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The Spleen governs the four limbs. The Liver governs the sinews (tendons). The Kidney governs the bones. The lower part of the body, which contacts the ground, is governed by the Three Yin meridians (Taiyin, Shaoyin, Jueyin), referring specifically to the waist and feet. If excessive labor leads to extreme fatigue, damaging the sinews, bones, skin, and flesh, Wind-Cold-Dampness pathogens will take advantage of this vulnerability to invade, causing pain in the legs. Manifestations in the muscle layer are superficial, while those penetrating into the sinews and bones are deep. If Wind-dispelling herbs are subsequently used, Yin fluids will be further depleted; if Cold-cooling herbs are administered, Qi will be further damaged. This may eventually lead to perforation and ulceration that becomes unmanageable. Therefore, treating such patients requires tonification rather than purging, warming rather than cooling, and expelling pus/toxins outward rather than astringing. This differs from the three types of carbuncles above, which favor attacking, purging, and dissipating. Formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Bazhen Tang (Eight Treasure Decoction), or Bawei Wan (Eight-Ingredient Pill) may be used, possibly with meridian-guiding herbs like Papaya (Mugua), Cinnamon Twig (Rougui), Eucommia Bark (Duzhong), and Achyranthes Root (Niuxi). When Qi and Blood are abundant and sinews and bones are strong, the lesion will easily suppurate and heal. Clinging solely to detoxification will lead to failure.

Clinical Case:
A man, accustomed to hard work, contracted Cold-Dampness, resulting in leg pain lasting over half a month. Excessive use of damp-draining and exterior-resolving medications caused his leg to swell into a carbuncle, with the patient crying out in continuous pain. I told him, "Chen states that this condition arises from Cold invading the Kidney meridian; only Cinnamon Twig (Guizhi) and Aconite (Fuzi) can unblock the joints; only Notopterygium Rhizome (Qianghuo), Saposhnikovia Root (Fangfeng), and Achyranthes Root (Niuxi) can move stagnation; only Ginseng (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), and Licorice Root (Gancao) can transmit Spleen Qi to the four limbs; only Siwu Tang (Four Substance Decoction) combined with Carthamus Flower (Honghua) can nourish and invigorate Blood." He strictly followed this method and indeed recovered after suppuration occurred.

Da Fangfeng Tang (Great Saposhnikovia Decoction):
Ginseng (2 qian), Saposhnikovia Root (Fangfeng), Atractylodes Macrocephala Rhizome (Baizhu, stir-fried with earth), Prepared Aconite Root (Fuzi), Angelica Sinensis Radix (Danggui), White Peony Root (Baishao, fried with wine), Ligusticum Chuanxiong Rhizome (Chuanxiong), Eucommia Bark (Duzhong, stir-fried with salt water), Astragalus Membranaceus Root (Huangqi), Notopterygium Rhizome (Qianghuo), Achyranthes Bidentata Root (Niuxi), Prepared Rehmannia Root (Shudihuang) (each 1 qian), Licorice Root (Gancao, 0.5 qian).
One slice of Ginger, decocted in water.

Note: Carbuncles (Yong) belong to Yang and manifest externally; sores (Ju) belong to Yin and sink internally. Yang conditions are relatively mild while Yin conditions are critical—a fact known to all. However, it is also known that if Yang conditions are treated with excessive Cold-cooling herbs, toxins cannot disperse externally and the condition worsens; conversely, if Yin conditions are treated with Warming-Tonifying methods, toxins are transformed and the condition alleviates. Yet, few realize that for Yang conditions, dispersing is primary, detoxifying is secondary, and tonifying is tertiary; one must avoid Bitter-Cold herbs to prevent internal collapse. For Yin conditions, lifting and supporting is primary, warming-tonifying is secondary, and regulating is tertiary; one must avoid excessive Pungent-Hot herbs to prevent fluid exhaustion. Although I do not specialize in surgery, observing cases reveals that major Warming and Tonifying methods facilitate easy suppuration and healing. In cases of empty blood vessels and prolonged pain, both Qi and Blood must be supplemented, assisted by nurturing the Heart-Mind. Since the Heart governs blood vessels and the Spleen governs muscles, significant loss of pus and blood necessitates nourishment; one should not use purely Hot herbs to deplete again. This may be one approach.

