Library

Boils and carbuncles present with a floating and rapid pulse, accompanied by aversion to cold and fever. If there is a painful area, this is where the boil or carbuncle has developed.

A rapid pulse with fever and pain indicates a Yang condition (Yang sore). A non-rapid pulse, no fever, and no pain indicate a Yin sore.

For boils and carbuncles that have not yet ulcerated, a flooding and large pulse is not feared. For those that have already ulcerated, a flooding and large pulse is alarming.

"Boil" (Yong) implies obstruction; "carbuncle" (Ju) implies blockage. These are caused by the obstruction and stagnation of Ying and Wei Qi and blood and qi, leading to郁 heat and pus formation. They can be distinguished by Yin/Yang and Zang/Fu organs. Boils are large and superficial; carbuncles are small and deep. Large size indicates Qi bubbling outward; outward bubbling means the lesion tends toward the surface and is shallow. Small size indicates Qi converging inward; inward convergence means the lesion tends toward the interior and is deep. Superficial lesions belong to Fu organs and Yang, so they are easy to resolve and ulcerate. Deep lesions belong to Zang organs and Yin, so they are difficult to resolve and ulcerate. Easy ulceration allows toxins to drain externally; difficult ulceration allows toxins to sink internally. This distinction determines the severity and prognosis. Medical texts state five sources: 1. Epidemic pathogens (Tianxing Shiqi); 2. Internal emotional depression (Seven Emotions); 3. Deficiency with external pathogen invasion; 4. Body heat combing with wind-cold; 5. Heat toxins from roasted foods, strong wine, or cinnabar/stone medicines. Although divided into five, they ultimately fall under the "Three Causes." The first cause is External: as mentioned in *Suwen* chapters on Six Qi, such as the guest Qi of Taiyang, Shaoyin, Yangming, Taiyin, Shaoyang, and Jueyin, and variations like cold, dryness, dampness, excessive heat, or excessive fire causing rashes, sores, boils, and carbuncles. According to *Maiyao Jingwei Lun*, Huangdi asked: How do various swellings, tendon spasms, and bone pains arise? Qibo answered: These are swellings due to cold Qi and changes from the Eight Winds. *Shengqi Tongtian Lun* states: Sweat from labor exposed to wind causes cold to press into the skin, resulting in 'Fei' (a skin disorder); prolonged stagnation results in 'Cuo' (acne). It also states: If Yang Qi's opening and closing fail, cold Qi enters, causing major boils. If Ying Qi does not flow smoothly and rebels within the muscle tissue, boils and swellings arise. (The opening and closing of Couli are governed by Wei Qi. If Wei Qi is abnormal, opening and closing are disrupted. Pathogens enter through gaps, knotting in meridians causing stooping; if pathogens sink into vessels, Ying Qi becomes unsmooth, rebelling in muscle tissue, eventually knotting into boils.) *Suwen·Qixue Lun* says: Excess pathogens and stagnant Qi, hot pulses and decaying flesh, blocked Ying and Wei Qi will soon turn to pus. Internally consuming marrow, externally breaking large sores, remaining in joints and Couli will lead to severe decay. *Lingshu·Cijie Zhenxie Pian* says: Empty pathogens invading humans, combing in vessels, cause blood closure. Blockage leads to boils. (This aligns with Ying Qi stagnation.) It also says: If heat overcomes cold, flesh rots and muscles decay into pus, damaging bones internally. Bone damage is called bone erosion. (Prolonged heat rots good flesh into pus. If it doesn't drain but sinks in, it rots bones. Bones damaged don't regenerate easily, like insect erosion.) It further says: Pathogens invade, condensing daily, gathering together, forming 'Xi Liu' (chronic tumors). Prolonged condensation grows larger. Non-decaying growths on the body are called tumors. "Xi" means past, indicating duration. It says: Bone and Qi combining, growing daily, becomes bone Ju. (Pathogens attaching to bone become bone Ju over time.) It says: With heat, it turns to pus; without heat, it becomes flesh Ju. (Pathogens knotting in flesh. With heat, flesh rots to pus; without heat, flesh turns to sludge. Common in some Ju tumors.) The second cause is Internal: *Suwen·Yinyang Bie Lun* says: Disease of the Three Yang channels presents with chills and fever, and lower-body boils. (Three Yang refers to Taiyang. Taiyang governs the exterior, hence chills and fever; its meridian runs down