（谓阴囊患痈）
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
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。此症虽大溃，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。
治验
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，此肝经血虚气损也。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。
京兆朱二峰，阴囊胀痛，彼以为疝。余诊其脉数而滑，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。
知州王汝道，先晡热发热，肢体倦怠，入房则腿足酸软，足心热至腿膝，六脉洪数，两
尺为
甚，形气愈虚。服温补之药，肿痛上攻，小便不利，两尺脉洪滑，按之虚甚。余曰∶此囊痈
也，因气血虚而不能溃也。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，五十余剂而痊。
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。
余以除湿热、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，前症复作，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，虚症
悉具，疮口开大。余谓∶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，调补全愈。
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。余
曰∶此肾水亏损，虚火内炽。用补中益气之类，加麦门、五味，前症将愈；又别用清热凉血之剂
，饮食少思，唾痰不止。余以为脾肺复虚，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。余曰∶此精已耗而复竭所致，危殆之症也。遂
朝用前汤加麦门、五味，夕用六味丸料加五味子、萆 ，五十余帖，诸症顿退。后又入房，
阴囊阴茎作痛，别用淡渗之剂，阴囊内溃。余用补阴托里之剂，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。余曰∶肾虚之症复作矣，诚为可虑。有保
其
。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
剂而愈。却以补中益气加麦门、五味，调理而康。若用淡渗，复损真阳，决致不起。
（所谓阴囊患痈）
囊痈归属于肝、肾二经，是由于阴虚导致湿热下注所致。如果小便涩滞不畅的，先用分利的方法以排泄毒邪，接着滋补阴液使其自行消散。如果随后用针刀排脓，脓液排出后病症即解。如果脓液排出后肿痛仍未减轻，说明热毒尚未解除，使用清肝养荣汤。如果口干且小便频数的，是肾经虚热，使用六味丸。如果体内发热或傍晚发热（晡热）的，是肝经血虚，使用四物汤加人参、白术。如果身体疲倦、饮食减少的，是脾气虚热，使用补中益气汤。如果脓水清稀的，是气血俱虚，使用十全大补汤。此症虽然溃烂严重，睾丸悬露，只要治疗得当，十天左右肌肉逐渐生长即可痊愈。如果专门攻伐疮口，会使阴道更加虚弱，那么肿大的不能溃破，溃破的不能收敛，年轻力壮的多变成顽固疾病，年老体弱的多导致死亡。也有患痔疮漏管，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正气，损伤胃气。
治验记录：
给事陆贞山，阴囊肿胀发红疼痛，小便涩滞，伴有寒热和口渴，这是肝肾阴虚、湿热下注的表现。应当清肝火、除湿毒，于是使用柴胡、炒龙胆草、吴茱萸、炒黄连、当归、金银花、皂角刺、赤芍药、防风、木通、甘草节，服用一剂后肿痛逐渐消退；稍加防风、木通、川芎、茯苓煎汤饮用；同时服用滋肾丸以滋补阴液，其热肿全部消退。但内部有一条筋络未消，这是肝经血虚气损的表现。应当滋补肾水，使用六味丸方料，去掉茯苓加入五味子，服用两剂；再使用补中益气汤加茯苓煎汤饮用，送服滋肾丸，筋络顿时消除而痊愈。
京兆朱二峰，阴囊胀痛，他自己认为是疝气。我诊察他的脉象数而滑，这是囊痈。因为肝肾二经阴虚湿热所致，脓液已经形成。服用活命饮一剂后溃破，再用补阴托里药促使疮口收敛。
知州王汝道，先出现傍晚发热，肢体倦怠，房事后腿足酸软，脚心热感延伸至腿膝，六脉洪数，两尺脉尤为明显，形体和气机都显得虚弱。服用温补药物后，肿痛上攻，小便不利，两尺脉洪滑，重按空虚。我说：这是囊痈，因为气血虚弱而不能溃破。使用补中益气汤加山药、山茱萸、车前子、柴胡、山栀，服用一剂肿胀顿时消退；随即使用六味丸方料加车前子、牛膝、柴胡、山栀，服用一剂小便逐渐通畅。然后使用活命饮，与前两种药物交替使用，共二十余剂，阴囊裂开流出大量秽浊脓液。接着使用托里消毒散，六剂后脓秽变清；又使用托里散数剂，脓水逐渐减少；更使用补阴托里散及十全大补汤，五十余剂后痊愈。
儒者陈时用，考试不顺利。一天晚上喝烧酒后行房，妻子拒绝接纳。第二天，阴囊肿胀疼痛，派人求治。我用除湿热、清肝火的药剂，但因城门夜间关闭，来不及回去服药。第二天早上报告说：昨晚阴囊完全腐烂，玉茎下面贴近阴囊的部分也腐烂了，这是肝火挟带酒毒而湿热炽盛的表现，仍然使用前面的药物，加入人参、[缺失字]、当归、白术，四剂后腐肉全部脱落，睾丸悬挂暴露，使用大补气血的药物，并涂抹当归膏，阴囊和阴茎完全恢复而痊愈。
