丹溪曰："六气之中，湿热为病，十居八九"。有外感而得之者；有内伤而得之者。有居处卑湿，或早行雾露，或冒雨，或涉水．或汗衣湿履．则湿从外感之者；或恣①饮酒浆，过食生冷，则湿从内伤之者。又一说云：饮食人胃，无非湿也。脾土旺，则能运化水谷，上归于肺，下输膀腕，无湿气之可留也。脾弱不能运化水谷，亦谓之湿。治湿之法，古人惟以利水为主，亦不可执一，必当因其症而药也。湿气在于皮肤者，宜解表之药，如麻黄、桂枝、防己、苍术、白术之类，譬如六合阴晦②，非雨不晴也。水湿积于肠胃，肚腹肿胀者，宜攻下之药，如大黄、甘遂、大戟、芫花．牵牛、槟榔之类，譬如水满沟渠，非导之不去也。寒湿在于肌肤筋骨之间，拘牵作痛，或麻痹不仁者，宜温经之药，如干姜、附子、丁香、肉桂之类，譬如太阳在于中天，则阴湿自干也。湿气在于脏腑肌肤之间，微而不甚者，宜健脾燥湿之药，如苍术．白术、厚朴、半夏、木香、桑皮之类，譬如些须③之湿，以灰土浥④之，则湿自干也。湿热在于小腹膀胱之间，或肿，或泻，或小便不通，宜用渗泄之药，如猪苓、泽泻、茯苓、滑石、茵陈、木通、葶苈、车前子、海金砂之类，譬如水溢沟浍⑤，非疏通其窦，则不达也。湿气在于皮肤，宜用胜湿之药，如防风、羌活、独活之类，譬如清风荐爽，湿气自消也。
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①恣：zi1（音资）。恣饮酒浆：任意的喝酒。
②六合：天、地和东、西、南、北四方，叫做六合。六合阴晦：天气阴的很厉害．
③些须：很少的一点。
④浥：yi4（音意）。
⑤浍：kuai4（音桧）。水沟
火有七说
丹溪曰：五行各有一性，惟火有二，曰君火、曰相火。君火者心火也；相火者命门火也，此火出自先天。又有五志之火：大怒气逆，则火起于肝；悲哀恸中，则火起于肺；醉饱过伤，则火起于脾；房劳过度，则火起于肾；思虑过度，则火起于心。此火出于人为。火之为病，不独在五脏十二经中，凡气有余，莫非火也！诸风眩掉、胁痛、目赤，肝火动也，柴胡、黄连主之。诸痛疮疡、口舌生疮，心火动也，黄连主之。诸湿肿胀、口疮口臭，脾火动也，芍药主之。诸气膹郁①，干咳鼻衄，肺火动也，栀子、黄芩主之。遗精梦泄、赤白便浊，肾火动也，知母主之。目黄、口苦、坐卧不宁，胆火动也，柴胡主之。癃闭淋沥、赤白带浊，小肠火动也，木通主之。牙疼龈宣、颧腮颐肿，胃火动也，石膏主之。舌苔喉痛、便秘不通，大肠火动也，黄芩、大黄主之。小便不利、小腹作痛，膀胱火动也，黄柏主之。头眩、体倦、手足心热，三焦火动也，柴胡、黄芩主之。阳事频举、精溺不止，命门火动也，黄柏主之。凡此皆苦寒之药，但能泻有余之火耳。又按《玉机微义》论曰：若饮食劳伤，内伤元气，自汗发热，困倦脉大而无力，气口大于人迎或一倍、二倍，为阳虚之症，以甘温之剂除之，如黄芪、人参、甘草之属。阴微阳强，相火炽盛，以乘阴位，日渐煎熬，为血虚之症，宜滋阴之剂，地黄、天门冬、黄柏、元参、龟板、当归、知母、五味、锁阳、牛膝、虎骨．丸服。若心火亢极，郁热内实，为阳强之症，以咸冷之剂折之，如大黄、芒硝之属。若肾水受伤，真阴失守，为无根之火，阴虚之症，以壮水之剂治之，如生地、元参之属。若命门火衰，为阳脱之病，阳事不举，饮食不进，右尺脉迟细无力，命门无火，则如釜底无薪，当以温热之剂治之，如附子、干姜之属。若胃虚过食生冷，抑遏阳气于脾土之中，为火郁之症，以升散之剂发之，如升麻、葛根之类。
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①膹：fen4（音愤）。膹郁：喘急上逆，否塞不通。
痰有十因
痰不自生，生必有故，或因风，或因寒，或因热，或因湿，或因暑，或因燥，或因酒积，或因食积，或因脾虚，或因肾虚。今之治痰者，但知南星、半夏为治痰之药，而不知治痰之本，故痰愈生而病难除也。予也管见，敢以治本之药叙之：夫因风而生痰者，痰唾涎沫，其脉浮弦，治以前胡、旋复花之类。因寒而生痰者，痰唾清冷，其脉沉迟，治以姜、桂、细辛之类。因热而生痰者，痰唾胶黄，其脉洪数，治以芩、连、栀、膏之类。因湿而生痰者，痰唾碧绿，其脉浮缓，治以苍术、茯苓之类。因暑而生痰者，痰唾腥臭，其脉虚微，治以香薷、扁豆之类。因燥而生痰者，痰唾如线，或如小珠，或如胶漆，咳嗽难出，其脉滑数。治以蒌仁、花粉、贝母之类。因酒积而生痰者．痰唾呕恶，清晨发嗽，治以猪苓、葛花之类。因食积而生痰者，痰唾桃胶、蚬肉之状，胸腹闷闷不安，治以香附、枳实、神曲、麦芽之类。因脾虚而生痰者，痰唾不时，倦怠少食，治以白术、陈皮之类。因肾虚而生痰者，痰唾之时，即如潮涌，发于五更之际，治以天门冬、麦门冬、五味子之类。然此皆为辅佐之药，而主剂--二陈汤，又不可少也。
二陈汤见7页
导痰汤见7页
气有九论
气者，一身之主。内无七情所伤，外无寒暑所犯，则一气周流百骸疏畅。如有七情所干、寒暑所犯，则疾病生焉。《内经》云：怒则气上，喜则气缓，悲则气消，恐则气下，惊则气乱，劳则气耗，思则气结，寒则气收，热则气泄，九气不同，为病亦异。张子和论之详矣，予不复论。如以气虚、气实论之，夫实者，邪气实也；虚者，正气虚也。气虚为病，或精神短少，或倦怠嗜卧，或少进饮食，或眩晕，或痿躄，或自汗，或泄泻，或遗脱，诸病生焉。审其症候，诊其脉息，果然气虚，则人参、黄芪、白术之类必当用用也。若夫心痛、胁痛、小腹气痛，此则邪气阻遏①，正气不行，故作痛耳。邪气何也？或寒、或热、或痰、或食、或血是也。法当先去其邪，则正气流通，痛不作矣。大抵气属阳，调气之药必用温散，如沉香、木香、丁香、茴香、藿香、白豆蔻、陈皮、香附、砂仁之类。如病日久，则气从火化，而温热之剂，又不可单投，必以黄芩、黄连、栀子之类为主，少加热药为之向导。又闻，气者血之先，血者气之配，气既病焉，则血不得以独利，故亦从而病焉。是以治气药中必加理血之品，如当归、芍药、川芎、红花、桃仁之类。
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①遏：e4（音扼〕。阻止。
郁有六名
丹溪曰："气血冲和，百病不生，一有怫郁①，诸病生焉"。大抵诸病中多有兼郁者，或郁久而生病，或病久而生郁，故凡治病必以郁法参而治之。郁有六：气、血、湿、热、食、痰也。气郁：胸胁痛、脉沉涩。血郁：四肢无力、能食、便红、脉沉。湿郁：周身走痛，或关节痛，遇阴寒则发，脉沉细缓。热郁：瞀闷②，尿赤，脉沉而数。食郁；嗳酸饱满，不喜饮食，人迎脉平，气口脉盛。痰郁：动则喘满，寸口脉沉滑。治以六郁汤、越鞠丸主之。湿加白术、羌活。气加木香、槟榔。食加山查、砂仁。血加桃仁、红花。热加柴胡、黄芩。痰加半夏、南星。
