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Xue Lizhai stated: Whenever a sore or ulcer reaches the stage of suppuration, it is due to the corruption of flesh into pus, which is the result of toxic qi eroding and causing rupture. If this is not removed promptly, there is a risk that the toxic qi will accumulate and invade healthy tissue. In areas such as the elbows and knees, which are joint pivots, this can lead to damage of tendons and bones, resulting in disability. Some individuals who fear acupuncture often reach an incurable state; alternatively, using fine needles or applying Sai Zhen San (a topical drug for drawing out toxins) to allow pus to drain is extremely effective.

Wang Shengzhi stated: Carbuncles, ulcers, sores, and boils all arise from the stagnation of Qi and Blood. One should assess deficiency and excess, exterior and interior conditions, and treat them early to achieve internal resolution. This method of internal resolution is best applied early. However, if toxic qi has already condensed, one should not rigidly adhere to internal resolution methods. Instead, one must distinguish the presence and depth of pus and promptly decide on puncturing. Delaying puncture allows toxic qi to attack inward, penetrating viscera and rotting tendons and bones; how can one be careless? A tight pulse indicates that pus has not yet formed; when the tightness disappears but the pulse becomes rapid, it indicates that pus has formed. Pressing the area with heat suggests the presence of pus, while lack of heat suggests its absence. Firm hardness upon pressing indicates no pus, whereas semi-softness indicates pus is present. Extreme softness signifies mature pus. Severe pain only upon deep pressure indicates deep-seated pus, while mild pain upon light pressure indicates immature pus. Pain that returns immediately after releasing pressure indicates pus, whereas pain that does not return indicates no pus. Thin, peeling skin indicates superficial pus, while unchanged skin color and lack of elevation indicate deep pus. Superficial pus is treated with Bian stone therapy, while deep pus requires needle drainage. For fingertips, toes, and breasts, one must wait until the pus is abundant and soft before opening for drainage. Following smallpox or measles, if residual toxicity remains and carbuncles appear in the limbs and joints, once slight suppuration is felt, immediate incision is necessary; otherwise, it may lead to contracture deformities. (From *Li Li*)

Wang Shengzhi further stated: Regarding carbuncles and ulcers that have already formed, in cases of Qi and Blood deficiency, deep pathogenic factors, or diffuse pathogens that fail to protrude and are difficult to suppurate, or where post-incision pus is scanty, thin, or the area remains hard without softening, or where the base of the ulcer is red, swollen, and expanding despite suppuration, these are signs of Qi and Blood deficiency combined with excessive pathogenic factors and transformations caused by the Six Exogenous Pathogens. In such cases, Internal Support (Nei Tuo) therapy must be used to expel toxic heat through the muscle layer, facilitating recovery. Internal Support therapy primarily uses tonifying herbs, with blood-invigorating and pathogen-expelling herbs as adjuncts. Alternatively, aromatic herbs may be used to resolve stagnation, or warm herbs to ward off wind and cold. (From *Li Li*)

Zhou Wencai stated: The term "Tuo" (Support/Prop up) implies lifting and raising. When treating carbuncle toxicity, if the pathogen moves from the exterior to the interior, the pathogen naturally attacks the interior. This is a natural principle. Therefore, one should use Toli Decoction (Interior-Supporting Liquid) supplemented with Rhizoma Cimicifugae (Shengma) and Flos Lonicerae Japonicae (Yinhua) to promote the circulation of Ying and Wei, harmonize the blood vessels, and dissipate carbuncle toxicity. Thus, it is said that those treating sores must employ Interior Support daily. (From *Qi Xuan*)

Wang Kentang stated: Once carbuncles and ulcers have formed, formulas such as Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder), Tuoli San (Interior-Supporting Powder), Xiao Tuoli San (Minor Interior-Supporting Powder), and Shixuan San (Ten-Accumulations Powder) are essential medications, subject to modification based on timing and condition. For instance, in winter or for patients with Qi stagnation, Wuxiang Lianqiao Tang (Five-Aromatic and Forsythia Decoction) is suitable; for weak patients, remove Rhizoma et Radix Rhei (Dahuang); for those generally intolerant to cold-natured drugs, use Xiao Wuxiang Tang (Minor Five-Aromatic Decoction); for patients with substantial form and pulse, thick pus, and contraindications for tonification, use pills such as Rendong Wan (Honeysuckle Pill). Once large amounts of pus are discharged, necrotic tissue is removed, and redness and swelling subside, large doses of Radix Ginseng (Renshen), Radix Astragali Membranacei (Huangqi), Radix Angelicae Sinensis (Danggui), and Rhizoma Atractylodis Macrocephalae (Baizhu) should be administered to tonify vigorously, ensuring the abundance of Qi and Blood to facilitate the growth of new tissue. (From *Zhun Sheng*)

Xue Xinpu stated: There are modifications of prescriptions according to symptoms, generally centering on Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder), which is indeed an excellent method of Internal Support.