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[Main Discussion on Water Carbuncle]

When small sores suddenly appear on a person's hands and feet, with the surrounding area red and swollen, and a single spot in the center as black as lacquer, hard as stone, and intolerably painful, it is called Shuiding (Water Carbuncle). After rupture, only bloody fluid flows out. (From *Qixuan*)

Treatment for Shuiding: Take Tu Niuxi (Achyranthes Bidentatae Radix) in any quantity, pound it into a paste, mix with a small amount of salt, and apply to the upper half of the carbuncle. It will heal in half a day.
Another prescription: Chen Bi Tu (Old Wall Earth), Shi Yan (Halitum), each 1 qian; Xiong Huang (Realgar), 3 fen. Grind all into fine powder, mix with saliva to form a paste, and apply to the carbuncle. The carbuncle will naturally fall off.
Shuiding: Collect [herb] (specific herb name missing in original text) at noon on the fifth day of the fifth lunar month, grind into fine powder, mix with wine, take 3 qian orally, inducing sweating.
Another prescription: Apply one lychee meat to the carbuncle, drink raw baijiu until drunk and sweating occurs.

Hu Gongbi states: Hongsi Ding (Red Thread Carbuncle), also known as Ji Ding (Urgent Carbuncle), arises between the elbows and wrists of the hands and feet. Initially, it is the size of a soybean, colored like a crimson robe. The root of this carbuncle spreads like an arrow, advancing one chi two cun per day and night, resembling a red thread. This is caused by excessive joy or anger leading to reverse flow of Qi and Blood. If the toxin enters the heart and abdomen, it causes confusion and is incurable. In such emergencies, locate the red thread, immediately puncture its root with a divine needle to a depth of four or five fen, extract purple-black foul blood, urgently administer Zhuding Duoming Dan (Carbuncle-Chasing Life-Snatching Pill), and immediately drink Fuping Jiu (Duckweed Wine). It will heal instantly. (From *Wukui Qingnang*)

Fuping Jiu (Prescription of Lu Bodi): Cures Hongsi Ding with one dose. Take Fuping (Lemna Minoris Herba) in any quantity, pound into a paste, boil in one or half a jin of good wine, add the Fuping paste, and steep for about half an hour. Drink the entire volume orally, while chewing Fuping grass and applying it topically to the carbuncle.

[Main Discussion on Yángméi Chuāng - Syphilitic Chancre]

Chen Shigong states: Yángméi Chuāng (Syphilitic Chancre), also known as Shichuang (Seasonal Chancre) or Daichuang (Vile Chancre) in common parlance, is named for its resemblance to a bayberry. It is generally transformed from Damp-Heat and Evil Fire. When it first appears on the upper body, with skin itching but no bone/joint pain, and lesions that are small and dry, it indicates transmission via Qi transformation, involving toxicity in the Spleen and Lung. Since the toxin is confined to the skin and has not penetrated inward, it is a mild condition. It is appropriate to use Wanling Dan (Ten Thousand Spirits Pill) to induce sweating for natural resolution. If it first appears on the lower body, accompanied by significant bone/joint pain, and difficult, dribbling urination, with lesions that are large and hard, it indicates deep penetration via essence transformation, involving toxicity in the Liver and Kidney. Since the toxin is in the marrow and has not yet reached the skin, it is a severe condition. It is appropriate to use Jiulong Dan (Nine Dragons Pill) to promote urination and drain the toxin from the bones. One must wait until the internal toxin is resolved, bone/joint pain ceases, and the base of the sore becomes pale white before applying topical medicines. Seeking quick results by indiscriminately using fumigation or rubbing agents will surely cause lingering complications; both physicians and patients must exercise caution. (From *Zhengzong*)

