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After taking the medicine, even the dregs were used to induce vomiting. Unexpectedly, not only did it fail to work after taking the medicine, but initially, there was only severe distension and stuffiness in the lower abdomen. After one episode of induced vomiting, the distension and stuffiness became unbearable throughout the chest and diaphragm. I said: Previously, during the early summer heat, the damage to Qi was not severe. Moreover, since the acute illness had not lasted long, the Shen (Spirit) and Qi had not yet declined. Therefore, the problem lay only in the insufficiency of nourishment and plumpness of the Five Zang Organs. Using medicines that tonify the nourishment of the Five Zang Organs would suffice. Now, during midsummer, the damage to Qi is severe. Furthermore, with day and night unbearable distension and stuffiness, sleep and diet are likely to be abandoned, sweating is profuse, heart palpitations occur, and energy is extremely fatigued. Although there are excellent medicines to nourish Yin fluids, without the transportation and transformation of Middle Jiao Qi, how can they provide relief? The six pulses are large and empty upon pressure, indicating extreme depletion of Qi in the center. Therefore, the root treatment of turbid tonification to nourish plumpness is indispensable. However, it must be followed by assisting Middle Qi to promote movement, so that the Qi of the Middle Jiao can ascend and descend, allowing the previous medicines to function. Thus, I ordered the continuous administration of Modified Ba Wei Tang (Eight-Ingredient Decoction) for two doses. Indeed, the distension and stuffiness above and below worsened. Then, I prescribed Ren Shen (Ginseng Root) 1 liang, Fu Zi (Aconite Lateral Root) 3 qian, decocted strongly into one zhong (measure), and administered it warm. After a short while, rumbling sounds were heard from the chest down to the lower abdomen, and urination occurred several times consecutively, leading to recovery. This confirms that medication should not adhere rigidly to fixed formulas.

Is it not precious for a physician to recognize the disease, but more precious to thoroughly understand the origin of the disease, the reasons for the waxing and waning of Qi and Blood, the subtleties of changes between deficiency and excess, and the pulses reflecting the flourishing and declining of Yin and Yang? Administering medicine accordingly is indeed easy. If one seeks too much diversity or displays lofty eccentricity, one will go astray, heading south while intending to go north. Generally, although the appearances and natures of myriad things differ, their principles of Zang-Fu organs and Yin-Yang are one. Although the names of hundreds of diseases vary, they all fall within the realm of Qi and Blood and cannot transcend the principle of deficiency and excess. Therefore, if one masters the situation regarding Qi, Blood, deficiency, and excess, and prescribes according to the pulse, then the method for treating one disease can be extended to treat hundreds of diseases; ultimately, the method for treating hundreds of diseases is still like treating one disease.

For example, a pregnant woman suffered difficult labor. After five days, the mother's spirit was exhausted, she was unconscious, the six pulses were deep and minute, her breath was faint, and she felt no fetal movement in the abdomen. The lower body was extremely swollen, and she requested me to reduce the swelling. If she died after delivery, there would be no blame. I said: Both the mother and child have exhausted their energy; how can they move healthily out of the womb? I immediately administered Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Jiu Shao Yao (Wine-processed White Peony Root), Niu Xi (Achyranthes Bidentata Root), Jiang (Fresh Ginger), and Gui Zhi (Cinnamon Twig). This is a formula to warm, regulate, and tonify Qi and Blood. After swallowing, after a short while, abdominal movement and pain occurred, resulting in delivery. Both mother and child survived.

Another pregnant woman, suffering from accumulated fatigue due to mourning, ate little and caught cold. Suddenly, her four limbs became cold, panting and urgency became severe, forehead sweat poured like rain, and the six pulses were deep, minute, and nearly vanished. I ordered Ren Shen (Ginseng Root) 5 qian, combined with Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Lateral Root) totaling 3 qian, decocted as a soup. The patient's family said: She is three or four months pregnant; administering Gui Zhi and Fu Zi will surely cause abortion. I said: Although true, at this time, saving the mother takes precedence over the fetus. There is no case where the mother dies and the child lives. We urged her to take it. Soon, she vomited. What she vomited was clear white water; the yellow, rich Ginseng soup was not expelled. A small amount went down, accompanied by several belches. The panting decreased, and sweating stopped. The next day, the pulse qi gradually rose. We then regulated peacefully, and Qi and Blood gradually settled. Ten months later, she gave birth to a son. Where was the risk of abortion? This shows that if one thoroughly understands the condition, the medication will be appropriate. It is called "violating the taboo when necessary," which seems like no violation. If, in critical moments, one adheres to routine methods and ancient formulas without knowing how to adapt, mistakes are inevitable.

