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Li Dongyuan treated a patient. The external genitalia emitted a fishy odor. Additionally, due to consecutive days of drinking alcohol, the abdomen felt uncomfortable, prompting him to seek treatment. Li Dongyuan stated: "The external genitalia are traversed by the Foot Jueyin Liver Meridian, which emerges at the tip of the penis. All odors are governed by the Heart; when dispersed into the five directions, they form five distinct odors. When entering the Liver, it manifests as a fishy odor. One should drain Xingjian (LR2) on the Liver Meridian to treat the root cause. Subsequently, one should drain Shaochong (HT9) on the Heart Meridian to treat the branch manifestation. If the patient dislikes acupuncture, medication should be used instead. Alcohol possesses both flavor and nature that are Yang; it can generate damp-heat within the interior. This represents wind, dryness, and heat pathogens combining in the Lower Jiao. The Classics state: 'The Lower Jiao is like a drainage ditch.' It also states: 'For pathologies located below, employ methods to drain them completely.' Since alcohol is a damp-heat substance, it is appropriate to eliminate it through excretion from the anterior yin. The treatment employed was Longdan Xiegan Tang (Gentian Liver-Draining Decoction). Furthermore, for treating itching caused by evil heat in the yin region, the prescription consisted of: Chaihu Shao (Bupleurum Tip) 2 qian, Zexie (Alisma Rhizome) 2 qian, Cheqianzi (Plantago Seed) 2 qian, Mutong (Akebia Caulis) 0.5 fen, Sheng Dihuang (Rehmanniae Radix Recens) 3 fen, Danggui Shao (Angelicae Sinensis Radix Tip) 3 fen, and Caolongdan (Gentianae Scabrae Radix) 3 fen. Prepared as one dose, decocted in water. After ingestion, consume a nutritious meal to moderate the harsh cold nature of the herbs."

Yu Zhen commented: "Longdan Xiegan Tang treats anterior yin diseases caused by damp-heat. People nowadays learned of this formula largely through this case record. However, the dosage weights in this case were precisely matched to the disease and were not immutable numbers. Dosages should be adjusted appropriately according to changes in the condition."

Zhu Danxi treated a young man whose penis was erect, swollen, and flaccid, with loose, moist skin, making walking difficult due to friction against the thighs. There was a sensation of Qi rushing upward in both hypochondriac regions. Initially, Xiao Chaihu Tang (Minor Bupleurum Decoction) was administered with added Huanglian (Coptidis Rhizoma) in large doses to circulate and clear damp-heat. Subsequently, Huangbai (Phellodendri Cortex) was added to descend the rebellious Qi. The penile swelling gradually subsided by half, but a hard mass remained inside the shaft. Therefore, Qingpi (Citri Reticulatae Pericarpium Viride) was used as the sovereign herb, assisted by wind-dispersing agents, ground into powder for oral administration. Externally, Luggua juice (Luffa Fruit Juice) was mixed with Wubeizi powder (Galla Chinensis Powder) and applied to the area, resulting in a cure.

Another patient, with dark complexion and over fifty years old, who habitually drank alcohol, suddenly experienced an erection that prevented clothing from touching the penis, and he could not bend his waist to bow. He often held a bamboo strip bent like a bow in front of his penis. He desired to drink alcohol immediately after urination; otherwise, he felt a disconnect in his Qi. This was caused by damp-heat flowing into the Jueyin Meridian. Specialized treatment for Jueyin damp-heat resulted in recovery.

Yu Zhen commented: "This is also a syndrome suitable for Longdan Xiegan Tang. The previous case used Xiao Chaihu Tang plus Huanglian because of the Qi rushing upward in the hypochondrium. The latter case did not identify it as Liver Fire damp-heat, demonstrating true expertise. This illustrates that disease differentiation must be detailed, allowing no ambiguity."

A postpartum woman, whose child had died, had ceased menstruating for half a year. One day, she suddenly suffered lower abdominal pain, with a stone-hard object blocking the vagina causing unbearable pain. Many physicians did not recognize the condition. Qing Lin said: "This is Shi Xia (Stone Mass). Use Siwu Tang (Four Substances Decoction) added with Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma), Sanleng (Sparganii Rhizoma), Binglang (Arecae Semen), Yuanhusuo (Corydalis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Zexie (Alismatis Rhizoma), and Xuexie (Draconis Sanguis). Decoct as a soup. Two doses resulted in a cure."

Xue Lizhai treated a woman with chest and diaphragm discomfort, internal heat with thirst, lack of taste in food, limb fatigue, vaginal stuffiness and itching, and red, scanty, painful urination. This was caused by depression and anger. Guipi Tang (Restore the Spleen Decoction) added with Zhizi (Gardeniae Fructus), Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix) cured her. Later, when internal heat and afternoon fever occurred, Xiaoyao San (Free and Easy Wanderer Powder) added with Zhizi (Gardeniae Fructus) also cured her. Subsequently, due to labor-induced fever, swelling occurred at the affected site with continued urinary difficulty. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Zhizi (Gardeniae Fructus), Fuling (Poria), and Mudanpi (Moutan Cortex) cured her.

