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，用六君加木香、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。仲景先生云∶下利肠鸣，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∶痈疽呕泻，肾脉虚者，不治。此发《内经》之微旨也。凡此实难治之症，如按前法治之
，多有可生者。
治验
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，仍患脾胃虚寒殁。
疮疡，小便淋漓频数，或茎中涩者，肾经亏损之恶症也，宜用加减八味丸，以补阴。足
胫逆冷者，宜用八味丸，以补阳。若小便频而黄者，宜用四物汤加麦门、参、术、五味，以滋肺
肾。若小便短而少者，宜用补中益气加山药、麦门、五味，以补脾肺。若热结膀胱而不利者
，宜用五淋散，以清热。若脾气燥而不能化者，宜用黄芩清肺饮，以滋阴。若膀胱阴虚，阳
无以生者，宜用六味丸。若膀胱阳虚，阴无以化者，宜用滋肾丸。肾虚之患，多传此症，非
滋化源不救。若用黄柏、知母，反泻其阳，以速其危。若老人阴痿思色，精内败，茎中痛而
不利者，用加减八味丸加车前、牛膝。不应，更加附子，多有复生者。若精已竭而复耗之，
大小便中牵痛，愈痛则愈便，愈便则愈牵痛，以前药加附子，亦有复生者。王太仆云∶无阴
则阳无以化，无阳则阴无以生。当滋其化源，苟专用淡渗，复损真阴，乃速其危也。
治验
职坊王的塘背疽溃后，小便淋漓，或时自遗，作渴引饮，烦热不寐，疮口 赤，时或如
灼，时或便遗。余曰∶此肾虚之恶症，用加减八味丸加麦门，数剂而痊。
太守朱阳山患背疽，漫肿色黯，微痛作渴，疮头数十。左尺洪数，按之无力，此肾虚
之症，
气。喜其未用败毒之药，元气未损，故数日脓出肉腐而愈。
驾部林汝玉冬不衣绵，作渴饮冷，每自喜壮实，晒余衣绵，诊其脉，数大无力。余曰∶
至火
芩、连，加参、术、茯苓，二十余剂，及前丸半斤许，渴减六七，背热亦退。至夏背发一疽
，纯用托里之剂而敛。
封君袁怀雪，背疽发热作渴，脉数无力，用四物加黄柏、知母、玄参、山栀、连翘、五
味、麦门、银花，背疽渐退；又加白芷、参、 ，腐肉尽溃。因停药且劳，热渴仍作，乃以参、
、归、芷、炙草、山药、山茱、茯苓、泽泻、肉桂而愈；又以六味丸及十全大补而敛。
疮疡患者出现大便泄泻，可能是因为寒凉药物攻伐过度，导致脾气亏损；或者因为脾气虚弱，食物无法消化；或者因为脾虚气陷，不能升举清阳；或者因为命门火衰，不能温煦脾土；或者因为肾经虚弱，不能固摄二便；或者因为脾肾两脏虚寒，不能履行各自职能。针对这些情况的主要治法如下：如果是寒凉损伤了脾胃，使用六君子汤加木香、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，使用参附汤送服四神丸。《病机》中说：脉象沉而细，身体不动作，眼睛视物不清，饮食不下，鼻准部气息微弱者，用姜附汤主治。身体沉重，四肢不能抬举者，用参附汤主治。仲景先生说：下利且肠鸣，应当温里。脉象迟紧，疼痛未止，应当温里。肛门疼痛，应当温里。心痛，应当救里，可以给予理中汤、附子、四逆汤这类方剂。《精要》中说：痈疽患者出现呕吐泄泻，如果肾脉虚弱，属于不治之症。这是阐发《内经》的深奥旨意。凡是这种难以治疗的病症，如果能按照前面的方法治疗，大多可以存活。
医案记录
御医王彭峰的妻子，年龄超过四十岁，背部疽疮不起发，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，属于阳气虚寒证。使用大补剂，加入附子、干姜、肉桂。服药后没有见效，再增加两剂附子，腹泻反而更严重；于是改用大附子、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，手脚逐渐变暖，脉搏随即恢复；随后继续用大补气血的药物使疮疡溃破，再用托里排脓的药物使疮口收敛。十年后，仍然因为脾胃虚寒去世。
疮疡患者出现小便淋漓不尽、频数不利，或者尿道中有涩痛感，这是肾经亏损的危重症状，适宜使用加减八味丸来滋补阴液。如果足胫部逆冷，适宜使用八味丸来温补阳气。如果小便频数且颜色黄，适宜使用四物汤加麦冬、人参、白术、五味子，以滋养肺肾。如果小便短少，适宜使用补中益气汤加山药、麦冬、五味子，以补益脾肺。如果热邪结聚膀胱导致排尿不利，适宜使用五淋散以清热。如果脾气燥热而不能化生津液，适宜使用黄芩清肺饮以滋阴。如果膀胱阴虚，阳气无法生成，适宜使用六味丸。如果膀胱阳虚，阴液无法气化，适宜使用滋肾丸。肾虚引起的疾病，多会传变出此类症状，如果不滋生化之源就无法挽救。如果使用黄柏、知母，反而会泻伤阳气，加速病情恶化。如果老年人阳痿且思欲色事，导致精气内败，尿道疼痛且排尿不利，使用加减八味丸加车前子、牛膝。服药无效，再加附子，大多能恢复生机。如果精气已经枯竭还继续耗损，大小便时牵拉疼痛，越痛越想排便，越排便越牵拉疼痛，用前面的药加附子，也有恢复生机的。王太仆说：没有阴则阳气无法化生，没有阳则阴液无法生成。应当滋生化之源，如果专门使用淡渗利湿的药物，又会损伤真阴，这是加速死亡的做法。
