内蕴热毒寒热者，解散之。
劳役而患者，补之。
不遂交感，或强固精气，致败而结者，解散之。
湿热而致者，清肝导湿。
大抵此证，多患于劳役之人，亦有内蕴热毒而生者，须辨虚实及脓成否，不可妄投药饵。常
见治此，概用大黄之类下之，以求内消，或脓成，令脓从大便出，鲜有见其痊者。人多欲内消者，
恐收之难也，若补养气血，不旬日而收矣。若脓既成，其有可消之理？再用克伐之剂，反为
难也。
一人患此，未作脓，小便秘涩，以八正散，三剂少愈，以柴胡加泽泻、山栀、木通二剂
而愈。
一老妇肿痛，脓未作，小便滞，肝脉数，以加减龙胆泻肝汤，加山栀、黄柏，四剂而消。
一人肿痛，发寒热，以荆防败毒散，二剂而止，解散，二剂而消。
一人脓未成，大痛，以消毒托里内疏药，不应，脉洪大，毒尚在，以仙方活命饮，一贴
痛止，又剂而消。
一人肿痛，日晡发热，以小柴胡加青皮、天花粉，四剂痛止热退，以神效栝蒌散，四
剂而消。
一人 肿作痛，大小便秘，脉有力，以五烛散，二剂顿退，更以龙胆泻肝汤，四剂而消。
一人溃而痛不止，诸药不应，诊之脉大，按之则数，乃毒未解也。以仙方活命饮
而止，又二剂而消。
一人溃而痛不止，以小柴胡、黄柏、知母、芎归，四剂少止，更以托里当归汤，数剂
而敛。
一人服克伐药以求内消，致泻利少食，以二神丸，先止其泻，以十全大补，倍加白术、
茯苓，数剂而消。
一人不慎房劳，患此肿痛，以双解散，二服，其病即止，更以补中汤，数剂而脓成，
针之，以八珍汤加五味子、麦门冬、柴胡，三十余剂。大抵便痈者，血疝也，俗呼为便毒，
言于不便处患之故也。乃足厥阴肝经，络及冲任督脉，亦属肝之旁络也，是气血流通之道路，
今壅而肿痛，此则热毒所致，宜先疏导其滞，更用托里之剂，此临证制宜也。
一人年逾四十，患便毒，克伐太过，饮食少思，大便不实，遗精脉微。东垣云∶精滑
不禁，大便自利，腰脚沉重，下虚也。仲景曰∶微弱之脉，主气血俱虚。先以六君子，加破
故纸、肉豆蔻煎服，泄止食进，更以十全大补汤，加行经药，十余剂而消。
一人患便毒，脓稀脉弱，以十全大补汤，加五味、麦冬、白敛，三十余剂稍愈；更
以参 归术膏而平。因新婚复热，聚肿坚硬，四肢冷，脉弱皮寒，饮食少思，此虚极也。仍
用前药，加桂附，三剂稍可。彼欲速愈，自用连翘消毒散，泄利不止而殁。
一人年逾四十，数劳苦，患便毒，发寒热，先以小柴胡加青皮，一服，表证悉退；次
以补中益气汤加穿山甲，二剂，肿去三四；更以托里之药五六服，脓成刺去，旬日而敛。
夫便毒，足厥阴湿气因劳倦而发，用射干三寸，同生姜煎，食前服，利二三行，效。
射干，紫花者是，红花者非。
又方 破故纸（炒） 牛蒡子（炒） 牵牛（炒） 大黄（酒拌，煨。各等分）
上为细末，每服一两，酒调下。
又方 已成脓者。
大黄 连翘（各半两） 枳实（三钱） 浓朴（二钱） 甘草节（各二钱） 桃仁（二十一粒）
上咀，作三服，姜三片，水煎服。
消毒饮 治便毒初发，三四日可消。
皂角刺 金银花 防风 当归 大黄 甘草节 栝蒌仁（各等分）
上水酒各半煎，食前温服，仍频提掣顶中发，立效。
又方 白僵蚕 槐花（各等分）
为末，酒调服。一方，加大黄。
又方 木鳖子 大黄 栝蒌 桃仁 草龙胆（各等分）
上咀，浓煎，露一宿，清晨温服，立愈。
又方 栀子 大黄 乳香 没药 代赭石（各一钱） 当归（五分） 作一服，水煎温服。
一人肿而不溃，以参 归术、白芷、皂角刺、柴胡、甘草节，数剂而溃，以八珍汤加柴
胡，数剂愈。
一人溃而肿不消且不敛，诊之，脉浮而涩，以豆豉饼灸，更以十全大补汤，月余而愈。
体内蕴藏热毒并伴有寒热症状的，采用解散法治疗。
因过度劳累而患病的，采用补益法治疗。
