立斋曰∶疮疡大便泄泻，或因寒凉克伐，脾气亏损。或因脾气虚弱，食不克化。或因脾
虚下陷，不能升举。或因命门火衰，不能生土。或因肾经虚弱，不能禁止。或因脾肾虚寒，
不能司职。所主之法，若寒凉伤脾，六君加木香、砂仁，送二神丸。脾虚下陷，用补中益
气，送二神丸。命门火衰，用八味丸料，送四神丸。肾虚不禁，用姜附汤加吴茱萸、五味。
脾肾虚寒，用参附汤，送四神丸。《病机》云∶脉沉而细，身不动作，睛不了了，饮食不下
，鼻准气息者，姜附汤主之。身重，四肢不举者，参附汤主之。仲景云∶下痢肠鸣，当
温之。脉迟紧，痛未止，当温之。大孔痛，当温之。心痛当救里，可与理中、附子、四逆辈
。《精要》云∶痈疽呕吐，肾脉虚者，不治。凡此难治之证，如按前法治之，多有可生者。
御医王彭峰之内，年逾四十，背疽不起发，泄泻作呕，食少厥逆，脉息如无，属阳气虚
寒。用大补剂加附子、姜、桂，不应。再加附子二剂，泻愈甚。更以大附子、姜、桂各三
钱，参、 、归、术各五钱，作一剂，腹内始热，呕泻乃止，手足渐温，脉息遂复。更用大
补而溃，再用托里而敛。十年后，仍患脾胃虚寒而殁。（薛按）
立斋曰∶疮疡大便秘结，若作渴饮冷，其脉洪数而有力者，属实火，宜用内疏黄连汤。
若口干饮汤，其脉浮大而无力者，属气虚，宜八珍汤。若肠胃气虚而燥而不通者，宜用十全大
补汤培养之。若疮证属阳，或因入房伤肾，而不通者，宜用前汤加姜附回阳，多有得生者。若
饮食虽多，大便不通，而肚腹不胀者，此内火消烁，切不可通之。若肚腹痞胀，而直肠干涸
不通者，宜用猪胆汁导之。若误行疏利，复伤元气，则不能溃敛。经曰∶肾开窍于二阴，藏
精于肾。津液润则大便如常。若溃疡有此，因气血亏损，肠胃干涸，当大补为善，设若不
审虚实，而一于疏利者，鲜有不误。若老弱或产后而便难者，皆气血虚也，猪胆汁最效。甚
者多用之。更以养气血药助之，万不可妄行攻伐。
居宾鸥，仲夏患发背，黯肿尺余，皆有小头如铺粟状，四日矣。此真气虚而邪气实也。
遂隔蒜灸之，服活命饮二剂，其邪顿退。乃纯补其真阴，又将生脉散以代茶饮，疮邪大退。
余因他往三日，复视之，饮食不入，中央肉死，大便秘结，小便赤浊。余曰∶中央肉死，毒
气盛而脾气虚也。大便不通，肠虚而不能传送也。小便赤浊，脾虚而火下陷也治亦难矣。
彼始云∶莫非间断补药之过也。余曰∶然。乃急用六君子加当归、柴胡、升麻，饮食渐进，
大便自通。外用乌金膏，涂中央三寸许，四周红肿渐消，中央黑腐渐去。乃敷当归膏，用地
黄丸与前药间服，将百剂而愈。（薛按）
薛立斋说：疮疡患者出现大便泄泻，可能是因为寒凉药物损伤脾胃，导致脾气亏损；也可能是因为脾气虚弱，食物无法消化；或者是脾虚气陷，不能升举清阳；或者是命门火衰，不能温煦脾土；或者是肾经虚弱，不能固摄二便；或者是脾肾两脏虚寒，不能履行各自职能。针对这些情况的治疗方法如下：如果是寒凉药物伤及脾脏，使用六君子汤加入木香、砂仁，并用二神丸送服；如果是脾虚气陷，使用补中益气汤，并用二神丸送服；如果是命门火衰，使用八味丸的药料，并用四神丸送服；如果是肾虚导致的不禁泄，使用姜附汤加入吴茱萸、五味子；如果是脾肾两脏虚寒，使用参附汤，并用四神丸送服。