【方歌】五藏皆可发疔疮,现于形体细考详,若论阴阳分上下,
欲知经藏辨何方。
疔名火焰发心经,往往生于唇指中,心作烦时神恍惚,
痛兼麻痒疱黄红。
毒发肝经名紫燕,此患多于筋骨见,破流血水烂串筋,
指青舌强神昏乱。
黄鼓由于脾发毒,多生口角与颧骨,疱黄光润红色缠,
麻痒硬僵兼呕吐。
毒发肺经名白刃,白疱顶硬根突峻,易腐易陷多损腮,
咳吐痰涎气急甚。
从来黑靥发肾经,黑斑紫疱硬如钉,为毒极甚疼牵骨,
惊悸沈昏目露睛。
以上五疔应五藏,又有红丝疔一样,初如小疮渐发红,
最忌红丝攻心上。
凡治疔证贵乎早,三阴三阳更宜晓,在下宜灸上宜针,
速医即愈缓难保。
【注】此数证俱名曰疔。盖疔者,如丁钉之状,其形小,其根
深,随处可生。由恣食厚味,或中蛇蛊之毒,或中疫死
牛、马、猪、羊之毒,或受四时不正疫气,致生是证。
夫疔疮者,乃火证也。迅速之病,有朝发夕死,随发随
死,三、五日不死,一月半月亦必死,此系藏府之乖逆
,性情之激变,节候之寒温肃杀,且毒中有浅深也,若
一时失治,立判存亡。有名为火焰疔者,多生于唇、口
及手掌指节间,初生一点红黄小疱,痛痒麻木;甚则寒
热交作,烦燥舌强,言语疏忽,此属心经毒火而成也。
有名为紫燕疔者,多生于手、足、腰、肋筋骨之间,初
生便作紫疱,次日破流血水,三日后串筋烂骨,甚则目
红甲青,邪视神昏、睡语惊惕,此属肝经毒火而成也。
有名为黄鼓疔者,初生黄疱,光亮明润,四畔红色缠绕
,多生口角、腮、颧、眼胞上下,及太阳正面之处,发
时便作麻痒,重则恶心呕吐,肢体木痛,寒热交作,烦
渴干哕,此属脾经毒火而成也。有名为白刃疔者,初生
白疱,顶硬根突,破流脂水,痒痛兼作,多生鼻孔、两
手,易腐易陷,重则腮损咽焦,欬吐痰涎,鼻掀气急,
此属肺经毒火而成也。有名为黑靥疔者,多生耳窍、牙
缝、胸腹、腰肾偏僻之处,初生黑斑紫疱,毒串皮肤,
渐攻肌肉,顽硬如丁,痛彻骨髓,重则手足青紫,惊悸
沈困,软陷孔深,目睛透露,此属肾经毒火而成也。以
上五疔,本于五藏而生。
又有红丝疔,发于手掌及骨节间,初起形似小疮,渐发
红丝,上攻手膊,令人寒热往来,甚则恶心呕吐,治迟
者,红丝攻心,常能坏人。又有暗疔,未发而腋下先坚
肿无头,次肿阴囊睾丸,突兀如筋头,令人寒热拘急,
焮热疼痛。又有内疔,先发寒热腹痛,数日间,忽然肿
起一块如积者是也。又有羊毛疔,身发寒热,状类伤寒
但前心、后心有红点,又如疹形,视其斑点,色紫黑者
为老,色淡红者为嫩。以上诸证,初起俱宜服蟾酥丸汗
之;毒势不尽,情寒壮热仍作者,宜服五味消毒饮汗之
。如发热,口渴,便闭,脉沈实者,邪在里也,宜服黄
连解毒汤加生大黄一钱五分,葱头五个清之。凡证轻者
,宜服化疔内消散;若疔毒将欲走黄,急服疔毒复生汤
;已走黄者,令人心烦昏愦,急用七星剑汤以救之。若
手足冷,六脉暴绝者,系毒气闭塞,元气不能宣通,先
宜蟾酥丸,随服木香流气饮行气,其脉自见。若疔毒误
灸,烦躁谵语者,乃逼毒内攻也,宜服解毒大青汤。若
溃后余毒未尽,五心烦热者,宜服人参清神汤。针后出
脓之时,气虚惊悸者,宜服内托安神散。若攻利太过,
以致发渴、六脉虚大者,宜服补中益气汤。若发汗之后
,汗不止,热不退,疮不疼,便不利者,此属里虚,宜
服八珍汤加黄耆、麦冬治之。凡疔溃后不宜补早,虽见
真虚,只可平补,忌用温补之药。
外治用药、针灸,亦当循其次第。书云:疔疮先刺血,
内毒宜汗泻,禁灸不禁针,怕绵不怕铁。初觉贵乎早治
,十证十全;稍迟者,十全五六;失治者,十坏八九。
初发项以上者,三阳受毒,必用铍针刺入疮心四、五分
,挑断疔根,令出恶血;随用立马回疔丹,或蟾酥条插
入孔内,外以巴膏盖之。如项以下生者,三阴受毒,即
当艾灸以杀其势,灸之不痛,亦须针刺出血,插蟾酥条
,旁肿以离宫锭涂之。如旁肿顽硬,推之不动,用针乱
刺顽硬之处,令多出恶血,否则必致走黄。挑法:先用
针干将毒顶焦皮刮开,针入疔根,坚硬如针者为顺;若
针刺入,绵软如瓜穣而不知痛者为逆,百无一生。凡挑
疔根先出紫黑血,再挑刺至鲜血出,以知痛为止;随填
