A carbuncle on the buttocks, also known as phlegmon of the buttock, occurs on the thicker part of the gluteus maximus on either side of the sacrum, belonging to the Taiyang Bladder meridian. However, the Benjing often has a deficiency of qi and abundant blood, and since the buttock muscles are thick and substantial, the carbuncle tends to be deep and wide, often resulting in necrotic tissue after ulceration.

bubble_chart Pattern Analysis

1. Fire Toxin Accumulation︰Redness, swelling, heat, and pain occur on one side of the buttock, with the redness and swelling most severe at the center and lighter toward the periphery, with indistinct borders. The affected area gradually expands and develops hard nodules. After a few days, the skin ulcerates, turning black and necrotic, or becoming soft in the center without ulceration. After ulceration, the pus is typically thick and yellow, but in some cases, large chunks of necrotic tissue may slough off, resulting in a deep, hollow wound that heals very slowly. At the onset, this condition is accompanied by systemic symptoms such as aversion to cold with fever, headache, joint aching pain, poor appetite, yellow tongue coating, and rapid pulse. It is caused by excessive consumption of rich and greasy foods, leading to accumulated heat in the six fu-organs, the congealing of dampness-heat fire toxin, and the stagnation of Yingqi, resulting in impaired circulation of qi and blood and localized swelling. Excessive heat causes flesh to necrotize, and necrotic flesh transforms into pus. The condition progresses rapidly, with deep and wide abscesses prone to necrosis and slow healing, accompanied by pronounced systemic symptoms. At the initial stage, treatment should focus on clearing heat and removing toxin, harmonizing the nutrient aspect, and resolving dampness. Internally, Astragalus Root Internal Resolving Decoction can be taken, while externally, Golden Yellow Ointment can be applied. Once pus has formed, the treatment should aim to expel the internal to drain pus, and Support and Detoxify Powder can be used. After ulceration, internal medication is generally unnecessary. For those with weak constitution and slow wound healing, treatment should focus on regulating and tonifying qi and blood, and Ten Major Tonics Decoction can be used. For copious pus, Five-Five Elixir is applied; for scant pus, Nine-One Elixir is used; and when pus is completely drained, Granulation-Promoting Jade and Red Paste is applied.
2. Pathogenic Heat Accumulation︰The buttock mass is large and hard, with no obvious redness or heat, but tenderness is present. The progression is relatively slow, and healing after ulceration is also slow. Systemic symptoms are not apparent, and the tongue and pulse are normal. This condition arises due to external contraction of the six excesses or traumatic infection, leading to disharmony between nutrient and defensive qi, accumulation of pathogenic heat, and stagnation of qi and blood. The disease tends to progress slowly, with no obvious redness or swelling, but a large, hard, and painful mass, and no significant systemic symptoms. In the early stage, treatment should focus on invigorating blood to remove toxins, harmonizing the nutrient qi, and resolving dampness. The Immortal Formula Life-Saving Decoction can be used, with the addition of Peach Kernel, Carthamus, and Shiny Bugleweed, while reducing the dosage of heat-clearing and toxin-removing herbs. If pus forms but does not rupture, treatment should aim to regulate and tonify qi and blood, using the Ten Major Tonics Decoction. After ulceration, apply the Nine-to-One Elixir externally. Once the pus is completely drained, use the Granulation-Promoting Jade and Red Paste. For wounds that do not heal after prolonged ulceration, administer the Ten Major Tonics Decoction internally.

bubble_chart Documentation

1. Waike Dacheng-Phlegmon of Buttock: "This condition, from the inside to the outside occurs in eighty to ninety percent of cases, from six excesses external contraction to the inside occurs in one to two percent of cases, therefore the treatment should focus on external release to avoid internal invasion."