臀痈，属膀胱经湿热，或禀赋阴虚。若肿硬作痛，用内托羌活汤。微肿微痛，用托里消毒散。若初起大痛，或五日
之间，似消不消，似溃不溃者，先用仙方活命饮，后用托里消毒散。若已溃，食少体倦，疮不生肌，脾胃虚弱者，用五
味异功散加柴胡、升麻。禀赋阴虚，小便数而不敛者，加减八味丸。气虚，久不生肌收口，用豆豉饼及补中益气汤，培
养元气。若用解热攻毒，及敷围寒冷之剂，则气血受伤，必成败症矣。
一小儿患此，肿硬不赤旬余矣，面赤痿黄，饮食少进，此脾气虚弱也，先用异功散，饮食渐进，漫肿渐消，乃用托
里散，少加肉桂而溃，又用八珍汤而敛。
一小儿患此，久不收敛，四围微黯，疮口黑色，脓水清稀，寒热晡热，脉浮而数，两寸按之如无，此阳气虚而阴血
弱也，朝用补中益气汤，夕用异功散，半载而愈。
一小儿臀疮溃而不敛，面色时赤，此禀肝肾阴虚，朝用八珍汤加五味子，夕用加减八味丸，诸症渐退。又用托里散，
间服而愈。
一小儿臀疮，久不收敛，肢体倦怠，晡热作渴，此禀足三阴虚也，用五味异功散、加减八味丸渐愈，又用托里散而
敛。
一小儿臀痈，久不生肌，面色痿黄，仍欲败毒以收敛。余曰∶脾主肌肉，腱健则肉生。遂朝用补中益气汤，夕用五
味异功散及葱熨法，脾气壮肌肉生而愈。
一小儿肿硬不消，肉色不变，此脾胃之气虚怯，不能运及患处耳，朝用补中益气汤，夕用五味异功散，以接虚怯之
气，月余而消。其时同患是症，外敷寒凉之药，内服犀角丸者，无不受害。
一小儿十五岁，久不愈，发热体瘦，面白嗳气，恪服消食清热药等，余谓心火虚而脾气弱也，先用八味丸为主，佐
以六君子汤、补中益气汤寻愈。毕姻后，臀间患疽，漫肿坚硬，肉色不变，手足时冷，脉浮大，按之微细，两尺为甚，
先用八味丸料四剂，又用十全大补汤，患处色正而消。
内托羌活汤 治尻肾生痈，坚硬肿痛。
羌活 黄柏（酒制。各一钱） 防风 本 当归尾（各五分） 肉桂 连翘 甘草（炙） 苍术 陈皮（各三分）
黄 （八分）
上作二剂，水一杯煎，空心服。
仙方活命饮
托里消毒散
托里散（三方见热毒疮疡）
神效解毒散（方见臂痈）
加味八味丸（方见作渴）
八珍汤（方见发热不止）
葱熨法（方见流注）
Buttock carbuncle (Tun Yong) is attributed to damp-heat in the Bladder Meridian or congenital Yin deficiency. If there is swelling, hardness, and pain, Neituo Qianghuo Tang (Internal Supportive Decoction with Notopterygium) should be used. If there is slight swelling and slight pain, Tuoli Xiaodu San (Supporting Interior Powder for Detoxification) should be used. If severe pain occurs at the onset, or within five days where the condition seems to resolve but does not, nor seems to suppurate but does not, Xianfang Huoming Yin (Immortal Formula for Life Preservation Decoction) should be used first, followed by Tuoli Xiaodu San. If it has already ulcerated, accompanied by poor appetite, fatigue, and failure of the sore to generate flesh, indicating Spleen-Stomach deficiency, Wuwei Yigong San (Five-Ingredient Decoction for Extraordinary Merit) with Chaihu (Bupleurum Root) and Shengma (Cimicifugae Rhizoma) should be used. For those with congenital Yin deficiency presenting with frequent urination and inability to consolidate, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) should be used. For Qi deficiency with prolonged failure to granulate and close the wound, Douchi Bing (Fermented Soybean Cake) applied externally and Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) taken internally should be used to nourish Yuan Qi (Primordial Qi). If heat-clearing and toxin-attacking methods are employed, or cold-natured agents are applied topically, it will injure Qi and Blood, inevitably leading to Bai Zheng (failure syndrome/necrosis).
