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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All pain, itching, and sores belong to the Heart." It further states: "When Ying Qi (Nutritive Energy) does not flow smoothly and reverses into the muscle tissue, carbuncles and swellings arise." It also states: "Changes resulting from excessive consumption of rich and sweet foods can lead to the growth of large Ding sores (hard, deep-seated infections)." It says: "Sweating on only one half of the body (Pian Ju) leads to hemiplegia; sweating while exposed to dampness generates acne." It also states: "If the opening and closing of the pores are dysfunctional, cold Qi enters, leading to severe spinal curvature (Da Lou)."

When earthly dampness is abundant, it causes cold. By examining the skin, flesh, sinews, and vessels, one can understand the branch manifestations of internal organ blockages. If there is no stagnant heat accumulating internally, and no damp-heat invading externally, then Qi and Blood remain harmonious, and the muscles feel light and agile. From where would a Yang abscess (Yong) come? From where would a Yin ulcer (Ju) arise! In treating Yong and Ju, one must first differentiate between Deficiency and Excess, and Yin and Yang. The classics state: "All pain indicates Excess; all itching indicates Deficiency; all Yong are Yang syndromes; all Ju are Yin syndromes." One must also distinguish whether it is Yong or Ju, Ding sore or Back-Fa (Back Carbuncle), before administering medication, thus avoiding errors. Heat manifesting on the surface of the muscles, with slight swelling and a small base, not exceeding one or two cun in diameter, is called a Jie (small boil); heat originating between the internal organs, with high swelling and a broad base, exceeding four or five cun in diameter, is called Yong; heat-toxin from the Five Zang organs flowing into the bone marrow and attaching to the bones is called Ju; excessive drinking and eating, consuming strong flavors, thwarted will, and unexpressed stagnant heat, specifically appearing on the inner arms with small holes like a honeycomb, are all cases of Fa (Back Carbuncle). If it is a Ding toxin, it arises from accumulated heat in the Five Zang and injury to the Six Fu organs, or from exposure to animal toxins, or contact with cattle/sheep filth. Initially the size of a millet grain, if not carefully protected and touched, mild cases become severe, and severe cases result in death. Administer realgar powder mixed with sesame oil orally to attack the toxin; otherwise, rapid deterioration will occur. Regarding the generation of Yong toxins and Back-Fa, there are Five Good Signs and Seven Bad Signs that must be distinguished. Calm movement and appetite indicate the First Good Sign; regular bowel and bladder functions indicate the Second Good Sign; clear spirit and loud voice indicate the Third Good Sign; pus discharge with reduced swelling, fresh color, and no odor indicate the Fourth Good Sign; physical peace and normal daily routine indicate the Fifth Good Sign. If all Five Good Signs appear, it is auspicious. If the whites of the eyes turn black, eyes shrink tightly, lips turn blue, and the sore turns black, this is the First Bad Sign; difficulty turning legs/arms, heavy