六郁香（附）苍（术）（神）曲，栀（子）（连）翘共（枳）壳陈（皮），（川）芎（黄）芩苏梗（甘）草，郁结总能伸。
越鞠丸开郁，香附并苍术，川芎栀子仁，神曲各等分。湿加白术、茯苓。热加青黛。痰加南星、海石、瓜蒌。血加桃仁、红花。食加山查、砂仁。气加木香。
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《内经》曰："夏伤于暑，秋为□（病去丙换皆）疟①"。又曰："先寒后热者，名曰寒疟。先热后寒者，名曰温疟。但热不寒者，名曰瘅疟②"、丹溪曰：有暑疟、有风疟、有温疟、有痰疟、有食疟……邪在气分，则发之早；邪在血分，则发之晚。…又有缠绵不休，邪气伏藏胁肋，结为□（病去丙换征）块者，谓之疟母。
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①□：jie1（音皆）。□疟：疟的总称．夜病为□，昼病为疟。
②瘅：dan4（音旦）。
疟脉自弦，弦而数者多热。弦而迟者多寒。弦短者伤食。弦滑者多痰。微则为虚，代散者危。
凡症发时，耳聋、胁痛、寒热往来、口苦、喜呕，脉弦，多风疟，小柴胡汤。疟发时热多寒少、口苦、咽干、小便赤涩，脉弦数者，多阳疟，清脾饮。疟发时先热后寒者，多温疟，石膏知母汤加桂枝。疟发时独热无寒名瘅疟，当责之暑，香薷饮加茯苓，或柴胡石膏知母汤亦可。疟发时独寒无热脉迟者，名牡疟，当责之寒，蜀漆散。疟发时一身尽痛、手足沉重、寒多热少，脉濡者，名湿疟，柴平汤。……因感疫疠之气，发时乍寒乍热、一身沉重，名瘴疟，平胃散加藿香、石菖蒲、生姜。疟疾痰多胸满，发时昏乱谵语，脉弦滑者，名痰疟，二陈汤加常山、草果、黄芩、柴胡。疟疾胸膈不宽、恶闻食气者，食疟也，清脾饮加山查、神曲、麦芽。疟疾积滞胸满、热多寒少、大便燥实者，大柴胡汤下之。……疟疾微劳不任，经年不瘥，前后复发者，名劳疟，小柴胡汤去半夏加天花粉。夜疟宜用血药，引出阳分而散，川芎、当归、红花、苍术、白芷、黄柏、甘草，水煎露一宿服。疟母用醋炙鳖甲、三棱、莪术、木香、香附、海石、青皮、桃仁、红花、神曲、麦芽，醋为丸，滚汤下。截疟用常山、草果、槟榔、知母各一钱，热酒一盅，水煎后，漫露一宿，五更温服。
小柴胡汤见7页
清脾饮柴（胡）（黄）芩，甘草厚（朴）青（皮）（茯）苓，半（夏）（白）术并草果，痰食疟相应。
石膏知母汤见15页
香薷饮见21页
蜀漆（洗去腥）云母（烧二日夜）龙骨三味杵为散未发前以浆水服半钱。
二陈汤见7页
平胃散见8页
大柴胡汤见15页
痢因湿热及受积停
痢疾之症，里急后重，或血、或脓、或脓血相杂，或痛、或不痛。此症原其所因，不外湿、热、食积三者。伤于气分，痢下则白；伤于血分，痢下则赤；气血俱伤，则赤白相杂。下痢之脉，微小者吉，浮洪者凶，滑大者吉，弦急者凶。刘河间曰：治痢大法，行血则便脓自愈，调气则后重自除。又曰："后重则宜下，腹痛则宜和，身重则除湿，脉弦则去风。脓血稠粘，以重药揭之。身冷自汗，以热药温之。风邪外来宜汗之。鹭溏为痢宜温之"。
治痢验方：痢疾初起，便脓下血，里急后重，用芍药汤。白痢用温六丸。赤痢用清六九。赤白相杂，里急后重，用立效散。痢疾初时失下，反用兜涩之药，以致邪杂内蓄，血不得行，腹痛难忍者，用桃仁承气汤。痢疾发热，肠胃中有风邪也，人参败毒散加黄连、陈仓米、生姜、大枣，煎服。时行疫痢，噤口不食，加石莲子肉七个。下痢日久。赤白已尽，虚寒脱肛者，养脏汤。
治痢芍药汤，（黄）芩（黄）连（肉）桂大黄，（木）香槟（榔）（当）归甘草，后重即安康。
滑石（六两水飞）粉草（一两）红曲（五钱）为末，水丸。
黄连（四两酒洗）吴茱萸（二两，二味同炒去茱萸）陈皮（二两）枳壳（二两麸炒）共为末。每服三钱，黄酒送下。噤口痢用陈仓米煎汤调下。
桃仁承气汤见16页
人参败毒散见17页
养脏（白）芍当归，人参（肉）桂（白）术随，木香甘（草）米壳，诃子（肉）蔻乌梅。
和中（当）归酒（黄）连，陈（皮）（白）芍（厚）朴苍（术）甘（草），茯苓并枳壳，新久痢皆痊。
按：痢疾是湿热之邪积滞肠道引起，故治疗大法，应清热祛湿导滞。初起如有发热，可予葛根芩连汤、白头翁汤加减，湿热清，则发热自除，下痢自止、又痢疾初起，不宜用涩止药，盖湿热未清，收涩过早，易转成休息痢。
Danxi stated: "Among the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), diseases caused by Damp-Heat account for eight or nine out of ten." Some are acquired through external contraction; some through internal injury. Some arise from dwelling in low and damp places, walking early in fog and dew, being caught in rain, wading through water, or wearing wet clothes and shoes; these are cases where Dampness invades from the exterior. Others arise from indulging in alcoholic beverages or overeating raw and cold foods; these are cases where Dampness results from internal injury to the Spleen and Stomach. Another theory holds: Food entering the Stomach is essentially Damp. If the Earth element of the Spleen is vigorous, it can transform and transport food and fluids, sending them up to the Lung and down to the Bladder, leaving no