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Zhou Wencai stated: The classics say, "Deficiency patterns should be treated with tonification." Whenever a carbuncle or ulcer has formed, regardless of location, if the base is diffuse and the apex is not high and pointed, one should tonify Qi for Qi deficiency and nourish Blood for Blood deficiency. Add herbs such as *Jinyinhua* (Lonicerae Japonicae Flos), *Gancao Jie* (Glycyrrhizae Radix et Rhizoma nodules), *Baizhi* (Angelicae Dahuricae Radix), and *Guixin* (Cinnamomi Ramulus) to make the apex naturally rise and point, and the base contract, facilitating rupture and suppuration. If after rupture there is excessive discharge of pus and blood, one must vigorously tonify Qi and Blood so that the wound may heal easily.

Chen Shigong stated: In cases where a sore has been open for a long time with massive discharge of pus and blood, leading to deterioration of Qi and Blood, eight or nine out of ten will fail to heal. Furthermore, due to sexual indulgence causing the sore to rot, foul flesh remains while new flesh fails to grow; this presents as necrotic tissue that is slippery and frequently discharges clear fluid. There are also cases where, due to lack of correct treatment, healing does not occur even after several years. Internally, one should administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with drugs that expel toxins. Externally, wash the area with medicinal water, then take dried mulberry branches, ignite one end, blow out the flame, and moxa-burn near the wound (keeping it slightly distant so as not to cause pain, but not too far away which would be ineffective). The goal is to achieve warmth and slight itching. Moxa-burning several times a day is not excessive. After moxa-burning, apply Changrou Shengji Gao (Flesh-Growing and Tissue-Regenerating Ointment) shortly thereafter to achieve rapid efficacy. (*Waike Zhengzong*)

Chen Shigong stated: For brain carbuncles or back ulcers presenting as Yin patterns, characterized initially by no swelling elevation, no heat, and no pain upon moxa-burning, the disease is difficult to treat and will likely prove fatal. Within ten days of onset, insert a lancet from the top until pain is felt, then stop. Immediately insert Chan Su strips (Toad Venom Strips) to the bottom of the hole, two strips daily. Cover with ointment for three days, then add more insertion medication. When the base becomes swollen, elevated, and painful, use Shen Deng Zhao Fa (Divine Lamp Illumination Method) externally to transform Yin into Yang. Continue insertion and illumination for seven days; the sore will crack and discharge pus, and the base will naturally detach by the thirteenth day. If the condition persists and the root is firmly established preventing detachment, remove it with a lancet. Internally use Yuhong Gao (Jade Red Ointment); detached parts will separate, and non-healing parts will close. This method ensures success in all hundred cases, with no failures. (*Waike Zhengzong*)

Xue Lizhai stated: Regarding ulcer conditions, when pus has formed, one must distinguish between its maturity/immaturity and depth/shallowness; regarding necrotic flesh, one must verify its putrefaction and detachment. Danxi said: Carbuncles and ulcers arise from accumulated toxins in the Zang-Fu organs. One should primarily support the Stomach and strengthen Qi to solidify the root, using methods to promote circulation and resolve stasis as adjuvants to allow internal resolution. I often treat patients with weak pulse and symptoms using Tuoli drugs (interior-supporting and toxin-expelling agents), which strengthen Qi and Blood so flesh does not die. For patients with excess-heat pulses and symptoms, use Qingre agents (heat-clearing formulas) to retreat toxins so flesh regenerates naturally. Whenever sores gather between bones/tendons and within muscles due to Qi and Blood deficiency, use Shiquan Dabu Tang (Perfect Fourteen Tonifying Decoction) to strengthen Spleen and Stomach; thus, unformed sores will dissipate spontaneously, and formed sores will rupture spontaneously, leaving no necrotic flesh! If there is little pain, no pain, no redness, internal pus does not rupture, or external flesh does not rot, this indicates Qi and Blood deficiency. It is appropriate to use Sangzhi Moxibustion (Mulberry Branch Moxibustion) and Shiquan Dabu Tang plus Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark) to strengthen Yang Qi; then the surrounding area will subside immediately, the sore head will rot, and toxins will resolve naturally, without needing needle cutting! If Spleen and Stomach are weak with poor appetite, use Liujunzi Tang (Six Gentlemen Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) to strengthen Ying Qi (Nutritive Qi); then flesh affected by toxins will survive, necrotic flesh will rupture, and ruptured sores will close. If at the onset, due to excessive purgation or sexual activity, the color becomes dark and painless, this indicates collapse of Yang Qi transforming into a Yin pattern. Urgently use Shenfu Tang (Ginseng and Aconite Decoction) to warm, tonify, and restore Yang; survival is possible.

Dou Hanqing stated: To remove necrotic flesh, first wash with Zhuti Tang (Pig Trotter Decoction) to remove dirt, so that old and new flesh can be distinguished. Identify truly necrotic tissue, secure it with a hook, and gently and slowly cut it off enduring the odor. Do not mistakenly injure new flesh to cause bleeding. Do not rush; take care. After removal, apply Lingyao (Spiritual Medicine) and cover with an external plaster. If any necrotic flesh remains the next day, remove it according to the same method. (*Waike Quanshu*)