痛。或不痛。及麻木者。邪气盛也。隔蒜灸之。痛者灸至不痛。不痛者灸至痛。毒随
火而散。再不痛者。须明灸（不隔蒜灸。）之。或用黄连解毒散之类。
右关脉弱而肌肉迟生者。宜健脾胃。
头痛拘急乃表症。先服人参败毒散一二剂。如 痛。用金银花散。或槐花酒。神效托里
痛肿硬。脉实者。以清凉饮。仙方活命饮。苦参丸。
肿硬木闷。疼痛发热。烦躁饮冷。便秘脉沉实者。内疏黄连汤。或清凉饮。大便已利。
欲得作脓。用仙方活命饮。托里散。蜡矾丸。外用神异膏。
饮食少思。或不甘美。用六君子汤加藿香。连进三五剂。更用雄黄解毒散洗患处。每日
金膏涂疮口处。候有疮口。即用纸作捻。醮乌金膏 入疮内。若有脓为脂膜间隔不出而作胀
痛者。宜用针引之。腐肉堵塞者去之。若瘀肉腐动。用猪蹄汤洗。如脓稠或痛。饮食如常。
瘀肉自腐。用消毒与托里药相兼服之。仍用前二膏涂贴。若腐肉已离好肉。宜速去之。如脓
不稠不稀。微有疼痛。饮食不甘。瘀肉腐迟。更用桑柴灸之。亦用托里药。若瘀肉不腐。或
脓清稀。不 痛者。急服大补之剂。亦用桑柴灸之。以补接阳气。解散郁毒。
大抵气血壮实。或毒轻少者。可假药力。或自腐溃。怯弱之人。热毒中膈。内外不通。
针灸。药无全功。然此症若脓已成。宜急开之。否则重者溃通脏腑。腐烂筋骨。轻者延溃良
肉。难于收功。因而不敛者多矣。
一人患此痛甚。服消毒药愈炽。予为隔蒜灸之而止。与仙方活命饮二剂顿退。以托里药
溃而愈。（此凭症也。）
一妇发热。烦躁饮冷。与黄连解毒汤四剂少愈。更与托里消毒散始溃。与托里药而敛。
（此凭症也。）
一人已愈。唯一眼番出 肉如菌。三月不愈。乃伤风寒也。以生猪油调藜芦末涂之即愈
。亦有 出三寸许者。乌梅涂之亦效。但缓硫黄亦可。（此凭症也。）
一人年逾五十。患已五日。 肿大痛。赤晕尺余。重如负石。势炽。当峻攻。察其脉又
。遂先砭赤处。出黑血碗许。肿痛背重皆去。更敷神效散。及服仙方活命饮二剂。疮口及砭
处出黑水而消。（此凭症也。）
大抵疮毒势甚。若用攻剂。怯弱之人必损元气。因而变症者多矣。
一人 肿作痛。脉浮数。与内托复煎散二剂少退。与仙方活命饮四剂痛止而溃。再与托
里药而愈。（此凭脉症也。）
一人毒势炽甚。痛不可忍。诸药不应。以仙方活命饮二剂。诸症悉退。又二剂而溃。以
金银花散六剂而愈。（此凭症也。）
一人浓味气郁。形实性重。年近六十背疽。医与他药皆不行。惟饮香附末甚快。自肿至
始终只此一味而安。然此等体实而又病实。盖千百而一见也。每思香附。经不言补。惟不老
汤乃言有益于老人。用片子姜黄、甘草、香附三味。以不老为名。且引铁瓮先生与刘君为证
。夫岂无其故哉。盖于行中有补之理耳。天之所以为天健而有常。因其不息。所以生生无穷
。正如芜蔚活血行气。有补阴之妙。故名益母。胎产所恃者气血也。胎前无滞。产后无虚。
以其行中有补也。夏枯草治瘰 亦然。（此因情性而治。）
一人感冒后发 。不醒人事。磨死膂肉三寸许一块。此膀胱经必有湿热。其脉果数。
死肉最毒。宜速去之。否则延害良肉。多致不救。取之。果不知痛。因 不止。疑为去肉所
触。予曰非也。由风热未已。彼不听。另用乳没之剂。愈盛。复请治。予以怯风消毒敷贴。
饮以怯风凉血化痰降火之剂而愈。
按此因脉因症而处治也。
一通府发背十余日。势危脉大。先饮槐花酒二服杀其势。退。再饮败毒散二剂。更饮
药数剂。渐溃。又用桑柴燃灸患处。每日灸良久。仍贴膏药。灸至数次。脓溃腐脱。以托里
药加白术、陈皮。月余而愈。
按此先发后补。当时必有所见也。惜乎脉症不甚辨。
一县尹发背六七日。满背肿痛。势甚危。隔蒜灸百壮。饮槐花酒二碗即睡觉。用托里药
消毒。十去五六。令将桑柴燃患处而溃。数日而愈。
一侍御髀HT 患毒。痛甚。服消毒药不减。饮槐花酒一服。势随大退。再用托里消毒药而
大抵肿毒。非用蒜灸。及饮槐花酒先杀其势。虽用托里诸药。其效未必甚速。（按前条皆先
泻后补法。）
一园丁发背甚危。取金银藤五六两捣烂。入热酒一钟。绞取汁。温服。渣罨患处。四五
平。彼用此药治疮。足以养身成家。遂弃园业。盖金银花治疮。未成即散。已成即溃。有回
一妇半月余尚不发起。不作脓。痛甚。脉弱。隔蒜灸二十余壮而止。更服托里药渐溃
。脓清而瘀肉不腐。以大补药及桑柴灸之。渐腐。取之而寻愈。（此凭脉症也。）
一人腐肉渐脱而脓微清。饮食无味。以十宣散去白芷、防风。加茯苓、白术、陈皮。
月余而敛。（此凭症也。）
一人将愈。但肌肉生迟。脾胃俱虚。以六君子汤。加芎、归、五味、黄 治之而愈。（此凭
一人已愈。唯一口不敛。脉浮而涩。以十全大补汤治之而愈。（此凭脉也。）
一老人七十余。背疽径尺余。杂服五香汤。十宣散数十帖。脓血腥秽。呕逆不食。旬余
自言。服十宣散膈中不安。且素有淋病三十年。今苦淋痛。呕逆。及不得睡而已。急煎参
归术膏。以牛膝汤入竹沥调化与之。三日尽药斤半。淋止思食。七日尽药四斤。脓自涌出。
得睡。兼旬而安。时六七月也。（此凭症也。）
一人年六十余。好酒肉。背疽见脓。呕逆发热。得十宣已多。医以呕逆。投嘉禾散加丁
时七月大热。脉洪数有力。予曰。脉症在溃疡尤忌。然形气尚可为。只与独参汤加竹沥。尽
药十五六斤。竹百余竿而安。予曰。此幸耳。不薄味。必再发。后因夏月醉坐池中。左胁傍
