立斋曰∶多骨疽者，由疮疡久溃，气血不能营于患处，邪气陷袭，久则烂筋腐骨，而脱
出，属足三阴亏损之证也，用补中益气汤，以固根本。若阴火发热者，佐以六味丸，壮水
之主，以镇阳光。阳气虚寒者，佐以八味丸，益火之源，以消阴翳。外以附子饼，葱熨法，
祛散寒邪，补接营气，则骨自脱，疮自敛也。夫肾主骨，若肾气亏损，其骨渐肿，荏苒岁月
，溃而出骨，亦用前法。若投以克伐之剂，复伤真气，鲜有不误者。
下疳一证，本肝肾湿热证也。若无外因而病者，不过去其湿热，或滋真阴。湿热既清，
其疮自愈，无足虑也。惟感触淫毒而患者，毒有浅深，则病有微甚，皆宜用百草煎熏洗，外
以螵蛸散敷之，则轻者自愈。若湿热甚，而为肿为痛者，宜用芍药疾藜煎，兼而治之。如毒
甚者，必用萆 汤方可。若感触淫邪毒，自少阴直入精宫者，不易愈。即治如前法，然必
见便毒、广疮发出，而后下疳始愈。既见疮毒，即当于本证条下，求法治之。
余尝治一少年，因偶触秽毒，遽患下疳，始溃龟颈，敷治不效，随从马口延入尿管，以
渐而深，直至肛门，逐节肿痛，形如鱼骨。每过夜则脓结马口，胀不得出，润而通之，则先
脓后尿，敷洗皆不能及，甚为危惧。余尝遇一山臾，传得槐花蕊方，因以治之，不十日而茎
根渐愈，半月后即自内达外，退至马口而全愈。疳愈后，即见些微广疮，复以五加皮饮，十
余剂而全愈。向彼传方者曰∶此方善治淫疮热毒，悉从小便泄去，所以能治此疳，但服此者
，可免终身疮毒后患。然犹有解毒奇验，则在疮发之时，但见通身忽有云片红斑，数日而没
者，即皆疮毒应发之处。疮毒已解，而疮形犹见，是其验也。予初未之信，及此人疮发之时
，疮固不多，而通身红斑果见，凡两日而没。予始知疮之有奇，一至如此。（新按）
立斋曰∶下疳，属肝经湿热下注，或阴虚火燥治法，肿痛发热者，血虚而有热也，四
物汤加柴胡、山栀。肿痛寒热者，肝经湿热也，小柴胡汤加龙胆草、黄连。肿痛便涩者，湿
热壅滞也，龙胆泻肝汤。肿痛腐溃者，气血虚而有火也，八珍汤加山栀、柴胡。日晡热甚者
，阴血虚而有火也，小柴胡汤加参、术、芎、归。日晡倦怠者，阳气虚而下陷也，补中益气
汤。有经久不愈而发寒热者，肾水不能生肝木也，宜六味丸。若筋缩或纵，或为痒痛，或
出白津，此筋疝也，用龙胆泻肝汤。气虚者，补中益气汤加炒山栀、炒龙胆。阴虚火燥者，
用六味丸。茎中痒，出白津，用补中益气汤，与清心莲子饮间服。盖此证，肝经阴虚为本，
肿痛寒热等证为标，须用六味丸，以生肝血。凡脾土虚不能生金水，而见一切肝证者，当佐
以补中益气汤加麦门冬，以滋化源。
一男子肿痛不消。一男子溃而肿痛发热，小便秘涩，日晡或热。一小儿肿痛，诸药不应
。俱以小柴胡汤吞芦荟丸，数服而愈。
一小儿，十五岁，患前证，杂用消毒之药，虚证悉具，二年余矣。询之乃禀所致，用萆
汤，月余诸证渐愈。又用补阴八珍汤、补中益气二汤而痊。
庶吉士刘华甫，或茎中作痛，或窍出白津，或小便秘涩。先用小柴胡汤加山栀、泽泻、
黄连、木通、胆草、茯苓二剂，以清肝火，导湿热，诸证渐愈。后因劳倦，忽然寒热，此元
气复伤也，用补中益气而安。又用六味丸，以生肝血滋肾水而全愈。
一男子，玉茎肿痛，小便如淋，自汗，甚苦，时或尿血少许，尺脉洪数，按之则涩。
先用清心莲子饮加牛膝、山栀、黄柏、知母、柴胡，数剂少愈，更以滋肾丸，一剂而痊。《
玉机微义》曰∶如自汗小便少，不可以药利之。既已自汗，则津液外亡，小便自少。若再利
之，则营卫枯竭，无以制火，而烦热愈甚，当俟热退汗止，小便自行也。兼此证，乃阳明经
病，大忌利小便。（俱薛按）
海藏治下疳久不愈方
橡斗子二个，合盛黄丹令满，以乱发浓缠定，烧烟尽为度，同研为细末。先用葱白热
浆水，洗疮脓尽，次上药。甚者不过三次，如神。
又下疳方
下疳，疮内毒盛者，必须治内方愈。外治者，须螵蛸散，或此方亦佳。
人中白（生用） 官粉（ 黄） 红丹（飞炒）
上等分为末，先用药汤或浓茶洗净，然后敷药。每日二三次，或用猪油，或用蜜水调敷之。
