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A male patient, after the ulceration of a sore, experienced aversion to cold. He was treated with Sijunzi Tang (Four Gentlemen Decoction), with Guizhi (Cinnamon Twig) added, and Huangqi (Astragalus Root) doubled in dosage, administered in a large decoction. After four doses, the symptom ceased. There was still much pus and fluid, so Bazhen Tang (Eight Treasures Decoction) was administered with several doses of Guizhi (Cinnamon Twig), after which the discharge gradually decreased. Only the wound failed to close. A moxa cone made of Fuzi (Prepared Aconite Root) cake was applied, and Shiquan Dabu Tang (Ten Significant Tonifying Decoction) was taken, with five fen of Pao Fuzi (Prepared Aconite Root) added to each dose. After several doses, Fuzi was removed, and he continued taking medicine for over a month until he recovered.

Another male patient, after ulceration, feared cold, and his pulse was deficient. He was treated with Sijunzi Tang (Four Gentlemen Decoction) plus Pao Jiang (Prepared Ginger Rhizome). After four doses, he recovered, and subsequently took Shiquan Dabu Tang (Ten Significant Tonifying Decoction) for over a month until the wound healed. Zhang Zhongjing said: "A deficient pulse indicates blood deficiency." Blood deficiency generates cold; this is insufficient Yang Qi. For sores and swellings with a deficient pulse, one should employ the interior-supporting method to harmonize and nourish the blood. Truly so!

Danxi treated an elderly man, aged seventy (see the section on vomiting as a concomitant symptom). Wuxiang Baizhu San (Five-Aromatic Atractylodes Powder) broadens and harmonizes Qi, nourishes the Spleen Earth, generates Lung Metal, and promotes appetite. (The formula is found in the Internal Abscess section, under Lung Abscess.)

[Dan] Wuxiang Tang is essentially Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction), with Shegan (Belamcanda Rhizome), Dahuang (Rhubarb Root), Shengma (Cimicifuga Rhizome), and Liaoqiao (Forsythia Fruit) removed, and Renshen (Ginseng Root) and Xijiao (Rhinoceros Horn) added. If used for a swelling (undecayed sore), its penetrating nature can still be borrowed to attack and disperse toxicity, preventing it from spreading. However, if used for an ulcer (decayed sore), although there is much slow tonification from Renshen (Ginseng Root) and Gancao (Licorice Root), the dispersing action is too excessive. Does this not violate Zhongjing's warning against "sweating again after sweating has occurred, or purging again after purging has occurred," which leads to severe deficiency? One must awaken to this truth.

*Jingyao* states: "Qi and Blood move freely upon smelling fragrance but reverse upon smelling foul odors." It also says: "Diet should be regulated to be fragrant and delicious to benefit Spleen Earth and nourish True Qi." Sweet and bland substances can nourish Spleen Earth, but so-called fragrant and delicious foods only generate fire. The Classics warn against "heat injuring the Spleen and heat injuring Qi." Now, saying it benefits the Spleen and nourishes Qi seems reasonable when applied to patients with swellings, as it may facilitate circulation. But applying fragrant and delicious foods after ulceration may cause damp-heat to arise and damage True Yin.

*Jingyao* states: "When heat is abundant and the pulse is rapid, administer Loulu Tang (Euphorbia Decoction) or decoct Dahuang (Rhubarb Root) alone. When heat is not severe and the pulse is slow and weak, administer only Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction)." If heat is abundant and the pulse is rapid during the swelling stage, and the Zang-Fu organs are blocked while the constitution is excess, Dahuang (Rhubarb Root) may still be given. However, after ulceration, with significant loss of pus and blood, if heat is abundant and the pulse is rapid, death is near; how can purgatives be used? An ancient view holds that a slow and weak pulse indicates the dissipation of pathogenic toxins; thus, the penetrating and ascending nature of Wuxiang Tang (Five-Aromatic Decoction) should not be used.

*Jingyao* states: "When pus is initially formed, cauterization is appropriate; effective results are seen when pus drains freely. Also, Shenxian Zhuidu Wan (Immortal Poison-Expelling Pill) can be taken." This raises doubts. Zhuidu Wan (Poison-Expelling Pill) works by purging to accumulate and expel internal toxins; it certainly does not promote pus drainage. Now, using cauterization to obtain pus: if the internal Qi and Blood are strong, pus will naturally emerge as if pushed out. Why not use herbs that harmonize Qi and invigorate Blood, assisted by tonics like Renshen (Ginseng Root) and Huangqi (Astragalus Root), to naturally support the expulsion of pus?

