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[Prescription Verse] The "Chuangdang" toxin arises anterior to the Huiyin acupoint; its etiology stems from worry, overexertion, and dampness stagnation. Redness, swelling, heat, and pain indicate a favorable prognosis (Shun), while collapse indicates an unfavorable one (Ni); deep ulceration with urinary leakage and difficulty in healing is critical.

[Note] This condition occurs anterior to the Huiyin acupoint (Huiyin, CV-8) and posterior to the scrotum. It is formed by the condensation of worry, overexertion, and dampness stagnation. Initially resembling millet grains, it gradually becomes red, bright, hot, and painful. Ulceration discharging thick pus is favorable (Shun). If it begins like a peppercorn, appearing black and scorched, sinking into the skin and flesh, with diffuse purple-dark swelling, no heat sensation, and pain radiating to the testicles, lower back, and anus, it is unfavorable (Ni). This area is where the skin folds are empty; for any toxic lesion here, rapid ulceration with shallow roots is preferred. However, if the root is deep and difficult to ulcerate, damaging the urethra and causing urinary leakage that cannot be contained, it is extremely dangerous. Internal treatment follows the protocol for Xuan Yong (Suspended Abscess), and external treatment follows the protocols for Tumors and Sores (Yong Ju) Swelling Stage and Ulcer Stage sections.

[Prescription Verse] "Kuma Yong" arises beside the scrotum, caused by Liver and Kidney fire and dampness injury, presenting with a heavy dragging sensation. Redness, swelling, heat, and pain require rapid ulceration; early treatment should clear and support the interior, avoiding excessive use of cold-natured herbs.

[Note] This condition is also known as "Pian Ma Zhui," arising beside the scrotum on the medial side of the upper thigh, in the inguinal fold. It is caused by the stagnation of Liver and Kidney damp-fire. Initially like a bean, it gradually swells to the size of a goose egg, hanging heavily with redness, heat, and pain. Rapid onset of high swelling with quick ulceration discharging thick pus is favorable (Shun). Diffuse flat swelling with slight heat and redness, discharging thin pus upon ulceration, is perilous and often leads to sinus tracts (Chuan Pi Lou). This location is at the lowest point of Yin; treatment must not overuse cold-natured herbs. Early stage: take Xian Fang Huo Ming Yin (Immortal Life Elixir), followed by Tuo Li Tou Nong Tang (Interior-Supporting Pus-Expelling Decoction). After ulceration, internal and external treatments follow the Tumors and Sores Ulcer Stage section.
Formulas: Xian Fang Huo Ming Yin (See Swelling Stage Section); Tuo Li Tou Nong Tang (See Head Region Qinao Jure Section).

[Prescription Verse] "Bian Du" arises in the leg crease, caused by retained semen, blood stasis, and Liver injury from anger. Symptoms include hardness, numbness/pain, and alternating chills and fever. Early treatment requires diaphoresis, followed by purgation or moxibustion for cure.

