发背，属督脉膀胱经，凡阴虚火盛，或醇酒浓味，或郁怒房劳，或丹石热毒，皆能致之
。若肿赤痛甚，脉洪数而有者，热毒之证也，为易治。若漫肿微痛，色黯作渴，脉虽洪数而
无力者，阴虚之证也，为难治。若不肿不痛，或漫肿色黯，脉微细者，阳气虚甚也，尤为难
治。大抵发背之证，其名虽多，总惟阴阳二证为要。若发一头或二头，其形 赤肿高，发
热疼痛，头起者为痈，属阳易治。若初起一头如粟，不肿不赤，闷痛烦躁，大渴便秘，睡语
切牙，四五日间，疮头不计其数，疮口各含如粟形，如莲蓬，故名莲蓬发。积日不溃，按之
流血。至数日或八九日，其头成片，所含之物俱出，通结一衣，揭去又结，其口共烂为一疮
，其脓内攻，其色紫黯者，为疽。属阴，难治。且此证不可大痛，又不可不痛，若见烦闷者
，多不治。总之，疮疡虽云属火，然未有不由阴虚而致者，故经云∶督脉经虚从脑而出，膀
胱经虚从背而出。故不可专泥于火。
陈良甫曰∶背疽之源有五∶一天行，二瘦弱气滞，三怒气，四肾气虚，五饮冷酒，食炙
爆，服丹药。
立斋曰∶大抵发背之证，虽发热疼痛，情势高硕，烦渴不宁，但得脉息有力，饮食颇进
，可保无虞。其脓一溃，诸证悉退，多有因脓不得外泄，以致疼痛，若用败毒寒药攻之，反
致误事。若有脓，急针之，脓一出，苦楚即止。脓未成而热毒作痛者，可用解毒之药。亦有
腐溃尺余者，若无恶证，则投以大补之剂，肉最易生，亦无所妨。惟忌肿不高，色不赤，不
痛，脉无力，不饮食，肿不溃，腐不烂，脓水清，或脓多不止，皆属元气虚也，为难治
，
宜峻补之。其或脓血既泄，肿痛尤甚，浓水臭败，烦躁时嗽，腹痛渴甚，泻利无度，小便如
淋，乃恶证也，皆不可治。
又《灸法》曰∶予常治发背，不问日期阴阳肿痛，或不痛，或痛甚，但未成脓，或不溃
者，即与灸之，随手取效。或麻木者，明灸之，毒瓦斯自然随火而散。或疮头如黍者，灸之尤
效，亦有数日色尚微赤，肿尚不起，痛不甚，脓不作者，尤宜多灸，勿拘日期。更服甘温托
里药，切忌寒凉之剂。其有势未定者，或先用箍药围之，若用乌金膏点患处尤妙。凡人初
觉发背，赤热肿痛，莫辨其头者，但以湿纸覆其上，立候视之，其纸有先干处，即是结痈头
也。取大蒜切成片如二三钱浓薄，安于头上，用大艾炷灸之，三壮换一蒜片，痛者灸至不痛
、不痛灸至痛时方止。最要早觉早灸为上。一日二日，十灸十活，三日四日六七活，五日六
日三四活，过七日则难为力矣。若有十数头作一处者，即用大蒜研成膏，作薄饼铺头上，聚
艾于蒜饼上烧之，亦能活也。若背上初发赤肿一片，中间有一片黄粟米头子，便用独蒜切去
两头，取中间半寸浓者，正安于疮上，灸十四壮，多至四十九壮。盖如此恶证，惟隔蒜灸及
涂乌金膏有效。又《治法》曰∶肿硬痛深脉实者，邪在内也，可下之。肿高 痛脉浮者，
邪
在表也，宜托之。 痛烦躁或咽干，火在上也，宜泻之。肿高或不作脓者，邪气凝结也，
宜
解之。肿痛饮冷，发热睡语者，火也，宜清之。不作脓或不溃不敛者，阳气虚也，宜补之。
瘀肉不腐，或积毒不解者，阳气虚也，宜助阳气。脓多或清者，气血俱虚也，宜峻补之。脉
浮大或涩，而肌肉迟生者，气血俱虚也，宜补之。右关脉弱，而肌肉迟生者，宜补脾胃。
又《诸毒治法》曰∶如头痛有表证者，宜先服人参败毒散一二剂。如 痛发热脉数者
，
用金银花散、槐花酒、神功托里散。如疼痛肿硬脉实者，以清凉饮、仙方活命饮、苦参丸。
肿硬木闷，疼痛发热，烦躁饮冷便秘，脉沉实者，内疏黄连汤，或清凉饮。大便已通，欲其
作脓，宜仙方活命饮、托里散、蜡矾丸，外用神异膏。如饮食少思，或不甘美，用六君子汤
加藿香，连进三五剂，更用雄黄解毒散洗患处，每日用乌金膏涂疮口处。俟有疮口，即用纸
作捻蘸乌金膏 入疮内。若有脓为脂膜间隔不出，或作胀痛者，宜用针引之。腐肉堵塞者
去
之，若瘀肉腐动，用猪蹄汤洗之。如脓稠或痛，饮食如常，瘀肉自腐，用消毒与托里药相兼
服之，仍用前二膏涂贴。若腐肉已离好肉者，宜速去之。如脓不稠不稀，微有疼痛，饮食不
甘，瘀肉腐迟，更用桑柴灸之，亦用托里药。若瘀肉不腐，或脓清稀，不 痛者，急服大
补之剂，亦用桑木灸之，以补接阳气，解散郁毒。常观患疽稍重未成脓者，不用蒜灸之法，
