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This arises from cold pathogenic factors clashing with the muscles, obstructing the flow of blood and qi (vital energy), leading to coagulation and accumulation, thereby forming a carbuncle (a deep-seated skin infection). For any carbuncle that has persisted for a long time and cannot be resolved, if palpation reveals it is uniformly hard and firm, there is no pus; if palpation reveals it is half-hard and half-soft, there is pus. Furthermore, placing a hand over the swelling: if it is not hot, there is no pus; if it is severely hot, there is pus. Whenever pus is detected, it should be incised and drained immediately; otherwise, the toxic pus will erode the sinews and bones.

This arises from cold pathogenic factors lodging in the muscles, obstructing the flow of blood and qi, leading to coagulation and accumulation, thereby forming a carbuncle. After a carbuncle ruptures and ulcerates, the prognosis can be either favorable (Shun) or unfavorable (Ni). The patient having white sclerae turning blue-black and eyes appearing small constitutes one unfavorable sign; vomiting after taking medicine constitutes the second unfavorable sign; abdominal pain and severe thirst constitute the third unfavorable sign; inability to move the arms and neck constitutes the fourth unfavorable sign; hoarseness and loss of complexion/luster constitutes the fifth unfavorable sign. Apart from these five, all other conditions are considered favorable. These five signs indicate a fatal outcome.

Whenever a carbuncle or furuncle erupts, heat pathogens enter the interior, causing the Zang organs (internal organs) to become scorched and dry. The patient feels thirsty and desires to drink. If they consume excessive cold beverages, the intestines and stomach suffer from cold, leading to diarrhea. Diarrhea causes deficiency in both the intestines and stomach. Cold clashes with the Stomach, causing Qi rebellion, which transforms into vomiting; if Qi circulation is blocked and further constrained by cold, it transforms into hiccups (inverted Qi).

Shi Yong (Stone Carbuncle) is also formed by cold pathogenic factors lodging in the muscles, obstructing blood and qi flow, and resulting from coagulation and accumulation. The swelling is solid and firm, deeply rooted, with the skin adhering closely to the mass. It is not very hot, presents with slight pain, and fever comes and goes. Because cold predominates over heat and the hardness resembles stone, it is called Stone Carbuncle. After a long period, heat pathogens may invade, eventually leading to pus formation.

Fu Gu Yong (Bone-Adhering Carbuncle) occurs when a person, already suffering from heat in a systemic carbuncle, seeks cooling by exposing themselves to wind and cold. Wind-cold enters the muscles and clashes with internal heat, lying dormant and accumulating near the bone to form a carbuncle. Its presentation lacks a distinct head, presenting only with widespread swelling and pain, and thin, glossy skin. This is called Bone-Adhering Carbuncle.

This results from cold pathogens lodging in the meridians, causing stagnation and涩ness (sluggishness) of blood and qi, leading to coagulation, swelling, and carbuncle formation. Heat pathogens accumulate and congeal, transforming blood into pus. After the pus drains and the carbuncle heals, residual heat remains while blood and qi are deficient. The patient suffers from continuous low-grade fever and general weakness and fatigue, hence termed Deficient Heat.

Carbuncles arise from cold pathogens clashing with the blood, causing blood sluggishness and obstruction, followed by the gathering of heat, resulting from accumulation and congestion. Heat fails to vent outward and steams inwardly affecting the Zang organs, causing restlessness and irritability. In cases of carbuncles with heat-induced thirst and drinking, if cold pathogens enter the intestines and stomach, they transform into dysentery, and may also transform into vomiting and hiccups. The reason for this is that internally there is originally deficient heat causing Qi rebellion, leading to vomiting; after vomiting, Qi rebels further, and external cold exploits this vulnerability, blocking Qi circulation, thus causing hiccups.