肿痛未作脓者。宜除湿消毒。黄连消毒饮之类。
大痛或不痛。或麻木者。毒甚也。隔蒜灸之。更用解毒药。
肿痛便秘者。邪在内也。泄之。
不甚痛。或不作脓者。虚也。托里为主。
脓成胀痛者。针之。更以托里。
不作脓。或不溃者。托里药为主。
脓溃或不敛。或多者。大补气血。
烦躁饮冷。脉实而痛。宜泻火。
一人素不慎起居饮食。 赤肿痛。尺脉洪数。以黄连消毒散一剂。湿热顿除。惟肿硬作
以仙方活命饮二剂。肿痛悉退。但疮头不消。投十宣。去桂。加金银花、 本、白术、茯
、陈皮。以托里排脓。彼欲全消。自制黄连解毒散二服。反肿硬不作脓。始悟。仍用十宣散
。加白术、茯苓、陈皮、半夏。肿少退。仍去桂。又四剂而脓成。肿势亦退。继以八珍汤加
黄、五味子、麦门。月余脓溃而愈。（此凭脉症也。）
夫苦寒之药虽治阳症。尤当分表里虚实次第时宜。岂可始末悉用之。然 肿赤痛。尺脉
按之则濡。乃膀胱经湿热壅盛也。故用黄连消毒散。以解毒除湿。顾肿硬作痛。乃气血凝滞
不行而作也。遂用仙方活命饮。以散结消毒破血也。其疮头不消。盖因热毒熏蒸。气血凝滞
而然也。宜用甘温之剂补益阳气。托里以腐溃之。况此症原属督脉经因虚火盛而出。若不审
其因。专用苦寒之药。胃气以伤。何以腐化收敛。几何不致于败耶。凡疮易消散。易腐溃。
易收敛。皆气血壮盛故也。
一人耳后漫肿作痛。肉色不变。脉微数。以小柴胡汤加芎、归、桔梗四剂。肿少起。更
里消毒散数剂。脉活数。此脓已成。宜针。彼畏不从。因痛极始针。出脓碗许以托里药两月
余始安。（此凭脉症也。）
一人脑疽。肿痛脉数。以黄连消毒散二剂少退。与仙方活命饮二剂而止。再以当归、川
芎、芍药、金银花、黄柏、知母而溃。又以托里药而愈。（此凭脉症也。）
一人头项俱痛。虽大溃。肿痛益甚。兼作泻。烦躁不睡。饮食少思。其势可畏。诊其
毒尚在。与仙方活命饮二剂。肿痛退半。与二神丸及六君子汤。加五味、麦门、酸枣仁四剂
。诸症少退。食颇进睡少得。及与参苓白术散数服。饮食颇进。又与十全大补汤。加金银花
、白芷、桔梗。月余瘥。
一老患此。色赤肿痛。脉数有力。与黄连消毒散二剂少退。更与清心莲子饮。四剂而消
。（此凭脉症也。）
一人肿硬不作脓。惟疮头出水。疼甚。以仙方活命饮二剂。痛止而脓成。针之。更以托
里药而愈。
一妇脑左肿痛。左鼻出脓。年余不愈。时或掉 如坐舟车。许叔微曰。肝虚风邪袭之然
以川芎一两。当归三钱。羌活、旋复花、细辛、防风、蔓荆子、石膏、 本、荆芥穗、半夏
曲、干地黄、甘草各半两。每服一两。姜水煎服。一料而愈。
机按此条认作肝虚风邪袭之。而治以去风清热养血祛痰之剂。因其掉 。痛偏于左也。
。诸风掉 。皆属肝木。又病偏左。乃肝胆所主。又曰。风从上受之。又曰。无痰不成 运
。又曰。肝藏血。又曰。风乃阳邪。故方以风热痰血为主治者。理也。
一人脑疽已十余日。面目肿闭。头 如斗。脉洪数。烦躁饮冷。此膀胱湿热所致。用黄
毒饮（百二一）二剂。次饮槐花酒二碗。顿退。以指按下。肿则复起。此脓已成。于颈额肩颊
各刺一孔。脓并涌出。口目始开。更以托里药。加金银花、连翘三十余帖而愈。（此凭脉症
一儿头患白疮。皮光且急。诸药不应。名曰脑疳疮。乃胎毒挟风热而成。服龙胆丸。（
百十五）及吹芦荟末鼻内。
兼搽解毒散 而愈。若重者。发结如穗。脑热如火。遍身出汗。腮肿胸高。尤宜此药。
机按龙胆丸芦荟末。皆凉肝胆杀虫之剂。盖肝胆主风。又风木自甚则生虫。故治疳多此
