血愈衰。《针经》曰∶怒气所至，食则气逆不下；劳气所至，为膈噎、喘促；思气所至，为
中痞，三焦闭塞，咽嗌不利。痰饮脉滑或伏，二陈汤、古参夏汤、化痰丸、栝蒌实丸，或用
黄连、吴萸、贝母、栝蒌仁、牛转草，水煎；食积脉滑而短，枳术丸加黄连、陈皮、半夏，
或狗米平胃丸、虎脂平胃丸，或用保和丸二钱，加姜炒黄连三钱、山楂二钱为丸，麻仁大，
胭脂为衣，每六十丸，人参煎汤，入竹沥下。七情郁结，脉沉而涩，饮食喜静，胸背痛者，
四七汤、温胆汤；痞满烦闷，微嗽，二便不利者，分心气饮、四磨汤，或木香、槟榔二味等
分为末，白汤下；伤神不睡者，十味温胆汤、朱砂安神丸；腹胀肠鸣者，木香匀气散；有积
聚者，阿魏撞气丸；恶闻食气者，五膈宽中散。
气血两虚多口沫；
沫大出者，死。气虚不能运化生痰者，脉必缓而无力，四君子汤；大便闭，加芦
根、童便；气虚甚者，六君子汤加附子、大黄；酒毒，加甘庶汁；单人参汤、人参膏尤妙。
血虚不能滋润生火者，脉必数而无力，四物汤加童便、竹沥、姜汁；大便闭，加桃仁、红花
；有瘀血，加牡丹皮、韭汁；防生虫，加驴尿；血虚甚，加干姜；血燥，加牛、羊乳汁，不
可以人乳代之，盖人乳反有七情、饮食之毒火故也；气血俱虚者，八物汤主之。
金水二脏须扶持，
血阴主静，内外两静，则脏腑之火不起，而金水二气有养，阴血自生，津液传
化合宜，何膈噎之有？肾气丸主之。
益阴养胃是总诀。
不问虚实，俱以益阴养胃为主，庶免后患。通用二陈汤加童便、竹沥、姜汁、
韭汁；有热，加土炒芩、连、栝蒌、桔梗；七情，加香附、川芎、木香、槟榔；不纳食，加
麦芽、神曲；热结食反上奔，加大黄、桃仁；气虚，合四君子汤；血虚
，合四物汤。杂方∶烧
针丸、杵糠丸、紫金锭、霞天膏、神仙夺命丹、古阿魏散，或灵砂，烧酒下。凡五十岁后，
血枯粪如羊屎，及年少不淡薄饮食、断绝房室者，不治。
关格
与呕吐、膈噎、淋证参看。
关不小便格吐逆，
经云∶人迎脉大于气口四倍，名曰格；气口脉大于人迎四倍
，名曰关。
上寒下热中焦窒；
关，乃阳不下，以寒在胸中，塞而不入；格，乃阴不上，以热在下焦，寒而不
出。上下不通，三焦撩乱，中气不足，阴阳不能相荣，
故既关且格。中虚者，补中益气汤加
槟榔以升降之；中虚痰盛者，六君子汤去术，加柏子仁及麝少许；虚甚，吐利俱不得者，既
济丸。
吐提其气非为痰，
关格与噎秽稍异，胃中觉气有碍，欲升不升，欲降不降，欲食不食，宜二陈汤，
加木通，吐其横格之气，不必在出痰也。
或治下焦不可执。
古云∶关格死在旦夕，但治下焦可愈。经云∶少阳所至，为呕涌溢，食不下。言
火逆上而为呕吐，非膈上所生，独为关，非格也，大承气汤下之。若但吐而不得小便者，胃
苓汤。有膏粱积热，损伤北方真水者，滋肾丸主之。忌用淡渗利水之药，详前淋证。凡关格
见头汗者，死。
证虚柔实则刚，
阳极则为刚 ，多类风证，宜清热化痰祛风；阴极则为柔 ，多类厥证
，宜温补化痰降火。此丹溪胃实则为刚，虚则为柔，皆危证也。余详伤寒。
口噤不醒通身强。
病发则身强不醒，痫病发则身软时醒。 、痫相似，而实不同。
内外因皆挟痰火，
或外因风邪，或内因七情，皆必挟痰火而后发 。痰壅发 不醒，或只
手足搐
搦，左右动摇，宜祛风导痰汤，加竹沥、姜汁。风痰盛者，败毒散加防风、天麻、黄芩、全
蝎、生姜、薄荷，或通圣散加人参、柴胡，间服寿星丸，姜汁、竹沥下。火盛则遍身战掉，
犹火炎而旋转也。火能燥物，而使气液不足，宜四物二陈汤，加芩、连、知、柏、竹沥、童
便
，补而散之。实火则胸满，口噤切牙，脚挛，卧不着床，大便闭者，大承气汤下之，仍忌
风药。盖火为风燥之本，能治其火，则风自散，而燥自润矣。
郁闷诸虚甚则亡。
七情郁闷者，乌药顺气散、八味顺气散主之。诸虚绝无风邪，而筋脉挛急，角弓
反张者，乃
气血虚脱，无以主持养筋，此等尤不可纯用风药。经曰∶诸 强直，皆属于湿。湿极反
兼风
化制之，实非风也，虚也。故又有言曰∶虚为本，痰火外邪为标。气虚者，补中益气汤加
竹沥，或六君子汤加黄 、附子、柴胡；血虚者，四物汤加防风、羌活，或大秦艽汤。
病比痫更重，甚则因而昏死者有之。
痫
痫与癫狂相似，但痫病时发时止，邪流五脏；癫狂经久不愈，邪全归心。
痫有阴阳只是痰，
内伤最多，外感极少。盖伤饮食，积为痰火，上迷心窍；惊恐忧怒，则火盛神不
守舍，舍空痰寒。丹溪云∶痫因痰寒心窍，发则头旋卒倒，手足搐搦，口眼相引，胸背强直
，叫吼吐涎，食顷乃醒。病先身热脉浮在表者，阳痫，属六腑，易治；病先身冷脉沉在里者
，阴痫，属五脏，难治。若神脱目瞪，如愚痴者，不治。
时师何必究五三。
痫久必归于五脏∶肝痫面青，摇头喜惊，作鸡鸣状；心痫面赤口张，摇头马嘶；
脾痫面黄下利，吐舌羊吼；肺痫面白吐沫，腹胀牛吼；肾痫面黑直视，如尸猪叫。此五痫，
病状偶类之耳，其实痰、火与惊三者而已。小儿风、惊、食三痫，见五卷。
痰挟火与惊多少，
肥人多痰，动则有声，沫出。风痰，星香散加全蝎三枚，姜煎服，或追风祛痰丸
、五生丸。惊痰，紫石散、惊气丸、抱龙丸、三痫丸、引神归舍丹、寿星丸；因怒者，
顺气导痰汤加菖蒲、辰砂；因忧思者，妙香散；食痰，醒脾散。瘦人火盛面赤者，防风当
归饮、或小调中汤加南星，或滚痰丸、泻青丸、牛黄清心丸、龙脑、安神丸、千金龙胆汤。
痰
火俱盛者，猪心丸温酒下，上吐下利，去顽痰、老痰为妙。通用断痫丹、活虎丹、蝙蝠散、控
涎丸、紫金锭。
调中补北泻东南。
痫本痰热挟惊，宜寒药清心、降火、化痰为主，故古法用二陈汤加栝蒌、南星、
黄连探吐，吐后必服朱砂安神丸，以降南方之火；当归龙荟丸，以平东方之木。但化痰必先
顺气，顺气必先调中。顽痰胶固，非辛温热药为佐，何以开导？是以古方治惊痫，皆有温剂
。
又如钱仲阳治小儿痫，经吐泻及服凉药过多，身冷闭目不食，后用益黄散补中，能食；次用
肾气丸补北方肾水，能语。此须从权以救痫之坏证，亦可以为成法。
癫狂
癫狂痰火闭心堂，都缘喜怒太无常；
《素问》注云∶多喜为癫，多怒为狂，喜属心，怒属肝，二经皆火有余之地。但喜则气散，
毕竟谋为不遂，郁结不得志者多有之。大概痰迷心窍者，叶氏清心丸、金箔镇心丸、朱砂安
神丸。心风癫者，牛黄清心丸、追风祛痰丸；虚者，加紫河车一具为糊。怒伤肝者，宁神导
痰汤
、泻青丸、当归龙荟丸；因惊者，抱胆丸、惊气丸。丹溪云∶五志之火，郁而成痰，为癫为
狂，宜以人事制之。如喜伤心者，以怒解之，以恐胜之；忧伤肺者，以喜胜之，以怒解之。
阳明热结膏粱味，
阳明发狂，见伤寒杂证，胃与大肠，实热燥火郁结于中，大便闭者，凉膈散，加
