（莲子发 蜂窝发 竟体疽附）
背文正脊，分上中下三发，俱属督脉经。上发背生天柱骨下，是火毒伤肺，其形横广如肚。中发背生背心，
正对前心，是火毒伤肝，其形中阔，两头有尖如瓜。下发背生腰中，正对前脐，是火毒伤肾，其形平漫如龟。初
起皆如粟米， 痛麻痒，寒热拘急，宜隔蒜灸。以知痛为度，则毒瓦斯随火而散。有表症者，寒热无汗，荆防败
毒散汗之。有里症者，溺涩便闭，内疏黄连汤下之。兼表里症者，神授卫生汤双解之，以减疮势。其红肿痛甚，
脉洪数有力，热毒症也，易治。漫肿赤痛，色黯作渴，脉洪数无力，阴虚症也，难治。若不肿不痛，或漫肿色
黯，脉微细者，气虚症也，尤难治。疮顶发一头，或二头，红肿高突者为痈，属阳，宜清凉消毒。如 痛发热，
脉数者，内消散、托里散。如肿硬疼痛，脉实者，活命饮、五香连翘汤。若初起一头如粟，不肿不赤，闷痛烦
躁，渴饮便秘。四五日间，疮头不计其数，疮口各含如粟状，如莲蕊，
积日不溃。数日后疮头迸出，通结一衣，揭去又结，色紫黯者为疽，属阴，宜温补托里。如气血两虚，往来寒
热者，托里当归汤。不能起发，不能腐溃者，托里养营汤。将溃时脚根走散不收束者。四围以铁桶膏涂之。
已溃后，腐肉不去者，外贴巴膏化之。溃后仍痛，宜兼消托者，内服托里消毒散。如脓稀不稠，或脓成不溃，
腐肉化迟者，内服托里散加参、 、肉桂。恶寒形寒，或不收敛，系阳气虚者，十全大补汤。晡热内热，或不
收敛，系阴血虚者，四物汤加参、术。如作呕哕，或不收敛，系胃气虚者，六君子汤加炮姜。食少体倦，或
不收敛，系脾气虚者，补中汤加茯苓、半夏。小便频数，烦躁作渴，系肾阴亏者，加减八味丸。余按诸疮总论
治法。
上搭手生肩下肺俞穴，脊骨第三节，傍开一寸半。属膀胱经，偏左属肝，偏右属肺，由气郁痰热，
凝结而成。初宜神授卫生汤双解之，次以逍遥散消之，兼以六郁汤调之。中搭手生脊旁膏肓穴，脊骨第四节，
傍开三寸。属膀胱经，由怒火而生。初宜三香连翘饮散之，次以清气饮消之。气血虚，不即溃腐者，参 托
里散补之。下搭手生腰傍肓门穴，脊骨第十四节，傍开三寸。亦属膀胱经，由肾经亏，热炽而成。初宜活命
饮解毒，次以内托黄 散托毒，次服地黄汤滋阴。溃后治法同前。又有生脊背及两肋，形似莲蓬，名莲子发，属
胆膀胱经火毒。生肩后及脊傍，形似蜂房，名蜂窝发，由脾经蕴热。高肿半背，若头尖向上，属心火热极，防
毒火内攻，若形长尺许，根横满背，名竟体疽，急服黄连消毒饮，以清心解毒。余按前法治之。
背部沿正中线脊柱，分为上发、中发、下发三种，均归属于督脉经。
上发生于天柱骨下方，这是火毒损伤肺脏所致，其形状横向宽广如同肚腹。
中发生于背心部位，正对着前胸心口，这是火毒损伤肝脏所致，其形状中间宽阔，两头尖细如同瓜形。
下发生于腰部中间，正对着前腹脐部，这是火毒损伤肾脏所致，其形状平坦弥漫如同龟背。
初起时都像粟米大小，伴有疼痛、麻木、瘙痒，以及恶寒发热、肢体拘急等症状，适宜采用隔蒜灸法治疗。
以患者感觉到疼痛为度，这样毒气就会随着火力的作用而消散。
如果有表证，表现为恶寒发热、无汗，用荆防败毒散发汗解表。
如果有里证，表现为小便涩滞、大便闭塞，用内疏黄连汤泻下通里。
如果兼有表里证，用神授卫生汤表里双解，以减轻疮势。
如果红肿疼痛剧烈，脉象洪大数动且有力，属于热毒证，容易治疗。
如果漫肿赤痛，颜色暗紫并伴有口渴，脉象洪大数动但无力，属于阴虚证，难以治疗。
如果不肿不痛，或者漫肿颜色暗紫，脉象微细的，属于气虚证，尤其难以治疗。
疮顶生出一个头，或两个头，红肿高突的是痈，属于阳证，适宜用清凉消毒法。
如果疼痛发热，脉象数的，用内消散、托里散。
如果肿胀坚硬疼痛，脉象实的，用活命饮、五香连翘汤。
如果初起时一个头像粟米一样，不肿不红，闷痛烦躁，口渴饮水，便秘。
经过四五天后，疮头数量不计其数，疮口各自含有像粟米状、像莲蕊样的东西，多日不溃破。
几天后疮头迸出，连通结成一整块衣膜样，揭去后又重新结聚，颜色紫暗的是疽，属于阴证，适宜用温补托里法。
如果气血两虚，出现往来寒热的症状，用托里当归汤。
如果不能起发，不能腐溃的，用托里养营汤。
将要溃破时，如果脚根走散不收束的，在四周涂抹铁桶膏。
已经溃破后，如果腐肉不去除的，外贴巴膏化除腐肉。
溃破后仍然疼痛，适宜兼顾消法和托法的，内服托里消毒散。
如果脓液稀薄不浓稠，或者脓成但不溃破，腐肉化除缓慢的，内服托里散加人参、[缺字，通常为白术或黄芪]、肉桂。
如果恶寒形寒，或者伤口不收敛，属于阳气虚的，用十全大补汤。
午后发热、内热，或者伤口不收敛，属于阴血虚的，用四物汤加人参、白术。
如果出现呕吐呃逆，或者伤口不收敛，属于胃气虚的，用六君子汤加炮姜。
饮食减少、身体疲倦，或者伤口不收敛，属于脾气虚的，用补中汤加茯苓、半夏。
小便频数，烦躁口渴，属于肾阴亏的，用加减八味丸。
其余按照诸疮总论中的治法处理。
上搭手生于肩下肺俞穴，脊骨第三节，旁开一寸半处。
归属于膀胱经，偏左侧属肝，偏右侧属肺，由气郁痰热凝结而成。
初起适宜用神授卫生汤双解，其次用逍遥散消散，兼用六郁汤调理。
中搭手生于脊旁膏肓穴，脊骨第四节，旁开三寸处。
归属于膀胱经，由怒火而生。
初起适宜用三香连翘饮发散，其次用清气饮消散。
如果气血虚弱，不能立即溃烂腐坏的，用参[缺字，通常为芪或术]托里散补益。
下搭手生于腰旁肓门穴，脊骨第十四节，旁开三寸处。
也归属于膀胱经，由肾经亏损，热势炽盛而成。
初起适宜用活命饮解毒，其次用内托黄[缺字，通常为芪]散托毒，其次服用地黄汤滋阴。
溃破后的治法同前文所述。
又有生于脊背及两肋，形状像莲蓬的，名叫莲子发，属于胆经和膀胱经的火毒。
生于肩后及脊旁，形状像蜂房的，名叫蜂窝发，由脾经蕴藏的热邪所致。
