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[Essential Discussion on Back Carbuncle, its etiology has five sources: one is epidemic qi, two is emaciation and weakness, three is anger stagnation, four is kidney qi deficiency, five is drinking cold wine, eating roasted or fried foods, and taking elixirs.]

At the end of the Yuan Dynasty, Xu Tongpan from Houzhu Village, Tongxiang County, Jiaxing, admired Lü Dongbin and offered worship morning and night. One day, a carbuncle erupted on his back, and although his condition was critical, he still propped himself up to bow as usual. He accidentally saw a piece of white paper under a water basin, on which was written a poem: "Heap upon heap of grave soil like golden shields, Flakes of flowers flying like white jade mushrooms, The ruler weighs one jin, the minister four liang, Mix and take them, and peace will be restored." He thought it was an immortal prescription but did not know what "golden" and "white jade" referred to, so he consulted the immortal, asking if Da Huang (Rhei Radix et Rhizoma) and Bai Zhi (Angelicae Dahuricae Radix) corresponded. The immortal said, "Yes." Taking it proved effective. Later, he used this prescription to treat others, with no failure. Xu had no sons, so he eventually passed the prescription to his son-in-law, the Shen family. To this day, the Shens make their living by selling this medicine, with people coming from hundreds of miles away to buy it daily. The clan is large, divided into dozens of branches, but only those living under the old Chinese chestnut tree (Cinnamomum camphora) find it effective. Shen's son once studied with my friend Yu Yuanpan and mentioned that the prescription now includes Shan Jia Pian (Squama Manis), Dang Gui Xu (Radix Angelicae Sinensis Cauda), and Jin Yin Hua (Flos Lonicerae Japonicae). However, since Da Huang is used in large quantities, acting primarily as a purgative, using it indiscriminately regardless of yin or yang toxicity may cause harm. Yet, it works continuously for many, yet only proves effective for the branch under the chestnut tree. Is this not heaven's gift? (From *Qi Xiu Lei Bian*)

Wang Chao, a student at Wansheng Gate in the capital, suddenly felt a hidden pain on his back as if from a sore. Upon inspection, it was already the size of a cup mouth, with countless heads. Someone advised him to buy medicine from Zhang Jiagou'er, a surgeon in Liangmen. Doctor Zhang frowned and said, "This sore is very malignant; medicines cannot cure it. Only moxibustion offers a slim hope, though it is laborious." He gave him some mugwort and said, "Go home and try moxibustion on the sore. You likely won't feel pain; only when it hurts can treatment proceed." After more than ten moxa cones, he felt no pain, while his wife watched and cried. It was only at the thirteenth cone that severe pain occurred. The necrotic flesh around the edges curled and rotted, falling off easily, and he improved slightly. He thanked Doctor Zhang again, who gave him several doses of medicine, after which he remained stable. Thus, we know that for carbuncles erupting on the back or flanks, the quickest method is moxibustion. (From *Lei Bian*)

Wang Min treated a patient with a back carbuncle that failed to suppurate. The doctor said that once it suppurates, it can be treated. Wang Min said, "This is a 'finger-striking' pulse; even if it suppurates, it cannot be cured." The crowd forced moxibustion, and the carbuncle rose like millet grains. The crowd said, "No danger." Three days later, he died. (From *Gusu Zhi*)

To treat back carbuncles, brain carbuncles, and all malignant sores at the initial stage, harvest a single-stemmed Xian Er Cao (Asteris Tatarici Herba), including leaves and seeds. Finely chop without touching iron. Boil in two large bowls of water in a clay pot until reduced by half. If the sore is on the upper body, take slowly after meals. Wait for vomiting to subside, then continue until finished. If the sore is on the lower body, take on an empty stomach. The sore will naturally rupture and discharge pus, preventing further spreading. Apply ointment separately. This prescription was kept secret by Zhang Boyu of Jingzhao; later, his brothers passed the imperial examinations, and people attributed this to good karma. (From Yuan Haowen's *Xu Yijian Zhi*)

