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Xuan Yong (Hanging Abscess) arises in the perineal region, specifically between the anterior orifice (genitals) and the posterior orifice (anus), at the location of Pingyi, which corresponds to the Huiyin acupoint. This area belongs to the collateral branch of the Ren Mai (Conception Vessel) and is the convergence point where the three Yin meridians of the foot (Liver, Spleen, Kidney), Du Mai (Governing Vessel), and Chong Mai (Penetrating Vessel) intersect. When an abscess forms here, standing upright feels as if something is hanging, hence the name "Xuan Yong" (Hanging Abscess). This condition belongs to the deficiency syndrome of the three Yin meridians of the foot. In mild cases, it develops into a fistula, draining Qi and Blood until death; in severe cases, internal ulceration leads to immediate demise.

If in the initial stage there is stagnation of Damp-Heat without pus formation but with pain, or if urination is obstructed and difficult, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If swelling and pain are severe, use Xianfang Huoming Yin (Immortal Life-Earning Powder) combined with prepared Gancao (Licorice Root) as an adjuvant. With this approach, even if illness occurs, it is mild; even if ulceration happens, the wound is shallow. If pus fails to form, or if pus has formed but fails to ulcerate spontaneously, use Bazhen San (Eight-Treasure Powder) for tonification. If pus has already formed, puncture it urgently with a needle. To promote tissue regeneration and wound contraction: for Kidney Deficiency, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia); for Blood Deficiency, use Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala); for Qi Deficiency, use Sijunzi Tang (Four-Gentlemen Decoction) added with Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis); for Spleen Deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for combined Qi and Blood Deficiency, use Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Using cold-natured drugs for detoxification would be a mistake.

[Xue Ji's Commentary]: Xuan Yong originally stems from Yin Deficiency of the Liver and Kidney meridians. Even in pure Yin Deficiency cases, one might fear that tonification alone is insufficient for cure; how much more so if attacking/draining methods are used after pus formation? Death is inevitable. Typically, for initial swelling and pain, or red and difficult urination, first administer prepared Gancao (Licorice Root) for one to two doses, along with Garlic Moxibustion, followed by drinking Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If fever with swelling and pain is present, use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Cheqianzi (Plantago Seed), Huangbai (Phellodendron Bark), Chuanxiong, and Danggui. Once pus has formed, puncture it. After ulceration, use Bazhen Tang (Eight-Treasure Decoction) added with prepared Gancao, Chaishao Jiu Chao (Bupleurum Tip stir-fried with wine), Huangbai, and Zhimu (Anemarrhena Rhizome). If urination is obstructed but the pulse is forceful, continue using Longdan Xiegan Tang added with prepared Gancao. If urination is obstructed but the pulse is weak, use Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) added with prepared Gancao. If pus is clear and does not contract, use major tonifying agents, interspersed with Fermented Soybean Cake moxibustion. For chronic non-healing wounds, Moxibustion with Aconite Cake is also effective.

Shangbao Bao Xichuan suffered from hot feet and had taken Siwu Tang (Four-Substance Decoction), Huangbai, and Zhimu for over a year. He developed Xuan Yong, expectorating phlegm, thirst for warm drinks, and heat extending to his knees. He then took Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Erchen Tang (Two-Aged Phlegm Decoction), causing the hot phlegm to worsen. He asked me, "Why?" I replied, "This is deficiency of the three Yin meridians of the foot, causing water flooding to transform into phlegm; cold-natured medicines have severely damaged the Stomach Qi." Thus, I first used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), administered Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) in the evening, and occasionally supplemented with Danggui Buxue Tang (Angelica Tonify Blood Decoction). It took half a year to recover.

The Prefect of Zhaozhou suffered from this condition, with significant swelling and pain for over five months. He experienced afternoon fever, dry mouth, night sweats, poor appetite, fatigue, shortness of breath, and a floating, rapid, yet weak pulse. This indicated Qi and Blood deficiency of the three Yin meridians of the foot. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with prepared Gancao, Wuweizi (Schisandra Berry), and Maimendong (Ophiopogon Tuber). After more than thirty doses, his appetite improved and symptoms eased. Then I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for over fifty doses, leading to pus discharge and wound healing. Later, anger triggered pain, reduced food intake, hypochondriac pain, and fever. I continued with the previous prescription. Relying on his strong constitution and careful management, he recovered.

