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When the tongue surface is scorched black, without prickles, dry, cracked, and wrinkled, Aconite (Fuzi) is also suitable. This is because although the pulse in this syndrome may be floating and surging or wiry and tight, it definitely lacks a root. After administering Aconite, if the disease trend eases, the pulse will inevitably reveal deficiency signs. A purely red tongue indicates Yin deficiency, while a scorched black tongue indicates deficient fire. There are also cases presenting with Yang heat symptoms but with a tongue that instead lacks coating and remains moist; this is an ominous sign. In such cases, if the patient suffers from chest obstruction, administering medication to open and unblock the chest and heart qi, followed by the emergence of tongue coating, is a favorable omen. However, if despite medication intended to restrain the heat, the heat intensifies further and no new coating forms, it is an untreatable condition. After taking medicine, if the tongue coating sheds and the color becomes discordant, some cases require Gypsum (Shigao), some require Aconite (Fuzi), and some require Rehmannia (Dihuang); these must be carefully distinguished. In summary, the tongue and pulse are critical for judging Yin-Yang and deficiency-excess, and they must not be examined carelessly. Therefore, our school adds abdominal and tongue diagnosis to determine the etiology's deficiency or excess. Physicians of the world who do not understand this, relying solely on abdominal diagnosis while abandoning pulse and tongue diagnosis, can be considered negligent. (Zhuoxuan commented: During the Kansei era, Tsuchida Jotan of Mito wrote a volume titled *Tongue Diagram Explanation*, based on Zhang Luyu's *Tongue Diagnosis* and others, adding his own observations. It was quite detailed and clear, truly capturing the essence of Master Dongguo.)

Regardless of whether the tongue coating is yellow or white, if the surface is smooth and dry, Aconite (Fuzi) is suitable. If the tongue is red, it is even more indicative of an Aconite syndrome.

If a patient has a white coating on the tongue, with a purple-black hue showing underneath like a cow's tongue, it is an ominous sign. If this tongue presentation is accompanied by facial flushing (floating yang), it is even more critical.

Generally, tongue presentations in various epidemics are similar, so epidemic pox can be diagnosed using the same methods. However, in the case of syphilis (Jiedu), a specific tongue color appears, which must not fail to be distinguished. (White coating with dark spots, redness under the tongue forming wrinkles, and a purple color like a cow's tongue all belong to syphilis.) Saki Tokimori Shiro (a senior official of the Shigarashi clan) suffered from sinusitis (Bi Yuan) for three years. Various physicians attributed it to Lung deficiency, but hundred treatments yielded no effect. Upon examination, I found turbid discharge dripping from both nostrils like rainwater from eaves, a wiry and tight pulse, and abdominal tension. I said: This is caused by Liver fire scorching the Lungs, leading to blockage of Qi between the upper and lower bodies. Worldly physicians, unaware of this, casually attribute it to Lung disease or mistakenly diagnose wind-pathogen invading the Lungs, using only herbs like Xin Yi (Magnolia Flower) and Bai Zhi (Angelica Dahurica). No wonder treatment fails. I prescribed Si Ni San (Frigid Extremities Powder) added with Wu Zhu Yu (Evodia) and Mu Li (Oyster Shell). After about half a month, the illness resolved completely. For such diseases, one should carefully examine the pulse and abdomen; the prescription does not necessarily have to be Si Ni San.

Whenever a patient's chest and diaphragm are not open, the lower body will inevitably feel constrained. Therefore, to regulate the epigastrium, one must first treat the chest and diaphragm; this is a crucial point for physicians. I privately compare this to the single vow of the Pure Land sect (implying exclusive focus).

A woman, twenty days after menstruation, suddenly vomited continuously for several days, with severe rushing pain under the left hypochondrium. She was given Wu Zhu Yu Tang (Evodia Decoction) with American Ginseng (Yang Shen), and she suddenly stabilized.

