A Boil on the Back of the Neck, Red and Swollen? Support Vital Qi and Drive Out the Toxin
What people search for: boil on the back of the neck / carbuncle behind the head / boil on the upper back / boil red and swollen / boil with a big hard lump inside / boil that will not come to a head / boil draining pus / furuncle
In medical terms: yongju (boils and carbuncles) · naoju (carbuncle of the brain region) · fabei (carbuncle on the back) · heat toxin surging with insufficient vital qi
Opening: the name sounds old-fashioned, but in ancient times this disease could kill you
Today Doctor Luo Dalun continues the story of Doctor Zhu Danxi at work, and the disease is called yongju (痈疽) — in plain words, boils that grow on the skin. These are rarely seen nowadays, because bathing is easy and hygiene is good. But in the past, ordinary people could rarely bathe every day, so yongju became a major illness that people ran into very easily.
💬 Note from Doctor Luo: How dangerous was this disease in ancient times? Fan Zeng (范增), the chief counselor of Xiang Yu, the Hegemon-King of Western Chu, died because a carbuncle grew on his back — what the ancients called "fabei" (发背). When a boil grew on the back or the back of the neck, the ancients genuinely could lose their lives over it.
Yong and ju are actually two different diseases
Although yong and ju are usually spoken together, they are not the same. Yong (痈), in today’s terms, is a deep inflammation of many hair follicles at once — once it flares up it covers a large area, red, swollen, hot and painful, quite frightening. Ju (疽), by contrast, may begin as small as a grain of millet. Its hallmark is what the old doctors called the "headless ju": the skin color does not change — locally there is numbness, itching and pain, and it does not look like much on the surface, but when you press it, the root plate underneath is very large and very hard — the disease has taken root deeply.
💬 Note from Doctor Luo: Precisely because the skin color does not change and it does not look alarming, many people pay no attention at first; by the time it truly flares up it is a serious matter, and some people even die from it. Later generations also described the "headed ju" (有头疽): it starts with a visible head and a pus point, somewhat like yong, and flares up with the same redness, swelling, heat and pain. So the Huang Di Nei Jing (Yellow Emperor’s Inner Canon) already discussed yongju long ago — the ancients kept a close eye on this class of disease. Hygiene is better now, but people eat rich, fatty and sweet food in abundance and carry damp-heat inside, so these problems still appear.
Doctor Zhu Danxi’s first remark: if you get this disease after middle age, do not rush to clear heat and resolve toxin
What was Doctor Zhu Danxi’s view of yongju? He said that in treating it you generally do need to clear heat and resolve toxin — but if the disease strikes after middle age, you must consider the patient’s vital qi. Some people are genuinely weak. You cannot look at a boil and immediately attack it with heat-clearing, toxin-resolving herbs — those herbs are cold in nature, and the more you clear, the more you injure the stomach qi; the more the stomach qi and vital qi decline, the less chance the body has to recover. In ancient times many people died of this disease precisely for that reason.
💬 Note from Doctor Luo: Doctor Zhu Danxi’s thinking was: clearing heat and resolving toxin alone will not do — you must support the vital qi (fu zheng). When the vital qi is sufficient, it can push the pathogen outward, lift it up and expel it; add a little heat-clearing, toxin-resolving medicine and the poison easily scatters. Remember this sentence — the whole essence of this case lies right here.
Who was the patient? A seventy-year-old woman — sturdy, quick-tempered, and fond of wine
The patient in this case was a seventy-year-old woman. In the old days "from seventy on is a rarity" (人生七十古来稀) — this was no small age. She was not a frail sort; she was quite sturdy and ate well. But Doctor Zhu Danxi immediately recorded two crucial details: she was quick-tempered (性急), and she was fond of wine (好酒).
💬 Note from Doctor Luo: The greatest feature of Doctor Zhu Danxi’s case records is that he writes out the patient’s temperament and constitution. Quick-tempered people easily develop fire, and the nature of wine is scorching heat — fire in the temperament, quick temper, plus a love of wine: put the three together and the fire inside the body grows large. That is why I always say that a person’s temperament decides what disease they will get.
With so much fire, the heat rushed upward — and sure enough, a ju (deep carbuncle) grew at the back of the woman’s head. The skin of the head is thin, the fat layer is thin; a boil here can easily threaten life. Once it flared up it was no small matter, and in the past doctors were extremely cautious about this situation.
