Sore³

1. A generic term for diseases of external medicine, such as welling-abscess (yōng), flat-abscess (jū), clove sore dīng chuāng, boil jié, streaming sore liú zhù, flowing phlegm liú tán, and scrofula luǒ lì, generally caused by toxic evils invading the body, evil heat scorching the blood, and congestion of qì and blood. Sores are treated differently according to whether they are yīn or yáng, according to their stage of development, and according to the channel affected.

Yīn-yáng Most common are yáng sores, which appear suddenly and develop swiftlyand are characterized by clearly circumscribed elevated swelling, redness, heat, pain, and glossy skin. Usually, yáng sores that fail to disperse within a week will suppurate and burst, but heal quickly. Even though there may be general signs such as physical cold, heat effusion, thirst, constipation, reddish urine, and a forceful surging rapid pulse, essence-spirit and appetite are not endangered.

Yīn sores, by contrast, develop more slowly, are flat or sunken and diffuseand are associated with dull or pulling if any pain, purple or black if any discoloration, and mild if any heat. Since they disperse, burst, and heal with difficulty, they are of long duration. They produce pus that is often watery and clear. They are associated with general signs such as lack of strength, bright-white facial complexion, spontaneous or night sweating, torpid intake, and a forceless fine sunken pulse, which indicate dual vacuity of qì and blood.

Half-yīn half-yáng sores are without pronounced yīn or yáng signs such as heat or cold and elevated swelling or sunkenness. They resemble yáng sores though redness, pain, and swelling are mild; they resemble yīn sores though they are not hard or sunken. They are associated with swelling of a vacuity rather than a repletion type and that do not easily disperse. They are painfulbut do not easily suppurate and burst. Pain continues after bursting, and they heal slowly. Prognosis improves if the yáng signs come into greater evidence, and poor if the yīn signs increase. Successful treatment of half-yīn half yáng sores lies in mastering yīn-yáng conversion.

Stage of development Sores are treated differently at different stages of their development. Before suppuration the method of internal dispersion is used to prevent the sore from developing. When suppuration begins, internal expression is used to hasten the sore through its development. After a sore has burst, supplementation is applied to speed the healing.

The stage of development is judged in the following way:

• A sore associated with mild local heat, hardness and tenderness accompanied by a tight pulse whether rapid or slow indicates that pus has not formed.
• If the sore is hot and tender, fails to rebound after pressure is releasedand is accompanied by a rapid pulse, pus has already formed.
• If the swelling is markedly elevated with thin skin, is soft and depressed in the middle, has thick skin, is hot, red, and shiny, is painful at the slightest pressure, and rebounds after pressure is released, there is pus close to the surface.
• If the swelling is diffuse and hard with sheenless skin, pits slightly when pressed, is slightly hotand is only painful when heavy pressure is applied, the pus is deep in the body.
• A sore that bursts to discharge thick clean-looking, slightly fishy-smelling pus that is yellow-white or the color of peach blossom indicates favorable development.
• Discharge of thin turbid dull dark pus with a foul smell indicates an unfavorable development.

Channel Sores may develop differently and may be treated differently depending on their location on or proximity to channels.

• The yáng brightness (yáng míng) channel has copious qì and copious blood, hence sores of the extremities on this channel tend to heal quickly.
• The greater yáng (tài yáng) and reverting yīn (jué yīn) channels have copious blood and scant qì, hence sores on these channels have a tendency to inward fall so that in treatment attention must be paid to timely and effective internal expression.
• The lesser yáng (shào yáng), lesser yīn (shào yīn), and greater yīn (tài yīn) channels have copious qì and scant blood; hence sores of the extremities located on these channels do not heal easily so that it becomes important to supplement yīn and nourish the blood.

Sores on different channels are treated with formulas that include appropriate channel conductors, as the table below shows.

Channel Conductors Used to Treat Sores

Greater yáng (tài yáng)

• notopterygium (Notopterygii Rhizoma et Radix, 羌活 qiāng huó) for the upper body
• charred phellodendron (Phellodendri Cortex Carbonisatus, 黄柏炭 huáng bǎi tàn) for the lower body

yáng brightness (yáng míng)

• Dahurian angelica (Angelicae Dahuricae Radix, 白芷 bái zhǐ) and cimicifuga (Cimicifugae Rhizoma, 升麻 shēng má) for the upper body
• gypsum (Gypsum Fibrosum, 石膏 shí gāo) for the lower body

Lesser yáng (shào yáng)

• bupleurum (Bupleuri Radix, 柴胡 chái hú) for the upper body
• unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí) for the lower body

Greater Yin

• platycodon (Platycodonis Radix, 桔梗 jié gěng) for the upper body
• white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào) for the lower body

Reverting Yin

• bupleurum (Bupleuri Radix, 柴胡 chái hú) for the upper body
• unripe tangerine peel (Citri Reticulatae Pericarpium Viride, 青皮 qīng pí) for the lower body (as for lesser yáng (shào yáng))

Lesser Yin

• pubescent angelica (Angelicae Pubescentis Radix, 独活 dú huó) for the upper body
• anemarrhena (Anemarrhenae Rhizoma, 知母 zhī mǔ) for the lower body

2. In a wider sense, the term sore includes shallow skin diseases such as scab (jiè), lichen (xiǎn), and cinnabar toxin dān dú.

Etymology

Chin 疮 chuāng, sore; 疡 yáng, open sore, ulceration.