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One Treatise, Thirty-Three Prescriptions

The treatise states: Various types of carbuncle (superficial suppurative infection) present with diverse symptoms. Regardless of whether the condition is recent or chronic, they should all be primarily treated with Wuxiang Liaoqiao Tang (Five Fragrances and Forsythia Decoction). Initially, puncture with a needle to drain heat, apply a thin paste of Adzuki Bean (Vigna angularis), and repeatedly prick to release blood during the interval. If treatment was delayed leading to ulceration, one should still frequently take decoctions such as Wuxiang Loulu Tang (Five Fragrances and Rhapontic Decoction) to purge downward; if large amounts of stool are passed after inserting a large needle five fen deep, recovery will be rapid. For carbuncles that are high and shiny, the heat is not severe. For those with flat flesh, no protrusion, and purple color, no specific treatment is needed; simply administer Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction) to benefit Lung Qi. Flat flesh indicates the absence of pus. When a carbuncle suddenly becomes painful, apply Bayi Huangqi San (Eight-Ingredient Astragalus Powder) externally; for large carbuncles, apply for seven days, and for small ones, five days. If the swelling is hard and firm, diagnose whether it will develop into Back Carbuncle (Daji) or Breast Carbuncle (Faru). If the area is hot to the touch and unbearable, internally take Wangbuliuxing San (Vaccaria Seed Powder) and externally massage with Fabei Gao (Back-Carbuncle Ointment). If there is an open sore on the back but no pain in the breast, allow the sore to mature thoroughly. The sign of maturity is that pressing with the hand causes immediate rebound; at this point, puncture is required. The key to puncturing is to reach the pus cavity, adjusting according to circumstances. Puncture depth on the chest and back must not exceed one cun, to be judged appropriately. If there is no pus, apply Shirou Gao San (Flesh-Eating Ointment Powder) into the wound opening. If body heat subsides, take Muzhansi San (Caulis Sarcostemmas Powder). Five days later, when the carbuncle is about to heal, take Painong Neisai San (Pus-Draining and Internal-Sealing Powder). After any carbuncle ruptures, the patient often feels weak and near death. Cold inside and heat outside with swelling may resemble a carbuncle but is not one; press the swollen area with the hand. If there is no connection or tension, it is Wind-Toxin. Do not puncture; instead, take Shengma Tang (Cimicifuga Decoction). Apply ointment externally to the ruptured carbuncle opening. Leave the upper third and lower one-third of the opening intact. The needle must be extremely hot; extreme heat prevents pain. For ruptured carbuncles that fail to heal due to decay, wash with Zhu Ti Tang (Pig Trotter Decoction) twice daily. In summer, use the decoction for two days; in winter, six to seven days, half a dose is also acceptable. For chest pain and shortness of breath, enter a dark room, press the left eye with the middle finger, and observe. If light is seen, there is a clustered carbuncle in the chest; if no light is seen, it is a deep-seated jiu (gangrenous sore) originating internally. Puncture injuring the vessels without blood flow causing stagnation and fullness will result in carbuncle formation. Generally, if the pulse is fine and deep, sometimes straight, there is a carbuncle or jiu on the body. If the pulse starts large and gradually becomes small, it indicates Yin knotting causing muscle bi-syndrome. Examine the Cun Kou (Radial Pulse); the pulse changes from large to small in this manner.

Loulu Tang Prescription:
Rhapontic Radix (Loulou), White Peony Root (Bailian), Scutellaria Root (Huangqin), Immature Bitter Orange (Zhishi, roasted), Red Peony Root (Shaoyao), Cimicifuga Rhizome (Shengma), Ephedra Stem (Mahuang), Licorice Root (Gancao, roasted, each 2 liang), Rhubarb (Dahuang, 3 liang).
These nine ingredients are coarsely crushed. Boil in ten dou of water to obtain three sheng. Divide into three doses. In areas without these herbs, taking Rhubarb alone to purge downward is effective. Another variation uses Cistanche Vine (Baiwei) 2 liang.

Liaoqiao Wuxiang Tang Prescription:
Forsythia Fruit (Liaoqiao), Aucklandia Root (Qingmuxiang), Frankincense (Xunluxiang), Musk (Shexiang), Agarwood (Chenxiang), Belamcanda Rhizome (Shegan), Angelica Pubescens Root (Duhuo), Taxillus Branches (Sangjisheng), Ligusticum Stem (Tongcao), Cimicifuga Rhizome (Shengma, each 2 liang), Clove Bud (Dingxiang, 1 liang), Rhubarb (Dahuang, 3 liang, soaked separately).
These eleven ingredients are coarsely crushed. Boil in nine sheng of water until reduced by half. Add two sheng of Bamboo Juice (Zhuli) and boil until three sheng remain. Divide into three doses. If not cured, continue taking it intermittently for best results.

Wangbuliuxing San: Mainly treats carbuncles, jiu, and various miscellaneous swellings that have already ulcerated. All should take this prescription:
Vaccaria Seed (Wangbuliuxingzi, 1 sheng), Five-Color Dragon Bone (Wuse Longgu), Kadsura Bark (Yegepi), Trichosanthes Fruit (Gualou, 6 he), Angelica Sinensis Root (Danggui, 2 liang), Dried Ginger (Ganjiang).
These seven ingredients are pounded and sifted into a powder. After meals, take one fangcun bi (square-inch measure) with warm wine, three times a day. Stop when the limbs feel slightly numb. If no sensation is felt, gradually increase the dosage slightly. This is a prescription by Hao Zhongan, named "Shen San" (Divine Powder) by Ji Anli of the Sui Dynasty. It eliminates swellings quickly and provides great stability (Qianjin Jiyao states: Treats swellings that cannot ulcerate, alleviating distress and helplessness).