仪卿先生大人阁下：闰月接展，还云详论瘅疟，因夏秋忙甚，未遑握管，致稽裁复，抱疚无如。正深渴想，十月中又奉手教，诵悉福履，恒绥潭禧晋吉，以欣以慰。承惠《风雷集》及大著《医中一得》，浣读之下，仰见仁人用心，志在济世。至产后房劳论，发千古不发之蕴，诚为医中暗室一灯，尤征学识精进，不胜欣佩之至。惟荷蒙雅爱，垂问谆谆，谓如有别说，或尚有未到处，统祈示悉改正，不致贻误后人，更见虚怀若谷。瑛敢不以三十年临证考核之苦衷，心有所悟者为知己告？谨将下询原由及瘅疟二字不可以伤暑混同立论之处，另单呈核，伏祈鉴定，正其缨，存其真，为幸。瑛与阁下，交有年矣，何幸而得此益友也。日后拙作告竣，寄阅之后尚望匡以不逮是荷。窃思医以活人，笔之于书，传之于后，立言宜万世无弊。若择之不精，便有偏而不全之处。敢将管窥之见与平日临症有得合于古而可信于今者，印证高明，尚祈赐教为荷。高论云：瘅疟之名乃通称，其实即伤暑也。亦仍其旧而已。窃谓瘅疟本于《内经》仲景，特发明《金匮》，盖实有是症也。考《说文》：瘅者，劳也，因劳生热（即《内经》阴虚生内热也）。故劳字从火从力，谓有所过用其力，则君相二火上越高颠，其病为热。此虽臆说，似与阴气孤绝，阳气独发二句颇合。因其但热不寒，故曰瘅。作止有时，故曰 疟。大抵肾水不足，素多内热之人，冬不藏精，寒伏少阴，至春夏阳升气暖，邪寻出路而发于心肺，从上焦而达之也。喻氏论瘅疟，主以甘寒，言之未能十分透彻。徐忠可谓与温疟同一机局，沈图南谓瘅疟亦微有洒渐恶寒，至但热不寒，心阳发病，肺邪不能复，心为寒，故但热不寒。又曰：白虎加桂枝汤即前瘅疟而出方也。喻氏谓心肺两阳合邪，故但热不寒。鄙意瘁疟即疟病中之一症，《内经》列于疟论，仲景发明于疟门，谓伤暑乃瘅疟中之兼症则可，谓瘅疟即伤暑则不可。既登梨枣，似直立言无弊，不可拘于俗称也。谨奉劝分作二说，以为后学之一助。近诊患瘅疟者甚众，非若伤暑寒轻热重，或寒热往来者可比。高论中有"经云肺素有热，邪尚在卫，起至此病，乃从前所伏之邪止"一段甚为明晰，可请将大著正其名曰《伤暑浅说》，另著《瘅疟浅说》发明《内经》《金匮》奥旨，以启后人，庶几名实不混。高论越婢乃脾字之讹，为发越脾气，其说甚正。此一节发明脾胃病机，诚为治法之关键。大青龙有兴云致雨之能。说本柯氏，用之伤暑宜石膏为君，尤见卓识。鄙意麻黄虽与石膏同用，似非暑病所宜，用之于二三月瘅疟之壮热无汗、大渴脉数大者似安。高论中邪伏脾胃营分则右关之脉沉分必独洪数，此明言之至确者，先辈有以葛根、犀角并用。尤为瘅疟中阳明少阳经之的方。来札云：方中葛根、升麻并未论及，窃有所疑。然鄙意以为此方之关键全在此二味云云。细绎尊方，所主在脾，本东垣清暑益气汤来。东垣所论者脾胃也，立法全在中焦，一味升阳为主。如果邪在足阳明之经，葛根乃一定之主药。若在阳明之府，非葛根所宜。升麻为手阳明之主药，若邪在上中二焦，又恐药过病所，反伤无病之所。至香薷芳香清透之品，为伤暑之主药，于伏暑又非所宜。鄙意宜凭脉辨症，随症活法去取，有是病则用是药，所重在识症。医者识得真辨得明，不患无治法。尝考方者，则也，仿也，有一定不易之方，有随时交易之方。一定不易者，如胃家实用承气，太阳病无汗用麻黄，有汗用桂枝，不拘方氏三大纲之说是也。随时变易者，以古方如明文时文取来看样，不可直钞一篇名作以应试。又如画家仿某人法、某人笔意是也。许学士云：予尝读仲景书，用仲景法，未尝执仲景方。罗太无云：用古方譬如拆旧料添新料，必经匠氏之手方善。来书云：伏邪亦应分六经，若河间之究三焦。似言受病之始尚非伏邪之确论，此言专主手少阳一经是也。试畅言之。河间温热主乎三焦，其说有二：一则专言手少阳经也，盖一岁有六气，自春分至小满为二之气，手少阴君火主令，其候温甚化火，自小满至大暑为三之气，少阳相火主令，其候热甚化暑。故温暑必从手经先受，亦犹伤寒必从足经先入也。此不独天时一定之运气，亦人身同气相求之至理。故叶氏论温热曰：温邪上受，首先犯肺。力辨以足经药治手经病之谬。又日：河间法至精至妙，后医未读其书，焉能治病臻效。惜乎专以陶书六经治病等语，其叹服也如此。况三焦与手厥阴为表里，暑先入心，故逆传心胞最易。人身一小天地，谁日不然，此实发明《内经》五运六气之奥旨，有功后学不浅。