及脓熟不开，或待腐肉自去，则多致不救。大抵气血壮实，或毒少轻者，可假药力，或自
腐溃。若怯弱之人，热毒中隔，内外不通，不行针灸，药无全功矣。此证若脓已成，急宜开
之，否则重者溃通脏腑，腐烂筋骨。若使透膈则不可治。轻者延溃良肉，难于收功，因而不
敛者多矣。
又《诸补治法》曰∶若肿 作痛，寒热作渴，饮食如常，此形气病气俱有余也，先用
仙
方活命饮，后用托里消毒散解之。漫肿微痛，或色不赤，饮食少思，此形气病气俱不足也，
用托里散调补之。不作脓或脓成不溃，阳气虚也，托里散倍加肉桂、参、 。脓出而反痛
，或脓清稀，气血俱虚也，八珍汤。恶寒形寒，或不收敛，阳气虚也，十全大补汤。晡热内
热或不收敛，阴血虚也，四物加参术。作呕欲呕，或不收敛，胃气虚也，六君加炮姜。食少
体倦，或不收敛，脾气虚也，补中益气汤加茯苓、半夏。肉赤而不敛，血热也，四物加山栀
、连翘。肉白而不敛，脾虚也，四君加酒炒芍药、木香。小便频数者，肾阴亏损也，加减八
味丸。大抵病毒势甚，若妄用攻剂，怯弱之人必损元气，因而变证者众矣。
又《三证治法》曰∶若初患未发出，而恶寒疼痛，作渴饮冷，此邪气内蕴也，仙方活命
饮。若口干饮热，漫肿微痛，此元气内虚也，托里消毒散。若饮食少思，肢体倦怠，此脾胃
虚弱也，六君子汤，如未应，加姜、桂。其有死者，乃邪气盛，真气虚而不能发出也，在于
旬余之间见之。若已发出，用托里消毒散。不腐溃，用托里消毒散。如不应，急宜温补脾胃
。其有死者，乃真气虚而不能腐溃也，在于二旬之间见之。若已腐溃，用托里散以生肌。如
不应，急温补脾胃。其有死者，乃脾气虚而不能收敛也，在于月余见之。此三证虽不见于经
籍，余尝治而历验者。
《千金方》灸法治发背，已溃未溃者，用淡豆豉以水和捣成硬泥，根据肿大小作饼三四分
浓。如已有疮孔，勿置疮孔上，但四布豆饼，列艾其上灸之，使微热，勿令破肉，如热痛急
少起之，日灸二度。如先有疮孔，孔出汁即瘥。
一、验透膈法，凡背疽大溃，欲验穿透内膜者，不可用皂角散嚏法，但以纸封患处，令
病者用意呼吸，如纸不动者，未穿透也。倘用取嚏法鼓动内膜，则反致穿透，慎之慎之。
都宪周弘冈，背患疽肿而不溃，脉大而浮，此阳气虚弱而邪气壅滞也，用托里散倍加参
、。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。
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
。余曰∶遍身作痛，营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肉也。此皆由脾胃
之气不足所致。遂用补中益气汤，诸证渐退。更以十全大补汤，腐肉渐溃。又以六君子汤加
芎、归，肌肉顿生而愈。
府庠彭碧溪，患腰疽，服寒凉败毒之药，色黯不痛，疮头如铺黍，背重不能安寝，耳
聩目白，面色无神，小便频涩，作渴迷闷，气粗短促，脉浮数，重按如无。余先用滋水之
药
一剂，少顷便利渴止，背即轻爽。乃砭出瘀血，以艾半斤许，明灸患处，外敷乌金膏，内服
参、 、归、术、肉桂等药。至数剂，元气稍复，自疑肉桂辛热，一日不用，手足并冷，大
便不禁，仍用肉桂及补骨脂二钱，肉豆蔻一钱，大便复常，其肉渐溃。更用当归膏以生肌肉
，八珍汤以补气血而愈。
上舍蔡东之，患此，余用托里之药而溃，疮口尚未全敛。时值仲冬，且兼咳嗽。余曰∶
疮口未敛，脾气虚也，咳嗽不止，肺气虚也，法当补其母。一日与之同宴，见忌羊肉，余曰
∶补可去弱，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。
一男子，年逾五十，患发背色紫肿痛，外皮将溃，寝食不安，神思甚疲，用桑柴灸患
处出黑血，即鼾睡觉，而诸证如失。服仙方活命饮二剂，又灸一次，脓血皆出。更进二剂，
肿痛大退，又服托里消毒散数剂而敛。夫疮势炽甚，本宜峻剂攻之，但年老血气衰弱，况又
发在肌表，若专于攻毒，则胃气先损必反误事。（薛按）
