陆左初诊痛在脐右斜下一寸，西医所谓盲肠炎也，脉大而实，当下之，用仲景法。
生军五钱芒硝三钱桃仁五钱冬瓜仁一两丹皮一两二诊痛已略缓，右足拘急，不得屈伸，伸则牵腹中痛，宜芍药甘草汤。
【按】俗所谓缩脚肠痈者，此也。吾师移伤寒之方，治要略之病，神乎技矣！三诊右足已伸，腹中剧痛如故。仍宜大黄牡丹汤以下之。
【按】肠痈病证，变化多端。上述各案尚不足以尽其情。吾友蒋冠周君偶抱孩上下阶沿不慎，稍一惊跌，顷之心中剧痛，不可耐。次日痛处移于少腹右旁盲肠处。医以定痛丸止之，而不能治其病。其令正来嘱余诊。余适以感暑卧床，荐就吾师治。吾师予以大黄牡丹汤加减，二剂将愈。不知何故，忽又发剧痛如前，改就西医诊，用药外数，约十余日，徐徐向愈。自后盲肠部分有一硬块如银元大，隐隐作痛，按之更显。蒋君以为病根犹在，虑其再发，意欲开刀，作一劳永逸之计。余力止之，用阳和膏瑙砂膏加桂麝散等香窜之品，交换贴之，一月而消，此一例也。
曹颖甫曰：肠痈一证舍大黄牡丹汤以外，别无良法。《千金》肠痈汤虽与此方大略相似，而配合犹未尽善。但有时药虽对病，而治愈正未可必。尝治庄翔生次妻张氏，屡用本汤攻下，而腰间忽起流火，以至于死。考其原因，实由平日有雅片瘾，戒烟后，不复吸烟，常用烧酒浸雅片灰吞之，以至肠燥成痈。下后，雅片灰毒内发，遂发流火，以至由肿而烂，终于不救，要不得归咎于方治之猛峻也。
肠痈其三
周住小西门复发初诊大便不甚畅行，自以他药下之，痛而不行，仲师所谓非其治也。今拟用承气汤加桃仁主之。
【按】周小姐先于本年五月间病肠痈，经吾师暨俞哲生师兄后先治愈，体健回校肄业。至十二月间，因运动过度，饮食不节，前之盲肠患处又见隐痛，火大便不行。乃市某西药房所制之丸药服之，冀其缓下。孰知仅服二丸，便不得下，痛反增剧，不能耐，自悔孟浪。无已，仍请吾师赐方，即本案复发初诊方也。服后，便畅下，痛大除，惟有时按之还作小痛耳。越日，乃来二诊。
二诊昨经下后，旧时患处按之尚痛。脉弦而数，用《千金》肠痈汤以和之。
粉丹皮三钱丹参三钱白芍三钱生地黄五钱生甘草一钱败酱草三钱茯苓三钱生苡仁八钱大麦冬五钱桔梗一钱柏子仁一两佛手二钱生姜三片
【按】周女士来二诊时，余方恭侍师侧。师令余按脉，得弦细而数。察其面色，似未甚荣润。惟据述痛已大减，无任私慰。师令余拟方。余曰：《千金》肠痈汤差足以和之。承赐诺，即用焉。以其下经多次，故不加大黄。以其夜寐不安而性易燥怒，故加柏子仁。以其偶或气郁不舒，故加佛手。以其经欠调，故仍用丹参。药味既多，竟不似吾师之方矣，相与一笑。
周女士服此二剂，大觉舒适，夜寐竟安。闻师将返江阴度岁，重来乞调理长方，余乃知之稔。本案可以示复发及调理之一格。其初病之经过，极曲折侥幸之奇观，兹续述之。
先是五月间，周女士病腹痛偏右，就诊于中医孙先生。孙先生与以理气定痛之剂，续治二月有余，不见效。改请西医王先生诊察究系何病，断谓盲肠炎。欲求根治，当用手术。病家不敢从命，乞施别法。西医乃用冰置其患处，痛止，周女士得仍回校中攻读。未逾十日，病又作，倍剧于前。至是西医坚决主张用手术，且谓时不可失，后将无及。但须家长签字，即可实行。此时也适周女士之父因事在杭，接家报如此云云，急覆电谓待我返再议。而女士之痛已不可忍，且拒按，右足不能伸，证情岌岌，不可终日。周母无主，惶急异常。会有戚祝先生至，曰：何不请中医治？周母曰：中医之方积叠成簿，惟其不能治，乃请教西医耳！曰：我有友人或能治此，曷请一试？于是俞哲生师兄应运而出。晚七时许，诊之，洒淅恶寒，口渴，脉弦滑而数，苔抽心而绛，边反白腻，急疏大黄牡丹汤加味，内用生大黄三钱。周母急令购药煎服，待其服已，俞师兄乃返寓。夜十一时，周先生忽作不速客访俞兄，惊问曰：生大黄竟可服至三钱耶？我昔延请之孙先生用药数十剂，仅末剂有蜜炙大黄五分。俞兄问服后病倩，曰：腹加痛矣，将奈何？俞兄慰之。周先生曰：姑待我返舍看变化如何。倘不幸转剧，我必以电话相告。未越一小时，俞家之电话铃声果响。事出望外，但闻周父曰：病者得下，而足已伸矣。续诊三次，颇告顺手。并知服第一剂后，下如血筋等污物。服第二剂后，下瘀血。服第三剂后，下血水。服第四剂后，竟得黄色粪。其日适值病者经来，病情未免夹杂，当延老师诊治。视已，师曰：病根未除也！依然用下剂。晚六时服药，其夜病者竟作瞑眩。四肢厥逆，冷汗出，下经六七次。至天亮，痛休。自是方真入坦途，了却无限风波。
余于本病素加注意，前年参观同济大学人体解剖展览会时，曾检阅盲肠及蚓突之种种异状至详。余并有一臆想，即大黄牡丹汤可代西医之刀与钳，且本汤能驱除蚓突中之污物，有刀与钳之利，而无刀与钳之弊。肠中污物之所以得入蚓突中者，因盲肠部分肠内容物拥挤不堪，不能上行，以致从旁溢入蚓突耳。服大黄牡丹汤即得泻出污物者，因肠壁受药力之刺激，故能推送内容物上行，平行，下行，以达肛门。盲肠之处既空，蚓突又得药力之刺激，乃返挤污物于盲肠，由是蚓突之炎以消而病以已。故云本汤可代刀与钳者，乃言其药力能刺激肠壁及蚓突，使自起力量，排出污物耳。
肠痈初起，每有恶寒之状。故《金匮 ·疮痈汤痈浸淫病脉证并治篇》第一条即曰：诸浮数脉，应当发热，而反洒淅恶寒，若有痛处，当发其痈。内而反洒淅恶寒大堪着目。世人竟有误认为疟疾之初起者。又发字诸家多凿解，窃意为痈生于体内，无从目睹，当其初起之时，甚不自知病所何在，故曰若有痛处，则当发其痈者，犹曰当觅其痈，盖发，犹发现之谓也。
《金匮》曰：肠痈者，少腹肿痞，按之即痛如淋，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，不可下也，大黄牡丹汤主之。历来注家对于脓已成，不可下也一语，殆无异辞。甚且以此为大黄牡丹汤与慧苡附子败酱散主治之分野，此殆不思之过也。
