伍氏曰∶夫痈发背者，皮薄肿高，多有椒眼数十粒。疽发背者，皮肤顽硬，壮如牛颈之
皮，二症皆宜灼艾。痈成脓则宜针。其针当以马衔铁为之，形如薤叶样，两面皆利，可以横
直裂开五六寸许，取去毒血，其病顿轻，须先灸而后裂。可服神仙追毒丸，利去毒根，次服
排脓托里等药调治。疽成脓则宜烙，用银篦大寸许，长六寸，烧赤频烙患处，以脓出为效。
大抵痈疽难于诸科，非心传契妙，其可以易治耶。
愚按∶前症，若气血充实，其脓既成，宜速针之，勿药可愈。若气血亏损，脓不能出，
成脓出反痛，须托里养胃，庶保终吉。详见第四十。
伍氏曰∶但觉背两胛间赤痒肿痛，或有白粒，且以津唾时润令湿，切勿抓破。大抵在背
微有赤肿点，或因抓破入浴犯水，或因饮酒脍炙而作，初未辨症，且以津润，时用墨围之。
若肿赤，急就围中灼艾最善。人皆疑以火热太过，多致延漫，误者众矣。
愚按∶疽发背胛，若有瘀肉腐烂，脓水淋漓，肿痛仍作者，此处有筋一层间隔，内脓不
出故也，宜用针引之。老弱者若待其自溃，多致不救，治者审之。
附治验
水部曹文兆，背胛患之，半月余，疮头如粟且多，内痛如刺，其脉歇止。此元气虚而疽
蓄于内，非灸不可。遂灼二三十余壮，余以六君加藿香、归数剂，疮势渐起，内痛顿去，胃
脉渐至。但疮色紫，瘀肉不溃，此阳气虚也。燃桑枝灸患处，以解散其毒，补接阳气，仍以
前药，加参、 、归、桂，色赤脓稠，瘀肉渐腐，两月而愈。夫邪气沉伏，真气怯弱，不能
起发，须灸而兼大补。若投以常药，待其自溃，鲜有不误者。
上舍陈履学之内，先从左肩下一点寒，三日后，右肩下发一白肿如瓯，中红如酒盏，自
用消解凉药一剂不散，次投十宣散四剂，加痛略红，次连投参、 、丁、桂、防、芷之剂，
脓溃后，恶心呕吐，头晕不止，厥逆寒战，鼓牙，虚汗，顶平脓清，此投解散凉剂之误。急洗
去围药，投以参、 、归、术、地黄、姜、附大剂一服，原从左肩下旧寒一点先热起，又进
一服，遍肿浮热，肿高脓稠。兼 乌金膏，数日出腐筋如脂膜大小数片。日进前药二服，
参、 投至八钱，逾两月始安。愈后时以劳厥，即投参、 、归、术、姜、附大剂乃苏。
Wu stated: A carbuncle (Yong, 痈) developing on the back presents with thin skin and high swelling, often accompanied by dozens of pus heads resembling pepper eyes. An abscess (Ju, 疽) developing on the back presents with hard, rough skin, thick like the hide of an ox's neck. Both conditions are suitable for moxibustion. Once a carbuncle suppurates, it should be lanced. The lancet should be made from horse-bit iron, shaped like a leek leaf, sharp on both edges, capable of splitting open horizontally or vertically for about five to six inches to drain toxic blood, providing immediate relief; however, moxibustion must be applied first before lancing. One may administer Shenxian Zhuidu Wan (Immortal’s Poison-Chasing Pill) to purge the root of toxicity via purgation, followed by regulating treatment with formulas such as Paiming Tuoli Tang (Pus-Draining and Interior-Supporting Decoction). Once an abscess suppurates, it should be cauterized using a silver spatula approximately one cun wide and six cun long, heated red-hot and frequently applied to the affected area until pus drains, which indicates efficacy. Generally, treating carbuncles and abscesses is more difficult than diseases in other departments; without intuitive understanding and exquisite skill, how can they be easily cured?
