小腹硬痛。脉迟紧者。瘀血也。宜下之。
小腹软痛。脉洪数者。脓成也。宜托之。
一产妇小腹痛。小便不利。以薏苡仁汤二剂痛止。更以四物加桃仁、红花。下瘀血升许
大抵此症、皆因荣卫不调。或瘀血停滞所致。若脉洪数。已有脓。脉但数。微有脓。脉
。乃瘀血。下之则愈。若患甚者。腹胀大转侧作水声。或脓从脐出。或从大便出。宜蜡矾丸
、太乙膏、及托里药。
一妇小腹肿痛。小便如淋。尺脉芤而迟。以神效栝蒌散二剂少愈。更以薏苡仁汤二剂而
愈。（此凭脉症也。）
一人脓已成。用云母膏一服。下脓升许。更以排脓托里药而愈。后因不守禁忌。以致不
救。（此凭症也。）
一人里急后重。时或下脓。胀痛。脉滑数。以排脓散及蜡矾丸而愈。（此凭症脉也。）
一妇小腹痛有块。脉芤而涩。以四物汤加玄胡、红花、桃仁、牛膝、木香而愈、（此凭
一妇小腹隐痛。大便秘涩。腹胀。转侧作水声。脉洪数。以梅仁汤一剂。诸症悉退。以
薏苡仁汤二剂而瘥。（此凭脉症也。）
一妇腹胀痛。皮毛错纵。小便不利。脉数滑。以太乙膏一服。脓下升许。胀痛顿退。以
神效栝蒌散二剂而全退更以蜡矾丸及托里药十余剂而安。（此凭脉症也。）
一妇因经水。多服涩药止之。致腹作痛。以失笑散（百九）二服而瘳。（此凭症也。）
一人小腹痛而坚硬。小便数。汗时出。脉迟紧。以大黄汤一剂。下瘀血合许。以薏苡仁
汤四剂而安。（此凭脉也。）
一妇小腹恶露不尽。小腹痛。以薏苡仁汤（二百十五）下瘀血而痊。（此凭症也。）凡瘀血
停涩。宜急治之。缓则腐为脓。最难治疗。若流满节骨。则患骨疽。失治多为败症。
肠痈。身甲错。腹皮急。按之濡。如肿状。腹无聚积。身无热。此久积冷所致。故金匮
附子温之。若小腹肿痞。按之痛如淋。小便自调发热身无汗。复恶寒。脉迟紧。肿未成可下
之。当有血。洪数者脓已成。不可下、此内结热所成。故金匮有用大黄利之甚者腹胀大。
转侧闻水声。或绕脐生疮。脓从疮出者。有出脐中者。不治必死。惟大便下脓血者自愈。
一妇病少腹痞坚。小便或涩。或时汗出。或复恶寒。此肠痈也。脉滑而数。为痈已成。
设脉迟紧。即为瘀血。惟血下则愈。（此凭症脉也。）
内经载有息积病。此得之二三年。遍身微肿。续乃大肠与脐连日出脓。遂至不救。此亦
肠痈之类。
肠痈作湿热积治。入风难治。千金谓妄治必杀人。要略以薏苡仁附子败毒散。千金以大
黄牡丹汤。三因以薏苡仁汤。千金又有灸法。曲两肘头正肘锐骨灸百壮。下脓血而安。
一人伤寒逾月。既下。内热未已。胁及小腹偏左肿满。肉色不变。俚医为风矢所中。以
之。月余。毒循宗筋流入睾丸。赤肿如瓠。翁诊关尺滑数且芤。曰。数脉不时见。当生恶
疮。关芤为肠痈。用保生膏。 更以乳香。用硝黄作汤下之。脓如糜者五升许。明日再圊。
余脓而瘥。（此凭脉症也。）
一妇肠中痛。大便自小便出。诊之芤脉见于关。此肠痈也。以云母膏（二百十六）作百十
丸。煎黄 汤吞之。利脓数升而安。
一女腹痛。百方不应。脉滑数。时作热。腹微急。曰。痛病脉沉细。今滑数。此肠痈也
云母膏一两。丸如梧桐子。以牛皮胶熔入酒中。并水吞之。饷时服尽。下脓血。愈（此凭脉
一人年逾五十。腹内隐痛。小便如淋。皮肤错纵而脉滑数。此肠痈也。滑数脓成。以广
东牛皮胶酒熔化送太乙膏。脓下升许。更以排脓托里药、及蜡矾丸而愈。（此凭脉也。）
一妇产后小腹作痛。诸药不应。其脉滑数。此瘀血内溃为脓也。服瓜子仁汤（五九）痛止
。更以太乙膏而愈。（此凭脉也。）
今人产后。多有此病。纵非痈毒。用之更效。有人脐出脓水。久而不愈。亦以前膏及蜡
矾丸而痊。
一儿年十二。患腹胀。脐突颇锐。医谓肠痈。舍针脐无他法。翁曰。脐神阙也。针刺当
况痈舍子内。惟当以汤丸攻之。进透脓散一剂。脓自溃。继以十奇汤下善应膏丸。渐瘥。（
此凭症也。）
小腹部位坚硬且疼痛，脉象迟而紧的，是瘀血阻滞。应当使用攻下法治疗。
小腹部位柔软且疼痛，脉象洪大而数的，是脓液已经形成。应当使用托毒排脓法治疗。
有一位产妇小腹部疼痛，小便不通利。服用薏苡仁汤两剂后疼痛停止，随后又服用四物汤加入桃仁、红花，排出了一升多的瘀血。
