Library

Qi injury. Dampness obstructs Qi mechanism. The Lung governs the circulating Qi of the whole body. Its position is high. It belongs to the Hand-Taiyin Meridian. According to the described symptoms, red face and cold feet, epigastric fullness and blockage. This is significantly a disease of the Upper Jiao (Upper Burner). Because the patient usually drinks alcohol, damp-heat has been潜伏 (latent) in the Stomach for a long time. Using acrid-warm and drying-hot drugs is not only unsuitable for Lung disease, but also the damp-heat in the Stomach, being confined by dry-heat, leads to diarrhea with watery stools, which is called "Xie Re Xia Li" (Diarrhea with accompanying heat). Therefore, Huang Lian (Coptis Rhizome), being bitter-cold, causes worsening diarrhea every time it is taken, because although bitter-cold drugs overcome acrid-hot drug flavors, the acrid-hot residues remain at the bottom of the Stomach. However, this has no direct relation to the initial pathogenic factor in the Lung. Shi Gao (Gypsum Fibrosum) is acrid-cold; acrid flavor enters the Lung first; Zhi Mu (Anemarrhenae Rhizoma) has a cool taste and is the mother Qi of the Lung (Metal generates Water, Earth generates Metal, here referring to nourishing the source to moisten the Lung). If one does not understand the Lung pathogen and merely speaks of generating fluids, how can that be the ultimate principle? In the past, Sun Simiao asked about medical history before diagnosis, which was least likely to cause errors. Furthermore, according to the family, the illness began twenty days ago, with no sweating to vent the pathogen. The *Classic* says: For Summerheat diseases, sweat should be allowed to come out, do not stop it. When Qi obstruction lasts for a long time, heat invades the Blood level, causing coughing up of phlegm with blood, red tongue, and little thirst. If the Upper Jiao is not resolved, it spreads to the Middle and Lower Jiao. All these require urgent clearing of the Three Jiao, which is the main theme of the first chapter. Thus, the stasis-heat of heat diseases, remaining in the collaterals as residual toxins, or entering the Fu organs and intestines as profuse diarrhea, becomes a situation where one is helpless. Again, dampness is a heavy and turbid pathogen, heat is a steaming Qi. Heat residing in dampness, the steaming and excessive Qi presses upward upon the clear orifices, causing deafness. This is different from Shaoyang deafness. Qing Hao (Artemisiae Annuae Herba) is one grade lower than Chai Hu (Bupleuri Radix), yet it is also a primary herb for Shaoyang. Moreover, treating a major illness is like fighting a great enemy; selecting herbs is like selecting generals. If not cautious, success is rare. It is proposed to use the method of clarifying the Three Jiao, following He Jian's method. (3rd day)
Fei Hua Shi (Talcum), Sheng Shi Gao (Raw Gypsum Fibrosum), Han Shui Shi (Calcitum), Da Xing Ren (Semen Armeniacae Amarum), Chao Huang Zhu Ru (Fried Bamboo Shavings), Chuan Tong Cao (Tetrapanacis Medulla), Ying Bai Jin Zhi (Pure White Gold Juice), Jin Yin Hua Lu (Honeysuckle Dew).

Another visit in the evening. After pulse diagnosis, urticaria appeared on the abdominal and chest skin and pores. Damp-heat in the Qi level originally had a mechanism for hidden discharge. As discussed in the morning, residual pathogens and lingering heat must be accompanied by detoxification for this purpose. After taking medicine in the afternoon, the pulse was larger than in the morning. Consciousness remained the same. Only the tongue was red, especially dry in the center. Touching the body, the heat was more severe than in the morning. This indicates the Yin level is also injured by steaming heat. For thin people, worry about fluid depletion arises. However, since phlegm cannot be expectorated clearly, Yin-nourishing drugs are invariably cloying and stagnating. It is proposed to take one dose of Qing Ge (Clear Diaphragm) early, and for the accumulation of heat and filth in the Three Jiao, use Zi Xue Dan (Purple Snow Pill) two or three spoons, borrowing its aromatic opening of orifices and expelling of filth, so that confined heat can be resolved and turbid phlegm will not stick. Subsequent conditioning formulas should clear the Ying (Nutritive) level and nourish Stomach juices, only then can care be taken. The removal of accumulated fecal matter will still take ten days. The ancients said that purgation is not too late; this is not an arbitrary statement. Zi Xue Dan 1 qian 6 fen.
Zhi Mu (Anemarrhenae Rhizoma), Zhu Ye Xin (Bamboo Leaf Heart), Lian Qiao Xin (Forsythiae Fruit Heart), Chao Chuan Bei (Fried Fritillariae Bulbus), Zhu Li (Bamboo Sap), Xi Jiao (Rhinocerotis Cornu - note: substitute with water buffalo horn in modern practice), Yuan Shen (Scrophulariae Radix), Jin Zhi (Gold Juice), Yin Hua Lu (Honeysuckle Dew).