Postpartum weakness of the waist and knees is often caused by Pi accumulation (masses). If edema or beriberi occurred during early pregnancy, and shortness of breath develops postpartum, administer symptomatic medication. After the previous symptoms resolve, one must carefully examine the abdomen and consult a physician to treat the Pi mass; moxibustion is most important here. If decoctions and moxibustion for Pi masses fail to cure, administer Guizhi Jia Zhu Fu Tang (Cinnamon Twig Decoction plus Atractylodes and Aconite) or Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), and within two to three or four to five days, purge with Zi Yuan (Purple Pill) to achieve recovery. This is the unique brilliance of my late master, Master Dongdong. I, however, combine this with Si Ni San, Li Qi Tang (Regulate Qi Decoction), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), frequently purging with Zi Yuan, often achieving efficacy.

Zi Yuan primarily purges the chest and diaphragm. Thus, it is effective for mania with upward flaming, severe postpartum weakness, and conditions where Qi in the heart and diaphragm cannot descend. Formerly, Master Dongdong used this formula to treat turtle back and turtle chest, following this principle.

For eye diseases belonging to internal miasma, moxibustion is most effective, yet specialists who forbid it are laughable. Other conditions like Huang Feng (yellow wind) and Que Mu (night blindness) due to Liver deficiency require differentiation to avoid misdiagnosis. Huang Feng presents with fine wrinkles and yellow discoloration in the sclera; Ziyin Mingmu Tang (Nourish Yin and Brighten Eyes Decoction), Ba Wei Wan (Eight-Ingredient Pill), or Dan Yang Bao Zhu (Single Cnidium and Atractylodes) are effective. Liver deficiency presents with normal cornea and sclera but blurred vision, making it difficult to treat.

Matsubara Ikken Sai was a teacher and friend of Yoshitsune Dongdong and Yamawata Toyo. Originally a retainer of the Wakasa Lord, he treated turtle back and chest. For patients with chronic paralysis, he used Qi Fei Wan (Revive the Disabled Pill), composed of Rhubarb (Da Huang) and raw lacquer, ground into powder and formed into pills. Taken fresh (one or two qian), it causes intense heat and red rashes as a sign of efficacy, followed by complete recovery when combined with other medications according to the syndrome.

Ikken Sai's disciple, Hashimoto Junji, treated a woman whose hair felt hot and emitted sparks visible in the dark when combed. She recovered after taking San Huang Jia Shigao Tang (Three Yellows Plus Gypsum Decoction).

I personally witnessed a woman returning home whose clothes crackled audibly and emitted sparks in the dark. All these are manifestations of Liver fire and are not surprising. (Zhuoxuan commented: Lang Ying's *Seven Categories Draft*, Vol. 26, contains a section on "Clothing Fire," discussing this same topic. Also seen in Zhang Fangzhou's *Miscellaneous Sayings*: Rubbing human hair or cat skin in the dark produces light and crackling sounds. Westerners consider this evidence of electricity, not necessarily Liver fire. *Yi Sheng* records: My father, Lanxi, knew a noblewoman who sparked when changing clothes in the dark, and sparks flew when combing hair or rubbing against a cat's fur in the dark. This is likely due to strong constitution causing static discharge, not true fire.)

In Shi Zao Tang syndrome with diarrhea, the diarrhea results from intense upper pressure causing heat to sink downward. Thus, its therapeutic intent differs significantly from treating collapse-type diarrhea. Similarly, Chai Hu Xie Xin Tang treats diarrhea differently.

Diarrhea accompanying smallpox/rash is the same as diarrhea in Taiyang syndrome combined disease. However, if it persists for over ten days, it follows the pattern of Shaoyin diarrhea, which is an ominous sign.

Ono Matajuro of Otsu suffered from epidemic hiccups. After five or six days, mild diarrhea appeared, and the pulse became faint and unpredictable. Many physicians deemed it a collapse syndrome and resigned. After examining him for half a day, I told bystanders: This pulse is not ominous; it is caused by hyperactive Liver fire. I administered Si Ni San added with Dihuang (Rehmannia) and Gu Jin Zhi (Ancient Gold Juice). The pulse immediately stabilized, and all symptoms resolved.

