小腹硬痛，脉迟紧者，瘀血也，宜下之。小腹 痛，脉洪数者，脓成也，宜托之。
一男子小腹痛而坚硬，小便数，汗时出，脉迟紧。以大黄汤，一剂下瘀血合许；以薏苡
仁汤，四剂而安。
一产妇小腹疼痛，小便不利。以薏苡仁汤，二剂痛止；更以四物汤加桃仁、红花，下瘀
血升
；脉迟紧，乃瘀血；下之即愈。若患甚者，腹胀大，转侧作水声，或脓从脐出，或从大便出
，宜以丸太乙膏，及托里药。
一妇人小腹肿痛，小便如淋，尺脉芤而迟。以神效栝蒌散，二剂稍愈；更以薏苡仁汤
，二剂而痊。
一男子脓已成，用云母膏，一服下脓升许，更以排脓托里药而愈。后因不守禁忌，以致
不救。
一男子里急后重，时或下脓胀痛，脉滑数，以排脓散及蜡矾丸而愈。
一妇人小腹作痛有块，脉芤而涩。以四物汤，加玄胡索、红花、桃仁、牛膝、木香、治
之而愈。
一妇人小腹隐痛，大便秘涩腹胀，转侧作水声，脉洪数。以梅仁汤，一剂诸证悉退；以
薏苡仁汤，二剂而瘥。
一妇人腹胀， 痛不食，纵小便不利，脉滑数。以太乙膏一服，脓下升许，胀痛顿退；
以神效栝蒌散，二剂而全退；更以蜡矾丸及托里药，十数剂而安。
一妇人因经水多，服涩药止之，致腹作痛，以失笑散二服而瘳。
一妇人产后恶露不尽，小腹患痛，服瓜子仁汤，下瘀血而痊。凡瘀血停滞，宜急治之，
缓则腐化为脓，最难治疗。若流注骨节，则患骨疽，失治多为败证。
附方
大黄汤 治肠痈，小腹坚肿如掌而热，按之则痛，肉色如故，或 赤微肿，小便
频数，汗出增寒，其脉迟紧者，未成脓，宜服之。
朴硝 大黄（炒，各一钱） 牡丹皮 栝蒌仁（研） 桃仁（去皮尖，各三钱） 作一剂，水
二钟，煎八分，食前，或空心温服。
牡丹皮散 治肠痈腹濡而痛，时时下脓。
牡丹皮 人参 天麻 白茯苓 黄 （炒） 薏苡仁 桃仁（去皮尖） 白芷 当归（酒拌）
川
梅仁汤 治肠痈腹痛，大便秘涩。
梅核仁（九个，去皮尖） 大黄（炒） 牡丹皮 芒硝（各一钱） 犀角（锉末，一钱） 冬瓜
仁（研，二钱） 作一剂，水二钟，煎八分，入犀角末，空心服。
神效栝蒌散（方见乳痈门）
薏苡仁汤 治肠痈腹中 痛，或胀满不食，小便涩。妇人产后多有此病，纵非痈
，服之尤效。
薏苡仁 栝蒌仁（各三钱） 牡丹皮 桃仁（去皮尖，各二钱） 作一剂，水二钟，煎八分
云母膏 治一切疮疽及肠痈（方见《丹溪纂要》）
神仙太乙膏 治痈疽，及一切疮毒，不问年月深浅，已未成脓，并治之。如发背
，先以
下；咳嗽，及喉闭缠喉风，并用新绵裹，置口中含化下；一切风赤眼，捏作小饼，贴太阳穴
，以山栀子汤下；打扑伤损外贴，内服橘皮汤下；腰膝痛者，患处贴之，盐汤下；唾血者，
桑
下一丸。妇人经脉不通，甘草汤下。一切疥，别炼油少许，和膏涂之。虎犬并蛇蝎汤火刀斧
伤，皆可内服外贴。
玄参 白芷 当归 肉桂 大黄 赤芍药 生地黄（各一两）
为咀，用麻油二斤，入铜锅内，煎至黑，滤去粗，入黄丹十二两，再煎，滴水中，捻软
硬得
行痛止。遂随前云，治证用之，无不有效，愈知此方之妙用也。
蜡矾丸（方见发背门）
失笑散 治产后心腹绞痛欲死，或血迷心窍，不知人事，及寻常腹内瘀血，或积
血作痛。又妇人气血痛之圣药也，及治疝气疼痛。
五灵脂 蒲黄（俱炒，等分） 每服二三钱，醋一合，熬成膏，入水一盏，煎七分，食前
热服。
四物汤（方见瘰 门）
排脓散 治肠痈少腹胀痛，脉滑数，或里急后重，或时时下脓。
黄 （炒） 当归（酒拌） 金银花 白芷 穿山甲（蛤粉拌炒） 防风 连翘 栝蒌（各二
钱） 作一剂，用水二钟，煎八分，食前服。或为末，每服二钱，食后蜜汤调下，亦可。
瓜子仁汤 治产后恶露不尽，或经后瘀血作痛，或肠胃停滞，瘀血作痛，或作痈
患，并效。
薏苡仁（四钱） 桃仁（去皮尖，研） 牡丹皮 栝蒌仁（各一钱） 作一剂，水二钟，煎八
分，食前服。
小腹部位坚硬且疼痛，脉象迟而紧的，是瘀血阻滞所致，适宜采用攻下法治疗。小腹疼痛，脉象洪大而数的，是脓液已经形成，适宜采用托毒排脓法治疗。
有一位男子小腹部疼痛且坚硬，小便频数，时常出汗，脉象迟而紧。使用大黄汤，服用一剂后排出约一升多的瘀血；随后使用薏苡仁汤，服用四剂后病情安定。
有一位产妇小腹部疼痛，小便不通利。使用薏苡仁汤，服用两剂后疼痛停止；接着使用四物汤加入桃仁、红花，以排出瘀血。脉象迟而紧，属于瘀血证；采用攻下法治疗后痊愈。如果病情严重的，会出现腹部胀大，身体转动时听到水声，或者脓液从肚脐流出，或从大便排出，适宜使用丸状太乙膏，以及补益气血、托毒外出的药物。
有一位妇女小腹部肿胀疼痛，小便像淋证一样频急涩痛，尺部脉象芤（中空）而迟。使用神效栝蒌散，服用两剂后症状稍有好转；接着使用薏苡仁汤，服用两剂后痊愈。
