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Li stated: If patients with carbuncles and sores (Yong Ju, 痈疽) do not take Neituo San (Internal Support Powder), or fail to properly disperse internal toxins, it may lead to sores in the throat and tongue. In severe cases, red and black fungal-like growths may appear, causing rapid death. One should use Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment) for treatment. Previously, there was a patient with this condition who did not respond to various methods. I used this medicine, and he recovered within one day.

I observe: The aforementioned conditions are mostly caused by excessive indulgence in alcohol and sex, leading to depletion of Kidney Water (Kidney Yin). This results in Deficient Fire flaming upward, or it may be due to Wugan (Five types of childhood malnutrition syndromes), where Yuan Qi (Original Qi) is consumed and depleted, causing Deficient Fire to attack upwards. Treatment should focus on nourishing the source of transformation (Spleen and Stomach). It is most taboo to use herbs like Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), as they may further damage Stomach Qi.

Attached Clinical Cases

Wang Rulin, Grand Secretary, experienced heat in both feet and profuse expectoration of phlegm. His left Chi (Cun-Guan-Chi pulse position at the wrist) pulse was rapid but forceless. I diagnosed this as deficiency of the three Yin meridians of the foot. However, he took medicines such as Siwu Tang (Four Substance Decoction), Erchen Tang (Two Aged Things Decoction), Huangbai, and Zhimu. Consequently, his throat and tongue became painful. He then took heat-clearing and detoxifying agents. His tongue turned red like a peach, and his pulse became surging, rapid, yet forceless. This indicated that the Spleen and Lung were injured again, and the Kidney meridian was severely deficient. Deficient fire flared upward, and water overflowed to form phlegm. I treated him by nourishing the source of transformation to generate Kidney Water, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). He recovered.

Han Zongqi, Prefectural Governor, neglected his daily routine. His tongue swelled like a fungus, accompanied by profuse phlegm and constipation. He had taken Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Erchen Tang. His pulse was floating and rapid. He desired acupuncture bloodletting. I said this is a syndrome of deficiency in the three Yin meridians of the foot. Moreover, what is有形 (having form) but painless belongs to the Yin category. The method should be to vigorously tonify Yin without damaging Blood, especially given the floating and deficient pulse. Thus, I tonified the Spleen and Lung in the morning and nourished the Kidney and Liver in the evening. He recovered. Later, due to overexertion, his face and eyes turned red, and his whole body itched. It was already mid-winter. I said: "The heat is extreme, and cold treatments cannot cool it; this indicates a lack of Water (Kidney Yin)." I used formulas to control fire and strengthen water, and he recovered.

Jin Yunwen from Yaocheng had a swollen tongue and expectorated phlegm. He mistakenly took fire-descending and phlegm-resolving medicines and underwent acupuncture bloodletting. He suffered from constipation and severe phlegm. Upon diagnosis, his left Chi and Guan positions were surging and rapid, while the right Cun and Guan positions were wiry and rapid. I used agents to nourish Kidney Water, generate Liver Blood, and benefit the Spleen and Stomach. His symptoms improved slightly. Due to proximity to fire, his face suddenly turned red and his body itched; all six pulses became wiry and rapid. I said this is a sign of exhaustion of Water and rising Fire. He would likely not survive until the second month of spring. Indeed, he died on Qingming Festival the following year.

Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment)
Zhen Hupo (True Amber, ground) - 1 qian
Xijiao (Rhinoceros Horn, shaved) - 1 qian
Chensha (Cinnabar, ground extremely fine) - quantity not specified in text snippet, implied part of formula
Fushen (Poria with Hostwood, peeled and cored) - 2 qian
Pian Nao (Borneol, ground, amount equivalent to 'yi zi') - quantity not specified
Renshen (Ginseng Radix et Rhizoma) - 3 qian
Suanzaoren (Ziziphi Spinosae Semen, peeled and stir-fried) - 2 qian

Grind the above into powder. Make pills the size of a mustard seed using refined honey. Take one pill per dose, dissolved in decoction of Ophiopogonis Radix (Maidong).

I observe: Although the previous formula contains Renshen, Fushen, and Suanzaoren to calm the spirit and tonify Qi, the four items including Amber have acrid and dispersing properties, which may deplete True Qi. They must be used only after careful syndrome differentiation.

Li stated: For carbuncles and sores, if supportive interior-tonifying medicines are not taken, heat-toxins attack inward, causing sores in the throat and tongue. In severe cases, black rot occurs. One should take Xijiao San (Rhinoceros Horn Powder) to resolve the toxicity.

Xijiao Xie (Rhinoceros Horn shavings) - 1 liang
Xuanshen (Scrophulariae Radix) - 1 liang
Shengma (Cimicifugae Rhizoma) - 1 liang
Huangqi (Astragali Radix) - 1 liang
Chishaoyao (Red Peony Root) - 1 liang
Maidong (Ophiopogonis Radix, cored) - 1 liang
Sheng Gancao (Raw Licorice Root) - 1 liang
Danggui (Angelicae Sinensis Radix) - 1 liang
Dahuang (Rhei Radix et Rhizoma, lightly stir-fried) - 3 liang

Make into coarse powder. Take 3 qian per dose, decoct in water.

I observe: The previous formula is an agent that breaks blood, descends fire, and purges internally. If the pulse is deep and solid, with constipation, fever, thirst, and a preference for cold drinks, it belongs to heat accumulation inside, and this formula can be used. If the pulse is deficient and floating, with no constipation, fever, thirst, and aversion to cold drinks, it belongs to blood deficiency on the exterior, and Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) can be used. If the Chi pulse is surging and rapid but forceless, with fever, thirst, and frequent urination, it belongs to insufficiency of Kidney Water with Deficient Fire flaming upward. Jiajian Bawei Wan (Modified Eight-Ingredient Pill) is appropriate. Generally, this syndrome is caused by depletion of Kidney Water and flaming of Deficient Fire.