脓者血之变也。血不阻气。气不战血。则血气调和。疮疖不生。血滞气则凝结为痛。气蒸血则腐化成脓。躯
壳外者易治。至于吐脓。则出于脏腑之内。其证最危。在中焦以下。则便脓。在中焦以上。则吐脓。夫人身之
气。乃水所化。气即水也。故血得气之变蒸。亦化而为水。不名曰水。而名曰脓者。以其本系血质。虽化为水。
而较水更浓也。当其未化。则仍是血。消瘀则脓自不生。及其既化。则同于水。逐水则脓自排去。
一肺痈。乳上第三根肋骨间。名肺募穴。隐隐疼痛。食豆而香。是痈将成。仲景云。风舍于肺。其人则咳。口干
喘满。咽燥不渴。时时吐浊沫。时时振寒。热之所过。血为之凝滞。蓄结痈脓。吐如米粥。始萌可救。脓成则死。
谓重者肺坏而死。若肺不坏。亦有可救。故仲景又曰。口中辟辟燥咳。胸中隐隐作痛。脉数而实。喘不得卧。
鼻塞不闻香臭者。葶苈大枣泻肺汤主之。吐脓如米粥者。甘桔汤主之。仲景此论。非谓除此二方。别无治
法。不过分别未成脓者。当泻实。已成脓者。当开结。指示两条门径。使人知所从事。且曰。以此汤主之。明明
有加减之法。见于言外。余因即泻实开结二义。推而广之。其成脓者。用通窍活血汤。加麻黄杏仁石膏甘
草。从表以泻之。无表证者。用人参泻肺汤。加葶苈大枣。从里以泻之。如病势猛勇。急须外攘内除。则用防
风通圣散。三方力量。雄浓于仲景泻实之法。庶尽其量。如识力不及。只用甘桔汤。加荆芥薄荷杏仁黄芩。
亦许免疚。然而无功。其已成脓者。急须将脓除去。高者越之。使从口出。用千金韦茎汤。或用瓜蒂散。加冬
瓜仁桃仁苡仁栀子。或用泻白散。加黄连栝蒌。皆取在膈上则吐。使脓远去。以免久延为患。白散尤能吐
能下。加升麻郁金。以助其吐下之机。再加黄芩栝蒌。以解其火更善。如只须下泻。不宜涌吐。则合甘桔泻
肺二汤。再加赤豆芽苡仁防己栝蒌杏仁知母枳壳。使从下降。或用桔梗宁肺汤。补泻兼行。如此则于仲
景开结之法。庶尽其妙。惟收口之法。仲景未言。然亦可以义例求也。诸疮生肌。皆用温补。肺是金脏。温则
助火刑金。只宜清敛以助金令。使金气足。而肺自生。人参清肺汤治之。后服清燥救肺汤以收功。
一脾胃痈。与肺痈治法略同。但肺痈多由外感风邪而成。故有发表之法。脾胃痈。则由湿热酒毒。七情之
火内蕴而成。故无发表之法。胃痈初起。中脘穴在脐上四寸。必隐隐作痛。脾痈初起。章门穴在脐上二寸。
旁开六寸。必隐隐作痛。二病皆食豆而香。其证寒热如疟。皮肤甲错。腹满咽干。治宜攻热下血。热去而血
不停。更自何地酿为痈脓哉。故凡内痈脓未成者。以夺去瘀热为主。丹皮汤治之。脓已成者。以排为主。脓
即水也。逐水即是排脓。赤豆苡仁汤治之。脓血既去之后。则脏腑空虚。见火象者。人参固本汤。加黄 茯
苓。以清补之。若现虚寒之象。则用六君子汤。加黄 当归煨姜。以温补之。方外有方。视其所兼之证。随宜
用之。笔楮难尽。
此外。如胸背腰胁肝膈。大小肠。凡有瘀热壅血。均能成痈。总以丹皮汤主之。近上焦者。去芒硝。加葶苈黄
桔梗荆芥甘草。中下焦者。加姜黄。余详便脓门。
此书原专论血证。所以兼及内痈者。以痈脓之病。皆由血积而成。知血之变痈脓。即可知血之能为干血。
能变痨虫。知内痈之生寒热。即可知血证之郁热矣。但痈脓之证。系血家实积。与失血虚证有异。然不以
此反观合勘。亦无以尽血证之情伪。
脓是血液变化而成的。如果血液不阻滞气机，气不搏结血液，那么气血就会调和，疮疖就不会产生。血滞而气郁则凝结成痛，气蒸而血腐则化生为脓。在体表的脓疡容易治疗，至于吐脓，则是出于脏腑内部，病情最为危重。病位在中焦以下，则出现便脓；病位在中焦以上，则出现吐脓。人体之气是由水所化生的，气即是水。所以血液得到气的变蒸作用，也会化为水，但不叫水而叫脓，是因为它原本属于血的质地，虽然化为水，但比水更浓稠。当它尚未化脓时，仍然是血，消除瘀血则脓自然不生；等到已经化脓，就等同于水，逐水利尿则脓自然排出。
一是肺痈。乳上第三根肋骨间的穴位名为肺募穴（俞府穴附近），此处隐隐作痛，闻到豆类气味觉得香，这是痈即将形成的征兆。张仲景说：风邪客舍于肺，患者就会咳嗽，口干，气喘胸闷，咽喉干燥但不想喝水，时常吐出浑浊的泡沫，时常发冷战栗。热邪经过之处，血液为之凝滞，蓄积结聚而成痈脓，吐出的痰像米粥一样。在初期萌芽阶段还可以救治，脓液形成后则难以治愈。这是指病情严重的会导致肺脏毁坏而死。如果肺脏没有毁坏，也有可救的可能。所以张仲景又说：口中干涩，咳嗽，胸中隐隐作痛，脉象数而有力，气喘不能平卧，鼻塞闻不到香味和臭味的，用葶苈大枣泻肺汤主治。吐出脓液像米粥一样的，用甘桔汤主治。张仲景的这个论述，并不是说除了这两个方剂外没有其他治法，不过是区分未成脓者，应当泻实邪；已成脓者，应当开结排脓，指示两条治疗途径，使人知道如何着手。并且说“以此汤主之”，明明暗示有加减变化的方法存在于言外之意。我因此根据泻实、开结这两层含义，推演并扩大其应用范围。对于已成脓的，使用通窍活血汤，加入麻黄、杏仁、石膏、甘草，从体表以泻除邪气；没有表证的，使用人参泻肺汤，加入葶苈子、大枣，从体内以泻除邪气。如果病势猛烈勇悍，急需外解内除，则使用防风通圣散。这三个方的力量，比张仲景的泻实之法更为雄浑浓烈，这样才能尽其药力。如果诊断能力不足，只使用甘桔汤，加入荆芥、薄荷、杏仁、黄芩，也许可以避免过错，然而可能效果不佳。那些已经成脓的，急需将脓液除去，病位高的通过涌吐使脓从口排出，使用千金苇茎汤，或者使用瓜蒂散，加入冬瓜仁、桃仁、薏苡仁、栀子；或者使用泻白散，加入黄连、瓜蒌，都是取其在膈上则通过呕吐排出，使脓液远离，以免久延成为祸患。白散尤其能催吐也能泻下，加入升麻、郁金，以助其吐下的机制；再加入黄芩、瓜蒌，以解除火热之邪更好。如果只需要泻下，不宜涌吐，则将甘桔汤与泻肺汤合用，再加入赤豆芽、薏苡仁、防己、瓜蒌、杏仁、知母、枳壳，使邪气从下降排出；或者使用桔梗宁肺汤，补益与泻实兼行。这样就能把张仲景开结排脓的方法发挥到极致。只有收口愈合的方法，张仲景没有提及，但也可以依据义理来寻求。各种疮疡生肌长肉，都使用温补法。肺是金脏，温补则会助火克金，只宜清润收敛以辅助肺气，使金气充足，而肺自然生长。用人参清肺汤治疗，随后服用清燥救肺汤以巩固疗效。
一是脾胃痈。治疗方法与肺痈大致相同，但肺痈多由外感风邪引起，所以有发表（发散表邪）的方法；脾胃痈，则由湿热、酒毒以及七情之火内蕴而成，所以没有发表的方法。胃痈初起，中脘穴（位于脐上四寸）必然隐隐作痛；脾痈初起，章门穴（位于脐上二寸，旁开六寸）必然隐隐作痛。这两种病都会闻到豆类气味觉得香，症状表现为寒热往来如疟疾，皮肤粗糙如鳞甲，腹部胀满，咽喉干燥。治疗应当攻逐热邪、下行瘀血。热邪去除而瘀血不停止，又从哪里酿成痈脓呢？所以凡是内痈脓液未成的，以夺取瘀热为主，用丹皮汤治疗。脓液已成的，以排脓为主。脓就是水，逐水也就是排脓，用赤豆薏苡仁汤治疗。脓血既去之后，脏腑空虚，如果出现火象（热证），用人参固本汤，加入黄芪、茯苓，以清补之；如果呈现虚寒之象，则使用六君子汤，加入黄芪、当归、煨姜，以温补之。方剂之外还有方剂的变化，视其所兼夹的症状，随意选用。笔墨难以详尽列举。
