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[Pulse]
The pulse is rapid (Shu), yet the body has no fever; this indicates an internal carbuncle or abscess (Yong). A rapid pulse typically warrants fever, but if there is aversion to cold instead, and a painful area exists, a carbuncle or abscess is likely to develop. If the pulse is rapid and deficient, with coughing and expectoration of saliva and foam, it is Lung Abscess (Fei Wei); if the pulse is rapid and excess, or slippery, with dull pain in the chest upon coughing, it is Lung Carbuncle (Fei Yong). If the pulse is tight and rapid, pus has not yet formed; if the tightness disappears leaving only rapidity, pus has formed. If the pulse is slippery and rapid, with hardness and fullness in the lower abdomen, and urination being either obstructed or accompanied by sweating or aversion to cold, it is Intestinal Carbuncle (Chang Yong). If the pulse is slow and tight, indicating a collection of blood stasis, evacuating blood leads to recovery; if the pulse is surging and rapid, pus has formed. In intestinal carbuncles, a slippery pulse indicates excess, and a rapid pulse indicates heat. When Wei Qi descends rapidly and Ying Qi rises smoothly, they interfere with each other, causing blood to become turbid and敗坏; this is all due to damp-heat.

Sites of death: Futu (ST32), calf muscles, back, Back-Shu points of the five zang organs, upper neck, head, chin, temples, and jaw.

[Etiology]
Fire toxin and qi stagnation toxin emerge from deficiency; this implies that pathogens penetrate first at weak points. The master uses purely tonifying methods. This is because fire toxins from rich foods and qi stagnation blockages congest the meridians, potentially drawing in phlegm-fluids. Blood becomes stagnant, and qi becomes chaotic. After accumulation, these exit through the meridians from deficient areas. Yin stagnating in Yang causes carbuncles (Yong); Yang stagnating in Yin causes gangrenous sores (Ju). When qi stagnates and郁结s, body fluids become thick and sticky, forming phlegm and fluid retention, which eventually seep into the lungs, making blood turbid; this is yin stagnating in yang. When blood is constrained by pathogens, channels are blocked, phlegm accumulates over time, leaks out of vessels, and qi becomes chaotic; this is yang stagnating in yin.

Lung Abscess (Fei Wei) involves heat in the Upper Jiao. Lung Carbuncle (Fei Yong) results from wind injuring the Wei level and heat overwhelming the Ying level, causing blood coagulation and stagnation to form a carbuncle. Scrotal Carbuncle (Nang Yong) is caused by damp-heat pouring downward. Some cases suppurate because turbid qi moves downward toward the urinary tract, due to yin deficiency and poor water passage. Peace returns only when pus is exhausted. Bone Gangrene (Gu Ju) arises from consuming rich foods and wading in water after drinking alcohol, allowing heat pathogens to deeply enter around the Bitshu acupoint, where old phlegm and blood collide to form the lesion. Internal Gangrene (Nei Ju) is caused by fire from diet and seven emotions郁结and erupting within the thoracic cavity towards the interior, not in the intestines, stomach, or Hui-Mo. Because it cannot be seen externally, it is named "Internal."

[Symptoms]
Lung Abscess (Fei Wei): Excessive saliva and sputum, difficult and frequent urination, stool resembling pig brain, desire to cough but inability to do so, dry frothy sputum, blood in saliva, shortness of breath and chest fullness, or dryness and thirst. The cunkou pulse is rapid and deficient, rough on pressure.

Lung Carbuncle (Fei Yong): Cough with reversed qi flow, expectoration of turbid matter like porridge, pus and blood, dull chest pain. Also coughing up pus and blood, dry mouth, or wheezing and fullness without thirst, foul-smelling sputum, frequent chills. The cunkou pulse is rapid and excess, slippery on pressure.

