薛立斋治一男子囊痈，未作脓而肿痛，以加味龙胆泻肝汤，二剂少愈。更以四物汤加木通、知母、
黄柏而愈。
一男子囊痈， 肿痛甚，小便涩，发热，脉数，以龙胆泻肝汤，倍用车前子、木通、茯苓，四剂
势去其半。
仍以前汤，止加黄柏、金银花，四剂又减二三，便利如常。唯一处不消，此欲成脓也，再用前汤加金
银花、白芷、角刺，六帖微肿痛，脉滑数。乃脓已成，令针之，肿痛悉退。投滋阴托里药，及紫苏末
敷之愈。
一膏粱之客，阴囊肿胀，小便不利，此中焦积热，乘虚下注。先用龙胆泻肝汤加黄柏、牛膝，四
剂渐愈。后用补阴八珍汤加柴胡、山栀而愈。后不守禁忌，前症复作，仍用补阴八珍汤、补中益气汤、
六味丸而痊。又因劳倦发热，自用四物汤、知、柏之类，虚症悉具，疮口大开，五脏气血俱虚也。朝
用补中益气，夕用六君加当归，各五十余帖，疮口始敛。又用六味丸，调理而愈。
知州黄汝道先晡热发热，肢体倦怠，入房则腿足酸软，足心热至腿膝，六脉洪数，两尺为甚。此
足三阴虚，欲滋补化源，彼反服苦寒降火之剂。后阴囊肿胀，以疝治之，肿胀益甚，形气愈虚。服温
补之剂，肿痛上攻，小便不利，两尺脉洪，按之虚甚。曰∶此囊痈也。因气血虚而不能溃，先用补中
益气汤加山药、山萸、车前、柴胡、山栀，一剂，肿胀顿消。随用六味丸料加车前、牛膝、柴胡、山
栀，一帖，小便渐通。乃用活命饮与前二药消息间用，至二十余剂，囊裂出秽脓甚多。乃用托里消毒
散六剂，脓秽清。又用托里散数剂，脓水渐少。更用补阴托里散及十全大补，五十余剂而痊。
府庠李达卿，素肾虚发热，久服知、柏之类，形体渐瘦，遗精白浊，晡热吐痰。此肾水亏损，虚
火内炽，用补中益气之类，加五味、麦冬。前症将愈，又别用清热凉血之剂，饮食少思，唾痰不止。
此脾虚复损，不能摄涎归源，仍用前汤加茯苓、半夏而愈。后入房，头晕吐痰，腰骨作痛，大小便牵
痛，此精已耗而复竭所致，危殆之症也。遂朝用前汤加麦冬、五味，夕用六味丸料加五味、萆 ，五
十余帖，诸症顿退。后又入房，阴囊阴茎作痛，别用淡渗之剂，阴囊内溃。乃用补阴托里之剂，出脓
甚多。喜肿消痛止，竟不善调养，致大便不通，小便如淋，痰涎上涌。此肾虚之症复作矣，诚为可虑。
有保其可生者，用礞石滚痰丸、牛黄清心丸之类，吐痰愈加。曰∶非惟无益，保其生而反促其危矣。
辞不治，果殁。
一男子患囊痈，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愈。
一男子囊痈，脓热作胀，致小便不利。令急针之，以小柴胡汤加黄柏、白芷、银花，四剂少愈，
更以托里消毒散，数剂而痊。
一男子囊肿，状如水晶，时痛时痒，出水，小腹按之作水声，小便频数，脉迟缓，此醉后饮水入
房，汗出遇风，寒湿毒瓦斯聚于囊为患，名水疝也。先以导水丸二服，腹水已去，小便如常。再饮胃苓
散，倍苓、术，更用针引，去聚水而痊。
一男子患囊痈，久而不敛，以十全大补汤加五味子、麦冬，灸以豆豉饼，月余而平。
一弱人囊痈肿痛，未成脓，小便赤涩，以炙甘草、青皮、木通、黄柏、当归、麦冬，四剂少愈，
以清心莲子饮而消。
一男子患囊痈，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。脉
之滑数，乃脓已成，须针之，否则囊皆溃。不信，遂更他医，果大溃，睾丸悬挂。复求治，诊之，脉
将静，以八珍汤加黄 、知、柏、山栀，更敷紫苏末，数日而痊。此症势虽可畏，多得保全，患者勿
惧。
一弱人患囊痈，脓熟胀痛，大小便秘结。针之脓出三碗许，即鼾睡，觉而神思少健。但针后虽敷
解毒药，亦溃尽矣，故用托里药，三十余剂始痊。大抵此症属阴道亏，湿热不利所致，故滋阴除湿为
要。常治肿痛，小便秘涩者，用除湿为主，滋阴佐之；肿痛退，便利和者，除湿滋阴相兼治之；欲其
成脓，用托里为主，滋阴佐之；脓成即针之，仍用托里滋阴；湿毒已尽，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，年逾五十患此，疮口年余不敛。诊之，
微有湿热，以龙胆泻肝汤治之，湿热悉退，乃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。
朱丹溪曰∶痈疽入囊者，予尝治数人，悉以湿热入肝经施治，而用补阴佐之。虽脓溃皮脱，睾丸
悬挂，皆不死。（《外科心法》）
薛立斋治胡同知，年逾五十，阴囊肿痛，得热愈甚，服蟠葱散等药不应。肝脉数，此囊痈也，乃
肝经湿热所致。脓已成，急针之。以龙胆泻肝汤，脉症悉退。更以托里滋阴药，外搽杉木灰、紫苏末，
月余而愈。此症虽溃尽无害，患者审之。
柏道官六十余，阴囊已溃，痛不可忍，肾丸露出，与以龙胆泻肝汤服之，及敷前末不应。竟此湿
气炽甚，先以槐花酒一碗，仍投前药，少愈。更以托里加滋阴药，月余而乎。设以前药不应，加之峻
利，未有不损中气，以致败者也。聘士陈时用、沈汝和患此，悉用前药而愈。
窦材治一人，忽遍身拘急，来日阴囊连茎大肿如斗，六脉沉紧，此阴疽也。幸未服解毒凉药，若
服之，则茎与睾丸必皆烂去而死。急令服救生汤五钱，又一服全安。
Dr. Xue Lizhai treated a male patient with scrotal carbuncle (Nang Yong). Although pus had not yet formed, there was swelling and pain. He prescribed Jiawei Longdan Xiegan Tang (Modified Gentiana Liver-Draining Decoction), which improved the condition slightly after two doses. Subsequently, Siwu Tang (Four Substances Decoction) was used with added Tongcao (Akebia Caulis), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex), leading to recovery.
