立斋引《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。若脉见洪数，脓已成也，急宜排之。设脉迟紧，其脓未就，有瘀血也，急下
之。否则邪毒内攻，腐烂肠胃矣。丹溪云∶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，宜
助胃壮气为主，而佐以前法，不可专治其疮。
立斋曰∶腹痈，谓疮生于肚腹，或生于皮里膜外，属膏粱浓味，七情郁火所致。若漫肿
坚硬，肉色不变，或脉迟紧，未成脓也，四君加芎、归、白芷、枳壳，或托里散。肿软色赤
，或脉洪数，已成脓也，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。若用克伐之剂，欲其消散，则肿者
不能溃，溃者不能敛。若用疏利之药，
下其脓血，则少壮者，多为难治，老弱者，立见危亡。若有食积疝气类此者，当辨而治之。
进士边云庄，腹痛、恶寒，脉浮数。余曰∶浮数之脉而反恶寒，疮疽之证也。不信。数
日后，复请视之，左尺洪数。余曰∶内有脓矣。仍不信。至小腹痛胀，连及两臀，始悟
。余曰∶脓溃臀矣，气血俱虚，何以收敛。急服活命饮一钟，臀溃一孔，出脓斗许，气息奄
奄。用大补药一剂，神思方醒。每去后，粪从疮出，痛不可当，小腹间如有物上挺，即发痉
不省人事，烦躁，脉大，举按皆实。省而细察之，脉虽洪大，按之如无，以十全大补，倍加参、
至四斤，更加附子二枚，煎膏服之而痉止。又用十全大补汤，五十余剂而疮敛。
上舍周一元，患腹痈三月不愈，脓水清稀，朝寒暮热，服四物、黄柏、知母之类，食少
作泻，痰涎上涌。服二陈、枳实之类，痰涎愈甚，胸膈痞闷。谓余曰∶何也。余曰∶朝寒暮
热，血气虚也。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，数剂诸证渐退。又用十
全大补汤，肌肉渐敛。更用补中益气汤，调理而愈。（薛按）
薛立斋引用《圣济总录》的说法：胃脘痈，是由于寒气阻隔阳气，热气聚集在胃口，寒热不调和，导致血肉腐败。因为气逆乱于胃，所以胃脉呈现沉细之象；因为阳气不能上升，所以人迎穴处热象严重，使人出现像疟疾一样的寒热往来，皮肤干枯如鳞甲交错，或者咳嗽，或者呕吐脓血。如果脉象出现洪大且数，说明脓已经形成，应当紧急排脓。假如脉象迟而紧，说明脓尚未形成，有瘀血存在，应当紧急攻下。否则邪毒内攻，会腐蚀肠胃。朱丹溪说：内疽，是因为饮食的毒素，加上七情郁结化火，相互郁滞而发作，用射干汤主治。我（薛立斋）常用薏苡仁汤、牡丹皮散、太乙膏选用治疗，也有效。如果出现吐脓血，饮食减少不想进食，应当以扶助胃气、强壮正气为主，并配合前面的方法，不可专门治疗疮疡。
薛立斋说：腹痈，是指疮疡生于肚腹，或生于皮里膜外，属于因食用膏粱厚味及七情郁结化火所致。如果漫肿坚硬，肌肉颜色不变，或者脉象迟紧，说明脓未形成，可用四君子汤加川芎、当归、白芷、枳壳，或者使用托里散。如果肿处变软、颜色发红，或者脉象洪数，说明脓已形成，可用托里消毒散。脓已形成但未能向外溃破的，是气血虚弱，应用卧针浅刺法。肿胀且疼痛剧烈的，是邪气实盛，先用仙方活命饮，隔蒜灸，以杀灭其毒性，后用托里法来补益其气。如果在初起阶段，希望它从内部消散，应当扶助胃气、强壮正气，使根本坚固，并用疏通经络、活血的药物辅助。如果使用攻伐的药物，希望它消散，那么肿的地方不能溃破，溃破的地方也不能愈合。如果使用疏利通下的药物，排出脓血，那么年轻力壮的人，大多难以治疗，年老体弱的人，立刻就会面临危亡。如果有食积、疝气等类似情况，应当辨别后治疗。进士边云庄，腹痛、恶寒，脉浮数。我说：脉象浮数却反而恶寒，这是疮疽的证候。他不相信。几天后，再次请我去诊视，左尺脉洪数。我说：体内已经有脓了。他仍然不相信。直到小腹胀痛，牵连到两侧臀部，才醒悟过来。我说：脓已经从臀部溃破了，气血都虚弱，用什么来收敛伤口？急忙服用一钟活命饮，臀部溃破一个孔，流出脓液约一斗，气息微弱。服用一剂大补药，神志才清醒。每次排便后，粪便从疮口流出，疼痛难忍，小腹间好像有东西向上挺举，随即发生痉挛、不省人事，烦躁，脉象大，轻按重按都感觉坚实。清醒后仔细诊察，脉象虽然洪大，但重按却感觉空虚，于是用十全大补汤，加倍人参、黄芪，至四斤之多，再加附子两枚，煎成膏剂服用，痉挛停止。又用十全大补汤，五十多剂后疮口愈合。
上舍周一元，患腹痈三个月不好，脓水清稀，早晨怕冷晚上发热，服用四物汤、黄柏、知母之类的药物，吃得少且腹泻，痰涎上涌。服用二陈汤、枳实之类的药物，痰涎更加严重，胸膈痞闷。他问我：为什么呢？我说：早晨怕冷晚上发热，是血气虚弱。吃得少且腹泻，是脾肾虚弱。痰涌胸中痞闷，是脾肺虚弱。都是因为真气虚弱，而邪气实盛。应当先壮大他的胃气，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，几剂药后各种症状逐渐消退。又用十全大补汤，肌肉逐渐收敛。再用补中益气汤调理而痊愈。（薛己按语）
Xue Lizhai quoted from *Shengji Zonglu*: Wei-wan abscess (abscess of the stomach region) is caused by cold qi obstructing yang qi, with heat gathering at the stomach opening. The disharmony between cold and heat leads to the putrefaction of flesh and blood. Because qi rebels in the stomach, the stomach pulse appears deep and fine. Because yang qi cannot ascend, there is excessive heat at the Renying (ST 9) acupoint, causing chills and fever resembling malaria, rough skin resembling fish scales, cough, or vomiting of pus and blood. If the pulse is surging and rapid, the pus has formed; it should be drained urgently. If the pulse is slow and tight, the pus has not yet formed, indicating blood stasis; purgation should be performed urgently. Otherwise, pathogenic toxins will attack internally, corroding the intestines and stomach. Zhu Danxi stated: Internal carbuncles arise from food toxicity combined with fire generated by emotional stagnation. They are treated primarily with Shegan Tang (Belamcanda Decoction). I frequently selected Yiyiren Tang (Coix Seed Decoction), Mudanpi San (Moutan Powder), or Taiyi Gao (Great One Plaster) for treatment, with good efficacy. If there is vomiting of pus and blood, loss of appetite, the primary approach should be to support the stomach qi and strengthen righteous qi, assisted by the aforementioned methods, rather than treating the sore exclusively.
