bubble_chart Concept

It refers to sores and ulcers that occur at the hairline on the back of the neck, forming a honeycomb-like pattern with numerous pus-filled heads. It is commonly referred to as "nape gangrene." When it occurs at the center of the back of the head, it is called "duikou" (opposite mouth), and when it occurs slightly to the left or right, it is called "piankou" (side mouth)

. In various medical texts throughout history, there are multiple names for this condition, such as: Yizong Jinjian ． Waike Xinfa records: "Pian nape gangrene occurs one and a half inches to the side of the hairline on the back of the neck, belonging to the bladder meridian." "The occurrence at the back of the head is below the occipital bone." The "Dong Tian Ao Zhi" records: "Duikou (opposite mouth) occurs at the Fengfu and Yamen acupoints, directly opposite the front lips, hence the name 'opposite mouth.'"

bubble_chart Pattern Analysis

1. Dampness-heat︰Localized redness, swelling, and protrusion with burning pain; after ulceration, it resembles a honeycomb, with thick yellow pus and easily sloughing necrotic tissue. Systemic symptoms include aversion to cold with fever, headache, and poor appetite. During the stage of suppuration, there is high fever, dry mouth with thirst, severe constipation, yellow urine, a surging and rapid pulse, and a yellow greasy tongue coating. This condition is mostly caused by excessive consumption of rich and sweet foods, leading to upward stagnation of dampness toxin, resulting in the steaming interaction of dampness-heat, stagnation of qi and blood, and accumulation of toxic pathogens. Waike Zhengzong The Treatise on Nape Gangrene states: "When caused by the steaming interaction of dampness-heat, those contracted externally are mild..." This indicates that the syndrome is yang in nature and excess in pattern, with mostly favorable outcomes and a good prognosis. During the initial stage [first stage], treatment should focus on clearing heat and dispersing swelling, using the Immortal Formula Life-Saving Decoction. In the stage of diabrosis, heat-clearing and toxin-removing agents can be added, using the Coptis Detoxification Decoction.
2. Yin Deficiencyfire Toxin︰The local sore appears dark purple, does not suppurate after the expected time, and after ulceration, the necrotic tissue is difficult to detach, with scanty pus or pus mixed with blood. There is severe pain, accompanied by systemic high fever, dry lips and mouth, severe constipation, dark urine, a red tongue texture, and a thready, rapid pulse. The mechanism of disease is yin deficiency with intense fire failing to dissipate externally. The treatment involves enriching yin and producing fluid, clearing heat, and expelling toxins. The prescription used is Bamboo Leaf Astragalus Decoction.
3. Qi Deficiency with Blood Depletion︰The lesion appears flat, diffuse, and slow to suppurate, with necrotic tissue that is difficult to detach and thin, clear pus. Systemic fever is not high, or tidal fever may be present. The complexion is pale, the pulse is thin, rapid, and weak, and the tongue texture is pale with scant coating. This indicates dual deficiency of qi and blood, where the healthy qi cannot overcome the pathogenic factors. Therefore, the treatment should focus on draining toxins by tonifying and replenishing, using the Tuoli Xiaodu Powder.

Regarding carbuncle and gangrene, carbuncle is a yang pattern, while gangrene is a yin pattern. However, within yin there is yang, and within yang there is yin. The three symptoms and signs are all yin pattern, but carbuncle caused by dampness-heat steaming is a yang within yin syndrome, which is easier to treat. Carbuncle caused by yin deficiency fire toxin is commonly seen in patients with consumptive thirst and is most prone to inward invasion. Carbuncle caused by qi deficiency and blood deficiency can transform from yin to yang if treated promptly with tonification and support.

bubble_chart Documentation

1. Lingshu-Yongju: "When the yang qi (also written as 'retention') is greatly emitted, it consumes the brain and remains in the neck, called brain melting. The complexion is not joyful, the neck is painful as if pricked by needles, and if the patient is vexed, it is incurable and fatal."

