（胁、 也；胁；胁骨也。有骨曰胁，无骨曰胁。）
《灵枢》云∶发于胁，名曰败疵，败疵者女子之病也，灸之。其状大痈脓，其中乃
有生肉，大如赤小豆，治之锉陵 草根，各一升。以水一斗六升，煮之竭，为取三升，即
强饮，浓衣坐于釜上，令汗至足己。（疵，疾HT 切。《甲乙经》于赤小豆下，作治之锉陵草、赤松根，
各一升。） 《鬼遗》云∶侠荧疽，肿起发肋及两肩肘头，二十日不穴死，九日可刺，发赤
白相间，脓多可治；全无赤白者不治。 又云∶两肋起疽，名为发肋，初肿盛至十数日
不穴，攻即肿大如杯碗，高如 ，背痛彻内肠绞。刺左边患，应右边痛；右边患，应左
边痛，唯有此处多是内毒，却入攻而死者多人。有斯患，急以针刺出脓血，则免内攻伤
内矣。 或问∶肋上生疽何如？曰∶是名肋疽，属手厥阴心包络、足厥阴肝，火热毒怒
气相并而作，活命饮加柴胡，紫金丹、乌金散选用。壮实者，八阵散、一粒金丹下之。此
证宜速治，不然溃烂不敛，多致危困。 一人患此，如胡桃微痛微肿，月余渐大如杯，医
作痰治，或作肝积，或云痞块，竟莫能效。数月遂大如盎，坚硬如石，不甚疼痛，微红漫
肿；复得暴怒，胸腹胀满，小水不利，脉迟而微。投以化气丸、六一散小便利，胸次宽；
继投乌金散、夺命丹，间服八阵散，月余渐消。
一人年逾五十，腋下患毒，疮口不合，右关脉数而渴，此胃火也。用竹叶黄 汤而止，
再用补气药而愈。尝治午后发渴或发热，用地骨皮散效。 一人性急味浓，常服燥热之
药，左胁一点痛，轻诊弦、重芤，知其痛处有脓。与四物加桔梗、香附、生姜，煎十余
帖，痛处微肿如指大。针之少时，屈身脓出，与四物调理而安。 一夫人，左胁内作痛，牵
引胸前，此肝气不和，尚未成疮。用小柴胡加青皮、枳壳，四剂少可加芎归治之愈。
一人连年病疟，后生子三月病热，右胁下阳明少阳之分，生一疖甫平，左胁下相对又一
疖，脓血淋漓几死。医以四物汤、败毒散，数倍人参，以香附为佐，犀角为使，大料饮乳
母，两月而愈。逾三月，忽腹胀生赤疹如霞片，取剪刀草汁，调原蚕砂敷随消。又半月，
移胀入囊为肿。黄莹裂开，两丸显露水出，以紫苏叶盛麸炭末托之，旬余而合，此胎毒证
也。 一妇因忿郁，腋下结一核二十余年，因怒加肿痛，完谷不化，饮食少思，此肠胃虚
也，以六君子加砂仁、肉桂、干姜、肉豆蔻，泄虽止而脓清，疮口不合，用十全大补汤，月
余而愈。（机按∶前项二条胁疮，一因其性多躁急，故用四物汤阴柔之剂，以安静之；一因其肝气不
平，故用小柴胡疏理之剂，以和解之。此又因其性情为治，不特专于攻毒也。） 张通北人，年逾四十，
夏月腋下患毒，溃后不敛，脓出清稀，皮寒脉弱，肠鸣切痛，大便溏泄，食下即呕，此寒变而
内陷也，宜大辛温之剂，遂以托里温中汤，二帖诸证悉退。更以六君子加炮干姜、肉桂数
剂，再以十全大补汤而愈。 一人胁肿一块，日久不溃，按之微痛，脉微而涩，此形证俱
虚也。经曰∶形气不足，病气不足，当补不当泻。宜用人参养荣汤。彼不信，乃服流气
饮虚证悉至，方服前汤，月余少愈，但肿尚硬，以艾叶炒热熨患处，至十余日脓成，以
火针刺之，更灸豆豉饼，又服十全大补百帖而愈。盖流气饮通行十二经，诸经皆为所损，
况胆经之血本少，又从而损之，宁不伤生。东垣曰∶凡一经受病，止当求责其一经，不可
干扰余经，苟泛投克伐之剂，则诸经被 ，宁无危乎。 一人年三十，素饥寒，患右肋肿
如覆瓢，转侧作水声，脉数。经曰∶阴虚阳气凑袭，寒化为热，热甚则肉腐为脓，即此
证也。及按其肿处即起，是脓成。遂浓煎黄 六一汤，令先饮二盅，然后针之，脓出数
碗，虚证并至，遂用大补，三月余而愈。大抵脓血大泄，血气俱虚，当峻补之，虽有他
病，皆宜缓治。盖元气一复，诸病自退，老弱之人，不问肿溃，尤当补也。 一人因劳
发热，胁下肿痛，脉虽大按之无力，此气血虚，腠理不密，邪气袭于肉理而然也，当补
之以接虚怯之气。以补中益气汤加羌活，四剂少可。去羌活，又百余剂而愈。 一人面
白神劳，胁下生一红肿如桃，教用补剂，不信。乃用流气饮、十宣散，血气俱惫而死。
一人年逾二十，腋下患毒十余日，肿硬不溃，脉弱时呕。予谓∶肿硬不溃，阳气虚，呕吐
少食，胃气弱，宜六君子汤加砂仁、藿香。彼谓∶肿疡时呕，毒瓦斯攻心，溃疡时呕，阴虚
宜补。予曰∶此丹溪大概言也，若肿赤痛甚，烦躁脉实而呕为有余，当作毒瓦斯攻心而下之，
以疮属心火故也；肿硬不溃，脉弱时呕为不足，当补之。亦有痛伤胃气，或感寒邪秽气
而呕者，虽肿疡，尤当助胃壮气。盖肿疡毒瓦斯内侵作呕，十有一二；溃汤湿气内伤作呕，
