或问∶背之下极发疽何如？曰∶此名穿裆发，属督脉及太阳经，由劳伤忧思积郁所
致。活命饮加羌活、黄柏，内托羌活汤主之，及胜金丹、神仙追毒丸。壮实者，八阵散、一
粒金丹下之。老弱者，十全大补汤、人参养荣汤。此证宜速治，稍缓则溃烂，难收敛。成
漏者，多麻木黑陷，泄泻呕哕疲倦者，不治。
《灵枢》曰∶发于尻，名曰锐疽。其状赤坚大，急治之。不治，三十日死矣。
《鬼遗》云∶涌泉疽，肿起发太阴，（太阴，尻尾前是也。）如伏鼠，二十日不穴死，十日可
刺，发清脓，赤黑者死。白者可治。
或问∶臀上生痈何如？曰∶肿高根浅为痈，肿平根深为疽，俱属足太阳经，湿热所
致。宜服内托羌活汤、内托复煎散加羌活主之。胜金丹、黄 木香散选用。壮实者，一
粒金丹、八阵散下之。老弱者，十全大补汤、人参养荣汤。先贤云∶此疮当服补养之剂，若
无补养之功；其祸多在结痂之后，治之难愈，切须戒谨，勿辍大补之剂。肿而不溃者，服
台阁紫微丸。
〔薛〕 臀，膀胱经部分也，居小腹之后，此阴中之阴，其道远，其位僻，虽太阳多血，
气运难及，血亦罕到，中年后尤虑此患，治者毋伤脾胃，毋损气血，但当固根本为主。若
肿硬作痛者，形气虚而邪气实也，用托里消毒散主之，微肿微痛者，形气病气俱虚也，用
托里散补之。欲作脓，用托里羌活汤。若痛甚，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，六君加芎、归、黄 。若阴虚不能消散，或作
渴便淋者，六味丸加五味子。阳虚不能溃或脓清不能敛者，补中益气汤；气血俱虚者，十
全大补汤。若肿硬末成脓者，隔蒜灸；活命饮。溃后，豆豉饼；补中益气、十全大补二
汤。若灸后大势已退，余毒末消，频用葱熨，以补气消余毒为善。 巡抚陈和峰，脾胃不
健，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。彼惑于众论云∶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；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，肿痛仍作，寒热头疼，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，漫肿而色不变，脉滑数而无力，脓将成矣。余
用托里而欲针，彼畏针而欲内消，误用攻伐之剂，顿加恶寒发热，自汗等证。余用十全
大补汤数剂，肿起色赤，仍外针内补而愈。吴辅之父患此，内溃肿胀，发热口干，饮食
少思，此脾胃虚弱也，先用六君子加芎归 数剂而溃，又用十全大补汤，倍加参 五十
余剂而愈。 一人年三十，脉如屋漏、雀啄，肿硬色夭，脓水清稀，误服败毒之药。余曰∶
此足三阴亏损而药复伤也。余用六君加归、 、附子一钱，二剂肿溃色赤，又减附子五
分数剂，元气复而疮愈。 一男子硬痛发热，此膀胱气虚而湿热壅滞，用内托羌活汤二剂，
热痛悉退；后用托里消毒散而溃。又用托里散四十余剂而敛。 一上舍患痔，外敷寒凉，
内服消毒，攻溃于臀，脓水清稀，脉洪大而数，寒热作渴。余辞不治，果殁。此足三阴
亏损之证，失滋化源，以致真气益虚，邪气愈甚矣，不死何俟。
内托羌活汤 治尻臀生痈，坚硬肿痛大作。
羌活 黄柏（酒制，各二钱） 防风 当归尾 本 连翘 苍术 陈皮 甘草（炙，各一钱）
肉桂（三分） 黄 （一钱半）
上作一服。水一盅，酒半盅，煎至八分，食前服。
有人问：背部下方极尽之处发生的疽疮怎么样？回答说：这种病名叫穿裆发，归属于督脉及足太阳膀胱经，是由于劳累损伤、忧思积郁所致。治疗以活命饮加羌活、黄柏为主，配合内托羌活汤服用，以及胜金丹、神仙追毒丸。体质壮实者，可用八阵散、一粒金丹攻下泄热。年老体弱者，用十全大补汤、人参养荣汤调理。此证应当迅速治疗，稍一迟缓就会溃烂，难以收敛愈合。如果形成瘘管（慢性溃疡），多表现为麻木、颜色黑陷；若伴有腹泻、呕吐呃逆、疲倦无力等症状的，属于不治之症。
《灵枢》说：发生在尾骨部位的疽，名叫锐疽。其症状是红肿坚硬且大，必须紧急治疗。如果不治，三十天后会死亡。
《鬼遗钞》记载：涌泉疽，肿胀从太阴经发出（太阴经，指尻尾前方的部位），形状像伏着的老鼠，二十天不排脓就会死亡，十天可以针刺，排出清澈脓液的可以治愈，排出赤黑色脓液的则死亡。
有人问：臀部上方生痈疮怎么样？回答说：肿胀高突、根基浅表的是痈，肿胀平坦、根基深固的是疽，两者都归属于足太阳膀胱经，由湿热邪气所致。适宜服用内托羌活汤、内托复煎散加羌活为主。也可选用胜金丹、木香散。体质壮实者，用一粒金丹、八阵散攻下泄热。年老体弱者，用十全大补汤、人参养荣汤调理。先贤曾说：这种疮疡应当服用补益滋养的药物，如果没有补养的疗效，祸患多在结痂之后出现，治疗起来很难痊愈，务必谨慎小心，不要停止使用大补的药物。肿胀但不溃破的，服用台阁紫微丸。
