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How to treat carbuncles and sores on the back? Regardless of whether it is a Yin syndrome or a Yang syndrome, moxibustion should be performed first. If there is no pain, moxa until pain appears; if there is pain, moxa until pain disappears.

When diagnosing and treating large sores caused by carbuncles and sores erupting on the brain, neck, etc., one must first remain calm and establish a treatment plan. Count the days from the onset date to the present. Observe whether the sore's appearance corresponds with the number of days passed; correspondence indicates a favorable prognosis, while discrepancy suggests danger. Next, examine the source of the disease: which Zang-Fu organ is affected and which body part is involved. Consider the upper and lower body distinctions, the severity of the location, differentiate between favorable and unfavorable signs based on color and shape, and assess the presence of healthy Qi based on the patient's spirit. Also consider the patient's age (young or old), the strength or deficiency of Qi and Blood, whether it is a Yin or Yang eruption, and whether the pathogenic toxin is deep or superficial. Generally, Yang syndromes are easier to treat and more likely to survive, whereas Yin syndromes are difficult to treat and more likely to result in death. Then, palpate the pulse for excess or deficiency to determine the favorability or unfavorability of the condition and predict the final outcome. Before the sore ulcerates, the pulse should be slightly forceful (exceeding normal by one or two beats); after ulceration, the pulse should be slightly weak (deficient by two or three parts). This is called "pulse and disease corresponding," ensuring no unexpected changes occur from start to finish. If the pulse and symptoms contradict each other, unexpected complications may arise. However, diagnosis relies on the physician's sharp observation and mental attunement, thoroughly understanding the interior and exterior before determining the treatment method. For sores within seven days of onset, when the condition has not yet fully formed and healthy Qi is not yet weak, regardless of Yin/Yang, Interior/Exterior, Cold/Heat, or Excess/Deficiency, moxibustion should be applied first. For mild cases, it disperses the toxic vapors via fire; for severe cases, it draws out stagnant toxins and connects the interior and exterior. Fire guides the toxic vapors to transform into Yang, promoting swelling and pain, after which diaphoresis, purgation, resolution, or suppuration methods can be used. Treatment should address both root and branch, matching the pulse with the medicine and the medicine with the disease. Such treatment will naturally be error-free. Therefore, prescription cannot be rigid; flexibility is key. The most important principle is to avoid damaging Healthy Qi and the Spleen-Stomach at any stage.

Internally administer Chan Su Wan (Toad Venom Pill) once; externally apply Shen Deng Zhao (Divine Lamp Illumination) three times.

For newly erupted sores, before the seventh day, or after moxibustion but before taking other medicines, it is appropriate to take one dose of Chan Su Wan (Toad Venom Pill). Sweating is ideal. Alternatively, Wan Ling Dan (Ten Thousand Spirits Pill) can be used to induce sweating. As the saying goes, dispersing toxic vapors through sweat is the quickest method. If sweating does not occur after taking these two medicines, it is due to tight closure of the Exterior and Interior, indicating heavy toxicity. In this case, Shen Miao Ba Gen Fang (Divine and Wonderful Root-Pulling Prescription) should be used. Shen Deng Zhao (Divine Lamp Illumination) should not be used too early. Between the fourth and fifth day, if the shape has not gathered and the toxin has not emerged, early use may trap the stagnating toxin inside, making it harder to expel. It should be used only after the eighth or ninth day, when the sore's trend is stable, toxic vapors have gathered, and pus/necrosis has not yet formed. Using this method, formed abscesses will rise, unformed ones will dissipate, non-ulcerated ones will ulcerate, and non-detaching necrotic tissue will detach. It is also an excellent method for resolving toxins, invigorating blood, reducing swelling, and dispersing stasis.

Apply plaster to the top of the sore and wrap medicated poultices around the sides.

