或问∶背发疽有几？曰∶上中下三发，俱在脊中，属督脉。上发者，伤于肺，发于天
柱骨下。中发者，伤于肝，为对心发。下发者，伤于肾，为对脐发，皆由积热怒气所致。
初如粟米，或麻或痒，或拘急，或不痛，或大痛，初觉便宜隔蒜灸之。或汗，或下，或
托，量其虚实施治。脑发背发在上者，不可用木通，恐导虚下元故也。老弱者，尤宜戒。
然三发背，总要之地，与他处不同，尤所当谨。微有痛痒，宜速治之，活命饮加羌活，紫
金丹、胜金丹、夺命丹选用。壮实者，一粒金丹、八阵散等下之；老弱者，黄 木香散、
十全大补汤，托之。
《鬼遗》云∶蜂疽发髀背，起心俞及心包络俞，若肩 二十日不穴死。十日可刺，其
色赤黑，脓清者，可治。或问∶一人年六十，背患疽，状如蜂房，十日而平塌，寒热痛楚
殊甚，饮食少进，膨胀淋沥何如？曰∶此蜂窠发也，诊其脉微而迟，四肢厥冷为不足。询
其先前过服耗气之剂，又得暴怒，用活命饮加参 、归术，兼以乌药、青皮、木香，间
与紫金丹服之，起发脓溃，服十全大补汤而愈。
特疽，发肺俞及肝俞，不穴二十日死。八日可刺，其色红赤，内隐起如椒子者死。
阴阳二气疽，广阔满背，或大或小不常，肿热胀大，十日可刺，导引出脓，不拘深浅
多少，发渴体倦，十日外不见脓不治。 或问∶背上麻木不常，时肿时塌，忽软忽硬，乍
寒乍热何如？曰∶此名阴阳疽，由七情内乖，阴阳不和也，此证必大渴神清脉定者可治。宜
活命饮加羌活，或胜金丹、夺命丹选用。昏迷躁乱，饮食不进者死。十日得黄白脓者可
治，数日无脓者死。
筋疽，发夹脊两边大筋上，其色苍，八日可刺，有痈在肥肠中，九十日死。
禽疽，始发者如疹，数十处如拳打之状，发寒齿噤，如此者，十四日死。十日可刺，导
引脓出，即愈。 或问∶背忽麻木，拘急不痛，十数处肉紫色，如拳触状何如？曰∶此
名禽疽。七日内，寒热口噤者死。急服活命饮加羌活、独活，胜金丹、夺命丹，得汗可
治无汗不治。神清脉和可治，神昏脉躁或微或代者死。漫肿不溃，宜服台阁紫微丸。
或问∶背疽两头小，四边散何如？曰；此名两头发，又名满天星，一名广绵背发。因
积怒蓄热所致，活命饮加羌活，紫金丹，胜金丹。壮实者，八阵散、一粒金丹下之。肿
高红润者生，低陷黑暗者死。
或问∶背胁之间，三两处发疽何如？曰∶此名老鼠攒，一名游走血脾痈。由怒气积热
所致，多发于足少阳、足厥阴二经。宜顺气清热之剂，服黄连解毒汤、活命饮，加黄连、
栀子及服紫金丹。壮实者，一粒金丹下之。老
弱者，黄 木香散、内补十宣散选用。七日不见脓，黑陷及躁乱者死。
或问∶背上生疽，肉色不变，麻木微痒，顽如牛领之皮，二三尺许何如？曰∶此名竟
体发，亦名椒眼发。由盛暑时，空腹感触秽气，及愤怒积郁所致。宜活命饮加羌活，或
黄连解毒汤、胜金丹、乌金散选用。壮实者，八阵散、一粒金丹下之。七日内未成脓宜隔
蒜灸，灸而起发，神清脉和者可治，灸而不起，腹胀神昏，脉微或促或代者死，服汗剂
得汗者生，无汗者死。服补剂红润起发知痛者生，膨胀不食，干枯黑陷者死。
或问∶背当心而痛，麻木不常，累累如弹如拳，坚硬如石，痛彻五内，遍身拘急何
如？曰∶此名酒毒发疽，由饥饱劳伤，炙爆、浓味所致。宜服黄连解毒汤，加羌活、干葛，
或神效消毒散、内疏黄连汤、紫金锭、胜金丹选用。神昏脉乱，大渴狂言，有妨饮食者
死，二便闭结者死。有因寒变而内陷者，用托里温中汤。
或问∶背上细 无数，浸淫一二尺，如汤火伤。烦躁多渴何如？曰∶此丹毒发疽也，
因服丹石刚剂所致，红润者生，紫黯者死。恶证少者，宜服黄连消毒散、胜金丹、国老膏，
恶证多，神昏脉躁，膨胀呕哕者死。
或问∶背侧生疽，高二寸，长尺许，状如黄瓜，肉色不变何如？曰∶此名黄瓜痈，一
名肉龟。疼痛引心，四肢麻木是也，此证多不可治。急服紫金丹、胜金丹、活命饮加羌
活、柴胡，及夺命丹、神仙追毒丸选用。脉微自汗谵语者死。平塌黑色者，独姜散主之，
服台阁紫微丸。
或问∶第九椎两旁，忽肿痛而无头，寒热大作何如？曰∶此名龙疽，即中搭也。属
太阳经，由七情不和，愤怒积热所致。壮实者，急服一粒金丹，或八阵散下之，活命饮
加柴胡、羌活、黄芩，水酒各半煎服。老弱者，黄 木香散、内补十宣散、十全大补汤
选用。色赤起发润泽者可治。色黑低陷，恶心眩晕，大便滑泄，小便如淋，谵语者死。
《鬼遗方》云∶人生最可忧者，发背也，其种有五∶一曰阳毒，因风热而有，或患热
毒消渴，或先患伤寒，余有阳毒，触处蓄积，起于背脊膂之间，不问椎数，但从两夹脊起
止，腰上、满背 热，如炊之状，赤紫或红如焰，脓毒难成，成后不止，止后痛不除，蓦
忽数日之间，复平如旧，将谓肿消，此是内攻肉陷，不可疗矣。二曰阴毒发背，是气冷
而作，初如黍米粒起，情绪不快， 而痛，直应前心，心忪怔，头目昏重，寒热如疟，五
七日后，始发引攻肿，开阔难收，内积有脓，深沉迟缓未透，宜急以补气汤药内托，外以
抽脓药贴之，宜急见脓，无脓即平，愈未期。三曰有人多服金石烧炼之药，毒恶流滞成发
背者，初起如丹疹之状， 渐开如汤火疮，面色如朱，心膈烦躁，多渴嗜冷，其疮难起，
起即惊人，犹胜于阴阳二毒者，缘此有解金石药毒汤散，治其内也，赖有根底分明，亦
须急疗方安。四曰人有患酒食毒发背者，此疾非近得之，乃脏腑久积，乘饥乘困食之便
睡，或多食酒肉，冷热粘滑，肥鲜炽腻，未下胸膈，房室不禁，恣意当风取快，脾脏气
虚，不能受乘，发毒攻背两夹脊，不问椎数，初起痈头如小弹子，后大如拳，坚如石，痛
遍四肢，加之拘急口苦舌干，腹急大小便涩，十数日后，头面手足虚肿，及脏腑通泄，如
利内急痛者，是其证也。喜方肿引，急用收肿、发穴、溃脓汤药内实，外泄脓水不可放
纵，迟缓则皮肉腐坏，伤骨烂筋，渐成脓多，因而感邪内败者死矣。五曰人有冒山岚瘴气，
发背毒瓦斯，先在脏腑。年月浸远，气血虚损衰弱，初起肿色青黑如靴皮，顽痹痛深，附
筋骨彻髓，按之如木石，引手加深，方觉似有痛处，至五七日，毒瓦斯浮浅肿高，色变青
白，有如拳打之状，寒战似疟，及有风候，头动口偏，手足厥逆，眼黑睛小，白多而慢，此
内有邪气相搏，急破出清血三五升，方有黄脓白汁，相和发泄，其反不宽不慢亦急，胀
痛亦不住，直至色退热疼方愈，亦宜急急追赶脓与毒瓦斯外出，无害。
初患肿，三日内灸者生。 八日内脓成，针烙导引者生。未瘥，慎劳力者生。慎忌食
者生。慎喜怒者生。催肿，猛疗者生。急疗者生。不讳发背者生。待脓自出，不导引者
死。未内攻，而针烙用药导引者生；内攻后，导引针烙者死。肿 热痛方盛，已前疗者生；
如过此后，已内攻者死。脓成后，不出不导引，但敷药者死。如赤白痢气急者，是已内
攻，医疗无益必死，痈不救十得五生，疽不疗十全死，轻肿，怕痛者必死。不遇良方者
死。节候不根据法者，必死。愚执恣意用性，逸情者死。
有发背痈，有发背疽，如毒瓦斯勇猛而发，如火焚茅，易于败坏。初发即可如黍米粒大，
三两日渐赤引种，如手掌面大，五七日如碗面大，即易为攻。 热赤引如火烧之状，浮