一人素饮酒。九月患脑之下项之上出小疮。后数日脑项麻木。肿势外 。疡医处五香连
且云不可速疗。俟脓出用药。或。砭刺。三月可平。四月如故。予曰。凡疮见脓。九死一生
。果如医言。则束手待毙矣。且膏粱之变。不当投五香。当先火攻。然后用药。以大艾炷如
两核许者。灸至百壮乃痛。次为处方。足太阳膀胱经其病逆。当反治。脉得弦紧。按之洪大
而数有力。必当伏其所主。而先其所因。其始则同。其终则异。以时言之。可收不可汗。经与
病禁下。法当结者散之。咸以 之。然寒受邪而又禁咸。遂以诸苦寒为君。甘寒为佐。酒热
为因。用大辛以解结为臣。三辛三甘。益元气而和血脉。淡渗以导酒湿。扶持秋令。益气泻
火。以入本经药通经为引用。故以羌活、独活、防风、 本、连翘以解结。黄连、芩、柏、
知母、酒制以泻火、生甘草泄肾火。补下焦元气。参、 、橘皮以补胃。但参、 、甘草配
诸苦寒药三之一。多则滋营气补土湿邪也。苏木、归尾去恶血。生地黄补血。酒防己除膀胱
留热。泽泻助秋去酒湿热。凡此诸药。必得桔梗为舟楫。乃不下沉。服之投床大鼾。日出乃
寤。以手扪疮。肿减七八。至疮痂敛。都十四日而已。
机按脉之紧弦主疮痛。按之洪数主内热。大阳寒水而受阳热。故曰其病逆寒水之经。而
用寒凉之药。
故曰反治。此因脉因经因其所嗜而制此方也。
一人患脑疽。势剧脉实。用黄连消毒散不应。以金银藤二两。水二钟。煎一钟。入酒半
服之势去三四。再服渐退。又加黄柏、知母、栝蒌、当归、甘草节。数剂而溃止。加黄 、
川芎、白芷、桔梗数剂而愈。（机按此条凭脉而治也。）
一人脑疽。其头数多。痛不可忍。服消毒药不应。更以金银花服之。即鼾睡。觉而势去
。再四剂而消。一人所患尤甚。亦令服之。肿痛顿退。但不能平。加黄 、当归、栝蒌仁、
白芷、桔梗、甘草节数剂而愈。
前条因治不应而变法。后条因症而处治。
一人脓将成。微痛兼渴。尺脉大而无力。此阴虚火动之症。彼谓心经热毒。自服清凉降
。愈炽。复求治。乃以四物汤加黄柏、知母、五味、麦门、黄 。及加减八味丸。渴止疮溃
。更以托里药兼前丸而愈。（此凭脉也。）
一妇脓成不溃。胀痛欲呕。饮食少思。急针之。与托里药而愈。（此凭症也。）
一妇脑疽不甚痛。作脓。以托里消毒。脓成针之。补以托里药亦愈。（此凭症也。）
一老人脓清兼作渴。脉软而涩。予以为气血俱虚。用八珍汤加黄 、五味。彼不信。乃
火之剂。果反作呕少食。始信。服香砂六君子汤四剂。呕止食进。仍投前汤。月余而愈。（
此脉凭症也。）
一人未溃兼作渴。尺脉大而无力。以四物汤加黄柏、知母、黄 、麦门四剂而渴减。又
与加减八味丸。渴止疮溃。更用托里药兼前丸而愈。（此凭症也。）
一夫人年逾八十。脑疽已溃。发背。继生头如粟许。脉大无力。此膀胱经湿热所致。脉
。血气衰。进托里药消毒数服。稍可。更加参 。虽起而渴。此血气虚甚。以参、 各一两
。归、 各五钱。麦门、五味各一钱。数服渴止不溃。加肉桂十余剂。脓成针之。瘀肉渐腐
。徐徐取去。而脓清不敛。投十全大补汤。（十三）加白蔹、贝母、远志三十余剂。脓稠而
愈。设不峻补。不去腐肉。以渴为火。投以凉药。宁免死哉。疮疽之症。虽属心火。当分表
里虚实。果元气充实。内有实火。寒剂或可责效。若寒凉过度。使胃寒脾弱。阳症变阴。或
结而不溃。或溃而不敛。阴阳乖戾。水火交争。死无日矣。（机按此凭形凭脉凭症而治之也
一人肿痛。脉数。以荆防败毒散二剂而痛止。更以托里消毒药而消。（此凭脉也。）