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，四剂后逐渐好转；后用补阴八珍汤加柴胡、山栀而痊愈。后来不遵守禁忌，前症复发，仍使用补阴八珍汤、补中益气汤、六味丸而痊愈。又因劳累发热，自行服用四物汤、黄柏、知母之类，虚证全部显现，疮口扩大。我说：这是五脏气血俱虚。早晨服用补中益气汤，晚上服用六君子汤加当归，各五十余剂，疮口逐渐收敛；又使用六味丸，调理补益全愈。
府庠李达卿，素来肾虚发热，长期服用黄柏、知母之类，形体逐渐消瘦，遗精白浊，傍晚发热，咳唾痰涎。我说：这是肾水亏损，虚火内炽。使用补中益气汤之类，加麦门冬、五味子，前症将愈；又另外使用清热凉血的药剂，导致饮食少思，咳唾不止。我认为脾肺再次虚弱，不能摄纳涎液归源，仍然使用前面的汤剂加茯苓、半夏而痊愈。后来行房后头晕，吐痰，腰骨作痛，大小便通道牵拉疼痛。我说：这是精气已耗竭后又进一步枯竭所致，是危重的病症。于是早晨服用前面的汤剂加麦门冬、五味子，晚上服用六味丸方料加五味子、萆薢，五十余帖，诸症顿时消退。后来又行房，阴囊阴茎作痛，另外使用淡渗利湿的药剂，导致阴囊内溃。我使用补阴托里的药剂，排出脓液很多，庆幸的是肿胀消退疼痛停止，竟然不善调养，以致大便不通，小便如淋，痰涎上涌。我说：肾虚之症复发了，确实令人担忧。有保其[缺失字]。坚决推辞不治，后果去世。
一名男子醉酒后行房，阴囊肿胀大如斗，小腹胀闷，小便淋沥色赤，发热口干，痰涎壅盛，这是膀胱阴[缺失字]。[缺失字]剂而愈。却用补中益气汤加麦门冬、五味子，调理而康复。如果使用淡渗利湿药，会再次损伤真阳，必定导致死亡。
(Speaking of carbuncles affecting the scrotum)
Scrotal carbuncle (Nangyong) belongs to the Liver and Kidney meridians, caused by Yin deficiency with damp-heat sinking downward. If urination is difficult and stagnant, first use diuretic methods to drain the toxicity, then tonify Yin to allow spontaneous resolution. If needles are subsequently used to drain pus, the condition resolves once the pus is expelled. If swelling and pain persist after pus drainage, it indicates that heat-toxin has not been cleared; use Qinggan Yangrong Tang (Clear Liver and Nourish Blood Decoction). If there is dry mouth and frequent urination, it is deficiency-heat in the Kidney meridian; use Liuwei Wan (Six-Ingredient Pill with Rehmannia). If there is internal fever or afternoon fever (Buke), it is Liver blood deficiency; use Siwu Tang (Four Substance Decoction) plus Ginseng and Atractylodes Macrocephala Rhizome. If there is fatigue and poor appetite, it is Spleen Qi deficiency with heat; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If pus and discharge are clear and thin, it is a deficiency of both Qi and Blood; use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). Although this condition may present with severe ulceration and exposed testicles, if treated correctly, the flesh will gradually regenerate within ten days leading to recovery. If one focuses solely on attacking the wound, the Yin vessels will become increasingly deficient, resulting in swelling that cannot suppurate and ulcers that cannot heal. Young and strong individuals often develop chronic diseases, while the old and weak may die. There are also cases where hemorrhoids and fistulas spread to the scrotum over time; these should be treated concurrently. One must strictly avoid cold-natured drugs that attack healthy Qi and damage Stomach Qi.
