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[Song on Scarification for Carbuncles and Ulcers]

Carbuncles and ulcers presenting with swelling, redness, and wandering migration; erysipelas (acute skin infection); filiform carbuncle (an acute infectious disease characterized by a red line on the skin); and patterns of epidemic toxins causing severe stagnation of blood stasis—all are most appropriately treated with scarification. One need only puncture the skin without injuring the flesh; using a porcelain edge against the affected area requires lightness. When toxic blood is expelled upon puncture, the swelling subsides and redness dissipates, demonstrating miraculous efficacy.

[Note] For all conditions such as carbuncles and ulcers with red, wandering swelling; erysipelas; spreading filiform carbuncle; and severe blood stasis due to epidemic toxins, the method of stone scarification is suitable. However, excessive depth must be avoided, as stated in the *Neijing*: "Puncture the skin without injuring the flesh." The technique involves crushing fine porcelain and selecting a piece with a sharp edge. A chopstick is split at one end to clamp and bind the porcelain shard. Using two fingers to gently press the handle end, the porcelain edge is held about one cun away from the lesion. Another heavier chopstick is used to frequently tap the handle, allowing toxic blood to flow out upon puncture. If the swelling has not fully resolved the next day, scarification should be performed again according to judgment, stopping when the swelling subsides and redness dissipates.

[Song on Moxibustion for Carbuncles and Ulcers]

For carbuncles and ulcers in their initial stage within seven days, moxibustion is most suitable for resolving nodules and drawing out toxins. For painless lesions, moxa is applied until pain is felt; for painful sores, it is applied until the pain ceases. The method involves covering the area with wet paper; moxibustion should begin immediately where the paper dries first, without delay. Methods include garlic-interposed moxibustion, yellow wax moxibustion, prepared aconite cake moxibustion, fermented soybean cake moxibustion, and larva moxibustion.

[Note] For early-stage carbuncles and ulcers within seven days, moxibustion is indispensable for resolving nodules and extracting toxins. Painless areas are moxed until sensation returns; painful sores are moxed until pain stops. This is because toxin attachment causes numbness, while heat reaching healthy tissue causes pain. Moxibustion must continue until pain is felt, indicating that the fire qi has reached healthy tissue. Conversely, contact with undamaged skin causes pain, while contact with toxin causes no pain; thus, one must moxe until pain disappears, indicating the fire qi has penetrated the toxin. The technique involves soaking paper in water and covering the lesion completely. Observe where the paper dries first and apply moxa there. Early application is crucial: treating on days 2–3 yields an 80–90% cure rate; days 4–5 yield 60–70%; days 6–7 yield 40–50%. Earlier is better. Various methods exist: garlic-interposed, direct flesh moxibustion, yellow wax, prepared aconite cake, fermented soybean cake, and larva moxibustion. One session may involve up to one hundred moxa cones, stopping when effective. The size of the moxa cone depends on the severity of the sore. However, there are contraindications: *Shenshu* carbuncle (carbuncle at the Shenshu acupoint) should not be moxed to avoid depleting kidney fluids; finger lesions should not be moxed due to thin skin and flesh, risking cracking and rot. The head is the summit of all Yang meridians; classical texts prohibit moxibustion here. Mistaken moxibustion may force toxins inward, causing phlegm and wheezing, exacerbating swelling. However, in pure Yin sinking patterns, moxibustion is mandatory to restore Yang. In half-Yin half-Yang patterns, it remains prohibited.

