Library

Qi stated: If the swelling is soft and painless, it is a blood tumor (Xueliu). If the swelling gradually increases but is not very hot, with occasional pulling pain, it is an air tumor (Qiliu). Qi stagnation causes slight swelling that does not resolve for a long time; later, pus may form. This is caused by cold and heat pathogens. After prolonged accumulation, extreme Yin generates Yang, and cold transforms into heat. When such lesions ulcerate, they often become fistulas (Lou); therefore, one should take Neisai San early to drain them. Furthermore, when examining carbuncles and sores, if pressing the area reveals intense heat, the pus has matured and the area becomes soft. If the superficial skin peels up, the pus is shallow. If the swelling is not very hot, the pus has not yet formed. If one suffers from scrofula (Luoli) with alternating chills and fever, thirst, and persistent non-resolution, accompanied with sallow complexion, this indicates steaming by heat pathogens, and pus has already formed. As for internal ulcers of the viscera and intestines, the disease is concealed and deep, invisible to the eye and inaccessible to touch, making diagnosis extremely difficult. It can be distinguished only by pulse diagnosis. For gastric epigastric abscess (Weiwanyong), one should inspect the Stomach pulse, which refers to the Renying (ST9) point. If the pulse is deep and rapid, with severe Qi rebellion, heat accumulates at the stomach opening, leading to gastric epigastric abscess. If the pulse is surging and rapid, pus has formed. If the pulse is slow and tight, although pus has not formed, blood stasis exists. Urgent treatment is required; otherwise, pathogenic factors will attack inward, rotting the intestines and stomach, rendering the condition incurable. Additionally, "Lung Abscess Treatise" states: It is curable in the initial stage, but fatal once pus forms; caution is essential. If after a long duration, coughing up pus resembling rice porridge occurs, it is untreatable. If vomiting pus stops the symptoms, spontaneous recovery will occur. "Intestinal Abscess Treatise" states: Sores may appear around the umbilicus with pus draining from the sore or from the umbilicus itself; only cases with pus and blood in the stool will heal spontaneously.

Wu stated: If the sore is red, and pressing it does not change color, pus has formed. If pressing it immediately turns red, pus is also present. If pressing turns it white, which slowly turns red after a long time, the wandering toxin has subsided; moxibustion can be applied at the boundary between red and pale areas to block the toxin, and the red swelling will subside. Generally, for carbuncles and sores, if pressing feels hard without fluctuation, there is no pus; if half-soft and half-hard, pus is present. If the swollen area is not hot upon pressing, there is no pus. Intense heat indicates pus presence, requiring urgent incision.

Lizhai stated: In ulcerative conditions where toxins have aggregated, one should tonify Qi and Blood to hasten pus formation. Once pus forms, assess its maturity, depth, and suitability for drainage, then use a needle to evacuate it. Do not rely on internal resolution methods. Slight tenderness upon pressing indicates shallow pus; deep tenderness upon heavy pressing indicates deep pus. Indentation that does not rebound indicates unformed pus; immediate rebound indicates formed pus. Needling too early depletes Qi and Blood, hindering pus formation. Delaying needling until pus matures leads to deeper necrosis and delayed healing. If the lesion is deep but needled shallowly, internal pus remains while external blood is lost. If the lesion is shallow but needled deeply, internal pus drains but healthy tissue is damaged. In cases of weak Yuan Qi, tonification must precede needling. Once pus drains, symptoms naturally recede. If pain persists or irritability/vomiting occurs after drainage, it indicates Stomach Qi deficiency; urgent tonification is needed. For back sores with intense heat toxicity and dark central flesh, use internal Tuoli (supporting interior) formulas to strengthen the Spleen and Stomach, and apply Wujin Ointment externally to the dark area. As the red area rises and the dark area sinks, a clear boundary appears after six to seven days with crack-like lines resembling knife cuts; the dark flesh will gradually slough off. Use a bi needle and sharp scissors to remove it slowly, aiming for painlessness and absence of fresh bleeding. If cracks exist but pus flow is poor, or pain persists despite drainage, internal blockage remains; use needles to guide drainage through the cracks. For lesions on the back/scapula region, where fascia lies beneath the skin, even if the skin breaks, the fascia resists rupture, trapping internal pus, causing distension, pain, Qi/Blood deficiency, and various complications. Waiting for spontaneous rupture often proves fatal; surgical opening and drainage combined with Tuoli therapy are necessary. Even with sharp instruments, removing hardened tissue is difficult; waiting for spontaneous rupture is worse. Only individuals with robust Qi and Blood can expect spontaneous rupture. If Yuan Qi is weak and astringent/cold-draining herbs are mistakenly used, causing lack of pain or impending necrosis, warm tonification of the Spleen and Stomach is urgent, and survival is possible. Subsequent pure tonification aids convergence. Reckless use of knives/needles causing bleeding further depletes Qi and Blood, hindering tissue regeneration. Upon ulceration, prioritizing massive tonification of Qi and Blood is essential; other symptoms should be addressed subsequently.

