〔薛〕 腹痈谓疮，生于肚腹，或生于皮里膜外，属膏粱浓味，七情郁火。若漫肿坚
硬，肉色不变，或脉迟紧，未成脓也，四君加芎归、白芷、枳壳，或托里散。肿软色赤，
或脉洪数，已成脓也，托里消毒散。脓成而不外溃者气血虚也，卧针而刺之。肿 作痛
者，邪气实也，先用仙方活命饮；隔蒜灸以杀其毒，后用托里以补其气。若初起欲其内
消，当助胃壮气，使根本坚固而以行经活血之药佐之。若用克伐之剂欲其消散，则肿者
不能溃，溃者不能敛。若用疏利之药下其脓，则少壮者多为难治，老弱者立见危亡。
一人年逾三十，腹患痈肿，脉数喜冷。齐氏曰∶疮疡肿起，坚硬者实也。河间曰∶肿
硬瞀闷，烦躁饮冷，邪在内也，用清凉饮倍大黄，三剂稍缓，次以四物汤加芩连、山栀、
木通，四剂而溃，更以十宣散去参 、桂，加金银花、天花粉。彼欲速效，自服温补药，肚
腹遂肿，小便不利。仍用清凉饮，脓溃数碗，再以托里药治之而愈。 一人腹痈 痛，烦
躁作呕，脉实。河间曰∶疮疡火属，须分内外，以治其本。 又云∶呕哕心烦，肿硬瞀
闷，或皮肉不变，脉沉而实，毒在内也，当疏其内，以绝其源，用内疏黄连汤利二三行。
诸证悉退，更以连翅消毒散而愈。 一人腹痈，脓熟开迟，脉微细。脓出后，疮口微脓
如蟹吐沫，此内溃透膜也。疮疡透膜，十无一生，虽用大补，亦不能救，此可为待脓自
出之戒也。 一人素嗜酒色，小腹患毒，脉弱微痛，欲求内消。予谓∶当助胃壮气，兼
行经活血佐之可消。彼欲速效，自用败毒等药，势果盛，疮不溃脓，饮食少思，两月余
复请诊。脉愈弱，盗汗不止，聚肿不溃，肌寒肉冷，自汗色脱，此气血俱虚，故不能发
肿成脓。以十全大补汤，三十余剂脓成针之，反加烦躁脉大，此亡阳也。以圣愈汤二剂，仍
以前汤百剂而愈。 司马李梧山患此，腹痛而势已成，用活命饮一剂，痛顿止；用托里
消毒散，肿顿起，此脓将成也。用托里散补之，自溃而愈。锦衣掌堂，刘廷器。正德辛
未，仲夏，腹患痈溃而脓清，热渴腹胀，作呕不食，或以为热毒内攻，皆用芩连、大黄
之剂，病愈甚。薛曰∶当舍时从证，投以参 、姜附等药，一剂呕止食进，再用托里等
剂而疮愈。 进士边云庄，腹痛恶寒，脉浮数。薛曰∶浮数之脉而反恶寒，疮疽之证也。
不信。数日后复请视之，左尺洪数。薛曰∶内有脓矣，仍不信，至小腹痛胀，连及两臀，始
悟。薛曰∶脓溃臀矣，气血俱虚，何以收敛？急服活命饮一盅，臀溃一孔，出脓斗许，气
息奄奄，用大补药一剂，神思方醒。每去后粪从疮出，痛不可当，小腹间如有物上挺，即
发痉不省人事，烦躁脉大，举按皆实，省而诊之，脉洪大按之如无。以十全大补，倍用
参至四斤，更加附子二枚，煎膏服而痉止，又用十全大补汤，五十余剂而疮敛。 上舍
周一元，腹患痈，三月不愈，脓水清稀，朝寒暮热，服四物黄柏、知母之类，食少作泻，
痰涎上涌，服二陈、枳实之类，痰涎愈甚，胸膈痞闷，谓薛曰何也？薛曰∶朝寒暮热，血
气虚也，食少作泻，脾肾虚也，痰涌胸痞，脾肺虚也，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。遂用六君，加黄 、当归数剂，诸证渐退，又用十全大
补汤，肌肉渐敛，更用补中益气汤调理而痊。上舍毛体仁，素阴虚，春初咳嗽，胸中隐
痛，肾脉数而无力，肺脉数而时见，此肾气亏损，阴火炽盛，用六味丸料一剂，服之病
势虽减，内痈已成。盖因元气虚而未能发出，火令可畏。不信，服痰火之剂，两月后，乳
间微肿，脉洪数而无力。薛曰∶脓内溃矣，当刺出其脓，以免内攻之祸。不信，又月余请
视，但针得一孔，脓KT 不利，仍复内攻，唇舌青赤。薛曰∶脏腑已坏，吾何能治之？后
果殁。 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。薛往他，适
归诊之。左关洪数，右尺尤甚，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，二剂诸证少退，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、山茱、山药、骨脂、吴茱等剂，疮口渐敛，瘵证悉具，其
脉非洪大而数，即微细如无，唯专服独参汤、人乳汁，少复，良久仍脱。余曰∶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
此警后。
