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In the treatment of carbuncles and sores after their onset, replenishing Qi and Blood and promoting dietary intake are indeed crucial. This is because excessive discharge of pus and blood leads to deficiency in both Yin and Yang; this prescription can restore life and revive the dying. However, regardless of the meridians involved or the season, it must be used under the guidance of knowledgeable practitioners to support healthy Qi. Modern physicians, seeing the swelling subside and pain alleviate, consider the condition cured and neglect further observation. Often, two to three months or even half a year after scabbing forms, deficiency syndromes manifest. Physicians fail to recognize this and instead apply tonifying treatments, frequently resulting in other diseases. One case involves weakness in the legs (see subsequent section).

The *Jingyao* states: In general, for carbuncles and sores, one should not discard Wuxiang Tang (Five Fragrances Decoction).

Danxi said: I do not know if, in Liangfu's time, there were many cases of severe constipation with stagnant pathogenic Qi and stubborn, thickened conditions that could be suddenly resolved and aggressively purged. One should explain the timing and suitability of symptoms, so that later generations dare not recklessly cause death. Little do they realize that slight chills and fever may result from disharmony of Qi and Blood; mistaking this for an external contraction and applying diaphoresis harms patients most rapidly.

This is a formula regulating the exterior and interior, Qi and Blood. It treats all wind-toxins and accumulated heat causing sores and swellings. The pulse may appear wiry, surging, excess, rapid, floating, or tight. For those with abundant and excess Qi and Blood...

Danxi said: A secret transmission adds Ginseng Radix (Renshen), Astragali Radix (Huangqi), Atractylodis Rhizoma (Cangzhu), Poria (Fuling), and Lonicerae Japonicae Flos (Jinyinhua) to this formula, naming it Xiao Zhong Tuo Li San (Reduce Swelling and Support Interior Powder). Although it lists Ginseng and Astragalus as main ingredients, it also states that Ginseng is optional, which raises doubts and makes its use difficult. Furthermore, modifications during clinical practice must compare exterior and interior conditions. If exterior symptoms predominate, one should follow this formula using pungent and sweet herbs to disperse them; if interior symptoms predominate, variations must be applied.

The *Jingyao* states: Dahuang (Rhei Radix et Rhizoma) disseminates heat and disperses toxins; it is a key herb for treating carbuncles and sores. When carbuncles and sores first arise, one must use decoctions containing Dahuang to vigorously promote bowel movements. This should be done daily without cessation. It also states: Diarrhea in sores and carbuncles is always a ominous sign.

Danxi said: These statements raise doubts. Even if Dahuang is used, it might be because of constipation combined with a robust constitution and entrenched accumulated heat. Its function is merely to break stagnation and guide blockage, promoting movement. How can it be described as vigorously purging daily? If laxatives are given after diarrhea has already occurred, it contradicts the principle of preventing disease progression. When a sore first appears, swelling is in the muscle layer. Unless there is severe fullness and hardness, one should naturally adopt Zhang Zhongjing’s method of releasing the exterior. Taking Wuxiang Tang as an example, dispersing from the outside is sufficient. Why rush to use harsh purgatives that damage the interior? Some say: Using Dahuang to drain and remove toxins in carbuncles was mentioned by Sun Simiao. Liangfu simply followed his theory. I reply: Sun Simiao practiced unique arts among nobles with great fame. Liangfu was a Song dynasty figure; if his associates were also nobles consuming rich diets, quick effects were natural. Today, applying this indiscriminately regardless of poverty or wealth invites reckless error. Moreover, those deficient due to mental exertion, anger/worry, strenuous labor, or overindulgence in alcohol and food suffer from scant Qi (stagnant) and scant Blood (turbid). Carbuncles in such cases are hard to treat. If constipation exists but appetite remains slightly intact, and diet is bland with disciplined habits, it is still treatable, though requiring adjustment and tonification. If one assumes constipation lasting ten days or half a month indicates excess syndrome and uses Dahuang, ignoring that it may stem from failing descent of Qi, is this not killing people?