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Q: How do carbuncles and ulcers (yongju) arise?
A: The human body consists merely of Qi and Blood. Without Qi, there is no generation; without Blood, there is no circulation. Qi and Blood belong to the category of Yin and Yang. When Yin and Yang are harmonious, the bones and joints are smooth and comfortable. However, if the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade from outside, or the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) harm from inside, coupled with unregulated diet and careless living habits, it leads to dysfunction of the Zang-Fu organs and obstruction of the meridians. Consequently, Qi and Blood coagulate. Depending on their Yin or Yang attributes, they erupt between the skin, muscles, sinews, and vessels. This is the cause of carbuncles and ulcers.

Q: Are there distinctions between carbuncles (yong) and ulcers (ju)?
A: "Yong" implies obstruction. Pathogenic heat obstructs and gathers, preventing the free flow of Qi and Blood. Its clinical manifestation is a Yang syndrome, associated with the Fu organs, characterized by high swelling. "Ju" manifests as a Yin syndrome, associated with the Zang organs, characterized by diffuse swelling, pale color, hardness, and numb pain. Its onset is necessarily slow, making the lesion deep-seated and difficult to treat. These are the distinctions between Yong and Ju.

Q: How should they be treated?
A: In the initial stage, observe the syndrome and apply resolution methods; when pus forms, follow the momentum and apply drainage methods; when toxins are exhausted, tonify deficiencies and apply astringent methods. This is the general principle for treating Yong and Ju. Before pus formation, Yong requires dispersing Yang toxin stagnation, while Ju requires resolving Yin cold coagulation. After pus discharge, if toxin stagnation remains in Yong, supportive methods (Tuo) should be used; if cold coagulation persists in Ju, warming methods should be applied. Even if suffering from a Yin Ju during midsummer, acrid-hot formulas must be used to assist Yang Qi. Conversely, if developing a Yang Yong during severe winter, cooling formulas must be used to drain Fire pathogens. One should not be bound by seasonal considerations but rather adhere strictly to the syndrome differentiation.

Q: Can internal conditions be known by observing external signs?
A: I have heard that medicine relies on intuitive understanding; internal pathology manifests externally. Therefore, the Four Diagnostic Methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation) are essential for syndrome differentiation, with Inspection being one of them. Thus, in surgery, color and shape provide reliable evidence for determining prognosis. These signs are fixed and obvious, unlike the meridian transmission variations seen in Cold Damage syndromes. Generally, redness and pain indicate excess heat accumulation; pallor and dull pain indicate deficiency cold; aversion to cold and fever indicate unresolved exterior pathogens; thirst and constipation indicate unpassed interior pathogens; bright red, high swelling indicates Qi and Blood constraining toxins externally; pale, collapsed, diffuse swelling indicates Qi and Blood freezing internally; a red, spreading base indicates Qi deficiency failing to secure blood; painless hardness indicates Blood stasis failing to support Qi movement; red exterior with black interior indicates untransformed toxin stagnation; purple-dark indistinctness indicates severe damage to Stomach Qi and muscle necrosis; indentation upon pressure that does not rebound immediately, with a warm but not hot apex, indicates pus has not yet formed; rebound upon pressure, with a soft and hot apex, indicates pus is fully formed; thick pus indicates strong Qi and Blood; thin pus indicates weak Qi and Blood. By examining the exterior to understand the interior, palpating the site, and tracing the source, one achieves "knowing through inspection."

Q: Are sores and scabies (chuangjie) the same as carbuncles and ulcers? What causes some to manifest as sores and scabies instead?
A: The human body has five layers: skin, vessels, flesh, sinews, and bones. Lesions arising between sinews and bones are Ju; those between vessels and flesh are Yong; those between the skin and interstices are Chuangjie. Generally, due to insufficiency of Ying and Wei, damp-heat, pathogenic wind, and turbid qi from rich foods invading the skin and lingering without dispersal, sores and scabies arise. They may present as itching, pain, suppuration, or weeping, with various names and treatments. Heat is cooled, dampness is drained, parasites are killed, wind is dispersed, and dryness is moistened and nourished. One should also avoid bathing to prevent dampness exposure and avoid rich flavors to clear Ying and Wei, leading to recovery. Thus, compared to Yong and Ju, Chuangjie shares similarities but has minor differences. Alas! If people cultivate carefully, ensuring smooth Qi and abundant Blood, preventing physical decline, where would Yong, Ju, Chuangjie, and Scabies arise? If not, myriad diseases will emerge, far exceeding just these dermatological conditions. The ancients advocated treating disease before it arises, which is not an empty phrase.