面渐溃烂阔开，内发肿如炊之状，外烂皮肉如削去，紫瘀脓汁多而肿不退，疼亦不止，发
渴发逆，饮食不下，呕吐气急，浮浅开阔者，尤宜发脓，托毒汤药用之必愈，（阳证实也。）
其间有只如盏面大者，此非不大，缘为毒瓦斯深沉内虚，毒瓦斯近膜也，此必内攻，近
入脏腑。却外入四肢，先攻头面虚浮，后攻手面，次攻两足面肿，名曰毒瓦斯散入四肢。其
人声嘶气脱，眼睛黑小，十指肿黑干焦，不治，（阴证虚也）。
《精要》云∶凡痈疽初发肿硬高者，而毒瓦斯却浅，此乃六腑不和为痈，其证属阳，势
虽急而易治。若初发如粟粒，甚则如豆许，与肉俱平，或作赤色，时觉痒痛，痒时慎勿抓
破，此乃五脏不调为疽，其证属阴，盖毒瓦斯内蓄已深，势虽缓而难治。
始发一粒如麻豆大，身体便发热，生疽处肿大热痛，此为发于外，虽大如盆，治之
百可百活，（阳证实也）。或身体不热，自觉倦怠，生疽处亦不热，数日后渐大，不肿不痛，低
陷而坏烂，此为发于内，虽神仙无如之何，（阴证虚也。）
〔薛〕 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，热毒之证也为易治。漫肿微痛，色黯作渴，脉洪数而无力，阴虚之
证也为难治。不肿不痛，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。（薛又
云∶头痛拘急，乃表症，先服人参败毒散一二剂，如 痛用金银花散，或槐花酒、神效托里散。 痛肿硬，
脉实，以清凉饮、仙方活命饮、苦参丸。肿硬木闷，疼痛发热，烦躁饮冷，便秘脉沉实者，内疏黄连汤或
清凉饮。大便已利，欲得作脓，用仙方活命饮、托里散、蜡矾丸，外用神异膏。）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。脯热内热，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，补中益气加
茯苓、半夏。肉赤而不敛，血热也，四物加山栀、连翅。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，用托里散以生肌。如不应，急温补脾胃。其有死者，乃脾气虚而不能收敛也，在
于月余间见之。
外治法∶初起 痛或不痛，及麻木者，邪
气盛也，隔蒜灸之。痛者灸至不痛，不痛者灸至痛，毒随火而散。再不痛者，须明灸之，
（谓不隔蒜）。但未溃以前，皆可灸也，更用箍药围之。若用乌金膏，或援生膏点患处，数点
尤好。间用雄黄解毒散洗患处，每日用乌金膏涂疮口处，候有疮口，即用纸作捻，醮乌
金膏 人疮内，（翠青锭子尤妙）。若有脓为脂膜间隔不出。而作胀痛者，宜用针引之，腐肉
堵塞者去之。若瘀肉腐动，用猪蹄汤洗，如脓稠或痛，饮食如常，瘀肉自腐，用消毒与
托里药，相兼服之，仍用前二膏举涂贴。若腐肉已离好肉，宜速去之。如脓不稠不稀，微
有疼痛，饮食不甘，瘀肉腐迟，更用桑柴灸之，多用托里药。若瘀肉不腐，或脓清稀不
痛者，急服大补之剂，亦用桑柴灸之。以补接阳气，解散郁毒。尝观患疽稍重，未成
脓者，不用蒜灸之法，及脓熟不开，或待腐肉自去，多致不救。大抵气血壮实，或毒少
轻者，可假药力或自腐溃，怯弱之人，热毒中隔，内外不通，不行针灸，药无全功矣。然
此证若脓已成，宜急开之，否则重者溃通脏腑，腐烂筋骨，轻者延溃良肉，难于收功，因
而不敛者多矣。大抵发背之患，其名虽多，唯阴阳二证为要，若发一头或二头，其形 赤
肿高，头起疼痛，发热为痈，属阴易治。若初起一头如黍，不肿不赤，闷痛烦躁，大渴
便秘，寐语 齿，四五日间，其头无数，其疮口各含一粟，形似莲蓬，名莲蓬发，积日
不溃，按之流血，至八九日或数日，其头成片，所含之物俱出，通结一衣，揭去又结，其
口共烂为一疮，其脓内攻，色紫黯为疽，属阴难治。脉洪滑者尚可，沉细尤难，如此恶
证，惟隔蒜灸，及涂乌金膏有效。凡人背近脊并髀，皮里有筋一层，患此证者，外皮虽
破难溃，以致内脓不出，令人胀痛苦楚，气血转虚，变证百出，若待自溃，多致不救。必
须开之，兼以托里之剂，常治此证，以利刀剪之，尚不能去，以此坚物，待其自溃，岂
不反伤乎？非气血壮实者，未见其能自溃也。
罗谦甫治一人，年逾六旬，冬至后数日，疽发背五七日，肿势约七寸许，痛甚。疡医
曰∶脓已成，可开发矣。病者恐，不从。三日，医曰∶不开恐生变症。遂以燔针开之，脓
有人问：背部的发疽有几种？回答说：分为上发、中发、下发三种，都发生在脊柱正中，归属于督脉。上发者，损伤肺脏，发生在天柱骨下方。中发者，损伤肝脏，称为对心发。下发者，损伤肾脏，称为对脐发，这都是由积热和怒气所致。初起时像粟米大小，或者像麻子，或者瘙痒，或者拘急不舒，或者不痛，或者剧痛，刚发觉时最好隔着蒜片进行艾灸。或者采用发汗法，或者攻下法，或者托毒法，根据患者体质的虚实来施治。脑发和背发在上部的，不可使用木通，恐怕会引导虚火下行损伤下元。年老体弱者，尤其应当禁忌。然而这三种发背，都是至关重要的部位，与其他地方不同，尤其应当谨慎。稍有痛痒，应当迅速治疗，可用活命饮加羌活，或选用紫金丹、胜金丹、夺命丹。体质壮实的人，用一粒金丹、八阵散等药攻下；年老体弱的人，用黄耆木香散、十全大补汤，用托毒法治疗。
《鬼遗方》说：蜂疽发于髀部背部，起始于心俞穴及心包络俞穴，如果肩部……二十天不刺破就会死亡。十天可以刺破，如果颜色赤黑，脓液清稀的，可以治疗。有人问：有一人六十岁，背部患疽，形状像蜂房，十天后平塌，寒热疼痛非常严重，饮食减少，腹部膨胀且淋沥不尽，怎么样？回答说：这是蜂窠发，诊察其脉象微而迟，四肢厥冷属于正气不足。询问他先前过服耗气药物，又遭遇暴怒，用活命饮加人参、当归、白术，兼用乌药、青皮、木香，间或服用紫金丹，使疮疡起发、化脓溃破，服用十全大补汤而痊愈。
特疽，发于肺俞及肝俞穴，如果不刺破，二十天死亡。八天可以刺破，如果颜色红赤，内部隐起如椒子状的死亡。
阴阳二气疽，广阔布满背部，或大或小变化无常，肿胀发热胀大，十天可以刺破，引导引出脓液，不拘泥于深浅多少，如果发病渴身体疲倦，十天外不见脓液的无法治疗。有人问：背上麻木无常，时而肿胀时而平塌，忽软忽硬，乍寒乍热怎么样？回答说：这名叫阴阳疽，由七情内伤失调，阴阳不和所致，此证必定是大渴但神志清醒、脉象平稳的可以治疗。宜用活命饮加羌活，或选用胜金丹、夺命丹。昏迷躁乱，饮食不进的死。十天得到黄白色脓液的可治疗，数日无脓液死的。
筋疽，发于夹脊两边的大筋上，颜色苍老，八天可以刺破，如果在肥肠中有痈，九十天死亡。
禽疽，刚开始发作时像疹子，数十处像拳头打过的样子，发寒战牙关紧闭，像这样的，十四天死亡。十天可以刺破，引导脓液流出，即可痊愈。有人问：背部忽然麻木，拘急不痛，十几处肌肉紫色，像拳头触碰的样子怎么样？回答说：这名叫禽疽。七日内，出现寒热口噤的死。急服活命饮加羌活、独活，胜金丹、夺命丹，得汗的可治疗，无汗的不治。神志清醒脉象平和的可治疗，神志昏沉脉象躁动或微弱或代脉的死。漫肿不溃破，宜服用台阁紫微丸。
