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[Xue Ji] Abdominal carbuncle refers to sores occurring in the abdomen, or between the skin and fascia. It is attributed to excessive consumption of rich and greasy foods (gaoliang nongwei) and fire generated from emotional stagnation. If there is diffuse swelling that is hard, with unchanged skin color, or a slow and tight pulse, indicating that pus has not yet formed, Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Angelicae Dahuricae Radix (Baizhi), and Aurantii Fructus (Zhike) should be used, or Tuoli San (Supporting Interior Powder). If the swelling becomes soft and red, or the pulse is surging and rapid, indicating that pus has formed, Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) should be used. If pus has formed but fails to ulcerate externally, it is due to deficiency of Qi and Blood; flat needling (Wozhen) should be employed. If swelling causes pain, it indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Life Elixir) should be used first, combined with garlic-separated moxibustion to neutralize toxicity, followed by methods to support the interior and tonify Qi. If internal resolution is desired at the onset, one should strengthen the Stomach and boost Qi to solidify the root, assisted by herbs that promote circulation in the collaterals and invigorate blood. If purgative agents are used to dissipate the swelling, the swelling will fail to ulcerate, and if ulcerated, it will fail to heal. If draining agents are used to evacuate pus, young and strong patients may become difficult to treat, while old and weak patients may face immediate danger.

A man over thirty suffered from an abdominal carbuncle with a rapid pulse and a preference for cold drinks. Qi Shi stated: "When sores swell and rise, hardness indicates excess." He Jian (Liu Wansu) stated: "Swelling, hardness, mental confusion, irritability, and desire for cold drinks indicate pathogens within the interior." Qingliang Yin (Cooling Drink) with doubled Dahuang (Rhei Radix et Rhizoma) was administered for three doses, slightly alleviating symptoms. Subsequently, Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Mutong (Akebiae Caulis) were given for four doses, leading to suppuration. Shixuan San (Ten Declarations Powder) without Renshen (Ginseng Radix) and Guizhi (Cinnamomi Ramulus) plus Jinyinhua (Lonicerae Japonicae Flos) and Tianhuafen (Trichosanthis Radix) were then used. The patient sought quick results and self-administered warming and tonifying medicines, causing increased abdominal swelling and difficulty in urination. Qingliang Yin was used again, evacuating several bowls of pus, and he recovered after treatment with interior-supporting medicines.

Another man suffered from abdominal carbuncle pain, irritability, vomiting, and a full pulse. He Jian stated: "Sores belong to Fire; one must distinguish between interior and exterior to treat the root cause." He also said: "Vomiting, hiccups, irritability, swelling, hardness, mental confusion, or unchanged skin color with a deep and full pulse indicate toxins within the interior. One should unblock the interior to cut off the source, using Neishu Huanglian Tang (Interior-Draining Coptis Decoction) to induce bowel movements two or three times. After all symptoms subsided, Lianqiao Xiaodu San (Forsythia Detoxifying Powder) cured him.

Another man had a ripe abdominal carbuncle that failed to ulcerate slowly, with a faint and thin pulse. After pus discharge, the sore oozed pus like crab bubbles, indicating internal perforation through the fascia. Sores perforating the fascia rarely survive; even major tonification cannot save them. This serves as a warning against waiting for spontaneous pus discharge.

A man accustomed to alcohol and sexual indulgence developed a toxin in the lower abdomen with a weak pulse and slight pain, desiring internal resolution. I advised strengthening the Stomach and boosting Qi, assisted by herbs promoting collateral circulation and blood invigoration. Seeking quick results, he self-administered detoxifying drugs, worsening the condition. The sore failed to suppurate, appetite decreased, and after two months, upon re-examination, the pulse was weaker, with continuous night sweats, persistent swelling without ulceration, cold muscles and flesh, spontaneous sweating, and pale complexion. This indicated dual deficiency of Qi and Blood, preventing swelling and suppuration. Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was administered for over thirty doses until pus formed, then punctured. Irritability and a large pulse appeared, indicating Yang collapse. Shengyu Tang (Sage Preservation Decoction) for two doses, followed by the previous formula for one hundred doses, led to recovery.

Simas Li Wushan suffered from this condition with abdominal pain and established pathology. One dose of Huoming Yin stopped the pain immediately. Tuoli Xiaodu San caused sudden swelling, indicating impending suppuration. Tuoli San supported recovery through spontaneous ulceration.

Liu Tingqi, Director of the Imperial Guard, in mid-summer of Xinwei year, had an abdominal carbuncle that ulcerated with clear pus, accompanied by fever, thirst, abdominal distension, vomiting, and anorexia. Some attributed this to internal attack by heat-toxin and prescribed Huangqin, Huanglian, and Dahuang, worsening the illness. Xue stated: "Abandon the season and follow the syndrome." Shenren (Ginseng), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) were administered. Vomiting ceased, and appetite improved after one dose. Further treatment with interior-supporting formulas healed the sore.

