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Background Information:
Book: Xianzhe Yihua (Conversations of Ancient Sages on Medicine)
Chapter: Gaoduan Zhiyuan (Part 1/2)
Category: Medical Discourse

Translation:
Zhiyuan, whose given name was Jingxuan and courtesy name was Zishun, belonged to the Gaoduan clan. During the Wenhua and Fangzheng eras, he gained fame in the capital for his medical skills. His benevolence and relief efforts benefited people of his time. After retiring from official duties, he lived in seclusion at Yingfeng, enjoying a leisurely life and self-cultivation, passing away at the age of seventy-three. Descending from renowned physicians such as Fengting, Taizhou, and Dongguo, Zhiyuan integrated various medical techniques with great acumen. His works, including *Yipu* (Medical Canon), *Fangpu* (Prescription Canon), *Yaopu* (Medicine Canon), and *Renzheng Lu* (Record of Syndrome Differentiation), offer a glimpse into his expertise. Herein, excerpts are recorded for reflection and enlightenment. Others such as Sanjiao, Xiaolin Zhuzhong, and Youchi also enjoyed successive reputations, but details remain unknown to me; thus, I hope to supplement them another day.

Diagnosis involves four causes, six syndromes, twelve signs, three examinations, and seven inspections. The four causes refer to external causes, internal causes, separate internal-external causes, and combined internal-external causes. The six syndromes refer to initial, middle, terminal, favorable, dangerous, and adverse stages. The twelve signs include cold, heat, deficiency, excess, superficial, deep, slow, urgent, stable, intermittent, normal, and variable conditions. The three examinations consist of pulse taking, abdominal palpation, and assessment of constitutional endowment. The seven inspections involve inquiring about the origin, seeking symptoms, observing complexion, viewing body shape, listening to voice, smelling odor, and careful study. These five methods comprising thirty-two rules are legacies of ancient Hehan sages and have been verified by our school. Those who carefully diagnose disease origins and syndromes must thoroughly investigate these principles.

In the early stage of epidemic febrile diseases (Wenyi), if appetite remains unchanged, taste is normal, spirit is clear, and daily activities are unaltered, fever will likely resolve. If appetite decreases or ceases when food is about to be taken, leading to weakness of Yuan Qi (Vital Energy), this occurs occasionally and should not be confused with mild epidemics where appetite remains good. For epidemics from onset to fever resolution, if food intake is poor, there is no need for excessive worry.

If a person suddenly faints and loses consciousness, then wakes with mental confusion, weak legs unable to stand, followed by burning body heat, dry mouth and tongue, frequent delirium, speech errors, spontaneous sweating, severe phlegm-wheezing, and irritability resembling stroke with hemiplegia, or accompanied by diarrhea/vomiting, hiccups, or slightly cold limbs, treating it as wind-stroke is an error. This results from severe epidemic heat transmitting directly inward, causing Yuan Qi depletion. It commonly affects those with weak constitutions and the elderly. Use Chaihu Runzao Tang (Bupleurum Moistening-Dryness Decoction) or Chaihu Gualou Tang (Bupleurum Trichosanthes Decoction). For phlegm-wheezing, Loubei Yangrong Tang (Trichosanthes & Fritillaria Nourishing-Nutrient Decoction) is suitable, though often incurable.

If epidemic disease lingers unresolved or pathogenic factors sink, suddenly transforming into Hongkong Jiao (Japanese Foot Disease / Beriberi), it is a critical sign.

If fingers twitch slightly at the onset of an epidemic, epilepsy may follow, which is difficult to treat.

After recovery from Cold Damage (Shanghan), epidemics, malaria-dysentery, or cholera, Hongkong Jiao may occur, or unresolved illness may transform into it. Unaware physicians mistakenly treat it as post-illness water qi, leading to death from upward rushing affecting the heart. Caution is required.

Postpartum Hongkong Jiao presents with numbness, bi-syndrome, weakness in limbs, difficulty moving, mental restlessness and palpitations, insensitivity in the abdomen, constant bodily heat, generalized or slight swelling, obesity/distension, tense sinews, emaciated/tense sinews, urinary retention, and a tight, forceful pulse. Use Xijiao Mahuang Tang (Rhinoceros Horn & Ephedra Decoction). Mistaking headache, rushing qi, and scant lochia for blood-qiu disorders and using blood-regulating agents is incorrect.

