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The principle of myriad diseases is that every disease must have a primary prescription for its treatment. Surgical medicine merely employs a few methods such as expelling toxins, clearing fire, and generating flesh to promote healing. Even with modifications, one only selects a few herbs based on symptoms; there are not many complex methods. If practitioners can carefully study the properties of medicines, they will naturally be able to treat according to symptoms, and their prescriptions will invariably be effective.

Miao Zhongchun's prescription for treating ding carbuncles (malignant furuncles) and all kinds of swelling and toxicity: Raw Chrysanthemum Indicum (Gan Ju) with roots, crushed, 1.5 liang; Purple Flower Siegesbeckia Orientalis (Zi Hua Di Ding), 5 qian; Licorice Root (Gan Cao) honey-fried, 3 qian; Burdock Fruit (Niu Bang Zi) fried and ground, 1.5 qian; Trichosanthes Root (Gua Lou Gen), 2 qian; Fritillaria Bulb (Bei Mu), 3 qian; Honeysuckle Flower (Jin Yin Hua), 5 qian; Angelica Dahurica (Bai Zhi), 1.5 qian; Rehmannia Root (Sheng Di), 3 qian; Bletilla Rhizome (Bai Ji), 3 qian; Forsythia Fruit (Lian Qiao), 2.5 qian; Five-claw Dragon (Wu Zhao Long, i.e., Rubia Cordifolia root / Qian Gen), 5 qian. First, decoct six liang of Prunella Vulgaris (Xia Ku Cao) in six bowls of river water until reduced to three bowls, strain, take one bowl of this decoction and mix it with the previously prepared herbal mixture. Take at any time. After ulceration, add Astragalus Root (Huang Qi) stir-fried with salt water, 5 qian, and Ophiopogon Tuber (Mai Dong), 5 qian.

Another prescription for treating yin-pattern sores and ulcers: Polygonum Multiflorum Vine (Hong Yao Zi), 4 liang; Bletilla Rhizome (Bai Ji), 1.5 liang; Ampelopsis Rhizome (Bai Lian), 1.5 liang; Frankincense (Ru Xiang), 6 qian; Myrrh (Mo Yao), 6 qian; Cinnabar (Zhu Sha), 3 qian; Realgar (Xiong Huang), 3 qian; Musk (She Xiang), 1 qian; Borneol (Bing Pian), 1 qian; One lower jaw of a black dog (preserved by calcination), Pea Flour (Wan Dou Fen), 1 liang. Grind each herb into an extremely fine powder and mix evenly. Apply around the sore using vinegar and honey as a vehicle, moistening with very hot vinegar. This can also be taken internally.

Xue Lizhai treated a man suffering from a brain carbuncle (Nao Ju) with numerous heads, unbearable pain. He first took Huanglian Xiaodu San (Coptis Decoction for Disinfecting Toxins) without effect. He then took honeysuckle wine and fell into a deep sleep. Upon waking, the condition had improved by sixty or seventy percent. After four more doses, he recovered. Another man suffered even more severely; upon taking the same remedy, his swelling and pain subsided instantly. However, it did not completely resolve, so Huang Qi (Astragalus), Dang Gui (Angelica Sinensis), Gua Lou (Trichosanthes), Bai Zhi (Angelica Dahurica), Gan Cao Jie (Licorice Knots), and Jie Geng (Platycodon) were added. After several doses, he healed.

Pan Guangfu, a Juren degree holder, aged forty, suffered from a swollen brain carbuncle. His pulse was calm and still. Xue diagnosed this as a yang-pattern disease presenting with a yin-pulse, predicting death, which subsequently proved true. Generally, sores and ulcers, although belonging to heart-fire, require differentiation between exterior/interior and deficiency/excess. If vital qi is substantial and there is internal excess heat, cold-natured medicines may be effective. However, excessive use of cold and cooling agents causes stomach cold and spleen weakness, transforming yang into yin, leading to condensation without ulceration, or ulceration without healing. With yin-yang disharmony and conflict between water and fire, death is imminent.

