论曰发背已溃，毒瓦斯外泄，或有逆证难治者，盖以腑脏之伤也，有白睛青黑而眼小，服
药而呕，腹痛渴甚，膊项中不便，音嘶色败者，是为五逆，其余热渴，利呕，与脓溃不愈，
皆以
治发背已溃，去脓汁，理虚劳。内补黄 汤方
黄 （细锉） 麦门冬（去心焙各一两） 熟干地黄（焙） 人参 白茯苓（去黑皮） 甘
草（
炙锉各三分） 当归（锉焙） 芍药 芎 桂（去粗皮） 远志（去心各半两）
上一十一味，粗捣筛，每服三钱匕，水一盏，入生姜半分拍碎，枣二枚擘破，同煎至五
分，去滓空心温服，日晚再服。
治发背痈疽已溃，排脓生肉。当归散方
当归（锉焙） 桂（去粗皮） 人参 防风（去叉各一两） 芎 浓朴（去粗皮生姜
汁炙）
甘草（炙锉） 白芷 桔梗（锉炒各半两）
上九味，捣罗为细散，每服二钱匕，空心温酒调下，日晚再服。
治发背已溃，痢下不住。白石脂汤方
白石脂（炮） 龙骨（炮各一两） 当归（锉焙） 桔梗（锉炒各半两） 女萎 白头
翁（各一
分） 黄连（去须半两） 干姜（炮裂） 甘草（炙锉各三分）
上九味，粗捣筛，每服三钱匕，水一盏，煎至五分，去滓空心温服，日午晚后各一服。
灸发背后服。大黄汤方
大黄 朴硝各三钱
上二味，粗捣筛，水一盏，浓煎热服，即泻出毒瓦斯。
治发背先穿破，出脓水不住，伤外风冷毒 痛。淋洗当归汤方
当归（锉焙） 甘草（炙锉） 芍药 葛根（锉） 细辛（去苗叶） 黄柏（去粗皮） 麻
黄（去
根节） 苦参 白芷 桂（去粗皮） 蜀椒（去目并闭口者炒） 防风（去叉各一分）
上一十二味，粗捣筛，以水六升，煎取三升，滤去滓，温洗疮上日再。
治发背痈疽已溃，积毒恶肉未去。猪蹄汤淋洗方
猪蹄（一只） 黄 黄连（去须） 芍药 黄芩（去黑心各一分） 野狼牙根 蔷薇根
（各半
两）
上七味锉碎，先以水煮猪蹄令熟，取汁五升，下药煎至三升，去滓放温，淋洗疮，候水
冷，即贴苁蓉膏，痛不止，加当归半两，甘草半两，和煎洗疮。
治发背痈疽已溃不生肉，暖肌干疮。苁蓉膏方
肉苁蓉（去皴皮） 半夏（生锉） 熟干地黄（各一两） 当归 蜀椒（去目并闭口者
炒出汗）
细辛（去苗叶） 乌喙（去皮） 蛇衔草 白芷 甘草 桂（去粗皮各半两） 薤白（七
茎） 猪脂（二斤）
上一十三味，除猪脂外，锉碎，以醋半升，拌药一宿，先熬脂令沸，次下诸药，煎候白
芷赤黑色，漉出绵滤，瓷合盛，取涂疮上，日三次立效。
治发背溃后，毒瓦斯未散，脓不绝。露蜂房散方
露蜂房（二两烧灰） 乱发灰（一两） 蛇皮灰（三分） 赤小豆（二两炒熟） 川大
黄（三两
半锉研微炒） 玄参（一两半） 子芩（二两半） 川芒硝（三两半）
上八味，捣罗为细散，每服二钱匕，煎黄 汤调下，不计时候。
治发背溃后，脓水不绝。托里生肌散方
川芎（二两） 黄 （二两锉） 白芷（半两） 赤芍药（一两） 桂心（三分） 人
参（半两去
芦头） 丁香（半两） 当归（一两）
上八味，捣筛为散，每服二钱匕，粥饮调下。
治痈肿发背恶疮生肌后，用力劳动，努伤出血不止。麒麟竭散方
麒麟竭（半两） 黄连（三分） 槟榔（半两） 黄柏（半两锉） 白芨（半两） 诃
黎勒皮（一
分）
上六味，捣罗为细散，鸡子白调涂疮口上，以白薄纸贴之，药干即换，忌用力劳动。
治痈疽发背疮肿，或已溃，或未溃。连翘饮方
连翘 山栀子仁 黄 （锉炒） 防风（去叉） 升麻 羚羊角（镑） 漏芦（去芦头）
甘草
（炙锉） 大黄（锉炒） 枸杞根皮（各一两）
上一十味，粗捣筛，拌令匀，每服五钱匕，用水一盏半，煎取八分，去滓空心温服。
治发背发脑疼痛侵溃。黑锡煎方
黑锡一斤，先熔令浮，乘热研成泥，以无灰酒一斗，煎锡至三升，瓷瓶中盛，
每服一盏，调生甘草末二钱匕，日三服，甚者五七遍瘥。
论述说：发背疮已经溃破，毒邪之气向外宣泄，但有时会出现逆证而难以治疗，这是因为脏腑受到损伤所致。如果出现白眼球呈现青黑色且眼睛变小、服药后呕吐、腹痛且极度口渴、肩膊和颈部活动不便、声音嘶哑面色败坏这五种症状，就称为“五逆”。其余如发热口渴、腹泻呕吐，以及脓液溃破后久不愈合的情况，都按照治疗发背疮已溃破的原则处理，即去除脓汁，调理虚劳。
内补黄芪汤方
黄芪（细切）一两，麦门冬（去心焙干）一两，熟干地黄（焙干），人参，白茯苓（去黑皮），甘草（炙后切）各三分，当归（切后焙干），芍药，川芎，桂枝（去粗皮），远志（去心）各半两。
以上十一味药，粗捣筛过，每次服用三钱匕，加水一盏，放入生姜半分拍碎，大枣两枚掰开，一同煎煮至剩余五分水量，滤去药渣，空腹时温服，晚上再服一次。