一则统人身上中下之三焦而言，不专主乎手少阳一经立论也。经曰：上部天，中部人，下部地。又曰：上焦如雾，中焦如沤，下焦如渎。是人身之有三焦，犹天地之有三元也。试以太阳经而论。起于目内毗，上额交巅，则自头项至心肺之俞，太阳经之上焦也，自背至腰脊命门穴，太阳经之中焦也，自肾俞至足少阴穴，太阳经之下焦也。举一经而六经皆有，上中下可以类推矣。故上焦法天，纯乎清气，在脏为心肺之部，上焦之邪必在初感，其病浅，药用轻宣透达，药重反过病所。上焦失治，传及中焦，其病深矣。中焦法人，为气交之中清浊之界，在脏为脾胃之部，其受邪也，阳明独多，如省垣都会，万物辐揍也。有在经在腑之别，不可混治。实投攻下，热用寒凉，虚进参芪，寒宜姜附，瘅疠可破可逐，湿热可清可燥。中焦失治，传入下焦，伤及血分，其病笃矣。下焦法地，纯是浊 阴，在脏为肝肾之部，药用滋填。火则清之，寒则温之，湿则利之。下焦失治，伤及肝肾，十难救一矣。仲景六经发明于前，河间三焦辅翼于后。一经一纬，如日中天。仲景六经非专为伤寒设，此内伤外感不能舍六经而言症言治也。举足经而手经亦包括在内矣。河间三焦非止为温暑设，凡外感内伤亦不能外三焦而言清言浊也。明得三焦而十二经皆在其中矣。所以时贤吴鞠通著《温病条辨》，汪瑟苍侍郎详加评点，发明上中下三焦症治，虚实寒热，不惮烦言，良以世之人不明温暑指归，不究三焦深浅，特为唤醒，弹克遵循，诚医门之一火炬也。质之高明，未识以为然否也。高论产后房劳可为万世规，则补气通血一句乃不刊之论也。两方一治全实者，一治半虚半实者。鸡冠一味尤征。格物精确，读此明快之书，令人心开目爽，舍下家秘女科中采有经验之方，宜于藜霍而不宜于膏粱。尊方则贫富皆可用，惟已成咳嗽寒热者，未识有何妙法。室女经闭成劳有血枯而闭者，郁损而闻者，尤为难治。统祈教以不逮，曷胜幸甚！
俯恬先生阁下：接读手书，藉悉交棋佳畅与序更新，欣慰奚似，承示教言，皆有根据，并无杜撰，足征学有渊源。凡读古人书，应先胸有识见，引伸触类，融会贯通，当悟乎书之外，勿泥乎书之中，方为善读书人。若以瘅疟为劳症，为阴虚生内热而发，及冬不藏精，寒伏少阴等说，恐非。夏月所发之病，识之不真则治之下的。无怪遇此症延之日久而无效矣。此则但热不寒者则为瘅疟，寒热往来者则为疟疾。二症俱由伤暑得来，暑湿之邪传入太阴，与阳明合病则成瘅疟。暑湿之邪传入太阴，与少阳合病则成疟疾。所谓夏伤于暑，秋必痎疟也。知病在大阴少阳，须用柴芩，是将太阴之邪提归少阳测知病在太阴阳明，须用升葛，是将太阴之邪提归阳明也。何以此病之邪不离太阴脾经者？盖则每日起伏如是，乃脾主信故也。因此症敝邑之医皆称瘅疟，若别立名目，人必不知指何症而言，是以仍其旧也。人身有二火二土，肾火生脾土，心火生日土，脾胃二土位居中宫，一阴一阳，一表一里，一脏一腑，一升一降，运行一身，相须为用，即身中之太极，犹河图之五十居中也。经曰：饮人于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。此之谓也。自湿热蕴阻脾经测不能与目相配行其津液矣。仲师云：阴气孤绝者，是太阴之气孤绝也。阳气独发者，是阳明之气独发也。阳明之阳亢而无配，故但热不寒也。玩孤独二字，便明下即云邪气内藏于心，外合分肉之间，心为胃之母，肌肉为胃所主也。内藏于心，故烦冤。外舍分肉，故肌肉消烁也。非指阳明而何所指乎？即如白虎加桂枝汤，非阳明药乎，非足经药乎？加桂枝者，为石膏之反佐，以助辛散之力，兼能人营发汗也。若无汗之瘅疟必须发汗，则邪始透达。若不用麻黄、桂枝，将有何药以令发汗乎？如不得汗，则邪从何解乎？仲师之立麻杏甘石汤方，亦为热邪在肺而设。若本阳虚之体，麻黄原不可轻用，恐再亡阳也。夏月表疏，不可重虚其表，古人之言似因有汗者而发。若无汗而热邪蕴结不解，而用数钱之石羔，少位数分之麻黄，亦属经权之道。若恐汗出不止，则止汗之方甚多。邪解之后选而用之，亦无不可也。若但用麻黄而不兼用枝枝，尚恐汗不速发，盖以汗为阴液，麻黄但能入气分而桂校则兼入营分矣。故桂枝汤中无麻黄，而麻黄汤中有桂枝也。因风伤卫不可用麻黄，寒伤营须兼用桂枝也。瘅疟为夏至以后之病，若在二三月间，尚无瘅疟。惟温病则有之，所谓冬伤于寒，春必病温也。