夫大肠生痈者，或其人平素醇酒炙 ，湿热郁蒸，相傅受伤，肺气不能宣降，致湿
热下注，壅遏气血而发（肺与大肠为表里，肺伤则湿热下注于大肠而生痈也）；或由七情所伤
，饥饱劳役，担负重物，致使气血乖违，湿动痰生，肠胃痞塞，运化不通而结。初起发热恶
寒，脉数而芤，皮毛甲错，右足屈而不伸，腹急渐肿，按之急痛，大便坠重，小便涩滞若淋
。如痈未成者，宜以大黄汤下之，瘀血去尽自安；如体虚脉细，不敢下者，以活血散瘀汤和
利之；痈已成，腹中疼痛，胀满不食，便淋刺痛者，以薏苡仁汤决之。如脓从大便出者，易
治；若在脐旁出头者，即以卧针刺之；若从脐内出脓者，不治。亦有脐突肿硬，绕脐生疮者
，此名盘肠痈证，治法与上同。
小肠痈者，少腹肿而硬，按之则痛，左足屈而不伸，溲数似淋，时时汗出，复恶寒，身
皮甲错，腹皮急，甚则腹胀大。此证或由于肝邪积聚，寒凝气阻而成；或由于产后经期气滞
瘀凝，营卫失和而发；至若奔走暴急，负重远行，或醉饱房劳，生冷并进，致肠胃受伤，败
血浊气壅遏，皆能致之。其因久积阴冷所成者，宜用温热之剂以温发之，《金匮》之用附子
苡仁败酱散是也；其因内结热所成者，宜利之，《金匮》之用大黄汤是也；若气滞瘀凝者，
宜用旋复花葱绛汤。又薛立斋曰∶脉迟紧者，未有脓也，宜牡丹皮汤下之，当有血下；脉洪
数者，已有脓也，用薏苡仁汤排之；小腹疼痛，小便不利，脓壅滞也，用牡丹皮散主之；气
血虚者，宜用八珍汤加黄 、肉桂、丹皮、北五味敛而补之。古人治法，可以酌用。要知成
脓后，外有头可刺者为顺；若外不可刺，而或从小便出脓者死。盖大小肠二痈，虽名为肠痈
，大抵生于皮里膜外者多，故能在外出脓，是为易愈；若外无头者，必生于肠内，而肠皮甚
薄，易于腐烂，此恶证也。彼大肠痈之从大便出脓者，以湿热内结，腑气通而顺势下趋，出
尽秽浊，故可愈。至从脐内出脓者，大便必结而不通，邪从上泄，难以去尽，久则烂肠，故
不治耳。而小肠痈之脓从小便出者，以其邪传入膀胱渗泄，或恐腑气不能宣达，而秽浊即未
能循窍下行，因致正虚邪着，延久而毙者多矣。
大肠发生痈肿，可能是因为患者平素嗜酒、食用辛辣炙烤食物，导致湿热郁结蒸腾，损伤了肺脏（相傅之官），肺气不能正常宣发和肃降，致使湿热下注到大肠，气血壅滞阻塞而发病（肺与大肠互为表里，肺受损则湿热下注于大肠而生痈）；或者由于七情内伤，加上饥饱失常、过度劳累、背负重物，致使气血运行逆乱，湿气变动、痰浊内生，肠胃痞塞不通，运化功能受阻而凝结。初期出现发热恶寒，脉象数且芤，皮肤干燥如鳞甲交错，右腿弯曲不能伸直，腹部拘急逐渐肿胀，按压时剧烈疼痛，大便有坠重感，小便涩滞如同淋证。如果痈肿尚未形成脓液，适宜用大黄汤攻下，瘀血排尽后自然安宁；如果体质虚弱、脉象细弱，不敢使用攻下法的，用活血散瘀汤调和利导；如果痈肿已经形成，腹中疼痛，胀满不能进食，大小便涩痛刺痛的，用薏苡仁汤决断排脓。如果脓液从大便排出，容易治疗；如果脓液在脐旁破溃流出，就用卧针针刺排脓；如果脓液从脐内部流出，则难以治愈。也有脐部突起、肿胀坚硬，围绕脐部长疮的，这叫做盘肠痈证，治疗方法与上述相同。
小肠发生痈肿，表现为少腹部肿胀坚硬，按压则疼痛，左腿弯曲不能伸直，小便频数似淋证，时常出汗，又怕冷，全身皮肤干燥如鳞甲交错，腹皮紧绷，严重时腹部胀大。此证有的由于肝邪积聚，寒气凝滞、气机阻滞而成；有的由于产后或经期气滞血凝，营卫不和而发作；至于那些奔走急促、负重远行，或者醉酒后行房事、生冷食物并进，导致肠胃受伤，败血浊气壅滞阻塞，都能导致此病。如果是因久积阴冷所成的，适宜用温热药剂来温通发散，《金匮要略》中使用的附子薏苡仁败酱散就是此类；如果是因内结热毒所成的，适宜用通利之法，《金匮要略》中使用的大黄汤就是此类；如果是气滞血凝的，适宜用旋复花葱绛汤。另外薛立斋说：脉象迟紧的，说明还没有成脓，适宜用牡丹皮汤攻下，应当有瘀血排出；脉象洪数的，说明已经有脓，用薏苡仁汤排脓；小腹疼痛，小便不利，是脓液壅滞的表现，用牡丹皮散主治；气血虚弱的，适宜用八珍汤加黄芪、肉桂、丹皮、北五味子收敛补益。古人的治法，可以参考选用。要知道成脓之后，外部有头可以针刺的是顺证；如果外部不可针刺，或者脓液从小便排出的则是死证。大概大小肠二处的痈肿，虽然名为肠痈，大多生于皮里膜外，所以能从外部排脓，这是容易痊愈的；如果外部没有头，必定生于肠内，而肠壁很薄，容易腐烂，这是恶证。那个大肠痈从大便排脓的，是因为湿热内结，腑气通畅顺势向下趋走，排出所有秽浊之物，所以可以痊愈。至于从脐内部排脓的，大便必然结滞不通，邪气从上泄出，难以去尽，时间久了会烂肠，所以难以治愈。而小肠痈的脓液从小便排出的，是因为邪气传入膀胱渗泄，或者恐怕腑气不能宣达，秽浊之气未能顺着窍道下行，因而导致正气虚弱、邪气附着，拖延久了死亡的多。
When an abscess occurs in the large intestine, it may be due to the patient's habitual consumption of alcohol and roasted/spicy foods, leading to the stagnation and steaming of Damp-Heat, which injures the Lung (the official minister). The Lung Qi fails to disperse and descend properly, causing Damp-Heat to flow downward into the large intestine, where it obstructs Qi and Blood, resulting in the formation of an abscess (The Lung and Large Intestine are exterior-interiorly related; when the Lung is injured, Damp-Heat flows downward into the Large Intestine to form an abscess); or it may result from emotional injury, irregular diet, overexertion, or carrying heavy loads, causing Qi and Blood to become disordered. Dampness arises, Phlegm generates, intestinal obstruction occurs, and transformation and transportation fail, leading to condensation. In the early stage, there is fever with aversion to cold, a rapid and hollow pulse, skin dry and scaly like fish scales, the right leg flexed and unable to extend, abdominal urgency with gradual swelling, severe pain upon pressure, a sensation of heaviness in defecation, and dysuria resembling strangury. If the abscess has not yet suppurated, Da Huang Tang (Rhubarb Decoction) should be used to purge; once the blood stasis is completely expelled, peace will return. If the constitution is weak and the pulse is fine, making purgation inadvisable, Huoxue Sanyu Tang (Blood-Invigorating and Stasis-Dispelling Decoction) should be used to harmonize and promote circulation. If the abscess has formed, accompanied by abdominal pain, distension, anorexia, and painful, difficult urination and defecation, Yiyi Ren Tang (Coix Seed Decoction) should be used to resolve and drain pus. If pus discharges through the stool, it is easy to treat; if it emerges at the side of the umbilicus, a horizontal needle should be used for puncture; if pus emerges from within the umbilicus, it is incurable. There is also a condition where the umbilicus protrudes, becomes swollen and hard, and sores develop around the umbilicus, known as Pan Chang Yong (Intertwined Intestine Abscess), treated similarly to the above.
