发背、搭手之为疡重矣，其证各异，而治则同揆也，故合而论之。发背者，发于脊中，
属督脉及足太阳膀胱经，其证有上中下之分。伤于肺，则发于上，在天柱骨下；伤于心与肝
，则发于中，为对心发；伤于脾与肾，则发于下，为对脐发。大抵发背之证，其名虽多（有
莲蓬发、蜂窝发、对心发、对脐发等名），总不越乎阴阳二证。其感于六淫之邪而发者，为
阳证。初起或一头，或二头，数日后，或大如手掌，或大如碗面， 赤肿高，疼痛发热，烦
渴不宁，势若甚重，其脉洪数有力，能进饮食。先以蟾酥丸发汗，更与银花解毒汤，或犀角
地黄汤清营解热，勿使伤其脾胃。俟脓一溃，诸症悉安。须知有脓时，急宜当头开之，否则
使毒内攻，致生变证。至溃后，即腐烂尺余者，若无恶证，则投以大补之剂，肉最易生，此
阳证易治者也。其感于七情而发者，为阴证。或由于郁怒忧思，或由于房劳过度，或由于膏
粱浓味，醇酒炙 ，丹石热毒，其人平素阴精消涸，火毒内生结聚，酿成大患。初起一
头如粟，根盘散漫，不甚高肿，不甚 痛，色不红活，紫滞无神，脉微细而无力，饮食不进
，止觉闷痛烦躁，大渴便秘，睡语切牙。四、五日间，疮头不计其数，形如莲蓬，故名莲蓬
发，又名蜂窠疽发。若见中间一头独大，四边出无数小头者，即名百鸟朝王。疮口各含黄浊
，而积日不溃，按之流血。至八、九日，其头成片，所含之物俱出，通结一衣，揭去又结，
其浮面共烂为一疮，肉虽腐而不脱，其脓内攻，其色黑黯。此元气大虚，而为内陷之证，必
致神昏痉厥，手足逆冷，腹痛泄泻，而不可救矣。必于成功后，用参 内托散，峻补元气，
冀其引血成脓，化毒外泄；外用乌金膏或夺命丹盖贴，以提其毒，俾不至肿不溃，腐不烂，
方得生机。丹溪曰∶痈疽未溃，以疏托解毒为主；已溃，以托补元气为主。陈远公谓∶阳毒
可用攻毒，阴毒必须补正。此数语，实为外科枢要，慎勿坐失机宜，致证危势笃，而束手待
毙也。
至于搭手，亦有上中下之分。上搭手生于肩膊后骨上，去背沟二指之间，名鼠疽，乃手
足太阴、太阳之所司也；中搭手生于脊骨第九椎两旁膏肓穴，名青龙疽，系阳明、太阴之所
司也；下搭手生于脊骨第十四节腰窝间旁开三寸肓门穴，乃太阴经之所司也。谓之搭手者，
因患者以手搭之，上中下俱能搭着，故名。盖上搭由上焦积热，中搭由心火有余，下搭由肝
脾火炽，总归于下元虚弱、肾水耗散而成。此证亦有阴阳之别。阳证形高而肿起，阴证形低
而陷下；阳证色红，阴证色带滞；阳证初起必痛，阴证初起必痒；阳证溃烂多脓，阴证溃烂
多血；阳证由于外感，阴证由于内伤。其调治之法，与发背之证，大略可通，虽曰证有大小
，势有轻重，而所以清热化毒、补养气血之方，则无二致也。此二证中，亦有三陷变象，与
脑疽同，其候数亦同。又发背搭手及脑疽，至溃脓腐脱后，新肉既满，而口不敛，有忽发流
火者，其人憎寒壮热，甚至神识昏迷，疮口四边红赤，延开四布，切勿惊惧。斯时可用凉血
清解，如鲜地、犀角、丹皮等。俟一日或二日后，汗出身凉，赤退肿平，其疮口自然敛小。
此由营卫亏损，火旺浮越所致。汗出而火自散，营卫自和，疮口自敛矣。世俗睹此，每莫能
措手，不知非败证也。外又有流毒一证，疽发肿大，势如发背，但头虽溃，而外面不腐，因
暑湿郁遏而成。若脓出稠浓，而内腐易脱者易愈。治与阳证发背同。
又治发背、搭手之证，最妙灸法，不问日期、阴阳，肿痛或不痛，或痛甚，但未成脓，
或不溃者，俱可灸之。取大蒜切片，安疮头上，用大艾炷灸之，三壮换一蒜片，痛者灸至不
痛，不痛者灸至痛方止，其毒瓦斯自然随火而散；若有十数头作一处生者，即用大蒜研成膏，
作薄饼，铺疮头上，聚艾于蒜饼上烧之亦可。盖如此恶证，惟隔蒜灸，及涂乌金膏有效。
发背和搭手是外科中极为严重的疮疡，它们的症状表现各不相同，但治疗原则却是相通的，因此将它们合并在一起讨论。
发背，生于脊柱正中，归属于督脉及足太阳膀胱经，其病症有上、中、下三个部位的区别。若病邪伤及肺，则发于上部，位于天柱骨下方；若病邪伤及心与肝，则发于中部，称为对心发；若病邪伤及脾与肾，则发于下部，称为对脐发。大抵而言，发背的病症，名称虽然繁多（有莲蓬发、蜂窝发、对心发、对脐发等名称），但总归不出阴阳两类证候。因感受六淫（风、寒、暑、湿、燥、火）邪气而引发的，属于阳证。初起时可能是一个头，也可能是两个头，数日后，或大如手掌，或大如碗口，红肿高突，疼痛发热，烦躁口渴不安，病情看似很重，脉象洪大而数且有力，饮食尚可。先服用蟾酥丸以发汗解表，再给予银花解毒汤，或犀角地黄汤清营分热毒，注意不要损伤脾胃。等到脓液溃破后，各种症状都会安定下来。必须知道，当有脓时，应当及时在顶部切开引流，否则会导致毒邪内攻，产生变证。到了溃烂之后，即使腐烂面积有一尺多，如果没有恶性的征象，就投以大补气血的药剂，肌肉最容易生长，这是阳证容易治疗的情况。
因感受七情（喜、怒、忧、思、悲、恐、惊）而引发的，属于阴证。或者由于郁怒忧思，或者由于房劳过度，或者由于食用膏粱厚味、醇酒炙烤食物以及丹石热毒，导致患者平素阴精枯竭，火毒内生并结聚，酿成大患。初起时一个头如粟米大小，根盘散漫，不太高肿，不太疼痛，颜色不红活，呈紫滞无神状，脉象微细而无力，饮食不进，只感到闷痛烦躁，大渴便秘，睡梦中说胡话、磨牙。四、五日间，疮头不计其数，形状像莲蓬，所以名叫莲蓬发，又名蜂窠疽发。如果见到中间一个头特别大，四周发出无数小头的，就名叫百鸟朝王。疮口各含黄浊之物，经过多日也不溃破，按压时流血。到了八、九日，其头成片，所含之物全部排出，连成一片皮膜，揭去后又重新结聚，表面共同腐烂成一个疮，肉虽腐坏但不脱落，脓毒内攻，颜色黑黯。这是元气大虚，导致毒邪内陷的证候，必然导致神志昏迷、抽搐厥逆，手足逆冷，腹痛泄泻，而无法救治了。必须在正气尚存之时，使用参苓内托散，峻补元气，希望它能引血化脓，将毒邪向外透泄；外用乌金膏或夺命丹覆盖贴敷，以提毒外出，使得不至于肿而不溃、腐而不烂，方有一线生机。朱丹溪说：痈疽未溃破时，以疏利托毒、清热解毒为主；已溃破后，以托补元气为主。陈远公说：阳毒可以用攻毒法，阴毒必须用扶正法。这几句话，实在是外科治疗的枢要关键，千万不要坐失良机，导致病情危重、势态笃急，而束手待毙。
