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Why do carbuncles, ulcers, and back eruptions arise, appearing on a healthy body?

Those who live in the world without disease are so because Kidney Water ascends, Heart Fire descends, Essence is conserved, and Blood is abundant. The Chapter on Health Preservation states: "Do not agitate your Essence, do not overwork your Form; return the mind to stillness and silence, and you may attain longevity." These methods involve distancing oneself from worldly affairs, forgetting fame and profit, eliminating greed and anger, thereby avoiding disease. Only those who cultivate their nature and preserve life can achieve this; how can modern people compare! Generally speaking, stillness generates Water, movement generates Fire; Water can generate all things, while Fire can overcome all things. Therefore, all diseases arise from Fire. Once Fire arises, the Seven Emotions and Six Desires enter accordingly; once inside, various diseases manifest. Those manifesting internally present as Wind-Lao (chronic deficiency syndromes), Gu-Ge (abdominal masses and dysphagia), Phlegm-Asthma, and Internal Injury; those manifesting externally form Carbuncles, Ulcers, Back Eruptions, Opposite-to-Mouth Sores, and Ding Sores (hard boils). This covers only the general outline. Thus, "Carbuncle" (Yang Abscess) implies obstruction; it belongs to Yang, representing the toxicity of the Six Fu Organs surging outward. Its onset is sudden, and the lesion is superficial because the pathogen originates in the Yang aspect. Since Yang Qi is light, clear, floating, and high-rising, it easily swells, suppurates, putrefies, and heals. It is indeed a condition that does not damage sinews and bones and is easy to treat. "Ulcer" (Yin Abscess) implies blockage; it belongs to Yin, representing the toxicity of the Five Zang Organs attacking inward. Its onset is slow, and the lesion is deep because the pathogen originates in the Yin aspect. Since Yin Blood is heavy, turbid, and sinking, it is a condition that damages sinews and bones and is difficult to treat. In young individuals with strong Qi and Blood overcoming the toxin, the prognosis is favorable; in the elderly where the toxin overcomes Qi and Blood, the prognosis is dangerous. Treatment methods are recorded in the Second Discourse; please study them carefully.

Internally, the Seven Emotions disturb the Zang Organs; worry and anxiety always concern the mind.

The Seven Emotions and Six Desires are thieves that steal the body's Primordial Qi. If one can distance oneself from these, one will be peaceful and long-lived; if one engages with them, one will inevitably suffer harm. Yet few people truly understand and avoid them. The movements of emotions and desires are seemingly harmless and ubiquitous. Joy injures the Heart, Anger injures the Liver, Sorrow injures the Lungs, Pensive thought injures the Spleen, Grief harms the Hun and Po (Soul and Corporeal Soul), Fear injures the Kidneys, and Shock injures the Gallbladder. These seven emotions are the germs of destruction that consume the body's Primordial Qi. As for the Six Desires: ears listening to sounds, eyes observing colors, nose smelling fragrances, tongue craving flavors, the heart encompassing the earth, and the intention covering all directions—these six desires damage the true nature endowed by generations of spiritual essence. They cause suffering, illness, premature death, pain, disability, and decay. All diseases and sores arise from these emotions and desires. Both physicians and patients should examine this cautiously.

Externally, the Six Excesses damage Qi and Blood; Wind, Cold, Summer-heat, Dampness, and Fire invade sequentially.

The Six Excesses are Wind, Cold, Summer-heat, Dampness, Dryness, and Fire. Wind is the irregular, vast, and killing qi of the four seasons; when it arises, it most readily affects humans. Cold results from irregular seasons, fierce winds, heavy rains, ice, snow, and severe cold, or from consuming raw and cold foods. Summer-heat strikes due to intense sun, scorching heat, steaming dampness, and heat. Dampness comes from sitting or lying in long-standing yin, low, and damp places, or from sudden exposure to wind, rain, and moisture. Dryness is internal heat due to Yin deficiency, consuming fluids and failing to nourish the Zang Organs, leading to withered skin and dry stools. Fire arises from mental agitation, rich wine and fatty foods, and unregulated sexual activity. These Six Excesses enter from outside. Those with strong constitutions may encounter them without being affected, but those with weak constitutions often contract them and develop symptoms immediately. Sometimes, after contracting them, symptoms do not appear immediately; the pathogenic qi lodges in the Zang Organs, meridians, and joints. After accumulating for a long time, triggered by internal injury or external sensation, the pathogenic qi erupts. Once erupted, treatment must consider cold, heat, warmth, coolness, and the balance between pathogenic and righteous factors.

