薛立斋治上舍周一元，腹患痈，三月不愈，脓水清稀，朝寒暮热。服四物、知、柏之类，食少作
泻，痰涎上涌。服二陈、枳实之类，痰涎愈甚，胸膈痞闷。问故，曰∶朝寒暮热，血气虚也，食少作
泻，脾肾虚也，悉因真气虚而邪气实也。当先壮其胃气，使诸脏有所禀而邪自退矣。乃遂用六君子、
黄、当归，数剂诸症渐退。又用十全大补汤，肌肉渐敛，更用补中益气调理而愈。
从侄孙年十四而毕姻。乙巳春，年二十四，腹中作痛。用大黄等药二剂，下血甚多，胸腹胀满，
痰喘发热。又服破气降火药，一剂汗出如水，手足如冰。薛归诊之，左关洪数，右关尤甚，乃腹痈也。
虽能收敛，至夏必变而成瘵症。用参、 各一两，归、术各五钱，陈皮、茯苓各三钱，炙草、炮姜各
一钱，二剂诸症稍退，腹始微赤，按之觉痛。又二剂作痛，又二剂肿痛，脉滑数。针出脓瘀，更用大
补汤，精神饮食如故。因遗精，患处色黯，用前药加五味、山萸、山药、骨脂、吴萸等剂，疮口渐敛，
瘵症悉具。其脉非洪大而数，即微细如无，惟专服独参汤、人乳汁少复，良久仍脱。曰∶当备后事，
以俟火旺，乃祷鬼神。巫者历言往事如见，更示以方药，皆峻利之剂，且言保其必生。敬信服之，后
果殁。经曰∶拘于鬼神者，不可与言至德。而况又轻信方药于邪妄之人耶，书此以警后患。
薛立斋治一男子，腹患痈，肿硬不溃，乃阳气虚弱，呕吐少食，乃胃气虚寒，法当温补脾胃。假
如肿赤痛甚，烦躁脉实而呕，为有余，当下之；肿硬不溃，脉弱而呕，为不足，当补之。若痛伤胃气，
或感寒邪秽气而呕者，虽肿疡，犹当助胃壮气。彼信不真，仍服攻伐药而呕甚。复请治，脉微弱而发
热。曰∶热而脉反静，脱血脉反实，汗后脉反躁者，皆为逆也。辞不治，果殁。
秋官钱可容腹患痈， 肿烦渴作痛，饮冷，大便不通，脉沉数实，此热毒蕴于内。清热用消毒散
加大黄二钱，一剂诸症悉退。但形气顿虚，用托里消毒散去银花、白芷，倍加参、 、归、术而安。
毛砺安侧室，肚患痈月余矣，色黯不肿，内痛作呕，饮食不入，四肢逆冷，其脉或脱绝或浮大，
杂用定痛败毒之药。曰∶此气血俱虚而作痛，内决无脓，不治之症也。强用大温补之药，二剂痛止色
赤，饮食少进。谓但可延日而已。人皆以为有脓，复强针之，又用大补之剂，始生清脓少许。众仍以
为毒结于内，用攻脓保其必生，殊不知乃速其死耳。惜哉。
一男子腹患痈，肿硬木闷，烦热便秘，脉数而实，以黄连内疏汤，一剂少愈。以黄连解毒散，二
剂顿退。更以金银花散四剂，疮头出水而消。
一男年逾三十，患腹痈肿，脉数喜冷。齐氏云∶疮疡肿起坚硬，疮疽之实也。河间云∶肿硬木闷，
喜饮冷，邪气在内也。遂用清凉饮，倍用大黄，三剂稍缓。次以四物汤加芩、连、山栀、木通，四剂
而遂溃。更以十宣散去参、 、肉桂，加金银花、天花粉渐愈。彼欲速效，自服温补之剂，致腹俱肿，
小便不利。仍以清凉饮治之，脓溃数碗，再以托里药治之愈。东垣云∶疮疽之发，其受有内外之别，
治之有寒温之异。受之外者，法当托里以温剂，反用寒药，则是皮毛始受之邪，引入骨髓。受之内者，
法当疏利以寒剂，反用温补托里，则是骨髓之病，上彻毛皮，表里通溃，共为一疮，助邪为毒，苦楚
百倍，轻则几殆，重则死矣。
一男子素好酒色，小腹患毒，脉弱微痛，欲求内消。谓当助胃壮气，兼行经活血药佐之可消，不
宜用败毒等药。彼欲速效，乃自用之，病热果盛，疮亦不溃，饮食少思。迨两月余复请治，诊其脉愈
弱，盗汗不止，聚肿不溃，肌寒肉冷，自汗色脱。此气血俱虚也，故不能发肿成脓。以十全大补汤三
十余服，遂成脓。刺之反加烦躁脉，此亡阳也。以圣愈汤服二剂，仍用前药百帖愈。
刘贵患腹痈， 痛，烦躁作呕，脉实。河间云∶疮疡者，火之属，须分内外，以治其本。若脉沉
实者，先当疏其内，以绝其源。又曰∶呕哕以烦，脉沉而实，肿硬木闷，或皮肉不变，邪气在内，宜
内疏黄连汤治之。
今作呕脉实，毒在内也，遂用前汤通利二三行，诸症悉退。更以连翘消毒散而愈。
一人患腹痈，脓熟开迟，脉微细。脓出后，疮口微脓如蟹吐沫，此内溃透膜也。凡疮疡透膜，十
无一生，虽以大补药治之，亦不能救。此可为待脓自出之戒也。
黄师文云∶男子服建中汤，妇人服四物汤，往往十七八得，但时为之损益耳。有男病小腹一大痈，
其诸弟侮之曰∶今日用建中汤否？师文曰∶服建中汤。俄而痈溃。盖小腹痈本虚，其热毒乘虚而入，
建中汤既补虚，而黄 且溃脓也。（《北窗炙 》）
