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Chen Yuan Gong said: Between the Changqiang acupoint (Changqiang, GV1) on the side of the thigh, there is sudden pain and high swelling, turning into a carbuncle or ulcer (Yong Ju). Over time, bone-like structures grow within the flesh. When extracted with iron forceps, they regenerate later. People consider this to be Duogu Carbuncle (Duogu Yong), but who knows it is transformed from damp-heat toxicity? The generation of Duogu Carbuncle arises because people consume too many melons and fruits, resulting in damp-heat accumulation. If treated early, one or two doses can resolve it. However, if treatment is delayed due to procrastination, dampness stagnates and adds heat; excessive heat transforms into bone. Prolonged illness leads to bedridden immobility. Some say that initially, no bone exists, so internal resolution is possible; once bone forms, it must rot for external extraction, and internal resolution alone is insufficient. This view is incorrect. Essentially, the "bone" in Duogu syndrome is formed by formless pathogens, not true bone growing in the flesh; it resembles bone but is not true bone. True bone is difficult to dissolve, so how could something resembling bone be difficult? The treatment method involves promoting diuresis to clear dampness and clearing heat, combined with herbs that tonify Qi and Blood. The bone will naturally dissipate. Wushen Tang (Five Gods Decoction): Fu Ling (Poria) 1 liang, Jin Yin Hua (Lonicerae Japonicae Flos) 3 liang, Niu Xi (Achyranthis Bidentatae Radix) 5 qian, Zi Hua Di Ding (Viola Yedoensis Herba) 1 liang, Che Qian Zi (Plantaginis Semen) 1 liang. Decoct in water and take orally. After two doses, symptoms lighten; after three doses, the bone dissolves; after four doses, the wound flattens; after five doses, recovery is complete. Here, Che Qian Zi and Fu Ling promote urination; Zi Hua Di Ding clears heat; Niu Xi and Jin Yin Hua tonify the middle and scatter toxicity. How could this fail to achieve efficacy? (From *Bing Jian*)

Wang Kentang said: Duogu Ju (Duogu Ulcer), also known as Sheng Gu (Remaining Bone) or Xiu Gu (Rotten Bone), occurs on the lower leg. It refers to an ulcer that has ulcerated and failed to heal for a long time, eventually rotting and expelling bone. This is caused by excessive accumulation of toxic qi, which condenses into this bone structure, which is not normal bone. This ulcer occurs because excessive tonifying agents were used before ulceration, causing the toxin to condense rather than disperse. (From *Zhun Sheng*)

Qi Tian Shi said: Duogu Ju grows in the middle of the thigh, characterized by the growth of an extra piece of bone, generated by damp-heat. If treated correctly, it is easy to cure. Otherwise, terrifying complications may arise. Treatment with Huagu Zhishen Dan (Bone-Dissolving Divine Elixir) leads to recovery. If neglected, a bone may grow and insert horizontally between the skin, causing pain; it must be removed with iron forceps for healing, followed by application of Shengji Gao (Flesh-Regenerating Ointment). The brilliance of this formula lies in the use of Bai Shao (Paeoniae Radix Alba), which soothes the Liver and activates tendons. The "bone" in Duogu Ju is not true bone; it is tendon transformed into bone, resembling bone but not being true bone. Bai Shao not only pacifies Liver Fire but also disperses Liver pathogenic factors. Once the pathogen is expelled, the tendons relax; when tendons relax, the bone-like structures dissolve. Added with Jin Yin Hua, which removes toxicity, these two ingredients complement each other perfectly. (From *Mi Lu*)

Lei Zhen Jun said: Generally, when toxicity arises at the Huantiao acupoint (Huantiao, GB30), it is Duogu Ju.

Zhang Zhong Jing said: The generation of bone-like structures, although arising from damp-heat, is not solely formed by damp-heat. It results from a habit of drinking cold water and consuming fruits. Initially, Xiaodu San (Toxin-Dispersing Powder) should be applied externally.

Chen Shigong said: Duogu Ju occurs when a sore fails to close after ulceration because Qi and Blood cannot circulate to the area, leaving the bone without nourishment. Fine bones are formed by the condensation of toxic qi, while large bones result from the intermingling of essence and blood during conception, leading to this ulcer later in life. Since the Kidney governs bone, it is appropriate to administer Shenqi Wan (Kidney Qi Pill) and Shiquan Dabu Tang (Decoction for Tonifying All Deficiencies). First, tonify the Spleen and Kidney; then apply Ai Fu Bing Moxibustion (Moxibustion with Mugwort and Asarum Cake) to warm the area and rot out the toxicity. The rotten bone will naturally fall off completely, allowing new flesh to grow and the wound to close. (From *Zheng Zong*)

Wang Sheng Zhi said: In Duogu Ju, if the condition persists for one or two years without healing, pieces of bone, either fine or with carious holes, may fall out every three to five months. This bone does not arise from the failure of Ying Qi (Nutritive Qi) to follow its course, but is formed by the reception of essence and qi during maternal conception. (From *Li Li*)

*Xin Fa* states: Duogu Ju can occur in people of any age, commonly appearing on the cheeks, gums, eyelids, chin, hands, feet, arms, and legs. In individuals with Kidney deficiency, sores may remain hard and unhealed for a long time without closing. External cold pathogens invade and condense with pus and toxins, utilizing the body's Qi and Blood to transform into bone-like structures. Alternatively, upon birth, pressing the muscles may reveal brittle bone-like structures caused by congenital transmission and the intermingling of essence and blood. As the person grows, swelling suddenly erupts at these sites, forming an ulcer. After ulceration, the bone-like structures detach, and the wound closes. However, if bone-like structures continue to discharge endlessly, it is called Gu Zhang (Bone Distension), which is difficult to cure. For both causes, the treatment is the same: use Ge Fu Zi Moxibustion (Moxibustion with Prepared Aconite Slice) and regular moxibustion to dispel cold stagnation and accelerate bone detachment. Since bone belongs to the Kidney and congeals with cold, it is treated using heat methods.