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To remove "evil flesh" (necrotic tissue) refers to the removal of putrid flesh, which must be done to eliminate the old and promote the new. In robust individuals, it may fall off spontaneously; in the elderly or weak, it must be manually removed. If not removed, it will cause rotting of the fascia and tendons, potentially leading to the formation of exostoses (extra bone growth). Some patients may die from severe ulceration. In such cases, use herbs that greatly tonify Qi and Blood to aid convergence; alternatively, manual removal can be employed; or apply Realgar (Xionghuang) and Calomel (Qingfen) externally. If worm-eaten flesh protrudes, apply powder of Polygala Root (Yuanzhi), mixed with wine. Another method: for protruding polyps, take half a liang of Aconite Root (Wutou), steep it in three bowls of vinegar for three zhou shi (approx. 6 hours), then wash the area. Wash three to four times day and night. For various sores where fleshy granulations protrude like snakes by several inches, sprinkle Sulfur powder, and they will fall off. For chronic suppuration with long-standing ulcers where necrotic tissue does not decay, also apply a mixture of Sulfur and Calomel. If swelling persists around the periphery, prick the area with a fine needle heated red-hot to a depth of approximately one cun; the redness and swelling will immediately subside.

The speed of wound contraction after ulceration depends on the abundance or deficiency of Qi and Blood. Although drugs such as Dragon Bone (Longgu), Dragon's Blood (Xuejie), Frankincense (Ruxiang), Myrrh (Moyao), Red Halloysite (Chishizhi), Arsenolite (Hanshuishi), Elephant Skin (Xiangpi), Mercury (Shuiyin), and Calomel (Qingfen) possess astringent properties, they must be supported internally by decoctions containing Ginseng Root (Renshen), Astragalus Root (Huangqi), Angelica Sinensis Root (Danggui), Atractylodes Macrocephala Rhizome (Baizhu), and Angelica Dahurica Root (Baizhi). If the sore is red due to blood heat preventing contraction, add Gardenia Fruit (Shanzhi) and Forsythia Fruit (Lianqiao) to the Four Substances Decoction (Siwu Tang). If the color is pale, employ the method of tonifying and pushing out toxins. If, after ulceration, the base shows a red halo and spreads rather than contracting, use the Great Tonification Shixuan Decoction (Da Bu Shixuan San), removing Pinellia Tuber (Banxia - *Note: text says Pu, likely Poxiao/Pinellia contextually or Magnolia Bark, but strictly 'Pu' usually refers to Poxiao/Magnolia in some contexts or typo for Banxia/Xixin, here translated as generic 'Pu' or assuming Poxiao based on common formula variants, however text says 'Pu', let's stick to literal 'Pu' or assume Poxiao/Magnolia Bark if standard. Given 'Shixuan San' usually contains Ren Shen, Dang Gui etc., 'Pu' might be a typo for 'Banxia' or 'Poxiao'. I will translate as 'Pu' referring to the herb mentioned, likely Magnolia Bark or similar aromatic herb, but strictly following text 'Pu'. Actually, in many editions, it is 'Poxiao' (Magnolia Bark) or 'Banxia'. Let's use 'Pu' as written, or interpret as 'Poxiao' if standard. Wait, 'Shixuan San' typically has Ren Shen, Huang Qi, Dang Gui, Bai Zhu, Chuan Xiong, Bai Shao, Dang Shen, etc. 'Pu' is likely 'Poxiao' (Magnolia Bark) or 'Banxia'. I will use 'Pu' as a placeholder or 'Magnolia Bark' if inferred. However, instruction says no inference. I will use 'Pu' or 'Poxiao' if it's a known variant. Let's look at the character: '朴'. This is Poxiao (Magnolia Bark). So remove Poxiao and Guizhi. Double Renshen, Huangqi, Danggui. Add Honeysuckle Flower (Jinyinhua), Angelica Dahurica Root (Baizhi), Forsythia Fruit (Lianqiao), Rhinoceros Horn (Xijiao - *now protected, historically used*), and Trichosanthes Root (Gualougen). In summer and autumn, add the Three Yellows (Sanhuang: Coptis Rhizome, Scutellaria Root, Phellodendron Bark) and Notopterygium Rhizome (Qianghuo). If the wound breaks but does not suppurate, and the sore opening is hard, this is due to Wind pathogen. For necrotic tissue that does not decay, grind Realgar and Calomel evenly and apply externally. For carbuncles, furuncles, rotting flesh, and various toxic sores, mix one liang of Talcum Powder (Huashi) and five qian of Realgar, grinding them finely. Clean the area first, apply the powder, and cover externally with cotton paper. If healing has not occurred, use powders for generating muscle (Shengji San) again.

Patients suffering from various toxic sores should be cautious against wind and cold, guard their diet, regulate their daily routine, and reduce speech and physical activity. Medications and food should be pure and clean; meals should be taken at regular times. Even if symptoms slightly improve, sexual intercourse must be strictly prohibited. Violating this will prevent the wound from closing, leaving small holes like the eye of an awl, oozing fluid continuously and forming fistulas. These may persist for months or years without healing, often transforming into conditions such as dysuria with frequency, Xiao Ke (Wasting-Thirst/Diabetes), or Xiao Zhong (Wasting-and-Thirst syndrome). This leads to exhaustion of body fluids, emaciation of muscles, and death from various complications. How can one not be cautious! Furthermore, regarding the condition of "Fa Bei" (Back Carbuncle), the foul odor is particularly strong. Small centipedes often crawl into the wound, causing severe deterioration and massive ulceration, inevitably leading to death. It is crucial to place the bed in the center of the room and tie several roosters under the bed to avoid this harm. Qi and Blood flow smoothly when exposed to fragrant aromas and reverse when exposed to foul odors. Moreover, fragrant aromas enter the Spleen, awakening the Spleen and stimulating appetite. The patient's sleeping area should have a pleasant fragrance and be free from foul odors.