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Qi stated: The so-called Ding Chuang (Ding carbuncle) refers to a lesion whose shape resembles the cover of a nail. Ancient prescriptions discuss ten types. Hua Yuanhua's discussion includes five-colored Ding; the *Qianjin Fang* states there are thirteen types of Ding. Even in the *Waitai Miyao* and *Shenqiao Wanquan*, the discussions are similar, yet all revolve around toxic qi lodging in the meridians and heat-toxin accumulating within the five zang organs. When initially appearing as a single head, it is concave, swollen, and painful, with colors varying among green, yellow, red, and black without a fixed hue, causing restlessness and confusion, or aversion to cold with headache, or vomiting and cardiac reversal. If needling the lesion causes no pain and yields no blood, this is its characteristic sign. It often arises from excessive consumption of rich and sweet foods, lack of restraint in sexual activity and alcohol intake, leading to evil pathogens inducing toxin accumulation, thereby generating Ding Chuang. As stated in the *Neijing*: "Changes from rich and fatty foods can produce large Ding." This is what is meant. The treatment method urgently requires moxibustion with moxa cones. If there is no sensation of pain, needle the four sides of the Ding until blood flows, insert Du Ming Dan (Life-Restoring Pill) or Hui Sheng Dan (Reviving Life Pill) into the needle holes, apply a plaster on top, and simultaneously administer decoctions such as Wuxiang Liaoqiao Tang (Five-Spice Forsythia Decoction) or Loulu Tang (Euphorbia Decoction), aiming for efficacy through purgation and drainage. If needling still yields no pain or blood, use a hot iron needle heated red-hot to cauterize the lesion until it resembles charcoal, aiming for pain sensation as effectiveness. Also use the aforementioned medicines and apply a plaster. After one or two days, when pus discharges and the root emerges, administer Tuoli Tang San (Support the Interior Powder/Decoction) and treat according to standard Ding protocols to achieve recovery. If needling yields no pain, and the patient has darkened eyes or sees flashes of light, it is incurable. This is because the toxic qi has entered the zang-fu organs. The *Yangsheng Fang* states: "If human sweat enters meat food, consuming it will generate Ding Chuang." One must be extremely cautious.

Lizhai stated: This condition mostly results from excessive consumption of rich and greasy foods, or sudden poisoning from diet, or contracting abnormal qi of the four seasons, or being poisoned by snakes and insects, or contaminated by filth from dead livestock. Each case should be carefully examined and treated accordingly. The toxin often manifests on the head, face, and limbs, with varied shapes and colors: some resemble small sores, others blisters; symptoms may include pain, numbness, alternating chills and fever with pain, vomiting, nausea, or limb stiffness and spasm. All are suitable for garlic-separated moxibustion. Moaize until pain ceases if it was painful; moxaize until pain appears if it was numb/painless. If moxibustion still yields no pain, perform direct moxibustion (Ming Jiu). Then needle the periphery of the Ding to remove bad blood, insert one pill of Du Ming Dan into the sore's opening, cover with a plaster, and administer detoxifying agents, such as Jingfang Baidu San (Aristolochia and Saposhnikovia Decoction to Overcome Toxins). If needling yields no pain or blood, use a red-hot needle, treating as described in Qi's method above. If the patient loses consciousness or suffers from trismus (lockjaw), grind Du Ming Dan into powder, mix with scallion and wine, and force-feed. Once awake, administer Baidu San or Du Ming Dan again, which is very effective. If lesions occur on both feet, red threads often extend to the umbilicus; if on hands, to the heart and abdomen; if on lips, face, or inside the mouth, to the throat. These are difficult to treat. Urgently use a needle to pierce the end of the red thread to release bad blood. If the red thread is near the heart/abdomen, additionally pierce the sore head to drain bad fluid and vent the toxin, applying a plaster; many survive. If the lesion is in remote lower areas where medicinal power rarely reaches, relying solely on medicine is too slow; only moxibustion can achieve great life-saving effects. Although Ding names and forms vary among thirteen types, treatment methods should focus on assessing the deficiency or excess of yuan qi (primordial qi) and the exterior or interior nature of the pathogen, thus avoiding fatal errors. Relying exclusively on dispersing and releasing the exterior is not only useless but harmful. Sudden death in humans is often due to Ding toxin; urgently illuminate the body with a lamp; if small sores are found, they are the toxin, and urgent moxibustion is required. Administer Du Ming Dan etc., and recovery is possible.

Furthermore: For floating and rapid pulses, use dispersion; for deep and solid pulses, use purgation. For simultaneous exterior and interior excess, resolve the exterior and attack the interior. For numbness, severe pain, or absence of pain, apply moxibustion combined with anti-toxic measures.

Zhang Hengshan, Governor of Caojiang, suffered on his left foot's second toe. The pain was unbearable. He urgently underwent thirty-plus moxa cones via garlic separation and could immediately walk. Desiring quick recovery, he applied cooling medicines himself, causing blood coagulation and muscle necrosis, leading to renewed intensification of toxic vapors. He underwent another hundred moxa cones, took Huoming Yin (Life-Saving Decoction), expelled purple blood, and the toxin finally resolved. The sole of his foot ulcerated extensively, with much rotting tendon and flesh. As he was nearing recovery, I traveled north for an official review. He mistakenly used flesh-regenerating medicines, which further aided the toxin, depleting his yuan qi and making wound closure difficult. Upon my return, I used interior-supporting tonics. Fortunately, his constitution was robust, and being away from home, he recovered after more than three months.

My cousin-in-law, Ju Fu, suffered on his right hand's little finger. Someone bled him with needles and applied cooling medicines, causing the palm and fingers to swell three to four times their normal size. The six pulses were flooding. This indicates deficiency due to loss of true qi and excess due to flourishing pathogenic qi. Initially, one dose of Du Ming Dan and two doses of Huoming Yin slightly alleviated the condition. Due to other matters, I was away. Someone else repeatedly pricked for bleeding, causing swelling to spread to the arm and wrist, resembling a large gourd, with fingers swelling several times larger, unable to dissipate or suppurate. This indicated further depletion of true qi and intensification of pathogenic qi. Upon my return, I used large doses of Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizoma (Baizhu), along with frequent moxibustion. After the swelling in the entire hand gradually subsided, he experienced loose stools and frequent flatulence, indicating sinking of yuan qi. I prescribed Buzhong Yiqi Tang (Middle-Boosting Qi-Rescuing Decoction) supplemented with Psoraleae Fructus (Buguzhi), Myristicae Semen (Roudoukou), Evodiae Fructus (Wuzhuyu), and Schisandrae Fructus (Wuweizi), using Shengmai San (Generate the Pulse Powder) as tea substitute. As stools solidified and the back of the hand began to ulcerate, I administered over fifty doses of major tonic formulas until gradual recovery. (Commentary by Xue Ji)