泄痛减，以开迟之故，迨二日，变症果生，觉重如负石，热如 火，痛楚倍常，六脉沉数，
按之有力，此膏粱积热之变也。邪气酷热，固宜以寒药治之，时月严寒，复有用寒远寒之
戒！乃思《内经》云∶有假者反之，虽违其时，从证可也。急作清凉饮子，加黄连秤一
两五钱，作一服服之。利下两行，痛减七分，翌日复进前药，其证悉除，月余平复。 虞
奕侍郎，背中发小疮，不悟，只以药调补，数日不疼不痒，又不滋蔓，疑之，呼外医灸二
百壮，已无及。此公平生不服药，一年来，唯觉时时手脚心热，疾作不早治，又误服补药，
何可久也。盖发背无补法，谚云∶背无好疮，但发于正中者，为真发背。（按∶谓发背无补法，
此非通论。然一种痴补而无通变者，又不可不知。）扬州名医杨吉老，其术甚着。有一士人，状
若有疾，厌厌不聊，莫能名其为何苦。往谒之，杨曰∶君热证已极，气血销铄且尽，自
此三年，当以疽死，不可为也。士人不乐而退。闻茅山观中一道士，医术通神，但不肯
以技自名，未必为人致力。士人心计交切，乃衣僮仆之衣，诣山拜之，愿执役左右，道士
喜留寞弟子中，诲以诵经，日夕祗事，顺指如意。经两月余，觉其与常隶别，呼扣其所
从来。士人始再拜谢过，以实告之。道士笑曰∶世岂有医不得之病？当为子脉之，又笑
曰∶汝便可下山，吾亦无药与汝，但日日买好梨啖一颗，如生梨已尽，则取干者泡汤饮
之，仍食其滓，此疾自当平矣。士人归，谨如其戒，经一岁，复往扬州，杨医见之，讶
其颜貌腴泽，脉息和平，谓之曰∶君必遇异人，不然何以至此。士人以告。杨立具衣冠，
焚香望茅山设拜，盖自咎其术之未至也。
程明佑，治槐充胡妪，年六十，疽发背，大如盂，头如蜂窠，呕逆咽不下，疡医药之，
毒虽何杀而胃寒泄。程曰∶病必分阴阳虚实，胃伤于寒，令人呕逆，温补则荣卫充而气血
周贯，则毒随脓出而肌肉渐生，根据方投药四五剂，咽遂下，呕止，已痈溃体渐平。 陈
斗岩治王主政，福建人，背患一痈痛甚。发咳逆十余日，水谷不下，脉伏如绝，医皆不
治。陈视之曰∶此寒凉过甚，中气下陷，以四君加姜桂，三进而病如失，痈亦渐愈。
一男子年五十余，形实色黑，背生红肿，及髀骨下痛，其脉浮数而洪紧，食亦呕，正冬
月，与麻黄桂枝汤，加酒黄柏、生附、栝蒌子、甘草节、羌活、青皮、人参、黄芩、半
夏、生姜，六帖而消，此亦内托之意也。周评事观患背痈，疮口久不合，召疡医徐廷
礼疗治，恒以托里、十宣二散与服，不效。徐谓周曰∶更请盛用美来共事料理，吾技穷矣。
即而盛至，按脉用药，率与徐类，但多加人参五钱，附子稍行功耳，服后两足俱暖，自
下而上，谓其子曰∶今之药，何神哉！顿觉神爽，快服之。旬日而宿口平复。 御医王
介之之内，年四十，背疽不起，泄泻作呕，食少厥逆，脉息如无，属阳气虚寒，用大补剂
加附子、姜桂而不应，再加附子二剂泻愈甚，更以大附子一枚、姜桂各三钱，参、 、归、
术各五钱，作一剂，腹内始热，呕泻乃止，手足渐温，脉息遂复，更用大补而溃，托里而
敛。十年后，终患脾胃虚寒而殁。
丹溪治一人，背痈径尺，穴深而黑，急作参 归术膏饮之，三日略以艾芎汤洗之，气
息奄奄。然可饮食，每日作多肉馄饨，大碗与之，尽药膏五斤，馄饨三十碗，疮渐合，肉
与馄饨，补气之有益者也。 一老人，背发疽径尺，已与五香、十宣散数十帖，呕逆不
睡，素有淋病，急以参 归术膏、以牛膝汤入竹沥饮之，淋止思食，尽药四斤，脓自涌
出而愈。 一人发背痈疽，得内托、十宣多矣，见脓呕逆发热，又用嘉禾散加丁香，时
天热，脉洪数有力，此溃疡尤所忌，然形气实，只与参膏竹沥饮之，尽药十五六斤，竹
百余竿而愈。后不戒口味，夏月醉坐水池中，经年余，左胁旁生软块，二年后成疽，自见
脉证呕逆如前，仍服参膏等而安。 汪石山治一老人患背痈，诊视之，其脉洪缓而濡，痈
肿如碗，皮肉不变，按之不甚痛，微发寒热。乃语之曰∶若在膊胛，经络交错，皮薄骨高
之处，则难矣！今肿去胛骨下掌许，乃太阳经分，尚可治。遂用黄 五钱，当归、羌活、
甘草节各一钱，先令以被盖暖，药熟热服令微汗，寝熟肿消一晕，五服遂安。 薛己治
进士张德弘，背疽微肿微赤，饮食少思，用托里药脓成而溃，再用大补汤之类，肉生而
敛。忽寒热作呕，患处复肿，其脉浮大，按之若无，形气殊倦。薛谓之曰∶此胃气虚惫，
非疮毒也。彼云∶侵晨登厕，触秽始作，仍用补药而敛。 一人，大背患疽年余，疮口
甚小，色黯陷下，形气怯弱，脉浮缓而涩，此气血虚寒也，用十全大补加附子少许，数剂
而元气渐复，却去附子，又三十余剂全愈。一妇年五十余，四月初，背当心生疽如栗大，
三日渐大，根盘五寸许，不肿痛，不寒热。薛诊其脉微而沉，曰∶脉病而形不病者忌也，实
则痛，虚则痒，阴证阳证之所由分也，不发不治，溃而不敛亦不治，乃与大补阳气之剂，
色白而黯，疮势如故，至十二日，复诊其脉沉，疮势不起，神疲食减，小便淋涩，乃与
大补气血加姜桂二剂，疮亦不起，十五日因怒，呕泻并作，服大补药一剂，疮仍不起，薛
留药二剂而去。病者昏愦不服，或劝之省悟，根据方连进七剂，十六日疮起而溃，色红而淡，
脓亦如之。十九日薛至，喜曰∶疮已逾险处，但元气消铄尚可忧，连与大补二十余剂，五
月十一日，病者因劳自汗，口干舌强，太阳发际、胸顶俱胀，复延薛至，诊之曰∶此气
血俱虚，肝胆火上炎，用补中益气汤加山栀、芍药顿愈。但内热少睡，手足发热，不时霍
热，用逍遥散加山栀，热退，复用归脾汤，疮乃愈。计疮发及敛，四十二日。 内翰杨皋
湖，少参史南湖之内（二条并见阳气脱陷。） 一儒
者年几六旬，仲冬，背疽初起入房，患处黑死五寸许，黯晕尺余，漫肿坚硬，背如负石，
发热作渴，小便频数，两耳重听，扬手露体，神思昏愦，脉沉而细，右手为甚，便秘，二
