Library

When True Yin is insufficient, solitary Yang loses its foundation, and wandering fire easily floats upward. Therefore, it is appropriate to use sweet, warm, and tranquil agents to nourish it, and sour and salty flavors to astringe and store it. People only know that excess Qi transforms into fire, but do not realize that the remnant of fire is essentially Qi. This may manifest as wheezing and fullness, or irritability and oppression; this excess belongs to pathogenic Qi. The excess of pathogenic Qi indicates the insufficiency of healthy Qi. For stagnation of dietary Qi, one can employ methods to promote drainage, circulation, smooth flow, and regulation. However, for floating Yang Qi, one should only guide, anchor, astringe, and seal it, using tonification to eliminate deficiency-fire. This Qi is the root of life, distinct from dietary stagnation. If Qi-moving medicines are used, they merely open the door for healthy Qi leakage; acrid and drying medicines instead cause fluid depletion. Even herbs like Xiong Gui Chen Pi (Ligusticum Chuanxiong Rhizome, Angelica Sinensis Radix, and Tangerine Peel), which are acrid-aromatic and moistening, can stir up rootless Qi and cause lost-to-control fire to ascend, causing harm; thus, they should all be avoided. Moreover, if healthy Qi is damaged, Stomach Qi must be weak. Fragrant and delicious foods may not even be palatable upon entry, let alone strange-tasting medicinal substances. Although there are herbs that open the appetite and support the Spleen, could they not risk damaging the Spleen and reversing Stomach Qi? Therefore, they are especially contraindicated. Herbs with exotic fragrances or foul tastes damage Stomach Qi upon contact with the mouth; how can they enter the abdomen and take effect? This is my humble opinion.

Si Wu Tang (Four Substances Decoction) is used to tonify Blood, and Si Jun Zi Tang (Four Gentlemen Decoction) is used to tonify Qi. Si Jun Zi Tang consists of warm herbs. Tonifying Qi can simultaneously generate Blood. Si Wu Tang is a cloying/stagnant formula. It fails to tonify Blood and first damages Stomach Qi; furthermore, its acrid-warm nature cannot tonify True Yin. Zhang Zhongjing used Ren Shen (Ginseng Radix et Rhizoma) to generate new Blood, following the principle of "Yang generates Yin." Because Blood is difficult to replenish rapidly, fearing that slow action would miss the critical moment, he employed Qi-tonification in cases of Blood collapse. Ren Shen is yellowish-white and has a sweet, warm flavor; its color, form, and taste all tonify Qi and generate Blood. In recent times, due to the scarcity of Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma) has been used as a substitute. Who knows that Bai Zhu has weak power and cannot achieve great success, and its nature and flavor are vastly different. Huang Qi (Astragali Radix) consolidates the exterior and specifically raises Wei Qi (Defensive Qi); Bai Zhu dries dampness and can obstruct turbid Qi. Neither is as harmonious and pure as Ren Shen, which can supplement and connect True Shen (Spirit), serving its ethereal functions. For various deficiencies, Ren Shen serves as the sovereign herb, just as humans rely on Gu Qi (Grain Qi) as their mainstay; dosage is simply adjusted according to deficiency or excess. Zhang Zhongjing was the sage of treating Shang Han (Cold Damage); if this applies to external contraction, how much more so for internal injury? For Qi deficiency, Sheng Mai San (Generate the Pulse Powder) is used, without mentioning Bai Zhu; for Blood deficiency, San Cai Wan (Three Immortals Pill) is used, without mentioning Si Wu Tang. The profound reasoning is clear within.

Zhu Danxi treated Yin-deficiency fever by dividing the blood-tonifying Si Wu Tang into Yin and Yang. The moving blood herbs are Yang, namely Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis Radix). The still blood herbs are Yin, namely Di Huang (Rehmanniae Radix) and Bai Shao (Paeoniae Radix Alba). When Yin-blood is insufficient, even the acrid-warm Chuan Xiong and Dang Gui are not used. When Yang-blood is insufficient, even the acrid-hot Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex) are used. This deeply grasps the essence of tonifying Yin. However, the way of Heaven and Earth is that Yang is often in excess and Yin is often insufficient, and the human body is the same. Thus, Blood is hard to form and easy to deplete. Furthermore, plants are unfeeling; how can they directly generate Blood? They merely use Di Huang and Bai Shao to nourish the Yin of the Five Zang Organs, and Chuan Xiong and Dang Gui to regulate Ying Qi (Nutritive Qi) within the vessels. When Yin and Yang are harmonized, Blood generates itself. However, when blood loss is excessive and breath is nearly imperceptible, one must strictly avoid giving this! Si Wu Tang belongs to the Yin category and is not suitable for generating life. One should heavily use Ren Shen and Huang Qi (Astragali Radix). Hence it is said: "In cases of Blood collapse, first benefit the Qi," because tangible Blood cannot be generated quickly, while intangible Qi must be urgently secured. If given with Si Wu Tang, the acrid-penetrating nature of Chuan Xiong and Dang Gui will consume Qi and disturb Blood, leading to death from the exhaustion of both Qi and Blood. Therefore, those with various deficiencies and weak Stomach Qi should not take it frequently.

