便毒论治如薛氏之法，固已详矣，然又惟交感不洁，遭淫毒而患者为最多。每每先起下
疳，下疳未已，便毒继之，此湿热秽毒之为患也。凡初起肿痛，尚未成脓，而元气尚强者，速
宜先去其毒，唯会脓散，或牡蛎散为最善。若已成脓，则或针或蚀，惟速去其脓，随因证调补
，使速收口为善。若初起一核，其痛微，其肿漫者，此有二证，一以邪轻，一以元气虚弱毒
深而然。若邪轻者，只用会通膏加麝香贴之，无有不散，或降痈散亦可。若元气虚弱而毒深
者，既不肯散，又不早溃，愈久必愈甚，最为可畏。及其溃后，多不能收，轻则为 ，重则
殒命。此惟大补元气，方不致害。若 肿痛甚，脓已将成，势不能消，宜用降痈散留头围
之，则势可敛，痛可解，脓可速成而溃也。
立斋曰∶便痈，属足厥阴肝经，内热外寒，或劳役过度，或房欲不节，或欲火不遂，
或强固其精，或肝经湿热而致，大抵多患于劳役不足，精气俱虚之人。俗云一石米疮，此言百
日方可愈。若大补血气，不旬日可愈，何用百日。盖疮之收敛，在乎血气之盛也。亦有内蕴
热毒而生者，须辨虚实及成脓与否，不可概投攻药。凡妇人患此者，多在两拗肿痛，或腹中
结块，小便涩滞，苟治者得法，患者又能调摄，无足虑也。常见治此证者，概用大黄之类之下
之，以求内消，或其脓成，令脓从大便而出，鲜有见其痊也。人多欲内消者，恐收口之难也。
若知补养血气，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，必
致难治。
又曰∶便痈者，血疝也，俗呼为便毒，言于不便处为痈也。乃足厥阴之经络，及冲任督
脉，亦属肝之傍络。此气血流通之道路，今壅而肿痛，是则热毒所致，宜先疏导其滞，更以
托里之剂，此临证制宜之法也。
又《治法》曰∶内热外寒者，牛黄双解散。湿热壅滞者，宜用龙胆泻肝汤，疏肝导滞。
欲心不遂致逆精气者，先用五苓散加大黄，疏其逆滞，后用地黄丸，以补肝肾强固其精。房欲
不节者，宜六味丸料。劳倦过度者，补中益气汤。
一男子，患便毒 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，脓未成大痛，服消毒托里等药不应。诊之脉洪大，毒尚在，以仙方活命饮，一
剂痛止，又剂而消。
一儒者，肿痛便涩，用八正散二剂，以清肝火，导湿热，而肿痛愈。再以小柴胡加芎、
归、泽泻、山栀二剂，以清火补血，而小便利。
一男子，已溃而痛不止，小便秘涩，此肝火未解也，与小柴胡加黄柏、知母、芎、归，
痛止便利，更以托里当归汤而疮敛。若毒未解，而痛不止者，须用活命饮。
府庠沈尼文，年二十，左拗患之。余以肝肾阴虚，先用托里药，溃而将愈。因入房发热
作渴，右边亦作痛，脓水清稀，虚证悉至，脉洪大而无力，势甚可畏。用十全大补加附子一
钱，脉证顿退，再剂全退。后用大补汤，三十剂而愈。
一男子肿而不溃，此因阳气虚弱，用参、 、归、术，以补托元气，用白芷、皂刺、柴
胡、甘草，以排脓清肝，数剂而溃，以八珍加柴胡，补其气血，数剂而愈。
春元凌待之，虚而服克伐药，几至危殆。余用托里健脾药而愈。秀才王文远，因劳苦患
之，服小柴胡汤而表证散后，用托里药，脓成，针之，而旬日愈。又胡判官，脓清脉弱，以
大补之药而已愈，因新婚复发，自用连翘消毒散，致泻痢不止，竟致不救。可见此证，属不足
者多矣，非补不可。大抵便毒属肝经，初起坚硬，肝主筋故也。五七日后，当赤软，脓成故
也。若尚坚硬，乃元气不能腐化。往往人见坚硬，只欲内消，反服攻散药，多致虚虚之祸，
前此治者，即其验也。
一妇人，两拗肿痛，小腹痞满，小便数，白带时下，寒热往来，小水淋漓。余谓脾气
滞而血病，用龙胆泻肝汤渐愈，又用加味逍遥散，六味丸而全愈。
一妇人，小腹内如有所梗，两拗并人门俱肿，小便淋涩，经候不调，内热作渴，饮食
少思，腹内初如鸡卵而渐大，脉洪数而虚，左关尤甚，属肝胆郁结之证也。用加味归脾汤，
肝火退，而脾土健，间以逍遥散下芦荟丸而愈。（俱薛按）
关于便毒的论治，薛己（立斋）的方法已经非常详尽了。然而，其中因房事不洁、感染淫毒而患病的患者最为多见。这类病症往往先出现下疳，下疳未愈，便毒随即发作，这是湿热秽毒为害所致。凡是初起时肿痛，尚未化脓，且元气尚强的，应当迅速去除毒素，使用会脓散或牡蛎散效果最好。如果已经化脓，则应通过针刺或腐蚀法，尽快排出脓液，随后根据证候进行调补，使疮口迅速愈合为好。
如果初起只有一个硬结，疼痛轻微，肿胀弥漫的，这有两种情况：一是邪气轻浅，二是元气虚弱导致毒邪深重。如果是邪气轻浅的，只需用会通膏加麝香外贴，没有不散去的，或者使用降痈散也可以。如果是元气虚弱而毒邪深重的，既不肯消散，又不早日溃破，拖延越久病情越严重，最为可怕。等到溃破后，大多不能收口，轻则形成漏管，重则危及生命。这种情况只有大补元气，才不会造成危害。
如果肿痛非常剧烈，脓液即将形成，势态无法消除，宜用降痈散保留顶部围敷，这样势态可以收敛，疼痛可以缓解，脓液可以快速成熟并溃破。
薛己说：便痈属于足厥阴肝经，表现为内热外寒，或因过度劳累，或房事不节制，或欲念不得满足，或强行固摄精气，或肝经湿热所致。大体上多发生于劳累过度、精气俱虚的人。俗话说是“石米疮”，说这种病要一百天才能痊愈。如果大补气血，不到十天即可痊愈，何必用一百天？因为疮口的收敛，取决于气血的盛衰。也有因体内蕴藏热毒而生的，必须辨别虚实及是否成脓，不可一概投用攻伐药物。凡是妇女患此病的，多在两胁肿痛，或腹中结块，小便涩滞，如果治疗得当，患者又能调养，不足为虑。常见治疗此证者，一概使用大黄之类泻下，以求内消，或者等脓成后，让脓从大便排出，很少见到痊愈的。人们之所以想内消，是担心收口困难。如果知道补养血气，不到十天就能收口，有什么难的？如果脓已经形成，岂有能消散的道理？如果再使用克伐药物，必然导致难以治疗。
薛己又说：便痈就是血疝，俗称便毒，意思是在不便之处生痈。它涉及足厥阴经络，以及冲脉、任脉、督脉，也属于肝脏的旁络。这是气血流通的道路，现在壅滞而肿痛，这是热毒所致，应当先疏导其滞塞，再用托里剂，这是临证制宜的方法。