Generally, stone-type herbs often treat carbuncles. The world-transmitted Maifan Shi Gao (Kaolinite) is very effective for back carbuncles; it is a secret formula of Lü Zihua, a hermit from Mount Zhong. Pei Yuanwai tried to buy it with official rank, and the Henan Prefect threatened him with heavy punishment, but Lü Ning refused all glory and chose death over transmission. The method involves crushing the stone like chess pieces, heating it red in charcoal, and soaking it in rice vinegar. Repeat ten times, then grind into fine powder. Take four taels of this powder. Use one deer antler (Lu Rong), preferably fresh with the skull bone attached; naturally shed ones are unusable. Cut into 2-3 inch pieces, burn in charcoal until smoke ceases, and grind into two taels of fine powder. Add two taels of raw Bai Lian (Ampelopsis Radix). Place three-year-old rice vinegar in a silver or earthenware vessel, boil until bubbles resemble fish eyes, then add the medicine. Stir constantly with a bamboo stick for one to two hours until the consistency is appropriate. Pour into a basin to cool, cover with paper to prevent dust. When using, apply the ointment with a goose feather to the swelling, covering all red areas but leaving a coin-sized hole in the center for ventilation. If no pus has formed, it will resolve internally; if a head has formed, it will shrink; if ulcerated, it will drain pus rapidly. If muscles have rotted exposing bone, apply to fine cloth and patch; change when dry, promoting daily contraction. As long as the diaphragm is not perforated, recovery is certain. For ulcerated sores, wash with pig trotter soup to remove pus and blood, dry with cloth, then apply. Avoid touching tender flesh with hands, blowing on it, or letting menstruating or pregnant women see it during preparation. Initially, wash and change daily; after ten days, change every two days. This medicine is effective only if applied meticulously; otherwise, it causes extreme pain. This prescription appears in *Qianjin Yue Ling* but lacks such detail. (From *Bencao Gangmu*)

Feng Chuzhan treated Jiang Sinong, whose pulse was strong at the cun position and weak at the chi position, so he had taken Ba Wei Wan (Eight-Ingredient Pill with Rehmannia Root) for years. (Such pulses often indicate yin deficiency with flaming fire; taking Ba Wei Wan may cause future complications.) However, due to overwork, the medicine could not control the erratic fire, leading to severe epistaxis. Although调理 (regulation) helped, thirst became extreme; he drank soups and water as if they were ambrosia, yet dozens of cups were insufficient. (This is xiao ke [wasting-thirst] becoming carbuncles over time.) He was advised to take large doses of yin-nourishing medicine assisted by fire-guiding agents, so that water rises and fire descends, eliminating thirst and preventing complications. He ignored this; although a few doses reduced thirst slightly, he stopped the medicine. By early summer, his back suddenly ached and itched, progressing to hardness. After half a month, pain was severe. Examination showed a bowl-sized hard mass half a cun lateral to the spine. Feng said, "Untreated chronic thirst depletes yin water daily and intensifies yin fire; texts warn of brain and back carbuncles as signs." Urgently, he aimed to expel toxins to the exterior to prevent internal collapse. Externally, he used Da Huang (two liang), Fu Rong Ye (Lotus Leaf, one liang each), Chi Shao (Red Peony Root, one liang), Bai Lian (two qian each), and Bai Ji (Bletilla Rhizome, two qian), ground to powder, mixed with egg white, and applied around the toxin. Internally, he heavily nourished yin water with Shu Di Huang (Prepared Rehmannia Root), Shan Yao (Dioscorea Rhizome), Tu Bei Mu (Fritillaria Thunbergii Bulb), Ci Jia (Spina Gleditsiae), Tian Chong (Beetle), Jia Pian (Manis Scale), Sheng Gan Cao (Raw Licorice Root), Lian Qiao (Forsythia Fruit), and Jin Yin Hua (Honeysuckle Flower). Once swelling matured, he took Ba Wei Wan (5-6 qian) in the morning to tonify primordial water and fire. Far from meals, he took Ren Shen (Ginseng), Huang Qi (Astragalus Root), Dang Gui (Angelica Root), Bai Shao (White Peony Root), Bai Zhu (Atractylodes Rhizome), Gan Cao (Licorice Root), Jin Yin Hua, Jia Pian, Tian Chong, Ci Jia, and Bai Zhi to support post-heaven qi and blood. Externally, Tai Yi Gao (Great One Ointment) with human hair, Bi Ma Zi (Castor Seed), Ru Xiang (Frankincense), and Mo Yao (Myrrh) was boiled and applied to draw out toxins. Within ten days, redness and swelling subsided, pain decreased, the sore elevated, and pus formed. Then, a surgeon changed tactics, nearly causing internal collapse. Emergency treatment resumed the previous decoction with added Rou Gui (Cinnamon Bark, approx. one qian). Swelling remained high, red, and active, resembling a minor sore, which eventually ruptured and healed.

