王肯堂曰∶痈疽喘急，恍惚嗜卧，此心火刑肺金，宜用人参平肺散，面赤者不治。（《准绳》）
夫疮疡大便泄泻，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，用六君子加木香、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∶痈疽呕泻，肾脉虚者，不治。此发《内
经》之微旨也。凡此实难治之证，如按前法治之，多有可生者。
东垣云∶疮疡热毒深固，呕 心逆，发热而烦，脉沉而实，肿硬木闷，大便秘结，
此毒在脏，宜疏通之；故曰∶疏通其内，以绝其源。又曰∶疮疡及诸病面赤，虽伏火
热，不得妄攻其里，而阳气拂郁，邪气在经，宜发表以去之；故曰∶火郁则发之。凡
大便不通，饮食虽多，肚腹不胀，切不可通。若腹痞胀而不通者，乃直肠干涸也；宜
用猪胆导之。若肠胃气虚血涸而不通者，宜用十全大补汤培养之。若疮证属阴，或因
入房伤肾，而不通者，宜用前汤加姜附回阳，多有得生者。经云∶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。
又曰∶凡病患大肠干燥，当用蜜导法，或胆导法，听其在床，随便出之，不可扶
起。若大肠干燥，胀挣则疮口鲜血突出，此肝不藏血故也。
申斗垣曰∶大凡疮疡，皆由五脏不和，六腑壅滞，则令经络不通而生焉。疮初起
未溃之先，肿 大痛，脉洪数实大，欲作脓时，大便秘结，宜托里，倍加硝黄，即
发表攻里之剂是也。如已溃后，脉微芤数涩者，乃脓血出多，气血衰弱，宜八珍汤、
圣愈汤内加桃仁、火麻仁、当归，少加熟地以润之。如弱甚，以胆汁导之更妙。切
不可以巴豆、牵牛驱逐峻厉之药，复伤元气，致生变证。
薛立斋曰∶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。
张景岳曰∶后阴乃大肠之门，而其通与不通，结与不结，可察阳明之虚实。凡
大便热结，而腹中坚满者，方属有余，通之可也。若新近得解，而不甚干结，或旬
日不解，而全无胀意者，便非阳明实邪。观仲景曰∶大便先硬后溏者，不可攻。可见
后溏者，虽有先硬，已非实热，矧夫纯溏而连日得后者，又可知也。若非真有坚燥
痞满等证，则原非实邪，其不可攻也，明矣。
又曰∶大便通水谷之海，肠胃之门户也。小便通血气之海，冲任水道之门户也。
二便皆主于肾，本为元气之关，必真见实邪，方可议通议下，否则最宜详慎，不可
误攻。使非真实而妄逐之，导去元气，则邪之在表者，反乘虚而深陷。病因内困者，
必由泄而愈亏，所以凡病不足，慎勿强通，最喜者小便得气而自化，大便弥固者弥良。
营卫既调，自将通达，即大肠秘结旬余，何虑之有！若滑泄不守，乃非虚弱者所宜，当
首先为之防也。
王肯堂说：痈疽患者出现气喘急促、神志恍惚、嗜睡，这是心火克制肺金所致，适宜使用人参平肺散；若伴有面色发红，则属于难治之症。（出自《医学准绳六要》）
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；也可能是因为脾气虚弱，食物无法消化；或者是因脾虚气陷，不能升举清阳；或者是因命门火衰，不能温煦脾土；或者是因肾经虚弱，不能固摄二便；或者是因脾肾两脏虚寒，不能履行其生理职能。针对这些情况的治疗原则是：如果是寒凉损伤脾胃，使用六君子汤加木香、砂仁，并送服二神丸；如果是脾虚气陷，使用补中益气汤送服二神丸；如果是命门火衰，使用八味丸药料送服四神丸；如果是肾虚不固，使用姜附汤加吴茱萸、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，眼神呆滞，饮食不下，鼻准部位气息微弱者，用姜附汤主治。