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Yangmei Chuang (Mulberry Sores) is a condition named for its swollen, protruding, red, and ulcerated lesions that resemble mulberries. In the northwest, it is called Tianpao Chuang (Heaven Blister Sore); in the southeast, it is known as Guangdong Chuang (Guangdong Sore). When the toxin is mild and the lesions are small, resembling cornels (Zhu Yu), it is named Zhuyu Chuang (Cornel Sore). When the toxin is severe and the lesions are large, with widespread, terrifying ulcers resembling cotton, it is named Mianhua Chuang (Cotton Sore). Generally, this condition arises from transmission of venereal toxins. This foul toxin, after ejaculation, penetrates directly through the essence pathway into Mingmen (Gate of Life) due to deficiency, then floods Chong Mai (Penetrating Vessel). Thus, externally it reaches the skin and hair, and internally it enters the bone marrow; wherever Chong Mai travels, the toxin reaches, making its harm profound and dire. If the toxin is not thoroughly eliminated at the onset, or if treatment is inappropriate, leading to decay, ulceration, and death, such cases are numerous. Some may develop Feng Du (Mad Toxin) decades later, causing ulceration of the head or nose, or foul decay in hidden areas of the limbs, or transmit residual toxins to offspring, causing lifelong illness. Its malignancy is such that anyone who sees this evil path without feeling horror and knowing to avoid it is extremely foolish. Therefore, the key to treatment lies in grasping the essentials; one must be extremely cautious. However, some contract it not from venereal transmission but by accidentally contracting damp-heat; these cases remain merely between the skin and muscles, and clearing the damp-heat leads to full recovery, requiring no concern.

1. Nowadays, when people suffer from this, fearing exposure or the severity of the toxin, they often use harsh attacking and purgative medicines excessively. This frequently results in the pathogenic toxin remaining while the Yuan Qi (Primary Qi) collapses first, leading to Lao Zhai (Consumption Disease), immediate death, or worsening over time until decay prevents healing. All these are due to the prior collapse of Yuan Qi, which I have seen often. Thus, those afflicted should not panic nor rely solely on aggressive attacks. Instead, follow the method to gradually resolve the toxin, ensuring Yuan Qi remains undamaged. Then Zheng Qi (Upright Qi) can overcome Xie Qi (Pathogenic Qi), rendering the toxin harmless. If Zheng Qi cannot overcome Xie Qi, even slight toxins can be fatal. This is the crux, which must be carefully examined.

1. Treatment methods for Guang Chuang (Broad Sore/Yangmei Chuang): For early stages where Yuan Yang is unharmed and the toxin is not severe, rapid use of clearing and draining methods to expel toxins via urine is indicated. Huanji Xiaodu San (Skin-Rejuvenating and Toxin-Resolving Powder) is the primary choice, followed by Wujia Pi Yin (Acanthopanax Bark Decoction). If accompanied by Fire Evil, Mi Wanxian Yiliang Tang (Secret Ten-Thousand Immortals' Ration Decoction) is suitable. For those with weak constitutions, Fuling Gao (Poria Paste) is appropriate. These medicines, taken for ten days, half a month, or even a month in severe cases, invariably show efficacy.

1. Those suffering from sores and toxins should consume Huai Hua Rui (Sophora Flower Buds), up to two or three sheng, to expel toxins via urine, preventing lifelong affliction; this is truly a miraculous prescription. Refer to the section on Xiagan Chuang (Chancre). At the onset, this sore often begins with Xiagan (Chancre), followed by Biandu (Bubo/Groin Swelling), and then the general sores appear—a sequence. If Biandu is severe, with swelling, pain, heat, and constipation, in patients with strong Yuan Qi, Huinong San (Suppurating Powder) or Muli San (Oyster Shell Powder) should be used first to reduce the major force of the toxin, before applying the aforementioned formulas. This is also a crucial step.

1. If the sore persists for a long time, or if Yuan Qi is inherently weak, or weakened by excessive purging, and signs indicate Zheng Qi failing to overcome Xie Qi, one must assess the severity. One may focus purely on tonifying Yuan Qi. Formulas for Spleen and Kidney, Yin and Yang, Qi and Blood should be selected according to the syndrome. As long as Qi and Blood are restored, the toxin becomes harmless. The greatest taboo is indecision due to poor judgment, which yields no benefit; this is another crucial point.

