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[Xue Ji] The syndrome of Liuzhu (Flowing Abscess) may arise from: damage to the Spleen and Stomach due to improper diet and overexertion; invasion of Yang pathogenic factors due to Yin deficiency caused by excessive sexual activity; reversal of Ying Qi (Nutritive Qi) within the muscle tissue due to its failure to flow smoothly; invasion of external pathogens due to loose Cou Li (skin pores and interstitial spaces); liver injury due to sudden anger; spleen injury due to emotional depression; accumulation of damp-phlegm; blood stasis due to falls or trauma; or retention of lochia after childbirth. All these conditions result from the stagnation of Qi and Blood. Lesions may occur in the joints of the limbs, or in the chest, abdomen, waist, and buttocks; they may present as nodular masses or diffuse swelling, and may be painful. These are all caused by the depletion of Yuan Qi (Original Qi). All cases should be treated with Cong Yi (Green Onion Moxibustion/Fomentation) and Yiqi Yangrong Tang (Qi-Nourishing Decoction) to consolidate the Original Qi. In this way, abscesses that have not yet suppurated will resolve spontaneously, and those that have already suppurated will ulcerate spontaneously. If the ulcer fails to heal for a long time, auxiliary treatment with Dou Chi Bing (Fermented Soybean Cake Moxibustion) and Hupo Gao (Amber Plaster) is used to dispel cold pathogens and replenish Yang Qi. If there is an internal sinus tract but the wound does not heal, Zhentou San (Needle-Head Powder) is used to remove necrotic tissue and promote pus discharge. As stated in the Classics: "Injury to form causes pain; injury to Qi causes swelling." It also says: "Depletion of True Qi leads to Deficiency; excess of Pathogenic Qi leads to Excess." If one does not tonify Qi and Blood, regulate diet, maintain regular daily routines, and restrain the Seven Emotions, but instead exclusively uses cold-natured drugs to attack and drain, survival would be merely fortunate.

If the yellow fluid does not spread along the meridians, it is commonly called Mating (Horse Carbuncle). If it spreads along the meridians, it is called Zousan Liuzhu (Scattering Flowing Abscess), commonly called Zhuateng Ma (Claw-Vine Horse). If the exterior shows slight swelling but severe pain inside the bone joints, it is called Suogu Ma (Sucking-Bone Horse). If there is severe pain inside the bone joints throughout the body, inability to rise or sit, no mass accumulation, and unremitting fever, it is also called Suogu Ma. If masses accumulate on the spine and femur, whether one or two, or three to five, it is called Guoji Ma (Cross-Spine Horse). If a mass accumulates on the coccyx accompanied by heat, it is called Shazhe Ma (Killing-Stick Horse). If severe pain occurs below the malleolus without mass accumulation but with swelling, it is called Suojiao Ma (Lock-Foot Horse). If pain occurs at the junction of bones without mass accumulation but with slight swelling, it is called Jiegu Ma (Connecting-Bone Horse). This condition arises because Wind-Heat scatters to the four limbs; treatment should focus on dispersing Wind and clearing Heat. In the early stage, fire needle cauterization is contraindicated. If swelling and heat are severe, only pricking with a triangular needle (Leng Zhen) for bleeding is appropriate. For chronic, mature lesions, fire needle cauterization may be used. Liuzhu occurring in the thigh indicates a fatal prognosis. For residual pathogens from Cold Damage (Shanghan) not yet fully resolved, use Harmonizing methods with Renshen Baidu San (Ginseng Detoxification Powder); subsequently, Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Er Chen Tang (Two-Cured Decoction) plus Qianghuo, Chuanxiong, Zhike, Danggui, and Baizhu. For chest and diaphragm obstruction caused by sudden anger, prioritize regulating Qi with Fangmai Liuqi Yin (Pulse-Regulating Qi-Flowing Drink). For depression causing symptoms without pain, prioritize regulating meridians and tonifying Qi and Blood with Yiqi Yangrong Tang. For hard, swollen, and painful lesions, promote Qi circulation and harmonize Blood with Chuangke Liuqi Yin (Surgical Qi-Flowing Drink). For ulcers that fail to heal, tonify Qi and Blood with Renshen Yangrong Tang or Shiquan Dabu Tang. For cases caused by Spleen Qi deficiency with damp-heat stagnating in muscle tissue, presenting as a single non-painful swelling with normal skin color and poor appetite, prioritize invigorating the Spleen and draining dampness with Liujunzi Tang (Six-Gentlemen Decoction) plus Chuanxiong, Danggui, Huangqi, Baishao, and Rougui. For cases caused by blood stasis from sprains or contusions, harmonize Qi and Blood and regulate meridians with Fangmai Liuqi Yin; subsequently, Er Chen Tang combined with Siwu Tang plus Xiangfu, Wuyao, and Jiegeng. For tendon spasms and bone pain caused by Cold pathogen invasion, or generalized body pain, warm the meridians and nourish Qi and Blood with Dafangfeng Tang, Wuji San (Five Accumulations Powder) combined with Baidu San, plus Chuan Niuxi and Duzhong, or Duhuo Jisheng Tang; subsequently, Siwu Tang plus Huangqi, Qianghuo, and Duzhong. For cases with tidal fever, indicating incomplete dispersion of interior Cold, use Yingwei Fanhun Tang plus Gegen, Shengma, Zisu, Chuanxiong, and Duhuo, decocted with ginger water. If there is no tidal fever, use Yingwei Fanhun Tang plus Duhuo, decocted with half wine and half water.

