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Wu said: After the abscess ulcerates, the necrotic flesh gradually disappears, and new flesh gradually grows. Daily observation reveals raised granulation tissue, forming a white membrane and new flesh. At this stage, nourishment and regulation are required to ensure flat healing without danger. Generally, wound closure should not be rushed. The area should be washed daily with Pig Trotter Decoction (Zhuti Tang) to remove foul impurities, and externally applied with Flesh-Generating Ointment (Shengji Gao) or Miraculous Ointment (Shenyi Gao). Once all toxic pus is discharged, Sacred Efficacy Powder (Shengxiao San) can be used to promote wound closure. One must also be cautious with daily routine, regulate diet, and guard against excessive emotional fluctuations (Seven Emotions); otherwise, deficiency syndromes will arise in swarms, often leading to untreatable conditions. Be extremely cautious!

My commentary: Regarding the aforementioned condition, when necrotic flesh is removed and new flesh grows, it must first appear slightly red, with a white membrane gradually forming around the edges. This indicates the generation of Qi from the Stomach. Use Four Gentlemen Decoction (Sijunzi Tang) to cultivate and tonify Qi. If redness is severe, it indicates Blood deficiency with Fire; use Four Substances Decoction (Siwu Tang) added with Ginseng, [missing character, likely Astragalus], and Atractylodes Macrocephala Rhizome (Baizhu) to harmonize and tonify. If red but no membrane forms, it indicates Qi deficiency; use Four Gentlemen Decoction added with Angelica Sinensis Radix (Danggui) and [missing character, likely Astragalus]. If the color is pale and lacks luster, it indicates dual deficiency of Qi and Blood; use Ten Great Tonifying Decoction (Shiquan Dabujun Wan/Tang) added with Ginger and Cinnamon Twig (Guizhi). If there is no response, add Aconite Lateralis Radix Preparata (Fuzi) urgently. Generally, after an abscess or carbuncle ulcerates, the gradual disappearance of necrotic flesh and growth of new flesh indicates the sufficiency of Spleen and Stomach Qi. Once foul impurities are cleared, Angelica Sinensis Radix Ointment (Danggui Gao) should be used.

Wu said: For the syndrome of abscess and carbuncle, the patient must self-monitor. When it first appears, mark the affected area with ink, then observe the floating/sunken nature and aggregation/dispersion of the swelling. Observe the amount of pus discharge, the width/narrowness of flesh regeneration, and the quality of diet. Prevent constipation or diarrhea of the Zang-Fu organs, and prevent excessive splitting of the wound. One should avoid anger, conserve energy, regulate and tonify Yuan Qi, and protect oneself with careful observation. Do not neglect this.

My commentary: The above discussion aligns with what Master Danxi stated: treating abscesses and carbuncles requires first assisting Stomach Qi and strengthening Yuan Qi to solidify the root. Master Dongyuan taught that diet should be regulated and daily routine regular. The *Suwen* repeatedly emphasizes this; how can one be careless? Generally, diarrhea easily damages Yuan Qi. If it occurs during the tumorous stage (swelling), pus cannot form; if it occurs during the ulcerated stage, flesh cannot regenerate. Patients must be cautious.

Attached Treatment Case:
The wife of Prefect Zhu Yangshan, aged 52, developed a carbuncle on her back at the Xinshu acupoint region on April 4th, resembling a chestnut. Within three days, it enlarged to a base diameter of about five cun. It was neither painful nor swollen, with no chills or fever, and the pulse was faint and deep. I said: "Excess causes pain, deficiency causes itching. If it does not erupt, it is untreatable; if it ulcerates and does not heal, it is also untreatable." Therefore, I administered a formula to greatly tonify Yang Qi. However, the lesion remained white and dull, the condition unchanged, with mental fatigue, reduced appetite, and dysuria. Subsequently, I administered a formula to greatly tonify Qi and Blood, added with Ginger and Cinnamon Twig. After two doses, the lesion still did not erupt. On the 15th day, due to anger, vomiting and diarrhea occurred simultaneously. Another dose of the great tonifying formula was given, but the lesion still did not erupt. Two doses of the previous formula were left, but the patient was confused and refused to take them. Persuaded by others, she regained clarity and continued taking the prescription for seven doses. On the 16th day, the lesion erupted and ulcerated, appearing red and pale. On the 19th day, over twenty doses of the great tonifying formula were given. Later, due to exertion, spontaneous sweating occurred, accompanied by dry mouth, stiff tongue, and distension/pain at the hairline of the Taiyang channel and the vertex of the head. This indicated dual deficiency of Qi and Blood, with Liver-Gallbladder Fire flaming upward. I used Tonifying the Middle and Augmenting Qi Decoction (Buzhong Yiqi Tang) added with Gardenia Fruit (Shanzhi) and White Peony Root (Shaoyao), resulting in immediate recovery. However, internal heat, insomnia, hot sensations in hands and feet, and intermittent paroxysmal heat persisted. I used Free and Easy Wanderer Powder (Xiaoyao San) added with Gardenia Fruit. After the heat subsided, I used Gui Pi Decoction (Guipi Tang), and the wound healed. From onset to healing, it took 42 days, without using a single herb for attacking/toxicity-clearing purposes.

Chen Mingqi, a Juren (degree holder) from Jiangyin, suffered from a back carbuncle while residing in the capital. He recovered using great tonifying formulas. The next day, he intended to return home and held a banquet in advance to express gratitude. His conversation was normal. That evening, he received a family letter that greatly displeased him. Anger led to fever and thirst. He ate a few slices of pear. By night, he suffered multiple episodes of diarrhea. In the morning, he urgently summoned me. His pulse had scattered/disappeared, and he ultimately died. Pears are slippery and promoting downward movement. They should be avoided by those with Spleen-Stomach deficiency-cold, postpartum women, and patients with traumatic injuries.