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Wang Haicang stated: For sores and ulcers caused by external pathogens invading the body, moxibustion is not suitable; for those originating from within the body, moxibustion is appropriate. For externally invading pathogens, one should use methods to push them out without letting them go inward; for internally emerging pathogens, one should guide them outward. Therefore, the classics state: For sinking conditions, apply moxibustion. When applying moxibustion, if there is no pain, stop when pain occurs. If there is no pain during moxibustion, it is because the heat first contacts the ulcerated area, hence no pain; later it contacts healthy flesh, hence pain. If there is pain during moxibustion, stop when pain ceases. If there is pain, it is because the heat first contacts the non-ulcerated area, hence pain; subsequently it contacts the impending ulcerated area, hence no pain.

Li Shi said: In treating carbuncles (Ju), the efficacy of burning mugwort surpasses that of medication, as it allows toxic factors to discharge outward. This is like a thief entering a house; one should open the door to drive him out, otherwise he will enter the room and cause harm. For sores and ulcers in their initial stage (one or two days after onset), one must slice a large single-clove garlic into three fen thickness, place it on the top of the carbuncle, and perform moxibustion through the garlic slice. Replace the garlic slice every three moxa cones (Zhuang). Once the sore ulcerates, apply Shenyi Gao (Miraculous Ointment). This prevents the sore from enlarging, preserves the flesh, and facilitates healing, achieving three benefits at once. The subtlety of this method is rarely known. However, if a carbuncle appears on the head, this method should not be used. (Recorded in *Wu Fu Ji Guan Bei*).

He further stated: For patients with back carbuncles presenting as diffuse swelling without a distinct head, paste wet paper onto the swollen area; the point where the paper dries first indicates the head of the sore. Use ten cloves of garlic, half he of fermented soybeans (Dan Dou Chi), and a small amount of frankincense (Ruxiang), grind them into a paste, apply to the sore, and perform moxibustion. Whether painful or not, follow the previously described method as the standard.

Chen Shi said: The head is the convergence point of all Yang meridians; the neck is near the throat; the Shenshu (BL23) acupoint is a critical vital area. None of these locations should undergo burning moxibustion.

Wu Shi said: The use of garlic cake moxibustion relies on the pungent, warm, and slightly toxic nature of garlic, which primarily disperses carbuncles and ulcers, utilizing the fire's power to propagate the medicinal effect. Direct moxibustion with moxa cones alone can be applied to stubborn carbuncles and chronic eruptions. For cases with severe redness, swelling, purple-black discoloration, and intense toxicity, simultaneous moxibustion with garlic and mugwort is optimal. He also stated: In treating carbuncles, ulcers, back eruptions, and carbuncles (Ding), if pain occurs immediately upon starting moxibustion, the toxic factor is light and superficial; if there is no pain, the toxic factor is deep and heavy. In both cases, internal administration of drugs to chase toxins and drain pus, along with external application of detoxifying medicines, is indicated. Generally, carbuncles and ulcers should not be completely painless, nor should they be excessively painful. Cases with confusion and lack of sensation are difficult to treat. Furthermore, regarding garlic-interposed moxibustion, regardless of the number of moxa cones, the pathogenic factor has no place to reside, and the healthy Qi remains undamaged. However, for sores on the head and neck, the "Bamboo Horse" moxibustion method and moxibustion on Zusanli (ST36) are appropriate.

*Qianjin Fang* states: At the onset of carbuncles and ulcers, whether characterized by severe pain, mild pain, or eruption like millet grains followed by pus discharge, one should immediately restrict diet, promote the discharge of toxins, and use the "Bamboo Horse" moxibustion method or direct moxibustion on the affected area. For severe cases, apply a total of 100-200 moxa cones around the four sides and center, combined with topical applications, yielding very rapid results.