For Jiegu Ma, use Chuanshan Wugong, Bai Tianke, Shinan Teng, Shan Liangjiang, Jiujiexiang, Zijinpi, and Hanxiaoye, decocted for hot washing/fomentation. Subsequently administer Xugu San, Jiujin Lima San. For small nodular masses, slightly smaller than typical, called Mating or Malin, use Zijinzhong, Zijinpi, Ziheche, and Tiannanxing, ground with vinegar and applied warm. Alternatively, use Zijinpi, Zijinteng, Hongneixiao, Matixiang, and Matiteng, decocted in wine for oral administration. For Suojiao Ma, use Ye Yu Gen, Malancao, Lulu Zi, Ziheche, Shan Pipa Genpi, Shanbugua Gen, and Zijinpi, pounded into a paste, stir-fried with salt and fermented rice lees, bound to the affected area, and washed with the decoction. Subsequently administer Qingjiao San, Jiujin Lima San. For Suogu Ma, use Chuanshan Wugong, Zijinpi, Shinan Teng, Bai Tianke, Xifeng Gen, Jiujiexiang, and Duiejie Jinjing, decocted for washing. Subsequently administer Suogu San, Jiujin Lima San, and Siwei Jinjiu Fang. For Guoji Ma, use Shan Pipa Genpi, Lilizi, Xiaozhang Genpi, Tiantongdong, Tiannanxing, Zhangxian Gen, Shanbugua Gen, Chi Niuxi, Banxia, Lingxiao Genpi, Fosanghua, Malancao, Ye Yu Gen, Tiangkou Ke, Puyingzi Genpi, Chi Mao Tao Genpi, and Chixiong Genpi, pounded into a paste, mixed with half rice water and half vinegar, heated and brushed on, with dregs applied as a poultice. This is also effective for Guateng Ma; subsequently administer Juanji San, Jiujin Lima San. For Guateng Ma, use Shanbugua Gen, Duochige Genpi, Zhangliugen, Zijinpi, Zijinzhong, Luoyaqiang Gen, Qiye Yangxiang, Tianhuafen, Zhenzhulian Gen, Bai Furong Ye, Lingxiao Genpi, Xifeng Genpi, and Chi Mao Tao Genpi, pounded into a paste, stir-fried with salt and fermented rice lees, and bound. Another formula: Shanbugua Gen, Gehegen, Ziheche, Lilizi, Mabianhui, Zijinpi, Shan Pipa Genpi, Lingxiao Genpi, Fosanghua, Luoyaqiang Gen, and Bai Tianke, pounded into a paste, stir-fried with salt and fermented rice lees, and bound. Another method: Shanbugua Gen, Zijinpi, and Xifeng Genpi, pounded into a paste, stir-fried with wine, and bound; this formula is highly effective for various "Ma" syndromes. Subsequently administer Jiujin Lima San, Siwei Jinjiu Fang, and wash with Xizhong Fang. For Shazhe Ma, use Ziheche, Shan Pipa Genpi, Lilizi, Shanbugua Gen, Lingxiao Genpi, Fosanghua, Gehegen, and Shiping, pounded into a paste, mixed with vinegar, brushed on, with dregs applied as a poultice. Wash with Xizhong Fang. Subsequently administer Jiujin Lima San and Juanji San. For "Ma" syndromes with heat, use Qure San; for exterior patterns, use Jingfang Baidu San; for interior patterns, use Neishu Huanglian Tang; for simultaneous exterior and interior patterns, use Zhuoding Duoming Tang. Then apply Shuijinfeng, pounded and bound to the nodule, which is effective. For "Ma" syndromes with heat but no suppuration, medication can reduce the heat; if suppuration has occurred, heat subsides once pus drains. If four or five nodules appear, but only one or two have not suppurated while others have drained, the heat will not subside until all five have drained. If ulcerated, treat according to the Ulcer section.

