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How to treat carbuncles and back sores? Regardless of whether it is a Yin syndrome or a Yang syndrome, moxibustion should be performed first. If the affected area is painless, moxa until pain is felt; if painful, moxa until the pain subsides.

When diagnosing large sores on the head, neck, etc., caused by carbuncles and ulcers, one must first remain calm and establish a clear treatment strategy. Start counting from the day of onset to determine how many days have passed. Observe whether the sore's appearance corresponds with the number of days elapsed. A correspondence indicates a favorable prognosis, while a discrepancy suggests danger. Next, investigate the source of the disease: which Zang-Fu organ is involved and which body part is affected. The body has upper and lower sections, and locations vary in severity. Distinguish between favorable and unfavorable conditions based on color and shape, and assess the presence of healthy Qi through mental spirit. Consider the patient's age (young or old) and the strength or deficiency of Qi and Blood. Differentiate between Yin and Yang syndromes, and determine the depth of the pathogenic toxin. Generally, Yang syndromes are easier to treat and often result in survival, whereas Yin syndromes are difficult to treat and often lead to death. Then, palpate the pulse to determine its excess or deficiency, which reveals the favorability or unfavorability of the condition and helps predict the outcome. Before the sore ulcerates, the pulse should be slightly forceful (exceeding normal by one or two beats); after ulceration, the pulse should be slightly weak (deficient by two or three degrees). This alignment between pulse and symptoms ensures stability throughout the course. If the pulse and symptoms contradict each other, unexpected complications may arise. Diagnosis relies on the physician's keen observation and mental focus, thoroughly analyzing internal and external aspects before determining the treatment method. For sores within seven days, where the pathology is not yet formed and healthy Qi is not yet weakened, moxibustion should be applied regardless of Yin/Yang, interior/exterior, cold/heat, or excess/deficiency patterns. In mild cases, the toxin dissipates with the fire; in severe cases, it draws out stagnant toxins and unblocks internal and external pathways. The fire transforms the toxin into Yang, promoting swelling and pain, after which diaphoresis, purgation, resolution, or expulsion methods can be used. Treatment must harmonize the pulse with the prescription and the prescription with the disease. Thus, treatment will be error-free. Medicinal formulas cannot be rigidly adhered to; flexibility is key. Throughout the treatment, protecting healthy Qi and the Spleen-Stomach is paramount.

Internally administer Chan Su Wan (Toad Venom Pill), externally apply Shen Deng Zhao (Divine Lamp Illumination) for three branches.

For newly arising sores, within seven days, or after moxibustion but before taking other medicines, administering one dose of Chan Su Wan (Toad Venom Pill) to induce sweating is ideal. Alternatively, Wan Ling Dan (Ten Thousand Spirits Pill) for diaphoresis is also suitable. Dispersing toxins through sweat is the quickest method. If sweating does not occur after taking these medicines, it indicates tight closure of the exterior and interior, and the toxin is significant. In such cases, Shen Miao Ba Gen Fang (Divine Marvel Root-Pulling Formula) should be used, and Shen Deng Zhao (Divine Lamp Illumination) is very effective. However, this should not be used too early. Between the fourth and fifth day, if the sore has not consolidated and the toxin has not emerged, premature use may trap the stagnation and make internal toxins harder to expel. This method should be used after the eighth or ninth day, when the sore's trend is established and the toxin has gathered but has not yet suppurated or necrosed. Illumination with the lamp causes existing abscesses to rise, non-suppurating ones to resolve, un-ulcerated ones to break, and non-detaching ones to shed. It is also an excellent method for resolving toxins, invigorating blood, reducing swelling, and dispersing stasis.

Apply plaster to the top of the sore, and powder around the perimeter.