大黄下之。膏粱醉饱后发狂者，止用盐汤吐痰即愈，或小调中汤；服芳草石药，热气
悍发狂者，三黄石膏汤加黄连、甘草、青黛、板蓝根，或紫金锭。
谩议重阴与重阳。
《难经》云∶重阴者癫，重阳者狂。河间以癫、狂一也，皆属痰火，重阴之说非
也。但世有发狂，一番妄言妄语，而不成久癫者；又有痴迷颠倒，纵久而不发狂者。故取河
间合一于前，《难经》分析于后。癫者，异常也。平日能言，癫则沉默，平日不宁，癫则呻
吟，甚则僵仆直视，心常不乐，此阴虚血少，心火不宁，大调中汤主之；不时倒晕者，滋阴
宁神汤；言语失伦者，定志丸；悲哭呻吟者，烧蚕蜕、故纸，酒调二钱，蓖麻仁煎汤，常服
可以断根。狂者，凶狂也。轻则自高自是，好歌好舞，甚则弃衣而走，逾墙上屋，又甚则披
头大叫，不避水火，且好杀人，此心火独盛，阳气有余，神不守舍，痰火壅盛而然，小调中
汤、三黄丸、控涎丹、单苦参丸。狂则专于下痰降火，癫则兼乎安神养血。经年心经有损者
，不治。
妄言未见如神鬼，邪祟由来痰作殃。
视、听、言、动俱妄者，谓之邪祟。甚则能言平生未见闻事及五色神鬼，此乃气
血虚极，神光不足，或挟痰火壅盛，神昏不定，非真有妖邪鬼祟。大概内服伤寒温疫条人中
黄丸，照根据气、血、痰，汤药为使，或单人中黄亦好服，或单石菖蒲末，猪心血为丸服亦可
。有妇人夜梦鬼来交者，定志丸料，如赤小豆水煎服。有妇人月水崩漏过多，血气迷心，或
产后恶露上冲，而言语错乱，神志不守者，此血虚神耗也，宜宁神膏。但亦 不可纯服补
心敛神
药。血热者，小柴胡汤加生姜、生地煎服，百余帖即安。血迷心胞，逾墙上屋，歌唱无时者
，逍遥散加远志、桃仁、红花、苏木，服后病退，用平胃散，少用浓朴，倍加苍术、升麻，
常服以绝病根。又男子挟瘀血者，陶氏当归活血汤。有卒中尸恶，吐利如干霍乱状，或狂谵
如醉人，有起心先知其肇，或已死口噤不开者，急用伤寒门追魂汤，灌之即醒。外法，辟邪
丹灌鼻法。
惊悸、怔忡、健忘
惊悸惕惕不自定，如人将捕曰怔忡。
思虚过度及因大惊、大恐，以致心虚停痰，或耳闻大声，目见异物，临危触事，
便觉惊悸，甚则心跳欲厥，脉弦濡者，虚也。血虚，四物汤、茯神汤、妙香散、朱砂安神丸
；气血俱虚，人参养荣汤、养心汤。时作时止者，痰也，二陈汤加白术、黄连、远志、竹沥
、
姜汁。怔忡因惊悸久而成，痰在下，火在上故也，温胆汤加黄连、山栀、当归、贝母；气郁
者，四七汤加茯神、远志、竹沥、姜汁，或十味温胆汤、金箔镇心丸；停饮胸中漉漉有声，
怏怏不安者，二陈汤加茯神、槟榔、麦门冬、沉香，或朱雀丸。
又有健忘非质钝，精神短少痰相攻。
怔忡久则健忘，三证虽有浅深，然皆心脾血少神亏，清气不足，痰火浊气上攻，
引神归舍丹主之。亦有所禀阴魂不足善忘者，当大补气血及定志丸。如老年神衰者，加减固
本丸。三证通用归脾汤、仁熟散、梦授天王补心丹、寿星丸、参枣丸。
咽喉\x（附失音、骨鲠）
种种咽喉总是火，
咽喉，气之呼吸，食之出入，乃人身之门户也。一十八种，虽后世强名，亦不可
不知，一、左单蛾风。二、右单蛾风，形圆如小箸头大，生于咽喉关上可治，生于关下不见
者
难治。三、双蛾风，两个生于喉间关下，难治。四、蝉舌风，舌下再生二舌。五、牙蜞风
，
牙龈肿毒成疮。六、木舌风，舌肿大如煮熟猪舌，不能转动。七、舌黄风，舌上肿痛黄色。
八、鱼口风，口如鱼吸水，不治。九、寒喉风，喉痹聚毒，涎唾稠实而发寒热，关上可治，
关下难治。十、悬蜞蛊毒风，上眶肿，水食不下，形肿如鸡卵。十一、抢食风，因食鲤
恶物发泡。十二、猎颊风，腮颊结肿，牙尽处肿破
。十三、缠喉风，自颐缠绕赤色，寒热。十四
、松子风，口内、满喉赤如猪肝，张口吐物，则气逆关闭，饮食不能。十五、崩砂甘口风，
自
舌下牙龈上肿赤，口内作 如汤热，牙龈渐烂，亦能脱齿。十六、连珠风，自舌
下起，初起
一个，又起一个，甚者三五、七九个连珠生起。十七、蜂子毒，或在脸腮泮烂，或在喉关、
舌下作 ，色黄如蜂。十八、走注瘰 风，颈项结核五七个，皮肤赤肿作寒热。寻常咽疮痛者
，多是虚火。噫！种类虽繁，同归于火，盖少阴君火，少阳相火，二脉并络于咽喉。君火势
缓，则热结而为疼为肿；相火势速，则肿甚不仁而为痹。痹甚不通，而痰塞以死矣。故曰∶
一阴一阳结，谓之喉痹。一阴，肝与心包；一阳，少阳三焦。四经皆有相火，火者，痰之本
；痰者，火之标，故言火则痰在其中矣。言咽喉则牙舌亦包在其中矣。
火有虚实从何如？实火便闭胸必紧，
实火，因过食煎炒，蕴热积毒，烦渴，二便闭塞，风痰上壅，将发喉痹，必先三
日胸膈不利，脉弦而数。治宜先祛风痰，而后解热毒，凉膈散加黄连、荆芥、石膏，或古荆
防汤、防风通圣散，三黄丸含化。又风燥咽喉干枯，常如毛刺，吞咽有碍，败毒散加黄芩半
夏
，倍桔梗、薄荷，生姜煎服；痰盛，加石膏。凡服此药，子服午攻，午服子攻。如呕吐咯伤
，因食热物及谷芒刺涩，风热并与血气相搏肿痛者，消风散加薄荷、玄参、全蝎，或射干
汤、牛蒡子汤。木舌，重舌者，如圣金锭。舌根肿者，麝香朱砂丸。时行咽
痛者，普济消毒饮。
虚火便利脉亦微。
虚火，因饮酒则动脾火，忿怒则动肝火，色欲则动肾火，火炎上攻，咽膈干燥，
必
Blood becomes increasingly deficient. The *Zhen Jing* (Needle Classic) states: When anger arises, eating causes qi to rebel and fail to descend; when qi is damaged by labor, it leads to Ge Ye (diaphragmatic dysphagia) and panting; when qi is affected by excessive thinking, it results in middle jiao pi (fullness and obstruction), closure of the San Jiao (Triple Burner), and difficulty in the pharynx. For Phlegm-Fluid retention with a slippery or hidden pulse, use Er Chen Tang (Two-Cured Decoction), Gu Shen Xia Tang (Ancient Ginseng and Pinellia Decoction), Hua Tan