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The condition of external sores is generally distinguished by the size and urgency of swelling to determine severity. However, it cannot be judged solely by external appearance. The key lies in taking as the primary principle the depth and urgency of the disease source, as well as the deficiency or excess and safety or danger of the affected site. Therefore, there are cases where the swelling is extremely large and the situation appears formidable, yet with appropriate treatment, success is achieved readily; conversely, there are cases where a hard nodule is still small and seems easy to treat, yet despite exhaustive procedures, it remains unresponsive. This is not due to differences in medical skill, but rather because the sources of disease vary infinitely, and one must not view them all under a single category. Generally speaking, if the swelling is superficial in the skin or within the muscles, even major sores are often easy to treat. If located between tendons and bones or at the boundaries of major joints, even if the onset is mild, it is often difficult to cure. For shallow external sores, the swelling must be prominent with a constricted base and not overly flat, which is the most auspicious sign. If the swelling is diffuse and scattered without clear boundaries, it is often troublesome. For deep lesions, initially, there may only be soreness, numbness, or in severe cases, slight soreness without pain, while the skin and flesh appear normal, with no obvious swollen, hard nodules. After several days, upon deep pressure, hardness is felt within, which then gradually spreads, increasing in magnitude daily, yet still lacking a prominent shape. The skin color and subcutaneous muscles remain unchanged. This is the sequence of swelling in deep bone-abscessing carbuncles (Fugu Daju), conditions that patients often do not recognize as sores. Regarding observed swelling patterns: firm swelling with distinct margins indicates a favorable prognosis; firm swelling with diffuse margins indicates a severe condition, reflecting either dispersed pathogenic factors or insufficient healthy Qi. If the swelling is firm, large, and painful, with hardness around the periphery upon palpation but a soft spot in the center, pus has formed internally. Conversely, soft, diffuse swelling without boundaries, accompanied by heaviness but no pain, indicates severe depletion of Qi and Blood, which is unfavorable. Some cases involve pus formation without pain throughout, likely because healthy Qi fails to overcome pathogenic factors, nerve perception becomes dull, and the struggle between healthy Qi and pathogens ceases, resulting in no pain sensation; this is a sign of defeat. Another type begins in the skin as a grain-sized bump with a white head (colloquially known as "toxic seed" in our region, resembling pustular heat rash in summer, though not necessarily small); this characterizes the swelling of major sores such as occipital carbuncle (Naoju), dorsal carbuncle (Beiju), abdominal furuncle, and carbuncle-poison (Dingdu). If such grain-like bumps appear on the forehead, temples, cheeks, or lips, accompanied by numbness or itching/pain, it indicates a severe case of Dingdu. Initially non-swollen, it gradually becomes hard and swollen, rising prominently. If the face swells diffusely without such grains, with variable hardness or softness, possibly accompanied by pain or itching, arising suddenly and rapidly, with or without chills and fever, it is identified as Big Head Plague (Datouyi). Patients often mistake this for an external sore, and some specialists in sores may fail to recognize it, mistakenly using knives, needles, or topical applications, causing much harm. In reality, it is caused by Wind pathogen invading the meridians of the Six Yang, and resolving the exterior yields immediate results. As ancient texts state, facial swelling is attributed to Wind, referring to this disease. Similarly, leg swelling is attributed to Dampness, which is also accurate, provided one distinguishes between Cold-Damp and Damp-Heat. Red, swollen, and shiny areas indicate Damp-Fire. Swelling without redness indicates excessive Dampness. If truly Cold-Damp, the swelling will not be hard, the pulse will be slow and choppy, and the tongue coating will be white and greasy. Ancient treatments for Hong Kong Foot (Gangjiao) often used warming and drying methods, specifically legislated for Cold-Damp. However, south of the Yangtze River, Dampness and Heat coexist; where swelling is hard, Dampness easily transforms into Heat, and thus cannot be treated uniformly with ancient texts. The general principles of pre-ulcerative swelling are as above.

After ulceration, purulent toxins must be discharged smoothly and thoroughly; naturally, the swelling will gradually subside, indicating a favorable course. If pus discharge is obstructed, swelling cannot recede. If pus drains freely but swelling remains hard, thick pus indicates incomplete clearance of toxins (Excess pattern); clear pus indicates insufficiency of Healthy Qi (Deficiency pattern). Treatment should be differentiated accordingly, leaving no room for oversight.