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[Prescription Verse] Chancre (Chancre) arises in two types; essence transformation and qi transmission are their sources. Essence transformation stems from lust, while qi transmission is contagious. For qi transmission, sweating therapy is indicated; for essence transformation, purgation is indicated.

[Annotation] This condition is also known as Guang Chuang (Broad Chancre), because the toxin originates from the Lingnan region; it is also called Shi Chuang (Seasonal Chancre), due to abnormal seasonal climate changes allowing pathogenic factors to invade; it is named Mian Hua Chuang (Cotton Chancre) because of its lingering and persistent nature; it is called Fan Hua Yang Mei (Reversed Flower Myrtle Berry) because the craterous granules break open, with flesh protruding outward like yellow wax; it is named Tian Pao Chuang (Heaven Blister Chancre) because it involves dampness generating white blisters. Those resembling red beans, embedded in the flesh and hard as needles, are called Yang Mei Dou (Myrtle Berry Pox); those resembling wind rash with itching are called Yang Mei Zhen (Myrtle Berry Rash); those starting with a red halo and later developing spots are called Yang Mei Ban (Myrtle Berry Spots); those that are red, itchy, with circles of varying sizes, two or three concentric rings, caused by consuming toxic substances entering the large intestine, are called Yang Mei Quan (Myrtle Berry Rings). Although names and forms differ, they all stem from either qi transformation or essence transformation. However, qi transmission cases are mild, while essence contamination cases are severe. In qi transmission cases, one may inhale the odor of an infected person, ingest unclean food, or be exposed to toxic vapors in latrines. The Spleen and Lung receive the toxin, so symptoms appear first on the upper body: skin itching and slight bone/joint pain, with small, dry lesions. In essence transformation cases, caused by impure sexual intercourse, when semen is discharged, toxins enter the interior taking advantage of Liver and Kidney deficiency. This is "desire contamination," appearing first on the lower body: frequent bone/joint pain, difficult or painful urination, with large, hard lesions. Qi transmission toxins remain on the exterior, not yet penetrating the interior; if just beginning to manifest, urgently administer Tou Gu Sou Feng San (Bone-Penetrating Wind-Searching Powder). If Yuan Qi (Primal Qi) is robust, use Yang Mei Yi Ji San (Myrtle Berry One-Dose Powder) to induce sweating. Essence transformation toxins reside in the interior, deeply hidden in the marrow, not yet reaching the skin; administer Jiu Long Dan (Nine Dragons Pill) to promote bowel and urinary movement, draining toxins from the bones. Severe cases may require two doses to purge toxic matter, using earth-natured herbs to suppress them. After purgation, if the constitution is strong, use Sheng Ma Jie Du Tang (Cimicifuga Detoxification Decoction); if weak, use Gui Ling Nei Tuo San (Gui Ling Internal-Supporting Powder). Continue until bone/joint pain ceases, lesions turn pale white, and internal toxins are resolved. Then, use Jin Chan Tuo Qiao Jiu (Golden Cicada Molting Wine) to clear residual toxins and cut off the source.
If Syphilis (Mei Chuang) is in its initial stage and taking exterior-releasing medicines, fear of toxins attacking the head and face warrants pre-administration of Hu Mian San (Face-Protection Powder). If lesions have already appeared on the face and scars remain after healing, apply Cui Yun San (Emerald Cloud Powder) to fade marks. If chancre ulcerates with pus and filth spreading over a large area causing pain, sprinkle E Huang San (Goose Yellow Powder). For Fan Hua Yang Mei, add Realgar powder to this formula, mixed with sesame oil for external application. There is also Hu Cong Wan (Attendant-Protecting Pill); having attendants take it during outbreaks prevents transmission. Initial Chancre presenting without headache, bone/joint pain, or urinary difficulty, with small, bright red lesions sparse on the head/face but dense on chest/back, and clear anal region, indicates a favorable prognosis (Shun). If Chancre follows the appearance of Chancre Ulcer (Xia Gan) and Buboes (Bian Du/Yu Kou), accompanied by bone/joint pain, dark purple hard lesions, widespread on hands/feet, resembling scald blisters, indicates a dangerous prognosis (Xian). Ultimately, with proper treatment throughout, mild cases resolve in half a year, severe cases in one year. If patients do not follow correct methods, seeking quick results by forcibly taking corrosive drugs like Calomel (Qing Fen), Mercury (Shui Yin), or White Frost (Bai Fen Shuang), or abusing fumigation, rubbing, inhalation methods, toxins hide in the marrow, leading to recurrent Condyloma (Dao Fa Jie Du). Mildly, it affects spouses; severely, it causes rotting and deformity. Caution is essential.