如果高肿占据半个背部，若头尖向上，属于心火极盛，需防备毒火内攻；
如果形状长一尺左右，根部横向布满背部，名叫竟体疽，急需服用黄连消毒饮，以清心解毒。
其余按照前述方法治疗。
(Attached Discussion on Back Carbuncles: Lotus Seed Eruption, Honeycomb Eruption, and Whole-Body Ulcer)
The back along the central spinal column is divided into upper, middle, and lower eruptions, all belonging to the Du Meridian (Governing Vessel).
The upper eruption occurs below the Tianzhu bone (C2 vertebra), caused by fire-toxin damaging the Lung; its shape is broad horizontally like a belly.
The middle eruption occurs at the center of the back, directly opposite the heart in the chest, caused by fire-toxin damaging the Liver; its shape is wide in the middle with pointed ends like a melon.
The lower eruption occurs in the middle of the waist, directly opposite the umbilicus in the front, caused by fire-toxin damaging the Kidney; its shape is flat and spreading like a turtle shell.
Initially, they appear like millet grains, accompanied by pain, numbness, itching, aversion to cold, fever, and limb stiffness. Moxibustion with garlic slices is appropriate.
Stop when the patient feels pain, so that the toxic qi dissipates with the heat.
If there are exterior symptoms, such as aversion to cold, fever, and anhidrosis, Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction for Resolving Toxins) should be used to induce sweating.
If there are interior symptoms, such as dysuria and constipation, Neishu Huanglian Tang (Internal Purging Coptis Decoction) should be used to purge the interior.
If both exterior and interior symptoms are present, Shenshou Weisheng Tang (Divine Grant Health-Preserving Decoction) should be used to resolve both, thereby reducing the severity of the sore.
If redness, swelling, and pain are severe, and the pulse is surging, rapid, and forceful, it is a heat-toxin syndrome, which is easy to treat.
If there is diffuse swelling and redness, dark color, thirst, and a surging, rapid but weak pulse, it is a yin-deficiency syndrome, which is difficult to treat.
If there is no swelling or pain, or if there is diffuse swelling with dark color and a faint, fine pulse, it is a qi-deficiency syndrome, which is particularly difficult to treat.
If the top of the sore has one or two heads, is red, swollen, and protruding, it is a carbuncle (Yong, 痈), belonging to the Yang aspect; cool-clearing and detoxifying methods are appropriate.
