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Wu stated: In the treatment of carbuncles, ulcers, back sores, and ding sores (hard, deep-seated infections), if there is no pain, moxibustion must be applied to induce pain; if there is already pain, moxibustion must be applied to alleviate it. If pain occurs immediately upon starting moxibustion, it indicates that the pathogenic toxin is light and superficial; if there is still no pain after moxibustion, it indicates that the pathogenic toxin is deep and severe. In all such cases, internal administration of formulas to expel toxins and drain pus, along with external application of detoxifying medicaments, is appropriate. Generally speaking, carbuncles and ulcers should not be completely painless, nor should they cause severe pain. Cases presenting with mental confusion and insensitivity to pain are difficult to treat.

My commentary: Among the previous discussions, only ding sores exhibit diverse symptoms and varying colors. They may appear as small sores or blisters; they may be painful or numb; they may present with red streaks spreading from the lesion; or they may be accompanied by chills, fever, headache, vomiting, nausea, or limb stiffness and spasms. The manifestations are manifold. Without employing the aforementioned moxibustion methods and detoxifying decoctions, effective results are hard to achieve. If the patient loses consciousness or suffers from trismus (lockjaw), Duoming Dan (Life-Restoring Pill) should be ground into powder and administered via gavage. If the sore appears on either foot, red streaks often extend to the umbilicus; if on either hand, they extend toward the heart region; if on the lips or face, they extend into the throat. These conditions are all difficult to treat. However, pricking the red streaks to release blood can often lead to survival. When the lesion occurs at the extremities of the limbs, the toxin becomes more stagnant, and medicinal efficacy is difficult to reach; in such cases, the therapeutic value of moxibustion is significant. Indiscriminate use of purgative agents depletes the body's true qi (vital energy). Not only will this fail to eliminate the toxin, but it will also cause further harm.

Attached Treatment Cases

Zhang Hengshan, Censor of the River Command, suffered from a lesion on the second toe of his left foot, with unbearable pain. Urgent moxibustion was performed using garlic slices for over thirty moxa cones, after which he could immediately take steps. Desiring a rapid cure, he self-applied cooling medicaments, resulting in blood coagulation and muscle necrosis, causing the toxin to flare up again. He underwent another hundred moxa cones and took Huoming Yin (Life-Saving Decoction), which expelled purple-black blood, allowing the toxin to resolve. The sole of the foot became fully ulcerated with extensive necrotic tendons and flesh. As he was nearing recovery, I departed northward due to an official performance review. He then mistakenly used flesh-regenerating medicines, which exacerbated the toxin and depleted his yuan qi (original qi), making wound closure difficult. Upon my return, I administered Tuo Li medicines (formulas to support the interior and boost immunity) to tonify him. Fortunately, his constitution was robust and he was residing away from home; he recovered after more than three months.

My cousin-in-law, Ju Fu, suffered from a lesion on the little finger of his right hand. Someone pricked it to release blood and applied cooling medicaments, causing the palm and fingers to swell three to four times their normal size. The six pulse positions were surging and large, indicating deficiency due to depletion of true qi and excess due to the dominance of pathogenic factors. Initially, one dose of Duoming Dan and two doses of Huoming Yin were administered, slightly alleviating the condition, while I was away on other business. Someone else repeatedly pricked the area to release blood, causing swelling to extend to the arm and wrist like a large gourd, with fingers swollen several times their original size, unable to dissipate or ulcerate. This indicated further depletion of true qi and intensification of pathogenic factors. Upon my return, I prescribed large doses of Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizoma (Baizhu), combined with frequent moxibustion over the entire hand, gradually reducing the swelling. Later, he experienced loose stools and frequent flatus, indicating sinking of yuan qi. I prescribed Buzhong Yiqi Tang (Middle-Warming and Qi-Boosting Decoction) supplemented with Psoraleae Fructus (Buguzhi), Myristicae Semen (Roudoukou), Evodiae Fructus (Wuzhuyu), and Schisandrae Fructus (Wuweizi), and used Shengmai San (Generate the Pulse Powder) as a tea substitute. His stools gradually solidified, and the dorsum of the hand began to ulcerate. After taking over fifty doses of major tonic prescriptions, he gradually recovered.

A man suffered from a lesion on his lip, with a purple vein extending from the sore into the oral cavity. I stated: "If this vein passes through the throat, it will be difficult to treat. One must prick the purple vein and the head of the sore to release foul blood, thereby draining the toxin." He did not believe me and used other detoxifying agents instead, resulting in complete swelling of the head and face. He requested treatment again. The pulse was surging and rapid, but empty upon deep pressure, and all ominous signs were present. I said: "I am powerless to help." He sought treatment earnestly, but at that time, the intraoral swelling was so severe that needles could not be inserted. I performed phlebotomy with a stone needle on the swollen area. Although the condition slightly receded, he ultimately died.