Library

Zhongyang (Swollen Ulcer) refers to the stage where a sore or ulcer has not yet ruptured. The Classics state: "Injury to form causes pain, injury to Qi causes swelling." It also states: "When Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, abscesses and swellings arise." All these conditions are caused by congenital endogenous toxins, or the nursing mother consuming rich and greasy foods, combined with Yin Fire resulting from emotional disturbances, or the infant accumulating toxins from eating roasted, sweet, and delicious foods, leading to disharmony of Qi and Blood. One must differentiate according to the affected meridians, the mutual overcoming relationships among the Five Zang Organs, and deficiencies in innate constitution, pre-emptively and prudently selecting formulas for purging, tonifying, or harmonizing to rapidly cause resolution or rupture. Particular attention must be paid to whether the swelling is diffuse or localized, whether the color is red or pale, whether the pain is slight or severe, and whether the pathogenic toxin is superficial or deep. If the swelling is high and painful, and bowel movements and urination are harmonious, the pathogen is at the exterior; it is appropriate to use exterior-releasing methods. If the swelling is hard and the pain is deep, accompanied by constipation and dryness, the pathogen is at the interior; it is appropriate to use purgative methods. If there is no external tension but internal bowel and urinary functions are harmonious, the pathogen is in the meridians; it is appropriate to harmonize Ying and Wei (Nutritive and Defensive Qi). If the swelling is large and painful, or numb and painless, indicating stagnation of pathogenic factors, Garlic-partitioned moxibustion or Xianfang Huoming Yin (Immortal Life Elixir Decoction) should be used. If restlessness, desire for cold drinks, redness, pain, fever, and obstruction of both bowels and urine occur, indicating intense internal Heat-Fire, Qingliang Yin (Cooling Drink Decoction) or Xianfang Huoming Yin (Immortal Life Elixir Decoction) should be used, adding Da Huang (Rhubarb Rhizome) is especially beneficial. If there is only slight swelling and pain, or no pain, indicating deficiency of Yang Qi, Shenqi Tuoli San (Ginseng and Astragalus Interior-Tonifying Powder) should be used. If the color is slightly dark or slightly red, or not red at all, indicating deficiency and cold of Yang Qi, Jiawei Tuoli San (Modified Interior-Tonifying Powder) should be used. If aversion to cold occurs without pus formation, or if pus matures but fails to rupture, indicating deficiency of Yang Qi, Jiawei Tuoli San (Modified Interior-Tonifying Powder) should be used. In this manner, unformed lesions will naturally dissipate, and formed lesions will naturally suppurate and rot. It is crucial to distinguish whether the condition belongs to Yin, Yang, or half-Yin half-Yang, and treat accordingly. If one rigidly adheres to the saying that "acrid and hot substances are contraindicated for swollen ulcers," without differentiating the etiology of symptoms or the meridian involvement of accompanying symptoms, and indiscriminately uses detoxifying herbs, disturbing various meridians, and attacking non-pathogenic areas, it may result in failure of the lesion to rise or suppurate and heal, leading to unpredictable complications. The *Tongju Lun* (Treatise on Carbuncles and Sores) states: "When both interior and exterior of a swollen ulcer are obstructed, the primary treatment should be interior-tonifying and exterior-releasing. Whenever swelling and pain are observed, if pulse and symptoms indicate weakness, tonification should be administered immediately. As long as Qi and Blood are not depleted, auspicious outcomes can be ensured." When infants are ill, their mothers should also be regulated simultaneously. If treatment during the swollen ulcer stage is improper, it will inevitably lead to complications in the ulcerated stage. This deduces the subtle principles of the *Neijing* (Inner Canon) and reflects personal clinical verification; one should particularly extend understanding through analogy. What need is there for me to add further words?