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The anus is governed by the Foot-Taiyang Bladder Meridian (the Huiyang [BL35] acupoint of this meridian is located beside the anus). This meridian is a site where damp-heat pathogens accumulate. Abscesses occurring here are mostly due to injuries from excessive alcohol and sexual activity, leading to the failure of turbid dampness to transform and the stagnation of Qi movement. Initially, it presents with aversion to cold and fever, pain encircling the anus, diffuse redness and swelling, hard and constipated stools, and difficult urination. In the early stage, treatment should focus on clearing and draining heat from the Lung and Stomach, using herbs such as fresh Rhizoma Dioscoreae Hypoglaucae (Xian Di), Semen Armeniacae Amarum (Xing Ren), Flos Sophorae (Huai Mi), Radix Sanguisorbae (Di Yu), Radix Scutellariae (Qin), Fructus Gardeniae (Lian - *Note: Context implies Huanglian/Coptis*, but text says Lian, usually refers to Coptis or Gardenia in combination, here likely Coptis for clearing heat), Fructus Aurantii (Zhi Qiao), Rhizoma Phragmitis (Lu Gen), and juice of Sugarcane (Zhe Zhi) etc. If stool remains unpassed, Liangge San (Cool the Middle Palace Powder) should be used to unblock the Fu organs. Once stool is passed, the damp-toxin is discharged with the feces, and sometimes pus may not form at all. If after stool passage the swelling and pain remain unchanged and pus forms around the anus, it is called Zang Tou Du (Visceral Head Toxin); if pus forms on the left or right side, it is called Tou Fen Shu (Stealing Feces Rat); if pus discharges from both sides, it is called Gang Men Yong (Anal Abscess). Medications should include Radix Angelicae Sinensis Caulis (Gui Wei), Rhizoma Anemarrhenae (Bi Xie), Flos Sophorae (Huai Mi), Semen Coicis (Yi Yi Ren), Cortex Moutan (Dan Pi), and Fructus Gardeniae (Shan Zhi) to clear and drain damp-heat from the Lower Jiao. After this condition ulcerates and discharges pus, the fever naturally subsides, the body cools, and pain stops. If the Liver and Kidney essence are sufficient and Qi and Blood are harmonious, the wound will heal within ten days. If it lingers without healing, it often becomes a fistula; generally, Sheng Yao Tiao (Elevating Medicine Strips) should be used to promote pus discharge and remove necrotic tissue. Although this sore has three names, its essence is always the downward pouring and knotting of damp-heat. The medication and treatment methods are identical, so they are discussed together.

Commentary: For treating fistulas, there is also the method of ligature and cutting, which is most detrimental, only increasing pain and damaging the spirit, while the fistula ultimately does not resolve. This is because muscle fibers obstruct and form a tube. Without gradually applying medicine to cause necrotic tissue to fall off and be removed, how can the muscle texture be thoroughly repaired? The treatment method of Zhuge Jing Shan in recent times was excellent, but unfortunately, he has passed away, and his method has been lost.

Tun Yong (Buttock Abscess) occurs above the buttocks, below the hip joint, near the thigh. It is formed by the flow and accumulation of damp-heat in the Foot-Taiyang Bladder Meridian, causing Qi and Blood to condense. The mass is large like a plate, swollen and broad reaching one chi, covering the waist above and hiding the hip below. This belongs to Yin within Yin. It is essential to vent heat and extract toxins, greatly tonify Qi and Blood, nourish the Kidneys and Stomach, and supplement the root. Only then can blood easily gather, pus easily form, toxins easily exit, and heat be dispersed. Otherwise, after months, the swelling remains as before, and pain deepens daily. Therefore, even after middle age, one must fear contracting this disease. As soon as weakness is observed, immediate tonification ensures ultimate auspiciousness. If mistakenly treated with cooling and detoxifying agents, taken internally and applied externally, Qi and Blood will become more stagnant due to cold, and toxic vapors will fail to emerge outward, instead attacking inward, often leading to untreatable conditions. Treatment method: If initially the affected area has a head, with redness, heat, heaviness, and hardness like stone, accompanied by dry mouth and fever, this indicates toxin accumulated from the Five Zang organs. It is appropriate to internally use Wo Xue Tang (Snow-Melting Decoction) to unblock accumulated heat, externally apply Ru Yi Jin Huang San (Ruyi Golden Yellow Powder) to draw out stasis, pus, and purple blood, and simultaneously use supporting/tonifying drugs for self-healing; if there is diffuse swelling with white color and a weak pulse, this indicates cold coagulation and damp stagnation with deficiency of both Qi and Blood. It is appropriate to take Guizhi Heying Tang (Cinnamon Twig Decoction to Harmonize the Ying Level) and concurrently take Wan Ling Dan (Ten Thousand Spirits Pill) to induce sweating; after ulceration, take Bazhen Tang (Eight Treasure Decoction) or Shiquan Dabu Tang (Complete Great Tonifying Decoction) to promote healing.

Qima Yong (Horse-Riding Abscess), also known as Pian Ma Zhui, occurs beside the scrotum, on the inner side of the root of the thigh, in the cleft between the thighs. It is formed by the knotting and stagnation of damp-fire in the Liver and Kidneys. This location is the lowest part of extreme Yin. Medical treatment must not overuse cold-cooling agents, nor should scalpels or needles be used. If needles must be used, depth should be limited to one or two fen; caution is paramount! At the onset, treating with Qiwei Shenshen Tang (Seven-Ingredient Divine Spirit Decoction) is very effective. Since this toxin enters via deficiency, it is necessary to greatly tonify Blood and assist with anti-pathogenic herbs, so that the disease will depart as if lost. Other methods are the same as previously described.

Appendix: Shangma Yong (Upper Horse Abscess) occurs in the fold below the left buttock; Xia Ma Yong (Lower Horse Abscess) occurs in the fold below the right buttock; Zuoma Yong (Sitting Horse Abscess) occurs slightly above the coccyx. All are caused by the concretion of damp-heat.