Library

Since the *Huangdi Neijing* (Yellow Emperor's Inner Canon) elucidated that "the Stomach is the sea of the Five Zang and Six Fu organs," physicians of successive dynasties have attached great importance to the role of the Spleen and Stomach in the human body. Li Gao (Li Dongyuan) of the Jin Dynasty further wrote *Pi Wei Lun* (Treatise on the Spleen and Stomach) to expound this view, stating: "The sufficiency of Yuan Qi (Original Qi) depends entirely on the Qi of the Spleen and Stomach being unharmed, thereby nourishing Yuan Qi; if the root of Stomach Qi is weak and food intake doubles, the Qi of the Spleen and Stomach will be injured, and Yuan Qi cannot be filled, leading to the onset of various diseases." He also believed that the ascending and descending of Zang organ Qi relies on the Spleen and Stomach. Therefore, he emphasized that if the Spleen and Stomach become diseased, all Five Zang and Six Fu organs, limbs, and nine orifices will suffer. However, how should one handle cases where other Zang organs' diseases damage the Spleen and Stomach? Most physicians rarely discuss this. From my observation of various clinical diseases, if various diseases cause abnormalities in the Spleen and Stomach, manifesting as poor appetite, vomiting, or diarrhea, they generally progress from mild to severe. Conversely, if Spleen and Stomach symptoms gradually recover, it indicates a progression from severe to mild. This is the second meaning of "the Spleen and Stomach are the sea of the Five Zang and Six Fu organs."

Treatment Has Urgency and Slowness
Since the *Suwen: Zhenshi Yao Dalun* chapter proposed "treatment has urgency and slowness," Zhang Zhongjing further clarified the specific application methods of "urgency and slowness in treatment" in the *Shanghan Lun* (Treatise on Cold Damage Diseases). He stated: When both exterior and interior syndromes are present, generally one should first resolve the exterior and then treat the interior; but if the interior syndrome is urgent, one should first treat the interior and then resolve the exterior. He said: "In Taiyang disease (disease of the Taiyang channel), if the exterior signs are not resolved, purgation must not be used; using purgation is contrary to principle. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate." "In Taiyang disease, if sweating was administered first but the disease did not resolve, and purgation was subsequently used, and the pulse remains floating, the disease will not resolve. A floating pulse indicates the pathogen is outside; using purgation in error leads to non-resolution. Since the pulse is now floating, we know the pathogen is still in the exterior, and resolving the exterior will lead to recovery; Guizhi Tang is appropriate." "In Shanghan (Cold Damage), if there is constipation for six or seven days accompanied by headache and fever, Chengqi Tang (Ephedra Decoction, referring to purgative formulas like Tiaowei Chengqi Tang, Dachengqi Tang, or Xiaochengqi Tang) may be given; however, if urination is clear, we know the disease is not in the interior but still in the exterior, and sweating is required. If headache persists, epistaxis may occur, and Guizhi Tang is appropriate." "In Yangming disease, if the pulse is floating, there is no sweat, and wheezing occurs, sweating will lead to recovery; Mahuang Tang (Ephedra Decoction) is appropriate." "If there is diarrhea, abdominal fullness, and body pain, first warm the interior, then attack the exterior. Warming the interior is appropriate with Sini Tang (Four Reversal Decoction), and attacking the exterior is appropriate with Guizhi Tang." "In Shanghan, if a physician mistakenly used purgation, followed by incessant diarrhea with undigested food and body pain, urgently save the interior; later, if body pain persists but bowel movements normalize, urgently save the exterior. Saving the interior is appropriate with Sini Tang; saving the exterior is appropriate with Guizhi Tang." "If a patient has fever and headache, but the pulse is unexpectedly deep, and if the condition does not improve, accompanied by body pain, save the interior; Sini Tang is appropriate." "Originally indicated for sweating but purgation was used instead; this is contrary treatment. If sweating had been done first, the treatment would not have been contrary. Originally indicated for purgation but sweating was used instead; this is contrary treatment. If purgation had been done first, the treatment would not have been contrary."

