（男妇同用）
腹痈谓疮生于肚腹，或生于皮里膜外。属膏粱浓味，七情郁火。若漫肿坚硬，肉色不变
，或
也，托里消毒散。脓成而不外溃者，气血虚也，卧针而刺之。肿 作痛者，邪气实也，先用
仙方活命饮，隔蒜灸以杀其毒；后用托里散以补其气。若初起欲其内消，当助胃壮气，使根
本坚固，而以行经活血之药佐之。若以克伐之剂，欲其内消，则肿者不能溃，溃者不能敛。
若用疏利之药，下其脓，则少壮者，多为难治，老弱者立见危亡。亦有食积疝气类此者，见
治验
司马李梧山患此，腹痛而势已成，用活命饮，一剂痛顿止。用托里消毒散，肿顿起，此
脓将成也。用托里散补之，自溃而愈。
锦衣掌堂刘廷器，正德辛未仲夏，腹患痈，溃而脓清，热渴腹胀，作呕不食。或以为热
毒内
呕止食进；再用托里等剂而疮愈。
进士边云庄，腹痛恶寒，脉浮数。余曰∶浮数之脉，而反恶寒，疮疽之症也。不信，数
日后
脓溃臀矣，气血俱虚，何以收敛。急用活命饮一钟，臀溃一孔，出脓斗许，气息奄奄。用大
补
烦躁，脉大，举按皆实。省而诊之，脉洪大，按之如无，以十全大补，倍用参、 至四斤，
更加附子二枚，煎膏服而痉止；又用十全大补汤，五十余剂而疮敛。
上舍周一元，腹患痈，三月不愈。脓水清稀，朝寒暮热，服四物、黄柏、知母之类，食
少作
，气血虚也。食少作泻，脾肾虚也。痰涌胸痞，脾肺虚也。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。遂用六君加黄 、当归，数剂诸症渐退；又用十全
大补汤，肌肉渐敛，更用补中益气汤，调理而痊。
上舍毛体仁，素阴虚。春初咳嗽，胸中隐痛，肾脉数而无力，肺脉数而时见，此肾脉亏
损，阴火炽盛。用六味地黄丸料一剂，服之，病势虽减，内痈已成。盖因元气虚，而未能发出，
火令可畏。不信，服痰火之剂，两月后，乳间微肿，脉洪数而无力。余曰∶脓内溃矣，当刺
出其脓，以免内攻之祸。不信，又月余，请视。但针得一孔，脓HT 不利，仍复内攻，唇舌青
赤。余曰∶脏腑已坏，吾何能治之！后果殁。
从侄孙年十四而HT 姻，乙巳春，年二十四，腹中气痛，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。余他往适归，诊之左关洪数，
右尺尤甚，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
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、山茱、山药、骨脂、吴茱等剂，疮痛渐敛，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。余曰∶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，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。
（男女通用）
腹痈是指疮疡生于肚腹部位，或者生于皮肤与筋膜之间的组织。其病因多归属于饮食肥甘厚味，以及七情郁结化火。如果患处漫肿坚硬，皮色不变，属于正气不足，宜用托里消毒散。脓液形成但不能向外溃破的，是气血虚弱所致，应用卧针浅刺法排脓。肿胀且作痛的，是邪气实盛的表现，先用仙方活命饮，配合隔蒜灸以杀灭毒邪；后用托里散来补益正气。如果在初起阶段希望病灶内消，应当助益胃气、壮旺元气，使根本坚固，并辅以行经活血的药物。如果使用攻伐克削的药物企图使其内消，则肿胀者不能溃破，溃破者不能愈合。如果使用疏利通下的药物排出脓液，那么对于年轻力壮者，大多难以治愈，对于年老体弱者则会立即出现危亡。也有因食积或疝气引起的症状与此相似的，详见治验篇。
司马李梧山患此病，腹痛且病情已成，使用活命饮，一剂药后疼痛立刻停止。再用托里消毒散，肿块顿时隆起，这是脓液即将形成的征兆。再用托里散补益正气，疮口自然溃破而痊愈。
锦衣卫掌堂官刘廷器，在正德辛未年仲夏，腹部患痈，溃破后脓液清稀，伴有发热口渴、腹胀、呕吐不食的症状。有人认为是热毒内蕴，使用清热凉血解毒之剂，呕吐停止，食欲增进；再用托里等药剂，疮疡得以痊愈。
进士边云庄，腹痛恶寒，脉象浮数。我说：“脉象浮数，反而恶寒，这是疮疽的症候。”他不相信，几天后脓液从臀部溃破，此时气血俱虚，如何能收敛愈合？急忙使用活命饮一钟（量词），臀部溃破一个孔洞，流出脓液约一斗，气息微弱。使用大补汤……（原文此处有缺漏，根据上下文推断为补气养血之剂），烦躁止息，脉象洪大，举按皆实。省察后诊脉，脉象洪大，重按却似无根，使用十全大补汤，倍用人参、黄芪至四斤，再加附子两枚，煎膏服用，抽搐停止；又用十全大补汤，五十余剂后疮口收敛。
上舍周一元，腹部患痈，三个月不愈。脓水清稀，早晨怕冷晚上发热，服用四物汤、黄柏、知母之类药物，导致食少腹泻，这是气血虚弱。食少腹泻，是脾肾虚损。痰涌胸痞，是脾肺虚弱。全因真气虚弱，而邪气实盛。应当先壮旺胃气，使各脏腑有所禀受，邪气自然退去。于是用六君子汤加黄芪、当归，数剂后各种症状逐渐消退；又用十全大补汤，肌肉逐渐收敛，更用补中益气汤调理而痊愈。
上舍毛体仁，素来阴虚。春初咳嗽，胸中隐痛，肾脉数而无力，肺脉数时而可见，这是肾脉亏损，阴火炽盛。用六味地黄丸料一剂，服用后，病势虽减，但内痈已成。这是因为元气虚弱，未能将毒邪发出，正值火令季节，颇为可畏。他不相信，服用化痰火之剂，两个月后，乳房间微肿，脉象洪数而无力。我说：“脓液已在内部溃破，应当针刺排出脓液，以免发生内攻的祸患。”他不相信，又过一个多月，请我去看。只针刺出一个孔洞，脓液排出不利，仍然内攻，唇舌青赤。我说：“脏腑已坏，我怎么能治好！”后果然去世。
