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Zhang Tingyi, a Commissioner of the Ministry of Revenue, suffered from a carbuncle on his back, accompanied by vomiting and pain, constipation, dry mouth, and thirst. This indicated heat-toxin accumulated internally. After taking two doses of Zhuye Shigao Tang (Leafy Bamboo Sheath and Ophiopogon Decoction), all symptoms subsided immediately. Subsequently, Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) was used, eliminating the swelling around the wound. Finally, Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) was administered, leading to rapid healing.

A man suffered from a back sore that ulcerated but failed to resolve blood stasis, indicating deficiency of Yang Qi. He was treated with vigorous tonification using Renshen (Ginseng Radix et Rhizoma), [missing herb name], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). Additionally, mugwort moxibustion with mulberry branches was applied, followed by Tuoli San (Interior-Supporting Powder) augmented with Rougui (Cinnamon Bark). The wound healed naturally, demonstrating the method of replenishing and connecting Yang Qi.

Another man presented with a diffuse swelling and slight pain on his back, reduced appetite, and fatigue. This condition belonged to deficiency of both form and pathogenic factors; the treatment principle should prioritize tonifying Yuan Qi (Original Qi). Disbelieving this, he took detoxifying agents, resulting in darkening of the flesh in the center for about five cun, with all malignant signs appearing. Upon seeking further treatment, I stated: "This is a transformation caused by deficiency-cold of the Stomach Qi. Urgent warming and tonification of the Spleen and Stomach are required; then the malignant signs will recede, and healthy flesh will regenerate." He still refused, opting to excise the necrotic tissue, which ultimately led to his death.

Cao Wenzhao, a Director in the Ministry of Water Affairs, suffered from a lesion on his shoulder blade for over half a month. The sore head resembled millet grains, with internal stabbing pain and intermittent pulse. This indicated deficiency of Yuan Qi with toxin accumulation internally, necessitating moxibustion. Thirty moxa cones were burned, and Liu Jun Zi Tang (Six Gentlemen Decoction) augmented with Huoxiang (Patchouli Herba) was drunk. After several doses, the lesion subsided, internal pain ceased, and the Stomach pulse recovered. However, the lesion remained purple with non-ulcerating necrotic tissue, indicating Yang Qi deficiency. Mulberry branch moxibustion was applied to dissipate the toxin and replenish Yang Qi. The previous formula was augmented with Renshen (Ginseng Radix et Rhizoma), [missing herb name], Danggui (Angelicae Sinensis Radix), and Rougui (Cinnamon Bark). The color turned red, pus became thick, necrotic tissue gradually sloughed off, and healing occurred within two months. When pathogens lie deep and Zhen Qi (True Qi) is weak, preventing eruption, moxibustion combined with strong tonification is essential. Relying on ordinary medicines and waiting for spontaneous rupture rarely succeeds without error.

Huang Yuyun suffered from a back carbuncle. Premature use of Shengji San (Flesh-Generating Powder) exacerbated the ulceration and caused diarrhea. The pulse was faint and slow, indicating Spleen-Stomach deficiency. Ershen Wan (Two Divine Pills) was used to stop diarrhea, followed by strong tonic medicines to secure the root. The affected area was washed with Pig Trotter Soup, and Huangqi (Astragali Radix) powder was applied externally. Fortunately, initial moxibustion prevented the toxin from invading inward, leading to recovery in two months.

Xu Honglu suffered from a back carbuncle for over ten days, presenting with hard, numb swelling and unchanged skin color. The pulse was deep and excess. This indicated toxin residing internally. Hualian Neishu Tang (Coptis Internal-Purging Decoction) was administered first, followed by disinfecting and interior-supporting medicines, allowing the toxin to surface. Impatient for quick recovery, he urgently applied flesh-generating medicines. The affected area felt like carrying a stone, and his body felt like burning, leading to his death.

