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[Verse] "Zuoban Chuang" (Saddle Sore) arises on the buttocks and thighs, resembling millet grains or beans in shape, accompanied by itching, redness, swelling, and pain. This is caused by the condensation of summer heat, dampness, and toxic heat within the muscles. Initially, it is advisable to use scalding washes and the method of burning oil-soaked cotton wicks for fumigation.

[Annotation] This condition is also known as "Feng Gan" (Wind Chancre). It occurs between the buttocks and thighs, appearing like millet grains or beans, with red coloration and itching. In severe cases, it presents with intense redness, swelling, and pain, potentially spreading to the anal region, feeling as if burning. The etiology involves sitting on furniture heated by the sun during summer, or remaining seated for long periods in cold, damp places, leading to the stagnation of summer heat, dampness, and toxic heat in the muscles. For initial treatment, a decoction of Daphne Genkwa Flower (Yuanhua), Sichuan Pepper (Chuanjiao), and Phellodendron Bark (Huangbai) should be used for scalding washes, which can resolve the condition. If the toxicity is severe and itching/pain persist, take a strip of green cloth from an oil vat, approximately three fingers wide. Mix one qian of Realgar powder (Xionghuang) with sesame oil, spread it on the cloth, ignite it, blow out the flame, and hold it near the sore to fumigate. This will immediately stop the itching and pain and is highly effective.

[Verse] "Fugu Ju" (Bone-Adhering Carbuncle) arises on the lateral side of the thigh, while "Yaogu Ju" (Bone-Biting Carbuncle) arises on the medial side. In individuals with weak constitutions, cold-dampness invades due to deficiency. Symptoms include alternating chills and fever without redness; pain is severe, penetrating to the bone, making flexion and rotation difficult. If cold-dampness transforms into heat, swelling becomes prominent. Garlic moxibustion causing blisters indicates a favorable prognosis; absence of blisters indicates an unfavorable one. After ulceration, the discharge of foul, watery pus is strictly contraindicated as a sign of deterioration.

[Annotation] These two conditions occur on the medial and lateral aspects of the thigh. The lateral aspect belongs to the Foot-Yang meridians, while the medial aspect belongs to the Foot-Yin meridians. Fugu Ju occurs on the lateral thigh, and Yaogu Ju occurs on the medial thigh. These arise in individuals with weak constitutions who sleep exposed to wind and cold, cool off after bathing, suffer cold-damp invasion, or have insufficient covering after sexual activity, allowing cold pathogens to invade the interior due to deficiency. Initially, patients feel alternating chills and fever, similar to a wind-cold common cold, followed by bone and tendon pain without heat or redness. Severe cases experience pain like needle pricks, with inability to flex or extend the limbs. Over time, extreme Yin generates Yang; stagnant cold transforms into heat. Excessive heat corrupts flesh into pus. Externally, there is diffuse swelling without a distinct head, skin color remains normal, but gradually a bright red spot appears, indicating internal pus formation.

For treatment at the initial stage with alternating chills/fever and mild pain, administer Wanling Dan (Ten Thousand Spirits Pill). For severe pain, administer Wuji San (Five Accumulations Powder) added with Achyranthes Root (Niuxi) and Safflower (Honghua). Apply Leihuo Zhen (Thunder-Fire Needle) acupuncture at the painful site to induce sweating, dispel cold, and unblock meridians. Once pus forms, incise and drain. Post-ulceration management follows the principles of the Ulcer Section.

If diffuse swelling and pain occur in the sacral/buttock region, administer Neituo Qianghuo Tang (Supporting Interior Decoction with Notopterygium). If occurring on the medial thigh near the knee, involving the Foot-Taiyin Spleen and Foot-Jueyin Liver meridians, administer Neituo Huangqi Tang (Supporting Interior Decoction with Astragalus). If occurring on the lateral thigh, involving the Foot-Shaoyang Gallbladder meridian, administer Neituo Jiu Jian Tang (Supporting Interior Wine-Decoction). If occurring on the anterior thigh, involving the Yangming Stomach meridian, accompanied by headache, dizziness, vomiting, anorexia, chest fullness, irritability, and heat, administer Fuling Zuojing Tang (Poria Meridian-Assisting Decoction). If occurring on the medial thigh, involving the Taiyin Spleen meridian, accompanied by joint redness/swelling/pain, limb stiffness, spontaneous sweating, shortness of breath, dysuria, and edema of hands/feet, administer Fuzi Liuwu Tang (Aconite Six-Ingredient Decoction). If occurring on the posterior thigh, involving the Foot-Taiyang Bladder meridian, accompanied by leg/foot spasms/numbness, heavy/joint pain, aversion to cold with fever, anhidrosis, aversion to wind, or headache, administer Mahuang Zuojing Tang (Ephedra Meridian-Assisting Decoction).