薛立斋治疗上舍周一元，腹部患痈，三个月未愈，脓水清稀，早晨怕冷晚上发热。服用四物汤、知母、黄柏之类的药物后，食欲减少并出现腹泻，痰涎向上涌溢。又服用二陈汤、枳实之类的药物，痰涎更加严重，胸膈部痞塞闷胀。询问病因，回答说：早晨怕冷晚上发热，是血气虚弱；食欲减少导致腹泻，是脾肾虚弱；这都是因为真气虚弱而邪气亢盛所致。应当先强壮胃气，使各脏腑有所禀受，邪气自然消退。于是使用六君子汤加黄芪、当归，服用数剂后各种症状逐渐消退。接着使用十全大补汤，肌肉逐渐愈合，再用补中益气汤调理而痊愈。
薛立斋的侄孙十四岁结婚。乙巳年春天，二十四岁时，腹中疼痛。服用大黄等药两剂，排出大量血液，胸部和腹部胀满，伴有痰喘和发热。又服用破气降火的药物，一剂后出汗如水，手脚冰凉。薛立斋诊察，左关脉洪数，右关脉尤其明显，诊断为腹痈。虽然能够收敛，但到了夏天必定转变为虚劳病（瘵症）。使用人参、白术各一两，当归、白术各五钱，陈皮、茯苓各三钱，炙甘草、炮姜各一钱，服用两剂后症状稍退，腹部开始微红，按压时感觉疼痛。再服两剂感到疼痛，又服两剂肿痛，脉象滑数。针刺排出脓液和瘀血，再用大补汤，精神和饮食恢复正常。因遗精，患处颜色变暗，用前面的药方加入五味子、山茱萸、山药、骨碎补、吴茱萸等药剂，疮口逐渐愈合，虚劳病的症状全部具备。其脉象不是洪大而数，就是微弱细小如无，只专服独参汤和人乳汁，稍微恢复，不久仍然脱证。说：应当准备后事，等待火旺之时，于是向鬼神祈祷。巫师详细讲述往事如同亲眼所见，又给出方药，都是峻烈通利的药剂，并且保证一定能生还。恭敬信服，后来果然死亡。经书说：拘泥于鬼神的人，不可以与他谈论高尚的道德。何况又轻信邪妄之人的方药呢，写下这些以警示后人。
薛立斋治疗一名男子，腹部患痈，肿胀坚硬不溃烂，这是阳气虚弱，呕吐少食，这是胃气虚寒，治法应当温补脾胃。假如红肿疼痛剧烈，烦躁脉象实而呕吐，属于有余，应当攻下；如果肿胀坚硬不溃烂，脉象弱而呕吐，属于不足，应当补益。如果疼痛损伤胃气，或者感受寒邪秽气而呕吐的，即使是肿疡，也应当助胃壮气。那人信念不坚定，仍然服用攻伐药物而导致呕吐加重。再次请求治疗，脉象微弱而发热。说：发热而脉象反而平静，脱血而脉象反而实，发汗后脉象反而躁动的，都属于逆证。推辞不治疗，果然死亡。
秋官钱可容腹部患痈，肿胀烦渴疼痛，想喝冷水，大便不通，脉象沉数实，这是热毒蕴结在体内。清热用消毒散加大黄二钱，一剂后各种症状全部消退。但形体和气机顿时虚弱，用托里消毒散去金银花、白芷，加倍加入人参、白术、当归、白芍而安定。
毛砺安的侧室，肚子上患痈一个多月了，颜色暗而不肿，内部疼痛并呕吐，饮食无法进入，四肢逆冷，脉象时而断绝时而浮大，杂用定痛败毒的药物。说：这是气血俱虚而导致的疼痛，内部绝对没有脓，是不治之症。强行使用大温补的药物，两剂后疼痛停止颜色变红，饮食稍微进用。说只能延缓时日而已。人们都认为有脓，又强行针刺，又用大补的药剂，才生出少许清稀脓液。众人仍然认为是毒结在内部，用排脓的方法保证能生还，却不知道这是加速死亡罢了。可惜啊。
一名男子腹部患痈，肿胀坚硬木闷，烦热便秘，脉象数而实，用黄连内疏汤，一剂后稍有好转。用黄连解毒散，两剂后症状顿退。再用金银花散四剂，疮头出水而消散。
一名男子三十多岁，患腹痈肿胀，脉数喜欢冷饮。齐氏说：疮疡肿起坚硬，是疮疽的实证。河间说：肿胀坚硬木闷，喜欢喝冷水，是邪气在体内。于是用清凉饮，加倍使用大黄，三剂后稍缓解。接着用四物汤加黄芩、黄连、山栀、木通，四剂后遂溃烂。再用十宣散去人参、白术、肉桂，加金银花、天花粉逐渐痊愈。那人想要快速见效，自行服用温补的药剂，导致腹部全部肿胀，小便不利。仍然用清凉饮治疗，脓液流出几碗，再用托里药治疗而痊愈。东垣说：疮疽的发生，致病原因有内外之别，治疗有寒温的差异。感受外邪的，治法应当用温剂托里，反而用寒药，则是将皮毛始受的邪气引入骨髓。感受内邪的，治法应当用寒剂疏利，反而用温补托里，则是将骨髓的病邪上彻到皮毛，表里贯通溃烂，共成一疮，助长邪气为毒，痛苦百倍，轻则几乎危险，重则死亡。
一名男子平时好酒色，小腹患毒，脉象弱微痛，想要内部消散。说应当助胃壮气，兼用行经活血药辅助可以消散，不宜用败毒等药。那人想要快速见效，乃自行服用，病情果然热盛，疮也不溃烂，饮食减少思虑。等到两个多月后再次请求治疗，诊察脉象更弱，盗汗不止，聚肿不溃烂，肌肤寒冷肌肉冰冷，自汗面色苍白。这是气血俱虚，所以不能发肿成脓。用十全大补汤三十多剂，遂成脓。针刺后反而增加烦躁脉象，这是亡阳。用圣愈汤服用两剂，仍用前面的药一百帖而痊愈。
