Library

Internal resolution (Neixiao) should assess the depth and size of the lesion, its location along the meridians, and the deficiency or excess patterns manifested in the physical condition and pulse. For instance, the brain, back, waist, neck, and buttocks belong to the Taiyang Meridian (Foot-Taiyang Bladder Channel), where Huanglian (Coptidis Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) are suitable. The area connecting the spine and back to the hypochondrium is close to the Shaoyang Meridian (Foot-Shaoyang Gallbladder Channel), making Baidu San (Detoxification Powder) appropriate. For patients with robust physique and a forceful pulse, Lulu Tang (Rhinanthi Decoction) or Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) can be used to promote drainage and purgation. In cases of Qi deficiency, Renshen (Ginseng Radix et Rhizoma) serves as the principal herb; for Blood deficiency, Danggui (Angelicae Sinensis Radix) and Renshen are primary, supplemented by detoxifying agents and guiding herbs. The six meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) each follow their respective root-and-branch cold-warm properties and the relative abundance of Qi and Blood to apply tonification or sedation methods. Only the Shaoyang meridian follows treatment principles similar to those for Qi and Blood deficiency. (Herbs such as Gualou (Trichosanthis Fructus), Shegan (Belamcandae Rhizoma), Chuanshanjia (Pangolin Scales), Chansu (Toad Venom), Lianqiao (Forsythiae Fructus), Dideng (Violaris Herba), Dalizi (Arctii Fructus), Jinyinhua (Lonicerae Japonicae Flos), and Mubiezi (Strychni Semen) are all drugs used for internal resolution.)

The external application of plasters aims to release the exterior pathogen. The Classics state: "Releasing the exterior does not distance itself from heat." Generally, heat dissipates when encountering Yang Qi but coagulates and causes pain when encountering cold. Would it be rational for physicians to apply cold medicines externally?

When sores and ulcers cause thirst, regardless of whether there is swelling or suppuration, if the pulse is rapid, accompanied by fever and thirst, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used. If there is no fever or thirst, or if the pulse is rapid but weak with thirst, or only dry mouth, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is indicated. If the pulse is rapid with constipation, Qingliang Yin (Cooling Drink) is used. If the Chi pulse (Kidney position) is flooding but weak upon deep pressure, accompanied by thirst, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) is prescribed. This pill is particularly effective for treating dry mouth, yellow tongue coating, and a desire to drink without actual thirst.

The *Jingyao* states: Thirst differs from dry mouth; one should not use mineral pills that suppress and sink, as disaster can strike instantly. Instead, Sangzhi Jian (Mulberry Twig Decoction) and Wuwei Tang (Five-Flavor Decoction) to nourish Kidney Water and rescue Yang are excellent.

Danxi stated: Without considering fire arising from dietary tastes, anger, or sexual exhaustion, I fear thirst will be difficult to stop.

The *Jingyao* states: When sores cause urgent thirst, Shenxian Zhuidu Wan (Immortal's Poison-Chasing Pill) can be used to purge toxic substances. Qingdan Tang (Clear Gallbladder Decoction), Qianjin Lulu Tang (Thousand-Gold Rhinanthi Decoction), Wuxiang Lianqiao Tang (Five-Aroma Forsythia Decoction), Liuwei Che'ao San (Six-Ingredient Sea-Cow Shell Powder), and Wanjin San (Ten-Thousand-Gold Powder) are also selectable options. If thirst persists after purgation, switch to herbs that generate fluids and tonify Qi. Once fluids are generated and Qi and Blood are replenished, thirst will cease naturally.

Danxi asked: If massive thirst is treated with purgatives, how can one know it is indicated without clearly stating the pulse and symptoms? Later, it says to use tonics if thirst persists after purgation, yet again without specifying pulse and symptoms. It seems the logic is simply that massive thirst requires purgation, and only if thirst remains afterward are tonics given. Is this how ancients practiced preventive treatment? Moreover, thirst belongs to the Upper Jiao (Upper Burner). Perhaps it could be used during the stage of indurated sores. However, thirst after ulceration is mostly due to Qi and Blood deficiency; why wait until after purgation to discuss deficiency?

