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Chen Wuzhuo stated: Carbuncles and sores (Yong Ju, 痈疽) initially have no fixed location; they are named according to where they occur. On the exterior, they are called "Fa Bei" (发背, back carbuncle) or "Fa Nao" (发脑, head carbuncle); on the interior, they are called Chang Yong (肠痈, intestinal abscess), Nei Yong (内痈, internal abscess), Xin Yong (心痈, heart abscess), Fei Yong (肺痈, lung abscess), Qi Yong (脐痈, umbilical abscess), etc. If the syndrome is treated correctly, life is preserved; if the correct treatment is lost, death ensues. Exterior syndromes are easy to identify, while interior syndromes are difficult to clarify; therefore, they must be described in detail.

The disease of Chang Yong (intestinal abscess) presents with rough skin resembling fish scales (Shen Jia Cuo, 身甲错), tense abdominal skin that feels soft upon pressure (as if swollen), but without any accumulation masses in the abdomen, no fever, and a rapid pulse (Mai Shu, 脉数). This indicates pus within the intestines, formed by long-standing accumulation of yin-cold. Therefore, *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) uses Fuzi (Aconite Root) for warming. If there is swelling and stagnation in the lower abdomen, feeling like stranguria (Lin Zheng, 淋证) upon pressure, yet urination is normal, accompanied by fever, anhidrosis, and aversion to cold, with a slow and tight pulse, the pus has not yet formed; purgation can be used, and blood may appear in the stool. If the pulse is surging and rapid, the pus has already formed; purgation is contraindicated. This is caused by internal heat binding. Thus, *Jin Gui Yao Lue* uses Dahuang (Rhubarb Rhizome) for purgation. In severe cases, abdominal distension occurs, water sounds are heard when turning over, ulcers may form around the navel, pus may discharge from the navel, or pus and blood may pass in the stool; these conditions, if untreated, will inevitably lead to death. As for ulcers within the five zang organs, treatment merely involves regulating yin and yang; it does not require the sequential application of the four seasons and eight principles as required for external carbuncles.

*Mai Jing* (Pulse Classic) cites a case of an official's wife who was ill. The physician diagnosed her pulse as slippery and rapid. Slippery indicates excess; rapid indicates heat. Slippery reflects Ying (Nutritive) Qi; rapid reflects Wei (Defensive) Qi. The descending rapidity of Wei Qi and the ascending slipperiness of Ying Qi interfere with each other, causing the blood to become turbid and degenerated. The lower abdomen is stiff and hard; urination is sometimes obstructed, sometimes sweating occurs, and sometimes aversion to cold appears, indicating that pus has already formed. If the pulse is slow and tight, it indicates blood stasis; once the stasis passes down, the disease resolves. Additionally, *Nei Jing* (Inner Canon) records a condition called Xi Ji (Breathing Accumulation), where patients suffer for two or three years with slight edema all over the body, followed by daily discharge of pus from the connection between the large intestine and the navel, leading to untreatable death. This is also a type of Chang Yong (intestinal abscess) and must be carefully examined.

Note: The above statements regarding internal abscesses and intestinal abscesses are concise and precise. *Mai Jing* is largely similar to this text; both should be examined in detail.

In my early years, residing in Huainan, I obtained two volumes of *Chu Ke Xin Yao* (Heart Essentials of Surgery), a family heirloom of Guo Wencai Fu from Dongyuan, at the Zhai Tang (Study Hall) of Chen Fuchu. Carrying them while traveling, I applied the methods prescribed and often achieved miraculous effects. Therefore, I dare not let this knowledge be forgotten. I have collected various trial-effective methods from Mr. Li Dongyuan, interspersed with famous prescriptions from ancient and modern times below. Each prescription is accompanied by the principles of Master Zhu Danxi’s *Wai Ke Jing Yao Fa Hui* (Elucidation of the Essence of External Medicine) to serve as a guide for adaptation, assisting learners.

