经曰∶巨阙隐隐痛者心疽，其上肉微起者心痈。（巨阙穴在鸠尾下一寸，心之募也。）
王肯堂曰∶心痈始发巨阙穴，必隐痛微肿，令人寒热身痛，头面色赤，口渴随
饮随干。由心火炽盛，更兼酷饮嗜热而成，宜服凉血饮。如酒毒为病，宜升麻葛根汤
治之。但此证甚属罕有，而治法不可不备。
凉血饮
生地 麦门冬 连翘 天花粉 木通 赤芍 荆芥 车前子 瞿麦 白芷 甘草 薄荷 山栀（各等分）
灯芯为引。潮热引加淡竹叶。
升麻葛根汤
升麻 柴胡 黄芩 白芍 葛根 木通 山栀 黄连 甘草 水煎服。
经曰∶期门隐隐痛者肝疽，其上肉微起者肝痈。（期门穴，又名肝募，在乳旁一寸半，再直上一寸半。）
《素问》曰∶肝痈两 满，卧则惊，不得小便。
华真君曰∶肝痈不可用针刺，须用内消内散。（《秘录》）
陈远公曰∶人素多恼怒，容易动气，一旦两胁胀满，发寒发热，已而胁痛之至，按
之疼不可忍，人以为肝火盛也，谁知肝叶生疮乎！人但知肺生痈，不知肝亦能生痈
也，且《灵》、《素》诸书，亦未详言，得毋创论以惊俗乎！余闻异人云∶胁疼手不
可按者，肝叶生痈也。《灵》、《素》未详者，以肝痈世不常有，所以略之也。凡古今之
气运不同，痈毒之生长不一，肝能生痈，乌可缺而不论乎！况肝之生痈，未尝无理也，
肝一恼怒，则叶开张，肝气即逆，大怒之后，肝叶空胀，未易平复。设使时加恼怒，
是肝叶竟不得安，且怒后必然动火，怒益多而火益盛，盛必灼干肝血，血干则肝气
大燥，无血养肝，更易发怒，欲不郁结成痈，乌可得乎？然痈生于内，何从而见，然
外可辨也。肝痈生在左而不在右，左胁之皮必见红紫之色，而舌必见青色也。此而
辨之，断断无差，治必以平肝为主，佐以泻火去毒，切不可因循令其溃烂而不可救
也。化肝消毒汤∶白芍、当归各三两，金银花五两，黑山栀五钱，生甘草三钱。水
煎三剂疼止，又减半服，数服全愈。（《冰鉴》。此方以归芍入肝以滋肝血，则肝血骤生，易平肝血之燥，
又得甘草缓急，栀子清火，银花解毒，安得不效哉。唯是火毒大盛，肝血大亏，不如此大剂，亦自徒然。倘执
以肝火之旺，非肝痈之证，只用当、芍治胁痛，必不效也。）
又曰∶有左胁大痛，按之尤甚，此肝痈耳，非胁痛也。肝痈多得之恼怒，前条
已论之矣。然而忧郁亦能生痈也，惟恼怒得者其痛骤，忧郁得者其痛缓，初痛之时，
逍遥散大剂煎饮，痛立止矣，何至成痈也。因失于速治，而肝中郁气，若不能宣，而
血因之结矣。血结不通，遂化脓而成痈，其势似缓，然肝性最急，痈成而毒发甚骤也。
有胁疼数日而死者，正因生痈毒败而死，非胁痛能死也，可不急为治之乎！宣郁化毒
汤∶柴胡、薄荷、香附各二钱，白芍、当归、金银花各一两，生甘草、天花粉各三
钱，陈皮、枳壳各一钱，水煎服，四剂全愈，重则六剂，后用四物汤大剂调治，不
再发也，此证世不常有，前论已悉，然肝
痈少见，而胁痛世所常有，余特发明忧郁之能成痈，又如此人知急治，何至成痈哉。
朱丹溪曰∶肝痈始发期门穴，必隐痛微肿，令人两脚胀满胁痛，侧卧则惊，便
溺艰难，由愤郁气逆而成。初服复元通气散，次服柴胡清肝汤；痛胀已止，宜六味
地黄丸；脾虚食少，佐以八珍汤滋肾补脾治之。
《黄帝内经》说：巨阙穴处隐隐作痛的，是心疽；该处肌肉微微隆起的，是心痈。（巨阙穴位于鸠尾穴下一寸，是心的募穴。）
王肯堂说：心痈起初在巨阙穴发作，必定隐痛且微肿，使人感到寒热交替、身体疼痛，头部和面色发红，口渴想喝水但喝完立刻又干。这是由于心火炽盛，再加上大量饮用热性饮品而形成的，适宜服用凉血饮。如果是酒毒致病，适宜用升麻葛根汤治疗。但这种病症非常罕见，然而治疗方法不可不准备齐全。
凉血饮
生地黄、麦门冬、连翘、天花粉、木通、赤芍、荆芥、车前子、瞿麦、白芷、甘草、薄荷、山栀（各等分）
以灯芯草为引药。若有潮热症状，加淡竹叶。
升麻葛根汤
升麻、柴胡、黄芩、白芍、葛根、木通、山栀、黄连、甘草，水煎服。