Sores are most vulnerable to Wind-Cold invasion. At the initial stage, or after moxibustion, Tai Yi Gao (Great Emperor Plaster) should be applied to the top of the sore. Its functions include drawing out toxins, lifting the apex, promoting pus discharge, and preventing Wind-Cold entry. If the sore is swollen and painful, indicating a Yang sore, after seven days, yellow thick pus will naturally adhere to the plaster at the apex, while the surrounding redness remains bright and vivid. Wash daily with Scallion Decoction and change the dressing. The main pus will likely discharge around the eleventh day, indicating an easy-to-treat and safe condition. If after seven days the sore is not highly swollen, the surroundings are not painful, and there is no pus at the apex, it indicates a balance of Yin and Yang. Apply Hua Fu Zi Xia Gao (Rot-Resolving Purple Cloud Plaster) to the apex and cover with plaster. After changing dressings beyond the tenth day, the apex will gradually necrose, and the surrounding swelling will rise, suggesting impending pus. Main pus may discharge after the fifteenth day, indicating a transition from dangerous to favorable. If there is no pus after twenty days, it is a Pure Yin syndrome, and treatment will be ineffective. Regarding the swelling at the base of the four sides, applying powder helps consolidate the root and prevent spreading. Initially, Jin Huang San (Golden Yellow Powder) applied around the sides draws out toxins, reduces swelling, and relieves pain. After ulceration, Tie Tong Gao (Iron Bucket Plaster) is used to bind the root, helping it tighten and converge. Since all sores result from Qi and Blood stagnation, avoid using only cooling herbs, as they may freeze the muscles, leading to difficulty in suppuration and healing. Instead, use warming herbs to disperse stagnation, move blood, draw out toxins, and invigorate blood circulation.

When Qi is abundant, the apex rises high and protrudes; when Blood is abundant, the base is tightly bound without doubt.

Qi and Blood are the original endowments of human life. Even the elderly may have surplus, and the young may have deficiency. Human vitality depends entirely on them. Since all diseases arise from imbalances here, losing this foundation inevitably leads to changes, especially in surgery. During the swelling stage, without sufficient healthy Qi to support, the apex cannot swell high or become painful. During the ulceration stage, without True Yin to nourish, the base cannot consolidate, and the color cannot become red and vibrant. Observing a high apex and active base indicates sufficient Qi and Blood, regardless of age, ensuring safety. "Intersection" refers to the natural boundary between the sore root and healthy flesh. "Clear distinction" means the sore shape and healthy tissue are distinct without mixing. Understanding this makes the diagnosis clear.

Highly swollen sores should avoid purgative drugs to prevent damaging healthy Qi; flat and spreading sores require tonifying and supporting agents to address deficiency.

Naturally high-rising sores at onset belong to Yang syndromes, with no deep internal toxin and surface manifestation. Support the interior to accelerate suppuration. Avoid internal resolving and attacking drugs that damage Spleen Qi, which would hinder pus formation and healing. Flat, non-red, spreading sores at onset indicate inherent healthy Qi deficiency. Immediately administer interior-supporting, middle-warming, and Spleen-strengthening drugs to push the toxin outward and prevent complications.

If internal heat is severe, add detoxifying and clearing agents appropriately; if constipation and dryness exist, ensure appropriate bowel movement. This promotes free flow of organs and smooth circulation of Qi and Blood.

During the swelling stage, internal heat, dry mouth, forceful pulse, irritability, constipation, and preference for cold indicate pathogenic toxin in the interior. Urgently use cold and purgative treatments. Suitable formulas include Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction), Si Shun Qing Liang Yin (Four Smooth Cooling Drink), or Nei Xiao Wo Xue Tang (Internal Resolution Snow-Washing Decoction). If accompanied by exterior symptoms, use Fang Feng Tong Sheng San (Saposhnikovia Unblocking Success Powder) removing Ma Huang (Ephedrae Herba), or Shuang Jie San (Double Resolution Powder) adding Jie Geng (Platycodonis Radix) and Tian Hua Fen (Trichosanthis Radix). If urination is difficult, combine with Tian Shui San (Heavenly Water Powder) or Wu Ling San (Five Spice Powder) to ensure free passage of urine and feces, cutting off the source. For patients with inherent Qi deficiency who cannot tolerate strong drugs, use Tuo Li Xiao Du San (Interior-Supporting Toxin-Resolving Powder) with honey-fried Da Huang (Rhei Radix et Rhizoma), or combine with Pig Gallbladder method, aiming for free passage. Treatment should maintain openness without leakage, harmonizing organs and penetrating interior/exterior, before using interior-supporting, pus-expelling, or internal-tonifying drugs. In the ulceration stage, even with dry mouth, constipation, organ disharmony, or difficult urination, these result from excessive loss of pus/fluid, leading to Yin fluid depletion and Qi/Blood exhaustion, failing to nourish organs. The pulse is fine and rapid, mouth feels normal but dry, appetite decreases, and hot soup is preferred. This is deficiency-Yang fire, not excess. Nourish Qi and Blood, moisten fluids, harmonize organs, and regulate Spleen-Stomach. This harmonizes bowels/bladder and prevents complications. Misusing purgatives often leads to untreatable conditions.