有一位男子脓液已经形成，使用云母膏，服用一次后排出脓液约一升多，接着使用排脓及补益气血、托毒外出的药物而痊愈。后来因为不遵守禁忌，导致病情恶化无法救治。
有一位男子出现里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽），时而排出脓液并伴有胀痛，脉象滑而数，使用排脓散及蜡矾丸而痊愈。
有一位妇女小腹部隐痛且有肿块，脉象芤而涩。使用四物汤，加入玄胡索、红花、桃仁、牛膝、木香，治疗而痊愈。
有一位妇女小腹部隐隐作痛，大便秘结涩滞，腹部胀满，身体转动时听到水声，脉象洪大而数。使用梅仁汤，服用一剂后所有症状全部消退；接着使用薏苡仁汤，服用两剂后病愈。
有一位妇女腹部胀满，疼痛且不能进食，即使小便不通利，脉象滑而数。服用太乙膏一次，排出脓液约一升多，胀痛立刻消退；接着使用神效栝蒌散，服用两剂后症状完全消退；再使用蜡矾丸及补益气血、托毒外出的药物，服用十数剂后病情安定。
有一位妇女因为月经量过多，服用收敛止血的药物来止血，导致腹部疼痛，服用失笑散两次后病愈。
有一位妇女产后恶露不尽，小腹部患病疼痛，服用瓜子仁汤，排出瘀血后痊愈。凡是瘀血停滞，应当紧急治疗，拖延则瘀血腐化为脓，最难治疗。如果流注到骨节，则会患骨疽（生于骨间或附骨深处的疮疡），失治大多成为败证（危重的证候）。
附方：
大黄汤：治疗肠痈，小腹部坚硬肿胀如手掌大小且发热，按压则疼痛，皮肤颜色如常，或微红微肿，小便频数，出汗且怕冷加重，脉象迟而紧的，脓液尚未形成，适宜服用此方。
朴硝、大黄（炒，各一钱）、牡丹皮、栝蒌仁（研碎）、桃仁（去皮尖，各三钱）。作为一剂，用水二钟，煎至八分，饭前或空腹温服。
牡丹皮散：治疗肠痈腹部柔软而疼痛，时常排出脓液。
牡丹皮、人参、天麻、白茯苓、黄芪（炒）、薏苡仁、桃仁（去皮尖）、白芷、当归（酒拌）、川芎。
梅仁汤：治疗肠痈腹痛，大便秘结涩滞。
梅核仁（九个，去皮尖）、大黄（炒）、牡丹皮、芒硝（各一钱）、犀角（锉成末，一钱）、冬瓜仁（研碎，二钱）。作为一剂，用水二钟，煎至八分，加入犀角末，空腹服用。
薏苡仁汤：治疗肠痈腹中疼痛，或胀满不能进食，小便涩滞。妇人产后多有此病，即使不是痈证，服用此方也特别有效。
薏苡仁、栝蒌仁（各三钱）、牡丹皮、桃仁（去皮尖，各二钱）。作为一剂，用水二钟，煎至八分。
神仙太乙膏：治疗痈疽，及一切疮毒，不论年月深浅，无论脓液是否形成，都进行治疗。如发背（背部生痈），先用……；咳嗽，及喉闭缠喉风，均用新棉包裹，置于口中含化咽下；一切风赤眼，捏成小饼，贴于太阳穴，用山栀子汤送服；打扑伤损外贴，内服橘皮汤送服；腰膝痛者，贴于患处，用盐汤送服；唾血者，用桑枝汤送服一丸。妇人经脉不通，用甘草汤送服。一切疥疮，另取少许炼油，调和药膏涂抹。虎犬咬伤及蛇蝎汤火刀斧伤，皆可内服外贴。
玄参、白芷、当归、肉桂、大黄、赤芍药、生地黄（各一两）。
切碎，用麻油二斤，放入铜锅内，煎至黑色，滤去药渣，加入黄丹十二两，再煎，滴水测试软硬适中即可。行气止痛。于是遵循前述方法，根据病症使用，没有不有效的，更加知道此方的妙用。
失笑散：治疗产后心腹绞痛欲死，或血迷心窍，不知人事，以及寻常腹内瘀血，或积血作痛。又是妇女气血痛的圣药，以及治疗疝气疼痛。
五灵脂、蒲黄（均炒，等分）。每次服用二三钱，醋一合，熬成膏，加入水一盏，煎至七分，饭前热服。
排脓散：治疗肠痈少腹胀痛，脉象滑数，或里急后重，或时常排出脓液。
黄芪（炒）、当归（酒拌）、金银花、白芷、穿山甲（蛤粉拌炒）、防风、连翘、栝蒌（各二钱）。作为一剂，用水二钟，煎至八分，饭前服用。或制成粉末，每次服用二钱，饭后蜜汤调服，也可以。
瓜子仁汤：治疗产后恶露不尽，或经后瘀血作痛，或肠胃停滞，瘀血作痛，或发生痈患，均有效。
薏苡仁（四钱）、桃仁（去皮尖，研碎）、牡丹皮、栝蒌仁（各一钱）。作为一剂，用水二钟，煎至八分，饭前服用。
The lower abdomen is hard and painful, with a slow and tight pulse; this indicates blood stasis, and purgation (Purgative method) is indicated. The lower abdomen is painful, with a surging and rapid pulse; this indicates that pus has formed, and the method of supporting the healthy qi to expel toxins (Supporting method) is indicated.