性生活不遂或强行固摄精气，导致败浊凝结而成的，采用解散法治疗。
由湿热引起的，清泻肝火并引导湿气排出。
大抵这种病症，多见于过度劳累之人，也有因体内蕴藏热毒而生发的，必须辨别虚实以及脓液是否形成，不可随意投药。常见治疗此病，一概使用大黄之类攻下药物，以求内部消散，或者脓已形成，让脓液从大便排出，很少有见到痊愈的。人们多希望内部消散，是担心收口困难，如果补养气血，不到十天就能收口愈合。如果脓已经形成，哪里还有消散的道理？再使用克伐（攻伐）的药物，反而更加难以治愈。
有一人患此病，脓未形成，小便涩滞不畅，用八正散，服用三剂后稍见好转，再用柴胡加泽泻、山栀、木通，服用两剂而痊愈。
一位老妇人肿痛，脓未形成，小便滞涩，肝脉数急，用加减龙胆泻肝汤，加入山栀、黄柏，四剂后消散。
一人肿痛，发寒热，用荆防败毒散，两剂后寒热止，再两剂后肿痛消。
一人脓未形成，疼痛剧烈，用消毒托里内疏药，无效，脉象洪大，说明毒邪尚在，用仙方活命饮，一帖后疼痛停止，又服两剂后消散。
一人肿痛，傍晚发热，用小柴胡汤加青皮、天花粉，四剂后疼痛停止、热退，再用神效栝蒌散，四剂后消散。
一人肿胀作痛，大小便闭塞，脉象有力，用五苓散（注：原文“五烛”疑为“五苓”之误，此处依文意及常用方推测，但按规则保留原名或修正为通假，考虑到中医古籍中“五烛”极大概率为“五苓”之讹，且后文有“顿退”，符合五苓散利水功效，故译为五苓散，若严格忠实原文则译为“五烛散”，鉴于翻译准确性要求，此处标注为五苓散/五烛散，通常校勘为五苓），两剂后迅速消退，再用龙胆泻肝汤，四剂后消散。
一人溃破后疼痛不止，各种药物无效，诊察其脉象大而按之则数，这是毒邪未解。用仙方活命饮使疼痛停止，又服两剂后消散。
一人溃破后疼痛不止，用小柴胡汤、黄柏、知母、川芎、当归，四剂后稍见缓解，再用托里当归汤，数剂后疮口收敛。
一人服用攻伐药物以求内部消散，导致腹泻、食欲减少，用二神丸先止住腹泻，再用十全大补汤，加倍白术、茯苓，数剂后消散。
一人不慎房事劳损，患此病肿痛，用双解散，服用两次，病情即止，再用补中汤，数剂后脓成，针刺排脓，用八珍汤加五味子、麦门冬、柴胡，三十余剂后痊愈。大抵便痈，属于血疝一类，俗称为便毒，是因为发生在隐蔽部位之故。它涉及足厥阴肝经，络脉联系冲脉、任脉、督脉，也属于肝脏的旁络，是气血流通的道路，如今壅滞而肿痛，这是热毒所致，应当先疏导其滞塞，再用托里（扶正祛邪）的药物，这是临证制宜的原则。
有一人年过四十，患便毒，攻伐太过，饮食少思，大便不成形，遗精，脉微。李东垣说：精滑不禁，大便自利，腰脚沉重，这是下元虚损。张仲景说：微弱之脉，主气血俱虚。先用六君子汤，加破故纸、肉豆蔻煎服，泄止食进，再用十全大补汤，加行经药物，十余剂后消散。
一人患便毒，脓稀薄，脉弱，用十全大补汤，加五味子、麦冬、白敛，三十余剂后稍见好转；再用参归术膏而平复。因为新婚再次受热，聚肿坚硬，四肢冷，脉弱皮肤寒，饮食少思，这是极度虚弱。仍用前药，加桂枝、附子，三剂后稍可。那人想快速痊愈，自行服用连翘消毒散，导致腹泻不止而死。
一人年过四十，多次劳苦，患便毒，发寒热，先用小柴胡汤加青皮，一服后表证全部消退；再用补中益气汤加穿山甲，两剂后，肿块消退三四；再用托里药物五六服，脓成刺破排出，十天伤口收敛。
夫便毒，是足厥阴湿气因劳倦而发作，用射干三寸，同生姜煎煮，饭前服用，利下二三行，有效。
射干，以紫花者为正品，红花者非正品。
又一方：破故纸（炒）、牛蒡子（炒）、牵牛（炒）、大黄（酒拌，煨）。各等分。
以上研为细末，每服一两，酒调下。
又一方：适用于已成脓者。
大黄、连翘（各半两）、枳实（三钱）、浓朴（二钱）、甘草节（各二钱）、桃仁（二十一粒）。
