立斋曰∶悬痈，谓疮生于玉茎之后，谷道之前，属足三阴亏损之证。轻则为漏，沥尽气
血而亡，重则内溃而即殒。大抵此证，原属肝肾阴虚，故不足之人多患之，虽一于补，犹恐
不治，况脓成而又克伐，不死何俟。即寒凉之剂，亦不可过用，恐伤胃气。惟制甘草一药，
不损血气，不动脏腑，其功甚捷，最宜用之，不可忽也。 痛或发热者，清肝解毒。肿痛
者，解毒为主。肿痛而小便赤涩者，肝经湿热也，宜分利清肝。不作脓，或不溃者，气血虚也
，宜补之。
又《治法》曰∶凡初起湿热肿痛，或小便赤涩，宜先以制甘草一二剂，及隔蒜灸，更
饮龙胆泻肝汤。 肿痛甚，宜仙方活命饮，以制甘草佐之。若发热肿痛者，以小柴胡汤加
车前、黄柏、芎、归。若不成脓，或脓成不溃者，八珍汤补之。若脓已成者，急针之。已溃者
，用八珍汤加制甘草、柴胡梢、酒炒黄柏、知母。小便涩而脉有力者，仍用龙胆泻肝汤加制
甘草。小便涩而脉无力者，清心莲子饮加制甘草。脓清不敛者，用大补之剂，间以豆豉饼灸
之。久而不敛者，用附子饼灸之，并效。欲其生肌收敛，肾虚者，六味地黄丸。血虚者，四
物加参、术。气虚者，四君加芎、归。脾虚者，补中益气汤。气血俱虚者，八珍汤，并十全
大补汤。若用寒凉消毒则误矣。
陈良甫曰∶治谷道前后生痈，谓之悬痈，用粉甘草一两截断，以涧水浸润，炙令透内，
细锉，用无灰酒煎服。有人患此已破，服两剂，疮即合。
一弱人，茎根结核如大豆许，劳则肿痛，先以十全大补汤去桂加车前、麦冬、酒制黄柏
、知母少愈，更服制甘草渐愈，仍以四物车前之类而消。
一男子患此， 痛发热，以龙胆泻肝汤二剂，及制甘草四剂而溃，再用滋阴之剂而愈。
若或脓未成，以葱炒熟敷上，冷即易之，隔蒜灸之亦可。数日不消，或不溃，或溃而不敛，
以十全大补汤加柴胡梢为主，间服制甘草并效。若不保守，必成漏矣。
一儒者，患悬痈，服坎离丸及四物、黄柏知母之类不应。脉浮洪，按之微细，余以为
足三阴之虚，用托里散及补阴八珍汤渐愈。又用六味丸、补中益气汤，调补化源，半载而痊
。大凡疮疡等证，若肾经火气亢盛，致阴水不能生化，而患阴虚发热者，宜用坎离丸，取其
苦寒能化水中之火，令火气衰而水自生。若阳气衰弱，致阴水不能生化，而患阴虚发热者
，宜用六味丸，取其酸温能生火中之水，使阳气旺而阴自生。况此证属肾经精气亏损者，十
有八九，属肾经阳气亢盛者，十无一二。然江南之人患此者，多属脾经阴血亏损，元气下陷
，须用补中益气汤，升补阳气，使阳生而阴长。若嗜欲过多，亏损真阴者，宜用六味丸，补
肾经元气，以生精血，仍用补中益气汤，以培脾肺之生气，而滋肾水。经云阴虚者，脾虚也
，但多误认为肾经火证，用黄柏知母之类，复伤脾肺，绝其化源，反致不起，惜哉。
通府张敬之，患前证，久不愈，日晡热甚，作渴，烦而喘，或用四物汤、黄柏、知母之
类，病益甚，肢体倦，少食，大便不实，小便频数。谓余曰∶何也。余曰∶此脾虚之证，前
药复伤而然，遂用补中益气汤加茯苓、半夏数剂，饮食渐进，前证渐愈。更加麦冬、五味，
调理乃痊。经曰∶脾属太阴，为阴土而主生血。故东垣云∶脾虚元气下陷，发热烦渴，肢体
倦怠等证，用补中益气汤，以升补阳气而生阴血。若误认为肾虚火盛，而用四物黄柏知母之
类，反伤脾胃生气，是虚其虚矣。况黄柏知母乃泻阳损阴之剂，若非膀胱阳火盛，而不能生
阴水，以致发热者，不可用也。（俱薛按）
薛己说：悬痈，是指疮疡生长在玉茎（阴茎）之后、谷道（肛门）之前，属于足三阴经亏损的证候。轻症会形成瘘管，耗竭气血而导致死亡；重症则内部溃烂而立即致死。大抵这个病证，原本属于肝肾阴虚，所以体质虚弱的人多患此病，即使单纯使用补法，还担心治不好，何况在脓液形成后又使用攻伐药物，不死还要等到什么时候呢？即使是寒凉性质的药剂，也不可以过度使用，恐怕会损伤胃气。只有炮制过的甘草这一味药，不损耗血气，不扰动脏腑，功效非常迅速，最适合使用，不可忽视。
如果疼痛或伴有发热，应清肝解毒。如果肿胀疼痛，以解毒为主。如果肿胀疼痛且小便赤红涩痛，是肝经湿热所致，适宜分利湿热并清肝。如果不化脓，或不溃破，是气血虚弱，应当补益。
又《治法》中说：凡是初起时湿热导致的肿痛，或者小便赤红涩痛，适宜先用炮制甘草一二剂，以及隔蒜灸，再饮用龙胆泻肝汤。如果肿痛严重，适宜用仙方活命饮，并用炮制甘草辅助。如果有发热肿痛，用小柴胡汤加车前子、黄柏、川芎、当归。如果不化脓，或脓成但不溃破，用八珍汤补益。如果脓已经形成，急刺排脓。已经溃破的，用八珍汤加炮制甘草、柴胡梢、酒炒黄柏、知母。小便涩痛且脉象有力的，仍用龙胆泻肝汤加炮制甘草。小便涩痛且脉象无力的，用清心莲子饮加炮制甘草。脓液清稀且不收敛的，用大补的药剂，间或用豆豉饼灸。久不收敛的，用附子饼灸，也有效。想要生肌收敛，肾虚者，用六味地黄丸。血虚者，四物汤加人参、白术。气虚者，四君子汤加川芎、当归。脾虚者，用补中益气汤。气血俱虚者，用八珍汤，以及十全大补汤。如果使用寒凉消毒的方法就错了。
陈良甫说：治疗谷道前后生的痈，称为悬痈，用粉甘草一两，截断，用山涧水浸润，炙烤至透内，细切，用没有灰杂的酒煎服。有人患此病已经破溃，服用两剂后，疮口即愈合。
有一个体弱的人，茎根处结核如大豆大小，劳累则肿痛，先用十全大补汤去掉桂枝，加车前子、麦冬、酒制黄柏、知母，稍微好转，再服用炮制甘草逐渐痊愈，最后仍以四物汤、车前子之类消除余邪。
一个男子患此病，疼痛发热，用龙胆泻肝汤二剂，及炮制甘草四剂后溃破，再用滋阴的药剂而痊愈。
如果脓未形成，用葱炒熟敷在上面，冷了即更换，隔蒜灸也可以。数日不消退，或不溃破，或溃破但不收敛，以十全大补汤加柴胡梢为主，间服炮制甘草也有效。如果不注意保养，必定形成瘘管。