Formula: Tou Gu Sou Feng San (Bone-Penetrating Wind-Searching Powder)
Composition: Tou Gu Cao (Daphne Genkwa, white-flowered variety, dried in shade), Sesame Seed (Sheng Zhi Ma), Notopterygium Root (Qiang Huo), Angelica Pubescens Root (Du Huo), Black Soybean (Xiao Hei Dou), Purple Grape (Zi Pu Tao), Sophora Fruit (Huai Zi), White Sugar (Bai Tang), Lu'an Tea (Liu An Cha), Walnut Meat (Tao He Rou) (each 1.5 qian).
Ginger (3 slices), Red Date Flesh (3 pieces), Water (3 zhong), decoct to obtain 1 zhong. Expose overnight, drink hot on an empty stomach, cover with blankets to induce sweating, avoid wind.

[Verse] Tou Gu Sou Feng San treats Syphilis, slight bone/joint pain and skin itching; Sesame, Notopterygium, Angelica, Black Bean, Grape, Sophora, Sugar, Tea, Walnut.

Another Formula: Yang Mei Yi Ji San (Myrtle Berry One-Dose Powder)
Composition: Ephedra Stem (Ma Huang, honey-fried, 1 liang), Spirit Vine Stem (Wei Ling Xian, 8 qian), Rhubarb Root (Da Huang, 7 qian), Notopterygium Root (Qiang Huo), Angelica Dahurica Root (Bai Zhi), Gleditsia Sinensis Thorn (Zao Ci), Chrysanthemum Indicum Flower (Jin Yin Hua), Pangolin Scale (Chuan Shan Jia, fried, ground), Silkworm Moth Cocoon (Chan Tui, each 5 qian), Saposhnikovia Root (Fang Feng, 3 qian).
Mountain Goat Meat (1 jin), boiled in river water, take 2 bowls of clear broth. Add 1 bowl of Yellow Wine, decoct herbs to 1 bowl. Patient eats goat meat plainly until full on an empty stomach, then takes medicine, covers blankets to sweat, avoids wind.

[Verse] Yang Mei Yi Ji San strengthens Yuan Qi, for upper body toxins from qi transmission; Ephedra, Notopterygium, Angelica, Spirit Vine, Thorn, Chrysanthemum, Saposhnikovia, Pangolin, Silkworm, Rhubarb.

Another Formula: Sheng Ma Jie Du Tang (Cimicifuga Detoxification Decoction)
Composition: Cimicifuga Rhizome (Sheng Ma), Gleditsia Sinensis Thorn (Zao Ci) (each 4 qian), Smilax Glabra Rhizome (Tu Fu Ling, 1 jin).
Water (8 bowls), decoct to 4 bowls, divide into 4 doses, consume within one day. Heat each dose, mix with 3 teaspoons of Sesame Oil. Take before or after meals depending on lesion location (upper/lower).
Add Bai Zhi if lesions are on the vertex. Add Platycodon Root (Jie Geng) for throat involvement. Add White Peony Root (Bai Shao) for chest/abdomen. Add Notopterygium Root (Qiang Huo) for shoulders/back. Add Achyranthes Root (Niu Xi) for lower body.

[Verse] Sheng Ma Jie Du Tang relieves bone/joint pain, for lingering Syphilis in robust constitutions; Tu Fu Ling, Zao Ci, Sesame Oil; add meridian-guiding herbs by location.

