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The treatment of sores and ulcers includes methods suitable for purging (Purging), those suitable for tonifying (Tonifying), those suitable for dispersing (Dispersing), and those suitable for regulating Ying (Nutrient) blood and resolving toxins. Medications should be selected according to the syndrome, each with its specific indication. The *Classic of Medicine* states: "When both physical constitution and pathogenic factors are in excess, purging is indicated rather than tonifying; when both physical constitution and pathogenic factors are deficient, tonifying is indicated rather than purging." This constitutes the general principle. Therefore, in diagnosing diseases, if the pulse is slippery, full, flooding, or rapid, accompanied by severe swelling and pain, irritability, heat, epigastric fullness and stagnation, and blockage both internally and externally, this represents a true Excess syndrome. Here, the toxin resides within the Zang-Fu organs. Without using potent agents such as Mirabilite (Natrii Sulfas) and Rhubarb (Rhei Radix et Rhizoma) to purge and drive out the toxin, the toxin will never be resolved. Thus, purgative methods must be employed; however, they should not be used lightly unless there is genuine accumulation. This explains why purgatives are not to be used casually.

In cases where the pulse is faint and fine, and the Qi and Blood have always been weak, or where there is swelling without ulceration, or ulceration without healing, or reduced appetite, mental fatigue, vomiting and diarrhea, cold hands and feet, and thin, clear pus, these are all signs of severe Deficiency. Such cases require complete use of warming and tonifying methods, which is beyond doubt. However, it is not limited to this. Even if the pulse lacks flooding or rapid qualities, there is no external irritability or heat, and no internal stagnation, yet the toxin remains a concern, although this is not a severe Deficiency syndrome, one should observe that since there is no Excess pathogen, methods to support the interior and nourish Ying (Nutrient) blood should be used to protect Yuan Qi (Original Qi) in advance. Why? Because prolonged suffering may lead to spontaneous deficiency after the pus drains, before any further damage occurs. When the condition becomes critical, it is too late to act. Therefore, Zhu Danxi stated: "Carbuncles and sores result from accumulated toxins in the Zang-Fu organs; one should first strengthen the Stomach and boost Qi to consolidate the root." In this way,凝结 (coagulated) Qi and Blood will naturally disperse, formed pus and stasis will naturally ulcerate, necrotic muscle will regenerate, dead tissue will slough off, and open wounds will heal. If one only attacks the sore, the Spleen and Stomach will weaken, leading to the emergence of the Seven Evil syndromes (Seven Evil Syndromes); survival would be merely fortunate. This is the point being made.

In cases where the pulse is tight and rapid, with fever and aversion to cold, headache, body pain, or limb stiffness without sweating, this indicates invasion by abnormal seasonal pathogens closing the skin and hair, with excessive Wind-Heat causing swelling and carbuncles. This is an Exterior pathogen suitable for dispersing. If there are no Exterior symptoms, dispersing methods should not be used recklessly, to avoid damaging Yang and Wei (Defensive) Qi. Thus, Zhang Zhongjing said: "Patients with sores should not be induced to sweat," referring to this principle.

In cases where Ying (Nutrient) and Wei (Defensive) Qi are disharmonious, and Qi and Blood stagnate, causing occasional carbuncles, provided Yuan Qi is intact, diet is normal, the pulse shows no ominous signs, and there are no Seven Evil syndromes, the disease is in the Fu (Hollow) organs rather than Zang (Solid) organs, and in the Exterior rather than the Interior. Heat should be cleared, toxins resolved, and stagnation moved. One should regulate Ying and Wei and treat according to peaceful methods. Generally, for sores and ulcers, Yang syndromes with Excess in both pathological and constitutional Qi are mild; Yin syndromes with Deficiency in both are severe. If Righteous Qi is insufficient while Pathogenic Toxin is excessive, neither tonification nor attack is appropriate, indicating a critical condition. If the toxin is gone but the Spleen and Kidney are ruined and Qi and Blood cannot recover, it is incurable. Therefore, clinicians must carefully examine Excess and Deficiency, assess Pathogen and Righteous Qi, distinguish Exterior and Interior, and weigh the pros and cons. Any slight deviation in management will cause great harm. The responsibility is heavy and must not be taken lightly.