一人 肿。疼痛发热。饮冷。脉洪数。与凉膈散二剂而止。以金银花四剂而溃。更以托
里药而愈。（此凭症脉也。）
一老妇禀实。溃而痛不止。脉实便秘。以清凉二剂而止。更以托里消毒药而愈。（此凭脉
一妇年逾七十。冬至后脑出疽如瓯面大。疡医诊视。候熟以针出脓。因怒笞婢。疽辄凹
韭叶许。面色青黄不泽。四肢逆冷。汗出身清。时呕吐。脉极沉细而迟。盖缘衰老之年。严
寒之时。病中苦楚。饮食淡薄。肥脓之气色涤。瘦悴之形独存。加之暴怒。精神愈损。故有
此寒变也。病与时同速。制五香汤一剂。加丁香附子各五钱。剂尽疽复大发。随症调理而愈
经曰。治病必察其下。谓察时下之宜。诸痛疮疡皆属心火。言其常也。如疮盛形羸。邪
高痛下。始热终寒。此反常也。固当察时下之宜而权治之。不可执一。
机按此条年老冬寒。理宜温补。兹用五香汤加丁附以辛散。何也。盖因其怒气郁结。阻
气。不得营运。致疽凹陷。且脉极沉细而迟。其为气郁可知矣。故用五香以开结。丁、附以
助阳。则郁散阳复。疽乃大发。此亦因其性因其脉而为治也。
一人脑疽作渴。脉虽洪。按之无力。予 咀加减八味丸与之。彼不信。自用滋阴等药。
并至而殁。精要曰。患疽虽云有热。皆因虚而得之。愈后作渴。或先渴后疽。非加减八味丸
一妇年将七十形实性急。好酒。脑疽才五日。脉紧急又涩。急用大黄酒煨细切。酒拌炒
末。又酒拌人参炒。入姜煎调一钱服。过两时再与。得卧而上半身汗。睡觉病已失。此亦内
托之意。
机按此治。因性急。因好酒。兼因其脉而制此方。脉紧急且涩。由其性急嗜酒。以伤其
血而然。故用大黄以泄酒热。人参以养气血也。
一人便血数年。舌下筋紫。午后唇下赤。胃肺脉洪。予谓大肠脉散舌下。大肠有热。故
筋紫而又便血。胃脉环承浆。唇下即承浆。午后因火旺。故承浆发赤。盖胃为本。肺为标。
乃标本有热也。用防风通圣散（六）为丸治之而愈。后每睡觉惊跳而起。不自知其故。如是者
年余。脑发一毒。 痛。左尺脉数。此膀胱经热。而然。服黄连消毒散数剂少愈。次服金银
花、栝蒌、甘草节、当归。月余而平。
机按便血之后。睡觉惊跳者。由失血阴虚。心失所养而然。阴虚阳必亢。头为诸阳之首
。故亢阳上从于阳。疽发于脑。此条治法。因经因脉而制方也。
杜清碧病脑疽。疗之不愈。丹溪往视之。曰。何不服防风通圣散。（四十）曰。已服数剂
。丹溪曰。合以酒制之。清碧乃自悟以为不及。（此因症也。）
一举人年逾四十。患脑疽肿 。其脉沉静。此阳症阴脉。断不起。果殁。
For brain carbuncle presenting with swelling and pain but without suppuration, it is appropriate to employ methods for removing dampness and detoxifying. Formulas such as Huanglian Xiaodu Yin (Coptis Decoction for Detoxification) may be used.
If the pain is severe or absent, or if there is numbness, the toxin is profound. Moxibustion with garlic partition should be applied, along with the use of detoxifying medicines.
