Library

Mu Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Hua Fen (Tetrastigomatis Rhizoma), and in severe cases Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhenae Rhizoma) are used to quench thirst. These are all tangible fluids used to irrigate intangible fire, merely causing water and fire to contend with each other; how can they nourish the True Yin within the Kidney? If Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) is taken in large doses, the thirst will be cured immediately, so why would it transmit to the Shao Yin channel and form symptoms of dryness, excess, and hardness? Once these symptoms of dryness, excess, and hardness have formed, Zhang Zhongjing had no choice but to use Cheng Qi Tang (Purgative Decoction) to purge them. This is a temporary, coercive measure, yet he repeatedly warned against its use in patients with deficiency, the elderly, and the weak, thus sometimes substituting Da Chai Hu Tang (Major Bupleurum Decoction). Tao Hua (Tao Jie'an) substituted Liu Yi Shun Qi Tang (Six-Yi Regulating Qi Decoction); did he consider these two decoctions to be mild? Although substitution led to recovery, much was lost in terms of vital energy. Moreover, how many failed to recover—eight or nine out of ten! At that time, if Liu Wei Di Huang Yin Zi (Six-Ingredient Rehmannia Drink) had been used more frequently and taken in large doses, although the effect might have been slow, the benefits would have been infinite. Furthermore, patients with Yin deficiency fever necessarily have scanty urine and constipation; their upper symptoms such as thirst and irritability are no different from those in Shang Han (Cold Damage). Those who used Cheng Qi Tang were merely following the principle that "excess causes harm," using purgation to support and preserve the Qi of True Yin. Now, by directly exploring the source of True Yin and tonifying it, it is like rain falling during a severe drought, moistening both earth and water, instantly turning the world cool and refreshing. Why should this not be done? Moreover, once Kidney Water is deficient, another round of purgation leaves no hope for survival. Be cautious, be cautious! This is Zhao Xianke's innovative theory, truly a scholarship that probes the root and exhausts the source.

Note: Yin Excess Repelling Yang and Yang Excess Repelling Yin are two conditions extremely difficult to distinguish. When Yin is excessively strong, it repels Yang to the exterior, resulting in external heat and internal cold; when Yang is excessively strong, it repels Yin to the exterior, resulting in external cold and internal heat. This is what the Classic states: "Extreme Yin transforms into Yang, extreme Yang transforms into Yin; extreme cold generates heat, extreme heat generates cold." Differentiation should be based on urination: clear urine indicates that despite external dryness and heat, the interior is cold; dark urine indicates that despite external cold limbs, the interior is hot. Observe the moisture of the mouth and the depth of the tongue coating. The tongue is the sprout of the Heart, corresponding to the Fire of the South. When the pathogen is in the exterior, no coating forms; when the pathogen enters the interior, body fluids bind together to form a coating. A slippery white coating indicates heat in the Dantian and cold in the chest, with the pathogen at the half-exterior half-interior level. As heat penetrates deeper, the tongue becomes dry and rough, indicating heat gathering in the Stomach; in such cases, Cheng Qi Tang (Purgative Decoction) and Bai Hu Tang (White Tiger Decoction) are appropriate. If a heat disease causes a dry mouth and black tongue, it signifies that Kidney Water fails to control Heart Fire, indicating deep heat and critical illness. However, there are also cases of black coating due to cold, characterized by the absence of prickles on the tongue and the presence of saliva in the mouth. Even the clarity or turbidity of urine, the moisture or dryness of the mouth, and the slipperiness or roughness of the tongue coating all depend on the flourishing or withering of body fluids, and are insufficient grounds for hasty judgment of cold or heat. Therefore, one must carefully differentiate based on whether the pulse is forceful or feeble. In summary, physicians must adapt flexibly to changing circumstances, remaining agile and not rigidly adhering to a single formula or herb. One need not treat the disease solely with herbs, but rather use herbs to regulate the pulse. The Qi and Yun (Luck/Climate) of ancient and modern times differ; old formulas cannot perfectly match new diseases. One should read the books, expand their meaning, examine the formulas, grasp the principles, and through quiet contemplation, naturally acquire their spirit. As Luo Tianyi比喻ed, it is like rebuilding a new house from old materials, ensuring precision and stability.

