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(This condition is not significantly different from syphilitic sores.)

Zhu Danxi treated a neighbor, over thirty years old, with a cunning and irritable temperament, who suffered from chronic chancres (genital ulcers) that came and went. In early summer, he developed white dysentery and slight chest oppression. The physician administered Lizhong Tang (Regulate the Middle Decoction) for four doses, after which the patient became comatose as if dead, reviving only after a short while. Pulse diagnosis revealed both wrists were choppy (Se); upon heavy pressure, they felt slightly wiry and rapid. Zhu said: "This indicates severe and deep-seated chancres." He prescribed Danggui Longhui Wan (Angelica Sinensis and Gardenia Pill) without musk, taken for four doses, which reduced the dysentery. Subsequently, he prescribed Xiaochaihu Tang (Minor Bupleurum Decoction) without Banxia, adding Huanglian, Baishao, Chuanxiong, and Shengjiang, decocted and taken for five to six doses, resulting in recovery.

Xue Lizhai treated a male patient with chancres characterized by swelling and pain that did not subside; another male patient with ulcerated, swollen, and painful lesions, fever, and scanty, difficult urination, with afternoon fevers; and a child with swelling and pain unresponsive to various medications. All three were cured after taking several doses of Xiaochaihu Tang (Minor Bupleurum Decoction) swallowed with Longhui Wan (Gardenia Pill).

Another fifteen-year-old boy suffered from the aforementioned condition. Due to the indiscriminate use of detoxifying herbs, he developed symptoms of deficiency and cold over more than three years. Upon inquiry, it was determined to be due to congenital constitution. After one month of treatment with Bixie Tang (Dioscorea Hypoglauca Decoction), his symptoms gradually improved. He was then cured using Buyin Bazhen Tang (Nourish Yin Eight Treasure Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction).

A male patient presented with swelling and pain of the penis, urinary symptoms resembling strangury, severe spontaneous sweating, and occasional slight hematuria. His Chi pulse was surging and rapid but choppy upon heavy pressure. Initially, Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) was used with Niuxi, Zhizi, Huangbai, Zhimu, and Chaihu for several doses. He was then cured with one dose of Zishen Wan (Kidney-Nourishing Pill). *Yuji Wei Yi* states: "In cases of spontaneous sweating and scanty urine, further promoting diuresis will deplete Ying and Wei (Nutritive and Defensive Qi), failing to control Fire, thereby worsening irritability and heat. One must wait for the heat to recede and sweating to stop, at which point urination will normalize naturally." This condition involves the Yangming channel and strictly contraindicates diuretics.

Zhang Jingyue treated a young man who suddenly developed chancres after accidental exposure to toxic filth. Initially, the glans and shaft ulcerated, and topical treatments failed. The lesion subsequently spread from the Meikou (urethral meatus) into the urethra, progressing deeply toward the anus, causing segmental swelling and pain resembling fish bones. Every night, pus accumulated at the meatus, causing distension and inability to expel it. Lubrication allowed the discharge of pus followed by urine, but topical washes could not reach the site. Zhang had previously met an old mountain dweller who transmitted the Huaihua Rui Formula (Sophora Flower Bud Formula). Using this, the root of the penis healed within ten days. Within half a month, the healing progressed from inside out, retreating to the meatus until full recovery. Later, mild syphilitic sores appeared, which were cured with Wujia Pi Yin (Acanthopanax Bark Decoction) over ten doses. The informant stated: "This formula effectively treats venereal sores by draining heat toxins via urine, preventing lifelong sequelae." He also mentioned a diagnostic sign: during the outbreak, sudden cloud-like red patches appearing on the body and disappearing within days indicate where sores will emerge. Once the toxin is resolved, the scar forms remain, confirming the diagnosis. Zhang initially doubted this, but when the patient later exhibited these signs, the red patches appeared and vanished in two days. (Formula found in *Xinyin Zhen*, Volume 40.)