A male patient suffered from pain and hardness in the lower abdomen, frequent urination, occasional sweating, and a slow and tight pulse. He was administered Dahuang Tang (Rhubarb Decoction); after one dose, approximately one sheng of blood stasis was discharged. Subsequently, Yiyiren Tang (Coix Seed Decoction) was given for four doses, resulting in stabilization.
A postpartum woman suffered from lower abdominal pain and difficulty in urination. She was administered Yiyiren Tang (Coix Seed Decoction); after two doses, the pain ceased. Then, Siwu Tang (Four Substance Decoction) was modified with Taoren (Peach Kernel) and Honghua (Safflower) to discharge blood stasis. A slow and tight pulse indicates blood stasis; purgation leads to recovery. In severe cases, the abdomen becomes distended and large, producing a splashing sound upon turning, or pus discharges from the umbilicus or via the stool. In such instances, Taiyi Gao (Great One Ointment) in pill form, along with medicines to tonify the interior and support the healthy qi (Tonifying and Supporting methods), are indicated.
A female patient suffered from swelling and pain in the lower abdomen, urinary symptoms resembling strangury (Lin syndrome), and a knotted and slow pulse at the chi position. Shenxiao Gualou San (Miraculous Trichosanthes Powder) was administered; after two doses, symptoms slightly improved. Subsequently, Yiyiren Tang (Coix Seed Decoction) was given for two doses, leading to recovery.
A male patient had already formed pus. Yunmu Gao (Mica Ointment) was used; after one dose, approximately one sheng of pus was discharged. He was then treated with Pai Nong San (Pus-Expelling Powder) and medicines to tonify the interior and support the healthy qi, resulting in recovery. However, due to failing to observe dietary and lifestyle restrictions, his condition deteriorated fatally.
