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*Jiangjiu Huangfu Xiang Yongju Lun* (Discussion on the Appearance of Carbuncles and Ulcers by Huangfu of Jiangjiu) The Yellow Emperor asked Qibo: I have heard that the intestines and stomach receive grain, the Upper Jiao (Upper Burner) releases Qi to warm the muscles, nourish the joints, and penetrate the interstices. The Qi generated by the Middle Jiao (Middle Burner) is like mist, flowing upward into the muscle clefts (Xigu) and seeping into the Sun vessels (the finest collateral vessels). When the body fluids are harmonious, they transform into red blood. When the blood is harmonious, the Sun vessels fill first, then flow into the Luo vessels; when the Luo vessels are full, they flow into the Jing vessels (Main Vessels). Yin and Yang Qi are fully expanded and move with respiration. This movement has its principles and cycles according to reason, conforming to Heaven and Earth, never ceasing. By palpating and regulating it, one should tonify deficiency and drain excess. Draining reduces excess; rapid treatment reduces Qi stagnation. Retaining the needle for varying durations depends on whether treating excess or deficiency. Tonifying ensures sufficiency. Once the Qi and Blood are regulated, the form and spirit are maintained. I already understand the balance and imbalance of Qi and Blood, but I do not know how carbuncles and ulcers arise. Regarding their prognosis, timing of success or failure, and periods of life and death, which may be near or far, how can we estimate them? Please explain.

Qibo replied: The circulation of Qi and Blood in the meridians never stops, corresponding to the degrees of Heaven and the records of Earth. Therefore, if celestial bodies lose their order, causing eclipses of the sun and moon; or if earthly rivers lose their course, overflowing channels, failing to grow grass and reeds, preventing the planting of grains, blocking paths, and isolating villages and cities—so too does the circulation of Qi and Blood. Let me explain the cause. The blood vessels, Ying (Nutritive) Qi, and Wei (Defensive) Qi flow incessantly, corresponding above to the stars and below to the numerical order of the meridians. When cold pathogen invades the meridians, the blood becomes stagnant. Stagnant blood leads to obstruction; obstruction causes Wei Qi to gather there and return no longer, thus forming a swelling (Yong). Cold transforms into heat. When heat prevails, flesh rots; rotted flesh becomes pus. If pus is not drained, tendons rot; rotten tendons damage bones; damaged bones lead to marrow depletion. If not drained at the bone cavities, the cavities cannot excrete, leading to dryness and deficiency of bones and tendons. Dryness and deficiency cause bones, tendons, muscles, and flesh to lose mutual support. Meridians fail and leak, severely damaging the Zang organs. Damage to the Zang organs leads to death.

One Formula:
The Yellow Emperor said: I wish to hear completely about the forms of carbuncles and ulcers and their taboo days. Qibo said: Briefly speaking, there are eighteen types of extreme carbuncles and ulcers.

A carbuncle occurring in the middle of the throat is called Mengju (Fierce Ju). If not treated urgently, it turns to pus. If pus is not drained and blocks the throat, death occurs within half a day. If it has turned to pus, after draining, hold pig fat ointment in the mouth. Do not eat for three days (some say avoid cold food).

A carbuncle occurring in the neck is called Taoju (Premature Death Ju). It is large, red, and black. If not treated urgently, heat qi descends into the Yuanye area, damages the Ren Mai (Conception Vessel) anteriorly, and internally steams the Liver and Lungs. Death occurs in more than ten days.

Excessive expansion of Yang Qi depletes the brain and flows to the nape, called Nao Shuo Ju (Brain Melting Ju). The complexion is unhappy (or lingering), the nape hurts as if pierced by a needle. If the patient is vexed, it is a fatal condition and untreatable.

A carbuncle occurring in the shoulder and [missing character] is called Ci Ju. Its appearance is red and black. If not treated urgently, it causes sweating down to the feet. It does not harm the Zang organs. After four or five days, adverse signs appear... [text fragment].

A carbuncle occurring in the armpit that is red and hard is called Zhu Ju (Vermilion Ju). Treat with bi stone (lithotripsy stone). The stone should be fine and long, pricking sparsely. Apply pig fat ointment. Recovery in six days. Do not bind (or wrap). If the carbuncle is hard and does not suppurate, it is called Ma Dao Jia Ying (Scimitar Knife with Goiter). Treat urgently.

A carbuncle occurring in the chest is called Jing Ju (Well Ju). Its appearance is like a soybean. If not treated early within three or four days, it descends into the abdomen. Untreated, death occurs in seven days.

A carbuncle occurring in the chest wall (Ying) is called Gan Ju (Sweet Ju). Its appearance is like a melon seed. The patient often suffers from alternating chills and fever. Treat urgently to remove chills and fever. Untreated, death occurs in ten years, with spontaneous discharge of pus after death.

A carbuncle occurring in the hypochondrium is called Gai Zi. Gai Zi is a disease of women. After a long time, it becomes a large carbuncle with pus inside, sometimes growing meat-like tissue the size of a red bean. Treatment formula:
Use Yi Cao (Euphorbia humifusa) and its roots, one dou each. Boil in one dan six sheng of water to obtain two sheng of decoction. Drink it strongly while wearing thick clothes, sitting over a pot to induce sweating until the feet sweat.