《黄帝内经》说：期门穴处隐隐作痛的，是肝疽；该处肌肉微微隆起的，是肝痈。（期门穴，又名肝募穴，位于乳头旁一寸半，再直上一寸半处。）
《素问》说：肝痈表现为两胁胀满，睡觉时容易惊醒，小便不通畅。
华真君说：肝痈不能用针刺治疗，必须采用内消和内散的方法。（出自《秘录》）
陈远公说：人如果平时容易恼怒，动不动就生气，一旦感到两胁胀满，出现发冷发热，随后胁部疼痛剧烈，按压时疼得无法忍受，人们以为这是肝火旺盛，谁知道竟是肝叶生了疮疡呢！人们只知道肺会生痈，不知道肝也能生痈，而且《灵枢》、《素问》等书中也没有详细记载，这难道不是创论来惊世骇俗吗？我听说有异人说：胁部疼痛且手不能按触的，就是肝叶生痈。《灵枢》、《素问》没有详细记载，是因为肝痈世间不常有，所以省略了。大凡古今的气运不同，痈毒的生长情况也不一样，肝能生痈，怎么能缺而不讨论呢？况且肝生痈并非没有道理，人一恼怒，肝叶就会张开，肝气随即上逆，大怒之后，肝叶空虚胀大，不容易平复。假如时时恼怒，那么肝叶就不得安宁，而且发怒后必然动火，怒气越多火势越盛，火势旺盛必然会灼干肝血，血液干枯则肝气大燥，没有血液滋养肝脏，更容易发怒，想要不郁结形成痈肿，怎么可能呢？然而痈生于体内，从哪里能看出来呢？但是可以从外部辨别。肝痈生在左边而不在右边，左侧胁部的皮肤必定呈现红紫色，舌头上必定呈现青色。这样辨别，绝对没有差错，治疗必须以平肝为主，辅以泻火去毒，切不可拖延导致溃烂而无法救治。化肝消毒汤：白芍、当归各三两，金银花五两，黑山栀五钱，生甘草三钱。水煎服三剂疼痛停止，再减半量服用，服用几剂后痊愈。（出自《冰鉴》。此方用当归、白芍入肝以滋补肝血，则肝血迅速生成，容易平息肝血的燥热，又得到甘草缓解急迫，栀子清火，银花解毒，怎能无效呢？只是当火毒极盛，肝血大亏时，不用如此大的剂量也是徒劳。倘若固执地认为这只是肝火旺而非肝痈证，只用当归、白芍治疗胁痛，必定无效。）
又说：有人左胁部剧烈疼痛，按压时更甚，这是肝痈，不是普通的胁痛。肝痈大多由恼怒引起，前面的条文已经论述过了。然而忧郁也能生痈，因恼怒得的病其疼痛突然，因忧郁得的病其疼痛缓慢。初痛之时，用大剂量的逍遥散煎服，疼痛立即停止，怎么会发展成痈呢？因为未能及时快速治疗，导致肝中郁结之气不能宣散，血液因此凝结。血液凝结不通，于是化脓形成痈肿，其势头似乎缓慢，但肝性最急躁，痈成之后毒发非常迅猛。有的人胁痛几天后就死了，正是因为生了痈毒败坏而死，不是普通的胁痛能致死的，能不急于治疗吗？宣郁化毒汤：柴胡、薄荷、香附各二钱，白芍、当归、金银花各一两，生甘草、天花粉各三钱，陈皮、枳壳各一钱，水煎服，四剂痊愈，重症六剂，之后用大剂量的四物汤调理，不再复发。这种病症世间不常有，前面的论述已经详尽，然而肝痈少见，而胁痛世间常见，我特意阐明忧郁能形成痈肿，像这样的人知道急于治疗，怎么会发展成痈呢？
朱丹溪说：肝痈起初在期门穴发作，必定隐痛微肿，使人两脚胀满、胁痛，侧卧时易惊，小便排尿困难，这是由于愤懑忧郁、气机逆乱而形成的。初期服用复元通气散，接着服用柴胡清肝汤；疼痛胀满停止后，宜服用六味地黄丸；若脾虚食少，辅以八珍汤滋肾补脾治疗。
The *Classic of Difficult Issues* (Jing Yue) states: If there is a dull pain at the Juque point, it is Heart Carbuncle (Xin Ju); if the flesh above slightly protrudes, it is Heart Abscess (Xin Yong). (The Juque point is located one cun below the Jiutui point and is the Front-Mu point of the Heart.)
