《素问》以肝痈两 满，卧则惊，不得小便。又曰∶期门隐隐痛者，肝痈。其上肉微起
者，肝痈。未能详言。后陈远公曰∶人素多郁怒，致两 胀满，发寒发热，继而胁疼，手不可
按，火盛烁乎肝血，此肝叶生疮，在左不在右。左胁之皮必见红紫五色，以化肝消毒汤。丹溪
治以复元通气散、柴胡清肝汤，溃后八珍、六味滋补脾肾法，致难稍备，究未详明确当。肝
之脉从股阴入毛中，环阴起器，抵少腹，上贯肝膈，布 ，至期门而终。肝气壅滞，故胀满不
得小便。肝病发惊骇，魂不藏，故卧则多惊，故肝盛则两 痛，怒火动则烁肝血，血凝气壅则
肝胀生痈，手不可按，毒聚而未成。若皮现红紫之色，内脓已成，发越于外之象也。嗜酒之
人每多此患，酒入于胃则肝横胆浮，肝即横则气血不能顺行，胃中痰浊亦旁流于胁。痰气血
交混，结而为痈。又有闪气之人，亦生此患。闪则气滞，而血亦滞，久而不愈，亦发痈疡。小儿
亦见有之。小儿之生，乃因痰热入于肝络，先咳嗽而后胁助肿胀，但此症初生，病者因不生
痈而医者总云肝气，十有八九一派辛香耗气，迨至胁肋肿胀，姑知生痈。必呼吸不利，转侧
不能，手不可按，症明且确，医者岂可自恃万能，按脉即晓，以肝气治，贻误匪浅。肝火甚
者，脉必弦数，挟瘀者脉弦涩，挟痰者脉弦兼滑，治与肝气迥殊。伤于此者，不知几何，故谆
谆辨论，临症之时不可不审也。用特列方于后，并录治验数则，以便参观。
一方化肝消毒汤
当归 白芍 银花 黑栀 甘草
此用归芍入肝滋血，甘草缓肝，栀子清肝，银花解毒火平肝，缘血生而痛自止。
二方柴胡清肝汤 治怒火上升，憎寒恶热，肝胆风热疮疡。
柴胡 黄芩 甘草 南沙参 川芎 黑栀
三方复元通气散 治闪挫气血凝滞，腰胁引痛。
小茴香 延胡 陈皮 甘草 炙甲片 白丑 木香
四方六味地黄汤 治肝痈溃后发热，虚羸脉数，服此以滋肝肾。
大生地 山萸肉 泽泻 丹皮 淮药
五方八珍汤 治肝痈溃久，气血俱虚，脉弱。
当归 川芎 白芍 生地 党参 白术 茯苓 炙甘草
六方清肝活瘀汤 治闪挫胁痛，瘀凝于络，肋骨肿胀者。
当归 赤芍 新绛 桃仁 青皮 广郁金 参山七 枳壳 苏根 泽兰 瓦楞子
七方疏肝流气饮 治肝痈初起，左胁掣痛，呼吸不利。
苏根 枳壳 通草 广郁金 延胡 青皮 佛手 当归 乌药 香附
八方舒郁涤痰汤 治肝痈六七日后，胁肋微肿，或兼咳嗽，大便不利
香附 当归 佛手 橘红 蒌仁 广郁金 茯苓 苏根 枳壳 参三七 半夏 竹茹
加味金铃子散
川楝子 延胡 青皮 赤芍 甘草 黑栀 枳壳 通草 橘红
《素问》中提到：两侧胁肋部胀满，睡眠时易受惊扰，小便不通畅。又说：期门穴处隐隐作痛，是肝痈的表现；该部位肌肉微微隆起，也是肝痈的表现。但原文未能详细阐述。后来陈远公说：人如果平素多郁怒，导致两侧胁肋胀满，出现怕冷发热，继而胁肋疼痛，手不能触碰，这是火热旺盛灼伤肝血，致使肝叶生疮，病位在左侧而非右侧。左侧胁部的皮肤必定呈现红紫五色，应用化肝消毒汤治疗。丹溪用复元通气散、柴胡清肝汤治疗，溃破后用八珍汤、六味地黄丸滋补脾肾的方法，虽然大致完备，但终究不够详尽明确恰当。
肝的经脉从大腿内侧进入阴毛中，环绕生殖器，到达少腹，向上穿过肝和膈肌，散布于胁肋，到期门穴结束。肝气壅滞，所以出现胀满和小便不通。肝病引发惊骇，魂不内守，所以睡觉时容易惊醒。因此肝气盛则两侧胁肋疼痛，怒火动则灼伤肝血，血液凝滞、气机壅塞则肝部肿胀生痈，手不可触碰，这是毒邪聚集但尚未化脓。如果皮肤呈现红紫色，说明内部脓液已成，是毒邪向外发越的迹象。嗜酒的人常常患此病，酒入胃后使肝横胆浮，肝横则气血不能顺行，胃中的痰浊也旁流至胁部。痰、气、血互相混杂，结聚而成痈。又有因闪挫（扭伤）导致气机阻滞的人，也会发生此病。闪挫则气滞，血也随之停滞，久不痊愈，也会发为痈疡。小儿也有患此病的。小儿患病，是因为痰热侵入肝络，先咳嗽而后胁肋肿胀。但这种病症初起时，患者因为尚未形成明显的痈肿，医生总认为是肝气郁结，十有八九使用一派辛香耗气的药物，等到胁肋肿胀明显时，才知晓生了痈。此时必然呼吸不畅，转侧困难，手不可触碰，症状明显且确切，医生岂可自恃万能，仅凭把脉就断定是肝气，用治肝气的方法处理，贻误匪浅。肝火旺盛者，脉象必定弦数；挟瘀血者脉象弦涩；挟痰者脉象弦兼滑，治疗方法与肝气郁结截然不同。受伤于此症的人不知有多少，所以谆谆辨论，临症时不可不审慎。特此列出方剂在后面，并记录几个治疗验案，以便参考。
一方 化肝消毒汤
当归、白芍、银花、黑栀、甘草。
此处用归、芍入肝滋养血液，甘草缓和肝急，栀子清肝火，银花解毒、平肝，因为血液得以滋生而疼痛自然停止。
二方 柴胡清肝汤 治疗怒火上升，憎寒恶热，肝胆风热疮疡。
柴胡、黄芩、甘草、南沙参、川芎、黑栀。
三方 复元通气散 治疗闪挫导致的气血凝滞，腰胁牵引疼痛。
小茴香、延胡、陈皮、甘草、炙甲片、白丑、木香。
四方 六味地黄汤 治疗肝痈溃破后发热，身体虚弱消瘦，脉数，服用此方以滋补肝肾。
大生地、山萸肉、泽泻、丹皮、淮药。
五方 八珍汤 治疗肝痈溃破日久，气血俱虚，脉弱。
当归、川芎、白芍、生地、党参、白术、茯苓、炙甘草。
六方 清肝活瘀汤 治疗闪挫导致的胁痛，瘀血凝滞于络脉，肋骨肿胀者。
当归、赤芍、新绛、桃仁、青皮、广郁金、参三七、枳壳、苏根、泽兰、瓦楞子。
七方 疏肝流气饮 治疗肝痈初起，左胁掣痛，呼吸不畅。
苏根、枳壳、通草、广郁金、延胡、青皮、佛手、当归、乌药、香附。
八方 舒郁涤痰汤 治疗肝痈六七日后，胁肋微肿，或兼咳嗽，大便不通利。
香附、当归、佛手、橘红、蒌仁、广郁金、茯苓、苏根、枳壳、参三七、半夏、竹茹。
The *Suwen* (Basic Questions) states: distension and fullness in both hypochondriac regions, startle during sleep, and inability to urinate. It also says: dull pain at the Qimen (LR-14) acupoint indicates liver abscess; slight elevation of the flesh in that area also indicates liver abscess. However, it does not elaborate in detail. Later, Chen Yuangong stated: If a person is prone to depression and anger, causing distension and fullness in both hypochondriac regions, accompanied by aversion to cold and fever, followed by hypochondriac pain that cannot be touched, this is due to excessive fire scorching the liver blood, leading to sores on the liver lobes. The pathology is on the left, not the right. The skin over the left hypochondrium must show red, purple, and five-color changes; treat with