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Li stated: Although there are many prescriptions for treating back carbuncles (back abscesses), few are effective. I have now selected those that have been verified and recorded them, to avoid misleading people. For example, Huxin San (Heart-Protecting Powder): for any person suffering from carbuncle diseases, taking a few doses early on allows the toxic pathogenic factors to disperse outward, preventing the misfortune of vomiting. Otherwise, sores may appear in the throat and tongue, or they may turn black and rot like fungi. If the sore appears after four or five days, other medicines should be used intermittently for treatment.

My commentary: Huxin San is a medicine for resolving carbuncles caused by mineral drugs. It is suitable if there is fever, swelling, thirst, drinking cold water but vomiting; it is not suitable if there is fever, swelling, thirst, drinking hot water but vomiting. If it is due to Spleen deficiency with phlegm retention, or invasion of cold pathogens internally, or damage to the Spleen and Stomach caused by pain, Liujunzi Tang (Six Gentlemen Decoction) is suitable. If sores appear in the throat and tongue, or there is dry mouth and thirst, or frequent urination, Liuwei Wan (Six-Ingredient Pill with Rehmannia) is suitable. Generally, when various sores present with vomiting: if drinking cold water and constipation occur, this is heat toxicity, resolved by Huanglian Xiaodu San (Coptis Detoxification Powder); if drinking cold water but stool is normal, this is Stomach fire, cleared by Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); if there is reluctance to eat and preference for hot drinks, this is Stomach deficiency, supplemented by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if stool is unformed and there is a preference for hot drinks, this is Spleen and Stomach deficiency-cold, warmed by Liujunzi Tang plus Pao Jiang (Roasted Ginger). I often see that people with weak Spleen and Stomach, using the aforementioned powder, instead suffer from coldness in the heart region, leading inevitably to vomiting. Those cases where sores appear in the throat and tongue are due to exhaustion of Kidney Water with deficient fire flaming upward; the condition is very severe, requiring urgent use of Jiaban Bawei Wan (Modified Eight-Ingredient Pill), and some have survived.

Attached Treatment Cases

Zhang Tingyi, a Tongfu official, suffered from a back carbuncle, with vomiting, pain, constipation, dry mouth, and thirst. This indicated internal accumulation of heat toxicity. Two doses of Zhuye Shigao Tang were administered, and all symptoms subsided immediately. Tuoli Xiaodu San (Support the Interior and Detoxify Powder) was used, and swelling around the periphery subsided. Xianfang Huoming Yin (Immortal Formula for Life Preservation Decoction) was used, and the sore healed quickly.

Li Tongfu, a Shangshe scholar, suffered from a sore on his leg, with pain, reduced appetite leading to vomiting, and aversion to cold. I considered this to be damage to Stomach Qi caused by pain. Six doses of Liujunzi Tang plus Danggui (Angelicae Sinensis Radix) were given; pain decreased slightly, and food intake increased. Then, Shixuan San (Ten Acupoints Powder) plus Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) was administered for several doses until pus formed, which was then drained via needle puncture. Subsequently, the previous formula minus Fangfeng (Saposhnikoviae Radix) and Baizhi (Angelicae Dahuricae Radix) was taken for several doses, resulting in recovery.

Bian Yunqu, a Juren degree holder, suffered from toxicity in the axilla, with retching, inability to eat, loud borborygmus with severe pain, cold limbs, and a deep, fine pulse. I diagnosed insufficient Middle Qi and internal invasion of cold pathogens. Tuoli Wenzhong Tang (Support the Interior and Warm the Middle Decoction) was administered, resulting in immediate recovery after one dose. He was then treated with Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction). The patient claimed that vomiting during the swelling stage should be treated as toxic factors attacking the Heart, and vomiting during the ulceration stage should be treated as Yin deficiency. I said: This is Danxi’s general statement, meaning "all pain, itching, and sores belong to Heart Fire." For instance, if redness, swelling, and severe pain accompany irritability, a full pulse, and vomiting, it is excess (Shi syndrome), and purgation is indicated. If swelling is hard, painless, non-ulcerated, accompanied by a weak pulse and vomiting, it is deficiency (Xu syndrome), and tonification is indicated. There are also cases where vomiting is caused by pain damaging Stomach Qi or by contracting cold pathogens and foul air; even in the swelling stage, strengthening the Stomach and Qi is necessary. The patient stubbornly refused to believe this, used attacking/draining medicines, and the condition worsened. Upon re-examination, his pulse was faint and fine, accompanied by fever. I said: Fever with a quiet pulse, blood loss with a full pulse, and agitation with a rapid pulse after sweating are all difficult to treat. He subsequently died.