从侄孙十四岁时早婚，乙巳年春季，二十四岁时，腹中气痛，服用大黄等药二剂，便血甚多，胸腹胀满，痰喘发热。又服用破气降火药一剂，汗出如水，手足如冰。我外出刚回来，诊察左关脉洪数，右尺脉尤其严重，这是腹痈，虽然能收敛，到夏天必定变成为劳瘵症。用人参、黄芪各一两，当归、白术各五钱，陈皮……（原文此处有缺漏，推测为理气药），又服两剂，肿痛减轻，脉滑，多次针刺排出脓瘀，再用大补汤，精神饮食如常。因遗精，患处颜色黯黑，用前面的药，加五味子、山茱萸、山药、骨碎补、吴茱萸等药剂，疮痛逐渐收敛，劳瘵症候全部具备。其脉象非洪大而数，即微细若无，只专服独参汤、人乳汁，稍有好转，许久仍脱证复发。我说：“应当准备后事，等待火旺之时（指夏季或病情恶化期）。”于是祈祷鬼神，巫师历数往事如同亲眼所见，更出示方药，都是峻烈通利之剂。并且说保证必生，恭敬信服，后果然去世。经文说：“拘泥于鬼神的人，不可与他谈论至高医德。”何况又轻信方药于邪妄之人呢！写下此文以警示后人。
(Universal for both men and women)
Abdominal carbuncle (Fu Yong) refers to sores occurring in the abdomen, or between the skin and fascia. It is attributed to rich and greasy dietary habits (Gao Liang Nong Wei) and fire generated from emotional stagnation (Qi Qing Yu Huo). If the swelling is diffuse and hard with unchanged skin color, it indicates deficiency of healthy qi; Tuoli Xiaodu San (Support Interior and Eliminate Toxin Decoction) should be used. If pus forms but fails to ulcerate externally, it is due to deficiency of qi and blood; a horizontal needle insertion technique should be employed. If there is swelling accompanied by pain, it indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Life Preserving Powder) should be used first, combined with garlic-separated moxibustion to neutralize toxicity; subsequently, Tuoli San (Support Interior Powder) should be used to tonify qi. If internal resolution is desired at the onset, one should strengthen stomach qi and consolidate the root, assisting with herbs that promote meridian circulation and invigorate blood. If purgative agents are used to seek internal resolution, the swelling will fail to ulcerate, and if ulcerated, it will fail to heal. If draining agents are used to evacuate pus, young and strong patients will mostly prove difficult to treat, while old and weak patients will face immediate danger. There are also cases resembling this caused by food retention or hernia; see Clinical Cases.
Simu Li Wushan suffered from this condition, experiencing abdominal pain with established pathology. After using Huoming Yin (Life Preserving Powder), pain ceased immediately after one dose. Following this, Tuoli Xiaodu San was administered, causing the swelling to rise sharply, indicating impending pus formation. Subsequently, Tuoli San was used to tonify, leading to spontaneous ulceration and recovery.
