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A person asked: "What is the condition of a carbuncle occurring at the extreme lower part of the back?" The reply was: "This condition is named Chuan Dang Fa (Penetrating Crotch Carbuncle), belonging to the Du Mai (Governing Vessel) and the Taiyang Bladder Meridian. It is caused by physical exhaustion, worry, and accumulated depression. The primary treatment is Huo Ming Yin (Life-Saving Decoction) added with Qiang Huo (Notopterygii Rhizoma et Radix) and Huang Bo (Phellodendri Cortex), accompanied by Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction), as well as Sheng Jin Dan (Victory Golden Pill) and Shen Xian Zhui Du Wan (Immortal Poison-Chasing Pill). For those with strong constitutions, Ba Zhen San (Eight-Array Powder) or Yi Li Jin Dan (One-Pill Golden Pill) should be used to purge. For the elderly and weak, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) and Ren Shen Yang Rong Tang (Ginseng Nourishing Nutritive Qi Decoction) are indicated. This condition requires rapid treatment; if delayed even slightly, it will ulcerate and become difficult to heal. If it forms a fistula, it often presents with numbness and black depression; if accompanied by diarrhea, vomiting, hiccups, and fatigue, it is incurable.

The *Ling Shu* states: "A carbuncle arising at the sacrum is named Rui Ju (Sharp Carbuncle). Its presentation is red, hard, and large; it must be treated urgently. If untreated, death occurs within thirty days."

The *Gui Yi* records: "Yong Quan Ju (Spring Spring Carbuncle) swells from the Taiyin Meridian (Taiyin refers to the area anterior to the sacrococcygeal region). It resembles a crouching rat. If not punctured within twenty days, death ensues. Puncture may be performed after ten days. If clear pus is discharged, it is treatable; if red-black pus is discharged, it is fatal."

A person asked: "What is the condition of a boil arising on the upper buttocks?" The reply was: "If the swelling is high and the root is shallow, it is a Boil (Yang abscess); if the swelling is flat and the root is deep, it is a Carbuncle (Yin abscess). Both belong to the Foot-Taiyang Bladder Meridian and are caused by Damp-Heat. It is suitable to take Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) and Nei Tuo Fu Jian San (Internal Support Double-Boiled Powder) added with Qiang Huo (Notopterygii Rhizoma et Radix). Sheng Jin Dan (Victory Golden Pill) and Mu Xiang San (Costus Powder) may also be selected. For those with strong constitutions, Yi Li Jin Dan (One-Pill Golden Pill) and Ba Zhen San (Eight-Array Powder) should be used to purge. For the elderly and weak, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) and Ren Shen Yang Rong Tang (Ginseng Nourishing Nutritive Qi Decoction) are indicated. Ancient sages stated: 'For this type of sore, tonifying and nourishing agents should be taken. If there is no effect from tonification, disaster often occurs after the scab forms, making healing difficult. One must be extremely cautious and not discontinue major tonifying agents.' If swollen but not ulcerated, Tai Ge Zi Wei Wan (Imperial Purple Micro Pill) should be taken.

[Xue Ji] The buttocks are the distribution area of the Foot-Taiyang Bladder Meridian, located posterior to the lower abdomen. This is Yin within Yin. The meridian path is distant, and the location is remote. Although the Taiyang Meridian contains abundant blood, Qi circulation rarely reaches it, and Blood flow is scarce. Especially after middle age, one must fear this affliction. In treatment, do not injure the Spleen and Stomach, nor deplete Qi and Blood; rather, focus primarily on consolidating the Root. If the area is swollen, hard, and painful, it indicates Deficiency of Form/Qi and Excess of Pathogenic Qi; Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) is the primary treatment. If mildly swollen and mildly painful, both Form/Qi and Pathogenic Qi are deficient; Tuo Li San (Support Interior Powder) is used to tonify. When suppuration is imminent, Tuo Li Qiang Huo Tang (Support Interior Notopterygium Decoction) is used. If pain is severe, Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction) is used. After the major symptoms subside, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) is also used. If Spleen deficiency prevents resolution, or if there is no ulceration or healing, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) and Huang Qi (Astragali Radix) is used. If Yin deficiency prevents resolution, or if there is thirst and dysuria, Liu Wei Wan (Six-Ingredient Pill) added with Wu Wei Zi (Schisandrae Fructus) is used. If Yang deficiency prevents ulceration or if the pus is clear and fails to heal, Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) is used; for combined Qi and Blood deficiency, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) is used. If swollen and hard without suppuration, Garlic-Separated Moxibustion is applied alongside Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction). After ulceration, Fermented Soybean Cake (Dou Chi Bing) is applied externally, along with Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) and Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction). If after moxibustion the major symptoms have subsided but residual toxins remain, frequent Scallion-Ironing (Cong Yun) is beneficial to tonify Qi and eliminate residual toxins.

