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Chen Yuangong stated: There are cases where sores arise in the chest region due to imprudence regarding alcohol and sexual activity, leading to the formation of fistulas. Multiple openings may develop, bleeding over time, eventually causing physical and mental exhaustion, severe lower back pain with difficulty extending the body, and a stooped gait resembling kyphosis (hunchback). People consider this to be Heart Fistula (Xin Lou), but little do they know it is actually caused by Kidney Deficiency (Shen Xu) manifesting as a fistula! The Heart and Kidney are originally interconnected; Heart Qi (Xin Qi) must receive nourishment from Kidney Qi (Shen Qi) to generate each other, and Kidney Qi must be secured by Heart Qi to remain closed. The formation of Heart Fistula results from the leakage of Kidney Qi; therefore, one must urgently treat the decline of Kidney Qi. However, if treatment focuses solely on the Kidneys without securing Heart Qi, tonifying the Kidneys is futile, akin to having an outlet for Qi without a mechanism to stop its escape. Some argue that fistulous sores mostly arise from Damp-Heat (Shi Re); thus, tonifying the Kidneys without closing the Heart orifice will not cure the fistula, nor will closing the Heart orifice without eliminating Damp-Heat while only treating the Heart and Kidneys. Yet, fistulas vary. Those occurring elsewhere can have their Damp-Heat drained, but those in the chest region cannot. This is because a fistula arising from Kidney Deficiency implies Cold (Han) rather than Heat (Re). Kidney Deficiency refers to a deficiency of True Water (Zhen Yin) rather than an excess of Pathogenic Fire (Xie Huo). Tonifying True Yin causes pathogenic fluids to dissipate naturally, and warming Kidney Cold causes Damp-Heat to recede naturally. Use Wen Shen Dan (Warm the Kidney Decoction): two pieces of Lu Rong (Cervus Nippon Antler, prepared with butter), two A Zi (Aconiti Lateralis Radix Praeparata), two liang each of Ren Shen (Ginseng Radix et Rhizoma) and Qing Yan (Halitum), two branches of Wa Song (Sedum Acre), and four liang of Hong Zao (Jujubae Fructus). Boil the dates, mash them, and form pills. Take thirty pills per dose with wine on an empty stomach. After half a month, lower back pain decreases slightly; after more than a month, the fistula heals. (From *Bing Jian*. The novelty of this formula lies in Lu Rong, which benefits both the Water and Fire within the Kidneys and supplements defects in the Heart. Combined with the acrid-hot nature of Fu Zi (Aconiti Lateralis Radix Praeparata), it reaches all meridians, guiding Lu Rong directly into the Heart and Kidneys to fill the hollow orifices. Qing Yan acts by using its salty flavor to soften hardness. Since fistulas with multiple orifices bleed heavily, blood coagulates upon contact with salt. Wa Song eliminates Damp-Heat invisibly; although Heart Fistula is not primarily caused by Damp-Heat, any residual dampness hinders orifice closure, hence Wa Song is added to prevent complications. Furthermore, to address potential Qi Deficiency (Qi Xu) hindering transformation, Ren Shen is added to generate Qi between the Heart and Kidneys, assisting the power of Lu Rong and Fu Zi to unblock the upper and lower jiao, facilitating success.)

Feng Luzhan stated: A single orifice on the chest frequently discharges bloody fluid, named Heart Fistula (Xin Lou). Use tender Lu Rong (Cervus Nippon Antler) de-haired and prepared with butter, and Fu Zi (Aconiti Lateralis Radix Praeparata) processed, skin and umbilicus removed, and dissolved in salt water. Grind both into fine powder, bind with Jujube flesh to form pills. Take thirty pills per dose with wine on an empty stomach. It also treats Kidney Deficiency Lower Back Pain (Shen Xu Yao Tong) with miraculous efficacy. (From *Jin Nang*)