有人问：背疽两头小，四边散开怎么样？回答说：这名叫两头发，又名满天星，一名广绵背发。因积怒蓄热所致，用活命饮加羌活，紫金丹，胜金丹。体质壮实的人，用八阵散、一粒金丹攻下。肿胀高起红润的生，低陷黑暗的死。
有人问：背胁之间，两三处发疽怎么样？回答说：这名叫老鼠攒，一名游走血脾痈。由怒气积热所致，多发于足少阳、足厥阴二经。宜用顺气清热之剂，服用黄连解毒汤、活命饮，加黄连、栀子及服用紫金丹。体质壮实的人，用一粒金丹攻下。年老体弱的人，用黄耆木香散、内补十宣散选用。七日不见脓液，黑陷及躁乱的死。
有人问：背上生疽，肉色不变，麻木微痒，坚硬如牛颈之皮，长达二三尺怎么样？回答说：这名叫竟体发，亦名椒眼发。由盛暑时节，空腹感触秽气，以及愤怒积郁所致。宜用活命饮加羌活，或黄连解毒汤、胜金丹、乌金散选用。体质壮实的人，用八阵散、一粒金丹攻下。七日内未成脓宜隔蒜灸，灸后起发，神志清醒脉象平和的可治疗，灸后不起发，腹胀神志昏沉，脉象微弱或急促或代脉的死，服用发汗剂得汗的生，无汗的死。服用补剂红润起发知痛的生，腹部膨胀不食，干枯黑陷的死。
有人问：背部当心而痛，麻木无常，累累如弹丸如拳头，坚硬如石，疼痛彻入五脏，遍身拘急怎么样？回答说：这名叫酒毒发疽，由饥饱劳伤，炙烤爆炒、浓味食物所致。宜服用黄连解毒汤，加羌活、干葛，或神效消毒散、内疏黄连汤、紫金锭、胜金丹选用。神志昏沉脉象紊乱，大渴狂言，妨碍饮食的死，二便闭结的死。有因寒变而内陷的，用托里温中汤。
有人问：背上细碎无数，浸淫一二尺，像汤火烫伤一样。烦躁多渴怎么样？回答说：这是丹毒发疽，因服用丹石刚烈药物所致，红润的生，紫黯的死。恶证少的，宜服用黄连消毒散、胜金丹、国老膏，恶证多的，神志昏沉脉象躁动，腹部膨胀呕哕的死。
有人问：背侧生疽，高二寸，长一尺左右，形状像黄瓜，肉色不变怎么样？回答说：这名叫黄瓜痈，一名肉龟。疼痛牵引心脏，四肢麻木是也，此证大多不可治疗。急服紫金丹、胜金丹、活命饮加羌活、柴胡，及夺命丹、神仙追毒丸选用。脉象微弱自汗谵语的死。平塌黑色的，用独姜散主治，服用台阁紫微丸。
有人问：第九椎两旁，忽然肿痛而无头，寒热大作怎么样？回答说：这名叫龙疽，即中搭疽。属太阳经，由七情不和，愤怒积热所致。体质壮实的人，急服一粒金丹，或八阵散攻下，活命饮加柴胡、羌活、黄芩，水酒各半煎服。年老体弱的人，用黄耆木香散、内补十宣散、十全大补汤选用。颜色赤红起发润泽的可治疗。颜色黑陷，恶心眩晕，大便滑泄，小便如淋，谵语的死。
《鬼遗方》说：人生最可担忧的，是发背，其种类有五种：一是阳毒，因风热而有，或者患热毒消渴，或者先患伤寒，其余有阳毒，触处蓄积，起于背脊膂之间，不问椎骨数量，只从两夹脊起止，腰以上、满背灼热，像炊煮一样的状态，赤紫或红如火焰，脓毒难成，成后不止，止后痛不除，突然几天之间，又平复如旧，将以为肿消，这是内攻肉陷，不可治愈了。二是阴毒发背，是气冷而作，初起如黍米粒突起，情绪不快，闷而痛，直应前心，心慌怔忡，头目昏重，寒热如疟，五七日后，才开始发引攻肿，开阔难收，内积有脓，深沉迟缓未透，宜急以补气汤药内托，外用抽脓药贴之，宜急见脓，无脓即平，愈合没有定期。三是有人多服金石烧炼的药物，毒恶流滞成为发背的，初起如丹疹状，渐渐开如汤火疮，面色如朱，心膈烦躁，多渴嗜冷，其疮难起，起即惊人，犹胜于阴阳二毒者，缘于此有解金石药毒汤散，治其内也，赖有根底分明，也必须急疗才安。四是人有患酒食毒发背的，此疾不是近来得的，乃脏腑久积，乘饥乘困食之便睡，或多食酒肉，冷热粘滑，肥鲜炽腻，未下胸膈，房室不禁，恣意当风取快，脾脏气虚，不能受乘，发毒攻背两夹脊，不问椎骨数量，初起痈头如小弹子，后大如拳，坚如石，痛遍四肢，加之拘急口苦舌干，腹急大小便涩，十数日后，头面手足虚肿，及脏腑通泄，如利内急痛者，是其证也。喜方肿引，急用收肿、发穴、溃脓汤药内实，外泄脓水不可放纵，迟缓则皮肉腐坏，伤骨烂筋，渐成脓多，因而感邪内败的死矣。五是人有冒山岚瘴气，发背毒瓦斯，先在脏腑。年月浸远，气血虚损衰弱，初起肿色青黑如靴皮，顽痹痛深，附筋骨彻髓，按之如木石，引手加深，方觉似有痛处，至五七日，毒瓦斯浮浅肿高，色变青白，有如拳打之状，寒战似疟，及有风候，头动口偏，手足厥逆，眼黑睛小，白多而慢，此内有邪气相搏，急破出清血三五升，方有黄脓白汁，相和发泄，其反不宽不慢亦急，胀痛亦不住，直至色退热疼方愈，亦宜急急追赶脓与毒瓦斯外出，无害。
初患肿，三日内灸的生。八日内脓成，针烙导引的生。未痊愈，慎劳力的生。慎忌食的生。慎喜怒的生。催肿，猛疗的生。急疗的生。不讳发背的生。待脓自出，不导引的死。未内攻，而针烙用药导引的生；内攻后，导引针烙的死。肿热痛正盛，已前疗的生；如过此后，已内攻的死。脓成后，不出不导引，但敷药的死。如赤白痢气急的，是已内攻，医疗无益必死，痈不救十得五生，疽不疗十全死，轻肿，怕痛的必死。不遇良方的死。节候不根据法的，必死。愚执恣意用性，逸情的死。
有发背痈，有发背疽，如毒瓦斯勇猛而发，如火焚茅，易于败坏。初发即可如黍米粒大，三两日渐赤引种，如手掌面大，五七日如碗面大，即易为攻。热赤引如火烧之状，浮面渐溃烂阔开，内发肿如炊之状，外烂皮肉如削去，紫瘀脓汁多而肿不退，疼亦不止，发渴发逆，饮食不下，呕吐气急，浮浅开阔的，尤宜发脓，托毒汤药用之必愈，（阳证实也。）其间有只如盏面大的，此非不大，缘为毒瓦斯深沉内虚，毒瓦斯近膜也，此必内攻，近入脏腑。却外入四肢，先攻头面虚浮，后攻手面，次攻两足面肿，名叫毒瓦斯散入四肢。其人声嘶气脱，眼睛黑小，十指肿黑干焦，不治，（阴证虚也）。
《精要》说：凡痈疽初发肿硬高的，而毒瓦斯却浅，此乃六腑不和为痈，其证属阳，势虽急而易治。若初发如粟粒，甚则如豆许，与肉俱平，或作赤色，时觉痒痛，痒时慎勿抓破，此乃五脏不调为疽，其证属阴，盖毒瓦斯内蓄已深，势虽缓而难治。
始发一粒如麻豆大，身体便发热，生疽处肿大热痛，此为发于外，虽大如盆，治之百可百活，（阳证实也）。或身体不热，自觉倦怠，生疽处亦不热，数日后渐大，不肿不痛，低陷而坏烂，此为发于内，虽神仙无如之何，（阴证虚也。）
