【方歌】穿裆毒发会阴前，忧思劳伤湿郁源，焮痛红顺塌陷逆，
腐深漏溺收敛难。
【注】此证生于会阴穴之前，肾囊之后。由忧思、劳伤、湿郁
凝结而成。初起如粟，渐生红亮焮痛，溃出稠脓者顺；
若起如椒子，黑焦陷于皮肉之内，漫肿紫暗，并无焮热
，痛连睾丸及腰背肛门者逆。此系皮囊空处，凡生毒患
，宜速溃根浅；但遇根深迟溃，腐伤尿管，漏溺不能收
敛者至险。内治按悬痈，外治按痈疽肿疡、溃疡门。
【方歌】跨马痈生肾囊旁，重坠肝肾火湿伤，红肿焮痛宜速溃，
初清托里勿寒凉。
【注】此证一名骗马坠，生于肾囊之旁，大腿根里侧，股缝夹
空中。由肝、肾湿火结滞而成。初如豆粒，渐渐肿如鹅
卵，陨坠壅重，色红焮痛，暴起高肿，速溃稠脓者顺；
若漫肿平塌，微热微红，溃出稀脓者险，多成串皮漏证
。此处乃至阴之下，医治不可过用寒凉。初宜服仙方活
命饮之，次服托里透脓汤。既溃之后，内外治法，俱按
痈疽溃疡门。
方剂：仙方活命饮（见肿疡门）
托里透脓汤（见头部侵脑疽）
【方歌】便毒生于腿缝间，忍精瘀血怒伤肝，坚硬木痛寒热作，
初汗次下灸之痊。
【注】此证又名血疝，又名便痈，无论男女，皆可以生。发于
少腹之下，腿根之上折纹缝中，经属肝、肾。由强力房
劳，忍精不泄，或欲念不遂，以致精搏血留，聚于中途
，壅遏而成；或为暴怒伤肝，气滞血凝而发。初如杏核
，渐如鹅卵，坚硬木痛，微热不红，令人寒热往来，宜
荆防败毒散汗之；若烦躁作渴气郁者，宜山甲内消散以
消解之；若过于坚硬大痛者，宜红花散瘀汤舒通之。前
药用之不应者，宜九龙丹攻之；若无痛无热，则不可攻
下，宜阳燧锭日灸五、七壮，以或软、或消、或溃为止
。脓势将成，不可强消，宜黄耆内托散托之；甚虚者，
托里透脓汤。既溃宜八珍汤、十全大补汤、补中益气汤
，因证用之。外用五色灵药撒之，化腐煨脓；兼琥珀膏
、万应膏贴之，生肌敛口。斯证溃后，即名鱼口。因生
于折纹缝中，其疮口溃大，身立则口必合，身屈则口必
张，形如鱼口开合之状，故有鱼口之名。但此毒系忍精
不泄，及怒气伤肝而成。至于生杨梅而兼有便毒者，另
详注于杨梅门。
方剂：红花散瘀汤
组成：红花 当归尾
皂刺（各一钱） 生军（三钱）
连翘（去心） 苏木
穿山甲（炙研） 石决明
僵蚕（炒） 乳香
贝母（去心，研，各一钱） 黑牵牛（二钱）
酒、水各一钟，煎八分，空心服；行五、六次，方
食稀粥补之。
【方歌】红花散瘀消坚硬，便毒初起肿痛添，归刺军翘苏木甲，
石决僵蚕乳贝牵。
又方：黄耆内托散
组成：黄耆（二钱） 白术（土炒，一钱）
当归 川芎（各二钱）
金银花 皂刺
天花粉（各一钱） 泽泻
甘草（炙，各五分）
水二钟，煎八分，食前服。
【方歌】黄耆内托医便毒，肿盛不消托溃良，白术归芎银皂刺，
天花泻草刀同劻。
又方：荆防败毒散（见项部脑疽）
山甲内消散（见腹部中脘疽）
九龙丹（见前悬痈）
阳燧锭（见卷首烙法）
托里透脓汤（见头部侵脑疽）
八珍汤、十全大补汤、补中益气汤、五色灵药、万应膏
（俱见肿疡门）
琥珀膏（见头部发际疮）
【方歌】穿裆毒发作于会阴穴之前，其病因源于忧思、劳伤及湿邪郁结。红肿热痛为顺证，塌陷不起为逆证；若腐肉深重、漏尿且难以收敛者，病情危重。
【注】此病生于会阴穴之前，肾囊之后。由忧思、劳伤、湿邪郁结凝结而成。初起如粟米大小，逐渐变为红亮、焮热疼痛，溃破后流出稠厚脓液者为顺证；若初起如花椒子，黑焦陷没于皮肉之内，漫肿紫暗，并无焮热感，疼痛牵连睾丸、腰背及肛门者为逆证。此部位属于皮囊空虚之处，凡生毒患，宜速溃且根浅；但若遇根深难溃，腐蚀损伤尿管，导致漏尿不能收敛者，最为危险。内治法参照悬痈，外治法参照痈疽肿疡门和溃疡门。