Secondly, when deficiency and excess syndromes coexist: if interior excess is particularly urgent and life-threatening, urgently attack the excess pathogen, as Zhongjing said: "In Shaoyin disease (disease of the Shaoyin channel), after two or three days, if there is dry mouth and throat, urgently purge; Dachengqi Tang (Major Order the Yang Decoction) is appropriate." "In Shaoyin disease, if there is spontaneous diarrhea of clear water, pure green in color, with必 pain in the epigastrium and dry mouth/throat, urgently purge; Dachengqi Tang is appropriate." "In Shaoyin disease, after six or seven days, if there is abdominal fullness and constipation, urgently purge; Dachengqi Tang is appropriate." If excess is primary and deficiency is secondary, adopt a method of dispelling pathogens while gently tonifying deficiency. Zhongjing said: "Due to five types of overwork leading to extreme emaciation, abdominal fullness, inability to eat, caused by dietary injury, emotional distress, drinking injury, sexual excess, hunger injury, labor injury, and damage to meridians, Ying (Nutritive) and Wei (Defensive) Qi, with internal dried blood, rough skin resembling scales, and dark eyes. Gently tonify deficiency and benefit the middle; Dahuang Zhenzhu Wan (Rhubarb and Ground Beetle Pill) is the main treatment." "For women with deficiency during lactation, restlessness, and vomiting, to calm the middle and boost Qi; Zhupi Da Wan (Bamboo Peel Large Pill) is the main treatment." If deficiency is primary and excess is secondary, tonify righteous Qi. For slower conditions, use a method of tonifying the middle with auxiliary purging. Later physicians discussed urgency and slowness extensively, but always based it on the strength or weakness of righteous Qi.

Formulas Have Large and Small Dosages
I once observed Mr. Peng Ze-min's prescriptions using Zhang Zhongjing's original formulas and original dosages in jin and liang. Later, I saw the prescription dosages of renowned late-life TCM practitioners Bai Qingzuo and Wang Yaxuan from the Shanxi Provincial Institute of Traditional Chinese Medicine. Their prescriptions often reached around one jin per formula, with individual herbs frequently measuring one liang, or even half a jin. Observing their efficacy, it was often significant. In contrast, examining Mr. Li Dongyuan's prescriptions, although they contained many herbs, the dosages were very small. Similarly, renowned late-life TCM practitioners Li Hanqing and Han Yuhui from the Shanxi Provincial Institute of TCM used very small dosages for each herb and extremely refined formulas, often consisting of just a few qian to one liang per formula, yet their efficacy was excellent. Which is correct? Which is wrong? It is difficult to decide or follow either strictly.

Reading the *Wujutong Yi'an* (Medical Cases of Wu Jutong), I was inspired by the note that Chen's listed treatments were identical to Wu Jutong's but yielded different results due to differences in dosage. Further pondering the texts of *Shanghan Lun* and *Jingui Yaolue*, I realized: if pathogens are abundant and righteous Qi is not deficient, large doses of medicine are suitable; if righteous Qi is deficient and pathogens are slight, small doses are suitable. I once treated a male patient, surnamed Liu, aged 45, who suffered from chronic abdominal fullness and cold-like symptoms. Various doctors failed to cure him after years of treatment, and my own 20+ prescriptions were also ineffective. Reflecting that his righteous Qi was deficient and pathogens slight, why use large doses? Why not try small doses? I prescribed Su Ye (Perilla Leaf) 1 fen, Chen Pi (Tangerine Peel) 1 fen, and Gan Cao (Licorice Root) 1 fen, for 3 doses. He recovered completely. The patient stated that pharmacists and hospital staff mocked the prescription as foolish, but he persisted and was cured in three doses. Thereafter, whenever I encountered such cases, I applied this principle and often achieved success.

