Synopsis of the Golden Chamber, Volume 2, Chapter Eighteen: Pulse, Syndrome, and Treatment of Sores, Intestinal Abscess, and Spreading Sores
Overall Paraphrase
This chapter focuses specifically on the pulse presentations, syndromes, and formulae for sores, intestinal abscess, incised wounds, and spreading sores. 🩺
Whenever one encounters a floating-rapid pulse (floating and fast), there should logically be fever; yet if the patient instead presents with chills and shivering — a sensation of being drenched by cold water — and there is also a fixed, localized area of pain on the body, one should consider the impending formation of an abscess (purulent infection).
The master said: For all types of abscesses, to determine whether pus is present, press on the swollen area with the hand. If the local area feels warm, pus is present; if it does not feel warm, there is no pus. This is a simple diagnostic method of distinguishing pus through local palpation of temperature.
In conditions of intestinal abscess (roughly corresponding to intra-abdominal abscesses, which classical physicians associated with conditions similar to periappendiceal abscess), the patient's skin is rough and scaly, like fish scales — this is called "tortoise-shell skin (jiǎ cuò)." The abdominal skin feels tight and tense, yet when pressed it is soft, as if there is a mass, but within the abdomen there are no hard conglomerations of accumulations or aggregations. The whole body does not present with fever, yet the pulse is rapid. This is the manifestation of a purulent abscess within the abdominal cavity. The classical formula Yiyi Fuzi Baijiang San (Coix Seed, Aconite, and Patrinia Powder) is indicated for this condition.
🌿 Yiyi Fuzi Baijiang San Formula: Coix seed sixty partes, Prepared aconite two partes, Patrinia (Bai Jiang) five partes. Grind these three ingredients into a fine powder. Take one fangcunbi (an ancient measure for dispensing powdered medicine, approximately the volume of a one-inch square spoon), add two sheng of water, decoct until reduced by half, and take in a single dose. The annotation states that "urination should occur," meaning that after taking the medicine, the urine should flow freely. (Here "partes/fen" is an ancient proportional unit for formulae, not a modern gram weight.)
For patients with intestinal abscess, there is swelling, fullness, and hardness in the lower abdomen. Pressing on it causes pain. The pain resembles that of strangury (painful urinary dribbling), yet urination itself is normal. There are episodic fevers, spontaneous sweating, and chills. If the pulse is slow and tense, it indicates that pus has not yet formed; a purging method may be used, and stagnant blood should be expelled. If the pulse is flooding and rapid, indicates that pus has already formed, and the purging method should not be used. Dahuang Mudan Tang (Rhubarb and Moutan Decoction) is indicated for this intestinal abscess before pus has formed.
🌿 Dahuang Mudan Tang Formula: Rhubarb four liang, Moutan bark one liang, Peach kernel fifty pieces, Winter melon seeds (Dong Gua Zi) half sheng, Mirabilite (Mang Xiao) three ge. Take these five ingredients, add six sheng of water, decoct to obtain one sheng, strain out the dregs, add mirabilite, bring to a brief boil, and take in a single dose. The annotation states: if pus is present, pus will be expelled; if there is no pus, stagnant blood will be expelled.
Someone asks: At the inch opening (cun kou) pulse is floating, faint, and rough, and logically there should be blood loss or sweating. If there is no sweating, what is the explanation? The answer says: If the body has sores caused by knives or axes, that is a pulse pattern resulting from blood loss.
For incised wounds (jīn chuāng) caused by metal blades knives or axes, the classical formula Wangbuliuxing San (Vaccaria Seed Powder) is indicated for treatment.
🌿 Wangbuliuxing San Formula: Vaccaria seed ten partes (harvested on the eighth day of the eighth month), Shu Qu (Japonica) fine leaves ten partes (also known as Shuo Diao (bursaceae) fine leaves, one version: harvested on the seventh day of the seventh month), White bark from the southeastern root of a mulberry tree, Phyllostachys (bamboo) shavings ten partes (harvested on the third day of the third month), Licorice root eighteen partes, Sichuan pepper (Chuan Jiao) three partes (remove the eyes and closed-eye fruits, stir-fry lightly to remove sweat), Scutellaria root two partes, Dried ginger two partes, White peony two partes, Magnolia bark two partes. The first three ingredients (above the mulberry root bark) are burned to preserve character (burned to charcoal but preserving medicinal property, not over-burned into ashes), ground and sifted separately and then mixed to form a powder. Take one fangcunbi per dose. For small sores, apply the powder directly topically; for large sores, take internally. It can also be taken after childbirth. If there is external wind-cold invasion, do not use the mulberry tree southeastern root bark. The first three ingredients should all be dried in the shade for one hundred days.