以上切碎，分为三服，姜三片，水煎服。
消毒饮：治疗便毒初发，三四日内可消散。
皂角刺、金银花、防风、当归、大黄、甘草节、栝蒌仁（各等分）。
以上用水和酒各半煎煮，饭前温服，同时频繁提拉头顶头发，立竿见影。
又一方：白僵蚕、槐花（各等分）。
研为末，酒调服。另一方，加大黄。
又一方：木鳖子、大黄、栝蒌、桃仁、草龙胆（各等分）。
以上切碎，浓煎，露置一夜，清晨温服，立即痊愈。
又一方：栀子、大黄、乳香、没药、代赭石（各一钱）、当归（五分）。作一服，水煎温服。
一人肿胀但不溃破，用参、归、术、白芷、皂角刺、柴胡、甘草节，数剂后溃破，再用八珍汤加柴胡，数剂后痊愈。
一人溃破后肿胀不消且不收敛，诊察其脉浮而涩，用豆豉饼灸，再用十全大补汤，月余后痊愈。
If the interior harbors heat-toxin accompanied by alternating chills and fever, employ the method of dispersing and resolving.
If caused by overexertion, employ the method of tonifying.
If caused by unsatisfied sexual intercourse or forcibly retaining essence, leading to stagnation and knotting, employ the method of dispersing and resolving.
If caused by damp-heat, clear the Liver fire and guide out the dampness.
Generally, this condition mostly affects those who are overworked; it can also arise from internally harbored heat-toxin. One must distinguish between deficiency and excess, and whether pus has formed, without administering medication recklessly. It is common to see treatments for this condition using purgatives like Dahuang (Rhei Radix et Rhizoma) to seek internal resolution, or allowing pus to exit via stool if formed; rarely does one see a cure. People often desire internal resolution because they fear difficulty in healing the wound. If Qi and Blood are tonified and nourished, the wound will heal within ten days. If pus has already formed, how can there be any principle of resolution? Using attacking/depleting agents again would only make it more difficult to treat.
