A man in his fifties had developed a *ju* (carbuncle/abscess) on the center of his back for thirteen days. He could not take any food or liquid, his back was hard and heavy as if carrying a stone, he felt restless and silent. Upon examination, although the condition of the sore was severe and the skin color was purple, it was fortunate that the base of the sore was distinct and clear, indicating that the pathogenic toxin was still localized and had not invaded inward; thus, it was treatable. It was necessary to employ the extraction method (*ba fa*) to draw the toxic qi outward, preventing internal attack. Subsequently, a medicinal tube was used twice for suction, extracting approximately one bowl of foul blood. Given his solid pulse and constipation, *Neishu Huanglian Tang* (Internal Purging Coptis Decoction) and the pig gallbladder套法 (套法: a specific application method using pig gallbladder) were administered, resulting in two bowel movements, allowing both internal and external toxic qi to be discharged. He then slept peacefully at night, and the heaviness in his back decreased by more than half. Next, herbs for supporting the healthy qi and expelling pus were used, along with mugwort moxibustion on mulberry wood externally. The swelling and hardness gradually softened and suppurated, and pus and toxins were discharged. He took several doses of *Shiquan Dabu Tang* (Comprehensive Great Tonifying Decoction) added with *Ophiopogonis Radix* (Maidong) and *Schisandrae Fructus* (Wuweizi). The necrotic tissue naturally detached, dietary intake gradually improved, and the wound closed. After over two months of regulation, he recovered.

An elderly woman near seventy years old had a back sore for over half a month. The condition was terrifying, and her family had given up treatment, sadly preparing for her funeral. I was called to examine a child's sore and asked about her condition. The whole family said she would die soon and asked if there was any hope. Upon inspection, half of her back was swollen. Although the sore did not protrude significantly nor sink inward, palpation revealed firmness externally and suppuration internally. This was due to internal deficiency in the elderly, where pus and toxins were blocked by septa and could not discharge outward. Although she refused food, it was fortunate that the base was clear without mixing, and the facial colors of the organs showed no signs of failure; this indicated a vital sign. The family remained stubbornly unconvinced, stating that fortune-telling predicted death, so why treat? I sighed in regret! I warned that if not treated for three or four days, the inner membrane would perforate, leading to certain death, leaving her life lost unjustly. The next day, unwilling to accept this, I insisted on treating her, saying: "I am not forcing you; I see vitality and cannot bear to let her wait for death. I insist on treating her. I will not charge a penny for medicine or fees until she is truly cured. Then, whatever compensation she offers is acceptable." Only then did they agree. First, a decoction of scallion and mugwort was poured over the sore. The surface consisted of tough, non-necrotic flesh. Using a lancet and sharp scissors, two inches of this tough flesh were removed from the center to open the pus channel. With gentle pressure, the accumulated pus and blood inside were squeezed out, flowing continuously for about three bowls. Bystanders nodded in shock. Once the pus and blood subsided, the area was washed with the previous decoction and covered with ointment. Internally, *Huiyuan Dacheng Tang* (Great Completion Restoring Origin Decoction) was taken twice to support and tonify true qi. Later, *Renshen Yangrong Tang* (Ginseng Nourishing Grace Decoction) with doubled Ginseng and Atractylodes, plus Cyperi Rhizoma, was given. In the morning, *Bawei Wan* (Eight-Ingredient Pill) and *Baxian Gao* (Eight Immortals Paste) were alternated to strengthen the spleen, promote appetite, shed necrotic tissue, and generate muscle. Fortunately, the woman followed precautions strictly without complications. Within a hundred days, the sore healed, and she regained health. Only then did they believe my words were correct.