room for Dampness to accumulate. If the Spleen is weak and cannot transform and transport food and fluids, this also constitutes Dampness. The method for treating Dampness in ancient times focused mainly on promoting urination, but one must not adhere rigidly to a single approach; treatment must be based on symptoms. When Dampness resides in the skin, dispersing exterior herbs such as Ephedrae Herba (Mahuang, 麻黄), Cinnamon Twig (Guizhi, 桂枝), Stephaniae Radix (Fangji, 防己), Atractylodis Rhizoma Rubrum (Cangzhu, 苍术), and Atractylodis Rhizoma Alba (Baizhu, 白术) should be used. This is like the sky being dark and gloomy; it will not clear without rain. When Water-Damp accumulates in the intestines and stomach causing abdominal swelling, purgative herbs such as Rhei Radix et Rhizoma (Dahuang, 大黄), Kansui Radix (Gansui, 甘遂), Euphorbiae Pekinensis Radix (Daji, 大戟), Genkwa Flos (Yuanhua, 芫花), Pharbitidis Semen (Qianniu, 牵牛), and Arecae Pericarpium (Binglang, 槟榔) should be used. This is like a full ditch; it cannot be drained without guidance. When Cold-Damp resides between the muscles, skin, sinews, and bones causing spasmodic pain or numbness and loss of sensation, warming meridian herbs such as Zingiberis Rhizoma (Ganjiang, 干姜), Aconiti Lateralis Radix Praeparata (Fuzi, 附子), Eugeniae Flos (Dingxiang, 丁香), and Cinnamomi Cortex (Rougui, 肉桂) should be used. This is like the sun at its zenith; Yin-Damp will naturally dry up. When Dampness resides between the zang-fu organs and skin/muscles, mildly and not severely, spleen-strengthening and damp-drying herbs such as Atractylodis Rhizoma Rubrum (Cangzhu, 苍术), Atractylodis Rhizoma Alba (Baizhu, 白术), Magnoliae Officinalis Cortex (Houpo, 厚朴), Pinelliae Tuber (Banxia, 半夏), Aucklandiae Radix (Muxiang, 木香), and Morus Alba Root Bark (Sangpi, 桑皮) should be used. This is like slight dampness being dried by ash and soil. When Damp-Heat resides in the lower abdomen and Bladder causing swelling, diarrhea, or urinary obstruction, draining and leaching herbs such as Polyporus (Zhuling, 猪苓), Alisma Rhizoma (Zexie, 泽泻), Poria (Fuling, 茯苓), Talcum (Huashi, 滑石), Artemisiae Scopariae Herba (Yinchen, 茵陈), Akebiae Caulis (Mutong, 木通), Lepidii Semen (Tingli, 葶苈), Plantaginis Seed (Cheqianzi, 车前子), and Menispermi Semen (Haijinsha, 海金砂) should be used. This is like water overflowing ditches; it cannot flow freely without clearing the outlets. When Dampness resides in the skin, wind-dispelling and damp-resolving herbs such as Saposhnikoviae Radix (Fangfeng, 防风), Notopterygii Rhizoma et Radix (Qianghuo, 羌活), and Angelicae Pubescentis Radix (Duhuo, 独活) should be used. This is like a refreshing breeze dissipating the dampness.
