《千金》谓∶妄治必杀人。肠痈为病，小腹重而强，按之则痛，便数似淋，时时汗出
复恶寒，身皮甲错，腹皮急如肿状，其脉数者，小有脓也。巢云∶洪数者，已有脓；脉
若迟紧者，未有脓。甚者腹胀大，转侧有水声，或绕脐生疮，或脓自脐出，或大便出脓
血。 《脉经》问曰∶羽林妇病，何以知肠有脓？师曰∶脉滑而数，滑则为实，数则为
热，滑则为荣，数则为卫，卫数下降，荣滑上升，荣卫相干，血为败浊，小腹痞坚，小
便或涩，或自汗出，或复恶寒，脓为已成，设脉迟紧，则为瘀血，血下即安。丹溪云∶肠
痈大肠有热，积死血流注，桃仁承气汤加连翘、秦艽。
〔薛〕 肠痈因七情饮食所致。治法∶脉迟紧者，未有脓也，用大黄汤下之。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，牡丹皮散主之。若大
便或脐间出脓者不治。《内经》曰∶肠痈为病，不可惊，惊则肠断而死。故患是者，其坐卧
转侧，理宜徐缓，时少饮薄粥，及服八珍汤固其元气，静养调理，庶可保全其生。丹溪
治一女子腹痛，百方不治，脉滑数，时作热，腹微急。曰∶痛病脉当沉细，今滑数，此肠
痈也。以云母膏一两，丸梧子大，以牛皮胶溶入酒中，并水下之，饷时服尽，下脓血愈。
一妇以毒药去胎，后当脐右结一块，痛甚则寒热，块与脐高一寸，痛不可按，脉洪数。谓
曰∶此瘀血流溢于肠外肓膜之间，聚结为痈也。遂用补气血、行结滞、排脓之剂，三日。
决一锋针，脓血大出，内如粪状者臭甚，病妇恐，因调气血生肌，则内外之窍自合，不
旬日而愈。吕沧洲治郡守李母庞病小腹痛，众医皆以为瘕聚，久药不效。吕诊循其少阴脉，
如刀刃之切手，胞门芤而数，知其阴中痛，痈结小肠也，告之曰∶太夫人病在幽隐，不敢
以闻，幸出侍人语之，乃出老妪。吕曰∶苦小肠痈，以故脐下如瘕聚，今脓已成，痛迫
于玉泉，当不得前后溲，溲则痛甚。妪拜曰∶诚如公言。遂用国老、将军为向导，麒麟竭、
琥珀之类攻之，脓自小便出，应手愈。吕又治一小儿，十二岁患内痈，腹胀脐凸而颇锐，
医欲刺脐出脓。其母不许，请吕视之，见一僧拥炉炽炭，燃铜箸一枚烈火中，瞪目视翁
曰∶此儿病痈，发小肠，苟舍刺脐无他法。吕谕之曰∶脐神阙也，针刺所当禁，矧痈舍于
内，惟当以汤丸攻之，苟如而言，必杀是子矣！僧怒趋而出。吕投透脓散一匕，明日脓
自气合溃，继以十奇汤，下万应膏丸而瘥。虞恒德治一人，得潮热微似虐，但小腹右边有
一块，大如鸡卵作痛，右脚不能伸缩。一医作奔豚气治十余日不验，虞诊其脉，左寸芤
而带涩，右寸芤而洪实，两尺两关俱洪数，曰∶此大小肠之间，欲作痈耳，幸脓未成，犹可
治，与五香连翘汤加减与之，间以蜈蚣炙黄，酒调服之，三日愈。儒医李生，治一富家妇
有疾。诊之曰∶肠胃间有所苦耶？妇曰∶肠中痛不可忍，而大便从小便出，医皆谓古无
此证，不可治，李曰∶试为筹之，若服我之药，三日当瘳，下小丸子数十丸，煎黄 汤
下之，下脓血数升而愈。其家喜问治法？李曰∶始切脉时，觉芤脉见于阳部，《脉诀》云∶
寸芤积血在胸中，关内逢芤肠里痈。此痈在内，所以致然。所服者，乃云母膏为丸耳！切
脉至此，可以言医矣。薛己治通府张廷用，患之两月余矣，时出白脓，体倦恶寒，此邪气
去而中气虚也。乃用托里散兼益气汤，徐徐呷之，又令以猪肚肺煮烂，取其汤调米粉煮，
时呷半盏，后渐调理而痊。一男子里急后重，下脓胀痛，此脾气下陷，用排脓散、蜡矾丸
而愈。后因劳役，寒热体倦，用补中益气汤而安。一妇人小腹胀痛，小便如淋，时时汗
出，此瘀血凝结于内，先以神效栝蒌散二剂少愈，更以薏苡仁汤而愈。一妇人，小腹胀
痛而有块，脉芤而涩，此瘀血为患也，以四物加玄胡索、红花、桃仁、牛膝、木香，二
剂血下而痊。一妇人小腹胀痛，大便秘涩，转侧有水声，脉洪数，此脓瘀内溃也。以梅仁
汤一剂，下瘀血，诸症悉退，再以薏苡仁汤二剂而瘥。一妇人脓成胀痛，小便不利，脉
洪数，此脓毒内溃也。服太乙膏三钱，脓下甚多。更以栝蒌散、蜡矾丸，及托里散而安。
（如用云母膏尤妙。） 一妇人，产后恶血不止，小腹作痛，服瓜子仁汤，下瘀血而痊。凡瘀血
停滞，宜急治之，缓则腐化为脓，最为难治。若流注关节，则为败症。
薏苡附子散 治身甲错腹皮急，如腹胀本无积聚，身热脉数者。
附子（炮，二分） 败酱（五分） 薏苡仁（一钱）
上为末。每服方寸匕，以水二合，煎顿服，小盒饭下。
《三因》薏苡、附子同前，败酱用一两一分。每四钱，水盏半，煎七分，去渣，空心
服。
按∶此方乃辛热之剂也，若积久阴冷所致宜用。丹溪云∶身甲错腹皮急，按之濡如
肿状，腹无积聚，身无热，脉数，此肠内有痈，积久阴冷所致，故《金匮》有用附子温
之，即此方也。
牡丹汤 治肠痈小腹肿痞，按之即痛，小便如淋，时时发热，自汗恶寒，其脉迟紧者，
脓未成，可下之，当有血。洪数者，脓已成，不可下。
牡丹皮 栝蒌仁（各一钱） 桃仁（去皮尖） 芒硝（各二钱） 大黄（五钱）
上作一服。水二盅，煎至一盅，去滓，入硝再煎数沸，不拘时服。
按∶此乃破血之剂也，如发热，自汗恶寒，小腹作痛，小便如淋，脉迟者，有效。丹
溪云∶小腹肿痞，按之痛，小便如淋或自调，发热身无汗，复恶寒，其脉迟紧者，脓未成，
宜下之，当有血。此内结热所成也，故《金匮》有用大黄利之，即此方也。若无前证，恐
不宜用。亦有腹内胀痛，脉滑数，或脓已下，或后重时时而下，宜用排脓散、太乙膏、蜡
矾丸及托里药。
薏苡仁汤 治肠痈腹中 痛，烦毒不安，或胀满不食，小便涩，妇人产后虚热，多有
此病。纵非痈但疑似间，便可服。
薏苡仁 栝蒌仁（各三钱） 牡丹皮 桃仁（各二钱）
上作一服。水二盅，煎至一盅，不拘时服。
按∶此方药品和平，其功且速，常治腹痛，或发热，或胀满不食，水道涩滞，产后
多有此证。或月经欲行，或行后作痛尤效。
牡丹散 治肠痈冷证，腹濡而痛，时时利脓。
牡丹皮 人参 天麻 白茯苓 黄 木香 当归 川芎 官桂 桃仁（去皮，炒，各七钱半） 白芷
薏苡仁 甘草（炙，各五钱）
为细末。每服三钱，用水一盅，煎至七分，食前温服。
梅仁汤 治肠痈里急隐痛，大便秘涩。
梅核仁（四十九粒，去皮尖） 大黄（三两） 牡丹皮（一两七钱半） 芒硝（二两半） 冬瓜仁（四两）
犀角（镑，一两半）
上锉如麻豆大。每服五钱，水二盏，煎至一盏，去滓，温服，以利下脓血三两行为度。
大黄汤 治肠痈少腹坚硬，肿大如掌而热，按之则痛，其上色或赤、或白，小便稠
数，汗出憎寒，其脉迟紧者，未成脓；如脉数，则脓已成。
大黄（锉，炒） 牡丹皮 硝石（研） 芥子 桃仁（汤浸，去皮尖。双仁，炒。各半两）
上锉碎。每服五钱，水二盏，煎至一盏，去滓，空心温服，以利下脓血为度，未利再
服。
四圣散（一名神效栝蒌散） 治肠痈痈疽，生于脑髭、背腋、孔便毒，服之神效。
生黄栝蒌（一枚，去皮） 粉草（四钱，研末） 没药（研末，三钱） 乳香（研末，一钱）
