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[Dan] The *Taiping Huimin Heji Jufang* (Formulas of the Bureau for Benefiting the People) states in the section on treating Qi disorders: To treat all types of Qi, including Cold Qi, Stagnant Qi, Rebellious Qi, and Ascending Qi, use Anyixiang Wan (Benzoin Pill), Dingchen Wan (Clove and Agarwood Pill), Da Chenxiang Wan (Large Aquilaria Pill), Suzi Wan (Perilla Seed Pill), Yunqi San (Uniform Qi Powder), Rushen Wan (Miracle Pill), Jixiang Wan (Gathered Fragrance Pill), Bai Chenxiang Wan (White Aquilaria Pill), Weijiang Wan (Roasted Ginger Pill), Yanjian San (Salt-Boiled Powder), Qi Qi San (Seven Qi Powder), Wenbai Wan (Warm White Pill), and Shengjiang Tang (Fresh Ginger Decoction). For treating vomiting and Ge Ye (dysphagia/choking sensation), use Wuge Wan (Five Diaphragm Pills), Wuge Kuanzhong San (Five Diaphragm Middle-Widening Powder), Geqi San (Diaphragm Qi Powder), Jiuzheng Wan (Wine-Stasis Pill), Caodoukou Wan (Cardamomum Rotundum Pill), Zhuangqi Wan (Qi-Striking Pill), and Renshen Dingxiang San (Ginseng and Clove Powder). For treating Tun Suan (acid regurgitation), use Dingxiang Jian Wan (Clove Decoction Pill) and Xia Lizhong Wan (Minor Regulate Middle Pill). For treating Tan Yin (Phlegm-Fluids), use Beishu Wan (Double Atractylodes Pill), Xiaoyin Wan (Eliminate Fluids Pill), Wenzhong Huatan Wan (Warm Middle Transform Phlegm Pill), and Wutao Wan (Five-Ring Pill). Furthermore, under the entries of various formulas, it mentions bitter taste with loss of flavor, acid belching, astringent tongue coating, spitting clear water, chest and abdominal fullness/stuffiness, shortness of breath, acute pain under the ribs, heat in the five centers (palms, soles, and chest), and oral ulcers. These are explicitly stated as Heat syndromes. Why are hot medicines used exclusively?

The Qi that circulates throughout the human body as the master is vital. When Yang goes, Yin comes; when Yin goes, Yang comes. One ascends, one descends, without end. If internally not injured by the Seven Emotions (joy, anger, worry, thought, sadness, fear, fright) and externally not affected by the Six Exogenous Pathogens (wind, cold, summerheat, dampness, dryness, fire), how could Qi cause disease? Now, the so-called Cold Qi, Stagnant Qi, Rebellious Qi, and Ascending Qi are all cases where the Lung is affected by Fire pathogenic factors. Since Qi has the nature of flaming upward, it rises but does not descend, steaming the Clear Orifices. In severe cases, this leads to the Upper Jiao failing to receive, the Middle Jiao failing to transform, and the Lower Jiao failing to seep. Consequently, it transforms into vomiting, spitting, Ge (diaphragmatic obstruction), Ye (choking), Phlegm, Fluids, Fanwei (regurgitation), and Tun Suan (acid regurgitation).

Treating Cold with Heat, and treating Heat with Cold, is the method of Direct Treatment (Zheng Zhi). Treating Heat with Heat, and treating Cold with Cold, is the method of Indirect/Supplementary Treatment (Fan Zuo). Carefully examining the aforementioned formulas, they are neither Direct nor Indirect treatments. This is why I harbor doubts.

According to Liu Wansu's *Yuan Bing Shi* (Original Treatise on Disease Mechanisms): All vomiting and acid regurgitation belong to Heat; all accumulations, fluids, stuffiness, and diaphragmatic fullness belong to Dampness; all rebellious Qi rushing upward, vomiting and gushing, inability to swallow food, belong to Fire; all hard masses, abdominal fullness with acute pain, spitting foul-smelling substances, belong to Cold. This deeply aligns with Zhang Zhongjing's intent.