Wang Haizang in *Yuan Rong* stated: "If a person has abundant and obstructed Qi and Blood, with充盈 (full) Ying and Wei Qi that cannot circulate, leading to putrefaction and carbuncle formation, purging should be used to drain the excessive heat. If a person has poor appetite, weak spirit, short and stagnant Ying and Wei Qi, with Cold binding causing carbuncle, tonifying should be used to replenish the deficient and timid Qi." Zhu Danxi also said: "For early-stage sores (Swollen Ulcer) with internal and external deficiency, the main approach should be tonification, connection, and dispersion."

Li Dongyuan stated: "The onset of sores and carbuncles differs in origin (internal vs. external) and treatment (cold vs. hot). External origins should be treated with interior-supporting warm formulas. Using cold herbs instead draws the pathogen from the skin into the bone marrow. Internal origins should be treated with draining and promoting cold formulas. Using warm interior-supporting herbs instead causes bone marrow pathology to penetrate to the skin, resulting in systemic ulceration, aiding the pathogen's toxicity, causing immense suffering, danger, or death." *Ji Yao* states: "Internal-originating external lesions present with deep, full pulses, fever, irritability, and no superficial redness/pain; because the pathogen is deep inside, one should unblock the Zang-Fu to cut off the source. External-originating internal lesions present with floating, rapid pulses, superficial swelling, and visible exterior signs; fearing extreme pathogen penetration inward, one should first support the interior. Lesions between internal and external show no evil signs externally and smooth Zang-Fu function internally, indicating involvement of the meridians; one should harmonize Ying and Wei. After applying these three methods, even if not immediately cured, complications are avoided, the pathogen is significantly reduced, and recovery is facilitated. Thus, the key to treating sores is understanding these three methods: supporting the interior, unblocking/dredging, and harmonizing Ying and Wei."

Chen Liangfu stated: "All painful, itching sores and ulcers belong to Heart Fire." Seniors noted that carbuncles often occur in people taking mineral drugs or engaging in excessive sexual activity. People over forty should first use Neituo San (Interior-Supporting Powder), then Wuxiang Liaoqiao Tang (Five-Aromatic and Forsythia Decoction), along with Qizhuma moxibustion, garlic-separated moxibustion, and direct moxibustion on Zusanli (ST 36) to vent the toxin. Wherever pathogen gathers, Qi is deficient; where it lingers, it becomes Excess. Thus, before ulceration, no hot herbs should be used. After ulceration, when Zang-Fu are depleted, no cold herbs should be used. Also, avoid topical applications that close pores. For heat, thirst, constipation, and deep, full, flooding, rapid pulses, use Rhubarb (Rhei Radix et Rhizoma) to purge toxins, followed by Guolao Gao, Wanjing San, Huangfan Wan, or Yuanzhi Jiu.

