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Xue Lizhai treated Peng Bixi, a government school student (Fuxiang), who suffered from a lumbar carbuncle (Yao Ju). After taking cold-natured detoxifying medicines, the lesion's color became dark and painless, with the head of the sore lying flat like scattered millet grains. The patient felt heavy in the back and could not sleep comfortably; his eyes and ears were dim, face red but lacking spirit, urination frequent and difficult, thirst present with confusion and oppression, breathing coarse and short, pulse floating and rapid but empty upon deep pressure. First, one dose of medicine to nourish Kidney Water was administered. Shortly after, bowel movements and urination became smooth, thirst ceased, and the back felt light and comfortable. Then, bloodletting with a stone knife was performed to drain stasis. Approximately half a jin of moxa was applied directly to the affected area for moxibustion. Wujin Gao (Black Gold Ointment) was applied externally, while internally, Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala), and Rou Gui (Cinnamon Bark) were taken over several doses, gradually restoring Yuan Qi (Original Qi). Suspecting Rou Gui's pungent heat, the patient omitted it for one day, resulting in cold limbs and fecal incontinence. Rou Gui (2 qian) and Bu Gu Zhi (Psoralea Fruit) (2 qian), along with Rou Dou Kou (Nutmeg) (1 qian), were readministered, normalizing bowel movements and allowing gradual suppuration. Subsequently, Dang Gui Gao (Angelica Ointment) was used to regenerate flesh, and Bazhen Tang (Eight Treasures Decoction) was employed to tonify Qi and Blood, leading to recovery.

Fu Yuncheng, a member of the Imperial Guard, sought treatment for his mother, aged over seventy, who had developed a boil on her waist with intense itching. Her pulse was floating and rapid, yet she felt aversion to cold. I stated: "This is a sores-and-maggots syndrome. Weakness appearing before ulceration makes healing impossible. Moreover, constipation indicates exhaustion of True Qi; treatment will be futile." Reluctantly, due to persistent requests, Liu Jun Zi Tang (Six Gentlemen Decoction) with Huo Xiang (Patchouli) and Shen Qu (Medicated Leaven) was prescribed. After several doses, diet improved, and bowels moved. Strong tonics were then given. Upon ulceration, pus was clear, and thirst appeared. Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Dang Gui (Angelica Sinensis), Di Huang (Rehmannia Root), Mai Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Berry) stopped the thirst. The patient rejoiced, saying, "I am safe now." I replied, "Convergence remains difficult, as previously noted." Doubting my words, he sought another physician and eventually died.

Gu Dongxi, a Juren degree holder, suffered from chronic thirst. In early June, he developed a lumbar carbuncle due to careless living habits. The ulcer opened about one chi wide, with dark, foul-smelling tissue, urinary symptoms resembling strangury, cracked lips, and prickling dryness in the mouth and tongue. Seeking treatment at the end of July, his left Chi pulse was flooding and rapid, and the left Guan pulse was floating and choppy. I said: "Thirst preceding carbuncle indicates dried-up Kidney Water and flaming deficient fire, often fatal. Now, foul pus, dark color, painlessness, and gaping wound indicate Spleen Qi failure and muscle death. Urinary strangury, phlegm obstruction, panting, and dry cracked tongue indicate Spleen-Lung failure and exhaustion of Kidney Water. A flooding Chi pulse shows Kidney has no source; a floating-choppy Guan pulse shows Lung overcoming Liver. Amidst the peak of Metal energy, danger is imminent." He indeed died two days later. Such cases dying within two months result from deficient Yuan Qi failing to converge. If tonification had been provided early to preserve Qi and Blood, survival might have been possible.

A man suffered from a toxic swelling on his waist. The pus matured but did not rupture. Puncturing caused massive drainage and increased irritability. Sheng Yu San (Holy to Save Powder) decocted and taken for four doses calmed him. Ren Shen Yang Rong Tang (Ren Shen Nourishing Vigor Decoction) with Mai Dong and Wu Wei Zi cured him in two months. He later developed dampness, becoming a chronic ailment. When sores lose much pus and blood, making closure difficult, tonification is crucial to restore Qi and Blood balance; otherwise, secondary complications arise, making treatment hard. Caution is advised.