Feng Luzhan states: Yángméi Chuāng is named for its shape. Those acquired through Qi infection present as firm and raised, also known as Mianhuachuang (Cotton Chancre); those acquired through Blood infection present as flat, folded, and ulcerated, also known as Guozichuang (Fruit Chancre); these names mimic their appearance. In the North, it is called Tianpaochuang (Heaven Blister Chancre); although the names differ, the pathology is the same, though treatment requires distinction. Self-inflicted cases are severe; contagious cases are mild. Self-inflicted cases result from excessive lust, leading to initial symptoms in the genital region, and indulgence in diet causing Heat in the Triple Burner, exhaustion of Essence, stagnation of Blood, and retention in the meridians. Contagious cases arise from deficiency of Middle Qi and lighter external infection. However, patients must absolutely avoid using toxic substances to induce eruption, nor should they use Cold medicines to suppress it while seeking quick results. Treatment should involve decoctions to resolve toxicity, tonify and support to expel pathogens, external washing with decoctions, and application of plasters to draw toxins outward, ensuring no lingering complications. (From *Jinnang*)

Shen Douyuan states: Yin Yángméi Chuāng differs significantly from Yang Yángméi Chuāng. Yin Yángméi Chuāng presents with red color but does not elevate or ulcerate, indicating Wind-Heat toxicity absorbed into the Blood. He also states that men may contract this from women suffering from syphilis through contact with toxic filth. (From *Qixuan*)
He further states: Fanhua Yángméi Chuāng (Flower-Reversing Syphilitic Chancre) results from superficial deficiency and rampant toxin vapors.
He also states: Yangmei Dounzi (Bayberry Bean) indicates mild toxin vapor and light infection.
He also states: Yangmei Xuan (Syphilitic Tinea) occurs when patients consume beef during the illness, scratch itches while bathing in the wind, or engage in sexual desire, resulting in a foul odor over the whole body, dryness with white scales, or dripping foul fluid. Treatment must differentiate based on Qi/Blood status and location on the body.
He also states: Consuming pig intestines and viscera during Yángméi Chuāng can cause recurrence of ring-shaped sores after healing.

Chen Yuan Gong states: There are cases where individuals engage in promiscuous sex, feeling needle-like pain in the urethral meatus, indicating the toxin has passed. Soon, Yu Kou (Fish Mouth Chancre) appears, followed by Gan Chuang (Chancre Ulcer), and then sores cover the body. With abundant yellow pus and unbearable rot, people assume the toxin is strong and frequently use detoxifying herbs. They do not realize that constantly using detoxifying herbs increases the toxin and the number of sores, leading to death from rotting. The Yángméi toxin enters during ejaculation when Yuan Qi (Original Qi) is depleted, allowing the toxin to exploit the deficiency. If Yuan Qi is robust, the toxin cannot penetrate deeply; even if contracted, it remains mild and can be cured with purgation. Generalized toxic sores indicate severe deficiency with deep-seated toxin; without tonifying deficiency while draining toxin, how can efficacy be achieved? Using only detoxifying herbs is akin to pushing someone down a well. Ersheng Tang: Sheng Huangqi (Astragali Radix) and Tu Fuling (Smilax Glabrae Rhizoma), each 3 liang; Sheng Gancao (Glycyrrhizae Radix et Rhizoma), 3 qian. Decoct in water and take orally. After four doses, sores gradually turn red; after another four doses, they dry up; after four more doses, recovery is complete. This formula does not primarily aim to detoxify but uses Huangqi to tonify Qi; when Qi is robust, pathogens cannot remain. Combined with Gancao’s ability to transform toxin and Tu Fuling’s ability to guide toxin out, the toxin is removed without damaging Zheng Qi (Upright Qi), and generated Qi nourishes Blood. This is the subtlety of treatment, unknown to many, which is lamentable. (From *Bianzheng Bingjian*)