此外，如胸背腰胁、肝膈、大小肠等部位，凡是有瘀热壅塞血液的，都能形成痈肿。总以丹皮汤为主治方。病位近上焦的，去掉芒硝，加入葶苈子、黄芩、桔梗、荆芥、甘草；病位在中下焦的，加入姜黄。其余详细内容见“便脓”章节。
这本书原本专门论述血证，所以兼及内痈的原因，是因为痈脓这类疾病，都是由血积滞而成。知道了血液变为痈脓的道理，就可以知道血液能成为干血，能变成劳虫（消耗性疾病的病原）。知道了内痈产生的寒热症状，就可以知道血证中的郁热了。但是痈脓的证候，属于血分实证积聚，与失血导致的虚证有所不同。然而如果不以此反观对照，也无法穷尽血证的真实情况与虚假表现。
Pus is a transformation of blood. If blood does not obstruct qi, and qi does not contend with blood, then blood and qi will be harmonious, and sores and boils will not arise. When blood stagnates and qi becomes constrained, it condenses into pain; when qi steams and blood putrefies, pus is formed. Pus on the exterior of the body is easy to treat. However, vomiting pus originates from within the zang-fu organs, making the condition most critical. If the pathology is below the middle jiao (middle energizer), there is pus in the stool; if above the middle jiao, there is vomiting of pus. The qi of the human body is transformed from water; thus, qi is essentially water. Therefore, when blood undergoes the steaming and transforming action of qi, it also transforms into water. It is not called water but pus because its original substance is blood; although transformed into water, it is thicker than water. Before it transforms, it remains blood; eliminating blood stasis prevents pus formation. Once it has transformed, it is equivalent to water; promoting diuresis expels the pus.
First, Lung Abscess. There is a hidden pain between the third rib on the chest, known as the Front-Mu point of the Lung (Yufu area). A pleasant smell of beans indicates that the abscess is about to form. Zhang Zhongjing stated: "When wind lodges in the lung, the person coughs, has a dry mouth, wheezing and chest fullness, dry throat without thirst, frequently spits turbid froth, and experiences frequent chills. Where heat passes, blood coagulates and stagnates, accumulating to form an abscess and pus, which is vomited like congee. In the early stage, it can be saved; once pus forms, death ensues." This refers to severe cases where the lung is destroyed leading to death. If the lung is not destroyed, it may still be salvageable. Thus, Zhang Zhongjing also said: "If the mouth is parched, coughing occurs, there is hidden pain in the chest, the pulse is rapid and excess, wheezing prevents lying down, and nasal congestion causes loss of smell, Tingli Dazao Xiefei Tang (Thladiantha and Jujube Decoction to Drain the Lung) is indicated. If pus is vomited like congee, Ganjie Tang (Licorice and Platycodon Decoction) is indicated." Zhang Zhongjing's discussion does not imply that no other treatments exist besides these two formulas. Rather, it distinguishes between those where pus has not yet formed, requiring draining of excess, and those where pus has formed, requiring opening blockages and draining pus. It points out two pathways for treatment. The phrase "indicated by this decoction" clearly implies methods of modification beyond the literal text. I have therefore extrapolated