Li stated: In Longyou, a patient with a severe back carbuncle had ulcerated extensively, leaving only the diaphragm separating the viscera. Believing death was inevitable, he used a fish gut removed and filled with roasted sheep dung, ground into powder, which was sprinkled dry onto the wound. The wound closed spontaneously. This comes from Hong’s Formula, which has been effective repeatedly, so it is recorded here. It should be used when pus is scant and flesh regeneration is desired. (Chen Ziming, *Waike Jingyao*)

Chen Mingqi, a Juren (provincial graduate) from Jiangyin, suffered from a back carbuncle while residing in Beijing. He recovered after taking strong tonic medicines. The next day, preparing to return home, he hosted a thank-you banquet and conversed normally. That night, receiving a family letter that greatly displeased him, he became angry, developed fever and thirst, ate a few slices of pear, and suffered multiple episodes of diarrhea by midnight. At dawn, Xue’s pulse was found to be depleted, and he died. Pear implies "slippery/descending." Items with draining and descending properties should be avoided by those with Spleen-Stomach deficiency-cold, postpartum women, and those with traumatic injuries. (The mentioned strong tonic medicines must have contained Renshen (Ginseng Radix et Rhizoma) and [missing herb name]. After a major sore, Yin Qi is severely damaged. Without proper post-treatment care leading to sudden changes, blaming the pear for the tragedy is an excuse.)

(Note: His qi had not yet recovered after the sore healed. Anger stirred up Liver Yang fire, causing fever and thirst. The hyperactivity of Liver Wood is evident. Wood overacting on Earth leads to vomiting or diarrhea. How could a small amount of pear cause such a catastrophe?)

Chen Ziming treated a man with a back carbuncle where the head resembled millet, heavy as if carrying a stone. Shenxian Taiyi Dan (Immortal Supreme One Pill) was taken internally and applied externally. After three or four applications, defecation felt like burning, but he recovered soon.

A woman suffered from this condition with swelling, pain, fever, and somniloquy. A large pulse was present. Qingxin Tang (Heart-Clearing Decoction) one dose brought relief. Jinnyinhua (Lonicerae Japonicae Flos), Gancao (Licorice Root), Tianhuafen (Trichosanthis Radix), Danggui (Angelicae Sinensis Radix), Gualou (Trichosanthis Fructus), and Huangqin (Scutellariae Radix) were used for several doses until ulceration occurred. Further treatment with interior-supporting medicines led to recovery. (The formula is very stable.)

A man recovered from this condition but had a fleshy growth protruding from one eye resembling blood (known as Fanhua Chuang / Flower-Reversing Sore). It persisted for three months due to wind-cold injury. Fresh pig lard mixed with Licai (Veratrum nigrum) powder was applied, resulting in immediate cure. For growths extending five cun, this medicine is especially suitable. Smoked plum (Wumei) application is also effective but slower. Sulfur can also be used.

A man suffered from back toxicity with pain, desire for cold drinks, fever, excessive sweating, constipation, and delirium. Po Guan Dan (Broken Coffin Pill) two pills calmed him. Jinyinhua San (Honeysuckle Powder) four doses allowed for incision once pus formed, followed by interior-supporting medicines for recovery.

A woman suffered from this condition with painful swelling and restlessness due to formed pus. Puncture was performed, and Tuoli Xiaodu Yao (Interior-Supporting and Toxin-Resolving Medicine) led to recovery. Generally, for back carbuncles, even with fever, stasis, pain, high severity, irritability, thirst, and restlessness, if the pulse is forceful and appetite is good, safety can be assured. Once pus drains, all symptoms subside. Pain often results from pus retention. Using cooling and purgative drugs to attack toxins causes errors. If pus is present, puncture stops suffering immediately. If pus is not formed and heat-toxin causes pain, use detoxifying medicines. Even with extensive ulceration, if no malignant signs exist, strong tonics promote rapid flesh growth without harm. Contraindications include low swelling, non-red color, absence of pain, weak pulse, poor appetite, lack of ulceration, non-putrefying tissue, clear pus, continuous discharge, and failure of flesh growth, all indicating Yuan Qi deficiency and difficulty in treatment; vigorous tonification is required. If after pus and blood discharge, swelling and pain worsen, pus is foul-smelling, irritability and cough occur, abdominal pain and severe thirst arise, uncontrolled diarrhea occurs, and urination resembles strangury, these are malignant signs and are incurable. (Xu Lingtai said: Vigorous tonification must include toxin-resolving measures; it is not solely dependent on Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata).)

A frail woman suffered from this condition with external rotting but internal pus retention, causing painful swelling, irritability, and heat. Immediate opening was advised to release toxin and pain, allowing symptoms to subside. Waiting for spontaneous rupture increases pain and depth of ulceration. She refused, waited nearly ten days, became exhausted from pain, and although punctured, failed to heal, eventually dying.