刘贵患腹痈，疼痛，烦躁作呕，脉象实。河间说：疮疡属于火类，必须分内外，以治其本。如果脉象沉实的，首先应当疏通内部，以断绝源头。又说：呕吐哕逆且烦躁，脉象沉而实，肿胀坚硬木闷，或者皮肉不变，邪气在体内，宜用内疏黄连汤治疗。
现在作呕脉实，毒在内部，于是用前面的汤剂通利二三行，各种症状全部消退。再用连翘消毒散而痊愈。
一人患腹痈，脓熟开迟，脉象微细。脓出后，疮口微脓如螃蟹吐沫，这是内部溃烂穿透膜。凡是疮疡透膜，十无一人生还，即使以大补药治疗，也不能挽救。这可以作为等待脓液自然流出的警戒。
黄师文说：男子服用建中汤，妇人服用四物汤，往往十七八人中有十人有效，只是根据时机进行增减罢了。有一名男子小腹患一个大痈，他的弟弟们嘲笑他说：今天用建中汤吗？师文说：服用建中汤。不久痈溃烂。大概小腹痈本是虚证，热毒乘虚而入，建中汤既补虚，而黄芪且促使溃脓。（《北窗炙輠录》）
Xue Lizhai treated Zhou Yiyuan, a Shangshe (official title), who suffered from an abdominal carbuncle that had not healed for three months. The pus was clear and thin, with chills in the morning and fever in the evening. After taking herbs such as Siwu Tang (Four Substances Decoction), Zhimu (Anemarrhenae Rhizoma), and Baipiao (Phellodendri Cortex), his appetite decreased, he experienced diarrhea, and phlegm-saliva surged upward. He then took Erchen Tang (Two-Aged Decoction) and Zhishi (Aurantii Fructus), but the phlegm-saliva became worse, causing fullness and oppression in the chest and diaphragm. Upon inquiry, it was explained: "Chills in the morning and fever in the evening indicate deficiency of blood and Qi; decreased appetite leading to diarrhea indicates deficiency of Spleen and Kidney; all are due to deficiency of True Qi and excess of pathogenic factors." The treatment should first strengthen Stomach Qi so that the Zang-Fu organs receive nourishment and pathogens recede spontaneously. Thus, Liujunzi Tang (Six Gentlemen Decoction) combined with Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix) was used. After several doses, symptoms gradually subsided. Then, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was administered, allowing muscles to gradually heal. Finally, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) was used for regulation until recovery.