Gao Gufeng treated a villager with a back carbuncle extending from Fengfu (GV16) to Shenshu (BL23). The entire area swelled, muscles were cyanotic and cold, hard as iron, with loss of appetite and consciousness. Doctors continued using detoxifying herbs. Pulse was fine and rapid in all six positions, indicating severe qi and blood deficiency with impending internal collapse. Urgently, he used Yang Rong Tang (Nourish the Blood Decoction) with Fu Zi (Aconite Root) and Pao Jiang (Prepared Ginger). After three large doses, stomach qi opened; after ten doses, hardness resolved by 80-90%, leaving only a tea-cup-sized red swelling on the left. He warned, "Do not use binding drugs or knives/needles. With gentle qi and blood, toxins will exit naturally. Binding delays it; puncturing out of season makes healing difficult." Unable to bear pain, he allowed puncture bleeding. Gao said, "Double the previous medicine urgently to promote healing." He also advised restraining desires, careful diet, and taking Huan Shao Dan (Restore Youth Pill) and Ba Wei Wan. He recovered.

Zhu Danxi said: "I saw Brother Wu, who consumed rich foods and had qi stagnation, with a solid constitution and heavy temperament, near sixty years old, suffering from a back carbuncle. Other medicines failed; only Xiang Fu Mo (Cyperi Rhizoma Powder) drunk quickly brought relief. He relied solely on this one herb throughout swelling and ulceration for safety. Such solid constitutions are rare in thousands." (Named Du Sheng San, suitable only for qi stagnation and blood stasis excess syndromes.)

Lady Lou, widowed early, enjoyed drinking and eating, was fat and robust, with a dark and toxic nature. At sixty-six, in July, she developed a back carbuncle near the spine. Doctors lanced it horizontally and vertically to drain blood, mixing it with Wu Xiang San (Five Fragrances Powder) and Shi Xuan San (Ten Acupoints Powder), given with wine. For over a month, no one discussed her widowhood depression, the toxicity of alcohol and meat, stagnation from attachment, or seasonal heat. Eventually, it sank flat, dragging on for two to three months without rescue.

In Zijiguan, Jiangling Prefecture, a stone tablet was unearthed recording: "For anyone with a back carbuncle, before it knots, with red, swollen, hot pain, first cover with wet paper. Stand and watch where the paper dries first; that is the carbuncle head. Slice garlic, about three qian thick, place on the head, and moxa with large cones. Change garlic after three cones. If painful, moxa until pain stops; if painless, moxa until pain starts. Early detection and moxa are best. (If heads are small like hemp seeds, skip the wet paper method.) If there are ten or more heads clustered together, crush garlic head into paste, make thin cakes, place on heads, and pile moxa on cakes to burn. (Moxa ten times in 1-2 days, ten survive; 3-4 days, six or seven survive; 5-6 days, three or four survive.)"

