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When sores and ulcers are accompanied by thirst, if there is pain, fever, and normal bowel movements and urination, it indicates heat in the Upper Jiao (Upper Burner); use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). If there is swelling, pain, fever, and constipation, it indicates heat within the five Zang organs; use Sishun Qingliang Yin (Four-Compliant Cooling Beverage). If swelling and pain are severe, it indicates accumulation and binding of heat-toxin; use Xianfang Huoming Yin (Immortal Life Saving Decoction). If there is diffuse swelling with slight pain, it indicates stagnation due to deficiency of Qi and Blood; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If thirst is caused by stomach fire consuming fluids leading to a shortage of body fluids, use Zhuye Huang Tang (Bamboo Leaf and [Huang] Decoction - *Note: Text likely implies a variation containing Bamboo Leaf and Huang*). If thirst is caused by deficiency of stomach Qi failing to generate fluids, use Buzhong Yiqi Tang. If thirst is caused by injury to stomach Qi leading to internal loss of fluids, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). If thirst is caused by dryness and depletion of Kidney Water, or if yellow, dry, and hard crusts appear on the mouth and tongue, accompanied by frequent urination and the development of carbuncles, this is particularly a malignant and difficult condition. If the cause can be anticipated in advance, taking Jiaban Bawei Wan (Modified Eight-Ingredient Pill) and Buzhong Yiqi Tang to nourish the source of transformation (the Spleen and Stomach as the source of post-heaven Qi and Blood) can prevent subsequent complications.

Bleeding from sores and ulcers is caused by the deficiency of Qi in the five Zang organs, where deficient fire moves recklessly, causing blood to flow erratically outside its vessels. One must identify the affected meridian, examine the cause, and treat accordingly. If liver heat causes blood to run wild, use Siwu Tang (Four Substances Decoction) plus Chao Lian (Stir-fried Coptis Rhizoma), Mudan Pi (Moutan Cortex), Qin (Scutellaria Radix), and Zhu (Atractylodis Rhizoma). If spleen deficiency with heat fails to control blood, use Sijunzi Tang (Four Gentlemen Decoction) plus Chao Zhi (Stir-fried Gardenia Fructus) and Mudan Pi. If there is depression and binding in the spleen meridian, use Guipi Tang (Restore the Spleen Decoction) plus Wuweizi (Schisandrae Fructus). If there is deficiency of Qi in the spleen and lungs, use Buzhong Yiqi Tang plus Wuweizi. If both Qi and Blood are deficient, use Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction). If yin fire moves recklessly, use Liuwei Wan (Six-Ingredient Pill) plus Wuweizi. Generally, when excessive blood loss presents with symptoms such as fever and thirst, regardless of the pulse, one should urgently use Dushen Tang (Single Ginseng Decoction) to tonify Qi. The Classics state: "Blood is born from Qi." Without using sweet-warm agents such as Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) to generate the blood of the Heart and Liver, recovery is impossible. If there is fever and a large pulse, it is untreatable. For all hemorrhagic conditions, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used as the primary formula.

Clinical Cases:
Tu Jianshan, a Hanlin Academician, aged forty, suffered from damp-toxin sores. Due to the mistaken use of calomel-containing preparations, his primal Qi was damaged, and the condition persisted for a long time. One evening, upon examination, his Liver pulse was urgent, surging, rapid, and forceful. I asked, "Why is the Liver pulse like this?" In the early morning, three to four bowls of dark blood were discharged from the sore. He felt fatigued and sweated spontaneously. Although this appeared frightening, fortunately, the blood was dark and the pulse was relatively calm. I said, "This is the heat toxicity of calomel; the blood has been affected by its poison and flows recklessly. The toxin of calomel is also being expelled through the blood. The pathogenic factor has left, but the True Qi is deficient. We must urgently use Dushen Tang as the main treatment." I valued his character and felt deep sympathy, but he was confused by others' advice and did not follow my recommendation, resulting in the continuous persistence of pathogenic factors.

