Library

For lower back pain caused by external pathogens and the five accumulations, appropriate treatments should be applied; if caused by internal deficiency, Liuwei Dihuang Decoction (Six-Ingredient Rehmannia Decoction) or Bawei Shengqi Wan (Eight-Ingredient Kidney Qi Pill) should be modified. If due to blood stasis, Lu Jiao (Deer Antler) can be used; if it is Shen Zhuo Bing (Kidney-Dampness Disease), Shen Zhuo Tang (Kidney-Dampness Decoction) should be used, characterized by a heavy sensation in the body and fixed pain.

Regarding Bu Mei (Insomnia), besides the discussions in the *Neijing*, the *Jingui Yaolue* primarily attributes it to the Liver Hun (Liver Ethereal Soul) failing to reside in its abode, treating it with Suanzaoren Tang (Sour Jujube Seed Decoction). I believe that if insomnia is due to Yang Qi failing to return to Yin, one may use Gan Baihe (Dried Lily Bulb) 1.5 liang, Zi Su Ye (Perilla Leaf) 3 qian, and appropriately add Long Gu (Dragon Bone), Mu Li (Oyster Shell), Fushen (Poria with Hostwood), and Suanzaoren (Sour Jujube Seed).

(Exegesis of Classics) The *Lingshu · Xieke Pian* states: "Bo Gao said: When Jue Qi (Rebellious Qi) invades the five zang and six fu organs, Wei Qi (Defensive Qi) can only circulate independently on the exterior, moving through the Yang aspects without entering the Yin. Moving through Yang leads to an excess of Yang Qi; when Yang Qi is excessive, the Yang Qiao vessel becomes obstructed (Note: The character 'Xian' here implies a trap, meaning Yang Qi is blocked and cannot flow), preventing entry into Yin, resulting in Yin deficiency and thus inability to close the eyes for sleep. The Emperor said: Excellent. How should it be treated? Bo Gao said: Tonify the deficiency, drain the excess, regulate the true and false, unblock the pathways, and eliminate the pathogen. Administer one dose of Banxia Tang (Pinellia Decoction); once Yin and Yang are harmonized, sleep will resume immediately." The *Lingshu · Daguo Lun* states: "The Emperor asked: What qi causes the inability to lie down? Qibo answered: Wei Qi fails to enter Yin and often remains in Yang. Remaining in Yang makes Yang Qi full; full Yang Qi makes the Yang Qiao vessel vigorous. Failure to enter Yin results in Yin Qi deficiency, hence the inability to close the eyes."

Regarding Bu Mei (Insomnia), the *Neijing* provides the most detailed discussion. To attract and settle the Liver Hun, Suanzaoren Tang (Sour Jujube Seed Decoction) is used; Zi Su Ye (Perilla Leaf) and Bai He (Lily Bulb) guide Yang Qi back to the Yin aspect (*Lushantang Leibian* notes: "I planted lilies, whose flowers open in the morning and close at dusk; perilla leaves stand upright in the morning and droop at dusk; both can guide Yang Qi to return to Yin"). Long Gu (Dragon Bone), Mu Li (Oyster Shell), and Fushen (Poria with Hostwood) serve as effective adjuvants.

Inability to eat is due to deficiency of Yuan Qi (Primal Qi) in the Stomach. However, there are distinctions between Cold Deficiency and Heat Deficiency. In Cold Deficiency, the complexion is yellowish-white, the body constantly fears cold, food is difficult to digest, there is laziness and lack of appetite, and bowel movements alternate between loose and constipated. The disease is located in the Upper and Middle Jiao, and Xiaoshi Wan (Digestion-Promoting Pill) is indicated. If the disease is in the Lower Jiao, it is due to the Mingmen Fire (Gate of Life Fire) lacking the function of transformation and digestion, and Ershen Wan (Two-Gentlemen Pill) from *Jisheng Fang* is indicated. In Heat Deficiency, the complexion is yellow with red hues, the body constantly dislikes heat, there is fullness and oppression in the chest and diaphragm, lack of appetite, occasional acid regurgitation, short urine, and constipation. The disease is located in the Upper and Lower Jiao; mild cases use Zisheng Wan (Nourishing Life Pill), and severe cases use Ninghen San (Calming Spirit Powder). If the disease is in the Lower Jiao, Gao Gufeng stated: "The Kidney is the gate of the Stomach; if the gate is not functional, ascending and descending cease." This gate refers to the intersection of Qi, the pivot of Heaven. If Kidney Qi is prosperous, Stomach Yin is sufficient; if Stomach Yin is sufficient, there is desire to eat. At this point, Liuwei Dihuang Decoction (Six-Ingredient Rehmannia Decoction) added with Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) should be urgently used to nourish. If Blood Dryness causes dryness of the Large Intestine, with black feces accumulating at the bottom of the stomach, one should use Shu Di Huang (Prepared Rehmannia Root) 5 qian, Dang Gui (Angelica Sinensis) 3 qian, Huo Ma Ren (Hemp Seed) 3 qian, Bai Shao (White Peony Root) 2 qian, and Tao Ren (Peach Kernel) 2 qian to gently moisten. Observing that the patient's physique is normal and Qi and Blood are still sufficient, Da Huang (Rhubarb Root) 3 qian can be added to assist the blood-nourishing herbs; once the Large Intestine is unblocked, Stomach Qi will naturally open. This secret method was most favored by Gu Xichou of Jiangsu. His disciple Xu Bingnan, in printing *Jingui Yi* (Wings to the Essentials of the Golden Cabinet), attributed it to You Zaijing, which I dare not fully trust. However, I have used this method frequently in my youth with good results, so it seems unnecessary to revere the ancients while despising the moderns. Additionally, this condition includes a syndrome called Gu Lao (Grain Exhaustion/Labor). Patients are lethargic and prone to lying down, limbs feel heavy and vexed, abdomen is full yet they feel hungry but cannot eat; symptoms flare after eating because Grain Qi fails to circulate. *Jingui Yi* uses Chenxiang Tang (Agarwood Decoction). *Zhouhou Beiji Fang* states: Eating when hungry and then lying down immediately causes "Gu Lao" disease, making limbs heavy and vexed, causing silence and desire to sleep, worsening after eating. It can be treated with Damai Ya (Sprouted Barley) 1 sheng, Chuan Jiao (Sichuan Pepper) 1 liang, and fried Gan Jiang (Dried Ginger) 3 liang, pounded into powder, taken as one fang cun bi (square-inch spoonful) per dose, three times daily.