Another Formula: Gui Ling Nei Tuo San (Gui Ling Internal-Supporting Powder)
Composition: Ginseng Root (Ren Shen), Papaya (Mu Gua), Atractylodes Macrocephala Rhizome (Bai Zhu, soil-fried), Chrysanthemum Indicum Flower (Jin Yin Hua), Pyracantha Root (Fang Ji), Trichosanthes Root (Tian Hua Fen), Dictamnus Bark (Bai Xian Pi), Coix Seed (Yi Yi Ren) (each 1 qian), Angelica Sinensis Root (Dang Gui), Rehmannia Root (Shu Di), White Peony Root (Bai Shao, wine-fried), Szechwan Lovage Root (Chuan Xiong) (each 1 qian), Smilax Glabra Rhizome (Tu Fu Ling, 2 liang), Spirit Vine Stem (Wei Ling Xian, 6 fen), Licorice Root (Gan Cao, 5 fen).
Water (3 zhong), decoct to 2 zhong, divide into 2 doses, take according to lesion location. Decoct dregs again for second use.
Add Niu Xi (5 fen) for lower body. Double Ren Shen and Dang Gui for deficient Yuan Qi. Double Jin Yin Hua and add Dandelion (Pu Gong Ying) for intense toxins.
Externally: Ophiopogon Root (Mai Dong, heart removed, 5 qian), Coix Seed (Yi Yi Ren, 5 qian), Smilax Glabra Rhizome (Tu Fu Ling, 1 liang), decoct and drink regularly as tea.

[Verse] Gui Ling Nei Tuo San uses Ren Shen, Mu Gua, Bai Zhu, Jin Yin Si Wu Tang, Fang Ji, Tian Hua Fen, Tu Fu Ling, Bai Xian Pi, Yi Yi Ren, Wei Ling Xian, Gan Cao; praised for weak constitutions with Chancre.

Another Formula: Jin Chan Tuo Qiao Jiu (Golden Cicada Molting Wine)
Composition: Strong Wine (5 jin), Large Toad (1), Smilax Glabra Rhizome (Tu Fu Ling, 5 liang) soaked in wine. Seal bottle tightly, heat in water bath for duration of two incense sticks, then remove. Drink next day, up to intoxication. Regardless of season, warmth and sweating indicate efficacy. Remaining wine can be drunk next day in moderation; cure occurs when wine is finished. Also excellent for Condyloma causing bone/joint pain unresponsive to other drugs. After 7 days of drinking, avoid wind for efficacy; observe dietary restrictions and abstain from sex.

Another Formula: Hu Mian San (Face-Protection Powder)
Composition: Woman's Hair (burnt to charcoal, retaining nature), Realgar (Ming Xiong Huang) (each 3 fen).
Grind finely, mix with half a wine-cup of Sesame Oil. Take with boiling Yellow Wine, 3 times daily.

[Verse] Hu Mian San treats emerging Chancre, preventing toxins from attacking head/face; mix with Sesame Oil, take with Yellow Wine; only Realgar and burnt hair used.

Another Formula: Cui Yun San (Emerald Cloud Powder)
Composition: Calomel (Qing Fen, 1 liang), Gypsum Fibrosum (Shi Gao, calcined, 1 liang), Toad Venom Salt (Chan Fan), Malachite (Tong Lv) (each 5 qian).
Grind to ultra-fine powder. Sprinkle dry on wet lesions; for dry lesions, mix with male pig bile to a thick paste for application, 3 times daily. Spots will fade naturally.

[Verse] Cui Yun San removes post-chancre spots; Calomel, Gypsum, Toad Venom Salt; Malachite ground together, sprinkle dry on wet lesions; Pig bile moistens dry lesions.

Another Formula: E Huang San (Goose Yellow Powder)
Composition: Calomel (Qing Fen), Gypsum Fibrosum (Shi Gao, calcined), Phellodendron Bark (Huang Bo, stir-fried) (equal parts).
Grind to powder. Sprinkle dry on affected areas to form scabs; reapply if ulcerated again. Cure upon complete toxin elimination.

[Verse] E Huang San treats ulcerated Chancre, pus/filth spreading and painful; Calomel, Gypsum, Phellodendrum ground; dry sprinkling stops pain and detoxifies effectively.

Another Formula: Hu Cong Wan (Attendant-Protecting Pill)
Composition: Realgar (Xiong Huang), Sichuan Pepper (Chuan Jiao) (each 5 qian), Apricot Kernel (Xing Ren, stir-fried, peeled, de-seeded).
Grind to powder, make pills with flour paste using Shaoxing Wine, size of Sophora seeds. Take 15 pills per dose, wash down with plain boiled water.

[Verse] Hu Cong Wan prevents Chancre infection; Realgar, Chuan Jiao 5 qian each; 100 Apricot Kernels, wine-paste pills; attendants take them to prevent transmission.

Another Formula: Jiu Long Dan (Nine Dragons Pill) (See section on Perineal Abscess below)