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Xue Lizhai stated: Duogu Ju (Bone-abscess) arises from chronic ulceration where Qi and Blood fail to nourish the affected area, allowing pathogenic factors to invade. Over time, this leads to the rotting of sinews and bones, resulting in the shedding of bone fragments. This condition belongs to the deficiency syndrome of the three Yin meridians of the foot. Treatment should employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to consolidate the root. If fever is caused by deficient fire, it should be assisted with Liuwei Wan (Six-Ingredient Pill with Rehmannia) to strengthen the source of water (nourish Kidney Yin) to calm the excessive Yang. If there is Yang deficiency and cold, it should be assisted with Bawei Wan (Eight-Ingredient Pill with Rehmannia) to benefit the source of fire (warm Kidney Yang) to dissipate Yin shadows. Externally, use Aizi Bing (Moxibustion with Prepared Aconite Cake) and Congyi Fa (Scallion Moxibustion Method) to disperse cold pathogens and replenish Ying Qi (Nutritive Qi), so that the bone will naturally shed and the sore will heal. The Kidney governs the bones; if Kidney Qi is deficient, the bones gradually swell, and after a long period, they ulcerate and expel bone fragments. The aforementioned methods should also be used here. If one administers purgative or attacking agents, further damaging the True Qi, few cases will not result in disaster.

Xiagan (Chancre) is essentially a damp-heat syndrome of the Liver and Kidney. If contracted without external causes, one need only clear the damp-heat or nourish the True Yin. Once the damp-heat is cleared, the sore heals spontaneously, requiring no worry. However, for those infected by obscene toxins, the depth of the toxin determines the severity of the disease. All such cases are suitable for fumigation and washing with Baicao Jian (Hundred Herb Decoction), and externally applying Piaoxiao San (Cuttlefish Bone Powder). Mild cases will heal on their own. If damp-heat is severe, causing swelling and pain, Shaoyao Jili Jian (Peony and Tribulus Decoction) should be used for combined treatment. If the toxin is deep-seated, Bishe Tang (Dissolve Turbidity Decoction) is necessary. If the obscene toxic pathogen enters directly from the Shao Yin meridian into the Jing Gong (Essence Palace/reproductive system), it is difficult to cure. Even when treated as described above, healing of Xiagan will only occur after Biandu (Perineal Abscess) and Guangchuang (Lues/Soft Chancre) manifest. Once these sores appear, treatment should follow the protocols for those specific conditions.

I once treated a young man who suddenly developed Xiagan after accidentally contacting filth and toxins. Initially, the glans penis ulcerated, and topical treatments were ineffective. The toxin then spread inward from the Meikou (Urethral Orifice) along the urethra, deepening progressively until it reached the anus, causing segmental swelling and pain resembling fish bones. Every night, pus accumulated at the urethral orifice, causing distension and inability to discharge. After lubricating and clearing the passage, pus would exit before urine. Topical applications and washes could not reach the lesion, making the situation critical and frightening. I encountered a hermit who passed down the Huaihua Rui Fang (Sophora Flower Bud Prescription). Using this formula, the base of the penis improved within ten days, and within half a month, the lesion receded from inside out to the urethral orifice, achieving complete recovery. After the chancre healed, slight signs of Guangchuang appeared. I then administered Wujia Pi Yin (Acanthopanax Decoction) for over ten doses, leading to full recovery. When asked about the prescription, the hermit said, "This formula excels at treating heat-toxins from obscene sores, expelling them entirely through urination, which is why it cures this chancre. Those who take it can avoid lifelong sequelae of skin toxins." However, there is another miraculous verification for detoxification: during the outbreak of sores, if cloud-like red macules suddenly appear all over the body and vanish after a few days, these are the sites where toxins are destined to erupt. The resolution of the toxin is confirmed when the toxin clears but the sore morphology remains visible. I initially did not believe this, but when this patient's sores erupted, although few in number, the whole-body red macules indeed appeared and vanished after two days. Only then did I realize the miraculous nature of sores, reaching such an extent. (New Commentary)

