（一名便毒、一名 ）
便痈属厥阴肝经，内热外寒；或劳倦过度，或房欲不节，或欲心不遂，或强固其精，或
肝经湿热而致。治法∶内热外寒者，双解散。劳倦过度者，补中益气汤。房欲不节者，六味丸料
。欲心不遂者，先用五苓散加大黄，疏其精滞；后用地黄丸，以补其肝肾，强固其精。或湿
热壅滞者，宜用龙胆泻肝汤，疏肝导滞。夫便痈血疝也，属厥阴肝经之络脉，冲任督脉之隧
道。故妇人患此，多在两拗肿痛，或腹中结块，小便涩滞。苟治者得法，患者又能调摄，何
难敛之有。若概用大黄等剂，以求其内消；或令脓随便下，损其气血，及不慎起居饮食者，
治验
府庠沈尼文，年二十，左拗患之。余以肝肾阴虚。先用托里药，溃而将愈。因入房，发
热作渴，右边亦作痛，脓水清稀，虚症悉至，脉洪大而无力，势甚可畏。用十全大补加附子一钱
，脉症顿退，再剂全退。后用大补汤，三十剂而愈。
一儒者肿痛便涩，用八正散二剂，清肝火，导湿热，而肿痛愈；再以小柴胡加芎、归、
泽泻、山栀，二剂清肝火补脾血而小便利。
一男子溃而肿痛不止，此余毒未解，用活命饮，一剂而痛止；再剂而肿消。
一男子痛甚发热，用前饮一剂痛止；再以神效栝蒌散，加山栀、柴胡、二剂而消。
一男子肿而不溃，余谓此因阳气虚弱，用参、 、归、术，以补托元气；用白芷、皂角
刺、柴胡、甘草节，以排脓清肝，数剂而溃；以八珍加柴胡，补其气血，数剂而愈。
一男子已溃，而痛不止，小便秘涩，此肝火未解也。与小柴胡汤加黄柏、知母、芎、归
，痛止便利，更以托里当归汤而疮敛。若毒未解，而痛不止者，须用活命饮。
一妇人素清苦，因郁怒，患前症。或用败毒寒凉之药，反晡热内热，自汗盗汗，月经不
行，口干咽燥。余谓此郁气伤脾，因药复损，先以当归汤数剂，后兼逍遥散，各五十余剂，而诸
一妇人小腹内如有所梗，两拗并人门俱肿，小便淋涩，经候不调，内热不渴，饮食少思
，腹内初如鸡卵而渐大，脉洪数而虚，左关尤甚，属肝脾郁结之症也。用加味归脾汤，肝火退而
脾土健，间以逍遥散下芦荟丸而愈。
一妇人两拗肿痛，腹内一块，不时上攻，月经不调，小便不利。余以为肝脾气滞，以四
君加芎、归、柴胡、山栀而愈。后因郁怒，前症复作，却兼胸胁胀满盗汗，此肝木甚而伤脾土。
用加味归脾汤下芦荟丸而愈。
一妇人小腹内，或作痛，或痞闷，两拗肿痛，内热寒热，胸膈不利，饮食不甘，形体日
瘦，此肝气滞，而伤脾气。朝用补中益气汤，夕用六味丸，渐愈，更用芦荟丸而痊愈。
一妇人两拗肿痛，小腹痞胀，小便时数，白带时下，寒热往来，小水淋沥。余谓脾气滞
而血病，用龙胆泻肝汤渐愈；又用加味逍遥散、六味丸而痊愈。
一妇人患前症，胸胁胀闷，或小便不利，或时作痛，小便涩滞，服疏气豁痰等药益甚。
余谓肝火气分之病，用龙胆泻肝汤以清肝热；又用加味逍遥散以生肝血；六味丸以滋肾水而愈。
一妇人患前症。余谓此肝脾郁怒之症。不信，别服化痰利气之剂，胸腹胀闷。又服峻利
疏导之剂，变脾虚发肿之症而殁。
一妇人两拗肿痛，内热作渴，饮食不甘，肢体倦怠，阴中作梗，小便赤涩。为肝脾阴
虚湿热
理肝火，胀痛顿止。又以加味逍遥散，调补肝火而痊。
一妇人两拗作痛，寒热内热，小便赤涩，胸胁不利，此肝火动而脾气伤。用补中益气汤
加茯苓，数剂少愈；又与加味归脾汤，诸症悉退，再用加味逍遥散而痊愈。
一妇人小腹痞闷，小便不利，内热体倦懒食，此气血虚，而兼肝火。用八珍汤加柴、栀
、胆草，治之而安。
一妇人阴中如梗，两拗肿痛，寒热不食，小便频数，小腹重坠，余以为肝脾郁结所致
。先以补中益气汤，加山栀、茯苓、车前子、青皮，以清肝火升脾气；更以加味归脾汤，二十余
剂，调理脾郁而愈。
(Bian Yong, also known as Biandu or Hengxuan)
Bian Yong (Perineal Abscess) belongs to the Jueyin Liver Meridian, presenting with internal heat and external cold; it may be caused by excessive fatigue, irregular sexual activity, unfulfilled sexual desire, forced retention of semen, or damp-heat accumulation in the Liver Meridian. Treatment methods: For cases with internal heat and external cold, use Shuangjie San (Double Release Powder). For cases due to excessive fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For cases due to irregular sexual activity, use the ingredients of Liuwei Wan (Six-Ingredient Pill with Rehmannia). For cases of unfulfilled sexual desire, first use Wuling San (Five-Ingredient Powder with Poria) plus Dahuang (Rhubarb Rhizome) to unblock seminal stasis; subsequently use Dihuang Wan (Rehmannia Pill) to tonify the Liver and Kidney and consolidate essence. If caused by damp-heat obstruction, Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) should be used to soothe the Liver and guide out stagnation. Bian Yong and Xuehan (Blood Hernia) involve the collateral vessels of the Jueyin Liver Meridian and the pathways of the Chong, Ren, and Du meridians. Therefore, when women suffer from this condition, swelling and pain often occur in both inguinal regions, or there are abdominal masses and dysuria. If treated correctly and if the patient maintains proper lifestyle regulation, healing is not difficult. However, if one indiscriminately uses purgatives such as Dahuang (Rhubarb Rhizome) seeking internal resolution, or allows pus to drain freely causing Qi and Blood damage, or if the patient neglects diet and rest, [healing will be hindered].
