Library

[Background Information]
Book: *Waike Jingyao* (Essentials of Surgery)
Author: Chen Ziming
Dynasty: Song
Chapter: Chapter 55, Hong Chengxiang's Method Using Leeches / Empirical Miscellaneous Formulas for Carbuncles and Ulcers
Category: Surgery

**Treatment for Early-Stage Carbuncles and Ulcers (Skin and subcutaneous purulent infections)**
When treating early-stage carbuncles and ulcers, first take a pen tube, insert one leech (a type of aquatic worm), align the tube opening with the head of the sore, and allow the leech to suck the pus and blood from the wound. The toxicity will then dissipate. If the sore enlarges, replace three or four leeches. If a leech sucks at an acupoint, it will inevitably die. This method has been tested repeatedly with consistent efficacy. If bleeding does not stop, apply mud from lotus rhizomes to the affected area. If the head of the sore is indistinct, apply mud from beside a well; the area that dries first indicates the location of the sore head.

**My Commentary:** Once a carbuncle or ulcer has formed, toxic blood accumulates on the exterior. Using this method to suction it out is indeed beneficial, but it only treats the branch (symptoms). One must also examine whether the pathogenic factor is in the exterior or interior, and assess the deficiency or excess of Yuan Qi (Original Qi), then administer medication accordingly. Integrating internal and external treatments ensures complete safety.

**Empirical Formula for Treating Carbuncles Caused by Mineral Drugs**
Black Lead (1 jin / approx. 600g)
Licorice Root (3 liang / approx. 90g)
Place one dou (approx. 10 liters) of wine in a porcelain vessel. Place the Licorice Root on one side. Separately, melt the lead and pour it into the wine on the other side. Retrieve the lead, remelt it, and pour it back in again. Repeat this process nine times. Drink the medicinal wine until intoxicated and sleep; the condition will be cured.

**My Commentary:** The above formula is an excellent method for treating ulcers caused by mineral drugs. For patients with Qi and Blood deficiency, supplementation and support methods should still be employed.

**From *Zhouhou Fang* (Handbook of Prescriptions for Emergencies): Treatment for Severe Back Carbuncles (Life-Threatening Back Abscess)**
Take a winter melon, cut off one end, and place it over the sore. When the melon rots, cut a new piece and place it again. Continue until the melon is exhausted but the sore has stabilized, then apply a plaster.

**My Commentary:** If swelling and pain are severe and the pathogen is in the exterior, this method is most suitable for dispersing heat and extracting toxicity to unblock stagnation. If there is swelling, pain, thirst, and constipation, the pathogen is in the interior; one must assist with Huanglian Tang (Coptis Decoction) to unblock the fu organs and drain toxicity. If the pathogen is in the meridians, assist with Tuoli Rongwei Tang (Support Interior and Nourish Wei Decoction) to regulate Qi and Blood. This is optimal.

**Zhang Wenzhong’s Treatment for Stone Carbuncles Below the Ear (Hard Abscess) Not Suppurating**
Use Phytolacca radix (Shanglu Gen), pound it until soft, and apply frequently.

**My Commentary:** Phytolacca breaks Qi stagnation and softens hardness. If it is indeed a stone carbuncle, this formula is appropriate. If swelling and hardness are caused by anger stirring Liver Fire, accompanied by chills and fever, use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) plus Gouteng (Uncaria) and Zhizi (Gardenia Fruit) to nourish Qi and Blood and clear Liver Fire. If skin color remains unchanged with afternoon tidal fever and internal heat, use Xiaoyao San (Free and Easy Wanderer Powder) plus Longdancao (Gentian Root) to nourish Liver Blood and clear Liver Fire. If Liver Fire and Blood dryness cause tendon spasms or nodules like beads, use Chaishao Shenling San (Bupleurum and Peony with Ginseng and Poria Powder) plus Gouteng to nourish Qi and Blood, assisted by Liuwei Wan (Six-Ingredient Pill with Rehmannia) to generate Kidney Water. If symptoms fluctuate, this is due to Qi stagnation in Spleen and Lung with phlegm knotting; use Guipi Tang (Restore the Spleen Decoction) and Liujun Zi Tang (Six-Gentlemen Decoction) harmoniously. If previous medicines fail, assist with Haizao Wan (Seaweed Pill) to dissipate hardness. The Classics state: "Injury to form causes pain; injury to Qi causes swelling." Do not lightly use formulas that move Qi and break Blood (Symptom management seen in *Waike Shuyao*).

