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When the pus is ripe but the ulcer does not rupture, it is due to deficiency of Yang Qi; supplementation should be administered. When necrotic flesh fails to slough off, Yang Qi should be greatly supplemented, and moxibustion with mulberry wood should be applied. If the pus is thin or the wound fails to heal and contract, it indicates deficiency; supplementation is indicated. If cold pathogen invades the wound causing failure to heal or sunken non-healing wounds, warming and tonifying methods are required. A pulse that is large but forceless, or thready and faint, indicates simultaneous deficiency of Qi and Blood; vigorous tonification is necessary. Excessive bleeding or profuse discharge of pus accompanied by restlessness and insomnia indicates loss of Yang; emergency tonification is required.

A male patient suffered from a carbuncle. The pus formed but did not rupture. After administering tonic formulas, it ruptured, and he was subsequently cured with spleen-strengthening herbs. Danxi stated: "If Qi and Blood are robust, pus will naturally surge forth." This is indeed true.

Another male patient had an ulcerated wound where the necrotic flesh did not slough off. He was treated with vigorous tonification of Qi and Blood using Ginseng [Atractylodes], Angelica Sinensis (Danggui), and Atractylodes macrocephala (Baizhu), along with mulberry wood moxibustion, resulting in the sloughing of necrotic tissue and cure.

A young boy developed a carbuncle in his axilla. The wound failed to contract, and the pus was thin. His pulse was large, and he exhibited fatigue, poor appetite, scant sleep, spontaneous sweating, and dry mouth. He was treated with Neibu Huangqi Tang (Internal Tonifying Decoction with Astragalus) and moxibustion using fermented soybean cakes. These symptoms were due to simultaneous deficiency of Qi and Blood. Without tonification, cure would be impossible.

A male patient had a toxic swelling on his waist. Although the pus was ripe, it did not rupture. After puncturing, a large amount of pus drained out, exacerbating his restlessness. After four doses of Shengyu Tang (Sage Renewal Decoction), his condition stabilized. He was then given Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction) for tonification. It is crucial to restore the balance of Qi and Blood; otherwise, other complications may arise, making treatment difficult. Caution is advised.

A female patient had a carbuncle on her arm. The wound opening was purple and sunken, with thin pus that failed to heal. She believed the toxin was not fully expelled and wished to take detoxifying agents. I stated: "In cases of sores and ulcers, [treatment must be based on syndrome differentiation]; it takes a hundred doses to achieve a cure." (Note: The original text implies that aggressive detoxification is inappropriate here and tonification is needed).

A female patient suffered from a deep bone abscess (Fugu Yong) that failed to heal for a long time, resulting in thinning and weakness of the leg. Her pulse was slow and delayed. She was treated with Shiquan Dabu Tang (Perfect Ten Great Supplement Decoction) added with Achyranthes Bidentata (Niuxi) and Eucommia Ulmoides (Duzhong), along with moxibustion using Aconite cakes. This indicated interior deficiency with a tendency toward transformation into complicated syndromes. If pain and restlessness persist and the pulse becomes flooding, slippery, and scattered, the prognosis is poor because Zheng Qi (Upright Qi) is deficient while Xie Qi (Pathogenic Qi) is excess.

A male patient contracted wind pathogen at the wound site, presenting with trismus (lockjaw) and opisthotonos (arching of the back). One dose of Yuzhen San (Jade True Powder) cured him, followed by interior-supporting herbs to promote healing.

A male patient suffering from a carbuncle nearing the healing stage experienced generalized pruritus and a floating pulse. Two doses of Xiaofeng San (Wind-Dispersing Powder) stopped the itching, and he was subsequently cured with interior-supporting herbs.