If there is swelling, pain, and constipation, the pathogenic factor is in the interior. Purging methods should be employed.
If the pain is not severe, or if suppuration does not occur, it indicates deficiency. The treatment should focus on supporting the interior (boosting Qi to expel toxins).
If pus has formed causing distending pain, puncture should be performed, followed by medicine to support the interior.
If suppuration does not occur, or if the ulcer fails to heal, medicine to support the interior should be the primary treatment.
If the pus has drained but the wound fails to close, or if there is excessive discharge, substantial tonification of Qi and Blood is required.
If restlessness and a desire for cold drinks are present, accompanied by a full pulse and pain, clearing fire is appropriate.
A certain person who had been negligent in diet and lifestyle presented with red, swollen, and painful lesions, and a surging and rapid radial pulse at the cun position. After one dose of Huanglian Xiaodu San (Coptis Powder for Detoxification), the damp-heat was suddenly eliminated. However, the swelling remained hard and painful. Two doses of Xianfang Huoming Yin (Immortal Formula for Preserving Life) were administered, after which the swelling and pain completely subsided. Yet the head of the sore did not resolve. Shixuan San (Ten Acupoints Powder) was prescribed, with Guizhi (Cinnamon Twig) removed, and Jinyinhua (Honeysuckle Flower), Bencao (Ligusticum Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), and Chenpi (Tangerine Peel) added, to support the interior and expel pus. The patient desired complete resolution and self-administered two doses of Huanglian Jiedu San (Coptis Powder for Resolving Toxins), which resulted in the swelling becoming hard and preventing suppuration. Only then did he realize his error. Shixuan San was resumed, with Baizhu, Fuling, Chenpi, and Banxia (Pinellia Tuber) added. The swelling decreased slightly. Guizhi was again removed, and after four more doses, pus formed, and the swelling subsided. Subsequently, Bazhen Tang (Eight Treasures Decoction) was given with Huangqi (Astragalus Root), Wuweizi (Schisandra Fruit), and Maidong (Ophiopogon Tuber). Over a month later, the pus drained, and the patient recovered. (This diagnosis was based on pulse and symptoms.)
Although bitter-cold medicines treat Yang syndromes, one must carefully distinguish the layers (exterior/interior), excess/deficiency, and the sequence and timing of treatment. How can they be used indiscriminately from start to finish? However, if the lesion is red, swollen, and painful, and the radial pulse at the chi position feels soft upon pressure, this indicates abundant damp-heat in the Bladder Meridian. Therefore, Huanglian Xiaodu San was used to resolve toxicity and remove dampness. Considering the hardness and pain of the swelling, which results from stagnation of Qi and Blood, Xianfang Huoming Yin was subsequently used to dissipate nodules, detoxify, and break blood stasis. The failure of the sore head to resolve was likely due to steaming by heat-toxin causing Qi and Blood stagnation. It was appropriate to use sweet-warm agents to tonify Yang Qi and support the interior to facilitate suppuration and rupture. Moreover, this condition originally arose from the Du Meridian due to deficient fire. If the cause is not examined and only bitter-cold medicines are used, the Stomach Qi will be damaged. How can suppuration and healing occur? Would it not lead to collapse? Generally, sores that easily dissipate, suppurate, and heal do so because Qi and Blood are robust.
A certain person presented with diffuse swelling and pain behind the ear, with unchanged skin color and a slightly rapid pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Szechwan Lovage Rhizome), Danggui (Angelica Sinensis Root), and Jiegeng (Platycodon Root) was administered for four doses, resulting in slight elevation of the swelling. Several doses of Tuoli Xiaodu San (Interior-Supporting Detoxification Powder) were then given. The pulse became active and rapid, indicating that pus had formed. Puncture was indicated. The patient feared it and refused, only agreeing when the pain became extreme. Approximately one bowl of pus was drained, and the patient stabilized after two months of interior-supporting medication. (This diagnosis was based on pulse and symptoms.)
A certain person with brain carbuncle presented with swelling, pain, and a rapid pulse. Two doses of Huanglian Xiaodu San reduced symptoms slightly. Two doses of Xianfang Huoming Yin halted progression. Subsequent treatment with Danggui, Chuanxiong, Shaoyao (Peony Root), Jinyinhua, Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) led to suppuration. The patient recovered with interior-supporting medicine. (This diagnosis was based on pulse and symptoms.)
