脉因证治诸说 夫阴阳升降，则荣卫流通；气逆而隔，则留结为痈。胃脘痈者，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。以阳气不得下通，故颈人迎甚盛，令人寒热如疟，身皮甲错，
或咳或呕，或唾脓血。观伏梁之病，亦有侠胃脘内痈者，以其裹大脓血，居肠胃之外故也。（《圣济》）
诸书少论此病，惟孙真人言此（按∶《千金》别无其说，盖是误忆），后学以此论乃胃热为邪治之（按∶
《外科集验方》作治法亦与肠痈颇同），初以疏利为先，以消毒托里退胃热，此为良法。不识病者，误人不浅，
可不慎之。（《奇效》）
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，以脓之淤浊，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，轻则金匮排脓汤，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（宜参《肺痈》）作丸服，虚人宜八珍加黄
、忍冬、连翘之类调补之。凡舌胎经久不退，色黑垢腻，口中作甜，臭气秽浊，即是胃脘发痈之候，明眼辨之，
毋俟痈成而致莫救也。（《医通》）
胃脘痈则有虚实二种∶其实者易消，若作脓，必大吐脓血而愈；惟虚症则多不治。先胃中痛胀，久而心下渐高，
其坚如石，或有寒热，饮食不进，按之尤痛，形体枯瘦，此乃思虑伤脾之症，不待痈成即死。故凡腹中有一定痛处，
恶寒倦卧，不能食者，皆当审察，防成内痈。甚毋因循求治于不明之人，以至久而脓溃，自伤其生也。（《源流
论》）
胃痈，胃阳遏抑病也。（原此下引《圣济》）若脉洪数，脓已成也，急用排脓之剂。脉迟紧，属瘀血也，急当议
下。否则毒瓦斯内攻，肠胃并腐，其害不小。但此症又不比肺痈之可认，苟不呕脓血，未免他误矣，疡医可不知
方脉之理乎。据此则知胃痈之症，端由胃阳之遏。然其所以致遏，实又有因，不但寒也。必其人先有饮食积聚，
或好饮醇醪，或喜食煎 ，一种热毒之气，累积于中，又或七情之火，郁结日久，复感风寒，使热毒之气，填
塞胃脘。胃中清气下陷，故胃脉沉细，惟为风寒所隔，故人迎紧盛也。若有此二脉，非胃痈而何。然症之成也
必以渐，而治之之法亦不可混施。（《尊生书》）
胃痈亦生腹内，痛在心下脐上。其有红肿见于胸下者，此躯廓之伏梁痈，非胃痈也。肠痈痛在下腹左右少
腹间，以此为异云云。凡内痈脓未成，皆宜从清导之。已成脓者，必溃脓。胃痈之脓，有呕退场门者，有下溃于
肛者。（《医级》）
治验 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，召余视之。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，即知饿索
饮食，六剂全愈。（《类案》）
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，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，
复以保元苓橘平调，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。（《医通》）
治方 治热聚胃脘，留结为痈，连翘升麻汤方。（《圣
济》）（按∶即五香连翘汤。）
治胃腑实热，留结为痈，阳气不得下，胃脉沉细者，犀角汤方。
犀角（镑） 栀子仁 赤芍药 赤茯苓（去黑皮） 黄芩（去黑心） 射干（去毛） 大黄（锉炒各一两）
上七味粗捣筛，每服五钱匕，水一盏半，煎至一盏去滓，入蜜一匙搅匀，再煎一两沸，食后温服。（同上）
治荣卫不流，热聚胃口，血肉腐坏，胃脘成痈，射干汤方。
射干（去毛） 栀子仁 赤茯苓（去黑皮） 升麻（各一两） 赤芍药 白术（各一两半）
上六味 咀，如麻豆大，每服五钱匕，水一盏半，煎至八分去滓，入生地黄汁一合，蜜半合，再煎三沸，温
服不拘时候，日二服。（同上）
《脉因证治》中的各种论述：阴阳之气的升降运动，使得营气和卫气流通顺畅；如果气机逆乱并发生阻隔，就会停滞结聚而形成痈肿。胃脘痈（发生在胃部的痈肿），是由于寒气阻隔了阳气，导致热邪聚集在胃口部位，寒热之气不调和，从而导致血肉腐败坏死。因为气机逆乱于胃中，所以胃部的脉象表现为沉细。由于阳气不能向下通达，所以颈部的人迎穴处脉搏非常盛大，使人出现像疟疾一样的寒热症状，皮肤干枯粗糙如鳞甲，或者咳嗽、呕吐，或者吐出脓血。观察伏梁病（一种腹部积块病），也有发生在胃脘内部形成痈肿的情况，这是因为其包裹着大量的脓血，位于肠胃之外。（出自《圣济总录》）
各书中很少讨论这个疾病，只有孙思邈提到过此病（按：《千金方》中并无其他相关论述，大概是记忆有误），后世学者根据这一理论，认为这是胃热为邪所致，治疗上采用清热解毒、托毒排脓以退去胃热的方法，这是一种很好的治疗方法。如果不了解病情而误治，对人的伤害很大，怎能不谨慎呢？（出自《奇效良方》）
张仲景说：呕吐伴有痈脓的患者，不可以单纯止呕，等脓液排尽后呕吐自然会停止。这里没有说明痈肿的具体位置，只提到呕吐脓液，因为他只呕吐而不咳嗽，可知这不是肺痈，而是胃脘痈，这已经很明确了。《黄帝内经》说：热邪聚集在胃口而不运行，就会使胃脘形成痈肿。胃脘属于阳明经，阳明经气机逆乱，所以脓液不会像肺痈那样通过咳嗽排出，而是从呕吐中排出。脓液的性状也不像肺痈那样像米粥，这种来自胃脘的脓液，是由湿气转化并聚结而成，其中夹杂的凝结痰浊就像蚬肉一样。所谓“不可治呕”，意思是不能使用辛香温胃止呕的药物，因为脓液的淤滞浊气熏蒸谷气而导致呕吐，如果脓液排出，呕吐自然痊愈，这是针对痈肿位于胃脘上部的情况。如果痈肿超过中部，位于膈膜之下，那么脓液会从大便排出，轻症选用《金匮要略》的排脓汤，重症选用大黄牡丹汤或凉膈散。如果脓液从上端吐出，轻症用《金匮要略》的排脓汤，重症用射干汤，或者犀角地黄汤加忍冬藤、连翘，这些都是顺应病势加以引导的治疗方法。脓液稀薄且呕吐停止后，使用太乙膏（参看《肺痈》章节）制成丸药服用，体质虚弱的人宜用八珍汤加黄芪、忍冬藤、连翘等药物进行调补。凡是舌苔经久不退，颜色黑且垢腻，口中发甜，口气秽浊，这就是胃脘发生痈肿的征兆，明眼医生应当辨别清楚，不要等到痈肿形成无法救治时才后悔。（出自《医宗必读》）