Appropriateness as the Goal
Whether to use toxic medicines, how to use them, and in what quantities are issues highly valued by clinicians.
Some argue: Toxic medicines should not only be used but used boldly and heavily. Because toxic medicines can treat major diseases and chronic incurable conditions, those aiming to reverse severe chronic illnesses must use toxic medicines. However, due to their toxicity, improper use can cause harm or death. Thus, several precautions are necessary. According to the *Neijing*, there are roughly five points: First, Zhengzhi (Direct Treatment), i.e., treating against the nature of the disease with toxic medicine. *Suwen: Zhenshi Yao Dalun* states: "Cold is treated with heat, heat with cold; mild cases are treated oppositely, severe cases similarly; hardness is reduced, invaders removed, fatigue warmed, stagnation dispersed, retention attacked, dryness moistened, urgency relieved, scattering gathered, loss replenished, lethargy moved, fright calmed, rising lowered, massaged, bathed, pressed, robbed, opened, and released." Second, Fanzi (Contrary Treatment), i.e., adopting a treatment method similar to the symptom's appearance. The key lies in subduing the main cause and addressing the origin. *Suwen: Zhenshi Yao Dalun* states: "The Yellow Emperor asked: What is contrary treatment? Qibo answered: Heat used with cold properties, cold used with heat properties, obstruction treated with obstruction, diarrhea treated with purgation. One must subdue the main cause and address the origin." Third, dosage and compatibility. *Suwen: Zhenshi Yao Dalun* states: "The treatment depends on whether the medicine is toxic or not, determining the size of the formula... One Sovereign, Two Ministers, a small formula; One Sovereign, Three Ministers, Five Assistants, a medium formula; One Sovereign, Three Ministers, Nine Auxiliaries, a large formula." Fourth, degree. Toxic medicines should stop upon seeing effect, not be overused. *Suwen: Wuchang Zheng Dalun* states: "The Yellow Emperor asked: Is there a limit to taking toxic or non-toxic medicines? Qibo answered: Diseases vary in duration and newness, formulas vary in size. There are standard regulations for toxic and non-toxic medicines. Treating with highly toxic medicine removes 60% of the disease; moderately toxic removes 70%; slightly toxic removes 80%; non-toxic removes 90%. Use grains, meats, fruits, and vegetables to complete the nourishment. Do not exceed these limits, lest you injure righteous Qi." Fifth, use only when indicated. *Suwen: Liuyuan Zhengji Dalun* states: "When there is a cause, there is no destruction, nor destruction to the body... Major accumulations and masses can be attacked, but stop when the pathogen is reduced by more than half; exceeding this leads to death." In summary, toxic medicines must be used only when the syndrome matches, and the usage must be appropriate, as stated in *Suwen: Zhenshi Yao Dalun*: "Observe the situation," "Take appropriateness as the goal."

Harmonization Method
The *Neijing* treats diseases by either using toxic medicines to attack pathogens or by harmonizing. Harmonization is called the most sacred of all methods. It states: "The essence of Yin and Yang is that Yang must be dense for Yin to be secure. If the two do not harmonize, it is like spring without autumn, winter without summer. Harmonizing them is the sage's standard. (*Suwen: Shengqi Tongtian Lun*)"
The *Neijing* defines harmonization as regulating Qi, specifically regulating the Yin and Yang of Qi. *Suwen: Zhenshi Yao Dalun* states: "Pungent and sweet disperse and belong to Yang; sour and bitter induce vomiting/drain and belong to Yin; salty induces vomiting/drain and belongs to Yin; bland promotes drainage and belongs to Yang. These six flavors, whether astringent, dispersing, relaxing, urgent, drying, moistening, softening, or hardening, should be used according to what is beneficial to regulate Qi and bring it to balance... The Yellow Emperor asked: How is Qi regulated? Qibo answered: By opposing or following, opposing then following, following then opposing, ensuring Qi flows smoothly. Formulas for regulating Qi must distinguish Yin and Yang, determine interior and exterior, and stay within their domains. Interior diseases are treated internally, exterior diseases externally. Mild cases are regulated, next level balanced, excessive cases subdued via sweating or purgation. Cold, heat, warmth, coolness are used according to their attributes to reduce excess. Follow the principles carefully, and every attempt will succeed, keeping Qi and Blood balanced for longevity."
