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Generally, sores and ulcers (purulent infections of the skin and subcutaneous tissues) arise from disharmony among the Five Zang Organs and stagnation in the Six Fu Organs, leading to blockage of the meridians. In the initial stage of a sore or ulcer, before it suppurates, there is swelling and severe pain, with a pulse that is洪大 (Hongda, large and forceful), 数 (Shu, rapid), 实 (Shi, full/excess), and 大 (Da, large). When pus is about to form, if constipation occurs, it is appropriate to treat this by doubling the dosage of Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) in Tuoli Sanxie Xin Decoction; this belongs to the category of formulas that release the exterior and purge the interior. If, after the sore has ulcerated, the pulse appears 微 (Wei, faint), 芤 (Kou, empty/bamboo-sheath), rapid, or 涩 (Se, choppy), it indicates massive discharge of pus and blood, leading to Qi and Blood deficiency. It is appropriate to use Bazhen Tang (Eight Treasure Decoction) or Wanshengyu Tang (Pill for Replenishing Life and Vitality), adding Taoren (Persicae Semen), Tianmazi (Cannabis Fructus), Danggui (Angelicae Sinensis Radix), and a small amount of Shudihuang (Rehmanniae Radix Praeparata) and Dahuang to moisten and unblock. If the weakness is extreme, using bile as a suppository is even better. One must absolutely avoid using harsh purgatives such as Badou (Crotonis Fructus) or Qianniuzi (Semen Phytolaccae) for aggressive evacuation, considering that the constitution varies between the elderly, children, and those with differing degrees of deficiency and excess.

The Classic states: "All pain, itching, sores, and ulcers belong to Heart Fire." This is because fire has the nature to consume and melt all things, causing various forms of destruction. When human skin is near burning fire, sores are formed; being close to fire causes pain, while being slightly farther away causes itching; this is the function of fire. Some experience itching and pain like light pricks from needle points, similar to flying sparks burning the skin. However, itching is generally considered a mild condition (a favorable sign). There are cases where applying moxibustion or hot water immersion to an itchy sore exacerbates the itching; this is caused by slight heat assisting the fire. In other cases, itching ceases because heat relaxes the skin, opens the Couli (pores and interstices), allows Yang Qi to dissipate, and enables heat to scatter easily, thus resulting in no itching. If cold water is applied to relieve itching, providing temporary relief followed by intensified itching later, this is because cold causes contraction, leading to stagnation of Yang Qi which cannot disperse, generating internal郁热 (Yu Re, constrained heat), hence the recurrence and worsening of itching. Scratching can also relieve itching; scratching involves movement, movement is Yang, and Yang transforms into fire, so gentle scratching stops itching due to mild fire activity. Heavy scratching removes itching because the friction creates a pungent sensation belonging to Metal transformation; Pungency disperses, so when Metal transformation encounters fire energy, it resolves, and itching ceases. The Classic states: "Pain indicates Excess, itching indicates Deficiency." Here, "Deficiency" does not refer to Cold-Deficiency, but rather signifies the subtle intensity of Fire-Heat pathogenic factors. Additionally, numbness in sores and ulcers where pain and itching are not felt results from Qi deficiency failing to circulate, combined with toxin stagnation blocking the meridians, leading to numbness and insensitivity. This also varies in severity. Generally, "Ma" (numbness/tingling) is the mild form of "Mu" (woodiness/heavy numbness), and "Mu" is the severe form of "Ma". For instance, sitting for a long time may cause legs and knees to feel wooden and insensitive; after stretching and waiting, feeling tingling ("Ma") indicates that stagnation is slightly clearing and Qi-Blood circulation is resuming. Broadly speaking, numbness before ulceration reflects the degree of toxin blockage; numbness after ulceration reflects muscle rot and Qi-Blood depletion, indicating the degree of deficiency. I have roughly understood these principles and recorded them to show future generations.