一位儒者患悬痈，服用坎离丸及四物汤、黄柏、知母之类无效。脉象浮洪，重按微细，我认为这是足三阴经的虚损，用托里散及补阴八珍汤逐渐痊愈。又用六味丸、补中益气汤，调补化源，半年后痊愈。大凡疮疡等证，如果是肾经火气亢盛，导致阴水不能生化，而患阴虚发热的，适宜用坎离丸，取其苦寒能化水中的火，使火气衰退而水自生。如果是阳气衰弱，导致阴水不能生化，而患阴虚发热的，适宜用六味丸，取其酸温能生火中的水，使阳气旺盛而阴自生。况且这个病证属于肾经精气亏损的，十有八九，属于肾经阳气亢盛的，十无一二。然而江南之人患此病的，多属于脾经阴血亏损，元气下陷，须用补中益气汤，升补阳气，使阳生而阴长。如果嗜欲过多，亏损真阴的，适宜用六味丸，补肾经元气，以生精血，仍用补中益气汤，以培补脾肺的生气，而滋补肾水。经文说阴虚者，其实是脾虚，但多误认为是肾经火证，用黄柏、知母之类，再次损伤脾肺，断绝化源，反而导致不治，可惜啊。
通府张敬之，患上述病证，久不痊愈，傍晚热势甚重，口渴，烦躁而喘，有人用四物汤、黄柏、知母之类，病情更加严重，肢体疲倦，少食，大便不成形，小便频数。他问我：为什么呢？我说：这是脾虚的证候，之前的药物再次损伤所致，于是用补中益气汤加茯苓、半夏数剂，饮食逐渐增加，前面的症状逐渐痊愈。再加麦冬、五味子，调理后痊愈。经文说：脾属太阴，为阴土而主生血。所以东垣先生说：脾虚元气下陷，发热烦渴，肢体倦怠等证，用补中益气汤，以升补阳气而生阴血。如果误认为肾虚火盛，而用四物汤、黄柏、知母之类，反而损伤脾胃的生气，这是虚其虚了。况且黄柏、知母是泻阳损阴的药剂，如果不是膀胱阳火盛，而不能生阴水，以致发热的，不可用。（以上均为薛己按语）
Xue Ji stated: Xuan Yong (Hanging Abscess) refers to a sore located posterior to the Yujing (penis) and anterior to the Gudao (anus). It belongs to the syndrome of deficiency in the Three Yin Meridians of the Foot. In mild cases, it may develop into a fistula; draining all Qi and Blood leads to death. In severe cases, internal ulceration occurs leading to immediate demise. Generally, this condition originates from Yin deficiency of the Liver and Kidney; thus, individuals with constitutions prone to deficiency are susceptible. Even if treated solely with tonification, there is still concern that it may not be curable, let alone if purgative or attacking methods are used after pus formation—who could expect survival? Even cold-natured medicines should not be overused, as they may damage Stomach Qi. Only processed Licorice Root (Zhi Gancao) stands out; it does not deplete Blood and Qi nor disturb the Zang-Fu organs, and its efficacy is rapid. It is most suitable for use and should not be neglected.
If pain or fever is present, clear the Liver and resolve toxicity. If swelling and pain predominate, resolving toxicity is the primary approach. If swelling, pain, accompanied by red and scanty/difficult urination, indicates Damp-Heat in the Liver Meridian; appropriate treatment involves separating and draining Damp-Heat while clearing the Liver. If pus fails to form or the sore fails to ulcerate, it indicates Qi and Blood deficiency, requiring tonification.
