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Axillary carbuncle (Yè Jū) initially presents as a nodule-like swelling, caused by Qi stagnation and Blood congealment due to Liver anger and Spleen worry. It manifests as diffuse swelling and hardness; garlic-moxibustion is indicated. If the condition persists for a long time, redness and heat develop, and pain precedes ulceration.

[Note] This syndrome, also known as Rice Carbuncle (Mǐ Jū) or Ji Carbuncle (Jiù Jū), occurs in the center of the axilla. Initially, it resembles a nodule. It arises from Qi knotting and Blood stasis in the Liver and Spleen meridians due to worry, thought, anger, and resentment. The presentation includes diffuse swelling and hardness with normal skin color. As it approaches ulceration, the area becomes red, slightly hot, and painful. Initially, moxibustion with mugwort cones separated by garlic slices is appropriate, combined internally with Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction) plus Wuyao (Lindera Root) to dissipate the swelling. For patients with deficiency, Xiangbei Yangrong Tang (Aucklandia and Tangerine Peel Nourishing Harmony Decoction) should be taken, with Wulong Gao (Black Dragon Plaster) applied externally. Early treatment may lead to complete resolution; if delayed, pus forms, requiring Tuoli Toung Tang (Interior-Supporting Pus-Permeating Decoction). If there is distending pain from pus, needle drainage is indicated. After pus discharge, pain decreases, followed by tonification based on the patient's excess or deficiency patterns. Other internal and external treatments follow the protocols for Carbuncles and Ulcers. Throughout the course of this syndrome, cold and cooling agents are strictly contraindicated in both internal and external treatments. It heals easily in middle-aged individuals but is difficult to cure in the elderly.

Garlic-Moxibustion Method (see Moxibustion Methods in Volume 1)
Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction) (see Temporal Carbuncle in Head Section)
Xiangbei Yangrong Tang (Aucklandia and Tangerine Peel Nourishing Harmony Decoction) (see Upper Stone Carbuncle in Neck Section)
Wulong Gao (Black Dragon Plaster) (see Swollen Ulcer Section)
Tuoli Toung Tang (Interior-Supporting Pus-Permeating Decoction) (see Brain-Infiltrating Carbuncle in Head Section)

Dark Carbuncle (Àn Dīng) arises in the axilla, caused by Fire-Toxin in the Liver and Spleen, presenting with itching and pain, alternating chills and fever, limb stiffness, and purple-black discoloration. Urgent treatment according to the Carbuncle category brings peace.

[Note] This syndrome occurs in the axilla, resulting from Fire-Toxin in the Liver and Spleen meridians. The lesion is hard, resembling a nail head, accompanied by itching and pain, alternating chills and fever, limb stiffness, purple-black color, irritability, vomiting, and pain radiating to half the body. Mai Ling Dan (Wheat Spirit Pill) is indicated. Subsequently, urgent internal and external treatment according to the Carbuncle category leads to recovery.

Dark Carbuncle Diagram
Mai Ling Dan (Wheat Spirit Pill) (see Swollen Ulcer Section)

Costal Carbuncle (Lèi Jū) originates in the Liver Meridian, where Fire-Toxin and pent-up anger condense into a swelling. It appears purple, painful, and ranges in size from a plum or apricot to a bowl. Needle scarification is urgently required to prevent internal invasion of toxins.

[Note] Also known as Clinging Fluorescent Carbuncle (Jiā Yíng Jū), this syndrome occurs between the ribs, caused by the condensation of Liver Meridian Fire-Toxin and pent-up anger. Initially small like a plum or apricot, it gradually enlarges to the size of a bowl, appearing purple and painful, extending to the shoulder and elbow. If on the left, pain radiates to the right costal region; if on the right, pain radiates to the left costal region. Within twenty-one days, if pus breaks out thickly and viscously, it is a favorable sign (Shun); if it does not break out by the deadline, or if clear fluid is discharged after breaking out, it is an unfavorable sign (Ni). For initial swelling, urgent scarification with a porcelain needle to release purple blood is necessary to prevent toxin invasion into the interior. After scarification, if redness, swelling, and pain worsen, accompanied by irritability, full pulse, and vomiting, it indicates an Excess pattern, treated with Shuangjie Guijin Wan (Double-Resolving Precious Metal Pill) to purge. If the swelling is hard and does not suppurate, Toung San (Pus-Permeating Powder) is indicated. If the pulse is weak and vomiting occurs, this indicates Stomach Deficiency, treated with Xiangsha Liujunzi Tang (Atractylodes and Amomum Six-Gentlemen Decoction) to tonify. Vomiting may also result from pain damaging Stomach Qi, treated similarly to Stomach Deficiency. If vomiting is caused by Cold pathogen invasion or accidental exposure to foul odors, strengthening the Stomach and assisting Qi is the primary approach even during the swelling phase. Only one or two cases of vomiting during swelling are due to internal toxin invasion, while eight or nine cases are due to retained fluids and internal injury. Physicians must distinguish these carefully clinically. When pus is ripe, use a horizontal needle to incise. Other treatments follow the protocols for Carbuncles and Ulcers.

Costal Carbuncle Diagram
Shuangjie Guijin Wan (Double-Resolving Precious Metal Pill) & Toung San (Pus-Permeating Powder) (both see Swollen Ulcer Section)
Xiangsha Liujunzi Tang (Atractylodes and Amomum Six-Gentlemen Decoction) (see Ulcer Section)