Library

... (preceding text omitted) If the root is severed, the stem and leaves will wither. Death occurring when the Cun Kou pulse is peaceful indicates that the Sheng Qi (Vital Energy) alone has been exhausted internally. The so-called "Kidney Intercostal Moving Qi" is interpreted by commentators as referring to the two Chi pulses. If the two Chi pulses are already exhausted, how can it be said that the Cun Kou pulse is peaceful? Why not directly refer to the Chi position's Kidney pulse, but instead speak of the Kidney Intercostal Moving Qi? Please clarify and resolve my doubts; I would be most grateful. The reply is: When it is said here that death occurs with a peaceful Cun Kou pulse, it also discusses the Guan and Chi positions together. The Kidney Intercostal Moving Qi refers to the area below the umbilicus, specifically the Qihai (Sea of Qi) and Dantian (Elixir Field). One might ask: The midline below the umbilicus belongs to the Ren Mai (Conception Vessel); what does it have to do with the Kidneys? The reply is: Each line opening one-and-a-half cun laterally constitutes the second line, which all belong to the Foot Shaoyin Kidney Meridian. The umbilicus corresponds to the Mingmen (Gate of Life) acupoint on the back; each opening one-and-a-half cun laterally marks the Shenshu (Kidney Transport) acupoints. Thus, the Dantian Qihai connects with the Kidney pulses, serving as the root of the Kidneys. It is also held that at the beginning of life, the two Kidneys are formed first, with the Bao Mai (Uterine Vessel) connected to the umbilicus; therefore, the Qihai Dantian is truly the source of Sheng Qi (Vital Energy) and the foundation of the Twelve Meridians. One might ask: If the Cun Kou pulse is peaceful, why suspect death? The reply is: This statement applies to cases where the disease is severe and the physical form is depleted. The *Nei Jing* (Inner Canon) states: "If flesh and muscles are already depleted, even if the Nine Pulses are harmonious, death will occur." Whenever one sees a patient with severe illness, emaciated body, and depleted large muscles, even if the Six Pulses are peaceful, one must examine the Chongyang (ST42) acupoint of the Foot Yangming Stomach Meridian and the Taixi (KI3) acupoint of the Foot Shaoyin Kidney Meridian. If these two pulses are absent, then examine the Kidney Intercostal Moving Qi below the umbilicus. If the Moving Qi is not yet exhausted, there is still a possibility of survival; if the Moving Qi is also exhausted, despite the Three Positions (Cun, Guan, Chi) being peaceful, death is certain. Physicians must investigate this in detail.

One asks: The *Nei Jing* says: "When Yangming disease is severe, the patient may discard clothes and run, climb high and sing, or go without food for several days yet cross walls and roofs—places they could never reach before. How can someone who cannot perform such actions normally, due to illness and lack of food, suddenly ascend to extraordinary heights? Is this possible?" The reply is: The *Nan Jing* (Classic of Difficult Issues) states: "Excess Yang leads to mania (Kuang), excess Yin leads to epilepsy/dementia (Dian)." It further says: "Dian is characterized by excessive laughter, while Kuang is characterized by excessive anger." What is meant by Excess Yang is that the pulses of the Three Positions (Yin and Yang) are all surging, full, and firm; thus, the patient appears strong and powerful, hence termed "mania." What is meant by Excess Yin is that the pulses of the Three Positions are all deep, hidden, and thin; thus, the patient appears fatigued and weak, hence termed "dementia/epilepsy." I once witnessed a young man from the Lou family in Dongyang suffering from mania. On a day with fierce winds, he suddenly flew to the top of a pagoda east of the city, singing and crying. The pagoda had no space for standing, and everyone found it strange. I reasoned that dragons are pure Yang entities, lurking within the seas. They possess only scales and armor, lacking wings. On days when Yang Qi ascends vigorously, they borrow the momentum of wind and clouds to fly. This is the same principle; what is there to find strange about it?

