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[Song] Adverse manifestations present as sores initially the size of a millet seed yet painless, with diffuse swelling lacking local heat and a flattened, collapsed apex. Before maturation, the head is hard and white; the tongue is dry, restlessness prevails, and suppuration fails to occur. Muscle swelling accompanies a sunken sore aperture, colored purple like pig liver, accompanied by urinary incontinence, fixed gaze, and grasping at empty air (cuo kong). The eyes reveal protrusion and spirit is deficient; the body curls up, fingers trace clothes, lips and corners of the mouth turn cyanotic, the face appears red as if coated with rouge, skin is dry and emaciated, lips are pale, abdomen is distended—these conditions are invariably fatal. After ulceration, the interior remains hard while the epidermis is broken; post-necrosis, there is mental restlessness, thin pus, failure of new flesh to grow, and foul odor difficult to bear; the head droops, the neck is soft, and the countenance is haggard. In Yang syndromes, cyanotic nails indicate certain death; in Yin syndromes, malar flush indicates inevitable demise. Black smoke-like discoloration on the nose, delirious speech, new flesh growing in plate-like sheets, diarrhea flowing straight down, sallow complexion, dry black ears, contraction of the philtrum, and flattening of the nasal groove are observed. Mouth open with exhaled breath not returning, nostrils flapping with respiration, sweat beading like pearls and difficult to dissipate, bloody fluid resembling suet juice, and coagulated phlegm. Muscle splitting, widespread ulcers, chaotic spirit, dark qi covering the face and Tian Ting area, chronic ulceration resembling grape clusters inside, and dense dark qi surrounding the eye sockets. Regardless of whether swelling or ulceration is present, encountering these signs all belongs to ominous prognoses.

[Note] At the onset of carbuncles and sores, the shape resembles a millet seed, pain is absent, swelling is diffuse without heat, the apex is flat, there is no white head prior to ulceration, and palpation reveals hardness. Dry tongue and restlessness characterize these adverse syndromes, which absolutely fail to suppurate. If muscle swells but the sore aperture sinks, and the color is purple like pig liver, it indicates that toxic pathogens have penetrated deeply. If additionally urinary incontinence, fixed gaze, protruding eyes, deficient spirit, grasping at empty air, tracing clothes, cyanotic lips and mouth corners, face appearing rouged, dry and withered skin, pale lips, and abdominal distension are seen among these various malignant signs, life is undoubtedly lost. After ulceration, internal hardness with broken skin, mental restlessness post-necrosis, thin pus, failure of new flesh growth, unbearable foul odor, drooping head, soft neck, emaciated appearance, cyanotic nails in Yang syndromes, red malar bones in Yin syndromes, and dense dark qi surrounding the eye sockets—all these signs, regardless of whether the toxin is in the swelling or ulcerated stage, constitute ominous and difficult-to-treat syndromes.

[Song] Deficiency-type swelling is diffuse; excess-type swelling is elevated; fire toxicity causes redness, inflammation, and heat; cold stagnation causes wooden hardness with purple-dark cyanotic color; deep dampness causes soft flesh with superficial blisters; wind-induced swelling is floating and slightly hot/painful; phlegm-induced swelling is hard yet soft, non-red/non-hot; Qi stagnation causes further hardness like rock edges; Qi swelling features tight skin but soft interior, subsiding with joy and expanding with anger, without redness or heat; traumatic swelling presents as sudden large swelling with heat; postpartum or sprain-induced blood stasis results in wooden hardness without heat but slight redness; if pus has formed and is about to ulcerate, the color must be purple.

[Note] Human Qi and Blood flow continuously; any slight stagnation leads to swelling. However, swelling includes deficiency, excess, cold, damp, wind, and phlegm types, as well as those caused by Qi stagnation injuring the Liver, Qi swelling, traumatic blood stasis, and postpartum/sprain-induced blood stasis. The forms of these swellings vary greatly. For instance: deficiency swelling is diffuse; excess swelling is elevated; fire swelling is red, shiny-skin, inflamed, hot, and stiff; cold swelling is wooden-hard, purple-dark cyanotic; damp swelling features heavy, sagging flesh—deep ones feel like rotten cotton upon pressure, shallow ones form shiny blisters leaking yellow fluid; wind swelling shows wrinkled, non-red skin, floating swelling with slight heat/pain; phlegm swelling is soft as cotton, hard as a steamed bun, non-red/non-hot; Liver-injuring Qi stagnation swelling is non-red/non-hot, hard as stone with angular edges, resembling rock protrusions; Qi swelling feels tight on skin but soft internally, subsides with joy, expands with anger, lacks redness/heat, and maintains normal skin color; traumatic blood stasis swelling is suddenly large, hot, swollen but non-red; postpartum/sprain blood stasis swelling involves long-standing stasis in meridians, suddenly manifesting as wooden-hard, non-heat, slightly red; if pus has formed and is about to ulcerate, the color is inevitably purple. Thus, the shapes of various swellings differ, and one cannot generalize.