若夏月之症，即将太阴所沾暑湿之邪及早提归阳明，清而散之，又何有伏邪窃发，自冬至春变成难治之症哉。无汗之瘅疟两候内有大青龙去姜枣加葛根，若两候外则忌用，恐津液已伤，不可强逼其汗，重亡津液也。脉洪数而实，仍烦冤者，参用白虎加桂枝汤等方，后此再用甘寒之法可矣。吴鞠通《温病条辨》论症立方，其说理精透处固属不少，其间未是处亦不能无。瑜 不掩瑕，未可一概论也。兹因心力不逮，惜不能通本批评耳。至室女经闭成劳与产后房劳症不月同，而所以不月则不同。经云二阳之病发心脾，有不得隐曲，女子不月，此因不得隐曲则肝木郁而不伸，肝郁则病及于所生、病及于所克，故发于心脾也。心主血，脾统血，肝藏血，三脏均郁，故不月也。此症当从木郁达之之例，宜用加味逍遥散参入桃仁、红花、延胡、贝母、生地之类。十数剂后，再用通瘀决津大黄（庶/虫）虫丸之属以治之。体极弱者，亦可加用人参，务须药及病所，不可病重药轻，当以经通为断耳。若已成咳嗽者，是木火刑金，未可与感冒并论也。诗曰涉彼阿邱言采其虻虻，即贝母能活郁也，故宜参入。愚意如此，还请高明有以教之。知阁下好学深思，旁搜博采，更兼虚以待人，故敢以鄙陋之见冒昧直陈，盖彼此讨论，庶能于此道鞭逼入细，不致贻误后人。或可藉为启悟而有种来兹，未可知也。瘅疟，魏柏卿注为热毒，则视温疟较重。仲师治瘟疟用白虎加桂枝汤，则瘅疟用大青龙去姜枣加葛根可类推。去姜枣者，姜性烈，枣腻滞也。此独为瘅疟初起立法。若延至日久，则症已变而治法亦变矣。《金匾》瘅疟条中云：阴气孤绝，阳气独发。此二句是仲师发明瘅疟之病源，盖阴阳不相配为之孤，往来不相通为之绝，阴气孤绝故阳气独发也。此所以脾不能为胃行其津液而为病也。若非如此解，须知仲师原文一字不苟，孤绝二字甚重，试细思之人，可阴气孤绝耶？白虎加枝枝汤与大青龙汤，其中所用桂枝均当去皮而用本，盖皮性大热，本性温和也。
大青龙加味汤
石膏六钱 麻黄八分 枝枝四分，去皮 杏仁去皮尖，三钱甘草五分葛根一钱五分 分两临症加减。
产后房劳论俗称产母病
妇人生产二三月后，身忽发热，逾时暂解。数日后身又发热，仍复暂解。始则数日一发热，继则两三日即发热。后则连日脉数身热，不能暂解，身体困倦，饮食渐减，面色萎黄，或似外感，或似内伤，咸为蓐劳。但蓐劳乃产后月内之病，因坐草艰难所致。此则生产二三月后之病，与蓐劳似同而实异，俗称产母病也。医者调治，始用发表疏解治之，不应，旋用养阴清热，后用健脾开胃补虚等药，总归无效。其人日见困顿，热仍不解，脉象虚数，沉分带弦，一病淹淹，渐成劳怯，遍考方书，既无确论，又无专方，医家无所折衷，只好束手坐视而已，殊不知此症都由生产一月之内，八脉空虚，恶露未尽，夫妇同房，致将恶露阻住子宫，不能尽去，是以血络日渐瘀积，则气亦生滞，一身气血不能昼夜流通，而营卫不调，身热作矣。初不甚觉，以后血愈积则身愈热，身愈热则气愈弱，而血愈积，遂成干血劳症而难治类。疗治之法不外补气通血四字而已，盖气为血帅，若气不足则瘀难通，故补气通血不可偏废也。失血热则行，血寒则滞，若但知养阴清热则血更滞，而热更甚。热久不解，势必血渐涸而气愈馁，欲望不成，劳症得乎。谨录两方，临症加减，聊为此症之规法，庶几后之学者有所适从焉。
延胡索散 专治妇人产后房劳。
延胡索二钱 生赤芍二钱 生蒲黄二钱上肉桂二钱 琥珀二线 当归二钱 红花二钱 右药用好醋浸一宿，共为细末，每服二钱，七眼而尽，陈酒送下。如虚弱者，用参汤送下。
To Mr. Yi Qing:
In the leap month, I received your letter in which you discussed Dan Nue (a type of malaria characterized by high fever and little or no sweating) in detail. Due to the busy schedule during summer and autumn, I had no time to write a reply, causing a delay in my response, for which I feel deeply guilty. Just as I was longing to hear from you, I