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If there is necrotic tissue in carbuncles and sores (severe purulent infections) that needs to be removed, use Baidingxiang (Guano of White Pigeon) and Shuangmei (Frost Plum). If the wound is deep, pack it in; if shallow, sprinkle it dry onto a plaster. This is very effective.

[Xue Ji] Another prescription: Add a small amount of Xionghuang (Realgar) and Badou (Croton Seed) to the plaster. It does not damage healthy flesh but only removes foul necrotic tissue. Not only for foul ulcers, but for any carbuncle or toxin with foul tissue, this can remove it.

Another prescription: Xionghuang San (Realgar Powder). Take one qian of Realgar and grind separately. Do not peel Croton Seed, grind into a paste. Add a small amount of Ruxiang (Frankincense) and Moyao (Myrrh), grind finely again. Sprinkle a little on top, and the foul tissue will naturally fall off.

Wujin Gao (Black Gold Ointment): Treats central necrosis in back carbuncles. Applied, it causes immediate putrefaction of dead tissue; applied to living tissue, it promotes immediate growth. If used at the initial stage of swelling and pain, applying it to a few points will instantly dissipate the toxicity. If the flesh has already rotted, application leads to immediate ulceration. For foul or stubborn ulcers where the vital energy (Yuan Qi) is not depleted but healing is prolonged due to internal toxic roots, dip paper twists in the medication and insert them into the wound. Some back carbuncles occur due to depletion of vital energy, or excessive purging damaging the stomach qi, causing toxic vapors to scatter. The center appears dark red while the periphery is bright red, neither rotting nor ulcerating. After taking major tonifying formulas, apply the ointment centrally over an area of three to four cun. Within five to six days, cracks resembling knife cuts will naturally appear at the boundary between the red and dark areas. The center will gradually turn black and detach. Pure yang medications must be used to reconnect the vital energy, allowing for convergence. If knives or needles are recklessly used to remove flesh and cause bleeding, yang energy scatters with yin blood, further injuring vital energy. Or if cooling medications are applied, toxic vapors are not resolved, and qi and blood become more deficient. This is useless and harmful.

Use only Croton Seed, remove the shell, stir-fry until black, and grind into a paste. Dab onto the affected area, mixing when ready for use.

Zuidu Dan (Toxin-Chasing Pill): Treats carbuncles and sores that have turned black and sunken. Use a needle or knife to open the sore, insert this pill to induce ulceration, then remove necrotic tissue and drain pus. Treat according to the syndrome. It treats carbuncles, sores, ding sores (hard boils), and deep bone abscesses.

Ingredients: Croton Seed (7 seeds, remove skin and heart, do not remove oil, grind to paste); Baidingxiang (Guano of White Pigeon) and Qingfen (Calomel) (each 1 qian); Xionghuang (Realgar) and Huangdan (Lead Oxide) (each 2 qian).
Grind these ingredients together evenly. Add 3 qian of white flour, mix with water drops to form pills the size of wheat grains. Pierce the sore and insert the pill, cover with Frankincense Plaster to chase out pus, blood, and toxic matter. If necrotic muscle on the walls of a fistula is not removed, it cannot be cured. This formula also chases toxins and removes dead muscle to nourish new tissue. For small lesions, use one pill; for larger ones, increase the number of pills.

Zuidu Wujin San (Toxin-Chasing Black Gold Powder): Treats foul tissue and toxins in sore openings, discharging pus and blood.
Ingredients: Badou (Croton Seed) (5 qian); Hanshi Mian (Cold Food Flour) (1 liang); Hao Xi Mo (Fine Ink Stick) (1 stick).
Grind into fine powder. Mix with water and flour to make cakes, wrap the Croton Seed tightly inside without letting air escape. Fire-roast over mild to strong heat until deep black, then grind to fine powder. Apply to the sore as needed. Mix with gallbladder bile to form pellets. Grind with fresh water for use. Scanning/applying 5-7 times is excellent.

Wutong Lei Fang (Tallow Tree Resin Formula)
For carbuncles with severe swelling, foul nature, induration, and lack of ulceration. Use a sharp knife to cut the affected area into a cross shape. Mix flour and water to a thick consistency, building up the perimeter of the sore opening by about 0.5 fen high, like a pond. Fill half full with Tallow Tree Resin. Drop good rice vinegar onto the resin; it will boil shortly. Do not let it boil over. The next day, wash clean with decoction of Jinyinhua (Honeysuckle Flower), and repeat the application. Washing only with vinegar causes no pain, and rotten flesh falls off naturally.

