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Regarding the discussion and treatment of "Bian Du" (Inguinal Abscess), Xue Ji's methods are already quite detailed. However, cases caused by unclean sexual intercourse and infection with venereal toxins are the most common. Such conditions often begin with chancre (genital ulcer); before the chancre heals, Bian Du follows, which is a manifestation of damp-heat and foul toxins. In the initial stage, if there is swelling and pain but no pus formation yet, and the patient's Yuan Qi (Original Qi) remains strong, it is urgent to eliminate the toxin first. Huinong San (Hui Nong Powder) or Muli San (Oyster Shell Powder) are considered the best options. If pus has already formed, one should use acupuncture or cauterization to drain the pus as quickly as possible, followed by syndrome-specific tonification to promote rapid wound healing.

If initially there is a single nodule with slight pain and diffuse swelling, this presents two patterns: one due to mild pathogenic factors, and the other due to weak Yuan Qi allowing deep-seated toxins. For mild pathogens, applying Huitong Gao (Hui Tong Plaster) mixed with musk externally will invariably resolve the swelling; Jiangyong San (Jiang Yong Powder) may also be used. For cases where Yuan Qi is weak and toxins are deep, the condition will neither dissipate nor suppurate early; the longer it persists, the worse it becomes, which is most alarming. After ulceration, healing is often difficult; in mild cases, it may lead to fistula formation, and in severe cases, it can be fatal. Only vigorous tonification of Yuan Qi can prevent such harm.

If swelling and pain are severe and pus is about to form, making resolution impossible, apply Jiangyong San around the base while leaving the head open. This will help contain the spread, relieve pain, and accelerate pus maturation and rupture.

Xue Ji stated: Bian Yong (Inguinal Abscess) belongs to the Foot Jueyin Liver Meridian, characterized by internal heat and external cold. It may result from excessive labor, irregular sexual activity, suppressed desires, forced retention of essence, or damp-heat in the Liver meridian. Generally, it affects those who are overworked and deficient in both essence and qi. The folk saying calls it "Shi Mi Chuang" (Stone Rice Sore), claiming it takes 100 days to heal. However, if blood and qi are vigorously tonified, it can heal in less than ten days. Why wait 100 days? Wound healing depends on the abundance of blood and qi. Some cases arise from internal accumulation of heat toxins; one must differentiate between deficiency and excess, and whether pus has formed, rather than indiscriminately using purgative drugs. Women suffering from this usually present with swelling and pain in the hypochondrium, abdominal masses, and dysuria. With proper treatment and self-care, there is little to worry about. Often, practitioners indiscriminately use rhubarb and similar purgatives to seek internal resolution, or allow pus to exit via the bowel once formed; few recover. People desire internal resolution because they fear the difficulty of wound closure. But if blood and qi are tonified, closure occurs in ten days; what is the difficulty? Once pus is formed, it cannot be dissolved. Using draining agents at this stage will inevitably make treatment difficult.

He further stated: Bian Yong is essentially a Blood Hernia, commonly called Bian Du, meaning an abscess in an inconvenient location. It involves the Foot Jueyin meridians, as well as the Chong, Ren, and Du vessels, which are collateral branches of the Liver. These are pathways for the smooth flow of qi and blood. Obstruction here causes swelling and pain due to heat toxins. One should first unblock the stagnation, then use interior-supporting formulas. This is the method of adapting treatment to clinical circumstances.

According to "Treatment Methods": For internal heat and external cold, use Niuhuang Shuangjie San (Cattle Gallstone Double-Resolution Powder). For damp-heat obstruction, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction) to soothe the Liver and guide out stagnation. For reversed qi and essence due to suppressed desires, first use Wuling San plus rhubarb to unblock stagnation, then use Dihuang Wan (Rehmannia Pill) to tonify the Liver and Kidney and strengthen essence. For irregular sexual activity, use Liuwei Wan (Six-Ingredient Pill) ingredients. For excessive fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

A male patient suffered from Bian Du with testicular swelling and pain, constipation of both stool and urine, and a forceful pulse. Two doses of Yuzhu San (Jade Candle Powder) rapidly alleviated symptoms, followed by four doses of Longdan Xiegan Tang, which resolved the condition.

