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(Speaking of carbuncles affecting the scrotum)
Scrotal carbuncle (Nangyong) belongs to the Liver and Kidney meridians, caused by Yin deficiency with damp-heat sinking downward. If urination is difficult and stagnant, first use diuretic methods to drain the toxicity, then tonify Yin to allow spontaneous resolution. If needles are subsequently used to drain pus, the condition resolves once the pus is expelled. If swelling and pain persist after pus drainage, it indicates that heat-toxin has not been cleared; use Qinggan Yangrong Tang (Clear Liver and Nourish Blood Decoction). If there is dry mouth and frequent urination, it is deficiency-heat in the Kidney meridian; use Liuwei Wan (Six-Ingredient Pill with Rehmannia). If there is internal fever or afternoon fever (Buke), it is Liver blood deficiency; use Siwu Tang (Four Substance Decoction) plus Ginseng and Atractylodes Macrocephala Rhizome. If there is fatigue and poor appetite, it is Spleen Qi deficiency with heat; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If pus and discharge are clear and thin, it is a deficiency of both Qi and Blood; use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). Although this condition may present with severe ulceration and exposed testicles, if treated correctly, the flesh will gradually regenerate within ten days leading to recovery. If one focuses solely on attacking the wound, the Yin vessels will become increasingly deficient, resulting in swelling that cannot suppurate and ulcers that cannot heal. Young and strong individuals often develop chronic diseases, while the old and weak may die. There are also cases where hemorrhoids and fistulas spread to the scrotum over time; these should be treated concurrently. One must strictly avoid cold-natured drugs that attack healthy Qi and damage Stomach Qi.

Case Records:
Lu Zhenshan, a Censor, presented with swollen, red, painful scrotum, difficult urination, alternating chills and fever, and thirst. This indicated Liver and Kidney Yin deficiency with damp-heat sinking downward. The treatment was to clear Liver fire and remove damp-toxin. I prescribed Chai Hu (Bupleuri Radix), fried Long Dan Cao (Gentianae Radix), Wu Zhu Yu (Evodiae Fructus), fried Huang Lian (Coptidis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Yin Hua (Lonicerae Japonicae Flos), Zao Jiao Ci (Gleditsiae Spina), Chi Shao Yao (Paeoniae Radix Rubra), Fang Feng (Saposhnikoviae Radix), Mu Tong (Akebiae Caulis), and Gan Cao Jie (Licorice Root Joint). After one dose, swelling and pain subsided. I added Fang Feng, Mu Tong, Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Fu Ling (Poria) for decoction, and administered Zishen Wan (Kidney-Nourishing Pill) to tonify Yin. The heat and swelling completely resolved. However, a tendon-like structure remained internally, indicating Liver blood deficiency and Qi damage. I proceeded to nourish Kidney Water using Liuwei Wan formula, removing Fu Ling and adding Wu Wei Zi (Schisandrae Chinensis Fructus), for two doses. Then, I used Buzhong Yiqi Tang with Fu Ling as a drink, delivering Zishen Wan, which caused the tendon to disappear immediately, leading to recovery.

Zhu Erfeng, Mayor of Jingzhao, presented with painful swelling of the scrotum, believing it to be a hernia. My pulse diagnosis revealed rapid and slippery pulses, diagnosing Scrotal Carbuncle. It was caused by Yin deficiency and damp-heat in the Liver and Kidney meridians, with pus already formed. He took Huoming Yin (Life-Saving Decoction) for one dose, causing suppuration, followed by Yin-tonifying and interior-supporting herbs to promote healing.

Wang Rudao, Prefect, initially presented with afternoon fever, limb fatigue, soreness and weakness of legs and feet after intercourse, heat sensation from soles extending to knees, and surging, rapid pulses in all six positions, especially at the Chi (Knee) position. His form and Qi appeared deficient. After taking warming and tonifying medicines, swelling and pain moved upward, and urination became difficult. The Chi pulses were surging and slippery but empty upon deep pressure. I stated: "This is Scrotal Carbuncle, unable to suppurate due to Qi and Blood deficiency." I prescribed Buzhong Yiqi Tang plus Shan Yao (Dioscoreae Rhizoma), Shan Zhu Yu (Corni Fructus), Che Qian Zi (Plantaginis Semen), Chai Hu, and Shan Zhi (Gardeniae Fructus). After one dose, swelling vanished. Subsequently, I used Liuwei Wan formula plus Che Qian Zi, Niu Xi (Achyranthis Bidentatae Radix), Chai Hu, and Shan Zhi. After one dose, urination gradually unblocked. Then, I used Huoming Yin, alternating with the previous two medications. After more than twenty doses, the scrotum ruptured, discharging large amounts of foul pus. I then used Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder) for six doses, clearing the foul pus. Another few doses of Tuoli San reduced the discharge further. Finally, using Buyin Tuoli San (Yin-Tonifying Interior-Supporting Powder) and Shiquan Dabu Tang, he recovered after fifty-plus doses.

