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Zhang Zhongjing treated cold damage (Shanghan) using three methods: sweating (Han), vomiting (Tu), and purging (Xia). Li Dongyuan treated sores and ulcers (Chuangyang) using three methods: unblocking and draining, supporting the interior (Tuo Li), and harmonizing Ying and Wei (nutritive and defensive qi). When applied appropriately, chronic diseases can be cured. For instance, if a sore or ulcer is swollen, hard, numb, and stifling, accompanied by vexation, heat, constipation, and a deep, forceful pulse, indicating pathogenic factors inside, one should first unblock the interior and purge it. If the swelling becomes painful, bowel movements and urination are smooth and regulated, and the pulse is floating and surging, indicating pathogenic factors on the exterior, one should first support the interior and induce sweating to release the exterior. Zhang Zhongjing stated: "Patients with sores, even if they have body pain, should not undergo sweating therapy; inducing sweat will lead to spasms." If the condition is not carefully examined and sweating or purging are used recklessly, causing depletion of Qi and Blood, the toxin may instead sink inward and spread. Young and strong individuals may fail to suppurate and heal, while old and weak individuals often die from it. (See *Waike Shuyao*.)

Luo Qianfu said: In the winter of the Ding Si year, I followed the army to Caozhou. An official named Niu Jingli suffered from redness and swelling of the head and eyes, worse on the front and back of the body, unbearable pain, fever, aversion to cold, lockjaw, thick and sticky nasal discharge and saliva, difficulty swallowing food, and inability to lie down comfortably. A surgeon pricked the swelling with four or five hundred needles using a stone needle (Bianshi), but the swelling did not decrease, and the pain intensified, leaving everyone puzzled about the cause. I went to examine him and found his pulse floating and tight, becoming surging and slow upon heavy pressure. This condition was caused by cold covering the skin and hair, obstructing the meridians, preventing heat from dissipating, and accumulating to form swelling. The *Classic of Acupuncture and Moxibustion* (*Ling Shu*) states: "When heaven is cold, the earth freezes and water turns to ice. Inside the human body, the skin is dense, pores are closed, no sweat is produced, Qi and Blood are strong, and flesh is firm and stiff. At this time, those skilled in managing water cannot make ice flow, those skilled in digging cannot break frozen ground, and those skilled in acupuncture cannot treat cold limbs (Si Jue). One must wait for warm weather and thawed ice before water can flow and ground can be dug; similarly, human meridians require warmth." It also states: "In winter, when storage prevails, medication is used more frequently than acupuncture or moxibustion." It is appropriate to use bitter-warm formulas to warm the meridians and disperse cold, after which the disease will resolve naturally. As stated, when cold causes pore closure, bitter flavors disperse it, and pungent flavors scatter it. Thus, I prescribed *Tuoli Wenzhong Tang* (Support Interior and Warm Middle Decoction) according to the formula. The patient covered his head with thin cloth and his body with thick blankets, lying in a warm place to warm the meridian blood, open the pores, disperse cold, and raise Yang Qi. After profuse sweating, the swelling reduced by eight or nine tenths. In the next dose, Ephedrae Herba (Mahuang) and Saposhnikoviae Radix (Fangfeng) were removed, and Forsythiae Fructus (Lianqiao) and Arctii Fructus (Niubangzi) were added, resulting in complete resolution of swelling and pain. The classics say: "Sweating cures sores." This statement is indeed true. Some ask: Zhang Zhongjing said that patients with sores should not undergo sweating therapy even if they have body pain. What is the rationale? I reply: This refers to cases where Nutritive Qi does not flow smoothly, reverses into the muscle tissue, causing sores and body pain. This is not an external cold pathogen invasion, hence the warning against sweating, as it would lead to spasms. Another question: Zhang Zhongjing said those with epistaxis (nosebleed) should not sweat, yet he also said those with a floating and tight pulse should use Mahuang Tang to induce sweating, after which the nosebleed stops. These statements seem contradictory. Why? I reply: This is similar to the case of sores. Blood and sweat share the same origin but have different names. Depletion of sweat leaves no blood; depletion of blood leaves no sweat. Now, spontaneous epistaxis is forced by heat. Inducing sweat further aids the heat pathogen and severely depletes fluids, leading to critical conditions; thus, sweating is contraindicated. However, a floating pulse indicates exterior pathology, and a tight pulse indicates cold. Cold obstruction prevents Yang Qi from extending, while heat hides in the Nutritive level, forcing blood to move recklessly upward through the nose. Therefore, Mahuang Tang should be used to disperse cold, allowing Yang Qi to expand and bleeding to stop spontaneously. Someone sighed and said: "Those who grasp the essence need only one word to conclude; those who do not wander endlessly. Jiegu's (Zhang Yuansu's) learning can be said to grasp the essence."