生软块如饼。二年后溃为疽。自见脉症如前。仍服参膏竹沥而安。
二人年老血气弱。无以供给。脓血。胃虚而呕。若与十宣。宁保无危。
机按后条。乃膏粱积热之变。宜用寒凉之剂。兹用骤补。盖以年老溃疡故也。
一妇发背。用托里消毒药二十余剂而溃。因怒。顿吐血五六碗。气弱脉细。此气血虚极
令服独参膏斤许少缓。更以参、 、归、术、陈皮、炙甘草三十余剂。疮口渐合。若投犀角
地黄汤沉寒之药。鲜不误矣。（此凭脉症也。）
一妇年逾四十发背。治以托里药而溃。或呕而疮痛。胃脉弦紧。彼为余毒内攻。东垣云
呕无时。手足逆冷。脏腑虚也。丹溪曰。溃后发呕不食者。湿气侵内也。又云。脓出反痛。
虚也。今胃脉弦紧。木乘土位。其虚明矣。用六君子（二）加酒炒芍药、砂仁、藿香。彼自服
护心散。呕愈盛。复邀治。仍用前药。更以补气血药。两月而愈。（此凭脉症也。）
大抵湿气内侵。或感秽气而作呕。必喜温而脉弱。热毒内攻而作呕。必喜凉而脉数。必
须辨
不应。加熟附子二三片。有侵晨作泻者。名曰肾泄。宜二神丸。有食少渐瘦者。为脾肾虚。
尤宜二神丸。又治梦遗。生肌肉圣药。予尝饮食少思。吞酸嗳腐。诸药不应。惟服理中丸。
及附子理中丸有效。盖此皆因中气虚寒。不能运化郁滞所致。故用温补之剂。中气温和。自
一人渴后发背未溃。脉数无力。此阴虚火动。 咀加减八味丸二剂稍缓。次用丸药而愈
。（此凭脉症也。）
一人年逾五十。发背。生肌太早。背竟腐溃。更泄泻。脉微缓。用二神丸先止其泻。次
补药。以猪蹄汤洗净。用黄 末填满患处。贴以膏药。喜其初起时多用蒜灸。故毒不内攻。
两月而愈。（此凭脉症也）
一妇因子迟。服神仙聚宝丹。背生痈甚危。脉散大而涩。急以加减四物汤百余帖。补其
阴血。幸质浓易于收救。
机按此条。因服食因脉而处治也。
一人背疮如碗大。溃见五脏。仅膈膜耳。自谓必死。精要。取大鲫鱼一枚去肠脏。以羯
羊粪填实。焙令焦黑极燥为末。干掺之疮口遂合。累用有效。须脓少欲生肌时用之。
机按此二味有补土功。土主肌肉。故用生肌。
一人背疽径尺。穴深而黑。家贫得此。急作参 归术膏与之。三日以艾芎汤洗之。气息
。然可饮食。每日作多肉馄饨大碗与之。尽药膏五斤。馄饨三十碗。疮渐合。肉与馄饨补气
有益者也。
机按此条。因饥寒多虚。故用此补法也。
一老妇患此。初生三头皆如粟。肿硬木闷。烦躁。至六日。其头甚多。脉大。按之沉
隔蒜灸及托里。渐起发。尚不溃。又数剂。内外虽腐。惟筋所隔。脓不得出。胀痛不安。予
谓须开之。彼不从。后虽自穿。毒已攻深矣。亦没。
一妇素弱。未成脓。大痛发热。予欲隔蒜灸以拔其毒。令自消。不从而殁。
大抵发背之患。其名虽多。惟阴阳二证为要。若发一头或二头。其形 赤。肿高头起。
发热。为痈属阳。易治。若初起一头如黍。不肿不赤。闷痛烦躁。大渴便秘。睡语切牙。四五
日间。其头计数十。其疮口各含如一粟。形似莲蓬。故名莲蓬发。积日不溃。按之流血。至
八九日或数日。其头成片。所含之物俱出。通结一衣。揭去又结。其口共烂为一疮。其脓内
攻。色紫黯。为疽属阴。难治。脉洪滑者尚可。沉细尤难。如此恶症。惟隔蒜灸。及涂乌金
凡人背近脊。并髀皮里有筋一层。患此症者。外皮虽破难溃。以致内脓不出。令人胀痛
。气血转虚。变症百出。若待自渍。多致不救。必须开之。兼以托里。常治此症。以利刀剪
之。尚不能去。以此坚物。待其自溃。不亦反伤。非气血壮实者。未见其能自溃也。
一弱妇。外皮虽腐。内脓不溃。胀痛。烦热不安。予谓宜急开之。脓一出。毒即解。痛
。诸症自退。待其自溃。不惟疼痛。溃烂愈深。彼不从。待将旬日。脓尚未出。人已痛疲矣
。须针之。终不能收敛。竟至不起。一人溃而瘀肉不腐。予欲取之。更以峻补。不从而没。
一妇发背。待其自破。毒瓦斯内攻而殁。开迟故也。东垣云。过时不烙。反攻于内。内既
消败。不死何待。
一指挥年逾五十发背。形症俱虚。用托里药而溃。但腐肉当去。彼惧不从。延至旬日。
肉皆败矣。虽投大剂。毒甚不救。古人谓坏肉恶如野狼虎。毒如蜂螫。缓去则戕性命。信哉。
一人年逾四十发背。心脉洪数。势危剧。经曰。痛痒疮疡。皆属心火。心脉洪数。乃心
甚。心主血。心气滞则血不流。故生痈也。骑竹马灸、灸其穴。是心脉所游之地。急用隔蒜
灸。以泻心火。拔其毒。再用托里消毒而愈。（此凭脉也。）
一人发背十八日。疮头如粟。内如锥。痛极。时有闷瞀。饮食不思。气则愈虚。以大艾
灸十余壮。不知热。内痛不减。遂明灸二十余壮。内痛悉去毒瓦斯大发。饮食渐进。更用大补
汤。及桑柴燃灸。瘀肉渐溃。（此凭症也。）
一人发背。疮头甚多。肿硬色紫。不甚痛。不腐溃。以艾铺患处灸之。更用大补药。数
日死肉脱去而愈。（此因症处治也。）
一人发背。 痛如灼。隔蒜灸三十余壮。肿痛悉退。更用托里消毒药而愈。（此凭症也
一人发背已四五日。疮头虽小。根畔颇大。隔蒜灸三十余壮。其根内消。惟疮头作脓
一人忽恶心。大椎骨甚痒。须臾臂不能举。神思甚倦。此谓夭疽。危病也。隔蒜灸。痒
愈盛。乃明灸（着肉灸也）五十余壮。痒止。旬日而愈。精要谓之灸有回生之功。信矣。
一人患此已四日。疮头如黍。 痛背重。脉沉实。与黄连内疏汤二剂少退。更与仙方活
命饮二剂而消。（此凭脉症也。）
一妇肿痛发热。睡语脉大用清心汤一剂而安。以金银花、甘草、天花粉、当归、栝蒌、
