或问∶小腹至阴之下，玉茎之根，痒极。沸汤沃之，稍止而复作。有三四窍，黄水淋
漓何如？曰∶此广疮结毒也，询之幼时曾生恶疮。旬日后大痛肿甚，饮食少进，作结毒
治之。
〔丹〕 《外科精要》云∶痈疽入囊者死。囊属厥阴，今以死言之，将以为属少阴肾经
邪？予亲见入囊者七八人，悉以湿热入肝经施治，而用补阴药佐之，虽脓溃皮脱，睾丸
悬挂可畏者，皆不死。但不知下虚年老者如何耳。 囊痈，湿热下注也，有作脓者，此
浊气润下，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，而囊自裂开，睾丸悬挂水出，以麸炭（杉木炭）末敷，
外以紫苏叶包裹，仰卧养之。 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，用托里为主，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。
〔薛〕 囊痈属肝肾二经，阴虚湿热下注。若小便涩滞者，先分利以泄其毒，继补阴以
令其自消。若湿热退而仍肿痛，宜补阴托里以速其脓。脓 而便秘者，热毒壅闭也，先
用托里消毒散，后用针以泄之，脓去即解。若脓去而肿痛不减者，热毒未解也，用清肝养
荣汤。口干而小便数者，肾经虚热也，六味丸。内热晡热者。肝经血虚也，四物加参术。
体倦食少者，脾气虚热也，补中益气汤。脓水清稀者，气血俱虚也，十全大补汤，此证
虽大溃而睾丸悬露，治得其法，旬日肉渐生而愈。若专攻其疮，阴道益虚，则肿者不能
溃，溃者不能敛，少壮者多成痼疾，老弱者多致不起。亦有患痔漏久而串及于囊者，当
兼治其痔，切忌寒药克伐，亏损胃气。
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。以小柴胡加黄柏、白芷、金银花，四剂
少愈，更以托里消毒散，数剂而消。 一人年逾五十，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，进龙胆泻肝汤，脉证悉退。更
服托里滋阴药，外敷杉木炭、紫苏末，月余而愈。 一人年逾六十，阴囊溃痛不可忍，睾
丸露出，服龙胆泻肝汤，敷麸炭、紫苏末不应。薛意此湿气炽盛，先饮槐花酒一碗，次
服前汤少愈，更服托里加滋阴药而平。设以前药不应，加之峻剂，未有不损中气以致败
也。 一弱人，肿痛未成脓，小便赤涩，以制甘草、青皮、木通、黄柏、当归、麦门，四
剂少愈，以清心莲子饮，四剂而消。 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，势减半，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、白芷六剂，微肿痛，脉
滑数，乃脓已成针之，肿痛悉退。投滋阴托里药，及紫苏末敷之而愈。 一人病势已甚，
脉洪大可畏，用前汤二剂，肿少退，以仙方活命饮二剂，痛少止，脉洪数，脓已成须针
之，否则阴囊皆溃。彼不信，更他医，果大溃，睾丸挂，复求治。脉将静，以八珍汤加
黄、黄柏、知母、山栀，更敷紫苏末，数日而痊。 一人连日饮酒，阴挺并囊湿痒，服
滋阴等药不应。薛谓∶前阴肝脉络也，阴气从挺而出，素有湿，继以酒为湿热，合干下
焦而然，经曰∶下焦如渎。又云∶在下者，引而竭之。遂以龙胆泻肝汤，及清震汤而愈。此
或不应，宜补肝汤及四生散治之。 儒者陈时用，考试不利，一夕饮烧酒入房，妻不纳，
翌日阴囊肿胀 痛，遣人求治。薛以除湿热，清肝火之剂，城门夜闭不及归服。翌早报云∶
夜来阴囊悉腐，玉茎下面贴囊者亦腐，此肝火挟酒毒而湿热炽盛也，仍以前药，加参、 、
归、术四剂，腐肉尽脱，睾丸悬挂，用大补气血，并涂当归膏，囊茎全复而愈。
一人患此，肿痛发热，以小柴胡加青皮、
黄连，四剂少愈，更以龙胆泻肝汤而消。给事陆贞山，肿赤胀痛，小便涩滞，寒热作渴，
此肝肾阴虚，湿热下注也，当清肝火，除湿毒。遂用柴胡、炒龙胆、吴茱萸、炒黄连、当
归、银花、皂角刺、赤芍药、防风，木通、甘草节，一剂肿痛渐退，少加防风、木通、川
芎、茯苓作饮，下滋肾丸以补阴，其热肿俱退。但内有一条筋不消，此肝经血气虚损也，
当滋肾水，用六味丸料，去茯苓加五味二剂，再用补中益气加茯苓作饮，送滋肾丸，筋顿
消而愈。
加味泻肝汤 治肝经湿热不利，阴囊肿痛。或溃烂皮脱，睾丸悬挂，或便毒及下疳
肿痛，或溃烂并皆治之。
龙胆草（酒拌，炒） 当归尾 车前子（炒） 泽泻 生地黄 芍药（炒） 黄连（炒） 黄柏（酒拌，炒）
知母（酒拌，炒） 防风（各一钱） 甘草梢（五分）
作一剂。水二盅，煎八分，食前服。外敷乌金散。
京兆朱二峰，阴囊胀痛，彼以为疝。薛诊其脉，数而滑，此囊痈也，因肝肾二经阴
虚，湿热所致，脓已成矣。服活命饮一剂而溃，更用补阴托里而敛。 一膏粱之客，阴
囊肿胀，小便不利，此中焦积热，乘虚下注，先用龙胆泻肝汤加黄柏、知母、黄连、牛膝，
