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[Suwen] Heaven is deficient in the northwest, therefore the northwest belongs to Yin, and people's right ear and eye are not as acute as the left. Earth is incomplete in the southeast, therefore the southeast belongs to Yang, and people's left hand and foot are not as strong as the right. The Yellow Emperor asked: Why is this? Qibo replied: The East belongs to Yang; the essence of Yang gathers in the upper part. When it gathers in the upper part, the upper becomes excess and the lower deficiency, thus the ears and eyes are acute but the hands and feet are inconvenient. The West belongs to Yin; the essence of Yin gathers in the lower part. When it gathers in the lower part, the lower becomes excess and the upper deficiency, thus the ears and eyes are not acute but the hands and feet are convenient. Therefore, if simultaneously affected by pathogenic factors, those in the upper part will be more severe on the right, and those in the lower part will be more severe on the left. This is because the Yin and Yang of Heaven and Earth cannot be complete, so the pathogens reside there (from *Da Lun on Yin-Yang and Resonance*). Headache and diseases of the vertex belong to lower deficiency and upper excess, affecting the Foot Shaoyin Kidney Meridian and Foot Taiyang Bladder Meridian; in severe cases, the pathogen enters the Kidney. Dizziness, swaying head, blurred vision, and deafness belong to lower excess and upper deficiency, affecting the Foot Shaoyang Gallbladder Meridian and Foot Jueyin Liver Meridian; in severe cases, the pathogen enters the Liver. Abdominal fullness and distension, limb obstruction and hypochondriac discomfort belong to lower Jue and upper covering, affecting the Foot Taiyin Spleen Meridian and Foot Yangming Stomach Meridian. Cough and rebellious Qi with rebellion in the chest affect the Hand Yangming Large Intestine Meridian and Hand Taiyin Lung Meridian. Heart vexation and headache, disease in the diaphragm, affect the Hand Taiyang Small Intestine Meridian and Hand Shaoyin Heart Meridian (from *Da Lun on Generation of Five Zang Organs*).

[Ling shu] Lower deficiency leads to Jue, lower excess leads to heat, upper deficiency leads to dizziness, upper excess leads to heat.

[Li Gao (Dongyuan)] If the pulse at both Cun positions is excess (called Yang excess and Yin deficiency, purgation cures it); if both Cun pulses are deficient (called both Yin and Yang deficiency, tonifying Yin exhausts Yang, tonifying Yang exhausts Yin, suitable to regulate with sweet medicines); if both Cun pulses are insufficient, seek from the Earth, which refers to the Spleen and Stomach (should draw Yang from Yin). If both Cun pulses are short and small, it is Yang Qi insufficiency, disease is in the lower part, called Yin excess and Yang deficiency. Acupoints Xiaguling (Zusanli) and Sanli should be taken. Regulating formless Qi and harmonizing Jing is the method, referring to the methods in *Wu Luan*, treating insufficiency diseases. One should take the Front-Mu point Qihai, located 1.5 cun below the umbilicus. In severe cases, take Zusanli and Qichong, guiding with filiform needles. If both Guan pulses are excess (not inducing sweating above, not promoting urination below, suitable for Shaoyao Tang to drain Earth excess); if both Guan pulses are deficient (pulse deep and fine suitable for Lizhong Tang, pulse wiry and slow suitable for Jianzhong Tang, if excess add Huangqi and Fuzi); if both Chi pulses are excess (Yin excess and Yang deficiency, sweating cures it); if both Chi pulses are deficient (suitable for Jiangfu Tang to tonify Yang. Question: Why tonify Yang for Yin deficiency? Answer: Yin originates from Yang. Zhang Zhongjing said: If both Chi pulses are deficient, do not use purgation; purgation is contrary treatment, leading to death); if both Chi pulses are absent or short/small, the disease is in Heaven (upper), seek from the Back-Shu points of the Five Zang organs, or latent fire in blood collaterals and meridians (this is Yin fire in Heaven, so Yang cannot store. Also, *Nanjing* says: No pulse in the lower part, or exhaustion of both Chi pulses, is due to food stagnation, should use emesis).

[Suwen] Rapid arrival and slow departure of the pulse indicate upper excess and lower deficiency, constituting severe Jue disease. Slow arrival and rapid departure indicate upper deficiency and lower excess, constituting aversion to wind (from *Jingwei Lun on Pulse Essentials*). Tonifying the upper and treating the upper requires a slow preparation; tonifying the lower and treating the lower requires a rapid preparation. Rapid means strong flavor and substance, slow means weak flavor and substance, ensuring the medicine reaches its destination. For distant diseases where the middle path consumes the medicine's energy, eating can assist the medicine's journey without exceeding the system. Thus, the way to balance Qi is: for nearby locations and odd/even pulse patterns, make the dosage small; for distant locations and odd/even pulse patterns, make the dosage large. Large means few doses, small means many doses, up to nine times, down to two times (from *Yaoyao Lun on Supreme Necessity*. Near and far refer to the position of Zang-Fu organs).