Wang Kentang stated: Heart Abscess initially manifests at the Juque point, characterized by dull pain and slight swelling, causing chills and fever, body aches, redness of the head and face, and thirst that persists immediately after drinking. This arises from blazing Heart Fire compounded by excessive consumption of hot beverages. It is suitable to take Liangxue Yin (Cool Blood Decoction). If the disease is caused by alcohol toxicity, Shengma Gegen Tang (Ephedra and Kudzu Root Decoction) should be used for treatment. Although this condition is very rare, the treatment methods must not be neglected.
Liangxue Yin (Cool Blood Decoction)
Shengdi Huang (Rehmanniae Radix Preparata), Maidong (Ophiopogonis Tuber), Lianqiao (Forsythiae Fructus), Tianhuafen (Trichosanthis Radix), Mutong (Akebiae Caulis), Chishao (Paeoniae Radix Rubra), Jingjie (Schizonepetae Spica), Cheqianzi (Plantaginis Semen), Qumai (Dianthi Herba), Baizhi (Angelicae Dahuricae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Bohe (Menthae Haplocalycis Herba), Shanzhi (Gardeniae Fructus) (all in equal parts).
Use Dengxincao (Junci Medullia) as a guiding herb. For tidal fever, add Danzhuye (Lophatheri Herba).
Shengma Gegen Tang (Ephedra and Kudzu Root Decoction)
Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Gegen (Puerariae Lobatae Radix), Mutong (Akebiae Caulis), Shanzhi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
The *Classic of Difficult Issues* (Jing Yue) states: If there is a dull pain at the Qimen point, it is Liver Carbuncle (Gan Ju); if the flesh above slightly protrudes, it is Liver Abscess (Gan Yong). (The Qimen point, also known as the Liver Mu point, is located 1.5 cun lateral to the nipple, and another 1.5 cun directly upward.)
The *Suwen* (Basic Questions) states: Liver Abscess presents with fullness in both hypochondria, waking up startled during sleep, and difficulty urinating.
Hua Zhenjun stated: Liver Abscess cannot be treated with acupuncture; internal resolution and dispersion must be employed. (From *Milu*)
Chen Yuangong stated: People who are prone to anger and easily lose their temper may suddenly experience fullness in both hypochondria, accompanied by chills and fever, followed by severe hypochondriac pain that is unbearable upon palpation. People assume this is due to excess Liver Fire, but little do they know that sores have formed on the liver lobes! People only know that the lungs can develop abscesses, unaware that the liver can as well. Moreover, texts such as the *Lingshu* and *Suwen* do not detail this. Is this not a novel theory intended to shock the world? I heard from an unusual person that hypochondriac pain which cannot be touched indicates a liver lobe abscess. The reason the *Lingshu* and *Suwen* did not detail it is that liver abscesses are rare in the world, hence omitted. Since the Qi and Yun of ancient and modern times differ, and the growth of carbuncles and toxins varies, how can we omit discussing the liver's ability to form abscesses? Furthermore, there is logic to the liver forming abscesses. When one becomes angry, the liver lobes expand, and Liver Qi rebels. After great anger, the liver lobes become empty and distended, making it difficult to return to normal. If one continues to get angry, the liver lobes will never rest. Anger generates fire; the more anger, the stronger the fire. Excessive fire burns dry the Liver Blood. Dry blood leads to extreme dryness of Liver Qi. Without blood nourishing the liver, anger increases further. Under these conditions, how could one avoid stagnation and condensation into an abscess? However, since the abscess forms internally, how can it be seen? It can be distinguished externally. Liver abscesses occur on the left side, not the right. The skin of the left hypochondrium will show red-purple discoloration, and the tongue will appear cyanotic. With such differentiation, there will certainly be no error. Treatment must focus primarily on soothing the Liver, assisted by purging fire and removing toxins. One must not delay treatment until ulceration occurs, rendering it incurable.
