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Wine preparations, Fangfeng Tang (Saposhnikovia Decoction), Wugong San (Centipede Powder), Da Xionghuang Tang (Major Rhubarb and Ligusticum Decoction), Qianghuo Tang (Notopterygium Decoction), Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction), Yuzhen San (True Jade Powder), external application medicines, and Yangxue Danggui Dihuang Tang (Blood-Nourishing Decoction of Angelica Sinensis and Rehmannia).

Xue Lizhai stated: Generally, after the ulceration of carbuncles and sores, muscles and flesh rot, pus and blood are largely discharged, and Yang Qi scatters with Yin fluids. This may result in tendon and vessel spasms, aversion to cold, and tremors or convulsions. In severe cases, it presents with a stiff tongue, locked jaw, opisthotonos (backward arching of the head and back), excessive phlegm and saliva, constipation, sweating, and intermittent fever. These indicate deficiency of both Qi and Blood. Although these manifestations resemble wind-stroke (Pochang Feng, Tetanus-like syndrome), the primary treatment method should be greatly tonifying Qi and Blood. If there is indeed a wind pathogen, the main approach must still be tonifying Qi and Blood, supplemented by herbs that treat wind. If one fails to examine the nature of the disease and prescribes recklessly, it will lead to error.

Si Tu Bian Huaquan suffered from a shoulder carbuncle with fever, staring eyes or strabismus, resembling wind-stroke. His fever intensified at Shen hour (3-5 PM), and his pulse became more rapid. This was due to Qi and Blood deficiency in the three Yin meridians of the foot, causing deficient fire to move recklessly. He was treated with Ren Shen (Ginseng Radix et Rhizoma), [missing character], Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Zhi Gan Cao (Prepared Licorice Root), added with Jiu Chao Hei Huang Bo (Phellodendri Cortex fried with wine and charred), Wu Wei Zi (Schisandrae Fructus), Mai Dong (Ophiopogonis Tuber), and Rou Gui (Cinnamomi Cortex). After four doses, he recovered; after several more doses, the wound healed.

A scholar suffered from a leg carbuncle, with deep accumulation internally and unchanged skin color, failing to ulcerate for a long time. Needling released about five bowls of pus and blood stasis. Various malignant symptoms appeared simultaneously, completely resembling wind-stroke. This was a transformation due to Spleen and Stomach deficiency. He was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix) and Pao Jiang (Prepared Ginger Rhizome), as well as Shengyu Tang (Sage Preservation Decoction). Each prescription was taken for four doses, leading to stability. Later, due to mental exertion causing insomnia, Guipi Tang (Restore the Spleen Decoction) cured him. (Note by Xue Lizhai)

The condition of macules and papules (Ban Zhen), although detailed in the main section, refers specifically to infantile measles. For those who do not have measles, whether adults or children, suddenly suffering from macules and papules or small sores, this resembles the former but has subtle differences. It must be differentiated and treated, as it mostly arises from external contraction of Wind-Heat.

The treatment method for this condition: If the pulse is floating and the body is hot with exterior signs, the focus is on dispersing Wind pathogens. If the pulse is floating and rapid, dispel Wind and clear Heat simultaneously. If the pulse is deep and slippery without exterior signs, clearing Fire is the priority. If both superficial and deep pulses are slippery and rapid, with both exterior and interior signs present, a simultaneous release of exterior and interior is appropriate. However, this condition is mostly seen in children. One must observe the exterior/interior and deficiency/excess patterns and prescribe accordingly. In general, children are fragile; thus, medications that stabilize the interior should be used more frequently than those that attack and disperse. If constipated, mildly purge; if bound, gently guide out stagnation. As long as the pathogen does not obstruct and dissipates easily, the condition will be mild and the child safe. Generally, a warm body indicates a favorable prognosis, while a cool body indicates an unfavorable one.

Wang Haicang said: Predecessors stated that purgatives should not be used at the beginning or end of the disease. Why? The answer is: At the beginning, purgatives are forbidden because the macules have not yet emerged on the surface. Using purgatives prevents the pathogen from extending outward. Since the pulse and symptoms show exterior presence without interior excess, purgatives are prohibited at the start. At the end, purgatives are forbidden because the macule toxin is already manifest externally, lacking internal roots, and the stool is not constipated, meaning there are no interior excess syndromes. Using purgatives would cause the macule Qi to sink and rebel, hence they are prohibited at the end.

