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The method of promoting bowel movement (Zhuàn Lì) is employed, and it is not discontinued on a daily basis. Subsequently, it was claimed that patients suffering from carbuncles and sores often experience diarrhea, which is considered an ominous sign; I cannot but harbor doubts about this assertion. If one argues that Dahuang (Rhei Radix et Rhizoma) was used previously out of concern for the patient's robust constitution leading to constipation of the large intestine due to entrenched accumulated heat, its purpose should only be to break up stagnation and guide it out, facilitating bowel movement. How can it be described as excessively promoting diarrhea without cessation day after day? If laxatives are administered again after diarrhea has already occurred, this would likely contradict the principle of preventing trouble before it arises. The initial stage of a sore corresponds to the "Swelling Sore" (Zhǒng Yáng) mentioned in the *Rites of Zhou*. When swelling occurs in the muscles, unless there is a syndrome of fullness, excess, and hardness, one should naturally adopt Zhang Zhongjing's method of releasing the exterior. Taking Wuxiang Tang (Five Fragrances Decoction) as an example, the pathogenic factor should be dispersed outward. Why resort abruptly to harsh purgatives to attack the interior and invite disaster upon oneself?

The *Jingyao* states: "Generally speaking, for carbuncles and sores, one should not discard Wuxiang Tang." Regarding this, I must offer some comments. In the first discussion at the beginning of the book, I elaborated on this. I do not know if, in Liangfu's time, there were many cases of hard constipation of the large intestine with such stubborn and dense obstruction of pathological qi that they could be suddenly dispersed and heavily purged. If such cases indeed existed, the sequence of timing and the appropriateness of the syndrome should have been clearly explained, so that later generations would not dare to recklessly kill people. Or someone might say: "Using Dahuang to drain and eliminate toxins in treating carbuncles and sores was stated by Sun Simiao in the *Qianjin Fang*; Liangfu followed his theory, why do you criticize him so severely?" I reply: Dahuang clears various excess-heat conditions, but its nature is harsh and urgent. Sun Simiao practiced medicine widely among nobles and officials during the late Song Dynasty, when the people were unfamiliar with war and socialized mainly with wealthy families who consumed meat; thus, the effects were indeed rapid. Today, Liangfu uses Dahuang indiscriminately regardless of wealth, hardship, leisure, or labor. Could this not lead to reckless harm? Moreover, there are those deficient due to excessive sexual activity, those deficient due to worry and anger, those deficient due to extreme greed, those deficient due to strenuous labor, and those deficient due to drunkenness and overeating. These individuals suffer from weak qi causing sluggish circulation and scant blood causing turbidity. Developing a gangrenous sore is inherently difficult to treat. However, if the large intestine is constipated but the patient can still consume some grain food, is willing to observe dietary restrictions, and accepts bland flavors, the condition remains treatable, though it requires more effort in tonification. If, however, because of constipation lasting ten days or half a month, one fails to recognize that this is due to descending qi failing to descend rather than excess, and proceeds to use Dahuang; or if, due to slight chills and fever, one fails to recognize disharmony of qi and blood rather than an external contraction, and proceeds to use diaphoretic herbs, such practices harm lives very quickly.

[Li Dongyuan] For sores and other diseases presenting with facial redness, even if there is latent fire-heat, internal purging is prohibited because this indicates constrained yang qi with pathogens in the meridians; one should release the exterior to dispel them. Thus it is said: "When fire is constrained, disperse it." Even if there has been no bowel movement for several days, one should focus on dispersing from the exterior to ventilate yang qi, adding a small amount of moistening-dryness herbs. If wind-pulse and wind-syndromes are present, using exterior-releasing wind-dispelling herbs alone can facilitate bowel movement. If there is only dryness and constipation, moistening is particularly indicated; internal purging must be avoided. When the nine orifices are obstructed, purging is contraindicated. Coma associated with sores, commonly called unconsciousness, must not be treated with purging; sweating will lead to recovery.

[Zhu Danxi] Painong Neibu Shixuan San (Ten-Accumulation Powder for Draining Pus and Tonifying Internally), if used for minor carbuncles and sores or in winter, can fully assist the function of internal support. If used for swelling sores in winter, it can transform severe conditions into mild ones and deep conditions into superficial ones. However, if used for ulcerated sores or in summer, the warming and dispersing properties of Guizhi (Cinnamomi Ramulus) and Houpo (Magnoliae Officinalis Cortex), assisted by Fangfeng (Saposhnikoviae Radix) and Baizhi (Angelicae Dahuricae Radix), make me fear that despite the presence of Renshen (Ginseng Radix) and Huangqi (Astragali Radix), reliance on this formula is precarious. Recently, I have seen people using this formula without distinguishing between carbuncles and sores, seasons, meridians, or stages, like a blind man riding a blind horse standing by a deep pool at midnight—extremely dangerous. It is also stated: "Paion Neibu Shixuan San contains too many herbs that drain defensive qi and dry blood; it is only suitable for mild and small syndromes. For severe deficiency, it is unreliable."

