Library

[Zhang Zhongjing] When treating diseases located in the Zang organs that require purgation, one should attack according to where the pathogen has gathered. For example, for patients with thirst, use Zhu Ling Tang (Polyporus Decoction); other cases should follow this principle.

[Li Dongyuan] Headache requires the use of Chuanxiong Rhizoma (Chuanxiong). If ineffective, add meridian-guiding herbs according to the affected channel: Taiyang channel uses Chuanxiong Rhizoma (Chuanxiong), Yangming channel uses Angelicae Dahuricae Radix (Baizhi), Taiyin channel uses Atractylodis Rhizoma (Cangzhu), Shaoyin channel uses Asari Radix et Rhizoma (Xixin), Shaoyang channel uses Bupleuri Radix (Chaihu), Jueyin channel uses Evodiae Fructus (Wuzhuyu). Pain at the vertex requires the use of Ligustici Rhizoma et Radix (Gaoben) and removal of Chuanxiong Rhizoma (Chuanxiong) (another version reads "neck, nape, and brain pain"). Limb and joint pain require the use of Notopterygii Rhizoma et Radix (Qianghuo). To dispel wind-dampness, Qianghuo is also appropriate. Abdominal pain requires the use of Paeoniae Radix Alba (Shaoyao); if accompanied by aversion to cold, add Cinnamomi Ramulus (Guizhi); if accompanied by aversion to heat, add Phellodendri Cortex (Huangbai); epigastric fullness and stuffiness require Zizyphi Fructus (Zhishi) and Coptidis Rhizoma (Huanglian); fever in the muscles and phlegm resolution require Scutellariae Radix (Huangqin); muscle fever also uses Huangqin; abdominal distension requires Zingiberis Rhizoma Recens processed with ginger (Jiang Zhi Houpo); deficiency heat requires Huangqin, and stopping deficiency sweating also uses Huangqin; hypochondriac pain, alternating chills and fever, afternoon tidal fever require Bupleuri Radix (Chaihu). Spleen and stomach dampness causing heaviness, fatigue, and desire to lie down, phlegm resolution uses Atractylodis Macrocephalae Rhizoma (Baizhu); breaking stagnant Qi uses Aurantii Fructus (Zhiqiao), used for upper parts. Zhiqiao damages the highest Qi in the chest; two or three doses are sufficient. Breaking stagnant blood uses Persicae Semen (Taoren) and Callicophyllum Multiflorum Stem (Sumu); insufficient blood tonification requires Glycyrrhizae Radix et Rhizoma (Gancao); phlegm resolution requires Pinelliae Rhizoma (Banxia); hot phlegm adds Huangqin; wind-phlegm adds Arisaematis Rhizoma (Nanxing); cold-phlegm obstruction in the chest requires Citri Reticulatae Pericarpium (Chenpi) and Baizhu. Excessive use of bitter-cold herbs drains Spleen and Stomach Qi. Narrowness in the abdomen requires Cangzhu; regulating Qi requires Aucklandiae Radix (Muxiang); tonifying Qi requires Ginseng Radix et Rhizoma (Renshen); harmonizing blood requires Angelicae Sinensis Radix (Danggui). Any disease affecting the Blood level should use Danggui. Removing lower jiao damp-swelling and pain, and bladder fire pathogens, requires alcohol-washed Stephaniae Tetrandrae Radix (Fangji), Gentianae Macrophyllae Radix (Caolongdan), Huangbai, and Anemarrhenae Rhizoma (Zhimu); removing upper jiao dampness and heat requires Huangqin, as it clears Lung Fire. Removing middle jiao damp-heat and pain uses Huanglian, as it clears Heart Fire. Removing stagnant Qi uses Citri Reticulatae Pericarpium Viride (Qingpi); do not take excessively, as it drains true Qi. Thirst uses Puerariae Radix (Gegen) and Polyporus (Fuling); Banxia is contraindicated. Cough uses Schisandrae Fructus (Wuweizi); wheezing uses Ecliptae Herba (Ejiao - *Note: Text says Ejiao, usually Donkey-hide gelatin, but context might imply other herbs, sticking to text*) ; retained food not digesting uses Huanglian and Zhishi; vexatious heat in the chest requires Gardeniae Fructus (Zhizi); watery diarrhea requires Baizhu, Fuling, and Shaoyao; stabbing pain due to Qi uses Zhishi, guided by meridian herbs according to the location. Stabbing pain due to Blood uses Danggui, using root or tip depending on upper/lower location. Unbearable sore pain uses bitter-cold herbs like Huangbai and Huangqin, using root/tip and guiding herbs. Unbearable eye pain uses Huanglian and Danggui root, soaked and decocted in wine; yellow urine uses Huangbai; frequent and difficult urination may add Alismatis Rhizoma (Zexie). Solid abdominal pain with heat uses Rhei Radix et Rhizoma (Dahuang) and Mang Xiao. Lower abdominal pain uses Qingpi; penile pain uses raw Gancao tip. Injury from excessive drinking uses Baizhu, Fuling, and Zhu Ling. Epigastric pain uses Kaempferiae Semen (Caodoukou). When using purely cold or purely hot drugs, Gancao must be used to moderate their force. In mixed cold-heat conditions, Gancao is also used to harmonize properties. However, Gancao is contrainddicated in fullness; the Classic states: "Do not eat sweet foods when there is fullness."

[Zhang Jiegu] Without Baizhu, dampness cannot be removed; without Zhishi, fullness cannot be eliminated; without Tianxiong, deficiency of Upper Jiao Yang cannot be tonified; without Fuzi, deficiency of Lower Jiao Yin cannot be tonified.

