（男妇同用）
发背属膀胱督脉经，或阴虚火盛，或醇酒浓味，或郁怒房劳所致。若肿赤痛甚，脉洪数
而有力，热毒之症也，为易治。漫肿微痛，色黯作渴，脉洪数而无力，阴虚之症也，为难治。不
痛不肿，或漫肿色黯，脉微细，阳气虚甚也，尤为难治。若肿 作痛，寒热作渴，饮食如常
，此形气病气俱有余也，先用仙方活命饮，后用托里消毒散解之。漫肿微痛，或色不赤，饮
食少思，此形气病气俱不足也，用托里散调补之。不作脓，或脓成不溃，阳气虚也，托里散倍
加肉桂、参、 。脓出而反痛，或脓清稀，气血俱虚也，八珍汤。恶寒形寒，或不收敛，阳
气虚也，十全大补汤。晡热内热，或不收敛，阴血虚也，四物加参、术。作呕欲呕，或不收
敛，胃气虚也，六君加炮姜。食少体倦，或不收敛，脾气虚也，补中益气汤加茯苓、半夏。
肉赤而不敛，血热也，四物加山栀、连翘。肉白而不敛，脾虚也，四君加酒炒芍药、木香。
小便频数者，肾阴亏损也，加减八味丸。若初患未发出，而寒热疼痛，作渴饮冷，此邪气内
蕴也，仙方活命饮。口干饮热，漫肿微痛，此元气内虚也，托里消毒散。饮食少思，肢体倦
怠，脾胃虚弱也，六君子汤；如未应，加姜、桂。其有死者，乃邪气盛，真气虚，而不能发
出也，在于旬余之间见之。若已发出，用托里消毒散；不腐溃，用托里散；如不应，急温补
脾胃。其有死者，乃真气虚而不能腐溃也，在于二旬之间见之。若已腐溃，用托里以生肌；
如不应，急温补脾胃。其有死者，乃脾气虚而不能收敛也，在于月余见之。此三证，虽不见于
经籍，余尝治而历验者。
治验
都宪周弘冈，背患疽，肿而不溃，脉大而浮，此阳气虚弱，而邪气壅滞也。用托里散，
倍用
愈。若以为热毒，而用寒药，则误矣。
太仆王的塘，初起因大劳，又用十宣散之类，加烦渴内热，脉大无力。此阳气自伤，不
能升举，下陷于阴分，而为内热也。余以补中益气，加酒炒芍药、麦门冬、五味子，治之而愈。
上舍张克恭患此，内服外敷皆寒凉败毒，遍身作痛，欲呕少食，晡热内热，恶寒畏寒。
余曰∶遍身作痛，荣卫虚而不能营于肉里也。欲呕少食，脾胃虚寒，而不能消化饮食也。内热晡
热，阴血内虚，而阳气陷于阴分也。恶寒畏寒，阳气虚弱，而不能卫于肌肤也。此皆由脾胃
之气不足所致。遂用补中益气汤，诸症渐退；更以十全大补汤，腐肉渐溃；又用六君子汤，
加芎、归，肌肉顿生而愈。
府庠鼓碧溪患腰疽，服寒凉败毒之药，色黯不痛，疮头如铺黍，背重不能安寝，耳聩目
白，面色无神，小便频涩，作渴迷闷，气粗短促，脉浮数，重按如无。余先用滋肾水之药一剂，
少顷便利渴止，背即轻爽；乃砭去瘀血，以艾半斤许，明灸患处；外敷乌金膏，内服参、
、归、术、肉桂等药。至数剂，元气稍复。自疑肉桂辛热，一日不用，手足并冷，大便不禁
。仍加肉桂及补骨脂二钱，肉豆蔻一钱，大便如常，其肉渐溃；更用当归膏以生肌肉，八珍
汤以补气血而愈。
儒者周雨峰，怀抱久郁，背脊患疽，肝脉弦洪，脾脉浮大，按之微细。以补中益气汤加
桔梗、贝母，少用金银花、白芷，二剂肝脉顿退，脾脉顿复。乃以活命饮二剂，脓溃肿消，肝脉
仍弦，此毒虽去，而胃气复伤，仍用补中益气汤加茯苓、半夏而愈。
上舍蔡东之患此，余用托里之药而溃，疮口尚未全敛，时值仲冬，兼咳嗽。余曰∶疮口
未敛，脾气虚也。咳嗽不止，肺气虚也。法当补其母。一日与其同宴，见忌羊肉。余曰∶补可以
去弱，人参、羊肉之类是也，最宜食之。遂每日不撤，旬余而疮敛，嗽亦顿愈矣。
宪副屠九峰，孟春患此，色黯漫肿，作渴便数，尺脉洪数。此肾水干涸，当没于火旺之
际。不信，更用苦寒之药，复伤元气，以促其殁。
京兆柴黼庵仲夏患之，色黯微肿，发热烦躁，痰涎自出，小腹阴实，手足逆冷，右关浮
涩，两尺微细。余曰∶此虚寒之症也。王太仆云∶大热而不热，是无火也。决不能起，恳求治之
，用大温补之药一剂，流涎虽止，患处不起，终不能救。
举人顾东溪久作渴，六月初，腰患疽，不慎起居，疮溃尺余，色黯败臭，小便如淋，唇
裂舌刺
起。然脓水败臭，色黯不痛，疮口张大，乃脾气败而肌肉死也。小便如淋，痰壅喘促，口干
舌
危殆速矣，二日后果殁。盖此症既发于外，两月方殁者，乃元气虚，不能收敛也。若预为调
补，使气血无亏，亦有得生者。
（男女通用）
发背属于膀胱经和督脉。其成因可能是阴虚火旺，也可能是因饮用烈酒、食用厚味，或因情志抑郁、愤怒及房劳过度所致。如果患处红肿疼痛剧烈，脉象洪大而数且有力，这是热毒实证，容易治疗。如果漫肿而疼痛轻微，颜色暗紫并伴有口渴，脉象洪大数但无力，这是阴虚证，难以治疗。如果不痛不肿，或者漫肿色暗，脉象微细，这是阳气极度虚弱，尤其难以治疗。如果肿胀作痛，伴有寒热交替和口渴，饮食正常，这说明形体之气与病邪之气都有余，应先用仙方活命饮，后用托里消毒散来化解。如果漫肿微痛，或者颜色不红，饮食减少思食，这说明形体之气与病邪之气都不足，应用托里散进行调补。如果不化脓，或者脓成但不溃破，是阳气虚，应在托里散中加倍加入肉桂、人参、白术。如果脓出后反而疼痛，或者脓液清稀，是气血俱虚，用八珍汤。如果恶寒形寒，或者疮口不收敛，是阳气虚，用十全大补汤。如果午后发热或内热，或者疮口不收敛，是阴血虚，用四物汤加人参、白术。如果出现呕吐或欲呕，或者疮口不收敛，是胃气虚，用六君子汤加炮姜。如果食少体倦，或者疮口不收敛，是脾气虚，用补中益气汤加茯苓、半夏。如果疮面肉色红赤而不收敛，是血热，用四物汤加山栀、连翘。如果疮面肉色苍白而不收敛，是脾虚，用四君子汤加酒炒芍药、木香。如果小便频数，是肾阴亏损，用加减八味丸。如果在发病初期尚未发出时，出现寒热疼痛、口渴喜冷饮，这是邪气内蕴，用仙方活命饮。如果口干想喝热水，漫肿微痛，这是元气内虚，用托里消毒散。如果饮食减少思食，肢体倦怠，是脾胃虚弱，用六君子汤；如果无效，加生姜、肉桂。其中导致死亡的病例，是因为邪气盛而真气虚，不能将毒邪发出，这种情况通常在发病十几天内出现。如果已经发出，用托里消毒散；如果不腐溃，用托里散；如果无效，急温补脾胃。其中导致死亡的病例，是因为真气虚而不能腐溃，这种情况通常在发病二十天内出现。如果已经腐溃，用托里散以生肌；如果无效，急温补脾胃。其中导致死亡的病例，是因为脾气虚而不能收敛，这种情况通常在发病一个月后出现。这三种情况，虽然不见于经典医籍，但我曾治疗过并多次验证有效。
治验记录：
都宪周弘冈，背部患疽，肿胀但不溃破，脉象大而浮，这是阳气虚弱，邪气壅滞。我用托里散，加倍用量后痊愈。如果误认为是热毒而用寒凉药，那就错了。
