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Xue Ji stated: In the practice of acupuncture and moxibustion, there are taboos regarding Taiyi Ren Shen (Taiyi Human Spirit), Zhou Shen Xue Ji (Whole Body Blood Taboo), Nian Fei Shi Shen (Yearly Flying Corpse Spirit), and Ri Ren Shen (Daily Human Spirit). There are also discussions on acupoints that are forbidden for needling or moxibustion. Violating these leads to difficult recovery, which is logically sound. However, in cases of sores and ulcers where Qi and Blood are already damaged and muscles are necrotic, it is urgent to employ the methods of "meeting and seizing" (Ying Er Duo Zhi) and "following and taking" (Shun Er Qu Zhi). This differs from acupuncture in healthy individuals; what is there to fear? *Waike Jingyi* (Essentials of Surgery) states: In sore and ulcer conditions, if toxic factors have no way to dissipate and pus/blood stasis has no way to drain, they will attack inward. Once the internal organs are depleted, how can survival be expected? Critical and malignant conditions occurring at vital sites bring disaster in an instant. Abdominal carbuncles and scrotal carbuncles causing obstruction of urination and defecation, chest and abdominal distension; lip carbuncles and throat bi (obstruction) causing swelling and blockage of the throat—these dangers are particularly rapid. Patients must exercise caution.

My neighbor, Su Ziyu, suffered from a ding (carbuncle/furuncle) on his left finger, presenting with numbness, itching, aversion to cold with fever, nausea, and numbness throughout the left half of his body. His pulse was rapid and intermittent. I said: Generally, sores should not be completely painless, nor should they cause severe pain. Cases accompanied by irritability and oppression are untreatable. The current presentation of numbness and itching is even more ominous. Two doses of Duoming Dan (Life-Rescuing Pill) were ineffective. After using detoxifying agents, the numbness and itching subsided, turning into swelling and pain. I said: Although the condition is critical, it is fortunate that pain has developed, indicating the toxic factor has a pathway to express itself. However, since the toxin lacks an outlet, I wish to use needling to drain it. Coinciding with the full moon (Wang day), his family insisted that the Fei Shi Shen taboo prohibited treatment. Consequently, the swelling worsened. I forcefully performed needling, after which all symptoms instantly receded. Subsequent use of detoxifying agents led to the healing of the sore. (Commentary by Xue Ji)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the five zang organs are disharmonious, the nine orifices become obstructed; when the six fu organs are disharmonious, stagnation forms abscesses. It further states: Injury to form causes pain; injury to Qi causes swelling. This clearly indicates that disharmony of the zang-fu organs leads to sores manifesting externally. If one applies cooling herbs, how can one harmonize the zang-fu and promote the circulation of Qi and Blood? If the presentation involves redness, swelling, heat, and thirst, with a slippery and rapid yet forceful pulse, the syndrome belongs to Pure Yang. One should internally administer Jiyin Tang (Nourish Yin Decoction) and externally apply Yiyang San (Suppress Yang Powder), so that heat-toxin resolves and blood stasis disperses spontaneously. If the presentation is swollen but not fully swollen, painful but not severely painful, appearing to ulcerate but not actually ulcerating, reddish but not truly red, with a surging and rapid but weak pulse, the syndrome belongs to Half-Yin Half-Yang. One should internally administer Chonghe Tang (Harmonizing Decoction) and externally apply Yinyang San (Yin-Yang Powder), so that Qi and Blood harmonize and stasis消 (disappears) spontaneously. If there is slight swelling and pain, or dark discoloration without pain, or hardness without ulceration, and although the pulse appears surging and large, it is fine and weak upon pressure, the syndrome belongs to Pure Yin. One should internally take Huiyang Tang (Restore Yang Decoction) and externally apply Yiying San (Suppress Yin Powder), so that the Spleen and Stomach strengthen and Yang Qi returns spontaneously. Zhu Danxi stated: Topical applications are only suitable for mild, minor heat syndromes. If one fails to distinguish between Yin and Yang syndromes and recklessly applies cooling agents, one will block the couli (pores/skin texture), stagnate Qi and Blood, cause toxins to attack inward, and result in tissue death. Moreover, if the physiological climate encounters cold, vitality is impaired; if blood stasis encounters cold, it does not disperse; if necrotic tissue encounters cold, it does not ulcerate; if new flesh encounters cold, it does not grow. Practitioners must be cautious. (From *Waike Shuyao*)

