《素问》帝曰∶人病胃脘痈者，诊当何如？岐伯曰∶诊此者当候胃脉，其脉当沉细，沉
细者气逆（《甲乙经》沉细作沉涩。）逆者人迎甚盛，甚盛则热。人迎者胃脉也，逆而盛则热
聚于胃中而不行，故胃脘为痈也。（病能篇）
〔薛〕 《圣济总录》云∶胃脘痈由寒气隔阳，热聚胃口，寒热不调，故血肉腐坏。以
气逆于胃，故胃脉沉细。以阳气不得上升，故人迎热盛，令人寒热如虐，身皮甲错，或咳
嗽，或呕脓唾血。若脉洪数脓成也，急排之；
脉迟紧瘀血也，急下之。否则其毒内攻，腐烂肠胃矣。丹溪先生云∶内疽者，因饮食之
毒，七情之火，相郁而发，用射干汤主之。愚常以薏苡仁汤、牡丹皮散、太乙膏选用之，亦
效。若吐脓血，饮食少思，助胃壮气为主，而佐以前法，不可专治其疮。一男子寒热作渴，
不时咳吐，口内血腥，又五日吐脓，身皮甲错，用射干汤四剂，脓血已止，但气壅痰多，
以甘桔汤而愈。一男子用射干汤之类将愈，但气喘体倦，发热作渴，小便频数，此肺气不
足，用补中益气、山药、山茱、麦门、五味。时仲夏，更以生脉散代茶饮而愈。一妇人，素
食浓味，吐脓已愈，但小便淋沥，此肺肾气虚，用补中益气加麦门、五味，及加减八味
丸而愈。若膏粱之人，初起宜用清胃散。
射干汤 治胃脘痈，人迎脉逆而盛，嗽脓血，荣卫不流，热聚胃口成痈。
射干（去毛） 栀仁 赤茯苓（去皮） 升麻（各一两） 赤芍药（一两半） 白术（半两）
上为末。每服五钱，水二盏，煎至一盏，去渣，入地黄汁一合，蜜半合，再煎温服，不
计时候。
复元通气散（《精要》） 治诸气涩，耳聋，腹痈，便痈，疮疽无头，止痛消肿。
青皮 陈皮（各四两） 甘草（三寸，生熟各半）
穿山甲（炮） 栝蒌根（各二两） 金银花 连翘（各一两）
上为细末，热酒调下。
芍药汤 治胃脘积热，结聚为痈。
赤芍药 石膏 犀角（镑） 麦门冬 荠 木通（各二两） 朴硝 升麻 玄参 甘草（生，
各一两）
上 咀。每服五钱，水一盏半，煎八分，去滓，不拘时温服。
黄帝问道：人患胃脘痈，诊察时应当如何？岐伯回答说：诊察这种病应当候察胃脉，其脉象应当沉细，沉细说明气机逆乱（《甲乙经》中“沉细”写作“沉涩”）。气机逆乱则人迎脉非常盛大，人迎脉盛大则表明有热。人迎脉属于胃脉，气逆且盛大则热邪聚集于胃中而不能运行，所以胃脘部位形成痈肿。（出自《素问·病能篇》）
薛己按语：《圣济总录》说：胃脘痈是由于寒气阻隔阳气，热邪聚集在胃口，寒热不调，导致血肉腐败坏死。因为气逆于胃，所以胃脉呈现沉细。因为阳气不能上升，所以人迎脉热盛，使人出现寒热往来如疟疾状，皮肤干枯粗糙如鳞甲，或者咳嗽，或者呕吐脓血。如果脉象洪数，说明脓已形成，应立即排脓；如果脉象迟紧，说明有瘀血，应立即攻下瘀血。否则毒邪内攻，会腐蚀肠胃。丹溪先生说：内疽，是因为饮食之毒与七情之火相互郁结而发作，用射干汤主治。我常选用薏苡仁汤、牡丹皮散、太乙膏，也有效。如果出现吐脓血、饮食减少思虑的情况，应以扶助胃气、壮大正气为主，并辅以前面的方法，不可专门治疗疮疡。有一个男子，寒热交替、口渴，不时咳嗽吐痰，口中有血腥味，五天后吐出脓液，皮肤干枯粗糙，我用射干汤服用四剂，脓血已止，但气壅痰多，用甘桔汤治愈。另一个男子，用射干汤之类药即将痊愈，但气喘体倦，发热口渴，小便频数，这是肺气不足，我用补中益气汤加山药、山茱萸、麦门冬、五味子。当时正值仲夏，又用生脉散代替茶饮而治愈。有一个妇人，平时喜欢吃浓味食物，吐脓症状已愈，但小便淋漓不尽，这是肺肾气虚，我用补中益气汤加麦门冬、五味子，以及加减八味丸而治愈。如果是吃精细肥甘食物的人，初起宜用清胃散。
射干汤 治疗胃脘痈，人迎脉逆乱而盛大，咳嗽吐脓血，营卫运行不畅，热邪聚集在胃口形成痈肿。
药材及用量：射干（去毛）、栀子仁、赤茯苓（去皮）、升麻（各一两），赤芍药（一两半），白术（半两）。
制法用法：以上药物研为末。每次服用五钱，加水二盏，煎煮至一盏，去渣，加入地黄汁一合，蜂蜜半合，再煎煮后温服，不限时间。
复元通气散（出自《外科精要》） 治疗各种气机阻滞，耳聋，腹部痈肿，便部痈肿，无头疮疽，止痛消肿。
药材及用量：青皮、陈皮（各四两），甘草（三寸，生甘草和熟甘草各半），穿山甲（炮制），栝蒌根（各二两），金银花、连翘（各一两）。
制法用法：以上药物研为细末，用热酒调服。
芍药汤 治疗胃脘积热，结聚形成痈肿。
药材及用量：赤芍药、石膏、犀角（镑片）、麦门冬、荠菜、木通（各二两），朴硝、升麻、玄参、甘草（生用，各一两）。
制法用法：以上药物切碎。每次服用五钱，加水一盏半，煎煮至八分，去渣，不拘时间温服。
Huangdi asked: When a person suffers from a carbuncle in the stomach region (Wei Wan Yong), how should the diagnosis be conducted? Qibo replied: In diagnosing this condition, one should observe the Stomach pulse. The pulse should be deep and fine (Chen Xi). A deep and fine pulse indicates rebellious Qi (Qi Ni) [Note: *Jia Yi Jing* reads "deep and choppy" (Chen Se)]. Rebellious Qi causes the Renying pulse to be extremely full. An extremely full Renying pulse indicates heat. The Renying pulse belongs to the Stomach channel. When Qi is rebellious and the pulse is full, heat gathers in the Stomach and fails to circulate, thus forming a carbuncle in the stomach region. (From *Su Wen*, Chapter "Bing Neng")
Xue Ji commented: *Sheng Ji Zong Lu* states that a carbuncle in the stomach region arises from cold qi obstructing Yang qi, causing heat to gather at the stomach opening. The disharmony of cold and heat leads to the corruption and necrosis of flesh and blood. Because Qi rebels in the Stomach, the Stomach pulse appears deep and fine. Because Yang Qi fails to ascend, the Renying pulse becomes hot and full, causing symptoms such as alternating chills and fever resembling malaria, rough and scaly skin (Pi Jia Cuo), cough, or vomiting of pus and blood. If the pulse is surging and rapid (Hong Shu), it indicates that pus has formed; immediate drainage is required. If the pulse is slow and tight (Chi Jin), it indicates blood