〔薛己〕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，热毒之证也为易治。漫肿微痛，色黯作渴，脉洪数而无力，阴虚之证也为难治。不肿不痛，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。（薛又云：头痛拘急，乃表症，先服人参败毒散一二剂，如痛用金银花散，或槐花酒、神效托里散。痛肿硬，脉实，以清凉饮、仙方活命饮、苦参丸。肿硬木闷，疼痛发热，烦躁饮冷，便秘脉沉实者，内疏黄连汤或清凉饮。大便已利，欲得作脓，用仙方活命饮、托里散、蜡矾丸，外用神异膏。）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、人参、白术。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。脯热内热，或不收敛，阴血虚也，四物加人参、白术。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。小便频数的，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。其有死的，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。其有死的，乃真气虚而不能腐溃也，在于二旬之间见之。若已腐溃，用托里散以生肌。如不应，急温补脾胃。其有死的，乃脾气虚而不能收敛也，在于月余间见之。
外治法：初起痛或不痛，及麻木的，邪气盛也，隔蒜灸之。痛的灸至不痛，不痛的灸至痛，毒随火而散。再不痛的，须明灸之，（谓不隔蒜）。但未溃以前，皆可灸也，更用箍药围之。若用乌金膏，或援生膏点患处，数点尤好。间用雄黄解毒散洗患处，每日用乌金膏涂疮口处，候有疮口，即用纸作捻，醮乌金膏插入疮内，（翠青锭子尤妙）。若有脓为脂膜间隔不出。而作胀痛者，宜用针引之，腐肉堵塞的去之。若瘀肉腐动，用猪蹄汤洗，如脓稠或痛，饮食如常，瘀肉自腐，用消毒与托里药，相兼服之，仍用前二膏举涂贴。若腐肉已离好肉，宜速去之。如脓不稠不稀，微有疼痛，饮食不甘，瘀肉腐迟，更用桑柴灸之，多用托里药。若瘀肉不腐，或脓清稀不痛的，急服大补之剂，亦用桑柴灸之。以补接阳气，解散郁毒。尝观患疽稍重，未成脓的，不用蒜灸之法，及脓熟不开，或待腐肉自去，多致不救。大抵气血壮实，或毒少轻的，可假药力或自腐溃，怯弱之人，热毒中隔，内外不通，不行针灸，药无全功矣。然此证若脓已成，宜急开之，否则重者溃通脏腑，腐烂筋骨，轻者延溃良肉，难于收功，因而不敛者多矣。大抵发背之患，其名虽多，唯阴阳二证为要，若发一头或二头，其形赤肿高，头起疼痛，发热为痈，属阴易治。若初起一头如黍，不肿不赤，闷痛烦躁，大渴便秘，寐语啮齿，四五日间，其头无数，其疮口各含一粟，形似莲蓬，名莲蓬发，积日不溃，按之流血，至八九日或数日，其头成片，所含之物俱出，通结一衣，揭去又结，其口共烂为一疮，其脓内攻，色紫黯为疽，属阴难治。脉洪滑者尚可，沉细尤难，如此恶证，惟隔蒜灸，及涂乌金膏有效。凡人背近脊并髀，皮里有筋一层，患此证的，外皮虽破难溃，以致内脓不出，令人胀痛苦楚，气血转虚，变证百出，若待自溃，多致不救。必须开之，兼以托里之剂，常治此证，以利刀剪之，尚不能去，以此坚物，待其自溃，岂不反伤乎？非气血壮实者，未见其能自溃也。
罗谦甫治疗一人，年逾六旬，冬至后数日，疽发背五七日，肿势约七寸许，痛甚。疡医说：脓已成，可开发了。病人恐惧，不从。三日，医生说：不开恐生变症。遂以燔针开之，脓
A person asked: How many types of back carbuncles are there? It was answered: There are three types—upper, middle, and lower—all located in the center of the spine, belonging to the Du Meridian (Governing Vessel). The upper type injures the Lung (Zang organ), occurring below the Tianzhu bone. The middle type injures the Liver (Zang organ), called "Opposite Heart Carbuncle." The lower type injures the Kidney (Zang organ), called "Opposite Umbilicus Carbuncle." All are caused by accumulated heat and anger. Initially, it resembles a millet grain or hemp seed, may be itchy, stiff, painless, or extremely painful. Upon initial perception, it is best to apply moxibustion with garlic slice separation. Treatment should involve sweating, purging, or supporting expulsion methods, tailored to the patient's deficiency or excess. For brain and upper back carbuncles, Tongcao (Platycodon Root) should not be used, as it may guide deficiency downward and damage the lower origin. Elderly and weak individuals should especially avoid this. However, these three types of back carbuncles occur in critical areas, different from other parts, requiring extra caution. Any slight pain or itchiness should be treated promptly; Huoming Yin (Life-Saving Decoction) with Qianghuo (Notopterygii Rhizoma et Radix) can be used, or Zijin Dan (Purple Gold Pill), Shengjin Dan (Victory Golden Pill), and Duoming Dan (Life-Extending Pill) selected. For robust individuals, Yili Jindan (One Grain Golden Pill) or Bazhen San (Eight Formations Powder) can be used to purge; for elderly and weak individuals, Huangqi Muxiang San (Astragalus and Costus Powder) or Shiquan Dabu Tang (Ten Significant Tonifying Decoction) can be used to support and expel toxins.
