典藏书目

Yuanyong stated: For sores and ulcers caused by external invasion, moxibustion is not suitable; for those originating from within, moxibustion is indicated. For externally invaded lesions, the method of expelling toxins outward should be used to prevent internal sinking; for internally originated lesions, the method of guiding healthy Qi outward should be employed. Thus, the classics state: "For depressed (sunken) lesions, apply moxibustion."

Regarding "moxibustion without pain" and "pain then cessation":
If there is no pain during moxibustion followed by pain later, it is because the moxibustion first targeted the already ulcerated area (hence no pain), and subsequently targeted healthy flesh (hence pain).
If there is pain during moxibustion which ceases upon completion, it is because the moxibustion first targeted the non-ulcerated area (hence pain), and subsequently targeted the area about to ulcerate but not yet fully broken (hence no pain).

Commentary: This is a general principle. The methods of Dongyuan et al. are appended here for reference. When one initially feels a carbuncle on the back beginning to form but not yet consolidated, with redness, heat, swelling, and pain, cover the area with wet paper and observe immediately. The place where the paper dries first indicates the head of the abscess. Take garlic, slice it to a thickness equivalent to approximately 3 qian, and place it on the head of the abscess. Apply large moxa cones for three moxibustions (zhuang), then replace with a new garlic slice. If the patient feels pain, continue until the pain stops; if there is no pain, continue until pain is felt. The most crucial aspect is early detection and early application of moxibustion, which is the superior approach. Within one to three days of onset, ten applications can save ten lives; within three to four days, six or seven applications can save lives; within five to six days, three or four applications can save lives. After seven days, moxibustion is contraindicated. If multiple heads arise in one cluster, grind garlic into a paste, make a thin cake, spread it over the lesion, and burn moxa gathered on the garlic cake; this can also be curative. If the back initially presents with a patch of redness and swelling with a single yellow millet-grain-sized head in the center, take a single bulb of garlic, cut off both ends, use the middle half-inch section, adjust the thickness appropriately, place it directly on the sore, and apply moxibustion for fourteen zhuang, up to forty-nine zhuang.

Commentary: This refers to the indication for moxibustion in the onset of carbuncles and deep abscesses. However, for chronic sores that have become fistulas, often with continuous discharge of pus that is odorless and without necrotic tissue inside, it is especially suitable to soak Fuzi (Aconiti Lateralis Radix Praeparata) in water, slice it thickly (about 2-3 fen), place it on the sore, and apply moxibustion, while simultaneously administering internal supportive medicines. Repeat moxibustion every two to three days; after five to seven sessions, the muscle will naturally regenerate and fill the defect. For cases with gradual erosion of foul pus and deep-rooted pathology, Guo's treatment uses white flour, sulfur, and garlic pounded together into a paste. Formed into a cake according to the size of the sore, with a thickness of about 3 fen, it is placed on the sore and moxibusted with twenty-one zhuang, replacing the cake after each session. Subsequently, every four to five days, Cuixia Dingzi (Emerald Cloud Pill) and Xinxiao Dingzi (Trustworthy Effect Pill) are used alternately and inserted into the sore. Once necrotic tissue is completely removed and healthy flesh grows level, apply astringent topical medicines and administer internal remedies corresponding to the disease for regulation, leading to recovery. This demonstrates that moxibustion is not only suitable for the initial stage of sores. Generally, moxibustion is indicated at the onset, but must be combined with diaphoretic, purgative, and nourishing herbs according to the syndrome. Even for treating cold sores, internal supportive medicines are essential and must be applied cautiously. If the condition reverses adversely, not only will it not heal, but it may lead to other diseases.

Sores are classified into three categories of etiology:
Chen Wuyue stated: Carbuncles and deep abscesses on the back involve all three etiologies. He discussed: Scrofula and gangrenous sores, regardless of deficiency/excess or cold/heat, are all formed by Qi stagnation. The classics also state: "Qi remains in the meridians and collaterals, stalling with blood, causing obstruction and knotting to form carbuncles and deep abscesses." It does not mention heat causing the formation of sores, because this arises from internal factors such as emotional depression due to anger, joy, sorrow, or worry. When the body has heat and is struck by wind-cold, causing blood vessels to congeal and stagnate, heat qi obstructs and knots to form carbuncles; or when Yin deficiency allows Yang Qi to invade, transforming cold into heat, excessive heat rots flesh into pus. These are also formed by external factors of cold, heat, wind, and dampness. Furthermore, taking cinnabar/mineral drugs, excessive moxibustion, alcohol consumption, eating wheat products, sleeping on warm beds, covering with thick quilts, and exhausting oneself through sexual activity leading to essence deficiency and Qi depletion belong to injuries from neither internal nor external causes. Thus, the three etiologies are complete.

Commentary: Although the classification of three etiologies here is comprehensive, it lacks detail regarding the differentiation of pathogenic factors in the meridians, exterior, or interior for sores and ulcers; therefore, its therapeutic methods cannot be exhaustive.