治疗发背痈疽已溃破，排脓生肌的当归散方
当归（切后焙干），桂枝（去粗皮），人参，防风（去叉梢）各一两，川芎，厚朴（去粗皮，用生姜汁炙），甘草（炙后切），白芷，桔梗（切后炒）各半两。
以上九味药，捣罗成细散，每次服用二钱匕，空腹时用温酒调服，晚上再服一次。
治疗发背已溃破，痢疾不止的白石脂汤方
白石脂（炮制），龙骨（炮制）各一两，当归（切后焙干），桔梗（切后炒）各半两，女萎，白头翁各一分，黄连（去须）半两，干姜（炮裂），甘草（炙后切）各三分。
以上九味药，粗捣筛过，每次服用三钱匕，加水一盏，煎煮至剩余五分水量，滤去药渣，空腹时温服，中午和晚饭后各服一次。
灸治发背后服用的大黄汤方
大黄，朴硝各三钱。
以上两味药，粗捣筛过，加水一盏，浓煎后热服，即可泻出毒邪之气。
治疗发背先穿孔，脓水流出不止，受外风冷毒侵袭疼痛的淋洗当归汤方
当归（切后焙干），甘草（炙后切），芍药，葛根（切），细辛（去苗叶），黄柏（去粗皮），麻黄（去根节），苦参，白芷，桂枝（去粗皮），蜀椒（去目及闭口者，炒），防风（去叉梢）各一分。
以上十二味药，粗捣筛过，用水六升，煎取三升，滤去药渣，温热时清洗疮面，每天两次。
治疗发背痈疽已溃破，积毒恶肉未去除的猪蹄汤淋洗方
猪蹄一只，黄芪，黄连（去须），芍药，黄芩（去黑心）各一分，野狼牙根，蔷薇根各半两。
以上七味药切碎，先用水煮猪蹄至熟，取汁五升，加入其他药物煎煮至三升，滤去药渣放温，淋洗疮口，待水冷后，贴上苁蓉膏；如果疼痛不止，加当归半两、甘草半两，一起煎煮洗疮。
治疗发背痈疽已溃破不生肌肉，温暖肌肤干燥疮面的苁蓉膏方
肉苁蓉（去皴皮），半夏（生切），熟干地黄各一两，当归，蜀椒（去目及闭口者，炒出汗），细辛（去苗叶），乌喙（去皮），蛇衔草，白芷，甘草，桂枝（去粗皮）各半两，薤白七茎，猪脂二斤。
以上十三味药，除猪脂外，切碎，用醋半升拌药浸泡一夜，先熬猪脂令其沸腾，然后下入诸药，煎煮直到白芷呈赤黑色，捞出用绵布过滤，盛于瓷盒中，取药涂抹疮上，每天三次，立见疗效。
治疗发背溃破后，毒邪未散，脓液不绝的露蜂房散方
露蜂房（二两烧成灰），乱发灰（一两），蛇皮灰（三分），赤小豆（二两炒熟），川大黄（三两半切研微炒），玄参（一两半），子芩（二两半），川芒硝（三两半）。
以上八味药，捣罗成细散，每次服用二钱匕，用煎煮的黄芪汤调服，不限时候。
治疗发背溃破后，脓水不绝的托里生肌散方
川芎（二两），黄芪（二两切），白芷（半两），赤芍药（一两），桂心（三分），人参（半两去芦头），丁香（半两），当归（一两）。
以上八味药，捣筛成散，每次服用二钱匕，用米粥饮调服。
治疗痈肿发背恶疮生肌后，因用力劳动，努伤导致出血不止的麒麟竭散方
麒麟竭（半两），黄连（三分），槟榔（半两），黄柏（半两切），白芨（半两），诃黎勒皮（一分）。
以上六味药，捣罗成细散，用鸡蛋清调匀涂抹疮口上，用薄白纸贴住，药干即换，忌用力劳动。
治疗痈疽发背疮肿，或已溃或未溃的连翘饮方
连翘，山栀子仁，黄芪（切炒），防风（去叉梢），升麻，羚羊角（镑片），漏芦（去芦头），甘草（炙后切），大黄（切炒），枸杞根皮各一两。
以上十味药，粗捣筛过，拌匀，每次服用五钱匕，用水一盏半，煎取八分，滤去药渣，空腹时温服。
治疗发背发脑疼痛侵蚀溃烂的黑锡煎方
黑锡一斤，先熔化使其浮起，趁热研磨成泥，用无灰酒一斗，煎煮黑锡至三升，盛于瓷瓶中，每次服用一盏，调入生甘草末二钱匕，每天三次，重症者服用五到七次痊愈。
Discussion states: When a back carbuncle (back abscess) has ulcerated, the pathogenic toxic factors are discharged externally. However, there may be adverse syndromes that are difficult to treat, which is due to injury of the Zang-Fu organs. If white sclera appears blue-black and eyes become small, vomiting occurs after taking medicine, abdominal pain with extreme thirst, stiffness and inconvenience