A postpartum woman came to summon me because of excessive head sweating. She had no other complaints. Her pulse was large but slow. I said: Excessive head sweating in various conditions is called Wang Yang (Loss of Yang). However, postpartum, Yin Qi is greatly deficient. It is fortunate that Wang Yang balances with the deficient Yin. This is Xue Ji's argument; she can recover without medication. The owner doubted this and hired another doctor who used strong Ren Shen (Ginseng Root) for warm tonification. This resulted in sudden violent diarrhea with undigested food. They further recognized Yang deficiency and heavily used Ren Shen (Ginseng Root), Fu Zi (Aconite Lateral Root), and Pao Jiang (Prepared Ginger) in large doses. The diarrhea worsened. Within a few days, flesh wasted away, and spirit was exhausted. They summoned me again. The six pulses were large, wiry, and rapid. This indicates exhaustion of True Yin. How can it be saved? The owner and the doctor still believed that excessive head sweating was a symptom of Wang Yang (Loss of Yang). Taking Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), and Fu Zi (Aconite Lateral Root) yet having undigested food—was this not extreme Deficient Yang? I said: Postpartum head sweating is caused by Yin deficiency leading to floating Deficient Fire steaming upward, isolated Yang pressing up, and Jin Ye (Body Fluids) failing to be contained. Mistaking this for Yang deficiency and adding heavy warm tonification causes dry-heat Qi to rush downward violently, resulting in undigested food. This is because Fire nature is rapid, leaving no time for transformation and digestion. Adding more warm and hot herbs creates a burning effect, which will only stop when strength is exhausted. The *Jing* (Classic) says: When Yin is peaceful and Yang is secret, Spirit is governed. Now, Yin Qi cannot be peaceful, so Yang Qi naturally cannot be secret. Spirit separation is imminent. What medicine can save her? Treating Yin deficiency as Yang deficiency exhausts True Yin with dryness. The Middle Jiao becomes cracked dry earth; how can it generate all things? The doctor and patient finally regretted the wrong medication, but it was too late.

Indeed, all diseases must be judged by the pulse, and diagnosis cannot be abolished. For instance, I diagnosed a pregnant woman who had been severely vomiting for over seventy days before two months of pregnancy. She could not tolerate rice, soup, water, or medicine. Her pulse was deep and minute. I heavily used Fu Zi Li Zhong Tang (Aconite Decoction to Regulate the Middle) plus Wu Wei Zi (Schisandra Berry). Diet was gradually introduced. After more than ten doses, the six pulses gradually became large. Then, I administered proper fetal-calming medicines such as Tiao Qin (Scutellaria Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), and Shao Yao (Peony Root). She recovered after regulation. Not long after, I diagnosed another pregnant woman who had been severely vomiting for forty days at two months of pregnancy. Her six pulses were also very deep and minute. I used the same prescription for dozens of doses until the pulse became peaceful. Finally, it was difficult to administer Tiao Qin (Scutellaria Root), Dang Gui (Angelica Sinensis Root), and Shao Yao (Peony Root) for clearing heat and calming the fetus. This shows that people's constitutions differ, and medications cannot be uniformly determined. Regarding Fu Zi (Aconite Lateral Root), the *Ben Jing* states it causes abortion quickly. However, when there is disease, the disease bears the brunt of the medicine. This is what the *Nei Jing* means by "If there is pathology, there is no injury."

The origin of all diseases arising in the human body lies in formless Qi and Blood. Changes in the formless generate disease, which is also formless. Since disease is formless, how can medicine have a fixed form? Li Zhizi said that when Qi and Blood are deficient, various symptoms manifest indescribably. When Qi and Blood are robust, they nourish; when Spirit is deficient, other symptoms arise. Thus, all diseases come from "deficiency." Only if the practitioner grasps the two characters "deficiency and excess" can all diseases be covered without error. But if all diseases are called by deficiency, are all diseases deficiency? Why distinguish deficiency and excess? From the perspective of external pathogens invading, deficiency refers to Zheng Qi (Upright Qi) deficiency, and excess refers to Xie Qi (Pathogenic Qi) excess. From the perspective of internal organ dysfunction, there is Yang excess with Yin deficiency, and Yin excess with Yang deficiency. These are false excess and true deficiency. As stated in books, fire surplus stems from water insufficiency; water insufficiency is seen as fire surplus. Thus, excess in disease is false surplus, and deficiency in disease is true insufficiency. If Zheng Qi (Upright Qi) were truly sufficient, as the *Jing* says: "If Spirit is kept within, how can disease arise?"

