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Fa Bei (Back Carbuncle) belongs to the Du Meridian and Bladder Meridian. Any condition of Yin deficiency with hyperactive fire, or consumption of strong alcohol and rich flavors, or emotional depression, anger, and sexual exhaustion, or heat-toxin induced by cinnabar and stone medicines, can all cause this disease.

If the swelling is red, painful, and severe, with a surging and rapid pulse, it is a Heat-Toxin syndrome, which is easy to treat. If there is diffuse swelling with slight pain, dark coloration accompanied by thirst, and although the pulse is surging and rapid, it is forceless upon pressure, it is a Yin Deficiency syndrome, which is difficult to treat. If there is no swelling or pain, or diffuse swelling with dark coloration, and a faint, thin pulse, it indicates extreme Yang Qi deficiency, which is particularly difficult to treat. Generally speaking, although Fa Bei has many names, it is essentially categorized into two main types: Yin Syndrome and Yang Syndrome.

If the lesion starts with one or two heads, appearing red, swollen, elevated, accompanied by fever and pain, with raised ulcer heads, it is called "Yong" (Carbuncle), belonging to Yang Syndrome, which is easy to treat. If initially there is one head like a millet grain, without swelling or redness, but with stifling pain, restlessness, extreme thirst, constipation, somniloquy (sleep-talking), and teeth grinding, after four or five days, the number of ulcer heads becomes countless. Each ulcer opening contains a millet-grain-like concretion, resembling a lotus pod, hence named "Lian Peng Fa" (Lotus Pod Eruption). After several days without suppuration, pressing yields blood. By the seventh or eighth day, the heads merge into a patch, expelling all contained matter, forming a continuous membrane that reforms when peeled off. The openings rot together into one large sore, with pus attacking inwardly and a purple-dark color; this is called "Ju" (Deep Abscess/Gangrene). It belongs to Yin Syndrome and is difficult to treat. Furthermore, this condition should not present with severe pain, nor should it be completely painless. If irritability and oppression are observed, it is mostly incurable. In summary, although sores and ulcers are often attributed to Fire, none arise without underlying Yin Deficiency. Thus, the classics state: "When the Du Meridian is deficient, pathogens emerge from the head; when the Bladder Meridian is deficient, pathogens emerge from the back." Therefore, one cannot solely adhere to the theory of Fire.

Chen Liangfu stated: There are five origins of Back Ju: 1. Epidemic qi; 2. Emaciation and Qi stagnation; 3. Anger; 4. Kidney Qi deficiency; 5. Drinking cold wine, eating roasted/baked foods, and taking elixirs.

Xue Lizhai stated: Generally, for Fa Bei, even if there is fever, pain, high and severe presentation, restlessness, and thirst, as long as the pulse is forceful and dietary intake is adequate, safety can be assured. Once the pus discharges, all symptoms recede. Many cases suffer pain because pus cannot drain externally; using cooling and detoxifying herbs in such cases causes error. If pus is present, immediate needle drainage stops suffering instantly. If heat-toxin causes pain before pus formation, detoxifying herbs may be used. Even if decay extends over a chi, provided there are no malignant signs, strong tonics promote rapid flesh regeneration without harm. Contraindications include: non-elevated swelling, non-red color, absence of pain, forceless pulse, anorexia, failure to suppurate, lack of necrotic tissue sloughing, clear pus, or excessive unceasing discharge. These indicate Yuan Qi (Primary Qi) deficiency and are difficult to treat, requiring vigorous tonification. If, after pus and blood discharge, swelling and pain worsen, pus becomes foul, restlessness and coughing occur, abdominal pain and extreme thirst appear, diarrhea is uncontrollable, and urination resembles strangury, these are malignant signs and are incurable.

