马益卿曰∶臀痈证，臀居小腹之下，此阴中之阴也，道远位僻，虽曰多血，然气运不到
，血亦罕来，中年之后，尤虑患此。才有肿痛，参之脉证，但见虚弱，便与滋补。气血无亏，可保终吉。
立斋曰∶凡治此者，毋伤脾胃，勿损脾气，但当以固根本为主。若 痛，尺脉紧而无力者
，托之。肿硬痛甚者，隔蒜灸之，更以解毒。不作脓者，托里为主。不作脓而痛者，解毒为
主。不溃或溃而不敛者，托里为主。
又《治法》曰∶若肿硬作痛者，形气虚而邪气实也，用托里消毒散。微肿微痛者，形气病
气俱虚也，用托里散补之。欲作脓者，用内托羌活汤。若痛甚者，用仙方活命饮。大势既退
，亦用托里消毒散。若脾虚不能消散，或不溃不敛者，六君子加芎、归、黄 。若阴虚不能
消散，或作渴便淋者，六味丸加五味子。若阳虚不能溃，或脓清不能敛者，用补中益气汤。
气血俱虚者，十全大补汤。若肿硬未成脓者，用隔蒜灸，及活命饮。溃后，宜豆豉饼，及补
中益气、十全大补二汤。若灸后大势已退，余毒未消，频用葱熨，以补其气，以消余毒为善。
又曰∶凡毒瓦斯已退不起者，但可补其血气，使脓速成而针去之，不可用内消之论。若
肿高而软者，发于血脉，肿下而坚者，发于筋骨，肉色不变者，发于骨髓也。脓血大泄之后
，当大补气血为先，虽有他证，以末治之。
巡按陈和峰，脾胃不健，常服消导之剂，左腿股及臀患肿。余曰∶此脾气虚而下注，非
疮毒也，当用补中益气，倍加白术。彼惑于众人云，白术能溃脓，乃专以散肿消毒为主，而
肿益甚，体益倦。余用白术一味煎饮而消。
儒者杨启元，左臀患此，敷贴凉药，肿彻内股。服连翘消毒散，左体皆痛。余以为足三
阴亏损，用补中益气汤，以补脾肺；用六味丸加五味子，以补肝肾。股内消而臀间溃，又用
十全大补汤而疮口敛。
一儒者， 肿痛甚，此邪毒壅滞，用活命饮、隔蒜灸而消。后因饮食劳倦，肿痛复作
，寒热头痛，此元气虚而未能复也，与补中益气汤，频用葱熨法，两月而愈。
一男子，患臀痈作脓而痛，以仙方活命饮，二剂痛止。更以托里消毒散，脓溃而瘥。
一弱人，臀痈脓成不溃，以十全大补汤数剂始托起。乃针之，又二十余剂而愈。（薛按）
Ma Yiqing stated: Regarding the condition of buttock carbuncle (Buttock Carbuncle), the buttocks are located below the lower abdomen, which is a yin within yin area. This location is distant from the zang-fu organs and remote in position. Although it is said to be rich in blood, qi circulation does not reach it easily, and blood flow is also scarce. Therefore, after middle age, one must particularly beware of contracting this disease. Once swelling and pain appear, upon correlating pulse and symptoms, if weakness is observed, tonification should be administered immediately. If qi and blood are not depleted, auspicious recovery can be ensured.
Lizhai stated: In treating this condition, do not injure the spleen and stomach, nor damage spleen qi; instead, focus primarily on consolidating the root. If there is severe pain with a tight yet powerless chi pulse, employ methods to support interior and expel toxins. If swelling is hard and pain is severe, apply garlic-partitioned moxibustion and further use detoxifying agents. For cases that do not suppurate, prioritize supporting the interior. For those that do not suppurate but experience pain, prioritize detoxification. For those that do not ulcerate or fail to heal after ulceration, prioritize supporting the interior.
