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As an adjunct. Chop the herbs to the size of hemp seeds or beans, weigh the water, decoct, and take orally. Cover the hands with thin clothing, cover the body with thick blankets, and lie in a warm place. Thus, the blood in the meridians will become warm, the *Couli* (pores and skin texture) will open, the cold pathogen will dissipate, the *Yang Qi* (defensive and warming energy) will extend, resulting in profuse sweating. The swelling will decrease by eight or nine parts out of ten. For the next dose, remove *Ephedrae Herba* (Mahuang, 麻黄) and *Saposhnikoviae Radix* (Fangfeng, 防风), and add *Scutellariae Barbatae Herba* (Lianqiao, 连翘) and *Araliae Chinensis Fructus* (Niubangzi, 牛蒡子). The pain and swelling will completely disappear. The Classics state that "when sweat is discharged, the sores heal," which is indeed true.

Xue Lizhai said: The occurrence of sores and ulcers is caused by consuming rich and greasy foods (*Gaoliang Houwei*), strong wine, and roasted meats; excessive sexual activity; emotional stagnation transforming into fire (*Seven Emotions Stagnant Fire*); *Yin Deficiency* with *Yang* encroaching; deficiency of essence and qi with stagnant qi mechanism; decline of the *Mingmen Fire* (Gate of Life fire) failing to generate Earth (Spleen/Stomach); weakness of *Ying* (Nutritive) and *Wei* (Defensive) qi allowing external pathogens to invade; and injury to qi and blood leading to pathology. One must examine which meridian is affected and treat according to the root and branch, urgency and slackness.

Chen Liangfu said: A sore appearing as small as hemp seeds on the outside may be as large as a melon inside; a sore appearing as small as a coin on the outside may accommodate a fist inside.

Chen Ziming said: Diseases can lead to death due to severity, or due to mildness. How can life and death be determined when symptoms are difficult to distinguish? The answer is: If a Back Carbuncle (*Fa Bei*) ulcerates through to the inner membrane, it is fatal. If not yet ulcerated but sinking inward, with a red face, black lips, and foul stool, it is fatal. Restlessness and oppression are untreatable. Ulceration reaching the throat is untreatable. Yin sores entering the abdomen are untreatable. Sores entering the scrotum/testicles are untreatable. Deep sores in the temples about one cun deep are untreatable. A condition named *Rui Du* (Sharp Poison) located one cun three fen behind the chin is also untreatable. Those without these conditions will survive; even if there are many cases of *Liu Zhu* (Flowing Deposits), treatment will surely lead to recovery.

The *Ji Yan* states: Although there are more than twenty names for carbuncles and sores, their essentials are two: Yin and Yang. Manifestations originating from Yang are called *Yong* (Carbuncle), characterized by heat and excess; manifestations originating from Yin are called *Ju* (Deep Sore/Abscess), characterized by cold and deficiency. Therefore, Yang onset presents with thin skin, red color, high swelling, often with dozens of pepper-like pores and pain; Yin onset presents with thick skin, pale color, hard swelling, resembling ox neck skin, and no pain. There is also "Yin within Yang," which appears hot but is not truly hot, swollen but essentially deficient, red but not dry, wanting pain but lacking pus, floating then subsiding, appearing vigorous externally but rotting internally. There is also "Yang within Yin," which appears cold but is not truly cold, not swollen but essentially solid, slightly red and dry, having pus and pain, appearing less vigorous externally but suffering internal restlessness. Persons with "Yin within Yang" tend to be fat with tight flesh but internal deficiency; persons with "Yang within Yin" tend to be thin with loose flesh but internal solidity. Furthermore, Yang transforming into Yin is due to herbalists overusing cooling formulas; Yin transforming into Yang is due to physicians using heating medicines too abruptly. However, when Yang transforms into Yin, the signs are numerous, yet it can still revert to Yang, so survival is common; when Yin transforms into Yang, the signs are few, and it cannot revert to Yin, so death is common. Occasionally, survival occurs only when the physician accidentally follows the correct method, one in a hundred. Observing this, the difference between *Yong* and *Ju* lies only in the depth of Yin/Yang, and internal/external excess/deficiency, not in size. The *Jing Yao* claims that two to five cun is *Yong* and five cun to one chi is *Ju*, which is erroneous.

