《鬼遗方》云∶痈之痛，只在皮肤之上。其发如火焚茅。初如黍米，三两日如掌
大，五七日如碗大。即易治。如肿冷，（热不外发。）发渴，（邪热在内。）发逆，（邪攻里而呕。）治
之难愈。又云∶疽发如小疖，触则彻心痛，四边微起如橘皮孔，色红赤，不全变，
脓水不甚出。至七八日，疼闷喘急。若始肿高，五七日忽平陷，此内攻之候也。又
云∶痈疽有三等。毒瓦斯浮浅，属腑。毒瓦斯沉深，属脏。毒瓦斯猛烈而行经络，或浅或
深无定，五脏六腑，皆受五毒，难为调理。惟宜于痈疽诸处，不问虚实，高肿起盛，
光泽疼痛，只在皮肤之上，热急胀满，或有痒疼，别无恶候。初用温药平气，次用排脓发穴。（治痈所谓平气者，
乃犀角饮之类。其方用犀角、连翘、漏芦、甘草、当归、肉桂，皆发表之药也。所谓
发穴者，乃棘针之类，用皂角刺为君，甘草、川芎、乳香为佐使，亦托里之药也。然不若洁古、东垣
诸方发表托里为稳当。）疽发诸处，不拘大小，唯起在背。广一尺、二尺、三尺，皮浓紫黑，高肿不常，
内疼如锥刺攻击，满闷应四肢重疼，前心亦痛，余处发犹可。惟虚处及近筋骨处，
若脓毒未溃，即伤烂筋骨肉。损为疽者，属五脏毒瓦斯深沉，气伏坚实。不宜缓治之，
须内实五脏，外透皮肤，令软匀和。即脓透，宜用内托实脏气之药，排脓匀气乃可，
不比痈之毒瓦斯浅也。毋一类治之。
凡一切疮肿，见有内攻之候，急以内托散及内补汤药，补填脏腑令实，最怕透
膜，膜穿十无一生矣。娄全善云∶痈之邪浅。其稽留壅遏，独在经脉之中，而专攻
于外。故初发时，自表便发热，患处便如碗如盆，高肿而痛甚者。纵欲下陷，缘正
气内固，不肯受，故或便秘，或发渴、发逆以拒之。是以骨髓终不焦枯，五脏终不
伤也。疽之邪深，其稽留壅遏，内连五脏而不专攻于外，故身体或无热，患处或不
肿。毒甚者，声嘶气脱，眼黑眼小，十指肿黑如墨，多死也。治之之法，痈之初发，
当以洁古法为主。表者散之，里者下之，火以灸之，药以敷之。脓未成者，必消
脓。已成者，速溃。又当以《鬼遗方》为主，补填脏腑令实，勿令下陷之邪蔓延。
外以火灸，引邪透出，使有穴归着而不乱，则可转死为生。今外科不分痈疽，一例
宣热拔毒。外以五香耗其气，内以大黄竭其血。终不能自悟其药之非。惜哉！《集验》
云∶痈疽之名虽多，而其要则二，阴阳而已。发于阳者，为痈，为热，为实；发
于阴者，为疽，为冷，为虚。故阳发，则皮薄色赤肿高，多有椒眼数十而痛；阴
发，则皮浓色淡肿硬，状如牛颈之皮而不痛。又有阳中之阴，似热而非热，虽肿而
实虚。若赤而不燥，欲痛而无脓，既浮而复消，外盛而肉腐。阴中之阳，似冷而非
冷，不肿而实，赤微而燥，有脓而痛，外虽不盛而内实烦闷。阳中之阴，其人多肥，
肉紧而内虚。阴中之阳，其人多瘦，肉缓而内实。而又有阳变而为阴者，草医凉剂
之过也；阴变而为阳者，大方热药之骤也。然阳变阴者，其证多，犹可返于阳，故
多生。阴变为阳者，其证少，不能复为阴矣，故多死。然间有生者，此医偶合于法，
百中得一耳。观此，则痈与疽但有阴阳深浅内外虚实之分，而无大小之别。精要乃
谓二寸至五寸为痈，五寸至一尺为疽者，谬矣。凡痈疽之脉沉实，发热烦躁，外无
赤痛，其邪深在里，宜先疏通以绝其源。浮大数， 肿在外，当先托里，恐邪入
内。不沉不浮，内外证无，知其在经，当和荣卫。身无热而脉数者，内有痈脓。数脉不时见，当生恶疮。
诸痈肿，欲知有脓无脓，以手掩肿上热者为有脓，不热者为无脓。
人身之有经络，犹地理之有界分。治病不知经络，犹捕贼不知界分，其能无诛
伐无过之咎乎？况手足十二经络，有血气多少之分。如手少阳三焦、足少阴肾、太
阴脾，多气少血。手厥阴心包络、手太阳小肠、足太阳膀胱，多血少气。手阳明大
肠、足阳明胃，多气多血。此其大较也。多血少气者易愈，多气少血者难疗。气多
之经，可行其气。血多之经，可破其血，不可执一也。
疮疡有五善七恶。动息自宁，饮食知味，一善也。便利调匀，二善也。脓清肿
消，不臭，三善也。神采精明，语声清爽，四善也。体气和平，五善也。烦躁时嗽，
腹痛渴甚，或泄利无度，小便如淋，一恶也。脓血大泄，肿 尤甚，脓色臭败，痛
不可近，二恶也。喘粗短气，恍惚嗜卧，三恶也。目视不正，黑睛紧小，白睛青赤，
瞳子上看，四恶也。肩背不便，四肢沉重，五恶也。饮食不下，服药而呕，食不知
味，六恶也。声嘶色败，鼻青赤，面目四肢浮肿，七恶也。五善见三则瘥，七恶见
四则危。《元戎》云∶疮疡自外而入者，不宜灸。自内而出者，宜灸。外入者，托
之而不内。内出者，接之而令外。故经云∶陷者灸之。灸而不痛，痛而后止其灸。