【薛己】腹部痈肿是指疮疡生于肚腹部位，或者生于皮里膜外，多因过食膏粱厚味、七情郁结化火所致。如果漫肿坚硬，皮肤颜色不变，或者脉象迟紧，说明脓尚未形成，可用四君子汤加川芎、当归、白芷、枳壳，或者使用托里散。如果肿处变软且色红，或者脉象洪数，说明脓已经形成，可用托里消毒散。脓已成熟但未向外溃破的，是气血虚弱所致，应用卧针（平刺）的方法针刺。肿胀作痛的，是邪气实盛所致，先用仙方活命饮；配合隔蒜灸以杀灭毒邪，随后用托里法补益正气。如果在初起阶段希望使其内消，应当助胃壮气，使根本坚固，并辅以行经活血的药物。如果使用克伐攻下的药物想要消散，那么肿者不能溃破，溃者不能收敛愈合。如果使用疏利攻下的药物排出脓液，那么年轻力壮者多难治愈，年老体弱者立刻面临危亡。
有一人年过三十，腹部患痈肿，脉数且喜冷饮。齐氏说：疮疡肿起，坚硬的是实证。河间（刘完素）说：肿硬、神志昏闷、烦躁、想喝冷水，是邪气在体内，用清凉饮加倍大黄，服用三剂后症状稍缓，接着用四物汤加黄芩、黄连、山栀、木通，服用四剂后溃脓，再用十宣散去人参、桂枝，加金银花、天花粉。那人追求速效，自行服用温补药，导致肚腹更加肿胀，小便不利。仍然使用清凉饮，排出脓液数碗，再用托里药治疗而痊愈。
有一人患腹部痈痛，烦躁作呕，脉象实。河间说：疮疡属火证，必须分辨内外，以治其本。又说：呕吐呃逆、心烦、肿硬昏闷，或者皮肉颜色不变，脉沉而实，是毒邪在体内，应当疏通内部，以断绝病源，用内疏黄连汤通便二三行。各种症状全部消退后，再用连翘消毒散治疗而痊愈。
有一人患腹部痈，脓已成熟但溃破迟缓，脉象微细。脓流出后，疮口微流脓如螃蟹吐沫，这是内溃穿透了膜原。疮疡穿透膜原，十个人中没有能救活的，即使使用大补药，也不能挽救，这可以作为等待脓液自然排出的警戒。
有一人平时嗜好酒色，小腹患毒，脉弱微痛，希望使其内消。我说：应当助胃壮气，兼用行经活血的药物辅助可以消除。那人追求速效，自行服用败毒等药，病情果然加重，疮不溃脓，饮食减少思虑，两个多月后再次请诊。脉象更弱，盗汗不止，聚肿不溃，肌肉寒冷，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，三十多剂后脓成针刺，反而出现烦躁脉大，这是亡阳。用圣愈汤两剂，仍用前药一百剂而痊愈。
司马李梧山患此病，腹痛且势已成，用活命饮一剂，疼痛立刻停止；用托里消毒散，肿胀立刻突起，这是脓即将形成的征兆。用托里散补益，自行溃破而痊愈。
锦衣卫掌堂官刘廷器，正德辛未年仲夏，腹部患痈溃破后脓液清稀，发热口渴腹胀，作呕不食，有人认为是热毒内攻，都用黄芩、黄连、大黄的药剂，病情更加严重。薛己说：应当舍时从证，投以人参、干姜、附子等药，一剂后呕吐停止进食增加，再用托里等剂而疮愈。
进士边云庄，腹痛恶寒，脉浮数。薛己说：浮数的脉象却反而恶寒，是疮疽的证候。他不相信。数日后再次请视，左尺脉洪数。薛己说：体内有脓了，他仍不相信，直到小腹痛胀，牵连到两侧臀部，才醒悟。薛己说：脓已从臀部溃出，气血俱虚，如何收敛？急服活命饮一盅，臀部溃开一孔，流出脓液斗许，气息奄奄，用大补药一剂，神思才清醒。每次排便后粪便从疮口流出，疼痛难忍，小腹间如有物体上挺，就发生痉挛不省人事，烦躁脉大，举按皆实，清醒后诊察，脉洪大按之如无。用十全大补汤，倍用人参至四斤，再加附子二枚，煎膏服用而痉挛停止，又用十全大补汤，五十多剂而疮口收敛。
上舍周一元，腹部患痈，三个月不愈，脓水清稀，早晨怕冷晚上发热，服用四物汤加黄柏、知母之类，饮食少且腹泻，痰涎上涌，服用二陈汤、枳实之类，痰涎更甚，胸膈痞闷，问薛己为什么？薛己说：早晨怕冷晚上发热，是血气虚；饮食少且腹泻，是脾肾虚；痰涌胸痞，是脾肺虚；都因为真气虚而邪气实，应当先壮其胃气，使各脏腑有所禀受而邪气自然退去。于是用六君子汤，加黄芪、当归几剂，各种症状逐渐消退，又用十全大补汤，肌肉逐渐收敛，再用补中益气汤调理而痊愈。
上舍毛体仁，素来阴虚，春初咳嗽，胸中隐痛，肾脉数而无力，肺脉数而时而出现，这是肾气亏损，阴火炽盛，用六味丸料一剂，服用后病势虽减，但内痈已成。大概是因为元气虚而不能发出，火令季节令人畏惧。他不信，服用治痰火的药剂，两个月后，乳间微肿，脉洪数而无力。薛己说：脓在内溃破了，应当针刺排出脓液，以免内攻的祸患。他不信，又过一个多月再请视，只针得一孔，脓液排泄不畅，仍然内攻，唇舌青赤。薛己说：脏腑已坏，我怎么能治好它？后来果然死亡。