Case Records:
Shen Niwen, a student at the Prefectural School, aged twenty, suffered from the disease in the left inguinal region. I diagnosed it as Yin deficiency of the Liver and Kidney. I first used Tuoli Yao (Supporting Interior Medicines); after suppuration, it was nearly healed. Due to sexual intercourse, fever and thirst developed, and pain appeared on the right side as well. The pus was clear and thin, all deficiency symptoms manifested, and the pulse was surging yet forceless. The condition was alarming. I used Shiquan Dabu Tang (Complete Great Tonifying Decoction) plus Qian Chen of Fuzi (Aconite Lateral Root), and the pulse and symptoms subsided immediately. After two more doses, they completely subsided. Later, he took Dabu Tang (Great Tonifying Decoction) for thirty doses and recovered.
A scholar presented with swelling, pain, and dysuria. I used Bazheng San (Eight-Ingredient Powder for Rectification) for two doses to clear Liver Fire and drain damp-heat, resolving the swelling and pain. Subsequently, I used Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), ZeXie Alisma (Zexie), and Zhizi Gardeniae Fructus (Zhizi). After two doses, Liver Fire was cleared, Spleen Blood was tonified, and urination became smooth.
A male patient had persistent swelling and pain after suppuration. This indicated residual pathogenic factors were unresolved. I used Huoming Yin (Decoction for Saving Lives) for one dose, stopping the pain; after two doses, the swelling subsided.
A male patient suffered severe pain and fever. One dose of the aforementioned decoction stopped the pain; Shenxiao Gualou San (Miraculous Trichosanthes Powder) plus Zhizi and Chaihu was administered for two doses, resulting in the resolution of the mass.
A male patient had swelling without suppuration. I attributed this to Yang Qi deficiency. I used Renshen Ginseng Radix (Renshen), Huangqi Astragali Radix (Huangqi), Danggui Radix (Danggui), and Baizhu Atractodis Rhizoma (Baizhu) to tonify and support Yuan Qi; and Baizhu Angelicae Dahuricae Radix (Baizhi), Zaojiaoci Spina Gleditsiae (Zaojiaoci), Chaihu Bupleuri Radix (Chaihu), and Gancaojie Glycyrrhizae Radix et Rhizoma (Gancaojie) to discharge pus and clear Liver Heat. After several doses, suppuration occurred. Then, using Bazhen Tang (Eight-Treasure Decoction) plus Chaihu to tonify Qi and Blood, he recovered after several doses.
A male patient had suppuration but persistent pain and urinary obstruction. This indicated unresolved Liver Fire. I used Xiao Chaihu Tang plus Huangbai Phellodendri Cortex (Huangbai), Zhimu Anemarrhenae Rhizoma (Zhimu), Chuanxiong, and Danggui. Pain ceased, urination normalized, and the wound healed after using Tuoli Danggui Tang (Supporting Interior Danggui Decoction). If pathogenic factors remain unresolved and pain persists, Huoming Yin must be used.