received your handwritten letter in October, learning that you are healthy and blessed with longevity, which brought me both joy and comfort. I am grateful for your gift of *Feng Lei Ji* and your masterpiece *Yi Zhong Yi De*. After careful reading, I admire your benevolent intention to save the world. Your discussion on postpartum sexual indiscretion (disease caused by sexual activity too soon after childbirth) reveals medical mysteries unexplored for millennia, truly serving as a lamp in the darkness of medicine, further demonstrating your advanced scholarship, which fills me with admiration. However, out of your kindness, you earnestly asked if there were any other views or shortcomings, requesting corrections to avoid misleading future generations, thereby showing your open-mindedness. How dare I not share with a confidant the bitter experiences of thirty years of clinical practice and my personal insights? I respectfully present separately the reasons for your inquiry and why "Dan Nue" should not be conflated with Shang Shu (exogenous disease caused by summerheat). I humbly request your appraisal to correct errors and preserve the truth, which would be my honor. Having known you for many years, how fortunate I am to have such a beneficial friend! Once my humble work is completed and sent for your review, I hope you will point out my deficiencies.
I privately believe that medicine aims to save lives; writing it down and passing it to posterity requires words that stand the test of time without flaw. If selection is imprecise, bias and incompleteness may arise. I boldly offer my limited insights combined with clinical experiences that align with ancient methods and are credible today, seeking your verification and guidance.