黄数剂渐溃。更以托里药而愈。（此凭脉症也。）
一人背毒。 痛发热。饮冷。多汗。便秘。谵言。以破棺丹二丸而宁。以金银花四剂而
脓成。开之。更用托里药而愈。
一太监发背。肿痛色紫。脉息沉数。良甫曰。脉数发热而痛者。发于阳也。且疮疡赤甚
。火极似水也。询之。常服透骨丹半载。乃积温成热所致。遂以内疏黄连汤再服稍平。更用
排脓消毒药。及猪蹄汤大乙膏而愈。
机按此条。因脉因服食而为之处治也。
一人伤寒后亦患此。甚危。取去死肉。以神效当归膏敷贴。饮内疏黄连汤。狂言愈盛。脉愈
大。更用凉膈散（二六）二剂。又以四物汤。（九）加芩连数剂而愈。
机按此条脉症不甚详悉。观其下后狂愈盛、脉愈大。似属虚也。仍用凉膈散下之。此必
形实进食。故用此也。
大凡患疮者责效太迫。一二剂未应。辄改服他药。及致有误。不思病有轻重。治有缓急
。而概欲效于一二剂。难矣。况疮疡一症。其所由来固深已久。又形症在外。肌肉溃损。较
无形之疾不同。安可旦夕取效。患者审之。
一人形实色黑。背生红肿。近髀骨下痛甚。脉浮数而洪紧正冬月。与麻黄桂枝汤。加酒
、生附子、栝蒌子、甘草节、人参、羌活、青皮、黄 、半夏、生姜六贴而消。此亦用托里
机按此条。因时因脉而制方也。
Pain. Or no pain, and numbness, indicates an excess of pathogenic factors. Apply garlic-partitioned moxibustion. If painful, moxa until the pain ceases; if not painful, moxa until pain is felt. The toxin will dissipate with the fire. If still painless after moxibustion, direct moxibustion (without garlic partition) is required. Alternatively, use formulas such as Huanglian Jiedu San (Coptis Decoction to Relieve Toxicity).
If the pulse at the right Guan position is weak and muscle regeneration is slow, strengthen the Spleen and Stomach.
Headache and stiffness are exterior syndromes. Administer one or two doses of Renshen Baidu San (Ginseng Detoxification Powder) first. If pain occurs, use Jinyinhua San (Honeysuckle Powder) or Huaihua Jiu (Sophora Flower Wine). Shenzhi Tuoli Tang (Divine Effect Supporting Interior Decoction) is used for swelling, hardness, and pain. If the pulse is excess, use Qingliang Yin (Cooling Drink), Xianfang Huoming Yin (Immortal Formula for Preserving Life Infusion), or Kushen Wan (Sophora Pill).
For swelling, hardness, wooden sensation, pain, fever, irritability, preference for cold drinks, constipation, and a deep-excess pulse, use Neishu Huanglian Tang (Internal Draining Coptis Decoction) or Qingliang Yin. Once the bowels have moved and pus formation is desired, use Xianfang Huoming Yin, Tuoli San (Supporting Interior Powder), or Lafan Wan (Beeswax Alum Pill). Apply Shenyi Gao (Divine Unusual Ointment) externally.