stasis; immediate purgation is required. Otherwise, the pathogenic toxin will attack internally, corroding the intestines and stomach. Mr. Danxi stated that internal abscesses (Nei Ju) arise from the toxicity of diet and the fire of the seven emotions, which become stagnant and erupt. They are treated primarily with Shegan Tang. I often select Yiyiren Tang, Mudanpi San, or Taiyi Gao for use, which are also effective. If there is vomiting of pus and blood, along with poor appetite and lack of desire for food, the treatment should focus on supporting the Stomach and strengthening Qi, assisted by the aforementioned methods, rather than treating the sore exclusively. One male patient presented with alternating chills and fever, thirst, intermittent coughing and expectoration, a metallic taste in the mouth, and five days later vomited pus, with rough and scaly skin. I administered Shegan Tang for four doses; the vomiting of pus and blood ceased, but Qi stagnation and excessive phlegm remained. He was cured using Ganjie Tang. Another male patient was nearly cured using Shegan Tang and similar formulas, but presented with asthma, fatigue, fever, thirst, and frequent urination. This indicated deficiency of Lung Qi. I used Buzhong Yiqi Tang supplemented with Shanyao, Shanzhuyu, Maimendong, and Wuweizi. It was mid-summer, so I also prescribed Shengmai San to be taken as tea, resulting in a cure. One female patient, accustomed to rich and greasy foods, had her vomiting of pus cured, but continued to experience dribbling urination. This indicated deficiency of Lung and Kidney Qi. I used Buzhong Yiqi Tang supplemented with Maimendong and Wuweizi, along with Jiajian Bawei Wan, resulting in a cure. For individuals consuming refined and fatty foods, Qingwei San should be used at the initial stage.
Shegan Tang treats carbuncles in the stomach region, characterized by a rebellious and full Renying pulse, coughing up pus and blood, impaired circulation of Ying and Wei, and heat gathering at the stomach opening to form a carbuncle.
Ingredients: Shegan (descaled), Zhiren, Chifuling (peeled), Shengma (each 1 liang), Chishao Yao (1.5 liang), Baizhu (0.5 liang).
Preparation and Administration: Grind the above ingredients into powder. Take 5 qian per dose, add 2 zhan of water, decoct until 1 zhan remains, strain, add 1 he of Rehmanniae Radix juice (Dihuang Zhi) and 0.5 he of honey, decoct again, and take warm. Administer at any time.
Fuyuan Tongqi San (from *Waike Jingyao*) treats various Qi obstructions, deafness, abdominal carbuncles, anal/perineal carbuncles, headless sores and ulcers, relieving pain and reducing swelling.
Ingredients: Qingpi, Chenpi (each 4 liang), Gancao (3 cun, half raw and half processed), Chuanshanjia (prepared), Gualugen (each 2 liang), Jinyinhua, Lianqiao (each 1 liang).
Preparation and Administration: Grind into fine powder. Mix with hot wine and take orally.
Shaoyao Tang treats accumulated heat in the stomach region that condenses to form a carbuncle.
Ingredients: Chishao Yao, Shigao, Xijiao (sliced), Maimendong, Qicai, Mutong (each 2 liang), Puxiao, Shengma, Xuanshen, Gancao (raw, each 1 liang).
Preparation and Administration: Coarsely crush the ingredients. Take 5 qian per dose, add 1.5 zhan of water, decoct until 0.8 zhan remains, strain, and take warm at any time.