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[Song on Adverse Syndromes of Carbuncles and Ulcers]
If the initial lesion resembles a millet seed, yet the patient feels no pain; if the swelling is diffuse and local heat is absent, with the apex flat and collapsed; if it remains hard before forming a white head for suppuration, accompanied by dry tongue, irritability, and failure to suppurate.
If muscle swelling occurs but the ulcer sunken, with color resembling the purple of pig liver; if incontinence, fixed gaze, grasping at empty air, protruding eyes, shortness of spirit, body curling up, fingers tracing clothes, cyanosis of lips and corners of mouth, facial ruddiness like applied rouge but with withered skin, pale lips, and abdominal distension are present, survival is impossible.
If the ulcer has already ruptured, yet the interior remains hard with torn epidermis; after sloughing, there is mental restlessness, thin pus, lack of new flesh, foul odor, drooping head with stiff neck, and emaciated appearance.
In Yang syndromes, cyanotic nails indicate certain death; in Yin syndromes, malar flush indicates imminent demise.
If coal-black smoke-like discoloration appears on the nose, accompanied by delirious speech, board-like induration of new flesh, uncontrolled diarrhea, sallow complexion, withered black ears, and contraction or flattening of the philtrum.
If the mouth opens with breath escaping without return, nostrils flapping with respiration, sweat beading like pearls and difficult to dissipate, bloody fluid resembling lung tissue, and phlegm coagulating.
If muscles split with widespread rotting spots, spirit disordered, dark qi covering the face and Tian Ting (forehead), chronic ulcers showing grape-like clusters internally, and dense dark qi obscuring the eye sockets.
Regardless of whether swelling or rupture, encountering any of these signs constitutes an ominous prognosis.

[Note] At the onset of carbuncles and ulcers, the shape resembles a millet seed, with no pain felt, diffuse swelling without heat, flat apex, hardness upon pressure before the white head forms, dry tongue, and irritability. These are adverse syndromes that will absolutely not suppurate.
If muscle swells but the ulcer sinks, with color like purple pig liver, this indicates deep penetration of toxic pathogens.
If additionally seen are incontinence, fixed gaze, protruding eyes, shortness of spirit, grasping at empty air, tracing clothes, cyanotic lips, facial ruddiness like rouge, withered skin, pale lips, and abdominal distension—these various malignant signs indicate no hope of life.
After rupture, if the interior is hard with torn skin, mental restlessness after sloughing, thin pus, lack of new flesh, foul odor, drooping head with stiff neck, emaciation, cyanotic nails in Yang syndromes, red malar cheeks in Yin syndromes, and dense dark qi in the eye sockets—regardless of whether the toxin is in the swelling or ruptured stage, encountering any of these constitutes an ominous and difficult-to-treat syndrome.

[Song on Differentiating Swelling in Carbuncles and Ulcers]
Deficiency-type swelling is diffuse; Excess-type swelling is elevated. Fire-induced swelling is red and shiny. Cold-induced swelling is woody-hard and purplish-dark cyan. Dampness-deep swelling yields soft flesh; superficial dampness causes blisters. Wind-induced swelling is floating, slightly hot, and painful. Phlegm-induced swelling is hard yet soft, non-red, and non-hot. Stagnation-induced swelling is harder, like rock edges. Qi-stagnation swelling has tight skin but soft interior, subsiding with joy and enlarging with anger, without redness or heat. Blood stasis from trauma causes sudden swelling and heat. Postpartum or sprain-induced blood stasis lingers in meridians, causing woody hardness without heat but slight redness; impending rupture shows purple color indicating pus formation.

[Note] Human Qi and Blood flow continuously; slight stagnation results in swelling. However, swellings vary: Deficiency swelling, Excess swelling, Cold swelling, Damp swelling, Wind swelling, Phlegm swelling; swelling due to stagnation injuring the Liver; Qi swelling; swelling due to traumatic blood stasis; swelling due to postpartum or sprain-induced blood stasis. The manifestations differ greatly.
For instance: Deficiency presents as diffuse swelling; Excess as elevated swelling; Fire as red, shiny skin, burning stiffness; Cold as woody hardness, purplish-dark cyan color; Damp as heavy sagging flesh, deep lesions feel like rotten cotton, superficial lesions form bright blisters leaking yellow fluid; Wind as contracted wrinkled skin without redness, floating nature with slight heat and pain; Phlegm as soft as cotton, hard like a steamed bun, non-red and non-hot; Liver-injuring stagnation as non-red/non-hot, stone-hard with angular edges, resembling rocky protrusions; Qi stagnation as tight skin over soft interior, subsiding with joy, enlarging with anger, no redness/heat, normal skin color; Traumatic blood stasis as sudden large swelling with heat, distended but non-red; Postpartum/sprain blood stasis as lingering stasis in meridians, sudden onset with woody hardness, no heat, slight redness; impending pus formation shows purple color. Such are the shapes of various swellings; they cannot be generalized.