External abscess and internal abscess are collectively referred to as abscess syndrome, and only the former is discussed here. External abscess is an acute infectious sexually transmitted disease characterized by local redness, swelling, burning pain.
The cause of this syndrome is often due to excessive consumption of rich and sweet foods leading to internal zang-fu organ toxin accumulation, dampness toxin rising, resulting in dampness-heat fire toxin steaming together, condensing in the skin, qi and blood trapped by evil toxins, meridian and collateral blockage, leading to the development of external abscess. Those that come on rapidly and are severe are called "eruptions". This is the focus of discussion.
Regarding the acupuncture and moxibustion treatment of this syndrome, Neijing has a dedicated section discussing it, especially Suwen-Tongping Xushi Lun which mentions the treatment of dangerous and severe external abscesses: "Sudden abscess with soft tendons, pain along the divisions, incomplete sweating, insufficient bladder qi, treat at the meridian points". Later works such as Beiji Qianjin Yaofang, Shenying Jing, Leijing Tuyi, Zhenjiu Dacheng also have records.
In modern Western medicine, conditions such as cellulitis are equivalent to this syndrome.
bubble_chart Pattern Identification
External abscess can be classified by location into cervical carbuncle (acute yogenic lymphadenitis of neck), throat-blocking carbuncle (cellulitis of floor of mouth), perineal abscess, phlegmon of buttock, Weizhong toxin (acute pyogenic popliteal lymphadenitis), elbow carbuncle, back carbuncle, hip abscess, etc. Back carbuncle is more common and severe, and is used as an example here.
Back carbuncle can occur anywhere on the back and shoulders, initially with sudden local swelling and discomfort, soft and headless, skin red, gradually expanding to become high, hard, and extremely painful, with chills, fever, dizziness, headache; in severe cases, high fever, thirst, constipation, dark urine, rapid and full pulse, red tongue with yellow coating.bubble_chart Treatment
1. Principle: Clearing heat and removing toxin, subduing swelling to relieve pain.
2. Prescription: Jianjing (GB21), Weizhong (BL40), ashi point, perineal moxibustion point.
3. Explanation: Jianjing (GB21) is the intersection of the hand foot shaoyang and yang link vessel (Yang LV), located at the shoulder, can disperse fire toxin and reach yang pathogen, is a proven point for treating back carbuncle, highly regarded by physicians throughout history; Weizhong (BL40) pricking to clear heat toxin in the blood; ashi point moxibustion to disperse stagnant qi and blood, as Zhang Jing-yue said: "Yongju is caused by nothing but the stagnation of qi and blood, not moving... without the help of fire, it cannot be quickly resolved" (Jingyue Quanshu‧外科鈐). Perineal moxibustion point, created in the Song Dynasty, is a highly effective point for treating Yongju.
4. Treatment method: Weizhong (BL40) pricking to remove toxic blood, ashi point moxibustion with garlic, if the affected area is large, use moxa roll rotation method, same as "boil and sore"; Jianjing (GB21) acupuncture should not be too deep to avoid causing pneumothorax, apply draining method. Perineal moxibustion: have the patient sit on a bamboo pole (the pole can be placed on two stools and fixed), feet slightly touching the ground, measure from the tip of the sacrum up along the governor vessel (GV) the length from the midpoint of the inner wrist to the tip of the middle finger (excluding the nail length), mark the point, then measure one body cun to each side from this point, these are the moxibustion points, apply moxibustion, usually direct contact moxibustion seven to ten cones, if indirect moxibustion, increase the number of cones.
bubble_chart Ancient PrescriptionsBeiji Qianjin Yaofang‧Volume 22: "Back gangrene: ... When one feels unusual itching and pain on the back, immediately take clean soil and mix it with water to make mud, shape it into cakes, two fen thick and one and a half cun wide. Use large moxa sticks, place them on the mud cakes, and apply them to the sore for moxibustion, changing the cake after each moxa stick."
Shenying Jing‧Ulcer Toxin Section: "Yongju back gangrene: Jianjing (GB21), Weizhong (BL40). Also, apply garlic slices to the ulcer and moxibustion. If there is no pain, moxibustion until there is pain; if there is pain, moxibustion until there is no pain. The more, the better" .
Leijing Tuyi‧Volume 11: "back gangrene: Xinshu (BL15), Weiyang (BL39), Qizhuma point. Left and right hand grasp, add Huiyang (BL35)" .
Zhenjiu Dacheng‧Volume 9: "back gangrene Yongju: Jianjing (GB21), Weizhong (BL40), Tianying, Qizhuma" .