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At the initial stage, if the sore's apex is high and its base is vital, with red color and thin skin, accompanied by pain and heat, but the swelling fails to dissipate, it is a favorable condition (Shun).
Once the sore has formed, regardless of whether it is lateral or central, if the sore shape protrudes, accompanied by pain and fever, and easily suppurates and putrefies, it is a favorable condition.
After ulceration, if the pus is thick, the flesh color is red and vital, necrotic tissue detaches easily, swelling gradually subsides, and pain decreases, it is a favorable condition.
After ulceration, when necrotic tissue falls off and new flesh grows immediately, the wound margin gradually contracts and closes, scabbing occurs with pus formation accompanied by itching, it is a favorable condition.

If at birth there is only a single yellow blister, or like a nodule, without swelling or pain, and the patient feels nothing, it is an unfavorable condition (Ni).
Once formed, if it does not swell high, nor is painful, with a soft and depressed apex and a flat, scattered base, it is an unfavorable condition.
After ulceration, if the pus is clear, the flesh color is purple-black, the outer skin does not putrefy, the interior emits a foul odor, and appetite is lost, it is an unfavorable condition.
Although necrotic tissue is exhausted, if new flesh does not grow, the wound margin is scattered and soft-depressed, with a decadent complexion, it is an unfavorable condition.

Whether the initial lesion has a head or not, whether it causes severe pain or no pain, apply garlic-separated moxibustion (Gesan Jiu) and concurrently administer detoxifying formulas.
If the formed sore is hard, accompanied by fever, pain, dry mouth, and constipation, the pathogenic factor is internal; purgation should be used.
If the swelling is hard but painless, accompanied by fever, aversion to cold, headache, and limb stiffness, combine exterior-releasing and interior-purging methods.
If the swelling and hardness deepen daily, with purple-black color, outer skin not putrefying, and internal pus not erupting, employ extraction methods.
If there is neck stiffness, facial heat, dry mouth, nausea, and vomiting, the pathogen is in the upper jiao; clearing heat is indicated.
If there is redness, swelling, heat, and pain, with bright red color, intermittent severe pain, and internal distending pain from pus, urgent incision and drainage are required.
If it is about to ulcerate but does not, with slight heat and redness, failing to putrefy, it indicates Spleen and Stomach deficiency; tonification is indicated.
After ulceration, if necrotic tissue does not detach, pus water is clear and thin, and swelling and pain persist, substantial tonification of Qi and Blood is necessary.
For frequent loose stools, scanty and dysuric urination, spontaneous sweating, poor appetite, fine pulse, and cool body, warm the middle and strengthen the Spleen.

A man suffered from a carbuncle on the neck for over ten days. The lesion appeared severe, with the base extending to both sides, causing swelling and red-hotness in the ears and neck. The pulse was floating and rapid. Initially, two doses of Huanglian Xiaodu San (Coptis Detoxification Decoction) were used to reduce the major symptoms. After the base stabilized, Tuoli Xiaodu San (Support Interior and Detoxify Decoction) was administered. After several doses, no putrefaction occurred, and the pulse was found to be floating but weak. Inquiry revealed the patient was over fifty years old, had long struggled with infertility, had a concubine, and suffered from excessive mental worry and sexual indulgence, damaging his Yuan Qi. Given the severity of the lesion, which could raise but not generate pus, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was modified with Jiegeng (Platycodon Root) and Baizhi (Angelica Dahurica), doubling the dosage of Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala) to three qian each. Externally, mulberry wood moxibustion was applied twice daily. Purple Xia Gao (Purple Rosin Ointment) was also applied. Several days later, the patient's head and face swelled completely, eyes closed shut, looking terrifying. Then putrefaction and suppuration began, discharging liters of pus daily. After half a month, due to the ineffectiveness of previous medicines, internal restlessness, five-palm heat, and reduced diet appeared. This was attributed to excessive loss of Qi and Blood from pus discharge, resulting in false symptoms of deficient fire. Although changes occurred, they were manageable. Shengyu Tang (Sage Renewal Decoction) was then used. One dose was ineffective; a second dose with Ershu Fuzi (Prepared Aconite Root) added proved effective, resolving previous symptoms. Subsequently, Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction) with Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), and doubled Renshen and Baizhu up to three qian was used for over a month调理. Later, necrotic tissue from the brain bone area detached in sheets, looking gruesome, astonishing all observers. Fearing deep putrefaction outpaced tonification, three qian of Renshen were added to daily porridge meals to support Spleen Yuan. Gradually, Yuan Qi recovered, and after four months of regulation, he healed.
One year later, he fathered a son to continue the family line.

