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Itching at the initial stage is caused by wind-heat; after ulceration, pus accumulation or exposure to wind may also cause itching; itching during the healing phase when new flesh is growing indicates that Qi and Blood are abundant. If the itching feels like insects crawling under the skin, it signifies sufficient Qi and Blood.

[Note] Itching belongs to Wind pathogenic factors, but causes vary. For early-stage ulcers (sores), skin itching is due to the struggle between Wind and Heat. Itching after ulceration is mildly caused by pus macerating the skin, or severely by the sore opening being exposed to Wind, causing sudden bumps resembling millet grains. After scratching, discharge of serum indicates Spleen Dampness; discharge of blood indicates Spleen Dryness. Itching during the impending healing phase occurs because initially, muscle stagnation prevented Qi and Blood from reaching the area; as healing approaches, Qi and Blood gradually fill up to nourish new flesh, causing itching. However, only itching that feels like insects crawling constitutes a favorable sign of recovery. Other itches caused by scabies or tinea belong to excessive Wind and should not be classified similarly.

True halos (redness surrounding a sore) should be distinguished from swelling marks. The shape beside the sore resembles red veins. This results from sharp toxins accumulated in the Zang-Fu organs. Two or three halos can be cured; five halos are difficult to treat and damage the body.

[Note] Commonly, swelling marks are mistaken for halos, which is incorrect. True halos appear beside the sore, resembling red veins, formed by sharp toxins accumulated in the Zang-Fu organs. Two or three halos are treatable; five halos are hard to cure.

Carbuncles, sores, and ulcers initially resemble millet grains; accompanied by numbness, itching, and pain, indicating severe toxicity. Regardless of Yin or Yang nature, moxibustion is most suitable. After moxibustion, wash with decoction and apply ointment for protection. Internally use dispersing and unblocking agents; externally apply compresses and bind around the perimeter. For mild cases, use Shen Deng (Divine Lamp) illumination with three branches. For flat lesions, urgently tonify deficiency; for high swelling, avoid excessive purgation; for internal heat and severe toxicity, must clear heat and detoxify. Constipation of both bowels requires purgation; unobstructed Zang-Fu function is auspicious. If the sore remains hard after ten days, piercing with a Pi Needle (Bī Zhēn) is best first. If pus is scant after half a month, use the Medicine Jar Extraction method to draw out pus; viscous pus and blood indicate a favorable prognosis, while thin purple blood and watery discharge indicate unfavorable prognosis. If the ulcerated sore has necrotic tissue that does not shed, cut open to create an opening to allow pus drainage, naturally preventing blockage. Frequently wash with decoction, avoiding wind. To remove necrotic tissue, use Ling Yao (Spiritual Medicine). Apply Sheng Ji San (Flesh-Generating Powder) when nearing closure. Maintenance must be diligent, not negligent. Avoid cold-natured herbs after pus discharge. In winter, stay in warm rooms; in summer, near bright windows. When muscles level out and the sore closes, pay detailed attention to care. If new flesh resembles pearls but skin does not close, loss of maintenance may lead to death.

[Note] Carbuncles and sores initially resemble millet grains; if accompanied by numbness, itching, and pain, toxicity is severe. Before the seventh day, when the condition is not yet fully formed, regardless of Yin or Yang, moxibustion should be performed first. Mild cases disperse toxins via fire; severe cases draw out stagnant toxins, penetrating inside and out, which is indeed a good method. After moxibustion, wash with decoction, then apply Tai Yi Gao (Great One Ointment) on top of the sore to prevent wind invasion; internally take dispersing and unblocking agents such as Shen Shou Wei Sheng Tang (Divine Bestowal Health Protection Decoction), Nei Shu Huang Lian Tang (Internal Purging Coptis Decoction), Chan Su Wan (Toad Venom Pill); externally apply compresses such as Chong He Gao (Harmony Ointment), Yu Long Gao (Jade Dragon Ointment), binding around the perimeter. For mild cases, illuminate with Shen Deng (Divine Lamp), using three branches. If the condition is fully formed, treat according to symptoms.

For flat lesions, administer tonics to supplement deficiency and expel toxins outward; for high swelling, do not over-purgate to avoid damaging Yuan Qi (Original Qi), leading to difficulty in ulceration and healing; for severe internal heat, assist with detoxifying agents to prevent toxin flare-up; for constipation, urgently use purgative formulas to unblock Zang-Fu, which is a good sign. If the sore remains hard after ten days, must use Pi Needle (Bī Zhēn) to pierce the head; if pus is scant after half a month, urgently use Medicine Jar Extraction (Yào Tǒng Bá) method; viscous pus and blood are favorable, thin purple blood and watery discharge are unfavorable; after twenty-one days, even with thin pus, it is difficult to treat. If after ulceration, necrotic tissue still does not shed and blocks the sore, cut open about one cun with knife and scissors to allow pus duct flow, naturally preventing blockage. After extracting pus and removing necrotic tissue, place a square basin under the sore, pour pig trotter decoction over soft cloth to wash the sore and enter pores, gently wipe clean internal pus, so that rotten old pus exits with the soup, stopping when clean. Then fold soft cloth seven or eight layers, not too dry, carry hot soup to cover the sore, press lightly with hands for a moment, replace when cloth cools. Wash and press four or five times, unblocking Qi and Blood, patient naturally feels refreshed. Wash daily thus, carefully avoid wind and cold. Sprinkle Huang Ling Yao (Yellow Spirit Medicine) on necrotic areas; when necrotic tissue sheds completely and red flesh appears, after washing, melt Yu Hong Gao (Jade Red Ointment) on palm, apply to sore interior, cover externally with Tai Yi Gao (Great One Ointment). Within a few days, new flesh grows suddenly, sore tends to close, sprinkle Sheng Ji San (Flesh-Generating Powder) or Zhen Zhu San (Pearl Powder). Maintain caution, do not slacken. After pus discharge, strictly avoid cold-natured drugs. Patients in winter should stay in warm rooms to prevent cold; in summer, near bright windows to avoid wind and summer heat. When muscles level out and sore closes, exercise extra caution in regulation. Even if new flesh resembles pearls and skin nearly closes, if regulation is negligent and maintenance lost, fear collapse and sudden changes, life will be endangered.