Library

[Xue Ji] For leg carbuncles (leg abscesses), the meridians involved differ, and thus the treatment methods vary. Those occurring on the medial side belong to the Liver Meridian and Spleen Meridian; those on the lateral side belong to the Gallbladder Meridian and Stomach Meridian. Diffuse swelling with induration indicates deficiency of Yuan Qi (Original Qi); treat with Neibu Huangqi Tang (Internal Supplementing Decoction of Astragalus). High-rising swelling indicates that Yuan Qi is not yet deficient; treat with Neituo Chaihu Huangqi Tang (Internal Supporting Decoction of Bupleurum and Astragalus), combined externally with Garlic-Separator Moxibustion (Ge Suan Wen Fa). If blood stasis stagnates without resolving, or if pus fails to form, use Xianfang Huoming Yin (Immortal Life Elixir). If Qi and Blood are too weak to ulcerate, or if flesh fails to regenerate, use Tuoli San (Supporting Interior Powder). This is a general overview.

A child suffered from a toxic sore on the anterior medial aspect of the leg. After ulceration, the area remained swollen, hard, and dark-colored, with thin pus that failed to heal, and the complexion was greenish-yellow. This indicated Spleen deficiency with Liver hyperactivity, compounded by Cold pathogen invading the affected area. The primary approach should be to strengthen Yuan Qi. Initially, Yigong San (Extraordinary Skill Powder) was administered with added Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), along with Scallion-Moxibustion (Cong Wen Fa). As Spleen Qi gradually recovered and the lesion improved, it was supplemented with Bazhen Tang (Eight Treasures Decoction) and Fermented Soybean Cake (Douchi Bing), leading to recovery.

Another child presented with painful swelling on the lateral leg, with normal skin color. Two doses of Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) caused the swelling to turn red; four more doses reduced the redness; six further doses led to ulceration with thin pus discharge, accompanied by poor appetite and fatigue. Yigong San was given with added Xiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix), while Tuoli San continued to tonify Yuan Qi, resulting in recovery.

A third child exhibited diffuse, hard swelling with unchanged skin color, indicating Yang Qi deficiency preventing pus formation. Tuoli San and Rusheng Bing (Rusheng Cake) were used. Once the swelling rose and turned red, Tuoli Xiaodu San was employed. After pus formed, it was lanced, and the patient gradually recovered using Bazhen Tang with Rougui (Cinnamomi Cortex). Due to food stagnation causing vomiting and diarrhea, the lesion became pale white, and appetite decreased. Liujun Zi Tang (Six Gentlemen Decoction) with Ganjiang (Zingiberis Rhizoma) was used first, followed by Bazhen Tang and Scallion-Moxibustion, leading to recovery.

A fourth child suffered from this condition for a long time without healing, with thin pus, sallow complexion, abdominal distension with visible subcutaneous veins. This indicated Spleen Qi deficiency being overacted upon by Liver Wood. Bu Zhong Yi Qi Tang (Supplement the Middle and Boost the Qi Decoction) was administered in the morning, and Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) in the evening. After Yuan Qi slightly recovered, Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) and Scallion-Moxibustion were added, leading to recovery after more than two months.

A fifth child had a localized swelling on the lateral leg. After taking detoxifying herbs, the swelling worsened, limbs became emaciated, appetite decreased, and pain intensified. I stated: Swelling preceding pain indicates injury to Form affecting Qi; pain preceding swelling indicates injury to Qi affecting Form. One should tonify and connect Yang Qi. The parents did not believe this and continued administering draining/purgative herbs. The child subsequently died. *Jiyao* states: When Ying (Nutritive) and Wei (Defensive) Qi are abundant but obstructed from flowing, causing Qi and Blood blockage and putrefaction into carbuncle, one should use purgation to drain excess heat. However, if due to poor diet, mental exhaustion, weak Qi and Blood, and thin muscles, causing short and stagnant Ying and Wei Qi, where Cold condenses at the pores and obstruction leads to carbuncle, one should use tonification to support deficient Qi. This is indeed true!