the leg, hence lower-body boils.) *Suwen·Qi Jue Lun* says: Kidney transferring cold to Spleen causes boils and shortness of breath. Spleen transferring cold to Liver causes boils and tendon spasms. (Kidney water cold reversing to Spleen earth is adverse. Adversity causes Qi stagnation in muscles swelling, as Spleen governs muscles. Spleen cold reversing to Liver wood is also adverse. Adversity causes Qi not only to stagnate in muscles but also tendons to spasm and swell, as Liver governs tendons.) *Suwen·Jue Lun* says: Shaoyang Qi reversal causes intestinal abscesses, untreatable. If convulsions occur, death ensues. (Refers to Shaoyang wandering fire. Reversal and knotting create severe toxicity, hence untreatable. Convulsions indicate pathogen entering Zang, specifically Jueyin Pericardium, hence death.) *Lingshu·Maidu Pian* says: Disharmony of the Six Fu organs leads to knotting and boils. (Fu organs are Yang, governing Wei Qi. Wei Qi disharmony knots in muscle-Couli, causing boils.) *Yuban Lun* records Huangdi saying: Diseases arise from unpredictable joy/anger and irregular diet. Yin Qi deficiency and Yang Qi excess, with blocked Ying Qi, lead to boils and carbuncles. Yin-Yang blockage and combing of two heats transform into pus. (Joy/anger damage Qi; diet damages Zang. Unpredictable means sudden onset, causing Qi stagnation and Yang excess. Irregular diet means indulgence, damaging Five Zang and Yin deficiency. Yang excess causes Qi gathering and heat victory; Yin deficiency causes Ying stagnation and heat victory. Two heats comb, blocking Ying-Wei, transforming to pus.) Chen Wuyue also stated: Boils, carbuncles, and scrofula, regardless of deficiency/excess or cold/heat, are all caused by Qi depression, likely from long-term emotional stagnation. Treatment uses Yuanzhi Wine and Dusheng Powder, combined with the theory of Five Emotions overcoming each other (e.g., fear overcomes thought). The third cause is Neither Internal nor External: *Shengqi Tongtian Lun* says: Changes from rich/greasy foods suffice to generate major Ding (carbuncles), accepted as easily as holding an empty vessel. (*Yifang Fangyi Lun* says: Eastern regions produce fish and salt. People eat fish and love salt, settling there. Fish causes internal heat. Salt consumes blood, so people have dark skin and loose texture, prone to sores, treated with Bian stones. Fish is Yin outside, Yang inside, moving constantly like Fire. Long-term consumption causes internal heat, making sores common.) Long-term use of cinnabar/stone medicines and strong wine accumulates heat toxins, causing boils/carbuncles similar to rich food effects. Pulses floating and rapid indicate blood stagnation with Qi following. Pathogen-Qi depression transforms to heat, hence rapid pulse. Surface/Yang location makes pulse float. Zheng Qi battling pathogens weakens exterior defense, causing aversion to cold. Symptoms resemble Taiyang syndrome. However, Shanghan pain varies (head, body, joints), never localized. Localized pain with rapid pulse indicates heat turning to pus at the specific site, characteristic of boils/carbuncles. As *Shanghan Lun·Bian Mai Fa* states: Floating-rapid pulses with fever/chills and localized pain with normal appetite indicate accumulated pus. This is Yang Du. If pulse is not rapid, no fever, no pain, pathogen is in Yin division, unable to push out, likely sinking internally. Accompanied by irritability, vomiting, chest discomfort. Otherwise, no heat/pain/rapid pulse implies no disease, so calling it Yin sore worse than Yang is incorrect. Before ulceration, whether pus forms or not, heat stagnation without external release makes flooding-large pulses appropriate. After ulceration, heat drains, pathogen resolves, so flooding-large pulses should subside. Persistent flooding-large pulse after ulceration indicates unchecked heat, threatening Zheng Qi recovery, akin to *Ping Re Bing Lun*'s Yin-Yang Jiao (fever returning after sweat, rapid pulse unsubsided). Specifics of boils/carbuncles are in dedicated texts, but *Lingshu·Yong Ju* covers origins thoroughly. Huangdi asked: I hear Stomach/Intestines receive grain, Upper Jiao emits Qi to warm muscles/joints/open Couli (Wei Qi source). Middle Jiao emits Qi like dew, pouring into Xigu, penetrating Sun vessels, harmonizing fluids into red blood. Blood harmonizes, filling Sun vessels, then Luo vessels, then Jing vessels. Yin-Yang expand, moving with breath (Ying