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A patient suffered from long-term pain in the medial aspect of the thigh. The physician treated it as Gout (Tongfeng, 痛风), but after more than a month, there was no effect. The pus had matured and the flesh was rotting, yet it could not penetrate to form an opening. Eventually, it ulcerated into the abdomen, causing mental confusion and stupor, with an inability to take even porridge or medicine. I was consulted. The pulse was fine like a thread, and the breath was faint, nearly perishing. I said, "It is treatable." Using a Pi Needle (Biren, 铍针), I punctured the abdomen, draining several sheng (a unit of volume) of large amounts of pus. However, all the pus was clear and watery, and the wound opening resembled crab bubbles. I suspected penetration of the peritoneum. I said, "There is no harm." I administered Ren Shen (Ginseng Root, 人参), [Missing Herb], and Fu Zi (Aconite Lateral Root, 附子), along with herbs guiding to the Jueyin Meridian (Liver and Pericardium). These were taken in large doses. Before meals, one hundred pills of Sheliu Dihuang Wan (Eight-Ingredient Rehmannia Pill, 八味地黄丸) were swallowed. Appetite greatly improved; daily rice intake exceeded one sheng. Several pieces of healthy flesh grew, and recovery occurred within ten days. The reason I knew it was treatable was that for ulcerative conditions, a洪实 (Hongshi, surging and excess) pulse indicates death, while a微细 (Weixi, fine and thin) pulse indicates life. Now the pulse is fine and thin, consistent with the physical symptoms, indicating the body can accept tonification. The reason I believed the peritoneum was not penetrated, or even if it were, it was still treatable, was the absence of malignant signs. Taking Sheliu Dihuang Wan aims to strengthen Kidney Qi (Kidney Energy, 肾气) so it rises, thereby opening the Stomach appetite and allowing food intake. Although much pus was drained, advancing stomach-opening medicines encourages eating grains and meats to tonify the body, leading to rapid muscle regeneration. This is the major principle for treating ulcers.

Shen Shou Wei Sheng San (Divine Grant Hygiene Powder, 神授卫生散), Zhenzhu Dan (Azure Pearl Pill, 绀珠丹), Neishu Huanglian Tang (Internal Draining Coptis Decoction, 内疏黄连汤), Guijin Wan (Noble Gold Pill, 贵金丸), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction, 补中益气汤), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill, 六味地黄丸), Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction, 十全大补汤), Liujunzi Tang (Six Gentlemen Decoction, 六君子汤), Ci Weizhong Xue Fa (Puncturing Weizhong Acupoint Method, 刺委中穴法), An Xue Jiu Fa (Pressing Acupoint Moxibustion Method, 按穴灸法), Bazhen Tang (Eight Treasures Decoction, 八珍汤), Baoyuan Dacheng Tang (Preserve Origin Great Achievement Decoction, 保元大成汤), Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction, 香砂六君子汤) (all seen in Volume One); Xiaoyao San (Free and Easy Wanderer Powder, 逍遥散) (seen in the Scrofula section); Bin Su Baidu San (Betel Nut and Eclipta Detoxifying Powder, 槟苏败毒散).

Meridians: The Classic states, "The small gatherings of flesh are called Xi (Creeks)." "Xi" refers to the two elbows, two knees, and four wrists. It also states, "Spleen disease occurs at the Xi." And again, "When the Kidneys have pathogenic factors, their Qi remains in the two knees." All tendons belong to the joints; tendon diseases belong to the joints, and further belong to the Liver. Patients with tendon diseases should not eat much sour food and should avoid Wind-dispelling medicines. Various abscesses arising at joints with corresponding involvement are difficult to cure. (This implies internal pathology manifesting externally). Those arising in Yang meridians die in one hundred days; those arising in Yin meridians die in thirty days. (Yang refers to the dorsal aspects of joints, Yin to the interstices).

Ju (Deep Abscess): Arising at the knee. The Ling Shu (Spiritual Pivot) states: "Its appearance is a large abscess, color unchanged, accompanied by chills and fever, and hard. Do not stone (incise) it. Those who incise it die; those who soften it live."

Knee Abscess (Xi Yong): Swelling and pain of the knee joint. At onset, use Wei Sheng San added with Niu Xi (Achyranthes Root, 牛膝), or Jiawei Ermiao San (Modified Two Marvels Powder, 加味二妙散).

Knee Eye Wind (Xi Yan Feng): There are acupoints on both sides of the knee named Guiyan (Ghost Eye, 鬼眼). At onset, swelling and pain feel like awl piercing, with severe chills and fever. Zhenzhu Dan is suitable to harmonize.