灸而不痛者，先及其溃，所以不痛。而后及良肉，所以痛也。灸而痛，不痛而后止
其灸。灸而痛者，先及其未溃，所以痛。而次及将溃，所以不痛也。凡人初觉发背，
欲结未结，赤热肿痛，先以湿纸覆其上，立视候之。其纸先干处，即是结痈头也。
取大蒜切成片，如当三钱浓薄，安于头上，用大艾炷灸之。三壮即换一蒜片。痛者，
灸至不痛。不痛者，灸至痛时方住。最要早觉早灸为上。一日、二日，十灸十活。
三日、四日，六七活。五、六日，三四活。过七日，则不可救矣。若有十数头作一
处生者，即用大蒜研成膏，作薄饼铺头上，聚艾于蒜饼上烧之，亦能活也。若背上
初发赤肿一片，中间有一片黄粟米头子，便用独蒜，切去两头，取中间半寸浓薄，
正安于疮上，着艾灸十四壮，多至四十九壮。又头为诸阳所聚，艾炷宜少而小。若
少阳分野，尤不可灸。灸之多致不救。亦有因灸而死者，盖虚甚孤阳将绝，其脉必
浮数而大，且鼓，精神必短而昏，无以抵当火气，宜其危也。方书治痈疽，用针烙
者，乃用圆针如箸，如纬铤大，头圆平，长六七寸，一样二枚，蘸香油于炭火中烧
红，于疮头近下烙之。宜斜入向软处，一烙不透，再烙必得脓也，总要用得其宜。
若毒深针浅，脓不得出。毒浅烙深，损伤良肉。不当其所，他处作头。此皆不能愈
疾，反增痛苦，又有用砭镰者，此血实者宜决之。砭镰者，瓷锋之类。未熟而决，
以泄其毒，不可太深。所谓刺皮无伤肉，不可轻用。又有敷贴之法。初生之疮，肿
似有头而未起，即当贴温热药，引出热毒。火就燥之义。若疮肿初生即高起，四畔
赤，宜捣生寒药贴之，折伏其热势，驱逐其邪恶，扑火之义。大抵敷贴之法，欲
消散肿毒，疏通血脉。寒热错综，皆期于不成脓也。又有用淋洗法。疮肿初生，一
二日不退，须用汤水淋射之。其在四肢者，泻渍之。其在腰腹及背者，淋射之。其
在下部委曲者，淹渍之。无非疏导腠理，通调血脉，使无凝滞耳。
《鬼遗方》说：痈的疼痛，仅在皮肤表层。其发作如同火烧茅草。初起时像黍米大小，两三天后如手掌大，五到七天后如碗口大。此时容易治疗。如果患处肿而发冷（说明热邪不能向外发散），口渴（说明邪热在体内），呕吐逆气（说明邪气攻里导致呕吐），则治疗难以痊愈。又说：疽的发作像小疖子，触碰时心痛彻骨，四周微微隆起像橘子皮孔，颜色红赤，但未能完全转变成熟，脓水流出不多。到了七八天，出现疼痛闷乱、气喘急促的症状。如果起初肿胀高起，五到七天后突然平陷下去，这是毒邪内攻的征兆。又说：痈疽分为三等。毒邪浮浅的，属于腑；毒邪沉深的，属于脏；毒邪猛烈且行于经络，或浅或深没有定处，五脏六腑都受五种毒邪侵害，难以调理。只有那些痈疽患处，不论虚实，表现为高肿隆起、光泽疼痛，仅在皮肤之上，感觉热急胀满，或有痒痛，没有其他恶候的，才适宜治疗。初期先用温药调和气血，接着用排脓透穴的方法。（所谓治疗痈所说的“平气”，是指犀角饮之类的方剂。该方使用犀角、连翘、漏芦、甘草、当归、肉桂，都是发表的药物。所谓“发穴”，是指棘针之类的方法，以皂角刺为君药，甘草、川芎、乳香为佐使药，也是托里透脓的药物。然而，不如洁古、东垣等人的方剂在发表托里方面稳妥。）疽发生在各处，不拘大小，唯独发生在背部的最为严重。面积有一尺、二尺、三尺宽，皮肤浓紫黑色，高肿不定，内部疼痛如锥刺攻击，胸闷并伴有四肢沉重疼痛，前心也痛，其他部位发生的还可以。唯独发生在虚损部位及靠近筋骨的地方，如果脓毒未溃破，就会损伤腐烂筋骨肌肉。损为疽者，属于五脏毒邪深沉，气机潜伏坚实。不宜缓慢治疗，必须内实五脏，外透皮肤，使其变软均匀平和。一旦脓液透出，宜用内托实脏气的药物，排脓调气才可以，这与痈的毒邪浮浅不同。不能用同一方法治疗。
凡是所有疮肿，见到有内攻的征兆，急忙使用内托散及内补汤药，补填脏腑使其充实，最怕穿透膜络，膜穿破了十个人中没有一个能活下来。娄全善说：痈的邪气浅。其稽留壅遏，独在经脉之中，专门攻伐于外。所以初发时，体表就发热，患处就像碗盆一样，高肿而且疼痛剧烈。即使想要下陷，因为正气内固，不肯接受邪气，所以或者便秘，或者口渴、呕吐来抗拒邪气。因此骨髓最终不会焦枯，五脏最终不会受伤。疽的邪气深，其稽留壅遏，内连五脏而不专门攻伐于外，所以身体可能不发热，患处可能不肿。毒邪严重的，声音嘶哑气息脱失，眼睛发黑变小，十个手指肿黑如墨，大多死亡。治疗的方法，痈的初发，应当以洁古的方法为主。表证的用发散法，里证的用泻下法，用艾灸火疗，用药敷贴。脓未形成的，必定要消除它；脓已形成的，迅速使其溃破。又应当以《鬼遗方》为主，补填脏腑使其充实，不让下陷的邪气蔓延。