从侄孙，十四岁结婚。乙巳年春天，二十四岁时，腹部作痛，用大黄等药两剂，下血很多，胸腹胀满，痰喘发热。又服破气降火药一剂，出汗如水，手足如冰。薛己外出，刚好回来诊察。左关脉洪数，右尺尤其严重，这是腹痈，虽然能收敛，到了夏天必定变成劳瘵症。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，两剂后各种症状稍退，腹部开始微红，按压觉痛，又两剂作痛；又两剂肿痛，脉滑数，针刺出脓瘀。再用大补汤，精神饮食如故，因遗精，患处色黯，用前药加五味子、山茱萸、山药、骨碎补、吴茱萸等剂，疮口逐渐收敛，劳瘵症状具备，其脉非洪大而数，即微细如无，唯专服独参汤、人乳汁，稍有好转，很久后又脱陷。我说：应当准备后事，等待火旺之时。于是祈祷鬼神，巫师历言往事如见，更指示方药，都是峻烈通利的药剂，且说保证必生。恭敬信服，后来果然死亡。经上说：拘泥于鬼神的人，不可与他谈论至高道德，何况又轻信方药于邪妄之人呢！写下此文以警示后人。
[Xue Ji] Abdominal carbuncle refers to sores occurring in the abdomen, or between the skin and fascia. It is attributed to excessive consumption of rich and greasy foods (gaoliang nongwei) and fire generated from emotional stagnation. If there is diffuse swelling that is hard, with unchanged skin color, or a slow and tight pulse, indicating that pus has not yet formed, Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Angelicae Dahuricae Radix (Baizhi), and Aurantii Fructus (Zhike) should be used, or Tuoli San (Supporting Interior Powder). If the swelling becomes soft and red, or the pulse is surging and rapid, indicating that pus has formed, Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) should be used. If pus has formed but fails to ulcerate externally, it is due to deficiency of Qi and Blood; flat needling (Wozhen) should be employed. If swelling causes pain, it indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Life Elixir) should be used first, combined with garlic-separated moxibustion to neutralize toxicity, followed by methods to support the interior and tonify Qi. If internal resolution is desired at the onset, one should strengthen the Stomach and boost Qi to solidify the root, assisted by herbs that promote circulation in the collaterals and invigorate blood. If purgative agents are used to dissipate the swelling, the swelling will fail to ulcerate, and if ulcerated, it will fail to heal. If draining agents are used to evacuate pus, young and strong patients may become difficult to treat, while old and weak patients may face immediate danger.
