经曰∶气伤痛,形伤肿。患于肛门之前、阴囊之后者,悬痈也。因于七情郁怒,气滞血凝,
有强忍败精,有情欲不遂,皆能致此。治之不早,鲜不伤生。凡觉肿痛,急用大赤皮甘草连节数
两,取长流水煎汁,空心饮。更制入药。先服败毒散,如寒热 痛,清肝解热,小柴胡汤;如痛
肿之甚,肝经湿热,龙胆泻肝汤。诸方皆制甘草为君,外用隔蒜灸法,脓成不穿,针之。
主方 甘草(五钱) 龙胆草 当归尾 金银花 生地黄 柴胡(各三钱) 泽泻 车前
子木通(各五分)水煎,空心服。
小便涩,倍车前子、木通、泽泻,加茯苓、黄柏、知母。发热加黄连、青皮。阴虚加四物汤
。小柴胡汤(方见伤寒)∶次服此方,以制甘草为主。不溃,用八珍汤加制甘草。无力,清心莲
子饮(方见便浊。)以上诸方,悉制甘草为君。久不收,服大补药,外用豆豉饼灸。
制甘草法 治悬痈肿痛,发热,不问肿溃,俱效。
甘草(赤皮,大者用四两,切十段) 用涧流水一大盏浸透,慢火炙干,又浸又炙,水尽为
度。每服一两,无灰好酒一碗,煎七分去渣,空心服。
证属厥阴肝经。阴道亏虚,湿热不利,浊气下注,流入渗道而然;有腹肿渐流入囊,水液不
分而致。甚有脓溃皮脱,睾丸悬挂,囊裂水流。惟在治理得宜,亦可平复。先疏肝除湿,次滋阴
补养气血。有醉后饮水入房,乃汗出遇风寒湿毒,乘聚于囊,先以导水丸二服,水去小便如常,
以胃苓汤倍白术、茯苓。
主方 归尾 龙胆草 生地(各三钱) 柴胡 泽泻 木通 车前子 茯苓(各一钱)上
加灯心,水煎,空心服。
未效加黄柏、金银花、皂角刺、白芷。脓成不破,针之。次服参、 、归、术、四物汤加知
母、黄柏。外用紫苏末敷。或杉炭末敷,紫苏叶包裹,仰卧养之。久不收敛,服大补药,外以附
子饼灸。
《黄帝内经》中说:气机受伤则导致疼痛,形体受伤则导致肿胀。发生在肛门之前、阴囊之后的痈肿,称为悬痈。其病因多因七情(喜、怒、忧、思、悲、恐、惊)郁结愤怒,导致气滞血凝;也有因强行忍射精液,或情欲不得满足,都能导致此病。治疗如果不及时,很少有不危及生命的。凡是感觉肿痛,应立即用大赤皮甘草(带节的甘草数两),取长流水煎煮成汁,空腹服用。更制作入药的方法。先服用败毒散,如果有寒热往来且疼痛,用于清肝解热,用小柴胡汤;如果肿痛非常严重,属于肝经湿热,用龙胆泻肝汤。这些方剂都以经过炮制的甘草为君药。外用隔蒜灸法,脓成熟但不破溃时,用针穿刺排脓。
主方:甘草(五钱)、龙胆草、当归尾、金银花、生地黄、柴胡(各三钱)、泽泻、车前子、木通(各五分)。水煎,空腹服用。
小便涩痛,加倍使用车前子、木通、泽泻,加茯苓、黄柏、知母。发热加黄连、青皮。阴虚加四物汤。小柴胡汤(方剂见《伤寒论》章节):其次服用此方,以炮制过的甘草为主药。如果不溃破,用八珍汤加炮制甘草。体质无力,服用清心莲子饮(方剂见便浊章节)。以上各方,均以炮制甘草为君药。久不愈合,服用大补药,外用豆豉饼灸。
炮制甘草的方法:治疗悬痈肿痛、发热,无论是否溃破,都有效。
甘草(赤皮,大的用四两,切成十段):用山涧流水一大盏浸泡透彻,用慢火炙干,又浸泡又炙干,直到水尽为止。每次服用一两,用无灰好酒一碗,煎至七分,去渣,空腹服用。
证候属于厥阴肝经。阴道亏虚,湿热不利,浊气下注,流入渗道所致;有的腹部肿胀逐渐流入阴囊,水液不分流而致。严重的有脓溃皮脱,睾丸悬挂,阴囊破裂流水。只要在治理得当,也可以平复恢复。先疏肝除湿,其次滋阴补养气血。有醉酒后饮水行房事,导致汗出遇风寒湿毒,乘聚于阴囊,先用导水丸服两次,水去后小便如常,再用胃苓汤加倍白术、茯苓。
主方:归尾、龙胆草、生地(各三钱)、柴胡、泽泻、木通、车前子、茯苓(各一钱)。上面加灯心草,水煎,空腹服用。
无效加黄柏、金银花、皂角刺、白芷。脓成不破,用针穿刺。其次服用人参、[原文缺字,推测为黄芪或类似补气药]、当归、白术、四物汤加知母、黄柏。外用紫苏末敷贴。或用杉炭末敷贴,紫苏叶包裹,仰卧调养。久不收敛,服用大补药,外用附子饼灸。