外部用火灸，引导邪气透出，使邪气有穴位归着而不混乱，这样就可以转死为生。现在外科不分痈疽，一律宣热拔毒。外部用五香类药物耗散其气，内部用大黄竭尽其血。最终不能自己醒悟药物的错误。可惜啊！《集验》说：痈疽的名称虽然多，但其要点只有两个，就是阴阳而已。发于阳的，称为痈，属热，属实；发于阴的，称为疽，属冷，属虚。所以阳证发作，则皮肤薄、色红、肿高，多有几十个椒眼样突起且疼痛；阴证发作，则皮肤厚、色淡、肿硬，形状像牛颈皮且不痛。又有阳中之阴，似热而非热，虽然肿胀但实际上是虚证。如果色红但不干燥，想痛但没有脓，既浮起后又消退，外表盛壮但肌肉腐烂。阴中之阳，似冷而非冷，不肿但实际上是实证，色微红而干燥，有脓且痛，外表虽不盛壮但内部烦闷。阳中之阴的人，身体多肥胖，肌肉紧实但内部虚弱。阴中之阳的人，身体多消瘦，肌肉松弛但内部充实。又有阳证变为阴证的，这是草医使用凉剂的过错；阴证变为阳证的，是大方使用热药的骤变所致。然而阳变阴的，症状多，还可以返回阳证，所以多存活。阴变阳的，症状少，不能再复为阴证了，所以多死亡。然而间或有存活的，这是医生偶然合乎法度，百人中得其一罢了。看这些，则痈与疽只有阴阳、深浅、内外、虚实的区别，而没有大小的分别。《精要》说两寸至五寸为痈，五寸至一尺为疽的，是错误的。凡痈疽脉象沉实，发热烦躁，外部没有赤痛，邪气深在里，宜先疏通以断绝病源。脉象浮大数，肿胀在外，应当先托里，恐怕邪气入内。脉象不沉不浮，内外症状无显著特征，知道病在经络，应当调和营卫。身体不发热而脉数的，内部有痈脓。数脉不时出现，应当生恶疮。
各种痈肿，想知道有没有脓，用手按在肿胀上，感觉热的就是有脓，不热的就是无脓。
人身有经络，就像地理上有疆界划分。治病不知道经络，就像抓贼不知道疆界，难道能不犯诛伐无辜的错误吗？何况手足十二经络，有血气多少的区别。如手少阳三焦经、足少阴肾经、足太阴脾经，多气少血。手厥阴心包经、手太阳小肠经、足太阳膀胱经，多血少气。手阳明大肠经、足阳明胃经，多气多血。这是大概情况。多血少气的容易治愈，多气少血的难治。气多的经络，可以行气；血多的经络，可以破血，不可固执一端。
疮疡有五善七恶。呼吸平稳安静，饮食知味，是一善。大小便调匀，是二善。脓液清稀肿胀消退，无臭味，是三善。神采精明，语声清爽，是四善。体质气息平和，是五善。烦躁时常咳嗽，腹痛极度口渴，或者泄利无度，小便像淋证一样，是一恶。脓血大量流失，肿胀更加严重，脓色臭败，疼痛不可触碰，是二恶。喘促气短，恍惚嗜睡，是三恶。目光不正，黑睛紧缩变小，白睛青赤，瞳子上视，是四恶。肩背不便，四肢沉重，是五恶。饮食不下，服药即呕，食物不知味道，是六恶。声音嘶哑面色败坏，鼻子青赤，面目四肢浮肿，是七恶。五善见到三个就能痊愈，七恶见到四个就危险了。《元戎》说：疮疡从外而入的，不宜灸。从内而出的，宜灸。外入的，用托法防止内陷。内出的，用接法使其外透。所以经书说：下陷的用灸法。灸了不痛，痛了才停止灸。灸了不痛的，是因为先灸到了溃破处，所以不痛。后来灸到好肉，所以痛。灸了痛，不痛了就停止灸。灸了痛的，是因为先灸到了未溃处，所以痛。后来灸到将溃处，所以不痛。凡人初觉背部发背，欲结未结，赤热肿痛，先用湿纸覆盖在上面，立即观察等待。纸上先干的地方，就是痈头所在。取大蒜切成片，厚度约当三钱重，放在头上，用大艾炷灸之。三壮就换一片蒜片。痛的，灸到不痛为止。不痛的，灸到痛时才停止。最重要的是早发觉早灸为上策。一天、两天，灸十次活十次。三天、四天，六七次活。五、六天，三四次活。过了七天，就不可救了。如果有十几个头长在一处生的，就用大蒜研成膏，做成薄饼铺在头上，聚集艾绒在蒜饼上烧之，也能救活。如果背上初发赤肿一片，中间有一片黄粟米大小的头子，便用独蒜，切去两头，取中间半寸厚薄，正安放在疮上，着艾灸十四壮，多至四十九壮。另外头部为诸阳汇聚之处，艾炷宜少而小。如果是少阳分野部位，尤其不可灸。灸了多导致无法救治。也有因灸而死的，这是因为极度虚弱孤阳即将绝灭，其脉必浮数而大，且搏动有力，精神必短少而昏沉，无法抵挡火气，所以危险。方书治疗痈疽，用针烙的，是用圆针如筷子粗细，如纬铤大小，头圆平，长六七寸，同样的两枚，蘸香油在炭火中烧红，在疮头近下方烙之。宜斜入向软处，一次烙不透，再烙必定出脓，总之要用得适宜。如果毒深针浅，脓不得出。毒浅烙深，损伤好肉。不当其位置，会在别处形成疮头。这都不能治愈疾病，反而增加痛苦。又有用砭镰法的，这是血实证宜决泄之法。砭镰是瓷锋之类。未熟而决泄，以泄其毒，不可太深。所谓刺皮不伤肉，不可轻用。又有敷贴法。初生的疮，肿似有头而未起，就应当贴温热药，引出热毒。这是火就燥的道理。如果疮肿初生即高起，四周红赤，宜捣碎生寒药贴之，折伏其热势，驱逐邪恶，这是扑火的道理。大抵敷贴法，想要消散肿毒，疏通血脉。寒热错综，都期望不成脓。又有用淋洗法。疮肿初生，一两天不退，须用汤水淋射。在四肢的，泻渍之。在腰腹及背的，淋射之。在下部弯曲处的，淹渍之。无非疏导腠理，通调血脉，使无凝滞罢了。