[Case Records]
One patient suffered hypochondriac pain due to anger, cured with Xiao Chai Hu Tang combined with Siwu Tang plus Qingpi, Jiegeng, and Zhike.
One patient had a single swollen area on the buttock with slight pain and a wiry-tight pulse, resolved with four doses of Chuangke Liuqi Yin.
One patient suffered hypochondriac swelling and pain with chest/diaphragm obstruction and a deep-slow pulse after anger; improved slightly with several doses of Fangmai Liuqi Yin, then rapidly improved with Xiao Chai Hu Tang combined with Er Chen Tang plus Qingpi, Jiegeng, and Beimu. Cured after more than twenty doses of Xiao Chai Hu Tang.
A woman suffered shoulder swelling and generalized body pain after a sprain; pain stopped after two doses of Hei Wanzi, swelling resolved after two doses of Fangmai Liuqi Yin, and she was cured with Er Chen Tang combined with Siwu Tang plus Xiangfu, Zhike, and Jiegeng.
A woman suffered tendon spasms and bone pain in the leg, unresponsive to other medicines, with a slow-tight pulse; symptoms resolved instantly after one dose of Dafangfeng Tang and settled after two more doses. Another woman with similar symptoms was cured after two doses of the previous decoction followed by Hei Wanzi. If untreated, these cases would ulcerate into fatal conditions.
A woman with weak constitution and irritable temperament suffered hypochondriac/arm swelling and pain with chest fullness. After taking Liuqi Yin and Baidu San, she developed fever and poor appetite. Chest comfort and free Qi flow were achieved after several doses of Siqi Tang; swelling and pain subsided after Xiao Chai Hu Tang combined with Siwu Tang plus Xiangfu and Chenpi.
One patient had a leg ulcer failing to heal; cured after two months with Renshen Yangrong Tang, moxibustion with Aizi Bing (Moxa Cake), and application of tonic paste.
One patient with inherent Spleen Qi weakness had a non-painful arm swelling with normal skin color and poor appetite for six months without suppuration. Appetite improved after more than twenty doses of Liujunzi Tang plus Chuanxiong, Danggui, and Shaoyao. After daily moxibustion with Dou Chi Bing and adding Huangqi and Rougui to the prescription for thirty-plus doses, pus formed and was drained with a needle. Cured after one month with Shiquan Dabu Tang and Aizi Bing moxibustion.
One patient had leg swelling, normal skin color, no pain, and a floating-slippery pulse. Treated with Buzhong Yiqi Tang plus Banxia, Fuling, Zhike, and Muxiang, and fomentation with Xiangfu Bing. The patient believed "Qi cannot be tonified" and took Fangmai Liuqi Yin, worsening deficiency. Cured after several doses of Liujunzi Tang plus Chuanxiong and Danggui improving appetite, and further tonic treatment for a month resolving swelling. The notion that "Qi cannot be tonified" is a secular fallacy; although symptoms like fullness suggest difficulty in tonification, true Qi deficiency fails to circulate, allowing pathogenic Qi to stagnate. Without tonification, how can Qi move?
One patient had arm swelling, tendon spasms, and bone pain, ulcerating after a year without healing, with a deficient pulse. Improved slightly with one dose of Neisai San; cured with Shiquan Dabu Tang and Aizi Bing moxibustion. *Jingyao* states: "Long-standing accumulation generates Yang from extreme Yin, transforming Cold into Heat." Such ulcers often become fistulas; early administration of Neisai San promotes drainage.
One patient had a leg swelling persisting for a year without suppuration, poor appetite, bloating or diarrhea upon forced eating, and gradual emaciation. Pulse was fine and minute, indicating Mingmen Fire decline failing to generate Earth (Spleen), leading to Spleen deficiency. Cured with Bawei Wan, with gradual improvement in appetite and resolution of swelling.
One patient with back/thigh swelling, physical fatigue, and Qi weakness was treated with Yiqi Yangrong Tang, intermittently taking Hei Wanzi, and applying a cake of Muxiang and Shengdihuang to the site for fomentation. Pus formed after a month, was drained, and cured with continued medication.
One patient with a chronic leg ulcer was cured after drinking large-tonic medicines, using Aizi Bing, and treating with Zhentou San.
One patient had a hard arm lesion for over a year with poor appetite, morning chills and evening fevers. Chills and fever subsided slightly after a month of Bazhen Tang plus Chaihu, Digupi, and Mudanpi. Pus formed after two months of Yiqi Yangrong Tang and Aizi Bing moxibustion; cured after half a year of Renshen Yangrong Tang.
