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Carbuncles and sores are divided into three types. Those that are elevated and soft originate in the blood vessels (xue mai). Those that are flat and hard originate in the tendons, bones, skin, and flesh. Those with indistinct skin color originate in the bone marrow.

Furthermore: When pressing and shaking the swelling, a firm base and large scope indicate a deep location; a small base and floating appearance indicate a superficial location. Another method of verification is as follows: At the initial onset of carbuncles or sores, if one immediately feels high fever, aversion to cold, limb stiffness, headache, mental restlessness, irritability, and a desire for cold drinks, the lesion is definitely deep. If daily activities are peaceful and normal, and diet remains unchanged, the lesion is superficial. Malignant sores initially present with heads like millet grains, slightly painful or itchy. If accidentally ruptured, they will spread and carry the risk of deepening. One must assess the depth: superficial lesions are treated with exterior-releasing methods, while deep lesions are treated with interior-draining methods.

The *Jing Yao* states: If the swelling is high at the beginning and does not flatten or sink after five to seven days, this is the time to treat the interior. Use Tuoli San (Support the Interior Powder) and Neibu Tang (Interior-Nourishing Decoction) to tonify the Zang-Fu organs and solidify the righteous Qi. The greatest fear is the penetration of the membranes (tou mo); if this occurs, fewer than one in ten survives.

Zhu Danxi said: The pathogenic factor of a boil (yong) is shallow, stagnating and obstructing within the meridians, focusing primarily on the exterior. Therefore, upon initial onset, the body surface becomes hot, and the affected area swells like a basin, becoming high, painful, and swollen. Even if it tends to sink, it cannot do so because the internal righteous Qi is solid and resists invasion. Thus, symptoms such as constipation, thirst, or rebellious Qi may appear to repel the pathogen. Consequently, the bone marrow is never scorched dry, and the Five Zang organs are never damaged.

In contrast, the pathogenic factor of carbuncles and sores (yong ju), while stagnating and obstructing, connects internally to the Five Zang organs and does not focus solely on the exterior. Therefore, there may be no fever, and the affected area may not be painful or swollen. In severe cases, hoarseness, loss of facial luster, blackened eyes with constricted pupils, and blackened, swollen fingers like ink occur, leading mostly to death. For treating boils at the initial stage, the method of Zhang Jiegu should be primary: release the exterior with dispersing methods, purge the interior with draining methods, apply moxibustion, and use topical applications. If pus has not formed, it will resolve; if formed, it will rapidly ulcerate. For treating carbuncles at the initial stage, the method of Liu Juanzi should be primary: tonify the Zang-Fu organs to solidify them, preventing sinking pathogens from spreading. Externally apply moxibustion to guide the pathogen outward, providing an exit route so it does not attack chaotically. This can turn death into life and misfortune into auspiciousness.

Today, people fail to distinguish between boils and carbuncles, uniformly using heat-clearing and toxin-purging methods. Externally, aromatic drugs like Wuxiang deplete the Qi; internally, Rhubarb (Dahuang) exhausts the Blood. They remain unaware of their medicinal errors. What a pity.