According to the *Gui Yi Fang* (Ghost's Remnant Formula): The pain of a carbuncle (Yang abscess, characterized by redness, swelling, heat, and pain) is confined to the superficial skin. Its onset is like burning thatch. Initially, it is as small as a millet seed; after two or three days, it becomes palm-sized; after five to seven days, it reaches bowl-size. At this stage, it is easy to treat. However, if the swelling is cold (indicating heat pathogen cannot diffuse outward), accompanied by thirst (indicating pathogenic heat inside), and vomiting/nausea (indicating pathogen attacking the interior causing stomach rebellion), treatment will be difficult to succeed. It further states: A gangrene (Yin abscess, characterized by deep-seated, dark, non-suppurative or scanty pus lesions) starts like a small boil; touching it causes heart pain radiating through the body; the surrounding area rises slightly like orange peel pores, with a red color but not fully maturing, and pus discharge is scanty. By the seventh or eighth day, symptoms include painful oppression, panting, and urgency. If initially swollen and high, it suddenly flattens and sinks after five to seven days; this is a sign of internal attack by the pathogen. It also states: Carbuncles and gangrenes are divided into three grades. Pathogenic toxins that are shallow belong to the Fu organs; those that are deep belong to the Zang organs; those that are fierce and travel through meridians, varying in depth without fixed location, affect all Zang and Fu organs with the "Five Toxins," making regulation difficult. Only those lesions where, regardless of deficiency