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External sores (external ulcers) arise from external causes, such as the influence of the six climatic pathogens (Six Excesses) of the four seasons, and internal causes, such as damage from the seven emotions and six types of qi stagnation; all kinds of etiological factors are fully present. Speaking of the most common situations, heat syndromes account for the majority. This is because external contraction of the six climatic pathogens, when accumulated, invariably transforms into heat; and changes in the five zang organ emotions invariably generate fire. Thus, among the hundred diseases of internal medicine, those belonging to heat must also constitute more than half; moreover, in the case of external sores, where the skin and muscles are burning and painful, and flesh rots to form pus, if it is not due to heat郁结 (stagnation) within that consumes and melts the tissue, what else could it be? This is why secular treatments for external sores invariably focus on the path of clearing heat with moistening and cold-cooling agents; indeed, one cannot deny that this approach has significant applicability. Nevertheless, although heat-type sores are indeed the most numerous, I dare not blindly believe in Linwushanren's assertion that Yanghe Decoction (Warming and Unblocking Decoction) is universally appropriate, thereby inflicting upon innocent patients a punishment akin to branding or scorching, allowing them to wail miserably and violently until their flesh is scorched and bones melted. In reality, the manifestations of heat diseases vary infinitely. To achieve precise dosage balance, where every grain is weighed correctly, seems not easy at all. It is certainly not like street peddlers or market bell-ringers who merely memorize a few herbs such as Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Shigao (Gypsum Fibrosum), Dahuang (Rhei Radix et Rhizoma), Jinyinhua (Lonicerae Japonicae Flos), and Diding (Violae Herba), and thus claim to have fulfilled the duties of a surgeon.

Let us discuss heat-type external sores separately. There are Wind-Heat syndromes, where heat arises from wind, such as various sores on the head and face and Youfeng (Roaming Wind, a condition characterized by wandering redness and itching). Although clearing heat is indicated, one must first use pungent-cool herbs to disperse wind; cold-cooling drugs should not be used prematurely. Otherwise, even if the heat subsides, hard lumps may remain; lingering for a long time without dissolving, they eventually become stubborn and difficult-to-treat conditions. Worse still, if cold-cooling herbs are used to directly suppress the fire, it may instead cause blood stasis and qi condensation, inadvertently assisting the pathogen. There are Damp-Heat diseases, where heat arises from dampness, such as various itchy sores caused by dampness and Liuhuo (Flowing Fire, a type of erysipelas presenting with local redness, swelling, heat, and pain). Although clearing heat is necessary, especially light-draining and diuretic methods to guide dampness out are required; one must not rely solely on bitter-cold herbs like Huangqin and Lianzi. Otherwise, while the heat intensity gradually resolves, damp accumulation remains undissipated, making swelling and putrefaction difficult to heal. Only in Toxic-Fire syndromes, manifesting as Dingchuang (Ding sores/carbuncles), does the onset proceed rapidly, being easy to scatter but hard to gather. The toxic heat not only penetrates directly into the Blood level but also has a direct relationship with the Heart and Liver organs. Therefore, when the toxin spreads causing Zouhuang (Toxin spreading inward, colloquially known as "Zouhuang". The literal meaning is extremely obscure, yet everyone knows the term. Those who die from Ding toxicity may have their whole body turn yellow like gold; this is actually the toxin entering the meridians, unable to transform itself, accumulating and steaming to create this change, hence the name "Zouhuang"), there will inevitably be signs of coma and rebellious Liver Fire. Thus, Xijiao (Rhinocerotis Cornu) and Lingyangjiao (Capricornis Cornu) are essential in treatment. Otherwise, the condition changes abnormally, fast as a galloping horse; if the initial strike fails, remediation is extremely difficult. This is the most violent and aggressive syndrome in surgery, requiring urgent administration of heavy doses to extinguish a raging fire; one must not treat it lightly or with insufficient measures (like a cup of water trying to save a burning cartload of firewood), which would instead lead to an uncontrollable inferno in an instant.

Among Ding toxins prone to Zouhuang, those on the head and face are the most severe. The swelling spreads diffusely and is exceptionally hard; puncturing yields no blood, water, or pus. Once the patient reaches a state of mental confusion and slurred speech, it is indeed difficult to treat. Early use of Xijiao and Lingyangjiao can cure nine out of ten cases; this works by cooling and descending to calm Qi and Fire, preventing them from attacking upward. Hence, Ding sores on the head and face easily become critical. Additionally, fingers often develop Ding sores, and the therapeutic principle is the same, though the progression is slower and curable cases are more common. However, there is a specific type called Hongsi Ding (Red Thread Ding), where a red halo emerges from the site of initial swelling, visible on the surface of the muscle, traveling up the arm and gradually reaching the axilla. Tradition holds that if this red line crosses the armpit and enters the chest, it is incurable. Yet, having treated external sores for thirty years, I have never seen such a deteriorated condition; perhaps this is merely an idealized statement by ancients. Master Lang stated that this is Heat in the Heart, and treatment should focus on draining the Heart, heavily using Huangqin, Lianzi, Zhizi (Gardeniae Fructus), and Liaoqiao (Forsythiae Fructus), yielding immediate results. In summary, these all clear Heat from the Heart and Liver. Since the Heart and Liver are the sources of Ministerial and Sovereign Fires, although the manifestation is on the exterior, the root lies in the interior. As the saying goes, mild diseases reside in the meridians, while severe diseases involve the fu-zang organs. Among external sores, the only ones suitable for large doses of cold-cooling herbs without fear of excess are this specific type. On the feet, there is also what is called Shuiding (Water Ding). Initially, there is spreading redness and swelling, intense heat and pain, leading to massive putrefaction within one or two days. This involves Damp-Fire and Toxic-Dampness; it requires urgent, heavy doses of Xijiao, Lingyangjiao, Huangqin, and Lianzi to save the crisis, assisted by light-draining dampness-promoting herbs. This is a disease combining Damp-Fire and Toxic-Fire, which should be slightly distinguished from those treating Toxic-Fire alone. As for external sores after ulceration, if there is fire, it should be cleared, but the dosage must be judged according to the severity or mildness of the syndrome. Unless it is Yangfa Shuiding (Shuiding is also called Yangfa Du), one must not blindly pursue the four characters "Cooling and Detoxifying," treating them as a precious secret recipe; otherwise, many patients will die from the medication rather than the disease.