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The *Waike Shuyao* (Key to External Medicine) states: In treating sores and ulcers, one must consider the transmission along the meridians, the location of the disease in the exterior or interior, and the deficiency or excess of the patient's constitution, to decide whether to employ attacking or tonifying methods. For instance, if there is swelling, pain, heat, thirst, and constipation, it indicates that the pathogenic factor is inside (the zang-fu organs), and one should use unblocking methods. If there is swelling and pain accompanied by aversion to cold, fever, and headache, it indicates that the pathogenic factor is on the exterior, and one should use dispersing methods. If the swelling and pain are severe, it indicates that the pathogenic factor is in the meridians, and one should use harmonizing methods. If there is slight swelling and pain without suppuration, it indicates a deficiency of Qi and Blood, and one should use tonifying and pushing-out methods. If there is diffuse swelling without pain, or failure to suppurate, or failure of the pus to rupture after formation, it indicates a severe deficiency of Qi and Blood, and one should use vigorous tonification. If the color is dark with slight swelling and pain, or if the pus forms but does not discharge, or if necrotic tissue does not slough off, it indicates Yang deficiency and cold, and one should use warming and tonifying methods. If one adheres rigidly to the stage before ulceration and indiscriminately uses detoxifying (clearing heat and resolving toxicity) herbs, it will further damage the Spleen and Stomach. Not only will the swollen area fail to form pus, but even ulcerated wounds will struggle to heal, leading to the emergence of the "Seven Evil" syndromes, often resulting in death. Ma Yiqing said: For non-ulcerated sores where both interior and exterior are obstructed, the primary approach should be tonifying the interior and releasing the exterior. If one wishes to use Rhubarb (Rhei Radix et Rhizoma), it may be considered rash. For ulcerated sores where both interior and exterior are deficient, the primary approach should be tonifying and connecting the interior; if one wishes to use aromatic and dissipating herbs, it inevitably leads to the error of making the deficient even more deficient. Practitioners must exercise caution.

Qi Dezhi said: Regarding all types of sores, carbuncles, erysipelas, swellings, tubercles, and scrofula, as soon as they are perceived, internal resolution methods should be employed immediately. If they persist for a long time without removal, Qi and Blood gradually decline, muscles become cold and stiff, pus becomes thin and watery, toxic factors do not exit, the wound fails to close, aggregated swelling is not red, tubercles lack pus, and external signs are unclear, all these cases are suitable for interior-tonifying methods. For those where pus has not yet formed, promote early suppuration; for those already ulcerated, promote early granulation. For Qi and Blood deficiency, tonify the interior via interior-tonifying methods. For disharmony of Yin and Yang, regulate the interior via interior-tonifying methods. Generally, the function of interior-tonifying methods is to prevent the sore from developing deteriorating signs. Any physician treating sores should not be without interior-tonifying medicines for a day. However, regarding cold, heat, warmth, coolness, vexation, thirst, diarrhea, and vomiting, one must assess the urgency during clinical practice.

Ma Yiqing said: Carbuncles and sores arise from accumulated toxins in the zang-fu organs. One should first assist Stomach Qi and strengthen Yuan Qi to solidify the root, then use blood-invigorating and meridian-unblocking herbs as auxiliaries, referencing the meridians and seasonal timing, ensuring that toxic factors are excreted externally. If treated early, the toxin can be resolved internally. This is the essence of interior-tonifying methods.

Xue Lizhai said: Generally, the occurrence of sores and ulcers is due to Stomach Qi failing to follow its normal course. The ulceration of sores is due to the putrefying action of Stomach Qi. The healing of sores is due to the nourishing function of Stomach Qi. I have treated initial nodules that have not yet formed pus by using interior-tonifying methods to disperse them; those that have formed and are about to suppurate by using interior-tonifying methods to promote suppuration; those with formed pus but not yet ulcerated by using interior-tonifying methods to open them; and those already ulcerated by using interior-tonifying methods to promote closure. Li Dongyuan said: The Spleen is the official of the granary, and the Stomach is the sea of water and grain, primarily nourishing the four peripheries to generate Qi and Blood. Therefore, Stomach Qi is the source of growth and development and the foundation of the human body. The principle here is indeed profound.