肿痛未作脓者。疏肝导湿。
肿硬发热。清肝降火。
脓清不敛者。大补气血。
已溃者。滋阴托里。
脓成胀痛者。急针之。更饮消毒之剂。
囊痈。湿热下注也。有作脓者。此浊气顺下。将流入渗道。因阴道或亏。水道不利而然
。脓尽自安。不药可也。
惟在善于调摄耳。又有因腹肿。渐流入囊。肿甚而囊自裂开。睾丸悬挂水出。以麸炭（
杉木炭也）末敷外。以紫苏叶包裹。仰卧养之。
精要谓痈入囊者死。将以为属肾耶。予治数人。悉以湿热入肝经施治。而以补阴佐之。
虽脓溃皮脱。睾丸悬挂亦不死。但未知下虚年老者如何耳。
大抵此症属阴道亏。湿热不利所致。故滋阴降湿药不可缺。常治肿痛小便秘滞者。用除
主。滋阴佐之。肿痛已退。便利已和者。除湿滋阴药相兼治之。欲其成脓。用托里为主。滋
阴佐之。候脓成即针之。
仍用托里滋阴。若湿毒已尽者。专用托里。如脓清或多或敛迟者。用大补之剂。或附子
一人囊痈。未作脓而肿痛。以加减龙胆泻肝汤二剂少愈。更以四物加木通、知母、黄柏
而消。（此凭症也。）
一人脓熟作胀。致小便不利。急针。以小柴胡。加黄柏、白芷、金银花。四剂少愈。更
托里消毒散数剂而消。（此凭症也。）
一弱人脓熟胀痛。大小便秘。急针之。脓出三碗许。即鼾睡。觉神思少健。但针迟。须
服解毒药。亦溃尽矣。故用托里药至三十余剂始瘥。（此凭症也。）
一人年逾四十。阴囊肿痛。以热手熨之。少缓。服五苓散不应。尺脉迟软。此下虚寒邪
而然。名曰阴疝。非疮毒也。治以蟠葱散（九七）少可。更服葫芦巴丸而平。（此因脉迟为寒
。脉软为虚而治。）
一人年逾三十。阴囊湿痒。茎出白物如脓。举则急痛。此肝疝也。用龙胆泻肝汤而愈。
（此因症处治）阴茎或肿。或缩。或挺。或痒。皆宜此药治之。
一人年逾五十。患此疮口不敛。诊之微有湿热。治以龙胆泻肝汤。湿热悉退。乃以托里
豆豉饼灸而愈。次年复患湿热颇盛。仍用前汤四剂而退。又以滋阴药而消。若溃后虚而不补
。少壮者成漏。老弱者不治。脓清作渴脉大者亦不治。（此凭脉也。）
一人年逾五十。阴囊肿痛。得热愈盛。服蟠葱散不应。肝脉数。此囊痈也。乃肝经湿热
所致。脓已成。急针之。
进龙胆泄肝汤（六七）。脉症悉退。更服托里滋阴药。外敷杉木炭紫苏末。月余而愈。（
此因脉处治）
一人年逾六十。阴囊溃痛不可忍。睾丸露出。服龙胆泻肝汤。敷麸炭紫苏末不应。予意
气炽盛。先饮槐花酒一碗。次服前汤。少愈。更服托里加滋阴药而平。设以前药不应。加之
峻剂。未有不损中气以致败也。（此因处治不效。而知为湿盛。）
一少年玉茎捷长。肿而痿。皮塌常润。磨股难行。两胁气冲上。手足卷弱。先以小柴胡
连大剂。行其湿热。少加黄柏降其逆气。肿渐收。茎中有坚块未消。以青皮为君。少佐散风
之药末服之。外丝瓜子汁调五倍子敷。愈。（此凭症也。）
一人囊肿状如水晶。时痛时痒。出水。小腹按之作水声。小便频数。脉迟缓。此醉后饮
房。汗出遇风寒。湿毒乘聚于囊。名水疝也。先以导水丸二服。腹水已去。小便如常。再以
胃苓散倍白术、茯苓。更用气针引去聚水而瘥。（此凭症脉也。）
一弱人茎根结核如大豆许。劳则肿痛。先以十全大补汤去桂。加车前、麦门、酒制黄柏
母少愈。更加制甘草四剂。仍以四物、车前之类而消。又有患此 痛发热。服龙胆泻肝汤二
剂。制甘草四剂而溃。再用滋阴之剂而愈。或脓未成。以葱炒热敷上。冷易之。隔蒜灸赤。
