证
夫便毒者，生于小腹下，两腿合缝之间。其毒初发，寒热相作，腿间肿起疼痛是也。夫肾为作强之官，
所藏者，精与志也。男女大欲，不能以直遂其志，故败精搏血，留聚中途，而结为便毒矣。况其所，乃精
气所出入之道路也。或触物而动心，或梦寐而不泄，既不得偶合阴阳，又不能忘情息念，故精与血，交滞
而肿结也。初起慎不可用寒凉之药，恐气血愈结而不得宣散，反成大患。
惟当发散寒气，清利热毒，使精血宣畅，自然愈矣。
阴头肿痛生疮者，名为下疳也。乃督、任、冲三脉之属，督脉属阳，任脉属阴，冲脉属厥阴。阳
脉主气，阴脉主血，皆由气血大热，有毒有风，故生此疮。其疮一生，则便毒、厉风疮、次第而发
也。先宜升麻葛根汤发出，其发后；服凉血解毒丸即愈，不必用轻粉之类。
下疳疮，乃男子玉茎生疮，皆由所欲不遂，或交接不洁，以致邪毒浸溃，发成疮毒。日久不愈，或成
便毒，或损烂阳物，多致危笃。又鱼口疮，妒精疮，皆其类也。俗云疳疮未已，便毒复来生也。
妒精疮者，由妇人阴中先有宿精，因而交接，虚热熏蒸，即成此疾。初发在阴头如粟，拂之即痛甚，
两日出清脓，作臼孔，蚀之太痛。妇人有生于玉门内，正似疳蚀疮，不痛为异耳。
方
通直散 治便毒如神。
黑牵牛（一钱半） 大黄（三钱） 归尾（三钱） 甘草节（二钱） 白僵蚕（一钱半）
木鳖（三个，去壳） 穿山甲（壁土炒，各二钱）
上锉一剂，好酒煎，早晨空心服，少食至已时，泻下脓血便安。
神异散 治便毒、鱼口疮。
金银花 天花粉 木鳖子（各一钱） 连翘 黄芩（各八分） 山栀子（七分）
穿山甲（炒珠，二钱） 大黄（二钱） 木香（五分） 皂角刺（三钱） 甘草（五钱）
上锉一剂，酒水煎，空心服。
通解散 治男子交感，强固不泄，以致血气交错，大小便涩滞，或肛门肿痛，或作便毒痈疽。
黑丑（炒，捣末） 大黄（炒） 桃仁（去皮尖） 官桂 白芍 泽泻（各二钱半）
干姜（一钱） 甘草（五分）
上锉二剂，水煎，空心服。
黄芷汤 治鱼口疮。
大黄 香白芷（各五钱）
水煎露一宿，次早空心温服。至午后肚痛，未成者自消，已成未穿者，脓血从大便中出。
攻毒散 治鱼口疮。
油核桃去肉，将蝎子于内，火烧存性研末，黄酒下，出汗。如未愈，加蜈蚣同烧为末，烧酒调服。（出汗）
百五散（王小庵传） 治鱼口疮初出三、五日。
五倍子炒黄为末，入百草霜醋调贴患处，一日夜即消。
立消散 治鱼口便毒。
大虾蟆一个，剥去皮，连肠捣烂，入葱五钱再捣，敷肿处，却
用皮复贴其上，此疮立刻消散，决无遗毒之患也。
泻肝汤 治肝经湿热不利，阴囊肿痛，或脓溃皮脱，睾丸悬挂，及下疳疮。
当归梢 赤芍药 生地黄 龙胆草（酒浸，炒） 防风 黄连（炒
）黄柏 知母（酒炒） 车前子（炒） 泽泻（各一钱） 甘草梢（五分）
上锉一剂，空心水煎服。
珍珠散（焦确斋传） 治下疳疮。
黄连（末） 黄柏（末） 乳香 没药 孩儿茶 轻粉 官粉（
）五倍子（炒） 珍珠（研） 象牙（锉，各等分）
上为末，以米泔水洗净，糁患处。
白金散 治下疳疮。
黄柏分作手指大条，慢火炙热，淬猪胆汁中，用二枚，每炙淬汁昼为度。研细，入轻粉钱余，香油调敷患处。
凤凰散（李宠庵传） 治下疳，阴头生疮肿痛，名蜡烛发。
抱过鸡卵壳 黄连 轻粉各等分
各研末均一处，香油调搽。
洗疳汤（桑柳南传）
川楝 黄连 瓦松 花椒 葱根 艾叶各等分。
上水煎，倾入盆内，用青布一块展洗疮上，立效。
[Discussion on Symptoms]
The so-called "Bian Du" (Perineal Abscess) is a disease occurring in the lower abdomen, between the inner seams of the two thighs. Upon initial onset, it presents with alternating chills and fever, along with swelling and pain in the thigh region. The Kidney is referred to as the "Official of Strength and Endurance," storing Essence (Jing) and Will (Zhi). When intense sexual desires in men and women cannot be fulfilled directly, defeated Essence and Blood contend and stagnate midway, condensing into Bian Du. Moreover, this area serves as the pathway for the exit and entry of Qi and Essence. Sometimes, contact with external objects stirs the mind, or nocturnal emissions occur without release; since Yin and Yang cannot be harmonized through intercourse, nor can emotional thoughts be extinguished, Essence and Blood become mutually obstructed, leading to swelling and condensation. At the initial stage, cold-natured medicines must strictly be avoided, lest Qi and Blood become further condensed and unable to disperse, thereby causing greater disaster. One should only employ methods to disperse cold pathogens and clear heat-toxins, allowing Essence and Blood to circulate freely, which will naturally lead to recovery.
