或问，痈疽五善七恶，何谓也。答曰∶五善者，饮食知味，一也；便溺调匀，二也；脓
溃肿消，脓水不臭，三也；神气清爽，动息自宁，四也；脉息有神，不违时令，五也。七恶
者，大渴发热，泄泻淋闭，一也；脓溃尤肿，脓稀臭秽，二也；目睛无神，语声不亮，三也
；食少不化，服药作呕，四也；恍惚嗜卧，气短乏力，腰背沉重，五也；唇青鼻黑，面目浮
肿，六也；脉息无神，或躁动不和，七也。古语云∶五善得三则吉，七恶得四则凶。余谓七
恶之凶，不待四矣。然而急救之方，正不容以不讲。大抵热渴淋闭，喘急内热，皆真阴受伤
，宜六味汤加麦冬、五味。如不应，用八珍汤加麦冬、五味。更不应，用十全大补汤，兼服
六味地黄丸。此乃补阴生阳之说也。若气短倦怠，昏愦乏力，饮食不化，乃阳虚之候，宜用
补中益气汤。若卧睡不宁，宜用归脾汤。若饮食减少，面目浮肿，宜用香砂六君子汤。若兼
脾胃虚寒，更用理中汤。肾气虚寒须用桂附八味丸，兼用十全大补汤加附子，此温补回阳之
法。若痈疽溃后，脓血去多，变为角弓反张，手足搐搦，肢体振摇而发痉者，并用参 归术
并附子等药以救之。如不应，用十全大补汤，间有可生者。当此时势，性命急如悬缕，司命
者宜叮咛反复，熟思而审处之。
A question was asked: What are the "Five Good Signs" (Wu Shan) and "Seven Bad Signs" (Qi E) in carbuncles and sores?
The answer is: The "Five Good Signs" are as follows: Ability to taste food, which is the first; regular and balanced urination and defecation, which is the second; discharge of pus with reduction of swelling, and the pus fluid is not foul-smelling, which is the third; clear spirit and calm breathing/rest, which is the fourth; a pulse that has spirit/vitality and conforms to the seasonal patterns, which is the fifth.
The "Seven Bad Signs" are as follows: Extreme thirst, fever, diarrhea, and stranguria or urinary retention, which is the first; increased swelling after pus discharge, with thin and foul-smelling pus, which is the second; eyes lacking spirit/luster and hoarse voice, which is the third; poor appetite with indigestion, and vomiting after taking medicine, which is the fourth; mental confusion, drowsiness, shortness of breath, fatigue, and heaviness in the waist and back, which is the fifth; blue lips and black nose, with edema of the face and eyes, which is the sixth; a pulse lacking vitality, or being restless/irregular, which is the seventh.
Ancient sayings state: If three of the Five Good Signs are present, the prognosis is auspicious; if four of the Seven Bad Signs are present, the prognosis is ominous. I believe that regarding the ominous nature of the Seven Bad Signs, danger arises before four signs even appear. However, emergency rescue methods must indeed be studied.
Generally speaking, heat, thirst, stranguria, rapid breathing, and internal heat indicate injury to True Yin (Zhen Yin). It is appropriate to use Liuwei Tang (Six-Ingredient Decoction) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus). If there is no response, use Bazhen Tang (Eight-Treasure Decoction) added with Maidong and Wuweizi. If still ineffective, use Shiquan Dabu Tang (Ten Complete Tonifying Decoction), taken concurrently with Liuhui Dihuang Wan (Six-Ingredient Rehmannia Pill). This is the theory of tonifying Yin to generate Yang.
If there is shortness of breath, lassitude, mental cloudiness, fatigue, and food stagnation, this indicates Yang Deficiency (Yang Xu). It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
If sleep is restless, it is appropriate to use Guipi Tang (Restore the Spleen Decoction).
If food intake decreases and there is facial edema, it is appropriate to use Xiangsha Liujunzi Tang (Aucklandia and Tsaoko Six-Gentlemen Decoction).
If accompanied by Spleen-Stomach Deficiency-Cold (Pi Wei Xu Han), Lizhong Tang (Regulate the Middle Decoction) should be used additionally.
For Kidney Qi Deficiency-Cold (Shen Qi Xu Han), Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill) must be used, along with Shiquan Dabu Tang added with Fuzi (Aconiti Lateralis Radix Praeparata). This is the method of warming and tonifying to restore Yang.
If after the ulceration of carbuncles and sores, excessive loss of pus and blood leads to opisthotonos (body stiffening backward like a bow), convulsions of the hands and feet, tremors, and spasms, one should use herbs such as Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuzi to rescue the patient.
If there is no response, use Shiquan Dabu Tang; occasionally, survival is possible.
At such critical moments, when life hangs by a thread, physicians should give repeated instructions, think deeply, and handle the case prudently.