Xue Lizhai’s nephew married at age fourteen. In the spring of the Yisi year, at age twenty-four, he suffered from abdominal pain. After taking two doses of Da Huang (Rhei Radix et Rhizoma) and other drugs, he passed a large amount of blood, resulting in chest and abdominal distension, phlegm-wheezing, and fever. He then took Qi-po Jiehuo Yao (Qi-breaking and Fire-descending medicines). After one dose, he sweated profusely like water, and his hands and feet became ice-cold. Xue examined the pulse: the Left Guan position was surging and rapid, especially the Right Guan position, diagnosing an abdominal carbuncle. Although it could be收敛 (astringed/healed), by summer it would inevitably transform into a consumptive disease (Zhai Syndrome). A prescription of Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) each 1 liang, Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) each 5 qian, Chenpi (Citri Reticulatae Pericarpium) and Fuling (Poria) each 3 qian, Zhigancao (Prepared Licorice Root) and Paojiang (Prepared Ginger) each 1 qian was given. After two doses, symptoms slightly receded, and the abdomen became slightly red, painful upon pressure. After two more doses, pain occurred; after two further doses, swelling and pain appeared, with a slippery and rapid pulse. Needling drained pus and stasis. Using Dabu Tang (Great Tonifying Decoction), spirit and diet returned to normal. Due to spermatorrhea, the lesion turned dark. The previous formula was modified with Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gubuli (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus). The wound gradually closed, but signs of consumptive disease fully manifested. His pulse was either surging, large, and rapid, or minute and fine as if absent. Only Du Shen Tang (Single Ginseng Decoction) and human milk were taken, providing slight recovery before relapsing into collapse. It was said: "Prepare for death, wait for the Fire phase to peak, and pray to ghosts and gods." A shaman recounted past events as if seeing them, prescribing harsh purgatives, guaranteeing survival. Trusting this, he eventually died. The Classic states: "One bound by ghosts and gods cannot be spoken to regarding the highest Virtue." How much less can one trust prescriptions from deceitful persons? This is recorded to warn future generations.
Xue Lizhai treated a man with an abdominal carbuncle that was swollen, hard, and unruptured, indicating Yang Qi deficiency. Vomiting and poor appetite indicated deficiency-cold of Stomach Qi. The method should be to warm and tonify Spleen and Stomach. If the swelling were red and painfully hot, with irritability, a full pulse, and vomiting, it would be Excess, requiring purgation. Since it was hard and unruptured with a weak pulse and vomiting, it was Deficiency, requiring tonification. If pain injured Stomach Qi, or cold/dirty pathogens caused vomiting, even with a superficial abscess, one must assist Stomach Qi and strengthen Wei Qi. The patient lacked conviction, continued taking attacking drugs, and vomiting worsened. Upon re-consultation, the pulse was minute and weak with fever. Xue stated: "Fever with a calm pulse, collapse with a full pulse, agitation after sweating—all are adverse signs." He refused treatment, and the patient died.
Qian Kerong, a magistrate, suffered from an abdominal carbuncle with swelling, irritability, thirst, pain, desire for cold drinks, and constipation. The pulse was deep, rapid, and full, indicating heat-toxin accumulation internally. To clear heat, Xiaodu San (Detoxication Powder) plus 2 qian of Da Huang (Rhei Radix et Rhizoma) was used. One dose cleared all symptoms. However, form and Qi suddenly weakened. Tuoli Xiaodu San (Interior-Supporting Detoxication Powder) without Jinyinhua (Lonicerae Japonicae Flos) and Baizhi (Angelicae Dahuricae Radix), with doubled Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baishao (Paeoniae Radix Alba), stabilized him.