Hu Gongbi states: Yángméi Chuāng is also known as Shenren Chuang (Amomum Chancre). Its onset is due to excessive sexual desire and exposure to filthy toxic contaminants, or following prior Xia Gao (Genital Chancre) or Heng Xuan (Bubo). As this chancre begins to emerge, faint red spots should be visible on the palms. Physicians must not greedily seek profit by secretly using Qinfen (Calomel) to conceal symptoms. Once Yángméi Chuāng is treated with Qinfen, the toxin penetrates the sinews and bones like oil entering dough, becoming intractable. This leads to lifelong bone pain, condensation of toxin with ulceration, affecting everything from the head and facial orifices to the penis, causing tissue destruction. Alas, the harm of Qinfen is indescribable! Patients often ignore public opinion and seek quick cures. Physicians must fully express the toxin, driving it outward, ensuring no lingering complications. (From *Wukui Qingnang*)
He also states: In cases of generalized Yángméi Chuāng, if one or two lesions are dark purple/black like smoked plums and extremely painful, preventing other sores from erupting, this is Yangmei Ding (Bayberry Carbuncle). Similar to how Douding (Pox Carbuncle) obstructs progression, it prevents maturation and suppuration. Puncture to bleed and administer formulas containing Tu Fuling to support the interior.
He also states: Early Yángméi Chuāng resembles blisters with peeling white skin. Peeling layer by layer, up to thirty or forty layers, before breaking open. Administer Renshen Fuling Tang (Ginseng and Poria Decoction). Do not use plasters until the toxin has broken through. If already ruptured, apply Meilou Gao (Bayberry Leak Plaster) until the flesh levels out, then remove the plaster.

Jiang Shiji states: In summary, Yángméi Chuāng should be dispersed rather than suppressed; the key is eradication, not seeking rapid cure. Understanding this principle is essential. (From *Shuoyue*)

*Guang Biji* states: Some used Mercury and Strychnos Nux-vomica rubbed on the five centers to treat Yángméi Chuāng, causing the patient to suffer tongue erosion, tooth loss, and throat ulceration within three days. A foul odor filled the room, and they vomited liver-colored necrotic tissue. With no bowel or bladder movement, inability to swallow liquids, and abdominal distension nearing death, the condition was critical. To treat this, press the patient's abdomen; if painless, the distension is not hard, the toxin has not reached the Heart, and the toxin is shallow. Rapid treatment can be effective. Use two jin of Lead, divided into over a hundred pieces, combined with a large dose of Ganjie Tang ingredients: Jinyinhua (Lonicerae Japonicae Flos) and Gancao (Glycyrrhizae Radix et Rhizoma), each 4 liang, in thirty bowls of water. Boil to a concentrated decoction. First, drink three or four bowls, slowly pouring the remainder onto the tongue to flow freely. Irrigate for one shichen (two hours), after which tongue mobility returns and the mouth is cleansed. Then have the patient drink several cups. Re-boil the dregs, mix with the remaining liquid, and frequently wash the hands and feet. The next day, numerous amounts of black water are excreted from bowels and bladder, bringing stability. Then use oral powders and internal detoxifying and supporting formulas for recovery.

Gu Shicheng states: Yángméi Chuāng is also called Mianhuachuang (Cotton Chancre) because it is persistent and hard to eradicate. It is also called Zhou Chuang (Elbow Chancre). It arises from abnormal seasonal Qi and invasion of pathogenic factors, resembling a bayberry, appearing above or below, persistently. It is caused by impure sexual intercourse and郁结 (stagnation) of Lust-Fire toxicity. If transmitted via Qi transformation, it is mild, entering the Spleen and Lung first, appearing on the upper body with skin itching but no bone pain, small and dry lesions, with toxin confined to the skin and not penetrating inward; treatment should focus on dispersing. If contracted through illicit sexual intercourse and essence contamination, it is severe, flowing to the Liver and Kidney, starting with Xia Gao, then Yu Kou, appearing first on the lower body, spreading to the whole body, becoming large and hard, with significant bone pain and difficult urination; this is the most severe condition. Because the toxin penetrates internally to the marrow and externally to the skin/hair, unless sweating and purging are used together, how can the organs be cleansed? If the sores have been present for a long time, Qi and Blood are deficient, but the toxin remains, treatment should prioritize resolving toxicity and supporting expulsion. Only when bone/joint pain ceases, the base of the sores becomes pale white, and internal toxin is scattered, should point-treatment medicines be used. Mild cases take six months; severe cases take one year to recover. Deviating from this method and seeking quick cures through fumigation, rubbing, or inhalation often leads to chronic complications.