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Xuan Yong (Abscess of the Perineum) refers to a sore occurring posterior to the jade stem (penis) and anterior to the grain gate (anus). It belongs to the syndrome of deficiency in the three foot yin meridians. In mild cases, it develops into a fistula; draining all qi and blood leads to death. In severe cases, internal ulceration occurs leading to immediate demise. If at the initial stage there is stagnation of damp-heat, pain without suppuration, or difficult urination, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) should be used. If swelling and pain are severe, Xianfang Huoming Yin (Immortal Life Elixir) is used, assisted by prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao). Although this results in a milder condition with shallower accumulation, if suppuration fails to form or does not rupture spontaneously, Bazhen Tang (Eight-Treasure Decoction) is used for tonification. If pus has formed, urgent needle drainage is required. For granulation and healing, if kidney deficiency is present, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is used. For blood deficiency, Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) are added to Siwu Tang (Four-Substance Decoction). For qi deficiency, Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) are added to Sijunzi Tang (Four-Gentlemen Decoction). For spleen deficiency, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) is used. For combined qi and blood deficiency, Bazhen Tang (Eight-Treasure Decoction) and Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) are used. Using cold and cool herbs for detoxification is an error.

Case Record:
Bao Xichuan, Minister of Works, suffered from heat in the feet. After taking Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) for over a year, he developed Nang Yong (Scrotal Abscess). He expectorated phlegm, felt thirsty and desired hot drinks, with heat extending to the knees. Adding Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), and Erchen Tang (Two-Aged Decoction) exacerbated the heat-phlegm. He asked me, "Why?" I replied, "This is due to deficiency of the three foot yin meridians, causing water flooding to transform into phlegm. Cold and cool agents have damaged the stomach qi." I initially prescribed Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi), followed by Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) in the evening, occasionally assisting with Danggui Buxue Tang (Danggui Tonifies the Blood Decoction). He recovered after half a year.

The Prefect of Zhaozhou suffered from this syndrome, with significant swelling and pain lasting over fifty days. He had afternoon fever, dry mouth, night sweats, poor appetite, body fatigue, shortness of breath, and a floating, rapid but forceless pulse. This indicated deficiency of the three foot yin meridians. After more than fifty doses, pus drained and the sore healed. Later, due to pain from pus, poor appetite, hypochondriac pain, and fever, he reused the previous medicines. Relying on his robust constitution and careful management, he recovered.

Zhang Jingzhi, Vice Minister, suffered from the aforementioned syndrome, which persisted for a long time. He had severe afternoon fever, thirst, irritability, and panting. Others used Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), worsening the symptoms. He experienced limb fatigue, poor appetite, loose stools, and frequent urination. He asked me, "Why?" I said, "This is a spleen deficiency syndrome, aggravated by previous medications damaging the spleen and stomach." I prescribed Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) with Fuling (Poria) and Banxia (Pinelliae Rhizoma). After several doses, diet improved and symptoms subsided. Adding Maimen Dong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) led to full recovery. The Classic states: "The Spleen belongs to Taiyin, is Yin Earth, and governs the generation of blood." Therefore, Mr. Dongyuan stated: "For spleen deficiency causing sinking of yuan qi, presenting with fever, thirst, and limb fatigue, use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) to raise and tonify yang qi, thereby generating yin blood." Mistaking this for kidney deficiency and using Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) damages the vital qi of the spleen and stomach, making deficiency worse. Moreover, Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) drain yang and damage yin; they should not be used unless bladder yang fire is excessive and unable to generate yin water, causing fever.

A scholar suffered from this syndrome. Taking Kanli Wan (Kanli Pill), Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) was ineffective. His pulse was floating and surging, but fine and subtle upon deep pressure. I considered this deficiency of the three foot yin meridians.

Generally, for sores and ulcers, if kidney meridian yang qi is hyperactive, preventing yin water generation and causing yin-deficiency fever, Kanli Wan (Kanli Pill) may be used for its bitter-cold nature, or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for its sour-warm nature to generate water within fire, allowing strong yang qi to naturally generate yin. However, 80-90% of such cases belong to kidney essence and qi deficiency, while only 1-2% belong to kidney yang hyperactivity. People in Jiangnan often suffer from spleen meridian issues, with yin blood deficiency and sinking of yuan qi. Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) must be used to raise and tonify yang qi, promoting yang growth and yin lengthening. For those with excessive desires damaging true water, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is suitable to tonify kidney yuan qi and generate essence and blood; still, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) is needed to cultivate the generating qi of spleen and lung, thereby nourishing kidney water. The Classic says: "Yin deficiency is actually spleen deficiency." But it is often mistaken for kidney fire syndrome, leading to the use of Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), which further damage spleen and lung, cutting off the source of transformation, leading to fatal outcomes. Regrettable!

Liu Kexin, Scholar of the Upper Chamber, suffered from pain and fever after ulceration, with dry mouth and red, difficult urination. Self-medication with heat-clearing and detoxifying herbs was ineffective. The left chi pulse was surging and rapid. [Context implies diagnosis of deficiency]. Gradually improved. Later, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) were used to tonify spleen and lung and nourish kidney water, leading to wound healing.

A scholar had red, difficult urination. Fatigue caused soft, swollen, painful, and hot feet, dry mouth and tongue, poor appetite, body fatigue, worsening in the afternoon. This indicated qi and blood deficiency failing to expel toxins. After five doses, pus emerged spontaneously; after another fifty doses, the wound nearly healed. Due to labor and stopping medication, chills, fever, thirst, swelling, pain, and abundant pus occurred. Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) with fried Gardeniae Fructus (Chao Zhizi) relieved symptoms after two doses. Subsequently, Bazhen Tang (Eight-Treasure Decoction) with Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi) for over a hundred doses eliminated swelling and pain. Fortunately, he managed daily life carefully, regulated diet, and took tonic herbs regularly. However, slight pus discharge occurred with fatigue. Confused by others' advice, he used internal fire-draining herbs and external cauterizing agents, causing premature contraction and massive ulceration, nearly resulting in death. He was eventually cured through tonification.