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The stomach and intestines receive grain. The Upper Jiao (Upper Burner) emits Qi, which warms the muscles, nourishes the joints, and unblocks the interstices. (The Qi emitted by the Upper Jiao is Zong Qi (Gathering Qi). Zong Qi emerges from the throat to govern respiration; its function of warming muscles, nourishing joints, and unblocking interstices indicates that Wei Qi (Defensive Qi) is transformed from Zong Qi.) The Middle Jiao (Middle Burner) emits Qi like dew, flowing upward into the muscle valleys (intermuscular spaces) and seeping into the Sun vessels (finest collateral vessels). When fluids are harmonized, they transform into red blood. When blood is harmonized, the Sun vessels fill first, overflowing into the Luo vessels (collaterals); when these are full, they flow into the Jing vessels (main meridians). At this point, Yin and Yang Qi are fully expanded and move with respiration. (The Qi emitted by the Middle Jiao like dew is Ying Qi (Nutritive Qi). Its movement with respiration when Yin and Yang are expanded indicates that Ying Qi is also transformed from Zong Qi.) Movement has its order, circulation has its principles, aligning with Heaven's agreement, never ceasing. (Movement has order, circulation has principles; human Ying and Wei Qi accord with Heaven's measure.) Palpating and regulating: proceed from deficiency to eliminate excess; using draining methods results in insufficiency (of pathogenic factors). (Eliminating excess by treating deficiency means draining reduces the pathogen.) Rapid draining reduces Qi; retaining needle application distinguishes sequence. (Draining should be rapid; tonifying requires retention, showing the difference in speed and timing between tonification and draining.) Proceed from deficiency to treat deficiency; using tonifying methods results in abundance (of healthy Qi). (Treating deficiency to remove weakness means tonification restores abundance. These two sections regarding flavor and thickness should be emulated.) Once Blood and Qi are regulated, Form Qi is maintained; thus one knows if Blood and Qi are balanced, but not yet how carbuncles and ulcers arise. Regarding their success or failure, and the timing of life and death, which may be near or far, how can one estimate them? ("Holding" means stability; "Du" is pronounced entering tone, meaning to estimate.) However, meridian Qi flows endlessly, matching Heaven's measure and Earth's order. Thus, if celestial bodies lose their order, eclipses occur; if Earth's lines lose their rhythm, waterways overflow, grass fails to grow, grains do not multiply, paths become blocked, people cease to travel, and villages and cities separate. Human Blood and Qi are similar. Blood vessels, Ying, and Wei Qi circulate without rest, corresponding above to stars and below to earthly measures. When Cold Evil lodges in the meridians, Blood becomes stagnant and does not flow. Stagnation prevents Wei Qi from returning, causing it to gather there, resulting in swelling. (Wei Qi gathering and not returning means it stays and accumulates. , pronounced Yi, is a plant, specifically Deer Onion.) Cold transforms into Heat; excessive Heat rots flesh, which turns to pus. If pus is not drained, tendons rot; tendon rot injures bones; bone injury causes marrow depletion. If not at bone openings for drainage, Blood dries up and empties, so tendons, bones, and muscles lose mutual nourishment. Meridians fail and leak, fumes affect the Five Zang Organs, organ damage leads to death. (Carbuncle toxins progress from shallow to deep; damaging organs leads to death, as described below.) Let us discuss the forms and forbidden names of carbuncles and ulcers. A carbuncle arising in the throat is called Meng Ju (Fierce Ulcer). If untreated, it turns to pus; if pus blocks the throat, death occurs within half a day. If pus is formed and drained, taking Shi Gao (Pig Fat), consumed cold, cures it in three days. (Meng Ju implies urgent harm. If pus is drained, Shi Gao [refined pig fat] heals it. Wan's formula for sudden loss of voice due to Lung Heat uses one jin of refined pig fat mixed with one jin of white honey, refined again, filtered, cooled, and taken by the spoonful. It moistens lungs and intestines.) A carbuncle on the neck is called Tian Ju (Heavenly Ulcer). Large and red-black, if not treated urgently, heat enters Yuan Ye acupoint, damages the Ren Mai (Conception Vessel) anteriorly, and steams the Liver and Lungs internally. Steaming Liver and Lungs leads to death in ten-plus days. (Neck refers to anterior neck. Red-black color indicates severe toxin. Yuan Ye is a Foot Shaoyang Gallbladder channel point. Neck lesions connect to Lung system; descending into Shaoyang affects the Liver, causing death.) Excessive Yang Qi expansion, consuming brain marrow and lingering in the nape, is called Nao Shuo (Brain Melting). The complexion is unhappy, nape pain feels like needle pricks; irritability