一男子风寒未经发散，寒中肾囊，作肿痛甚。以万灵丹一服洗浴发汗，寒邪顿退；又以四物汤加泽泻、苍
术、山栀、天花
粉，外敷如意金黄散数次而痊消。
一男子囊肿甚大，不热胀痛，按之软而即起。此湿水流注，聚而不散，以披针导去黄水碗许，以导水消肾
丸服月余而肿消。又以木香补肾丸服之不作。
一男子患此十余日，肿甚胀痛，内脓已成。针之出脓碗许，以十全大补汤加泽泻、丹皮十余剂而收敛。
一老年人素有疝气，因怒伤肝，举发疼痛。自服盘葱散热药，肿痛益甚，视之肾囊半边坚硬，皮损紫黑，
此欲腐烂见睾丸候也。彼不为信，尚欲内消，请别医治之，内服龙胆泻肝汤，外敷四黄散寒凉等药，坚硬果腐，
饮食少进，虚热不睡，痛甚昏愦，又复请治。予曰∶凡病有主末，治有权宜，初起以药治疝非疝也。凡疝为患
，小腹作疼，牵引肾子，多寒少热，好饮热汤。此症乃恼怒伤肝，阴虚湿热为患，其囊红肿发热，小便赤涩，
内热口干，坠重作痛，此为囊痈之候。初宜清利湿热，而返用疝家热药；已成宜用补阴，况又用泻肝凉剂，此
年老气血有亏，攻补机关已误，其疾岂有不致危亡者。即当养气血、固根本为主，而佐以安神定痛之药接补元
气，死生在进退之间尚可转也。随以八珍汤加麦冬、五味子、远志、牡丹皮，外以甘草汤淋洗腐上，将已坏黑
肉尽行剪落，其睾丸已露；数日后，其患得于补力，前症渐退，饮食渐进，外腐已尽，肾子已突大半。搽玉红
膏，外以膏盖，长肌渐收，调理半年外而得始安。
一男子肿痛十余日，坚硬无脓，囊头肿上紫色作烂。此欲外腐，以蟾酥锭为末掺上膏盖，三日腐肉脱下，
搽玉红膏、太乙膏掩之，内服补阴滋肾药而安。
一男子欲后受寒，致阴囊牵引小腹作痛，恶寒发热，诊之脉紧数而无力。以五积散一服，寒热乃退，痛亦
稍止，更以八珍汤加肉桂、丹皮、泽泻，数服而愈。
一个男子因风寒之邪未能及时发散，寒邪侵入阴囊，导致肿胀疼痛剧烈。先用万灵丹煎汤洗浴以发汗，寒邪随即消退；接着服用四物汤加泽泻、苍术、山栀、天花粉，并外用如意金黄散敷贴数次，最终痊愈消散。
另一个男子阴囊肿胀非常大，但不热不胀痛，按压后迅速回弹。这是湿邪流注积聚不散所致，用披针穿刺排出约一碗黄水，再服用导水消肾丸一个月左右，肿胀消退。之后又服用木香补肾丸调理，防止复发。
第三个男子患此病十余日，肿胀严重且胀痛，内部脓液已经形成。针刺排出了约一碗脓液，随后服用十全大补汤加泽泻、丹皮十余剂，伤口逐渐收敛愈合。
第四个老年人素有疝气病史，因愤怒伤肝而诱发疼痛。他自行服用盘葱散热类药物，导致肿痛更加严重。检查发现其阴囊半边坚硬，皮肤破损呈紫黑色，这是即将腐烂露出睾丸的征象。他不相信医生的判断，仍希望内服药物消除病灶，请其他医生诊治。其他医生内服龙胆泻肝汤，外敷四黄散等寒凉药物，结果患处果然腐烂，饮食减少，出现虚热失眠，疼痛剧烈导致神志昏沉，再次请求诊治。我说：凡是疾病都有本末，治疗需权衡变通。初起时用药治疗并非真正的疝气。通常疝气发作，小腹部疼痛，牵引睾丸，多寒少热，喜欢喝热汤。此症乃是恼怒伤肝，阴虚湿热为患，表现为阴囊红肿发热，小便赤涩，内热口干，坠胀疼痛，这是囊痈的症状。初期适宜清利湿热，却反用了治疝的热药；脓成期适宜补阴，却反而使用泻肝的凉剂。这位老人气血亏虚，攻补策略都已错误，病情怎能不危及生命？应当以滋养气血、固护根本为主，辅以安神定痛的药物接补元气，生死存亡在于进退之间，尚可挽回。随即给予八珍汤加麦冬、五味子、远志、牡丹皮，外用甘草汤淋洗腐坏部位，将已坏死发黑的肉全部剪除，露出睾丸；数日后，由于补益之力见效，前症逐渐消退，饮食逐渐增加，外部腐肉已尽，睾丸大部分显露。涂抹玉红膏，外用膏药覆盖，肌肉逐渐生长收口，经过半年调理才恢复安定。
第五个男子肿痛十余日，坚硬无脓，阴囊头部肿胀上端紫色溃烂。这是将要向外腐烂的表现，用蟾酥锭研末撒在患处并用膏药覆盖，三天后腐肉脱落，涂抹玉红膏、太乙膏覆盖，内服补阴滋肾药物而痊愈。
第六个男子房事后受寒，导致阴囊牵引小腹部疼痛，恶寒发热，诊察脉象紧数而无力。服用一剂五积散，寒热症状退去，疼痛也稍止，再用八珍汤加肉桂、丹皮、泽泻，服用数剂后痊愈。
A male patient suffered from wind-cold pathogen that was not dispersed in time, causing cold to penetrate the scrotum, resulting in severe swelling and pain. He was bathed with a decoction of Wanling Dan (Ten Thousand Spirits Pill) to induce sweating, which immediately expelled the cold pathogen; subsequently, he took Siwu Tang (Four Substances Decoction) added with Ze Xie (Alisma Rhizome), Cang Zhu (Atractylodis Rhizoma), Shan Zhi (Gardeniae Fructus), and Tian Hua Fen (Trichosanthis Radix), while applying Ruyi Jinhuang San (Ruyi Golden Yellow Powder) externally several times, leading to complete recovery.
