薛立斋治一弱人臀痈，脓成不溃，以十全大补汤，数剂始托起。乃针之，又二十余剂而愈。此症
弱人宜补气血为要。
一人臀痈， 肿痛甚，此邪毒壅滞，用活命饮隔蒜灸而消。后因饮食劳倦，肿痛复作，寒热头痛，
此元气
虚而未能复也。与补中益气汤，频用葱熨法，两月而愈。
昆庠吴转之父患此，内溃又胀，发热口干，饮食少思，此脾虚弱也。先用六君子加芎、归、 ，
数帖而溃。又用十全大补汤，倍加参、 ，五十余剂而愈。
一男子臀痈，硬痛发热，此膀胱气虚，而湿热壅滞。用内托羌活汤二剂，热痛悉退。后用托里消
毒散而溃，又用托里散四十余剂而敛。
一男子臀痈，肿硬作痛，尺脉浮紧，按之无力，以内托羌活汤，一剂痛止。以金银花散，四剂脓
溃而愈。
一男子臀痈，肿硬痛甚，隔蒜灸之，更服仙方活命饮，二剂痛止肿消。以托里消毒散加黄柏、苍
术、羌活，疮头溃而愈。
一男子臀痈，作脓而痛，以仙方活命饮，二剂痛止。更以托里消毒散，脓溃而瘥。
一男子臀痈，不作脓，饮食少思，先用六君子汤加芎、归、黄 ，饮食渐进。更以托里消毒散，
脓溃而愈。
一男子臀痈溃，而脓清不敛，以豆豉饼灸之，更饮十全大补汤，两月余而痊。凡疮不作脓，或不
溃，或溃而不敛，皆气血之虚也。若脓清稀，尤其虚甚也。
一男子臀痈，脓水不止，肌肉渐瘦，饮食少思，胃脉见弦，以六君子汤加藿香、当归，数剂饮食
渐进。以十全大补汤及豆豉饼灸之，两月余而敛。
薛立斋治一弱人，臀漫肿，色不变，脉滑数而无力，此臀痈也。脓将成尚在内，欲治以托里药，
待发出而用针。彼欲内消，服攻伐药愈虚。复求治，仍投前药，托出针之，以大补药而愈。凡疮毒瓦斯
已结不起者，但可补其血气，使脓速成而针去，不可论内消之法。脓成又当辨其生熟浅深而针之。若
大按之乃痛者，脓深也；小按之便痛者，脓浅也；按之不甚痛者，未成脓也；按之即复起者，有脓也；
按之不复起者，无脓也。若肿高而软者，发于血脉；肿下而坚者，发于筋骨；色相不变，发于骨髓也。
（此条旧案已收，因无后段发明，故录之。）
一男子臀痈腐溃，肌肉不生，用药敷之，四沿反硬。诊之，脉涩而弱，此气血不能荣于患处，故
敷凉药反硬，乃气血受寒凝结而非毒也。用大补药愈矣。
一人患臀痈，用五爪龙，连枝捣汁，酒漉服，日进四五次，脓从大便出，未成脓者内消。如有头，
以渣敷上立散。治鱼口极效。（《广笔记》）
曹文部文兆，年逾四十，髀胛患毒，已半月余，头甚多，状如粟许，内痛如癞，饮食不思，怯甚，
脉歇止。此元气虚，疽蓄于内也。非灸不可，遂灸二十五壮。以六君子汤加藿香、当归，数剂疮势渐
起，内痛顿去，胃脉渐至。但色尚紫，瘀肉不溃，此阳气尚虚也。燃桑柴灸之，以补接阳气，解散其
毒。仍以前药加参、 、归、桂，色赤脓稠，瘀肉渐腐取去，两月余而愈。夫邪气沉伏，真气怯弱，
不能起发，须火灸而兼大补。投以常药，待其自溃，鲜有不误者。
沈侍御患臀肿痛，小便不利。彼谓关格症，以艾蒸脐，大便赤不利。以降火分利之药，治之不应。
诊其脉数脓成，此痈患也，遂针之，出脓数碗许，大便即利。五日阴囊肿胀，小便不行，仍针之，参、
连、归、术之药犹缓，俾服独参汤至二斤，气稍复。又服独参汤，兼以托里药，两月余而平。大抵疮
疡脓血之泄，先补气血为主，虽他病，当从末治。
滕千兵年逾五十，臀患痈，脓熟不开，攻通大肛，脓从大便而出。辞不能治，果毙。丹溪云∶臀
居小腹之后，阴中之阴也。道远位僻，血亦罕周。中年后尤虑患此，况脓成不刺，欲不亡得乎？
Xue Lizhai treated a patient with weak constitution suffering from a carbuncle on the buttocks. The pus had formed but failed to ulcerate spontaneously. He prescribed Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction), and after several doses, the healthy qi was boosted, causing the pus to rise. Subsequently, acupuncture was performed to drain the pus, and after more than twenty additional doses of herbal medicine, the patient recovered. For this condition in patients with weak constitutions, tonifying Qi and Blood is essential.