至于搭手，也有上、中、下的区别。上搭手生于肩胛骨后方，距离背部正中线两指宽处，名叫鼠疽，由手足太阴、太阳经所主管；中搭手生于脊柱第九椎两旁膏肓穴处，名叫青龙疽，由阳明、太阴经所主管；下搭手生于脊柱第十四节腰窝间旁开三寸的肓门穴处，由太阴经所主管。之所以叫搭手，是因为患者用手可以搭到患处，上、中、下都能搭着，所以得名。大概上搭手是由上焦积热引起，中搭手是由心火有余引起，下搭手是由肝脾火炽引起，总归是由于下元虚弱、肾水耗散而形成的。此证也有阴阳的区别。阳证形态高而肿胀突起，阴证形态低而凹陷；阳证颜色红，阴证颜色带滞涩；阳证初起必定疼痛，阴证初起必定瘙痒；阳证溃烂多脓，阴证溃烂多血；阳证由于外感引起，阴证由于内伤引起。其调理治疗方法，与发背的病症大致相通，虽然说症状有大小之分，势态有轻重之别，但用来清热化毒、补养气血的方药，则没有两样。在这两种病症中，也会出现三种内陷变象，与脑疽相同，其候症数量也相同。另外，发背、搭手及脑疽，在溃脓腐肉脱落后，新肉已经长满，但疮口不收敛，忽然发作流火者，其人憎寒壮热，甚至神识昏迷，疮口四边红赤，蔓延扩散，切勿惊慌恐惧。此时可用凉血清解之法，如鲜地黄、犀角、牡丹皮等。等到一天或两天后，出汗身凉，红退肿平，疮口自然收敛变小。这是由于营卫亏损，火旺浮越所致。出汗后火气自然消散，营卫调和，疮口自然收敛。世俗之人看到这种情况，往往不知如何处理，不知道这不是败证。此外还有流毒一证，疽发肿大，势态如同发背，但头部虽然溃破，外面却不腐烂，因暑湿郁遏而成。如果脓出稠浓，内部腐肉容易脱落的，容易治愈。治疗方法与阳证发背相同。
另外治疗发背、搭手的病症，最妙的是灸法，不问日期、阴阳，肿痛或不痛，或痛甚，只要尚未成脓，或未溃破的，都可以施灸。取大蒜切片，放在疮头上，用大艾炷灸之，三壮换一片蒜片，痛的灸到不痛为止，不痛的灸到痛为止，毒气自然随火而散；如果有十几个头聚在一起生长的，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可以。大概如此恶重的病症，只有隔蒜灸，以及涂抹乌金膏才有效。
Fa Bei (Back Carbuncle) and Da Shou (Hand-Reaching Carbuncle) are severe conditions in surgery. Although their manifestations differ, their treatment principles are consistent; therefore, they are discussed together.
Fa Bei (Back Carbuncle) occurs on the midline of the spine, belonging to the Du Mai (Governing Vessel) and Foot-Taiyang Bladder Meridian. Its lesions are divided into upper, middle, and lower sections. If injured by the Lung, it appears in the upper section, below the Tian Zhu bone (C7 vertebra); if injured by the Heart and Liver, it appears in the middle section, called Dui Xin Fa (Opposite-Heart Carbuncle); if injured by the Spleen and Kidney, it appears in the lower section, called Dui Qi Fa (Opposite-Navel Carbuncle). Generally speaking, although there are many names for Fa Bei (such as Lian Peng Fa (Lotus-Pod Carbuncle), Feng Wo Fa (Honeycomb Carbuncle), Dui Xin Fa, Dui Qi Fa, etc.), they all fall under either Yin or Yang syndromes. Those caused by the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) are Yang syndromes. Initially, there may be one head or two heads. After a few days, it may swell as large as a palm or a bowl surface, with redness, swelling, elevation, pain, fever, restlessness, thirst, and agitation. The condition appears severe, with a洪 (Surging) and 数 (Rapid) pulse that is forceful, and appetite remains intact. First, administer Chan Su Wan (Toad Venom Pill) to induce sweating, followed by Yin Hua Jie Du Tang (Honeysuckle Detoxification Decoction) or Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) to clear heat from the Ying (Nutritive) level and resolve toxicity, without damaging the Spleen and Stomach. Once pus ruptures, all symptoms will subside. It must be noted that when pus has formed, prompt incision at the apex is necessary; otherwise, toxicity may penetrate inward, causing complications. In the post-ulceration stage, even if necrosis extends over a chi (approx. 33 cm), provided there are no malignant signs, potent tonifying agents should be administered to promote granulation tissue growth. This represents the easier-to-treat Yang syndrome.