[Luo Tianyi] Disease in the upper part belongs to Heaven; decoction should use vigorous fire, be clear/light, drunk slowly, and processed with wine (washing/soaking). Disease in the lower part belongs to Earth; decoction should use gentle fire, be concentrated, drunk quickly.

[Li Gao (Dongyuan)] For disease in the upper part, frequent small doses are not tiresome; for disease in the lower part, single large doses are not tiresome. Small doses nourish Ying Qi in the upper part; large doses strongly tonify the lower part. For disease in the upper Heart, eat first then take medicine. For disease in the lower Heart, take medicine first then eat. When using Huangqin, Huanglian, Banxia, and Zhimu for diseases in the head, face, and skin of the hands, one must use a cup of wine to borrow its ascending power. Below the throat and above the umbilicus, wash with wine; below, use raw herbs. Generally, raw herbs descend and cooked herbs ascend. For herbs, the upper half of the root has ascending Qi and pulse, considered the root; the lower half has descending Qi and pulse, considered the tip. Use roots for Middle and Upper Jiao diseases, tips for Lower Jiao diseases, so roots ascend and tips descend. Pills for下部 diseases are large and smooth; for Middle Jiao diseases, medium; for Upper Jiao diseases, very small. Thick wheat paste allows slow digestion reaching the Lower Jiao; thin wheat paste allows easy digestion; pills made from soaked overnight steamed bread or dripping water also digest easily.

[Luo Tianyi] Master Dongyuan treated Xiao Ke (Wasting-Thirst) with Ganlu Yin Zi made into a coarse powder, licked frequently by the tongue to stay in the Diaphragm, a slow preparation. For heart vexation, desire to vomit, palpitations, and insomnia, he used Chen Sha An Shen Wan, rice-grain sized, swallowed with saliva about ten pills. This is near location and odd/even pattern, making the dosage small (Heart and Lung are upper/near. Small dosage prevents downward movement). For foul odor, he prepared Xie Gan Tang, citing *Nanjing*: Heart governs five odors, entering Liver as foul odor. Chaihu (bitter, neutral, slightly cold) is the Sovereign drug; Longdan (bitter, cold) assists to drain Heart Fire; Zexie and Cheqianzi (sweet, salty, cold, plain, mild)渗利 (percolate/drain) Liver pathogens, "draining what is below". Boiled with much water and taken in one dose, this is a rapid preparation. For Lower Jiao Yin deficiency, he prepared Zishen Wan, Huangbo (very bitter, cold) as Sovereign, Zhimu (bitter, cold) as Assistant, Guizhi and Gancao (pungent, sweet, very hot) as Minister, made into pills the size of corn kernels, taken with boiling water over 100 pills on an empty stomach. This is distant location and odd/even pattern, making the dosage large.

[Suwen] Suppress what is high, lift what is low (from *Yaoyao Lun on Supreme Necessity*. Wang Bing's commentary: Suppressing the high controls its dominance; lifting the low aids its weakness).

[Hua Shou] Heat in the highest division uses light agents to suppress from above, treating slowly. If taken rapidly, upper heat remains while middle cold arises (e.g., treating severe headache with wine-baked Dahuang, Huanglian, Huangqin, Gancao, and Niu Bang Zi decoction, sipped slowly).

*[Taiping Huimin Heji Jufang]* Yangzheng Dan (Formula seen in Xuanyun section).

[Li Gao (Dongyuan)] Chaihu Tiaojing Tang A woman had menstrual black blood coagulated into masses, a blood mass (Xuejia) on the left side, continuous watery diarrhea, grain sometimes digested, sometimes not. Dongyuan said: Continuous menstrual leakage means Qi and Blood of the anterior orifice have descended and escaped. Years of watery diarrhea mean Qi and Blood of the posterior orifice have sunk and escaped. The patient's whole body Qi follows Autumn/Winter commands, sinking and descending for long; it needs great lifting and ascending to aid Spring/Summer. Then use Siwu Tang, modified according to obvious symptoms (Tiaojing Tang formula seen in Bengang section).