A man over thirty suffered from an abdominal carbuncle with a rapid pulse and a preference for cold drinks. Qi Shi stated: "When sores swell and rise, hardness indicates excess." He Jian (Liu Wansu) stated: "Swelling, hardness, mental confusion, irritability, and desire for cold drinks indicate pathogens within the interior." Qingliang Yin (Cooling Drink) with doubled Dahuang (Rhei Radix et Rhizoma) was administered for three doses, slightly alleviating symptoms. Subsequently, Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Mutong (Akebiae Caulis) were given for four doses, leading to suppuration. Shixuan San (Ten Declarations Powder) without Renshen (Ginseng Radix) and Guizhi (Cinnamomi Ramulus) plus Jinyinhua (Lonicerae Japonicae Flos) and Tianhuafen (Trichosanthis Radix) were then used. The patient sought quick results and self-administered warming and tonifying medicines, causing increased abdominal swelling and difficulty in urination. Qingliang Yin was used again, evacuating several bowls of pus, and he recovered after treatment with interior-supporting medicines.
Another man suffered from abdominal carbuncle pain, irritability, vomiting, and a full pulse. He Jian stated: "Sores belong to Fire; one must distinguish between interior and exterior to treat the root cause." He also said: "Vomiting, hiccups, irritability, swelling, hardness, mental confusion, or unchanged skin color with a deep and full pulse indicate toxins within the interior. One should unblock the interior to cut off the source, using Neishu Huanglian Tang (Interior-Draining Coptis Decoction) to induce bowel movements two or three times. After all symptoms subsided, Lianqiao Xiaodu San (Forsythia Detoxifying Powder) cured him.
Another man had a ripe abdominal carbuncle that failed to ulcerate slowly, with a faint and thin pulse. After pus discharge, the sore oozed pus like crab bubbles, indicating internal perforation through the fascia. Sores perforating the fascia rarely survive; even major tonification cannot save them. This serves as a warning against waiting for spontaneous pus discharge.
A man accustomed to alcohol and sexual indulgence developed a toxin in the lower abdomen with a weak pulse and slight pain, desiring internal resolution. I advised strengthening the Stomach and boosting Qi, assisted by herbs promoting collateral circulation and blood invigoration. Seeking quick results, he self-administered detoxifying drugs, worsening the condition. The sore failed to suppurate, appetite decreased, and after two months, upon re-examination, the pulse was weaker, with continuous night sweats, persistent swelling without ulceration, cold muscles and flesh, spontaneous sweating, and pale complexion. This indicated dual deficiency of Qi and Blood, preventing swelling and suppuration. Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was administered for over thirty doses until pus formed, then punctured. Irritability and a large pulse appeared, indicating Yang collapse. Shengyu Tang (Sage Preservation Decoction) for two doses, followed by the previous formula for one hundred doses, led to recovery.
Simas Li Wushan suffered from this condition with abdominal pain and established pathology. One dose of Huoming Yin stopped the pain immediately. Tuoli Xiaodu San caused sudden swelling, indicating impending suppuration. Tuoli San supported recovery through spontaneous ulceration.
Liu Tingqi, Director of the Imperial Guard, in mid-summer of Xinwei year, had an abdominal carbuncle that ulcerated with clear pus, accompanied by fever, thirst, abdominal distension, vomiting, and anorexia. Some attributed this to internal attack by heat-toxin and prescribed Huangqin, Huanglian, and Dahuang, worsening the illness. Xue stated: "Abandon the season and follow the syndrome." Shenren (Ginseng), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) were administered. Vomiting ceased, and appetite improved after one dose. Further treatment with interior-supporting formulas healed the sore.
