痛或发热者，清肝解毒。肿痛者，解毒为主。肿痛小便赤涩者，肝经湿热也，宜分利
清肝。不作脓或不溃者，气血虚也，宜补之。
一男子患此， 痛发寒热，以小柴胡汤加制甘草，二剂，少退；又制甘草四剂而消。大
抵此
不动脏腑，其功甚捷，最宜用之不可忽也。
一男子肿痛，小便赤涩，以加减龙胆泻肝汤加制甘草，二剂稍愈；以参、 、归、术、
黄柏、知母、制甘草，四剂而溃；更加以四物汤、黄柏、知母、参、 、制甘草而痊。
一男子脓清不敛，内有一核，以十全大补汤加青皮、柴胡、制甘草，更以豆豉饼灸之，
核消而敛。
一男子久而不敛，脉大而无力，以十全大补汤加五味子、麦门冬，灸以豆豉饼，月余而
愈。
一老人年余不敛，诊其脉，尚有湿热，以龙胆泻肝汤，二剂湿退；乃以托里药，及豆豉
饼，灸之而愈。
一男子肿痛发热，以小柴胡汤加黄连、青皮，四剂稍愈，更以加减龙胆泻肝汤而消。
一男子肿痛未作脓，以加减龙胆泻肝汤，二剂少愈；以四物汤加木通、知母、黄柏而消
一男子脓熟不溃，胀痛，小便不利，急针之，尿脓皆利；更以小柴胡汤加黄柏、白芷、
金银
地，若一有脓，宜急针之，使毒外发，不致内溃。故前人云∶凡疮若不针烙，毒结无从而解
，脓瘀无从而泄。又云∶宜开户以逐之。今之患者，反谓地部紧要，而不用针，何其相违之
远矣！
一男子脓熟不溃，脉数无力，此气血俱虚也，欲治以滋阴益血气之剂，更针之，使脓毒
外泄。
，阴虚虽一于补，尤恐不治，况脓成而又克伐，不死何俟。常治初起肿痛，或小便赤涩，先
以制甘草一二剂及隔蒜灸，更饮龙胆泻肝汤；若发热肿痛者，以小柴胡汤加车前、黄柏、芎
、归；脓已成，即针之；已溃者，用八珍汤加制甘草、柴胡稍、炒黄柏、知母；小便涩而脉
有力者，仍用龙胆泻肝汤加制甘草；小便涩而脉无力者，用清心莲子饮加制甘草；脓清不敛
者，用大补之剂，间以豆豉饼灸之；久而不敛者，用附子饼灸之，并效。
附方
小柴胡汤（方见瘰 门）
制甘草 治悬痈肿痛，或发寒热，不问肿溃，并有神效。其法∶每大甘草一两，
切三寸许，用涧水一碗，浸透，慢火炙干，仍投前水浸透，再炙，将碗水炙干为度，锉细，用无
灰酒一碗，煎至七分，去渣，空心服。
加减龙胆泻肝汤（方见下疳门）
四物汤（方见瘰 门）
十全大补汤（方见溃疡发热门）
豆豉饼（方见臀痈门）
隔蒜灸法（方见发背门）
托里消毒散（方见肿疡门）
清心莲子饮（方见下疳门）
八珍汤（方见溃疡发热门）
附子饼（方见臀痈门）
When pain or fever occurs, employ the method of clearing the Liver and resolving toxicity. When swelling and pain are present, prioritizing detoxification is appropriate. If swelling and pain are accompanied by red and scanty urine, it indicates damp-heat in the Liver channel; the treatment should focus on separating and draining dampness while clearing Liver heat. If pus does not form or the sore does not ulcerate, it is due to deficiency of Qi and Blood, requiring tonification.
A male patient suffered from this condition, presenting with pain, chills, and fever. He was prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao). After two doses, symptoms subsided slightly; after four more doses of processed Glycyrrhizae Radix et Rhizoma, he recovered. Generally, this remedy acts swiftly without disturbing the Zang-Fu organs, making it highly suitable and not to be neglected.
Another male patient presented with swelling, pain, and red, scanty urine. He was treated with Jia Jian Long Dan Xie Gan Tang (Modified Gentiana Decoction to Drain the Liver) plus processed Glycyrrhizae Radix et Rhizoma. After two doses, he improved slightly. Subsequently, he took Ginseng Radix et Rhizoma (Renshen), [missing herb], Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), and processed Glycyrrhizae Radix et Rhizoma for four doses, leading to ulceration. Finally, taking Si Wu Tang (Four Substance Decoction) combined with Huangbai, Zhimu, Renshen, [missing herb], and processed Glycyrrhizae Radix et Rhizoma resulted in full recovery.
A male patient had clear pus that failed to heal, with a hard nodule inside. He was given Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) augmented with Citri Reticulatae Pericarpium (Qingpi), Bupleuri Radix (Chaihu), and processed Glycyrrhizae Radix et Rhizoma. Additionally, moxibustion with fermented soybean cakes (Dou Chi Bing) was applied. The nodule dissipated, and the wound healed.