A certain person suffered from pain in both the head and neck. Although extensive ulceration had occurred, swelling and pain worsened, accompanied by diarrhea, restlessness, insomnia, and poor appetite. The condition was alarming. Examination revealed that the toxin remained. Two doses of Xianfang Huoming Yin reduced swelling and pain by half. Ershen Wan (Two Spirit Pill) and Liujunzi Tang (Six Gentlemen Decoction) plus Wuweizi, Maidong, and Suanzaoren (Ziziphus Seed) were administered for four doses, leading to slight improvement in all symptoms, better appetite, and improved sleep. Several doses of Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) further improved appetite. Subsequently, Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) plus Jinyinhua, Baizhi (Angelica Dahurica Root), and Jiegeng was given. The patient recovered after over a month.
An elderly patient presented with red, swollen, and painful lesions and a rapid, forceful pulse. Two doses of Huanglian Xiaodu San reduced symptoms slightly. Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) was then administered for four doses, resulting in resolution. (This diagnosis was based on pulse and symptoms.)
A certain person presented with hard, non-suppurating swelling, with only fluid exuding from the sore head and severe pain. Two doses of Xianfang Huoming Yin stopped the pain and promoted suppuration. After puncture, interior-supporting medicine cured the condition.
A female patient presented with swelling and pain on the left side of the brain, purulent discharge from the left nostril, lasting over a year. She occasionally experienced tremors, feeling as if rocking in a boat or carriage. Xu Shuwei stated: "This is liver deficiency with wind-pathogen invasion." The prescription contained Chuanxiong 1 liang, Danggui 3 qian, Qianghuo (Notopterygium Rhizome), Xuanfuhua (Inula Flower), Xixin (Asarum Root), Fangfeng (Saposhnikovia Root), Manjingzi (Vernonia Fruit), Shigao (Gypsum Fibrosum), Bencao, Jingjiesui (Perilla Leaf with Stem), Banqu (Medicated Leaven), Dihuang (Rehmannia Root), and Gancao (Licorice Root) each 0.5 liang. One liang was taken per dose, decocted with ginger water. One course cured the condition.
Wang Ji commented: This case was identified as liver deficiency with wind-pathogen invasion, treated with wind-dispelling, heat-clearing, blood-nourishing, and phlegm-resolving agents. Because of the tremors and pain localized to the left side. All wind-induced tremors belong to Liver Wood. Furthermore, pathology on the left side is governed by the Liver and Gallbladder. It is said that wind enters from above. It is also said that "no phlegm, no dizziness." It is said that the Liver stores Blood. It is said that wind is a Yang pathogen. Therefore, treating wind, heat, phlegm, and blood as the main targets is logical.
A certain person with brain carbuncle for over ten days presented with swollen and closed eyes and face, and a head swollen like a bucket. The pulse was surging and rapid, with restlessness and a desire for cold drinks. This was caused by damp-heat in the Bladder. Two doses of Huanglian Xiaodu Yin (see page 121) were given, followed by drinking two bowls of Huaihua Jiu (Sophora Flower Wine), resulting in sudden relief. Pressing with a finger caused the swelling to rebound immediately, indicating pus formation. Holes were punctured in the neck, forehead, shoulder, and cheeks, allowing pus to gush out, opening the mouth and eyes. Interior-supporting medicine plus Jinyinhua and Lianqiao (Forsythia Fruit) for over thirty doses cured the condition. (This diagnosis was based on pulse and symptoms.)
An infant presented with a white sore on the head, with smooth and tight skin, unresponsive to various medicines. This is called Brain Gan Sore, caused by fetal toxin combined with wind-heat. Longdan Wan (Gentian Pill) (see page 115) was administered, and Luben powder (Aloe) was blown into the nose, combined with external application of Jiedu San (Detoxification Powder), resulting in recovery. For severe cases, where hair mats into tufts, the head feels hot like fire, the whole body sweats, the cheeks swell, and the chest protrudes, these medicines are especially suitable.
Wang Ji commented: Longdan Wan and Luben powder are cooling agents for the Liver and Gallbladder that kill parasites. Since the Liver and Gallbladder govern wind, and excessive wind generates parasites, such medicines are often used to treat Gan conditions.
