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The condition of sores and ulcers (Chuang Yang), when pus has formed, requires differentiation based on the maturity of the pus and the depth of the lesion. For necrotic flesh (Si Rou), one must examine whether it is rotting and detaching. Mr. Danxi stated: Carbuncles and furuncles (Yong Ju) are caused by accumulated toxins in the Zang-Fu organs. Treatment should primarily focus on supporting the Stomach Qi and strengthening vital energy (Zheng Qi), thereby solidifying the root, assisted by herbs that promote circulation in the meridians and invigorate blood, allowing the toxin to dissipate internally. I have treated patients with weak pulse and symptoms using formulas for supporting the interior (Tuo Li), resulting in strengthened Qi and Blood, preventing flesh necrosis. For those with excess-heat patterns indicated by pulse and symptoms, I used heat-clearing formulas, which caused the toxic factors to retreat and allowed flesh to regenerate naturally. Wherever sores gather around tendons and bones, how could there be dead flesh? If there is little pain, no pain, or lack of redness, or if internal pus does not ulcerate, or external flesh does not rot, this indicates deficiency of Qi and Blood. It is appropriate to use moxibustion with mulberry branches and administer Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) added with Ginger and Cinnamon Twig to strengthen Yang Qi. Consequently, swelling at the periphery will subside, the sore head will slough off, and the toxin will resolve spontaneously, without awaiting needle incision! If the Spleen and Stomach are weak, with reduced appetite and desire for food, use Liujunzi Tang (Six Gentlemen Decoction) with doubled Atractylodis Macrocephalae Rhizoma (Baizhu) to strengthen Ying Qi. Then, flesh affected by toxins will survive, necrotic flesh will ulcerate, and open sores will heal. If at the onset, due to improper use of purgatives or sexual indiscretion, the area becomes dark and painless, this indicates collapse and sinking of Yang Qi, transforming into a Yin syndrome. Urgently use Shenfu Tang (Ginseng and Aconite Decoction) to warm, tonify, and restore Yang; recovery is possible.

Clinical Case 1:
The wife of Shi Bangzhi from Wu Xiang suffered from a back carbuncle in midsummer. The necrotic flesh did not ulcerate, accompanied by fever and severe pain, vomiting, poor appetite, dry mouth desiring hot drinks, and a surging pulse that felt empty upon deep pressure. This presented as true cold internally with false heat externally. One should disregard the season and treat according to symptoms. Initially, Liujunzi Tang was administered with roasted Ginger and Cinnamon Twig. After four doses, appetite suddenly improved, and all symptoms receded rapidly. Subsequently, Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) was continued with Ginger and Cinnamon Twig. After more than fifty doses, the necrotic flesh ulcerated; after another fifty doses, new flesh grew. This patient had abundant Qi and Blood, so the sore easily raised and healed. Had the physician anticipated this and pre-emptively supported the interior, such complications would have been avoided.

In treating sores and ulcers, one must observe the transmission through meridians, the location of the disease (exterior or interior), and the constitution of the person (deficiency or excess) to decide between attacking pathogens or tonifying deficiencies. For example, if there is swelling, pain, heat, thirst, and constipation, the pathogen is inside; it should be unblocked and drained. If swelling arises with pain, aversion to cold, fever, and headache, the pathogen is on the exterior; it should be dispersed and released. If swelling and pain are severe, the pathogen is in the meridians; it should be harmonized. If there is slight swelling and pain without suppuration, it indicates Qi and Blood deficiency; it should be tonified and supported to expel toxins. If there is diffuse swelling without pain, or failure to suppurate, or pus formation without ulceration, it indicates severe Qi and Blood deficiency; it requires vigorous tonification. If the color is dark with slight swelling and pain, or pus forms but does not discharge, or necrotic flesh does not slough, it indicates Yang deficiency and cold; it should be warmed and tonified. If one rigidly adheres to the stage before ulceration and indiscriminately uses detoxifying drugs, it further damages the Spleen and Stomach. Not only will swelling fail to suppurate, but already ulcerated sores will also struggle to heal. The "Seven Evils" syndromes may arise simultaneously, often leading to untreatable conditions. Mr. Danxi stated: For sores and ulcers before ulceration (Zhongyang), where both interior and exterior are obstructed, treatment should primarily focus on supporting the interior and dispersing the exterior. If one wishes to use Rheum Radix et Rhizoma (Dahuang), it risks being rash. For ulcers after rupture (Kuangyang), where both interior and exterior are deficient, treatment should primarily focus on supporting the interior and reconnecting tissues. If one wishes to use aromatic dispersants, it inevitably leads to the error of further depleting the deficient. Physicians must exercise caution.

Clinical Case 2:
A man suffered from excessive sexual activity, resulting in swelling on his back shoulder blade about three cun high and over one chi wide. He experienced spontaneous sweating and night sweats, internal heat and fever, dry mouth desiring hot drinks, and a floating-superficial pulse that was weak and choppy upon deep pressure. This was caused by essence deficiency and Qi stagnation. I prescribed Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) added with Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Corni Fructus (Shanzhuyu), and Dioscoreae Rhizoma (Shanyao). After four doses, all symptoms subsided. Due to my absence, another practitioner administered Liuqi Yin (Flowing Qi Drink) for one dose, causing all deficiency symptoms to manifest, with the swelling becoming hard as stone. I resumed the previous prescription, and he recovered after six doses.

Clinical Case 3:
A scholar had a single swelling on his back. It was soft upon pressure, with normal skin color and diet. However, fatigue induced phlegm expectoration and body weakness. This indicated Spleen Qi deficiency with phlegm stagnation. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Poria Sclerotium (Fuling) and Pinelliae Tuber (Banxia), with a small amount of Notopterygii Rhizoma et Radix (Qianghuo). Externally, Yinyang San was applied mixed with ginger juice, leading to resolution. Later, due to fatigue, he developed dizziness and vomiting. I used the same formula, removing Qianghuo and adding Zingiberis Rhizoma Recens (Shengjiang) and Viticis Trifoliate Fructus (Manjingzi), resulting in recovery.

Clinical Case 4:
The mother of Ma Jinbo from Kun Xiang complained of pain extending from the left shoulder blade to the hypochondrium. She sent someone to request treatment. I suspected this was Liver and Spleen injury due to suppressed anger, and prescribed Liujunzi Tang (Six Gentlemen Decoction) added with Platycodonis Radix (Jiegeng), Aurantii Fructus (Zhiqiao), Bupleuri Radix (Chaihu), and Cimicifugae Rhizoma (Shengma). She had previously used other topical sore remedies, worsening her condition, before seeking my care. Her pulse was wiry and long at the right Guan position, feeling weak upon pressure, and wiry and surging at the left Guan position, feeling choppy upon pressure. This indicated insufficient Spleen Earth and excessive Liver Wood. The cause was toxicity from diet and fire from emotional disturbances. I used the aforementioned prescription for four doses, after which the pulse and symptoms completely receded. Then, Chuanxiong Rhizoma (Chuanxiong) and Angelicae Sinensis Radix (Danggui) were added, leading to full recovery. Many such cases have proven fatal due to the mistaken use of Qi-moving, detoxifying, blood-breaking, and phlegm-draining methods.