饮
薄粥，乃服八珍汤，固其元气，静养调理，庶可保全其生。
治验
通府张廷用患之，两月余矣。时出白脓，体倦恶寒，此邪气去而中气虚。余用托里散兼
益气汤，而徐徐呷之。又令以猪肚肺煮烂，取其汤调米粉煮，时呷半盏，后渐调理而痊。
一男子里急后重，下脓胀痛，此脾气下陷，用排脓散、蜡矾丸而愈。后因劳，复寒热体
倦，用补中益气汤而安。
一妇人小腹胀痛，小便如淋，时时汗出，此瘀血凝结于内。先以神效栝蒌散，二剂少愈
，更以薏苡仁汤而愈。
一妇人小腹胀痛而有块，脉芤而涩，此瘀血为患也。以四物加玄胡索、红花、桃仁、牛
膝、木香，二剂血下而痊。
一妇人小腹胀痛，大便秘涩，转侧有水声，脉洪数，此脓瘀内溃也，以梅仁汤一剂，下
瘀血，诸症悉退；再以薏苡仁汤，二剂而瘥。
一妇人脓成胀痛，小便不利，脉洪数，此脓毒内溃也，服太乙膏三钱，脓下甚多；更以
栝蒌散、蜡矾丸及托里散而安，如用云母膏尤妙。
一妇人产后，恶血不止，小腹作痛，服栝子仁汤，下瘀血而痊。凡瘀血停滞，宜急治之
，缓则腐化为脓，最为难。若流注关节，则为败症。
《圣济总录》记载：胃脘痈，是由于寒气阻隔阳气，导致热邪聚集在胃口，寒热不调和，致使血肉腐败坏死。因为气逆于胃，所以胃脉呈现沉细之象；因为阳气不能上升，所以人迎穴处脉搏跳动热盛，使人出现像疟疾一样的寒热症状，皮肤干枯如鳞甲或咳嗽，或者呕吐脓血。如果脉象洪大且数，说明脓已形成，应立即排脓。如果脉象迟而紧，说明是瘀血，应立即攻下瘀血。否则毒邪内攻，会腐蚀肠胃。朱丹溪先生说：内疽，是因为饮食的毒邪与七情之火，相互郁结而发作，用射干汤主治。我常用薏苡仁汤、牡丹皮散、太乙膏选用治疗，也有效。如果出现呕吐脓血、饮食减少思虑的情况，应以扶助胃气、强壮正气为主，并配合上述方法，不可专门治疗疮疡。
治验记录：
一个男子寒热交替发作并口渴，不时咳嗽吐痰，口中有血腥味，又过了五天，吐出脓液，皮肤干枯如鳞甲。使用射干汤四剂后，脓血停止，但气机壅滞、痰多，用甘桔汤治愈。
一个男子服用射干汤等药即将痊愈时，出现气喘、身体疲倦、发热口渴、小便频数的症状。这是肺气不足，用补中益气汤，加山药、山茱萸、麦门冬、五味子。当时正值仲夏，再用生脉散代替茶饮而治愈。
一个妇人平时喜欢吃浓厚滋味的食物，吐脓的症状已经痊愈，但小便淋漓不尽，这是肺肾气虚。用补中益气汤，加麦门冬、五味子，以及加减八味丸，而治愈。如果是吃精细美味食物的人，初起宜用清胃散。
孙思邈说：肠痈这种病，小腹沉重，用力按压则疼痛，小便像淋病一样（涩痛），经常出汗，又恶寒，皮肤干枯如鳞甲，腹皮紧张像肿胀，严重的腹部胀大，转动身体时有水声，或者肚脐周围生疮，或者脓从脐部流出，或者从大便排出，大概是因为七情和饮食所致。治疗方法：脉象迟紧的，说明还没有成脓，用大黄汤攻下。脉象洪数的，说明已有脓，用薏苡仁汤排脓。小腹疼痛，小便不利，是脓液壅滞，用牡丹皮散主治。如果大便或脐间出脓的，属于难治之症。《内经》说：肠痈这种病，不可受惊，受惊会导致肠断而死。所以患此病的人，坐卧转身应当缓慢，时常少量饮用稀薄的粥，然后服用八珍汤，巩固元气，安静调养，才可以保全生命。
治验记录：
通政使张廷用患此病，两个多月了。时常排出白色脓液，身体疲倦恶寒，这是邪气已去而中气虚弱。我用托里散兼益气汤，慢慢喂服。又让他用猪肚肺煮烂，取汤汁调米粉煮，慢慢喝半盏，后来逐渐调理而痊愈。
一个男子有里急后重感，下脓胀痛，这是脾气下陷，用排脓散、蜡矾丸而治愈。后来因劳累，再次出现寒热、身体疲倦，用补中益气汤而安定。
一个妇人小腹胀痛，小便像淋病一样，经常出汗，这是瘀血凝结在体内。先用神效栝蒌散，两剂后稍有好转，再用薏苡仁汤而治愈。
一个妇人小腹胀痛且有肿块，脉象芤而涩，这是瘀血为患。用四物汤加玄胡索、红花、桃仁、牛膝、木香，两剂后瘀血排出而痊愈。
一个妇人小腹胀痛，大便秘结涩滞，转动身体时有水声，脉象洪数，这是脓瘀在内溃破，用梅仁汤一剂，排出瘀血，所有症状全部消退；再用薏苡仁汤，两剂而病愈。
一个妇人脓已成且胀痛，小便不利，脉象洪数，这是脓毒在内溃破，服用太乙膏三钱，脓液排出很多；再用栝蒌散、蜡矾丸及托里散而安定，如果用云母膏尤其奇妙。
一个妇人产后，恶露不止，小腹作痛，服用栝子仁汤，排出瘀血而痊愈。凡是瘀血停滞，应当紧急治疗，拖延则会腐败化为脓，最为难治。如果流注到关节，就变成败症。