The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: For Xiong Bi (Chest Bi syndrome) with chest and back pain, Gualou Xiebai Tang (Trichosanthes Rhizome and Macrostemon Stem Decoction) is the primary formula. For Xiong Bi with heart pain radiating to the back and back pain radiating to the heart, Gualou Xiebai Banxia Tang (Trichosanthes Rhizome, Macrostemon Stem, and Pinellia Tuber Decoction) is the primary formula. For Pi Qi (stuffiness qi) below the heart, with Qi knotting in the chest and Qi from the hypochondrium rushing upward striking the heart, Zhishi Xiebai Gualou Guizhi Tang (Aurantium Fructus, Macrostemon Stem, Trichosanthes Rhizome, and Cinnamon Twig Decoction) is the primary formula. For vomiting with Pi (stuffiness) below the heart, Banxia Xiexin Tang (Pinellia Tuber Decoction to Drain the Epigastrium) is the primary formula. For dry heaving with diarrhea, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Root Decoction with Added Pinellia and Fresh Ginger) is the primary formula. For all vomiting where food cannot enter, Xiaobanxia Tang (Minor Pinellia Tuber Decoction) is the primary formula. For vomiting where the pathology is above the diaphragm, Zhuling Tang (Polyporus Decoction) is the primary formula. For Fanwei (regurgitation) with vomiting, Banxia Shenmi Tang (Pinellia Tuber, Ginseng, and Honey Decoction) is the primary formula. For vomiting immediately after eating, Dahuang Gancao Tang (Rhubarb and Licorice Decoction) is the primary formula. For Fanwei vomiting with thirst, Fuling Zexie Tang (Poria and Alisma Decoction) is the primary formula. For wanting to drink after vomiting, Wen Sha Tang (Clam Shell Decoction) is the primary formula. For symptoms resembling vomiting but not quite, resembling hiccup but not quite, with a sense of helplessness in the heart, Jiangzhi Banxia Tang (Ginger Juice and Pinellia Tuber Decoction) is the primary formula. For dry heaving with cold hands and feet, Chenpi Tang (Tangerine Peel Decoction) is the primary formula. For hiccups, Chenpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary formula. For dry heaving with diarrhea, Huangqin Tang (Scutellaria Root Decoction) is the primary formula. For Qi rushing upward, Zaojiao Wan (Ziziphus Spinosus Fruit Pill) is the primary formula. For Shang Qi (ascending Qi) with a floating pulse, Nongpu Mahuang Tang (Magnolia Bark and Ephedra Decoction) is the primary formula. For Shang Qi with a deep pulse, Zexie Tang (Alisma Decoction) is the primary formula. For Fire rebellion causing ascending Qi, Maidong Tang (Ophiopogon Decoction) is the primary formula. For Phlegm-Fluids below the heart with chest and hypochondriac distension/fullness and vertigo, Fuling Guizhu Tang (Poria, Cinnamon Twig, and Atractylodes Macrocephala Decoction) is the primary formula. For shortness of breath with slight Fluid retention, which should be expelled via urination, Fuling Guizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) is indicated; Shenqi Wan (Kidney Qi Pill) is also indicated. For patients with a hidden pulse who desire spontaneous diarrhea, feeling relief after defecation, yet continuing to have hardness/fullness below the heart, this indicates Liuyin (Retained Fluids) attempting to exit; Gansui Banxia Tang (Kansui and Pinellia Tuber Decoction) is the primary formula. For Xuan Yin (Hanging Fluids), Shizao Tang (Ten Jujube Decoction) is the primary formula. For Yi Yin (Overflowing Fluids), sweating is indicated; Da Qinglong Tang (Major Green Dragon Decoction) or Xiao Qinglong Tang (Minor Green Dragon Decoction) is indicated. For Zhi Yin (Supporting Fluids) below the heart causing severe vertigo, Zexie Tang (Alisma Decoction) is the primary formula. For Zhi Yin causing chest fullness, Nongpu Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is the primary formula. For Zhi Yin causing difficulty breathing, Tingli Dazao Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) is the primary formula. Those prone to vomiting should be thirsty; if not, it is due to Zhi Yin in the heart; Xiaobanxia Tang (Minor Pinellia Tuber Decoction) is the primary formula. For sudden vomiting with epigastric stuffiness and vertigo/palpitations due to Water between the diaphragm, Xiaobanxia Jia Fuling Tang (Minor Pinellia Tuber Decoction with Added Poria) is the primary formula. For thin individuals with palpitations below the navel, spitting saliva, and vertigo, this is Water pathology; Wuling San (Five-Ingredient Powder with Poria) is the primary formula. For retained Phlegm and old Water in the heart and chest, after self-vomiting leaves the area empty, Qi-full preventing eating, Xiaotan Qi Ling Nengshi (Eliminate Phlegm Qi to Enable Eating, i.e., Fuling Yin) is used. For thirst followed by vomiting, indicating Water stopping below the heart, belonging to Yin families, Banxia Tang (Pinellia Decoction) with added Fuling is used. Observing the subtle intent: those suitable for release should be sweated; those suitable for purging should be drained; stagnation should be guided; depression should be raised; Heat should be cleared; Cold should be warmed; mixed Cold/Heat should be treated with supplementary methods; Dampness should be leached with bland flavors; Deficiency should be supplemented and nourished. Where did it ever say to uniformly use acrid-aromatic drying-hot agents? Using Fire to save Fire, making excess more excess and deficiency more deficient—who bears the blame?

