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In diseases of sores and ulcers, if one or two of the "Five Auspicious" signs are present among the symptoms, it is treatable. If one or two of the "Seven Malignant" signs appear within the "Seven Evils," it is difficult to treat. If malignant signs appear in a deficiency pattern, or if no malignant signs appear in an excess pattern, the condition may resolve spontaneously. Although these conditions are often attributed to Fire pathogen, none arise without Yin deficiency as the root cause. Thus, the classics state: when the Du Meridian (Governing Vessel) is deficient, pathogens emerge from the brain; when the Bladder Meridian is deficient, pathogens emerge from the back. How can one rigidly adhere to the concept of Fire and use Bitter-Cold herbs for treatment? Although Bitter-Cold herbs can treat Yang patterns, one must distinguish between Exterior/Interior, Deficiency/Excess, the sequence of treatment, and seasonal appropriateness. One cannot use them exclusively from beginning to end.

When a sore or swelling is hard and lacks luster (luster refers to lacking shine and appearing withered), hard like the skin of an ox's neck, with a head resembling millet grains, and the pulse is Surging (Hong) but feels Choppy (Se) upon deep pressure, this indicates that Essence and Qi have been exhausted. This is untreatable and will lead to death.

The occurrence of carbuncles and ulcers results from the accumulation of toxins in the Five Zang and Six Fu organs that fail to circulate freely; it is not merely due to the stagnation of Ying (Nutrient) Qi. The movement of toxins has specific locations, and their governance has specific origins. For instance, toxins manifesting in the throat and tongue belong to the Heart; those on the skin and hair belong to the Lung; those in the muscles belong to the Spleen; those in the bone marrow belong to the Kidney. Those manifesting in the lower body are toxins of Yin; those in the upper body are toxins of Yang. Those on the exterior are toxins of the Six Fu organs; those on the interior are toxins of the Five Zang organs. Therefore, internal lesions are termed "Huai" (destruction/collapse), while external ones are termed "Kui" (ulceration). Manifestations in the upper part are considered "Cong" (favorable/compliant); those in the lower part are "Ni" (adverse/rebellious). Lesions in the upper body develop rapidly; those in the lower body develop slowly. Infections involving the Six Fu organs are easier to treat, whereas those involving the Five Zang organs are difficult to treat.

Conditions such as Back Carbuncle (Fabei), Brain Carbuncle (Naoju), Large Ding (Dingchuang), Xuan Yong (Hanging Abscess), Tuo Ju (Devitalized Gangrene), and Jiao Fa (Leg Erysipelas) are caused by consuming rich and greasy foods (Gao Liang Hou Wei), excessive sexual activity, emotional disturbances (Seven Emotions), exogenous pathogens (Six Evils), or improper use of tonifying herbs, leading to depletion of Essence and exhaustion of Qi. They do not arise solely from the stagnation of Ying and Wei (Defensive) Qi. Moxibustion must be used to draw out toxins, and the etiology must be differentiated. Treatment should be based on observing the differences in pathogens affecting the Zang/Fu organs and distinguishing between Deficiency and Excess patterns to avoid errors. Major carbuncles and ulcers rely primarily on Qi and Blood. If the lesion collapses and fails to rise, or ulcerates without putrefaction (draining pus), or fails to heal, or if there is little pus or the pus is clear/thin, these indicate Qi and Blood deficiency. Great tonification is indicated. Aggressive draining/purgative formulas are strictly contraindicated. There are cases where pus is excessive; this is due to Qi and Blood deficiency failing to secure fluids. If fever and thirst occur after ulceration, with a Surging pulse and increasing pus volume, this indicates True Qi deficiency and Pathogenic Excess; such cases are untreatable. It is commonly observed that individuals with robust Qi and Blood present with high, swollen, red lesions that easily putrefy and drain thick pus, and heal quickly. Weak individuals often fail to raise the lesion, lack putrefaction/drainage, and heal slowly. Failure to examine carefully and administering aggressive draining formulas blindly will inevitably result in the harm of "making deficiency more deficient."

Generally, when a sore first appears, it presents as swelling due to the stagnation and accumulation of Qi and Blood, which steams the flesh into pus, causing pain. After the pus drains, as the pus recedes and the tissue relaxes, the pain gradually decreases.

(Referencing *Yuan Tai Yi Ling*): Sores and ulcers involve differentiations in Zang/Fu organs, Qi/Blood, Upper/Lower regions, True/Pathogenic nature, and Deficiency/Excess states; these must not be ignored. For example: swelling that is elevated, hard, with thick pus indicates Excess; swelling that is flat, soft/slow, with thin pus indicates Deficiency. Diarrhea, borborygmus, inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, free urination, or difficulty urinating, loose stools, loss of voice, and poor spirit all indicate Zang/Fu Deficiency. Hard stools, scanty/difficult urination, normal appetite, abdominal distension, chest/epigastric oppression, limb/joint pain, bitter taste, dry throat, irritability, polydipsia, fever, Surging pulse, and mental confusion all indicate Zang/Fu Excess. For various sores and ulcers, if the discharge is clear and thin, the wound fails to close, swelling is aggregated but not red, muscles are cold, spontaneous sweating occurs, and the complexion is pale/washed-out, this indicates Qi and Blood Deficiency. Elevated swelling, redness, aversion to cold/fever, pain, hot skin, sticky/thick pus, and heavy/dizzy head indicate Qi and Blood Excess. Headache, nasal congestion, red eyes, palpitations, pharyngeal obstruction, mouth/tongue sores, irritability with craving for cold drinks, somniloquy, and teeth grinding indicate Upper Excess. Involuntary seminal emission, loose stools, heavy waist/legs, and inability to lie down comfortably indicate Lower Deficiency. Stiff shoulders, heavy limbs, abnormal vision, unclear eyes, loss of taste, hoarse voice, dull complexion, and edema of limbs indicate True Qi Deficiency. Severe swelling, unbearable pain, failure to ulcerate after many days, alternating chills/fever, constipation, dysuria resembling strangury, mental restlessness, and agitation indicate Pathogenic Excess. It is said: All pain belongs to Excess; all itching belongs to Deficiency. It is also said: A Surging and rapid pulse indicates Excess; a fine, thready, and soft pulse indicates Deficiency. For Deficiency, apply Tonification to harmonize Qi and Blood and support the Interior to expel pathogens. For Excess, apply Purging/Draining to unblock and guide Qi. The *Neijing* states: For Blood Excess, pierce/drained it; for Qi Deficiency, lift/support it.

Although ulcerated sores may present with Exterior signs, if fever is present, the primary treatment should be Interior-Supporting (Tuo Li) herbs, assisted by Exterior-Dispersing agents.