My commentary: Regarding the aforementioned conditions, if the patient’s Qi and Blood are substantial and suppuration has occurred, rapid lancing is indicated, and cure may be achieved even without medication. If Qi and Blood are deficient and pus cannot drain, pain may persist despite suppuration; in such cases, interior-supporting and stomach-nourishing methods are necessary to ensure ultimate recovery. See Chapter 40 for details.
Wu stated: Whenever one feels redness, itching, swelling, and pain between the two scapulae on the back, or observes white granules, moisten the area frequently with saliva to keep it wet, and absolutely avoid scratching it open. Generally, when slight redness and swelling appear on the back, it may arise from scratching leading to water exposure during bathing, or from consuming alcohol and rich meats. Before differentiating the syndrome, moisten with saliva and mark the perimeter with ink. If redness and swelling are severe, applying moxibustion urgently within the ink-marked circle is most beneficial. People often suspect that excessive heat fire will cause the pathogen to spread, leading many to err in this regard.
My commentary: For an abscess developing on the back scapula, if there is necrotic flesh rotting with dripping pus and persistent swelling and pain, it is because a layer of tendon separates the area, preventing internal pus drainage; needle drainage is indicated. Elderly or weak patients who wait for spontaneous rupture often face untreatable outcomes; practitioners must exercise caution.
Attached Case Record
Cao Wenzhao, an official in the Ministry of Water, suffered from this condition on his back for over half a month. There were numerous pustules like millet grains, with internal stabbing pain, and the pulse showed intermittent pauses. This indicated deficiency of primal Qi with toxin accumulation internally, necessitating moxibustion. Thirty moxa cones were applied. Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) was administered with Huo Xiang (Patchouli Herb) and Dang Gui (Angelica Sinensis Root) for several doses. The lesion gradually rose, internal pain ceased immediately, and the Stomach pulse recovered. However, the lesion color was purple, and necrotic flesh did not slough, indicating Yang Qi deficiency. Moxibustion with burning mulberry branches was applied to the affected area to dissipate toxicity and replenish Yang Qi. The previous formula was continued, adding Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), and Gui Zhi (Cinnamon Twig). The lesion turned red, pus became thick, and necrotic flesh gradually sloughed, resulting in recovery after two months. When pathogens are deeply seated and true Qi is weak, failing to rise and manifest, moxibustion combined with strong tonification is required. Relying on ordinary medications and waiting for spontaneous rupture rarely avoids error.
The wife of Chen Lvxue, a student at the Imperial Academy, initially felt coldness at one point below her left shoulder. Three days later, a white swelling like a bowl appeared below her right shoulder, red in the center like a wine cup. She self-administered one dose of cooling dispersing herbs without resolution. Then, Shixuan San (Ten Acupoints Powder) was administered for four doses, resulting in increased pain and slight redness. Subsequently, a decoction containing Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Ding Xiang (Clove), Gui Zhi (Cinnamon Twig), Fang Feng (Saposhnikovia Root), and Bai Zhi (Angelica Dahurica Root) was continuously administered. After suppuration, she experienced nausea, vomiting, continuous dizziness, cold limbs with shivering, teeth chattering, and sweating due to deficiency. The vertex was flat with clear pus, indicating an error from administering cooling dispersing agents. The peripheral paste was urgently washed off, and a large dose of Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Di Huang (Rehmannia Root), Sheng Jiang (Fresh Ginger Rhizome), and Fu Zi (Aconite Lateralis Radix Preparata) was administered. The original cold spot below the left shoulder first became hot. After another dose, generalized swelling, floating heat, high swelling, and thick pus appeared. Wujin Gao (Black Gold Ointment) was applied externally. Within a few days, pieces of necrotic tendon resembling fat membrane were discharged. The previous medicine was taken twice daily, with Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) dosed up to eight qian. Stability was achieved after over two months. Post-recovery, she occasionally fainted due to fatigue, reviving only upon administration of large doses of Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Sheng Jiang (Fresh Ginger Rhizome), and Fu Zi (Aconite Lateralis Radix Preparata).