or excess, there is high swelling, luster, pain, confined to the skin surface, feeling hot, urgent, distended, possibly itchy or painful, without other malignant signs, are suitable for treatment. Initially, use warm herbs to harmonize Qi, then use methods to drain pus and open acupoints. (The so-called "harmonizing Qi" in treating carbuncles refers to formulas like Xijiao Yin (Rhinoceros Horn Drink). This formula uses Rhinoceros Horn, Forsythia, Agrimonia, Licorice, Angelica Sinensis, and Cinnamon Twig, all exterior-releasing herbs. The so-called "opening acupoints" refers to methods like Ji Zhen (Thorn Needle), using Gleditsia Sinensis Thorn as the sovereign herb, with Licorice, Ligusticum Chuanxiong, and Frankincense as minister and envoy herbs, which are also interior-supporting herbs. However, these are not as stable as the exterior-releasing and interior-supporting formulas by Jiegu and Dongyuan.) Gangrenes occurring anywhere, regardless of size, are most severe when on the back. They may span one, two, or three chi in width, with thick purple-black skin, variable high swelling, internal pain like needle pricks, chest fullness with heavy pain in limbs, and anterior chest pain. Those occurring elsewhere are manageable. However, if they occur in deficient areas or near sinews and bones, and the pus-toxin has not ulcerated, it will damage and rot the sinews, bones, and muscles. Gangrene belonging to the Zang organs involves deep-seated toxins and latent, firm Qi. It should not be treated slowly; one must internally strengthen the Zang organs and externally penetrate the skin to make it soft, even, and harmonious. Once pus penetrates, use herbs to internally support and solidify Zang Qi, draining pus and regulating Qi can then proceed. This differs from carbuncles where toxins are shallow. Do not treat them with the same method.