indicates death, untreatable. (Excessive Yang Qi is extreme evil heat. Unhappy complexion shows spirit injury. Needle-like pain shows sharp toxin. Irritability shows evil invading organs, hence untreatable. These likely refer to Tian Ju Rui Du.) A carbuncle on the shoulder and is called Ci Yong. Red-black, treat urgently. This causes sweating down to the feet but does not harm the Five Zang Organs. After four to five days, apply moxibustion. (Soft white flesh below shoulder is . Not a vital area, so organs are spared. Cheng means cure. is moxa cone. Apply moxibustion quickly. Pronunciations vary. Ci sounds like Ci. sounds like Rui.) A red, hard carbuncle under the armpit is called Mi Ju (Rice Ulcer). Treat with Bian stones (lithic needles), thin and long, sparse puncture, apply Shi Gao, cure in six days, do not bandage. (Thin Bian stones avoid muscle injury; long ones reach depth; sparse is better than dense.) Hard carbuncles that do not ulcerate are called Ma Dao Jia Ying (Horse Knife with Goiter), treat urgently. (This is Scrofula; urgent treatment prevents delay.) A carbuncle on the chest is called Jing Ju (Well Ulcer), size of soybean, appearing in three to four days. If not treated early, toxin descends to abdomen, untreatable, death in seven days. (Chest lesions steam Heart and Lung; descending to abdomen increases toxicity, causing rapid death.) A carbuncle on the breast is called Gan Ju (Sweet Ulcer), green color, shape like grain seeds or Trichosanthes fruit, often with chills and fever. Treat urgently to remove chills/fever; death in ten days after pus discharge. (Ying is high flesh on side of chest. Grain seeds refer to clustered shapes. KT is Trichosanthes. Soft without ulceration, accumulation inside. Similar to Breast Carbuncle. KT is ancient character for Gua Lou.) A carbuncle on the hypochondrium is called Bai Ci. Bai Ci is a disease in women, treat with moxibustion. Large abscess with pus; during treatment, fleshy growths the size of red beans appear. Decoct rhizome of Water Caltrop and root of Forsythia, each one sheng, in sixteen dou of water until reduced to three sheng. Drink strongly, sit on hot pot wrapped in thick clothes, sweat to feet to cure. ( is Water Caltrop. is Forsythia. Roots detoxify. Ancient sheng approximates modern he. Sounds: Ling. ) A carbuncle on thigh and calf is called Gu Ting Ju. Appearance changes little, but pus adheres to bone. Untreated, death in thirty days. (Gu Ting is thigh. Little change means superficial signs are faint. Pus adhering to bone is modern "Bone-Adherent Carbuncle". Deep toxin erodes major meridians, causing death if not treated urgently.) A carbuncle on the buttock is called Rui Ju. Red, hard, large. Treat urgently; untreated, death in thirty days. (Kao is coccyx. Chang Qiang acupoint is Governor Vessel connection; untreated leads to death.) A carbuncle on inner thigh is called Chi Shi. Untreated, death in sixty days; if on both inner thighs, death in ten days. (Inner thigh is medial thigh. Located between Spleen and Liver channel points, areas of Yin organ convergence. Untreated leads to death. Both sides affected means extreme Yin injury, faster death.) A carbuncle on the knee is called Ci Yong. Large, color unchanged, cold and hard as stone. Do not use Bian stone; using it causes death. Wait for softness before using Bian stone for survival. (Puncturing pre-pus knee injury sinews, causing death. Softness indicates pus formation, safe for puncture. Modern indiscriminate knife use is dangerous.) Carbuncles/ulcers at joints with corresponding symptoms elsewhere are untreatable. Those on Yang meridians die in one hundred days; those on Yin meridians die in thirty days. (Joints are pathways for Shen Qi; lesions here are bad. Correspondence implies widespread damage. Yang lesions are shallow/fu, slower death; Yin lesions are deep/zang, death within a month.) A carbuncle on the shin is called Tu Nie (Rabbit Bite). Red to bone. Treat urgently; untreated harms. (Tie Nie resembles bite marks.) A carbuncle on the inner ankle is called Zou Huan. Appears as carbuncle, color unchanged. Frequent Bian stone puncture of Shu points stops chills/fever; no death. (Puncturing swollen areas.) A carbuncle on top and bottom of foot is called Si Yin. Large abscess. Treat urgently; death in one hundred days. (Yang Qi ends in extremities; large abscess here indicates extreme Yang toxin. True Yin declines over time, death after three months.) A carbuncle on the side of the foot is called Li Yong. Small initially, like toe lesion. Treat urgently, remove black parts. If not resolved, it grows; untreated, death in one hundred days. (Initial small size grows if ignored.) A carbuncle on the toe is called Tuo Yong. Red-black, fatal and untreatable. If not red-black, neither dying nor healing; amputate urgently, otherwise death. (Original points on feet; toe lesions involve Jing-Well points. Red-black indicates severe toxin. Amputation saves life; otherwise