According to the *Shengji Zonglu* (General Records of Holy Relief): Gastric abscess arises from cold qi obstructing yang qi, causing heat to gather at the stomach opening. The disharmony between cold and heat leads to the putrefaction and necrosis of flesh and blood. Because qi rebels in the stomach, the stomach pulse is deep and fine; because yang qi cannot ascend, the Renying (ST 9) pulse is excessively hot, causing chills and fever resembling malaria, rough skin like scales, or cough, vomiting of pus and blood. If the pulse is surging and rapid, pus has formed; immediate drainage is required. If the pulse is slow and tight, it indicates blood stasis; immediate purgation is required. Otherwise, the pathogenic toxin will attack internally, corroding the intestines and stomach. Master Zhu Danxi stated: Internal carbuncles arise from the toxicity of diet and the fire of the seven emotions, emerging through mutual stagnation. They are primarily treated with Shegan Tang (Belamcanda Decoction). I often use Yiyiren Tang (Coix Seed Decoction), Mudanpi San (Moutan Powder), or Taiyi Gao (Taiyi Plaster) with good effect. If there is vomiting of pus and blood and loss of appetite, the treatment should focus on supporting the stomach and strengthening qi, assisted by the aforementioned methods, rather than treating the sore exclusively.
Case Record 1: A man suffered from alternating chills and fever with thirst, frequent coughing and expectoration, and a bloody taste in his mouth. Five days later, he vomited pus and had rough skin like scales. After four doses of Shegan Tang, the pus and bleeding stopped, but qi stagnation and excessive phlegm remained. He was cured using Ganjie Tang (Licorice and Platycodon Decoction).
Case Record 2: A man was nearly cured after taking Shegan Tang but presented with panting, fatigue, fever, thirst, and frequent urination. This indicated deficiency of lung qi. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Dioscoreae Rhizoma (Shanyao), Corni Fructus (Shanzhuyu), Ophiopogonis Radix (Maimendong), and Schisandrae Fructus (Wuweizi). Since it was midsummer, Shengmai San (Generate the Pulse Powder) was also used as a tea substitute, leading to recovery.
