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Shen Douyuan stated: The "Duikou" (Opposite Mouth Carbuncle) arises at the Fengfu (Wind Palace, GV16) and Menmen (Gate Gate, GV17) acupoints. (Fengfu is also known as Sheben, located one cun directly above the posterior hairline, one and a half cun posterior to Naohu, within the depression of the large tendons of the neck. Menmen is five fen posterior to Fengfu, five fen into the hairline; it is the meeting point connecting the root of the tongue and the Yangwei Vessel; the head should be tilted back to locate it.)

Duikou can be central or lateral. If the toxin flows to the shoulder, the shoulder swells; if it flows to the back, the back swells.

Wang Shengzhi stated: Lateral Duikou is also called Fajifa (Hairline Carbuncle). (From *Li Li*)

Chen Yuangong stated: At the initial stage of Duikou, a small sore appears, first itching then painful, followed by ulceration. People consider it an extremely fierce carbuncle. However, they do not know that those arising centrally are relatively mild, while those arising laterally are particularly severe. This is because the upper neck and nape are the regions governed by the Kidney and the Governor Vessel (Du Mai). This area belongs to Yin, so the lesions produced are mostly Yin abscesses (Yin Ju), not Yang carbuncles (Yang Yong). Yang syndromes must be elevated and protruding, with red, swollen, bright skin, and severe pain causing cries for help; whereas Yin abscesses have dark, blackish coloration, pain is not severe, the body feels heavy and lethargic with weak moaning, the sore does not protrude, or numerous small sores appear, leaving people unsure where to find the pus head. Nevertheless, both Yin and Yang syndromes can be resolved internally via "Neixiao" (Internal Resolution); why wait until the skin breaks and swelling suppurates before treating? The method of internal resolution need not distinguish between Yin and Yang initially. However, once the sore has ruptured and pus has emerged, if Yin and Yang are not carefully assessed and medications are administered indiscriminately, disaster will strike instantly. For internal resolution, use Sanxing Tang (Three Star Decoction): 2 liang of Jin Yin Hua (Honeysuckle Flower, *Lonicerae Japonicae Flos*), 1 liang of Pu Gong Ying (Dandelion Herb, *Taraxaci Herba*), and 3 qian of Sheng Gan Cao (Raw Licorice Root, *Glycyrrhizae Radix et Rhizoma*). Decoct in water; two doses result in complete resolution. For Yang syndromes that have already ruptured, this formula is also used; three doses ensure pus exhaustion and flesh regeneration. For severe Yin syndrome ulcers, switch to Qisheng Tang (Seven Sage Decoction): 1 liang each of Ren Shen (Ginseng Root, *Panacis Ginseng Radix*), Huang Qi (Astragalus Root, *Astragali Radix*), Dang Gui (Angelica Root, *Angelicae Sinensis Radix*), and Bai Zhu (Atractylodes Rhizome, *Atractylodis Macrocephalae Rhizoma*), plus 2 liang of Jin Yin Hua. Decoct in water; after one dose bleeding stops, after two doses flesh regenerates, after three doses the wound shrinks, after four doses the skin closes, and after two more doses recovery occurs. (From *Bing Jian*. This formula is miraculous for treating various carbuncles and sores that are depressed and fail to close, not just for lateral Yin toxins. The principle is that Yang syndromes require cooling purgation, while Yin syndromes require warming tonification.)

Chen Shigong stated: Duikou is also known as Naoju (Brain Carbuncle), arising at the back of the neck facing anteriorly. Central Duikou is governed by the Governor Vessel (Du Mai). The Governor Vessel originates from below, penetrates the spine, and travels upward. Therefore, when toxin encounters it, it conflicts and becomes elevated and swollen, preventing the toxin from flowing downward and sinking, allowing it to manifest externally; thus, it is generally easy to treat. Lateral Duikou is governed by the Taiyang Bladder Meridian. The Taiyang Bladder governs Cold Water, with a nature that tends to sink. It originates at the vertex, passes through both sides of the neck, and descends smoothly. When it intersects with carbuncle toxins, the toxins flow downward, resulting in flat, collapsed sores, which are difficult-to-treat conditions. Obtaining pus within fifteen days is auspicious. (From *Zheng Zong*)

