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Carbuncles (Yong, 痈), deep abscesses (Ju, 疽), sores (Chuang, 疮), and boils (Jie, 疖) all arise from disharmony of Qi and Blood, unregulated emotions of joy and anger, irregular diet, and improper adaptation to cold and heat. These factors cause the Qi of the Zang-Fu organs to become stagnant internally, leading to a disorder of Yin and Yang and stagnation of Qi and Blood, which ultimately manifest as these diseases.

Diseases such as carbuncles and deep abscesses often occur in wealthy individuals who consume rich and fatty foods (Gao Liang, 膏粱). Their daily diet consists of greasy, roasted, and fried foods; they live comfortably without labor, and their desires are unregulated. This leads to the internal attack of deficient pathogens and hot toxins, which scorch and condense Qi and Blood, forming the disease.

"Carbuncle" (Yong, 痈) implies obstruction; it presents as a large, elevated swelling belonging to the Yang aspect, generated by the Qi of the Six Fu organs. Its pulse is floating and rapid. "Deep abscess" (Ju, 疽) generally belongs to Heart Fire. Since the Heart governs Blood and promotes the movement of Qi, if Qi and Blood stagnate and are accompanied by the heat of Heart Fire, conditions like carbuncles and deep abscesses arise.

Carbuncles originate in the Six Fu organs and resemble a prairie fire, easily ulcerating externally through muscles. Deep abscesses originate in the Five Zang organs, are deep and sluggish, difficult to treat, and resemble the embers in a kiln, internally consuming bone marrow. Carbuncles are relatively easy to treat but difficult to heal completely; deep abscesses are difficult to treat but easier to recover from. Among various sores, only back carbuncles (Beiju, 背疽) and carbuncle-like sores with hard roots (Dingchuang, 疔疮) are the most urgent. Next in urgency are brain carbuncles (Naoju, 脑疽), intestinal carbuncles (Changyong, 肠痈), and throat carbuncles (Houyong, 喉痈). Sores such as scrofula (Luoli, 瘰疬), hanging abscesses (Xuanyong, 悬痈), hemorrhoids, and fistulas have symptoms that allow for slower treatment. Conditions like scabies, tinea, malignant sores, and wind-related childhood sores vary in severity and urgency.

For individuals over forty years old, any sore or boil appearing on the head, neck, temples, chin, back, waist, flanks, or above bones and tendons—in areas not easily visible—should not be neglected. Treating them casually as minor ailments often leads to death as the condition progresses from mild to severe. Urgent treatment is required to ensure survival.

When a sore has not yet ulcerated and toxins are attacking the Zang-Fu organs, absolutely no warming herbs should be used. Once ulcerated, when the Zang-Fu organs are depleted and appetite is lost, absolutely no cooling herbs should be used. This is the essential principle of sequential treatment.

Sores present "Five Auspicious Signs" (Wushan, 五善) and "Seven Inauspicious Signs" (Qie, 七恶), which must be distinguished. The above discusses the general outline; specific symptoms and treatments are detailed later.

The appearance of a carbuncle (Yong, 痈) involves sudden onset, with skin that is smooth, soft, swollen, painful, and elevated. A deep abscess (Ju, 疽) manifests violently and maliciously, originating from muscle and bone. Initially, it presents as a single head, shaped like... [text missing/ambiguous].

The term "Five Eruptions" (Wufa, 五发) refers to eruptions on the back, brain, temples, eyebrows, and jaw. Qi and Blood circulate continuously throughout the body; any stagnation will erupt wherever it accumulates, hence the name.

Carbuncle-like sores with hard roots (Dingchuang, 疔疮) result from accumulated heat toxins in the Zang-Fu organs interacting with pathogenic winds in the meridians, causing Qi and Blood stagnation that penetrates the hair follicles. They erupt in the hands, feet, head, and face according to the regions associated with the Five Zang organs. Initially, they resemble millet grains, causing pain or itching, generalized numbness, dizziness, alternating chills and fever, nausea, and in severe cases, heavy limbs, palpitations, and blurred vision. Because the initial tip resembles a thorn or nail, it is called Dingchuang. These sores contain toxic vapors that protrude slightly, causing extreme pain and itching, and can be fatal within one or two days, making them more dangerous than typical carbuncles or deep abscesses.

