脓熟不溃者，阳气虚也，宜补之。（圣愈汤是也。）瘀肉不腐者，宜大补阳气。（
参、归术是也。）更以桑柴火灸之，脓
清不敛者，气血俱虚，宜大补。（八珍汤是也。）溃后食少不睡，或发热者，虚也，宜
补之。（内补黄 汤。）倦怠懒言，食少不睡者，虚也，宜补之。（黄 人参汤。）
寒气袭于疮口，不敛或陷下不敛者，温补之。（十全大补汤。）脉大无力或微涩，而
肌肉迟生者，气血俱虚也，峻补之。（十全大补汤。）出血或脓多，烦躁不眠者，乃亡
阳也，急补之。脓多或清者，气血俱虚也，宜峻补之。右关脉弱而肌肉迟生者，宜健
脾胃。（六君子汤是也。）脓清，补之不应，及不痛，或木闷及硬坚者，俱不治。
脓出而反痛者，虚也，宜补之。脓溃之后，脉涩、迟、缓者易愈，以其有胃气故
也。脉细而沉、时直者，里虚，欲变证也。若痛尚未痊，洪、滑、粗、散者，难疗，以正
气虚邪气实也。脉数、虚而痛者，属阴火，宜滋阴。（托里散加地黄。）脉数实而痛者，邪
气实也，宜泄之。脉实便秘而痛者，邪在内也，宜下之。（清凉饮）。脉涩而痛者，
气血虚寒也，温补之。（定痛托里散。）若有脓为脂膜间膈不出，或作胀痛者，宜用针引
之，或用利刀剪之。腐肉堵塞者，去之。
When the pus is ripe but the ulcer does not rupture, it is due to deficiency of Yang Qi; tonification is indicated. (e.g., Shengyu Tang / Saintly Vitality Decoction.)
When necrotic tissue remains unsloughed, substantial tonification of Yang Qi is required. (e.g., using Ginseng Radix et Rhizoma [Renshen], Angelicae Sinensis Radix [Danggui], and Atractylodis Macrocephalae Rhizoma [Baizhu].)
Furthermore, moxibustion with mulberry wood fire should be applied.
If the pus is thin and the wound fails to close, it indicates a dual deficiency of Qi and Blood; substantial tonification is indicated. (e.g., Bazhen Tang / Eight Treasures Decoction.)
After the ulcer has ruptured, if there is poor appetite and insomnia, or fever, this is a deficiency pattern; tonification is indicated. (e.g., Neibu Huangqi Tang / Internal Nourishing Astragalus Decoction.)
If the patient feels fatigued, reluctant to speak, has poor appetite, and suffers from insomnia, this is a deficiency pattern; tonification is indicated. (e.g., Huangqi Renshen Tang / Astragalus and Ginseng Decoction.)
If cold pathogenic factors invade the wound, causing failure to heal or sunken non-healing ulcers, warming and tonifying methods are indicated. (e.g., Shiquan Dabu Tang / Ten Complete Tonifying Decoction.)
If the pulse is large but forceless, or fine and choppy, accompanied by slow muscle regeneration, this indicates a dual deficiency of Qi and Blood; vigorous tonification is indicated. (e.g., Shiquan Dabu Tang / Ten Complete Tonifying Decoction.)
If there is excessive bleeding or profuse pus, accompanied by restlessness and insomnia, this signifies loss of Yang; emergency tonification is required.
If there is excessive pus or thin pus, this indicates a dual deficiency of Qi and Blood; vigorous tonification is indicated.
If the Right Guan pulse (corresponding to Spleen and Stomach) is weak and muscle regeneration is slow, strengthening the Spleen and Stomach is indicated. (e.g., Liujunzi Tang / Six Gentlemen Decoction.)
If the pus is thin, responds poorly to tonification, and the wound is painless, or presents with numbness, fullness, hardness, and induration, these are intractable conditions with poor prognosis.
If pain worsens after pus discharge, this is a deficiency pattern; tonification is indicated.
After pus drainage, if the pulse is choppy, slow, or moderate, recovery is likely because the Stomach Qi remains intact.
If the pulse is fine, deep, and rigid without flexibility, this indicates interior deficiency and impending transformation of the disease.
If pain persists and the pulse is surging, slippery, coarse, or scattered, treatment is difficult because the healthy Qi is deficient while the pathogenic factor is excess.
If the pulse is rapid, deficient, and painful, it belongs to Yin Fire; nourishing Yin is indicated. (Toli San / Support Interior Powder modified with Rehmanniae Radix [Dihuang].)
If the pulse is rapid, excess, and painful, it indicates excess pathogenic factors; draining methods are indicated.
If the pulse is excess, constipation is present, and there is pain, the pathogen is internal; purgation is indicated. (e.g., Qingliang Yin / Cooling Drink.)
If the pulse is choppy and painful, it indicates Qi and Blood deficiency with Cold; warming and tonifying are indicated. (e.g., Dingtong Tuoli San / Pain-Settling Support Interior Powder.)
If pus is trapped between fatty membranes and cannot drain out, or causes distending pain, needle drainage or incision with sharp instruments should be used.
Necrotic tissue blocking the wound should be removed.