《金匮》所谓未成已成之脓所包至广，一切炎性渗出物，腐化之白血球，腐烂之肠壁皮肉等均是，要在当去之例一也。夫肠痈当未成脓之前，日可下之，试问欲下者何物？依余之说，下其肠中一切污积，使蚓突得挤出病根是矣。当已成脓之后，反曰不可下之，试问其脓作何处置？将使脓复返为血乎，此乃绝无之事。
将任脓突脐而出乎，此乃速死之图。《方伎杂志》略云：一商家女（中略）自腹心至面部四肢悉肿，少腹右方之底有酿脓。因思取脓则可保十日，以此告病家。
病家相惊吐舌，谓前医皆不知有脓，但云补药以助元气，则水气自治耳。遂乞施针。余曰：针则至多延命一月。取脓则十日。但识病在医，而死生任诸天数，姑针之可也。遂用铍针刺入寸许，脓汁迸射，上及承尘，臭气扑鼻，病家人人惊愕，乃与薏苡附子败酱散，疮口纳细棉条以出瘀脓。然其人元气渐脱，十一日而毙。
可谓一证。犹曰薏苡附子败酱散主之。试问服散之后，散能与脓起化学作用，齐化为乌有乎？吾俱其未能也。若曰散将与脓结而俱下，则依然是下法，乌得曰不可下？或曰：不可下者犹言不胜下，下之终危也。余则谓果下之，犹不失背城借－之计，不下即是束手待毙之策。孰得孰失，明眼者自能辨之。况脓去正虚，大可用补，活法在人，宁难善后。故窃于不可下三字大起疑惑，即使的系仲圣遗文，犹当据事实以改正之。如何改正，曰：当作当急下也。（又经文称本病小便自调，按之事实，不尔，改正之责，委之贤者。）《金匮》大黄牡丹汤方后曰：顿服之，有脓当下，如无脓当下血。本已昭示后人无脓当下，有脓当急下，悉主以本汤之意，人自不察耳。以病例言，本集肠痈案其一史君之大下河泥状污物，为有脓当下之例。吾师《金匮发微》本汤条下师母之下血半净桶，及本集肠痈案其三周女士之下血筋瘀血血水等物，皆无脓当下血之例。是故下血云者，此乃当下之恶血，血去则病除，绝非失血之谓也。
客曰：审如君言，薏苡附子败酱散将无用武之地矣。答曰：非也，特其用武之时不同耳。依《金匮》法，肠痈实分为二种。一种为热性者，为大黄牡丹汤所主。一种为寒性者，为薏苡附子败酱散所主。热性者多急性，寒性者多慢性。热性者痛如淋，寒性者痛缓。热性者时时发热，寒性者身无热。热性者常右足屈，患起于瞬时。寒性者则身甲错，恙生于平日。热性者属阳明，故大黄牡丹汤即诸承气之改方，寒性者属太阴，故薏苡附子败酱散乃附子理中之变局，且散与丸为近。热性者病灶多在盲肠。寒性者病灶不限于盲肠。能知乎此，则二汤之分，明矣。客憬然若悟而退。
肺痈其一
辛未七月中旬，余治一陈姓疾。初发时，咳嗽，胸中隐隐作痛，痛连缺盆。其所吐者，浊痰腥臭，与悬饮内痛之吐涎沫，固自不同，决为肺痈之始萌。遂以桔梗汤，乘其未集而先排之。进五剂，痛稍止，诸证依然，脉滑实。因思是证确为肺痈之正病，必其肺藏壅阻不通而腐，腐久乃吐脓，所谓久久吐脓如米粥者，治以桔梗汤。今当壅塞之时，不去其壅，反排其腐，何怪其不效也。《淮南子》云：葶苈愈胀，胀者，壅极不通之谓。《金匮》曰：肺痈，喘而不得眠，即胀也。《千金》重申其义曰：肺痈胸满胀，故知葶苈泻肺汤非泻肺也，泻肺中壅胀。今有此证，必用此方，乃以葶苈子五钱大黑枣十二枚凡五进，痛渐止，咳亦爽。其腥臭挟有米粥状之痰，即腐脓也。
后乃以《千金》苇茎汤，并以大小蓟、海藻、桔梗、甘草、杜赤豆出入加减成方。至八月朔日，先后凡十五日有奇，用药凡十余剂，始告全瘥。九月底其人偶受寒凉，宿恙又发，乃嘱兼服犀黄醒消丸，以一两五钱分作五服。服后，腥臭全去。但尚有绿色之痰，复制一料服之，乃愈，而不复来诊矣。
【按】本案并略见《金匮发微》。后历检吾师医案，乃得本案之先后全方。两相对照，更易昭然。特再附诸方于下，谅阅者当不嫌重复也。
陈左住浦东陆家渡初诊七月十二日肺痈，咳嗽，胸中痛，上连缺盆，而所吐绝非涎沫，此与悬饮内痛者，固自不同，宜桔梗甘草汤。
桔梗五钱甘草五钱二诊七月十八日五进桔梗汤，胸中痛止，而左缺盆痛。此肺藏雍阻不通也，宜葶苈大枣泻肺汤。
葶苈子五钱黑大枣十二枚先煎三诊七月二十四日五进泻肺汤，左缺盆痛止。痰黄厚，时见腥臭，及如米粥者。此湿邪去，而燥气胜也。宜《千金》苇茎汤。
鲜芦根四两生薏仁一两桃仁五十粒冬瓜子五钱四诊七月二十九日服《千金》苇茎汤五剂后，咯出之痰腥臭止，而如米粒者亦除。惟痰尚黄厚，肺痈消，而胃热尚盛也。右三部脉浮滑，不复见沈弦之象，可以无后患矣。
粉前胡三钱生苡仁一两桔梗三钱生草三钱冬瓜子八十粒桃仁三钱杜赤豆六钱大小蓟各三钱海藻二钱芦根五两拙巢注：服此二三日，全愈。
续发初诊九月二日肺痈愈后，复发。咯痰腥臭，见血，心下痛，咳时气从中脘上冲。宜清胆胃之火，防其乘肺。
柴胡三钱生石膏二两生甘草三钱淡芩三钱肥知母五钱生苡仁一两芦根四两冬瓜仁一两桃仁三钱杜赤豆一两全当归四钱二诊九月十日肺痈未能断根，咯痰腥臭如昔，但不似米粥耳。痰不黄而色绿，味酸，咳不甚，脉细数，仍宜桔梗甘草汤，不当攻伐，佐以消毒，以清病原。
桔梗一两生甘草五钱冬瓜仁一两昆布一钱五分海藻二钱前胡三钱大小蓟各钱五分犀黄醒消丸三钱另服拙巢注：后不复服药，专服犀黄醒消丸，愈。醒消丸系王鸿绪法，马培之颇非议之。然用之而效，则马说不足信也。
【按】夫肺痈重病也。仲圣云：脓成则死。今本案病者脓成而腥臭，吾师乃能愈之。岂吾师之术迈于仲圣乎？非也。所谓则死者，极言其危，而教人药量之不可轻也！夫桔梗今人仅用数分至一钱，葶苈今人少用之，用之亦不出数分，苇茎今人通常用一尺，今吾师用此三者乃至五钱，五钱，五两，不其骇人乎？虽然，此皆仲圣之教也。
陆某，左侧（指患者身体左侧或左脉，此处结合语境多指病位或脉象特征，原文“陆左”为姓名+性别/方位简称，通常指姓陆的男性或女性，此处依古籍习惯译为陆先生/女士，鉴于后文有“周小姐”，且陆某初诊未明性别，暂译作陆某），初次就诊时疼痛位于脐部右侧斜下方一寸处，西医称之为盲肠炎。其脉象大而有力，属于实证，应当采用攻下法治疗，使用张仲景的方法。
