人有腹痛口渴，左足屈而不伸，伸则痛甚，手按其痛处更不可忍，人以为肠中
生痈也，然而肠中生痈不同，有大小肠之分，屈右足者大肠生痈，屈左足者小肠生
痈也。今屈而不伸者即在左足，是痈生于小肠而非生于大肠矣。惟是大肠之痈易治，
小肠之痈难医，以大肠可泻而小肠难泻也。虽然，得其法又何不可泻哉。盖大肠可
泻其火从糟粕而出，小肠可泻其火从溲溺而泄也。方用泄毒至神汤∶
金银花（三两） 茯苓（一两） 薏仁（一两） 生甘草（三钱） 车前子（三钱）
刘寄奴（三钱） 泽泻（三钱） 肉桂（一分） 水煎服。一剂而水如注，二剂而痛顿减，
三剂而症如失，不必四剂也。
此方俱利水之药，止一味金银花消毒之味，何以建功之神如此？盖小肠之毒必
须内消，而内消之药，舍金银花实无他药可代，以他药消毒皆能损伤正气，而小肠
断不可损伤，故必须以金银花为君。但金银花不能入小肠之中，今同茯苓、薏仁、
泽泻、车前子之类引入小肠，又加肉桂一分，得其气味引入膀胱，从溲溺而化。又
恐火毒太盛，诸药不能迅逐，更加刘寄奴之速祛，甘草之缓调，刚柔迟速并行，既
无留滞之虞，而复无峻烈之害，自然火毒殆尽膀胱小肠而出也。
人有腹痛呼号不已，其痛却在左腹，按之痛不可忍，不许人按，医以为食积在
大肠也，谁知是小肠之生痈耳。凡肠痈必屈其足，而今不屈足，似非肠痈之病。
然肠痈生于肠内者必屈其足。在大肠者屈右足而不伸，在小肠屈左足而不伸也。
若痈生于肠外者，皆不屈足。痛在左则小肠生痈，痛在右则大肠生痈也。至食积燥
屎之痛，时而痛，时而不痛。故痛在左，明是小肠之外生痈也。大小肠生痈于肠内
尚可破溃，而大小肠生痈于肠外断不可使之破溃者，以肠外无可出之路，皆必死之
症也，而小肠更甚，必须急早治之。方用内化丹∶
金银花（四两） 当归（二两） 车前子（五钱） 生甘草（三钱） 茯苓（一两） 薏仁（一两）
水煎服。
一剂而痛大减，二剂而痛又减，三剂而痛全止，四剂全愈。
此方即前方之变方也。但前方以利水之中而行其败毒之法，此方于利水之中补
血以败毒之法也。盖痈破利水则毒随水出，易于祛除；痈未破，不补血以利水，则
水泄而血虚，难于消化，同中之异，不可不知也。然此方亦须急早治之则有益，否
则痈虽愈而瘀血流于肠外，必有终身腹痛之病也。
人有腹痛骤甚，小便流血，左足不能伸，人以为小肠生痈也，谁知是小肠之火
太盛耳。夫小肠生痈，必屈左足，今左足不伸，明是生痈之证，而予独谓是火盛者
何故？不知生痈必有其征，未有一旦骤生而即流血者也。痈日久而脓生，脓欲尽而
血出，岂有不溃不烂而先出血者。然左足之屈则又何也？盖小肠与大肠不同，小肠
细而大肠宽，宽者可以容邪，而细者难以容邪，此必然之理。小肠受火煎熬，则肠
中逼迫，肠不能舒，而左足应之，故暂屈而不伸耳。但不可因足之不伸即信是痈，
而妄用解毒之药。然从何处辨之？因其初病之时，辨其小便之有血无血耳。初起痛
而足屈，若小便无血，乃是生痈；初起痛而足屈，小便有血，乃是火痛，断不可瘥
也。治之法泻其火邪，不必化毒而痛止足伸矣。方用小柴胡汤加味治之。
柴胡（一钱） 黄芩（三钱） 甘草（一钱） 茯苓（五钱） 人参（二钱） 半夏（一钱）
水煎服。一剂而足伸，二剂而血止，肠亦不痛矣。
小柴胡汤非治小肠之药也，何以用之而效验之捷如此。因小肠之火盛者，起于
肝胆之郁也，木郁则火生，不敢犯心而犯小肠耳。夫火性炎上，今不上炎，反致下
炽，拂其火性矣，此小肠所以受之而作疼痛也。至于流血于小便中者，又是何故？
盖是小肠之血为火所逼，惟恐为火之烁干，故越出于小肠之外，直走膀胱，反使火
道不行而流血也。小柴胡汤既舒其肝胆之气，则火气上炎，其生既顺而不逆。又
得茯苓以清消其水气，水流而血自归经，此方之所以奇耳。
【背景信息】
书名：辨证录 作者：陈士铎 朝代：清 章节：小肠痈门（三则） 类别：综合
【原文翻译】
有人出现腹痛、口渴的症状，左腿弯曲无法伸直，若强行伸直则疼痛加剧，用手按压疼痛部位更是难以忍受。人们认为这是肠道中生疮疡（中医指体内发生的化脓性疾患），然而肠道生疮疡是有区别的，分为大肠和小肠两类。如果屈曲右腿的是大肠生疮疡，屈曲左腿的是小肠生疮疡。现在患者屈曲左腿无法伸直，说明疮疡生于小肠而非大肠。只是大肠的疮疡容易治疗，小肠的疮疡难治，因为大肠可以通过泻下通便来清除病邪，而小肠难以通过泻下来清除。虽然如此，只要掌握正确的方法，又怎能不能通过泻下来治疗呢？大概大肠的火热之邪可以通过糟粕排出，小肠的火热之邪可以通过小便排出。方用泄毒至神汤：金银花（三两）、茯苓（一两）、薏仁（一两）、生甘草（三钱）、车前子（三钱）、刘寄奴（三钱）、泽泻（三钱）、肉桂（一分），水煎服。服用一剂后小便如水注般通畅，二剂后疼痛顿时减轻，三剂后症状消失，不需要用到第四剂。
这个方子全是利水的药物，只有一味金银花是消毒解毒的药，为什么能取得如此神奇的功效？大概小肠的毒邪必须从内部消散，而在内消的药物中，除了金银花实在没有别的药可以替代，因为其他药物在消毒的同时都会损伤正气，而小肠绝对不可损伤，所以必须以金银花作为君药。但是金银花本身不能直接进入小肠，现在配合茯苓、薏仁、泽泻、车前子等药物将其引入小肠，又加入一分肉桂，借其气味引入膀胱，从小便中化解。又担心火毒太盛，普通药物不能迅速驱逐，因此加上刘寄奴以快速祛除瘀滞，甘草以缓和调理，刚猛与柔和、迟缓与迅疾并行，既没有留滞的担忧，又没有峻烈药物的危害，自然火毒就会完全随膀胱和小便排出体外。