[Zhu Zhenheng (Danxi)] A woman postpartum had a thing like a skirt, half in the abdomen, half on the mat, doctors did not understand. Mr. Zhu said: This is the uterus. Qi and Blood are deficient, following the fetus down and unable to return. He gave Huangqi and Danggui formulas, adding Shengma to lift it. Externally, he used Wubeizi decoction to wash, causing the skin to wrinkle and contract slowly, after a while the uterus rose. He comforted her: You can bear another child in three years, do not worry. It happened as predicted.

*Ling shu* When the pulse sinks, use moxibustion (Dongyuan said: Sinking means skin and hair cannot withstand Wind-Cold, knowing Yang Qi has sunk. Although the pulse is rapid, internally it must be fine, strong, tight, small, or deep and choppy covered on top, knowing Fire-Heat has sunk. Even if the pulse is 8-9 beats per breath, very rapid, if the Yin pulse covers it, moxibustion can be used. Yin pulse refers to fine, strong, tight, small, deep, and choppy).

[Suwen] When Qi rebels, treat the lower for disease in the upper, treat the upper for disease in the lower, treat the sides for disease in the middle (from *Wuchang Zheng Da Lun*).

[Zhu Zhenheng (Danxi)] A man suffered from urinary retention; doctors treated with dysentery medicines, worsening the condition. Danxi said: This is accumulated Phlegm-Dampness. Accumulated Phlegm is in the Lung (Upper Jiao), while the Bladder is Lower Jiao. Upper Jiao closure causes Lower Jiao blockage, like a water vessel: only when the upper aperture is open does water flow from the lower. So he used emesis to induce heavy vomiting; after vomiting, the illness disappeared. He also treated an elderly man with chronic diarrhea and dysentery unresponsive to hundred remedies, with chest oppression and reduced appetite. Danxi gave an emetic, expelling a liter of sticky Phlegm, stopping the dysentery (See *Chronic Dysentery*. These two methods also reflect "lifting what is low". Urinary retention is Qi and Blood congestion in Lower Jiao. Chronic diarrhea is Qi and Blood sinking in Lower Jiao. Now, heavy vomiting lifts all Qi and Blood to float back to Upper Jiao, clearing Lower Jiao congestion and lifting sinking Qi, thus curing both).

For disease in the upper, treat the lower: e.g., hiccup, wheezing/fullness, rebellious Qi, moxa Qihai and Zusanli below the umbilicus to guide Qi downward, curing the disease immediately.

[Wang Bing's Commentary] If Upper Excess persists, use emesis to release it. If Lower Excess persists, use purgation to drain it.

*[Baoming Ji]* Zhang Zhongjing said: In Shanghan (Cold Damage) days 3-4, pathogen not yet transmitted to interior, only use Goudi San to vomit and cure, how can sweating be used? Again, Shanghan days 6-7, slight chest stuffiness, unwilling to speak, restlessness, dizziness, no signs for purgation, Zhang Zhongjing's Zhizi Tang induces vomiting for immediate relief. Also: Stroke with loss of consciousness need not sweat; if rattling sound in throat, use Xixian San to vomit. Also: Wind headache, if Phlegm-Saliva not vomited, blindness ensues untreatable; use Goudi San to vomit, three times cures. Also: Sudden cough with Wind-Phlegm blocking upward, throat obstruction, use Chatiao San to vomit; Yang Epilepsy long untreated, not yet dementia, use Daoxian San to vomit; Yin Epilepsy, use Sansheng San to vomit. Also: People rich in rich food, eating too much raw/cold food, parasites hide in chest, chest discomfort, choking food down, use Lilu San to vomit. Also: Long-term hypochondriac pain unresponsive to drugs, use Dusheng San plus Scorpion tail half qian to vomit. Various epilepsies occurring anytime, loss of consciousness, use Banshengshu Tang to vomit. Hidden Wind disease long untreated, returning to normal after attack, use Yujin San to vomit. Malaria long untreated, irregular chills/fever, use Changshan San to vomit. Jiaolong mass pain, abdominal distension like drum, long untreated dying, use Tangqiu San to vomit, expelling object like lizard 7-8 cun long, acceptable. One person initially had Shanghan, drank cold, chest/abdomen stuffy, fever, vomiting upon seeing food, use Chixiaodou San to vomit. Woman with tendon spasm/pain, use Shenyingsan to vomit. Someone asks: Why vomit for tendon disease? Answer: Wood stagnation should be dispersed ("Da"). Dispersing means allowing free growth. Or for trauma/falls, first vomit with Jinhua San; then purge with Chengqi Tang. "Cheng" means following. Hemiplegia, use Zhuifeng San to vomit. After Head Wind, eye disease, half vision recoverable, use Fangfeng San to vomit. Children with upper wheezing/fever, first Yujin San to vomit, then Zhenxian San to purge, immediate effect. Treat Mania long untreated, use Sansheng San to vomit, then heavy purge. All Wind shaking/trembling, eyes straight, loss of consciousness, use Xuantou Gao to vomit Phlegm-Saliva, immediate effect. Chest/Diaphragm fullness, back/arm pain, first Qufeng Tang to vomit, then Wu Yao San. Leprosy or malignant sores, use Sansheng San to vomit, then Kushen Wan. All Jue Qi, stroke unconscious, use Shensheng San nasal instillation, vomiting Phlegm-Saliva immediate effect. Traumatic Wind jaw stiffness/opisthotonos, use Shensheng San to vomit, then sweat/purge after, effective. Using all three methods belongs to ancient high physicians, divine and unfathomable. Modern mediocre doctors only look at formulas, don't know treatment methods, origins, don't follow Sage's laws, drifting further from Sages day by day. Pity! Sad!