in shoulders/neck, hoarseness, and deterioration of complexion occur—these five symptoms are called "Five Adverse Signs" (Wu Ni). Other conditions such as fever and thirst, diarrhea and vomiting, or non-healing after pus discharge should all be treated according to the principle for treating ulcerated back carbuncles: removing pus and managing deficiency consumption.
Neibu Huangqi Tang (Internal Tonification Decoction with Astragalus)
Huangqi (Astragali Radix, finely cut) 1 liang, Maimendong (Ophiopogonis Radix, heart removed and dried) 1 liang, Shugan Dihuang (Prepared Rehmanniae Radix, dried), Renshen (Ginseng Radix), Baifuling (Poria, black skin removed), Gancao (Licorice Root, honey-fried and cut) each 3 qian, Danggui (Angelicae Sinensis Radix, cut and dried), Shaoyao (Paeoniae Radix), Xiong (Ligustici Chuanxiong Rhizoma), Guizhi (Cinnamomi Ramulus, coarse bark removed), Yuanzhi (Polygalae Radix, heart removed) each 0.5 liang.
The above eleven herbs are coarsely crushed and sieved. Each dose consists of 3 qianbi (approx. 9g), boiled with one sheng (approx. 200ml) of water, plus 0.5 fen of crushed fresh ginger and two cracked jujubes. Decoct until 0.5 sheng remains, strain, and take warm on an empty stomach; repeat in the evening.
Danggui San (Angelica Powder) for treating ulcerated back carbuncles and sores, promoting pus discharge and flesh regeneration.
Danggui (Angelicae Sinensis Radix, cut and dried), Guizhi (Cinnamomi Ramulus, coarse bark removed), Renshen (Ginseng Radix), Fangfeng (Saposhnikoviae Radix, forked tips removed) each 1 liang, Xiong (Ligustici Chuanxiong Rhizoma), Houpo (Magnoliae Officinalis Cortex, coarse bark removed, stir-fried with ginger juice), Gancao (Licorice Root, honey-fried and cut), Baizhi (Angelicae Dahuricae Radix), Jiegeng (Platycodonis Radix, cut and stir-fried) each 0.5 liang.
