经曰∶气伤痛，形伤肿。发背之证，感受有五。酒肉肥鲜，帏幕恣意一；阳热炽盛，伤寒余
毒二；误服金石，烧炼热药三；阴毒瓦斯冷，深隐渐发四；山岚瘴气，冒蓄脏腑五也。大都富贵家
，多因法酒肥羊，膏粱浓味。寒薄者，大怒忧愤，郁结不舒。属于督脉及足太阳膀胱之经。或痒
或麻，或痛或不痛，有阴阳，腑脏之别焉。感于六腑积热，举发于肤肉之间。其候暴速，肿皮高
软，侵展阔大，炎灼于表，如碗如盆， 赤热痛，名曰背痈。乃邪气壅遏于经络，证属于阳，故
其毒专攻于外，势虽盛而骨髓终不枯竭，脏腑亦不致伤，此为易治。惟难调护而愈迟，十无一死
。感于五脏积热，攻注于肌骨之内，其发迟缓，内外俱平，微作赤色，如粟如钱，时作痒痛，名
曰背疽。乃邪气隐伏于筋膜，证属于阴，故其毒专于内，形虽微而精气皆已败坏，荣卫必不能固
敛，此为难治。虽然极力而罔效，十无一生。所谓外如粟，内如谷；外如钱，内着拳是也。治法
宜先用蒜捣饼，多艾灸之（痛灸至不痛，不痛灸至痛），或去蒜明灸。先以加减败毒散大剂汗之
，接服真人活命饮，日二、三剂。其银花酒，槐花酒，蜡矾丸，皆可兼用。次服托里
诸方，十宣、八珍、十全大补之类。便秘服黄连内疏汤，清凉饮（忌木通。）必服护心散，外用敷药
。脓成不得穿破者，用替针丸；不穿，用针法（方见前。）
主方 真人活命饮，倍皂角刺，加羌活（二钱）、肉桂（三分），好酒煎服。如不饮酒，水、酒同
煎。前后宜用诸方，皆于总论中采用。
男子五十外患此，四、五日 肿大病，赤晕尺许，重如负石。势炽当峻攻，察其脉虚，先砭
赤处，出黑血碗许；稍轻，外围药，内多服真人活命饮，砭处出黑水而消。
《黄帝内经》中说：气机受伤则导致疼痛，形体受伤则导致肿胀。发背这一病症，致病原因主要有五种：一是饮酒吃肉、肥甘厚味无节制；二是阳热邪气炽盛，或伤寒病后的余毒未清；三是误服金石类药物，或长期服用烧炼而成的热性药物；四是阴寒毒气寒冷，潜伏体内逐渐发作；五是山间的瘴气，侵入并蓄积在脏腑之中。大多数富贵人家，多是因为饮用药酒、食用肥羊以及膏粱厚味所致。体质虚寒的人，往往因为大怒、忧愁愤懑，导致气机郁结而不舒展。该病主要归属于督脉及足太阳膀胱经。症状表现为或痒、或麻、或痛、或不痛，有阴证和阳证、腑病和脏病的区别。
如果是感受六腑的积热，爆发于皮肤肌肉之间，其发病急骤迅速，患处肿胀、皮高而软，范围扩散宽阔，表面炎症灼热，形状像碗或盆一样，红肿热痛，称为“背痈”。这是由于邪气壅塞阻滞于经络，证候属于阳证，所以毒气专门攻冲于体表，虽然病情看似猛烈，但骨髓最终不会枯竭，脏腑也不会受到损伤，这属于容易治疗的类型。只是难以调养护理，痊愈较慢，但十人中无一死亡。
如果是感受五脏的积热，攻注深入肌骨之内，其发病缓慢，患处内外平坦，微微发红，大小如粟米或铜钱，时常感到痒痛，称为“背疽”。这是由于邪气隐伏于筋膜之间，证候属于阴证，所以毒气专门攻冲于体内，虽然外形微小，但精气已经败坏，营卫之气必然不能固敛，这属于难治的类型。即使极力治疗也无效，十人中无一存活。这就是所说的“外如粟米，内如谷粒；外如铜钱，内如拳头”的意思。
治疗方法宜先用大蒜捣成饼敷于患处，进行多次艾灸（如果痛就灸到不痛为止，如果不痛就灸到有感觉为止），或者去掉蒜饼直接施灸。先使用大剂量的加减败毒散使其发汗，接着服用真人活命饮，每天二至三剂。金银花酒、槐花酒、蜡矾丸等都可以兼用。随后服用托里透脓的各种方剂，如十宣散、八珍汤、十全大补汤之类。如果便秘，服用黄连内疏汤、清凉饮（忌用木通）。必须服用护心散，并外用敷药。如果脓液形成但不能自行穿破，使用替针丸；如果不能穿破，采用针刺法（方法见前文）。
主方为真人活命饮，加倍皂角刺，加入羌活（二钱）、肉桂（三分），用好酒煎服。如果不饮酒，用水和酒同煎。前后适宜使用的其他方剂，都在总论中选用。
男子五十岁以后患此病，四、五天后肿势严重，周围有一尺左右的红晕，患处沉重得像背着石头一样。病情炽盛时应当峻猛攻下，观察其脉象若虚弱，先在发红的部位进行砭石放血，放出约一碗的黑血；病情稍轻后，在外围用药，内部多服用真人活命饮，待砭刺处流出黑水后消散。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Injury to Qi causes pain, injury to the Form causes swelling." The etiology of Back Carbuncle (Fabei) involves five factors: First, indulgence in alcohol, meat, and rich foods; Second, excessive Yang-Heat pathogenic factors or residual toxins from Shaoyang Cold Damage (Shanghan); Third, ingestion of mineral drugs or long-term use of heat-producing decoctions refined through calcination; Fourth, cold Yin-toxic vapors lying dormant and gradually manifesting; Fifth, mountain miasma invading and accumulating in the Zang-Fu organs. Most affluent individuals suffer this due to medicinal wine, fatty mutton, and rich, greasy diets. Those with deficient-cold constitutions often suffer from anger, worry, and resentment, leading to Qi stagnation and constraint. The disease primarily belongs to the Du Meridian (Governing Vessel) and the Foot-Taiyang Bladder Meridian. Symptoms may include itching, numbness, pain, or absence of pain, distinguishing between Yin/Yang patterns and Fu/Zang organ involvement.
If caused by accumulated Heat in the Six Fu organs erupting between the skin and flesh, the onset is rapid. The lesion is swollen, high, soft, spreading widely, with burning inflammation on the surface, resembling a bowl or basin, characterized by redness, heat, and pain. This is named Back Abscess (Bei Yong). It results from pathogenic factors obstructing the meridians, belonging to a Yang pattern. Thus, the toxicity attacks outwardly. Although the condition appears severe, the marrow is not ultimately depleted, and the Zang-Fu organs are not damaged, making it easy to treat. However, nursing care is difficult, recovery is slow, but mortality is low (one in ten does not die).