Swelling, pain, and ulceration of the glans penis are named "Xia Gan" (Chancre). These belong to the governing vessel (Du Mai), conception vessel (Ren Mai), and penetrating vessel (Chong Mai). The Du Mai belongs to Yang, the Ren Mai to Yin, and the Chong Mai to Jueyin. Yang vessels govern Qi, and Yin vessels govern Blood; all arise from excessive heat in Qi and Blood, combined with toxic and wind pathogens, thus generating such sores. Once this sore appears, Bian Du and Li Feng Chuang (Leprosy-like Sores) will subsequently develop. Initially, Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) should be used to vent the pathogen; after venting, Liang Xue Jie Du Wan (Cooling Blood and Resolving Toxin Pill) should be taken for complete recovery. Medicines like Qian Fen (Calomel) are unnecessary.
Xia Gan Chuang (Chancre Ulcer) refers to ulcers on the male organ (Yu Jing), caused by unfulfilled sexual desire or unclean intercourse, leading to the infiltration and erosion of evil toxins, resulting in ulcerative sores. If not healed over time, it may transform into Bian Du or cause damage and rotting of the genitalia, often leading to critical conditions. Yu Kou Chuang (Fish Mouth Ulcer) and Du Jing Chuang (Jealousy Essence Ulcer) are also of this category. Folklore states that Chancre recurs when Bian Du reappears.
Du Jing Chuang arises when residual semen remains in the female vagina prior to intercourse; subsequent sexual activity causes deficiency-heat to steam and ferment, forming this ailment. It initially appears on the glans like millet grains; touching it causes severe pain. After two days, clear pus flows out, forming hole-like erosions that are extremely painful when eroded. In women, it may grow inside the Yu Men (vaginal opening), resembling Chancre erosion, except that it is painless.
[Formulas]
Tong Zhi San (Unblocking Direct Powder) - Miraculous treatment for Bian Du.
Hei Qian Niu (Semen Stramonii, 1.5 qian) Da Huang (Radix et Rhizoma Rhei, 3 qian) Gui Wei (Radix Angelicae Sinensis Cauda, 3 qian) Gan Cao Jie (Radix Glycyrrhizae Preparata, 2 qian) Bai Jiang Can (Bombyx Batryticatus, 1.5 qian)
Mu Bie Zi (Semen Momordicae, 3 pieces, shell removed) Chuan Shan Jia (Squama Manis, stir-fried with wall earth, 2 qian each)
Crush these ingredients into one dose, decoct with good wine, and take on an empty stomach in the morning. Eat little until Si hour (9-11 AM); purging pus and blood will bring relief.
Shen Yi San (Divine Extraordinary Powder) - Treatment for Bian Du and Yu Kou Chuang.
Jin Yin Hua (Flos Lonicerae Japonicae) Tian Hua Fen (Radix Trichosanthis) Mu Bie Zi (Semen Momordicae, 1 qian each) Lian Qiao (Fructus Forsythiae) Huang Qin (Radix Scutellariae, 0.8 qian each) Shan Zhi Zi (Gardeniae Fructus, 0.7 qian)
Chuan Shan Jia (Squama Manis, fried to pearls, 2 qian) Da Huang (Radix et Rhizoma Rhei, 2 qian) Mu Xiang (Radix Aucklandiae, 0.5 qian) Zao Jiao Ci (Gleditsiae Spina, 3 qian) Gan Cao (Radix Glycyrrhizae, 5 qian)
Crush into one dose, decoct with water and wine, and take on an empty stomach.
Tong Jie San (Unblocking Release Powder) - Treatment for men who forcibly retain semen during intercourse, causing Qi and Blood disorder, difficulty in urination and defecation, anal swelling and pain, or formation of Bian Du carbuncles.
