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Apply plaster to the ulcerated area. Touch the swollen area with your hand; if it feels hot, there is pus; if not hot, there is no pus.

It is also said: For any injury to the muscles where the sore does not heal, use Liu Jun Zi Tang (Six Gentlemen Decoction) primarily to tonify the Spleen and Stomach; if Qi deficiency causes aversion to cold and the sore does not heal, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify the Spleen and Lungs; if Blood deficiency causes fever and the sore does not heal, use Si Wu Shen (Four Substances Decoction with Ginseng) to nourish the Liver and Spleen; if there is excessive pus and the sore does not heal, use Ba Zhen Tang (Eight Treasures Decoction) or Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) to nourish Blood and tonify Qi. The Classics state: The Spleen governs the muscles. If the aforementioned medicines are ineffective, use Si Jun Gui (Four Gentlemen Decoction with Angelica Sinensis) solely to tonify the Spleen and Stomach; if still ineffective, it indicates deficiency of Yang in the Lower Yuan, use Ba Wei Wan (Eight-Ingredient Pill) to strengthen the Fire of the Gate of Vitality to generate Earth; if the pulse is rapid and there is thirst, it is difficult to treat, as this represents deficiency of True Qi and excess of Pathogenic Factors.

It is also said: Regarding all carbuncles and sores, at the initial stage, the pathogenic toxins have not yet reached the exterior, and the Zang-Fu organs are congested with heat; absolutely no warming herbs should be used. After pus has been discharged, the toxic vapors are excreted externally, Qi and Blood are both deficient, and Stomach Qi naturally weakens; absolutely no cooling herbs should be used. This follows the established methods of the ancients. However, there are cases of Qi and Blood deficiency with Cold, where toxins sink into the Yin aspect at the onset. Without using Yang-Harmonizing and Interior-Supporting methods, how can they rise and reach the exterior? After ulceration, if Yin Blood is dry and depleted, without nourishing Yin and promoting circulation, how can pus production continue? Externally, the sore toxin becomes dry and scorched; internally, there is dry mouth and irritability. Therefore, treatment depends entirely on careful assessment via the pulse. Generally, Qi provides warmth, Blood provides moisture; Qi forms the structure, Blood provides luster. Thus, for various carbuncles and sores that are flat and fail to elevate, it is due to weakness of Yang Qi, unable to expel toxins from the Yin aspect, termed Yin Toxin. If the base is red and diffuse, it is also due to Qi deficiency failing to constrain Blood tightly. If red and vibrant/lustrous, it indicates Qi and Blood constraining toxins to the exterior. If red externally but black internally, toxins are stagnant within. If purple and dull, Qi and Blood are insufficient to transform toxins into pus. Thick pus indicates robust Qi and Blood; thin pus indicates declining Qi and Blood. Before pus appears, there may be excess Heat; after pus appears, treatment must address deficiency. As long as even a fraction of toxic vapors remains, one must not tolerate their retention, lest they spread and cause major disaster, like raising a tiger which will eventually bite. For Qi deficiency failing to expel toxins, warm tonification combined with supporting expulsion is needed; once Yang Qi turns, stagnation in the Yin aspect resolves like melting ice. For Blood deficiency failing to transform toxins, nourishment and suppuration promotion are especially suitable. During the time of ulceration and pus discharge while toxins remain, the function of supporting the interior cannot be delayed for a moment; tolerance allows toxins to linger; clearing/dispersing causes toxins to become frozen/stagnant. Supporting the interior without tonifying Qi and Blood leaves the deficient unable to form pus, like trying to cook rice without grain; nourishing without supporting the interior only harmonizes Qi and Blood but cannot reach the ulcerated site to succeed, and in cases of abundant toxins, it反而 aids them, like feeding grain to bandits. Nourishment without warmth leads to Blood coagulation and Qi stagnation, who then serves as the vessel for pus formation? Like brewing wine without warmth, how can it become liquid? Like cooking rice without fire, how can it become熟? People generally know to treat toxin as Fire and clear Fire to detoxify, but do not realize that toxin is Fire; when toxin transforms, Fire clears; when toxin stagnates, Fire becomes more depressed. However, toxin transformation necessarily goes through pus; pus generation necessarily comes from Qi and Blood; Qi and Blood transformation necessarily comes from Fire. Can Fire be cleared? Moreover, cooling methods are only applicable to minor skin eruptions like sores and boils. If encountering a deep abscess penetrating meridians and collaterals, attacking and supporting may barely suffice; how can one further apply clearing and resolving, thereby damaging Stomach Qi, leading to invigoration of Yang, difficulty in ulceration and healing, and potentially internal attack on Zang-Fu organs? Is this not something to fear! Once toxins are completely removed and flesh regenerates, within the peaceful tonification of Qi and Blood, one may add Jin Yin Hua (Lonicerae Japonicae Flos) and Guo Lao (Licorice Root) to resolve residual toxins. As for Lian Qiao (Forsythiae Fructus) and Hua Fen (Trichosanthis Radix), they can detoxify but damage Stomach Qi and should be strictly prohibited.

