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Qi stated: In conditions of sores and carbuncles, there are differences in the zang-fu organs, qi and blood, upper and lower regions, as well as true versus pathogenic factors, and deficiency versus excess. These must not fail to be distinguished. For instance: swelling that is elevated and hard, with thick pus, indicates an Excess condition of sores and carbuncles; swelling that is depressed and soft/slow, with thin pus, indicates a Deficiency condition. Hard stools, astringent urination, normal diet, abdominal fullness and distension, chest and diaphragm stuffiness, pain in limbs and joints, bitter taste in the mouth, dry throat, irritability, excessive thirst, fever, a large pulse, and mental depression/closure all constitute Zang-Fu Excess. Diarrhea or dysentery, borborygmus (intestinal rumbling), inability to eat, frequent vomiting, cold hands and feet, weak pulse, cold skin, spontaneous free urination, or conversely, scanty urine, loose stools, low voice, and mental fatigue all constitute Zang-Fu Deficiency. Regarding any sore or carbuncle: swelling that is elevated and red, accompanied by aversion to cold and fever, pain, hot skin, thick and sticky pus, and heavy/dizzy head and eyes, constitutes Blood and Qi Excess. Pus that is clear and thin, wound edges failing to close, swelling gathered but not red, intolerance to heat/pain, cold muscles and flesh, spontaneous sweating, and sallow/lusterless complexion constitute Blood and Qi Deficiency. Headache, nasal congestion, red eyes, palpitations, pharyngeal obstruction, sores on the mouth and tongue, irritability/thirst for cold drinks, somnolence with muttering, and teeth grinding constitute Upper Excess. Involuntary seminal emission, spontaneous loose stools, heavy waist and legs, and restless sleep constitute Lower Deficiency. Swelling that is particularly severe, pain so intense it cannot be touched, alternating chills and fever, constipation, urinary frequency/urgency resembling strangury, mental restlessness, and confusion constitute Pathogenic Factor Excess. Stiffness in shoulders and neck, heaviness in limbs, abnormal vision, cloudy eyes, loss of taste, hoarse voice, deteriorated complexion, edema in limbs, and failure to ulcerate after many days constitute True Qi Deficiency. It is also said: When pathogenic factors prevail, it is Excess; when true qi is depleted, it is Deficiency. It is also said: All pains are Excess; all itching is Deficiency. It is also said: A洪大 (Hongda, surging and rapid) and numerous pulse indicates Excess; a 细微 (Xixi, fine and soft) pulse indicates Deficiency. For Deficiency, apply tonification; harmonize the qi to support the interior and expel toxins. For Excess, apply purgation/draining; unblock and guide stagnation. The *Neijing* states: For blood excess, resolve it (e.g., via pricking); for qi deficiency, draw it (e.g., via acupuncture tonification). It also states: Injury to form causes pain; injury to qi causes swelling. Swelling preceding pain indicates form injuring qi; pain preceding swelling indicates qi injuring form.

The *Jingyao* (Essentials) states: For sores and carbuncles with high swelling, severe pain, irritability, thirst, and desire for cold drinks, this indicates both disease qi and yuan qi are in excess. One should primarily use Qingre Xiaodu San (Clear Heat and Detoxify Powder) or Xianfang Huoming Yin (Immortal Life Elixir Decoction). If swelling is high and painful, with dry mouth but desire for hot drinks, this indicates disease qi is in excess while yuan qi is deficient. One should primarily use Tuoli Xiaodu San (Support Interior and Detoxify Powder). If swelling is flat/spreading with slight pain, reduced appetite, and body fatigue, this indicates both disease qi and yuan qi are deficient. One should use Liujunzi Tang (Six Gentlemen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to strengthen the spleen and stomach. This will cause unformed abscesses to dissipate, formed abscesses to ulcerate, and open wounds to heal.

The *Xinfa* (Core Methods) states: Wounds that fail to close with clear, thin pus indicate dual deficiency of qi and blood. Reduced intake and difficult digestion indicate spleen-stomach deficiency-cold. Emaciation and sallow complexion indicate stagnant gallbladder qi. Such conditions cannot be tonified without herbs like Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), nor can efficacy be assisted without Fuzi (Aconiti Lateralis Radix Praeparata). Current symptoms of poor intake and indigestion belong to spleen-stomach deficiency-cold. Since spleen and stomach belong to Earth, this results from Mingmen fire deficiency failing to generate Earth. Direct tonification of the spleen and stomach is inappropriate; instead, one should administer Bawei Wan (Eight-Ingredient Pill) to tonify fire to generate earth.