Zhang Jingzhi, Commissioner of Communications, suffered from the aforementioned condition for a long time without recovery. He had severe afternoon fever, thirst, irritability, and panting. Others used Siwu Tang (Four-Substance Decoction), Huangbai, and Zhimu, worsening his prior symptoms. He further developed fatigue, poor appetite, loose stools, and frequent urination. He asked me, "Why?" I said, "This is a Spleen Deficiency syndrome caused by the previous medications damaging the Spleen and Stomach again." I then used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber). After several doses, his diet gradually increased, and all symptoms improved. I added Maimendong and Wuweizi, and he recovered after regulation. The Classic states: "The Spleen belongs to Extreme Yin, is Yin Earth, and governs the generation of Blood." Therefore, Mr. Dongyuan (Li Gao) stated: "For Spleen Deficiency causing sinking of Yuan Qi, presenting with fever, irritability, thirst, and limb fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise and tonify Yang Qi to generate Yin Blood." If mistakenly diagnosed as Yin Deficiency and one uses Siwu Tang (Four-Substance Decoction), Huangbai, and Zhimu, it damages the vital Qi of the Spleen and Stomach, making the deficiency worse. Moreover, Huangbai and Zhimu are drugs that drain Yang and damage Yin. They should not be used unless there is excessive Bladder Yang Fire failing to generate Yin Water, causing fever.

A scholar suffered from this condition. He took Kanli Wan (Kan-Li Pill) and Siwu Tang (Four-Substance Decoction), Huangbai, and Zhimu, to no effect. His pulse was floating and surging, but faint and fine upon deep pressure. I considered this deficiency of the three Yin meridians of the foot. I used Tuoli San (Support Interior Powder) and Buyin Tuoli San (Tonify Yin Support Interior Powder), leading to gradual improvement. Then I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to regulate and tonify the source of transformation. He recovered in half a year. Generally, for sores and ulcers, if Kidney Meridian Yang Qi is hyperactive, preventing Yin Water from generating, causing Yin Deficiency fever, Kanli Wan (Kan-Li Pill) is suitable because its bitter-cold nature drains fire in the water, allowing Yang Qi to decline and Yin Water to self-generate. If Yang Qi is weak, preventing Yin Water from generating, causing Yin Deficiency fever, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is suitable because its sour-warm nature generates water in the fire, allowing Yang Qi to flourish and Yin to self-generate. Furthermore, nine out of ten cases of this condition belong to Jing-Qi deficiency of the Kidney Meridian, while only one or two out of ten belong to hyperactivity of Kidney Meridian Yang Qi. However, people in Jiangnan suffering from this often have Yin Blood deficiency of the Spleen Meridian and sinking of Yuan Qi. They require Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Yang and tonify Qi, ensuring Yang generates and Yin grows. If excessive desires deplete True Water, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is suitable to tonify Kidney Meridian Yuan Qi to generate Essence and Blood, still using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to cultivate the generating Qi of the Spleen and Lung to nourish Kidney Water. The Classic says: "Yin Deficiency is Spleen Deficiency." Yet, many mistakenly diagnose it as Kidney Meridian Fire Syndrome and use Huangbai and Zhimu, further damaging the Spleen and Lung, cutting off the source of transformation, leading to untreatable conditions. What a pity!

Liu Kexin, Shangshe, suffered pain and fever with dry mouth and red, difficult urination after ulceration. Self-medication with heat-clearing and detoxifying drugs failed. His left Chi pulse was surging and rapid. I believed this was excess Yang and deficiency Yin. I first used Siwu Tang (Four-Substance Decoction) added with Huangbai and Zhimu to drain Yang Qi so Yin could self-generate. After several doses, symptoms gradually improved. Then I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify the Spleen and Lung, nourish Kidney Water, and heal the wound.

A scholar had red, difficult urination. Fatigue caused soft, swollen, and painful legs, fever, dry mouth, dry tongue, poor appetite, and worsening fatigue in the afternoon. This indicated Qi and Blood deficiency preventing pus formation. I used Bazhen Tang (Eight-Treasure Decoction) added with Maimendong and Shanyao (Dioscorea Tuber), doubling the dose of prepared Gancao. After several doses, all symptoms receded. However, local swelling and pain persisted, indicating internal pus pushing outward. After five more doses, pus naturally drained. After fifty-plus doses, the wound nearly healed. Due to labor and stopping medication, he developed chills, fever, thirst, swelling, pain, and copious pus. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with stir-fried Shanzhi (Gardenia Fruit) for two doses, showing slight improvement. Then I used Bazhen Tang (Eight-Treasure Decoction) added with Maimendong and Wuweizi for over a hundred doses, eliminating all swelling and pain. Fortunately, he managed his lifestyle carefully, regulated his diet, and frequently took tonics, remaining safe. Only when fatigued did a drop or two of pus appear. Later, influenced by others, he took internal fire-draining drugs and external cauterizing/astringent drugs, forcing contraction. This caused massive local ulceration, nearly leading to death. He recovered only through subsequent tonification.