胃脘痈分为虚证和实证两种：实证容易消散，如果化脓，必须大量吐出脓血才能痊愈；只有虚证大多难以治愈。起初是胃中疼痛胀满，时间久了心下部位逐渐隆起，坚硬如石头，有时伴有寒热，饮食不进，按压时更加疼痛，形体枯瘦，这是思虑过度损伤脾脏的症状，不用等到痈肿形成就会死亡。所以凡是腹中有固定痛处，恶寒倦卧，不能进食的人，都应当仔细审查，防止发展成内痈。千万不要因为拖延而在不明医术的人那里求治，以至于时间长了脓液溃破，损害自己的生命。（出自《医学源流论》）
胃痈，是胃阳被遏制抑制的疾病。（原文此处引用《圣济总录》）如果脉象洪数，说明脓已经形成，急需使用排脓的药物。如果脉象迟紧，属于瘀血阻滞，应当紧急考虑使用泻下法。否则毒气内攻，导致肠胃腐烂，危害不小。但是此症又不比肺痈容易辨认，如果不呕吐脓血，难免会被误诊，外科医生难道不懂得脉理吗？由此可知，胃痈的症状，确实是由于胃阳被遏制所致。然而导致遏制的根本原因，实际上还有其他的因素，不仅仅是寒邪。必定是患者先前有饮食积聚，或者喜欢饮用美酒，或者喜欢吃煎炸烧烤的食物，产生一种热毒之气，累积在体内；或者是七情之火，郁结日久，又感受风寒，使热毒之气填塞胃脘。胃中的清气下陷，所以胃脉沉细，只是因为被风寒所阻隔，所以人迎脉紧盛。如果有这两种脉象，不是胃痈是什么？然而病症的形成必然是渐进的，治疗的方法也不可混淆施用。（出自《尊生书》）
胃痈也生长在腹腔内部，疼痛位于心下至脐上之间。如果在胸下有红肿表现，这是躯壳内的伏梁痈，而不是胃痈。肠痈的疼痛在下腹左右少腹之间，以此作为区别等等。凡是内痈脓液未成，都应当从清热疏导入手。脓液已成者，必然需要溃破排脓。胃痈的脓液，有的通过呕吐从口排出，有的通过大便从肛门排出。（出自《医级》）
治疗案例：江应宿治疗上舍汪中宇，患者喉咙肿胀无法进食，腹部感觉不到饥饿，只是每天喝几盏清茶，邀请我去诊治。诊察发现气口脉紧数，这是胃痈。脓液已经形成，适宜引导下行。投用凉膈散，稍微通利一两次，第二天早上吐出脓血，再服用一剂射干汤，立刻知道饥饿索食，服用六剂后完全痊愈。（出自《名医类案》）
石顽治疗谈仲安，身体肥胖且善于饮酒，初夏时节患高热呕吐逆气，左侧胸膈隐痛，手不能触碰，大小便涩滞频数，舌苔滑腻，饭后疼痛，呕吐稠痰，渐渐见到血水，脉象涩滞不调。给予凉膈散加石斛、连翘，排出大量稠腻之物。起初外科医生按肺痈治疗无效，我说：“肺痈必然咳嗽，吐出腥臭秽浊的痰。此人只呕吐不咳嗽，确实是胃病无疑。”泻下后四五天，再次呕吐如前，再用小剂量药物调理，经过三次泻下后病势才平复，随后用保元苓橘汤平和调理，二十天后痊愈。先前有个姓李的人患此病，专门致力于清热豁痰解毒，直到膈膜边缘溃烂腐坏，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，后悔莫及。（出自《医宗必读》）
治疗方剂：治疗热邪聚集胃脘，留滞结聚形成痈肿，连翘升麻汤方。（出自《圣济总录》）（按：即五香连翘汤。）
治疗胃腑实热，留滞结聚形成痈肿，阳气不能下行，胃脉沉细者，犀角汤方。
犀角（镑片） 栀子仁 赤芍药 赤茯苓（去掉黑皮） 黄芩（去掉黑心） 射干（去掉毛） 大黄（锉碎炒制，各一两）
以上七味药粗捣筛匀，每次服用五钱匕，用水一盏半，煎煮至一盏，去渣滓，加入蜂蜜一匙搅匀，再煎一两沸，饭后温服。（同上）
治疗营卫不流通，热邪聚集胃口，血肉腐败坏死，胃脘形成痈肿，射干汤方。
射干（去掉毛） 栀子仁 赤茯苓（去掉黑皮） 升麻（各一两） 赤芍药 白术（各一两半）
以上六味药切碎，如麻豆大小，每次服用五钱匕，用水一盏半，煎煮至八分，去渣滓，加入新鲜地黄汁一合，蜂蜜半合，再煎三沸，不拘时候温服，每日两次。（同上）
Various discussions in *Mai Yin Zheng Zhi*: The ascending and descending of Yin and Yang allows the smooth circulation of Ying (Nutritive Qi) and Wei (Defensive Qi); if Qi rebellion occurs with obstruction, stagnation and knotting will form an abscess. Gastric epigastric abscess (an abscess occurring in the stomach region) arises from cold qi obstructing Yang, causing heat to gather at the gastric opening. Due to the disharmony of cold and heat, flesh and blood become corrupted and necrotic. Because Qi rebels in the stomach, the stomach pulse is deep and fine. Since Yang Qi cannot descend smoothly, the Renying (ST9) pulse at the neck becomes very vigorous, causing chills and fever resembling malaria, rough and scaly skin, or coughing, vomiting, or expectorating pus and blood. Observing the disease of Fuliang (a type of abdominal mass), there are cases where an internal abscess forms within the gastric epigastrium, because it wraps large amounts of pus and blood located outside the intestines and stomach. (From *Sheng Ji Zong Lu*)