Xue Lizhai treated Jiang Jiefu, Prefect of Zhou, who suffered from chancres with dripping pus, thirst, expectoration, morning chills, and afternoon fever. Xue explained: "Morning chills indicate deficient Yang Qi; afternoon fever indicates deficient Yin Blood." The patient disbelieved this and took Erchen Tang (Two-Aged Decoction) along with Zhi Mu and Huang Bai, leading to decreased appetite and loose stools. Later, he developed evening fever/thirst, heavy sensation in the lower abdomen, and local swelling. Taking Siwu Tang (Four Substance Decoction) with Zhi Mu and Huang Bai resulted in loss of appetite, indicating Spleen Qi deficiency with sinking. Xue first prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) to regulate the Spleen and Stomach and raise Yang Qi, resolving most symptoms. He then used Liuwei Wan (Six-Ingredient Pill) to nourish Kidney Water, generating Liver Blood, leading to recovery.

A male patient with chancres presented with hard swelling, pain, and alternating chills and fever. He was treated with Renshen Baidu San (Ginseng Detoxification Powder) for two doses to stop the symptoms, followed by Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huanglian and Qingpi, resulting in cure.

Another male patient with ulcerated, swollen, and painful chancres and dark, scanty urine was treated with Jiajian Longdan Xiegan Tang (Modified Gentiana Drain Liver Decoction) added with Qingpi and Huanglian. After two doses, he improved slightly. He was then cured with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhi Mu, Huang Bai, Danggui, and Fuling over several doses.

A male patient, exhausted by labor, experienced itching in the urethral orifice, intermittent discharge of white fluid, fever, and dry mouth. He was treated with Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) and recovered.

A male patient with ulcerated, swollen, and painful chancres and fever, worse in the evening, was cured with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huanglian, Zhimu, and Danggui.

A male patient whose chancres had healed still had a persistent nodule in the penis. He was treated with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qingpi, Jingjie, and Fangfeng. Additionally, a decoction of Jingjie, Fangfeng, Niuxi, Shouwu, Huashi, and Gancao (each 5 qian) was used for fumigation and washing. Several doses eliminated the nodule.

A male patient experienced pain in the penis, sometimes with tendon spasms/contraction or itching, accompanied by white fluid discharge following urination. This is classified as Jin Han (Tendon Hernia). It was cured using Longdan Xiegan Tang (Gentiana Drain Liver Decoction). Zhang Zihe stated: "Enuresis, retention of urine, impotence, bladder paralysis, seminal emission, and leukorrhea are all types of hernia in men and should not be wrongly attributed to Kidney Cold. In women, blood depletion with amenorrhea, heat in the waist and knees after menstruation ceases, dryness of the legs and throat, urinary retention, abdominal masses (fixed or moving), protrusion of the external genitalia, and posterior anal hemorrhoids are all types of hernia in women. However, in women, this is called Jia (masses) rather than Han."

A male patient with lower body chancres unresponsive to medication developed generalized edema resembling "turning flowers," with tendon pulling and bone pain, worse at night. This was caused by Damp-Heat in the Liver and Kidney channels. He was first given Daoshui Wan (Water-Guiding Pill) five times, then Longdan Xiegan Tang (Gentiana Drain Liver Decoction) for several doses, followed by Damp-draining and Spleen-strengthening herbs. Topically, Shenyi Gao (Miraculous Ointment) was applied to drain pus and blood, and garlic moxibustion was used to draw out toxins, leading to recovery. For exterior excess patterns, Jingfang Baidu San (Arisaema and Saposhnikovia Detoxification Powder) is used. For interior excess, Neishu Huanglian Tang (Interior-Draining Coptis Decoction) is used. For simultaneous exterior and interior excess, Fangfeng Tongsheng San (Saposhnikovia Unblocking Success Powder) is used. For simultaneous exterior and interior deficiency, Bazhen Tang (Eight Treasure Decoction) is used. For Qi deficiency, Sijunzi Tang (Four Gentlemen Decoction) is used. For Blood deficiency, Siwu Tang (Four Substance Decoction) is used. All are modified according to accompanying symptoms and result in cure. (The general principles of treating sores are outlined here.) If mercury compounds like Qinfen are used, toxins may be driven inward, causing recurrent outbreaks. Many patients died because they indiscriminately took Fangfeng Tongsheng San (Saposhnikovia Unblocking Success Powder), further depleting Qi and Blood.

