囊痈之患，湿热下注也。有作脓者，此浊气顺下将流入渗道，因阴道或亏，水道不利而然，
脓尽自安，不药可也，惟在善于调摄耳。又有因腹肿渐流入囊，肿甚，则囊自裂开，睾丸悬
挂，水出，以杉木炭末敷，外以紫苏叶包裹，仰卧养之。
《精要》谓∶痈入囊者死。将以为腐肾耶！予治数人，悉以湿热入肝经施治，而以补阴佐
之，虽脓溃皮脱，睾丸悬挂，亦不死。但下虚年老者，非大补不起。大抵此证，属阴道亏，
湿热不利所致，故滋阴降湿药不可缺。常治肿痛，小便秘滞者，用除湿为主，滋阴佐之。肿痛
已退，便利已和者，除湿滋阴药相兼治之。欲其成脓，托
里为主，滋阴佐之，候脓成即针之，仍用托里滋阴。若湿毒已尽者，专用托里。如脓清
或多、或敛迟者，用大补之剂，或附子饼灸之。
脓成胀痛者，急针之，更饮消毒之剂。
肿痛，未作脓者，疏导肝之滞湿。
肿硬发热，清肝降火。
凡脓清不敛，大补血气。
已溃者，滋阴托里。
一人囊痈，未作脓而肿痛，以加减龙胆泻肝汤，二剂少愈，更以四物加木通、知母、
黄柏而消。
一人脓熟作胀，致小便不利，急针之，脓出，以小柴胡加黄柏、白芷、金银花，四剂少
愈，更以托里散，数剂而消。
一人年五十，阴囊肿痛，得热愈盛，服蟠葱散不应，肝脉数，此囊痈也，乃肝经湿热所
致。脓已成，急针之，以龙胆汤，脉证悉退。更服托里滋阴药，外敷杉木炭、紫苏末，月余而愈。
一人囊肿，状如水晶，时痛时痒，出水，小腹按之作水声，小便数，脉迟缓，此醉后饮水
入房，汗出，遇风寒湿毒乘聚于囊，名水疝也。先以导水丸，二服，腹水已去，小便如常；
再以胃苓散，倍加白术、茯苓、更用气针引去聚水而瘥。
一人 肿痛甚，小便涩，发热脉数，以龙胆泻肝汤，倍车前、木通、泽泻、茯苓，病去半；
仍以前汤加黄柏、金银花，四剂，又减二三，便利如常，唯一处不消，此欲成脓，再用前汤加
金银花、皂角针、白芷，数剂，惟肿痛，脉滑数，乃脓已成，针之，肿消，投滋阴托里药，及
紫苏末敷之，愈。
一妇阴内脓水淋漓，或痛或痒，状如虫行，少阴脉滑数，此阴中有疮也，名曰 ，由心神
烦郁，胃气
虚弱，气血凝滞所致。与升麻、白芷、黄连、木通、当归、川芎、白术、茯苓、柴胡煎服，
以榻肿汤薰洗，更搽蒲黄、水银，两月而愈。
又有子脏虚寒，冷气下冲，致阴脱出，谓之下脱，或因产时努力而脱者，宜当归散。久
不愈者，补中益气汤，倍加升麻、柴胡举之。
囊痈这种病症，是由于湿热之邪向下流注所致。有的患者会化脓，这是因为浊气顺行下注即将流入渗道，但因阴道（指前阴部位）亏损，水道不通利而形成的。待脓液排尽后自然安宁，可以不服药，关键在于善于调养护理。又有因腹部肿胀逐渐蔓延至阴囊，肿胀严重时，阴囊自行破裂，睾丸悬挂外露，流出水液，可用杉木炭末外敷，外用紫苏叶包裹，让患者仰卧静养。
《精要》中说：“痈毒侵入阴囊者死。”难道这是认为肾脏腐烂了吗！我治疗过几个人，都按照湿热侵入肝经来施治，并辅以滋阴药物，虽然脓溃皮脱，睾丸悬挂，也没有死亡。但是下元虚亏、年老体弱的人，非用大补之法不能起效。大体上此证，属于阴道亏损，湿热不利所致，所以滋阴降湿的药物不可缺省。常遇到肿痛、小便短少滞涩的患者，以除湿为主，滋阴为辅。肿痛已退，二便调和的患者，将除湿与滋阴药物配合使用。希望其成脓的，以托里透脓为主，滋阴为辅，待脓成即行针刺排脓，之后仍用托里滋阴法。若湿毒已尽，则专用托里法。如果脓液清稀或过多、或收口迟缓的，用大补剂，或用附子饼灸治。
脓已成且胀痛剧烈的，立即针刺，再服用消毒药剂。
肿痛但未化脓的，疏导肝经停滞的湿气。
肿胀坚硬且发热的，清肝降火。
凡是脓液清稀不收敛的，大补气血。
已经溃破的，滋阴托里。
有一人患囊痈，未化脓但肿痛，用加减龙胆泻肝汤，服两剂后稍见好转，再用四物汤加木通、知母、黄柏而痊愈。
有一人脓熟作胀，导致小便不利，紧急针刺，脓出后，用小柴胡汤加黄柏、白芷、金银花，服四剂后稍见好转，再用托里散，数剂后痊愈。
有一人五十岁，阴囊肿痛，遇热更甚，服用蟠葱散无效，肝脉数，这是囊痈，乃肝经湿热所致。脓已成，紧急针刺，用龙胆汤，脉证全部消退。再服用托里滋阴药，外敷杉木炭、紫苏末，月余而愈。
有一人阴囊肿胀，状如水晶，时痛时痒，流水，小腹按压有水声，小便频数，脉迟缓，这是醉酒后饮水行房，出汗后遭遇风寒湿毒乘虚聚于阴囊，名为水疝。先用导水丸，服两剂，腹水已去，小便恢复正常；再用胃苓散，倍加白术、茯苓，并用气针引去积聚的水液而痊愈。
有一人肿痛严重，小便涩痛，发热脉数，用龙胆泻肝汤，倍用车前子、木通、泽泻、茯苓，病去一半；仍用前方加黄柏、金银花，服四剂，又减轻二三成，二便正常，唯有一处未消，这是欲成脓，再用前方加金银花、皂角刺、白芷，数剂后，仅余肿痛，脉滑数，这是脓已成，针刺后，肿消，投予滋阴托里药，及紫苏末外敷，痊愈。
一妇人阴内脓水淋漓，或痛或痒，状如虫行，少阴脉滑数，这是阴中有疮，名为阴疮，由心神烦郁，胃气虚弱，气血凝滞所致。给予升麻、白芷、黄连、木通、当归、川芎、白术、茯苓、柴胡煎服，用榻肿汤熏洗，再搽蒲黄、水银，两月而愈。
又有子宫虚寒，冷气下冲，导致阴户脱出，称为下脱，或因分娩时用力过度而脱出的，宜用当归散。久不愈的，用补中益气汤，倍加升麻、柴胡以升举之。