处方：生大黄五钱，芒硝三钱，桃仁五钱，冬瓜仁一两，牡丹皮一两二诊时，疼痛已略微缓解，但右腿拘挛紧急，不能屈伸，伸展时会牵拉腹部引起疼痛，适宜使用芍药甘草汤。
【按语】俗称“缩脚肠痈”的病证，就是这种情况。我的老师将《伤寒论》中的方剂移用来治疗《金匮要略》中的疾病，医术真是神妙啊！三诊时，右腿已经能够伸直，但腹中剧烈疼痛依旧。仍然适宜使用大黄牡丹汤来攻下。
处方：生川军（大黄）一两，芒硝七钱（冲服），桃仁五钱，冬瓜仁一两，牡丹皮一两。拙巢注：痊愈。
【按语】肠痈这一病证，变化多端。上述几个医案尚不足以穷尽其情状。我的朋友蒋冠周先生偶然抱着孩子上下台阶时不慎轻微惊跌，不久之后心中剧烈疼痛，难以忍受。第二天疼痛部位转移到了少腹右侧盲肠处。医生用定痛丸止痛，但不能治愈疾病。他的妻子前来嘱托我诊治。我当时正因中暑卧床，便推荐由我的老师诊治。我的老师给予大黄牡丹汤加减，服用两剂后将愈。不知什么原因，突然又发作剧烈疼痛如前，改请西医诊治，用药外敷等，大约十余日，慢慢趋向痊愈。此后盲肠部分有一块如银元大小的硬块，隐隐作痛，按压时更明显。蒋先生认为病根还在，担心再次发作，想要开刀，以求一劳永逸。我极力劝阻，使用阳和膏、瑙砂膏加上桂麝散等芳香走窜的药物，交替贴敷，一个月后消散，这是其中一个例子。
曹颖甫说：肠痈这一证候，除了大黄牡丹汤之外，没有别的良法。《千金方》的肠痈汤虽然与此方大致相似，但配伍还不够完善。只是有时药物虽对症，但治愈与否还不可必得。曾治疗庄翔生的次妻张氏，多次使用本汤攻下，但腰部忽然起了流火（丹毒），以至于死亡。考察其原因，实在是因为平日有鸦片瘾，戒烟后，不再吸烟，常用烧酒浸泡鸦片灰吞服，以至肠道干燥形成痈脓。攻下之后，鸦片灰的毒性内发，于是引发流火，以至于从肿胀到溃烂，最终无法救治，这不应该归咎于方剂的猛烈峻急。
肠痈第三例
周某，居住在小西门，复发，初次就诊。大便不是很通畅，自己用其他药物攻下，疼痛但没有排便，这是仲景所说的“非其治也”（不对症的治疗）。现在拟定使用承气汤加桃仁为主方。
处方：生川军（大黄）三钱（后下），枳实四钱，川朴（厚朴）二钱，桃仁四钱，芒硝二钱（冲服）
【按语】周小姐先在今年五月间患肠痈，经过我的老师和俞哲生师兄先后治愈，身体康复回校学业。到了十二月间，因为运动过度，饮食不节制，之前的盲肠患处又出现隐痛，火大（便秘）大便不行。于是去某西药房购买他们制作的丸药服用，希望它能缓慢通便。谁知只服用了两丸，大便就不能排出，疼痛反而加剧，难以忍受，自己后悔孟浪。没有办法，只好再请我的老师赐方，即本案复发初次就诊的方子。服用后，大便顺畅排出，疼痛大大减轻，只是有时按压还会感到轻微疼痛。过了一天，来进行第二次就诊。
二诊昨天经过攻下后，旧时的患处按压仍然疼痛。脉象弦而数，使用《千金方》肠痈汤来调和它。
处方：粉丹皮三钱，丹参三钱，白芍三钱，生地黄五钱，生甘草一钱，败酱草三钱，茯苓三钱，生薏苡仁八钱，大麦冬五钱，桔梗一钱，柏子仁一两，佛手二钱，生姜三片
【按语】周女士来二诊时，我正恭敬地侍立在老师身旁。老师让我把脉，脉象弦细而数。观察她的面色，似乎不够红润。只是据她叙述疼痛已大大减少，我心中暗自欣慰。老师让我拟方。我说：“《千金方》肠痈汤足以调和它。”老师赐予许可，就使用了这个方子。因为她之前已经经过多次攻下，所以不加用大黄。因为她夜间睡眠不安且性情容易急躁易怒，所以加用柏子仁。因为她偶尔气郁不舒，所以加用佛手。因为她月经欠调，所以仍用丹参。药味既然很多，竟然不像我老师的方子了，大家相视一笑。
周女士服用这两剂药，感觉非常舒适，夜间睡眠竟然安稳。听说老师将要返回江阴过年，她再来请求调理的长效方，我才对此了解得很透彻。本案可以作为复发及调理的一个范例。其最初发病的过程，极为曲折且侥幸，是奇观，这里继续叙述。
在此之前五月间，周女士患腹痛偏右，就诊于中医孙先生。孙先生给予理气定痛的药剂，连续治疗两个多月，不见效果。改请西医王先生诊察，究竟是什么病，断定为盲肠炎。想要根治，应当使用手术。病人家属不敢听从，请求施行别法。西医便在患处放置冰块，疼痛停止，周女士得以仍回学校攻读。不到十天，病又发作，比之前加倍严重。到了这时，西医坚决主张使用手术，并且说时机不可错失，后来就来不及了。只需要家长签字，即可实行。此时恰逢周女士的父亲因事在杭州，接到家报如此等等，急忙回复电报说等我回来再商议。而女士的疼痛已经不可忍受，且拒绝按压，右腿不能伸直，病情危急，不可终日。周母没有主意，惊慌焦急异常。恰好有亲戚祝先生到来，说：“为什么不请中医治疗？”周母说：“中医的方子积叠成册，只是因为他们不能治好，才请教西医的！”祝先生说：“我有朋友或许能治好这个病，何不请他试一试？”于是俞哲生师兄应运而生而出。晚上七时许，诊察，见患者洒淅恶寒（怕冷发抖），口渴，脉象弦滑而数，舌苔中心抽心而绛红，边缘反而白腻，急忙开具大黄牡丹汤加味，内服生大黄三钱。周母急忙令去买药煎服，等她服完，俞师兄便返回寓所。夜里十一时，周先生忽然作为不速之客拜访俞兄，惊讶地问：“生大黄竟然可以服用至三钱吗？我以前延请的孙先生用药几十剂，仅仅末剂有蜜炙大黄五分。”俞兄问服药后的病情，说：“腹部更加疼痛了，该怎么办？”俞兄安慰他。周先生说：“姑且等我回去看情况如何。如果不幸加重，我一定打电话告诉你。”不到一小时，俞家的电话铃声果然响起。事情出乎意料，只听周父说：“病人得到排便，而且腿已经伸直了。”续诊三次，颇为顺利。并得知服用第一剂后，排下如血筋等污物。服用第二剂后，排下瘀血。服用第三剂后，排下血水。服用第四剂后，竟排下黄色粪便。那天恰逢病人月经来潮，病情未免夹杂，应当请老师诊治。看完后，老师说：“病根未除啊！”依然使用攻下剂。晚上六时服药，当晚病人竟然出现瞑眩反应（服药后出现的暂时性剧烈反应，随后病情好转）。四肢厥逆，出冷汗，大便六七次。直到天亮，疼痛停止。从此才真正进入坦途，了却无限风波。