limbs, closed eyes, open mouth, and deafness constitute the Second Bad Sign; inability to eat or take medicine, loss of taste, extreme pain, and severe thirst constitute the Third Bad Sign; phlegm, wheezing, rapid breathing, blue-black complexion, closed eyes, and open mouth constitute the Fourth Bad Sign; spontaneous cold sweat, mental confusion, drowsiness, and incoherent speech constitute the Fifth Bad Sign; irritability, coughing, diarrhea, and turbid urine constitute the Sixth Bad Sign; high swelling, severe pain, and foul-smelling pus constitute the Seventh Bad Sign. If all Seven Bad Signs are present, the condition is incurable. Seeing three of the Five Good Signs is auspicious; seeing four of the Seven Bad Signs is critical. In treating Yong toxins, initially resolve toxicity and extract poison; after ulceration, drain pus and relieve pain. Before ulceration, do not administer hot-natured medicines; after ulceration, do not administer cold-natured medicines. For initial onset, first support the interior (Tuo Li); for ulcerated cases, drain pus. This is the general principle for treating Yong, Ju, and other sores. One must also consider seasonal timing, diagnose pulse patterns, differentiate deficiency/excess, determine severity, assess disease progression, and adjust treatment accordingly to avoid premature death. For example, when toxins first appear, regardless of Yong, Ju, or Back-Fa, first administer Qianjin Tuo Li San (Thousand-Gold Interior-Supporting Powder) for three to four doses to stabilize the internal organs; Qianjin Nei Tuo San is also acceptable. Then, use Liang Ge San (Cool the Diaphragm Powder) to clear heat, Bai Du San (Detoxifying Powder) to support the interior, Ru Xiang Tang (Frankincense Decoction) to relieve pain, Xiao Chai Hu Tang (Minor Bupleurum Decoction) for chills and high fever, Ren Shen Yang Wei Tang (Ginseng Stomach-Nourishing Decoction) for vomiting and inability to retain intake, Shen Zhu Yang Wei Tang for indigestion, Mai Dong Qing Yin Tang for hoarseness, Da Chai Hu Tang for constipation, Huang Qin Tang (Scutellaria Decoction) for fever and thirst, Lian Qiao San Xiang Tang for filth exposure, Gan Cao Shao Yao Tang for abdominal pain, Huang Lian Qing Re Tang for irritability, Yi Qi Qing Shen Tang for excessive sleep, Ren Shen Huang Qi Tang for weakness, Mu Xiang Shun Qi Tang for asthma and cough, Qing Ji Kuai Fu Tang for severe pain, Zhen Jing San for fright and confusion, Miao Ji San for delayed suppuration, Zhen Ren Huo Ming Yin (True Man’s Life-Preserving Decoction) for persistent swelling after ulceration, Zhen Ren Yang Zang Tang for uncontrollable diarrhea, Huang Qi Gu Zhen Tang for persistent spontaneous sweating, Wan Ling Gao (Ten-Thousand Spirits Ointment) for draining pus, and Sheng Ji San (Flesh-Generating Powder) for wound closure. These methods cover all aforementioned conditions. For critical malignant cases, moxa dozens of times at Zhuma Acupoint, which has the power to revive the dying. Internal Yong include Brain Yong, Intestine Yong, Lung Yong, and Bladder Yong. These differ from external sores; physicians must accurately identify them before treating. Do not recklessly use decoctions or powders to avoid triggering toxic disasters. Exercise extreme caution.

