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Li stated: For brain carbuncle (Nao Ju) and carbuncles occurring on the neck, moxibustion with garlic partition should not be used, as it may induce pathogenic toxins to attack upward. It is appropriate to apply moxibustion to Zusanli (ST36) for five cones (zhuang), Qihai (CV6) for three to seven cones, while simultaneously administering herbs that cool blood and resolve toxins. Alternatively, the "Riding Bamboo Horse" acupoint moxibustion method can be used. In ancient practice, carbuncles arising in the head, neck, or throat were considered incurable; however, if this method is employed, many patients survive. Formulas such as Wuxiang Lianqiao Loulu Decoction, Guolao Paste, and Wanjin Powder are all suitable options.

My commentary: The aforementioned conditions belong to the Bladder Meridian, caused either by damp-heat obstructing upwards or by ministerial fire flaming upward. If due to damp-heat, there is an excess of pathogenic qi but a deficiency of healthy qi. One should use Huanglian Xiaodu San (Coptis Decoction for Clearing Toxins) to eliminate damp-toxin, and Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment Qi) to nourish the source of transformation. If due to ministerial fire, both healthy qi and pathogenic qi are deficient. One should use Buzhong Yiqi Tang combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney water. If Kidney water is exhausted and the disease progresses to terminal symptoms, Jiajian Bawei Wan (Modified Eight-Ingredient Pill) and Buzhong Yiqi Tang should be urgently administered to consolidate the root and guide fire back to its source. If the lesion is dark purple and does not suppurate, or suppurates but fails to heal, it is termed "Brain Scorched" (Nao Shuo) and is incurable. Generally, when swelling and pain are severe, Xianfang Huoming Yin (Immortal Formula for Preserving Life) should be used, combined with garlic-partitioned moxibustion to dissipate blood stasis and draw out stagnant toxins; however, the moxa cones should be small and few in number. To promote suppuration, necrosis discharge, flesh regeneration, and wound contraction, the primary approach should be tonifying the interior (Tuoli).

Attached Treatment Cases

A woman suffered from swelling in both the head and neck, unbearable pain, fever, thirst, and a preference for cold drinks. After taking internal heat-clearing medicines and applying external cooling agents, the lesion became dark purple without suppurating, and she experienced chest oppression. This indicated deficiency-cold of Yang qi. She adhered to her prior condition of phlegm-fire and refused warm-tonic treatment. I prescribed Ren Shen (Codonopsis Root / Ginseng Radix) and Huang Qi (Astragalus Root) at 5 qian each, Gan Jiang (Dried Ginger Rhizome) and Rou Gui (Cinnamon Bark) at 2 qian each. After one dose, the swelling rapidly rose and suppurated. Subsequently, she was treated with major tonic medicines and recovered. Generally, when sores and carbuncles present with high swelling, severe pain, irritability, thirst, and a desire for cold drinks, both pathogenic qi and healthy qi are in excess. Qingre Xiaodu San (Powder for Clearing Heat and Resolving Toxins) and Xianfang Huoming Yin should be the main treatments. If there is high swelling, severe pain, dry mouth, and a desire for hot drinks, pathogenic qi is in excess while healthy qi is deficient. Tuoli Xiaodu San (Powder for Supporting the Interior and Resolving Toxins) and Shenqi Sibusa San (Four-Tonic Powder with Ginseng and Astragalus) should be the main treatments. If there is diffuse swelling, slight pain, poor appetite, and physical fatigue, both pathogenic qi and healthy qi are deficient. Liujunzi Tang (Six-Gentlemen Decoction) and Buzhong Yiqi Tang should be used to strengthen the Spleen and Stomach. Thus, unformed lesions will dissipate, formed lesions will suppurate, and suppurated lesions will heal.

The wife of the Confucian scholar Hu Benzhong contracted the disease in winter, presenting with swelling, pain, heat, thirst, and a surging, rapid, and full pulse. She was treated with heat-clearing and toxin-resolving medicines, suppurated, and recovered. In March of the following year, her tongue swelled, and she developed numerous purple ding (hard nodules/boils) resembling grapes all over her body, especially on the hands and feet. Black blood was pricked out from each. This indicated toxicity affecting the Spleen and Stomach. First, Duoming Dan (Life-Snatching Pill) was administered, seven pills. Stinky sweat was excreted, but the sore heat intensified, accompanied by constipation. Two days later, Da Huang (Rhubarb Root), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome) at 3 qian each, Shengma (Cimicifuga Rhizome), Baizhi (Angelica Dahurica Root), Shanzhi (Gardenia Fruit), Bohe (Mint Herb), Lianqiao (Forsythia Fruit) at 2 qian each, and Sheng Gancao (Raw Licorice Root) at 1 qian were decocted in water, boiled for three to five boils, and taken orally. Large amounts of stinky blood were passed via urination and defecation, and symptoms in the lower body subsided slightly. Then, Xijiao (Rhinoceros Horn - *Note: Modern substitutes like Water Buffalo Horn are used*) juice was ground into the preparation and administered again. Stinky blood was discharged from the base of the tongue and gum margins. All toxins were instantly resolved, and she finally recovered after taking Xijiao Dihuang Tang (Rhino-Horn and Rehmannia Decoction).