Li Dongyuan said: Sores caused by external constraint of wind-heat present with irritability, red color, high swelling, hardness, pain, and a surging, tight, and wiry pulse. This indicates pathogens lodging above the blood vessels and between the skin. Sweating to unblock and regulate Ying and Wei will expel the pathogens. He also stated: For various sores, if the face is red, despite latent intense heat, purging the interior is forbidden, as it leads to diarrhea. This is because Yang pathogens are constrained in the meridians, and releasing the exterior is appropriate. Hence, "Fire constrained should be dispersed." Even if there is constipation for several days, one should focus on releasing the exterior to disperse Yang Qi, adding only a small amount of moistening drugs. If wind-pulse or wind-symptoms are present, only wind-dispersing drugs should be used; once wind pathogens are resolved, bowel movements will naturally clear. If it is merely dryness and constipation, only moistening is appropriate; purging must be avoided. Regarding "Yu Mao" (depression and dizziness/coma) in sores, sweating leads to recovery.

Chu Yushi said: When carbuncles and malignant sores first appear, purgatives like Rhubarb (Dahuang) should be urgently administered to promote bowel movements, disregarding the patient's distress. It is better to die from purging than from suppuration and decay, and there remains a chance of survival. Ancient laws typically used formulas containing Benzoin (Wuxiang), Forsythiae Fructus (Lianqiao), and Euphorbiae Radix (Loulu). Poor patients boiled Rhubarb decoction alone to promote purgation. Only after pus formed were tonics like Astragali Radix (Huangqi) used to drain pus. *Qianjin Fang* and *Waitai Miyao* record these methods extensively. Many people die from neglecting purgation for external sores. Xue Lizhai stated: Regarding the aforementioned symptoms, if swelling is high and painful with internal blockage, indicating excess in both interior and exterior, purgatives should be used. If swelling is diffuse with slight pain and internal organs are deficient, indicating deficiency in both interior and exterior, interior-supporting tonification should be used. If swelling has no head and skin color is unchanged, strengthen Stomach Qi to allow internal resolution. If pain persists and swelling does not subside, use Renshen Huangqi Tang (Ginseng and Astragalus Decoction) to support the interior and drain pus. If appetite is poor and muscles do not regenerate, use Cantuo Li San to nourish Spleen and Stomach.

Xue Lizhai recounted: Wang Dezhi suffered from a dorsal carbuncle. His pulse was floating and rapid, becoming choppy upon pressure. Bowel movements had not occurred for five or six days, but the abdomen was not distended. I said: The pathogen is in the exterior, not the interior. The constipation is due to Qi and Blood deficiency and poor diet, not heat accumulation. Treatment should primarily generate Qi and Blood. He did not believe this, assuming toxic accumulation internally, and continued using Rhubarb. This led to continuous diarrhea, increased fever, hiccups, loss of appetite, and death. His son asked: Can purging cause harm? I replied: Death occurs if diarrhea continues after purgative administration. Death occurs if purging is forced when inappropriate, causing uncontrollable洞泄 (profuse watery diarrhea). Death occurs from Yin depletion due to excessive purging. He asked: Sores are toxic accumulation in the Zang-Fu; how can they resolve without expulsion? I replied: Although sores involve toxic accumulation, treatment must first strengthen Stomach Qi to solidify the root, combined with appropriate herbs to move meridians and invigorate blood. Rhubarb should not be used recklessly. The disease is currently in the exterior; using harsh purgatives to severely deplete Yin is unjustifiable. Thus, if the exterior is diseased but the interior is harmonious, purging weakens Middle Qi, allowing exterior pathogens to invade. Consequently, myriad complications arise. Although a floating and rapid pulse suggests exterior pathogens warranting *Tuoli Fujian San* (Support Interior and Re-boil Powder), one should not recklessly use Scutellariae Radix (Huangqin) or Atractylodis Rhizoma (Cangzhu) within it. A deep and forceful pulse suggests interior pathogens warranting *Nishu Huanglian Tang* (Interior-Draining Coptis Decoction), but Rhubarb and Arecae Semen (Binglang) therein should not be used recklessly. Moreover, floating, rapid, and choppy pulses indicate Qi and Blood deficiency. Using harsh agents to injure the interior when pathogens are in the exterior is punishing the innocent; death is inevitable.

I consider that sores attributable to exterior pathogens include seasonal toxins (Shidu), erysipelas (Dandu), macules and papules (Ban Zhen), and conditions affecting the head, face, neck, and Upper Jiao. Only when external pathogens are confirmed with a tight and rapid pulse, accompanied by chills and fever, should dispersing methods be employed. However, dispersing methods must distinguish Yin-Yang excess and deficiency: some require warm dispersal, some cool dispersal, some neutral dispersal, some combined with tonification, and some combined with detoxification. There is discretion within dispersal. Similarly, for interior conditions requiring purgation, severe toxicity and vigorous patterns require strong purgation; mild stagnation requires gentle purgation; Nutritive deficiency with constipation and unresolved toxin requires nourishing Blood and Yin to facilitate purgation; Middle Qi deficiency with constipation and stagnation requires moistening and guiding. All these are methods of unblocking purgation, applied according to urgency and severity. One must observe whether toxicity is truly excessive and Yuan Qi (Original Qi) is robust enough to withstand purgation without harm. Otherwise, not only current risks exist, but future difficult-to-treat complications are feared. Therefore, if exterior signs are false, sweating leads to Yang collapse. If interior signs are false, purging leads to Yin collapse. Both Yin and Yang collapse result in death. How can physicians be reckless?