For all swellings and sores, if signs of internal attack appear, urgently use Neituo San (Internal Support Powder) and internal tonifying decoctions to fill and strengthen the Zang organs. The greatest fear is penetration of the membrane; if the membrane perforates, ten out of ten die. Lou Quanshan said: The pathogen of a carbuncle is shallow. Its stagnation and obstruction occur solely within the meridians, attacking specifically outward. Thus, upon initial onset, the body surface heats up, and the affected area swells high like a bowl or basin, with severe pain. Even if it tends to sink inward, because righteous Qi is internally solid and refuses to accept the pathogen, it may manifest as constipation, thirst, or vomiting to resist it. Therefore, the bone marrow does not eventually dry up, and the Zang organs are not damaged. The pathogen of a gangrene is deep. Its stagnation and obstruction connect internally to the Zang organs and do not attack specifically outward. Thus, the body may have no fever, and the affected area may not swell. In severe toxicity, hoarseness, Qi depletion, blackening and shrinking of eyes, and blackened swollen fingers like ink occur, leading mostly to death. For treatment: For the initial onset of a carbuncle, prioritize the methods of Jiegu. For exterior patterns, disperse them; for interior patterns, purge them; use moxibustion and herbal applications. If pus has not formed, eliminate it; if formed, expedite its rupture. Also, prioritize the *Gui Yi Fang*: fill and strengthen the Zang organs to prevent sinking pathogens from spreading. Externally use moxibustion to guide pathogens outward, ensuring they exit through specific acupoints without chaos, thus turning death into life. Currently, surgery does not distinguish between carbuncles and gangrenes, uniformly promoting heat-clearing and toxin-extracting. Externally, aromatic herbs like Wuxiang (Five-Aromatic Powder) deplete Qi; internally, Rhubarb exhausts Blood. Practitioners fail to realize their error. Regrettably! The *Ji Yan* states: Although names of carbuncles and gangrenes are many, the essence lies in two: Yin and Yang. Manifesting in Yang constitutes a carbuncle, characterized by Heat and Excess; manifesting in Yin constitutes a gangrene, characterized by Cold and Deficiency. Thus, Yang manifestations feature thin skin, red color, high swelling, often with dozens of pepper-like eyes and pain; Yin manifestations feature thick skin, pale color, hard swelling, resembling ox neck skin, and lack of pain. There is also "Yin within Yang," appearing hot but not truly hot, swollen yet actually deficient. If red but not dry, wanting pain but no pus, floating then subsiding, externally vigorous but muscle rotting. There is "Yang within Yin," appearing cold but not truly cold, not swollen yet actually excessive, slightly red and dry, with pus and pain, externally not vigorous but internally oppressed. Persons with "Yin within Yang" are often obese with tight flesh but internal deficiency. Persons with "Yang within Yin" are often emaciated with loose flesh but internal excess. Yang transforming into Yin is due to folk doctors' misuse of cooling agents; Yin transforming into Yang is due to sudden use of strong heating prescriptions. However, Yang transforming into Yin presents more symptoms and can revert to Yang, hence more survivors. Yin transforming into Yang presents fewer symptoms and cannot revert to Yin, hence more deaths. Rare survivals occur only when doctors accidentally follow correct principles, one in a hundred. From this, we see carbuncles and gangrenes differ only in Yin/Yang, depth/shallowness, interior/exterior, and excess/deficiency, not in size. The claim in *Jing Yao* that 2-5 cun is a carbuncle and 5 cun-1 chi is a gangrene is erroneous. For carbuncle/gangrene pulses: if deep and solid, with fever and irritability but no external redness/pain, the pathogen is deep in the interior; first unblock to cut off the source. If floating, large, and rapid, with external swelling, first support the interior to prevent pathogen entry. If neither deep nor floating, with no significant interior/exterior signs, the disease is in the meridians; harmonize Ying and Wei. If body has no fever but pulse is rapid, there is internal abscess-pus. Intermittent rapid pulses suggest impending malignant sores.
To determine if various swellings have pus, press the hand over the swelling; heat indicates pus, absence of heat indicates no pus.
Meridians in the human body are like boundaries in geography. Treating diseases without knowing meridians is like catching thieves without knowing boundaries; how can one avoid punishing the innocent? Moreover, the twelve meridians of hands and feet vary in Qi and Blood quantity. Hand Shaoyang Sanjiao, Foot Shaoyin Kidney, and Foot Taiyin Spleen have abundant Qi and scarce Blood. Hand Jueyin Pericardium, Hand Taiyang Small Intestine, and Foot Taiyang Bladder have abundant Blood and scarce Qi. Hand Yangming Large Intestine and Foot Yangming Stomach have abundant Qi and Blood. This is the general rule. Abundant Blood and scarce Qi conditions heal easily; abundant Qi and scarce Blood conditions are difficult to treat. In meridians with abundant Qi, regulate Qi; in meridians with abundant Blood, invigorate Blood. Do not adhere rigidly to one approach.
