内经病能论云。人病胃脘痈。当候胃脉。其脉当沉细。沉细者气逆。逆者人迎甚盛。甚盛则
热。人迎者。胃脉也。逆而盛。则热聚于胃口而不行。故胃脘为痈也。
马仲化云。胃为水谷之海。其经多气多血。脉见右关。本宜洪盛。今反沉细。则是胃气已逆。
人迎者。胃经穴名。在结喉两傍。动脉应手。其脉见于左手。今右关脉沉细。人迎甚盛。则是热
聚胃口而不行耳。灵枢经脉篇谓。人迎大三倍于寸口。则胃经为实。即此验之。而知胃脘痈之脉也。
仲景云。呕家有痈脓者。不可治呕。脓尽自愈。此不言痈之所在。而言呕脓者。以其但呕而
不咳。知非肺痈。而为胃脘痈明矣。内经曰。热聚于胃口而不行。胃脘为痈。胃脘属阳明。阳明
气逆。故脓不自咳出。而从呕出。脓亦不似肺痈之
如米粥者。此出自胃脘。从湿化而聚结成脓。有结痰如蚬肉也。谓不可治呕。言不得用辛香温胃
止呕之剂。以脓之瘀浊。熏蒸谷气。故呕。若脓出则呕自愈。夫痈之在胃脘之上者则然。若过乎
中。在膈之下。则脓从大便而出。轻则金匮排脓汤。重则大黄牡丹汤、凉膈散选用。若脓自上而
吐。轻则金匮排脓散。重则射干汤。或犀角地黄汤加忍冬、连翘。皆因势利导之法也。脓稀呕止。
后用太乙膏作丸服。虚人。宜八珍加黄 、忍冬、连翘之类调补之。凡舌苔经久不退。色黑垢腻。
口中作甜。其气秽浊。即是胃脘发痈之候。明眼辨之。毋俟痈成而致莫救也。
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。舌上苔
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。予曰。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。
《内经·病能论》说：人患胃脘痈（胃部化脓性炎症）时，应当诊察胃脉。其脉象应当表现为沉细。脉象沉细说明气机逆乱。气机逆乱则人迎脉（足阳明胃经在颈部的动脉）特别盛大。人迎脉特别盛大则表示有热邪。人迎脉是反映胃经状况的脉位。如果脉气逆乱且盛大，那么热邪就会聚集在胃口处而不能消散，因此导致胃脘形成痈肿。
马仲化说：胃是水谷汇聚的海，其经脉多气多血。脉象出现在右关部（右手寸口脉的关部，候脾胃），本来应该洪大旺盛。现在反而出现沉细的脉象，这就是胃气已经逆乱的表现。人迎穴是胃经的穴位名称，位于结喉两侧，跳动应手。其脉象通常见于左手（此处指人迎脉本身的搏动位置，与寸口相对）。现在右关脉沉细，而人迎脉特别盛大，这说明热邪聚集在胃口处而不能运行。《灵枢·经脉篇》说：人迎脉比寸口大三倍，就是胃经实证。据此验证，就可以知道胃脘痈的脉象特征了。
张仲景说：呕吐带有痈脓的病人，不可单纯止呕，待脓液排尽后自然痊愈。这里没有明确指出痈的位置，而是提到呕吐脓液，因为病人只是呕吐而不咳嗽，可知这不是肺痈，而是胃脘痈，这是很明确的。《内经》说：热邪聚集在胃口处而不能运行，导致胃脘形成痈肿。胃脘属于阳明经，阳明经气机逆乱，所以脓液不能通过咳嗽排出，而是从呕吐中排出。脓液的性状也不像肺痈那样如米粥般浑浊，这是因为脓液出自胃脘，由湿邪转化并聚结而成，有时凝结成痰，状如蚬肉。所谓“不可治呕”，意思是不能使用辛香温胃止呕的药物，因为脓液的瘀浊之气熏蒸谷气，导致呕吐。如果脓液排出，呕吐自然停止。如果是痈肿位于胃脘上部，情况确实如此；如果痈肿位置超过中部，位于膈膜之下，那么脓液会从大便排出。病情轻的选用《金匮要略》中的排脓汤，病情重的选用大黄牡丹汤或凉膈散。如果脓液从上端吐出，病情轻的选用《金匮要略》中的排脓散，病情重的选用射干汤，或者犀角地黄汤加忍冬藤、连翘。这些都是因势利导的治疗方法。脓液变稀、呕吐停止后，后续服用太乙膏制成的丸药。体质虚弱的人，宜用八珍汤加黄芪、忍冬、连翘等药物进行调补。凡是舌苔经久不退，颜色黑且垢腻，口中感觉甜，气味秽浊，这就是胃脘发痈的征候。明眼医生应仔细辨别，不要等到痈肿已成而无法救治时才后悔。
石顽治疗谈仲安。此人身体肥胖，喜欢饮酒。初夏时节患上高热、呕吐逆气，胸膈左侧隐隐作痛，手不能触碰，大小便涩滞频数，舌苔滑腻，进食后疼痛并呕吐稠痰，逐渐出现血水，脉象涩滞不调。给予凉膈散加石斛、连翘，服后排出大量稠腻之物。起初疡医按肺痈治疗无效。我说：“肺痈必定伴有咳嗽并吐出腥臭的痰，此人只是呕吐而不咳嗽，确实是胃病无疑。”服药通下后四五日，再次呕吐如前。再用小剂量药物调理，经过三次通下，病势才平息。后来用保元汤、茯苓、陈皮平调二十天而痊愈。先前有个姓李的人患此病，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。这实在是因为发现时机不早，直到病情败坏，后悔也来不及了。
The *Neijing* (Classic of Internal Medicine) in the chapter "Bing Neng Lun" states: When a person suffers from stomach epigastrium abscess (a purulent inflammation of the stomach), one should examine the stomach pulse. The pulse should be deep and fine. A deep and fine pulse indicates rebellious Qi. Rebellious Qi causes the Renying pulse (the artery of the Foot-Yangming Stomach Meridian located at the neck) to become extremely full. An extremely full pulse indicates heat. The Renying pulse reflects the condition of the Stomach Meridian. If the pulse is rebellious and full, heat gathers at the gastric opening but cannot circulate, thus causing an abscess in the stomach epigastrium.