太仆王的塘，起初因为过度劳累，又使用了十宣散之类的药物，加重了烦渴和内热，脉象大而无力的。这是阳气自伤，不能升举，下陷于阴分，从而产生内热。我用补中益气汤，加酒炒芍药、麦门冬、五味子，治愈了他。
上舍张克恭患此病，内服外敷都用寒凉败毒的药物，导致遍身疼痛，想呕吐且食欲少，午后发热及内热，恶寒畏寒。我说：遍身疼痛，是营卫虚弱不能滋养肌肉；想呕吐食欲少，是脾胃虚寒不能消化饮食；内热午后热，是阴血内虚，阳气陷入阴分；恶寒畏寒，是阳气虚弱不能护卫肌肤。这些都是由脾胃之气不足引起的。于是用补中益气汤，诸症逐渐消退；再用十全大补汤，腐肉逐渐溃烂脱落；又用六君子汤，加川芎、当归，肌肉顿时生长而痊愈。
府庠鼓碧溪患腰疽，服用寒凉败毒的药物，颜色暗紫且不痛，疮头像铺着的黍米，背部沉重不能安寝，耳聋目眩，面色无神，小便频涩，口渴迷闷，气粗短促，脉浮数，重按如没有。我先生用滋补肾水的药一剂，不久大小便利，口渴停止，背部即感轻松；然后砭刺放出瘀血，用半斤左右的艾绒在患处直接灸治；外敷乌金膏，内服人参、白术、当归、肉桂等药。服几剂后，元气稍复。他自己怀疑肉桂辛热，有一天没吃，手足变冷，大便失禁。我又加上肉桂二钱、补骨脂二钱、肉豆蔻一钱，大便恢复正常，肌肉逐渐溃烂；再用当归膏生肌，八珍汤补气血而痊愈。
儒者周雨峰，怀抱长期郁结，背脊患疽，肝脉弦洪，脾脉浮大，重按微细。我用补中益气汤加桔梗、贝母，少量金银花、白芷，两剂后肝脉顿退，脾脉顿复。然后用活命饮两剂，脓溃肿消，但肝脉仍弦，这是毒虽去，但胃气又受伤，仍用补中益气汤加茯苓、半夏而痊愈。
上舍蔡东之患此病，我用托里的药物使其溃破，疮口尚未完全愈合，正值仲冬，兼有咳嗽。我说：疮口未敛，是脾气虚；咳嗽不止，是肺气虚。治法应当补其母脏（脾）。一天与他同宴，见他不肯吃羊肉。我说：补益可以去除虚弱，人参、羊肉之类就是，最适合食用。于是他每天不停食用，十多天后疮口愈合，咳嗽也立刻好了。
宪副屠九峰，孟春患此病，颜色暗紫漫肿，口渴便数，尺脉洪数。这是肾水干涸，当死于火旺之时。他不相信，更用苦寒药物，再次损伤元气，加速了他的死亡。
京兆柴黼庵仲夏患此病，颜色暗紫微肿，发热烦躁，痰涎自流，小腹阴实，手足逆冷，右关脉浮涩，两尺脉微细。我说：这是虚寒证。王太仆说：大热而不热，是无火。决不能起死回生，但他恳求治疗，我用大温补药一剂，流涎虽止，但患处不起，最终没能救活。
举人顾东溪长期口渴，六月，腰部患疽，起居不慎，疮溃开一尺多，颜色暗败发臭，小便如淋，唇裂舌刺起。然而脓水败臭，色黯不痛，疮口张大，这是脾气败坏而肌肉死亡。小便如淋，痰壅喘促，口干舌燥，病情危殆迅速，两天后果然死亡。这种病症既然发于外部，两个月才死的，是元气虚，不能收敛。如果预先调补，使气血无亏，也有能存活的。
(Normally applicable to both men and women)
Fabei (Back Carbuncle) belongs to the Bladder Meridian and the Du Meridian. Its etiology may be due to Yin deficiency with flourishing fire, or caused by drinking strong wine, consuming rich flavors, or resulting from emotional depression, anger, and sexual exhaustion. If the swelling is red, painful, severe, and the pulse is surging, rapid, and forceful, this is a syndrome of heat toxin excess, which is easy to treat. If there is diffuse swelling with slight pain, dark discoloration accompanied by thirst, and the pulse is surging, rapid but weak, this is a Yin deficiency syndrome, which is difficult to treat. If there is no pain or swelling, or if there is diffuse swelling with dark color and the pulse is minute and fine, this indicates extreme Yang Qi deficiency, which is particularly difficult to treat. If there is swelling with pain, alternating chills and fever, thirst, and normal diet, it indicates that both the constitutional Qi and pathogenic Qi are in excess. One should first use Xianfang Huoming Yin (Immortal Life Elixir), followed by Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder). If there is diffuse swelling with slight pain, or non-red color, and reduced appetite, it indicates that both constitutional Qi and pathogenic Qi are deficient. One should use Tuoli San (Supporting Interior Powder) for regulation and tonification. If pus does not form, or if pus forms but