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The condition of Naoju (Brain Carbuncle), as mentioned previously, is mild when caused by external pathogenic factors and severe when originating internally from the accumulation and stagnation of the Five Zang organs manifesting outwardly. Here, we reiterate and clarify this point. Those arising from external infections often occur in the center of the head, governed by the Du Mai (Governing Vessel). The Du Mai originates at the Weili acupoint (Tailbone), penetrates the spine upward, where Qi and Blood intersect. When toxic pathogens attach to this intersection, they can manifest outwardly; thus, it is prone to high swelling, suppuration, tissue regeneration, and wound closure, making it an easily treatable syndrome. Those arising internally often occur on the sides of the head, governed by the Foot-Taiyang Bladder Meridian. The Foot-Taiyang Bladder governs cold water and its nature is often sinking. Its meridian starts at the vertex, passes through both sides of the neck, and descends flanking the spine. When a carbuncle develops here, Qi and Blood intersect with the sore toxin and flow downward. Consequently, the sore tends to be flat and collapsed, with spreading roots, diffuse swelling on both shoulders, difficulty turning the arms and neck, a sensation of carrying a heavy stone on the back, difficulty in forming pus, difficulty in ulcerating, and difficulty in healing. This is a difficult-to-treat syndrome.

As for those formed by internal accumulation of the Five Zang organs, there are five sources: First, mental agitation stirs the mind, causing Fire to flare up and boil. Heat travels to the neck region, stagnates with Cold Water, and transforms into pus. This is the first type. Second, anger injures the Liver. The neck is where the Three Yang meridians converge to govern the sinews. Liver injury leads to insufficient blood circulation and lack of nourishment to the sinews, resulting in凝结 (coagulation) and swelling. Thus, the neck becomes stiff and painful, unable to turn. Before ulceration, the flesh appears purple-dark, hard, and diffusely swollen; upon rupture, bloody fluid drains out, accompanied by numb pain without significant redness or swelling. This is the second type. Third, excessive thinking injures the Spleen, daily depleting Spleen Qi. Alternatively, rich and greasy foods damage the Stomach, drying up Stomach fluids. This leads to fullness and obstruction in the Zhongwan area, preventing Qi movement. Qi reverses and obstructs within the muscles, causing stagnation and swelling. Although the outer skin may rot, the interior remains hard and un-ulcerated; symptoms include dry mouth and tongue, loss of appetite, spreading roots, and foul, pale-dispersed pus. This is the third type. Fourth, melancholy injures the Lungs. Lung injury causes pore closure and blockage of Couli (interstices), leading to stagnant Qi that obstructs the meridians longitudinally and transversally, coagulating into swelling. The sore shape is often flat and depressed, color pale and lacking luster, with rotting skin and flowing fat-like exudate, resembling scalding by hot water. Symptoms include coarse, short breathing, dry or blackened nostrils, dripping nasal discharge, and frequent coughing. This is the fourth type. Fifth, excessive sexual desire injures the Kidneys. Kidney injury leads to the failure of True Yin Qi. Once True Yin fails, Ministerial Fire arises. This fire rises and descends freely, whether in motion or stillness. The sore appears purple-black, the pulse is rapid and irregular, accompanied by irritability, dry mouth, and thirst immediately after drinking. This is the fifth type. Therefore, it is said that internally originated cases are severe.

Among external sores, Naoju (Brain Carbuncle) is the most dangerous syndrome. It is easy to form and easy to deteriorate, with numerous variations. Therefore, it is discussed in detail here and placed at the beginning of the chapter for emphasis.