Intestinal Carbuncle (Chang Yong): Heaviness in the lower abdomen, pain upon firm pressure, hardness and fullness like swelling, frequent urination resembling strangury or obstruction, spontaneous sweating, and aversion to cold. Also, skin rough as fish scales, tense abdominal wall, soft upon pressure like swelling, abdomen feeling like a mass, pain upon pressure resembling strangury, but normal urination. Severe cases show abdominal distension, sound of water when turning, ulcers around the umbilicus, or pus discharging from the navel.

Back Carbuncle: Rapid pulse, no fever but aversion to cold, pain in the back indicating carbuncle development.

Bone Gangrene (Fu Gu Ju) resembles White Tiger Disease (Bai Hu), Flying Corpse Disease (Fei Shi), and Lijie Disease. Lijie features wandering pain; Bai Hu and Fei Shi have superficial pain relieved by pressure and can suppurate; Fu Gu Ju attaches to bone, has deep pain, and pressure is ineffective.

[Treatment]
The method should tonify qi and blood, purge fire, and dissipate qi. At the initial stage, clear heat and extract toxicity; once ulcerated, extract toxicity and tonify qi. Adjust based on the amount of qi and blood in specific meridians; for example, the Shaoyang meridian has little blood and much qi, so tonification is suitable.

Qianjin Neituo San: The name "Neituo" implies filling qi so that pus is pushed out.
Qianghuo, Duhuo, Bencao (each 1.5 qian), Fangfeng (body tip), Danggui Shao (each 0.5 qian), Danggui Shen (4 qian), Lianqiao (3 qian), Huangqin (wine-fried), Huangqi, Renshen, Gancao (each 1.5 qian, raw Gancao 0.5 qian), Chenpi, Sumu, Wuweizi (each 0.5 qian), Huangbai (wine-fried), Zhimu (wine-fried), Shengdi (wine-processed), Huanglian (wine-processed, each 1.5 qian), Hanfangji (wine-processed), Jiegeng (each 0.5 qian), Shanzhi (2 qian), Zhuling (2 qian, peeled), Maidong (2 qian, heart removed), Dahuang (wine-processed, 3 qian).
Prepare as two doses for decoction.

Verified Formula: A 70-year-old woman, fond of wine, robust and irritable, developed a carbuncle on the head. Pulse was urgent and rough. Jinwen Dahuang (wine-fried), Renshen (wine-cooked), 1 qian each, decocted with ginger juice.

Verified Formula: A 50-year-old man, robust and dark-skinned, had red swelling on the back with severe pain near the bone. Pulse was floating, rapid, surging, and tight. Severe vomiting occurred in winter.
Mahuang, Guizhi (used in winter), Sheng Fuzi (use if pulse is tight), Huangbai (wine-fried), Gualou, Gancao Jie, Qianghuo, Qingpi, Banxia, Renshen, Huangqi.
Decoct with ginger juice.

Verified Formula: Treats all initial sores, boils, carbuncles, gangrenes, and back carbuncles with great effect. Also expels dead blood.
Dahuang, Gancao, Chensha, Xuejie.
Take with wine.

Jiedu Dan: Treats all back carbuncles, carbuncles, gangrenes, and mineral/toxin poisons.
Large purple-backed chea clam, sealed with salt mud, fired red to remove fire toxicity, formed into pills with Gancao paste, taken with Gancao soup. For foul discharge, use Hanshuishi fired red, soaked in a well, mixed with lard from the twelfth lunar month, and applied.

Another formula: Use Qingfen and Dengcao as adjuvants to reduce swelling and detoxify; mild cases may be treated with beating.

Qingliang Gao: Treats back carbuncles.
Danggui, Baizhi, Mubie Rou, Baiji, Bailian (each 1 liang), Ruxiang (powdered), Nifen (small amount), Baijiao (small amount), Huangdan (5 liang), Mahuang (7 liang).
Decoct the first six ingredients until purple, remove residue, add Huai and Liu branches (7 cun each), decoct again, add Huangdan, and mix with other powders before use.

Sansheng San: Treats diffuse swelling adhering to bone with a shiny surface, effective as magic.
Lufengfang, Chantui, Hair (equal parts).
Burn to ash preserving nature, 3 qian, powder fine, take with wine.