*Jingyao* states: "If a sore causes severe thirst, urgently administer Shenxian Zhuidu Wan (Immortal Poison-Expelling Pill) to purge evil toxins. Qingdan Tang (Clear Diaphragm Decoction), Wanjin San (Myriad Gold Powder), Wuxiang Liaoqiao Tang (Five-Aromatic Forsythia Decoction), Liuwei Che'ao San (Six-Clam Powder), and Qianjin Loulu Tang (Thousand-Gold Euphorbia Decoction) can all be selected." After purgation, if thirst persists, fluids-generating and Qi-tonifying medicines should be used. Then fluids will be generated, Qi and Blood will be complete, and thirst will cease. Giving purgatives for severe thirst without clearly indicating the pulse and symptoms—how can one know purgation is indicated? Later, it says after purgation, if thirst continues, tonics are used, yet without specifying pulse and symptoms. It seems to imply that severe thirst always requires harsh purgation, and tonics are only considered if thirst persists after purgation. Is this appropriate for a physician treating disease before it arises? Moreover, thirst belongs to the Upper Jiao. It might be usable during the swelling stage, but if thirst occurs during ulceration, it is likely due to Qi and Blood deficiency. Why wait until after purgation to discuss deficiency?

*Jingyao* discusses Ju diseases (deep-seated abscesses), where sores appear in the throat, mouth, and tongue, attributing them to the failure of interior support, leading to toxic heat rushing to the Heart, and prescribes Hupo Xijiao Gao (Amber and Rhinoceros Horn Paste). Using this during the swelling stage might be somewhat logical, but using it after ulceration: won't the ascending and dispersing nature of Xijiao (Rinoceros Horn) and Naozi (Borneol) assist the pathogen and cause deficiency, thereby hastening death? Later, there is Xijiao San (Rhinoceros Horn Powder), which uses Dahuang (Rhubarb Root) to assist Huangqi (Astragalus Root). Using Huangqi (Astragalus Root) indicates deficiency, but using Dahuang (Rhubarb Root) suggests suspicion of excess heat. With an ulcerated sore and a deficient body, even old heat will gradually dissipate with the discharge of pus and blood. Why use harsh cold purgatives to disturb the Zang-Fu organs? Using them in autumn or winter is akin to using swords and knives to harm people.

*Jingyao* discusses Yongju (boils and carbuncles) presenting with chills, fever, and profuse sweating, or alternating chills and fever, occurring daily or every other day. There is often vomiting of phlegm before the chills and fever appear. After the chills and fever resolve, profuse sweating occurs. This cannot be solely attributed to heat; it can also result from Qi deficiency, anger, or initial exposure to cold pathogens causing improper Spleen Qi function. For Qi deficiency, tonify with Qi-tonifying herbs. For cases caused by anger, harmonize with Qi-regulating herbs. For improper Spleen Qi function, nourish with Spleen-regulating herbs. Now, using Buhuanjin Zhengqi San (Golden-Exchange Upright Qi Powder), which consists entirely of warming and dispersing herbs that leak Wei Qi, hoping that one or two qian of Renshen (Ginseng Root) can counteract the leakage of fourteen liang of Wei Qi—is this feasible? If used for cold-pathogen invasion during the swelling stage, it might be acceptable. But can this formula treat Qi deficiency, anger-induced cases, and Spleen dysfunction simultaneously? Furthermore, it is unknown whether this applies to swelling or ulceration.

*Guiyi* states: "When there is a hole in an acupoint, guard against wind carefully, and still prevent re-closure. If it re-closes, Wind-Dampness pathogens will attack and generate pus again. Treat as before with Tonghe Tang (Harmonizing Decoction), following the sequence step-by-step. Do not act hastily, lest you injure Qi and endanger life." *Sanyin* states: "For unhealed sores, Wind invasion causes Broken-Wind Trauma (Tetanus); Dampness invasion causes Broken-Water Trauma. These two are most urgent in harming people. In haste, without knowing the cause, recognition and treatment are very difficult. For Yongju (boils/carbuncles) and Luoli (scrofula), caution is especially required after ulceration."