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The affliction of sores and swellings is nothing more severe than carbuncle (Yong, 痈) and gangrene (Ju, 疽). However, how can one distinguish between them? As stated in the classics: when Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) stagnate within the meridians, they become sluggish and fail to circulate. When circulation fails, Yang Qi becomes depressed and obstructed, leading to chills and fever. The foul and toxic qi surges outward, accumulating and condensing to form Carbuncle. If it persists for a long time without resolving, heat qi takes advantage of this, causing tissue corruption and pus formation. However, if the bone marrow remains unscorched and the Zang-Fu organs are not damaged or failed, it is treatable and curable. What is Gangrene? It arises from wind-toxin and accumulated heat in the five Zang organs; the toxic heat is extremely fierce, sinking down into the skin and muscles, causing the bone marrow to wither and blood and Qi to dry up. The swelling appears dull and lifeless, hard like the skin on an ox's neck, hence named Gangrene. The characteristic of Carbuncle is that the swelling has thin and lustrous skin; this is its sign. The origin of Carbuncle and Gangrene can be internal or external: internal ones arise within the chest, abdomen, and Zang-Fu organs, while external ones appear on the surface of skin, flesh, sinews, and bones. These two types of toxins have no fixed location of onset but have consistent names. The root of stagnation begins with emotional disturbances such as anger, joy, worry, and happiness, irregular diet, unregulated living habits, or the triggering effects of mineral drugs and herbal medicines, as well as imbalances in cold, heat, dryness, and dampness. These factors cause Yin and Yang imbalance and accumulation, externally leading to the coagulation and slowness of Ying and Wei Qi, resulting in corruption and ulceration. Mild cases originate in the Six Fu organs, manifesting superficially as Carbuncle, where Qi moves through the meridians and floats upward; severe cases originate in the Five Zang organs, manifesting deeply and sluggishly as Gangrene, where Qi moves through the meridians and sinks downward. Understanding these two allows one to infer other conditions such as sores, toxins, erysipelas, and rashes.

Gangrene attached to the bone (Fugu Ju, 附骨疽) is so named because its toxic qi is deep-seated and adheres to the bone. This disease is similar to but distinct from "Thief Wind" (Zeifeng, 贼风 - a pathogenic factor characterized by sudden onset and rapid progression), and misdiagnosis often occurs due to failure to differentiate. Bone gangrene results from sleeping outdoors in autumn or summer, suffering cold injury, where wind-heat lies dormant and accumulates, attaching to the bone to form gangrene. The manifestation of Thief Wind involves wind-pathogen qi clashing with the bone joints, causing pain that penetrates deeply into the bone marrow, which worsens upon exposure to cold. In contrast, Gangrene attached to the bone presents with pain and immobility; initial palpation reveals tenderness against the bone, with slight tension in the skin and flesh, and a swelling that feels full like obesity. Thief Wind, however, presents with little heat in the skin and bones, yet shivering aversion to cold, intermittent sweating, and a desire for hot compresses on the painful area for temporary relief. Initially, Gangrene attached to the bone presents only with intermittent pain, alternating chills and fever without sweating. It does not resolve over time; eventually, extreme Yin generates Yang, transforming cold into heat, leading to suppuration. If Thief Wind is untreated, it may eventually lead to deformity, curvature, or hemiplegia, which distinguishes it from Gangrene attached to the bone. If diagnosed as Thief Wind, administering formulas that guide the action to expel wind will lead to recovery. If diagnosed as Gangrene attached to the bone, one should urgently administer Loulu Tang (Cirsium Decoction) or Wuxiang Lianqiao San (Five-Aromatic and Forsythia Powder) to vent and purge, followed by Neixiao Shengma Tang (Internal-Resolving Cimicifuga Decoction) and topical application of Ulcerating Ointments. Even if resolution cannot be achieved, the condition can be made superficial and easier to treat. Additionally, Huan Ju (Slow Gangrene) and Shi Ju (Stone Gangrene) are also similar to Gangrene attached to the bone. The difference lies in the etiology: Huan Ju and Shi Ju are caused by cold qi lying deep within the bone marrow, with swelling resembling skin and flesh lesions. If painful and hard as stone, it is called Stone Gangrene; if the heat is slow to develop, persisting for days without suppuration, eventually turning purple-dark with rotting skin and flesh, it is called Slow Gangrene. For the treatment of these two, early intervention should prioritize tonifying deficiency and supporting the interior with warm-tonifying agents to eliminate the pathogen; subsequent treatment requires adjusting according to the specific disease presentation, so detailed prescriptions are not listed here.