拔疔散令满,以万应膏盖之,过三、四时,拨去旧药,
易以新药;若药干无水不痛者,此挑法未断疔根也,再
深挑之,必以上药知痛,药入水流为率;三、四日后,
疮顶干燥,以琥珀膏贴之,令疔根托出,换九一丹撒之
,黄连膏抹之,外盖白膏药生肌敛口。若初起失治,或
房劳、梦遗损气,以致毒气内攻,走黄不住者,其疮必
塌陷,急当随走黄处,按经找寻,有一芒刺直竖,即是
疔苗,急当用铁针刺出恶血,即在刺处用艾壮灸三壮,
以宣余毒。若身面漫肿,神昏闷乱,干呕心烦作渴,遍
身起疱抽搐者,俱为逆证。惟红丝疔于初起时,急用磁
针于红丝尽处,砭断出血;寻至初起疮上挑破,即用蟾
酥条插入,万应膏盖之,随服黄连解毒汤。
再暗、内二疔,不用挑法,先以蟾酥丸含化令尽,以冷
水漱去毒涎,再用三丸嚼葱白三寸,裹药黄酒送下,盖
卧出汗;少时无汗,再饮热酒催之;仍无汗,系毒热滞
结,急用霹雳火法令汗出,毒热随之而解。次用双解贵
金丸下之自效。若暗、内二疔,初起牙关紧急者,用蟾
酥丸三、五粒,葱头煎汤研化灌之;俟稍苏,治法如前
。
至羊毛疔,先将紫黑斑点,用衣针挑出如羊毛状,前后
心共挑数处,用黑豆、荞麦研粉涂之,实时汗出而愈。
一法:用明雄黄末二钱,青布包扎,蘸热烧酒于前心擦
之,自外圈入内,其毛即奔至后心,再于后心擦之,其
羊毛俱拔出于布上,埋之,忌茶水一日。
再诸疔部位、形色,亦有急缓,生于头、项胸背者最急
,生于手、足骨节之间者稍缓。一疔之外别生一小疮,
名曰应候;四围赤肿而不散漫者,名曰护场;四旁多生
小疮者,名曰满天星;有此者缓,无此者急。疔证初起
,至四、五日间,由白色而至青紫色,疔头溃脓,形似
蜂窝,内无七恶等证者为顺;若初起似疔非疔,灰色顶
陷如鱼脐,如蚕斑,青紫黑疱,软陷无脓,内见七恶等
证者为逆。凡疔毒俱由火毒而生,忌服辛热之药,恐反
助其邪也;忌敷寒凉之药,恐逼毒攻里也。再膏药不宜
早贴,惟在将溃己溃时贴之,呼脓长肉,以避风寒。初
溃时,忌用生肌药,恐毒未除,反增溃烂。生项以上者
,属三阳经,不宜灸,若火日生疔,亦禁灸,犯之或为
倒陷,或至走黄。俱忌椒、酒、鸡、鱼、海味、鹅肉、
猪首、辛辣、生冷等物,气怒、房劳、诸香并孝服、经
妇、僧道、鸡犬等项,犯之必致反复,慎之。
方剂:蟾酥丸
组成:蟾酥(酒化,二钱) 轻粉
铜录 枯矾
寒水石(〔火段〕) 胆矾
乳香 没药
麝香(各一钱) 朱砂(三钱)
雄黄(二钱) 蜗牛(二十一个)
以上各为末,称准,于端午日午时,在净室中先将
蜗牛研烂,同蟾酥和研稠粘,方入各药,共捣极匀,丸
如绿豆大。每服三丸,用葱白五寸,令患者嚼烂,吐于
手心内,男用左手,女用右手,将药丸裹入葱泥内,用
无灰热酒一茶钟送下;被盖约人行五、六里路,病者出
汗为度;甚者,再用一服。如外用之法,搓条作饼,随
证用之。修合时,忌妇人、鸡、犬等见之。
【方歌】蟾酥丸治诸疔毒,初起恶疮皆可逐,外用化腐又消坚,
内服驱毒发汗速。朱砂轻粉麝雄黄,铜绿枯矾寒水入,
胆矾乳没共蜗牛,丸如绿豆葱酒服。
又方:五味消毒饮
组成:金银花(三钱) 野菊花
蒲公英 紫花地丁
紫背天葵子(各一钱二分)
水二钟,煎八分,加无灰酒半钟,再滚二、三沸时
热服。渣,如法再煎服,被盖出汗为度。
【方歌】五味消毒疗诸疔,银花野菊蒲公英,紫花地丁天葵子,
煎加酒服发汗灵。
又方:化疔内消散
组成:知母 贝母(去心,研)
穿山甲(炙,研) 蚤休
白芨 乳香
天花粉 皂刺
金银花 当归
赤芍 甘草(生,各一钱)
酒、水各一钟,煎一钟,去渣,量病上、下服之。
【方歌】化疔内消知贝甲,蚤休芨乳草天花,皂刺银花归芍酒,
疔证毒轻服更嘉。
又方:疔毒复生汤
组成:金银花 栀子(生,研)
地骨皮 牛蒡子(炒,研)
连翘(去心) 木通
牡蛎(〔火段〕) 生军
皂刺 天花粉
没药 乳香(各八分)
酒、水各一钟,煎一钟,食远服。不能饮酒者,只
用水煎,临服入酒一杯,和服亦效。脉实便秘者,加朴
硝。
【方歌】疔毒复生欲走黄,头面肿浮毒内伤,银栀骨蒡翘通蛎,
