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In the disease of sores and ulcers, there are five favorable signs (Wu Shan) and seven unfavorable signs (Qi E). If three of the five favorable signs appear, the condition will improve; if four of the seven unfavorable signs appear, the condition is critical.

The favorable signs are: calm breathing and rest, food tasting good, regular bowel movements and urination, reduction of swelling after pus discharge, fresh and odorless pus, bright and clear spirit, clear voice, and harmonious body qi. These belong to fu-organ diseases (diseases of the six fu organs), where the pathogenic factor is slight and superficial. With careful daily routine and dietary restraint, self-healing may occur without medication.

The unfavorable signs refer to deficiencies of the five zang organs, often caused by weak primordial qi, excessive loss of blood and qi due to profuse pus drainage, depletion of ying and wei qi due to improper sweating or purging, insufficiency of blood and qi from overuse of cold-cooling drugs that suppress healthy qi, or injury to stomach qi from harsh and drastic medicines. This results in deficiency of true qi and excess of pathogenic qi, appearing externally as excess but internally as actual deficiency. The treatment method should purely tonify stomach qi, and survival is often possible. One must not abandon treatment simply because it is an unfavorable sign.

If there is extreme thirst, fever, diarrhea, stranguria, or urinary retention, this indicates internal flooding of pathogenic fire, which is the first unfavorable sign. Use Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction).

If both qi and blood are deficient, use Bazhen Tang (Eight Treasure Decoction), adding Huangqi (Astragali Radix), Maidong (Ophiopogonis Tuber), Wuweizi (Schisandrae Fructus), and Shanzhuyu (Corni Fructus). If ineffective, administer Jiajian Bawei Wan (Modified Eight-Ingredient Pill) decocted and taken orally.

If pus and blood have been discharged but the swelling and toxicity worsen, with foul-smelling and degenerated pus, this indicates deficiency of stomach qi and flourishing fire, which is the second unfavorable sign. Use Renshen Huangqi Tang (Ginseng and Astragalus Decoction). If ineffective, use Shiquan Dabu Tang (Complete Great Tonifying Decoction) adding Maidong and Wuweizi.

If gaze is misaligned, the black pupil is tight and small, the white sclera is blue-red, and the pupil looks upward, this indicates yin deficiency of the liver and kidney with tension of the eye meridians, which is the third unfavorable sign. Use Liuwei Dihuang Wan material (Six-Ingredient Pill with Rehmanniae Radix) adding Chao Shanzhi (Stir-fried Gardenia Fruit), Maidong, and Wuweizi. If ineffective, use Bazhen Tang adding Chao Shanzhi, Maidong, and Wuweizi.

If panting is coarse and breath is short, with mental confusion and drowsiness, this indicates deficiency-fire of the spleen and lung, which is the fourth unfavorable sign. Use Liujunzi Tang (Six Gentlemen Decoction) adding Dazao (Jujubae Fructus) and Shengjiang (Zingiberis Rhizoma Recens). If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) adding Maidong and Wuweizi. If heart fire attacks lung metal, use Renshen Pingfei San (Ginseng Lung-Pacifying Powder). If yin fire injures the lung, use Liuwei Dihuang Wan adding Wuweizi, decocted and taken.

If the shoulder and back are stiff and limbs feel heavy, this indicates deficiency and damage of the spleen and kidney, which is the fifth unfavorable sign. Use Buzhong Yiqi Tang adding Shanzhuyu, Shanyao (Dioscoreae Rhizoma), and Wuweizi. If ineffective, use Shiquan Dabu Tang adding Shanzhuyu, Shanyao, and Wuweizi.

If unable to eat, vomiting after taking medicine, and food has no taste, this indicates weakness of stomach qi, which is the sixth unfavorable sign. Use Liujunzi Tang adding Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus). If ineffective, urgently add Fuzi (Aconiti Lateralis Radix Praeparata).

If hoarse voice and ruined complexion, blue-red lips and nose, and edema of face, eyes, and limbs, this indicates joint deficiency of spleen and lung, which is the seventh unfavorable sign. Use Buzhong Yiqi Tang adding Dazao and Shengjiang. If ineffective, use Liujunzi Tang adding Paojiang (Zingiberis Rhizoma Preparatus). If still ineffective, urgently add Fuzi, or use Shiquan Dabu Tang adding Fuzi and Paojiang.

If abdominal pain and diarrhea, cough with rebellious qi, and coma/confusion occur, this is a critical condition of yang qi deficiency with internal invasion of cold qi. Urgently use Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction), then use Liujunzi Tang adding Fuzi, or add Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex) for warming and tonifying. These are the treatments for the seven unfavorable signs.

Additionally, there are unfavorable signs after ulceration such as fever, aversion to cold, and thirst; palpitations, fright, insomnia, and restless sleep; trismus (lockjaw); red and painful head and eyes; spontaneous and night sweats; chills with teeth grinding; flaccid hands and body heat with a surging pulse that feels empty upon pressure; or body heat with aversion to clothing, desire to throw oneself into water, yet the pulse is floating and large but fine upon pressure, and cold persists despite thick clothing. These are critical conditions resulting from extreme deficiency of blood and qi and transformation.

If extremities are cold, abdominal pain, diarrhea/dysentery with borborygmus, and hiccups/vomiting immediately after eating occur, this is a critical condition of yang qi deficiency with cold qi attacking.

If there is sweating without aversion to cold, or no sweating with aversion to cold, trismus, cold feet, opisthotonos (arching of the back), and neck stiffness, this is a critical condition of extreme blood and qi deficiency transforming into spasm (jing zheng). Urgently treat with Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuzi to rescue; survival is occasionally possible.

Generally, unfavorable signs appearing in deficiency patterns are difficult to treat. Patterns without unfavorable signs are easy to treat. In the Song Dynasty, Qi Yuanling compiled these symptoms but did not detail their causes. In the Ming Dynasty, Tao Jie'an established separate formulas for each, but they were brief and incomplete. Therefore, I supplement these deficiencies.