Library

Whenever a carbuncle (back abscess) occurs on the back, whether it is painful or painless, or even numb, it indicates an abundance of pathogenic factors. Moxibustion with garlic slices should be applied. If there is pain, moxibustion should continue until the pain ceases; if there is no pain, moxibustion should continue until pain arises, so that the toxin dissipates with the fire. For cases without pain, thorough moxibustion is required, or formulas such as Huanglian Jiedu San (Coptis Decoction for Resolving Toxicity) may be used.

Headache accompanied by stiffness and tension indicates a exterior syndrome. One to two doses of Renshen Baidu San (Ginseng Decoction for Overcoming Toxins) should be administered. If pain is present, Jinyinhua San (Honeysuckle Powder), Huaihua Jiu (Sophora Flower Wine), or Shenxiao Tuoli San (Miraculous Interior-Supporting Decoction) may be used.

For swelling and hardness with a full pulse, Qingliang Yin (Cooling Drink), Xianfang Huoming Yin (Immortal Life-Preserving Decoction), or Kushen Wan (Sophora Pill) are indicated.

In cases of swelling and hardness with a sensation of numbness and oppression, accompanied by pain, fever, irritability, desire for cold drinks, constipation, and a deep, full pulse, Neishu Huanglian Tang (Internal-Draining Coptis Decoction) or Qingliang Yinzi (Cooling Drink) should be used. Once bowel movements become unobstructed, if suppuration is desired, Xianfang Huoming Yin (Immortal Life-Preserving Decoction), Tuoli San (Interior-Supporting Powder), or Lafan Wan (Beeswax and Arsenic Pill) may be used, along with external application of Shenyi Gao (Miraculous Ointment).

For decreased appetite and food intake, Liujunzi Tang (Six Gentlemen Decoction) with Huoxiang (Patchouli) should be taken continuously for three to five doses. Subsequently, Xionghuang Jiedu San (Realgar Detoxifying Powder) can be used to wash the affected area, and Wujin Gao (Black Gold Ointment) should be applied to the wound daily. Once a wound opening exists, paper twists dipped in Wujin Gao should be inserted into the cavity. If pus is present but trapped by fatty membranes causing distending pain, needle drainage is appropriate. If blocked by necrotic tissue, remove it. If sloughing tissue begins to loosen, wash with Zhu Ti Tang (Pig Trotter Decoction). If pus is thick or painful, yet diet remains normal, the slough will naturally decay; combine detoxifying and interior-supporting herbs, continuing to apply the aforementioned ointments. If necrotic tissue has separated from healthy flesh, remove it promptly and use interior-supporting herbs. If slough does not decay, or pus is thin and painless, urgently administer strong tonics and apply Sangchai Jiu (Mulberry Twig Moxibustion) to supplement Yang Qi and resolve stagnant toxins.

Generally, patients with robust Qi and Blood or mild toxicity may rely on medicinal power or undergo spontaneous suppuration. However, frail individuals with heat-toxin blocking the middle jiao and internal-external obstruction require acupuncture and moxibustion; medication alone yields incomplete results. If pus has formed, urgent incision and drainage are necessary. Otherwise, severe cases may ulcerate through organs and corrode bones and sinews, while mild cases may erode healthy flesh, making healing difficult, leading to many non-healing outcomes.

One patient suffered severe pain; detoxifying herbs exacerbated the condition, but moxibustion with garlic slices stopped the pain. Two doses of Xianfang Huoming Yin (Immortal Life-Preserving Decoction) rapidly reduced symptoms, followed by interior-supporting herbs to achieve suppuration and cure.

A fifty-year-old patient had a back carbuncle for four to five days, with significant swelling, pain, a red halo over one chi wide, and heaviness on the back like carrying a stone. The vigorous pathogen suggested aggressive treatment, but the pulse was unsuitable. First, bloodletting with a bi stone was performed on the red area, releasing about one bowl of dark blood, eliminating pain, swelling, and back heaviness. Shenxiao San (Miraculous Powder) was applied, followed by two doses of Xianfang Huoming Yin (Immortal Life-Preserving Decoction). Dark fluid discharged from the wound and puncture sites, leading to resolution.

