bubble_chart Concept

Shoulder and back carbuncle refers to the condition of redness, swelling, heat, and pain in the shoulder and back area, accompanied by pus formation. The shoulder is where the three yang meridians of the hands and feet converge. The back belongs to the Governor Vessel and Bladder meridians. The conditions "dabei" and "back gangrene" recorded in ancient medical texts should be classified as headed carbuncle (carbuncle). Although they share the yang pattern with carbuncle, their disease causes and treatments differ. Therefore, "back gangrene" and "dabei" are not discussed in this section.

bubble_chart Pattern Analysis

1. Accumulation of Fire Toxin︰Boils can occur anywhere on the shoulders or back. Initially, there is sudden localized swelling and discomfort, appearing smooth and headless, with reddened skin (in a few cases, the skin may not be red at first but turns red during the stage of pus brewage). The area feels burning hot and painful, gradually expanding and becoming more swollen and hardened. In mild cases, there are no systemic symptoms, and the swelling and hardness soften and dissipate after treatment. In severe cases, symptoms such as aversion to cold with fever, headache, nausea, a yellow tongue coating, and a surging, rapid pulse may occur. The stage of suppuration typically lasts about seven days. Even if the patient's constitution is weak and qi deficiency makes it difficult to expel toxins and form pus, it usually does not exceed two weeks. During suppuration, the swelling becomes more pronounced, the pain intensifies (often described as pecking-like), and systemic symptoms such as persistent fever may appear. If pressing the area reveals softness and fluctuation, it indicates pus formation. The boil often ruptures spontaneously at the thinnest part of the skin, discharging thick, yellowish-white pus, sometimes mixed with purple blood clots. If pus is expelled smoothly after rupture, the swelling and pain subside, and systemic symptoms disappear. Healing typically occurs within about ten days as the wound transmission from one meridian to the next. If the area around the ruptured boil remains hard, or the pus is thin and new flesh fails to grow, it may indicate an overly small wound opening hindering expelling pus, or a weak constitution impairing tissue regeneration, delaying healing. This condition is often caused by excessive consumption of rich, fatty foods, leading to heat accumulation in the fu-organs, stagnation of dampness-heat fire toxin, obstruction of Yingqi, and stagnation of nutrient-defense and qi-blood. Key diagnostic points: localized burning heat and burning pain, accompanied by systemic symptoms such as aversion to cold with fever, headache, nausea, a yellow tongue coating, and a surging, rapid pulse. In the initial stage [first stage], treatment should focus on clearing heat and removing toxin, and Immortal Formula Life-Saving Decoction may be used.
2. Summerheat-dampness Accumulation︰It occurs in summer and autumn, with the back being more commonly affected than the shoulders. Initially, there is redness on the back, followed by swelling and pain. The local symptoms at various stages are similar to those described above, but systemic manifestations may include fever at any time, persisting day and night, dizziness and blurred vision, dry mouth with a bitter taste, restlessness, back heat, limb fatigue, yellow and greasy tongue coating, and slippery-rapid or surging-rapid pulse. It is often caused by the hot summer and autumn climate, or exposure to intense sunlight, leading to the invasion of summerheat toxins. Additionally, impaired sweating causes summerheat-dampness to accumulate in the skin, or scratching damages the skin, allowing toxic qi to infect, resulting in the obstruction of Yingqi and stagnation of qi and blood. Key diagnostic points: onset in summer or autumn, persistent fever, dizziness and blurred vision, dry mouth with a bitter taste, restlessness, back heat, limb fatigue, yellow and greasy tongue coating, and slippery-rapid or surging-rapid pulse. In the initial stage [first stage], treatment should focus on clearing summerheat and resolving dampness, and modified Clearing Summerheat Decoction may be selected.
3. Static Blood︰The affected area is more common in the shoulder than the back. Initially, a localized lump forms with burning pain, accompanied by fever and chills. As swelling and pain intensify, pus formation becomes imminent. The local symptoms at each stage and systemic manifestations are the same as the pattern of coagulation and binding of fire toxin. It is often caused by bearing heavy loads, leading to static blood coagulation, blood stasis and qi stagnation, resulting in obstructed qi and blood flow; or due to infection with toxic qi, causing Yingqi to fail to circulate and defense qi to stagnate, leading to blockage of qi and blood. Key points for pattern identification: localized swelling is prominent, and the softening of the lump occurs more slowly compared to the previous two patterns, with mild systemic symptoms. Treatment is the same as for fire toxin coagulation in shoulder and back abscesses, with the addition of blood-activating and softening-hardness herbs.

Fire toxin congealing and causing abscesses on the shoulders and back, summerheat dampness accumulating and causing abscesses on the shoulders and back, and static blood congealing and causing abscesses on the shoulders and back: all result from pathogenic heat obstructing between the skin and flesh, leading to abnormal qi movement, impeded blood circulation, disharmony between nutrient and defensive qi, which gathers and forms abscesses. However, the reasons for the impeded qi and blood circulation in the above three conditions are different.