A male patient developed a furuncle below his shoulder. For several days, it presented as diffuse swelling with slight pain, numerous small heads resembling millet grains, unchanged color, and no elevation. This indicated deficiency of Qi and Blood. [The text implies inability to generate pus]. Qi and Blood were still deficient, unable to transform into pus. The patient wished to use Taiyi Dingzi (Taiyi Plaster/Pill). I stated: "This medicine can attack toxins from above but cannot support the interior." He did not believe this and continued taking it. After four doses, he lost his appetite, the wound turned black and sunken, and hiccups persisted unceasingly, indicating extreme deficiency of Stomach Qi. This was incurable. Despite forcibly administering warming and spleen-tonifying agents, he died without response.

Another male patient had a similar lesion near his hypochondrium. It swelled but did not rupture. After administering great tonics, it ruptured and healed. However, he later died from a deficiency syndrome.

A male patient had a lesion on his waist that erupted but did not rupture. His Qi and Blood could only cause the eruption but not nourish the formation of pus. After several doses of great tonics, it ruptured. After a few more doses, the pus remained thin. He then consumed over one jin (approx. 500g) of a paste made from Ginseng, [Atractylodes], Angelica, and Atractylodes. The pus became scanty and thick. After consuming several more jin, the pus gradually thickened, and muscle tissue regenerated rapidly. In major carbuncles and furuncles, Qi and Blood are paramount. If lesions fail to erupt, or if after rupture they fail to slough, fail to heal, or produce scant/thin pus, it is due to deficiency of Qi and Blood, requiring great tonification. Aggressive purging agents are strictly contraindicated. There are cases where pus increases excessively; this is due to deficiency of Qi and Blood failing to contain it. If fever and thirst occur after rupture, with a large pulse and increased pus, it indicates deficiency of True Qi and excess of Pathogenic Qi, which is incurable. Generally, individuals with robust Qi and Blood present with high, red, swollen sores that easily slough, produce thick pus, and heal quickly. Weak individuals often fail to erupt, do not slough, and heal slowly. Failure to examine the condition and blindly administering purging agents leads to the disaster of "deficiency inducing deficiency." Post-illness care is essential; conditions like scrofula (Luoli) and flowing deposits (Liuzu) especially require tonification. Otherwise, other complications may arise, making treatment difficult. Caution is advised.

A male patient had a toxic swelling on his shoulder, hard and painful, with successive malignant signs. Three qian of Alum powder were made into pills with paste and taken with decoction of seven green onion bulbs. The swelling and pain subsided completely. [Text repetition/corruption follows]: Taken with green onion soup; because powder was hard to swallow, pills were made. A certain physician treats sores and furuncles regardless of swelling or rupture, first administering two to three doses of this medicine, followed by detoxifying agents, with great effect. Often used for common people, it resolves symptoms without needing interior-supporting herbs. This is likely because it clears heat-toxin without depleting Qi and Blood. It is particularly effective for furuncles caused by mineral/metallic poisons, as Alum can resolve such toxicity. Another formula uses five qian of Alum powder and five fen of Cinnabar, taken with hot wine, also effective. This formula is unknown in remote areas. It can also be used for insect or dog bites: dissolve and apply hot to the site, and take powder mixed with hot wine orally. Both are effective.

A male patient had a carbuncle on his chest, presenting with [pain], restlessness, fever, thirst, and a rapid, excess pulse. It was late winter. I stated: "This is internal accumulation of heat-toxin. We must set aside seasonal restrictions [and treat accordingly]." After two treatments, all symptoms receded. Four doses of Jinyinhua San (Honeysuckle Powder) added with Forsythia (Lianqiao) and Gardenia (Shanzhi) resolved the swelling through urination/sweating. Generally, syndromes have primary and secondary aspects; treating the primary causes the secondary to recede. Using flexibility allows one to disregard rigid seasonal rules. Adhering strictly to convention leads to critical illness. Moreover, indiscriminate use of purging agents damages the meridians. Thus, Danxi said: "When a sore arises in one meridian, seek its root in that meridian; do not interfere with others." Luo Qianfu said: "Adhering to convention is the view of the masses; knowing change is the act of the wise. Many fail in minor matters due to knowing convention but not change."