上用好红酒二大碗，慢火煎至一碗，分作两服，两日服尽，大便顺导恶物妙。若干
栝蒌则用两枚。一方，若病在上食后服，病在下食前服，毒已结成，即脓化为水，毒未
成，即于小便中出。疾甚再合服，以退为度。
郭氏瑞效丸（方见肿疡。）
云母膏 治一切痈疽、疮疖，折伤等证。
蜀椒（去目及闭口者，微炒） 白芷 没药 赤芍药 肉桂 当归 盐花 菖蒲 麒麟竭
黄 白芨 芎 木香 龙胆草 白蔹 防风 浓朴 麝香 桔梗 柴胡 松脂 人参 苍术 黄芩
乳香 附子 茯苓 良姜 合欢皮（各五钱） 硝石 甘草 云母（各四两） 桑白皮 槐枝 柳枝 柏叶
水银（以绢劳包，待膏成以手细弹，在上名养膏母） 陈皮（各二两） 清油（四十两） 黄丹（二十两）
上除云母、硝石、麒麟竭、乳香、没药、麝香、盐花、黄丹八味另研外，余药并细切。
入油浸七日，文火煎，以柳枝不住手搅，候匝沸乃下火，沸定又上火，如此者三次，以药黑色为度，
去渣再熬，后入丹与八味末，仍不住手以槐、柳枝搅，滴水中成珠，不软不硬为度，瓷器收贮，候温，将
水银弹上。用时先刮去水银，或服或贴，随宜用之，其功甚大也。
排脓散 治肠痈小腹胀痛，脉滑数，或里急后重，或时时下血。
黄 （盐水拌，炒） 当归（酒拌） 金银花 白芷 穿山甲（蛤粉炒） 防风 连翘 栝蒌（杵）
甘草（各一钱）
作一剂。水二盅，煎八分，食前服。若脓将尽，去穿山甲、连翘，加当归、川芎。或
为末，每服三钱，食后蜜汤调下亦可。
神仙蜡矾丸 治肠痈内托神妙，不问老幼，皆可服之，无不效。最止疼痛，不动脏
腑。
黄蜡（半两，要黄色者。一方，用七钱） 白矾（一两，要通明者，细研）
上熔化黄蜡和矾为丸，如梧桐子大。每服二十丸，渐加至三十丸，食远，用温白汤
送下。
《千金方》说：误治必定致人死亡。肠痈这种病，小腹沉重且僵硬，按压时疼痛，小便频数类似淋证，经常出汗又恶寒，皮肤粗糙如鳞甲，腹部皮肤紧绷像肿胀的样子，脉象数的，说明脓液少量形成。巢元方说：脉象洪数的，说明已有脓液；脉象若迟紧的，说明还没有脓液。病情严重的，腹部胀大，翻身时有水声，或者肚脐周围生疮，或者脓液从肚脐流出，或者大便排出脓血。《脉经》问道：羽林军妇女患病，怎么知道肠道有脓？医生说：脉象滑而数，滑脉代表实邪，数脉代表热邪，滑脉反映营气，数脉反映卫气，卫气之数下降，营气之滑上升，营卫相互干扰，血液败坏浑浊，小腹痞块坚硬，小便或涩滞，或自汗出，或再次恶寒，这是脓已形成的表现；假如脉象迟紧，则是瘀血，瘀血下行后病情就会缓解。朱丹溪说：肠痈是大肠有热，积聚的死血流注所致，用桃仁承气汤加连翘、秦艽。
薛己说：肠痈由七情和饮食引起。治疗方法：脉象迟紧的，说明没有脓液，用大黄汤攻下。脉象洪数的，说明已有脓液，用薏苡仁汤排脓。小腹疼痛，小便不利，是脓液壅滞，主用牡丹皮散。如果大便或肚脐间流出脓液的，属于不治之症。《内经》说：患肠痈病，不可受惊，受惊则肠断而死。所以患此病的人，坐卧转身应当缓慢，偶尔喝些稀粥，并服用八珍汤巩固元气，静养调理，才可以保全生命。丹溪治疗一名女子腹痛，用各种方法都不见效，脉象滑数，时常发热，腹部轻微拘急。他说：痛病的脉象应当沉细，现在却是滑数，这是肠痈。用云母膏一两，制成梧桐子大小的丸药，用牛皮胶溶入酒中，送服，一顿饭的时间服完，排出脓血后痊愈。另一名妇人用毒药堕胎，后来在肚脐右侧结成一肿块，疼痛剧烈时伴有寒热，肿块与肚脐平齐高一寸，疼痛不能按压，脉象洪数。我说：这是瘀血流溢到肠外肓膜之间，聚结而成痈。于是用补气血、行结滞、排脓的药剂，三天后。用锋针决破，脓血大量流出，内部物质像粪便一样气味极臭，病人恐惧，因此调理气血生肌，内外孔窍自然愈合，不到十天就痊愈了。吕沧洲治疗郡守李的母亲庞氏患小腹痛，众医生都认为是瘕聚，久服药无效。吕沧洲诊察她的少阴脉，像刀刃切手一样锐利，胞门脉芤而数，知道她阴部疼痛，是小肠结痈，告诉她说：“老夫人病在隐蔽之处，不敢直言，请让侍从出来告知。”于是叫出老妪。吕沧洲说：“苦于小肠痈，所以脐下像瘕聚，现在脓已形成，疼痛压迫玉泉（指尿道），导致大小便不通，排尿时疼痛加剧。”老妪拜谢说：“确实如您所说。”于是用国老（甘草）、将军（大黄）作为向导，麒麟竭、琥珀之类攻逐，脓液从小便排出，应手而愈。吕沧洲又治疗一名小儿，十二岁患内痈，腹胀肚脐凸出且颇尖锐，医生想刺破肚脐排脓。其母亲不允许，请吕沧洲诊治，见一僧人拥炉烧炭，将一根铜筷在烈火中燃烧，瞪着眼睛对老人说：“这小孩患痈，发于小肠，除了刺脐没有其他办法。”吕沧洲告诫他说：“脐部是神阙穴，针刺是禁忌，况且痈生在体内，只应当用汤剂丸药攻治，如果照你所说的做，必杀此子！”僧人愤怒地冲了出去。吕沧洲投予透脓散一匕，第二天脓液从气合穴溃破，继以十奇汤，服用万应膏丸而痊愈。虞恒德治疗一人，得潮热微似疟疾，只有小腹右边有一块，大如鸡蛋作痛，右脚不能伸缩。一名医生按奔豚气治疗十余日无效，虞恒德诊察他的脉象，左寸脉芤而带涩，右寸脉芤而洪实，两尺两关俱洪数，说：“这是大小肠之间，将要发生痈肿罢了，幸好脓未形成，还可以治疗，给予五香连翘汤加减与他，间歇用蜈蚣炙黄，酒调服，三日痊愈。”儒医李生，治疗一名富家妇有病。诊察后说：“肠胃间有什么痛苦吗？”妇人说：“肠中痛不可忍，而且大便从小便中排出，医生都说古无此证，不可治，李生说：“试着为我筹划一下，如果服用我的药，三天应当好转。”下小丸子数十丸，煎黄连汤送下，排出脓血数升而痊愈。家属高兴地问治疗方法？李生说：“开始切脉时，感觉芤脉出现在阳部，《脉诀》说：‘寸口芤脉积血在胸中，关内逢芤肠里痈。’此痈在内，所以导致这样。所服的，乃是云母膏制成的丸药啊！切脉达到这种境界，才可以谈论医学了。”薛己治疗通府张廷用，患此病两个多月了，时常排出白脓，身体疲倦恶寒，这是邪气去而中气虚的表现。于是用托里散兼益气汤，慢慢呷服，又令他用猪肚肺煮烂，取汤汁调米粉煮，每次呷半盏，后来逐渐调理而痊愈。一男子里急后重，下脓胀痛，这是脾气下陷，用排脓散、蜡矾丸而痊愈。后来因劳役，寒热身体疲倦，用补中益气汤而安定。一妇人小腹胀痛，小便如淋，时时汗出，这是瘀血凝结于内，先用神效栝蒌散二剂稍好，再用薏苡仁汤而痊愈。一妇人，小腹胀痛而有肿块，脉芤而涩，这是瘀血为患，用四物汤加玄胡索、红花、桃仁、牛膝、木香，二剂后血下而痊愈。一妇人小腹胀痛，大便秘涩，转侧有水声，脉洪数，这是脓瘀内溃。用梅仁汤一剂，下瘀血，诸症悉退，再用薏苡仁汤二剂而痊愈。一妇人脓成胀痛，小便不利，脉洪数，这是脓毒内溃。服用太乙膏三钱，脓下很多。再用栝蒌散、蜡矾丸，及托里散而安定。（如果用云母膏尤其妙。）一妇人，产后恶血不止，小腹作痛，服瓜子仁汤，下瘀血而痊愈。凡瘀血停滞，宜急治之，缓则腐化为脓，最为难治。如果流注关节，则为败症。
