Library

A "Zhongyang" (swollen ulcer) refers to a carbuncle or furuncle that has swelled but has not yet suppurated. Zhu Danxi stated: In the stage of Zhongyang, both internal and external qi and blood are obstructed; treatment should primarily focus on supporting the interior and dispersing pathogens, such as using Tuoli San (Support Interior Powder). If Rhubarb (Dahuang, 大黄) is used, one must beware of the error of reckless and violent medication.

A "Kuangyang" (ulcerated sore) refers to a carbuncle or furuncle where pus has already ruptured and drained. Zhu Danxi stated: In the stage of Kuangyang, both internal and external righteousness (zheng qi, 正气) are deficient; treatment should primarily focus on tonifying and reconnecting tissues. If aromatic and drying herbs are desired, one must beware of the error of further depleting the deficiency.

When the swelling is high, painful, and the pulse is floating, the pathogen is in the exterior; it is appropriate to use internal support therapy (e.g., Neituo Fujian San). When the swelling is hard, the pain is deep, and the pulse is sinking, the pathogen is in the interior; it is appropriate to use purgation (e.g., Huanglian Neishu Tang, Xianfang Huoming Yin, Kushen Wan). When there is no external swelling, but internal bowel movements and urination are harmonious, the pathogen is in the meridians; it is appropriate to harmonize Ying and Wei (nutritive and defensive qi) (e.g., Tuoli Yangrong Tang, or herbs like Baizhi and Shengma). When there is pain accompanied by irritability, or dry throat and thirst, it is appropriate to descend fire (e.g., Huanglian Jiedu Tang). When there is pain accompanied by fever, stiffness/spasms, or headache, the pathogen is in the exterior; it is appropriate to disperse it (e.g., Jingfang Baidu San, Renshen Baidu San), inducing sweating to vent the sores. When the pain is severe or absent, the pathogenic factor is excess; it is appropriate to apply garlic-separated moxibustion and use detoxifying agents (e.g., Xianfang Huoming Yin). When there is irritability, desire for cold drinks, pain, and a rapid pulse, the pathogen is in the upper jiao; it is appropriate to clear heat (e.g., Qingliang Yin, Jinyinhua San). When a malignant sore persists without ulcerating over a long period, it indicates excess qi combined with cold pathogen; it is appropriate to ventilate and tonify (e.g., Shixuan San). When there is pain, fever, profuse sweating, extreme thirst, constipation, and delirium, it is a Jieyang syndrome (accumulation of yang/heat); it is appropriate to purge (e.g., Huanglian Neishu Tang, Po Guan Dan). When pus does not form, or forms but does not rupture, it indicates deficiency; it is appropriate to tonify (e.g., Buzhong Yiqi Tang, Shiquan Dabu Tang, Bazhen Tang). When there is pain or failure to suppurate, it indicates pathogenic condensation; it is appropriate to resolve/dissipate it (e.g., Xianfang Huoming Yin). When there is swelling, pain, desire for cold drinks, fever, and somniloquy (talking in sleep), it is fire/toxin; it is appropriate to clear it (e.g., Qingxin Tang, Fangfeng Tongsheng San added with Huanglian). When there is failure to suppurate, failure to ulcerate, or failure to heal after ulceration, it indicates deficiency of Yang qi; it is appropriate to tonify (e.g., Tuoli Xiaodu San). After the sore heals, recuperation is necessary. For conditions like Luoli (scrofula) and Liuzhu (flowing abscesses), tonification is especially crucial; otherwise, the righteous qi will be too weak to sustain itself, making treatment difficult.