Seven Discussions on Fire
Danxi stated: "Each of the Five Elements has its own nature, but Fire has two: Ministerial Fire (Jun Huo) and Assistant Fire (Xiang Huo). Ministerial Fire is Heart Fire; Assistant Fire is Mingmen Fire, originating from congenital essence. There is also fire arising from the Five Emotions: Anger causing qi rebellion generates fire in the Liver; excessive grief generates fire in the Lung; excess in drinking and eating damages the Spleen generating fire; sexual exhaustion generates fire in the Kidney; excessive thinking generates fire in the Heart. This fire arises from human activity. Diseases caused by Fire are not limited to the five zang organs and twelve meridians; wherever there is excess qi, there is Fire. Various wind-induced vertigo and tremors, hypochondriac pain, and red eyes indicate Liver Fire moving, treated primarily with Bupleuri Radix (Chaihu, 柴胡) and Coptidis Rhizoma (Huanglian, 黄连). Various painful sores and ulcers, mouth and tongue ulcers indicate Heart Fire moving, treated primarily with Coptidis Rhizoma (Huanglian, 黄连). Various damp swellings, mouth ulcers, and bad breath indicate Spleen Fire moving, treated primarily with Paeoniae Radix Alba (Shaoyao, 芍药). Various qi stagnation and distension, dry cough, and epistaxis indicate Lung Fire moving, treated primarily with Gardeniae Fructus (Zhizi, 栀子) and Scutellariae Radix (Huangqin, 黄芩). Nocturnal emission, cloudy urine, and dysentery with blood indicate Kidney Fire moving, treated primarily with Anemarrhenae Rhizoma (Zhimu, 知母). Yellow eyes, bitter taste, and restlessness indicate Gallbladder Fire moving, treated primarily with Bupleuri Radix (Chaihu, 柴胡). Dysuria and leukorrhea indicate Small Intestine Fire moving, treated primarily with Akebiae Caulis (Mutong, 木通). Toothache, swollen gums, and cheek swelling indicate Stomach Fire moving, treated primarily with Gypsum Fibrosum (Shigao, 石膏). Tongue coating abnormalities, sore throat, and constipation indicate Large Intestine Fire moving, treated primarily with Scutellariae Radix (Huangqin, 黄芩) and Rhei Radix et Rhizoma (Dahuang, 大黄). Urinary difficulty and lower abdominal pain indicate Bladder Fire moving, treated primarily with Phellodendri Cortex (Huangbai, 黄柏). Vertigo, fatigue, and heat in the palms and soles indicate Sanjiao Fire moving, treated primarily with Bupleuri Radix (Chaihu, 柴胡) and Scutellariae Radix (Huangqin, 黄芩). Frequent erections and uncontrollable seminal emission indicate Mingmen Fire moving, treated primarily with Phellodendri Cortex (Huangbai, 黄柏). All these are bitter-cold herbs that only drain excess Fire. Furthermore, referencing *Yu Ji Wei Yi*: If dietary and labor injuries damage primordial qi, causing spontaneous sweating, fever, fatigue, and a large but forceless pulse, with the Qi Kou pulse larger than the Ren Ying pulse by one or two times, this is Yang deficiency, treated with sweet-warm formulas such as Astragali Radix (Huangqi, 黄芪), Ginseng Radix (Renshen, 人参), and Glycyrrhizae Radix et Rhizoma (Gancao, 甘草). When Yin is weak and Yang strong, with Assistant Fire blazing and invading Yin positions, gradually consuming fluids, this is Blood deficiency, treated with yin-nourishing formulas such as Rehmanniae Radix (Dihuang, 地黄), Asparagi Radix (Tianmendong, 天门冬), Phellodendri Cortex (Huangbai, 黄柏), Scrophulariae Radix (Yuanshen, 元参), Testudinis et Chelonis Carapax et Plastrum (Guiban, 龟板), Angelicae Sinensis Radix (Danggui, 当归), Anemarrhenae Rhizoma (Zhimu, 知母), Schisandrae Fructus (Wuweizi, 五味子), Curculiginis Rhizoma (Suoyang, 锁阳), Achyranthis Bidentatae Radix (Niuxi, 牛膝), and Pantheris Os (Hugu, 虎骨) prepared as pills. If Heart Fire is extremely hyperactive with internal stagnant heat, this is Yang excess, treated with salty-cold formulas to subdue it, such as Rhei Radix et Rhizoma (Dahuang, 大黄) and Natrii Sulfas (Mangxiao, 芒硝). If Kidney Water is injured and True Yin is lost, resulting in rootless Fire, this is Yin deficiency, treated with water-strengthening (yin-nourishing) formulas such as Shengdihuang (Rehmanniae Radix Preparata, 生地) and Scrophulariae Radix (Yuanshen, 元参). If Mingmen Fire declines, leading to Yang collapse with impotence, poor appetite, and a slow, thin, and forceless Right Chi pulse, indicating no fire in the Mingmen like a stove without fuel, treat with warm-hot formulas such as Aconiti Lateralis Radix Praeparata (Fuzi, 附子) and Zingiberis Rhizoma (Ganjiang, 干姜). If Stomach deficiency combined with excessive raw/cold food suppresses Yang qi within the Spleen Earth, causing Fire stagnation, treat with ascending and dispersing formulas such as Cimicifugae Rhizoma (Shengma, 升麻) and Puerariae Lobatae Radix (Gegen, 葛根).