does not ulcerate, it is due to Yang Qi deficiency; one should double the dosage of Rougui (Cinnamon Bark), Renshen (Ginseng Root), and Baizhu (Atractylodes Rhizome) in Tuoli San. If pain persists after pus discharge, or if the pus is clear and thin, it is due to deficiency of both Qi and Blood; use Bazhen Tang (Eight Treasure Decoction). If there is aversion to cold and cold limbs, or if the wound fails to heal, it is due to Yang Qi deficiency; use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). If there is afternoon tidal fever or internal heat, or if the wound fails to heal, it is due to Yin Blood deficiency; use Siwu Tang (Four Substance Decoction) added with Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome). If there is vomiting or nausea, or if the wound fails to heal, it is due to Stomach Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger). If there is poor appetite and fatigue, or if the wound fails to heal, it is due to Spleen Qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber). If the granulation tissue is red and fails to heal, it is due to Blood Heat; use Siwu Tang (Four Substance Decoction) added with Shanzhi (Gardenia Fruit) and Lianqiao (Forsythia Fruit). If the granulation tissue is pale and fails to heal, it is due to Spleen deficiency; use Sijunzi Tang (Four Gentlemen Decoction) added with Jiuchaoshao Yao (Wine-fried White Peony Root) and Muxiang (Aucklandia Root). If urination is frequent, it is due to Kidney Yin depletion; use Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If at the initial stage before eruption, there are chills, fever, pain, thirst, and desire for cold drinks, this is due to internal accumulation of pathogenic factors; use Xianfang Huoming Yin (Immortal Life Elixir). If there is dry mouth with desire for hot drinks, diffuse swelling, and slight pain, this is due to internal deficiency of Yuan Qi (Primary Qi); use Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder). If there is reduced appetite and limb fatigue, it is due to Spleen and Stomach weakness; use Liujunzi Tang (Six Gentlemen Decoction); if ineffective, add Shengjiang (Fresh Ginger) and Rougui (Cinnamon Bark). Cases resulting in death occur when pathogenic factors are excessive and True Qi is deficient, preventing the expulsion of toxins; these typically manifest within ten days. If the lesion has erupted, use Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder); if it does not putrefy and ulcerate, use Tuoli San (Supporting Interior Powder); if unresponsive, urgently warm and tonify the Spleen and Stomach. Death in these cases occurs because True Qi