肿痛未作脓者，宜除湿消毒，黄连消毒饮之类。大痛或不痛、或麻木者、毒甚者，隔
蒜灸之，更用解毒药。肿痛便秘者，邪在内也，宜泄之；不甚痛或不作脓者，虚也，托里为主；
不作脓及不溃，俱宜托里。脓成而痛者，针之，更以托里。脓溃而多及不敛者，大补气血。
烦躁饮冷，脉实而痛，宜泻火。
一人素不慎起居饮食，脑 赤肿痛，尺脉洪数。以黄连消毒散一剂，湿热顿除，惟肿硬作
痛，以仙方活命饮二剂，肿痛悉退，但疮头不消，投十宣，去桂，加金银花、 本、白术、
茯苓、陈皮以托里排脓。彼欲全消，自制黄连解毒散，二服，反肿硬不脓。仍用十宣，加白术、
陈皮、茯苓，肿少退，仍去桂，又四剂而脓成肿退。继以八珍汤，加黄 、五味子、麦门冬，
月余，脓溃而愈。
一人脑疽，肿痛脉数，以黄连消毒散，二剂少退，与仙方活命饮，二剂而止，再以当归、
川芎、芍药、金银花、黄柏、知母而溃，又以托里药而愈。
一人头项俱痛，虽大溃，肿痛亦甚，兼作泻，烦躁不睡，饮食少思，其势可畏。诊其脉，
毒尚在，与仙方活命饮，二剂，肿痛退半，与二神丸及六君子汤，加五味、麦门冬、酸枣仁，
四剂，诸证少退，食颇进，睡少安，及与参苓白术散，数服而食进，又与十全大补汤，加金
银花、白芷、桔梗，月余瘥。
一妇脑疽，左肿痛，左鼻出脓，年余不愈，时或掉眩，如坐舟车。许叔微曰∶肝虚，
风邪袭之然也。以川芎一两、当归三钱、羌活、旋覆花、细辛、防风、蔓荆子、石膏、 本、
荆芥穗、半夏曲、干葛、生地黄、甘草各半两，每服一两，姜水煎服，一料而愈。
一人脑疽十余日，面目肿闭，头 如斗，脉洪数，烦躁饮冷，此膀胱湿热所致。用黄
连消毒饮二剂，次饮槐角酒二腕，顿退，以指按下，肿则复起。此脓已成，于颈、额、肩、
颊各刺一孔，脓并出，口目始开。更以托里药，加金银花、连翘，三十余贴愈。
一人患脑疽势剧，脉实，用黄连消毒散，不应，以金银藤二两，水二钟煎一钟，入酒
半盏服之，势去三四，再服渐退。又加黄柏、知母、栝蒌、当归、甘草节，数剂而溃止，
加黄 、川芎、白芷、桔梗，数剂愈。
一人脑疽，其头数多，痛不可忍。服消毒药不应，更以金银花，服之即鼾睡，觉而
势去半，再数剂而消。
一人脓将成，微痛兼渴，尺脉大而无力，此阴虚火动之证。彼谓心经热毒，自服清
凉降火药，愈炽，复求治。乃以四物汤中加知、柏、五味子、麦门冬、黄 ，及加减八味丸，
渴止疮溃，更以托里药兼前丸而愈。
一妇年将七十，形实性急，好酒，脑疽作才五日，脉紧急又涩。急用大黄，酒煨细切，
酒拌炒为末，又酒拌人参炒入姜煎，调一钱服，过两时再与，得卧，而上半身汗，睡觉病
已失。此亦内托之意。
杜碧清亦明医也，自病脑疽，疗之不愈。丹溪往视之，曰∶何不服防风通圣散？曰∶
已服数剂，丹溪曰∶合以酒制之。碧清乃自悟，以为不及。
For Naoju (carbuncle located at the back of the head), if there is swelling and pain but no pus formation yet, it is appropriate to employ methods for removing dampness and detoxifying, such as using formulas like Huanglian Xiaodu Yin (Coptis Decoction for Detoxification). If the pain is severe or absent, or if there is numbness, indicating deep-seated pathogenic toxins, moxibustion with garlic partition should be performed, along with the use of detoxifying herbs. If there is swelling, pain, and constipation, the pathogen is in the interior, and purgation is indicated; if the pain is mild or there is no pus formation, it indicates deficiency, and the primary treatment should focus on supporting the healthy qi and expelling toxins outward; whether there is no pus formation or no ulceration, supporting the healthy qi is always appropriate. If pus has formed accompanied by pain, puncture with a needle to drain the pus, followed by continued use of formulas to support the healthy qi. If the pus has ulcerated excessively and the wound fails to heal, substantial tonification of qi and blood is required.
