Library

The manifestation of carbuncles and sores (Yong Ju) occurs without a fixed location. To achieve internal resolution, one should administer herbs that promote Qi circulation, invigorate blood, resolve toxicity, and reduce swelling at the initial stage when redness, swelling, and nodulation appear. At this time, it is necessary to examine the depth and size of the lesion, its location along the meridians, and the deficiency or excess indicated by the physical constitution and pulse. For instance, lesions occurring on the head, back, waist, neck, and buttocks belong to the Taiyang Meridian (Foot-Taiyang Bladder Meridian), for which Huanglian (Coptidis Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) are suitable. Lesions on the back extending to the hypochondrium are near the Shaoyang Meridian (Foot-Shaoyang Gallbladder Meridian); Chaihu (Bupleuri Radix) is suitable, along with Baidu San (Detoxification Powder) and Xianfang Huoming Yin (Immortal Life-Protecting Decoction). Patients with a robust physique and an excess pulse are suitable for Loulu Tang (Radix Euphorbiae Humifusae Decoction), Neishu Huanglian Tang (Internal-Draining Coptis Decoction), and Zhuidu Wan (Poison-Chasing Pill) to promote drainage and unblocking. For those with Qi deficiency, Renshen (Ginseng Radix et Rhizoma) serves as the principal herb; for Blood deficiency, Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) serve as the principal herbs, assisted by detoxifying herbs, and guided by meridian-specific directing herbs according to the affected meridianal region to reach the disease site. For carbuncles and sores in the six meridianal regions, the other five meridians should be treated according to their respective characteristics, distinguishing between root and branch, cold and heat, and the relative abundance or scarcity of Qi and Blood, applying tonification or purgation accordingly. The Shaoyang Meridian alone, although described as having abundant Qi and scarce Blood, actually presents with insufficiency in both Qi and Blood; its treatment follows the same principles as for Qi and Blood deficiency. Herbs such as Gualou (Trichosanthis Fructus), Shegan (Belamcandae Rhizoma), Chuanshanjia (Manis Squama), Jinyinhua (Lonicerae Japonicae Flos), Xiakucao (Prunellae Spica), Chansu (Bufonis Venenum), Lianqiao (Forsythiae Fructus), Diding (Violae Herba), Shunianzi (Arctii Fructus), and Mubiezi (Strychni Semen) are classified as internal-resolving herbs. Formulas such as Xianfang Huoming Yin (Immortal Life-Protecting Decoction), Neixiao Wan (Internal-Resolution Pill), Zuomu Yinzi (Zuomu Decoction), Niujiao Yinzi (Ox-Horn Decoction), Che'ao San (Chambered Nautilus Powder), Fanhun Dan (Soul-Returning Elixir), and Xiaodu Yin (Detoxification Decoction) are classified as internal-resolving formulas, which are well known. However, one must not forget that applying tonification and purgation, addressing deficiency and excess, and regulating cold and heat to restore the normal state of Qi and Blood is what enables internal resolution. External applications, such as washing with Zige Tang (Purple Vine Decoction) and applying powders or plasters, also aim to harmonize Qi and Blood, thereby reducing swelling and heat. Xue Xinfu stated: In treating sores and ulcers, one must observe the transmission through meridians, the interior or exterior nature of the disease, and the deficiency or excess of the person, then decide whether to attack or tonify. If there is swelling, pain, heat, thirst, and constipation, the pathogen is in the interior, and draining methods should be used. If swelling arises with pain, accompanied by aversion to cold, fever, and headache, the pathogen is in the exterior, and dispersing methods should be used. If swelling and pain are severe, the pathogen is in the meridians, and harmonizing methods should be used. If there is slight swelling and pain without suppuration, it indicates Qi and Blood deficiency, and tonifying and supporting methods should be used. If there is diffuse swelling without pain, or failure to suppurate, or suppuration without rupture, it indicates severe Qi and Blood deficiency, and vigorous tonification should be employed. If the color is dark with slight swelling and pain, or if pus forms but does not discharge, or if necrotic tissue does not slough off, it indicates Yang deficiency and cold, and warming and tonifying methods should be used. If one rigidly adheres to the idea that the sore has not yet ruptured and indiscriminately uses toxic-resolving drugs, it will further damage the Spleen and Stomach. Not only will the swollen area fail to suppurate, but the ruptured area will also have difficulty healing, leading to the emergence of the Seven Evil syndromes (critical conditions in TCM surgery), often resulting in untreatable cases. Master Danxi said: In external abscesses (Zhongyang), where there is blockage internally and externally, the primary approach should be supporting the interior and dispersing from the exterior. If one wishes to use Dahuang (Rhei Radix et Rhizoma), it may be considered rash. In ulcerated sores (Kuangyang), where there is deficiency internally and externally, the primary approach should be supporting the interior and replenishing. If one wishes to use aromatic dispersants, it inevitably leads to the error of further depleting the deficient. Practitioners must exercise caution.