医案记录
职坊王塘背部疽疮溃烂后，小便淋漓不尽，有时自行遗尿，口渴想喝水，烦躁发热失眠，疮口颜色红赤，有时感觉像被灼烧，有时大小便失禁。我说：这是肾虚的危重症状，使用加减八味丸加麦冬，几剂药后痊愈。
太守朱阳山患背部疽疮，漫肿颜色暗，轻微疼痛且口渴，疮头有几十个。左尺脉洪数，但按之无力，这是肾虚的症状，兼有气虚。庆幸他没有使用败毒的药物，元气没有受损，所以几天后脓出肉腐而痊愈。
驾部林汝玉冬天不穿棉衣，口渴想喝冷水，常常自认为身体壮实，晒剩下的棉衣（指不穿），诊察他的脉象，数大但无力。我说：这是虚火。使用黄芩、黄连，加入人参、白术、茯苓，二十多剂药，以及前面提到的丸药半斤左右，口渴减轻六七成，背部发热也退了。到了夏天背部发出一个疽疮，纯用托里排脓的药剂而收敛。
封君袁怀雪，背部疽疮发热且口渴，脉数但无力，使用四物汤加黄柏、知母、玄参、山栀、连翘、五味子、麦冬、金银花，背部疽疮逐渐消退；又加入白芷、人参、当归、白芷（注：原文重复或指代其他，此处依原文“参、 、归、芷”推测为人参、当归、白芷等，结合上下文补全逻辑，但翻译需忠实原文结构，原文此处似缺字或泛指，译为“人参、当归、白芷”等补气养血药）、腐肉完全溃脱。因为停药且劳累，发热口渴再次发作，于是用人参、当归、白芷、炙甘草、山药、山茱萸、茯苓、泽泻、肉桂而痊愈；后来又用六味丸及十全大补汤使疮口收敛。
In the treatment of sores and ulcers, if diarrhea occurs, it may be due to excessive use of cold-cooling purgatives damaging the Spleen Qi; or due to weak Spleen Qi causing indigestion; or due to Spleen deficiency with sinking Qi failing to raise the clear Yang; or due to decline of Mingmen Fire failing to warm the Earth (Spleen); or due to weakness of the Kidney Meridian failing to control excretion; or due to cold-deficiency of both Spleen and Kidney failing to perform their functions. The primary treatment methods are as follows: If cold-damage injures the Spleen and Stomach, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Mu Xiang (Aucklandiae Radix) and Sha Ren (Amomi Fructus), administered with Er Shen Wan (Two Spirits Pill). If Spleen deficiency causes sinking Qi, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), administered with Er Shen Wan. If Mingmen Fire declines, use Ba Wei Wan (Eight-Ingredient Pill) ingredients, administered with Si Shen Wan (Four Spirits Pill). If Kidney deficiency causes incontinence, use Jiang Fu Tang (Ginger and Aconite Decoction) with Wu Zhu Yu (Evodiae Fructus) and Wu Wei Zi (Schisandrae Fructus). If Spleen-Kidney cold-deficiency exists, use Shen Fu Tang (Ginseng and Aconite Decoction) administered with