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Zeng Shi stated: In all cases of carbuncles and ulcers (Yong Ju), if the pulse is floating, rapid, full, and tight, with local swelling and pain, fever, restlessness, thirst, and normal appetite, this indicates disharmony of the Six Fu organs, with toxic heat erupting on the exterior forming a carbuncle. Although the condition may be acute, administering cooling formulas often preserves life. If the pulse is deep, fine, hidden, and tight, with initial symptoms being very mild or lacking a pustule, no fever but internal restlessness, heavy body, painful distress, low mood, chest and diaphragm stuffiness, and loss of taste, this indicates disharmony of the Five Zang organs, with toxin accumulating internally forming an ulcer. In such cases, urgently administer Wuxiang Liaoqiao Tang (Five-Spice Forsythia Decoction). For severe cases, use Zhuan Du San (Toxin-Transforming Powder), Shenxian Jie Fa (Immortal's Method of Interception), Huangfan Wan (Yellow Alum Pill), or Guolao Gao (Old Man's Paste) to prevent and support the expulsion of toxic qi, avoiding internal invasion by transformed pathogens. It is especially appropriate to perform garlic-partitioned moxibustion directly on the lesion. Applying toxic ointments can block the cou li (skin pores and interstices); administering various cooling medicines can deplete true qi. Therefore, determining whether a condition is favorable or unfavorable depends on the skill of the physician.

If symptoms include belching with obstruction, coughing with counterflow qi, cold body, spontaneous sweating, fixed gaze, deafness, mental confusion with palpitations, and incoherent speech, these are all malignant signs. If three of the Five Favorable signs appear, recovery is expected; if four of the Seven Unfavorable signs appear, the condition is critical. If all Five Favorable signs manifest, goodness cannot be added to; if all Seven Unfavorable signs manifest, evil has reached its extreme.

My commentary: The aforementioned "favorable" conditions indicate that the Five Zang organs are undamaged, the pathogen is mild and superficial. With careful daily routine and dietary restraint, self-healing can occur even without medicine. The "unfavorable" conditions indicate deficiency of the Five Zang organs. Although ancient sages claimed they were untreatable, if one tonifies the Spleen and Stomach and consolidates the root, survival is often possible. How can one abandon treatment simply because it is unfavorable?

Attached Treatment Cases:
The wife of my neighbor Su Ziyu suffered from a carbuncle on her left index finger, experiencing numbness and itching, accompanied by aversion to cold, fever, and nausea. Her entire left half-body was numb, and her pulse was rapid with intermittent irregularities. I said: Generally, sores should not be completely painless, nor should they cause severe pain. Conditions with restlessness and oppression are untreatable. Numbness and itching now indicate a particularly malignant sign. She took two doses of Duoming Dan (Life-Seizing Pill) without effect. Then, detoxifying agents were used, after which the numbness and itching subsided, transforming into swelling and pain. I said: Although the situation is dangerous, it is fortunate that pain has appeared, indicating the toxin has a pathway to exit. I wished to puncture it, but it happened to be the Full Moon day. Her family refused, citing taboos against surgery on this day. The swelling worsened. I forcibly punctured it, and all symptoms immediately receded. After administering detoxifying agents, the sore healed completely.

In early summer of the Xinchui year, I arrived at Siming. Mr. Tu Shouqing experienced sudden, unbearable pain in his front teeth, as if struck. His pulse was full and large, yet wiry. I said: The combination of wiry and full pulses suggests impending carbuncle toxicity. I first prescribed Qingwei San (Stomach-Clearing Powder) with Bai Zhi (Angelicae Dahuricae Radix), Yin Hua (Lonicerae Japonicae Flos), and Liao Qiao (Forsythiae Fructus). One dose stopped the pain. That evening, a sore erupted on his nose, with dark, swollen, and painful facial features. I added Xi Jiao (Rhinocerotis Cornu) to the previous formula. One dose caused swelling to spread to both temples, foul breath exhaled, and the pulse became even fuller and larger, with aversion to cold and internal heat. This indicated blazing toxin and blood stasis, where medicinal power could not contend. I repeatedly scarified the affected areas to release purple-black blood, administered Xi Jiao Jiedu agents, but the next day swelling and pain intensified. I scarified the affected areas and lips again, pricked red vessels inside the mouth to release toxic blood, and continued the previous medication for several doses until cure.