Formulas and rhymes are recorded in the Graphic Volume; do not underestimate them. For sores before ulceration presenting with the aforementioned symptoms, add Lian Qiao (Forsythiae Fructus), Zhi Zi (Gardeniae Fructus), Niu Bang Zi (Arctii Fructus), Er Hua (Lonicerae Japonicae Flos & Forsythiae Fructus), and Zao Jiao Ci (Gleditsiae Spina) to the respective decoctions. After ulceration, add Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Er Hua, Lian Qiao, and Zhi Zi. In spring, add more Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix), Chai Hu (Bupleuri Radix), and Chuan Xiong (Chuanxiong Rhizoma); in summer, add Huang Lian (Coptidis Rhizoma), Zhi Zi, Lian Qiao, and Mai Dong (Ophiopogonis Radix); in autumn, add Huang Qin (Scutellariae Radix), Cang Zhu (Atractylodis Rhizoma), Lian Qiao, and Zhi Zi; in winter, add Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Lian Qiao, and Gan Cao (Glycyrrhizae Radix et Rhizoma). Treatment of Yong, Ju, and Back-Fa generally follows this pattern.

Regarding Cold Damage (Shang Han) syndromes, there are cases where sweating should have occurred but did not, or harmonization was needed but failed. Sweat stagnates in the skin, and toxins block the bone marrow, leading to Yong syndromes due to rebellious and disharmonious Qi and Blood. Resolve toxicity and clear heat using Qianjin Xiao Du Yin (Thousand-Gold Detoxifying Drink). Do not apply plasters, as this may open pathways for toxin release. If critical, treat as described previously. There are various types of Ding sores, thirty-six in total, all equally harmful. Use Ba Du San (Toxin-Extracting Powder) or apply Tie Gu San (Iron-Hoop Powder) circumferentially, and internally administer Bai Du San and Xiong Huang San. If complications arise, treat according to previous methods. Phlegm nodules, goiters, and Scrofula (Ma Dao Chuang) are caused by damp-heat generating phlegm, phlegm generating fire, fire generating wind, wind generating heat, and extreme heat causing illness. Use phlegm-resolving and fire-descending agents, and heat-releasing and toxin-extracting formulas. Apply moxibustion at the first sign; never perform reckless incisions. Medicine is indeed difficult to master. Without profound understanding of nature and principles, Yin-Yang differentiation, and extensive reading, how can one achieve true efficacy? Modern practitioners of surgery are often uneducated villagers who have never seen surgical cases or heard of wound pulses, do not know herb properties, cannot distinguish sovereign-minister herbs in formulas, yet claim expertise based on a few herbs to boast and profit. Patients, stingy with money, trust these quacks, handing their lives to incompetent hands—a lamentable situation. As the proverb says: "When poor, no wise doctor is found; give gold to the sick [to buy bad advice]." One must deeply beware of quack prescriptions.

Ancients stated: "Among the meridians, only Shaoyin and Jueyin generate Yong and Ju; Shaoyang and Yangming generate Scrofula." Quacks do not understand the essence of these meridians, likely because these meridians have abundant Qi but scarce Blood.

In diagnosing surgical pulses: Before ulceration, the pulse should be洪大 (Hong Da - Surging and Large), forceful upon pressure, and floating upon lifting. After ulceration, it should be沉健 (Chen Jian - Deep and Strong) upon pressure, and lightly floating upon lifting; this indicates easy recovery. If before ulceration the pulse is 沉缓 (Chen Huan - Deep and Slow), neither rapid nor frequent, and after ulceration it becomes 健实 (Jian Shi - Strong and Solid) or large/surging, recovery will be difficult. If the pulse is weak throughout, it is a critical condition; full recovery over time is unlikely. Nourish Qi and Blood, strengthen Spleen and Stomach using Ren Shen, Huang Qi, Dang Gui (Angelicae Sinensis Radix), and Bai Zhu. If neglected, toxin enters the abdomen, causing abdominal distension, asthma, swelling, groaning, and flat sores; this is critical. Immediately use Qianjin Tuo Li San to vent from the exterior, or Ma Li Hui Sheng San to intercept the pathogen; there is a chance of cure. Otherwise, disaster is imminent.

When treating swellings, check for pus presence by palpation: warmth indicates pus; coolness indicates none. Place wet paper on the area; the dry spot marks the center of the pus. Then puncture with a needle. Do not fear a large wound, as a larger opening facilitates complete drainage. For deep sores, use deep needling; for superficial ones, shallow needling. Superficial needling applies to umbilical/abdominal areas to avoid injuring internal membranes. Deep needling applies to thick-fleshed areas to drain toxin. Current surgeons who perform hook-cutting on Back-Fa to remove necrotic fascia cause unnecessary pain; this is not the way of benevolence. Medication alone suffices for healing. Avoid such violent methods. I compile this Surgical Pulse and Formula text to remedy lack of observation and hearing. Yong and Ju arise from internal stagnant heat and external Wind-Damp. High, large swellings are Yong; deep, bony ones are Ju; those on the back are Fa. Starting as millet-sized grains with chills and fever, they develop gradually. Do not cut/wash; use moxibustion for good effect. Alternatively, use internal attack, followed by heat-clearing, detoxification, pain relief, pus drainage, flesh-generation, and wound closure. This is the correct path. Abstain from sexual activity and avoid animal filth odors. Inhose fragrances to alleviate pain; otherwise, pain is unbearable. Ignorant people attribute this to spirits and pray, gaining no benefit. Wise people recognize this, compound medicines, and study medical texts. Herbs are plant roots; doctors are leaders of the nine schools. Those valuing medicine treat surgery as sacred; those stingy with money treat it as a game. My descendants and future physicians must carefully diagnose cold/heat, deficiency/excess, compound medicines correctly, and distinguish sovereign-minister roles to avoid error. Students must practice diligently.