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Xue Lizhai stated: Diarrhea in patients with sores and ulcers may be caused by cold-cooling herbs damaging the spleen, leading to a deficiency of spleen Qi; or it may be due to weak spleen Qi, causing food to fail to digest; or it may result from sinking of spleen Qi, preventing the ascending of clear Yang; or it may stem from decline of Mingmen Fire (Fire of the Gate of Life), failing to warm Spleen Earth; or it may be due to weakness of the Kidney channel, failing to secure the lower orifices; or it may be caused by cold-deficiency of both Spleen and Kidney, failing to perform their respective functions. The treatment methods for these conditions are as follows: If cold-cooling herbs injure the Spleen, use Liujunzi Tang (Six Gentlemen Decoction) added with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus), administered withershenshen Wan (Two Spirits Pill). If there is sinking of spleen Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), administered with ershen Wan. If there is decline of Mingmen Fire, use the ingredients of Bawei Wan (Eight-Ingredient Pill), administered with sishen Wan (Four Spirits Pill). If Kidney deficiency leads to incontinence, use Jiangfu Tang (Ginger and Aconite Decoction) added with Wuzhuyu (Evodiae Fructus) and Wuweizi (Schisandrae Fructus). If there is cold-deficiency of both Spleen and Kidney, use Shenfu Tang (Ginseng and Aconite Decoction), administered with sishen Wan. *Bingji* states: When the pulse is deep and fine, the body is unwilling to move, the eyes appear dull and lifeless, food and drink are difficult to swallow, and breath at the tip of the nose is faint, treat with Jiangfu Tang. When the body feels heavy and the four limbs cannot be lifted, treat with Shenfu Tang. Zhang Zhongjing stated: For dysentery accompanied by borborygmus, warming treatment is indicated. When the pulse is slow and tight, and pain persists, warming treatment is indicated. When there is pain in the anus, warming treatment is indicated. For heart pain, interior rescue is required; one may administer Lizhong Tang (Regulate the Middle Decoction), Fuzi Tang (Aconite Decoction), or similar formulas like Sixini Tang (Reverse the Four Coldness Decoction). *Jingyao* states: For carbuncles and ulcers accompanied by vomiting, if the Kidney pulse is weak, it is an untreatable condition. For such difficult-to-treat syndromes, if treated according to the aforementioned methods, survival is often possible.

The wife of Imperial Physician Wang Pengfeng, aged over forty, suffered from a back carbuncle that failed to suppurate, accompanied by diarrhea and vomiting, poor appetite, and cold extremities. Her pulse was faint, almost imperceptible, indicating deficiency-cold of Yang Qi. Initially, a major tonifying formula with Fuzi (Aconiti Lateralis Radix Preparata), Ganjiang (Zingiberis Rhizoma), and Ronggui (Cinnamomi Cortex) was used without effect. Two additional doses of Fuzi were added, but the diarrhea worsened. Subsequently, a larger dose of Fuzi, Ganjiang, and Ronggui (each 3 qian), along with Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Fuling (Poria), each 5 qian, was prepared as a single dose. After taking this, warmth began to spread in the abdomen, vomiting and diarrhea ceased, hands and feet gradually warmed, and the pulse recovered. Thereafter, a major tonifying formula was used to promote suppuration, followed by formulas to support the interior and promote healing. Ten years later, she passed away due to deficiency-cold of the Spleen and Stomach. (Commentary by Xue Ji)

Xue Lizhai stated: Constipation in patients with sores and ulcers: If accompanied by thirst for cold drinks, with a surging, rapid, and forceful pulse, it belongs to excess fire; Neishu Huanglian Tang (Internal Dispersing Coptis Decoction) is appropriate. If there is dry mouth with desire for hot drinks, and a floating, large, and weak pulse, it belongs to Qi deficiency; Bazhen Tang (Eight Treasure Decoction) is appropriate. If gastrointestinal Qi deficiency causes dryness and obstruction, Shiquan Dabu Tang (Complete Great Tonification Decoction) should be used to nourish and regulate. If the sore syndrome belongs to Yang, or if obstruction results from sexual activity injuring the Kidneys, adding Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata) to the aforementioned decoctions to restore Yang can often lead to survival. If food intake is abundant but stool is constipated, and the abdomen is not distended, this is due to internal fire consuming fluids; purgatives must strictly be avoided. If there is abdominal fullness and dryness in the rectum causing obstruction, pig bile enema is appropriate. If laxatives are mistakenly used, further damaging Yuan Qi (Original Qi), the sore will fail to suppurate or heal. The Classics state: The Kidneys open into the two lower orifices and store Essence. When Jin Ye (Body Fluids) moisten, bowel movements are normal. In ulcer patients presenting with this, it is due to loss of Qi and Blood and dryness of the intestines and stomach; major tonification is the best approach. If one fails to examine deficiency and excess and blindly uses laxatives, errors are rare to avoid. For the elderly, the frail, or postpartum women experiencing difficulty defecating, it is all due to Qi and Blood deficiency; pig bile enema is most effective. It may be used frequently in severe cases. It should be assisted by herbs that nourish Qi and Blood. One must never recklessly employ attacking methods.

Ju Binou contracted a back carbuncle in midsummer. The area was dark and swollen, spanning more than one chi, with numerous small heads resembling scattered millet grains, persisting for four days. This indicated deficiency of True Qi and excess of pathogenic factors. Garlic-partitioned moxibustion was applied, and Huoming Yin (Life-Saving Infusion) was taken for two doses, causing the pathogen to recede abruptly. Then, pure tonification of True Yin was performed, and Shengmai San (Generate the Pulse Powder) was used as tea. The pathogenic evil greatly receded. I left for three days on other business. Upon returning to examine him, he could not take food, the central flesh had died, stool was constipated, and urine was red and turbid. I said: Death of the central flesh indicates excessive toxic qi and deficiency of Spleen Qi. Constipation indicates intestinal weakness failing to transport and excrete. Red and turbid urine indicates Spleen deficiency with sinking of ministerial fire. This is also difficult to treat. He initially asked: Is this perhaps the fault of interrupting the tonic medicines? I said: Indeed. Urgently, Liujunzi Tang (Six Gentlemen Decoction) was prescribed with Danggui (Angelicae Sinensis Radix), Chaihu (Bupleuri Radix), and Shengma (Cimicifugae Rhizoma). Food intake gradually improved, and bowel movements naturally resumed. Waimei Zijin Gao (External Black Gold Ointment) was applied externally to the central three cun area. The surrounding redness and swelling gradually subsided, and the central black necrosis gradually disappeared. Then, Danggui Gao (Angelica Ointment) was applied. Dihuang Wan (Rehmannia Pill) was alternated with the previous oral medicine. After more than one hundred doses, he recovered. (Commentary by Xue Ji)