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Xue Lizhai said: The methods of acupuncture and moxibustion include taboos such as Taiyi Renshen (Taiyi Human Spirit), Zhou Shen Xueji (Whole Body Blood Taboo), Zhounian Koushen (Annual Sacral Spirit), and Zhuri Renshen (Daily Human Spirit). There are also discussions on acupoints that are contraindicated for needling or moxibustion. Those who violate these taboos find their conditions difficult to cure, which is indeed the principle. However, in cases of sores and ulcers, the qi and blood are already damaged, and the muscles are already deteriorated. It is appropriate to intercept and drain the pathogenic factors according to the disease's momentum, and to act in accordance with its mechanism. This situation cannot be compared to that of a healthy person; what taboos could there possibly be? *Waike Jingyi* (Essentials of Surgery) states: In sore and ulcer conditions, if toxic heat has no way to resolve and pus and stasis have no way to drain, they will attack inward. Once the interior is depleted and destroyed, how can one hope for survival? Critical and malignant eruptions occurring at vital locations bring disaster within a snap of the fingers. Examples include abdominal carbuncles and scrotal carbuncles causing obstruction of urination and defecation, chest and abdominal distension and fullness, lip carbuncles, and throat bi (obstruction) causing swelling and blockage of the throat. The harm here is particularly rapid; patients should exercise caution.

Li Dongyuan said: Sores and swellings arising externally are caused by the accumulation and knotting of hot toxic qi internally. Generally, external swellings may present with a defined head (localized elevation), diffuse swelling (spreading edema), thick skin, thin skin, deep toxic qi, or shallow toxic qi. Some are suitable for application with warming herbs, others with cooling herbs; some allow for dry dressing changes, others for moist dressing changes. Due to differences in depth, the medications used vary, and thus careful differentiation is essential. If a sore or swelling initially appears with a defined head, it should be treated with warm medicated plasters to draw out the internal hot toxicity, following the principle that "fire tends toward dryness." On the surrounding reddened areas, crushed raw cooling herbs should be applied to subdue the heat and drive away evil pathogens, akin to "extinguishing fire." Raw cooling herbs possess complete and potent energy, with robust nature and flavor. If practitioners do not adhere to pharmacological principles but instead use herbal pastes with weak efficacy, attempting to make the feeble resist the vigorous, is this not difficult? Furthermore, incompetent physicians who fail to distinguish between adverse and favorable patterns may apply cold medicines indiscriminately. This chasing of pathogenic toxins may force them deeper into the body, affecting the heart and liver, leading to death in eight or nine out of ten cases. Generally, the method of application aims to reduce swelling and dissipate stagnation, promoting smooth blood vessels. If cold qi acts reversely, it cuts off the flow and retention. One must not rigidly adhere to fixed formulas without flexibility; otherwise, how can one dissipate depression and generate pus? For swellings with thick skin, apply medicine using soft cloth or cotton paper, changing when dry. For swellings with thin skin, use gauze or thin paper, changing before the medicine dries. After pus rupture, apply warming plasters that nourish muscle and promote flesh regeneration. The key lies in eliminating foul rot, discharging bad fluids, removing dead tissue, and generating healthy flesh, relying entirely on the power of warm ointments. Do not use cold-cooling medicines mixed with water for application, as blood vessels prefer warmth and dislike cold. If cold qi penetrates deeply, blood stasis will occur, making healing difficult. (From *Ten Books · Application Method*)

Zhu Danxi said: External application of plasters aligns with the intent of releasing the exterior (dispersing exterior pathogens). The classics state: "Releasing the exterior does not avoid heat." Generally, qi disperses with heat and condenses with cold; this must be known.
He further stated: Medicines for application are only suitable for mild and minor heat syndromes. If one fails to differentiate yin and yang and recklessly applies cooling medicines, the consequences can be severe. This is indeed an unchangeable truth.

Dai Yuan Shi said: There are cases where pain exists without application but ceases with application, and cases where there is no pain without application but pain arises with it. This is because cold, wind, heat, dampness, and emotional factors like worry and anger accumulate and attack internally, causing uncontrollable pain. Application draws these out, hence the pain stops. Conversely, if dead blood and yin toxins are trapped inside, the deeper they lie, the less pain is felt. When the medicine stimulates them outward, pain may actually increase.

Wang Shengzhi said: External application of medicines is precisely the intent of releasing the exterior. The classics state: "Releasing the exterior does not avoid heat." Generally, qi disperses with heat and coagulates with cold. Is it reasonable for mediocre doctors to apply cold medicines?

Zhou Wencai said: "Fu" (application) means transformation and dispersion, aiming to transform and disperse toxicity without allowing stagnation. However, depending on the urgency of the sore and the cold/heat nature of the toxin, the medication varies. For severe redness and swelling, cold-natured medicines should be applied. For swelling with unchanged skin color but deep, dark intensity, warm-natured medicines should be applied. For cases without heat or cold, Chonghe Gao (Harmonizing Ointment) should be used. For spreading roots, Tiegu Gao (Iron Hoop Ointment) or Tietong Gao (Iron Bucket Ointment) should be applied. This prevents the toxin from spreading, facilitates dissipation, and promotes ripening of pus.