Someone asked: Old Zhu, why do you emphasize regulating the Liver to treat difficult diseases in your book *Nan Bing Qi Zhi*? I answered: *Suwen: Liujie Zangxiang Lun* states: "All eleven Zang organs depend on the Gallbladder." Li Gao said: "The Gallbladder possesses the Qi of Shaoyang Spring generation. When Spring Qi generates, all transformations are peaceful. Thus, when Gallbladder Qi rises like Spring, the remaining organs follow, so all eleven Zang organs depend on the Gallbladder." The Liver and Gallbladder are exterior-interior paired. Therefore, if Liver and Gallbladder Qi stagnates, all organs stagnate. Thus, soothing the Liver and Gallbladder and regulating their Yin-Yang Qi harmonizes all organ Qi, curing hundred diseases. Hence, regulating the Liver and Gallbladder cures myriad ailments.

Increased Qi Over Time Leads to Premature Death
In clinical practice, patients often appear where deficiency treated with tonification becomes more deficient, excess treated with purging becomes more excess, heat treated with cooling becomes hotter, and cold treated with warming becomes colder. The causes are roughly three: First, not knowing the affiliation. *Suwen: Zhenshi Yao Dalun* states: "For those whose cold makes them hot, seek the Yin; for those whose heat makes them cold, seek the Yang. This is called seeking the affiliation." *Leijing* explains: "Those whose cold makes them hot means using bitter-cold to treat heat but heat increases; this is not excess fire, but deficiency of True Yin. Deficient Yin leads to relative Yang excess causing heat, so treat the Yin, not the Fire. Tonify Yin to match Yang, and heat recedes. Those whose heat makes them cold means using pungent-hot to treat cold but cold worsens; this is not excess cold, but deficiency of True Yang. Deficient Yang leads to relative Yin excess causing cold, so treat the Yang, not Cold. Add fire to water, and Yang recovers, cold dissipates. Thus, Qixuanzi noted: Benefit the source of Fire to eliminate Yin shadows; strengthen the master of Water to control Yang sunlight. Also: Organs have masters of cold, heat, warmth, coolness. Treating Heart need not uniformly use heat; treating Kidney need not uniformly use cold. Boost Heart Yang, and cold circulates; strengthen Kidney Yin, and heat is tolerable. Thus, treating heat with heat, cold with cold, ensures success." Second, treating the Wang Qi (Dominant/Exuberant Qi). *Suwen: Zhenshi Yao Dalun* states: "The Yellow Emperor asked: Good. Taking cold causes heat, taking heat causes cold. Why? Qibo answered: Treating the Wang Qi causes this reversal." *Leijing* explains: "Treating Wang Qi means disease has Yin/Yang, Qi has decline/excess, so treatment reverses. E.g., Yang excess Yin deficiency means Yin deficiency with Fire exuberance. Treators don't tonify Yin to match Yang but use bitter-cold to suppress Fire. Bitter-cold sinks and descends, destroying Yin. As Yin destroys, Fire surges, so taking cold causes heat; Yin deficiency should not be descended. Similarly, Yang deficiency Yin excess means Qi weakness generating cold. Treators don't tonify Yang to eliminate Yin but use pungent-warm to suppress Yin. Pungent-warm consumes and scatters, destroying Yang. As Yang destroys, cold worsens, so taking heat causes cold; Yang deficiency should not be scattered. This happens because exclusively treating Wang Qi." Third, long-term increase of Qi. *Leijing* states: "All five flavors enter the Stomach first, then go to their preferred Zang. 'Preferred attack' means five flavors belong to five Zangs. As per *Jiuzhen Lun*: If disease is in sinews, avoid sour; in Qi, avoid pungent; in bones, avoid salty; in blood, avoid bitter; in flesh, avoid sweet. Violating this is the 'five flavors affiliation.'" It also says: "Each flavor enters specific organs. If flavors are biasedly used, Qi becomes biasedly diseased. Long-term bias increases Qi, which is normal transformation. Increased Qi over time leads to Zang excess and eventual exhaustion. This is the cause of premature death." *Suwen: Zhenshi Yao Dalun* states: "Five flavors enter the Stomach, each goes to its preferred organ. Sour enters Liver first, Bitter Heart, Sweet Spleen, Pungent Lung, Salty Kidney. Long-term use increases Qi, normal transformation. Increased Qi over time is the cause of premature death."
