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This is a formula for treating disorders of the exterior and interior, qi and blood. It is indicated for all sores and swellings caused by wind-toxin and accumulated heat. For patients with pulse patterns that are wiry (Xian), flooding (Hong), excess (Shi), rapid (Shu), floating (Fu), or tight (Jin), and who present with an excess syndrome of abundant qi and blood, this medicine is indispensable. Zhu Danxi stated: In the *Secret Transmission* (*Mi Chuan*), this formula was modified by adding Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Cang Zhu (Atractylodis Rhizoma), Chi Fu Ling (Poria Cocos with Red Cortex), and Yin Hua (Lonicerae Flos), and named Xiao Zhong Tuo Li San (Swelling-Reducing and Interior-Supporting Powder). Although it takes Ren Shen as the principal ingredient, it also states that Ren Shen can be omitted, which raises doubts and makes its application difficult. Furthermore, when modifying the prescription according to clinical presentation, one must compare the extent of exterior versus interior syndromes. If exterior symptoms predominate, one should follow this formula, using acrid and sweet herbs as the main components to disperse the pathogen; if interior symptoms predominate, adjustments must be made accordingly.

The *Jing Yao* (Essentials) states: Da Huang (Rhei Radix et Rhizoma) disseminates heat and scatters toxins; it is a crucial herb for treating carbuncles and ulcers. When carbuncles and ulcers first appear, decoctions containing Da Huang should be used urgently to promote bowel movement, without interruption day after day. It further states: Diarrhea or dysentery occurring in the course of sores and ulcers are ominous signs.

Zhu Danxi commented: These statements raise considerable doubt. Assuming Da Huang is used, it is likely because the patient suffers from constipation and an excess condition, with deep-seated accumulated heat triggering the disease. In such cases, it may only be appropriate to break up stagnation and guide it out, promoting motility. How can it be said that urgent purgation is required, continued daily without cessation? If laxatives are administered after diarrhea has already occurred, this would likely contradict the principle of preventing minor issues from escalating. When a sore first appears, the swelling is located in the muscle layer. Unless there is a syndrome of severe fullness and hardness, one should naturally adopt Zhang Zhongjing’s method of releasing the exterior. Taking Wu Xiang Tang (Five-Aromatic Decoction) as an example, dispersing the pathogen from the exterior is sufficient; why resort hastily to harsh purgatives to attack the interior? Some argue that Da Huang is used for carbuncles and ulcers to drain and eliminate toxins, a view frequently expressed by Sun Simiao, and Liangfu (Wang Haogu) merely followed this theory. I respond: Sun Simiao practiced his unique arts among high officials due to his great reputation. Liangfu was a Song dynasty scholar; if his associates were also high officials, could he have avoided the error of being rash and reckless? Moreover, consider those who are deficient due to mental overwork, deficiency due to worry and anger, deficiency due to strenuous labor, and deficiency due to excessive drinking and eating. These individuals suffer from scanty qi that is stagnant and scanty blood that is turbid. Developing a carbuncle is already difficult to treat. If the bowels are constipated but the condition is relatively stable, and the patient adheres to a bland diet and moral precepts, treatment is still feasible, though it will require effort in regulation and tonification. However, if one assumes that constipation persisting for ten days or half a month indicates an excess syndrome, failing to recognize that it might result from descending qi failure, and consequently administering Da Huang, would this not be fatal?