Those caused by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Grief, Fear, Fright) are Yin syndromes. These may result from suppressed anger or worry, excessive sexual activity, consumption of rich/greasy foods, strong wine, roasted meats, or toxic minerals (Dan Shi). The patient typically suffers from depletion of Yin essence, leading to internal generation and accumulation of Fire-Toxin. Initially, a single head appears like a millet grain, with a diffuse base, mild swelling, slight pain, dull purple color lacking luster, a fine and weak pulse, loss of appetite, stifling pain, irritability, extreme thirst, constipation, somnolence with muttering, and teeth grinding. Within four to five days, numerous heads appear, resembling a lotus pod, hence named Lian Peng Fa (Lotus-Pod Carbuncle) or Feng Ke Ju (Honeycomb Abscess). If one central head is significantly larger with numerous small heads surrounding it, it is called Bai Niao Chao Wang (Hundred Birds Paying Homage to the King). The sores contain yellow turbid discharge but do not ulcerate after many days; pressing them causes bleeding. By the eighth or ninth day, the heads coalesce into a sheet, discharging accumulated material, forming a continuous membrane that reforms after removal. The superficial area rots into a single ulcer; flesh necrotizes but does not slough off, pus penetrates inward, and the color becomes dark black. This indicates severe deficiency of Yuan Qi (Original Qi) with internal sinking of toxin, inevitably leading to coma, convulsions, cold extremities, abdominal pain, and diarrhea, which is incurable. At this stage, Shen Zhi Nei Tuo San (Ginseng and Angelica Internal Support Powder) should be used to strongly tonify Yuan Qi, hoping to guide blood to form pus and expel toxin outward; externally, Wu Jin Gao (Black Gold Ointment) or Duo Ming Dan (Life-Saving Pill) should be applied to draw out toxin, preventing failure to ulcerate or slough, thereby preserving a chance of survival. Zhu Danxi stated: For carbuncles and sores before ulceration, focus on dispersing, supporting, and clearing heat-toxin; after ulceration, focus on supporting and tonifying Yuan Qi. Chen Yuangong stated: Yang toxins can be treated with attacking/detoxifying methods, while Yin toxins require strengthening the healthy Qi. These words are pivotal in surgical treatment; do not miss the opportunity, allowing the condition to become critical and desperate, leaving you helpless.
