肠痈实热，滑数可知。数而不热，关脉芤虚。
微涩而紧，未脓当下。紧数脓成，切不可下。
肠痈者，肠内生痈也。大肠、小肠皆有之。大抵得之不节饮食、不适寒温。或
积垢瘀凝，或败血留滞。壅塞不行，久郁化热，久热腐脓，而痈斯成矣。如小腹肿
痞皮急，按之则痛，小便数如淋，或复自调，时或发热，或自汗恶寒，身如甲错。
外无热，内无积聚而见上证者，皆肠痈之候也。甚者腹胀大，转侧有水声。或绕脐
生疮，或脓自脐出，或大便出。其脉数者，小便脓也。洪数、滑数者，大有脓也（宜
薏苡附子败酱散。）迟紧，或微涩而紧者，未有脓也。（宜大黄牡丹汤、万氏桃仁承气汤加连翘、秦艽。入风
者加防风。准绳蜡矾丸亦效。）郁结成热，其热自实。热实，则脉之滑数，不言可知。若数而
无热，则数为虚促之数，非热所鼓。不惟不实，而与腹中相应之关脉，亦且芤虚矣。
虽见诸证，未必成脓。设的确有痈，亦瘀凝之血耳。盖血瘀聚于肠腹，则流行之脉
道中，反觉空虚，故脉芤也。若脉微涩而紧者，气犹滞着敛实，未化脓也，下之足
以荡其留结之邪。若脉紧滑数，热已沸涌消熔，脓已成也。下之反以夺其生新之力。
即痈疡未溃，宜泻实。已溃，宜补虚义。
薏苡附子败酱散 治肠痈为病，其身甲错，腹皮急，按之濡，如肿状。腹无积聚，
身无热，脉数，此肠内有痈脓也。此方主之。
薏苡仁（十分） 附子（二分） 败酱（五分）
上三味，杵为末，取方寸匕。以水二升，煎减半，顿服。小盒饭下。
大黄牡丹汤 治肠痈少腹肿痞，按之痛如淋，小便自调，时时发热，自汗出，复恶
寒，其脉迟紧者，脓未成，可下之。当有血。脉洪数者，脓已成，不可过下，总以此方主之。
大黄（四两） 牡丹皮（一两） 桃仁（五十个） 瓜子（半升） 芒硝（三合）
上五味，以水六升，煮取一升。去滓，内芒硝再煎沸。顿服之。有脓当下。如无脓，当下血。
万氏治肠痈方
桃仁承气汤加秦艽、连翘。（桃仁承气汤见第二十。）
薏苡仁汤 治肠痈，腹中 痛，烦躁不安。或胀满不食，小便涩。妇人产后虚热，
多有此病。纵非痈，但疑似间，便可服。
薏苡仁 栝蒌仁（各三钱） 牡丹皮（去骨） 桃仁（各二钱）
上作一服。水二钟，煎一钟，不拘时服。
按此方药品和平，其功且速，常治腹痛，或发热，或胀满不食，水道涩滞。产
后多有此证。或月经欲行，或行后作痛尤效。
四圣散 一名神效栝蒌散。治肠痈，痈疽生于脑髭背腋，及便毒。服之神效。
生黄栝蒌（一枚，去皮） 粉草（四钱，研末） 没药（研末，三钱） 乳香（研末，一钱）
上用好红酒二大碗，慢火煎至一碗。分作两服，两日服尽。大便顺导恶物妙。
若干栝蒌，则用两三枚。一方。若病在上，食后服。在下，食前服。毒已结成，
即脓化为水。毒未成，即于小便中出。疾甚，再合服，以退为度。
神仙蜡矾丸（见第七十四）
云母膏 治一切痈疽疮疖，折伤等证。
蜀椒（去目及闭口者，微炒） 白芷 没药 赤芍药 肉桂 当归 盐花 菖蒲 麒麟竭
黄 白芨 芎 木香 龙胆草 白蔹 防风 浓朴 麝香 桔梗 柴胡 松
脂人参 苍术 黄芩 乳香 附子 茯苓 良姜 合欢皮（各五钱） 硝石 甘草
云母（各四两） 桑白皮 槐枝 柳枝 柏叶 水银（以绢另包。待膏成，以手细弹在上，名养膏母
）陈皮（各二两） 清油（四十两） 黄丹（二十两）
上除云母、硝石、麒麟竭、乳香、没药、麝香、盐花、黄丹八味另研外，余药
并细切，入油浸七日。文火煎，以柳枝不住手搅。候匝沸，乃下火。沸定，又上