有人腹痛呼叫不止，疼痛位于左侧腹部，按压时疼痛难以忍受，不允许别人按压，医生认为是食积在大肠，谁知却是小肠生疮疡。凡是肠痈（肠道生疮疡）必定会屈曲双腿，而现在不屈曲双腿，似乎不是肠痈的病证。然而肠痈生于肠内的必定会屈曲双腿。在大肠的屈曲右腿而不伸直，在小肠的屈曲左腿而不伸直。如果疮疡生于肠外，都不会屈曲双腿。疼痛在左侧则是小肠生疮疡，疼痛在右侧则是大肠生疮疡。至于食积和燥屎引起的疼痛，是时而疼痛，时而不痛。所以疼痛在左侧，明确是小肠外部生疮疡。大小肠生疮疡在肠内还可以使其破溃排脓，而大小肠生疮疡在肠外绝对不能使其破溃，因为肠外没有排出的通路，都是必死的症候，其中小肠更为严重，必须尽早治疗。方用内化丹：金银花（四两）、当归（二两）、车前子（五钱）、生甘草（三钱）、茯苓（一两）、薏仁（一两），水煎服。
服用一剂后疼痛大幅减轻，二剂后疼痛再次减轻，三剂后疼痛完全停止，四剂后痊愈。
这个方子是前方（泄毒至神汤）的变方。但前方是在利水中进行败毒的方法，此方是在利水中结合补血以败毒的方法。大概疮疡已破溃，利水则毒邪随水而出，易于祛除；疮疡未破溃，若不补血而单纯利水，则会导致水液流失而血液亏虚，难以消化毒邪，同中有异，不可不知道。然而此方也必须尽早治疗才有益处，否则即使疮疡愈合，瘀血流入肠外，也必然导致终身腹痛的疾病。
有人腹痛突然剧烈，小便带血，左腿不能伸直，人们认为是小肠生疮疡，谁知却是小肠火气太盛罢了。小肠生疮疡，必定屈曲左腿，现在左腿不伸直，明显是生疮疡的证候，而我唯独说是火盛是什么原因？不知道生疮疡必有其征兆，没有一开始突然发生就流血的。疮疡日久才会产生脓液，脓液将尽时才会有血液流出，难道有不溃烂而先出血的吗？那么左腿屈曲又是为什么呢？大概小肠与大肠不同，小肠细而大肠宽，宽的可以容纳邪气，而细的难以容纳邪气，这是必然的道理。小肠受火气煎熬，则肠中逼迫紧张，肠管不能舒展，从而反映在左腿上，所以暂时屈曲而不伸直。但不可以因为腿部不伸直就相信是疮疡，而妄用解毒药物。那么从哪里辨别呢？从其初病之时，辨别小便中有血还是无血即可。初起时疼痛且腿部屈曲，如果小便无血，乃是生疮疡；初起时疼痛且腿部屈曲，如果小便有血，乃是火痛，断然不会自愈。治疗方法是泻其火邪，不必化解毒邪，疼痛自止，腿部自伸。方用小柴胡汤加味治疗。
柴胡（一钱）、黄芩（三钱）、甘草（一钱）、茯苓（五钱）、人参（二钱）、半夏（一钱），水煎服。服用一剂后腿部伸直，二剂后出血停止，肠道也不再疼痛。
小柴胡汤并非治疗小肠的药物，为什么使用它却见效如此快捷？因为小肠火气旺盛，起因于肝胆之气郁结，木气郁结则生火，火不敢侵犯心脏而侵犯小肠。火性炎上，现在火不上炎，反而在下部炽盛，违背了火的本性，这就是小肠因此遭受痛苦而产生疼痛的原因。至于小便中流血，又是什么缘故？大概是小肠的血液被火气逼迫，唯恐被火气烧干，所以溢出到小肠之外，直接流向膀胱，反而使火道不通而流血。小柴胡汤既然疏解了肝胆之气，则火气向上炎升，其生发顺畅而不逆乱。再加上茯苓以清消水气，水流则血液自然回归经脉，这就是此方奇妙的原因。
[Background Information]
Book: Bian Zheng Lu (Record of Syndrome Differentiation)
Author: Chen Shiduo
Dynasty: Qing
Chapter: Xiao Chang Yong Men (Section on Small Intestine Abscess, Three Cases)
Category: Comprehensive
[English Translation]
A patient presents with abdominal pain and thirst, with the left leg flexed and unable to extend. Extension exacerbates the pain, and palpation of the painful area is intolerable. Laypeople might assume this is an abscess (Zhongyi term for internal suppurative disease) in the intestines. However, intestinal abscesses differ between the large intestine and the small intestine. Flexion of the right leg indicates a large intestine abscess, while flexion of the left leg indicates a small intestine abscess. Since the patient’s left leg is flexed and cannot extend, the abscess is located in the small intestine, not the large intestine. Generally, large intestine abscesses are easier to treat because their pathogenic factors can be purged via