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[Acupuncture and Moxibustion Methods for Carbuncles and Ulcers]

**Acupuncture Methods**
Use the *pi* needle (a broad-bladed needle shaped like a sword tip), whose end is sharp, to incise and drain large amounts of pus. (*Ling Shu*)

When qi stagnates in carbuncles and ulcers, it is appropriate to use needles to open and remove necrotic tissue. The annotation states that "xi" is synonymous with "si rou," referring to dead muscle tissue. (*Nei Jing*)

After carbuncles and ulcers have suppurred, iron made from horse bits can be fashioned into needles shaped like leek leaves, sharp on both sides, to horizontally or vertically lacerate the area and drain pus and blood. (*Jing Yao*)

If carbuncles resemble pepper eyes with dozens of grains, or look like honeycombs or lotus pods, and pain persists despite pus drainage, it is appropriate to use a *pi* needle to horizontally or vertically split the lesion. This allows toxic blood mixed with pus to exit, leading to recovery. (*Gang Mu*)

When carbuncles and ulcers form pus, if moxibustion or cauterization is not performed, toxic factors cannot be resolved, and stagnant pus cannot be drained. If this critical period passes without needling or cauterization, and one instead attacks the interior, survival is impossible. For boils with thin skin, simply puncturing with a needle to drain pus and blood, combined with cauterization, is effective. (*Jing Yi*)

Generally, do not indiscriminately perform acupuncture or cauterization near tendons, vessels, or joints.

For carbuncles and ulcers with thick skin and small openings where pus drains slowly, needle-cauterization is appropriate. (*Jing Yi*)

In general, the purpose of using needles is only to guide the discharge of pus. If no pus flows upon needling, it indicates that qi is latent; needle-cauterization should not be used.

**Leech Therapy (Qi Zhen Fa)**
When a boil or carbuncle first appears and gradually enlarges, place a piece of wet paper over the sore. The spot that dries first is the apex (pus head). First, wash the area to remove impurities. Take a large brush tube, place it over the apex, and insert a large water leech into it. Frequently pour cold water over it. The leech will suck the pus and blood from the apex until the skin wrinkles and the flesh turns white, indicating the dissipation of toxicity, ensuring recovery. If the toxicity is severe and the leech is small, three or four leeches may be needed for efficacy. If the leech sucks the apex, it will die; it can be revived with water, which has proven miraculous in repeated trials. If bleeding does not stop, apply mud from lotus rhizomes to stop it. (*De Xiao*)

This leech method is applicable only to mild and minor conditions. If carbuncles and ulcers involve deep-seated toxicity accumulating in the zang-fu organs, attempting to treat by exhausting blood externally is of no benefit. (*Dan Xin*)

**Moxibustion Methods for Carbuncles and Ulcers**
The onset of carbuncles and ulcers may result from internal accumulated heat or external cold constraining internal heat. Applying moxibustion at the site of onset to disperse toxicity, if treated early, can shift the condition from deep to shallow and from severe to mild. While various moxibustion methods are beneficial, the "Riding the Bamboo Horse" moxibustion method (see Acupuncture section) is particularly crucial; this is a strategy to eliminate disease before it manifests. (*Dan Xin*)

If a carbuncle presents with slight diffuse swelling and hardness, unchanged skin color, a deep pulse, and no pain, external moxibustion should be applied to draw out pathogenic factors until cessation. The Classics state: "For sinking/collapsed conditions, use moxibustion." If there is slight numbness and hardness externally without pain, urgent moxibustion is required, indicating deep pathogen invasion. Shallow conditions should not be moxibusted. If pus is present, moxibustion is contraindicated; needling should be used instead. (*Ming Bao*)

When carbuncles first present with swelling and pain, cover them with wet paper and observe where it dries first; this is the head. Place a slice of garlic on the head and apply large moxa cones for three burns (zhuang), then replace the garlic. For painful lesions, moxicate until pain ceases; for non-painful lesions, moxicate until pain arises. Generally, aim for one hundred burns. Early detection and early treatment are paramount. If a distinct head is present, covering with paper is unnecessary. (*San Yin*)

If multiple heads arise in one cluster, grind garlic into a paste, make a thin cake, place it on the head, and gather moxa on top of the cake for burning. (*San Yin*)

For initial small spots within one or two days, apply a garlic slice to the center and burn with small moxa cones for five burns. (*Zhi Shi*)

Onset within one to two days: ten treatments yield ten recoveries. Three to four days: six or seven treatments yield recovery. Five to six days: three or four treatments yield recovery. (*Gang Mu*)

Moxibustion functions to unblock and draw out stagnant toxins, following the principle of "treating according to the nature of the disease" (concordant treatment). It is like a thief entering a house; one must open the door to drive him out. If the door remains closed, the thief has nowhere to go and will inevitably cause harm or death. (*Gang Mu*)

The head is the convergence of all yang channels. If sores occur here, moxibustion is appropriate, but moxa cones should be small, and the number of burns few (three to five). For the abdomen and back, heavier moxibustion is advisable. (*Jing Yao*)

With heavy moxibustion, internally administer Milk Powder and Tuo Li San (Support the Interior Powder) to prevent fire-qi from entering the heart. (*Dan Xin*)

Practitioners skilled in treating carbuncles and ulcers often apply moxibustion directly to the sore up to two or three hundred burns, achieving recovery without exception. By keeping the moxa cones small, patients are less afraid of the treatment; increasing the number of burns ensures efficacy. (*Zi Sheng*)

Garlic-partitioned moxibustion, Fermented Soybean Cake moxibustion, Mulberry Branch moxibustion, Aconite moxibustion, Sulfur moxibustion, and Earth Cake moxibustion are all used to treat carbuncles, malignant sores, and swellings/toxins (see Acupuncture section for details).

**Clinical Case of Moxibustion Efficacy**
A patient suffered from a back carbuncle for over a month, with worsening condition. A person named Zhang advised applying moxibustion to the affected area for 150 burns until pain was perceived. The next day, black scabs were removed with tweezers; pus was fully discharged, the granulation tissue was red, and pain ceased. Ointment was applied daily, replacing it each time by trimming away blackened, necrotic tissue. Recovery occurred after more than a month. (*Ben Shi*)

**Moxibustion for Stone Carbuncle**
Hard, non-suppurating lesions are called Stone Carbuncles. Apply 100 burns; the stone-like concretion should fragment and be expelled. (*Zi Sheng*)

**Moxibustion for Parotid Swelling (Fa Yi)**
This condition is most dangerous, causing swelling of the head and face and tooth loss. Part the hair and locate the vertex whorl; apply 21 burns. If ineffective, continue up to 49 burns. (*Zhi Shi*)

**Moxibustion for Ding Ju (Malignant Furuncle)**
Pound garlic into a paste and apply around the sore, leaving the apex exposed. Apply moxa cones to the apex until it bursts. Lack of bursting indicates difficulty in healing. Burning 100 burns guarantees recovery. (*Zheng Zhuan*)

**Moxibustion for Inguinal Abscess (Bian Du)**
Use a thin grass stalk. Measure from the distal transverse crease of the middle finger of the patient's left or right hand, spanning three segments to the fingertip, excluding the nail. Cut the grass. Use this grass to measure from the wrist transverse crease towards the center of the arm. The point where the grass ends is the acupoint. Apply moxa cones the size of wheat grains, 2–3 burns. When swelling subsides and pain stops, the patient is safe. (*De Xiao*)