《病机》中说：脉象沉细，身体不愿活动，眼神呆滞无光，饮食难以下咽，鼻准部位气息微弱者，用姜附汤主治。身体沉重，四肢无法抬举者，用参附汤主治。张仲景说：下痢且肠鸣，应当温治；脉象迟紧，疼痛未止，应当温治；肛门疼痛，应当温治；心痛应当救里，可以给予理中汤、附子汤、四逆汤这类方剂。《精要》中说：痈疽伴有呕吐，如果肾脉虚弱，属于不治之症。凡是这种难以治疗的证候，如果能按照前面的方法治疗，大多可以存活。
御医王彭峰的妻子，年龄超过四十岁，背部生疽但不起发，伴有泄泻和呕吐，进食少且有四肢厥冷，脉搏微弱几乎摸不到，这属于阳气虚寒。起初使用大补剂并加入附子、干姜、肉桂，没有见效。又增加两剂附子，反而腹泻更加严重。随后改用大附子、干姜、肉桂各三钱，人参、白术、当归、茯苓各五钱，作为一剂药服用，腹部才开始感到温热，呕吐和腹泻才停止，手脚逐渐回暖，脉搏也随之恢复。之后继续用大补剂使疮疡溃破，再用托里透脓的方法使疮口收敛。十年后，她仍然因脾胃虚寒而去世。（薛己按语）
薛立斋说：疮疡患者出现大便秘结，如果口渴想喝冷水，脉象洪数且有力，属于实火，适宜使用内疏黄连汤。如果口干想喝热水，脉象浮大且无力，属于气虚，适宜使用八珍汤。如果肠胃气虚导致干燥且不通畅，适宜使用十全大补汤来滋养调理。如果疮证属于阳证，或者因为房事损伤肾脏导致不通畅的，适宜用前面提到的汤药加入干姜、附子来回阳救逆，大多能够存活。如果饮食虽然很多，但大便秘结，且肚腹不胀满，这是内火消烁津液所致，切不可使用通下法。如果肚腹痞闷胀满，且直肠干涸不通畅的，适宜用猪胆汁灌肠导便。如果误用疏利通便的药物，再次损伤元气，则会导致疮疡不能溃破或愈合。经典记载：肾开窍于前后二阴，精气藏于肾。津液滋润则大便正常。如果溃疡患者出现这种情况，是因为气血亏损，肠胃干涸，应当以大补气血为善策，如果不审察虚实，一味地使用疏利通便之法，很少有不失误的。如果是年老体弱或产后出现排便困难的，都是气血虚弱的表现，猪胆汁导便效果最好。严重的可以多用。再配合养气血的药物辅助，千万不可妄行攻伐。
居宾鸥在仲夏时节患发背疽，局部黯肿有一尺多宽，上面有许多像铺开的粟米一样的小头，已经四天了。这是真气虚弱而邪气盛实的表现。于是采用隔蒜灸法，并服用活命饮两剂，邪气顿时消退。接着纯粹滋补真阴，又用生脉散代替茶饮，疮毒邪气大大消退。我因为其他事情外出三天，回来复诊时，发现他饮食不进，中央肌肉坏死，大便秘结，小便赤浊。我说：中央肌肉坏死，是毒气盛而脾气虚的表现。大便秘结，是肠道虚弱而不能传导排泄。小便赤浊，是脾虚而相火下陷所致。这也很难治疗了。他开始说：莫非是间断服用补药的过错吗？我说：确实如此。于是急忙使用六君子汤加入当归、柴胡、升麻，饮食逐渐进用，大便自然通畅。外用乌金膏，涂抹在中央约三寸的地方，四周红肿逐渐消退，中央黑腐部分逐渐去除。然后敷上当归膏，用地黄丸与前药交替服用，经过一百多剂药后痊愈。（薛己按语）
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)