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Shen Douyuan stated: Pi Yong (Spleen Abscess) arises at the Jianzhen (Shoulder True, SI9) and Shu acupoints. This relates to the Hand-Taiyang Small Intestine Meridian, which is characterized by abundant blood but deficient Qi, and is also caused by the Spleen being affected by rich and greasy foods. Sweating therapy should be employed. The Classics state: "Sweating will cure the ulcer." (From *Qi Xuan*)

Li Dongyuan stated: Pi Yong is also known as Bei Ju (Back Carbuncle), located behind the shoulder, in the gap between the divergent bones of the outer layer below the posterior axilla. Both left and right sides belong to the Jianzhen (Shoulder True, SI9) acupoint of the Small Intestine Meridian. It is formed by the coagulation of Wind and Fire pathogens.

He further stated: If it occurs above the anterior shoulder and anterior axilla, in the hollow of the bone joint opening and closing, identical on both sides. Initially, it resembles a pepper seed, gradually swelling and hardening to the size of a goose egg. Pressing causes pain penetrating to the bone. It belongs to the Pericardium Collateral Meridian and is named Le Ju (Joy Carbuncle). It is formed by Blood Heat and Qi Stagnation.

[Image: Pi Yong]

*Xuan Ji* states: An ulcer on the lateral aspect of the arm is called Yong (Abscess); one on the medial aspect is called Yudu Fa (Fish Belly Eruption); swelling in the upper segment of the arm extending to the shoulder is called Bi Feng Du (Arm Wind Toxicity).

Wang Kentang stated: When an abscess or boil erupts from the elbow on both arms down to the junction with the bone, radiating to the small bone of the hand, although this presents as an Excess pattern, it connects to the large and small tendons and bones, causing difficulty in movement. Hanging the hand down often causes a dragging pain. If the pus is deep and penetrates the bone, it damages the tendons and vessels, leading to fist contraction and inability to extend, spasms, and convulsions. Slow-acting tendon-soothing medications should be urgently administered. (From *Zhun Sheng*)

Shen Douyuan stated: Arm abscess toxicity involves the Heart and Kidney meridians connecting to the five fingers. Toxic qi flows and forms a chain-like sinus tract. (From *Qi Xuan*)

*Xin Fa* states: Yudu Fa occurs in the hanging flesh behind the buttocks region. The swelling is red, belonging to the Qingling (Azure Spirit, HT8) acupoint of the Heart Meridian. It is formed by the coagulation of Fire toxicity.

Chen Yuangong stated: When a sore suddenly appears on the arm and transforms into an abscess or carbuncle, it is also classified as Yin Yong (Yin Abscess). Although slightly less severe than those on the head, face, mouth, shoulders, or back, if treated improperly, it can still be fatal. Therefore, differentiation between Yin and Yang patterns is essential. Generally, pain indicates a Yang pattern, while itching indicates a Yin pattern. For a Yang pattern, one to two doses of Sanxing Tang (Three Star Decoction) can eliminate it immediately. However, this formula is contraindicated for a Yin pattern. One must strongly tonify Qi and Blood, assisted by herbs that resolve phlegm and transform toxicity, to achieve success. Do not neglect tonifying deficiency simply because the hands and feet are not vital organs like the heart or abdomen. Yin governs stillness, whereas the hands are highly mobile. Extreme mobility generating a Yin abscess implies a transformation from motion to stillness, which is contrary to normal physiology; how can one not fear this? Moreover, moving towards stillness is a path towards Yin. Yang shifting towards Yin is akin to approaching death. It is easy for Yang to revert to Yin, but difficult for Yin to revert to Yang. Who would consider an arm abscess trivial? Xiaoyong Huanyang Dan (Abscess-Resolving Yang-Restoring Pill): Ren Shen (Ginseng Radix et Rhizoma), Fen Hua (Tianhuafen, Trichosanthis Radix), and Sheng Gan Cao (Raw Licorice Root) each 3 qian; Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Sheng Huang Qi (Raw Astragalus Root) each 1 liang; Rou Gui (Cinnamon Bark) and Ru Xiang Mo (Frankincense Powder) each 1 qian; Jin Yin Hua (Honeysuckle Flower) 2 liang; Dang Gui (Angelica Sinensis Radix) 5 qian. Decoct in water and take orally. After one dose, itching turns to pain; after two doses, pain ceases; after three doses, it completely resolves. (From *Bing Jian*. Note: This formula is similar to Qisheng Tang, but its intent and indications differ. Qisheng Tang treats already ulcerated lesions, focusing first on flesh regeneration. This formula treats un-ulcerated lesions, focusing on protecting the muscle tissue. Thus, Qisheng Tang lacks Ru Xiang Mo and Tian Hua Fen, whereas this formula includes them to provide protective support amidst attacking the pathogen.)