Previously used Wuhui Gao, applied overnight. After foul flesh rotted, removed completely with a knife. Soak brocade in sesame oil, wring dry, and cover. Wait for healthy flesh to grow like rock merging, then apply Longgu, Bailian, Ruxiang, Mumyue etc. to close the wound.

For internal gangrene, use Siwu Tang with modifications. A person with a quick temper and rich diet had pain under the rib. Taking hot/dry medicines resulted in a string-taut pulse on light pressure and a hollow pulse on heavy pressure, indicating pus. Treated as internal gangrene.
Gancao, Ganjiang, Renshen. Treats Lung Abscess (Fei Wei).
Gancao (4 liang), Ganjiang (2 liang), Renshen (1 liang), Dazao (3 pieces).
Decoct and take.

Xiao Qinglong Tang: Treats Lung Carbuncle (Fei Yong) by first releasing exterior pathogens; this is a method for treating un-ulcerated masses.

Tingli Dazao Xiefei Tang: Treats carbuncles/gangrene with wheezing preventing lying down.
Fried Tinglizi powder, pill-sized. Water 3 sheng, boil dates in 2 sheng, remove dates, add Tinglizi, boil to 1 sheng, take at once. Take Xiao Qinglong Tang three doses first, then this.

Jiegeng Tang: Treats cough with chest fullness, sputum like rice porridge, expecting pus and blood.
Gancao, Jiegeng (each 1 liang).

Weijing Tang: Treats cough with slight fever and rough chest skin; this is a method for treating ulcerated lesions.
Weijing (2 sheng cut), Gualou Ren, Yiyiren (each 0.5 jin), Taoren (50, peeled and crushed).
Decoct and take. Another method: decoct Gualou with pulp.

Yiyi Fuzi Baijiang San: Treats intestinal carbuncle with rough skin, tense/abdominal distension, no prior mass, no fever, rapid pulse.
Pao Fuzi, Baijiangcao (each 2 qian), Yiyiren (10 grains).
Decoct in water.

Dahuang Mudan Tang: Treats intestinal carbuncle in the lower abdomen, or left/right of bladder, palm-sized, hot, normal urination, spontaneous sweating, slow/tight pulse. Purge if pus not formed; do not purge if pus formed.
Dahuang (4 liang), Mudanpi (3 liang), Mangxiao (2 liang), Gua Zi (1 piece), Taoren (50).
Decoct in water, take at once.

Yunmu Gao: If abdominal pain is incurable (100%), pulse is slippery/rapid. Abdomen slightly tight, pulse should be deep/thin, but now slippery/rapid. Use Yunmu Gao to purge. Pills size of wutong seeds. 100 pills, dissolve Ejiao in wine, take. Stop when pus/blood is evacuated.

Qingpi Danggui Tang (Mr. Li's Formula): Treats perineal carbuncle (Bian Yong).
Qingpi, Fangfeng, Danggui, Gancao Shao.
Decoct on empty stomach.

Taoren Chengqi Tang (Mr. Zhang's Formula): Treats perineal carbuncle (Bian Yong).

Verified Perineal Sore Formula: Huluba powder orally; Chuannan Lian ash is also good.

Bone Gangrene Formula: Qingpi, Huangbai, Guizhi (add in winter), Huangqin (add in summer), Niuxi (add if deficient), Gancao, Ginger juice, Mahuang (add if sweating fails).

Another: Fangfeng Tongsheng San, remove Xiaomiao and Dahuang, add Sheng Xijiao and Pingtong powder, treat bone gangrene.

Goiter (Ying) often occurs on shoulders/back. Hard and immobile is Stone Goiter (Shi Ying); unchanged skin color is Flesh Goiter (Rou Ying); visible tendons/nodes is Sinew Goiter (Jin Ying); intersecting red veins is Blood Goiter (Xue Ying); varies with emotion is Qi Goiter (Qi Ying).

Tumors follow qi condensation, categorized into bone, sinew, flesh, pus, and blood tumors.