If the sore remains hard within ten days, it must be punctured with a needle at the center.

After ten days, sores should naturally necrose and suppurate. If still hard without suppuration, it indicates a mixed Yin-Yang syndrome with deep-rooted fixation. Puncture the center with a needle about one cun deep to open the orifice and vent the toxin, preventing internal attack. If pus is present, it will drain easily, following the principle of "opening the door to drive out the thief." If after ten days the sore does not necrose but remains red/vibrant with heat/swelling/pain, suppuration is delayed but will occur. No need to needle; this is due to insufficient healthy Qi, failure to use tonifying/supporting drugs, misuse of cold herbs, or inadequate warmth. Use Spleen-tonifying and major tonifying/supporting drugs to achieve suppuration. The period from fifteen to twenty-one days is critical. Beyond this, even with thin pus, prolonged toxin consumption depletes Qi, making healing difficult.

After half a month, if pus is scant, use Yao Tong (Medicinal Cylinder) to suction the apex. Adherent pus/blood facilitates necrotic tissue shedding.

If after fifteen days the sore still does not necrose or suppurate, the toxin has sunken internally. Urgently use a needle to create three holes about one cun apart at the apex, inserting one to two cuns deep depending on depth. Insertion should be painless. Heat the Yao Tong (Medicinal Cylinder) beforehand and apply to the holes for a while, then remove when warm. Extracted blood should be red with slight purple; pus should be yellow and fresh. This indicates active Qi/Blood circulation and a good prognosis. Fresh red color and adherent pus/blood facilitate healing and necrotic shedding. If extracted blood is dark purple/black, foul-smelling, with watery fluid and no pus, it indicates internal Qi/Blood collapse and a fatal sore. Such cases are difficult to sustain, and death may occur by month-end.

If pus exists internally but cannot emerge, use a needle hook to lift tough tissue from the front, and cut open about one cun at the apex with scissors to allow drainage and prevent blockage.

After suctioning with Yao Tong (Medicinal Cylinder), external and internal orifices are open. If pus is still scant, it is not spontaneous. Blockage by necrotic matter or tough membranes hinders flow. Use a needle hook to lift tough tissue at the apex, and use a scalpel/scissors to remove about one cun of hard tissue. Mild pain and bleeding are acceptable. Gently press from the base toward the center to expose the pus tube. Accumulated pus will gush out. Yellow thick pus is auspicious; increasing volume indicates mildness. Reverse signs are concerning. The goal is to clear blockages and expel toxic pus.

Frequently wash with decoction; strictly avoid wind exposure.

Before ulceration, or after lamp therapy, wash the sore once daily with Cong Ai Tang (Scallion and Mugwort Decoction), twice daily for severe cases, to unblock Qi/Blood and facilitate rupture. After ulceration and suction, avoid wind. Remove old dressing. Place a square pan near the sore. Pour Zhu Ti Tang (Pig Trotter Decoction) over the sore with soft silk, gently pressing into holes to clean internal pus. Expel rotten pus with the broth until clean. Fold soft cloth seven to eight layers, keep slightly damp, place on sore, and gently press. Replace when warm. Repeat four to five times to soothe Qi/Blood and relieve the patient. This clears stagnation, resolves toxins, sheds necrotic tissue, and reduces pain. It is essential for large sores. When red meat appears after necrotic shedding, apply Yu Hong Gao (Jade Red Plaster) after washing. Melt plaster in palm, apply to new/old tissue, cover with Tai Yi Gao (Great Emperor Plaster). Do not bind edges if swelling has subsided. Daily application leads to complete shedding of pus/necrosis and rapid growth of new tissue within days. With proper internal tonification, mild sores heal in a month, large sores in seventy days.