[Xue Ji] Commentary: This formula is indeed suitable for foul ulcers and necrotic tissue that does not slough. However, cases where yang qi is deficient and cannot promote putrefaction should be treated with major tonifying formulas.

Treating foul ulcers with necrotic tissue and chasing pus (from *Baoming*)
Ingredients: Baidingxiang (Guano of White Pigeon), Qingfen (Calomel), Fenshuang (White Lead Powder), Xionghuang (Realgar), Shexiang (Musk) (each 1 qian); Badoushuang (Croton Seed Frost/Paste) (3 units).
Grind into fine powder, mix with fresh rice dough to form pellets for use.

Shenyi Gao (Miraculous Ointment): Treats carbuncles and sores with decay and various toxic eruptions.
Ingredients: Xionghuang (Realgar) (5 qian); Huashi (Talcum) (double the amount).
Grind to powder. After washing, sprinkle on the sore, and cover externally with cotton for protection. Use this plaster for any washed, broken sores.

Zhitong Badu Gao (Pain-Relieving Toxin-Pulling Ointment): Treats all types of eruptive sores that are foul-smelling and unbearable to approach. If unbroken, apply to induce rupture; if broken, promotes flesh regeneration. Used for beating injuries and ding sores.
Ingredients: Banmao (Mylabris Beetle) (49 pieces); Liuzhi (Willow Branch) (49 strips); Mugua Zi (Momordica Seed) (7 pieces); Ruxiang (Frankincense) (3 qian); Moyao (Myrrh) (3 qian); Shexiang (Musk) (a little); Songzhi (Pine Rosin) (3 qian).
Boil the black willow branches in 14 liang of pure clear sesame oil until charred and dry. Filter out the dregs. Add 5 liang of Huangdan (Lead Oxide), testing by dropping into water until pearls form. Then add the other medicines, stir well, and store in porcelain jars for later use.

Guoshi Qingjin Dingzi (Gu Family Green Gold Pellets)
Ingredients: Tonglv (Malachite) (3 qian); Qingfan (Green Vitriol), Danfan (Blue Vitriol), Qingfen (Calomel), Pishuang (Arsenic Trioxide), Baidingxiang (Guano of White Pigeon), Kutingli (Seed of Lepidium) (each 1 qian); Naizi (Borneol) (a little); Shexiang (Musk).
First grind Tulingli finely, then add all other medicines and grind extremely fine. Make into pellets with thick paste. Alternatively, refine honey with 1 qian of Baiji (Bulbus Belamcandae) powder to form pellets, similar in thickness to Mahuang (Ephedra), about 2-3 cun long. Insert according to the depth of the sore opening. If painful, it is treatable; if painless, difficult to treat.
Type 1: Jinjun Biyun Dingzi (Tight Jade Cloud Pellet), raw Pishuang (Arsenic Trioxide), used to open the sore.
Type 2: Jinwan Bixia Dingzi (Loose Jade Glow Pellet), processed Pishuang, used to remove dead flesh.
Type 3: Manwan Biyu Dingzi (Slow Jade Jade Pellet), remove Pishuang, add Kufan (Burnt Alum), used to generate healthy flesh.

Cuixia Dingzi (Emerald Glow Pellet): Treats chronic cold fistulas and long-standing foul ulcers with bad flesh.
Ingredients: Tonglv (Malachite), Hanshuishi (Calcined Halloysite) (processed, each 3 qian); Huashi (Talcum) (3 qian); Mingfan (Alum), Nifen (Calomel), Pishuang (Arsenic Trioxide), Yunmushi (Mica) (ground to powder, each 1.25 qian).
Grind into fine powder. Make into pellets with paste, thickness of Mahuang, length unrestricted. Insert according to sore depth. Preparation should be done on clear, sunny days.