十七日计进饮食百余碗，腹内如常，众欲通之。薛曰∶所喜者此耳！急用大剂六君子加
姜、附、肉桂三剂，疮始 痛。自后空心用前药，午后以六味丸料 加参 ，归、术五
剂∶复用活命饮二剂，针出黑血甚多，瘀脓少许，背即轻软，仍用前药，便亦通利。薛
他往四日，神思复昏，疮仍黑陷，饮食不进，皆以为殒。薛以参、 、归、术各一两，炮
附子五钱，姜、桂各二钱服之，即索饮食并鸭子二枚，自后日进前药二剂，肉腐脓溃而
愈。 操江都宪伍松月，背疮愈后大热，误为实火，用苦寒药一钟，寒热益甚，欲冷水
浴身，脉浮大，按之全无。薛曰∶此阳气虚浮在肌表，无根之火也，急用六君加附子，一
剂即愈。 一男子，背疮不敛， 肿发热，小便赤涩，口干体倦，脉洪数而无力，用参、 、
归、术、熟地黄、芎芍、陈皮、麦冬、五味、炙草、肉桂，补元气，引虚火归经，脉证益
甚，此药力未能及也，再剂顿退。却去肉桂，又数剂而愈。此证因前失补元气故耳。 宪
副陈鲁山年五旬，居官勤苦，劳伤元气，先口干舌燥，后至丙午仲夏，发背疽漫肿，中
央色黯，四畔微赤微痛，脉举之浮大，按之微细，左寸短而右寸若无，十余日，肿未全
起。薛曰∶此属病气元气虚寒，当舍时从证，朝用参、 、姜、桂、归、术、陈皮、半夏、
炙草，温补其阳；夕用加减八味丸，滋其肝肾，各四剂而腐溃。但脓水清稀，盗汗自汗，
内热晡热，脉浮而数，改用八珍汤。复发热而夜阳举，此肾虚而火妄动，仍用加减八味
丸料煎服而安。又因怒动肝火，疮出鲜血二盏许，左关弦数，右关弦弱，此肝木侮脾，肝
不能藏血，脾不能统血也，用十全大补兼用前药料，各二剂而血止，再用前药调理而痊。
一人仲夏，疽发背，黯肿尺余，皆有小头如铺黍状，四日矣，此真气虚而邪气实也。外
用隔蒜灸，内服活命饮二剂，其邪稍退，仍纯补其气，又将生脉散代茶饮，疮邪大退。薛
因他往，三日复视之，饮食不入，中央肉死，大便秘结，小便赤浊，曰∶此间断补药之过
也。盖中央肉死，毒瓦斯盛而脾气虚，大便不通，胃气虚而肠不能送。小便赤浊，脾土虚
而宦陷。治亦难矣，急用六君加当归、柴胡、升麻，饮食渐进，大便自通，外用乌金
膏，涂中央三寸许，四围红肿渐消，中央黑腐渐去，乃敷当归膏，用地黄丸料，与前药
间服，将百剂而愈。 中翰郑朝用，背疽发热，吐痰，饮食无味，肌肉不生，疮出鲜血。
薛曰∶此脾气亏损，不能摄血归源也，法当补脾胃。彼不信，用消毒凉血，加恶寒呕吐，
始悟其言。用六君加炮姜、半夏、茯苓，数剂诸证悉退，又令用十全大补，疮口渐敛。后
因饮食稍多，泄泻成痢，此脾胃虚寒下陷，用补中益气，下四神丸而痢止，继以六君子汤
而疮愈。 封君袁怀雪，背疽发热作渴，脉数无力，用四物加黄柏、知母、玄参、山栀、
连翘、五味、麦冬、银花，脉证渐退，又加白芷、参、 ，腐肉悉溃。因停药且劳，热
渴仍作，乃与参、 、归、芷、炙草、山药、山萸、茯苓、泽泻、肉桂而安。又以六味地
黄丸及十全大补而敛。 都宪周弘FS ，背患疽肿而不溃，脉大而浮，此阳气虚弱而邪气
壅滞也，用托里散倍用参 ，反内热作渴，脉洪大鼓指，此虚火也，用前散急加肉桂，脉
证顿退，仍用托里而愈。若以为热毒而用寒药，则误矣。太仆王 塘，初起因大劳，又
用十宣散之类，加喘渴内热，脉大无力，此阳气自伤不能升举，下陷于阴分而为内热也。
薛以补中益气，加酒炒芍药、麦门冬、五味子，治之而愈。 上舍张克恭患此，内服外
敷，皆寒凉败毒，遍身作痛，欲呕少食，晡热内热，恶寒畏寒。薛曰∶遍身作痛，荣卫
虚而不能营于肉里也；欲呕少食，脾胃虚寒而不能消化饮食也；内热晡热，阴血内虚而
阳气陷于阴分也；恶寒畏寒，阳气虚弱而不能卫于肌肤也。此皆由脾胃之气不足所致。遂
用补中益气汤，诸证渐退，又以十全大补汤，腐肉渐溃，又用六君子汤加芎、归，肌肉顿
生而愈。 儒者周两峰，怀抱久郁，背脊患疽，肝脉弦洪，脾脉浮大，按之微细。以补
中益气汤加桔梗、贝母，少用金银花、白芷，二剂肝脉顿退，脾脉顿复。乃以活命饮二剂，
脓溃肿消，肝脉仍弦，此毒虽去而胃气复伤，仍用补中益气汤加茯苓、半夏而愈。 上舍
蔡东之患此，薛用托里之药而溃，疮口尚未全敛，时值仲冬，兼咳嗽。薛曰∶疮口未敛，
脾气虚也，咳嗽不止，肺气虚也，法当补其母，一日与其同宴，见忌羊肉。薛曰∶补可
以去弱，人参羊肉之类是也，最宜食之，遂每日不彻，旬余而疮敛，嗽亦顿愈矣。 宪
副屠九峰，孟春患此，色黯漫肿，作渴便数，尺脉洪数，此肾水干涸，当殁于火旺之际。不
信，更用苦寒之药；复伤元气，以促其殁。京兆柴黼庵，仲夏患之，色黯微肿，发热烦
躁，痰涎自出，小腹阴实。手足逆冷，右关浮涩，两尺微细。薛曰∶此虚寒之证也，王
太仆云∶大热而不热，是无火也，决不能起。恳求治之，遂用大温补之药一剂，流涎虽止，
患处不起，终不能救。 顾包泉老医，年六十有五，因盛怒疽发于背，大如盂，四围色
黑，召疡医治之，用冷药敷贴，敷已觉凉。约曰∶七八日后，为用刀去瘀肉。顾俟其去，曰∶
四围色黑，乃血滞，更加冷药，非其治也。乃更治热敷药，去旧药敷之。觉甚痒终夜，明
日色鲜红， 肿亦消。惟中起数十孔如蜂房，一日许，又觉恶心作哕，视一人头如两人头，
自诊曰∶此虚极证也，用参附大剂进二服，视已正矣，不数日竟愈。
一妇因得子迟，服神仙聚宝丹，背生痈甚危。脉散大而涩，急以加减四物汤百余帖，
补其阴血，幸其质浓，易于收敛。