〔薛己〕臀部，是足太阳膀胱经分布的区域，位于小腹后方，这是阴中之阴，经络路径远，位置偏僻，虽然太阳经多血，但气运难以到达，血液也很少流注，中年以后尤其要担心这种病患。治疗时不要损伤脾胃，不要损耗气血，只应当以巩固根本为主。如果肿胀坚硬且疼痛，是形体正气虚而邪气实，用托里消毒散主治；轻微肿胀轻微疼痛的，是形体正气和病邪之气都虚，用托里散补益。快要化脓时，用托里羌活汤。如果疼痛剧烈，用仙方活命饮。大势已退后，也用托里消毒散。如果脾虚不能消散，或者不溃破不收敛的，用六君子汤加川芎、当归、黄芪。如果阴虚不能消散，或者口渴、小便淋涩的，用六味丸加五味子。阳虚不能溃破或脓液清稀不能收敛的，用补中益气汤；气血都虚的，用十全大补汤。如果肿胀坚硬尚未成脓的，用隔蒜灸法；配合仙方活命饮。溃破后，用豆豉饼外敷；配合补中益气汤、十全大补汤两种汤剂。如果灸后大势已退，余毒未消，频繁使用葱熨法，以补气消除余毒为善。巡抚陈和峰，脾胃不健，服用消导类药物，左腿大腿及臀部发生肿胀。我说：这是脾气虚导致湿浊下注，不是疮毒，应当用补中益气汤加倍白术。他听信众人议论说：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，肿胀就消除了。儒者杨启元，左臀患此病，敷贴凉药，肿胀蔓延至大腿内侧，服用连翘消毒散，左侧身体都疼痛。我认为这是足三阴经亏损，用补中益气汤补益脾肺；用六味丸加五味子补益肝肾，大腿内侧消肿而臀部间溃破。又用十全大补汤使疮口收敛。一位儒者，肿胀疼痛剧烈，这是邪毒壅滞，用仙方活命饮、隔蒜灸法消散。后来因饮食劳倦，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，两个月痊愈。一名男子，漫肿且颜色不变，脉象滑数但无力，脓将要形成。我用托里法想要针刺排脓，他害怕针刺想要内消，误用攻伐类药物，顿时加重了恶寒发热、自汗等症状。我用十全大补汤数剂，肿胀起色变红，仍然采用外针内补的方法而痊愈。吴辅的父亲患此病，内部溃破肿胀，发热口干，饮食减少思虑，这是脾胃虚弱，先用六君子汤加川芎、当归等数剂而溃破，又用十全大补汤，加倍人参五十多剂而痊愈。一人年三十岁，脉象如屋漏、雀啄，肿胀坚硬颜色枯槁，脓水清稀，误服败毒药物。我说：这是足三阴经亏损而药物又伤了正气。我用六君子汤加当归、肉桂、附子一钱，两剂后肿胀溃破颜色变红，又减去附子五分，再服数剂，元气恢复而疮愈。一名男子硬痛发热，这是膀胱气虚而湿热壅滞，用内托羌活汤两剂，热痛全部消退；后用托里消毒散而溃破。又用托里散四十多剂而收敛。一位上舍生患痔疮，外敷寒凉药物，内服解毒药物，攻溃于臀部，脓水清稀，脉象洪大而数，寒热作渴。我推辞不治疗，果然去世。这是足三阴经亏损的证候，失去了滋生化之源，导致真气更加虚弱，邪气更加旺盛，不死还等什么。
内托羌活汤 治疗尾骨臀部生痈，坚硬肿痛大作。
羌活 黄柏（酒制，各二钱） 防风 当归尾 藁本 连翘 苍术 陈皮 甘草（炙，各一钱） 肉桂（三分） 黄芪（一钱半）
以上为一服量。用水一盅，酒半盅，煎至八分，饭前服用。
A person asked: "What is the condition of a carbuncle occurring at the extreme lower part of the back?" The reply was: "This condition is named Chuan Dang Fa (Penetrating Crotch Carbuncle), belonging to the Du Mai (Governing Vessel) and the Taiyang Bladder Meridian. It is caused by physical exhaustion, worry, and accumulated depression. The primary treatment is Huo Ming Yin (Life-Saving Decoction) added with Qiang Huo (Notopterygii Rhizoma et Radix) and Huang Bo (Phellodendri Cortex), accompanied by Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction), as well as Sheng Jin Dan (Victory Golden Pill) and Shen Xian Zhui Du Wan (Immortal Poison-Chasing Pill). For those with strong constitutions, Ba Zhen San (Eight-Array Powder) or Yi Li Jin Dan (One-Pill Golden Pill) should be used to purge. For the elderly and weak, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) and Ren Shen Yang Rong Tang (Ginseng Nourishing Nutritive Qi Decoction) are indicated. This condition requires rapid treatment; if delayed even slightly, it will ulcerate and become difficult to heal. If it forms a fistula, it often presents with numbness and black depression; if accompanied by diarrhea, vomiting, hiccups, and fatigue, it is incurable.