Ten Causes of Phlegm
Phlegm does not generate itself; its generation always has a cause: due to Wind, Cold, Heat, Dampness, Summer-heat, Dryness, Wine accumulation, Food accumulation, Spleen deficiency, or Kidney deficiency. Current practitioners only know that Arisaema Cum Bile (Nanxing, 南星) and Pinelliae Tuber (Banxia, 半夏) treat phlegm, ignoring the root cause, thus phlegm increases and the disease persists. My humble opinion presents root-treating herbs: For phlegm due to Wind, presenting as saliva and foam with a floating-wiry pulse, treat with Peucedani Radix (Qianhu, 前胡) and Inulae Flos (Xuanjufanhua, 旋复花). For phlegm due to Cold, presenting as clear-cold saliva with a deep-slow pulse, treat with Ginger (Jiang, 姜), Cinnamon (Gui, 桂), and Asari Radix et Rhizoma (Xixin, 细辛). For phlegm due to Heat, presenting as sticky-yellow saliva with a surging-rapid pulse, treat with Scutellariae Radix (Huangqin, 黄芩), Coptidis Rhizoma (Huanglian, 黄连), Gardeniae Fructus (Zhizi, 栀子), and Gypsum Fibrosum (Shigao, 石膏). For phlegm due to Dampness, presenting as green saliva with a floating-slow pulse, treat with Atractylodis Rhizoma Rubrum (Cangzhu, 苍术) and Poria (Fuling, 茯苓). For phlegm due to Summer-heat, presenting as fishy-smelling saliva with a deficient-micro pulse, treat with Moslae Herba (Xiangru, 香薷) and Dolichos Lablab Seed (Bian Dou, 扁豆). For phlegm due to Dryness, presenting as thread-like or bead-like or glue-like saliva with difficult coughing and a slippery-rapid pulse, treat with Trichosanthis Semen (Louren, 蒌仁), Trichosanthis Radix (Huafen, 花粉), and Fritillariae Bulbus (Beimu, 贝母). For phlegm due to Wine accumulation, presenting with nausea/vomiting and morning cough, treat with Polyporus (Zhuling, 猪苓) and Puerariae Flos (Ge Hua, 葛花). For phlegm due to Food accumulation, presenting with saliva resembling peach gum or clam meat, chest/abdominal fullness and discomfort, treat with Cyperi Rhizoma (Xiangfu, 香附), Aurantii Fructus Immaturus (Zhishi, 枳实), Massae Fermentatae Medicinatae (Shenqu, 神曲), and Hordeum Germ (Maiya, 麦芽). For phlegm due to Spleen deficiency, presenting with intermittent saliva, fatigue, and poor appetite, treat with Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) and Citri Reticulatae Pericarpium (Chenpi, 陈皮). For phlegm due to Kidney deficiency, presenting with tidal saliva surging like waves, occurring at dawn (Wu Geng), treat with Asparagi Radix (Tianmendong, 天门冬), Ophiopogonis Radix (Mendong, 麦门冬), and Schisandrae Fructus (Wuweizi, 五味子). However, these are auxiliary herbs; the main formula, Er Chen Tang (Two-Aged Decoction), is indispensable.
Er Chen Tang (Two-Aged Decoction) see page 7
Dao Tan Tang (Guiding Phlegm Decoction) see page 7
Gun Tan Wan (Rolling Phlegm Pill)
Gun Tan Wan contains Da Huang (Rhei Radix et Rhizoma, 川军), Huang Qin (Scutellariae Radix, 黄芩) each half jin, Qing Meng Shi (Lapis Malachitis, 青礞石) one liang, and Chen Xiang (Aquilariae Lignum Resinatum, 沉香) five qian.
Nine Discussions on Qi
Qi is the master of the body. Without emotional injury or climatic invasion, Qi circulates freely throughout the body. With emotional interference or climatic invasion, disease arises. *Nei Jing* states: Anger causes Qi to ascend; Joy causes Qi to slacken; Sorrow causes Qi to dissipate; Fear causes Qi to descend; Shock causes Qi to disperse; Labor causes Qi to consume; Thinking causes Qi to knot; Cold causes Qi to contract; Heat causes Qi to leak. These nine variations differ and cause different diseases. Zhang Zihe discussed this in detail, so I will not elaborate. Regarding Qi Deficiency vs. Qi Excess: Excess refers to pathogenic excess; Deficiency refers to healthy Qi deficiency. Qi deficiency diseases include mental fatigue, lethargy, intolerance to food intake, vertigo, flaccidity, spontaneous sweating, diarrhea, or seminal emission. Carefully examine symptoms and pulses; if Qi deficiency is confirmed, Ginseng Radix (Renshen, 人参), Astragali Radix (Huangqi, 黄芪), and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) must be used. Regarding heart pain, hypochondriac pain, and lower abdominal Qi pain, these result from pathogenic obstruction blocking healthy Qi circulation. Pathogens include Cold, Heat, Phlegm, Food, or Blood stasis. The method is to first eliminate pathogens so healthy Qi flows freely and pain ceases. Generally, Qi belongs to Yang; Qi-regulating herbs must be warm and dispersing, such as Aquilariae Lignum Resinatum (Chenxiang, 沉香), Aucklandiae Radix (Muxiang, 木香), Eugeniae Flos (Dingxiang, 丁香), Foeniculum Vulgare Fruit (Huixiang, 茴香), Agastaches Herba (Huoxiang, 藿香), Amomi Fructus Rotundus (Baidoukou, 白豆蔻), Citri Reticulatae Pericarpium (Chenpi, 陈皮), Cyperi Rhizoma (Xiangfu, 香附), and Amomi Fructus (Sharen, 砂仁). If illness persists long-term, Qi transforms into Fire, so warm herbs alone are insufficient; use Scutellariae Radix (Huangqin, 黄芩), Coptidis Rhizoma (Huanglian, 黄连), and Gardeniae Fructus (Zhizi, 栀子) as main herbs, adding small amounts of warm herbs as guides. It is said that Qi precedes Blood, and Blood accompanies Qi. If Qi is diseased, Blood cannot flow independently and becomes diseased too. Therefore, blood-regulating herbs such as Angelicae Sinensis Radix (Danggui, 当归), Paeoniae Radix (Shaoyao, 芍药), Chuanxiong Rhizoma (Chuanxiong, 川芎), Carthami Flos (Honghua, 红花), and Persicae Semen (Taoren, 桃仁) must be added to Qi-treating formulas.