The *Moxibustion Method* states: I frequently treat Fa Bei, regardless of duration, Yin/Yang nature, or presence/absence of pain, provided pus has not formed or the sore has not ulcerated, I apply moxibustion immediately with prompt results. For numbness, bright moxibustion disperses toxin naturally. For millet-sized heads, moxibustion is especially effective. Even if after several days the color is slightly red, swelling is minimal, pain is mild, and no pus has formed, frequent moxibustion is indicated, ignoring specific days. Concurrent administration of sweet-warm interior-supporting herbs is essential; cold-cold agents are strictly forbidden. For uncertain progression, use encircling pastes first; applying Wu Jin Gao (Black Gold Ointment) to the site is excellent. When initial Fa Bei presents with redness, heat, swelling, and pain without identifiable heads, cover with wet paper; the first dry spot indicates the carbuncle head. Place garlic slices (2-3 qian thick) on the head and apply large moxa cones. Change garlic every three burns. Stop moxibustion when pain ceases (if painful) or begins (if painless). Early detection and application are paramount. Days 1-2: 10/10 survive; Days 3-4: 6-7/10 survive; Days 5-6: 3-4/10 survive; After Day 7: difficult to save. For multiple clustered heads, grind garlic into paste, make thin cakes, place on heads, and burn moxa on top; survival is possible. For initial red swelling with a central yellow millet-like head, cut a single garlic clove, take the middle half-inch section, place on the sore, and moxibustate 14 times, up to 49 times. For such severe conditions, only garlic-partitioned moxibustion and Wu Jin Gao are effective.

The *Treatment Methods* state: Swelling, hardness, deep pain, and solid pulse indicate pathogen inside; purge it. High swelling, pain, and floating pulse indicate pathogen on the surface; support/expel it. Pain, restlessness, or dry throat indicate Fire above; drain it. High swelling or failure to suppurate indicates pathogen condensation; resolve it. Swelling, pain, preference for cold drinks, fever, and somniloquy indicate Fire; clear it. Failure to suppurate, ulcerate, or heal indicates Yang Qi deficiency; tonify it. Necrotic tissue not sloughing or accumulated toxin not resolving indicates Yang Qi deficiency; assist Yang Qi. Excessive or clear pus indicates dual Qi and Blood deficiency; vigorously tonify. Floating-large or choppy pulse with slow flesh regeneration indicates dual Qi and Blood deficiency; tonify. Weak Right Guan pulse with slow flesh regeneration indicates Spleen/Stomach deficiency; tonify Spleen/Stomach.

The *Methods for Various Toxins* state: For headache with exterior signs, administer Ren Shen Bai Du San (Ginseng and Imperata Decoction to Overcome Toxicity) for 1-2 doses. For pain, fever, and rapid pulse, use Jin Yin Hua San (Honeysuckle Powder), Huai Hua Jiu (Sophora Flower Wine), or Shen Gong Tuo Li San. For painful, hard swelling and solid pulse, use Qing Liang Yin (Cooling Drink), Xian Fang Huo Ming Yin (Immortal Formula to Activate Life), or Ku Shen Wan (Sophora Pill). For hard, woody oppression, pain, fever, restlessness, cold drink preference, constipation, and deep-solid pulse, use Nei Shu Huang Lian Tang (Internal Draining Coptis Decoction) or Qing Liang Yin. After bowel movement clears, to induce suppuration, use Xian Fang Huo Ming Yin, Tuo Li San, or La Fan Wan (Beeswax Alum Pill); externally apply Shen Yi Gao. For poor appetite or lack of taste, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Huo Xiang, taken for 3-5 doses; wash with Xiong Huang Jie Du San (Realgar Detoxifying Powder); apply Wu Jin Gao daily. Once an opening exists, insert paper wicks dipped in Wu Jin Gao. If pus is blocked by fatty membranes causing distending pain, puncture to drain. Remove obstructing necrotic tissue. If necrotic tissue loosens, wash with Zhu Ti Tang (Pig Trotter Decoction). If pus is thick or painful with normal diet and spontaneous sloughing, combine detoxifying and supporting herbs; continue applying the two ointments. If necrotic tissue separates from healthy flesh, remove it quickly. If pus is neither thick nor thin, with slight pain, poor appetite, and slow sloughing, apply Sang Chai Jiu (Mulberry Twig Moxibustion) and supporting herbs. If necrotic tissue does not slough, or pus is clear/thin and painless, urgently administer strong tonics and apply Mulberry Wood Moxibustion to supplement Yang Qi and dissipate constrained toxin. Observing moderately severe pre-suppurative gangrene, failure to use garlic moxibustion, delaying incision until natural sloughing, or waiting for spontaneous necrosis often leads to death. Generally, those with robust Qi/Blood or mild toxins may recover via medication or spontaneous sloughing. However, for frail individuals with internal heat-toxin blockage preventing external communication, without acupuncture/moxibustion, medication alone fails. If pus forms, urgent incision is required; otherwise, severe cases penetrate viscera and rot bones. Penetration of the diaphragm is incurable. Mild cases extend destruction to healthy flesh, making healing difficult, leading to many non-healing outcomes.