🌿 Pai Nong San Formula (Pus-expelling Powder): Zhi Shi (Immature bitter orange) sixteen pieces, White peony six partes, Platycodon (Jie Geng) two partes. Grind these three into powder. Take one egg yolk and an equal amount of the powder, knead until thoroughly mixed, and take. Administer once daily.
🌿 Pai Nong Tang Formula (Pus-expelling Decoction): Licorice two liang, Platycodon three liang, Fresh ginger one liang, Jujube (Chinese dates) ten pieces. Take these four ingredients, add three sheng of water, decoct to obtain one sheng, take warm five he per dose, twice daily.
Spreading sore (a skin disease that gradually extends from a local area outward to the periphery): If it spreads from the mouth (the center, chest, or internal organs, inward direction) toward the four limbs (outward), it is treatable. If it spreads from the four limbs toward the mouth (chest and internal organs), it is difficult to treat. The classical formula Huanglian Fen (Coptis powder) was used to treat this. (The formula itself has been lost.)
Note: The units "partes/fen", "liang", etc., in the above formulae are all ancient dose units and should not be directly understood according to modern gram weights.
🧠 Deep Understanding
Core Principles 💡
- Diagnostic Concept of Pus: Using hand pressure on an abscess and detecting local warmth to determine the presence of pus represents an early method of palpatory diagnosis in traditional Chinese surgery. The principle is that pus forms when heat accumulates, and when heat is abundant, there is increased local temperature. This shares conceptual similarities with modern signs of "redness, warmth, and fluctuation" in infected, suppurating lesions, though the ancient methodology is much less refined.
- Same Disease, Different Treatments for Intestinal Abscess: For similarly diagnosed intestinal abscess, if there is skin scaling (tortoise-shell skin), tense but soft (moist) abdominal skin, absence of general fever, and a rapid pulse, the formula Yiyi Fuzi Baijiang San is used; if there is lower abdominal swelling and hard mass with tenderness upon palpation, fever, chills, slow tense pulse, with pus not yet formed, Dahuang Mudan Tang (Rhubarb and Moutan Decoction) should be administered. The former pattern leans toward cold-dampness with stasis binding, weak yang-prebiotic energy unable to transform; yang is warmed with prepared aconite, while coix seed and patrinia promote pus drainage. The latter pattern denotes stasis-heat and bound excess coupled with obstruction of the bowels; rhubarb, Moutan, peach kernel, and mirabilite clear heat and disperse blow stasis. This embodies Traditional Chinese Medicine's treatment selection based on syndrome differentiation rather than simplistic "seeing abscess treating only the abscess."
- The Treatment Boundary Between Formed and unformed Pus: The original text stresses that "by slow tense pulses, pus has not yet formed—purge them." Conversely, "by flooding rapid pulses, pus has already formed—do not use the purging method." It reflects an ancient understanding of stages within abscess fever progression: when pus has not yet formed, puruing diaesis can melt accumulation with expelling stasis; when pus has already formed, one should not indiscriminately attack with purgatives because they may spread toxic matter, ruin healthy qi, hindering proper resolution.
- Combining Pulse Readings' Whole With the Full Therapy Chain for Blood Loss from Trauma: A floating, faint, and rough ("cuo") pulse at an inch opening could physiologically suggest blood loss; however, if the patient presents no sweating and has suffered an uncouth open wound from steel blade cut (by ax?), strong prior wounding may have led to greater blood depletion though not from external cause - thus questioning whether one ought to determine possibilities of such hemorrhage rather than only fixating a diagnosis commonly based solely on one recorded vital sign within self-limited systemic blood imbalance.
- Qi-and-blood Viewpoint Embedded Into Wound-Dressing Formulae: Utilizing carbon-fumed analogues from herbs subjected to "charring-while-embedding-drug-power discipline' preserves their absorptive, sedative wound protecting a pragmatic blending of plain recovery after hardening & management blending and re-release care use. Intermingled with charcoal-induced measures to stipulate immediate ex uemergence pain-control requirements, final treatment includes dry ginger & more Sichuan peppercorn, warming-acuparsion; gentian and powders facilitate sweet blanching for restoring-blood-course-balance - accentuating dual handling and staged protection wherever incised swabs arose for wounds: function focusing singly upon overall energy movement instead of only regional influence around natural surgical regions prevents cavity healing jumbled with risk an additional blood clotting mal-ads fit accordingly because two areas: bleeding area additionally and any passive local zone entering in consequence support inflammation possibility emerge.