Another patient suffered from a buttock carbuncle with severe swelling and pain, indicating stagnation of pathogenic toxins. He was treated with Xianfang Huoming Yin (Immortal Formula for Life Preservation) combined with garlic-separated moxibustion, which resolved the swelling and pain. Later, due to improper diet and overexertion, the swelling and pain recurred, accompanied by aversion to cold, fever, and headache. This indicated deficiency of Yuan Qi (Original Qi) and failure to recover. He was given Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and frequent application of scallion-moxibustion (a method involving hot compresses with scallions to unblock meridians). After two months, he recovered.
The father of Wu Zhuan, a student at the Kunshan Imperial Academy, suffered from this condition with internal ulceration and abdominal distension, fever, dry mouth, and poor appetite, indicating Spleen deficiency. Initially, Liujunzi Tang (Six-Gentlemen Decoction) was administered with Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Astragali Membranacei Radix (Huangqi). After several doses, it ulcerated. Then, Shiquan Dabu Tang was used with doubled doses of Ginseng Radix et Rhizoma (Renshen) and Astragali Membranacei Radix (Huangqi). After more than fifty doses, he recovered.
A male patient presented with a hard, painful, and febrile buttock carbuncle, caused by Bladder Qi deficiency leading to damp-heat stagnation. Two doses of Nituo Qianghuo Tang (Supporting Interior and Notopterygium Decoction) completely relieved the heat and pain. Thereafter, Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) was used to induce ulceration, followed by Tuoli San (Interior-Supporting Powder) for more than forty doses until healing occurred.
Another male patient had a swollen, hard, and painful buttock carbuncle. His Chi pulse was floating and tight, but forceless upon deep pressure. One dose of Nituo Qianghuo Tang stopped the pain. Jin Yin Hua San (Honeysuckle Powder) was then administered for four doses, resulting in pus discharge and recovery.
A male patient suffered from a severely swollen, hard, and painful buttock carbuncle. He underwent garlic-separated moxibustion and took Xianfang Huoming Yin. After two doses, pain ceased and swelling subsided. Tuoli Xiaodu San was modified with Phellodendri Cortex (Huangbai), Atractylodis Macrocephalae Rhizoma (Cangzhu), and Notopterygii Rhizoma et Radix (Qianghuo). The abscess head ulcerated, leading to recovery.
A male patient had a buttock carbuncle that formed pus and caused pain. Xianfang Huoming Yin was given for two doses, stopping the pain. Subsequently, Tuoli Xiaodu San was administered, and after pus discharge, he recovered.
A male patient had a buttock carbuncle that failed to form pus and showed poor appetite. Initially, Liujunzi Tang was given with Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Astragali Membranacei Radix (Huangqi), gradually improving his diet. Then, Tuoli Xiaodu San was used, and after pus discharge, he recovered.
A male patient’s buttock carbuncle had ulcerated, but the pus was clear and thin, failing to heal. Moxibustion with fermented soybean cakes (Douchi Bing) was applied, and Shiquan Dabu Tang was drunk. After more than two months, he healed. Generally, if sores fail to form pus, fail to ulcerate, or fail to heal after ulceration, it is due to Qi and Blood deficiency. If the pus is clear and thin, it indicates severe deficiency.
A male patient had a buttock carbuncle with continuous pus discharge, gradual muscle wasting, and poor appetite. His Stomach pulse appeared wiry. Liujunzi Tang was administered with Agastaches Herba (Huoxiang) and Angelicae Sinensis Radix (Danggui). After several doses, his diet improved. He was then treated with Shiquan Dabu Tang and moxibustion with fermented soybean cakes. After more than two months, the wound closed.
