（一名便毒、一名 ）
便痈属厥阴肝经，内热外寒；或劳倦过度，或房欲不节，或欲心不遂，或强固其精，或
肝经湿热而致。治法∶内热外寒者，双解散。劳倦过度者，补中益气汤。房欲不节者，六味丸料
。欲心不遂者，先用五苓散加大黄，疏其精滞；后用地黄丸，以补其肝肾，强固其精。或湿
热壅滞者，宜用龙胆泻肝汤，疏肝导滞。夫便痈血疝也，属厥阴肝经之络脉，冲任督脉之隧
道。故妇人患此，多在两拗肿痛，或腹中结块，小便涩滞。苟治者得法，患者又能调摄，何
难敛之有。若概用大黄等剂，以求其内消；或令脓随便下，损其气血，及不慎起居饮食者，
治验
府庠沈尼文，年二十，左拗患之。余以肝肾阴虚。先用托里药，溃而将愈。因入房，发
热作渴，右边亦作痛，脓水清稀，虚症悉至，脉洪大而无力，势甚可畏。用十全大补加附子一钱
，脉症顿退，再剂全退。后用大补汤，三十剂而愈。
一儒者肿痛便涩，用八正散二剂，清肝火，导湿热，而肿痛愈；再以小柴胡加芎、归、
泽泻、山栀，二剂清肝火补脾血而小便利。
一男子溃而肿痛不止，此余毒未解，用活命饮，一剂而痛止；再剂而肿消。
一男子痛甚发热，用前饮一剂痛止；再以神效栝蒌散，加山栀、柴胡、二剂而消。
一男子肿而不溃，余谓此因阳气虚弱，用参、 、归、术，以补托元气；用白芷、皂角
刺、柴胡、甘草节，以排脓清肝，数剂而溃；以八珍加柴胡，补其气血，数剂而愈。
一男子已溃，而痛不止，小便秘涩，此肝火未解也。与小柴胡汤加黄柏、知母、芎、归
，痛止便利，更以托里当归汤而疮敛。若毒未解，而痛不止者，须用活命饮。
一妇人素清苦，因郁怒，患前症。或用败毒寒凉之药，反晡热内热，自汗盗汗，月经不
行，口干咽燥。余谓此郁气伤脾，因药复损，先以当归汤数剂，后兼逍遥散，各五十余剂，而诸
一妇人小腹内如有所梗，两拗并人门俱肿，小便淋涩，经候不调，内热不渴，饮食少思
，腹内初如鸡卵而渐大，脉洪数而虚，左关尤甚，属肝脾郁结之症也。用加味归脾汤，肝火退而
脾土健，间以逍遥散下芦荟丸而愈。
一妇人两拗肿痛，腹内一块，不时上攻，月经不调，小便不利。余以为肝脾气滞，以四
君加芎、归、柴胡、山栀而愈。后因郁怒，前症复作，却兼胸胁胀满盗汗，此肝木甚而伤脾土。
用加味归脾汤下芦荟丸而愈。
一妇人小腹内，或作痛，或痞闷，两拗肿痛，内热寒热，胸膈不利，饮食不甘，形体日
瘦，此肝气滞，而伤脾气。朝用补中益气汤，夕用六味丸，渐愈，更用芦荟丸而痊愈。
一妇人两拗肿痛，小腹痞胀，小便时数，白带时下，寒热往来，小水淋沥。余谓脾气滞
而血病，用龙胆泻肝汤渐愈；又用加味逍遥散、六味丸而痊愈。
一妇人患前症，胸胁胀闷，或小便不利，或时作痛，小便涩滞，服疏气豁痰等药益甚。
余谓肝火气分之病，用龙胆泻肝汤以清肝热；又用加味逍遥散以生肝血；六味丸以滋肾水而愈。
一妇人患前症。余谓此肝脾郁怒之症。不信，别服化痰利气之剂，胸腹胀闷。又服峻利
疏导之剂，变脾虚发肿之症而殁。
一妇人两拗肿痛，内热作渴，饮食不甘，肢体倦怠，阴中作梗，小便赤涩。为肝脾阴
虚湿热
理肝火，胀痛顿止。又以加味逍遥散，调补肝火而痊。
一妇人两拗作痛，寒热内热，小便赤涩，胸胁不利，此肝火动而脾气伤。用补中益气汤
加茯苓，数剂少愈；又与加味归脾汤，诸症悉退，再用加味逍遥散而痊愈。
一妇人小腹痞闷，小便不利，内热体倦懒食，此气血虚，而兼肝火。用八珍汤加柴、栀
、胆草，治之而安。
一妇人阴中如梗，两拗肿痛，寒热不食，小便频数，小腹重坠，余以为肝脾郁结所致
。先以补中益气汤，加山栀、茯苓、车前子、青皮，以清肝火升脾气；更以加味归脾汤，二十余
剂，调理脾郁而愈。
便痈归属于厥阴肝经，表现为内热外寒；或因过度劳累，或因房事不节制，或因性欲不得满足，或因强行忍精不泄，或因肝经湿热蕴结所致。治疗方法：对于内热外寒者，使用双解散。对于过度劳累者，使用补中益气汤。对于房事不节者，使用六味丸的药料。对于性欲不得满足者，先用五苓散加大黄，以疏通精液瘀滞；随后用地黄丸，以滋补肝肾，巩固精气。若是湿热壅滞者，宜用龙胆泻肝汤，以疏肝导滞。所谓便痈、血疝，属于厥阴肝经的络脉，以及冲脉、任脉、督脉的通道。因此妇女患此病，多发生在两侧腹股沟处肿痛，或腹部有结块，小便涩滞不畅。如果治疗得当，患者又能注意调养，收敛愈合有什么困难呢？若一概使用大黄等攻下药物，以求内部消散；或者让脓液随意流出，损伤气血，以及起居饮食不慎的患者，（则难以治愈）。