White Dingchuang appears on the right nostril; red on the root of the tongue; yellow on the lips; black before the ears; green below the eyes. This corresponds to the five colors matching the Five Zang organs and their respective locations. Those appearing on the shoulders, back, waist, or hips have no fixed location. Eruptions at the joints of the hands, feet, or head are most urgent; others are less so. There are thirteen types of sore shapes described in *Waike Jingyi* (*Essentials of Surgery*); however, if the shape is dark and sunken, draining clear fluid, surrounded by yellow discoloration, accompanied by abdominal pain and nausea, it is difficult to treat.

Intestinal carbuncle (Changyong, 肠痈) occurs when Qi and Blood stagnate between the intestines and stomach, accumulating and forming a swelling. Symptoms include a hard, palm-sized swelling in the lower abdomen, pain upon pressure, dysuria resembling strangury, occasional sweating, aversion to cold, tight abdominal skin, gurgling sounds when turning, or ulcers around the umbilicus.

Breast carbuncle (Ruyong, 乳痈) involves swelling and hardness of the breast due to blood stagnation and Qi obstruction, often caused by anger injuring the Liver, or unresolved heat blocking milk flow, leading to painful knots. It may also result from "blowing milk" (Chuiniu, 吹乳), where an infant's breath introduces heat, causing swelling, hardness, chills, and fever. Additionally, women with chronic emotional depression may develop hidden nodules, size of a turtle egg, painless and non-itchy, which after three to five years may ulcerate into hollow cavities, known as breast cancer (Ru'ai, 乳癌), a difficult-to-treat condition.

Genital carbuncle (Bianyong, 便痈), also known as blood hernia (Xueshan, 血疝) or common genital swelling (Biandu, 便毒), is a painful swelling in the genital area caused by stagnant heat and Qi in the Liver meridian.

Scrotal carbuncle (Nangyong, 囊痈) presents with redness and swelling of the scrotum extending to lower abdominal pain. It is often caused by damp-heat in the Liver meridian penetrating the Bladder, leading to Qi stagnation, or by cold pathogens causing Qi to fail to ascend and stagnate, generating heat. Damp-heat steams turbid fluids into pus. It is common among those who drink alcohol excessively or are prone to anger.

Bone deep abscess (Guju, 骨疽) involves pain in the flesh of the limbs, inability to turn the body, tenderness to bone upon pressure, alternating chills and fever, normal skin color but slight tension resembling fat. It often results from sleeping exposed to cold in summer or autumn, preventing Qi dispersion, leading to deep-seated stagnation attached to the bone, eventually becoming a carbuncle or deep abscess. Stone deep abscess (Shiju, 石疽) and slow deep abscess (Huanju, 缓疽) are similar but differ slightly in shape and symptoms.

Flowing injection (Liuzhu, 流注) is caused by suppressed Qi stagnating and forming painful masses. Skin color remains unchanged, there is no head or millet-grain-like point, and the swelling moves unpredictably.

Scrofula (Luoli, 瘰疬) presents as tubercles in the neck, chest, and axillae, starting like bean grains and growing like plums or cherries in clusters. Patients experience chills and high fever; if unresolved, they ulcerate and drain pus. It is often caused by angry Qi reversal or wind-heat pathogens injuring the Liver meridian, causing tendon knotting and swelling. If women suffer from chronic scrofula and amenorrhea, it may transform into consumption (Laozhi, 痨瘵) with chills, fever, and cough.

