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Wu stated: Whenever garlic cake moxibustion is used, it is because garlic has a pungent and warm flavor and is slightly toxic; its primary function is to dissipate carbuncles and sores. It relies on the heat of fire to promote the medicinal power. There are cases where only moxa cones are used for direct moxibustion; this method can be applied to stubborn carbuncles or chronic back infections. For cases presenting with redness, swelling, purple-black discoloration, and severe toxicity, it is essential to use simultaneous garlic and moxa moxibustion for optimal results.

I observe: The aforementioned methods indeed possess the merit of restoring life. In cases of stubborn ulcers or chronic diseases where the Spleen and Stomach are weak, and Ying Qi (nutritive energy) fails to nourish the affected area, leading to internal invasion by cold pathogens that resist healing, it is advisable to frequently apply small moxa cones to the ulcer opening to dispel cold pathogens and replenish Ying Qi. Regarding internal supplementation methods, please refer to the first treatise and the thirty-second treatise.

Wu’s Formula Theory states: The occurrence of carbuncles, sores, and back infections stems from specific causes, which have been discussed in detail in previous chapters. When initial redness and swelling are perceived, moxibustion should be applied to both sides of the second depression along the spinal column, each located one cun five fen away from the midline at the point referred to as Refu (Heat Chamber). Seven moxa cones should be applied at each site. This can vent excess Yang heat and permanently prevent the suffering of carbuncles and sores. Alternatively, garlic-interposed moxibustion can be used regardless of the number of cones; this ensures that pathogenic factors have no place to reside while the True Qi remains undamaged. However, if sores appear on the head or neck, the Riding Bamboo Horse method and moxibustion at Zusanli (ST36) are appropriate.

I observe: The preceding discussion is indeed an excellent strategy. Its regulatory methods should be sought in the first treatise.

Case cited by Shi:
In the Ji Xu year, surgeon Chang Qizhi diagnosed the mother of Scholar Shi, stating: "There is accumulated heat within, posing a risk of developing a sore." By the sixth month of the Xin Si year, she indeed experienced slight itching on her back and shoulder blades, with lesions appearing like millet grains. Moxibustion temporarily resolved them, but they recurred overnight. A plaster was applied, causing the erythema to spread to approximately six cun, accompanied by unbearable pain, leading to blame being placed on moxibustion. Coincidentally, a monk met them, claiming his own critical sore condition had only resolved after receiving over eight hundred moxa cones. Consequently, large moxa cones the size of ginkgo nuts were used. Several cones were applied to the center of the sore and its surroundings. Pain ceased, and after more than thirty cones, the red erythema completely subsided. Subsequently, moxa balls the size of plums or apricots were applied, totaling forty cones. Afterward, the patient could eat porridge and sleep peacefully. The lesion protruded four cun, with about a hundred small openings; although the diseased tissue necrosed, the patient eventually recovered.

I observe: The method of burning moxa must ensure that those who feel pain do not feel it, and those who do not feel pain do feel it. Only then will the toxin disperse with the fire. Otherwise, it brings no benefit and causes harm.

Attached Treatment Case:
Gao Zhuzhen, an official of the Ministry of Justice, suffered from a back sore. The lesion was dark, hard, and heavy as if bearing a stone, with mental confusion that was alarming. His relative, Zheng Shacun, invited me to join him in treatment. Zheng remarked: "When Gao served in a certain county in Huguang, he improved a dangerous river crossing. The locals built a living shrine for him, and all who crossed prayed there. Now that he suffers this illness, people suspect the shrine caused malevolent spirits." I replied: "Not so. The etiology is deficiency-cold of Yuan Qi (primordial qi) combined with intense accumulation of toxins." Garlic paste was spread on the affected area, and large moxa cones placed on a coin were applied for more than twenty cones; he felt nothing. More garlic paste was applied with continued moxibustion; still, he felt nothing. Direct skin moxibustion was then performed. After a long time, sensation returned. Further application induced pain. Internally, a major tonic formula containing Renshen (Ginseng Radix) and Fuzi (Aconiti Lateralis Radix Praeparata) was administered, leading to recovery.