A person who frequently drank alcohol developed a small sore below the back of the head and above the neck in September. Days later, the head and neck became numb, and the swelling spread outward. The surgeon prescribed Wuxiang Lianqiao Tang (Five Fragrant Forsythia Decoction), stating that rapid cure was impossible; one must wait for pus to form before medicating, or use cupping/lancing, expecting resolution in three months and normalization in four. I said: Once pus appears in a sore, nine out of ten die. If we follow the doctor's advice, we would simply wait to die. Moreover, changes due to rich food and drink should not be treated with Five Fragrants. Fire therapy should be applied first, followed by medicine. Large moxa cones, sized like walnut kernels, were moxa-burned until the patient felt pain, totaling one hundred burns. Then a prescription was formulated. The disease of the Foot-Taiyang Bladder Meridian is rebellious and requires contrary treatment. The pulse was wiry and tight, surging and rapid upon pressure, forceful. One must subdue the dominant pathogen and address the root cause. Initially similar, finally different. In terms of season, consolidation is preferred over sweating. Classics and disease contraindications mention purging; the method should be to disperse congealed pathogens and soften hardness with salty flavors. However, since cold pathogen is involved, salty flavors are contraindicated. Thus, various bitter-cold herbs were used as Sovereign, sweet-cold herbs as Ministers, and wine-heat as the etiology. Great acrid herbs were used as Deputy to resolve congealment. Three acrid and three sweet herbs tonify Yuan Qi and harmonize blood vessels. Bland-draining herbs guide wine-dampness. Supporting the Autumn season, tonifying Qi and draining fire, with meridian-guiding herbs as Guides. Therefore, Qianghuo, Duhuo (Angelica Pubescens Root), Fangfeng, Bencao, and Lianqiao were used to resolve congealment. Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Huangbai, and Zhimu, prepared with wine, drain fire. Shenggancao (Raw Licorice Root) drains Kidney fire and tonifies Lower Jiao Yuan Qi. Renshen (Ginseng Root), Huangqi, and Jupi (Tangerine Peel) tonify the Stomach. However, Renshen, Huangqi, and Gancao are combined with bitter-cold herbs in a ratio of one-third; too much would cloy Ying Qi and generate Earth-dampness. Sumu (Sappan Wood) and Guiwei (Angelica Sinensis Root Tail) remove bad blood. Shengdihuang (Rehmannia Root) nourishes blood. Jiu Fangji (Stephania Tetrandra prepared with wine) removes residual heat in the Bladder. Zexie (Alisma Rhizome) assists in removing wine-damp-heat in Autumn. All these herbs require Jiegeng as a boat and oar to prevent sinking. After administration, the patient fell into bed snoring loudly, waking at sunrise. Palpation of the sore showed 70-80% reduction in swelling. By the time the scab healed, fourteen days had passed.
Wang Ji commented: A wiry-tight pulse indicates sore pain; surging-rapid upon pressure indicates internal heat. The Taiyang Cold Water Meridian receives Yang Heat, hence its rebellion. Using cold-cooling medicines on the Cold Water Meridian constitutes contrary treatment. This formula was created based on the pulse, meridian, and patient's habits.
A person with brain carbuncle presented with severe condition and full pulse. Huanglian Xiaodu San was ineffective. Jin Yin Teng (Honeysuckle Stem) 2 liang was decocted in 2 zhong of water to yield 1 zhong, mixed with half a zhong of wine, and taken in divided doses. The condition improved by 30-40%. Continued dosing led to gradual resolution. Huangbai, Zhimu, Gualou (Trichosanthes Fruit), Danggui, and Gancaojie (Licorice Joint) were added. After several doses, suppuration stopped. Huangqi, Chuanxiong, Baizhi, and Jiegeng were added for several doses, resulting in recovery. (Wang Ji commented: This case was treated based on pulse.)
A person with brain carbuncle presented with multiple sore heads and unbearable pain. Detoxifying medicines were ineffective. Jin Yinhua (Honeysuckle Flower) was administered, leading to deep sleep. Upon waking, the condition had receded. Four more doses led to resolution. Another patient with a more severe condition also took it, resulting in immediate reduction of swelling and pain, though unable to lie flat. Huangqi, Danggui, Gualouren (Trichosanthes Seed), Baizhi, Jiegeng, and Gancaojie were added for several doses, resulting in recovery.
