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According to the *Gui Yi Fang* (Ghost's Remnant Formula): The pain of a carbuncle (Yang abscess, characterized by redness, swelling, heat, and pain) is confined to the superficial skin. Its onset is like burning thatch. Initially, it is as small as a millet seed; after two or three days, it becomes palm-sized; after five to seven days, it reaches bowl-size. At this stage, it is easy to treat. However, if the swelling is cold (indicating heat pathogen cannot diffuse outward), accompanied by thirst (indicating pathogenic heat inside), and vomiting/nausea (indicating pathogen attacking the interior causing stomach rebellion), treatment will be difficult to succeed. It further states: A gangrene (Yin abscess, characterized by deep-seated, dark, non-suppurative or scanty pus lesions) starts like a small boil; touching it causes heart pain radiating through the body; the surrounding area rises slightly like orange peel pores, with a red color but not fully maturing, and pus discharge is scanty. By the seventh or eighth day, symptoms include painful oppression, panting, and urgency. If initially swollen and high, it suddenly flattens and sinks after five to seven days; this is a sign of internal attack by the pathogen. It also states: Carbuncles and gangrenes are divided into three grades. Pathogenic toxins that are shallow belong to the Fu organs; those that are deep belong to the Zang organs; those that are fierce and travel through meridians, varying in depth without fixed location, affect all Zang and Fu organs with the "Five Toxins," making regulation difficult. Only those lesions where, regardless of deficiency or excess, there is high swelling, luster, pain, confined to the skin surface, feeling hot, urgent, distended, possibly itchy or painful, without other malignant signs, are suitable for treatment. Initially, use warm herbs to harmonize Qi, then use methods to drain pus and open acupoints. (The so-called "harmonizing Qi" in treating carbuncles refers to formulas like Xijiao Yin (Rhinoceros Horn Drink). This formula uses Rhinoceros Horn, Forsythia, Agrimonia, Licorice, Angelica Sinensis, and Cinnamon Twig, all exterior-releasing herbs. The so-called "opening acupoints" refers to methods like Ji Zhen (Thorn Needle), using Gleditsia Sinensis Thorn as the sovereign herb, with Licorice, Ligusticum Chuanxiong, and Frankincense as minister and envoy herbs, which are also interior-supporting herbs. However, these are not as stable as the exterior-releasing and interior-supporting formulas by Jiegu and Dongyuan.) Gangrenes occurring anywhere, regardless of size, are most severe when on the back. They may span one, two, or three chi in width, with thick purple-black skin, variable high swelling, internal pain like needle pricks, chest fullness with heavy pain in limbs, and anterior chest pain. Those occurring elsewhere are manageable. However, if they occur in deficient areas or near sinews and bones, and the pus-toxin has not ulcerated, it will damage and rot the sinews, bones, and muscles. Gangrene belonging to the Zang organs involves deep-seated toxins and latent, firm Qi. It should not be treated slowly; one must internally strengthen the Zang organs and externally penetrate the skin to make it soft, even, and harmonious. Once pus penetrates, use herbs to internally support and solidify Zang Qi, draining pus and regulating Qi can then proceed. This differs from carbuncles where toxins are shallow. Do not treat them with the same method.