1. Regarding diet: Some advocate dietary restrictions, others do not, allowing sores to erupt freely. There is a principle here. Initially, when the toxin is fresh and not severe, clearing and draining is best to gradually eliminate the toxin. Eating "Fa Wu" (Hair-Raising/Triggering Foods) causes more eruptions and worsens the toxin; thus, restriction is necessary at this stage. However, if the sore has persisted, Yuan Qi is weak, pus is abundant, and Qi and Blood are depleted, nutritional support via medicine and food is required to prevent daily deterioration and achieve healing; thus, restriction is unnecessary here. Whether to restrict or not depends on whether tonification is needed or not. Without discernment, errors are inevitable.

1. For sores on the face or inaccessible parts of the body, desiring rapid healing, topical applications can cause detachment in two to three days; this is also miraculous. However, this is only a symptomatic treatment. See Xin Yin (New Causes), Chapter 42.

1. Accumulated toxins manifesting as Feng Du (Mad Toxin), also called Yangmei Yong Lou (Mulberry Carbuncle Fistula), eroding sinews or bones, with non-healing ulcers, is a dire prognosis. Recent treatments favor Wubao Dan (Five Treasures Pill), Xu Donggao's Yangmei Yong Lou Fang, or Secret Water Mercury Ointment, chosen appropriately.

Xue Lizhai stated: Tianpao Chuang belongs to insufficiency of Yuan Qi with pathogenic invasion, and can also be contagious. The pathology involves the Liver and Kidney meridians, so it often originates in the lower body. It may present with bone/joint pain preceding sores, or sores preceding pain. Red, protruding, painful sores indicate intense Heat-Toxin. Mild pain suggests the toxin is subsiding. White sores without scabbing indicate Yang Qi deficiency. Red sores without scabbing indicate Yin-Blood deficiency. Itching with a deficient, floating pulse indicates Qi failing to nourish. Itching with a floating, rapid pulse indicates Blood failing to nourish. Itching between buttocks/back or neck indicates Bladder Yin deficiency. Itching in genitals/thighs indicates Liver Blood deficiency. Heavy, itching scrotum indicates Liver Yin deficiency with Damp-Heat. Frequent, scanty, red urine indicates Liver Yin deficiency. Frequent, scanty, white urine indicates Spleen-Lung Qi deficiency. Facial itching or reddening indicates external pathogen conflict. Eyebrow itching or hair loss indicates Liver-Gallbladder Blood dryness. Poor appetite and dry mouth craving hot drinks indicate Stomach Qi deficiency. Indigestion and loose stools indicate Spleen Qi deficiency. Morning or night diarrhea indicates Spleen-Kidney deficiency.

Furthermore, *Treatment Methods* states: For exterior excess, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) to release the exterior. For interior excess, use Neishu Huanglian Tang (Internal Draining Coptis Decoction) to purge the interior. For both exterior and interior excess, use Fangfeng Tongsheng San (Saposhnikovia and Gardenia Detoxifying Powder) to resolve both. For Heat-Toxin in the Liver Meridian, use Longdan Xiegan Tang (Gentian Decoction to Drain the Liver). Subsequently, use Huanji Xiaodu San as the main formula; upon recovery, bone and joint pain will not recur. For Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction). For Blood deficiency, use Siwu Tang (Four Substance Decoction). For combined Qi and Blood deficiency, use Bazhen Tang (Eight Treasure Decoction). Add herbs for accompanying syndromes; cure is assured. If treatment fails, causing eye damage, penile rot, or limb contracture, use Jiawei Lushan Wan (Nine-Ingredient Aloe Pill) to clear Liver Fire, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to generate Kidney Water, and Juanbi Xiaodu San (Bi-Unblocking and Toxin-Resolving Powder) to nourish Blood and dispel pathogens; survival is possible. Using Qingfen (Calomel) etc., may trap toxins internally, causing recurrence. General use of Fangfeng Tongsheng San may further deplete Qi and Blood, leading to untreatable conditions. For swelling, hardness, or pain, external garlic moxibustion and Chonghe Gao (Harmony Paste) application, combined with internal tonics, are effective.