四剂渐愈，后用补阴八珍汤加柴胡、山栀而愈。后不守禁忌，前证复作，仍用补阴八珍
汤、补中益气汤、六味丸而痊。又因劳发热，自用四物、黄柏、知母之类，虚证悉具，疮
口开大。薛谓五脏气血俱虚也，朝用补中益气，夕用六君子加当归，各五十余剂，疮口
渐敛，又用六味丸调补而愈。 府庠李达卿，素肾虚发热，久服黄柏、知母之类，形体渐
瘦，遗精白浊，晡热唾痰。薛曰∶此肾水亏损，虚火内炽，用补中益气之类，加五味、麦
门，前症将愈。又别用清热凉血之剂，饮食少思，唾痰不止。薛以为脾肺复虚，不能摄
涎归源，仍用前汤加茯苓、半夏而愈。后入房头晕吐痰，腰骨作痛，大小便道牵痛。薛
曰∶此精己耗而复竭所致，危殆之证也，遂朝用前汤加麦门、五味，夕用六味丸料加五
味子，萆 ，五十余剂诸证顿退。后又入房，阴囊、阴茎作痛，别用淡渗之剂，阴囊内溃。
薛用补阴托里之剂，出脓甚多，喜肿消痛止，竟不善调养，以致大便不通，小便如淋，痰
涎上涌。薛曰∶肾虚之证复作矣，诚为可虑。有保其可生者，用礞石滚痰丸，牛黄清心丸
之类，吐痰愈加。薛曰∶非惟无以保其生，而反促其危矣！固辞不治，后果殁。 一男子，
醉而入房，阴囊肿胀大如斗，小腹胀闷，小水淋赤，发热口干，痰涎壅甚，此膀胱阴虚，
酒毒所乘也，用六味丸料，加车前、牛膝作饮，下滋肾丸，诸证顿退，再加五味、麦门
二剂而愈。却以补中益气加麦门、五味，调理而康。若用淡渗，复损真阴，决致不起。
加味小柴胡汤 治囊痈腐烂，或饮食少思，日晡发热。
柴胡 人参 黄芩（炒） 川芎 白术（炒） 盐水（浸，炒） 当归（酒洗） 黄柏（酒拌，炒） 知
母（酒拌，炒） 甘草（各一钱） 半夏（五分）
作一剂。水二盅，煎八分，食前服。痛甚加黄连。小便不利，加木通。
知州王汝道，先晡热发热，肢体倦怠，入房则腿足酸软，足必热至腿膝，六脉洪数，两
尺为甚。余以足三阴虚，欲滋补化源。彼反服苦寒降火之剂，后阴囊肿胀，用治疝之药，
肿胀益甚，形气愈虚。服温补之剂，肿痛上攻，小便不利，两尺脉洪滑，按之虚甚，余
曰∶此囊痈也，因气血虚而不能溃。先用补中益气汤加山药、山茱萸、车前子、柴胡、山
栀，一剂肿胀顿消，随用六味丸料加车前、牛膝、柴胡、山栀，一剂小便渐通，乃用活命
饮与前二药，消息兼用至二十余剂。囊裂出秽脓甚多，乃用托里消毒散六剂，脓秽清，又
用托里散数剂，脓水渐少，更用补阴托里散，及十全大补汤五十余剂而痊。 一人年逾五
十，患此疮口不敛，诊之微有湿热。治以龙胆泻肝汤，湿热悉退，乃以托里药，及豆豉
饼灸而愈。次年复患湿热颇盛，仍用前汤四剂而退，又以滋阴药而消。若溃后虚而不补，
少壮者成漏，老弱者不治。脓清作渴，脉大者，亦不治。 一人患此久不敛，以十全大
补汤加五味、麦门、灸以豆豉饼，月余而平。
一弱人，脓熟胀痛，大小便秘，急针之，脓出三碗许即鼾睡，觉神思少健。但针迟，故
用托里药，至三十余剂始瘥。若服解毒药，即溃尽矣。
〔似是而非〕
一人囊肿，状如水晶，时痛时痒出水，小腹按之作水声，小便频数，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，再以胃苓散倍白术、茯苓，更用气针，引去聚水而瘥。 一人年逾四十，阴囊肿痛，以
热手熨之少缓，服五苓散不应，尺脉迟软，此下虚寒邪所袭而然，名曰阴疝，非疮毒也。治
以蟠葱散少可，更服葫芦巴丸而平。 一人年逾三十，阴囊湿痒，茎出白物如脓，举则
急痛，此肝疝也。用龙胆泻肝汤而愈。阴茎或肿，或缩，或挺，或痒，皆宜此药治之。
治肾痈，用石蟹热水磨服。
锻石散 治肾漏，阴囊先肿后穿破，出黄水，疮口如鱼口，能致命。
上用五倍子同锻石炒黄色，去灰摊地，出火毒，砂盆内研细末。不犯铜铁，干掺上五
七次可。
治外肾痈疮
抱鸡卵壳 鹰爪黄连 轻粉（各等分）
上为细末。用煎过清油，调涂。
乌金散
麸炭 紫苏叶（各等分）
上为末。香油调搽。
有人问：从小腹到阴部下方，阴茎根部，瘙痒极其严重。用沸水浇烫，暂时缓解后又发作。有三四个孔窍，黄水淋漓不止，这该怎么办？回答说：这是广疮结毒（梅毒晚期症状），询问病史得知患者幼年曾患恶疮。十几天后剧烈疼痛且肿胀严重，饮食减少，按结毒治疗。
〔薛己〕《外科精要》说：痈疽发生在阴囊部位的会死亡。阴囊属于厥阴肝经，现在说会死，难道认为是少阴肾经受邪吗？我亲眼见到患此病七八个人，都用清利湿热、疏泄肝经的方法治疗，并辅以滋阴药物，虽然脓液溃破、皮肤脱落，睾丸悬挂外露令人畏惧，但都没有死亡。只是不知道下元虚亏的年长患者情况如何罢了。囊痈，是由于湿热下注所致，有的化脓，这是因为浊气向下浸润，即将流入尿道，因为阴道（指前阴部位）亏损，水道不利而形成的，脓液排尽自然安宁，不吃药也可以，关键在于善于调养。又有因腹部肿胀，逐渐流入阴囊肿胀严重，导致阴囊自行裂开，睾丸悬挂出水，用麸炭（杉木炭）粉末外敷，外面用紫苏叶包裹，仰卧静养即可。大抵这个病症属于阴道亏损，湿热不利所致。所以滋阴降湿的药物不可缺少。通常治疗肿痛、小便便秘滞的情况，以除湿为主，滋阴为辅；肿痛消退，二便调和的情况，除湿和滋阴药物配合治疗。想要促使成脓，以托里透脓为主，滋阴为辅。等到脓成即行针刺，仍然使用托里滋阴法。如果湿毒已尽，专门使用托里法，如脓液清稀或过多或收敛迟缓的，使用大补剂，或用附子饼灸治。
