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(From *Ling Shu: Yu Ban Pian*)

Huangdi said: At the onset of disease, there are often uncontrolled emotions (anger and joy), irregular diet, insufficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi (Nutritive Qi). These factors lead to the development of carbuncles and ulcers. When Yin and Yang are not communicating, and two types of heat pathogenic factors collide, pus is formed. Can this be treated with small needles? (Uncontrolled emotions cause Qi rebellion; irregular diet damages the Zang organs; insufficiency of Yin Qi leads to the failure of Ying Qi circulation; excess Yang Qi causes heat to gather. All these can result in carbuncles and ulcers.)

Qibo replied: Even a sage cannot resolve lesions that have already solidified and cannot be transformed, because once pathogens remain, they cannot be eliminated. This is like two armies facing each other, flags visible to one another, and white blades arrayed in the open field; such a situation does not arise from a plan made in a single day. To enable the people to obey orders and prohibit violations, and for soldiers to avoid the danger of white blades, requires more than a day's instruction; it is the result of long-term cultivation. If one waits until the body suffers from carbuncles and ulcers, with accumulation of pus and blood, is this not far from the correct path of treatment? The generation of carbuncles and ulcers, and the formation of pus and blood, do not fall from the sky nor emerge from the earth; they arise from the gradual accumulation of minor factors. Therefore, sages regulate themselves before any form appears, while fools encounter disaster only after the condition has fully developed. (When pathogens exist in the world, they cause chaos; when they exist in the human body, they cause disease. Once the pathology has fully manifested, even a sage cannot transform it, hence pathogens must not remain. Just as military strategy requires prior training and established plans to ensure safety without danger, how can one manage their body without daily nourishment and regulation? Thus, only sages can self-regulate before illness manifests, whereas fools often suffer misfortune.)

Huangdi asked: What if the pathological changes have already manifested but were not noticed, and pus and blood have already formed but were not seen? How should we proceed?

Qibo answered: When pus and blood have already formed, the mortality rate is extremely high (nine out of ten die, with only one chance of survival). Therefore, sages prevent conditions from reaching this stage. They clearly formulate effective prescriptions, inscribe them on bamboo slips and silk, so that capable successors may inherit and transmit them to future generations without end. This is precisely to address cases where timely detection was missed. (This refers to the vast number of people and the remoteness of time across millennia; how can everyone encounter a physician to relieve their suffering? Thus, methods are recorded on bamboo and silk to leave instructions for the future, specifically for those who fail to detect early signs.)

Huangdi asked: If pus and blood have already formed and we encounter the patient, can we treat it using small needles?

Qibo replied: Using small needles to treat large lesions yields little effect; using large needles on large lesions often causes harm. Therefore, for conditions where pus and blood have already formed, only bi stones (stone scalpels) or pi-feng needles (large-bladed needles) should be used to drain the abscess. (Small needles have limited efficacy and are useless here; large needles may cause injury. Thus, only bi stones, pi needles, and feng needles can be used to extract pus and blood from carbuncles and ulcers. For details on needle principles, see Category 2 of Acupuncture. 'Bi' is pronounced bīan jiān qiē. 'Pi' is pronounced pī.)

Huangdi asked: If it causes more harm, can it still be completely cured?

Qibo answered: It depends on whether the case presents as "Ni" (Rebellious/Ominous) or "Shun" (Favorable/Smooth).

Huangdi said: I wish to hear about the Rebellious and Favorable patterns.

Qibo said: If the injury is severe, and the patient exhibits white sclera with blue-black discoloration around the eyes and constricted palpebral fissures, this is the First Rebellious sign. If vomiting occurs after taking medicine, this is the Second Rebellious sign. If abdominal pain is accompanied by extreme thirst, this is the Third Rebellious sign. If there is stiffness and inconvenience in the shoulders and neck, this is the Fourth Rebellious sign. If hoarseness and pallor (loss of facial luster) are present, this is the Fifth Rebellious sign. Apart from these five conditions, the rest are considered Favorable. (Additionally, the *Han Re Bing Pian* chapter states: There are five regions on the body corresponding to the Five Zang organs: Region 1 is the Fubu area, Region 2 is the calf (Fei), Region 3 is the back, Region 4 is the Back-Shu points of the Zang organs, and Region 5 is the neck. If carbuncles and ulcers occur in any of these five regions, death ensues. This also belongs to the category of the Five Rebellious signs. See Category 54 of Acupuncture. 'Nei' is interchangeable with 'Na', meaning to take/administer. 'Si' is pronounced sī, referring to damaged voice.)