可数日不消。或不溃。或溃而不敛。以十全大补加柴胡稍为主。间服制甘草而愈。若不保守
。必成漏矣。（以上二条。此凭症也。）
一弱人拗中作痛。小便淋沥。此因火躁下焦。无血气不能降。而渗泄之令不行。用四物加
黄柏、知母、茯苓、牛膝、木通十余剂。痛止便利。（此凭症也。）
一人气短。拗中若疮。小便不通。用四物加参、 煎吞滋肾丸而愈。（此凭症也。）
前症以虚为本。以病为末。益其本则末自去。设若不固元气。专攻其病。宁无害耶。
一人遗精。劳苦愈盛。拗中结核。服清心莲子饮、连翘消毒散不应。予以八珍汤（十四）
药、山茱萸、远志十余剂渐愈。更服茯兔丸遂不复作。又有患此。诸药不应。服八味丸而愈
。（此因处治不应。故推求另为之治。）
一人尿血。阴茎作痛。服清心莲子饮不应。服八正散愈盛。予以发灰醋汤调服少愈。更
服斑龙丸（百二）而平。（此因处治不应以推求也。）
一人患而久不敛。以十全大补加五味、麦门。灸以豆豉饼。月余而平。（此凭症也。）
一弱人肿痛未成脓。小便赤涩。以制甘草、青皮、木通、黄柏、当归、麦门。四剂少愈
。以清心莲子饮四剂而消。（此凭症也。）
一人 肿痛甚。小便涩。发热脉数。以龙胆泻肝汤倍车前、木通、泽泻、茯苓。势去半
以前汤加黄柏、金银花四剂。又减二三。便利如常。唯一处不消。此欲成脓。再用前汤加金
银花、皂角针、白芷六剂。微肿痛。脉滑数。乃脓已成。针之。肿痛悉退。投滋阴托里药。
及紫苏末敷之而愈。
一人病势已甚。脉洪大可畏。用前汤二剂。肿少退。以仙方活命饮二剂。痛少止。脉洪
脓已成。须针之。否则阴囊皆溃。彼不信。更他医。果大溃。睾丸挂。复求治。脉将静。以
八珍汤加黄 、黄柏、知母、山枝。更敷紫苏末。数日而痊。
一人患此。肿痛发热。以小柴胡加黄连、青皮。四剂少愈。更以龙胆泄肝汤而消。（凡
肿属湿痛属热。故痛者宜清湿热。）
一儿生三月。病热。左右胁下节次生疖。用四物汤败毒散倍人参。香附为佐犀角为使
饮乳母两月。而愈。逾三月腹胀生丹疹。又半月移胀入囊为肿。黄莹裂开。两丸显露水出
。以紫苏叶盛麸炭末托之。
旬余而合。此因父病疟遗热于胎也。（此凭症也。）
一人玉茎肿痛。服五苓散等药不应。其脉左关弦数。此肝经积热而成。以小柴胡（五）送
芦荟丸。一服势去三四。再服顿愈。（此凭脉凭症也。）
一人连日饮酒。阴挺并囊湿痒。服滋阴等药不应。予谓前阴肝脉络也。阴气从挺而出。
湿。继以酒。为温热合于下焦而然。经曰。下焦如渎。又云在下者引而竭之。遂以龙胆泻肝
肠。及清震汤而愈。此或不应。宜补肝汤及四生散治之。（此凭症也。）
一妇隐内脓水淋漓。或痒或痛。状如虫行。少阴脉滑数。此阴中有疮也。名曰 。由心
郁。胃气虚弱。气血凝滞所致。与升麻、白芷、黄连、木通、当归、川芎、白术、茯苓、柴
胡煎服。以拓肿汤熏洗。更搽蒲黄、水银。两月余而愈。此条因脉而知疮。其曰胃气虚者。
当时必有见也。或有包络虚。风邪乘阴。血气相抟。令气痞涩。致阴肿痛。治以菖蒲散。（
一百）更以枳实炒热。帛包熨之。冷则再炒。
或有子脏虚。冷气下冲。致阴脱出。谓之下脱。或因产努力而脱者。宜当归散。久不
愈者。补中益气汤。倍加升麻柴胡举之。
For swelling and pain without suppuration, employ the method of soothing the Liver and guiding out dampness.
