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When the patient lies down to rest at night, first take over a hundred pills, followed by administering Jun Chuan San (Jun Chuan Powder) and other purgatives. Bowel movements should occur around Wugeng time (5:00-7:00 AM). Various pathogens will be expelled with the stool. After a small amount of purgation, administer He Ge Yao (Harmonizing Diaphragm Medicine), ensuring the condition is relieved through unblocking. Some patients may have bowel movements every five days, others every three days. For mild cases, one or two treatments may suffice; for severe cases, five or six treatments are needed for recovery. This demonstrates the subtlety of employing grasping/releasing and rolling/unrolling techniques, requiring flexible application in clinical practice, which cannot be fully explained by words alone. Although the medicines used are potent and urgent, as long as the disease pattern is accurately identified, only experienced physicians capable of bearing heavy responsibilities would dare to apply them. I prepare them personally each time, and their efficacy is as reliable as a tally matching its counterpart. Furthermore, dosage should be adjusted gradually according to the patient's constitution, referencing He Jian's methods. For robust individuals, Dai Ren's (Zhang Congzheng) treatment methods can be applied, yielding miraculous results.

Da Sheng Jun Chuan San (Great Sage Jun Chuan Powder)
Da Huang (Rhubarb Root and Rhizome, 1 liang, roasted) Gan Sui (Kansui Root, half qian) Qian Niu (Pharbitis Seed, 1 liang, first powder) Mu Xiang (Vladimiria Root, 3 qian) Yu Li Ren (Bush Cherry Kernel, 1 liang) Mang Xiao (Mirabilite, 3.5 qian)
Commentary: This is the supreme medicine for purging various accumulations. Dampness belongs to Earth; fire and heat generate damp earth. Thus, in summer heat, all things are moist; in autumn coolness, dampness returns to dryness. Damp diseases do not arise spontaneously but result from fire-heat stagnation preventing the free flow of body fluids, leading to accumulation and generation of water-dampness. Most damp diseases originate from heat, and heat often acts as a concurrent pathogen. The *Nei Jing* states: "Clearly understanding the root and branch, and executing correctly without interruption." When dampness is above, there is yellowing of the eyes and facial edema; when below, swelling and coldness of the thighs and knees; when in the middle, limb fullness, diaphragmatic obstruction, flaccidity, and rebellion. If lingering in Yang channels, it transforms into qi disorders over time; if lingering in Yin channels, it forms physical masses. Laypeople, unaware of the *Nei Jing*'s principle "Attack what remains," cling to drying tonics, worsening stagnation and aggravating the disease. Treatment must target the location of the pathogen, draining excess and tonifying deficiency, expelling evil and nourishing righteousness, aiming for balance. Examining Dai Ren's methods: if Liver Wood overacts on Spleen Earth, Earth fails to control Wood. The deficient Qi seeks relief from its "son" organ. Ji Earth generates Geng Metal; Geng corresponds to the Large Intestine, and pungent flavors belong to Metal. Therefore, large amounts of Sheng Jiang (Fresh Ginger) are added to subdue Liver Wood. However, without opening Spleen Earth blockage, movement is impossible. Thus, Zhou Che Wan (Boat and Cart Pill) is used first to clear obstructions, draining the "non-conquering" element (Liver). Then, Jun Chuan San mixed with ginger juice is administered to forcefully purge, draining the "conquered" element (Spleen). Dai Ren often stated that Dao Shui Wan (Water-Guiding Pill) must be followed by Yu Gong San (Yu Gong Powder), and Zhou Che Wan must be followed by Jun Chuan San. For example, in Cold Hernia attacks causing acute pain in the waist, legs, and hips, purgation is indicated to drain cold-water. Laypeople, ignorant of treatment principles, act rashly, using inappropriate purgatives, leading to debility. They fail to realize that Ba Dou (Croton Seed) drains cold, Gan Sui and Yuan Hua (Genkwa Flower) drain dampness, while Da Huang and Mang Xiao drain dryness. Medicines should be selected based on channel affinity, combined with dietary therapy, rather than rigidly adhering to a single formula. Thus, Dai Ren said: "Nourishing life and attacking pathogens are fundamentally different." Using tonics to treat disease often yields no effect, which is difficult to explain.