Sores and ulcers have Five Good Signs and Seven Bad Signs. Calm breathing and appetite are the First Good Sign. Regular bowel movements and urination are the Second Good Sign. Clear pus, reduced swelling, and no foul odor are the Third Good Sign. Bright spirit and clear voice are the Fourth Good Sign. Balanced constitution and Qi are the Fifth Good Sign. Restlessness, frequent coughing, abdominal pain, extreme thirst, profuse diarrhea, and dysuria-like symptoms are the First Bad Sign. Profuse pus/blood loss, worsening swelling, foul-smelling pus, and unbearable pain are the Second Bad Sign. Panting, shortness of breath, confusion, and lethargy are the Third Bad Sign. Misaligned gaze, constricted pupils, blue-red sclera, and upward-looking eyes are the Fourth Bad Sign. Shoulder/back stiffness and heavy limbs are the Fifth Bad Sign. Inability to eat, vomiting after medication, and loss of taste are the Sixth Bad Sign. Hoarse voice, deteriorated complexion, blue-red nose, and edema of face/limbs are the Seventh Bad Sign. Three Good Signs indicate recovery; four Bad Signs indicate critical danger. The *Yuan Rong* states: Sores entering from outside should not be moxa-ed; those emerging from inside should be. External entries are managed by supporting outward to prevent internal sinking. Internal exits are managed by guiding outward. Hence, scriptures say: Use moxibustion for sunken lesions. If moxibustion causes no pain, continue until pain arises, then stop. No pain initially means moxa reached the ulcerated area; pain later means it reached healthy tissue. If moxa causes pain, stop when pain ceases. Pain initially means moxa reached non-ulcerated tissue; cessation later means it reached impending ulceration. When a back carbuncle is suspected but not yet formed, presenting with redness, heat, swelling, and pain, cover with wet paper and observe. The spot where the paper dries first is the head of the carbuncle. Place a garlic slice (approx. 3 qian thickness) on the head and apply large moxa cones. Change garlic after three moxa units. If painful, moxa until pain stops; if painless, moxa until pain begins. Early detection and moxibustion are crucial. Day 1-2: 10/10 survive. Day 3-4: 6-7/10 survive. Day 5-6: 3-4/10 survive. After Day 7: incurable. If multiple heads cluster, grind garlic into paste, make a thin cake, place on the area, and burn moxa on top; this can also save lives. If a red swollen patch appears on the back with a yellow millet-grain head, use a single garlic clove, cut ends off, take middle half-cun thickness, place directly on sore, and moxa 14-49 units. Note: The head is the gathering point of Yang Qi; use small/few moxa cones. Shaoyang regions especially should not be moxa-ed; doing so often leads to untreatable conditions or death. Death from moxa occurs in cases of extreme deficiency with isolated Yang about to extinguish; pulse is floating, rapid, large, and forceful; spirit is short and confused, unable to withstand fire heat, hence critical. Formulas using needle-cautery for carbuncles/gangrene use round needles like chopsticks, 6-7 cun long, heated red in charcoal with sesame oil, cauterizing near the sore head. Insert obliquely toward soft areas; if one cauterization doesn't release pus, repeat. Proper application is key. Deep toxin with shallow needle prevents pus drainage; shallow toxin with deep cauterization damages healthy flesh. Incorrect placement causes new sores elsewhere, increasing suffering rather than curing. Bianlian (stone lancet) therapy is for blood-excess patterns requiring drainage. Using ceramic blades to lance immature sores drains toxin but must not be too deep ("pierce skin without damaging flesh"); do not use lightly. Application therapy: For early sores with swelling but no head, apply warm herbs to draw out heat-toxin (principle of fire attracting dryness). For early high-swelling sores with red margins, apply raw cold herbs to suppress heat and drive out evil (principle of extinguishing fire). Generally, applications aim to dissipate swelling/toxin and unblock vessels, hoping to prevent suppuration despite mixed cold/heat. Washing therapy: For sores persisting 1-2 days, wash/spray with decoctions. Limbs: soak/drench. Waist/abdomen/back: spray/wash. Lower body crevices: immerse. All aim to open cou-li (interstices), regulate vessels, and prevent stagnation.