Xue Lizhai stated: Xiagan belongs to damp-heat pouring downward from the Liver Meridian, or Yin deficiency with dry fire. For treatment: if swelling, pain, and fever are present, it indicates Blood deficiency with heat; use Siwu Tang (Four Substances Decoction) added with Chaihu (Bupleurum) and Shanzhi (Gardenia). If swelling, pain, and alternating chills and fever occur, it is damp-heat in the Liver Meridian; use Xiaochaihu Tang (Minor Decoction for the Gallbladder) added with Longdancao (Gentian) and Huanglian (Coptis). If swelling, pain, and urinary difficulty are present, it is damp-heat stagnation; use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If swelling, pain, and ulceration occur, it is Qi and Blood deficiency with fire; use Bazhen Tang (Eight Treasure Decoction) added with Shanzhi and Chaihu. If high fever occurs around Shen hour (3-5 PM), it is Yin Blood deficiency with fire; use Xiaochaihu Tang added with Renshen (Ginseng), Baizhu (Atractylodes), Chuanxiong (Sichuan Lovage), and Danggui (Angelica Sinensis). If fatigue occurs around Shen hour, it is Qi deficiency with sinking; use Buzhong Yiqi Tang. If the condition persists for a long time with chills and fever, it indicates Kidney Water failing to generate Liver Wood; use Liuwei Wan. If tendon contraction or flaccidity, itching, pain, or white discharge occurs, this is Jinshan (Sinew Hernia); use Longdan Xiegan Tang. For Qi deficiency, use Buzhong Yiqi Tang added with fried Shanzhi and fried Longdancao. For Yin deficiency with dry fire, use Liuwei Wan. For itching in the shaft with white discharge, alternate Buzhong Yiqi Tang with Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction). Generally, the root of this condition is Liver Yin deficiency, while symptoms like swelling, pain, chills, and fever are the branch. One must use Liuwei Wan to generate Liver Blood. Whenever Spleen Earth is too weak to generate Lung Metal and Kidney Water, presenting with various Liver syndromes, assist with Buzhong Yiqi Tang added with Maidong (Ophiopogon) to nourish the source of transformation.

One man had persistent swelling and pain. Another man had ulceration with swelling, pain, fever, scanty and difficult urination, and afternoon fever. A child had swelling and pain unresponsive to various medicines. All three were cured after taking several doses of Xiaochaihu Tang swallowed with Lushui Wan (Aloe Pill).

A fifteen-year-old boy suffered from the aforementioned condition. Due to indiscriminate use of detoxifying drugs, he exhibited all signs of deficiency for over two years. Upon inquiry, the cause was congenital constitution. He was treated with Bishe Tang, and after a month, his symptoms gradually resolved. He then recovered using Buyin Bazhen Tang (Nourishing Yin Eight Treasure Decoction) and Buzhong Yiqi Tang.

Shuji Shi Liu Huaful occasionally experienced pain in the penile shaft, white discharge from the orifice, or scanty and difficult urination. Initially, he took Xiaochaihu Tang added with Shanzhi, Zexie (Alisma), Huanglian, Mutong (Akebia), Dancao (Gentian), and Fuling (Poria) for two doses to clear Liver Fire and drain damp-heat, resolving his symptoms. Later, due to fatigue, he suddenly developed chills and fever, indicating a relapse of Yuanqi (Original Qi) injury. He was stabilized with Buzhong Yiqi Tang. He then took Liuwei Wan to generate Liver Blood and nourish Kidney Water, achieving complete recovery.

One man had painful swelling of the jade stem (penis), urinary symptoms resembling strangury, spontaneous sweating, severe distress, occasional slight hematuria, and a Chi pulse that was flooding and rapid but choppy upon pressure. He first took Qingxin Lianzi Yin added with Niuxi (Achyranthes), Shanzhi, Huangbai (Phellodendron), Zhimu (Anemarrhena), and Chaihu for several doses, showing slight improvement. Then, he took Zishen Wan (Nourish Kidney Pill), recovering completely after one dose. *Yuji Wei Yi* states: "If there is spontaneous sweating and little urine, do not use diuretics. Since sweating has occurred, fluids have escaped externally, and urine is naturally reduced. Further diuresis would deplete Ying and Wei, failing to control fire, thereby worsening irritability and heat. One should wait for the fever to subside and sweating to stop, after which urination will resume naturally." This condition involves the Yangming Meridian and strictly forbids diuretic therapy. (All comments by Xue Ji)

Haizang's prescription for chronic non-healing Xiagan:
Two acorn cups filled with Huangdan (Red Lead Oxide), tightly bound with tangled hair, burned until smoke ceases, then ground into fine powder. First, wash the sore with hot scallion water until pus is gone, then apply the medicine. Severe cases require no more than three applications for miraculous results.

Another prescription for Xiagan:
For Xiagan with intense internal toxins, internal treatment is necessary for cure. For external treatment, Piaoxiao San is required, or this formula is also good.
Renzhongbai (Human Tooth Ash, raw) Guafen (Refined Starch, calcined yellow) Hongdan (Red Lead, refined and stir-fried)
Grind equal parts into powder. First clean with medicinal decoction or strong tea, then apply. Use two to three times daily, mixed with pig fat or honey water for application.