Pain decreased due to the delay in treatment. By the second day, complications indeed arose: the body felt heavy as if carrying a stone, feverish as if burning with fire, and pain was doubled. The six pulses were deep and rapid, forceful upon pressure. This is a transformation caused by accumulated heat from rich food (gaoliang). Although the pathogenic factor is intensely hot and should theoretically be treated with cold herbs, the season is bitterly cold, invoking the taboo of "avoiding cold when using cold remedies" (yong han yuan han)! Recalling the *Neijing* stating: "When there is a false presentation, act contrary to it," although this contradicts the seasonal timing, one must follow the syndrome. I hastily prepared Qingliang Yin (Cooling Drink), adding 1 liang 5 qian of Huanglian (Coptidis Rhizoma), administered as a single dose. After two bowel movements, pain reduced by seventy percent. The next day, the same prescription was repeated, symptoms completely resolved, and full recovery occurred within a month.
Yu Yi, Vice Minister, developed a small sore on his back but failed to recognize it, relying only on tonic medications for days. It became painless and itchless without spreading, which aroused suspicion. An external surgeon was called to apply moxibustion (two hundred moxa cones), but it was too late. This gentleman rarely took medicine; for a year he had felt intermittent heat in his palms and soles. Failure to treat early, combined with mistaken use of tonics, made longevity impossible. Generally, Fa Bei (Back Carbuncle) has no place for tonic therapy. As the saying goes: "There are no good sores on the back"; only those arising in the midline are considered true Fa Bei. *(Note: The statement that Fa Bei admits no tonification is not an absolute rule. However, those who blindly apply tonics without flexibility must be warned against this.)*
Yang Jilao, a famous physician in Yangzhou, possessed great skill. A scholar appeared ill, listless and unable to describe his suffering. Upon consultation, Yang stated: "Your heat syndrome is extreme; qi and blood are nearly exhausted. In three years, you will die from a carbuncle; it is incurable." The scholar left displeased. He heard of a Daoist priest at Maoshan Temple whose medical skills were divine, though he did not boast of them and might not wish to serve others. Desperate, the scholar dressed as a servant, went to