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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Injury to Qi causes pain, injury to the Form causes swelling." The etiology of Back Carbuncle (Fabei) involves five factors: First, indulgence in alcohol, meat, and rich foods; Second, excessive Yang-Heat pathogenic factors or residual toxins from Shaoyang Cold Damage (Shanghan); Third, ingestion of mineral drugs or long-term use of heat-producing decoctions refined through calcination; Fourth, cold Yin-toxic vapors lying dormant and gradually manifesting; Fifth, mountain miasma invading and accumulating in the Zang-Fu organs. Most affluent individuals suffer this due to medicinal wine, fatty mutton, and rich, greasy diets. Those with deficient-cold constitutions often suffer from anger, worry, and resentment, leading to Qi stagnation and constraint. The disease primarily belongs to the Du Meridian (Governing Vessel) and the Foot-Taiyang Bladder Meridian. Symptoms may include itching, numbness, pain, or absence of pain, distinguishing between Yin/Yang patterns and Fu/Zang organ involvement.

If caused by accumulated Heat in the Six Fu organs erupting between the skin and flesh, the onset is rapid. The lesion is swollen, high, soft, spreading widely, with burning inflammation on the surface, resembling a bowl or basin, characterized by redness, heat, and pain. This is named Back Abscess (Bei Yong). It results from pathogenic factors obstructing the meridians, belonging to a Yang pattern. Thus, the toxicity attacks outwardly. Although the condition appears severe, the marrow is not ultimately depleted, and the Zang-Fu organs are not damaged, making it easy to treat. However, nursing care is difficult, recovery is slow, but mortality is low (one in ten does not die).

If caused by accumulated Heat in the Five Zang organs attacking inward into the muscle and bone, the onset is slow. The lesion is flat internally and externally, slightly red, size like millet grains or coins, with intermittent itching and pain. This is named Back Ulcer (Bei Ju). It results from pathogenic factors hiding in the fascia, belonging to a Yin pattern. Thus, the toxicity attacks inwardly. Although the external appearance is minor, the Essence and Qi are already corrupted, and Ying (Nutritive) and Wei (Defensive) Qi cannot consolidate, making it difficult to treat. Even with vigorous treatment, it is ineffective, and mortality is high (none in ten survive). This corresponds to the saying: "Externally like millet, internally like grain; externally like a coin, internally like a fist."

Treatment should first involve applying mashed garlic as a cake to the area and moxibustion (moxa until pain ceases if painful; moxa until sensation returns if painless), or direct moxibustion after removing the garlic cake. Initially, administer a large dose of Jiajian Baidu San (Modified Detoxification Decoction) to induce sweating, followed immediately by Zhenren Huoming Yin (Immortal Life Decoction), two to three doses daily. Yinhua Jiu (Honeysuckle Wine), Huaihua Jiu (Sophora Flower Wine), and Lafan Wan (Wax and Alum Pill) can be used concurrently. Subsequently, administer formulas for supporting the interior and expelling pus, such as Shixuan San (Ten Acupoints Powder), Bazhen Tang (Eight Treasures Decoction), and Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). For constipation, use Huanglian Neishu Tang (Coptis Internal Purging Decoction) or Qingliang Yin (Cooling Drink, avoiding Mutong/Akebia Caulis). Huxin San (Heart-Protecting Powder) must be taken, along with external applications. If pus forms but does not rupture spontaneously, use Tizhen Wan (Needle-Replacement Pill); if it does not rupture, employ needle drainage (method seen previously).

The main formula is Zhenren Huoming Yin (Immortal Life Decoction), with doubled Gleditsiae Spina (Zaojiaoci) and added Qianghuo (Notopterygii Rhizoma et Radix, 2 qian) and Rougui (Cinnamomi Cortex, 3 fen), decocted in good wine. If the patient does not drink alcohol, decoct with water and wine together. Other appropriate formulas mentioned before and after are selected from the General Discussion.

For men over fifty suffering from this, after four to five days, the swelling becomes severe with a red halo about one chi wide, feeling heavy as if carrying a stone. When the pathogenic factor is fierce, aggressive purging is indicated. Observe the pulse; if deficient, first perform Bian Shi bloodletting (stone pricking) on the red area to release approximately one bowl of dark blood. As the condition lightens, apply external medicine and internally take more Zhenren Huoming Yin. The lesion will resolve when dark fluid flows from the pricked area.