A child suffered from this condition; the area was swollen, hard, and non-red for over ten days, with a red yet sallow complexion and reduced food intake. This indicated Spleen Qi deficiency. Initially, Yigong San was administered. As food intake gradually increased and diffuse swelling subsided, Tuoli San was used with a small addition of Rougui (Cinnamon Bark), leading to suppuration. Subsequently, Bazhen Tang (Eight-Treasure Decoction) was used to promote healing.
Another child suffered from this condition with prolonged failure to heal. The surrounding tissue was slightly dark, the wound mouth black, with thin purulent discharge, chills and fever, afternoon tidal fever, and a floating and rapid pulse. The Cun positions on both wrists were imperceptible upon pressure. This indicated Yang Qi deficiency and Yin Blood weakness. Bu Zhong Yi Qi Tang was administered in the morning, and Yigong San in the evening. Recovery occurred after half a year.
Yet another child had an ulcerated buttock sore that failed to heal, with intermittent facial flushing. This was due to congenital Liver-Kidney Yin deficiency. Bazhen Tang with Wuweizi (Schisandra Fruit) was administered in the morning, and Jiaban Bawei Wan in the evening. Symptoms gradually receded. Tuoli San was then used intermittently, resulting in recovery.
Another child had a buttock sore that failed to heal for a long time, accompanied by limb fatigue, afternoon fever, and thirst. This indicated deficiency of the Three Yin Meridians of the Foot. Wuwei Yigong San and Jiaban Bawei Wan were used to achieve gradual improvement, followed by Tuoli San to promote closure.
Another child suffered from buttock carbuncle with prolonged failure to granulate and a sallow complexion. The parents desired to use toxin-attacking methods to promote healing. I stated: The Spleen governs muscles; when the Spleen is robust, flesh grows. Thus, Bu Zhong Yi Qi Tang was administered in the morning, Wuwei Yigong San and Congyun Fa (Scallion Moxibustion Method) in the evening. With strengthened Spleen Qi and regenerated muscle, the child recovered.
Another child presented with persistent swelling and hardness without color change in the skin. This was due to deficient and timid Spleen-Stomach Qi, unable to transport therapeutic effects to the affected area. Bu Zhong Yi Qi Tang was administered in the morning, and Wuwei Yigong San in the evening, to support the deficient Qi. Resolution occurred after more than a month. At that time, others suffering from the same condition who used topical cold-cooling herbs and internal Xijiao Wan (Rhinoceros Horn Pill) all suffered harm.
A fifteen-year-old child had a chronic condition that failed to heal, presenting with fever, emaciation, pale complexion, and belching. Having strictly consumed digestive-promoting and heat-clearing medicines, I diagnosed Heart Fire deficiency and weak Spleen Qi. Bawei Wan was used as the principal formula, assisted by Liujunzi Tang (Six-Gentlemen Decoction) and Bu Zhong Yi Qi Tang, leading to recovery. After marriage, the child developed a carbuncle between the buttocks, characterized by diffuse swelling, hardness, unchanged skin color, cold hands and feet, and a floating and large pulse that became minute upon pressure, especially at the Chi positions. Four doses of Bawei Wan decoction material were administered first, followed by Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction). The lesion returned to normal color and subsided.
Neituo Qianghuo Tang treats carbuncles arising in the sacral and renal regions, presenting with hardness, swelling, and pain.
Qianghuo (Notopterygii Rhizoma et Radix), Huangbai (Phellodendri Cortex, wine-processed, each 1 qian), Fangfeng (Saposhnikoviae Radix), Bencao (Ligustici Rhizoma et Radix), Dangguiwei (Angelicae Sinensis Radix, tail, each 5 fen), Rougui (Cinnamon Bark), Lianqiao (Forsythiae Fructus), Gancao (Licorice Root, honey-fried), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium, each 3 fen), Huangqi (Astragali Radix, 8 fen).
Prepare two doses. Decoct in one cup of water. Take on an empty stomach.
Xianfang Huoming Yin
Tuoli Xiaodu San
Tuoli San (See "Heat-Toxin Carbuncles and Ulcers" for the above three formulas)
Shenxiao Jiedu San (See "Arm Carbuncle" for formula)
Jiaban Bawei Wan (See "Thirst" for formula)
Bazhen Tang (See "Unceasing Fever" for formula)
Congyun Fa (See "Liuzhu/Metastatic Abscesses" for method)