Bian Yunzhuang, a Jinshi degree holder, suffered from abdominal pain, aversion to cold, and a floating, rapid pulse. Xue stated: "Floating and rapid pulses with aversion to cold indicate carbuncles and ulcers." He did not believe this. Days later, upon re-examination, the left Chi pulse was surging and rapid. Xue stated: "Pus is inside." He still did not believe. Until lower abdominal pain and distension radiated to both buttocks, he realized the truth. Xue stated: "Pus has ulcerated from the buttocks; Qi and Blood are deficient, how can healing occur?" Urgent administration of Huoming Yin resulted in one hole ulcerating on the buttock, discharging a bucket of pus. Breath became faint. One dose of major tonifying medicine restored consciousness. Stool passed through the sore after defecation, causing unbearable pain. A sensation of rising mass in the lower abdomen triggered spasms and unconsciousness. Irritability and a large pulse were present, feeling full upon lifting and pressing. Upon waking, the pulse was surging and large but empty upon deep pressure. Shiquan Dabu Tang with quadrupled Renshen (four jin) and two Fuzi, prepared as a paste, stopped spasms. Fifty doses of Shiquan Dabu Tang healed the sore.

Zhou Yiyuan, a Shangshe student, suffered from an abdominal carbuncle for three months without healing. Pus was clear and thin, with morning chills and evening fevers. He took Siwu Tang plus Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), resulting in poor appetite and diarrhea. Phlegm saliva surged upward; he took Erchen Tang and Zhishi (Aurantii Fructus), worsening phlegm and causing chest oppression. He asked Xue for the cause. Xue stated: "Morning chills and evening fevers indicate Qi and Blood deficiency; poor appetite and diarrhea indicate Spleen and Kidney deficiency; phlegm surge and chest obstruction indicate Spleen and Lung deficiency. All result from deficiency of True Qi and excess of pathogenic factors. First strengthen Stomach Qi so organs receive nourishment and pathogens retreat." Liujun Zi Tang (Six Gentlemen Decoction) plus Huangqi (Astragali Radix) and Danggui was given for several doses, gradually resolving symptoms. Shiquan Dabu Tang promoted muscle contraction, and Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) regulated recovery.

Mao Tiren, a Shangshe student, had inherent Yin deficiency. In early spring, he coughed with hidden chest pain. The Kidney pulse was rapid and powerless; the Lung pulse was rapid and intermittent. This indicated Kidney Qi depletion and blazing Yin Fire. Liuwei Wan (Six-Ingredient Pill with Rehmannia) reduced symptoms initially, but an internal carbuncle formed. Due to deficient Yuan Qi, it could not erupt, which was dangerous during the Fire season. Disbelieving this, he took phlegm-fire resolving drugs. Two months later, slight swelling appeared between the breasts with a surging, rapid, yet powerless pulse. Xue stated: "Pus has internally ulcerated; it should be drained via needle to prevent internal attack." Disbelieving again, he returned a month later. Only one hole was pricked; pus drainage was obstructed, leading to internal attack with bluish-red lips and tongue. Xue stated: "Organs are damaged; what can I do?" He subsequently died.

My nephew's grandson married at fourteen. In spring of Yisi year, at age twenty-four, he suffered abdominal pain. Two doses of Dahuang caused significant hematochezia, chest/abdominal distension, phlegmic wheezing, and fever. Another dose of Qi-breaking and Fire-draining drugs caused profuse sweating like water and ice-cold limbs. Xue was away but returned to diagnose. The left Guan pulse was surging and rapid; the right Chi was even more severe, indicating abdominal carbuncle. Although it could heal, it would transform into consumptive disease (Zai) by summer. Renshen and Baizhu (one liang each), Danggui and Baizhu (five qian each), Chenpi (three qian), Fuling (three qian), Zhi Gancao (one qian), and Pao Jiang (one qian) were given. Two doses slightly reduced symptoms; abdomen turned slightly red and tender to touch. Two more doses caused pain; two more doses caused swelling and pain with a slippery, rapid pulse. Needling evacuated pus and stasis. Major tonifying soup restored spirit and appetite. Following seminal emission, the lesion darkened. Previous formula plus Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gubuzi (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus) gradually closed the sore. Consumptive symptoms manifested fully. Pulse was either surging, large, and rapid, or faint and thin as if absent. Only Dushen Tang (Single Ginseng Decoction) and human milk provided temporary relief before collapse. I advised preparing for death, awaiting the Fire phase. Prayers to spirits were made; a shaman recounted past events accurately and prescribed harsh purgatives, guaranteeing survival. Trusting this, he died. The Classic states: "One bound by ghosts and spirits cannot be spoken to regarding supreme virtue, let alone trust prescriptions to deceitful persons!" This is recorded to warn posterity.