Cheng Shanling said: When taking medicine for carbuncles and sores, priority should be given to protecting the Spleen and Stomach. Cooling herbs should be used only when necessary, targeting the disease precisely, and never overdosed. At the onset, if complicated by Wind-Cold, first use Xiong Zhi Xiang Su San (Cyperi Rhizomatis, Chuanxiong, Aucklandiae, and Perilla Leaf Powder) for one dose, or Wan Ling Dan (Ten Thousand Spirits Pill) or Chan Su Wan (Toad Venom Pill) to disperse. After dispersion, if swelling persists, immediately use Yin Hua Gan Cao Tang (Honeysuckle and Licorice Decoction) or Si Miao Tang (Four Marvels Decoction) to harmonize. If swelling is painful, stool is constipated, and internal heat is extreme, cooling herbs must be combined with supporting/expelling agents, primarily Tou Nong San (Pus-Releasing Powder). If pus has drained, priority must be given to supporting and tonifying Yuan Qi, primarily Shen Nei Tuo San (Ginseng Interior-Supporting Powder); if Yuan Qi is deficient and cold, acrid-hot herbs must be added to the supporting/tonifying formula; for Spleen deficiency, Li Zhong Tang (Regulate the Middle Decoction) or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder); for Qi deficiency sinking downward, Bu Zhong Yi Qi Tang; for Stomach Meridian Cold with food stagnation, Huo Xiang Zheng Qi San (Agastache and Magnolia Bark Powder); for dual Qi and Blood deficiency, Shi Quan Da Bu Tang plus Fu Zi (Aconite Root) and Lu Rong (Deer Antler Velvet); occasionally, deficiency with Heat occurs, in which case remove Fu Zi and Rou Gui (Cinnamon Bark), add Mai Dong (Ophiopogonis Radix), Jin Yin Hua, and Mu Dan Pi (Moutan Cortex) to conclude treatment; these points must be known. Generally, there are Yang Toxin and Half-Yin Half-Yang types, which must be carefully distinguished. Yang Toxin symptoms: sore is red and swollen, tip is elevated, base is compact, appetite is normal, thirst with constipation, five-palm heat, pulse is surging and rapid. Yin Toxin symptoms: sore is gray-white and flat, numb with little pain, base is spreading, poor appetite with loose stools, cold extremities, cold breath from mouth/nose, pulse is deep and slow. Half-Yin Half-Yang symptoms: sore is red and swollen but not highly elevated, appetite slightly reduced, stool not constipated, alternating chills and fever, slight thirst preferring hot drinks, pulse is deficient and soft. These three must be carefully distinguished so that medication is appropriately cold or warm, constituting legal treatment. Treat Yang Toxin with cooling and detoxification; treat Yin Toxin with warming the middle and restoring Yang; treat Half-Yin Half-Yang with methods that clear without damaging the Stomach and warm without aiding pathogens, and nothing more. (From "Ten Methods")

Hu Gongbi said: Carbuncles and sores most strongly contraindicate sweating, fearing that exterior deficiency prevents pus formation, making later treatment difficult. (From "Wu Kui Qing Nang")

It is also said: For unexpelled foul pus, use Bai Zhi (Angelicae Dahuricae Radix); do not use Bai Zhu (Atractylodis Macrocephalae Rhizoma), as Bai Zhu promotes toxin transformation and pus generation.

The Classics state: Without Yang, Yin cannot be generated; without Yin, Yang cannot be transformed.

Zhang Jingyue said: Yin roots in Yang, Yang roots in Yin. For diseases that cannot be treated conventionally, one should guide Yin from Yang, and guide Yang from Yin, seeking their respective affiliations to reduce them. For example, seeking sweat from Blood, generating Qi from Essence, this is guiding Yin from Yang; again, guiding Fire back to its source, gathering Qi into the Kidney, this is guiding Yang from Yin; this is the meaning of extracting Fire from Water and Water from Fire.

It is also said: Yin diseases come slowly and leave slowly; Yang diseases come quickly and leave quickly. Yang is born from Heat, Heat is relaxing; Yin is born from Cold, Cold is contracting and tense.

