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For conditions where sores and carbuncles have ruptured with pus, and toxic swelling is spreading and infiltrating, presenting with critical and dangerous symptoms, it is essential to differentiate between deficiency (Xu) and excess (Shi). Moreover, deficiency syndromes are difficult to tonify, while excess syndromes are easier to purge. The methods of tonification and purging must not be used lightly; even a slight error can lead to significant harm. However, the manifestations of deficiency and excess are manifold: there are deficiencies and excesses specific to the sores themselves, those of the Zang-Fu organs, those of Qi and Blood, as well as upper excess with lower deficiency, and true deficiency with false excess. These must not fail to be distinguished.

When swelling is raised, hard, and the pus is thick, it indicates an excess syndrome of the sore or carbuncle; when swelling is flat, diffuse, and the pus is thin, it indicates a deficiency syndrome of the sore or carbuncle.

Symptoms such as diarrhea with borborygmus, inability to take in food, frequent vomiting, coldness of hands and feet, weak pulse, cold skin, free urination, or difficulty in urination accompanied by loose stools, loss of voice, and mental dullness or discomfort, all indicate deficiency of the Zang-Fu organs. Conversely, hard constipation, astringent and difficult urination, normal appetite, abdominal fullness and distension, chest and diaphragm stuffiness, pain in limbs and joints, bitter taste in the mouth and dry throat, irritability, excessive thirst, fever, large pulse, and mental confusion or obstruction, all indicate excess of the Zang-Fu organs.

If the pus and water are clear and thin, the sore opening fails to heal, swelling gathers but is not red, muscles are cold, flesh is cold, spontaneous sweating occurs, and the complexion is pale and depleted, this is deficiency of Qi and Blood. If swelling is raised and red, accompanied by aversion to cold and fever, pain, hot skin, thick and sticky pus, and heaviness and dizziness of the head and eyes, this is excess of Qi and Blood.

Headache, nasal congestion, red eyes, palpitations, pharyngeal dysfunction, sores in the mouth and tongue, irritability and thirst for cold drinks, somnolence with muttering and teeth grinding, constitute upper excess. Essence slipping and failing to consolidate, spontaneous loose stools, heaviness in the waist and legs, and restless sleep constitute lower deficiency.

Inconvenience in the shoulders, neck, and nape, heaviness in the four limbs, abnormal vision, unclear gaze, loss of taste, hoarse and deteriorated voice, and edema of the four limbs indicate deficiency of True Qi (Zheng Qi). Swelling that is particularly severe, pain so intense it cannot be touched, failure to suppurate after many days, alternating chills and fever, constipation and astringency, urine resembling strangury, mental restlessness and oppression, and恍惚 (fluctuating) uneasiness indicate excess of Pathogenic Qi (Xie Qi).

It is said: Depletion of True Qi results in deficiency; flourishing of Pathogenic Qi results in excess. It is also said: All pain belongs to excess; itching belongs to deficiency. Furthermore: A pulse that is surging, large, and rapid indicates excess; a pulse that is minute, fine, and soft indicates deficiency. For deficiency, apply tonification to harmonize Qi and support the interior (Tuo Li). For excess, apply purging to unblock and guide Qi freely. The *Neijing* states: "If Blood is in excess, pierce/draining; if Qi is deficient, pull and lift." Yuan Rong (Zhang Yuansu) stated: If a person has congested Qi and Blood, full Ying and Wei, obstructed flow, leading to putrefaction and formation of abscesses, one should purge to drain the excessive heat. If a person has reduced appetite, weakened spirit, short and astringent Ying and Wei, with cold binding leading to abscesses, one should tonify to connect with the deficient and timid Qi. This is the general principle for treating deficiency and excess.

For sores and carbuncles, if movement and rest are naturally peaceful, appetite returns, and both pulse and symptoms are moderate/slow, treatment should address the root. Thus, one may use gentle, kingly-method (Wang Dao) medicines to treat slowly, and recovery will invariably follow. If the pulse is excess, swelling is prominent, accompanied by irritability, chills, and fever, and both pulse and symptoms indicate excess, only fierce agents like Mirabilite (Xiaoshi) and Rhubarb (Dahuang) can eliminate the pathogen; using gentle medicines would be incorrect. If sores gather and swell without suppurating, or upon suppuration the pus is clear and thin, or if there is diarrhea with borborygmus, inability to eat, frequent vomiting, or cold hands and feet, these pulse and symptom patterns indicate deficiency. Only major tonifying medicines can calm the condition; using purging agents like Mirabilite and Rhubarb would be incorrect. Therefore, in treating these conditions, one must distinguish exterior/interior and deficiency/excess, and treat according to appropriateness, thereby ensuring complete safety.