the mountain, and begged to serve the priest. The priest gladly accepted him among his disciples, teaching him sutra chanting and daily service. After over two months, the priest noticed the scholar differed from ordinary servants and questioned him. The scholar bowed, apologized, and confessed the truth. The priest laughed and said: "Is there any disease in the world that cannot be cured?" He examined the pulse and added: "You may return home. I have no medicine for you, but buy good pears daily, eat one raw each day. If fresh pears run out, soak dried pears in water to drink, and consume the dregs. Your illness will heal naturally." The scholar followed these instructions strictly. One year later, he returned to Yangzhou. Physician Yang saw him, amazed by his ruddy complexion and harmonious pulse, remarking: "You must have met a supernatural person; otherwise, how could you recover thus?" The scholar explained. Physician Yang immediately donned formal robes, burned incense, and bowed towards Maoshan, blaming his own lack of mastery.
Cheng Mingyou treated Hu, an elderly woman of sixty, with Fa Bei Ju (Back Carbuncle). The lesion was bowl-sized with a honeycomb-like head. She suffered from vomiting and inability to swallow. External surgeons treated her, killing the toxin but causing cold-stomach diarrhea. Cheng stated: "Diseases must be differentiated into yin/yang and deficiency/excess. Cold injury to the stomach causes vomiting and reflux. Warming and tonifying will replenish Ying and Wei (nutritive and defensive qi), circulate Qi and Blood, allowing the toxin to exit with pus while muscles regenerate." Prescribing four or five doses according to the formula, swallowing improved, vomiting ceased, the abscess ruptured, and the body gradually flattened.
Chen Douyan treated Wang, a Chief Magistrate from Fujian, who suffered severe pain from a back carbuncle. For ten days he coughed violently, could not eat or drink, and his pulse was hidden and faint, resembling absence. Physicians gave up. Chen observed: "This results from excessive use of cold-cooling herbs, causing sinking of Middle Qi." He prescribed Si Jun Zi Tang (Four Gentlemen Decoction) with Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex). After three doses, the illness vanished, and the carbuncle healed.