Jiegu said: The manifestations of macules and papules vary. Swelling appearing on the exterior belongs to the Ministerial Fire of the Shaoyang Triple Burner and is called Ban (Macules). Small red spots moving within the skin without emerging belong to the Sovereign Fire of Shaoyin and are called Zhen (Papules). Whenever Ban syndrome appears, spontaneous vomiting and diarrhea are generally auspicious; do not treat recklessly, as this indicates the pathogen exiting through both upper and lower pathways. If Ban and Zhen appear together, the pathogen is likely severe, which children may not withstand, often leading to other complications. However, purgatives are prohibited at both the beginning and end.

Xue Lizhai said: Regarding infantile Dan Du (Erysipelas), if the entire body turns red and one does not use Bian therapy (scarification/bloodletting), allowing the toxic vapor to enter the abdomen, the patient cannot be saved. This condition involves evil toxic hot blood accumulating in the Mingmen (Gate of Life), combining with Ministerial Fire to erupt. For lesions like rosy patches, scarification to remove bad blood is best. For swollen, bright red lesions that wander unpredictably, apply raw Sesame Oil to the affected area first, then scarify to drain the toxicity. Lesions starting from the limbs and moving inward are incurable. Although there are several types of Dan and several treatments, none are as effective as scarification. Commonly, severe cases treated without scarification fail to recover.

A woman suffered from macules with itching and a floating pulse. She was treated with Xiaofeng San (Wind-Dispersing Powder) for four doses and recovered.

Another woman suffered from macules with itching and a floating-rapid pulse. She was treated with Renshen Baidu San (Ginseng Detoxification Powder) for two doses, showing slight improvement, followed by Xiaofeng San for four doses, leading to stability.

A man suffered from macules, which were crimson-purple and painful, accompanied by fever and a preference for cold drinks. His pulse was deep and solid. He was treated with Fangfeng Tongsheng San (Saposhnikovia Unblocking and Generating Powder) for one dose, resulting in immediate relief, followed by Fangfeng Baidu San (Saposhnikovia Detoxification Powder) added with Huang Qin (Scutellariae Radix) and Lian Lian (Coptidis Rhizoma) for four doses, leading to recovery.

An elderly man suffered from papules, which were slightly red, itchy, and accompanied by fever. He was treated with Renshen Baidu San for two doses, showing slight improvement, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Huang Qin (Scutellariae Radix) and Shan Zhi (Gardeniae Fructus), leading to recovery.

A child suffered from papules with fever, pain, irritability, and thirst, desiring to take Qingliang Yin (Cooling Drink) to purge. Examination revealed a pulse that was not solid and not rapid upon light pressure, indicating the pathogen was in the collaterals. Purging was contraindicated. He was treated with Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) for two doses and recovered. This condition is common in children; one must carefully examine whether the pathogen is in the exterior or interior and its severity before treating.

A toddler had itching and fever. After one dose of Xijiao San (Rhinoceros Horn Powder), he experienced vomiting and diarrhea, indicating the pathogen exiting via upper and lower pathways; the toxin naturally resolved. Shortly after, vomiting and diarrhea stopped, and the papules disappeared. Following the emesis and purgation, the pulse showed seven beats per breath cycle, which is a harmonious pulse for children, indicating the pathogen was exhausted. No further treatment was needed, and he recovered. (All noted by Xue Lizhai)

A man suffered from Dan Du (Erysipelas) with swelling, pain, constipation, and a rapid-solid pulse. Fangfeng Tongsheng San was ineffective. Scarification of the affected area was performed to remove bad blood, and the previous medication was continued, leading to recovery.

A child had Dan on the leg, resembling rosy patches, wandering unpredictably. Raw sesame oil was applied to the site, followed by scarification to remove bad blood, gradually dissipating the toxicity. Then, Shengong Tuoli San (Divine Efficacy Supporting Interior Powder) was administered for one dose, leading to stability.

A child suffered from Dan Du. Although the external presentation was mild, internally there was difficulty defecating, indicating the disease involved the Zang organs. Dalianqiao Yin (Large Forsythia Decoction) was taken, and Shengong San (Divine Efficacy Powder) was applied externally, leading to cure.

A child had redness all over the body. After scarification and administration of detoxifying medicines, he recovered. I once treated children with Dan Du presenting with constipation or irritability; administering Wufu Huadu Dan (Five Blessings Toxin-Dissolving Pill) was also effective. (All noted by Xue Lizhai)

1. The treatment for Baihu Dan (White Tiger Dan) can be found in Surgical Formulas, page 292.