A male patient experienced tenesmus (urgent desire to defecate with heavy sensation in the rectum), occasional discharge of pus accompanied by distending pain, and a slippery and rapid pulse. Pai Nong San (Pus-Expelling Powder) and Lafan Wan (Beeswax-Alum Pill) were administered, leading to recovery.
A female patient suffered from dull pain in the lower abdomen with a palpable mass, and a knotted and choppy pulse. Siwu Tang (Four Substance Decoction) was modified with Yuanhuxue (Corydalis Rhizome), Honghua (Safflower), Taoren (Peach Kernel), Niuxi (Achyranthes Root), and Muxiang (Aucklandia Root), resulting in recovery.
A female patient suffered from dull pain in the lower abdomen, constipation with dry stools, abdominal distension, a splashing sound upon turning, and a surging and rapid pulse. Meiren Tang (Plum Kernel Decoction) was administered; after one dose, all symptoms subsided. Subsequently, Yiyiren Tang (Coix Seed Decoction) was given for two doses, leading to recovery.
A female patient suffered from abdominal distension, pain, anorexia, even if accompanied by difficulty in urination, and a slippery and rapid pulse. One dose of Taiyi Gao (Great One Ointment) resulted in the discharge of approximately one sheng of pus, with immediate relief of distension and pain. Shenxiao Gualou San (Miraculous Trichosanthes Powder) was then administered for two doses, causing complete resolution of symptoms. Finally, Lafan Wan (Beeswax-Alum Pill) and medicines to tonify the interior and support the healthy qi were given for over ten doses, leading to stability.
A female patient took astringent herbs to stop excessive menstrual bleeding, which led to abdominal pain. Shixiao San (Staggering Shock Powder) was administered twice, leading to recovery.
A postpartum woman suffered from incomplete lochia discharge and lower abdominal pain. Guazi Ren Tang (Melon Seed Decoction) was administered, discharging blood stasis and leading to recovery. Any stagnation of blood stasis should be treated urgently; delay allows the stasis to rot and transform into pus, which is difficult to treat. If it flows into the bone joints, it may cause Guju (Bone Abscess). Failure to treat properly often results in fatal complications.
Attached Formulas:
Dahuang Tang (Rhubarb Decoction): Treats Changyong (Intestinal Abscess) characterized by hardness and swelling in the lower abdomen like a palm, heat, tenderness on pressure, normal skin color or slight redness/swelling, frequent urination, sweating with increased aversion to cold, and a slow and tight pulse. This formula is indicated when pus has not yet formed.
Ingredients: Xiaoshi (Mirabilite), Dahuang (Rhubarb Root and Rhizome, stir-fried, 1 qian each), Mudanpi (Tree Peony Bark), Gualouren (Trichosanthes Seed, crushed), Taoren (Peach Kernel, peeled and removed of pits, 3 qian each). Prepare as one dose. Add two zhong of water, decoct until eight parts remain. Take warm before meals or on an empty stomach.
Mudanpi San (Tree Peony Bark Powder): Treats Changyong (Intestinal Abscess) with soft abdomen and pain, and frequent discharge of pus.
Ingredients: Mudanpi (Tree Peony Bark), Renshen (Ginseng Root), Tianma (Gastrodia Rhizome), Baifuling (Poria, white), Huangqi (Astragalus Root, stir-fried), Yiyiren (Coix Seed), Taoren (Peach Kernel, peeled and removed of pits), Baizhi (Angelica Dahurica Root), Danggui (Chinese Angelica Root, soaked in wine), Chuanxiong (Szechwan Lovage Rhizome).
Meiren Tang (Plum Kernel Decoction): Treats Changyong (Intestinal Abscess) with abdominal pain and constipation with dry stools.
Ingredients: Meiheren (Prunus mume kernel, 9 pieces, peeled and removed of pits), Dahuang (Rhubarb Root and Rhizome, stir-fried), Mudanpi (Tree Peony Bark), Mangxiao (Mirabilite, 1 qian each), Xijiao (Rhinoceros Horn, powdered, 1 qian), Dongguaren (Winter Melon Seed, crushed, 2 qian). Prepare as one dose. Add two zhong of water, decoct until eight parts remain. Add Xijiao powder and take on an empty stomach.
Shenxiao Gualou San (Miraculous Trichosanthes Powder) (See Ru Yong Men section for formula details).