Cao Ying-fu's Medical Discussion

Yu Shishunchen once said: "Before the 128 Incident, there was an old woman in Zhabei whose son worked at the post office. The woman suffered from nape gangrene, which spread around, nearly a foot in diameter. When the plaster covering it was removed, hot steam rose, and she could not turn her head or neck. I and Mr. Yu Hongsun consulted on her case, but after three days, there was no significant improvement. On the fourth day, when we examined her, it was already late, and the patient was hiding under the quilt, unwilling to come out. When asked why, the attendant said that every day at this time, she had an aversion to cold, fever, and sweating. I then realized that this was the syndrome of aversion to cold and fever as described in the Cinnamon Twig Decoction. I immediately used five fen of Cinnamon Twig, one qian of Peony Root, and added ginger, licorice, and jujube in a light formula. The next day, the illness greatly reduced. Gradually, the dosage was increased daily, up to three qian of Cinnamon Twig and five qian of Peony Root, with the other three ingredients also increased accordingly, without adding any other medicine. After a few days, she was completely cured."

Jiang Zuojing noted, nape gangrene is a disease. Initially, Mr. Yu and Mr. Yu used the method to treat nape gangrene, but after three days, there was no significant effect. Upon realizing that the patient had the syndrome of Cinnamon Twig Decoction, they tried the Cinnamon Twig Decoction, using only five fen of Cinnamon Twig and one qian of Peony Root, with ginger, licorice, and jujube, all mild ingredients, expecting only a slight effect. However, the result was unexpectedly successful, no wonder Mr. Yu was surprised. Moreover, using a single formula to achieve complete success further shows that only those who can recognize the syndrome can treat the disease. Furthermore, the flexible use of Zhongjing's formulas is not limited to the Cinnamon Twig Decoction. Zhongjing detailed the modifications of the Cinnamon Twig Decoction to set an example for future generations. If one can flexibly use these decoctions, the benefits would be even greater! From this detailed study, the true value of Zhongjing's "pulse syndrome treatment method" is understood.

Cao Ying-fu said: Mr. Ding Ganren once said, nape gangrene belongs to the taiyang, back gangrene belongs to the taiyang combined with shaoyin, and prescribing cold medicine for these two syndromes is fatal, how true! I remember when I was young, living in Houcheng, east of Jiangyin, there was a Chinese medicine practitioner named Jiang Kuntian who suffered from nape gangrene and stayed at home for three days. My late father met him in the market and asked about his illness. He said he was cured. When asked how he was treated, he said with Cinnamon Twig Decoction. When asked how much Cinnamon Twig was used, he said four fen. With four fen of Cinnamon Twig, he cured nape gangrene, which explains the special effect of Yu using five fen. However, Jiang's condition was mild, so four fen was enough. The old woman's condition was severe, so it was increased to three qian. If one sticks to Jiang's four fen and takes it as a rule, it would be dangerous when encountering severe cases that require three or four qian.

Wu Peiheng's Medical Case

(2) Ke You, male, 1 and a half years old. On the morning of the ninth day of the ninth lunar month in 1922, he was carried out after waking up, caught a cold wind, and was startled, developed fever, spontaneous sweating, was in a deep coma, had opisthotonos, spasms in hands and feet, and upward gaze. The fingerprint was red and floating. The lips were red, the tongue pale white, and the pulse floating and slow. This was due to wind-cold obstructing the taiyang's qi movement, combined with the child's nutrient-defense not being fully developed,zang-fu organs being tender, unable to withstand wind-cold, leading to sudden spasms and acute infantile convulsion syndrome.

This is a syndrome of the taiyang's exterior, treated with Zhongjing's Cinnamon Twig Decoction to allow the evil in the taiyang's muscles and skin to be resolved with slight sweating. Prescription:
Cinnamon Twig tip 9g, Peony Root 9g, Liquorice Root 6g, Fresh Ginger Rhizome 9g, small jujube 7 pieces
Cook with a small handful of rice, instruct to cover warmly and lie down after taking to induce slight sweating. After one dose, the child fell into a deep sleep, sweated, the fever subsided, and the next day he was completely well.