肿痛未作脓者，疏肝导湿。肿硬发热者，清肝降火。脓成胀痛者，急针之，更饮清毒之
剂。已溃者滋阴托里。脓清不敛者，大补气血。
一男子患此，肿痛发热，以小柴胡汤加黄连、青皮，四剂少愈；更以加减龙胆泻肝汤而
消。
一男子未作脓而肿痛，以加减龙胆泻肝汤，二剂稍愈；更以四物汤加木通、知母、黄柏
而愈。
一男子脓熟作胀，致小便不利，令急针之；以小柴胡汤加黄柏、白芷、金银花，四剂少
愈；更以托里消毒散，数剂而愈。
一男子阴囊肿，状如水晶，时痛时痒，出水，小腹按之作水声，小便频数，脉迟缓，此
醉后
便如常，再饮胃苓散，倍用白术、茯苓，更用气针引去积水而瘥。
一男子患而久不敛，以十全大补汤，加五味子、麦门冬，灸以豆豉饼，月余而平。
一弱人肿痛，未成脓，小便赤涩，以制甘草、青皮、木通、黄柏、当归、麦门冬，四剂
少愈，以清心莲子饮，而消。
一男子 肿痛甚，小便涩，发热脉数，以龙胆泻肝汤，倍用车前子、泽泻、木通、茯苓
，四
也；再用前汤加金银花、白芷、皂角刺，六剂，微肿痛，脉滑数，乃脓已成，令针之，肿痛
悉退；投之滋阴托里药，及紫苏末敷之而愈。
一男子病势已甚，脉洪大可畏，用前汤二剂，肿少退；以仙方活命饮，二剂痛少止。诊
其脉
挂悬。复求治，诊其脉将静，以八珍汤加黄 、黄柏、知母、山栀，更敷紫苏末，数日而愈
。此证势虽可畏，多得保全，患者勿惧。
一弱人脓熟胀痛，大小便秘，急针之，脓出三碗许，即鼾睡，觉后神思少健，但针迟虽
敷解
除湿药不可缺。常治肿痛小便秘涩者，用除湿为主，滋阴佐之；肿痛已退便利已和者，除湿
滋阴药，相兼治之；欲其成脓，用托里药为主，滋阴佐之；候脓成，即针之，仍用托里滋阴
湿毒已尽者，专用托里；如脓清，或多，或敛迟者，用大补之剂，及豆豉饼，或附子饼灸之
。如卢武选封君年五十患此，疮口年余不敛，诊之微有湿热，乃以龙胆泻肝汤治之，湿热悉
退；又以托里药及豆豉饼灸之而愈。次年复患，湿热颇盛，仍用前汤四剂而退，又以滋阴药
而消。若溃后，虚而不补，少壮者成漏，老弱者不治。脓清作渴，脉大者，亦不治。
附方
加减龙胆泻肝汤（方见下疳门）
小柴胡汤（方见瘰 门）
十全大补汤（方见溃疡发热门）
制甘草（方见悬痈门）
四物汤（方见瘰 门）
清心莲子饮（方见下疳门）
八珍汤（方见溃疡发热门）
托里消毒散（方见肿疡门）
导水丸（方见便痈门）
胃苓散
猪苓 泽泻 白术 茯苓 苍术 浓朴 陈皮（各一钱） 甘草（炙） 肉桂（各五分） 作
一剂，水二钟，姜三片，枣二枚，煎八分服。
仙方活命饮（方见发背门）
豆豉饼（方见臀痈门）
For Nangyong (scrotal abscess characterized by swelling and pain), if there is swelling and pain but no pus formation, employ methods to soothe the Liver and guide out dampness. If there is hard swelling accompanied by fever, employ methods to clear Liver heat and descend fire. If pus has formed causing distending pain, urgently puncture with a needle, and subsequently administer detoxifying agents. If the sore has ulcerated, employ nourishing Yin and supporting the interior to expel toxins. If the pus is thin and the wound fails to heal, employ major tonification of Qi and Blood.
A male patient suffered from this condition, presenting with swelling, pain, and fever. He was treated with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huanglian (Coptis Rhizome) and Qingpi (Aurantii Fructus Immaturus). After four doses, symptoms slightly improved; subsequently, Jiajian Longdan Xiegan Tang (Modified Gentiana Liver-Draining Decoction) was used until resolution.
Another male patient presented with swelling and pain before pus formation. He was treated with Jiajian Longdan Xiegan Tang (Modified Gentiana Liver-Draining Decoction). After two doses, symptoms slightly improved; subsequently, Siwu Tang (Four Substances Decoction) added with Mutong (Akebia Caulis), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex) led to recovery.
Another male patient had mature pus causing distending pain, resulting in difficulty urinating. The physician ordered urgent puncture to drain the pus. He was then treated with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huangbai (Phellodendri Cortex), Baizhi (Angelicae Dahuricae Radix), and Jinyinhua (Lonicerae Japonicae Flos). After four doses, symptoms slightly improved; subsequently, Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) was administered for several doses until recovery.