If there is pain and fever with a rapid pulse, Neixiaosan (Internal Dissolution Powder) and Tuolisan (Supporting Interior Powder) are indicated.
If there is hard swelling and pain with a solid pulse, Niusheng Yin (Life-Saving Decoction) and Wuxiang Liaoqiao Tang (Five-Aromatic and Forsythia Decoction) are indicated.
If initially there is one head like a millet grain, without swelling or redness, but with stifling pain, restlessness, thirst, and constipation.
After four or five days, the number of sore heads becomes countless, each opening containing something like a millet grain or lotus stamen, failing to suppurate after many days.
Several days later, the sore heads burst out, merging into a single membrane-like layer; if it reforms after being removed and turns purple-dark, it is a deep abscess (Ju, 疽), belonging to the Yin aspect; warming, tonifying, and supporting interior methods are appropriate.
If there is deficiency of both qi and blood with alternating chills and fever, Tuolidanggui Tang (Supporting Interior Angelica Decoction) is indicated.
If it fails to rise or suppurate, Tuoli Yangying Tang (Supporting Interior Nourishing Ying Decoction) is indicated.
When about to suppurate, if the base spreads and lacks definition, apply Tietong Gao (Iron Bucket Plaster) around the perimeter.
After suppuration, if necrotic tissue remains, apply Bagao (Ba Plaster) externally to dissolve it.
If pain persists after suppuration, requiring both resolving and supporting methods, Neifu Tuolixiaodu San (Internal Supporting Interior Detoxification Powder) is taken orally.
If the pus is thin and not thick, or if pus forms but does not rupture, or if necrotic tissue dissolves slowly, take Tuolisan (Supporting Interior Powder) added with Renshen (Ginseng Radix et Rhizoma), [missing character, likely Baizhu or Huangqi], and Rougui (Cinnamon Bark).
If there is aversion to cold and cold limbs, or failure of the wound to heal, indicating yang qi deficiency, Shiquan Dabu Tang (Complete Great Tonifying Decoction) is indicated.
If there is afternoon fever or internal heat, or failure of the wound to heal, indicating yin-blood deficiency, Siwu Tang (Four Substance Decoction) added with Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) is indicated.
If there is vomiting or hiccups, or failure of the wound to heal, indicating stomach qi deficiency, Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger) is indicated.
If there is poor appetite and fatigue, or failure of the wound to heal, indicating spleen qi deficiency, Buzhong Tang (Middle-Boosting Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma) is indicated.
If there is frequent urination, restlessness, and thirst, indicating kidney yin deficiency, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) is indicated.
For other cases, refer to the general treatment principles for various sores.
The Upper Dashou (Upper Hand-Clinging Eruption) arises below the shoulder at Feishu (BL13), the third thoracic vertebra, 1.5 cun lateral.
It belongs to the Bladder Meridian; the left side relates to the Liver, and the right side to the Lung. It is formed by qi stagnation and phlegm-heat condensation.
Initially, Shenshou Weisheng Tang (Divine Grant Health-Preserving Decoction) is used for dual resolution, followed by Xiaoyao San (Free Wanderer Powder) to dissipate, combined with Liuyu Tang (Six Stagnations Decoction) to regulate.
The Middle Dashou arises at Gaohuang (BL43) beside the spine, the fourth thoracic vertebra, 3 cun lateral.
It belongs to the Bladder Meridian and arises from angry fire.
Initially, Sanxiang Liaoqiao Yin (Three-Aromatic and Forsythia Decoction) is used to disperse, followed by Qingqi Yin (Clear Qi Decoction) to dissipate.
If qi and blood are deficient and it fails to suppurate and rot promptly, Canqi Tuolisan (Ginseng and [Missing Character] Supporting Interior Powder) is used to tonify.
The Lower Dashou arises at Mangmen (BL47) beside the waist, the fourteenth thoracic vertebra (lumbar region), 3 cun lateral.
It also belongs to the Bladder Meridian and is formed by kidney meridian deficiency and blazing heat.
Initially, Niusheng Yin (Life-Saving Decoction) is used to detoxify, followed by Neituo Huangqi San (Internal Supporting Astragalus Powder) to support the interior and expel toxin, followed by Dihuang Tang (Rehmannia Decoction) to nourish yin.
Treatment after suppuration is the same as described above.
There are also eruptions arising on the spinal back and both flanks, shaped like a lotus pod, named Lianzi Fa (Lotus Seed Eruption), belonging to fire-toxin of the Gallbladder and Bladder meridians.
Eruptions arising behind the shoulders and beside the spine, shaped like a honeycomb, named Fengwo Fa (Honeycomb Eruption), are caused by heat accumulating in the Spleen meridian.
If high swelling occupies half the back and the head points upward, it indicates extreme heart fire; beware of internal attack by toxic fire.
If the shape is about one chi long and the root spreads across the entire back, it is named Jingti Ju (Whole-Body Ulcer); urgently administer Huanglian Xiaodu Yin (Coptis Detoxification Decoction) to clear the heart and detoxify.
Treat the remaining cases according to the aforementioned methods.