A man in his fifties, robust and dark-skinned, developed red swelling on his back and pain below the femur. His pulse was floating, rapid, surging, and tight. He vomited after eating. It was mid-winter. I prescribed Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) plus Jiuhuangbai (Alcohol-processed Phellodendri Cortex), Sheng Fuzi (Prepared Aconiti Lateralis Radix), Gualouzi (Trichosanthis Semen), Gancao Jie (Glycyrrhizae Radix et Rhizoma segments), Qianghuo (Notopterygii Rhizoma et Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), and Sheng Jiang (Zingiberis Rhizoma Recens). Six doses eliminated the condition, employing the principle of internal support (Neituo).
Zhou Pingshi Guan suffered from a back carbuncle with a non-healing wound. Surgeon Xu Tingli treated him with Tuoli San (Support Interior Powder) and Shixuan San (Ten Acupoints Powder) repeatedly without effect. Xu told Zhou: "Invite Sheng Yongmei to assist; my skills are exhausted." When Sheng arrived, his pulse-taking and prescribing were similar to Xu's, but he added 5 qian of Renshen (Ginseng Radix et Rhizoma) and slightly adjusted the usage of Fuzi (Aconiti Lateralis Radix Praeparata). After taking the medicine, both feet became warm, rising upwards. Zhou told his son: "How miraculous this medicine is! I feel refreshed; take it quickly." Within ten days, the chronic condition resolved.
Wang Jiezhi, an Imperial Physician, treated his wife, aged forty, for a back carbuncle that failed to rise. She had diarrhea, vomiting, poor appetite, and cold extremities. Her pulse was imperceptible, indicating Yang deficiency and cold. Large tonics with Fuzi (Aconiti Lateralis Radix Praeparata), Sheng Jiang (Zingiberis Rhizoma Recens), and Rou Gui (Cinnamomi Cortex) failed. Adding more Fuzi worsened the diarrhea. Finally, using one large Fuzi, 3 qian each of Sheng Jiang and Rou Gui, and 5 qian each of Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu again, prepared as one dose, warmth returned to the abdomen, vomiting and diarrhea stopped, hands and feet warmed, and the pulse recovered. Subsequent large tonics promoted suppuration, and interior-supporting formulas promoted healing. Ten years later, she died of Spleen-Stomach deficiency-cold.
Danxi treated a patient with a back carbuncle one chi in diameter, deep and black. He urgently prepared a paste of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) for drinking. For three days, he washed the area with Aixiong Tang (Mugwort and Ligustici Chuanxiong Decoction). The patient's breath was faint, but he could eat. Danxi provided large bowls of wontons with plenty of meat daily. Consuming five jin of the paste and thirty bowls of wontons, the wound gradually closed. Meat and wontons are beneficial for tonifying Qi.
An elderly man had a back carbuncle one chi in diameter. After dozens of doses of Wuxiang San (Five Fragrances Powder) and Shixuan San (Ten Acupoints Powder), he suffered vomiting, insomnia, and had a history of strangury (linbing). Urgently, he was given the Renshen-Huangqi-Danggui-Baizhu paste mixed with Niuxi Tang (Achyranthis Bidentatae Decoction) and Zhuli (Bambusae Caulis in Taenia Succus). Strangury stopped, appetite returned. After consuming four jin of medicine, pus gushed out, and he healed.
Another patient with a back carbuncle received many Neituo (Internal Support) and Shixuan prescriptions. Seeing pus, vomiting, fever, and heat, Jihe San (Harmonizing Grain Powder) with Dingxiang (Caryophylli Flos) was added. The weather was hot, and the pulse was surging, rapid, and forceful. This ulcerative stage particularly forbids such treatments. However, since the constitution was strong, only Renshen paste and Zhuli (Bambusae Caulis in Taenia Succus) were given. After consuming fifteen to sixteen jin of medicine and over a hundred bamboo stalks' worth of juice, he healed. Later, failing to guard his diet, he sat drunk in a pond in summer. Over a year later, a soft mass appeared on the left hypochondrium. Two years later, it became a carbuncle. With recurring vomiting and fever, he resumed Renshen paste and stabilized.
Wang Shishan treated an elderly man with a back carbuncle. Pulse was surging, slow, and slippery. The swelling was bowl-sized, skin unchanged, not very painful upon pressure, with slight chills and fever. Wang said: "If located on the shoulder blade where meridians intersect, skin is thin, and bone is high, it would be difficult. Now, the swelling is below the scapula, belonging to the Taiyang meridian, so it is treatable." He prescribed Huangqi (Astragali Radix) 5 qian, Danggui (Angelicae Sinensis Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Gancao Jie (Glycyrrhizae Radix et Rhizoma segments) 1 qian each. The patient was covered warmly, and the hot decoction was taken to induce slight sweating. After sleeping soundly, the swelling subsided significantly. Five doses brought peace.
