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Li stated: When a ju (deep-seated abscess) first appears, if it presents as a single grain the size of a hemp seed or bean, accompanied by fever, swelling, elevation, burning pain, and redness, this is an external manifestation. Although the condition may appear vigorous, if treated with appropriate methods, life can be preserved. However, if there is no fever at the onset, the body feels fatigued and weak, the affected area remains unchanged, and after several days there is neither swelling nor pain, this indicates that the internal organs have already deteriorated. Even with the medicines of Lu [Yi] and Bian [Que], nothing can be done.

My commentary: Regarding the aforementioned conditions where the disease fails to manifest externally, some cases are due to deficiency of Yuan Qi (Original Qi) preventing eruption; some are due to the application of cold-natured topical medications inhibiting eruption; some are due to excessive purgation damaging Qi and Blood, preventing eruption; and some are due to internal accumulation of heat-toxin without timely venting and pushing out. Upon careful differentiation and treatment, many patients survive.

Attached Treatment Cases

Shen Tianyi, a Jinshi degree holder, suffered from a carbuncle on his arm, presenting with aversion to cold, fever, headache, and weakness in form and Qi. This was a syndrome of Wind pathogen affecting the Hand and Foot Yangming meridians. After two doses of Jiegeng Shengma Tang (Platycodon and Cimicifuga Decoction), the exterior pathogens dispersed instantly. Two doses of Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder) caused the swelling and pain to subside immediately. Subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used for regulation, leading to gradual recovery of form and Qi until cure.

Qian Kerong, a magistrate of the Ministry of Justice, suffered from a carbuncle on his abdomen, presenting with local swelling and pain, irritability, thirst with a desire for cold drinks, and constipation. His pulse was deep, rapid, and full. This indicated heat-toxin accumulating internally. Qingre Xiaodu San (Clear Heat and Eliminate Toxin Powder) with added 2 qian of Dahuang (Rhubarb Rhizome) was administered for one dose, causing all symptoms to retreat. However, his form and Qi suddenly became deficient. Therefore, Tuoli Xiaodu San was modified by removing Jinyinhua (Lonicerae Flos) and Baizhi (Angelicae Dahuricae Radix), and doubling the dosage of Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), which stabilized the condition.

A man suffered from a toxic sore on the inner thigh, seeking internal resolution. His pulse was slippery and rapid, indicating that pus had already formed. Due to deficiency of Qi and Blood, it failed to ulcerate spontaneously. It was then punctured, releasing pus and causing pain. Bazhen Tang (Eight Treasures Decoction) was used for treatment, leading to gradual improvement. However, the discharge was clear and thin. Shiquan Dabu Tang (Ten Significant Tonifying Decoction) with 5 fen of Paofuzi (Prepared Aconiti Lateralis Radix) was added. After several doses, he gradually improved. The Fuzi was then removed, and after more than thirty additional doses, he fully recovered.

A young boy suffered from a carbuncle in the axilla that failed to heal for a long time. The pus was clear, the pulse was large and empty, he felt lethargic and lazy to eat, sweated spontaneously, and had a dry mouth. Neibu Huangqi Tang (Internal Supplement Huangqi Decoction) and fermented soybean cakes were applied. He healed after two months. Generally, when sores ulcerate with clear pus, or the wound does not close, or swelling aggregates without ulcerating, accompanied by cold muscles and flesh, spontaneous sweating, and pallor, these are signs of extreme deficiency of Qi and Blood. Only strong warming and tonification will suffice.

A man suffered from a toxic sore on his shoulder, presenting with aversion to cold, desire for cold drinks, irritability, constipation, and a rapid, full pulse. These symptoms and pulse belong to excess patterns. Qingliang Yin (Cooling Drink) was given for two doses, resulting in slight improvement. Jinyinhua San (Honeysuckle Powder) was given for four doses, causing all symptoms to retreat. Then, Shixuan San (Ten Acupoints Powder) was modified by removing Guizhi (Cinnamon Twig) and adding Tianguafen (Trichosanthis Radix) and Jinyinhua (Lonicerae Flos). After several doses, the sore ulcerated and healed.

A man’s back sore ulcerated, but blood stasis did not dissipate. This was due to deficiency of Yang Qi. Strong tonification with Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) was used, along with moxibustion using mulberry branches. Tuoli San (Support Interior Powder) with Rougui (Cinnamomi Cortex) was also applied, leading to natural contraction of the wound. This is the method of supplementing and connecting Yang Qi.

Mao Tiren, a student of the Imperial Academy, had chronic Yin deficiency. In early spring, he suffered from cough and dull pain in the chest. His Kidney pulse was surging and rapid, while his Lung pulse was rapid and occasionally imperceptible. I said: There should be an internal abscess forming. First, administer one dose of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) material. The next morning, he reported: "Yesterday I took the effective prescription; my cough improved by six or seven tenths. I earnestly request a formula to take to the prison for regulation." I replied: "This is Flaming Fire rising due to Yin deficiency, a symptom of impending abscess. It is merely because Yuan Qi is weak and unable to erupt. Because it is easily overlooked, I decline to treat." Consequently, other physicians used prescriptions for descending fire and resolving phlegm, which worsened the condition. Over a month later, upon re-examination, the pulse was surging, slippery, and rapid. I said: "The pus has formed. You should consult regular practitioners to discuss needle drainage to avoid internal rupture." He still hesitated. Another month passed. Other physicians had already opened a hole slightly above the center, trapping the pus, which failed to drain, leading to internal rupture. The pulse became even more surging and large. I said: "With a surging, slippery, and rapid pulse, and observing his dark blue tongue, the internal organs have already deteriorated. Nothing can be done." This proved true eventually.