For hard swelling accompanied by fever, employ the method of clearing the Liver and descending fire.
For thin pus with non-healing sores, employ the method of greatly tonifying Qi and Blood.
For already ulcerated cases, employ the method of nourishing Yin and pushing toxins outward.
For mature pus causing distending pain, urgently puncture with a needle and administer internal decoctions for detoxification.
Nangtong (Scrotal Abscess) is caused by the downward pouring of Damp-Heat. In some cases, suppuration occurs; this indicates that turbid Qi is moving downward, about to flow into the shen dao (urinary or reproductive tract). This happens due to deficiency in the yin dao (functional pathway of the anterior yin) and obstruction of the water passages. Once the pus is discharged, peace returns naturally, and medication may not be necessary.
The key lies in proper care and regulation. In other instances, abdominal swelling gradually extends into the scrotum, causing severe swelling that leads to spontaneous rupture of the scrotum, with the testis hanging out and fluid leaking. Apply powder of bran-charcoal (specifically fir charcoal) externally, wrap with Perilla leaves, and have the patient lie supine to recuperate.
*Jingyao* states that carbuncles entering the scrotum are fatal, implying they belong to Kidney pathology? I have treated several such patients, all according to the principle of Damp-Heat invading the Liver Meridian, assisted by Yin-nourishing herbs. Even if pus discharges, skin sheds, and the testis hangs, death does not ensue. However, it remains unknown how this applies to elderly patients with lower-jiao deficiency.
Generally, this condition stems from deficiency of the yin dao and obstruction of Damp-Heat. Therefore, herbs for nourishing Yin and draining Damp-Heat are indispensable. Typically, for cases with swelling, pain, and scanty, difficult urination, use damp-draining herbs as the main treatment, assisted by Yin-nourishing herbs. When swelling and pain subside and bowel/bladder functions normalize, combine damp-draining and Yin-nourishing herbs. To promote suppuration, use qi-tonifying and pus-expelling herbs as the main treatment, assisted by Yin-nourishing herbs. Once pus matures, puncture it.
Thereafter, continue using qi-tonifying and Yin-nourishing herbs. If damp-toxins are completely cleared, use only qi-tonifying herbs. If pus is thin, excessive in volume, or healing is slow, use strongly tonifying formulas.
Case 1: A patient with Nangtong had swelling and pain before suppuration. After two doses of Modified Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver), symptoms slightly improved. Subsequently, Siwu Tang (Four Substance Decoction) added with Tongcao (Akebia Stem), Zhimu (Anemarrhena Rhizome), and Huangbai (Phellodendron Bark) resolved the condition. (Treatment based on symptoms.)
Case 2: A patient with mature pus felt distension, leading to difficulty in urination. Urgent puncture was performed. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Huangbai, Baizhi (Angelica Dahurica Root), and Jinyinhua (Honeysuckle Flower) was given for four doses, resulting in slight improvement. Further administration of Tuoli Xiaodu San (Pus-Pushing and Toxin-Expelling Powder) resolved the condition. (Treatment based on symptoms.)
Case 3: A weak patient with mature pus experienced distending pain and constipation of both stool and urine. Urgent puncture drained approximately three bowls of pus. The patient fell into deep sleep and woke up with slightly improved mental clarity. Due to delayed puncture, detoxifying herbs were necessary to ensure complete discharge. Consequently, thirty-plus doses of qi-tonifying herbs were required for recovery. (Treatment based on symptoms.)