Case Records:
Lu Zhenshan, a Censor, presented with swollen, red, painful scrotum, difficult urination, alternating chills and fever, and thirst. This indicated Liver and Kidney Yin deficiency with damp-heat sinking downward. The treatment was to clear Liver fire and remove damp-toxin. I prescribed Chai Hu (Bupleuri Radix), fried Long Dan Cao (Gentianae Radix), Wu Zhu Yu (Evodiae Fructus), fried Huang Lian (Coptidis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Yin Hua (Lonicerae Japonicae Flos), Zao Jiao Ci (Gleditsiae Spina), Chi Shao Yao (Paeoniae Radix Rubra), Fang Feng (Saposhnikoviae Radix), Mu Tong (Akebiae Caulis), and Gan Cao Jie (Licorice Root Joint). After one dose, swelling and pain subsided. I added Fang Feng, Mu Tong, Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Fu Ling (Poria) for decoction, and administered Zishen Wan (Kidney-Nourishing Pill) to tonify Yin. The heat and swelling completely resolved. However, a tendon-like structure remained internally, indicating Liver blood deficiency and Qi damage. I proceeded to nourish Kidney Water using Liuwei Wan formula, removing Fu Ling and adding Wu Wei Zi (Schisandrae Chinensis Fructus), for two doses. Then, I used Buzhong Yiqi Tang with Fu Ling as a drink, delivering Zishen Wan, which caused the tendon to disappear immediately, leading to recovery.
Zhu Erfeng, Mayor of Jingzhao, presented with painful swelling of the scrotum, believing it to be a hernia. My pulse diagnosis revealed rapid and slippery pulses, diagnosing Scrotal Carbuncle. It was caused by Yin deficiency and damp-heat in the Liver and Kidney meridians, with pus already formed. He took Huoming Yin (Life-Saving Decoction) for one dose, causing suppuration, followed by Yin-tonifying and interior-supporting herbs to promote healing.
Wang Rudao, Prefect, initially presented with afternoon fever, limb fatigue, soreness and weakness of legs and feet after intercourse, heat sensation from soles extending to knees, and surging, rapid pulses in all six positions, especially at the Chi (Knee) position. His form and Qi appeared deficient. After taking warming and tonifying medicines, swelling and pain moved upward, and urination became difficult. The Chi pulses were surging and slippery but empty upon deep pressure. I stated: "This is Scrotal Carbuncle, unable to suppurate due to Qi and Blood deficiency." I prescribed Buzhong Yiqi Tang plus Shan Yao (Dioscoreae Rhizoma), Shan Zhu Yu (Corni Fructus), Che Qian Zi (Plantaginis Semen), Chai Hu, and Shan Zhi (Gardeniae Fructus). After one dose, swelling vanished. Subsequently, I used Liuwei Wan formula plus Che Qian Zi, Niu Xi (Achyranthis Bidentatae Radix), Chai Hu, and Shan Zhi. After one dose, urination gradually unblocked. Then, I used Huoming Yin, alternating with the previous two medications. After more than twenty doses, the scrotum ruptured, discharging large amounts of foul pus. I then used Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder) for six doses, clearing the foul pus. Another few doses of Tuoli San reduced the discharge further. Finally, using Buyin Tuoli San (Yin-Tonifying Interior-Supporting Powder) and Shiquan Dabu Tang, he recovered after fifty-plus doses.
