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The urination and defecation (urinary and bowel functions) serve as the gates of the body. Regardless of whether the etiology is internal injury or external contraction, one must observe these two excretions to differentiate between cold-heat and deficiency-excess patterns. The anterior yin (urethral opening) connects with the pathway of the Bladder; observing whether urination is unobstructed or obstructed, and whether there is heat or not, allows one to assess the strength of Qi transformation (Qi Hua). In cases of Cold Damage (Shanghan) where urination is free, it indicates that the Qi of the Taiyang (Greater Yang) channel has not been severely compromised, which is a favorable omen. The posterior yin (anus) opens into the Large Intestine; observing whether defecation is smooth or blocked, and whether stool is consolidated or not, allows one to assess the deficiency-excess status of the Yangming (Yang Brightness) channel. Only when dry stool is bound by heat resulting in a hard and full abdomen does this constitute an Excess pattern, for which purgative methods may be applied. However, if stool was passed recently and is not very dry, or if no bowel movement occurs for ten days yet there is absolutely no sensation of abdominal distension, this is not a Yangming Excess syndrome. As Zhang Zhongjing stated: "When stool is initially hard but becomes loose later, it should not be attacked with purgatives." This shows that when the latter part of the stool is loose, even if the beginning was hard, it is no longer a true Heat-Excess pattern. How much more so for those who pass purely loose stool continuously over several days? Unless there are genuine signs of hardness, dryness, epigastric fullness, and distension, it is fundamentally not an Excess pattern, making it clear that purgation is contraindicated.

First, regarding urination, people often see yellow urine and immediately attribute it to Fire, unaware that fatigue and overwork cause yellow urine; excessive anxiety and worry cause yellow urine; diarrhea and dysentery cause yellow urine; and sexual excess damaging Yin causes yellow urine. Unless accompanied by symptoms such as strangury or pain indicating concurrent Heat syndromes, one cannot conclude it is Fire merely based on color. I have witnessed many deaths caused by forcing out withered fluids under the mistaken assumption of Fire. The Classic states: "Deficiency of Middle Qi leads to abnormalities in urination and defecation," which clarifies the meaning. If urine is clear and flows freely, it indicates that pathogenic factors inside are not severe and the disease does not reside in the Qi level, since body fluids depend on Qi transformation for their generation and distribution; if Qi is diseased, urination becomes difficult. Gradual improvement in urinary flow indicates the restoration of Qi transformation, which is the most auspicious sign.

Second, the Large Intestine transmits water and grain, serving as the gate of the stomach and intestines; the Bladder excretes urine, relating to the Sea of Blood and Qi, and serves as the gate for the Chong and Ren vessels' water pathways. Both urination and defecation are governed by the Kidney, acting as the critical juncture of Yuan Qi (Original Qi). One may only consider promoting drainage or using purgatives after confirming a genuine Excess pattern; otherwise, extreme caution and thoroughness are required to avoid erroneous attack. If non-genuine Excess conditions are wrongly treated with purgation, Original Qi will be drained away. Consequently, pathogens remaining in the exterior may sink deeper due to the deficiency, and etiologies trapped internally will become further depleted through diarrhea. Therefore, in cases of Deficiency, one must strictly avoid forced purgation. The most desirable state is when urine transforms naturally upon receiving Qi, and stool retains its firmness. Once Ying (Nutritive) and Wei (Defensive) Qi are harmonized, natural unblocking will occur spontaneously. Even if constipation persists for more than ten days, what is there to worry about? Conversely, slippery incontinence and inability to retain stool are unsuitable for those with Deficiency; prevention should be prioritized.