and expanded upon the principles of draining excess and opening blockages. For those with formed pus, Tongqiao Huoxue Tang (Unblocking Orifices and Invigorating Blood Decoction) is used, added with Mahuang, Xingren, Shigao, and Gancao (Ephedra, Apricot Seed, Gypsum, and Licorice), to drain via the exterior. For those without exterior symptoms, Renshen Xiefei Tang (Ginseng Decoction to Drain the Lung) is used, added with Tingli and Dazao (Thladiantha and Jujube), to drain via the interior. If the disease momentum is fierce and urgent external release and internal removal are needed, Fangfeng Tongsheng San (Saposhnikovia Universal Salvation Powder) is used. These three formulas possess greater potency than Zhang Zhongjing's method of draining excess, thereby fully utilizing their strength. If diagnostic acumen is insufficient, using only Ganjie Tang added with Jingjie, Bohe, Xingren, and Huangqin (Schizonepeta, Mint, Apricot Seed, and Scutellaria) might avoid error, though efficacy may be poor. For those with formed pus, it is urgent to remove the pus. For high-located pathogens, induce vomiting to expel pus from the mouth, using Qianjin Weijing Tang (Millennium Reed Stem Decoction) or Guiti San (Melon Seed Powder) added with Dongguaren, Taoren, Yiren, and Zhizi (Winter Melon Seed, Peach Kernel, Coix Seed, and Gardenia); or use Xiebai San (Drain White Powder) added with Huanglian and Gualou (Coptis and Trichosanthes Fruit), aiming to expel via vomiting since the pathogen is above the diaphragm, keeping the pus distant to prevent prolonged suffering. Baisan (White Powder) is particularly effective in inducing both vomiting and purgation; adding Shengma and Yujin (Cimicifuga and Curcuma Rhizome) assists this mechanism; further adding Huangqin and Gualou better resolves fire-toxin. If only purgation is needed and vomiting is contraindicated, combine Ganjie Tang and Xiefei Tang, adding Chidouya, Yiren, Fangji, Gualou, Xingren, Zhimu, and Zhike (Red Bean Sprout, Coix Seed, Stephania Root, Trichosanthes Fruit, Apricot Seed, Anemarrhena Rhizome, and Aurantium Peel), to direct downward expulsion; or use Jiegeng Ningfei Tang (Platycodon Decoction to Calm the Lung), combining tonification and draining. This way, the subtlety of Zhang Zhongjing's method of opening blockages is fully realized. Only the method for closing wounds was not mentioned by Zhang Zhongjing, but it can be deduced by analogy. All sores generating flesh use warm tonification. The Lung is a Metal organ; warm tonification aids fire to damage metal. Only clear, astringent methods should be used to assist Metal, ensuring sufficient Metal Qi so the Lung regenerates naturally. Renshen Qingfei Tang (Ginseng Decoction to Clear the Lung) treats it, followed by Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) to conclude treatment.