After taking one dose.
Zhu Ye Xin (Bamboo Leaf Heart), Zhi Mu (Anemarrhenae Rhizoma), Lv Dou Pi (Mung Bean Peel), Yuan Shen (Scrophulariae Radix), Xian Sheng Di (Fresh Rehmanniae Radix), Jin Yin Hua (Lonicerae Japonicae Flos).

After another dose. Remove Jin Yin Hua and Lv Dou Pi. Add Ren Shen (Ginseng Radix) and Mai Dong (Ophiopogonis Tuber).

Another visit at Shen hour on the 10th day. After a month of seasonal pathogens, the pulse form is small and rapid. Small indicates disease retreat, rapid indicates residual heat. Therefore, skin desquamation like bran indicates the meaning of Qi and Blood circulation. Desire for food and appetite indicates the Stomach has a mechanism of awakening and clarity; all are good omens. Only the tongue is red with yellow coating in the center. Long-standing heat steaming injures both Stomach fluids and Yin liquids, causing difficulty swallowing as if obstructed, pain in the urethra during urination, thick phlegm expectoration, and unpassed accumulated feces. If aggressive purging is used hastily, true Yin may be further depleted. This case prioritizes preserving Yin, while simultaneously clearing the Fu organs. Therefore, indiscriminate eating aids heat. Only light and bland flavors are compatible with the disease. Since ancient times, heat diseases fear relapse due to diet and fatigue, known to all, not an arbitrary statement.
Xi Sheng Di (Rehmanniae Radix Preparata), Yuan Shen Xin (Scrophulariae Radix Heart), Zhi Mu (Anemarrhenae Rhizoma), Chao Chuan Bei (Fried Fritillariae Bulbus), Mai Dong (Ophiopogonis Tuber), Di Gu Pi (Lycii Cortex), Jin Yin Hua Lu (Honeysuckle Dew), Zhu Li (Bamboo Sap).

Pulse and symptoms as yesterday. Still propose nourishing and clearing residual heat in the Yin level, assisting in clearing heat-phlegm in the upper epigastrium.
Follow yesterday's formula, remove Di Gu Pi and Jin Yin Hua Lu, add Yan Shui Chao Ju Hong (Salt-water fried Tangerine Peel).

Certain Patient: Pulse deficient. Summerheat injury. Heavy head, epigastric stuffiness, soreness in the dorsum of foot.
Si Gua Ye (Loofah Leaf, 3 qian), Da Xing Ren (Semen Armeniacae Amarum, 3 qian), Liu Yi San (Six-to-One Powder, 3 qian), Fu Ling Pi (Poria Cocos Peel, 3 qian), Han Fang Ji (Stephaniae Tetrandrae Radix, 1.5 qian), Mian Yin Chen (Artemisiae Scopariae Herba, 1 qian), Xi Mu Tong (Akebiae Caulis, 1 qian), Bai Kou Ren (Amomi Fructus Rotundus, 0.5 qian).

Certain Patient: Zhong E (Sudden Evil) Summerheat Jue (Summerheat Collapse). Cang Zhu Bai Hu Tang (Atractylodis Rhizoma White Tiger Decoction) plus Hua Shi (Talcum).

Wang: Summerheat pathogen with alternating chills and fever. White tongue, no thirst. Hematemesis. This is named Shu Zhai (Summerheat Consumption), a severe condition.
Xi Gua Cui Yi (Watermelon Rind Green Layer), Zhu Ye Xin (Bamboo Leaf Heart), Qing He Ye Zhi (Green Lotus Leaf Juice), Xing Ren (Semen Armeniacae Amarum), Fei Hua Shi (Talcum), Yi Yi Ren (Coicis Semen).

Wan: Summerheat pathogen unresolved, sinking into Jueyin. Grey tongue, excessive thirst. Hardness below the heart. Vomiting and nausea, vomiting roundworms. Chills and fever. Diarrhea with bloody water. A most critical condition. (Summerheat invading Jueyin)
Chuan Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Gan Jiang (Zingiberis Rhizoma), Sheng Bai Shao (Paeoniae Radix Alba), Chuan Jiao (Zanthoxyli Pericarpium), Wu Mei (Mume Fructus), Ren Shen (Ginseng Radix), Zhi Shi (Aurantii Fructus Immaturus).

