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A question was asked: "What is the condition of toxic sores arising on the cheeks and face?" The answer was: "This is named 'Facial-Jaw Carbuncle' (Saihan Fa). When the flesh swells but does not adhere to the bone, it is called 'Cheek Swelling' (Sai). Both belong to wind-heat affecting the Yangming channel. One should urgently administer Huoming Yin (Life-Saving Decoction) with added Xuan Shen (Scrophulariae Radix), Huang Qin (Scutellariae Radix), and Lian (Coptidis Rhizoma), decocted in water and wine, and take Zijin Dan (Purple Gold Pill) to induce sweating." Another question was asked: "What about a carbuncle occurring one cun and three fen anterior to the ear, below the zygomatic bone and above the jaw?" The answer was: "This is named 'Chin Carbuncle' (Yi Fa). Ancient texts state this is an untreatable condition, caused by heat-toxin attacking upward from the Yangming channel. It is suitable to administer Huoming Yin (Life-Saving Decoction) with added Sheng Ma (Cimicifugae Rhizoma), Jie Geng (Platycodonis Radix), and Huang Lian (Coptidis Rhizoma), decocted in water and wine, and take Zijin Dan (Purple Gold Pill) or Duoming Dan (Life-Seizing Pill) to induce sweating. For those with strong constitutions, Yili Jin Dan (One-Pill Golden Pill) should be used to purge; for the elderly and weak, Shiquan Dabu Tang (Decoction for Complete Great Tonification), Huang Qi Neituo San (Astragalus Internal-Supporting Powder), and Renshen Yangrong Tang (Ginseng Nourishing-Nourishment Decoction) are indicated. If treated improperly, the condition may spread to the throat, leading to ulceration, perforation, inability to eat, and death.

I once observed a woman suffering from this condition who happened to have her menses. A physician mistakenly used purgatives, leading to vomiting, inability to eat, and death. Another patient suffered from this condition; the physician applied cauterizing topicals, causing foul-smelling ulceration, which led to rising deficiency-fire, hemoptysis, expectoration, delirium, and death.

Xue Ji noted: The cheek area belongs to the Foot-Yangming Stomach Channel. It may be caused by external invasion of wind-heat or internal accumulation of heat. If there is swelling, pain, and alternating chills and fever, use Baizhi Weifeng Tang (Angelica Dahurica Wind-Guarding Decoction). If there is internal heat with swelling and pain, use Shengma Lianhuang Tang (Cimicifuga and Coptis Decoction). If there is external swelling and pain with internal heat and dry mouth, use Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction). If caused by internal cold injuring yang, preventing resolution and suppuration, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). If there is fever with thirst and constipation, use Jiawei Qingliang Yin (Modified Cooling Beverage). If exterior and interior symptoms are resolved but swelling and pain persist, indicating impending suppuration, use Tuoli San (Internal-Supporting Powder). If appetite is poor due to weak stomach qi, use Liujunzi Tang (Six Gentlemen Decoction). If limbs are fatigued due to weak yang qi, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). If pus has erupted but swelling and pain persist, indicating unresolved heat-toxin, use Tuoguo Xiaodu San (Supporting-Expelling Toxin Powder); if pain persists after pus discharge, indicating qi and blood deficiency, use Renshen Neituo San (Ginseng Internal-Supporting Powder). If there is afternoon fever, indicating yin-blood deficiency, use Bazhen Tang (Eight Treasures Decoction). If there are aversion to cold and fever, indicating combined qi and blood deficiency, use Shiquan Dabu Tang (Decoction for Complete Great Tonification). If swelling and pain extend to below the ear, it belongs to the Hand and Foot Shaoyang channels, requiring clearing of liver fire. If it extends to the chin and behind the ear, it belongs to deficiency-fire of the Foot-Shaoyin Kidney channel, requiring tonification of kidney water. Many cases go untreated because physicians stick to the theory of wind-heat and stubbornly use draining and attacking medicines.

Note: The *Suwen* states: 'In kidney heat, the chin first becomes red.' Thus, the chin belongs to the Foot-Shaoyin Kidney channel. However, current physicians name the sharp toxin occurring one cun and three fen behind the ear as 'Facial-Jaw Carbuncle,' which corresponds to the Shaoyang territory. Why did Xue also consider it belonging to the Foot-Shaoyin Kidney channel and recommend tonifying kidney water? Because the kidney is the residence of ministerial fire; when the residence is intact and secure, the fire returns to rest. Therefore, treating the kidney is precisely how one treats the Shaoyang. This condition often occurs in patients with incomplete sweating during Shanghan (Cold Damage). It can also arise from lingering pathogenic heat in miscellaneous diseases affecting the chin. Medication should be used promptly to dissipate it; if neglected until suppuration occurs, treatment becomes difficult. If draining medicines are taken without nourishing qi and blood, perforation of the throat and death will result.