〔薛己〕囊痈属于肝肾两经，阴虚湿热下注。如果小便涩滞不通，先分利小便以排泄毒邪，随后补阴使其自行消散。如果湿热退去但仍肿痛，宜补阴托里以加速成脓。脓成而便秘的，是热毒壅闭，先用托里消毒散，后用针刺泄毒，脓排出即解。如果脓排出后肿痛不减，是热毒未解，用清肝养荣汤。口干而小便频数的，是肾经虚热，用六味丸。内热或傍晚发热的，是肝经血虚，用四物汤加人参、白术。身体疲倦、饮食少的，是脾气虚热，用补中益气汤。脓水清稀的，是气血俱虚，用十全大补汤。这个病症虽然大面积溃烂而睾丸悬露，只要治疗方法得当，十几天肌肉渐生而痊愈。如果专门攻伐疮毒，会使阴道更加虚损，那么肿的不能溃破，溃的不能收敛，年轻力壮的多变成顽固疾病，年老体弱的多导致死亡。也有患痔疮瘘管日久蔓延波及到阴囊的，应当兼治痔疮，切忌使用寒凉药物克伐，损伤胃气。
有一人，囊痈未成脓而肿痛，用加减龙胆泻肝汤，两剂后稍见好转，再用四物汤加木通、知母、黄柏而消散。一人脓熟作胀，导致小便不利，紧急针刺。用小柴胡汤加黄柏、白芷、金银花，四剂后稍见好转，再用托里消毒散，数剂后消散。一人年过五十，阴囊肿痛，遇热更盛，服用蟠葱散，无效。肝脉数，这是囊痈，乃肝经湿热所致。脓已成急行针刺，进服龙胆泻肝汤，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。一人年过六十，阴囊溃痛不可忍受，睾丸露出，服用龙胆泻肝汤，敷麸炭、紫苏末无效。薛己认为此湿气炽盛，先饮槐花酒一碗，次服前方稍见好转，再服用托里加滋阴药而平复。假如前方药无效，加上峻猛药剂，没有不损伤中气而导致败症的。一虚弱之人，肿痛未成脓，小便赤涩，用制甘草、青皮、木通、黄柏、当归、麦门冬，四剂后稍见好转，用清心莲子饮，四剂后消散。一人肿痛甚，小便涩，发热脉数，用龙胆泻肝汤，倍用车前子、木通、泽泻、茯苓，势减半，仍用前方加黄柏、金银花四剂，又减二三，二便如常。唯有一处不消，这是欲成脓，再用前方，加金银花、皂角针、白芷六剂，微肿痛，脉滑数，乃脓已成，针刺之，肿痛悉退。投予滋阴托里药，及紫苏末外敷而愈。一人病势已甚，脉洪大可畏，用前方两剂，肿稍退，用仙方活命饮两剂，痛稍止，脉洪数，脓已成须针刺，否则阴囊皆溃。他不相信，找其他医生，果然大溃，睾丸悬挂，又来求治。脉将平静，用八珍汤加黄芪、黄柏、知母、山栀，再敷紫苏末，数日而痊。一人连日饮酒，阴挺并囊湿痒，服用滋阴等药无效。薛己说：前阴是肝经络属之处，阴气从挺出而出，素有湿气，继以酒为湿热，合干下焦所致，经上说：下焦如渎。又说：在下者，引而竭之。遂用龙胆泻肝汤，及清震汤而愈。此若不应，宜用补肝汤及四生散治疗。儒者陈时用，考试不利，一夜喝烧酒后入房，妻子不接纳，第二天阴囊肿胀痛，派人求治。薛己用除湿热、清肝火的药剂，城门夜闭不及回家服用。第二天早上报告说：夜里来阴囊全腐烂，阴茎下面贴囊的部分也腐烂，这是肝火挟酒毒而湿热炽盛，仍用前方，加人参、[缺字]、当归、白术四剂，腐肉尽脱，睾丸悬挂，用大补气血，并涂当归膏，阴囊阴茎全复而愈。
一人患此，肿痛发热，用小柴胡汤加青皮、黄连，四剂后稍见好转，再用龙胆泻肝汤而消散。给事陆贞山，肿赤胀痛，小便涩滞，寒热作渴，这是肝肾阴虚，湿热下注，当清肝火，除湿毒。遂用柴胡、炒龙胆、吴茱萸、炒黄连、当归、银花、皂角刺、赤芍药、防风，木通、甘草节，一剂后肿痛渐退，少加防风、木通、川芎、茯苓作茶饮，下滋肾丸以补阴，其热肿俱退。但内有一条筋不消，这是肝经血气虚损，当滋肾水，用六味丸料，去茯苓加五味子二剂，再用补中益气加茯苓作茶饮，送服滋肾丸，筋顿消而愈。
加味泻肝汤 治疗肝经湿热不利，阴囊肿痛。或溃烂皮脱，睾丸悬挂，或便毒及下疳肿痛，或溃烂并皆治之。
龙胆草（酒拌，炒） 当归尾 车前子（炒） 泽泻 生地黄 芍药（炒） 黄连（炒） 黄柏（酒拌，炒） 知母（酒拌，炒） 防风（各一钱） 甘草梢（五分）
作一剂。水二盅，煎至八分，食前服。外敷乌金散。
