Library

Qi Dezhi stated: Sores and ulcers appearing on the exterior are all caused by accumulated heat harbored within. The *Neijing* (Inner Canon) states that when blood is hot, flesh rots; when Ying and Wei Qi (Nutritive and Defensive Qi) fail to circulate, pus will inevitably form. If retained in the joints and interstices, it will lead to tissue necrosis. Generally, when a carbuncle or furuncle is about to suppurate, if the head is small and unruptured, the sore opening not yet open, or the pathogenic factors not yet expelled, causing unbearable pain, one must immediately employ methods to cauterize and expel necrotic tissue. This allows the pathogenic factors to discharge outward rather than attacking inward, facilitating the removal of foul flesh and the regeneration of healthy flesh. If the sore bleeds incessantly, one should not immediately apply cauterizing powders to the wound; wait until it is mature before applying them. If touching the sore causes pain radiating to the heart root (indicating severe pain affecting the heart), one should not force treatment. Accidental contact with the sore will double the pain, leading to unpredictable complications; caution is essential. If a boil has formed pus but remains unruptured, with the superficial skin peeling up, one should immediately apply a formula for lancing to the top and cover it with a plaster. After the pus drains, use herbs to search out pus and resolve toxins, yielding miraculous results. If pus and blood are not fully discharged, using formulas to generate muscle and close sores in an attempt to hasten healing is misguided. One fails to realize that if foul flesh remains and the sore closes early, it will inevitably recur later. Caution is paramount.

Xue Ji (Li Zhai) stated: In cases of sores and ulcers, when pus has formed, one must distinguish between its maturity and depth. Regarding dead flesh, one must verify the extent of rotting and detachment. I have treated patients with weak pulses and deficient syndromes by using formulas to support the interior and promote suppuration; this strengthens Qi and Blood, preventing flesh from dying. For patients with excess-heat syndromes indicated by strong pulses, using heat-clearing formulas allows the pathogenic factors to recede and flesh to regenerate naturally. When sores gather between bones and tendons or within muscles, it is due to deficiency of Qi and Blood. Using Shiquan Dabu Tang (Complete and Great Tonifying Decoction) to strengthen the Spleen and Stomach allows unformed abscesses to resolve spontaneously and formed abscesses to rupture naturally, leaving no dead flesh. If there is little pain or severe pain, lack of redness, internal pus not rupturing, or external flesh not rotting, this indicates Qi and Blood deficiency. It is appropriate to use moxibustion with mulberry branches, or Shiquan Dabu Tang added with Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark) to strengthen Yang Qi. Then swelling around the periphery will subside, the sore head will rot, and toxins will dissipate naturally, without waiting for needle cutting. If the Spleen and Stomach are weak, with poor appetite and lack of desire for food, use Liujunzi Tang (Six Gentlemen Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) to strengthen Ying Qi. Then flesh affected by toxins will rupture spontaneously, dead flesh will revive, and open sores will heal. If at the onset, due to mistaken use of purgatives or sexual indiscretion, the area becomes dark purple and painless, this indicates collapse of Yang Qi, transforming into a Yin syndrome. Urgently use Shenfu Tang (Ginseng and Aconite Decoction) to warm, tonify, and restore Yang; survival is possible.

He further stated: Necrotic flesh is foul flesh. Generally, after an abscess or ulcer ruptures, if necrotic tissue remains stagnant, it must be removed, embodying the principle of eliminating the old to bring forth the new. In robust individuals with strong sinews and bones, abundant Qi and Blood, who can truly overcome pathogens, the necrotic tissue may fall off naturally or level out, causing no harm. However, in elderly or frail individuals with scant blood and dry flesh, one must intercept and remove it according to the situation, which is likened to quelling chaos to establish peace. If left untreated, it leads to rotting sinews and foul flesh. For example, Liu Dayin and Lady Wang had timely removal, allowing new flesh to grow and full recovery; whereas Jin Gongbu and Zheng Huishi delayed removal, leading to massive溃破 (rupture) and death. I have observed that even in robust individuals, if necrotic tissue is removed but Qi and Blood are not supplemented, healing cannot occur; in frail individuals, if foul flesh is not removed and Qi and Blood are not replenished, survival is unlikely. Thus, the ancients said: Foul flesh is worse than wild wolves and tigers, more toxic than bees and scorpions; delaying its removal endangers life. This is true.

He also stated: In sores and ulcers, if toxins have consolidated, with intense redness and swelling, and the central flesh is necrotic and dark black, internally administer formulas to support the interior and strengthen the Spleen and Stomach, and externally apply Wujin Gao (Black Gold Ointment). The dark areas will gradually recede, and red areas will rise. By the sixth or seventh day, cracks will naturally appear at the boundary between red and dark areas, resembling knife marks, and the dark areas will gradually suppurate. It is good to slowly remove them with a bi needle (lancet) or sharp scissors. Ideally, this should be done without causing pain or visible bleeding. If pus flow is not smooth, use a needle to guide drainage through the cracks. If pus has drained but swelling and pain persist, it indicates internal fascial separation; use a needle to guide drainage. If Yuan Qi (Primal Qi) is weak, and purgatives were mistakenly taken, resulting in painless lesions or non-suppurating necrotic flesh, urgently warm and tonify the Spleen and Stomach; recovery is possible. Subsequently, purely tonify the Spleen and Stomach to facilitate healing. In such cases, do not recklessly use needles or knives. Mistakenly using them to remove flesh and cause bleeding makes Yang follow Yin into defeat, accelerating danger.