Another woman had tissue protruding from the vagina like a mushroom, with surrounding swelling and pain, frequent urination, internal heat, afternoon fever, and sensations of itching and pain. This was a disease of Liver-Spleen stagnation. It was attributed to Liver Fire damp-heat causing swelling and pain, and Spleen deficiency sinking causing heaviness. Initially, Buzhong Yiqi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), Cheqianzi (Plantaginis Semen), and Qingpi (Citri Reticulatae Pericarpium Viride) was used to clear Liver Fire and raise Spleen Qi, leading to gradual improvement. Then, Guipi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), and Chuanxiong (Ligustici Chuanxiong Rhizoma) was used for regulation. Finally, fresh pig fat mixed with Lilu powder (Veratrum Nigrum Powder) was applied topically, achieving a cure.

Another woman had a projection of about five cun extending from the vagina, accompanied by stifling pain, heaviness, discharge of fluid, dysuria, and urinary retention. In the evening, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was taken to separate and drain damp-heat; in the morning, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was taken to raise and tonify Spleen Qi. Various symptoms gradually improved. Subsequently, Guipi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Huangbai (Phellodendri Cortex) was taken alternately for regulation, resulting in a cure. Later, due to labor or anger, damp itching in the lower part and difficult urination recurred; the previous medications were used again, resulting in recovery. Cases with projections up to one chi long, or even growths of various parasites, were treated with this method.

A woman suffered from internal vaginal pain and itching, internal heat, fatigue, and poor appetite. She was treated with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Chao Zhizi (Fried Gardeniae Fructus), Cheqianzi (Plantaginis Semen), Shengma ( Cimicifugae Rhizoma), Shaoyao (Paeoniae Radix), Mudanpi (Moutan Cortex), and Fuling (Poria), resulting in a cure. If there were parasites in the vagina causing itching and pain, this also belongs to Liver Wood pathology. Tao Ren (Persicae Semen) was ground and mixed with Xionghuang (Realgar) powder, inserted into the vagina to kill the parasites. Clearing Liver Fire and resolving stagnation was still employed, or chicken liver was inserted into the vagina, which is a method for extracting parasites.

Xue Lizhai further stated: "While attending to the Emperor Wu's medicinal needs, I suffered from excessive labor, irregular diet, and compounded anger. In the spring of the following year, my penis itched, occasionally discharging white fluid, and sometimes suffering severe pain, which stopped only when tightly pinched by hand. This indicated deficiency of Liver and Spleen Qi. I took Dihuang Wan (Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Fuling (Poria), and Mutong (Akebiae Caulis), resulting in recovery. In September of the Dingyou year, due to labor, I experienced dribbling urine, penile itching, and orifice pain. I again took the previous decoction added with Mutong (Akebiae Caulis), Fuling (Poria), Danshen (Scutellariae Radix - *Note: Text says Dancao/Chanshao likely referring to Longdan/Gentiana*), Zexie (Alismatis Rhizoma), and Dihuang Wan (Rehmannia Pill), resulting in recovery."

A male patient suffered from penile pain, discharge of white fluid, urinary retention, and occasional itching. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus), Zexie (Alismatis Rhizoma), Chao Lian (Fried Coptidis Rhizoma), Mutong (Akebiae Caulis), Danshen (Scutellariae Radix - *Note: Text says Danshen/Chanshao likely referring to Longdan/Gentiana*), and Fuling (Poria) was used. Two doses led to immediate recovery. Sixwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was also taken concurrently, leading to convalescence.

Yu Zhen commented: "Xue Lizhai's cases are detailed and comprehensive, supplementing the deficiencies of Li Dongyuan and Zhu Danxi. Moreover, using tonics to resolve stagnation and calm the Liver opens a new approach. Generally, he excelled in tonification; his use of Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) was as accurate as Lu Bu shooting arrows or Yi shooting birds, hitting the target every time. The final case relied purely on clearing and regulating, showing he was not someone who blindly used tonics."

[Appendix] A male patient had scrotal swelling as large as a sheng (unit of volume), with testicular pain, untreatable by other doctors. Crushed Mabiancao (Verbena officinalis) was applied topically, resulting in a cure.

One patient had a glans penis swollen as large as a sheng, shiny like a blister. Erchen Tang (Two-Cured Decoction) added with Shengma (Cimicifugae Rhizoma), Qingdai (Indigo Naturalis), and Muli (Ostrea Concha) was used. Two doses resulted in a cure.

One patient had a rigid, non-flaccid penis with continuous seminal flow, occasional needle-like pain, and distension upon pressure. This was identified as Shen Man Lou Ji (Kidney Fullness and Leakage Disease). Jiu Zi (Allii Tuberosi Semen) and Po Gu Zhi (Psoraleae Fructus), each 1 liang, were ground into powder. Three qian were taken three times daily, stopping the symptoms immediately.

One person lay naked in a mountain pavilion. His penis was entangled by flying silk, causing the glans to swell nearly to the point of rupture. Weilingxian juice (Clematidis Radix et Rhizoma Juice) diluted in water was used for soaking and washing, resulting in a cure.