内蕴热毒寒邪者。解散之。劳役而患者。补之。
不遂交感。或强固精气致败而结者。解散之。
湿热而致者。清肝导湿。
一人患此未作脓。小便秘涩。以八正散三剂少愈。以小柴胡加泽泻、山枝、木通。二剂
而消。（此凭症也。）
一老妇肿痛。脓未作。小便滞。肝脉数。以加减龙胆泻肝汤加山枝、黄柏。四剂而消。
（此因症也。）
一人肿痛发寒热。以荆防败毒散二剂而止。以双解散二剂而消。（此因寒热认作外邪处
一人脓未成大痛。服消毒托里内疏药不应。脉洪大。毒尚在。以仙方活命饮一剂痛止。
又剂而消。（此因治不应而处也。）
一人肿痛。日晡发热。以小柴胡加青皮、天花粉四剂。痛止。热退。以神效栝蒌散四剂
而消。（此因症也）
一人 肿作痛。大小便秘。脉有力。以玉烛散二剂顿退。更以龙胆泻肝汤四剂而消。（
此因症因脉而治。）
一人溃而痛不止。诸药不应。诊之脉大。按之则数。乃毒未解也。以仙方活命饮而止。
又二剂而消。（此因症因脉而治。）
一人溃而痛不止。以小柴胡加黄柏、知母、芎、归四剂少止。更以托里当归汤数剂而敛
。（此因症也。）
一人服克伐药以求内消。致泻利少食。以二神丸先止其泻。以十全大补倍加白术、茯苓
。数剂而消。（此因症也。）
大抵此症多患于劳役之人。亦有内蕴热毒而生者。须辨虚实及脓成否。不可妄投药饵。
治此概用大黄之类下之。以求内消。或脓成。令脓从大便出。鲜有见其痊者。人多欲内消者
。恐收之难也。若补养气血。不旬日而收矣。若脓既成。岂有可消之理。再用克伐之剂。反
一人不慎房劳。患此肿痛。以双解散二服。其病即止。更以补中汤数剂而脓成针之。以
八珍汤加五味、麦门、柴胡三十余剂。（此因症也）
大抵便痈者血疝也。俗呼为便毒。言于不便处患之故也。乃足厥阴肝经络及冲任督脉。
肝之旁络也。是气血流通之道路。今壅而肿痛。此则热毒所致。宜先疏导其滞。更用托里之
剂。此临症制宜也。
一人年逾四十。患便毒克伐太过。饮食少思。大便不实。遗精脉微。东垣云。精滑不禁
便自利。腰脚沉重。下虚也。仲景曰。微弱之脉。主气血俱虚。先以六君子（二）加破故纸、
肉豆蔻煎服。泄止食进。更以十全大补汤（十三）加行经药十余剂而消。（此因脉虚也）
一人患便毒。脓稀脉弱。以十全大补汤。加五味、麦门、白蔹三十剂稍愈。更以参 归
而平。因新婚复发。聚肿坚硬。四肢冷。脉弱皮寒。饮食少思。此虚极也。仍用前药加桂、
附。三剂稍可。彼欲速愈。自用连翘消毒散。泄利不止而殁。（此因症脉也）
一人年逾四十。素劳苦。患便毒发寒热。先以小柴胡加青皮一服。表症悉退。次以补中
汤加穿山甲二剂。肿去三四。更以托里之药五六服。脓成刺去。旬日而敛。（此因症也。）夫
便毒足厥阴湿气。因劳倦而发。用射干三寸同生姜煎。食前服。得利一二行。效。射干紫花
者是。红花者非。又方。破故纸牛蒡子（微炒）牵牛（炒）大黄（酒拌煨）等分末之。每服一两。
酒调下。
又方 已成脓者。大黄连翘（各五钱）枳实（三钱）浓朴甘草节（各二钱）桃仁（二十一粒）姜
三片。分三贴。煎服。
消毒饮 便毒初发。三四日可消。
皂角刺 金银花 防风 当归 大黄 甘草节 栝
水酒各半煎。食前温服。仍频提掣顶中发。立效。
又方 白僵蚕、槐花为末。酒调服。一方。加酒大黄。
又方 木鳖子 大黄 栝蒌 桃仁 草龙胆 咀。浓煎。露一宿。清晨温服。立愈。
又方 山栀 大黄 乳香 没药 当归（各半钱）
栝蒌仁（二钱） 代赭石（一钱） 上作一服。煎。
一人肿而不溃。以参、 、归、术、白芷、皂角针、柴胡、甘草节数剂而溃。以八珍汤
加柴胡数剂愈。（此因症也。）
一人溃而肿不消且不敛。诊之脉浮而涩。以豆豉灸。（四三）更以十全大补汤（十三）月余
而愈。（此因症也）
Those with internal accumulation of heat-toxin and cold-pathogen should be treated with dispersing methods. Those suffering from overwork should be treated with tonification.
Those resulting from improper sexual activity or forced retention of essence leading to deterioration and nodulation should be treated with dispersing methods.