Xue Ji treated Zhang Dehong, a Jinshi, with a slightly swollen and reddish back carbuncle and poor appetite. Interior-supporting medicines promoted suppuration and rupture. Large tonics then promoted flesh growth and healing. Suddenly, chills, fever, and vomiting occurred, and the site swelled again. The pulse was floating and large but empty upon pressure; the form and Qi were extremely fatigued. Xue said: "This is Stomach Qi deficiency and exhaustion, not toxic damage." The patient claimed it started after morning defecation and contact with filth. Continued use of tonics led to healing.
Another man suffered from a large back carbuncle for over a year. The wound was small, dark, and depressed. Constitution was weak, pulse floating, slow, and choppy. This indicated Qi and Blood deficiency-cold. Shiquan Dabu Wan (Comprehensive Great Tonifying Pill) with a little Fuzi (Aconiti Lateralis Radix Praeparata) was used. After several doses, Yuan Qi gradually recovered. Fuzi was removed, and over thirty more doses resulted in complete cure.
A woman over fifty developed a chestnut-sized carbuncle on the back center in early April. In three days it grew to a five-inch base, without pain, swelling, chills, or fever. Xue Ji palpated a faint, deep pulse, stating: "Disease in pulse but not in form is ominous. Excess causes pain; deficiency causes itching; this distinguishes Yin and Yang syndromes. If it does not erupt, it is untreatable; if it erupts but does not heal, it is also untreatable." He prescribed large Yang-tonifying agents. The color was white and dull, condition unchanged. On the twelfth day, pulse remained deep, condition did not rise, spirit was tired, appetite decreased, urination was difficult. Two doses of large Qi-Blood tonics with Sheng Jiang and Rou Gui failed to raise the carbuncle. On the fifteenth day, anger induced vomiting and diarrhea. One dose of tonic failed again. Xue Ji left two doses and departed. The patient, confused, refused to take them. Advised to reflect, she finally took seven consecutive doses according to the formula. On the sixteenth day, the carbuncle rose and ruptured, becoming pale red with similar pus. On the nineteenth day, Xue Ji arrived, rejoicing: "The danger has passed, but depletion of Yuan Qi is worrying." Continuous administration of large tonics for twenty-plus doses. On May eleventh, exertion caused spontaneous sweating, dry mouth, stiff tongue, and distension at the Taiyang hairline and chest apex. Xue Ji diagnosed Qi and Blood dual deficiency with Liver-Gallbladder Fire flaming upward. Buyi Zhongyi Tang (Tonify the Middle and Augment the Qi Decoction) with Shanzhi (Gardeniae Fructus) and Shaoyao (Paeoniae Radix Alba) cured it instantly. Due to internal heat, insomnia, and hot hands/feet, Xiaoyao San (Free and Easy Wanderer Powder) with Shanzhi cooled the heat. Guipi Tang (Restore the Spleen Decoction) was then used, and the wound healed. Total duration from onset to healing: 42 days.
*(Two cases involving Yang Qi collapse and sinking are recorded under Hanlin Academician Yang Gaohu and Vice Minister Shi Nanhu's wife.)*
A scholar near sixty, in mid-winter, engaged in sexual activity when a back carbuncle first appeared. The affected area turned black and necrotic for about five cun, with a dark halo extending over a chi. Diffuse swelling was hard. The back felt heavy as if carrying a stone. Fever, thirst, frequent urination, deafness in both ears, restless waving of arms, exposed body, confused spirit, deep and fine pulse (worse on the right), constipation. Over twenty-seven days, he consumed over a hundred bowls of food, abdomen normal. Others wanted to purge bowels. Xue Ji said: "This is what I am pleased to see!" Urgently, a large dose of Liujun Zi Tang (Six Gentlemen Decoction) with Sheng Jiang, Fuzi, and Rou Gui for three doses made the carbuncle painful. Thereafter, taken on an empty stomach. Afternoon: Liuwei Dihuang Wan ingredients plus Renshen, Huangqi, Danggui, Baizhu for five doses. Huoming Yin (Living Life Decoction) twice more. Needling released much black blood and some stasis-pus. Back became soft. Bowels cleared. Xue Ji was away for four days; spirit became confused again, carbuncle dark and depressed, no intake. All thought death imminent. Xue Ji prescribed Renshen, Huangqi, Danggui, Baizhu 1 liang each, Pao Fuzi 5 qian, Sheng Jiang, Rou Gui 2 qian each. Patient demanded food and two ducks. Daily two doses of previous medicine. Flesh rotted, pus erupted, and he healed.