Case 1: A man suffered all over his body with a floating, rapid pulse. Treated with Jingfang Baidu San, exterior symptoms resolved. Followed by Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction) for six doses, sores improved. Combined with Bibi Tang (Dioscorea Hypoglauca Decoction), cured in over a month.

Case 2: A man had chancre in the lower part, unresponsive to various medicines, spreading to the whole body with swelling resembling foreign flowers, tendon spasms, and bone pain, worse at night. Caused by Damp-Heat in Liver and Kidney meridians. First, Daoshui Wan (Water-Directing Pill) five doses; then Longdan Xiegan Tang several doses; followed by Damp-removing and Spleen-strengthening herbs. Applied Shenyi Gao (Miraculous Differentiation Paste) externally to absorb pus, and garlic moxibustion to draw out toxins. Cured.

Case 3: A boy suffered on the penis, spreading to several spots on the lower abdomen with pain and fever. Treated with Xiaochaihu Tang (Minor Bupleurum Decoction) swallowed with Lushan Wan (Aloe Pill), plus Shenyi Gao applied externally. Settled in over a month.

Case 4: A scholar suffered the above syndrome. Initially, the penis itched and discharged fluid, then small sores appeared on the scrotum, thighs, lower abdomen, ribs, and arms, either dry or pustular. Mistakenly treated with Wind-dispelling medicines, leading to limb fatigue, aversion to cold, fever, reduced appetite, loose stools, floating-wiry pulse, and floating-rapid pulses at the Chi position. Diagnosed as Kidney Water deficiency with Empty Heat, and Liver Wood overacting on Spleen Earth. Treated primarily with Liujun Diwang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Middle-Warmer Boosting Qi-Decoction), assisted by Huanji Xiaodu San. Cured.

Case 5: A person suffered this condition, took anti-toxin medicines, resulting in convex, red, painful lesions, limb fatigue, aversion to cold, fever, and a floating, deficient pulse. This indicated renewed injury to Yuan Qi with Excess Pathogens. Treated with Buzhong Yiqi Tang; cured in two doses.

Case 6: Jinshi Liu Huafu suffered for months, using Calomel and Cinnabar. Lumps formed on the head, face, back, and buttocks, about two cun each, ulcerating with decline in form and Qi, alternating chills and fever, dry mouth, dry tongue, cracked lips, dribbling urine, phlegm obstructing upwards, and poor appetite. This indicated Spleen-Stomach damage, weakness of all organs, and stirring of Deficient Fire. First, Liujunzi Tang for over twenty doses; then Buzhong Yiqi Tang added with Shan Yao (Dioscorea Rhizome), Shanzhuyu (Cornus Fruit), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Fruit). Stomach Qi recovered, and symptoms resolved. Only unclear urine and persistent phlegm remained; treated with Jiawei Bawei Wan (Modified Eight-Ingredient Pill). Cured.

Case 7: A man, after Yangmei Chuang, developed ulcers about two cun deep on both legs and one arm, with dripping pus, poor appetite, insomnia, and chronic non-healing. Treated with Bazhen Tang added with Fushen (Poria with Hostwood) and Zaoren (Ziziphus Seed, stir-fried). Daily application of mashed garlic to the sores, prolonged moxibustion, followed by plaster application; improved in a few days. Switched to Douchi Bing Jiu (Fermented Soybean Cake Moxibustion), and took Shiquan Dabu Tang (Ten Complete Tonifying Decoction). Cured.

Case 8: A woman, mostly recovered, except for palm-sized ulcers on both legs and knees, with tendon spasms and bone pain, persisting for three years, unresponsive to medicines. Severe afternoon fever, poor appetite. Treated with Bibi Tang combined with Xiaoyao San (Free and Easy Wanderer Powder), doubling Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome) for several doses; fever stopped, appetite returned. Applied Shenyi Gao, then took Bazhen Tang added with Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), and Mugua (Chaenomeles Fruit) for over thirty doses. Cured.

Case 9: A woman suffered this condition, fumigated herself with Calomel under blankets, causing widespread skin sloughing, dripping pus, and inability to rise. Spread powder of Huashi (Talcum), Huangbai (Phellodendron Bark), and Lüdou (Mung Bean) on the mat to lie on. Took Shengong Tuoli San (Divine Efficacy Supporting Interior Powder). Cured in over a month. (All cases annotated by Xue Ji)