If there is deficiency of the Three Yin meridians and excess external pathogens, causing generalized thigh swelling with unchanged skin color, increasing pain, neither resolving nor suppurating, this belongs to deficiency-cold and cold bones. Urgently administer Dafangfeng Tang (Great Wind-Expelling Decoction) to tonify deficiency and expel cold. If resolution fails over time and suppuration is imminent, apply garlic-slice moxibustion externally. Blister formation and audible popping sounds during moxibustion are auspicious; absence of blisters and lack of perceived heat in the bone indicate adverse signs. Post-moxibustion, administer Shiquan Dabu Tang (Complete Ten Tonifying Decoction) added with Niuxi, Qianghuo, and Paeonia Lactiflora Root (Fangji), or Bazhen Tang (Eight Treasures Decoction) added with Aconite Root (Fuzi) to tonify and support expulsion. When pus forms with distending pain, puncturing to release sticky white pus is favorable; discharge of white serous fluid or bean-jelly-like liquid constitutes foul pus, indicating a critical condition. Post-ulceration management for all these conditions follows the Carbuncle/Ulcer Section.

All above conditions stem from deep-seated cold and stubborn chill. External applications and internal medicines must not use bitter-cold herbs that damage the Spleen and deplete Qi. Violation leads to ice-like coagulation of Qi and Blood, internal tissue necrosis, eventual conversion to watery discharge, resulting in incurable disease. According to *Zhunsheng* and other texts: After sweating therapy for Cold Damage, residual pathogens become Liuzhu (Flowing Deposits); bad outcomes of Liuzhu become Fugu Ju. However, post-sweating Liuzhu is easy to cure; only mismanagement leads to bad outcomes that cannot regenerate, seemingly unable to transform into Fugu Ju. Moreover, Fugu Ju is curable with proper regulation. If it undergoes multiple transformations, it becomes worse again! How could success be achieved? Thus, the theory that bad Liuzhu transforms into Fugu Ju should be retained but not discussed further.

Formula: Leihuo Shen Zhen (Thunder-Fire Divine Needle)
Composition: Qiai (Mugwort from Qichun) (3 qian), Dingxiang (Clove) (5 fen), Shexiang (Musk) (2 fen).
Mix herbs with mugwort. Spread evenly on a sheet of interleaf paper, roll tightly finger-thick, and store. For use, place seven layers of paper on the affected area. Light one end of the needle, press firmly against the paper over the lesion until pain subsides, then remove. For severe cases, repeat once. After seven days, significant fire-blister eruption occurs, yielding excellent results.

[Verse] Thunder-Fire Divine Needle attacks cold-dampness; suitable for needling pain in Fugu Ju. Clove and Musk combined with Qiai; igniting the needle at the painful site yields miraculous efficacy.

Another Formula: Neituo Huangqi Tang (Supporting Interior Decoction with Astragalus)
Composition: Huangqi (Astragalus Root) (salt-water mixed, stir-fried), Danggui (Angelica Sinensis Root), Mugua (Chaenomeles Fruit), Lianqiao (Forsythia Fruit) (core removed), Chaihu (Bupleurum Root) (each 1 qian), Qianghuo (Notopterygium Rhizome), Rougui (Cinnamon Bark), Shengdi (Rehmannia Root), Huangbai (Phellodendron Bark) (each 5 fen).
Decoct with one zhong of wine and one zhong of water until one zhong remains. Take hot on an empty stomach.

[Verse] Neituo Huangqi Tang contains Danggui and Mugua, plus Qianghuo, Chaihu, Lianqiao, Rougui, Shengdi, and Huangbai. Suitable for carbuncles on knees and thighs involving Liver and Spleen meridians; best taken with wine and water decoction.

Another Formula: Neituo Jiu Jian Tang (Supporting Interior Wine-Decoction)
Composition: Danggui (Angelica Sinensis Root), Huangqi (Astragalus Root) (each 2 qian), Chaihu (Bupleurum Root) (1.5 qian), Dalizi (Arctium Fruit), Lianqiao (Forsythia Fruit) (core removed), Rougui (Cinnamon Bark) (each 1 qian), Shengma (Cimicifuga Rhizome), Huangbai (Phellodendron Bark), Gancao (Licorice Root) (each 5 fen).
Decoct with one zhong of wine and one zhong of water until one zhong remains. Take before meals.