The *Tonification Methods* state: For swelling with pain, alternating chills/fever, thirst, and normal diet (excess Form and Pathogen Qi), first use Xian Fang Huo Ming Yin, then Tuo Li Xiao Du San. For diffuse swelling, slight pain, non-red color, and poor appetite (deficient Form and Pathogen Qi), use Tuo Li San for regulation and tonification. For failure to suppurate or rupture due to Yang Qi deficiency, double the Guizhi (Cinnamon Twig), Renshen (Ginseng), and Huangqi (Astragalus) in Tuo Li San. For increased pain after discharge or clear pus (dual Qi/Blood deficiency), use Ba Zhen Tang (Eight Treasures Decoction). For aversion to cold/chills and non-healing (Yang Qi deficiency), use Shi Quan Da Bu Tang (Great Tonifying Decoction of Ten Ingredients). For afternoon/internal heat and non-healing (Yin Blood deficiency), use Si Wu Tang (Four Substances Decoction) plus Renshen and Baizhu. For nausea/vomiting and non-healing (Stomach Qi deficiency), use Liu Jun Zi Tang plus Pao Jiang (Roasted Ginger). For low food intake, fatigue, and non-healing (Spleen Qi deficiency), use Bu Zhong Yi Qi Tang plus Fuling and Banxia. For red flesh and non-healing (Blood Heat), use Si Wu Tang plus Shan Zhi and Lian Qiao. For white flesh and non-healing (Spleen Deficiency), use Si Jun Zi Tang plus Jiuzhi Shaoyao and Muxiang. For frequent urination (Kidney Yin depletion), use Jiajian Ba Wei Wan. Generally, if viral power is strong, reckless purgatives damage Yuan Qi in frail patients, causing numerous complications.

The *Three Syndromes Treatment Methods* state: For initial onset without eruption, featuring chills, pain, thirst, and cold drink preference (internal pathogen accumulation), use Xian Fang Huo Ming Yin. For dry mouth, hot drink preference, diffuse swelling, slight pain (internal Yuan Qi deficiency), use Tuo Li Xiao Du San. For poor appetite, limb fatigue (Spleen/Stomach weakness), use Liu Jun Zi Tang; if ineffective, add Shengjiang and Rougui. Death occurs when pathogen is strong and True Qi is too weak to erupt, seen within 10+ days. If erupted, use Tuo Li Xiao Du San. If not sloughing, use Tuo Li Xiao Du San; if ineffective, urgently warm/tonify Spleen/Stomach. Death occurs when True Qi is too weak to slough, seen within 20 days. If sloughed, use Tuo Li San to generate flesh; if ineffective, urgently warm/tonify Spleen/Stomach. Death occurs when Spleen Qi is too weak to contract/heal, seen after 1 month+. These three syndromes, though not in classics, have been verified by my experience.

*Qianjin Fang* Moxibustion for Fa Bei (ulcerated or not): Mix Tan Dou Chi (Fermented Soybean) with water into a hard paste, form cakes 3-4 fen thick based on swelling size. Do not place on existing holes; surround with bean cakes, arrange moxa on top, keep mildly warm without breaking skin. Lift if too hot/painful; moxibustate twice daily. If holes existed, discharge of fluid indicates cure.