Furthermore, "Treatment Methods" states: For initial onset characterized by Damp-Heat-induced swelling and pain, or red/scanty urination, initially administer one to two doses of processed Licorice Root (Zhi Gancao), combined with Garlic-Separated Moxibustion (Gesu Jiu), followed by drinking Longdan Xiegan Tang (Gentiana Liver-Draining Decoction). If swelling and pain are severe, Xianfang Huoming Yin (Immortal Life Elixir) is indicated, assisted by processed Licorice Root (Zhi Gancao). If accompanied by fever and swelling/pain, Xiaochaihu Tang (Minor Bupleurum Decoction) added with Qiancao (Plantago Seed), Huangbai (Phellodendron Bark), Chuanxiong (Szechwan Lovage Rhizome), and Danggui (Angelica Sinensis) should be used. If pus does not form, or forms but does not ulcerate, Bazhen Tang (Eight-Treasure Decoction) is used for tonification. If pus has already formed, urgent needle drainage is required. For already ulcerated sores, Bazhen Tang (Eight-Treasure Decoction) added with processed Licorice Root (Zhi Gancao), Chaishao (Bupleurum Tip), wine-fried Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) is prescribed. If urination is difficult but the pulse is forceful, continue using Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) with processed Licorice Root (Zhi Gancao). If urination is difficult but the pulse is weak, Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) with processed Licorice Root (Zhi Gancao) is indicated. If pus is thin and fails to heal, use strong tonifying agents, interspersed with Fermented Soybean Cake Moxibustion (Douchi Bing Jiu). For chronic non-healing, Aconite Cake Moxibustion (Fuzi Bing Jiu) is also effective. To promote tissue regeneration and contraction: for Kidney deficiency, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); for Blood deficiency, Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala); for Qi deficiency, Sijunzi Tang (Four-Gentlemen Decoction) added with Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis); for Spleen deficiency, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for combined Qi and Blood deficiency, Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten Great Tonifying Decoction). Using cold-natured detoxifying methods would be an error.
Chen Liangfu stated: To treat abscesses arising before and after the anus, termed Xuan Yong (Hanging Abscess), use one liang of Fen Gancao (Powdered Licorice Root), cut into sections, soak in mountain spring water, roast thoroughly until penetrating, finely chop, and decoct in pure wine (without ash impurities) for administration. One patient whose sore had already ruptured healed completely after two doses.