The *Jingyao* states: "Neituo San, taken in doses of ten or more within one to three days of onset, treats toxic factors attacking the zang-fu organs, named Huxin San (Heart-Protecting Powder). This formula is specifically for sores caused by taking cinnabar and sulfur pills. If not caused by these substances, it may not be essential. For the elderly, those with deep disease, exhausted syndromes, or heavy bodies, although Lv Dou (Vigna radiata) has tonifying properties, there is a risk of the body being unable to bear the burden."

[Zhang Zhongjing] Patients with sores, even if experiencing body pain, should not undergo sweating therapy; sweating will lead to spasms. (Note: Sweating refers to profuse sweating, not the mild exterior-releasing effect of various internal-supporting herbs.)

Li Shiying suffered from a gangrenous sore that was neither hot nor painful, indicating a Yin syndrome. Cold medicines applied externally must absolutely be avoided, as this may force toxic factors inward.

[Zhu Danxi] External application is similar in intent to releasing the exterior. The Classics state: "Releasing the exterior does not avoid heat." Generally, qi disperses with heat and contracts with cold. I once treated Zheng Jingli, who loved alcohol and fried foods. In his fifties, around late spring and early summer, a horn-like protrusion emerged at the Sizhukong (Ex2) acupoint on his forehead, hard like a chicken spur. I said: "Is this not caused by rich diet? You must stop rich foods, resolve dietary toxicity, and use acupuncture and moxibustion to open and drain stagnation. This is difficult to treat." This area belongs to the Shaoyang Meridian, where qi is abundant and blood is scarce. Zheng, fearing trouble, summoned another doctor who applied cold medicines like Dahuang, Xiaomingjiao (Natrii Sulfas), and Bingpian (Borneolum Syntheticum). Overnight, it ulcerated like a sauce clam, three inches in diameter. One or two days later, blood spurted from the wound several feet high, and he died. This was due to cold medicines forcing externally, causing heat to constrain and fail to vent, leading to such violent eruption.

The Leech Therapy (Qí Zhēn Fǎ) claims to open the gate to release toxins, considering it swift and effective. I believe this applies only to mild and small syndromes. Leeches suck only evil blood from the skin. If toxins accumulate in the zang-fu organs, exhausting them only on the surface without reaching the interior is inappropriate. I once saw the son of Brother Zhang, aged two, covered in red rashes like clouds. His mother had long suffered from a disease I attributed to toxic heat in the blood. Zhang asked: "Doesn't everyone originate from maternal blood? Why call it toxic heat blood?" I replied: "Although his mother ate meat as usual, the heat nature of meat combined with her chronic illness constitutes toxicity." Zhang did not believe me and applied five or six leeches to suck the child's blood. The rash disappeared instantly, and feeding and behavior returned to normal. I said: "This is not proper treatment; do not rejoice." Zhang became angry. Two or three days later, the child developed high fever and died suddenly. Was this not because exhausting blood externally left qi unable to exist independently?

The *Jingyao* states: "Dry mouth and thirst are different; alchemical pills should not be used for suppression, as the disaster will be immediate. Boiling Sang Zhi (Mori Ramulus) with Wu Wei Tang (Five-Flavor Decoction) to nourish yin water is an excellent prescription." However, it does not mention fire generated by dietary tastes, anger, or sexual exhaustion. I fear thirst will not be easily resolved.

The *Jingyao* states: "For hair-bearing sores on the head, moxibustion is forbidden, fearing that fire qi will draw up heat toxins, aggravating the pathogen and worsening the disease." I consider this statement excessive. Fire is meant to promote circulation and draw out constrained toxins, following the principle of contrary treatment. The head is the gathering place of all yang meridians; moxa cones should be small, and the number of moxibustions few—small as peppercorns, three to five cones. Recklessly applying the rule of "moxa until pain stops, or stop moxa until pain starts" as seen in abdominal/back treatments would be erroneous.

