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External sores (external ulcers) are mostly characterized by blood stasis and qi stagnation, which are excess syndromes. Even with purgation, resolution, dispersion, unblocking, and promoting circulation, one might still fear that the treatment is insufficient; initially, there is no need to employ the method of supporting the interior (supporting healthy qi to push out toxins). Since some misread Jiegu’s statement that "Huangqi (Astragali Radix) is the sacred medicine for sores," surgeons have actually taken supporting the interior as their primary skill. They open with Huangqi and frequently add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). Although this may cater to the preferences of the wealthy, it practically validates the saying that "nurturing an abscess leads to disaster." Is it because the ulceration is not severe enough to display the physician's supreme skill? Must they use tonification and support to deepen the patient's suffering, making them cry out more intensely, so that they can claim great merit as if entrusting an orphan or a life?

Shouyi (the author referring to himself) treats external sores and often states that except for Shenshu Ju (abscess at the Shenshu acupoint), Yao Ju (lumbar abscess), Xu Sun (deficiency consumption), and Liu Tan (scrofula/tuberculous lymphadenitis), there are no deficiency syndromes. Even when facing these deficiency syndromes, one must prioritize unblocking collaterals and promoting qi circulation; it is certainly not possible to hope for resolution by relying solely on brute-force tonification. If one mistakenly believes that supporting the interior is an essential principle, the more severe the external lesion, the more the healthy qi will be damaged, inevitably accelerating suppuration and leading to death. This approach of "tonifying while supporting toxins" is what causes me the most heartache and indignation.

However, in cases of deep-seated bone-abscesses where pus forms internally but cannot penetrate outward for drainage, and surgery is temporarily impractical, one must administer formulas to promote pus discharge to accelerate its outward expulsion, thereby allowing pus and toxins to be drained. Otherwise, internal attack by pathogens will intensify, corroding bones and rotting tendons, causing even greater harm. In such instances, Zaocis (Saposhnikoviae Radix - *Note: Context implies Zao Ci/Gleditsiae Spina* -> Gleditsiae Spina) and Chuanshanjia (Pangolin Scales) may occasionally be relied upon. But during periods of diffuse swelling without pus, these substances must never be lightly administered. For Chuanshanjia breaks through hardness, and Zaocis is sharp and penetrating; both possess the ability to generate pus and cause rapid溃破 (ulceration). If the condition can still be resolved internally, but these are used rashly, internal resolution will fail, leading to external ulceration, resulting in a state where nothing remains unbroken and no hole is left unpenetrated.

Regarding Nao Ju (carbuncle of the head/neck) and Bei Ju (dorsal carbuncle), these conditions are favorable when pus reaches the exterior and dangerous when pus sinks inward; thus, methods to promote pus discharge are indispensable. However, this merely involves venting qi mechanisms and opening the interstices (couli). Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) are sufficient to handle this; there is no need for Zaocis or Chuanshanjia. Furthermore, Ding Du (carcinogenic toxin/fixed carbuncle) is a major syndrome in surgery. If toxins gather and pus flows, it is serious but harmless; if toxins fail and no pus forms, even a small lesion is dangerous. In such cases, large doses of detoxifying and clearing-heat herbs should be used to reduce residual swelling, after which pus and toxins will naturally resolve. One must absolutely not mix in herbs that promote pus discharge, yet the pus will naturally emerge. All these examples take promoting pus discharge as the guiding principle, yet the reasons for achieving pus vary according to each case. From this, we know that each syndrome has its own specific treatment method; one cannot rigidly adhere to a single fixed formula and claim that a specific formula possesses certain miraculous effects.