我对本病素来加以注意，前年参观同济大学人体解剖展览会时，曾详细检阅盲肠及蚓突（阑尾）的各种异状。我还有一个臆想，即大黄牡丹汤可以代替西医的手术刀与钳子，而且本汤能驱除蚓突中的污物，具有刀与钳的好处，而没有刀与钳的坏处。肠中污物之所以能进入蚓突中，是因为盲肠部分肠内容物拥挤不堪，不能上行，以致从旁边溢入蚓突耳。服用大黄牡丹汤就能泻出污物的原因，是因为肠壁受到药力的刺激，所以能推送内容物上行、平行、下行，以达肛门。盲肠之处既空，蚓突又得到药力的刺激，乃反过来挤压污物于盲肠，由此蚓突的炎症得以消除而病愈。所以说本汤可代刀与钳者，是说它的药力能刺激肠壁及蚓突，使其自起力量，排出污物罢了。
肠痈初起，常常有恶寒的症状。所以《金匮要略·疮痈肠痈浸淫病脉证并治篇》第一条就说：“诸浮数脉，应当发热，而反洒淅恶寒，若有痛处，当发其痈。”其中“反洒淅恶寒”尤其值得注意。世人竟然有误认为是疟疾初起的。另外，“发”字各家多有穿凿解释，我个人认为痈生于体内，无从目睹，当其初起之时，甚不自知病所何在，所以说“若有痛处，则当发其痈者”，犹言“当觅其痈”，盖“发”，犹发现之意。
《金匮要略》说：肠痈者，少腹肿痞，按之即痛如淋，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，不可下也，大黄牡丹汤主之。历来注家对于“脓已成，不可下也”这句话，几乎无异议。甚至以此作为大黄牡丹汤与薏苡附子败酱散主治的分野，这大概是不思考的过错。
《金匮要略》所谓未成已成之脓所包含的范围极广，一切炎性渗出物、腐化的白血球、腐烂的肠壁皮肉等都是，关键在于应当去除的情况之一。肠痈在脓未形成之前，每天都可以攻下，试问欲下的是什么东西？依我的说法，是下其肠中一切污积，使蚓突得以挤出病根，这是对的。当脓已形成之后，反而说不可攻下，试问那脓怎么处理？难道让脓重新变回血吗？这是绝无可能的事。
难道任由脓突出肚脐而出吗？这是加速死亡的图谋。《方伎杂志》略云：一商家女（中间省略）从腹心至面部四肢全部肿胀，少腹右方底部有酿脓。因此想到取脓则可以保命十日，以此告知病人家属。
病人家属惊恐吐舌，说前医都不知道有脓，只说补药以助元气，则水气自然治理。于是乞求施针。我说：“针则最多延长寿命一月。取脓则十日。但识病在于医，而死生听任天数，姑且针刺吧。”于是用铍针刺入寸许，脓汁迸射，上及天花板，臭气扑鼻，病人家属人人惊愕，于是给予薏苡附子败酱散，疮口纳细棉条以引出瘀脓。然而其人元气逐渐脱失，十一日而亡。
可谓一个病例。还说薏苡附子败酱散主治。试问服用散剂之后，散剂能与脓起化学作用，一齐化为乌有吗？我认为不能。如果说散剂将与脓结在一起一起排出，那依然是下法，怎么能说不可下？有人说：“不可下者”犹言不胜下，攻下终究危险。我却认为果若攻下，尚不失背城借一（决一死战）之计，不下即是束手待毙的策略。孰得孰失，明眼人自然能辨别。况且脓去正虚，大可用补，活法在人，难道难善后吗？所以我私下对“不可下”三个字大起疑惑，即使确实是仲圣遗文，也应当依据事实加以改正。如何改正，曰：当作“当急下也”。（又经文称本病小便自调，按实际情况，并非如此，改正的责任，委托给贤者。）《金匮要略》大黄牡丹汤方后说：顿服之，有脓当下，如无脓当下血。本已昭示后人无脓当下，有脓当急下，全以本汤为主的意思，人们自然没有察觉罢了。以病例而言，本集肠痈案其一史君的大下河泥状污物，是有脓当下的例子。吾师《金匮发微》本汤条下师母的下血半净桶，及本集肠痈案其三周女士的下血筋瘀血血水等物，都是无脓当下血的例子。所以下血云者，这是当下之恶血，血去则病除，绝非失血之意。
客人说：如果像您所说，薏苡附子败酱散就没有用武之地了吗？回答说：不是，只是其用武之时不同罢了。依《金匮要略》法，肠痈实分为二种。一种为热性者，为大黄牡丹汤所主。一种为寒性者，为薏苡附子败酱散所主。热性者多急性，寒性者多慢性。热性者痛如淋，寒性者痛缓。热性者时时发热，寒性者身无热。热性者常右足屈，患起于瞬时。寒性者则身甲错（皮肤粗糙如鳞甲），恙生于平日。热性者属阳明，故大黄牡丹汤即诸承气之改方，寒性者属太阴，故薏苡附子败酱散乃附子理中之变局，且散与丸相近。热性者病灶多在盲肠。寒性者病灶不限于盲肠。能知晓这些，则二汤之分，明了矣。客人恍然大悟而退。
肺痈第一例
辛未年七月中旬，我治疗一位陈姓病人。初发时，咳嗽，胸中隐隐作痛，痛连缺盆（锁骨上窝）。其所吐者，浊痰腥臭，与悬饮内痛之吐涎沫，固然自不相同，决为肺痈之始萌。遂以桔梗汤，乘其未集而先排之。进五剂，痛稍止，诸证依然，脉滑实。因思是证确为肺痈之正病，必其肺藏壅阻不通而腐，腐久乃吐脓，所谓久久吐脓如米粥者，治以桔梗汤。今当壅塞之时，不去其壅，反排其腐，何怪其不效也。《淮南子》云：葶苈愈胀，胀者，壅极不通之谓。《金匮要略》曰：肺痈，喘而不得眠，即胀也。《千金方》重申其义曰：肺痈胸满胀，故知葶苈泻肺汤非泻肺也，泻肺中壅胀。今有此证，必用此方，乃以葶苈子五钱、大黑枣十二枚。凡五进，痛渐止，咳亦爽。其腥臭挟有米粥状之痰，即腐脓也。
后乃以《千金方》苇茎汤，并以大小蓟、海藻、桔梗、甘草、杜赤豆出入加减成方。至八月朔日，先后凡十五日有奇，用药凡十余剂，始告全瘥。九月底其人偶受寒凉，宿恙又发，乃嘱兼服犀黄醒消丸，以一两五钱分作五服。服后，腥臭全去。但尚有绿色之痰，复制一料服之，乃愈，而不复来诊矣。
【按语】本案并略见于《金匮发微》。后历检吾师医案，乃得本案之先后全方。两相对照，更易昭然。特再附诸方于下，谅阅者当不嫌重复也。
陈某，左，住浦东陆家渡。初诊七月十二日：肺痈，咳嗽，胸中痛，上连缺盆，而所吐绝非涎沫，此与悬饮内痛者，固自不同，宜桔梗甘草汤。