Huaguan Xiaodu Decoction (Liver-Purifying and Toxin-Expelling Decoction). Danxi treated it with Fuyuan Tongqi Powder (Restoring Flow and Promoting Qi Powder) and Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction), and after ulceration, used Bazhen Tang (Eight-Treasure Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to tonify the spleen and kidneys. Although these methods are generally comprehensive, they remain insufficiently detailed, clear, and appropriate.
The liver meridian enters the pubic region from the inner thigh, circles the external genitalia, reaches the lower abdomen, pierces through the liver and diaphragm, spreads into the hypochondrium, and ends at Qimen (LR-14). Liver qi stagnation causes distension and inability to urinate. Liver disease triggers fright and alarm; when the hun (ethereal soul) fails to reside within, there is frequent startle during sleep. Therefore, when liver qi is exuberant, both hypochondria hurt; when angry fire moves, it scorches liver blood; when blood coagulates and qi obstructs, liver swelling and abscess form, rendering the area untouchable. This indicates toxin accumulation but no pus formation yet. If the skin shows red or purple coloration, it signifies that internal pus has formed and toxins are manifesting externally. People who habitually drink alcohol often suffer from this condition. Alcohol entering the stomach causes the liver to become horizontal and the gallbladder to float; when the liver becomes horizontal, qi and blood cannot flow smoothly, and phlegm-turbidity from the stomach flows laterally into the hypochondrium. Phlegm, qi, and blood mix and knot together to form an abscess. Those suffering from sprains or traumatic injuries may also develop this condition. Trauma causes qi stagnation, which leads to blood stasis; if unresolved for a long time, it also develops into an abscess. Children may also present with this disease. In children, the onset is due to phlegm-heat entering the liver collaterals, starting with cough followed by hypochondriac swelling. However, in the early stage, because no obvious abscess has formed, physicians often diagnose it merely as liver qi stagnation. Ninety percent use pungent, aromatic, qi-consuming herbs. Only when hypochondriac swelling becomes pronounced do they realize an abscess has formed. At this point, breathing is difficult, turning the body is impossible, and the area is untouchable; the symptoms are clear and definite. How can physicians rely on their supposed omnipotence, diagnose solely by pulse, and treat it as liver qi stagnation, thereby causing significant delay and harm? When liver fire is severe, the pulse is wiry and rapid; when complicated by blood stasis, the pulse is wiry and choppy; when complicated by phlegm, the pulse is wiry and slippery. The treatment is completely different from that for liver qi stagnation. Many have been harmed by this misdiagnosis; hence, I earnestly debate this issue. One must examine carefully during clinical practice. I hereby list the prescriptions below and record several verified cases for reference.
