Abscesses and Sores

The Yellow Emperor said: I have heard that the intestines and stomach receive water and grain, and the upper burner outputs the clear qi to warm and moisten the muscles, nourish the bones and joints, and open the interstices of the skin. The middle burner outputs essence qi like dew, which rises upward and pours into the xi valleys (muscle interstices) and penetrates into the sun mai (fine collateral vessels). When the jin and ye fluids are harmonized, they transform into red and become blood. When blood is harmonized, the sun mai are first to fill and overflow, then pour into the collateral vessels. When all collateral vessels are filled, they then pour into the main channels. The yin and yang qi have already been dispersed, moving in accordance with respiration. Their movement has regularity, their circulation has order, and they accord with heaven and earth, never ceasing. Pulse examination is used to regulate treatment: from deficiency to excess (excess is drained), draining causes the upright qi to be insufficient; rapid draining reduces qi, while retaining the needle has a sequence of priority. From excess to deficiency (deficiency is supplemented), supplementation causes the upright qi to be abundant. When blood and qi are already harmonized, the physical form and qi mechanism can maintain normalcy. I already know the balance and imbalance of blood and qi, but I do not know from where abscess and gangrene arise, the time of their formation and rupture, the period of life and death, which differ in distance and proximity. By what means can these be measured? May I hear about this?

Qi Bo said: The movement of the main channels never stops, and it is the same as the law of heaven’s movement, and accords with the pattern of the earth’s movement. Therefore, if the movements of the heavenly constellations lose their regularity, solar and lunar eclipses occur; if the courses of earthly waterways lose their pattern, flooding results, water plants cannot grow, the five grains cannot flourish; when roads are impassable, the common people cannot travel, and in cities with streets and neighborhoods, people scatter and dwell apart. Blood and qi are also like this. Allow me to explain the reasons. The construction qi and defense qi in the blood vessels circulate unceasingly, corresponding above to the constellations, and below to the numbers of the channels. When cold evil enters the channels and vessels, it causes the blood to become congealed and sluggish; when blood is congealed and sluggish, it does not flow freely; when it does not flow freely, the defense qi gathers here and cannot return, thus forming a swollen abscess. Cold qi transforms into heat; when heat evil is excessive, it causes the muscles to rot; when muscles rot, they become pus. If pus is not expelled, it rots the sinews; when sinews rot, it injures the bones; when bones are injured, the marrow is depleted and reduced; if it is not in a bone hollow, it cannot be drained; when blood is exhausted and empty, then the bones, sinews, and muscles receive no nourishment; the main channels are damaged and leak, scorching and fumigating the five viscera; when the five viscera are injured, death results.