An elderly woman with a robust constitution suffered from a brain carbuncle. After ulceration, pain persisted. Her pulse was excess-type, accompanied by constipation. She was given Qingliang Yin (Cooling Drink) for two doses, after which the pain stopped. She was then treated with disinfecting and supporting interior medicines and recovered.

An elderly man presented with redness, swelling, and pain, with a rapid and forceful pulse. He was given Huanglian Xiaodu San for two doses, showing slight improvement. He was then given Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) for four doses and recovered.

A man presented with swelling, pain, and a rapid pulse. Huanglian Xiaodu San was administered for two doses, resulting in slight reduction. Xianfang Huoming Yin (Immortal Life Preserving Powder) was given for two doses, stopping the pain. Then Chuan Xiong (Szechwan Lovage Rhizome), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Jin Yin Hua (Honeysuckle), Zhi Mu (Anemarrhena Rhizome), and Huang Bo (Phellodendron Bark) were used to induce ulceration. Finally, interior-supporting medicines were used for recovery.

A man presented with swelling of the head and neck. Although large ulcers had formed, swelling and pain worsened, accompanied by diarrhea, irritability, insomnia, and poor appetite. The situation was alarming. Pulse diagnosis indicated the toxin remained. Xianfang Huoming Yin was given for two doses, reducing swelling and pain by half. Er Shen Wan (Two Spirit Pill) and Liu Jun Zi Tang (Six Gentlemen Decoction) plus Wu Wei Zi (Schisandra), Mai Dong (Ophiopogon), and Zao Ren (Ziziphus Seed) were given for four doses. Symptoms slightly improved, appetite increased slightly, and sleep improved.

Huang Qin Bai Zhu San (Scutellaria and Atractylodes Macrocephala Powder) was then given for several doses, further improving appetite. Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) plus Jin Yin Hua, Bai Zhi, and Jie Geng was given for over a month until recovery.

An elderly man presented with facial redness, swelling, and pain, with a rapid and forceful pulse. Huanglian Xiaodu San was given for two doses, showing slight improvement. Qingxin Lianzi Yin was then given for four doses, resolving the condition.

A woman presented with ripe pus but no ulceration, distending pain, nausea, and poor appetite. Acupuncture was performed urgently, followed by interior-supporting medicines, leading to recovery. Another woman presented with mild pain and no pus formation. Tuoli Xiaodu San (Support Interior and Disinfect Toxin Powder) was given. Once pus formed, she was needled and treated with interior-supporting tonics for recovery.

An elderly man presented with clear thin pus and thirst, with a soft and choppy pulse. This was diagnosed as dual deficiency of qi and blood. Bazhen Tang (Eight Treasures Decoction) plus Huang Qi and Wu Wei Zi was prescribed. The patient disbelieved and took fire-clearing herbs instead, resulting in vomiting and reduced food intake. Believing the doctor finally, he took Xiang Sha Liu Jun Zi Tang (Amomum and Aucklandia Six Gentlemen Decoction) for four doses, stopping vomiting and improving appetite. He then took the previous Bazhen Tang for four more doses and recovered.

A man presented with formed but un-ulcerated pus and thirst, with a large and weak chi pulse. Si Wu Tang (Four Substances Decoction) plus Zhi Mu, Huang Bo, Mai Dong, and Huang Qi was given for four doses, reducing thirst. Jiawei Bawei Wan (Modified Eight-Ingredient Pill) was then given, stopping thirst and inducing ulceration. Interior-supporting medicines combined with the previous pill led to recovery.

A man presented with swelling, pain, and a rapid pulse. Jingfang Baidu San (Aucklandia and Saposhnikovia Decoction to Overcome Toxicity) was given for two doses, stopping pain. Tuoli Xiaodu medicines were then used to resolve the condition.

A man presented with red swelling, pain, fever, desire for cold drinks, and a surging rapid pulse. Liangge San (Cooling Chest Powder) was given for two doses, stopping symptoms. Jin Yin Hua was given for four doses, causing resolution and ulceration. Interior-supporting medicines completed the cure.