Chen Shiyong, a scholar, failed an examination. One night, after drinking liquor and attempting intercourse, his wife refused him. The next day, his scrotum swelled and hurt. He sent for me. I prepared herbs to drain damp-heat and clear Liver fire, but the city gates were closed at night, preventing me from returning to administer them. The next morning, he reported that his entire scrotum had rotted overnight, including the skin below the penis attached to the scrotum. This indicated Liver fire combined with alcohol toxin and intense damp-heat. I continued with the previous prescription, adding Ren Shen (Ginseng Radix), [missing character], Dang Gui, and Bai Zhu (Atractylodis Macrocephalae Rhizoma). After four doses, all necrotic tissue sloughed off, exposing the testicles. Using major Qi and Blood tonics and applying Dang Gui Ointment, the scrotum and penis fully recovered.

A wealthy guest presented with scrotal swelling and difficult urination, caused by accumulated heat in the Middle Jiao sinking downward due to deficiency. I first used Longdan Xiegan Tang (Gentian Liver-Draining Decoction) plus Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Huang Lian, and Niu Xi for four doses, showing gradual improvement. Later, Bu Yin Bazhen Tang (Yin-Tonifying Eight Treasure Decoction) plus Chai Hu and Shan Zhi cured him. However, failing to observe dietary restrictions, the symptoms recurred. He was cured again using Bu Yin Bazhen Tang, Buzhong Yiqi Tang, and Liuwei Wan. Later, due to labor-induced fever, he self-medicated with Siwu Tang, Huang Bo, and Zhi Mu, resulting in full manifestation of deficiency symptoms and an enlarged wound. I diagnosed deficiency of Qi and Blood in the Five Viscera. I prescribed Buzhong Yiqi Tang in the morning and Liujunzi Tang (Six Gentlemen Decoction) plus Dang Gui in the evening, each for over fifty doses, gradually closing the wound. Finally, Liuwei Wan was used for complete recuperation.

Li Daqing, a student, suffered from chronic Kidney deficiency fever. Long-term use of Huang Bo and Zhi Mu led to emaciation, seminal emission, white turbid urine, afternoon fever, and coughing up phlegm. I diagnosed Kidney Water depletion with internal flaring deficiency fire. I prescribed Buzhong Yiqi Tang plus Mai Men Dong (Asparagi Radix) and Wu Wei Zi. The symptoms improved. However, he separately used heat-clearing and blood-cooling herbs, leading to loss of appetite and persistent phlegm. I diagnosed renewed Spleen and Lung deficiency, unable to control saliva. I returned to the previous decoction plus Fu Ling and Ban Xia (Pinelliae Rhizoma), achieving recovery. Later, after intercourse, he experienced dizziness, vomiting phlegm, lower back pain, and pulling pain in the urinary and anal tracts. I diagnosed exhaustion of Essence and Jing, a critical condition. I prescribed the previous decoction plus Mai Men Dong and Wu Wei Zi in the morning, and Liuwei Wan formula plus Wu Wei Zi and Bi Xie (Dioscoreae Hypoglaucae Rhizoma) in the evening. After fifty-plus doses, symptoms subsided. Later, after intercourse, he had pain in the scrotum and penis. He used diuretic herbs, causing internal scrotal ulceration. I used Yin-tonifying interior-supporting herbs, draining much pus. Swelling and pain subsided, but he failed to rest properly, leading to constipation, dysuria, and surging phlegm-saliva. I diagnosed recurrence of Kidney deficiency, a worrying prognosis. [Missing text]. He firmly refused treatment and subsequently died.

A man engaged in intercourse while drunk, presenting with scrotal swelling as large as a bucket, lower abdominal distension, scanty dark urine, fever, dry mouth, and copious phlegm. This was Bladder Yin [missing text]. [Missing text] doses cured him. He was then regulated with Buzhong Yiqi Tang plus Mai Men Dong and Wu Wei Zi, recovering health. Had diuretic herbs been used, True Yang would have been damaged, likely leading to death.