How bad was it? She came for consultation on the fifth day, with an urgent yet astringent pulse
The woman fell ill and waited five days before coming to see Doctor Zhu Danxi. When he took her pulse: the pulse was urgent, and astringent upon deeper pressure (脉紧急，切之涩). The pulse racing urgently showed that the struggle between vital qi and pathogen was intense; the astringent quality — what does se (涩) mean? The pulse is not full, lacks strength — it indicates insufficient qi and blood; the body is actually deficient inside.
💬 Note from Doctor Luo: Someone may ask: wasn’t this woman sturdy and well-fed? How can she have insufficient qi and blood? Everyone, eating well is not the same as having sufficient vital qi — some people eat well and instead injure their spleen and stomach, ending up with insufficient vital qi and blood. The moment Doctor Zhu Danxi felt the pulse he understood: this disease could not be treated by attack alone.
The prescription: just two herbs — but with every bit of processing skill brought into play
Doctor Zhu Danxi’s method is especially interesting — he used Dahuang (rhubarb) and Renshen (ginseng), just these two herbs (plus a little ginger).
For Dahuang, he used wine-prepared Dahuang (酒制大黄): repeatedly processed with wine — finely sliced, mixed with wine and stir-fried, then ground to powder. There is real craft in this:
💬 Note from Doctor Luo: Chinese medicine has lost much of its processing tradition. Wine’s nature is to move upward, and it can carry the medicine’s action upward, so for diseases of the upper body you can use wine-prepared herbs. Dahuang by nature drains heat, sweeps the intestines, and moves downward — but this woman’s heat toxin was up above, and she also needed it to sweep the garbage out of her intestines (she ate rich, fatty, sweet food in abundance, after all), while wanting the medicine’s power to remain in the upper body. How to manage that? Use wine-prepared Dahuang. Moreover, after wine preparation the nature of Dahuang becomes gentler: raw Dahuang purges most violently, and after long decoction its purging action is partly destroyed; wine-prepared Dahuang is not so fierce — exactly right.
For Renshen, he used wine-mixed stir-fried Renshen (酒拌炒人参) — mixing it with wine while stir-frying, and adding ginger slices when decocting. This is yet another processing method.
💬 Note from Doctor Luo: Wine-mixed ginseng has basically vanished today. Wine has a penetrating quality — it can dredge, invigorate blood and free the collaterals; when ginseng is processed with it, the ginseng tonifies without stagnating — it supplements without cloying. In the past, famous physicians insisted on this kind of refinement. Mr. Wang Fengchun (汪逢春), one of the Four Great Doctors of the Republican era in Beijing, had every single herb freshly processed on the spot when he wrote a prescription — ginseng mixed and stir-fried, prepared rehmannia pounded together with cardamom — controlling precisely where each medicine’s power should go. His prescriptions were so refined that even Tongrentang could not fill them; they had to be given to Hetang (鹤年堂) — an old brand founded in the Ming dynasty, with a longer history than Tongrentang, especially skilled at processing, preparing and weighing each herb fresh. This craft of "clinical processing" is now lost too — which pharmacy today will mix and stir-fry herbs for you on the spot?
As for the decoction method, Doctor Zhu Danxi described two: one is to decoct the wine-mixed stir-fried ginseng with ginger slices, then use the liquid to wash down Dahuang powder; the other is to put the Dahuang powder and ginseng directly together with ginger and boil them. Doctor Luo Dalun analyzes that the first method is the correct one — boil the ginseng and ginger water, use it to wash down one qian (about 3 grams) of Dahuang powder, drink it; two hours later (one shichen), drink another dose.
The turn: she slept, sweated over her upper body, and the boil drew in
After taking the medicine, the old woman fell asleep. While asleep, she sweated over her upper body — you see, the medicine’s power moved upward, so the sweat came out over the upper body. When she woke up, the disease was already gone (病已失): the boil had begun to draw in, no longer so swollen and painful — the illness was essentially cured.
💬 Note from Doctor Luo: Doctor Zhu Danxi himself called this "ci nei tuo zhi yi" (此内托之意) — "this is the meaning of lifting from within." The formula is exquisite: while resolving toxin, it pairs ginseng, which tonifies qi and blood — why tonify qi and blood? To support the vital qi, and then use it to carry the pathogen outward (tuo xie wai chu). Whenever there is a pathogen, when you support the vital qi you are in effect carrying the pathogen outward; add a little heat-clearing, toxin-resolving medicine to draw it out, and the pathogen leaves. The old woman’s pulse was astringent — blood was deficient — so ginseng was exactly right to nourish the blood. And the little bit of ginger? It warms the qi and blood, gets them moving, and serves as a counterweight (fan zuo) to Dahuang’s cool nature. With just these two or three herbs, the problem was solved at one stroke — Doctor Zhu Danxi’s medicine always paid close attention to the patient’s vital qi. That is his signature.