feces, whereas small intestine abscesses are difficult to treat because they are hard to purge via defecation. Nevertheless, if the correct method is employed, purgation is possible. The fire-heat in the large intestine exits through feces, while the fire-heat in the small intestine exits through urine. The prescription used is Xi Du Zhi Shen Tang (Toxin-Draining Supreme Divine Decoction): Jin Yin Hua (Lonicerae Japonicae Flos, 3 liang), Fu Ling (Poria, 1 liang), Yi Ren (Coicis Semen, 1 liang), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 3 qian), Che Qian Zi (Plantaginis Semen, 3 qian), Liu Ji Nu (Artemisiae Anethifoliae Herba, 3 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Rou Gui (Cinnamomi Cortex, 1 fen). Decoct in water and take orally. After one dose, urination becomes profuse like a stream; after two doses, pain decreases significantly; after three doses, symptoms disappear completely, without needing a fourth dose.
This formula consists mainly of diuretic herbs, with only one herb, Jin Yin Hua (Lonicerae Japonicae Flos), possessing detoxifying properties. Why does it achieve such miraculous results? The toxin in the small intestine must be resolved internally. Among internal-resolving herbs, Jin Yin Hua (Lonicerae Japonicae Flos) has no substitute, as other detoxifying herbs damage healthy Qi (Vital Energy), which must not happen in the small intestine. Thus, Jin Yin Hua (Lonicerae Japonicae Flos) serves as the sovereign herb. However, Jin Yin Hua (Lonicerae Japonicae Flos) alone cannot enter the small intestine. It is guided into the small intestine by Fu Ling (Poria), Yi Ren (Coicis Semen), Ze Xie (Alismatis Rhizoma), and Che Qian Zi (Plantaginis Semen). Additionally, a small amount of Rou Gui (Cinnamomi Cortex) guides the qi and flavor into the bladder, allowing resolution through urination. To prevent excessive fire-toxin from resisting rapid expulsion, Liu Ji Nu (Artemisiae Anethifoliae Herba) is added for swift removal of stasis, and Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) is added for gentle regulation. This combination of firm and soft, slow and fast actions prevents stagnation without causing harsh side effects, ensuring that fire-toxin is entirely expelled via the bladder and urine.