Mao Li'an's concubine had an abdominal carbuncle for over a month. The color was dark without swelling, internal pain with vomiting, inability to eat, cold limbs, and pulses alternating between absent and floating-large. Various pain-relieving and detoxifying herbs were used. Xue said: "This is pain due to dual deficiency of Qi and Blood. There is absolutely no pus internally; it is an untreatable condition." Forcing strong warming-tonics for two doses stopped pain and reddened the area, allowing slight food intake. It was noted that life could only be prolonged. Others believed there was pus and forced needling, followed by strong tonics, producing only a little clear pus. Believing toxin remained inside, they attempted to drain pus to ensure survival, unknowingly hastening death. Regrettable.
A man suffered from an abdominal carbuncle, swollen, hard, numb, with irritability, fever, and constipation. The pulse was rapid and full. Huanglian Neishu Tang (Coptis Internal-Draining Decoction) improved him slightly after one dose. Huanglian Jiedu San (Coptis Detoxication Powder) resolved symptoms after two doses. Jinyinhua San (Lonicera Powder) for four doses allowed the sore head to discharge water and resolve.
A man over thirty suffered from an abdominal carbuncle with swelling, rapid pulse, and preference for cold drinks. Qi Shi stated: "Swollen, hard sores indicate Excess in carbuncles." He Jianwei stated: "Swelling, hardness, numbness, and preference for cold drinks indicate pathogens inside." Qingliang Yin (Cooling Drink) with extra Da Huang (Rhei Radix et Rhizoma) relieved symptoms after three doses. Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), and Mutong (Akebiae Caulis) caused rupture after four doses. Shixuan San (Ten-Vitality Powder) without Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Rougui (Cinnamomi Cortex), plus Jinyinhua (Lonicerae Japonicae Flos) and Tianhuafen (Trichosanthis Radix), gradually healed him. Wanting quick results, he self-administered warming-tonics, causing total abdominal swelling and difficult urination. Qingliang Yin (Cooling Drink) was used again, draining several bowls of pus. Tuoli medicines (Interior-Supporting Drugs) cured him. Dong Yuan stated: "Carbuncles have external and internal origins, requiring warm or cold treatments respectively. External pathogens require warming interior-supporters; using cold herbs draws pathogens to the marrow. Internal pathogens require cold draining herbs; using warming tonics draws marrow pathology to the skin, causing systemic ulceration, aiding toxins, increasing suffering tenfold—light cases nearly die, heavy cases die."
A man fond of alcohol and sex suffered from a toxic lump in the lower abdomen with a weak pulse and mild pain, seeking internal resolution. Xue advised assisting Stomach Qi and strengthening Wei Qi, aided by blood-invigorating herbs, avoiding detoxifying drugs. Seeking quick results, he self-medicated, worsening heat, preventing rupture, and reducing appetite. Two months later, the pulse was weaker, with night sweats, clustered swelling without rupture, cold skin and flesh, spontaneous sweating, and pale complexion. This was dual deficiency of Qi and Blood, preventing pus formation. Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) for over thirty doses produced pus. Needling increased irritability and pulse agitation, indicating Yang collapse. Shengyu Tang (Sage Preservation Decoction) for two doses, followed by the previous hundred doses, cured him.
Liu Gui suffered from an abdominal carbuncle with pain, irritability, vomiting, and a full pulse. He Jianwei stated: "Carbuncles belong to Fire; distinguish internal/external to treat the root. Deep-full pulses require internal draining to cut off the source." Also: "Vomiting with irritability, deep-full pulse, hard swelling/numbness, or unchanged skin/flesh indicate internal pathogens; use Neishu Huanglian Tang (Internal-Draining Coptis Decoction)."
Now, vomiting with a full pulse indicates internal toxin. The previous decoction was used to promote defecation two or three times, clearing all symptoms. Lianqiao Xiaodu San (Forsythia Detoxication Powder) cured him.
A man with an abdominal carbuncle had delayed rupture despite mature pus, with a minute-fine pulse. After drainage, the wound oozed pus like crab bubbles, indicating internal rupture through the membrane. Carbuncles penetrating the membrane are almost invariably fatal; even strong tonics cannot save them. This serves as a warning against waiting for spontaneous rupture.
Huang Shiwen stated: "Men taking Jianzhong Tang (Middle-Building Decoction) and women taking Siwu Tang (Four Substances Decoction) often succeed, adjusting for timing." A man had a large lower abdominal carbuncle. His brothers mocked him: "Are you taking Jianzhong Tang today?" Shiwen said: "Take Jianzhong Tang." Soon, the carbuncle ruptured. Lower abdominal carbuncles are essentially deficient; heat-toxins enter via deficiency. Jianzhong Tang tonifies deficiency, and Huangqi (Astragali Radix) promotes pus rupture. (From *Beichuang Zhigelu*)