Case 4: A patient over forty suffered from scrotal swelling and pain. Hot compresses provided slight relief, but Wuling San (Five-Ingredient Poria Powder) was ineffective. The Chi pulse was slow and soft, indicating lower-jiao deficiency and Cold Evil. This is named Yinhan (Yin Hernia), not a sore toxin. Treatment with Pancong San (Allium Scallion Mixture) brought slight improvement, followed by Huluba Wan (Trigonella Seed Pill) for full resolution. (Treatment based on slow pulse indicating Cold and soft pulse indicating Deficiency.)
Case 5: A patient over thirty had scrotal dampness and itching, with white purulent discharge from the penis and severe pain upon erection. This is Ganhan (Liver Hernia). Longdan Xiegan Tang cured it. (Treatment based on symptoms.) Any penile swelling, retraction, protrusion, or itching should be treated with this formula.
Case 6: A patient over fifty had a non-healing sore. Examination revealed mild Damp-Heat. Longdan Xiegan Tang was used to clear the Damp-Heat completely. Then, Tuoli Douchi Bing Jiu (Qi-Tonifying Fermented Soybean Cake Moxibustion) was applied for cure. The following year, recurrence with strong Damp-Heat was treated with four doses of the previous decoction, followed by Yin-nourishing herbs to resolve the lesion. If post-ulceration weakness is not tonified, young and strong individuals may develop fistulas, while old and weak individuals may not survive. Thin pus, thirst, and large pulse also indicate incurability. (Diagnosis based on pulse.)
Case 7: A patient over fifty had scrotal swelling and pain, worsening with heat. Pancong San was ineffective. The Liver pulse was rapid, indicating Nangtong caused by Liver Meridian Damp-Heat. Pus had formed, requiring urgent puncture.
Longdan Xiegan Tang was administered, resolving all pulse and symptom signs. Follow-up with qi-tonifying and Yin-nourishing herbs, plus external application of fir charcoal and Perilla powder, led to recovery within a month. (Treatment based on pulse.)
Case 8: A patient over sixty had unbearable scrotal ulceration and pain, with exposed testis. Longdan Xiegan Tang and external application of bran-charcoal/Perilla powder were ineffective. Suspecting intense Qi-Fire, I first administered one bowl of Huaihua Jiu (Sophora Flower Wine), then the previous decoction, yielding slight improvement. Further administration of qi-tonifying and Yin-nourishing herbs resolved the condition. Had stronger purgatives been added if initial treatments failed, it would have damaged Middle-Jiao Qi and led to collapse. (Treatment inferred from lack of response, indicating excess Dampness.)
Case 9: A youth had a rapidly enlarging, swollen, and flaccid penis with loose, moist skin, making thigh rubbing painful. Qi rushed up from the hypochondrium, and limbs were curled and weak. First, Xiao Chaihu Tang in large dosage was used to move Damp-Heat, with slight Huangbai to descend rebellious Qi. Swelling subsided, but a hard lump remained in the shaft. Qingpi (Green Tangerine Peel) was used as the chief herb, assisted by wind-dispersing powders. Externally, bitter melon juice mixed with Wubeizi (Chinese Gallnut) powder was applied. Cured. (Treatment based on symptoms.)
Case 10: A patient had a scrotal cyst resembling crystal, with intermittent pain and itching, leaking fluid. Pressing the lower abdomen produced a water sound, and urination was frequent. Pulse was slow and moderate. This resulted from drinking alcohol and engaging in sexual activity after sweating and encountering Wind-Cold, causing Damp-Toxin to accumulate in the scrotum, named Shuihan (Water Hernia). Dao Shui Wan (Water-Guiding Pill) was taken twice to remove abdominal ascites and normalize urination. Then, Weiling San (Poria and Magnolia Powder) with doubled Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) was used, along with Qi Zhen (Qi Acupuncture) to drain accumulated water. Cured. (Treatment based on symptoms and pulse.)