In the field of sores and ulcers, practitioners often rigidly adhere to "detoxification," regardless of location, meridian affiliation, Yin/Yang nature, or etiology (external Six Evils or internal Seven Emotions). They indiscriminately use Bitter-Cold herbs like Scutellaria Root (Huangqin), Phellodendron Bark (Huanglian), and Trichosanthes Root (Huafen), causing toxins to fail to transform and pathogens to hide internally. This can lead to sudden variations or failure to suppurate. Among Baidu San (Eliminate Toxin Powder) formulas, only Renshen Baidu San (Ginseng Eliminate Toxin Powder) is considered effective. One must understand that Fire-Stagnation requires dispersal; accumulated toxins require support and transformation; Blood-Heat requires cooling; Qi-Deficiency requires tonification; Water-Deficiency requires enrichment; Fire-Deficiency requires warming. These approaches vary greatly; why persist in using Bitter-Cold herbs without remorse?

Renshen Baidu San (Ginseng Eliminate Toxin Powder):
Ginseng, Poria (Fuling), Notopterygium Rhizome (Qianghuo), Angelica Dahurica Root (Duhuo), Peucedanum Root (Qianhu), Bupleurum Root (Chaihu), Platycodon Root (Jiegeng), Aurantium Fruit (Zhike) (each 1 qian), Ligusticum Chuanxiong Rhizome (Chuanxiong, 0.8 fen), Licorice Root (Gancao, 0.5 fen).
Decoct in water. For cases involving fatigue/labor, double the Ginseng and add Angelica Sinensis Radix (Danggui) and White Peony Root (Shaoyao).

Huadu Yinzi (Toxin-Transforming Drink): Treats eruptions caused by emotional depression/stagnation.
Polygala Root (Yuanzhi, processed with Licorice), Angelica Sinensis Radix (Danggui), Licorice Node (Gancao Jie, 0.5 fen), Forsythia Fruit (Lianqiao), Fritillaria Bulb (Chuanbeimu, heart removed and crushed), Honeysuckle Flower (Jinyinhua, 2 qian), Poria with Hostwood (Baifushen), Uncaria Ramulus (Gouteng, 2 qian), Moutan Cortex (Mudanpi) (each 1 qian).
One slice of Ginger, decoct in water. Optionally add Bupleurum Root (Chaihu), Aucklandia Root (Muxiang), and Cyperus Rhizome (Xiangfu).

Xianfang Huoming Yin (Immortal Formula for Preserving Life):
Pangolin Scales (Chuanshanjia, stir-fried with clam powder until yellow), Angelica Dahurica Root (Baizhi), Saposhnikovia Root (Fangfeng), Red Peony Root (Chishaoyao), Myrrh (Moyao), Licorice Root (Gancao), Angelica Sinensis Radix Tail (Dangguiwei), Frankincense (Ruxiang), Trichosanthes Root (Huafen), Soapberry Thorn (Jiaozhen), Citrus Peel (Chenpi) (each 1 qian), Honeysuckle Flower (Jinyinhua, 3 qian).
Decoct with wine.

Renshen Neituo San (Ginseng Internal Support Powder):
Ginseng (1.5 qian), Astragalus Membranaceus Root (Huangqi, 3 qian), Angelica Sinensis Radix (Danggui), Ligusticum Chuanxiong Rhizome (Chuanxiong), Pangolin Scales (Chuanshanjia), Angelica Dahurica Root (Baizhi), Tangerine Peel (Guangpi) (each 1 qian), Licorice Root (Gancao, 0.5 fen).
Decoct with one slice of Ginger. For Blood Deficiency, add Prepared Rehmannia Root (Shudihuang) and White Peony Root (Baishaoyao); for Weak Spleen, add Atractylodes Macrocephala Rhizome (Baizhu) and Poria (Fuling); for Deficient-Cold, add Roasted Ginger (Paojiang) and Aconite (Fuzi); for Detoxification, add Honeysuckle Flower (Jinyinhua).

Jiajian Bawei Wan (Modified Eight-Ingredient Pill): Highly effective for thirst during eruption of sores/carbuncles.
Huai Rehmannia Root (Huaishudihuang, 8 liang), Chinese Yam (Shanyao), Cornus Officinalis Fruit (Shanzhuyu) (each 4 liang), Moutan Cortex (Mudanpi), Poria (Fuling), Alisma Rhizome (Zexie) (each 3 liang), Schisandra Berry (Wuweizi), Cinnamon Twig (Rougui) (each 1 liang).
Grind into powder, form pills with juice of fresh Rehmannia Root. From Dr. Xue's medical texts. Note: Dr. Xue used 4 liang of Schisandra Berry, fearing excessive astringency.