Library

The *Ling Shu Jing* (Spiritual Pivot) states: When Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) stagnate within the meridians, blood flow becomes sluggish and ceases to circulate. When blood circulation stops, Wei Qi follows but becomes obstructed, leading to congestion and blockage that prevents movement, thereby generating heat. If intense heat persists, excessive heat causes flesh to rot, and rotted flesh turns into pus. However, if the pathogen cannot penetrate deep into the skin and muscle, nor scorch the bone marrow, and does not injure the Zang organs, it is termed "Yong" (Carbuncle/Abscess). If the pathogenic heat is thick and abundant, sinking deep into the skin and muscle, causing withering of sinews and bone marrow, connecting internally to the Zang organs, exhausting blood and Qi, and destroying bones, sinews, and healthy flesh at the site of the lesion, it is termed "Ju" (Deep-seated Abscess/Gangrene). Ju is characterized by skin that is pale and hard, resembling the thick skin on a cow's neck. Yong is characterized by thin, shiny skin; these are their respective signs.

The *Gui Yi Fang* (Prescriptions from the Ghost's Legacy) states: The pain of Yong is confined to the superficial skin. Its onset is fierce like burning thatch; initially the size of a millet grain, it expands to the size of a palm within two or three days, and to the size of a bowl within five to seven days, making it easy to treat. However, if accompanied by cold swelling, thirst, and rebellious Qi, it is difficult to cure. Ju may initially appear like a small boil; touching it causes heartache penetrating to the back. The surrounding area rises slightly like orange peel pores, with uneven redness, and little pus discharges. By the seventh or eighth day, severe pain, stifling sensation, and rapid breathing persist. If the swelling is high initially but suddenly sinks flat after five to seven days, this indicates internal attack by the pathogen. Furthermore, Yong and Ju are categorized into three levels based on pathogen depth: shallow pathogens belong to the Fu organs, deep pathogens belong to the Zang organs, and fierce pathogens travel along the meridians with unpredictable depth. All Zang and Fu organs can be affected by various toxins, making regulation difficult. Urgent treatment should focus on the sites of Yong, regardless of deficiency or excess, provided there is high swelling, luster, pain, superficial location, feeling of heat and distension, or itching/pain, without other malignant signs. Initially, warm herbs should be used to calm the Qi, followed by herbs that drain pus and open acupoints. ("Calming Qi" in treating Yong refers to formulas like Xijiao Yin (Rhinoceros Horn Decoction), containing Rhinoceri Cornu (Xijiao), Forsythiae Fructum (Lianqiao), Euphorbiae Humifusae Herba (Loulu), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Danggui), and Cinnamomi Ramulus (Guizhi), all releasing exterior pathogens. "Opening Acupoints" refers to techniques like Ji Zhen (Thorn Needles), using Gleditsiae Sinensis Spina (Zaocys/Saponaria Thorn) as the sovereign herb, supported by Glycyrrhizae Radix et Rhizoma (Gancao), Ligusticum Chuanxiong Rhizoma (Chuanxiong), and Boswellia Carterii Resin (Ruxiang), which also tonify the interior. However, methods from Zhang Congzheng (Jiegu) and Li Dongyuan are more reliable for releasing the exterior and supporting the interior.) For Ju occurring anywhere, regardless of size, especially on the back spanning one to three chi, the skin is thick, purple-black, and variably swollen. Internal pain feels like needle pricking, causing fullness and oppression, heavy painful limbs, and anterior chest pain. Occurrences elsewhere are manageable, but those in deficient areas or near sinews and bones, if pus and toxin do not ulcerate, will damage sinews, bones, and muscles. Ju relates to the Zang organs, with deep-seated toxins manifesting as stagnant, hard, and firm conditions, requiring prompt treatment rather than delay. Treatment must solidify the Zang organs internally and promote external penetration through the skin, softening the area to allow pus discharge. Herbs that support the interior and strengthen Zang Qi, draining pus and harmonizing Qi, are suitable. This differs from the superficial nature of Yong toxins; they should not be treated identically. For any swelling that initially rises high but suddenly sinks flat after five to seven days, indicating internal attack, urgently use Neituo San (Internal Support Powder) and internal tonic decoctions to fill and solidify the Zang organs. The greatest fear is perforation of membranes; once perforated, survival is rare.

Lou Quanshan stated: The pathogen of Yong is superficial, stagnating only within the meridians and attacking externally. Thus, upon onset, the body surface heats up, and the lesion swells high like a bowl or basin, painful. Even if it tends to sink, the righteous Qi remains internally solid and rejects the pathogen, manifesting as constipation, thirst, or rebellious Qi to resist it. Therefore, bone marrow remains unscorched, and Zang organs remain uninjured. The pathogen of Ju is deep, stagnating and connecting internally to the Zang organs without focusing externally. Thus, the body may lack fever, and the lesion may not swell or hurt. In severe cases, hoarseness, Qi collapse, blackened eyes, and blackened fingers occur, often leading to death. Treatment for early-stage Yong should follow Jiegu’s methods: release the exterior with dispersants, purge the interior with purgatives, apply moxibustion, and use topical applications. Unformed pus will resolve; formed pus will quickly ulcerate. Early-stage Ju should follow the *Gui Yi Fang*: tonify and solidify the Zang organs to prevent sinking pathogens from spreading. Use external moxibustion to guide pathogens outward, ensuring they exit through specific points without chaos, turning fatal cases into recoveries and misfortune into auspiciousness. Modern surgeons fail to distinguish between Yong and Ju, uniformly clearing heat and extracting toxins. They use aromatic herbs externally to deplete Qi and Da Huang (Rhei Radix et Rhizoma) internally to exhaust Blood, never realizing their error. Regrettably!

The *Ji Yan* states: Although there are over twenty names for Yong and Ju, the essence lies in Yin and Yang. Manifestations of Yang are Yong, Heat, and Excess. Manifestations of Yin are Ju, Cold, and Deficiency. Yang lesions have thin skin, red color, high swelling, numerous pepper-like pores, and pain. Yin lesions have thick skin, pale color, hard swelling, resembling cow neck skin, and no pain. There is also "Yin within Yang," appearing hot but not truly so, swollen yet deficient, red but not dry, wanting pain but lacking pus, rising then subsiding, appearing vigorous but with rotting flesh. There is "Yang within Yin," appearing cold but not truly so, non-swollen yet substantial, slightly red and dry, with pus and pain, appearing mild externally but internally stifling. Patients with Yin within Yang are often obese with tight flesh but internal deficiency. Patients with Yang within Yin are often emaciated with loose flesh but internal excess. Yang transforming into Yin results from herbalists' misuse of cooling agents. Yin transforming into Yang results from physicians' abrupt use of strong heating drugs. Yang-to-Yin transformations are common and reversible, leading to survival. Yin-to-Yang transformations are rare and irreversible, leading to death. Rare survivals occur only when doctors accidentally adhere to correct principles. Thus, Yong and Ju differ only in Yin/Yang, depth, location, and excess/deficiency, not size. The claim in *Jing Yao* that lesions 2-5 cun are Yong and 5 cun-1 chi are Ju is erroneous.