A woman suffered from a flowing abscess (Liuzhu) on her back, with internal ulceration, distension, and pain. After taking Liqi Huatan agents (Qi-Regulating Phlegm-Resolving formulas), she developed spontaneous and night sweats. Her pulse was large and weak, indicating Yuan Qi (Original Qi) deficiency. I prescribed Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) each 1 liang, Dang Gui (Angelicae Sinensis Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 5 qian, and Rou Gui (Cinnamomi Cortex) 2 qian. After administration, I punctured the lesion. By midnight, approximately two bowls of thin pus were discharged. The next day, she sweated profusely, felt extremely fatigued, restless, hot, thirsty, waved her hands, breathed rapidly, and her pulse was full, large, and rapid. I used the previous formula adding Fu Zi (Aconiti Lateralis Radix Praeparata) 1 qian and Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 2 qian. Two doses resolved the pulse and symptoms. Subsequently, she took Liu Jun Zi Tang (Six-Gentlemen Decoction) with Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui for over twenty doses before getting out of bed. Later, due to overexertion, relapse occurred with chills, fever, thirst, and sweating. It was mid-winter, and her breath fogged the curtains. I prescribed Shiquan Dabu Tang (Perfect Great Tonifying Decoction) with Rou Gui and Fu Zi. Two doses resulted in recovery.

Zheng Chaoyong, a Hanlin Academician, had an ulcer that ulcerated with fever, expectoration, loss of taste, lack of muscle regeneration, and fresh blood from the wound. I said: This is Spleen Qi deficiency failing to control blood return to its source. The method should be to tonify the Spleen. He did not believe me and used detoxifying and blood-cooling agents, which led to aversion to cold and vomiting. Only then did he realize my words. I prescribed Liu Jun Zi Tang with Pao Jiang (Zingiberis Rhizoma Preparatum) and Ban Xia (Pinelliae Tuber), along with Fu Ling (Poria). Several doses resolved all symptoms. Then, Shiquan Dabu Tang was used, and the wound gradually closed. Later, due to slight overeating, diarrhea turned into dysentery. This was Spleen and Stomach deficiency-cold with sinking. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) delivered with Sishen Wan (Four-Spirit Pill), stopping the dysentery. Subsequently, Liujunzi Tang cured the ulcer.

A woman, in winter of the Guimao year, became angry over lost items, resulting in slight swelling in the supraclavicular fossa. In spring of the Jiachen year, it swelled like an inverted bowl, and her left scapula also swelled, though skin color remained normal. Someone punctured it, releasing about three bowls of fresh blood. She then suffered abdominal pain like needle insertion, incessant diarrhea, cold limbs, vomiting, aversion to cold, occasional fever, and had been fasting for seven days. Her pulse was full and large, sometimes fine and subtle, indicating collapse and sinking of Yang Qi. I prescribed Liu Jun Zi Tang with Pao Jiang 3 qian and Fu Zi 2 qian, taken in the morning. By noon, there was no response. In the second dose, I increased Fu Zi to 5 qian. Upon waking from sleep, her symptoms receded by six or seven parts, and she ate a little thin porridge. After four more doses, all symptoms receded, diet returned to normal, and only then did the supraclavicular area become painful. Puncture released about two bowls of clear pus, but symptoms returned, indicating extreme deficiency. I prescribed Shiquan Dabu Tang with Gan Jiang (Zingiberis Rhizoma), Rou Gui, and Fu Zi each 1 qian. Three doses brought stability. Later, I reduced Gan Jiang, Rou Gui, and Fu Zi to 0.5 qian each, and prescribed Guilpi Tang (Restore the Spleen Decoction). Combined administration for over fifty doses resulted in cure.

A man suffered from a diffuse, slightly painful back sore, with poor appetite and fatigue. I said: The condition belongs to deficiency of both form and disease energy. The method should primarily tonify Yuan Qi. He did not believe me and used attacking-toxin agents. The central flesh turned dark over an area of five cun, exhibiting all malignant signs. He sought treatment again. I said: This is Stomach Qi deficiency-cold with transformed pathology. Urgently warm and tonify the Spleen and Stomach, and the malignant signs will retreat, and healthy flesh will grow. He still did not believe me, cut away dead flesh, and removed the malignant tissue, ultimately leading to death.

Mr. Mao Li'an's concubine had suffered from an abdominal carbuncle for over a month. The color was dark, not swollen, with internal pain and vomiting, inability to eat, cold limbs, and a pulse that was either absent or floating and large. Various pain-relieving and toxin-defeating agents were used. I said: This is pain caused by joint deficiency of Qi and Blood. There is absolutely no pus internally; it is an untreatable condition. I forced the use of strong warming and tonifying agents for two doses. Pain stopped, color turned red, and food intake slightly improved. I believed it could only prolong life. People thought there was pus and forcibly punctured it. Using strong tonifying agents again, only a small amount of clear pus was discharged. The crowd still believed the toxin was trapped internally and used methods to drain pus, believing this guaranteed survival. Little did they know this accelerated death. What a pity!