Another patient presented with back swelling and pain, with a floating and rapid pulse. Neituo Fujian San (Internal-Supporting Double-Boiled Decoction) was given for two doses, slightly reducing symptoms. Then, Xianfang Huoming Yin (Immortal Life-Preserving Decoction) was administered for four doses, stopping pain and inducing suppuration. Interior-supporting herbs were subsequently used for recovery.

A patient with intense toxic heat suffered unbearable pain unresponsive to various medicines. Two doses of Xianfang Huoming Yin (Immortal Life-Preserving Decoction) resolved all symptoms; two more doses induced suppuration. Six doses of Jinyinhua San (Honeysuckle Powder) completed the cure.

A patient with a robust constitution, dietary excess, and qi stagnation, aged nearly sixty, developed a back carbuncle. Interior-supporting herbs failed. Only Xiangfu powder (Cyperus Rhizome) provided relief. From swelling to suppuration, this single herb ensured safety. (This case of robust constitution and robust disease is rare, occurring once in thousands. Xiangfu is not traditionally described as tonic, except in Bu Lao Tang (Anti-Aging Decoction) which benefits the elderly using Pianzi Jianghuang, Licorice, and Cyperus. This implies a principle of tonification within movement. Just as Chongwei (Motherwort) invigorates blood and moves qi, possessing yin-tonifying properties, hence its name "Beneficial Mother." Pregnancy and childbirth rely on Qi and Blood; pre-natal absence of stagnation and post-natal absence of deficiency result from tonification within movement. Xia Ku Cao (Prunella Spike) treats scrofula similarly, treating based on its nature.)

Tong Fu suffered from a back carbuncle for over ten days with critical condition and large pulse. Two doses of Huaihua Jiu (Sophora Flower Wine) reduced the pathogen. Two doses of Baidu San (Toxin-Overcoming Powder) followed, then several doses of interior-supporting herbs led to gradual suppuration. Mulberry twig moxibustion was applied to the site for long periods daily, alongside plaster application. After several sessions, pus drained and necrotic tissue shed. Tuoli San (Interior-Supporting Powder) with Baizhu (Atractylodes Macrocephala Rhizome) and Chenpi (Citrus Peel) cured him in over a month.

An attendant general suffered severe pain in the thigh and shoulder blade from toxicity. Detoxifying herbs failed. One dose of Huaihua Jiu (Sophora Flower Wine) reduced the pathogen. Interior-supporting detoxifying herbs completed the cure.

A patient with a critical back carbuncle took five to six liang of Jinyin Teng (Honeysuckle Stem), mashed it, mixed with a cup of hot wine, strained the juice for warm consumption, and applied the dregs externally. Four to five doses brought peace. Jinyinhua (Honeysuckle Flower) is a sacred herb for skin diseases, capable of restoring life whether suppuration has occurred or not.

A seventy-year-old man had a back carbuncle over one chi wide. He had taken dozens of doses of Wuxiang Tang (Five Fragrances Decoction) and Shixuan San (Ten Acupoints Powder). Pus was bloody and foul, with vomiting, inability to eat for over ten days. The patient reported discomfort in the chest after Shixuan San and a thirty-year history of strangury, now suffering from strangury pain, vomiting, and insomnia. Ginseng and Danggui (Angelica Sinensis) paste was decocted, mixed with Niuxi (Achyranthes Root) soup and Zhuli (Bamboo Sap) for administration. In three days, 1.5 jin of medicine was consumed, strangury ceased, and appetite returned. In seven days, 4 jin were consumed, pus spontaneously drained, sleep resumed, and stability was achieved in twenty days. It was mid-summer.