The affliction of scrotal carbuncle (Nang Yong) is caused by the downward pouring of damp-heat. In some cases, pus forms; this occurs because turbid qi flows downward and is about to enter the excretory ducts, but due to deficiency in the yin pathway (referring to the external genitalia region) and obstruction of the water passages, it manifests thus. Once the pus is exhausted, peace returns naturally; medication may not be necessary, provided there is proper care and regulation. In other instances, abdominal swelling gradually spreads into the scrotum. When the swelling is severe, the scrotum ruptures spontaneously, with the testis hanging exposed and fluid oozing out. This can be treated by applying powder from charred Chinese Toon Tree bark (Shanmu Tan) externally, wrapping it with Perilla leaf (Zisu Ye), and keeping the patient supine for recovery.
The *Jingyao* states: "If a carbuncle enters the scrotum, death ensues." Does this imply that the kidney rots? I have treated several patients, managing them according to damp-heat invading the Liver Meridian, assisted by yin-nourishing herbs. Even when pus drained and skin peeled off, leaving the testis hanging, they did not die. However, for those with lower jiao deficiency and advanced age, only major tonification can restore health. Generally, this condition stems from deficiency of the yin pathway and obstructed damp-heat; therefore, herbs that nourish yin and drain dampness are indispensable. For common cases involving swelling, pain, and scanty or difficult urination, treatment focuses on draining dampness, assisted by yin nourishment. When swelling and pain have subsided and bowel/bladder functions are normalized, combine damp-draining and yin-nourishing herbs. To promote suppuration, focus on supporting the interior (Tuo Li) to expel toxins, assisted by yin nourishment. Once pus matures, puncture it, and continue with interior-supporting and yin-nourishing methods. If damp-toxins are fully exhausted, use interior support exclusively. If pus is clear, excessive, or healing is delayed, use major tonifying formulas or moxibustion with Aconite Cake (Fuzi Bing).