Jing (Essence) is born from Blood, and Yin grows with Yang. Thus, neither tonifying Qi nor tonifying Blood should be neglected. However, Qi has the function of generating Blood, while Blood has no function of benefiting Qi. Hence it is said: "Solitary Yin does not grow"; also: "In Blood collapse, tonify Qi"; also: "Sweet-warm can remove great heat." All these refer to the fact that the energies of Spring and Summer allow development, while those of Autumn and Winter do not promote growth. Moreover, consumptive diseases that accept tonification can be treated; those that do not accept tonification are incurable. Ge Kejiu was skilled in treating Lao (Consumption); his formulas mostly used Ren Shen, while Zhu Danxi specialized in nourishing Yin. Yet, six or seven out of ten used Ren Shen. Since Li Dongyuan's theory of "Lung Heat Damaging the Lung" arose, many have echoed it, causing later students to hesitate. Little do they know that when Metal Qi is severely damaged, only Ren Shen can protect it. Moreover, when Earth is prosperous, Metal is generated; do not rigidly focus on protecting the Lung. When Wood is prosperous, Fire is extinguished; do not anxiously focus on clearing the Heart. Know that Fire and Yuan Qi (Original Qi) are mutually exclusive; when one wins, the other loses. Without such herbs seemingly emerging from the void, how can one breathe life back into ruined Yang and salvage impending death? If one does not understand that deficiency-fire requires tonification and mistakenly administers bitter-cold herbs, myriad symptoms will arise, and rescue will be impossible.

Wu Hegao said: In the human body, there is True Fire, residing in the Right Kidney, circulating through the San Jiao (Triple Burner), entering and exiting the Gallbladder channel, and obeying the Tian Jun (Heavenly Lord/Heart). This fire warms the hundred bones, nourishes the Zang-Fu organs, and fills the nine orifices. It is the father of all things. If this fire ceases, it is like all things having no father; thus, flesh becomes emaciated, blood withered, bones decayed with teeth falling out, sinews weakened with limbs tired, and Qi deficient with faint speech.

There are countless miraculous formulas, but the major principles fall into three categories: Yang Deficiency, Yin Deficiency, and Middle Qi Deficiency. Yang Deficiency refers to the congenital True Yang being insufficient. It manifests as fire failing to steam and rot food and drink, leading to indigestion, weakness in legs and knees, frequent urination, involuntary leukorrhea, and a deep, slow, forceless pulse. One must benefit the source of fire using Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). Yin Deficiency refers to the depletion of Tian Yi True Yin. It manifests as cough, night fever, night sweats soaking clothes, and a wiry, rapid pulse. One must strengthen the master of water using Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). Middle Qi Deficiency refers to injury to the Spleen and Stomach, with hot palms, lethargy, poor appetite, and a large, forceless pulse at the Qi Kou (Radial Artery). This is the syndrome of internal injury and insufficiency described by Li Dongyuan. One must use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). In this way, the analysis of principles is clear, and treatment is appropriate.