Jiang: Summerheat pathogen deeply invading Jueyin. Retracted tongue. Fullness and hardness in the lower abdomen. Loss of voice. Spontaneous diarrhea. Obstruction between upper and lower. Critical period arrives quickly. Tentatively propose Sour-Bitter Heat-Draining method for Summerheat, assisting Righteousness to drive out Pathogens.
Huang Lian (Coptidis Rhizoma), Dan Gan Jiang (Mild Dried Ginger), Wu Mei (Mume Fructus), Sheng Bai Shao (Paeoniae Radix Alba), Ban Xia (Pinelliae Rhizoma), Ren Shen (Ginseng Radix), Zhi Shi (Aurantii Fructus Immaturus).

Certain Patient (18 years old): Labor injury combined with Summerheat. Lung Qi damaged. Hemoptysis and dry mouth. First clear Summerheat-heat (Summerheat combined with Blood Disease).
Xian He Ye (Fresh Lotus Leaf), Bai Bian Dou (Dolichos Lablab Seed), Da Sha Shen (Glehniae Radix), Fu Shen (Poria Cocos with Hostwood), Yi Yi Ren (Coicis Semen).

Zhu (32 years old): During the Three Fu periods, Yin Qi does not generate, Yang Qi does not submerge. Head distension and body pain indicate initial Summerheat invasion. Summerheat-Dampness-Heat must first injure the Qi level. Hence white tongue, thirst, and body pain. Refreshing in the morning, vexatious steaming at midnight. Resembles Warm Malaria. Bathing agitates blood collaterals. Old illness acquired through seasonal pathogen. Zhang Zhongjing said: Treat new illness first, then manage old illness. This is also Yin Qi injured first, Yang Qi acting alone.
Xian Sheng Di (Fresh Rehmanniae Radix), Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Yuan Shen (Scrophulariae Radix), Lian Qiao (Forsythiae Fructum), Zhu Ye Xin (Bamboo Leaf Heart), He Ye Zhi (Lotus Leaf Juice).

Wang (39 years old): Although coughing phlegm and blood loss, strong appetite, unaware of hunger. Yellow eyes, afternoon fever. Yellow coating on tongue center. Already showing signs of Summerheat-heat guest pathogen. This should first clear and regulate Lung and Stomach. Do not use cloying tonics due to chronic illness.
Xing Ren (Semen Armeniacae Amarum), Xiang Bei Mu (Fritillariae Cirrhosae Bulbus), Yu Jin (Curcumae Radix), Chuan Tong Cao (Tetrapanacis Medulla), Sang Ye (Mori Folium), Shi Gao (Gypsum Fibrosum), Ju Hong (Citri Reticulatae Pericarpium), Yi Yi Ren (Coicis Semen).

Again: Evening take Pi Pa Ye Gao (Loquat Leaf Paste). Morning six ingredients plus E Jiao (Asini Corii Colla) and Mai Dong (Ophiopogonis Tuber).

Again: E Jiao (Asini Corii Colla), Ji Zi Huang (Egg Yolk), Xiao Sheng Di (Rehmanniae Radix Preparata), Mai Dong (Ophiopogonis Tuber), Sang Ye (Mori Folium), Chao Hei Dan Pi (Moutan Cortex Stir-fried Black).

Xu (36 years old): Labor injury combined with Summerheat. Hemoptysis and lack of appetite.
Xian He Ye Zhi (Fresh Lotus Leaf Juice, mixed in), Da Sha Shen (Glehniae Radix), Sheng Yi Yi Ren (Coicis Semen), Liu Yi San (Six-to-One Powder), Lv Dou Pi (Mung Bean Peel), Xing Ren (Semen Armeniacae Amarum), Ju Hong (Citri Reticulatae Pericarpium), Bai Kou Ren (Amomi Fructus Rotundus).

