Also flat-abscess. A yáng-type sore on the body's surface. A headed flat-abscess is characterized in the initial stage by single or multiple white sores the size of millet seeds. Headed flat-abscesses may be named according to its location, e.g., effusion of the brain or effusion of the back. They are caused by external contraction of wind-damp fire toxin, or damp-heat fire toxin brewing in the interior causing accumulation of heat in the viscera, provisioning-defense disharmony, and evil causing blockage in the flesh and skin. Distinction is made between vacuity and repletion.
Patterns
Repletion patterns are characterized by local redness and heat, a large swelling with one or several white heads, pain that in severe cases is acute, generalized heat, thirst, constipation, reddish urine, a surging rapid pulse, and a red tongue with yellow fur.
Medicinal therapy: Clear heat and course wind; resolve toxin and quicken the blood. Immortal Formula Life-Giving Beverage (仙方活命饮xiān fāng huó mìng yǐn) or Coptis Toxin-Resolving Decoction (黄连解毒汤huáng lián jiě dú tāng) can be taken as oral medication; Golden Yellow Powder (金黄散jīn huáng sǎn) can be applied topically. If, after bursting, the putrid flesh does not disappear, Five-to-Five Elixir (五五丹wǔ wǔ dān) can be used. If, after elimination of the putrid flesh, a bright red wound is left, Flesh-Engendering Powder (生肌散shēng jī sǎn) or Flesh-Engendering Jade and Red Paste (生肌玉红膏shēng jī yù hóng gāo) can be prescribed.
Vacuity: The sore is flat with a diffuse root, dark and dull in color, only mildly painful at onset; it is slow to suppurate and exudes clear thin pus and is associated with lassitude of spirit and reduced food intake, lusterless complexion, a forceless rapid pulse, and crimson or pale tongue.
Medicinal therapy: Treatment differs depending on whether yīn vacuity or dual vacuity of qì and blood is more pronounced. For yīn vacuity, use Lophatherum and Astragalus Decoction (竹叶黄芪汤zhú yè huáng qí tāng) from The Golden Mirror of Medicine (医宗金鑑 yī zōng jīn jiàn), which consists of ginseng (Ginseng Radix, 人参rén shēn), raw astragalus (Astragali Radix Cruda, 生黄芪shēng huáng qí), gypsum (Gypsum Fibrosum, 石膏shí gāo), pinellia (Pinelliae Rhizoma, 半夏bàn xià), ophiopogon (Ophiopogonis Radix, 麦门冬mài mén dōng), white peony (Paeoniae Radix Alba, 白芍药bái sháo yào), licorice (Glycyrrhizae Radix, 甘草gān cǎo), chuanxiong (Chuanxiong Rhizoma, 川芎chuān xiōng), Chinese angelica (Angelicae Sinensis Radix, 当归dāng guī), scutellaria (Scutellariae Radix, 黄芩huáng qín), dried/fresh rehmannia (Rehmanniae Radix, 生地黄shēng dì huáng), and bitter lophatherum (Pleioblasti Folium, 苦竹叶kǔ zhú yè). For qì-blood vacuity, use Internal Expression Toxin-Dispersing Powder (托里消毒散tuō lǐ xiāo dú sǎn). If a headed flat-abscess is not treated or is mistreated, the toxic evil may fall inward to form a fall pattern.