马益卿曰∶臀痈证，臀居小腹之下，此阴中之阴也，道远位僻，虽曰多血，然气运不到
，血亦罕来，中年之后，尤虑患此。才有肿痛，参之脉证，但见虚弱，便与滋补。气血无亏，可保终吉。
立斋曰∶凡治此者，毋伤脾胃，勿损脾气，但当以固根本为主。若 痛，尺脉紧而无力者
，托之。肿硬痛甚者，隔蒜灸之，更以解毒。不作脓者，托里为主。不作脓而痛者，解毒为
主。不溃或溃而不敛者，托里为主。
又《治法》曰∶若肿硬作痛者，形气虚而邪气实也，用托里消毒散。微肿微痛者，形气病
气俱虚也，用托里散补之。欲作脓者，用内托羌活汤。若痛甚者，用仙方活命饮。大势既退
，亦用托里消毒散。若脾虚不能消散，或不溃不敛者，六君子加芎、归、黄 。若阴虚不能
消散，或作渴便淋者，六味丸加五味子。若阳虚不能溃，或脓清不能敛者，用补中益气汤。
气血俱虚者，十全大补汤。若肿硬未成脓者，用隔蒜灸，及活命饮。溃后，宜豆豉饼，及补
中益气、十全大补二汤。若灸后大势已退，余毒未消，频用葱熨，以补其气，以消余毒为善。
又曰∶凡毒瓦斯已退不起者，但可补其血气，使脓速成而针去之，不可用内消之论。若
肿高而软者，发于血脉，肿下而坚者，发于筋骨，肉色不变者，发于骨髓也。脓血大泄之后
，当大补气血为先，虽有他证，以末治之。
巡按陈和峰，脾胃不健，常服消导之剂，左腿股及臀患肿。余曰∶此脾气虚而下注，非
疮毒也，当用补中益气，倍加白术。彼惑于众人云，白术能溃脓，乃专以散肿消毒为主，而
肿益甚，体益倦。余用白术一味煎饮而消。
儒者杨启元，左臀患此，敷贴凉药，肿彻内股。服连翘消毒散，左体皆痛。余以为足三
阴亏损，用补中益气汤，以补脾肺；用六味丸加五味子，以补肝肾。股内消而臀间溃，又用
十全大补汤而疮口敛。
一儒者， 肿痛甚，此邪毒壅滞，用活命饮、隔蒜灸而消。后因饮食劳倦，肿痛复作
，寒热头痛，此元气虚而未能复也，与补中益气汤，频用葱熨法，两月而愈。
一男子，患臀痈作脓而痛，以仙方活命饮，二剂痛止。更以托里消毒散，脓溃而瘥。
一弱人，臀痈脓成不溃，以十全大补汤数剂始托起。乃针之，又二十余剂而愈。（薛按）
马益卿说：臀痈这一病证，臀部位于小腹之下，这是阴中之阴的部位。此处距离脏腑较远且位置偏僻，虽然中医理论认为该处多血，但气机运行难以到达，血液也很少流注，因此人到中年以后，尤其需要警惕患此病。一旦出现肿痛，结合脉象和症状进行辨证，只要见到虚弱的征象，就应当给予滋补药物。气血没有亏损，就能保证最终痊愈。
立斋说：凡是治疗这种病，不要损伤脾胃，不要损耗脾气，只应当以巩固根本为主。如果疼痛剧烈，尺脉紧而无力，应采用托毒排脓的方法。如果肿胀坚硬且疼痛严重，采用隔蒜灸法，并配合解毒药物。如果不化脓的，以托里扶正为主。如果不化脓但疼痛的，以解毒为主。如果不溃破或溃破后不愈合的，以托里扶正为主。
又《治法》中说：如果肿胀坚硬且作痛，是形体正气虚弱而邪气实盛，使用托里消毒散。如果微肿微痛，是形体、正气和病气都虚弱，使用托里散来补益。如果即将化脓，使用内托羌活汤。如果疼痛剧烈的，使用仙方活命饮。如果大势已退，也使用托里消毒散。如果脾虚不能消散，或不溃破不愈合的，用六君子汤加川芎、当归、黄芪。如果阴虚不能消散，或出现口渴、小便淋涩的，用六味丸加五味子。如果阳虚不能溃破，或脓液清稀不能愈合的，使用补中益气汤。气血都虚弱的，使用十全大补汤。如果肿胀坚硬尚未成脓的，使用隔蒜灸及仙方活命饮。溃破之后，适宜用豆豉饼敷贴，以及补中益气汤、十全大补汤两方。如果灸后大势已退，余毒未消，频繁使用葱熨法，以补益其气，消除余毒为善。
又说：凡是毒瓦斯已经消退不再发作的，只可补益其血气，使脓液迅速成熟后用针切开排出，不可使用内消的理论。如果肿胀高突而柔软的，发于血脉；肿胀低平而坚硬的，发于筋骨；肌肉颜色不变的，发于骨髓。在脓血大量泄出之后，应当以大补气血为先，即使有其他证候，也放在次要地位处理。
巡按陈和峰，脾胃功能不强健，常服用消食导滞的药物，左腿大腿及臀部发生肿胀。我说：这是脾气虚弱导致湿浊下注，并非疮毒，应当使用补中益气汤，加倍加入白术。他听信众人说白术能溃脓，于是专门以散肿消毒为主，结果肿胀更加严重，身体更加疲倦。我单用白术一味煎水饮用，肿胀便消除了。
儒生杨启元，左侧臀部患此病，敷贴凉性药物，肿胀蔓延至内侧大腿。服用连翘消毒散后，左侧身体都疼痛。我认为这是足三阴经亏损，使用补中益气汤，以补益脾肺；使用六味丸加五味子，以补益肝肾。大腿内侧消肿而臀部间溃破，又使用十全大补汤使疮口愈合。
一位儒生，肿痛非常严重，这是邪毒壅滞，使用仙方活命饮、隔蒜灸而消除。后来因为饮食不节和劳累，肿痛再次发作，伴有寒热头痛，这是元气虚弱未能恢复，给予补中益气汤，频繁使用葱熨法，两个月后痊愈。
Ma Yiqing stated: Regarding the condition of buttock carbuncle (Buttock Carbuncle), the buttocks are located below the lower abdomen, which is a yin within yin area. This location is distant from the zang-fu organs and remote in position. Although it is said to be rich in blood, qi circulation does not reach it easily, and blood flow is also scarce. Therefore, after middle age, one must particularly beware of contracting this disease. Once swelling and pain appear, upon correlating pulse and symptoms, if weakness is observed, tonification should be administered immediately. If qi and blood are not depleted, auspicious recovery can be ensured.