京兆朱二峰，阴囊胀痛，他以为是疝气。薛己诊其脉，数而滑，这是囊痈，因肝肾二经阴虚，湿热所致，脓已成矣。服用活命饮一剂而溃，再用补阴托里药而收敛。一位富贵之人，阴囊肿胀，小便不利，这是中焦积热，乘虚下注，先用龙胆泻肝汤加黄柏、知母、黄连、牛膝，四剂后渐愈，后用补阴八珍汤加柴胡、山栀而愈。后来不守禁忌，前证复发，仍用补阴八珍汤、补中益气汤、六味丸而痊愈。又因劳累发热，自用四物、黄柏、知母之类，虚证悉具，疮口开大。薛己说五脏气血俱虚，早晨用补中益气，晚上用六君子加当归，各五十余剂，疮口渐敛，又用六味丸调补而愈。府庠李达卿，素来肾虚发热，久服黄柏、知母之类，形体渐瘦，遗精白浊，傍晚发热唾痰。薛己说：这是肾水亏损，虚火内炽，用补中益气之类，加五味子、麦门冬，前症将愈。又别用清热凉血之剂，饮食少思，唾痰不止。薛己认为是脾肺复虚，不能摄涎归源，仍用前方加茯苓、半夏而愈。后来入房头晕吐痰，腰骨作痛，大小便道牵痛。薛己说：这是精已耗而复竭所致，危殆之证，遂早晨用前方加麦门冬、五味子，晚上用六味丸料加五味子，萆薢，五十余剂诸证顿退。后来又入房，阴囊、阴茎作痛，别用淡渗之剂，阴囊内溃。薛己用补阴托里之剂，出脓甚多，喜肿消痛止，竟不善调养，以致大便不通，小便如淋，痰涎上涌。薛己说：肾虚之证复作了，诚为可虑。有保证他可以生的，用礞石滚痰丸，牛黄清心丸之类，吐痰愈加。薛己说：非但不能保其生，反而促其危！坚决推辞不治，后果去世。一男子，醉而入房，阴囊肿胀大如斗，小腹胀闷，小便淋赤，发热口干，痰涎壅盛，这是膀胱阴虚，酒毒所乘，用六味丸料，加车前子、牛膝作茶饮，下滋肾丸，诸证顿退，再加五味子、麦门冬二剂而愈。却用补中益气加麦门冬、五味子，调理而康。如果用淡渗之剂，复损真阴，决致不起。
加味小柴胡汤 治疗囊痈腐烂，或饮食少思，日晡发热。
柴胡 人参 黄芩（炒） 川芎 白术（炒） 盐水（浸，炒） 当归（酒洗） 黄柏（酒拌，炒） 知母（酒拌，炒） 甘草（各一钱） 半夏（五分）
作一剂。水二盅，煎至八分，食前服。痛甚加黄连。小便不利，加木通。
知州王汝道，先傍晚发热，肢体倦怠，入房则腿足酸软，足必热至腿膝，六脉洪数，两尺为甚。我以足三阴虚，欲滋补化源。他反服苦寒降火之剂，后阴囊肿胀，用治疝之药，肿胀益甚，形气愈虚。服温补之剂，肿痛上攻，小便不利，两尺脉洪滑，按之虚甚，我说：这是囊痈，因气血虚而不能溃。先用补中益气汤加山药、山茱萸、车前子、柴胡、山栀，一剂肿胀顿消，随用六味丸料加车前、牛膝、柴胡、山栀，一剂小便渐通，乃用活命饮与前二药，斟酌兼用至二十余剂。囊裂出秽脓甚多，乃用托里消毒散六剂，脓秽清，又用托里散数剂，脓水渐少，更用补阴托里散，及十全大补汤五十余剂而痊愈。一人年过五十，患此疮口不敛，诊之微有湿热。治以龙胆泻肝汤，湿热悉退，乃以托里药，及豆豉饼灸而愈。次年复发湿热颇盛，仍用前方四剂而退，又以滋阴药而消。若溃后虚而不补，年轻力壮者成漏，年老体弱者不治。脓清作渴，脉大的，亦不治。一人患此久不敛，以十全大补汤加五味子、麦门冬，灸以豆豉饼，月余而平。
一虚弱之人，脓熟胀痛，大小便秘，急针刺之，脓出三碗许即鼾睡，醒后神思稍健。但针迟，故用托里药，至三十余剂始愈。若服解毒药，即溃尽矣。
〔似是而非〕
一人囊肿，状如水晶，时痛时痒出水，小腹按之作水声，小便频数，脉迟缓，这是醉后饮水入房，汗出遇风寒湿毒乘聚于囊，名叫水疝。先以导水丸二服，腹水已去，小便如常，再以胃苓散倍白术、茯苓，更用气针，引去聚水而愈。一人年过四十，阴囊肿痛，以热手熨之稍缓，服五苓散无效，尺脉迟软，这是下虚寒邪所袭而然，名叫阴疝，不是疮毒。治以蟠葱散稍可，更服葫芦巴丸而平。一人年过三十，阴囊湿痒，茎出白物如脓，举则急痛，这是肝疝。用龙胆泻肝汤而愈。阴茎或肿，或缩，或挺，或痒，皆宜此药治疗。
锻石散 治疗肾漏，阴囊先肿后穿破，出黄水，疮口如鱼口，能致命。
上用五倍子同锻石炒黄色，去灰摊地，出火毒，砂盆内研细末。不犯铜铁，干掺上五七次可。
治外肾痈疮
抱鸡卵壳 鹰爪黄连 轻粉（各等分）
上为细末。用煎过清油，调涂。
乌金散
麸炭 紫苏叶（各等分）
上为末。香油调搽。
A question was asked: From the lower abdomen to below the yin (genitals), at the root of the jade stem (penis), there is extreme itching. Pouring boiling water on it provides temporary relief, but it recurs. There are three or four orifices with dripping yellow fluid. What should be done? The answer is: This is a condensation toxin from broad sores (late-stage syphilis). Inquiry reveals that in childhood, he once suffered from malignant sores. Ten days later, severe pain and swelling occurred, and food intake decreased. It should be treated as a condensation toxin.
