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1. When prescribing medication for sores and ulcers, one must examine the symptoms affected by the meridians, distinguish between root and branch, excess and deficiency, and treat accordingly. One should not rigidly adhere to the notion of internal attack by heat-toxin and exclusively use cold and purgative agents, which would damage the spleen and stomach's qi and blood, often leading to misdiagnosis and mistreatment. If the swelling is high and painful, it indicates an excess of pathogenic factors; initially use Xianfang Huoming Yin (Immortal Life Elixir), followed by Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder). If the swelling is diffuse with slight pain, it indicates a deficiency of true qi; use Tuoli San (Support Interior Powder). If there is no response, add Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). If pus does not form and the ulcer does not suppurate, it indicates a deficiency of yang qi; use Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi (Astragali Radix) and Rougui (Cinnamomi Cortex). If pain persists after pus discharge, it indicates a deficiency of qi and blood; use Bazhen San (Eight Treasures Powder). If granulation tissue does not grow and the wound does not contract, it indicates a deficiency of spleen qi; use Sijunzi Tang (Four Gentlemen Decoction) added with Shaoyao (Paeoniae Radix Alba) and Muxiang (Aucklandiae Radix). Furthermore, one must prioritize symptoms over seasonal norms. For instance, if there are symptoms such as swelling, pain, irritability, fever, preference for cold drinks, constipation, and a surging, rapid, and full pulse, this constitutes "Five Excesses." Even in severe cold, bitter-cold agents must be used to drain yang heat and rescue yin fluids. Conversely, if the pulse is fine, skin is cold, there is diarrhea with borborygmus, anorexia, vomiting, and cold extremities, this constitutes "Five Deficiencies." Even in peak summer, pungent-hot agents must be used to disperse yin cold and restore yang. Adhering rigidly to conventional rules leads to error.

2. Vomiting in sores and ulcers: If accompanied by intense heat and pain, it indicates excess pathogenic factors; use Xianfang Huoming Yin (Immortal Life Elixir) to resolve it. If caused by pus formation and pain, it indicates deficiency of stomach qi; use Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder) as the primary treatment. If there is distending pain due to ripe pus, it indicates deficiency of qi and blood; use Tuoli San (Support Interior Powder) or puncture to drain. If pain is accompanied by constipation, it indicates heat accumulation internally; use Neishu Huanglian Tang (Internal Draining Coptis Decoction) to guide out the heat. If cold medicines have damaged the stomach, use Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction). If there is poor appetite and cold stomach, use Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction). If there is middle jiao deficiency with cold-dampness, use Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction). If liver wood overacts on spleen earth, use Tuoli Yiqing Tang (Support Interior and Benefit Green/ Liver Decoction). If phlegm stagnates in the epigastrium, use Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction). If spleen deficiency causes self-pathology, use Tuoli Yihuang San (Support Interior and Benefit Yellow/ Spleen Powder). If depression injures the spleen, use Tuoli Yueju Tang (Support Interior and Resolve Stagnation Decoction).

3. Use of external encircling medications for sores and ulcers: If there is swelling, pain, heat, and thirst, indicating a pure-yang syndrome, internally administer Jiyin Dan (Nourish Yin Pill) and externally apply Yangsan San (Suppress Yang Powder). If the swelling is indistinct, pain is vague, and the ulcer does not fully break, indicating a half-yin half-yang syndrome, internally administer Chonghe Tang (Harmony Decoction) and externally apply Yinyang San (Yin-Yang Powder). If there is slight swelling and pain, dark discoloration without pain, or hardness without suppuration, indicating a pure-yin syndrome, internally administer Huiyang Tang (Return Yang Decoction) and externally apply Yinyin San (Suppress Yin Powder).

4. Pain in sores and ulcers: If accompanied by constipation, use Neishu Huanglian Tang (Internal Draining Coptis Decoction). If heat-toxin is vigorous, use Xianfang Huoming Yin (Immortal Life Elixir). If blood stasis is stagnant, use Ruxiang Dingtong San (Frankincense Pain-Relieving Powder). If pain occurs during pus formation, use Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder). If pain is due to pus distension, puncture; if pain persists after rupture, tonify. If pain is due to qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix). If pain is due to blood deficiency, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Radix) and Huangqi (Astragali Radix). If pain is due to kidney deficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If there is dry mouth and thirst, or frequent urination, use Jiawei Bawei Wan (Modified Eight-Ingredient Pill).