One asks: Chapter 53 of the *Nan Jing* states: "The classics say transmission through seven organs leads to death, while transmission skipping an organ leads to survival." This is correct. Transmission through seven refers to transmission to the organ it overcomes (Ke cycle). Skipping an organ refers to transmission to its offspring (Sheng cycle). Why is this so? Suppose Heart disease transmits to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney, and Kidney to Heart. Since one organ is not injured twice, it is said that transmission through seven leads to death. Skipping an organ involves transmission to the organ it generates. Suppose Heart transmits to Spleen, Spleen to Lung, Lung to Kidney, Kidney to Liver, and Liver to Heart. This is mother-to-son transmission, cycling endlessly like a ring without end, hence it is said to lead to survival. However, the text mentions "seven transmissions," but numerically there are only six transmissions. Saying "one organ is not injured twice" implies four organs are not injured based on the count. Moreover, the rationale for skipping organs lacks clear exposition, with commentators merely interpreting the text literally. Please clarify to resolve my doubt. The reply is: This passage discusses Xu Lao (Consumptive Disease). The phrase regarding Heart disease likely omits "Kidney disease transmitting to Heart." The phrase "one organ is not injured twice" should read "three organs are not injured twice." These are errors in transcription. Generally, Xu Lao begins in the Kidney Meridian. If the Five Zang organs transmit inversely according to the overcoming cycle, and after exhausting all, transmit again to the Kidney and Heart, Water is extinguished and Fire flares up excessively, leading to death without further transmission to those three organs. In cases of direct transmission via the generating cycle, if Kidney Water intends to transmit to Heart Fire, it may be intercepted by Liver Wood, transmitting to Liver Wood first, then to Heart Fire. This sequential, forward progression carries the meaning of endless generation, hence "skipping an organ leads to survival." Scholars should ponder this deeply.

One asks: Physicians use water to decoct medicines. Materia Medica lists many types of water but does not detail their uses. There is Chang Liu Shui (Long-flowing Water), Ji Liu Shui (Rapid-flowing Water), Shun Liu Shui (Downward-flowing Water), Ni Liu Shui (Upward-flowing Water), Qian Li Shui (Thousand-li Water), Ban Tian He Shui (Half-sky River Water), Chun Yu Shui (Spring Rain Water), Qiu Lu Shui (Autumn Dew Water), Xue Hua Shui (Snowflake Water), Jing Hua Shui (Well Flower Water), Xin Ji Shui (Freshly Drawn Water), Wu Gen Shui (Rootless Water), Ju Ying Shui (Chrysanthemum Petal Water), Liao Shui (Rainwater/Puddle Water), Gan Lan Shui (Sweet Ripple Water), and Yue Ku Shui (Moon Cave Water). Why does one type of water have so many names? Surely each has specific advantages. Please explain them without reservation. The reply is: Chang Liu Shui is the same as Qian Li Shui; one simply takes water that flows from afar. One should not rigidly adhere to the term "thousand li." Its nature is distant and penetrating, having traversed many obstacles; thus, it is used to decoct medicines for diseases of the four extremities, medicines for distant pathways, and for promoting urination and defecation. Ji Liu Shui refers to turbulent, rapid flowing water. Due to its swift and downward-penetrating nature, it is specifically used to decoct medicines that promote urination/defecation and treat wind-dampness below the shins. Shun Liu Shui flows naturally downward; thus, it is used to treat lower Jiao disorders of the waist and knees, and for promoting urination/defecation. Ni Liu Shui is swirling, eddying water. Due to its reverse flow, it is used to harmonize emetic formulas for phlegm-fluid retention. Ban Tian He Shui refers to the "Water above the Pool" given by Chang Sang Jun to Bian Que; it is stagnant water collected in bamboo fences. It is taken because it is clean, falling from heaven, and untainted by lower filth; thus, it is used for refining Elixir Fields and preparing immortal medicines. Chun Yu Shui is water caught in vessels from the sky on the Day of Start of Spring. Its nature just acquired the ascending and generative Qi of Spring; thus, it is used to decoct medicines for insufficient Middle Qi and failure of Clear Yang to ascend. ... Qiu Lu Shui possesses the astringent and肃杀 (astringent/killing) Qi of Autumn; thus, it is used to decoct anti-parasitic medicines and preparations for treating scabies and tinea. Jing Hua Shui is the first draw from a well in the early morning. The true Essence of Heaven and Earth floats on the surface; thus, it is used to decoct Yin-nourishing medicines and for refining Elixir Fields. Elegant people today use it daily to brew spring tea, believing it best clears the head and eyes; its nature and taste are similar to snow water. Ju Ying Shui comes from the Longevity Source in Shu, where chrysanthemums abound, and the running water smells of chrysanthemums year-round. Residents drinking this water live to 200-300 years. Thus, Tao Yuanming and similar figures planted chrysanthemums, steeping petals in water for tea to prolong life. Xin Ji Shui is freshly drawn well water not yet poured into jars. It is taken for its cleanliness and lack of contamination, used for decocting medicinal agents. Gan Lan Shui is made by stirring water in a vessel until foam covers the surface. Its nature is similar to Yue Ku Shui; it is sweet, warm, and soft, used to decoct medicines for Cold-type Taiyang/Yin syndromes. Liao Shui, also called Wu Gen Shui, is water in depressions of new soil in uninhabited mountain valleys. It is taken because its nature is undisturbed, retaining internal Earth Qi; thus, it is used to decoct spleen-strengthening, appetite-arousing, and Middle Qi-tonifying agents. Although Materia Medica lists these waters, it does not detail their uses; I record them here as models for future students.

