内蕴热毒，外挟寒邪者，解散之。劳役而患者，补之。不遂交感，或强固精气，致败精
而结者，解散之。湿热而致者，清肝导湿。
一男子患此，未作脓，小便秘涩，以八正散三剂，稍愈；以小柴胡汤加泽泻、山栀、木
通，二剂而消。
一男子肿痛，发寒热，以荆防败毒散，二剂而止，以双解散，二剂而消。
一男子脓未成，大痛，服消毒托里内疏药，不应。诊之脉洪大，毒尚在，以仙方活命饮
，一剂痛止，又一剂而消。
一男子肿痛，日晡发热，以小柴胡汤加青皮、天花粉，四剂痛止，热退，以神效栝蒌散
，四剂而消。
一男子肿而不溃，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，数剂而愈。
一男子溃而肿不消，且不敛，诊之脉浮而涩，以豆豉饼灸之；更以十全大补汤，月余而
愈。
一男子溃而痛不止，以小柴胡汤加黄柏、知母、芎、归，四剂少止，更以托里当归汤，
数剂而敛。
一男子 肿作痛，大小便秘，脉有力，以玉烛散，二剂顿退；更以龙胆泻肝汤，四剂而
消。
一男子溃而痛不止，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
，又二剂而敛。
一男子服克伐之药，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。
大抵此证多患于劳逸之人，亦有内蕴热毒而生者，须辨虚实及成脓否，不可妄投药饵。
尝见
者，盖恐收口之难也。若补养血气，不旬日而收矣，何难之有。若脓既成，岂有可消之理，
如再用克伐之剂，反为难治。
一男子不慎房劳，患此肿痛，以双解散，一服通之，其痛即止；更以补中汤数剂，而脓
成，
便毒，言于不便处肿毒，故为便痈也。乃足厥阴肝之经络，及冲任督脉，亦属肝之旁络，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，更以托里之剂，此临证制宜
之法也。
一老妇肿痛，脓未作，小便涩，肝脉数，以加减龙胆泻肝汤，加山栀、黄柏，四剂而消
附方
双解散 治便痈，内蕴热毒，外挟寒邪，或交感强固精气，致精血交错，肿结疼
痛，大小便秘者，宜用此药通解，更随证调治。
辣桂 大黄（酒拌炒） 白芍药 牵牛（炒、捣） 桃仁（去皮尖） 泽泻 甘草（炒） 干姜
（炮，各五分） 作一剂，水二钟，煎八分，空心服。
补中益气汤（方见溃疡发热门）
加减龙胆泻肝汤（方见下疳门）
八正散 治积热小便癃闭不通，及一切淋证脉实。
大黄（酒拌炒） 车前子（炒） 瞿麦 蓄 山栀仁（炒） 木通 甘草（各一钱） 滑石（
，二钱） 作一剂，水二钟，煎八分，食前服。
仙方活命饮（方见发背门）
小柴胡汤（方见瘰 门）
荆防败毒散（方见溃疡发热门）
神效栝蒌散（方见乳痈门）
八珍汤（方见溃疡发热门）
豆豉饼（方见肾痈门）
十全大补汤（方见溃疡发热门）
二神丸（方见作呕门）
导水丸 治便痈初起肿痛，及下疳大小便秘，又治杨梅疮初起，湿盛之际，宜先
用此丸数服。
大黄（酒拌炒） 黄芩（炒，二钱） 黑牵牛末（炒） 滑石（ ，各四两） 为末糊丸，梧子
大。每服五十丸，临卧，温水下。
桃仁承气汤 治症同玉烛散（方见杖疮门）
玉烛散 治便痈初起，肿痛发热，大小便秘，用此以行散之。
川芎 当归（酒拌） 芍药 生地黄（酒拌） 芒硝 大黄（ ，各二钱） 甘草（炙，五分）
作一剂，水二钟，煎八分，食前服。
托里当归汤 治溃疡气血俱虚发热，及瘰 流注乳痈，不问肿溃，但疮疡气血虚
而发热者，皆宜服之。久服能收敛疮疡。
当归（酒拌） 黄 （盐水拌炒） 人参 熟地黄（酒拌） 川芎 芍药（炒，各一钱） 柴胡
甘草（炙，各五分） 作一剂，水二钟，煎八分，食远服。
体内蕴藏热毒，外部夹杂寒邪的，采用解散法治疗。因劳累过度而患病的，采用补益法治疗。未能正常进行房事，或强行固摄精气，导致败精凝结而成的，采用解散法治疗。由湿热引起的，清泻肝火并引导湿气排出。
有一个男子患此病，脓尚未形成，小便短少涩痛，服用八正散三剂后，症状稍有好转；再服用小柴胡汤加泽泻、山栀、木通，两剂后肿块消散。
有一个男子患处肿痛，伴有发冷发热，服用荆防败毒散，两剂后寒热停止，再服用双解散，两剂后肿块消散。
有一个男子脓未形成，疼痛剧烈，服用消毒托里内疏类药物，无效。诊察其脉象洪大，说明毒邪仍在，服用仙方活命饮，一剂后疼痛停止，又一剂后肿块消散。
有一个男子患处肿痛，傍晚时分发热，服用小柴胡汤加青皮、天花粉，四剂后疼痛停止，热退，再服用神效栝蒌散，四剂后肿块消散。