薏苡附子散 治疗身体皮肤粗糙如鳞甲，腹部皮肤紧绷，像腹胀但本无积聚，身热脉数的情况。
附子（炮制，二分） 败酱草（五分） 薏苡仁（一钱）
以上研为末。每服方寸匕，用水二合，煎煮顿服，饭后服用。
《三因方》薏苡仁、附子用量同前，败酱草用一两一分。每服四钱，用水一盏半，煎至七分，去渣，空腹服用。
按语：此方是辛热之剂，如果是积久阴冷所致的适宜使用。丹溪说：身体皮肤粗糙如鳞甲，腹部皮肤紧绷，按压柔软像肿胀的样子，腹部无积聚，身无热，脉数，这是肠内有痈，积久阴冷所致，所以《金匮要略》有用附子温之，即此方也。
牡丹汤 治疗肠痈小腹肿痞，按压即痛，小便如淋，时时发热，自汗恶寒，脉象迟紧的，脓未形成，可攻下，应当有血排出。脉象洪数的，脓已形成，不可攻下。
牡丹皮 栝蒌仁（各一钱） 桃仁（去皮尖） 芒硝（各二钱） 大黄（五钱）
以上为一服量。水二盅，煎至一盅，去渣，加入硝再煎数沸，不拘时候服用。
按语：这是破血之剂，如发热，自汗恶寒，小腹作痛，小便如淋，脉迟者，有效。丹溪说：小腹肿痞，按压痛，小便如淋或自调，发热身无汗，复恶寒，脉象迟紧的，脓未形成，宜攻下，应当有血排出。这是内结热所成，所以《金匮要略》有用大黄利之，即此方也。若无前述症状，恐怕不宜使用。也有腹内胀痛，脉滑数，或脓已下，或后重时时而下，宜用排脓散、太乙膏、蜡矾丸及托里药。
薏苡仁汤 治疗肠痈腹中隐痛，烦毒不安，或胀满不食，小便涩，妇人产后虚热，多有此病。即使不是痈，但在疑似之间，便可服用。
薏苡仁 栝蒌仁（各三钱） 牡丹皮 桃仁（各二钱）
以上为一服量。水二盅，煎至一盅，不拘时候服用。
按语：此方药品平和，功效迅速，常治腹痛，或发热，或胀满不食，水道涩滞，产后多有此证。或月经欲行，或行后作痛尤效。
牡丹散 治疗肠痈冷证，腹部柔软而痛，时时利脓。
牡丹皮 人参 天麻 白茯苓 黄芪 木香 当归 川芎 官桂 桃仁（去皮，炒，各七钱半） 白芷 薏苡仁 甘草（炙，各五钱）
研为细末。每服三钱，用水一盅，煎至七分，食前温服。
梅仁汤 治疗肠痈里急隐痛，大便秘涩。
梅核仁（四十九粒，去皮尖） 大黄（三两） 牡丹皮（一两七钱半） 芒硝（二两半） 冬瓜仁（四两） 犀角（镑，一两半）
以上锉如麻豆大。每服五钱，水二盏，煎至一盏，去渣，温服，以利下脓血三两行为度。
大黄汤 治疗肠痈少腹坚硬，肿大如掌而热，按之则痛，其上色或赤、或白，小便稠数，汗出憎寒，脉象迟紧的，未成脓；如脉数，则脓已成。
大黄（锉，炒） 牡丹皮 硝石（研） 芥子 桃仁（汤浸，去皮尖。双仁，炒。各半两）
以上锉碎。每服五钱，水二盏，煎至一盏，去渣，空腹温服，以利下脓血为度，未利再服。
四圣散（一名神效栝蒌散） 治疗肠痈痈疽，生于脑髭、背腋、孔便毒，服用之神效。
生黄栝蒌（一枚，去皮） 粉草（四钱，研末） 没药（研末，三钱） 乳香（研末，一钱）
上好红酒二大碗，慢火煎至一碗，分作两服，两日服尽，大便顺导恶物妙。若干栝蒌则用两枚。一方，若病在上食后服，病在下食前服，毒已结成，即脓化为水，毒未成，即于小便中出。疾甚再合服，以退为度。
郭氏瑞效丸（方见肿疡篇。）
云母膏 治疗一切痈疽、疮疖，折伤等证。
蜀椒（去目及闭口者，微炒） 白芷 没药 赤芍药 肉桂 当归 盐花 菖蒲 麒麟竭 黄芪 白芨 川芎 木香 龙胆草 白蔹 防风 浓朴 麝香 桔梗 柴胡 松脂 人参 苍术 黄芩 乳香 附子 茯苓 良姜 合欢皮（各五钱） 硝石 甘草 云母（各四两） 桑白皮 槐枝 柳枝 柏叶 水银（以绢包，待膏成以手细弹，在上名养膏母） 陈皮（各二两） 清油（四十两） 黄丹（二十两）
以上除云母、硝石、麒麟竭、乳香、没药、麝香、盐花、黄丹八味另研外，其余药物并细切。入油浸七日，文火煎，以柳枝不住手搅，候匝沸乃下火，沸定又上火，如此者三次，以药黑色为度，去渣再熬，后入丹与八味末，仍不住手以槐、柳枝搅，滴水中成珠，不软不硬为度，瓷器收贮，候温，将水银弹上。用时先刮去水银，或服或贴，随宜用之，其功甚大也。
排脓散 治疗肠痈小腹胀痛，脉滑数，或里急后重，或时时下血。
黄芪（盐水拌，炒） 当归（酒拌） 金银花 白芷 穿山甲（蛤粉炒） 防风 连翘 栝蒌（杵） 甘草（各一钱）
作一剂。水二盅，煎八分，食前服。若脓将尽，去穿山甲、连翘，加当归、川芎。或为末，每服三钱，食后蜜汤调下亦可。
神仙蜡矾丸 治疗肠痈内托神妙，不问老幼，皆可服之，无不效。最止疼痛，不动脏腑。
黄蜡（半两，要黄色者。一方，用七钱） 白矾（一两，要通明者，细研）
以上熔化黄蜡和矾为丸，如梧桐子大。每服二十丸，渐加至三十丸，食远，用温白汤送下。
*Qianjin Fang* states: Mismanagement will inevitably lead to death. Intestinal abscess (Chang Yong) presents with heaviness and rigidity in the lower abdomen, pain upon pressure, frequent urination resembling strangury (Lin syndrome), intermittent sweating accompanied by aversion to cold, rough skin resembling scales, abdominal wall tension resembling swelling, and a rapid pulse indicating small amounts of pus formation. Chao Yuanfang states: A surging and rapid pulse indicates existing pus; a slow and tight pulse indicates no pus yet. In severe cases, abdominal distension occurs with splashing sounds when turning, ulcers may form around the umbilicus, pus may discharge from the umbilicus, or pus and blood may be passed via stool. *Mai Jing* asks: How do we know there is pus in the intestines for a woman of the Yulin guard? The Master says: A