Another male patient had severe pain without significant pus formation; decoctions for detoxification and interior support were ineffective. His pulse was flooding and large, indicating lingering toxin. One dose of Xianfang Huoming Yin (Immortal Life Elixir Decoction) stopped the pain, and a second dose resolved the swelling.

A scholar presented with swelling, pain, and dysuria. Two doses of Bazheng San (Eight-Ingredient Powder for Rectification) cleared Liver fire and guided out damp-heat, resolving the swelling and pain. Subsequently, two doses of Xiaochaihu Tang (Minor Bupleurum Decoction) modified with Chuanxiong, Danggui, Ze Xie, and Shan Zhi cleared fire, nourished blood, and restored normal urination.

A male patient had an ulcerated sore with persistent pain and urinary retention, indicating unresolved Liver fire. He was given Xiaochaihu Tang modified with Huangbai, Zhimu, Chuanxiong, and Danggui. Pain ceased, urination normalized, and Tuoli Danggui Tang (Interior-Supporting Angelica Decoction) promoted wound contraction. If toxin remains unresolved and pain persists, Xianfang Huoming Yin is required.

Shen Niwen, a government student aged twenty, suffered from left-sided testicular disease. Identifying Kidney and Liver Yin deficiency, I first used interior-supporting herbs. After ulceration and near recovery, he engaged in sexual activity, leading to fever, thirst, right-sided pain, thin purulent discharge, and full manifestation of deficiency signs. His pulse was flooding and forceless, a dire prognosis. Tenquan Dabu Tang (Complete Great Tonification Decoction) with one qian of Fuzi (Prepared Aconite Root) rapidly reduced pulse and symptom severity; two more doses led to complete resolution. He subsequently took Dabu Tang (Great Tonification Decoction) for thirty doses to fully recover.

A male patient presented with swelling but no ulceration due to Yang Qi deficiency. Ginseng, Astragalus, Angelica, and Atractylodes were used to tonify and support Yuan Qi; Baizhi, Gleditsia Spine, Bupleurum, and Licorice were added to drain pus and clear Liver heat. After several doses, it ulcerated. Bazhen Tang (Eight-Treasure Decoction) plus Bupleurum was then used to tonify blood and qi, leading to recovery after several doses.

Ling Daizhi, a student, was nearly critical due to taking draining medicines while deficient. I cured him with interior-supporting and spleen-strengthening herbs. Scholar Wang Wenyuan contracted the disease due to hard labor; after Xiaochaihu Tang dispersed exterior signs, interior-supporting herbs were used. Once pus formed, it was lanced, and he recovered within ten days. Official Hu had thin pus and a weak pulse; he recovered with great tonification. However, upon remarriage, the condition recurred. Self-medication with Liaoqiao Xiaodu San (Forsythia Detoxification Powder) caused intractable diarrhea and dysentery, leading to death. This demonstrates that this condition is mostly deficiency-type and requires tonification. Generally, Bian Du belongs to the Liver meridian; initial hardness is due to the Liver governing sinews. After five to seven days, it should become red and soft as pus forms. If it remains hard, it indicates Yuan Qi's inability to transform tissue into pus. Often, seeing hardness, people seek internal resolution and take attacking/dispersing medicines, causing deficiency-to-deficiency disasters. Previous treatments serve as proof.

A female patient presented with bilateral hypochondriac swelling and pain, abdominal fullness, frequent urination, leukorrhea, alternating chills and fever, and dribbling urine. I diagnosed Spleen Qi stagnation and Blood pathology. Longdan Xiegan Tang gradually improved her condition, followed by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Liuwei Wan (Six-Ingredient Pill) for complete recovery.

Another female patient felt a blockage in the lower abdomen, with swelling in both hypochondria and around the anus, dysuria, irregular menstruation, internal heat, thirst, poor appetite, and an abdominal mass growing from egg-sized. Her pulse was flooding, rapid, and empty, especially at the Left Guan position, indicating Liver-Gallbladder Qi Stagnation. Jiawei Guipi Tang (Modified Restore the Spleen Decoction) cleared Liver fire and strengthened Spleen Earth. Intermittently, Xiaoyao San with Lubellia Pills was administered, resulting in recovery. (All notes by Xue Ji)