Wang Hongxu's 'General Treatise On Carbuncles And Ulcers' From 'Quansheng Compendium On External Conditions'

The "General Treatise on Carbuncles and Ulcers" in Wang Hongxu's Waike Zhengzhi Quansheng Ji is the master outline of Wang's treatment of yong and ju—various inflammatory diseases, purulent diseases, tumors and cancers. Studying this outline reveals Wang's overall approach to treating all kinds of yong and ju.

Below is the original text together with notes by other physicians; at the end are notes by the author based on his own clinical experience.

The two toxins of yong and ju arise from the heart. For the heart governs blood and moves qi; when qi and blood congeal, toxin erupts. The toxin takes its name from the location, but treating it by following the channels is an error. When the root-plate of the lesion exceeds an inch across and is red and swollen, it is a yong; yong arises from the six fu organs. If the shape is only a few fen across, it is a small furuncle. If on pressure it sinks and does not immediately rise, though warm the apex is not very hot—pus has not yet formed; if on pressure it rises with the finger, being soft and very hot at the apex—pus has fully formed. When there is no pus, dissipate and scatter; when there is pus, do not let it linger. Xingxiao Wan alone can immediately reduce swelling and stop pain; it is the divine medicine for treating yong. A sunken white lesion is called ju; ju arises from the five zang organs, hence the root of ju is deep while the toxin of yong is shallow. When the root is red and diffuse, it means qi deficiency cannot tightly bind the blood; when red, vivid and glossy, qi and blood are driving the toxin outward; when red outside and black inside, toxin is congested within; when purple, dark and dull, qi and blood are insufficient and cannot transform toxin into pus. When the pus is thick and rich, qi and blood are flourishing; when the pus is clear and thin, qi and blood are declining. Before pus emerges, between the interstices, a yong has congested fire-toxin, while a ju has congealed cold-phlegm; after pus has emerged, a yong with lingering heat-toxin should be supported, while a ju with unresolved cold congelation should be warmed. Once one has contracted cold-ju, even in the greatest heat of summer it should still be kept warm; if one has contracted heat-toxin, even in the depths of winter it especially prefers cold. Yet the treatment of yin deficiency and yang excess is utterly different; reading the ancient formulas, I always felt they were not detailed enough, so I unfold their meaning for reference. All sunken white ju are caused by cold deficiency congelation of qi and blood. At the onset the toxin sinks into the yin layer; without warming yang to free the interstices, how can one resolve the cold congelation? Once ulcerated and yin blood dried up, without nourishing yin and warming freely, how can one thicken the pus? For qi gives form and blood gives luster; thus when all ju are flat and sunken and cannot expel toxin, once yang-warmth turns, the congealed toxin in the yin layer of itself dissolves. When blood is deficient and cannot transform toxin, warmly supplementing to expel pus is especially needed; thus when the ulcerating toxin has not yet fully discharged, the work of freeing the interstices still cannot be delayed. A single forbearance or indulgence lets the toxin linger; a single loosening or expelling scatters the toxin. If one opens the interstices without also warmly supplementing, how can cold-deficient qi and blood form pus? It is like cooking without rice. If one supplements and nourishes without also opening the interstices, one merely fills the deficiency; then how can the cold-congealed toxin find its way out and dissolve? Moreover, when toxin is exuberant, supplementation instead aids it—it is like carrying grain to feed a bandit. If one supplements and nourishes without also warming, blood congeals and qi stagnates; what then is the vessel for brewing pus? It is like making wine without warmth—how can it become must? Or cooking rice without fire—how can it be done? People in the world only know to clear fire and resolve toxin indiscriminately, unaware that toxin itself is cold; resolve the cold and the toxin of itself transforms, while clearing fire only makes the toxin congeal further. Yet the transformation of toxin must pass through pus, the coming of pus must pass through qi and blood, and the transformation of qi and blood must pass through warmth—how can it be treated with cold?

