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Chen Shigong stated: In cases of penile injury due to squeezing or clamping during the first marriage, presenting with bleeding and pain, one should first wash the wound with scallion soup. Subsequently, apply Zhenzhu San (Pearl Powder) mixed with Bingpian (Borneol) topically. As the necrotic skin gradually dries, the pain will naturally subside. (*Waike Zhengzong*)

Feng Luzhan stated: After recovery from Shanghan (Cold Damage), if there is astringency in urination accompanied by blood, this is also caused by residual heat and toxin, termed "Nei Wai Chuang" (Internal and External Sores), which typically form crusts. If pus cannot be discharged, the prognosis is fatal. The appropriate prescription is Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) added with Shengdihuang (Rehmanniae Radix Recens), Dangguizhiwei (Angelicae Sinensis Radix Caudex), Lianqiao (Forsythiae Fructus), Mutong (Akebiae Caulis), Huashi (Talcum), Niuxi (Achyranthis Bidentatae Radix), Xianshe (Dichroae Radix), Hupo (Succinum), and Gancaoshao (Glycyrrhizae Radix et Rhizoma Tip). (*Waike Jinang*)

Wang Kentang stated: Nang Yong (Scrotal Abscess) is governed by the Foot Jueyin Liver Meridian and results from damp-heat flowing into the Liver Meridian. Treatment should focus on clearing damp-heat from the Liver, assisted by nourishing Yin and consolidating the Kidney. He further stated: Shen Yin Du (Kidney Yin Toxin), also known as Scrotal Carbuncle, arises from sitting or lying on damp ground or wearing sweat-dampened clothes for long periods. Cold-dampness attacks downward, injecting into the meridians, and persists without dispersing, leading to this condition. It initially presents as redness, swelling, and pain of the scrotum.

Zhu Danxi stated: Nang Yong is also called Waishen Yong (External Genital Abscess). This sore occurs on the upper part of the scrotum; its manifestation is most severe, causing deficiency of the Vagina (Yin Dao). Damp-heat gathers, generating this toxin. If not treated promptly, the scrotum may rupture and the testicles may hang outside. One can wrap them with fresh green lotus leaves, or with Perilla leaves (after removing hairs), or with boiled single-layer oil paper.

Chen Yuangong stated: Sores appearing on the left and right sides of the scrotum are named Biandu (Genital Swelling); those appearing below the scrotum and anterior to the anus are named Nang Yong (Scrotal Abscess). Comparing these three locations, Biandu is easy to treat, while Nang Yong is the most difficult. This is because the area below the scrotum, the Huan Yuan (Perineum), has different skin and flesh structure compared to other parts. On other parts, whether growing horizontally or vertically, wounds heal easily. However, the perineum has complex horizontal and vertical structures, making it hard to close. These conditions often result from young men indulging in alcohol and sex, suppressing ejaculation during intercourse, having sex while hungry, or engaging in coitus with women carrying venereal diseases or prostitutes with sores. This is what is meant by "desire to ejaculate but unable to, transforming into pus and blood." Treatment must strongly tonify deficiency and assist with ingredients that resolve toxins, because the toxin arises from deficiency; how can it be cured without treating the deficiency? The formula Zhuxie Zhishen Dan (Toxin-Expelling Divine Pill): Jinyinhua (Lonicerae Japonicae Flos) 4 liang, Gongying (Taraxaci Herba) 2 liang, Renshen (Ginseng Radix) 1 liang, Danggui (Angelicae Sinensis Radix) 2 liang, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 1 liang, Dahuang (Rhei Radix et Rhizoma) 5 qian, Tianhuafen (Trichosanthis Radix) 2 qian. Decoct in water. Two doses lead to recovery; for ulcerated cases, three doses achieve healing. This formula uses large doses of Jinyinhua and Gongying, assisted by substantial amounts of Renshen, Danggui, and Dahuang, which may seem too aggressive. However, for severe deficiency, using Dahuang to purge seems inappropriate. Yet, when toxin strength is high at the onset, and righteous Qi is not yet severely depleted, using strong tonification combined with purging fire is appropriate! If one hesitates and dares not treat, waiting until pus flows and blood bleeds, when righteous Qi is exhausted, and then starts using Renshen to tonify Qi, often requiring several jin, still failing to restore vitality, why not use it early within the process of resolving toxins? This protects righteous Qi and facilitates toxin dispersion. This is the method of guiding according to the trend, which must be understood. (*Shishi Milu*)