又《治法》中说：内热外寒的，用牛黄双解散。湿热壅滞的，宜用龙胆泻肝汤，疏肝导滞。因欲念不遂导致精气逆乱的，先用五苓散加大黄，疏导其逆滞，后用六味地黄丸，以补肝肾强固精气。房事不节制的，宜用六味地黄丸料。劳累过度的，用补中益气汤。
有一个男子，患便毒，睾丸肿痛，大小便秘结，脉有力，服用玉烛散两剂后症状顿退，再服用龙胆泻肝汤四剂而消退。
有一个男子，脓未成大痛，服用消毒托里等药无效。诊察其脉洪大，毒邪尚在，服用仙方活命饮，一剂后疼痛停止，再一剂后消退。
有一个读书人，肿痛且小便涩滞，服用八正散两剂，以清肝火、导湿热，肿痛痊愈。再服用小柴胡汤加川芎、当归、泽泻、山栀两剂，以清火补血，小便通畅。
有一个男子，已溃破但疼痛不止，小便秘涩，这是肝火未解，给予小柴胡汤加黄柏、知母、川芎、当归，疼痛停止，小便通畅，再用托里当归汤使疮口收敛。如果毒邪未解而疼痛不止的，须用仙方活命饮。
府学生沈尼文，二十岁，左侧睾丸患病。我认为他是肝肾阴虚，先用托里药，溃破后将愈。因行房后发热口渴，右侧也开始疼痛，脓水清稀，虚证全部显现，脉洪大而无力，势态很可怕。用十全大补汤加附子一钱，脉证顿退，再剂后完全消退。后用大补汤，三十剂而痊愈。
有一个男子，肿胀但不溃破，这是因为阳气虚弱，用人参、黄芪、当归、白术，以补托元气，用白芷、皂角刺、柴胡、甘草，以排脓清肝，数剂后溃破，再用八珍汤加柴胡，补益气血，数剂后痊愈。
春元凌待之，体虚却服用克伐药，几乎危殆。我用托里健脾药治愈。秀才王文远，因劳苦患病，服用小柴胡汤表证散去后，用托里药，脓成，针刺后，十日痊愈。还有胡判官，脓液清稀脉弱，用大补药已愈，因新婚复发，自用连翘消毒散，导致腹泻痢疾不止，最终不治身亡。可见此证，属虚损的多，非补不可。大体上便毒属于肝经，初起坚硬，是因为肝主筋的缘故。五七日后，应当变红软，是因为脓成的缘故。如果仍然坚硬，是元气不能腐化脓液。往往人们见其坚硬，只想内消，反而服用攻散药，多导致虚上加虚的祸患，之前的治疗者就是验证。
有一个妇人，两胁肿痛，小腹痞满，小便频数，白带时下，寒热往来，小便淋漓。我认为她是脾气滞涩而血病，用龙胆泻肝汤逐渐痊愈，又用加味逍遥散、六味地黄丸而全愈。
有一个妇人，小腹内如有梗塞感，两胁及肛门周围都肿，小便淋涩，月经不调，内热口渴，饮食少思，腹内初如鸡卵状而渐大，脉洪数而虚，左关尤其明显，属于肝胆郁结之证。用加味归脾汤，肝火退去，脾土健运，间服逍遥散下芦荟丸而愈。（均为薛己按语）
Regarding the discussion and treatment of "Bian Du" (Inguinal Abscess), Xue Ji's methods are already quite detailed. However, cases caused by unclean sexual intercourse and infection with venereal toxins are the most common. Such conditions often begin with chancre (genital ulcer); before the chancre heals, Bian Du follows, which is a manifestation of damp-heat and foul toxins. In the initial stage, if there is swelling and pain but no pus formation yet, and the patient's Yuan Qi (Original Qi) remains strong, it is urgent to eliminate the toxin first. Huinong San (Hui Nong Powder) or Muli San (Oyster Shell Powder) are considered the best options. If pus has already formed, one should use acupuncture or cauterization to drain the pus as quickly as possible, followed by syndrome-specific tonification to promote rapid wound healing.
If initially there is a single nodule with slight pain and diffuse swelling, this presents two patterns: one due to mild pathogenic factors, and the other due to weak Yuan Qi allowing deep-seated toxins. For mild pathogens, applying Huitong Gao (Hui Tong Plaster) mixed with musk externally will invariably resolve the swelling; Jiangyong San (Jiang Yong Powder) may also be used. For cases where Yuan Qi is weak and toxins are deep, the condition will neither dissipate nor suppurate early; the longer it persists, the worse it becomes, which is most alarming. After ulceration, healing is often difficult; in mild cases, it may lead to fistula formation, and in severe cases, it can be fatal. Only vigorous tonification of Yuan Qi can prevent such harm.