军刺天花没乳香。
又肮:七星剑
组成:苍耳头 野菊花
豨莶草 地丁香
半枝连(各三钱) 蚤休(二钱)
麻黄(一钱)
用好酒一斤,煎至一碗,澄去渣热服,被盖出汗为
度。
【方歌】七星剑呕热兼寒,疔毒走黄昏愦添,麻黄苍耳菊豨莶,
地丁香蚤半枝连。
又方:木香流气饮
组成:当归 白芍(酒炒)
川芎 紫苏
桔梗 枳实(麸炒)
乌药 陈皮
半夏白茯苓 黄耆
防风 青皮(各一钱)
大腹皮 槟榔
枳壳(麸炒) 泽泻
甘草节 木香(末,各五分)
生姜三片,红枣肉二枚,水煎服。下部加牛膝。
【方歌】木香流气宣气滞,归芍芎苏桔枳实,乌药二陈耆大腹,
风榔青枳泻煎之。
又方:解毒大青汤
组成:大青叶 木通
麦门冬(去心) 人中黄
栀子(生,研) 桔梗
元参 知母
升麻 淡竹叶
石膏(〔火段〕,各一钱)
水二钟,灯心二十根,煎八分,食远服。
大便秘加大黄,闷乱加烧人粪。
【方歌】解毒大青过麦门,中黄栀子桔元参,知升竹叶石膏〔火
段〕,疔疮误灸毒内侵。
又方:人参清神汤
组成:人参 陈皮
白茯苓 地骨皮
麦门冬(去心) 当归
白术(土炒) 黄耆
远志(去心,各一钱) 柴胡
黄连 甘草(炙,各五分)
水二钟,粳米一撮,煎八分,食远服。
【方歌】人参清神疔毒溃,陈苓地骨麦冬归,尤耆柴远黄连草,
益气除烦热可推。
又方:内托安神散
组成:人参 麦门冬(去心)
茯神 黄耆
白术(土炒) 元参
陈皮(各一钱) 石菖蒲
甘草(炙) 酸枣仁(炒,研)
远志(去心) 五味子(研,各五分)
水二钟,煎八分,临服入朱砂末三分和匀,食远服
。
【方歌】内托安神多惊悸,疔疮针后元气虚,参麦茯菖耆术草,
元参枣远味陈皮。
又方:立马回疔丹
组成:轻粉 蟾酥(酒化)
白丁香 硵砂(各一钱)
乳香(六分) 雄黄
朱砂 麝香(各三分)
蜈蚣(炙,一条) 金顶砒(注末卷,五分)
共为细末,面糊搓如麦子大。凡遇疔疮,以针挑破
,用一粒插入孔内,外以膏盖,追出脓血疔根为效。
【方歌】立马回疔轻蟾酥,白丁香乳麝雄朱,硵蜈金顶砒研末,
疔疮用此根自除。
又方:九一丹
组成:石膏(〔火段〕,九钱) 黄灵药(一钱)
共研极细,撒于患处。
【方歌】九一丹医疔破后,根除用此把脓搜,〔火段〕石膏对黄
灵药,清热生肌患自瘳。
又方:霹雳火
组成:鹅卵石烧红,安铁杓内,杓安桶内,以醋淬石,令患者
将患处覆桶上,厚衣密盖,勿令泄气,热气微再添红石
,加醋淬之,疮头及肿处,使热气熏蒸至汗出,其毒减
半。
又方:黄连解毒汤(见耳部黑疔)
补中益气汤、八珍汤、巴膏、万应膏、白膏药、黄灵药
(俱见溃疡门)
离宫锭、双解贵金丸(俱见肿疡门)
拔疔散(见齿部牙疔)
珀琥膏(见头部发际疮)
黄连膏(见鼻部鼻疮)
[Verse] Carbuncles (Ding Chuang) can arise from any of the Five Zang Organs; examine the physical manifestations carefully. To distinguish Yin and Yang, upper and lower, and to know which meridian and organ is involved for appropriate prescription selection.
Flame Carbuncle (Huo Yan Ding) originates from the Heart Meridian, often occurring on the lips or fingers. When affected by the Heart, symptoms include restlessness and mental confusion, with pain accompanied by numbness and itching, and blisters appearing yellow or red.