【方歌】跨马痈生于肾囊旁，因肝肾火与湿邪受伤所致，症见重坠感。红肿焮痛宜速溃，初起宜清解托里，不可过用寒凉药物。
【注】此证又名骗马坠，生于肾囊之旁，大腿根内侧，股缝夹空中。由肝、肾湿火结滞而成。初起如豆粒，渐渐肿如鹅卵，下坠壅重，色红焮痛，暴起高肿，迅速溃破流出稠厚脓液者为顺证；若漫肿平塌，微热微红，溃破后流出稀薄脓液者险恶，多形成串皮漏证。此处位于至阴之下，医治不可过用寒凉药物。初起宜服用仙方活命饮，随后服用托里透脓汤。既已溃破之后，内外治法，均参照痈疽溃疡门。
方剂：仙方活命饮（见肿疡门）
托里透脓汤（见头部侵脑疽）
【方歌】便毒生于腿缝间，因忍精、瘀血及怒伤肝所致，症见坚硬、木痛及寒热发作，初起宜发汗，次宜攻下，或施灸以痊愈。
【注】此证又名血疝，又名便痈，无论男女皆可发生。发于少腹之下，腿根之上折纹缝中，经络归属肝、肾。由强力房劳、忍精不泄，或欲念不遂，致使精搏血留，聚于中途，壅遏而成；或因暴怒伤肝，气滞血凝而发。初起如杏核，渐如鹅卵，坚硬木痛，微热不红，令人寒热往来，宜用荆防败毒散发汗；若烦躁作渴、气郁者，宜用山甲内消散以消解之；若过于坚硬大痛者，宜用红花散瘀汤舒通之。前述药物使用无效者，宜用九龙丹攻逐；若无痛无热，则不可攻下，宜用阳燧锭每日灸五、七壮，以疮口变软、消散或溃破为止。脓势将成时，不可强行消散，宜用黄耆内托散托毒外出；身体极虚者，用托里透脓汤。既已溃破，宜用八珍汤、十全大补汤、补中益气汤，根据证候选用。外用五色灵药撒敷，以化腐煨脓；兼贴琥珀膏、万应膏，以生肌敛口。此证溃后，即名鱼口。因生于折纹缝中，其疮口溃大，站立时疮口必合，屈身时疮口必张，形状如鱼口开合之状，故有鱼口之名。但此毒系忍精不泄及怒气伤肝而成。至于生杨梅疮而兼有便毒者，另详注于杨梅门。
方剂：红花散瘀汤
组成：红花 当归尾
皂刺（各一钱） 生军（三钱）
连翘（去心） 苏木
穿山甲（炙研） 石决明
僵蚕（炒） 乳香
贝母（去心，研，各一钱） 黑牵牛（二钱）
酒、水各一钟，煎至八分，空腹服；排便五、六次后，方可进食稀粥以补益。
【方歌】红花散瘀消坚硬，便毒初起肿痛添，归刺军翘苏木甲，石决僵蚕乳贝牵。
又方：黄耆内托散
组成：黄耆（二钱） 白术（土炒，一钱）
当归 川芎（各二钱）
金银花 皂刺
天花粉（各一钱） 泽泻
甘草（炙，各五分）
水二钟，煎至八分，食前服。
【方歌】黄耆内托医便毒，肿盛不消托溃良，白术归芎银皂刺，天花泻草刀同劻。
又方：荆防败毒散（见项部脑疽）
山甲内消散（见腹部中脘疽）
九龙丹（见前悬痈）
阳燧锭（见卷首烙法）
托里透脓汤（见头部侵脑疽）
八珍汤、十全大补汤、补中益气汤、五色灵药、万应膏
（俱见肿疡门）
琥珀膏（见头部发际疮）
[Prescription Verse] The "Chuangdang" toxin arises anterior to the Huiyin acupoint; its etiology stems from worry, overexertion, and dampness stagnation. Redness, swelling, heat, and pain indicate a favorable prognosis (Shun), while collapse indicates an unfavorable one (Ni); deep ulceration with urinary leakage and difficulty in healing is critical.