A woman with thin pus, weak pulse, aversion to cold, and chronic non-healing was cured with Neisai San and Aizi Bing moxibustion.
One patient expelled three pieces of necrotic bone from an arm ulcer, still unhealed, with fever, thirst, and a large-slippery pulse, indicating dual Qi and Blood deficiency. Multiple doses of Qi-and-Blood-generating agents were necessary for preservation. The patient believed the "fire" was not extinguished and used cooling herbs internally and externally, nearly dying. With emaciation and increasingly deficient pulse, appetite improved after a month of Liujunzi Tang plus Chuanxiong and Danggui. Wound color reddened after thirty-plus doses of Bazhen Tang plus Rougui. Cured after nearly a year with Shiquan Dapu Tang and external Aizi Bing moxibustion.
An elderly patient with unresolved exterior Cold pathogens had thigh swelling and fever. Fever stopped after two doses of Renshen Baidu San and Xiangfu Bing moxibustion; swelling resolved after several doses of Xiao Chai Hu Tang combined with Er Chen Tang, Qianghuo, Chuanxiong, Danggui, Baizhu, and Zhike.
Zhu Dongxi, a Court Gentleman, had a four-cun mass near the left hypochondrium/abdomen in the Liver/Gallbladder meridian region. Diffuse swelling without redness, tender on pressure. I advised tonifying Spleen and Stomach. He believed exterior-dispersing methods were needed for swellings and took Liuqi Yin, causing sudden Stomach Qi deficiency, after which he accepted my advice. Cured with Sijunzi Tang plus Chuanxiong, Danggui, wine-fried Baishao, Jiang, and Gui. After Stomach Qi recovered and evil signs receded, Ganjiang was removed and Huangqi added for several doses. Mild redness and pain appeared; after thirty-plus doses, swelling became painful indicating internal suppuration, which was drained. Cured with modified Buzhong Yiqi Tang and Bawei Wan.
One man had a hypochondriac swelling, un-ulcerated for a long time, slightly tender on pressure, with a faint-slippery pulse, indicating both form and syndrome deficiency requiring tonification rather than purgation. Cured after hundred doses of Renshen Yangrong Tang, hot mugwort fomentation, fire-needle drainage upon suppuration, Dou Chi Bing, and Shiquan Dabu Tang.
A woman had a small waist swelling with normal skin color, fever, and no ulceration. I intended to treat with Yiqi Yangrong Tang for depression resolution. She took Liuqi Yin instead; after puncturing and draining fluid, she died after a year.
Another woman with chronic non-healing suddenly developed chills and fever. I diagnosed dual Qi and Blood deficiency, but she took exterior-dispersing agents, developed high fever, and died.
One man with inherent weak Qi suffered chest/diaphragm obstruction and poor appetite. I intended to invigorate Spleen, resolve depression, and nourish Qi/Blood. He took pungent-aromatic Qi-flowing agents causing abdominal distension, then took Sanleng, Pengze, and Houpo, leading to poor appetite, mild limb swelling, and a waist swelling. He died without ulceration.
A woman with irregular menstruation (every 2-3 months), limb swelling, poor appetite, and afternoon fever was diagnosed with Spleen Earth Qi/Blood deficiency. I prescribed Spleen-nourishing and Qi/Blood-tonifying herbs. She considered this too slow, used harsh purgatives to regulate menstruation first, resulting in abdominal pain, intractable diarrhea, generalized edema, poor appetite, and death during the Wood-prosperous month.
A man over thirty had lower abdominal hardness swelling, becoming an ulcer after a year, discharging blood and fluid upon rupture. Diagnosed as Liuzhu caused by Seven Emotions injuring Ying Qi reversal in muscle tissue. Liver pulse was choppy; Liver disease pulses should not be choppy (Metal nature). Since the lower abdomen belongs to the Liver meridian, the choppy Metal pulse must retreat for recovery. I intended to use sweet-warm herbs to tonify Qi/Blood for spontaneous resolution. He did not believe me, took attacking/draining herbs, worsened Qi/Blood deficiency, and died during the Metal-prosperous month.
One man had abdominal swelling/hardness without ulceration, weak pulse with occasional vomiting. I intended to use Baidu etc. I stated that swelling/hardness without ulceration indicates Yang Qi weakness; vomiting/poor appetite indicates Stomach Qi deficiency and Cold. Treatment should warm/tonify Spleen/Stomach. He did not believe me, continued attacking/draining, worsening vomiting. Upon return, pulse was faint with fever. I stated: "Fever with quiet pulse, collapse with strong pulse, agitation after sweating—all are adverse signs." Refused treatment; he subsequently died.