According to Li Dongyuan, when treating Yuan Haowen's brain carbuncle, large moxa cones the size of two kernels were used, totaling one hundred cones, until pain was felt and recovery ensued. From this, we infer: for hair-bearing sores on the head, if painful, use small cones and few moxibustions; if painless, use larger cones and more moxibustions, which is also acceptable. Citing Chen Rihua, who claimed that acupuncture and moxibustion at the onset result in eight or nine deaths out of ten, shows a lack of deep thought. Careful examination reveals that those who died from moxibustion were likely blood-deficient, with isolated yin nearing extinction, unable to withstand fire qi; their pulses were floating, rapid, and large, and their spirit was short and confused. How can one generally forbid moxibustion at the onset and mislead others?

*[Baoming Ji]* When a sore feels slightly swollen, hard, with unchanged skin color, sinking pulse, and no pain, external moxibustion should be applied to guide pathogenic factors out. The Classics state: "Sunken conditions require moxibustion." If there is slight wood-like hardness without pain, urgent moxibustion is needed, indicating deep pathogen invasion. Superficial conditions should not be moxed; exercise caution. If pus and fluid are present, do not moxa; puncture instead.

Analysis: After puncturing, if pus drains and pain/swelling cease, the pathogen is gone; moxibustion is unnecessary. If pus drains but pain/swelling persist, moxibustion on the swelling is acceptable. Even if the toxin is shallow but presents with multiple painful heads, moxibustion is acceptable.

[Wang Juan] Once a carbuncle, sore, or boil appears, one must follow the seasons. Spring and summer are the correct times, making management easier. Because the weather is mild, muscles are slow and warm, treatment is easier. If the flesh is cold, it is due to the patient's qi deficiency; use warm medicines to regulate qi and blood, and apply warm pus-draining plasters externally. Wait for the pore to form and drain completely, then urgently use flesh-regenerating medicines to fill the wound. Do not delay, lest it become a fistula in autumn/winter. If it erupts in autumn/winter, it stems from steaming heat-toxin accumulated internally during spring/summer, combined with latent toxin after the arrival of yin, triggered by toxic foods, alcohol, wheat products, or sexual indulgence. Initially appearing tiny, it swells and becomes unbearably painful within days. Initial signs include constipation for five to seven days and dribbling urination. First, strengthen spleen qi, then administer medicines to open pores, drain pus, detoxify, and remove accumulation. Internal support should be warm and neutral; avoid overly hot/astringent herbs. The spleen organ needs warmth; hot herbs may cause qi stagnation and disrupt Ying and Wei. External applications should be warm-cool, not cold, to avoid forcing toxins inward. Pus must be guided outward for gradual peace.

[Zhang Zhongjing] Floating and rapid pulses usually indicate fever; if accompanied by shivering aversion to cold and a painful area, a carbuncle is developing.

*[Jingyi]* Yin stagnating in Yang causes carbuncles; Yang stagnating in Yin causes gangrenous sores. These two toxins appear in不定 locations and should be distinguished by pulse: floating, surging, slippery, and rapid indicate Yang; fine, sinking, moderate, and choppy indicate Yin. Yin syndromes are treated with heat; Yang syndromes with cold.

However, Yang pulses should be treated according to carbuncle protocols, and Yin pulses according to gangrene protocols; one need not rigidly adhere to heat or cold treatments.

[Li Dongyuan] Heavy body with moderate pulse indicates dampness excess; resolve dampness. Fever with large pulse, restlessness, intermittent swelling, coming and going indicates heat; clear heat. Pain, vertigo, tremors with wiry pulse indicate wind; dispel wind.

Sluggish/stagnant qi, dryness, loss of body fluids, and choppy pulse indicate qi stagnation and blood deficiency; purge qi and tonify blood. Excess cold with floating pulse, inability to eat, frequent urination/defecation, aversion to cold, and tight pulse indicate cold-water excess; purge cold-water. Very choppy kidney pulse indicates major carbuncle. (See Fullness-Emptiness Methods for full text.)

[Wang Juan] The most worrying condition in humans is Back Carbuncle (Fā Bèi), which has five types:

1. Yang Toxin: Caused by wind-heat, or resulting from heat-toxin diabetes, or residual yang toxin accumulating after typhoid fever. It arises between the spine ribs, starting from both sides of the spine up to the waist. The entire back feels hot like cooking, red-purple or flame-red. Pus and toxin are hard to form; if formed, discharge continues, pain persists. Suddenly, within days, it flattens as if healed, but this indicates internal attack and muscle collapse, untreatable.

2. Yin Toxin Back Carbuncle: Caused by cold qi. Starts like a millet grain, with bad mood, stifling pain radiating to the front heart, palpitations, heavy head/eyes, and malaria-like chills/fever. After five to seven days, swelling spreads, hard to contain, with deep, slow, unruptured pus inside. Urgently use Qi-Bu Tang (Tonify-Qi Decoction) for internal support and pus-draining plasters externally. Pus should appear quickly; without it, healing is uncertain.