薛立斋说：多骨疽，是由于疮疡长期溃烂，气血不能滋养患处，邪气乘虚侵入，日久导致筋烂骨腐，骨头脱落排出，这属于足三阴经亏损的证候。治疗应用补中益气汤，以巩固根本。如果是阴虚火旺引起的发热，可配合使用六味丸，通过滋补肾阴（壮水之主）来抑制亢盛的阳火（镇阳光）。如果是阳气虚弱、体内有寒，可配合使用八味丸，通过温补肾阳（益火之源）来消散阴寒之邪（消阴翳）。外用附子饼和葱熨法，以驱散寒邪，补充接引营气，这样骨头自然会脱落，疮口也会自行愈合。肾主司骨骼，如果肾气亏损，骨骼逐渐肿胀，经过长时间后溃破并排出死骨，也采用上述方法治疗。如果误用攻伐类药物，再次损伤真气，很少有不酿成祸患的。
下疳这一病症，本质上是肝肾湿热证。如果没有外部感染因素而发病，只需去除湿热，或者滋养真阴。湿热清除后，疮疡自然痊愈，不必担忧。只有因接触淫秽毒邪而患病者，毒邪有深浅之分，病情有轻重之别，都适宜用百草煎熏洗，外用螵蛸散敷贴，轻症可自行痊愈。如果湿热严重，出现肿胀疼痛，适宜用芍药疾藜煎，内外兼治。如果毒邪深重，必须使用萆薢汤才能奏效。如果是接触淫邪毒气，从少阴经直接传入精宫（生殖系统），则难以治愈。即使按照前述方法治疗，也必须等到便毒、广疮发出之后，下疳才能痊愈。一旦见到疮毒症状，就应当在相应的病证条目下，寻求治疗方法。
我曾经治疗过一个少年，因为偶然接触污秽毒邪，突然患上下疳，起初龟头颈部溃烂，外敷药物治疗无效，随后毒邪从尿道口向内蔓延，逐渐加深，直至肛门，逐节肿痛，形状像鱼骨一样。每到夜晚，脓液积聚在尿道口，胀满无法排出，润滑通畅后，先流出脓液然后才是尿液，外敷和外洗都无法触及病灶，情况非常危险令人恐惧。我曾遇到一位山居隐士，传授给我槐花蕊方，于是用它来治疗，不到十天阴茎根部逐渐好转，半个月后疮口由内向外消退，退至尿道口完全痊愈。下疳痊愈后，随即出现轻微的广疮症状，又用五加皮饮，服用十余剂后完全康复。向那位传授药方的人请教，他说：“这个药方善于治疗淫疮热毒，使毒素全部从小便排出，所以能治好这种下疳，但服用此药的人，可以避免终身遭受疮毒的后患。”然而还有一种解毒的奇特验证，就是在疮疡发作时，如果发现全身突然云片状红斑出现，几天后又消失，那就是所有疮毒应该发出的部位。疮毒已经解除，但疮形仍然可见，这就是验证。我起初并不相信，等到这个人疮发的时候，虽然疮不多，但全身红斑果然出现，持续两天后消失。我才得知疮疾有奇验，竟然达到如此程度。（新按语）
薛立斋说：下疳，属于肝经湿热下注，或者是阴虚火燥。治疗方面，如果出现肿痛发热，是血虚而有热，用四物汤加柴胡、山栀。如果出现肿痛且伴有寒热往来，是肝经湿热，用小柴胡汤加龙胆草、黄连。如果出现肿痛且小便涩滞，是湿热壅滞，用龙胆泻肝汤。如果出现肿痛腐烂，是气血虚弱而有火，用八珍汤加山栀、柴胡。如果在下午申时左右发热严重，是阴血虚弱而有火，用小柴胡汤加人参、白术、川芎、当归。如果在下午感到倦怠无力，是阳气虚弱而下陷，用补中益气汤。如果有经久不愈且发作寒热的，是肾水不能生养肝木，适宜用六味丸。如果出现筋脉收缩或松弛，或者瘙痒疼痛，或者流出白色津液，这是筋疝，用龙胆泻肝汤。气虚的，用补中益气汤加炒山栀、炒龙胆。阴虚火燥的，用六味丸。阴茎内部瘙痒，流出白色津液，用补中益气汤与清心莲子饮交替服用。大概这个病症，肝经阴虚是本，肿痛寒热等症状是标，必须用六味丸来生养肝血。凡是脾土虚弱不能生养肺金肾水，而出现一切肝系病症的，应当辅助使用补中益气汤加麦门冬，以滋养化源。
有一个男子，肿痛不消。另一个男子，溃烂后肿痛发热，小便短少涩滞，下午有时发热。还有一个小儿，肿痛，各种药物无效。这三人都用小柴胡汤吞服芦荟丸，服用几剂后痊愈。
有一个十五岁的小儿，患有前述病症，胡乱使用消毒药物，导致虚证全部显现，病程两年多。询问病因，乃是先天禀赋所致，使用萆薢汤，一个月后诸症逐渐痊愈。后来又用补阴八珍汤、补中益气汤两方调理而康复。
庶吉士刘华甫，有时阴茎内部作痛，有时尿道口流出白色津液，有时小便短少涩滞。先用小柴胡汤加山栀、泽泻、黄连、木通、胆草、茯苓，服用两剂，以清肝火，导湿热，诸症逐渐痊愈。后来因为劳累疲倦，突然发生寒热，这是元气再次受伤，用补中益气汤而安定。又用六味丸，以生肝血、滋肾水而完全康复。
