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Cheng Shanling said: Someone asked, what are the "Five Goods" and "Seven Evils" in carbuncles and sores? The answer is: The "Five Goods" refer to: being able to taste food and drink, which is the first good; regular and balanced urination and defecation, which is the second good; after pus drains and swelling subsides, with no foul odor in the discharge, which is the third good; clear spirit, with natural calmness in movement and rest, which is the fourth good; a pulse that shows vitality and does not contradict the seasonal patterns, which is the fifth good. The "Seven Evils" refer to: extreme thirst, fever, diarrhea, and dysuria or urinary retention, which is the first evil; swelling persists despite pus drainage, with foul-smelling discharge, which is the second evil; eyes lack spirit, voice is hoarse or weak, which is the third evil; poor appetite with indigestion, vomiting after taking medicine, which is the fourth evil; mental confusion, drowsiness, shortness of breath, fatigue, and a sensation of heaviness on the back as if carrying a stone, which is the fifth evil; cyanotic lips, black nose, and edema of the face and eyes, which is the sixth evil; a pulse lacking vitality, or restless and irregular, which is the seventh evil. Ancient sayings state: "If three of the Five Goods are present, it is auspicious; if four of the Seven Evils are present, it is ominous," without needing all signs to appear. However, emergency rescue methods must be studied. Generally, heat-thirst, dysuria, rapid breathing, and internal heat indicate damage to True Yin (Zhen Yin); Liuwei Tang (Six-Ingredient Decoction) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) is suitable. If ineffective, Bazhen Tang (Eight-Treasure Decoction) added with Maidong and Wuweizi should be used. If still ineffective, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be used, along with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). This follows the theory of tonifying Yang to generate Yin. If there is shortness of breath, fatigue, lethargy, weakness, and indigestion, this indicates Yang Deficiency (Yang Xu); Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable. If sleep is restless, Guipi Tang (Restore the Spleen Decoction) is suitable. If appetite is reduced with facial and ocular edema, Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) is suitable. If accompanied by Spleen-Stomach Cold-Deficiency (Pi Wei Xu Han), Lizhong Tang (Regulate the Middle Decoction) should be used. For Kidney Qi Cold-Deficiency (Shen Qi Xu Han), Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill) is required, along with Shiquan Dabu Tang added with Fuzi (Aconiti Lateralis Radix Praeparata); this is the method of warming and tonifying to restore Yang. If after carbuncle/sores ulcerate, excessive pus and blood lead to opisthotonos (body bent backward like a bow), convulsions of hands and feet, and trembling limbs, Shen (Ginseng), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuzi should be urgently used for rescue. If ineffective, Shiquan Dabu Tang may be tried, with occasional survival. At such critical moments, when life hangs by a thread, physicians must deliberate carefully and handle the case prudently. (From *Shifa*)

Jiang Shiji said: The "Five Goods" and "Seven Evils" are recorded in medical texts, but they do not cover all cases. For instance: death occurs if pus forms but does not drain spontaneously due to missed guidance/drainage; death occurs if puncture/cauterization is not performed for formed pus, but only topical applications are used; death occurs if severe heat and pain are untreated, leading to internal attack of toxins; death occurs if, after internal toxin attack, medicine is not taken but puncture/cauterization is used instead; death occurs if ulceration penetrates internal membranes; death occurs if the sore remains in the throat; death occurs if un-ulcerated sores sink inward with cyanotic face, black lips, and foul stool; death occurs if yin-area sores invade the abdomen or scrotum; death occurs if high swelling is treated with purgatives instead of interior-supporting methods; death occurs if diffuse swelling is treated with cold-cooling purgatives instead of interior-supporting methods; death occurs if cold-cooling herbs are mistakenly used after ulceration, turning the sore purple-black; death occurs if acrid-dispersing herbs are mistakenly used after ulceration, causing rashes or perforation of flesh/cheeks; death occurs if erosion goes up to the nasal bridge or down through the pharynx. Therefore, treatment must be timely and prudent. (From *Shuoyue*)

Li Dongyuan said: Generally, post-carbuncle/sores conditions showing Evil signs within Deficiency patterns are incurable; Excess patterns without Evil signs will heal spontaneously. After pus drainage, if pain and vexation persist, a Hong-Hua-Cu-San (surging, slippery, coarse, scattered) pulse indicates difficult treatment, while a Wei-Se-Chi-Huan (slight, choppy, slow, delayed) pulse indicates easy recovery. Thus, Good/Evil signs can be known through pulse diagnosis. For Back Carbuncles, Brain Sores, and other malignant sores, the "Five Reversals" include: white sclera appearing blue/black with small palpebral fissures, vomiting after taking medicine, severe pain with extreme thirst, stiffness/inconvenience in shoulders/neck, hoarseness, and deteriorated complexion. Other symptoms like heat-thirst, dysentery, and vomiting suggest toxins entering the interior and damaging Zang-Fu organs, requiring treatment based on specific signs. (From *Shishu*)