Six Names of Stagnation (Yu)
Danxi stated: "When Qi and Blood are harmonious, no disease arises; once there is stagnation (Fu Yu, 怫郁), various diseases emerge." Most diseases involve some degree of stagnation; either stagnation leads to disease over time, or chronic disease leads to stagnation. Thus, treating any disease must incorporate methods for resolving stagnation. Stagnation has six types: Qi, Blood, Dampness, Heat, Food, and Phlegm. Qi Stagnation: Hypochondriac pain, deep-choppy pulse. Blood Stagnation: Limb weakness, good appetite, bloody stool, deep pulse. Damp Stagnation: Wandering body pain or joint pain, worsening in cold/damp weather, deep-thin-slow pulse. Heat Stagnation: Mental confusion/fogginess, red urine, deep-rapid pulse. Food Stagnation: Acid belching, fullness, dislike of food, normal Ren Ying pulse, full Qi Kou pulse. Phlegm Stagnation: Panting/fullness upon movement, deep-slippery Cun Kou pulse. Treat with Liu Yu Tang (Six Stagnations Decoction) or Yue Ju Wan (Pill Resolving Stagnation). Add Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) and Qianghuo (Notopterygii Rhizoma et Radix, 羌活) for Damp. Add Muxiang (Aucklandiae Radix, 木香) and Binglang (Arecae Pericarpium, 槟榔) for Qi. Add Shan Zha (Crataegi Fructus, 山楂) and Sharen (Amomi Fructus, 砂仁) for Food. Add Taoren (Persicae Semen, 桃仁) and Honghua (Carthami Flos, 红花) for Blood. Add Chaihu (Bupleuri Radix, 柴胡) and Huangqin (Scutellariae Radix, 黄芩) for Heat. Add Banxia (Pinelliae Tuber, 半夏) and Nanxing (Arisaema Cum Bile, 南星) for Phlegm.
Liu Yu Tang (Six Stagnations Decoction)
Contains Xiang Fu (Cyperi Rhizoma, 香附), Cang Zhu (Atractylodis Rhizoma Rubrum, 苍术), Shen Qu (Massae Fermentatae Medicinatae, 神曲), Zhi Zi (Gardeniae Fructus, 栀子), Lian Qiao (Forsythiae Fructum, 连翘), Zhi Ke (Aurantii Fructus Immaturus, 枳壳), Chen Pi (Citri Reticulatae Pericarpium, 陈皮), Chuan Xiong (Chuanxiong Rhizoma, 川芎), Huang Qin (Scutellariae Radix, 黄芩), Su Geng (Perillae Caulis, 苏梗), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草). It can relieve all stagnations.
Yue Ju Wan (Pill Resolving Stagnation)
Resolves stagnation using Xiang Fu (Cyperi Rhizoma, 香附) and Cang Zhu (Atractylodis Rhizoma Rubrum, 苍术), Chuan Xiong (Chuanxiong Rhizoma, 川芎), Zhi Zi Ren (Gardeniae Fructus, 栀子仁), Shen Qu (Massae Fermentatae Medicinatae, 神曲) in equal parts. Add Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) and Fuling (Poria, 茯苓) for Damp. Add Qing Dai (Azurite, 青黛) for Heat. Add Nanxing (Arisaema Cum Bile, 南星) and Hai Shi (Lapis Calcitae, 海石) and Gua Lou (Trichosanthes Fruit, 瓜蒌) for Phlegm. Add Taoren (Persicae Semen, 桃仁) and Honghua (Carthami Flos, 红花) for Blood. Add Shan Zha (Crataegi Fructus, 山楂) and Sharen (Amomi Fructus, 砂仁) for Food. Add Muxiang (Aucklandiae Radix, 木香) for Qi.
Malaria Caused by Summer-heat and Wind, Complicated by Phlegm and Food
*Nei Jing* states: "Summer injury by Summer-heat leads to Malaria in Autumn." It also states: "Chills preceding fever is named Han Malaria (Cold Malaria). Fever preceding chills is named Wen Malaria (Warm Malaria). Fever only without chills is named Dan Malaria (Intense Malaria)." Danxi stated: There are Shu Malaria (Summer-heat Malaria), Feng Malaria (Wind Malaria), Wen Malaria (Warm Malaria), Tan Malaria (Phlegm Malaria), Shi Malaria (Food Malaria)... If pathogen is in the Qi level, onset is early; if in the Blood level, onset is late. ... Persistent malaria where pathogen hides in the hypochondrium forming a mass is called Nu Mu (Malaria Mother).
Malaria pulse is naturally wiry (Xian, 弦). Wiry and rapid indicates Heat. Wiry and slow indicates Cold. Wiry and short indicates Food injury. Wiry and slippery indicates Phlegm. Micro indicates Deficiency. Intermitting or scattered indicates critical condition.