Wan (Phlegm-Resolving Pill), Gua Lou Shi Wan (Trichosanthes Fruit Pill), or decoct Huang Lian (Coptidis Rhizoma), Wu Zhu Yu (Evodiae Fructus), Bei Mu (Fritillariae Bulbus), Gua Lou Ren (Trichosanthis Semen), and Niu Zhuan Cao (Dichroae Radix) in water. For Food Stagnation with a slippery and short pulse, use Zhi Zhu Wan (Aurantii Fructus and Atractylodis Macrocephalae Rhizoma Pill) added with Huang Lian, Chen Pi (Citri Reticulatae Pericarpium), and Ban Xia (Pinelliae Rhizoma); or Gou Mi Ping Wei Wan (Dog Rice Spleen-Pacifying Pill), Hu Zhi Ping Wei Wan (Tiger Fat Spleen-Pacifying Pill); or take Bao He Wan (Preserve Harmony Pill) 2 qian, add Jiang Chao Huang Lian (Ginger-fried Coptidis Rhizoma) 3 qian and Shan Zha (Crataegi Fructus) 2 qian, make into pills the size of Hemp Seeds, coat with Red Dye, take 60 pills each time, decoct Ren Shen (Ginseng Radix et Rhizoma) in water, mix with Zhu Li (Bamboo Sap), and swallow. For Seven Emotions stagnation with a deep and choppy pulse, preference for quiet diet, and chest/back pain, use Si Qi Tang (Four-Seven Decoction) or Wen Dan Tang (Warm Gallbladder Decoction). For pi man (fullness and oppression), vexation, slight cough, and difficulty in urination and defecation, use Fen Xin Qi Yin (Divide Heart Qi Drink) or Mo Ge Tang (Four-Mortar Decoction), or equal parts of Mu Xiang (Aucklandiae Radix) and Bing Lang (Arecae Semen) powdered, taken with warm water. For spirit injury causing insomnia, use Shi Wei Wen Dan Tang (Ten-Warm Gallbladder Decoction) or Zhu Sha An Shen Wan (Cinnabar Spirit-Calming Pill). For abdominal distension and borborygmus, use Mu Xiang Yun Qi San (Aucklandia Qi-Distributing Powder). For accumulations, use A Wei Zhuang Qi Wan (Styrax Qi-Striking Pill). For aversion to food odors, use Wu Ge Kuan Zhong San (Five Diaphragms Middle-Widening Powder).
Qi and Blood both deficient often present with salivation;
If saliva flows out profusely, it indicates death. If Qi deficiency fails to transform fluids leading to phlegm, the pulse will be slow and forceless; use Si Jun Zi Tang (Four-Gentlemen Decoction). For constipation, add Lu Gen (Reed Rhizome) and Tong Bian (Child's Urine). For severe Qi deficiency, use Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Fu Zi (Aconiti Lateralis Radix Praeparata) and Da Huang (Rhei Radix et Rhizoma). For alcohol toxicity, add Gan Zhe Zhi (Sugarcane Juice). Dan Ren Shen Tang (Single Ginseng Decoction) and Ren Shen Gao (Ginseng Paste) are especially excellent.