The *Ling Shu* states: "A carbuncle arising at the sacrum is named Rui Ju (Sharp Carbuncle). Its presentation is red, hard, and large; it must be treated urgently. If untreated, death occurs within thirty days."
The *Gui Yi* records: "Yong Quan Ju (Spring Spring Carbuncle) swells from the Taiyin Meridian (Taiyin refers to the area anterior to the sacrococcygeal region). It resembles a crouching rat. If not punctured within twenty days, death ensues. Puncture may be performed after ten days. If clear pus is discharged, it is treatable; if red-black pus is discharged, it is fatal."
A person asked: "What is the condition of a boil arising on the upper buttocks?" The reply was: "If the swelling is high and the root is shallow, it is a Boil (Yang abscess); if the swelling is flat and the root is deep, it is a Carbuncle (Yin abscess). Both belong to the Foot-Taiyang Bladder Meridian and are caused by Damp-Heat. It is suitable to take Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) and Nei Tuo Fu Jian San (Internal Support Double-Boiled Powder) added with Qiang Huo (Notopterygii Rhizoma et Radix). Sheng Jin Dan (Victory Golden Pill) and Mu Xiang San (Costus Powder) may also be selected. For those with strong constitutions, Yi Li Jin Dan (One-Pill Golden Pill) and Ba Zhen San (Eight-Array Powder) should be used to purge. For the elderly and weak, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) and Ren Shen Yang Rong Tang (Ginseng Nourishing Nutritive Qi Decoction) are indicated. Ancient sages stated: 'For this type of sore, tonifying and nourishing agents should be taken. If there is no effect from tonification, disaster often occurs after the scab forms, making healing difficult. One must be extremely cautious and not discontinue major tonifying agents.' If swollen but not ulcerated, Tai Ge Zi Wei Wan (Imperial Purple Micro Pill) should be taken.
[Xue Ji] The buttocks are the distribution area of the Foot-Taiyang Bladder Meridian, located posterior to the lower abdomen. This is Yin within Yin. The meridian path is distant, and the location is remote. Although the Taiyang Meridian contains abundant blood, Qi circulation rarely reaches it, and Blood flow is scarce. Especially after middle age, one must fear this affliction. In treatment, do not injure the Spleen and Stomach, nor deplete Qi and Blood; rather, focus primarily on consolidating the Root. If the area is swollen, hard, and painful, it indicates Deficiency of Form/Qi and Excess of Pathogenic Qi; Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) is the primary treatment. If mildly swollen and mildly painful, both Form/Qi and Pathogenic Qi are deficient; Tuo Li San (Support Interior Powder) is used to tonify. When suppuration is imminent, Tuo Li Qiang Huo Tang (Support Interior Notopterygium Decoction) is used. If pain is severe, Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction) is used. After the major symptoms subside, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) is also used. If Spleen deficiency prevents resolution, or if there is no ulceration or healing, Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) and Huang Qi (Astragali Radix) is used. If Yin deficiency prevents resolution, or if there is thirst and dysuria, Liu Wei Wan (Six-Ingredient Pill) added with Wu Wei Zi (Schisandrae Fructus) is used. If Yang deficiency prevents ulceration or if the pus is clear and fails to heal, Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) is used; for combined Qi and Blood deficiency, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) is used. If swollen and hard without suppuration, Garlic-Separated Moxibustion is applied alongside Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction). After ulceration, Fermented Soybean Cake (Dou Chi Bing) is applied externally, along with Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) and Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction). If after moxibustion the major symptoms have subsided but residual toxins remain, frequent Scallion-Ironing (Cong Yun) is beneficial to tonify Qi and eliminate residual toxins.
