立斋曰∶脑疽，属膀胱经积热，或湿毒上壅，或阴虚火炽，或肾水亏损，阴精消涸所致
。若肿痛未作脓者，宜除湿消毒。大痛或不痛，或麻木者，毒甚也，隔蒜灸之，更用解毒药
。肿痛便秘者，邪在内也，宜泄之。不甚痛，或不做脓者，虚也，托里为主。脓成胀痛者，针
之，更以托里。上部脉数，实而痛者，宜降火。上部脉数虚而痛者，宜滋阴降火为主。尺部
脉数而作渴者，滋阴降火。脉数而虚细无力，或脓清，或不敛，或脓多者，大补血气。不作
脓，或不溃者，托里药主之。烦躁饮冷，脉实而痛者，宜泻火。
又《治法》曰∶初起肿赤痛甚，烦渴饮冷，脉洪数而有力，乃湿热上壅，当用黄连消毒
散，并隔蒜灸，以除湿热。若漫肿微痛，渴不饮冷，脉洪数而无力，乃阴虚火炽，当用六味
丸，及补中益气汤，以滋化源。若口干舌燥，小便频数，或淋漓作痛，乃肾水亏损，急用加
减八味丸，及前汤，以固根本，而引火归经。若不成脓，不腐溃，阳气虚也，四君加归 。
若不生肌，不收敛，脾气虚也，十全大补汤。若色黯不溃，或溃而不敛，乃阴精消涸，名曰脑
烁，为不治。若攻补得宜，亦有可愈。大凡肿 痛甚，宜活命饮，隔蒜灸之，以解散瘀血
，拨引郁毒。但艾炷宜小而少，若欲其成脓腐溃生肌收敛，并用托里为主。
李氏曰∶脑疽及颈项有疽，不可用隔蒜灸，恐引毒上攻，宜灸足三里穴五壮，气海穴三七
壮，仍服凉血化毒之药，或以骑马穴法灸之。凡头项咽喉生疽，古法皆为不治，若用此法，
多有生者。如五香连翘漏芦等汤、国老膏、万金散，皆可选用。（见《外科精要》）
一老人患此，色赤肿痛，脉数而有力，与黄连消毒散二剂少退，更与清心莲子饮四剂而消。
一男子肿痛脉数，以荆防败毒散二剂而痛止，更以托里消毒药而消。
一男子 肿疼痛，发热饮冷，脉洪数，与凉膈散二剂而痛止，以金银花散四剂而溃，
更以托里药而愈。
一老妇，禀壮实，溃而痛不止，脉实便秘，以清凉饮二剂而痛止，更以托里消毒药而愈。
一妇人，冬间患此，肿痛热渴，余用清热消毒溃之而愈。次年三月，其舌肿大，遍身发
疔如葡萄，不计其数，手足尤多，乃脾胃受毒也。先各刺出黑血，随服夺命丹七粒，出鼻汗
，疮热益甚，便秘二日。与大黄、芩、连各三钱，升麻、白芷、出栀、薄荷、连翘各二钱，
生甘草一钱，水煎三五沸，服之，大小便出，臭血甚多，下体稍退。乃磨入犀角汁再服，舌
本及齿缝出臭血，诸毒乃消。更以犀角地黄汤而愈。
一妇人患前证，口干舌燥，内服清热，外敷寒凉，色黯不 ，胸中气噎，此内真寒而
外
假热也。彼疑素有痰火，不欲温补，余以参 各五钱，姜桂各二钱，一剂顿溃。又用大补药
而愈。
一男子头项俱肿，虽大溃，肿痛益甚，兼作泻，烦躁不睡，饮食少思，其势可畏。诊其
脉则毒尚在。与仙方活命饮二剂，肿痛退半，与二神丸及六君子汤加五味子、酸枣仁四剂，
诸证少退，饮食少进，睡亦少得。又与参苓白术散数服，饮食顿进。再与十全大补汤加金银
花、白芷，月余而瘥。（薛按）
Li Chan stated: Naoju (Brain Carbuncle) belongs to the accumulation of heat in the Bladder Meridian, or is caused by damp-toxicity obstructing upwards, yin deficiency with blazing fire, or depletion of kidney water and essence. If there is swelling and pain but no suppuration, it is appropriate to use methods for removing dampness and detoxifying. If there is severe pain or no pain, or numbness, the toxicity is profound; garlic-separated moxibustion should be applied, along with detoxifying herbs. If there is swelling, pain, and constipation, the pathogen is internal, and purgation is indicated. If the pain is mild or suppuration does not occur, it is a deficiency syndrome, primarily treated with methods to support the interior and promote pus discharge. If there is distending pain after suppuration has formed, puncture should be performed, followed by interior-supporting herbs. If the pulse at the upper position is rapid and excess with pain, reducing fire is indicated. If the pulse at the upper position is rapid and deficient with pain, nourishing yin and reducing fire is primary. If the radial pulse is rapid with thirst, nourish yin and reduce fire. If the pulse is rapid, fine, weak, or if the pus is clear, the sore does not heal, or there is excessive pus, greatly tonify qi and blood. If suppuration does not form or the sore does not ulcerate, interior-supporting herbs are primary. If there is irritability, desire for cold drinks, an excess pulse, and pain, draining fire is indicated.