身体沉重、四肢不能抬举者，用参附汤主治。张仲景说：下痢且肠鸣，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、四逆汤之类的方剂。《外科精要》中说：痈疽患者呕吐腹泻，若肾脉虚弱，属于难治之症。这是阐发《黄帝内经》的深奥旨意。凡是这种难以治疗的证候，如果按照上述方法治疗，大多可以痊愈。
李东垣说：疮疡热毒深重稳固，恶心呕吐，发热烦躁，脉象沉而实，患处肿胀坚硬且麻木闷痛，大便秘结，这是毒邪在脏腑，适宜疏通；所以说：疏通内部，以断绝病源。又说：疮疡及其他疾病出现面色发红，虽然潜伏火热之邪，不可妄自攻下肠胃，而是阳气拂郁，邪气在经络，适宜发表以祛除邪气；所以说：火郁则发散它。凡是排便不通，虽然饮食很多，但肚腹不胀，切不可通下。如果腹部痞满胀痛而不通，这是直肠干涸；适宜用猪胆汁导法通便。如果是肠胃气虚血少导致的不通，适宜用十全大补汤来培养气血。如果疮证属于阴证，或者因房事伤肾导致的不通，适宜用前文提到的汤剂加干姜、附子回阳，大多能获生。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，应当大补为宜。如果不审察虚实，一味使用疏利通便的药物，很少有不误事的。
又说：凡是病患大肠干燥，应当用蜜导法，或胆导法，让患者躺在床上，随意排出，不可扶起。如果大肠干燥，用力努挣导致疮口鲜血突出，这是因为肝不藏血所致。
申斗垣说：大凡疮疡，都是由五脏不和、六腑壅滞，导致经络不通而生成的。疮疡初起尚未溃破之前，肿高大痛，脉象洪数实大，欲作脓时，大便秘结，适宜托里透脓，加倍加入芒硝、大黄，这就是发表攻里的方剂。如果已经溃破后，脉象微芤数涩，这是因为脓血流出过多，气血衰弱，适宜在八珍汤、圣愈汤中加入桃仁、火麻仁、当归，少量加入熟地黄以润燥。如果体质极弱，用胆汁导法更好。切不可使用巴豆、牵牛子等驱逐峻厉的药物，再次损伤元气，导致产生变证。
薛立斋说：如果饮食虽多，大便不通，但肚腹不胀，这是内火消烁津液，切不可通下；如果肚腹痞满胀痛，而直肠干涸不通，适宜用猪胆汁导法。如果误用疏利药物，再次损伤元气，则伤口不能溃破或收敛。
张景岳说：后阴是大肠之门，其通畅与否、结聚与否，可以观察阳明经的虚实。凡是大便热结，且腹中坚硬胀满的，才属于有余实证，可以通下。如果是新近刚解大便，且不太干结，或者十天半月不解大便，但完全没有胀意的，这就不是阳明实邪。看张仲景说：大便先硬后溏的，不可攻下。可见后溏的，即使先前有硬便，已非实热，何况纯溏且连日排出的，更可知不是实邪了。如果不是真有坚燥痞满等证候，那就原本不是实邪，不可攻下，这很明白了。
又说：大便通水谷之海，是肠胃的门户；小便通血气之海，是冲任水道的门户。二便都由肾主宰，本是元气的关键，必须确见实邪，才可以讨论通下，否则最宜详细审慎，不可误攻。如果不是真实邪气而妄自驱逐，会导去元气，那么停留在体表的邪气，反而会乘虚深陷。病因在内困阻的，必然通过泄下而更加亏虚，所以凡是病属不足的，千万不要强行通下，最喜欢的是小便得气而自然化行，大便保持秘结状态反而更好。营卫既已调和，自然通达，即使大肠秘结十余天，有什么可忧虑的呢！如果滑泄不止，则不是虚弱者所宜有的，应当首先加以防范。
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.