【方歌】鹳口疽生尻尾尖，经属督脉湿痰源，肿如鱼肫溃鹳嘴，
少壮易愈老难痊。
【注】此证一名锐疽，生于尻尾骨尖处。初肿形如鱼肫，色赤
坚痛，溃破口若鹳嘴，属督脉经，由湿痰流结所致。朝
寒暮热，夜重日轻，溃出稀脓为不足；或流稠脓鲜血为
有余。少壮可愈，老弱难敛，易于成漏。初起宜滋阴除
湿汤以和之；已成不得内消者，用和气养荣汤以托之；
气血虚弱，溃而敛迟者，滋肾保元汤以补之。若失治久
而不敛者，宜服先天大造丸，兼服琥珀蜡矾丸，久久收
敛。外治法按痈疽肿疡、溃疡门。
方剂：滋阴除湿汤
组成：当归 熟地
川芎 白芍（酒炒，各一钱）
陈皮 柴胡
知母 贝母（去心，研）
黄芩（各八分） 泽泻
地骨皮 甘草（生，各五分）
水二钟，姜三片，煎八分，食前服。
【方歌】滋阴除湿鹳口疽，退热消痰初起宜，四物陈柴知母草，
泽泻黄芩地骨皮。
又方：和气养荣汤
组成：人参 白术（土炒）
白茯苓 丹皮
陈皮 熟地
当归 黄耆（各一钱）
沈香 甘草（炙，各五分）
水二钟，煎八分，食前服。
【方歌】和气养荣托锐疽，将脓煎服溃更宜，四君丹皮陈熟地，
当归沈香共黄耆。
又方：滋肾保元汤
组成：人参 白术（土炒）
白茯苓 当归身
熟地 黄耆
山萸肉 丹皮
杜仲（各一钱） 肉桂
附子（制） 甘草（炙，各五分）
水二钟，姜三片，红枣二枚、建莲子七个去心，煎
八分，食前服。
【方歌】滋肾保元溃后虚，敛迟脓清水淋漓，十全大补除芎芍，
山萸附子牡丹皮。
又方：先天大造丸
组成：人参 白术（土炒）
当归身 白茯苓
菟丝子 枸杞
黄精 牛膝（各二钱）
补骨脂（炒） 骨碎补（去毛，微炒）
巴戟肉 远志（去心，各一两）
广木香 青盐（各五钱）
丁香（以上共研末，三钱）
熟地（酒煮，捣膏，四两）
仙茅（浸去赤汁，蒸熟，去皮，捣膏）
何首乌（去皮，黑豆同煮，去豆，捣膏）
胶枣肉（捣膏，各二两）
肉苁蓉（去鳞并内膜，酒浸捣膏）
紫河车（白酒煮烂捣膏，一具以上六膏共入前药末内）
上为细末，捣膏共合一处，再加炼过白蜂蜜为丸，
如梧桐子大。每服七十丸，空心温酒送下。
【方歌】先天大造补气血，专治痈疽溃后虚，脓水清稀难收敛，
参术归苓地首乌。补骨青盐骨碎补，枸杞黄精远菟丝，
巴戟仙茅丁木枣，河车牛膝苁蓉俱。
又方：琥珀蜡矾丸（见肿疡门）
[Prescription Verse] Guan Kou Ju (Stork's Mouth Carbuncle) arises at the tip of the coccyx, belonging to the Du Meridian (Governing Vessel), with damp-phlegm as its source. The swelling resembles a fish's ventriculus; upon ulceration, the opening looks like a stork's beak. It is easily cured in the young and strong but difficult to heal in the old and weak.
[Annotation] This condition is also known as Rui Ju (Sharp Carbuncle), occurring at the tip of the coccyx. Initially, the swelling resembles a fish's ventriculus, appearing red, hard, and painful. Upon ulceration, the wound resembles a stork's beak. It belongs to the Du Meridian (Governing Vessel) and is caused by the flow and accumulation of damp-phlegm. There is chills in the morning and fever in the evening, with symptoms worsening at night and improving during the day. Discharge of thin pus indicates deficiency (Zheng Qi Deficiency); discharge of thick pus mixed with fresh blood indicates excess (Xie Qi Excess). The young and strong can recover, while the old and weak have difficulty healing and are prone to forming fistulas. At the initial stage, Ziyin Chushi Tang (Nourish Yin and Remove Dampness Decoction) is suitable for harmonization. If the abscess has formed and cannot be resolved internally, Heqi Yangrong Tang (Harmonize Qi and Nourish Ying Decoction) should be used to expel toxins. For those with deficient Qi and Blood who heal slowly after ulceration, Zishen Baoyuan Tang (Nourish Kidney and Preserve Yuan Decoction) is used for tonification. If treatment is delayed and healing fails to occur over a long period, Xiantian Dazao Wan (Heavenly Origin Great Creation Pill) should be taken, along with Hupo Lafan Wan (Amber Beeswax Alum Pill), until healing eventually occurs. External treatments follow the methods described in the sections on Carbuncle Swelling Ulcer and Ulcerative Wounds.