[Danxi]: Six Stagnations (When Qi and Blood are harmonious, no disease arises; once stagnation occurs, various diseases emerge).
Qi Stagnation: Xiang Fu (Cyperus Rhizome), Fu Xiong (Ligusticum Chuanxiong), Cang Zhu (Atractylodes Rhizome)
Damp Stagnation: Cang Zhu, Chuan Xiong, Bai Zhi (Angelica Dahurica)
Phlegm Stagnation: Hai Shi (Floating Lithostes), Xiang Fu, Gua Lou (Trichosanthes Fruit), Nan Xing (Arisaema Cum Bile)
Heat Stagnation: Qing Dai (Indigo Naturalis), Xiang Fu, Cang Zhu, Chuan Xiong, Zhi Zi (Gardenia Fruit)
Blood Stagnation: Tao Ren (Peach Kernel), Hong Hua (Carthamus Flower), Qing Dai, Chuan Xiong, Xiang Fu
Food Stagnation: Cang Zhu, Xiang Fu, Shan Zha (Hawthorn Fruit), Shen Qu (Medicated Leaven), Zhen Sha (Magnetite, stir-fried with vinegar)
In Spring, add Chuan Xiong; in Autumn/Winter, add Zhu Yu (Cornus Fruit); in Summer, add Ku Shen (Sophora Root).
Yue Ju Wan (Resolving Stagnation Pill) resolves various stagnations.
Ingredients: Cang Zhu, Xiang Fu, Chuan Xiong, Shen Qu, Zhi Zi.
For stagnation in the Middle Jiao, use Cang Zhu and Fu Xiong to lift and ascend Qi. If food stagnates above Qi, lifting Qi causes food to descend naturally; apply this principle to others.
Tonifies Yin channel blood, resolves knotting Qi in the Five Zang organs. Use Zhi Zi (Gardenia Fruit) fried until 12 parts are charred black, powdered. Decoct with Jiang Zhi (Ginger Juice) in water and drink. Its efficacy is faster than other formulas.

[World Physicians]: Shun Qi Wan (Regulate Qi Pill) treats Blood Stagnation.
Xiang Fu (8 liang), soaked in child's urine, dried, formed into pills with millet paste.

[Ben Cao]: Bei Mu (Fritillaria Bulb) can dissipate knotting Qi in the chest and heart, with significant merit.

[Bao Ming Ji]: Discussion: In deficiency damage, cold and heat are contracted due to deficiency. Contracting cold damages Yang; Yang deficiency leads to Yin excess, so damage proceeds from top to bottom. Treatment should use Pungent, Sweet, and Bland flavors; if it reaches the Stomach, it is incurable. Contracting heat damages Yin; Yin deficiency leads to Yang excess, so damage proceeds from bottom to top. Treatment should use Sweet, Bitter, Sour, and Salty flavors; if it reaches the Spleen, it is incurable. From top to bottom: First damage affects Lung, causing skin contraction and hair loss; Second damage affects Heart, causing blood vessel deficiency, inability to nourish Zang organs, and amenorrhea in women; Third damage affects Stomach, causing food not transforming into flesh. From bottom to top: First damage affects Kidney, causing bone flaccidity and inability to rise from bed; Second damage affects Liver, causing tendon laxity and inability to grasp; Third damage affects Spleen, causing inability to digest food. Discussion: Damage to Heart/Lung causes complexion deterioration; damage to Kidney/Liver causes physical flaccidity; inability to transform grain indicates Spleen damage. These are all damage diseases, deeply infiltrated, constituting Deficiency Consumption illnesses.

Si Jun Zi Tang (Four Gentlemen Decoction) treats Lung damage with skin contraction and hair loss; tonify Qi. (Formula seen previously)
Ba Wu Tang (Eight Substance Decoction) treats Heart/Lung deficiency damage, skin/hair loss, blood vessel deficiency, delayed menstruation in women; tonify Qi and harmonize Blood. (Formula seen previously)
Shi Quan San (Ten Complete Powder) treats Heart/Lung damage extending to Stomach, food not transforming into flesh; tonify Qi, harmonize Blood, and regulate diet. (Formula seen previously)
Jin Gang Wan (Diamond Pill) treats Kidney damage, bone flaccidity, inability to rise; tonify Essence and tonify Kidney.
Bi Xie (Dioscorea Hypoglauca Rhizome), Du Zhong (Eucommia Bark, stir-fried), Rou Cong Rong (Cistanche Stem, wine-soaked), Tu Si Zi (Cuscuta Seed, wine-soaked, equal parts).
Grind into fine powder, decoct pig kidneys in wine to form pills, size of paulownia seeds. Take 50-70 pills per dose, with wine on an empty stomach.