toxin reaches organs, causing death.) Difference between Carbuncle and Ulcer? Ying and Wei stagnate in meridians, Blood stagnates, Wei Qi follows but cannot pass, obstruction causes Heat. Persistent intense Heat rots flesh into pus. However, it does not penetrate bone, marrow does not dry, Zang organs are not injured; thus named Carbuncle. (Differentiating severity. Carbuncle is superficial, does not penetrate bone/marrow/organs, so less worrying.) Intense Heat sinks into skin, dries sinews/marrow, connects internally to Zang organs, exhausts Blood/Qi. Flesh, sinews, bones, and good tissue are destroyed; thus named Ulcer. (Ulcer is deep, toxin severe, destroys internal organs and external tissues, hence feared.) Ulcer: skin upper part is dark and hard, like ox neck skin. Carbuncle: skin upper part is thin and glossy. These are the signs. (Darkness indicates lack of luster; helps distinguish depth.) How do carbuncles/swellings with tendon spasms and bone pain arise? (Discussing swellings accompanied by spasms/pain. Interpreting as three separate diseases misses the point. Text says "Cold swelling," implying origin.) They arise from Cold swelling and Eight Winds variations. (Wind-Cold in meridions causes accompanying bone/tendon pain. Examples include stiff neck, mumps, throat/carbuncle, or joint/muscle swellings.) How to treat? These are seasonal diseases, cured by treating with the controlling element. (Seasonal diseases are epidemic Qi. Treat by control: Cold with Heat, Heat with Cold, etc., balancing Qi, ensuring clarity and stillness, reducing pathogenic Qi.) Diagnosis of Stomach Carbuncle: Palpate Stomach pulse. Should be deep and fine; deep/fine indicates Qi reversal. (Stomach pulse at Right Guan. Stomach is abundant in Qi/Blood, pulse should be洪大; deep/fine indicates reversal. Wan sounds like Guan.) Reversal makes Ren Ying pulse very full; fullness indicates Heat. (Qi reversal at Zang, Heat at Meridian. Ren Ying three times full indicates Yangming disease.) Ren Ying is Stomach pulse. (Ren Ying is beside larynx, Foot Yangming artery.) Reversal and fullness cause Heat to gather at stomach opening without moving, forming Stomach Carbuncle. (Yangming Qi reversal gathers Heat in stomach, forming carbuncle.) Neck Carbuncle treated with either Bian stone or acupuncture/cupping, both curing. What is the true method? (Asking for the correct standard treatment.) Same name, different categories. (Same name, different symptoms require different treatments.) For stagnant Qi carbuncles, use needle to open and remove. (Xi means stop. Use needle to release stuck Qi, curing carbuncle.) For Qi excess and Blood accumulation, use Bian stone to drain. This is "Same Disease, Different Treatment." (Bian stone drains Blood, reducing Qi and curing carbuncle. Same disease, different therapy.) Disease onset: unpredictable emotions, irregular diet, Yin deficiency, Yang excess, Ying Qi stagnation lead to Carbuncles/Ulcers. Yin/Yang blockage, two Heats clashing form pus. Can small needles cure this? (Emotions cause Qi reversal; diet injures Zang; Yin deficiency stops Ying; Yang excess gathers Heat, all causing carbuncles.) Sage cannot make accumulated pus resolve spontaneously because Evil must not remain. Like armies facing each other, swords drawn, not planned in a day. Training soldiers takes time. Allowing body to suffer pus/blood accumulation is far from the Way. Carbuncles/pus arise from accumulation of minute factors, not heaven or earth. Sages treat before form appears; fools suffer after formation. Is it only about treating the body? (Evil in world causes chaos; in body causes disease. Once formed, even sages cannot dissolve it easily. Like military strategy requiring preparation. Body cultivation requires daily maintenance. Sages prevent; fools suffer. Must beware!) If form appears and is missed, pus forms and is unseen, what to do? Pus formed means ten deaths, one life. Sages prevent formation, write good prescriptions on bamboo/silk for successors, so they are not missed. (Many people, long history; cannot save everyone individually. Writing texts preserves knowledge for future encounters.) If pus/blood already formed and encountered, why not use small needles? Small needles have small effect; large needles cause harm. For formed pus/blood, only Bian stones, Pi needles, or Feng needles should be used to drain. (Small needles ineffective; large needles risky. Use lithic/blade needles for drainage.) Harmful methods not complete? Depends on Reverse/Favorable. Signs of Reverse: white eye blue/black eye small (1st Reverse); vomiting after oral medicine (2nd); abdominal pain/thirst (3rd); shoulder/nape stiffness (4th); hoarse voice/color loss (5th). Others are Favorable. Are Reverse/Favorable only for body treatment? (Five body parts: Thigh, Calf, Back, Zang Shu, Nape. Lesions here are fatal, akin to Five Reverses. Reverse leads to ruin, Favorable to cure. Reiterating importance. Author's intent is profound.)