Formula: Ziyin Chushi Tang (Nourish Yin and Remove Dampness Decoction)
Composition: Danggui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Preparata), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba, stir-fried with wine, each 1 qian), Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Zhimu (Anemarrhenae Rhizoma), Beimu (Fritillariae Thunbergii Bulbus, heart removed, ground), Huangqin (Scutellariae Radix, each 8 fen), Zexie (Alismatis Rhizoma), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma, raw, each 5 fen).
Add 2 zhong of water and 3 slices of ginger, decoct until 0.8 zhong remains. Take before meals.
[Prescription Verse] Ziyin Chushi Tang treats Guan Kou Ju, suitable for the initial stage to reduce fever and resolve phlegm. It contains Siwu Tang plus Chenpi, Chaihu, Zhimu, and Gancao, along with Zexie, Huangqin, and Digupi.
Another Formula: Heqi Yangrong Tang (Harmonize Qi and Nourish Ying Decoction)
Composition: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Baifuling (Poria), Danpi (Moutan Cortex), Chenpi (Citri Reticulatae Pericarpium), Shudi (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix, each 1 qian), Chenxiang (Aquilaria Lignum Resinatum), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 5 fen).
Add 2 zhong of water, decoct until 0.8 zhong remains. Take before meals.
[Prescription Verse] Heqi Yangrong Tang expels toxins to treat Rui Ju; it is suitable to take when pus is about to form or after ulceration. It contains Sijunzi Tang plus Danpi, Chenpi, and Shudi, combined with Danggui, Chenxiang, and Huangqi.
Another Formula: Zishen Baoyuan Tang (Nourish Kidney and Preserve Yuan Decoction)
Composition: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Baifuling (Poria), Dangguishen (Angelicae Sinensis Radix Heart), Shudi (Rehmanniae Radix Preparata), Huangqi (Astragali Radix), Shanzhurou (Corni Fructus), Danpi (Moutan Cortex), Duzhong (Eucommiae Cortex, each 1 qian), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 5 fen).
Add 2 zhong of water, 3 slices of ginger, 2 red dates, and 7 Jian lotus seeds (heart removed). Decoct until 0.8 zhong remains. Take before meals.
[Prescription Verse] Zishen Baoyuan Tang treats post-ulcer deficiency, where healing is slow and pus/water is clear and dripping. It is essentially Shiquan Dabu Tang minus Chuanxiong and Baishao, adding Shanzhuyu, Fuzi, and Mudanpi.
Another Formula: Xiantian Dazao Wan (Heavenly Origin Great Creation Pill)
Composition: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Dangguishen (Angelicae Sinensis Radix Heart), Baifuling (Poria), Tusizi (Cuscutae Semen), Gouqi (Lycii Fructus), Huangjing (Polygonati Rhizoma), Niuxi (Achyranthis Bidentatae Radix, each 2 qian), Buguzhi (Psoraleae Fructus, stir-fried), Gusuibu (Drynariae Rhizoma, hairs removed, lightly stir-fried), Bajirou (Morindae Officinalis Radix), Yuanzhi (Polygalae Radix, heart removed, each 1 liang), Guangmuxiang (Costi Root), Qingyan (Halitum, each 5 qian), Dingxiang (Caryophylli Flos, above ingredients ground together into powder, dosage 3 qian).
Shudi (Rehmanniae Radix Preparata, boiled in wine, pounded into paste, 4 liang), Xianmao (Curculiginis Rhizoma, soaked to remove red juice, steamed, skin removed, pounded into paste), Heshouwu (Polygoni Multiflori Radix, skin removed, boiled with black soybeans, beans removed, pounded into paste), Jiazaorou (Zizyphi Fructus pulp, pounded into paste, each 2 liang), Rongzong (Cistanches Herba, scales and inner membrane removed, soaked in wine, pounded into paste), Zheche (Placenta Humana, boiled rotten in white wine, pounded into paste, one placenta. The above six pastes are added to the previously prepared powder).
Grind all into fine powder, mix with the pastes, add refined white honey to form pills, size of Sophora japonica seeds. Take 70 pills per dose, swallow with warm liquor on an empty stomach.
[Prescription Verse] Xiantian Dazao Wan tonifies Qi and Blood, specifically treating deficiency after ulceration of carbuncles and sores where pus/water is clear and thin and difficult to heal. It contains Renshen, Baizhu, Danggui, Fuling, Dihuang, Heshouwu, Buguzhi, Qingyan, Gusuibu, Gouqi, Huangjing, Yuanzhi, Tusizi, Bajitian, Xianmao, Dingxiang, Muxiang, Zaorou, Zheche, Niuxi, and Rongzong.
Another Formula: Hupo Lafan Wan (Amber Beeswax Alum Pill) (See section on Carbuncle Swelling Ulcers)