For all swellings and sores, if signs of internal attack appear, urgently use Neituo San (Internal Support Powder) and internal tonifying decoctions to fill and strengthen the Zang organs. The greatest fear is penetration of the membrane; if the membrane perforates, ten out of ten die. Lou Quanshan said: The pathogen of a carbuncle is shallow. Its stagnation and obstruction occur solely within the meridians, attacking specifically outward. Thus, upon initial onset, the body surface heats up, and the affected area swells high like a bowl or basin, with severe pain. Even if it tends to sink inward, because righteous Qi is internally solid and refuses to accept the pathogen, it may manifest as constipation, thirst, or vomiting to resist it. Therefore, the bone marrow does not eventually dry up, and the Zang organs are not damaged. The pathogen of a gangrene is deep. Its stagnation and obstruction connect internally to the Zang organs and do not attack specifically outward. Thus, the body may have no fever, and the affected area may not swell. In severe toxicity, hoarseness, Qi depletion, blackening and shrinking of eyes, and blackened swollen fingers like ink occur, leading mostly to death. For treatment: For the initial onset of a carbuncle, prioritize the methods of Jiegu. For exterior patterns, disperse them; for interior patterns, purge them; use moxibustion and herbal applications. If pus has not formed, eliminate it; if formed, expedite its rupture. Also, prioritize the *Gui Yi Fang*: fill and strengthen the Zang organs to prevent sinking pathogens from spreading. Externally use moxibustion to guide pathogens outward, ensuring they exit through specific acupoints without chaos, thus turning death into life. Currently, surgery does not distinguish between carbuncles and gangrenes, uniformly promoting heat-clearing and toxin-extracting. Externally, aromatic herbs like Wuxiang (Five-Aromatic Powder) deplete Qi; internally, Rhubarb exhausts Blood. Practitioners fail to realize their error. Regrettably! The *Ji Yan* states: Although names of carbuncles and gangrenes are many, the essence lies in two: Yin and Yang. Manifesting in Yang constitutes a carbuncle, characterized by Heat and Excess; manifesting in Yin constitutes a gangrene, characterized by Cold and Deficiency. Thus, Yang manifestations feature thin skin, red color, high swelling, often with dozens of pepper-like eyes and pain; Yin manifestations feature thick skin, pale color, hard swelling, resembling ox neck skin, and lack of pain. There is also "Yin within Yang," appearing hot but not truly hot, swollen yet actually deficient. If red but not dry, wanting pain but no pus, floating then subsiding, externally vigorous but muscle rotting. There is "Yang within Yin," appearing cold but not truly cold, not swollen yet actually excessive, slightly red and dry, with pus and pain, externally not vigorous but internally oppressed. Persons with "Yin within Yang" are often obese with tight flesh but internal deficiency. Persons with "Yang within Yin" are often emaciated with loose flesh but internal excess. Yang transforming into Yin is due to folk doctors' misuse of cooling agents; Yin transforming into Yang is due to sudden use of strong heating prescriptions. However, Yang transforming into Yin presents more symptoms and can revert to Yang, hence more survivors. Yin transforming into Yang presents fewer symptoms and cannot revert to Yin, hence more deaths. Rare survivals occur only when doctors accidentally follow correct principles, one in a hundred. From this, we see carbuncles and gangrenes differ only in Yin/Yang, depth/shallowness, interior/exterior, and excess/deficiency, not in size. The claim in *Jing Yao* that 2-5 cun is a carbuncle and 5 cun-1 chi is a gangrene is erroneous. For carbuncle/gangrene pulses: if deep and solid, with fever and irritability but no external redness/pain, the pathogen is deep in the interior; first unblock to cut off the source. If floating, large, and rapid, with external swelling, first support the interior to prevent pathogen entry. If neither deep nor floating, with no significant interior/exterior signs, the disease is in the meridians; harmonize Ying and Wei. If body has no fever but pulse is rapid, there is internal abscess-pus. Intermittent rapid pulses suggest impending malignant sores.

To determine if various swellings have pus, press the hand over the swelling; heat indicates pus, absence of heat indicates no pus.

Meridians in the human body are like boundaries in geography. Treating diseases without knowing meridians is like catching thieves without knowing boundaries; how can one avoid punishing the innocent? Moreover, the twelve meridians of hands and feet vary in Qi and Blood quantity. Hand Shaoyang Sanjiao, Foot Shaoyin Kidney, and Foot Taiyin Spleen have abundant Qi and scarce Blood. Hand Jueyin Pericardium, Hand Taiyang Small Intestine, and Foot Taiyang Bladder have abundant Blood and scarce Qi. Hand Yangming Large Intestine and Foot Yangming Stomach have abundant Qi and Blood. This is the general rule. Abundant Blood and scarce Qi conditions heal easily; abundant Qi and scarce Blood conditions are difficult to treat. In meridians with abundant Qi, regulate Qi; in meridians with abundant Blood, invigorate Blood. Do not adhere rigidly to one approach.