Sores are most susceptible to Wind-Cold invasion. At the initial stage, or after moxibustion, Tai Yi Gao (Great Emperor Plaster) should be applied to cover the top of the sore. Its efficacy lies in drawing out toxins, lifting the sore head and pus, and preventing Wind-Cold entry. If the sore is high and swollen, and after seven days of a Yang sore, the sore head naturally turns yellow with thick pus adhering to the plaster, and the surrounding redness is bright and shiny, wash daily with Scallion Decoction and change the plaster. The main pus will discharge around the eleventh day, indicating an easy-to-treat and safe condition. If after seven days the sore is not highly swollen, the surroundings are not painful, and the sore head shows no sign of pus adhesion, it is a condition where Yin and Yang are equal. Apply Hua Fu Zi Xia Gao (Rot-Decaying Purple Cloud Plaster) to the sore head and cover with plaster. After changing dressings beyond the tenth day, if the sore head gradually necroses and the surrounding swelling rises with signs of pus, the main pus will discharge after the fifteenth day. This is a condition turning from dangerous to favorable. If there is no pus after twenty days, it is a Pure Yin syndrome, and even treatment will be ineffective. Regarding the residual swelling at the base of the sore, the application of medicated poultices helps consolidate the root to prevent expansion. Initially, Jin Huang San (Golden Yellow Powder) should be applied to the sides to draw out toxins, reduce swelling, and relieve pain. After ulceration, Tie Tong Gao (Iron Bucket Plaster) should be used to bind the sore, helping the root tighten. Since all sores result from Qi and Blood stagnation, cool/cold medicines should never be used exclusively, as they may freeze the muscles, leading to difficulty in necrosis and healing. Warmth is required to disperse stagnation and move blood; using detoxifying and blood-invigorating herbs is appropriate.

When Qi is abundant, the sore head naturally rises and protrudes; when Blood is abundant, the root is consolidated without doubt.

Qi and Blood are the original endowments of humans. Even the elderly may have surplus, while the young may have deficiency. Human life depends entirely on them. Since all diseases arise from their imbalance, how can there be no changes if they are lost? This is especially critical in surgery. During the swelling stage, without sufficient Healthy Qi to support and lift, the sore head cannot become high and swollen, nor can it become painful and suppurate. Without True Yin to nourish, the root cannot consolidate, and the color cannot become red and lively. If the sore head is high and the root is lively, regardless of age, as long as Qi and Blood are sufficient, there is no cause for concern. The boundary should be clear: "Jiao Hui" (intersection) refers to the junction between the sore root and healthy flesh, where height differences are natural; "Ming Bai" (clarity) means the sore shape and healthy shape do not mix. Observing this makes things clear.

High and swollen sores should avoid purgative/diuretic drugs to prevent damaging Healthy Qi. Flat and spreading sores should receive tonifying and supporting agents to benefit deficiency.

For sores that initially erupt high, there is originally no deep toxin in the Five Viscera; the toxin is on the surface. Supporting the Interior accelerates pus formation. Avoid internal resolution and attacking methods to prevent damaging Spleen Qi, which would hinder pus formation and lead to failure in ulceration and healing. For sores that are initially neither high nor red, but flat and spreading, Healthy Qi is inherently deficient. Urgently support the Interior, warm the Middle, and strengthen the Spleen to urge the toxic vapors outward. This prevents complications.

For severe internal heat, add detoxifying and clearing agents according to measure. For constipation and dryness, ensure appropriate purgation. This allows the Zang-Fu organs to circulate freely and Qi and Blood to flow smoothly.

During the swelling stage, if there is internal heat, dry mouth, forceful pulse, irritability, constipation, and preference for cold, this indicates pathogenic toxin in the Interior. Urgently use cold and purgative methods. Options include Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction), Si Shun Qing Liang Yin (Four Smooths Clearing and Cooling Drink), or Nei Xiao Wo Xue Tang (Internal Resolution Snow-Washing Decoction). If accompanied by Exterior symptoms, Fang Feng Tong Sheng San (Saposhnikovia Universal Benefit Powder) with Ephedrae Herba removed, or Shuang Jie San (Double Resolution Powder) with Platycodonis Radix (Jiegeng, 桔梗) and Trichosanthis Radix (Tianhuafen, 天花粉) added can be used. If urination is difficult, Tianshui San (Heavenly Water Powder) or Wu Ling San (Five-Ling Powder) can be combined. Ensure free passage of urine and stool to cut off the source. For those with inherent Healthy Qi deficiency who cannot tolerate the above, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) with honey-fried Rheum Palmatum Rhizome (Dahuang, 大黄) or Pig Gallbladder enema can be used. The goal is free passage without leakage. Throughout treatment, maintain closure without blockage and openness without leakage, harmonizing the Zang-Fu and penetrating the Interior/Exterior, before supporting the Interior to drain pus. For internal tonification, in the ulceration stage, although symptoms like dry mouth, constipation, and Zang-Fu disharmony exist, these are caused by excessive loss of pus/fluid, leading to fluid depletion and Qi/Blood exhaustion, failing to nourish the Zang-Fu. The pulse is fine and rapid, the mouth feels normal but is dry, appetite is low, and hot drinks are preferred. This is Deficient Yang Fire, different from the Excess type mentioned earlier. Only nourish Qi and Blood, replenish fluids, and harmonize the Zang-Fu. This will naturally harmonize bowel movements and prevent complications. Misuse of purgatives often leads to untreatable conditions.