It is also said: Cold pathogens strike the lower part; Heat pathogens strike the upper part; dietary pathogens strike the middle.

It is also said: Examining the *Zhong Zang Jing*, it says: Yang diseases are quiet in the morning, Yin diseases are calm at night; Yang deficiency causes confusion in the evening, Yin deficiency causes contention in the morning. Generally, Yang deficiency favors Yang assistance, so symptoms are lighter in the morning and heavier in the evening; Yin deficiency favors Yin movement, so symptoms are heavier in the morning and lighter in the evening. This refers to deficiency of Yin and Yang. If presenting with excess pathogens, the opposite holds: Yang excess is heavy in the morning and light in the evening; Yin excess is light in the morning and heavy in the evening. This is Yang meeting Yang becoming prosperous, Yin obtaining Yin becoming strong. Cases occurring day or night, intermittently, arise because Righteous Qi cannot maintain control, causing Yin and Yang victory and defeat to intermingle chaotically. Treatment should focus on cultivating Righteous Qi, after which Yin and Yang will naturally harmonize. However, whether dealing with Water or Fire, one must seek based on deficiency or excess.

It is also said: Diseases have six transformations: Exterior/Interior, Cold/Heat, Deficiency/Excess. These are the keys to medicine; understanding these six makes all diseases clear as palm lines. From the Exterior perspective, Wind, Cold, Summerheat, Dampness, Fire, Dryness affecting the outside are Exterior syndromes; from the Interior perspective, Seven Emotions, Labor/Desire, Diet injuring the inside are Interior syndromes. Cold belongs to Yin, either Internal Cold or External Cold, Cold syndromes are mostly Deficient; Heat belongs to Yang, either Internal Heat or External Heat, Heat syndromes are mostly Excess. Deficiency is insufficiency of Righteous Qi, diseases arising internally are mostly deficient; Excess is surplus of Pathogenic Factors, diseases entering externally are mostly excess.

It is also said: A disease must enter from the Exterior to be called an Exterior syndrome; if it arises from the Interior and manifests outwardly, it is not an Exterior syndrome. The Classics state: From Interior to Exterior, regulate the Interior; from Exterior to Interior, treat the Exterior; from Interior to Exterior becoming severe externally, first treat the Interior, then the Exterior; from Exterior to Interior becoming severe internally, first treat the Exterior, then regulate the Interior. This sequence of Interior/Exterior treatment must be understood.

It is also said: Heat in the Exterior presents as fever and headache, erysipelas/swelling/rashes/yellowing, removing clothes/bedding, and various painful sores. Heat in the Interior presents as dizziness/distension/fullness, irritability/thirst/panting/constraint, or急促 breathing/shouting, or restlessness/manic behavior. Heat in the Upper presents as headache/red eyes, throat sores/toothache, various rebellious upward movements, preference for cold/black tongue. Heat in the Lower presents as waist/foot swelling/pain, urinary/fecal retention, or painful nocturnal emission, turbid urine/red stool.

It is also said: Cold in the Exterior presents as aversion to cold, cold body, edema, blue/gloomy complexion, and cold paralysis of limbs. Cold in the Interior presents as cold throat/bowel sounds, nausea/vomiting, heart/abdominal pain, aversion to cold/preference for warmth. Cold in the Upper presents as acid regurgitation, dysphagia, undigested food, belching/rotten smell/distension/hiccups. Cold in the Lower presents as indistinct clear/turbid separation, loose/painful diarrhea, impotence, enuresis, cold knees/cold feet.

It is also said: The pulse of True Cold is definitely slow, weak, and spiritless; the pulse of True Heat is definitely slippery, full, and forceful.

It is also said: Persons with Yang Constitution tend toward Heat; persons with Yin Constitution tend toward Cold. Yang Constitution persons invariably prefer cold and fear heat in life; eating cold morning and night causes no illness, indicating Yang excess. Yin Constitution persons, upon exposure to cold/cool, inevitably injure Spleen and Kidney, indicating Yang insufficiency. Only few are Yang-strong (2-3 in 10); many are Yang-weak (5-6 in 10). However, those relying on strength often fall ill; those fearing weakness often remain healthy.

It is also said: For False Cold misusing Hot Medicine, or False Heat misusing Cold Medicine, test with a small amount of cold water. False Heat patients will dislike water; even if some like it, vomiting may occur after ingestion, requiring immediate resolution with Warm-Hot medicine. False Cold patients will likely like water; if ingestion brings comfort without resistance, resolve with Cold-Cool medicine.