When Heaven's Summerheat moves, Earth's damp-turbidity naturally rises. Humans, amidst steaming and oppressive heat, if Righteous Qi has any gap, pathogens enter from mouth and nose. Qi level obstructed first. Upper Jiao's clearing and descending function fails. Transport and transformation mechanism loses normal degree. Essence and micro-nutrients of water and grain also accumulate and become dampness. The human body is a small heaven and earth; internal and external correspond. Thus Summerheat diseases must carry dampness, which is the meaning here. Ancients distinguished between movement and stillness, injury or penetration, entering Heart or Liver, becoming Malaria or Dysentery, Zhong Sha (Miasma) Huo Luan (Cholera-like syndrome), sudden collapse and death. Various origins of transmission each have profound meanings to reference. Here not repeated in detail. Thinking of south of the Yangtze River, low land and thin Qi, dampness wins and heat steams. At this time, prevention must be prior. As Li Ki Weng recorded in his notes: "If heaven had only three seasons without Summer, human illness would surely be rare." This statement is most accurate. The injury of Summer-dampness, acute cases suffer at the time, chronic cases become latent Qi disease after Autumn. Its manifestations: pulse and color must be stagnant, mouth and tongue must be greasy. Or slight chills, or single fever. During fever, epigastric fullness and Qi obstruction, thirst, oppression, vexation. Worse in afternoon, more severe at dusk. Heat until dawn, sweating alleviates symptoms slightly. Day after day like this, necessary beyond two or three pulses, decreasing day by day, only then fully resolved. If Yuan Qi cannot support, or conditioning is illegal, many are untreatable. However, this disease compared to Shang Han (Cold Damage), its momentum feels slower; compared to Malaria, chills and fever are not distinct. Its changes are no different from Shang Han, but recovery period feels lingering. If exteriorized, sweat is not easy to penetrate thoroughly; if attacked internally, loose stool easily occurs. Over-clearing leads to cold limbs and vomiting; over-drying leads to dry lips and cracked teeth. Every autumn comes, this symptom is most common. Seeking ancient teachings, many are not recorded. Only Ji Ren compiled and named it "Autumn Late Onset," feeling symptoms resembling Malaria. Generally treat with methods for feeling pathogens. Know that latent Qi disease exists in four seasons, but unlike Wind-Cold pathogen solved by one sweat, Warm-Thermal Qi relieved by cooling. Summer and Dampness are steaming and sticky pathogens, hardest to cure suddenly. If treatment is not appropriate, Summer-heat steams upward from Yang, injuring Yin and transforming into dryness; Damp-pathogen sinks downward from Yin, injuring Yang and transforming into turbidity. Leading to confusion, deafness, dry tongue, gingival bleeding, epigastric fullness, vomiting, profuse diarrhea, cold limbs. Thorny symptoms arise, eventually collapsing beyond rescue. Referencing Mr.'s intent, base legislation on Liu Hejian's Theory of Three Jiao. Clearly recognize which of Summer-damp two Qi is heavier. Then investigate the disease, actually in Ying-Qi what division. Generally, Six Qi injuring humans transform according to person. Yin deficiency leads to Fire hyperactivity, pathogens return mostly to Ying-Blood levels. Yang deficiency leads to Dampness winning, pathogens injure Qi level mostly. One tolerates clearing, one tolerates warming. Yin-Yang of organ nature can be known from this. Thus, those above use Acrid-Cool Slight-Bitter, such as Zhu Ye, Lian Qiao, Xing Ren, Bo He (Mint). Those in middle use Bitter-Acid Dredging, such as Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction). Those below use Warm-moving Cold-nature, heavy quality opening downward, such as Gui Ling Gan Lu Yin (Cinnamon, Poria, Sweet Dew Drink). These are the general ideas of treating Three Jiao. Or if there is夹杂 (intermingling), must adapt. Regarding treating Qi level, there is difference between Cold and Warm. Cold follows various Bai Hu (White Tiger) methods and Tian Shui San (Heavenly Water Powder) intent. Warm follows Er Chen Tang (Two Aged Decoction) and Zheng Qi San (Upright Qi Powder) methods. Managing Ying level, know suitability of Clearing and Tonifying. Clearing like Xi Jiao Di Huang Tang (Rhino Horn Rehmannia Decoction), adding Heart-entering products. Tonifying like San Cai Fu Mai Tang (Three Talents Reviving Pulse Decoction). Also like Cang Zhu Shi Gao Tang (Atractylodes Gypsum Decoction) for deep-mixed damp-heat, Yu Nu Fa (Jade Maiden Method) for Qi and Blood simultaneous flaming. Opening closure and expelling filth, with Niu Huang (Calculus Bovis) and Zhi Bao Zi Xue (Treasure Purple Snow) agents. Supporting deficiency advancing Ren Shen and Fu Zi (Aconite), and Liang Yi (Two Powers) methods. Following changes, examining Yin-Yang, the subtlety of application lies in the mind. Attaching to the tail with humble words, taught by the wise. (Shao Xin Fu)

Xu's Commentary: The listed cases are mostly chronic latent Summerheat symptoms. Cases of sudden Summerheat invasion are extremely rare. If sudden invasion, must use Xiang Ru Yin (Agastache Drink) as main treatment. Must not be unknown.
This elder treats Summerheat pathogen, able to use light-cool moistening products to harmonize Lung, which is his strength. But when Summerheat pathogen goes deep, there must be stifled chaos and irritability symptoms, close to Cholera-like syndrome. This then has other treatment methods. As for severe and critical illness, belonging to Heat pathogen horizontal reversal, not only is Ren Shen not to be used lightly, but Gui (Cinnamon Bark), Fu Zi (Aconite), Gan Jiang (Dried Ginger) taken, all die immediately. Yet he imitated Zhang Zhongjing's treatment method for damaged Shang Han conditions, lightly trying once. At that time, unknown whether harmful or not, but gossips actually thought it was a necessary drug, name originating from this elder. I have seen many deaths, heartbreaking, must blame the instigator.