The *Guiyi Fang* states: Bee carbuncle occurs on the thigh and back, originating at Xinshu (BL15) and Xinbaoluo Shu (BL14) acupoints. If the shoulder... is not punctured within twenty days, death ensues. Puncturing is permissible after ten days; if the color is red-black and the pus is clear, it is treatable. A person asked: A sixty-year-old man suffered from a back carbuncle resembling a honeycomb. After ten days, it became flat. He experienced severe chills, fever, and pain, with reduced appetite, abdominal distension, and dribbling urination. What is the prognosis? It was answered: This is "Honeycomb Carbuncle." His pulse was faint and slow, and his four limbs were cold, indicating deficiency. Inquiry revealed he had previously overconsumed qi-consuming medicines and suffered sudden anger. He was treated with Huoming Yin (Life-Saving Decoction) added with Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), along with Wuyao (Linderae Radix), Qingpi (Citri Reticulatae Pericarpium Viride), and Muxiang (Aucklandiae Radix), intermittently taking Zijin Dan (Purple Gold Pill). The carbuncle rose, suppurated, and ulcerated. He recovered after taking Shiquan Dabu Tang (Ten Significant Tonifying Decoction).
Te carbuncle occurs at Feishu (BL13) and Ganshu (BL18) acupoints. If not punctured, death occurs in twenty days. Puncturing is permissible after eight days. If the color is bright red and the interior shows protrusions like pepper seeds, death ensues.
Yin-Yang Qi Carbuncle covers the entire back broadly, varying in size, with swelling, heat, and distension. Puncturing is permissible after ten days to guide out pus, regardless of depth or quantity. If thirst and fatigue develop, and no pus appears after ten days, it is untreatable. A person asked: Numbness on the back that varies, alternating between swelling and flattening, softness and hardness, chills and fever. What is the prognosis? It was answered: This is named "Yin-Yang Carbuncle," caused by internal disharmony of the Seven Emotions and imbalance of Yin and Yang. This condition is treatable only if there is intense thirst but clear consciousness and a stable pulse. Huoming Yin (Life-Saving Decoction) with Qianghuo (Notopterygii Rhizoma et Radix) is suitable, or Shengjin Dan (Victory Golden Pill) and Duoming Dan (Life-Extending Pill) can be selected. Coma, restlessness, and inability to eat indicate death. Yellow-white pus appearing within ten days indicates treatability; absence of pus after several days indicates death.
Jin Carbuncle (Sinew Carbuncle) occurs on the large sinews on both sides of the spine. The color is pale-green. Puncturing is permissible after eight days. If an abscess exists in the fatty intestines, death occurs in ninety days.
