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The *Classic of Difficult Issues* (Jing Yue) states: If there is a dull pain at the Juque point, it is Heart Carbuncle (Xin Ju); if the flesh above slightly protrudes, it is Heart Abscess (Xin Yong). (The Juque point is located one cun below the Jiutui point and is the Front-Mu point of the Heart.)

Wang Kentang stated: Heart Abscess initially manifests at the Juque point, characterized by dull pain and slight swelling, causing chills and fever, body aches, redness of the head and face, and thirst that persists immediately after drinking. This arises from blazing Heart Fire compounded by excessive consumption of hot beverages. It is suitable to take Liangxue Yin (Cool Blood Decoction). If the disease is caused by alcohol toxicity, Shengma Gegen Tang (Ephedra and Kudzu Root Decoction) should be used for treatment. Although this condition is very rare, the treatment methods must not be neglected.

Liangxue Yin (Cool Blood Decoction)
Shengdi Huang (Rehmanniae Radix Preparata), Maidong (Ophiopogonis Tuber), Lianqiao (Forsythiae Fructus), Tianhuafen (Trichosanthis Radix), Mutong (Akebiae Caulis), Chishao (Paeoniae Radix Rubra), Jingjie (Schizonepetae Spica), Cheqianzi (Plantaginis Semen), Qumai (Dianthi Herba), Baizhi (Angelicae Dahuricae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Bohe (Menthae Haplocalycis Herba), Shanzhi (Gardeniae Fructus) (all in equal parts).
Use Dengxincao (Junci Medullia) as a guiding herb. For tidal fever, add Danzhuye (Lophatheri Herba).

Shengma Gegen Tang (Ephedra and Kudzu Root Decoction)
Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Gegen (Puerariae Lobatae Radix), Mutong (Akebiae Caulis), Shanzhi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.

The *Classic of Difficult Issues* (Jing Yue) states: If there is a dull pain at the Qimen point, it is Liver Carbuncle (Gan Ju); if the flesh above slightly protrudes, it is Liver Abscess (Gan Yong). (The Qimen point, also known as the Liver Mu point, is located 1.5 cun lateral to the nipple, and another 1.5 cun directly upward.)

The *Suwen* (Basic Questions) states: Liver Abscess presents with fullness in both hypochondria, waking up startled during sleep, and difficulty urinating.

Hua Zhenjun stated: Liver Abscess cannot be treated with acupuncture; internal resolution and dispersion must be employed. (From *Milu*)

Chen Yuangong stated: People who are prone to anger and easily lose their temper may suddenly experience fullness in both hypochondria, accompanied by chills and fever, followed by severe hypochondriac pain that is unbearable upon palpation. People assume this is due to excess Liver Fire, but little do they know that sores have formed on the liver lobes! People only know that the lungs can develop abscesses, unaware that the liver can as well. Moreover, texts such as the *Lingshu* and *Suwen* do not detail this. Is this not a novel theory intended to shock the world? I heard from an unusual person that hypochondriac pain which cannot be touched indicates a liver lobe abscess. The reason the *Lingshu* and *Suwen* did not detail it is that liver abscesses are rare in the world, hence omitted. Since the Qi and Yun of ancient and modern times differ, and the growth of carbuncles and toxins varies, how can we omit discussing the liver's ability to form abscesses? Furthermore, there is logic to the liver forming abscesses. When one becomes angry, the liver lobes expand, and Liver Qi rebels. After great anger, the liver lobes become empty and distended, making it difficult to return to normal. If one continues to get angry, the liver lobes will never rest. Anger generates fire; the more anger, the stronger the fire. Excessive fire burns dry the Liver Blood. Dry blood leads to extreme dryness of Liver Qi. Without blood nourishing the liver, anger increases further. Under these conditions, how could one avoid stagnation and condensation into an abscess? However, since the abscess forms internally, how can it be seen? It can be distinguished externally. Liver abscesses occur on the left side, not the right. The skin of the left hypochondrium will show red-purple discoloration, and the tongue will appear cyanotic. With such differentiation, there will certainly be no error. Treatment must focus primarily on soothing the Liver, assisted by purging fire and removing toxins. One must not delay treatment until ulceration occurs, rendering it incurable.

Huagan Xiaodu Tang (Soothe Liver and Remove Toxin Decoction): Baishao (Paeoniae Radix Alba) and Danggui (Angelicae Sinensis Radix) each 3 liang, Jinyinhua (Lonicerae Japonicae Flos) 5 liang, Heishanzhi (Gardeniae Fructus) 5 qian, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 3 qian. Decoct in water, take three doses until pain stops, then take half the dose. A few doses will lead to complete recovery. (From *Bingjian*. This formula uses Danggui and Baishao to enter the Liver and nourish Liver Blood, rapidly generating blood to ease Liver Blood dryness. Combined with Gancao to relieve urgency, Zhizi to clear fire, and Jinyinhua to detoxify, how could it fail? Only when Fire-Toxin is extremely abundant and Liver Blood is severely deficient is such a large dosage necessary; otherwise, it is futile. If one stubbornly believes this is merely excess Liver Fire rather than a Liver Abscess, and uses only Danggui and Baishao to treat hypochondriac pain, it will certainly be ineffective.)

It is also said: Severe pain in the left hypochondrium, exacerbated by pressure, indicates Liver Abscess, not ordinary hypochondriac pain. Liver Abscess is mostly caused by anger, as discussed in previous sections. However, depression can also cause abscesses. Those caused by anger have sudden pain, while those caused by depression have gradual pain. At the initial stage of pain, a large dose of Xiaoyao San (Free and Easy Wanderer Powder) decocted and drunk will stop the pain immediately. How could it develop into an abscess? Because timely treatment was neglected, the stagnant Qi in the Liver could not be dispersed, causing Blood to congeal. Congealed Blood blocks flow, transforming into pus and forming an abscess. The progression seems slow, but the Liver nature is urgent, and once the abscess forms, the toxin erupts rapidly. Some die within days of hypochondriac pain precisely because of toxic decay from the abscess, not from simple hypochondriac pain. Should one not treat it urgently?

Xuanyu Huadu Tang (Disperse Stagnation and Resolve Toxin Decoction): Chaihu (Bupleuri Radix), Bohe (Menthae Haplocalycis Herba), Xiangfu (Cyperi Rhizoma) each 2 qian, Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Jinyinhua (Lonicerae Japonicae Flos) each 1 liang, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Tianhuafen (Trichosanthis Radix) each 3 qian, Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus Immaturus) each 1 qian. Decoct in water and take orally. Four doses lead to recovery; severe cases require six doses. Afterwards, use a large dose of Siwu Tang (Four Substances Decoction) for regulation to prevent recurrence. This condition is rare in the world, and previous discussions have covered it thoroughly. However, while Liver Abscess is rare, hypochondriac pain is common. I specifically elucidate that depression can form abscesses. If people like this knew to treat it urgently, how would it develop into an abscess?

Zhu Danxi stated: Liver Abscess initially manifests at the Qimen point, characterized by dull pain and slight swelling, causing fullness in both legs, hypochondriac pain, startling when lying on the side, and difficulty in urination. This is caused by indignation, depression, and rebellious Qi. Initially, take Fuyuan Tongqi San (Restore Origin and Unblock Qi Powder), followed by Chaihu Qinggan Tang (Bupleurum Clear Liver Decoction). Once pain and distension cease, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be taken. If there is Spleen deficiency and poor appetite, supplement with Bazhen Tang (Eight Treasures Decoction) to nourish the Kidney and tonify the Spleen.