The above nine herbs are pounded into a fine powder. Each dose is 2 qianbi (approx. 6g), taken warm with wine on an empty stomach; repeat in the evening.
Baishizhi Tang (White Halloysite Decoction) for treating ulcerated back carbuncles with persistent dysentery.
Baishizhi (Halloysitum Rubrum, calcined), Longgu (Fossilized Bones, calcined) each 1 liang, Danggui (Angelicae Sinensis Radix, cut and dried), Jiegeng (Platycodonis Radix, cut and stir-fried) each 0.5 liang, Nuwei (Stemonae Radix), Baitouweng (Pulsatillae Radix) each 1 fen, Huanglian (Coptidis Rhizoma, mustache removed) 0.5 liang, Ganjiang (Zingiberis Rhizoma, calcined), Gancao (Licorice Root, honey-fried and cut) each 3 qian.
The above nine herbs are coarsely crushed and sieved. Each dose is 3 qianbi, boiled with one sheng of water until 0.5 sheng remains. Strain and take warm on an empty stomach; take once at noon and once after dinner.
Dahuang Tang (Rhubarb Decoction) to be taken after moxibustion for back carbuncles.
Dahuang (Rhei Radix et Rhizoma), Poxiao (Natrii Sulfas) each 3 qian.
The above two herbs are coarsely crushed and sieved. Boil with one sheng of water, decoct strongly, and take hot. This will induce purging to expel toxic factors.
Linxi Danggui Tang (Infusion/Washing Decoction with Angelica) for treating perforated back carbuncles with continuous pus drainage, pain from external wind-cold-toxin invasion.
Danggui (Angelicae Sinensis Radix, cut and dried), Gancao (Licorice Root, honey-fried and cut), Shaoyao (Paeoniae Radix), Gegen (Puerariae Lobatae Radix, cut), Xixin (Asari Radix et Rhizoma, seedlings and leaves removed), Huangbai (Phellodendri Cortex, coarse bark removed), Mahuang (Ephedrae Herba, roots and joints removed), Kushen (Sophorae Flavescentis Radix), Baizhi (Angelicae Dahuricae Radix), Guizhi (Cinnamomi Ramulus, coarse bark removed), Shujiao (Zanthoxyli Pericarpium, remove eyes and closed ones, stir-fry), Fangfeng (Saposhnikoviae Radix, forked tips removed) each 1 fen.
The above twelve herbs are coarsely crushed and sieved. Boil with six shengs of water to obtain three shengs. Filter and wash the wound warmly twice daily.
Zhuti Tang (Pig Trotter Decoction) for washing ulcerated back carbuncles where accumulated toxic foul flesh remains.
Zhuti (Pig Trotters, one piece), Huangqi (Astragali Radix), Huanglian (Coptidis Rhizoma, mustache removed), Shaoyao (Paeoniae Radix), Huangqin (Scutellariae Radix, black heart removed) each 1 fen, Yelangyagen (Wild Wolf's Tooth Root), Qiangweigen (Rose Root) each 0.5 liang.
The above seven herbs are chopped. First boil pig trotters in water until cooked, obtain five shengs of broth. Add other herbs and decoct to three shengs. Strain and let cool slightly. Wash the wound. After the water cools, apply Congrong Gao. If pain persists, add Danggui 0.5 liang and Gancao 0.5 liang, decoct together and wash.
Congrong Gao (Cistanche Ointment) for treating back carbuncles that have ulcerated but fail to regenerate flesh, warming muscles and drying sores.
Roucong rong (Cistanches Herba, wrinkled skin removed), Banxia (Pinelliae Rhizoma, raw and cut), Shugan Dihuang (Prepared Rehmanniae Radix) each 1 liang, Danggui (Angelicae Sinensis Radix), Shujiao (Zanthoxyli Pericarpium, remove eyes and closed ones, stir-fry until sweat appears), Xixin (Asari Radix et Rhizoma, seedlings and leaves removed), Wu Hui (Aconiti Lateralis Radix Preparata, skin removed), She xiancao (Patriniae Herba), Baizhi (Angelicae Dahuricae Radix), Gancao (Licorice Root), Guizhi (Cinnamomi Ramulus, coarse bark removed) each 0.5 liang, Xiebai (Allii Macrostemonis Bulbus) seven stalks, Zhuzhi (Porcine Fat) two jin.