If Blood deficiency fails to moisten leading to fire, the pulse will be rapid and forceless; use Si Wu Tang (Four-Substance Decoction) added with Tong Bian, Zhu Li, and Jiang Zhi (Ginger Juice). For constipation, add Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos). For blood stasis, add Mu Dan Pi (Moutan Cortex) and Jiu Zhi (Allii Tuberosi Juice). To prevent parasites, add Lv Niao (Donkey Urine). For severe Blood deficiency, add Gan Jiang (Zingiberis Rhizoma). For Blood dryness, add Niu Nai (Cow Milk) and Yang Nai (Sheep Milk); human milk cannot replace them because human milk contains toxins and fire from emotions and diet. For both Qi and Blood deficiency, Ba Wu Tang (Eight-Substance Decoction) is the main treatment.
The Metal (Lung) and Water (Kidney) organs must be supported.
Blood belongs to Yin and is static; if both internal and external environments are static, the fire of the zang-fu organs does not arise, allowing Metal and Water qi to nourish each other, Yin-Blood generates naturally, and fluid transmission and transformation are appropriate, so how could there be diaphragmatic dysphagia? Use Shen Qi Wan (Kidney-Qi Pill) as the main treatment.
Nourishing Yin and benefiting the Stomach is the general principle.
Regardless of deficiency or excess, the focus should be on nourishing Yin and benefiting the Stomach to avoid future complications. The universal formula is Er Chen Tang added with Tong Bian, Zhu Li, Jiang Zhi, and Jiu Zhi. For heat, add Tu Chao Qin (Earth-fried Scutellariae Radix), Lian (Scutellariae Radix), Gua Lou (Trichosanthis Fructus), and Jie Geng (Platycodonis Radix). For seven emotions, add Xiang Fu (Cyperi Rhizoma), Chuan Xiong (Chuanxiong Rhizoma), Mu Xiang, and Bing Lang. For poor appetite, add Mai Ya (Hordei Fructus Germinatus) and Shen Qu (Massa Medicata Fermentata). For heat binding with food rushing upward, add Da Huang and Tao Ren. For Qi deficiency, combine with Si Jun Zi Tang. For Blood deficiency, combine with Si Wu Tang. Miscellaneous formulas: Shao Zhen Wan (Burned Needle Pill), Chu Kang Wan (Pounded Bran Pill), Zi Jin Ding (Purple Gold锭), Xia Tian Gao (Rosy Sky Ointment), Shen Xian Duo Ming Dan (Immortal Life-Snatching Elixir), Gu A Wei San (Ancient Styrax Powder), or Ling Sha (Cinnabar and Mercury Sublimate), taken with boiled wine. After age fifty, if blood is exhausted and stool resembles sheep droppings, or in youth if one does not eat blandly and does not abstain from sexual activity, the condition is incurable.
Guan Ge (Obstruction and Reversal)
Refer to Vomiting, Ge Ye (Diaphragmatic Dysphagia), and Lin Zheng (Strangury Syndrome).
Guan refers to inability to urinate, Ge refers to vomiting and reversal.
The Classics state: If the Ren Ying pulse is four times larger than the Qi Kou pulse, it is called Ge; if the Qi Kou pulse is four times larger than the Ren Ying pulse, it is called Guan.