A carbuncle occurring in the lateral thigh is called Gu Tuo Ju. The color change is not obvious. The pus presses internally against the bone. If not treated urgently, death occurs in thirty days.

A carbuncle occurring in the medial thigh is called Chi Chi. If not treated urgently, death occurs in sixty days. If occurring in both medial thighs, untreated, death occurs in six days.

A carbuncle occurring in the buttocks is called Rui Ju. It is red, hard, and large. Treat urgently. Untreated, death occurs in thirty days.

A carbuncle occurring in the knee is called Ci Ju. It is large, the color does not change, accompanied by chills and fever, and is hard. Do not prick with bi stone; pricking leads to death. Wait until the color changes and it becomes soft, then prick with bi stone for survival.

Any carbuncle occurring at a joint and corresponding on both sides is untreatable.

Those occurring in Yang areas die in one hundred days.
Those occurring in Yin areas die in thirty days (some say forty days).

A carbuncle occurring in the tibia is called Tu Chi (Rabbit Tooth). It looks like a red bean, reaches the bone. Untreated, it kills.

A carbuncle occurring in the ankle is called Zou Huan. The color does not change. Prick its Shu points repeatedly to stop chills and fever. No death.

A carbuncle occurring above and below the foot is called Si Yin. It is a large carbuncle. Untreated, death occurs in one hundred days.

A carbuncle occurring on the side of the foot is called Li Ju. It is not large, initially starting from the little toe. Treat urgently. Remove the black necrotic tissue. If it does not subside and increases, untreated, death occurs in one hundred days.

A carbuncle occurring on the toe is called Tuo Fu Ju. If red and black, death ensues; if not red and black, no death. If treatment fails to resolve it, amputate urgently to survive. If not amputated, death ensues.

The Yellow Emperor said: How do you distinguish between carbuncles and ulcers? Qibo said: When Ying Qi stagnates in the meridians, blood becomes stagnant and does not flow. Non-flowing blood causes Wei Qi to gather there. Gathering without passage leads to blockage and inability to move, thus generating heat. Persistent high heat, when heat prevails, flesh rots; rotted flesh becomes pus. However, it cannot sink into the skin and bone marrow, nor does it scorch the marrow or damage the Zang organs. Thus it is named Carbuncle (Yong). What is an Ulcer (Ju)? Answer: Pure and excessive heat sinks into the skin, muscles, sinews, marrow, and bones, connecting internally to the Zang organs. Qi and Blood are exhausted. When the lesion occurs, the good flesh of sinews and bones is completely destroyed. Thus it is named Ulcer (Ju). The skin of a Ju is dark, stagnant, and hard, like the skin of an ox's neck. The skin of a Yong is thin and lustrous. These are their signs. The Yellow Emperor said: Good.

The Emperor asked: How does one die from a Ju? Qibo said: There are five parts of the body: Futu (ST32) is one, the calf (Fei) is two (some say Fu), the back is three, the Shu points of the Five Zang organs are four, and the neck is five. If a Ju occurs in any of these five parts, death ensues.

The Emperor asked: How does the body correspond to the Nine Palaces? Qibo said: Let me explain how the body corresponds to the Nine Fields.

The left foot corresponds to Start of Spring (Lichun), on days Wuyin and Jichou.
The left chest corresponds to Spring Equinox (Chunfen), on day Jimao.
The left hand corresponds to Start of Summer (Lixia), on days Wuchen and Jisi.
The chest, throat, head, and neck correspond to Summer Solstice (Xiazhi), on day Bingwu.
The left hand corresponds to Start of Autumn (Liqiu), on days Wushen and Jiwei. *(Note: Text says Left Hand, likely error for Right)*
The right chest corresponds to Autumn Equinox (Qiufen), on day Xinyou.
The left foot corresponds to Start of Winter (Lidong), on days Wuxu and Jihai. *(Note: Text repeats Left Foot)*
The waist, buttocks, and lower extremities correspond to Winter Solstice (Dongzhi), on day Renzi.
The Six Fu organs and the two Zang organs below the diaphragm correspond to the Central Region. The days when Taiyi resides, and all Wu (Earthly Branches associated with Earth/Stomach/Spleen context in some systems, here referring to Heavenly Stems Wu and Ji) and Ji days are forbidden.

When observing these nine areas, one should observe the locations of the Eight Normals (Solstices and Equinoxes plus Start of Four Seasons). If there is a swelling in the corresponding left/right/upper/lower body part to be treated, do not perform incision/drainage on the day directly corresponding to that location. This is called the Heavenly Taboo Day.

Regarding the Five Zi days:
Zi hour (Night Midpoint): Wu Zi day.
Chou hour (Rooster Crow): Wu Chou day.
Yin hour (Daybreak): Wu Yin day.
Mao hour (Sunrise): Wu Mao day.
Chen hour (Meal Time): Wu Chen day.
Si hour (Late Morning): Wu Si day.
Wu hour (Noon): Wu Wu day.
Wei hour (Afternoon): Wu Wei day.
Shen hour (Afternoon Meal): Wu Shen day.
You hour (Sunset): Wu You day.
Xu hour (Twilight): Wu Xu day.
Hai hour (Human Rest): Wu Hai day.
If a carbuncle arises during these days and hours, the patient will not recover.