[Agents for Acrid-Cool Dispersal]

**Dongyuan Huanglian Xiaodu San (Coptis Decoction for Detoxification):** Treats carbuncles and sores occurring on the head, neck, or back along the Taiyang channel, with swelling extending outward, dissipating heat and toxic pathogens. For those presenting with numbness and no pain, moxibustion should be applied first. For those with pain and fever, this formula is suitable.
Huanglian (Processed Coptis Rhizome) 1 qian, Qianghuo (Notopterygium Rhizome) 1 qian, Huangqin (Scutellaria Root) 0.5 qian, Huangbai (Phellodendron Bark, wine-processed) 0.5 qian, Sheng Dihuang (Rehmannia Root) 0.5 qian, Zhimu (Anemarrhena Rhizome, processed) 0.5 qian, Duhuo (Angelica Pubescens Root) 0.5 qian, Fangfeng (Saposhnikovia Root) 0.5 qian, Danggui Wei (Tail of Angelica Sinensis Root) 0.5 qian, Lianqiao (Forsythia Fruit) 4 fen, Ben (Ligusticum Chuanxiong Rhizome) 0.5 qian, Fangji (Stephania Root) 0.5 qian, Jiegeng (Platycodon Root) 0.5 qian, Huangqi (Astragalus Root) 2 fen, Sumu (Sappan Wood) 2 fen, Chenpi (Tangerine Peel) 2 fen, Zexie (Alisma Rhizome) 2 fen, Renshen (Ginseng Root) 3 fen, Gancao (Licorice Root) 3 fen.
Crush the herbs and decoct in water.

Note: Yuan Haowen recorded: A person who habitually drank alcohol developed a small sore below the brain and above the neck in mid-autumn. After several days, the head and neck became numb and swollen, with swelling extending outward. The surgeon prescribed Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction). By the eighth day, pus had not emerged, and it was said that quick healing was impossible. Pus appeared on the eighteenth day; medication or pricking was to wait until after pus discharge, taking three months to flatten and four months to heal completely. I recall from medical classics that whenever pus appears in sores, nine out of ten die. If the doctor’s words were true, one would regret having nothing to do but await death. Thus, I invited a renowned physician. He stated that changes due to rich foods and alcohol should not be treated with Wuxiang Tang. It was too late for Wuxiang Tang; fire therapy should be used first. Large moxa cones, size of two nuts, were applied until 100 moxibustions were completed before pain was felt. Then a prescription was made: This is a disease of the Foot-Taiyang Bladder channel. The pathology is rebellious and requires contrary treatment. The pulse is wiry and tight, surging, large, rapid, and forceful upon pressure. One must rely on the channel’s dominance and treat the cause first. Initially similar, finally different; it can break accumulations, soften hardness, and unblock Qi, ensuring recovery. One must follow the annual Qi and not disrupt Heavenly Harmony. According to the season, it can be resolved but not through sweating. The classics prohibit purgation for such diseases; accumulations should be scattered, and salty flavors used to soften hardness. However, since cold pathogen is involved, salty flavor is prohibited. Bitter-cold herbs are Sovereign; sweet-cold herbs are Assistant; wine-heat is the etiology, used as Envoy; acrid-warm herbs harmonize blood; highly acrid herbs resolve knots as Ministers. Three acrid and three sweet herbs benefit Yuan Qi and harmonize blood vessels; bland-draining herbs guide off alcohol-dampness, supporting autumn Qi to benefit Qi and drain fire into the relevant channel. Blood is harmonized, serving as a guiding agent. Since the main goal is unblocking the channel, Sovereign herbs include Huangqin, Huanglian, Huangbai, Sheng Dihuang, Zhimu (wine-processed). Channel-guiding herbs include Qianghuo, Duhuo, Fangfeng, Ben, Fangji, Danggui, Lianqiao to resolve knots. Huangqi, Renshen, Gancao combined with one-third of the bitter-cold herbs prevent excessive nourishment of Ying Qi and tonification of Earth. Raw Gancao drains Kidney fire and benefits Lower Jiao Yuan Qi; Renshen and Jupi tonify Stomach; Sumu and Danggui Wei remove bad blood; Sheng Dihuang nourishes blood; wine-processed Fangji removes stagnant heat in the Bladder; Zexie assists autumn in removing damp-heat from alcohol. All these herbs require Jiegeng as a boat to prevent sinking. After administration, the carbuncle becomes painless and non-tender, appetite improves, and the body becomes strong. As predicted, after taking the medicine, the patient slept deeply until sunrise. Palpation showed the swelling reduced by 70-80%. Scabs formed, and the disease resolved in fourteen days. Do worldly surgeons lack efficacy? Beyond treating symptoms, he could enumerate secrets unknown even to the body itself. In my life, I have seen only Mingzhi achieve this. See detailed trial prescriptions.

