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Wenketang stated: In cases of carbuncles and sores (Yongju, 痈疽) presenting with panting and urgency (Chuanji, 喘急), mental confusion, and drowsiness, this is due to Heart Fire suppressing Lung Metal. It is appropriate to use Renshen Pingfei San (Ginseng Lung-Pacifying Powder). If accompanied by a red face, it is considered incurable. (From *Yixue Zhunsheng*)

Diarrhea in patients with sores may result from excessive use of cold-cooling drugs damaging the Spleen Qi; or from weak Spleen Qi failing to digest food; or from Spleen deficiency with sinking Qi, failing to raise the clear Yang; or from decline of Mingmen Fire, failing to warm Earth (Spleen); or from weakness of the Kidney Meridian, failing to control the lower orifices; or from cold-deficiency of both Spleen and Kidney, failing to perform their functions. The treatment principles are as follows: For spleen damage by cold-cooling agents, use Liujunzi Tang (Six-Gentlemen Decoction) added with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus), administered withershins Ershen Wan (Two-Spirit Pill). For Spleen deficiency with sinking Qi, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Ershen Wan. For Mingmen fire decline, use the ingredients of Bawei Wan (Eight-Ingredient Pill) with Shenshen Wan (Four-Spirit Pill). For Kidney deficiency with inability to hold, use Jiangfu Tang (Ginger and Aconite Decoction) added with Wuyu (Evodiae Fructus) and Wuwei Zi (Schisandrae Fructus). For Spleen-Kidney cold-deficiency, use Shenfu Tang (Ginseng and Aconite Decoction) with Shenshen Wan. *Bingji* states: With a deep and fine pulse, immobility, dull eyesight, inability to eat or drink, and faint breath at the nose tip, treat with Jiangfu Tang. For heaviness of the body and inability to move the limbs, treat with Shenfu Tang. Zhang Zhongjing stated: For dysentery with borborygmus, apply warming methods. With a slow and tight pulse and unceasing pain, apply warming methods. For anal pain, apply warming methods. For heart pain, rescue the interior; one may administer Lizhong Tang (Regulate the Middle Decoction), Fuzi (Aconiti Lateralis Radix Praeparata), or Sini Tang (Frigid Extremities Decoction) and similar formulas. *Jingyao* states: For carbuncles and sores with vomiting and diarrhea, if the Kidney pulse is deficient, it is incurable. This elucidates the subtle purport of *Neijing*. For such difficult-to-treat conditions, following the aforementioned treatments often leads to recovery.

Li Dongyuan stated: When heat-toxin of sores is deep-seated and fixed, accompanied by nausea and vomiting, fever, irritability, a deep and excess pulse, swelling that is hard and numb, and constipation, the toxin resides in the Zang organs. It is suitable to dredge and unblock; thus, "dredge the interior to cut off the source." He also stated: For sores and other diseases presenting with a red face, although latent heat exists, one must not recklessly purge the interior. Instead, Yang Qi is stifled, and pathogenic factors reside in the meridians; one should release the exterior to dispel them; thus, "if Fire is stifled, disperse it." For constipation, even if dietary intake is large but the abdomen is not distended, do not purge. If there is abdominal fullness and distension with constipation, this indicates dryness of the large intestine; use pig bile for enema. If constipation results from Qi deficiency and blood depletion of the intestines and stomach, use Shiquan Dabu Tang (Complete Great Tonifying Decoction) to nourish. If the sore condition belongs to Yin syndrome, or constipation results from sexual indiscretion injuring the Kidney, use the aforementioned decoction added with Ganjiang (Zingiberis Rhizoma) and Fuzi to restore Yang; many will survive. Classics state: The Kidney opens into the two lower orifices and stores essence. When fluids moisten, bowel movements are normal. In ulcer cases, this occurs due to Qi and Blood deficiency and intestinal dryness; major tonification is best. If one fails to examine deficiency or excess and indiscriminately uses draining and purging methods, errors are common.
He further stated: For patients with dry large intestines, use honey suppositories or bile enemas. Let the patient lie on the bed and pass stool naturally; do not lift them up. If dryness causes straining leading to bright red blood spurting from the sore, this is due to the Liver failing to store Blood.

Shen Douyuan stated: Generally, sores arise from disharmony of the Five Zang organs and stagnation of the Six Fu organs, leading to blocked meridians. Before the initial swelling breaks, with severe pain, a surging, rapid, and excess pulse, and impending suppuration accompanied by constipation, use internal support techniques, doubling the dosage of Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma); these are formulas that release the exterior and purge the interior. After rupture, if the pulse is faint, knotted, rapid, and choppy, indicating significant loss of pus and blood and weakening of Qi and Blood, add Taoren (Persicae Semen), Huomaren (Cannabis Semen), and Danggui (Angelicae Sinensis Radix) to Bazhen Tang (Eight-Treasure Decoction) or Shengyu Tang (Generate Life Decoction), with a small amount of Shudi (Rehmanniae Radix Praeparata) to moisten. If very weak, bile enema is superior. Do not use harsh purgatives like Badou (Crotonis Semen) or Qianniu (Pharbitidis Semen) which further damage Yuan Qi and cause complications.

Xue Lizhai stated: If dietary intake is large and stools are unpassed, but the abdomen is not distended, this is due to internal Fire consuming fluids; do not purge. If there is abdominal fullness and distension with dry rectal constipation, use pig bile enema. Mistaken use of draining methods damages Yuan Qi, preventing ulceration or healing.

Zhang Jingyue stated: The posterior orifice is the gate of the Large Intestine; its patency or obstruction reflects the deficiency or excess of the Yangming channel. Heat accumulation causing hardness and fullness indicates excess, warranting purgation. If stool was recently passed and is not very dry, or if no stool has passed for days without any sense of distension, this is not Yangming excess. As Zhang Zhongjing said: Stools that are hard initially then loose should not be attacked. Thus, loose stools, even if preceded by hard ones, are not true heat-excess. Purely loose stools over consecutive days confirm this. Unless there are signs of hardness, dryness, and fullness, it is not an excess pathogen, and purgation is contraindicated.
He further stated: The Large Intestine is the gateway of the Sea of Water and Grain; the Urinary Bladder is the gateway of the Sea of Blood and Qi and the Chong and Ren vessels. Both excretions are governed by the Kidney and serve as the gate of Yuan Qi. Only when true excess pathogens are evident should one consider purgation; otherwise, caution is paramount. Blind purging drains Yuan Qi, allowing exterior pathogens to sink deeper or worsening internal deficiencies through leakage. Therefore, in deficiency patterns, avoid forced purgation. It is preferable for Qi to transform urine naturally and for stools to remain firm. Once Ying and Wei Qi are harmonized, patency will occur naturally; even ten-day constipation need not be a concern. However, incontinence is unsuitable for the deficient and must be prevented first.