Wang Qu's preface to *Fa Bei Fang* says: "In the fourth month of summer in the third year of Yuan [era], I was an official in the capital. A carbuncle erupted on my back. National doctors treated me, but the condition worsened the next day. I met Zhang Sheng from Xiao County, Xuzhou, who applied moxa to the sore from dawn to dusk, totaling 150 cones, stopping only when I felt pain. The next day, black scabs were removed with tweezers, pus drained completely, flesh inside turned red, and pain ceased. Then, ointment was applied separately, changed daily. During changes, black rotting flesh was trimmed, and the sore flattened. That autumn and summer, seven scholar-officials in the capital died of carbuncles; I alone survived. Although fate has its fixed numbers, those who do not know the methods meet misfortune. Considering human effort, this is lamentable. Thus, I compiled the prescriptions obtained before and after, modeled them for distribution, hoping to fulfill the ancients' intent to save the multitude." (This is the 'Head Moxa' method, just without garlic.)

Shi Yuan's mother felt slight itching between her shoulder blades. Inspection showed a half-cun red patch with millet-like white grains. She urgently applied moxa, and the redness vanished. After fourteen cones, she stopped. Two nights later, she felt slight pain. Inspection showed redness flowing down two cun long, as wide as a leek leaf. The whole family regretted the earlier moxa. Someone mentioned Nun Zhiquan from Dengci Temple, who was cured of a large sore by moxa. They rushed to ask. Zhiquan said, "During severe stages, I was unconscious. Young nuns said Fan Bayi Fenyi persisted, moxa-ing over 800 cones before I woke, using about one sieve of mugwort." They hurried home, agreed, and started moxa with cones the size of ginkgo nuts. Ten or more cones caused no pain. They cut the red extension at the sides, reducing cone size by three-quarters. All felt pain. After seven cones, itching began. With each cone burning out, redness receded. After twenty-plus cones, the red halo faded. The patient endured it. Cones were increased to the size of a chicken egg, then quail egg, totaling about forty cones before pain was felt. The burnt area was over an cun deep. Because moxa was delayed, the initial flesh had necrosed, forming a barrier; only healthy flesh felt pain. Sides felt pain because flesh wasn't necrosed yet. The patient slept poorly for six nights, then ate congee and slept peacefully. Evening inspection showed the sore like an overturned steamer, protruding three cun high, with hundreds of small pores, jet black. Protrusion indicated toxins gathering externally. Pores indicated toxins floating in skin/muscle without gathering. Jet black color meant skin and flesh necrosis. Without moxa drawing toxins from within the necrotic flesh, the five zang organs would be compromised.

Xue Lizhai treated Wang Tongfu, who had a back eruption for over ten days, critical condition, large pulse. First, two doses of Huai Hua Jiu (Sophora Flower Wine) reduced the severity. Then, two doses of Bai Du San (Defeat Toxin Powder), followed by several doses of Tuo Li Yao (Support Interior Medicine) to gradually soak. Also, moxa with mulberry wood on the affected area for long periods daily, plus ointment patches. After several moxa sessions, pus discharged, rot fell off. Tuo Li Yao with Bai Zhu (Atractylodes Macrocephala Rhizome) and Chen Pi (Tangerine Peel) led to recovery in over a month.

Grand Magistrate Liu had a back carbuncle for six to seven days, full back swelling and pain, critical condition. He received 100 garlic-separated moxa cones and drank two bowls of Huai Hua Jiu, then slept. Upon waking, he took Tuo Li Xiao Du Yao (Support Interior and Detoxify Medicine); ten parts disappeared, six remaining. Mulberry branch moxa caused ulceration; he healed in a few days. Whenever moxa and Huai Hua Jiu were used, the effect of supporting interior was very rapid.

A gardener had a critical back carbuncle. He was told to take 5-6 liang of Jin Yin Teng (Lonicerae Japonicae Caulis), crush it, mix with one cup of hot wine, squeeze out juice, and drink warm. Dregs were applied to the site. After 4-5 doses, it flattened. Using this medicine to treat sores was enough to support his family, allowing him to abandon gardening. Books say: "Jin Yin Hua treats sores; unformed ones disperse, formed ones ulcerate, having life-restoring power."