If symptoms include irritability, desire for cold drinks, solid pulse, and pain, clearing fire is indicated.
A patient who had been negligent in daily routine and diet developed a carbuncle on the head with redness, swelling, and pain, and the chi position of the pulse was surging and rapid. After one dose of Huanglian Xiaodu San (Coptis Powder for Detoxification), the damp-heat was instantly eliminated, leaving only hard swelling and pain. Two doses of Xianfang Huoming Yin (Immortal Life Preserving Decoction) were administered, after which the swelling and pain completely subsided, but the top of the sore remained unresolved. Shixuan Tang (Ten Acupoints Decoction) without Gui Zhi (Ramulus Cinnamomi Cassiae) was prescribed, adding Jin Yin Hua (Flos Lonicerae Japonicae), Ben Cao (Rhizoma Ligustici Wallichii), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), and Chen Pi (Pericarpium Citri Reticulatae) to support the healthy qi and expel pus. The patient wished for complete resolution and self-prescribed Huanglian Jiedu San (Coptis Powder for Resolving Toxins); after two doses, the condition worsened with increased hardness and swelling without pus formation. Shixuan Tang was used again, adding Bai Zhu, Chen Pi, and Fu Ling; the swelling slightly receded. Gui Zhi was removed again, and after four more doses, pus formed and swelling subsided. Subsequently, Bazhen Tang (Eight Treasures Decoction) was given, adding Huang Qi (Radix Astragali Membranacei), Wu Wei Zi (Fructus Schisandrae Chinensis), and Mai Men Dong (Tuber Ophiopogonis Japonici). Over a month, the pus ulcerated and the patient recovered.
Another patient with Naoju presented with swelling, pain, and a rapid pulse. Two doses of Huanglian Xiaodu San reduced symptoms slightly, followed by two doses of Xianfang Huoming Yin which halted progression. Then, Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong), Shao Yao (Radix Paeoniae Lactiflorae), Jin Yin Hua, Huang Bo (Cortex Phellodendri Amurensis), and Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) were administered, leading to ulceration, and finally, formulas to support the healthy qi resulted in recovery.
A third patient suffered from pain in both the head and neck. Although severely ulcerated, swelling and pain persisted, accompanied by diarrhea, irritability, insomnia, and poor appetite, presenting a grave prognosis. Pulse diagnosis revealed that the toxin remained. Two doses of Xianfang Huoming Yin reduced swelling and pain by half. Then, Ershen Wan (Two Spirits Pill) and Liujunzi Tang (Six Gentlemen Decoction) were given, adding Wu Wei Zi, Mai Men Dong, and Suan Zao Ren (Semen Ziziphi Spinosae). After four doses, various symptoms improved, appetite increased significantly, and sleep stabilized. Subsequently, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) was administered several times, further improving appetite. Finally, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was given, adding Jin Yin Hua, Bai Zhi (Radix Angelicae Dahuricae), and Jie Geng (Radix Platycodonis Grandiflori), resulting in recovery after over a month.
