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At the initial stage, if there is no dryness of the mouth, no aversion to cold or fever, normal appetite, and ordinary behavior when sores appear, it is a favorable condition (Shun). When the sore has formed, if the head swells up, the base does not spread, the color is red and vibrant, and pain occurs with pus discharge, it is a favorable condition. After ulceration, if the pus is thick, the color is fresh and red/vibrant, swelling subsides, pain stops, the neck feels comfortable, the head feels light, and the mouth feels harmonious, it is a favorable condition. After ulceration, if necrotic flesh easily sloughs off, new flesh easily grows, the wound easily flattens, and appetite remains, it is a favorable condition.

At the initial stage, if the sore head is like millet grains, soft and not high at the apex, purple in color with a spreading base, accompanied by numbness/pain and poor appetite, it is an unfavorable condition (Ni). When the sore has formed, if the shape is purple-black, soft and depressed without pus, feet are cold, body is cool, bowels/bladder are open but pulse is deficient, it is an unfavorable condition. After ulceration, if the pus/water is clear and thin, foul odor is produced, necrotic flesh does not rot, and new flesh does not grow, it is an unfavorable condition; if after ulceration there is excessive eating, body fever, dry mouth, insomnia, muscle wasting, and rough skin, it is an unfavorable condition.

At the initial stage, if the swelling is hard, internal heat and dry mouth occur, and the pulse is rapid and forceful, this indicates excess pathogenic factors; one should use purgative methods. When the sore has formed, if aversion to cold with high fever, limb stiffness/spasms, and floating pulse occur, this indicates pathogens in the exterior; one should use dispersing methods. Red swelling with pain indicates blood stasis; use herbs to disperse blood and clear Liver heat. Dark color with diffuse swelling indicates failure to raise Yang and assist Stomach; use methods to raise Yang and support Stomach function. After ulceration, if hardness/swelling persists, pulse is fine and rapid, and afternoon fever occurs, nourish Yin and strengthen Spleen. If Liver/Gallbladder fire attacks upward causing mental restlessness/agitation, and redness/heat in cheeks/zygomatic area, suppress Yin fire and descend fire. After ulceration, if pus is clear, swelling/pain remain severe, with vexation and poor appetite, nourish Qi and Blood, strengthen Spleen/Stomach. After ulceration, if both Qi and Blood are deficient, body is cool, pulse is fine, and stools are often loose, use strong warming tonification of the Middle Jiao. If the ulcer fails to close, new flesh grows slowly, the wound is pale white, and pus flows endlessly, strengthen the Middle and tonify Spleen.

A man suffered from this for three days, presenting with swelling, aversion to cold/fever, and a floating-rapid pulse. One dose of Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction) resolved all exterior symptoms, but swelling and pain persisted as pus was about to form. Tuoli Xiaodu San (Support Interior and Eliminate Toxin Decoction) was administered. After pus discharged, Yiqi Yangrong Tang (Qi-Supporting and Nourishing Nutrient Decoction) with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) was used to gradually close the wound, leading to recovery.

A man suffered from this for five days, with a high apex and a base the size of a coin, red and vibrant in color. This was caused by Damp-Heat in the Liver Meridian. Seven moxa cones the size of hemp seeds were applied. Two doses of Zhizi Qinggan Tang (Gardenia Clearing Liver Decoction) slightly halted the swelling. A Chansu Bing Gao (Toad Venom Cake Paste) was applied over the moxa site. Several doses of Chaihu Qinggan Tang (Bupleurum Clearing Liver Decoction) with Baizhi (Angelica Dahurica), Huangqin (Scutellaria Root), and Tianguafen (Trichosanthes Root) were given. Pus discharged, swelling subsided, and healing occurred within half a month.

A man had suffered from Xiao Ke (Wasting-Thirst) for three years and alternating chills/fever for half a month, mistaking it for Malaria. A small sore suddenly appeared on his temple. After three to four days, it resembled a millet grain externally, was flat and hard, dark in color and dull. The pulse was surging, rapid, yet powerless. This indicated exhaustion of Kidney Water and flourishing Fire. It ultimately failed to ulcerate or heal, so he declined treatment. Another physician deemed it easy to treat, punctured the swelling with a needle, drained about a cup of purple blood, and prescribed detoxifying herbs internally. The next day, the surrounding area became more swollen. The physician stated that high swelling belongs to Yang and is easy to treat, pleasing the family. Three days later, the cheek and neck were swollen, jaw locked preventing eating. Needling was repeated, and daily confusion increased. Upon re-evaluation, I said: Death is imminent. This patient had thirst before the disease onset, indicating exhausted Kidney Water; the external appearance like a millet grain suggests internal emptiness; the purple-black color indicates Qi failure and Blood decline; the surging but powerless pulse indicates internal collapse of Yuan Qi. With such signs, how could he survive? The family finally believed, but it was too late. He died after twenty-one days.

A man had swelling for five to six days. He sought internal resolution, applying cooling herbs externally and taking Dahuang (Rhubarb Root) and other Qi-draining formulas internally. Although the swelling receded, he developed chills/fever, nausea/dry retching, and shoulder/arm stiffness. The pulse was rapid and powerless. This indicated internal deficiency allowing Toxic Heat to enter the interior, caused by the cooling herbs. Dongyuan (Li Dongyuan) stated: Sores and carbuncles arise from internal or external causes, requiring warm or cold treatments accordingly. For external pathogens, the method is to support the interior with warm agents; using cold drugs instead damages the Spleen/Stomach, causing internal deficiency, allowing external toxins to enter the interior. For internal pathogens, the method is to drain with cold agents; using warm tonics instead... [Note: Text implies error in treating internal origin with warm tonics]. Initially, the toxin is in the marrow; misusing warm agents forces the toxin to the skin surface, causing simultaneous exterior-interior ulceration, creating one large sore, aiding the pathogen into toxicity, causing hundredfold suffering. Mild cases worsen, severe cases lead to death. Since the previous case resulted from cold drugs, Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) stopped vomiting after two doses. Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) with Baizhi made the original sore rise after several doses. Ren Shen Yang Rong Tang (Ginseng Nourishing Nutrient Decoction) taken intermittently led to thick pus formation. Over two months, the wound closed.

A woman suffered from this, with hard swelling, chills/fever, dry mouth, pain, and a surging-forceful pulse. This indicated excess in both exterior and interior. One dose of Fangfeng Tongsheng San (Saposhnikovia Unblocking and Generating Defense Decoction) resulted in two bowel movements, slightly relieving symptoms. Another dose caused multiple bowel movements, stopping fever and thirst. Only the original sore remained hard/swollen. It was punctured with a silver needle, a Chansu strip inserted, and Tuoli Xiaodu San administered internally. Gradual ulceration and pus discharge led to stability.

A man suffered from this for three to four days, with a high apex and viable base, and no exterior-interior symptoms. This was caused by Damp-Heat in the Liver Meridian. The apex was pricked with a needle, covered with a Chansu Bing paste. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Zaojiaoci (Gleditsia Sinensis Thorn) was taken internally. A small amount of pus emerged from the head, and root swelling subsided.