Joint points occur at this time; complications arise from these stages.

"Joint points" refer to critical nodes: fourteen days for Yang sores, twenty-one days for Yin sores. Pus must discharge during these periods. Do not interfere excessively. Pus discharge leads to necrotic shedding, then muscle generation, then contraction, then flattening. This sequence is crucial. Failure to discharge pus on schedule leads to complications. A favorable node leads to favorable outcomes; an unfavorable node leads to unfavorable outcomes. Careful observation is necessary.

Treatment should focus on major tonification to achieve full contraction; strictly avoid cold herbs to prevent complications.

After ulceration and pus discharge, the Five Zang organs are damaged, and Qi/Blood are severely deficient. Although the exterior may seem robust, the interior is truly deficient. Pure tonification is required for survival. If fever/chills, profuse pus, spontaneous sweating, and pain occur after ulceration, administer Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction). If deficiency heat, insomnia, and poor appetite exist, administer Huang [Ren] Shen Tang (Yellow Ginseng Decoction - *Note: Text implies a specific Ginseng formula*). If cold skin, deficiency heat, cough with phlegm occur, administer Tuo Li Qing Zhong Tang (Interior-Supporting Middle-Clearing Decoction). If limb fatigue, muscle wasting, sallow complexion, and shortness of breath occur, administer Ren Shen Yang Rong Tang (Ginseng Nourishing Spirit Decoction). If profuse pus, irritability, poor appetite, restlessness, and insomnia occur, administer Sheng Yu Tang (Holy Recovery Decoction). If Spleen deficiency, Qi weakness, cool body, fine pulse, and loose stools occur, administer Tuo Li Wen Zhong Tang (Interior-Supporting Middle-Warming Decoction). If poor appetite, nausea, and vomiting occur, administer Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). If Spleen deficiency with sinking, poor appetite, and intermittent deficiency heat occur, administer Bu Zhong Yi Qi Tang (Tonify Middle and Augment Qi Decoction). If Kidney deficiency with thirst and inability to control Heart Fire occur, administer Jia Jian Ba Wei Wan (Modified Eight Flavor Pill). Select accordingly. Supporting the interior strengthens Qi/Blood and Spleen-Stomach, allowing natural expulsion of pus/toxins, necrosis, new tissue growth, appetite return, and wound closure. Failing to tonify and instead using cold herbs exacerbates deficiency and excess, leading to internal toxin sinking, foul pus, forceful pulse, thirst, red face, and shortness of breath, resulting in death from true Qi deficiency.

Sores rely entirely on Spleen Earth; regulation requires careful attention.

The Spleen is the official of granaries; the Stomach is the sea of water and grain. Stomach governs intake; Spleen governs digestion. Exterior/interior, intake/digestion, continuous operation, infinite transformation. All Qi/Blood, meridians, limbs, bones, and Zang-Fu organs depend on this for nourishment. "Prosperity comes from Earth; ruin comes from losing Earth." Strong Spleen-Stomach leads to increased appetite, weight gain, and robust Qi/Blood. Weak Spleen-Stomach leads to poor appetite, indigestion, weight loss, and depleted Qi/Blood. Life depends on this for survival and disease management, especially in surgery. Good health preservation involves regulating diet, adjusting to temperature changes, controlling emotions, and conserving energy to protect Spleen-Stomach. Otherwise, Qi/Blood decline daily, organs/meridians deteriorate, and muscles/waste away. One misstep in regulation leads to myriad diseases. Thus, Spleen-Stomach must be carefully managed.

In winter, warm the bed and room; in summer, keep desks clean and windows bright.

Qi and Blood prefer warmth and dislike cold. Cold causes coagulation; heat causes dispersion. Sores are breaks in muscle/flesh, easily invaded by Wind-Cold if unprotected. In winter, use charcoal fire to generate warmth and dispel residual cold. In summer, keep rooms clean and bright to prevent external wind. Only then can dressings be changed and washed. Patients often sleep in drafts in summer or cold places in winter, leading to Cold invasion. Mild cases hinder healing; severe cases cause collapsing, non-suppurating, non-contracting Yin syndromes. Wise individuals must be cautious.