A female patient suffered from Naoju with left-sided swelling and pain, and pus draining from the left nostril, persisting for over a year. She occasionally experienced dizziness and vertigo, feeling as if riding in a boat or carriage. Xu Shuwei stated: This is due to liver blood deficiency allowing wind pathogens to invade. A prescription containing Chuan Xiong (one liang), Dang Gui (three qian), Qiang Huo (Radix Notopterygii Rhizomatis et Radicis), Xuan Fu Hua (Flos Inulae), Xi Xin (Herba Asari), Fang Feng (Radix Saposhnikoviae), Man Jing Zi (Fructus Viticis Trifoliae), Shi Gao (Gypsum Fibrosum), Ben Cao, Jing Jie Sui (Cacumen Schizonepetae), Ban Xia Qu (Fermented Rhizoma Pinelliae Ternatae), Gan Ge (Radix Puerariae Lobatae), Sheng Di Huang (Radix Rehmanniae Glutinosae), and Gan Cao (Radix Glycyrrhizae Uralensis) each half liang was prepared. One liang was taken per dose, decocted with ginger water. One course of treatment resulted in recovery.
A male patient had Naoju for over ten days, with swollen and closed eyes and face, and a head swollen like a bucket. The pulse was surging and rapid, with irritability and desire for cold drinks, caused by damp-heat in the Bladder. Two doses of Huanglian Xiaodu Yin reduced symptoms, followed by drinking two large bowls of Huai Jiao Jiu (Styloceratis Fruit Wine), causing immediate reduction. However, swelling rebounded upon pressure, indicating pus formation. Holes were pricked at the neck, forehead, shoulders, and cheeks to drain the pus, allowing the mouth and eyes to open. Formulas to support the healthy qi, adding Jin Yin Hua and Lian Qiao (Fructus Forsythiae Suspensae), were administered for over thirty doses, resulting in recovery.
Another patient with severe Naoju and a solid pulse did not respond to Huanglian Xiaodu San. Instead, two liang of Jin Yin Teng (Caulis Lonicerae Japonicae) were decocted in two zhong of water to yield one zhong, mixed with half a zhan of wine and consumed. The severity decreased by three or four parts, and subsequent doses led to gradual improvement. Huang Bo, Zhi Mu, Gua Lou (Fructus Trichosanthis), Dang Gui, and Gan Cao Jie (nodules of Radix Glycyrrhizae Uralensis) were added. After several doses, ulceration occurred and stopped progressing. Huang Qi, Chuan Xiong, Bai Zhi, and Jie Geng were then added, leading to recovery after several doses.
A patient with numerous Naoju heads endured unbearable pain. Detoxifying herbs were ineffective. Jin Yin Hua was administered, inducing deep sleep. Upon waking, the condition had halved. Several more doses led to resolution.
A patient with impending pus formation had mild pain and thirst, with a chi pulse that was large but forceless, indicating yin deficiency with hyperactive fire. Believing it to be heart meridian heat-toxin, he self-medicated with cooling and fire-clearing drugs, worsening the condition. Seeking treatment, Siwu Tang (Four Substances Decoction) was modified with Zhi Mu, Huang Bo, Wu Wei Zi, Mai Men Dong, and Huang Qi, along with Jiajian Bawei Wan (Modified Eight-Ingredient Pill). Thirst ceased, the sore ulcerated, and combined use of formulas to support the healthy qi and the previous pill led to recovery.
A woman nearing seventy years old, with a robust physique and irritable temperament, who enjoyed alcohol, developed Naoju five days prior. Her pulse was urgent and choppy. Da Huang (Radix et Rhizoma Rhei Palmati) was urgently prescribed, stir-fried with wine after being soaked and sliced finely, then powdered. Ginseng was also stir-fried with wine and ginger, decocted, and one qian was mixed and ingested. After two hours, another dose was given. She slept, sweated from the upper body, and woke up cured. This exemplifies the principle of internal support.
Du Biqing, a renowned physician himself, suffered from Naoju that failed to heal despite treatment. Zhu Danxi visited and asked: Why do you not take Fangfeng Tongsheng San (Saposhnikovia and Gardenia Powder for Unblocking and Assisting)? Du replied: I have already taken several doses. Zhu said: They should be processed with wine. Du realized his own inadequacy compared to Zhu's expertise.