Eunuch Liu Guan had a back carbuncle, swelling, pain, purple color. Pulse was deep and rapid. Chen Liangfu said: "Rapid pulse, fever, and pain indicate yang eruption. Moreover, severe redness turning purple indicates extreme fire resembling water." Inquiry revealed he had taken elixirs for half a year, causing accumulated warmth turning to heat. He took Nei Shu Huang Lian Tang (Internal Purging Coptis Decoction), taking two doses to calm. More Pai Nong Xiao Du Yao (Drain Pus and Detoxify Medicine), Zhu Ti Tang (Pig Trotter Soup), and Tai Yi Gao led to recovery. The Classic says: "Color and pulse should correspond; treatment lies in understanding excessive harm and controlling mechanisms, and the dynamics of yin and yang transformation."

A man over fifty had a back carbuncle, purple color, swelling, pain, outer skin about to ulcerate, restless sleep and appetite, mental fatigue. Moxa with mulberry wood on the site; black blood came out, followed by snoring sleep. Upon waking, symptoms vanished. He took Xian Fang Huo Ming Yin (Immortal Life-Preserving Decoction) for two doses, moxa again, pus and blood discharged. Two more doses greatly reduced swelling and pain. Then, Tuo Li Xiao Du San (Support Interior and Detoxify Powder) for several doses promoted closure. When carbuncle toxins are intense, harsh purgatives are not suitable initially. But for an elderly person with weak qi and blood, especially with surface eruptions, focusing solely on detoxification damages the stomach first, causing mistakes.

Shen Qianxian of Wujiang had a back carbuncle, hard, deep and solid pulse, indicating toxin inside. He used Xuan Du San (Disperse Toxin Powder): Da Huang (five qian, baked), Bai Zhi (five qian), decocted in water, taken before meals. One dose expelled filth via stool and urine; two doses cleared it. This is a dispersing and attacking toxin formula; for deep, solid pulses with constipation, its merit is great. (Note: This is the 'Golden White Jade' formula from the beginning; Xue used it without detailing its source.)

Grand Magistrate Chen Guoxin had inherent yin deficiency. He developed a back carbuncle. Using Ren Shen (Ginseng) and Huang Qi (Astragalus) for major tonification failed to close the wound. Internal heat, fever, dry tongue, cracked lips, scanty frequent urination, dry mouth desiring soup, vomiting, diarrhea, deafness, blindness, dizziness looking up, floating-large-rapid pulse. Xue said: "Wound not closing indicates spleen earth failure; dry tongue/cracked lips indicate kidney water exhaustion; frequent urination indicates lung qi decline; internal heat/fever indicates deficient fire flaming upward; dry mouth/desire for soup indicates true cold; vomiting/diarrhea indicates true fire decay; deafness/blindness indicates liver wood withering; dizziness indicates kidney qi extinction." He declined treatment; the patient subsequently died. (Note: Regardless of internal/external disease, for yin deficiency patients, taking Ren Shen/Huang Qi and qi-moving herbs is not only useless but harmful. Based on these symptoms, it is pure triple-yin depletion. If initially treated with Di Huang, Mai Dong, Gou Qi, Dang Gui, Bai Shao, it might have been saved.)

Wu Xiang Shi Bangzhi's wife, in mid-summer, had a back carbuncle. Dead flesh did not ulcerate, severe fever/pain, vomiting, poor appetite, dry mouth desiring soup, large pulse, empty on pressure. This is true cold inside, false heat outside; discard season, follow symptoms. First, Liu Jun Tang (Six Gentlemen Decoction) with Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark). Four doses improved diet immediately. Then, Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with ginger/cinnamon. Over fifty doses, dead flesh ulcerated; another fifty doses, new flesh grew. This person had abundant qi/blood, so sores rose and closed easily. If doctors anticipated this and prepared interior-supporting measures beforehand, this trouble would be avoided. (Xiong notes: Shi Quan Da Bu Tang must only be used after toxin-fire is completely cleared.)

He Zhaoqing, Southern Ministry of Rites official, promoted to Vice Minister of Shanxi. At parting, his lips/nose were cyanotic-black, scratching back occasionally. Asked why, he said, "Small sore." Inspected, indeed a carbuncle. This is spleen/stomach failure, incurable. Xue was friends with him, pitying the difficulty of funeral arrangements en route, asked colleagues like Zhang Dongsha to keep him, forcing major tonification. Only purple blood came out, indicating extreme deficiency. Some said intense toxin couldn't form pus, so he took attacking toxin medicine, leading to vomiting, reverse flow, and pulse disappearance. He indeed died in Nanjing.

