古之医者，无分内外，又学有根柢，故能无病不识。后世内外科既分，则显然为内证者
，内
科治之；显然为外证者，外科治之。其有病在腹中，内外未显然者，则各执一说，各拟一方
，历试诸药，皆无效验。轻者变重，重者即殒矣。此等证，不特外科当知之，即内科亦不可
不辨明真确。知非己责，即勿施治，毋至临危束手，而后委他人也。腹内之痈有数证；有肺
痈，有肝痈，有胃脘痈，有小肠痈，有大肠痈，有膀胱痈。惟肺痈咳吐腥痰，人犹易辨。余
者或以为痞结，或以为瘀血，或以为寒痰，或以为食积，医药杂投，及至成脓，治已无及。
并有不及成脓而死者，病者、医者，始终不知何以致死，比比然也。今先辨明痞结瘀血，寒
痰食积之状。凡痞结瘀血，必有所因，且由渐而成；寒痰则痛止无定，又必另现痰症；食积
则必有受伤之日，且三五日后，大便通即散。惟外症则痛有常所，而迁延益甚。《金匮》云
∶诸脉浮数， 当发热，而反淅淅恶寒，若有痛处，当发其痈。以手按肿上热者，有脓；不
热者，无脓。此数句乃内痈真谛也。又云∶肠痈之为病，身甲错，腹皮急，按之濡，如肿状
，腹无积聚，身无热是也。若肝痈，则胁内隐隐痛，日久亦吐脓血。小肠痈，与大肠相似，
而位略高。膀胱痈，则痛在少腹之下，近毛际，着皮即痛，小便亦艰而痛。胃脘痈，则有虚
实二种，其实者易消；若成脓，必大吐脓血而愈。惟虚症则多不治，先胃中痛胀，久而心下
渐高，其坚如石，或有寒热，饮食不进，按之成痛，形体枯瘦，此乃思虑伤脾之症，不待痈
成即死。故凡腹中有一定痛处，恶寒倦卧，不能食者，皆当审察，防成内痈。甚毋因循求治
于不明之人，以至久而脓溃，自伤其生也。
古代的医生，不分内科和外科，且学问根基深厚，所以没有他们识别不了的疾病。后世将内科和外科分开，那么显然是内科病症的，由内科治疗；显然是外科病症的，由外科治疗。如果有病在腹部内部，内外表现不明显的，就会各执己见，各自拟定一方，尝试各种药物，都没有疗效。轻的病变成重的，重的立即死亡。这类病症，不仅外科医生应当知道，内科医生也不可不明辨清楚。如果认为不是自己的职责，就不进行治疗，不要等到危急时刻束手无策，然后才推给别人。腹内的痈脓有几类证候：有肺痈（肺部化脓性病变），有肝痈（肝脏化脓性病变），有胃脘痈（胃部化脓性病变），有小肠痈，有大肠痈，有膀胱痈。只有肺痈表现为咳嗽吐腥臭痰液，人们还容易辨别。其他的有的误认为是痞结（气机阻滞形成的痞块），有的误认为是瘀血，有的误认为是寒痰，有的误认为是食积，医药混杂使用，等到脓液形成时，治疗已经来不及了。还有来不及成脓就死亡的，病人和医生，始终不知道导致死亡的原因，这种情况比比皆是。现在先辨明痞结、瘀血、寒痰、食积的症状。凡是痞结、瘀血，必定有起因，且是逐渐形成的；寒痰则疼痛位置不定，又必然另外出现痰症的表现；食积则必定有受伤（饮食不当）的日子，且三到五天后，大便通畅后就会消散。只有外症（此处指内痈的外在表现或特定体征）则是疼痛有固定部位，且拖延越久越严重。《金匮要略》说：各种脉象浮数，应当发热，反而感到淅淅恶寒（怕冷），如果有疼痛的地方，应当发生痈脓。用手按压肿胀处感觉热的，是有脓；不热的，是无脓。这几句话是内痈的真谛啊。又说：肠痈这种病，身体皮肤粗糙如鳞甲交错，腹部皮肤紧张，按压柔软，像肿的样子，腹部没有积聚包块，身体没有发热，就是这样的症状。如果是肝痈，则胁肋内部隐隐作痛，日子久了也会吐出脓血。小肠痈，与大肠痈相似，但位置略微偏高。膀胱痈，则疼痛在小腹下方，靠近阴毛际，皮肤接触即痛，小便也艰涩而痛。胃脘痈，则有虚实两种类型，实证容易消除；如果成脓，必须大吐脓血才能痊愈。只有虚证大多无法治愈，先是胃中疼痛胀满，时间久了心下（胃脘部）渐渐隆起，坚硬如石头，或有寒热往来，饮食不进，按压则疼痛，形体枯瘦，这是思虑伤脾的病症，不需要等到痈脓形成就会死亡。所以凡是腹部有固定疼痛部位，恶寒倦卧，不能进食的，都应当仔细审查，防止形成内痈。千万不要因循守旧，向不明医理的人求治，以至于时间久了脓液溃破，自己伤害自己的生命。
Ancient physicians did not distinguish between internal and external medicine, and their scholarly foundation was solid; therefore, there were diseases they could not identify. In later generations, internal and external medicine were separated: obviously internal conditions were treated by internal medicine specialists, and obviously external conditions by external medicine specialists. However, for diseases located within the abdomen where internal and external manifestations are not obvious, practitioners would each adhere to their own theories and prescribe different formulas. They would trial various herbs without effect. Mild cases would worsen, and severe cases would result in death. For such conditions, not only should surgeons be knowledgeable, but internists must also clearly differentiate them with precision. If one considers it not their responsibility and refrains from treatment, they will end up helpless at the critical moment before handing the patient over to others. There are several types of abdominal abscesses (internal carbuncles): lung abscess (Fei Yong), liver abscess (Gan Yong), stomach epigastrium abscess (Weiwuan Yong), small