External contraction headache presents as continuous pain, feeling as if bound by external pathogens. Internal injury headache comes and goes, feeling like internal distension. This arises from Blood deficiency, with deficient Fire rushing up to the Ni Wan Palace (the brain). In internal injury, the palms are hot while the backs of the hands are not; in external contraction, the backs of the hands are hot while the palms are not.

Treating Yin syndromes focuses on rescuing Yang; treating Shang Han (Cold Damage) focuses on rescuing Yin. However, even if Shang Han involves Yang deficiency requiring treatment, one must first assess if the patient has sufficient flesh and blood, and if the Yin aspect can tolerate Yang-tonifying herbs, before attempting to restore Yang. If the face is sallow/black, the tongue is black, and the body is like dried firewood with a mass of pathogenic fire burning internally, the Yin has already been exhausted. How dare one use Yang-restoring herbs to further deplete Yin?

The *Shang Han Lun* states: "Yin syndromes with Yang pulses indicate survival; Yang syndromes with Yin pulses indicate death." Everyone reveres this statement without exploring its meaning. When Zheng Qi (Upright Qi) is deficient and Xie Qi (Pathogenic Qi) is vigorous, leading to prolonged non-recovery, tonifying Zheng Qi will cause Xie Qi to eliminate itself; this typically presents with a deficient, fading Yin pulse. Those with substantial Zheng Qi often show Yang pulses; those with deficient Zheng Qi often show Yin pulses. Yang symptoms represent false excess; Yin pulses represent true deficiency. Chen氏 said: "When examining Yin syndromes, regardless of the presence or absence of heat, rely solely on the pulse for medication, and you will rarely fail." Regardless of whether the pulse is floating, sunken, large, or small, if it is feeble upon heavy pressure, it indicates hidden Yin; cooling agents are contraindicated, and violating this leads to death. Thus, while people know that sunken/small pulses are Yin pulses, they do not realize that floating/large pulses can also be Yin pulses. Any internal injury to Heart Qi results in a feeble pulse, which must not be overlooked. Hence, all diseases, with their myriad changes, can be summarized by the two characters "Excess" and "Deficiency," not just Shang Han. It is a struggle between one Excess and one Deficiency, where Zheng and Xie vie for supremacy; if Zheng wins, recovery occurs; if Xie wins, death ensues. Those with substantial Zheng Qi suffer only mild illness even from major pathogens; those with deficient Zheng Qi suffer severe illness even from minor pathogens. Therefore, for diseases caused by Excess Qi, removing the pathogen is straightforward; for diseases complicated by Deficiency, if Deficiency is not tonified, how can the pathogen retreat? Unfortunately, the saying "Shang Han has no tonification method" has led many with deficient Shang Han to remain stubborn and wait for death, which is lamentable! Have we not seen that Zhang Zhongjing, the ancestor of Shang Han treatments, established 396 methods? Over 100 involved pulse and symptom patterns of deficiency and cold. Among his 113 prescribed formulas, 30 contained Ren Shen (Codonopsis Ginseng Radix), and over 50 contained Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Preparata). Even Li Dongyuan, Zhu Danxi, and Luo Tianyi utilized formulas like Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Hui Yang Fan Ben Tang (Restore Yang and Return to the Root Decoction), and Wen Jing Yi Yuan Tang (Warm the Channels and Enrich the Primordial Qi Decoction). They certainly included tonification. Who says Shang Han has no tonification method? Moreover, nowadays, six or seven out of ten Shang Han cases involve underlying deficiency, and eight or nine out of ten deficiency-like conditions mimic Shang Han. Repeating this erroneous phrase leads to mistreatment: failing to tonify deficiency and instead attacking it brings imminent danger. People do not realize that failure to sweat after dispersing agents indicates withered body fluids, preventing Yin Qi from reaching the exterior. People know sweat belongs to Yang and that raising Yang can release the exterior, but they do not know that sweat is born from Yin; nourishing Water is equivalent to inducing sweating. If clearing heat fails to reduce fever, it is because Yang lacks Yin to contain it, indicating Yin insufficiency. People know cold-natured herbs can remove heat, but they do not know that nourishing Yin reduces Yang. For internal invasion of Yin Cold due to deficiency of Primordial Yang, strengthening Primordial Yang dispels external cold. For lingering or tidal fever due to Spleen-Stomach deficiency failing to store and accept Primordial Yang, tonifying Spleen-Stomach converges floating Yang. Know that when Zheng Qi is insufficient, Xie Qi is excessive; if Zheng cannot overcome Xie, Xie will not resolve. Once Zheng Qi is strengthened, Xie Qi has no place to reside; the exterior resolves without dispersing, and Xie retreats without attacking. Today, people ignore deficiency and excess, and upon seeing fever, prioritize attacking Xie Qi, injuring Zheng Qi before Xie Qi is gone. This disaster stems from a single phrase. Since Zhang Zhongjing, worthy scholars have arisen continuously; their writings are detailed, but the abundance confuses practitioners. Tao Jie'an said: "Grasping the essence makes it easy as picking up a mustard seed; it lies in pulse, symptoms, and principle." Seeking too many divergent paths leads to fragmentation, like asking for directions while crossing the sea. Pulse and symptoms refer to Exterior/Interior, Yin/Yang, Excess/Deficiency, Cold/Heat. Principle refers to knowing the constant and adapting to change. Divergent paths refer to proliferating medical texts.

