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Xue Ji stated: Xuan Yong (Hanging Abscess) refers to a sore located posterior to the Yujing (penis) and anterior to the Gudao (anus). It belongs to the syndrome of deficiency in the Three Yin Meridians of the Foot. In mild cases, it may develop into a fistula; draining all Qi and Blood leads to death. In severe cases, internal ulceration occurs leading to immediate demise. Generally, this condition originates from Yin deficiency of the Liver and Kidney; thus, individuals with constitutions prone to deficiency are susceptible. Even if treated solely with tonification, there is still concern that it may not be curable, let alone if purgative or attacking methods are used after pus formation—who could expect survival? Even cold-natured medicines should not be overused, as they may damage Stomach Qi. Only processed Licorice Root (Zhi Gancao) stands out; it does not deplete Blood and Qi nor disturb the Zang-Fu organs, and its efficacy is rapid. It is most suitable for use and should not be neglected.

If pain or fever is present, clear the Liver and resolve toxicity. If swelling and pain predominate, resolving toxicity is the primary approach. If swelling, pain, accompanied by red and scanty/difficult urination, indicates Damp-Heat in the Liver Meridian; appropriate treatment involves separating and draining Damp-Heat while clearing the Liver. If pus fails to form or the sore fails to ulcerate, it indicates Qi and Blood deficiency, requiring tonification.

Furthermore, "Treatment Methods" states: For initial onset characterized by Damp-Heat-induced swelling and pain, or red/scanty urination, initially administer one to two doses of processed Licorice Root (Zhi Gancao), combined with Garlic-Separated Moxibustion (Gesu Jiu), followed by drinking Longdan Xiegan Tang (Gentiana Liver-Draining Decoction). If swelling and pain are severe, Xianfang Huoming Yin (Immortal Life Elixir) is indicated, assisted by processed Licorice Root (Zhi Gancao). If accompanied by fever and swelling/pain, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qiancao (Plantago Seed), Huangbai (Phellodendron Bark), Chuanxiong (Szechwan Lovage Rhizome), and Danggui (Angelica Sinensis) should be used. If pus does not form, or forms but does not ulcerate, Bazhen Tang (Eight-Treasure Decoction) is used for tonification. If pus has already formed, urgent needle drainage is required. For already ulcerated sores, Bazhen Tang (Eight-Treasure Decoction) added with processed Licorice Root (Zhi Gancao), Chaishao (Bupleurum Tip), wine-fried Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) is prescribed. If urination is difficult but the pulse is forceful, continue using Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) with processed Licorice Root (Zhi Gancao). If urination is difficult but the pulse is weak, Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) with processed Licorice Root (Zhi Gancao) is indicated. If pus is thin and fails to heal, use strong tonifying agents, interspersed with Fermented Soybean Cake Moxibustion (Douchi Bing Jiu). For chronic non-healing, Aconite Cake Moxibustion (Fuzi Bing Jiu) is also effective. To promote tissue regeneration and contraction: for Kidney deficiency, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); for Blood deficiency, Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala); for Qi deficiency, Sijunzi Tang (Four-Gentlemen Decoction) added with Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis); for Spleen deficiency, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for combined Qi and Blood deficiency, Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten Great Tonifying Decoction). Using cold-natured detoxifying methods would be an error.

Chen Liangfu stated: To treat abscesses arising before and after the anus, termed Xuan Yong (Hanging Abscess), use one liang of Fen Gancao (Powdered Licorice Root), cut into sections, soak in mountain spring water, roast thoroughly until penetrating, finely chop, and decoct in pure wine (without ash impurities) for administration. One patient whose sore had already ruptured healed completely after two doses.

A frail individual presented with a nodule at the root of the penis, size of a soybean, causing swelling and pain upon exertion. Initially treated with Shiquan Dabu Tang (Ten Great Tonifying Decoction) minus Rougui (Cinnamon Bark), added with Cheqianzi (Plantago Seed), Maidong (Ophiopogon Tuber), wine-processed Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome), showing slight improvement. Subsequently, processed Licorice Root (Zhi Gancao) was administered, leading to gradual recovery, finally resolved with Siwu Tang (Four-Substance Decoction) and Cheqianzi (Plantago Seed).