A student at the Imperial Academy presented with a neck sore initially appearing on the right side. It must not be taken lightly; moxibustion is superior. Garlic-separated moxibustion was applied for fifteen cones until pain was felt. He later considered it a minor ailment and neglected internal medicine. Four days later, the sore recurred with neck swelling and stiffness, red-purple numbness and pain, constipation, and a strong, forceful pulse. Neishu Huanglian Tang (Interior-Draining Coptis Decoction) with Xuanmingfen (Mirabilite) was used to unblock bowels. Two doses of Xiaodu Jiuku Tang (Detoxify and Save from Distress Decoction) failed to reduce swelling. This indicated internal toxin manifesting externally; further dissolving was inappropriate. Tuoli Xiaodu San was switched to. Near twenty days later, due to the patient's obesity and tight external flesh preventing putrefaction, I proposed needle opening, but his family firmly opposed it. Consequently, complications arose: irritability, confusion, and unconsciousness. Only then did they regret. I immediately used a lancet to open holes on both sides and the center of the neck. Necrotic flesh within pus pockets was cut away, releasing over a bowl of accumulated toxic pus and blood. Internally, herbs to strengthen Spleen/Stomach, nourish Qi/Blood, and support pus expulsion were given. Pus flowed continuously. Daily intake included six to seven qian of Renshen mixed with food. After necrotic tissue fell off and new flesh grew, forty more days passed before the patient regained consciousness, unaware of what happened. If needles/knives had been forbidden and strong tonification withheld, survival would have been impossible. Because his son valued reason and trusted my advice, he healed within one hundred days.

A man with a neck sore for five to six days visited a pharmacy. The head was yellow, and the base was flat and scattered. I advised urgent treatment. He left displeased. Another local doctor called it a minor illness. Trusting this, medication continued for five more days. The sore became hard, the base expanded, poison spread to shoulders and anterior neck, chest and breasts swelled, with nausea, vomiting, chills, fever, and anorexia. The appearance was terrifying, confirming my earlier warning. Upon re-examination, the sore was beyond simple medicinal reach. Old medicine was washed off with Cong Ai Tang (Scallion and Mugwort Decoction). Two areas were treated with boiling herbal cupping to extract over a bowl of stasis blood. Silver needles were inserted obliquely into the base to penetrate the bottom of the lesion. Chan Su strips (Toad Venom Strips) were inserted into the holes. This best detoxifies and promotes suppuration. Covered with ointment, Zhenjun Miao Tie San (True Lord Wonderful Paste Powder) was applied to spreading areas. Day by day, it subsided, drawing poison back to the posterior neck. Internal supportive, fire-descending, and phlegm-resolving herbs were taken. After three to four days, major symptoms receded and internal pus drained. Shiquan Dabu Tang was resumed. Hard non-melting areas were addressed, painless putrefied areas removed, and slow new blood generation supported. Regulation lasted nearly three months until complete healing. This outcome resulted from the patient's concealment of illness and avoidance of doctors, nearly costing his life.