[Garlic-Interposed Moxibustion Method]

Slice fresh garlic to a thickness of approximately 3 qian. Place it on the sore and apply large moxa cones. Replace the garlic slice after three cones. For diffuse swelling without a head, cover with wet paper, identify the first drying spot, place garlic there, and moxa. If multiple spots dry simultaneously, moxa them together. If a white grain-sized nodule appears surrounded by coin-sized redness, moxa directly on the white grain. For large or long-standing sores, mash garlic, spread it on the sore, place moxa on top, and replace the garlic when it burns. Efficacy is indicated by intense pain. For carbuncles, flowing abscesses, and knee-crane wind, apply 20–30 cones daily. For yin-type sores, use abundant moxa; administer *Huxin San* (Heart-Protecting Powder) beforehand to prevent fire toxins from entering internally. For children, place garlic on an adult's arm, ignite moxa until the garlic warms, then transfer to the child's lesion, following the previous method. As stated in the classics: "When cold pathogens lodge in the collaterals, blood congeals and flows poorly. Wei Qi gathers there, obstructing flow and generating heat. Unchecked heat rots flesh into pus." Toxin originates from fire but combines with external cold; thus, moxa and garlic are used to resolve nodules and draw deep toxins to the surface.

[Yellow Wax Moxibustion Method]

For carbuncles, back carbuncles, malignant sores, and stubborn ulcers, first use wet dough to form a circle around the base of the swelling, about one cun high, adhering tightly to the skin like a well mouth, preventing leakage. Surround the circle with several layers of cloth to protect the skin from heat. Fill the circle with 3–4 fen thick yellow wax shavings. Suspend a copper scoop containing mulberry charcoal fire above the wax to melt it until boiling. Add more shavings until the circle is full. For painless skin (shallow toxin), moxa until pain is felt; for painful skin (deep toxin), moxa until pain ceases. Remove the heat source, spray a little cold water on the wax, wait for it to cool, and remove the wax. Blackish-green residue at the bottom indicates toxin expulsion. For diffuse swelling, test with wet paper and moxa the first drying spot. Early stages resolve in 1–2 sessions; established stages ulcerate in 2–3. For chronic non-healing ulcers with hard margins, moxa directly on the wound opening. Wax penetrates deeper for better results, dissolving stubborn necrotic tissue and pus rapidly, promoting quick healing.

[Prepared Aconite Cake Moxibustion Method]

Grind raw Sichuan aconite (*Radix Aconiti Lateralis Preparata*) into powder, mix with yellow wine to form cakes about 3 qian thick. Place on the sore and apply moxa cones. Apply a few cones daily, ensuring mild warmth without pain. Replace dried cakes. Continue until the sore becomes red and vibrant. This method is highly effective for ulcers with Qi and Blood deficiency failing to heal, or where Wind-Cold invasion impedes circulation.

[Fermented Soybean Cake Moxibustion Method]

For carbuncles and back carbuncles, whether ulcerated or not, grind Jiangxi light fermented soybeans (*Faber Semen Preparatum*) into powder. Mix with yellow wine to form cakes 3 fen thick based on sore size. Place on the lesion and moxa. Replace dried cakes. If an opening exists, do not cover it; arrange soybean cakes around the opening, place moxa on top, and apply mild heat without breaking the skin. Change if too hot/painful. Apply three times daily until the sore sweats, indicating recovery.

[Larva Moxibustion Method]

For malnutrition-related malignant sores unresponsive to other drugs, take larvae (*Megaselia scalaris*), cut off both ends, place on the sore, and apply moxa. Replace every seven cones, using no more than seven larvae total. This method is invariably effective.

[Mai Dong Jing Mi Yin]

This formula treats yin-type carbuncles and ulcers where moxibustion was either indicated but excessive, or contraindicated (Yang sores) but mistakenly applied, leading to fire toxins entering the interior. Symptoms include swelling of the head and neck, coma, phlegm surging, and panting. Administer this urgently to clear and resolve fire toxins effectively.

Ophiopogon Root (*Ophiopogonis Radix*, heart removed) and Coix Seed/Job's Tears? No, Rice (*Oryzae Sativa Germen*) — each 3 qian.

Decoct in two sheng of water until one sheng remains. Drink slowly while warm.

[Formula Song]
Mai Dong and Jing Mi in equal parts,
Cures head and neck swelling post-moxa.
Coma, phlegm, and panting cease,
Slow decoction brings greatest success.