Upper cold and lower heat cause middle jiao obstruction.
Guan means Yang fails to descend due to cold in the chest, blocking entry; Ge means Yin fails to ascend due to heat in the lower jiao, preventing exit. Upper and lower blockage, San Jiao chaos, insufficient middle Qi, and inability of Yin and Yang to nourish each other result in both Guan and Ge. For middle deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Bing Lang to regulate ascending and descending. For middle deficiency with abundant phlegm, use Liu Jun Zi Tang removing Bai Zhu, adding Bai Zi Ren (Biota Seed) and a small amount of She Xiang (Musk). For extreme deficiency where neither vomiting nor purging is possible, use Ji Ji Wan (Ji Ji Pill).
Vomiting raises the qi, but it is not for expelling phlegm.
Guan Ge differs slightly from throat obstruction. There is a sensation of obstruction in the stomach, wanting to ascend but unable, wanting to descend but unable, wanting to eat but unable. Use Er Chen Tang added with Mu Tong (Akebia Caulis) to vomit out the horizontal obstructing qi; it is not necessary to expel phlegm.
Treatment of the lower jiao should not be rigid.
Ancients said: Guan Ge is fatal within the day, but treating the lower jiao can cure it. The Classics state: Where Shao Yang qi reaches, there is vomiting and overflow, and inability to eat. This refers to fire rebelling upward causing vomiting, not generated in the diaphragm; it is solely Guan, not Ge. Use Da Cheng Qi Tang (Major Order the Qi Decoction) to purge. If only vomiting occurs without urination, use Wei Ling Tang (Stomach-Ling Decoction). For accumulation of heat from rich foods damaging the True Water of the North, use Zi Shen Wan (Nourish Kidney Pill). Avoid diuretic drugs that promote leaching; see previous section on Strangury. If Guan Ge presents with sweating on the head, it is fatal.
Deficient conditions are soft, excess conditions are hard.
Extreme Yang manifests as Hardness, resembling Wind syndromes; clear heat, resolve phlegm, and dispel wind. Extreme Yin manifests as Softness, resembling Jue syndromes; warm tonify, resolve phlegm, and descend fire. This is Dan Xi's view: Stomach excess is Hard, deficiency is Soft; both are critical conditions. See Shang Han for details.
Jaw lock, unconsciousness, and whole-body rigidity.
During an attack, the body is rigid and unresponsive; during Epilepsy attacks, the body is soft and responsive intermittently. They appear similar but are fundamentally different.
Both internal and external factors involve Phlegm-Fire.
Whether caused by external Wind pathogen or internal Seven Emotions, Phlegm-Fire must be involved for the disease to manifest. If Phlegm obstruction causes unconsciousness, or only hand-foot convulsions and shaking, use Qu Feng Dao Tan Tang (Dispel Wind and Guide Out Phlegm Decoction) added with Zhu Li and Jiang Zhi. For abundant Wind-Phlegm, use Bai Du San (Eliminate Toxicity Powder) added with Fang Feng (Saposhnikoviae Radix), Tian Ma (Gastrodiae Rhizoma), Huang Qin (Scutellariae Radix), Quan Xie (Scorpio), Sheng Jiang, and Bo He (Menthae Haplocalycis Herba), or Tong Sheng San (Universal Salvation Powder) added with Ren Shen and Chai Hu (Bupleuri Radix), taking Shou Xing Wan (Longevity Star Pill) alternately, swallowed with Jiang Zhi and Zhu Li. Excessive Fire causes whole-body trembling, like rotating fire. Fire dries substances, depleting Qi and fluids; use Si Wu Er Chen Tang added with Qin, Lian, Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Zhu Li, and Tong Bian to tonify and disperse. Excess Fire causes chest fullness, jaw lock, teeth grinding, leg cramps, inability to lie flat, and constipation; use Da Cheng Qi Tang to purge, avoiding Wind-dispelling herbs. Fire is the root of Wind-dryness; treating Fire disperses Wind and moistens dryness.
Depression and various deficiencies may lead to death.
For Seven Emotions depression, use Wu Yao Shun Qi San (May Chang Qi-Smooth Powder) or Ba Wei Shun Qi San (Eight-Ingredient Qi-Smooth Powder). Various deficiencies without Wind pathogen, presenting with tendon spasms and opisthotonos, indicate Qi and Blood exhaustion failing to nourish tendons; do not use pure Wind-dispelling herbs. The Classics state: All rigidity belongs to Dampness. Extreme Dampness mimics Wind transformation; it is actually not Wind, but Deficiency. Thus, Deficiency is the root, Phlegm-Fire and external pathogens are the branch. For Qi deficiency, use Bu Zhong Yi Qi Tang added with Zhu Li, or Liu Jun Zi Tang added with Huang Qi (Astragali Radix), Fu Zi, and Chai Hu. For Blood deficiency, use Si Wu Tang added with Fang Feng and Qiang Huo (Notopterygii Radix et Rhizoma), or Da Qin Jiao Tang (Great Gentian Decoction).
The condition is more severe than Epilepsy, and severe cases may result in fainting and death.
Epilepsy
Epilepsy resembles Dian Kuang (Mania), but Epilepsy comes and goes, with evil flowing through the five zang organs; Dian Kuang persists long-term, with evil fully residing in the Heart.
Epilepsy has Yin and Yang types, caused merely by Phlegm.
