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Xue Lizhai stated: The *Neijing* (Inner Canon) records that when the five zang organs are disharmonious, the nine orifices become obstructed; when the six fu organs are disharmonious, pathogenic factors remain and knot to form carbuncles. It also states that injury to the physical form causes pain, while injury to qi causes swelling. This clearly indicates that disharmony of the zang and fu organs leads to sores manifesting on the exterior. How can applying cold-natured topical medications harmonize the zang and fu organs or promote the circulation of qi and blood? If there is swelling, pain, fever, thirst, and a slippery, rapid, and forceful pulse, it belongs to pure yang syndrome. It is appropriate to internally administer Jiyin Dan (Nourish Yin Pill) and externally apply Yiyang San (Benefit Yang Powder), so that heat toxins will naturally resolve and stasis will dissipate. If the appearance resembles swelling but is not true swelling, resembles pain but is not true pain, resembles ulceration but does not ulcerate, resembles redness but is not true redness, and the pulse is flooding and rapid yet powerless, it belongs to half-yang, half-yin syndrome. It is appropriate to internally administer Chonghe Wan (Harmonizing Pill) and externally apply Yinyang San (Yin-Yang Powder), so that qi and blood will naturally harmonize and stasis will eliminate itself. If there is slight swelling and slight pain, or dark color without pain, or hardness without ulceration, and the pulse is flooding and large but fine, weak, and soft upon deep pressure, it belongs to pure yin syndrome. It is appropriate to internally take Huiyang Tang (Restore Yang Decoction) and externally apply Yiyin San (Suppress Yin Powder), so that the spleen and stomach will naturally strengthen and yang qi will naturally return. Zhu Danxi said: Topical applications are merely for responding to minor heat syndromes. If one does not distinguish the differentiation between yin and yang syndromes and recklessly applies cold-natured medications, it will block the couli (skin pores and interstices) and stagnate qi and blood, causing toxins to attack inwardly and flesh to necrose. Moreover, if the vital energy (yunqi) is affected by cold, it fails to function healthily; if stagnant blood is affected by cold, it does not disperse; if necrotic flesh is affected by cold, it does not ulcerate; if new flesh is affected by cold, it does not grow. Practitioners must exercise caution.

Li Shiyeng stated: Carbuncles that are neither hot nor painful belong to yin syndrome. Cold medications must absolutely not be used for topical application, lest they force toxic vapors inward.

Gu Shicheng stated: In winter, regardless of whether using green onion juice, yellow honey, wine, vinegar, or medicinal pastes, they must be heated in a water bath before being applied around the lesion. Cold application is forbidden. If applied cold, how long would it take for the muscle tissue to warm up? Furthermore, the harm of ice-like cold forcing toxins inward must not be treated casually, as this could lead to errors in treatment.

Wang Kentang stated: For un-ulcerated sores, it is suitable to wash them with Zige Tang (Purple Kudzu Decoction) five to seven times a day. After each wash, dry the area thoroughly. Observe if there are white grains the size of rice on the top of the sore; puncture them with Wuhui Gao (Five Ashes Ointment). Apply Laopi San (Old Skin Powder) to the sore opening. Next, mix Datiegu San (Great Iron Hoop Powder) with water and apply it around the swollen and red areas. Mix Zhengtiegu San (Correct Iron Hoop Powder) with water and apply it directly to the sore opening. Upon the next wash, remove the old medication first, and replace it with fresh medication as described above. For ulcerated sores, use Zhuti Tang (Pig Trotter Decoction) to wash once or twice a day. Continue to apply Datiegu San around the sore opening as before. Apply Zhodu (Toxin-Expelling) and Badu (Toxin-Pulling) ointments on top. After necrotic flesh is removed, wash every two or three days, and then apply Zhangrou Gao (Flesh-Growing Ointment). The benefit of washing and rinsing lies in its effects: at the initial stage of abscesses and carbuncles, washing extracts pathogenic factors and promotes resolution; for established lesions, it guides the couli, harmonizes blood vessels, draws deep heat toxins outward, transforms deep lesions into shallow ones, and reduces large lesions to small ones; for spreading redness and swelling, it promotes contraction; for purple, dark, or black discoloration, it restores vibrant redness; it expels evil wind and dispels wind pathogens, removing the old to generate the new. If the sore opening is cold and sluggish and refuses to close, wash with strongly brewed Bei'ai Tang (Northern Mugwort Decoction) and fumigate with burned Songxiang (Pinus Resin) and rabbit fur. Medications for washing and rinsing can work in parallel with Tiegu San (Iron Hoop Powder) to achieve similar results.

Li Dongyuan stated: The method of washing and soaking promotes the free flow of surface-level qi, disperses pathogenic factors, and allows sores to resolve internally. Water has the power of cleansing. Ancient texts discuss that if a sore or swelling persists for one or two days after appearing, it is necessary to use decoctions for washing and spraying. For lesions on the limbs, soak them; for those on the waist and back, spray/wash them; for those in the lower body's creases, bathe/soak them. This is called guiding the couli and regulating blood vessels to prevent stagnation. For example, take two liang of herbs and two sheng of water as a standard, boil down to one and a half sheng. Dip clean cloth or new cotton wool into the warm herbal liquid and gently wash the affected area. Change immediately when it cools slightly. Do not use cold preparations, because blood and qi become stagnant and coarse when cold, but smooth and moist when warm. Use five to seven times daily. For severe pain, use continuously day and night, or even ten-plus times. Resolution of swelling and cessation of pain serve as the verification. This is a divine and excellent method for treating sores and swellings (from *Shi Shu*).

He further stated: Whenever treating newly arising sores and swellings within one or two days, it is appropriate to use herbal decoctions for bathing and fumigation. The purpose is merely to open the couli, harmonize the blood vessels, prevent stagnation, relieve suffering, and detoxify. If washing an already ulcerated sore, the intent is to cleanse the wound of pus and address pain in the surrounding calloused skin; this applies similarly to whip marks. Recently, yaws (Mei Du Chuang) appeared in the anal region and resisted various treatments. By decocting Wu Gen (Five Roots) and pouring the liquid into a woman's urinal, then fumigating and washing, it healed in just a few sessions. This is even more effective for other sores, not just syphilis!

Jiang Shiji stated: When toxin-sores first appear, ancients used herbal decoctions for washing and spraying. This is because when qi and blood stagnate, abscesses and swellings form; receiving heat opens the couli and unblocks the meridians, which is indeed profound truth. The method involves boiling herbs into a strong decoction. For sores on the limbs, soak them; for those on the waist and abdomen, spray/wash them; for those in the lower body, bathe/soak them. Still, dip clean cloth in the water and wash the affected area. Replace the water when it cools, changing it multiple times until the heat penetrates deeply.