In Lao disease with chronic cough, Lung deficiency is evident. Even if there are heat symptoms, they are all deficiency-fire. Zhang Congzheng took protecting the Lung as the sovereign strategy, using Zi Wan (Asteli Radix) and E Jiao (Colla Corii Asini) for this purpose. He took clearing fire as the minister strategy, using Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Thunbergii Bulbus). He used Ren Shen and Fu Ling (Poria) as assistants to support Earth to generate Metal. He used Gan Cao (Glycyrrhizae Radix) and Jie Geng (Platycodonis Radix) as guides to carry the medicine to the Lung. Wu Wei Zi (Schisandrae Fructus) nourishes the insufficient Water of the Kidney meridian and astringes the dissipating Metal of the Lung; this is essential for chronic cough. Using herbs to nourish Yin and cool Blood is common. However, herbs like Sheng Di Huang (Rehmanniae Radix), E Jiao, Mai Dong (Ophiopogonis Radix), and Mu Dan Pi (Moutan Cortex) are cold and moistening. If used by those with weak Stomach Qi and poor appetite, they will further damage the Post-Heaven Yuan Qi of the Spleen and Stomach. Zhu Danxi stated regarding Lao disease: "Treating Qi disease by tonifying Blood, though not hitting the target, causes no harm." But he did not realize that the pathogen had already潜伏 (lurked) in the middle, gradually causing chest and diaphragm stuffiness, reduced diet, and myriad changes. These are due to the cloying nature of Yin, which damages the harmonious Qi. For extremely deficient syndromes, careful nursing and pure medicines can only maintain peace; over time, gradual growth of Qi and Blood may be hoped for. If nursing is slightly negligent or the drug property slightly deviates, the condition will change and arise, becoming uncontrollable. This is because Middle Qi is very weak and lacks strength to resist, like a small boat unable to bear heavy loads. Slight cold generates cold disease; slight heat generates heat disease; slight moisture causes diarrhea; slight dryness causes dehydration. Slight deviation in the Qi level harms the Lung; slight deviation in the Blood level harms the Spleen. Diligent nursing yields little visible result; slight imbalance produces illness. How then can one claim that tonifying Blood for Qi disease is harmless?

For bone-steaming fever with fine, rapid pulse and cough, worsening in the afternoon, Qin Jiao Bie Jia San (Gentian and Turtle Shell Powder) is most effective. Note: Qin Jiao (Gentianae Macrophyllae Radix) and Chai Hu (Bupleuri Radix) are wind-dispelling herbs. Extreme heat generates wind; bone-steaming cannot expel pathogens from the hair follicles without them. Bie Jia (Testudinis Carapax et Plastrum) belongs to Yin; using the shell implies reaching the bone. W Mei (Mume Fructus) is sour, guiding bones into the bone and astringing heat. Qing Hao (Artemisiae Annuae Herba) is bitter, clearing heat and killing parasites. Dang Gui is acrid, invigorating Blood and dispersing stagnation. Di Gu Pi (Lycii Cortex) uses Earth for Yin, Bone for interior, and Skin for exterior, treating external, anhidrotic bone-steaming. Zhi Mu clears Lung Metal and drains fire above, moistens Kidney dryness and nourishes Yin below, thus treating hyperhidrotic bone-steaming. The prescription is thorough and stable. It is suitable for early-stage bone-steaming where Blood fluids have not yet dried up.

Lao disease primarily involves Yin deficiency. From Zi hour to Si hour belongs to Yang; from Wu hour to Hai hour belongs to Yin. In Yin deficiency, heat occurs after noon and before Zi hour. Awakening belongs to Yang, sleep belongs to Yin; in Yin deficiency, night sweats occur during sleep. Ascending belongs to Yang, descending belongs to Yin; in Yin deficiency, Qi fails to descend, phlegm-saliva rebels upward, and expectoration is incessant. Floating pulse belongs to Yang, sinking pulse belongs to Yin; in Yin deficiency, floating is surging and large, while sinking is empty. One should use Yin-nourishing and fire-descending agents, and also avoid sexual desires, eat bland foods, and rest quietly to assist recovery.

Zhang Yuansu often treated extreme deficiency syndromes where patients were confused about people facing them but aware of events outside, or saw ghosts and spirits. These are signs of Yang collapse and insufficiency, caused by their own wandering Hun (Ethereal Soul). By providing deficiency-tonification and rescue, combined with astringency and anchoring, the Hun and Shen (Spirit) settle, and hallucinations cease.

Zi He Che (Human Placenta) can be boiled and eaten by those with True Yin insufficiency, yielding remarkable results. It is best for men to use female placenta and for women to use male placenta; otherwise, placenta from robust women is also acceptable. For illnesses resembling dementia or foolishness, with disordered spirit, eating this yields indescribable efficacy.

Those who, near death, crave meat and rice, and die after eating their fill, suffer from Spleen deficiency and exhaustion of Jin Ye (Body Fluids) and Hua Qi (Splendor Qi). Meat has weak power and cannot rescue them. Spleen deficiency seeks relief from grain; fluid exhaustion seeks relief from fat. Only thick Ren Shen Tang (Ginseng Decoction) can rescue them. Meat only fills tangible emptiness; how can it replenish intangible exhaustion?

