Library

Discourse states: After the ulceration of carbuncles and sores, the physical manifestations can be either favorable (Shun) or unfavorable (Ni). White sclera turning black with a constricted pupil is the first unfavorable sign; inability to eat, vomiting after taking medicine, and loss of taste are the second unfavorable sign; severe pain and extreme thirst is the third unfavorable sign; stiffness in the body and neck, heaviness in the four limbs is the fourth unfavorable sign; hoarseness, sallow complexion, cyanosis and blackness of the lips and nose, and edema of the face and eyes is the fifth unfavorable sign; irritability, frequent coughing, abdominal pain with extreme thirst, uncontrolled diarrhea and dysentery, and painful urination resembling strangury is the sixth unfavorable sign; massive discharge of pus and blood, worsening swelling and pain, foul-smelling and discolored pus is the seventh unfavorable sign; rapid breathing, shortness of breath, mental confusion, and somnolence is the eighth unfavorable sign; before ulceration, black sinking of the sore, cyanotic face, black lips, and fecal incontinence is the ninth unfavorable sign; choking sensation and chest stuffiness, coughing, cold body, spontaneous sweating at any time, staring eyes, deafness, mental confusion, palpitations, and incoherent speech is the tenth unfavorable sign. Furthermore, the head is the convergence point of all Yang meridians, and the neck is near the throat and Shenshu (BL23), which are all fatal areas; moxibustion should not be applied here.

My commentary: Regarding the aforementioned symptoms where the sore has not yet ulcerated but presents with black sinking, cyanotic face, and dark lips with fecal incontinence, these are unfavorable signs of internal organ collapse. Belching, chest stuffiness, coughing, cold body, and spontaneous sweating are unfavorable signs of Spleen and Lung deficiency and decline. Inability to eat, diarrhea, borborygmus, deafness, and staring eyes are unfavorable signs of Spleen and Kidney deficiency and decline, indicating disease progression. Treatment methods are detailed in the appendix.

Appendix on Assessing Internal Symptoms for Medication
Spontaneous diarrhea and vomiting, inability to take food, with the most deficient Ren Mai (Kidney Pulse): Such diseases were considered incurable by ancient physicians, yet there are principles for rescue and treatment.

My commentary: The previous discourse elucidates the subtle purport of the Huangdi Neijing (Yellow Emperor's Inner Canon), awakening people for ten thousand generations, bringing immense benefit. This condition is actually due to the decline of Mingmen Fire (Gate of Vitality Fire), failing to warm Pi Tu (Spleen Earth), resulting in deficiency-cold, leading to spontaneous diarrhea and vomiting, or discomfort in the chest and diaphragm, or undigested food, or loose stools. It is appropriate to use Bawei Wan (Eight-Ingredient Pill) and Liujunzi Tang (Six-Gentlemen Decoction), added with Shengjiang (Fresh Ginger) and Fuzi (Prepared Aconite Root). If it is caused by excessive sexual activity leading to the failure of True Yang, or innate insufficiency failing to warm Spleen Earth, resulting in anorexia, Buyi Yiqi Tang (Tonify Middle and Augment Qi Decoction) added with Fuzi, Shengjiang, and Rougui (Cinnamon Bark), along with Dongyuan's Buzhen Wan (Tonify True Pill), often results in survival. Using herbs like Renshen (Ginseng Root) and Fuling (Poria) to directly tonify the Spleen and Stomach rarely avoids error. If treated as internal attack by toxic factors, death will inevitably ensue.

Attached Case Records
Li Tingyi, Secretary of the Ministry of Justice, suffered from Liuzhu (flowing abscesses), expectorating phlegm and experiencing shortness of breath. Relying on his medical knowledge, he used formulas for resolving phlegm and regulating Qi, leading to continuous discharge of pus and water, persistent hard swelling, alternating chills and fever, reduced appetite, emaciation, loose stools, cold extremities, and floating-large Chi pulse (Kidney pulse) that becomes fine upon deep pressure. I said: This belongs to the decline of Mingmen Fire, and Bawei Wan should be used. He did not believe this, instead taking Renshen, [missing character], Danggui (Angelica Sinensis), and Baizhu (Atractylodes Macrocephala Rhizome), which worsened his phlegm-wheezing and diarrhea. Later, taking Bawei Wan and Yiqi Tang, he recovered after more than a year.

The wife of Imperial Physician Wang Jiezhi had a back carbuncle that failed to rise and suppurate, was not red, accompanied by diarrhea and nausea, reduced appetite, cold extremities, and a pulse barely perceptible, indicating Yang deficiency and cold. Large-tonifying formulas were used with 2 qian of Fuzi, 1 qian each of Shengjiang and Rougui, without effect. Increasing Fuzi to 3 qian, after two doses, diarrhea worsened. Then, one piece of Fuzi, 3 qian each of Shengjiang and Rougui, and 5 qian each of Renshen, [missing character], Danggui, and Baizhu were made into one dose. Only then did warmth begin in the abdomen, vomiting stop, extremities become warm, and the pulse return. Still using large-tonifying formulas with Shengjiang and Fuzi, after four doses the sore ulcerated, and after thirty doses, it healed. Six years later, she died of deficiency-cold syndrome.

Chen Guoxin, Magistrate, had a constitution of Yin deficiency and developed a back carbuncle. Using large-tonifying herbs like Renshen failed to close the wound, leading to internal heat and fever, dry tongue and cracked lips, frequent urination, dry mouth desiring hot drinks, vomiting and diarrhea, ear blockage and blindness, dizziness when looking up, and a floating-large-rapid pulse. I said: The non-healing wound indicates Spleen Earth failure. Dry tongue and cracked lips indicate Kidney Water exhaustion. Frequent urination indicates Lung Qi decline. Internal heat and fever indicate defluxion of deficient fire. Dry mouth desiring hot drinks indicates true cold appearance. Vomiting and diarrhea indicate true fire failure. Ear blockage and blindness indicate Liver Wood withering. Dizziness when looking up indicates Kidney Qi exhaustion. I declined to treat him, and he subsequently died.

A man suffered from a boil, with hard swelling that did not ulcerate and a weak pulse with occasional vomiting. He wished to use detoxifying and attacking medicines. I said: Hard swelling without ulceration indicates Yang Qi deficiency; vomiting and poor intake indicate Stomach Qi deficiency and cold. The method should be to warm and tonify the Spleen and Stomach. Generally, if there is redness, swelling, severe pain, irritability, solid pulse, and vomiting, it is excess, and purgation should be used. If there is hard swelling without ulceration, weak pulse, and vomiting, it is deficiency, and tonification should be used. If vomiting is caused by pain damaging Stomach Qi or contracting cold pathogenic factors, even in the stage of swelling, assisting Stomach Qi and strengthening Qi is necessary. He did not believe this, continued to take attacking medicines, and indeed died.