有一个男子患处肿胀但未溃破，用人参、[缺失药材]、当归、白术、白芷、皂角刺、柴胡、甘草节，数剂后溃破；再服用八珍汤加柴胡，数剂后痊愈。
有一个男子已溃破但肿胀不消，且伤口不收敛，诊察其脉象浮而涩，用豆豉饼灸治；随后服用十全大补汤，月余后痊愈。
有一个男子溃破后疼痛不止，服用小柴胡汤加黄柏、知母、川芎、当归，四剂后疼痛稍减，随后服用托里当归汤，数剂后伤口收敛。
有一个男子患处肿胀作痛，大小便不通利，脉象有力，服用玉烛散，两剂后症状顿然减退；随后服用龙胆泻肝汤，四剂后肿块消散。
有一个男子溃破后疼痛不止，各种药物均无效，诊察其脉象大而按之则数，这是毒邪未解的表现，服用仙方活命饮后疼痛停止，又服两剂后伤口收敛。
有一个男子服用攻伐类药物，以求内部消散，导致腹泻、食欲减少，先用二神丸止住腹泻；再用十全大补汤加倍白术、茯苓，数剂后肿块消散。
大抵此类病症多发生于劳逸不当之人，也有因体内蕴藏热毒而生发的，必须辨别虚实以及是否成脓，不可妄投药物。
我曾见过[缺失内容]的情况，大概是担心收口困难吧。如果补养气血，不出十天就能收口，有什么难的呢？如果脓已经形成，哪里还有消散的道理，如果再使用攻伐的药物，反而难以治疗。
有一个男子不慎于房劳，患此病出现肿痛，服用双解散，一服后通畅，疼痛立即停止；随后服用补中益气汤数剂，脓液形成，[此处原文可能有缺漏，意指脓成后处理或自然演变]。
“便毒”是指发生在隐蔽部位的肿毒，所以称为便痈。这属于足厥阴肝经的经络，以及冲脉、任脉、督脉，也属于肝脏的旁络，是气血流通的道路。现在壅滞而肿痛，这是热毒所致，应当先疏导其阻滞，再用托里透脓的药物，这是临证制宜的方法。
一位老年妇女患处肿痛，脓未形成，小便涩痛，肝脉数，服用加减龙胆泻肝汤，加山栀、黄柏，四剂后肿块消散。
附方：
双解散 治疗便痈，体内蕴藏热毒，外部夹杂寒邪，或房事后强行固摄精气，导致精血交错，肿胀结聚疼痛，大小便不通利的，适宜用此药通解，随后随证调治。
辣桂 大黄（酒拌炒） 白芍药 牵牛（炒、捣） 桃仁（去皮尖） 泽泻 甘草（炒） 干姜（炮，各五分） 作为一剂，水两钟，煎至八分，空腹服用。
补中益气汤（方剂见溃疡发热门）
八正散 治疗积热导致的小便癃闭不通，以及一切淋证脉实者。
大黄（酒拌炒） 车前子（炒） 瞿麦 蓄草 山栀仁（炒） 木通 甘草（各一钱） 滑石（[缺失量词]，二钱） 作为一剂，水两钟，煎至八分，饭前服用。
荆防败毒散（方剂见溃疡发热门）
八珍汤（方剂见溃疡发热门）
豆豉饼（方剂见肾痈门）
十全大补汤（方剂见溃疡发热门）
二神丸（方剂见作呕门）
导水丸 治疗便痈初起肿痛，以及下疳大小便不通利，又治疗杨梅疮初起，湿气盛的时候，适宜先用此丸服用数次。
大黄（酒拌炒） 黄芩（炒，二钱） 黑牵牛末（炒） 滑石（[缺失量词]，各四两） 研为细末，糊丸，如梧桐子大。每次服用五十丸，临睡前，温水送服。
玉烛散 治疗便痈初起，肿痛发热，大小便不通利，用此药以行散之。
川芎 当归（酒拌） 芍药 生地黄（酒拌） 芒硝 大黄（[缺失量词]，各二钱） 甘草（炙，五分） 作为一剂，水两钟，煎至八分，饭前服用。
托里当归汤 治疗溃疡气血俱虚发热，以及瘰疬流注乳痈，不问肿胀还是溃破，只要是疮疡气血虚弱而发热的，都适宜服用。久服能收敛疮疡。
当归（酒拌） 黄芪（盐水拌炒） 人参 熟地黄（酒拌） 川芎 芍药（炒，各一钱） 柴胡 甘草（炙，各五分） 作为一剂，水两钟，煎至八分，饭后远时服用。
Internal accumulation of heat-toxin with external constraint by cold pathogen: treat with dispersing and resolving methods. Cases caused by overexertion: treat with tonification. Cases resulting from unfulfilled sexual intercourse or forced retention of essence, leading to the coagulation of degenerated essence: treat with dispersing and resolving methods. Cases caused by damp-heat: clear the Liver and guide out dampness.