Few books discuss this disease; only Sun Simiao mentioned it (Note: *Qian Jin Fang* has no other discussion on this, likely a misremembered reference). Later scholars treated this theory as gastric heat pathogen, using methods to clear heat, detoxify, and support the interior to reduce gastric heat, which is a good method. Misunderstanding the disease and treating incorrectly causes significant harm; one must be cautious. (From *Qi Xiao Liang Fang*)
Zhang Zhongjing said: For patients with vomiting accompanied by abscess pus, do not treat the vomiting directly; once the pus is exhausted, it will heal itself. This does not specify the location of the abscess but mentions vomiting pus; since he vomits without coughing, it is clear that this is not Lung Abscess but Gastric Epigastric Abscess. *Nei Jing* states: Heat gathering at the gastric opening without moving leads to gastric epigastric abscess. The gastric epigastrium belongs to the Yangming channel; Yangming Qi rebels, so pus does not come out via coughing like in Lung Abscess, but is expelled through vomiting. The pus also differs from Lung Abscess pus which resembles congee; this pus originates from the gastric epigastrium, transforms from dampness, gathers and knots into pus, containing condensed phlegm resembling clam meat. Saying "do not treat the vomiting" means one should not use acrid-aromatic warming stomach anti-emetic agents, because the turbid stasis of pus steams the grain Qi causing vomiting; if the pus exits, the vomiting heals naturally. This applies when the abscess is in the upper part of the gastric epigastrium. If it exceeds the middle, below the diaphragm, the pus exits via stool. Mild cases use Pai Nong Tang from *Jin Gui Yao Lue*; severe cases use Da Huang Mu Dan Tang or Liang Ge San. If pus is vomited from above, mild cases use Pai Nong Tang; severe cases use She Gan Tang, or Xi Jiao Di Huang Tang added with Jin Yin Hua and Lian Qiao. These are all methods of guiding according to the trend. After the pus becomes thin and vomiting stops, use Tai Yi Gao (see *Lung Abscess* section) made into pills. For deficient persons, use Ba Zhen Tang plus Huang Qi, Jin Yin Hua, Lian Qiao, etc., for tonification and regulation. Whenever tongue coating persists long-term, black and greasy, mouth feels sweet, breath is foul and turbid, these are signs of gastric epigastric abscess forming. Clear-eyed physicians should distinguish them early, not waiting until the abscess is formed and incurable. (From *Yi Tong*)