火。如此者三次，以药黑色为度。去滓，再熬。后入丹与八味末，仍不住手以槐
柳枝搅。滴水中成珠，不软不硬为度。瓷器收贮。候温，将水银弹上。用时先刮
去水银，或服或贴，随宜用之，其功甚大也。
排脓散 治肠痈小腹胀痛，脉滑数。或里急后重，或时时下血。
黄 （盐水拌炒） 当归（酒拌） 金银花 白芷 穿山甲（蛤粉炒） 防风 连翘 栝
蒌（杵） 甘草（各一钱）
作一剂，水二钟，煎八分，食前服。若脓将尽，去穿山甲、连翘，加当归、川
芎。或为末，每服三钱，食后蜜汤调下，亦可。
肠痈属于实热证，脉象滑数是可以推断出来的。如果脉数但身体不发热，关脉呈现芤虚之象。
脉象微涩而紧，说明脓尚未形成，应当使用攻下法；如果脉象紧数，说明脓已经形成，千万不可使用攻下法。
所谓肠痈，就是肠道内部生出的痈肿。大肠和小肠都可能发生此病。大抵是因为饮食不节制、寒温不适所致。或者是积滞污垢与瘀血凝结，或者是败血留滞体内。气血壅塞不通，日久郁结化热，久热导致血肉腐败成脓，于是痈肿就形成了。比如小腹部肿胀痞硬，皮肤绷紧，按压则疼痛，小便频数像淋病一样，或者小便反而正常，有时发热，有时自汗出且恶寒，皮肤粗糙如鳞甲交错。体表没有明显的热象，体内也没有其他积聚病症，而出现上述症状的，都是肠痈的表现。严重的会出现腹部胀大，转动身体时有水声。或者肚脐周围生疮，或者脓液从肚脐流出，或者随大便排出。脉象数的，说明小便中有脓。脉象洪数或滑数的，说明脓液很多（适宜用薏苡附子败酱散）。脉象迟紧，或微涩而紧的，说明还没有脓液（适宜用大黄牡丹汤、万氏桃仁承气汤加连翘、秦艽。如果有风邪侵袭加防风。《准绳》中的蜡矾丸也有效）。郁结导致热盛，这种热是实热。热实，那么脉象滑数，是不言而喻的。如果脉数却没有热象，那么这个数是虚促之数，不是由热邪鼓动引起的。不仅不是实证，而且与腹部相应的关脉，也会呈现芤虚之象。虽然出现各种症状，未必一定成脓。假设确实有痈，也只是瘀凝的血液罢了。因为血液瘀聚在肠腹中，使得流行于血脉中的气血反觉空虚，所以脉象呈芤状。如果脉象微涩而紧，说明气机仍然滞着收敛结实，尚未化为脓液，使用攻下法足以荡涤那些留结的邪气。如果脉象紧滑数，说明热势已经沸腾涌溢，脓液已经形成。此时再用攻下法反而会剥夺机体新生的力量。即痈疡未溃破时，宜泻其实邪；已溃破后，宜补其虚损的道理。
薏苡附子败酱散：治疗肠痈疾病，患者身体皮肤粗糙如鳞甲交错，腹皮紧张，按压柔软，像是有肿块的样子。腹部没有积聚症，身体无发热，脉数，这是肠内有痈脓的表现。此方主治。
薏苡仁（十分） 附子（二分） 败酱草（五分）
以上三味药，捣碎研末，取一方寸匕的药量。用水二升，煎至减半，一次性服用。小的脓包应该会排下来。
大黄牡丹汤：治疗肠痈少腹部肿胀痞硬，按压疼痛像淋病一样，小便正常，时时发热，自汗出，又恶寒，脉象迟紧的，说明脓未形成，可以使用攻下法。应当会有瘀血排出。脉象洪数的，说明脓已形成，不可过度攻下，总之以此方为主治。
大黄（四两） 牡丹皮（一两） 桃仁（五十个） 瓜子（半升） 芒硝（三合）
以上五味药，用水六升，煮取一升药液。去掉药渣，加入芒硝再煮沸。一次性服用。有脓液就会排出。如果没有脓液，就会排出瘀血。
万氏治疗肠痈方
桃仁承气汤加秦艽、连翘。（桃仁承气汤见第二十卷。）