Regarding Da Shou (Hand-Reaching Carbuncle), it also has upper, middle, and lower divisions. Upper Da Shou arises on the posterior shoulder blade, two fingers' width from the spinal groove, named Shu Ju (Mouse Abscess), governed by the Hand and Foot Taiyin and Taiyang meridians. Middle Da Shou arises beside the Gao Huang acupoint at the ninth thoracic vertebra, named Qing Long Ju (Green Dragon Abscess), governed by the Yangming and Taiyin meridians. Lower Da Shou arises beside the Mang Men acupoint, three cun lateral to the waist hollow at the fourteenth vertebral segment (lumbar region), governed by the Taiyin meridian. It is called "Da Shou" because the patient can reach it with their hand, covering upper, middle, and lower areas. Generally, Upper Da Shou results from accumulated heat in the Upper Jiao (Upper Burner), Middle Da Shou from excess Heart Fire, and Lower Da Shou from blazing Liver and Spleen Fire, ultimately stemming from deficiency of the Lower Yuan (Lower Origin) and depletion of Kidney Water. This condition also distinguishes between Yin and Yang. Yang syndromes present with high, swollen elevations; Yin syndromes with low, depressed lesions. Yang syndromes are red; Yin syndromes are dull/stagnant. Yang syndromes hurt initially; Yin syndromes itch initially. Yang ulcers produce much pus; Yin ulcers produce much blood. Yang syndromes arise from external pathogens; Yin syndromes from internal injury. The treatment principles are largely similar to Fa Bei. Although severity varies, the formulas for clearing heat, resolving toxin, and tonifying Qi and Blood remain the same. These two conditions may also exhibit three types of internal sinking transformations, identical to Nao Ju (Brain Abscess), with similar prognostic indicators. Furthermore, for Fa Bei, Da Shou, and Nao Ju, after pus drains and necrotic tissue sloughs, if new flesh fills the wound but the opening fails to close, and sudden "Flowing Fire" (erysipelas-like spread) occurs, accompanied by aversion to cold, high fever, coma, and spreading redness around the sore, do not panic. At this time, use blood-cooling and clearing methods, such as Xian Di Huang (Fresh Rehmannia Root), Xi Jiao (Rhino Horn - *note: substitute with legal alternatives in practice*), and Mu Dan Pi (Moutan Cortex). After one or two days, when sweating subsides, body temperature normalizes, redness fades, and swelling decreases, the wound will naturally contract. This is caused by deficiency of Ying and Wei (Nutritive and Defensive) levels and floating hyperactive Fire. Sweating dissipates the Fire, harmonizing Ying and Wei, allowing natural healing. Laypeople often find this perplexing, mistakenly believing it to be a terminal sign. Additionally, there is a condition called Liu Du (Flowing Toxicity): abscesses swell severely like Fa Bei, but although the head ulcerates, the exterior does not rot, caused by stagnation of Summerheat and Dampness. If pus is thick and internal necrosis sloughs easily, it heals readily. Treatment is the same as for Yang-type Fa Bei.
Furthermore, regarding the treatment of Fa Bei and Da Shou, moxibustion is most effective, regardless of timing, Yin/Yang nature, whether painful or painless, severe pain or mild, provided pus has not yet formed or the sore has not ulcerated. Place slices of garlic on the sore, apply large moxa cones, replacing the garlic slice after three moxa burns. For painful sores, moxa until pain ceases; for painless sores, moxa until pain begins. The toxic vapors will naturally dissipate with the fire. If multiple heads cluster together, grind garlic into a paste, form a thin cake, place it on the sore, and burn moxa on top of the garlic cake. For such severe conditions, only garlic-partitioned moxibustion and application of Wu Jin Gao (Black Gold Ointment) are effective.