有一个男子，阴茎肿痛，小便像淋病一样，自汗，非常痛苦，偶尔尿出少许血，尺脉洪大数急，重按则涩。先用清心莲子饮加牛膝、山栀、黄柏、知母、柴胡，服用几剂后稍有好转，再用滋肾丸，一剂即痊愈。《玉机微义》说：如果有自汗且小便少，不可以用药利尿。既然已经自汗，说明津液外泄亡失，小便自然减少。如果再利尿，会导致营卫枯竭，无法制约火邪，从而使烦热更加严重，应当等待热退汗止，小便自然恢复。兼有此证，属于阳明经病，严禁使用利小便的方法。（以上均为薛己按语）
海藏治疗下疳久不愈合的方子：
橡斗子两个，装入盛满黄丹的容器中，用乱发紧紧缠绕固定，烧至烟尽为止，共同研磨成细末。先用葱白和热浆水清洗疮口，直到脓液排尽，然后上药。重症不过三次，效果如神。
又一个治疗下疳的方子：
治疗下疳，疮内毒邪旺盛的，必须内治才能痊愈。外治的话，须用螵蛸散，或者这个方子也很好。
人中白（生用） 官粉（煅黄） 红丹（飞炒）
上等分研为末，先用药汤或浓茶洗净，然后敷药。每日二三次，或用猪油调和，或用蜜水调和敷用。
Xue Lizhai stated: Duogu Ju (Bone-abscess) arises from chronic ulceration where Qi and Blood fail to nourish the affected area, allowing pathogenic factors to invade. Over time, this leads to the rotting of sinews and bones, resulting in the shedding of bone fragments. This condition belongs to the deficiency syndrome of the three Yin meridians of the foot. Treatment should employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to consolidate the root. If fever is caused by deficient fire, it should be assisted with Liuwei Wan (Six-Ingredient Pill with Rehmannia) to strengthen the source of water (nourish Kidney Yin) to calm the excessive Yang. If there is Yang deficiency and cold, it should be assisted with Bawei Wan (Eight-Ingredient Pill with Rehmannia) to benefit the source of fire (warm Kidney Yang) to dissipate Yin shadows. Externally, use Aizi Bing (Moxibustion with Prepared Aconite Cake) and Congyi Fa (Scallion Moxibustion Method) to disperse cold pathogens and replenish Ying Qi (Nutritive Qi), so that the bone will naturally shed and the sore will heal. The Kidney governs the bones; if Kidney Qi is deficient, the bones gradually swell, and after a long period, they ulcerate and expel bone fragments. The aforementioned methods should also be used here. If one administers purgative or attacking agents, further damaging the True Qi, few cases will not result in disaster.