[Note] This condition is also known as Xue Shan (Blood Hernia) or Bian Yong (Genital Abscess), occurring in both men and women. It develops below the lower abdomen, in the crease above the groin. The meridians involved are the Liver and Kidney. Etiology includes strenuous sexual activity, retention of semen, or unfulfilled desires, leading to semen and blood accumulation and stagnation midway; or sudden anger injuring the Liver, causing Qi stagnation and blood coagulation. Initially like an apricot kernel, it grows to the size of a goose egg, becoming hard, numb, and painful, with slight heat but no redness, causing alternating chills and fever. Use Jing Fang Bai Du San (Scutellaria and Saposhnikovia Decoction to Overcome Toxins) for diaphoresis. For irritability, thirst, and Qi stagnation, use Shan Jia Nei Xiao San (Pangolin Interior-Resolving Powder) to resolve it. For extreme hardness and severe pain, use Hong Hua San Yu Tang (Safflower Blood-Dispersing Decoction) to soothe and unblock. If previous remedies fail, use Jiu Long Dan (Nine Dragons Pill) to attack the pathogen. If there is no pain or heat, do not use purgatives; instead, use Yang Sui Ding (Yang Sui Moxa Cone) for daily moxibustion (5-7 cones) until the lesion softens, resolves, or ulcerates. When pus is forming, do not force resolution; use Huang Qi Nei Tuo San (Astragalus Interior-Supporting Powder) to support and expel. For severe deficiency, use Tuo Li Tou Nong Tang. After ulceration, use Ba Zhen Tang (Eight Treasures Decoction), Shi Quan Da Bu Tang (Complete Great Tonifying Decoction), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) according to the syndrome. Externally, apply Wu Se Ling Yao (Five Colors Spirit Medicine) to transform necrotic tissue and generate pus; combine with Hu Po Gao (Amber Plaster) and Wan Ying Gao (Universal Plaster) to promote granulation and close the wound. After ulceration, this condition is named Yu Kou (Fish Mouth). Because it arises in the crease, the large ulcer opens when standing and closes when bending, resembling a fish mouth, hence the name. This toxicity results from retained semen and Liver injury from anger. Cases of Chancre (Mei Du) complicated with Bian Du are detailed in the Chancre section.
Formula: Hong Hua San Yu Tang
Composition: Hong Hua (Carthami Flos), Dang Gui Wei (Angelicae Sinensis Radix Caudex), Zao Ci (Gleditsiae Spina), Sheng Jun (Rhei Radix et Rhizoma - raw), Lian Qiao (Forsythiae Fructus), Su Mu (Sappan Lignum), Chuan Shan Jia (Manis Squama - roasted and powdered), Shi Jue Ming (Haliotidis Concha), Jiang Can (Bombyx Batryticatus - stir-fried), Ru Xiang (Olibanum), Bei Mu (Fritillariae Bulbus - heart removed, powdered), Hei Qian Niu (Pharbitidis Semen). Dosages: Each of Hong Hua, Dang Gui Wei, Zao Ci, Bei Mu is 1 qian; Sheng Jun is 3 qian; Hei Qian Niu is 2 qian. Decoct with 1 zhong of wine and 1 zhong of water to yield 0.8 zhong. Take on an empty stomach; after 5-6 bowel movements, consume thin rice porridge to tonify.

[Prescription Verse] Hong Hua San Yu Tang disperses hardness; for early-stage Bian Du with swelling and pain, add Angelica, Thorn, Rheum, Forsythia, Sappan, Pangolin, Abalone, Silkworm, Frankincense, Fritillaria, and Pharbitis.

Another Formula: Huang Qi Nei Tuo San
Composition: Huang Qi (Astragali Radix, 2 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma - earth-fried, 1 qian), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, each 2 qian), Jin Yin Hua (Lonicerae Japonicae Flos), Zao Ci (Gleditsiae Spina), Tian Hua Fen (Trichosanthis Radix, each 1 qian), Ze Xie (Alismatis Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma - roasted, each 0.5 fen). Decoct 2 zhong of water to yield 0.8 zhong. Take before meals.

[Prescription Verse] Huang Qi Nei Tuo San treats Bian Du; for severe swelling without resolution, it supports ulceration well. Add Atractylodes, Angelica, Ligusticum, Honeysuckle, Thorn, Trichosanthes, Alisma, Licorice, and other ingredients.

Other Formulas: Jing Fang Bai Du San (See Neck Region Naoju Section); Shan Jia Nei Xiao San (See Abdominal Region Zhongwanju Section); Jiu Long Dan (See Preceding Xuan Yong Section); Yang Sui Ding (See Volume 1 Moxibustion Method Section); Tuo Li Tou Nong Tang (See Head Region Qinaoju Section); Ba Zhen Tang, Shi Quan Da Bu Tang, Bu Zhong Yi Qi Tang, Wu Se Ling Yao, Wan Ying Gao (All See Swelling Stage Section); Hu Po Gao (See Head Region Facai Chuang Section).