典藏书目

The *Jingyuan Bingji* (Essentials of Pathogenesis) states: Sores and ulcers belong to the category of Fire pathogen. One must distinguish between internal and external causes to treat the root. If the pulse is deep and solid, one should first unblock the interior to cut off the source; if the pulse is floating and large, one should first support the interior (support healthy qi and push out toxins) to prevent the pathogen from sinking inward. There are also cases involving both interior and exterior, where the pathogen is extremely abundant, blocking the meridians and collaterals, thus causing carbuncles and swellings. This results from failure to support the interior, failure to unblock, and failure to harmonize Ying and Wei (nutritive and defensive qi). The general principle for treating sores requires understanding these three methods: supporting the interior, unblocking, and harmonizing Ying and Wei.

For those originating from the interior and manifesting externally, the pulse is deep and solid, accompanied by fever and irritability, with no obvious redness or pain on the body surface, indicating that the pathogen has penetrated deeply into the interior; therefore, one must unblock the zang-fu organs to cut off the source. For those transmitting from the exterior to the interior, the pulse is floating and rapid, with swelling manifesting in external signs, fearing that the pathogen is extreme and moving inward; thus, one should first use the method of supporting the interior. For those involving both interior and exterior, there are no exterior symptoms such as aversion to cold, and the internal zang-fu functions are unobstructed and normal; the disease is located in the meridians, and one should harmonize Ying and Wei. After applying these three methods, even if the disease is not yet cured, complications will certainly be avoided, and the pathogen can be significantly reduced, making recovery easier.

The *Neijing* (Inner Canon) says: "Sweating will cure the sore." Li Dongyuan said: People in the southeast regions correspond to the lower part of the human body; there is heat in the Small Intestine and wind in the Gallbladder. Both the Small Intestine and Gallbladder reside in the lower part, and their nature is inflammatory and ascending. Such sores present with manifestations of the Six Channels externally, but internally there is no obstruction in urination or defecation, diet remains normal, and stools and urine are clear and regulated. Knowing that the disease is not in the interior, nor is it a deep abscess (Ju), it is merely a superficial abscess (Yong) or boil (Jie). Small ones are Jie, large ones are Yong. This pathogen comes from the damp-wind region below, invading the body from the outside. The *Classic* says: "When Ying Qi does not follow its course and reverses into the muscle tissue, carbuncles and swellings arise." All painful, itching sores belong to Heart Fire. However, this sore enters from the outside; it is the Bing Fire (Small Intestine) migrating leftward into the Gallbladder, presenting as pain rather than itching. These two locations are related to Blood; diseases of Blood inevitably involve pain. This is due to insufficiency of Yuan Qi (Original Qi) and reversal of Ying Qi flow. When the sore first appears without transmission, it is located above the muscles and between the skin and hair, emerging only in the meridian pathways traversed by Wind-Heat. It is appropriate to drain Wind-Damp-Heat. Physicians only know that "Yin covering Yang" allows for sweating, but here sweating is indicated because Damp-Heat stagnates in the Hand-Shaoyang and Foot-Shaoyang meridians, causing blood vessels to coagulate and reverse, weakening the Ying and Wei throughout the body and depleting Yuan Qi. With Wind-Heat stagnating in the lower part, the complexion must be red and swollen, slightly dark, which is the color of Eastern Wood Qi being submerged. The nature of Wind-Wood rushes upward to the face, causing anger and a flushed appearance. The sore's color is also red, swollen, hard, and slightly dark. The sore's condition is also elevated, protruding, hardened, and painful. The pulse is found only on the left hand; the left hand governs the exterior. The Cun position on the left is externally large and slow; the Guan position on the left is large, slow, and wiry. This indicates an exogenous pathogen located above the blood vessels and between the skin. One should urgently induce sweating and unblock Ying and Wei, so that the pathogen may depart. Use Tuoli Yingwei Tang (Support Interior and Harmonize Ying-Wei Decoction) as the main formula.

In strict accordance with the previous discussion, the three general principles mentioned therein—namely, "sores should be treated by sweating" and "first support the interior to fear pathogen invasion"—refer to external causes; "first unblock the interior to cut off the source" refers to internal causes; "harmonize Ying and Wei" refers to non-internal/non-external causes. Therefore, for sores erupting on the skin surface, generally speaking, the sweating method can be used. However, among sweating, purging, and harmonizing, there is also a sequence for external treatments. For example, Guo Shi's clinical case records: A fifty-nine-year-old woman suffered from a Ding Chuang (hard boil/leukoderma-like lesion) between the Tianrong acupoint below her right ear. The head was black and scabbed, with blisters around it oozing yellow fluid. Her whole body felt numb, she had fever and delirious speech, and was occasionally lethargic. Her six pulses were floating and large. She was given Wu Jin San (Black Gold Powder) to induce sweating. First, a needle was used to prick the center of the sore; it did not hurt. Then, more than ten pricks were made around the periphery, releasing purple-black blood, after which pain was felt. The Cunjing Dingzi (Inch-Gold Plug) was inserted into the sore, and the Tiding Dingzi (Lifting Boil Plug) was placed on top, covered with a plaster. The next day, after sweating, her spirit refreshed slightly. Then, Po Guan Dan (Coffin-Breaking Pill) was administered to purge, stabilizing the illness. After the Ding Chuang ulcerated, Shou Xiao San (Guard Efficacy Powder) was applied, followed by Hongyu Dingzi (Red Jade Plug). On the eighth day, the Ding Chuang expelled itself. This is what is meant by examining the pulse and symptoms, choosing between sweating and purging, and following a sequence of external treatments, which is highly effective. Those who do not examine the pulse and symptoms, seeing only fever and delirium and immediately administering cooling agents and purgatives, or adding aromatic penetrating drugs, cause great harm.