Moreover, cooling and cooling formulas may only be applied to red, swollen yong and furuncles; if one encounters a yin-cold, dangerous-location ju, even warm supplementation is feared to be insufficient—how can one rashly apply clearing and resolving, and instead damage the stomach qi? Worse, if yang-warmth fails to rise, it is hard to ulcerate and hard to dissipate, and the toxin attacks the inner viscera—should this not be feared? Since the spleen and stomach determine life and death, the first priority is stopping pain, and next is fortifying the spleen. When pain stops, the evil qi of itself transforms; when the spleen is strong, flesh of itself grows. Yang-warmth turning exuberant and red, glossy flesh growing depends solely on harmonizing and supplementing qi and blood; as for cold-natured herbs, throughout they should all be forbidden.

Ma (Zhiyuan's note: Ma Peizhi) says: A few-fen furuncle must also be seen in its location. If it lies on a crucial spot, it must not be taken lightly; who says a few-fen furuncle is harmless!

He further says: A sunken white lesion is a phlegm condition arising within the flesh, formed by qi stagnation. If it hardens and adheres to the sinew and bone, it is a disease of the blood layer; it must begin red, hard and headed to be called ju. But one must also distinguish yin and yang.

He further says: There are those with yin deficiency and yang exuberance in which toxin-fire binds in the nutritive layer—the sore is hard, flat and purple, and on pressure burns the hand; one must drain its fire-toxin so that yin is filled and blood harmonized, and only then can it rise. How can this be called a cold-ju and treated with warmth? Applying warmth only dries the yin further and makes the fire more raging. In examination it all depends on inspecting the pulse and observing color and shape; be especially careful.

He further says: To call all toxin cold is one-sided. One must know there is yin within yang and yang within yin; there is true cold with false heat, and true heat with false cold. If one rigidly holds to the saying that whiteness means ju, then there are white lesions that on pressure burn the hand and have a surging rapid pulse—would one treat them as ju? If one rigidly holds to redness meaning yong, there are red lesions that on pressure are not hot and whose pulse is not surging and rapid—would one treat them as yong? If one does not understand the principles of the pulse, how can one be free of error?

Tao says: Chinese ulcer-toxin is what Western countries call inflammation. There are names for internal inflammation and external inflammation; external inflammation is yong and ju, while internal inflammation is lung abscess, intestinal abscess and the like. They take several leeches, place them on the swollen spot, and let them suck out the toxin.

He further says: If a furuncle arises on a crucial spot, use the gold-shell comb produced in Guangdong, ground with water and applied; it can move the sore an inch or two away to a non-fatal location. But this medicine is toxic and must not enter the mouth. Also, in Yanfang Xinbian, Various Treatments for Carbuncle Toxins, there are formulas like Yishan Guohai San and Gandu San, both of which can move a sore away to a non-fatal spot.

He further says: Xu Lingtai also said: a red lesion may not be a yong, and a white lesion may not be a ju.

Zhiyuan's note: Wang Hongxu's thought on treating yong and ju greatly influences the treatment of cancer today. Several of Wang's ancestral secret formulas are now used clinically for cancer; the most famous are Xihuang Wan, Xiaojin Wan (Xiaojin Dan, Xiaojin Capsules) and Meihua Dianshe Dan. Wang Hongxu opened up an important approach to treating cancer. I have seen several cancer patients treated with Wang's ancestral formulas and pills, and they all had good results.

But Wang Hongxu's views also have biased aspects, and especially when applied to cancer treatment they should be approached with caution. Clinically it is not easy to distinguish whether a cancer patient belongs to the yin or yang pattern. For some typical yin-pattern patients, whether Wang's approach of Yanghe Tang plus Xihuang Wan is effective is also uncertain. During treatment one should closely observe efficacy; Wang's approach generally must show some effect within two months. If after two months there is no effect following Wang's approach, one should consider changing the approach.