A man suffered from bleeding back sores, restlessness, and thirst. His pulse was surging and large but empty upon deep pressure. This was restlessness following blood depletion. He used Danggui Buxue Tang (Dong Quai Decoction for Tonifying Blood) for two doses, with slight improvement; then he used Bazhen Tang (Eight-Treasure Decoction) plus Huangqi and Zhizi for several doses, achieving full recovery.

A woman vomited about three bowls of bright red blood after her sore ulcerated. I used Dushen Tang to stop the bleeding, followed by Sijunzi Tang, Shudi (Prepared Rehmanniae Radix), Xiong (Ligusticum Chuanxiong Rhizome), and Danggui to heal the sore. This follows the principle of "tonifying Qi for blood depletion" and "Yang generating Yin." If cold and yin-cooling agents that clear heat and descend fire were used, the vital Qi of the Spleen and Stomach would be further injured. Not only would the blood fail to return to its source, but death would be inevitable.

An elderly woman developed a ding (carbuncle/furuncle) on her thumb. After being pricked by someone, bright red blood flowed out, and her entire hand dorsum swelled, with pain affecting half her body. She had been in a stupor for five days. I used Huoming Yin (Life-Saving Decoction) to drain toxic fluid; after another dose, the redness and swelling gradually ulcerated; finally, she recovered after using Toli medicines (supportive therapies to promote pus discharge and tissue regeneration).

He Zhaoqing, a Secretary in the Ministry of Rites, was promoted to Vice Minister of Shanxi Province. Upon parting, I noticed his lips and nose were cyanotic and black, and he frequently scratched his back. When asked, he replied, "It is just a small sore." I observed that it was indeed a ju (deep-seated abscess/cancerous sore). This indicated failure of the Spleen and Stomach, an untreatable condition. As we were friends, I pitied his inconvenience regarding funeral arrangements during travel, so I entrusted him to his colleagues, Zhang Dongsha, etc., and strongly urged him to stay. I reluctantly administered strong tonics, but only purple blood was discharged, indicating extreme deficiency. Some suggested that intense toxin prevented pus formation, so he took a cup of attacking/purgative medicine, leading to vomiting, reversal of Qi, and pulse collapse. He indeed died in Nanjing.

Zhang Biya, a Surveillance Commissioner, developed a ju on his lower back. After drinking heavily and engaging in sexual activity, his pulse was surging and rapid, with the Chi (Kidney) pulses at both wrists being even larger. I declined treatment and prepared to depart by boat. His son insisted I stay. Shortly after, he vomited foul-smelling blood, five to six bowls. I reasoned this was deficient fire in the Kidney meridian causing reckless blood movement, and the blood would likely emerge from the gum margins. I compounded herbs such as Rougui (Cinnamon Bark) to tonify the Kidney and control fire, decocting them separately in jars for use. After the bleeding stopped, wiping the teeth confirmed my prediction. He drank one cup, taken cold, which instantly relieved heat and thirst. After a while, he drank another cup, taken warm. His pulse became fine and nearly imperceptible, his breath faint. The medicine temporarily revived his pulse slightly, but it collapsed again after a long time. His son suspected pus inside and wanted to puncture it. I said, "There certainly is none." I inserted a goose-quill tube into his nostril, which proved me correct. The next day, his pulse collapsed, his feet were cold up to the knees, and his abdomen felt like ice. I urgently used Liujunzi Tang (Six-Gentlemen Decoction) plus Shengjiang (Fresh Ginger) and Fuzi (Prepared Aconite Root). Only then did his abdomen warm up, pus begin to discharge, and the sore opening start to close. However, because his attendants favored his wife's family, and he suffered from urinary retention, this indicated impotence of the Yin mechanism due to lust-induced essence depletion, causing internal corruption of essence that could not be expelled. I prescribed Jiaban Bawei Wan material plus Renshen, Huangqi, and Baizhu for one dose. Although his urination improved, the sore opening failed to heal, and he died.