Jiang Shiji said: Application medicines should only surround the four sides of the sore, leaving the center empty. Apply Baijiang Dan (White Reduction Powder) to the sore head to extract toxicity, thereby avoiding the error of inversion. (From *Shuoyue*)
He further stated: If after rupture the root spreads and redness/swelling persists, it is a malignant sign. Use Tiegu Gao to constrict it. If pain persists after pus drainage, there may be tendinous barriers preventing internal pus exit; puncture with a needle to drain it. When a carbuncle is ripe and about to burst, apply Baijiang Dan to the head; it will naturally rupture in half a day.
He also stated: When preparing application medicines, grinding them extremely fine is paramount to ensure painless application. Mixing requires stirring over a thousand times with a spatula to ensure adhesion. Before application, warm the medicine in water to facilitate penetration. Leave a central hole during application to allow toxic gases to escape. This method must be observed.
Furthermore: Cold-cooling applications like Furong San (Hibiscus Powder) and Dahuang Gao (Rhubarb Ointment) carry significant risks. Cold inhibits qi and vessel flow, prevents resolution of blood stasis, hinders suppuration of necrotic tissue, and inhibits growth of new flesh.

Dou Hanqing said: When preparing surrounding medicines, they must be ground very finely to avoid pain. Stirring thoroughly for over a thousand times ensures thickness. Apply gently, leaving a hole shaped like a goose egg. Cover the applied medicine with thin paper, tearing it to fit securely to prevent cracking and pain. As the surrounding medicine dries, re-moisten it with the residual mixing liquid to enhance efficacy, as dry medicine cannot penetrate muscle; moisture aids channel patency. Reflect deeply on this.

Ma Siming of the Qi Dynasty treated Yang Zunyan's back carbuncle using Baimai Fanshi (White Wheat Rice Stone, i.e., coarse yellow stone suitable for grinding, similar to whetstone). Quench it in strong vinegar, heat it red-hot, and quench again until particles fall into the vinegar. Grind into powder, boil with vinegar into a paste, and apply thickly for immediate cure. Materia Medica states: Stones generally treat carbuncles and sores; this stone is miraculous for back carbuncles.

Cheng Shanling said: Texts state: Apply plaster to the apex and surround with application medicine. For large abscesses nearing suppuration, apply Baijiang Dan or Wujin Gao (Black Gold Ointment) to the head, cover with Wanquan Gao (Perfect Safety Ointment), and surround with Tiegu, Tietong, or Furong ointments. The plaster extracts pus, while the surrounding medicine dissipates swelling, constraining the root to prevent spread. This constitutes a three-layer method. Layer 1: Baijiang Dan or Wujin Gao on the apex. For diffuse swelling without a head, stick wet paper; the first dry spot indicates the head. Layer 2: Wanquan Gao. Layer 3: Surrounding application medicine. Cover with torn mulberry bark paper. If mixed with honey, keep moist with honey water; if mixed with vinegar, keep moist with vinegar juice. This enhances efficacy and prevents drying. I once used Wanquan Gao to cover the entire swollen area, including the root, achieving complete resolution or suppuration as needed, demonstrating its efficacy.

*Jiyan* states: For carbuncles/sores without heads, apply Shenzhi Gao, Linggui Gao, Badu Gao, or Tiegu San to cause regression. For suppurating lesions, apply Linggui Gao, or use Zuidu Gao to drain pus, or a suction tube. For furuncles with heads, after washing, assess the width of the erythema. Mix Datiegu San (Great Iron Hoop Powder) with cool water into a paste; in deep winter, use warm water at body temperature. For intense redness/swelling, mix with fresh Rehmannia juice. Surround from the red margin using mulberry bark paper. If white grains appear scattered like rice or beans, remove the pore with a silver hairpin base, apply Laopi San (Old Skin Powder), then replace with fresh medicine. Heat causes redness and diffuse swelling; extreme heat causes purple-black discoloration; external cold constraint also causes purple; blood deficiency with cold causes blue-white. Datiegu San and Zhengtiegu San are commonly used. Adjust for wind-cold-heat and foul odors seasonally. For heat, use Sanhuang San; for extreme heat, use Sansan San. Add Qianghuo and Fangfeng for wind; Muxiang for qi stagnation; Guizhi for cold constraint; aromatic herbs for foul odors; remove Baiji for fragile/swollen areas. Upon removal, check for sweat droplets under hairs, indicating smooth vessels, resolved toxicity, shrinking erythema, cessation of pain upon suppuration, and reversal from adverse to favorable. Moist skin indicates healthy flesh formation. If the carbuncle head slightly opens, do not use knives/scissors. If no sweat forms, necrosis will be extensive. Post-suppuration application collects residual toxins draining with pus; apply Badu Gao to the wound. If pus drainage is poor, use Zuidu Gao; if foul flesh remains, use Jinbao Gao. After removing necrotic tissue, surrounding application revitalizes qi/blood and promotes new flesh growth. Apply Changrou Gao to the wound; combine with washing for synergistic effect.

Guo's Method states: For furuncles/carbuncles with heads, place a pill-sized (soybean size) Zhu Sha Beijij Gao (Cinnabar Emergency Relief Ointment) on the head and cover with soft adhesive plaster. The sore will likely rupture. If the halo is purple-black, surround with Xuandu San to contain toxicity. If red, apply Shui Cheng Gao. Next day, use Jianjun Biyun Ding (Firm Green Cloud Pill) to open the mouth, then Jin Huan Bixia Ding (Tight-Loose Green Rosy Pill) to remove foul flesh. Once clean, use Man Huan Biyu Ding (Slow-Loose Green Jade Pill) to regenerate tissue. Collectively called Qingjin Ding (Blue Gold Pill). Continue until foul flesh is gone, then use plain plaster. Only apply Shengji Liankou Gao (Flesh-Generating Mouth-Closing Ointment) after pus clears and muscle levels. Following this avoids knife/scissor/needle/cautery suffering. For headless abscesses, wait for suppuration, puncture with needle, then proceed with treatment.