予长男于一周患背疽，治按在肿疡条中。（新按）
论外通用方
神仙熏照法（外一二三）
发背，归属于督脉和膀胱经。凡是阴虚火旺，或长期饮用烈酒、食用厚味，或情志抑郁、愤怒及房劳过度，或服用丹石类药物导致热毒内蕴，都能引发此病。
如果患处红肿疼痛剧烈，脉搏洪大且数，这是热毒证，属于容易治疗的类型。如果患处漫肿（肿胀范围广泛但边界不清）且微痛，颜色暗紫并伴有口渴，虽然脉搏洪大数，但按之无力，这是阴虚证，属于难以治疗的类型。如果不肿不痛，或者漫肿色暗，脉搏微弱细小，这是阳气极度虚弱，尤其难以治疗。大体上，发背这类病症，名称虽多，但总归以阴证和阳证两类最为关键。
如果发背初起只有一个或两个头，形状赤红肿胀高突，伴有发热疼痛，疮头隆起的是“痈”，属于阳证，容易治疗。如果初起时一个头像粟米大小，不肿不赤，闷痛烦躁，极度口渴，大便秘结，睡梦中说胡话、咬牙齿，经过四五天时间，疮头数量不计其数，疮口各自含有如粟米大小的脓栓，状如莲蓬，所以称为“莲蓬发”。经过多日不溃破，按压时流出血液。到了几天或七八九天后，疮头连成片，所含的脓栓全部排出，通体结成一层衣膜，揭去后又重新凝结，疮口共同腐烂成一个大的疮面，脓液向内攻陷，颜色紫暗的，称为“疽”。属于阴证，难以治疗。而且这种病症不可出现剧烈疼痛，也不可完全不痛，如果见到心烦闷乱的症状，大多是不治之症。总之，疮疡虽然常说属于火邪，但没有不是由阴虚导致的，所以医经说：督脉经气虚弱，邪气从头部而出；膀胱经气虚弱，邪气从背部而出。因此不能专门拘泥于火邪论治。
陈良甫说：背疽的成因有五种：一是天行疫气，二是身体瘦弱且气机阻滞，三是怒气郁结，四是肾气虚弱，五是饮用冷酒，食用烤爆炙烧的食物，以及服用丹药。
薛立斋说：大体上发背病症，虽然发热疼痛，病情形势高亢硕大，烦渴不安，但只要脉搏有力，饮食尚可，就可以保证没有危险。一旦脓液溃破，各种症状都会消退，很多是因为脓液不能向外排泄而导致疼痛，如果使用败毒寒凉药物攻伐，反而会导致误事。如果有脓，应立即针刺排脓，脓液一出，痛苦即刻停止。脓未形成而热毒作痛的，可以使用解毒的药物。也有腐烂溃破达一尺多深的，如果没有恶候，则投以大补的药剂，肌肉最容易生长，也没有妨碍。唯独忌讳那些肿不高、颜色不红、不痛、脉搏无力、不想吃东西、肿处不溃破、腐肉不腐烂、脓水清稀，或者脓液过多不止的，这些都属于元气虚弱，难以治疗，应当用峻猛的补益药。如果脓血已经泄出，肿痛更加严重，脓水臭败，烦躁时常咳嗽，腹痛极度口渴，腹泻无度，小便像淋证一样涩痛，这些都是恶候，都不可治愈。
又《灸法》中说：我常治疗发背，不问日期长短、阴阳属性、肿痛与否，或者不痛，或者痛甚，只要尚未成脓，或者尚未溃破的，就立即施灸，随手取得疗效。如果患处麻木的，明灸之，毒气自然随着火势而消散。如果疮头像黍米大小的，施灸尤为有效。也有几天后颜色尚且微红，肿胀尚且不明显，疼痛不剧烈，没有化脓的，尤其适宜多施灸，不要拘泥于日期。同时服用甘温托里的药物，切忌使用寒凉剂型。对于病势尚未确定的，或者先用箍围药包围患处，如果用乌金膏点涂患处尤其奇妙。凡人刚开始觉得发背，赤热肿痛，无法辨别疮头的，可以用湿纸覆盖在患处，立刻观察，纸上先干燥的地方，就是结痈头的地方。取大蒜切成二三钱厚的片，安放在疮头上，用大艾炷施灸，三壮换一个蒜片，痛的要灸到不痛为止，不痛的灸到有感觉时才停止。最重要的是早发现早施灸为上策。发病一二天，十次施灸十次能活；三四天，六七次能活；五六天，三四次能活；过了七天就很难救治了。如果有十几个头聚在一起，就用大蒜研成膏，做成薄饼铺在疮头上，聚集艾绒在蒜饼上烧灼，也能救活。如果背上初发一片赤肿，中间有一片黄粟米样的头子，便用独蒜切去两头，取中间半寸厚的部分，正安放在疮上，施灸十四壮，多至四十九壮。大概如此严重的病症，只有隔蒜灸及涂抹乌金膏有效。