Rich and greasy foods are consumed without restraint; labor and sexual excess lead to Yin deficiency.

"Gao Liang" refers to fine wines, rich meats, roasted, fried, and grilled foods. People today often smoke them over charcoal or boil them in oil and lard. Their taste is fragrant, dry, sweet, and mellow; their nature is salty, sour, pungent, and spicy. They are stored with strong seasonings, boiled heavily, and cooked intensely to satisfy the palate and heart, disregarding their ability to consume Yin and damage the viscera. Surrounded by beauties, spirits soaring, warm beds, thick quilts, and surrounding fires, one eats before hunger and sleeps before coldness, seeking immediate pleasure and excessive sexual exertion. Taking pleasure only for the moment, one unknowingly consumes Yin daily. Moreover, diseases arising from such habits do not stem from coarse vegetables but from rich foods. Who realizes that the benefit of rich food is short-lived compared to the longevity derived from coarse vegetables? Those who understand destiny should avoid them and use them selectively.

Thus, the Five Zang Organs undergo many abnormalities, and naturally, the Six Fu Organs become imbalanced.

The Five Zang Organs correspond to the Five Elements: Metal, Wood, Water, Fire, and Earth. Normally, they follow mutual generation: Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, and Water generates Wood. When the Five Zang Organs harmonize and generate each other, they possess the Qi of Great Harmony, and disease cannot arise. However, in disease, the Five Zang Organs mutually overcome: Wood overcomes Earth, Earth overcomes Water, Water overcomes Fire, Fire overcomes Metal, and Metal overcomes Wood. This mutual punishment and overcoming reverse the mechanism of change. Disease is inevitable. As stated, "Mutual generation leads to prosperity; mutual overcoming leads to decline." This is the fixed principle of generation and overcoming in all things, not just in disease. Furthermore, if the Five Zang Organs are disordered, the Six Fu Organs become blocked; if the Six Fu Organs are blocked, the Nine Orifices become dysfunctional; if the Nine Orifices are dysfunctional, stagnation forms Carbuncles. Thus, carbuncles and ulcers arise from Zang-Fu abnormalities, where orifices fail to circulate freely. Treatment principles: For pain due to Cold pathogens, disperse with warmth; for swelling and stiffness due to Dampness, drain and guide; for spasms and cramps due to Dryness, moisten and lubricate; for diarrhea and pain, warm; for constipation and pain, unblock; for deficiency and pain, tonify; for excess and pain, purge; for Yin-Yang disharmony, regulate; for meridian blockage, harmonize; for abscess swelling and pain, incise; for necrotic flesh erosion, remove; for fatigue and pain, rest; for injury and pain, reconnect. These are flexible methods requiring careful application by the practitioner.

Eruptions on the upper heart area are dangerous; the interaction of the Five Zang Organs clarifies this.

Among the Five Zang Organs, the Heart, Liver, Spleen, and Lungs are connected to the back, while only the Kidney resides lower. Although lower, the Kidney's essence, fluids, Primordial Qi, and Shen irrigate the upper body. Thus, the Fire of the four upper organs relies on the Water of the Kidney to balance them. This is why the root of the Five Zang Organs is linked to the back. Any carbuncle or ulcer first injures the Zang Organs before manifesting. Moreover, the back is governed by the Bladder Meridian of Foot-Taiyang and the Du Mai (Governing Vessel). Taiyang is the leader of the Six Meridians; Du Mai is the commander of the Twelve Meridians. Therefore, sores on the back face toxic invasion. Since the Heart holds the position of the Sovereign, how can it tolerate toxic invasion? Eruptions here are often dangerous and difficult to treat; physicians must be cautious.

Eruptions below the heart are generally favorable; the causes related to the Six Fu Organs can also be evaluated.