Si Shen Wan. *Bing Ji* states: If the pulse is deep and fine, the body is immobile, vision is blurred, food and drink cannot be taken, and breath at the nose tip is weak, treat with Jiang Fu Tang. If the body feels heavy and limbs cannot be lifted, treat with Shen Fu Tang. Mr. Zhang Zhongjing said: For dysentery with borborygmus, warming is indicated. If the pulse is slow and tight with unceasing pain, warming is indicated. If there is anal pain, warming is indicated. If there is heart pain, rescue the interior, and Li Zhong Tang (Regulate the Middle Decoction), Fu Zi (Aconiti Lateralis Radix Praeparata), or Si Ni Tang (Frig Extremities Decoction) may be given. *Jing Yao* states: In carbuncles and ulcers, if vomiting and diarrhea occur and the Kidney pulse is weak, it is incurable. This elucidates the profound meaning of *Nei Jing*. For such difficult-to-treat conditions, if treated according to the aforementioned methods, many patients can survive.
Case Record
The wife of Imperial Physician Wang Pengfeng, over forty years old, suffered from a back carbuncle that failed to suppurate, accompanied by diarrhea and vomiting, poor appetite, and cold extremities. Her pulse was faint and barely perceptible, indicating Yang deficiency and cold. She was prescribed a major tonifying formula with Fu Zi (Aconiti Lateralis Radix Praeparata), Gan Jiang (Zingiberis Rhizoma), and Rou Gui (Cinnamomi Cortex). There was no response. Two additional doses of Fu Zi were added, but diarrhea worsened. Subsequently, a larger dose of Da Fu Zi (Prepared Aconite Root), Gan Jiang, and Rou Gui (each 3 qian), along with Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Fu Ling (Poria) (each 5 qian) was prepared as one dose. Only then did warmth return to the abdomen, vomiting and diarrhea ceased, hands and feet warmed, and the pulse recovered. Further major tonification led to ulceration, followed by Tuo Li (Supporting the Interior) formulas for healing. Ten years later, she died due to Spleen-Stomach cold-deficiency.