Modern physicians often ignore these three situations, falsely claiming deficiency cannot accept tonification, excess cannot accept purging, and heat cannot accept cooling.

Strong Fire Scatters Qi, Minor Fire Generates Qi
Reading *Suwen: Yin-Yang Yingxiang Dalun*: "Qi of Strong Fire declines, Qi of Minor Fire strengthens; Strong Fire consumes Qi, Qi feeds on Minor Fire; Strong Fire scatters Qi, Minor Fire generates Qi." I read Zhang Jingyue's *Leijing* annotation: "Fire is the Yang Qi of Heaven and Earth. Without this Fire, Heaven cannot generate things; humans cannot live without it. All life comes from Yang Qi. But gentle Fire generates life, while fierce Fire harms it. Thus, excessive Fire leads to Qi decline, while peaceful Fire leads to Qi strength." Ma Shi's *Huangdi Neijing Suwen Zhu Zheng Fa Wei* notes: "Flavor and aroma too thick constitute Strong Fire. Using Strong Fire products, our Qi cannot withstand it and declines, e.g., Wu Tou (Aconite Root) and Fu Zi (Prepared Aconite Root), causing fever as our Qi fails to overcome it. Warm flavor/aroma constitutes Minor Fire. Using Minor Fire products, our Qi gradually grows strong, and Blood strengthens, e.g., Ren Shen (Ginseng Root) and Dang Gui (Angelica Sinensis Root), where Qi and Blood gradually flourish." I found the discussion on Fire confusing. What are Strong Fire and Minor Fire? Are they Heaven/Earth Fire? Human Fire? Medicinal Fire? Among medicinal fires, what is Strong Fire? What is Minor Fire? If Wu Tou and Fu Zi are Strong Fire, why did Zhang Zhongjing use Fu Zi and Gui Zhi (Cinnamon Twig) in Shenqi Wan (Kidney Qi Pill) to tonify Minor Fire? If Ren Shen and Dang Gui are Minor Fire, why did Zhang Hezi fear them like tigers and scorpions? Re-reading *Suwen: Yin-Yang Yingxiang Dalun*'s opening: "Yin and Yang are the Way of Heaven and Earth, the net of all things, parents of change, origin of life and death, residence of spirit. Treating disease must seek the root." And *Xuezheng Lun*'s argument: "The words Yin and Yang refer to Water and Fire," I began to understand. Fire refers neither solely to natural fire nor solely to medicinal fire. Strong Fire and Minor Fire refer neither solely to Heaven/Earth fire nor human fire. Medicinal Strong/Minor Fire refers neither solely to Wu Tou/Fu Zi nor solely to Ren Shen/Dang Gui. Yet, what exactly are Strong Fire and Minor Fire? Still unclear.