Furthermore, "Treatment Methods" states: If there is hard swelling with pain, it indicates deficiency of form and qi alongside excess of pathogenic factors; use Tuoli Xiaodu San (Support Interior and Detoxify Powder). If there is slight swelling and slight pain, it indicates deficiency in form, qi, and pathogenic factors; use Tuoli San (Support Interior Powder) for tonification. If suppuration is imminent, use Neituo Qianghuo Tang (Interior-Supporting Notopterygium Decoction). If pain is severe, use Xianfang Huoming Yin (Immortal Recipe for Preserving Life Decoction). After the major symptoms have subsided, also use Tuoli Xiaodu San. If spleen deficiency prevents resolution, or if there is non-ulceration/non-healing, use Liujunzi Tang (Six Gentlemen Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Astragali Membranacei Radix (Huangqi). If yin deficiency prevents resolution, or if thirst and dysuria occur, use Liuwei Wan (Six-Ingredient Pill) plus Schisandrae Fructus (Wuweizi). If yang deficiency prevents ulceration, or if pus is clear and fails to heal, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For simultaneous deficiency of qi and blood, use Shiquan Dabu Tang (Ten Complete Tonifying Decoction). If swelling is hard but suppuration has not formed, use garlic-partitioned moxibustion and Xianfang Huoming Yin. After ulceration, it is appropriate to use Fermented Soybean Cake (Douchi Bing) and the two decoctions Buzhong Yiqi Tang and Shiquan Dabu Tang. If after moxibustion the major pathogenic force has receded but residual toxins remain, frequently apply scall-moxibustion (Congyun) to tonify qi and eliminate residual toxins.
It is also stated: Whenever toxic pathogens have receded and ceased to flare up, only blood and qi should be tonified to hasten suppuration, followed by needle drainage; the theory of internal resolution should not be used. If swelling is high and soft, it originates in the blood vessels; if swelling is low and hard, it originates in the sinews and bones; if skin color remains unchanged, it originates in the bone marrow. After massive discharge of pus and blood, large-scale tonification of qi and blood should be prioritized; even if other syndromes exist, they should be treated secondarily.
Chen Hefeng, Censor-in-Chief, had weak spleen and stomach function and frequently consumed digestive-promoting agents. He developed swelling in his left thigh and buttock. I said: This is dampness sinking due to spleen qi deficiency, not a carbuncle toxin. It should be treated with Buzhong Yiqi Tang, doubling the dosage of Atractylodis Macrocephalae Rhizoma (Baizhu). Confused by others claiming Baizhu promotes pus rupture, he focused solely on reducing swelling and detoxifying, resulting in worsened swelling and increased fatigue. I prescribed a decoction of single-ingredient Baizhu, which resolved the swelling.
Yang Qiyuan, a scholar, suffered from this condition in his left buttock. After applying cooling plasters, swelling extended to the inner thigh. After consuming Liaoqiao Xiaodu San (Forsythia Detoxifying Powder), pain spread throughout his left body. I diagnosed it as deficiency of the three yin meridians of the foot. I used Buzhong Yiqi Tang to tonify spleen and lung; and Liuwei Wan plus Wuweizi to tonify liver and kidney. The inner thigh swelling subsided, and the buttock ulcerated. Subsequently, Shiquan Dabu Tang was used to close the wound.
Another scholar experienced severe swelling and pain, caused by stagnation of pathogenic toxins. He was treated with Xianfang Huoming Yin and garlic-partitioned moxibustion, leading to resolution. Later, due to dietary irregularities and overwork, swelling and pain recurred with chills, fever, and headache. This indicated deficiency of primordial qi failing to recover. He was given Buzhong Yiqi Tang and frequent scall-moxibustion, recovering after two months.
A man suffered from buttock carbuncle with suppuration and pain. He took Xianfang Huoming Yin; after two doses, pain ceased. He then took Tuoli Xiaodu San, leading to pus discharge and recovery.
A frail individual had a buttock carbuncle where pus formed but did not ulcerate. After several doses of Shiquan Dabu Tang, the pus was supported to the surface. It was then lanced with a needle, and after more than twenty additional doses, he recovered. (Commentary by Xue Ji)