A male patient presented with scrotal swelling resembling crystal, intermittent pain and itching, discharge of fluid, water-sounding percussion note upon pressing the lower abdomen, frequent urination, and a slow, moderate pulse. This was caused by sexual activity after drinking alcohol. Treatment involved regulating his constitution, followed by Weiling San (Gastrointestinal Regulating Powder) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria), combined with Qi acupuncture to drain accumulated fluids, leading to recovery.
A male patient suffered from the condition for a long time without healing. He was treated with Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Wuweizi (Schisandrae Fructus) and Maimendong (Ophiopogonis Radix), moxibustion with Douchi Bing (Fermented Soybean Cake), resulting in resolution after more than a month.
A frail patient presented with swelling and pain, no pus formation, red and scanty urine. He was treated with Zhi Gancao (Prepared Licorice Root), Qingpi (Aurantii Fructus Immaturus), Mutong (Akebia Caulis), Huangbai (Phellodendri Cortex), Danggui (Angelicae Sinensis Radix), and Maimendong (Ophiopogonis Radix). After four doses, symptoms slightly improved; subsequently, Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) led to resolution.
A male patient presented with severe swelling and pain, obstructed urination, fever, and rapid pulse. He was treated with Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) with increased amounts of Cheqianzi (Plantaginis Semen), Zexie (Alismatis Rhizoma), Mutong (Akebia Caulis), and Fuling (Poria). After four doses, symptoms slightly improved. The formula was then modified by adding Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Zaojiaoci (Gleditsiae Spina), administered for six doses. Only slight swelling and pain remained, with a slippery, rapid pulse, indicating pus formation. Puncture was performed, resolving all swelling and pain. Nourishing Yin and supporting interior medications were administered, along with external application of Zisu Mo (Perilla Leaf Powder), leading to recovery.
A male patient presented with severe disease progression and a terrifyingly large, surging pulse. Two doses of the previous formula reduced swelling slightly. Xianfang Huoming Yin (Immortal Life Elixir) was then administered for two doses, reducing pain slightly. Upon re-examination, the pulse was still hanging and tense. Upon seeking treatment again, the pulse had calmed. Bazhen Tang (Eight Treasures Decoction) added with Huangqi (Astragali Radix), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and Shanzhi (Gardeniae Fructus) was used, along with external application of Zisu Mo (Perilla Leaf Powder), leading to recovery within several days. Although the condition appeared formidable, most patients were preserved; patients need not fear.
A frail patient presented with mature pus, distending pain, and constipation of both stool and urine. Urgent puncture drained approximately three bowls of pus. He fell into a deep sleep immediately after, and upon waking, his mental state slightly improved. However, due to delayed puncture, although detoxifying and damp-draining applications were used, they were indispensable. Generally, for swelling and pain with difficult urination, damp-draining is primary, with Yin-nourishing as auxiliary. For resolved swelling/pain and normalized bowel/bladder functions, damp-draining and Yin-nourishing are combined. To promote pus formation, interior-supporting drugs are primary, with Yin-nourishing as auxiliary. Once pus forms, puncture is performed, continuing interior-supporting and Yin-nourishing treatments. If damp-toxin is exhausted, solely use interior-supporting drugs. If pus is thin, excessive, or healing is slow, use major tonifying agents and moxibustion with Douchi Bing (Fermented Soybean Cake) or Fuzi Bing (Aconite Cake). For example, Lu Wuxuan, a nobleman aged fifty, suffered from this condition with a non-healing sore for over a year. Diagnosis revealed slight damp-heat. He was treated with Longdan Xiegan Tang (Gentiana Liver-Draining Decoction), clearing the damp-heat completely, followed by interior-supporting drugs and moxibustion with Douchi Bing, leading to recovery. It recurred the following year with significant damp-heat, treated with four doses of the same formula to resolve it, followed by Yin-nourishing drugs for complete resolution. If, after ulceration, deficiency is not tonified, young and strong individuals may develop fistulas, while old and weak individuals may die. Thin pus with thirst and a large pulse also indicates an untreatable condition.
Attached Formulas:
Jiajian Longdan Xiegan Tang (Modified Gentiana Liver-Draining Decoction) (See Under-Foreskin Section)
Xiaochaihu Tang (Minor Bupleurum Decoction) (See Scrofula Section)
Shiquan Dabu Tang (Complete Great Tonifying Decoction) (See Ulcer Fever Section)
Zhi Gancao (Prepared Licorice Root) (See Suspended Perineum Section)
Siwu Tang (Four Substances Decoction) (See Scrofula Section)
Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) (See Under-Foreskin Section)
Bazhen Tang (Eight Treasures Decoction) (See Ulcer Fever Section)
Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) (See Swollen Sore Section)
Daoshui Wan (Water-Guiding Pill) (See Genital Abscess Section)
Weiling San (Gastrointestinal Regulating Powder)
Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Cangzhu (Atractylodis Rhizoma), Nongpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium) (each 1 qian), Gancao (Licorice Root, honey-fried) (0.5 qian), Rougui (Cinnamomi Cortex) (0.5 qian). Prepare as one dose, boil with two zhong of water, three slices of ginger, and two jujubes, reduce to eight fen, and take orally.
Xianfang Huoming Yin (Immortal Life Elixir) (See Back Carbuncle Section)
Douchi Bing (Fermented Soybean Cake) (See Buttock Abscess Section)