Later, through repeated clinical experience, I gained a deeper understanding. 30 years ago, I encountered a 40-year-old female patient. Four years prior, due to rheumatic heart disease with mitral stenosis and recurrent hemoptysis, she underwent mitral valvotomy at a certain hospital. Post-surgery, hemoptysis stopped, but atrial fibrillation and total heart failure developed. Symptoms included shortness of breath, palpitations, edema, and oliguria. Hospitalized for nearly 4 years with uncontrolled condition, she sought TCM treatment. A doctor said: Body heat, thirst, red tongue with little coating, fine-rapid pulse indicate Heart Yin deficiency and severe Qi/Blood depletion. Prescribed Yin-nourishing, heat-clearing, Heart-calming agents: Sheng Di Huang (Rehmannia Root) 13g, Tian Hua Fen (Trichosanthes Root) 15g, Ren Shen 15g, Mai Dong (Ophiopogon Tuber) 15g, Wu Wei Zi (Schisandra Berry) 15g, Zhi Mu (Anemarrhena Rhizome) 15g, Xuan Shen (Scrophularia Root) 9g, Chao Suan Zao Ren (Fried Ziziphus Seed) 30g, Yu Zhu (Polygonatum Odoratum Rhizome) 15g, Fu Ling (Poria) 15g. Next day, family reported: After 1 hour of medication, her shortness of breath worsened significantly, she looked panicked, and occasionally lost consciousness. Emergency Western medical rescue was required to sustain her until morning. Condition critical, I urgently invited my mentor Li Hanqing. The teacher was about to leave for a meeting and could not visit, but instructed to use modified Zhenwu Tang (True Warrior Decoction). Prescription: Fu Zi 15g, Bai Shao (White Peony Root) 15g, Fu Ling 15g, Bai Zhu (Atractylodes Rhizome) 15g, Ren Shen 15g, Xing Ren (Apricot Seed) 9g. Afternoon re-examination. Family relayed: After medication, shortness of breath and palpitations worsened, and she produced no urine. Re-examining the patient: severe shortness of breath, extreme edema, fluctuating consciousness. Seeking mentor again, he said: Patient has severe Yin-Yang deficiency and severe Water Pathogen. Slightly increasing Yin makes Yang unable to support; slightly tonifying Yang makes Yin Essence unable to supply. The previous prescription's failure likely lies here. *Neijing* stated: "Qi of Strong Fire declines, Qi of Minor Fire strengthens; Strong Fire scatters Qi, Minor Fire generates Qi." The previous prescription used 15g Fu Zi and 15g Ren Shen, clearly constituting Strong Fire. Better to reduce dosage to assist Minor Fire. Prescription: Fu Zi 0.3g, Bai Shao 0.6g, Fu Ling 0.6g, Bai Zhu 0.6g, Ren Shen 0.3g, Xing Ren 0.3g. Next day visit. Patient said: After first decoction for one hour last night, shortness of breath and palpitations began improving. Around 2 AM, significant improvement occurred, with multiple urinations, reducing edema and abdominal distension. After second decoction, spirit improved greatly this morning, with hunger sensation. Subsequently treated with this formula for 30 days; edema basically disappeared, spirit and appetite significantly improved. At that time, due to new work, I could no longer treat. Another doctor took over, saying the illness was heavy but medicine light, how could it cure serious disease. Prescription: Fu Zi 12g, Bai Shao 12g, Bai Zhu 15g, Fu Ling 15g, Ren Shen 15g, Wu Wei Zi 15g, Tian Hua Fen 15g, Sheng Di Huang 30g. Five days later, sudden death. Family reported: Next day after taking this doctor's prescription, patient suddenly felt severe shortness of breath and chest fullness as if suffocating, edema with no urine, body heat and thirst, progressing to unconsciousness and death. Hearing this, I reflected deeply: Fu Zi and Ren Shen both have distinctions between Minor Fire and Strong Fire; the human body also has distinctions between Minor Fire and Strong Fire. The key lies in matching the dosage of medicine with the syndrome.