悬痈谓疮生于玉茎之后，谷道之前，属足三阴亏损之症。轻则为漏，沥尽气血而亡，重
则内溃而即殒。若初起湿热壅滞，未成脓而作痛，或小便涩滞，用龙胆泻肝汤。肿 痛甚，仙
方活命饮，并以制甘草佐之。如此虽患亦轻，虽积亦浅。若不能成脓，或脓成不溃者，八珍
汤补之。若脓已成者，急针之。若其生肌收敛，肾虚，六味地黄丸。血虚者，四物加参、术
。气虚者，四君加芎、归。脾虚者，补中益气汤。气血俱虚者，八珍汤，并十全大补汤。若
用寒凉消毒，则误矣。
治验
尚书鲍希传，足发热。服四物、黄柏、知母之类，年余患囊痈。唾痰作渴饮汤，其热至
膝，更加芩、连、二陈，热痰益甚。谓余曰∶何也？余曰∶此足三阴亏损，水泛为痰，寒凉之剂
，伤胃而甚耳。遂先用补中益气，夕用六味丸，间佐以当归补血汤，半载乃愈。
赵州守患此症，肿多作痛，五月余矣。晡热口干，盗汗，食少体倦，气短脉浮数而无力
，此足
五十余剂，脓溃疮敛；后因脓作痛少食，胁痛发热；又用前药，赖其禀实，慎疾而愈。
通府张敬之患前症，久不愈。日晡热甚，作渴烦喘，或用四物汤、黄柏、知母之类，前
症益甚。肢体倦、少食，大便不实，小便频数。谓余曰∶何也？余曰∶此脾虚之症，前药复
伤而然。余遂用补中益气加茯苓、半夏，数剂饮食渐进，前症渐愈；更加麦门、五味，调理
乃痊。经云∶脾属太阴为阴土，而主生血。故东垣先生云∶脾虚元气下陷，发热烦渴，肢体
倦怠等症，用补中益气汤，以升补阳气，而生阴血。若误认为肾虚，辄用四物、黄柏、知母
之类，反伤脾胃生气，是虚其虚矣。况黄柏、知母，乃泻阳损阴之剂，若非膀胱阳火盛而不
能生阴水，以致发热者，不可用也。
一儒者患此，服坎离丸，及四物、黄柏、知母之类，不应。脉浮洪，按之细微，余以为
足三
凡疮疡等症，若肾经阳气亢盛，致阴水不能化生，而患阴虚发热者，宜用坎离丸，取其苦寒
，
六味丸，取其酸温，能生火中之水，使阳气旺则阴自生。况此症属肾经精气亏损而患者，十
有八九；属肾经阳气亢盛而患者，十无一二。然江南之人，患之多属脾经，阴血亏损，元气
下陷。须用补中益气，升补阳气，使阳生而阴长。若嗜欲过多，亏损真水者，宜用六味丸，
补肾经元气，以生精血；仍用补中益气汤，以培脾肺之生气，而滋肾水。经云∶阴虚者脾虚
也。但多误以为肾经火症，用黄柏、知母之类，复伤脾肺，绝其化源，反致不起。惜哉！
上舍刘克新，溃后作痛，发热口干，小便赤涩，自用清热消毒之药，不应。左尺洪数，
余以
渐愈。后用补中益气汤、六味地黄丸，补脾肺滋肾水，而疮口愈。
一儒者小便赤涩，劳则足软肿痛发热，口干舌燥，食少体倦，日晡益甚，此气血虚而未
能溃
五剂，脓自涌出；又五十余剂，而疮口将完。又因劳役且停药，寒热作渴，肿痛脓多，用补
中益气汤加炒山栀，二剂少愈；又以八珍汤加麦门、五味百余剂，肿痛悉去。喜其慎起居，
节饮食，常服补剂而安。但劳则出脓一二滴，后惑于他言。内用降火，外用追蚀，必其收敛
，致患处大溃，几至不起。仍补而愈。
悬痈是指疮疡生长在玉茎（阴茎）之后、谷道（肛门）之前，属于足三阴经亏损的病症。病情轻者会形成漏管，耗竭气血而死亡；病情重者则内部溃烂而立即致死。如果在初起阶段表现为湿热壅滞，尚未化脓但出现疼痛，或者小便涩滞不畅，可使用龙胆泻肝汤。如果肿痛剧烈，使用仙方活命饮，并配合炮制过的甘草作为辅助药物。这样即使患病也较轻，且病灶积聚较浅。如果不能化脓，或者脓成后不能自行溃破的，用八珍汤进行补益。如果脓已经形成，应立即针刺排脓。在生肌收敛阶段，如果是肾虚，使用六味地黄丸；血虚者，在四物汤中加入人参、白术；气虚者，在四君子汤中加入川芎、当归；脾虚者，使用补中益气汤；气血俱虚者，使用八珍汤，以及十全大补汤。如果使用寒凉药物进行消毒，那就是错误的。
治验案例：
尚书鲍希传，足部发热。服用四物汤、黄柏、知母等药物，一年多后患囊痈。咳吐痰涎且口渴想喝热汤，热度甚至蔓延至膝盖，又加入黄芩、黄连和二陈汤，导致热痰更加严重。他问我：“这是为什么呢？”我说：“这是足三阴经亏损，水湿泛滥化为痰饮，寒凉药物损伤了胃气所致。”于是先用补中益气汤，晚上服用六味地黄丸，间或配合当归补血汤，半年后才痊愈。
赵州守患有此症，肿胀且多疼痛，持续五十多天。午后发热，口干，盗汗，食欲减退，身体疲倦，气短，脉象浮数但无力，这是足三阴亏损的表现。服用五十多剂药后，脓液排出，疮口愈合；后来因为脓液产生疼痛、食欲减少、胁痛发热，又使用前药，依靠其体质强健，谨慎调养而痊愈。
通府张敬之患有前症，久治不愈。日晡时（下午3-5点）发热严重，口渴烦躁气喘，有人使用四物汤、黄柏、知母等药物，导致前症更加严重。肢体疲倦，食欲少，大便不成形，小便频数。他问我：“这是为什么呢？”我说：“这是脾虚的病症，之前的药物再次损伤脾胃所致。”我于是使用补中益气汤加入茯苓、半夏，几剂药后饮食逐渐增加，前症逐渐好转；再加入麦门冬、五味子，调理后痊愈。《内经》说：“脾属太阴，为阴土，主生血。”所以东垣先生曾说：“脾虚导致元气下陷，出现发热、烦渴、肢体倦怠等症状，应使用补中益气汤，以升提补益阳气，从而化生阴血。”如果误认为是肾虚，随意使用四物汤、黄柏、知母等药物，反而损伤脾胃的生气，这就是使虚者更虚了。况且黄柏、知母，是泻阳损阴的药物，如果不是膀胱阳火旺盛而不能生阴水，以致发热的情况，不可使用。
一位儒者患有此症，服用坎离丸，以及四物汤、黄柏、知母等药物，没有效果。脉象浮洪，重按细微，我认为这是足三阴亏损。
