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[Formula Song] Brain carbuncle located at the center of the nape belongs to the Du Meridian (Governing Vessel); lateral brain carbuncles belong to the Foot-Taiyang Bladder Meridian. Yang-type (central) and Yin-type (lateral) differ in difficulty, yet their treatment follows the general principles for sores and ulcers.

[Annotation] This type of carbuncle can be central or lateral. Central cases involve the Du Meridian, penetrating the hairline, and are called "Brain Carbuncle" (Nao Ju), commonly known as "Dui Kou" (Facing Mouth). Lateral cases involve the Foot-Taiyang Bladder Meridian and are called "Lateral Brain Carbuncle" (Pian Nao Ju), commonly known as "Pian Dui Kou". Central brain carbuncles arise from hyperactive Yang and extreme heat; symptoms include intense redness, swelling, and pain, with a fresh red color, a constricted base, and a pointed apex, accompanied by intermittent pain. Since the Du Meridian is purely Yang, originating at the Weilu point (Changqiang, GV-1) and ascending through the vertex, carrying toxic heat upward, it tends to suppurate easily, slough off easily, and heal easily, generally representing a favorable prognosis (Shun Zheng). In contrast, lateral brain carbuncles arise from a mixture of cold and heat; symptoms present as diffuse swelling without a distinct head, dark discoloration, flat collapse, and hardness. As the Foot-Taiyang Meridian is exteriorly Yang and interiorly Yin, running from head to foot, with descending Yang and coagulating Yin, it tends to be difficult to suppurate, difficult to slough, and difficult to heal, generally representing an unfavorable prognosis (Ni Zheng). Furthermore, if complicated by Wind-Dampness, the base of the lesion may spread widely and discharge pus laterally. Therefore, for both favorable and unfavorable conditions, one must distinguish whether it is a carbuncle (Yong) or a deep abscess/carbuncle (Ju). Brain carbuncles (Nao Yong) have thin skin and rupture easily; brain deep abscesses (Nao Ju) have thick skin and are hard to rupture. If there are exterior syndrome patterns at the onset, causing alternating chills and fever, Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction for Overcoming Toxicity) is appropriate. If there are interior syndrome patterns, causing scorched purple lips, extreme thirst, and dry constipation, Neishu Huanglian Tang (Internal Draining Coptis Decoction) is appropriate. Once the lesion has fully formed, treat according to the general principles outlined in the chapters on Sores/Ulcers (Zhongyang) and Ulcers (Kuoyang).

Formula: Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction for Overcoming Toxicity)
Composition: Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Qianhu (Peucedani Radix), Chaihu (Bupleuri Radix), Jiegeng (Platycodonis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Zhike (Aurantii Fructus Immaturus, stir-fried with bran), Fuling (Poria), each 1 qian; Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), each 0.5 qian. Add three slices of Shengjiang (Zingiberis Rhizoma Recens), two zhong of water, decoct to obtain eight fen, take after meals. If chills are severe, add three stalks of Congbai (Allii Fistulosi Bulbus).

[Formula Song] Jingfang Baidu San treats initial sores, alleviating aversion to cold, high fever, and sweating; it contains Qianghuo, Duhuo, Qianhu, Chaihu, Jingjie, Fangfeng, Jiegeng, while Chuanxiong, Zhike, Renshen, Fuling, and Gancao strengthen the effect.

Another Formula: Neishu Huanglian Tang (Coptis Decoction for Internal Draining) (See Chapter on Sores/Ulcers)