立斋曰∶囊痈，属肝肾二经，阴虚湿热下注也。肿痛未作脓者，疏肝导湿。肿硬发热者
，清肝降火。已溃者，滋阴托里。大抵此证，属阴道亏，湿热不利所致，故滋阴除湿药不可
缺。常治肿痛小便秘涩者，用除湿为主，滋阴佐之。肿痛已退，便利已和者，除湿滋阴药，
相兼用之。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。湿毒已尽
者，专用托里。如脓清，或多，或敛迟者，用大补之剂，及豆豉饼灸之。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。
又法曰∶若小便涩滞者，先用分利，以泄其毒，继补阴，以令其自消。若湿热退，而仍
肿痛，宜补阴托里，以速其脓。脓肿而便秘者，热毒壅闭也，先用托里消毒散，后用针以泄
之，脓去即解。若脓去而肿痛不减者，热毒未解也，用清肝益营汤。口干而小便数者，肾经
虚热也，六味丸。内热晡热者，肝经血虚也，四物加参、术。体倦食少者，脾气虚热也，补
中益气汤。脓水清稀者，气血俱虚也，十全大补汤。此证虽大溃，而睾丸悬露，治得其法，
旬日间肉可渐生而愈。若专攻其疮，阴道益虚，则肿者不能溃，溃者不能敛，少壮者成痼疾
，老弱者多致不起。亦有患痔久漏，而串及于囊者，当兼治其痔，切忌寒药克伐，亏损胃气
。
马益卿曰∶囊痈者，湿热下注也。有作脓者，此浊气下流入渗道，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，以麸炭末敷之，外以紫苏包裹，仰卧而养之。痈疽入囊者，予尝治数人，悉
以湿热入肝经施治，而用补阴佐之，虽脓溃皮脱，睾丸悬挂，皆不死。
一男子患此，未作脓而肿痛，以加味龙胆泻肝汤，二剂少愈，更以四物汤加木通、知母、黄柏而愈。
一男子， 肿痛甚，小便涩，发热脉数，以龙胆泻肝汤，倍用车前子、木通、茯苓，四
剂势去其半。仍用前汤，止加黄柏、金银花四剂，又减二三，便利如常。唯一处不消，此欲
成脓也。再用前汤加金银花、白芷、皂角刺六剂。微肿痛，脉滑数，乃脓已成，令针之，肿
痛悉退。投滋阴托里药，及苏叶末敷之而愈。
一膏粱之客，阴囊肿胀，小便不利，此中焦积热，乘虚下注，先用龙胆泻肝汤，加黄
柏、牛膝，四剂渐愈，后用补阴八珍汤，加柴胡、山栀而愈。后不守禁忌，前证复作，仍用
补阴八珍汤、补中益气汤、六味丸而痊。又因劳倦发热，自用四物、黄柏、知母之类，虚证
悉具，疮口大开。余谓五脏气血俱虚也，朝用补中益气，夕用六君加当归各五十余剂，疮口
始敛，又用六味丸，调补而愈。
儒者陈时用，考试不利，一夕饮烧酒入房，其妻不纳，翌日阴囊肿胀 痛，遣人求治
，与清肝火除湿热之剂。城门夜闭，不及归服。翌日报云，夜来阴囊悉腐，玉茎下面贴囊者
亦腐，此肝火挟酒毒而湿热炽盛也。仍以清肝火除湿之剂加参、 、归、术四剂，腐肉尽
脱，睾丸悬挂，用大补气血并涂当归膏，囊茎全复而愈。
一男子，醉而入房，阴囊肿胀大如斗，小腹胀闷，小水淋赤，发热口干，痰涎壅盛，此膀胱
阴虚，酒毒所乘也。用六味丸料加车前、牛膝作饮，下滋肾丸，诸证顿退。再加五味、麦冬
，二剂而愈。却以补中益气加麦冬、五味，调理而瘳。若全用淡渗，复损真阴，决致不起。（俱薛按）
Xue Ji stated: Scrotal carbuncle (Nang Yong) belongs to the Liver and Kidney meridians, caused by damp-heat pouring downward due to Yin deficiency. If there is swelling and pain but no pus formation yet, one should soothe the Liver and guide out dampness. If there is induration and fever, one should clear the Liver and descend fire. If it has already ulcerated, one should nourish Yin and support the interior to expel toxins. Generally, this condition results from a deficit in the Yin pathway and unfavorable damp-heat; therefore, herbs that nourish Yin and remove dampness are indispensable. Typically, for cases with swelling, pain, and difficult urination, treatment focuses on removing dampness with nourishing Yin as an adjunct. When swelling and pain have subsided and bowel/bladder functions are normalized, herbs for removing dampness and nourishing Yin should be used together. To promote pus formation, the focus is on supporting the interior to expel toxins, with nourishing Yin as an adjunct; once pus forms, it should be lanced immediately, followed by continued use of interior-supporting and Yin-nourishing herbs. Once damp-toxins are exhausted, solely interior-supporting methods are used. If the pus is thin, excessive, or healing is slow, strong tonifying agents should be used, along with moxibustion using fermented soybean cakes. If, after ulceration, deficiency is not treated with tonification, young and robust patients may develop fistulas, while old and weak patients may not survive. Cases with thin pus, thirst, and a large pulse are also considered untreatable.