Xue Ji stated: "Regarding previous syndromes: If heat-toxin is trapped internally with constipation and intact Yuan Qi, use Rhubarb (Rhei Radix et Rhizoma) to purge heat-toxin. If Yin deficiency with Yang encroachment, essence deficiency, timid Qi, and weak Spleen-Stomach, use sweet-warm agents to cultivate the root. If the sore does not swell or suppurate, even before ulceration, warming and tonifying are still required. If ulcerated but swelling and pain persist, cool agents are still appropriate. If acute and Yuan Qi is strong, treat the branch first. If chronic and Yuan Qi is weak, treat the root first. If acute and Yuan Qi is very weak, treat the root primarily while addressing the branch. Generally, high, swollen, painful sores with thick pus indicate intact Yuan Qi and easy treatment. Flat, mildly painful sores with thin pus indicate weak Yuan Qi and difficult treatment. Non-swollen, non-painful, or flat dark sores not ulcerating indicate Yin onset, severe Yuan Qi deficiency, and likely incurability. For high, swollen, painful sores, use Xianfang Huoming Yin (Immortal Life Elixir) first, then Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) later. For flat, mildly painful sores, use Tuoli San (Interior-Supporting Powder); if ineffective, add Ginger (Zingiberis Rhizoma Recens) and Cinnamon Twig (Cinnamomi Ramulus). If pain increases after pus drainage, it is Qi and Blood deficiency; use Bazhen Tang (Eight-Treasure Decoction). If no suppuration or sloughing, it is Yang Qi deficiency; use Sijunzi Tang (Four-Gentlemen Decoction) plus Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), and Cinnamon Twig (Cinnamomi Ramulus). If no granulation or healing, it is Spleen Qi deficiency; use Shiquan Dabu Tang (Perfect Great Tonifying Decoction) plus Ginger and Cinnamon Twig. If afternoon fever or internal heat, it is Yin Blood deficiency; use Siwu Tang (Four-Materials Decoction) plus Ginseng (Ren Shen) and Atractylodis Macrocephalae Rhizoma (Baizhu). If nausea or vomiting, it is Stomach Qi deficiency; use Liujunzi Tang (Six-Gentlemen Decoction) plus roasted Ginger (Shengjiang Pao). If spontaneous or night sweats, it is Five Zang deficiency; use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Schisandrae Fructus (Wuweizi). If poor appetite and fatigue, it is Spleen Qi deficiency; use Buzhong Yiqi Tang (Middle-Warming and Qi-Boosting Decoction) plus Poria (Fuling) and Pinelliae Rhizoma (Banxia). If panting and cough, it is Spleen-Lung deficiency; use the previous decoction plus Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi). If nausea and poor intake, it is Spleen-Stomach deficiency; use Renshen Lizhong Tang (Ginseng and Magnolia Bark Decoction). If abdominal pain and diarrhea, it is Spleen-Stomach deficiency-cold; use Fuzi Lizhong Tang (Aconite and Magnolia Bark Decoction). If lower abdominal fullness and leg edema, it is Spleen-Kidney weakness; use Shiquan Dabu Tang plus Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), and Cinnamon Twig. If diarrhea and cold feet, it is Spleen-Kidney deficiency-cold; add Cinnamon and Aconite to the previous medicine. For heat, thirst, and dysuria due to Kidney deficiency and deficient fire, use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). For panting, cough, and dysuria due to Lung-Kidney deficiency-fire, combine Buzhong Yiqi Tang with Jiajian Bawei Wan. All these variations result from Yuan Qi depletion and failure to tonify in advance. Furthermore, when medicating sores, one must examine meridian involvement, root and branch, and Excess/Deficiency. Do not rigidly adhere to 'heat-toxin attacking inward' using only cold-draining agents that damage Spleen-Stomach Qi and Blood, leading to errors. Especially for weak patients, harsh purgatives injure Stomach Qi before reaching the target, causing 'deficiency upon deficiency.' Thus, for insufficient Yuan Qi, besides treating the initial complaint, internally use Ginseng (Ren Shen), Angelica (Danggui), and Atractylodes (Baizhu) to warm-tonify Spleen-Stomach, and externally use Mulberry Branch and Scallion moxibustion to connect and supplement Yang Qi for natural resolution. Also, if early-stage carbuncles present with deep-fine pulse, irritability, weak viscera, cold skin, fierce toxin, restlessness, and deep exterior signs, immediately use Tuoli San and warm-hot agents to treat from the side. If fever, thirst, and constipation exist due to internal pathogen accumulation, use Nishu Huanglian Tang (Internal-Draining Coptis Decoction) to purge internal toxin. If headache, stiffness, fever, and aversion to cold exist due to external pathogen invasion, use Renshen Baidu San (Ginseng and Rescue the Extremities Powder) to disperse exterior pathogen. If swelling, pain, redness, fever, and thirst exist due to toxin condensing in flesh, use Xianfang Huoming Yin to resolve the toxin. If poor appetite, fatigue, fever, and aversion to cold exist due to Middle Qi weakness, use Liujunzi Tang to tonify Spleen-Stomach. Generally, syndromes have root and branch; treatments allow flexibility. Treating the main issue resolves secondary issues. Using flexibility avoids rigid adherence to time or convention. Rigid adherence leads to critical conditions. Moreover, indiscriminate use of attacking agents damages various meridians. Luo Qianfu said: 'Adhering to convention is the view of the masses; knowing change is the act of the wise. Knowing convention but not change leads to many failures over minor matters.'"

For all carbuncles and sores, Excess syndromes should not be warmed-tonified, and Deficiency syndromes should not be cooled-purged; this is the general rule. As Chen Liangfu stated: "Before ulceration, no hot herbs should be used. After ulceration, when Zang-Fu are depleted, no cold herbs should be used." Xue Ji added: "Severe swelling/pain, irritability, large pulse, alternating chills/fever, constipation, painful urination, and mental confusion indicate pathogenic heat. Hot agents are contraindicated for both early-stage and ulcerated sores." This is correct. However, these masters only addressed half the truth. I argue that for Yin-excess/Yang-deficiency sores, presenting with weak constitution, faint pulse, and powerless Yang, even bitter-cold agents are contraindicated for both early-stage and ulcerated sores. Conversely, for toxins caused by Yin-Cold coagulation, how can circulation be maintained without warm-hot agents? Therefore, Chen's statement that hot herbs are universally contraindicated for early-stage sores cannot be generalized.