You stated in your high opinion: "The name Dan Nue is a general term; in reality, it is Shang Shu. This merely follows the old usage." I personally hold that Dan Nue originates from *Nei Jing* and Zhang Zhongjing, particularly elucidated in *Jin Gui Yao Lue*, indicating its existence as a specific condition. Consulting *Shuo Wen Jie Zi*: "Dan" means labor/toil, generating heat due to toil (as described in *Nei Jing* as yin deficiency generating internal heat). Thus, the character "labor" consists of fire and strength, implying that overexertion causes Ministerial Fire (Mingmen fire) and Sovereign Fire (Heart fire) to ascend to the vertex, resulting in heat symptoms. Although this is my speculation, it seems to align well with the phrases "yin qi is isolated and absolute" and "yang qi acts alone." Because it features only heat without chills, it is called "Dan." Since it has regular onset and cessation, it is called "Nue." Generally, individuals with insufficient kidney water and inherent internal heat, who fail to store essence in winter, allow cold to lurk in the Shaoyin channel. When yang qi rises and warmth arrives in spring and summer, the pathogen seeks an exit, manifesting in the Heart and Lung, spreading from the Upper Jiao. Yu Jia Yan (Yu Shi) argued for treating Dan Nue with sweet-cold methods, but his explanation was not entirely thorough. Xu Zhong Ke suggested it shares the same mechanism as Wen Nue (malaria with prominent fever and slight aversion to cold). Shen Tunan noted that Dan Nue also presents with slight shivering and aversion to cold initially, progressing to heat-only symptoms; this indicates Heart Yang pathology where Lung pathogen fails to recover, leading to Heart coldness and thus heat-only presentation. He also stated: *Bai Hu Jia Gui Zhi Tang* is the formula previously mentioned for Dan Nue. Yu Shi believed the combination of two Yang pathogens in Heart and Lung causes heat-only symptoms. My view is that Dan Nue is a symptom within Malaria diseases, listed in *Nei Jing*'s *Mai Lun* and elaborated by Zhang Zhongjing in the *Mai Bing* section. It is acceptable to say Shang Shu is a concurrent symptom of Dan Nue, but unacceptable to equate Dan Nue directly with Shang Shu. Since it is now published, one should state clearly without ambiguity rather than adhering to common names. I respectfully advise separating these into two distinct theories to assist future students. Recently, I have treated many Dan Nue patients, whose conditions differ significantly from Shang Shu (characterized by mild chills and heavy heat) or alternating chills and fever.
Your commentary regarding "The Classic states the Lung has prior heat, the pathogen remains in the Wei level... this disease arises from previously latent pathogens stopping here" is very clear. You suggest titling your work *Shang Shu Qian Shuo* and writing a separate *Dan Nue Qian Shuo* to elucidate the profound meanings of *Nei Jing* and *Jin Gui*, preventing confusion between names and realities.
Regarding your note that "Yue Bi" is a typo for "Pi," meaning to disperse Spleen Qi, this is correct. This section elucidates the pathogenesis of Spleen and Stomach diseases, which is indeed key to treatment. *Da Qing Long Tang* (a formula with cloud-raising and rain-bringing capabilities) based on Ke Qin's theory uses Gypsum (*Shi Gao*) as the sovereign herb for Shang Shu, showing great insight. However, I believe although Ephedra (*Ma Huang*) is used with Gypsum, it may not be suitable for summerheat diseases. It seems more appropriate for Dan Nue occurring in February-March presenting with severe fever, anhidrosis, intense thirst, and rapid, large pulse.
You correctly identified that if pathogens lie in the Spleen/Stomach Ying level, the right Guan pulse's deep position must show distinct surging and rapid qualities. Ancestors used Ge Gen (*Puerariae Radix*) and Xi Jiao (*Rhinocerotis Cornu*) together, which is a precise formula for Yangming and Shaoyang meridians in Dan Nue. You questioned the omission of Ge Gen and Sheng Ma (* Cimicifugae Rhizoma*). I believe the key to this formula lies in these two herbs. Analyzing your prescription, it targets the Spleen, derived from Li Dong Yuan's *Qing Shu Yi Qi Tang*. Li focused on Spleen/Stomach, establishing laws centered on the Middle Jiao, emphasizing raising Yang. If the pathogen is in the Foot Yangming Meridian, Ge Gen is essential. If in the Yangming Fu organ, Ge Gen is unsuitable. Sheng Ma is the sovereign herb for Hand Yangming; if the pathogen is in Upper/Middle Jiao, using it might exceed the disease site, harming healthy areas. Xiang Ru (*Moslae Herba*), aromatic and clearing, is sovereign for Shang Shu but unsuitable for latent summerheat. My advice is to differentiate by pulse and symptoms, adapting prescriptions flexibly. The emphasis is on recognizing symptoms. If doctors recognize and differentiate accurately, treatments will follow.