The above thirteen herbs, excluding porcine fat, are chopped. Mix with half a sheng of vinegar and soak overnight. First boil the fat until boiling, then add the herbs. Decoct until Baizhi turns dark red/black. Strain through cotton cloth, store in a porcelain jar. Apply to the wound three times daily for immediate effect.
Lufengfang San (Honeycomb Powder) for treating back carbuncles after ulceration where toxic factors remain and pus does not cease.
Lufengfang (Vespa Nidus, burned to ash) 2 liang, Luangfa Hui (Ash of tangled hair) 1 liang, Shepi Hui (Ash of snake skin) 3 fen, Chixiaodou (Adzuki Bean, stir-fried until ripe) 2 liang, Chuan Dahuang (Rhei Radix et Rhizoma, cut, ground, lightly stir-fried) 3.5 liang, Xuanshen (Scrophulariae Radix) 1.5 liang, Ziqin (Scutellariae Radix) 2.5 liang, Chuan Mangxiao (Natrii Sulfas) 3.5 liang.
The above eight herbs are pounded into a fine powder. Each dose is 2 qianbi, taken with decocted Huangqi soup, at any time.
Tuoli Shengji San (Support Interior and Generate Flesh Powder) for treating continuous pus discharge after ulcerated back carbuncles.
Chuanxiong (Ligustici Chuanxiong Rhizoma) 2 liang, Huangqi (Astragali Radix, cut) 2 liang, Baizhi (Angelicae Dahuricae Radix) 0.5 liang, Chishaoyao (Red Paeoniae Radix) 1 liang, Guixin (Cinnamomi Ramulus Heart) 3 fen, Renshen (Ginseng Radix, rhizome head removed) 0.5 liang, Dingxiang (Caryophylli Flos) 0.5 liang, Danggui (Angelicae Sinensis Radix) 1 liang.
The above eight herbs are pounded and sieved into a powder. Each dose is 2 qianbi, taken with millet drink.
Qilinjie San (Kirin Blood Powder) for treating bleeding that does not stop due to strenuous labor causing injury after flesh regeneration in carbuncles/back sores.
Qilinjie (Dragon's Blood) 0.5 liang, Huanglian (Coptidis Rhizoma) 3 fen, Binglang (Arecae Semen) 0.5 liang, Huangbai (Phellodendri Cortex, cut) 0.5 liang, Baiji (Bletillae Rhizoma) 0.5 liang, Helile Pi (Pericarpium Terminaliae Chebulae) 1 fen.
The above six herbs are pounded into a fine powder. Mix with egg white and apply to the wound. Cover with thin white paper; change when dry. Avoid strenuous labor.
Lianqiao Yin (Forsythia Drink) for treating carbuncles and back sores, whether ulcerated or not.
Lianqiao (Forsythiae Fructus), Shanzhizi Ren (Gardeniae Semen, kernel), Huangqi (Astragali Radix, cut and stir-fried), Fangfeng (Saposhnikoviae Radix, forked tips removed), Shengma ( Cimicifugae Rhizoma), Lingyangjiao (Saigae Tataricae Cornu, shaved), Loulu (Euphorbiae Humifusae Herba, rhizome head removed), Gancao (Licorice Root, honey-fried and cut), Dahuang (Rhei Radix et Rhizoma, cut and stir-fried), Gouqigenpi (Lycii Cortex, root bark) each 1 liang.
The above ten herbs are coarsely crushed and mixed evenly. Each dose is 5 qianbi, boiled with 1.5 shengs of water to obtain 0.8 shengs. Strain and take warm on an empty stomach.
Heixi Jian (Black Tin Decoction) for treating pain and erosion/ulceration caused by back carbuncles affecting the brain/head.
Heixi (Black Tin, one jin) is first melted until floating, then ground into mud while hot. Decoct with one dou (ungraded liquid measure) of unadulterated wine until reduced to three shengs. Store in a porcelain bottle. Each dose is one sheng, mixed with 2 qianbi of raw Gancao powder. Take three times daily. Severe cases may require five to seven doses for recovery.