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Zheng Zhonghan, a civil official in Nanjing, suffered from a carbuncle on the back (Fabei) in mid-summer, with the disease lasting for half a month. There were more than ten sores, each the size of a millet grain, diffusely swollen and hard, with a base as large as a plate. His back felt heavy as if carrying a stone. Even after moxibustion with garlic slices for over fifty moxa cones, his back suddenly felt lighter. Believing he was recovering due to this relief, he did not observe dietary and lifestyle taboos. Three days later, the condition worsened significantly; the sore failed to suppurate or rise, causing only severe pain. He took four doses of Xianfang Huoming Yin (Immortal Life Elixir), and the severity slightly subsided. He then took four doses of Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction), and his appetite slightly improved. Relying on his medical knowledge, he self-administered two doses of detoxifying herbs, which further reduced his food intake. He drooled saliva involuntarily, seemingly unaware of it, indicating severe Spleen deficiency. Each time he used internal support herbs with Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) at 3 qian each, he secretly removed most of them. Later, even when using major tonifying herbs with Zingiberis Rhizoma Recens (Shengjiang) and Cinnamomi Cortex (Guirui), there was no response. Consequently, I instructed his son to prepare a decoction paste using one jin each of Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi), half a jin each of Angelicae Sinensis Radix (Danggui) and Atractylodis Macrocephalae Rhizoma (Baizhu), and one liang each of Zingiberis Rhizoma (Ganjiang), Cinnamomi Cortex (Guirui), and Aconiti Lateralis Radix Praeparata (Fuzi). This was consumed over three days. The salivation stopped immediately, the necrotic tissue ulcerated promptly, and his appetite returned. Subsequent use of internal support and Spleen-fortifying herbs led to the natural shedding of necrotic tissue and recovery. (The following are comments by Xue Ji)

Zhang Shiyu, a court attendant, had three sores on his back, each the size of a millet grain. He considered the toxicity minor and took heat-clearing and phlegm-resolving herbs, applying cold external patches. After several days, the sores remained flat, dark in color without luster, and his chest qi was obstructed, unable to circulate freely, presenting a dire situation. Two doses of Xianfang Huoming Yin (Immortal Life Elixir) were administered consecutively; although his qi flow improved, the pus remained thin and clear, and the sores did not rise. When considering tonifying formulas, he resisted the inclusion of Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) due to his belief in his chronic Phlegm-Fire condition. Due to his stubbornness, I ostensibly prescribed detoxifying agents while secretly administering a decoction containing five qian each of Ginseng Radix et Rhizoma (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizoma (Baizhu), along with two qian each of Zingiberis Rhizoma (Shengjiang) and Cinnamomi Cortex (Guirui). After two doses, his back felt warm, and the necrotic tissue began to slough off. Only then did he believe my advice and understand that major tonification was necessary for recovery.

A man surnamed Nie in Nanjing suffered from a carbuncle on the back in June. The necrotic tissue had been removed, leaving a sore about one chi in diameter, red, swollen, and painful. He experienced fever, anorexia, and nausea without vomiting. After taking Shixuan San (Ten-Aperture Powder) and believing it ineffective, he sought my diagnosis. His pulse was floating and scattered on light palpation, and weak and choppy on heavy palpation, which is a normal pulse pattern after ulceration. However, the open sore indicated Blood and Qi deficiency. The nausea without vomiting indicated Spleen and Stomach deficiency. The redness and swelling indicated deficient Fire. The condition was still treatable. I prescribed Shiquan Dabu Tang (Perfect Tonifying Decoction) modified with wine-fried Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Schisandrae Fructus (Wuweizi), and Ophiopogonis Radix (Maidong), along with drinking child urine. His diet immediately improved, and flesh regenerated. After eight doses, the sore contracted to the size of a millet grain. Misled by others who claimed residual toxins remained, he took two doses of detoxifying herbs, leading to recurrent fever and confusion. Urgent administration of the previous formula resulted in recovery after another twenty-plus doses. Two months later, due to charitable acts involving staying awake for a full day and night, he developed fatigue-induced fever and drowsiness. Two doses of the previous decoction exacerbated the fever and loss of appetite. Only after consuming hot water and taking the previous formula with the addition of one qian of Aconiti Lateralis Radix Praeparata (Fuzi) did he recover after two doses.

Gao Qiu Guan Zhenfu developed a carbuncle on the back in early autumn. The lesion was dark, hard, painless, and non-suppurating. His pulse was deep and fine, and his limbs were cold. Emergency moxibustion with large moxa cones over garlic slices for over thirty cones did not elicit pain. Subsequently, small moxa cones the size of millet grains were applied directly to the skin for seven cones, which finally elicited pain. He was given two doses of Liujunzi Tang (Six Gentlemen Decoction) with two qian of Aconiti Lateralis Radix Praeparata (Fuzi) added to each dose, but there was no response. In subsequent doses, two qian of Cinnamomi Ramulus (Rougui) were added, after which the treatment became effective and he recovered.

A male patient had a swelling on his hypochondrium that had persisted for a long time without ulcerating. Palpation revealed slight pain. His pulse was faint and choppy, indicating both physical constitution and pathological signs of deficiency. The Classics state: "When both form/energy and pathogenic energy are insufficient, tonification is indicated, not purgation." I treated him with Renshen Yangying Tang (Ginseng Nourishing Camp Decoction). Disbelieving in this approach, he took Liuqi Yin (Flowing Qi Decoction). All deficiency symptoms manifested, and only then did he take the previous tonic. After more than a month, he showed slight improvement. However, the swelling remained hard. I applied hot-wrapped mugwort leaves to the affected area. After more than ten days, pus formed. It was punctured with a fire needle, followed by moxibustion with fermented soybean cakes. He then took Shiquan Dabu Tang (Perfect Tonifying Decoction) for one hundred doses before fully recovering.