For reduced appetite or lack of taste in food, use Liujunzi Tang (Six Gentlemen Decoction) with Huoxiang (Patchouli). Take continuously for three to five doses. Then wash the affected area with Xionghuang Jiedu San (Realgar Detoxification Powder). Apply Jingao (Golden Ointment) to the wound daily. Once a wound opening exists, insert paper wicks dipped in Wujin Gao (Black Gold Ointment) into the cavity. If pus is trapped by fatty membranes causing distension and pain, puncture to drain it. Remove obstructing necrotic tissue. If sloughing tissue is loose, wash with Zhuti Tang (Pig Trotter Decoction). If pus is thick or painful but diet is normal, slough will naturally detach. Combine detoxifying and supporting interior medicines. Continue applying the previous ointments. If necrotic tissue has separated from healthy flesh, remove it promptly. If pus is neither thick nor thin, with slight pain, poor appetite, and slow sloughing, apply Sangchai Moxibustion (Mugwort Branch Moxibustion). Also use supporting interior medicines. If slough does not detach or pus is clear and thin without pain, urgently administer strong tonics. Apply Sangchai Moxibustion to supplement Yang Qi and resolve stagnant toxins.
Generally, those with robust Qi and Blood, or mild toxicity, may rely on medicinal power or natural suppuration. Those who are weak, with heat-toxin blocking the middle Jiao and internal-external blockage, find acupuncture and herbs ineffective alone. However, if pus has formed, urgent incision is necessary; otherwise, severe cases may penetrate viscera and rot bones/tendons, while mild cases extend to destroy healthy flesh, making healing difficult. Many fail to heal due to this.
One patient suffered severe pain; detoxifying herbs aggravated it. I applied garlic-partitioned moxibustion to stop the pain, followed by two doses of Xianfang Huoming Yin, which rapidly subsided. Supporting interior medicine promoted suppuration and cure. (Treated based on symptoms.)
A woman had fever, irritability, and preference for cold drinks. Four doses of Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) brought slight improvement. Tuoli Xiaodu San (Supporting Interior Detoxification Powder) promoted suppuration, followed by supporting interior medicine for closure. (Treated based on symptoms.)