薏苡仁汤：治疗肠痈，腹中疼痛，烦躁不安。或者胀满不想吃饭，小便涩滞。妇女产后虚热，多有此病。即使不是痈，但在疑似之间，也可以服用。
薏苡仁 栝蒌仁（各三钱） 牡丹皮（去骨） 桃仁（各二钱）
以上作为一剂。用水二钟，煎至一钟，不拘时候服用。
按：此方药物平和，功效迅速，常用来治疗腹痛，或者发热，或者胀满不想吃饭，水道涩滞。产后多有此证。或者月经将要来潮，或者行经后疼痛尤为有效。
四圣散：又名神效栝蒌散。治疗肠痈，以及生于脑、髭、背、腋部的痈疽，还有便毒。服用后效果神奇。
生黄栝蒌（一枚，去皮） 粉甘草（四钱，研末） 没药（研末，三钱） 乳香（研末，一钱）
用好红酒两大碗，慢火煎至一碗。分作两次服用，两天服完。大便顺畅排出恶物最好。
如果是干栝蒌，则用两三枚。另一说法：如果病位在上部，饭后服用；在下部，饭前服用。毒邪已经结成，脓就会化为水排出。毒邪未成，就会从小便中排出。病情严重，再次合服，以病退为度。
神仙蜡矾丸（见第七十四卷）
云母膏：治疗一切痈疽疮疖，折伤等证。
蜀椒（去掉目及闭口者，微炒） 白芷 没药 赤芍药 肉桂 当归 盐花 菖蒲 麒麟竭 黄芪 白芨 川芎 木香 龙胆草 白蔹 防风 浓朴 麝香 桔梗 柴胡 松脂 人参 苍术 黄芩 乳香 附子 茯苓 良姜 合欢皮（各五钱） 硝石 甘草 云母（各四两） 桑白皮 槐枝 柳枝 柏叶 水银（用绢布另包。待膏成，用手细弹在上面，名为养膏母） 陈皮（各二两） 清油（四十两） 黄丹（二十两）
以上除了云母、硝石、麒麟竭、乳香、没药、麝香、盐花、黄丹这八味药另外研磨外，其余药物并切碎，放入油中浸泡七日。用文火煎，用柳枝不停地搅拌。等到沸腾，然后离火。沸定之后，再上火。如此三次，以药色变黑为度。去掉药渣，再熬。之后加入丹和那八味药末，仍不停地用槐柳枝搅拌。滴入水中能成珠，不软不硬为度。用瓷器收贮。等温度降低后，将水银弹在上面。使用时先刮去水银，或者内服或者外贴，随意使用，功效很大。
排脓散：治疗肠痈小腹胀痛，脉滑数。或者里急后重，或者时时下血。
黄芪（盐水拌炒） 当归（酒拌） 金银花 白芷 穿山甲（蛤粉炒） 防风 连翘 栝蒌（杵） 甘草（各一钱）
作为一剂，用水二钟，煎至八分，饭前服用。如果脓即将排尽，去掉穿山甲、连翘，加当归、川芎。或者研为末，每次服用三钱，饭后蜜汤调下，也可以。
Intestinal abscess belongs to the excess-heat syndrome, which can be inferred from a slippery and rapid pulse. If the pulse is rapid but there is no fever, the Guan position pulse will appear hollow (Kou) and deficient.
If the pulse is slightly choppy and tight, it indicates that pus has not yet formed, and purgation should be applied; if the pulse is tight and rapid, it indicates that pus has already formed, and purgation must absolutely not be used.
