Library

Children's constitutions are purely Yang and prone to heat; when Heart Qi is stagnant, sores often arise. If fetal toxins and dietary accumulations are excessive and affected by heat-toxins, Xijiao San (Rhinoceros Horn Powder) is the most suitable formula. Other treatments should follow standard protocols; however, if drastic purgation is used, it may damage the Stomach Qi.

Zhu Danxi stated: Among the six Yang meridians, some have abundant Qi and scarce Blood, some have scarce Qi and abundant Blood, and some have both abundant Qi and Blood; they cannot be generalized. Among all meridians, only the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are prone to carbuncles and should be prevented in advance. This is because these two meridians have abundant Qi but scarce Blood; with insufficient Blood, muscle tissue is difficult to regenerate, and sores fail to heal for a long time, inevitably leading to fatal outcomes. Some practitioners hastily use drugs that expel toxins and promote bowel movements, thereby depleting the Blood of the Yin aspect, bringing disaster swiftly. When swelling and pain first appear, upon correlating pulse and symptoms, if weakness is detected, tonifying agents should be administered immediately to prevent deficiency of Qi and Blood, ensuring a favorable outcome. Conversely, using routine heat-clearing, toxin-resolving, or Qi-moving drugs will cause a "deficiency on top of deficiency" disaster, which happens as easily as flipping a hand.

A thirty-year-old man presented with redness and swelling on the lateral aspect of his left leg; a forty-year-old man had redness and swelling under his ribs. Both died after recklessly using Dahuang (Rhei Radix et Rhizoma) to purge interior excess, without considering the inherent scarcity of Blood in their respective meridians (Shaoyang).
A sixty-year-old man had a nodule on the lateral aspect of his left arm; a young woman suffered from pain in her thigh bone. Both also died after recklessly using Wuxiang Shixuan San (Five-Aromatic Ten-Aperture Powder) for exterior dispersion, failing to anticipate the blood-scarcity of the involved meridians. (The above cases were not caused by changes from rich foods, erysipelas, or fire-heat pathogens, but resulted from consumptive fatigue and Qi stagnation. Treatment should have focused on tonifying the physical vitality and regulating the meridians, allowing the sores to resolve spontaneously without requiring sweating or purging. Failure to meticulously differentiate pulses, symptoms, and meridian involvement led to the violation of contraindications for diseases and meridians, resulting in therapeutic failure.)

Whenever carbuncles and ulcers have formed, in cases of deficient Qi and Blood or deep-seated pathogenic factors, the pathogens may scatter and fail to protrude, making suppuration difficult. Or, after ulceration, there may be scant pus, thin pus, induration without softening, or even if pus appears, the base remains red and the opening large. These indicate deficient Qi and Blood combined with exuberant pathogens and invasion by the Six Exogenous Pathogens, generating various syndromes. In such cases, Neituo (Internal Support/Supporting the Interior) therapy must be employed, primarily using tonifying herbs to allow the toxin-heat to exit via the muscular surface, facilitating recovery. Tonifying herbs should serve as the Sovereign (Jun) drugs, while blood-invigorating and pathogen-expelling herbs act as Ministers (Chen). Alternatively, acrid-aromatic herbs can be used to move stagnation, or warm-hot herbs added to ward off wind-cold.

In cases where carbuncles and ulcers present with swelling and pain, and within one or two days of onset, the pulse is deep and fine accompanied by restlessness, the Zang-Fu organs are weak, the skin is cold, the pathogenic toxin is fierce, the patient is agitated and uneasy, and external signs are deep-seated, Toli San (Support-the-Interior Powder), Zengsun Fuling Tang (Modified Poria Decoction), or warm-hot preparations should be used immediately to treat according to the apparent syndrome (Congzhi).

Regarding Neituo therapy, Liu Hejian treated swellings located externally with shallow bases and superficial manifestations, where the pulse was typically floating and the disease resided in the skin and flesh. If the Qi was not exuberant, the pathogen would inevitably invade internally, necessitating immediate Neituo. The appropriate formula was Fujian San (Double-Decoction Powder) to drain dampness and dissipate stagnation, harmonizing Stomach Qi. If the condition persisted, half a dose could be decocted again and consumed. If constipation and irritability/heat were present, a small amount of Huanglian Tang (Coptis Decoction) was given. If there was mild diarrhea and the irritability/heat had subsided, Fujian San was then administered. This approach ensures the smooth flow of Ying (Nutrient) and Wei (Defensive) Qi, preventing internal injury by pathogens.