Internal injury is most common, external contraction rare. Dietary injury leads to Phlegm-Fire accumulation confusing the Heart orifice; fright, worry, and anger cause Fire excess and Spirit loss, leaving the residence empty for Cold-Phlegm. Dan Xi said: Epilepsy is due to Cold-Phlegm confusing the Heart orifice; upon attack, there is dizziness, sudden collapse, convulsions, eye-mouth deviation, chest-back rigidity, roaring, and salivation, waking after a meal period. If the attack begins with fever and floating pulse (exterior), it is Yang Epilepsy, belonging to Six Fu organs, easy to treat. If it begins with cold body and deep pulse (interior), it is Yin Epilepsy, belonging to Five Zang organs, difficult to treat. If Spirit escapes and eyes stare blankly like a fool, it is incurable.
Why must contemporary physicians investigate the five and three types?
Long-standing Epilepsy returns to the five zang organs: Liver Epilepsy presents with blue face, head shaking, fear, and crowing sounds; Heart Epilepsy with red face, open mouth, head shaking, and neighing sounds; Spleen Epilepsy with yellow face, diarrhea, tongue protrusion, and bleating sounds; Lung Epilepsy with white face, foaming, abdominal distension, and mooing sounds; Kidney Epilepsy with black face, staring, and grunting like a dead pig. These five epilepsies are merely coincidental similarities; essentially, they are Phlegm, Fire, and Fright. Pediatric Wind, Fright, and Food Epilepsy are in Volume 5.
The proportion of Phlegm, Fire, and Fright varies.
Fat people have much Phlegm; movement produces sound and foam. For Wind-Phlegm, use Xing Xiang San (Star-Aromatic Powder) added with 3 Quan Xie, decocted in Ginger; or Zhui Feng Qu Tan Wan (Wind-Chasing Phlegm-Expelling Pill) or Wu Sheng Wan (Five-Life Pill). For Fright-Phlegm, use Zi Shi San (Purple Stone Powder), Jing Qi Wan (Fright-Qi Pill), Bao Long Wan (Embracing Dragon Pill), San Xian Wan (Three-Epilepsy Pill), Yin Shen Gui She Dan (Guide Spirit Return Home Elixir), or Shou Xing Wan. Caused by anger, use Shun Qi Dao Tan Tang added with Shi Chang Pu (Acori Tatarinowii Rhizoma) and Chen Sha (Cinnabar); caused by worry/thinking, use Miao Xiang San (Miraculous Incense Powder). For Food-Phlegm, use Xing Pi San (Spleen-Awakening Powder). Thin people with Fire excess and red face use Fang Feng Dang Gui Yin (Saposhnikovia and Angelica Decoction), or Xiao Tiao Zhong Tang (Minor Regulate Middle Decoction) added with Nan Xing (Arisaema Cum Bile), or Gun Tan Wan (Rolling Phlegm Pill), Xie Qing Wan (Drain Green Pill), Niu Huang Qing Xin Wan (Calves' Gallbladder Clear Heart Pill), Long Nao (Borneolum Syntheticum), An Shen Wan (Spirit-Calming Pill), or Qian Jin Long Dan Tang (Thousand Years Gentian Decoction).
For simultaneous Phlegm and Fire excess, use Zhu Xin Wan (Pig Heart Pill) taken with warm wine; upper vomiting and lower purging helps remove stubborn and old phlegm. Universal formulas: Duan Xian Dan (Stop Epilepsy Elixir), Huo Hu Dan (Living Tiger Elixir), Bian Fu San (Bat Powder), Kong Xian Wan (Control Fluid Pill), Zi Jin Ding.
Regulate the Middle, Tonify the North, Drain the Southeast.
Epilepsy is originally Phlegm-Heat with Fright; cold herbs should be used to clear Heart, descend Fire, and resolve Phlegm. Ancient methods used Er Chen Tang added with Gua Lou, Nan Xing, and Huang Lian to induce vomiting; after vomiting, Zhu Sha An Shen Wan must be taken to descend Southern Fire; Dang Gui Long Hui Wan (Angelica Dragon Bile Pill) to pacify Eastern Wood. But resolving Phlegm requires smoothing Qi first, and smoothing Qi requires regulating the Middle. Stubborn phlegm is sticky; without acrid-warm herbs as assistants, how can it be guided out? Thus, ancient formulas for Fright-Epilepsy contain warm agents.
For example, Qian Zhong Yang treated pediatric epilepsy; after vomiting/diarrhea and excessive cold herbs, the child was cold, eyes closed, and refused food. Later, Yi Huang San (Yellow-Protecting Powder) tonified the Middle, restoring appetite; then Shen Qi Wan tonified Northern Kidney Water, restoring speech. This is a flexible approach to save critical epilepsy cases, serving as a standard method.
Dian Kuang (Mania and Depression)
Dian Kuang is caused by Phlegm-Fire closing the Heart hall, all due to unpredictable joy and anger.
Su Wen commentary states: Much joy is Dian, much anger is Kuang. Joy belongs to Heart, anger to Liver; both meridians are places of Fire excess. Joy scatters Qi; those who fail in their plans and suffer from depression often have this. Generally, for Phlegm confusing the Heart orifice, use Ye Shi Qing Xin Wan (Ye's Clear Heart Pill), Jin Po Zhen Xin Wan (Gold Leaf Heart-Calming Pill), or Zhu Sha An Shen Wan. For Heart Wind Dian, use Niu Huang Qing Xin Wan or Zhui Feng Qu Tan Wan; for deficiency, add one Zi He Che (Placenta Humanum) made into paste. For anger injuring Liver, use Ning Shen Dao Tan Tang, Xie Qing Wan, or Dang Gui Long Hui Wan; for fright, use Bao Dan Wan or Jing Qi Wan. Dan Xi said: Fire of the Five Emotions condenses into Phlegm, causing Dian or Kuang; it should be controlled by human affairs. For joy injuring Heart, resolve with anger, overcome with fear; for sorrow injuring Lung, overcome with joy, resolve with anger.
