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[Xue Ji] Master Zhang Zhongjing treated Shaoyang disease (Shaoyang disease, a syndrome caused by pathogenic factors affecting the Shaoyang channel) using three methods: sweating (sweating method), vomiting (vomiting method), and purging (purging method). Master Li Dongyuan treated sores and ulcers (sores and ulcers, external skin lesions) using three methods: unblocking and draining (unblocking and draining method), supporting the interior (supporting the interior method), and harmonizing Ying and Wei (harmonizing Ying and Wei method). When applied appropriately, the serious illness would be cured. For instance, if a sore or ulcer is swollen, hard, numb, and stifling, accompanied by irritability, heat, constipation, and a deep, forceful pulse, the pathogen is in the interior; one should first unblock the interior and use purging. If the swelling becomes painful, bowel movements and urination are regulated, and the pulse is floating and surging, the pathogen is in the exterior; one should first support the interior and use sweating. The *Yuan Rong* states: When Ying and Wei Qi are full and obstructed, causing an abscess, one should use draining to remove excessive heat; when Ying and Wei Qi are weak and stagnant, causing an abscess, one should use tonification to replenish deficient Qi. Furthermore, Master Li Dongyuan stated: Although a patient with a sore or ulcer may have a red face and latent heat, one must not attack the interior, as interior deficiency leads to diarrhea. Master Zhang Zhongjing stated: Although a patient with a sore or ulcer may have body pain, one must not induce sweating, as doing so will lead to tetanus (tetanus, characterized by muscle spasms). If one fails to examine carefully and recklessly uses sweating or purging, it will deplete Qi and Blood, causing the toxin to sink deeper. Young and strong individuals may fail to suppurate and heal, while the old and weak often die.

[Li Dongyuan] In sores, ulcers, and other diseases presenting with facial redness, although there is latent fire and heat, attacking the interior is prohibited because Yang Qi is constrained and the pathogen is in the channels; it is appropriate to release the exterior to eliminate it, hence the saying "when fire is constrained, release it." Even if stool has not passed for several days, one should focus on releasing the exterior, dispersing Yang Qi, and adding a small amount of moistening drugs to lubricate the intestines. If wind pulse or wind symptoms are present, only exterior-releasing wind-dispelling herbs are needed to facilitate bowel movement; if it is merely dryness and constipation, moistening is especially appropriate, and purgatives must strictly be avoided. Any condition involving dysfunction of the nine orifices should not be treated with purgatives. Coma induced by sores and ulcers (commonly called coma) must not be treated with purgatives; sweating therapy will cure it.

[Zhu Danxi] The *Jing Yao* states: Rhubarb (*Rhei Radix et Rhizoma*) is a key drug for treating carbuncles and malignant sores because it disseminates heat and extracts toxins. It also states: At the onset of a sore, one must use decoctions containing Rhubarb etc., to induce strong purgation, continuing daily without interruption. Later, Zhu himself remarked that patients with carbuncles and malignant sores often experience diarrhea, which is a bad omen; this raises doubts. Perhaps the previous use of Rhubarb was intended for patients with excess syndromes, fecal impaction, and accumulated deep heat; it could only break stagnation and guide it out, but certainly not to induce extreme purgation daily! If purgatives are given after diarrhea has already occurred, it contradicts the principle of preventing minor issues from becoming major ones. The initial stage of a sore corresponds to the "swollen ulcer" stage in the *Zhou Li*. If the swelling is in the muscles and does not present as fullness, excess, or hardness, one should naturally follow Zhang Zhongjing’s method of releasing the exterior, taking Wuxiang Tang (Five Fragrances Decoction) as an example, to disperse externally. Why rush to use harsh purgatives to attack the interior and invite disaster?
The *Jing Yao* states: Generally, carbuncles and malignant sores should not discard Wuxiang Tang. Regarding this, I must speak. As detailed in the first chapter. I do not know how many people in Liangfu’s time had such stubborn and severe fecal impaction and Qi stagnation that they could be suddenly dispersed and heavily purged? If such cases existed, the timing and appropriateness of the syndrome should have been clearly explained, so later generations would not dare to kill rashly. Some say: Using Rhubarb for carbuncles to drain and remove toxins was stated since Sun Simiao’s *Qianjin Fang*; Liangfu followed this theory, why do you criticize it so deeply? I reply: Rhubarb clears various excess heats and is harsh and urgent. Sun Simiao practiced his unique arts among nobles in the late Song Dynasty, when people were unfamiliar with war and socialized with wealthy meat-eaters, so quick effects were indeed common. Now, Liangfu uses it indiscriminately regardless of wealth, hardship, leisure, or labor. Could this not lead to rash harm? Moreover, those deficient due to sexual exhaustion, worry and anger, excessive greed, forced labor, or drunkenness overeating all suffer from weak Qi causing stagnation and scanty blood causing turbidity. Carbuncles are indeed difficult to treat; however, if the bowels are constipated but the patient can eat slightly and rest, abiding by dietary restrictions and accepting bland food, treatment is possible, though it requires tonifying efforts. If one assumes constipation for ten days or half a month indicates excess and uses Rhubarb, or attributes slight chills and fever to external contraction and uses diaphoretics without recognizing Qi non-descent or Qi-Blood disharmony, such practices harm people rapidly.

