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Chen Shigong stated: Fugu Ju (Bone-attached Carbuncle) is a disease caused by Yin-cold pathogenic factors penetrating into the bone. Those who contract it are invariably individuals with deficient constitution, who sleep outdoors in summer and autumn, allowing cold-dampness to invade internally; or after sexual intercourse, when covered thinly, cold qi enters the interior taking advantage of the deficiency. Initially, chills and fever alternate, resembling wind-pathogen invasion, followed by pain in the tendons, bones, and muscles of the buttocks and thighs. The area is neither hot nor red, but the pain penetrates deeply to the bone. In severe cases, flexion and extension are impossible, and turning over is difficult. After a long time, the Yin condition transforms into Yang, and cold transforms into heat. When heat becomes excessive, flesh rots and turns into pus, indicating that the carbuncle has formed. At the onset, Wanling Dan (Ten Thousand Miracles Pill) should be used to induce sweating, dispel cold, and unblock the meridians; subsequently, Dafangfeng Tang (Great Wind-Expelling Decoction) is used to promote circulation in the meridians, invigorate blood, drain dampness, and tonify deficiency. If it occurs in the sacral and gluteal region with diffuse swelling and pain, Neituo Qianghuo Tang (Interior-Supporting Notopterygium Decoction) is indicated; if there is diffuse swelling and numbness-pain near the knee and thigh on the medial aspect of the leg, Neituo Chai Tang (Interior-Supporting Bupleurum Decoction) is indicated; for the lateral aspect of the leg, Neituo Jiu Jian Tang (Interior-Supporting Wine-Decoction) is indicated. For patients with deficiency, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) plus Qianghuo, Niuxi, Fangfeng, and Fangji is prescribed. If the lesion has formed but pus has not yet developed, Fuzi Bazhen Tang (Aconite Eight-Treasure Decoction) is used. If pus has formed causing distending pain, it should be lanced with a needle. One must absolutely avoid using drugs that damage the spleen, deplete Qi, or fail to resolve toxicity. Externally, cold and cooling applications are contraindicated; mismanagement will inevitably cause Qi and Blood to congeal like ice, leading to internal stasis and rotting of flesh, which over time turns into foul water and败脓 (decayed pus), flowing uncontrollably. The thigh gradually swells like a winter melon, spreading upward to the hip and abdomen, and downward to the sole of the foot, with diffuse swelling. The skin color remains unchanged. Over time, it ulcerates and discharges pus that is white, foul-smelling, and turbid. The swelling does not subside, nor does the pain diminish. Yuanqi (Original Qi) declines daily, the body shrinks, lips and tongue become dry and scorched, urination and defecation become scanty and constipated, and food intake ceases. These are ultimately ominous signs. (From *Waike Zhengzong*)

Feng Luzhan stated: If there is unceasing pain extending from the Huantiao acupoint (the crease of the hip) to the heel, while the external skin appears normal, and the pulse is deep-rapid or slippery, one must guard against the development of Fugu Ju. This arises from deficiency in the Three Yin meridians, where cold-dampness flows and accumulates, and toxic qi adheres to the bone. What exactly is this "toxic qi"? It is actually insufficient Yang-warming Qi in the Kidney meridian. Consequently, in the tunnels and bone fissures of the Kidney region, Qi fails to circulate freely, Yin-Blood stagnates, and internal damp-heat郁积 (accumulates), leading to ulceration and pus formation. Hence, there is a saying that long-term use of Bawei Wan (Eight-Ingredient Pill) prevents bone carbuncles, meaning that when the bones receive warming Qi, blood circulates without obstruction, and how can toxicity arise? (From *Jinnang*)

He further stated: All forms of Fugu abscesses and carbuncles originate from the Kidneys, as the Kidneys govern the bones. Treatment should focus on warming and tonifying Kidney Qi. Once the bones receive Yang-warming Qi, the swelling and hardness will naturally dissolve like ice melting.

Li Dongyuan stated: Fugu Ju is so named because its toxic qi sinks deeply and adheres to the bone. This disease resembles Zeifeng (Thief-Wind) but is distinct. Recognizing this distinction prevents error. Generally, Fugu Ju results from sleeping outdoors in autumn and summer, suffering cold injury, where wind-heat lies dormant and coalesces, attaching to the bone to form a carbuncle. The syndrome of Zeifeng is caused by wind-pathogen qi clashing with the bone joints, resulting in pain that penetrates deeply to the marrow, worsening with cold. In contrast, Fugu Ju causes pain preventing movement; upon initial palpation, it feels hard against the bone, with slightly tense skin and flesh, feeling full and firm like adipose tissue. Zeifeng, however, presents with no significant heat in the skin or bones, but rather shivering aversion to cold, occasional sweating, and a desire to apply heat to the painful area for relief. Fugu Ju initially presents with intermittent pain, alternating chills and fever without sweat, persisting for a long time without resolution. Eventually, extreme Yin generates Yang, cold transforms into heat, and ulceration occurs. Untreated Zeifeng may eventually lead to contracture, deformity, and hemiplegia, which distinguishes it from Fugu Ju.

Dou Hanqing stated: Fugu Ju is also known as Tiegu Ju (Bone-Sticking Carbuncle). At the onset, press the affected area with the head of a chopstick. The point of extreme pain is the acupoint; mark it with ink and moxa. The standard is 100 moxa cones, though the number is not rigid; the treatment is effective when the moxa cone burns out spontaneously, at which point further moxibustion is unnecessary. The general principle is to use moxibustion initially to save life; if one waits until pus forms before using fire needles, few among a hundred will survive.