Gastric epigastric abscess has two types: excess and deficiency. Excess types are easy to resolve; if pus forms, healing requires vomiting large amounts of pus and blood. Deficiency types are mostly untreatable. Initially, there is pain and distension in the stomach; over time, the area below the heart gradually bulges, hard as stone, possibly with chills and fever, inability to eat, extreme tenderness upon pressure, and emaciation. This is a syndrome of spleen injury due to excessive thinking; death occurs before the abscess even forms. Therefore, anyone with fixed abdominal pain, aversion to cold, lethargy, and inability to eat should be carefully examined to prevent internal abscess formation. Do not delay treatment seeking unqualified practitioners, leading to late-stage pus rupture and self-harm. (From *Yuan Liu Lun*)
Stomach abscess is a disease where Stomach Yang is suppressed. (Original text cites *Sheng Ji*). If the pulse is surging and rapid, pus has formed; urgently use pus-draining formulas. If the pulse is slow and tight, it belongs to blood stasis; urgently consider purgative methods. Otherwise, toxic factors attack internally, rotting the intestines and stomach, causing great harm. However, this condition is not as recognizable as Lung Abscess; if pus and blood are not vomited, misdiagnosis is inevitable. Surgeons must understand pulse diagnosis principles. Thus, we know the symptoms of stomach abscess stem from the suppression of Stomach Yang. The cause of this suppression is not merely cold. It often involves prior food accumulation, preference for rich wine, or consumption of fried/spicy foods, accumulating heat-toxic qi in the center; or emotional fire stagnating for a long time, compounded by wind-cold invasion, filling the gastric epigastrium with heat-toxic qi. Clear Qi of the stomach sinks downward, making the stomach pulse deep and fine; blocked by wind-cold, the Renying pulse becomes tight and vigorous. With these two pulses, what else could it be but stomach abscess? However, the formation of symptoms is gradual, and treatment methods must not be applied indiscriminately. (From *Zun Sheng Shu*)
Stomach abscess also grows inside the abdomen, with pain between the epigastrium and umbilicus. If redness and swelling appear below the chest, this is Fuliang abscess within the torso cavity, not stomach abscess. Intestinal abscess pain is located in the lower abdomen, left and right lower quadrants, distinguishing it thus. For all internal abscesses where pus has not yet formed, clearing and guiding is appropriate. Once pus has formed, it must be drained. Pus from stomach abscess may exit via vomiting from the mouth or via defecation from the anus. (From *Yi Ji*)
Treatment Case: Jiang Yingsu treated Wang Zhongyu, a scholar-official, who suffered from throat swelling preventing food intake, no sensation of hunger in the abdomen, drinking only several cups of clear tea daily. Upon examination, the Qi Kou pulse was tight and rapid, indicating stomach abscess. Pus had formed; it was appropriate to guide it downward. Administered Liang Ge San, resulting in slight bowel movements one or two times. The next morning, he vomited pus and blood. After taking one dose of She Gan Tang, he felt hungry and sought food. Six doses led to complete recovery. (From *Lei An*)