The *Classic of Medicine* states: Injury to Qi causes pain, and injury to the form (structure) causes swelling. An abscess occurring anterior to the anus and posterior to the scrotum is called Xuantong (Hanging Abscess). Its etiology often stems from the stagnation and anger of the Seven Emotions (Joy, Anger, Worry, Overthinking, Sadness, Fear, Fright), leading to Qi stagnation and blood coagulation; it can also result from forcibly retaining seminal emission or unfulfilled sexual desire. If treatment is not initiated promptly, survival is rarely ensured. Whenever swelling and pain are felt, immediately use several taels of large red-bark Licorice Root (*Gancao*, *Glycyrrhizae Radix et Rhizoma*) with nodes intact, decoct in long-flowing water, and drink on an empty stomach. A method for preparing the medicinal herb is as follows. First, administer Baidu San (Detoxification Powder); if there are alternating chills and fever accompanied by pain, use Xiaochaihu Tang (Minor Bupleurum Decoction) to clear the Liver and resolve heat; if the swelling and pain are severe, indicating Damp-Heat in the Liver Channel, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). All these formulas take processed Licorice Root (*Zhi Gancao*) as the Sovereign herb. Externally, apply Garlic-Separator Moxibustion; when pus has matured but not ruptured, puncture it with a needle.
Main Formula: Licorice Root (*Gancao*, *Glycyrrhizae Radix et Rhizoma*) (5 qian), Gentian Root (*Longdancao*, *Gentianae Radix*), Angelica Sinensis Tail (*Dangguiwei*, *Angelicae Sinensis Radix*), Honeysuckle Flower (*Jinyinhua*, *Lonicerae Japonicae Flos*), Rehmannia Root (*Shengdihuang*, *Rehmanniae Radix*), Bupleurum Root (*Chaihu*, *Bupleuri Radix*) (each 3 qian), Alisma Tuber (*Zexie*, *Alismatis Rhizoma*), Plantago Seed (*Cheqianzi*, *Plantaginis Semen*), Akebia Stem (*Mutong*, *Akebiae Caulis*) (each 5 fen). Decoct in water and take on an empty stomach.