If swelling and pain are severe and pus is about to form, making resolution impossible, apply Jiangyong San around the base while leaving the head open. This will help contain the spread, relieve pain, and accelerate pus maturation and rupture.
Xue Ji stated: Bian Yong (Inguinal Abscess) belongs to the Foot Jueyin Liver Meridian, characterized by internal heat and external cold. It may result from excessive labor, irregular sexual activity, suppressed desires, forced retention of essence, or damp-heat in the Liver meridian. Generally, it affects those who are overworked and deficient in both essence and qi. The folk saying calls it "Shi Mi Chuang" (Stone Rice Sore), claiming it takes 100 days to heal. However, if blood and qi are vigorously tonified, it can heal in less than ten days. Why wait 100 days? Wound healing depends on the abundance of blood and qi. Some cases arise from internal accumulation of heat toxins; one must differentiate between deficiency and excess, and whether pus has formed, rather than indiscriminately using purgative drugs. Women suffering from this usually present with swelling and pain in the hypochondrium, abdominal masses, and dysuria. With proper treatment and self-care, there is little to worry about. Often, practitioners indiscriminately use rhubarb and similar purgatives to seek internal resolution, or allow pus to exit via the bowel once formed; few recover. People desire internal resolution because they fear the difficulty of wound closure. But if blood and qi are tonified, closure occurs in ten days; what is the difficulty? Once pus is formed, it cannot be dissolved. Using draining agents at this stage will inevitably make treatment difficult.
He further stated: Bian Yong is essentially a Blood Hernia, commonly called Bian Du, meaning an abscess in an inconvenient location. It involves the Foot Jueyin meridians, as well as the Chong, Ren, and Du vessels, which are collateral branches of the Liver. These are pathways for the smooth flow of qi and blood. Obstruction here causes swelling and pain due to heat toxins. One should first unblock the stagnation, then use interior-supporting formulas. This is the method of adapting treatment to clinical circumstances.