Wu Songyue, Provincial Surveillance Commissioner, experienced high fever after back wound healing. Mistakenly treated as excess fire with bitter-cold medicine, chills and fever worsened, desire for cold baths. Pulse floating-large, empty upon pressure. Xue Ji said: "This is deficient Yang floating on the surface, rootless fire." Urgent Liujun Zi Tang with Fuzi cured it in one dose.
A man with a non-healing back wound had swelling, fever, red-difficult urination, dry mouth, fatigue. Pulse surging-rapid but powerless. Prescription: Renshen, Huangqi, Danggui, Baizhu, Shudihuang (Rehmanniae Radix Preparata), Xiongyao (Ligustici Chuanxiong Radix et Paeoniae Radix), Chenpi (Citri Reticulatae Pericarpium), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), Rou Gui. To tonify Yuan Qi and guide deficient fire back to its channel. Pulse and symptoms worsened initially, as medicinal power had not yet reached. Second dose caused sudden retreat. Rou Gui was removed, and several more doses healed the case. This resulted from prior failure to tonify Yuan Qi.
Chen Lushan, Vice Commissioner, aged fifty, worked hard, damaging Yuan Qi. Initially dry mouth/tongue. In mid-summer of Bingwu year, diffuse back carbuncle appeared, dark center, slightly red/painful edges. Pulse floating-large superficially, fine-deep deeply. Left Cun short, Right Cun imperceptible. Swelling did not fully rise after ten days. Xue Ji said: "Pathogenic and Yuan Qi are deficient-cold. Ignore season, follow syndrome." Morning: Renshen, Huangqi, Sheng Jiang, Rou Gui, Danggui, Baizhu, Chenpi, Banxia, Zhi Cao to warm/tonify Yang. Evening: Jiaban Bawei Wan (Modified Eight Immortals Pill) to nourish Liver/Kidney. Four doses each led to suppuration. Pus was clear/thin, night sweats, spontaneous sweats, internal heat, afternoon fever, floating-rapid pulse. Changed to Bazhen Tang (Eight Treasures Decoction). Fever returned with nocturnal erection, indicating Kidney deficiency with wild fire. Resumed modified Bawei Wan. Anger stirred Liver Fire, bleeding two cups from wound. Left Guan string-rapid, Right Guan string-weak. Liver Wood insulting Spleen; Liver fails to store blood, Spleen fails to control blood. Shiquan Dabu Wan combined with previous ingredients, two doses each, stopped bleeding. Continued conditioning led to recovery.
In mid-summer, another man developed a back carbuncle, dark-swollen over a chi, with small heads like scattered millet grains. Four days duration. True Qi deficient, pathogen excess. External: Garlic-partitioned moxibustion. Internal: Huoming Yin twice. Pathogen receded slightly. Purely tonified Qi. Shengmai San (Generate the Pulse Powder) replaced tea. Carbuncle pathogen greatly retreated. Xue Ji was away; returned after three days. No intake, central flesh dead, constipation, red-turbid urine. Said: "This is fault of interrupting tonics. Central flesh death means strong toxin and weak Spleen Qi. Constipation means weak Stomach Qi and intestines cannot transport. Red-turbid urine means weak Spleen Earth and Qi sinking. Treatment is difficult." Urgent Liujun Zi Tang with Danggui, Chaihu, Shengma. Intake gradually increased, bowels opened. External: Wujin Gao applied to central three cun. Surrounding redness/swelling faded, central black decay removed. Then Danggui Gao applied. Dihuang Wan ingredients alternated with previous medicine. Nearly one hundred doses to heal.
Zheng Chaoyong, Hanlin Compiler, had back carbuncle with fever, phlegm, tasteless food, non-growing flesh, bloody discharge. Xue Ji said: "Spleen Qi deficiency fails to control blood returning to source. Method: Tonify Spleen/Stomach." Patient disbelieved, used detoxifying/cooling-blood herbs, adding chills/vomiting, then realized truth. Liujun Zi Tang with Pao Jiang, Banxia, Fuling cured symptoms. Then Shiquan Dabu Wan for gradual closure. Later, slight overeating caused diarrhea/dysentery due to Spleen-Stomach deficiency-cold sinking. Buzhong Yiqi Tang and Six God Pills stopped dysentery. Liujun Zi Tang healed the wound.
Yuan Huaixue, Retired Official, had back carbuncle with fever/thirst, rapid-powerless pulse. Siwu Tang plus Huangbai, Zhimu, Xuanshen, Shanzhi, Lianqiao, Wuweizi, Maidong, Jinyinhua. Pulse/symptoms receded. Added Baizhi, Renshen, Huangqi. Necrotic flesh sloughed. Stopping medicine and labor caused recurrence of heat/thirst. Given Renshen, Huangqi, Danggui, Baizhi, Zhi Cao, Shanyao, Shanzhuyu, Fuling, Zexie, Rou Gui. Stabilized. Liuwei Dihuang Wan and Shiquan Dabu Wan promoted healing.
