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Xue Lizhai stated: Naoju (Brain Carbuncle) belongs to the accumulation of heat in the Foot-Taiyang Bladder Meridian, or is caused by the upward congestion of damp-heat, external contraction of wind-warmth, hyperactivity of fire due to Yin deficiency, or depletion of Kidney Water leading to the exhaustion of Yin essence. The depth of the pathogenic source varies, resulting in different severities of symptoms. Initially, it appears as a small lump resembling a hemp seed; after one or two days, slight aversion to cold and fever occur, with the lump gradually enlarging; by the seventh day, it takes shape with redness and swelling at the base, and a protruding, loose top, which constitutes a favorable syndrome (Shun Zheng). At this stage, if there is severe aversion to cold and high fever, lighter in the morning and heavier in the evening, white greasy tongue coating, chest fullness, hiccups, and nausea, with a fine, wiry, and rapid pulse, this indicates upward congestion of damp-heat. One should immediately use Huanglian Xiexin Tang (Coptis Decoction to Drain the Heart) or employ the Wendan method. If the face is oily and red, the tongue is dry, crimson, and red, accompanied by irritability, dry hiccups, thirst with desire to drink, and firm stools, this indicates fire damaging body fluids. In such cases, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) may be used, or herbs such as Lingyangjiao (Antelope Horn), Yinhua (Honeysuckle Flower), Diding (Viola Herba), Shihu (Dendrobium Stem), Lugeng (Reed Rhizome), Xian Shouwu (Fresh Polygonum Multiflorum Stem), Huangqin (Scutellaria Root), Zhike (Aurantium Fructus), Shanzhi (Gardeniae Fructus), Danpi (Moutan Cortex), Dengxincao (Juncus Effusus), Zhuye (Bamboo Leaf), and Xiakucao (Prunella Spica) can be utilized to clear fire toxins and resolve Ying-level heat. After fourteen days, when pus penetrates, the base turns scorched purple, fever subsides, the body becomes cool, and pus flows profusely, if penetration is incomplete, add powder of Jiashan Jia (Pangolin Scales), Zhi Jiangcan (Silkworm), and Jiaozhen (Gleditsia Sinensis Spine) to the Qingying formula to attack the toxin. By the middle of the second period (approximately 15-20 days), necrotic tissue gradually detaches, new flesh begins to grow, fever recedes, and the Spleen and Stomach function recover. After twenty-eight days, if all necrotic tissue has detached, new flesh fills the wound, appetite is good, and care is adequate, recovery is achieved around forty days.

There is another type, the Yin Syndrome, where the initial appearance and color are abnormal, chills and fever do not intensify, although the body may feel hot, the complexion and form show signs of cold. The lesion does not swell prominently, the base is flat and collapsed, spreading without confinement, failing to penetrate even after the appropriate time, producing thin pus that does not slough, indicating internal deficiency of healthy Qi unable to expel toxins outward, manifesting as inward sinking of pathogens. This results from chronic depletion of Kidney Water and exhaustion of Yin essence, leading to intense Yin fire. It is dangerous and cannot survive beyond three periods. Among these, there are three types of sinking transformations: Huoxian (Fire Sinking), Ganxian (Dry Sinking), and Xuxian (Deficiency Sinking). Huoxian occurs when Qi fails to guide Blood outward to form pus, causing fire toxins to sink into the Ying level, gradually leading to coma, convulsions, and syncope. Ganxian occurs when pus and necrosis have not penetrated, Ying and Wei levels are damaged, the base is purplish and stagnant, the top is dry and withered, gradually leading to clouded consciousness and signs of internal closure and external collapse. Xuxian occurs when pus and necrosis have detached, but no new flesh grows, the surface is smooth like a mirror, pale and shiny, Spleen Qi fails to recover, aversion to grain increases daily, physical and mental strength decline, gradually presenting with abdominal pain, diarrhea, and alternating chills and fever, resembling consumptive diseases; these are all incurable conditions. Generally, this condition is called Duikou Ju (Opposite Neck Carbuncle) if small, and Naoju (Brain Carbuncle) if large, commonly known as Luotou Ju (Head-Dropping Carbuncle). Those caused by the six excesses (pathogenic factors) are favorable and Yang-type; those caused by the seven emotions are adverse and Yin-type. Other carbuncles follow this principle. (For Duikou Ju and Fabei [Back Eruption], the timeline is strict: formation in 7 days, pus formation in two periods, necrosis detachment in three periods, and muscle regeneration in four periods.)

In the above discussion, regarding Yin syndromes and the three sinking transformations, formulas and drugs are not recorded because the changes are manifold, and treatment should be adapted to each specific syndrome.