intestine abscess (Xiaochang Yong), large intestine abscess (Dachang Yong), and bladder abscess (Pangguang Yong). Only lung abscess, characterized by coughing up foul-smelling sputum, is relatively easy to identify. Others are often mistaken for pi-jie (obstruction syndrome forming a palpable mass), blood stasis (Yu Xue), cold-phlegm (Han Tan), or food retention (Shi Ji). With mixed and indiscriminate use of medicines, when pus finally forms, treatment is already futile. Some patients die even before pus formation occurs; both patients and doctors remain unaware of the cause of death, which is a common occurrence. Now, let us first differentiate the presentations of obstruction, blood stasis, cold-phlegm, and food retention. Obstruction and blood stasis always have a specific etiology and develop gradually; cold-phlegm presents with wandering pain and distinct phlegm symptoms; food retention has a clear history of dietary injury and resolves after bowel movement within three to five days. In contrast, the signs of these abscesses involve fixed pain that intensifies with time. The *Jin Gui Yao Lue* states: "When pulses are floating and rapid, fever is expected, yet the patient feels chilly and aversion to cold; if there is a painful area, an abscess is likely." It further states: "Pressing on the swelling reveals heat, indicating pus; no heat indicates no pus." These sentences capture the essence of internal abscesses. It also says: "In intestinal abscess, the body skin is rough like fish scales, the abdominal wall is tense, but soft upon pressure, resembling a swelling, without abdominal masses or systemic fever." For liver abscess, there is dull pain in the hypochondrium, eventually leading to vomiting of pus and blood. Small intestine abscess resembles large intestine abscess but is located slightly higher. Bladder abscess causes pain in the lower abdomen near the pubic region, with tenderness upon skin contact, and difficult, painful urination. Stomach epigastrium abscess has two types: excess and deficiency. Excess type is easier to resolve; if pus forms, recovery follows profuse vomiting of pus and blood. Deficiency type is mostly incurable; it begins with gastric pain and distension, followed by a gradual, stone-hard elevation in the epigastrium, alternating chills and fever, anorexia, tenderness on pressure, and emaciation. This is a condition caused by excessive worry injuring the Spleen, leading to death even before abscess formation. Therefore, any case with fixed abdominal pain, aversion to cold, lethargy, and inability to eat requires careful examination to prevent the development of internal abscesses. One must not delay seeking treatment from incompetent practitioners, thereby allowing the condition to progress until pus ruptures, causing self-harm and death.