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Li stated: Recently, several individuals suffered from back carbuncle (back abscess). Some experienced chills followed by fever, others fever followed by chills, and some vomited phlegm and sweated profusely to cessation either daily or every other day. Treatments using Chaihu Tang (Bupleurum Decoction) and Hengshan (Dichroa Root) were ineffective. I reasoned that this was due to spleen qi deviation compounded by cold pathogen invasion, resulting in excessive phlegm-dampness. Thus, I first administered Bu Huan Jin Zheng Qi San (Unchanging Metal Rectifying Qi Powder), followed by Pai Nong Nei Bu San (Draining Pus and Interior-Nourishing Powder) and Mu Xiang Tang (Costus Decoction), leading to recovery within three days.

My commentary: In the aforementioned conditions, if symptoms recur after external pathogens have been expelled, Liu Jun Zi Tang (Six Gentlemen Decoction) should be used to tonify the spleen and stomach. Generally, vomiting caused by deficient stomach qi is relieved by warmth; vomiting caused by internal attack of toxins is relieved by cold. Treatment must distinguish between these two (see Appendix on Key Principles of Medication Use).

Family-inherited Bu Huan Jin Zheng Qi San treats wind-cold common cold, injury from raw/cold foods, miasma malaria, or epidemic pestilence.
Cang Zhu (Atractodis Rhizoma, soaked in rice water and stir-fried, 4 liang) Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice, 4 liang) Fen Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, honey-fried, 2 liang) Ju Hong (Citri Reticulatae Pericarpium Rubrum, baked, 3 liang) Huo Xiang Ye (Pogostemonis Herba) and Ban Xia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine, each prepared with ginger juice, 2 liang) Mu Xiang (Aucklandiae Radix, baked in wet paper) Ren Shen (Ginseng Radix) Bai Fu Ling (Poria, each 1 liang).
Take 5 qian per dose, decoct with fresh ginger and jujube in water.

Li’s discussion states: Patients with carbuncles must avoid consuming beef, mutton, chicken, goose, shrimp, fish, alcohol, wheat products, and fried/roasted foods. Violating this will inevitably cause fever; Zhi Zi Huang Qin Tang (Gardenia and Scutellaria Decoction) is appropriate. Generally, when the zang-fu organs are unobstructed and the sore has ulcerated, with qi and blood already depleted, careful nursing is paramount. If fever occurs and cooling medicines are administered, disaster is inevitable.

Zhi Zi Huang Qin Tang
Lou Lu (Leuzeae Radix) Lian Qiao (Forsythiae Fructus) Shan Zhi Zi (Gardeniae Fructus, stir-fried) Fang Feng (Saposhnikoviae Radix) Ku Shen (Sophorae Flavescentis Radix, stir-fried) Ren Shen (Ginseng Radix) Xi Jiao (Rhinocerotis Cornu, shaved slices) Gan Cao (Glycyrrhizae Radix et Rhizoma, stir-fried) Bai Fu Ling (Poria) Shi Wei (Pyri Folium) (If unavailable, replace with Sang Bai Pi [Mori Cortex], each 3.5 qian).
Take 5 qian per dose, decoct in water.

My commentary: For the aforementioned condition where dietary injury to the spleen and stomach causes fever, use Liu Jun Zi Tang (Six Gentlemen Decoction), Shen Qu (Massa Medicata Fermentata), and Shan Zha (Crataegi Fructus). For fever due to yin-blood deficiency, use Si Wu Tang (Four Substances Decoction), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Huang Qin (Scutellariae Radix). For fever due to excessive loss of pus and blood, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). Mr. Dongyuan stated: The stomach is the root of the five zang organs. Once stomach qi is injured, all zang organs become deficient, and the seven evils arise like bees swarming. Can one not be cautious?