Censor Chen Hefeng had weak Spleen and Stomach function and took digestive-purging agents, resulting in swelling of the left thigh and buttock. I said: "This is Spleen Qi deficiency causing downward pouring of dampness, not a carbuncle toxin. Use Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) with doubled Bai Zhu (Atractylodis Macrocephalae Rhizoma)." He was confused by popular opinion stating that "Bai Zhu (Atractylodis Macrocephalae Rhizoma) can discharge pus," so he focused solely on dispersing swelling and detoxifying, which worsened the swelling and fatigue. I used only Bai Zhu (Atractylodis Macrocephalae Rhizoma) decocted in water, which resolved the swelling.

Scholar Yang Qiyuan suffered from this on his left buttock. After applying cooling pastes and taking Lian Qiao Xiao Du San (Forsythia Eliminate Toxin Powder), his entire left body became painful. I diagnosed it as Deficiency of the Three Foot-Yin Meridians. I used Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) to tonify the Spleen and Lung; Liu Wei Wan (Six-Ingredient Pill) added with Wu Wei Zi (Schisandrae Fructus) to tonify the Liver and Kidney. The inner thigh subsided, and the buttock ulcerated. Subsequently, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) was used to close the wound.

Another scholar presented with severe swelling and pain, indicating stagnation of pathogenic toxins. Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction) and Garlic-Separated Moxibustion were used to resolve it. Later, due to dietary irregularities and overwork, swelling and pain recurred with chills, fever, and headache. This indicated Qi Yuan (Original Qi) deficiency and failure to recover. Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) was administered, along with frequent Scallion-Ironing (Cong Yun), resulting in recovery after two months.

A man presented with diffuse swelling without color change, and a slippery, rapid yet forceless pulse, indicating impending suppuration. I intended to use a supporting method and needle drainage, but fearing needles, he sought internal resolution and mistakenly used purging agents. This immediately aggravated chills, fever, and spontaneous sweating. I administered several doses of Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction). The swelling rose and turned red. External needle drainage combined with internal tonification led to recovery.

Wu Fu's father suffered from this, with internal ulceration, swelling, fever, dry mouth, and poor appetite. This was Spleen-Stomach weakness. Six Jun Zi Tang (Six Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) was used for several doses until ulceration occurred. Then, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) with doubled Ren Shen (Ginseng Radix) was used for over fifty doses, leading to recovery.

A thirty-year-old man presented with a pulse resembling a leaking roof or sparrow pecking, hard swelling with dull color, and thin pus. He had mistakenly taken toxic-clearing drugs. I said: "This is Deficiency of the Three Foot-Yin Meridians compounded by drug injury." I used Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix), Rou Gui (Cinnamomi Cortex), and Fu Zi (Aconiti Lateralis Radix Praeparata, 1 qian). After two doses, the swelling ulcerated and turned red. Fu Zi (Aconiti Lateralis Radix Praeparata) was reduced by half a fen, and after several more doses, Original Qi recovered and the sore healed.

A man presented with hard pain and fever, indicating Bladder Qi deficiency with Damp-Heat stagnation. Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) was used for two doses, resolving heat and pain completely. Subsequently, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) was used to induce ulceration. Tuo Li San (Support Interior Powder) was used for over forty doses to promote healing.

A student of the Imperial Academy suffered from hemorrhoids. He applied cold-cooling external agents and took internal detoxifiers, causing an ulceration on the buttock with thin pus, a surging rapid pulse, chills, fever, and thirst. I declined treatment, and he indeed died. This was a condition of Three Foot-Yin Meridian deficiency, losing the source of transformation and nourishment, leading to further depletion of True Qi and exacerbation of pathogenic Qi. Death was inevitable.

Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) treats boils/carbuncles arising at the sacrum and buttocks, characterized by hardness, swelling, and severe pain.
Qiang Huo (Notopterygii Rhizoma et Radix), Huang Bo (Phellodendri Cortex, wine-processed, each 2 qian), Fang Feng (Saposhnikoviae Radix), Dang Gui Wei (Angelicae Sinensis Radix Caulis), Ben Cao (Ligustici Rhizoma), Lian Qiao (Forsythiae Fructus), Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Licorice Radix et Rhizoma, honey-fried, each 1 qian), Rou Gui (Cinnamomi Cortex, 3 fen), Huang Qi (Astragali Radix, 1.5 qian).

Take as one dose. Decoct with one cup of water and half a cup of wine until eight-tenths remains. Take before meals."