Lizhai stated: In treating this condition, do not injure the spleen and stomach, nor damage spleen qi; instead, focus primarily on consolidating the root. If there is severe pain with a tight yet powerless chi pulse, employ methods to support interior and expel toxins. If swelling is hard and pain is severe, apply garlic-partitioned moxibustion and further use detoxifying agents. For cases that do not suppurate, prioritize supporting the interior. For those that do not suppurate but experience pain, prioritize detoxification. For those that do not ulcerate or fail to heal after ulceration, prioritize supporting the interior.
Furthermore, "Treatment Methods" states: If there is hard swelling with pain, it indicates deficiency of form and qi alongside excess of pathogenic factors; use Tuoli Xiaodu San (Support Interior and Detoxify Powder). If there is slight swelling and slight pain, it indicates deficiency in form, qi, and pathogenic factors; use Tuoli San (Support Interior Powder) for tonification. If suppuration is imminent, use Neituo Qianghuo Tang (Interior-Supporting Notopterygium Decoction). If pain is severe, use Xianfang Huoming Yin (Immortal Recipe for Preserving Life Decoction). After the major symptoms have subsided, also use Tuoli Xiaodu San. If spleen deficiency prevents resolution, or if there is non-ulceration/non-healing, use Liujunzi Tang (Six Gentlemen Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Astragali Membranacei Radix (Huangqi). If yin deficiency prevents resolution, or if thirst and dysuria occur, use Liuwei Wan (Six-Ingredient Pill) plus Schisandrae Fructus (Wuweizi). If yang deficiency prevents ulceration, or if pus is clear and fails to heal, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For simultaneous deficiency of qi and blood, use Shiquan Dabu Tang (Ten Complete Tonifying Decoction). If swelling is hard but suppuration has not formed, use garlic-partitioned moxibustion and Xianfang Huoming Yin. After ulceration, it is appropriate to use Fermented Soybean Cake (Douchi Bing) and the two decoctions Buzhong Yiqi Tang and Shiquan Dabu Tang. If after moxibustion the major pathogenic force has receded but residual toxins remain, frequently apply scall-moxibustion (Congyun) to tonify qi and eliminate residual toxins.
It is also stated: Whenever toxic pathogens have receded and ceased to flare up, only blood and qi should be tonified to hasten suppuration, followed by needle drainage; the theory of internal resolution should not be used. If swelling is high and soft, it originates in the blood vessels; if swelling is low and hard, it originates in the sinews and bones; if skin color remains unchanged, it originates in the bone marrow. After massive discharge of pus and blood, large-scale tonification of qi and blood should be prioritized; even if other syndromes exist, they should be treated secondarily.
Chen Hefeng, Censor-in-Chief, had weak spleen and stomach function and frequently consumed digestive-promoting agents. He developed swelling in his left thigh and buttock. I said: This is dampness sinking due to spleen qi deficiency, not a carbuncle toxin. It should be treated with Buzhong Yiqi Tang, doubling the dosage of Atractylodis Macrocephalae Rhizoma (Baizhu). Confused by others claiming Baizhu promotes pus rupture, he focused solely on reducing swelling and detoxifying, resulting in worsened swelling and increased fatigue. I prescribed a decoction of single-ingredient Baizhu, which resolved the swelling.
Yang Qiyuan, a scholar, suffered from this condition in his left buttock. After applying cooling plasters, swelling extended to the inner thigh. After consuming Liaoqiao Xiaodu San (Forsythia Detoxifying Powder), pain spread throughout his left body. I diagnosed it as deficiency of the three yin meridians of the foot. I used Buzhong Yiqi Tang to tonify spleen and lung; and Liuwei Wan plus Wuweizi to tonify liver and kidney. The inner thigh swelling subsided, and the buttock ulcerated. Subsequently, Shiquan Dabu Tang was used to close the wound.
Another scholar experienced severe swelling and pain, caused by stagnation of pathogenic toxins. He was treated with Xianfang Huoming Yin and garlic-partitioned moxibustion, leading to resolution. Later, due to dietary irregularities and overwork, swelling and pain recurred with chills, fever, and headache. This indicated deficiency of primordial qi failing to recover. He was given Buzhong Yiqi Tang and frequent scall-moxibustion, recovering after two months.
A man suffered from buttock carbuncle with suppuration and pain. He took Xianfang Huoming Yin; after two doses, pain ceased. He then took Tuoli Xiaodu San, leading to pus discharge and recovery.
A frail individual had a buttock carbuncle where pus formed but did not ulcerate. After several doses of Shiquan Dabu Tang, the pus was supported to the surface. It was then lanced with a needle, and after more than twenty additional doses, he recovered. (Commentary by Xue Ji)