[Note] This condition occurs anterior to the Huiyin acupoint (Huiyin, CV-8) and posterior to the scrotum. It is formed by the condensation of worry, overexertion, and dampness stagnation. Initially resembling millet grains, it gradually becomes red, bright, hot, and painful. Ulceration discharging thick pus is favorable (Shun). If it begins like a peppercorn, appearing black and scorched, sinking into the skin and flesh, with diffuse purple-dark swelling, no heat sensation, and pain radiating to the testicles, lower back, and anus, it is unfavorable (Ni). This area is where the skin folds are empty; for any toxic lesion here, rapid ulceration with shallow roots is preferred. However, if the root is deep and difficult to ulcerate, damaging the urethra and causing urinary leakage that cannot be contained, it is extremely dangerous. Internal treatment follows the protocol for Xuan Yong (Suspended Abscess), and external treatment follows the protocols for Tumors and Sores (Yong Ju) Swelling Stage and Ulcer Stage sections.
[Prescription Verse] "Kuma Yong" arises beside the scrotum, caused by Liver and Kidney fire and dampness injury, presenting with a heavy dragging sensation. Redness, swelling, heat, and pain require rapid ulceration; early treatment should clear and support the interior, avoiding excessive use of cold-natured herbs.
[Note] This condition is also known as "Pian Ma Zhui," arising beside the scrotum on the medial side of the upper thigh, in the inguinal fold. It is caused by the stagnation of Liver and Kidney damp-fire. Initially like a bean, it gradually swells to the size of a goose egg, hanging heavily with redness, heat, and pain. Rapid onset of high swelling with quick ulceration discharging thick pus is favorable (Shun). Diffuse flat swelling with slight heat and redness, discharging thin pus upon ulceration, is perilous and often leads to sinus tracts (Chuan Pi Lou). This location is at the lowest point of Yin; treatment must not overuse cold-natured herbs. Early stage: take Xian Fang Huo Ming Yin (Immortal Life Elixir), followed by Tuo Li Tou Nong Tang (Interior-Supporting Pus-Expelling Decoction). After ulceration, internal and external treatments follow the Tumors and Sores Ulcer Stage section.
Formulas: Xian Fang Huo Ming Yin (See Swelling Stage Section); Tuo Li Tou Nong Tang (See Head Region Qinao Jure Section).
[Prescription Verse] "Bian Du" arises in the leg crease, caused by retained semen, blood stasis, and Liver injury from anger. Symptoms include hardness, numbness/pain, and alternating chills and fever. Early treatment requires diaphoresis, followed by purgation or moxibustion for cure.