Sores arising below the heart, except at the Shenshu point, are generally mild. The Six Fu Organs include the Stomach Meridian of Foot-Yangming, Small Intestine Meridian of Hand-Taiyang, Bladder Meridian of Foot-Taiyang, Pericardium Meridian of Hand-Jueyin, Sanjiao Meridian of Hand-Shaoyang, and Gallbladder Meridian of Foot-Shaoyang. These six meridians belong to the Fu category, are located inferiorly, govern the exterior, and manifest as carbuncles. Diseases originating in the Zang Organs are severe; those in the Fu Organs are mild. This distinguishes the severity based on interior-exterior and Zang-Fu relationships.

Accumulated toxicity in the Spleen manifests on the shoulders and spine.

Eruptions between the shoulders and upper spine result from accumulated toxicity due to rich diet. High, bright swelling with roots confined within the shoulders indicates a favorable course. Initially, prioritize detoxification and protecting the Heart; subsequently, use internal support and clearing Heart heat. Occasionally use Larfan Wan (Wax and Alum Pill) and Huxin San (Heart-Protecting Powder) to prevent toxin from attacking the Heart. If swelling becomes flat and hard, gradually enlarging and spreading to both shoulders, chest, and neck with unstable swelling, the prognosis is critical.

Heart Fire Toxin Approaches the Center (Opposite-to-Mouth)

"Eruption Opposite-to-Mouth" arises from reckless Heart Fire and extreme heat. As the Heart is the sovereign, heat accumulates and converges here, forming a lesion known as "Du" (toxic nodule). The Sovereign position is easily harmed; it obstructs the Du Meridian, causing significant damage. Since the vertebrae in this area have depressions, eruption is difficult; the sore shape sinks, and swelling is not sharp. Treatment requires strongly descending Heart Fire, urgently dispersing accumulated heat, using needles to open the apex, and applying extraction methods to ensure toxins vent internally and externally through openings, preventing internal attack. Maintain care until day fifteen; if no complications arise and pus forms, it resolves. If complications arise gradually, hardness increases, and no pus forms, death occurs around day twenty-two. Early treatment is crucial; three or four out of ten cases may survive.

Simultaneous Eruptions on Both Shoulders: Lung and Liver Accumulation Justify the Name.

Left eruptions relate to the Liver, right eruptions to the Lungs. Occurring at movable points of the shoulder bones, they are treatable. Ancient texts say cross-infection (left to right, right to left) is difficult to treat. Modern practice differs. I have never seen death in such cases if treatment is appropriate. For this condition, first use Wanling Dan (Ten Thousand Spirits Pill) to induce sweating and unblock interior/exterior; then use Qinggan Jieyu Tang (Clear Liver and Resolve Depression Decoction) or Chaihu Qinggan Tang (Bupleurum Clear Liver Decoction). For Qi issues, use Sijunzi Tang (Four Gentlemen Decoction); for Blood, Siwu Tang (Four Substances Decoction); after ulceration, Bazhen Tang (Eight Treasures Decoction). Combine with Liuyu Tang (Six Depressions Decoction) for regulation. This is appropriate. The condition originates from Phlegm coagulation, Qi stagnation, and Fire depression, caused by Qi-Blood imbalance. As stated, "Depression requires opening; stagnation requires moving." Misusing detoxifying, Qi-draining, mistaken tonifying, or attacking herbs will lead to danger.

Lotus Seed and Beehive Sores: Prevent Toxin Collapse.

Beehive and Lotus Seed eruptions mostly occur on the back, near the Heart and level with the spine. Mild cases are elongated and highly swollen, or on half the back; severe cases are slanted and flat, injuring both flanks, with holes like a beehive and protrusions like lotus seeds. Though feared, they pose many risks. Common in frail elderly, they contrast with stable health. The main rule fears non-pure Yang; treatment method matters despite severe appearance. Protect the Heart and membranes; adjust pills and powders. Flexibility depends on the physician's intent. Refer to the General Discourse for mechanisms; methods determine survival.

Kidney Shu Eruption on the Waist is Difficult to Treat.