**Neituo Qianghuo Tang (Internal Support Notopterygium Decoction):** Treats tight pulses at both left and right Chi positions of the Foot-Taiyang channel, weak upon pressure, with carbuncles arising in the buttocks, hard, painful, and swollen.
Qianghuo 2 qian, Huangbai (wine-processed) 2 qian, Fangfeng 1 qian, Ben 1 qian, Danggui Wei 1 qian, Rougui (Cinnamon Twig) 3 fen, Lianqiao 0.5 qian, Gancao (roasted) 0.5 qian, Cangzhu (Atractylodes Rhizome) 0.5 qian, Chenpi 0.5 qian, Huangqi 1.5 qian.
Crush the herbs, decoct in half water and half wine, take warm before meals to induce sweating.

**Baizhi Shengma Tang (Angelica Dahurica and Cimicifuga Decoction):** Treats carbuncles on the arms along the Hand-Yangming channel. Pulses at both left and right Cun positions are short, wiry in the middle, and surging, slow, and forceful upon pressure. This results from variations of the Eight Winds.
Baizhi 1.5 qian, Shengma (Cimicifuga Rhizome) 1 qian, Jiegeng 1 qian, Gancao (roasted) 0.5 qian, Huangqi 4 qian, Huangqin (wine-processed) 4 qian, Sheng Huangqin (Raw Scutellaria Root) 3 qian, Honghua (Safflower) 0.5 qian.
Crush the herbs, divide into two doses. Decoct each dose in half water and half wine, take warm after meals.

**Neituo Huangqi Chaihu Tang (Internal Support Astragalus and Bupleurum Decoction):** Treats sores near the knee/thigh inside the leg, or initial deep-seated bone abscesses with significant swelling and pain. This involves the Foot-Taiyin and Jueyin channels. Pulses are fine and wiry, surging, slow, and forceful upon pressure.
Huangqi 2 qian, Chaihu (Bupleurum Root) 1 qian, Qianghuo 0.5 qian, Lianqiao 1.5 qian, Rougui 3 fen, Tugua Gen (Trichosanthes Kirilowii Root) (wine-processed) 1 qian, Sheng Dihuang 2 fen, Huangbai 2 fen, Danggui Wei 7 fen.
Crush the herbs, make one dose. Decoct in 2 parts water and 1 part wine, take before meals.

**Neituo Huangqi Jiu Jian Tang (Internal Support Astragalus Wine-Decoction):** Treats sores on the outer side of the leg, or deep-seated bone abscesses caused by cold-dampness, affecting the Foot-Shaoyang channel slightly invading the Foot-Yangming channel. Hard, diffuse swelling causes pain during walking or inability to walk.
Chaihu 1.5 qian, Lianqiao 1 qian, Rougui 1 qian, Dali Zi (Arctium Fruit, stir-fried) 1 qian, Huangqi 2 qian, Danggui Wei 2 qian, Huangbai 0.5 qian, Shengma 7 fen, Zhi Gancao (Roasted Licorice Root) 0.5 qian.
Crush the herbs, decoct in half water and half wine, take before meals.

Note: The above formulas exemplify the integration of pulse, disease, and syndrome differentiation, reflecting the principles of Dongyuan’s trial-effective methods. Learners who understand these will have a basis for prescribing.

**Danggui Niantong Tang (Angelica Pain-Relieving Decoction):** Treats all wind-damp-heat-toxic pathogens infiltrating sores, downward pouring damp-toxicity causing sores on feet and knees, red swelling, continuous pus discharge from internal and external sores, itching or pain. Suitable for sinking, tight, solid, rapid, moving, or slippery pulses.
Qianghuo 0.5 liang, Renshen 2 qian, Kushen (Sophora Root, wine-processed) 2 qian, Shengma 2 qian, Gegen (Pueraria Root) 2 qian, Cangzhu 2 qian, Zhi Gancao 0.5 liang, Huangqin (wine-processed) 0.5 liang, Yinchene Ye (Artemisia Capillaris Leaf, wine-stir-fried) 0.5 liang, Fangfeng 2 qian, Danggui Shen (Body of Angelica Sinensis Root) 2 qian, Zhimu (wine-processed) 3 qian, Zexie 3 qian, Zhuling (Polyporus) 3 qian, Baizhu (Atractylodes Macrocephala Rhizome) 1.5 qian.
Crush the herbs. Take 1 liang per dose, decoct in water, take on an empty stomach, and again before sleep.

