Library

Whenever wiping pus and soiled paper, it is necessary to place them in a bamboo basket and hang them in a well-ventilated area. This is because necrotic flesh and stagnant pus are all transformations of the body's Qi and Blood. If exposed to the sun at noon, it will cause pain in the wound; if placed in a damp area, the pus will not dry up. After the patient has completely recovered, burn them with a bundle of dry firewood.

Gu Shicheng said: Swollen ulcers (Zhongyang) in the initial stage refer to carbuncles and malignant sores that have just started to develop, presenting with congestion and swelling. Within seven days, before suppuration occurs, they are called "Swollen Ulcers" (Zhongyang). Early treatment allows for internal resolution (Neixiao) of 60-70% of the condition. Even if complete resolution is not achieved, it can shift the pathology from deep to superficial and from severe to mild. However, one must not suddenly use cold-natured external compresses, which would cause ice-like coagulation of the muscle tissue; nor should bitter-cold pills be lightly administered, as this would stagnate Qi and Blood and suppress the郁结 toxic vapors, making resolution difficult. If eight or nine days have passed and internal pus has formed, the method of internal resolution is no longer applicable. Forcing internal resolution at this stage will not only fail to resolve the condition but also deplete Qi and Blood, causing the root of the sore to scatter and the internal pus to fail to drain externally, resulting in thin and clear pus. Therefore, the key to treating swollen ulcers lies in early intervention.

Wang Kentang said: The manifestations of carbuncles and malignant sores appear without fixed locations. To achieve internal resolution during the initial stage of redness, swelling, and aggregation, one should administer herbs that promote Qi circulation and blood activation, detoxify, and reduce swelling. One must examine the depth, size, and meridian location, as well as assess the excess or deficiency in the physical constitution and pulse. For instance, lesions on the head, back, waist, neck, buttocks, and thighs belong to the Taiyang Meridian and are suitable for Huanglian (Coptis Rhizome) and Qianghuo (Notopterygium Rhizome). Lesions on the back extending to the hypochondrium are close to the Shaoyang Meridian and are suitable for Chaihu (Bupleurum Root), along with Baidu San (Detoxification Powder) and Xianfang Huoming Yin (Immortal Life Decoction). In cases of robust physique and excess pulse, Loulu Tang (Arnebia Decoction), Neishu Huanglian Tang (Internal Draining Coptis Decoction), and Zhuodu Wan (Toxin-Chasing Pill) are suitable for unblocking and draining. For Qi deficiency, Renshen (Ginseng Radix et Rhizoma) is the primary herb; for Blood deficiency, Danggui (Angelica Sinensis Radix) and Chuanxiong (Ligusticum Chuanxiong Rhizoma) are primary, assisted by detoxifying herbs. According to the meridian distribution, select guiding herbs to lead the medicinal power to the disease site. Regarding the six meridians: when carbuncles occur in the upper body, the other five meridians follow their respective meridian characteristics of cold/heat and the abundance/scarcity of Qi and Blood for tonification or purgation. Only the Shaoyang Meridian, although described as having abundant Qi and scarce Blood, actually suffers from insufficiency of both Qi and Blood; its treatment follows the same principles as Qi and Blood deficiency. Herbs such as Gualou (Trichosanthes Fruit), Shegan (Belamcanda Rhizome), Chuanshanjia (Pangolin Scales), Jinyinhua (Lonicerae Flos), Xiakucao (Prunellae Spica), Chansu (Toad Venom), Lianqiao (Forsythiae Fructus), Diding (Violae Herba), Niuzi (Arctii Fructus), and Muguaizi (Strychni Semen) serve as internal resolution agents. Formulas such as Xianfang Huoming Yin (Immortal Life Decoction), Neixiao Wan (Internal Resolution Pill), Zhamu Yinzi (Zelkova Decoction), Niujiao Yinzi (Ox Horn Decoction), Cheche San (Cart Track Powder), Fanhun Dan (Soul-Returning Elixir), and Xiaodu Yin (Detoxification Decoction) are known internal resolution formulas. However, one must understand that balancing tonification/purgation and excess/deficiency, and regulating cold/heat to restore Qi and Blood to their normal state, is what enables internal resolution. External applications such as washing with Zigey Tang (Polygonum Vine Decoction) and applying powders or plasters also aim to harmonize Qi and Blood, thereby reducing swelling and clearing heat.