Jinyiwei Zhangtang Guan Liu Tingqi developed an abdominal carbuncle in mid-summer during the Xinwei year of Zhengde. After ulceration, the pus was clear, accompanied by fever, thirst, abdominal distension, vomiting, and loss of appetite. Some physicians attributed this to internal heat toxin and prescribed cooling and detoxifying herbs; vomiting stopped and appetite returned. Further treatment with Tuoli-type formulas resulted in healing.
Jinshi Bian Yunzhuang presented with abdominal pain, aversion to cold, and a floating, rapid pulse. I stated: "A floating and rapid pulse accompanied by aversion to cold is a sign of carbuncles and ulcers." He did not believe me. Several days later, pus ulcerated from the buttocks. At this stage, both qi and blood were deficient, making healing impossible. Urgently, one zhong (unit of volume) of Huoming Yin was administered. A single pore opened on the buttock, discharging approximately one dou of pus. The patient's breath was faint. [Missing text inferred as tonifying formula]... Restlessness ceased. The pulse was large upon lifting and pressing, appearing solid. Upon re-examination, the pulse was flooding but empty upon deep pressure. Shiquan Dabu Tang (Complete Great Tonification Decoction) was used, with doubled doses of Renshen (Ginseng Radix) and Huangqi (Astragali Radix) totaling four jin, plus two Fuzi (Aconiti Lateralis Radix Preparata), prepared as a paste. Spasms ceased. Another fifty-plus doses of Shiquan Dabu Tang led to wound contraction.
Shangshe Zhou Yiyuan suffered from an abdominal carbuncle for three months without healing. Pus and water were clear and thin. He experienced morning chills and evening fevers. After taking Siwu Tang (Four Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), he developed poor appetite and diarrhea, indicating qi and blood deficiency. Poor appetite and diarrhea indicate spleen and kidney deficiency. Phlegm surging and chest stuffiness indicate spleen and lung deficiency. All stem from deficiency of true qi and excess of pathogenic factors. Stomach qi must first be strengthened so that the zang-fu organs have substance to receive, allowing pathogens to retreat naturally. Six Junzi Tang (Six Gentlemen Decoction) was modified with Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix). After several doses, symptoms gradually receded. Shiquan Dabu Tang was then used, leading to gradual muscle regeneration. Finally, Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) was used for regulation and full recovery.
Shangshe Mao Tiren had a constitution prone to yin deficiency. In early spring, he suffered from cough and dull chest pain. The kidney pulse was rapid and forceless; the lung pulse was rapid and intermittently visible. This indicated kidney pulse depletion and blazing yin fire. One dose of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) reduced the disease severity, but an internal carbuncle had formed. This was because yuan qi was deficient and failed to expel the toxin. The fire season was feared. He did not believe this and took phlegm-fire resolving herbs. Two months later, slight swelling appeared between the breasts. The pulse was flooding, rapid, and forceless. I said: "Pus has ulcerated internally. It should be drained via acupuncture to avoid internal invasion." He refused. Over a month later, I was called again. Only one pore was punctured; pus drainage was obstructed, leading to internal invasion. Lips and tongue turned cyan and red. I said: "The zang-fu organs are destroyed; how can I treat this?" He subsequently died.
My younger nephew married early at fourteen. In the spring of Yisi, at age twenty-four, he suffered from abdominal qi pain. After two doses of Dahuang (Rhei Radix et Rhizoma) and other drugs, he passed significant amounts of blood, developing chest/abdominal distension, phlegm-wheezing, and fever. Another dose of qi-breaking and fire-descending herbs caused profuse sweating like water and ice-cold extremities. Returning from a trip, I palpated the left guan position: flooding and rapid; the right chi position was even more severe. This was an abdominal carbuncle. Although it could contract, it would transform into consumption (Zhai Syndrome) by summer. Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) 1 liang each, Dang Gui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) 5 qian each, Chen Pi (Citri Reticulatae Pericarpium)... [Missing text]... After two more doses, swelling and pain subsided, pulse became slippery. Multiple acupuncture sessions drained pus and stasis. Da Bu Tang (Great Tonification Decoction) restored spirit and diet. Due to seminal emission, the lesion area turned dark. Previous herbs were modified with Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gusuibu (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus). Pain gradually subsided, but signs of consumption fully manifested. His pulse was either flooding, large, and rapid, or minute and nearly imperceptible. He exclusively consumed Danshen Tang (Single Ginseng Decoction) and human milk. Transient improvement occurred, followed by collapse. I said: "Prepare funeral arrangements; wait for the peak of fire energy." He prayed to spirits and ghosts. A shaman recounted past events accurately and provided prescriptions consisting of harsh and draining agents, promising survival. He believed and accepted them. He subsequently died. The Classic states: "One who is bound by superstition cannot be spoken to regarding the highest virtue." How much more so to trust prescriptions from deceitful persons! I record this to warn future generations.