Library

Yongju (Carbuncle and Ulcer) refers to the condition where local congestion and swelling occur initially, but pus has not yet formed. The *Jiyan* discusses methods for treating sores and ulcers, classifying them into three names: Jie (Furuncle), Yong (Carbuncle), and Ju (Deep Abscess).

Jie (Furuncle): Initially appears as a protrusion, floating red in color with no distinct root (base). The swelling is confined to the skin, spanning only one or two cun, accompanied by slight pain. After several days, it becomes slightly soft, the thin skin peels off, first exuding clear fluid, then spontaneously rupturing to discharge pus. If it does not rupture spontaneously, apply Tipin Wan (Needle-Replacement Pill) and Badu Gao (Poison-Expelling Plaster). Once pus is discharged, it heals.

Yong (Carbuncle): Initially presents with redness and swelling, protruding without a head. Immediately puncture with a fire needle to disperse it. If it does not disperse, puncture the root. It spans three or four cun, accompanied by fever, aversion to cold, irritability, and thirst, or sometimes no fever but pulling pain. After four or five days, pressing reveals slight softness. This condition involves superficial toxin. In spring and summer, use Fangfeng Baidu San (Saposhnikovia Decoction to Overcome Toxins), adding scallion heads, ginger, jujube, and dates decocted together. In autumn and winter, remove ginger, jujube, and scallion heads, add Muxiang (Aucklandiae Radix). For lesions on the upper half of the body, add Gualou (Trichosanthis Fructus); for the lower half, add Shegan (Belamcandae Rhizoma). Timely treatment leads to dispersion. Alternatively, use Zhidu Wan (Toxin-Chasing Pill), Fanhun Dan (Soul-Returning Elixir), or Fuyuan Tongqi San (Restore-Origin Qi-Circulating Powder) for mild purgation. When pus forms, incise with a Pi Zhen (Pi Needle) or use Tipin Wan to erode/open it. Another type presents with unchanged skin color, slight swelling, deep muscle pain worsening at night, fever, aversion to cold, irritability, and thirst. This indicates deep heat-toxin, also named Ju (Deep Abscess), because it can damage sinews, vessels, and bone marrow. After prolonged duration, pressing reveals slight softness in the center. When pus forms, use fire cauterization to open it and drain large amounts of pus. Apply Badu Ruxiang Gao (Poison-Expelling Frankincense Plaster) externally, and internally administer Tuoli (Interior-Supporting) medicines. At onset, urgently puncture the swollen and hard area with a large needle to disperse it.

Ju (Deep Abscess): Initially presents as white granules the size of millet seeds, accompanied immediately by itching and pain. Touching causes pain to resonate in the heart; this is the sign of initial Ju development. Urgently puncture the white granule with a fire needle. If accidentally broken or immersed in water, it becomes slightly red, swollen, and painful. After three or four days, if it does not disperse, the red halo around the root expands. Observe carefully to determine the width of the halo, e.g., about four or five cun. The whole body experiences high fever, slight thirst, and the sore itself feels hot. This is Ju. Puncture the initial white granule with a fire needle to a depth of over one cun. Within an area of one cun square, puncture four points on each side. Immediately wash with Siwei Zigeg Tang (Four-Ingredient Purple Kudzu Decoction), washing five or six times over a day and night. Dry with a soft cloth after washing. Check if new white granules like millet seeds are forming on the Ju. If present, pick them off with a silver comb. Avoid bleeding; slight bleeding is acceptable, but no bleeding is better. Then apply Laopi San (Old Skin Powder). Surround the lesion with Datiegu San (Great Iron-Hoop Powder) mixed with cool water, leaving the sore opening uncovered. Do not use plasters yet. If washing again, first completely remove the surrounding powder, then wash. Each wash must be followed by inspection. As white granules gradually appear, pick them off as before. By the sixth or seventh day, numerous sore heads may resemble a honeycomb, refusing to discharge pus. Continue washing and surrounding. In winter, use Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction), adjusting Dahuang (Rhei Radix et Rhizoma) dosage according to deficiency or excess. In summer and autumn, use Huanglian Qianghuo San (Coptis and Notopterygium Powder). In late spring and early summer, use Fangfeng Baidu San, adding scallion whites and jujubes decocted; in autumn, remove these and add Muxiang. If the constitution is robust and the pulse is surging, slippery, and forceful, with wide-open painful swelling, high fever, and constipation, select one of Wuli Dahuang Tang (Five-Purgative Rhubarb Decoction), Loulu Tang (Euphorbiae Humifusae Herba Decoction), Fanhun Dan, Zhidu Wan, or Fuyuan Tongqi San to promote purgation. If stools are moist, stop the medicine. This applies to those under forty. For weak or elderly persons, even with constipation, exercise caution to avoid overdose. If the red halo opens wide for surrounding, and the redness recedes, change to Tiegu San (Iron-Hoop Powder). If too late for fire needles, after seven or eight days, when the central initial white granule has ulcerated internally with large pus, roll a small paper wick from bark paper, insert it into the orifice to ensure patency, allowing pus to flow out gradually, avoiding needle scarification. To ensure pus penetration, puncture with a large needle or around four or five points. If pus refuses to exit from honeycomb-like areas around the orifice, apply Zhengtiegu San (Correct Iron-Hoop Powder) mixed with sesame oil. After initial white granules are touched, if mood becomes depressed, back feels heavy as if carrying five to seven jin of rice, body aches irritably, chest and diaphragm feel stifled and restless, appetite is lost, and smell of food is repulsive—described as "externally like hemp, internally like melon"—the Ju toxin is deep and malignant, connecting internally to the zang-fu organs. Within three to five days, cauterization can be used on the center, left, right, top, and bottom to unblock toxins, allowing pus to exit through various orifices. If unresolved after five to six days, white granules like peppercorns appear on the Ju apex, increasing later, some as large as honeycombs or lotus seeds. Pressing yields pus and blood that do not flow, with occasional clear fluid leakage. Slight swelling without protrusion, red halo at the root expanding gradually, possibly itchy or painless, or purple-red halo widening to seven or eight cun, with low heat—this is a severe condition. Wash with Zigeg Tang (Purple Kudzu Decoction) plus one cup of rice vinegar to restore vitality. Remove white granules as directed, apply Laopi San, surround with Datiegu San, and apply Zhengtiegu San to the sore opening. Using these methods, if the root redness recedes and the Ju protrudes, the medicine is effective, turning severity into mildness. If the first white granule on top contains pus but drainage is blocked, remains hard upon pressing, or pain diminishes, promptly use fire cauterization to penetrate. If the root remains purple-black, the sore sinks like ox neck skin, turns black, muscles and bones rot, and the patient feels confused and heavy, apply Badu Ruxiang Gao to the periphery, surround with Datiegu San, and wash with Zhu Ti Tang (Pig Trotter Decoction). These changes often involve multiple complications; adjust treatment accordingly. If the pulse is weak, use large doses of Renshen (Ginseng Radix) and Danggui (Angelicae Sinensis Radix) in strong decoction to support detoxification and channel circulation. All Yongs and Jus require Wanquan San (Perfect Safety Powder); in summer, use Taohong San (Peach Kernel and Safflower Powder) to protect the Heart. After pus appears, manage according to ulceration methods. (Note: The treatments in *Jiyan* should not be taken as absolute standards; prioritize the following discussions and consult various formulas.)