Case Record 3: A woman who habitually consumed rich and heavy foods had her vomiting of pus cured but continued to experience dribbling urination, indicating deficiency of lung and kidney qi. She was treated with Buzhong Yiqi Tang plus Ophiopogonis Radix and Schisandrae Fructus, along with Jiajian Bawei Wan (Modified Eight-Ingredient Pill), resulting in recovery. For individuals consuming refined and fatty foods, Qingwei San (Clear Stomach Powder) should be used at the onset.
Sun Simiao stated: Intestinal abscess presents with heaviness in the lower abdomen, pain upon firm pressure, dysuria resembling strangury, frequent sweating, aversion to cold, rough skin like scales, tense abdominal skin resembling swelling, severe cases showing abdominal distension, fluid sounds when turning, ulcers around the umbilicus, pus discharging from the umbilicus, or pus passing through the stool. This is generally caused by emotional disturbances and dietary factors. Treatment methods: If the pulse is slow and tight, pus has not yet formed; treat with Dahuang Tang (Rhubarb Decoction) to purge. If the pulse is surging and rapid, pus has formed; treat with Yiyiren Tang to drain pus. Lower abdominal pain with dysuria indicates stagnant pus; treat with Mudanpi San. If pus discharges from the stool or umbilicus, the condition is difficult to treat. The *Neijing* states: In intestinal abscess, one must avoid fright, as fright can cause intestinal rupture and death. Therefore, patients should sit, lie down, and turn slowly, consume thin gruel frequently in small amounts, and then take Shenzhen Tang (Eight-Treasure Decoction) to consolidate yuan qi, resting quietly to preserve life.
Case Record 4: Zhang Tingyong, a Commissioner, suffered from this for over two months, occasionally expelling white pus, with fatigue and aversion to cold, indicating that the pathogen had departed but middle qi was deficient. I administered Tuoli San (Support the Interior Powder) combined with Yiqi Tang, given slowly. I also instructed him to boil pig stomach and lungs until soft, using the broth to cook rice flour, sipping half a cup at a time. Gradual调理 led to full recovery.
Case Record 5: A man experienced tenesmus, purulent discharge, and distending pain, indicating sinking of spleen qi. He was cured using Painong San (Drain Pus Powder) and Lavan Wan (Beeswax and Alum Pill). Later, due to overwork, he relapsed with chills, fever, and fatigue, which were resolved with Buzhong Yiqi Tang.
Case Record 6: A woman had lower abdominal distending pain, dysuria resembling strangury, and frequent sweating, indicating internal coagulation of blood stasis. Initially, Shenxiao Gualou San (Miraculous Trichosanthes Powder) was given for two doses, yielding slight improvement, followed by Yiyiren Tang for complete recovery.
Case Record 7: A woman had lower abdominal distending pain with a palpable mass, and a choppy and wiry pulse, indicating pathology due to blood stasis. She was treated with Siwu Tang (Four Substances Decoction) added with Corydalis Rhizoma (Yanhusuo), Carthami Flos (Honghua), Peach Kernel (Taoren), Achyranthis Bidentatae Radix (Niuxi), and Aucklandiae Radix (Muxiang). After two doses, blood stasis was expelled, and she recovered.
Case Record 8: A woman had lower abdominal distending pain, constipation with dry stools, fluid sounds when turning, and a surging and rapid pulse, indicating internal ulceration of pus and stasis. One dose of Meiren Tang (Apricot Kernel Decoction) expelled blood stasis, resolving all symptoms; subsequently, Yiyiren Tang was given for two doses, leading to recovery.
Case Record 9: A woman had formed pus with distending pain and dysuria, and a surging and rapid pulse, indicating internal ulceration of pus toxin. She took three qian of Taiyi Gao, resulting in significant pus discharge; she was then stabilized with Gualou San, Lavan Wan, and Tuoli San. Using Yunmu Gao (Mica Plaster) is particularly excellent.
Case Record 10: A postpartum woman suffered from continuous lochia and lower abdominal pain. She took Guoziren Tang (Trichosanthes Seed Decoction), expelled blood stasis, and recovered. Any stagnation of blood stasis should be treated urgently; if delayed, it will rot and transform into pus, becoming very difficult to treat. If it flows into the joints, it becomes a critical condition.