If the sore remains hard within ten days, it must be punctured with a lancet at the center.

After ten days, the sore should naturally necrose and suppurate. If it does not necrose and remains hard, it is a Yin-Yang half syndrome with a deep-rooted base. A lancet must be inserted about one cun into the center to open the orifice and vent the toxic vapors; otherwise, the toxin will attack internally. If pus exists inside, it will drain easily, following the principle of "opening the door to drive out the thief." However, after ten days, if the sore is not necrotic but remains red, lively, hot, swollen, and painful, pus may be delayed but will eventually appear, requiring no needle. This is due to insufficient Healthy Qi, failure to use tonifying/supporting herbs, misuse of cold herbs, or inadequate warmth. In such cases, use Spleen-strengthening and major tonifying/supporting herbs to achieve suppuration. The period from fifteen to twenty-one days is critical. Beyond this, even if thin pus appears, the Healthy Qi is repelled by the toxin and will eventually dissipate, making recovery difficult.

After half a month, if pus is scarce, use a medicinal suction cup to pull from the top. Pus-blood adhesion facilitates necrotic tissue detachment.

If after half a month the sore still does not necrose or suppurate, the toxin has sunk inward. Urgently use a lancet to make three holes about one cun apart at the top. Depth depends on the sore (one or two cun). Insertion should be painless. Heat the medicinal suction cup beforehand, place it over the holes for a long time, and remove when warm. If the extracted blood is red with slight purple and pus is yellow with freshness, it indicates circulating Qi and Blood in a living sore, suggesting survival. Fresh red color and easy detachment of necrotic tissue are good signs. If extracted blood is dark purple/black, with foul odor and watery pus, it indicates internal collapse of Qi and Blood in a dead sore ("Qi failure, Blood decline"). Such sores are difficult to treat, and death may occur by month-end.

If pus exists internally but cannot emerge, use a needle hook to lift stubborn flesh from the front, and cut open about one cun at the top with scissors to ensure patent pus ducts and prevent blockage.

After using the suction cup, external pores and internal channels are open. Following major pus discharge, if pus is still scant and not naturally emerging, it is likely blocked by necrotic debris or membranes. Use a needle to lift stubborn flesh at the top, and carefully trim about one cun of hard tissue with a lancet/scissors. Mild pain and bleeding are acceptable. Gently press from the base toward the center where the pus duct was opened. Accumulated pus will naturally surge out. Yellow, thick pus is auspicious; increasing volume indicates mildness; the opposite is concerning. The goal is to clear obstructions and allow toxic pus to discharge externally.

Frequently wash with decoction; strictly avoid wind exposure.

Before ulceration, or after lamp illumination, boil Scallion and Mugwort Decoction to wash the sore once daily (twice for severe cases) to promote Qi/Blood circulation and facilitate ulceration. After ulceration and suction cup treatment, wind avoidance is crucial. Remove old dressings. Place the patient comfortably. Wash the sore and insert soft cloth soaked in Pork Trotter Decoction into the hole, gently pressing out internal pus. Let decayed pus exit with the water until clean. Cover with folded soft cloth (7-8 layers), not too dry, keeping it warm with the decoction. Press gently for a moment, replace when cooled. Repeat 4-5 times. This promotes Qi/Blood circulation, relieves patient discomfort, resolves toxins, detaches necrotic tissue, and reduces pain. This manual technique is essential for large sores. When red meat appears after necrotic detachment, apply Hong Yu Gao (Red Jade Ointment) rubbed in the palm onto new and old flesh, cover with plaster. Once the base swelling subsides, binding paste is unnecessary. Daily care leads to complete pus/necrotic tissue clearance and rapid new flesh growth within days. With internal tonification and proper care, mild sores heal in a month, large sores in seventy days.

