Library

(Sui Jin Chapter)

Toxic pathogens must be resolved through suppuration; thus, the presence of pus indicates life, while its absence indicates death. However, pus is the accumulation of Qi and the transformation of Blood. Therefore, if the vertex of the lesion is plump, lustrous, and moist, and the base shows gathered Blood, it is a sign that pus will naturally form. Conversely, if the vertex is sunken and grayish-white, and the base shows scattered Blood, it indicates an absence of pus, which is a sign of death.

Generally, on the fourth or fifth day after onset, if the body exhibits tidal fever, the lesion roots are red and the vertices are white, food and drink are taken normally, urination and defecation are regular, and the spirit and breath are calm, this is auspicious. Once the lesions reach the stage of nourishing the paste (yangjiang), one must strictly observe all taboos. This is because during the initial rising phase, the disease duration is short, and Qi and Blood are still strong, sufficient to resist the daily erratic pathogenic qi. By this stage, however, Qi is depleted and Blood is deficient, with spirit and vitality diminished; even slight deviation cannot be borne, especially since the lesions are in the process of flourishing and maturing!

When lesions reach five or six days, toxic pathogens transform into paste. Initially, the color is white, then changes to green, and finally resembles pale wax—plump, lustrous, with red and vibrant bases. The skin feels hard upon touch, while the paste inside is soft, with no other symptoms present; this is auspicious. Red and vibrant bases indicate appropriate Yin Blood; white vertices indicate appropriate Yang Qi. This represents the intersection of Qi and Blood, and the alternating movement of Yin and Yang. Furthermore, if the paste is thick and pure amidst the whitening, it signifies that Blood has transformed and Toxicity is attached, meaning Yang contains Yin. This is the harmonious interaction of Yin and Yang, an auspicious omen. Otherwise, the interior becomes an "Empty Granary," and the exterior resembles dried cornel fruits, with both Qi and Blood exhausted, making survival difficult.

If swelling extends beyond the neck and paste reaches the chest without delay, and the pus is slightly yellow, this is called "True Paste." It is also ideal for the glans to be filled with paste first. The paste on the dorsum of both hands and feet should also be full, as these areas are governed by the Spleen and Stomach; otherwise, during crusting, eating will be impossible and complications likely. When examining lesions, one must carefully inspect the "Mother Lesion" (the primary lesion); if it is lustrous and fully filled with pus/paste, the remaining lesions, though secondary, will ultimately cause no harm. Treatment should primarily focus on tonifying and resolving toxicity.

If a lesion rises and swells with good luster but feels soft and wrinkled to the touch, the paste is incomplete and Qi is weak; immediately apply Baoyuan Tujiang method. Otherwise, crusting will be difficult, leading to itching. If lesions are grayish-white, paste is insufficient, skin is thin and prone to rupture, showing signs of collapse, urgently administer Baoyuan Tang with Guimi. If lesions are red-purple, paste is insufficient, showing signs of dryness and black depression, urgently administer herbs such as Danggui, Chuanxiong, and Shengdi to invigorate Blood, cool Blood, and support paste formation. If lesions throughout the body suddenly turn grayish-white during suppuration, this belongs to Deficiency-Cold; warm and tonify to support the interior. If they turn red-purple, this belongs to Excess-Heat; cool Blood and clear the exterior. However, some cases may be caused by sudden pathogenic invasion, which comes violently and requires careful examination. If lesions have risen and suppurated for seven or eight days but constipation persists, urgently administer Weiqi, Zhike, Shengdihuang, and Huangqin. Otherwise, at the crusting stage, severe fever will occur leading to death.

Pain during suppuration has two causes: Qi stagnation causes pain where lesions lack luster; treatment should promote Qi movement. Blood Heat causes pain where lesions are red-purple; treatment should cool Blood, but not excessively, to avoid stasis of Blood and cessation of paste flow. Dense lesions on the high points of the cheeks, nose tip, and forehead gather toxic vapors from the Five Zang organs and are easily broken. Injury here causes all lesions to subside and toxins to attack internally, so strict protection is essential. If accidentally scratched open, seal the wound firmly and continue internal supportive therapy. If lesions re-emerge and fill normally, or if "Gift Lesions" (extra lesions) appear in empty spaces—small but easy to fill and resolve—it indicates residual toxins are expelling outward, which is also auspicious. Purple-black eye sockets indicate Xiao Du attacking and damaging the Liver, or may result from chronic cough. Early emergence of vitality during suppuration suggests insufficient Yuan Qi; use Baoyuan Tang combined with interior support. Dry lesions indicate Blood Deficiency, requiring Blood nourishment.

Low voice during suppuration is acceptable. However, sudden fever, hoarseness, abdominal distension, and coarse breathing indicate Ding Chuang or Zei Dou at critical limb points; examine urgently, puncture, and seal firmly with You Yanzhi and Zhenzhu Mo. Paste spreading on the head and face with emptiness below indicates toxins floating upward, avoiding fatal danger. Conversely, paste filling limbs first with upper emptiness indicates toxins sinking inward, risking death. Lesions breaking into pits indicate internal collapse; apply Bailong San externally and internal tonification/support. Extensive involvement or multiple clusters indicate ominous prognosis. Thirst, irritability, heat, choking, and wheezing before suppuration begins are ominous. Lesions appearing full but hollow and soft inside are named "Empty Granary Lesions," extremely malignant. If there is clear fluid, raised bases, and red-vibrant blood attachment, urgently rescue with Renshen, Chuanxiong, Danggui, and Renru. Large blisters like beans during suppuration require Baizhu and Fuling to strengthen Spleen/Stomach and drain dampness from the skin. Purple blisters are untreatable. Lesions rotting in patches with non-drying pus require major Qi and Blood tonification plus damp-draining herbs, applied with Baicao San externally. White, crystal-clear lesions without pus require no neglect; watch for itching and collapse on days 11-12, and certain death on days 14-15; early administration of Neituo San with Dingxiang and Ganjiang, or Muxiang San with Nuomi, Renru, and Jiu is indicated. Chills and teeth-grinding on days 7-8 when paste is formed indicate Interior Deficiency; treat with Baoyuan Tang plus Dingxiang and Rougui. Cessation of shaking and scabbing is favorable. After paste fills and heat-toxins resolve, if lesions do not scab/dry for several days during the recovery phase, and color remains original, it is due to Qi Deficiency failing to consolidate or Spleen Deficiency failing to drain dampness; use Bazhen Tang with Spleen-tonifying and water-draining herbs, and lesions will naturally heal.