Purple Swallow Carbuncle (Zi Yan Ding) results from toxicity in the Liver Meridian, commonly seen in areas of tendons and bones. Upon rupture, it bleeds and discharges fluid, corroding tendons, accompanied by cyanosis of the fingers, stiff tongue, and mental confusion.
Yellow Drum Carbuncle (Huang Gu Ding) stems from toxicity in the Spleen Meridian, frequently arising at the corners of the mouth and zygomatic bones. The blisters are yellow, shiny, and moist, surrounded by redness, with symptoms of numbness, itching, stiffness, and vomiting.
White Blade Carbuncle (Bai Ren Ding) arises from the Lung Meridian, characterized by white blisters that are hard at the apex and prominent at the base. It is prone to ulceration and sinking, often damaging the cheeks, accompanied by coughing up phlegm and severe shortness of breath.
Black Crust Carbuncle (Hei Ye Ding) originates from the Kidney Meridian, presenting as black spots and purple blisters, hard as a nail. The toxicity is extreme, causing pain radiating to the bones, palpitations, deep coma, and protruding eyes.
The above five carbuncles correspond to the Five Zang Organs. There is also the Red Thread Carbuncle (Hong Si Ding), which initially resembles a small sore but gradually turns red. The most critical danger is the red thread advancing towards the heart.
In treating carbuncles, early intervention is crucial. One must understand the distinctions among the Three Yin and Three Yang meridians. Lower body lesions are suitable for moxibustion, while upper body lesions are suitable for acupuncture. Prompt treatment leads to recovery; delay may result in death.
[Annotation] These conditions are collectively termed "Carbuncles" (Ding). A carbuncle resembles a nail: small in size but deep-rooted, capable of arising anywhere. Causes include indulgence in rich and greasy foods, poisoning from snakes or gu, exposure to toxins from livestock (cattle, horses, pigs, sheep) that died of epidemic diseases, or invasion by pathogenic factors from abnormal seasonal climates.
Carbuncles belong to Fire syndromes. They are rapid-onset diseases; some may cause death from morning to evening, or immediately upon onset. If survival extends beyond three to five days, death is still inevitable within a month or half a month. This results from disharmony of the Zang-Fu organs, extreme emotional changes, climatic influences, and varying depths of toxicity. Failure to treat promptly can be fatal.
Flame Carbuncle (Huo Yan Ding) typically occurs on the lips, mouth, and finger joints. Initially, a small red-yellow blister appears with pain, itching, and numbness. Severe cases present with alternating chills and fever, irritability, stiff tongue, and slurred speech, caused by toxic fire in the Heart Meridian.
Purple Swallow Carbuncle (Zi Yan Ding) usually arises between the tendons and bones of the hands, feet, waist, and ribs. It begins as a purple blister, bleeding and discharging fluid the next day, and corroding tendons and bones after three days. Severe cases feature red eyes, cyanotic nails, strabismus, coma, sleep talking, and startle, caused by toxic fire in the Liver Meridian.
Yellow Drum Carbuncle (Huang Gu Ding) starts as a bright, smooth yellow blister surrounded by redness, often found at the mouth corners, cheeks, zygomatic bones, eyelids, and temples. Onset involves numbness and itching; severe cases include nausea, vomiting, limb stiffness and pain, alternating chills and fever, thirst, and dry heaving, caused by toxic fire in the Spleen Meridian.
White Blade Carbuncle (Bai Ren Ding) begins as a white blister with a hard apex and prominent base, discharging serous fluid upon rupture, with simultaneous itching and pain. It commonly occurs in the nostrils and hands, prone to ulceration and sinking. Severe cases involve cheek damage, scorched throat, coughing up phlegm, nasal flaring, and tachypnea, caused by toxic fire in the Lung Meridian.
Black Crust Carbuncle (Hei Ye Ding) arises in obscure areas such as ear canals, tooth gaps, chest, abdomen, and kidneys. It starts as black spots and purple blisters, spreading through skin and muscle, becoming hard as a nail with bone-piercing pain. Severe cases present with cyanotic limbs, palpitations, lethargy, deep soft ulcers, and protruding eyes, caused by toxic fire in the Kidney Meridian. These five carbuncles originate from the Five Zang Organs.
Red Thread Carbuncle (Hong Si Ding) appears on the palms and joints, starting as a small sore that develops red threads ascending the arm, causing alternating chills and fever. Severe cases involve nausea and vomiting; delayed treatment allows the red thread to attack the heart, leading to deterioration.
Dark Carbuncle (An Ding) presents with initial induration and swelling without a head in the axilla, followed by swelling of the scrotum and testicles, resembling tendon knots, causing chills, rigidity, burning heat, and pain.
Internal Carbuncle (Nei Ding) begins with chills, fever, and abdominal pain, followed by sudden swelling resembling an accumulation mass.
Wool Carbuncle (Yang Mao Ding) presents with chills and fever similar to Cold Damage, with red spots on the anterior and posterior chest resembling rashes. Dark purple spots indicate advanced stage; pale red spots indicate early stage.