He further stated: Some individuals drink strong liquor and engage in sexual activity, preventing ejaculation. By midnight, they experience chills, fever, restlessness, thirst, dysuria with red urine, and profuse phlegm-saliva. The next day, the scrotum swells and hurts. The following day, the entire scrotum becomes necrotic, and the penis adhering to the scrotum also rots. People attribute this to liquor toxicity, unaware that Liver Fire is exacerbated by liquor toxin and dampness. How can liquor cause rotting? Strong liquor is extremely hot. Excessive drinking often leads to death from drunkenness, after which the body rots. This is because liquor is qi; when liquor meets heat, it burns itself. The five zang and six fu organs inherently possess fire. Using fire to attract fire, how can inflammation not occur? Drinking strong liquor before sex stirs the fire of the essence chamber, which should be Mingmen Fire (Gate of Life Fire), not Liver Fire. However, Wood generates Fire; the Liver naturally generates Ministerial Fire, which is normal. With the aid of strong liquor during sex, the fire force becomes fierce. Fire moving without root, how can it last? It must cease when essence is released. Unfortunately, the desire to release is suppressed, leaving no outlet for the fire, no foundation to rely on, and no way to resolve the liquor. Thus, fire enters the Liver, returning to its mother organ. Ministerial fire is internal fire, able to attach to the Liver as home. Liquor fire is external fire, which instead burns the body through Wood. The scrotum and penis are fire of the sinews; sinews belong to the Liver. Due to gathering in the yin organs during sex, fire erupts causing scrotal swelling. Extreme swelling leads to penile necrosis. Treatment should resolve liquor toxin and supplement Qi and Blood, so that damp-heat resolves and necrotic tissue regenerates. The formula Jiufu Tang (Decoction for Saving Necrotic Tissue): Renshen (Ginseng Radix) 1 liang, Danggui (Angelicae Sinensis Radix) 2 liang, Huangqi (Astragali Radix) 2 liang, Baizhu (Atractylodis Macrocephalae Rhizoma) 1 liang, Fuling (Poria) 5 qian, Huangbai (Phellodendri Cortex) 3 qian, Chao Zhizi (Gardeniae Fructus, Stir-fried) 3 qian, Yiren (Coicis Semen) 5 qian, Zexie (Alismatis Rhizoma) 3 qian, Baishao (Paeoniae Radix Alba) 1 liang, Gegen (Puerariae Lobatae Radix) 3 qian. Decoct in water and take orally. Four doses remove necrotic tissue and generate new flesh; another four doses flatten the scrotum and penis completely. Liquor toxin forms due to suppression; soothing the Liver, draining fire, promoting diuresis, and resolving toxin is appropriate. Why use Renshen, Huangqi, Danggui, and Baizhu to strongly tonify Qi and Blood? Generally, those with abundant Qi and Blood have strength to overcome liquor; even heavy drinking causes no harm. Rotting after consuming strong liquor implies Qi and Blood were deficient, lacking strength to overcome the liquor. Thus, two fires combined led to burning the outer body. If Qi and Blood are not urgently supplemented, liquor toxin cannot be eliminated, and how can necrotic tissue grow quickly?

Chen Shigong stated: Nang Yong (Scrotal Abscess) is caused by Yin deficiency with damp-heat flowing into the scrotum, condensing into a swelling. Even if the testicles hang after ulceration, it does not endanger life, as the toxin emanates externally. Treatment should nourish Yin and clear/drain damp-heat; efficacy is achieved in 80-90% of cases. Modern practitioners mistakenly use hot herbs for hernia, often exacerbating heat into pus, making convergence difficult. Initially, Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) is suitable. Later, nourish Yin. Apply Jinhuang San (Golden Yellow Powder) externally. If swelling and pain persist for a long time and internal pus forms, causing distending pain, puncture to drain. Internally, administer Shiquan Dabu Tang (Ten Substance Tonifying Decoction) added with Shanzhuyu (Corni Fructus), Mudanpi (Moutan Cortex), and Zexie (Alismatis Rhizoma). Intermittently administer Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) for peace. (*Waike Zhengzong*)

Feng Luzhan stated: Books say sores/carbuncles entering the scrotum are fatal, belonging to damp-heat in the Liver Meridian. Initial swelling and pain with red, astringent urination should be treated primarily with clearing, draining, and detoxifying. If pus forms and urination is difficult, the toxic gas has not dispersed; puncture to drain. If pain persists after pus discharge, it indicates Qi and Blood deficiency; tonify them. If primordial Qi is intact but the scrotum fully ulcerates with exposed testicles, it is also harmless. (*Waike Jinang*)

He further stated: If children suffer from this due to their wet nurse's frequent anger, both mother and child should take herbs to clear the Liver.

He further stated: Ulceration of the scrotum with exposed testicles is called Tuonang (Scrotal Detachment). Grind Perilla stems into fine powder. Apply dry if wet, or mix with sesame oil if unbroken. Wrap with fresh green lotus leaves. Internally administer Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Mutong (Akebiae Caulis), Danggui (Angelicae Sinensis Radix), etc. Most patients survive; do not fear.

Dou Hanqing stated: For Nang Yong requiring surgical incision when pus is ripe, wait until the pus is mature. Tie the testicles tightly with an oiled hair rope. Use a small knife to open the Haidi Acupoint (Sea Bottom Point). Pus and blood will flow out completely.

Li Dongyuan stated: The classic says carbuncles entering the scrotum are fatal. Does this imply it belongs to the Kidney? I treated several patients, addressing damp-heat entering the Liver Meridian, assisted by Yin-nourishing herbs. Even with pus discharge, skin shedding, and hanging testicles, death did not occur. I am only unsure about elderly patients with lower deficiency. (*Waike Jingyao*)

Wang Shengzhi stated: Nang Yong is caused by damp-heat sinking downward, turbid qi flowing smoothly into the Bladder. Deficiency of the Vagina leads to obstructed damp-heat, sometimes forming pus. Therefore, herbs for nourishing Yin and removing dampness are absolutely indispensable. Once pus is exhausted, peace returns. (*Waike Lili*)

Hu Gongbi stated: There are cases where abdominal swelling gradually flows into the scrotum. Severe swelling causes the scrotum to split open, with testicles hanging outside and continuous fluid leakage. Apply fir wood charcoal powder. Wrap thickly with Perilla leaves. Have the patient lie supine to rest. Internally administer Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) added with Yin-nourishing herbs. Self-healing occurs upon ingestion. (*Qingnang Mijuan*)