Dietary restrictions are unnecessary, except avoiding cold, hard, and greasy foods.

Food sustains life and should be eaten according to timing. During painful swelling, Stomach Qi is injured, and appetite is lost. After ulceration, when pus/toxins exit, Stomach Qi returns, and hunger arises. Offer preferred foods to nourish Spleen-Stomach. Denying desired food opposes Stomach Qi and worsens anorexia. Avoid excess. Prohibited items: cold/raw foods injure Spleen; hard foods are hard to digest; greasy foods loosen bowels. Others can be consumed freely.

Carbuncles and ulcers belong to Surgery, but medication principles are the same as Internal Medicine.

Ancients prioritized surgery among miscellaneous diseases because injury is rapid and significant. Although carbuncles, head/neck sores, and Ding toxins manifest externally, their source is internal. How can treatment ignore the interior to treat the exterior? If external eruption fails, add interior-supporting drugs. If exterior heat is severe, clear internally. For Blood deficiency, use Si Wu Tang (Four Substances Decoction); for Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction). For weak pulse/cold feet, warm the middle; for forceful pulse/fever, cool the chest. Externally and internally, principles are identical. Society calls it "Surgery" based on form, but "Internal Injury" based on Qi/Blood treatment. Physicians must not confuse internal principles to avoid complications.

Weak pulse and deficiency require tonification from start to finish; Excess exterior and interior require temporary purgation.

Dan Xi said: Before ulceration, if toxin attacks organs, never use hot drugs. After ulceration, if organs are deficient, never use cold drugs. This is true. However, exceptions exist. If initially un-ulcerated, pulse is micro/deep/slow/rough/fine/rapid/floating/hollow, with cool body, sweating, normal bowels/vomit, poor appetite, non-rising/non-red/non-painless/no pus, these indicate Qi/Blood deficiency. Insisting on "toxin attack = cold drugs" damages healthy Qi and kills the patient. I argue that treatment depends on pulse/symptoms, not just duration. If weak, tonify immediately for safety. If tonification fails, consider severe deficiency: use Shen Zhu Gao (Ginseng and Atractylodes Paste) or Ba Xian Gao (Eight Immortals Cake). For Yang deficiency with sweating/poor appetite, use Single Ginseng Paste or Liu Jun Zi Tang (Six Gentlemen Decoction) adding Sha Ren (Amomi Fructus) and Mu Xiang (Aucklandiae Radix), or Fuzi (Aconiti Lateralis Radix Preparata) if severe. For diarrhea/borborygmus/Stomach deficiency/vomiting, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) adding Dou Kou (Cardamomi Fructus), Shan Yao (Dioscoreae Rhizoma), Mu Xiang, and Shi Di (Datiscae Caulis). For Spleen deficiency with sinking/loose stools/anal heaviness, use Bu Zhong Yi Qi Tang adding Shan Yao, Shan Yu (Corni Fructus), and Wu Wei Zi (Schisandrae Fructus). For exterior excess (fever, no sweat, aversion to cold), use Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Detoxifying Powder) to release exterior. For interior excess (forceful pulse, fever, dry stool/thirst), use Si Shun Qing Liang Yin (Four Smooth Cooling Drink) to purge interior. For combined exterior/interior excess, use Fang Feng Tong Sheng San (Saposhnikovia Unblocking Success Powder) to release exterior and purge interior. Application depends on flexibility. Those who respond to tonification lack phlegm-fire/internal toxin; those who do not accept tonification have Yin-fire/damp-heat. Responding to tonification leads to survival; non-responsive deficiency is untreatable.

Disease duration (new vs. old) dictates broad vs. aggressive treatment.

Diseases vary in duration and urgency. Early stage with intact healthy Qi allows symptom-specific resolution. Fear of harsh drugs prevents efficacy in crises. Treat the disease and stop; "If medicine does not cause dizziness, the chronic disease will not heal." For strong exterior symptoms, use Wan Ling Dan (Ten Thousand Spirits Pill) for heavy diaphoresis. For urgent interior symptoms, use...