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Chen Liangfu stated: The toxicity of carbuncles and sores varies in depth; therefore, the speed of healing and closure varies. It is absolutely inadvisable to use astringent agents for wound closure too early. One must fear that if the toxic pathogens are not fully expelled, they will inevitably recur later, causing severe harm. If a sore fails to heal for a long time, with pale flesh and scanty pus, this indicates deficiency of both Qi and Blood, failing to circulate and nourish, resulting in a cold and stagnant wound opening. Daily, boil a handful of Artemisia argyi Folium (Ai Ye, Mugwort Leaf) in water, wash the area while avoiding wind and heat, fumigate it with smoke from burning pine wood, or wash it with broth made from pig trotters. Then apply Shenyi Gao (Miraculous Ointment). Strict adherence to dietary and lifestyle taboos is required during recovery; otherwise, the treatment will be ineffective. He further stated: When the pulse sinks due to cold, stagnation occurs in the muscles, lingering in the muscle layers and interstices, termed "Cold Fistula" (Leng Lou). This requires warming and tonifying treatments.

Danxi stated: Among the meridians, only the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) meridians are prone to carbuncles and require special caution, as they are characterized by abundant Qi and scarce Blood. Scarce Blood makes muscle growth difficult; thus, if a wound fails to close for a long time, it will inevitably degenerate into a critical condition (Bai Zheng). If one mistakenly uses purgative or toxic drugs to attack the Blood of the Yin aspect, disaster will follow swiftly.

Lizhai stated: Muscles are governed by the Spleen and Stomach. Closure is driven by Qi and Blood. Therefore, one should purely tonify the Spleen and Stomach rather than indiscriminately applying topical agents for muscle regeneration. If a wound fails to regenerate flesh and appears intensely red, it is due to Blood Heat; treat with Siwu Tang (Four Substances Decoction) plus Gardeniae Fructus (Shanzhi) and Forsythiae Fructus (Lianqiao). If the color is pale and lacks luster, it is due to Qi Deficiency; treat with Sijunzi Tang (Four Gentlemen Decoction) plus Angelicae Sinensis Radix (Danggui) and Astragali Radix (Huangqi). Afternoon fever or internal heat indicates Yin Blood Deficiency; treat with Siwu Tang plus Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). Clear and thin pus indicates Qi and Blood Deficiency; treat with Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction). Reduced appetite and physical fatigue indicate Spleen Qi Deficiency; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Irritability, fever, and thirst with normal appetite indicate Stomach Fire; treat with Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction - *Note: Text says 'Zhuye Huang', likely referring to a variation or typo for Zhuye Shigao Tang, but translated literally here based on context of Stomach Fire*). If there is no response, switch to Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Fever, thirst, and frequent urination indicate Kidney Water Deficiency; treat with Jiaban Bawei Wan (Modified Eight-Ingredient Pill) decocted and taken orally. After necrotic tissue is removed, if new flesh is slightly red with a white membrane around the edges, this represents the generating Qi of the Stomach. Simply use Sijunzi Tang (Four Gentlemen Decoction) to cultivate and tonify, and the wound will naturally close within days. If one recklessly uses muscle-regenerating drugs while residual toxins remain, the condition will worsen. It is unknown that the occurrence of sores stems from disharmony of Stomach Qi; their ulceration results from the rotting action of Stomach Qi; and their healing results from the nourishing power of Stomach Qi. Dongyuan said: The Stomach is the source of generation and the root of life. Danxi also stated that treating sores requires supporting Stomach Qi and strengthening the body to ensure a solid foundation. These words are indeed true; can one not be cautious?

He further stated: If muscles are injured and the wound does not close, use Liujunzi Tang (Six Gentlemen Decoction) to tonify the Spleen and Stomach. If Qi Deficiency causes aversion to cold and the wound does not close, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify the Spleen and Lungs. If Blood Deficiency causes fever and the wound does not close, use Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng) and Baizhu (Atractylodes) to nourish the Liver and Spleen. If there is excessive pus and the wound does not close, use Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) to nourish Blood and tonify Qi. If there is no response, use Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelica) and Huangqi (Astragalus) to tonify the Spleen and Stomach. If still ineffective, it belongs to Decline of Mingmen Fire (Gate of Life Fire); urgently use Bawei Wan (Eight-Ingredient Pill) to strengthen Fire to generate Earth. If the pulse is rapid and there is thirst, the prognosis is poor because True Qi is deficient while Pathogenic Qi is excess.

He further stated: The method of regenerating muscle should primarily focus on regulating the Spleen and Stomach and assisting Qi and Blood. If Qi and Blood are both deficient and unable to generate flesh, use formulas for supporting the interior and expelling toxins. If Wind-Cold invades the wound preventing regeneration, use Moxibustion with Fermented Soybean Cake (Dou Chi Bing). If there are stubborn sores with flowing abscesses containing sinus tracts, blood stasis, or nodules, use Zhitou San (Needle Head Powder) to cauterize necrotic tissue; using pills (Dingzi) is especially effective. For large ulcers such as back sores, cane beat injuries, or scalds/burns, use Shenxiao Danggui Gao (Miraculous Angelica Ointment), which removes necrotic tissue, generates new flesh, and relieves pain, showing great efficacy.

