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Li stated: The prescriptions and discussions I have authored are comprehensive and complete. My intention is for practitioners to study them carefully one by one and apply them in sequence, ensuring efficacy without exception. Herein, I briefly outline the essential principles and sequence of medication usage:

1. Upon the initial onset of carbuncle and ulcer (Yong Ju), immediately administer Neituo San (Internal Support Powder) to prevent subsequent mouth and tongue ulcers. Simultaneously, employ Qizhuma moxibustion (Bamboo Horse Moxibustion) or garlic-separated moxibustion.

2. Administer Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction). Discontinue use once bowel movements become loose and smooth, adjusting dosage according to the patient’s deficiency or excess condition.

3. After the carbuncle and ulcer have suppurated and ruptured, it is appropriate to take Painong Neibu San (Pus-Draining Internal-Nourishing Powder). If vomiting and regurgitation occur, administer this powder using Muxiang Tang (Aucklandia Decoction) as a vehicle.

4. When carbuncle and ulcer first arise, moxibustion should be applied promptly. Apply Maifan Shi Gao (Wheat Meal Stone Gypsum) around the periphery of the lesion, leaving the center open to allow the discharge of toxins. If the lesion is small, apply it comprehensively; after rupture, apply Shenyi Gao (Divine Efficacy Ointment).

5. For already ruptured carbuncles and ulcers, wash the area daily with Zhuti Tang (Pig Trotter Decoction). As healing approaches, reduce frequency to once every three days.

6. When the carbuncle and ulcer are nearing closure, Shenyi Gao (Divine Efficacy Ointment) is suitable. If toxins remain, do not hastily use agents that promote tissue regeneration.

7. When the condition stabilizes, Jiawei Shiquan Tang (Modified Complete Ten Ingredients Decoction) should be used to tonify Qi and Blood, facilitating easier muscle growth.

8. Back carbuncles often present with thirst preceding the eruption, or eruption preceding thirst; such cases are frequently incurable. If Jiawei Bawei Wan (Modified Eight-Ingredient Pill) is administered, it not only prevents thirst but also greatly nourishes Qi and Blood, promoting muscle growth.

My commentary: The aforementioned symptoms and various treatment methods are detailed in Treatise 47 et al.; they should be selected with prudence.

1. Vomiting and regurgitation caused by carbuncle and ulcer have two etiologies: one is due to failing to take Neituo San at the onset, leading to latent heat accumulating in the Heart; the other is due to dysfunction of the Spleen Qi. If caused by latent heat in the Heart, symptoms include mental restlessness, fever, swelling, and pain; administer 3 liang of Neituo San. If caused by Spleen Qi dysfunction, there is no restlessness or fever, but nausea may be triggered by foul odors; administer Jiahe San (Harvesting Grain Powder). If chills and fever are present, use Buhuanjin Zhengqi San (Golden Exchange Rectifying Qi Powder); at dawn (wugeng), additionally administer Shanyao Wan (Dioscorea Pill) to tonify the Kidney.

My commentary: The treatment methods for these conditions should be cross-referenced with Treatise 11.

Li stated: Vomiting and regurgitation in carbuncle and ulcer result from toxic vapors rushing to the Heart, not from cold in the Spleen and Stomach; therefore, Neituo San should be taken. Yang stated: After epistaxis has just healed, if sweating was not induced to release the exterior, toxins remain in the meridians, leading to a large back carbuncle. This extends from the shoulder down to the waist and hypochondrium, becoming swollen, hard as stone, and purple-black. If treated with cooling herbs, severe vomiting occurs throughout the night. Continuous administration of Tuoli San (Support Interior Powder) stopped the vomiting and allowed the ulcer to rupture, discharging red pus profusely; recovery occurred in forty days. Another patient suffered from excruciating pain penetrating to the bones accompanied by vomiting, which ceased upon taking this medicine. Since some patients with carbuncles refuse to take this medicine, I cite Yang’s words to resolve worldly doubts.

My commentary: The principle of medication application is that specific diseases require specific medicines. However, currently, eight or nine out of ten cases of vomiting are due to Spleen-Stomach deficiency-cold, rebellious Qi, and phlegm stagnation; only one or two out of ten are due to internal attack by heat-toxin. Treatment should be guided by the principles outlined in Treatise 1 and Treatise 11.