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The use of medicine by medical officials is like the use of troops by generals and commanders. As the proverb says: "A thousand soldiers are easy to find, but one good general is hard to seek." The one who determines victory in battle is a good general; the one who determines efficacy in treatment is a good physician. Even with tens of thousands of soldiers, without a good general, they cannot achieve victory; even with tens of thousands of medicinal materials, without a good physician, they cannot achieve efficacy. A good general must have soldiers to utilize him; a good physician must have medicines to utilize them. The prestige of a good general lies in his ability to use unconventional tactics to defeat the enemy; the merit of a good physician lies in his ability to use extraordinary medicines to cure diseases. In using troops and medicines, one should first seek out good generals and good physicians to employ. If it is not the right person, then neither the troops nor the medicines will succeed. To treat bodily illnesses, one should follow the sound advice of good physicians.

The *Shenghui Fang* (Prescriptions from the Holy Benefit Bureau) states: How can one distinguish between favorable and unfavorable outcomes of *yongju* (carbuncles and sores)? Dysfunction of the five Zang organs leads to carbuncles. Those who suffer from chronic *xiaoke* (wasting-thirst syndrome, similar to diabetes) are also prone to carbuncles and sores. When Qi and blood flow is obstructed, and heat pathogens clash, carbuncles and sores erupt, causing intense heat; severely, flesh rots and turns into pus. However, carbuncles and sores do not penetrate to the bone marrow, nor does the marrow get scorched. Carbuncles and sores arise internally or externally; internally, they occur between the chest, abdomen, and Zang-Fu organs; externally, they appear on the surface of skin, flesh, muscles, and bones. These two types of toxins have no fixed location of onset but have standard names. The root of a carbuncle (*yong*) begins with stale blood failing to be expelled through sweat, internal accumulation of waste failing to shed, and steaming Qi failing to reach the exterior, leading to stagnation and accumulation caused by heat.

The formation of pus and fluid in *dingchuang* (hard carbuncles) is not descended from heaven or emerged from earth, but is formed by accumulation. Those who preserve life strive to prevent injury and nip problems in the bud. At the initial stage, when slight differences are felt, one must harbor great fear; people who underestimate this condition often die due to misjudgment.

When carbuncles and sores first appear, their symptoms are extremely subtle, yet many people ignore them; rapid treatment is necessary. Heat erupting in the skin causes swelling with a small base; even when it becomes very large, it presents as excess rather than deficiency. Deficiency patterns require tonification, while excess patterns require purgation. Cases with excess heat are easier to treat, while those with deficiency-cold combined with pathogenic heat are difficult. Swelling that is hard and dense with thick pus indicates an excess pattern; swelling that is soft and slow with thin pus indicates a deficiency pattern. Generally, treatments are often disorganized and lack sequence; acting hastily in emergencies makes it impossible to distinguish the depth of the disease, leading to death.

Treating carbuncles and sores is similar to treating sudden syncope (*bao jue*); such injuries inevitably lead to complications. However, some carbuncles and sores require urgent treatment: those occurring in the throat, tongue, face, head, neck, shoulders, and back are more dangerous than injuries in other areas.

Treating these diseases is like fighting fires, rescuing drowning victims, or chasing fugitives—it requires urgency. Without rapid treatment, disaster will surely ensue. Carbuncles and sores manifest in three degrees: superficial sores should be treated to remain superficial; deep sores should be treated to resolve deeply.

If pressing a swollen carbuncle causes pain only with deep pressure, the pus is deep; if light pressure causes pain, the pus is shallow. If depression after pressing does not rebound, there is no pus, only edema; if it rebounds immediately, it is Qi stagnation causing swelling. If this persists, it may later transform into carbuncles, sores, or *dingdu* (hard toxic sores), caused by cold pathogens. Long-term stagnation transforms extreme Yin into Yang, turning cold into heat, leading to ulceration. This ulceration will definitely form pus. However, diseases have variable manifestations and fluctuations; understanding this requires insight, not mere chance. Physicians rely on intuition and adapt to changing conditions.

The *Shenghui Fang* states: Carbuncles, back carbuncles (*fabei*), *dingchuang*, breast carbuncles (*ruyong*), and boils have five favorable signs (*wushan*) and seven unfavorable signs (*qi'e*), which must be examined carefully. Irritability and coughing constitute one unfavorable sign; stiffness in the shoulders and neck with heavy limbs constitutes the fifth unfavorable sign; inability to eat or drink, vomiting after taking medicine, and loss of taste constitute the sixth unfavorable sign; hoarseness, pallor, cyanotic lips and nose, and edema of the face and limbs constitute the seventh unfavorable sign. Pain subsiding with rest and normal appetite constitute the first favorable sign; regular bowel and bladder movements constitute the second favorable sign; spontaneous resolution of abscesses with fresh color indicating non-lethality constitute the third favorable sign; bright spirit and clear voice constitute the fourth favorable sign; balanced body constitution constitutes the fifth favorable sign. If two of the five favorable signs appear, recovery is likely; if four of the seven unfavorable signs appear, the condition is critical. Sometimes, despite having the same underlying pathology as the seven unfavorable signs, the skin may be tight like the favorable signs; conversely, despite having the same pathology as the five favorable signs, the skin may be loose and weak like the unfavorable signs. Such nuances are beyond the comprehension of ordinary people. If all five favorable signs converge, goodness cannot be exceeded; if all seven unfavorable signs converge, evil is severe. The following symptoms are recorded, along with Shu and Mu points for detailed explanation.