Gancao Gao (Licorice Ointment): Treats abscesses arising before and after the anal canal, called Xuan Yong. A nodule forms like an olive or plum/pit, initially painless. After ten days to a month, heat develops. If not treated early, the sore ulcerates, discharging cups of pus and blood daily, potentially leading to intestinal rot and feces exiting through the wound—a suffering indescribable. Recovery may take months to years. Treatment must occur before the nodule becomes painful; one or two doses will cause spontaneous resolution. The disease starts the size of a pine nut, grows to a lotus seed, and after dozens of days, if red and swollen like a peach or plum, it breaks. Once broken, it is hard to treat. Taking this medicine may not resolve it quickly but will certainly eliminate it within twenty days. Two doses are harmless. Lin Yuanpan Kangchao once suffered from this broken abscess. After two doses of this medicine, the wound closed miraculously.

Take half a jin of high-quality Gancao (Licorice Root), selecting four liang without nodes, split like counting rods. Soak thoroughly in running water from springs and rocks. Roast the Gancao over charcoal fire, dipping it in water, until one bowl of water is consumed. Do not rush; split it open. Take the roasted Gancao and decoct it separately in three bowls of spring water and five bowls of good unadulterated wine in a clay pot until reduced to one-third, forming a paste. Take all at once for immediate cure. Separately, take four liang of Gancao with nodes, decoct in spring water according to pot size, filter, and wash the affected area three times. The effect is miraculous. Re-warm the water if cool.

[Zhu Danxi] Qima Yong (Horse-Riding Abscess): Use four liang of large Gancao with nodes. Soak in one bowl of running water until absorbed. Grind into powder, add a little Zaojiao Hui (Gleditsia Spine Ash). Divide into four doses. Mix with water and take immediately for instant effect.

[Xue Ji] Generally, this condition belongs to Yin Deficiency, so those with insufficiency are prone to it. Cold-natured drugs should not be overused to avoid damaging Stomach Qi. Only prepared Gancao (Licorice Root) does not damage Qi and Blood or disturb the Zang-Fu organs, and its efficacy is very swift.

Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction) (Formula seen previously).

Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction): Treats Xuan Yong where the main pathogen has subsided, leaving only red and difficult urination.
Huangqin (5 qian), Huangqi (Honey-roasted), Shilian Rou (Lotus Plumule, heart removed), Renshen, Chifuling (Each 7.5 qian), Cheqianzi (Stir-fried), Maimendong (Heart removed), Gancao (Roasted), Digupi, Zhigancao (Preparation method seen previously).
Take 1 liang per dose. Add 2 zhong of water, decoct to 8 fen. Take before meals. If fever adds Chaihu and Bohe.

Jiawei Tuoli San (Modified Support Interior Powder): Treats Xuan Yong that neither dissipates nor ulcerates.
Renshen, Huangqi (Salt-water stir-fried), Danggui (Wine-soaked), Chuanxiong, Maimendong (Heart removed), Zhimu (Wine-soaked, stir-fried), Huangbai (Wine-soaked, stir-fried), Shaoyao (Stir-fried), Jinyinhua (Honeysuckle), Chaihu, Zhigancao (Preparation method seen previously, each 1 qian).
Make one dose. Add 2 zhong of water, decoct to 8 fen. Take before meals.

Jiawei Shiquan Dabu Tang (Modified Ten Significant Tonifying Decoction): Treats Xuan Yong, ulcerated but not contracting, or with fever and poor appetite.
Renshen, Huangqi (Salt-water stir-fried), Baizhu (Stir-fried), Fuling, Shudihuang (Wine-soaked, reduce if abdominal fullness), Danggui (Wine-soaked), Chuanxiong, Shaoyao (Stir-fried, each 1 qian), Rougui, Maimendong (Heart removed), Wuweizi (Crushed and stir-fried), Gancao (Stir-fried, each 0.5 qian).
Make one dose. Add 2 zhong of water, decoct to 1 zhong. Take before meals. For penile swelling, add Qingpi. For heat, add Huangqin and Chaihu. For afternoon fever, add Chaihu and Digupi. For red urine, add wine-processed Zhimu and Huangbai. For difficult urination, add Cheqianzi and Shanzhi (both stir-fried).

Jinei Jin San (Chicken Gizzard Membrane Powder): Treats sores near the anus that do not heal for a long time.
Jinei Jin (Any amount, i.e., the inner lining of the chicken gizzard, remove the yellow skin).
Burn the above ingredients to ash while retaining their properties, grind into an extremely fine powder. Apply a small amount directly to the site dry. Effect is miraculous.

Treat Sores in the Anal Canal: Finely crush water plantain leaves (Xingye), wrap in cotton, insert into the lower orifice, three times daily.

Formula for Internal Anal Abscess with Swelling and Pain:
Wugong (Centipede), Chuanshanjia (Pangolin Scale, processed with clam powder), Xuyü (Human Hair Charcoal), Daixueguan Emao (Goose feather with blood vessel), Sheng Luji (Raw Deer Antler).
Process all above drugs to retain properties, grind finely, mix equally. Take 5 qian per dose with good liquor on an empty stomach.