Library

According to *Ji Yan* (Collection of Proven Experiences): A pulse that is tight and rapid indicates that pus has not yet formed; if the tightness disappears and only rapidness remains, it indicates that pus has already formed. Pressing the affected area with hand: if it feels hot, there is pus; if not hot, there is no pus. If pressing feels firm and hard, there is no pus; if it feels half-soft and half-hard, pus has formed; if it becomes completely soft, the pus is mature. Pain upon deep pressure indicates deep-seated pus; slight pain upon pressure indicates pus has not yet formed. If the depression rebounds immediately after pressing, there is pus; if it does not rebound, there is no pus. Pain upon slight pressure with thin skin lifting like peeled bark indicates superficial pus; pain upon pressing all four sides with unchanged skin color and no elevation indicates deep-seated pus. Superficial pus is suitable for chemical cauterization with medicine; elevated pus is suitable for incision with a Pi needle (Bī Zhēn); deep pus is suitable for moxibustion/cautery. Additionally, one must carefully distinguish between deficiency and excess. Soft swelling without pain indicates a Blood Tumor (Xuè Liú); swelling that gradually increases but is not very hot, with occasional pulling pain, indicates an Qi Tumor (Qì Liú); hollow yellowish swelling indicates Water retention; slight swelling due to Qi stagnation that persists for a long time and later turns into pus is caused by Cold and Heat pathogens. Long-standing accumulation leads to Yin accumulating and generating Yang, transforming Cold into Heat. Once ulcerated, it will form a sore; early administration of internal medicines to support the interior and expel pus is advisable. Various Ying tumors (Yǐng Liú) and warts will spontaneously ulcerate internally in old age. Blindly using attacking and corrosive treatments while nourishing tonifying will surely endanger life. Regarding Scrofula (Luǒ Lí) nodules, accompanied by alternating cold and fever, thirst, persistence over time, sallow complexion, and steaming heat from above, pus has already formed. (Treatment see relevant section.) For abscesses on finger/toe tips and breasts, incision should only be performed when pus is ripe and fully developed. After smallpox/measles, abscesses on limbs and joints must be drained as soon as pus is suspected; delay may lead to contracture deformities.

For any carbuncle or swelling, press from the side towards the edges with fingers. If the pressed area turns dark red/black, pus has formed. If it turns red immediately after pressing, this also indicates pus. If it turns white and takes a long time to turn red, wandering toxic heat has subsided; moxibustion can be applied at the boundary of red and white colors to block the toxin. When the tissue becomes flat and solid, it will eventually resolve. Generally, Carbuncles (Yōng) have thin skin and high swelling, while Ulcers/Gangrene (Jū) have thick skin and firm swelling. Early stage treatment for both favors moxibustion. Only when pus forms in Carbuncles is needle incision appropriate; when pus forms in Jū, cautery is appropriate. One must examine carefully, waiting for maturity until the pus is ready to burst out. At this point, use "Ti Zhen Wan" (Substitute Needle Pill) to bite open the head of the sore; pus will flow naturally within half a day. Do not use needles or knives. (Zhu Danxi said: The *Jing Yao* warns against using needles and knives; surgeons should hold this in high regard.)

**Ti Zhen Wan**: Treats carbuncles/ulcers that are ulcerated but unbroken, or where pus drainage is slow.
Ingredients: Bai Ding Xiang (White Sparrow Droppings), Nao Sha (Nuo Sha/Rock Salt derivative), Moyao (Myrrh), Ruxiang (Frankincense).
Preparation: Plant 14 grains of glutinous rice inside ash cakes made from these herbs. Method: Use 5 sheng of calcined stone powder and 3 sheng of furnace ash, add 5 sheng of water, leach to obtain clear juice, boil in a large pot until concentrated to 2-3 sheng, store in a pottery vessel. To use, take half a cup of concentrated juice in a small cup, place parchment paper on top to stabilize, then plant 14 glutinous rice grains on the paper overnight.
Usage: Grind ingredients into fine powder, mix with glutinous rice paste to make pills the size of wheat grains. Apply one pill to the thinnest part of the unbroken sore head to induce rupture. If pus is stagnant, insert one pill into the opening to facilitate drainage and promote healthy tissue growth.

Another Formula:
Xiong Que Fen (Male Sparrow Droppings), Nao Sha, Chen Cang Mi (Aged Rice), Moyao.
Grind evenly, make pills the size of millet seeds with rice paste. Apply one pill to the center of the sore opening to induce pus discharge.

**Ti Zhen Ding Xiang Wan**:
Cao Wu (Aconite root tip), Nao Sha, Bai Ding Xiang (Hard variety).
Grind into powder, mix with vinegar for topical application to accelerate rupture of impending sores. If urgent, knife incision is faster. The Leech Needle method is also excellent (see later).