I observe that "Fang" (prescription) implies rules and imitation. There are fixed formulas and changing ones. Fixed examples include Cheng Qi Tang for stomach excess, Ma Huang Tang for Taiyang anhidrosis, and Gui Zhi Tang for Taiyang diaphoresis, ignoring Fang Yi's three main outlines. Changing formulas are like studying eight-legged essays for style, not copying verbatim, or painters imitating styles. Xu Xue Shi said he used Zhang Zhongjing's methods but not necessarily his formulas. Luo Tai Wu compared using ancient formulas to rebuilding with old and new materials requiring craftsmanship. You mentioned latent pathogens should be differentiated by Six Channels, similar to He Jian's investigation of Three Jiaos. I argue that focusing solely on Hand Shaoyang at the onset is not definitive. He Jian's warm-heat theory focuses on Three Jiaos with two aspects: first, specifically Hand Shaoyang. One year has six Qi phases: Spring Equinox to Minor Fullness is Second Qi, governed by Hand Shaoyin Sovereign Fire (warmth turning to fire); Minor Fullness to Great Heat is Third Qi, governed by Shaoyang Ministerial Fire (heat turning to summerheat). Thus, warm/summerheat enters via Hand meridians first, just as Cold Damage enters via Foot meridians. This reflects both heavenly luck and human resonance. Ye Tianshi stated warm pathogens enter from above, attacking the Lung first, refuting using Foot meridian herbs for Hand meridian diseases. He praised He Jian's methods but lamented reliance on Tao Hong Jing's Six Channel framework. Since San Jiao pairs with Hand Jueyin Pericardium, summerheat entering the Heart easily transmits reversely to the Pericardium. Humanity is a microcosm, elucidating *Nei Jing*'s Five Movements and Six Qi, benefiting students greatly. Second, San Jiao covers Upper/Middle/Lower generally, not just Hand Shaoyang. Classics state: Upper Heaven, Middle Man, Lower Earth; Upper Jiao like mist, Middle Jiao like fermentation, Lower Jiao like drainage. Human San Jiao mirrors Heaven/Earth/San Yuan. Taking Taiyang Meridian: starting inner canthus to vertex covers Head/Neck to Heart/Lung acupoints (Upper Jiao); back to waist/Mingmen (Middle Jiao); Kidney Shu to Foot Shaoyin (Lower Jiao). This applies to all Six Channels. Upper Jiao follows Heaven, pure clear Qi, governing Heart/Lung; pathogens here are superficial, treated with light dispersing herbs; heavy herbs overshoot. Untreated Upper Jiao transmits to Middle Jiao (deepening). Middle Jiao follows Man, boundary of clear/turbid Qi, governing Spleen/Stomach; Yangming is most susceptible, like a capital city. Differentiate Meridian vs. Fu organ. Excess needs purgation, Heat needs cold, Deficiency needs Ginseng/Astragalus, Cold needs Ginger/Aconite. Untreated Middle Jiao transmits to Lower Jiao (blood level, critical). Lower Jiao follows Earth, pure turbid Yin, governing Liver/Kidney; treat with nourishing/filling. Fire clears, Cold warms, Dampness drains. Untreated Lower Jiao damages Liver/Kidney, rarely salvageable. Zhang Zhongjing's Six Channels preceded, He Jian's Three Jiaos followed. One warp, one weft, like the sun in the sky. Six Channels aren't just for Cold Damage; internal/external injuries require them. Foot meridians include Hand meridians. Three Jiaos aren't just for Warm/Summerheat; internal/external injuries involve clear/turbid dynamics. Understanding San Jiao encompasses Twelve Meridians. Wu Ju Tong's *Wen Bing Tiao Bian*, reviewed by Wang Se Cang, clarifies Upper/Middle/Lower differentiation, vital for awakening those confused by warm/summerheat, serving as a torch in medicine. Do you agree?
