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Chancre occurs in the anterior yin region, also known as "Jealousy of Essence Sore" (Du Jing Chuang), formed by damp-heat pouring downward due to Liver meridian involvement. Its etiology has three sources: first, desires arise but are not fulfilled, leading to suppression of pathogenic fire, causing ruined essence and turbid blood to stagnate in the collaterals and meridians, condensing into a swelling; second, it arises from unclean sexual intercourse resulting in the transmission of licentious toxins; third, the use of hot medicines for sexual techniques, applied via smearing, washing, or rubbing, prevents ejaculation for a long time, stirring up pathogenic fire and causing stagnation. All these cases result from accumulated toxins.

Initially, some present with dysuria and painful urination, followed by the discharge of yellow, turbid ruined essence, then itching and pain in the penis, becoming hard, purple, and swollen, gradually breaking down and rotting, with dripping pus that has a fishy and pungent odor (reflecting the Liver's affinity for the fishy smell); others may initially show skin swelling that is bright and translucent like crystal, which breaks to release toxic fluid, with worsening swelling and pain, and intermittent numbness and itching. The treatment principle should focus on venting and draining pathogenic fire from the Liver and Kidney, removing dampness, and detoxifying. Formulas such as Qing Gan Dao Zhi Tang (Clear Liver and Guide Out Stagnation Decoction), Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver), Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity), Bi Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate the Clear), and Lu Hui Wan (Aloe Pill) may be selected according to circumstances; externally, Zhen Zhu San (Pearl Powder) or Wu Bao Dan (Five Treasures Pellet) can be applied.

In summary, this condition presents with diverse forms and names, varying in severity. Chancre occurring at the Ma Kou (urethral meatus) is named Xia Gan; that on the Yu Jing (penile shaft) is named Zhu Gan; sores on the shaft wrapped in swollen outer skin are named Xiu Kou Gan; external swelling of the glans resembling a crop is named Ji Su Gan; chancre that rots and falls off to one side after a long duration is named La Zhu Gan; additionally, there are various types such as Sao Gan, Yang Mei Gan, and Xuan Gen Gan. Generally, cases without exogenous pathogens require only the removal of damp-heat or nourishment of True Yin; once damp-heat is cleared, the sore heals spontaneously and is not a cause for concern. However, cases where licentious pathogens are contracted, and toxins enter directly from the Shaoyin meridian into the Essence Palace, are difficult to cure. Even when treated as described, the patient must maintain a bland diet and abstain from sexual activity. If these prohibitions are observed, medication will naturally be effective, reducing a one-month recovery period to half a month.

Shen Yan Fan Hua (Kidney Rock Turning Flower), commonly known as Fan Hua Xia Gan, does not arise from unclean sexual contact or infection with filth. It results from inherent deficiency of the Liver and Kidney, exacerbated by depression and excessive worry, causing Ministerial Fire to scorch internally. When Kidney Water fails to nourish Liver Wood, Liver Blood becomes dry and collaterals become empty. Over time, deficiency worsens, Yin Essence dries up, and Fire Pathogens stagnate, leading to disease in the Liver and Kidney regions. Initially, a fleshy nodule appears inside the Ma Kou, resembling an upright piece of meat, hard and itchy, with serous discharge. After one or two years, or five to six years, pain radiates to the heart, the Yu Jing swells gradually, and the fleshy growth at the Ma Kou turns outward like pomegranate seeds, indicating that Shen Yan is established. Gradually, the glans becomes ulcerated, convex and concave, with unbearable pain, or even profuse bleeding. At this stage, Spleen and Stomach function inevitably weakens, appetite is lost, food tastes bland, and physical and mental energy is exhausted; if bleeding occurs two or three times, the Yu Jing may completely rot away; if semen cannot be conveyed, sudden death ensues. Upon initial detection, Da Bu Yin Wan (Major Supplement Yin Pill) or Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron and Eight Ingredient Pill) should be used, combined with Ba Zhen Tang (Eight Treasure Decoction) or Shi Quan Da Bu Tang (Complete Great Tonifying Decoction). If the patient can further cultivate their spirit and preserve health, life extension may be hoped for. Once the condition reaches its advanced stage ("success"), survival is rare, and medicinal power alone cannot save them. This condition, along with She Gan (Tongue Chancre), Shi Ying (Lost Camp), and Ru Yan (Breast Rock), constitutes the Four Major Incurable Syndromes, analogous to Feng (Madness), Lao (Consumption), Gu (Abdominal Distension), and Ge (Diaphragmatic Obstruction) in Internal Medicine, and must be understood.