One asks: Danxi focuses on Spleen Earth failure and Liver Wood invasion, with damp-heat acting as the pathogen, in treating swelling/distension. Dongyuan often emphasizes Cold, stating that the *Bing Ji* (Pathogenesis) phrase "all abdominal distensions and enlargements belong to Heat" refers specifically to severe excess-fullness in the Yangming Meridian of Hand-Yangming/Foot-Yangming (Taiyang/Yangming context in Shanghan). He also says: "Heat distension is rare; Cold distension is common." These theories differ; which is wrong and which is right? The reply is: Dongyuan was from the North, where the land is high and dry, with little damp-heat and much cold air; hence his theory. My Master Danxi grew up in the Southeast, where such diseases arise entirely from Spleen deficiency with dampness invasion and hyperactive Liver Wood; hence his statement. One asks: Having understood the difference in meaning, Danxi's general method for treating swelling states: "One must nourish the Lung to control Liver Wood, sparing the Spleen from hostile invasion; nourish the Kidney to control Fire, allowing the Lung to obtain a source of clear transformation; eliminate delusions to protect Mother Qi; reject salt to prevent aiding evil; use large doses of Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala) to tonify the Spleen, making Spleen Qi solid, thereby naturally strengthening transportation and transformation, ascending and descending." This is an unchanging doctrine for millennia, a miraculous method with ten successes out of ten, saving many lives. I once used this method to treat Huang Zhong (Yellow Swelling/Icteric Edema), but it worsened the patient's agitation and discomfort. Switching to a formula with Xiangfu (Cyperus), Cangzhu (Atractylodes Lancea), and Houpo (Magnolia Bark) resulted in complete recovery. I ponder: Both Shui Zhong (Edema) and Huang Zhong are caused by damp-heat injuring the Spleen. Why are the treatments different? The reply is: Shui Zhong arises from extreme Spleen Earth deficiency and excessive Liver Wood, causing water-dampness to act recklessly within. Although there may be clear phlegm and retained fluids, there is no stagnation or gumming adhesion. Therefore, using Renshen and Baizhu as sovereign herbs, combined with diuretics, Lung-clearing, and damp-heat-resolving drugs, treats both root and branch, achieving perfection. Huang Zhong, however, may be Jiudan (Alcoholic Jaundice) or Gudan (Grain Jaundice), with accumulated stubborn phlegm gummed and knotted inside, forming Pi (masses) or Ji Ju (accumulations). Thus, accumulation internally manifests externally, yellowing due to Earth Qi's external manifestation. Therefore, one should use Houpo, Cangzhu, Xiangfu, and Chenpi to level the excessive Earth Qi, use Tie Fen (Iron Powder) and Qingpi (Green Tangerine Peel) to subdue excessive Wood Qi, add Qu (Medicated Leaven) to assist the Spleen and resolve accumulations. After jaundice recedes, continue with Renshen and Baizhu to tonify the Spleen to achieve perfection. This is treating the branch first, then the root. If the medicines for these two conditions are swapped, disaster will follow swiftly; scholars must know this.

One asks: Eating only when extremely hungry often leads to poor digestion, manifesting as vomiting and acid regurgitation. Why? The reply is: Eating when hungry and drinking when thirsty is the natural law of creation. If hunger persists without food, Stomach Qi is damaged, Spleen Qi is injured, and Middle Qi becomes severely deficient. Encountering food and eating voraciously, or overeating, further damages Stomach Qi. Mild cases cause acid regurgitation and nausea; severe cases cause aversion to cold and fever, leading to many Internal Injury syndromes. Similarly, carrying heavy loads over long distances while exhausted and hungry, followed by excessive eating, leads to limb fatigue. Forcing continued movement while encountering external wind-rain results in Internal Injury complicated by External Contraction, or critical swelling diseases. Those cultivating health must guard against subtle beginnings and prevent gradual escalation; beware!