Xiagan (Chancre) is essentially a damp-heat syndrome of the Liver and Kidney. If contracted without external causes, one need only clear the damp-heat or nourish the True Yin. Once the damp-heat is cleared, the sore heals spontaneously, requiring no worry. However, for those infected by obscene toxins, the depth of the toxin determines the severity of the disease. All such cases are suitable for fumigation and washing with Baicao Jian (Hundred Herb Decoction), and externally applying Piaoxiao San (Cuttlefish Bone Powder). Mild cases will heal on their own. If damp-heat is severe, causing swelling and pain, Shaoyao Jili Jian (Peony and Tribulus Decoction) should be used for combined treatment. If the toxin is deep-seated, Bishe Tang (Dissolve Turbidity Decoction) is necessary. If the obscene toxic pathogen enters directly from the Shao Yin meridian into the Jing Gong (Essence Palace/reproductive system), it is difficult to cure. Even when treated as described above, healing of Xiagan will only occur after Biandu (Perineal Abscess) and Guangchuang (Lues/Soft Chancre) manifest. Once these sores appear, treatment should follow the protocols for those specific conditions.
I once treated a young man who suddenly developed Xiagan after accidentally contacting filth and toxins. Initially, the glans penis ulcerated, and topical treatments were ineffective. The toxin then spread inward from the Meikou (Urethral Orifice) along the urethra, deepening progressively until it reached the anus, causing segmental swelling and pain resembling fish bones. Every night, pus accumulated at the urethral orifice, causing distension and inability to discharge. After lubricating and clearing the passage, pus would exit before urine. Topical applications and washes could not reach the lesion, making the situation critical and frightening. I encountered a hermit who passed down the Huaihua Rui Fang (Sophora Flower Bud Prescription). Using this formula, the base of the penis improved within ten days, and within half a month, the lesion receded from inside out to the urethral orifice, achieving complete recovery. After the chancre healed, slight signs of Guangchuang appeared. I then administered Wujia Pi Yin (Acanthopanax Decoction) for over ten doses, leading to full recovery. When asked about the prescription, the hermit said, "This formula excels at treating heat-toxins from obscene sores, expelling them entirely through urination, which is why it cures this chancre. Those who take it can avoid lifelong sequelae of skin toxins." However, there is another miraculous verification for detoxification: during the outbreak of sores, if cloud-like red macules suddenly appear all over the body and vanish after a few days, these are the sites where toxins are destined to erupt. The resolution of the toxin is confirmed when the toxin clears but the sore morphology remains visible. I initially did not believe this, but when this patient's sores erupted, although few in number, the whole-body red macules indeed appeared and vanished after two days. Only then did I realize the miraculous nature of sores, reaching such an extent. (New Commentary)
Xue Lizhai stated: Xiagan belongs to damp-heat pouring downward from the Liver Meridian, or Yin deficiency with dry fire. For treatment: if swelling, pain, and fever are present, it indicates Blood deficiency with heat; use Siwu Tang (Four Substances Decoction) added with Chaihu (Bupleurum) and Shanzhi (Gardenia). If swelling, pain, and alternating chills and fever occur, it is damp-heat in the Liver Meridian; use Xiaochaihu Tang (Minor Decoction for the Gallbladder) added with Longdancao (Gentian) and Huanglian (Coptis). If swelling, pain, and urinary difficulty are present, it is damp-heat stagnation; use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If swelling, pain, and ulceration occur, it is Qi and Blood deficiency with fire; use Bazhen Tang (Eight Treasure Decoction) added with Shanzhi and Chaihu. If high fever occurs around Shen hour (3-5 PM), it is Yin Blood deficiency with fire; use Xiaochaihu Tang added with Renshen (Ginseng), Baizhu (Atractylodes), Chuanxiong (Sichuan Lovage), and Danggui (Angelica Sinensis). If fatigue occurs around Shen hour, it is Qi deficiency with sinking; use Buzhong Yiqi Tang. If the condition persists for a long time with chills and fever, it indicates Kidney Water failing to generate Liver Wood; use Liuwei Wan. If tendon contraction or flaccidity, itching, pain, or white discharge occurs, this is Jinshan (Sinew Hernia); use Longdan Xiegan Tang. For Qi deficiency, use Buzhong Yiqi Tang added with fried Shanzhi and fried Longdancao. For Yin deficiency with dry fire, use Liuwei Wan. For itching in the shaft with white discharge, alternate Buzhong Yiqi Tang with Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction). Generally, the root of this condition is Liver Yin deficiency, while symptoms like swelling, pain, chills, and fever are the branch. One must use Liuwei Wan to generate Liver Blood. Whenever Spleen Earth is too weak to generate Lung Metal and Kidney Water, presenting with various Liver syndromes, assist with Buzhong Yiqi Tang added with Maidong (Ophiopogon) to nourish the source of transformation.