十有八九。彼不信，饮攻伐药愈甚。复请诊，脉微弱而发热，予谓∶热而脉静，及脱血脉
实，汗后脉躁，皆难治胁，果殁。
（胁，指腋下肋骨部位；肋，指肋骨。有骨头覆盖的叫“胁”，没有骨头覆盖的叫“肋”。）
《灵枢》说：发于胁部的疽，名叫败疵，这是女子易患的病，可用灸法治疗。其症状表现为大的痈脓，其中会有像赤小豆大小的生肉。治疗方法是锉碎陵草根，各取一升。用水一斗六升，煎煮至药液枯竭，取汁三升，让患者强力饮下，然后穿上厚衣服坐在锅上熏蒸，使汗出至脚部为止。（“疵”音同“次”。《甲乙经》在“赤小豆”后，写作“治之锉陵草、赤松根，各一升”。）
《鬼遗钞》说：夹脊而发的疽，肿胀蔓延至两肋及两肩肘头，二十天不排脓就会死亡，九天时可行针刺。若疮色红白相间，脓多者可治；若全无红白色泽者则不可治。又说：两肋起疽，名为发肋，初起肿胀剧烈，十几天不排脓，若强行攻伐则肿大如杯碗，高耸如山丘，背痛牵连内脏绞痛。刺左边患处，右边会感到疼痛；刺右边患处，左边会感到疼痛。唯独此处多为内毒，若强行攻伐导致内陷，死者众多。有此病患，急用针刺排出脓血，则可避免内攻伤及内脏。
有人问：肋上生疽怎么样？回答说：这名叫肋疽，归属于手厥阴心包络和足厥阴肝经，因火热毒气与怒气相搏结而发作。可用活命饮加柴胡，或选用紫金丹、乌金散。体质壮实者，用八阵散、一粒金丹攻下。此证宜速治，否则溃烂后难以收敛，多会导致危重困顿。
有一人患此病，起初如胡桃大小，微痛微肿，月余逐渐增大如杯，医生误作痰证治疗，或作肝积，或云痞块，竟然毫无效果。数月后肿大如盆，坚硬如石，不甚疼痛，微红漫肿；又因暴怒，胸腹胀满，小便不利，脉迟而微弱。投以化气丸、六一散，小便通利，胸膈宽舒；继投乌金散、夺命丹，间服八阵散，月余逐渐消退。
有一人年过五十，腋下患毒，疮口不合，右关脉数且口渴，这是胃火所致。用竹叶石膏汤而止住热象，再用补气药而痊愈。曾治疗午后发渴或发热者，用地骨皮散有效。
有一人性情急躁，口味浓重，常服用燥热药物，左胁一点疼痛，轻按脉弦，重按脉芤，知其痛处有脓。给予四物汤加桔梗、香附、生姜，煎服十余帖，痛处微肿如手指大。针刺片刻，屈身脓出，再予四物汤调理而安。
有一位夫人，左胁内部作痛，牵引胸前，这是肝气不和，尚未成疮。用小柴胡汤加青皮、枳壳，四剂后稍好转，加川芎、当归治疗而愈。
有一人连年患疟疾，产后三月病热，右胁下阳明、少阳之分，生一疖子刚平，左胁下相对位置又一疖，脓血淋漓几乎致死。医生用四物汤、败毒散，数倍人参，以香附为佐使，犀角为使，大量煎煮给乳母喝，两月而愈。逾三月，忽腹胀生赤疹如霞片，取剪刀草汁，调原蚕砂敷贴随即消退。又半月，胀气移入阴囊为肿。黄囊裂开，两丸显露出水，以紫苏叶盛麸炭末托敷，旬余而愈合，这是胎毒证。
有一妇人因忿郁，腋下结一核二十余年，因怒加重肿痛，完谷不化，饮食少思，这是肠胃虚寒所致，用六君子汤加砂仁、肉桂、干姜、肉豆蔻，泄泻虽止但脓清稀，疮口不合，用十全大补汤，月余而愈。（王机按：前两项胁疮，一人因其性多躁急，故用四物汤阴柔之剂，以安静之；一人因其肝气不平，故用小柴胡疏理之剂，以和解之。这都是根据其性情来治疗，不仅专于攻毒。）
张通，北方人，年过四十，夏月腋下患毒，溃后不敛，脓出清稀，皮肤寒冷脉弱，肠鸣切痛，大便溏泄，食下即呕，这是寒邪变异而内陷，宜用大辛温之剂，遂用托里温中汤，二帖诸证悉退。更以六君子汤加炮干姜、肉桂数剂，再以十全大补汤而愈。
有一人胁肿一块，日久不溃，按之微痛，脉微而涩，这是形证俱虚。经曰：形气不足，病气不足，当补不当泻。宜用人参养荣汤。他不信，乃服流气饮，虚证悉至，方服前汤，月余稍愈，但肿尚硬，以艾叶炒热熨患处，至十余日脓成，用火针刺之，更灸豆豉饼，又服十全大补汤百帖而愈。盖流气饮通行十二经，诸经皆为所损，况胆经之血本少，又从而损之，岂能不伤生。东垣曰：凡一经受病，只当求责其一经，不可干扰余经，若泛投克伐之剂，则诸经被损伤，岂无危险。
有一人年三十，素来饥寒，患右肋肿如覆瓢，转侧作水声，脉数。经曰：阴虚阳气凑袭，寒化为热，热甚则肉腐为脓，即此证也。及按其肿处即起，是脓已成。遂浓煎黄芪六一汤，令先饮二盅，然后针之，脓出数碗，虚证并至，遂用大补之法，三月余而愈。大抵脓血大泄，血气俱虚，当峻补之，虽有他病，皆宜缓治。盖元气一复，诸病自退，老弱之人，不问肿溃，尤当补也。
有一人因劳发热，胁下肿痛，脉虽大按之无力，这是气血虚，腠理不密，邪气袭于肌肉纹理而然，当补之以接引虚怯之气。以补中益气汤加羌活，四剂稍好转。去羌活，又百余剂而愈。