Zhang Zhongjing said: Although a patient with a sore has body pain, one must not sweat them, as sweating causes tetanus. (Note: Sweating refers to profuse sweating, not mild exterior dispersion via supporting interior herbs.)

[Zhu Danxi] Paining Neibu Shixuan San (Ten-Expanse Internal-Supplementing Pus-Draining Powder) can assist internal support when used for minor carbuncles or in winter. Used in winter for swollen ulcers, it can turn heavy conditions light and deep conditions superficial. However, if used for open ulcers or in summer, the warming and dispersing nature of Cinnamon Twig (*Cinnamomi Ramulus*) and Phellodendron Bark (*Phellodendri Cortex*), assisted by Saposhnikovia Root (*Saposhnikoviae Radix*) and Angelica Dahurica Root (*Angelicae Dahuricae Radix*), makes me fear that even with Ginseng (*Ginseng Radix*) and Astragalus Root (*Astragali Radix*), reliance is precarious. I have seen people using this formula regardless of season or meridian sequence, like a blind man riding a blind horse facing a deep pool at midnight—dangerous! Also, Paining Neibu Shixuan San contains too many herbs that drain Wei Qi and dry Blood; it is only suitable for mild cases. In severe deficiency, it cannot be relied upon.

The *Jing Yao* states: Neituo San, taken in large doses within one to three days, treats toxic qi attacking the zang-fu organs, named Huxin San (Heart-Protecting Powder). This formula is specifically for carbuncles caused by taking mineral pills (Dan Shi). If not caused by mineral pills, it may not be essential. For the elderly, those with deep disease, complete syndromes, or heavy bodies, although Mung Bean (*Vigna mungo*) is nourishing, there is a risk of failing to bear the burden.

[Zhu Danxi] External application is similar in intent to releasing the exterior. The Classics state: Releasing the exterior does not avoid heat. Generally, Qi disperses when warm and contracts when cold. I once treated Zheng Jingli, who loved alcohol and fried foods. In late spring/early summer, at age fifty-plus, a horn-like swelling appeared at Sizhukong (EX-HN4), hard like a chicken spur. I said: Is this not caused by rich food? Stop rich foods, resolve food toxicity. Acupuncture and moxibustion to open stagnation are not easy to treat; this is the Shaoyang channel, where Qi is abundant and Blood is scarce. Fearful of trouble, Zheng hired another doctor who applied cold herbs like Rhubarb, Mirabilite (*Natrii Sulfas*), and Borneol (*Borneolum Syntheticum*). Overnight, it burst open like a sauce clam, three inches in diameter. One or two days later, blood sprayed from the wound, reaching several feet high, and he died. This was caused by cold herbs forcing from outside, trapping heat internally, leading to violent eruption. Li Shiy ing said: Yin-type carbuncles are neither hot nor painful; cold applications must strictly be avoided to prevent forcing toxins inward.

[Xue Ji] The *Neijing* states: Disharmony of the five zang organs leads to blockage of the nine orifices; disharmony of the six fu organs leads to accumulation and formation of abscesses. It also states: Injury to form causes pain; injury to Qi causes swelling. Thus, it is clear that zang-fu disharmony manifests as external sores. Applying cold pastes cannot harmonize zang-fu or promote Qi and Blood circulation. If swelling, pain, heat, and thirst are present, with a slippery, rapid, and forceful pulse indicating pure Yang excess, one should internally use Jiyin Dan (Nourish-Yin Pill) and externally use Yiyang San (Benefit-Yang Powder); heat toxins will resolve, and stasis will dissipate. If swelling and pain are ambiguous, with a surging, rapid, but forceless pulse indicating half-Yang half-Yin, one should internally use Chonghe Tang (Harmonizing Decoction) and externally use Yinyang San (Yin-Yang Powder); Qi and Blood will harmonize, and stasis will消. If swelling and pain are slight, color is dark, hardness persists without suppuration, and the pulse is surging and large but fine, weak, and soft upon pressure, indicating pure Yin, one should internally use Guiyang Tang (Restore-Yang Decoction) and externally apply Yi Yin San (Suppress-Yin Powder); Spleen and Stomach will strengthen, and Yang Qi will return. Mr. Danxi said: Pastes are only for responding to mild, small heat syndromes. If one fails to distinguish between Yin and Yang syndromes and recklessly applies cold pastes, it blocks pores, stagnates Qi and Blood, causes toxins to attack inward, and leads to tissue necrosis. Furthermore, cold prevents healthy Qi movement, prevents blood stasis resolution, prevents necrotic tissue suppuration, and prevents new flesh growth. Practitioners must be cautious.