Note: These are herbs for Foot-Taiyang, Yangming, and the Three Yin channels. Originally formulated by Dongyuan for damp-heat Hongjiao (Gout/Podagra), but widely used successfully for the above sores, hence recorded.

**Neituo Shengma Tang (Internal Support Cimicifuga Decoction):** Treats black-headed sores appearing between the breasts of women, with depressed centers resembling black eyes. Pulse is wiry and surging, fine upon pressure. Also treats initial breast abscesses.
Shengma 1.5 qian, Gegen 1.5 qian, Lianqiao 1.5 qian, Rougui 3 fen, Huangqi 1 qian, Danggui Shen 1 qian, Shuniu Zi (Arctium Seed) 0.5 qian, Huangbai 2 fen, Zhi Gancao 1 qian.
Crush the herbs, make one dose. Decoct in 2 parts water and 1 part wine, take after meals.

Note: These are herbs for Foot-Yangming and Jueyin channels.

**Sanzhong Kuijian Tang (Disperse Swelling and Soften Hardness Decoction):** Treats Machang sores (scrofula-like lumps) hard as stones from below the ear to the collarbone, shoulder, or hypochondrium, involving Hand and Foot Shaoyang channels. Also treats Luoli (scrofula)遍布 the chin or jaw, hard as stones in the Foot-Yangming channel. Treats both conditions whether broken with pus discharge or not.
Chaihu 4 qian, Shengma 3 fen, Caolongdan (Gentiana Root, wine-processed and fried) 0.5 liang, Huangqin (wine-fried) 8.2 qian, Zhi Gancao 3 qian, Jiegeng 0.5 liang, Lianqiao 3 qian, Gualou Gen (Trichosanthes Root, wine-processed) 0.5 liang, Danggui Wei 2 qian, Baishao (White Peony Root) 2 qian, Huangbai (wine-processed, peeled) 0.5 liang, Zhimu (wine-processed) 0.5 liang, Gegen 2 qian, Huanglian (Coptis Rhizome) 1 qian, Jing Sanleng (Burreed Tuber, wine-processed and lightly fried) 3 qian, Guang E Zhu (Curcuma Rhizome, processed) 3 qian, Kunbu (Kelp) 0.5 liang.
Crush the herbs. Take 6-7 qian per dose, decoct in 2 cups of water (reduced to 1 cup) after soaking for most of the day. Strain and drink hot. Lie down with feet elevated and head lowered to keep the medicine suspended in the upper diaphragm. Alternatively, prepare half the material as a fine powder, mix with honey into pills the size of mung beans. Take 100-150 pills with a mouthful of this decoction after meals. Adjust dosage based on patient’s deficiency or excess. This example applies to all such medications.

**Shengma Tiaojing Tang (Cimicifuga Regulating Menstruation Decoction):** Treats scrofula under the chin or jaw. This condition originates from the Foot-Yangming Stomach channel. If the sore is deep and hidden in the flesh, it originates from the Foot-Shaoyin Kidney channel (Wu transmitting to Gui, Husband transmitting to Wife). Both present as hard lumps of varying sizes and are treated similarly. Can also be taken as pills.
Shengma 8 qian, Gegen 5 qian, Caolongdan (wine-processed and fried) 0.5 liang, Huangqin (wine-processed) 0.5 liang, Danggui Wei 3 qian, Jiegeng 0.5 liang, Lianqiao 0.5 liang, Shaoyao 3 qian, Huangbai (wine-fried) 1 qian, Zhimu (wine-fried) 1 liang, Huanglian 0.5 liang, Guang E Zhu (wine-fried) 0.5 liang, Zhi Gancao 0.5 liang, Jing Sanleng (wine-fried) 0.5 liang, Sheng Huangqin 4 qian.
Weigh half separately, make into powder, mix with honey into mung-bean-sized pills. Take 100-150 pills. The other half, crushed coarsely, take 0.5 liang per dose. If appetite is good and stool is hard, increase gradually to 7-8 qian, following the method of Kuijian Tang. This is a slow-acting preparation.