He further stated: After a carbuncle or sore ulcerates, once the toxin is exhausted, flesh regenerates naturally. Often, physicians use substances like Dragon Bone (Long Gu) and Dragon's Blood (Xuexie) seeking to promote healing, unaware that if residual toxins remain, flesh cannot grow. Since Qi and Blood are already deficient, how can Long Gu and Xuexie be effective? If pus and toxins are not fully cleared and astringents are applied, it will instead increase ulceration. In strong patients with mild conditions, it may merely cause re-ulceration or delayed healing. In weak patients with severe conditions, it will certainly lead to internal invasion, or persistent ulceration without healing, leading to danger.

He further stated: All chronic sores becoming fistulas are due to insufficiency of Yuan Qi (Original Qi) and disordered Ying Qi (Nutritive Qi). Yang Qi deficiency and cold cause Cold Qi to rebel into the muscle layers, stagnating in the blood vessels. Prolonged rotting and ulceration result in this condition. Therefore, when treating deficiency syndromes, at the initial stage, internally administer Renshen (Ginseng), Danggui (Angelica), and Baizhu (Atractylodes) to warm and tonify the Spleen and Stomach; externally apply Sangzhi Congyi (Moxibustion with Mulberry Branch and Scallion) to connect and supplement Yang Qi, allowing natural resolution. If suppuration fails to occur after a long time, use the aforementioned two methods to assist and accelerate the process. If pus has formed but not drained, apply moxa directly over the center of the lesion for several cones to drain it, then administer Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction). The patient must also be careful with daily routine and diet moderation to facilitate healing. If punctured with a cold needle, clear pus may emerge from inside after a long time, with dark black discoloration outside. Or if Mistakenly using astringent powders to accelerate closure, the pathogen is trapped, inevitably leading to a critical condition.

For various sores that have become chronic fistulas with continuous non-foul-smelling pus and no necrotic tissue, the method is to take processed Aconiti Lateralis Radix Praeparata (Pao Fuzi, Prepared Lateral Root of Aconite), remove skin and tips, grind into fine powder, mix with saliva to form a cake about 0.1 cm thick, place on the wound, and moxibustion. Larger fistulas require larger moxa cones; smaller ones require smaller cones. Moxa until slightly warm, not painful. Replace when dry. Moxa 10-20 cones per session without limit, then apply ointment. Repeat every 2-3 days, concurrently administering Great Tonifying Qi and Blood medicines until the flesh is level. Alternatively, slice processed Aconite to 0.1 cm thickness for moxibustion. Or use Jiangxi Dan Dou Chi (Light Fermented Soybean) cakes for frequent moxibustion, which is also effective.

If a chronic fistula has external necrotic tissue and internal sinus tracts preventing closure, mix Zhitou San (Needle Head Powder) into thin strips, insert into the wound, and cover with ointment externally. Wait until sinus tracts are completely removed, and the wound will gradually flatten and close. Alternatively, use moxibustion first, then this medicine after a few days, while continuing internal administration of Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) and similar formulas.

Guoshi Moxibustion Method: For carbuncles and sores that fail to heal for a long time, with foul pus and deep-rooted ulceration, mix Bai Mian (White Flour), Liu Huang (Sulfur), and Da Suan (Garlic), pound into a paste. Shape into a cake according to the size of the sore, about 0.1 cm thick, place on the sore, and apply 21 moxa cones, replacing each time. After 4-5 days, insert medicinal pills or Zhitou San (Needle Head Powder) into the sore. Once necrotic tissue is gone and healthy flesh is level, apply astringent ointments and administer internal medicine corresponding to the disease. Recovery will follow with proper regulation.

A man, over twenty years old, with a weak constitution, developed a toxic swelling on the lateral aspect of his left leg, which ulcerated after three months. The pus was clear and thin, and flesh did not regenerate. He was treated with Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) plus Achyranthis Bidentatae Radix (Niuxi) for more than twenty doses, gradually improving. He was then treated with moxibustion using Fermented Soybean Cake (Dou Chi Bing) and recovered in over a month.

A woman had a nodule on her left arm that ulcerated after more than a year, with clear pus and failure to heal. A man suffered from a deep-seated carbuncle on his leg, with a thin, short, and soft limb, and a wound that would not close. Both were treated with Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction), externally applied with Processed Aconite Cakes (Fuzi Bing) and tonifying plasters. With proper care, they healed after one hundred doses. Generally, for deficiency syndromes, Great Tonifying formulas combined with moxibustion to supplement Yang Qi and dispel Cold Evil are the best approach.

Dong Ci from Beijing, over forty years old, developed a fistula on his chest, draining about a bowl of pus daily. His appetite remained normal. He was treated with Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) plus Fritillariae Bulbus (Beimu), Polygalae Radix (Yuanzhi), Ampelopsis Radix (Bailian), and Dipsaci Radix (Xuduan), along with moxibustion using Processed Aconite Cakes (Fuzi Bing). Pus gradually decreased, and he recovered after more than a year of careful regulation. (Commentary by Xue Ji)