凡是疮疡等病症，如果是肾经阳气亢盛，导致阴水不能化生，而出现阴虚发热的，适宜使用坎离丸，取其苦寒之性；或者使用六味地黄丸，取其酸温之性，能生火中之水，使阳气旺盛则阴自生。况且此症属于肾经精气亏损而患病的，十有八九；属于肾经阳气亢盛而患病的，十无一二。然而江南地区的人，患病多属于脾经，阴血亏损，元气下陷。必须使用补中益气汤，升提补益阳气，使阳生而阴长。如果嗜欲过多，亏损真水的，适宜使用六味地黄丸，补肾经元气，以生精血；仍需用补中益气汤，来培补脾肺的生气，从而滋润肾水。《内经》说：“阴虚者，实为脾虚也。”但人们多误认为是肾经火症，使用黄柏、知母等药物，再次损伤脾肺，断绝化源，反而导致病情恶化无法挽回。可惜啊！
上舍刘克新，疮疡溃破后作痛，发热口干，小便赤涩，自行使用清热消毒的药物，没有效果。左尺脉洪数，我判断为……（原文此处似有缺漏，依上下文推断为虚证），逐渐好转。后来使用补中益气汤、六味地黄丸，补脾肺滋肾水，疮口愈合。
一位儒者小便赤涩，劳累后足部软弱肿痛发热，口干舌燥，食欲少，身体疲倦，日晡时加重，这是气血虚而未能溃破（指正气不足难以托毒外出）。服用五剂药后，脓液自然涌出；又服用五十多剂，疮口将愈。又因劳役且停药，出现寒热、口渴、肿痛、脓多，使用补中益气汤加炒山栀，两剂后稍有好转；又以八珍汤加麦门冬、五味子一百多剂，肿痛全部去除。庆幸他起居谨慎，节制饮食，常服补益药物而安定。但劳累时仍会流出脓液一二滴，后来听信他人言论，内服降火药，外用追蚀药，必然导致收敛过早，致使患处大面积溃烂，几乎危及生命。最终还是通过补益治疗而痊愈。
Xuan Yong (Abscess of the Perineum) refers to a sore occurring posterior to the jade stem (penis) and anterior to the grain gate (anus). It belongs to the syndrome of deficiency in the three foot yin meridians. In mild cases, it develops into a fistula; draining all qi and blood leads to death. In severe cases, internal ulceration occurs leading to immediate demise. If at the initial stage there is stagnation of damp-heat, pain without suppuration, or difficult urination, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) should be used. If swelling and pain are severe, Xianfang Huoming Yin (Immortal Life Elixir) is used, assisted by prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao). Although this results in a milder condition with shallower accumulation, if suppuration fails to form or does not rupture spontaneously, Bazhen Tang (Eight-Treasure Decoction) is used for tonification. If pus has formed, urgent needle drainage is required. For granulation and healing, if kidney deficiency is present, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is used. For blood deficiency, Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) are added to Siwu Tang (Four-Substance Decoction). For qi deficiency, Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) are added to Sijunzi Tang (Four-Gentlemen Decoction). For spleen deficiency, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) is used. For combined qi and blood deficiency, Bazhen Tang (Eight-Treasure Decoction) and Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) are used. Using cold and cool herbs for detoxification is an error.