Those caused by damp-heat should be treated by clearing the Liver and guiding out dampness.
A patient presented with this condition without suppuration, accompanied by scanty and difficult urination. After three doses of Bazheng San (Eight-Normal Decoction), symptoms slightly improved; subsequently, after two doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Ze Xie (Alisma Rhizome), Shan Zhi (Gardenia Fruit), and Mu Tong (Akebia Caulis), the swelling resolved. (This treatment was based on symptoms.)
An elderly woman presented with painful swelling without suppuration, stagnant urination, and a rapid Liver pulse. After four doses of Ji Jian Long Dan Xie Gan Tang (Modified Gentian Liver-Draining Decoction) added with Shan Zhi (Gardenia Fruit) and Huang Bo (Phellodendron Bark), the swelling resolved. (This treatment was based on etiology.)
A patient presented with painful swelling accompanied by aversion to cold and fever. After two doses of Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Resolving Toxins), the chills and fever ceased; subsequently, after two doses of Shuang Jie San (Double-Resolving Powder), the mass resolved. (This treatment identified external pathogens based on chills and fever.)
A patient presented with severe pain before significant pus formation. Previous treatments with detoxifying, supporting interior, and purgative herbs were ineffective. The pulse was surging and large, indicating the toxin remained. After one dose of Xian Fang Huo Ming Yin (Immortal Life-Giving Elixir), the pain stopped; after another two doses, it resolved. (This adjustment was made due to previous treatment failure.)
A patient presented with painful swelling and afternoon fever. After four doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qing Pi (Tangerine Peel) and Tian Hua Fen (Trichosanthes Root), the pain stopped and fever subsided. Subsequently, after four doses of Shen Xiao Gua Lou San (Miraculous Trichosanthes Powder), it resolved. (This treatment was based on symptoms.)
A patient presented with swelling and pain, constipation of both stool and urine, and a forceful pulse. After two doses of Yu Zhu San (Jade Candle Powder), symptoms receded abruptly; subsequently, after four doses of Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction), it resolved. (This treatment was based on both symptoms and pulse.)
A patient presented with persistent pain after ulceration, unresponsive to various medications. The pulse was large but rapid upon deep pressure, indicating unresolved toxin. After Xian Fang Huo Ming Yin (Immortal Life-Giving Elixir), the pain stopped; after another two doses, it resolved. (This treatment was based on both symptoms and pulse.)
A patient presented with persistent pain after ulceration. After four doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huang Bo (Phellodendron Bark), Zhi Mu (Anemarrhena Rhizome), Chuan Xiong (Szechwan Lovage Rhizome), and Dang Gui (Angelica Sinensis), the pain slightly subsided. Subsequently, after several doses of Tuo Li Dang Gui Tang (Support-Interior Angelica Decoction), the wound closed. (This treatment was based on symptoms.)
A patient took harsh purgatives seeking internal resolution, resulting in diarrhea and poor appetite. Er Shen Wan (Two-Spirit Pill) was first used to stop the diarrhea, followed by Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with doubled Bai Zhu (Atractylodes Macrocephala Rhizome) and Fu Ling (Poria), which resolved the condition after several doses. (This treatment was based on symptoms.)
Generally, this condition often affects those who are overworked. It may also arise from internal heat-toxin accumulation. One must distinguish between deficiency and excess, and whether pus has formed, avoiding arbitrary medication. Treating this generally with Da Huang (Rhubarb Rhizome) to purge internally, hoping for resolution, or allowing pus to exit via stool, rarely leads to recovery. People often desire internal resolution, fearing difficulty in healing. However, if Qi and Blood are tonified, healing occurs within ten days. Once pus is formed, there is no rationale for its resolution; using harsh purgatives instead...
A patient contracted this painful swelling due to imprudent sexual activity. After two doses of Shuang Jie San (Double-Resolving Powder), the disease halted. Subsequently, after several doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), pus formed and was lanced. Finally, after thirty-plus doses of Ba Zhen Tang (Eight-Treasure Decoction) added with Wu Wei Zi (Schisandra Berry), Mai Men Dong (Ophiopogon Tuber), and Chai Hu (Bupleurum Root), he recovered. (This treatment was based on symptoms.)
Generally, Bian Yong (Perineal Abscess) is a type of Xue Shan (Blood Hernia), commonly called Bian Du (Perineal Poison), named so because it occurs in an inconspicuous area. It involves the Foot-Jueyin Liver Meridian and the Chong, Ren, and Du vessels, serving as collateral pathways for the Liver and channels for Qi and Blood circulation. Now, obstruction causes swelling and pain, attributed to heat-toxin. One should first guide out stagnation, then use formulas that support the interior and promote pus discharge. This is adapting treatment to clinical presentation.