If pus has formed causing distending pain, puncture immediately and administer detoxifying agents.
For swelling and pain without suppuration, guide and resolve stagnant dampness in the Liver.
For hard swelling with fever, clear the Liver and descend fire.
For clear pus that fails to heal, greatly tonify blood and qi.
For already ulcerated cases, nourish yin and support the interior.
One patient had a scrotal carbuncle without suppuration but with swelling and pain. After two doses of Modified Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver), symptoms slightly improved. Subsequently, Siwu Tang (Four Substance Decoction) added with Tongcao (Akebia Stem), Zhimu (Anemarrhena Rhizome), and Huangbai (Phellodendron Bark) resolved the condition.
Another patient had mature pus causing distension and urinary difficulty. Emergency puncture released the pus. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Huangbai, Baizhi (Angelica Dahurica Root), and Jinyinhua (Honeysuckle Flower) was given for four doses, leading to slight improvement. Further treatment with Tuoli San (Interior-Supporting Powder) over several doses resulted in resolution.
A fifty-year-old man suffered from scrotal swelling and pain, worsening with heat. Pancong San (Scallion Mixture Powder) was ineffective. The Liver pulse was rapid, indicating a scrotal carbuncle caused by damp-heat in the Liver Meridian. With pus formed, immediate puncture was performed. Longdan Tang (Gentiana Decoction) was administered, resolving all pulse and symptom manifestations. He then took interior-supporting and yin-nourishing herbs, with external application of Shanmu Tan and Zisu powder, recovering after more than a month.
Another patient presented with a scrotal cyst resembling crystal, intermittent pain and itching, fluid discharge, hydrostatic sound upon pressing the lower abdomen, frequent urination, and a slow, moderate pulse. This was diagnosed as Shui Han (Water Hernia), caused by drinking alcohol and engaging in sexual activity while thirsty, followed by sweating and exposure to wind-cold-damp toxins accumulating in the scrotum. Daoshui Wan (Water-Guiding Pill) was used for two doses, removing abdominal fluid and normalizing urination. Then, Weiling San (Stomach-Cinnamon Powder) with doubled Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) was used, along with Qi Zhen (Qi Acupuncture) to draw out accumulated fluid, leading to cure.
Another patient had severe swelling and pain, astringent urination, fever, and a rapid pulse. Longdan Xiegan Tang was used with increased Cheqianzi (Plantago Seed), Mutong (Akebia Stem), Zexie (Alisma Rhizome), and Fuling. Symptoms reduced by half. The same formula added with Huangbai and Jinyinhua was taken for four doses, reducing symptoms by another two or three parts. Bowel and bladder functions normalized, except for one area remaining swollen, indicating impending suppuration. The previous formula was repeated with added Jinyinhua, Zaogiao Zhen (Gleditsia Spine), and Baizhi. After several doses, only swelling and pain remained, with a slippery, rapid pulse, confirming pus formation. Puncture was performed, swelling subsided, and yin-nourishing, interior-supporting herbs were given, along with external Zisu powder application, resulting in recovery.
A female patient had dripping purulent fluid from the vagina, alternating pain and itching, sensation like insects crawling, and a slippery, rapid Shaoyin pulse. This was an ulcer within the yin organs, named Yin Chuang (Yin Ulcer), caused by mental agitation, weak Stomach qi, and stagnation of blood and qi. Shengma, Baizhi, Huanglian (Coptis Rhizome), Mutong, Danggui (Angelica Sinensis Root), Chuanxiong (Ligusticum Chuanxiong Rhizome), Baizhu, Fuling, and Chaihu (Bupleurum Root) were decocted and administered. The area was fumigated and washed with Ta Zhong Tang, and applied with Puhuang (Lygodium Spore) and Mercury. Recovery occurred after two months.
In cases of uterine deficiency-cold, where cold qi rushes downward causing prolapse of the yin (Xia Tuo), or prolapse due to excessive effort during childbirth, Danggui San (Angelica Powder) is appropriate. For chronic cases, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with increased Shengma (Cimicifuga Rhizome) and Chaihu is used to lift the prolapsed tissue.