Dull pain in the Lung Mu point indicates Lung *ju* (deep sore); slight elevation above indicates Lung *yong* (carbuncle). Dull pain at Juque indicates Heart *ju*; slight elevation above indicates Heart *yong*. Dull pain at Qimen indicates Liver *ju*; slight elevation above indicates Liver *yong*. Dull pain at Zhangmen indicates Spleen *ju*; slight elevation above indicates Spleen *yong*. Dull pain at Zhongwan indicates Stomach *ju*; slight elevation above indicates Stomach *yong*. Dull pain at Jingmen indicates Kidney *ju*; slight elevation above indicates Kidney *yong*. Dull pain at Dantian indicates Sanjiao *ju*; slight elevation above indicates Sanjiao *yong*. Dull pain at Guanyuan indicates Small Intestine *ju*; slight elevation above indicates Small Intestine *yong*.

By examining the patient's Mu points according to these signs, one can determine the depth of the carbuncle or sore, identify the originating Zang organ, check for prior consumption of mineral drugs (*rushishi*), assess Qi deficiency or excess, and treat accordingly based on careful analysis.

The *Qianjin Fang* states: When carbuncles and sores first appear, whether large or small boils, painful or less painful, careful observation is required. Any slight abnormality should cause alarm. Careful nursing allows for normal activity. If not kept secure, new tissue is easily damaged; severe damage leads to ulceration, and recurrence brings disaster. Be cautious, be cautious.

When carbuncles and sores first appear, urgently administer *Zhuding Duoming Tang* (Pursuing Ding and Snatching Life Decoction) to resolve them internally. Apply *Huadu Xiaozhong Tuoli San* (Detoxifying, Reducing Swelling, and Supporting Interior Powder), *Michuan Neituo Qianjin San* (Secretly Transmitted Internal Support Thousand Gold Powder), or *Shiliuwei Liuqi Tang* (Sixteen-Ingredient Flowing Qi Decoction) to puncture the lesion, allowing pus to drain. If drainage is incomplete, use a medicated suction tube to extract pus, toxic fluids, and blood, leading to immediate recovery.

A boil with a base width of 1 to 3 cun is a boil (*jie*); 2 to 5 cun is a carbuncle (*yong*); 5 cun to 1 chi is a sore (*ju*); 1 to 3 chi is called *jingti* (whole-body involvement); a size like a mung bean is a painful nodule. After the flesh fills out, apply paper-separated plasters.

Another classic states: Qi blocked in meridians, with stagnant Qi and blood forming clots, results in carbuncles and sores. It is not merely caused by heat; later stages involve Yang Qi. Formed carbuncles can be resolved. If uniform hardness upon pressing indicates no pus; semi-softness indicates pus. If pressing above and below yields no heat, there is no pus; intense heat indicates pus. Upon sensing pus, rupture is urgent. If there is no pus but only Qi swelling, or if blood is present, be extremely cautious; do not needle or rupture. Use *Qianjin Baidu Gao* (Thousand Gold Detoxifying Plaster) to stop progression. Uniform hardness with a soft center confirms pus. Softness on one side may also indicate pus. Uniform hardness indicates malignant nodules or Qi stagnation. Uniform softness indicates blood stasis or hemangioma. Assessing hardness, softness, deficiency, and excess is crucial. If a hard sore persists and later develops heat and localized softness, incise the soft area; do not needle. For soft sores, keep warm with clothing; needle rupture is untreatable.

For carbuncles and sores with pus, do not worry about thick skin; rupture urgently. For bone carbuncles, skin color remains unchanged; urgently administer *Huadu Xiaozhong Tuoli San*... Insert needles 3-4 fen deep. To drain pus, do not rupture the top; rupture from the bottom for smooth flow. Once pus is exhausted, flesh regenerates; apply flesh-generating powders, followed by plasters for healing.

It is said: Eruptions on the neck are called *yaoju* (premature death sores); they are large, red, and black. Without urgent treatment, heat descends into Yuanye, damaging the Ren Mai internally, steaming the Liver and Lungs, leading to death within ten days. The Classics state: The front of the neck is named...

The *Weiji Baoshu* states: An eruption one inch and three fen behind the ear, at the vital spot, is fatal. Therefore, *ruidu* (sharp toxin) must not go untreated. *Ruidu* refers to sharp toxicity, also called *fayi* (parotid swelling), caused by heat steaming upward to the forehead and mouth, piercing the throat and causing immediate death.

Eruptions on the brain are called *naojun*; heat attacks the brain, emerging on the skin as a head, initially like a millet grain, with red, swollen, hard edges connecting to the ears and neck, accompanied by chills, fever, and pain...

The *Waitai Mi Yao* states: Eruptions in the pharynx are called *mengju* (fierce sores). Without urgent treatment, blood turns to pus and fails to drain, blocking the throat and causing death; if blood turns to pus within half a day... irritability indicates death, untreatable. Again, verify Qi deficiency or excess and treat accordingly. It is also said: Eruptions on the chest are called *jingju* (well sores), sized like beans. Appearing in three to four days, without early treatment, they descend into the abdomen; if untreated in the abdomen, death occurs in ten days. Persistent chills and fever also lead to death. It is also said: Eruptions on the toes are called *tuoju* (falling-off sores); they are red and black. If dry, death is inevitable and untreatable; if moist and not red/black, treatable. If treatment fails, amputation is urgent for survival. Without amputation, death follows.

The *Shenghui Fang* states: If pus and fluids are not fully drained from a sore, and the wound closes early, although it looks good, wind-toxin remains unresolved. Recurrence with foul discharge leads to transformation... Adhere strictly to this warning. (Formulas are listed below.) First, urgently administer *Zhuding Duoming Tang* for immediate effect. (Formula recorded below.)