[Note] This condition is also known as Xue Shan (Blood Hernia) or Bian Yong (Genital Abscess), occurring in both men and women. It develops below the lower abdomen, in the crease above the groin. The meridians involved are the Liver and Kidney. Etiology includes strenuous sexual activity, retention of semen, or unfulfilled desires, leading to semen and blood accumulation and stagnation midway; or sudden anger injuring the Liver, causing Qi stagnation and blood coagulation. Initially like an apricot kernel, it grows to the size of a goose egg, becoming hard, numb, and painful, with slight heat but no redness, causing alternating chills and fever. Use Jing Fang Bai Du San (Scutellaria and Saposhnikovia Decoction to Overcome Toxins) for diaphoresis. For irritability, thirst, and Qi stagnation, use Shan Jia Nei Xiao San (Pangolin Interior-Resolving Powder) to resolve it. For extreme hardness and severe pain, use Hong Hua San Yu Tang (Safflower Blood-Dispersing Decoction) to soothe and unblock. If previous remedies fail, use Jiu Long Dan (Nine Dragons Pill) to attack the pathogen. If there is no pain or heat, do not use purgatives; instead, use Yang Sui Ding (Yang Sui Moxa Cone) for daily moxibustion (5-7 cones) until the lesion softens, resolves, or ulcerates. When pus is forming, do not force resolution; use Huang Qi Nei Tuo San (Astragalus Interior-Supporting Powder) to support and expel. For severe deficiency, use Tuo Li Tou Nong Tang. After ulceration, use Ba Zhen Tang (Eight Treasures Decoction), Shi Quan Da Bu Tang (Complete Great Tonifying Decoction), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) according to the syndrome. Externally, apply Wu Se Ling Yao (Five Colors Spirit Medicine) to transform necrotic tissue and generate pus; combine with Hu Po Gao (Amber Plaster) and Wan Ying Gao (Universal Plaster) to promote granulation and close the wound. After ulceration, this condition is named Yu Kou (Fish Mouth). Because it arises in the crease, the large ulcer opens when standing and closes when bending, resembling a fish mouth, hence the name. This toxicity results from retained semen and Liver injury from anger. Cases of Chancre (Mei Du) complicated with Bian Du are detailed in the Chancre section.
Formula: Hong Hua San Yu Tang
Composition: Hong Hua (Carthami Flos), Dang Gui Wei (Angelicae Sinensis Radix Caudex), Zao Ci (Gleditsiae Spina), Sheng Jun (Rhei Radix et Rhizoma - raw), Lian Qiao (Forsythiae Fructus), Su Mu (Sappan Lignum), Chuan Shan Jia (Manis Squama - roasted and powdered), Shi Jue Ming (Haliotidis Concha), Jiang Can (Bombyx Batryticatus - stir-fried), Ru Xiang (Olibanum), Bei Mu (Fritillariae Bulbus - heart removed, powdered), Hei Qian Niu (Pharbitidis Semen). Dosages: Each of Hong Hua, Dang Gui Wei, Zao Ci, Bei Mu is 1 qian; Sheng Jun is 3 qian; Hei Qian Niu is 2 qian. Decoct with 1 zhong of wine and 1 zhong of water to yield 0.8 zhong. Take on an empty stomach; after 5-6 bowel movements, consume thin rice porridge to tonify.
[Prescription Verse] Hong Hua San Yu Tang disperses hardness; for early-stage Bian Du with swelling and pain, add Angelica, Thorn, Rheum, Forsythia, Sappan, Pangolin, Abalone, Silkworm, Frankincense, Fritillaria, and Pharbitis.
Another Formula: Huang Qi Nei Tuo San
Composition: Huang Qi (Astragali Radix, 2 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma - earth-fried, 1 qian), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligusticum Chuanxiong Rhizoma, each 2 qian), Jin Yin Hua (Lonicerae Japonicae Flos), Zao Ci (Gleditsiae Spina), Tian Hua Fen (Trichosanthis Radix, each 1 qian), Ze Xie (Alismatis Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma - roasted, each 0.5 fen). Decoct 2 zhong of water to yield 0.8 zhong. Take before meals.
[Prescription Verse] Huang Qi Nei Tuo San treats Bian Du; for severe swelling without resolution, it supports ulceration well. Add Atractylodes, Angelica, Ligusticum, Honeysuckle, Thorn, Trichosanthes, Alisma, Licorice, and other ingredients.
Other Formulas: Jing Fang Bai Du San (See Neck Region Naoju Section); Shan Jia Nei Xiao San (See Abdominal Region Zhongwanju Section); Jiu Long Dan (See Preceding Xuan Yong Section); Yang Sui Ding (See Volume 1 Moxibustion Method Section); Tuo Li Tou Nong Tang (See Head Region Qinaoju Section); Ba Zhen Tang, Shi Quan Da Bu Tang, Bu Zhong Yi Qi Tang, Wu Se Ling Yao, Wan Ying Gao (All See Swelling Stage Section); Hu Po Gao (See Head Region Facai Chuang Section).