Lizhai stated: Sores and ulcers have internal causes that manifest externally. For external manifestations, draw them out; for internal issues, unblock and purge them. The efficacy of moxibustion is significant. For mild cases of stagnant toxic factors and coagulated blood, herbal dispersants may suffice; for severe cases, herbs alone cannot achieve complete success. Dongyuan stated: Without acupuncture or cauterization, toxic factors have no pathway to resolve. Therefore, skilled practitioners always use garlic-interposed moxibustion. Abandoning this for bitter-cold detoxifying formulas may work for robust individuals with internal heat, but for those who are weak and deficient in Qi, it invariably leads to deterioration. In cases where toxic factors are latent, or the patient is elderly and weak, or has taken harsh purgative drugs leading to further Qi deficiency and failure of pus to form, fire therapy is necessary to succeed. Generally, steaming moxibustion draws out stagnant toxins before ulceration and tonifies Yang Qi, dispels cold pathogens, and promotes healing after ulceration, demonstrating great efficacy. I once treated patients with limb sores due to Qi and Blood deficiency using only this method, and all recovered. Severe Ding toxins are particularly suitable for moxibustion because heat toxins block internal and external communication; without venting, they cannot disperse. In poor or remote areas lacking medicine, garlic-interposed moxibustion is especially convenient. Replace the garlic slice every three moxa cones, generally aiming for 100 cones. Garlic is used for its pungency to disperse; moxa cones are used for their penetrating heat. Following this method ensures suppuration and ulceration. Subsequent application of Shenyi Gao leads to spontaneous healing within days. It prevents enlargement, preserves internal flesh, and facilitates closure, showing miraculous results. Danxi stated: Since the head is the gathering point of all Yang meridians, moxa cones should be small and few in number.

Official Cao suffered from a back eruption for eighteen days. The sore head was like millet, feeling like a needle prick inside, with extreme pain accompanied by occasional fainting and loss of appetite. His Qi became increasingly deficient. After more than ten moxa cones of large moxa via garlic interposition, he felt no relief and pain persisted. Subsequently, direct moxibustion was applied for over twenty cones. Internal toxins were expelled, toxic factors erupted, and appetite gradually returned. Further treatment with major tonics and burning mulberry wood led to gradual necrosis of dead flesh.

Liu Guanqing suffered from a Ding carbuncle on the foot for eleven days. Due to weak Qi, he underwent over fifty moxa cones and recovered with interior-supporting medicines.

Mr. Huang had a leg abscess with clear pus and a weak pulse. A female patient had an arm lump that had ulcerated. Neither wound would close. Both were treated with fermented soybean cake moxibustion and administered interior-supporting medicines, resulting in recovery.

A male patient had a chest lump persisting for half a year without resolution. He was ordered to undergo direct moxibustion for one hundred cones until ulceration occurred. Major tonics failed to promote closure, but application of Aconite Cake moxibustion led to recovery.

A male patient suffered from a back eruption with many sore heads, hard purple swelling, minimal pain, and no necrosis/ulceration. Mugwort was spread on the affected area for moxibustion, followed by several days of major tonics. Dead flesh detached, and he recovered. Official Chen suffered from a back eruption for four to five days. Although the sore head was small, the base was wide. Garlic-interposed moxibustion of thirty-plus cones caused the base to subside internally. Only the sore head suppurated, and he recovered in a few days.

In the Bingzi year, I suddenly experienced nausea, intense itching at the Dazhui (GV14) bone, inability to lift my arm shortly after, and extreme mental fatigue. This was a critical condition known as Tian Ju (Early Mortality Carbuncle). I urgently applied garlic-interposed moxibustion, which intensified the itching. Direct moxibustion of fifty-plus cones stopped the itching, and I recovered within ten days. *Jing Yao* states that moxibustion possesses the merit of generating life in four ways; this is true. (Commentary by Xue Ji)

Shi Shi cited evidence: The surgeon Chang Qizhi diagnosed the mother of Tai Shi in the Jiaxu year, noting internal accumulated heat and warning of potential carbuncle formation. In June of the Xin Si year, she indeed experienced slight itching on her back and shoulder blades, with grain-like eruptions. Moxibustion cleared them temporarily, but they recurred overnight. Topical plasters widened the redness to about six cun, causing unbearable pain, leading to blame being placed on moxibustion. An encounter with a monk, who claimed to have survived a critical sore after 800+ moxa cones, prompted the use of large moxa cones the size of ginkgo nuts on the sore head and surrounding areas. Pain ceased. After 30+ cones, the red halo disappeared. Forty moxa balls the size of plum/apricots were then applied, allowing him to eat congee and sleep. The actual sore covered four areas with over a hundred small openings; necrotic tissue sloughed off, and he recovered. Lizhai stated: The method of moxibustion requires making painful areas become painless and painless areas become painful; thus, toxins disperse with the fire. Otherwise, it is not only ineffective but harmful.

My opinion is that carbuncles and ulcers result from stagnation and accumulation of Qi and Blood. Large accumulations are hardest to disperse and require fire therapy for rapid resolution, making moxibustion highly suitable. However, Sun Daoren’s Shenxian Xunzhao Formula is even more exquisite. For mild pathogens, deep-seated pathogens in distant meridians, or blocked Qi flow, moxibustion is good. For intense, rapidly progressing pathogens in critical conditions, the Xunzhao formula is superior to moxibustion.