有一人面白神疲，胁下生一红肿如桃，教用补剂，不信。乃用流气饮、十宣散，血气俱惫而死。
有一人年过二十，腋下患毒十余日，肿硬不溃，脉弱时呕。我说：肿硬不溃，阳气虚，呕吐少食，胃气弱，宜六君子汤加砂仁、藿香。他说：肿疡时呕，毒瓦斯攻心，溃疡时呕，阴虚宜补。我说：这是丹溪的大概说法，若肿赤痛甚，烦躁脉实而呕为有余，当作毒瓦斯攻心而下之，以疮属心火故也；肿硬不溃，脉弱时呕为不足，当补之。亦有痛伤胃气，或感寒邪秽气而呕者，虽肿疡，尤当助胃壮气。盖肿疡毒瓦斯内侵作呕，十有一二；溃疡湿气内伤作呕，十有八九。他不信，饮攻伐药愈甚。复请诊，脉微弱而发热，我说：热而脉静，及脱血脉实，汗后脉躁，皆难治。胁部果然死亡。
(Axillary rib area refers to the region under the armpit overlying the ribs; "Li" refers to the ribs. The part covered by bone is called "Xie," while the part without bone coverage is called "Li.")
The *Ling Shu* states: Carbuncles developing in the axillary rib area are named "Bai Ci." This is a disease prevalent in women and can be treated with moxibustion. Its presentation involves large abscesses with pus, containing fleshy growths resembling red adzuki beans. The treatment involves chopping Ling Cao (Radix Glehniae) root, taking one sheng of each. Boil in 16 sheng of water until reduced, extract three sheng of the decoction, and have the patient drink it forcefully. Then, dress warmly and sit over a pot to steam, inducing sweating down to the feet. ("Ci" is pronounced similarly to "Ci." In the *Jia Yi Jing*, after "red adzuki bean," it reads "treat by chopping Ling Cao and Chi Song Gen [Cortex Pinus], one sheng each.")
The *Gui Yi Miao Fang* states: Carbuncles occurring along the spine and swelling into the two ribs and both shoulders and elbows will result in death within twenty days if not punctured. Puncture may be performed on the ninth day. If the lesion shows alternating red and white colors with abundant pus, it is treatable; if there is no red or white coloration, it is untreatable. It further states: Carbuncles arising in both ribs are named "Fa Lei." Initially, swelling is severe; if not punctured for ten-plus days, aggressive intervention causes swelling like a cup or bowl, rising