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肠痈之为病，其身甲错，腹皮急，按之濡，如肿状，腹无积聚，身无热，脉数，此为肠内有痈脓，薏苡附子败酱散主之。

Here’s a line containing information on chang yong (肠痈) — or intestinal abscess — where pus has already formed. A rough translation: the body is dry, abdomen skin is tight, however when pressure is put on it, there is softness, as if there were a swell, but not a growth in the abdomen, no body heat, pulse is rapid. In this case there is abscess with pus in the intestines, use yiyi fuzi baijiang san (薏苡附子败酱散).

Any first time diagnosis of the disease described in the quotation would include appendicitis (阑尾炎). The tightness of the abdomen skin suggests that it could be acute abdomen (急腹症) — probably due to peritonitis — expressed as rebound tenderness. With acute abdomen, the disease possibly be anything from acute appendicitis to acute pancreatitis to acute cholecystitis.

The softness is meant to suggest it probably wasn’t so acute after all, because further examination would tell us no “growth” as obvious as a tumor (肿瘤) or cyst (囊肿) was detected, that it was more like a localized swelling due to inflammation.

The dryness of skin (其身甲错) may indicated — from a TCM perspective — that the person needs some blood moving herbs, because dryness of skin is associated with blood stasis. As from the lack of any heat effusion, this may have to do with low immunity (a concept well align with yang deficiency) and subsequent inability to react with a fever. It could also be — and this make sense too — that the local  inflammation is not so fiery as to cause further systemic immune reactions.

For the damp:

This formula is known to help with drainage of pus, hence eliminating the abscess.These days, we will probably understand this ‘elimination’ as a reabsorption instead, a breaking down of the putrid contents of the entire abscess. Coix seed (薏苡仁) is known to take away damp, and also to help eliminate pus (排脓). This elimination of pus (a form of damp) is a concept well-aligned with the known ability of coix seed to build the spleen and transform damp.

For the cold:

A dash of aconite (附子) — just 2/17th of the formula — is part of this prescription. The idea is that person probably lacks heat — hence an associated pattern of cold-damp — and needs a little something to turn on the heating system. This sprinkling of aconite will stimulate the production of yang qi (振奋阳气) to facilitate ‘pus elimination.’

What is bai jiang cao (败酱草):

Patrina aka bai jiang cao (败酱草) is an herb with known anti-inflammatory properties. Both patrina (败酱草) and sagentodoxa (大血藤/红藤) are known to enter the large intestine and liver channels. This channel entry business can be rationalize in the following manner: both herbs are used to treatment of anal-rectal-intestinal diseases (symbolized by the large intestines) and women’s disease (this is symbolized by the liver).

This is why the patrina and sagentodoxa pair is often employed when there is lower jiao inflammation — this lower jiao disease could be chronic appendicitis (慢性阑尾炎), obstruction of fallopian tubes (输卵管阻塞), ovarian cyst (卵巢囊肿), pelvic inflammatory disease (PID/盆腔炎), perianal abscess (肛周脓肿), or even prostatitis (前列腺炎). That said, we also see them employed in treatment diseases not exactly associated with the lower jiao, e.g. skin diseases.

Patrina and Sargentodoxa often appear as a pair in yiyi fuzi baijiang san (薏苡附子败酱散). Anywhere between 15-20g each is very common. Aconite can be taken away if there aren’t sign of yang deficiency. Some doctors like to create a cinnamon-aconite pair, with prepared aconite (制附片) 5-10g and cinnamon (肉桂) 3-5g.

Sources:

1. 中国中医药出版社，金匮要略，p. 334-335
2. 中国中医药出版社，中药学，p. 140-141

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