Niu Xi Wan (Achyranthes Pill) treats Kidney/Liver damage, bone flaccidity, inability to rise, tendon laxity; tonify Essence and soothe the Middle.
Niu Xi (Achyranthes Root, wine-soaked), Bi Xie, Du Zhong (stir-fried), Rou Cong Rong (wine-soaked), Fang Feng (Saposhnikovia Root), Tu Si Zi (wine-soaked), Bai Ji Li (Tribulus Fruit, equal parts), Gui Zhi (Cinnamon Twig, 1 fen).
Grind into fine powder, decoct pig kidneys in wine to form pills, size of paulownia seeds. Take 50-70 pills with wine on an empty stomach.

Wei Shen Wan (Roasted Kidney Pill) treats Kidney/Liver damage affecting Spleen, undigested food; tonify Essence, soothe Middle, and aid digestion.
Niu Xi, Bi Xie, Du Zhong, Rou Cong Rong, Tu Si Zi, Bai Ji Li, Hu Lu Ba (Trigonella Foenum-graecum Seed), Po Gu Zhi (Cibotium Rhizome, equal parts), Gui Zhi (0.5 liang).
Prepare pills following the method for Jin Gang Wan. Miraculous for treating back pain preventing rising.
The above formulas for Yin/Yang deficiency damage are designed for deficiency without heat. If deficiency involves heat, treat as Deficiency Heat. Deficiency Heat has two approaches: treat new-onset deficiency heat under "Contrary Treatment"; treat chronic deficiency heat (consumption) under "Bone Steaming".

[Su Wen]: When Luo Qi is insufficient and Jing Qi is excessive, Cun Kou pulse is hot while Chi pulse is cold. This is adverse in Autumn/Winter, favorable in Spring/Summer. Treat the primary disease. When Jing Qi is full and Luo Qi is deficient, puncture Yin channels and moxa Yang channels. If Jing Qi is deficient and Luo Qi is full, Chi pulse is hot and Cun Kou pulse is cold and choppy; fatal in Spring/Summer, survivable in Autumn/Winter. When Luo Qi is full and Jing Qi is deficient, moxa Yin channels and puncture Yang channels. When both Jing and Luo are excess, Cun pulse is rapid/tight and Chi pulse is slow/soft; both require treatment. Thus, Slippery pulse indicates favorable prognosis, Choppy pulse indicates unfavorable. (*Tong Ping Xu Shi Lun*)

[Su Wen]: The constant numbers of the human body: Tai Yang channel often has much Blood and little Qi; Shao Yang channel often has much Qi and little Blood; Yang Ming channel often has much Qi and much Blood; Shao Yin channel often has much Qi and little Blood; Jue Yin channel often has much Blood and little Qi; Tai Yin channel often has little Blood and much Qi. These are heavenly constants. (*Xue Qi Xing Zhi Lun*)

[Xu Xueshi]: Floating pulse with force indicates Exterior Excess. Floating pulse without force indicates Exterior Deficiency. Deep pulse with force indicates Interior Excess. Deep pulse without force indicates Interior Deficiency.

[Yun Qizi]: Floating pulse with 6 rapid/7 extreme beats indicates Exterior Excess. Floating pulse with 3 slow/2 failing beats indicates Exterior Deficiency. Mid-pulse with 6 rapid/7 extreme beats indicates Middle Jiao Heat Excess. Mid-pulse with 3 slow/2 failing beats indicates Middle Jiao Deficiency. Deep pulse with 6 rapid/7 extreme beats indicates Lower Jiao Real Heat. Deep pulse with 3 slow/2 failing beats indicates Lower Jiao Deficiency.

[Su Wen]: Emperor asked: How are diseases internal and external? Qibo answered: Methods for regulating Qi must distinguish Yin and Yang, determine internal and external, keeping each in its place. Internal diseases treated internally, external diseases treated externally. Mild cases regulated, next level balanced, severe cases drained. Use sweating or purging methods. Cold, Heat, Warm, Cool therapies reduce according to their nature. Follow benefits carefully, adhere to the Way, and success is assured. Qi and Blood become balanced, granting longevity. (*Zhi Zhen Yao Da Lun*). Emperor asked again: How are diseases internal and external? Qibo answered: Diseases originating internally manifest externally should be treated internally; diseases originating externally manifest internally should be treated externally. If internal disease manifests severely externally, treat internal first, then external. If external disease manifests severely internally, treat external first, then internal. If internal and external are unrelated, treat the primary disease.