Sores and ulcers have Five Good Signs and Seven Bad Signs. Calm breathing and appetite are the First Good Sign. Regular bowel movements and urination are the Second Good Sign. Clear pus, reduced swelling, and no foul odor are the Third Good Sign. Bright spirit and clear voice are the Fourth Good Sign. Balanced constitution and Qi are the Fifth Good Sign. Restlessness, frequent coughing, abdominal pain, extreme thirst, profuse diarrhea, and dysuria-like symptoms are the First Bad Sign. Profuse pus/blood loss, worsening swelling, foul-smelling pus, and unbearable pain are the Second Bad Sign. Panting, shortness of breath, confusion, and lethargy are the Third Bad Sign. Misaligned gaze, constricted pupils, blue-red sclera, and upward-looking eyes are the Fourth Bad Sign. Shoulder/back stiffness and heavy limbs are the Fifth Bad Sign. Inability to eat, vomiting after medication, and loss of taste are the Sixth Bad Sign. Hoarse voice, deteriorated complexion, blue-red nose, and edema of face/limbs are the Seventh Bad Sign. Three Good Signs indicate recovery; four Bad Signs indicate critical danger. The *Yuan Rong* states: Sores entering from outside should not be moxa-ed; those emerging from inside should be. External entries are managed by supporting outward to prevent internal sinking. Internal exits are managed by guiding outward. Hence, scriptures say: Use moxibustion for sunken lesions. If moxibustion causes no pain, continue until pain arises, then stop. No pain initially means moxa reached the ulcerated area; pain later means it reached healthy tissue. If moxa causes pain, stop when pain ceases. Pain initially means moxa reached non-ulcerated tissue; cessation later means it reached impending ulceration. When a back carbuncle is suspected but not yet formed, presenting with redness, heat, swelling, and pain, cover with wet paper and observe. The spot where the paper dries first is the head of the carbuncle. Place a garlic slice (approx. 3 qian thickness) on the head and apply large moxa cones. Change garlic after three moxa units. If painful, moxa until pain stops; if painless, moxa until pain begins. Early detection and moxibustion are crucial. Day 1-2: 10/10 survive. Day 3-4: 6-7/10 survive. Day 5-6: 3-4/10 survive. After Day 7: incurable. If multiple heads cluster, grind garlic into paste, make a thin cake, place on the area, and burn moxa on top; this can also save lives. If a red swollen patch appears on the back with a yellow millet-grain head, use a single garlic clove, cut ends off, take middle half-cun thickness, place directly on sore, and moxa 14-49 units. Note: The head is the gathering point of Yang Qi; use small/few moxa cones. Shaoyang regions especially should not be moxa-ed; doing so often leads to untreatable conditions or death. Death from moxa occurs in cases of extreme deficiency with isolated Yang about to extinguish; pulse is floating, rapid, large, and forceful; spirit is short and confused, unable to withstand fire heat, hence critical. Formulas using needle-cautery for carbuncles/gangrene use round needles like chopsticks, 6-7 cun long, heated red in charcoal with sesame oil, cauterizing near the sore head. Insert obliquely toward soft areas; if one cauterization doesn't release pus, repeat. Proper application is key. Deep toxin with shallow needle prevents pus drainage; shallow toxin with deep cauterization damages healthy flesh. Incorrect placement causes new sores elsewhere, increasing suffering rather than curing. Bianlian (stone lancet) therapy is for blood-excess patterns requiring drainage. Using ceramic blades to lance immature sores drains toxin but must not be too deep ("pierce skin without damaging flesh"); do not use lightly. Application therapy: For early sores with swelling but no head, apply warm herbs to draw out heat-toxin (principle of fire attracting dryness). For early high-swelling sores with red margins, apply raw cold herbs to suppress heat and drive out evil (principle of extinguishing fire). Generally, applications aim to dissipate swelling/toxin and unblock vessels, hoping to prevent suppuration despite mixed cold/heat. Washing therapy: For sores persisting 1-2 days, wash/spray with decoctions. Limbs: soak/drench. Waist/abdomen/back: spray/wash. Lower body crevices: immerse. All aim to open cou-li (interstices), regulate vessels, and prevent stagnation.