A student official over fifty years old suffered from chronic thirst and extreme obesity. He developed a back carbuncle about one chi long and sought treatment after twelve days. The sore was slightly swollen, pale red, with a base that was half-contracted and half-scattered, indicating an equal balance of yin and yang. Moreover, obese individuals have internal deficiency; with such a large sore, without tonification and support, the sore would fail to rise, and the toxin would easily sink, potentially making treatment futile. Initially, *Tuoli San* (Support Interior Powder) was taken to secure the interior. After fifteen days, a lancet was used to make small openings at the top to allow internal pus and toxins to exit. Care was taken not to drain too much to avoid depleting healthy qi, which might hinder pus formation. Internally, *Shenqi Neituo San* (Ginseng and Astragalus Supporting Interior Powder) with doubled Ginseng and Astragalus (3 qian each) was administered. By the twentieth day, abundant pus began to form, reaching about one sheng per day. In the morning, *Renshen Shu Gao* (Ginseng and Atractylodes Paste) was taken; at noon, *Shiquan Tang* with doubled Ginseng and Astragalus (4 qian each), Ophiopogonis Radix, and Schisandrae Fructus (1 qian each) was given. After more than a month, the flesh ulcerated completely, and pus flowed like a spring. *Shengyu Tang* (Sage Helps Decoction) and *Baxian Gao* were alternately used to protect the spleen and stomach and increase dietary intake. Later, fearing the previous prescriptions were insufficient, 1 qian of Prepared Aconite Root (Shu Fuzi) was added. Fortunately, the spleen functioned well, and the pus became thick and yellow, so the addition was stopped. By the fortieth day, the sore condition slightly receded. During midsummer, the weather was hot, causing the patient irritability. He mistakenly drank two bowls of cold water. That evening, the sore sank inward, suddenly transforming into a yin syndrome: painless, no pus, cool body, fine pulse, abdominal pain, and cold feet. Upon examination, the sore was soft and sunken, and the pulse was minute. This transformation was due to cold; only acrid-hot herbs could restore yang. Urgently, *Shierwei Yigong San* (Twelve-Ingredient Extraordinary Merit Powder) with doubled Ginseng and Prepared Aconite Root (3 qian each) was prescribed, but it failed, indicating the drug strength was insufficient against the cold. Then, Raw Aconite Root and Ginseng (5 qian each) were used twice daily. Finally, the body warmed, the pulse rose, the sore elevated, and abdominal pain ceased. After two more doses, pus flowed again. Over a month, more than a hundred bowls of pus were discharged without decrease. The outer skin turned pale and did not rot, characteristic of obese individuals who are externally solid but internally deficient, leading to internal ulceration without external rotting. Red Jade Ointment applied on cotton pads was pushed into the wound and covered. Gradually, necrotic tissue detached and exited. Ten days later, a large piece of necrotic tissue weighing about six liang was expelled naturally. Swelling subsided, pus decreased, and new muscle grew. After a hundred days, full recovery was achieved. More than five jin of Ginseng and over ten liang of Aconite were consumed before complete safety was restored. If detoxifying, spleen-damaging, or purgative herbs had been used instead of acrid-hot strong tonification, survival would have been impossible.

A retired official over seventy years old developed a sore on the right back for eight days. Externally, the sore was slightly swollen, pale, and non-red, resembling a turtle shape, with a flat, non-elevated base, due to the decline of qi and blood in old age. The pulse was slightly rapid yet forceful, indicating the root was still intact; thus, despite his age, it was treatable. *Painong Neituo San* (Expel Pus Support Interior Powder) with Gleditsia Sinensis Spine (Zaocis Spina) was used to facilitate pus discharge and support the interior. After thirteen days, the sore became higher and redder, but failed to suppurate properly. This was due to poor diet and weak spleen failing to nourish. Several doses of *Shiquan Dabu Tang* were given, and pus gradually appeared but was not smooth. Stagnant pus indicates blockage by the inner membrane. One must not hesitate due to age and miss the critical moment. A lancet was used to open about one cun at the head, and the pus channel was cleared. Pus flowed immediately. After washing with pork trotter decoction and covering with ointment, topical medication was applied once daily. External flesh gradually rotted into pus. The patient looked emaciated and dull. *Renshen Yangrong Tang* with doubled Ginseng and Astragalus was used to support the interior. Necrotic tissue ready to detach was removed, and new muscle growth was supported. However, qi and blood in the elderly do not recover quickly. *Renshen Shu Gao* was taken twice daily. Eventually, new muscle grew, and dietary intake doubled. After seventy-five days of regulation, he recovered.