The so-called intestinal abscess refers to an abscess forming inside the intestines. It can occur in both the large intestine and the small intestine. Generally, it arises from irregular diet or improper exposure to cold and heat. It may result from the accumulation of filth and coagulation of blood stasis, or from the stagnation of degenerated blood. Qi and blood become obstructed and fail to circulate; long-term stagnation transforms into heat, and prolonged heat causes tissue corruption and pus formation, thus creating the abscess. Symptoms include swelling and distension in the lower abdomen, tense skin, pain upon pressure, frequent urination resembling strangury, or conversely normal urination, occasional fever, spontaneous sweating with aversion to cold, and rough, scaly skin (like fish scales). When there is no obvious external heat, no other internal accumulations, yet these symptoms are present, they all indicate signs of intestinal abscess. In severe cases, the abdomen becomes distended and large, with a splashing sound when turning over. There may be sores around the umbilicus, pus discharging from the umbilicus, or discharge via stool. A rapid pulse suggests pus in the urine. A surging-rapid or slippery-rapid pulse indicates a large amount of pus (Yiyi Fuzi Baijiang San is suitable). A slow-tight, or slightly-choppy-and-tight pulse indicates no pus has formed yet (Dahuang Mudan Tang or Wan's Taoren Chengqi Tang plus Lianqiao and Qinjiao are suitable; add Fangfeng if wind pathogens are involved; Lafan Wan from *Zhunsheng* is also effective). Stagnation leads to heat accumulation, which is excess heat. With excess heat, a slippery and rapid pulse is self-evident. However, if the pulse is rapid without heat, this rapidness is a deficient and hurried rhythm, not driven by heat pathogens. Not only is it not an excess condition, but the Guan position pulse corresponding to the abdomen will also appear hollow and deficient. Although various symptoms appear, pus may not necessarily form. Assuming there is indeed an abscess, it is merely coagulated blood. Because blood stasis gathers in the intestines and abdomen, the qi and blood flowing in the vessels feel relatively empty, hence the hollow pulse. If the pulse is slightly choppy and tight, it indicates that qi is still stagnant and condensed, not yet transformed into pus; purgation is sufficient to sweep away the lingering pathogenic factors. If the pulse is tight, slippery, and rapid, it indicates that heat is boiling and surging, and pus has formed. Using purgation at this stage would instead deprive the body of its regenerative power. Thus, for unruptured abscesses, one should drain excess; for ruptured ones, one should tonify deficiency.
**Yiyi Fuzi Baijiang San**: Treats intestinal abscess where the patient has rough, scaly skin, tense abdominal wall that feels soft upon pressure (resembling a mass), no abdominal accumulation, no body fever, and a rapid pulse. This indicates pus within the intestines. This formula is indicated.
Coix Seed (Shi Fen), Aconite Root (Er Fen), Patrinia Herb (Wu Fen).
Grind the above three herbs into powder. Take one cun-bi (a square-inch measure) of the powder. Boil in two sheng of water until reduced by half, and take in one dose. Small abscesses should discharge.
**Dahuang Mudan Tang**: Treats intestinal abscess characterized by swelling and hardness in the lower abdomen, pain on pressure resembling strangury, normal urination, intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not formed, and purgation can be used. Blood stasis should be discharged. If the pulse is surging and rapid, pus has formed, and excessive purgation should be avoided. This formula is generally indicated.
Rhubarb Root (Si Liang), Moutan Bark (Liang Liang), Peach Kernel (Fifty pieces), Melon Seeds (Ban Sheng), Mirabilite (San He).
Boil the above five herbs in six sheng of water until one sheng remains. Strain, add Mirabilite, and boil again until bubbling. Take in one dose. Pus will be discharged if present; if no pus, blood stasis will be discharged.
**Wan's Formula for Intestinal Abscess**:
Taoren Chengqi Tang plus Qinjiao and Lianqiao. (See Vol. 20 for Taoren Chengqi Tang.)
**Yiyi Ren Tang**: Treats intestinal abscess with abdominal pain, restlessness, or distension with loss of appetite and dysuria. This condition is common in postpartum women with deficiency-heat. Even if it is not an abscess, it can be taken when the diagnosis is uncertain.