Case 11: A weak patient had a testicular nodule the size of a soybean at the root of the penis, becoming painful and swollen with exertion. Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) minus Guizhi (Cinnamon Twig), added with Cheqianzi (Plantago Seed), Maidong (Ophiopogon Tuber), and wine-processed Huangbai, yielded slight improvement. Four more doses of Zhigancao (Prepared Licorice Root) were added, followed by Siwu Tang and Cheqianzi to resolve the lesion. Another case with similar symptoms and fever was treated with two doses of Longdan Xiegan Tang and four doses of prepared Licorice, leading to suppuration, then cured with Yin-nourishing herbs. If pus has not formed, apply hot compress of stir-fried scallions, changing when cold, or perform Garlic-Separated Moxibustion until red. It may take days to dissipate, fail to suppurate, or fail to heal. Use Shiquan Dabu Tang with Chaihu (Bupleurum Root) as primary, interspersed with prepared Licorice. Without conservation, fistulas will form. (Above two cases: Treatment based on symptoms.)
Case 12: A weak patient had pain in the urethra and dribbling urine, caused by Fire agitating the Lower Jiao, lacking Qi and Blood to descend, thus failing to execute excretory functions. Siwu Tang added with Huangbai, Zhimu, Fuling, Niuxi (Achyranthes Root), and Mutong (Akebia Stem) for over ten doses stopped pain and normalized urination. (Treatment based on symptoms.)
Case 13: A patient with shortness of breath and urethral pain resembling a sore, with urinary retention, was cured by Siwu Tang added with Renshen (Ginseng) and Huangqi (Astragalus Root), decocted to swallow Zishen Wan (Kidney-Nourishing Pill). (Treatment based on symptoms.)
In previous conditions, Deficiency is the root, and Disease is the branch. Tonifying the root causes the branch to disappear. If Yuan Qi is not secured and only the disease is attacked, harm will surely result.
Case 14: A patient with spermatorrhea had worsening symptoms with labor and nodules in the urethra. Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) and Lianqiao Xiaodu San (Forsythia Detoxifying Powder) were ineffective. I prescribed Bazhen Tang (Eight Treasure Decoction) with Shanzhuyu (Cornus Fruit) and Yuanzhi (Polygala Root) for over ten doses, showing gradual improvement, followed by Futu Wan to prevent recurrence. Another case unresponsive to various drugs was cured by Bawei Wan (Eight-Ingredient Pill). (Treatment sought anew due to prior ineffectiveness.)
Case 15: A patient with hematuria and penile pain did not respond to Qingxin Lianzi Yin. Bazheng San (Eight-Ingredient Powder for Rectifying Urination) worsened symptoms. I administered Fa Hui (Hair Ash) mixed with Vinegar Water, yielding slight improvement, followed by Banlong Wan (Spotted Dragon Pill) for stability. (Treatment sought anew due to prior ineffectiveness.)
Case 16: A patient with a long-standing non-healing sore was treated with Shiquan Dabu Tang added with Wuweizi (Schisandra Berry) and Maidong, plus Fermented Soybean Cake Moxibustion, resolving in over a month. (Treatment based on symptoms.)
Case 17: A weak patient with pre-suppurative swelling and pain, and red, astringent urination, took four doses of Prepared Licorice, Qingpi, Mutong, Huangbai, Danggui (Angelica Sinensis), and Maidong for slight improvement, then Qingxin Lianzi Yin for four doses to resolve the condition. (Treatment based on symptoms.)
Case 18: A patient with severe scrotal swelling and pain, astringent urination, fever, and rapid pulse was treated with Longdan Xiegan Tang doubled with Cheqianzi, Mutong, Zexie (Alisma Rhizome), and Fuling. Symptoms reduced by half. The previous decoction added with Huangbai and Jinyinhua for four doses reduced symptoms further. Bowel and bladder functions normalized, except for one area. This indicated impending suppuration. The previous decoction added with Jinyinhua, Zaocis Spina (Black Locust Thorn), and Baizhi for six doses resulted in mild swelling and pain, with slippery-rapid pulse confirming pus formation. Puncture was performed, resolving all swelling and pain. Yin-nourishing and qi-tonifying herbs were administered, plus external Perilla powder application. Cured.