The critical junctures lie at this time; complications arise from this phase.

The "Guan" (pass) for Yang sores is fourteen days; the "Jie" (node) for Yin sores is twenty-one days. At this time, pus discharge must stabilize; do not delay excessively. Pus discharge leads to necrotic detachment, which leads to muscle regeneration, which leads to contraction, which leads to flattening. Failure to produce pus at this stage predicts later complications. One favorable pass leads to mostly favorable outcomes; one unfavorable pass leads to mostly unfavorable outcomes.

Treatment should focus on major tonification to achieve contraction; strictly avoid cold/herbals that cause complications.

After ulceration, the Five Zang organs are damaged, and Qi/Blood are severely deficient. Although the exterior seems robust, the interior is lacking. Treatment must be purely tonifying to ensure survival. For fever/chills, profuse pus, spontaneous sweating, and pain after ulceration, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). For deficient heat, insomnia, and poor appetite, use Ren Shen Tang (Ginseng Decoction). For cold skin, deficient heat, cough with phlegm, use Tuo Li Qing Zhong Tang (Support Interior Clear Middle Decoction). For limb fatigue, muscle wasting, sallow complexion, and shortness of breath, use Ren Shen Yang Rong Tang (Ginseng Nourishing Grace Decoction). For profuse pus, irritability, poor appetite, restlessness, and insomnia, use Sheng Yu Tang (Holy Recovery Decoction). For Spleen deficiency, Qi weakness, cool body, fine pulse, and loose stools, use Tuo Li Wen Zhong Tang (Support Interior Warm Middle Decoction). For poor appetite, nausea, and vomiting, use Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). for Spleen Qi sinking, poor appetite, and intermittent deficient heat, use Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi Decoction). For Kidney deficiency causing thirst and inability to control Heart Fire, use Jia Jian Ba Wei Wan (Modified Eight Flavor Pill). Select accordingly. Supporting the Interior strengthens Qi/Blood and Spleen/Stomach, allowing pus/toxins to discharge naturally, necrotic tissue to fall, new flesh to grow, appetite to return, and wounds to close. Failure to tonify/support and misuse of cold herbs leads to "True Qi deficiency worsening, Pathogenic Qi excess worsening," causing toxin sinking, foul pus, forceful pulse, thirst, red face, and shortness of breath, resulting in death from True Qi exhaustion.

Sores rely entirely on Spleen Earth; regulation requires careful attention.

The Spleen is the Official of Granaries; the Stomach is the Sea of Water and Grain. The Stomach governs reception; the Spleen governs digestion. Exterior/Interior, Reception/Digestion operate continuously, generating infinite transformations. The Five Zang and Six Fu organs rely on them for nourishment. "Gain Earth and prosper; lose Earth and perish." Strong Spleen/Stomach leads to increased appetite, weight gain, and robust Qi/Blood. Weak Spleen/Stomach leads to poor appetite, indigestion, emaciation, and depleted Qi/Blood. Life and health depend on this, especially in surgery. Those who nurture Spleen/Stomach regulate diet, adjust to temperature changes, control emotions, and conserve energy. Neglect leads to daily depletion of Spirit/Qi/Blood, damage to Zang-Fu/Meridians, and wasting of muscles/form. "One mistake in regulation breeds a hundred diseases." Thus, the Spleen/Stomach must be carefully managed.

In winter, keep beds and rooms warm; in summer, keep desks and windows clean and bright.

Human Qi and Blood prefer warmth and dislike cold; cold causes coagulation, heat causes dispersion. Sores involve broken muscle/flesh, making them vulnerable to Wind-Cold if unprotected. In winter, use stoves to warm rooms and dispel residual cold. In summer, keep environments clean and bright to exclude external wind before removing plaster, washing, or reapplying dressings.

Dietary restrictions need not be extreme; avoid cold, hard, and greasy foods.

During pain and swelling, Stomach Qi is injured, and appetite declines. After ulceration, once pus/toxins discharge, Stomach Qi recovers, and hunger returns. At this point, provide desired foods to support the Spleen/Stomach. Denying desired food reverses Stomach Qi and causes anorexia. However, avoid excess. Raw/cold foods injure the Spleen and are hard to digest; hard/greasy foods lubricate the intestines excessively. Hence, they are prohibited.

Although carbuncles/sores belong to Surgery, medication is similar to Internal Medicine.

