旧邻治父母张受先先生。久患穿肠痔漏。气血大为所耗。有荐吾乡黄先生善敷割者。先生神其术。
一切内治之药。并取决焉。不肖昌雅重先生文章道德之身。居瀛海时。曾令门下往
候脉息。私商善后之策。大意谓先生久困漏卮。一旦平成。精气内荣。自可百年无患。然新造之区。尚未坚
固。则有浸淫之虞。脏气久虚。肠蓄易 。则有转注之虞。清气久陷。既服甘温升举矣。然漏下已多。阴血
暗耗。恐毗于阳。水谷易混。既用养脏浓肠矣。然润剂过多。脾气易溜。恐毗于阴。且漏孔原通精孔。精
稍溢出。势必旁渗。则豢精当如豢虎。浓味最足濡脾。味稍不节。势必走泄。则生阴无取伤阴。盖人身脾气。
每喜燥而恶湿。先生漏孔已完。败浊下行者。无路可出。必转渗于脾。湿固倍之。是宜补脾之阳。勿伤脾之
阴。以复健运之常。而收和平之益云云。及至娄中。应召往诊。指下轻取鼓动有力。重按若觉微细。是
阳未见不足。阴则大伤矣。先生每进补阴之药。则夜卧甚宁。肠 亦稀。以故疡医妄引槐角地榆。治肠风下血
之法治之。亦不觉其误。其实漏病乃精窍之病。盖媾精时。气留则精止。气动则精泄。大凡强力入房者。
气每冲激而出。故精随之横决四射。不尽繇孔道而注。精溢于精管之外。久久渐成漏管。今漏管虽去。而肉
中之空隙则存。填窍补隧。非此等药力所能胜也。不肖姑不言其非。但于其方中去槐角地榆等。而加鹿角霜
一味。所谓惟有斑龙顶上珠。能补玉堂关下缺者是也。况群阴之药。最能润下。不有以砥之。则肠中之水。更
聚可虞耶。然此特微露一斑耳。疡医不解。已阻为不可用。因思吾乡一治漏者。溃管生肌外。更有二神方。
先以丸药半斤。服之令人阳道骤痿。俟管中肉满。管外致密。后以丸药半斤。服之令人阳道复兴。虽宜于少。
未必宜于老。然用意亦大奇矣。不肖才欲填满窍隧。而黄生阻之。岂未闻此人此法乎。
胡卣臣先生曰。漏管果通精窍。敷治易而填补难。案中所说。确乎有见。
我的旧邻居是张受先先生，他长期患有穿透肠道的痔疮和瘘管（漏证），气血因此被大量消耗。有人推荐我们乡下的黄先生擅长使用外敷和手术割治的方法，张先生对他的医术非常推崇。
于是，所有内服治疗的药物，都完全取决于黄先生的意见。我（喻昌）素来敬重张先生的文章与道德修养。当我居住在瀛海时，曾让门生前去问候并诊察脉息，私下商讨善后调理的策略。大意是说：张先生长期受瘘管困扰，一旦愈合平整，精气内在充盈，自然可以百年无患。然而，新修复的区域尚未坚固，就有湿邪浸淫的担忧；脏腑之气长期虚弱，肠道容易积聚湿热浊气，就有病邪转移注下的担忧。
清气长期下陷，虽然已经服用甘温升举的药物，但漏下已久，阴血暗中耗损，恐怕会损伤阳气；水谷运化容易混淆，虽然已经使用养脏厚肠的药物，但润燥剂过多，脾气容易滑泄，恐怕会损伤阴液。况且漏孔原本与精窍相通，精液稍微溢出，势必向旁边渗漏，所以养护精气应当像驯养老虎一样谨慎；浓味食物最能滋润脾土，如果口味稍不加节制，势必导致精气走泄，所以滋生阴液不宜采取损伤阴液的方法。
大概人体的脾气，通常喜欢干燥而厌恶潮湿。张先生的漏孔已经愈合，败浊之物下行已无路可出，必然转渗到脾脏，湿气必定加倍。因此适宜补益脾阳，不要损伤脾阴，以恢复脾胃健运的正常功能，从而收到平和健康的益处。
等到我在娄中应召前往诊治时，手指轻取脉搏鼓动有力，重按则感觉微细。这说明阳气未见不足，但阴液则受到严重损伤。张先生每次服用补阴的药物，夜间睡眠就很安宁，肠部的症状也很少发作。因此，外科医生错误地引用治疗肠风下血的槐角丸、地榆等药物来治疗，我也没有觉得这是错误的。
其实，漏证是精窍的疾病。大概在交媾时，气停留则精停止，气运动则精排泄。大凡强力房事的人，气往往冲激而出，所以精液随之横决四射，不全部经由正道注入，而是溢出于精管之外，久而久之逐渐形成漏管。现在漏管虽然去除了，但肌肉中的空隙仍然存在，填补窍隧，不是这类药物的力量所能胜任的。
我没有直接指出他的不对，只是在他的方剂中去掉了槐角、地榆等药，加入鹿角霜一味药。这就是所谓的“惟有斑龙顶上珠，能补玉堂关下缺”的意思。况且群阴性质的药物，最能润下，如果没有药物来遏制它，那么肠道中的水湿更加聚集，岂不令人担忧吗？
但这只是略微透露一点见解罢了。外科医生不理解，已经阻止认为不可用。因此想到我们乡下有一位治疗漏证的人，在溃烂的管道生肌愈合之外，还有两个神方：先用半斤丸药，服用后使人阳道突然痿软，等待管道中肉长满，管道外部致密后，再用半斤丸药，服用后使人阳道重新兴奋。这种方法虽然适合年轻人，未必适合老年人，但用意也非常奇特。我想填满窍隧，而黄先生阻止了我，难道没听说过这个人这种方法吗？
My old neighbor was Mr. Zhang Shouxian, who had long suffered from a penetrating hemorrhoid and fistula (Lou syndrome), causing significant depletion of Qi and Blood. Someone recommended Mr. Huang from our hometown, who was skilled in external application and surgical excision. Mr. Zhang highly esteemed his medical skills.