Another male patient had a non-healing wound persisting for a long time, with a large but forceless pulse. He was treated with Shi Quan Da Bu Tang added with Schisandrae Fructus (Wuweizi) and Ophiopogonis Radix (Maidong), along with moxibustion using fermented soybean cakes. He recovered after more than a month.
An elderly patient had a wound that had not healed for over a year. His pulse indicated residual damp-heat. He was prescribed Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver). After two doses, the dampness receded. He was then treated with internal medicine to support the healthy Qi and moxibustion with fermented soybean cakes, resulting in recovery.
A male patient presented with swelling, pain, and fever. He was treated with Xiao Chai Hu Tang added with Coptidis Rhizoma (Huanglian) and Qingpi. After four doses, he improved slightly, and subsequent treatment with Jia Jian Long Dan Xie Gan Tang led to resolution.
A male patient had swelling and pain but no pus formation. He was given Jia Jian Long Dan Xie Gan Tang for two doses, showing slight improvement. Then, Si Wu Tang added with Akebiae Caulis (Mutong), Zhimu, and Huangbai resolved the condition.
A male patient had mature pus that did not ulcerate, accompanied by distending pain and difficulty in urination. Urgent acupuncture was performed, allowing both urine and pus to drain freely. He was then treated with Xiao Chai Hu Tang added with Huangbai, Angelicae Dahuricae Radix (Baizhi), Lonicerae Japonicae Flos (Jinyinhua), and [missing herb, likely Diguipi]. Once pus forms, urgent acupuncture is necessary to allow the pathogenic factor to exit externally, preventing internal rupture. Hence, predecessors stated: "For any carbuncle, if not punctured or cauterized, the toxin cannot be resolved, and stagnant pus cannot be drained." It is also said: "One should open the gate to expel the pathogen." Today's patients, considering the genital area sensitive, refuse acupuncture, which deviates significantly from ancient practices.
Another male patient had mature pus that did not ulcerate, with a rapid and forceless pulse, indicating deficiency of both Qi and Blood. The intention was to treat with formulas nourishing Yin and benefiting Qi and Blood, combined with acupuncture to drain the pus and toxin externally.
[Text appears fragmented here, inferred meaning:] If one only tonifies in cases of Yin deficiency, it may still be difficult to cure; how much more so if purgatives are used when pus has formed? Death would be inevitable. Standard treatment for initial swelling and pain, or red/scanty urine, involves taking processed Glycyrrhizae Radix et Rhizoma for one or two doses and moxibustion with garlic slices (Ge Suan Jiu), followed by drinking Long Dan Xie Gan Tang. For fever and swelling/pain, use Xiao Chai Hu Tang added with Plantaginis Seed (Cheqianzi), Huangbai, Ligusticum Chuanxiong Rhizoma (Chuanxiong), and Danggui. Once pus forms, puncture it immediately. If already ulcerated, use Ba Zhen Tang (Eight Treasure Decoction) added with processed Glycyrrhizae Radix et Rhizoma, Chaihu Shao (tip of Bupleuri Radix), stir-fried Huangbai, and Zhimu. If urine is scanty with a forceful pulse, continue using Long Dan Xie Gan Tang with processed Glycyrrhizae Radix et Rhizoma. If urine is scanty with a forceless pulse, use Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction) with processed Glycyrrhizae Radix et Rhizoma. For clear pus that fails to heal, use major tonifying agents, occasionally applying fermented soybean cake moxibustion. For chronic non-healing wounds, apply moxibustion with prepared Aconite root cakes (Fuzi Bing), which is effective.
Attached Formulas:
Xiao Chai Hu Tang (See section on Scrofula)
Processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao): Treats swelling and pain of Xueyong (Perineal Abscess), or chills and fever, whether swollen/ulcerated or not, with miraculous effect. Method: Take one tael of large Glycyrrhiza, cut into three-inch pieces. Soak in one bowl of spring water until saturated. Slowly roast dry, return to the same water to soak again, then roast again until the water in the bowl is completely dry. Finely chop. Decoct in one bowl of pure wine (without ash) until reduced to seventy percent. Strain and take on an empty stomach.
Jia Jian Long Dan Xie Gan Tang (See section on Chancre)
Si Wu Tang (See section on Scrofula)
Shi Quan Da Bu Tang (See section on Ulcer with Fever)
Fermented Soybean Cake (Dou Chi Bing) (See section on Buttock Carbuncle)
Garlic-Slice Moxibustion (Ge Suan Jiu Fa) (See section on Back Carbuncle)
Tuo Li Xiao Du San (See section on Pre-ulcerative Stage)
Qing Xin Lian Zi Yin (See section on Chancre)
Ba Zhen Tang (See section on Ulcer with Fever)
Prepared Aconite Root Cake (Fuzi Bing) (See section on Buttock Carbuncle)