According to "Treatment Methods": For internal heat and external cold, use Niuhuang Shuangjie San (Cattle Gallstone Double-Resolution Powder). For damp-heat obstruction, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction) to soothe the Liver and guide out stagnation. For reversed qi and essence due to suppressed desires, first use Wuling San plus rhubarb to unblock stagnation, then use Dihuang Wan (Rehmannia Pill) to tonify the Liver and Kidney and strengthen essence. For irregular sexual activity, use Liuwei Wan (Six-Ingredient Pill) ingredients. For excessive fatigue, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
A male patient suffered from Bian Du with testicular swelling and pain, constipation of both stool and urine, and a forceful pulse. Two doses of Yuzhu San (Jade Candle Powder) rapidly alleviated symptoms, followed by four doses of Longdan Xiegan Tang, which resolved the condition.
Another male patient had severe pain without significant pus formation; decoctions for detoxification and interior support were ineffective. His pulse was flooding and large, indicating lingering toxin. One dose of Xianfang Huoming Yin (Immortal Life Elixir Decoction) stopped the pain, and a second dose resolved the swelling.
A scholar presented with swelling, pain, and dysuria. Two doses of Bazheng San (Eight-Ingredient Powder for Rectification) cleared Liver fire and guided out damp-heat, resolving the swelling and pain. Subsequently, two doses of Xiaochaihu Tang (Minor Bupleurum Decoction) modified with Chuanxiong, Danggui, Ze Xie, and Shan Zhi cleared fire, nourished blood, and restored normal urination.
A male patient had an ulcerated sore with persistent pain and urinary retention, indicating unresolved Liver fire. He was given Xiaochaihu Tang modified with Huangbai, Zhimu, Chuanxiong, and Danggui. Pain ceased, urination normalized, and Tuoli Danggui Tang (Interior-Supporting Angelica Decoction) promoted wound contraction. If toxin remains unresolved and pain persists, Xianfang Huoming Yin is required.
Shen Niwen, a government student aged twenty, suffered from left-sided testicular disease. Identifying Kidney and Liver Yin deficiency, I first used interior-supporting herbs. After ulceration and near recovery, he engaged in sexual activity, leading to fever, thirst, right-sided pain, thin purulent discharge, and full manifestation of deficiency signs. His pulse was flooding and forceless, a dire prognosis. Tenquan Dabu Tang (Complete Great Tonification Decoction) with one qian of Fuzi (Prepared Aconite Root) rapidly reduced pulse and symptom severity; two more doses led to complete resolution. He subsequently took Dabu Tang (Great Tonification Decoction) for thirty doses to fully recover.
A male patient presented with swelling but no ulceration due to Yang Qi deficiency. Ginseng, Astragalus, Angelica, and Atractylodes were used to tonify and support Yuan Qi; Baizhi, Gleditsia Spine, Bupleurum, and Licorice were added to drain pus and clear Liver heat. After several doses, it ulcerated. Bazhen Tang (Eight-Treasure Decoction) plus Bupleurum was then used to tonify blood and qi, leading to recovery after several doses.
Ling Daizhi, a student, was nearly critical due to taking draining medicines while deficient. I cured him with interior-supporting and spleen-strengthening herbs. Scholar Wang Wenyuan contracted the disease due to hard labor; after Xiaochaihu Tang dispersed exterior signs, interior-supporting herbs were used. Once pus formed, it was lanced, and he recovered within ten days. Official Hu had thin pus and a weak pulse; he recovered with great tonification. However, upon remarriage, the condition recurred. Self-medication with Liaoqiao Xiaodu San (Forsythia Detoxification Powder) caused intractable diarrhea and dysentery, leading to death. This demonstrates that this condition is mostly deficiency-type and requires tonification. Generally, Bian Du belongs to the Liver meridian; initial hardness is due to the Liver governing sinews. After five to seven days, it should become red and soft as pus forms. If it remains hard, it indicates Yuan Qi's inability to transform tissue into pus. Often, seeing hardness, people seek internal resolution and take attacking/dispersing medicines, causing deficiency-to-deficiency disasters. Previous treatments serve as proof.
A female patient presented with bilateral hypochondriac swelling and pain, abdominal fullness, frequent urination, leukorrhea, alternating chills and fever, and dribbling urine. I diagnosed Spleen Qi stagnation and Blood pathology. Longdan Xiegan Tang gradually improved her condition, followed by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Liuwei Wan (Six-Ingredient Pill) for complete recovery.
Another female patient felt a blockage in the lower abdomen, with swelling in both hypochondria and around the anus, dysuria, irregular menstruation, internal heat, thirst, poor appetite, and an abdominal mass growing from egg-sized. Her pulse was flooding, rapid, and empty, especially at the Left Guan position, indicating Liver-Gallbladder Qi Stagnation. Jiawei Guipi Tang (Modified Restore the Spleen Decoction) cleared Liver fire and strengthened Spleen Earth. Intermittently, Xiaoyao San with Lubellia Pills was administered, resulting in recovery. (All notes by Xue Ji)