**Treatment for Carbuncles, Ulcers, and Furuncles**
Use raw Deer Antler Tip. Grind it with rice vinegar in a stone mortar until it forms a paste. Apply around the periphery of the affected area. After one or two days, the lesion may resolve internally.

**My Commentary:** The above method promotes internal resolution. If ineffective, one must examine whether the pathogen is in the exterior or interior and assess the patient's deficiency or excess before treating. Do not treat the exterior while neglecting the interior.

**Treatment for Carbuncles and Ulcers**
Use raw Licorice Root ground into powder. Mix with wine and take 2 qian (approx. 6g). Take several doses consecutively; the lesion will spontaneously resolve.

**My Commentary:** The above formula is a heat-clearing and detoxifying agent. It is most suitable for cases caused by accumulation of heat from rich foods or toxicity from minerals, leading to Qi and Blood stagnation. However, for those with weak Spleen and Stomach and stagnant Qi and Blood, it should not be used indiscriminately, as it may cold-injure the Stomach Qi.

**Shengma Tang (Cimicifuga Decoction): Treatment for Lung Carbuncle**
Symptoms: Pain between chest and breast, vomiting of foul-smelling purulent blood.
Ingredients:
Chuan Shengma (Rhizoma Cimicifugae)
Kugen (Radix Platycodi)
Yiyiren (Semen Coicis)
Diyu (Radix Sanguisorbae)
Huangqin (Radix Scutellariae)
Chi Shaoyao (Radix Paeoniae Rubra)
Mudanpi (Cortex Moutan)
Gancao (Radix Glycyrrhizae)
(All in equal parts)
Grind into powder. Take 1 liang (approx. 30g) per dose, decoct in water, and drink.

**My Commentary:** The above formula is an excellent agent for detoxification, heat-clearing, and pus-draining. If ineffective, use Jiegeng Tang (Platycodon Decoction). For cough, shortness of breath, and scanty urination, assist with Renshen Bufeitang (Ginseng Lung-Supporting Decoction). For fatigue, poor appetite, cough, or shortness of breath, assist with Shen Zhu Buweitang (Ginseng and Atractylodes Stomach-Supporting Decoction). For profuse coughing with phlegm, this indicates Kidney deficiency with overflowing water; assist with Liuwei Wan (Six-Ingredient Pill with Rehmannia). For dry mouth and throat with defying deficient fire, assist with Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If fever, wheezing, expectoration of pus and blood occur, and food intake is impossible, it is a critical failure syndrome. This results from Spleen Earth deficiency failing to generate Lung Metal, and Lung Metal failing to generate Kidney Water. By tonifying Spleen and Lung and nourishing Kidney Water, many can survive. If the face is red and pulse large, it is difficult to treat; if the face is yellow-white and pulse floating and choppy, it is easy to treat. If vomiting of pus does not cease, it is untreatable. If vomiting of pus stops spontaneously, recovery occurs (Clinical cases seen in *Furen Liangfang* and *Waike Shuyao*).

**Treatment for Carbuncles Before and After the Anus, Known as Xuan Yong (Hanging Carbuncle)**
Use 1 liang (approx. 30g) of Fencacao (Licorice Root). Cut it, soak in spring water, roast thoroughly until permeated, finely chop, decoct in pure wine (without ash), and drink. Someone suffering from this who had already ruptured healed after taking two doses.

**My Commentary:** The aforementioned condition occurs behind the penis and in front of the anus, belonging to deficiency syndromes of the Three Yin Meridians of Foot. Mild cases become fistulas, draining all Qi and Blood leading to death; severe cases involve internal rupture and immediate demise. Typically, for early stages with damp-heat stagnation, pain without suppuration, or dysuria, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). For severe swelling and pain, use Xianfang Huoming Yin (Immortal Life Saving Decoction), assisted by processed Licorice. If suppuration cannot form or does not rupture, use Bazhen San (Eight-Treasure Powder) as the main treatment. If pus has formed, urgently puncture to drain, aiming for tissue regeneration and contraction. For Kidney deficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For Blood deficiency, use Siwu Tang (Four-Substance Decoction) plus Ren Shen and Bai Zhu. For Qi deficiency, use Sijun Zi Tang (Four-Gentlemen Decoction) plus Chuan Xiong and Dang Gui. For Spleen deficiency, use Buzhong Yiqi Tang (Center-Supplementing Qi-Augmenting Decoction). For combined Qi and Blood deficiency, use Bazhen Tang (Eight-Treasures Decoction) or Dabu Tang (Great Tonifying Decoction). Using cold-cooling detoxifying agents would be a mistake (Clinical cases seen in *Waike Shuyao*).