One patient had healed except for a polypoid growth protruding from an eye for three months, caused by Wind-Cold. Applied raw pork fat mixed with Licorice Root powder (Lilu) topically for immediate cure. Growths up to three cun long also responded to Smoked Plum (Wumei) application; Sulfur alone is also effective. (Treated based on symptoms.)
A man over fifty, ill for five days, had massive back swelling and pain, a red halo over one chi, feeling heavy as if carrying a stone, with intense pathology requiring aggressive purgation. However, his pulse was weak. I first pricked the red area with Bian stones, draining about one bowl of dark blood. Swelling, pain, and heaviness resolved. Applied Shenxiao San (Divine Effect Powder) and took two doses of Xianfang Huoming Yin. Dark fluid drained from the wound and pricking sites, leading to resolution. (Treated based on symptoms.)
Generally, when carbuncle toxicity is severe, purgatives damage the Yuan Qi of the weak, leading to complications.
One patient had back swelling and pain with a floating-rapid pulse. Two doses of Neituo Fujian San (Internal Support Re-decoction Powder) slightly reduced symptoms. Four doses of Xianfang Huoming Yin stopped pain and promoted suppuration. Supporting interior medicine completed the cure. (Treated based on pulse and symptoms.)
One patient had intense toxicity and unbearable pain unresponsive to various drugs. Two doses of Xianfang Huoming Yin resolved all symptoms. Two more doses promoted suppuration. Six doses of Jinyinhua San (Honeysuckle Powder) achieved cure. (Treated based on symptoms.)
One patient with a robust constitution and emotional stagnation, near sixty years old with back carbuncle, found other medicines ineffective. Only Xiangfu (Cyperus Rhizome) powder provided relief. From onset to cure, only this single herb was needed. Such robust constitutions with excess pathogens are rare (1 in 1000). I often reflect that although classics do not describe Xiangfu as tonic, the Bu Lao Tang (Anti-Aging Decoction) benefits the elderly using Xiangfu, Jianghuang (Turmeric), and Gancao (Licorice). This implies a principle of "tonifying within moving." Heaven is vigorous and constant through ceaseless movement, generating life endlessly. Similarly, Chongweizi (Leonurus Fruit) moves blood and Qi, benefiting Yin, hence its name Yimucao (Mother Plant). Pregnancy relies on Qi and Blood; pre-natal stasis-free and post-natal deficiency-free states result from "tonifying within moving." Xiakucao (Prunella Spike) treats scrofula similarly. (Treated based on temperament/constitution.)
One patient developed coma after a cold. A piece of dead rat meat (approx. 3 cun) was ground; this indicated Damp-Heat in the Bladder Meridian, confirmed by a rapid pulse. Dead tissue is highly toxic and must be removed quickly to prevent spread to healthy flesh and death. Removal caused no pain, but bleeding persisted, suspected trauma. I attributed it to unresolved Wind-Heat. He refused, using Myrrh and Frankincense preparations, worsening the condition. I treated with Qiefeng Xiaodu plaster and decoctions for dispelling Wind, clearing Heat, cooling Blood, resolving Phlegm, and descending Fire. Cure.
Note: Treated based on pulse and symptoms.
A Tong Prefect had back carbuncle for ten+ days, critical condition with large pulse. Two doses of Huaihua Jiu suppressed the pathogen. After reduction, two doses of Baidu San, then several doses of medicine, gradually suppurated. Sangchai moxibustion applied daily for long periods, plus plasters. After several sessions, pus drained and slough detached. Tuoli San with Baizhu (Atractylodes Macrocephala) and Chenpi (Tangerine Peel) led to cure in over a month.
Note: Initial release followed by tonification; likely had specific insight. Pulse/symptom differentiation was insufficient.
A County Magistrate had back carbuncle for six-seven days, full back swelling/pain, critical. Hundred moxa cones of garlic-partitioned moxibustion. Two bowls of Huaihua Jiu woke him. Tuoli San detoxified, reducing severity by 50-60%. Sangchai moxibustion promoted suppuration. Cure in days.
A Censor had thigh toxicity, severe pain unrelieved by detoxifying herbs. One dose of Huaihua Jiu greatly reduced pathology. Tuoli Xiaodu San completed the cure.
Generally, for swelling/toxicity, garlic moxibustion and Huaihua Jiu must precede suppression of pathology; otherwise, even with supporting interior medicines, results are slow. (These cases follow "drain first, tonify later" method.)
A gardener had critical back carbuncle. Five to six liang of Jinyinteng (Honeysuckle Stem) crushed, mixed with hot wine, juice taken warm, dregs applied locally. Flat in four-five days. He used this for wounds, gaining health and wealth, abandoning gardening. Jinyinhua disperses unformed abscesses and promotes suppuration of formed ones, having life-restoring power.