The origin of Bazhen Gao (Eight Treasures Cake): invented by the Ming dynasty surgical master Chen Shigong
Who carried on this thinking of "supporting the vital qi while expelling the toxin"? In the Ming dynasty, the great master of external medicine Chen Shigong (陈实功) — when people had boils and carbuncles with unchanged skin color, the pathogen lingering and refusing to be pushed out — invented Bazhen Gao (八珍糕, Eight Treasures Cake) to build up the person’s vital qi. When vital qi is sufficient, the body can push the boil out and push the external pathogen out. So Bazhen Gao was originally a formula for supporting vital qi and treating external diseases like boils and carbuncles.
💬 Note from Doctor Luo: You see — this idea of "supporting the vital qi while expelling the pathogen" was passed down from Doctor Zhu Danxi, taken up by Chen Shigong, and became a famous formula that has lasted for centuries. What everyone should learn: use Dahuang together with ginseng — drive out the pathogen while supporting the vital qi.
A bonus from personal experience: the Liu Shen Wan enclosing method — drawing a boil back in overnight
Finally, Doctor Luo Dalun tells a story of his own. When he was a child, his father grew a yongju on one side of the back of his neck, near Fengchi (GB20) — when you pressed it, the root plate was very large. His mother, with little experience, used Dujiao Gao (独角膏, Unicorn Horn Plaster) to draw out the toxin — and instead the boil grew bigger and bigger and burrowed inward. Later he went to the hospital, where they performed pus drainage (透脓) every day — it was a very deep "opposite-mouth" boil (duikou chuang); the doctor reached in with a cotton swab dipped in medicine, and the pus came out little by little. It took a long time to heal, and afterwards the muscle never fully leveled out — a hollow was left behind.
💬 Note from Doctor Luo: When I was little I kept wondering: why did my father’s boil get worse the more it was treated? Then I understood — Dujiao Gao pulls the toxin outward, but when it seals the surface of the boil, the pathogen has no place to go, so it can only go deeper and deeper, which is why he eventually needed daily pus drainage. So I thought at the time: you should leave an exit for the pathogen — smear the medicine around the four sides of the boil, leave a head in the middle unsmeared; when the surroundings are enclosed, the boil cannot spread outward, so it can only run out through the middle.
Later he put this into practice: he used Liu Shen Wan (六神丸, Six Spirit Pills) — the Lei Yun Shang brand, originally for sore throats — ten pills each time, dissolved in water, and applied around the whole ring just as the boil was beginning to swell (cover both the red inflamed part and the normal flesh at the edge), leaving a spot about the size of a red bean in the middle untouched. In basically one night the boil drew in and dried up.
💬 Note from Doctor Luo: I tested this method in college — in our dormitory corridor, whichever boy grew a boil on his back, neck or buttocks (colloquially called mentou chuang or jiezi, a furuncle), the moment it appeared they came to me; applied the night before, it always drew back by the next day. If you let it go and it turned to pus, you were stuck with a big gauze dressing and daily disinfection — a real nuisance. Later, when I read Doctor Zhu Danxi’s book, I was astonished: the ancients had already thought of all this. In the yongju chapter of Dan Xi Xin Fa there is the "enclosing medicine Iron Well Fence" (围药铁井栏): Beimu, Dannanxing, Lianqiao, Wubeizi and Furongye, one liang each, ground into fine powder, mixed with water and applied around the four sides — leaving only one opening in the middle for the poison to escape — like an iron well fence surrounding the boil, the poison comes out through the middle, and the disease is cured. Whatever the ancients could have thought of, they thought of.
Doctor Luo Dalun especially warns: never use a plaster like Dujiao Gao that seals the surface of the boil shut — you must leave an opening. When you meet this kind of boil, the earlier you enclose a ring of Liu Shen Wan around it, the better — often the crisis is resolved in a single night. This is the principle of "leaving the pathogen an exit."
Compiled from Doctor Luo Dalun’s explanation of Doctor Zhu Danxi’s case records; the case is from Dan Xi Xin Fa (《丹溪心法》), chapter on yongju (boils and carbuncles).