Huxin San (Heart-Protecting Powder)
Lüdou Mo (Mung Bean Powder, 1 liang) Ming Ruxiang (Clear Frankincense, ground to 0.5 liang)
Boil Sheng Gancao (Raw Licorice Root) decoction to mix with the powder. Have the patient sip frequently, keeping the medicine constantly in the diaphragm area.

Wuxiang Liaoqiao Tang (Five-Aromatics and Forsythia Decoction)
Ruxiang (Frankincense) Muxiang (Aucklandia) Chenxiang (Agarwood) Dingxiang (Clove) Liaoqiao (Forsythia) Shegan (Belamcanda) Shengma (Cimicifuga) Huangqin (Scutellaria) Mutong (Akebia) Duhuo (Angelica Pubescens) Sangjisheng (Taxillus) Gancao (Licorice) (each 3 fen)
Decoct in water and take orally.

My commentary: Regarding this prescription, see the discussion in the preceding section.

For all carbuncles and ulcers, do not use medicines that generate flesh and close wounds. Instead, use Maifan Shi (Maifan Stone); the wound will close naturally. Or, if caused by toxic drugs or knife cuts, for severe cases, concurrently administer Chenxie Tang (Agarwood and Musk Decoction).

My commentary: Previously, it was stated that wound-closing medicines should not be used for all sores, fearing that if toxic factors are not fully expelled, they might exacerbate the malignancy. Flesh is governed by the Spleen; by supporting the interior and strengthening the Spleen, residual toxins will resolve naturally, and the wound will heal. If the toxin manifests externally and Qi and Blood are not depleted, Maifan Shi can be relied upon. If Yuanqi (Primary Qi) is damaged, the Spleen must be supplemented, and needles/knives are contraindicated; see Chapter 43.

Chenxie Tang (Agarwood and Musk Decoction)
Muxiang (Aucklandia) Shexiang (Musk) Chenxiang (Agarwood) Huoxiang (Patchouli) Ruxiang (Frankincense) Liaoqiao (Forsythia) (equal parts)
Take 2 qian each time, decoct in water.

Wuxiang Qu Dahuang Jia Renshen Huangqi Xijiao Tang (Five-Aromatics Formula without Rhubarb, Added Ginseng, Astragalus, and Rhino Horn Decoction)
Muxiang (Aucklandia) Chenxiang (Agarwood) Ruxiang (Frankincense) Dingxiang (Clove) (each 5 qian) Fencao (Refined Licorice) Renshen (Ginseng) (each 4 qian) Huangqi (Astragalus, 1 liang) Xijiao Mo (Rhino Horn Powder, 2 qian) Shexiang (Musk, 1 qian)
Take 4 qian each time, decoct in water.

Loulu Tang (Rhynchosia Decoction)
Huangqi (Astragalus) Gancao (Licorice) Liaoqiao (Forsythia) Chenxiang (Agarwood) Loulu (Rhynchosia) (each 5 qian) Dahuang (Rhubarb, 1 liang, lightly stir-fried)
Take 2 qian each time, decoct in water with fresh ginger and jujubes.

My commentary: These three formulas are detailed in the first chapter; their methods for closing wounds are attached to Chapter 33.

Zhamu Yinzi (Oak Wood Infusion) Treats all carbuncles and ulcers; unformed ones dissipate spontaneously, formed ones ulcerate spontaneously. Very effective.
Gan Zha Ye (Dried Oak Leaves, 4 liang) Xuancao Gen (Daylily Root) Heye Di (Lotus Leaf Stalk Base) Gancao Jie (Licorice Joint) Diyú (Sanguisorba) (each 1 liang)
Take 5 qian each time, decoct in water. Divide one bowl into two doses, taken morning and evening.

My commentary: Lotus leaf stalk base removes bad blood; daylily detoxifies; oak leaves effectively expel pathogens; Sanguisorba and licorice joints clear blood and detoxify.

E'jiao Yinzi (Donkey-Hide Gelatin Infusion) Treats all carbuncles, ulcers, and furuncles.
Niu Jiao (Donkey-Hide Gelatin, cut and stir-fried with Ge Fen [Clam Shell Powder] until pearl-like) Fencao (Refined Licorice) (each 1 liang) Juhong (Tangerine Peel, 5 qian)
Prepare as three doses, decoct in water and take.

Niu Jiao Yin (Donkey-Hide Gelatin Infusion) Intercepts the progression of carbuncles and ulcers, prevents internal attack of toxins, stops transmission to malignant conditions, beneficial without harm.
Niu Pi Jiao (Donkey-Hide Gelatin, transparent grade, 4 liang)
Heat one bowl of wine in a double boiler until the gelatin melts, then take. Add more wine until drunk; if unable to drink alcohol, add plain water.

My commentary: These two infusions for detoxification have proven highly effective.