治验记录：
府庠生沈尼文，二十岁，左侧腹股沟患病。我认为这是肝肾阴虚。先用托里药，溃破后即将痊愈。因行房事，出现发热口渴，右侧也开始疼痛，脓水清稀，虚证全部显现，脉象洪大但无力，病情形势非常可畏。使用十全大补汤加附子一钱，脉象和症状立刻消退，再服两剂完全消退。后来用大补汤，服用三十剂而痊愈。
一位儒生肿痛且小便涩滞，使用八正散两剂，清肝火，导湿热，肿痛痊愈；再用小柴胡汤加川芎、当归、泽泻、山栀，两剂清肝火补脾血，小便通利。
一名男子溃破后肿痛不止，这是余毒未解，使用活命饮，一剂疼痛停止；再服两剂肿胀消退。
一名男子疼痛剧烈伴发热，使用前一方一剂疼痛停止；再用神效栝蒌散，加山栀、柴胡，两剂后肿块消散。
一名男子肿胀但未溃破，我认为这是因为阳气虚弱，用人参、[缺字，通常为黄芪]、当归、白术，以补益托举元气；用白芷、皂角刺、柴胡、甘草节，以排脓清肝，数剂后溃破；用八珍汤加柴胡，补益气血，数剂后痊愈。
一名男子已溃破，但疼痛不止，小便闭塞涩滞，这是肝火未解。用小柴胡汤加黄柏、知母、川芎、当归，疼痛停止，小便通利，再用托里当归汤使疮口愈合。如果毒邪未解而疼痛不止者，必须使用活命饮。
一名妇人平素清苦寡欲，因郁怒，患上前述病症。有人使用败毒寒凉的药物，反而导致傍晚发热、内热、自汗盗汗，月经不行，口干咽燥。我认为这是郁气伤脾，又因用药再次损伤，先用当归汤数剂，后兼用逍遥散，各服用五十余剂，各种症状痊愈。
一名妇人小腹内感觉如有梗塞，两侧腹股沟及肛门周围均肿胀，小便淋沥涩滞，月经不调，内热但不口渴，饮食少思，腹部初起如鸡蛋大小而后逐渐增大，脉象洪数而虚，左关脉尤为明显，属于肝脾郁结的病症。使用加味归脾汤，肝火退去而脾土健运，间或用逍遥散送服芦荟丸而痊愈。
一名妇人两侧腹股沟肿痛，腹部有一块状物，不时向上攻冲，月经不调，小便不利。我认为这是肝脾气滞，用四君子汤加川芎、当归、柴胡、山栀而痊愈。后因郁怒，前症复发，却兼见胸胁胀满、盗汗，这是肝木过旺而损伤脾土。用加味归脾汤送服芦荟丸而痊愈。
一名妇人小腹内，有时疼痛，有时痞闷，两侧腹股沟肿痛，内热恶寒交替，胸膈不适，饮食无味，形体日渐消瘦，这是肝气滞涩，而损伤脾气。早晨服用补中益气汤，晚上服用六味丸，逐渐好转，再用芦荟丸而痊愈。
一名妇人两侧腹股沟肿痛，小腹痞胀，小便频数，白带时下，寒热往来，小便淋沥不尽。我认为这是脾气滞涩而血分有病，用龙胆泻肝汤逐渐好转；又用加味逍遥散、六味丸而痊愈。
一名妇人患前述病症，胸胁胀闷，有时小便不利，有时发作疼痛，小便涩滞，服用疏气豁痰等药物后病情加重。我认为这是肝火在气分的病变，用龙胆泻肝汤以清肝热；又用加味逍遥散以生肝血；六味丸以滋肾水而痊愈。
一名妇人患前述病症。我认为这是肝脾郁怒的病症。患者不信，另服化痰利气的药剂，导致胸腹胀闷。又服用峻烈利导疏导的药剂，转变为脾虚发肿的病症而死亡。
一名妇人两侧腹股沟肿痛，内热口渴，饮食无味，肢体倦怠，阴中有梗塞感，小便赤涩。此为肝脾阴虚湿热。[此处原文似有脱漏，结合语境应为“予理肝火...”或类似表述，依下文逻辑推断] 调理肝火，胀痛立刻停止。又以加味逍遥散，调补肝火而痊愈。
一名妇人两侧腹股沟作痛，寒热内热，小便赤涩，胸胁不利，这是肝火动而脾气伤。用补中益气汤加茯苓，数剂后稍有好转；又给予加味归脾汤，各种症状全部消退，再用加味逍遥散而痊愈。
一名妇人小腹痞闷，小便不利，内热体倦懒食，这是气血虚，而兼有肝火。用八珍汤加柴胡、山栀、龙胆草，治疗而安。
一名妇人阴中有梗塞感，两侧腹股沟肿痛，寒热不食，小便频数，小腹重坠，我认为这是肝脾郁结所致。先以补中益气汤，加山栀、茯苓、车前子、青皮，以清肝火升脾气；更以加味归脾汤，二十余剂，调理脾郁而痊愈。