For external abscesses (Bian Du) without pus formation, approaching resolution, internal support formulas are ineffective. Administer San Wu Qiu Ye Tang (Three Materials Mulberry Leaf Decoction). If it does not suppurate, add Aconite. If still ineffective, it is generally obstructed by Shan Xia (hernia/masses). Si Ni San added with Aconite yields miraculous results. If there is never any tendency to suppurate throughout, Xiong Huang San (Peony and Rhizoma Curcumae Powder) added with buckwheat can be used to purge.

Pediatric congenital toxins are innate. Worldly physicians ignore this, and those who claim infants accidentally drank lochia during birth are ridiculous. To diagnose this toxin, press the subcostal area with fingertips; condensation in the Heart region indicates the presence of toxin. Its severity can be judged by the urgency of the reaction. Grayish-white, dark, or overly lustrous complexions all indicate congenital toxin. Syphilitic toxin inherited from parents is the most difficult to treat.

If a person has always had one wrist pulse absent, occasional absence is harmless. However, if one wrist pulse suddenly disappears after age forty, it is an ominous sign. This condition is common among those with excessive sexual activity and requires careful observation.

For severe abdominal pain unresponsive to Jian Zhong Tang (Establish the Middle Decoction), diagnosing Water Movement Qi (Shui Fen Dong Qi) and treating with Sha Cao Tang (Sedge Grass Decoction) leads to recovery. For severe rebellious pain under the left hypochondrium unresponsive to various medicines, if Water Movement is present, Di Huang preparations (Rehmannia-based) are effective.

Water Movement manifests in three ways: Those belonging to deficiency-fire of the Liver and Kidneys are suited to Dihuang (Rehmannia), Shanyao (Dioscorea), and Mudanpi (Tree Peony Bark). Movements superficial and generalized are governed by Fuling (Poria). Movements lacking a root, with pulsation at the umbilicus, are known as Kidney Gate Movement and are untreatable.

Mei Cun, a bookseller in Kyoto, stated: Senkoubo in Edo has a miraculous formula for accumulating Qi and Blood called Shun Qi San (Smooth Qi Powder), consisting of equal parts Si Wu Tang (Four Substances Decoction) and Xiang Fu (Cyperus). I found logic in this formula and thus created Sha Cao Tang, which proved repeatedly effective.

A twenty-four-year-old man suffered for five years. His right knee swelled like bound muscles, preventing walking. The appearance resembled Crane Knee Wind, but abdominal examination revealed severe tension below the right umbilicus. Pressing caused severe cramping pain in the right foot, and his temperament was irritable. I diagnosed it as consolidated Liver Pi mass. I administered Da Huang (Rhubarb) and Fuzi (Aconite) added with Gancao (Licorice). After several days, the mass activated, and the condition eased. Then, I prescribed Si Ni San added with Liang Jiang (Galangal), Mu Li (Oyster Shell), and Xiao Lian Qiao (Small Forsythia), resulting in full recovery. Worldly physicians, unaware of this, treat it merely as a leg disease using Ling Xian Cao (Akebia), Du Zhong (Eucommia), and Niu Xi (Achyranthes), failing to cure. One must examine the abdominal signs to treat this. This represents my years of painstaking experience, a novel approach for physicians. (Zhuoxuan commented: This treatment is Master's greatest pride; readers should study it carefully.)

For patients with epilepsy who lose consciousness and cannot swallow medicine, moxibustion is suitable. Large moxa cones are essential. If not thorough, moxa daily and night for seven days. For epilepsy caused by Taiyang syndrome, this method is also suitable. Large moxibustion until epilepsy subsides resolves the pathogen. This principle is not elaborated in medical classics, so worldly physicians fear heat and avoid moxibustion, which is laughable. (Dou Cai said: Using moxibustion is like cooking with fresh salt. People today cannot treat major illnesses precisely because they do not know acupuncture and moxibustion. He also said: Laypeople use only 30-50 moxa cones, not realizing that while removing minor ailments is easy, preserving life is hard. The *Bronze Man Acupuncture and Moxibustion Classic* states: For major illnesses, moxa 500 cones below the umbilicus to tonify and connect True Qi. This is the method. Our views coincide, like Ziyun across the sea.)

Patients with pre-existing hernia/masses who suddenly move the mass location upon contracting a major illness face a very ominous prognosis.

