Library

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Zang organs are in disharmony, the nine orifices become blocked; when the Fu organs are in disharmony, pathogenic factors remain and knot to form carbuncles. It also states: Injury to the form causes pain, injury to Qi causes swelling. This clearly indicates that disharmony of the Zang and Fu organs leads to the manifestation of sores on the exterior. How can applying cold-natured topical medications harmonize the Zang and Fu organs or promote the circulation of Qi and Blood? If there is swelling, pain, fever, and thirst, with a slippery, rapid, and forceful pulse, it belongs to the Pure Yang syndrome. It is appropriate to internally administer Jiyin Dan (Nourish Yin Pill) and externally apply Yiyang San (Benefit Yang Powder), so that heat-toxin will naturally resolve and stasis will dissipate. If the condition appears swollen but not fully swollen, painful but not fully painful, ulcerated but not fully ulcerated, red but not fully red, with a flooding, rapid but forceless pulse, it belongs to the Half-Yang Half-Yin syndrome. It is appropriate to internally administer Chonghe Tang (Harmonizing Decoction) and externally apply Yinyang San (Yin-Yang Powder), so that Qi and Blood will naturally harmonize and stasis will eliminate. If there is slight swelling and pain, or dark discoloration without pain, or hardness without ulceration, with a flooding pulse that becomes minute, fine, and weak upon deep pressure, it belongs to the Pure Yin syndrome. It is appropriate to internally take Huiyang Tang (Restore Yang Decoction) and externally apply Yiyin San (Suppress Yin Powder), so that the Spleen and Stomach will naturally strengthen and Yang Qi will recover. Master Zhu Danxi said: Topical applications should only be used for minor, mild heat conditions. If one fails to distinguish the differentiation between Yin and Yang syndromes and recklessly applies cold-natured agents, it will block the interstices (Couli), stagnate Qi and Blood, causing the toxin to attack inwardly and the flesh to die. Moreover, if the vital energy encounters cold, it fails to thrive; if blood stasis encounters cold, it fails to disperse; if necrotic flesh encounters cold, it fails to ulcerate; if new flesh encounters cold, it fails to grow.

[Clinical Cases]
The son of Zhai Shiman, a Grand Secretary, suffered from pain below the ear. Both internal medication and external application consisted of cold-natured detoxifying herbs, which exacerbated the swelling and pain. The neck became swollen and hard, with normal skin color, extending internally to the chest. I happened to arrive in the capital after completing my term of office and was invited to examine him. Although the swelling was hard, the pulse was slippery and rapid, indicating that pus had formed internally. Although this was a heat-toxin syndrome of the Foot-Taiyang, Taiyang, and Yangming meridians, the cold-natured herbs caused condensation, preventing external ulceration. I first administered Liu Junzi Tang (Six Gentlemen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), two doses each, to tonify the Spleen and Stomach and raise Yang Qi. The affected area subsequently softened. Upon puncture, a large amount of purulent exudate was discharged. After taking several more doses, he recovered.

Li Beichuan, an official of the Ministry of Works, suffered from a carbuncle on his leg. He used cold-natured detoxifying herbs both internally and externally. Due to extreme pain, he lanced it, releasing bloody pus, at which point he realized it was a carbuncle. The wound opened, the flesh turned purple and cold, sinking inward, with no external swelling. This indicated deficiency-cold of Yang Qi failing to consolidate. I used fermented soybean cakes (Douchi Bing) combined with Liu Junzi Tang added with Huoxiang (Patchouli Herb), Sharen (Amomum Fruit), and Paojiang (Prepared Ginger). His diet improved, and the affected area became warm. Subsequently, using Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction), his Yuan Qi (Original Qi) recovered, and the wound healed.

A man had a swelling on his leg that persisted for a year without subsiding. He had poor appetite and bloating after forced eating, occasional diarrhea, and progressive emaciation. His Chi pulses (at both wrists) were minute and fine. This indicated failure of the Fire of the Gate of Vitality (Mingmen) to generate Earth, resulting in deficiency-cold of the Spleen and Stomach. I treated him with Bawei Wan (Eight-Ingredient Pill). His diet gradually increased, and the swelling resolved.