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The onset of carbuncles and sores is generally caused by the stagnation and obstruction of Qi and blood, similar to the blockage of river channels. If Qi and blood could flow smoothly, how could carbuncles and sores arise? Therefore, when fire-toxin stagnates, it causes redness, swelling, and pain, forming a carbuncle (Yang sore); when cold-phlegm stagnates, it causes flatness, numbness, and swelling, forming a sore (Yin sore). Carbuncles should be treated as excess-heat patterns, while sores should be treated as deficiency-cold patterns; this is clear at a glance and does not require pulse diagnosis. However, once the stagnation persists for a long time, healthy blood transforms into pus, and healthy muscle tissue breaks open, which is truly painful! In the early stage before pus formation, one should urgently treat according to the syndrome of the carbuncle or sore using resolving methods, so that pain stops and swelling subsides, leaving the patient comfortable and at ease, would this not be delightful? I often see those who rely on their skill with knives and needles without carefully examining whether such instruments are indicated for the condition, casually claiming to drain toxin; these are people who kill within the blink of an eye. This not only subjects patients to extreme pain but also makes them endure such suffering. Moreover, reckless use of knives and needles can lead to difficult-to-heal ulcers and the sudden appearance of the "Seven Evils" (seven critical syndromes in external medicine). Physicians with benevolent hearts and skills would surely not act so recklessly.

If carbuncles and sores are neglected in the initial stage, it leads to ulceration of the skin and flesh. Whenever a carbuncle is about to suppurate, one should first resolve the area where pus has not yet formed, so that upon ulceration, it will not spread and rot; after ulceration, applying head ointment (topical plaster) ensures healing. For individuals with robust Qi and blood and thick skin and flesh, even slight needle pricking may suffice. However, sores always require treatment focused on warming and tonifying, opening the interstices (pores/skin texture), and resolving stagnation throughout their course. Mr. Wang Hongxu stated: When a sore initially presents as flat, how can one use the method of supporting and expelling (Tuo Fa)? Using Tuo Fa would cause ulceration. This applies even to conditions like flowing abscesses (Liuzhu), scrofula (Luoli), and malignant nodules (Ehe). If there are already ulcerated cases, one still dares not use Tuo Fa; if Tuo Fa were used, although the existing ulcers might heal, what would happen to the newly emerging lesions? These words are profound.

Mr. Wang said: After large carbuncles ulcerate, people often administer roasted Licorice Root (Zhi Gancao) or roasted Astragalus Root (Zhi Huangqi), or a mixture of half-roasted and half-raw. They fail to realize that in formulas like Neituo San (Internal Support Powder) containing Ginseng Radix et Rhizoma (Renshen), the purpose is not merely to tonify deficiency, but to assist Astragalus Root (Huangqi) in expelling toxin, avoiding the harm of nourishing the pathogen. Roughly speaking, roasted Astragalus only tonifies Qi but cannot expel toxin, and roasted Licorice only tonifies the Middle Jiao but cannot resolve toxin. If the toxic qi is not fully cleared, mistakenly administering roasted Astragalus and Licorice may inadvertently aid the toxin, causing severe internal pain; what then? My treatment approach for large carbuncles that have just ulcerated is to first stop the pain; once pain ceases, the toxin disperses, swelling recedes, and the color turns vibrant red. For elderly patients with weak constitutions, Ginseng, Astragalus, and Licorice are all used in their roasted forms. For those with strong constitutions and poor financial means, omitting Ginseng can still achieve therapeutic success.