For all these conditions at onset, Chan Su Wan (Toad Venom Pill) should be taken to induce sweating. If toxicity persists with persistent chills and high fever, Wu Wei Xiao Du Yin (Five-Ingredient Decoction for Clearing Toxicity) should be taken to induce sweating.
If fever, thirst, constipation, and deep, solid pulse are present, indicating interior pathogen, Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) plus Sheng Da Huang (Raw Rhizoma Rhei) and Cong Bai (Scallion Stem) should be used to clear heat.
For mild cases, Hua Ding Nei Xiao San (Pill for Dissolving Carbuncles Internally) is indicated. If the carbuncle toxin is about to spread internally (Zou Huang), Ling Du Fu Sheng Tang (Decoction for Reviving Carbuncle Toxicity) should be taken urgently. If Zou Huang has occurred, causing mental confusion and irritability, Qi Xing Jian Tang (Seven-Star Sword Decoction) is used for rescue.
If extremities are cold and pulses vanish, indicating blocked toxicity and impaired Yuan Qi, start with Chan Su Wan, followed by Mu Xiang Liu Qi Yin (Aucklandia Flowing-Qi Decoction) to move Qi, allowing pulses to return.
If moxibustion was mistakenly applied, causing irritability and delirium due to forced internal invasion of toxicity, Jie Du Da Qing Tang (Isatidis Decoction for Detoxification) is indicated.
If residual toxicity remains after ulceration, causing five-palm heat, Ren Shen Qing Shen Tang (Ginseng Decoction for Calming the Spirit) is used.
If Qi deficiency and palpitations occur during pus discharge after acupuncture, Nei Tuo An Shen San (Powder for Supporting Internally and Calming the Spirit) is indicated.
If purgatives were overused, causing thirst and deficient, large pulses, Bu Zhong Yi Qi Tang (Decoction for Tonifying the Middle and Augmenting Qi) is used.
If sweating continues unabated after diaphoresis, with persistent fever, lack of sore pain, and constipation, indicating interior deficiency, Ba Zhen Tang (Eight-Treasure Decoction) plus Huang Qi (Astragalus Root) and Mai Dong (Ophiopogon Tuber) is prescribed.
Post-ulceration, tonification should not be initiated prematurely. Even if true deficiency is evident, only mild tonification is allowed; warm-tonifying herbs are contraindicated.
External treatments, including medication and acupuncture, must follow proper sequence. As stated: "Treat carbuncles by first pricking to bleed, expel internal toxicity via sweating and purging, avoid moxibustion but allow acupuncture, fear cotton but not iron." Early treatment yields full recovery; slight delay yields 50-60% success; missed treatment results in 80-90% failure.
For lesions above the neck, affecting the Three Yang meridians, use a Pi needle to puncture the center 4-5 fen deep, sever the root, and drain foul blood. Apply Li Ma Hui Ding Dan (Instant Return Carbuncle Powder) or insert a Chan Su strip, covering with Ba Gao (Cantharis Plaster).
For lesions below the neck, affecting the Three Yin meridians, apply moxibustion to curb progression. If moxibustion causes no pain, prick to bleed, insert Chan Su strip, and apply Li Gong Ding (Palace Off-Duty Ointment) to surrounding swelling.
If surrounding swelling is hard and immobile, indiscriminate needling is required to drain foul blood; otherwise, Zou Huang (internal spread) will occur.
Picking Method: Scrape off necrotic skin at the apex with a dry needle, insert into the root. Hardness like a needle indicates favorable prognosis; softness like pumpkin pulp without pain indicates unfavorable prognosis with near-zero survival.
Drain purple-black blood first, then pick until fresh blood flows and pain is felt. Fill with Ba Ding San (Carbuncle-Pulling Powder), cover with Wan Ying Gao (Universal Efficacy Plaster). After 3-4 hours, replace old medicine with new. If dry and painless, the root is not severed; pick deeper until pain is felt and fluid flows. After 3-4 days, when the sore dries, apply Hu Po Gao (Amber Plaster) to draw out the root, dust with Jiu Yi Dan (Nine-to-One Powder), smear with Huang Lian Gao (Coptis Plaster), and cover with Bai Gao Yao (White Plaster) to generate flesh and close the wound.
If initial treatment was missed, or sexual exhaustion/Qi loss led to internal toxicity spread and persistent Zou Huang, the sore will sink. Locate the "carbuncle seed" (a vertical thorn-like projection) along the meridian at the site of spread. Prick with an iron needle to drain foul blood, then apply three moxa cones to dissipate residual toxicity.
Generalized swelling, coma, dry heaving, thirst, widespread blisters, and convulsions are adverse signs.
For Red Thread Carbuncle, at onset, use a magnetic needle to prick the end of the red thread to bleed, pick the original sore, insert Chan Su strip, cover with Wan Ying Gao, and take Huang Lian Jie Du Tang.