Hu Gongbi said: Whenever a carbuncle or sore is deep and painless, it indicates extreme deficiency of Stomach Qi, a sign of certain death, because the flesh has died and sensation is lost. (From *Qing Nang*)

Jiang Shiji said: Accumulated heat in the Six Fu Organs erupting between the skin and muscles, presenting as high swelling and pain like a bowl or basin, is called *Yong*; accumulated heat in the Five Zang Organs attacking the skin and muscles, initially appearing like millet grains or beans, flat with the flesh, not highly swollen, sometimes red, occasionally itchy and painful, is called *Ju*. (From *Shuo Yue*)

The *Xin Fa* states: Whether ulcerated or not, sudden teeth-chattering and chills indicate Qi deficiency unable to overcome the toxin, a sign of the toxin hiding and attacking inward.

It also states: After ulceration, if pus and fluid fluctuate greatly in amount, and the sore opening resembles crab bubbles, it indicates penetration of the inner membrane, which is a adverse sign (*Ni Zheng*).

It further states: During the swelling stage, without the support of righteous Qi, the sore top cannot swell high and hurt; during the ulceration stage, without nourishment from True Yin, the sore base cannot consolidate, showing redness, vitality, and contraction. Observing a high sore top and active base, regardless of age, confirms sufficient Qi and Blood.

Gong Zicai said: Carbuncles and sores arise from disharmony of Qi and Blood, irregular emotions, unregulated diet, and imbalance of cold and heat, causing Qi of the Five Zang and Six Fu organs to stagnate internally, leading to disorder of Yin and Yang and stagnation of Qi and Blood. It can also result from long-term use of cinnabar and stone minerals (hot/dry drugs), where deep-seated heat-toxin erupts. This disease mostly affects those of wealth who consume rich, greasy, roasted foods, sit idle, and lack restraint in desires, leading to empty pathogens and heat-toxin attacking inward, frying Qi and Blood. The Classics say: "All pain, itching, and sores belong to Heart Fire." Because the Heart governs Blood and moves Qi, if Qi and Blood stagnate, combined with Heart Fire heat, they cause carbuncles and sores. However, the depth of invasion varies, so the severity and size of eruption differ. Heat accumulating in the Six Fu organs surging outward between muscles, erupting violently with shiny, soft, spreading skin swelling, is *Yong*. Wind-toxin of the Five Zang organs, with accumulated heat attacking muscles, erupting fiercely and maliciously, starting as a single head like a new wound, white, scorched, dry, painful upon touch resonating with the heart, is *Ju*. Heat between the skin, presenting as edematous swelling with a small base, not exceeding two or three cun, is a boil (*Jie*). *Yong* arises from the Six Fu organs, like a prairie fire, ulcerating muscles outward; *Ju* arises from the Five Zang organs, deep and sluggish, difficult to treat, like fire-starting tinder in a clay room, ulcerating marrow inward. *Yong* is easy to treat but slow to heal due to poor recuperation; *Ju* is hard to treat but easier to recover from. Among all sores, Back Carbuncle and Ding Sores are the most acute. Externally, Brain Carbuncle, Intestinal Abscess, and Throat Carbuncle are also acute. Treating carbuncles and sores requires examining whether it is excess or deficiency, cold or heat, heavy or light, prescribing accordingly without missing the sequence. For anyone over forty, sores or boils on the crown, temples, chin, back, spine, waist, flanks, or above bones/tendons, especially in areas not easily visible, should not be treated lightly. Neglecting them as common ailments often leads from minor issues to fatal ones; prompt treatment is necessary for salvation. It is like fighting fire: easy to extinguish at the start, impossible once it becomes a prairie fire. When the sore is unbroken and toxin attacks the Zang-Fu, absolutely no heating medicine should be used; once broken and ulcerated, with Zang-Fu deficiency and loss of appetite, absolutely no cooling medicine should be used. This is the essential secret of sequential treatment.