人有素多恼怒，容易动气，一旦两胁胀满，发寒发热，既而胁痛之极，手按痛
处不可忍，人以为肝火之盛也，谁知是肝叶生疮耳。世人但知五脏中惟肺生痈，不
知肝亦能生痈也。且《灵》、《素》诸书亦未有及，得毋创论以惊世乎。余实闻异
人有谓∶胁痛手不可按者，肝叶生痈也。《灵》、《素》二经不谈者，肝经生痈世不常
有，古人未有此症，所以晷而不言。盖古今之气运不同，而痈毒之生长不一。肝一
恼怒，则肝叶张开，肝气即逆。大怒之后，肝叶空胀，未易平复。且怒必动火，怒
愈多而火愈盛，火盛必烁干肝血，烁干则肝气大燥，无血养肝更易发怒。怒气频伤，
欲不郁结而成痈，乌可得乎。然痈生于内，何从而见。然内不可见而外即可辩也。
凡生痈者，胁在左而不在右，左胁之皮必现红紫色，而舌必现青色，以此辩症，断
断无瘥。治之法，必平肝为主而佐之泻火去毒之药，万不可因循时日，令其溃烂而
不可救也。方用化肝消毒汤∶
白芍（三两） 当归（三两） 炒栀子（五钱） 生甘草（三钱） 金银花（五两） 水煎汁一碗，
饮之。
一剂而痛轻，二剂而痛又轻，三剂而痛如失。减半再服数剂而全愈。
此方用当归、白芍直入肝中以滋肝血，则肝血骤生，易解肝血之燥。又得甘草
以缓其急，栀子清火，金银花解毒，安得不取效之捷哉。盖是火毒既盛，肝血大亏，
用此方而不如此大剂煎饮，亦自徒然。倘执以肝火之旺而非是肝痈之成，单用归、
芍以治胁痛，断不能取效也。
人有左胁间疼痛非常，手按之更甚，人以为胁痛，而不知非胁痛也，此乃肝经
之痈耳。夫肝经生痈，多得之恼怒，予前条已畅论之矣。然而肝痈不止恼怒能生，
而忧郁亦未尝不生痈也。惟因恼怒而得之者，其痛骤；因忧郁而得之者，其痛缓。
当初痛之时，用逍遥散大剂煎饮，痛立止，又何至成痈也。因失于速治，而肝中郁
气苦不能宣，而血因之结矣。血结不通，遂化脓而成痈，其势似乎稍缓，然肝性最
急，痈成而毒发其骤也。世有胁痛数日而死者，正因生痈毒败而死，非胁痛而即能
死人，可不急救治之乎。方用宣郁化毒汤∶
柴胡（二钱） 白芍（一两） 香附（二钱） 薄荷（二钱） 当归（一两） 陈皮（一钱） 枳壳（一钱）
天花粉（三钱） 生甘草（三钱） 金银花（一两） 水煎服。一剂而痛轻，二剂而痛减，三剂而痛又减，
四剂全愈。重则不出六剂。愈后用四物汤大剂调治，不再发也。
夫肝痈世不常见，既有前条，不必又论及此。然肝痈不可见，而胁痛世人之所
常病，吾特发明忧郁之能成又若此，则人知急治，何至成痈哉。
有一个人性情易怒，容易动气，一旦感到两侧胁肋部胀满，出现怕冷发热的症状，随后胁痛剧烈到极点，用手按压疼痛部位时痛苦难忍。人们认为这是肝火旺盛所致，却不知这是肝叶生疮（肝痈）。世人只知道五脏中只有肺会生痈，却不知道肝脏也能生痈。而且《灵枢》、《素问》等经典著作中也未曾提及这一点，难道是我提出创论来惊世骇俗吗？我确实曾听一位异人说过：胁痛且手不可触碰的，是肝叶生了痈疽。《灵枢》、《素问》这两部经典不谈此症，是因为肝经生痈在世间并不常见，古人没有遇到过这种病症，所以顺着道理而没有记载。大概古今的气运不同，而痈毒的生长情况也不一样。肝脏一旦因恼怒而受损，则肝叶张开，肝气随即上逆。在大怒之后，肝叶空虚胀大，不容易平复。况且愤怒必定引动火邪，愤怒越多，火邪越盛；火邪旺盛必然煎熬耗干肝血，血液被熬干则肝气极度干燥，没有血液滋养肝脏更容易发怒。怒气频繁伤害肝脏，想要不郁结而成痈，怎么可能呢？然而痈生于体内，从哪里能看出来呢？虽然内部看不见，但外部是可以辨别的。凡是生痈的，疼痛部位在左侧而不在右侧，左侧胁部的皮肤必定呈现红紫色，舌头上必定呈现青色，根据这些来辨证，断定无法治愈。治疗的方法，必须以平抑肝气为主，辅以泻火解毒的药物，万万不可拖延时日，导致其溃烂而无法救治。方用化肝消毒汤：
白芍（三两） 当归（三两） 炒栀子（五钱） 生甘草（三钱） 金银花（五两），水煎取汁一碗，服用。
服一剂后疼痛减轻，服两剂后疼痛更轻，服三剂后疼痛消失。减半剂量再服几剂即可痊愈。
此方使用当归、白芍直接入肝中以滋养肝血，则肝血迅速生成，容易解除肝血的燥热。又得到甘草来缓解急迫，栀子清泄火邪，金银花解毒，怎么能不取得如此迅速的疗效呢？因为火毒既已旺盛，肝血大亏，使用此方如果不如此大剂量煎煮服用，也是徒劳无功。如果固执地认为是肝火旺盛而不是肝痈形成，仅用当归、白芍来治疗胁痛，绝对不可能取得疗效。
有人左侧胁间疼痛非常剧烈，用手按压时更加严重，人们以为是胁痛，却不知道这不是普通的胁痛，而是肝经的痈疽。肝经生痈，大多是由于恼怒引起，我在前一条中已经详细论述过了。然而肝痈不仅仅由恼怒产生，忧郁也未曾不能生痈。只是因恼怒而得的，疼痛突然发作；因忧郁而得的，疼痛缓慢发生。当初疼痛的时候，如果用逍遥散大剂量煎煮服用，疼痛立刻停止，又何至于发展成痈呢？因为未能及时快速治疗，导致肝中郁结之气苦于不能宣通，血液因此凝结。血液凝结不通，于是化脓而成痈，其势头似乎稍微缓和，然而肝性最急躁，痈成而毒发也是迅猛的。世间有胁痛几天就死亡的，正是因为生了痈毒败坏而死，并非单纯的胁痛就能使人死亡，难道不可以紧急救治吗？方用宣郁化毒汤：
柴胡（二钱） 白芍（一两） 香附（二钱） 薄荷（二钱） 当归（一两） 陈皮（一钱） 枳壳（一钱） 天花粉（三钱） 生甘草（三钱） 金银花（一两），水煎服用。服一剂后疼痛减轻，服两剂后疼痛减少，服三剂后疼痛又减，服四剂完全痊愈。病情重的不出六剂。痊愈后用四物汤大剂量调理治疗，不再复发。
肝痈在世间不常见，既然有了前一条，不必又讨论这个。然而肝痈不可见，而胁痛是世人常患的疾病，我特别阐明忧郁也能造成这样的后果，那么人们就知道紧急治疗，何至于发展成痈呢。