[Xue Ji] *Waike Jingyao* (Essentials of Surgery) states: Carbuncles and sores entering the scrotum result in death. The scrotum belongs to the Jueyin Liver Meridian. Now, saying it results in death, does this imply it belongs to the Shaoyin Kidney Meridian? I have personally seen seven or eight cases of scrotal involvement, all treated by clearing damp-heat and draining the Liver Meridian, assisted by Yin-nourishing herbs. Although pus ruptured, skin peeled off, and testicles hung exposed—frighteningly—the patients did not die. However, I do not know how to treat elderly patients with deficiency in the lower jiao. Scrotal carbuncle is caused by damp-heat sinking downward. Some cases suppurate; this is due to turbid qi sinking and flowing into the urinary tract, occurring because of deficiency in the yin pathway (anterior yin) and obstruction of the water passages. Once the pus is exhausted, peace returns naturally; medication may not even be necessary, provided one manages care well. In other cases, abdominal swelling gradually flows into the scrotum, causing severe swelling, leading to spontaneous rupture of the scrotum, with testicles hanging out and fluid leaking. Apply bran charcoal (cedar charcoal) powder externally, wrap with Perilla leaves, and keep the patient supine for recovery. Generally, this condition stems from deficiency of the yin pathway and obstructed damp-heat. Therefore, herbs that nourish Yin and descend dampness are indispensable. For typical treatment of swelling, pain, and constipated urine, prioritize draining dampness with Yin-nourishing herbs as an adjunct. When swelling and pain subside and bowel/bladder functions normalize, combine damp-draining and Yin-nourishing herbs. To promote suppuration, prioritize interior-supporting methods with Yin-nourishing herbs as an adjunct. Once pus forms, puncture it immediately, continuing with interior-supporting and Yin-nourishing methods. If damp-toxins are fully exhausted, use only interior-supporting methods. If pus is clear, excessive, or healing is slow, use major tonifying formulas or moxa cones made with Aconite Cake.