Shang Han contracted in Autumn and Winter is True Shang Han. Shang Han contracted in Spring and Summer is Cold Epidemic. These are distinct from Warm Diseases and Heat Diseases that manifest after a long latency period; they cannot be treated identically. People only know of external cold contraction and ignore internal cold injury. Even mislabeling it as "sexual exhaustion Yin syndrome" is incorrect. Any condition caused by consuming cold foods damaging the Middle is an internal injury Yin syndrome, not limited to sexual exhaustion. Sexual exhaustion does not always cause disease; Yang syndrome headaches with fever simply require avoiding cold-natured herbs lightly. Assuming any history of sexual activity mandates Yin syndrome and warm herbs, or assuming no sexual activity mandates Yang syndrome and cold herbs, without relying on pulse diagnosis but only on inquiry, kills many. Thus, Yang syndromes mostly arise from Wind-Cold-Damp-Heat, with pathogens originating in the Tai Yang channel entering from outside. Yin syndromes mostly arise from diet, daily routine, and Seven Emotions, with pathogens originating in the Shao Yin channel rising from within. Internal injury in Shang Han accounts for eight or nine out of ten cases. Rescuing the Interior and releasing the Exterior are worlds apart. If Gui Zhi Tang (Cinnamon Twig Decoction) is ingested in Yang Excess, death follows; if Cheng Qi Tang (Purgative Decoction) enters the Stomach in Yin Excess, death follows. Can one neglect differentiation? Generally, if one truly knows it is Yang deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); if truly Yang deficiency with direct transmission, use Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction); if truly Yin deficiency, use Liu Wei Shen Qi Tang (Six-Ingredient Kidney Qi Decoction); if truly Yin deficiency without Fire, use Ba Wei Shen Qi Tang (Eight-Ingredient Kidney Qi Decoction). For pseudo-symptoms resembling Yin or Yang, use the method of "treating cold with heat" (counter-assimilation) to follow the false presentation, without error. Focus primarily on tonifying Zheng Qi; there is no need to attack Xie Qi. When Zheng Qi gains strength, it naturally expels Cold Xie Qi, leading to sweating and recovery. The character "attack" is abhorrent to benevolent people. Winning every battle is good at war; subduing the enemy without fighting is the best of the best. Thus, it is said that those skilled in war receive punishment (implying warfare is ultimately disastrous).