Another male patient presented with massive scrotal swelling without heat or distending pain, soft upon pressure and rebounding quickly. This was due to dampness flowing and accumulating without dispersing. A lancet was used to drain approximately one bowl of yellow fluid, followed by oral administration of Daoshui Xiaoshen Wan (Water-Draining Kidney-Reducing Pill) for over a month until the swelling subsided. Thereafter, Muxiang Bushen Wan (Costus Root Tonifying Kidney Pill) was taken to prevent recurrence.
A third male patient had suffered for more than ten days with severe swelling and distending pain, indicating internal pus formation. Puncture released about one bowl of pus, after which Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) added with Ze Xie (Alisma Rhizome) and Dan Pi (Moutan Cortex) was administered for over ten doses, resulting in wound contraction and healing.
An elderly male with a history of hernia experienced pain triggered by anger injuring the Liver. Self-medication with Pancong Sanre drugs exacerbated the swelling and pain. Examination revealed hardness on half of the scrotum with skin breakdown turning purple-black, signaling impending rotting and exposure of the testicle. Disbelieving this prognosis, he sought other physicians hoping for internal resolution. They prescribed Longdan Xiegan Tang (Gentian Liver-Draining Decoction) internally and Sihuang San (Four Yellows Powder) and other cooling agents externally. Consequently, the area indeed rotted, appetite decreased, deficiency-heat and insomnia appeared, and severe pain led to stupor. Upon re-evaluation, I stated: Diseases have primary and secondary aspects; treatment requires flexibility. Initial medication did not address true hernia. Typical hernia involves lower abdominal pain radiating to the testicles, characterized by excess cold and deficient heat, with a preference for hot drinks. This case resulted from anger injuring the Liver, causing yin deficiency with damp-heat, manifesting as scrotal redness, swelling, heat, dark scanty urine, internal heat, dry mouth, heaviness, and pain—symptoms of Scrotal Carbuncle (Nang Yong). Initially, clearing damp-heat was indicated, yet warming herbs for hernia were used; once pus formed, nourishing yin was appropriate, yet liver-draining cooling agents were applied. Given the elderly patient's qi and blood deficiency, both attacking and tonifying strategies were erroneous, endangering life. The priority became nourishing qi and blood, securing the root, assisted by calming spirit and relieving pain herbs to restore yuan qi. Survival depended on correct intervention. Thus, Bazhen Tang (Eight Treasures Decoction) added with Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Yuan Zhi (Polygalae Radix), and Mu Dan Pi (Moutan Cortex) was given. Externally, licorice decoction was used to wash the necrotic area, and all blackened dead tissue was trimmed away, exposing the testicle. After several days, benefiting from tonification, symptoms receded, appetite improved, external necrosis cleared, and most of the testicle was exposed. Yuhong Gao (Jade Red Ointment) was applied under a plaster dressing. Muscle regeneration occurred gradually, and after six months of regulation, stability was achieved.
Another male patient suffered swelling and pain for over ten days, hard without pus, with the scrotal head swollen and purple-rotten at the top, indicating external rotting. Chan Su Ding (Toad Venom Tablet) powder was sprinkled on the lesion and covered with a plaster. After three days, necrotic tissue detached. Yuhong Gao (Jade Red Ointment) and Taiyi Gao (Supreme One Elixir Plaster) were applied externally, while internal nourishing-yin and tonifying-kidney medicines were administered for recovery.
A sixth male patient contracted cold after sexual intercourse, causing scrotal traction pain radiating to the lower abdomen, aversion to cold, and fever. Pulse diagnosis showed tight, rapid, and forceless qualities. One dose of Wuji San (Five Accumulations Powder) resolved the chills and fever, alleviating pain slightly. Subsequently, Bazhen Tang (Eight Treasures Decoction) added with Rou Gui (Cinnamon Bark), Dan Pi (Moutan Cortex), and Ze Xie (Alisma Rhizome) was taken for several doses, resulting in cure.