For Dark and Internal Carbuncles, do not use picking. First, dissolve Chan Su Wan in the mouth, rinse with cold water. Chew three pills with 3-cun scallion white, wrap medicine, swallow with yellow wine, and cover to sweat. If no sweat, drink hot wine to induce it. If still no sweat, toxicity-heat stagnation exists; use Pi Li Huo (Thunderfire) method to induce sweating, resolving toxicity-heat. Follow with Shuang Jie Gui Jin Wan (Double-Resolving Noble Gold Pill) to purge.
If Dark/Internal Carbuncles present with trismus at onset, administer 3-5 pills of Chan Su Wan dissolved in scallion decoction. Once slightly recovered, proceed with previous methods.
For Wool Carbuncle, prick purple-black spots with a clothing needle to extract wool-like material from anterior and posterior chest. Apply powder of black beans and buckwheat. Sweating ensues, leading to cure.
Alternative method: Apply 2 qian of refined Realgar powder wrapped in blue cloth, dipped in hot liquor, rub on anterior chest from outside inwards. The "wool" migrates to the posterior chest. Rub again to extract wool onto cloth. Bury the cloth. Avoid tea and water for one day.
Severity varies by location: Head, neck, chest, and back are most urgent; hands and feet joints are less urgent. A small sore appearing alongside a carbuncle is called "Ying Hou" (Responding Time); red swelling confined around the sore is "Hu Chang" (Protecting Field); multiple small sores around are "Man Tian Xing" (Sky Full of Stars). Presence of these indicates milder course; absence indicates urgency.
By day 4-5, if color changes from white to cyan-purple, pus forms like a honeycomb, and Seven Evil signs are absent, it is favorable. If initial appearance is ambiguous, grey and sunken like fish navel or silkworm spots, with soft, pus-less cyan-purple blisters and Seven Evil signs present, it is adverse.
All carbuncle toxins arise from Fire-Toxicity. Avoid acrid-hot herbs to prevent aiding evil; avoid cold-cooling topical applications to prevent forcing toxicity inward. Plasters should not be applied early; apply only when ulcerating or ulcerated to promote pus discharge and flesh growth while protecting against wind-cold. At initial ulceration, avoid flesh-generating herbs to prevent exacerbating ulceration due to unresolved toxicity.
Lesions above the neck belong to Three Yang meridians and are unsuitable for moxibustion. Carbuncles arising on Fire days are also contraindicated for moxibustion; violation may cause inversion or Zou Huang.
Dietary restrictions include pepper, alcohol, chicken, fish, seafood, goose meat, pig head, spicy, and raw/cold foods. Behavioral restrictions include anger, sexual activity, incense, mourning attire, menstruating women, monks/nuns, chickens/dogs. Violation leads to recurrence; exercise caution.
Formula: Chan Su Wan (Toad Venom Pill)
Composition: Chan Su (Toad Venom, dissolved in wine, 2 qian), Qing Fen (Calomel), Tong Lv (Malachite Green), Ku Fan (Alum), Han Shui Shi (Calcitrite, calcined), Dan Fan (Chalcanthite), Ru Xiang (Frankincense), Mo Yao (Myrrh), She Xiang (Musk, each 1 qian), Zhu Sha (Cinnabar, 3 qian), Xiong Huang (Realgar, 2 qian), Wo Niu (Snail, 21 pieces).
Grind all to powder, weigh accurately. On the noon hour of the Dragon Boat Festival, in a clean room, grind snails into paste, mix with Chan Su until viscous, add other powders, pound uniformly, form pills the size of mung beans. Take 3 pills per dose. Chew 5-cun scallion white, spit into palm, wrap pill in scallion paste (men use left hand, women right), swallow with a cup of unrefined hot wine. Cover with blanket, walk 5-6 li until patient sweats. For severe cases, repeat dose. Externally, roll into strips or cakes as needed. During preparation, avoid exposure to women, chickens, and dogs.
[Verse] Chan Su Wan treats various carbuncle toxins, expelling malignant sores at onset. Externally resolves rot and hardness, internally drives out toxicity and induces sweating rapidly. Cinnabar, calomel, musk, realgar, malachite green, alum, calcitrite, chalcanthite, frankincense, myrrh, and snails form pills swallowed with scallion and wine.
Another Formula: Wu Wei Xiao Du Yin (Five-Ingredient Decoction for Clearing Toxicity)
Composition: Jin Yin Hua (Honeysuckle Flower, 3 qian), Ye Ju Hua (Wild Chrysanthemum Flower), Pu Gong Ying (Dandelion), Zi Hua Di Ding (Viola Yedoensis), Zi Bei Tian Kui Zi (Basella Alba Seed, each 1.2 qian).
Boil 2 zhong of water to 0.8 zhong, add 0.5 zhong unrefined wine, boil 2-3 times, take hot. Dregs boiled again similarly. Cover to sweat.
[Verse] Wu Wei Xiao Du Yin treats various carbuncles, Honeysuckle, wild chrysanthemum, dandelion, Viola, Basella seeds. Boil with wine for effective sweating.