Furthermore, *Zhi Fa* states: In the initial stage, if there is red swelling and severe pain, irritability, thirst with desire for cold drinks, and a surging, rapid, and forceful pulse, this is damp-heat obstructing upwards. Huanglian Xiaodu San (Coptis Decoction for Detoxification) should be used, along with garlic-separated moxibustion, to remove damp-heat. If there is diffuse swelling with slight pain, thirst without desire for cold drinks, and a surging, rapid but weak pulse, this is yin deficiency with blazing fire. Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to nourish the source of transformation. If there is dry mouth and tongue, frequent urination, or painful dribbling, this is depletion of kidney water. Jiajian Bawei Wan (Modified Eight-Ingredient Pill) and the aforementioned decoction should be urgently used to consolidate the root and guide fire back to its origin. If suppuration does not form and the tissue does not necrose, it is yang qi deficiency; Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelica Sinensis) is used. If granulation tissue does not grow and the wound does not contract, it is spleen qi deficiency; Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) is used. If the color is dark and does not ulcerate, or ulcerates but does not heal, this is depletion of yin essence, named Naoshuo (Brain Melting), which is considered incurable. However, if attack and tonification are appropriately balanced, cure is possible. Generally, for severe swelling and pain, Xianfang Huoming Yin (Immortal Formula for Preserving Life Decoction) and garlic-separated moxibustion are suitable to resolve blood stasis and draw out stagnant toxicity. However, moxa cones should be small and few in number. To promote suppuration, necrosis, granulation, and contraction, interior-supporting methods are primary.
Li Shi said: For Naoju (Brain Carbuncle) and carbuncles on the neck, garlic-separated moxibustion should not be used, as it may attract toxicity to attack upwards. It is appropriate to moxa Zusanli (ST 36) with five cones, Qihai (CV 6) with twenty-one cones, while administering blood-cooling and detoxifying herbs, or using the "Riding Horse" acupoint moxibustion method. Historically, carbuncles on the head, neck, and throat were considered incurable; however, using this method often results in survival. Formulas such as Wuxiang Liaoqiao Loulu Tang (Five Fragrances, Forsythia, and Rhapontic Decoction), Guolao Gao (Old Man Paste), and Wanjin San (Ten Thousand Gold Powder) can be selected. (See *Waike Jingyao*)
An elderly man suffered from this condition with red, swollen, painful skin and a rapid, forceful pulse. After two doses of Huanglian Xiaodu San (Coptis Decoction for Detoxification), symptoms slightly receded. Four doses of Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) then led to recovery.
A male patient presented with swelling, pain, and a rapid pulse. Two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxifying Powder) stopped the pain, followed by interior-supporting and detoxifying herbs for complete resolution.
A male patient presented with swelling, pain, fever, desire for cold drinks, and a surging, rapid pulse. Two doses of Liangge San (Cool the Diaphragm Powder) stopped the pain. Four doses of Jinyinhua San (Honeysuckle Powder) promoted ulceration, followed by interior-supporting herbs for recovery.
An elderly woman, constitutionally robust, experienced continuous pain after ulceration, with an excess pulse and constipation. Two doses of Qingliang Yin (Cooling Decoction) stopped the pain, followed by interior-supporting and detoxifying herbs for recovery.
A female patient contracted this disease in winter, presenting with swelling, pain, heat, and thirst. I treated her with heat-clearing and detoxifying methods to promote ulceration and recovery. In March of the following year, her tongue swelled, and she developed numerous furuncles resembling grapes all over her body, especially on the hands and feet. This was due to toxicity affecting the spleen and stomach. Black blood was pricked out from each lesion first. She then took seven pills of Mingdan (Life-Taking Pill). Nasal sweating occurred, and the sore heat intensified with two days of constipation. Da Huang (Rhubarb), Huangqin (Scutellaria), and Huanglian (Coptis) were administered at three qian each, along with Shengma (Cimicifuga), Baizhi (Angelica Dahurica), Zhizi (Gardenia), Bohe (Mint), and Lianqiao (Forsythia) at two qian each, and Sheng Gancao (Raw Licorice) at one qian. The mixture was boiled briefly and taken. Large and small bowel movements ensued, discharging much foul-smelling blood, and lower body symptoms subsided slightly. Rhinoceros horn juice was then ground into the remaining decoction and taken again. Foul-smelling blood flowed from the base of the tongue and gum margins, and various toxicities dissipated. Finally, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) was used for full recovery.
A female patient presented with the aforementioned symptoms: dry mouth and tongue. Internal administration of heat-clearing herbs and external application of cooling agents resulted in dark discoloration without ulceration, and chest oppression. This indicated true cold internally and false heat externally. Suspecting phlegm-fire, she resisted warming tonification. I prescribed Renshen (Ginseng) and Huangqi (Astragalus) at five qian each, Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark) at two qian each. One dose led to immediate ulceration. Subsequent treatment with great tonifying herbs resulted in recovery.
A male patient had swelling of both head and neck. Although severely ulcerated, swelling and pain worsened, accompanied by diarrhea, irritability, insomnia, and poor appetite, creating a dire situation. Pulse diagnosis indicated that toxicity remained. Two doses of Xianfang Huoming Yin (Immortal Formula for Preserving Life Decoction) reduced swelling and pain by half. Two Shen Wan (Two Spirits Pills) and Liujunzi Tang (Six Gentlemen Decoction) added Wuweizi (Schisandra) and Suanzaoren (Ziziphus Seed) for four doses slightly alleviated symptoms, improved appetite, and allowed some sleep. Several doses of Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) significantly improved appetite. Finally, Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) added Jinyinhua (Honeysuckle) and Baizhi (Angelica Dahuria) was administered, leading to recovery after more than a month. (Commentary by Xue Ji)