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The pulse at the cun, guan, and chi positions on both hands presents as floating and rapid. (A floating pulse indicates an exterior syndrome, and a rapid pulse indicates heat. If it is due to exterior pathogenic factors,) fever should occur.
(However, there is no fever now.) Instead, there is a sensation of chills as if being sprinkled with cold water. (This must be due to stagnation of qi and blood, as stated in the *Neijing*: when Ying Qi does not flow smoothly and reverses within the muscle tissue, carbuncles and swellings arise. When Yang Qi is excessive and Ying Qi fails to circulate, carbuncles develop.) If there is a painful area, (this is even more clearly verifiable. However, "carbuncle" implies obstruction.) one should (use herbs such as Ephedrae Herba [Mahuang] and Schizonepetae Spica [Jingjie] to) diffuse and disperse the (stagnant) carbuncle. The Master said: Regarding various carbuncles and swellings, to determine whether pus has formed, place the hand over the swelling. If it feels hot, (the toxin has gathered,) there is pus; if not hot, (the toxin has not gathered,) there is no pus. This passage explains the origin of carbuncles and simultaneously distinguishes between cases with and without pus. The implied meaning is that for established carbuncles, the goal is suppuration and rupture; for unestablished ones, the goal is resolution and dispersal.

Internal and external medicine were originally not separated into different departments. They were later separated because techniques such as acupuncture, stone knives, surgical incision, fumigation, and washing required specialized transmission and practice, which scholars tended to disregard. However, major syndromes are absolutely beyond the capability of specialists in external surgery alone. Xue Ji's *Xue Shi Yi An* discusses this in great detail, but relying on formulas such as Liuwei Wan, Bawei Wan, Buzhong Yiqi Tang, Shiquan Dabu Tang, Guipi Tang, Liujunzi Tang, Yigong San, and Xiaoyao San, with modifications, is suitable mainly for deficiency syndromes after ulceration. In reality, this is a generalized routine method and difficult to succeed in treating major syndromes. The *Jinkui Yaolue* states that a floating and rapid pulse should present with fever, yet if chills occur instead, it is because Wei Qi is restrained and cannot exit. The restraint of Wei Qi is attributed to excess in the Ying level. These few concise sentences already contain the supreme treatment principles for carbuncles and swellings. By referring to the manifestations of the Six Channels, their anatomical locations, and applying the specific formulas of the Six Channels, efficacy is assured. Relying solely on external surgical expertise is insufficient.

Intestinal carbuncle is characterized by... (qi and blood are depleted by the internal carbuncle and cannot nourish the skin and muscles externally, so the body appears) dry and wrinkled, like overlapping scales. The abdominal wall is (tense, but) soft upon palpation. Although the exterior looks swollen, there are no accumulations in the abdomen. Although the body has no fever, the pulse is rapid, resembling an exterior pathogen. This is due to (Ying Qi stagnation transforming into heat.) Pus forms within the intestines. (Treat with Yiyi Fuzi Baijiang San.) (This addresses small intestinal carbuncle.)

This provides the formula and treatment for small intestinal carbuncle. Baijiang Cao (Patriniae Herba), also known as Kucai, grows abundantly on earthen walls and roof tiles. People in Fujian mistakenly identify it as Taraxaci Herba (Dandelion).
Formula for Yiyi Fuzi Baijiang San
Coicis Semen (Yiyiren) - 10 parts
Aconiti Lateralis Radix Praeparata (Fuzi) - 2 parts
Patriniae Herba (Baijiangcao) - 5 parts
Grind these three ingredients into a powder. Take a measure equivalent to a square inch spoonful (fangcun bi). Add two sheng of water, decoct until reduced by half, and take in one dose. Small amounts of stool resembling rice grains will be passed (indicating discharge of pus via urine/stool).