One patient suffered from this condition; before pus formation, with scanty and difficult urination, Bazheng San (Eight-Herb Corrective Powder) was administered for three doses, resulting in slight improvement. Then, Chaihu Jia Zexie, Shanzhi, Mutong (Bupleurum Decoction plus Alisma, Gardenia, and Akebia) was given for two doses, leading to recovery.
An elderly woman presented with swelling and pain, no pus formed, stagnant urination, and a rapid Liver pulse. Ji Jian Longdan Xiegan Tang (Modified Gentian Liver-Draining Decoction) plus Shanzhi (Gardenia) and Huangbai (Phellodendron Bark) was prescribed for four doses, resulting in resolution.
One patient had swelling, pain, and chills/fever. Jingfang Baidu San (Aristolochia and Saposhnikovia Decoction to Relieve Toxicity) was given for two doses, stopping the chills/fever; another two doses resolved the swelling.
One patient had unformed pus but severe pain. Xiaodu Tuoli Neishu Medicines (Detoxifying, Supporting Interior, and Internal-Draining Medicines) were ineffective. The pulse was surging and large, indicating the toxin remained. Xianfang Huoming Yin (Immortal Life-Saving Decoction) was used; pain ceased after one dose, and resolution occurred after two more doses.
One patient had swelling, pain, and afternoon fever. Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Qingpi (Green Tangerine Peel) and Tianhuafen (Trichosanthes Root) was given for four doses, stopping pain and reducing fever. Shenxiao Gualou San (Miraculous Trichosanthes Powder) was then administered for four doses, resulting in resolution.
One patient had swelling and pain, constipation of both large and small intestines, and a forceful pulse. Wuzhu San (Five-Candle Powder - *Note: Likely a textual error for Wuling San/Five-Ling Powder*) was given for two doses, causing rapid regression. Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was then used for four doses, leading to resolution.
One patient had an ulcerated sore with continuous pain, unresponsive to various medicines. The pulse was large but rapid upon pressure, indicating unresolved toxin. Xianfang Huoming Yin (Immortal Life-Saving Decoction) stopped the pain, and resolution followed after two more doses.
One patient had an ulcerated sore with continuous pain. Xiao Chaihu Tang (Minor Bupleurum Decoction), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Xiong (Ligusticum Rhizome), and Danggui (Angelica Sinensis) were given for four doses, providing slight relief. Tuoli Danggui Tang (Supporting Interior Angelica Decoction) was then administered for several doses, leading to wound contraction.
One patient took depleting medicines seeking internal resolution, resulting in diarrhea and poor appetite. Ershen Wan (Two-Essence Pill) was used first to stop diarrhea. Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) with doubled Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) was then given for several doses, leading to resolution.
One patient neglected sexual restraint, suffering from swelling and pain. Shuangjie San (Double-Release Powder) was taken twice, stopping the disease. Buzhong Tang (Middle-Supporting Decoction) was then given for several doses until pus formed. It was punctured, and Bazhen Tang (Eight-Treasure Decoction) plus Wuweizi (Schisandra Berry), Maimendong (Ophiopogon Tuber), and Chaihu (Bupleurum Root) was administered for over thirty doses. Generally, Bi Yong (Perineal Abscess) is a type of Xue Shan (Blood Hernia), commonly called Bi Du (Perineal Toxin) because it occurs in an inconspicuous place. It involves the Foot-Jueyin Liver Meridian, linking to the Chong, Ren, and Du vessels, and belongs to the collateral branches of the Liver. These are pathways for the smooth flow of Qi and Blood. Now, obstruction causes swelling and pain due to heat-toxin. One should first dredge the stagnation, then use interior-supporting agents; this is adapting treatment to the clinical situation.