Feng Luzhan stated: Patients with Shen Xiao (Kidney Wasting-Thirst) may also develop Naoju or Bei Yong (Back Carbuncle). Since the Kidney governs bone, the brain is the Sea of Marrow, and the back is the pathway of Cold Water traversed by the Taiyang Meridian. If Kidney Water dries up and the Sea empties, Minister Fire flares upward, how could it not manifest as carbuncles and abscesses? If the sore is severe but does not ulcerate, or discharges red fluid, and worsens to black or purple, this is the image of extreme Fire resembling Water, indicating exhausted Kidney Water and incurability. If Yin is vigorously tonified, and the patient can eat, has regular bowel movements, calm spirit, and no other malignant symptoms, rescue might be possible.

Xue Lizhai stated: Naoju, commonly called Duikou, is formed by the steaming interaction of Damp-Heat. Those contracted from external pathogens are mild; those originating from internal accumulation in the Five Zang organs manifesting externally are severe. Although the back of the neck belongs to the Governor Vessel, it is also the pathway for Cold Water governed by the Taiyang Bladder. Those contracting from external sources often arise at central acupoints, possessing pure Yang Qi, and thus often heal without specific treatment. Central points belong to the Governor Vessel, originating at Weili (GV1), penetrating the spine upward, where Qi and Blood intersect, making them prone to elevation, suppuration, flesh regeneration, and wound closure. Lateral points belong to the Taiyang Bladder Meridian. The Taiyang Bladder governs Cold Water, originating at the vertex and descending along the spine. Here, carbuncle toxins stagnate, and Qi and Blood flow downward following the toxin. The sore shape is flat, swelling is not sharp, the base spreads, shoulders swell diffusely, the back feels like carrying a stone, pus formation is difficult, ulceration and healing are difficult, and it is absolutely untreatable.

He further stated: Those caused by Five Zang accumulation have five origins:
1. Mental agitation and restlessness stir up Fire, causing it to boil and travel to the neck, interacting with Cold Water to form pus.
2. Anger injures the Liver. The neck is where the Three Yang meridians unite tendons. Liver injury causes blood vessels to lack moisture, and tendons lose nourishment, condensing into swelling. Thus, the neck is stiff and painful, unable to turn. Before ulceration, the flesh is dark purple, hard and diffuse; upon rupture, it bleeds watery fluid, feels numb and painful with no pus.
3. Overthinking injures the Spleen, daily depleting Spleen Qi. Or, rich food damages the Stomach, drying Stomach fluids, leading to epigastric fullness, stagnant Qi reversing into muscle tissue, causing obstruction and swelling. The outer skin rots, but the interior remains hard and un-ulcerated; mouth and tongue are dry, appetite is lost, the base spreads, and pus is foul and discolored.
4. Melancholy injures the Lungs. Lung injury closes pores and interstices, obstructing Qi flow. Qi moves纵横 (horizontally and vertically) through meridians, knotting into swelling. The sore is flat, pale and dull, skin rots with fat discharge, resembling scalding by hot water; breathing is coarse and short, nose is stuffy and flared, phlegm is abundant, and coughing is persistent.
5. Excessive desire injures the Kidneys. Kidney injury败 (ruins) True Yin Qi. Once True Yin is ruined, Minister Fire generates. This Fire rises and falls freely, moving or still. The sore is purple-black, pulse is rapid and irregular, accompanied by irritability, dry mouth, and thirst quenched immediately by drinking. Thus, it is said that those originating internally are severe.

He further stated: For sores that are not red, painful, or swollen, and do not hurt even when moxa is applied, urgently use a lancet to pierce the apex until pain is felt, drain the evil blood, open the sore aperture, insert Chan Su strips (Toad Venom Strips) straight to the bottom, cover with ointment, and aim for pus discharge as auspicious. For others, follow general carbuncle and sore treatments to expel toxins.