Your postpartum sexual indiscretion theory is a model for eternity; "Tonify Qi and Unblock Blood" is an immutable principle. Two formulas treat full excess and half-deficient/half-excess respectively. The use of Cock Comb (*Ji Guan Bai*) shows precise empirical observation. Reading this clarifies the mind. My family secret gynecology formulas suit the poor, not the rich; yours suit both. For those with cough/fever, what is the method? Virgin amenorrhea turning into consumption (Blood Dryness or Depression-induced) is hard to treat. Please instruct me.
To Mr. Fu Tian:
Received your letter, glad to hear of your progress. Your teachings are grounded, showing deep scholarship. Reading ancients requires prior insight, connecting categories, understanding beyond the text, not being stuck within it. Viewing Dan Nue as Consumption or Yin Deficiency Heat, or Winter Essence Failure/Cold Lurking in Shaoyin, is likely incorrect. Summer diseases misidentified lead to wrong treatments, explaining prolonged ineffectiveness. Heat-only is Dan Nue; alternating chills/fever is Malaria. Both stem from Summerheat-Dampness. Entering Taiyin + Yangming = Dan Nue. Entering Taiyin + Shaoyang = Malaria ("Summer harm by summerheat, Autumn becomes Jie Nue"). Knowing disease in Taiyin/Shaoyang requires Chai Hu/Huang Qin (lifting Taiyin to Shaoyang); knowing disease in Taiyin/Yangming requires Sheng Ma/Ge Gen (lifting Taiyin to Yangming). Why does pathogen stay in Taiyin Spleen? Because daily fluctuations reflect Spleen's nature of trust/punctuality. Locals call it Dan Nue; renaming it causes confusion, so we keep the old name.
Human body has two Fires and two Earths: Kidney Fire generates Spleen Earth; Heart Fire generates Stomach Earth. Spleen/Stomach occupy Central Palace, Yin/Yang, Exterior/Interior, Zang/Fu, Ascending/Descending, operating as Taiji (like number 50 in Hetu). Classics: Drink enters Stomach, essence transports to Spleen, spreads to Lung, regulates waterways, sends to Bladder, distributes fluids through Five Meridians. This is the process. When Damp-Heat obstructs Spleen Meridian, fluid distribution fails. Zhang Zhongjing: "Yin qi isolated" refers to Taiyin isolation; "Yang qi acting alone" refers to Yangming hyperactivity without pairing, causing heat-only. "Lurking in Heart" causes vexation; "outside in muscle flesh" causes emaciation. This points to Yangming. *Bai Hu Jia Gui Zhi Tang* treats Yangming/Foot meridians. Gui Zhi counters Gypsum's cold, aiding dispersal and entering Ying to induce sweat. For anhidrotic Dan Nue, sweating is necessary to release pathogen. Without Ma Huang/Gui Zhi, how to sweat? Without sweat, how to resolve pathogen? *Ma Xing Gan Shi Tang* treats Lung heat. In Yang deficiency, Ma Huang is risky (fear of Yang collapse). Summer pores are open; do not overly weaken exterior. Ancient warnings likely applied to diaphoretic cases. For anhidrosis with trapped heat, small doses of Gypsum and Ma Huang are flexible adjustments. If fearing excessive sweat, stop-sweat formulas exist post-resolution. Using Ma Huang alone may fail to sweat quickly; Gui Zhi enters Ying while Ma Huang enters Qi. Hence Gui Zhi Tang lacks Ma Huang; Ma Huang Tang contains Gui Zhi. Wind injuring Wei avoids Ma Huang; Cold injuring Ying requires Gui Zhi. Dan Nue occurs after Summer Solstice; Feb-Mar has Warm Disease ("Winter harm by cold, Spring becomes Warm"). Summer diseases should lift Taiyin Summerheat-Damp to Yangming early, clearing and dispersing, preventing latent pathogens from becoming difficult chronic cases. For anhidrotic Dan Nue within two periods, use *Da Qing Long Tang* minus Ginger/Jujube plus Ge Gen; outside two periods, avoid forcing sweat to prevent fluid loss. If pulse is surging/rapid/excess with vexation, use *Bai Hu Jia Gui Zhi Tang*, then sweet-cold methods. Wu Ju Tong's *Wen Bing Tiao Bian* is insightful but flawed; merits outweigh demerits, cannot generalize. I lack energy to critique fully.