A frail individual presented with a nodule at the root of the penis, size of a soybean, causing swelling and pain upon exertion. Initially treated with Shiquan Dabu Tang (Ten Great Tonifying Decoction) minus Rougui (Cinnamon Bark), added with Cheqianzi (Plantago Seed), Maidong (Ophiopogon Tuber), wine-processed Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome), showing slight improvement. Subsequently, processed Licorice Root (Zhi Gancao) was administered, leading to gradual recovery, finally resolved with Siwu Tang (Four-Substance Decoction) and Cheqianzi (Plantago Seed).
A male patient suffered from this condition with pain and fever. After two doses of Longdan Xiegan Tang (Gentiana Liver-Draining Decoction) and four doses of processed Licorice Root (Zhi Gancao), the sore ulcerated. He recovered following treatment with Yin-nourishing agents.
If pus has not yet formed, apply cooked scallions topically, replacing when cool; Garlic-Separated Moxibustion (Gesu Jiu) is also applicable. If unresolved after several days, or failing to ulcerate/heal, prioritize Shiquan Dabu Tang (Ten Great Tonifying Decoction) with Chaishao (Bupleurum Tip), interspersed with processed Licorice Root (Zhi Gancao). Without proper care, it will inevitably become a fistula.
A scholar suffered from Xuan Yong (Hanging Abscess) without response to Kanli Wan (Kanli Pill), Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome). The pulse was floating and surging, but fine upon deep pressure. I diagnosed it as deficiency of the Three Yin Meridians of the Foot. Gradual recovery occurred with Tuoli San (Support-the-Interior Powder) and Buyin Bazhen Tang (Yin-Nourishing Eight-Treasure Decoction). Further treatment with Liuwei Wan (Six-Ingredient Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) regulated the source of transformation, resulting in complete recovery after half a year. Generally, for sores and ulcers, if Hyperactive Fire in the Kidney Meridian prevents the generation of Yin Water, causing Yin-deficiency fever, Kanli Wan (Kanli Pill) is indicated for its bitter-cold nature to transform fire within water, allowing fire to subside and water to regenerate. If Weak Yang prevents the generation of Yin Water, causing Yin-deficiency fever, Liuwei Wan (Six-Ingredient Pill) is indicated for its sour-warm nature to generate water within fire, strengthening Yang so Yin naturally arises. Moreover, 80-90% of such cases belong to Jing-Qi deficiency of the Kidney Meridian, while only 10-20% involve Hyperactive Yang of the Kidney Meridian. However, patients in Jiangnan often suffer from Yin-Blood deficiency of the Spleen Meridian and sinking of Yuan Qi; thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is necessary to raise and tonify Yang, promoting Yang growth to nourish Yin. For those with excessive sexual desire damaging True Yin, Liuwei Wan (Six-Ingredient Pill) is suitable to tonify Kidney Yuan Qi to generate Essence and Blood, combined with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to cultivate Spleen-Lung generating Qi and nourish Kidney Water. The Classic states that "Yin deficiency is essentially Spleen deficiency," yet it is frequently mistaken for Kidney Fire syndrome. Using Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) further damages Spleen-Lung, severing the source of transformation, leading to untreatability—a great pity.
Zhang Jingzhi of Tong Prefecture suffered from the aforementioned condition chronically. He experienced intense heat in the late afternoon, thirst, irritability, and panting. Treatment with Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) worsened his condition, leading to limb fatigue, poor appetite, loose stools, and frequent urination. He asked me, "Why?" I replied, "This is a Spleen deficiency syndrome exacerbated by previous medications." I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber) for several doses. His diet gradually improved, and symptoms subsided. Adding Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry) completed the regulation and cure. The Classic states: "The Spleen belongs to Taiyin, is Yin Earth, and governs blood generation." Therefore, Dongyuan stated: For Spleen deficiency with sinking of Yuan Qi, presenting with fever, irritability, thirst, and limb fatigue, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used to raise and tonify Yang to generate Yin Blood. Mistaking this for Kidney deficiency with hyperactive fire and using Siwu Tang (Four-Substance Decoction), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) damages the generating Qi of the Spleen and Stomach, thereby exacerbating deficiency. Furthermore, Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) are agents that drain Yang and damage Yin; they should not be used unless there is Hyperactive Bladder Yang Fire preventing the generation of Yin Water, causing fever. (All notes by Xue Ji)