slippery and rapid pulse. Slippery indicates excess, rapid indicates heat. Slippery reflects Ying (Nutritive) Qi, rapid reflects Wei (Defensive) Qi. The descent of Wei's rapidness and the ascent of Ying's slipperiness cause Ying and Wei to interfere with each other, leading to turbid and spoiled blood. This results in a hard mass in the lower abdomen, either obstructed urination, spontaneous sweating, or recurrent aversion to cold, indicating that pus has formed. If the pulse is slow and tight, it indicates blood stasis; relief follows once the stasis is expelled. Zhu Danxi states: Intestinal abscess is caused by heat in the large intestine and the accumulation and flow of dead blood; treat with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) added with Qiao Ying (Forsythia Fruit) and Qin Jiao (Gentian Root).
Xue Ji states: Intestinal abscess is caused by emotional disturbances and dietary factors. Treatment methods: For a slow and tight pulse indicating no pus, use Da Huang Tang (Rhubarb Decoction) to purge. For a surging and rapid pulse indicating existing pus, use Yi Yi Ren Tang (Coix Seed Decoction) to drain pus. For lower abdominal pain and difficult urination due to pus obstruction, primarily use Mu Dan Pi San (Moutan Bark Powder). If pus discharges from the stool or umbilicus, it is considered incurable. *Nei Jing* states: Patients with intestinal abscess must not be startled, as startling can cause intestinal rupture and death. Therefore, patients should sit, lie, and turn slowly, consume thin congee occasionally, take Ba Zhen Tang (Eight Treasure Decoction) to consolidate Yuan Qi (Primal Qi), and rest quietly to preserve life. Danxi treated a young woman with abdominal pain unresponsive to various treatments; her pulse was slippery and rapid, with intermittent fever and slight abdominal tension. He said: Painful conditions typically present with deep and fine pulses; a slippery and rapid pulse here indicates intestinal abscess. He administered one liang of Yunmu Gao (Cloud Mother Ointment) pills, sized like wutong seeds, dissolved with niu pi jiao (cowhide glue) in wine, taken at once. After a meal duration, pus and blood were discharged, and she recovered. Another woman used toxic drugs to abort a fetus and later developed a lump one cun above the right side of her umbilicus, with severe pain, chills, and fever upon exacerbation, and an inability to tolerate pressure; her pulse was surging and rapid. I stated: This is blood stasis overflowing into the huangmo (membranous space outside the intestines), gathering to form an abscess. I prescribed herbs to tonify qi and blood, resolve stagnation, and drain pus. After three days, I lanced it with a fengzhen (sharp needle), releasing a large amount of foul-smelling pus and blood