A woman had no elevation or suppuration for half a month, severe pain, weak pulse. Garlic-partitioned moxibustion (20+ cones) stopped progression. Tuoli San promoted gradual suppuration. Pus was clear, slough did not detach. Strong tonics and Sangchai moxibustion facilitated sloughing. Removal led to quick cure. (Treated based on pulse/symptoms.)
One patient had gradual slough detachment but clear pus, tasteless food. Shixuan San minus Baizhu (Angelica Dahurica) and Fangfeng (Saposhnikovia), plus Fuling (Poria), Baizhu, Chenpi. Cure in over a month. (Treated based on symptoms.)
One patient nearing cure had slow muscle growth, Spleen/Stomach deficiency. Liujunzi Tang plus Chuanxiong (Ligusticum), Danggui (Angelica Sinensis), Wuweizi (Schisandra), Huangqi (Astragalus) cured him. (Treated based on symptoms.)
One patient healed except for one non-healing orifice, floating-choppy pulse. Shiquan Dabu Tang (Ten Great Tonifying Decoction) cured him. (Treated based on pulse.)
An elderly man over seventy had a chi-diameter back carbuncle. Mixed use of Wuxiang Tang and dozens of Shixuan San packets resulted in bloody/foul pus, vomiting, inability to eat for ten+ days. He reported discomfort from Shixuan San and chronic stranguria (30 years), now suffering stranguria pain, vomiting, insomnia. Urgently prepared Shenguizhushu Gao (Ginseng, Angelica, Atractylodes Paste), administered with Niuxi (Achyranthes) Tang and Zhuli (Bamboo Sap). Finished 1.5 jin in three days; stranguria stopped, appetite returned. Finished 4 jin in seven days; pus spontaneously discharged, sleep restored. Stable in twenty days. (June/July). (Treated based on symptoms.)
A man over sixty, fond of alcohol/meat, had back carbuncle with pus, vomiting, fever. Received much Shixuan San. Doctor gave Jiahe San with Dingxiang (Clove) for vomiting. It was mid-summer, hot, pulse surging-rapid-forceful. I stated pulse/symptoms in ulcerative stage contraindicate warmth. Constitution supported it. Gave Dushen Tang (Single Ginseng Decoction) with Zhuli. Consumed 15-16 jin, over 100 bamboo poles' worth of bamboo sap. Stabilized. I said this was luck; without bland diet, recurrence is certain. Later, summer drunken pool sitting caused soft lump on left hypochondrium, which ulcerated into carbuncle two years later. Same pulse/symptoms, treated with Ginseng paste and bamboo sap. Stable.
Two elderly people with weak Qi/Blood cannot support nutrition loss via pus/blood. Stomach deficiency causes vomiting. Using Shixuan San risks danger.
Wang Ji notes: The latter case involves accumulation of heat from rich foods, suitable for cold/clearing herbs. Here, sudden tonification was used due to age and ulcerative state.
A woman with back carbuncle used Tuoli Xiaodu San for 20+ doses, then ruptured. Anger caused sudden vomiting of 5-6 bowls of blood. Weak Qi, fine pulse, extreme Qi/Blood deficiency. Gave Dushen Gao (Single Ginseng Paste) approx. 1 jin to stabilize. Then Ren Shen (Ginseng), Shaoyao (Peony), Danggui, Baizhu, Chenpi, Zhi Gancao (Honey-fried Licorice) for 30+ doses. Wound gradually closed. Using Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), a cold natured formula, would have been disastrous. (Treated based on pulse/symptoms.)
A woman over forty with back carbuncle, treated with supporting interior medicine, ruptured. Vomiting and wound pain occurred. Stomach pulse wiry-tight. She believed residual toxin attacked internally. Dongyuan said: Vomiting without time, cold extremities indicates Zang-Fu deficiency. Danxi said: Post-ulcer vomiting/anorexia indicates Dampness invading interior. Also: Pain after pus discharge indicates deficiency. Now, wiry-tight stomach pulse shows Wood overacting on Earth, clearly deficient. Used Liujunzi Tang plus wine-fried Shaoyao, Sharen (Amomum), Huoxiang. She self-administered Huxin San (Heart-Protecting Powder), worsening vomiting. Invited treatment again, continued previous prescription plus Qi/Blood tonics. Cure in two months. (Treated based on pulse/symptoms.)
Generally, internal Dampness or foul qi causing vomiting prefers warmth and weak pulse. Internal Heat-Toxin causing vomiting prefers coolness and rapid pulse. Must differentiate.
Ineffective. Add 2-3 slices of Shu Fuzi (Prepared Aconite). Morning diarrhea is called Kidney Diarrhea, suitable for Ershen Wan (Two Spirits Pill). Reduced intake/emaciation indicates Spleen/Kidney deficiency, especially suitable for Ershen Wan. Also treats nocturnal emission, sacred medicine for generating flesh. I once had poor appetite, acid regurgitation, belching rotten food, unresponsive to drugs. Only Lizhong Wan (Regulate the Middle Pill) and Fuzi Lizhong Wan were effective. These result from Middle Qi deficiency-cold failing to transform stagnation. Thus, warming/tonifying agents harmonize Middle Qi, restoring function.