[Image: Bi Feng Du]

Hu Gongbi stated: Arm abscesses can result from long-distance travel through water, exposure to wind, rain, cold, and dampness during the journey, or irregular diet. The condition may be slightly milder, and treatment should primarily use Fangfeng Chushi Wan (Saposhnikovia-Dampness-Expelling Pill). (From *Qing Nang*)

Feng Luzhan stated: Regarding arm abscesses, the anterior aspect belongs to the Hand-Yangming Large Intestine Meridian, the posterior aspect to the Hand-Taiyang Small Intestine Meridian, the lateral aspect to the Hand-Shaoyang Sanjiao Meridian, and the medial aspect to the Hand-Jueyin Pericardium Meridian. The inner-anterior aspect belongs to the Hand-Taiyin Lung Meridian, and the inner-posterior aspect to the Hand-Shaoyin Heart Meridian. Ultimately, these arise from heat stagnation in the meridians, external invasion by Wind pathogens, and disharmony of Qi and Blood. Treatment should differentiate by meridian, using drugs specific to that meridian as guiding agents to promote Qi and Blood circulation, leading to spontaneous recovery. (From *Jin Nang*)

Li Dongyuan stated: The arm (defined as the segment from elbow to wrist) lateral side belongs to the Three Yang meridians, and the arm interior belongs to the Three Yin meridians. All are caused by uneven circulation of Ying (Nutritive) and Wei (Defensive) Qi, invasion of Wind pathogens, and rebellion within the muscle layers. If already ulcerated, accompanied by fist contraction and inability to extend, with pain penetrating to the bone, it indicates deep ulceration damaging the vessels, which is considered a Ni (Rebellious/Adverse) pattern.

Li Dongyuan stated: There are six pathways for arm pain, which respond well when combined with meridian-guiding drugs. With both hands extended and hanging down, thumb forward and little finger backward, one can determine the location: Pain in the anterior aspect belongs to the Yangming Meridian, guided by Sheng Ma (Cimicifugae Rhizoma), Gan Ge (Puerariae Radix), and Bai Zhi (Angelicae Dahuricae Radix); pain in the posterior aspect belongs to the Taiyang Meridian, guided by Gao Ben (Ligustici Chuanxiongzhong Rhizoma) and Qiang Huo (Notopterygii Rhizoma et Radix); pain in the lateral aspect belongs to the Shaoyang Meridian, guided by Chai Hu (Bupleuri Radix); pain in the medial aspect belongs to the Jueyin Meridian, guided by Chai Hu (Bupleuri Radix) and Qing Pi (Citri Reticulatae Pericarpium Viride); pain in the inner-anterior aspect belongs to the Taiyin Meridian, guided by Sheng Ma (Cimicifugae Rhizoma) and Bai Zhi (Angelicae Dahuricae Radix); pain in the inner-posterior aspect belongs to the Shaoyin Meridian, guided by Xi Xin (Asari Radix et Rhizoma) and Du Huo (Angelicae Pubescentis Radix).