He further stated: For sores that do not protrude, use supporting methods to raise them; for those lacking pus, tonify to generate it, preventing internal invasion. Once pus forms, timely needling leads to quick recovery. Patients often fear pain or tissue damage from needling. However, even for superficial sores with inch-high swelling, needle depth should not exceed two fen. For back sores with three-inch swelling, needle depth is about one cun. Since the tissue is already necrotic, pain and damage concerns are unfounded. Weak patients suffering from bone-abscesses (Fugu Ju) who wait for spontaneous rupture often suffer extensive ulceration, exhaustion of Qi and Blood, and death.

He also stated: Once pus forms, if the skin does not vent, laypersons waiting for spontaneous rupture risk disaster. While robust individuals might self-resolve, frail persons with depleted Qi/Blood, especially after excessive purgation, face internal invasion of toxic pus, perforating intestines and membranes if not needled. Delayed needling for limb toxins causes deep necrosis. For critical areas like cheeks, neck, chest, or abdomen, urgent needling is required regardless of constitution; failure to do so is difficult to treat. Many, such as Lady Shen and Scholar Huang, died due to this negligence. Generally, superficial sores are high and soft, affecting blood vessels; deep sores are low and hard, affecting sinews and bones; bone marrow involvement shows no skin changes. Ancient methods prescribe bian (pricking) for superficial and ci (needle) for deep lesions to remove blood stasis early, facilitating resolution. At the pus stage, robust individuals may self-drain, but frail ones require needling; failure to do so is rarely successful. Penetration of membranes in ulcers is almost invariably fatal, even with strong tonics, serving as a warning against waiting for spontaneous drainage. Dongyuan noted: Without drainage, toxins cannot resolve, and pus/stasis cannot exit. Delaying cauterization/needling allows internal damage, leading to collapse and death. These examples are shared with colleagues and patients to encourage caution.

He further stated: Although sores/carbuncles arise from accumulated heat, early stages without pus showing surging/rapid pulses indicate Yin deficiency with Yang hyperactivity. Internal rupture without external venting causes fever and surging/rapid pulses, indicating disease progression. After pus drainage, the pulse should calm, body temperature normalize, and swelling/pain cease, similar to sweating resolving exterior Cold Damage syndromes. Persistent fever/thirst with surging/rapid pulses indicates true Qi deficiency and pathogen excess, signaling certain death.

Finally, he stated: For conditions of insufficient Yuan Qi, early treatment should use Ginseng (Renshen), Astragalus (Huangqi), Angelica (Danggui), and Atractylodes (Baizhu) to warm/tonify the Spleen/Stomach, combined with external mugwort-onion warming (Sangzhi Congyi) to support Yang Qi for spontaneous resolution. If pus fails to form over time, these methods accelerate maturation. If pus forms but does not rupture, moxa should be applied to the apex to induce drainage, followed by Shiquan Dabu Decoction.