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The full text of the *Ling Shu: Yong Ju Chapter* (Spiritual Pivot: Carbuncles and Ulcers)

Huang Di said: I have heard that the intestines and stomach receive grain, the Upper Jiao (the upper burner, located above the diaphragm, responsible for dispersing Wei Qi) releases Zong Qi (Gathering Qi), which warms the muscles, nourishes the joints, and unblocks the interstices. (The Qi released by the Upper Jiao is Zong Qi. Zong Qi emerges from the throat to govern respiration; its ability to warm the muscles, nourish the joints, and unblock the interstices stems from Wei Qi (Defensive Qi) being transformed from Zong Qi.) The Middle Jiao (the middle burner, involving the spleen and stomach, responsible for rotting and ripening food) releases Qi like dew, which flows upward into the muscle clefts and渗ates into the Sun Mai (finest collateral vessels). When the body fluids are harmonized, they transform and turn red to become Blood. When Blood is harmonized, the Sun Mai first fill up, then pour into the Luo Mai (collateral vessels); when the Luo Mai are all full, they pour into the Jing Mai (main meridians). Yin and Yang are fully distended, and movement proceeds with the breath. (The Qi released by the Middle Jiao like dew refers to Ying Qi (Nutritive Qi). The phrase "Yin and Yang are fully distended, and movement proceeds with the breath" indicates that Ying Qi is transformed from Zong Qi and moves in accordance with respiration.) Movement has its order, circulation has its principles, conforming to the agreement of Heaven, never ceasing. (Movement has its order, circulation has its principles; the meaning is detailed in Volume 1 of the Yun Qi category. Humans possess Ying and Wei Qi, conforming to the measure of Heaven; the meaning is detailed in Volumes 24 and 25 of the Jing Luo category.) Palpate and regulate them, removing excess from deficiency; the reducing method makes excess insufficient. (Removing excess by treating from the perspective of deficiency means the reducing method renders excess insufficient.) Rapid action reduces Qi; retention adjusts the sequence. (Reducing methods should be rapid, while tonifying methods should involve retention; this shows a difference in speed and retention time between tonification and reduction.) Treating deficiency from a deficient perspective makes sufficiency abundant; when Blood and Qi are regulated, form and Zheng Qi (Upright Qi) are stabilized. I already understand the balance and imbalance of Blood and Qi, but I do not yet know how carbuncles and ulcers arise, their timing for success or failure, and the proximity or distance of their death periods. How can we estimate this? May I hear it? ("Chi" means stable. "Du" is pronounced with an entering tone, meaning to estimate.)

Qi Bo said: The flow of Qi and Blood in the meridians never stops, matching the degrees of Heaven and the records of Earth. Thus, if celestial bodies lose their proper degree, solar and lunar eclipses occur; if earthly meridians lose their order, waterways overflow, grass fails to grow, grains fail to multiply, paths become blocked, people cease to travel, and villages and towns become separated and isolated. Human Blood and Qi are similarly affected; let me explain the reason. Blood vessels, Ying Qi, and Wei Qi circulate without rest, corresponding above to the stars and below to the measures of the earth. When Cold Evil lodges in the meridians, Blood becomes stagnant and does not flow. When Blood does not flow, Wei Qi gathers there and cannot return, thus forming a carbuncle (Yong). (Wei Qi gathering there and unable to return means it stays and accumulates without dispersing. Shi is pronounced shi. Yi is pronounced yi; Cao is Lu Cong [deer leek]. Zhi is pronounced zhi. Qi is synonymous with Se.) Cold Qi transforms into Heat. When Heat prevails, flesh rots; when flesh rots, pus forms. If pus is not drained, tendons rot; when tendons rot, bones are injured; when bones are injured, marrow diminishes. If not at bone apertures, pus cannot drain; Blood becomes depleted and empty, so tendons, bones, muscles, and flesh lose mutual nourishment. Meridians fail and leak, fumes熏 (smoke/percolate) into the Five Zang Organs. Injury to the Zang Organs leads to death. (Carbuncle toxins progress from shallow to deep; injury to the Zang Organs leads to death. As mentioned below, and in the Five Reversal signs of carbuncles and ulcers in the lower compilation, these are all syndromes of Zang Qi injury.)

Huang Di said: I wish to hear completely about the forms of carbuncles and ulcers, and their taboo days and names.

Qi Bo said: A carbuncle arising in the middle of the throat is called Meng Ju (Fierce Carbuncle). If Meng Ju is not treated, it turns to pus. If pus is not drained, it blocks the throat, leading to death within half a day. If it has turned to pus, after draining, administer Shi Gao (Pig Fat Ointment), take it cold, and it will heal in three days. (Meng Ju implies urgent harm. If pus is already drained, taking Shi Gao can cure it; this is refined, clean pig fat. In *Wan's Formulas*, there is a treatment for sudden aphonia due to Lung Heat using one jin of refined pig fat mixed with one jin of white honey, refined briefly, filtered, cooled, and taken by the spoonful as needed, which cures immediately. Taking this without illness best moistens the Lungs and Intestines. This belongs to the category of Shi Gao.)

