典藏书目

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All pain and sores belong to the Heart. It also states: When Ying Qi (Nutritive Energy) does not flow smoothly and reverses within the muscle tissue, abscesses and swellings arise. It further states: Changes resulting from a diet rich in fatty and sweet foods are sufficient to generate severe Ding Sores (hard carbuncles). It states: Uneven sweating can lead to hemiplegia; sweating while exposed to dampness generates acne and prickly heat. It states: If the opening and closing of the pores are impaired, cold qi enters, leading to severe curvature of the body (Da Lou). It states: Dampness from the earth, when contracted, harms the skin, flesh, sinews, and vessels. By investigating these points, one can understand that the root of organ diseases lies within, while the branches manifest as sores on the skin and flesh. If there were no accumulated heat internally and no invasion of damp-heat externally, the muscles would be smooth, and Qi and Blood harmonious; how could Yang Sores (superficial abscesses) or Yin Sores (deep abscesses) arise?

In treating all swellings, one must first differentiate between deficiency/excess and Yin/Yang. The classics state: All pain is excess; all itching is deficiency; all Yang Sores are Yang syndromes; all Yin Sores are Yin syndromes. One must also distinguish whether it is a Jie Nodule, Yong Abscess, Ju Deep Abscess, Fa Spreading Infection, or Ding Hard Carbuncle, before applying treatment, to avoid errors. For instance, if heat erupts between the skin, with swelling high and broad-based, it is a Yong Abscess. If depression-heat in the five Zang organs flows as toxin into the bone marrow, attaching to the bone and growing, becoming noticeable only after a day, with a mass large like a hidden melon, it is a Ju Deep Abscess. Due to indulgence in alcohol and sex confusing the spirit, or preference for strong-flavored foods; or due to frustrated will and unresolved depression, toxins may arise in thin-fleshed areas; or through infection with animal toxins or contact with cattle/horse filth. Initially the size of a millet seed, if not carefully protected and mistakenly touched, mild cases become severe, and severe cases become critical. Medication must be used to resolve the toxin, otherwise rapid decay will occur.

Regarding syndromes such as Yong, Ju, and Back Carcinoma, there are "Five Good Signs" and "Seven Bad Signs," which must not be ignored. Calm breathing and appetite constitute the First Good Sign; normal urination and defecation with a bright complexion constitute the Second Good Sign; clear spirit and distinct speech constitute the Third Good Sign; discharge of pus with reduction of swelling, fresh color without odor constitutes the Fourth Good Sign; physical peace and normal daily routine constitute the Fifth Good Sign. If all Five Good Signs appear, recovery is assured. As for the Seven Bad Signs: tight eyes with blue lips and black sores constitute the First Bad Sign; inability to turn the neck/shoulders, heavy limbs, closed eyes and deafness constitute the Second Bad Sign; hoarse voice, sallow complexion, blue face, panting, and restlessness constitute the Third Bad Sign; inability to eat, vomiting upon taking medicine, loss of taste, extreme pain, and severe thirst constitute the Fourth Bad Sign; spontaneous cold sweat, delirium, lethargy, and confused speech constitute the Fifth Bad Sign; irritability, cough, abdominal pain, diarrhea, and turbid urine constitute the Sixth Bad Sign; discharge of pus and blood yet persistent severe swelling with foul-smelling pus constitutes the Seventh Bad Sign. If all Seven Bad Signs appear, the prognosis is dire. Seeing three of the Five Good Signs indicates auspiciousness; seeing two of the Seven Bad Signs indicates凶兆 (ominous signs).

In treating Yong and Ju, at the initial stage, one should disperse heat and extract toxins; once formed, one should drain pus and relieve pain. If the swelling has formed but not ruptured, hot herbs must absolutely not be administered; one must first promote dispersion. If already ruptured, with depleted Zang-Fu and reduced intake, cold herbs must absolutely not be consumed; one must harmonize Ying and strengthen the Spleen. This was indeed the method of ancient physicians for treating Yong, Ju, and Back Carcinoma, leaving little room for improvement; however, one must still consider seasonal changes, examine pulse patterns, differentiate deficiency/excess, judge severity, and apply treatments according to the disease trend, so as not to shorten life expectancy.