Ma Zhonghua said: The Stomach is the sea of water and grain; its meridian is abundant in Qi and Blood. The pulse appearing at the Right Guan position (the Guan position of the radial artery on the right wrist, corresponding to the Spleen and Stomach) should originally be surging and full. Now that it is instead deep and fine, this indicates that Stomach Qi has already become rebellious. The Renying acupoint is named after the Stomach Meridian, located on both sides of the laryngeal prominence, where the arterial pulsation can be felt. Its pulse manifestation is typically seen on the left hand (referring to the palpable pulsation of the Renying point itself, contrasting with the Cunkou). Now, the Right Guan pulse is deep and fine, while the Renying pulse is extremely full; this shows that heat is gathering at the gastric opening and failing to circulate. The *Lingshu: Jingmai* chapter states: If the Renying pulse is three times larger than the Cunkou pulse, it indicates excess in the Stomach Meridian. Verifying this, one can know the pulse characteristics of stomach epigastrium abscess.
Zhang Zhongjing said: For patients vomiting pus from an abscess, one must not treat the vomiting directly; once the pus is exhausted, the patient will heal spontaneously. Here, the location of the abscess is not explicitly stated, but the mention of vomiting pus implies that since the patient vomits without coughing, it is known not to be lung abscess, but clearly stomach epigastrium abscess. The *Neijing* says: Heat gathers at the gastric opening and fails to circulate, leading to an abscess in the stomach epigastrium. The stomach epigastrium belongs to the Yangming channel; due to the rebellious Qi of Yangming, the pus cannot be expectorated through coughing but is expelled via vomiting. The nature of the pus is not like that of lung abscess, which resembles congee; rather, because the pus originates from the stomach epigastrium, it transforms from dampness and coagulates into pus, sometimes forming phlegm clots resembling clam meat. The statement "do not treat the vomiting" means one must not use acrid-aromatic warming Stomach anti-emetic agents. This is because the turbid stasis of the pus steams the谷物 Qi, causing vomiting. Once the pus is discharged, the vomiting will cease naturally. If the abscess is located in the upper part of the stomach epigastrium, this is indeed the case. However, if the abscess extends beyond the middle, below the diaphragm, the pus will exit through the feces. For mild cases, select Paishang Tang (Drain Pus Decoction) from the *Jinkui Yaolue*; for severe cases, select Dahuang Mudan Tang (Rhubarb and Moutan Decoction) or Liangge San (Cool the Diaphragm Powder). If the pus is vomited from above, for mild cases, select Paishang San (Drain Pus Powder) from the *Jinkui Yaolue*; for severe cases, select Shegan Tang (Belamcanda Decoction), or Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) added with Honeysuckle Stem (Jinyinhua) and Forsythia Fruit (Lianqiao). These are all methods of guiding the pathogen according to its tendency. When the pus becomes thin and vomiting stops, subsequently administer Taiyi Gao (Great Efficacy Ointment) made into pills. For deficient individuals, use Bazhen Tang (Eight Treasures Decoction) added with Astragalus Root (Huangqi), Honeysuckle Stem (Jinyinhua), and Forsythia Fruit (Lianqiao) for regulation and tonification. Whenever the tongue coating persists for a long time, is black and greasy, the mouth feels sweet, and the breath is foul and turbid, these are signs of stomach epigastrium abscess formation. Astute physicians should distinguish them early, lest they wait until the abscess is established and incurable.
Shi Wan treated Tan Zhongan. He was obese and fond of drinking alcohol. In early summer, he suffered from high fever, vomiting, and rebellious Qi, with dull pain on the left side of the chest and diaphragm, intolerant to touch, scanty and frequent urination, slippery tongue coating, vomiting thick phlegm after eating accompanied by pain, gradually presenting blood-tinged fluid, and a choppy and irregular pulse. He was prescribed Liangge San (Cool the Diaphragm Powder) added with Dendrobium Stem (Shihu) and Forsythia Fruit (Lianqiao). After administration, a large amount of thick and greasy material was discharged. Initially, a surgeon treated him as having lung abscess without effect. I said, "Lung abscess must present with coughing and expectoration of foul-smelling sputum. This patient only vomits without coughing; it is undoubtedly a Stomach disease." After purgation, four or five days later, vomiting recurred as before. He was treated again with small doses for regulation. After three purgations, the pathological trend finally subsided. Subsequently, he was regulated with Baoyuan Tang (Preserve the Origin Decoction), Poria (Fuling), and Tangerine Peel (Chenpi) for twenty days until recovery. Previously, a Mr. Li suffered from this disease, focusing exclusively on clearing heat, resolving phlegm, and detoxifying. Until the diaphragmatic margin ulcerated and腐rosion occurred, with pus and water dripping continuously, he lingered for a month and died. This was truly due to delayed recognition, waiting until the condition deteriorated irreversibly, making regret futile.