大抵这类病症，大多是因为营卫不调，或者瘀血停滞所致。如果脉象洪数，说明已有脓液；脉象仅数，说明微有脓液；脉象迟紧，则是瘀血。使用攻下法即可痊愈。如果病情严重的，腹部胀大，转动身体时能听到水声，或者脓液从肚脐流出，或者从大便排出。应当使用蜡矾丸、太乙膏以及托里药（补益气血以托毒外出）。
有一位妇女小腹部肿胀疼痛，小便像淋病一样频急涩痛，尺部脉象芤而迟。服用神效栝蒌散两剂后症状稍减，再服用薏苡仁汤两剂而痊愈。（这是依据脉象和症状判断的。）
有一人脓液已经形成，服用云母膏一服，排出一升多脓液，随后服用排脓托里药而痊愈。后来因为不遵守禁忌，导致死亡。（这是依据症状判断的。）
有一人感到里急后重，时而排出脓液，伴有胀痛，脉象滑数。服用排脓散及蜡矾丸而痊愈。（这是依据症状和脉象判断的。）
有一位妇女小腹部疼痛且有肿块，脉象芤而涩。服用四物汤加玄胡索、红花、桃仁、牛膝、木香而痊愈。（这是依据……）
有一位妇女小腹部隐隐作痛，大便秘结涩滞，腹部胀满，转动身体时发出水声，脉象洪数。服用梅仁汤一剂，所有症状全部消退，再服用薏苡仁汤两剂而康复。（这是依据脉象和症状判断的。）
有一位妇女腹部胀满疼痛，皮肤纹理粗糙交错，小便不利，脉象数而滑。服用太乙膏一服，排出一升多脓液，胀痛顿时减退，再服用神效栝蒌散两剂而完全消退，最后服用蜡矾丸及托里药十余剂而安定。（这是依据脉象和症状判断的。）
有一位妇女因为月经问题，过多服用收敛止血的药物，导致腹部疼痛。服用失笑散两服而痊愈。（这是依据症状判断的。）
有一人小腹部疼痛且坚硬，小便频数，时常出汗，脉象迟紧。服用大黄汤一剂，排出一合多的瘀血，再服用薏苡仁汤四剂而安定。（这是依据脉象判断的。）
有一位妇女产后恶露不尽，小腹部疼痛，服用薏苡仁汤排出瘀血而痊愈。（这是依据症状判断的。）凡是瘀血停滞涩阻，应当紧急治疗，拖延则会腐败化为脓液，最难治疗。如果流注到节骨之间，就会患骨疽，失治多为败症。
肠痈，身体皮肤干燥如鳞甲交错，腹皮紧张，按压时感觉濡软，像是有肿物但腹部没有积聚块状物，身体无发热，这是久积寒冷所致。所以《金匮要略》用附子温之。如果小腹部肿胀痞硬，按压疼痛像淋病一样，小便正常，身体发热无汗，又恶寒，脉象迟紧，说明肿物未成，可以攻下，应当会有瘀血排出；脉象洪数，说明脓已成，不可攻下，这是内结热邪所致，所以《金匮要略》有用大黄通利之法。病情严重的，腹部胀大，转动身体能听到水声，或者绕脐生疮，脓液从疮口流出，有的从脐中流出，不治必死。只有大便排出脓血的才能自愈。
有一位妇女病少腹部痞塞坚硬，小便有时涩滞，有时出汗，有时又恶寒，这是肠痈。脉象滑而数，说明痈脓已成；假如脉象迟紧，就是瘀血，只有瘀血下行才能痊愈。（这是依据症状和脉象判断的。）
《内经》记载有息积病，这个病得之二三年，全身轻微浮肿，接着大肠与脐部相连处每日流出脓液，最终导致死亡。这也是肠痈的一类。
肠痈当作湿热积滞来治疗，如果兼夹风邪则难治。《千金方》说误治必杀人。《金匮要略》用薏苡仁附子败毒散，《千金方》用大黄牡丹汤，《三因方》用薏苡仁汤。《千金方》还有灸法，在两肘头正中的肘锐骨处灸一百壮，排出脓血后安宁。
有一人伤寒超过一个月，已经经过攻下治疗，内热仍未消除，胁部及小腹部左侧肿胀满闷，肌肉颜色不变。庸医认为是被风邪所中，用药后月余，毒气顺着宗筋流入睾丸，红肿得像葫芦一样。汪机诊察关部和尺部脉象滑数且芤，说：“数脉不时出现，应当生恶疮；关部脉芤为肠痈。”使用保生膏，再用乳香，用硝黄煎汤送服，排出像糜粥一样的脓液五升左右。第二天再次排便，剩余脓液排出后痊愈。（这是依据脉象和症状判断的。）
有一位妇女肠中疼痛，大便从阴道排出，诊察发现关部脉象芤，这是肠痈。服用云母膏制成的一百多丸，煎煮黄芪汤吞服，利出几升脓液而安宁。
有一位女子腹痛，各种方法都不见效，脉象滑数，时常发热，腹部微微拘急。我说：“痛病的脉象应当沉细，现在却是滑数，这是肠痈。”服用云母膏一两，制成梧桐子大小的丸药，将牛皮胶熔化在酒中，连同水一起吞服，一顿饭工夫服完，排出脓血，痊愈。（这是依据脉象……）