is too deficient to cause putrefaction and ulceration; this typically manifests within twenty days. If the lesion has already putrefied and ulcerated, use Tuoli San (Supporting Interior Powder) to generate flesh; if unresponsive, urgently warm and tonify the Spleen and Stomach. Death in these cases occurs because Spleen Qi is too deficient to promote healing; this typically manifests after one month. These three syndromes, although not recorded in classical texts, have been verified through my clinical experience.
Clinical Records:
Zhou Honggang, Censor, suffered from a carbuncle on his back. It swelled but did not ulcerate, and the pulse was large and floating. This indicated Yang Qi deficiency with stagnation of pathogenic factors. I used Tuoli San (Supporting Interior Powder) with increased dosage, and he recovered. Had it been mistaken for heat toxin and treated with cold herbs, it would have been an error.
Wang Detang, Grand Minister of the Palace Household, initially suffered from overexertion and subsequently took Shixuan San (Ten Acupoints Powder), which exacerbated his vexation, thirst, and internal heat. His pulse was large but weak. This indicated self-injury of Yang Qi, failure to ascend and lift, sinking into the Yin aspect, resulting in internal heat. I treated him with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiuchaoshao Yao (Wine-fried White Peony Root), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Berry), and he recovered.
Zhang Kegong, Shangshe (Imperial Student), suffered from this condition. He used cold and cooling detoxifying herbs both internally and externally, resulting in generalized body pain, nausea, poor appetite, afternoon tidal fever, internal heat, and aversion to cold. I stated: Generalized body pain indicates deficiency of Ying (Nutritive) and Wei (Defensive) Qi, failing to nourish the muscles. Nausea and poor appetite indicate deficiency-cold of the Spleen and Stomach, failing to digest food. Internal heat and afternoon fever indicate internal deficiency of Yin Blood, with Yang Qi sinking into the Yin aspect. Aversion to cold indicates deficiency of Yang Qi, failing to protect the skin and muscles. All these stem from insufficiency of Spleen and Stomach Qi. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), after which symptoms gradually subsided. Then I used Shiquan Dabu Tang (Perfect Ten Tonifying Decoction), causing necrotic tissue to slough off. Finally, I used Liujunzi Tang (Six Gentlemen Decoction) added with Chuanxiong (Ligusticum Rhizome) and Danggui (Angelica Sinensis), leading to immediate muscle regeneration and recovery.