[Li Dongyuan]: Exterior Deficiency uses Gui Zhi (Cinnamon Twig) and Huang Qi (Astragalus Root); Exterior Excess uses Ma Huang (Ephedra Herb) and Ge Gen (Kudzu Root); Interior Deficiency uses Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome); Interior Excess uses Zhi Shi (Immature Bitter Orange) and Da Huang (Rhubarb Root). (Spontaneous sweating, floating pulse without force = Exterior Deficiency; No sweating, floating pulse with force = Exterior Excess; Spontaneous diarrhea, deep pulse without force = Interior Deficiency; Constipation, deep pulse with force = Interior Excess)

[Zhang Yuansu/Hai Zang): Excess: Ma Huang Tang (Ephedra Decoction), Excess: Tiao Wei Cheng Qi Tang (Regulate Stomach and Direct to Sorrow Decoction), Excess: Da Cheng Qi Tang (Great Direct to Sorrow Decoction), Floating/Middle Deficiency: Gui Zhi Tang (Cinnamon Twig Decoction); Deficiency: Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), Deficiency: Si Ni Tang (Four Reversal Decoction). If Floating pulse allows purging, there are no Six Channel manifestations externally; if Deep pulse allows sweating, there are no urinary/fecal obstructions internally.

[Yun Qizi]: Ma Huang is draining; it drains Exterior Excess but cannot drain Interior Excess. Gui Zhi is tonifying; it tonifies Exterior Deficiency but cannot tonify Interior Deficiency. Jiang (Ginger) and Fu Zi (Aconite Root) are tonifying; they cannot tonify Exterior Deficiency but can tonify Interior Deficiency. Cheng Qi formulas are draining; they drain Interior Excess but cannot drain Exterior Excess. Jian Zhong is tonifying; it tonifies Middle Jiao Deficiency but cannot tonify Upper/Lower Jiao Deficiency. Tiao Wei is draining; it drains Middle Jiao Excess but cannot drain Upper/Lower Jiao Excess.

[Ben Shi Fang): A patient had Shang Han (Cold Damage) with fever and headache. I diagnosed: Pathogen in Exterior, this is Exterior Excess, should sweat, prescribe Ma Huang Tang. Questioned: Shang Han is generally due to deficiency, allowing pathogen entry. Now pathogen is in Exterior, why call it Exterior Excess? Answer: Ancients say where pathogen gathers, Qi is deficient; if it stays, the disease becomes excess. Pathogen enters due to initial deficiency, but once centered, it becomes excess. Treating Shang Han requires clarifying Exterior/Interior and Excess/Deficiency. Understanding these four characters allows mastering Zhang Zhongjing's 397 methods. There is Exterior Excess, Exterior Deficiency, Interior Excess, Interior Deficiency, Both Exterior/Interior Excess, Both Exterior/Interior Deficiency. I discussed this in the Song of Exterior/Interior Excess/Deficiency. Zhang's Ma Huang Tang is for Exterior Excess; Gui Zhi Tang is for Exterior Deficiency; Cheng Qi formulas are for Interior Excess; Si Ni Tang is for Interior Deficiency. Both Exterior/Interior Excess is Yang Excess/Yin Deficiency, cured by purging. Both Exterior/Interior Deficiency is Yang Deficiency/Yin Excess, cured by sweating. Reading Hua Tuo's biography, officials Ni Xun and Li Yan both had headache and fever. Hua Tuo said: Ni Xun has Exterior Excess, purge him; Li Yan has Interior Excess, sweat him. Criticized for difference, Hua Tuo explained: Ni Xun is Exterior Excess, Li Yan is Interior Excess, hence different treatments.
Ma Huang Tang, Gui Zhi Tang, Cheng Qi Tang (see Shang Han section), Si Ni Tang (see Shang Han section).
Zhang Zhongjing's methods for treating Exterior/Interior Excess/Deficiency are the standard for eternity.

