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The folk-heralded surgical texts rarely fail to assert that for major conditions such as carbuncles and sores (Yong Ju, 痈疽), the utilization of tonification and expulsion methods is beneficial. Consequently, all practitioners treating external sores, upon observing more severe manifestations, invariably incorporate Codonopsis Radix (Dangshen, 党参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Poria (Fuling, 茯苓), etc., holding tonification in the highest regard; this is especially true for those versed in the school of Zhang Jingyue. They are unaware that the great toxicity of sores leads to qi and blood stagnation, obstruction without flow, retention without elimination. Once tonification and expulsion methods are applied, what would the clinical picture be? One should awaken to this truth upon quiet self-reflection. Furthermore, regarding cases where summer-heat and dampness mutually obstruct, or cold-dampness causes bi-syndrome with fixed pain, what would be the consequences of reckless tonification?

My treatment of external sores inherits the family learning of my late teacher, Mr. Zhu. I often state that except for a few specific conditions such as deficiency-type flowing phlegm (Liutan, 流痰), lumbar carbuncle (Yaoju, 腰疽), Shenshu abscess (Shenshufa, 肾俞发), deep-rooted bone abscess (Fugu huan tiao, 附骨环跳 - referring to abscesses around the hip/bone), there are rarely true deficiency syndromes. However, practitioners accustomed to tonification often cite the *Shennong Bencao Jing* stating that Astragali Radix (Huangqi, 黄芪) treats chronic, deteriorating sores of carbuncles and expels pus while stopping pain. They claim that since the Jin and Yuan dynasties, Huangqi has been called the "sage medicine for sores." Thus, upon encountering any surgical condition, regardless of whether the swelling is red, or whether it involves wind-fire or summer-heat, they consistently rely on Huangqi from start to finish. The result is that swollen areas become higher with each tonification attempt, and ulcerated wounds continue to fester despite supplementation. What the ancients described as "nourishing the carbuncle leads to harm" is truly a portrait of these tonifying medicines. Neither patients nor doctors realize this; why is this so? It is precisely the harm caused by misreading the entry on Huangqi in the *Bencao Jing*.

Examining the intent of the *Bencao Jing*, the phrase "treating chronic, deteriorating sores of carbuncles" indicates that Huangqi is indeed the primary herb for consolidating the exterior and strengthening the surface. For diseases characterized by exterior deficiency, it excels. When a carbuncle reaches the stage of "chronic deterioration," with profuse discharge of pus and fluid, leading to exhaustion of body fluids, the deficiency lies at the exterior level. Only Huangqi can replenish this consumption and consolidate the original qi. The main purport of the *Bencao Jing* is easy to understand: it does not imply that when great toxicity first erupts and pathogenic factors are strong, one must uniformly apply exterior-consolidating methods. Regrettably, superficial readers see only "treats carbuncles" and ignore the three characters "chronic deteriorating sores" (Jiu Bai Chuang, 久败疮). They further interpret it as "Huangqi is the sage medicine for carbuncles," implying that for any carbuncle, regardless of deficiency/excess, cold/heat, or presence/absence of toxicity, Huangqi is indispensable. With the prevalence of works by Xue Lizhai and Zhang Jingyue, those seeking to expel pus find that the more they expel, the more pus appears; those seeking to stop pain find that the more they treat, the worse the pain becomes. This is like teaching a monkey to climb a tree or adding wings to a tiger. As Jia Yi said, "A leg as thick as a waist, a finger as thick as a thigh," these practitioners implement this theory, unaware that their so-called "expelling pus and stopping pain" actually facilitates this disaster. How difficult it is to read ancient books!

In treating external sores, I am not unaware of appropriate methods for tonification. Conditions such as deficiency-type flowing phlegm, lumbar carbuncle, Shenshu abscess, and flowing abscess (Liuzhu, 流注) involve depletion of both qi and blood, poor transformation and transportation, and bi-obstruction without movement. Without the power of tonification to mobilize qi mechanism, retained pathogens will not move, and fixed pathogens will not leave. However, one cannot rely solely on herbs like Codonopsis Radix (Dangshen, 党参) and Astragali Radix (Huangqi, 黄芪) to achieve success by chance. For nuchal carbuncle (Naoju, 脑疽) or back carbuncle (Beiju, 背疽), even if necrotic tissue has formed but pus/toxin drainage is poor and foul flesh does not detach, it is due to insufficient qi and blood failing to expel toxin outward; tonifying formulas are necessary for efficacy. Especially for the elderly and debilitated, warm tonification is required. Additionally, if a sore has ulcerated with abundant pus, and the patient suddenly becomes emaciated and thin, tonification may also be appropriate. However, after one or two doses, once appetite returns and spirit revitalizes, tonifying medicines should be withdrawn, and clearing/cleaning methods resumed. Because residual toxins remain, one must prevent the ashes from reigniting; tonification might otherwise intensify the pathogenic heat. Similarly, in treating seasonal diseases, once the major symptoms subside, one must not recklessly tonify, lest lingering pathogens be retained and cause complex transformations. In summary, medicine is for treating disease, not for treating deficiency. When disease exists, the priority is eliminating the pathogen; "tonification and nourishment" are certainly not universal cures for all diseases. This principle applies equally to internal and external medicine. Yet, those in the world adhering to Xue Lizhai and Zhang Jingyue do not understand, and wealthy families who recognize only deficiency but not disease do not awaken. Does the use of tonifying medicines for illness merely serve to cater to the psychology of the rich? Medicine is thus brought to ruin. If a person truly has a deficiency syndrome requiring tonification, there are internal medicine principles and methods for that; it is not within the scope of surgical practice, so I will not elaborate further.