Crane Knee Wind (He Xi Feng): Swelling on both inner and outer aspects of both knees, alternating chills and fever, pain like tiger biting, with thighs gradually thinning and knees enlarging. This belongs to the Foot Shaoyang (Lesser Yang) and Foot Yangming (Stomach) meridians. Initially, use Zhenzhu Dan to induce sweating. Externally, apply Yulong Gao (Jade Dragon Ointment, 玉龙膏) mixed with wine to stop pain and restore Yang. If swelling and pain persist after sweating, it indicates deep-seated Yin-Cold. Use Dafangfeng Tang (Great Wind-Expelling Decoction, 大防风汤) to warm. Or add Ru Xiang (Frankincense Resin, 乳香) to stop pain and relax tendons. Moxibustion on Xiyan points, 14 moxa cones. In severe cases with visible blue veins and pain radiating to the sole, moxibustion on Sanyinjiao (SP6), 14 cones, until the knee straightens. Even more severe cases: seven cones on the top of the knee, a secret point.

Wandering Knee Wind (You Xi Feng): Pain in only one knee radiating up and down is the difference. Mild fever, slight swelling. Initially, use Zhenzhu Dan to induce sweating.

Stone Ju (Shi Ju): Swelling without color change, diffuse swelling and pain, hard as stone. This is swelling caused by Cold-Qi. Alternatively, crush fresh Shanglu (Phytolacca Root, 商陆) root, add a little salt, and apply.

Slow Ju (Huan Ju): Heat is slow, accumulating over days without ulceration, eventually turning dark purple with skin and flesh rotting. Both conditions require warming and tonifying.

Regarding the above conditions, although swelling has depth and pathogenic invasion has severity, the root cause is always deficiency of True Qi (Zhengqi, 真气), allowing pathogens to invade deeply. Thus, Gujue (Bone-attached Abscess, 附骨疽) and He Xi Feng are common in patients with Kidney Deficiency. Ancients used Fu Zi to warm and tonify Kidney Qi and to promote drug action to disperse Cold-Pathogens. There are also cases of weak constitution sleeping outdoors, invaded by Cold Air, unable to turn or lie sideways, with intermittent heat but no sweat, and pain upon pressure reaching the bone; this is injury by Thief-Wind (Zefeng, 贼风), characterized by mild heat, aversion to cold, and spontaneous sweating. Moxibustion stops pain slightly. All such cases should take Dafangfeng Tang and apply Yulong Gao for cure. If neglected, they become deformities like contracture or hemiplegia. Again, bilateral knee swelling with flaccid leg tendons is due to Yin-Deficiency with damp-heat invasion. Treat primarily with Liuwei Wan, assisted by Bazhen Tang added with Niu Xi and Duzhong (Eucommia Bark, 杜仲), interspersed with Buzhong Yiqi Tang. For Spleen-Stomach deficiency, use Buzhong Yiqi Tang. If essence is depleted and mouth dry, it is Middle-Jiao Qi deficiency; add Wuweizi (Schisandra Berry, 五味子). For dizziness and headache, it is failure of Yang Qi to ascend; add Manjingzi (Vernonia Seed, 蔓荆子). For Liver-Kidney damage, emaciation, lethargy, night fevers, excessive phlegm, thirst, and frequent urination indicate Five Viscera deficiency; use Liuwei Dihuang Tang. For umbilical/abdominal pain, nocturia, weak legs/knees, dizziness, and vomiting phlegm, it is Cold-Decay of Kidney Qi; use Sheliu Dihuang Wan. For fear of cold after pus formation and ulceration, it is Yang Qi deficiency. For clear, thin pus failing to generate flesh, it is Blood and Qi deficiency. For deficient heat coming and going at times, it is Rootless Deficient Fire. All these should use Shiquan Dabu Tang.

For the above three decoctions, adding Dafangfeng Tang is essential. For example, poor appetite and abdominal distension indicate Spleen-Stomach deficiency; use Sijunzi Tang (Four Gentlemen Decoction, 四君子汤). Withered yellow complexion indicates weak Spleen-Stomach; use Liujunzi Tang. Fever or afternoon fever indicates Yin-Blood deficiency; use Siwu Tang (Four Substances Decoction, 四物汤) added with Ren Shen, [Missing Herb], and Baizhu (Atractylodes Macrocephala Rhizome, 白术). Fever, great thirst, aversion to removing clothes, red face and eyes, and large empty pulse indicate Blood deficiency with Dryness; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction, 当归补血汤).

Weizhong Poison (Wei Zhong Du): Occurs in the crease behind the knee, hard as stone, slightly swollen and red. Caused by accumulated Heat in the Gallbladder Meridian flowing into the Bladder Meridian. Delayed treatment leads to tendon contraction and disability. Puncture the tendon at Weizhong (BL40) acupoint to release purple-black blood. Also administer Huayu Huoxue (Blood-invigorating and Stasis-resolving) medicines. After stasis clears, it resolves naturally.

Shangshuiyu (Upper Water Fish): Occurs on the side of the crease, forming a long nodule like a fish, causing swelling and pain. Prick the nodule repeatedly with a needle to release evil blood, then apply Huoxue (Blood-invigorating) medicines.