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When the pus of any carbuncle or ulcer (Yongju, 痈疽) has already formed, the mortality rate is extremely high (ten deaths for one survival). Therefore, wise physicians prevent the condition from progressing to suppuration. If pus and blood have already formed, they should be drained using Bian stones (砭石, stone knives for surgical incision) or Fengzhen (锋针, sharp needles for pricking). However, patients often fear pain and resist treatment, leading physicians to immediately administer formulas such as Shixuan San (Ten-Acun Powder), Baidu San (Resist Toxin Powder), or Liuqi Yin (Flowing Qi Decoction). Little do they know that although Shixuan San contains Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), ingredients like Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Houpo (Magnoliae Officinalis Cortex), and Jiegeng (Platycodonis Radix) are sufficient to consume healthy Qi. Moreover, without distinguishing the meridians involved and the seasonal variations in the abundance or deficiency of Qi and Blood, how can these drugs be used indiscriminately? Baidu San is a formula for dispersing exterior pathogens. Even if there are exterior symptoms, it should only be taken for one or two doses; furthermore, if there are no exterior symptoms, how can it be used? Liuqi Yin is a preparation for moving Qi and dissipating Blood. Overconsumption leads to the depletion of Qi and Blood, leaving nothing to generate pus. It is evident that these three formulas must not be used lightly.

If pus has already formed, ignorant physicians wait for it to rupture spontaneously. They fail to realize that while young and robust individuals with sufficient Qi and Blood might rupture on their own, elderly or weak individuals who have undergone excessive purgative or diaphoretic treatments will suffer internal invasion of pus toxins if not promptly needle-drained. The toxins may penetrate intestines and corrode membranes, rarely resulting in success. A woman with breast abscess (Ruyong, 乳痈) was needled promptly when pus formed and recovered within a month. A man with leg abscess feared needling and nearly died; after being needled and treated with substantial tonification for three months, he recovered. Another man with leg abscess presented with weak pulse and symptoms, a critical condition. He was treated with Tuo Li (Supporting Interior) methods to promote suppuration but was not needled urgently; subsequently, his wound failed to heal after drainage, leading to death. A woman with Back Carbuncle (Fabei, 发背) waited for spontaneous rupture, causing toxic invasion and death. Another man with abdominal abscess had his wound perforate, discharging foul matter; he also died due to fear of needling.

"Evil flesh" (Erou, 恶肉) refers to necrotic tissue. After an abscess or ulcer ruptures, necrotic tissue stagnates and must be removed to eliminate the old and promote the new. Robust individuals with strong sinews and bones and abundant Qi and Blood can resist pathogens effectively; necrotic tissue may detach or resolve spontaneously without harm. However, in the elderly or frail, where blood is scant and muscles are dry, retaining necrotic tissue risks rotting sinews and flesh. A lady had her necrotic tissue removed promptly, allowing new flesh to grow early and achieve full recovery. One person delayed removal and nearly died. Another missed the timing, leading to massive ulceration and death. I have observed that even in robust individuals, if Qi and Blood are not tonified after removing necrotic tissue, healing cannot occur. In frail individuals, failing to remove evil flesh and failing to tonify Qi and Blood results in death.

Necrotic tissue can be removed manually or by applying Xionghuang (Realgar) and Qingfen (Calomel) to cause the decayed flesh to protrude, then applying Yuanzhi powder mixed with wine. (Another method) For polyps, soak Wutou (Aconiti Lateralis Radix Praeparata) five qian in Kujiu (bitter wine) three sheng for three days, then wash the area three to four times daily. For various sores with fleshy protrusions resembling snakes extending several inches, apply Sulfur powder to shrink them immediately. If necrotic tissue remains after pus drainage but does not decay, apply Sulfur and Calomel. If swelling persists around the periphery, insert heated Filiform Needles (Haozhen, 毫针) to a depth of approximately one cun (note: original text says "one mi", likely a textual error for "cun" or shallow depth); redness and swelling will subside.