Yangming Heat Binding from Rich Foods.
Yangming Mania appears in Shang Han and miscellaneous diseases. Real Heat and Dry Fire bind in the Stomach and Large Intestine. For constipation, use Liang Ge San (Cool Diaphragm Powder) added with Da Huang to purge. For mania after rich food/drinking, use Salt Water to induce vomiting, or Xiao Tiao Zhong Tang. For mania from aromatic herbs/minerals causing fierce Heat, use San Huang Shi Gao Tang (Three-Yellow Gypsum Decoction) added with Huang Lian, Gan Cao (Glycyrrhizae Radix et Rhizoma), Qing Dai (Indici Folium), and Ban Lan Gen (Isatidis Radix), or Zi Jin Ding.
Discussing Heavy Yin and Heavy Yang arbitrarily.
Nan Jing states: Heavy Yin is Dian, Heavy Yang is Kuang. He Jian considered Dian and Kuang identical, both Phlegm-Fire, rejecting Heavy Yin. However, some manic patients speak wildly without becoming chronic Dian; some depressed patients remain confused without ever becoming manic. Thus, follow He Jian's unity first, Nan Jing's analysis later. Dian is abnormality. Usually talkative, Dian makes one silent; usually restless, Dian causes groaning, even stiff collapse and staring, with constant unhappiness. This is Yin deficiency and Blood scarcity with unsettled Heart Fire; use Da Tiao Zhong Tang (Major Regulate Middle Decoction). For occasional fainting, use Zi Yin Ning Shen Tang (Nourish Yin Calm Spirit Decoction). For incoherent speech, use Ding Zhi Wan (Settle Will Pill). For weeping/groaning, use burned silkworm pupae and Psoraleae Fructus, mixed with wine (2 qian), decocted with Ricinus Communes Fructus, taken regularly to cure root. Kuang is ferocious madness. Mild cases are arrogant and self-righteous, loving song and dance; severe cases discard clothes, climb walls/roofs, tear hair, scream, ignore fire/water, and kill. This is Heart Fire excess, Yang abundance, Spirit loss, and Phlegm-Fire congestion; use Xiao Tiao Zhong Tang, San Huang Wan (Three-Yellow Pill), Kong Xian Dan, or Dan Ku Shen Wan (Single Sophora Pill). Kuang focuses on purging Phlegm and descending Fire; Dian combines calming Spirit and nourishing Blood. Chronic Heart damage is incurable.
Delusions of spirits and ghosts are caused by Phlegm disasters.
Abnormal vision, hearing, speech, and action are called Evil Influence. Severe cases recount unheard/unseen events and colored spirits; this is extreme Qi/Blood deficiency, lack of Spirit light, or Phlegm-Fire congestion causing unstable Spirit, not real demons. Internally, use Ren Zhong Huang Wan (Human Center Yellow Pill) from Shang Han/Warm Epidemic sections, based on Qi/Blood/Phlegm, or single Ren Zhong Huang, or Shi Chang Pu powder with Pig Heart Blood pills. For women dreaming of ghost intercourse, use Ding Zhi Wan material decocted like Adzuki beans. For women with heavy menstruation bleeding or postpartum lochia rushing up causing confusion, this is Blood deficiency and Spirit consumption; use Ning Shen Gao (Calm Spirit Paste). Do not use pure Heart-tonifying/astringent herbs. For Blood Heat, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Sheng Jiang and Sheng Di Huang (Rehmanniae Radix), taken for over 100 doses for relief. For Blood confusing Pericardium, climbing walls/singing endlessly, use Xiao Yao San (Free and Easy Wanderer Powder) added with Yuan Zhi (Polygalae Radix), Tao Ren, Hong Hua, and Su Mu (Sappan Lignum); after symptoms subside, use Ping Wei San with less Hou Po (Magnoliae Officinalis Cortex), doubled Cang Zhu (Atractylodis Rhizoma) and Sheng Ma (Cimicifugae Rhizoma), taken regularly to eradicate root. For men with Blood Stasis, use Tao Shi Dang Gui Huo Xue Tang (Tao's Angelica Blood-Invigorating Decoction). For sudden stroke by corpse evil, vomiting/diarrhea like Gan Huo Luan (Dry Cholera), or delirium like drunkenness, or premonition of onset, or death with jaw lock, urgently use Zhui Hun Tang (Soul-Chasing Decoction) from Shang Han section to灌 (drench) and wake. External method: Bi Xie Dan (Evil-Repelling Pill) nasal insufflation.
Jing Ji (Fright Palpitations), Zheng Chong (Pounding Palpitations), Jian Wang (Forgetfulness)
Fright palpitations are unsettling, like being hunted; pounding palpitations feel like someone catching you.
Excessive mental depletion, great fright/fear causing Heart deficiency and Phlegm retention, or hearing loud noises, seeing strange objects, facing danger, leads to palpitations. Severe cases have heart pounding and syncope; pulse stringy and soggy indicates deficiency. For Blood deficiency, use Si Wu Tang, Fu Shen Tang (Poria Decoction), Miao Xiang San, or Zhu Sha An Shen Wan. For Qi/Blood deficiency, use Ren Shen Yang Rong Tang (Ginseng Nourish Glory Decoction) or Yang Xin Tang (Nourish Heart Decoction). Intermittent palpitations indicate Phlegm; use Er Chen Tang added with Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Lian, Yuan Zhi, Zhu Li, and Jiang Zhi. Zheng Chong results from long-term Jing Ji; Phlegm below, Fire above. Use Wen Dan Tang added with Huang Lian, Shan Zhi (Gardeniae Fructus), Dang Gui (Angelicae Sinensis Radix), and Bei Mu. For Qi stagnation, use Si Qi Tang added with Fu Shen, Yuan Zhi, Zhu Li, Jiang Zhi, or Shi Wei Wen Dan Tang, Jin Po Zhen Xin Wan. For fluid retention in chest with gurgling sound and unease, use Er Chen Tang added with Fu Shen, Bing Lang, Mai Men Dong (Ophiopogonis Radix), and Chen Xiang (Aquilariae Lignum Resinatum), or Zhu Que Wan (Vermilion Bird Pill).