Those with inherently weak Yuan Qi (Primordial Qi), excessive sexual indulgence, and loose pores allow Cold Xie Qi to enter directly into the Three Yin channels. Hence, Yin syndromes at onset do not present with sudden heat symptoms. If not treated immediately, deficient Yang is forced upward, presenting with red face and irritability, named Yin Excess Repelling Yang, or Extreme Yin Mimicking Yang. The patient may restlessly desire to sit in a mud-well; although thirsty and irritable, they do not wish to drink. If the pulse is flooding and rapid but feeble, it indicates Yin deficiency with floating False Yang; treat with Ba Wei Di Huang Tang (Eight-Ingredient Rehmannia Decoction) plus Niu Xi (Achyranthis Bidentatae Radix) and Wu Wei Zi (Schisandrae Fructus). If all six pulses are sunken, minute, and feeble, it is the true image of Yang deficiency; treat with Ren Shen (Codonopsis Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), and Gui Zhi (Cinnamomi Ramulus). If a disease originally belonged to Yang, had not transmitted inward, but was mistakenly treated with cold herbs, or excessive cold water was drunk, transforming it into a Yin syndrome, or excessive cold food or cold water after meals caused a "Food Yin" disease, all should be treated as Yin syndromes, focusing on warming the Middle. Thus, use Zhi Gan Cao (Prepared Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), and Gui Zhi (Cinnamomi Ramulus), avoiding Di Huang (Rehmanniae Radix) and Zhu Yu (Corni Fructus). If the pulse is feeble, but external symptoms include body heat, spontaneous sweating, fatigue, hot palms and soles, intermittent chills, loss of taste, and hesitant speech, this belongs to internal injury of Yuan Qi and requires tonifying the Middle, such as with Ren Shen Yang Rong Tang (Codonopsis Nourishing the Vigor Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). There is no need for harsh tonics or hot herbs like Gui Zhi and Fu Zi. However, human life relies solely on this one Yang Qi. In cases of Yang collapse with sunken, minute pulses, Yuan Yang is about to escape, life hangs by a thread. Even with harsh tonification, plant properties require the body's own Zheng Qi to generate effects. If the person's fundamental Qi is unstable, from where can the medicinal power be stimulated? It is like filling a void; the patient may briefly improve then relapse into weakness. Harsh tonification again yields only temporary relief. One must carefully observe, nurturing Yin to save Yang, and Yang to save Yin, continuously without pause, avoiding bias or delay. Ensure Yang arises first and Yin grows later; do not let Yin prevail until Yang perishes. After seven days, the Five Zang organs complete their transmission cycle; after half a month, solar terms shift. Then Zheng Qi can generate through this foundation, securing the root against sudden collapse. In collapse syndromes, saving Yang is paramount because as long as one part of Yang remains, death does not occur; thus, Yang is the mechanism of growth. Tonifying Yin makes the Yin path hard to grow, merely allowing Yang to perish. Moreover, if the Ming Men Fire (Gate of Life Fire) remains in its position, no disease arises. All diseases arise because the True Fire has left its position. Therefore, in treatment, although diseases vary, one must cherish this Fire as the foundation for eliminating disease! (Zhang) Chen's humble opinion, understood by the wise.

If the condition is七分 (70%) external contraction and 三分 (30%) internal injury, use mild and small doses of external-contracting medicines, with Ginger and Jujube to harmonize the Middle as guides, avoiding damage to Zheng Qi. If it is 六分 (60%) internal injury and 三分 (30%) external contraction, base the prescription primarily on internal injury, adding only one exterior-releasing herb, or administer hot to boost medicinal momentum, allowing Xie Qi to dissipate naturally. Those with Middle deficiency fall ill easily even with slight external contraction, unlike robust individuals who require heavy pathogenic accumulation to become ill. Moreover, minor external pathogens only affect the Qi and Clear Orifices, not transmitting through channels. Therefore, there is no need for heavy sweating or purging. Harmonizing Ying and Wei releases Xie Qi from the exterior; harmonizing Grain Qi restores Yuan Qi in the Middle.妄 (Wrongful) attacks and fasting only increase deficiency and distress.