Another method states: If urination is obstructed and difficult, first use diuretic methods to drain toxins, then tonify Yin to allow natural resolution. If damp-heat recedes but swelling and pain persist, tonify Yin and support the interior to accelerate pus formation. If there is an abscess accompanied by constipation, this indicates heat-toxin blockage; first use Tuoli Xiaodu San (Support Interior and Disperse Toxin Powder), then lance to drain, which resolves the condition once pus is expelled. If swelling and pain persist after pus drainage, heat-toxins remain unresolved; use Qinggan Yying Tang (Clear Liver and Nourish Blood Decoction). Dry mouth with frequent urination indicates deficient heat in the Kidney meridian; use Liuwei Wan (Six-Ingredient Pill with Rehmannia). Internal fever or afternoon tidal fever indicates blood deficiency in the Liver meridian; use Siwu Tang (Four-Substance Decoction) added with Ginseng and Atractylodes. Fatigue and poor appetite indicate deficient heat in the Spleen Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Thin and watery pus indicates deficiency of both Qi and Blood; use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). Although this condition may involve severe ulceration with exposed testicles, if treated correctly, flesh can gradually regenerate within ten days leading to recovery. If one exclusively attacks the sore, the Yin pathway becomes more deficient, causing swollen areas to fail to ulcerate and ulcerated areas to fail to heal; young patients may develop chronic diseases, and old/weak patients often die. In cases where hemorrhoids have been leaking for a long time and spread to the scrotum, treat the hemorrhoids concurrently; strictly avoid cold/clearing herbs that attack and damage Stomach Qi.
Ma Yiqing said: Scrotal carbuncle is caused by damp-heat pouring downward. Some cases form pus because turbid qi flows downward into the urethra due to Yin deficiency and unfavorable water pathways. Once pus is exhausted, peace returns naturally; medication is not necessary, provided proper care is taken. In other cases, abdominal swelling gradually spreads to the scrotum; when swelling is severe, the scrotum may rupture spontaneously, exposing the testicles and discharging fluid. This can be treated by applying wheat bran charcoal powder, wrapping externally with Perilla leaves, and keeping the patient supine to rest. For carbuncles entering the scrotum, I have treated several patients, all managed according to damp-heat entering the Liver meridian with Yin nourishment as an adjunct. Even with pus discharge, skin shedding, and exposed testicles, none died.
A male patient suffered from this condition; before pus formation, he experienced swelling and pain. After two doses of Jia Wei Longdan Xiegan Tang (Modified Gentiana Decoction to Drain the Liver), he improved slightly. He was then cured with Siwu Tang (Four-Substance Decoction) added with Akebia Stem, Anemarrhena Rhizome, and Phellodendron Bark.
Another male patient had severe swelling and pain, difficult urination, fever, and a rapid pulse. He took Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) with increased amounts of Plantago Seed, Akebia Stem, and Poria, taking four doses until symptoms reduced by half. The same formula was continued, adding Phellodendron Bark and Honeysuckle Flower for another four doses, reducing symptoms further by two or three parts, with normal bowel and bladder function. However, one area remained unabsorbed, indicating impending pus formation. The previous formula was used again, adding Honeysuckle Flower, Angelica Dahurica Root, and Gleditsia Sinensis Spine for six doses. Mild swelling and pain appeared with a slippery, rapid pulse, confirming pus formation; he was lanced, after which swelling and pain completely resolved. He was given Yin-nourishing and interior-supporting herbs and applied Perilla leaf powder, leading to recovery.
A well-fed guest presented with scrotal swelling and difficult urination, caused by accumulated heat in the Middle Jiao pouring downward due to deficiency. He initially took Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) added with Phellodendron Bark and Achyranthes Root, improving gradually over four doses. He was then cured with Buyin Bazhen Tang (Nourish Yin Eight-Treasure Decoction) added with Bupleurum Root and Gardenia Fruit. Later, disregarding dietary restrictions, the condition relapsed. He recovered again using Buyin Bazhen Tang, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and Liuwei Wan (Six-Ingredient Pill with Rehmannia). Subsequently, due to fatigue-induced fever, he self-medicated with Siwu Tang (Four-Substance Decoction), Phellodendron Bark, and Anemarrhena Rhizome, resulting in full manifestation of deficiency symptoms and an open sore. I diagnosed this as deficiency of Qi and Blood in all five Zang organs. He took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Liujunzi Tang (Six-Gentlemen Decoction) added with Angelica Sinensis in the evening, each for over fifty doses, until the wound began to close. Finally, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was used for regulation and tonification, leading to recovery.
The scholar Chen Shiyong, disappointed by examination results, drank distilled liquor and engaged in intercourse, but his wife refused him. The next day, his scrotum swelled and became painful. He sought treatment and was prescribed herbs to clear Liver fire and remove damp-heat. Due to city gates closing at night, he could not take the medicine immediately. The next day, he reported that his entire scrotum had necrosed overnight, including the skin below the penis attached to the scrotum. This was due to Liver fire combined with alcohol toxicity, causing intense damp-heat. The prescription for clearing Liver fire and removing dampness was continued, adding Ginseng, Astragalus Root, Angelica Sinensis, and Atractylodes Macrocephala Rhizome. After four doses, necrotic tissue fell off completely, exposing the testicles. Large-scale Qi and Blood tonification and application of Angelica Sinensis ointment led to complete restoration of the scrotum and penis.
A male patient engaged in intercourse while drunk, resulting in scrotal swelling as large as a bucket, lower abdominal distension and oppression, dysuria with red urine, fever, dry mouth, and profuse phlegm-saliva. This was caused by Bladder Yin deficiency exacerbated by alcohol toxicity. He drank a decoction of Liuwei Wan ingredients added with Plantago Seed and Achyranthes Root, followed by Zishen Wan (Kidney-Nourishing Pill). Symptoms subsided instantly. Adding Schisandra Berry and Ophiopogon Tuber for two doses led to recovery. He was then regulated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Ophiopogon Tuber and Schisandra Berry, leading to cure. If purely diuretic (bland-draining) herbs were used, they would damage True Yin further, inevitably leading to death. (All notes by Xue Ji)