Second, Spleen and Stomach Abscess. The treatment is slightly similar to Lung Abscess. However, Lung Abscess often arises from external wind pathogens, hence methods for releasing the exterior are used. Spleen and Stomach Abscess arises from internal accumulation of damp-heat, alcohol toxins, and fire from the seven emotions, hence no exterior-releasing methods are used. At the onset of Stomach Abscess, the Zhongwan point (4 cun above the umbilicus) must have hidden pain. At the onset of Spleen Abscess, the Zhangmen point (2 cun above the umbilicus, 6 cun lateral) must have hidden pain. Both conditions present with a pleasant smell of beans, symptoms resembling malaria (alternating chills and fever), skin roughness like scales, abdominal fullness, and dry throat. Treatment should attack heat and purge blood stasis. If heat is removed and blood stasis persists, where else could pus be brewed? Therefore, for all internal abscesses before pus formation, the main strategy is to seize and eliminate stasis-heat, treated with Danpi Tang (Moutan Decoction). For those with formed pus, the main strategy is drainage. Pus is water; draining water is draining pus, treated with Chidou Yiren Tang (Adzuki Bean and Coix Seed Decoction). After pus and blood are expelled, the zang-fu organs are empty. If signs of fire appear, Renshen Guben Tang (Ginseng Decoction to Secure the Root) added with Huangqi and Fuling (Astragalus and Poria) is used for clear tonification. If signs of deficiency-cold appear, Liujunzi Tang (Six Gentlemen Decoction) added with Huangqi, Danggui, and Wei Jiang (Astragalus, Angelica Sinensis, and Roasted Ginger) is used for warm tonification. Beyond these formulas, variations depend on accompanying symptoms, applied flexibly. Writing cannot exhaustively list them.
Furthermore, areas such as the chest, back, waist, flanks, Liver, Diaphragm, Large Intestine, and Small Intestine, where stasis-heat and blood congestion occur, can all form abscesses. Danpi Tang is generally indicated. For locations near the Upper Jiao, remove Mangxiao and add Tingli, Huangqin, Jiegeng, Jingjie, and Gancao (Thladiantha, Scutellaria, Platycodon, Schizonepeta, and Licorice). For Middle and Lower Jiao locations, add Jianghuang (Turmeric). Details are found in the "Pus in Stool" section.
This book originally focused specifically on blood disorders, so it mentions internal abscesses because abscess and pus diseases all result from blood accumulation. Understanding how blood transforms into abscess and pus allows one to understand how blood can become dried blood or transform into consumption parasites. Understanding the chills and fever generated by internal abscesses allows one to understand the stagnant heat in blood disorders. However, abscess and pus conditions belong to excess accumulation in the blood level, differing from deficiency syndromes caused by blood loss. Nevertheless, without reflecting and cross-examining through this perspective, one cannot fully grasp the true and false aspects of blood disorders.