resembling feces. The patient was frightened, so I regulated qi and blood to generate flesh, allowing the internal and external orifices to heal naturally within ten days. Lv Cangzhou treated Lady Pang, mother of Prefect Li, for lower abdominal pain. Other physicians diagnosed it as a jiaju (mass), but long-term medication failed. Lv palpated her Shaoyin pulse, feeling sharp like a blade, and found the baomen (uterine gate) pulse hollow and rapid, indicating pain in the yin region and an abscess in the small intestine. He told her: "The illness is in a hidden place, I dare not speak openly; please have your attendant step forward." He then spoke to the old maid: "You suffer from small intestinal abscess, hence the mass-like sensation below the umbilicus. Pus has formed, pressing on Yuquan (urethra), causing obstruction of urination and defecation, with severe pain during urination." The maid bowed and confirmed his diagnosis. He used Guolao (Licorice) and Jiangjun (Rhubarb) as guides, along with Qilinjie (Dragon's Blood) and Hupo (Amber) to attack the pathogen, resulting in pus discharging through urine, with immediate recovery. Lv also treated a twelve-year-old boy with an internal abscess presenting with abdominal distension and a sharp, protruding umbilicus. A physician wanted to lance the umbilicus, but the mother refused and sought Lv's opinion. Lv saw a monk heating a copper chopstick in fire, claiming this was the only cure for small intestinal abscess. Lv admonished him: "The umbilicus is Shenque, a forbidden point for acupuncture. Since the abscess is internal, it should be treated with decoctions and pills. Lancing it would kill the child!" The monk left angrily. Lv administered Tou Nong San (Pus-Draining Powder); the next day, pus溃破 (ruptured) from Qihe, followed by Shi Qi Tang and Wan Ying Gao Pills, leading to recovery. Yu Hengde treated a man with tidal fever resembling malaria and a chicken-egg-sized painful lump on the right lower abdomen, with immobility of the right foot. A physician treated it as Ben Tun Qi (Running Piglet Qi) for over ten days without effect. Yu palpated the pulse: Left Cun was hollow and slightly choppy, Right Cun was hollow and surging-solid, both Chi and Guan were surging and rapid. He said: "This is an impending abscess between the large and small intestines. Fortunately, pus has not yet formed, so it is treatable." He prescribed Wu Xiang Lian Qiao Tang (Five Fragrance Forsythia Decoction) with modifications, interspersed with roasted centipede powder mixed with wine, curing him in three days. Confucian physician Li Sheng treated a wealthy woman complaining of unbearable intestinal pain and stool passing through urine. Physicians claimed this condition had no precedent and was incurable. Li said: "Let me plan for you. Take my medicine, and you will improve in three days." He gave dozens of small pills, taken with Scutellaria decoction. She discharged several sheng of pus and blood and recovered. When asked about the method, Li said: "During pulse diagnosis, I felt a hollow pulse in the Yang regions. *Mai Jue* states: 'Hollow Cun indicates blood accumulation in the chest; Hollow Guan indicates intestinal abscess.' Since the abscess is internal, this explains the symptoms. The medicine was Yunmu Gao pills! Only when pulse diagnosis reaches this level can one discuss medicine." Xue Ji treated Zhang Tingyong of Tongfu, who suffered for over two months with intermittent white pus discharge, fatigue, and aversion to cold, indicating that pathogens had receded but Middle Qi was deficient. He used Tuo Li San (Support Interior Powder) combined with Yi Qi Tang, sipped slowly, and advised boiling pig stomach and lungs, using the broth to cook rice flour, sipping half a cup occasionally. Gradual调理 (regulation) led to recovery. A male patient with tenesmus, pus discharge, and distending pain was diagnosed with Spleen Qi sinking; he recovered with Pai Nong San (Pus-Draining Powder) and La Fan Wan (Beeswax Alum Pills). Later, due to labor, he experienced chills, fever, and fatigue, which settled with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). A woman with lower abdominal distending pain, stranguria-like urination, and sweating was diagnosed with internal blood stasis; she improved slightly after two doses of Shen Xiao Gua Lou San (Miraculous Trichosanthes Powder) and recovered with Yi Yi Ren Tang. Another woman with lower abdominal distending pain and a mass, with a hollow and choppy pulse, was diagnosed with blood stasis; she recovered after two doses of Si Wu Tang (Four Substance Decoction) plus Yuan Hu Suo, Hong Hua, Tao Ren, Niu Xi, and Mu Xiang. A woman with lower abdominal distending pain, constipation, splashing sounds, and a surging rapid pulse was diagnosed with internal rupture of pus and stasis; she recovered after one dose of Mei Ren Tang (Plum Kernel Decoction) to expel stasis, followed by two doses of Yi Yi Ren Tang. A woman with pus-induced distending pain, difficult urination, and a surging rapid pulse was diagnosed with internal rupture of pus toxin; she took three qian of Tai Yi Gao, discharging much pus, and stabilized with Gua Lou San, La Fan Wan, and Tuo Li San. (Yunmu Gao is especially effective.) A postpartum woman with continuous lochia and lower abdominal pain recovered after taking Gua Zi Ren Tang (Melon Seed Decoction) to expel stasis. Blood stasis stagnation requires urgent treatment; delay leads to putrefaction into pus, which is difficult to treat. If it flows into joints, it becomes a terminal condition.