**Lianqiao Sanjian Tang (Forsythia Softening Hardness Decoction):** Treats sores from below the ear to the collarbone or shoulder, hard as stones, rootless when moved, named Machang. Originates from Hand and Foot Shaoyang channels. Also treats sores on both hypochondriums or broken sores with pus.
Chaihu 1.2 liang, Lianqiao 0.5 liang, Danggui Wei (wine-processed) 0.5 liang, Shaoyao 0.5 liang, Sheng Huangqin 0.5 liang, Zhi Gancao 3 qian, Tugua Gen (wine-fried) 1 liang, Caolongdan (wine-processed four times) 1 liang, Cangzhu 2 qian, Huangqin (wine-fried twice) 2 qian, Huanglian (wine-fried twice) 2 qian, Guang E Zhu 0.5 liang, Jing Sanleng (finely sliced, wine-processed once and dried) 0.5 liang.
Weigh half separately, make into honey pills as above. Crush and mix evenly, take 0.5 liang per dose, following the same method for slow treatment.

Note: The above three formulas are based on channel-specific usage, agents for softening hardness and dispersing depression.

**Xiaozhong Tang (Reduce Swelling Decoction):** Treats Machang sores.
Chaihu 2 qian, Lianqiao 3 qian, Danggui Wei 1 qian, Gancao 1 qian, Sheng Huangqin 2 qian, Honghua (Safflower) a little, Huanglian 0.5 qian, Shuniu Zi (stir-fried) 0.5 qian, Gualou Gen 1.5 qian, Huangqi 1.5 qian.
Take 0.5-1 liang per dose, decoct in water, drink hot after meals.

Note: This follows the Foot-Shaoyang example.

**Chaihu Tongjing Tang (Bupleurum Unblocking Channel Decoction):** Treats children with hard, non-suppurating sores on the side of the neck, named Machang.
Chaihu 2 fen, Lianqiao 2 fen, Danggui Wei 2 fen, Huangqin 2 fen, Sheng Gancao 2 fen, Shuniu Zi 2 fen, Jiegeng 2 fen, Jing Sanleng 2 fen, Honghua a little, Huanglian 5 fen.
Crush the herbs, make one dose, decoct in water, drink slightly warm.

Note: These are herbs for Hand-Shaoyin, Taiyin, Foot-Shaoyang, and Jueyin channels. There are many similar methods by Dongyuan, not listed here. Guo Shi also has several formulas for treating scrofula, which are interior-purging and internal-resolving agents, thus attached to miscellaneous formulas.

**Guo Shi Shengma Niubangzi San (Guo’s Cimicifuga and Arctium Powder):** Treats epidemic toxic rashes with floating, surging pulses indicating exterior involvement, sores erupting on the head, face, chest, and diaphragm.
Shengma 1 qian, Niubangzi (Arctium Fruit) 1 qian, Gancao 1 qian, Jiegeng 1 qian, Gegen 1 qian, Xuanshen (Scrophularia Root) 1 qian, Mahuang (Ephedra Herb) 1 qian, Lianqiao 2 qian.
Crush the herbs, add 3 slices of ginger, 2 cups of water, make one dose.

**Zhonghe Tang (Harmonizing Decoction):** Treats epidemic toxicity with wiry, surging pulses indicating half-exterior/half-interior status.
Shichangpu (Acorus Rhizome), Niubangzi, Qianghuo, Chuanxiong (Ligusticum Chuanxiong Rhizome), Fangfeng, Loulu (Euphrasia Root), Jingjie (Schizonepeta Spike), Maidong (Ophiopogon Tuber), Qianhu (Peucedanum Root), Gancao.
Crush the herbs, take 1 liang per dose, decoct in water.

Note: These follow the Foot-Taiyang and Yangming examples.

**Jiyao Fang (Essential Formula):** Treats tubercles, including scrofula behind/in front of ears or below the jaw. Use 2 dou of very ripe, black mulberries. Crush with cloth to extract natural juice. Slow-boil in a clay pot over high heat until a thin paste forms. Take one spoonful dissolved in plain water after meals, three times daily.