Xinxiao Dingzi (Faithful Effect Pellet): Treats all foul ulcers.
Ingredients: Hongniangzi (Red Lady Beetle), Huangdan (Lead Oxide), Pishuang (Arsenic Trioxide), Yingshi (Eagle Droppings), Tuxiao (Saltpeter), Baiji (Bulbus Belamcandae), Tonglv (Malachite) (each 1.5 qian); Naoren (Borneol), Shexiang (Musk) (each a little).
Grind into fine powder. Mix with a little milk to form pellets. Stop when the disease is cured.

Hongyu Dingzi (Red Jade Pellet): Removes bad flesh and generates muscle.
Ingredients: Gan Yanzhi (Dry Rouge), Baifan (Alum) (calcined, each 3 qian); Qingfen (Calomel), Pishuang (Arsenic Trioxide), Huangdan (Lead Oxide), Naoren (Borneol), Shexiang (Musk) (each a little).
Grind to extremely fine powder. Mix with thick paste to form pellets.

Shixiao Zhentou San (Timely Needle-Head Powder): Erodes foul ulcers and bad flesh, also treats scrofula.
Ingredients: Chishizhi (Red Kaolin) (0.5 liang); Ruxiang (Frankincense), Baidingxiang (Guano of White Pigeon) (each 2 qian); Pishuang (Arsenic Trioxide, raw), Huangdan (Lead Oxide) (each 1 qian); Qingfen (Calomel), Shexiang (Musk) (each 0.5 qian); Wugong (Centipede) (1 piece, dried by roasting).
Grind to extremely fine powder. Sprinkle into the sore opening; bad flesh will naturally fall off. If knives/needles are used, the sore may heal but will leave scars.

Zuidu Bing (Toxin-Chasing Cake): Treats various foul ulcers where an opened sore closes up again, generating pus with unbearable swelling and pain. Roll this into balls the size of wheat grains, insert into the sore to prevent closure, allowing pus to drain naturally until the sore dries and heals.
Ingredients: High-quality Xinshi (Arsenolite) (0.5 qian); Xionghuang (Realgar), Cihuang (Orpiment), Dashazhu (Cinnabar) (each 1 qian); Qingfen (Calomel) (a little).
Grind to fine powder. Form pills with sticky rice paste, size of wheat grains. If the sore closes and generates pus, insert the medicine and cover with a plaster.
Internal medicine: Neizhidu Dan (see previous formula).

[Xue Ji] Commentary: This represents the principle of using toxicity to combat toxicity. I once treated a county magistrate with a back sore that became necrotic, dark, and heavy as if carrying a stone, critically ill. Fortunately, his appetite was good. After using Taohong San (Peach Red Powder), the color gradually turned red, the heaviness decreased, and after further use, muscle grew. He recovered after taking Tuoli (Supporting Interior) herbs. This is a major toxic condition, requiring harsh drugs. Since arsenic is used, it effectively attacks the toxin. However, in cases of qi and blood deficiency preventing putrefaction, one should tonify qi and blood. Commonly, for early-stage back carbuncles before suppuration, first use Wujin Gao or Yuansheng Gao, dabbing several points to reduce the main pathogenic force, then take Xianfang Huoming Yin. If appetite is poor or food tastes bland, use Liujunzi Tang (Six Gentlemen Decoction) with Huoxiang (Patchouli), taken for 3-5 doses. If the outer skin begins to rot/move, wash with Xionghuang Jiedu San (Realgar Detoxification Powder). Daily, apply Wujin Gao to the rotting area. When a sore opening forms, make paper twists dipped in Wujin Gao and insert them. If pus is trapped by fascial septa causing swelling and pain, use a needle to guide it out, removing blocked necrotic tissue. If bruised flesh moves/rots, wash with Zhu Ti Tang (Pig Trotter Decoction). If pus is thick and painful, but diet is normal, the bruised flesh will rot naturally; combine Xiaodu (Disinfecting) herbs with Tuoli (Supporting Interior) herbs, still applying Wujin Gao. If the bruised flesh separates from healthy flesh, remove it. If pus is neither thick nor thin, pain persists, diet is poor, and flesh rots slowly, moxa burn the affected area with Sangzhi (Mulberry Twig), and primarily treat with Tuoli herbs. If flesh does not rot, or pus is clear/thin and painless, take major tonifying formulas and continue Sangzhi moxibustion to supplement and connect yang qi, dissipate stagnant toxins, and the flesh will rot naturally.