One patient, over forty years old, suffered from Bi Yong. Excessive depletion led to poor appetite, loose stools, spermatorrhea, and a faint pulse. Dongyuan stated: Involuntary seminal emission, spontaneous loose stools, and heavy waist/legs indicate lower deficiency. Zhongjing said: A faint pulse indicates deficiency of both Qi and Blood. Liujunzi Tang (Six-Gentlemen Decoction) plus Pogostemon (Pogu Zhi) and Myristica (Roudoukou) was decocted and taken; once diarrhea stopped and appetite returned, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) plus blood-invigorating herbs was given for over ten doses, leading to resolution.
One patient had Bi Yong with thin pus and a weak pulse. Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) plus Wuwei Zi (Schisandra), Maidong (Ophiopogon), and Bailian (Lilii Bulbus) was given for over thirty doses, showing slight improvement. Can Gui Zhu Gao (Ginseng, Angelica, and Atractylodes Paste) was then used to achieve remission. Due to a new marriage and subsequent heat accumulation, hard swelling formed, limbs were cold, pulse weak, skin cold, and appetite poor, indicating extreme deficiency. The previous medicine plus Guizhi (Cinnamon Twig) and Fuzi (Aconite Lateralis Preparata) was used for three doses, bringing slight relief. Desiring a quick cure, the patient self-administered Lianqiao Xiaodu San (Forsythia Detoxifying Powder), resulting in incessant diarrhea and death.
One patient, over forty, subjected to frequent labor, suffered from Bi Yong with chills and fever. Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Qingpi (Green Tangerine Peel) was given for one dose, completely resolving exterior symptoms. Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) plus Chanshunjia (Pangolin Scales) was given for two doses, reducing swelling by three or four parts. Five or six doses of interior-supporting medicines followed; after pus formation and drainage, the wound healed within ten days.
Bi Yong arises from dampness in the Foot-Jueyin meridian triggered by fatigue. Shegan (Belamcanda Rhizome), three cun long, decocted with fresh ginger, taken before meals, induces two or three bowel movements and is effective. Shegan with purple flowers is authentic; red-flowered varieties are not.
Another prescription: Pogostemon (stir-fried), Arctium Seed (stir-fried), Morning Glory Seed (stir-fried), Rhubarb (wine-mixed, baked). Equal parts. Grind into fine powder. Take one liang per dose, mixed with wine.
Another prescription: For cases where pus has formed. Rhubarb, Forsythia (each half liang), Immature Bitter Orange (three qian), Magnolia Bark (two qian), Licorice Knots (each two qian), Peach Kernel (twenty-one grains). Chop, divide into three doses. Decoct with three slices of ginger in water.
Xiaodu Yin (Detoxifying Drink): Treats early-stage Bi Yong; can resolve within three to four days. Gleditsia Spine, Honeysuckle, Saposhnikovia, Angelica Sinensis, Rhubarb, Licorice Knots, Trichosanthes Seed (equal parts). Decoct with half water and half wine. Take warm before meals. Simultaneously, frequently pull the hair at the vertex for immediate effect.
Another prescription: Silkworm (white, stiffened), Sophora Flower (equal parts). Grind into powder, take with wine. Another variant adds Rhubarb.
Another prescription: Momordica Seed, Rhubarb, Trichosanthes, Peach Kernel, Gentiana Scabra (equal parts). Chop, decoct strongly, expose overnight, take warm in the morning for immediate cure.
Another prescription: Gardenia, Rhubarb, Frankincense, Myrrh, Hematite (each one qian), Angelica Sinensis (five fen). Make one dose, decoct in water, take warm.
One patient had swelling without ulceration. Ginseng, Angelica, Atractylodes, Angelica Dahurica, Gleditsia Spine, Bupleurum, Licorice Knots were given for several doses until ulceration occurred. Bazhen Tang (Eight-Treasure Decoction) plus Bupleurum was then given for several doses, leading to recovery.
One patient had an ulcerated sore with persistent swelling and lack of contraction. The pulse was floating and choppy. Moxibustion with Fermented Soybean Cake was applied, followed by Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). Recovery occurred after more than a month.