Xue Lizhai said: Carbuncle/sores conditions have "Five Goods" and "Seven Evils." Three Goods indicate recovery; four Evils indicate danger. "Goods" include: calm movement/rest, tasty appetite, balanced excretion, resolved swelling after pus drainage, fresh non-foul pus, bright spirit, clear voice, and harmonious constitution. These belong to Fu-organ patterns, with mild/shallow pathogens; with careful lifestyle and diet, self-healing may occur without medicine. "Evils" are Zang-organ deficiency patterns, often due to Yuan Qi weakness, excessive pus loss depleting Qi/Blood, improper sweating/purging damaging Ying-Wei, cold herbs injuring Qi/Blood, or harsh drugs damaging Stomach Qi. This results in True Qi deficiency and Pathogenic Excess, appearing externally full but internally empty. Treatment should purely tonify Stomach Qi, offering hope for survival; one should not abandon treatment due to Evil signs.
1. Extreme thirst/fever or diarrhea/dysuria indicates Internal Flaming Fire (First Evil): Zhuye Huangqi Tang. For Qi/Blood dual deficiency, Bazhen Tang added with Huangqi, Maidong, Wuweizi, Shanzhuyu. If ineffective, Jiajian Bawei Wan.
2. Severe swelling/pain after pus/blood drainage, foul敗 pus indicates Stomach Qi deficiency with Fire Excess (Second Evil): Renshen Huangqi Tang. If ineffective, Shiquan Dabu Tang added with Maidong, Wuweizi.
3. Misaligned gaze, constricted pupil, blue/red sclera, upward-looking pupil indicates Liver/Kidney Yin Deficiency with tight eye meridians (Third Evil): Liuwei Wan material added with Chao Zhizi, Maidong, Wuweizi. If ineffective, Bazhen Tang added with Chao Zhizi, Maidong, Wuweizi.
4. Rapid breathing, shortness of breath, confusion, drowsiness indicates Spleen/Lung Deficient Fire (Fourth Evil): Liujunzi Tang added with Dazao, Shengjiang. If ineffective, Buzhong Yiqi Tang added with Maidong, Wuweizi. For Heart Fire attacking Lung Metal, Renping Feisan; for Yin Fire damaging Lung, Liuwei Wan added with Wuweizi.
5. Shoulder/back stiffness, heavy limbs indicates Spleen/Kidney Deficiency (Fifth Evil): Buzhong Yiqi Tang added with Shanyao, Shanzhuyu, Wuweizi. If ineffective, Shiquan Dabu Tang added with Shanzhuyu, Shanyao, Wuweizi.
6. Inability to eat, vomiting after medicine, loss of taste indicates Stomach Qi Deficiency (Sixth Evil): Liujunzi Tang added with Muxiang, Sharen. If ineffective, urgently add Fuzi.
7. Hoarse voice, deteriorated complexion, cyanotic/red lips/nose, edema of face/limbs indicates Spleen/Stomach Dual Deficiency (Seventh Evil): Buzhong Yiqi Tang added with Dazao, Shengjiang. If ineffective, Liujunzi Tang added with Paojiang. If still ineffective, urgently add Fuzi, or use Shiquan Dabu Tang added with Fuzi, Paojiang. Abdominal pain, diarrhea, cough, reversal of Qi, lethargy indicates Yang Qi Deficiency with Internal Cold Invasion (Evil Syndrome): Urgently use Tuoli Wenzhong Tang, followed by Liujunzi Tang added with Fuzi, or Jiang/Gui for warming tonification. This covers the treatment of the Seven Evils.
Additionally, post-ulceration fever/chills, thirst, palpitations, insomnia, trismus, red/painful head/eyes, spontaneous/night sweats, chattering teeth, flaccid hands, body heat with surging-but-empty pulse, or aversion to clothing/thirst for water with floating-large-but-microscopic pulse, or feeling cold despite thick clothing, indicates extreme Qi/Blood deficiency transforming into Evil. Cold extremities, abdominal pain, diarrhea/borborygmus, inability to eat, hiccups/vomiting indicate Yang Deficiency with Cold invasion. Sweating without chills, or no sweating with chills, locked jaw, cold feet, opisthotonos, stiff neck indicate extreme Qi/Blood deficiency transforming into Spasm (Jing). Urgently use Shen, Huangqi, Danggui, Baizhu, Fuzi for rescue; occasional survival is possible. Generally, Evil signs in Deficiency are hard to treat; Excess without Evil signs are easy. Song dynasty Qi Yuanling compiled symptoms but lacked causes; Tao Jian'an set formulas but was incomplete. I thus supplement these deficiencies.

Hu Gongbi said: Carbuncles matching Seven Evils but with tight skin indicate Good prognosis because Qi is sufficient though Blood has not yet attached. Sores matching Five Goods but with loose/weak skin indicate Evil prognosis because Blood has attached but Qi is insufficient.