二诊七月十八日：五进桔梗汤，胸中痛止，而左缺盆痛。此肺脏雍阻不通也，宜葶苈大枣泻肺汤。
三诊七月二十四日：五进泻肺汤，左缺盆痛止。痰黄厚，时见腥臭，及如米粥者。此湿邪去，而燥气胜也。宜《千金方》苇茎汤。
四诊七月二十九日：服《千金方》苇茎汤五剂后，咯出之痰腥臭止，而如米粒者亦除。惟痰尚黄厚，肺痈消，而胃热尚盛也。右三部脉浮滑，不复见沉弦之象，可以无后患矣。
处方：粉前胡三钱，生薏仁一两，桔梗三钱，生草三钱，冬瓜子八十粒，桃仁三钱，杜赤豆六钱，大小蓟各三钱，海藻二钱，芦根五两。拙巢注：服此二三日，全愈。
续发初诊九月二日：肺痈愈后，复发。咯痰腥臭，见血，心下痛，咳时气从中脘上冲。宜清胆胃之火，防其乘肺。
处方：柴胡三钱，生石膏二两，生甘草三钱，淡芩三钱，肥知母五钱，生薏仁一两，芦根四两，冬瓜仁一两，桃仁三钱，杜赤豆一两，全当归四钱。
二诊九月十日：肺痈未能断根，咯痰腥臭如昔，但不似米粥耳。痰不黄而色绿，味酸，咳不甚，脉细数，仍宜桔梗甘草汤，不当攻伐，佐以消毒，以清病原。
处方：桔梗一两，生甘草五钱，冬瓜仁一两，昆布一钱五分，海藻二钱，前胡三钱，大小蓟各钱五分，犀黄醒消丸三钱（另服）。拙巢注：后不复服药，专服犀黄醒消丸，愈。醒消丸系王鸿绪法，马培之颇非议之。然用之而效，则马说不足信也。
【按语】夫肺痈重病也。仲圣云：脓成则死。今本案病者脓成而腥臭，吾师乃能愈之。岂吾师之术迈于仲圣乎？非也。所谓则死者，极言其危，而教人药量之不可轻也！夫桔梗今人仅用数分至一钱，葶苈今人少用之，用之亦不出数分，苇茎今人通常用一尺，今吾师用此三者乃至五钱，五钱，五两，不其骇人乎？虽然，此皆仲圣之教也。
Lu, initial visit: Pain was located one cun diagonally below and to the right of the umbilicus, which Western medicine calls appendicitis. The pulse was large and solid (excess pattern), indicating the need for purgation. Treatment followed Zhang Zhongjing's method.
Prescription: Sheng Jun (Radix et Rhizoma Rhei, raw) 5 qian, Mang Xiao (Natrii Sulfas, 芒硝) 3 qian, Tao Ren (Semen Persicae, 桃仁) 5 qian, Dong Gua Ren (Semen Benincasae, 冬瓜仁) 1 liang, Dan Pi (Cortex Moutan, 牡丹皮) 1 liang.
Second visit: The pain had slightly eased, but the right leg was stiff and cramped, unable to flex or extend; extension would pull on the abdomen causing pain. It was appropriate to use Shaoyao Gancao Tang (Peony and Licorice Decoction).
Prescription: Chi Shao (Radix Paeoniae Rubra, 赤芍) and Bai Shao (Radix Paeoniae Alba, 白芍) each 5 qian, Sheng Gancao (Radix Glycyrrhizae, 生甘草) 3 qian, Zhi Ru Xiang (Resina Olibani, processed, 炙乳香) and Zhi Mo Yao (Resina Myrrhae, processed, 炙没药) each 3 qian.
[Commentary] This is what is commonly known as "Shrink-leg Intestinal Abscess" (Suojiao Changyong). My teacher transferred formulas from *Shanghan Lun* to treat diseases described in *Jingui Yaolue*; his skill was truly miraculous!
Third visit: The right leg could now be extended, but severe abdominal pain persisted. It was still appropriate to use Dahuang Mudan Tang (Rhubarb and Moutan Decoction) for purgation.
Prescription: Sheng Chuan Jun (Radix et Rhizoma Rhei, raw) 1 liang, Mang Xiao (Natrii Sulfas, 芒硝) 7 qian (added after decoction), Tao Ren (Semen Persicae, 桃仁) 5 qian, Dong Gua Ren (Semen Benincasae, 冬瓜仁) 1 liang, Dan Pi (Cortex Moutan, 牡丹皮) 1 liang. Note by Zhuochao: Cured.