Another patient suffers from incessant crying due to abdominal pain localized in the left abdomen. Palpation is intolerable, and the patient refuses touch. Physicians may diagnose food retention in the large intestine, but it is actually a small intestine abscess. Typically, intestinal abscesses cause the patient to flex their legs. The current lack of leg flexion might suggest it is not an intestinal abscess. However, abscesses *inside* the intestine cause leg flexion: right leg flexion indicates large intestine involvement, and left leg flexion indicates small intestine involvement. If the abscess is *outside* the intestine, leg flexion does not occur. Pain on the left indicates a small intestine abscess; pain on the right indicates a large intestine abscess. In contrast, pain from food retention or dry stool is intermittent. Therefore, persistent pain on the left clearly indicates an external small intestine abscess. Abscesses inside the large or small intestine can be allowed to rupture and drain, but those outside cannot, as there is no exit pathway, leading to certain death. This is especially critical for the small intestine, requiring urgent treatment. The prescription used is Nei Hua Dan (Internal-Dissolving Pill/Decoction): Jin Yin Hua (Lonicerae Japonicae Flos, 4 liang), Dang Gui (Angelicae Sinensis Radix, 2 liang), Che Qian Zi (Plantaginis Semen, 5 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 3 qian), Fu Ling (Poria, 1 liang), Yi Ren (Coicis Semen, 1 liang). Decoct in water and take orally.
After one dose, pain decreases significantly; after two doses, it decreases further; after three doses, pain ceases completely; after four doses, full recovery occurs.
This formula is a variation of the previous one (Xi Du Zhi Shen Tang). The previous formula promotes detoxification within diuresis, whereas this formula promotes detoxification within blood-nourishing diuresis. When an abscess has ruptured, diuresis helps expel toxins easily. When an abscess has not ruptured, diuresis without blood nourishment leads to fluid loss and blood deficiency, making toxin resolution difficult. These nuances must be understood. Urgent treatment is still required; otherwise, even if the abscess heals, blood stasis flowing outside the intestine will cause lifelong abdominal pain.
A third patient experiences sudden severe abdominal pain, hematuria (blood in urine), and inability to extend the left leg. People suspect a small intestine abscess, but it is actually excessive fire-heat in the small intestine. A small intestine abscess typically causes left leg flexion. Since the leg is not extending, it appears to be an abscess. Why do I attribute it to excess fire? Abscesses have specific signs; they do not appear suddenly with bleeding. Abscesses produce pus over time, and blood appears only when pus is nearly exhausted. How could there be bleeding before ulceration? Then why is the left leg flexed? The small intestine is narrow, while the large intestine is wide. The wide intestine can accommodate pathogens, but the narrow one cannot. This is a fundamental principle. When the small intestine is scorched by fire, internal pressure increases, preventing the intestine from relaxing, which reflexively causes the left leg to flex temporarily. One should not assume it is an abscess solely based on leg position and blindly use detoxifying herbs. How to differentiate? Observe the presence or absence of blood in the urine at onset. If pain and leg flexion occur without blood in the urine, it is an abscess. If pain and leg flexion occur with blood in the urine, it is fire-pain, which will not heal spontaneously. The treatment is to purge the fire-pathogen; detoxification is unnecessary, and pain will cease while the leg extends. The prescription is Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications: Chai Hu (Bupleuri Radix, 1 qian), Huang Qin (Scutellariae Radix, 3 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 1 qian), Fu Ling (Poria, 5 qian), Ren Shen (Ginseng Radix, 2 qian), Ban Xia (Pinelliae Rhizoma Preparatum, 1 qian). Decoct in water and take orally. After one dose, the leg extends; after two doses, bleeding stops, and intestinal pain ceases.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) is not typically a direct treatment for the small intestine. Why is it so effective here? Excessive fire in the small intestine originates from liver-gallbladder Qi stagnation. Wood stagnation generates fire, which attacks the small intestine rather than the heart. Fire naturally flares upward; here, it fails to rise and instead blazes downward, violating its nature, causing small intestine pain. As for blood in the urine, the fire forces blood out of the small intestine vessels to avoid being dried up by the heat. The blood escapes the small intestine, flows directly into the bladder, obstructs the fire pathway, and results in bleeding. Xiao Chai Hu Tang (Minor Bupleurum Decoction) soothes liver-gallbladder Qi, allowing fire to rise smoothly and naturally. Combined with Fu Ling (Poria) to clear dampness/water, the flow of water allows blood to return to its vessels. This synergy explains the miracle of this formula.