**Yi Yi Fu Zi San** (Coix Seed and Aconite Powder): Treats body skin roughness, abdominal wall tension, apparent abdominal distension without actual masses, fever, and rapid pulse.
Prepared Fuzi (Aconite Root, processed, 2 fen), Baijiang Cao (Patrinia Herb, 5 fen), Yi Yi Ren (Coix Seed, 1 qian).
Grind into powder. Each dose is one fangcun bi (square-inch scoop), boiled in two he of water, taken in one dose after meals.
*San Yin Fang*: Yi Yi Ren and Fuzi dosages are the same as above; Baijiang Cao is 1 liang 1 fen. Each dose is 4 qian, boiled in 1.5 cups of water until 0.7 cups remain, strained, and taken on an empty stomach.
Note: This formula is acrid and hot, suitable for conditions caused by long-standing yin-cold. Danxi states: Body skin roughness, abdominal wall tension, soft upon pressure resembling swelling, no abdominal masses, no fever, but rapid pulse indicates intestinal abscess caused by long-standing yin-cold. Thus, *Jin Gui Yao Lue* uses Fuzi to warm, which is this formula.
**Mu Dan Tang** (Moutan Decoction): Treats intestinal abscess with lower abdominal swelling and hardness, pain upon pressure, stranguria-like urination, intermittent fever, spontaneous sweating, aversion to cold, and slow-tight pulse indicating no pus (purge indicated, expect blood discharge). Surging-rapid pulse indicates pus formed (do not purge).
Mu Dan Pi (Moutan Cortex, 1 qian), Gua Lou Ren (Trichosanthes Seed, 1 qian), Tao Ren (Peach Kernel, peeled and split, 2 qian), Mang Xiao (Mirabilite, 2 qian), Da Huang (Rhubarb Root, 5 qian).
One dose. Boil in two zhong of water until one zhong remains, strain, add Mang Xiao, boil briefly, take at any time.
Note: This is a blood-breaking formula. Effective for fever, sweating, aversion to cold, lower abdominal pain, stranguria-like urination, and slow pulse. Danxi states: Lower abdominal swelling/hardness, pain on pressure, stranguria-like urination or normal urination, fever, no sweating, aversion to cold, slow-tight pulse indicate no pus (purge indicated, expect blood). This is caused by internal heat binding. Thus, *Jin Gui Yao Lue* uses Da Huang to promote drainage, which is this formula. Without these symptoms, it is likely unsuitable. For abdominal distending pain, slippery-rapid pulse, or post-pus discharge/tenesmus, use Pai Nong San, Tai Yi Gao, La Fan Wan, and interior-supporting medicines.
**Yi Yi Ren Tang** (Coix Seed Decoction): Treats intestinal abscess with dull abdominal pain, irritability, fullness, loss of appetite, and difficult urination. Common in postpartum women with deficiency-heat. Can be taken even if abscess is only suspected.
Yi Yi Ren (Coix Seed, 3 qian), Gua Lou Ren (Trichosanthes Seed, 3 qian), Mu Dan Pi (Moutan Cortex, 2 qian), Tao Ren (Peach Kernel, 2 qian).
One dose. Boil in two zhong of water until one zhong remains, take at any time.
Note: This formula is mild and acts quickly. Often treats abdominal pain, fever, fullness, loss of appetite, and urinary obstruction. Common in postpartum conditions. Also effective for menstrual cramps before or after menstruation.
**Mu Dan San** (Moutan Powder): Treats cold-type intestinal abscess with soft abdomen, pain, and intermittent pus discharge.
Mu Dan Pi (Moutan Cortex, 7.5 qian), Ren Shen (Ginseng Root, 7.5 qian), Tian Ma (Gastrodia Rhizome, 7.5 qian), Bai Fu Ling (Poria, 7.5 qian), Huang Qi (Astragalus Root, 7.5 qian), Mu Xiang (Saussurea Root, 7.5 qian), Dang Gui (Angelica Sinensis, 7.5 qian), Chuan Xiong (Ligusticum Rhizome, 7.5 qian), Guan Gui (Cinnamon Bark, 7.5 qian), Tao Ren (Peach Kernel, peeled and fried, 7.5 qian), Bai Zhi (Angelica Dahurica, 5 qian), Yi Yi Ren (Coix Seed, 5 qian), Gan Cao (Licorice Root, honey-fried, 5 qian).
Grind into fine powder. Each dose is 3 qian, boiled in one zhong of water until 0.7 cups remain, taken warm before meals.
**Mei Ren Tang** (Plum Kernel Decoction): Treats intestinal abscess with internal urgency, dull pain, and constipation.
Mei He Ren (Plum Kernel, 49 grains, peeled and split), Da Huang (Rhubarb Root, 3 liang), Mu Dan Pi (Moutan Cortex, 1 liang 7.5 qian), Mang Xiao (Mirabilite, 2.5 liang), Dong Gua Ren (Winter Melon Seed, 4 liang), Xi Jiao (Rhinoceros Horn, shaved, 1.5 liang).
Cut into hemp-seed size. Each dose is 5 qian, boiled in two cups of water until one cup remains, strained, taken warm. Stop when 2-3 liang of pus/blood is discharged.
**Da Huang Tang** (Rhubarb Decoction): Treats intestinal abscess with hard, palm-sized swollen lower abdomen, heat, pain on pressure, red or pale discoloration, thick/frequent urination, sweating, aversion to cold. Slow-tight pulse indicates no pus; rapid pulse indicates pus formed.