A male patient suffered from this condition without suppuration (formation of pus), experiencing scanty and difficult urination. After three doses of Bazheng San (Eight-Positive Powder), symptoms slightly improved; subsequently, two doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Ze Xie (Alisma Rhizome), Shan Zhi (Gardenia Fruit), and Mu Tong (Akebia Caulis) resulted in the resolution of the swelling.
A male patient presented with painful swelling accompanied by chills and fever. After two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins), the chills and fever ceased; two doses of Shuangjie San (Double Resolution Powder) led to the resolution of the swelling.
A male patient had unsuppurated swelling with severe pain. Medications for detoxification, supporting the interior, and purging internally were ineffective. The pulse was large and forceful, indicating the toxin remained. One dose of Xianfang Huoming Yin (Immortal Life Elixir) stopped the pain, and a second dose resolved the swelling.
A male patient experienced painful swelling with afternoon fever. Four doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qing Pi (Citrus Aurantium Peel) and Tian Hua Fen (Trichosanthes Root) stopped the pain and reduced the fever. Subsequently, four doses of Shenxiao Gualou San (Miraculous Trichosanthes Powder) resolved the swelling.
A male patient had swelling without ulceration. Treatment with Ren Shen (Ginseng Root), [missing herb], Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Zhi (Angelica Dahurica Root), Zao Jiao Ci (Gleditsia Spine), Chai Hu (Bupleurum Root), and Gan Cao Jie (Licorice Knots) for several doses induced ulceration. Further treatment with Bazhen Tang (Eight-Treasure Decoction) added with Chai Hu (Bupleurum Root) for several doses led to recovery.