Hei Chou (Semen Stramonii, fried, pounded to powder) Da Huang (Radix et Rhizoma Rhei, fried) Tao Ren (Semen Persicae, skin and tip removed) Guan Gui (Cortex Cinnamomi) Bai Shao (Radix Paeoniae Alba) Ze Xie (Rhizoma Alismatis, 2.5 qian each)
Gan Jiang (Rhizoma Zingiberis, 1 qian) Gan Cao (Radix Glycyrrhizae, 0.5 qian)
Crush into two doses, decoct with water, and take on an empty stomach.
Huang Zhi Tang (Angelica Dahurica Decoction) - Treatment for Yu Kou Chuang.
Da Huang (Radix et Rhizoma Rhei) Xiang Bai Zhi (Radix Angelicae Dahuricae, 5 qian each)
Decoct with water, expose overnight, and take warm on an empty stomach the next morning. Abdominal pain in the afternoon indicates resolution; if unformed, it dissipates spontaneously; if formed but unruptured, pus and blood discharge via stool.
Gong Du San (Attacking Toxin Powder) - Treatment for Yu Kou Chuang.
Remove meat from You Tao He (Walnut), place a scorpion inside, burn until charred but retaining nature, and grind to powder. Take with yellow wine to induce sweating. If unresolved, add a centipede, burn together to powder, and take mixed with rice wine. (Induce sweating)
Bai Wu San (Hundred Five Powder - Transmitted by Wang Xiao'an) - Treatment for Yu Kou Chuang appearing for 3-5 days.
Wu Bei Zi (Galla Chinensis) fried yellow to powder, mixed with Bai Cao Shuang (soot from burning various herbs), applied to the affected area with vinegar. Disappears within one day and night.
Li Xiao San (Instant Dissipation Powder) - Treatment for Yu Kou Bian Du.
One large toad, skin peeled off, pounded with intestines, mixed with 5 qian of scallion, and pounded again. Apply to the swollen area, then cover with the peeled skin. The sore dissipates immediately without leaving residual toxin.
Xie Gan Tang (Draining Liver Decoction) - Treatment for damp-heat in the Liver channel causing scrotal swelling and pain, pus discharge with skin shedding, hanging testicles, and Xia Gan Chuang.
Dang Gui Shao (Radix Angelicae Sinensis Tip) Chi Shao Yao (Radix Paeoniae Rubra) Sheng Di Huang (Radix Rehmanniae Preparata) Long Dan Cao (Radix Gentianae, soaked in wine, fried) Fang Feng (Radix Saposhnikoviae) Huang Lian (Rhizoma Coptidis, fried) Huang Bo (Cortex Phellodendri) Zhi Mu (Rhizoma Anemarrhenae, wine-fried) Che Qian Zi (Semen Plantaginis, fried) Ze Xie (Rhizoma Alismatis, 1 qian each) Gan Cao Shao (Radix Glycyrrhizae Tip, 0.5 qian)
Crush into one dose, decoct with water, and take on an empty stomach.
Zhen Zhu San (Pearl Powder - Transmitted by Jiao Quezhai) - Treatment for Xia Gan Chuang.
Huang Lian (powder) Huang Bo (powder) Ru Xiang (Resina Acaciae Cathartae) Mo Yao (Resina Myrrhae) Hai Er Cha (Camelliae Semen) Qian Fen (Calomel) Guan Fen (Lead Carbonate) Wu Bei Zi (Galla Chinensis, fried) Zhen Zhu (Margarita, ground) Xiang Ya (Elephantis Dentis Cornu, shaved, equal parts)
Grind to powder. Wash the affected area with rice water, then sprinkle the powder on the lesion.
Bai Jin San (White Gold Powder) - Treatment for Xia Gan Chuang.
Cut Huang Bo (Cortex Phellodendri) into finger-sized strips, heat slowly, and quench in pig bile. Use two strips, heating and quenching repeatedly throughout the day. Grind finely, add slightly more than 1 qian of Qian Fen (Calomel), mix with sesame oil, and apply to the affected area.
Feng Huang San (Phoenix Powder - Transmitted by Li Chongan) - Treatment for Xia Gan, where the glans develops painful swelling named Candle Hair.
Bao Guo Ji Luo Ke (Eggshell from hatched chicken) Huang Lian (Rhizoma Coptidis) Qian Fen (Calomel) Equal parts
Grind each to powder, mix evenly, and apply with sesame oil.
Xi Gan Tang (Washing Chancre Decoction - Transmitted by Sang Liunan)
Chuan Lian Zi (Fructus Toosendan) Huang Lian (Rhizoma Coptidis) Wa Song (Saxifraga Stolonifera) Hua Jiao (Pericarpium Zanthoxyli) Cong Gen (Radix Allii Cepae) Ai Ye (Folium Artemisiae Argyi) Equal parts
Decoct with water, pour into a basin. Dip a piece of blue cloth in the liquid and wash the sore. Immediate effect.