He further stated: The eruption of bone carbuncles is due to blood stasis and Qi stagnation, causing bone-deep soreness and pain. Causes include excessive sexual activity, entering water while vulnerable and contracting wind-cold, invasion of wind-toxic and pathogenic heat into Ying and Wei, emotional depression injuring the Heart, Liver, Gallbladder, and Kidneys, or consumption of rich wine and roasted/spicy foods, leading to swelling and pain that eventually suppurate. Initially, 100 moxa cones are recommended until warmth penetrates the bone. Later, silver needles should be used to pierce it. Discharge of bloody pus indicates robust Yuanqi and easy recovery; discharge of white pus indicates weak Qi and difficult recovery. The treatment method involves Dubsheng Jisheng Tang (Dubsheng and Parasite-Expelling Decoction), combined with Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) doubled with Mao Cangzhu, Xinchang Baizhu, Rougui, Ganjiang, Renshen, Huangqi, and Danggui as the primary先锋 (vanguard) formula, which ensures cure. Externally, use equal parts of Rougui, Ganjiang, Baizhi, Fangfeng, Cangzhu, Wuyao, Guiban (prepared with酥), Wubeizi, and Chen Xiaofen, powdered and mixed with a small amount of Moxiang. Add 5 he of old ginger juice, 3 he of vinegar, half a jin of scallions, and 1 liang of honey. Pound together to extract juice, boil over fire until rolling, and while hot, mix with the powder to apply around the four directions of the lesion, allowing toxic qi to escape. Keep applying heated residual juice to assist the medicinal power. Rest lightly, avoid anger, abstain from sex, eliminate distracting thoughts, and recovery takes about 100 days. If the patient disregards medical advice, acts on personal whims, behaves arrogantly, worries excessively, and cannot control the influences of the Six Qi and Seven Emotions, even celestial healers could not cure them, let alone human physicians!

Hu Gongbi stated: Tiegong Yong (Bone-Sticking Abscess) is identical to Fugu Ju. It occurs on the outer bone of the thigh, with no obvious elevation, no redness in the swelling, and pain deep to the bone. (From *Qingnang*)

Chen Shigong stated: At the onset, generally use Ren Shen Bai Du San (Ginseng and Detoxification Powder) plus Mugua, Niuxi, Sumu, and Honghua. For deficiency, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) plus Qianghuo, Fangji, and Niuxi. If formed but not yet suppurating, use Fuzi Bazhen Tang (Aconite Eight-Treasure Decoction). Once pus forms, lance it. If the constitution is solid and pus is yellow, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction); if the constitution is weak and pus is clear/thin, use Baoyuan Dacheng Tang (Protect Origin and Great Success Decoction).

He further stated: There is also a syndrome of wind-dampness combining. Initially, chills and fever alternate, followed by leg swelling and pain. The shape is smooth and slightly red, with fever, swelling, and pain. Upon pressure, it feels like mud and does not rebound easily. Use Danggui Nian Tong Tang (Angelica Pain-Relieving Decoction).

He further stated: There are also cases where sexual indulgence, cold damage, and heat interact and transform, causing Qi and Blood to deviate and meridians to loosen. As the disease deepens, these syndromes all stem from insufficiency of Yuanqi. Cold and cooling drugs must absolutely be avoided.

Hu Gongbi stated: In Fugu Ju, the skin color does not change, there is no high heat, only slight pain and itching, it persists without ulceration, and produces no pus or blood. It originates in the bone marrow. Since the Kidneys govern the bones, Kidney meridian deficiency allows cold pathogens to enter easily. Once inside, the bone Qi becomes cold, forming toxic carbuncles that adhere tightly to the bone without external signs. Thus, the root of the carbuncle originates in the Kidneys. Use Bawei Wan (Eight-Ingredient Pill) with added Fuzi to warm Kidney Qi, assisted by Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction). Once Kidney Qi is warmed, the bones are no longer cold, and the toxic pathogen moves outward. The carbuncle detaches from the bone, and the patient gains vitality. (From *Qingnang*)

Wang Shengzhi stated: Fugu Ju is a deteriorated stage of Liuzhu (Flowing Collection). Using cooling medicines damages the Spleen internally and freezes the Blood externally. The Spleen governs muscle; if Spleen Qi is injured, appetite decreases, and muscles do not grow. Blood resides in the vessels; if frozen, Qi and Blood become weak and more stagnant. Therefore, sweet-warm medicines should be used to strongly regulate Spleen Qi. Once Spleen Qi functions well, the Middle Jiao is no longer cold, vitality thrives, muscles grow naturally, and Qi and Blood circulate properly. (From *Lili*)

Commentary: Books such as *Zhunsheng* state that residual pathogens after sweating in Shanghan (Cold Damage) become Liuzhu, and the deteriorated stage of Liuzhu becomes Fugu Ju. However, post-sweat Liuzhu is easy to cure; only mismanagement leads to a deteriorated state that cannot recover, seemingly unable to transform into Fugu Ju. Moreover, Fugu Ju is a condition curable through proper regulation. If it undergoes multiple transformations, it becomes worse and worse, making recovery impossible. Therefore, the theory that deteriorated Liuzhu transforms into Fugu Ju should be retained but not discussed further.