Penile ulceration refers to the condition of ulceration, erosion, pain, and itching of the penis.

In ancient medical texts, this condition is referred to by various names such as "pudendal sore," "penile eczema," "pudendal sore ulcer," "gan sore," "chancre sore," "jealousy sore," "shame sore," as well as "chancre," "restless gan," "itchy gan," and "stem worm." Due to its diverse forms and locations, this condition is further subdivided into multiple specific types. The "Waike Zhengzhi Quanshu" states: "The chancre condition is related to the liver, kidney, and governor meridians. Various texts differentiate chancre (occurring below the urethral meatus), stem worm gan (occurring on the shaft of the penis), sleeve infantile malnutrition with aphthae (sores on the shaft with swelling and wrapping of the outer skin), candle laugh (long-standing gan with partial ulceration)..., root gan (beside the urethral meatus, with a hole like a shuttle eye, itching inside, and slight pus when squeezed)...". In modern medical texts, syphilis occurring on the penis, glans, or foreskin is also referred to as chancre, and this disease also falls within the scope of this condition.

bubble_chart Pattern Analysis

1. Dampness-heat in Liver Meridian︰Swelling and pain in the penis, ulceration, red ulcer openings, discharge of water from the ulcer, dizziness, bitter taste in the mouth, dry throat, dry stool, difficult urination, yellow and greasy tongue coating, wiry and slippery pulse. This is due to dampness-heat in the liver meridian, often caused by liver depression transforming into heat, accumulation of dampness in the liver meridian, and the binding of dampness-heat, leading to multiple abscesses in the lower body. The discharge of water from the ulcer, dry stool, difficult urination, yellow and greasy tongue coating, and wiry and slippery pulse are signs of heat mixed with dampness. The treatment should focus on draining the liver and eliminating dampness, using Gentian Liver-Draining Decoction, and applying Golden Yellow Powder externally.
2. Liver-Kidney Excess Fire︰The penis is swollen, red, and painful, with bright red sores and thick yellow pus. Symptoms include dry mouth and throat, severe constipation, scanty dark urine, a red tongue tip and edges, yellow and dry coating, and a wiry, rapid pulse. This is due to liver and kidney excess fire, with varying disease causes and mechanisms. It may result from excessive seven emotions, liver yang transforming into fire, accumulated heat in the liver meridian, or prolonged sexual abstinence leading to heat accumulation in the liver and kidneys. Key diagnostic points: swelling, pain, and thick yellow pus. Severe constipation, scanty dark urine, a yellow and dry tongue coating, and a wiry, rapid pulse indicate an excess heat syndrome. Treatment should focus on clearing heat and purging fire, cooling blood to remove toxins. Cooling Blood to Remove Toxin Pills can be used internally, while Erhuang Powder is applied externally.
3. Kidney Deficiencywind-dampness︰Itching and ulceration of the penis resembling mustard-like ringworm, with oozing fluid, white and greasy tongue coating, and deep pulse. This belongs to deficiency. Penile ulceration due to kidney deficiency and wind-dampness results from inherent kidney qi deficiency, downward pouring of dampness pathogens, and occasional exposure to wind pathogens, leading to mutual contention of wind and dampness. These two conditions are not difficult to differentiate. For penile ulceration due to kidney deficiency and wind-dampness, treatment should focus on tonifying the kidney and draining dampness, nourishing blood, and dispelling wind. Huoxue Qufeng San (Blood-Activating Wind-Dispelling Powder) or Tribulus Powder can be used internally, while Indigo Powder can be applied externally.
4. Liver-kidney Deficiency Heat︰The penis is eroded, with exudation of fluid, and the ulcer surface is flat or cauliflower-like, or even the penis may rot away. Hard, stone-like lumps can be felt in the groin, accompanied by physical and mental exhaustion, vertigo, head distension, blurred vision, tinnitus, dry throat, parched mouth, vexing heat in the chest, palms, and soles, insomnia, aching pain in the waist and knees, a red tongue with scant fluid, and a wiry, thin, and weak pulse. This is caused by congenital kidney yin deficiency, or by excessive worry, depression, and anger, leading to ministerial fire scorching internally, liver channel fire-dryness, and the stagnation of fire pathogen. For the treatment of liver and kidney deficiency with accumulated heat causing penile ulceration, the principle is to nourish yin and reduce fire, and to tonify the liver and kidneys. Anemarrhena, Phellodendron, and Rehmannia Pill or Major Yin-Tonifying Pill can be used, along with external application of Haifu Powder and Peach Kernel Powder.

bubble_chart Documentation

1. Waike Zhengzong．Treatment of Chancre: "Initial swelling and pain with fever, difficulty in urination, dampness-heat in the liver meridian, it is advisable to purge the liver and nourish dampness. Swelling and pain with hardness, accompanied by chills and fever, dry mouth and throat, severe constipation, promote urination and defecation. Swelling and pain in the jade stem, urination like dripping, spontaneous sweating and night sweating, occasional hematuria, clear the heart and nourish the kidneys. Itching in the stem orifice, occasional discharge of turbid fluid, fever and dry mouth, lack of body fluids, benefit the kidneys and clear the heart. After ulceration, swelling and pain, red and astringent urine, quiet during the day, severe pain at night, enrich yin and purge fire. Persistent ulceration, recurring swelling and pain, increasing pain, foul odor not dissipating, clear the liver and remove toxins."

bubble_chart Differentiation

Dampness-heat in the liver meridian and kidney deficiency wind-dampness, although both have dampness pattern, the former is of excess type.

Kidney deficiency wind-dampness is caused by kidney yang deficiency and the mutual contention of wind and dampness, while liver-kidney deficiency with dampness-heat is due to inherent deficiency of kidney yin, or emotional distress and anger, leading to the internal scorching of ministerial fire, liver meridian fire-dryness, and the stagnation of fire pathogen.