Chen Shiyong, a scholar, failed an examination. One night, after drinking liquor and attempting intercourse, his wife refused him. The next day, his scrotum swelled and hurt. He sent for me. I prepared herbs to drain damp-heat and clear Liver fire, but the city gates were closed at night, preventing me from returning to administer them. The next morning, he reported that his entire scrotum had rotted overnight, including the skin below the penis attached to the scrotum. This indicated Liver fire combined with alcohol toxin and intense damp-heat. I continued with the previous prescription, adding Ren Shen (Ginseng Radix), [missing character], Dang Gui, and Bai Zhu (Atractylodis Macrocephalae Rhizoma). After four doses, all necrotic tissue sloughed off, exposing the testicles. Using major Qi and Blood tonics and applying Dang Gui Ointment, the scrotum and penis fully recovered.
A wealthy guest presented with scrotal swelling and difficult urination, caused by accumulated heat in the Middle Jiao sinking downward due to deficiency. I first used Longdan Xiegan Tang (Gentian Liver-Draining Decoction) plus Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Huang Lian, and Niu Xi for four doses, showing gradual improvement. Later, Bu Yin Bazhen Tang (Yin-Tonifying Eight Treasure Decoction) plus Chai Hu and Shan Zhi cured him. However, failing to observe dietary restrictions, the symptoms recurred. He was cured again using Bu Yin Bazhen Tang, Buzhong Yiqi Tang, and Liuwei Wan. Later, due to labor-induced fever, he self-medicated with Siwu Tang, Huang Bo, and Zhi Mu, resulting in full manifestation of deficiency symptoms and an enlarged wound. I diagnosed deficiency of Qi and Blood in the Five Viscera. I prescribed Buzhong Yiqi Tang in the morning and Liujunzi Tang (Six Gentlemen Decoction) plus Dang Gui in the evening, each for over fifty doses, gradually closing the wound. Finally, Liuwei Wan was used for complete recuperation.
Li Daqing, a student, suffered from chronic Kidney deficiency fever. Long-term use of Huang Bo and Zhi Mu led to emaciation, seminal emission, white turbid urine, afternoon fever, and coughing up phlegm. I diagnosed Kidney Water depletion with internal flaring deficiency fire. I prescribed Buzhong Yiqi Tang plus Mai Men Dong (Asparagi Radix) and Wu Wei Zi. The symptoms improved. However, he separately used heat-clearing and blood-cooling herbs, leading to loss of appetite and persistent phlegm. I diagnosed renewed Spleen and Lung deficiency, unable to control saliva. I returned to the previous decoction plus Fu Ling and Ban Xia (Pinelliae Rhizoma), achieving recovery. Later, after intercourse, he experienced dizziness, vomiting phlegm, lower back pain, and pulling pain in the urinary and anal tracts. I diagnosed exhaustion of Essence and Jing, a critical condition. I prescribed the previous decoction plus Mai Men Dong and Wu Wei Zi in the morning, and Liuwei Wan formula plus Wu Wei Zi and Bi Xie (Dioscoreae Hypoglaucae Rhizoma) in the evening. After fifty-plus doses, symptoms subsided. Later, after intercourse, he had pain in the scrotum and penis. He used diuretic herbs, causing internal scrotal ulceration. I used Yin-tonifying interior-supporting herbs, draining much pus. Swelling and pain subsided, but he failed to rest properly, leading to constipation, dysuria, and surging phlegm-saliva. I diagnosed recurrence of Kidney deficiency, a worrying prognosis. [Missing text]. He firmly refused treatment and subsequently died.
A man engaged in intercourse while drunk, presenting with scrotal swelling as large as a bucket, lower abdominal distension, scanty dark urine, fever, dry mouth, and copious phlegm. This was Bladder Yin [missing text]. [Missing text] doses cured him. He was then regulated with Buzhong Yiqi Tang plus Mai Men Dong and Wu Wei Zi, recovering health. Had diuretic herbs been used, True Yang would have been damaged, likely leading to death.