Prescription 1: Huaguan Xiaodu Decoction (Liver-Purifying and Toxin-Expelling Decoction)
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Yinhua (Lonicerae Japonicae Flos), Heizhi (Gardeniae Fructus Carbonized), Gancao (Glycyrrhizae Radix et Rhizoma).
Here, Danggui and Baishao enter the liver to nourish blood; Gancao moderates the liver; Zhizi clears liver heat; Yinhua detoxifies and calms the liver. Pain ceases naturally as blood is nourished.
Prescription 2: Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction)
Treats rising angry fire, aversion to cold with intolerance to heat, and wind-heat sores of the liver and gallbladder.
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Nanshashen (Glehniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Heizhi (Gardeniae Fructus Carbonized).
Prescription 3: Fuyuan Tongqi Powder (Restoring Flow and Promoting Qi Powder)
Treats qi and blood stagnation caused by sprain or trauma, with pulling pain in the waist and hypochondrium.
Xiaohuixiang (Foeniculi Fructus), Yanhu (Corydalis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Zhi Jiapian (Testudinis Carapax et Plastrum Praeparatum), Bai Chou (Momordicae Semen), Muxiang (Aucklandiae Radix).
Prescription 4: Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction)
Treats fever, emaciation, and rapid pulse after the ulceration of a liver abscess; takes this to nourish the liver and kidneys.
Dashengdi (Rehmanniae Radix Preparata), Shanyurou (Corni Fructus), Zexie (Alismatis Rhizoma), Danpi (Moutan Cortex), Huaiyao (Dioscoreae Rhizoma).
Prescription 5: Bazhen Tang (Eight-Treasure Decoction)
Treats prolonged ulceration of liver abscess with deficiency of both qi and blood, and weak pulse.
Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix), Dangshen (Codonopsis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle).
Prescription 6: Qinggan Huoyu Tang (Liver-Clearing and Blood-Activating Decoction)
Treats hypochondriac pain from sprain, with blood stasis congealing in the collaterals and rib swelling.
Danggui (Angelicae Sinensis Radix), Chishao (Paeoniae Radix Rubra), Xinjiang (Safflower-infused Silk), Taoren (Persicae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Guang Yujin (Curcumae Longae Rhizoma), Shen Sanqi (Notoginseng Radix et Rhizoma), Zhiqiao (Aurantii Fructus Immaturus), Sugeng (Perillae Caulis), Zelan (Lycopus Herba), Walengzi (Arcae Concha).
Prescription 7: Shugan Liuqi Yin (Liver-Soothing and Qi-Flowing Decoction)
Treats early-stage liver abscess with tugging pain in the left hypochondrium and difficulty breathing.
Sugeng (Perillae Caulis), Zhiqiao (Aurantii Fructus Immaturus), Tongcao (Tetrapanacis Medulla), Guang Yujin (Curcumae Longae Rhizoma), Yanhu (Corydalis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Foshou (Citrus Sarcodactylis Fructus), Danggui (Angelicae Sinensis Radix), Wuyao (Linderae Radix), Xiangfu (Cyperi Rhizoma).
Prescription 8: Shuyu Ditang Tang (Depression-Relieving and Phlegm-Cleansing Decoction)
Treats liver abscess after six or seven days, with slight hypochondriac swelling, possibly accompanied by cough and constipation.
Xiangfu (Cyperi Rhizoma), Danggui (Angelicae Sinensis Radix), Foshou (Citrus Sarcodactylis Fructus), Juhong (Citri Reticulatae Pericarpium), Louren (Trichosanthis Semen), Guang Yujin (Curcumae Longae Rhizoma), Fuling (Poria), Sugeng (Perillae Caulis), Zhiqiao (Aurantii Fructus Immaturus), Shen Sanqi (Notoginseng Radix et Rhizoma), Banxia (Pinelliae Rhizoma), Zhuru (Bambusae Caulis in Taenia).
Modified Jinlingzi San (Goldbell Pepper Powder)
Chuanlianzi (Meliae Fructus), Yanhu (Corydalis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Chishao (Paeoniae Radix Rubra), Gancao (Glycyrrhizae Radix et Rhizoma), Heizhi (Gardeniae Fructus Carbonized), Zhiqiao (Aurantii Fructus Immaturus), Tongcao (Tetrapanacis Medulla), Juhong (Citri Reticulatae Pericarpium).