Shenxian Huangfan Wan (Immortal Yellow Alum Pill) Taking over 1 liang most effectively stops pain without damaging the Zang-Fu organs.
Bai Fan (White Alum, 1 liang, bright quality, ground) Huang La (Yellow Beeswax, 5 qian yellow quality, melted; another source uses 7 qian)
Form pills the size of paulownia seeds. Take 10 pills initially, gradually increasing to 20 pills, swallowed with cooked water or warm wine. Unruptured lesions will dissolve internally; ruptured ones will heal naturally. If caused by mineral drug ingestion, take an additional 1 liang of alum powder, slowly swallowed with warm wine. Someone with widespread sores resembling snake heads found this effective, but required 100 pills daily to resist the toxin and prevent internal attack. It also treats snake bites: melt alum, apply hot drops to the wound; pain stops immediately, and toxin exits.

My commentary: The previous method indeed has good effects. I often use 3 qian of Bai Fan (White Alum) as powder, made into pills with paste, taken consecutively for two doses with Scallion Decoction, achieving particularly rapid results; hence named Qianjin Huadu Tang (Thousand-Gold Toxin-Resolving Decoction). Originally, alum powder was mixed with scallion water, but because powder is hard to swallow, it was made into pills. This medicine resolves mineral toxicity, stabilizes the Zang-Fu organs, is beneficial without harm, requires little effort but yields great success. It is essential knowledge for remote areas.

Guolao Gao (State Elder Paste) Treats all carbuncles and ulcers; pre-administration reduces swelling and expels toxins; its merits cannot be fully described.
Fencao (Refined Licorice)
Soak in river water for two nights, knead to extract juice, boil into paste in a clay pot. Take 1-2 spoons, washed down with non-grain wine or plain water. Most effective for resolving Dan Du (erysipelas/toxic heat).

My commentary: The previous formula is indeed a detoxifying agent, but those with weak Yuanqi (Primary Qi) should strictly avoid it.

Wanjīn San (Ten-Thousand-Gold Powder) Treats all carbuncles and ulcers, whether ulcerated or not.
Gualou (Trichosanthes Fruit, one fruit, crushed finely) Da Gancao Jie (Large Licorice Joint, 2 qian) Moyao (Myrrh, 1 qian, ground to powder)
Use two bowls of wine, decoct to one bowl, remove dregs, add Myrrh powder and take.

My commentary: The previous powder has the power to detoxify and break blood stasis, but lacks the power to putrefy necrotic tissue and generate flesh.

Yuanzhi Jiu (Polygala Wine) Treats all carbuncles and ulcers caused by worry, anger, and Qi stagnation.
Yuanzhi (Polygala Root, soaked in rice wash water, cleaned of soil and core removed)
Grind to powder. Take 3 qian each time, mix with one cup of wine, let settle, drink the clear liquid, and apply the dregs to the affected area.

My commentary: Yuanzhi Jiu indeed has the effect of resolving depression and detoxifying, but lacks the effect of supporting the interior and tonifying.

Rendong Jiu (Honeysuckle Vine Wine) Very effective for all carbuncles and ulcers; additionally apply Maifan Gao (Maifan Stone Paste) and Shenyi Gao (Miraculous Efficacy Paste).
Rendong Teng (Fresh Honeysuckle Vine, 5 liang) Da Gancao Jie (Large Licorice Joint, 1 liang)
Decoct two bowls of water to one bowl. Add one bowl of good non-grain wine, boil a few more times, remove dregs. Divide into three doses, consumed within 24 hours. For severe cases, two doses per day, until bowel and bladder movements are smooth. Additionally, take a handful of fresh Rendong Teng, mash thoroughly, add a little wine, and apply to the surrounding area.

Also, 49 pieces of Shuilian (Water Lotus/Nymphaea), remove hairs, grind finely, mix with wine, take warm. Its efficacy is the same as Rendong Cao (Honeysuckle Herb).

Also, one handful of Longlin Bili (Ficus pumila var. awkeotsang), grind finely, mix with wine, take juice warm. Promoting the discharge of evil substances is ideal.

[Image: Figure 4]

Hong Neixiao (Red Internal Resolution) Decoct in a water-sand vessel until ripe. Mix with wine equally with the medicine. Boil a few more times, remove dregs. Take frequently. Bake dregs into powder, form pills with wine paste to the size of paulownia seeds. Take 30 pills each time, with warm wine on an empty stomach, as a regular maintenance dose, because the potency is light. Medicine produced in Jianchang is superior.

My commentary: The previous three medicines are used for their simplicity and detoxifying properties, lacking any interior-supporting effect. If the toxin is gone but True Qi is deficient, tonification and support are necessary to achieve complete recovery.