5. Collapse and sinking of yang qi in sores and ulcers may result from误taking purgatives, massive loss of pus and blood, vomiting/diarrhea due to overwork, or sexual misconduct. Symptoms include fever, irritability, headache, dizziness, hematochezia, red eyes, panting with spontaneous and night sweats, shortness of breath with sputum, fatigue with heat and thirst, desire for water or even immersing in water, body heat with aversion to cold, aversion to wearing clothes, tossing limbs, profuse sweating like water, opisthotonos, continuous groaning, and a floating, surging, large pulse. These are symptoms of rootless deficient fire and false heat. Symptoms including aversion to cold, headache, cough with regurgitation, deafness, blurred vision, urinary incontinence or dribbling, diarrhea with borborygmus, tenesmus and abdominal pain, retraction of the penis, cold sweat, floating toothache, limb numbness; or cold extremities with body pain, biting tongue and lips, stiff tongue, hiccups with panting, and a minute, deep, fine pulse indicate critical danger. If any one or two of these appear, urgently administer a large dose of Shenfu Tang (Ginseng and Aconite Decoction) to tonify; recovery is likely.

6. Fever and irritability after ulceration: If fever prevents sleep, it indicates blood deficiency; use Shengyu Tang (Savior of Life Decoction). If spontaneous sweating persists, it indicates qi deficiency; use Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi (Astragali Radix) and Wuweizi (Schisandrae Fructus). If fever, irritability, muscle twitching, and tendon tremors occur, it indicates qi and blood deficiency; use Bazhen Tang (Eight Treasures Decoction). If there is extreme thirst, red face, and a surging, floating pulse, it indicates yin-deficiency fever; use Danggui Buxue Tang (Danggui Tonifying Blood Decoction). If there is slight limb heat, irritability, red face, and a deep, minute pulse, it indicates agitation due to yin excess; use Sijunzi Tang (Four Gentlemen Decoction) added with Shengjiang (Zingiberis Rhizoma Recens) and Fuzi (Aconiti Lateralis Radix Praeparata).

7. Constipation in sores and ulcers: If accompanied by thirst for cold drinks and a surging, rapid, forceful pulse, it is excess fire; use Neishu Huanglian Tang (Internal Draining Coptis Decoction). If there is dry mouth desiring hot drinks and a floating, large, weak pulse, it is qi deficiency; use Jiawei Bazhen Tang (Modified Eight Treasures Decoction). If food intake is large but the abdomen is not distended, it is internal fire consuming fluids; do not use purgatives. If there is abdominal fullness and obstruction due to dry rectum, use pig bile for enema. Misusing purgatives damages primal qi, preventing ulceration and healing.

8. Diarrhea in sores and ulcers: If caused by cold-cold damaging the spleen, use Liujunzi Tang (Six Gentlemen Decoction) added with Sharen (Amomi Fructus). If spleen qi is weak, use Liujunzi Decoction taken with Ershen Wan (Two Spirits Pill). If spleen qi sinks, use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) taken with Ershen Wan (Two Spirits Pill). If mingmen fire declines, use Bawei Wan (Eight-Ingredient Pill) decoction taken with Sishen Wan (Four Spirits Pill). If kidney deficiency fails to secure, use Jiangfu Tang (Ginger and Aconite Decoction) added with Wuzhuyu (Evodiae Fructus) and Wuweizi (Schisandrae Fructus). If spleen and kidney are cold, use Shenfu Tang (Ginseng and Aconite Decoction) taken with Sishen Wan (Four Spirits Pill). If the pulse is deep and fine with inability to eat, use Jiangfu Tang (Ginger and Aconite Decoction); recovery is common.

9. Frequent urination or painful涩 (astringency) in the urethra in sores and ulcers indicates kidney meridian yang qi deficiency failing to transform yin; this is a malignant symptom. Use Jiawei Bawei Wan (Modified Eight-Ingredient Pill) to tonify yin. If lower legs and calves are cold, use Bawei Wan (Eight-Ingredient Pill) to tonify yang. If urine is frequent and yellow, use Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus) to tonify the kidney. If heat binds the bladder causing difficulty, use Wulin San (Five Strangury Powder) to clear heat. If spleen and lung qi are dry failing to transform, use Huangqin Qingfei Yin (Scutellaria Lung-Clearing Drink) to nourish yin. If bladder yin is deficient failing to generate yang, use Zishen Wan (Nourish Kidney Pill). If bladder yang is deficient failing to transform yin, use Shenqi Wan (Kidney Qi Pill). For elderly men with impotence and deteriorated essence, use Jiawei Bawei Wan (Modified Eight-Ingredient Pill) added with Cheqianzi (Plantaginis Semen) and Niuxi (Achyranthis Bidentatae Radix). If ineffective, add Fuzi (Aconiti Lateralis Radix Praeparata). If defecation and urination cause pulling pain, worsening with each act, adding Fuzi (Aconiti Lateralis Radix Praeparata) to previous formulas often saves lives. Using bland-draining agents like Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) drains true yang and damages true yin, accelerating death.