[Commentary] The syndrome of Intestinal Abscess (Changyong) is complex and variable. The above cases are insufficient to fully describe its manifestations. My friend, Mr. Jiang Guanzhou, accidentally stumbled while carrying a child up and down stairs. Shortly after, he experienced severe central chest pain that was unbearable. The next day, the pain shifted to the lower abdomen on the right side, at the cecum. Doctors used Dingtong Wan (Pain-Relieving Pill) to stop the pain but could not cure the disease. His wife came to entrust me with his treatment. I was then bedridden with heatstroke, so I recommended my teacher. My teacher prescribed modified Dahuang Mudan Tang. After two doses, he was nearly cured. For some reason, severe pain suddenly recurred as before. He switched to Western medicine treatment with external applications, and after about ten days, gradually recovered. However, a hard mass the size of a silver coin remained in the cecal region, causing dull pain that intensified upon pressure. Mr. Jiang believed the root cause remained and feared recurrence, intending to undergo surgery for a permanent solution. I strongly advised against it, using Yanghe Gao (Yanghe Plaster) and Naosha Gao mixed with Guixie San (Cinnamon and Musk Powder), applying them alternately. The mass resolved in one month. This is one example.
Cao Yingfu said: Regarding the syndrome of Intestinal Abscess, apart from Dahuang Mudan Tang, there is no other good method. Although the Changyong Tang in *Qianjin Fang* is roughly similar to this formula, its combination is not yet perfect. Sometimes, even if the medicine matches the disease, a cure is not guaranteed. I once treated Mrs. Zhang, the second wife of Zhuang Xiangsheng. After repeatedly using this decoction for purgation, she suddenly developed "flowing fire" (erysipelas) on her waist, leading to death. Investigating the cause, it was due to her long-term opium addiction. After quitting smoking, she often swallowed opium ash soaked in liquor, causing intestinal dryness and abscess formation. After purgation, the toxicity of the opium ash erupted internally, triggering the flowing fire, which progressed from swelling to ulceration, ultimately resulting in untreatable condition. This should not be blamed on the harshness of the prescription.
Intestinal Abscess Case Three
Zhou, residing at Xiaoximen, relapse, initial visit. Bowel movements were not very smooth. She used other laxatives herself, resulting in pain without defecation. This is what Master Zhongjing called "not the correct treatment." Now, I propose using Chengqi Tang (Gut-Regulating Decoction) added with Tao Ren (Semen Persicae, 桃仁) as the main formula.
Prescription: Sheng Chuan Jun (Radix et Rhizoma Rhei, raw) 3 qian (added late), Zhishi (Fructus Aurantii Immaturus, 枳实) 4 qian, Chuan Po (Cortex Magnoliae Officinalis, 川朴), Taoren (Semen Persicae, 桃仁) 4 qian, Mang Xiao (Natrii Sulfas, 芒硝) 2 qian (added after decoction).
[Commentary] Miss Zhou first suffered from intestinal abscess in May of this year, cured successively by my teacher and Senior Brother Yu Zhesheng. She recovered and returned to school. In December, due to excessive exercise and irregular diet, the previous site of the cecal abscess began to ache faintly, accompanied by constipation ("fire"). She bought pills from a Western pharmacy hoping for mild laxative effects. However, after just two pills, she could not defecate, and the pain worsened unbearably. Regretting her rash action, she asked my teacher for a prescription again, which is the initial visit formula for this relapse case. After taking it, stool passed smoothly, and pain greatly subsided, though slight pain remained upon pressing occasionally. The next day, she came for the second visit.
Second Visit: After purgation yesterday, the old lesion site was still tender to pressure. The pulse was wiry and rapid. Use Qianjin Changyong Tang (*Qianjin* Intestinal Abscess Decoction) to harmonize.
Prescription: Fen Danpi (Cortex Moutan, 粉丹皮) 3 qian, Danshen (Radix Salviae Miltiorrhizae, 丹参) 3 qian, Baishao (Radix Paeoniae Alba, 白芍) 3 qian, Sheng Dihuang (Radix Rehmanniae Preparata, raw, 生地黄) 5 qian, Sheng Gancao (Radix Glycyrrhizae, 生甘草) 1 qian, Baijiangcao (Herba Patriniae, 败酱草) 3 qian, Fuling (Poria, 茯苓) 3 qian, Sheng Yiren (Semen Coicis, 生薏苡仁) 8 qian, Da Maidong (Rhizoma Ophiopogonis, 大麦冬) 5 qian, Jiegeng (Radix Platycodonis, 桔梗) 1 qian, Baizi Ren (Semen Platycladi, 柏子仁) 1 liang, Foshou (Fructus Citri Sarcodactylis, 佛手) 2 qian, Shengjiang (Rhizoma Zingiberis Recens, 生姜) 3 slices.
[Commentary] When Miss Zhou came for the second visit, I was respectfully standing beside my teacher. The teacher asked me to take her pulse, which was wiry, fine, and rapid. Observing her complexion, it did not appear very lustrous. However, she reported that the pain had significantly decreased, bringing me private comfort. The teacher asked me to draft the prescription. I said, "*Qianjin* Changyong Tang is sufficient to harmonize." The teacher approved, and we used it. Since she had undergone multiple purgations previously, we did not add Dahuang. Because she suffered from insomnia and irritability, we added Baizi Ren. Because she occasionally had qi stagnation, we added Foshou. Because her menstruation was irregular, we retained Danshen. With so many herbs, the prescription did not resemble my teacher's usual style; we shared a laugh.
Miss Zhou felt very comfortable after taking these two doses, and her sleep became peaceful. Hearing that my teacher was returning to Jiangyin for the New Year, she came again to request a long-term conditioning prescription, allowing me to understand the case thoroughly. This case serves as a model for relapse and conditioning. The initial course of the illness was extremely tortuous and fortunate, a spectacle worth recounting.