[Xue Ji] Scrotal carbuncle belongs to the Liver and Kidney meridians, characterized by Yin deficiency with damp-heat sinking downward. If urination is astringent and obstructed, first promote diuresis to drain toxins, then nourish Yin to allow self-resolution. If damp-heat subsides but swelling and pain persist, nourish Yin and support the interior to accelerate suppuration. If suppuration occurs accompanied by constipation, it indicates heat-toxin blockage; first use Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder), then puncture to drain pus, which resolves the condition. If swelling and pain persist after pus drainage, heat-toxins remain unresolved; use Qinggan Yangrong Tang (Clear Liver and Nourish Ying Decoction). Dry mouth with frequent urination indicates deficient heat in the Kidney Meridian; use Liuwei Wan (Six-Ingredient Pill). Internal heat or afternoon fever indicates Blood deficiency in the Liver Meridian; use Siwu Tang (Four-Substance Decoction) plus Ginseng and Atractylodes. Fatigue and poor appetite indicate Spleen Qi deficiency with heat; use Buzhong Yiqi Tang (Center-Boosting Qi-Supplementing Decoction). Clear and thin pus indicates dual deficiency of Qi and Blood; use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). Although this condition involves extensive ulceration with exposed testicles, if treated correctly, muscles regenerate within ten days, leading to recovery. If one exclusively attacks the sore, the yin pathway becomes more deficient, resulting in inability to suppurate when swollen or heal when ulcerated. Young and strong individuals often develop chronic fistulas, while old and weak individuals may die. Also, hemorrhoids or fistulas lingering for years may spread to the scrotum; treat both simultaneously. Avoid cold/cold-natured herbs that attack and damage Stomach Qi.
Case 1: A patient had scrotal carbuncle without suppuration, presenting with swelling and pain. After two doses of Modified Longdan Xiegan Tang (Modified Gentian Liver-Draining Decoction), symptoms improved slightly. Subsequently, Siwu Tang plus Tongcao, Anemarrhena, and Phellodendron resolved the condition.
Case 2: A patient had mature pus causing distension and urinary difficulty. Emergency puncture was performed. Xiao Chaihu Tang plus Phellodendren, Angelica Dahurica, and Honeysuckle were given for four doses, improving symptoms slightly. Then, Tuoli Xiaodu San was used for several doses until resolution.
Case 3: A man over fifty had scrotal swelling and pain, worsening with heat. Panchong San was ineffective. The Liver pulse was rapid, indicating scrotal carbuncle due to damp-heat in the Liver Meridian. Upon confirmation of pus formation, immediate puncture was performed, followed by Longdan Xiegan Tang, resolving all pulse and symptom signs. He then took interior-supporting and Yin-nourishing herbs, with external application of cedar charcoal and Perilla powder, recovering in over a month.
Case 4: A man over sixty had unbearable scrotal ulceration and pain with exposed testicles. Longdan Xiegan Tang and applications of bran charcoal/Perilla were ineffective. Xue Ji attributed this to intense dampness. First, a bowl of Sophora flower wine was drunk, followed by the previous decoction for slight improvement. Then, interior-supporting herbs with Yin-nourishing agents brought stability. Had the previous medicine failed, adding harsh purgatives would have damaged Middle Qi, leading to collapse.
Case 5: A weak patient had pre-suppurative swelling/pain and red, astringent urine. Zhi Gancao, Qingpi, Tongcao, Huangbai, Danggui, and Ophiopogon were used for four doses, showing slight improvement. Qingxin Lianzi Yin cleared the condition in four subsequent doses.
Case 6: A patient had severe swelling/pain, astringent urine, fever, and rapid pulse. Longdan Xiegan Tang was used with doubled Cheqianzi, Tongcao, Ze-xie, and Poria. Symptoms halved. The same formula plus Huangbai and Honeysuckle for four doses reduced symptoms further, restoring normal excretion. One area remained unabsorbed, indicating impending suppuration. The formula plus Honeysuckle, Gleditsia spine, and Angelica Dahurica for six doses resulted in mild swelling/pain and slippery-rapid pulse, confirming pus formation. Puncture relieved all symptoms. Yin-nourishing and interior-supporting herbs plus Perilla powder led to recovery.
Case 7: A patient had severe disease with terrifyingly flooding pulse. Two doses of the previous formula reduced swelling slightly. Xianfang Huoming Yin for two doses stopped pain slightly, but pulse remained flooding-rapid, indicating pus requiring puncture; otherwise, total scrotal溃烂 would occur. The patient refused, sought another doctor, and indeed suffered massive溃烂 with hanging testicles. Returning for treatment, the pulse was calming. Bazhen Tang plus Astragalus, Phellodendron, Anemarrhena, and Gardenia was used, along with Perilla powder application, leading to recovery in days.
Case 8: A patient drank alcohol daily, suffering from penile protrusion and scrotal dampness/itching. Yin-nourishing herbs failed. Xue Ji stated: The anterior yin is governed by the Liver Meridian. Yin energy protrudes; chronic dampness combined with alcohol creates damp-heat attacking the Lower Jiao. As the Classics say: "The Lower Jiao is like a ditch." And: "What is below, draw it out and exhaust it." Thus, Longdan Xiegan Tang and Qingzhen Tang cured him. If ineffective, Bugan Tang and Sisheng San should be used.
