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If the lesion is scratched open and exposed to wind, the pathogenic toxin will invade internally, leading to an incurable condition. Carbuncles or sores on the sole of the foot: superficial ones are treatable, while deep ones are not. "Tianshe Tou" (Snake-head on Heaven) refers to toxic sores on the fingers; they arise along various meridians, causing severe pain. One should examine the affected meridian and administer formulas that resolve toxicity and harmonize blood, supplemented by herbs that guide the action to the specific meridian. "Xuesi Ding" (Blood-thread Thorn) originates in the fingers, with red threads gradually extending to the joints, inevitably leading to death. Initially, one can tie a thread around the area where the red thread appears, then pierce it with a silver needle to release blood. Bright red blood indicates a mild case, purple indicates moderate, and black indicates severe. If treatment is delayed, the toxin lingers and does not dissipate, causing rotting and loss of fingers; in severe cases, it invades the abdomen and causes death. Sudden swelling and pain in the fingers is called "Daizhi" (Substitute Finger). Soak smoked plums (Wumei) in vinegar, grind them, and apply to the affected area for immediate recovery. "Bao Chuang" (Blistering Sore) occurs when wind-heat toxins invade and bind to the skin, forming blisters that ulcerate into sores, hence the name. "Bao Ju" (Blistering Carbuncle) presents in several types: small ones resemble millet seeds or beans, large ones resemble plums or peaches. Colors vary among green, black, red, and white, changing unpredictably. They may appear on arms, kidney regions, mouth/teeth, or umbilicus, without fixed locations, but are most commonly found between fingers. The root penetrates deeply into muscles, spreading with wandering swelling. Toxic blood flows and injects, penetrating sinews and collaterals, rotting flesh to expose bone, with massive bleeding. Symptoms such as delirium, restlessness, and confusion indicate the toxin attacking the heart, which is untreatable. "Yangmei Chuang" (Myrtle Ulcer) is named for its resemblance to myrtle fruits. When Qi is affected, lesions are firm and raised, also known as "Mianhua Chuang" (Cotton Ulcer). When Blood is affected, lesions are flat and ulcerated, also known as "Guozi Chuang" (Fruit Ulcer). These names are colloquial based on appearance. In the north, it is called "Tian Chuang". Although names differ, the essence is the same, but treatments must be distinguished. Self-inflicted cases are severe; contagious cases are mild. Self-inflicted cases result from excessive sexual desire, causing initial symptoms in the genital region, combined with indulgence in food and drink, leading to heat in the Triple Burner, exhaustion of essence, stagnation of blood, and accumulation in various meridions. Contagious cases result from deficiency of Middle Qi and lighter external infection. Patients must absolutely avoid using toxic drugs to induce sweating, nor use cold medicines to suppress the disease, nor seek quick results. One must use decoctions to resolve toxicity, tonify, and expel toxins outward. External treatment involves washing with decoctions and applying ointments to draw toxins out, ensuring no aftereffects.

Commentary by Zhang: At the initial stage of any carbuncle or sore, the pathogenic toxin has not yet reached the exterior, and the Zang-Fu organs are congested with heat. Not even a trace of hot medicine should be used. After pus has been discharged, the toxin escapes outward, Qi and Blood are both deficient, and Stomach Qi is weak. Not even a trace of cold medicine should be used. This is the conventional method of the ancients. However, there are cases of Qi and Blood deficiency with cold, where the toxin sinks into the Yin aspect at the onset. Without Yang-heating methods to support the interior and expel the toxin, how can it rise and emerge? Once the exterior lesion has ulcerated, if Yin Blood is dry, without nourishing and moistening Yin, how can pus formation continue? Externally, the sore becomes scorched and dry; internally, there is dry mouth and irritability. Therefore, diagnosis relies entirely on pulse examination. Qi primarily pushes and moves, while Blood primarily moistens. Qi forms the structure, and Blood provides luster. Thus, carbuncles and sores that are flat and fail to rise are due to weak Yang Qi, unable to drive the toxin out of the Yin aspect, constituting "Yin Toxin." Roots that are red and diffuse indicate Qi deficiency failing to constrain Blood tightly. Red, vibrant, and glossy lesions indicate Qi and Blood constraining the toxin and pushing it outward. Red externally but black internally indicates toxin stagnating inside. Purple and dark, unclear lesions indicate insufficient Qi and Blood, unable to transform toxin into pus. Thick, rich pus indicates robust Qi and Blood. Thin, clear pus indicates declining Qi and Blood. Before pus discharge, there may be excess heat; after discharge, treatment focuses on deficiency. As long as any portion of the toxin remains, one cannot tolerate its retention, lest it spread and become a major disaster, like raising a tiger which will eventually harm people. For Qi deficiency failing to expel toxin, warming and tonifying combined with Yang-heating transformation can melt the stagnation frozen in the Yin aspect. For Blood deficiency failing to transform toxin, nourishing and promoting pus discharge are especially appropriate. During ulceration, when toxin is not fully cleared, the function of supporting the interior cannot be delayed for a moment. Tolerance leads to toxin retention; clearing leads to toxin freezing. Supporting the interior without nourishing Qi and Blood leaves the deficient body unable to produce pus, like trying to cook rice without grain. Nourishing without supporting the interior only harmonizes Qi and Blood but cannot reach the ulcer site to achieve success. Moreover, if toxin is abundant, nourishment may aid it, like wrapping grain to supply bandits. Nourishment without warmth leads to blood coagulation and Qi stagnation, lacking the means to generate pus, like brewing wine without heat or cooking rice without fire. People generally know to treat toxin as fire and clear fire to resolve toxin, not realizing that toxin is fire itself. When toxin transforms, fire clears; when toxin stagnates, fire becomes more depressed. Toxin transforming into fire comes from pus; pus arises from Qi and Blood; Qi and Blood transformation requires fire. Can fire simply be cleared? Cold-clearing methods are only applicable to minor skin sores. For deep-seated carbuncles penetrating meridians, one is already busy with attacking and supporting; how can one additionally use clearing and resolving? Doing so damages Stomach Qi, causing Yang Qi to weaken, making ulceration and healing difficult, and potentially leading to internal invasion of Zang-Fu organs. Is this not something to fear! Once the toxin is completely gone and healthy pink tissue grows, within the gentle tonification of Qi and Blood, one can still add Honeysuckle Flower (Jinyinhua) and Licorice Root (Guolao/Gancao) to resolve residual toxin. Although Forsythia (Lianqiao) and Trichosanthes Root (Huafen) can also resolve toxicity, they damage Stomach Qi and should be strictly avoided. This is Zhang's humble opinion.