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Zhentou San (External Formula No. 144, for removing necrotic tissue and promoting healing)
Daizhen Gao (Formula No. 145, for opening abscess heads)
Tougu Dan (External Formula No. 143, for opening abscess heads)
Zhuti Tang (External Formula No. 125, for washing away necrotic tissue)

Xue Lizhai said: The *Neijing* states: "All pain, itching, and sores belong to the Heart." If there is swelling, redness, fever, restlessness, high body heat, severe pain, thirst for cold drinks, constipation, and a flooding, rapid, and full pulse, this is a Pure Yang syndrome. Even in the depths of winter, one must use strongly bitter-cold medications to drain heat and toxicity. If there is no swelling or pain, a fine pulse, cold skin, diarrhea with borborygmus, inability to eat, frequent vomiting, and cold extremities, this is a Pure Yin syndrome. Even in the height of summer, one must use strongly acrid-hot medications to assist Yang Qi. Regardless of severe cold or intense heat, one should discard the season and follow the syndrome. If there is slight swelling and pain, apparent but not actual ulceration, and frequent discharge of clear pus, this is a Half-Yin Half-Yang syndrome. It is appropriate to use acrid-hot medications to warm and tonify Stomach Qi; this is also a method for treating Yin-Yang imbalance. The *Neijing* says: "When using cold remedies, avoid cold times; when using hot remedies, avoid hot times," but reverse this if there are false manifestations. Although violating seasonal norms, one must follow the syndrome. Adhering rigidly to conventional methods inevitably leads to misdiagnosis and mistreatment. In the mid-winter of the Renwu year, a man in Jintai suffered from abdominal pain and mistakenly consumed Ganjiang Lizhong Wan, resulting in immediate bleeding from the mouth and nose, restlessness, madness, and death by jumping into a well. In the winter of the Xinmao year, an official suffered from Shanghan (Cold Damage) and mistakenly consumed a cup of Fuzi medication; upon swallowing, he became agitated, ran around, fell, and died. During the height of summer, the simultaneous use of Fuzi (Aconite Root), Ganjiang (Dried Ginger), and Guizhi (Cinnamon Twig) over three to four doses caused no harm; yet in the depths of winter, using just one of these three herbs in a single dose led to death. This demonstrates the profound skill of Mr. Luo Qianfu in "discarding the season to follow the syndrome" and employing flexible medication strategies. I adhere to this method: for any sore conditions occurring in winter, such as a deep, solid, flooding, and rapid pulse, constipation, severe sore pain, restlessness, or incessant desire for cold drinks, I immediately use formulas containing Xiaoshi (Niter), Dahuang (Rhubarb Root and Rhizome), Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome) to purge and clear heat. Even in summer, if the pulse is weak or floating and large, the sore does not ulcerate, the pus is clear and thin, and there is aversion to cold with a desire for drinks, I immediately use formulas containing Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), and Renshen (Ginseng Root and Rhizome) to tonify. If the pulse is deep and fine, the sore does not ulcerate or hurt but presents with hiccups, cold extremities, loose stools, diarrhea, or abdominal pain, adding Fuzi (Aconite Root) yields great efficacy. Ignorant people oppose this, confusing patients. Rigidly adhering to conventional laws—using warming herbs in winter and cooling herbs in summer—inevitably harms people, which is deeply lamentable. (Note by Xue Ji): On May 28th of the Renwu year in the Zhiyuan era, Wang Bolu, aged over fifty-seven, had severe swelling in his right arm extending from the shoulder to the fingers, with changed skin color and cold skin. His six pulses were deep, fine, and faint, indicating both pulse and syndrome were cold. I and the surgeon Sun Yanhe examined him and said, "This is Fusgu Yong (Bone-Adherent Abscess); drainage was delayed." We used a burning needle (Fanzhen) to open it, releasing clear, thin pus. The next day, we opened it again below the elbow, after which hiccups became incessant. Yanhe prescribed Dingxiang Shidi San (Clove and Persimmon Calyx Powder) for two doses, providing slight relief. The following day, hiccups worsened, accompanied by spontaneous diarrhea, cold pain in the umbilical and abdominal region, abdominal fullness, reduced food intake, and occasional confusion. We moxa-burned seven cones at the point where blackness ended under the left breast and prescribed Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) containing Ganjiang (Dried Ginger), Fuzi (Aconite Root), Muxiang (Aucklandia Root), Chenxiang (Agarwood), Huixiang (Fennel Fruit), and Qianghuo (Notopterygium Rhizome), chopped to one tael and half, preparing to administer it. Someone asked, "All pain, itching, and sores belong to Heart Fire; moreover, it is the height of summer, can we use Ganjiang and Fuzi?" I replied, "It is logically necessary and cannot be otherwise. The *Neijing* states: 'Fine pulse, cold skin, diarrhea before and after, inability to eat—this is called Five Deficiencies.' Furthermore, hiccups are due to deficiency-cold in the Stomach. 'All pain, itching, and sores belong to Heart Fire' refers to the general principle. This case presents contradictory internal and external signs; one must discard the season and follow the syndrome. Without urgently treating with a large formula of acrid-hot herbs, recovery is impossible." Thus, the medicine was administered, all symptoms vanished, food intake doubled, the sore condition became mild, and the pus color normalized. Yanhe subsequently used Wuxiang Tang (Five Fragrances Decoction) several times, leading to full recovery after more than a month. Alas! Those who stick to conventions have the vision of the masses; those who know how to adapt possess the ability of the wise. Many fail due to minor matters because they know the constant but not the variable, let alone medicine. (Seen in Luo's *Weisheng Baojian*)

My opinion is that Mr. Luo’s method of "discarding the season to follow the syndrome" serves as an eternal lesson for posterity, truly an indispensable principle that will never fade. However, the changes of time are inherently difficult to know, and the hidden or manifest nature of syndromes is even harder to discern. Why? Because what ordinary people call "time" refers to the seasons of spring, summer, autumn, and winter, and the dominant Qi of each year, which everyone knows. But they do not realize that within the five-six cycles of climate change, late summer may have commands of excessive cold, and the three winters may have the authority of intense heat. This appears to discard the season but actually follows it; can the ignorant truly understand this? Regarding the method of observing syndromes, anyone can recognize obvious cold syndromes like fine pulses, cold skin, diarrhea, and cold limbs. But they do not know that these have origins and gradual progression; before the syndromes appear, the underlying constitution is already established, making it difficult not to misjudge at this stage. If one waits until the situation is dire ("scorched head and broken forehead") before taking preventive measures ("curving the chimney and moving the firewood"), it is already too late. This is why Mr. Luo clarified existing syndromes, while I am more concerned with potential future syndromes, fearing that people see too late to be of service. Although I often see that contemporary people cannot even perceive existing syndromes, let alone potential ones, which is indeed pedantic, my sighing reflection compels me to detail this, deeply hoping that understanding minds will grasp it.