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A person asked: What is the condition of a carbuncle (ju, 疽) occurring between the fourth lumbar vertebra and the kidneys? The answer was: This is called "Lian Shen Fa" (Continuous Kidney Eruption), also known as "Xia Da". It is caused by excessive sexual activity, which injures the Kidney Yin (Kidney Water), leading to dry mouth, severe alternating chills and fever, and pain in all joints. One should immediately administer Sheng Jin Dan (Victory Gold Pill), Huangqi Neituo San (Astragalus Interior-Supporting Powder), or Huoming Yin (Life-Saving Decoction) with added Qianghuo (Notopterygii Rhizoma et Radix) and Huangqi (Astragali Radix). If treatment is delayed slightly and ulceration penetrates the fascia, death will ensue. If cough, vomiting, and hiccups appear, the waist feels as if broken, inability to bend or straighten, and inability to swallow food occur, death will also result. If already ulcerated but the pus is clear and thin, rotting with a fishy and foul odor, accompanied by coma and cold extremities, it is incurable.

A woman over seventy years old developed a sore on her waist with extreme itching, suspected to be poisoned by insects or lice. Her pulse was floating and rapid. Qi stated: A floating and rapid pulse with aversion to cold indicates a sore. On the second day, upon re-examination, the pulse became weak. I said: If the pulse becomes weak before ulceration, how can the sore heal and close? Moreover, constipation indicates that the True Qi is exhausted; treatment will be ineffective. Despite strong requests, I reluctantly used Liujunzi Tang (Six Gentlemen Decoction) with added Huoxiang (Pogostemonis Herba) and Shenqu (Massa Medicata Fermentata). Her diet gradually improved, and bowel movements resumed. Subsequently, potent tonifying agents were used. After ulceration, the pus was clear and thirst appeared. Ren Shen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Shudihuang (Rehmanniae Radix Praeparata), Maidong (Ophiopogonis Tuber), and Wuweizi (Schisandrae Fructus) were then administered, stopping the thirst. The family rejoiced, saying, "We are safe!" I replied, "Not so. This is a precursor to the failure of the sore to close." They doubted me. Later, they changed doctors, and indeed, she died.

A nineteen-year-old man had a swelling on his waist without a head, non-painful, with unchanged skin color, which did not ulcerate for three months. His appetite decreased, he lacked desire for food, and his muscles wasted daily. This was due to Qi stagnating in the interstices (Couli, 腠理), causing Ying Qi (Nutritive Qi) to fail to circulate, leading to swelling from depression. It is named "Shidu Liuzhu" (Damp-Toxin Flowing Deposit). *Yuanrong* states: If a person has coarse diet, depleted spirit, weak Qi and Blood, and emaciated muscles, their Ying and Wei (Defensive) Qi are short and stagnant. Thus, when cold stagnates in the interstices, closing and depressing to form an abscess, tonification should be used to support deficient and frail Qi. Therefore, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with Xiangfu (Cyperi Rhizoma) and Chenpi (Citri Reticulatae Pericarpium) was prescribed for over thirty doses. Only then was white pus expressed via needle puncture, amounting to about two bowls. Ren Shen and Huangqi were doubled in the prescription, and moxibustion with fermented soybean cakes was applied to the affected area, leading to gradual recovery. Confused by the desire for quick results, he took internal detoxifying drugs and applied cooling external medicines. This worsened his condition, causing poor appetite, thin pus, and purple discoloration at the site. He requested my treatment again. Finding his Essence and Qi still intact, I continued with the previous formula, adding Yuanzhi (Polygalae Radix), Beimu (Fritillariae Cirrhosae Bulbus), and Bailian (Tinosporae Caulis). After one hundred doses, he recovered. In cases where healing is prolonged or pus is clear and thin, Naise San (Internal-Sealing Powder) and moxibustion with Aconite cakes should be used before recovery is possible.

A woman over twenty years old had a sudden swelling of about one cun on her waist, with unchanged skin color, slight pain, no ulceration, fever, and a large pulse. This was caused by damage from the Seven Emotions (Seven Affects), leading to Qi and Blood stagnation and meridian obstruction. Treatment should tonify Qi and Blood, resolve depression, and apply Xiangfu cake compresses to the area to ensure abundant and smooth Qi and Blood circulation, allowing internal resolution. In such cases, even if ulceration occurs, there is no danger. She did not listen and instead took Shixuan Liuqi drugs, further depleting Qi and Blood. She ulcerated, discharged clear pus, failed to heal, and died.

