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(Normally applicable to both men and women)

Fabei (Back Carbuncle) belongs to the Bladder Meridian and the Du Meridian. Its etiology may be due to Yin deficiency with flourishing fire, or caused by drinking strong wine, consuming rich flavors, or resulting from emotional depression, anger, and sexual exhaustion. If the swelling is red, painful, severe, and the pulse is surging, rapid, and forceful, this is a syndrome of heat toxin excess, which is easy to treat. If there is diffuse swelling with slight pain, dark discoloration accompanied by thirst, and the pulse is surging, rapid but weak, this is a Yin deficiency syndrome, which is difficult to treat. If there is no pain or swelling, or if there is diffuse swelling with dark color and the pulse is minute and fine, this indicates extreme Yang Qi deficiency, which is particularly difficult to treat. If there is swelling with pain, alternating chills and fever, thirst, and normal diet, it indicates that both the constitutional Qi and pathogenic Qi are in excess. One should first use Xianfang Huoming Yin (Immortal Life Elixir), followed by Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder). If there is diffuse swelling with slight pain, or non-red color, and reduced appetite, it indicates that both constitutional Qi and pathogenic Qi are deficient. One should use Tuoli San (Supporting Interior Powder) for regulation and tonification. If pus does not form, or if pus forms but does not ulcerate, it is due to Yang Qi deficiency; one should double the dosage of Rougui (Cinnamon Bark), Renshen (Ginseng Root), and Baizhu (Atractylodes Rhizome) in Tuoli San. If pain persists after pus discharge, or if the pus is clear and thin, it is due to deficiency of both Qi and Blood; use Bazhen Tang (Eight Treasure Decoction). If there is aversion to cold and cold limbs, or if the wound fails to heal, it is due to Yang Qi deficiency; use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). If there is afternoon tidal fever or internal heat, or if the wound fails to heal, it is due to Yin Blood deficiency; use Siwu Tang (Four Substance Decoction) added with Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome). If there is vomiting or nausea, or if the wound fails to heal, it is due to Stomach Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger). If there is poor appetite and fatigue, or if the wound fails to heal, it is due to Spleen Qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber). If the granulation tissue is red and fails to heal, it is due to Blood Heat; use Siwu Tang (Four Substance Decoction) added with Shanzhi (Gardenia Fruit) and Lianqiao (Forsythia Fruit). If the granulation tissue is pale and fails to heal, it is due to Spleen deficiency; use Sijunzi Tang (Four Gentlemen Decoction) added with Jiuchaoshao Yao (Wine-fried White Peony Root) and Muxiang (Aucklandia Root). If urination is frequent, it is due to Kidney Yin depletion; use Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If at the initial stage before eruption, there are chills, fever, pain, thirst, and desire for cold drinks, this is due to internal accumulation of pathogenic factors; use Xianfang Huoming Yin (Immortal Life Elixir). If there is dry mouth with desire for hot drinks, diffuse swelling, and slight pain, this is due to internal deficiency of Yuan Qi (Primary Qi); use Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder). If there is reduced appetite and limb fatigue, it is due to Spleen and Stomach weakness; use Liujunzi Tang (Six Gentlemen Decoction); if ineffective, add Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark). Cases resulting in death occur when pathogenic factors are excessive and True Qi is deficient, preventing the expulsion of toxins; these typically manifest within ten days. If the lesion has erupted, use Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder); if it does not putrefy and ulcerate, use Tuoli San (Supporting Interior Powder); if unresponsive, urgently warm and tonify the Spleen and Stomach. Death in these cases occurs because True Qi is too deficient to cause putrefaction and ulceration; this typically manifests within twenty days. If the lesion has already putrefied and ulcerated, use Tuoli San (Supporting Interior Powder) to generate flesh; if unresponsive, urgently warm and tonify the Spleen and Stomach. Death in these cases occurs because Spleen Qi is too deficient to promote healing; this typically manifests after one month. These three syndromes, although not recorded in classical texts, have been verified through my clinical experience.

Clinical Records:

Zhou Honggang, Censor, suffered from a carbuncle on his back. It swelled but did not ulcerate, and the pulse was large and floating. This indicated Yang Qi deficiency with stagnation of pathogenic factors. I used Tuoli San (Supporting Interior Powder) with increased dosage, and he recovered. Had it been mistaken for heat toxin and treated with cold herbs, it would have been an error.

Wang Detang, Grand Minister of the Palace Household, initially suffered from overexertion and subsequently took Shixuan San (Ten Acupoints Powder), which exacerbated his vexation, thirst, and internal heat. His pulse was large but weak. This indicated self-injury of Yang Qi, failure to ascend and lift, sinking into the Yin aspect, resulting in internal heat. I treated him with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiuchaoshao Yao (Wine-fried White Peony Root), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Berry), and he recovered.

