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Huangfu of Jiujiang asked Qibo: I have heard that after the intestines and stomach digest food, the Upper Jiao (Upper Burner) emits Qi to warm the body surface, nourish the bone joints, and unblock the Cou Li (interstitial spaces). The Qi emitted by the Middle Jiao (Middle Burner) is like dew, pouring into the Xi Gu (valleys between muscles) to dry the meridians. When Jing Ye (Body Fluids) are harmonized, they transform into red Blood. Harmonized Blood first fills the Mai (Vessels), then pours into the Jing Luo (Meridians and Collaterals); when the Jing Luo are full, it pours into other collaterals (the sentence here may have omissions or errors). Yin and Yang Qi are already expanded, moving with respiration; movement has its order, circulation has its principles, aligning with Heaven and Earth, never ceasing. Pulse diagnosis reveals that transforming from Deficiency to Excess is a Draining method, leading to insufficiency; if too rapid, Qi stagnates; removing Deficiency and tonifying Excess leads to excess. Once Qi and Blood are harmonized, the Form and Spirit can be maintained. I already know whether Qi and Blood are balanced or not, but I do not yet know how Yong Ju (Carbuncles and Ulcers) arise, nor their prognosis, timing of death or survival. The timelines vary in length; how can we estimate them? Can you tell me?

Qibo replied: The flow of Qi and Blood in the meridians never stops, corresponding to the degrees of Heaven and the records of Earth. Thus, if major stars lose their regularity, solar and lunar eclipses occur. The meridians begin to record the overflow of paths (text likely erroneous, referring to meridian flow), similar to grass and reeds failing to grow, grains failing to plant, roads blocked, people not traveling, gathering in towns, separated in different places; Qi and Blood behave similarly, hence the need to explain the causes.

Blood vessels and Ying Wei (Nutritive and Defensive Qi) circulate ceaselessly, corresponding to stars above and meridian numbers below. When Cold pathogens lodge in the meridians, Blood becomes viscous and stagnant; stagnation leads to blockage; blockage prevents return, causing Qi and Blood to gather, forming swelling. This swelling combines with Cold to generate Heat. Excessive Heat rots flesh, and rotted flesh turns into Pus. If Pus is not drained, tendons rot; rotten tendons damage bones; damaged bones cause Marrow to diminish, unable to support flesh and bone; tendons become withered and empty, so bones, tendons, flesh, and muscles cannot adhere to each other. Meridians fail and leak, Heat steams the Zang Organs, damaging them, leading to death.

Huangfu said: I wish to hear about the forms of Yong Ju and their prognostic timelines.

Qibo said: Briefly speaking, there are eighteen extreme types of Yong Ju.
1. Yong arising in the throat is called Meng Ju (Fierce Carbuncle). If untreated, it turns to Pus, blocking the throat, causing death within half a day. For Excess patterns, draining therapy cures it; swallowing Pig Fat without cold food cures it in three days (another version says avoid cold food).
2. Yong arising in the neck is called Yao Ju (Premature Death Carbuncle). It appears large, red, and black. If not treated urgently, Heat enters the Yuan Mai and anterior axilla, damaging the Ren Mai (Conception Vessel), internally steaming the Liver Meridian, causing death in ten-plus days. If Yang Qi overflows excessively, consuming brain marrow, it is called Nao Luo. The complexion is unhappy, neck pain is severe... (text missing), involving the head and heart, it is incurable (original text uses "Liu").
3. Yong arising in the shoulder and [missing part] is called Ci Yong (Female Carbuncle). It is red and black. Treat urgently to induce profuse sweating down to the feet; this does not harm the Zang Organs.
4. Yong arising in the axilla, red and hard, is called Mi Ju (Rice Carbuncle). Treat with thin, long, sparse stone needles, or apply Pig Fat daily without bandaging. If the Yong is hard and does not suppurate, treat with Ma Dao Jia Ying (a specific technique/tool).
5. Yong arising in the chest is called Bing Ju (Combined Carbuncle). It looks like a soybean. Onset in 3-4 days. If not treated early, spreading downward to the abdomen is incurable, causing death in ten days.
6. Yong arising in the hypochondrium/chest area is called Gan Ju (Sweet Carbuncle). It resembles a withered melon seed. Accompanied by frequent chills and fever. Treat urgently to remove Cold. Death occurs in ten years (likely an error), with spontaneous Pus discharge after death.
7. Yong arising in the flank is called Gai Zi. Gai Zi is a disease of women. After a long time, it becomes a large abscess. Treatment reveals raw flesh the size of a red bean. Decoct Ling Qiao Cao and Ling Gen (each 1 Sheng) in 6 Sheng of water until reduced to 3 Sheng. Drink strongly while wrapped in thick clothes, sitting on a pot to induce sweating down to the feet.
8. Yong arising in the thigh along the Yangming Meridian is called Gu Weng Ju. The appearance changes little, but pus adheres to the bone. Untreated, death occurs in forty days.
9. Yong arising in the thigh along the Yin Meridian is called Chi Shi Ju. Untreated, death occurs in six days. Between the thighs, untreated death in six days (another version says sixteen days).
10. Yong arising in the sacrum is called Dui Ju. It is red, hard, large, and urgent. Treat urgently; if not treated quickly, death occurs in thirty days.
11. Yong arising in the knee is called Ci Ju. The color is neither hot nor cold, and it is hard. Do not pierce; piercing causes death. Gently massage to soften before piercing. Yong Ju arising at joints with corresponding symptoms are incurable.
12. Arising in Yang aspects: death in one hundred days.
13. Arising in Yin aspects: death in forty days.
14. Yong arising in the brain is called Tu Nie. It spreads rapidly and redness reaches the stomach. Treat urgently; untreated, it kills.
15. Yong arising in the ankle is called Zou Yuan. It is a Yong. Urgent treatment prevents change; moxibustion stops chills/fever; no death.
16. Yong arising on the dorsum of the foot is called Si Yin. It resembles a Yong. Untreated, death in one hundred days.
17. Yong arising on the foot is called Li Ju. Starts at the little toe. Treat urgently, remove blackened tissue. If not treated immediately, it worsens; death in one hundred days.
18. Yong arising on the toe is called Tuo Ju. Red/black but not fatal initially. If treatment fails, gradually remove necrotic tissue. If not removed, death is certain.

Yong Ju start small and are often ignored, which is a grave danger. They must be treated quickly. Delay makes them hard to save. This brings tragedy! I detail these thoughts to enlighten future scholars. Note: Huangfu's discussion on urgency and timelines, along with other Yong forms and treatments as noted by Seng Na, are recorded here not to confuse later generations, but for reference.

Superficial skin swelling, high and red, resolves spontaneously or with treatment.
Deep muscle swelling, hard, colored blue, yellow, white, black, or slightly hot/red, requires urgent treatment. If it involves bone or deep tissue, it is severe.
Back sores: Thin skin indicates Yong; hard skin indicates Ju. These often show warning signs; treat urgently. Very hard skin leads to disaster.
After Yong/Ju ulcerates, clean foul matter with Pork Trotter Soup. Apply Yin Gao San to remove all foul matter, then apply Sheng Ji Gao San. Massage edges to promote healing. Avoid sexual activity, wind/cold, and overexertion. Wait for meridians/tendons to recover before working. Otherwise, new tissue will be injured, causing recurrence and worsening ulceration. Be very careful.