Another Formula: Hua Ding Nei Xiao San (Powder for Dissolving Carbuncles Internally)
Composition: Zhi Mu (Anemarrhena Rhizome), Bei Mu (Fritillaria Bulb, dehearted, ground), Chuan Shan Jia (Pangolin Scale, roasted, ground), Zhe Bei Mu (Paris Polyphylla), Bai Ji (Bletilla Rhizome), Ru Xiang (Frankincense), Tian Hua Fen (Trichosanthes Root), Zao Ci (Gleditsia Spine), Jin Yin Hua (Honeysuckle Flower), Dang Gui (Angelica Sinensis), Chi Shao (Red Peony Root), Gan Cao (Licorice Root, raw, each 1 qian).
Boil 1 zhong wine and 1 zhong water to 1 zhong, strain, take according to lesion location.
[Verse] Hua Ding Nei Xiao contains Anemarrhena, Fritillaria, Pangolin, Paris, Bletilla, Frankincense, Licorice, Trichosanthes, Gleditsia, Honeysuckle, Angelica, Peony. Wine administration enhances efficacy for mild carbuncle toxicity.
Another Formula: Ling Du Fu Sheng Tang (Decoction for Reviving Carbuncle Toxicity)
Composition: Jin Yin Hua (Honeysuckle Flower), Zhi Zi (Gardenia Fruit, raw, ground), Di Gu Pi (Lycium Bark), Niu Bang Zi (Arctium Seed, roasted, ground), Lian Qiao (Forsythia Fruit, dehearted), Mu Tong (Akebia Stem), Mu Li (Oyster Shell, calcined), Sheng Jun (Raw Rhizoma Rhei), Zao Ci (Gleditsia Spine), Tian Hua Fen (Trichosanthes Root), Mo Yao (Myrrh), Ru Xiang (Frankincense, each 0.8 qian).
Boil 1 zhong wine and 1 zhong water to 1 zhong, take far from meals. Non-drinkers boil in water only, add wine before taking. Add Mang Xiao (Mirabilite) for solid pulse and constipation.
[Verse] Ling Du Fu Sheng Tang addresses impending Zou Huang, facial swelling, and internal toxicity injury. Ingredients include Honeysuckle, Gardenia, Lycium, Arctium, Forsythia, Akebia, Oyster, Rhubarb, Gleditsia, Trichosanthes, Myrrh, Frankincense.
Another Formula: Qi Xing Jian (Seven-Star Sword)
Composition: Cang Er Tou (Xanthium Fruit), Ye Ju Hua (Wild Chrysanthemum Flower), Xi Xian Cao (Siegesbeckia Herb), Di Ding Xiang (Symplocos Berry), Ban Zhi Lian (Scutellaria Barbata, each 3 qian), Zhe Bei Mu (Paris Polyphylla, 2 qian), Ma Huang (Ephedra Herba, 1 qian).
Boil 1 jin good wine to 1 bowl, strain, take hot, cover to sweat.
[Verse] Qi Xing Jian treats vomiting, heat, chills, and worsening Zou Huang coma. Ingredients: Ephedra, Xanthium, Chrysanthemum, Siegesbeckia, Symplocos, Paris, Scutellaria.
Another Formula: Mu Xiang Liu Qi Yin (Aucklandia Flowing-Qi Decoction)
Composition: Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root, wine-fried), Chuan Xiong (Ligusticum Rhizome), Zi Su (Perilla Leaf), Jie Geng (Platycodon Root), Zhi Shi (Immature Bitter Orange, bran-fried), Wu Yao (Lindera Root), Chen Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Bai Fu Ling (Poria, each 1 qian), Huang Qi (Astragalus Root), Fang Feng (Saposhnikovia Root), Qing Pi (Green Tangerine Peel, each 1 qian), Da Fu Pi (Areca Peel), Bing Lang (Betel Nut), Zhi Ke (Bitter Orange, bran-fried), Ze Xie (Alisma Rhizome), Gan Cao Jie (Licorice Node), Mu Xiang (Aucklandia Root, powdered, each 0.5 qian).
Add 3 slices ginger, 2 dates, boil in water. Add Niu Xi (Achyranthes Root) for lower body lesions.
[Verse] Mu Xiang Liu Qi Yin moves Qi stagnation. Contains Angelica, Peony, Ligusticum, Perilla, Platycodon, Bitter Orange, Lindera, Tangerine Peel, Poria, Astragalus, Areca, Betel, Saposhnikovia, Alisma.
Another Formula: Jie Du Da Qing Tang (Isatidis Decoction for Detoxification)
Composition: Da Qing Ye (Isatis Leaf), Mu Tong (Akebia Stem), Mai Men Dong (Ophiopogon Tuber, dehearted), Ren Zhong Huang (Human Waste Yellow), Zhi Zi (Gardenia Fruit, raw, ground), Jie Geng (Platycodon Root), Yuan Shen (Scrophularia Root), Zhi Mu (Anemarrhena Rhizome), Sheng Ma (Cimicifuga Rhizome), Dan Zhu Ye (Lophatherum Leaf), Shi Gao (Gypsum Fibrosum, calcined, each 1 qian).