3. Those who take excessive mineral/cinnabar pills may develop Back Carbuncle from toxic stagnation. Starts like erysipelas, spreading like burn wounds, face red like vermilion, chest irritability, excessive thirst for cold drinks. The sore is hard to rise; if it rises, it is alarming. Better than Yin/Yang toxins because internal mineral-detoxifying decoctions can be used. With clear root cause, urgent treatment brings peace.

4. Alcohol/Food-Toxin Back Carbuncle: Not recent, but accumulated in zang-fu over time. Triggered by hunger/fatigue, eating while lying down, excessive alcohol/meat, sticky/greasy foods, unrestrained sexual activity, and exposure to wind. Spleen qi deficiency cannot handle it; toxin attacks the back between spine ribs. Starts like a small marble, grows to fist-sized, hard as stone, pain throughout limbs, stiffness, bitter taste, dry tongue, abdominal urgency, constipation/difficult urination. After ten+ days, puffiness of head/face/extremities, diarrhea, internal urgency/pain. Urgently use Swelling-Resolving/Pore-Opening/Pus-Draining decoctions to solidify internally and drain externally. Pus must not be allowed to flow freely; delay leads to rotting flesh, bone damage, tendon decay, and death from internal failure.

5. Mountain Miasma Back Carbuncle: Toxic factors in zang-fu for years, depleting qi/blood. Starts with blue-black swelling like boots, numb/painful skin, deep attachment to bones/marrow, hard as wood/stone, pain only when pressed deeply. After five-seven days, toxin surfaces, swelling rises turning blue-white, like a punch mark, chills like malaria, wind symptoms, head tilting, limb reversal, small pupils with white dominance. Internal pathogen struggle requires urgent lancing to release 3-5 sheng of clear blood, followed by yellow/white pus discharge. Skin tension and pain persist until color fades and heat/pain cease. Urgently guide pus/toxin outward.

Survival indicators: Moxa within 3 days of onset; needle/cautery/guidance within 8 days when pus forms; avoid labor if not cured; strict diet; control emotions; treat aggressively; do not deny the disease.

Death indicators: Waiting for spontaneous pus without guidance; needle/cautery after internal attack; treatment after peak heat/pain if internal attack has occurred; pus formed but not drained, only topical application; dysentery with急促 breathing (internal attack, futile); untreated gangrene always fatal; fear of pain in mild swelling fatal; no good prescription fatal; ignoring seasonal laws fatal; reckless lifestyle fatal.

Back Carbuncle Sores vs. Gangrenous Sores: If toxin erupts violently like fire burning thatch, it deteriorates easily. Starts millet-grain sized, grows palm-sized in 2-3 days, bowl-sized in 5-7 days, easy to attack. Red/hot like burning, surface ulcerates, internal swelling like cooking, external flesh sloughs off, purple stasis/pus abundant, swelling/pain persist, thirst/reversal, inability to eat/vomit/shortness of breath, superficial/open: especially suitable for Fa Nong Tuo Du Decoction (Pus-Releasing Toxin-Supporting Decoction);必 recover. (Yang Syndrome, Excess.) Sometimes only cup-sized; not small, but toxin is deep, internal deficiency, toxin near membrane. Must attack internally, entering zang-fu, then extremities. First head/face puffiness, then hands, then feet swelling, named "Toxin Scattering to Four Limbs." Hoarse voice, qi depletion, black/small eyes, black/dry fingers: untreatable. (Yin Syndrome, Deficiency.)

*[Jingyi]* Early carbuncles with high/hard swelling but shallow toxin are Six-Fu disharmony, Yang syndrome, urgent but easy to treat. Early gangrenous sores like millet/bean, flat with flesh, red, itchy/painful, do not scratch: Five-Zang disharmony, Yin syndrome, deep toxin, slow but hard to treat.

Starting as hemp/bean sized, body fever, local swelling/heat/pain: Erupts externally, even basin-sized, 100% curable. (Yang Syndrome, Excess.) No body fever, fatigue, local non-hot, growing slowly, painless, sunken/rotten: Erupts internally, incurable even by immortals. (Yin Syndrome, Deficiency.)

*[Baoming Ji]* Muxiang San treats post-smallpox carbuncles in children miraculously. (From Children's Section.)

Digut皮的 (One liang), Muxiang (Half liang), Chuanshan Jia (Roasted yellow, 2.5 qian), Shexiang (One zi).

Grind to powder, take 3 qian with rice water.