A school student over sixty years old suffered from a back carbuncle for ten days. Externally, the sore was hard, deep purple, with many hairs, resembling a snail shell, standing vertically over one chi long, with a base spanning half the back. Fortunately, it was arched, swollen, and shiny, accompanied by fever and pain. The pulse was surging, rapid, and forceful. This sore resulted from damp-heat steaming caused by rich food and alcohol. Although severe, it was manageable. Three corresponding lines of topical medication were applied. The snail-like heads were expressed, and foul blood flowed for about a bell volume. The area was washed with scallion soup, coated with rotting agent, covered with paper, and surrounded by *Xidu San* (Absorb Toxin Powder) to contain the toxic qi and prevent spreading. The same dressing was applied the next day. After three days, external flesh gradually rotted. Internal supportive herbs were added to strengthen the spleen and stomach, detoxify, and convert to pus. *Bawei Wan* (Eight-Ingredient Pill) was taken in the morning to nourish kidney yin. The pork trotter wash and ointment were continued. When the rotting penetrated more than one cun, Red Ointment was applied daily to promote healing. However, this gentleman loved drinking and did not abstain during illness. Two months later, although new flesh was level, it was tender and could not close. Disliking the restriction on drinking, he cut off the tender flesh. After applying ointment for a few days, waiting for the flesh to mature and flatten, Pearl Powder was sprinkled several times. Finally, a hard crust formed, and he recovered in eighty days.

An elderly man suffered from a carbuncle for half a month. The sore spanned the spine, swelling across the entire back, from shoulders to waist, resembling a melon shape with hundreds of heads. His family thought it was untreatable. My pulse diagnosis showed a slight surging quality but lacked vigor. The swelling was outward-expanding. Inquiry about diet and taste revealed that although old, his root qi remained. There was no need to worry. Two doses of *Tuoli Xiaodu San* (Support Interior Detoxify Toxin Powder) stabilized the condition. Externally, mulberry wood moxibustion assisted in rotting and ulceration. The base was bound with Iron Tube Ointment. *Painong Neituo San* was taken to await proper pus discharge. However, in the elderly, external flesh does not easily rot. Where flesh color changed but did not rot, needle hooks and scissors were used to slowly trim the necrotic concave flesh, about one cun long and one chi wide. Whenever red flesh appeared, ointment was applied. When new flesh was half-formed, it was winter. The family opened the sore for washing, accidentally exposing it to fire heat, and failed to keep it warm, leading to cold invasion. Subsequently, the sore turned pale white, pus became thin and clear, appetite decreased, and general discomfort arose. Upon examination, this was due to neglecting care and cold invasion. Although transformed, since the sore originally originated from yang, yang could be preserved. Fire was lit in the room to warm and drive out residual cold. Opening the sore confirmed my prediction. Thick scallion soup was poured while warm, Red Ointment was melted and applied, and the area was covered with ointment and tightly wrapped with multiple layers of hot cotton silk. Internally, *Shengong Tuoli San* (Divine Merit Support Interior Powder) was taken twice daily. The next morning, the sore had returned to yang. Following this method for regulation, he recovered in a hundred days.