If urination is difficult/astringent, double the dosage of Plantago Seed, Akebia Stem, and Alisma Tuber, and add Poria (*Fuling*, *Poria*), Phellodendron Bark (*Huangbai*, *Phellodendri Cortex*), and Anemarrhena Rhizome (*Zhimu*, *Anemarrhenae Rhizoma*). For fever, add Coptis Rhizome (*Huanglian*, *Coptidis Rhizoma*) and Green Tangerine Peel (*Qingpi*, *Citri Reticulatae Pericarpium*). For Yin Deficiency, add Siwu Tang (Four Substances Decoction). Xiaochaihu Tang (Formula see *Shanghan Lun* section): Take this formula next, with processed Licorice Root as the main component. If it does not ulcerate, use Bazhen Tang (Eight Treasures Decoction) plus processed Licorice Root. For weakness, take Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) (Formula see Bianzhuo section). In all the above formulas, processed Licorice Root is used as the Sovereign herb. If healing is prolonged, take major tonifying medicines, and externally apply Fermented Soybean Cake Moxibustion.
Method for Processing Licorice Root: To treat swelling, pain, and fever of Xuantong, it is effective regardless of whether the abscess has ulcerated or not.
Licorice Root (*Gancao*, *Glycyrrhizae Radix et Rhizoma*) (Red-bark, large ones, use 4 liang, cut into ten segments): Soak thoroughly in one large cup of mountain stream water, slowly roast/dry over low fire, then soak again and dry again, until the water is exhausted. Each dose uses 1 liang, decocted in one bowl of good wine without ash residue, reduced to seven-tenths, strain the dregs, and take on an empty stomach.
The syndrome belongs to the Jueyin Liver Channel. Deficiency of the Yin pathway, Damp-Heat obstruction, turbid Qi sinking downward, flowing into the excretory ducts causes this condition; sometimes abdominal swelling gradually flows into the scrotum, causing failure of fluid differentiation. In severe cases, pus ulcerates and skin sheds, testicles hang exposed, and the scrotum cracks with fluid leakage. With proper management, recovery is possible. First, soothe the Liver and eliminate Dampness; subsequently, nourish Yin and tonify Qi and Blood. Cases involving sexual intercourse after drinking and taking water, where sweat encounters Wind-Cold-Damp-Toxic pathogens which accumulate in the scrotum, should first be treated with Dao Shui Wan (Water-Guiding Pills) twice. After the water pathogen is eliminated and urination returns to normal, use Weiling Tang (Gastrointestinal Ping-Taking Decoction) with doubled Baizhu (*Baizhu*, *Atractylodis Macrocephalae Rhizoma*) and Fuling (*Fuling*, *Poria*).
Main Formula: Angelica Sinensis Tail (*Guiwei*, *Angelicae Sinensis Radix*), Gentian Root (*Longdancao*, *Gentianae Radix*), Rehmannia Root (*Shengdi*, *Rehmanniae Radix*) (each 3 qian), Bupleurum Root (*Chaihu*, *Bulei Radix*), Alisma Tuber (*Zexie*, *Alismatis Rhizoma*), Akebia Stem (*Mutong*, *Akebiae Caulis*), Plantago Seed (*Cheqianzi*, *Plantaginis Semen*), Poria (*Fuling*, *Poria*) (each 1 qian). Add Centipede Grass (*Dengxincao*, *Spargani Rhizoma*) to the top, decoct in water, and take on an empty stomach.
If ineffective, add Phellodendron Bark (*Huangbai*, *Phellodendri Cortex*), Honeysuckle Flower (*Jinyinhua*, *Lonicerae Japonicae Flos*), Gleditsia Spine (*Zaocis Ci*, *Gleditsiae Sinensis Spina*), and Angelica Dahurica Root (*Baizhi*, *Angelicae Dahuricae Radix*). When pus matures but does not rupture, puncture with a needle. Next, take Ginseng, [missing character, likely Astragalus], Angelica Sinensis, Atractylodes Macrocephala, Siwu Tang (Four Substances Decoction) plus Anemarrhena Rhizome (*Zhimu*, *Anemarrhenae Rhizoma*) and Phellodendron Bark (*Huangbai*, *Phellodendri Cortex*). Externally apply Perilla Powder (*Zisu Mo*). Or apply Cedar Charcoal Powder wrapped in Perilla Leaves, while lying supine for recuperation. If healing is prolonged, take major tonifying medicines, and externally apply Prepared Aconite Root Cake Moxibustion.