Some say: The *Mai Jue* (Pulse Secrets) states that Heat generates Wind, Cold generates Qi, and Cold causes contraction. Now Cold Qi rushes up, Qi rebels, Qi stagnates—is it not Cold? You cite Zhang Zhongjing to refute errors, then do all Qi disorders, all Fluid disorders, all vomiting, regurgitation, and acid regurgitation lack Cold syndromes?

I say: Each of the Five Zang organs has its own Fire. When stirred by the Five Desires, Fire arises accordingly. If diseases are caused by Cold, one must physically encounter Cold air or consume Cold foods to become diseased with Cold. This differs from Fire diseases arising from within. Thus, Qi diseases caused by Cold account for less than one or two out of ten.

Some say: It is understandable to discuss Phlegm-Qi, vomiting, acid regurgitation, dysphagia, and regurgitation as Heat/Fire. But if the patient says Cold Qi rushes from below upward, is it not Cold?

I say: Ascending Qi originates from the Liver; it carries Ministerial Fire (Xiang Huo) rising from below. The Heat is extreme, yet the patient feels Cold; this is not true Cold. Extreme Fire resembles Water. Severe accumulated Heat leads to Yang hyperactivity and Yin deficiency, thus presenting these symptoms. "Cold generates Qi" is a fallacy attributed to Gao Yangsheng. If the disease were truly due to Cold, one should use Cold-dispelling agents. Why uniformly use acrid-aromatic drying-hot prescriptions, lacking flexibility, thereby harming people?

Some say: For ascending Qi, drugs like Heixi Dan (Black Tin Pill), Yangzheng Dan (Nourish Righteousness Pill), and Yangqi Dan (Nourish Qi Pill) are used for their heavy, descending properties. Patients recover instantly. Do you think treating such severe Heat diseases with these is erroneous?

I say: Besides Ministerial Fire, there is Jueyang Fire of the Zang-Fu. Movements of the Five Desires each generate Fire. Ministerial Fire is the "One Water unable to overcome Two Fires" mentioned in the classics. This Fire is innate. Jueyang Fire is the "One Water unable to overcome Five Fires," arising from human desires. These two Fires fan each other, causing Qi to rise with the flames, ascending without descending. Who can resist it? Now, using the heavy, descending nature of pills to suppress Qi. Qi stagnation forms Damp-Phlegm; pill properties are hot and drying, temporarily clearing the Phlegm. However, clearing pill toxicity over time excessively aids wild Fire, consuming Yin Blood further, causing Qi to ascend even more. Laypeople prefer warmth, remaining deluded; those suffering this disaster are numerous.

Some say: Pills are heavy; intending to descend but causing ascent, what should be done?

I say: Administer Acrid-Cool agents, move with Acrid-Warm agents to subdue Liver pathogenic factors; treat with Salty-Cold agents, assist with Sweet-Warm agents, astringe with Bitter-Sweet agents, harmonize with Sweet-Bland agents, nourish Yin Blood. Yang will naturally attach, Yin and Yang will harmonize, and there will be no ascending. The methods of ancient sages are close at hand; I need not elaborate.

Some say: Regarding Qi disorders, Fluid disorders, vomiting, acid regurgitation, dysphagia, and regurgitation, I know the *Heji Jufang* misses the mark. But are the formulas from the *Jin Gui Yao Lue* sufficient? Is there anything undeveloped?