又《治法》中说：肿胀坚硬疼痛深在、脉搏实有力的，是邪气在内，可以攻下。肿胀高突疼痛、脉搏浮的，是邪气在表，宜用托法。疼痛烦躁或咽干，是火邪在上，宜用泻法。肿胀高突或不化脓的，是邪气凝结，宜用解法。肿痛喜冷饮、发热说胡话的，是火邪，宜用清法。不化脓或不溃破不收敛的，是阳气虚，宜用补法。瘀肉不腐烂，或积毒不解的，是阳气虚，宜助阳气。脓液多或清稀的，是气血俱虚，宜峻补。脉搏浮大或涩，而肌肉生长迟缓的，是气血俱虚，宜补益。右关脉弱，而肌肉生长迟缓的，宜补脾胃。
又《诸毒治法》中说：如头痛伴有表证的，宜先服人参败毒散一两剂。如疼痛发热脉搏数的，用金银花散、槐花酒、神功托里散。如疼痛肿胀坚硬脉搏实的，用清凉饮、仙方活命饮、苦参丸。肿胀坚硬木闷，疼痛发热，烦躁喜冷饮大便秘结，脉搏沉实的，用内疏黄连汤，或清凉饮。大便已通，希望其化脓的，宜用仙方活命饮、托里散、蜡矾丸，外用神异膏。如饮食减少思食，或不甘美，用六君子汤加藿香，连续服用三五剂，再用雄黄解毒散清洗患处，每日用乌金膏涂疮口处。等到有疮口，即用纸捻蘸乌金膏插入疮内。如果有脓被脂膜间隔出不来，或产生胀痛感的，宜用针引流。腐肉堵塞的去除它，如果瘀肉松动腐烂，用猪蹄汤清洗。如果脓稠或痛，饮食正常，瘀肉自腐，用消毒与托里药兼服，仍用前两种膏药涂贴。如果腐肉已与好肉分离的，宜速去除。如果脓不稠不稀，微有疼痛，饮食不甘，瘀肉腐烂迟缓，更用桑柴灸，也用托里药。如果瘀肉不腐，或脓清稀，不痛的，急服大补药剂，也用桑木灸，以补接阳气，解散郁毒。常观察患疽稍重但未成脓的，不用蒜灸之法，以及脓熟不开，或等待腐肉自去，则多导致无法救治。大体上气血壮实，或毒少轻的，可借药力，或自行腐溃。如果怯弱之人，热毒中隔，内外不通，不行针灸，药物就没有全功了。此症如果脓已成，急宜切开，否则重的会溃通脏腑，腐烂筋骨。如果穿透膈膜则不可治。轻的也会延溃良肉，难于收功，因而不收敛的很多。
又《诸补治法》中说：如果肿胀作痛，寒热交替作渴，饮食正常，这是形气和病气都有余，先用仙方活命饮，后用托里消毒散解除。漫肿微痛，或颜色不红，饮食少思，这是形气和病气都不足，用托里散调补。不化脓或脓成不溃破，是阳气虚，托里散倍加肉桂、人参、黄芪。脓出反而痛，或脓清稀，是气血俱虚，用八珍汤。恶寒形寒，或不收敛，是阳气虚，用十全大补汤。下午发热内热或不收敛，是阴血虚，用四物汤加人参、白术。作呕欲呕，或不收敛，是胃气虚，用六君子汤加炮姜。食少体倦，或不收敛，是脾气虚，用补中益气汤加茯苓、半夏。肉色红而不收敛，是血热，用四物汤加山栀、连翘。肉色白而不收敛，是脾虚，用四君子汤加酒炒芍药、木香。小便频数的，是肾阴亏损，用加减八味丸。大体病毒势很盛，如果妄用攻剂，怯弱的人必损元气，因而变证的就多了。
又《三证治法》中说：如果初患尚未发出，而恶寒疼痛，作渴喜冷饮，这是邪气内蕴，用仙方活命饮。如果口干喜热饮，漫肿微痛，这是元气内虚，用托里消毒散。如果饮食少思，肢体倦怠，这是脾胃虚弱，用六君子汤，如无效，加生姜、肉桂。其中有死亡的，是邪气盛，真气虚而不能发出，发生在十多天之间。如果已经发出，用托里消毒散。不腐溃，用托里消毒散。如无效，急宜温补脾胃。其中有死亡的，是真气虚而不能腐溃，发生在二十天之间。如果已经腐溃，用托里散生肌。如无效，急温补脾胃。其中有死亡的，是脾气虚而不能收敛，发生在一个多月见之。这三证虽然不见于经典书籍，但我曾治疗并多次验证过。
《千金方》灸法治发背，已溃未溃的，用淡豆豉用水调和捣成硬泥，根据肿胀大小做成三四分厚的饼。如果已有疮孔，不要放在疮孔上，只在四周布置豆饼，排列艾绒在其上施灸，使微微发热，不要让皮肤破损，如果热痛急迫就稍微抬起，每天灸两次。如果先有疮孔，孔中出汁即痊愈。
一、验透膈法：凡背疽大溃，想要检验是否穿透内膜的，不可用皂角散吹鼻取嚏法，只用纸封住患处，让病人用心呼吸，如果纸不动，说明未穿透。倘若用取嚏法鼓动内膜，则反而导致穿透，务必谨慎。
都宪周弘冈，背部患疽肿而不溃，脉搏大而浮，这是阳气虚弱而邪气壅滞，用托里散倍加人参、黄芪。反见内热作渴，脉搏洪大鼓指，这是虚火，用前方急加肉桂。脉证顿时减退，仍用托里散而愈。如果认为是热毒而用寒药就错了。
