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The *Classic of Internal Medicine* states: All pain, itching, and sores/ulcers belong to Heart Fire. If there is swelling, redness, irritability, fever with a desire for cold drinks, constipation, thirst, and a surging, rapid, and full pulse, this is the normal presentation; even in severe winter, bitter-cold agents must be used to drain heat and toxicity. If the pulse is fine, skin is cold, there is diarrhea with borborygmus, inability to eat, frequent vomiting, and cold extremities, this is an atypical variation; even in peak summer, acrid-warm agents must be used to assist Yang Qi. The *Inner Canon* says: When using cold remedies, avoid cold seasons; when using hot remedies, avoid hot seasons. However, if there are false signs, reverse this rule; although it may violate seasonal timing, one must follow the symptoms.

Mr. Li Dongyuan stated: In sores and ulcers where heat-toxicity is deep-seated and fixed, accompanied by nausea and vomiting, fever and irritability, a deep and full pulse, swollen and hard numbness, and constipation, the toxicity resides in the Zang organs, and dredging and unblocking are indicated. Thus it is said: Dredge the interior to cut off the source. It is also said: In sores, ulcers, and other diseases presenting with facial redness, although latent fire-heat exists, do not recklessly purge the interior, as this indicates Yang Qi being stifled and pathogenic factors in the meridians; release the exterior to dispel them. Thus it is said: For stifled fire, use dispersing methods. Whenever there is bowel obstruction but no abdominal distension despite heavy eating, purgatives must absolutely not be used. If there is abdominal stuffiness and distension with bowel obstruction, this is due to dryness of the large intestine; pig bile enema is appropriate. If bowel obstruction is due to deficiency of Qi in the stomach and intestines and depletion of blood, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be used to tonify. If the sore condition belongs to Yang syndromes, or if obstruction results from sexual excess damaging Kidney Qi, adding Ginger and Aconite to the aforementioned decoction to restore Yang can often save lives. The *Classic* states: The Kidney opens into the two yin orifices. The Kidneys store Essence; when fluids are moistening, bowel movements are normal. If ulcer patients present with this due to Qi and Blood depletion and intestinal dryness, major tonification is best. Failing to examine deficiency and excess, and solely using draining and lubricating methods, rarely avoids error.

Case Record
A relative of mine residing in Bin'ou suffered from a carbuncle on the back during mid-summer. The swelling was dark and measured over one chi in diameter, with multiple small heads resembling scattered millet grains, persisting for four days. This indicated deficiency of True Qi and excess of pathogenic factors. I applied garlic-partitioned moxibustion and administered Huoming Yin (Life-Saving Decoction) for two doses, after which the pathogen receded abruptly. Then, I purely tonified the True Qi, using Shengmai San (Generate the Pulse Powder) as a tea substitute, causing the sore pathogens to greatly diminish. Due to other matters, I was away for three days. Upon returning to examine him, he could not eat, the central tissue had died, he was constipated, and his urine was red and turbid. I said: Central tissue death indicates abundant toxin and Spleen Qi deficiency; constipation indicates empty intestines unable to transport; red and turbid urine indicates Spleen deficiency with sinking fire. Treatment will be difficult. He then remarked: Could this be the fault of interrupting the tonic herbs? I said: Indeed. I urgently prescribed Liujunzi Tang (Six Gentlemen Decoction) added with Angelicae Sinensis Radix (Danggui), Bupleuri Radix (Chaihu), and Cimicifugae Rhizoma (Shengma). Food intake gradually improved, and bowel movements naturally cleared. Externally, Wujin Gao (Black Gold Ointment) was applied to the central three cun area; surrounding redness and swelling gradually subsided, and central black necrosis gradually disappeared. Then, Danggui Gao (Angelica Ointment) and Dihuang Wan (Rehmannia Pill) were applied and taken alternately with the internal medicine. After approximately one hundred doses, he recovered.

Another man suffered from a boil on his leg. Because he had consumed attacking/draining medicines, his Yuan Qi was depleted, and pus failed to form. I treated him with methods to support the interior and promote suppuration until it ruptured, followed by major tonification to promote healing. However, his stool remained dry and hard. I used Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Ophiopogonis Radix (Maimendong) and Schisandrae Fructus (Wuweizi) to moisten, but after a month, it remained hard. Confused by others' advice, he took Runchang Wan (Moisten Intestine Pill), resulting in incessant diarrhea. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to deliver Sishen Wan (Four Spirit Pill); after several doses, the diarrhea stopped.