[Zhu Zhenheng (Danxi)] For all vomiting, use reverse-flowing water to mix medicine and vomit. Any medicine that raises True Qi can cause vomiting. e.g., Fangfeng, Jiegeng, sprouted tea, Zhizi, Chuanxiong, Luobozhi, with ginger juice/vinegar少许, Goudi San少许, mixed in vegetable juice warm, probe with goose feather.

[Zhang Hezi] Xixian San
Zhuya Zaojiao (uncorroded, remove skin/string, 1 liang) Lvfan (5 qian) Lilu (0.5 liang)
Grind to fine powder. Take 0.5 qian or 1-2 qian, pry open teeth, mix with grain water and pour in.

[Zhu Zhenheng (Danxi)] To vomit food accumulation/phlegm, use 5 he of Luobozhi, stir-fry in oil, pound, extract juice with grain water, add少许 Tongyou and Baimi, warm slightly, bind belly tightly with cloth, then stir throat with goose feather to induce vomiting. Another method: 0.5 jin shrimp with shell, boil with soy sauce/ginger/scallion, eat shrimp first, drink broth, probe with goose feather to vomit, must tighten belly. To vomit damp-phlegm in fat people, use Yiyuan San mixed in vegetable juice, probe to vomit.

[Worldly/Secular] Doucan San Light agent to vomit phlegm.
Chixiaodou Kushen
Grind to powder. Mix with sour grain water, probe with goose feather.

[Zhu Zhenheng (Danxi)] Single herbs for vomiting
Jiegeng Lu Renshen Lu Aiye Mocha Goudi Lilu Fuzui Jiao Pi
These several items vomit themselves, no need for manual probing, any decoction can vomit; for deficiency syndromes use Renshen Lu to vomit.

[Zhang Hezi] Sansheng San
Fangfeng (2 liang, remove radix) Goudi (3 liang, select clean, stir-fry slightly yellow) Lilu (*Shenghui Fang* reduce to 1 liang, 0.5 liang, or 3 qian)
Grind each to coarse powder. Take approx 0.5 liang, with 3 tea cups of vegetable juice. First boil 2 cups 3-5 boils, discard vegetable juice, add 1 cup water, boil 3 boils, then mix previous 2 cups together boil 2 boils, filter clear, warm, drink slowly. Stop when vomiting occurs, no need to finish dose.

[Zhu Zhenheng (Danxi)] Another formula uses:
Yujin (0.5 liang) Lilu (1 qian) Kushen (1 qian)
Grind to powder. Mix with vegetable juice to vomit. If vomiting doesn't stop, one Dingxiang stops it. If still not stopping, drink Scallion White Decoction.
To treat Wind-Phlegm, use one Tian Nanxing, open hole like millet grain in center, fill with good vinegar, bake dry, repeat 3 times. Mix with 2.5 qian Lilu, grind to powder. Wine paste pills. Take 3-5 pills, empty stomach warm wine, vomit after one meal time. If not vomiting, take 3-5 more pills. If Phlegm exhausted but vomiting continues, cold scallion white soup stops it.

[Zhang Zhongjing] Goudi San (Formula seen in "Shanghan Hong Kong Foot Upward Rushing". *Huoren* method of taking Goudi attached below)
*Yanyi* says: Whenever using Goudi, if after long time no Phlegm-Saliva comes out, hold a piece of rock sugar, swallow, and Phlegm-Saliva will vomit out.

[Zhang Hezi] Erxian San
Goudi Good Tea equal parts
Grind to fine powder. Take 2 qian, mix with vegetable juice, use empty stomach.