Qi source). Movement has order, circling matches Heaven, ceaseless. Pulse diagnosis regulates, reducing excess, tonifying deficiency. Discharging reduces excess, quick needle reduces Qi, retaining adjusts timing, tonifying fills deficiency. Once Qi-blood harmonized, form-Qi sustains. I know Qi-blood balance but not boil/carbuncle origins, timing, or prognosis. Please explain. Qibo replied: Meridians flow endlessly, matching Heaven/Earth. Star deviations cause eclipses; river deviations cause floods/barren land/isolation. Qi-blood behaves similarly. Blood-Qi-Ying-Wei flow continuously, mirroring stars/numbers. Cold pathogens in meridians cause blood stagnation. Stagnation blocks Wei Qi return, causing boils. (Wei Qi stays, failing to return to normal flow.) Cold turns to heat; heat rots flesh to pus. Undrained pus rots tendons, damaging bones, consuming marrow. If not draining through bone holes, blood empties, muscles/tendons lose nourishment. Meridian leakage fumes on Five Zang, causing death. Huangdi asked for shapes, forbidden days/names. Qibo said: Boil in throat is Meng Ju (Fierce Ju). Untreated, it pus. Undrained pus blocks throat, death in half a day. Drained pus treated with cold pig fat, cured in three days. Neck boil is Yao Ju. (Extends to armpit/lungs. Highest point, hence Yao.) Large, red-black. Untreated, heat sinks to Yuanye, damages Ren Mai, steams Liver/Lungs, death in ten days. Excessive Yang Qi melting brain/neck is Nao Shuo. (Melting like gold. Brain scorched. Irritability is Kidney toxin transmitting to Heart.) Unhappy expression, neck pain like needle stick, irritability: fatal. Shoulder/armpit boil is Ci Ju. Red-black. Treat urgently to induce sweating to feet, sparing Zang. Treat within 4-5 days. Armpit small red-hard boil is Mi Ju (Rice Ju). Treat with Bian stone (fine/long), puncture lightly, apply pig fat, cure in six days, do not bandage. Hard non-ulcerating armpit/neck lumps are Ma Dao Xia Ying. Treat urgently. Chest deep boil is Jing Ju. Bean-sized. Starts in 3-4 days. Untreated, spreads to abdomen, death in seven days. Anterior chest green boil is Gan Ju. Gourd-seed shaped, chills/fever. Treat urgently to remove chills/fever, death in ten years (post-pus discharge). Rib-side female boil is Bai Ci. Moxibustion. If large pus forms, treat. Contains meat like adzuki bean. Decoct Ge Gen root, drink strong, sit over pot, sweat to feet, cure. Thigh/calf boil is Gu Ting Ju. Minimal change, pus binds bone. Untreated, death in thirty days. Tailbone sharp boil is Rui Ju. Red-hard-large. Urgent treatment. Untreated, death in thirty days. Inner thigh red spread is Chi Shi. (Taiyin/Jueyin pathway. Severe Yin-damaging fire. "Chi Shi" means red fire spreading.) Untreated, death in sixty days. Both inner thighs untreated, death in ten days. Knee boil is Ci Yong. Large, color unchanged, chills/fever, hard stone. Do not pierce; piercing kills. Wait for softness, then pierce for survival. Joint boils with corresponding points above/below are untreatable. Yang channel boils die in 100 days; Yin channel boils die in 30 days. (Joints are spirit pathways. Corresponding outbreaks are fatal.) Calf rabbit-bite boil is Tu Nie. Red to bone. Urgent treatment prevents harm. Inner ankle slow-walk boil is Zou Huan. (Foot poison slows gait.) Boil shape, color unchanged. Pierce acupoints repeatedly to stop chills/fever, survival. Foot upper-lower four-fluency boil is Si Yin. (Poison in extremities, Yang roots failed. Corresponding.) Large boil. Urgent treatment, death in 100 days. Foot-side malignant boil is Li Yong. (Li means evil.) Small, finger-sized start. Urgent treatment. Remove black parts; otherwise increases. Untreated, death in 100 days. Toe shedding boil is Tuo Yong. Red-black, fatal. Not red-black, survivable. If no regression, amputate toe immediately, else death. Huangdi asked how to distinguish boils/carbuncles. Qibo said: Ying-Wei stagnation in meridians causes blood stagnation. Wei Qi follows but cannot pass, knotting causes heat. Unchecked heat rots flesh to pus. But it doesn't sink deeply, marrow doesn't dry, Zang aren't harmed, so it's called Boil. Huangdi asked about Carbuncle. Qibo said: Intense heat sinks into skin, drying tendons/marrow; connects to Zang, exhausting Qi-blood. Under the lesion, bone/tendon/flesh are destroyed, so it's called Carbuncle. Carbuncle skin is pale/hard, like cow neck skin. Boil skin is thin/shiny. These are the signs.