One asks: Acupuncture employs tonification/reduction and following/against techniques to balance deficiency/excess. Moxibustion is applied regardless of deficiency/excess or cold/heat; does it also have tonification/reduction effects? The reply is: For deficiency, moxibustion uses fire Qi to assist Yuan Yang (Primary Yang). For excess, moxibustion allows excess pathogens to dissipate with fire Qi. For cold, moxibustion restores warmth. For heat, moxibustion draws trapped heat outward, following the principle that "fire follows dryness." Although acupuncture has tonification methods, I fear they are primarily reducing. The classics state reduction is "meeting and seizing" (Ying Er Duo Zhi), using the needle to meet the incoming meridian Qi and expel it, effectively reducing excess. Tonification is "following and assisting" (Sui Er Ji Zhi), following the departing meridian Qi and retaining it, but this may not effectively tonify deficiency. Otherwise, why does the *Nei Jing* say: Do not puncture those with blazing heat, chaotic pulses, profuse sweating; do not puncture those greatly fatigued, starving, thirsty, recently full, or greatly startled. It also says: If Form-Qi and Pathogenic-Qi are both deficient, this indicates Yin and Yang deficiency; do not puncture. Puncturing will exhaust Qi further; the elderly will perish, the robust will not recover. Such statements imply acupuncture is primarily reducing; scholars must know this.

One asks: For Xu Sun (Deficiency Damage) diseases, society commonly uses the Bureau Formula Shiquan Dabu Tang (Ten Thousand Complete Great Tonifying Decoction). This formula is key for various deficiencies, using Renshen, [Missing Character, likely Huangqi], Fuling, Baizhu, and Gancao to tonify Qi deficiency, and Chuanxiong, Danggui, Shaoyao, Dihuang, and Rougui to tonify Blood deficiency. How do you evaluate this? The reply is: This formula is for dual Qi and Blood deficiency. Can it be applied uniformly to those with Blood deficiency but sufficient Qi, or Qi deficiency but sufficient Blood? The *Nei Jing* states: "Poisonous substances treat diseases." Medicines have inherent toxicity/capability. If they match the disease, their capability brings peace; if not, their toxicity increases the disease. For example, if Heart and Spleen meridians are deficient, Fuling should be used. If deficient with no sweat and scanty urine, it helps; if deficient with frequent urination, excessive use causes blindness; if deficient with profuse sweating, long-term use depletes True Qi and shortens lifespan, due to its bland nature draining orifices. For weak Lung Qi and deficient Yuan Yang, Huangqi (Astragalus) should be used. Fat individuals or those with Qi deficiency and profuse sweating benefit; however, dark-skinned individuals with abundant Kidney Qi and mild deficiency will feel fullness and discomfort due to its clogging nature. Gancao (Licorice) is excellent for strengthening Spleen, tonifying Middle, clearing heat, and relieving irritability. However, those with vomiting, middle fullness, or alcoholism will suffer worsening oppression and vomiting with excessive use due to its sweet, slow nature. Chuanxiong (Ligusticum) is a holy medicine for tonifying/moving Blood and clearing the head. However, those with bone-steaming fever, profuse sweating, or weak Qi will scatter True Qi and worsen Yin deficiency with long-term use due to its pungent, dispersing nature. Sheng Dihuang (Raw Rehmannia) generates blood vessels, but harms the Stomach and reduces appetite in those with weak Stomach Qi. Shu Dihuang (Prepared Rehmannia) tonifies Blood, but causes chest oppression in those with abundant Phlegm-Fire. Renshen (Ginseng) moistens Lung and strengthens Spleen; indispensable for Yuan Qi deficiency. However, those with chronic cough, labor cough, hemoptysis, or constrained Fire in the Lung will worsen cough and wheezing due to its sweet-warm, Qi-stagnating nature. Baishao (White Peony Root) cools and nourishes Blood; essential for Blood deficiency abdominal pain. However, those who are thin, weak, or constitutionally cold-deficient will damage generative Qi due to its sour-cold nature. Medicine capabilities and toxicities are numerous; scholars should study Materia Medica thoroughly and avoid reckless application that kills.

One asks: The *Mai Jing* (Pulse Classic) states four breaths per pulse beat is normal for healthy people. Yet healthy people sometimes have five beats per breath, or three beats. Why such variation? The reply is: Naturally generated pulses vary in slack/tense and slow/fast. The classics say: "Quick temperament yields quick pulse; slow temperament yields slow pulse." Generally, slow/slack pulses indicate longevity; fast/tense pulses indicate premature death. The classics say: "Rooted within is called Shen Ji (Spirit Mechanism); when Spirit departs, mechanism ceases." Qi and Blood are the Spirit of the human body. Fast/tense pulses indicate Qi/Blood easily depleted and Spirit Mechanism easily ceased, hence premature death. Slow/slack pulses indicate harmonious Qi/Blood and resilient Spirit Mechanism, hence longevity. Ancients compared tidal waves to heaven-earth breathing, rising and falling twice daily; humans breathe 13,500 times daily. Thus, heaven-earth is eternal; human lifespan rarely exceeds a hundred. Such is my humble opinion; is it correct?