Case 9: Scholar Chen Shiyong, disappointed in exams, drank burning wine and attempted intercourse, but his wife refused. Next day, scrotal swelling and pain occurred. Treatment was sought. Xue Ji prescribed damp-heat draining and Liver-fire clearing agents, but gates closed before administration. Report next morning: scrotum completely rotted overnight, including the part of the penis adhering to the scrotum. This was Liver fire carrying wine toxicity with intense damp-heat. The previous formula plus Ginseng, [missing character], Danggui, and Atractylodes for four doses shed dead flesh, exposing testicles. Major Qi-Blood tonification and Angelica ointment application restored the scrotum and penis completely.
Case 10: Patient had swelling, pain, fever. Xiao Chaihu Tang plus Qingpi and Coptis for four doses improved slightly. Longdan Xiegan Tang resolved it.
Case 11: Official Lu Zhenshan had red/swollen painful scrotum, astringent urine, chills/fever, thirst. This was Liver/Kidney Yin deficiency with damp-heat sinking. Clear Liver fire, drain damp-toxins. Chaihu, fried Gentian, Evodia, fried Coptis, Danggui, Honeysuckle, Gleditsia spine, Red Peony, Fangfeng, Tongcao, and licorice joint were used. One dose reduced swelling/pain. Add Fangfeng, Tongcao, Chuanxiong, Poria as tea, swallow Zishui Wan to nourish Yin. Heat and swelling subsided. However, a tendon inside remained unabsorbed, indicating Liver Meridian Blood/Qi deficiency. Nourish Kidney Water using Liuwei Wan formula minus Poria plus Schisandra for two doses. Then, Buzhong Yiqi plus Poria as tea, swallowing Zishui Wan. The tendon instantly disappeared, curing the case.
Jiawei Xiegan Tang treats Liver Meridian damp-heat obstruction, scrotal swelling/pain. Or ulceration with skin peeling/hanging testicles, or buboes/chancres swelling/pain, or ulcerations—all are treated.
Gentian Root (wine-mixed, fried), Angelica Tail, Plantago Seed (fried), Alisma, Rehmannia Root, Peony (fried), Coptis (fried), Phellodendron Bark (wine-mixed, fried), Anemarrhena Rhizome (wine-mixed, fried), Saposhnikovia Root (each 1 qian), Licorice Tip (0.5 qian).
Make one dose. Boil in 2 cups water to 0.8 cup. Take before meals. External application: Wujin San.
Zhu Erfeng from Jingzhao had scrotal swelling/pain, mistaking it for hernia. Xue Ji palpated a rapid-slipping pulse, diagnosing scrotal carbuncle due to Liver/Kidney Yin deficiency and damp-heat, with pus formed. Huoming Yin for one dose caused rupture; Bu Yin Tuo Li (Nourish Yin Support Interior) promoted healing.
A wealthy guest had scrotal swelling and urinary difficulty, caused by Middle Jiao accumulated heat sinking due to deficiency. Longdan Xiegan Tang plus Phellodendron, Anemarrhena, Coptis, and Achyranthes for four doses improved gradually. Later, Bu Yin Bazhen Tang plus Chaihu and Gardenia cured him. Non-compliance with taboos caused recurrence. Bu Yin Bazhen Tang, Buzhong Yiqi Tang, and Liuwei Wan cured him again. Fat fever from labor led to self-medication with Siwu, Phellodendron, Anemarrhena, resulting in full deficiency signs and large open sores. Xue Ji diagnosed dual deficiency of Five Organs' Qi/Blood. Morning: Buzhong Yiqi. Evening: Liujunzi plus Danggui. Over 50 doses each gradually closed sores. Liuwei Wan regulated and cured.
Li Daqing from Fuyang had chronic Kidney deficiency fever, long-term use of Phellodendron/Anemarrhena led to emaciation, spermatorrhea, white turbidity, afternoon fever, and phlegm spitting. Xue Ji said: Kidney Water deficiency with internal deficient fire. Use Buzhong Yiqi plus Schisandra and Ophiopogon; prior symptoms healed. Using separate cooling-blood herbs caused poor appetite and persistent phlegm. Xue Ji diagnosed Spleen/Lung re-deficiency failing to control saliva. Previous formula plus Poria and Pinellia cured. Intercourse led to dizziness, phlegm vomiting, back pain,牵引 pain in urinary/bowel tracts. Xue Ji said: Essence consumed and exhausted; critical condition. Morning: Previous formula plus Ophiopogon/Schisandra. Evening: Liuwei Wan formula plus Schisandra and Dioscorea Hypoglauca. Over 50 doses resolved symptoms. Intercourse again caused scrotal/penile pain. Diuretics caused internal scrotal溃烂. Bu Yin Tuo Li herbs drained much pus. Swelling/pain stopped, but poor care led to constipation, stranguria-like urination, surging phlegm-saliva. Xue Ji said: Kidney deficiency relapsed; worrying. Someone guaranteed life using Mengshi Gun Tan Wan or Niuhuang Qingxin Wan, increasing phlegm vomiting. Xue Ji said: Not only no life preservation, but accelerated danger! Refused treatment, died subsequently.