有一位年过五十的人，腹内隐隐作痛，小便像淋病一样，皮肤粗糙交错且脉象滑数，这是肠痈。滑数脉说明脓已成，服用广东牛皮胶酒熔化送服太乙膏，排出一升多脓液，再服用排脓托里药及蜡矾丸而痊愈。（这是依据脉象判断的。）
有一位妇女产后小腹部疼痛，各种药物都不见效，其脉象滑数，这是瘀血内溃化为脓液。服用瓜子仁汤疼痛停止，再服用太乙膏而痊愈。（这是依据脉象判断的。）
如今人们产后，多有此病，纵然不是痈毒，使用此法效果更好。有人脐部流出脓水，长久不愈，也用前一种膏药及蜡矾丸而痊愈。
有一个十二岁的儿童，患腹胀，肚脐突出且很尖锐，医生说是肠痈，除了针刺肚脐没有其他办法。汪机说：“脐部是神阙穴，针刺应当……”况且痈肿生于体内，只应当用汤剂和丸药攻治。服用透脓散一剂，脓液自然溃破，继而又服用十奇汤送服善应膏丸，逐渐康复。（这是依据症状判断的。）
The lower abdomen is hard and painful, with a slow and tight pulse; this indicates blood stasis. It is appropriate to use purgation.
The lower abdomen is soft and painful, with a surging and rapid pulse; this indicates that pus has formed. It is appropriate to use the method of supporting the healthy qi to expel toxins.
A postpartum woman suffered from lower abdominal pain and difficulty in urination. After taking two doses of Yiyiren Decoction (Coix Seed Decoction), the pain ceased. Subsequently, she took Siwu Tang (Four Substances Decoction) added with Taoren (Peach Kernel) and Honghua (Safflower), which expelled more than one sheng of blood stasis.
Generally, this condition is caused by disharmony of Ying and Wei (nutritive and defensive qi) or stagnation of blood stasis. If the pulse is surging and rapid, pus has already formed; if the pulse is merely rapid, there is slight pus; if the pulse is slow and tight, it is blood stasis. Purging will lead to recovery. In severe cases, the abdomen becomes distended and large, producing a water-sloshing sound when turning over, or pus discharges from the umbilicus or through the stool. One should use Lafan Pill (Beeswax and Alum Pill), Taiyi Paste, and formulas for supporting the interior (tonifying qi and blood to expel toxins).