Another man had a lumbar carbuncle that emerged but did not ulcerate; his Qi and Blood could only raise the shape but not generate pus. Several doses of strong tonics induced ulceration, followed by more doses yielding thin pus. Consuming over one jin of a paste made of Ren Shen, Bai Shao, Dang Gui, and Bai Zhu thickened the pus. After consuming several jin, pus became thick, and flesh regenerated rapidly. Generally, carbuncles rely on Qi and Blood. Failure to rise, lack of suppuration, poor convergence, or thin/scanty pus all indicate Qi and Blood deficiency. Strong tonification is indicated; attacking agents are taboo. Excessive pus may also occur if Qi and Blood fail to contain it. Post-ulceration fever, thirst, large pulse, and increasing pus indicate deficient True Qi and excess pathogenic factors, which are untreatable. Healthy individuals with robust Qi and Blood typically present with swollen, red, easily suppurating, thick-pus lesions that heal quickly. Frail individuals often fail to rise, do not suppurate, and heal slowly. Blindly using attacking agents causes "deficiency compounding deficiency." Post-illness care, especially for Luoli (scrofula) and Liuzhu (flowing abscesses), requires tonification. Otherwise, secondary issues arise, complicating treatment. Caution is advised.

A person had a toxic carbuncle on the waist, red and swollen but unbroken, causing unbearable pain requiring bending forward. Someone sliced fresh liver from a newly slaughtered male pig and applied it to the sore, securing it with cloth. After one day and night, the disease healed well. The liver turned black and emitted an unbearable odor; discarded on the ground, even dogs refused to eat it. A small spot the size of a little finger remained hard, likely due to incomplete coverage by the liver slice, but no other consequences occurred.

Xue Lizhai treated Zhang Yuanzhong, a Juren from Kunshan, who developed a lumbar carbuncle in early autumn. The head was bean-sized, base three cun wide, slightly swollen and reddish, with full manifestation of deficiency signs. Moxibustion with mulberry branches was applied to the site. One dose of Huo Ming Yin (Living Life Decoction) raised swelling and redness, though appetite remained low. Four doses of Xiang Sha Liu Jun Zi Tang (Aromatic Sand Ginseng Six Gentlemen Decoction) improved diet. Subsequent strong tonics formed pus but failed to rupture. Adding one slice of Fu Zi (Aconite Lateral Root) per dose allowed natural rupture after two doses, curing him in ten days.

Ms. Lu, newly married, suffered from lower back pain without swelling. Pulse was sinking and slippery; mental fatigue was evident. This resulted from internal emotional fire and dietary toxicity. One dose of Tuo Li medicine (Interior-Supporting Medicine) expelled over one sheng of bloody pus. Chen Liangfu stated: "Sores collapsing inward with blue face and black lips are untreatable." She indeed died.

Wang Hongxu treated a man with a lumbar carbuncle. The base spanned over two chi, extending from abdomen to back. It was non-red, non-swollen, non-painful, non-soft, feeling like wood upon pressure. Wang prescribed Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark). Other physicians objected, citing summer heat and rejecting hot formulas, switching to attacking and cooling agents. Five days later, the patient became comatose. Re-examination showed unchanged painlessness, color like overnight pork liver, slurred speech, and inability to eat. Wang predicted death by the next evening.

Another patient took Yang He Tang (Yang Harmony Decoction), feeling relief the next day. After another dose, the carbuncle reduced by half. Xi Huang Wan (Rhino Horn Pill) was alternated with Yang He Tang, curing him in five days. Yang He Tang formula: Shu Di Huang (Prepared Rehmannia Root) 1 liang, Ma Huang (Ephedra Herb) 5 fen, Lu Jiao Jiao (Deer Antler Glue) 3 qian, Bai Jie Zi (White Mustard Seed) 2 qian, Rou Gui (Cinnamon Bark) 1 qian, Gan Cao (Licorice Root) 1 qian, Pao Jiang Tan (Charred Prepared Ginger) 5 fen. Here, Ma Huang paired with Shu Di Huang does not induce sweating; Shu Di Huang paired with Ma Huang does not stagnate the diaphragm. Its efficacy lies here. It treats Gu Cao Feng (Bone Channel Wind), Liuzhu (Flowing Abscess), Yin Ju (Yin Carbuncle), Tuo Gu Ju (Bone-Eating Carbuncle), He Xi Feng (Crane Knee Wind), Ru Yan (Breast Cancer), Jie He (Tubercles), Shi Ju (Stone Carbuncle), Fu Gu Ju (Bone-Adhering Carbuncle), and any diffuse swelling without head, flat collapse, white depression, or general Yin coagulation syndromes. Xi Huang Wan formula: Ru Xiang (Frankincense) 1 liang, Mo Yao (Myrrh) 1 liang, She Xiang (Musk) 1.5 qian, Niu Huang (Calculus Bovis) 3 fen. Ground to powder, mixed with rice paste into pills. Take 3 qian per dose with aged wine. Upper body lesions: take before bed. Lower body lesions: take on an empty stomach. It treats all severe Yin carbuncles and toxins.