上舍张克恭，患此病，内服外敷皆用寒凉败毒药，遍身疼痛，想呕吐少吃，午后发热内热，恶寒畏寒。我说：遍身疼痛，是营卫虚弱而不能营养肌肉。想呕吐少吃，是脾胃虚寒而不能消化饮食。内热午后热，是阴血内虚而阳气陷入阴分。恶寒畏寒，是阳气虚弱而不能护卫肌肉。这都是由脾胃之气不足所致。于是用补中益气汤，各种症状逐渐消退。再用十全大补汤，腐肉逐渐溃破。又以六君子汤加川芎、当归，肌肉顿生而愈。
府庠彭碧溪，患腰疽，服寒凉败毒药，颜色暗紫不痛，疮头如铺黍，背重不能安寝，耳聋目眩，面色无神，小便频涩，作渴迷闷，气粗短促，脉搏浮数，重按如无。我先用滋水药一剂，不久便利渴止，背部即轻爽。然后砭刺放出瘀血，用艾绒半斤左右，明灸患处，外敷乌金膏，内服人参、黄芪、当归、白术、肉桂等药。到几剂后，元气稍复，自己怀疑肉桂辛热，一天没用，手足并冷，大便失禁，仍用肉桂及补骨脂二钱，肉豆蔻一钱，大便恢复常态，肌肉逐渐溃破。再用当归膏生肌肉，八珍汤补气血而愈。
上舍蔡东之，患此病，我用托里药使其溃破，疮口尚未完全收敛。正值仲冬，且兼咳嗽。我说：疮口未敛，是脾气虚；咳嗽不止，是肺气虚，法当补其母（脾）。一天与他同宴，见他忌食羊肉，我说：补可去弱，人参羊肉之类就是，最适宜吃。于是每天不间断，十余天疮口收敛，咳嗽也顿时痊愈。
一男子，年过五十，患发背色紫肿痛，外皮将溃，寝食不安，神思甚疲，用桑柴灸患处引出黑血，随即鼾睡醒来，各种症状消失。服仙方活命饮两剂，又灸一次，脓血皆出。再进两剂，肿痛大退，又服托里消毒散数剂而收敛。夫疮势炽盛，本宜用峻剂攻之，但年老血气衰弱，况且又发在肌表，如果专于攻毒，则胃气先损必反误事。（薛己按语）
我的长子在一周岁时患背疽，治疗记录在肿疡条中。（新按语）
论外通用方
神仙熏照法（外一二三）
Fa Bei (Back Carbuncle) belongs to the Du Meridian and Bladder Meridian. Any condition of Yin deficiency with hyperactive fire, or consumption of strong alcohol and rich flavors, or emotional depression, anger, and sexual exhaustion, or heat-toxin induced by cinnabar and stone medicines, can all cause this disease.
If the swelling is red, painful, and severe, with a surging and rapid pulse, it is a Heat-Toxin syndrome, which is easy to treat. If there is diffuse swelling with slight pain, dark coloration accompanied by thirst, and although the pulse is surging and rapid, it is forceless upon pressure, it is a Yin Deficiency syndrome, which is difficult to treat. If there is no swelling or pain, or diffuse swelling with dark coloration, and a faint, thin pulse, it indicates extreme Yang Qi deficiency, which is particularly difficult to treat. Generally speaking, although Fa Bei has many names, it is essentially categorized into two main types: Yin Syndrome and Yang Syndrome.
