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Alternating chills and fever accompanied by pain, high skin temperature, thirst with irritability, normal diet, constipation with hard stools, scanty dark and astringent urination, thick and sticky pus discharge, and wound contraction after pus exhaustion, indicate an Excess syndrome (Excess pattern) which is easy to treat. In cases of Qi and Blood deficiency, the sore collapses and does not rise; although swollen, it is not red and feels soft and slow; muscles are cold, limbs are chilly, spontaneous sweating occurs, complexion is pale and devoid of luster, appetite is poor, speech is reluctant, urination is clear and frequent, stool is slippery and incontinent, the sore does not elevate nor putrefy, pus is scanty and clear, making contraction extremely difficult. Attack and purging methods must be strictly avoided; warm tonification is specifically indicated. This is a Deficient-Cold syndrome (Deficient-Cold pattern) which is difficult to treat. Tenderness upon light palpation indicates shallow pus, signifying an Excess condition; tenderness only upon heavy pressure indicates deep pus, signifying a Deficiency condition. If depression persists after pressing, there is no pus, only clear fluid. If it rebounds immediately after pressing, pus is present. Pain that worsens after pus discharge indicates Deficiency, requiring tonification. Abundant pus may also result from Qi and Blood deficiency failing to secure and contain. If swelling is high but soft, this relates to the Bladder meridian originating from the back. How can one generally assume it is Heat and use cooling herbs?

After ulceration, if the pulse is choppy and slow, recovery is easy; if fine and deep, occasionally straight and rigid, it indicates Interior Deficiency. If pain has not yet resolved, and the pulse is surging, slippery, coarse, and scattered, treatment is difficult due to Deficient Zheng Qi (Upright Qi) and Excess Xie Qi (Pathogenic Qi). Fever with thirst, and a pulse that is deficient and large/empty, indicates True Qi deficiency and Pathogenic Qi excess, constituting an untreatable condition. Whenever swelling is hard without luster, skin is thick with pustules like millet grains, and the pulse is surging and large but choppy upon pressure, Essence and Qi have exhausted, constituting an untreatable condition. If not yet broken, and toxic heat attacks the Zang-Fu organs, no hot herbs should be used at all; if already ulcerated, and Zang-Fu organs are injured with minimal food intake, no cold herbs should be used at all. This describes the general rule; variations require careful consideration. If toxic heat forms a pus tube inch-deep and full, with sticky pus and blood, it is easy to treat; if pus is foul-smelling like clear water, blood fails, Qi declines, Yang is exhausted and Yin is excessive, it is untreatable.

The human body is rooted in the Five Zang organs, and the Five Zang organs are rooted in Stomach Qi. When pathogenic factors stagnate in the Stomach, if Stomach Qi is robust and the constitution solid, pathogenic factors contend and flow into the meridians. Stagnating where blocked, blood vessels converge, knotting to form a carbuncle (Yong). If Stomach Qi is weak and the constitution deficient, pathogenic factors become excessive and lodge in the meridians, obstructing their course, causing blood vessels to coagulate and remain, knotting to form a deep abscess (Ju). Thus it is said: externally like millet, internally like grain; externally like a coin, internally like a fist. Although caused by disharmony of Ying and Wei (Nutritive and Defensive Qi) and meridian stagnation, the causes of disease are not limited to this. Investigating the source, there are five: 1. Seasonal epidemic qi (Tianxing Shiqi); 2. Emotional Qi stagnation (Seven Emotions Qi Yu); 3. Constitutionally deficient with external invasion (Ti Xu Wai Gan); 4. Accumulated heat contending with wind-cold (Yun Re Bo Feng Leng); 5. Consumption of rich, greasy, strong-flavored foods, fishy, mutton-like, and heat-toxic substances. Another view states: 1. Epidemic qi (Tianxing); 2. Fatigue and weakness leading to Qi stagnation (Pi Ruo Qi Zhi); 3. Anger (Nu Qi); 4. Kidney Meridian deficiency (Shen Jing Xu); 5. Consuming strong wine, taking elixirs, eating roasted/fried foods, along with great anger, depression, resentment, excessive sexual activity, leading to Essence deficiency and Qi consumption. All these can lead to various swelling and toxicity conditions such as Back Carbuncle (Fa Bei), Hand-Reach Abscess (Da Shou), Brain Carbuncle (Nao Ju), Large Ding (Da Ding), Suspended Carbuncle (Xuan Yong), Leg Outbreak (Jiao Fa), and Breast Carbuncle (Ru Yong).