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To treat erysipelas (Dan Du), carbuncle (Ding Chuang), with spreading red threads, or epidemic toxins, and excessive blood stasis, crush fine porcelain ware, select a piece with sharp edges. Hold it between the split tip of a chopstick, secure it tightly with thread. Pinch the end of the chopstick lightly with two fingers, aligning the porcelain shard precisely against the affected area, suspending it about one cun away. Then, use another chopstick to frequently tap the head of the first chopstick, causing toxic blood to drain out upon being pierced. If the toxin enters the abdomen causing distension and swelling, it is difficult to treat. Fermented Soybean Cake (method seen in the section on complicated symptoms and pain).

This refers to when a carbuncle or ulcer has already ruptured and pus is discharging. The *Ji Yan Fang* states: Once a carbuncle or ulcer has ruptured, with pus discharge and flesh decay, one should apply Antidote-Extracting Ointment. As the pathogenic factors gradually recede and Qi and Blood become deficient, the pulse, previously flooding and rapid, should gradually subside. One should internally administer tonifying and supporting therapies, ensuring that Qi and Blood are nourished and prospered, and righteous Qi becomes strong. The pus should be fresh and thick, and redness and swelling should gradually resolve. Medications should benefit Qi and generate Blood. In autumn and winter, slightly add herbs that ward off wind and cold; for example, using Cinnamon Twig (Guizhi) in Ten-Auspicious Powder (Shixuan San) or Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). For Qi stagnation, add Cyperi Rhizoma (Xiangfu). If the toxic force has largely subsided but Qi and Blood have not yet recovered, it is advisable to use formulas such as Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), and Four Substance Decoction (Sìwù Tāng). Although pus is visible in the carbuncle or ulcer, if the base shows expanding redness and halo, or if there is no pain or severe pain, this indicates that the toxic qi has not retreated. Use Silver-Gold and Angelica Dahurica Powder (Jinyin Baizhi San) or Ten-Auspicious Powder (Shixuan San), removing Magnolia Bark (Houpo) and Cinnamon Twig (Guizhi), doubling the dosage of Ginseng Radix (Renshen), Sichuan Angelica Root (Chuan Gui), and Astragali Radix (Huangqi), and adding Honeysuckle Stem (Ren Dong Teng), Forsythia Fruit (Lian Qiao), Rhinoceros Horn (Xi Jiao - note: substitute with Buffalo Horn in modern practice), and Trichosanthes Root (Gua Lou Gen) as detoxifying agents. In late spring, early summer, and early autumn, add Wine-fried Scutellaria Root (Jiu Huangqin), Coptis Rhizome (Huanglian), Phellodendron Bark (Huangbai), and Notopterygium Rhizome (Qianghuo); for conditions below the waist, remove Platycodon Root (Jiegeng). After pus appears, the primary treatment should focus on tonifying Qi and Blood, assisted by detoxifying herbs. If tonics are unsuitable, Honeysound Pill (Rendong Wan) is appropriate. On the swollen areas surrounding the wound, prick with a filiform needle heated until red to a depth of approximately one fen. If redness and swelling subside, and the pulse becomes harmonious and slow after medication, it is auspicious. If the wound fails to ulcerate after rupture and the opening is hard, it is due to Wind. Apply Centipede and Scorpion Powder (Wushe San). If necrotic tissue does not rot, apply Realgar (Xionghuang) and Calomel (Qingfen). It is strictly contraindicated if redness and swelling do not recede, or if food intake is low; in such cases, temporarily regulate the Spleen and Stomach. If other syndromes coexist, discuss medications separately. For necrotic tissue that is insensitive to pain and itch, appearing jet black, it can be removed, provided care is taken not to injure the healthy flesh at the periphery or the viable tissue inside. Only the external black necrotic tissue should be removed. Yellowish-white, cotton-like material within the pus should not be disturbed. Large amounts of pus will naturally detach the next day, sparing healthy tissue. If afraid of knife or lancet, detachment occurs naturally in three to four days. However, if removed by knife, new flesh grows easily, and toxic qi gradually dissipates. Necrotic tissue may have a slight foul odor, which disappears after removal. Gradually clean all surrounding necrotic tissue, then apply Flesh-Lengthening Ointment. Wash every other day with Pig Trotter Decoction. When new flesh grows like plums or pomegranate seeds—red, vibrant, and lovely—and rises in mound-like formations, or if a white membrane forms on top, these are auspicious signs. If, after necrotic tissue is removed, the underlying healthy flesh is white and flat, lacking texture, unable to resemble rice grains or millet, showing no sign of gradual regeneration, or if the pus is thin/clear or foul-smelling, this indicates accumulated toxins connecting internally to the Five Zang Organs, with exhaustion of Blood and Qi—a critical condition. If flesh cannot grow, Qi and Blood are not nourished, and Defensive Qi fails to protect the wound, Wind-Cold may invade. Use Northern Mugwort and Astragalus Decoction (Bei Ai Huang Tang) for fumigation and washing, apply Flesh-Generating and Lengthening Medicines, and paste with Frankincense Ointment (Ruxiang Gao) or Flesh-Lengthening Ointments. If flesh grows but appears purple, it indicates residual toxicity. Apply Sanguisorba Decoction (Diyu Tang) and Blood-Invigorating Powder (Huoxue San), and paste with Toxic-Chasing Ointment (Zuidu Gao). The wound will become red and vibrant, and the opening will gradually close; continue applying Flesh-Lengthening Ointment. If the wound itches, wash hotly with a decoction