Another male patient suffered from severe scrotal swelling and pain, dysuria (difficult and painful urination), fever, and a rapid pulse. He was given Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) with increased doses of Qiancaizi (Plantaginis Semen), Tongcao (Akebia Caulis), and Fuling (Poria), administered over four doses, which reduced the severity by half.
The same formula was continued, adding Huangbai (Phellodendri Cortex) and Jinyinhua (Lonicerae Japonicae Flos). After four more doses, symptoms decreased by another two-thirds, and bowel and bladder functions returned to normal. However, one area remained unsubsided, indicating impending suppuration. The previous formula was repeated with additions of Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Ci Jia (Spina Gleditsiae), taken for six doses. Mild swelling and pain persisted, and the pulse became slippery and rapid. Pus had now matured, so incision and drainage were performed, resulting in the complete resolution of swelling and pain. The patient was then given Ziyin Tuoli Yao (Yin-Nourishing and Toxin-Expelling Medicines) and externally applied with Perilla powder (Zisu Mo), achieving full recovery.
A guest accustomed to rich and fatty foods presented with scrotal swelling and dysuria. This was attributed to accumulated heat in the Middle Jiao descending due to deficiency. Initially, Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) with Huangbai (Phellodendri Cortex) and Niuxi (Achyranthis Bidentatae Radix) was used for four doses, yielding gradual improvement. Later, Buyin Bazhen Tang (Yin-Nourishing Eight-Treasure Decoction) with Chaihu (Bupleuri Radix) and Shanzhi (Gardeniae Fructus) led to recovery. However, due to violating dietary and lifestyle taboos, the condition recurred. Treatment with Buyin Bazhen Tang, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and Liuwei Wan (Six-Ingredient Pill with Rehmannia) resulted in healing. Later, fatigue-induced fever led the patient to self-medicate with Siwu Tang (Four Substances Decoction) and herbs like Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex), causing all deficiency symptoms to manifest, open sores, and depletion of Qi and Blood in the five Zang organs. Morning administration of Buzhong Yiqi Tang and evening administration of Liujun Zi Tang (Six-Gentlemen Decoction) with Danggui (Angelicae Sinensis Radix), each for over fifty doses, allowed the sores to close. Finally, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was used for conditioning and recovery.