Case 19: A patient with severe illness and terrifyingly large, flooding pulse was treated with the previous decoction for two doses, reducing swelling slightly. Xianfang Huoming Yin (Immortal Formula for Preserving Life) for two doses stopped pain slightly. The flooding pulse confirmed pus formation, requiring puncture; otherwise, total scrotal溃烂 would occur. The patient refused, seeking another doctor, who indeed caused massive溃烂 and hanging testis. Upon return, pulse was calming. Bazhen Tang added with Huangqi, Huangbai, Zhimu, and Zhizi (Gardenia Fruit) was used, plus external Perilla powder. Recovered in days.
Case 20: A patient with swelling, pain, and fever was treated with Xiao Chaihu Tang added with Huanglian (Coptis Rhizome) and Qingpi for four doses, slight improvement, then Longdan Xiegan Tang to resolve the condition. (Generally, swelling belongs to Dampness, pain belongs to Heat; thus, pain requires clearing Damp-Heat.)
Case 21: A three-month-old infant with fever developed boils sequentially under both hypochondria. Siwu Tang combined with Baidu San (Ten-Thousand Poison Expelling Powder) with doubled Renshen, assisted by Xiangfu (Cyperi Rhizoma), and guided by Xijiao (Rhinoceros Horn - *Note: Substitute with alternative in modern practice*) was administered to the nursing mother for two months, curing the infant. Three months later, abdominal distension with erysipelas appeared. Half a month later, swelling moved into the scrotum, rupturing with fluid leakage exposing both testes. Perilla leaves holding bran-charcoal powder were used to support them. Healed in ten days. Caused by residual heat from father's malaria transmitted to the fetus. (Treatment based on symptoms.)
Case 22: A patient with penile swelling and pain did not respond to Wuling San etc. Left Guan pulse was wiry and rapid, indicating accumulated Heat in the Liver Meridian. Xiao Chaihu Tang was used to deliver Luohui Wan (Aloe Pill). One dose reduced symptoms by 30-40%, second dose cured completely. (Treatment based on pulse and symptoms.)
Case 23: A patient with continuous alcohol consumption had penile protrusion and scrotal dampness/itching. Yin-nourishing herbs were ineffective. I reasoned that the anterior yin is the pathway of the Liver Meridian. Yin Qi protrudes, combined with alcohol-induced Heat-Warmth in the Lower Jiao. As the Classic states: "The Lower Jiao is like a ditch," and "Those below should be drained." Thus, Longdan Xiegan Tang and Qingzhen Tang were used for cure. If ineffective, Buye Tang (Tonify Liver Decoction) and Sisheng San (Four Generations Powder) should be used. (Treatment based on symptoms.)
Case 24: A woman had dripping purulent fluid in the vagina, with itching or pain, feeling like insects crawling. Shaoyin pulse was slippery and rapid, indicating a sore in the yin, named Yinchuang (Yin Sore). Caused by Heart Qi stagnation, Stomach Qi deficiency, and Qi-Blood stasis. Shengma (Cimicifuga Rhizome), Baizhi, Huanglian, Mutong, Danggui, Chuanxiong (Ligusticum Chuanxiong Rhizome), Baizhu, Fuling, and Chaihu were decocted and taken. Tuozhong Tang (Swelling-Expanding Decoction) was used for fumigation and washing, plus application of Puhuang (Lygodium Spore) and Shuiyin (Mercurius). Cured in over two months. This case identified the sore via pulse; the mention of Stomach Qi deficiency implies clinical observation. Alternatively, if Pericardium Deficiency allows Wind-Evil to invade the yin, stirring Qi-Blood and causing Qi blockage and yin swelling/pain, treat with Changpu San (Acorus Powder). Also, stir-fry Zhishi (Immature Bitter Orange) until hot, wrap in cloth, and apply as a warm compress; repeat when cool.
Case 25: If the Zi Zang (Uterus) is deficient, Cold Qi rushes down causing vaginal prolapse, called Xiatuan (Lower Prolapse). Or if prolapse results from bearing down during childbirth, use Danggui San (Angelica Powder). For chronic cases, Buzhong Yiqi Tang (Middle-Jiao Boosting and Qi-Invigorating Decoction) with doubled Shengma and Chaihu to lift.