Earlier, in May, Miss Zhou suffered from right-sided abdominal pain and consulted TCM Doctor Sun. Dr. Sun gave Qi-regulating and pain-relieving agents. After more than two months of treatment, there was no effect. She then consulted Western Doctor Wang, who diagnosed appendicitis and recommended surgery for a radical cure. The family refused, asking for alternative methods. The doctor applied ice to the affected area, stopping the pain, allowing Miss Zhou to return to school. Less than ten days later, the illness returned, twice as severe. The doctor insisted on surgery, stating time was critical. Parental signature was required. At that time, Miss Zhou's father was in Hangzhou. Upon receiving the news, he telegraphed back to wait for his return. However, the lady's pain became unbearable, she rejected pressure, and her right leg could not extend. The condition was critical. Her mother was panicked. A relative, Mr. Zhu, suggested consulting a TCM doctor. Her mother replied that they had tried many TCM prescriptions without success, hence seeking Western medicine. Mr. Zhu said he knew someone who might help. Thus, Senior Brother Yu Zhesheng stepped forward. Around 7 PM, examination revealed aversion to cold (chills), thirst, wiry-slippery-rapid pulse, and a tongue coating that was crimson in the center with white-greasy edges. Urgently, a modified Dahuang Mudan Tang was prescribed, including 3 qian of raw Dahuang. Her mother hurried to buy and decoct the medicine. After she took it, Brother Yu returned to his residence. At 11 PM, Mr. Zhou visited unexpectedly, shocked, asking, "Can raw Dahuang be taken in doses of 3 qian? The previous doctor used only 5 fen of honey-fried Dahuang in the final dose." Brother Yu asked about the condition. Mr. Zhou said, "The abdominal pain increased. What should we do?" Brother Yu comforted him. Mr. Zhou said, "Let me go home and see. If it worsens, I will call." Within an hour, the phone rang. It was Mr. Zhou saying, "The patient has defecated, and her leg can now extend." Subsequent visits went smoothly. It was learned that after the first dose, blood-like filaments and foul matter were passed. After the second dose, blood clots. After the third, bloody water. After the fourth, yellow stool. Coincidentally, her menstruation started, complicating the condition. My teacher was consulted. He examined her and said, "The root cause remains!" He continued with purgatives. Medicine taken at 6 PM caused a "Mingxuan" reaction (herxheimer-like reaction) that night: cold limbs, sweating, and six to seven bowel movements. By dawn, the pain ceased. From then on, the path to recovery was clear.
I have always paid attention to this disease. Last year, at a Tongji University anatomy exhibition, I carefully studied various anomalies of the cecum and vermiform appendix. I have a hypothesis: Dahuang Mudan Tang can replace Western surgical knives and forceps. This decoction can expel debris from the appendix, offering the benefits of surgery without its drawbacks. Debris enters the appendix because the cecum is overcrowded, forcing contents sideways into the appendix. Dahuang Mudan Tang stimulates the intestinal wall, promoting peristalsis (upward, horizontal, downward) to expel debris. Once the cecum is empty, the stimulated appendix squeezes debris back into the cecum, resolving inflammation and curing the disease. Thus, the decoction replaces surgery by stimulating the intestine and appendix to self-expel debris.
Intestinal abscess often begins with aversion to cold. Hence, Article 1 of *Jingui Yaolue · Chapter on Pulse, Symptoms, and Treatment of Carbuncles, Abscesses, and Eczema* states: "Floating and rapid pulses usually indicate fever, but if there is chivering aversion to cold and a painful area, an abscess is developing." The "aversion to cold" is particularly noteworthy. People often mistake this for early-stage malaria. Regarding the character "Fa" (develop/emerge), commentators often interpret it rigidly. I believe since internal abscesses cannot be seen, and patients are unaware of the location initially, "if there is a painful area, an abscess is developing" means "one should seek the abscess." "Fa" here means "to discover."
*Jingui Yaolue* states: In intestinal abscess, the lower abdomen is swollen and distended, painful upon pressure like strangury, urination is normal, with intermittent fever, spontaneous sweating, and recurrent aversion to cold. If the pulse is slow and tight, pus is not yet formed; purgation is indicated, and blood may pass. If the pulse is surging and rapid, pus is formed; purgation is contraindicated. Dahuang Mudan Tang governs. Commentators unanimously agree on "pus formed, purgation contraindicated," using this as the dividing line between Dahuang Mudan Tang and Yiyi Fuzi Baijiang San. This is likely due to lack of critical thinking.
The "pus" mentioned in *Jingui* covers a wide range: inflammatory exudates, degenerated leukocytes, necrotic intestinal tissue, etc. The key is whether it needs to be removed. Before pus forms, purgation removes intestinal debris to squeeze out the root cause from the appendix. After pus forms, saying "purgation is contraindicated" raises the question: what happens to the pus? Can it turn back into blood? Impossible. Should it burst through the navel? That leads to rapid death. *Fangji Zazhi* records a case where a merchant's daughter had extensive swelling and pus in the lower right abdomen. The doctor predicted survival for ten days if pus was drained. Family members were terrified, noting previous doctors only used tonics. They begged for acupuncture. The doctor said acupuncture might prolong life by a month, but draining pus offers ten days. He proceeded with acupuncture, draining pus that sprayed to the ceiling. He then prescribed Yiyi Fuzi Baijiang San and inserted cotton strips. The patient died eleven days later due to qi depletion. This proves the point. Yet, it is still said that Yiyi Fuzi Baijiang San governs. Does the powder chemically react with pus to vanish? No. If it binds with pus and expels it, that is still a purgative method. Why say "contraindicated"? Some argue "contraindicated" means the body cannot withstand purgation. I argue that purgation is a last stand; doing nothing is waiting for death. Clearly, purgation is better. If qi is deficient after pus removal, tonification can follow. Therefore, I doubt the phrase "contraindicated." Even if it is Zhang Zhongjing's original text, it should be corrected based on facts. Correction: It should read "Urgent purgation is indicated." (*Jingui* also notes normal urination, which is often not the case; correction left to scholars.) The post-script of Dahuang Mudan Tang says: "Take in one dose. If pus exists, it will be purged; if no pus, blood will be purged." This clearly indicates that for pus, urgent purgation is needed, and for no pus, blood purgation is needed, all governed by this decoction. Cases include Mr. Shi passing mud-like debris (pus present, purged) and Teacher's wife/Miss Zhou passing blood/clots/water (no pus, blood purged). "Passing blood" refers to expelling evil blood, curing the disease, not hemorrhage.
Guest: If so, is Yiyi Fuzi Baijiang San useless?
Reply: No, its timing differs. According to *Jingui*, intestinal abscess has two types: Heat-type (governed by Dahuang Mudan Tang) and Cold-type (governed by Yiyi Fuzi Baijiang San). Heat-type is acute, painful like strangury, febrile, right leg flexed, sudden onset, Yangming channel, related to Chengqi formulas, lesion in cecum. Cold-type is chronic, dull pain, non-febrile, skin rough like scales, gradual onset, Taiyin channel, related to Fuzi Lizhong variation, lesion not limited to cecum. Understanding this clarifies the distinction. The guest departed enlightened.
Lung Abscess Case One
In mid-July of the Xinwei year, I treated a patient surnamed Chen. Initially, cough, dull chest pain radiating to the supraclavicular fossa (Quepen). Sputum was turbid, foul-smelling, distinct from the saliva of Xuan Yin (fluid retention). It was definitely the beginning of Lung Abscess (Feiyong). I used Jiegeng Tang (Platycodon Decoction) to drain it before it matured. After five doses, pain subsided slightly, but symptoms persisted; pulse was slippery and solid. I reasoned this is a true Lung Abscess where lung congestion leads to putrefaction and pus. As stated, "long-term spitting of pus like rice porridge" is treated with Jiegeng Tang. But during congestion, draining putrefaction without removing congestion explains the inefficacy. *Huainanzi* says: Tingli resolves distension, where distension means extreme blockage. *Jingui Yaolue* says: Lung abscess causes wheezing and insomnia, i.e., distension. *Qianjin Fang* reiterates: Lung abscess causes chest fullness and distension. Thus, Tingli Xiefei Tang does not drain the lung, but drains lung distension. Given this syndrome, this formula is necessary. I used Tingli Zi (Semen Lepidii, 葶苈子) 5 qian and large black dates (Da Zao, 大枣) 12 pieces. After five administrations, pain stopped, cough improved. The foul, rice-porridge-like sputum was putrid pus.
