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The master asked the teacher, "What is the difference between carbuncle (Yong) and gangrene (Ju), which is heavier and which is lighter? By observing the exterior to understand the interior, and judging life and death based on morphology, how can they be distinguished?"

The teacher said, "When the disease is deep in the skin and superficial in the muscles, swelling is floating, empty, and extensive, or it spreads three or four cun, wanders around and injects laterally, this is Carbuncle (Yong)."

The master asked, "What should be done first in treating it?"

The teacher said, "For those that have formed pus, puncture them; for those with excessive heat and toxicity, hasten their treatment with needles. Attack the interior first, then the exterior, and success will be achieved in three days. (This refers to cases where the carbuncle has formed and contains pus; one should use acupuncture to drain it. If the heat and toxicity are severe, use needles to expel the pathogenic factors.)"

The master said, "I have heard of the treatment for carbuncles; may I ask about gangrene?"

The teacher said, "It is very serious. The sharp toxicity of the five Zang organs forms gangrene; heat accumulates within the five Zang organs and gathers, reversing through the Yang meridians and attempting to emerge, causing the Danfu (Elixir Field/Dantian) to become dry, while Ying (Nutritive Qi) and Wei (Defensive Qi) become excessively abundant and form knots. This root lies in the interior, seven-tenths originating from within, and three-tenths manifesting externally. The lesion appears small but the base is firm, sharp like a fine foot; touching or shaking it causes pain in the heart, brain, and bones. Symptoms of cold and heat attacking the Yang are all present. For rapid onset, drain the Hui-meeting points of the Yang meridians; for deteriorating conditions, urgently rescue the interior ('draining Hui' refers to moxibustion, 'rescuing the interior' refers to herbal medicine). Skilled practitioners follow the classics, intervening before the disease fully erupts or penetrates; the subtlety lies in the precision of the fingers. (Acupuncture is meant here; 'exiting the skin' is called 'Yue'.)"

The master asked, "Some diseases arise from extreme severity yet lead to survival, while others arise from slight symptoms yet lead to death. Since the pathological signs are clearly identified, how is life and death determined?"

The answer was, "Back carbuncles that penetrate the membrane are fatal and incurable (this refers to Liver pathology affecting above the diaphragm). Internal collapse without ulceration, with a cyan face and black lips, and foul stool, indicates death (this refers to organ involvement with blood stasis). Ulceration of the throat is incurable. Invasion into the abdomen is incurable. Invasion into the scrotum is fatal. Toxicity at the temples penetrating an inch deep is incurable (meaning depth equivalent to an inch needle insertion). Toxicity at the sharp point one inch and three fen behind the left cheek is incurable; if absent, survival is possible. Even with numerous flowing injections, treatment will surely lead to recovery."

The master asked, "There are various methods of acupuncture and moxibustion; which one is considered skilled?"

The answer was, "Acupuncture is indeed a wonderful method, but if its essence is not grasped, disaster can occur in the flip of a hand. Moxibustion is also a crucial path, but it must be avoided in heat diseases (for example, when the nine toxins and Heart Fire are both excessive, using fire to forcibly deplete them by applying moxa directly on the sore will cause immediate death)."

The master asked, "In treating diseases like carbuncles and gangrene, is there any reliance on pulse diagnosis?"

The answer was, "The Sages knew all about treating diseases as perfectly as matching tally marks; what else but the pulse could achieve this? By palpating the pulse, if the whole body is peaceful, the pulse returns to normal; changes in fullness/emptiness, slow/fast rates determine life and death. A severe illness presenting with a slow pulse is a counter-indication (Ni). A wasting disease presenting with a rapid pulse indicates the illness is not yet resolved. Slow indicates cold, rapid indicates heat, clear and unhidden. Full, rapid, tight, and vigorous pulses are disease pulses. If the disease presents with隆起 (protrusion/knotting), even if the pulse is vigorous, there is no fear; if the pulse is soggy and deep, death may occur in seven months; a thread-like and faint pulse is untreatable. For diseases in the Upper Jiao, if the Cun position does not respond and the pulse floats on the skin, it is a Carbuncle (Shun/Favorable); if it enters the muscles, it is Gangrene (Ni/Unfavorable). For diseases in the Lower Jiao, if the Cun position reverses to be vigorous and the Chi position does not respond, the determination of slow/fast and favorable/unfavorable depends on subtle observation. Floating, slippery, and penetrating the Cun; deep, solid, slippery, and firm—these are Metal-Stone pulses. Rapid and solid Ju-Yin and Yang-Ming pulses indicate food toxicity. Firm and secure pulses indicate Carbuncle knotting in Taiyin; encountering Ju-Yin string-like Ying pulses reflects the dominance of specific meridians, described by the Nine Sections."

