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Chu Yushi stated: Whenever a carbuncle or ulcer (Yongju) first appears, one must urgently administer purgatives such as Rhizoma et Radix Rhei (Dahuang) to promote bowel movements, without worrying about the patient's debility. It is better to die after purgation than to die from the rotting and spreading of the sore; moreover, there remains a chance of survival. The ancients established treatment principles, generally using herbs such as Xiang Ru (Moslae Herba), Fructus Forsythiae (Lianqiao), and Radix Euphorbiae Humifusae (Loulu). For those in poverty, decocting Rhizoma et Radix Rhei (Dahuang) alone was used to promote defecation. Only after the pus has formed and ruptured should one take Astragali Radix (Huangqi) and other herbs to discharge pus, as detailed in *Qianjin Fang* and *Waitai Miyao*. In the world, many people die because they do not perform purgation for sores that appear on the exterior, which is truly tragic!

I observe: If the aforementioned symptoms present with high, protruding swelling and severe pain, accompanied by constipation and closure of the zang-fu organs, it belongs to excess syndrome both internally and externally, and one should use the aforementioned drugs to purge. If the swelling is flat and diffuse with slight pain, and the zang-fu organs are deficient, it belongs to deficiency syndrome both internally and externally, and one should use internal support methods combined with tonification. If the swollen area has no head and the skin color remains unchanged, one should assist the stomach qi and strengthen the vital energy to cause internal resolution. If pain persists and swelling does not subside, one should use Ren Shen Huang Qi San (Ginseng and Astragalus Powder) to support the interior and discharge pus. If dietary intake is poor and muscles fail to regenerate, one should use Shen Ling Tuo Li San (Ginseng and Atractylodes Powder to Support the Interior) to nourish the spleen and stomach. Danxi stated: Carbuncles and ulcers arise from accumulated toxins in the zang-fu organs. One should first assist the stomach qi and strengthen the vital energy to solidify the root, then supplement with herbs that unblock meridians and invigorate blood, referencing the meridians and seasonal timing to allow the toxic factors to be excreted externally. Early treatment can lead to internal resolution; this is the essence of the internal support method. He further stated: During the stage of a non-ulcerated sore (Zhongyang), where qi and blood are congested both internally and externally, the primary approach should be supporting the interior and dispersing via the exterior. Using Rhizoma et Radix Rhei (Dahuang) would surely be a rash error. During the stage of an ulcerated sore (Kuangyang), where both interior and exterior are deficient, the primary approach should be tonification and restoration. Using aromatic dispersants would inevitably cause the deficiency to worsen. This is likely due to differences in constitutional endowment between ancient and modern times; treatment requires careful examination.

Chen Wuyue stated: A carbuncle (Yong) is characterized by thin skin and high swelling; a chancre/ulcer (Ju) is characterized by thick skin and hard swelling. At the initial stage, moxibustion burning is suitable for both. Only when pus forms in a carbuncle should it be punctured with a needle; when pus forms in a chancre, cauterization should be used. One must carefully examine the symptoms, guide the toxin outwards, and tonify/support the interior. However, carbuncles and ulcers are listed at the beginning of miscellaneous diseases. If treatment order is lost, it often leads to premature death. Therefore, I have collected effective moxibustion methods to leave for students, hoping to prevent reckless medication.

I observe: If the aforementioned symptoms include fever, irritability, thirst, and dry stool, it is due to pathogenic factors accumulating internally. One should use Huang Lian Nei Tuo Tang (Coptis Internal Support Decoction) to drain internal toxins. If headache, stiffness, fever, and aversion to cold occur, it is due to pathogenic factors lodging in the exterior. One should use Ren Shen Bai Du San (Ginseng Detoxifying Powder) to disperse exterior pathogens. If swelling, pain, redness, fever, and thirst occur, it indicates toxic qi condensing within the flesh and interstices. One should use Xian Fang Huo Ming Yin (Immortal Formula for Preserving Life Infusion) to dissipate the toxicity. If poor appetite, physical fatigue, fever, and aversion to cold occur, it indicates weakness of middle qi. One should use Liu Jun Zi Tang (Six Gentlemen Decoction) to tonify the spleen and stomach.