If caused by accumulated Heat in the Five Zang organs attacking inward into the muscle and bone, the onset is slow. The lesion is flat internally and externally, slightly red, size like millet grains or coins, with intermittent itching and pain. This is named Back Ulcer (Bei Ju). It results from pathogenic factors hiding in the fascia, belonging to a Yin pattern. Thus, the toxicity attacks inwardly. Although the external appearance is minor, the Essence and Qi are already corrupted, and Ying (Nutritive) and Wei (Defensive) Qi cannot consolidate, making it difficult to treat. Even with vigorous treatment, it is ineffective, and mortality is high (none in ten survive). This corresponds to the saying: "Externally like millet, internally like grain; externally like a coin, internally like a fist."
Treatment should first involve applying mashed garlic as a cake to the area and moxibustion (moxa until pain ceases if painful; moxa until sensation returns if painless), or direct moxibustion after removing the garlic cake. Initially, administer a large dose of Jiajian Baidu San (Modified Detoxification Decoction) to induce sweating, followed immediately by Zhenren Huoming Yin (Immortal Life Decoction), two to three doses daily. Yinhua Jiu (Honeysuckle Wine), Huaihua Jiu (Sophora Flower Wine), and Lafan Wan (Wax and Alum Pill) can be used concurrently. Subsequently, administer formulas for supporting the interior and expelling pus, such as Shixuan San (Ten Acupoints Powder), Bazhen Tang (Eight Treasures Decoction), and Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). For constipation, use Huanglian Neishu Tang (Coptis Internal Purging Decoction) or Qingliang Yin (Cooling Drink, avoiding Mutong/Akebia Caulis). Huxin San (Heart-Protecting Powder) must be taken, along with external applications. If pus forms but does not rupture spontaneously, use Tizhen Wan (Needle-Replacement Pill); if it does not rupture, employ needle drainage (method seen previously).
The main formula is Zhenren Huoming Yin (Immortal Life Decoction), with doubled Gleditsiae Spina (Zaojiaoci) and added Qianghuo (Notopterygii Rhizoma et Radix, 2 qian) and Rougui (Cinnamomi Cortex, 3 fen), decocted in good wine. If the patient does not drink alcohol, decoct with water and wine together. Other appropriate formulas mentioned before and after are selected from the General Discussion.
For men over fifty suffering from this, after four to five days, the swelling becomes severe with a red halo about one chi wide, feeling heavy as if carrying a stone. When the pathogenic factor is fierce, aggressive purging is indicated. Observe the pulse; if deficient, first perform Bian Shi bloodletting (stone pricking) on the red area to release approximately one bowl of dark blood. As the condition lightens, apply external medicine and internally take more Zhenren Huoming Yin. The lesion will resolve when dark fluid flows from the pricked area.