The master asked, "May I hear about the Five Good Signs and Seven Bad Signs?"

The answer was, "Normal diet and appetite is the First Good Sign; excess heat with difficult urination and defecation is the Second Good Sign; correspondence between internal and external symptoms is the Third Good Sign; clear distinction between healthy and unhealthy muscle tissue is the Fourth Good Sign; medication effects match expectations is the Fifth Good Sign. Fever, thirst, panting, bright eyes but sunken inner canthi, and paradoxical loose stools and urine constitute the First Bad Sign; weak breath and soggy pulse contrary to the disease state constitute the Second Bad Sign; inability to see clearly and sinking of the spirit's brightness constitutes the Third Bad Sign; pre-ulceration with black, sunken flesh constitutes the Fourth Bad Sign; post-ulceration with cyan-black color, rotting tendons, and black bones constitutes the Fifth Bad Sign; generation of phlegm is the Sixth Bad Sign; vomiting is the Seventh Bad Sign."

Humans are born endowing the Qi of the Five Elements: Metal, Wood, Water, Fire, Earth. Thus, they distribute across the four seasons with positions of Yin/Yang and Cold/Heat. Following them leads to harmonious wind and Qi; opposing them leads to chaotic wind and rebellious Qi, which is why hundred diseases arise. Although humans can understand this principle, due to occasional mishaps or overacting of the Four Seasons' Qi, the surface apertures become uneven, the Sanjiao becomes obstructed, blood becomes stagnant in the muscle surface, leading to the affliction of the Five Types of Carbuncles and Gangrenes. 'Fa' (Eruptions) are generated by disharmony among the Five Zang and Six Fu organs. Generally, the Five Zang govern interior Qi, generating meridians that sink; the Six Fu govern exterior Qi, generating meridians that float. If emotions are irregular, diet is immoderate, Yin and Yang are unbalanced, and cold and heat interfere with each other, then Zang Qi becomes deficient, and Couli (pores/skin texture) become open and sparse. When Couli are open, Cold Pathogens lodge between the meridians. Once the Cold Qi damages the Zheng Qi, Ying and Wei stagnate in the vessels. Ying is Blood, Wei is Qi; when Blood receives Cold, it becomes stagnant and fails to flow; Wei Qi follows, battling with the Cold Pathogen, thus becoming blocked and obstructed. Qi belongs to Yang; accumulated Yang Qi generates Heat; Heat causes Blood stagnation. With Cold and Heat unresolved, accumulation occurs forming Carbuncles and Gangrenes. The appearance of Gangrene involves Qi attacking internally, skin thick and strong, numbness and cold sensation; long-standing cold generates fever; accumulation of cold and heat damages flesh but does not immediately destroy muscle; once muscle is destroyed, it transforms into pus and blood. Carbuncle affections belong to the Exterior, bone marrow remains intact, making them easy to treat. Gangrene affections belong to the Interior, damaging bones and destroying tendons, making them difficult to regulate.

The Classic states: "One or two cun in size is Carbuncle; extending up to about one chi is Gangrene. Each of the Five Eruptions has its own color. Originating from the four eruptions of Biao, Ai, Ju, and Gu, each has distinct colors. Only the small ones are Carbuncles, which are relatively easy to treat. As soon as people feel the onset of nodulation, accompanied by chills and fever or just heat, pain, swelling, redness, and broad, hard scars; if exceeding five cun, whether on the head/back or limbs, or shapeless, one should immediately administer Da Che Ao San (Large Scorpion Powder); if only three or two cun of scar, administer Xiao Che Ao San (Small Scorpion Powder). If the Carbuncle has already ruptured, neither Da nor Xiao Che Ao San should be used. Now drawing the images and colors of the Five Eruptions, depicted below."

Discussion on Zheng Fa (Regular Eruption). Zheng Fa presents with a full and vigorous pulse, headache with chills and fever, constipation, dark urine, pain penetrating bones and tendons, eye pain, resembling Yang-pattern Shanghan (Cold Damage). However, the pain is tangible, swelling and redness make it intolerable to touch, swelling grows, with surfaces resembling boiling smoke-paste or white millet grains; these are caused by the combined action of Toxic Heart Fire. One should administer Rhubarb, Rhinoceros Horn, Juice of Raw Rehmannia Root, and Juice of Luffa Fruit alongside standard medications, while simultaneously assessing the use of acupuncture and moxibustion. Attacking while pus has not yet formed allows for resolution without ulceration; this is the work of a Superior Physician. Thirst alone carries no danger; constipation and dark urine with thirst and panting carry no danger; loose stools and urine indicate a counter-indication (Ni). The discussion on Good and Bad signs precedes this.