Xue Lizhai treated a weak patient with diffuse buttock swelling, unchanged skin color, and a slippery, rapid yet forceless pulse, diagnosing it as a buttock carbuncle. The pus was forming internally. The intention was to use interior-supporting herbs to wait for the pus to surface before puncturing. However, the patient desired internal resolution and took attacking/draining medicines, which further depleted his Qi. Upon seeking treatment again, the previous interior-supporting formula was administered to push the pus out, followed by puncture, and finally, great tonifying medicines led to recovery. For any sore where toxic qi has condensed but fails to rise, one should only tonify Qi and Blood to accelerate pus formation and drainage via puncture; discussing internal resolution methods is inappropriate. Once pus forms, one must distinguish its maturity and depth before puncturing. Deep tenderness upon heavy pressure indicates deep pus; tenderness upon light pressure indicates shallow pus; lack of significant tenderness upon pressure indicates no pus yet; immediate rebound after pressure indicates presence of pus; no rebound indicates absence of pus. High, soft swelling indicates involvement of blood vessels; low, hard swelling indicates involvement of sinews and bones; unchanged skin color indicates involvement of bone marrow. (This old case was already recorded, but is re-recorded here due to the lack of theoretical elaboration in the original text.)
A male patient had an ulcerated buttock carbuncle with no new muscle growth. Topical medication caused the surrounding area to become hard. Diagnosis revealed a choppy and weak pulse, indicating that Qi and Blood could not nourish the affected area. Thus, cooling herbs caused stiffness due to cold coagulation of Qi and Blood, rather than toxicity. Great tonifying medicines cured him.
One patient with a buttock carbuncle consumed juice extracted from fresh roots and branches of Smilax riparia (Wuzhualong, Five-claw Dragon Vine), filtered through wine, taken four to five times daily. Pus was discharged via stool, and unformed pus was resolved internally. If there were pustules, applying the dregs topically caused immediate dispersal. This method is highly effective for treating groin abscesses (Yukou). (From *Guang Biji*)
Cao Wenzhao, a Ministry of Rites official, aged over forty, suffered from a toxic lesion on his thigh/hip for over half a month. It had many heads, sized like millet grains, with internal pain resembling leprosy, loss of appetite, extreme weakness, and intermittent pulse. This indicated deficient Yuan Qi and accumulation of deep-seated carbuncles (Ju) internally. Moxibustion was indispensable; thus, twenty-five moxa cones were applied. Liujunzi Tang with Agastaches Herba (Huoxiang) and Angelicae Sinensis Radix (Danggui) was given. After several doses, the lesion began to rise, internal pain ceased, and the Stomach pulse normalized. However, the color remained purple, and necrotic tissue did not slough off, indicating persistent Yang Qi deficiency. Moxibustion with mulberry wood fire was used to supplement and connect Yang Qi and dissipate toxins. The previous formula was continued with added Ginseng Radix et Rhizoma (Renshen), Astragali Membranacei Radix (Huangqi), Angelicae Sinensis Radix (Danggui), and Cinnamomi Ramulus (Guizhi). The color turned red, pus became thick, and necrotic tissue gradually sloughed off. Recovery occurred after more than two months. When pathogens are deeply entrenched and true Qi is weak, preventing eruption, fire moxibustion combined with strong tonification is required. Relying on ordinary medicines and waiting for spontaneous ulceration rarely succeeds without error.
Attendant Shen suffered from buttock swelling and pain with difficulty urinating. He believed it was Guan Ge syndrome (a critical condition characterized by vomiting and inability to urinate). He used moxibustion on the navel, resulting in dark stools and constipation. Fire-clearing and diuretic treatments failed. Pulse diagnosis revealed rapidity and formed pus, diagnosing it as a carbuncle. Puncture drained several bowls of pus, and bowel movements immediately normalized. Five days later, scrotal swelling occurred with urinary retention. Puncture was repeated. Herbs such as Ginseng Radix et Rhizoma (Renshen), Coptidis Rhizoma (Huanglian), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizoma (Baizhu) acted too slowly. He was instructed to drink Du Shen Tang (Single-Ginseng Decoction) totaling two jin. His Qi slightly recovered. Another course of Du Shen Tang combined with interior-supporting herbs led to recovery after more than two months. Generally, for sores discharging pus and blood, tonifying Qi and Blood is primary. Even for other diseases, treatment should address the local manifestations (the "branch").
Officer Teng, aged over fifty, developed a buttock carbuncle. The pus matured but was not incised, leading to rupture into the large intestine/anus, with pus discharging via stool. The physician declined treatment, and the patient indeed died. Danxi stated: The buttocks are located behind the lower abdomen, representing Yin within Yin. The location is distant and remote, with scarce blood circulation. Those past middle age are particularly prone to this condition. How could one survive if pus forms but is not punctured?