When syphilis toxin fails to express externally, accumulates in the Zang-Fu, and is accompanied by hernia/masses, one must not merely treat the hernia/masses, as they are less urgent than the syphilis. If ominous signs form, one must prioritize protecting against the hernia/masses.

Ikken Sai's disciple, Hashimoto Junji, treated an infant with smallpox/rash affecting the eyes, leaving persistent red membranes. He used a preparation of Sheng Di Huang (Raw Rehmannia), Shao Yao (Peony), Chuan Xiong (Sichuan Lovage), and Dang Gui (Angelica Sinensis). The condition improved daily. This aligns with my teaching of using four flavors to soothe, moisten, disperse, and drain Liver heat, sharing the same intent for treating Liver diseases.

In Taiyang syndrome, mistaken purgation leading to Jie Xiong (chest binding) treated with Xian Xiong Fa (Depress Chest Method) implies the initial purgation was insufficient. Thus, the Depress Chest Method purges again to cure. (Zhuoxuan commented: This insight is rare. Mistaken purgation is often due to insufficient purgation. The original text implies failure to purge; no one since antiquity dared interpret it this way.)

Cheng Qi Tang (Order the Qi Decoction) acts faster against syphilis toxins than mercury agents.

For consumption (Lao Ke) with loose stools, Jian Zhong agents are usable. If stools are not loose but cough, afternoon fever, wheezing, hiccups, and phlegm are present, it is not a Jian Zhong syndrome; administering it worsens the condition.

Consumption does not necessarily start from deficiency. Individuals with strong constitutions suffering from prolonged fractures or non-healing ulcers can also develop consumption. However, this is essentially excess transforming into deficiency.

In Taiyang syndrome, if there is no bowel movement for seven to eight days and the lower abdomen protrudes, it is an ominous sign.

Ono Matajuro of Otsu, after recovering from an epidemic, presented with symptoms resembling consumption: cough and night sweats. I administered Dihuang preparations. Other physicians insisted on Jian Zhong, causing wheezing after five to seven days. Resuming Dihuang preparations cured him. (Zhuoxuan commented: Jian Zhong method must be used only when consumption presents with loose stools.)

Long-term loose stools leading to pale skin and muscle wasting indicate established consumption.

For consumption with loose stools, moxa cones on Tianshu (ST25), Gaohuang (BL43), Pishu (BL20), and Guanyuan (CV4) can also cure. Moxa Gaohuang 21-30 cones; moxa Guanyuan 35 cones.

Moxibustion for epilepsy requires endurance/pain tolerance.

Syphilis can also cause consumption.

Consumption starting with cough inevitably involves hemoptysis.

I once used Shanyao (Dioscorea) and Sheng Huang Qi (Raw Astragalus) added to Si Wu Tang (Four Substances Decoction) to treat pregnancy vomiting with loose stools, continuous leukorrhea, emaciation, and abdominal masses, curing all.

Pi masses and food stagnation in the chest/diaphragm respond well to Zi Yuan (Purple Pill).

Traumatic blood stasis responds to Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) for purging. I treated a woman with abdominal pain from trauma and impending amenorrhea. Cui Gang Qingzhou diagnosed blood stasis in the abdomen, agreeing with me but noting previous multi-dose failures. Using Da Huang Zhe Chong Wan, black stasis passed, and she recovered.

Dysentery preventing medication intake is called Jin Kou Li (Clamped Mouth Dysentery). However, undigested food, chest/diaphragmatic masses, and hardness causing nausea/prevention of intake should not be uniformly labeled as clamped mouth dysentery.

Infant spitting up milk that shoots straight out and stops easily is easy to treat. Spitting up repeatedly, flowing smoothly, is difficult to treat. Differentiate accordingly.

Taiyang syndrome mistakes involve more missed purgations than incorrect ones.