(Bian Yong, also known as Biandu or Hengxuan)
Bian Yong (Perineal Abscess) belongs to the Jueyin Liver Meridian, presenting with internal heat and external cold; it may be caused by excessive fatigue, irregular sexual activity, unfulfilled sexual desire, forced retention of semen, or damp-heat accumulation in the Liver Meridian. Treatment methods: For cases with internal heat and external cold, use Shuangjie San (Double Release Powder). For cases due to excessive fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For cases due to irregular sexual activity, use the ingredients of Liuwei Wan (Six-Ingredient Pill with Rehmannia). For cases of unfulfilled sexual desire, first use Wuling San (Five-Ingredient Powder with Poria) plus Dahuang (Rhubarb Rhizome) to unblock seminal stasis; subsequently use Dihuang Wan (Rehmannia Pill) to tonify the Liver and Kidney and consolidate essence. If caused by damp-heat obstruction, Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) should be used to soothe the Liver and guide out stagnation. Bian Yong and Xuehan (Blood Hernia) involve the collateral vessels of the Jueyin Liver Meridian and the pathways of the Chong, Ren, and Du meridians. Therefore, when women suffer from this condition, swelling and pain often occur in both inguinal regions, or there are abdominal masses and dysuria. If treated correctly and if the patient maintains proper lifestyle regulation, healing is not difficult. However, if one indiscriminately uses purgatives such as Dahuang (Rhubarb Rhizome) seeking internal resolution, or allows pus to drain freely causing Qi and Blood damage, or if the patient neglects diet and rest, [healing will be hindered].