An elderly man over sixty suffered from a back carbuncle for twelve days. The sore was half-swollen, half-red, slightly painful and hot. Located below the heart back and above the Shenshu acupoint, it was evenly high, wide open eight cun, with a swollen base, water-splash color, soft apex lacking spirit, appearing rotten but not fully so. The pulse was floating and large, but empty upon heavy pressure. This type of sore favors rupture over contraction. I declined to treat, stating it was incurable. The family laughed sighingly and invited another local old doctor. Seeing the patient's peaceful demeanor, clear speech, normal movement, and good appetite, the other doctor diagnosed it as having all five favorable signs, stable as Mount Tai, and unnecessary to worry. The family was delighted and used his prescription. Day by day, progress was made: pus discharged, swelling subsided, necrotic tissue shed, and muscle grew. Both sides considered it a perfect outcome. I often told the family and relatives: "This disease cannot wait; he will surely die when the wound closes to the size of a coin." They thought I was talking nonsense. Later, when the wound was only coin-sized from closing, I said, "He will not last long; prepare for funeral matters immediately, or it may be too late." Not long after, complications arose, and he died within four days. Only then did the locals believe my earlier words.

A sixty-two-year-old man developed a carbuncle on the right axilla. Moxibustion was applied first, followed by increasing swelling, hardness, and lack of pain. After fifteen days, no pus had formed. He felt increasingly restless, fearing toxin sinking. A needle was used to open it, followed by extraction methods, drawing out foul blood for about a bell volume. He felt slightly lighter afterward. Rotting ointment was applied and covered. After three days, the sore gradually suppurated. By the twentieth day, proper pus appeared, necrotic tissue shed, and new muscle grew. This exhausted external treatment methods. However, the family had a close relationship with an internal medicine physician who prescribed internal medications, ignoring surgical principles of tonification and support. Relying on their own views and ignoring my advice, they failed to use strong tonification, taking only 2 qian of Ginseng daily, believing it sufficient. I said, "Insufficient. The standard should be 5 qian, plus 2 qian of Prepared Aconite Root to match the disease. Otherwise, complications will arise." Neither side believed me. Consequently, the flesh turned pale white, the wound expanded, pus became thin and clear, and appetite decreased. All signs of failure appeared. Although strong warming, spleen-strengthening, and tonifying drugs were forced upon him, they were ineffective. His body wasted away, pus became foul-smelling, and after sixty days, depleted of qi and blood, he died. Only then did he regret. Little did he know that for large sores discharging one bowl of pus daily, at least 3 qian of Ginseng is required. This case discharged three bowls daily but used only 2 qian of Ginseng, representing major loss and minor supplementation. How could this not lead to death? Surgical diseases involve leakage, which easily depletes true qi. If loss and supplementation are unequal, there is nothing to resist the depletion, often leading to untreatable conditions. This was a case of rejecting tonification, holding onto common misconceptions, and bringing about self-destruction. Pity!

A man near sixty years old, in midsummer, developed over twenty hot boils on his back. The family invited me to examine his grandson's sore. Seeing him sitting in the hall with his back covered in boils, I glanced and noticed one sore much smaller than a boil but with severe toxicity. I said, "This is not comparable to ordinary boils; its progression will be uncontrollable." He smiled and replied, "It is fine." He sent me to the door. I urged, "Seek other medical help immediately; do not delay." No one listened. Ten days later, the condition worsened slightly. A local doctor was called, who also said, "It is just a boil." Another ten days passed, the condition sank inward, and all signs of failure appeared. Believing my earlier words, relatives begged me to examine him. He was lying in the hall, covered with cloth. I entered two or three steps and retreated. Someone asked why. I said, "The aura of failure fills the space; death is imminent. Why examine the sore? Prepare for funeral matters immediately. He will die in seven days." Indeed, he died exactly as predicted, without missing a moment. This was a case of concealing illness and fearing doctors, leading to self-destruction. Pity!

The above treatments are numerous and cannot be listed exhaustively. I briefly present a few cases for colleagues to review. Those who grasp the essentials can summarize them in one word; those who do not understand the essentials will scatter endlessly. If the disease is not thoroughly understood, actions will be chaotic. With clear medical principles, judgment becomes natural.