*[Yanyi]* Goudi is Sweet Melon Pedicel. Remove melon skin, use pedicel approx 0.5 cun, sun-dry extremely dry, unlimited amount, grind fine, measure disease, take 1-2 qian each time, mix with 1 qian Nifen (Calomel), half cup water, mix well, pour in. Treat sudden Wind-Phlegm, Qi blocked falling down, after long time drinking, Phlegm-Saliva comes out. Or feel Phlegm-Saliva, use other medicines to transform but won't come out, just take this way, Phlegm-Saliva comes out.

*[Heji Jufang]* Bilu Dan
Shilu (fine grind, passed through sieve 9 times, 10 liang) Fuzui Jiao Chuanwui Jiao Xieshao (each 70 pieces)
Grind to powder. Mix Shilu evenly, paste pills corn kernel size. Each dose melt one pill in half cup mint juice. Further warm drink half he wine, shortly vomit Phlegm-Saliva.
Above are agents to vomit Phlegm-Heat. Generally to vomit Phlegm, use cold agents; if repeatedly vomiting fails to penetrate, must use hot agents to vomit to penetrate. Danxi used Goudi, Zhizi, Kushen, Lilu etc. repeatedly vomited Master Baiyun but didn't penetrate, later with Fuzui Jiao mixed with grain water, finally got heavy vomiting.

[Zhang Hezi] Dusheng San
Use Pi (Arsenic) any amount, grind fine. Take one zi (measure), mix with new water, pry open teeth and pour in. Usually do not use.

[Worldly/Secular] Treat Phlegm Wheezing.
Pi 1 qian, Flour 2 liang, knead cake with clear water, fry in sesame oil until yellow, grind to powder. Each time take powder size of one copper coin, Jiangcha (river tea) size of three copper coins, mix well, predawn well water mix and take. If not vomiting, add half copper coin powder, take next day again.

[Zhang Hezi] Qingdai San Snuff nose to extract Phlegm-Saliva, divine (Formula seen in *Headache*. Qi excess with Wei-Heat knot, hard to vomit out, must first use Jiegeng 2-3 times to open).

[Zhu Zhenheng (Danxi)] Vomiting Method: First bind abdomen tightly with cloth strap, perform in non-windy place. For goose feather probes, soak in Tongyou, then wash oil off with Zaojiao water, sun dry for use.

[Zhang Hezi] Treating Phlegm, probe with chicken feather on hairpin shaft. If not coming out, throw vegetable juice in. If not vomiting, throw again. Throw and probe, none fail to come out. If vomiting leads to dizziness/fainting, do not panic. Book says: If medicine doesn't cause dizziness/heaviness, severe disease won't heal. If head dizziness occurs, drink ice water to resolve immediately. If no ice water, fresh drawn water is okay. Strong people settle after 1-2 vomits, weak people can do 3 times vomiting, little harm. Next day after vomiting, some relapse instantly, some worsen, because lifting hasn't stabilized, do again in a few days. If thirsty, ice water, fresh water, melon/pear cool foods not prohibited, only prohibit overeating, hard foods/dried meat hard to digest. One doctor vomited a woman, lasted half month, life hanging by thread, I decocted Shexiang Tang to resolve, swallowed stopped immediately. Asked why Shexiang stops vomiting? I said: Melon seedlings die smelling Shexiang. Vomiters use Goudi, so it resolves immediately. If Lilu vomiting doesn't stop, Scallion White Soup resolves it. If Stone Medicine vomiting doesn't stop, Gancao and Guanzhong resolve it. All plant/herb vomiters can be resolved by Shexiang. (Danxi said: Dingxiang, Gancao, Baizhu generally resolve all medicines). Bitter-cold vomiting medicines include: Douchi, Goudi, tea powder, Zhizi, Huanglian, Kushen, Dahuang, Huangqin. Bitter-pungent-cold: Yujin, Changshan, Lilu. Sweet-bitter-cold: Dihuang juice. Pungent-cold: Qingfen. Sour-cold: Jinjian, Lvfan, vegetable juice. Sour-pungent-cold: Danfan. Sour-salty-cold: Qingyan, Baimi Yin. Sweet-salty-cold: Cangyan. Sweet-cold: Yanxiao. Sweet-mild-warm & cold: Renshen Lu. Bitter-warm: Muxiang, Yuanzhi, Houpo. Bitter-pungent-warm: Bohe, Yuanhua. Pungent-warm: Gujingcao, Conggenxu. Sweet-warm: Wutou, Fuzui Jiao. Sour-warm: Fanjiang. Salty-warm: Zaojiao. Pungent-hot: Xieshao.