Wind-swelling (Fengzhong) manifests behind ears/neck (upper), chest/shoulders/back (middle), or thighs/shins (lower). Flowing accumulation swelling resembles carbuncles, being either congested or diffuse, painful or painless, resolving or suppurating. Initial signs include aversion to cold, high fever, headache, and body ache (exterior signs). Swelling behind ears/neck ranges from size of Luan seeds to pears. With exterior signs, use Jingjie Baidu San (Schizonepeta & Toxin-Resolving Powder).

Initial wind-swelling, if not distinguished from wind-cold or seasonal pathogens, may appear after exterior signs resolve, during exterior signs with swelling and heat resolution, with periodic chills/fever like malaria, continuous fever resembling warm diseases, or solely as swelling without exterior signs.

For measles, spontaneous sweating at onset indicates pathogen release via sweat. Vomiting indicates release via upper jiao. Diarrhea/vomiting indicates release via upper/lower jiao. Epistaxis indicates release via blood. These are auspicious signs; do not hastily use antiperspirants or hemostatics. Smooth eruption leads to natural recovery.

At measles onset, use Detoxifying, Shengma, Gegen, Muscle-Releasing, Yuebi, Lianqiao, or Liange decoctions. Failure to erupt is due to epidemic qi constraining toxin; use Qiyun Tang (Uncover Accumulation Decoction) to disperse epidemic qi for eruption. (Note: Qiyun Tang is a family formula of Gaoduan, containing Chaihu, Huangqin, Houpo, Banxia, Cao Guo, Zhishi, Gancao, Shengjiang—eight herbs, a variation of Jiawei Qingpi Tang.)

After eruption, if color is cinnabar-like but dull, spots are uneven/muddy, base pale red/dark, with fever/thirst, red eye vessels, bad breath, dry/cracked lips/tongue, restlessness, scant dark urine, and constipation, this is internal latent heat-toxin scorching blood. Use Liangxue Gongdu Yin (Cool-Blood Attack-Toxin Drink) with Xijiao and Shigao, or Dusheng San/Zixue. If spots are scorched purple/red macules with high fever, intense thirst, dark/scanty urine, hard stool, foul breath, mania/delirium, and irritability, use Yujin San. Sleep after administration brings mental clarity.

[Absent character, likely referring to 'Jia' or mass] disease occurs in the epigastric/hypochondriac region (upper), above umbilicus (middle), or lower abdomen (lower). It may surface or sink, support or invade hypochondria, be round/oval/flat/protruding, large like fists/turtles, small like eggplants/pears, hard as stone, soft as flesh, or flaccid as cotton. It may pull shoulders/back, cause spinal stiffness, pain or no pain, lower abdominal weakness, or sensation of narrowness. Pulse is typically deep/slow. In lower abdomen, starts small (walnut/egg), grows large over time, becoming round like pregnancy or squatting. Large masses fill abdomen like pumpkins, central or lateral, floating or fixed upon pressure. Painless or mildly painful, menstruation regular or heavy, mass expands. Eating/talking normal, only hindered when bending. Named Changtan (Intestinal Polyp/Mass). Difficult to cure, but not fatal; may shrink over years. Early use of Tongqi Songzhi agents (Qi-moving, stagnation-relieving) like Wuling Tongqi San may prevent it.

Jielao and Huan [missing char] Er Tang treat precursors of consumptive disease. Add Renshen (Ginseng) for weak abdomen. Add Beimu, Sangbaipi for mild cough. Add Digupi for deep heat. (Zhiyuan’s verified formulas, ancient or folk, constitute one-quarter of his practice, e.g., Huan [missing] Tang, Runfei Tang, Jiawei Chaihu Tang, often effective.)

When hernia heat is severe, causing delirium, thirst, yellow/white tongue coating, dysentery-like stool, lower abdominal cramping, unbearable lumbar/gluteal pressure, use Rongshan San. For severe heaviness/bearing-down, add Dahuang. Hernia without trigger, sudden hard lower abdominal pain radiating to hypochondrium, shortness of breath, intolerance to touch, agitation, fever resembling warm disease, thirst, dysuria, constipation, vomiting, hiccup, rising from lower abdomen to heart or pulling testicle, inability to lie down, abdominal distension with drum-like sound, is named Chongshen (Rushing Hernia). Mostly heat-type; use Rongshan Jada Huang Tang.

Neck tubercles in infants/children are俗称 as precursors of tuberculosis (Laobing). Not always true, but possible. (Note: *Jinkui Yaolue* states intestinal rumbling, machete-neck nodes indicate consumption. Neck nodes were considered a sign of consumption.)