At the initial onset of carbuncles and malignant sores, Qi and Blood are deficient. Use Renshen to tonify Qi, and Danggui and Dihuang to nourish Blood, or use Rendong Wan (Honeysuckle Pill) or Huangqi Liuyi Tang (Astragalus Six-to-One Decoction).

One patient developed a back carbuncle after a sore had healed, which had not yet suppurated. The pulse was rapid and weak, indicating Yin deficiency with floating Fire. Jiaban Bawei Wan was administered in coarse powder form. After two doses, symptoms slightly eased, followed by continued use of the pill for recovery.

Another patient with a nuchal carbuncle experienced thirst. Although the pulse was flooding, it was weak upon deep pressure, and this medication was used. The patient did not believe in it and self-medicated with Yin-nourishing herbs, causing the condition to worsen until the Seven Evil signs appeared, leading to death.

Dongyuan said: Patients who develop thirst after recovering from a carbuncle often prove incurable. Only Jiaban Bawei Wan is superb. Carbuncles and sores often arise from deficiency. For those whose carbuncles have settled but who develop thirst, taking this pill stops the thirst and brings peace. For those without thirst, taking it prevents future thirst. Even for those who experience thirst before developing a carbuncle, taking this pill not only stops thirst but may prevent the carbuncle from forming.

A nobleman developed thirst while his carbuncle was still unsettled, drinking several liters of water daily. I prescribed Jiaban Bawei Wan. Other physicians laughed, prescribing Queme (Papaveris Pericarpium), Wumei (Mume Fructus), Zisu (Perilla Folium), Renshen and Poria formulas, and Baiyaojian (Betel Nut Preparation), which exacerbated the thirst. Reluctantly, they used my prescription, and thirst ceased within three days. The disease originated from Kidney Water depletion and Heart Fire flaming upward, causing thirst. This drug generates Water and descends Fire most effectively; let physicians take note.

The *Jingyao* states: If thirst arises after a carbuncle tends toward healing, administer Jiaban Bawei Wan.

Danxi said: Thirst after a carbuncle indicates simultaneous deficiency of Qi and Blood. One should use Renshen to tonify Qi and Danggui/Dihuang to nourish Blood; thirst should then stop. Why use Ze Xie (Alismatis Rhizoma) and Fuling (Poria) assisted by Rougui (Cinnamon Bark) to guide water? Rendong Wan and Huangqi Liuyi Tang are also appropriate; Rendong nourishes Blood, and Huangqi tonifies Qi. How would thirst arise? (Xu Chunfu's commentary: Danxi’s argument that post-carbuncle thirst stems from Qi and Blood deficiency, treatable by Renshen for Qi and Danggui for Blood, thereby stopping thirst without needing Rougui to guide water, is indeed accurate. Dongyuan claimed that post-carbuncle thirst cannot be stopped except by Jiaban Bawei Wan, attributing it to Kidney Water deficiency. This reasoning holds true. However, universally applying Bawei Wan to all cases of pre-carbuncle thirst, claiming it prevents carbuncles, is not a general rule. Why? Carbuncles often result from accumulated heat. The Classics state: "If the pulse remains rapid, sores and ulcers will surely develop." Thus, prolonged accumulation of fire leads to carbuncles. I believe pre-carbuncle thirst is a sign of fire; one should use heat-clearing, toxin-resolving, blood-cooling, and fluid-generating methods to stop thirst and potentially prevent the carbuncle. Hasty use of Bawei Wan seems inappropriate. Furthermore, Fuzi (Aconiti Lateralis Radix Praeparata) is potent and suitable only for deficiency-cold after carbuncles via the method of following the false symptom. Laypeople mistake deficiency for heat, using only heat-clearing and thirst-quenching agents. Dongyuan likely emphasized Bawei Wan to counteract this error. I fear future physicians might misinterpret this and indiscriminately use Fuzi for pre-carbuncle thirst, which would be erroneous. Generally, for post-carbuncle thirst, adopting Danxi’s approach of tonifying Qi and Blood is very stable. If ineffective, one may then resort to Jiaban Bawei Wan, avoiding the risks of overly potent drugs.)