Regarding Liu Zhu (flowing deposits) originating from Shang Han (Cold Damage), caused by missed opportunities for diaphoresis or harmonization, leading to blood stasis in the skin and toxin obstruction in the bone marrow, thus generating this toxicity. Toxins flowing downward from above produce less toxicity; those flowing upward from below produce more. Such cases also require releasing the exterior, clearing the muscle layer, extracting toxins, and clearing heat, which can be resolved internally.

Although Ding Toxins have thirty-six types, their harm is identical; the primary approach should be detoxification, referring to relevant syndrome treatments. Diseases such as Tan He (phlegm nodules), Ying Liu (goiter), Luo Li (scrofula), and Ma Dao (horse knife-like tumors) all result from dampness generating phlegm, phlegm generating fire, fire generating wind, and wind reaching its extremity causing disease. These arise from internal emotional stagnation and external sensory desires. Treatments should include agents that clear phlegm and descend fire, and drugs that disperse heat and defeat toxins. Once established, external resolution methods must be used. Moxibustion may be applied initially, but surgical incision must never be performed recklessly.

Ancient physicians stated: Among the meridians, only Shaoyang and Jueyin are prone to Yong and Ju; only Shaoyang and Yangming are prone to Luo Li, largely due to being "abundant in Qi and deficient in Blood."

When diagnosing surgical pulses: A floating and tight pulse usually indicates fever; if there is no fever but rather aversion to cold with shivering, and there is a painful area, an abscess or deep sore will definitely develop. A floating and rapid pulse with no body heat, silent demeanor, slight chest dryness, and unknown pain location indicates an impending abscess or deep sore. Before rupture, if palpation feels sharp and floating like a knife edge, and after rupture it feels slightly light and floating, healing is easy. If before rupture the pulse is slow and moderate, and after rupture it becomes robust, large, or surging, efficacy is difficult to achieve. If upon contracting Yong or Ju the pulse is weak throughout, this is a critical condition.

When puncturing abscesses, one must determine the presence of pus. Pressing with the hand: if the indentation rebounds immediately, pus is present; if it does not rebound, there is no pus (this is called "Yin Shou"). Pain only upon deep pressure indicates deep pus; pain upon light pressure indicates superficial pus; lack of significant pain indicates unformed pus. Regarding incision technique, do not hesitate to make the incision wide enough to ensure complete drainage. Incise deeply if the lesion is deep, and shallowly if shallow; do not neglect this. For Yu Kou, Bian Du, Back Ju, Umbilical Yong, Abdominal Yong, and Luo Li, shallow incisions are appropriate; for Arm Yong, Groin Ju, and thick-fleshed areas, deep incisions are required to allow pus to flow out and drain internal toxins. This must be known.

When a sore first appears, accompanied by high fever, aversion to cold, stiffness, headache, mental unrest, and irritability with desire for cold drinks, the lesion is likely deep. If daily activities and diet remain normal, the lesion is superficial. If pain persists after pus discharge, it indicates deficiency and requires tonification. Pain triggered by foul odors requires harmonization; pain forced by wind-cold requires warming and nourishing. If a deep Ju arises without pain, it indicates severe Stomach Qi deficiency and necrotic tissue accumulation where sensation is lost.

Frequent vomiting during a sore should be treated as toxic vapors attacking upward; post-ulceration vomiting should be treated as Yin deficiency. In elderly patients with post-ulceration vomiting and anorexia, Shen Zhu Bai Zhu Gao (Ginseng, Atractylodes, and Licorice Paste) should be used for vigorous tonification. Hejian stated: Vomiting in sores is caused by dampness invading the Stomach; use double the dose of Bai Zhu (Atractylodes Macrocephala Rhizome).

Thirst in Yong and Ju indicates dual deficiency of Blood and Qi; use Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) to tonify Qi, and Dang Gui (Angelica Sinensis Root) and Di Huang (Rehmannia Root) to nourish Blood. Real-heat Yong and Ju are easy to treat; deficiency-cold with pathogenic heat is difficult. Swellings that are hard and thick-purulent indicate excess; swellings that are flat, soft, and thin-purulent indicate deficiency.

In treating Yong, Ju, Back Carcinoma, Ding Sores, Breast Abscesses, and all unnamed swellings, one must first support the interior (Tuo Li) to prevent toxin penetration into the bone marrow. After supporting the interior, dispersing heat, resolving toxins, relieving pain, and draining pus are the urgent priorities.