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The *Ling Shu* states: When it occurs on the shoulder and axilla, it is called Ci Yong (Cicada Abscess). Its presentation involves redness and blackness of the affected area, requiring urgent treatment. This condition causes sweating extending to the feet but does not harm the Five Zang Organs. If the abscess has been present for four or five days and presents with Ni Zheng (Rebellious Signs), the prognosis is poor.

The *Gui Yi Ji* states: Ding Ju (Ding Carbuncle) occurring on both shoulders is caused by evil blood stagnating and knotting internally and externally, leading to obstruction of Ying Wei (Defensive and Nutritive Qi), resulting in the formation of Ding Ju. After five days, swelling increases, causing trismus (lockjaw) and chills. Acupuncture may be performed on the twelfth day. Without treatment, death will occur within twenty days.

Chen records: Gan Ju (Dry Carbuncle) presenting with swelling originates on both shoulders and upper arms, connecting to the scapula. If pain persists without cessation after fourteen days, it must not be manipulated. After fifty days, if there is body heat but local redness is absent, acupuncture may be performed on the sixtieth day. Death ensues if no blood flows upon puncture.

A question was raised: "What about carbuncles arising on the shoulder?" The answer is: This location is where the Hand and Foot Yang Meridians intersect, known as Jian Ju (Shoulder Carbuncle). It is caused by the stagnation and knotting of Wind-Heat, or by injury from carrying heavy loads. Treat with Wu Jin San (Black Gold Powder), Sheng Jin Dan (Victory Golden Pill), or Xian Fang Huo Ming Yin (Immortal Life Decoction), adding Chai Hu (Bupleurum Root) and Jie Geng (Platycodon Root). For those with robust constitution, use Yi Li Jin Dan (One-Pill Golden Pill) to purge; for the elderly or weak, use Shi Quan Da Bu Tang (Decoction for Ten Complete Tonifications) to support and expel toxins.

A question was raised: "What about swelling inside the shoulder with pain gradually progressing to ulceration and sore formation?" The answer is: This is named Tai Yin Ju (Tai Yin Carbuncle), also known as Lian Zi Fa (Lotus Seed Eruption). It belongs to the Hand Tai Yin Lung Meridian and is caused by accumulated Heat. Suitable treatments include Xian Fang Huo Ming Yin (Immortal Life Decoction) added with Jie Geng (Platycodon Root) and Huang Qi (Astragalus Root). Duo Ming Dan (Life-Taking Pill), Sheng Jin Dan (Victory Golden Pill), or Huang Qi Mu Xiang San (Astragalus and Costus Powder) may be selected according to circumstances. For those with robust constitution, Ba Zhen San (Eight-Trigram Powder) or Yi Li Jin Dan (One-Pill Golden Pill) may be used to purge. Cases with red coloration are treatable; those with blue-black discoloration are untreatable. Death occurs if symptoms include panting and coughing, extreme thirst, chest fullness, and a faint pulse.

A question was raised: "What about carbuncles spreading across left and right sides?" The answer is: A carbuncle arising on the left shoulder bone and spreading to the right is treatable; one arising on the right shoulder bone and spreading to the left is difficult to treat. Although this view exists in ancient texts, I disagree. Spreading to both left and right indicates disharmony of Qi and Blood, and disorder of Yin and Yang. Suitable treatments include Sheng Jin Dan (Victory Golden Pill) or Xian Fang Huo Ming Yin (Immortal Life Decoction) added with Qiang Huo (Notopterygium Root) and Jie Geng (Platycodon Root). For those with robust constitution, Ba Zhen San (Eight-Trigram Powder) or Yi Li Jin Dan (One-Pill Golden Pill) may be used to purge. If the Seven Evil Signs (critical manifestations) are few, why worry about failure to recover? However, if Yuan Qi (Original Qi) is exhausted and depleted, what benefit can treatment bring?

A question was raised: "A sixty-year-old person has a carbuncle in the depression anterior to the shoulder, with severe alternating chills and fever, reduced food intake, stiffness and tension in the shoulder and back, difficulty urinating, and abdominal distension. What should be done?" The answer is: This is named Que Pen Ju (Clavicle Carbuncle), also known as Suo Gu Ju (Collarbone Carbuncle). It belongs to the Foot Yang Ming Stomach Meridian and the Hand Shao Yang San Jiao Meridian. Garlic-partitioned moxibustion is suitable. Initially administer Zi Jin Dan (Purple Gold Pill) and Duo Ming Dan (Life-Taking Pill) to resolve the critical signs. Since the patient suffers from difficulty urinating, Liu Yi San (Six-to-One Powder) should be given to promote urination. Subsequently, administer Shi Quan Da Bu Tang (Decoction for Ten Complete Tonifications) to stabilize the condition. If treatment is delayed even slightly, ulceration will inevitably occur. Because this meridian has abundant Qi but scarce Blood, the wound will fail to heal, leading to many critical cases.