Xue Lizhai stated: Abdominal abscess refers to sores occurring on the abdomen or between the skin and fascia, caused by rich, greasy foods and fire from emotional stagnation. If the swelling is diffuse and hard, with unchanged skin color, or if the pulse is slow and tight, the pus has not formed; treat with Sijunzi Tang (Four Gentlemen Decoction) added with Chuanxiong Danggui Baizhi Zhike (Atractylodes Macrocephala, Angelica Sinensis, Angelica Dahurica, Aurantium), or Tuoli San (Support Interior Powder). If the swelling becomes soft and red, or the pulse is surging and rapid, the pus has formed; treat with Tuoli Xiaodu San (Support Interior and Detoxify Powder). If pus has formed but fails to ulcerate externally, it indicates deficiency of qi and blood; use shallow needle insertion. If swelling and pain are severe, it indicates excess pathogenic qi; first use Xianfang Huoming Yin (Immortal Formula for Preserving Life Decoction) and garlic-separated moxibustion to neutralize toxicity, followed by interior-supporting methods to tonify qi. In the initial stage, if the goal is internal resolution, one must support stomach qi and strengthen the root, assisting with herbs that unblock meridians and invigorate blood. If harsh draining agents are used to resolve the swelling, the swollen area will fail to ulcerate, and the ulcerated area will fail to heal. If purgative herbs are used to drain pus and blood, young and strong patients may become difficult to treat, while old and weak patients may face immediate danger. Cases resembling food stagnation or hernia should be differentiated and treated accordingly.
The Jinshi Bian Yunzhuang suffered from abdominal pain and aversion to cold, with a floating and rapid pulse. I said: A floating and rapid pulse accompanied by aversion to cold is a sign of carbuncle or furuncle. He did not believe me. Several days later, he requested another consultation; the left Chi pulse was surging and rapid. I said: Pus has formed internally. He still did not believe me. Until the lower abdomen became distended and painful, radiating to both buttocks, he finally realized [my diagnosis]. I said: The pus has ulcerated through the buttock. Qi and blood are both deficient; how can the wound close? Urgently administer one cup of Huoming Yin. The buttock ulcerated one hole, discharging approximately one dou of pus. His breath was faint. After one dose of major tonic medicine, his consciousness returned. Each time he defecated, feces exited through the wound, causing unbearable pain. A sensation of something rising in the lower abdomen triggered spasms, unconsciousness, irritability, and a large pulse that felt solid upon both light and heavy pressure. Upon regaining consciousness and careful examination, although the pulse appeared surging and large, it felt empty upon heavy pressure. Therefore, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was used, with doubled Ginseng and Astragalus, up to four jin in total, plus two pieces of Aconite, decocted into a paste and administered. The spasms ceased. Subsequently, using Shiquan Dabu Tang for over fifty doses, the wound healed.
Shangshe Zhou Yi-yuan suffered from an abdominal abscess for three months without healing. The pus was clear and thin; he experienced morning chills and evening fevers. After taking Siwu Tang (Four Substances Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome), he had poor appetite and diarrhea, with phlegm-saliva surging upward. After taking Erchen Tang (Two Aged Herbs Decoction) and Zhishi (Bitter Orange Fruit), the phlegm-saliva worsened, causing chest and diaphragm stuffiness. He asked me: Why? I said: Morning chills and evening fevers indicate deficiency of blood and qi. Poor appetite and diarrhea indicate deficiency of spleen and kidney. Surging phlegm and chest stuffiness indicate deficiency of spleen and lung. All result from deficiency of true qi and excess of pathogenic qi. We must first strengthen stomach qi so that the zang-fu organs receive nourishment, allowing pathogenic qi to retreat naturally. Thus, Liujunzi Tang (Six Gentlemen Decoction) was used with added Huangqi (Astragalus Root) and Danggui (Angelica Sinensis Root). After several doses, symptoms gradually receded. Then, Shiquan Dabu Tang was used, and muscle tissue gradually closed. Finally, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used for regulation, leading to recovery. (Note by Xue Ji)