Chuangke Liuqi Yin treats Yin-type Liuzhu, anger-induced stagnation, nodular hard/swollen painful masses, chest/diaphragm fullness, Wind-Cold-Damp-Toxin binding meridians, Blood disharmony forming masses with normal skin color, diffuse numb swelling without head, or Yin-type Rock/Breast cancers. Promotes rapid resolution before suppuration and rapid ulceration after suppuration, expelling foul pus and necrotic tissue naturally. Highly effective.
Ingredients: Jiegeng, Renshen, Danggui, Rougui, Gancao, Huangqi (salt-water fried), Nongpu (ginger-processed), Zisu, Baishao, Wuyao, Fangfeng, Zhike, Binglang, Nanmuxiang, Chuanxiong, Baizhu.
Decoct with fresh ginger. Add Rushen, Moyao for pain. Add Zhimu, Beimu if exudate is excessive. Add Chao Zaojiaoci if wound is dry. Add Qianghuo, Duhuo for Liuzhu. Add Xiangfu for Qi stagnation. Add Chenpi for Stomach deficiency. This is a Qi-moving and Blood-scattering formula; excessive use depletes Qi/Blood, hindering pus formation. Students should note this.

Baidu Liuqi Yin treats early-stage Liuzhu with hard, painful nodules intolerable to touch. Disperses pathogens and moves Qi.
Ingredients: Qianghuo, Duhuo, Qingmuxiang, Chishaoyao, Danggui, Zisu, Chenpi, Xiangfu, Baizhi, Sanleng, Peng'e Zhu, Zhike, Chuanxiong, Jiegeng, Chaihu, Banxia (ginger-processed), Chifuling, Gancao.
Decoct with fresh ginger and Shengdihuang. Add Dahuang, Huangqin for heat. Add Renshen, Huangqi for deficiency.