of fine tea, scallions, and salt. If the wound closes too easily, it may be due to heat-toxin in Qi and Blood; without dispersing it, even if flesh grows, there is a risk of metastatic abscesses (Liuzhu). If confusion occurs, and the wound shrinks to the size of a coin, fear transformation into other critical syndromes. Once the carbuncle or ulcer wound has closed, if the skin is tender, do not immediately remove ointments. The *Gui Yi Fang* states: Regarding Back Carbuncles (Fabei) and ulcers, all located on the back, regardless of size, painful or painless, hot or cold, if they grow from small to large, swelling up to over one chi, and are red, swollen, and hot, immediately encircle them with urgent Redness-Resolving and Swelling-Reducing Medicines to prevent spread toward the center. Apply Pus-Extracting and Toxin-Gathering Powder (Chounong Judu San) to urgently promote external dispersion of toxins. Internally administer Pus-Discharging and Toxin-Contracting, Internal-Supporting Decoctions. Wait for pus to mature, then sequentially incise. Assess the size and depth of the wound to express pus internally. With massive discharge of pus, urgently support the interior and tonify. Even if pus discharge is not abundant after incision, further pus-discharging and toxin-extracting measures are needed. After penetration, carefully prevent re-swelling. Pain must cease, swelling must subside, and the patient should feel light and comfortable; this is a favorable course. Dietary restraint is most essential. If heat-toxin is flourishing, causing extreme thirst, and the patient drinks much cold water or cold beverages, this indicates toxic qi attacking the Heart, causing dry mouth and vexatious thirst. Resolve this only with Heart-Qi tonifying herbs to internally nourish the Zang-Fu organs. (Internal tonification refers to herbs like Ginseng; pus-discharging refers to herbs like Gleditsia Spine.)

[Xue Ji] When pus is ripe but does not ulcerate, it is due to Yang Qi deficiency; tonify it, such as with Holy to Restore Life Decoction (Shengyu Tang). When necrotic tissue does not rot, greatly tonify Yang Qi, and additionally moxa with mulberry wood fire. When pus does not form, or does not ulcerate, it is Qi deficiency. Use Interior-Supporting and Detoxifying Powder (Tuoli Xiaodu San), removing Honeysuckle Flower (Jinyinhua), Angelica Dahurica Root (Baizhi), and Forsythia Fruit (Lian Qiao), adding Ginseng Radix (Renshen), Atractylodes Rhizome (Baizhu), and Cinnamon Bark (Rougui). If ineffective, temporarily use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). Swelling, redness, and pain indicate Blood stagnation; add Frankincense Resin (Ruxiang) and Myrrh (Moyao) to the original formula. If ineffective, temporarily use Immortal Formula to Activate Life Decoction (Xianfang Huoming Yin). Pain returning after pus discharge indicates Qi and Blood deficiency; remove the three aforementioned herbs, add Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shudi), and Paeoniae Radix Alba (Baishao). After ulceration, poor appetite, insomnia, or fever indicate deficiency; tonify it, such as with Internal-Tonifying Astragalus Decoction (Neibu Huangqi Tang). Fatigue, reluctance to speak, poor appetite, and insomnia indicate deficiency; tonify it, such as with Astragalus and Ginseng Decoction (Huangqi Renshen Tang). Cold Qi invading the wound, preventing closure or causing sinking without closure, requires warming and tonifying; use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). A large, powerless, or choppy and faint pulse, with delayed muscle growth, indicates dual deficiency of Qi and Blood; strongly tonify with Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang), doubling the dosage of Ginseng Radix (Renshen). Red flesh that does not close indicates Blood deficiency with Heat; use Interior-Supporting and Detoxifying Powder (Tuoli Xiaodu San), removing the three herbs, adding Prepared Rehmannia Root (Shudihuang) and Moutan Cortex (Danpi). Dark flesh that does not close indicates Yang Qi deficiency and Cold; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Ampelopsis Radix (Bailian), and Official Cinnamon Bark (Guangui). Diffuse swelling without pain, or dead flesh failing to ulcerate, indicates Spleen Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen) and Atractylodes Rhizome (Baizhu). If ineffective, add Ginger (Shengjiang) and Cinnamon (Rougui). If still ineffective, urgently add Aconite Root (Fuzi). White flesh that does not close indicates Yang Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodes Rhizome (Baizhu). Excessive pus and failure to close indicate Qi and Blood deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Atractylodes Rhizome (Baizhu), and Prepared Rehmannia Root (Shudihuang). If ineffective, temporarily use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). Lack of desire to eat and failure to close indicates Stomach Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen). If ineffective, temporarily use Tonify the Middle and Augment the Qi Decoction (Buzhong Yiqi Tang). Difficulty digesting food and failure to close indicates Spleen Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen) and Atractylodes Rhizome (Baizhu). If ineffective, temporarily use Six Gentlemen Decoction (Liu Junzi Tang). If still ineffective, assist with Eight-Ingredient Pill (Bawei Wan). Excessive pus with blood streaks indicates Blood deficiency; use the previous formula, removing the three herbs, adding Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shudi), Ginseng Radix (Renshen), and Atractylodes Rhizome (Baizhu). If ineffective, temporarily use Eight Treasures Decoction (Bazhen Tang) plus Moutan Cortex (Danpi). (Bleeding, pain, fever, etc., are discussed in separate sections below.)