Virgin amenorrhea/consumption differs from postpartum amenorrhea in cause but not result. Classics: "Er Yang disease affects Heart/Spleen... women miss menses." Emotional constraint causes Liver Wood stagnation, affecting generated (Spleen) and controlled (Kidney/Liver) organs, impacting Heart/Spleen. Heart governs Blood, Spleen controls Blood, Liver stores Blood; triple stagnation causes amenorrhea. Treat via "Wood Stagnation reaching" principle: *Jia Wei Xiao Yao San* plus Tao Ren, Hong Hua, Yan Hu Suo, Bei Mu, Sheng Di. After ten doses, use *Da Huang Zhe Chong Wan*. For extreme weakness, add Ren Shen. Ensure dosage matches disease severity; stop when menstruation resumes. Cough indicates Wood-Fire insulting Metal, distinct from cold. Bei Mu resolves depression. I submit these views for your correction. Knowing your diligence and humility, I dare speak plainly. Discussion refines knowledge, preventing error, potentially sowing seeds for future enlightenment.
Wei Bo Qing annotated Dan Nue as Heat Toxicity, heavier than Wen Nue. Zhang Zhongjing used *Bai Hu Jia Gui Zhi Tang* for Wen Nue; thus, *Da Qing Long Tang* minus Ginger/Jujube plus Ge Gen is inferred for Dan Nue. Ginger is pungent/hot; Jujube is cloying/stagnant. This law applies only to early Dan Nue; long-term changes require different treatments. *Jin Gui* states: "Yin isolated, Yang acts alone." These explain Dan Nue origin: Yin/Yang mismatch is isolation; non-interaction is severance. Yin isolation causes Yang hyperactivity, preventing Spleen from transporting fluids. Interpreting "isolated/severed" heavily suggests Zhang Zhongjing's precision. In *Bai Hu Jia Gui Zhi Tang* and *Da Qing Long Tang*, Gui Zhi must be peeled (bark is hot; wood is warm).
**Da Qing Long Tang Modified**
Gypsum 6 qian, Ephedra 8 fen, Cinnamon Twig (peeled) 4 fen, Apricot Seed (skin/kernel removed) 3 qian, Licorice 5 fen, Kudzu Root 1.5 qian. Dosages adjusted clinically.
**Postpartum Sexual Indiscretion Theory (Commonly Known as Postpartum Mother Disease)**
Two to three months post-childbirth, sudden fever subsides temporarily. Days later, fever returns and subsides. Initially every few days, then every two-three days, finally continuous fever with rapid pulse, exhaustion, reduced appetite, sallow complexion. Resembles exogenous or endogenous injury, collectively called Chu Lao (Bedrest Consumption). But Chu Lao is a disease within the first month postpartum due to difficult labor. This disease occurs 2-3 months postpartum, seemingly similar but actually different, commonly called Postpartum Mother Disease. Doctors treat with exterior-releasing/dispersing agents (ineffective), then Yin-nourishing/clearing heat (ineffective), then Spleen-strengthening/appetite-opening/tonifying (ineffective). Patient deteriorates, fever persists, pulse deficient/rapid with wiry deep quality. Gradually becomes consumptive. Examining texts, no definitive theory or specific formula exists; doctors are helpless. Unknown to them, this stems from Eight Vessels emptiness and incomplete lochia expulsion within the first month postpartum, combined with sexual intercourse, blocking lochia in the uterus. Blood collaterals accumulate stasis, Qi stagnates, Ying/Wei discord causes fever. Initially mild, worsening blood stasis increases fever, weakening Qi, increasing stasis, forming Dry Blood Consumption (hard to treat). Treatment revolves around "Tonify Qi and Unblock Blood." Qi is commander of Blood; insufficiency hinders flow. Both aspects are crucial. Loss of blood: heat promotes flow, cold causes stagnation. Only nourishing Yin/clearing heat worsens stagnation and heat. Prolonged heat dries blood and weakens Qi, making recovery impossible. Recording two formulas for clinical adjustment as guidelines for future students.
**Yan Hu Suo San**
Specifically treats Postpartum Sexual Indiscretion in Women.
Corydalis 2 qian, Raw Red Peony Root 2 qian, Raw Typha Pollen 2 qian, Cinnamon Bark 2 qian, Amber 2 qian, Angelica Sinensis 2 qian, Safflower 2 qian. Soak in good vinegar overnight, grind to fine powder. Take 2 qian, finish in seven doses, wash down with aged wine. For weakness, wash down with Ginseng decoction.
**Ba Zhen Tang Modified**