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Xue Lizhai treated a male patient who suffered from a carbuncle in the chest. The swelling was high and painful, with a floating and tight pulse (Pulse Floating and Tight). After taking two doses of Neituo San (Internal Support Powder) decoction, the exterior symptoms (Exterior Syndrome) completely subsided. Subsequently, using Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder), four doses resulted in the resolution of the carbuncle.

Another male patient, whose constitution was inherently weak, developed a chest carbuncle. He had reduced appetite and fatigue. He was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), and Huangqi Radix Astragali Membranacei (Huangqi). Once pus formed, it was lanced with a needle, and he recovered after further treatment with interior-supporting medicines.

Xue Lizhai treated another male patient with a chest carbuncle characterized by painful irritability, fever, thirst, and a rapid and solid pulse (Pulse Rapid and Solid). It was late winter, indicating internal accumulation of heat-toxin. One should set aside seasonal constraints and treat based on symptoms, intending to use Neishu Huanglian Tang (Internal Draining Coptis Decoction). However, due to the severe cold, the patient had indiscriminately used cooling-toxin drugs, exacerbating the condition. Upon seeking treatment again, the aforementioned prescription was administered for two doses; later, the purgative components were removed twice, and all symptoms subsided. Then, Jinyinhua San (Lonicera Powder) added with Lianqiao Fructus Forsythiae (Lianqiao) and Gardeniae Fructus (Shanzhi) was given for four doses, leading to resolution through drainage. Generally, diseases have primary and secondary aspects; treating the primary aspect causes the secondary aspects to recede. Applying flexible strategies means not being bound by seasons or rigid conventions; sticking to routine will inevitably lead to critical conditions. Moreover, habitual use of attacking agents damages the meridians. Thus, Zhu Danxi stated: When sores arise in one meridian, one should seek the cause within that meridian and not interfere with others. Luo Qianfu said: Adhering to convention is the view of the masses; knowing how to vary is the act of the wise. Knowing the constant but not knowing how to vary leads many to failure over minor matters.

Another male patient suffered from chest toxicity with pain, aversion to cold, and a surging and rapid pulse (Pulse Surging and Rapid). Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) was administered for two doses, causing immediate relief. Subsequently, Jinyinhua San was given for six doses until resolution.

A young woman had an ulcerated opening between her chest and diaphragm, discharging pus and blood corresponding to what she coughed up. She was treated with Renshen Radix Ginseng (Renshen), Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu), Danggui Radix (Danggui), plus antipyretic and pus-draining herbs, resulting in recovery. (My note: This condition was caused by Fei Wei [Flaccidity Disease of the Lung]. Original annotation.)

Madam Zhang, wife of Commissioner Zhang, had a stern and irritable temperament. She experienced pain in the front of her chest, unchanged skin color, a rapid pulse, and aversion to cold. The Classic states: A surging and rapid pulse usually corresponds to fever; if there is aversion to cold instead, it indicates Chuang Ju (sores and ulcers). Since the pulse is surging and rapid, pus has already formed. However, because she was obese, the color did not change, suggesting no pus. Only when the pain became extreme did she consent to needling; several inches were inserted, draining bowls of pus. She was then cured with heat-clearing and detoxifying medicines. If one had stuck to the appearance of the skin and avoided needling, there would have been no hope for rescue.

(My note: The Liver Meridian passes through the stomach and pierces the diaphragm. It is also said that diseases generated by this meridian include chest fullness. Therefore, chest carbuncles and ulcers originate from the Liver.)

Military Officer Yang suffered from chest toxicity with high, red swelling, fever, a rapid pulse, and difficult urination and defecation, while his diet remained normal. Qi Shi stated: Swelling rising with red color, chills and fever, pain, hot skin, and heavy/dizzy head and eyes indicate excess of Qi and Blood. He also said: Hard stool, difficult urination, normal diet, abdominal distension, chest oppression, limb/joint pain, body heat, large pulse, and mental confusion indicate excess in the Zang-Fu organs. Thus, Huanglian Neishu Tang was given for two doses, gradually reducing symptoms. Then, Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Defeat Pathogens) added with Huangqin Radix Scutellariae (Huangqin), Huanglian Rhizoma Coptidis (Huanglian), and Shanzhi was given for four doses, showing slight improvement. Finally, Siwu Tang (Four Substance Decoction) added with Huangqin, Huanglian, Baizhis Radix Angelicae Dahuricae (Baizhi), Jiegeng Radix Platycodonis (Jiegeng), Gancao Radix Glycyrrhizae (Gancao), and Yinhua Flos Lonicerae Japonicae (Yinhua) was given for several doses until recovery.

A male patient had a chest lump that did not resolve for half a year. He was instructed to undergo moxibustion for one hundred burns before it could suppurate. Large tonifying medicines failed to close the wound, but he recovered after moxibustion with Fuzi Bing (Aconite Cake).

Zhang Luyu treated Tan Zhongan, who was obese and fond of drinking. In summer, he suffered from severe fever, vomiting, and retching, with dull pain on the left side of the chest/diaphragm, intolerable to touch, difficult and frequent urination/defecation, slippery tongue coating, vomiting thick phlegm after eating, and eventually bloody fluid. The pulse was choppy and irregular. Liangge San (Cool the Epigastrium Powder) added with Shihu Dendrobii Caulis (Shihu) and Lianqiao was prescribed, expelling much thick greasy material. Initially, other doctors treated him as Fei Yong (Lung Carbuncle) without effect. Zhang said: Lung Carbuncle must involve coughing and expectoration of foul-smelling sputum. This patient only vomited and did not cough, undoubtedly indicating Stomach disease. Four or five days after purgation, vomiting recurred. A small dose was administered again, and the condition stabilized after thirty doses. Later, Baoyuan Tang (Preserve the Origin Decoction), Fuling Sclerotium Poriae (Fuling), and Chenpi Pericarpium Citri Reticulatae (Chenpi) were used to harmonize for twenty days until cure. Previously, a Mr. Li suffered from this condition, focusing solely on clearing heat, resolving phlegm, and detoxifying. Eventually, the diaphragmatic area ulcerated and腐rotted, with dripping pus, lingering for a month before death. Indeed, failing to recognize the opportunity early led to irreparable regret.

(My note: This condition is hardest to distinguish clearly, corresponding to the Nei Jing's description of "internal wrapping of large amounts of pus and blood." A famous doctor in my hometown suffered from this himself. Colleagues diagnosed him but did not recognize it as a carbuncle. They indiscriminately administered Renshen, Fuzi Radix Aconiti Lateralis Preparata (Fuzi), Dingxiang Flos Syzygii Aromatici (Ding), and Rougu Cortex Cinnamomi (Rougui). Only after spitting out foul-smelling pus long afterward did he realize the truth, but it was too late.)