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Headed flat-abscess

有头疽 〔有頭疽〕yǒu tóu jū

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.

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