In Xu Lao (Deficiency Consumption), refusal to take Ren Shen and Huang Qi indicates inability to accept tonification, leading to death. Labor cough with hoarseness leads to death. Inability to lie on one side leads to death. Emaciation of large muscles leads to death. Coughing up light red blood resembling meat or lung tissue is called "coughing white blood," indicating Heart death. Progression from upper to lower parts, or chronic diarrhea, leads to death. Bone atrophy preventing rising from bed leads to death, indicating transmission from Lung to Kidney. Progression from lower to upper parts, with gathering skin and falling hair, leads to death, indicating transmission from Kidney to Lung. Chronic cough with blood, sore throat, and voice loss indicates transmission from lower to upper; chronic turbid urine, seminal emission, and diarrhea without cough or pain indicates transmission from upper to lower; both are death signs. Chronic illness with deep, fine, rapid pulse leads to death. Loss of flesh and bone, scattered voice, hematemesis, involuntary erection, cool days and hot nights lead to death. Ji Mai (Knotted Pulse) indicates death within three years. Dai Mai (Intermittent Pulse) indicates death within three months. Fine Left Hand pulse with surging, large, tense Right Hand pulse indicates Healthy Qi deficiency and Pathogenic Excess, leading to certain death. Fine, rapid pulse with bone-steaming, dry cough, hoarseness, and malaria-like chills and fever indicate certain death.

The Mai Jing (Pulse Classic) states: Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver. This means the Heart and Lung are floating and superior; floating governs exit, hence exhalation is governed by the Heart and Lung. The Kidney and Liver are sinking and inferior; sinking governs entry, hence inhalation is governed by the Kidney and Liver. The Spleen resides in the center, its pulse between floating and sinking. Thus, floating palpation examines Yang, and sinking palpation examines Yin. If all six positions are small upon heavy sinking pressure but solid and large upon light floating pressure, it is called Yang Excess and Yin Deficiency. If light floating pressure reveals smallness and heavy sinking pressure reveals solidity and largeness, it is called Yin Excess and Yang Deficiency. Discussing Cun (Inch) and Chi (Cubit) positions: Yang governs Cun, Yin governs Chi. If Cun floating is small and Chi sinking is large, it is Yin Excess and Yang Deficiency. If Cun floating is large and Chi sinking is small, it is Yang Excess and Yin Deficiency.

Cun Kou pulse floating and delayed: Floating indicates deficiency; delayed indicates labor/exhaustion. Large pulse indicates labor; extremely deficient pulse also indicates labor. Weak, fine, and wiry pulses all indicate insufficiency. The pulse of dual Yin-Yang deficiency appears only at dawn; by midday, it becomes surging and rapid. Floating-large and floating-wiry pulses are both signs of Fire Excess and Yin Deficiency, commonly seen in the evening. A pulse with many beats and rapidity is called Zhi Mai (Arriving Pulse), indicating Yin-deficiency Lao syndrome. Zhi Mai that is slow and forceless indicates Qi deficiency; rapid and forceless indicates Blood deficiency.

In chronic illness with complete wasting of form and flesh, even if the pulse seems harmonious, it is often untreatable. After prolonged delay, external pathogens are gone, but Yuan Yang (Original Yang) is extremely depleted, and Fire Qi is微弱 (weak). Although there is no suffering from Six Evils attacking, Qi and Blood are hardly recoverable. Only a thin thread remains connected. Thus, although the pulse rhythm is regular and seems harmonious, it actually lacks Shen (Spirit). Moreover, muscles are governed by the Spleen; Earth is the mother of all things. Wasting of form and flesh signifies Earth collapsing and Spleen perishing. The Jing (Classic) states: "If form and flesh are exhausted, even if the nine pulses are harmonious, death ensues." Long-standing heat-toxin in Xu Lao generates evil insects that devour viscera. Symptoms include steaming fever, cough, chest tightness, back pain, blurred vision, limb weakness, soreness and ache in waist and knees, insomnia, pale complexion, occasional malar flush, frequent anger, dreams of intercourse with spirits, and high contagion potential, potentially wiping out families. The method is to tonify deficiency to restore Yuan Qi and kill insects to eradicate the root. Killing the insects may not save the patient but can stop transmission. Those attending this disease should not approach while hungry. The deficient should take tonic medicines and wear An Xi She Xiang (Benzoin and Musk) amulets, so that insect pathogens dare not invade.