Take Zhang Xiangnian, who suffered sudden trauma from external injury. It seemed clearly related to blood stasis and pathogenic excess in the blood level. Ultimately, however, it was entirely due to Qi-level Zheng Qi (Upright Qi) deficiency. Rescue led to survival. How much more so for diseases originating internally? One must deeply contemplate the principles of deficiency and excess.

In the year Wuyin, Zhang Fang, aged fifty-one, returned to the capital from the office of Magistrate Han in Luancheng, Baoding Prefecture. Less than fifty li away, a villager was felling a large tree. Due to wind and sand blinding my eyes, I rode near the tree. It fell, crushing both man and horse. The tree pressed on my waist and spine. My sternum moved, waist skin turned purple, and the spinal joints dislocated. Pain felt like being cut in half at the waist. Lower body was cold, head sweat poured like rain. In the chapter on falls and injuries, there is a saying: "A thread of blood entering the heart leads to death." I took Tong Bian (Child Urine) mixed with wine. Immediately, I felt extreme cold below the umbilicus, and Qi rebelled upward. I reasoned that the dislocated spinal joint indicated severe damage to Qi level, nearing extinction. My goal was to preserve Yuan Qi (Original Qi) and continue life, not to follow ordinary routines. Moreover, lower body coldness indicated Yuan Yang (Original Yang) sinking/extinguishing. Head sweat indicated Yuan Yang (Original Yang) about to escape upward. Urgent consolidation of Yang Qi was needed. I prescribed Ren Shen (Ginseng Root) 1 liang, Chao Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) 6 qian, and Zhi Fu Zi (Processed Aconite Lateral Root) 3 qian, decocted and taken twice daily. The next day, we arrived in Luanyi County. Magistrate Han had hired an old surgical specialist. Seeing my prescription, he feared internal blood stasis. He argued that tonics would cause stasis to attack and forbade use, preferring blood-breaking herbs. I said: You know officialdom but not medical principles. Consider visible punishments. Blows to flesh causing stasis and swelling can be treated by incision. But blows to bones and joints (like the clamp torture) do not involve incision. My spinal joint was crushed open, similar to ankle joints clamped. Limbs rely on Qi and Blood; injuries require tonification. Upper injuries first resolve stasis; lower injuries first require tonification. This is a definitive rule. Furthermore, the Du Mai (Governing Vessel) of the spine was severely damaged, lower Yuan (Root) was near extinction, limbs were cold, pulse was minute, and sweat poured like rain. Formless Yuan Qi (Original Qi) was nearing exhaustion. Without rescue, what basis is there for shadow-like stasis? Insisting on promoting circulation would accelerate the loss of Yuan Yang (Original Yang) and Shen (Spirit). Though the body remains, what Qi and Blood would operate the medicine and treatment? Magistrate Han and the doctor laughed and allowed me to proceed. I administered Ba Wei Wan (Eight-Ingredient Pill) modified with Niu Xi (Achyranthes Bidentata Root), Du Zhong (Eucommia Bark), and Wu Wei Zi (Schisandra Berry) morning and evening, each 5 qian, along with single doses of Ren-Shen-Bai-Zhu-Fu Zi Soup. Relying on this potent medicine to connect Spirit, I dared not sleep soundly for half a month. Because the right kidney connected to the spine was injured, the Ancestral Qi in the Kidney region lost its root, causing insomnia and inability to speak. Any sleep or speech caused rebellious Qi to surge dangerously. The potency of this medicine suppressed it, allowing endurance. After such tonifying and connecting treatment, I forced dry cakes to press down. Intestines burned like fire. More dry cakes facilitated digestion. Eight days later, a bowel movement occurred, with no trace of blood stasis. External wounds were treated with pig lard replacing sesame oil, boiled hair added to Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction), modified into a paste, and applied with Ru Xiang (Frankincense) to bind. Soft grass and thick mattresses piled over three chi high were used before lying on a mat. After seven days, rebellious Qi eased slightly. After half a month, sleep and speech increased slightly. Over a month later, I could sit leaning on a table. After seventy-plus days, I could stand with support. The spinal pulse gradually reconnected and restored, though the spine protruded half a cun, becoming a chronic ailment. Energy declined significantly after the major injury. Soreness and pain occasionally occurred in the tendons and vessels of the right leg, knee, and ankle, due to social engagements and hard work in the capital post-injury, lacking proper recuperation. Fortunately, I understood the truth, broke through fixed ancient theories, and recognized exceptional circumstances, thus preserving life. If I had viewed it merely as blood stasis requiring breaking and invigorating, the medicine entering the mouth would have caused the thread-like, nearly extinct Qi to surge upward and deplete immediately. Be cautious! Must not the principles of deficiency and excess be clearly distinguished?