An elderly woman with a robust constitution presented with persistent pain after ulceration, excess pulse, and constipation. Qingliang Yin was given for two doses, stopping pain. Tuoli Xiaodu medicines completed the cure.

A man presented with hard swelling, no pus formation, only weeping from the wound, and severe pain. Xianfang Huoming Yin was given for two doses, stopping pain. Once pus formed, he was needled and treated with interior-supporting medicines for recovery. It is commonly seen that clear pus unresponsive to tonification, or non-painful, numb, stiff, and hard sores, are untreatable.

A man presented with impending pus formation, slight pain, and thirst, with a large and weak chi pulse. This was diagnosed as yin deficiency with hyperactive fire. The patient believed it was heart meridian heat-toxin and self-medicated with cooling fire-reducing herbs, worsening the condition. Seeking treatment again, Si Wu Tang plus Zhi Mu, Huang Bo, Wu Wei Zi, Mai Dong, and Huang Qi, along with Jiawei Bawei Wan, was prescribed. Thirst stopped, pus ulcerated, and interior-supporting medicines combined with the previous pill led to recovery. *Zhong Zang Jing* states: The occurrence of carbuncles, sores, and swellings is due to accumulated toxins in the five zang and six fu organs failing to circulate, not merely congestion of ying and wei. Their movement has specific locations, and their management has specific归 (orientations). For example, those appearing on the throat and tongue are toxins of the heart; on skin and hair, lung toxins; on muscles, spleen toxins; on bone marrow, kidney toxins; appearing below are yin toxins; appearing above are yang toxins; appearing externally are fu organ toxins; appearing internally are zang organ toxins. Therefore, internal sinking is called "huai" (ruin), external ulceration is "kui", upward progression is "cong" (following), and downward progression is "ni" (rebellious). Those appearing above develop quickly; those below develop slowly. Those affecting fu organs are easy to treat; those affecting zang organs are difficult. Observing this, a brain carbuncle arises from insufficiency of yin qi in the bladder and kidney meridians, with blazing yang fire. How can one focus solely on clearing fire without nourishing yin qi?

A man presented with diffuse swelling and pain behind the ear, unchanged skin color, and a slightly rapid pulse. Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Chuan Xiong, Dang Gui, and Jie Geng was given for four doses, raising the swelling slightly. Tuoli Xiaodu San was given for several doses. The pulse became slippery and rapid, indicating pus formation, requiring acupuncture. Fearful, the patient refused until extreme pain forced him to undergo needling, yielding about a bowl of pus. Interior-supporting medicines were used, and he recovered after over two months. For sores that do not rise, use support to raise them; for those not forming pus, use tonification to generate them, preventing internal attack. Timely needling of formed pus leads to quick recovery. Patients often fear needle pain or damage to healthy flesh. However, even if the sore is on thin flesh, once pus forms, the swelling rises over an inch, and the skin thickens slightly. Needling depth should not exceed two fen. On the back, where swelling may be three or four inches high, needling depth is only about one cun. Since the tissue is already necrotic, why would it hurt? Why worry about damage? Weak individuals with osteomyelitis (Fu Gu Ju) waiting for spontaneous drainage often suffer massive ulceration, failure to heal, exhaustion of qi and blood, and death. (This concerns acupuncture techniques.)

