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Xue Lizhai stated: If pain persists after the discharge of pus, it indicates deficiency; tonification is indicated. If the pulse is rapid and weak accompanied by pain, it belongs to deficient fire; nourishing yin is indicated. If the pulse is rapid and full accompanied by pain, it indicates excess pathogenic factors; draining is indicated. If the pulse is full with constipation and pain, the pathogen is internal; purgation is indicated. If the pulse is choppy accompanied by pain, it indicates deficiency-cold of qi and blood; warming and tonifying are indicated.

Generally, when a sore first appears, swelling occurs initially due to the stagnation of qi and blood, which steams the flesh into pus, thus causing pain. After the pus breaks, the swelling subsides and the tissue relaxes, so the pain must gradually decrease. If pain persists or worsens, it is due to deficiency, and tonification is required. There are also cases caused by contact with foul pathogens, where harmonizing is appropriate; or those forced by wind-cold, where warming and dispersing are appropriate.

Ding Lan, in his early twenties, had suffered from a toxic sore on the inner thigh for a long time and sought internal resolution. His pulse was slippery and rapid, indicating that pus had formed. However, due to deficiency of qi and blood, it failed to rupture spontaneously, so I punctured it. After the pus discharged, pain occurred. I treated him with Bazhen Tang (Eight Treasure Decoction), resulting in slight improvement. Since the pus was clear and thin, I prescribed Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with five fen of Pao Fuzi (Prepared Aconite Root). After several doses, he gradually recovered. He continued taking Shiquan Dabu Tang for over thirty doses until fully healed.

A monk had a swollen lump on his inner thigh that did not hurt nor rupture. After treating him with resolving and expelling agents for over twenty doses, pus formed. Upon puncturing, he felt pain. I said: Swelling without rupture, and pain upon rupture, indicates severe deficiency of qi and blood; vigorous tonification is required. He replied: "Tonifying qi is not a method." I said: When righteous qi is insufficient, it must be tonified. Tonification promotes qi transformation, relieving pain, and the pathogen will naturally be expelled. I then treated him with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Shudihuang (Rehmanniae Radix Praeparata). After more than two months, the condition resolved. (Note by Xue Ji)

There are three methods for palpating heat: If light palpation reveals heat but heavy pressure does not, the heat is in the skin and vessels. If heavy pressure down to the sinews and bones reveals intense heat steaming the hand, while light palpation shows no heat, the pathogen is between the sinews and bones. If moderate pressure reveals heat, the heat is above the sinews and bones but below the skin and vessels, i.e., in the muscles.

Zhang Zhongjing stated: A deficient pulse indicates blood deficiency; blood deficiency generates cold, reflecting insufficient yang qi. A faint pulse at the Cun position indicates insufficient yang qi; when yin qi enters the yang region, it causes shivering aversion to cold. A weak pulse at the Chi position indicates insufficient yin qi; when yang qi sinks into the yin region, it causes fever.

Wang Shi stated: In febrile disease with a rapid pulse that lacks force upon pressure, this is caused by extreme cold repelling yang, not true heat. If the clinical signs resemble cold, but the pulse qi beats vigorously under the fingers upon pressure, this is extreme heat repelling yin, not cold.

Li Dongyuan stated: Symptoms such as fever, aversion to heat, excessive thirst, restlessness, hot skin, desire to remove clothing, eye pain, and dry nose, combined with a flooding pulse that is empty upon pressure, do not constitute a Baihu Tang (White Tiger Decoction) syndrome. This is irritability due to blood deficiency; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) should be used. There are also conditions of heat due to constrained fire, such as fever with inability to eat, spontaneous sweating, and shortness of breath, which indicate deficiency; sweet-cold herbs should be used to drain heat and tonify qi. If there is fever with ability to eat, dry mouth and tongue, and difficult defecation, bitter-hot and acrid-hot herbs should be used to purge, thereby draining fire and preserving fluids. He further stated: Fever during the day and quietness at night indicates yang qi flourishing in the yang aspect. Quietness during the day and fever/restlessness at night indicates yang qi sinking into the yin aspect, termed Heat Entering the Blood Chamber. Fever and restlessness both day and night indicate excessive yang and absence of yin; one should urgently drain yang and vigorously tonify yin.

Xue Lizhai stated: A floating or weak pulse with fever or aversion to cold indicates deficiency of yang qi; tonifying qi is indicated. A choppy pulse with fever indicates blood deficiency; tonifying blood is indicated. A floating and rapid pulse with fever and pain indicates the pathogen is in the exterior; dispersing is indicated. A deep and rapid pulse with fever and pain indicates the pathogen is in the interior; purging is indicated. Fever occurring before noon is primarily treated by tonifying blood; fever occurring after noon is primarily treated by tonifying qi. If the pulse on the left hand is smaller than the right with fever, blood-invigorating herbs should outweigh qi-tonifying herbs. If the pulse on the right hand is smaller than the left with fever, qi-tonifying herbs should outweigh blood-invigorating herbs.