Li Dongyuan said: The generation of carbuncles, malignant sores, and erysipelas arises from disharmony of Yin and Yang, stagnation of Ying and Wei, and lack of flow in Qi and Blood. The ancients said: When Yang stagnates in Yin, sores arise; when Yin stagnates in Yang, malignant sores arise. Sores and malignant sores can originate internally or externally. Internal ones arise within the Zang-Fu organs and chest/abdomen; external ones arise on the surface of skin, flesh, sinews, and bones, appearing without fixed locations. The root of this stagnation is the lack of Qi and Blood flow, preventing steaming Qi from reaching the exterior, leading to retention and internal heat, thus generating sores and malignant sores. If one initially feels Qi and Blood stagnation, with skin and flesh aggregation, swelling but no ulceration, one can dispel wind-heat and unblock the Zang-Fu organs. After one or two treatments, slowly using various decoctions for soaking can achieve internal resolution. Otherwise, if treatment is delayed, toxic heat will not dissipate but instead attack inward, leading to the accumulation of pus and blood. The *Neijing* states: "In treating diseases, one must seek the root." The root of sores and malignant sores lies in the郁结 obstruction of middle-jiao heat and the aggregation of wind-cold pathogens. Treatment should employ warm-natured herbs to harmonize Qi and Blood for internal resolution. Differentiation requires recognizing that wind-cold causes hard, white swelling, while toxic heat causes red, swollen areas. If Qi has already aggregated, the method of internal resolution should not be used; instead, herbs for expelling pus and supporting toxicity expulsion should be employed. This represents the sequence of treatment.

He further stated: "Xiao" (Resolution) means destruction, destroying the morphological signs. The classics say: "All pain, itching, sores, and ulcers belong to Heart Fire." Fire corresponds to the Li Trigram in the Eight Trigrams. Li is outwardly Yang and inwardly Yin. Internal Yin stagnation inevitably attacks outwardly. Treatment should focus on internal resolution to cut off the source and clear the interior, preventing outward eruption, hence termed "Internal Resolution." This applies when symptoms are just beginning to manifest; immediately administering decoctions, pills, or powns orally, combined with external application, unblocks the source and cuts off the toxin, allowing for immediate resolution. If the morphological signs are fully established, this method is no longer used.

Cheng Shanling said: Internal resolution refers to using medication to dissipate swelling and toxins at the very onset. For conditions like carbuncles, back abscesses, opposite-mouth sores, and ding-toxic sores, the initial stage presents with aversion to cold and high fever, resembling Taiyang disease, with pain localized to one area and normal appetite, indicating accumulated pus. However, at the initial stage, pus has not yet formed; it is merely a deviation of Qi and Blood, reversing into the muscle tissues. External application of Yuanzhi Gao (Polygalae Plaster), Jinhuang Ruyi San (Golden Yellow Ruyi Powder), Tiegu San (Iron Hoop Powder), or Pujiu Wanchuan Gao (Universal Salvation Plaster); oral administration of Yinhua Gancao Tang (Honeysuckle and Licorice Decoction) or Neixiao San (Internal Resolution Powder) can achieve immediate resolution. If it is a Ding sore (hard chancre), it should be pricked open, or moxa applied to the swollen area, with Chansu Bing (Toad Venom Cake) applied topically and Wanchuan Gao pasted over it, accompanied by oral Ju Hua Gancao Tang (Chrysanthemum and Licorice Decoction), leading to rapid subsidence. Chrysanthemum, including roots and leaves, is a sacred herb for treating Ding sores. Some cases involve concurrent wind-cold, requiring prior use of Jingfang San (Aster and Saposhnikovia Powder) or Xiongzhi Xiangsu Yin (Ligusticum, Angelica, Perilla, and Platycodon Decoction), or Wanling Dan (Ten Thousand Spirits Elixir) in winter to disperse. Subsequently taking Jinyinhua (Honeysuckle) and Ju Hua (Chrysanthemum) allows for internal resolution. It is crucial to act early and not delay. (From *Ten Methods*)