Qin Carbuncle (Bird Carbuncle) initially presents like rashes, with dozens of spots resembling bruising from punches. Chills and locked jaw occur; such cases die in fourteen days. Puncturing is permissible after ten days to guide out pus, leading to recovery. A person asked: Sudden numbness on the back, stiffness without pain, purple discoloration of flesh in more than ten spots, resembling punch marks. What is the prognosis? It was answered: This is named "Qin Carbuncle." Death occurs within seven days if accompanied by chills, fever, and locked jaw. Urgently administer Huoming Yin (Life-Saving Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Duhuo (Angelicae Pubescentis Radix), Shengjin Dan (Victory Golden Pill), and Duoming Dan (Life-Extending Pill). Recovery is possible with sweating; impossible without sweat. Clear consciousness and harmonious pulse indicate treatability; coma, restless pulse, faint pulse, or intermittent pulse indicate death. Diffuse swelling without ulceration requires Taige Ziwei Wan (Taige Purple Micro Pill).
A person asked: Back carbuncle small at both ends, spreading widely on the four sides. What is the prognosis? It was answered: This is named "Two-Headed Carbuncle," also known as "Full Sky Stars" or "Broad Cotton Back Carbuncle." Caused by accumulated anger and heat, treat with Huoming Yin (Life-Saving Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix), Zijin Dan (Purple Gold Pill), and Shengjin Dan (Victory Golden Pill). Robust individuals take Bazhen San (Eight Formations Powder) or Yili Jindan (One Grain Golden Pill) to purge. High, red, and swollen lesions indicate survival; low, dark, and sunken lesions indicate death.
A person asked: Carbuncles appearing in two or three spots between the back and ribs. What is the prognosis? It was answered: This is named "Mouse Gathering," also known as "Wandering Blood Spleen Abscess." Caused by anger and accumulated heat, frequently affecting the Foot Shaoyang and Foot Jueyin meridians. Use qi-regulating and heat-clearing agents, such as Huanglian Jiedu Tang (Coptis Detoxification Decoction) and Huoming Yin (Life-Saving Decoction), added with Huanglian (Coptidis Rhizoma) and Zhizi (Gardeniae Fructus), along with Zijin Dan (Purple Gold Pill). Robust individuals take Yili Jindan (One Grain Golden Pill) to purge. Elderly and weak individuals select Huangqi Muxiang San (Astragalus and Costus Powder) or Neibu Shixuan San (Internal Tonification Ten-Ventilation Powder). Absence of pus after seven days, black sinking, and restlessness indicate death.
A person asked: Carbuncle on the back with unchanged skin color, numbness, slight itching, hard like ox neck skin, spanning two or three chi. What is the prognosis? It was answered: This is named "Whole Body Carbuncle," also known as "Pepper Eye Carbuncle." Caused by exposure to foul air while fasting during peak summer heat, combined with anger and depression. Treat with Huoming Yin (Life-Saving Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix), or Huanglian Jiedu Tang (Coptis Detoxification Decoction), Shengjin Dan (Victory Golden Pill), or Wujin San (Black Metal Powder). Robust individuals take Bazhen San (Eight Formations Powder) or Yili Jindan (One Grain Golden Pill) to purge. If pus has not formed within seven days, apply garlic-separated moxibustion. If the lesion rises after moxibustion, with clear consciousness and harmonious pulse, it is treatable. If it does not rise, accompanied by abdominal distension, coma, faint/rapid/intermittent pulse, it is fatal. Sweating after diaphoretic agents indicates survival; no sweat indicates death. Redness and rising with pain sensation after tonifying agents indicate survival; abdominal distension, anorexia, dryness, and black sinking indicate death.
A person asked: Pain in the center of the back, variable numbness, lumps like bullets or fists, hard as stone, pain penetrating the five Zang organs, general stiffness. What is the prognosis? It was answered: This is named "Alcohol Toxicity Carbuncle," caused by irregular eating, overwork, roasted/fried foods, and rich flavors. Treat with Huanglian Jiedu Tang (Coptis Detoxification Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Gegen (Puerariae Lobatae Radix), or Shenxiao Xiaodu San (Miraculous Detoxification Powder), Neishu Huanglian Tang (Internal Purging Coptis Decoction), Zijin Ding (Purple Gold锭), or Shengjin Dan (Victory Golden Pill). Coma, chaotic pulse, intense thirst, delirium, and impaired diet indicate death. Closure of urine and feces indicates death. Cases complicated by cold transformation with internal sinking require Tuoli Wenzhong Tang (Support Interior Warm Middle Decoction).
A person asked: Countless fine spots on the back, oozing over one or two chi, resembling scalds. Restlessness and excessive thirst. What is the prognosis? It was answered: This is "Dan Toxicity Carbuncle," caused by consuming mineral-based rigid medicines. Redness indicates survival; purple-darkness indicates death. Few severe symptoms: treat with Huanglian Xiaodu San (Coptis Detoxification Powder), Shengjin Dan (Victory Golden Pill), or Guolao Gao (Old Man Paste). Many severe symptoms, coma, restless pulse, abdominal distension, vomiting, and hiccups indicate death.
A person asked: Carbuncle on the side of the back, two cun high, one chi long, shaped like a cucumber, unchanged skin color. What is the prognosis? It was answered: This is named "Cucumber Abscess," also known as "Meat Turtle." Pain radiates to the heart, with limb numbness. This condition is mostly untreatable. Urgently take Zijin Dan (Purple Gold Pill), Shengjin Dan (Victory Golden Pill), Huoming Yin (Life-Saving Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Chaihu (Bupleuri Radix), plus Duoming Dan (Life-Extending Pill) or Shenxian Zhuidu Wan (Immortal Poison-Chasing Pill). Faint pulse, spontaneous sweating, and delirium indicate death. Flat and black lesions are treated with Dujiao San (Single Ginger Powder) and Taige Ziwei Wan (Taige Purple Micro Pill).
A person asked: Sudden swelling and pain on both sides of the ninth thoracic vertebra without a head, severe chills and fever. What is the prognosis? It was answered: This is named "Dragon Carbuncle," also known as "Middle Attachment." It belongs to the Taiyang Meridian, caused by emotional disharmony and anger-induced heat. Robust individuals urgently take Yili Jindan (One Grain Golden Pill) or Bazhen San (Eight Formations Powder) to purge, or Huoming Yin (Life-Saving Decoction) added with Chaihu (Bupleuri Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Huangqin (Scutellariae Radix), decocted with equal parts water and wine. Elderly and weak individuals select Huangqi Muxiang San (Astragalus and Costus Powder), Neibu Shixuan San (Internal Tonification Ten-Ventilation Powder), or Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Red, rising, and moist lesions are treatable. Black, sunken lesions, nausea, dizziness, loose stools, urinary difficulty, and delirium indicate death.