A patient over forty suffered excessive purging for perineal abscess, leading to poor appetite, loose stools, spermatorrhea, and a faint pulse. Li Dongyuan stated: Involuntary seminal emission, spontaneous diarrhea, heavy waist and legs indicate lower deficiency. Zhang Zhongjing stated: A faint pulse indicates deficiency of both Qi and Blood. First, Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Po Gu Zhi (Psoralea Fruit) and Rou Dou Kou (Nutmeg) was decocted and taken; once diarrhea stopped and appetite returned, Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with blood-moving herbs was taken for over ten doses, resolving the condition. (This treatment was based on a deficient pulse.)
A patient with perineal abscess had thin pus and a weak pulse. After thirty doses of Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Wu Wei Zi (Schisandra Berry), Mai Men Dong (Ophiopogon Tuber), and Bai Lian (Meadow Rue Rhizome), he slightly improved. He was further stabilized with Shen Gui (Ginseng and Angelica) preparations. Due to a new marriage, the condition relapsed with hard, clustered swelling, cold limbs, weak pulse, cold skin, and poor appetite, indicating extreme deficiency. The previous formula was used again with Gui Zhi (Cinnamon Twig) and Fu Zi (Prepared Aconite Root); after three doses, he felt somewhat better. Desiring quick recovery, he self-administered Lian Qiao Xiao Du San (Forsythia Detoxifying Powder), leading to incessant diarrhea and death. (This treatment was based on symptoms and pulse.)
A patient over forty, accustomed to hard labor, developed perineal abscess with chills and fever. First, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qing Pi (Tangerine Peel) was taken once, resolving all exterior symptoms. Next, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Chuan Shan Jia (Pangolin Scale) was taken for two doses, reducing swelling by three to four parts. Subsequently, five to six doses of interior-supporting herbs allowed pus formation and drainage, with healing within ten days. (This treatment was based on symptoms.)
Perineal abscess relates to dampness in the Foot-Jueyin meridian, triggered by fatigue. One may decoct She Gan (Belamcanda Rhizome, 3 cun) with fresh ginger and take it before meals; obtaining one or two bowel movements yields efficacy. Use purple-flowered She Gan; red-flowered varieties are incorrect. Another prescription: Po Gu Zhi (Psoralea Fruit), Niu Bang Zi (Arctium Fruit, lightly fried), Qian Niu (Morning Glory Seed, fried), and Da Huang (Rhubarb Rhizome, wine-treated and baked) in equal parts, powdered. Take one liang mixed with wine.
Another prescription for established pus: Da Huang (Rhubarb Rhizome) and Lian Qiao (Forsythia Fruit) (each 5 qian), Zhi Shi (Immature Bitter Orange) (3 qian), Hou Po (Magnolia Bark) and Gan Cao Jie (Licorice Knots) (each 2 qian), Tao Ren (Peach Kernel) (21 grains), and 3 slices of ginger. Divide into three portions, decoct, and take.
Xiao Du Yin (Detoxifying Drink): For early-stage perineal abscess, can resolve within three to four days.
Ingredients: Zao Jiao Ci (Gleditsia Spine), Jin Yin Hua (Honeysuckle Flower), Fang Feng (Saposhnikovia Root), Dang Gui (Angelica Sinensis), Da Huang (Rhubarb Rhizome), Gan Cao Jie (Licorice Knots), Gua Lou (Trichosanthes Fruit).
Method: Decoct with half water and half wine, take warm before meals. Simultaneously, frequently pull the hair at the vertex for immediate effect.
Another prescription: Bai Jiang Can (Bombyx Batryticatus) and Huai Hua (Sophora Flower) powdered, taken with wine. Another variant adds Jiu Da Huang (Wine-processed Rhubarb).
Another prescription: Mu Bie Zi (Momordica Seed), Da Huang (Rhubarb Rhizome), Gua Lou (Trichosanthes Fruit), Tao Ren (Peach Kernel), Cao Long Dan (Gentiana Scabra Root) chopped, heavily decocted, exposed overnight, taken warm in the morning for immediate cure.
Another prescription: Shan Zhi (Gardenia Fruit), Da Huang (Rhubarb Rhizome), Ru Xiang (Frankincense), Mo Yao (Myrrh), Dang Gui (Angelica Sinensis) (each half qian), Gua Lou Ren (Trichosanthes Seed) (2 qian), Dai Zhe Shi (Hematite) (1 qian). Prepare as one dose, decoct, and take.
A patient with swelling but no ulceration was treated with Ren Shen (Ginseng), [missing character], Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Zhi (Angelica Dahurica Root), Zao Jiao Zhen (Gleditsia Needle), Chai Hu (Bupleurum Root), and Gan Cao Jie (Licorice Knots) for several doses until ulceration occurred. Then, Ba Zhen Tang (Eight-Treasure Decoction) added with Chai Hu (Bupleurum Root) was taken for several doses to heal. (This treatment was based on symptoms.)
A patient with ulceration had persistent swelling and non-healing. The pulse was floating and choppy. Dou Chi Moxibustion (Acupoint 43) was applied, followed by Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) for over a month until recovery. (This treatment was based on symptoms.)