Buttock carbuncle (Tun Yong) is attributed to damp-heat in the Bladder Meridian or congenital Yin deficiency. If there is swelling, hardness, and pain, Neituo Qianghuo Tang (Internal Supportive Decoction with Notopterygium) should be used. If there is slight swelling and slight pain, Tuoli Xiaodu San (Supporting Interior Powder for Detoxification) should be used. If severe pain occurs at the onset, or within five days where the condition seems to resolve but does not, nor seems to suppurate but does not, Xianfang Huoming Yin (Immortal Formula for Life Preservation Decoction) should be used first, followed by Tuoli Xiaodu San. If it has already ulcerated, accompanied by poor appetite, fatigue, and failure of the sore to generate flesh, indicating Spleen-Stomach deficiency, Wuwei Yigong San (Five-Ingredient Decoction for Extraordinary Merit) with Chaihu (Bupleurum Root) and Shengma (Cimicifugae Rhizoma) should be used. For those with congenital Yin deficiency presenting with frequent urination and inability to consolidate, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) should be used. For Qi deficiency with prolonged failure to granulate and close the wound, Douchi Bing (Fermented Soybean Cake) applied externally and Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) taken internally should be used to nourish Yuan Qi (Primordial Qi). If heat-clearing and toxin-attacking methods are employed, or cold-natured agents are applied topically, it will injure Qi and Blood, inevitably leading to Bai Zheng (failure syndrome/necrosis).

A child suffered from this condition; the area was swollen, hard, and non-red for over ten days, with a red yet sallow complexion and reduced food intake. This indicated Spleen Qi deficiency. Initially, Yigong San was administered. As food intake gradually increased and diffuse swelling subsided, Tuoli San was used with a small addition of Rougui (Cinnamon Bark), leading to suppuration. Subsequently, Bazhen Tang (Eight-Treasure Decoction) was used to promote healing.

Another child suffered from this condition with prolonged failure to heal. The surrounding tissue was slightly dark, the wound mouth black, with thin purulent discharge, chills and fever, afternoon tidal fever, and a floating and rapid pulse. The Cun positions on both wrists were imperceptible upon pressure. This indicated Yang Qi deficiency and Yin Blood weakness. Bu Zhong Yi Qi Tang was administered in the morning, and Yigong San in the evening. Recovery occurred after half a year.

Yet another child had an ulcerated buttock sore that failed to heal, with intermittent facial flushing. This was due to congenital Liver-Kidney Yin deficiency. Bazhen Tang with Wuweizi (Schisandra Fruit) was administered in the morning, and Jiaban Bawei Wan in the evening. Symptoms gradually receded. Tuoli San was then used intermittently, resulting in recovery.

Another child had a buttock sore that failed to heal for a long time, accompanied by limb fatigue, afternoon fever, and thirst. This indicated deficiency of the Three Yin Meridians of the Foot. Wuwei Yigong San and Jiaban Bawei Wan were used to achieve gradual improvement, followed by Tuoli San to promote closure.

Another child suffered from buttock carbuncle with prolonged failure to granulate and a sallow complexion. The parents desired to use toxin-attacking methods to promote healing. I stated: The Spleen governs muscles; when the Spleen is robust, flesh grows. Thus, Bu Zhong Yi Qi Tang was administered in the morning, Wuwei Yigong San and Congyun Fa (Scallion Moxibustion Method) in the evening. With strengthened Spleen Qi and regenerated muscle, the child recovered.

Another child presented with persistent swelling and hardness without color change in the skin. This was due to deficient and timid Spleen-Stomach Qi, unable to transport therapeutic effects to the affected area. Bu Zhong Yi Qi Tang was administered in the morning, and Wuwei Yigong San in the evening, to support the deficient Qi. Resolution occurred after more than a month. At that time, others suffering from the same condition who used topical cold-cooling herbs and internal Xijiao Wan (Rhinoceros Horn Pill) all suffered harm.

A fifteen-year-old child had a chronic condition that failed to heal, presenting with fever, emaciation, pale complexion, and belching. Having strictly consumed digestive-promoting and heat-clearing medicines, I diagnosed Heart Fire deficiency and weak Spleen Qi. Bawei Wan was used as the principal formula, assisted by Liujunzi Tang (Six-Gentlemen Decoction) and Bu Zhong Yi Qi Tang, leading to recovery. After marriage, the child developed a carbuncle between the buttocks, characterized by diffuse swelling, hardness, unchanged skin color, cold hands and feet, and a floating and large pulse that became minute upon pressure, especially at the Chi positions. Four doses of Bawei Wan decoction material were administered first, followed by Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction). The lesion returned to normal color and subsided.

Neituo Qianghuo Tang treats carbuncles arising in the sacral and renal regions, presenting with hardness, swelling, and pain.
Qianghuo (Notopterygii Rhizoma et Radix), Huangbai (Phellodendri Cortex, wine-processed, each 1 qian), Fangfeng (Saposhnikoviae Radix), Bencao (Ligustici Rhizoma et Radix), Dangguiwei (Angelicae Sinensis Radix, tail, each 5 fen), Rougui (Cinnamon Bark), Lianqiao (Forsythiae Fructus), Gancao (Licorice Root, honey-fried), Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium, each 3 fen), Huangqi (Astragali Radix, 8 fen).
Prepare two doses. Decoct in one cup of water. Take on an empty stomach.

Xianfang Huoming Yin
Tuoli Xiaodu San
Tuoli San (See "Heat-Toxin Carbuncles and Ulcers" for the above three formulas)
Shenxiao Jiedu San (See "Arm Carbuncle" for formula)
Jiaban Bawei Wan (See "Thirst" for formula)
Bazhen Tang (See "Unceasing Fever" for formula)
Congyun Fa (See "Liuzhu/Metastatic Abscesses" for method)