A woman, who lived ascetically, developed the aforementioned symptoms due to depression and anger. Others used cooling and detoxifying herbs, which instead caused afternoon fever, internal heat, spontaneous sweating, night sweats, amenorrhea, dry mouth, and dry throat. I diagnosed this as Depression injuring the Spleen, compounded by medication damage. I first used Danggui Tang (Angelica Decoction) for several doses, then combined it with Xiaoyao San (Free and Easy Wanderer Powder), each taken for over fifty doses, resolving all symptoms.
A woman felt a blockage in the lower abdomen, with swelling in both inguinal regions and around the anus, dysuria, irregular menstruation, internal heat without thirst, poor appetite, and an abdominal mass initially the size of a chicken egg that gradually enlarged. The pulse was surging, rapid, and deficient, especially at the Left Guan position. This belonged to Liver-Spleen Qi Stagnation. I used Jiawei Guipi Tang (Modified Restore the Spleen Decoction); as Liver Fire receded and Spleen Earth strengthened, I intermittently administered Xiaoyao San with Lubin Wan (Aloe Pill), leading to recovery.
A woman presented with bilateral inguinal swelling and pain, an abdominal mass that occasionally moved upward, irregular menstruation, and dysuria. I diagnosed Liver-Spleen Qi Stagnation and used Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong, Danggui, Chaihu, and Zhizi, resulting in recovery. Later, due to depression and anger, the previous symptoms recurred, accompanied by distension in the chest and hypochondrium and night sweats. This indicated excessive Liver Wood injuring Spleen Earth. I used Jiawei Guipi Tang with Lubin Wan, leading to recovery.
A woman experienced intermittent pain and fullness in the lower abdomen, bilateral inguinal swelling and pain, alternating internal heat and chills, chest discomfort, loss of taste, and emaciation. This was Liver Qi Stagnation injuring Spleen Qi. In the morning, she took Buzhong Yiqi Tang; in the evening, Liuwei Wan. She gradually improved and fully recovered after taking Lubin Wan.
A woman had bilateral inguinal swelling and pain, lower abdominal fullness, frequent urination, leukorrhea, alternating chills and fever, and dribbling urine. I diagnosed Spleen Qi Stagnation affecting Blood. She gradually improved with Longdan Xiegan Tang; subsequent treatment with Jiawei Xiaoyao San and Liuwei Wan led to complete recovery.
A woman suffered from the aforementioned symptoms, including chest and hypochondriac distension, intermittent dysuria, and pain. Her condition worsened after taking Qi-regulating and phlegm-resolving herbs. I diagnosed this as Liver Fire affecting the Qi level. I used Longdan Xiegan Tang to clear Liver Heat; followed by Jiawei Xiaoyao San to generate Liver Blood; and Liuwei Wan to nourish Kidney Water, leading to recovery.
A woman suffered from the aforementioned symptoms. I diagnosed it as Liver-Spleen Depression and Anger. Disbelieving me, she took other phlegm-resolving and Qi-moving agents, causing chest and abdominal distension. She then took harsh draining and guiding agents, transforming into a Spleen Deficiency with edema condition, and died.
A woman had bilateral inguinal swelling and pain, internal heat with thirst, loss of taste, limb fatigue, a sensation of blockage in the vagina, and red, scanty urine. This was Liver-Spleen Yin Deficiency with Damp-Heat. [Text implies treatment logic] Regulating Liver Fire stopped the swelling and pain instantly. Subsequently, Jiawei Xiaoyao San was used to regulate and tonify Liver Fire, leading to recovery.
A woman had bilateral inguinal pain, chills, internal heat, red scanty urine, and chest/hypochondriac discomfort. This indicated Liver Fire agitation injuring Spleen Qi. I used Buzhong Yiqi Tang plus Fuling Poria (Fuling). After several doses, slight improvement occurred. Then, Jiawei Guipi Tang was given, resolving all symptoms. Finally, Jiawei Xiaoyao San was used for complete recovery.
A woman had lower abdominal fullness, dysuria, internal heat, fatigue, and anorexia. This was Qi and Blood Deficiency combined with Liver Fire. I treated her with Bazhen Tang plus Chaihu, Zhizi, and Dancao (Longdan Cao/Gentiana Root), resulting in stabilization.
A woman felt a blockage in the vagina, bilateral inguinal swelling and pain, chills, inability to eat, frequent urination, and heavy bearing sensation in the lower abdomen. I attributed this to Liver-Spleen Depression. First, I used Buzhong Yiqi Tang plus Zhizi, Fuling, Cheqianzi Plantaginis Semen (Cheqianzi), and Qingpi Citri Reticulatae Pericarpium Viride (Qingpi) to clear Liver Fire and raise Spleen Qi. Subsequently, Jiawei Guipi Tang was administered for over twenty doses to regulate Spleen Depression, leading to recovery.