Forgetfulness is not dullness, but Spirit shortage attacked by Phlegm.
Long-term Zheng Chong leads to forgetfulness. Though these three syndromes vary in depth, they all involve Heart/Spleen Blood deficiency, Spirit loss, insufficient Clear Qi, and attacking Turbid Qi of Phlegm-Fire. Use Yin Shen Gui She Dan. Some have innate insufficient Yin Soul leading to forgetfulness; strongly tonify Qi/Blood and use Ding Zhi Wan. For elderly with declining Spirit, use Jia Jian Gu Ben Wan (Modified Root-Fixing Pill). Universal formulas for these three: Gui Pi Tang (Restore the Spleen Decoction), Ren Shu San (Benevolent Mature Powder), Meng Shou Tian Wang Bu Xin Dan (Dream-Given Heavenly King Heart-Nourishing Elixir), Shou Xing Wan, or Shen Zao Wan (Ginseng Date Pill).
Throat (Appendix: Loss of Voice, Fish Bone)
Various throat issues are all Fire.
The throat is the gateway for breath and food. Although the eighteen types are later names, they must be known: 1. Left Single E Feng. 2. Right Single E Feng, round like a chopstick head, treatable if above the gate, difficult if below. 3. Double E Feng, two below the throat gate, difficult. 4. Cicada Tongue Feng, two tongues under the tongue. 5. Ya Bi Feng, gum swelling/ulcers. 6. Wood Tongue Feng, tongue swollen like cooked pig tongue, immobile. 7. Yellow Tongue Feng, painful/swollen yellow tongue. 8. Fish Mouth Feng, mouth like fish sucking water, incurable. 9. Cold Throat Feng, throat bi with toxic phlegm/spittle, chills/fever, treatable above gate, difficult below. 10. Xuan Bi Gu Du Feng, upper eyelid swelling, inability to eat/drink, swelling like chicken egg. 11. Qiang Shi Feng, blisters from eating bad carp. 12. Lie Jia Feng, cheek swelling, breaking at tooth end. 13. Chan Hou Feng, red wrapping around chin, chills/fever. 14. Song Zi Feng, red inside mouth/throat like pig liver, airway closure when opening mouth, unable to eat. 15. Beng Sha Gan Kou Feng, red swelling under tongue/gums, burning pain, gum rot/tooth loss. 16. Lian Zhu Feng, starting under tongue, one after another, up to 7-9 beads. 17. Feng Zi Du, ulcerated cheeks or throat/tongue, yellow like bee. 18. Zou Zhu Luo Li Feng, neck lumps 5-7, red/swollen skin with chills/fever. Common sore throats are mostly Deficient Fire. Alas! Many types return to Fire. Shao Yin Ministerial Fire and Shao Yang Ministerial Fire connect to the throat. Ministerial Fire is slow, causing heat binding/pain/swelling; Xiang Huo is fast, causing severe swelling/numbness/bi. Severe bi blocks with Phlegm leading to death. Thus: One Yin One Yang knot is called Hou Bi. One Yin is Liver/Pericardium; One Yang is Shao Yang San Jiao. Four meridians have Xiang Huo; Fire is root of Phlegm; Phlegm is branch of Fire. Speaking of Fire implies Phlegm; speaking of Throat includes Teeth/Tongue.
How to distinguish Fire Deficiency and Excess? Excess Fire has constipation and tight chest.
Excess Fire from fried/spicy food, heat/toxin accumulation, thirst, constipation, Wind-Phlegm rising, impending Hou Bi. Three days prior, chest discomfort, stringy-rapid pulse. Treat by dispelling Wind-Phlegm first, then clearing Heat-Toxin. Use Liang Ge San added with Huang Lian, Jing Jie (Schizonepetae Spica), Shi Gao (Gypsum Fibrosum), or Gu Jing Fang Tang (Ancient Jingfang Decoction), Fang Feng Tong Sheng San (Saposhnikovia Universal Salvation Powder), or San Huang Wan (Three-Yellow Pill) to dissolve. For Wind-Dryness with dry throat like bristles, swallowing difficulty, use Bai Du San added with Huang Qin, Ban Xia, double Jie Geng and Bo He, decocted in Sheng Jiang; for abundant Phlegm, add Shi Gao. Take these medicines: Zi hour dose, Wu hour purge; Wu hour dose, Zi hour purge. For vomiting/hemorrhage from hot food/thorns, Wind-Heat fighting Qi/Blood causing swelling/pain, use Xiao Feng San (Dispel Wind Powder) added with Bo He, Xuan Shen (Scrophulariae Radix), Quan Xie, or She Gan (Belamcandae Rhizoma) Tang, Niu Bang Zi (Arctii Fructus) Tang. For Wood Tongue/Double Tongue, use Ru Sheng Jin Ding (Like Sage Gold Tablet). For tongue root swelling, use She Xiang Zhu Sha Wan (Musk Cinnabar Pill). For epidemic sore throat, use Pu Ji Xiao Du Yin (Universal Relief Detoxification Decoction).
Deficient Fire has free bowels and faint pulse.
Deficient Fire from alcohol moving Spleen Fire, anger moving Liver Fire, lust moving Kidney Fire. Fire flares upward, drying throat/chest. Must...