The Yellow Emperor said: I wish to fully understand the forms of abscess and gangrene, as well as their prohibitions and names. Qi Bo said: An abscess occurring in the throat is called fierce abscess. If fierce abscess is not treated, it turns into pus; if the pus is not drained, it blocks the throat, and death occurs within half a day. If it has already turned into pus, drain the pus and mix with lard, take it cold, and recovery occurs in three days. An abscess occurring on the neck is called celestial abscess. This abscess is large and its color is red-black. If not treated quickly, the heat qi descends into the Yuanye point, forward it injures the Conception Vessel, and inward it fumigates the liver and lungs. When the liver and lungs are fumigated, death occurs in ten-odd days. When yang qi stagnates and greatly erupts, consuming and exhausting the brain marrow, and it stays in the nape, it is called brain consumption. The patient’s expression is unhappy, and the nape has pain like a needle prick. If there is restlessness, it is incurable and death follows. An abscess occurring on the shoulder and upper arm is called mole abscess. Its form is red-black. Treat it quickly; this disease causes sweating down to the feet, and does not harm the five viscera. When the abscess has been present for four or five days, quickly apply moxibustion. An abscess occurring under the armpit that is red and hard is called rice abscess. Treat it with a stone needle; choose a fine and long stone needle, puncture sparsely, apply lard, and recovery occurs in six days. Do not wrap it. If this abscess is hard and does not rupture, it is horse-sword and clamp-scrofula; treat it quickly. An abscess occurring on the chest is called well abscess. Its form is like a soybean; it arises in three or four days. If not treated early, it descends into the abdomen. If not treated, death occurs in seven days. An abscess occurring on the breast (front of chest) is called sweet abscess. Its color is blue, and its form is like a grain ear or a snakegourd. The patient often suffers from cold and heat. Treat it quickly to remove the cold and heat. Death occurs after ten years; after death, pus emerges. An abscess occurring on the ribs is called defeat abscess. Defeat abscess is a women’s disease. Use moxibustion. This disease becomes a large abscess with pus. To treat it, there will be raw flesh inside, about the size of a red bean. Use one sheng each of the roots of zulingqiao herb, boil them in one dou and six sheng of water, boil until the water is reduced to three sheng, then forcefully drink it. Put on many clothes, sit over a cauldron, and induce sweating down to the feet. An abscess occurring on the thigh and lower leg is called thigh-shin abscess. Its form does not change much, and the abscess adheres to the bone. If not treated quickly, death occurs in thirty days. An abscess occurring on the tailbone is called sharp abscess. Its form is red, hard, and large. Treat it quickly; if not treated, death occurs in thirty days. An abscess occurring on the inner thigh is called red spreading. If not treated quickly, death occurs in sixty days. When it occurs within both thighs, if not treated, death occurs in ten days. An abscess occurring on the knee is called mole abscess. Its form is large, the color of the abscess does not change, and there is cold and heat. It is like a hard stone. Do not puncture it with a stone needle; puncturing with a stone needle causes death. Wait until it becomes soft, then puncture with a stone needle, and it will be curable. Various abscesses and gangrenes that occur at joints and correspond above and below are incurable. Those occurring on the yang (outer) side cause death in one hundred days; those occurring on the yin (inner) side cause death in thirty days. An abscess occurring on the lower leg is called rabbit bite; its form is red down to the bone. Treat it quickly; if not treated, it will harm the person. An abscess occurring on the inner ankle is called slow walking; its form is like an abscess, and the color does not change. Puncture its transport point repeatedly with a stone needle to stop its cold and heat; it will not cause death. An abscess occurring on the top and bottom of the foot is called four excesses; its form is a large abscess. Treat it quickly; death occurs in one hundred days. An abscess occurring on the side of the foot is called severe abscess. Its form is not large; initially it is like a small finger; it erupts. Treat it quickly to remove the blackened part. If it does not subside, it increases. If not treated, death occurs in one hundred days. An abscess occurring on the toes is called sloughing abscess. Its form is red-black; if it is fatal, it is incurable; if it is not red-black, it will not cause death. If it does not subside, quickly amputate; otherwise, death results.

The Yellow Emperor said: Master, you have spoken of abscess and gangrene. How are they distinguished? Qi Bo said: When the construction and defense qi stagnate in the main channels, it causes the blood to become congealed and sluggish and not move; when it does not move, the defense qi follows and becomes blocked and obstructed, dammed up and unable to move, thus generating heat. When great heat does not stop, the heat evil becomes excessive, and it causes the muscles to rot; when muscles rot, they become pus. However, it does not deeply penetrate; the bone marrow is not burned and exhausted; the five viscera are not injured. Therefore, it is called abscess. The Yellow Emperor said: What is called gangrene? Qi Bo said: When the heat qi is pure and abundant, it descends and penetrates deeply into the skin and muscles, the sinews and marrow are exhausted, internally it connects with the five viscera, and blood and qi are depleted and exhausted. Below the abscess, the sinews, bones, and healthy flesh have nothing left over. Therefore, it is called gangrene. The skin color of gangrene is dull and hard, and its surface is like the skin of an ox’s neck. The skin of an abscess is thin and glossy. These are their signs.