If the lesion starts with one or two heads, appearing red, swollen, elevated, accompanied by fever and pain, with raised ulcer heads, it is called "Yong" (Carbuncle), belonging to Yang Syndrome, which is easy to treat. If initially there is one head like a millet grain, without swelling or redness, but with stifling pain, restlessness, extreme thirst, constipation, somniloquy (sleep-talking), and teeth grinding, after four or five days, the number of ulcer heads becomes countless. Each ulcer opening contains a millet-grain-like concretion, resembling a lotus pod, hence named "Lian Peng Fa" (Lotus Pod Eruption). After several days without suppuration, pressing yields blood. By the seventh or eighth day, the heads merge into a patch, expelling all contained matter, forming a continuous membrane that reforms when peeled off. The openings rot together into one large sore, with pus attacking inwardly and a purple-dark color; this is called "Ju" (Deep Abscess/Gangrene). It belongs to Yin Syndrome and is difficult to treat. Furthermore, this condition should not present with severe pain, nor should it be completely painless. If irritability and oppression are observed, it is mostly incurable. In summary, although sores and ulcers are often attributed to Fire, none arise without underlying Yin Deficiency. Thus, the classics state: "When the Du Meridian is deficient, pathogens emerge from the head; when the Bladder Meridian is deficient, pathogens emerge from the back." Therefore, one cannot solely adhere to the theory of Fire.
Chen Liangfu stated: There are five origins of Back Ju: 1. Epidemic qi; 2. Emaciation and Qi stagnation; 3. Anger; 4. Kidney Qi deficiency; 5. Drinking cold wine, eating roasted/baked foods, and taking elixirs.
Xue Lizhai stated: Generally, for Fa Bei, even if there is fever, pain, high and severe presentation, restlessness, and thirst, as long as the pulse is forceful and dietary intake is adequate, safety can be assured. Once the pus discharges, all symptoms recede. Many cases suffer pain because pus cannot drain externally; using cooling and detoxifying herbs in such cases causes error. If pus is present, immediate needle drainage stops suffering instantly. If heat-toxin causes pain before pus formation, detoxifying herbs may be used. Even if decay extends over a chi, provided there are no malignant signs, strong tonics promote rapid flesh regeneration without harm. Contraindications include: non-elevated swelling, non-red color, absence of pain, forceless pulse, anorexia, failure to suppurate, lack of necrotic tissue sloughing, clear pus, or excessive unceasing discharge. These indicate Yuan Qi (Primary Qi) deficiency and are difficult to treat, requiring vigorous tonification. If, after pus and blood discharge, swelling and pain worsen, pus becomes foul, restlessness and coughing occur, abdominal pain and extreme thirst appear, diarrhea is uncontrollable, and urination resembles strangury, these are malignant signs and are incurable.
The *Moxibustion Method* states: I frequently treat Fa Bei, regardless of duration, Yin/Yang nature, or presence/absence of pain, provided pus has not formed or the sore has not ulcerated, I apply moxibustion immediately with prompt results. For numbness, bright moxibustion disperses toxin naturally. For millet-sized heads, moxibustion is especially effective. Even if after several days the color is slightly red, swelling is minimal, pain is mild, and no pus has formed, frequent moxibustion is indicated, ignoring specific days. Concurrent administration of sweet-warm interior-supporting herbs is essential; cold-cold agents are strictly forbidden. For uncertain progression, use encircling pastes first; applying Wu Jin Gao (Black Gold Ointment) to the site is excellent. When initial Fa Bei presents with redness, heat, swelling, and pain without identifiable heads, cover with wet paper; the first dry spot indicates the carbuncle head. Place garlic slices (2-3 qian thick) on the head and apply large moxa cones. Change garlic every three burns. Stop moxibustion when pain ceases (if painful) or begins (if painless). Early detection and application are paramount. Days 1-2: 10/10 survive; Days 3-4: 6-7/10 survive; Days 5-6: 3-4/10 survive; After Day 7: difficult to save. For multiple clustered heads, grind garlic into paste, make thin cakes, place on heads, and burn moxa on top; survival is possible. For initial red swelling with a central yellow millet-like head, cut a single garlic clove, take the middle half-inch section, place on the sore, and moxibustate 14 times, up to 49 times. For such severe conditions, only garlic-partitioned moxibustion and Wu Jin Gao are effective.
The *Treatment Methods* state: Swelling, hardness, deep pain, and solid pulse indicate pathogen inside; purge it. High swelling, pain, and floating pulse indicate pathogen on the surface; support/expel it. Pain, restlessness, or dry throat indicate Fire above; drain it. High swelling or failure to suppurate indicates pathogen condensation; resolve it. Swelling, pain, preference for cold drinks, fever, and somniloquy indicate Fire; clear it. Failure to suppurate, ulcerate, or heal indicates Yang Qi deficiency; tonify it. Necrotic tissue not sloughing or accumulated toxin not resolving indicates Yang Qi deficiency; assist Yang Qi. Excessive or clear pus indicates dual Qi and Blood deficiency; vigorously tonify. Floating-large or choppy pulse with slow flesh regeneration indicates dual Qi and Blood deficiency; tonify. Weak Right Guan pulse with slow flesh regeneration indicates Spleen/Stomach deficiency; tonify Spleen/Stomach.