General Principles: High swelling with pain and floating pulse indicate pathogen in the exterior; use Tuoli (Interior Support), e.g., Neituo Fujian San. Hard swelling with deep pain and sinking pulse indicate pathogen in the interior; use Xia (Purge), e.g., Huanglian Neishu Tang, Xianfang Huoming Yin, Kushen Wan. No external swelling but internal comfort indicates pathogen in channels and collaterals; harmonize Ying and Wei (Nutritive and Defensive Qi), e.g., Tuoli Yingwei Tang, Baizhi (Angelicae Dahuricae Radix), Shengma (Cimicifugae Rhizoma). Pain with restlessness and thirst indicates Fire; descend Fire, e.g., Huanglian Jiedu Tang. Pain with fever, stiffness, or headache indicates pathogen in the exterior; disperse, e.g., Jingfang Baidu San, Renshen Baidu San. Severe pain or absence of pain indicates Excess Pathogen; moxa with garlic partition, plus detoxification like Xianfang Huoming Yin. Restlessness, desire for cold drinks, pain, and rapid pulse indicate pathogen in the Upper Jiao; clear Heat, e.g., Qingliang Yin, Jinyinhua San. Aversion to cold without ulceration indicates Qi Excess combined with Cold Pathogen; diffuse and tonify, e.g., Shixuan San. Pain with fever, profuse sweating, extreme thirst, constipation, and delirium indicates Jieyang Syndrome (Yang Knotting); purge, e.g., Huanglian Neishu Tang, Po Guan Dan. Failure to form pus or ripening without ulceration indicates Deficiency; tonify, e.g., Buzhong Yiqi Tang, Bawu Tang, Shiquan Dabu Tang. Pain or numbness indicates Excess Pathogen; moxa with garlic partition. Swelling and pain or failure to form pus indicates Pathogen Congestion; resolve, e.g., Xianfang Huoming Yin. Swelling, pain, desire for cold drinks, fever, and sleep-talking indicate Fire; clear, e.g., Qingxin Tang, or Fangfeng Tongsheng San plus Huanglian. Failure to form pus, ulcerate, or heal indicates Yang Qi Deficiency; tonify, e.g., Tuoli Xiaodu San.