Censor Chen Hefeng had weak Spleen and Stomach function and took digestive-purging agents, resulting in swelling of the left thigh and buttock. I said: "This is Spleen Qi deficiency causing downward pouring of dampness, not a carbuncle toxin. Use Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) with doubled Bai Zhu (Atractylodis Macrocephalae Rhizoma)." He was confused by popular opinion stating that "Bai Zhu (Atractylodis Macrocephalae Rhizoma) can discharge pus," so he focused solely on dispersing swelling and detoxifying, which worsened the swelling and fatigue. I used only Bai Zhu (Atractylodis Macrocephalae Rhizoma) decocted in water, which resolved the swelling.
Scholar Yang Qiyuan suffered from this on his left buttock. After applying cooling pastes and taking Lian Qiao Xiao Du San (Forsythia Eliminate Toxin Powder), his entire left body became painful. I diagnosed it as Deficiency of the Three Foot-Yin Meridians. I used Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) to tonify the Spleen and Lung; Liu Wei Wan (Six-Ingredient Pill) added with Wu Wei Zi (Schisandrae Fructus) to tonify the Liver and Kidney. The inner thigh subsided, and the buttock ulcerated. Subsequently, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) was used to close the wound.
Another scholar presented with severe swelling and pain, indicating stagnation of pathogenic toxins. Xian Fang Huo Ming Yin (Immortal Formula Life-Saving Decoction) and Garlic-Separated Moxibustion were used to resolve it. Later, due to dietary irregularities and overwork, swelling and pain recurred with chills, fever, and headache. This indicated Qi Yuan (Original Qi) deficiency and failure to recover. Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) was administered, along with frequent Scallion-Ironing (Cong Yun), resulting in recovery after two months.
A man presented with diffuse swelling without color change, and a slippery, rapid yet forceless pulse, indicating impending suppuration. I intended to use a supporting method and needle drainage, but fearing needles, he sought internal resolution and mistakenly used purging agents. This immediately aggravated chills, fever, and spontaneous sweating. I administered several doses of Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction). The swelling rose and turned red. External needle drainage combined with internal tonification led to recovery.
Wu Fu's father suffered from this, with internal ulceration, swelling, fever, dry mouth, and poor appetite. This was Spleen-Stomach weakness. Six Jun Zi Tang (Six Gentlemen Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix) was used for several doses until ulceration occurred. Then, Shi Quan Da Bu Tang (Ten Substance Great Tonifying Decoction) with doubled Ren Shen (Ginseng Radix) was used for over fifty doses, leading to recovery.
A thirty-year-old man presented with a pulse resembling a leaking roof or sparrow pecking, hard swelling with dull color, and thin pus. He had mistakenly taken toxic-clearing drugs. I said: "This is Deficiency of the Three Foot-Yin Meridians compounded by drug injury." I used Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix), Rou Gui (Cinnamomi Cortex), and Fu Zi (Aconiti Lateralis Radix Praeparata, 1 qian). After two doses, the swelling ulcerated and turned red. Fu Zi (Aconiti Lateralis Radix Praeparata) was reduced by half a fen, and after several more doses, Original Qi recovered and the sore healed.
A man presented with hard pain and fever, indicating Bladder Qi deficiency with Damp-Heat stagnation. Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) was used for two doses, resolving heat and pain completely. Subsequently, Tuo Li Xiao Du San (Support Interior Eliminate Toxin Powder) was used to induce ulceration. Tuo Li San (Support Interior Powder) was used for over forty doses to promote healing.
A student of the Imperial Academy suffered from hemorrhoids. He applied cold-cooling external agents and took internal detoxifiers, causing an ulceration on the buttock with thin pus, a surging rapid pulse, chills, fever, and thirst. I declined treatment, and he indeed died. This was a condition of Three Foot-Yin Meridian deficiency, losing the source of transformation and nourishment, leading to further depletion of True Qi and exacerbation of pathogenic Qi. Death was inevitable.
Nei Tuo Qiang Huo Tang (Internal Support Notopterygium Decoction) treats boils/carbuncles arising at the sacrum and buttocks, characterized by hardness, swelling, and severe pain.
Qiang Huo (Notopterygii Rhizoma et Radix), Huang Bo (Phellodendri Cortex, wine-processed, each 2 qian), Fang Feng (Saposhnikoviae Radix), Dang Gui Wei (Angelicae Sinensis Radix Caulis), Ben Cao (Ligustici Rhizoma), Lian Qiao (Forsythiae Fructus), Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Licorice Radix et Rhizoma, honey-fried, each 1 qian), Rou Gui (Cinnamomi Cortex, 3 fen), Huang Qi (Astragali Radix, 1.5 qian).
Take as one dose. Decoct with one cup of water and half a cup of wine until eight-tenths remains. Take before meals."