The *Guiyi Fang* states: The most worrying condition in humans is back carbuncle, which has five types. First is Yang Toxicity, arising from wind-heat, or associated with heat-toxicity diabetes, or following typhoid. Residual Yang toxicity accumulates everywhere, starting between the back bones, regardless of vertebral count, beginning and ending between the paraspinal muscles. Heat fills the back above the waist, feeling like cooking. Color is purple-red or flame-red. Pus and toxin are difficult to form; once formed, they do not stop. Pain persists even after stopping. Suddenly, within a few days, it flattens as before. One might think the swelling has subsided, but this is internal attack and muscle sinking, untreatable. Second is Yin Toxicity Back Carbuncle, caused by cold qi. Initially like a millet grain, mood is unhappy, stifling pain radiating to the front heart, palpitations, heavy head and eyes, chills and fever like malaria. After five to seven days, swelling expands and is hard to contain. Internal pus accumulates, deep and slow to penetrate. Urgently use Qi-tonifying decoctions for internal support and pus-drawing plasters externally. Pus should appear quickly; if flat without pus, healing is indefinite. Third, some people consume too many refined mineral metals, causing toxic stagnation leading to back carbuncle. Initially like erysipelas rash, gradually opening like scalds. Face is crimson, chest and diaphragm are irritable, thirsty for cold drinks. The sore is hard to rise; if it rises, it is alarming, worse than Yin-Yang toxicity. Fortunately, there are decoctions to resolve mineral metal toxicity internally. With clear root causes, urgent treatment brings peace. Fourth, alcohol-food toxicity back carbuncle. This disease is not recent but results from long-term accumulation in Zang-Fu. Sleeping after eating when hungry or tired, or overeating alcohol, meat, cold/hot/sticky/greasy/rich foods not yet digested, uncontrolled sexual activity, exposing oneself to wind for pleasure. Spleen Qi is deficient and cannot handle the load. Toxin attacks the back paraspinal area. Initial head is like a small bullet, later like a fist, hard as stone, pain throughout limbs, stiffness, bitter taste, dry tongue, abdominal urgency, difficult urination and defecation. After ten-plus days, puffiness of head, face, hands, feet, and internal leakage resembling urgent diarrhea are signs. Swelling spreads; urgently use swelling-reducing, pore-opening, and pus-ulcerating decoctions to solidify internally. External pus drainage must not be delayed; delay leads to flesh rotting, bone damaging, tendon destroying, excessive pus, pathogen invasion, internal failure, and death. Fifth, mountain mist and miasma exposure cause back carbuncle toxins residing first in Zang-Fu. Over years, Qi and Blood become deficient and weak. Initial swelling is blue-black like boot leather, stubborn numbness, deep pain attaching to bones and marrow, hard as wood/stone. Pressing deeper reveals pain. After five to seven days, toxin becomes superficial, swelling high, color turns blue-white, resembling punch marks. Chills like malaria, wind symptoms, head movement, mouth deviation, cold limbs, small pupils with white sclera dominance. Internal evil Qi struggles. Urgently puncture to release 3-5 sheng of clear blood, then yellow pus and white fluid mix and discharge. Relief is not immediate; swelling and pain persist until color fades and heat/pain cease. Urgently chase pus and toxins outward to avoid harm.
Initial swelling treated with moxibustion within three days survives. Pus formed within eight days, punctured/cauterized and guided survives. Not yet healed, avoiding labor survives. Observing dietary taboos survives. Controlling emotions survives. Promoting swelling and aggressive treatment survives. Urgent treatment survives. Not denying back carbuncle survives. Waiting for spontaneous pus without guidance dies. Before internal attack, puncturing/cauterizing/guiding with medicine survives; after internal attack, puncturing/cauterizing/guiding dies. When swelling, heat, and pain are peak, treated before survives; treated after internal attack dies. After pus formation, not draining/guiding, only applying ointment dies. Bloody dysentery with rapid breathing indicates internal attack; medical help is useless, death is certain. Abscess untreated: 5 out of 10 survive. Carbuncle untreated: all die. Mild swelling, fear of pain: death. No good prescription: death. Ignoring seasonal laws: death. Stubbornness, indulgence, laziness: death.
Back carbuncle abscesses and carbuncles erupt vigorously like fire burning thatch, easily deteriorating. Initially like millet grains, reddening and spreading in 2-3 days to palm size, bowl size in 5-7 days, easy to attack. Heat and redness like burning, surface ulcerates widely, internal swelling like cooking, external flesh peels off, purple stasis, abundant pus, swelling persists, pain continues, thirst, regurgitation, inability to eat, vomiting, rapid breathing, shallow and open lesions especially require pus induction. Toxin-supporting decoctions will cure (Yang syndrome, excess). Sometimes only cup-sized, not small because toxin is deep and internal deficiency, toxin near membranes. This must attack internally, approaching Zang-Fu. Then spreads to limbs, attacking head/face puffiness first, then hands, then feet swelling, named "Toxin dispersing into limbs." Hoarse voice, Qi depletion, small black eyes, black/dry fingers, untreatable (Yin syndrome, deficiency).
The *Jingyao* states: When abscess/carbuncle initially swells hard and high, toxin is shallow. This is Six Fu organ disharmony as abscess, Yang syndrome, urgent but easy to treat. If initially like millet bean, up to bean size, flat with flesh, or red, itchy/painful, do not scratch when itchy. This is Five Zang organ disharmony as carbuncle, Yin syndrome, toxin deeply stored internally, slow but hard to treat.
Starting with one grain like hemp/millet, body heats up, site swells hot/painful. This is external eruption. Even if basin-sized, hundred percent curable (Yang syndrome, excess). Or body not hot, feels fatigued, site not hot, enlarges after days, non-swollen, non-painful, sunken and rotten. This is internal eruption. Even immortals cannot help (Yin syndrome, deficiency).