A carbuncle arising on the neck is called Tian Ju (Heavenly Carbuncle). Its swelling is large and red-black. If not treated urgently, Heat Qi descends into Yuan Ye (Yuan-ye Acupoint, Foot Shaoyang Gallbladder Meridian), damages the Ren Mai (Conception Vessel) anteriorly, and internally fumigates the Liver and Lungs. Fumigation of the Liver and Lungs leads to death after more than ten days. (Neck refers to the anterior neck. Red-black color indicates severe toxicity. Yuan Ye is the Foot Shaoyang point. Arising on the neck connects to the Lung system; descending into Foot Shaoyang affects the Liver, hence death.)

Excessive expansion of Yang Qi consumes brain marrow and remains in the nape, called Nao Shuo (Brain Melting). The complexion is unhappy, neck pain feels like needle pricking, and irritability indicate a fatal, untreatable condition. (Excessive Yang Qi expansion is extreme pathogenic heat. Unhappy complexion indicates Spirit injury. Pain like needle pricking indicates sharp toxicity. Irritability indicates Evil invading the Zang Organs, hence untreatable. Shuo is pronounced shi zhuo qie.)

A carbuncle arising on the shoulder and the soft flesh below the armpit is called Ci Yong (Flaw Carbuncle). It appears red-black. Treat it urgently; this causes sweating down to the feet but does not harm the Five Zang Organs. Four to five days after onset, apply moxibustion swiftly to eliminate it. (The soft white flesh below the shoulder is called . This is not a vital area, so it does not affect the Zang Organs. Cheng means swift. refers to moxa cones. It means rapid moxibustion should be applied. is pronounced ru or ruan, also nu dao or nu dao. Ci is pronounced zi or zi. is pronounced ru rui qie.)

A carbuncle arising in the axilla that is red and hard is called Mi Ju (Rice Carbuncle). Treat with bi stone (lithic stone). The stone should be fine and long, puncture sparsely, apply Shi Gao (Pig Fat Ointment), and it will heal in six days. Do not bandage it. (Fine stones avoid damaging flesh; long stones reach deep areas. Hence, sparse rather than dense puncture is suitable. Bian is pronounced biao jian qie.)

Those carbuncles that are hard and do not ulcerate are called Ma Dao Xia Ying (Horse Knife with Pendant). Treat urgently. (This is Scrofula. Xia Ying is written as Xia Ying in the *Jing Mai Chapter*; see Volume 10 of this category, under Foot Shaoyang. Urgent treatment is feared to delay harm to the person.)

A carbuncle arising in the chest is called Jing Ju (Well Carbuncle). It resembles a soybean. It arises in three to four days. If not treated early, it descends into the abdomen and becomes untreatable, leading to death in seven days. (Arising in the chest fumigates the Heart and Lungs. If not treated early and allowed to enter the abdomen, the toxin is even more severe, hence such rapid death.)

A carbuncle arising in the anterior chest is called Gan Ju (Sweet Carbuncle). It is green, resembling grain fruits, often accompanied by aversion to cold and fever. Treat urgently to remove cold and fever; death occurs in ten days, with pus discharging after death. (Ying refers to the raised flesh on the side of the chest. Grain fruit refers to various grains, indicating the lump resembles clustered grains. KT refers to Trichosanthes fruit, soft and non-ulcerated, containing seeds inside. This condition is lingering and difficult to cure, belonging to breast carbuncles. KT is the ancient character for Gua Lou.)

A carbuncle arising in the hypochondrium is called Bai Ci (Ruined Flaw). Bai Ci is a disease of women. Moxibustion causes it to become a large carbuncle with pus. Treatment reveals new flesh growing inside, the size of a red bean. Decoct one sheng each of Ji Gen (Water Caltrop Root) and Qiao Gen (Forsythia Root) in one dou six sheng of water until reduced to three sheng. Drink strongly, wear thick clothes, sit over a pot to steam, and induce sweating down to the feet to cure. ( is Water Caltrop. is Forsythia. Both roots detoxify, hence one sheng each. Ancient one sheng equals roughly modern three he plus. One dou six sheng boiled to three sheng involves numerical conversion. Ling is pronounced ling. Qiao is same as qiao.)

A carbuncle arising in the thigh and shin is called Gu Ting Ju (Thigh-Shin Carbuncle). External changes are slight, but pus adheres to the bone. If not treated urgently, death occurs in thirty days. (Gu Ting refers to the thigh. Slight change means external appearance is not obvious. Pus adhering to bone refers to what is now called osteomyelitis/carbuncle adhering to bone. Toxin is intense and deep, eroding the great meridians of Three Yin and Three Yang; hence, lack of urgent treatment leads to death.)

