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Q: May I ask about the Five Good Signs and Seven Bad Signs? A: Normal appetite and digestion constitute the first good sign; excessive internal heat accompanied by difficulty in urination and defecation constitutes the second good sign; consistency between external lesions and internal symptoms constitutes the third good sign; clear distinction between healthy and necrotic muscle tissue constitutes the fourth good sign; therapeutic effects matching expectations constitute the fifth good sign. Thirst with wheezing, eyes retracted towards the nose, and involuntary diarrhea or urinary incontinence constitute the first bad sign; a feeble, continuous breath with a soggy pulse (Ru Mai), which contradicts the disease state, constitutes the second bad sign; blurred vision with sunken eyeballs constitutes the third bad sign; blackening and depression of flesh before ulceration constitutes the fourth bad sign; greenish-black discoloration after ulceration with blackened, rotting bone and tendon constitutes the fifth bad sign; excessive phlegm production constitutes the sixth bad sign; vomiting constitutes the seventh bad sign.

My commentary: The treatment methods for good and bad signs are detailed in the appendix.

Q: Some severe conditions lead to survival, while some mild conditions lead to death. Since symptoms are difficult to distinguish, how can one determine life from death? A: If a carbuncle on the back (Fabei) ulcerates through to the inner membrane (referring to areas above the Ganshu acupoint), it indicates death. If, before ulceration, there is internal sinking of toxin, cyanotic face, black lips, and foul stool (indicating organ failure and blood stasis), it indicates death. Ulceration reaching the throat is incurable. Yinxiong (Yin abscess) penetrating into the abdomen is incurable. Penetration into the scrotum is incurable. Deep penetration into the temple area (several inches deep) is incurable. Rui Du (Sharp Toxin), located 1.3 cun behind the chin, is also incurable. Cases not presenting these signs indicate survival. Although Liuzhu (Flowing Abscess) may be numerous, it will surely heal with treatment.

My commentary: The aforementioned conditions may arise from deficiency of Yuan Qi leading to internal sinking of toxins; or from initial stages where Tuoli therapy (supporting interior) was neglected to harmonize Ying and Wei; or from excessive toxin failing to be resolved; or from weakness failing to be supplemented and supported; or from formed pus failing to be drained via acupuncture; or from ulcerated decay failing to be nourished. For Fabei and Naoju (Brain Carbuncle) caused by damp-heat surging upward, Huanglian Xiaodu San (Coptis Decoction for Eliminating Toxicity) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to eliminate damp-toxin, tonify Spleen and Lung, and nourish Kidney Water. For Binju (Temple Carbuncle) and Rui Du caused by Wind-Heat, Chaihu Shanzhi San (Bupleurum and Gardenia Powder) should be used to clear Liver Fire and nourish Liver Blood; if Yin Deficiency is present, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be used to generate Kidney Water and nourish the source of transformation. If the lesion is on the lower abdomen, one must tonify the Blood of the Three Yin meridians and nourish the Qi of the Spleen and Stomach to ensure survival. Regarding Liuzhu conditions, they may result from dietary irregularities, overwork, sexual excess leading to Yin Deficiency, or emotional disturbances and invasion of Six Exogenous Pathogens, causing Blood Deficiency and mutual stagnation; or postpartum blood stasis flowing with deficiency; forming lumps or diffuse swelling. One should use Yiqi Yangrong Tang (Qi-Tonifying and Blood-Nourishing Decoction) to consolidate Yuan Qi, assisted by Congyi (Scallion Moxibustion) to dissipate stagnation, and Douchi Bing (Fermented Soybean Cake) to dispel Cold Evil. If chronic ulcers contain necrotic flesh, Zhentou San (Needle-Head Powder) should be used to cauterize and remove it; many patients survive. However, if one fails to observe dietary and lifestyle restrictions, recovery is unlikely. Exercise great caution!