Coix Seed, Trichosanthes Seed (each San Qian), Moutan Bark (de-boned), Peach Kernel (each Er Qian).
Take as one dose. Boil in two zhong of water until one zhong remains. Take at any time.
Note: This formula is mild in nature and acts quickly. It is commonly used for abdominal pain, fever, distension with anorexia, and urinary obstruction. It is particularly effective for postpartum conditions, pre-menstrual pain, or pain after menstruation.
**Sisheng San**: Also known as Shenxiao Gualou San. Treats intestinal abscess, carbuncles and sores occurring on the head, beard, back, armpits, and groin infections. It is highly effective.
Raw Trichosanthes Fruit (one piece, peeled), Licorice Root (Si Qian, powdered), Myrrh (powdered, San Qian), Frankincense (powdered, Yi Qian).
Simmer in two large bowls of good red wine over low heat until reduced to one bowl. Divide into two doses, to be consumed over two days. Ideally, foul matter is expelled through smooth bowel movements.
If using dried Trichosanthes fruit, use two or three pieces. Another method: If the disease is located upper, take after meals; if lower, take before meals. If toxins have already consolidated, pus will turn into water and discharge. If toxins have not yet formed, they will discharge via urine. For severe cases, repeat the dosage until recovery.
**Shenxian Lafan Wan** (See Vol. 74)
**Yunmu Gao**: Treats all types of carbuncles, sores, boils, and traumatic injuries.
Sichuan Pepper (remove eyes and closed ones, lightly stir-fried), Angelica Dahurica, Myrrh, Red Peony Root, Cinnamon Bark, Angelica Sinensis, Salt Crystals, Acorus Rhizome, Dragon's Blood, Astragalus Root, Bletilla Tuber, Ligusticum Chuanxiong, Costus Root, Gentiana Root, Ampelopsis Radix, Saposhnikovia Root, Magnolia Bark, Musk, Platycodon Root, Bupleurum Root, Pine Resin, Ginseng, Atractylodes Macrocephala, Scutellaria Root, Frankincense, Aconite Root, Poria, Galangal, Albizia Bark (each Wu Qian), Niter, Licorice Root, Cloud Mother (Ge Yun Mu) (each Si Liang), Mulberry Root Bark, Willow Branches, Poplar Leaves, Mercury (wrapped separately in silk; apply finely onto the finished ointment, named "Nourishing Mother"), Tangerine Peel (each Er Liang), Pure Sesame Oil (Si Shi Liang), Minium (Er Shi Liang).
Except for Cloud Mother, Niter, Dragon's Blood, Frankincense, Myrrh, Musk, Salt Crystals, and Minium which are ground separately, cut the remaining herbs finely and soak in oil for seven days. Simmer over low heat, stirring constantly with willow branches. When boiling, remove from fire. Once settled, return to fire. Repeat this process three times until the medicine turns black. Strain, and continue simmering. Then add Minium and the eight powdered herbs, stirring constantly with willow and locust branches. Test by dropping into water; it should form beads that are neither too soft nor too hard. Store in porcelain jars. When cool, apply mercury onto the surface. Before use, scrape off the mercury. Can be taken orally or applied externally as appropriate. Its efficacy is significant.
**Painong San**: Treats intestinal abscess with lower abdominal distension and pain, slippery-rapid pulse, tenesmus, or intermittent bloody discharge.
Astragalus Root (stir-fried with salt water), Angelica Sinensis (soaked in wine), Honeysuckle Flower, Angelica Dahurica, Pangolin Scales (stir-fried with clam powder), Saposhnikovia Root, Forsythia Fruit, Trichosanthes Fruit (pounded), Licorice Root (each Yi Qian).
Prepare as one dose. Boil in two zhong of water until eight fen remains. Take before meals. If pus is nearly exhausted, remove Pangolin Scales and Forsythia, and add Angelica Sinensis and Ligusticum Chuanxiong. Alternatively, grind into powder, take San Qian per dose, mixed with honey water after meals.