high like a mound, with back pain radiating inward causing intestinal cramping. Puncturing the left affected side elicits pain on the right; puncturing the right affects the left. This location often harbors internal toxins, and aggressive treatment leading to internal invasion has caused many deaths. For such conditions, urgently puncture with a needle to drain pus and blood to prevent internal damage.
A question was raised: How about carbuncles on the ribs? The answer is: This is named "Lei Ju" (Rib Carbuncle), belonging to the Hand Jueyin Pericardium Meridian and Foot Jueyin Liver Meridian. It arises from the combination of fire-heat toxin and angry qi. Treat with Huo Ming Yin (Life-Saving Decoction) added with Chai Hu (Radix Bupleuri), or select Zi Jin Dan (Purple Gold Pill) and Wu Jin San (Black Gold Powder). For robust individuals, use Ba Zhen San (Eight Array Powder) or Yi Li Jin Dan (One Pill Golden Elixir) to purge. This condition requires rapid treatment; otherwise, ulceration will fail to heal, leading to critical danger.
One patient suffered from this, initially presenting as a walnut-sized nodule with slight pain and swelling. After a month, it grew to the size of a cup. Physicians mistakenly treated it as phlegm, liver accumulation, or a mass, achieving no effect. Months later, it enlarged to the size of a basin, hard as stone, with minimal pain, slight redness, and diffuse swelling. Following a fit of rage, the patient experienced chest and abdominal distension, difficult urination, a slow and thready pulse. Administration of Hua Qi Wan (Qi-Transforming Pills) and Liu Yi San (Six-to-One Powder) facilitated urination and relieved chest tightness. Subsequently, Wu Jin San and Duo Ming Dan (Life-Restoring Pill) were given, interspersed with Ba Zhen San. After a month, the swelling gradually subsided.
