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The initial appearance is broad, flat, and sunken, with a diffuse root that does not gather. There is no swelling or pain, and the color is dull and not bright. This is the most dangerous syndrome among carbuncles (deep-seated suppurative infections). If cold-natured medicines are mistakenly taken, the color will change to resemble overnight pork liver; if the toxin attacks the internal organs, causing coma, death will follow immediately. The dull and diffuse color indicates deficiency of both Qi and Blood; the lack of pain and sunken appearance indicates condensation of toxin and phlegm. The treatment method requires Ephedrae Herba (Mahuang, 麻黄) to open the Couli (skin pores and interstices), and Cinnamon Twig (Rougui, 肉桂) and Prepared Ginger (Paoyang, 炮姜) to resolve cold condensation. These three herbs are indispensable even in the height of summer. Once the Couli are opened and cold condensation resolved, Qi and Blood can circulate, and the toxin will dissipate accordingly. Practitioners who treat according to this prescription without alteration will find all cases curable; any modification will likely fail to produce results.

Ma said: The treatment method is extremely correct.

He also said: Mahuang can be used before ulceration, but after ulceration has occurred, it must absolutely not be used to forcibly reopen the Couli.

This syndrome presents with white skin, swelling, and pain, with toxin emerging from the Yin aspect. It is generally due to phlegm obstructing the clear pathways (respiratory tract or upper meridians) and condensation of deficient Qi and Cold Blood, categorized as either "Cold Phlegm" or "Qi Toxin." Initially, the skin color remains unchanged, with only swelling and pain. Although the body may have fever, pus has not yet formed internally. Decocting Erchen Tang (Two-Aged Powder) together with Yanghe Wan (Yanghe Pill) and taking several doses will completely eliminate the condition. After resolution, continue administering Xiaojin Dan (Xiaojin Pill), seven pills at a time, to prevent recurrence. If the skin color changes slightly and extreme pain becomes unbearable, Yanghe Tang (Yanghe Decoction) must be taken to stop the pain and eliminate residual toxin in areas where pus has not yet formed. This allows already formed pus to gradually become painless and ulcerate, which is a method of transforming a large carbuncle into a small one. If the apex of the lesion becomes soft, puncture it. The pus is mostly white; apply Yanghe Gao (Yanghe Plaster) daily. However, after ulceration, this syndrome inevitably leads to the wandering of toxin and phlegm, with lesions appearing in various locations. Therefore, within five days after initial ulceration, administer ten pills of Xiaojin Dan to prevent future complications. Subsequently, use Xihuang Wan (Xihuang Pill) and Yanghe Tang, alternating morning and evening, to completely eliminate toxin and phlegm. Even without tonification, therapeutic success can be achieved.

If children cannot take decoctions, dissolve Xiaojin Dan for oral administration during the initial stage until the lesion resolves. For those with formed pus, also administer Xiaojin Dan to dissipate remaining indurations, rendering the lesion painless so that it can be punctured. Once the toxin is exhausted, use Baoyuan Tang (Baoyuan Decoction). Licorice Root (Gancao, 甘草) should be used raw, not honey-fried, with added Cinnamon Bark (Rougui, 肉桂) 5 fen, taken daily to achieve recovery.

If pregnant women suffer from this, inquire about the number of months of gestation. If less than six months, Xihuang Wan contains Moschus (Shexiang, 麝香) and must not be taken; instead, cure it with Yanghe Tang. After healing, take three or four additional doses to substitute for Xiaojin Dan and prevent the wandering of toxin.

Ma said: For this syndrome caused by stagnation of damp-phlegm, warming and dispersing methods are indeed appropriate. However, for those engaged in strenuous labor who do not suffer from external cold but instead damage the Spleen Earth internally, leading to stagnant and non-circulating Spleen Qi, which causes damp-phlegm to stagnate, the treatment should focus on moving Qi and resolving phlegm, with hope for resolution.

He also said: Liuzhu (Flowing Abscesses) occur in summer, most frequently in years governed by Taiyin (Too-Yang) influencing the Heaven and Earth. Working under the scorching sun and sleeping outdoors at night, the summer heat is constrained by cold, causing the Qi mechanism to cease functioning, resulting in localized swellings anywhere. Initially, resolution through sweating is suitable; Wanling Dan (Wanling Pill) is excellent. If there is no response after several doses, proceed with Yanghe Tang. If high fever, restlessness, and thirst with desire to drink occur, indicating pure internal accumulation of summer-heat toxin, how could Xiaojin Dan or Yanghe Tang be touched?

Ma said: Yanghe Tang is contraindicated for pregnant women, and even Xiaojin Dan is not suitable.