Jiegu said: Sores and ulcers belong to Fire; distinguish interior and exterior. If the pulse is deep and solid, first purge the interior to cut off the source. If the pulse is floating and large, first support the interior to prevent pathogen entry. In cases between interior and exterior, pathogen is extreme, blocking channels, causing carbuncles and swellings. The Classics state: "When Ying Qi does not follow its course and reverses in the flesh, carbuncles and swellings arise." This results from failure to support the interior, failure to purge/unblock, and failure to harmonize Ying and Wei. The key to treating sores requires understanding three methods: Tuoli (Interior Support), Shutong (Unblocking/Purging), and Xing Yingwei (Promoting Ying and Wei Circulation). Tuoli treats the exterior affecting the interior; Shutong treats the interior affecting the exterior; Xing Yingwei treats the middle. Interior affecting exterior: Pulse deep/solid, fever/irritability, no severe external redness/pain, pathogen deep inside; first unblock zang-fu to cut the source (Huanglian Neishu Tang). Exterior affecting interior: Pulse floating/rapid, swelling outside, symptoms manifest externally, fear pathogen reaching extreme and moving inward; first support interior to prevent invasion (Neituo Fujian San). Middle of interior/exterior: No external evil qi, internal zang-fu unblocked, knowing it is in the channels; harmonize Ying and Wei (Danggui Huangqi Tang). After using these three methods, even if not cured, complications will be avoided, pathogen reduced severely, and recovery facilitated.

Dongyuan said: The onset of sores and ulcers differs by interior/exterior origin, and treatment differs by cold/warm nature. Originating from exterior: method is to support interior with warm agents; using cold herbs instead draws pathogen from skin/hair into bone marrow. Originating from interior: method is to purge/drain with cold agents; using warm agents to wrap/support instead drives bone marrow disease up to skin, causing total perforation of interior/exterior, merging into one sore, aiding pathogen toxicity, causing hundredfold suffering, leading to danger or death. I heard Jiegu say: The birth of sores and ulcers differs in interior/exterior; whether attacking or releasing, slight errors lead to complications that can kill, worse than Shanghan (Cold Damage). Acupuncture and moxibustion should be applied appropriately. Medicines must clarify the Sovereign-Minister relationship of the Five Zang Organs; this is the method.

Huanglian Neishu Tang (Coptis Internal-Purging Decoction): Treats vomiting, hiccups, heart rebellion, fever with irritability, deep/solid pulse, hard/swollen woody sensation, unchanged skin color, deep/large root, distant interior disease, zang-fu constipation. Urgently purge/drain.
Ingredients: Huanglian (Coptidis Rhizoma), Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), Bohe (Menthae Haplocalycis Herba), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix) — 1 liang each; Lianqiao (Forsythiae Fructus) — 2 liang.
Preparation: Except Binglang and Muxiang which are powdered, all are chopped. Take 1 liang, decoct in 1.5 cups of water to 1 cup. Take 1-2 doses first, then increase Dahuang (Rhei Radix et Rhizoma) by 1 qian per dose, up to 2 qian, stopping when purged. If heat signs exist, take only Huanglian Tang; if constipated, add Dahuang. If no heat signs, take Fujian San frequently. Thus interior and exterior are unblocked, Ying and Wei harmonized, channels unblocked.

Neituo Fujian San (Interior-Supporting Double-Decoction Powder): Treats external swelling, shallow root, exterior symptoms, floating pulse, pain in skin, fear of pathogen invading interior due to excess. Urgently support interior.
Ingredients: Digupi (Lycii Cortex), Huangqi (Astragali Radix), Fangfeng (Saposhnikoviae Radix) — 2 liang each; Shaoyao, Huangqin, Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Renshen (Ginseng Radix), Gancao, Danggui, Fangji (Stephaniae Tetrandrae Radix) — 1 liang each; Gui (Cinnamomi Ramulus) — 5 qian.
Preparation: Coarsely crush. First decoct 1 jin of Cangzhu (Atractylodis Rhizoma) in 5 sheng of water to 3 sheng, discard residue. Add the twelve prior herbs, decoct to 3-4 cups, strain clear liquid. Divide into 3-4 doses, take throughout the day. Also decoct Cangzhu residue in water, strain, and decoct the twelve herb residues again. This removes dampness and disperses stagnant heat, harmonizing Stomach Qi. If unresolved, take half dose. If constipated and febrile, take less Huanglian Tang. If mild diarrhea and heat subsided, take half dose of Fujian San. Thus Ying and Wei circulate, preventing interior invasion.

Danggui Huangqi Tang (Angelica and Astragalus Decoction): Treats sores/ulcers where zang-fu function is active but pain is unbearable.
Ingredients: Danggui, Huangqi, Dihuang (Rehmanniae Radix), Chuanxiong (Chuanxiong Rhizoma), Digupi, Shaoyao — 0.5 qian each.
Preparation: Coarsely crush, decoct in water. If feverish, add Huangqin. If irritable and unable to sleep, add Zhizi. If vomiting, dampness invades Stomach; double Baizhu. These three formulas represent the three methods of Yi Shui (Li Dongyuan's teacher Zhang Congzheng and Li himself) for treating sores. Listed here first, followed by ancient and modern formulas. Practitioners should examine pulse and symptoms carefully to apply them correctly.