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Formulas for treating back carbuncles (back abscesses) have been transmitted in over a hundred varieties, yet very few are effective. Among them, some prescriptions are overly heavy in dosage, or too cold, or too hot, or possess toxic properties; these are not recorded here. I have selected only those that I have personally used and found to be effective, hoping not to deviate from the original intention of saving lives and curing diseases.

The etiologies are categorized into five types: 1. Epidemic pathogenic factors (seasonal infectious diseases); 2. Emaciation with qi stagnation; 3. Anger-induced stagnation; 4. Kidney qi deficiency; 5. Consumption of cold wine, roasted foods, or intake of hot-toxic medications. Generally, when treating back carbuncles, one cannot uniformly attribute them to heat-toxin. The difficulty of treatment varies, progressing from the first type to the fifth.

When a carbuncle first appears, it is as small as a hemp seed or bean. The body immediately develops fever, and the flesh at the site of the carbuncle also becomes hot, swollen, elevated, and painful. After rupture, the tissue color is red and purple; this is classified as an external manifestation (external onset). Even if the lesion is as large as a basin or bowl, if the medication is administered correctly, nearly all patients can be saved.
Conversely, if upon initial appearance, regardless of size, the body has no fever, the patient feels fatigued and weak, and the site of the carbuncle is not hot. Over several days, the lesion gradually enlarges without swelling or elevation, is painless, sunken, and necrotic. Upon rupture, the tissue turns dark purple or black; this is classified as an internal manifestation (internal onset). In such cases, the internal organs have already undergone necrosis before the external symptoms appear. Such cases are incurable, even with divine medicine.

Symptoms include spontaneous diarrhea, vomiting, and loss of appetite. Pulse diagnosis reveals the most deficient kidney pulse. Ancient physicians considered these conditions untreatable; however, there remains a rationale for intervention.

When the kidney pulse is extremely deficient, the use of tonifying herbs presents a dilemma: using warming and potent tonics like Deer Antler (Rusa alces Cornu) or Aconite Root (Aconiti Lateralis Radix Praeparata) would be like adding fuel to the fire; whereas using mild tonics may fail to restore kidney qi quickly, akin to waiting for the Yellow River to clear. Once, a nobleman suffered from a severe carbuncle presenting this specific syndrome, and all physicians were at a loss. I stated: I once heard a renowned physician explain that at dawn (Wugeng, approx. 3–5 AM), the kidney qi naturally opens. If one speaks or coughs during this time, the kidney qi closes. Administering a dose of mild tonic herb while the kidney qi is open yields efficacy superior to taking dozens of doses of strong tonics at other times. I proposed this strategy. Consequently, Shanyao Wan (Dioscorea Pill) was selected. Its ingredients mildly tonify kidney qi without any drying or heating bias. Following this method, and instructing the patient and attending family members carefully, the medication was administered. Three days later, pulse diagnosis showed the kidney pulse had normalized. Thus, for carbuncle patients with weak kidney pulses, one should not blindly follow ancient assertions of incurability. For patients with chronic coldness, weakness, or critical conditions, applying this method allows for minimal effort with doubled results. (Note: The formula for Shanyao Wan is missing.)