Gu Bixi, Fu Xiang (Provincial School Student), suffered from a lumbar carbuncle. After taking cold and cooling detoxifying herbs, the area became dark purple and painless, with pustules resembling scattered millet grains. He experienced heavy back pain unable to lie comfortably, deafness, blurred vision, dull complexion, frequent and difficult urination, thirst, confusion, coarse and short breathing, and a floating, rapid pulse that felt empty upon deep pressure. I first administered one dose of herbs to nourish Kidney Water. Shortly after, urination improved, thirst ceased, and his back felt light. I then performed bloodletting with a lancet to remove stasis, applied moxibustion using approximately half a jin of mugwort directly on the lesion, applied Wujin Gao (Black Gold Ointment) externally, and administered Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis), and Rougui (Cinnamon Bark) internally. After several doses, his Yuan Qi (Primary Qi) slightly recovered. Suspecting Rougui (Cinnamon Bark) was too acrid and hot, he omitted it for one day, resulting in cold extremities and fecal incontinence. I re-added Rougui (Cinnamon Bark) 2 qian, Buguzhi (Psoralea Fruit) 2 qian, and Roudoukou (Nutmeg) 1 qian. Bowel movements normalized, and the tissue began to slough. I then used Danggui Gao (Angelica Ointment) to regenerate flesh and Bazhen Tang (Eight Treasure Decoction) to tonify Qi and Blood, resulting in recovery.
Zhou Yufeng, a Confucian scholar, had long-standing emotional depression and developed a carbuncle on his back. His Liver pulse was wiry and surging, while his Spleen pulse was floating and large but minute and fine upon pressure. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiegeng (Platycodon Root) and Beimu (Fritillaria Bulb), with small amounts of Jinyinhua (Honeysuckle Flower) and Baizhi (Angelica Dahurica Root). After two doses, the wiry Liver pulse receded, and the Spleen pulse recovered. I then administered Huoming Yin (Life-Saving Elixir) for two doses, leading to pus discharge and reduction of swelling. However, the Liver pulse remained wiry, indicating that although the toxin was expelled, Stomach Qi was injured again. I continued with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber), resulting in recovery.
Cai Dongzhi, Shangshe (Imperial Student), suffered from this condition. I used interior-supporting herbs to induce ulceration, but the wound had not fully healed. It was mid-winter, and he also had coughing. I stated: The unhealed wound indicates Spleen Qi deficiency. Persistent coughing indicates Lung Qi deficiency. According to treatment principles, one should tonify the mother organ (Spleen). During a banquet, I noticed he avoided mutton. I said: Tonification can counteract weakness; examples include Renshen (Ginseng Root) and mutton. It is highly suitable for consumption. He ate it daily without cessation. Within ten days, the wound healed, and the cough resolved immediately.
Tu Jiufeng, Vice Commissioner, suffered from this condition in early spring. The area was dark purple and diffusely swollen, with thirst and frequent urination. The Chi (Cun Cun) pulse was surging and rapid. This indicated depletion of Kidney Water, destined to perish during the peak of Fire. Disbelieving this, he took more bitter-cold herbs, further injuring his Yuan Qi (Primary Qi) and hastening his death.
Chai Funan, Prefect Capital Official, suffered from this condition in mid-summer. The area was dark purple and slightly swollen, with fever, irritability, spontaneous salivation, hardness in the lower abdomen, and cold reversal of hands and feet. The Right Guan pulse was floating and choppy, and both Chi pulses were minute and fine. I stated: This is a deficiency-cold syndrome. Wang Taipu said: "Great heat without actual heat signifies absence of Fire." Recovery was impossible. Despite his earnest requests, I administered one dose of strongly warming and tonifying herbs. Although salivation stopped, the lesion did not improve, and he ultimately could not be saved.
Gu Dongxi, a Jinshi degree holder, suffered from chronic thirst. In June, he developed a lumbar carbuncle. Due to improper lifestyle management, the wound ulcerated over a chi in length, appearing dark, necrotic, and foul-smelling. Urination resembled strangury, lips were cracked, and tongue prickles appeared. The pus was foul-smelling, the area was dark and painless, and the wound opening was wide. This indicated failure of Spleen Qi and death of muscle tissue. Strangury-like urination, phlegm obstruction, panting, and dry mouth indicated critical danger. He died two days later as predicted. For such external manifestations, death occurring after two months is due to Yuan Qi (Primary Qi) deficiency failing to promote healing. If proper regulation and tonification had been provided beforehand to maintain Qi and Blood integrity, survival might have been possible.