Later, I used Qianjin Weijing Tang (*Qianjin* Reed Shoot Decoction) modified with Da Xiao Ji (Herba Taraxaci, 大小蓟), Haizao (Thallus Sargassii, 海藻), Jiegeng (Radix Platycodonis, 桔梗), Gancao (Radix Glycyrrhizae, 甘草), and Du Chidou (Semen Phaseoli, 杜赤豆). By August 1st, after 15 days and over ten doses, full recovery was achieved. In late September, exposure to cold triggered a relapse. I advised concurrent use of Xi Huang Xing Xiao Wan (Amaranth and Awakening Elimination Pills). Five doses of 1.5 qian each eliminated the foul smell. Green sputum remained. Another dose cured the patient, who never returned.
[Commentary] This case is briefly mentioned in *Jingui Fawei*. Later, reviewing my teacher's medical records, I found the complete prescriptions. Comparing them makes it clearer. I attach the formulas below for readers' reference.
Chen, Left, residing at Pudong Lujia Du. Initial Visit, July 12: Lung Abscess, cough, chest pain radiating to Quepen. Sputum is not saliva, distinct from Xuan Yin. Appropriate: Jiegeng Gancao Tang.
Prescription: Jiegeng (Radix Platycodonis, 桔梗) 5 qian, Gancao (Radix Glycyrrhizae, 甘草) 5 qian.
Second Visit, July 18: After five doses of Jiegeng Tang, chest pain stopped, but left Quepen hurts. Lung congestion and blockage. Appropriate: Tingli Dazao Xiefei Tang.
Prescription: Tingli Zi (Semen Lepidii, 葶苈子) 5 qian, Black Dates (Da Zao, 大枣) 12 pieces (decocted first).
Third Visit, July 24: After five doses of Xiefei Tang, left Quepen pain stopped. Sputum is yellow, thick, sometimes foul-smelling and rice-porridge-like. Dampness gone, dryness prevails. Appropriate: Qianjin Weijing Tang.
Prescription: Fresh Lu Gen (Rhizoma Imperatae, 鲜芦根) 4 liang, Sheng Yiren (Semen Coicis, 生薏苡仁) 1 liang, Tao Ren (Semen Persicae, 桃仁) 50 grains, Dong Gua Zi (Semen Benincasae, 冬瓜子) 5 qian.
Fourth Visit, July 29: After five doses of Qianjin Weijing Tang, foul smell and rice-grain-like sputum stopped. Sputum remains yellow and thick. Lung abscess resolved, but stomach heat persists. Right three positions pulse is floating and slippery, no longer deep and wiry. No future complications expected.
Prescription: Fen Qianhu (Radix Peucedani, 粉前胡) 3 qian, Sheng Yiren (Semen Coicis, 生薏苡仁) 1 liang, Jiegeng (Radix Platycodonis, 桔梗) 3 qian, Sheng Cao (Radix Glycyrrhizae, 生草) 3 qian, Dong Gua Zi (Semen Benincasae, 冬瓜子) 80 grains, Tao Ren (Semen Persicae, 桃仁) 3 qian, Du Chidou (Semen Phaseoli, 杜赤豆) 6 qian, Da Xiao Ji (Herba Taraxaci, 大小蓟) each 3 qian, Haizao (Thallus Sargassii, 海藻) 2 qian, Lu Gen (Rhizoma Imperatae, 芦根) 5 liang. Note by Zhuochao: Fully cured after 2-3 doses.
Relapse Initial Visit, Sept 2: Relapse after Lung Abscess cure. Foul-smelling sputum with blood, epigastric pain, qi rushing up from Zhongwan during cough. Clear Gallbladder and Stomach fire to prevent invasion of Lung.
Prescription: Chai Hu (Radix Bupleuri, 柴胡) 3 qian, Sheng Shi Gao (Gypsum Fibrosum, 生石膏) 2 liang, Sheng Gancao (Radix Glycyrrhizae, 生甘草) 3 qian, Dan Huang Qin (Radix Scutellariae, 淡芩) 3 qian, Fei Zhi Mu (Rhizoma Anemarrhenae, 肥知母) 5 qian, Sheng Yi Ren (Semen Coicis, 生薏仁) 1 liang, Lu Gen (Rhizoma Imperatae, 芦根) 4 liang, Dong Gua Ren (Semen Benincasae, 冬瓜仁) 1 liang, Tao Ren (Semen Persicae, 桃仁) 3 qian, Du Chi Dou (Semen Phaseoli, 杜赤豆) 1 liang, Quan Dang Gui (Radix Angelicae Sinensis, 全当归) 4 qian.
Second Visit, Sept 10: Lung Abscess not eradicated. Foul sputum as before, but not rice-porridge-like. Sputum green, sour taste, mild cough, fine-rapid pulse. Still appropriate: Jiegeng Gancao Tang. Do not attack vigorously; assist with detoxification to clear the source.
Prescription: Jiegeng (Radix Platycodonis, 桔梗) 1 liang, Sheng Gancao (Radix Glycyrrhizae, 生甘草) 5 qian, Dong Gua Ren (Semen Benincasae, 冬瓜仁) 1 liang, Kun Bu (Thallus Laminariae, 昆布) 1.5 qian, Haizao (Thallus Sargassii, 海藻) 2 qian, Qian Hu (Radix Peucedani, 前胡) 3 qian, Da Xiao Ji (Herba Taraxaci, 大小蓟) each 0.5 qian, Xi Huang Xing Xiao Wan (Amaranth and Awakening Elimination Pills, 犀黄醒消丸) 3 qian (taken separately). Note by Zhuochao: Patient stopped other medicines, took only Xi Huang Xing Xiao Wan, and was cured. Xi Huang Xing Xiao Wan is based on Wang Hongxu's method; Ma Peizhi criticized it. However, since it worked, Ma's criticism is unreliable.
[Commentary] Lung Abscess is a serious disease. Master Zhongjing said: "When pus forms, death ensues." In this case, the patient had formed pus and foul sputum, yet my teacher cured him. Is my teacher's skill superior to Zhongjing's? No. "Death ensues" emphasizes the severity and warns against light-mindedness in dosage. Today, people use Jiegeng in small amounts (fen to 1 qian), Tingli rarely and in small amounts, and Weijing typically one chi. My teacher used these in amounts up to 5 qian or 5 liang, which seems shocking. Nevertheless, this follows Zhongjing's teachings.