Lee Needle Method (Leeching Therapy): Claiming to open the gate to release toxins as a shortcut, this may only be suitable for mild cases. I believe leeches only suck evil blood from the skin surface. If toxins accumulate in the zang-fu, exhausting them externally without addressing the interior is inappropriate. I once saw Brother Zhang’s son, aged two, covered in red rashes like clouds. His mother had a long-term illness, which I attributed to heat-toxin in the blood. Zhang asked: Isn’t everyone formed by maternal blood? Why call it heat-toxin? I said: Although ill, she ate meat as usual. Meat is hot; combined with phlegm-heat, is it not toxic? Zhang did not believe me, took five or six leeches, and sucked the blood. Rashes vanished, feeding and activity resumed. I said: This is not proper treatment; do not rejoice. Zhang became angry. Two or three days later, the child developed high fever and died suddenly. Was this not due to exhausting externally, leaving Qi unable to stand alone?

Xue’s discussion is found in the preceding section on internal resolution.

[Xue Ji] Medication usage is like holding a balance scale; one must assess the severity of the disease, the location of pathogens (exterior/interior), the state of sores (swollen/suppurated), and the strength of Yuan Qi. Without investigating the cause and prescribing hastily, one risks exacerbating excess and depleting deficiency, leading to the "Seven Evils" disasters. Practitioners must be cautious. Wu Xiang, Sheng Yuanbo, suffered a carbuncle behind the palm with red streaks extending to the wrist, accompanied by aversion to cold and fever, indicating an exterior syndrome. One dose of Mingdan (Life-Saving Pill) cleared the red streaks immediately. A harmonizing formula reduced the main symptoms. However, he took detoxifying/purging herbs, leading to fever, dry mouth, and recurring red streaks with a floating, large, and empty pulse, indicating Qi and Blood injury. He was cured with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Mingdan and detoxifying herbs are extremely potent; using them after the pathogen has dispersed constitutes excessive attack, violating the *Neijing*. A scholar with inherent weak Qi was cured by tonifying Qi and Blood to promote suppuration. Later, itching at the scar site due to labor led him to take a dose of detoxifying herbs, resulting in trismus, stiff tongue, convulsions, upward rushing of phlegm-saliva, and spontaneous sweating—tetanus due to Qi and Blood injury. He revived after administering Shiquan Dabu Tang (Ten Complete Tonifying Decoction) with one qian of Aconite Root (*Aconiti Lateralis Radix Praeparata*). A man with a carbuncle took Mingdan, resulting in continuous sweating without sore pain, persistent fever without bowel movement. This indicated Yang loss from excessive sweating, with strong toxins injuring true Qi. Two doses of Ginseng (*Ginseng Radix*), Angelica Sinensis Root (*Angelicae Sinensis Radix*), Atractylodes Macrocephala Rhizome (*Atractylodis Macrocephalae Rhizoma*), Peony Root (*Paeoniae Radix Alba*), and Saposhnikovia Root resolved all symptoms except difficulty urinating. I said: After sweating, diuresis is contraindicated; once sweating stops and Yang recovers, urination will normalize. The same formula minus Saposhnikovia Root, plus Ophiopogon Tuber (*Ophiopogonis Tuber*), with doubled Angelica Sinensis Root and Astragalus Root (*Astragali Radix*), administered for four doses, resulted in normal urination, suppuration, and cure.

Li Dongyuan said: Eating meat for sores is self-abandonment. Sores arise from impaired Ying Qi; supplementing with meat is self-abandonment. Even with medication, it cannot be cured. The *Jing Yao* states: Lamb, chicken, beef, goose, fish, wheat noodles, fried/grilled foods, and alcohol will cause fever if consumed; Zhi Zi Huang Qin Tang (Gardenia and Scutellaria Decoction) is most effective. Danxi said: Gardenia, Scutellaria, Sophora Root (*Sophorae Flavescentis Radix*), and Rhinoceros Horn (*Rhinocerotis Cornu* - note: now substituted), assisted by Ginseng, can resolve food-toxin heat, but adjustments are necessary in winter or for deficient persons. The *Neijing* states: Changes from rich food give rise to large carbuncles, explaining the cause of sores. Avoiding rich flavors prevents reigniting latent heat, a caution for the wealthy. This does not apply to the poor. I treated a man with a back carbuncle one chi in diameter, deep and black. Poor, he was given a paste of Ginseng, Angelica, and Atractylodes, and fed wontons with plenty of meat, which stabilized him. Meat-filled wontons benefit Qi tonification.