[Mei]: Treats various carbuncles that do not subside and have formed pus, fearing needle failure to drain. Apply male sparrow droppings to the sore head; replace when dry. Harder droppings are male.

[Benshi Fang]: Treats carbuncles/ulcers with an opening but no pus, causing unbearable pain. Apply this medicine for immediate drainage. One Baidu bean (peeled, heart/oil retained), 14 salted soybeans (peeled and softened in mouth). Grind together with a little real Shexiang (Musk). If difficult to pill, add thin paste to form pellets the size of mouse feces. Insert via paper twist into the sore according to size. Pain will occur shortly; endure it, and pus will drain.

[Danxi]: To drain all sore openings, burn silkworm pupal cocoons to retain charred nature, administer with non-grain wine. One pellet per dose. Within one hour, one new opening will appear. Two pellets yield two openings.

[Jingyao]: Carbuncles with formed pus require needle incision. Iron needles should be made from horse bit iron. Shape like leek leaves, sharp on both sides, capable of horizontal or vertical splitting (approx. 5-6 fen) to drain toxic blood. If condition is mild, moxibustion first, then split.

[Lou]: Commentary: If carbuncles resemble pepper eyes or honeycombs/lily pads with persistent pain after pus drainage, needle splitting is indicated to release toxic blood and pus. If no such features exist, simple vertical insertion suffices. Alternatively, moxibustion on each "pepper eye" is also effective without splitting.

*LLing Shu*: Pi Needle (Bī Zhēn) has a tip like a sword edge, used to extract large amounts of pus.

*Sù Wèn*: Areas where Qi stagnates in carbuncles should be opened and removed with needles. (Wang Bing notes: Xi refers to polyps/necrotic flesh. This corresponds to modern surgical removal of necrotic tissue.)

Treating necrotic swelling: Pierce the necrotic area. Depth depends on the size and depth of the carbuncle. Larger ones bleed more; smaller ones require deeper penetration. Ensure the needle is inserted straight. ("Large bleed, small deep" is considered interpolational text; "Size and depth determine needling" summarizes the method perfectly.)

[Jingyao]: Jū (deep ulcers/gangrene) with formed pus requires cautery. Use a silver comb-like tool (2 fen wide, 6 cun long), heat red-hot in fire, and quickly apply to the toxic area. Pus discharge indicates efficacy. *Gui Yi Ke*: Carbuncles in "empty" (weak) areas or hidden places are malignant. High swelling with thin, purple-red, shiny skin suggests internal pus/toxin resistant to external plasters. Use a heated copper needle, mark with ink, prick shallowly. Smooth pus drainage is favorable. If pus does not follow the needle, insert a white paper twist to draw out toxin. Swelling should reduce by 3 fen. Failure to reduce swelling is the first adverse sign; failure to relieve pain is the second; lack of patient relief despite pus drainage is the third. In such cases, urgently use decoctions to guide pus and support the interior. For carbuncles in "solid" (strong) areas, cautery is safe regardless of depth if pus exists; delay risks damaging tendons/bones. Avoid cautery near tendons/joints to prevent complications. Initial Jū presents as red/hard. Toxicity is shallow in weak areas, deep in strong areas. Identify the largest pore as the main drainage point. Use a large heated iron needle (like ox hoof) in sesame oil lamp, insert 1-2 cun. If no pus, insert paper twist overnight to draw pus. Yellow-white pus is good; red-black suggests fresh bleeding risk and chills. Do not cauterize in weak areas. For Back Carbuncles (Fā Bèi), if pus seems formed, cauterize the center with a large heated iron needle (approx. 2 cun deep). Insert horizontally initially to avoid piercing fascia. If already ruptured/thin, do not cauterize. For elongated red areas, cauterize both ends. Fat people produce more pus; thin people less. Reverse patterns suggest tissue decay vs. strong Qi. Carefully assess pulse harmony and Ying-Wei flow before cautery. Weak Qi with large pulse contraindicates blind cautery. Assess skin texture/color (purple-red/shiny indicates suitability). Needling aims to drain pus; if no pus comes, Qi is trapped, do not cauterize.

[Danxi]: Question: How is cautery performed? Answer: If pus is abundant but skin is thick/deep making access difficult, and internal support meds were insufficient, cautery opens the pathway. Pus results from rotting flesh carrying toxic heat. Prolonged retention causes toxins to invade healthy flesh, turning it to pus. Thus, cautery benefits ulcerative conditions. Those with shallow roots and thin skin do not need this complex method to deceive or profit.