[Xue Ji] Back carbuncle belongs to Bladder and Du meridians, caused by Yin deficiency with fire hyperactivity, rich wine/flavors, or repressed anger/sexual exhaustion. If red/swollen/painful, surging/rapid/forceful pulse, heat-toxin syndrome, easy to treat. Diffuse swelling, slight pain, dark color, thirst, surging/rapid/weak pulse, Yin deficiency syndrome, hard to treat. Non-swollen/non-painful, or diffuse dark, faint/thin pulse, severe Yang deficiency, especially hard to treat. If swelling/pain, chills/fever/thirst, normal diet, shape/Qi/pathogen Qi are all sufficient. First use Xianfang Huoming Yin (Immortal Formula Life-Saving Decoction), then Tuoli Xiaodu San (Support Interior Detoxification Powder) to resolve. [Xue adds: Headache/stiffness is exterior syndrome, first take Renshen Baidu San (Ginseng Rescue Poison Powder) 1-2 doses. If pain, use Jinyinhua San (Honeysuckle Powder) or Huaishengjiu (Sophora Wine), Shenxiao Tuoli San (Miraculous Support Interior Powder). Painful/swollen/hard, solid pulse, use Qingliang Yin (Cooling Drink), Xianfang Huoming Yin, Kushen Wan (Kushen Pill). Swollen/hard/heavy, painful/hot, irritable/cold drink desire, constipation/solid pulse, use Neishu Huanglian Tang (Internal Purging Coptis Decoction) or Qingliang Yin. After bowel movement, wanting pus, use Xianfang Huoming Yin, Tuoli San (Support Interior Powder), Lafan Wan (Beeswax Alum Pill), externally Shenyi Gao (Divine Ointment). Diffuse swelling/slight pain, non-red, poor appetite, shape/Qi/pathogen Qi all insufficient. Use Tuoli San to regulate/tonify. No pus or pus formed but not ulcerating, Yang deficiency. Tuoli San doubled with Rougui (Cinnamon Bark), Renshen (Ginseng), Baizhu (Atractylodes). Pus flows but pain returns, or thin pus, Qi/Blood deficiency. Bazhen Tang (Eight Treasures Decoction). Aversion to cold/chills, or non-healing, Yang deficiency. Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Chest/internal heat, or non-healing, Yin/Blood deficiency. Siwu Tang (Four Substances Decoction) added with Renshen (Ginseng), Baizhu (Atractylodes). Vomiting/wanting to vomit, or non-healing, Stomach Qi deficiency. Liujunzi Tang (Six Gentlemen Decoction) added with Paojiang (Prepared Ginger). Poor appetite/fatigue, or non-healing, Spleen Qi deficiency. Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) added with Fuling (Poria), Banxia (Pinellia). Red flesh non-healing, Blood heat. Siwu Tang (Four Substances Decoction) added with Shanzhi (Gardenia), Lianqiao (Forsythia). White flesh non-healing, Spleen deficiency. Sijunzi Tang (Four Gentlemen Decoction) added with Jiuchaoshao Yao (Vinegar-fried Peony), Muxiang (Aucklandia). Frequent urination, Kidney Yin loss. Jiawei Bawei Wan (Modified Eight Flavors Pill). If initial onset not erupted, chills/fever/pain, thirst/cold drink desire, pathogen Qi internal retention. Xianfang Huoming Yin (Immortal Formula Life-Saving Decoction). Dry mouth/hot drink desire, diffuse swelling/slight pain, Yuan Qi internal deficiency. Tuoli Xiaodu San (Support Interior Detoxification Powder). Poor appetite/limb fatigue, Spleen/Stomach weakness. Liujunzi Tang (Six Gentlemen Decoction); if ineffective, add Jiang (Ginger) Gui (Cinnamon). Deaths occur when pathogen Qi is strong, True Qi is weak, unable to erupt, seen within ten-plus days. If erupted, use Tuoli Xiaodu San (Support Interior Detoxification Powder); if not rotting, use Tuoli San (Support Interior Powder). If ineffective, urgently warm/tonify Spleen/Stomach. Deaths occur when True Qi is weak, unable to rot, seen within twenty-plus days. If rotted, use Tuoli San (Support Interior Powder) to generate flesh. If ineffective, urgently warm/tonify Spleen/Stomach. Deaths occur when Spleen Qi is weak, unable to heal, seen within month-plus.
External treatment: Initial pain or no pain, numbness, pathogen Qi strong. Garlic-separated moxibustion. Painful moxicate until painless; painless moxicate until painful. Toxin disperses with fire. If still painless, direct moxibustion (without garlic). Before ulceration, all can be moxicated. Surround with binding herbs. If using Wu Jin Gao (Black Gold Ointment) or Yuansheng Gao (Life-Supporting Ointment) dotting the lesion, multiple dots are better. Occasionally wash with Xionghuang Jiedu San (Realgar Detoxification Powder). Daily apply Wu Jin Gao (Black Gold Ointment) to wound. Once wound exists, make paper wicks, dip in Wu Jin Gao (Black Gold Ointment), insert into wound (Cuiqing Dingzi (Emerald Green锭) is excellent). If pus is blocked by fat membrane causing distension/pain, use needle to guide. Remove blocking necrotic flesh. If sloughing moves, wash with Zhu Ti Tang (Pig Trotter Decoction). If pus thick or painful, diet normal, slough self-decomposes, use detoxification and support interior medicines together, continue previous two ointments. If necrotic flesh separates from healthy flesh, remove quickly. If pus neither thick nor thin, slight pain, poor diet, slow slough decomposition, use Sangchai Moxibustion (Mulberry Wood Moxa), more support interior medicines. If slough does not decompose, or pus thin/painless, urgently take major tonifying agents, also use Sangchai Moxibustion. To supplement/connect Yang Qi, disperse depressed toxin. Observing heavier carbuncles without pus, not using garlic moxibustion, or waiting for pus to ripen/open, or waiting for slough to fall off, often leads to non-rescue. Generally, robust Qi/Blood or mild toxin can rely on medicine or self-decompose. Weak people, heat-toxin blockage, internal/external不通, without acupuncture/moxibustion, medicine lacks full efficacy. If pus formed, urgent opening is required; otherwise, severe cases penetrate Zang-Fu, rot bones/tendons; mild cases spread to healthy flesh, hard to heal, resulting in many non-healing cases. Generally, back carbuncle names vary, but Yin/Yang syndromes are key. If one or two heads, red/swollen/high, head rises/painful, fever = Abscess, Yin type easy to treat. If initially one head like millet, non-swollen/non-red, stifling pain/irritability, intense thirst/constipation, sleep talking/grinding teeth, within 4-5 days, numerous heads, each containing a millet grain, resembling lotus pod, named "Lotus Pod Carbuncle." Days pass without ulceration, pressing bleeds. By day 8-9 or so, heads merge, contents extrude, forming one garment-like structure, peeling off reforms, mouths rot into one sore, pus attacks internally, purple-dark = Carbuncle, Yin type hard to treat. Surging/slipping pulse is acceptable; deep/thin pulse is very difficult. Such severe conditions, only garlic-separated moxibustion and Wu Jin Gao (Black Gold Ointment) application are effective. On the back near spine and thighs, there is a layer of fascia under the skin. Patients with this condition, although skin breaks, hard to ulcerate, internal pus cannot exit, causing distension/pain, Qi/Blood turning deficient, myriad changes. Waiting for spontaneous ulceration often leads to non-rescue. Must open, combine with support interior agents. Usually treating this with sharp scissors cannot remove it. Using hard objects waiting for spontaneous ulceration would cause injury. Only robust Qi/Blood can spontaneously ulcerate.
Luo Qianfu treated a man over sixty. Several days after Winter Solstice, carbuncle erupted on back for 5-7 days, swelling about seven cun, severe pain. Surgeon said: Pus formed, can open. Patient feared, refused. Three days later, doctor said: Not opening risks complications. Used burning needle to open, pus...