A man suffered from this condition with ulceration and non-sloughing necrotic tissue. Excision and vigorous tonification were attempted. A frail woman with severe pain and fever before pus formation was advised to undergo garlic-separated moxibustion to draw out toxin and allow self-resolution. Both refused and died. Standard treatment involves moxibustion for any non-ulcerated sore, regardless of pain level or timing, achieving quick resolution. For uncertain conditions, encircling medicines are used first. Wujin Gao (Black Gold Ointment) or Yuansheng Gao (Support-Life Ointment) applied to specific points is beneficial. For headache and stiffness (exterior syndrome), Ren Shen Bai Du San (Ginseng White Tiger Detoxifying Powder) one or two doses are given. For pain, fever, and rapid pulse, Jinyinhua San (Honeysuckle Powder), Huaier Jiu (Sophora Wine), or Shenxiao Tuoli San (Divine Efficacy Interior-Supporting Powder) are used. For painful, hard swelling and excess pulse, Qingliang Yin (Cooling Drink), Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction), or Kushen Wan (Sophora Pill) are prescribed. For hard, numb swelling, pain, fever, irritability, cold drink desire, constipation, and deep-excess pulse, Huanglian Neishu Tang (Coptis Internal-Purging Decoction) or Qingliang Yin are used. After bowel movement, to promote pus formation, Xianfang Huoming Yin, Tuoli San, or Lafan Wan (Beeswax Alum Pill) are used internally, with Shenyi Gao (Miraculous Difference Ointment) externally. For poor appetite or taste, Liujunzi Tang (Six Gentlemen Decoction) with Huoxiang (Patchouli Herba) is taken for three to five doses. Xionghuang Jiedu San (Realgar Detoxifying Powder) washes the area; Wujin Gao is applied daily. Once a cavity forms, paper rolls dipped in Wujin Gao are inserted. If pus is trapped by membranes causing swelling/pain, needle drainage is needed; obstructing necrotic tissue is removed. If necrotic tissue moves, Pig Trotter Soup washes the area. If pus is thick or painful with normal diet and natural sloughing, disinfecting and interior-supporting medicines are combined, along with the aforementioned ointments. If necrotic tissue separates from healthy flesh, it should be removed quickly. If pus is neither thick nor thin, with mild pain, poor appetite, and slow sloughing, mulberry wood moxibustion and interior-supporting medicines are used. If necrotic tissue does not slough or pus is clear/thin without pain, strong tonics and mulberry wood moxibustion are used to replenish Yang Qi and dissipate stagnant toxin. Severe cases without pus should avoid garlic moxibustion. Delayed opening or waiting for spontaneous sloughing often leads to death. Robust individuals or mild cases may rely on medicine or spontaneous resolution. Weak individuals with blocked heat-toxin require acupuncture/moxibustion alongside medicine for full efficacy. If pus is formed, urgent opening is necessary; otherwise, severe cases penetrate viscera and rot bones, while mild cases destroy healthy flesh, making healing difficult.

A man over fifty suffered from this condition for five days with massive painful swelling, a red halo over one cun, and heaviness like carrying a stone. The condition was severe, suggesting aggressive treatment, but the pulse contraindicated it. Bloodletting was performed on the red area, releasing a bowl of black blood, instantly reducing pain, swelling, and back heaviness. Shengong San (Divine Merit Powder) was applied, and Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) two doses were taken. Bleeding serum from the wound and bloodletting site resolved the issue. Generally, for severe toxin conditions, aggressive drugs damage Yuan Qi in weak individuals, causing transformations.

A woman suffered from this condition for over half a month without eruption or pus formation, with severe pain and weak pulse. Garlic-separated moxibustion (twenty-plus cones) was applied, followed by interior-supporting medicines. Pus gradually formed but was clear, and necrotic tissue did not slough. Strong tonics and mulberry wood moxibustion promoted sloughing, leading to quick recovery. Standard treatment: for non-pus-forming painful sores within 1-4 days, moxibustion eliminates pain; for painless sores, moxibustion induces pain. If moxibustion yields no pain or numbness, toxin disperses with fire. Hard swelling without pus, with or without pain, or millet-like heads respond well to moxibustion. Cases with no redness, swelling, or significant pain after several days benefit from frequent moxibustion without strict timing, combined with sweet-warm interior-supporting medicines. Cooling medicines are strictly forbidden. Internal non-sloughing necrosis also responds to mulberry wood moxibustion. Rapid pulse, fever, and pain indicate Yang onset (treatable); slow/no pulse and no pain indicate Yin onset (difficult). Absence of pain is most malignant. Back carbuncles, brain carbuncles, large ding sores, hanging abscesses, toe gangrene, and foot emissions generally result from rich foods, sexual exhaustion, emotional disturbances, or mineral tonics causing essence deficiency and Qi stagnation, not merely Ying-Wei stagnation. Moxibustion draws out toxin; differentiation of cause and location (viscera vs. exterior) and deficiency/excess is crucial for correct treatment.