A man, drunk and having intercourse, had scrotal swelling as large as a bucket, lower abdominal distension, red dribbling urine, fever, dry mouth, abundant phlegm-saliva. Bladder Yin deficiency attacked by wine toxicity. Liuwei Wan formula plus Plantago and Achyranthes as tea, swallowing Zishui Wan, resolved symptoms. Plus Schisandra/Ophiopogon for two doses cured. Regulate with Buzhong Yiqi plus Ophiopogon/Schisandra to health. Diuretics would damage True Yin, leading to death.
Jiawei Xiao Chaihu Tang treats scrotal carbuncle ulceration, poor appetite, afternoon fever.
Bupleurum, Ginseng, Scutellaria (fried), Chuanxiong, Atractylodes (fried), Salt water (soaked, fried), Angelica (wine-washed), Phellodendron (wine-mixed, fried), Anemarrhena (wine-mixed, fried), Licorice (each 1 qian), Pinellia (0.5 fen).
One dose. Boil 2 cups water to 0.8 cup. Take before meals. Severe pain add Coptis. Urinary difficulty add Tongcao.
Wang Rudao, Prefect, had afternoon fever, limb fatigue. Intercourse caused leg/foot soreness, heat rising to knees. Six pulses flooding-rapid, especially Chi positions. Diagnosed Foot Three Yin deficiency, intended to tonify source. Patient took bitter-cold fire-clearing herbs instead. Later scrotal swelling worsened with hernia meds, shape/Qi became more deficient. Warm-tonifying herbs caused swelling/pain to attack upward, urinary difficulty, Chi pulses flooding-slipping, empty on pressure. Diagnosed scrotal carbuncle due to Qi/Blood deficiency unable to suppurate. First, Buzhong Yiqi Tang plus Dioscorea, Cornus, Plantago, Bupleurum, Gardenia. One dose eliminated swelling. Then Liuwei Wan formula plus Plantago, Achyranthes, Bupleurum, Gardenia. One dose improved urination. Then Huoming Yin combined with previous two medicines, adjusted over 20+ doses. Scrotum ruptured, discharging much foul pus. Tuoli Xiaodu San for six doses cleared pus/foulness. Tuoli San for several doses reduced fluid. Bu Yin Tuo Li San and Shiquan Dabu Tang for 50+ doses cured.
Patient over 50 had non-healing sore, slight damp-heat detected. Longdan Xiegan Tang cleared damp-heat. Interior-supporting herbs and Fermented Soybean Cake Moxa cured. Next year, recurrent damp-heat treated with four doses of previous formula, then Yin-nourishing herbs resolved it. Post-ulcer deficiency without tonification leads to fistula in young/strong, death in old/weak. Clear pus with thirst and large pulse also untreatable.
Another patient with long-standing non-healing sore used Shiquan Dabu Tang plus Schisandra/Ophiopogon, Fermented Soybean Cake Moxa, flat in over a month.
Weak patient with mature pus swelling/pain, constipation. Urgent puncture released ~3 bowls of pus, followed by snoring sleep. Woke with slightly improved spirit. Delayed needle required interior-supporting herbs for 30+ doses to recover. Detox herbs would have caused complete溃烂.
[Similar but Different]
Patient with scrotal cyst, crystal-like, intermittent pain/itching with fluid discharge, water sound on lower abdomen pressing, frequent urination, slow-slow pulse. Caused by drinking water after drunken intercourse, sweating then encountering wind-cold-damp-toxin gathering in scrotum. Named Shui Han (Water Hernia). Dao Shui Wan twice removed abdominal water, urination normalized. Weiling San with doubled Atractylodes/Poria, plus Qi Needle to drain accumulated water, cured.
Patient over 40 had scrotal swelling/pain, hot hand compressions gave slight relief, Wuling San ineffective. Chi pulse slow-soft. Lower deficiency attacked by cold pathogen. Named Yin Han (Yin Hernia), not sore-toxin. Panchong San helped slightly, Huluba Wan stabilized.
Patient over 30 had scrotal dampness/itching, penis discharging white pus-like matter, acute pain upon erection. Gan Han (Liver Hernia). Longdan Xiegan Tang cured. Penile swelling/shrinkage/protrusion/itching all treatable with this herb.
Treat Kidney Carbuncle: Grind Stone Crab in hot water and drink.
Duanshi San treats Kidney Fistula, scrotal swelling then bursting, yellow fluid discharge, sore opening like fish mouth, fatal.
Use Chinese Gall mixed with Furnace Lime, stir-fry yellow, remove ash, spread on ground to remove fire toxicity, grind fine in mortar. Avoid copper/iron. Dry sprinkle 5-7 times acceptable.
Treat External Genital Carbuncles/Sores
Hen Eggshell, Eagle-claw Coptis, Calomel (equal parts)
Grind fine. Mix with boiled clear sesame oil, apply.
Wujin San
Bran Charcoal, Perilla Leaf (equal parts)
Grind fine. Mix with Sesame Oil, apply.