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The treatment of sores and ulcers was traditionally divided into five favorable signs (Wu Shan) and seven unfavorable signs (Qi E).
1. Calmness in movement and rest, and having an appetite with the ability to taste food is the first favorable sign.
2. Regular and harmonious bowel movements and urination is the second favorable sign.
3. Clear pus, reduction of swelling, and absence of foul odor is the third favorable sign.
4. Bright spirit and clear eyes, and a crisp voice is the fourth favorable sign.
5. Harmonious physical constitution and balanced Qi is the fifth favorable sign.

1. Restlessness, frequent coughing, abdominal pain, extreme thirst, or uncontrolled diarrhea, and dysuria resembling strangury is the first unfavorable sign.
2. Profuse discharge of pus and blood, worsening swelling, foul-smelling and putrid pus, and severe pain that cannot be touched is the second unfavorable sign.
3. Rough breathing, shortness of breath, mental confusion, and lethargy/somnolence is the third unfavorable sign.
4. Abnormal gaze, tight and small black pupils, blue-red sclera, and upward deviation of the pupils is the fourth unfavorable sign.
5. Inconvenience in the shoulders and back, and heaviness in the four limbs is the fifth unfavorable sign.
6. Inability to eat, vomiting after taking medicine, and loss of taste for food is the sixth unfavorable sign.
7. Hoarseness, deterioration of complexion, blue-red nose, and edema of the face, eyes, and four limbs is the seventh unfavorable sign.

If three of the five favorable signs appear, the prognosis is good; if four of the seven unfavorable signs appear, the condition is critical.
Mr. Xue stated: The three favorable signs belong to Fu-organ syndromes, where the pathogenic factor is mild and superficial. If one can be careful with daily life and regulate diet, self-healing may occur without medication.
Unfavorable signs are syndromes of deficiency in the Five Zang organs, often caused by weak Yuan Qi; or due to excessive loss of pus and water leading to Qi and Blood deficiency; or due to improper use of sweating or purging methods, causing consumption of Ying and Wei Qi; or due to the use of cold-cooling drugs attacking healthy Qi, resulting in insufficient Qi and Blood; or due to harsh and drastic medicines injuring Stomach Qi, leading to deficiency of True Qi and excess of Pathogenic Qi. Externally it appears as excess, but internally it is truly deficient. The treatment method should focus purely on tonifying Stomach Qi, and there is often hope for survival. One should not abandon treatment simply because it is an unfavorable sign.

If there is extreme thirst and fever, or diarrhea and urinary retention/dysuria, this is the first unfavorable sign caused by internal proliferation of Evil Fire. Use Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction).
If both Qi and Blood are deficient, use Bazhen Tang (Eight Treasure Decoction) added with Huangqi (Astragali Radix), Maimen (Ophiopogonis Radix), Wuwei (Schisandrae Fructus), and Shanzhuyu (Corni Fructus). If ineffective, assist with Jiaban Bawei Wan (Modified Eight-Ingredient Pill) decoction.
If pus and blood have been discharged but swelling and pain are worse, and the pus color is putrid and foul, this is the second unfavorable sign of Stomach Qi deficiency and flourishing Fire. Use Renshen Huangqi Tang (Ginseng and Astragalus Decoction). If ineffective, use Shiquan Dabu Tang (Ten Complete Tonifying Decoction) added with Maimen and Wuwei.
If the gaze is abnormal, pupils are tight and small, sclera is blue-red, and pupils look upward, this is the third unfavorable sign of Liver and Kidney Yin deficiency causing tension in the eye meridians. Use Liujunzi Wan (Six Gentlemen Pill) ingredients added with Chao Shanzhi (Fried Gardenia Fruit), Maimen, and Wuwei. If ineffective, use Bazhen Tang added with Chao Shanzhi, Maimen, and Wuwei.
If there is rough breathing, shortness of breath, mental confusion, and somnolence, this is the fourth unfavorable sign of Spleen and Lung deficiency fire. Use Liujunzi Tang (Six Gentlemen Decoction) added with Dazao (Jujubae Fructus) and Shengjiang (Zingiberis Rhizoma Recens). If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maimen and Wuwei. If Heart Fire attacks Lung Metal, use Renshen Pingfei San (Ginseng Lung-Pacifying Powder). If Yin Fire injures the Lung, use Liujunzi Wan added with Wuweizi (Schisandrae Fructus) decoction.
If shoulders and back are stiff and limbs are heavy, this is the fifth unfavorable sign of Spleen and Kidney depletion. Use Buzhong Yiqi Tang added with Shanzhuyu, Shanyao (Dioscoreae Rhizoma), and Wuwei. If ineffective, use Shiquan Dabu Tang added with Shanzhuyu, Shanyao, and Wuwei.
If unable to eat, vomiting after medication, and loss of taste, this is the sixth unfavorable sign of Stomach Qi weakness. Use Liujunzi Tang added with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus). If ineffective, urgently add Fuzi (Aconiti Lateralis Radix Praeparata).
If hoarse voice, deteriorated complexion, blue-red lips and nose, and edema of face, eyes, and limbs, this is the seventh unfavorable sign of combined Spleen and Lung deficiency. Use Buzhong Yiqi Tang added with Dazao and Shengjiang. If ineffective, use Liujunzi Tang added with Paojiang (Zingiberis Rhizoma Preparatus). If still ineffective, urgently add Fuzi, or use Shiquan Dabu Tang added with Fuzi and Paojiang.
If abdominal pain, diarrhea, retching, and coma/confusion occur, this is an unfavorable sign of Yang Qi deficiency with internal invasion of Cold Qi. Urgently use Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction). Afterwards, use Liujunzi Tang added with Fuzi, or add Jiang (Ginger) and Guirou (Cinnamomi Ramulus) for warming and tonification. This covers the treatment methods for the seven unfavorable signs.

Furthermore, after ulceration, there may be fever with aversion to cold and thirst; or palpitations and fright, restless sleep and wakefulness; or lockjaw; or red and painful head and eyes, spontaneous and night sweats, chattering teeth with cold shivers, flaccid hands with body heat, and a洪大 (Surging-Large) pulse that feels empty upon pressure; or body heat with aversion to clothing, desire to throw oneself into water, yet the pulse is floating and large but fine upon pressure, and feeling cold even under thick clothes. These are unfavorable signs of transformation due to extreme deficiency of Blood and Qi.
If there is cold reversal in the four extremities, abdominal pain, diarrhea with borborygmus, inability to keep fluids down, hiccupping, and vomiting, this is an unfavorable sign of Yang Qi deficiency with invasion of Cold Qi.
If there is sweating without aversion to cold, or no sweating with aversion to cold, lockjaw, cold feet, opisthotonos (arching of the back), and neck stiffness, this is an unfavorable sign of transformation into Spasm due to extreme deficiency of Blood and Qi. Urgently treat with Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuzi to rescue; occasionally, survival is possible.
Generally, unfavorable signs appearing in deficiency patterns are difficult to treat, while excess patterns without unfavorable prognostic signs are easy to treat. In the Song Dynasty, Qi Yuanling compiled the symptoms but did not fully explain the causes. In our dynasty, Tao Jie'an established formulas for each, but they were brief and incomplete. Therefore, I have supplemented these deficiencies.