One man had persistent swelling and pain. Another man had ulceration with swelling, pain, fever, scanty and difficult urination, and afternoon fever. A child had swelling and pain unresponsive to various medicines. All three were cured after taking several doses of Xiaochaihu Tang swallowed with Lushui Wan (Aloe Pill).
A fifteen-year-old boy suffered from the aforementioned condition. Due to indiscriminate use of detoxifying drugs, he exhibited all signs of deficiency for over two years. Upon inquiry, the cause was congenital constitution. He was treated with Bishe Tang, and after a month, his symptoms gradually resolved. He then recovered using Buyin Bazhen Tang (Nourishing Yin Eight Treasure Decoction) and Buzhong Yiqi Tang.
Shuji Shi Liu Huaful occasionally experienced pain in the penile shaft, white discharge from the orifice, or scanty and difficult urination. Initially, he took Xiaochaihu Tang added with Shanzhi, Zexie (Alisma), Huanglian, Mutong (Akebia), Dancao (Gentian), and Fuling (Poria) for two doses to clear Liver Fire and drain damp-heat, resolving his symptoms. Later, due to fatigue, he suddenly developed chills and fever, indicating a relapse of Yuanqi (Original Qi) injury. He was stabilized with Buzhong Yiqi Tang. He then took Liuwei Wan to generate Liver Blood and nourish Kidney Water, achieving complete recovery.
One man had painful swelling of the jade stem (penis), urinary symptoms resembling strangury, spontaneous sweating, severe distress, occasional slight hematuria, and a Chi pulse that was flooding and rapid but choppy upon pressure. He first took Qingxin Lianzi Yin added with Niuxi (Achyranthes), Shanzhi, Huangbai (Phellodendron), Zhimu (Anemarrhena), and Chaihu for several doses, showing slight improvement. Then, he took Zishen Wan (Nourish Kidney Pill), recovering completely after one dose. *Yuji Wei Yi* states: "If there is spontaneous sweating and little urine, do not use diuretics. Since sweating has occurred, fluids have escaped externally, and urine is naturally reduced. Further diuresis would deplete Ying and Wei, failing to control fire, thereby worsening irritability and heat. One should wait for the fever to subside and sweating to stop, after which urination will resume naturally." This condition involves the Yangming Meridian and strictly forbids diuretic therapy. (All comments by Xue Ji)
Haizang's prescription for chronic non-healing Xiagan:
Two acorn cups filled with Huangdan (Red Lead Oxide), tightly bound with tangled hair, burned until smoke ceases, then ground into fine powder. First, wash the sore with hot scallion water until pus is gone, then apply the medicine. Severe cases require no more than three applications for miraculous results.
Another prescription for Xiagan:
For Xiagan with intense internal toxins, internal treatment is necessary for cure. For external treatment, Piaoxiao San is required, or this formula is also good.
Renzhongbai (Human Tooth Ash, raw) Guafen (Refined Starch, calcined yellow) Hongdan (Red Lead, refined and stir-fried)
Grind equal parts into powder. First clean with medicinal decoction or strong tea, then apply. Use two to three times daily, mixed with pig fat or honey water for application.