Initial consumptive disease (Xulao) presents with abdominal fullness/hardness/pain, radiation to lower abdomen/cough, night sweats, low-grade fever, postprandial bloating, anorexia, frequent diarrhea (4-5 times/day), passage of intestinal mucus, relief after defecation, worsening if not, shortness of breath, agitation, prominent neck veins, dry throat/vomiting urge, slight limb edema with full dorsum pedis, throat noise, nasal flaring, unbearable abdominal pain, fatigue. Our school calls this Zhangfu Lao (Abdominal Distension Consumption). Pre-existing masses turning into consumption are often incurable. If Chai Ping Tang or Chaihu Binglang Tang hardens stool, reduces distension, stops pain/fever, it is a good sign. This is an adverse sign in consumption; misdiagnosing as simple distension is a major error.

Cold Damage with Guizhi syndrome plus vomiting is often due to retained fluids rejecting mild pathogens. Treating fluid retention resolves pathogen; thus, use Hexie Tang (Harmonizing Decoction) instead of Guizhi Tang.

Adding Qi-regulating herbs to diaphoretic agents accelerates efficacy by unblocking airways and expelling pathogens. Exception: severe pathogens. (My father added Gegen, Qianghuo, Jiegeng to Erchen Tang for mild wind-cold, following this principle. Note: During General Toyoda’s Korean campaign, many suffered exogenous pathogens; Bu Huan Jin Zhengqi San failed. An old physician in Oni General’s unit used Xiangsu San with immediate effect. Reason: Long campaigns cause Qi stagnation; Qi-agents are necessary. Kitayama Juian noted Xiangsu San treats colds, Qi stagnation headache/fullness, and foot disease, but its food-toxin resolving power is overlooked. Refer to this section.)

Warm disease with complete interior signs but slippery white tongue coating suggests Zangjie (Organ Knotting); do not miss the chance to purge. Verify other signs before purging. For chronic constipation patients, sudden slippery/watery stool in warm disease is not due to stomach deficiency/pathogen aggression. Delayed purging consumes Stomach Qi irreparably.

During hot baths, body feeling bound or poured with cold water indicates heat in muscle/surface.

*Qianjin Fang* considers floating pulse exterior and sunken pulse interior, a standard for physicians. Practically, floating pulse indicates dispersion/depletion, sunken pulse indicates closure/constriction; both can be Yin or Yang, so they cannot definitively determine exterior/interior.

Summer enuresis due to summer-heat uses Baihu Jia Renshen Tang. (Note: Some argue "enuresis" in Three Yang Combined Disease belongs under "delirium after sweating." Plausible, but real cases exist; verify clinically.)

Shoulder/back heaviness like 1000 jin spreading to whole body, followed by cold sweat, severe palpitations/agitation, then sudden relief, indicates impending stroke or Zhiyin (Supporting Fluid).

Wind disease coma recurring quickly is difficult to treat.

Post-stroke recovery with shoulder joint separation/dislocation is difficult; minor separation may heal. Hongkong Jiao without limb numbness/weakness/swelling/spasm, but with subcardiac urgency, lower abdominal insensitivity, normal appetite, postprandial shortness of breath, relieved lying down, upper body full/lower body thin, indicates upward rushing; do not ignore.

Dry Hongkong Jiao with hoarse voice/phlegm obstruction is often fatal.

Zhiyin, Hongkong Jiao, and Postpartum Blood-Qi diseases share similar symptoms but different origins; distinguish by pulse. Large pulse, empty on pressure = Zhiyin. Surging-rapid, tight-forceful on pressure = Hongkong Jiao. Weak-rapid, intermittent on pressure = Postpartum Blood-Qi. (Note: These three differ significantly; examine carefully.)

Lung萎 (Feiwei) with copious frothy sputum suddenly bleeding and fever is a bad omen.

Persistent cough with blood-streaked sputum or petechiae indicates Lung damage; seemingly mild externally but difficult to treat. I formulated Baiji Tang (Bletilla Decoction): Jiegeng Tang plus Baiji, Sangbaipi.

Consumptive hemoptysis varies: blood threads in sputum, or granules (bean-sized). Even minor bleeding must not be ignored.

Long-term cough with blood threads/petechiae indicates Lung damage; minor other symptoms still lead to incurability. Use Baiji Tang early. "Non-eating disease" (Bushi Bing) corresponds to Shenxian Lao in *Yiji*. Common in women, rare in men. Craving fried snacks/beans, fruits, raw vegetables, kelp/seaweed. Severe cases fast on grains, drink only water, yet muscles remain moist, activity normal, urination normal, constipation, dry mouth/thirst, lasting over a year. Originates from Qi stagnation; use Qi-regulating agents, not tonics.