(What about carbuncles located in the large intestine? The large intestine lies below the small intestine. If the swelling is high and the carbuncle severe, it presses against the bladder, causing) distension and hardness in the lower abdomen. Palpation causes pain resembling strangury (lin syndrome), (but this is not due to bladder pathology, so urination remains normal.) (Since the small intestine pairs with the Heart and its qi connects to the blood vessels, while the large intestine pairs with the Lung and its qi connects to the skin and hair, the former presents with rapid pulse and no fever, whereas here there is) intermittent fever, spontaneous sweating, and aversion to cold. (Further distinguishing by pulse based on symptoms: if the pulse is slow and tight, the pathogen is violently obstructing and the Ying blood has not yet changed, indicating pus has not formed. Purging may be used to resolve it. If the pulse is surging and rapid, the toxin has gathered and the Ying qi has腐rified, indicating pus has formed. Even purging cannot eliminate it, so purging is contraindicated. Use Dahuang Mudan Tang regardless of whether the carbuncle is formed or not.)

This provides the formula and treatment for large intestinal carbuncle.
Formula for Dahuang Mudan Tang
Rhei Radix et Rhizoma (Dahuang) - 4 liang
Moutan Cortex (Mudanpi) - 1 liang
Persicae Semen (Taoren) - 50 seeds
Benincasae Semen (Dongguaren) - 0.5 sheng
Natrii Sulfas (Mangxiao) - 3 he
Decoct the five ingredients in six sheng of water until one sheng remains. Strain, add Mangxiao, boil again, and take in one dose. If pus exists, it will be discharged; if no pus, blood clots will be discharged.

Question: The pulse at the cunkou position is floating, faint, and choppy. According to standard theory, this indicates blood loss or excessive sweating. If there is no sweating, what is the explanation? Answer: Blood and sweat both belong to Yin fluids. A faint pulse indicates weak Yang, and a choppy pulse indicates blood deficiency. If there is a wound on the body caused by knife or axe injury, resulting in blood loss (where the loss of blood leads to loss of Qi support, hence the faint and choppy pulse), and since those who lose blood do not sweat (explaining the floating pulse without sweating)...

This section distinguishes the pulse in cases of metallic wound blood loss.
For all types of metallic wounds (Jinchuang), Wangbuliuxing San is the primary treatment.