Yiyiren Tang (Coix Seed Decoction): Treats Changyong (Intestinal Abscess) with abdominal pain, or distension and anorexia, and astringent urination. This condition is common in postpartum women. Even if it is not an abscess, this formula is particularly effective.
Ingredients: Yiyiren (Coix Seed), Gualouren (Trichosanthes Seed, 3 qian each), Mudanpi (Tree Peony Bark), Taoren (Peach Kernel, peeled and removed of pits, 2 qian each). Prepare as one dose. Add two zhong of water, decoct until eight parts remain.
Yunmu Gao (Mica Ointment): Treats all sores, carbuncles, and Changyong (Intestinal Abscess) (See Danxi Zuan Yao for formula details).
Shenxian Taiyi Gao (Immortal Great One Ointment): Treats carbuncles, sores, and all kinds of toxic swellings, regardless of duration or whether pus has formed. For Fabei (Back Carbuncle), apply first...; for cough, Houbi (Throat Closure), and Chanhoufeng (Choked Throat Wind), wrap in new cotton and hold in mouth to dissolve and swallow; for all wind-red eyes, shape into small cakes and apply to Taiyang acupoints, taken with Shanzhizi Tang (Gardenia Decoction); for traumatic injuries, apply externally and take Jupi Tang (Tangerine Peel Decoction) internally; for waist and knee pain, apply to the affected area and take with Salt Water; for hemoptysis, take one pill with Sangzhi Tang (Mulberry Twig Decoction). For amenorrhea, take with Gancao Tang (Licorice Decoction). For all scabies, mix with a little refined oil and apply. For bites from tigers, dogs, snakes, scorpions, burns, scalds, cuts, and axe wounds, it can be taken internally and applied externally.
Ingredients: Xuanshen (Scrophularia Root), Baizhi (Angelica Dahurica Root), Danggui (Chinese Angelica Root), Rougui (Cinnamon Bark), Dahuang (Rhubarb Root and Rhizome), Chi Shaoyao (Red Peony Root), Sheng Dihuang (Rehmannia Root, raw, 1 liang each).
Cut into pieces. Use two jin of sesame oil, add to a copper pot, decoct until black, filter out dregs. Add twelve liang of Huangdan (Lead Monoxide), decoct again. Test consistency by dropping into water; knead until soft and suitable. It moves qi and stops pain. Thus, following the aforementioned methods and applying according to symptoms yields excellent results, confirming the efficacy of this formula.
Lafan Wan (Beeswax-Alum Pill) (See Fabei Men section for formula details).
Shixiao San (Staggering Shock Powder): Treats postpartum heart and abdominal colic severe enough to cause death, or blood confusing the mind orifices leading to unconsciousness, as well as ordinary intra-abdominal blood stasis or pain caused by accumulated blood. It is also a sacred medicine for women's qi and blood pain, and treats hernia pain.
Ingredients: Wulingzhi (Trogopterus Dung), Puhuang (Lygodium Spore, both stir-fried, equal parts). Take 2-3 qian per dose. Add one he of vinegar, boil into a paste. Add one zhong of water, decoct until seven parts remain. Take hot before meals.
Siwu Tang (Four Substance Decoction) (See Luoli Men section for formula details).
Pai Nong San (Pus-Expelling Powder): Treats Changyong (Intestinal Abscess) with lower abdominal distension and pain, slippery and rapid pulse, tenesmus, or frequent discharge of pus.
Ingredients: Huangqi (Astragalus Root, stir-fried), Danggui (Chinese Angelica Root, soaked in wine), Jinyinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica Root), Chuanshanjia (Pangolin Scale, stir-fried with clam powder), Fangfeng (Saposhnikovia Root), Lianqiao (Forsythia Fruit), Gualou (Trichosanthes Fruit, 2 qian each). Prepare as one dose. Add two zhong of water, decoct until eight parts remain. Take before meals. Alternatively, make into powder, take 2 qian per dose, mixed with honey water after meals.
Guazi Ren Tang (Melon Seed Decoction): Treats incomplete lochia discharge postpartum, pain from blood stasis after menstruation, gastrointestinal stagnation with blood stasis pain, or occurrence of abscesses. All are effective.
Ingredients: Yiyiren (Coix Seed, 4 qian), Taoren (Peach Kernel, peeled and removed of pits, crushed), Mudanpi (Tree Peony Bark), Gualouren (Trichosanthes Seed, 1 qian each). Prepare as one dose. Add two zhong of water, decoct until eight parts remain. Take before meals.