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(Universal for both men and women)

Abdominal carbuncle (Fu Yong) refers to sores occurring in the abdomen, or between the skin and fascia. It is attributed to rich and greasy dietary habits (Gao Liang Nong Wei) and fire generated from emotional stagnation (Qi Qing Yu Huo). If the swelling is diffuse and hard with unchanged skin color, it indicates deficiency of healthy qi; Tuoli Xiaodu San (Support Interior and Eliminate Toxin Decoction) should be used. If pus forms but fails to ulcerate externally, it is due to deficiency of qi and blood; a horizontal needle insertion technique should be employed. If there is swelling accompanied by pain, it indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Life Preserving Powder) should be used first, combined with garlic-separated moxibustion to neutralize toxicity; subsequently, Tuoli San (Support Interior Powder) should be used to tonify qi. If internal resolution is desired at the onset, one should strengthen stomach qi and consolidate the root, assisting with herbs that promote meridian circulation and invigorate blood. If purgative agents are used to seek internal resolution, the swelling will fail to ulcerate, and if ulcerated, it will fail to heal. If draining agents are used to evacuate pus, young and strong patients will mostly prove difficult to treat, while old and weak patients will face immediate danger. There are also cases resembling this caused by food retention or hernia; see Clinical Cases.

Simu Li Wushan suffered from this condition, experiencing abdominal pain with established pathology. After using Huoming Yin (Life Preserving Powder), pain ceased immediately after one dose. Following this, Tuoli Xiaodu San was administered, causing the swelling to rise sharply, indicating impending pus formation. Subsequently, Tuoli San was used to tonify, leading to spontaneous ulceration and recovery.

Jinyiwei Zhangtang Guan Liu Tingqi developed an abdominal carbuncle in mid-summer during the Xinwei year of Zhengde. After ulceration, the pus was clear, accompanied by fever, thirst, abdominal distension, vomiting, and loss of appetite. Some physicians attributed this to internal heat toxin and prescribed cooling and detoxifying herbs; vomiting stopped and appetite returned. Further treatment with Tuoli-type formulas resulted in healing.

Jinshi Bian Yunzhuang presented with abdominal pain, aversion to cold, and a floating, rapid pulse. I stated: "A floating and rapid pulse accompanied by aversion to cold is a sign of carbuncles and ulcers." He did not believe me. Several days later, pus ulcerated from the buttocks. At this stage, both qi and blood were deficient, making healing impossible. Urgently, one zhong (unit of volume) of Huoming Yin was administered. A single pore opened on the buttock, discharging approximately one dou of pus. The patient's breath was faint. [Missing text inferred as tonifying formula]... Restlessness ceased. The pulse was large upon lifting and pressing, appearing solid. Upon re-examination, the pulse was flooding but empty upon deep pressure. Shiquan Dabu Tang (Complete Great Tonification Decoction) was used, with doubled doses of Renshen (Ginseng Radix) and Huangqi (Astragali Radix) totaling four jin, plus two Fuzi (Aconiti Lateralis Radix Preparata), prepared as a paste. Spasms ceased. Another fifty-plus doses of Shiquan Dabu Tang led to wound contraction.

Shangshe Zhou Yiyuan suffered from an abdominal carbuncle for three months without healing. Pus and water were clear and thin. He experienced morning chills and evening fevers. After taking Siwu Tang (Four Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), he developed poor appetite and diarrhea, indicating qi and blood deficiency. Poor appetite and diarrhea indicate spleen and kidney deficiency. Phlegm surging and chest stuffiness indicate spleen and lung deficiency. All stem from deficiency of true qi and excess of pathogenic factors. Stomach qi must first be strengthened so that the zang-fu organs have substance to receive, allowing pathogens to retreat naturally. Six Junzi Tang (Six Gentlemen Decoction) was modified with Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix). After several doses, symptoms gradually receded. Shiquan Dabu Tang was then used, leading to gradual muscle regeneration. Finally, Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) was used for regulation and full recovery.

Shangshe Mao Tiren had a constitution prone to yin deficiency. In early spring, he suffered from cough and dull chest pain. The kidney pulse was rapid and forceless; the lung pulse was rapid and intermittently visible. This indicated kidney pulse depletion and blazing yin fire. One dose of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) reduced the disease severity, but an internal carbuncle had formed. This was because yuan qi was deficient and failed to expel the toxin. The fire season was feared. He did not believe this and took phlegm-fire resolving herbs. Two months later, slight swelling appeared between the breasts. The pulse was flooding, rapid, and forceless. I said: "Pus has ulcerated internally. It should be drained via acupuncture to avoid internal invasion." He refused. Over a month later, I was called again. Only one pore was punctured; pus drainage was obstructed, leading to internal invasion. Lips and tongue turned cyan and red. I said: "The zang-fu organs are destroyed; how can I treat this?" He subsequently died.

My younger nephew married early at fourteen. In the spring of Yisi, at age twenty-four, he suffered from abdominal qi pain. After two doses of Dahuang (Rhei Radix et Rhizoma) and other drugs, he passed significant amounts of blood, developing chest/abdominal distension, phlegm-wheezing, and fever. Another dose of qi-breaking and fire-descending herbs caused profuse sweating like water and ice-cold extremities. Returning from a trip, I palpated the left guan position: flooding and rapid; the right chi position was even more severe. This was an abdominal carbuncle. Although it could contract, it would transform into consumption (Zhai Syndrome) by summer. Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) 1 liang each, Dang Gui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) 5 qian each, Chen Pi (Citri Reticulatae Pericarpium)... [Missing text]... After two more doses, swelling and pain subsided, pulse became slippery. Multiple acupuncture sessions drained pus and stasis. Da Bu Tang (Great Tonification Decoction) restored spirit and diet. Due to seminal emission, the lesion area turned dark. Previous herbs were modified with Wuweizi (Schisandrae Fructus), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gusuibu (Drynariae Rhizoma), and Wuzhuyu (Evodiae Fructus). Pain gradually subsided, but signs of consumption fully manifested. His pulse was either flooding, large, and rapid, or minute and nearly imperceptible. He exclusively consumed Danshen Tang (Single Ginseng Decoction) and human milk. Transient improvement occurred, followed by collapse. I said: "Prepare funeral arrangements; wait for the peak of fire energy." He prayed to spirits and ghosts. A shaman recounted past events accurately and provided prescriptions consisting of harsh and draining agents, promising survival. He believed and accepted them. He subsequently died. The Classic states: "One who is bound by superstition cannot be spoken to regarding the highest virtue." How much more so to trust prescriptions from deceitful persons! I record this to warn future generations.