There is a person who is naturally prone to anger and easily loses their temper. Once, they experience fullness and distension in both hypochondriac regions, accompanied by aversion to cold and fever. Subsequently, the pain in the hypochondrium becomes extremely severe; pressing on the painful area with the hand causes unbearable suffering. People assume this is due to excessive Liver Fire (Liver Fire), but little do they know that it is actually an abscess forming on the liver lobe. The world only knows that among the five Zang organs, only the Lung can develop an abscess, not realizing that the Liver can also develop an abscess. Moreover, classics such as *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions) do not mention this. Could it be that I am proposing a novel theory to shock the world? I indeed heard from an unusual person that: "Hypochondriac pain that cannot be touched by hand indicates an abscess on the liver lobe." The reason *Ling Shu* and *Su Wen* do not discuss this is that Liver Meridian abscesses are rare in the world. Since ancient times, there were no such cases, so they were not recorded following the principle of discussing common ailments. Perhaps the Qi and fortune of ancient and modern times differ, and the growth of toxin-induced abscesses varies. When the Liver is angered, the liver lobes expand, and Liver Qi immediately rebels upward. After a great outburst of anger, the liver lobes become empty and distended, making it difficult for them to return to normal. Furthermore, anger inevitably stirs up Fire. The more anger, the stronger the Fire; when Fire is excessive, it scorches and dries up Liver Blood. Once dried up, Liver Qi becomes extremely dry, and without blood to nourish the Liver, one becomes even more prone to anger. Frequent injury from anger makes it impossible for the Qi not to stagnate and form an abscess. However, since the abscess forms internally, how can it be seen? Although it cannot be seen internally, it can be distinguished externally. For any abscess, the location is on the left side, not the right. The skin on the left hypochondrium must appear red-purple, and the tongue must appear blue-green. Based on these signs, the prognosis is definitely poor (incurable). The treatment method must focus primarily on soothing the Liver, assisted by herbs that drain Fire and remove toxins. One must never delay treatment, allowing it to ulcerate beyond salvation. Use Huagao Xiaodu Tang (Liver-Soothing and Toxin-Resolving Decoction):
Bai Shao (Radix Paeoniae Alba, 3 liang) Dang Gui (Radix Angelicae Sinensis, 3 liang) Chao Zhi Zi (Fructus Gardeniae Praeparatus, 5 qian) Sheng Gan Cao (Radix Glycyrrhizae Preparata, 3 qian) Jin Yin Hua (Flos Lonicerae Japonicae, 5 liang). Decoct in water to obtain one bowl of juice, and drink.