I say: The transformation of Heaven and Earth is infinite; diseases of the human body are equally infinite. Zhang Zhongjing's book records the Great Dao. Skilled physicians apply examples and infer categories, finding infinite utility. Even with slight modifications, one cannot exceed the rules. Initially, Qi disorder has subtle signs, perhaps due to minor dietary indiscretion, external exposure to wind/cold/summerheat/dampness, internal emotional injury, overly rich flavors aiding Yang Qi leading to Diaphragm Heat, constitutive robustness with closed pores and no sweat, or irritability causing Yin Fire to flare, obstructing Jin-Ye (body fluids) and mixing Clear and Turbid. Qi becomes diseased, causing Pi (stuffiness), pain, anorexia, belching with rotten odor, acid regurgitation, zaoza (discomfort), or bloating. Seeking no root cause, one assumes Cold and hastily administers acrid-aromatic drying-hot agents. After a few doses, temporary relief is felt, deemed a divine prescription. Yet, continuing rich diets and poor care, the old disease is temporarily suppressed by the harsh agents, allowing Turbid Fluids to accumulate easily. Half a month or a month later, the previous illness returns. This spreads: from Qi to Accumulation (Ji), from Accumulation to Phlegm. This is the origin of Phlegm, Fluids, and acid regurgitation. Without encountering a skilled physician, erroneous medicines are used. Phlegm mixes with turbid blood, forming nest-like pockets (ker nang). Thus, Pi, pain, vomiting, dysphagia, and regurgitation arise sequentially. Food and liquids stagnate, channels become obstructed, bowels become constipated or loose, lower transmission fails, Middle Jiao stagnates further. Physicians fail to observe, insisting on Cold, recalling the quick relief of previous medicines, blaming the drugs for not being hot enough. Waiting for long-term use to warm the Spleen and strengthen the Stomach, hoping for a sudden cure. They forget: The Stomach is the Sea of Water and Grain, abundant in Blood and Qi; only with clear and harmonious Qi can it receive. The Spleen is the Palace of Digestion; only with clear and harmonious Qi can it transport. Now receiving aromatic-hot drugs, excessively agitating Blood and Qi. Initially, Stomach fluids coagulate, unable to receive; eventually, Spleen Qi dissipates, transportation slows. Those with Stomach Heat, easy hunger, and urgency to eat, but with damaged Spleen failing to grind, accumulating pain, are told by physicians to have Deficiency and accumulated Cold, untreatable by ordinary herbs. They recklessly use Aconite (Wutou) and Prepared Aconite Root (Fuzi) to aid pills, focusing on ingestion. Over time, Blood is exhausted, the stomach wall becomes dry and shriveled. If shriveling is upper, near the throat, liquids pass but solids struggle to enter, entering little if at all—this is called Ye (dysphagia). If shriveling is lower, near the stomach, food enters but cannot fully reach the stomach, regurgitating after a long while—this is called Ge (diaphragmatic obstruction) or Fanwei (regurgitation). Constipation occurs, urine resembles sheep dung. Though names differ, the pathology stems from one source. The *Jin Gui Yao Lue* discusses six types of Yin: Tan Yin, Xuan Yin, Yi Yin, Zhi Yin, Liuyin, Fuyin. Differentiating Five Zang syndromes, the treatment methods are perfect. It is only regrettable that physicians fail to treat properly and patients ignore taboos, causing medicine to aid pathogens, deepening the disease, moving further from life, which is deeply pitiable.

Some say: *Qianjin Fang* (Prescriptions Worth a Thousand Gold) uses Ginger and Cinnamon for dysphagia and regurgitation. Why do you speak so much?

I say: Stagnant Qi lingering in the Clear Orifices requires aromatic-hot agents to move. However, these formulas always include Rhubarb, Gypsum, Bamboo Shavings, Mirabilite, Alisma, Peucedanum, Mirabilite, Poria, Scutellaria, Reed Rhizome, and Trichosanthes Rhizome as assistants. They start similarly but end differently. Pathogens are easily subdued, thus easily resolved.

Some say: Can ancient formulas really treat a dry, shriveled stomach wall? Are there quicker methods to supplement predecessors?

I say: Ancient formulas use Ginseng to tonify Lung, Poppy Capsule (Yu Mi) to detoxify, Bamboo Sap to clear Phlegm, Dried Ginger to nourish Blood, Millet to solidify Stomach, Honey Water to moisten dryness, and Ginger to remove filth. This is precisely the intent. Zhang Jifeng also said: Dysphagia is a disorder of the Spirit/Mind; only introspection and self-nurturing can treat it. This deeply hits the pathology, and the method is reasonable. Dysphagia is primarily due to Blood Dryness. Blood is Yin Qi; Yin prefers stillness. Internal and external stillness prevents Zang-Fu Fire from arising. Metal and Water Qi are nourished, Yin Blood generates naturally, and intestinal fluids transform appropriately. How could there be dysphagia?