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The reason why external medicine places carbuncles and sores (Yongju, 痈疽) before miscellaneous diseases is that changes occur in an instant, and life hangs by a hair. Although there are more than twenty types of carbuncle and sore syndromes, their key points are mainly two. Why? They are merely the Yin syndrome (Yin Zheng, 阴证) and Yang syndrome (Yang Zheng, 阳证). Those arising from Yang are called carbuncles (Yong, 痈), belong to heat syndromes (Re Zheng, 热证), and are excess syndromes (Shi Zheng, 实证); those arising from Yin are called sores (Ju, 疽), belong to cold syndromes (Leng Zheng, 冷证), and are deficiency syndromes (Xu Zheng, 虚证). Therefore, when a Yang lesion erupts, the skin is thin, red, and swollen high, often with dozens of pores like pepper eyes, accompanied by pain. When a Yin lesion erupts, the skin is thick, pale, and swollen hard, resembling the skin of an ox's neck, without pain. There is also "Yin within Yang," which appears hot but is not truly hot; although swollen, it is essentially deficient; though red, it is not dry; wanting to suppurate but lacking pus; rising then subsiding; appearing exteriorly full but interiorly rotting. There is "Yang within Yin," which appears cold but is not truly cold; not swollen but essentially solid; slightly red and dry; having pus and pain; appearing exteriorly not full but interiorly vexed and stifled. Patients with Yin within Yang tend to be obese, with tight flesh but internal deficiency. Patients with Yang within Yin tend to be emaciated, with loose flesh but internal solidity. Furthermore, Yang transforming into Yin is due to the overuse of cooling remedies by unskilled practitioners. Yin transforming into Yang is due to the sudden and excessive use of heating prescriptions by physicians. However, when Yang transforms into Yin, the symptoms are numerous, yet it can still revert to Yang, so survival is common. When Yin transforms into Yang, the symptoms are few, and it cannot revert to Yang, so death is common. Occasionally, survival occurs only when the physician accidentally adheres to proper methods, one in a hundred. The term "eruption" (Fa, 发) refers to pathogens accumulating internally and manifesting externally. Generally, the whole body originates from the Five Viscera (Wuzang, 五脏); the Qi of the Five Viscera is derived from Stomach Qi (Weiqi, 胃气). The Stomach is the root of the Five Viscera; thus, the Stomach receives grain, and the Spleen transforms it to generate Qi. The Spleen generates muscle tissue, while Stomach Qi transmits to the Five Viscera to circulate Blood (Xue, 血) through the meridians (Jingluo, 经络) throughout the body, completing a cycle day and night. Although carbuncles and sores vary in deficiency/excess and cold/heat, they all result from Qi stagnation (Qi Yu, 气郁). The causes are three: Internal causes (Nei Yin, 内因), External causes (Wai Yin, 外因), and Non-internal/External causes (Bu Nei Wai Yin, 不内外因). Internal causes are diagnosed via the Renying pulse (Renying Mai, 人迎脉). Renying is located one fen anterior to the Guan position on the left hand. External causes are diagnosed via the Qikou pulse (Qikou Mai, 气口脉). Qikou is located one fen anterior to the Guan position on the right hand. If both Renying and Qikou pulses are harmonious, it belongs to non-internal/external causes. The origins are five: First, epidemic pathogenic factors (Tianxing Shiqi, 天行时气); Second, emotional depression (Qingzhi Neiyu, 七情内郁); Third, constitutional weakness with external contraction; Fourth, body heat clashing with wind-cold; Fifth, consuming roasted/fried foods, drinking strong alcohol, or taking cinnabar/stone elixirs containing heat toxins. These five factors cause pathogens to stagnate in the Stomach. If Stomach Qi is strong and the constitution robust, pathogens clash and flow into the meridians, stagnating where blocked, causing blood vessels to converge, obstruct, and knot into carbuncles. If Stomach Qi is weak and the constitution deficient, pathogens prevail and lodge in the meridians, condensing and stagnating, preventing blood flow, leading to internal rotting and forming sores. Thus it is said: Exteriorly small as millet seeds, interiorly capable of holding grain; exteriorly small as coins, interiorly capable of holding fists; malignant pus tubes, an inch long and deep; pus and blood sticky, curable with medication; foul-smelling without silk threads, blood ruined and Qi exhausted; Yang exhausted, Yin prevailing, even immortals find it hard to treat. Physicians must assess patient deficiency/excess, observe disease cold/heat, deduce causes, investigate origins, and then treat, ensuring internal and external correspondence, avoiding generalizations. If a disease arises from Yang and is extremely hot, one should regulate Qi and harmonize Blood. Regulated Qi allows Yang Qi to circulate freely without stagnation; harmonized Blood ensures smooth vessel flow and natural dispersion. Since Qi is Yang and Blood is Yin, harmony between Yin and Yang brings peace to the patient. Externally, cooling medicines should be used to clear it. If heat is severe, blood disperses easily upon cooling; if it does not disperse, heat has waned while blood coagulates in the cold. This is the gradual transformation of Yang into Yin, the root of necrosis. Urgently return to warm-cool methods to treat it, resolve the blood pathways attacking the periphery, expel the formed pus and toxins from the center, and then follow protocol to achieve results. If a disease arises from Yin and is extremely cold, internally use balanced tonifying medicines to promote Qi circulation, nourish Blood, assist Yuan Yang (Yuan Yang, 元阳), support the Spleen and Stomach, wait for appetite to improve and spirit to recover, then regulate Qi and harmonize Blood as usual. Externally, utilize heating medicines to gather and circulate Qi and Blood throughout the body, revive dead muscle, extract toxic vapors, and then use warm medicines to dissipate it. For extreme cold cases mistakenly treated with cooling medicines, resorting to Sanjian Tang (Sanjian Wan, 三建丸) to restore Yang is necessary; if the disease does not exit, relapse may occur, which is considered favorable. This is the sign of Yin transforming into Yang, a兆 of regeneration. If internal Yang does not return and external signs do not appear, this is isolated Yang exhaustion and Yin severance, untreatable. Yang is Qi, Yin is Blood; Yang movement follows Yin, Qi transport drives Blood flow; if Qi fails to move, Blood dies; if Blood dies, Muscle dies; if Muscle dies, the Patient dies. Cold syndromes use heating medicines merely to move Qi and Blood. Qi and Blood move with heat and stop with cold. Although the use of cold/hot medicines is subtle, one must first use Ru Xiang (Frankincense, *Boswelliae Resina*) and Dou Fen (Bean Powder, *Fabae Semen Pulvis*) to save the Heart (Xin, 心) and protect the Membranes (Mo, 膜). The Heart is the sovereign of the body; membranes are the sacs of the Five Viscera. At onset, toxins attack the Pericardium Collateral (Baoluo, 包络); thus, vomiting precedes carbuncles, or carbuncles precede vomiting, because the Pericardium roots in the Heart. If treatment is delayed, the Heart Sovereign absorbs toxins, Spirit has no abode, and Yuan Qi becomes dim. At onset, toxins affect adjacent viscera and muscles; if treatment is delayed, toxic vapors penetrate the membranes. Penetrated membranes leak Yuan Qi, viscera lose nourishment, spirit withers, and pulses fail. Therefore, patients surviving severe illness have intact Five Viscera and membranes. Those dying from minor illnesses have penetrated membranes before muscle ulceration. This is why saving the Heart and protecting membranes is the primary principle. This prescription was secretly transmitted by immortals, embodying divine skill, incomparable to ordinary herbalists using single herbs or needles/knives. Those who grasp its essence, treasure it greatly.