One asks: A person's Cun, Guan, Chi pulses are imperceptible upon pressure, yet pulsation moves at Yangxi (LI5) and Hegu (LI4) of the Hand-Yangming Large Intestine Meridian. Why? The reply is: Hand-Taiyin Lung and Hand-Yangming Large Intestine are Zang-Fu pairs, exterior-interior. Lieque (LU7) is the Luo-connecting point of both meridians. Thus, the pulse emerges from the Luo into the Yangming Meridian. This is "Wife occupying Husband's position," representing Di Tian Jiao Tai (Heaven-Earth interaction), a normal pulse of growth and generation. Should scholars not understand this?

One asks: Danxi states postpartum conditions should primarily be treated by greatly tonifying Qi and Blood, addressing miscellaneous symptoms secondarily. He also says: Postpartum Wind-Stroke must not be treated as Wind using Wind-dispelling drugs. So, should all postpartum conditions be treated with great Qi and Blood tonification? The reply is: The terms "Primary" and "Secondary" clarify the meaning. If Qi and Blood are severely deficient with mixed symptoms, but essentially deficiency without other complications, great tonification of Qi and Blood will lead to self-healing. If contracted Wind-Cold due to deficiency, combine Qi/Blood tonics with Wind-dispelling agents. If Spleen deficiency with Food Injury to Taiyin, combine Qi/Blood tonics with digestive agents. If aversion to cold and fever due to incomplete expulsion of Lochia/Blood Stasis, first expel stasis/lochia, then tonify greatly. The classics say: "Treat root then branch," and "Treat branch in emergencies, root in stability." Danxi's "Primary/Secondary" refers to Root/Branch. In clinical practice, must one not distinguish via Observation, Listening/Smelling, Inquiry, and Palpation? Applying tonification uniformly is like carving a mark on a boat to find the sword (rigid thinking).

One asks: Pregnant women sometimes menstruate monthly while the fetus grows, or bleed heavily between 3-5 months without miscarriage, delivering on time or late. What is the rationale? The reply is: Monthly menstruation with fetal growth is called Sheng Tai (Abundant Fetus), due to abundant Qi and Blood, leaving surplus after nourishing the fetus. Heavy bleeding with a multi-month fetus is called Lou Tai (Leaking Fetus), caused by emotional/physical disturbance affecting the Ren Mai, causing bleeding without damaging the Uterus. Although the fetus does not miscarry, Qi and Blood are depleted, often delaying delivery. I have seen births at 12-13, 17-18, or 24-25 months, all due to insufficient Qi/Blood hindering fetal growth. For deliveries beyond ten months, administer great Qi/Blood tonics to cultivate the body, ensuring safe delivery. Scholars must know this.

One asks: Danxi attributes difficult labor in the 8th-9th month to lack of sexual restraint, causing Qi/Blood deficiency. Explain the rationale. The reply is: Pregnant women should strictly avoid cohabitation with husbands. Many ignore this, engaging in intercourse in the 8th-9th month. Sexual arousal consumes Qi and Blood. Fetal development relies entirely on Qi/Blood cultivation; depletion leads to weak fetal Qi. Upon term, the fetus awakens and seeks birth, breaking the sac. Amniotic fluid flows down. A strong fetus turns and descends with the fluid (easy birth). A weak fetus, like a sleeper waking slowly, turns sluggishly and fails to descend. Once fluid dries, bloody waste blocks the birth canal, causing malpresentation (transverse/breech). At onset of labor, if fluid breaks but birth hasn't occurred, one should worry and urgently administer parturition-promoting drugs like Shuhui Zi (Malva Seed) to expel bad blood, clear the pathway, and ensure rapid delivery. Physicians must understand this.

One asks: Stroke presents as hemiplegia. Some survive for years. Why? The reply is: Like a tree whose roots are not fully withered, but one side's branches die first. The classics say: "Rooted within is Shen Ji (Spirit Mechanism); Spirit departs, mechanism ceases (animals). Rooted outside is Qi Li (Qi Establishment); Qi stops, transformation ends (plants)." As long as Shen Ji has not ceased, it is akin to Qi transformation...