Chai Fuan'an of Jingzhao, mid-summer back eruption, dark color, slight swelling, fever, irritability, spontaneous saliva, cold lower abdomen, cold extremities, floating-choppy right guan, fine two chi pulses. Said: "This is deficiency-cold syndrome." Wang Tapu said, "Great heat without heat means no fire." Determined it wouldn't recover. Begged for treatment. One dose of major warming-tonifying medicine stopped salivation, but the lesion didn't rise; ultimately ineffective.

Tu Jiufeng, Vice Commissioner, contracted this in early spring. Dark color, diffuse swelling, thirst, frequent urination, large-rapid chi pulse. Kidney water dried up; destined to die during peak fire. Disbelieved, took bitter-cold medicine, further damaging yuan qi, hastening death.

A man neglected sexual activity. Shoulder blade swelling three cun high, over a chi wide. Spontaneous and night sweats, internal heat/fever, dry mouth desiring soup, floating-large pulse, weak-choppy on pressure. Yin deficiency with qi stagnation. Used Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with Wu Wei Zi (Schisandra), Mai Dong (Ophiopogon), Shan Yu (Cornus), Shan Yao (Dioscorea). Four doses, all symptoms retreated. Later, used Liu Qi Yin (Flowing Qi Decoction) for one dose; deficiency symptoms appeared fully, swelling/hardness like stone. Returned to previous medicine for six doses, finally healed.

A scholar had a back swelling. Soft on pressure, normal flesh color, normal diet. Fatigue/phlegm upon work. Spleen qi deficiency with phlegm stagnation. Used Bu Zhong Yi Qi Tang (Tonify Middle and Augment Qi Decoction) with Fu Ling (Poria), Ban Xia (Pinellia), slight Qiang Huo (Notopterygium). Externally, Yin Yang San (Yin-Yang Powder) mixed with ginger juice applied and resolved. Later, due to fatigue, dizziness/vomiting. Same medicine minus Qiang Huo, added Sheng Jiang (Fresh Ginger), Man Jing Zi (Vittex Seed). Healed.

Wang Qizhi, Judicial Officer, back carbuncle. Head like millet, painful, heavy back, deep-solid pulse. Toxin inside. Took Huang Lian Nei Shu Tang (Coptis Internal Purging Decoction). Two doses, slight improvement. Then Xian Fang Huo Ming Yin healed him.

Liu Huafu, Graduate Student, swelling/pain, floating-rapid pulse. Toxin stored in meridians. Used Nei Tuo Fu Jian San (Internal Support Re-decoction Powder) for two doses, swelling/pain occurred. Xian Fang Huo Ming Yin for four doses, swelling/pain stopped. Tuo Li Yao healed him.

A scholar had back carbuncle, severe swelling/pain. Heat-toxin accumulation intense. Garlic-separated moxa stopped pain. Xian Fang Huo Ming Yin reduced swelling. Tuo Li Yao caused ulceration/healing.

A man had back carbuncle. Necrotic flesh ulcerated but new flesh didn't grow. Toxin resolved but spleen/stomach qi deficient. Liu Jun Zi Tang (Six Gentlemen Decoction) with Xiong (Ligusticum), Gui (Angelica), Wu Wei Zi, Huang Qi (Astragalus) gradually improved. Shi Quan Da Bu Tang fully healed.

A man had back carbuncle, swelling/pain, red halo over a chi, back felt like carrying a stone. Condition demanded harsh attack, but pulse contraindicated. Pricked red area, draining a bowl of purple blood. Swelling/pain instantly retreated. Shen Gong San (Divine Merit Powder) and Xian Fang Huo Ming Yin for two doses, wound and pricked sites bled fluid and cleared.

A man had back carbuncle. Flesh rotted, pus clear, muscle didn't grow. Evil gone, qi/blood both deficient. Shi Quan Da Bu Tang, healed in over a month.