After one dose, the pain lightens; after two doses, the pain lessens further; after three doses, the pain disappears completely. Reduce the dosage by half and take several more doses to achieve full recovery.
This formula uses Dang Gui and Bai Shao to directly enter the Liver to nourish Liver Blood, causing Liver Blood to generate rapidly and easily resolving the dryness of Liver Blood. With Gan Cao to relieve urgency, Zhi Zi to clear Fire, and Jin Yin Hua to resolve toxins, how could it fail to produce swift effects? Given that Fire-Toxin is excessive and Liver Blood is severely deficient, using this formula without such large doses would be futile. If one stubbornly believes it is merely exuberant Liver Fire rather than a formed Liver Abscess, and uses only Dang Gui and Bai Shao to treat hypochondriac pain, efficacy will certainly not be achieved.
Another person experiences extraordinary pain in the left hypochondrium, which worsens upon pressure. People mistake it for simple hypochondriac pain, not realizing it is an abscess of the Liver Meridian. Liver Meridian abscesses are mostly caused by anger, as discussed in detail in the previous section. However, Liver Abscesses are not solely caused by anger; melancholy can also cause them. Those caused by anger have sudden onset of pain; those caused by melancholy have gradual onset. At the initial stage of pain, if Xiao Yao San (Free and Easy Wanderer Powder) were taken in large doses, the pain would stop immediately, preventing the formation of an abscess. Due to delayed treatment, the stagnant Qi in the Liver suffers from inability to diffuse, causing Blood to coagulate. Coagulated Blood blocks flow, transforming into pus and forming an abscess. The momentum may seem slightly slower, but the Liver nature is most urgent, so once the abscess forms, the toxin erupts swiftly. In the world, some die from hypochondriac pain within a few days; this is precisely because the abscess toxin destroys the body, not because simple hypochondriac pain kills. Should we not seek emergency treatment? Use Xuanyu Huadu Tang (Qi-Diffusing and Toxin-Resolving Decoction):
Chai Hu (Radix Bupleuri, 2 qian) Bai Shao (Radix Paeoniae Alba, 1 liang) Xiang Fu (Rhizoma Cyperi, 2 qian) Bo He (Herba Menthae Haplocalycis, 2 qian) Dang Gui (Radix Angelicae Sinensis, 1 liang) Chen Pi (Pericarpium Citri Reticulatae, 1 qian) Zhi Ke (Fructus Aurantii, 1 qian) Tian Hua Fen (Radix Trichosanthis, 3 qian) Sheng Gan Cao (Radix Glycyrrhizae Preparata, 3 qian) Jin Yin Hua (Flos Lonicerae Japonicae, 1 liang). Decoct in water and take orally. After one dose, pain lightens; after two doses, pain decreases; after three doses, pain reduces further; after four doses, full recovery. Severe cases do not exceed six doses. After recovery, use Si Wu Tang (Four Substance Decoction) in large doses for regulation to prevent recurrence.
Liver abscesses are rarely seen in the world. Since the previous section has been covered, there was no need to discuss this again. However, while Liver abscesses are invisible, hypochondriac pain is a common ailment. I specifically elucidate how melancholy can lead to such conditions, so that people know to treat it urgently and avoid the formation of abscesses.