During attacks, deafness, hypochondriac pain, alternating chills and fever, bitter taste, and desire to vomit with a wiry pulse indicate Wind Malaria, treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Malaria with more heat than chills, bitter taste, dry throat, red/scanty urine, and wiry-rapid pulse indicates Yang Malaria, treat with Qing Pi Yin (Clear the Spleen Drink). Malaria with fever preceding chills indicates Warm Malaria, treat with Shi Gao Zhi Mu Tang (Gypsum and Anemarrhena Decoction) plus Gui Zhi (Cinnamon Twig, 桂枝). Malaria with heat only, no chills, named Dan Malaria, attributed to Summer-heat, treat with Xiang Ru Yin (Mosla Drink) plus Fuling (Poria, 茯苓), or Chai Hu Shi Gao Zhi Mu Tang is also acceptable. Malaria with chills only, no heat, slow pulse, named Mu Malaria, attributed to Cold, treat with Shu Qi San (Shu Qi Powder). Malaria with whole-body pain, heavy limbs, more chills than heat, and soggy pulse indicates Damp Malaria, treat with Chai Ping Tang (Bupleurum and Pingwei Decoction). ... Contracting epidemic pestilence qi, causing alternating chills/fever and heaviness, named Zhang Malaria (Miasma Malaria), treat with Ping Wei San (Peace the Stomach Powder) plus Huoxiang (Agastaches Herba, 藿香), Shichangpu (Acori Tatarinowii Rhizoma, 石菖蒲), and Sheng Jiang (Zingiberis Rhizoma Recens, 生姜). Malaria with much phlegm, chest fullness, confusion/delirium during attacks, wiry-slippery pulse indicates Phlegm Malaria, treat with Er Chen Tang (Two-Aged Decoction) plus Chang Shan ( Dichroae Radix, 常山), Cao Guo (Tsaoko Fructus, 草果), Huang Qin (Scutellariae Radix, 黄芩), and Chai Hu (Bupleuri Radix, 柴胡). Malaria with chest oppression and aversion to food smell indicates Food Malaria, treat with Qing Pi Yin (Clear the Spleen Drink) plus Shan Zha (Crataegi Fructus, 山楂), Shen Qu (Massae Fermentatae Medicinatae, 神曲), and Mai Ya (Hordeum Germ, 麦芽). Malaria with stagnation, chest fullness, more heat than chills, and dry hard stool, treat with Da Chai Hu Tang (Major Bupleurum Decoction) to purge. ... Malaria due to slight exertion, persisting for years with recurrences, named Lao Malaria (Labor Malaria), treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Tuber, 半夏) adding Tian Hua Fen (Trichosanthis Radix, 天花粉). Night malaria should use Blood herbs to draw out to the Yang level and disperse: Chuan Xiong (Chuanxiong Rhizoma, 川芎), Dang Gui (Angelicae Sinensis Radix, 当归), Hong Hua (Carthami Flos, 红花), Cang Zhu (Atractylodis Rhizoma Rubrum, 苍术), Bai Zhi (Angelicae Dahuricae Radix, 白芷), Huang Bai (Phellodendri Cortex, 黄柏), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), decocted in water and exposed overnight before taking. Malaria Mother (Nu Mu) treats with Vine-processed Turtle Shell (Biejia, 鳖甲), San Leng (Sparganii Rhizoma, 三棱), E Zhu (Curcumae Rhizoma, 莪术), Mu Xiang (Aucklandiae Radix, 木香), Xiang Fu (Cyperi Rhizoma, 香附), Hai Shi (Lapis Calcitae, 海石), Qing Pi (Citri Reticulatae Pericarpium Viride, 青皮), Tao Ren (Persicae Semen, 桃仁), Hong Hua (Carthami Flos, 红花), Shen Qu (Massae Fermentatae Medicinatae, 神曲), Mai Ya (Hordeum Germ, 麦芽), made into pills with vinegar, taken with boiling water. To cut malaria, use Chang Shan (Dichroae Radix, 常山), Cao Guo (Tsaoko Fructus, 草果), Bing Lang (Arecae Pericarpium, 槟榔), Zhi Mu (Anemarrhenae Rhizoma, 知母) each one qian, one cup hot wine, decocted in water, exposed overnight, taken warm at Wu Geng (3-5 AM).
Xiao Chai Hu Tang (Minor Bupleurum Decoction) see page 7
Qing Pi Yin (Clear the Spleen Drink)
Contains Chai Hu (Bupleuri Radix, 柴胡), Huang Qin (Scutellariae Radix, 黄芩), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), Hou Po (Magnoliae Officinalis Cortex, 厚朴), Qing Pi (Citri Reticulatae Pericarpium Viride, 青皮), Fu Ling (Poria, 茯苓), Ban Xia (Pinelliae Tuber, 半夏), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 白术) and Cao Guo (Tsaoko Fructus, 草果), corresponding to Phlegm-Food Malaria.
Shi Gao Zhi Mu Tang (Gypsum and Anemarrhena Decoction) see page 15
Xiang Ru Yin (Mosla Drink) see page 21
Chai Hu Shi Gao Zhi Mu Tang
Is Xiao Chai Hu Tang combined with Shi Gao Zhi Mu Tang.
Shu Qi San (Shu Qi Powder)
Shu Qi (washed to remove fishy smell), Yun Mu (burned for two days and nights), Long Gu (three ingredients) pounded into powder. Take half a qian with grain water before onset.
Chai Ping Tang
Is Xiao Chai Hu Tang combined with Ping Wei San.
Er Chen Tang (Two-Aged Decoction) see page 7
Ping Wei San (Peace the Stomach Powder) see page 8
Da Chai Hu Tang (Major Bupleurum Decoction) see page 15
Dysentery Caused by Damp-Heat and Accumulation
Dysentery symptoms include tenesmus (Li Ji Hou Zhong, 里急后重), passing blood, pus, or mixed pus and blood, with or without pain. The causes are none other than Dampness, Heat, and Food accumulation. Injury to the Qi level results in white discharge; injury to the Blood level results in red discharge; injury to both results in mixed red and white. Pulse in dysentery: Micro is auspicious; Floating-Surging is ominous; Slippery-Large is auspicious; Wiry-Rapid is ominous. Liu Hejian stated: The general principle for treating dysentery is: Moving Blood heals pus/blood discharge; Regulating Qi eliminates tenesmus. Also: "Tenesmus requires purging; Abdominal pain requires harmonizing; Body heaviness requires removing Dampness; Wiry pulse requires expelling Wind. Thick/sticky pus/blood requires heavy medicine to lift/expel. Cold body/spontaneous sweating requires warm medicine to warm. External Wind pathogen requires sweating. Loose stools resembling bird droppings require warming."