Miao Zhongchun treated several friends with chancres using Huangbai, Gongfen, Nifen, Xingren, Zhumo, and Bingpian topically, achieving universal cures. Later, he removed Nifen and Xingren, added Huangqin, and washed the area with Da Xiaoji and Digupi Decoction before application, yielding even better results. (*Guang Biji*)

Another powder formula for chancres involves burning olives to ash, grinding them into fine powder, and applying it to the lesion.

Zhongchun’s secret divine formula for chancres uses fresh Xiaoji and fresh Digupi (3 liang each), decocted into a thick liquid for soaking. Recovery occurs in three to four days. This is highly effective for extremely painful cases. (Ibid.)

Xue Lizhai treated an elderly man with chancres, dribbling urine, thin pulse, and fatigue, diagnosed as Qi deficiency combined with Damp-Heat. He was cured with Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). Another frail patient suffered from pain in the urethra and dribbling urine due to Fire-Dryness, lack of Blood in the Lower Jiao, inability of Qi to descend, and failure of diffusion and excretion functions. He was cured with Siwu Tang (Four Substance Decoction) added with Huangbai, Zhimu, Fuling, Niuxi, and Mutong over ten doses, stopping pain and normalizing urination. My father suffered from shortness of breath, urethral pain resembling sores, and urinary retention. He was cured with Siwu Tang (Four Substance Decoction) added with Renshen and Huangqi, decocted and taken with Zishen Wan (Kidney-Nourishing Pill). Generally, such conditions have deficiency as the root and disease as the branch. Tonifying the root resolves the branch. Failing to consolidate Yuan Qi and focusing solely on attacking the disease causes deeper harm.

Wu Jinyi, over forty years old, suffered from chronic chancres, pain, and fatigue. He was cured with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huanglian, Huangbai, Qingpi, and Danggui.

Miao Zhongchun’s formula for chancres: Chan Tui (Cicada Slough) 7 fen, Bai Jiangcan (White Silkworm) wrapped in Zisu Ye and honey-fried, 7 pieces; Xingren (Apricot Seed) peeled and cored, 7 grains; Bajiao Gen (Musa Basjoo Root) mashed, 5 qian; Duhe Feizao Ren (Single Kernel Soap Nut) 7 grains; Xuelihong (Choy Sum) mashed, 1 handful; Tufuling (Smilax Glabra Rhizome) peeled, 2 liang; Baixianpi (Dictamnus Cortex) 1 qian; Niuxi (Achyranthes Root) 2 qian; Huangbai (Phellodendron Bark) 1 qian; Mutong (Akebia Stem) 7 fen; Zaojia He (Gleditsia Spine/Core) 7 grains; Yiyiren (Coix Seed) 2 qian; Lianqiao (Forsythia Fruit) 1 qian; Hanfangji (Stephania Tetrandra) soaked in wine, 6 fen; Gancao Jie (Licorice Joint) 1 qian; Shihu (Dendrobium Stem) 3 qian; Chaihu (Bupleurum Root) 6 fen; Bixie (Dioscorea Hypoglauca Rhizome) 2 qian; Digupi (Wolfberry Bark) 2 qian. Decoct in water, take anytime, especially when hungry. For Qi deficiency and weak Spleen, add honey-fried Huangqi (Astragalus Root) 3 qian. For Blood deficiency, add Shengdi (Rehmannia Root) 3 qian.