Li Zhang (Xue Ji) stated: The onset of sores and ulcers requires assessing the root and branch, deficiency and excess, and treating according to the urgency of pathogenic factors and righteous qi. If the disease is acute but yuan qi is solid, treat the branch first; if the disease is chronic but yuan qi is deficient, treat the root first; if the disease is acute and yuan qi is also deficient, prioritize treating the root while concurrently addressing the branch. Generally, high swelling with pain and thick, sticky pus indicates yuan qi is undamaged, making treatment easy. Flat swelling with slight pain and thin pus indicates yuan qi weakness, making treatment difficult. No swelling or pain, or flat, dark, non-ulcerating lesions, indicate extreme yuan qi deficiency, making treatment especially difficult. Treatment methods: For high swelling and pain, first use Xianfang Huoming Yin to resolve, followed by Tuoli Xiaodu San. For flat swelling and slight pain, use Tuoli San; if ineffective, add Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). If pain persists after pus discharge, it is qi-blood deficiency; use Bazhen Tang (Eight Treasure Decoction). Failure to suppurate or ulcerate indicates yang qi deficiency; use Sijunzi Tang plus Danggui, Huangqi, and Rougui. Failure to generate flesh or contract indicates spleen qi deficiency; use Sijunzi Tang plus Dihuang and Muxiang. Aversion to cold and fear of cold indicate yang qi deficiency; use Shiquan Dabu Tang plus Shengjiang and Fuzi. Afternoon tidal fever and internal heat indicate yin-blood deficiency; use Siwu Tang plus Renshen and Baizhu. Nausea and vomiting indicate stomach qi deficiency; use Liujunzi Tang plus Paojiang (Prepared Ginger). Spontaneous and night sweats indicate five-zang deficiency; use Liuwei Dihuang Wan material plus Wuweizi. Reduced food intake and fatigue indicate spleen qi deficiency; use Buzhong Yiqi Tang plus Fuling and Banxia. Panting and cough indicate spleen-lung deficiency; add Maidong and Wuweizi to the previous formula. Nausea and poor appetite indicate spleen-stomach deficiency; use Renshen Lizhong Tang. Abdominal pain and diarrhea indicate spleen-stomach deficiency-cold; use Fuzi Lizhong Tang. Hypogastric stuffiness and leg/shin edema indicate spleen-kidney deficiency; use Shiquan Dabu Tang plus Shanzhuyu, Shanyao, and Rougui. Diarrhea with cold feet indicates spleen-kidney deficiency-cold; add Guizhi and Fuzi to the previous medicine. Heat, thirst, strangury, and retention indicate kidney deficiency with yin-fire; use Jiajian Bawei Wan. Panting, cough, strangury, and retention indicate lung-kidney deficiency with false fire; combine Buzhong Yiqi Tang with Jiajian Bawei Wan.

It is also said: For generally frail individuals, regardless of swelling or ulceration, one must first tonify stomach qi. Some doubt the use of Renshen and Huangqi due to their potential to cause middle-jiao stagnation, and adding dispersing/detoxifying agents may result in more harm than benefit, often due to adherence to constitutions that were originally robust. Those with phlegm who cannot tolerate tonics are often misled. One must not realize that sores and ulcers arise from yin-yang depletion; once pus is discharged, qi and blood become even more deficient. Is there any reason not to tonify? Thus, Danxi stated: Whenever swelling and pain are seen, examine the pulse and signs; if deficient, immediately provide qi and blood tonification. Without depletion, ultimate auspiciousness can be ensured. How profound these words are.

It is also said: "There is no method to tonify qi" is a vulgar theory. Because qi pathology presents with stuffiness and obstruction, it seems difficult to tonify. However, one does not know that when righteous qi is deficient and fails to circulate, pathogenic factors stagnate and cause disease. The Classics state: The vigorous recover as qi moves; the weak have pathogenic factors adhere and cause disease. If one does not use qi-tonifying methods, how can qi move?