An Shangshe student over forty years old suffered from continuous pain in his hypochondrium due to anger. Days later, a three-cun mass appeared externally, diffusely swollen, non-red, and slightly [hard/painful] upon pressure. [Text missing: Diagnosis/Treatment details]. He used Cinnamon Bark (Rougui) etc. He cited Danxi: "For external swellings with internal and external stagnation, interior-supporting and exterior-releasing methods are primary." And: "Before an ulcer breaks, if toxin attacks the zang-fu, any heat-inducing herb is absolutely contraindicated." Since this case involved Qi and Blood stagnation, he took Liqi Yin (Flow-Qi Decoction), which worsened his deficiency. He then accepted my advice and sought treatment again. Examination revealed multiple deficiency syndromes. Pulse diagnosis showed further deficiency of Stomach Qi. He wanted to take my previous prescription. I said: "Treat the acute condition first." Thus, Sijunzi Tang (Four Gentlemen Decoction) added with wine-fried Paeonia Lactiflora (Shaoyao) and roasted Zingiber Officinale (Ganjiang) for four doses brought slight improvement. Dang Gui (Angelica) was added for another four doses, gradually reviving Stomach Qi. Ganjiang was removed, and Astragalus (Huangqi), Chuanxiong (Chuanxiong), Dang Gui, and Rougui were added for several doses. The wound became slightly red and mildly painful. After twenty-plus doses, pus formed. It was lanced, and he was given Shiquan Dabu Tang. Fortunately, he was careful with his health, and he recovered after two more months. Qi and Blood stagnation is often due to weak Ying and Wei Qi failing to circulate and disperse. How can Liqi Yin, which increases deficiency, be used? Furthermore, each meridian has different amounts of Qi and Blood: Pericardium, Bladder, Small Intestine, and Liver Meridians have much Blood and little Qi; Sanjiao, Gallbladder, Kidney, Heart, Spleen, and Lung Meridians have little Blood and much Qi. The previous case belonged to the Gallbladder Meridian, which has little Blood. After age forty, Yin Blood declines daily. The pulse and symptoms indicated deficiency. Although Danxi said exterior-releasing is primary for stagnation, this refers to adding moving/dispersing agents to tonics, not pure purging. If swelling and pain are severe, with restlessness and a large pulse, acrid-hot agents are contraindicated even for ulcers. Treatment must differentiate meridians, Qi/Blood, location, age, constitution, emotional factors, and seasonal appropriateness. Many fail by indiscriminately using Liqi and Shixuan medicines for nodular swellings.

**Attached Formulas**

**Mulberry Wood Moxibustion Method**: Treats back carbuncles that fail to erupt, necrotic flesh that fails to slough, yin sores, scrofula, flowing deposits, stubborn sores, and malignant sores that do not heal for a long time. Moxa the affected area for a short period until the necrotic tissue moves/sloughs. Danxi said: "Fire promotes free flow and draws out stagnant toxins." This follows the principle of contrary treatment.

**Shiquan Dabu Tang (Perfect Ten Great Supplement Decoction)** (See Fever Section of Ulcers): Treats ulcers with thin pus, or non-rupture/non-healing, all caused by deficiency of Yuan Qi failing to circulate. This formula generates Qi and Blood, strengthens the Spleen and Stomach, and tonifies various deficiencies.

**Huangqi Renshen Tang (Astragalus and Ginseng Decoction)** (See same section).

**Neibu Huangqi Tang (Internal Tonifying Astragalus Decoction)** (See Pain Section of Ulcers).

**Fermented Soybean Cake**

**Aconite Cake** (Both formulas see Buttock Abscess Section).

**Shengyu Tang (Sage Renewal Decoction)** (See Staff Injury Section).

**Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction)** (See Fever Section of Ulcers).

**Yuzhen San (Jade True Powder)** (See Staff Injury Section).

**Xiaofeng San (Wind-Dispersing Powder)** (See Sores and Scabies Section).