Xue Ji stated: Generally, the initiation, suppuration, and healing of sores depend on Qi and Blood. Since each person's Yuan Qi (Original Qi) varies in deficiency or excess, some die because the sore cannot initiate; some die because it initiates but fails to suppurate; some die because it suppurates but fails to putrefy and drain; some die because it drains but fails to heal. Topical applications are only suitable for mild conditions. If Qi and Blood are exhausted, the patient will inevitably die. Not only will topical treatments fail, but since Qi and Blood prefer warmth and dislike cold, and the couli prefer openness and dislike blockage, the use of cold/cooling agents will further stagnate Qi and Blood, intensify swelling, deepen the pathogenic factor, enlarge the area of putrefaction, and lead to defeat in frail patients. Furthermore, sores often arise from the fire of the seven emotions, consumption of rich/greasy foods, or ingestion of mineral drugs, which damage Yin Blood, leading to Excess Yang and Deficiency Yin. The disease originates internally and manifests externally. If one does not differentiate between Qi and Blood aspects, Yin and Yang, deficiency and excess, and the depth of putrefaction, even oral medication may fail to save life, let alone topical applications.

Shi Erzhou developed a nodule on the right side of his neck. After applying cooling herbs topically, the entire neck swelled. Upon re-application, the swelling extended to the chest and axillae, with a sensation of cold extending to the abdomen. Unaware that this was caused by the cooling herbs, he believed it indicated intense toxicity. He became physically exhausted and despaired of recovery. I treated him and observed heat vapor rising like fog from the application site. I urgently ordered the removal of the herbs. After a long time, the lesion turned red, and pus and blood were expressed via puncture. Treatment with Tuoli medicines (Supporting Interior Agents) led to recovery.

Zhang Siyu developed a back carbuncle and relied solely on topical applications. The lesion remained dark and did not rise; he experienced chest and diaphragm oppression and dyspnea, believing himself incurable. I treated him with Xinwen Tuoli medicines (Acrid-Warm Supporting Interior Agents) and he recovered.

A male patient had a gluteal carbuncle that had ulcerated but failed to regenerate muscle. After topical application, the surrounding muscle became hard. My diagnosis revealed a choppy and weak pulse, indicating dual deficiency of Qi and Blood, unable to nourish the affected area. Thus, the cooling herbs caused cold coagulation rather than toxicity. Treatment with major tonifying agents resulted in recovery.

A male patient suffered from a chest carbuncle, characterized by high swelling and pain. Topical application stopped the pain but caused the color to darken and pain to spread to the periphery. Continued application darkened the skin and caused throat pain. Unaware of the error caused by cooling herbs, he applied them extensively over the neck, resulting in total neck ulceration and death.

A male patient developed a non-painful lump on the left hypochondrium due to anger. The pulse was choppy and floating. I diagnosed this as blazing evil fire in the Liver channel combined with insufficiency of True Qi, requiring cultivation of Qi and Blood as the primary strategy. He used herbal poultices instead, leading to an untreatable outcome.

Wang Anren developed a back carbuncle. During the active ulceration phase, seeking rapid results, she applied herbal poultices and died on the same day.

Zhang Yiren, over sixty years old, developed a back carbuncle three days prior. The skin color was unchanged, the head was millet-sized, with shoulder and back swelling, surging and rapid pulse, alternating chills and fever, and a desire for cold drinks. I administered two doses of Renshen Baidu San (Ginseng Detoxification Powder) and performed fifty-plus moxa cones using garlic partitioning. The toxin erupted vigorously, and the back swelling subsided. Subsequent use of Tuoli medicines led to gradual ulceration. Due to severe Qi and Blood deficiency, she developed thirst, which ceased after administration of Renshen (Ginseng), Danggui (Angelica Sinensis), and Shudi (Prepared Rehmannia Root). Seeking rapid results, she self-applied herbal poultices to the lesion, causing the toxin to re-enter the interior, leading to her death. (Commentary by Xue Ji)

For all swellings and pains associated with sores and ulcers, if topical encircling medications (Weiyao) are indicated, Jiangyong San (Descending Carbuncle Powder) is the premier choice, suitable for both Yin and Yang toxic conditions.