Another patient, over fifty years old, had an infection in the axilla with non-healing wounds. The pulse at the Right Guan position was rapid, accompanied by thirst, indicating Stomach Fire. Treatment with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) stopped the heat, followed by Qi-tonifying herbs for recovery. Postprandial thirst or fever was effectively treated with Gu Pi San (Danhui Bark Powder).
A patient with an irritable temperament and preference for rich flavors, who frequently consumed drying and heating herbs, experienced localized pain in the left hypochondrium. Light palpation revealed a wiry pulse, while heavy pressure revealed a hollow pulse, indicating pus formation at the painful site. Four Mo Decoction (Si Wu Tang) added with Jie Geng (Radix Platycodonis), Xiang Fu (Rhizoma Cyperi), and Sheng Jiang (Rhizoma Zingiberis Recens) was decocted and taken for over ten doses. The painful area swelled slightly to the size of a finger. Upon needling, pus drained upon flexion. Recovery was achieved with Si Wu Tang for regulation.
A lady experienced internal pain in the left hypochondrium radiating to the chest, indicating Disharmony of Liver Qi, before abscess formation. Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Qing Pi (Exocarpium Citri Reticulatae Viride) and Zhi Ke (Fructus Aurantii) was administered for four doses, showing improvement. Adding Xiong Gui (Radix Chuanxiong and Radix Angelicae Sinensis) led to full recovery.
A patient suffering from malaria for years developed fever three months postpartum. A boil appeared in the Yangming-Shaoyang junction of the right hypochondrium. As it healed, a corresponding boil appeared in the left hypochondrium, draining pus and blood profusely, nearly causing death. The physician prescribed Si Wu Tang and Bai Du San (Anti-Toxin Powder) with multiple times the dose of Ren Shen (Radix Ginseng), using Xiang Fu as assistant and Xi Jiao (Cornu Rhinocerotis) as guide. Large amounts were brewed and given to the wet nurse. Recovery occurred after two months. Three months later, abdominal distension arose with red rashes like clouds. Juice from Jian Dao Cao (Hedyotis diffusa) mixed with Can Sha (Semen Bombyx Batryticatus) was applied topically, resolving immediately. Half a month later, distension moved to the scrotum, causing swelling. The yellow sac ruptured, exposing the testes with fluid discharge. Bran charcoal powder held in Perilla leaves was used for support. Healing occurred after ten days. This was identified as Fetal Toxin Syndrome.
A woman, due to anger and depression, had a nodule in her axilla for over twenty years. Anger exacerbated pain and swelling. She presented with undigested food in stool and poor appetite, indicating Spleen-Stomach Deficiency Cold. Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sha Ren (Fructus Amomi Rotundus), Rou Gui (Cortex Cinnamomi), Gan Jiang (Rhizoma Zingiberis Preparatum), and Dou Kou (Semen Myristicae) stopped diarrhea but resulted in thin pus and non-healing wounds. Shi Quan Da Bu Tang (Great Tonifying Decoction) cured her after a month. (Wang Ji notes: Regarding the previous two cases of hypochondriac sores, one was treated with Si Wu Tang's yin-nourishing nature to calm irritability; the other with Xiao Chai Hu Tang's soothing nature to harmonize Liver Qi. Treatment was tailored to temperament, not solely focused on detoxification.)
Zhang Tong, a northerner over forty, developed an axillary infection in summer. After ulceration, it failed to heal, discharging thin pus. Skin was cold, pulse weak, with borborygmus, cutting pain, loose stools, and vomiting after eating. This indicated Cold transformation with internal sinking. Strong acrid-warm formulas were indicated. Tuo Li Wen Zhong Tang (Support Interior and Warm Middle Decoction) resolved symptoms in two doses. Liu Jun Zi Tang added with Pao Gan Jiang and Rou Gui for several doses, followed by Shi Quan Da Bu Tang, led to recovery.