Consequently, all internal medicinal treatments were left entirely to Mr. Huang's discretion. I (Yu Chang) have always respected Mr. Zhang for his literary talent and moral character. While residing in Yinghai, I once sent my disciples to pay respects and examine his pulse, privately discussing strategies for post-treatment care. The general idea was: Since Mr. Zhang had been confined by the fistula for a long time, once it healed and became level, with Essence and Qi flourishing internally, he could naturally live without worry for a hundred years. However, the newly repaired area was not yet firm, posing a risk of dampness infiltration; the visceral Qi had been deficient for a long time, and the intestines easily accumulated turbid heat, posing a risk of pathogenic transmission downward.
Clear Yang had sunk for a long time. Although sweet-warm ascending and raising medicines had been taken, due to prolonged leakage, Yin Blood had been secretly depleted, risking damage to Yang Qi; the transformation and transportation of water and grain were prone to confusion. Although medicines nourishing the viscera and thickening the intestines had been used, excessive moistening agents caused Spleen Qi to slide and leak, risking damage to Yin fluids. Moreover, the fistula orifice originally connected to the essence orifice. If a small amount of Essence overflowed, it would inevitably seep sideways. Therefore, nurturing Essence should be done with caution, like taming a tiger; rich flavors can best moisten the Spleen Earth, but if dietary restraint is lacking, Essence will inevitably leak. Thus, generating Yin should not involve damaging Yin.
Generally, human Spleen Qi prefers dryness and dislikes dampness. With Mr. Zhang's fistula healed, there was no longer a path for turbid waste to descend, so it must shift to infiltrate the Spleen, doubling the dampness. Therefore, it was appropriate to tonify Spleen Yang without injuring Spleen Yin, to restore normal healthy transportation and receive the benefits of harmony.
When I went to Louzhong to respond to the summons for diagnosis, light palpation revealed a forceful, pulsating pulse, while heavy pressure felt faint and fine. This indicated that Yang Qi was not deficient, but Yin fluids were severely damaged. Whenever Mr. Zhang took Yin-nourishing medicines, his night sleep was very peaceful, and intestinal symptoms were rare. Therefore, when the surgeon incorrectly applied the treatment for Intestinal Wind bleeding using Huaijiao Wan (Sophora Fruit Decoction) and Diyü (Sanguisorbae Radix), I did not consider it erroneous.
In fact, Lou syndrome is a disease of the essence orifice. During intercourse, when Qi stays, Essence stops; when Qi moves, Essence flows. Generally, those who engage in strenuous sexual activity have Qi rushing out forcefully, causing Essence to burst forth in all directions, not all entering through the proper channel but overflowing outside the seminal ducts. Over time, this gradually forms a fistula. Although the fistula has now been removed, the voids within the flesh remain. Filling these orifices and tunnels cannot be achieved by the power of such medicines.
I did not directly point out his error but simply removed Huaijiao and Diyü from his prescription and added one ingredient: Lujiaoshuang (Cervus Nippon Antler Frost). This refers to the saying: "Only the pearl on top of the Spotted Dragon can fill the deficiency below Jade Hall and Guanxia." Furthermore, Yin-nourishing medicines are most capable of moistening and descending. Without something to check them, wouldn't the water accumulation in the intestines become even more worrying?
This was merely revealing a glimpse of insight. The surgeon did not understand and had already blocked its use. Thus, I recalled a person in our hometown who treated fistulas. Besides external applications to ulcerate tubes and generate flesh, he had two miraculous formulas: First, half a jin of pills were taken to cause sudden impotence of the Yang pathway, waiting until the tube was filled with flesh and the exterior became dense; then, another half jin of pills was taken to revive the Yang pathway. Although suitable for the young, it might not be suitable for the old, but the intention was quite unique. I wanted to fill the orifices and tunnels, but Mr. Huang stopped me. Had he not heard of this person and method?
Mr. Hu Youchen stated: "If the fistula indeed connects to the essence orifice, external treatment is easy, but filling is difficult." What is said in the case record is indeed insightful.