Zhang Kegong, Shangshe (Imperial Student), suffered from this condition. He used cold and cooling detoxifying herbs both internally and externally, resulting in generalized body pain, nausea, poor appetite, afternoon tidal fever, internal heat, and aversion to cold. I stated: Generalized body pain indicates deficiency of Ying (Nutritive) and Wei (Defensive) Qi, failing to nourish the muscles. Nausea and poor appetite indicate deficiency-cold of the Spleen and Stomach, failing to digest food. Internal heat and afternoon fever indicate internal deficiency of Yin Blood, with Yang Qi sinking into the Yin aspect. Aversion to cold indicates deficiency of Yang Qi, failing to protect the skin and muscles. All these stem from insufficiency of Spleen and Stomach Qi. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), after which symptoms gradually subsided. Then I used Shiquan Dabu Tang (Perfect Ten Tonifying Decoction), causing necrotic tissue to slough off. Finally, I used Liujunzi Tang (Six Gentlemen Decoction) added with Chuanxiong (Ligusticum Rhizome) and Danggui (Angelica Sinensis), leading to immediate muscle regeneration and recovery.

Gu Bixi, Fu Xiang (Provincial School Student), suffered from a lumbar carbuncle. After taking cold and cooling detoxifying herbs, the area became dark purple and painless, with pustules resembling scattered millet grains. He experienced heavy back pain unable to lie comfortably, deafness, blurred vision, dull complexion, frequent and difficult urination, thirst, confusion, coarse and short breathing, and a floating, rapid pulse that felt empty upon deep pressure. I first administered one dose of herbs to nourish Kidney Water. Shortly after, urination improved, thirst ceased, and his back felt light. I then performed bloodletting with a lancet to remove stasis, applied moxibustion using approximately half a jin of mugwort directly on the lesion, applied Wujin Gao (Black Gold Ointment) externally, and administered Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis), and Rougui (Cinnamon Bark) internally. After several doses, his Yuan Qi (Primary Qi) slightly recovered. Suspecting Rougui (Cinnamon Bark) was too acrid and hot, he omitted it for one day, resulting in cold extremities and fecal incontinence. I re-added Rougui (Cinnamon Bark) 2 qian, Buguzhi (Psoralea Fruit) 2 qian, and Roudoukou (Nutmeg) 1 qian. Bowel movements normalized, and the tissue began to slough. I then used Danggui Gao (Angelica Ointment) to regenerate flesh and Bazhen Tang (Eight Treasure Decoction) to tonify Qi and Blood, resulting in recovery.

Zhou Yufeng, a Confucian scholar, had long-standing emotional depression and developed a carbuncle on his back. His Liver pulse was wiry and surging, while his Spleen pulse was floating and large but minute and fine upon pressure. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiegeng (Platycodon Root) and Beimu (Fritillaria Bulb), with small amounts of Jinyinhua (Honeysuckle Flower) and Baizhi (Angelica Dahurica Root). After two doses, the wiry Liver pulse receded, and the Spleen pulse recovered. I then administered Huoming Yin (Life-Saving Elixir) for two doses, leading to pus discharge and reduction of swelling. However, the Liver pulse remained wiry, indicating that although the toxin was expelled, Stomach Qi was injured again. I continued with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber), resulting in recovery.

Cai Dongzhi, Shangshe (Imperial Student), suffered from this condition. I used interior-supporting herbs to induce ulceration, but the wound had not fully healed. It was mid-winter, and he also had coughing. I stated: The unhealed wound indicates Spleen Qi deficiency. Persistent coughing indicates Lung Qi deficiency. According to treatment principles, one should tonify the mother organ (Spleen). During a banquet, I noticed he avoided mutton. I said: Tonification can counteract weakness; examples include Renshen (Ginseng Root) and mutton. It is highly suitable for consumption. He ate it daily without cessation. Within ten days, the wound healed, and the cough resolved immediately.

Tu Jiufeng, Vice Commissioner, suffered from this condition in early spring. The area was dark purple and diffusely swollen, with thirst and frequent urination. The Chi (Cun Cun) pulse was surging and rapid. This indicated depletion of Kidney Water, destined to perish during the peak of Fire. Disbelieving this, he took more bitter-cold herbs, further injuring his Yuan Qi (Primary Qi) and hastening his death.

Chai Funan, Prefect Capital Official, suffered from this condition in mid-summer. The area was dark purple and slightly swollen, with fever, irritability, spontaneous salivation, hardness in the lower abdomen, and cold reversal of hands and feet. The Right Guan pulse was floating and choppy, and both Chi pulses were minute and fine. I stated: This is a deficiency-cold syndrome. Wang Taipu said: "Great heat without actual heat signifies absence of Fire." Recovery was impossible. Despite his earnest requests, I administered one dose of strongly warming and tonifying herbs. Although salivation stopped, the lesion did not improve, and he ultimately could not be saved.

Gu Dongxi, a Jinshi degree holder, suffered from chronic thirst. In June, he developed a lumbar carbuncle. Due to improper lifestyle management, the wound ulcerated over a chi in length, appearing dark, necrotic, and foul-smelling. Urination resembled strangury, lips were cracked, and tongue prickles appeared. The pus was foul-smelling, the area was dark and painless, and the wound opening was wide. This indicated failure of Spleen Qi and death of muscle tissue. Strangury-like urination, phlegm obstruction, panting, and dry mouth indicated critical danger. He died two days later as predicted. For such external manifestations, death occurring after two months is due to Yuan Qi (Primary Qi) deficiency failing to promote healing. If proper regulation and tonification had been provided beforehand to maintain Qi and Blood integrity, survival might have been possible.