The *Methods for Various Toxins* state: For headache with exterior signs, administer Ren Shen Bai Du San (Ginseng and Imperata Decoction to Overcome Toxicity) for 1-2 doses. For pain, fever, and rapid pulse, use Jin Yin Hua San (Honeysuckle Powder), Huai Hua Jiu (Sophora Flower Wine), or Shen Gong Tuo Li San. For painful, hard swelling and solid pulse, use Qing Liang Yin (Cooling Drink), Xian Fang Huo Ming Yin (Immortal Formula to Activate Life), or Ku Shen Wan (Sophora Pill). For hard, woody oppression, pain, fever, restlessness, cold drink preference, constipation, and deep-solid pulse, use Nei Shu Huang Lian Tang (Internal Draining Coptis Decoction) or Qing Liang Yin. After bowel movement clears, to induce suppuration, use Xian Fang Huo Ming Yin, Tuo Li San, or La Fan Wan (Beeswax Alum Pill); externally apply Shen Yi Gao. For poor appetite or lack of taste, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Huo Xiang, taken for 3-5 doses; wash with Xiong Huang Jie Du San (Realgar Detoxifying Powder); apply Wu Jin Gao daily. Once an opening exists, insert paper wicks dipped in Wu Jin Gao. If pus is blocked by fatty membranes causing distending pain, puncture to drain. Remove obstructing necrotic tissue. If necrotic tissue loosens, wash with Zhu Ti Tang (Pig Trotter Decoction). If pus is thick or painful with normal diet and spontaneous sloughing, combine detoxifying and supporting herbs; continue applying the two ointments. If necrotic tissue separates from healthy flesh, remove it quickly. If pus is neither thick nor thin, with slight pain, poor appetite, and slow sloughing, apply Sang Chai Jiu (Mulberry Twig Moxibustion) and supporting herbs. If necrotic tissue does not slough, or pus is clear/thin and painless, urgently administer strong tonics and apply Mulberry Wood Moxibustion to supplement Yang Qi and dissipate constrained toxin. Observing moderately severe pre-suppurative gangrene, failure to use garlic moxibustion, delaying incision until natural sloughing, or waiting for spontaneous necrosis often leads to death. Generally, those with robust Qi/Blood or mild toxins may recover via medication or spontaneous sloughing. However, for frail individuals with internal heat-toxin blockage preventing external communication, without acupuncture/moxibustion, medication alone fails. If pus forms, urgent incision is required; otherwise, severe cases penetrate viscera and rot bones. Penetration of the diaphragm is incurable. Mild cases extend destruction to healthy flesh, making healing difficult, leading to many non-healing outcomes.
The *Tonification Methods* state: For swelling with pain, alternating chills/fever, thirst, and normal diet (excess Form and Pathogen Qi), first use Xian Fang Huo Ming Yin, then Tuo Li Xiao Du San. For diffuse swelling, slight pain, non-red color, and poor appetite (deficient Form and Pathogen Qi), use Tuo Li San for regulation and tonification. For failure to suppurate or rupture due to Yang Qi deficiency, double the Guizhi (Cinnamon Twig), Renshen (Ginseng), and Huangqi (Astragalus) in Tuo Li San. For increased pain after discharge or clear pus (dual Qi/Blood deficiency), use Ba Zhen Tang (Eight Treasures Decoction). For aversion to cold/chills and non-healing (Yang Qi deficiency), use Shi Quan Da Bu Tang (Great Tonifying Decoction of Ten Ingredients). For afternoon/internal heat and non-healing (Yin Blood deficiency), use Si Wu Tang (Four Substances Decoction) plus Renshen and Baizhu. For nausea/vomiting and non-healing (Stomach Qi deficiency), use Liu Jun Zi Tang plus Pao Jiang (Roasted Ginger). For low food intake, fatigue, and non-healing (Spleen Qi deficiency), use Bu Zhong Yi Qi Tang plus Fuling and Banxia. For red flesh and non-healing (Blood Heat), use Si Wu Tang plus Shan Zhi and Lian Qiao. For white flesh and non-healing (Spleen Deficiency), use Si Jun Zi Tang plus Jiuzhi Shaoyao and Muxiang. For frequent urination (Kidney Yin depletion), use Jiajian Ba Wei Wan. Generally, if viral power is strong, reckless purgatives damage Yuan Qi in frail patients, causing numerous complications.