A man over thirty years old, after a summer febrile disease, developed a chin toxin. After many days without suppuration, his breath was faint, appetite decreased, and he had fecal incontinence. His pulse was imperceptible. The classics state: 'When the pulse seems present yet absent, fine and minute, it indicates decline of yang qi.' Qi stated: 'Inability to eat and loose stools indicate deficiency of the intestines and stomach.' I prescribed Liujunzi Tang (Six Gentlemen Decoction) with Pao Jiang (Prepared Ginger), Rou Dou Kou (Myristica Seed), and Po Gu Zhi (Psoralea Fruit). After several doses, diarrhea stopped slightly, and food intake improved. I then added Huang Bo (Phellodendri Cortex), Dang Gui (Angelica Sinensis), and Rou Gui (Cinnamon Bark). Upon suppuration, the pus was clear and thin. I added Shu Fu Zi (Prepared Aconite Root, 1 qian) to each dose. After several doses, diarrhea ceased, food intake increased, and pus thickened. Finally, I used Shiquan Dabu Tang (Decoction for Complete Great Tonification) with Jiu Chao Shao Yao (Wine-Fried Peony Root) and Bai Lian (Marsdeniae Rhizoma), resulting in recovery after more than a month.

Chen Yongzhi, a government official, took diaphoretic agents. Although chills and fever subsided, swelling and pain persisted, indicating blood stasis impending suppuration. I used Tuoli Xiaodu San (Internal-Supporting Toxin-Expelling Powder) to form pus, and Tuoli San (Internal-Supporting Powder) to promote rupture. However, clear pus and thirst indicated qi and blood deficiency. I used Bazhen Tang (Eight Treasures Decoction) with Mai Men Dong (Ophiopogonis Tuber) and Wu Wei Zi (Schisandra Berry), resulting in recovery after more than thirty doses.

Lu Maoshu, a scholar-official, suffered from this condition with a rapid chi pulse, indicating insufficiency of the Kidney channel. He mistakenly took detoxifying agents, damaging yuan qi and failing to recover. I cured him using Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) and Liuwei Wan material (Six-Ingredient Pill with Rehmannia).

Xiong Dongqing, a scholar-official, suffered from this behind the chin. With clear pus, emaciation, seminal emission, night sweats, afternoon fever, thirst, and surging phlegm-qi, he failed to recover for a long time. His pulse was large and forceful but fine and minute upon deep pressure, indicating kidney qi depletion. I used Jiawei Bawei Wan material (Modified Eight-Ingredient Pill) and Shiquan Dabu Tang (Decoction for Complete Great Tonification), resulting in recovery.

A woman, constitutionally prone to internal heat, experienced anger-induced swelling and pain from below the ear to the neck, with chills and fever. This was liver-gallbladder fire-dryness with blood deficiency. I used Chaihu Zhizi San (Bupleurum and Gardenia Powder) to resolve swelling and pain, Jiawei Xiaoyao San (Modified Free Wanderer Powder) to resolve chills and fever, and Bazhen Tang (Eight Treasures Decoction) with Mu Dan Pi (Moutan Cortex) to stop internal heat.

Liaoqiao Baidu San (Forsythia and Toxin-Expelling Decoction): Treats initial swelling of Facial-Jaw Carbuncle; takes this to dissipate it.
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Liao Qiao (Forsythiae Fructus), Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), Chai Hu (Bupleuri Radix), Sheng Ma (Cimicifugae Rhizoma), Jie Geng (Platycodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Niu Bang Zi (Arctii Fructus), Dang Gui Wei (Angelicae Sinensis Radix Caulis), Hong Hua (Carthami Flos), Su Mu (Sappan Lignum), Tian Hua Fen (Trichosanthis Radix).
Usage: Decoct one cup of water and one cup of good wine together until one cup remains. Strain and drink warm slowly. If not dissipated, add Chuan Shan Jia (Manis Squama, fried with clam powder, 1 qian). If swelling spreads to the face, add Xiang Bai Zhi (Angelica Dahurica, 1 qian) and Lou Lu (Euphorbiae Humifusae Radix, 0.5 qian). If stool is dry and solid, add Jiu Jin Da Huang (Rhei Radix et Rhizoma soaked in wine, 1.5 qian), doubling the dose for strong constitutions. For internal heat or alternating chills and fever, double Chai Hu (Bupleuri Radix), add Jiu Xi Huang Qin (Scutellariae Radix washed in wine, 1 qian), and Jiu Chao Huang Lian (Coptidis Rhizoma stir-fried with wine, 1 qian).