Shi Wan treated Tan Zhong'an, a fat man who drank heavily. In early summer, he suffered from high fever, vomiting, and reflux, with dull pain on the left side of the chest and diaphragm, intolerable to touch, scanty and frequent urination, slippery tongue coating, pain after eating, vomiting thick phlegm, gradually seeing bloody fluid, and a choppy, irregular pulse. Prescribed Liang Ge San plus Shi Hu and Lian Qiao, expelling much thick greasy material. Previously, a surgeon treated him as Lung Abscess without effect. I stated: "Lung Abscess must involve coughing and expectoration of foul-smelling sputum. This patient only vomits without coughing; undeniably a stomach disease." Four or five days after purgation, vomiting recurred. Treated again with small doses; after three purgations, the condition stabilized. Then regulated with Bao Yuan Ling Ju Tang, recovering in twenty days. Previously, a Mr. Li suffered from this, focusing solely on clearing heat, resolving phlegm, and detoxifying. Until the diaphragm edge ulcerated and pus flowed profusely, lingering for a month until death. Truly due to delayed intervention, until the condition became hopeless, regretting too late. (From *Yi Tong*)
Prescriptions: To treat heat gathering in the gastric epigastrium, stagnating and knotting to form an abscess, Lian Qiao Sheng Ma Tang formula. (From *Sheng Ji*) (Note: i.e., Wu Xiang Lian Qiao Tang.)
To treat excess heat in the stomach fu, stagnating and knotting to form an abscess, Yang Qi unable to descend, stomach pulse deep and fine, Xi Jiao Tang formula.
Xi Jiao (sliced) Zhi Zi Ren Chi Shao Yao Chi Fu Ling (remove black skin) Huang Qin (remove black heart) She Gan (remove hairs) Da Huang (crushed and stir-fried, each 1 liang)
Coarsely grind the seven herbs into a powder. Take 5 qian bi per dose, add 1.5 sheng of water, decoct to 1 sheng, remove dregs, add 1 spoonful of honey, mix well, boil briefly, take warm after meals. (Same source)
To treat Ying and Wei non-circulation, heat gathering at the gastric opening, flesh and blood corruption, forming gastric epigastric abscess, She Gan Tang formula.
She Gan (remove hairs) Zhi Zi Ren Chi Fu Ling (remove black skin) Sheng Ma (each 1 liang) Chi Shao Yao Bai Zhu (each 1.5 liang)
Chop the six herbs to the size of hemp seeds. Take 5 qian bi per dose, add 1.5 sheng of water, decoct to 0.8 sheng, remove dregs, add 1 he of fresh Sheng Di Huang juice and 0.5 he of honey, boil three times, take warm at any time, twice daily. (Same source)