Verified Dysentery Formulas: Early stage dysentery with pus/blood and tenesmus, use Shao Yao Tang (Peony Decoction). White dysentery uses Wen Liu Wan (Warm Six Pill). Red dysentery uses Qing Liu Wan (Clear Six Pills). Mixed red/white with tenesmus, use Li Xiao San (Instant Effect Powder). If early dysentery was missed and astringents were wrongly used, causing pathogen accumulation, blood stasis, and unbearable abdominal pain, use Tao Ren Cheng Qi Tang (Persicae Seed and Rhubarb Decoction). Dysentery with fever indicates Wind pathogen in intestines/stomach, use Ren Shen Bai Du San (Ginseng and Imperceptible Pestilence Powder) plus Huang Lian (Coptidis Rhizoma, 黄连), Chen Cang Mi (Old Rice, 陈仓米), Sheng Jiang (Zingiberis Rhizoma Recens, 生姜), Da Zao (Jujubae Fructus, 大枣). Epidemic dysentery with inability to eat (Jin Kou Li, 噤口痢), add seven Shi Lian Zi Rou (Nelumbinis Semen, 石莲子肉). Chronic dysentery with exhausted red/white discharge, deficiency-cold rectal prolapse, use Yang Zang Tang (Nourish Viscera Decoction).
Shao Yao Tang (Peony Decoction)
Contains Huang Qin (Scutellariae Radix, 黄芩), Huang Lian (Coptidis Rhizoma, 黄连), Rou Gui (Cinnamomi Cortex, 肉桂), Da Huang (Rhei Radix et Rhizoma, 大黄), Mu Xiang (Aucklandiae Radix, 木香), Bing Lang (Arecae Pericarpium, 槟榔), Dang Gui (Angelicae Sinensis Radix, 当归), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草). Tenesmus resolves immediately.
Wen Liu Wan (Warm Six Pills)
Hua Shi (Talcum, 滑石 - six liang water-ground), Fen Cao (Licorice, 粉草 - one liang), Gan Jiang (Zingiberis Rhizoma, 干姜 - five qian) pounded to powder, water pills.
Qing Liu Wan (Clear Six Pills)
Hua Shi (Talcum, 滑石 - six liang water-ground), Fen Cao (Licorice, 粉草 - one liang), Hong Qu (Red Yeast Rice, 红曲 - five qian) pounded to powder, water pills.
Li Xiao San (Instant Effect Powder)
Huang Lian (Coptidis Rhizoma, 黄连 - four liang wine-washed), Wu Zhu Yu (Evodiae Fructus, 吴茱萸 - two liang, stir-fried together then remove Evodia), Chen Pi (Citri Reticulatae Pericarpium, 陈皮 - two liang), Zhi Ke (Aurantii Fructus Immaturus, 枳壳 - two liang bran-fried) pounded to powder. Take three qian with yellow wine. For Jin Kou Li, mix with Old Rice decoction.
Tao Ren Cheng Qi Tang (Persicae Seed and Rhubarb Decoction) see page 16
Ren Shen Bai Du San (Ginseng and Imperceptible Pestilence Powder) see page 17
Yang Zang Tang (Nourish Viscera Decoction)
Contains Bai Shao (Paeoniae Radix Alba, 白芍), Dang Gui (Angelicae Sinensis Radix, 当归), Ren Shen (Ginseng Radix, 人参), Rou Gui (Cinnamomi Cortex, 肉桂), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 白术), Mu Xiang (Aucklandiae Radix, 木香), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), Ying Su Ke (Papaveris Capsicum, 罂粟壳), He Zi (Terminalia Chebulae Fructus, 诃子), Dou Kou (Myristica Seed, 肉豆蔻), Wu Mei (Mume Fructus, 乌梅).
He Zhong Tang (Harmonize Middle Decoction)
Contains Dang Gui (Angelicae Sinensis Radix, 当归), Jiu Huang Lian (Wine-processed Coptidis Rhizoma, 酒黄连), Chen Pi (Citri Reticulatae Pericarpium, 陈皮), Bai Shao (Paeoniae Radix Alba, 白芍), Hou Po (Magnoliae Officinalis Cortex, 厚朴), Cang Zhu (Atractylodis Rhizoma Rubrum, 苍术), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), Fu Ling (Poria, 茯苓) and Zhi Ke (Aurantii Fructus Immaturus, 枳壳). Cures both new and old dysentery.
Note: Dysentery is caused by Damp-Heat pathogen stagnating in the intestines; thus the general treatment principle is clearing Heat, removing Dampness, and guiding out stagnation. If fever occurs initially, Ge Gen Qin Lian Tang (Kudzu and Scutellaria Decoction) or Bai Tou Weng Tang (Pulsatilla Decoction) may be modified. Once Damp-Heat clears, fever subsides and dysentery stops. Early dysentery should not use astringents; premature astringency while Damp-Heat remains easily converts it to Resting Dysentery (Xiuxi Li, 休息痢).
Ge Gen Qin Lian Tang (Kudzu and Scutellaria Decoction)
Ge Gen (Puerariae Lobatae Radix, 葛根), Huang Qin (Scutellariae Radix, 黄芩), Huang Lian (Coptidis Rhizoma, 黄连), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), decocted in water.
Bai Tou Weng Tang (Pulsatilla Decoction)
Bai Tou Weng (Pulsatillae Radix, 白头翁), Qin Pi (Fraxini Cortex, 秦皮), Huang Lian (Coptidis Rhizoma, 黄连), Huang Bai (Phellodendri Cortex, 黄柏), decocted in water.
These two formulas may also be酌情 (discretionarily) added with Dang Gui (Angelicae Sinensis Radix, 当归), Bai Shao (Paeoniae Radix Alba, 白芍), Shan Zha (Crataegi Fructus, 山楂), Ma Chi Xian (Portulacae Herba, 马齿苋), etc.
Vomiting is when Stomach Qi rebels downward instead of descending.