Kidney Shu eruptions occur between the kidneys in the waist or centrally. Those arising here are extremely dangerous. The inner Kidney is the root of life, storing Essence, Qi, and Spirit, governing先天 (innate constitution), reproduction, and longevity. These functions originate from the Kidney orifice. Disease results from excessive sexual labor, exhausting Qi and damaging Essence, desire fire consuming Yin, and external yang provocation, depleting True Water and True Yin. After depletion, the organ becomes deficient, allowing various fires and evils to enter and coalesce into sores. If the organ retains some True Yin to control fire, the sore will be red, vibrant, swollen, and suppurative. Treat with Renshen Yangrong Tang (Ginseng Nourishing Glory Decoction) plus Cornus, Schisandra, Phellodendron, and Anemarrhena, and Jiajian Bawei Wan (Modified Eight Flavor Pill) to save the source. If the sore is purple-black, dry, hard, and non-suppurating, it indicates internal failure of True Yin, with no hope of recovery; death occurs around fifteen days.

Du Mai Deficiency Leads to Neck Eruptions, Commonly Called Opposite-to-Mouth.

"Opposite-to-Mouth" refers to eruptions on the back of the neck facing the mouth, varying in central or lateral position. Central eruptions are governed by the Du Mai; lateral ones by the Bladder Meridian. Both arise from Damp-Heat attacking upward and coagulating. Du Mai eruptions, though central, are easier to treat because the Du Mai rises from below, pierces the spine, and travels upward. Pathogenic Qi conflicts, causing high swelling, preventing toxin from sinking, thus venting externally. Bladder eruptions, though lateral, are difficult to treat because the Bladder Meridian starts at the vertex, passes through the neck sides, and flows downward, intersecting with toxin flow, causing flat sores. Taiyang Bladder governs Cold Water; its nature is cold and sinking, making eruption difficult, color dull, hardness resisting suppuration, and prone to metastasis to shoulders, chest, and neck. No pus after fifteen days indicates transformation to Yin (blackening); thus, often untreatable. Folk belief considers central severe and lateral mild; this is incorrect due to misunderstanding of mechanisms. Treat primarily with Huanglian Xiaodu Yin (Coptis Detoxification Drink); other methods focus on descending fire, resolving phlegm, detoxifying, clearing Heart, and supporting the interior.

Unexpectedly, Many Eruptions Arise Behind the Ears; Tian Ju and Rui Du Are Not Minor.

Eruptions at one inch and three fen behind the ear are fatal and dangerous. Left is Tian Ju (Doomed Boil), belonging to Liver Wood (due to demonic transformation); Right is Rui Du (Sharp Toxicity), belonging to Lung Metal (due to sharp instruments). Both arise from persistent thoughts, indecision, leading to Fire flourishing and depression, alternating to create disease. Shapes are hard, heads hidden, blackening before ulceration, rotting before suppuration, foul odor generating easily, Primordial Qi failing easily. Toxins often fail to vent externally and attack internally, causing death. Initially subtle and unnoticed, by the time detected, toxin is internal. If red, vibrant, swollen, suppurating, and rotting easily, no harm.

There is also Tuojue (Falling Gangrene) on hands and feet...

Tuojue eruption: "Tuo" means falling; "Ju" means black rot. This toxin... mostly affects hands and feet. Originating in bone and sinew, initially like millet, color like jujube, gradually enlarging, sinews and bones emaciated, pitch black, cutting pain heartbreaking, ruinous, foul air swallowing the person, extending to ankles, life teetering. This is not fate but self-destruction. Ancients had methods: amputation can save life. Who is willing today? Amputation is stigmatized. Treatment methods exist, detailed later.

Slow Swelling is Hard to Treat; Fast Swelling is Easy; Methods in the General Discourse Can Be Trusted.

"Slow swelling" means flesh swells but the sore does not; "Fast swelling" means the sore swells but the flesh does not. These two represent the general Yin-Yang patterns of sores and details for distinguishing favorable/unfavorable courses. Decision is made here. At initial stage, promotion is indicated; after suppuration, internal resolution is contraindicated; use supporting drugs. If ineffective, toxin overcomes Qi-Blood; death in ten days. If erupted but not rotting/ulcerating, with hard roots; or soft and spreading, urgently administer supporting drugs, greatly tonify Spleen-Stomach. If ineffective, death in twenty days. If ulcerated but color not red/vibrant, no granulation/healing, large halo, pain/swelling unchanged, Stomach Qi not returning, urgently tonify severely. If ineffective, Spleen collapse; death in a month.

Various Sores Have Separate Classifications; Do Not Lightly Confuse This Presentation.