A man presented with a millet-like head, stifling pain, irritability, thirst, constipation, and rapid-excess pulse, indicating toxin in the Zang organs. Urgent purging was advised to cut off the source. Dismissing it as minor, he took ordinary medicines, leading to massive ulceration and death.

An elderly woman presented with millet-like heads on day three, hard numb swelling, and irritability. By day six, numerous heads appeared with a large pulse, deep-thin upon pressure. Garlic-separated moxibustion and interior-supporting medicines promoted eruption. Still unulcerated, after several doses, internal/external tissues rotted but were separated by tendons, preventing pus exit, causing painful swelling. Opening was advised but refused. Spontaneous rupture occurred later, but toxin had invaded deeply, leading to death. Generally, despite various names, Yin and Yang syndromes are key. Single/double heads, red/swollen/high, painful/febrile are Yi (Yang) and treatable. Initial single millet-like head, non-swollen/non-red, stifling pain/irritability, severe thirst/constipation, somniloquy/clenching teeth, multiplying heads over 4-5 days, lotus-pod appearance, persistent non-ulceration, bleeding on pressure,成片 heads merging into one ulcer with purple-dark internal pus are Ju (Yin) and difficult. Large-slippery pulse is acceptable; deep-thin is harder. Such malignant signs respond best to garlic-separated moxibustion and Wujin Gao (Black Gold Ointment). Near the spine/spleen, a tendon layer exists; lesions here resist external rupture, trapping internal pus, causing distension/pain, Qi-Blood deficiency, and complications. Waiting for spontaneous rupture is fatal; opening and interior support are mandatory. Sharp scissors often fail to remove hard tissue; spontaneous rupture is unlikely in non-robust individuals.

A man over fifty presented with purple painful swelling, impending external rupture, sleep/appetite disturbance, and mental fatigue. Mulberry wood moxibustion released black blood, inducing deep sleep. Upon waking, symptoms vanished. Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) two doses, plus another moxibustion session, expelled pus/blood, significantly reducing swelling/pain. Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) several doses led to closure. While severe conditions warrant strong attacking drugs, elderly patients with weak Qi-Blood and superficial lesions risk damaging Stomach Qi if focused solely on detoxification, causing errors.

A woman suffered from fever and pain, exclusively taking cooling/fire-reducing detoxifying medicines. Post-ulceration worsened with irritability, cough, and strangury-like urination. These are malignant signs; refusal to treat resulted in death. Generally, among Five Good Signs, presence of one or two indicates treatability; among Seven Evil Signs, presence of one or two indicates difficulty. Deficiency with evil signs is incurable; Excess without evil signs resolves spontaneously. Although attributed to Fire, this condition stems from Yin deficiency. Classics state: Du Mai (Governor Vessel) deficiency emanates from the brain; Bladder Mai deficiency emanates from the back. Can one focus solely on Fire?

Prefect Zhao suffered from hard, non-lustrous swelling with millet-like heads. Pulse was large-superficial but choppy upon pressure. Classics state: If marrow is not枯竭 and viscera are not ruined, it is treatable. However, hard/swollen/deadly color, hardness like ox neck skin, and choppy pulse indicate exhaustion of Essence-Qi; incurable and fatal.

*Tujing* states: Biledi (Ficus pumila) treats back carbuncles. Recently in Yixing County, Zhangzhen, an old scholar teaching village school, aged over seventy, suddenly developed a back carbuncle. With no medical help available, fresh Biledi was crushed, juice extracted, mixed with honey, and drunk in large quantities. Residue was applied topically, followed by other medicines, leading to recovery. Physicians attributed this to Biledi, confirming *Tujing*’s accuracy. (*Bencao*)

Guo Hu told me: In my hometown, experts treat back carbuncles with extensive moxibustion (200-300 cones), always successful. Small cones reduce fear, allowing higher doses for efficacy. This method is effective but not rigid. Recently, a surgeon famous for external medicine treated a large bowl-sized back carbuncle with multiple holes. With no other options, he covered the wound with moxa and burned it. Pain came late because the tissue was necrotic. Subsequent medicinal treatment cured him unexpectedly. (*Baibai Fang*)