An abscess in the small intestine presents with swelling and hardness in the lower abdomen, pain upon pressure, the left leg flexed and unable to extend, frequent urination resembling strangury, occasional sweating, aversion to cold, generalized dry and scaly skin, tight abdominal wall, and in severe cases, abdominal distension. This condition may arise from Liver pathogenic accumulation, cold coagulation, and Qi obstruction; or from Qi stagnation and blood congealing during postpartum or menstruation, leading to disharmony of Ying and Wei (Nutritive and Defensive Qi); or from frantic running, carrying heavy loads over long distances, sexual indulgence after drunken meals, or simultaneous intake of raw and cold foods, injuring the intestines and stomach, causing敗血 (decayed blood) and turbid Qi to stagnate and obstruct. For those caused by long-standing Yin-Cold, warm agents should be used to warm and disperse, such as Fuzi Yiyi Ren Baijiang San (Aconite, Coix Seed, and Patrinia Powder) from *Jin Gui Yao Lue*; for those caused by internal heat binding, purgative methods should be used, such as Da Huang Tang (Rhubarb Decoction) from *Jin Gui Yao Lue*; for Qi stagnation and blood congealing, Xuanfu Hua Cong Jiang Tang (Inula Flower, Scallion, and Red Sage Decoction) is appropriate. Additionally, Xue Lizhai stated: A slow and tight pulse indicates no pus has formed; Dan Mudan Pi Tang (Moutan Cortex Decoction) should be used to purge, expecting blood discharge. A surging and rapid pulse indicates pus has formed; Yiyi Ren Tang (Cois Seed Decoction) should be used to expel pus. Lower abdominal pain with difficulty in urination indicates pus stagnation; Mudan Pi San (Moutan Cortex Powder) is the primary treatment. For Qi and Blood deficiency, Bazhen Tang (Eight Treasure Decoction) added with Huangqi (Astragalus Root), Rougui (Cinnamon Bark), Mudanpi (Moutan Cortex), and Bei Wuweizi (Schisandra Fruit) should be used to astringe and tonify. Ancient treatments can be酌情 (discretionarily) adopted. It must be understood that after suppuration, if there is an external head that can be punctured, it is a favorable sign; if it cannot be punctured externally, or if pus discharges through the urine, it is fatal. Generally, although named intestinal abscesses, these lesions mostly occur between the skin and fascia, allowing pus to discharge externally, which makes them easier to heal. If there is no external head, the lesion likely lies within the intestine; since the intestinal wall is thin, it is prone to rotting, constituting a malignant condition. Regarding large intestine abscesses discharging pus through stool, this is because internal Damp-Heat binding allows Fu Qi (Viscera Qi) to flow smoothly downward, expelling all turbid matter, thus allowing recovery. However, for pus discharging from within the umbilicus, the stool is necessarily constipated and blocked; pathogens exit upward, making it difficult to clear completely, leading to intestinal rot over time, hence incurable. For small intestine abscesses discharging pus through urine, this is because pathogens transmit to the Bladder for excretion, or perhaps Fu Qi fails to disseminate, preventing turbid matter from descending through the orifices, leading to righteous Qi deficiency and pathogen attachment, often resulting in death after prolonged duration.