The previous case changed methods due to treatment failure; this case treated based on symptoms.
A person near suppuration presented with slight pain and thirst, and a large, empty chi pulse. This is a Yin deficiency with fire hyperactivity syndrome. The patient believed it was Heart channel heat-toxin and self-medicated with cooling and descending agents, worsening the fire. Seeking treatment again, Siwu Tang (Four Substances Decoction) plus Huangbai, Zhimu, Wuweizi, Maidong, and Huangqi, along with Jiajian Bawei Wan (Modified Eight-Ingredient Pill), was prescribed. Thirst stopped, and the sore suppurated. Interior-supporting medicine combined with the pill cured the condition. (Diagnosed based on pulse.)
A woman with formed but unruptured pus presented with distending pain, nausea, and poor appetite. Emergency puncture was performed, and interior-supporting medicine cured her. (Diagnosed based on symptoms.)
A woman with mild pain in brain carbuncle during suppuration was treated with interior-supporting detoxification. After puncture upon pus formation, interior-supporting tonification cured her. (Diagnosed based on symptoms.)
An elderly man with clear pus and thirst presented with a soft and choppy pulse. I diagnosed dual Qi and Blood deficiency and prescribed Bazhen Tang plus Huangqi and Wuweizi. He did not believe it and used heating/drying agents, resulting in vomiting and poor intake, which convinced him. Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction) for four doses stopped vomiting and improved appetite. Returning to the previous decoction, he recovered after a month. (Diagnosed based on pulse and symptoms.)
A person with unruptured sore and thirst presented with a large, empty chi pulse. Siwu Tang plus Huangbai, Zhimu, Huangqi, and Maidong for four doses reduced thirst. Jiajian Bawei Wan was then given, stopping thirst and promoting suppuration. Interior-supporting medicine combined with the pill cured the condition. (Diagnosed based on symptoms.)
A woman over eighty years old presented with an ulcerated brain carbuncle and subsequent back carbuncle, with millet-sized pustules on the head. The pulse was large and empty. This was caused by damp-heat in the Bladder Meridian, with declining Qi and Blood. Several doses of interior-supporting detoxification provided slight relief. Ren Shen and Huangqi were added. Although improving, thirst persisted, indicating severe Qi and Blood deficiency. Ren Shen and Huangqi 1 liang each, Danggui and Baishao (White Peony Root) 5 qian each, Maidong and Wuweizi 1 qian each were administered for several doses, stopping thirst but failing to suppurate. Rougui (Cinnamon Bark) was added for over ten doses. Upon pus formation, puncture was performed. Necrotic tissue gradually sloughed off. Clear pus failed to heal. Shiquan Dabu Tang (see page 13) plus Bailian (Tiger Lily Bulb), Beimu (Fritillaria Bulb), and Yuanzhi (Polygala Root) for over thirty doses thickened the pus and cured the condition. Without vigorous tonification and debridement, mistaking thirst for fire and using cooling medicines would surely lead to death. Carbuncles, though related to Heart Fire, must be distinguished by exterior/interior and excess/deficiency. If Yuan Qi is solid and internal fire is excess, cold medicines may work. However, excessive cold-cooling damages Stomach and Spleen, transforming Yang syndromes into Yin. If nodules fail to suppurate or ulcers fail to heal, Yin-Yang disharmony and Water-Fire conflict ensue, leading to imminent death. (Wang Ji commented: This case was treated based on morphology, pulse, and symptoms.)
A person with swelling and pain presented with a rapid pulse. Jingfang Baidu San (Ephedra, Saposhnikovia, and Imperata Decoction) for two doses stopped pain. Interior-supporting detoxification resolved the swelling. (Diagnosed based on pulse.)
A person with localized swelling, pain, fever, desire for cold drinks, and surging-rapid pulse was given Liangge San (Cooling Chest Powder) for two doses, stopping symptoms. Jinyinhua for four doses promoted suppuration. Interior-supporting medicine cured the condition. (Diagnosed based on symptoms and pulse.)
An elderly woman with excess constitution presented with persistent pain after ulceration, full pulse, and constipation. Cooling medicines for two doses stopped pain. Interior-supporting detoxification cured her. (Diagnosed based on pulse.)