It is also said: Many people today suffer from Deficiency syndromes requiring tonification. However, tonification methods should not be hasty. To observe the opportunity for tonification, first examine if the chest and abdomen are comfortable/open. Then advance gradually. If not yet pathological, boldly use it later, ensuring no obstruction. This is the great method of tonification.

It is also said: In critical situations allowing no delay, one must first ask if the chest/abdomen are open before sudden advancement; if Yuan Qi is truly deficient but chest/abdomen are distended, this is a sign of "Deficiency unable to accept tonification." Forcing tonifying agents is not only useless but invites criticism.

It is also said: In prescribing and medicating, flavors and aromas have Yin/Yang. Yin descends, Yang ascends; Yin is static, Yang is active; Yin is soft, Yang is rigid; Yin is timid, Yang is brave; Yin governs Essence, Yang governs Qi. Their good/bad nature and preferences have subtle applications.

It is also said: Regarding ascending/descending of flavors/aromas, ascending ones float and disperse, descending ones sink and promote flow. Those suited for ascending should not descend; those suited for descending should not ascend.

It is also said: Regarding moving/staying of flavors/aromas, staying ones anchor, moving ones travel. Traveling ones can move, anchoring ones can stabilize.

It is also said: Regarding rigid/soft flavors/aromas, soft ones are pure and slow, rigid ones are restless and urgent. Pure ones can harmonize, restless ones can repel. Without rigidity, violent pathogens cannot be removed; without softness, rigidity cannot be assisted.

It is also said: Regarding brave/timid flavors/aromas, Brave ones reach the disease site directly, relying on surprise tactics; Timid ones ensure周全, relying on stability.

It is also said: Flavors/aromas governing Qi can be the mother of Essence; those governing Essence can be the root of Qi. Yin-within-Yang can move Qi within Blood; Yang-within-Yin can protect Essence within Qi.

It is also said: Flavors/aromas have good/bad qualities. Good ones have gentle natures, fully selectable for use. Bad ones have cruel flavors/aromas, why approach them?

It is also said: Flavors/aromas have good/bad qualities, inherent preferences, and temporary preferences. Compatibility yields easy effects; bad ones are avoided, no need to force administration.

It is also said: Treating diseases with medication values precision and specialization, and bravery. For chronic diseases, trace the beginning and end, treating slowly is appropriate. For acute diseases, once true Deficiency/Excess is identified, use potent formulas to attack the root directly; extraction is easy. Delaying or shrinking back creates entrenched patterns, determining life or death. Who bears the blame? Thus, for true Interior Excess, use Liang Ge San (Cool the Chest Powder) or Cheng Qi Tang (Order the Qi Decoction); for true Interior Deficiency, use Li Zhong Tang or Shi Quan Da Bu Tang; for Exterior Deficiency, use Bai Zhu and Jian Zhong Tang; for Exterior Excess, use Ma Huang, Chai Hu, Gui Zhi, etc. Use one herb as Sovereign, two or three as Ministers/Assistants, administer large doses, more is better. Where lies the principle of using large amounts? It relies on their power and safety. For mild-natured herbs, use several taels; for urgent-natured herbs, use several qian. The theory of 3-5-7 fen is merely child's play of counting names. A talent for resolving chaos and treating severe conditions acts thus!

It is also said: The principle of treatment requires knowing Evil vs. Righteous, weighing importance. Treating Excess is like weeding rice fields; barnyard grass is the thief of rice. Remove one weed for one plant, two weeds for two plants; this is good weeding. Removing two weeds damages one plant; removing four weeds damages two plants. If misidentifying rice as weeds and attempting total eradication, no rice remains. Using attacking methods requires accurate identification and avoiding excess. Treating Deficiency is like supplying rations: one person gets one sheng, ten get one dou; daily rations suffice. Giving one dou to a hundred, one hu to a thousand—can stone-carrying rations feed an army? If one ration fails, previous rations are abandoned, let alone deductions. Using tonifying methods requires measured weight/importance, not simplicity.