Ancients considered Surgery prior to miscellaneous diseases because it harms rapidly and is significant. Carbuncles/sores on the head/neck, despite external presentation, originate internally. Treatment cannot ignore the interior. If external eruption fails, add internal supporting herbs; if Exterior heat is severe, clear and resolve internally. Blood deficiency uses Si Wu Tang (Four Substances Decoction); Qi deficiency uses Si Jun Zi Tang (Four Gentlemen Decoction). Weak pulse/cold feet require warming the Middle; forceful pulse/fever require cooling the Chest. By analogy, Interior and Exterior treatments are consistent.

Disease duration determines strategy: gentle vs. aggressive treatment.

Diseases vary in novelty and urgency. Early stage with intact Healthy Qi allows symptom-specific resolution. Fear of using strong/potent agents prevents effectiveness in crises. Medication must hit the target. For strong Exterior symptoms, use Wan Ling Dan (Ten Thousand Spirits Pill) for heavy diaphoresis. For urgent Interior symptoms, use Nei Shu Huang Lian Tang (Internal Dispersal Coptis Decoction) for rapid purgation. For long-standing disease with resisting Pathogen and Healthy Qi, even with residual/mixed symptoms, first consolidate the Root, then harmonize, resolve, and disperse. This gradually retreats pathogenic Qi, restores Healthy Qi, improves diet, and strengthens the foundation, ensuring cure of remaining issues.

Medication must seek Root and Branch; distinction lies in treating Root first, then Branch. Uniform attack/tonification risks misuse.

All things have Root and Branch. Disease Root/Branch is critical. Body Root/Branch: Five Zang are Root, Six Fu are Branch. Zang govern Interior/Blood; Fu govern Exterior/Qi. Disease Root/Branch: Initial illness is Root, transmitted illness is Branch; Healthy Qi is Root, Pathogenic Qi is Branch. Thus, cold/heat, interior/exterior, urgent/chronic conditions correspond to diaphoretic, purgative, tonifying, draining, or harmonizing formulas. Treaters must treat Root first, then Branch. Treating Branch first exacerbates Pathogen and worsens disease. "Chronic conditions treat Root; acute conditions treat Branch." For example, if sore disease precedes diarrhea/vomiting/poor appetite, treat Branch (digestive symptoms) first. Once diarrhea stops, vomiting ceases, and appetite returns, treat the sore. Others follow this pattern.

Yang transforming into Yin results from internal/external cold/cool suppression.

Sores originating in Yang are carbuncles, heat, excess, and pain—easy to treat. Patients may ignore them as minor ailments and delay treatment. External Wind-Cold or internal raw/cold injury, combined with physician failure to tonify/support and use of cooling compresses for internal resolution, aligns with patient desires but often causes Qi/Blood freezing and Spleen/Stomach damage. If transformation to Yin occurs before the eleventh day (before pus), the sore becomes level with healthy flesh, painless, non-hot, soft/slow, draining clear/watery fluid. Body is not hot, pulse is fine/small, appetite is poor, spirit is dull. This enters True Yin. Even strong warming/Spleen-strengthening agents fail; mortality is nearly 100%. If transformation to Yin occurs after the fifteenth day (after pus discharge), with improper care or cold food ingestion, urgently use Tuo Li Wen Zhong Tang (Support Interior Warm Middle Decoction), Shi Er Wei Yi Gong San (Twelve-Ingredient Extraordinary Function Powder), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) for mild cases, doubling Ginseng, Cinnamon Twig, and Aconite Root to save the patient. Auspicious signs include sore heat/pain, warm body after pus discharge, rising pulse, and improved appetite. Originally Yang sores often survive.

Unexpectedly, Yin transforming into Yang requires pungent/warm herbs to support decline throughout; distinguish true/false, investigate Yin/Yang principles.

Sores originating in Yin are ulcers, cold, hardness, and deficiency—difficult to treat. Patients desire life and may self-administer large doses of pungent/aromatic wine-decocted hot herbs. Physicians may also apply hot compresses to induce swelling/hotness/pus. The sore receives intense heat, transforming Yin to Yang. The sore may show slight swelling/heat/pain/pus, but the shape lacks the red/lively quality of True Yang, and pus lacks true thick yellow consistency. Such sores soon revert to Yin. Originally Yin sores often result in death.