[Verse] Neituo Jiu Jian Tang addresses pre-meal cold-damp condensation; Fugu Ju arising in the lateral thigh Shaoyang meridian. Contains Danggui, Huangqi, Dalizi, Chaihu, Lianqiao, Rougui, plus Shengma, Huangbai, Gancao; flexible efficacy with wine/water.

Another Formula: Fuling Zuojing Tang (Poria Meridian-Assisting Decoction)
Composition: Baifuling (Poria), Cangzhu (Atractylodes Rhizome) (stir-fried with rice washing water), Chenpi (Citrus Reticulata Peel), Baizhu (Atractylodes Macrocephala Rhizome) (soil-stir-fried), Banxia (Pinellia Tuber) (processed, each 1 qian), Houpo (Magnolia Bark) (ginger-stir-fried), Mugua (Chaenomeles Fruit), Chaihu (Bupleurum Root), Huoxiang (Patchouli Herb), Zexie (Alisma Rhizome), Gegen (Pueraria Root), Gancao (Licorice Root) (each 5 fen).
Add three slices of fresh ginger. Decoct two zhongs of water until eight fen remain. Take before meals.

[Verse] Fuling Zuojing Tang treats Foot-Yangming meridian issues; thigh redness/swelling/pain with irritability and heat. Based on Pingwei San (Calm the Stomach Powder) with Cangzhu, Houpo, Chenpi, plus Mugua, Chaihu, Baizhu, Banxia, Huoxiang, Zexie, Ginger, and Gegen for meridian guidance.

Another Formula: Fuzi Liuwu Tang (Aconite Six-Ingredient Decoction)
Composition: Fuzi (Prepared Aconite Lateral Root), Gancao (Licorice Root) (each 1 qian), Fangji (Stephania Root), Baizhu (Atractylodes Macrocephala Rhizome) (soil-stir-fried), Baifuling (Poria), Guizhi (Cinnamon Twig) (each 8 fen).
Add three slices of fresh ginger. Decoct two zhongs of water until eight fen remain. Take well after meals.

[Verse] Fuzi Liuwu Tang treats Wind-Cold-Dampness flowing into the Spleen meridian; indicated for limb stiffness and joint pain. Contains Fangji, Baizhu, Gancao, Fuling, Guizhi.

Another Formula: Mahuang Zuojing Tang (Ephedra Meridian-Assisting Decoction)
Composition: Mahuang (Ephedra Stem), Cangzhu (Atractylodes Rhizome) (soaked in rice water, stir-fried), Fangfeng (Saposhnikovia Root), Fangji (Stephania Root), Qianghuo (Notopterygium Rhizome), Baifuling (Poria), Gegen (Pueraria Root) (each 1 qian), Guixin (Cinnamon Heart), Gancao (Licorice Root, raw), Xixin (Asarum Root) (each 5 fen).
Add three slices of fresh ginger and two dates (pulp). Decoct two zhongs of water until eight fen remain. Take before meals.

[Verse] Mahuang Zuojing Tang treats Foot-Taiyang meridian injury from Wind-Cold-Dampness. Contains Cangzhu, Fangfeng, Fangji, Qianghuo, Guixin, plus Fuling, Gancao, Xixin, Gegen, Dates, and Ginger.

Another Formula: Dafangfeng Tang (Great Wind-Expelling Decoction)
Composition: Renshen (Ginseng Root) (2 qian), Fangfeng (Saposhnikovia Root), Baizhu (Atractylodes Macrocephala Rhizome) (soil-stir-fried), Huangqi (Astragalus Root), Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), Danggui (Angelica Sinensis Root), Shudi (Prepared Rehmannia Root), Baishao (White Peony Root) (wine-stir-fried), Chuanxiong (Ligusticum Rhizome), Qianghuo (Notopterygium Rhizome), Gancao (Licorice Root), Fuzi (Prepared Aconite Lateral Root) (each 1 qian).
Add three slices of fresh ginger. Decoct two zhongs of water until eight fen remain. Take before meals.

[Verse] Dafangfeng Tang treats injury from Cold Pathogens; Fugu Ju swelling with normal skin color. Contains Renshen, Baizhu, Huangqi, Niuxi, Duzhong, Siwu Tang (Four Substances: Danggui, Shudi, Baishao, Chuanxiong), Qianghuo, Gancao, Fuzi, and Ginger.

Other Formulas Referenced:
Wanling Dan (See Swollen Ulcer Section)
Neituo Qianghuo Tang (See Buttock Upper Horse Carbuncle)
Ge Suan Jiu Fa (Garlic-Slice Moxibustion Method) (See First Volume Moxibustion Methods)
Shiquan Dabu Tang, Bazhen Tang (See Ulcer Section)
Wuji San (See Internal Carbuncles - Kidney Carbuncle)