A carbuncle arising in the buttocks is called Rui Ju (Sharp Carbuncle). It is red, black, hard, and large. Treat urgently; without treatment, death occurs in thirty days. (Kao is the coccyx, acupoint Chang Qiang, a collateral of the Du Mai, also named Qi Yin. Untreated, it leads to death. Kao is pronounced kai gao qie.)

A carbuncle arising in the medial thigh is called Chi Shi (Red Spread). If not treated urgently, death occurs in sixty days. If in both inner thighs, death occurs in ten days without treatment. (Medial thigh is the inner aspect of the thigh. Located between Ji Men, Xue Hai of Foot Taiyin Spleen Meridian, and Wu Li, Yin Bao of Foot Jueyin Liver Meridian, these are places where Yin Qi gathers. Untreated, it leads to death. If both thighs are diseased, Yin is extremely injured, leading to faster death.)

A carbuncle arising in the knee is called Ci Yong (Flaw Carbuncle). It is a large carbuncle, color unchanged, feeling cold and hard like stone. Do not pierce with bi stone; piercing leads to death. Wait until it softens before piercing; survival follows. (Piercing a pre-suppurative knee carbuncle damages the府 of tendons, causing death. Softness indicates pus formation; piercing is harmless then. Ci is pronounced ci or zi.)

All carbuncles and ulcers arising in joints with corresponding symptoms elsewhere are untreatable. Those arising in Yang aspects die in one hundred days; those in Yin aspects die in thirty days. (Joints are places where Shen Qi (Spirit Qi) travels and enters/exits; they should not suffer carbuncle toxins. Correspondence means upper corresponds to lower, left to right, causing greater harm, hence untreatable. However, those in Three Yang aspects have shallow toxin in Fu Organs, dying slightly slower. Those in Three Yin aspects have deep toxin in Zang Organs, dying within one month.)

A carbuncle arising in the shin is called Tu Nie (Rabbit Bite). It is red reaching the bone. Treat urgently; untreated, it harms the person. (Ting is the shin. Rabbit bite implies biting injury. Ting is pronounced xing jing or xing jing. Nie is pronounced nie.)

A carbuncle arising in the medial malleolus is called Zou Huan (Slow Walker). It presents as a carbuncle, color unchanged. Frequent bi stone puncture of the Shu points stops cold and fever; death does not occur. (Shu Shi Qi Shu means bi-stoning the swollen area. Huai is pronounced hu gua qie.)

A carbuncle arising on the top and bottom of the foot is called Si Yin (Four Excesses). It is a large carbuncle. Treat urgently; death occurs in one hundred days. (Yang Qi receives Qi from the four extremities; large carbuncles overflowing there indicate extreme Yang toxin. Seasonal changes cause daily decline of True Yin, hence death beyond three months.)

A carbuncle arising beside the foot is called Li Yong (Fierce Carbuncle). It is not large, initially like a small finger. Treat urgently. Remove black parts. If it does not subside but grows, untreated death occurs in one hundred days. (No subsidence but growth means starting small like a finger, untreated it grows daily.)

A carbuncle arising in the toes is called Tuo Yong (Peeling Carbuncle). Red-black indicates death and untreatability; non-red-black indicates survival. If no regression, amputation is urgent; otherwise, death ensues. (Yuan sources of the Six Meridians are in the feet; thus, foot carbuncles are often ominous. Toes are where the Six Jing Wells emerge; red-black color indicates severe toxin. Without regression, urgent toe amputation preserves life; otherwise, toxin connects to Zang Organs, leading to death.)

Huang Di said: You speak of carbuncles and ulcers; how do we distinguish them?

Qi Bo said: When Ying Qi stagnates in the meridians, Blood stagnates and does not flow. When Blood does not flow, Wei Qi follows but cannot pass, obstructing and failing to move, thus generating Heat. Unchecked high Heat causes flesh to rot and turn to pus. However, it does not sink into bones, marrow does not scorch, and the Five Zang Organs are not injured; thus it is named Yong (Carbuncle). (This section distinguishes severity. Yong toxin is superficial, cannot sink into bones, so marrow is not dried and Zang Organs are uninjured; thus, Yong patients need not worry.)

Huang Di said: What is Ju (Ulcer)?

Qi Bo said: When Heat Qi is pure and excessive, sinking into skin and muscle, drying sinews and marrow, connecting internally to the Five Zang Organs, exhausting Blood and Qi, the area beneath the carbuncle sees bones, sinews, and good flesh entirely destroyed; thus it is named Ju. (Yong is shallow, Ju is deep; toxin varies in severity. Internal connection to Zang Organs and external destruction of bones, sinews, and flesh defines Ju, which is fearsome.)

In Ju, the upper skin is dull and hard, resembling ox neck skin. In Yong, the upper skin is thin and lustrous. These are the signs. (Tao refers to color, dark and dull. This skin condition distinguishes depth/shallowness.)