A woman suffered from swelling and pain in the lower abdomen and urinary symptoms resembling strangury. Her chi (cun-kou position at the wrist) pulse was hollow and slow. After taking two doses of Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder), her condition improved slightly. She then took two doses of Yiyiren Decoction and recovered. (This diagnosis relied on pulse and symptoms.)
A man had already formed pus. He took one dose of Yunmu Paste (Cloud Mother Paste) and discharged more than one sheng of pus. He subsequently took formulas for draining pus and supporting the interior and recovered. However, due to failing to observe dietary and lifestyle taboos, he eventually died. (This diagnosis relied on symptoms.)
A man experienced tenesmus and occasional discharge of pus, accompanied by distending pain. His pulse was slippery and rapid. He recovered after taking Painong San (Drain Pus Powder) and Lafan Pill. (This diagnosis relied on symptoms and pulse.)
A woman suffered from lower abdominal pain with a palpable mass. Her pulse was hollow and choppy. She recovered after taking Siwu Tang (Four Substances Decoction) added with Yuanhusuo (Corydalis Rhizome), Honghua (Safflower), Taoren (Peach Kernel), Niuxi (Achyranthes Root), and Muxiang (Aucklandia Root). (This diagnosis relied on...)
A woman suffered from dull pain in the lower abdomen, constipation with dry stools, abdominal distension, and a water-sloshing sound when turning over. Her pulse was surging and rapid. After taking one dose of Meiren Tang (Apricot Kernel Decoction), all symptoms subsided. She then took two doses of Yiyiren Decoction and healed. (This diagnosis relied on pulse and symptoms.)
A woman suffered from abdominal distension and pain, rough and crisscrossed skin texture, and difficulty in urination. Her pulse was rapid and slippery. After taking one dose of Taiyi Paste, she discharged more than one sheng of pus, and the distending pain instantly receded. She then took two doses of Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder) until complete resolution, followed by more than ten doses of Lafan Pill and formulas for supporting the interior, leading to stability. (This diagnosis relied on pulse and symptoms.)
A woman took excessive amounts of astringent medicines to stop menstruation, resulting in abdominal pain. She recovered after taking two doses of Shixiao San (Instant Satisfaction Powder). (This diagnosis relied on symptoms.)
A man suffered from hard and painful lower abdomen, frequent urination, spontaneous sweating, and a slow and tight pulse. After taking one dose of Dahuang Tang (Rhubarb Decoction), he discharged about one he of blood stasis. He then took four doses of Yiyiren Decoction and stabilized. (This diagnosis relied on pulse.)
A woman suffered from incomplete expulsion of lochia postpartum and lower abdominal pain. She recovered after taking Yiyiren Decoction to expel blood stasis. (This diagnosis relied on symptoms.) Whenever blood stasis stagnates and obstructs, it should be treated urgently. Delay allows it to rot into pus, making it very difficult to treat. If it flows into the joints and bones, it results in bone abscess; neglect often leads to critical conditions.
Intestinal carbuncle presents with rough, scaly skin on the body, tense abdominal wall, and a soft feeling upon pressure, resembling a swelling but without accumulated masses in the abdomen. The body has no fever. This is caused by long-standing accumulation of cold. Therefore, Fuzi (Aconite Lateralis Radix Preparata) is used to warm, as per the *Jinkui Yaolue*. If the lower abdomen is swollen and痞 (fullness/hardness), painful upon pressure like strangury, with normal urination, fever, no sweat, aversion to cold, and a slow and tight pulse, the swelling has not yet formed pus and can be purged; blood stasis should be expected. If the pulse is surging and rapid, pus has formed, and purging is contraindicated; this is caused by internal heat binding. Thus, Dahuang (Rhubarb Radix et Rhizoma) is used to purge, as per the *Jinkui Yaolue*. In severe cases, the abdomen is distended and large, producing a water-sloshing sound when turning over, or sores appear around the umbilicus with pus discharging from them, or pus discharges from the umbilicus itself. Untreated, this is fatal. Only those who discharge pus and blood via the stool may heal spontaneously.
A woman suffered from hardness and fullness in the lower abdomen, intermittent difficulty in urination, occasional sweating, and intermittent aversion to cold. This is intestinal carbuncle. A slippery and rapid pulse indicates that the abscess has formed; if the pulse were slow and tight, it would indicate blood stasis, which must be discharged for recovery. (This diagnosis relied on symptoms and pulse.)