A woman over sixty, from an official family, constitutionally weak, developed a carbuncle on the neck. The initial head resembled millet grains, indicating a large cavity ("able to hold grain"). Fortunately, her slender build suggested easy putrefaction. Garlic-separated moxibustion was applied first, followed by Chan Su Bing (Toad Venom Cake) on the moxa site, and Xi Du San (Absorb Poison Powder) around the edges to contain the base. Internally, Tuoli Xiaodu San was taken. After several doses, the sore hardened with unceasing pain. I predicted cessation on a specific day. However, since it hadn't putrefied and the pulse was fine, rapid, and weak (indicating internal deficiency unable to transform poison into pus, hence pain persists), stopping was impossible. Yi Qi Yang Rong Tang (Tonify Qi and Nourish Grace Decoction) with Jiaozhen (Antler Horn) and Baizhi was prescribed for three doses. Swelling rose slightly. Mulberry wood moxibustion softened the hardness. Pus became thick but scant. Jiaozhen and Baizhi were removed from the formula; Xiangfu (Cyperus Rhizome) was added, and Renshen and Baizhu were doubled. After several more doses, suppuration occurred, but pain persisted. I predicted pain cessation afternoons in three days. At that time, half the necrotic tissue detached. Rushing Ding Tong San (Frankincense Pain-Stopping Powder) was taken at noon. Pain ceased instantly, allowing deep sleep. The family rejoiced. I explained this was timely medication application. Though I spoke of half a month, it applied to the present moment; trust ensures accuracy. Later dates for full necrosis removal, muscle leveling, and closure were predicted precisely, marked by ink lines by the family, proving accurate without error. This method relies on skilled observation, assessing difficulty, speed of new/necrotic tissue growth, appropriateness of tonification, and correct prescription, allowing precise temporal prediction.

A young woman had a neck sore for three days, positioned directly opposite the anterior fontanelle area. Her family feared it because she was obese and believed sores shouldn't appear there. I observed a high apex and active base, deeming it safe despite eruption. They sought internal resolution. I stated drugs alone couldn't dissolve it, but needling could. Following my advice, a lancet was inserted six to seven fen into the apex until soft flesh was reached. Stasis blood was removed, and a Chan Su strip inserted. Chan Su Wan (Toad Venom Pill) induced profuse sweating, resolving the condition. Next day, slight pus appeared, and swelling subsided. To ensure internal toxin clearance, detoxifying and heat-clearing herbs were given. Peace returned within ten days. Generally, to resolve sores, sever the root first, then drain toxins, preventing internal invasion.

A man had a carbuncle behind the ear for ten days, ignoring it as minor. Near half a month, the base enlarged, the head wept bloody fluid, foul and thin. Edges were purple-black, soft and depressed without pus. Face pale, nose flared, hands cold, breath short. Pulse was scattered, large, and rootless—indicating internal collapse. I declined treatment. A guest physician was hired. The patient, resentful of my refusal, vowed to friends he wouldn't die. I said, "The heart refuses death, but in five days you will die." It came true. I observe that any sore presenting this sign, even with a mountain-like constitution, collapses upon failure.

A woman had a sore at Zhengduikou (Center Opposite Mouth) for four to five days. She self-moxibusted over twenty times, feeling no pain. The scar was black and flat. Pulse was slightly rapid, fine, and weak—internal deficiency. Medication alone would be mistaken. A lancet pierced the apex one cun deep; no pain, no blood—indicating stagnant toxin not yet rising. Chan Su strips were inserted daily, covered with ointment. After seven days, cracks appeared around the periphery with pus discharge. Purely tonifying herbs were taken internally. On the fourteenth day, a finger-sized piece of sore root, over an inch long, dropped out. Yuhong Gao (Jade Red Ointment) promoted muscle growth. Half a month later, the wound flattened. Zhenzhu San (Pearl Powder) was sprinkled, promoting immediate skin regeneration and healing. Without needling, relying solely on drugs, while not fatal, would not yield such rapid recovery.

A forty-year-old obese woman had a neck sore for five to six days. Flesh swelled but the sore itself didn't. She doubted and feared. Dry mouth, irritability, hardness, purple color, flat scattered base, and surging pulses indicated an excessive condition. No pus would form. I declined treatment. Other doctors suggested external support or internal dissolution, citing youth and strong pulse as good signs. Confusion ensued. Seven to eight days later, chest, neck, and front swelled, stiff and numb. Re-evaluation showed: 1) Flesh swollen, sore flat/depressed; 2) Base flat/scattered, true Qi failed, unable to contain toxin; 3) Dry mouth/irritability, evil fire invading internally; 4) Purple-dark color, dead blood/stagnant toxin, no putrefaction; 5) Surging pulses, overwhelming toxin suppressing righteous Qi, leading to soft depression and internal attack death. Prepare funeral arrangements; death expected around the 27th day. It happened. Observing this logical progression, one sighs at the chaotic, erroneous treatments of contemporaries.