One patient developed back carbuncle after thirst, unruptured, rapid-weak pulse, indicating Yin deficiency with Fire hyperactivity. Jiajian Bawei Wan (Modified Eight-Ingredient Pill) for two doses relieved slightly, then pill form cured. (Treated based on pulse/symptoms.)
One patient over fifty with back carbuncle, premature flesh generation led to back rotting, diarrhea, micro-slow pulse. Ershen Wan stopped diarrhea first, then tonics. Washed with Zhuti Tang, filled defect with Huangqi powder, plastered. Benefited from initial garlic moxibustion preventing internal attack. Cure in two months. (Treated based on pulse/symptoms.)
A woman took Shenshen Jubao Dan for delayed childbirth, developed critical back carbuncle. Scattered-large-choppy pulse. Urgently gave 100+ doses of Jiajian Siwu Tang to tonify Yin-Blood. Fortunately, dense constitution allowed rescue.
Wang Ji notes: Treated based on ingestion history and pulse.
One patient had bowl-sized back sore, ulcerated exposing viscera, only diaphragm remaining. Believed death was certain. *Jingyao* records: Take large carp, remove guts, fill with ram feces, bake until black/dry, powder, dry sprinkle on wound. Wound closes. Effective repeatedly. Use when pus is scant and flesh generation is desired.
Wang Ji notes: These two ingredients tonify Earth. Earth governs flesh, thus used for flesh generation.
One patient had chi-diameter back carbuncle, deep/black hole. Poor family. Urgently made Shenguizhushu Gao. Washed with Aixiong Tang for three days. Breath faint, but could eat. Fed large bowls of meat wontons daily. Consumed 5 jin paste, 30 bowls wontons. Wound gradually closed. Meat and wontons benefit Qi.
Wang Ji notes: This case involved hunger/cold deficiency, hence this tonification method.
An old woman had three millet-sized heads initially, swollen/hard/numb, irritable. By day six, many heads appeared, large pulse, deep on pressure. Garlic moxibustion and supporting interior medicine promoted development, but no suppuration. Several more doses: internal/external sloughed, but tendons separated pus, causing distension/pain. I advised incision; she refused. Later spontaneous rupture, but toxin penetrated deep, leading to death.
A weak woman, unruptured, severe pain/fever. I wanted garlic moxibustion to draw out toxin for natural resolution. She refused, died.
Generally, back carbuncles vary in name, but Yin/Yang syndromes are key. Single/double head, red/swollen/elevated, fever = Carbuncle (Yang), easy to treat. Single head like millet, non-swollen/non-red, stuffy pain/irritability, extreme thirst/constipation, sleep talking/grinding teeth. Within 4-5 days, dozens of heads appear, each containing millet-like material, resembling lotus pod ("Lotus Pod Eruption"). Days pass without suppuration, bleeding on pressure. By day 8-9+, heads merge into patches, contents discharge, forming a unified garment-like structure, re-forming when removed. Mouths rot into one sore, internal toxin attack, purple-dark pus = Carbuncle (Yin), hard to treat. Surging-slipping pulse acceptable; deep-fine pulse very difficult. For such malignant conditions, only garlic moxibustion and Wujin Gao application work.
On the back near spine and inner thighs, there is a layer of tendon under skin. Patients with this condition, though skin breaks, struggle to suppurate, trapping internal pus, causing distension/pain, turning Qi/Blood deficient, generating myriad complications. Waiting for spontaneous drainage often leads to death. Incision is mandatory, combined with supporting interior medicine. Often, sharp scissors cannot remove hardened tissue. Waiting for spontaneous rupture harms further. Only robust Qi/Blood patients might spontaneously rupture.
A weak woman, external skin rotted, internal pus unruptured, distension/pain, irritability. I advised urgent incision; once pus drains, toxin resolves, pain stops, symptoms retreat. Waiting for spontaneous rupture increases pain and depth of ulceration. She refused. Ten days passed, no pus, patient exhausted from pain. Needling failed to close. Death ensued. Another patient, ulcerated with non-detaching slough, I advised removal and strong tonification. Refused, died.
A woman waited for spontaneous rupture of back carbuncle, toxin attacked internally, died due to delayed incision. Dongyuan said: Delayed cauterization/incision causes internal counter-attack. Once internal organs decay, how can one survive?
A Commander over fifty with back carbuncle, deficient form/symptoms, used supporting interior medicine, ruptured. Necrotic tissue needed removal; he feared refusal. Delayed ten days, tissue rotted completely. Large doses failed against severe toxin. Ancients said: Bad flesh is worse than wild beasts, toxin like bee stings. Delayed removal kills. True indeed.