It is also said: In treating Deficiency/Excess, generally Excess can tolerate Cold, Deficiency can tolerate Heat. Hence, tonification must include Warmth, purgation must include Cooling. Cooling is Autumn Qi, Yin governs killing; all things meeting it cease growth. To tonify Yuan Qi, Cooling is unsuitable; if Cooling is unfavorable for tonification, Cold is even worse. Even for Fire-excess with Qi-deficiency requiring Cool tonification, it is only temporary for Fire; once Fire is gone, stop. It is ultimately not a method for treating Deficiency. Some claim Bitter-Cold substances tonify Yin; however, *Nei Jing* states: For bodily insufficiency, warm with Qi; for Essence insufficiency, tonify with Flavor. Harmonious flavors/aromas suitable for humans are called tonification. Never heard of bitter-flavored, inferior-aroma substances unsuitable for humans being called tonification. Although *Nei Jing* mentions: For Water element ruler, purge with Salty, tonify with Bitter, this specifically refers to Five Elements seasonal Qi flavors, discussed theoretically. Furthermore, Wheat, Mutton, Apricot, Leek are all Bitter categories, representing Bitter tonification. How can Da Huang (Rhei Radix et Rhizoma) or Huang Bo (Phellodendri Cortex), with bitter-flavored inferior aromas, be called tonifying? This is illogical. Wang Yingzhen said: A point of True Yang resides in Kan Palace; strengthening the root requires Sweet-Warm. Sweet-Warm benefits, Cold does not tonify; laugh at mediocre doctors wasting effort. This summarizes it; one must investigate.

It is also said: Tonification and Purging are both treatments, but one must know the key. For acute diseases in young/strong individuals, attacking/purging is acceptable. Attack is for temporary use; chronic debilitation cannot be cured by repeated attacks without harm; thus, attack cannot achieve slow recovery for prolonged illness. Weak individuals should be warmed and tonified; tonification is for constant use. Once the root is damaged, abandoning tonification prevents recovery; thus, tonification cannot seek rapid effect. However, there is a key: In clinical practice, regardless of Deficiency/Non-Deficiency syndromes, if no Excess evidence exists, combine tonification to harmonize Ying-Wei, Jing-Blood Qi. Regardless of Fire/Non-Fire syndromes, if no Heat evidence exists, combine Warming to cultivate Mingmen and Spleen/Stomach Qi. This is the essence of tonification/purging. Ignoring this leads to disaster.

It is also said: Treatment methods have Reversal (Ni) and Following (Cong), due to Fake/True Cold/Heat, the essence of *Nei Jing*. Classics state: Reversal is Standard Treatment (Zheng Zhi); Following is Counter-Treatment (Fan Zhi). Treating Heat with Cold, Cold with Heat is Standard Treatment (Reversal); Treating Heat with Heat, Cold with Cold is Counter-Treatment (Following). E.g., using Hot medicine for Cold disease without relief indicates No Fire; treat Mingmen with Ren Shen, Sheng Jiang, Gui Zhi, Fu Zi. This is Wang Tai Pu’s "Enrich the Source of Fire to eliminate Yin Shadows," also Standard Treatment. If Hot medicine for Cold disease fails, but Cold medicine succeeds, this is Fake Cold, using Cold Following Method. If Cold medicine for Heat disease fails, treat Kidneys with Liu Wei Wan (Six-Ingredient Pill with Rehmannia). This is Wang Tai Pu’s "Strengthen the Master of Water to suppress Solar Flare," also Standard Treatment. If Cold medicine for Heat disease fails, but Ren Shen, Sheng Jiang, Gui Zhi, Fu Zi Ba Wei Wan succeeds, this is Fake Heat, using Heat Following Method, also "Sweet-Warm removes Great Heat." Today, Deficiency is common, Excess rare; thus, True Cold/Fake Heat is very common, True Heat/Fake Cold is rare.

It is also said: Probing disease methods must be known. In clinical practice, if Deficiency/Excess is unclear, Cold/Heat hard to distinguish, disease is ambiguous, and tonification/purgation intent is undecided, use this method first. Suspecting Deficiency, intending tonification but undecided, use mild/digestive agents with few herbs to probe. If digestion fails, it is True Deficiency. Suspecting Excess, intending attack but undecided, use mild Sweet-Warm pure tonification with few herbs to probe. If tonification causes stagnation, there is Excess Pathogen. For Fake Cold, slight warming reveals irritability; for Fake Heat, slight cooling reveals nausea/vomiting. Probing determines intent. Classics state: Seek what exists, seek what does not exist.

It is also said: Fake is opposite, this is the meaning. Probing methods must be concise, not mixed. Concise distinguishes true/false clearly; mixed makes right/wrong hard to judge. This is a flexible method for ambiguity, used only when necessary.

Hua Yuanhua said: Generally in treatment, if pulse is not tight/rapid, do not induce sweating; if pulse is not full/rapid, do not purge; if chest/mind not closed, Chi pulse weak, do not vomit; if joints not stiff, Ying-Wei not congested, do not needle; if Yin Qi not excessive, Yang Qi not declining,