A woman over seventy developed a bowl-sized carbuncle on the back of the head after Winter Solstice. The surgeon waited for maturation to lance it. Angered by whipping a maid, the carbuncle suddenly depressed like a leek leaf. Her complexion was sallow and lusterless, limbs cold, sweating with cool body, occasional vomiting. The pulse was extremely deep, fine, and slow. Due to old age, severe cold, illness suffering, bland diet, loss of robust qi, emaciation, and sudden anger damaging spirit, this cold transformation occurred. Disease progresses rapidly with the season. Wuxiang Tang (Five Fragrant Decoction) one dose plus Dingxiang (Clove) and Fuzi (Prepared Aconite Root) 5 qian each was prepared. After finishing the dose, the carbuncle flared up significantly. Symptomatic regulation led to recovery.
The Classic says: Treat diseases by observing the lower [signs], meaning observing the appropriateness of the time. All pains and sores belong to Heart Fire, describing the norm. Cases of full sores with emaciated bodies, high pathogen with low pain, starting hot ending cold are abnormalities. One must observe seasonal appropriateness and adapt treatment, not adhere rigidly.
Wang Ji commented: In old age and winter cold, warming tonification is appropriate. Here, Wuxiang Tang plus Dingxiang and Fuzi uses acrid dispersal. Why? Because anger caused Qi stagnation, blocking circulation, leading to depression. The extremely deep, fine, slow pulse confirms Qi stagnation. Thus, Wuxiang opens congealment, Ding and Fu assist Yang. Stagnation disperses, Yang returns, and the carbuncle flares. This treatment adapts to temperament and pulse.
A person with brain carbuncle and thirst presented with a surging pulse, empty upon pressure. I prescribed Jiajian Bawei Wan. He did not believe it, used self-prescribed Yin-nourishing medicines, and died as symptoms converged. *Jingyao* states: Carbuncles虽有热 (though having heat) are caused by deficiency. Thirst after recovery or preceding carbuncle requires Jiajian Bawei Wan.
A woman nearly seventy, robust in body but impatient, fond of wine, developed brain carbuncle after five days. Pulse was urgent and choppy. Da Huang (Rhubarb Root) was quickly wine-steamed, finely cut, wine-fried to powder. Renshen was wine-fried. Ginger decoction was mixed with one qian of powder and administered. Repeated after two hours. The patient slept, sweating on the upper half. Upon waking, the disease had vanished. This embodies the principle of interior support.
Wang Ji commented: This treatment adapted to impatience, wine habit, and pulse. Urgent and choppy pulse results from impatience and wine damaging blood. Da Huang drains wine-heat; Renshen nourishes Qi and Blood.
A person with hematochezia for years presented with purple veins under the tongue and redness below the lips in the afternoon. Stomach and Lung pulses were surging. I explained: Large Intestine pulses scatter under the tongue; Large Intestine heat causes purple veins and hematochezia. Stomach pulse circles Chengjiang; below the lips is Chengjiang. Afternoon fire prosperity causes Chengjiang redness. Stomach is Root, Lung is Branch; thus Root and Branch have heat. Fangfeng Tongsheng San (Wind-Barrier Unblocking Supreme Defense Powder) (see page 6) pills cured him. Later, he woke with startles for over a year, unaware why. A toxic sore developed in the brain, painful. Left chi pulse was rapid, indicating Bladder Meridian heat. Huanglian Xiaodu San for several doses improved it slightly. Subsequently, Jinyinhua, Gualou, Gancaojie, and Danggui were taken, resolving after a month.
Wang Ji commented: Startles after hematochezia result from blood loss, Yin deficiency, and Heart malnourishment. Yin deficiency leads to Yang hyperactivity. The head is the summit of all Yang; thus hyperactive Yang ascends, causing brain carbuncle. This treatment was formulated based on meridian and pulse.
Du Qingbi suffered from brain carbuncle, unresponsive to treatment. Danxi visited and asked: Why not take Fangfeng Tongsheng San? (See page 40) He replied: I have taken several doses. Danxi said: Prepare it with wine. Qingbi realized his inadequacy. (Diagnosed based on symptoms.)
A scholar over forty developed brain carbuncle swelling. His pulse was calm and still. This is a Yang syndrome with Yin pulse, predicted fatal. He indeed died.