A postpartum woman had swelling in her waist, worse in both legs. This was due to lochia stasis in the meridians. If not treated early, it would become an abscess. Two doses of Taoren Tang (Peach Kernel Decoction) provided slight relief, followed by several doses of Moyao Wan (Myrrh Pill) for full recovery. There are also cases where residual lochia causes stabbing pain in the umbilical and abdominal regions, or flows to the limbs, or injects into the inner thighs with pain like needle pricks, or causes bilateral thigh swelling. These result from imbalance of cold and heat, or mental worry and physical exertion, causing Qi obstruction and Blood accumulation in the meridians. Moyao Wan is suitable. There are also cases of swelling and pain due to water-dampness exposure and amenorrhea, treatable with Danggui Wan (Angelica Pill). Any stasis of evil blood is serious; if treatment is delayed, it becomes a flowing deposit or bone carbuncle, often proving fatal.

Peng Bixi, a government student, suffered from a lumbar carbuncle after taking cold-natured detoxifying drugs. The lesion was dark and painless, the head resembled spread millet seeds, his back felt heavy preventing sleep, he had deafness and cloudy vision, lackluster complexion, frequent and difficult urination, thirst, confusion, coarse and short breathing, and a floating-rapid pulse that vanished under heavy pressure. I first administered one dose of medicine to nourish Kidney Water. Soon, urination and defecation normalized, thirst ceased, and his back felt light. Then, bloodletting with a stone needle removed stasis. Half a jin of moxa was applied directly to the lesion. Wujin Gao (Black Gold Ointment) was applied externally, and internally, Ren Shen, Baizhu, Danggui, Renshen (Note: likely Baizhu repeated or similar root, context implies tonics), Rougui (Cinnamomi Cortex), etc., were taken for several doses, slightly restoring Yuan Qi (Primal Qi). Suspecting Rougui's pungent heat, he omitted it for one day. Consequently, his hands and feet became cold, and he suffered fecal incontinence. Rougui was reinstated, along with Buguzhi (Psoraleae Fructus, 2 qian) and Roudoukou (Myristicae Semen, 1 qian). Bowel movements normalized, the flesh gradually ulcerated, Danggui Gao (Angelica Ointment) was used to generate flesh, and Bazhen Tang (Eight Treasures Decoction) tonified Qi and Blood, leading to recovery.

Gu Dongxi, a licentiate, suffered from chronic thirst. In early June, he developed a lumbar carbuncle. Neglecting his lifestyle, the sore ulcerated to an inch wide, appearing dark, rotten, and foul-smelling. His urine resembled strangury, lips cracked, and tongue had prickles. He sought treatment at the end of July. The left Chi pulse was flooding and rapid; the left Guan pulse was floating and choppy. I said: Thirst preceding carbuncle indicates dried-up Kidney Water and flaming deficiency fire, usually resulting in death. However, rotten pus, dark color, painlessness, and gaping wound indicate Spleen Qi failure and muscle necrosis. Strangury-like urine, phlegm congestion, panting, dry mouth, and cracked tongue indicate Spleen-Lung failure and exhaustion of Kidney Water. Flooding Chi pulse shows Kidney has nothing to generate. Floating-choppy Guan pulse shows Lung Metal overcoming Spleen Earth. Moreover, during the peak of Metal energy, danger is imminent! Indeed, he died two days later. This disease manifested externally and lasted two months until death because Yuan Qi was too weak to close the sore. If regulated and tonified beforehand to prevent Qi and Blood deficiency, survival was possible.

A person asked: What is the condition of a carbuncle between the waist and hip, with unchanged skin color, hardness like stone, failing to ulcerate after a month? The answer was: This is called "Shi Ju" (Stone Carbuncle). It is caused by accumulated heat in the Shaoyang and Yangming meridians. Pathogenic toxins are firmly knotted, and Yuan Qi is insufficient, so it cannot rise and suppurate. Huoming Yin with Duohuo (Saussureae Radix), Qianghuo, Chaihu (Bupleuri Radix), and Huangqi, along with Zijin Dan (Purple Gold Pill), should be used to induce sweating. For robust individuals, Bazhen San (Eight Patterns Powder) or Yili Jindan (One Grain Golden Pill) should be used to purge. For the elderly and weak, Shiquan Dabu Tang and Renshen Yangrong Tang should be used to support and expel toxins. If the lesion turns black, sinks, does not rise, is numb and painless, accompanied by vomiting, inability to eat, mental confusion, and scattered or intermittent pulses, death will occur. If spirit is clear and pulse is harmonious, Taige Ziwei Wan (Imperial Purple Micro Pill) should be administered.