A male patient had an ulcerated lesion with persistent swelling and failure to heal. The pulse was floating and choppy. Moxibustion with Fermented Soybean Cakes was applied. Subsequently, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) was administered, leading to recovery after more than a month.
A male patient had an ulcerated lesion with continuous pain. Four doses of Xiaochaihu Tang (Minor Bupleurum Decoction) added with Huang Bo (Phellodendron Bark), Zhi Mu (Anemarrhena Rhizome), Xiong (Ligusticum Rhizome), and Dang Gui (Angelica Sinensis Root) slightly alleviated the pain. Subsequently, Tuoli Danggui Tang (Interior-Supporting Angelica Decoction) for several doses promoted healing.
A male patient presented with swollen, painful lesions and constipation of both urine and stool, with a forceful pulse. Two doses of Yuzhu San (Jade Candle Powder) caused immediate relief; four doses of Longdan Xiegan Tang (Gentian Decoction to Drain the Liver) resolved the swelling.
A male patient had an ulcerated lesion with continuous pain, unresponsive to various medications. The pulse was large but rapid upon deep pressure, indicating unresolved toxin. Xianfang Huoming Yin (Immortal Life Elixir) stopped the pain, and two additional doses promoted healing.
A male patient took harsh purgative drugs seeking internal resolution, resulting in diarrhea and poor appetite. Ershen Wan (Two Spirit Pills) was used first to stop the diarrhea. Subsequently, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) with doubled amounts of Bai Zhu (Atractylodes Macrocephala Rhizome) and Fu Ling (Poria) for several doses resolved the swelling.
Generally, this condition often affects individuals with improper work-rest balance or those with internal heat-toxin accumulation. It is essential to differentiate between deficiency and excess, and whether suppuration has occurred, avoiding indiscriminate medication.
I have observed cases of [missing content], likely due to fear of difficulty in wound closure. If Qi and Blood are tonified, closure can be achieved within ten days; what difficulty is there? Once pus has formed, it cannot be resolved; using purgatives at this stage makes treatment difficult.
A male patient indulged in sexual activity excessively, developing painful swelling. One dose of Shuangjie San (Double Resolution Powder) promoted drainage, stopping the pain immediately. Several doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) led to suppuration.
"Biandu" (Genital Abscess) refers to toxic swellings occurring in private areas, hence named "Bianyong" (Genital Carbuncle). This involves the Foot-Jueyin Liver Meridian, as well as the Chong, Ren, and Du meridians, which are also collateral branches of the Liver, serving as pathways for the smooth flow of Qi and Blood. Obstruction here causes swelling and pain due to heat-toxin. The initial approach should be to dredge the obstruction, followed by formulas that support the interior and expel toxins, representing the method of adapting treatment to clinical circumstances.
An elderly female patient presented with painful swelling, no suppuration, and difficult urination. The Liver pulse was rapid. Four doses of Jiajian Longdan Xiegan Tang (Modified Gentian Decoction to Drain the Liver) added with Shan Zhi (Gardenia Fruit) and Huang Bo (Phellodendron Bark) resolved the swelling.
Appendix Formulas:
Shuangjie San (Double Resolution Powder) Treats Biandu (Genital Abscess) characterized by internal heat-toxin and external cold constraint, or forced retention of essence after intercourse leading to chaotic essence and blood, causing swollen, knotted, painful lesions with urinary and fecal retention. Use this formula to resolve and unblock, then adjust according to symptoms.
