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At the initial stage of any carbuncle or ulcer, before suppuration occurs, it is termed "swollen ulcer" (Zhongyang). At this time, one must distinguish between deficiency and excess syndromes to ensure correct medication. If there is swelling, redness, and burning pain, accompanied by a surging, full, and rapid pulse, this indicates pathogenic factors in the exterior; appropriate treatment involves supporting methods (Tuo) or tonification. If there is hard swelling with deep-seated pain, and a deep, full, large, and tight pulse, this indicates pathogenic factors in the interior; purgative methods are indicated. This describes the differentiation of deficiency and excess at the level of the interior and exterior.

If there is no significant external swelling, redness, or pain, and internal bowel movements and urination are regular, the pathogen is known to be in the meridians. One must determine which specific meridian is involved and treat with Toli Rongwei Decoction (Supporting Interior Nourishing Defense Decoction), adding guiding herbs for the affected meridian to harmonize Ying and Wei (Nutritive and Defensive Qi), ensuring smooth blood and Qi circulation without stagnation, thereby eliminating pathogens and relieving pain. This describes the differentiation of deficiency and excess at the level of the meridians.

If the patient appears mentally clear but speaks with a weak voice, or has hoarseness and a dull complexion, experiences difficult urination and loose stools, and presents with a faint, choppy, fine, and weak pulse, along with edema of the face, eyes, and limbs, this indicates a deficiency of Yuan Qi (Original Qi). Conversely, if appetite remains normal, yet there is abdominal distension, bitter taste in the mouth, thirst, irritability, fever, a large and full pulse, mental confusion, severe swelling and pain where the area is intolerable to touch, this indicates an excess of Yuan Qi. The Classics state: "All pain belongs to excess, all itching belongs to deficiency." A pulse that is large, full, surging, rapid, or tight indicates excess; a pulse that is faint, fine, soft, weak, or choppy indicates deficiency. This describes the differentiation of deficiency and excess based on the pulse. The Classics state: "Tonify deficiency, drain excess." This constitutes the therapeutic principles of supporting the interior, promoting unblocking, and harmonizing Ying and Wei.

The term "ulcer" refers to the stage after a carbuncle or ulcer has ruptured and discharged pus. Treatment must also be guided by the differentiation of deficiency and excess. If a large amount of pus is discharged but pain persists, the wound fails to heal for a long time, accompanied by fever, dry mouth, thin and watery pus, and soft, collapsing tissue around the swelling, with a large, deficient, and faint pulse, this is a deficiency syndrome of the ulcer; it should be treated with Buzhen Tang (Eight Treasures Decoction) for tonification. If the pus is scanty, the surrounding tissue is hard, the color is abnormal, the pulse is deep, full, large, and strong, accompanied by pain, fever, irritability, constipation, and a protruding, congested wound margin, this is an excess syndrome of the ulcer; it can be cured with Jiedu Qingliang Yin (Detoxifying Cooling Drink).

The Eight Extraordinary Vessels, together with the Twelve Regular Meridians and Fifteen Collaterals, form twenty-seven Qi pathways that circulate continuously like a ring without beginning or end. The name "Extraordinary" implies uniqueness and pairing. Thus, sages dug channels to connect rivers and seas, preventing water from overflowing. Why do sores and ulcers arise due to the congestion and blockage of Qi and Blood? The twenty-seven Qi flowing through the meridians circulate endlessly like rivers, lakes, and seas in heaven and earth. In one day and night, there are 13,500 breaths, and the pulse travels 810 zhang. How could there be stagnation? Any stagnation arises from disorders of the Eight Extraordinary Vessels. This is analogous to heavy rain filling channels until they overflow, unable to drain into lakes and seas. The Classics state: "Yang Wei Mai originates from the convergence of all Yang meridians; Yin Wei Mai originates from the intersection of all Yin meridians." This signifies the failure of Yin and Yang to mutually support each other. Therefore, sores arising on the head, face, back, and spine are symptoms of Yang Wei Mai disorder. Sores arising on the chin, neck, chest, abdomen, and inner thighs are symptoms of Yin Wei Mai disorder. In treating all sores and ulcers, one must understand this principle and carefully identify the meridian and location involved; this is the practice of a skilled physician.