Goiter and tumors (Yingliu, 瘿瘤) arise from rage, causing Qi and Blood stagnation. Goiters typically appear on the neck and shoulders, with loose, soft, hanging skin. Tumors form with Qi aggregation, starting small and growing to cup-sized, with tender, shiny skin. Goiters are classified into five types: Flesh goiter (Rouying, 肉瘿) has normal skin color; Tendon goiter (Jinying, 筋瘿) shows visible veins; Blood goiter (Xueying, 血瘿) has intersecting red vessels; Qi goiter (Qiying, 气瘿) fluctuates with anger; Stone goiter (Shiying, 石瘿) is hard and immobile. Tumors are classified into six types: Fat tumor (Zhilium, 脂瘤) or powder meat tumor, Blood tumor (Xueliu, 血瘤), Pus tumor (Nongliu, 脓瘤), Bone tumor (Guliu, 骨瘤) or tendon-stone tumor. Although names vary, they are usually painless and non-itchy. They must never be incised, as rupturing pus and blood can cause severe injury. Generally, only Qi tumors and Fat tumors can be treated with aggressive methods; others are difficult to treat.

Sloughing gangrene (Tuoju, 脱疽) is a Dingchuang arising on the toes that ulcerates and falls off naturally. If it arises on fingers, it is called joint-boring Dingchuang (Zhujieding, 蛀节疔). Severe cases involve necrosis of the proximal phalanx; mild cases involve tendon contraction.

Hemorrhoidal fistula (Zhilou, 痔漏) begins near the anus as mouse-milk-like growths or small nodules, causing itching, pain, and fullness, possibly with fever and chills. It is caused by excessive sexual activity and drinking, long-term consumption of rich and sweet foods, and drunkenness.

Knee carbuncle (Xi yong, 膝痈) results from stagnant damp-heat toxins. Symptoms include knee swelling, redness, pain, chills, and fever. Damp-heat must be dispelled; otherwise, ulceration leads to permanent disability. Knee carbuncle and Crane-knee wind (Hexikengfeng, 鹤膝风) both stem from Kidney Qi deficiency and invasion of cold-dampness. Early treatment is crucial; delayed treatment leads to deformity and paralysis.

Crane-knee wind (Hexikengfeng, 鹤膝风) involves swollen and painful thighs with wasting of the calves, making walking difficult.

Carbuncles and deep abscesses present Five Auspicious Signs and Seven Inauspicious Signs.

Five Auspicious Signs:
1. Calm breathing and regular appetite.
2. Regular bowel movements and urination.
3. After ulceration, swelling subsides, discharge is fresh and odorless.
4. Clear spirit and coherent speech.
5. Harmonious physical constitution.

Seven Inauspicious Signs:
1. Restlessness, abdominal pain, extreme thirst, diarrhea, and dysuria.
2. Profuse bleeding and pus, severe pain, foul odor.
3. Rapid/shallow breathing, mental confusion, lethargy.
4. Darkening before ulceration, sunken lesions, blue face, dark lips, fecal incontinence.
5. Stiffness in shoulders/neck, heaviness in limbs.
6. Inability to eat, vomiting after medication, loss of taste.
7. Hoarse voice, pale complexion, blue/black lips and nose, edema of face/limbs.

Additional bad signs include chest oppression, hiccups, cold body, spontaneous sweating, staring eyes, deafness, mental confusion, palpitations, and disordered speech. If three of the Five Auspicious Signs are present, prognosis is good; if four of the Seven Inauspicious Signs appear, the condition is critical. All Five Auspicious Signs indicate safety; all Seven Inauspicious Signs indicate death.

Differentiating Presence or Absence of Pus:
Pain only upon deep pressure indicates deep pus; pain upon light pressure indicates shallow pus; little pain indicates no formed pus; immediate rebound indicates presence of pus; no rebound indicates absence of pus. High and soft swelling originates in the blood vessels; low and hard swelling originates in bones/tendons; unchanged skin color indicates origin in bone marrow.

Seasonal toxicity (Shidu, 时毒) results from abnormal seasonal Qi. Initial symptoms resemble Wind-Cold. Swelling occurs on the head, face, ears, neck, and throat, sometimes with rooted tubercles. Patients experience chills, fever, body pain, and potentially airway obstruction, nasal congestion, and phlegm accumulation, which can be fatal within six to seven days. Prompt treatment is essential.