10. Thirst in sores and ulcers: With carbuncle pain, fever, and normal bowel/bladder function, it is upper jiao heat; use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). With swelling, pain, fever, and constipation, it is internal five-zang heat; use Sishun Qingliang Yin (Four Smooth Cooling Drink). With severe carbuncle pain and heat-toxin accumulation, use Xianfang Huoming Yin (Immortal Life Elixir). With diffuse swelling and slight pain, it is qi and blood stagnation; use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction). If stomach fire consumes fluids causing shortness of fluids, use Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction). If stomach qi deficiency fails to generate fluids, use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction). If stomach qi injury causes internal fluid loss, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder). If kidney water depletion causes thirst or dry mouth/tongue, use Jiawei Bawei Wan (Modified Eight-Ingredient Pill). If preceded by dry mouth/thirst and frequent urination before developing a carbuncle, or thirst/water drinking after healing, or yellow dry hard tongue with frequent urination while a carbuncle grows, this is particularly malignant. Anticipating the cause and preemptively taking Jiawei Bawei Wan (Modified Eight-Ingredient Pill) and Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) to nourish the source of transformation can prevent this.

11. Bleeding in sores and ulcers results from亏损 (deficiency) of the five zang organs' qi, causing deficient fire to disturb and disrupt meridians. If due to liver heat causing wild bleeding, use Siwu Tang (Four Substances Decoction) added with fried Zhizi (Gardeniae Fructus), Mudanpi (Moutan Cortex), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma). If liver deficiency fails to store blood, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If heart deficiency fails to govern blood, use Siwu Tang (Four Substances Decoction) added with fried Lianhua/Coptis (Coptidis Rhizoma), Mudanpi (Moutan Cortex), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma). If spleen deficiency with heat fails to control blood, use Sijunzi Tang (Four Gentlemen Decoction) added with fried Zhizi (Gardeniae Fructus) and Mudanpi (Moutan Cortex). If spleen meridian stagnation, use Guipi Tang (Restore the Spleen Decoction) added with Wuweizi (Schisandrae Fructus). If spleen and lung qi are deficient, use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) added with Wuweizi (Schisandrae Fructus). If both qi and blood are deficient, use Shiquan Dabu Tang (Ten Great Tonifying Decoction). If yin fire moves, use Liuwei Wan (Six-Ingredient Pill) added with Wuweizi (Schisandrae Fructus).

12. Needling for sores and ulcers requires distinguishing ripeness and depth. Pain upon light pressure indicates shallow pus; pain only upon heavy pressure indicates deep pus. Depression that does not rebound indicates unformed pus; immediate rebound indicates formed pus. Puncturing before pus forms merely leaks qi and blood, hindering pus formation. Not puncturing ripe pus deepens corruption and hinders healing. Puncturing too shallowly in deep wounds retains internal pus and leaks external blood. Puncturing too deeply in shallow wounds releases internal pus but damages healthy flesh. For weak primal qi, tonify first then needle, regardless of Keshen (auspicious timing/deity). Pain after drainage, irritability, or vomiting indicates qi and blood deficiency; urgent tonification is needed. Ignoring Keshen is acceptable because the lesion is already ulcerated.

13. Failure of muscle regeneration in sores and ulcers: Red color without growth indicates blood heat; use Siwu Tang (Four Substances Decoction) added with Mudanpi (Moutan Cortex). Afternoon fever and internal heat indicate blood deficiency; use Sijunzi Tang (Four Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), and Mudanpi (Moutan Cortex). Thin and watery pus indicates qi and blood deficiency; use Shiquan Dabu Tang (Ten Great Tonifying Decoction). Poor appetite and fatigue indicate spleen qi deficiency; use Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction). Irritability, heat, thirst, with normal daily routine indicates stomach fire; use Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction). Irritability, heat, thirst, worse at afternoon indicates kidney deficiency; use Jiawei Bawei Wan (Modified Eight-Ingredient Pill).