- Producing Broke Palm of Direction, within "spreading-skin dry rot of serpigenous-diffuse-and-change-base-we'd review sore characterization to check its fashion prognosis:" With moving dry or fading (topical) propagating from deeper surfaces outward edges—benign outcome path implies using ability built by framing able order—internal collapse follows maybe opposite flows health considerations broadly align simple principle" inside-exterior-propagation-safe versa sequence — While perhaps particularly applicable considering 'external branch tissue distributions's central skin-travel outcomes → Surgical & combined internal diagnostics already in some folk-wisdom layer echoes relevant premonitions sharing structural ethics inherent in phrase's practice – That's lineage influence interwoven outside historical medicine alone).
Modern Perspectives 🌟
Present modern adaptational acknowledgments mapping anatomical manifestations equivalents from older medical time:
- Delving chronic practice confirms early relevance discerningly applying conceptual links modern analogs involving systemic inflamed layers including complication evaluation methods lacking what CT provides: Often clearer readings result.
- Combining: It's strongly underlying possible antibacterial microscopic proof demonstrating adaptogenic background working alignment using e. g role processing means improvements added by traditional pattern-evaluated approaches intended manage or improve course while progressive pathology resembling acute peritonitis almost medical severity automatically call surgical modern clinical steering plus possible supplemented herbs nothing substitution for live surgical possibilities standard if active in abating indicated cases –
- Analyzing Carbon-accessible constructs recognition empirical a degree and basis fundamental attraction consistency across strong stasis reductions biological logic observed since latest research (yet era limitations noteworthy.)
- Modern dermatological recognitions reveal classes ambiguous to sore-prone damp auto-immune range still Coptis main retains dermatological disinfect activity to indicate rational use categories require doctor judgement where recognizable diagnosis precedes definitive outcome.
- Underpresent medical conclusion applicable nevertheless partial realization measuring patients & lab data which governs factual integrity remains.
Wellness Takeaways ⚡
- Redness plus probable boil to infection complications should highlight hygiene proactively without tampering a-squeeze attempt unknown topicals ask necessary specialist care direct appropriate timely always.
- Appropriate nutritional wisdom curbs burning fats sugar heat-clear builds hygiene protection baseline counter any dermo layer onset vulnerability.
- Systematic disciplines harmonizing effort balanced dispositions less internal-standing chi obstruction trauma vulnerable with known lower danger contracting chronic slow onset long-settlement conditions that surgery historical warnings mention life constraints promoting sensible adaptations available regularly across user. Immediate involvement concern critical eventual comprehensive assessment first not delve unknown timing context hence major medicurg intervention far exceed herbal cultural adaptation parameter adjustments precedence.
- Heed signs fever/acute abdomen should forays ER reachability highest commitment therefore: Delay medical intervention adds no benefit over studies-derived self-confidence rarely anyway recognized ideally necessary decision regardless.
- Peripheral disturbance any note taking mild reassurance benefit possibly only completing expected route often enough management diligence derm conditions with minimal irritability demand verified match specific diagnosis doctor consult adequate.
📚 Related Knowledge
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Related Concepts: Abscess, Intestinal abscess, Incised wounds, Spreading sore wound infection, Blood depletion, Pulse patterns (floating-rapid, slow-tense, flooding-rapid, floating-faint-rough), expel-pus tactic called "pull decant", charcoal method's embedded discipline note & use-range-bound function overlapping indications; concerning historical practical acceptance and cases bridging distinctions by established patterns theoretical conceptuality drawn forth into application paths expansion acknowledged direct.
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Further Reading: “Huangdi Neijing" (Inner Canon of the Yellow Emperor), "Lingshu" sections on abscess as ancient parallels, also refers "Nanjing: Difficulty Fifty-Six"; surgically-oriented essays later arose — "Waike Zhengzong ", "Liu Juan Zi Gui Yi Fang" plus prescriptions preserved by Sun Simiao in "Beiji Qian Jin Yao Fang", following specialized precedent expanding such integrated boundary themes obviously abundant.
—— Bu Gua Reading Notes
This content is based on classical Chinese medical ancient texts and is intended solely for the study and traditional cultural scholarship. It does not constitute any medical diagnosis, medication guidance, or treatment advice. If you feel unwell, please seek timely medical attention.