Da Huang (Rhubarb Root, cut and fried), Mu Dan Pi (Moutan Cortex), Xiao Shi (Niter, ground), Jie Zi (Mustard Seed), Tao Ren (Peach Kernel, soaked, peeled, split, double-kernel fried, 0.5 liang each).
Cut into pieces. Each dose is 5 qian, boiled in two cups of water until one cup remains, strained, taken warm on an empty stomach. Stop when pus/blood is discharged; repeat if necessary.
**Si Sheng San** (also known as Shen Xiao Gua Lou San / Miraculous Trichosanthes Powder): Treats intestinal abscesses and carbuncles occurring on the head/beard, back/armpits, or groin/genitals. Highly effective.
Sheng Huang Gua Lou (Fresh Trichosanthes Fruit, peeled, 1 piece), Fen Cao (Licorice Root, 4 qian, ground), Mo Yao (Myrrh, 3 qian, ground), Ru Xiang (Frankincense, 1 qian, ground).
Boil in two large bowls of good red wine over low heat until one bowl remains. Divide into two doses, consumed over two days. Promotes evacuation of foul matter via stool. If dried Gua Lou is used, use two fruits. One prescription advises taking after meals for upper body diseases, before meals for lower body diseases. If toxin has formed, pus turns to water; if not formed, it exits via urine. Repeat if severe until improvement.
**Guo Shi Rui Xiao Wan** (Guo's Auspicious Efficacy Pills): See section on Swollen Ulcers.
**Yunmu Gao** (Cloud Mother Ointment): Treats all carbuncles, sores, boils, and traumatic injuries.
Shu Jiao (Sichuan Pepper, remove eyes and closed ones, lightly fried), Bai Zhi (Angelica Dahurica), Mo Yao (Myrrh), Chi Shao Yao (Red Peony Root), Rou Gui (Cinnamon Bark), Dang Gui (Angelica Sinensis), Yan Hua (Salt Flower), Chang Pu (Acorus Rhizome), Qilin Jie (Dragon's Blood), Huang Qi (Astragalus Root), Bai Ji (Bletilla Rhizome), Xiong (Ligusticum Chuanxiong), Mu Xiang (Saussurea Root), Long Dan Cao (Gentian Root), Bai Lian (Ampelopsis Rhizome), Fang Feng (Saposhnikovia Root), Hou Po (Magnolia Bark), She Xiang (Musk), Jie Geng (Platycodon Root), Chai Hu (Bupleurum Root), Song Zhi (Pine Resin), Ren Shen (Ginseng Root), Cang Zhu (Atractylodes Rhizome), Huang Qin (Scutellaria Root), Ru Xiang (Frankincense), Fu Zi (Aconite Root), Fu Ling (Poria), Liang Jiang (Galangal Root), He Huan Pi (Albizia Bark, 5 qian each), Xiao Shi (Niter), Gan Cao (Licorice Root), Yunmu (Cloud Mother, 4 liang each), Sang Bai Pi (Mulberry Root Bark), Huai Zhi (Locust Branch), Liu Zhi (Willow Branch), Bai Ye (Cypress Leaf), Shui Yin (Mercury, wrapped in silk, applied to surface of finished ointment as 'nourishing mother'), Chen Pi (Tangerine Peel, 2 liang each), Qing You (Clear Oil, 40 liang), Huang Dan (Lead Tetroxide, 20 liang).
Except for Yunmu, Xiao Shi, Qilin Jie, Ru Xiang, Mo Yao, She Xiang, Yan Hua, and Huang Dan (which are ground separately), cut all other herbs finely. Soak in oil for seven days. Simmer over gentle heat, stirring constantly with willow branch. Remove from heat when boiling subsides, then reheat. Repeat three times until herbs turn black. Strain and simmer again. Add Huang Dan and the eight ground powders, stirring constantly with locust and willow branches until drops form beads in water that are neither too soft nor too hard. Store in porcelain. When warm, apply mercury to the surface. Before use, scrape off mercury. Apply externally or take internally as appropriate. Its efficacy is great.
**Pai Nong San** (Pus-Draining Powder): Treats intestinal abscess with lower abdominal distending pain, slippery-rapid pulse, tenesmus, or intermittent blood discharge.
Huang Qi (Astragalus Root, salt-water stir-fried, 1 qian), Dang Gui (Angelica Sinensis, wine-stirred, 1 qian), Jin Yin Hua (Honeysuckle Flower, 1 qian), Bai Zhi (Angelica Dahurica, 1 qian), Chuan Shan Jia (Pangolin Scale, stir-fried with clam powder, 1 qian), Fang Feng (Saposhnikovia Root, 1 qian), Lian Qiao (Forsythia Fruit, 1 qian), Gua Lou (Trichosanthes Fruit, crushed, 1 qian), Gan Cao (Licorice Root, 1 qian).
One dose. Boil in two zhong of water until 0.8 zhong remains, take before meals. If pus is nearly exhausted, remove Chuan Shan Jia and Lian Qiao, add Dang Gui and Chuan Xiong. Alternatively, grind into powder, take 3 qian with honey water after meals.
**Shen Xian La Fan Wan** (Immortal Beeswax Alum Pills): Treats internal support for intestinal abscess with miraculous efficacy. Suitable for all ages. Most effective for stopping pain without disturbing organs.
Huang La (Yellow Beeswax, 0.5 liang, preferably yellow; alternative 7 qian), Bai Fan (Alum, 1 liang, clear and transparent, finely ground).
Melt beeswax and mix with alum to form pills the size of wutong seeds. Take 20 pills initially, gradually increasing to 30 pills. Take far from meals with warm plain water.