Bian Yunzhuang, a Jinshi degree holder, suffered from abdominal pain, aversion to cold, and a floating, rapid pulse. Xue stated: "Floating and rapid pulses with aversion to cold indicate carbuncles and ulcers." He did not believe this. Days later, upon re-examination, the left Chi pulse was surging and rapid. Xue stated: "Pus is inside." He still did not believe. Until lower abdominal pain and distension radiated to both buttocks, he realized the truth. Xue stated: "Pus has ulcerated from the buttocks; Qi and Blood are deficient, how can healing occur?" Urgent administration of Huoming Yin resulted in one hole ulcerating on the buttock, discharging a bucket of pus. Breath became faint. One dose of major tonifying medicine restored consciousness. Stool passed through the sore after defecation, causing unbearable pain. A sensation of rising mass in the lower abdomen triggered spasms and unconsciousness. Irritability and a large pulse were present, feeling full upon lifting and pressing. Upon waking, the pulse was surging and large but empty upon deep pressure. Shiquan Dabu Tang with quadrupled Renshen (four jin) and two Fuzi, prepared as a paste, stopped spasms. Fifty doses of Shiquan Dabu Tang healed the sore.
Zhou Yiyuan, a Shangshe student, suffered from an abdominal carbuncle for three months without healing. Pus was clear and thin, with morning chills and evening fevers. He took Siwu Tang plus Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), resulting in poor appetite and diarrhea. Phlegm saliva surged upward; he took Erchen Tang and Zhishi (Aurantii Fructus), worsening phlegm and causing chest oppression. He asked Xue for the cause. Xue stated: "Morning chills and evening fevers indicate Qi and Blood deficiency; poor appetite and diarrhea indicate Spleen and Kidney deficiency; phlegm surge and chest obstruction indicate Spleen and Lung deficiency. All result from deficiency of True Qi and excess of pathogenic factors. First strengthen Stomach Qi so organs receive nourishment and pathogens retreat." Liujun Zi Tang (Six Gentlemen Decoction) plus Huangqi (Astragali Radix) and Danggui was given for several doses, gradually resolving symptoms. Shiquan Dabu Tang promoted muscle contraction, and Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) regulated recovery.
Mao Tiren, a Shangshe student, had inherent Yin deficiency. In early spring, he coughed with hidden chest pain. The Kidney pulse was rapid and powerless; the Lung pulse was rapid and intermittent. This indicated Kidney Qi depletion and blazing Yin Fire. Liuwei Wan (Six-Ingredient Pill with Rehmannia) reduced symptoms initially, but an internal carbuncle formed. Due to deficient Yuan Qi, it could not erupt, which was dangerous during the Fire season. Disbelieving this, he took phlegm-fire resolving drugs. Two months later, slight swelling appeared between the breasts with a surging, rapid, yet powerless pulse. Xue stated: "Pus has internally ulcerated; it should be drained via needle to prevent internal attack." Disbelieving again, he returned a month later. Only one hole was pricked; pus drainage was obstructed, leading to internal attack with bluish-red lips and tongue. Xue stated: "Organs are damaged; what can I do?" He subsequently died.
My nephew's grandson married at fourteen. In spring of Yisi year, at age twenty-four, he suffered abdominal pain. Two doses of Dahuang caused significant hematochezia, chest/abdominal distension, phlegmic wheezing, and fever. Another dose of Qi-breaking and Fire-draining drugs caused profuse sweating like water and ice-cold limbs. Xue was away but returned to diagnose. The left Guan pulse was surging and rapid; the right Chi was even more severe, indicating abdominal carbuncle. Although it could heal, it would transform into consumptive disease (Zai) by summer. Renshen and Baizhu (one liang each), Danggui and Baizhu (five qian each), Chenpi (three qian), Fuling (three qian), Zhi Gancao (one qian), and Pao Jiang (one qian) were given. Two doses slightly reduced symptoms; abdomen turned slightly red and tender to touch. Two more doses caused pain; two more doses caused swelling and pain with a slippery, rapid pulse. Needling evacuated pus and stasis. Major tonifying soup restored spirit and appetite. Following seminal emission, the lesion darkened. Previous formula plus Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gubuzi (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus) gradually closed the sore. Consumptive symptoms manifested fully. Pulse was either surging, large, and rapid, or faint and thin as if absent. Only Dushen Tang (Single Ginseng Decoction) and human milk provided temporary relief before collapse. I advised preparing for death, awaiting the Fire phase. Prayers to spirits were made; a shaman recounted past events accurately and prescribed harsh purgatives, guaranteeing survival. Trusting this, he died. The Classic states: "One bound by ghosts and spirits cannot be spoken to regarding supreme virtue, let alone trust prescriptions to deceitful persons!" This is recorded to warn posterity.