Huang Roudao, a Prefectural Magistrate, experienced afternoon fevers, limb fatigue, soreness and weakness of legs and feet after intercourse, heat sensation in the soles extending to the knees, and a surging, rapid pulse in all six positions, especially pronounced at the Chi (Cun-Kou) position. This indicated deficiency of the three Yin meridians of the foot. Instead of tonifying the source, he took bitter-cold fire-draining agents. Subsequently, his scrotum swelled; treating it as a hernia exacerbated the swelling and further depleted his constitution. Warm-tonifying agents caused swelling and pain to ascend, dysuria, and a surging Chi pulse that felt empty upon deep pressure. I diagnosed this as scrotal carbuncle. Due to Qi and Blood deficiency preventing rupture, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was initially prescribed with Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), Cheqianzi (Plantaginis Semen), Chaihu (Bupleuri Radix), and Shanzhi (Gardeniae Fructus). One dose caused immediate reduction in swelling. Then, Liuwei Wan ingredients with Cheqianzi (Plantaginis Semen), Niuxi (Achyranthis Bidentatae Radix), Chaihu (Bupleuri Radix), and Shanzhi (Gardeniae Fructus) were given for one dose, gradually restoring urination. Huoming Yin (Elixir to Save Lives Decoction) was alternated with the previous two medicines for over twenty doses, until the scrotum ruptured, discharging large amounts of foul pus. Tuoli Xiaodu San (Toxin-Expelling and Toxin-Clearing Powder) was used for six doses to clear the pus. Further doses of Tuoli San (Toxin-Expelling Powder) reduced the discharge. Finally, Buyin Tuoli San (Yin-Nourishing Toxin-Expelling Powder) and Shiquan Dabu Tang (Complete Great Tonifying Decoction) were administered for over fifty doses, resulting in recovery.
Li Daqing, a student at the local academy, had chronic kidney deficiency with fever. Long-term use of Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) led to emaciation, seminal emission, white turbid discharge, afternoon fever, and expectoration. This was kidney Yin deficiency with internal flaring of deficient fire. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix) was used. As symptoms improved, he switched to heat-clearing and blood-cooling agents, leading to poor appetite and continuous phlegm spitting. This indicated secondary Spleen deficiency failing to control saliva. The previous formula with Fuling (Poria) and Banxia (Pinelliae Rhizoma) cured him. After intercourse, he developed dizziness, phlegm vomiting, back pain, and painful urination/defecation, signaling exhaustion of essence—a critical condition. Morning treatment with the previous formula plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus), and evening treatment with Liuwei Wan ingredients plus Wuweizi (Schisandrae Fructus) and Bibi (Dioscoreae Hypoglaucae Rhizoma) for over fifty doses, resolved symptoms. Another episode of intercourse caused scrotal and penile pain. Using diuretic agents led to internal scrotal ulceration. Bu Yin Tuo Li agents expelled much pus. Although swelling and pain subsided, lack of proper care led to constipation, stranguria-like urination, and rising phlegm-saliva, indicating recurrence of kidney deficiency. Someone claimed curability using Mengshi Gun Tan Wan (Fluorite Rolling Phlegm Pill) or Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill), worsening expectoration. I stated this would hasten death rather than save life, withdrew treatment, and the patient died.
A male patient with scrotal carbuncle, swelling, pain, and fever was treated with Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Huanglian (Coptidis Rhizoma) and Qingpi (Citri Reticulatae Pericarpium Viride) for four doses, showing slight improvement, followed by Jianjia Longdan Xiegan Tang (Modified Gentiana Liver-Draining Decoction) for recovery.
Another male patient with scrotal carbuncle, heat and swelling causing dysuria, was urgently needled. Xiao Chaihu Tang (Minor Bupleurum Decoction) with Huangbai (Phellodendri Cortex), Baizhi (Angelicae Dahuricae Radix), and Yinhua (Lonicerae Japonicae Flos) was given for four doses, improving slightly, followed by Tuoli Xiaodu San (Toxin-Expelling and Toxin-Clearing Powder) for several doses to cure.
A male patient had a scrotal cyst resembling a water bubble, intermittent pain and itching, fluid discharge, and a water sound upon abdominal palpation, with frequent urination and a slow, moderate pulse. This was caused by drinking water after intoxication and engaging in intercourse, followed by sweating and wind exposure, leading to accumulation of cold-damp toxic qi in the scrotum, named Shui Han (Water Hernia). Dao Shui Wan (Water-Guiding Pill) was taken twice to resolve abdominal ascites and normalize urination. Weiling San (Stomach-Pacifying Powder) with increased Ling (Poria) and Zhu (Atractylodis Macrocephalae Rhizoma) was drunk, followed by needle drainage to remove accumulated water, curing the condition.