Sudden decrease in appetite without cause signals major illness; cultivate health. Delay makes treatment futile. Acute decrease is treatable; gradual is difficult. Shenxian Lao differs despite anorexia.

Asthma with rapid pulse indicating Yin deficiency/Fire hyperactivity uses Ziyin Jianghuo Tang. Interior excess, constipation, forceful pulse uses Chengqi Tang.

Childhood asthma cured later may develop epilepsy, Xin Feng (Heart Wind), or seizure disorders due to congenital residual toxins; difficult to treat.

Childhood asthma treatment may transform into epilepsy, mania, Xin Feng, or vice versa. Adult-onset of these five diseases also stems from congenital toxins, differing only in Qi timing. Our school calls this Taibing (Fetal Disease), originating from *Suwen*.

Wind-phlegm patients with periodic fever/chills/headache/body ache, stiff shoulders/back, sore throat suffer from phlegm, not colds; commonly called Tan Feng (Phlegm Wind).

Chest Bi pain in skin/flesh is a bad omen.

Back pain (left/right) worsening with movement, sudden relief, often transforms into chest pain resembling Chest Bi but caused by sinew twisting. Causes shortness of breath, mild dysphagia. Pain differs from Chest Bi's penetrating pain; use Guixin San from *Beishi Fang*.

Hiccups unresponsive to hot herbs indicate constrained heat; use Xiexin Tang or Mafei Tang for quick recovery. (Note: *Wanbing Huichun* uses Huanglian Jiedu Tang/Baihu Tang for Cold Damage heat. Misuse of Ginger/Cinnamon aggravates fire/phlegm causing hiccups; same principle.)

Bitter/sour/astringent taste predicts Yige (Dysphagia); bitter-only is easier to treat.

Trauma with unresolved blood stasis causing late-onset shortness of breath, subcardiac rushing, coma, delirium, or amnesia is Blood Stasis mimicking wind.

Generalized edema with wasted/dry hands is incurable.

Female limb numbness often due to emotional stagnation/blocking meridians. Use Zhengqi Tianxiang Tang, or Xiangsu San + Erchen Tang + Wuyao.

Chronic female depression with vaginal pain/itching, discharge, poor appetite, fatigue uses Jiawei Guipi Tang. Heart blood deficiency leads to palpitations; use Siwu, Bazhen, Shibu, Renshen, Yangrong decoctions plus Maidong, Suanzaoren.

Changfeng (Intestinal Wind) usually lacks shortness of breath/tinnitus but may have dizziness.

Excess-type dizziness uses Fangfeng Tongsheng San plus Juhua.

Spontaneous dream vagueness, speech errors, hand tremors, flushed face/ears, laughter/grasping gestures, staring, then sudden clarity in robust individuals with dietary/emotional issues and labor fatigue is Xinhuang (Heart Palpitation/Stagnation). Untreated leads to wind-epilepsy. Start with Mituseng Wan, then Qingshen Tang or modified Qingshen Tang.

Rain-induced back pain uses Shen Shi Tang or Chushi Tang.

Sudden persistent night sweats with normal diet/activity/stool, scant urine, indicates water fluid seeping pores. Promote urination early with Fuling Gancao Tang; avoid astringents. If urination fails and sweating stops, edema/diarrhea may follow.

Tinnitus hearing only bells/clappers, losing other sounds, indicates impending deafness.

Epilepsy with foot/knee pain differs from Lijie (Joint Bi).

Anal worms in 10-year-olds, clustering like lanterns, causing itching, predict tuberculosis in young adulthood.

"Crane Chest" is likely "Chicken Chest." In children, it relates to Gan syndrome; in youth, epilepsy.

Infants healthy at 7-8 months gaining weight, fever (like cold/malaria), green vomit/stool, shiny scalp, fontanelle full/sunken, sleep twitching, indicate impending Yin Epilepsy. Misdiagnosed as fetal fat by quacks.

Children aged 4-5 with monthly epistaxis (5-6 spoons to cups), dark/thick or bright/thin blood, accompanied by qi reversal/red face, cold extremities, hunger, constipation, frequent urination. May follow breast lumps/abdominal pain or chickenpox. Modify *Qianjin* Zhuru Tang: remove Shaoyao, Renshen, Baizhu, Rougui; add Maidong, Huangqin, Zhizi, Shengma.