For pregnancy complicated by Taiyang syndrome requiring purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) can be administered. A twenty-six-year-old woman, over three months pregnant, suffered Taiyang syndrome for ten days. Symptoms included cold extremities, fever, delirium, convulsions, constipation, dry mouth, excessive Qi, restless fetus, and sweating on the forehead. Physicians diagnosed Bai Hu Syndrome (White Tiger Syndrome) and used Shigao (Gypsum), Zhimu (Anemarrhena), and Sheng Huang Qi (Raw Astragalus) for many doses without effect. Condition was critical: chest oppression, hard painful abdomen. I predicted Cheng Qi Tang would work; it did. (Zhuoxuan commented: "Having pathology, no injury." This applies. In critical situations, hesitation is forbidden. Not just for pregnancy Taiyang, but for other syndromes too.)

Hemiplegia affects the left side more often.

For smallpox/rash with white color and depressed tops, Bao Yuan Tang (Protect Origin Decoction) is effective.

Syphilis patients developing smallpox/rash often face critical conditions.

Hemiplegia can also be caused by syphilis.

Stroke presenting with open mouth, closed eyes, grasping hands, and urinary incontinence can be treated. I commonly use Liu Jun Zi Tang (Six Gentlemen Decoction) added with ginger juice to cure. Market physicians should carefully examine pulse and spirit before treating.

After Taiyang syndrome, relapse due to fatigue is rare; relapse due to dietary injury is common.

I treated Taiyang syndrome using Cheng Qi method, resulting in dozens of bowel movements, yet sticky black feces remained. How can one adhere to the theory of "one purge is enough"? (Zhuoxuan commented: Accurate diagnosis ensures precise medication. Multiple purgations are acceptable if necessary, but diagnosis must be rigorous.)

Throat bi (obstruction) often progresses too quickly for medication. If medication can be taken, administer urgently.

Postpartum treatment by market physicians rigidly adheres to Sheng Hua Tang (Generate Transformation Decoction). However, one must assess other syndromes prioritizing eliminating stasis and generating new blood. Weigh carefully.

Postpartum wind-stroke with tendon constriction and limb convulsions: Si Wu Tang combined with Shenyao (Dioscorea), Sheng Huang Qi (Raw Astragalus), and Qin Jiao (Gentiana Macrophylla) tonifies and cures easily. Do not simply treat as wind. Abdominal diagnosis seems more reliable than pulse diagnosis; tongue diagnosis is even more reliable than abdominal diagnosis.

My late master, Master Dongdong, frequently used Zi Yuan (Purple Pill) for sticky phlegm and rebellious Qi, demonstrating his skill. However, it is only effective when used appropriately.

Matsubara Ikken Sai treated a woman over thirty with pregnancy leakage. Two doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) combined with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), taken morning and evening, cured her. He also treated a twenty-year-old pregnant woman with leakage. Previous physicians used Bu Zhong Yi Qi Tang and Shi Quan Da Bu Tang without effect. Ikken Sai used Dihuang (Rehmannia) preparations, curing her. One case was Qi deficiency, the other Blood heat. Constitutions differ; treatment must differentiate via pulse and syndrome.

Guizhi Tang (Cinnamon Twig Decoction) treats Bi pain (painful obstruction) effectively.

Beriberi with upward rushing: My late master, Master Dongdong, also used Zi Yuan (Purple Pill) to treat it.

Moxa cones on Zusanli (ST36) can prevent beriberi from rushing upward.

For sores/ulcers, ginger-separated moxibustion acts very quickly.

Taohua (Peach Seed) treats Bi diarrhea and can be used generally.

Jaundice unresponsive to Yin Chen Hao Tang (Artemisia Scoparia Decoction) responds when combined with Wu Ling San (Five Ingredient Powder with Poria).

Infant convulsions are not always due to wind; they can stem from phlegm, food, or heat. Convulsions after long-term diarrhea or major illness are common. Fuzi Lizhong Tang (Aconite and Ginger Warming Middle Decoction) often works rapidly. Market physicians rigidly stick to Jing Feng (Wind Shock) treatments using Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig) methods, saving few. (Zhuoxuan commented: Awakening the deluded masses, the merit of saving lives is great.)

Moxibustion is very effective, but some Bi pains cannot be treated with it. Syphilitic Bi pain mostly cannot use moxibustion; moxa worsens it. Be cautious.

Massage is suitable for infants because medication errors are easy.

Detoxifying agents curing wind rash may still have hidden syphilitic complications.