Case Record:
Bao Xichuan, Minister of Works, suffered from heat in the feet. After taking Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) for over a year, he developed Nang Yong (Scrotal Abscess). He expectorated phlegm, felt thirsty and desired hot drinks, with heat extending to the knees. Adding Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), and Erchen Tang (Two-Aged Decoction) exacerbated the heat-phlegm. He asked me, "Why?" I replied, "This is due to deficiency of the three foot yin meridians, causing water flooding to transform into phlegm. Cold and cool agents have damaged the stomach qi." I initially prescribed Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi), followed by Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) in the evening, occasionally assisting with Danggui Buxue Tang (Danggui Tonifies the Blood Decoction). He recovered after half a year.
The Prefect of Zhaozhou suffered from this syndrome, with significant swelling and pain lasting over fifty days. He had afternoon fever, dry mouth, night sweats, poor appetite, body fatigue, shortness of breath, and a floating, rapid but forceless pulse. This indicated deficiency of the three foot yin meridians. After more than fifty doses, pus drained and the sore healed. Later, due to pain from pus, poor appetite, hypochondriac pain, and fever, he reused the previous medicines. Relying on his robust constitution and careful management, he recovered.
Zhang Jingzhi, Vice Minister, suffered from the aforementioned syndrome, which persisted for a long time. He had severe afternoon fever, thirst, irritability, and panting. Others used Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), worsening the symptoms. He experienced limb fatigue, poor appetite, loose stools, and frequent urination. He asked me, "Why?" I said, "This is a spleen deficiency syndrome, aggravated by previous medications damaging the spleen and stomach." I prescribed Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) with Fuling (Poria) and Banxia (Pinelliae Rhizoma). After several doses, diet improved and symptoms subsided. Adding Maimen Dong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) led to full recovery. The Classic states: "The Spleen belongs to Taiyin, is Yin Earth, and governs the generation of blood." Therefore, Mr. Dongyuan stated: "For spleen deficiency causing sinking of yuan qi, presenting with fever, thirst, and limb fatigue, use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) to raise and tonify yang qi, thereby generating yin blood." Mistaking this for kidney deficiency and using Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) damages the vital qi of the spleen and stomach, making deficiency worse. Moreover, Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) drain yang and damage yin; they should not be used unless bladder yang fire is excessive and unable to generate yin water, causing fever.
A scholar suffered from this syndrome. Taking Kanli Wan (Kanli Pill), Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma) was ineffective. His pulse was floating and surging, but fine and subtle upon deep pressure. I considered this deficiency of the three foot yin meridians.
Generally, for sores and ulcers, if kidney meridian yang qi is hyperactive, preventing yin water generation and causing yin-deficiency fever, Kanli Wan (Kanli Pill) may be used for its bitter-cold nature, or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for its sour-warm nature to generate water within fire, allowing strong yang qi to naturally generate yin. However, 80-90% of such cases belong to kidney essence and qi deficiency, while only 1-2% belong to kidney yang hyperactivity. People in Jiangnan often suffer from spleen meridian issues, with yin blood deficiency and sinking of yuan qi. Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) must be used to raise and tonify yang qi, promoting yang growth and yin lengthening. For those with excessive desires damaging true water, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is suitable to tonify kidney yuan qi and generate essence and blood; still, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) is needed to cultivate the generating qi of spleen and lung, thereby nourishing kidney water. The Classic says: "Yin deficiency is actually spleen deficiency." But it is often mistaken for kidney fire syndrome, leading to the use of Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), which further damage spleen and lung, cutting off the source of transformation, leading to fatal outcomes. Regrettable!
Liu Kexin, Scholar of the Upper Chamber, suffered from pain and fever after ulceration, with dry mouth and red, difficult urination. Self-medication with heat-clearing and detoxifying herbs was ineffective. The left chi pulse was surging and rapid. [Context implies diagnosis of deficiency]. Gradually improved. Later, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) were used to tonify spleen and lung and nourish kidney water, leading to wound healing.
A scholar had red, difficult urination. Fatigue caused soft, swollen, painful, and hot feet, dry mouth and tongue, poor appetite, body fatigue, worsening in the afternoon. This indicated qi and blood deficiency failing to expel toxins. After five doses, pus emerged spontaneously; after another fifty doses, the wound nearly healed. Due to labor and stopping medication, chills, fever, thirst, swelling, pain, and abundant pus occurred. Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) with fried Gardeniae Fructus (Chao Zhizi) relieved symptoms after two doses. Subsequently, Bazhen Tang (Eight-Treasure Decoction) with Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi) for over a hundred doses eliminated swelling and pain. Fortunately, he managed daily life carefully, regulated diet, and took tonic herbs regularly. However, slight pus discharge occurred with fatigue. Confused by others' advice, he used internal fire-draining herbs and external cauterizing agents, causing premature contraction and massive ulceration, nearly resulting in death. He was eventually cured through tonification.