La Gui (Cinnamon Twig), Da Huang (Rhubarb Root, stir-fried with wine), Bai Shao Yao (White Peony Root), Qian Niu (Morning Glory Seed, stir-fried and crushed), Tao Ren (Peach Kernel, skin and tip removed), Ze Xie (Alisma Rhizome), Gan Cao (Licorice Root, stir-fried), Gan Jiang (Dried Ginger, processed). Each ingredient five fen. Prepare as one dose, decoct two zhong of water to eight fen, take on an empty stomach.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See section on Ulcer Fever)
Jiajian Longdan Xiegan Tang (Modified Gentian Decoction to Drain the Liver) (See section on Chancre)
Bazheng San (Eight-Positive Powder) Treats retention of heat causing urinary retention and inability to void, and all types of strangury with a solid pulse.
Da Huang (Rhubarb Root, stir-fried with wine), Che Qian Zi (Plantago Seed, stir-fried), Qu Mai (Dianthus Herb), Xu Shi (Polygonum Aviculare Herb), Shan Zhi Ren (Gardenia Seed, stir-fried), Mu Tong (Akebia Caulis), Gan Cao (Licorice Root, each one qian), Hua Shi (Talcum, [missing quantity], two qian). Prepare as one dose, decoct two zhong of water to eight fen, take before meals.
Xianfang Huoming Yin (Immortal Life Elixir) (See section on Back Carbuncle)
Xiaochaihu Tang (Minor Bupleurum Decoction) (See section on Scrofula)
Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins) (See section on Ulcer Fever)
Shenxiao Gualou San (Miraculous Trichosanthes Powder) (See section on Breast Abscess)
Bazhen Tang (Eight-Treasure Decoction) (See section on Ulcer Fever)
Dou Chi Bing (Fermented Soybean Cake) (See section on Kidney Abscess)
Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) (See section on Ulcer Fever)
Ershen Wan (Two Spirit Pills) (See section on Vomiting)
Daoshui Wan (Water-Guiding Pill) Treats early-stage Biandu (Genital Abscess) with swelling and pain, chancre with urinary and fecal retention, and early-stage Yaws during peak dampness. Take several doses initially.
Da Huang (Rhubarb Root, stir-fried with wine), Huang Qin (Scutellaria Root, stir-fried, two qian), Hei Qian Niu Mo (Black Morning Glory Seed Powder, stir-fried), Hua Shi (Talcum, [missing quantity], four liang each). Grind into powder, bind with paste to form pills the size of wu zi (wuju seeds). Take fifty pills per dose before sleep, washed down with warm water.
Taoren Chengqi Tang (Peach Kernel and Cinnamon Twig Decoction to Direct the Qi) Treats conditions identical to Yuzhu San (See section on Stick Injury)
Yuzhu San (Jade Candle Powder) Treats early-stage Biandu (Genital Abscess) with swelling, pain, fever, and urinary/fecal retention. Use this formula to promote circulation and dispersion.
Chuan Xiong (Ligusticum Rhizome), Dang Gui (Angelica Sinensis Root, stir-fried with wine), Shao Yao (Peony Root), Sheng Di Huang (Rehmannia Root, stir-fried with wine), Mang Xiao (Mirabilite), Da Huang (Rhubarb Root, [missing quantity], two qian each), Gan Cao (Licorice Root, honey-fried, five fen). Prepare as one dose, decoct two zhong of water to eight fen, take before meals.
Tuoli Danggui Tang (Interior-Supporting Angelica Decoction) Treats ulcers with Qi and Blood deficiency causing fever, as well as scrofula, flowing abscesses, and breast abscesses. Regardless of swelling or ulceration, if the sore is associated with Qi and Blood deficiency and fever, this formula is suitable. Long-term use promotes wound closure.
Dang Gui (Angelica Sinensis Root, stir-fried with wine), Huang Qi (Astragalus Root, stir-fried with salt water), Ren Shen (Ginseng Root), Shu Di Huang (Prepared Rehmannia Root, stir-fried with wine), Chuan Xiong (Ligusticum Rhizome), Shao Yao (Peony Root, stir-fried, each one qian), Chai Hu (Bupleurum Root), Gan Cao (Licorice Root, honey-fried, each five fen). Prepare as one dose, decoct two zhong of water to eight fen, take long after meals.