One patient over forty with back carbuncle, Heart pulse surging-rapid, critical condition. Classics say: Pain/itching sores belong to Heart Fire. Surging-rapid Heart pulse indicates severe Heart Fire. Heart governs Blood; Qi stagnation stops Blood flow, causing abscess. Qizhumaxiu (Bamboo Horse Moxibustion) targets Heart Meridian pathways. Urgent garlic moxibustion cleared Heart Fire, drew out toxin. Supporting interior detoxification cured. (Treated based on pulse.)
One patient eighteen days post-back carbuncle, millet-like head, internal awl-like pain, extreme pain, occasional fainting, no appetite, Qi increasingly deficient. Large mugwort moxibustion (10+ cones), no heat sensation, internal pain unchanged. Direct moxibustion (20+ cones) resolved internal pain, toxin expelled vigorously, appetite improved. Strong tonifying soup and Sangchai moxibustion gradually resolved slough. (Treated based on symptoms.)
One patient with many back carbuncle heads, swollen/hard/purple, little pain, no sloughing. Mugwort placed on site for moxibustion, plus strong tonics. Dead flesh detached in days, cured. (Treated based on symptoms.)
One patient with burning back carbuncle pain. Garlic moxibustion (30+ cones) resolved swelling/pain. Supporting interior detoxification cured. (Treated based on symptoms.)
One patient four-five days post-back carbuncle, small head but large base. Garlic moxibustion (30+ cones) resolved base internally, head formed pus.
One patient suddenly nauseous, Da Zhui (GV14) very itchy, arm immovable shortly after, mental fatigue. Called Tianju (Heavenly Carbuncle), critical illness. Garlic moxibustion worsened itch. Direct moxibustion (50+ cones, touching flesh) stopped itch, cured in ten days. *Jingyao* says moxibustion has life-restoring power. Indeed.
One patient four days post-onset, millet-like head, back pain/heaviness, deep-excess pulse. Neishu Huanglian Tang (two doses) slightly reduced symptoms. Xianfang Huoming Yin (two doses) resolved it. (Treated based on pulse/symptoms.)
A woman with swelling/pain/fever, sleep talking, large pulse. Qingxin Tang (one dose) stabilized. Jinyinhua, Gancao, Tianguafen (Trichosanthes Root), Danggui, Gualou (Trichosanthes Fruit), Huangbai (Phellodendron) for several doses promoted suppuration. Supporting interior medicine cured. (Treated based on pulse/symptoms.)
One patient with back toxicity, burning pain/fever, cold drink preference, sweating, constipation, delirium. Po Guan Dan (Coffin Breaking Pill, two pills) calmed. Jinyinhua (four doses) promoted pus formation. Incised, supporting interior medicine cured.
Eunuch with back carbuncle, swelling/pain/purple color, deep-rapid pulse. Liangfu said: Rapid pulse, fever, pain indicates Yang origin. Red sores indicate extreme Fire resembling Water. History: Half-year use of Tougu Dan (Bone-Penetrating Pill) caused accumulated warmth-heat. Neishu Huanglian Tang (repeated doses) slightly flattened. Pai Nong Xiaodu San (Pus-Draining Detoxification Powder) and Zhuti Tang Dayi Gao cured.
Wang Ji notes: Treated based on pulse and medication history.
One patient developed back carbuncle after Cold Damage, critical. Removed dead flesh, applied Shenxiao Danggui Gao (Divine Effect Angelica Paste), drank Neishu Huanglian Tang. Delirium worsened, pulse enlarged. Liangge San (Cooling Chest Powder, two doses), then Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellaria) and Huanglian (Coptis) for several doses cured.
Wang Ji notes: Pulse/symptoms not detailed. Post-purgation worsening delirium/enlarged pulse suggests deficiency. Yet Liangge San (purgative) was used, likely because constitution was robust and intake adequate.
Generally, carbuncle patients expect too fast results. Changing drugs after one-two doses causes errors. Disease has severity, treatment has urgency. Expecting cure in one-two doses is difficult. Carbuncles have deep/long origins, external manifestations, muscle destruction, different from invisible diseases. How can effects be seen overnight? Patients should consider this.
One robust, dark-skinned patient, back red/swelling, severe pain near hip bone, floating-rapid-surging-tight pulse, winter season. Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) plus wine, Sheng Fuzi (Raw Aconite), Gualouzi (Trichosanthes Seed), Gancaojie (Licorice Joint), Renshen, Qianghuo (Notopterygium), Qingpi (Green Tangerine Peel), Huangbo, Banxia (Pinellia), Shengjiang (Fresh Ginger) for six doses resolved. This also uses supporting interior method.
Wang Ji notes: Prescription formulated based on season and pulse.