The *Neijing* records a disease called Xiji (Accumulation Disease). Contracted over two or three years, it presents with slight swelling throughout the body, followed by daily discharge of pus from the connection between the large intestine and the umbilicus, eventually leading to death. This is also a type of intestinal carbuncle.
Intestinal carbuncle should be treated as damp-heat accumulation. If complicated by wind pathogens, it is difficult to treat. The *Qianjin Fang* states that mistaken treatment kills. The *Jinkui Yaolue* uses Yiyiren Fuzi Baidu San (Coix Seed and Aconite Toxin-Expelling Powder); the *Qianjin Fang* uses Dahuang Mudan Tang (Rhubarb and Moutan Decoction); the *San Yin Fang* uses Yiyiren Tang (Coix Seed Decoction). The *Qianjin Fang* also mentions moxibustion: moxa is applied 100 cones to the sharp bone at the center of both elbows. Discharge of pus and blood leads to peace.
A man suffered from typhoid fever for over a month. After purgation, internal heat remained. The hypochondrium and left side of the lower abdomen became swollen and full, with unchanged skin color. Quacks attributed it to wind attack. Over a month later, the toxin flowed along the Zongjin (Vessel of Genitals) into the testicles, causing red and swollen lumps like gourds. Wang Ji diagnosed the guan and chi pulses as slippery, rapid, and hollow. He said, "The intermittent appearance of a rapid pulse suggests an impending malignant sore; the hollow guan pulse indicates intestinal carbuncle." He used Baosheng Paste, and additionally used Ruxiang (Frankincense Resin) administered with a decoction of Xiaoshihuang (Natrii Sulfas) and Dahuang (Rhubarb Radix et Rhizoma). He discharged five sheng of pus resembling gruel. The next day, after another bowel movement, the remaining pus was discharged, and he recovered. (This diagnosis relied on pulse and symptoms.)
A woman suffered from intestinal pain, with feces discharging through the vagina. Diagnosis revealed a hollow pulse at the guan position. This is intestinal carbuncle. She took Yunmu Paste (Cloud Mother Paste) made into over one hundred pills, swallowed with Huangqi (Astragalus Root) decoction, and discharged several sheng of pus, achieving peace.
A young woman suffered from abdominal pain unresponsive to various treatments. Her pulse was slippery and rapid, with intermittent fever and slight abdominal tension. I stated, "Painful diseases typically present with deep and fine pulses; the current slippery and rapid pulse indicates intestinal carbuncle." She took one liang of Yunmu Paste (Cloud Mother Paste), formed into pills the size of paulownia seeds, melted with NiuPi Jiao (Ox Hide Glue) in wine, and taken with water within the time of a meal. She discharged pus and blood and healed. (This diagnosis relied on pulse...)
A man over fifty years old suffered from dull internal abdominal pain, urinary symptoms resembling strangury, rough and crisscrossed skin, and a slippery and rapid pulse. This is intestinal carbuncle. The slippery and rapid pulse indicates pus formation. He took Guangdong NiuPi Jiao (Ox Hide Glue) melted in wine to swallow Taiyi Paste. He discharged more than one sheng of pus, then took formulas for draining pus and supporting the interior, along with Lafan Pill, and recovered. (This diagnosis relied on pulse.)
A postpartum woman suffered from lower abdominal pain unresponsive to various medicines. Her pulse was slippery and rapid, indicating that blood stasis had internally ulcerated into pus. She took Guazi Ren Tang (Melon Seed Decoction), and the pain stopped. She then took Taiyi Paste and recovered. (This diagnosis relied on pulse.)
Currently, many postpartum women suffer from this condition. Even if it is not a carbuncle or toxin, using these methods is even more effective. Some people have chronic pus discharge from the umbilicus that does not heal; they also recover using the aforementioned paste and Lafan Pill.
A twelve-year-old child suffered from abdominal distension with a prominent and sharp umbilicus. Physicians diagnosed intestinal carbuncle and suggested needle puncture of the umbilicus as the only method. Wang Ji said, "The umbilicus is Shenque (CV8). Needle puncture should..." Moreover, since the carbuncle is located internally, it should only be treated with decoctions and pills. After taking one dose of Tou Nong San (Penetrate Pus Powder), the pus ruptured spontaneously. Subsequently, he took Shiqi Tang (Ten Wonders Decoction) to swallow Shanying Gao Wan (Excellent Response Paste Pills), gradually recovering. (This diagnosis relied on symptoms.)