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My old neighbor was Mr. Zhang Shouxian, who had long suffered from a penetrating hemorrhoid and fistula (Lou syndrome), causing significant depletion of Qi and Blood. Someone recommended Mr. Huang from our hometown, who was skilled in external application and surgical excision. Mr. Zhang highly esteemed his medical skills.

Consequently, all internal medicinal treatments were left entirely to Mr. Huang's discretion. I (Yu Chang) have always respected Mr. Zhang for his literary talent and moral character. While residing in Yinghai, I once sent my disciples to pay respects and examine his pulse, privately discussing strategies for post-treatment care. The general idea was: Since Mr. Zhang had been confined by the fistula for a long time, once it healed and became level, with Essence and Qi flourishing internally, he could naturally live without worry for a hundred years. However, the newly repaired area was not yet firm, posing a risk of dampness infiltration; the visceral Qi had been deficient for a long time, and the intestines easily accumulated turbid heat, posing a risk of pathogenic transmission downward.

Clear Yang had sunk for a long time. Although sweet-warm ascending and raising medicines had been taken, due to prolonged leakage, Yin Blood had been secretly depleted, risking damage to Yang Qi; the transformation and transportation of water and grain were prone to confusion. Although medicines nourishing the viscera and thickening the intestines had been used, excessive moistening agents caused Spleen Qi to slide and leak, risking damage to Yin fluids. Moreover, the fistula orifice originally connected to the essence orifice. If a small amount of Essence overflowed, it would inevitably seep sideways. Therefore, nurturing Essence should be done with caution, like taming a tiger; rich flavors can best moisten the Spleen Earth, but if dietary restraint is lacking, Essence will inevitably leak. Thus, generating Yin should not involve damaging Yin.

Generally, human Spleen Qi prefers dryness and dislikes dampness. With Mr. Zhang's fistula healed, there was no longer a path for turbid waste to descend, so it must shift to infiltrate the Spleen, doubling the dampness. Therefore, it was appropriate to tonify Spleen Yang without injuring Spleen Yin, to restore normal healthy transportation and receive the benefits of harmony.

When I went to Louzhong to respond to the summons for diagnosis, light palpation revealed a forceful, pulsating pulse, while heavy pressure felt faint and fine. This indicated that Yang Qi was not deficient, but Yin fluids were severely damaged. Whenever Mr. Zhang took Yin-nourishing medicines, his night sleep was very peaceful, and intestinal symptoms were rare. Therefore, when the surgeon incorrectly applied the treatment for Intestinal Wind bleeding using Huaijiao Wan (Sophora Fruit Decoction) and Diyü (Sanguisorbae Radix), I did not consider it erroneous.

In fact, Lou syndrome is a disease of the essence orifice. During intercourse, when Qi stays, Essence stops; when Qi moves, Essence flows. Generally, those who engage in strenuous sexual activity have Qi rushing out forcefully, causing Essence to burst forth in all directions, not all entering through the proper channel but overflowing outside the seminal ducts. Over time, this gradually forms a fistula. Although the fistula has now been removed, the voids within the flesh remain. Filling these orifices and tunnels cannot be achieved by the power of such medicines.

I did not directly point out his error but simply removed Huaijiao and Diyü from his prescription and added one ingredient: Lujiaoshuang (Cervus Nippon Antler Frost). This refers to the saying: "Only the pearl on top of the Spotted Dragon can fill the deficiency below Jade Hall and Guanxia." Furthermore, Yin-nourishing medicines are most capable of moistening and descending. Without something to check them, wouldn't the water accumulation in the intestines become even more worrying?

This was merely revealing a glimpse of insight. The surgeon did not understand and had already blocked its use. Thus, I recalled a person in our hometown who treated fistulas. Besides external applications to ulcerate tubes and generate flesh, he had two miraculous formulas: First, half a jin of pills were taken to cause sudden impotence of the Yang pathway, waiting until the tube was filled with flesh and the exterior became dense; then, another half jin of pills was taken to revive the Yang pathway. Although suitable for the young, it might not be suitable for the old, but the intention was quite unique. I wanted to fill the orifices and tunnels, but Mr. Huang stopped me. Had he not heard of this person and method?

Mr. Hu Youchen stated: "If the fistula indeed connects to the essence orifice, external treatment is easy, but filling is difficult." What is said in the case record is indeed insightful.