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Carbuncles and deep abscesses (Yong Ju, 痈疽) are two types of toxic conditions originating from the Heart. The Heart governs blood circulation and promotes Qi movement; when Qi and Blood stagnate, toxins arise. These toxins are named according to their location. Treatment based solely on meridian theory without distinguishing Yin-Yang and Cold-Heat leads to errors.

Clinical manifestations: A lesion with a base diameter exceeding one cun that is red and swollen is called "Yong" (Carbuncle/Superficial Abscess), which arises in the Six Fu Organs. If the shape is only a few fen in size, it is termed a small boil (Jie, 疖). Pressing the area leaves an indentation that does not immediately rebound; although warm, if the apex is not very hot, pus has not yet formed. If pressing causes the tissue to rise with the finger, becoming soft with significant heat at the apex, pus is mature. When there is no pus, dispersal methods are suitable; when pus exists, it should not be retained for long. Xingxiao Wan (Wake-Up Pill) can rapidly reduce swelling and relieve pain, serving as a holy medicine for treating Yong. White lesions that sink inward are called "Ju" (Deep Abscess/Gangrene), which arise in the Five Zang Organs; thus, Ju has a deep root while Yong's toxin is shallow.

A red base that spreads diffusely indicates Qi deficiency failing to hold blood tightly. A red, vibrant, and lustrous base indicates sufficient Qi and Blood pushing the toxin outward. Red externally but black internally indicates toxin stagnation within. Purple-dark and unclear coloration indicates insufficient Qi and Blood, unable to transform toxin into pus. Thick pus indicates robust Qi and Blood; thin, clear pus indicates deficient Qi and Blood.

Before pus formation, between the interstices (Cou Li, 腠理), Yong involves stagnation of Fire-Toxin, while Ju involves condensation of Cold-Phlegm. After pus discharge, Yong requires supportive expulsion (Tuo, 托) due to residual Heat-Toxin, while Ju requires warming methods due to unresolved Cold-Condensation. For Cold-Ju, even in intense summer heat, warming therapies are appropriate. For Heat-Toxin, even in severe winter cold, cooling therapies are preferred. However, treatments for Yin Deficiency and Yang Excess differ significantly. Reading ancient formularies, I found them insufficiently detailed, so I elaborate their principles for reference.

Various white, sinking Ju are caused by Qi and Blood deficiency with Cold-Stagnation. In the early stage, when toxin sinks into the Yin aspect, unless Yang-Harmonizing methods (such as using Yanghe Tang, 阳和汤) open the interstices, how can Cold-Condensation be resolved? After ulceration, if Yin-Blood is dry, unless nourishing Yin and gently promoting circulation, how can thick pus be generated? Qi forms the structure, Blood provides luster. Therefore, for flat, sinking Ju that cannot expel toxin, once Yang energy harmonizes and rotates, the condensed toxin in the Yin aspect naturally dissolves. For Blood deficiency failing to transform toxin, warming and tonifying to promote pus discharge is especially suitable. Thus, during the phase of pus discharge with incomplete toxin elimination, the function of opening interstices must not be delayed. Laxity allows toxin to linger; resolution and expulsion allow toxin to dissipate. Opening interstices without concurrent warming and tonification—how can pus form amidst Qi and Blood deficiency and Cold? This is like cooking without rice. Tonifying without opening interstices merely supplements weakness; how can Cold-Condensed toxin find a path to dissipate? Moreover, in cases of abundant toxin, tonics may inadvertently aid the pathogen, like providing grain to thieves. Tonifying without warmth leads to Blood stasis and Qi stagnation; who will act as the vessel for pus formation? This is like brewing wine without heat—how can liquid form? Cooking rice without fire—how can it cook? People generally know only to clear Heat and drain Fire to detoxify, unaware that the toxin here is essentially Cold. Resolving Cold transforms the toxin; clearing Heat congeals it further. Toxin transformation necessarily proceeds through pus; pus generation relies on Qi and Blood; Qi and Blood transformation relies on Warmth. How can cooling agents be used? Cooling medicines are only applicable to red, swollen Yong and boils. For Ju in dangerous, Yin-Cold locations, warming and tonifying may still be insufficient; how can one recklessly use clearing and resolving methods, damaging Stomach Qi? This could lead to failure of Yang-Harmony, difficulty in ulceration or resolution, and toxin attacking internal organs—is this not terrifying? Since the Spleen and Stomach determine life and death, priority is given to stopping pain, followed by strengthening the Spleen. Pain cessation allows evil Qi to transform; Spleen strengthening allows muscle regeneration. With harmonized and vigorous Yang, reddish skin regenerates, relying entirely on formulas that harmonize and tonify Qi and Blood. Medicines with cold properties should strictly be avoided throughout.

Ma stated: Boils of a few fen must also be assessed by location. If occurring at critical acupoints, they cannot be disregarded. Who says small boils are harmless!

He also said: White, sinking lesions are Phlegm disorders manifesting in the flesh, caused by Qi stagnation. If hard and condensed, adhering to sinews and bones, it is a Blood-level pathology. It must initially present as red, hard, and headed to be called Ju. However, Yin and Yang must be differentiated.

He further said: Individuals with Yin Deficiency and Yang Prosperity may have Toxic-Fire結 (knotting) in the Ying (Nutritive) level. The sore is hard, flat, purple, and feels burning hot to touch. One must drain the Fire-Toxin. Only when Yin is filled and Blood harmonized can the sore rise. How can this be considered Cold-Ju treated with warming methods? Administering warming agents would dry Yin further and intensify Fire. Diagnosis relies entirely on observing pulse, color, and form.

He added: Generalizing all toxins as Cold is incorrect. One must know that Yang contains Yin, and Yin contains Yang. There are True Cold with False Heat, and True Heat with False Cold. If one clings to the "white color" criterion, what about lesions that are white but feel burning hot to touch with a surging, rapid pulse? Should these be treated as Ju? If one sticks to the "red color" criterion, what about lesions that are red but feel cool to touch with a non-surging, non-rapid pulse? Should these be treated as Yong? Without proficiency in pulse diagnosis, how can errors be avoided?

Tao stated: Chinese "sores and toxins" are referred to as inflammation in Western countries. There are names for Internal Inflammation and External Inflammation. External inflammation corresponds to Yong and Ju; Internal inflammation corresponds to Lung Abscess (Fei Yong, 肺痈) and Intestinal Abscess (Chang Yong, 肠痈), etc. Applying several leeches (Qi, 蜞) to the swollen area and sucking out the toxin is effective.

He also said: If a boil occurs at a critical acupoint, apply ground Golden-Shelled Comb (Jin Ke Zhi, 金壳栉, produced in Guangdong) with water. This can shift the toxicity to a non-lethal area within one or two cun. However, this medicine is toxic and must not be ingested. Additionally, the *Yan Fang Xin Bian* (New Compilation of Verified Prescriptions) in the chapter on miscellaneous treatments for carbuncles and toxins lists Yishan Guohai San (Mountain-Moving Sea-Crossing Powder) and Gandu San (Toxin-Chasing Powder), both capable of shifting sores to non-lethal locations.

He concluded: Xu Lingtai also stated: Redness does not always indicate Yong, and whiteness does not always indicate Ju.