Boil 2 zhong water with 20 roots灯心 (Juncus Effusus) to 0.8 zhong, take far from meals. Add Da Huang (Rhubarb) for constipation; add burned human feces for mental confusion.
[Verse] Jie Du Da Qing Tang treats carbuncles mistreated with moxibustion causing internal toxicity invasion. Ingredients: Ophiopogon, Human Waste Yellow, Gardenia, Platycodon, Scrophularia, Anemarrhena, Cimicifuga, Lophatherum, Gypsum.
Another Formula: Ren Shen Qing Shen Tang (Ginseng Decoction for Calming the Spirit)
Composition: Ren Shen (Ginseng Root), Chen Pi (Tangerine Peel), Bai Fu Ling (Poria), Di Gu Pi (Lycium Bark), Mai Men Dong (Ophiopogon Tuber, dehearted), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Rhizome, earth-fried), Huang Qi (Astragalus Root), Yuan Zhi (Polygala Root, dehearted, each 1 qian), Chai Hu (Bupleurum Root), Huang Lian (Coptis Rhizome), Gan Cao (Licorice Root, roasted, each 0.5 qian).
Boil 2 zhong water with a pinch of Jing Mi (Rice) to 0.8 zhong, take far from meals.
[Verse] Ren Shen Qing Shen Tang treats post-ulceration carbuncle toxicity. Contains Tangerine Peel, Poria, Lycium, Ophiopogon, Angelica, Astragalus, Bupleurum, Polygala, Coptis, Licorice. Tonifies Qi and clears irritability/heat.
Another Formula: Nei Tuo An Shen San (Powder for Supporting Internally and Calming the Spirit)
Composition: Ren Shen (Ginseng Root), Mai Men Dong (Ophiopogon Tuber, dehearted), Fu Shen (Poria with Hostwood), Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome, earth-fried), Yuan Shen (Scrophularia Root), Chen Pi (Tangerine Peel, each 1 qian), Shi Chang Pu (Acorus Rhizome), Gan Cao (Licorice Root, roasted), Suan Zao Ren (Ziziphus Seed, roasted, ground), Yuan Zhi (Polygala Root, dehearted), Wu Wei Zi (Schisandra Fruit, ground, each 0.5 qian).
Boil 2 zhong water to 0.8 zhong, add 0.3 qian Zhu Sha (Cinnabar) powder before taking, take far from meals.
[Verse] Nei Tuo An Shen San treats palpitations and Qi deficiency after carbuncle acupuncture. Contains Ginseng, Ophiopogon, Poria, Acorus, Astragalus, Atractylodes, Licorice, Scrophularia, Ziziphus, Polygala, Schisandra, Tangerine Peel.
Another Formula: Li Ma Hui Ding Dan (Instant Return Carbuncle Powder)
Composition: Qing Fen (Calomel), Chan Su (Toad Venom, wine-dissolved), Bai Ding Xiang (White Civet Musk, each 1 qian), Bi Sha (Realgar processed with vinegar), Ru Xiang (Frankincense, 0.6 qian), Xiong Huang (Realgar), Zhu Sha (Cinnabar), She Xiang (Musk, each 0.3 qian), Wu Gong (Centipede, roasted, 1 piece), Jin Ding Pi (Gold-topped Arsenic Trioxide, powdered, 0.5 qian).
Grind to fine powder, bind with wheat paste, form pills the size of wheat grains. For carbuncles, prick open, insert one pill, cover with plaster. Effective when pus and carbuncle root are expelled.
[Verse] Li Ma Hui Ding Dan uses Calomel, Toad Venom, Civet Musk, Frankincense, Musk, Realgar, Cinnabar, Centipede, Arsenic Trioxide. Used for carbuncles to remove the root.
Another Formula: Jiu Yi Dan (Nine-to-One Powder)
Composition: Shi Gao (Gypsum Fibrosum, calcined, 9 qian), Huang Ling Yao (Yellow Mercury Oxide, 1 qian).
Grind extremely fine, sprinkle on affected area.
[Verse] Jiu Yi Dan treats post-ulceration carbuncles, searching for and removing the root. Calcined Gypsum and Yellow Mercury Oxide clear heat and generate flesh for self-healing.
Another Formula: Pi Li Huo (Thunderfire)
Composition: Heat river stones red-hot, place in iron ladle inside a bucket. Quench stone with vinegar. Patient covers affected area over the bucket, wrapped tightly in thick clothes to retain heat. Add more red stones and vinegar as needed. Steam affects sore head and swelling until sweating occurs, reducing toxicity by half.
Other Formulas Mentioned:
Huang Lian Jie Du Tang (See Black Carbuncle in Ear Section)
Bu Zhong Yi Qi Tang, Ba Zhen Tang, Ba Gao, Wan Ying Gao, Bai Gao Yao, Huang Ling Yao (See Ulcer Section)
Li Gong Ding, Shuang Jie Gui Jin Wan (See Swollen Ulcer Section)
Ba Ding San (See Dental Carbuncle in Tooth Section)
Hu Po Gao (See Hairline Sore in Head Section)
Huang Lian Gao (See Nasal Sore in Nose Section)