I. Test for Diaphragm Penetration: For large ulcerated Back Ju, to test for membrane penetration, do NOT use Zaogao San (Gleditsia Powder) for sneezing. Seal the area with paper and instruct the patient to breathe intentionally. If paper remains still, penetration has not occurred. Sneezing may force penetration; beware.

Censor Zhou Honggang suffered Back Ju, swollen but not ulcerated, pulse large and floating (Yang Qi deficiency with pathogen stagnation). Used Tuo Li San doubled with Renshen and Huangqi. Developed internal heat/thirst, surging-forceless pulse (Deficient Fire). Urgently added Rougui to the formula. Pulse/symptoms subsided; cured with continued Tuo Li San. Using cold herbs for assumed Heat-Toxin would have been an error.

Shangshe Zhang Kegong suffered this condition, using cold/detoxifying herbs internally and externally. Resulted in body-wide pain, nausea, poor appetite, afternoon/internal heat, chills. Diagnosis: Body pain = Ying/Wei deficiency failing to nourish muscles; Nausea/poor appetite = Spleen/Stomach cold failing to digest; Internal/afternoon heat = Yin Blood deficiency with Yang sinking into Yin; Chills = Yang Qi deficiency failing to protect muscles. All caused by insufficient Spleen/Stomach Qi. Treated with Bu Zhong Yi Qi Tang (symptoms receded), then Shi Quan Da Bu Tang (necrotic tissue sloughed), then Liu Jun Zi Tang plus Chuanxiong and Danggui (flesh regenerated, cured).

Fuyang Peng Bixi suffered Waist Ju, took cold/detoxifying herbs. Color dark, painless, heads like scattered millet, heavy back unable to sleep, deaf/blind, spiritless face, frequent/scanty urination, thirst/confusion, coarse/short breathing, floating-rapid pulse, forceless on deep pressure. First dose of Zishui (Nourishing Water) herbs relieved urination/thirst/back heaviness. Then phlebotomy to release stasis, moxibustation with 0.5 jin mugwort, external Wu Jin Gao, internal Renshen, Huangqi, Danggui, Baizhu, Rougui. After several doses, Yuan Qi recovered. Patient stopped Rougui due to fear of heat; resulted in cold limbs/incontinence. Resumed Rougui (2 qian), Buguzhi (2 qian), Roudoukou (1 qian); stool normalized, tissue sloughed. Used Danggui Gao for flesh generation, Ba Zhen Tang for Qi/Blood replenishment; cured.

Shangshe Cai Dongzhi suffered this. I used supporting herbs to induce ulceration; wound not fully healed. Mid-winter, with cough. Diagnosis: Non-healing = Spleen Qi deficiency; Persistent cough = Lung Qi deficiency. Law: Tonify the Mother (Spleen). At dinner, he avoided mutton. I advised: Tonification removes weakness; Ginseng and Mutton are examples; highly suitable. He ate daily without interruption; healed in 10+ days, cough resolved.

Man, over 50, Fa Bei purple/swollen/painful, skin about to rupture, insomnia/poor appetite, mental fatigue. Sangchai Jiu (Mulberry Twig Moxibustion) on site released black blood; patient slept deeply, symptoms vanished. Took Xian Fang Huo Ming Yin (2 doses), moxibustated again, pus/blood discharged. Two more doses reduced swelling/pain significantly. Tuo Li Xiao Du San (several doses) led to healing. Although fierce sores require strong purgatives, elderly patients with weak Qi/Blood and superficial lesions risk damaging Stomach Qi if focused solely on detoxification, causing error. (Xue's Note)

My eldest son developed Back Ju at one week old; treatment recorded under "Swelling Ulcer" section. (New Note)

General Formulas Outside Discussion
Shen Xian Xun Zhao Method (External 123)