The *Three Syndromes Treatment Methods* state: For initial onset without eruption, featuring chills, pain, thirst, and cold drink preference (internal pathogen accumulation), use Xian Fang Huo Ming Yin. For dry mouth, hot drink preference, diffuse swelling, slight pain (internal Yuan Qi deficiency), use Tuo Li Xiao Du San. For poor appetite, limb fatigue (Spleen/Stomach weakness), use Liu Jun Zi Tang; if ineffective, add Shengjiang and Rougui. Death occurs when pathogen is strong and True Qi is too weak to erupt, seen within 10+ days. If erupted, use Tuo Li Xiao Du San. If not sloughing, use Tuo Li Xiao Du San; if ineffective, urgently warm/tonify Spleen/Stomach. Death occurs when True Qi is too weak to slough, seen within 20 days. If sloughed, use Tuo Li San to generate flesh; if ineffective, urgently warm/tonify Spleen/Stomach. Death occurs when Spleen Qi is too weak to contract/heal, seen after 1 month+. These three syndromes, though not in classics, have been verified by my experience.
*Qianjin Fang* Moxibustion for Fa Bei (ulcerated or not): Mix Tan Dou Chi (Fermented Soybean) with water into a hard paste, form cakes 3-4 fen thick based on swelling size. Do not place on existing holes; surround with bean cakes, arrange moxa on top, keep mildly warm without breaking skin. Lift if too hot/painful; moxibustate twice daily. If holes existed, discharge of fluid indicates cure.
I. Test for Diaphragm Penetration: For large ulcerated Back Ju, to test for membrane penetration, do NOT use Zaogao San (Gleditsia Powder) for sneezing. Seal the area with paper and instruct the patient to breathe intentionally. If paper remains still, penetration has not occurred. Sneezing may force penetration; beware.
Censor Zhou Honggang suffered Back Ju, swollen but not ulcerated, pulse large and floating (Yang Qi deficiency with pathogen stagnation). Used Tuo Li San doubled with Renshen and Huangqi. Developed internal heat/thirst, surging-forceless pulse (Deficient Fire). Urgently added Rougui to the formula. Pulse/symptoms subsided; cured with continued Tuo Li San. Using cold herbs for assumed Heat-Toxin would have been an error.
Shangshe Zhang Kegong suffered this condition, using cold/detoxifying herbs internally and externally. Resulted in body-wide pain, nausea, poor appetite, afternoon/internal heat, chills. Diagnosis: Body pain = Ying/Wei deficiency failing to nourish muscles; Nausea/poor appetite = Spleen/Stomach cold failing to digest; Internal/afternoon heat = Yin Blood deficiency with Yang sinking into Yin; Chills = Yang Qi deficiency failing to protect muscles. All caused by insufficient Spleen/Stomach Qi. Treated with Bu Zhong Yi Qi Tang (symptoms receded), then Shi Quan Da Bu Tang (necrotic tissue sloughed), then Liu Jun Zi Tang plus Chuanxiong and Danggui (flesh regenerated, cured).
Fuyang Peng Bixi suffered Waist Ju, took cold/detoxifying herbs. Color dark, painless, heads like scattered millet, heavy back unable to sleep, deaf/blind, spiritless face, frequent/scanty urination, thirst/confusion, coarse/short breathing, floating-rapid pulse, forceless on deep pressure. First dose of Zishui (Nourishing Water) herbs relieved urination/thirst/back heaviness. Then phlebotomy to release stasis, moxibustation with 0.5 jin mugwort, external Wu Jin Gao, internal Renshen, Huangqi, Danggui, Baizhu, Rougui. After several doses, Yuan Qi recovered. Patient stopped Rougui due to fear of heat; resulted in cold limbs/incontinence. Resumed Rougui (2 qian), Buguzhi (2 qian), Roudoukou (1 qian); stool normalized, tissue sloughed. Used Danggui Gao for flesh generation, Ba Zhen Tang for Qi/Blood replenishment; cured.
Shangshe Cai Dongzhi suffered this. I used supporting herbs to induce ulceration; wound not fully healed. Mid-winter, with cough. Diagnosis: Non-healing = Spleen Qi deficiency; Persistent cough = Lung Qi deficiency. Law: Tonify the Mother (Spleen). At dinner, he avoided mutton. I advised: Tonification removes weakness; Ginseng and Mutton are examples; highly suitable. He ate daily without interruption; healed in 10+ days, cough resolved.
Man, over 50, Fa Bei purple/swollen/painful, skin about to rupture, insomnia/poor appetite, mental fatigue. Sangchai Jiu (Mulberry Twig Moxibustion) on site released black blood; patient slept deeply, symptoms vanished. Took Xian Fang Huo Ming Yin (2 doses), moxibustated again, pus/blood discharged. Two more doses reduced swelling/pain significantly. Tuo Li Xiao Du San (several doses) led to healing. Although fierce sores require strong purgatives, elderly patients with weak Qi/Blood and superficial lesions risk damaging Stomach Qi if focused solely on detoxification, causing error. (Xue's Note)
My eldest son developed Back Ju at one week old; treatment recorded under "Swelling Ulcer" section. (New Note)
General Formulas Outside Discussion
Shen Xian Xun Zhao Method (External 123)