A male patient with a long-standing non-healing scrotal carbuncle was treated with Shiquan Dabu Tang (Complete Great Tonifying Decoction) plus Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix), and moxibustion with Fermented Soybean Cake (Douchi Bing), resolving after a month.
A frail patient with scrotal carbuncle, swelling, pain, and unsuppurated red, scanty urine was treated with Zhi Gancao (Prepared Licorice Root), Qingpi (Citri Reticulatae Pericarpium Viride), Tongcao (Akebia Caulis), Huangbai (Phellodendri Cortex), Danggui (Angelicae Sinensis Radix), and Maidong (Ophiopogonis Radix) for four doses, showing slight improvement, then cleared with Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction).
A male patient with severe scrotal carbuncle, terrifyingly surging pulse, was treated with the previous formula for two doses, reducing swelling slightly, then Xianfang Huoming Yin (Immortal Formula Elixir to Save Lives Decoction) for two doses, stopping pain slightly. A slippery, rapid pulse indicated mature pus requiring incision; otherwise, total scrotal rupture would occur. Disbelieving, he changed doctors, resulting in massive rupture and hanging testicles. Seeking further treatment, his pulse had calmed. Bazhen Tang (Eight-Treasure Decoction) with Huangqi (Astragali Radix), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), and Shanzhi (Gardeniae Fructus) was used, along with external Perilla powder application, curing him in days. Though severe, preservation was achieved; patients should not fear.
A frail patient with mature, painful scrotal carbuncle and constipation was needled, expelling about three bowls of pus, followed by deep sleep and improved mental clarity. Although detoxifying agents were applied post-needle, the wound was fully opened, requiring thirty-plus doses of Tuoli (Toxin-Expelling) medicine for recovery. Generally, this disease stems from Yin channel deficiency and damp-heat obstruction, making Yin-nourishing and damp-resolving essential. For swelling/pain with urinary difficulty, damp-resolving is primary, Yin-nourishing auxiliary; for resolved swelling/pain with normal bowels/bladder, both are combined; for promoting suppuration, Tuoli is primary, Yin-nourishing auxiliary; once pus forms, needle and continue Tuoli/Yin-nourishing; when damp-toxin is exhausted, focus on Tuoli; if pus is thin or healing is slow, use major tonics and moxibustion with Douchi Bing (Fermented Soybean Cake) or Fuzi Bing (Aconite Cake). Lord Lu Wuxuan, over fifty, had a non-healing sore for over a year. Diagnosis showed mild damp-heat, treated with Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) to clear damp-heat, then Tuoli medicine and Douchi Bing moxibustion cured him. Recurrence the next year with severe damp-heat was treated with the same formula for four doses, then Yin-nourishing medicine. If not tonified after rupture, young people develop fistulas, old people die. Thin pus with thirst and large pulse is also incurable.
Zhu Danxi said: Carbuncles entering the scrotum, I have treated several cases, all managed by addressing damp-heat in the Liver meridian, assisted by Yin-nourishing. Even with skin shedding and hanging testicles, death does not ensue. (*Waike Xinfa*)
Xue Lizhai treated Hu Tongzhi, over fifty, with scrotal swelling/pain worsening with heat, unresponsive to Pancong San (Scallion-Macerating Powder). Rapid Liver pulse indicated scrotal carbuncle due to Liver meridian damp-heat. Pus was mature, requiring urgent needling. Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) resolved pulse and symptoms. Followed by Tuoli and Yin-nourishing medicines, external application of Fir Wood Ash and Perilla powder, curing in a month. Though fully ulcerated, it is harmless; patients should be cautious.
Official Bai, over sixty, had an ulcerated scrotum with unbearable pain and exposed testicles. Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) and external powder failed. Dampness was intense. First, a bowl of Sophora Flower Wine was given, followed by the previous medicine, showing slight improvement. Then Tuoli medicine with Yin-nourishing agents cured him in a month. Had stronger purgatives been added if the first medicine failed, middle Qi would have been damaged, leading to failure. Scholars Chen Shiyong and Shen Ruhe, suffering similarly, recovered with the same medicines.
Dou Cai treated a person with sudden whole-body stiffness, followed by next-day massive scrotal and penile swelling like a bucket, with deep, tight pulses. This was Yin Ju (Yin Carbuncle). Fortunately, no cooling/detoxifying drugs were taken; otherwise, the penis and testicles would have rotted off, causing death. Emergency administration of Jiusheng Tang (Life-Saving Decoction), 5 qian, followed by another dose, resulted in complete recovery.