For sores and ulcers, if urination is dribbling, frequent, difficult, or accompanied by astringency in the urethra, this is a severe symptom of Kidney Meridian deficiency. Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill) should be used to nourish Yin. If the lower legs and calves feel cold, Ba Wei Wan (Eight-Ingredient Pill) should be used to tonify Yang. If urination is frequent and yellow, Si Wu Tang (Four Substance Decoction) plus Mai Men Dong (Ophiopogonis Radix), Ren Shen, Bai Zhu, and Wu Wei Zi should be used to nourish Lung and Kidney. If urine is scanty, Bu Zhong Yi Qi Tang plus Shan Yao (Dioscoreae Rhizoma), Mai Men Dong, and Wu Wei Zi should be used to tonify Spleen and Lung. If heat binds in the Bladder causing difficulty in urination, Wu Lin San (Five Strangury Powder) should be used to clear heat. If Spleen Qi is dry and fails to transform fluids, Huang Qin Qing Fei Yin (Scutellaria Lung-Clearing Decoction) should be used to nourish Yin. If Bladder Yin is deficient and Yang cannot generate, Liu Wei Wan (Six-Ingredient Pill) should be used. If Bladder Yang is deficient and Yin cannot transform, Zi Shen Wan (Nourish Kidney Pill) should be used. Diseases of Kidney deficiency often transmit to these symptoms; without nourishing the source of transformation, recovery is impossible. Using Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma) will drain Yang and accelerate danger. For elderly men with impotence desiring sexual activity, leading to internal depletion of essence, pain in the urethra and difficulty urinating, Jia Jian Ba Wei Wan plus Che Qian Zi (Plantaginis Semen) and Niu Xi (Achyranthis Bidentatae Radix) should be used. If ineffective, add Fu Zi; many recover. If essence is exhausted yet further depleted, causing pulling pain during defecation and urination—where more pain leads to more urge to defecate/urinate and vice versa—using previous formulas with Fu Zi can also lead to recovery. Wang Tai Pu said: Without Yin, Yang cannot transform; without Yang, Yin cannot generate. One must nourish the source of transformation. If only diuretic drugs are used, True Yin is damaged, accelerating death.
Case Record
Wang Tang, an official, suffered from a back carbuncle that ulcerated, resulting in dribbling urination and occasional incontinence, thirst with desire to drink, irritability, fever, insomnia, redness of the wound, burning sensation, and occasional bowel/bladder incontinence. I stated: This is a severe Kidney deficiency symptom. Jia Jian Ba Wei Wan plus Mai Men Dong was prescribed, and he recovered after several doses.
Zhu Yangshan, Prefect, suffered from a back carbuncle with diffuse swelling, dark color, slight pain, thirst, and dozens of pustules. The left Chi pulse was surging and rapid but empty upon pressure, indicating Kidney deficiency and Qi deficiency. Fortunately, he had not used toxic-draining medicines, so his Yuan Qi was undamaged. Pus drained and necrotic tissue sloughed off within days, leading to recovery.
Lin Ruyu, Department Official, refused to wear cotton in winter, felt thirsty and drank cold water, believing himself robust, and discarded leftover cotton garments. His pulse was rapid and large but empty. I diagnosed Xu Huo (Deficient Fire). Huang Qin (Scutellariae Radix) and Lian Zi (Lotus Plumule) were used with Ren Shen, Bai Zhu, and Fu Ling. After more than twenty doses and half a jin of the previous pill, thirst decreased by 60-70%, and back heat subsided. In summer, a back carbuncle developed and healed using purely Tuo Li (Supporting Interior) agents.
Yuan Huaixue, Lord, suffered from fever and thirst due to a back carbuncle, with a rapid but empty pulse. Si Wu Tang plus Huang Bo, Zhi Mu, Xuan Shen (Scrophulariae Radix), Shan Zhi Zi (Gardeniae Fructus), Lian Qiao (Forsythiae Fructus), Wu Wei Zi, Mai Men Dong, and Yin Hua (Jasminis Flos) were used, gradually reducing the carbuncle. Bai Zhi (Angelicae Dahuricae Radix), Ren Shen, Dang Gui, and others were added to resolve necrotic tissue. Due to stopping medication and labor, fever and thirst returned. Ren Shen, Dang Gui, Bai Zhi, Zhi Gan Cao (Honey-fried Licorice Root), Shan Yao, Shan Zhu Yu (Corni Fructus), Fu Ling, Ze Xie (Alismatis Rhizoma), and Rou Gui were used for cure. Finally, Liu Wei Wan and Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) were used for wound closure.