Case Records:
Shen Niwen, a student at the Prefectural School, aged twenty, suffered from the disease in the left inguinal region. I diagnosed it as Yin deficiency of the Liver and Kidney. I first used Tuoli Yao (Supporting Interior Medicines); after suppuration, it was nearly healed. Due to sexual intercourse, fever and thirst developed, and pain appeared on the right side as well. The pus was clear and thin, all deficiency symptoms manifested, and the pulse was surging yet forceless. The condition was alarming. I used Shiquan Dabu Tang (Complete Great Tonifying Decoction) plus Qian Chen of Fuzi (Aconite Lateral Root), and the pulse and symptoms subsided immediately. After two more doses, they completely subsided. Later, he took Dabu Tang (Great Tonifying Decoction) for thirty doses and recovered.
A scholar presented with swelling, pain, and dysuria. I used Bazheng San (Eight-Ingredient Powder for Rectification) for two doses to clear Liver Fire and drain damp-heat, resolving the swelling and pain. Subsequently, I used Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), ZeXie Alisma (Zexie), and Zhizi Gardeniae Fructus (Zhizi). After two doses, Liver Fire was cleared, Spleen Blood was tonified, and urination became smooth.
A male patient had persistent swelling and pain after suppuration. This indicated residual pathogenic factors were unresolved. I used Huoming Yin (Decoction for Saving Lives) for one dose, stopping the pain; after two doses, the swelling subsided.
A male patient suffered severe pain and fever. One dose of the aforementioned decoction stopped the pain; Shenxiao Gualou San (Miraculous Trichosanthes Powder) plus Zhizi and Chaihu was administered for two doses, resulting in the resolution of the mass.
A male patient had swelling without suppuration. I attributed this to Yang Qi deficiency. I used Renshen Ginseng Radix (Renshen), Huangqi Astragali Radix (Huangqi), Danggui Radix (Danggui), and Baizhu Atractodis Rhizoma (Baizhu) to tonify and support Yuan Qi; and Baizhu Angelicae Dahuricae Radix (Baizhi), Zaojiaoci Spina Gleditsiae (Zaojiaoci), Chaihu Bupleuri Radix (Chaihu), and Gancaojie Glycyrrhizae Radix et Rhizoma (Gancaojie) to discharge pus and clear Liver Heat. After several doses, suppuration occurred. Then, using Bazhen Tang (Eight-Treasure Decoction) plus Chaihu to tonify Qi and Blood, he recovered after several doses.
A male patient had suppuration but persistent pain and urinary obstruction. This indicated unresolved Liver Fire. I used Xiao Chaihu Tang plus Huangbai Phellodendri Cortex (Huangbai), Zhimu Anemarrhenae Rhizoma (Zhimu), Chuanxiong, and Danggui. Pain ceased, urination normalized, and the wound healed after using Tuoli Danggui Tang (Supporting Interior Danggui Decoction). If pathogenic factors remain unresolved and pain persists, Huoming Yin must be used.
A woman, who lived ascetically, developed the aforementioned symptoms due to depression and anger. Others used cooling and detoxifying herbs, which instead caused afternoon fever, internal heat, spontaneous sweating, night sweats, amenorrhea, dry mouth, and dry throat. I diagnosed this as Depression injuring the Spleen, compounded by medication damage. I first used Danggui Tang (Angelica Decoction) for several doses, then combined it with Xiaoyao San (Free and Easy Wanderer Powder), each taken for over fifty doses, resolving all symptoms.
