典藏书目

The life and death of a person are determined by the prosperity or withering of Qi and Blood. Diseases arise because Qi and Blood lose their normal regulation. Therefore, the onset of carbuncles (Yongju, 痈疽) may be due to Heat in Qi damaging Blood, or Heat in Blood damaging Qi. In summary, it is always due to the obstruction of meridians and the coagulation of Qi and Blood. However, there are differences between Yin syndromes and Yang syndromes, Exterior patterns and Interior patterns, Deficiency patterns and Excess patterns. The Classics state: "When the Five Zang organs accumulate Heat, carbuncles erupt." It also states: "When the Six Fu organs are disharmonious, stagnation and knotting form carbuncles." It further states: "All pain, itching, and sores belong to the Heart and Lung." If Heart Fire attacks the Liver, carbuncles erupt; if Cold from the Kidney transfers to the Liver, swelling and carbuncles occur with shortness of breath; if Cold from the Spleen transfers to the Liver, swelling and carbuncles occur with tendon spasms. These are all changes of the Zang-Fu organs, not exclusively caused by Heat nor solely attributed to external pathogens. *Ji Yan Fang* states: Although the names of carbuncles and ulcers number more than twenty types, their essence lies only in Yin and Yang. Those erupting in the Yang aspect are called Yong (carbuncle), characterized by Heat and Excess. Those erupting in the Yin aspect are called Ju (ulcer/gangrene), characterized by Cold and Deficiency. Thus, when a Yang eruption occurs, the skin is thin, color is red, swelling is high, often with dozens of pepper-like pustules, and it is painful. When a Yin eruption occurs, the skin is thick, color is pale, swelling is hard like the skin of an ox's neck, and it is painless. There is also "Yin within Yang," which appears hot but is not truly hot; although swollen, it is essentially deficient. If red but not dry, wanting pain but having no pus, initially floating then subsiding, externally abundant but internally rotting flesh, this is Yin within Yang. Such people have tight, fatty flesh but internal deficiency. "Yang within Yin" appears cold but is not truly cold; not swollen but essentially red, slightly dry, with pus and pain. Externally not abundant but internally solid with restlessness and oppression. Such people have loose, lean flesh but internal excess. Furthermore, there are cases where Yang transforms into Yin, caused by herbalists overusing cooling formulas; and Yin transforms into Yang, caused by physicians suddenly using large doses of heating medicines. However, Yang transforming into Yin is common and can often revert to Yang, so most survive. Yin transforming into Yang is rare and cannot revert to Yin, so most die. Occasionally, survival occurs when the physician accidentally follows the correct method, one in a hundred. Xue Lizhai stated that carbuncles and ulcers have five auspicious signs (Wu Shan) and seven ominous signs (Qi E). Eating and drinking normally, movement and rest naturally peaceful is the first auspicious sign. Bowels and urine regular, or slightly dry, is the second auspicious sign. After pus discharges and swelling subsides, food and drink do not smell foul, internal and external symptoms correspond, is the third auspicious sign. Spirit is bright and clear, voice is crisp, distinction between good and bad muscle tissue is clear, is the fourth auspicious sign. Constitution is harmonious, disease responds to medicine, is the fifth auspicious sign. The seven ominous signs are: irritability, frequent coughing, abdominal pain, severe thirst, eyes turning inward toward the nose, endless diarrhea, urination like dribbling, is the first ominous sign. Breath is faint and continuous, pulse contradicts the disease, after pus and blood discharge swelling is even worse, pus color is foul and败坏 (decayed), pain is unbearable to touch, is the second ominous sign. Vision is abnormal, eyeballs dark and tight, sclera dim, cyanosis and redness appear, pupils look upward, muscles at Jingming (BL-1) sink, is the third ominous sign. Panting, coarse breathing, shortness of breath, mental confusion, drowsiness, face cyanotic, lips black, stool filthy, flesh un-ulcerated but black and sunken, is the fourth ominous sign. Shoulder and back stiff, limbs heavy, ulcerated area cyanotic-black, tendons rot, bones black, is the fifth ominous sign. Unable to eat, vomiting after taking medicine, food has no taste, phlegm vomiting, qi stagnation and fullness, body cold, spontaneous sweating, deafness, palpitations, inverted speech, is the sixth ominous sign. Hoarse voice, complexion ruined, lips and nose cyanotic-red, edema of face, eyes, and limbs, is the seventh ominous sign. Symptoms showing five auspicious signs indicate the disease is in the Fu organs and is mild. Symptoms showing seven ominous signs indicate the disease is in the Zang organs and is critical. Generally, if one or two auspicious signs appear among the five, the sore is treatable. If one or two ominous signs suddenly appear among the seven, deep caution is required. Generally, Deficiency patterns showing ominous signs are incurable; Excess patterns without ominous signs will heal spontaneously. At the time of diagnosis, careful observation is essential. One must distinguish meridians and regions, the amount of Qi and Blood, and the distance of acupoints. Some are suitable for internal treatment, some for external treatment. *Yuan Rong* states: Pathogens entering from the exterior should not be moxibusted; pathogens exiting from the interior should be moxibusted. For externally entering pathogens, use expulsion methods to prevent inward penetration; for internally exiting pathogens, use guiding methods to promote outward discharge. Thus, the Classics state: "For sunken [conditions], apply moxibustion." Moxibustion is the meaning of treating according to the nature of the condition. For any initial carbuncle or ulcer within seven days, moxibustion should be applied immediately. It greatly breaks knots, resolves hardness, guides toxic heat outward, moves deep conditions to superficial levels, and its efficacy surpasses herbal medicine. Except for the head, which is the gathering point of all Yang meridians, where moxa cones should be small and few. Especially in the Shaoyang distribution areas, moxibustion is contraindicated; applying it often leads to untreatable conditions, and some may even die from it. This is because of extreme deficiency, where isolated Yang is about to perish. The pulse will be floating, rapid, large, and forceful. Spirit will be short and confused, unable to withstand the fire energy, hence the danger. *Jing Yao* also states: The brain is the meeting of all Yang; the neck near the throat, and the Shenshu (BL-23) acupoint, are vital locations where cauterization/moxibustion is strictly forbidden. If one does not know the indications and contraindications and applies them indiscriminately, it is not only useless but harmful. Although surgeons belong to surgery, those who observe complexion and pulse, differentiate Yin and Yang, clarify meridians, and distinguish deficiency and excess must be proficient in internal medicine to clearly understand external treatments.