A patient had a hypochondriac swelling that did not ulcerate after a long time, with slight pain on pressure and a faint, choppy pulse, indicating deficiency of both form and syndrome. The Classics state: When form and qi are insufficient, and pathogenic qi is insufficient, tonify rather than drain. Ren Shen Yang Rong Tang (Ginseng Nourishing Courage Decoction) was indicated. Distrusting this, he took Liu Qi Yin (Flowing Qi Decoction), exacerbating deficiency symptoms. Only then did he take the previous formula, improving slightly after a month, though hardness remained. Hot mugwort compresses promoted pus formation after ten days. Needling with fire needles and moxibustion with Fermented Soybean Cake, followed by hundred doses of Shi Quan Da Bu Tang, cured him. Liu Qi Yin circulates through all twelve meridians, damaging them all. Since Gallbladder Meridian blood is naturally scant, further damage is life-threatening. Dong Yuan stated: Disease in one meridian should be addressed in that meridian alone; interfering with others by indiscriminately using attacking agents damages all meridians, posing grave danger.
A thirty-year-old patient, chronically hungry and cold, developed a right hypochondriac swelling like an inverted gourd, making water sounds upon turning, with a rapid pulse. The Classics state: Yin deficiency allows Yang qi to converge; cold transforms into heat; excessive heat rots flesh into pus. This matches the case. Pressing the swelling caused it to rise, indicating pus formation. Concentrated Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction) was drunk first, then needled. Several bowls of pus drained. Deficiency symptoms emerged, requiring strong tonification. Recovery took over three months. Generally, massive loss of pus and blood leads to Qi and Blood deficiency, requiring vigorous tonification. Other ailments should be treated slowly. Once Yuan Qi recovers, other diseases retreat. Especially for the elderly and weak, tonification is crucial regardless of swelling or ulceration.
A patient developed fever due to overwork, with hypochondriac swelling and pain. The pulse was large but empty on pressure, indicating Qi and Blood deficiency with loose interstices allowing pathogenic invasion into muscle layers. Tonification was needed to support deficient Qi. Bu Zhong Yi Qi Tang (Pump Up the Middle and Benefit Qi Decoction) added with Qiang Huo (Radix Notopterygii) improved symptoms in four doses. Removing Qiang Huo and continuing for over a hundred doses led to recovery.
A pale-faced, fatigued patient had a peach-like red swollen nodule in the hypochondrium. Advised tonics, he refused, taking Liu Qi Yin and Shi Xuan San (Ten Acupoints Powder) instead. Depletion of Qi and Blood led to death.
A patient over twenty had an axillary infection for ten days, with hard swelling, no ulceration, weak pulse, and occasional vomiting. I stated: Hard swelling without ulceration indicates Yang Qi deficiency; vomiting and poor intake indicate weak Stomach Qi. Liu Jun Zi Tang added with Sha Ren and Huo Xiang was indicated. He argued: Vomiting during the swelling stage implies toxin attacking the Heart; vomiting during the ulcer stage implies Yin deficiency requiring tonification. I replied: This is Dan Xi’s generalization. If red, swollen, painful, with restlessness, solid pulse, and vomiting, it is excess (toxin attacking Heart), requiring purgation due to Heart Fire association. If hard, non-ulcerated, with weak pulse and vomiting, it is deficiency, requiring tonification. Vomiting can also result from pain injuring Stomach Qi or cold/dirty pathogens invading. Even in the swelling stage, supporting Stomach Qi is vital. Toxin-induced vomiting occurs in 10-20% of swelling cases; dampness-induced vomiting occurs in 80-90% of ulcer cases. He refused, taking attacking herbs, worsening his condition. Upon re-examination, pulse was faint with fever. I stated: Fever with quiet pulse, pulse becoming solid after collapse, or restless pulse after sweating are difficult to treat. The patient indeed died.