A woman felt a blockage in the lower abdomen, with swelling in both inguinal regions and around the anus, dysuria, irregular menstruation, internal heat without thirst, poor appetite, and an abdominal mass initially the size of a chicken egg that gradually enlarged. The pulse was surging, rapid, and deficient, especially at the Left Guan position. This belonged to Liver-Spleen Qi Stagnation. I used Jiawei Guipi Tang (Modified Restore the Spleen Decoction); as Liver Fire receded and Spleen Earth strengthened, I intermittently administered Xiaoyao San with Lubin Wan (Aloe Pill), leading to recovery.
A woman presented with bilateral inguinal swelling and pain, an abdominal mass that occasionally moved upward, irregular menstruation, and dysuria. I diagnosed Liver-Spleen Qi Stagnation and used Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong, Danggui, Chaihu, and Zhizi, resulting in recovery. Later, due to depression and anger, the previous symptoms recurred, accompanied by distension in the chest and hypochondrium and night sweats. This indicated excessive Liver Wood injuring Spleen Earth. I used Jiawei Guipi Tang with Lubin Wan, leading to recovery.
A woman experienced intermittent pain and fullness in the lower abdomen, bilateral inguinal swelling and pain, alternating internal heat and chills, chest discomfort, loss of taste, and emaciation. This was Liver Qi Stagnation injuring Spleen Qi. In the morning, she took Buzhong Yiqi Tang; in the evening, Liuwei Wan. She gradually improved and fully recovered after taking Lubin Wan.
A woman had bilateral inguinal swelling and pain, lower abdominal fullness, frequent urination, leukorrhea, alternating chills and fever, and dribbling urine. I diagnosed Spleen Qi Stagnation affecting Blood. She gradually improved with Longdan Xiegan Tang; subsequent treatment with Jiawei Xiaoyao San and Liuwei Wan led to complete recovery.
A woman suffered from the aforementioned symptoms, including chest and hypochondriac distension, intermittent dysuria, and pain. Her condition worsened after taking Qi-regulating and phlegm-resolving herbs. I diagnosed this as Liver Fire affecting the Qi level. I used Longdan Xiegan Tang to clear Liver Heat; followed by Jiawei Xiaoyao San to generate Liver Blood; and Liuwei Wan to nourish Kidney Water, leading to recovery.
A woman suffered from the aforementioned symptoms. I diagnosed it as Liver-Spleen Depression and Anger. Disbelieving me, she took other phlegm-resolving and Qi-moving agents, causing chest and abdominal distension. She then took harsh draining and guiding agents, transforming into a Spleen Deficiency with edema condition, and died.
A woman had bilateral inguinal swelling and pain, internal heat with thirst, loss of taste, limb fatigue, a sensation of blockage in the vagina, and red, scanty urine. This was Liver-Spleen Yin Deficiency with Damp-Heat. [Text implies treatment logic] Regulating Liver Fire stopped the swelling and pain instantly. Subsequently, Jiawei Xiaoyao San was used to regulate and tonify Liver Fire, leading to recovery.
A woman had bilateral inguinal pain, chills, internal heat, red scanty urine, and chest/hypochondriac discomfort. This indicated Liver Fire agitation injuring Spleen Qi. I used Buzhong Yiqi Tang plus Fuling Poria (Fuling). After several doses, slight improvement occurred. Then, Jiawei Guipi Tang was given, resolving all symptoms. Finally, Jiawei Xiaoyao San was used for complete recovery.
A woman had lower abdominal fullness, dysuria, internal heat, fatigue, and anorexia. This was Qi and Blood Deficiency combined with Liver Fire. I treated her with Bazhen Tang plus Chaihu, Zhizi, and Dancao (Longdan Cao/Gentiana Root), resulting in stabilization.
A woman felt a blockage in the vagina, bilateral inguinal swelling and pain, chills, inability to eat, frequent urination, and heavy bearing sensation in the lower abdomen. I attributed this to Liver-Spleen Depression. First, I used Buzhong Yiqi Tang plus Zhizi, Fuling, Cheqianzi Plantaginis Semen (Cheqianzi), and Qingpi Citri Reticulatae Pericarpium Viride (Qingpi) to clear Liver Fire and raise Spleen Qi. Subsequently, Jiawei Guipi Tang was administered for over twenty doses to regulate Spleen Depression, leading to recovery.