Jiawei Xiaodu Yinzi (Modified Toxin-Expelling Beverage): Treats cheek swelling.
Ingredients: Fang Feng (Saposhnikoviae Radix), Jing Jie (Schizonepetae Spica), Liao Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Qiang Huo (Notopterygii Rhizoma et Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) in equal parts.
Usage: Coarsely powder these ingredients. Decoct in water and take three liang. First dissipate the toxin, then apply medicine to the swollen cheek. Do not apply topical medicine first, or the toxin vapor may enter the throat, leading to untreatable conditions.

Neituo Xiaodu San (Internal-Supporting Toxin-Expelling Powder): Treats Facial-Jaw Carbuncle with pus that cannot be dissipated; take whether ruptured or not.
Ingredients: Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Jie Geng (Platycodonis Radix), Liao Qiao (Forsythiae Fructus), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Jin Yin Hua (Lonicerae Japonicae Flos), Gan Cao Jie (Glycyrrhizae Radix et Rhizoma with nodes).
Usage: Decoct one cup of water and one cup of good wine together until one cup remains. Strain and drink warm slowly. For ruptured sores, apply Xuanwu Gao (Black Tortoise Ointment). For persistent redness and swelling around the wound, apply the following topical medicine and simultaneously take La Fan Wan (Beeswax and Realgar Pill), which is best.

Xiaodu Jiuku San (Toxin-Expelling and Suffering-Saving Powder): Reduces swelling and expels toxins. Mix with rice vinegar and apply. Cover the surrounding area but leave the head (center) exposed. Reapply if dry.
Ingredients: Da Huang (Rhei Radix et Rhizoma), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex), Fu Rong Ye (Hibisci Mutabilis Folium), Da Ji Gen (Cirsii Japonici Radix), Bai Ji (Bletillae Rhizoma), Bai Lian (Marsdeniae Rhizoma), Tian Nan Xing (Arisaematis Rhizoma), Ban Xia (Pinelliae Rhizoma), Hong Hua (Carthami Flos), Tan Hua (Styracis Resina), Dang Gui Wei (Angelicae Sinensis Radix Caulis), Chi Xiao Dou (Adzuki Bean), Bai Zhi (Angelicae Dahuricae Radix) at 1.5 qian each; Pu Xiao (Natrii Sulfas), Xiong Huang (Realgar) separately ground into powder, at 1 qian each.
Another prescription: Use Jian Xiao Xiao Cao (Euphorbia humifusa), Sheng Bai Ji (Fresh Bletillae Rhizoma), Bai Lian (Marsdeniae Rhizoma), Tu Da Huang (Polygoni Cuspidati Radix), Sheng Da Ji Gen (Fresh Cirsii Japonici Radix), Ye Zhu Ma Gen (Boehmeriae Niveae Radix). Pound together into a cake, mix with 1 qian of Pu Xiao (Natrii Sulfas), apply to the swelling leaving the center exposed. Replace if dry. Adding Shan Ci Gu (Iphigeniae Bulbus) and Jin Xian Chong Lou Gen (Paris Polyphyllae Rhizoma) is even better.

Baihe San (Lily Powder): Treats chin ulcers, also known as 'Single-Bone Ulcer'.
Ingredients: Bai He (Lilii Bulbus), Huang Bo (Phellodendri Cortex) at 1 liang each; Bai Ji (Bletillae Rhizoma) at 1.5 qian; Bi Ma Zi (Ricini Semen) 50 grains, pounded.
Usage: Grind into powder. Make a cake with Pu Xiao (Natrii Sulfas) and water, and apply. Apply three to five times daily.

Erjin San (Two Glands Powder): Treats adults and children with ulcers penetrating the cheeks, initially appearing like millet or beans, named 'Han Sai Chuang' (Holding-Cheek Ulcer).
Ingredients: Ji Nei Jin (Galli Gigerii Endothelium Corneum), Yu Jin (Curcumae Radix).
Usage: Grind into fine powder. Rinse mouth with salt water first, then apply.

Furong Fu Fang (Hibiscus Poultice Formula): Treats cheek-jaw swelling and pain, or ruptured ulcers.
Ingredients: Fu Rong Ye (Hibisci Mutabilis Folium) as needed.
Usage: Pound until soft and apply. Secure with cloth, changing once daily.

Shenxiao Fang (Divine Efficacy Prescription): Treats cheek conditions, as well as carbuncles, back infections, boils, etc.
Ingredients: Chi Xiao Dou (Adzuki Bean) ground into fine powder.
Usage: Mix with fresh well-water and apply to the sore and surrounding red/swollen areas. Reapply if dry.