Zhou Hongfu, Provincial Surveillance Commissioner, had back carbuncle swelling without rupture. Pulse large-floating. Yang Qi weak, pathogen stagnant. Tuoli San with doubled Renshen/Huangqi caused internal heat/thirst, surging-large pulse beating fingers. This is deficient fire. Urgent addition of Rou Gui to previous powder made pulse/symptoms retreat. Continued Tuoli San healed. Using cold herbs for assumed heat-toxin would be error.
Wang Tang, Grand Commandant, initially due to great fatigue, used Shixuan San etc., adding panting/thirst/internal heat, large-powerless pulse. Yang Qi self-injured, unable to ascend, sinking into Yin division causing internal heat. Xue Ji used Buyi Zhongyi Tang plus Jiuchaoshao Yao (Alcohol-fried Paeoniae Radix), Maidong, Wuweizi. Cured.
Zhang Kegong, Shangshe, used internal/external cold-cooling detoxifying herbs. Whole-body pain, nausea, poor appetite, afternoon/internal heat, aversion to cold/chills. Xue Ji said: "Whole-body pain: Ying/Wei deficiency failing to nourish muscle interior. Nausea/poor appetite: Spleen/Stomach deficiency-cold failing to digest. Internal/afternoon heat: Yin blood deficiency with Yang sinking into Yin. Aversion to cold: Yang weakness failing to defend skin." All caused by insufficient Spleen/Stomach Qi. Buyi Zhongyi Tang resolved symptoms. Shiquan Dabu Wan sloughed necrotic flesh. Liujun Zi Tang plus Xiong/gui regenerated muscle. Cured.
Zhou Liangfeng, Scholar, long-term emotional depression, back carbuncle. Liver pulse string-surge, Spleen pulse floating-large, fine-deep upon pressure. Buyi Zhongyi Tang plus Jiegeng, Beimu, small amounts of Jinyinhua, Baizhi. Two doses: Liver pulse retreated, Spleen pulse recovered. Huoming Yin twice: Pus erupted, swelling subsided. Liver pulse still string-like. Toxin gone but Stomach Qi injured again. Buyi Zhongyi Tang plus Fuling, Banxia healed.
Cai Dongzhi, Shangshe, healed with interior-supporting medicine, wound not fully closed. Mid-winter, accompanied by cough. Xue Ji said: "Wound not closed: Spleen Qi deficiency. Cough persists: Lung Qi deficiency. Method: Tonify the Mother (Earth generates Metal)." At a banquet, saw him avoiding mutton. Xue Ji said: "Tonification removes weakness; Renshen and mutton are examples. Best to eat." Ate daily without cessation. Over ten days, wound closed, cough cured.
Tu Jiufeng, Vice Commissioner, early spring, dark diffuse swelling, thirst, frequent urination, surging-rapid Chi pulse. Kidney Water dried up, destined to die during peak Fire. Disbelieved, used bitter-cold herbs, further damaged Yuan Qi, hastening death.
Chai Fu'an, Capital Prefect, mid-summer, dark slight swelling, fever/restlessness, salivation, cold lower abdomen. Cold extremities, Right Guan floating-choppy, Chi pulses fine-deep. Xue Ji said: "Deficiency-cold syndrome. Wang Taipu said: 'Great heat without feeling hot means no Fire.' Definitely incurable." Begged treatment. One dose of large warming-tonic stopped salivation but lesion did not rise. Ultimately incurable.
Gu Baoquan, old physician, sixty-five, anger-induced back carbuncle, bowl-sized, black perimeter. Surgeon applied cold compresses, felt cool. Agreed to remove necrotic flesh with knife in 7-8 days. Gu waited, then said: "Black perimeter indicates blood stasis. Adding cold medicine is wrong treatment." Switched to hot compresses, removed old medicine. Intense itching all night. Next day, bright red color, swelling subsided. Center had dozens of holes like honeycomb. One day later, nausea/hiccups. Head looked like two heads. Self-diagnosed: Extreme deficiency. Large dose of Renshen-Fuzi taken twice. Appearance corrected. Healed in few days.
A woman, delayed conception, took Shenxian Jubao Dan. Developed critical back carbuncle. Pulse scattered-large-choppy. Urgently, Jiabian Siwu Tang (Modified Four Substances Decoction) over a hundred doses to tonify Yin/Blood. Fortunately, her constitution was dense, easy to converge.