An elder over sixty, fond of alcohol and meat, had a back carbuncle with pus, vomiting, and fever. Many doses of Shixuan San (Ten Acupoints Powder) had been taken. Due to vomiting, Jiahe San (Harvesting Grain Powder) with Dingxiang (Clove) was prescribed. In the intense heat of July, the pulse was surging, rapid, and forceful. I stated: Pulse and symptoms in ulcerative stages are particularly contraindicated, but the physical constitution allows for rescue. Only Dushen Tang (Single Ginseng Decoction) with Zhuli (Bamboo Sap) was given. Consumption of 15-16 jin of medicine and 100 stalks of bamboo sap restored health. I noted this was fortunate; without a bland diet, recurrence was likely. Later, he sat drunk in a pool in summer, developing a soft lump like a cake on the left hypochondrium. Two years later, it ulcerated into a carbuncle with similar pulse and symptoms. Treatment with Ginseng, Huangqi (Astragalus Root), and Zhuli (Bamboo Sap) restored health.

A woman with a back carbuncle underwent suppuration after over twenty doses of interior-supporting detoxifying herbs. Anger caused sudden hematemesis of five to six bowls, weak Qi, and fine pulse, indicating extreme Qi and Blood deficiency. One jin of Dushen Gao (Single Ginseng Paste) was prescribed, providing slight relief. Thirty doses of Ginseng, Huangqi (Astragalus Root), Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Citrus Peel), and Zhi Gancao (Prepared Licorice) gradually closed the wound. Using cooling herbs like Xijiao (Rhinoceros Horn) would have been a grave error.

A patient had a back sore the size of a bowl, ulcerating to expose viscera, held only by the diaphragm. He believed death was certain. *Jingyao* records: Take a large crucian carp, remove entrails, fill with sheep dung, bake until charred and dry, grind to powder, and apply dry to the wound. The wound closes. This method is effective repeatedly. Use when pus is scant and granulation tissue is desired.

A forty-year-old patient with a back carbuncle had a surging and rapid heart pulse, indicating critical severity. The Classics state: Pain, itching, sores, and ulcers belong to Heart Fire. A surging and rapid pulse indicates excessive Heart Fire. The Heart governs Blood; stagnation of Heart Qi prevents Blood flow, generating abscesses. The Zhuma Jiu (Donkey-Horse Moxibustion) acupoint lies on the pathway of the Heart pulse. Urgent garlic-slice moxibustion was applied to drain Heart Fire and extract toxins, followed by interior-supporting detoxifying herbs for cure.

A patient with a back carbuncle had numerous sore heads, swollen, hard, purple, with little pain and no suppuration. Moxibustion with mugwort applied to the site, combined with strong tonics, resulted in necrotic tissue shedding and recovery after several days.

A patient suddenly felt nausea, intense itching at the Dazhui point, followed by inability to raise the arm and mental fatigue. This is called Tian Ju (Heaven Carbuncle), a critical illness. Garlic-slice moxibustion intensified itching. Direct moxibustion (Ming Jiu) for fifty moxa cones stopped the itch, curing him in ten days. *Jingyao* states: Moxibustion has life-restoring powers, truly so.

A patient with back toxicity had pain, fever, desire for cold drinks, profuse sweating, constipation, and delirium. Two pills of Po Guan Dan (Coffin-Breaking Pill) calmed him. Four doses of Jinyinhua (Honeysuckle) promoted suppuration. Incision and drainage followed, then Tuoli San (Interior-Supporting Powder) for cure.

An eunuch with a back carbuncle had swelling, pain, purple color, and a deep, rapid pulse. Liangfu said: Rapid pulse, fever, and pain indicate Yang onset. Extreme redness turning purple suggests Fire resembling Water. Inquiry revealed half a year of continuous Tou Gu Dan (Bone-Penetrating Pill), causing accumulated warmth turning to heat. Neishu Huanglian Tang (Internal-Draining Coptis Decoction) was given, followed by slightly more, then pus-draining detoxifying herbs, Zhu Ti Tang (Pig Trotter Decoction), and Taiyi Gao (Great One Ointment) for cure.