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Shen Douyuan stated: Shu Ju (First Carbuncle) arises at the Mai Men and Yifeng acupoints beside the ear. These points belong to the Shaoyang Sanjiao Meridian of Hand-Taiyang, which is characterized by abundant Qi and scarce Blood. Symptoms include aversion to cold, high fever, and thirst. It can be punctured after seven or eight days. If the pus and discharge are yellowish-white, it is treatable; if there is black, thin discharge accompanied by severe thirst, or if carbuncles appear on both sides simultaneously, the prognosis is fatal. This represents an extreme severity of toxin. (From *Qixuan*)

[Image: Shu Ju]

Zhu Ju (Second Carbuncle)
*Gui Yi Fang* stated: Zhu Ju occurs within the hairline and behind both ears. If not punctured to drain pus, death will occur within fifteen days; if pus can be punctured but is black like fermented soybeans, or if blood appears, it is also a fatal condition.

Wang Kentang stated: Zhu Ju arises above the neck, behind both ears. Initially, swelling is not significant, but there is intermittent pain and itching with clear fluid discharge. It gradually enlarges, resembling tortoiseshell spots. It is also known as Hua Gu Chuang (Bone-Dissolving Ulcer). If left untreated until ulceration, and bones are discharged after a long period, it is a grave and malignant syndrome. This condition often occurs in individuals with chronic emotional depression, frequently presenting with the "Seven Evils" (seven critical signs in TCM surgery). If contraindications are violated, it is incurable. (From *Zhunsheng*)

Shen Douyuan stated: Zhu Ju belongs to the Shaoyang Sanjiao Meridian of Hand-Taiyang (abundant Qi, scarce Blood), arising beside the Tianyou and Yifeng acupoints below the ear. It can be punctured after six or seven days. If there is also a sore opposite the umbilicus, initially without swelling but accompanied by blistering that gradually enlarges, eroding flesh and discharging pus, starting from the heel with tortoiseshell-like spots, it is called Xian Chuang, also known as Hua Gu Chuang. The discharge of bone indicates failure of the Lung organ, which is extremely malignant. (From *Qixuan*)

Wang Kentang stated: Yue Shi Gan Chuang (Moon-Eclipse Chan Ulcer) arises beside the auditory meatus of infants. Although it is said to arise in correlation with the moon's phases, this may not necessarily be true. Generally, it is caused by the accumulation of wind-dampness and heat-toxin forming Chan sores. (From *Zhunsheng*)

Feng Luzhan stated: If wind and dampness interact and bind, ear sores arise. Furthermore, some cases where pointing at the moon leads to sores appearing behind both ears are named Yue Shi Chuang. Other external causes such as frostbite, insect bites, or mechanical injury should be treated externally. (From *Jinnang*)

Zhou Wencai stated: Yue Shi Chuang arises around both ears, the nose, and the face, rotting and spreading to the lower orifices, penetrating into the sinews and collaterals. The sore intensifies during the middle of the lunar month and subsides at the end of the month, hence its name derived from the waxing and waning of the moon. (From *Jiyan*)

*Xin Fa* stated: Yue Shi Chuang, also known as Xuan Er Chuang (Rotating Ear Ulcer), arises in the folds behind the ear, extending up and down the auricle, resembling a knife cut. The color is red, and it frequently exudes yellow fluid. It is caused by damp-heat in the Gallbladder and Spleen.

[Image: Yue Shi Gan Chuang]