A man who neglected diet and lifestyle suddenly developed red, swollen, painful head with a surging rapid chi pulse. Huanglian Xiaodu San for two doses cleared damp-heat. Hard swelling and pain remained. Xianfang Huoming Yin for two doses resolved swelling and pain. However, the sore head persisted. Shixuan San minus Gui Zhi, plus Jin Yin Hua, Gao Ben, Bai Zhu, Fu Ling, and Chen Pi was given to support interior and drain pus. Desiring complete resolution, the patient self-prescribed Huanglian Xiaodu San for two doses, causing re-hardening and lack of pus formation. Realizing his error, he returned to Shixuan San plus Bai Zhu, Fu Ling, and Ban Xia. Swelling subsided slightly. Gui Zhi was removed, and after four more doses, pus formed and subsided. Bajen San plus Huang Qi, Wu Wei Zi, and Mai Dong was given for over a month until pus drained and he recovered. Bitter-cold herbs treat yang patterns but require differentiation of exterior/interior and deficiency/excess, applied sequentially and appropriately. Can they be used throughout? Red, swollen, painful presentation with a rapid chi pulse that feels soft upon pressure indicates damp-heat stagnation in the bladder meridian, hence Huanglian Xiaodu San was used to detoxify and remove dampness. Hard swelling and pain indicate qi and blood stagnation, hence Xianfang Huoming Yin was used to dissipate nodules, detoxify, and break blood stasis. The persistent sore head was due to heat-toxin steaming and qi/blood stagnation, requiring sweet-warm herbs to tonify yang qi, support interior, and promote suppuration. This condition originally arose from yin deficiency and fire excess in the Du meridian. Without investigating the cause and using only bitter-cold herbs, stomach qi weakens, hindering suppuration and healing, leading to failure. Sores that easily dissipate, suppurate, and heal are due to strong qi and blood.

Madam Wang, Grand Secretary's mother, over eighty years old, had an ulcerated brain carbuncle followed by a back carbuncle, sized like millet grains. Pulse was large and weak, indicating damp-heat in the bladder meridian. Weak pulse indicates qi and blood decline. Tuoli Xiaodu medicines were given for several doses, providing slight relief. Ginseng and Astragalus were added. Although she rose, she became thirsty. This indicated severe qi and blood deficiency. Ren Shen (Ginseng) and Huang Qi (Astragalus) 1 liang each, Dang Gui (Angelica) and Shu Di (Prepared Rehmannia) 5 qian each, Mai Dong and Wu Wei Zi 1 qian each were given for several doses. Thirst stopped, but no ulceration. Rou Gui (Cinnamon Bark) was added to the previous formula. After ten-plus doses, pus formed and was needled. Necrotic tissue gradually rotted and was removed. Pus remained clear and failed to heal. Large doses of Shi Quan Da Bu Tang plus Bai Lian, Bei Mu, and Yuan Zhi were given for thirty-plus doses. Pus became thick, and she recovered. Patients with robust constitutions or phlegm often refuse tonics, unaware that profuse pus and blood loss lead to dual qi and blood deficiency, necessitating tonification. In treating sores, I use Yin-style major tonics (Ginseng, Astragalus) and Yang-style detoxifying formulas together. They do not cause fullness and are effective. For severe deficiency, Ginger, Cinnamon, and Aconite are added.

A man presented with a high, painful brain carbuncle. Topical application stopped pain but darkened the color. Pain outside the swelling persisted despite topical application, and flesh color turned dark. Throat flesh was neither painful nor swollen. This was a mistake caused by cooling herbs. Applying them over the entire neck led to widespread ulceration and death.

Zhu Danxi treated Du Qingbi, a Daoist scholar from Wuyi, who developed a brain carbuncle in Wuyuan and failed to heal himself. Zhu visited and asked, "Why not take Fangfeng Tongsheng San?" Du replied, "I have taken it several times." Zhu said, "Why not process it with wine?" Du understood, took the modified preparation, and recovered before finishing the dose. He thereafter deeply respected Danxi. (*Xu Yi Shuo*.)

Dou Cai treated a man with a brain carbuncle, critically ill on the sixth day, unable to eat. Dou said, "Advanced age, kidney deficiency, pathogenic qi stagnating in meridians." He prescribed Jiusheng Tang. Symptoms halved immediately. A second dose at night brought complete recovery.

An elderly woman presented with pain behind the ear and muscle spasms. Dou said, "This is about to become a brain carbuncle." Urgently prescribe Jiusheng Tang. Three doses led to complete recovery.