Huagan Xiaodu Tang (Soothe Liver and Remove Toxin Decoction): Baishao (Paeoniae Radix Alba) and Danggui (Angelicae Sinensis Radix) each 3 liang, Jinyinhua (Lonicerae Japonicae Flos) 5 liang, Heishanzhi (Gardeniae Fructus) 5 qian, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 3 qian. Decoct in water, take three doses until pain stops, then take half the dose. A few doses will lead to complete recovery. (From *Bingjian*. This formula uses Danggui and Baishao to enter the Liver and nourish Liver Blood, rapidly generating blood to ease Liver Blood dryness. Combined with Gancao to relieve urgency, Zhizi to clear fire, and Jinyinhua to detoxify, how could it fail? Only when Fire-Toxin is extremely abundant and Liver Blood is severely deficient is such a large dosage necessary; otherwise, it is futile. If one stubbornly believes this is merely excess Liver Fire rather than a Liver Abscess, and uses only Danggui and Baishao to treat hypochondriac pain, it will certainly be ineffective.)
It is also said: Severe pain in the left hypochondrium, exacerbated by pressure, indicates Liver Abscess, not ordinary hypochondriac pain. Liver Abscess is mostly caused by anger, as discussed in previous sections. However, depression can also cause abscesses. Those caused by anger have sudden pain, while those caused by depression have gradual pain. At the initial stage of pain, a large dose of Xiaoyao San (Free and Easy Wanderer Powder) decocted and drunk will stop the pain immediately. How could it develop into an abscess? Because timely treatment was neglected, the stagnant Qi in the Liver could not be dispersed, causing Blood to congeal. Congealed Blood blocks flow, transforming into pus and forming an abscess. The progression seems slow, but the Liver nature is urgent, and once the abscess forms, the toxin erupts rapidly. Some die within days of hypochondriac pain precisely because of toxic decay from the abscess, not from simple hypochondriac pain. Should one not treat it urgently?
Xuanyu Huadu Tang (Disperse Stagnation and Resolve Toxin Decoction): Chaihu (Bupleuri Radix), Bohe (Menthae Haplocalycis Herba), Xiangfu (Cyperi Rhizoma) each 2 qian, Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Jinyinhua (Lonicerae Japonicae Flos) each 1 liang, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Tianhuafen (Trichosanthis Radix) each 3 qian, Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus Immaturus) each 1 qian. Decoct in water and take orally. Four doses lead to recovery; severe cases require six doses. Afterwards, use a large dose of Siwu Tang (Four Substances Decoction) for regulation to prevent recurrence. This condition is rare in the world, and previous discussions have covered it thoroughly. However, while Liver Abscess is rare, hypochondriac pain is common. I specifically elucidate that depression can form abscesses. If people like this knew to treat it urgently, how would it develop into an abscess?
Zhu Danxi stated: Liver Abscess initially manifests at the Qimen point, characterized by dull pain and slight swelling, causing fullness in both legs, hypochondriac pain, startling when lying on the side, and difficulty in urination. This is caused by indignation, depression, and rebellious Qi. Initially, take Fuyuan Tongqi San (Restore Origin and Unblock Qi Powder), followed by Chaihu Qinggan Tang (Bupleurum Clear Liver Decoction). Once pain and distension cease, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be taken. If there is Spleen deficiency and poor appetite, supplement with Bazhen Tang (Eight Treasures Decoction) to nourish the Kidney and tonify the Spleen.