This provides the general treatment formula for metallic wounds.
Xu Zhongke stated: This is not the formula for metallic wounds from earlier in the text where long-standing injuries cause lack of sweating, but rather a general formula for treating metallic wounds. Hence it says: For metallic wounds, use Wangbuliuxing San. Wangbuliuxing Seed (Vaccariae Semen) is bitter and neutral in nature, capable of promoting blood circulation and unblocking collaterals, thus stopping bleeding from wounds and relieving pain. Desmodii Caulis (Shuodai) also promotes qi and blood circulation and is particularly effective in opening obstructions. Since the muscles are governed by the Lung, Mulberry Root Bark (Sangbaipiku) benefits Lung qi best. Roots facing southeast absorb sunlight and possess abundant vital energy, helping restore the vitality of muscles. Therefore, these three herbs are used in large quantities as sovereign drugs. Glycyrrhizae Radix et Rhizoma (Gancao) detoxifies and harmonizes Ying Qi, used in larger quantity as ministerial drug. Zanthoxyli Pericarpium (Chuanjiao) and Zingiberis Rhizoma (Ganjiang) warm and nourish Yang in the chest. Magnoliae Officinalis Cortex (Houpo) relieves internal stagnation. Scutellariae Radix (Huangqin) and Paeoniae Radix Alba (Shaoyao) clear heat in the Yin aspect as adjunctive drugs. If wind-cold is present, this belongs to external pathogens in the meridians. Sangbaipiku only benefits Lung qi and cannot expel external pathogens, so it should not be selected. (Sun Xinlan, grandson of Sun Simiao, noted: Patients with metallic wounds and blood loss should avoid diaphoresis because Yin is damaged. If they accidentally contract wind pathogen and become unconscious, they should still be treated as broken-wind-sickness (tetanus), not strictly adhering to the prohibition of sweating due to blood loss.)
Formula for Wangbuliuxing San
Vaccariae Semen (Wangbuliuxing) - 10 parts (harvested on the 8th day of the 8th lunar month)
Desmodii Caulis (Shuodai Xiye) - 10 parts (harvested on the 7th day of the 7th lunar month)
Mori Radix Cortex (Sanggen Dianangun Baipi) - 10 parts (harvested on the 3rd day of the 3rd lunar month)
Glycyrrhizae Radix et Rhizoma (Gancao) - 18 parts
Scutellariae Radix (Huangqin) - 2 parts
Zanthoxyli Pericarpium (Chuanjiao) - 3 parts
Magnoliae Officinalis Cortex (Houpo) - 2 parts
Zingiberis Rhizoma (Ganjiang) - 2 parts
Paeoniae Radix Alba (Shaoyao) - 2 parts
Burn the first three ingredients (Wangbuliuxing, Shuodai, Sangbaipiku) to ash while preserving their properties. Grind and sieve each separately, then mix into a powder. Take one fangcun bi per dose. For minor wounds, apply powder topically; for major wounds, take orally. It can also be taken postpartum.
Formula for Painong San
Immature Tangerine Peel (Zhishi) - 16 pieces
Paeoniae Radix Alba (Shaoyao) - 6 fen
Platycodonis Radix (Jiegeng) - 2 fen
Grind the three ingredients into a powder. Take one chicken egg yolk. Mix the powder with an equal amount of egg yolk, knead until well combined, and take with water once daily.
Zhishi obtains Metal Qi from the Yangming channel to control wind, and Water Qi from the Shaoyin channel to clear heat. Combined with Shaoyao to unblock blood, and Jiegeng to promote qi movement. It relies especially on the chicken egg yolk to nourish the Heart and Spleen. Using substances with life force assists the Yin of the Fire and Earth organs, serving as the foundation for draining pus and resolving toxins.
Formula for Painong Tang
Glycyrrhizae Radix et Rhizoma (Gancao) - 2 liang
Platycodonis Radix (Jiegeng) - 3 liang
Zingiberis Rhizoma Recens (Shengjiang) - 1 liang
Jujubae Fructus (Dazao) - 10 pieces
Decoct the four ingredients in three sheng of water until one sheng remains. Take five he of the warm decoction twice daily.
This is also a formula to regulate qi and blood and harmonize Ying and Wei.
Jinyin Chuang (Exudative dermatitis/weeping sores)... (flows continuously, commonly known as cotton sore, syphilis sore, or malignant leprosy-like lesions). If it starts from the mouth and flows toward the limbs, it is treatable (because it moves from interior to exterior). If it starts from the limbs and flows into the mouth, it is untreatable (because it moves from exterior to interior). Jinyin Chuang is treated with Huanglian Fen (Coptidis Rhizoma Powder). (Original formula not seen.)

This provides the treatment for Jinyin Chuang. The original formula is missing; it is suspected to be simply Coptidis Rhizoma (Huanglian) ground into powder for topical application. Severe cases may also take it internally.
All sores with pain and itching belong to Heart Fire. Huanglian is bitter and cold, clearing Heart Fire, hence it is used. From this, I deduced a formula that is very effective for treating syphilis sores, cotton sores, etc.: Lonicerae Japonicae Flos (Lianqiao), Tribuli Fructus (Jili), Phellodendri Cortex (Huangbai), and Lonicerae Japonicae Flos (Jinyinhua) each 3 qian; Angelicae Sinensis Radix (Danggui), Glycyrrhizae Radix et Rhizoma (Gancao), Sophorae Flavescentis Radix (Kushen), Schizonepetae Spica (Jingjie), and Saposhnikoviae Radix (Fangfeng) each 2 qian. Additionally, use Smilacis Glabrae Rhizoma (Tufuling) 2 liang, decoct in water, strain, and use this liquid to decoct the other herbs. Take on an empty stomach. Cure expected in ten days. If contracted through sexual intercourse, the toxin enters deeply into the Kidney via the essence aperture, exploiting Kidney Qi deficiency, and spreads through the Chong, Ren, and Du vessels, making it difficult to cure. Add Tortoise Plastron (Guiban) to enter the Ren vessel, raw Deer Antler Powder (Luji) to enter the Du vessel, and Phellodendri Cortex (Huangbai) to enter the Chong vessel. First, prepare black Bindweed Seed (Heiqianniu) powder into small pills, combine with burnt ash powder, and swallow with Tufuling decoction. After significant black stool discharge, resume the previous decoction for miraculous results.