[Li Dongyuan]: Early June, Wushen year, Vice Director Bai Wenju, age 62, had chronic Spleen/Stomach deficiency damage, recurrent eye disease, jaundice of body/face/eyes, yellow or white urine, irregular bowels, reduced appetite, shortness of breath, lethargy, desire to sleep, limbs unable to move. Mid-June, eye disease recurred. Doctor used Xie Gan San (Drain Liver Powder) several times, worsening previous symptoms. I said: Da Huang and Qian Niu remove damp-heat but do not enter channels. Swallowed, they enter Stomach first. Da Huang's bitter-cold heavily damages Stomach Qi; Qian Niu's pungency drains Lung Qi, heavily damaging Lung Root, causing severe cough. Since Branch Excess was not removed, Root Deficiency worsened. Plus, during summer rains, those with prior jaundice exacerbate. Treatment should tonify Spleen/Stomach/Lung Roots and drain External Channel Damp-Heat. Prescribed Qing Shen Yi Qi Tang (Clear Spirit and Boost Qi Decoction), resulting in cure.
Fang Feng (Saposhnikovia Root, 3 fen), Sheng Jiang (Fresh Ginger, 5 fen), Cang Zhu (Atractylodes Rhizome, 3 fen), Fu Ling (Poria, 3 fen), Ze Xie (Alisma Rhizome, 3 fen), Sheng Ma (Cimicifuga Rhizome, 2 fen).
This drug travels through channels, removes damp-heat without staying, thus not draining Root organs, but tonifying Lung and Spleen/Stomach Qi deficiency.
Chen Pi (Tangerine Peel, 2 fen), Qing Pi (Green Tangerine Peel, 1 fen), Ren Shen (Ginseng Root, 3 fen), Sheng Gan Cao (Raw Licorice Root), Bai Zhu (Atractylodes Rhizome), Bai Shao Yao (White Peony Root, 2 fen each).
This drug stays in Root without traveling channels. Not traveling channels avoids nourishing pathogens in meridians; staying tonifies Yuan Qi of Five Zang organs.
Wu Wei Zi (Schisandra Berry, 3 fen), Mai Men Dong (Ophiopogon Tuber, 2 fen), Ren Shen (Ginseng Root, 3 fen), Huang Bo (Phellodendron Bark, 1 fen).
This drug removes seasonal deficiency heat and damp steaming.
Cut like hemp beans. One dose, 2 cups water, decoct to 1 cup, strain. Drink slightly warm on empty stomach.
When Fire is blazing and Metal is subdued, Water is exhausted. Rescue urgently with Sheng Mai San (Generate Pulse Powder). Remove damp-heat to counteract extremity. Lung desires astringency, Heart suffers from laxity; use Sour flavor to astringe. Heart Fire excess, use Sweet flavor to drain. Thus, use Ren Shen's Sweetness assisted by Wu Wei Zi's Sourness. Sun Simiao said: Taking Wu Wei Zi in summer tonifies Five Zang Qi. Mai Men Dong is slightly bitter-cold, nourishes Water source at Metal position, clears Lung Qi, stops cough from Fire punishing Metal, and consolidates phlegm. Add slight Huang Bo bitterness-cold to guard position, nourish Water flow, settle floating Qi, and eliminate leg flaccidity.
Using Dongyuan's method as an example, others can be extended by analogy.

[Zhongjing]: When disease requires urgent rescue of Interior or Exterior, how to decide? Master said: If doctor purged incorrectly, leading to continuous diarrhea with undigested food and body pain, urgently rescue Interior. Later, if body pain persists but bowels normalize, urgently rescue Exterior. Rescue Interior with Si Ni Tang; Rescue Exterior with Gui Zhi Tang.

[Luo]: Southern Campaign Commander Bu Lin Ji Dai had borborygmus and spontaneous diarrhea, throat swelling/pain. Treated throat obstruction first, then dysentery, resulting in cure. (Formula see "Exterior Heat Interior Cold")

[Ben Shi Fang): Yao Sengyuan of Later Zhou was a famous physician. Emperor had fever, wanted to take Da Huang. Sengyuan said: Da Huang is a harsh drug; Your Majesty is old, do not use lightly. Emperor refused, took it, and died. When Yuan Emperor fell ill, doctors said he is noble, should not take Da Huang lightly, use mild drugs. Sengyuan said: Pulse is洪 (Surging) and Shi (Excess), must have retained food. Without Da Huang, no cure. Yuan Emperor agreed, passed retained food, and recovered. Whether to use or not must be judged clearly in mind.

[Zhang Yuansu/Zhongjing]: Floating pulse -> Sweat; Deep pulse -> Purge. Right Hand Deep Excess: Tiao Wei Cheng Qi Tang. Left Hand Deep Excess: Tao Ren (Peach Kernel), Di Dang (Di Dang Decoction).

[Nan Jing): Deep pulse -> Sweat; Floating pulse -> Purge. Right Hand Floating Excess: Zhi Shi, Qian Niu. Left Hand Floating Excess: Tao Ren, Si Shun (Si Shun San).
Right Hand: Miscellaneous diseases consider this Exterior; Shang Han considers this Interior.
Left Hand: Miscellaneous diseases consider this Interior; Shang Han considers this Exterior.