For early back carbuncles, leeches placed on the swelling drink blood, reducing abdominal distension. Replace with new leeches. Distended leeches revive in fresh water. Wu Nei Han’s *Beiji Fang* records his nephew Zu Ren developing a bowl-sized red swollen back sore, cured overnight using this method. (*Baibai Fang*)

Formerly, a Tongpan of Yanzhou (name forgotten) prayed for his mother’s back carbuncle. Laozi (Lao Tzu) appeared in a dream wearing green clothes, saying: "Your filial piety is great, so I bring this formula. One more day delay makes it untreatable." The Tongpan bought medicine, curing her immediately. Use five Gualou (Trichosanthis Fructus), grind seeds finely; five pieces of Rushan (Boswellia Carrii Resina), size of dates, grind finely; add one jin of white honey, boil into paste. Take 2-3 qian, dissolved in warm wine. Highly effective for back carbuncles and malignant sores; twice daily dosing ensures immediate effect. Yang Wang obtained this formula; family members with various sores/toxins cured immediately using it, sharing it with others with consistent success. It treats fistulas and malignant nodules. This is the miraculous formula mentioned by Zhu Baoyi of the Prince of Zheng’s mansion. (*Yishuo Xubian*)

Lizhai treated Zhang Jin yi, over forty, with a back carbuncle. Heart pulse was large-rapid, indicating critical danger. Classics state: Large-rapid heart pulse signifies extreme Heart Fire. All itching and sores belong to Heart Fire. Heart governs Blood; Heart Qi stagnation prevents Blood flow, causing carbuncles. Qizhuma acupoint is where Heart Mai originates. Urgent moxibustion clears Heart Fire; garlic-separated moxibustion draws out toxin; Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) ensured recovery.

Zheng Dali Boxing suffered from carbuncles on both sides of the hip bone, causing back heaviness like carrying a stone and arm drooping. Heads were bean-sized, with countless millet-like hidden spots. Dark, non-elevated color, age seventy, dry mouth/thirst. Spleen-Stomach pulses were very deficient. He reported undigested porridge causing acid regurgitation, deeming it untreatable. Consulting friends, garlic-separated moxibustion (20+ cones) relieved back/arm discomfort. Liujunzi Tang (Six Gentlemen Decoction) with ginger-fried Zhizi (Gardeniae Fructus) and Wuzhuyu (Evodiae Fructus) stopped acid regurgitation and improved appetite. Dry mouth and non-elevated/non-red/non-pus forming sore persisted. Another 20+ cones of moxibustion relieved back/arm, promoting eruption. In autumn, strong tonics and Shengmai San (Generate Pulse Powder) replaced tea.

Zhonghan of Liudu suffered from back carbuncle in mid-summer for half a month. Ten-plus millet-like heads, diffuse hard swelling, plate-like base, back heaviness. Fifty-plus garlic-separated moxa cones lightened the back. Believing cured, he ignored taboos. Three days later, severe recurrence with non-eruption. Fortunately, pain returned. Huoming San (Life-Saving Powder) four doses reduced severity. Xiangsha Liujunzi Tang (Amomum and Six Gentlemen Decoction) four doses improved appetite. Relying on medical knowledge, he took detoxifying medicines, worsening appetite, causing unconscious salivation, indicating severe Spleen deficiency. Tuoli medicines containing 3 qian each of Renshen (Ginseng Radix et Rhizoma) and [missing herb name] were secretly discarded by him. Later, strong tonics with Ginger/Cinnamon failed. His son prepared a decoction of 1 jin each of Renshen (Ginseng Radix et Rhizoma) and [missing herb name], 0.5 jin each of Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), 1 liang each of Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamon Bark), and Fuzi (Aconiti Lateralis Radix Preparata), boiled into a jar of paste, consumed in three days. Salivation stopped, necrotic tissue sloughed, appetite returned. Tuoli Jianpi medicines completed recovery. (Xu Lingtai said: After major ulceration, Essence-Blood is severely depleted, requiring warming tonification. However, incomplete healing implies concurrent surgical issues: clear/thin pus, unresolved chills/fever, unclear fire-toxin, unharmonized stomach, ungenerated new flesh, or accumulated toxin-phlegm. Various conditions exist. If...)