Strong individuals with syphilis may clear fire-toxin gradually without medication. Using Dang Gui (Angelica), Sheng Huang Qi (Raw Astragalus), and Shao Yao (Peony) to treat the Liver often achieves recovery.

After Taiyang syndrome, large purgation with Cheng Qi Tang may result in thick, scorched yellow tongue coating; re-purgation is necessary. Heat may intensify after purgation; re-purgation cures. Market physicians fear re-purgation, but I see fewer deaths from purgation and more from missed purgation.

Turtle back and chest are often caused by syphilis.

Scrofula (Luo Li) can also originate from syphilis; careful examination is required.

Zhi Yin (branching fluid) easily transforms into edema. Li Zhong Fa (Warming Middle Method) combined with Jin Gui Shen Qi Fa (Golden Cabinet Kidney Qi Method) is effective.

I treated a man with asthma worsening in summer and improving in winter, distinct from others. Qing Long Fa (Green Dragon Method) failed. Xiang Ru (Mosla) combined with Liu Yi San (Six-to-One Powder) cured him. Treating asthma with summerheat remedies worked because the asthma originated from summerheat. Thus, "seeking the root" is credible. During the Korean campaign, many suffered asthma; Green Dragon failed. Regrettably, I did not examine this deeply then.

Sudden fainting with sweating, cold limbs, and ruddy complexion indicates certain death.

Sudden fainting in the elderly with wiry, tight, or革 (leather-like) pulses is ominous. Same for Zhi Yin with floating yang on the face, which is especially fatal. (Wen Gong's Poetry Talks: Normal luster is fine, but sudden extreme luster is a death omen. Like dying grass flashing brilliance, physicians must know this.)

Those with strong constitutions occasionally damaging the Lower Origin, with deficient fire flaming upward, compounded by epidemic pathogens, may be misdiagnosed as excess and given Da Chai Hu Tang (Major Bupleurum Decoction). One purge may cause sudden collapse. Hence I say: Observe color not just with eyes, listen to sound not just with ears.

Cough originates from Heart/Lung or Stomach; failing to distinguish renders treatment ineffective.

Abdominal pain unresponsive to various medicines: Xiang Su San (Perilla and Tangerine Peel Powder) added with Qing Pi (Green Tangerine Peel) and ginger decoction hits miraculously, especially for severe pregnancy abdominal pain. (Pioneered by philosophers during the Korean campaign. Worldly physicians' ignorance is pitiable.)

Consumption patients show flesh loss at the collarbone first, different from general emaciation. Examine carefully. (Zhuoxuan commented: This is a major sign for diagnosing consumption, revealing it to students is profound. *Su You Zhuan Shi Lun* states: If spinal and arm muscles waste away, and chest bones protrude, it is hard to treat. *Ling Shu · Wu Bian Pian* states: Thin arms indicate insufficient marrow, prone to cold/heat. Dongguo's theory has origins.)

Long-term epilepsy/mass patients becoming irritable after recovery face an ominous prognosis.

Nocturnal emission and white turbidity often belong to hernia; generally not deficiency. Same for Qiang Zhong disease.

Lower bleeding due to damp-heat in Lower Jiao with deficiency: Yin Chen Si Ling Tang (Artemisia Four Poria Decoction) added with Fuzi (Aconite). Intestinal wind bleeding with water-fluid retention in intestines/stomach: Si Jun Zi Tang (Four Gentlemen Decoction) added with Huang Qi (Astragalus) and Bai Bian Dou (White Hyacinth Bean). Deficiency-cold in stomach and Lower Jiao: Zhen Wu Tang (True Warrior Decoction). Hemorrhoidal bleeding can also be treated generally by this method.

Gan Cao Fen Mi Tang (Licorice, Flour, and Honey Decoction) is effective for severe scrotal pain.

In Taiyang syndrome, purging with Da Chai Hu Tang or Chai Hu Jia Mang Xiao Tang. After heat removal, if Liver Qi moves violently causing delirium and madness, Zhu Ru Wen Dan Tang (Bamboo Shavings Warming Gallbladder Decoction) calms it. Worldly physicians, unaware, often mistreat with incorrect purgation.