A male patient suffered from this condition with pain and fever. After two doses of Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) and four doses of processed Licorice Root (Zhi Gancao), the sore ulcerated. He recovered following treatment with Yin-nourishing agents.

If pus has not yet formed, apply cooked scallions topically, replacing when cool; Garlic-Separated Moxibustion (Gesu Jiu) is also applicable. If unresolved after several days, or failing to ulcerate/heal, prioritize Shiquan Dabu Tang (Ten Great Tonifying Decoction) with Chaishao (Bupleurum Tip), interspersed with processed Licorice Root (Zhi Gancao). Without proper care, it will inevitably become a fistula.

A scholar suffered from Xuan Yong (Hanging Abscess) without response to Kanli Wan (Kanli Pill), Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome). The pulse was floating and surging, but fine upon deep pressure. I diagnosed it as deficiency of the Three Yin Meridians of the Foot. Gradual recovery occurred with Tuoli San (Support-the-Interior Powder) and Buyin Bazhen Tang (Yin-Nourishing Eight-Treasure Decoction). Further treatment with Liuwei Wan (Six-Ingredient Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) regulated the source of transformation, resulting in complete recovery after half a year. Generally, for sores and ulcers, if Hyperactive Fire in the Kidney Meridian prevents the generation of Yin Water, causing Yin-deficiency fever, Kanli Wan (Kanli Pill) is indicated for its bitter-cold nature to transform fire within water, allowing fire to subside and water to regenerate. If Weak Yang prevents the generation of Yin Water, causing Yin-deficiency fever, Liuwei Wan (Six-Ingredient Pill) is indicated for its sour-warm nature to generate water within fire, strengthening Yang so Yin naturally arises. Moreover, 80-90% of such cases belong to Jing-Qi deficiency of the Kidney Meridian, while only 10-20% involve Hyperactive Yang of the Kidney Meridian. However, patients in Jiangnan often suffer from Yin-Blood deficiency of the Spleen Meridian and sinking of Yuan Qi; thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is necessary to raise and tonify Yang, promoting Yang growth to nourish Yin. For those with excessive sexual desire damaging True Yin, Liuwei Wan (Six-Ingredient Pill) is suitable to tonify Kidney Yuan Qi to generate Essence and Blood, combined with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to cultivate Spleen-Lung generating Qi and nourish Kidney Water. The Classic states that "Yin deficiency is essentially Spleen deficiency," yet it is frequently mistaken for Kidney Fire syndrome. Using Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) further damages Spleen-Lung, severing the source of transformation, leading to untreatability—a great pity.

Zhang Jingzhi of Tong Prefecture suffered from the aforementioned condition chronically. He experienced intense heat in the late afternoon, thirst, irritability, and panting. Treatment with Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) worsened his condition, leading to limb fatigue, poor appetite, loose stools, and frequent urination. He asked me, "Why?" I replied, "This is a Spleen deficiency syndrome exacerbated by previous medications." I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber) for several doses. His diet gradually improved, and symptoms subsided. Adding Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry) completed the regulation and cure. The Classic states: "The Spleen belongs to Taiyin, is Yin Earth, and governs blood generation." Therefore, Dongyuan stated: For Spleen deficiency with sinking of Yuan Qi, presenting with fever, irritability, thirst, and limb fatigue, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used to raise and tonify Yang to generate Yin Blood. Mistaking this for Kidney deficiency with hyperactive fire and using Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) damages the generating Qi of the Spleen and Stomach, thereby exacerbating deficiency. Furthermore, Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) are agents that drain Yang and damage Yin; they should not be used unless there is Hyperactive Bladder Yang Fire preventing the generation of Yin Water, causing fever. (All notes by Xue Ji)