Fangmai Liuqi Yin treats Yin-type Liuzhu, Luoli (scrofula), and depression-induced clustered masses. Addresses wandering pain, chest/heart oppression, hypochondriac/abdominal fullness, vomiting/anorexia, upper asthma/wheezing, cough with profuse phlegm, facial/extremity edema, constipation.
Ingredients: Zisu, Qingpi, Baishao, Danggui, Baifuling, Wuyao, Jiegeng (fried), Banxia (ginger-processed), Huangqi (fried), Chuanxiong, Zhishi (fried), Chenpi, Fangfeng, Nanmuxiang, Dafupi, Gancao, Binglang, Zhike.
Decoct with fresh ginger. Add Qianghuo, Duhuo, Baizhishao for Liuzhu. Add Mutong, Zhizi for urinary obstruction. Add Zhuling, Zexie for edema. Add Xiangfu for Qi stagnation. Add Rougui for Blood stagnation. Add Huoxiang for vomiting. Add Xiakucao for Luoli.
This is a Qi-moving and Blood-consuming formula; stop after 2-3 doses; do not overuse.

Qure San treats Mating with fever. Clears heat; also effective for inflammatory swellings.
Ingredients: Jimianxiao, Shanwudou, Jishizi, JikT Gen, Shuitangzi, Guoshanlong, Jinliangsan (large leaf), Baigenzi, Zijinteng, Jiuniu Tianzhu, Choumu Dai (root), Liancha Daqing, Luoya, Zhuateng.
Decoct in water.

Jiujin Lima San treats Mating Liuzhu, MatKT, Mamian, Mata, Manuo, carbuncles/swellings, mastitis, hypochondriac abscesses, perianal abscesses, head wind, wind nodules.
Ingredients: Tiemabian, Baimagu, Dimashao, Zijinteng, Matiteng, Jinxingcao, Jinjing Gen, Jinyinhua, Shanhonghua (root), Matijin, Zijinpi, Jinliangsan (root), Jinnaoxiang, Shanwudou, Jishizi, Maolijinchai, Shuigunzi (root), Chuanshan Wugong.
Decoct in water, mix with wine for oral administration.

Sanxue Xiaohé Tang treats Mating.
Ingredients: Zijinpi, Daji Gen, Shansumu, Xifeng Gen, Shanwudou, Jishizi, Chi Niuxi, Matijin, Matiteng, Tienabian, Baimagu, Matixiang, Chuanshan Wugong.
Decoct in water, mix with wine for oral administration.

Er Ma San treats Mating.
Ingredients: Matijin, Tienabian, Boxue Gen.
Decoct in water, mix with a little wine for oral administration.

Lixiao San treats Mating.
Ingredients: Shuigunzi Gen (aka Xifeng Gen, aka Shuiyangliu, large amount), Dan Cha Li Gen (medium amount), Wanxiangxi Gen (small amount).
Decoct in water, mix with wine for oral administration. Also effective combined with Liu Ma San.

Jinjǐu Fang treats Mating wounds. Reduces trauma.
Ingredients: Laogongxu (root), Maolijinchai (root), Gouguzi (root), Daye Maochuqu.
Soak in wine, drink warm. Do not decoct.

Xugu San treats Jiegu Ma.
Ingredients: Tiandengxin, Zibeicao, Chi Niuxi, Shansumu, Diaogouteng, Matixiang, Matijin, Zijinpi, Tianhuafen, Baimagu, Tienabian, Choumu Dai (root), Jiutanzi (root).
Decoct with half water, half wine.

Qingjiao San treats Suojiao Ma.
Ingredients: Tiandengxin, Zibeicao, Chi Niuxi, Diaoteng (root), Shansumu, Jiutan Gen, Baimagu, Matijin, Tienabian, Chuanshan Wugong.
Decoct with half water, half wine.

Suogu San treats Suogu Ma.
Ingredients: Matijin, Matiteng, Baimagu, Zijinpi, Diaogouteng, Tienabian, Jiutan Gen, Matixiang, Tiandengxin, Shansumu, Chi Niuxi, Diqie Gen, Zijinteng, Lizigen, Choumu Dai (root), Wubaozi (root), Chuanshan Wugong.
Decoct with half water, half wine.