[Li Dongyuan] If the pulse is slow, lethargic, drowsy, limbs unreceptive, or stool is loose, this indicates excess dampness; treat with Ping Wei San. If the pulse is wiry, Qi is weak, spontaneous sweating occurs, limbs feel hot, or stool is loose, or skin/hair is dry and hair falls out, treat with Huangqi Jianzhong Tang. If the pulse is deficient and Blood is weak, select one or two herbs from Si Wu Tang and add them to the formula based on prominent symptoms. If True Qi is weak, with shortness of breath and weak pulse, treat with Si Jun Zi Tang. If thirsty or urinary difficulty with varying degrees of red/yellow urine, treat with Wu Ling San removing Guizhi, selecting one or two herbs to add. For example, in exterior deficiency with spontaneous sweating, add Huangqi in spring/summer; add Guizhi in autumn/winter. If abdominal cramping or wiry pulse, add Fangfeng; if severe, add Gancao. Also add for abdominal narrowness or shortness of breath. Do not add if abdominal fullness with non-moving Qi. Even if Qi does not move, if Middle Jiao Qi is disharmonious, do not remove it; just add Houpo to break stagnation, but not excessively (add 1 fen to 5 fen Gancao). Feeling of oppression in the abdomen is not distension, but scattering without gathering; add Shaoyao. If Lung Qi is short or insufficient, add Renshen and Bai Shao; using Bai Shao in Middle Jiao raises Spleen Yang, preventing Liver/Gallbladder pathogens from invading. Remove Shaoyao and all sour/astringent herbs if abdominal narrowness or cramping exists. Add Gancao and Shaoyao for abdominal pain. Sweetness belongs to Earth (Ji); Sourness belongs to Wood (Jia). Jia-Ji transforms into Earth; this is Zhang Zhongjing's subtle method. Add Huangqin for abdominal pain with fever; add Guizhi for aversion to cold or feeling cold in abdomen; add Cangzhu for lethargy/dampness, Spleen/Stomach deficiency anorexia, heaviness, or diarrhea; add Baizhu for spontaneous sweating; add Fuling for difficult urination, also for thirst; add Baifuling and Renshen for weak Qi; add Chifuling and Shasaren for strong Qi; add slight Huanglian for Qi stagnation with heat, also for vexation. Add Zhu Ling and Zexie for low urine volume; do not add if sweating caused fluid exhaustion above, as fluids return to Stomach. For no-thirst constipation, add fried Huangbai and Zhimu; for astringent urination, add fried Talcum (Huashi); for dribbling urination, add Zexiw. Wu Ling San treats thirst with difficult urination without aversion to cold; do not use Guizhi. No-thirst with free urination, hallucinations, indicates Blood stasis; use fried Huangbai and Zhimu to clear Kidney dryness-heat. For orifice obstruction with dribbling, add Zexie and Huashi; for orifice obstruction alone, Liu Yi San with Tong Cao is also acceptable. Heart Heat uses Qian Shi Dao Chi San; fullness or abdominal distension adds Houpo; Qi disharmony adds Chenpi. Qi stagnation adds Qingpi (1 part) and Chenpi (3 parts); shortness of breath with free urination removes Fuling from Si Jun Zi Tang and adds Huangqi. If abdominal Qi does not move, add half amount of Gancao. Stabbing pain in abdomen or body, or tenesmus, or feeling unrelieved internally, or straining without stool, all indicate Blood deficiency. Blood deficiency causes tenesmus; add Danggui Shen for Blood/Qi weakness with eye pain. Headache adds Chuanxiong; severe headache adds Xixin (Shaoyin headache); hair loss and umbilical pain add Shu Dihuang. If skin/muscles do not stretch, no high fever, anorexia, and thirst, add Gegen (0.5 liang). Dry-heat and Stomach Qi rushing up via Chong Mai, or rebellious Qi with tenesmus, add fried Huangbai and Zhimu; feeling chest heat without thirst adds fried Huangqin. Chest stagnation with heat adds these as needed. Low food intake with low urine indicates fluid insufficiency; do not promote urination, tonify Qi and Stomach will restore itself. Weak/short Qi adds Renshen. Yang-raising agents aiding Yang excess add more Renshen. Aversion to heat, fever, dry thirst,洪大 pulse: Bai Hu Tang governs. Wheezing adds Renshen. Unceasing thirst: Hanshui Shi and Shigao equal parts, small amounts; this is Qian Shi Gan Lu San, governing high fever and frequent urination, or drinking above and urinating below (dry-heat). Qi dryness adds Bai Kuihua; Blood dryness adds Chi Kuihua. If urination increases pathology, indicating internal dryness and fluid instability, add fried Huangbai and Chi Kuihua. Epigastric stuffiness: add Huanglian (1 part), Huangqin (3 parts), reduce sweet herbs; soft epigastric fullness with anorexia cured by Gancao Xiexin Tang (9 types of Pi, 5 formulas, see Zhang Zhongjing). Wheezing/fullness adds Zhi Houpo (add if difficult urination, contraindicated if loose stool). Stomach deficiency with Pi adds Gancao; wheezing with difficult urination adds Ku Tingli. Short/weak Qi with mild fullness: keep Renshen, remove Gancao, add Houpo; better to use bitter-draining without moving bowels. Mild fullness with non-moving Qi adds it. Fullness: remove Gancao, double Huanglian, add Huangbai, plus small amount of San Wei Wu Ling San. This disease benefits from raising/sweating. Fluid loss causing Yang collapse adds Huangqi; limb restlessness/muscle fever resolves with Chaihu, Qianghuo, Shengma, Gegen, Gancao. Clear nasal discharge, aversion to wind, or neck/back stiffness: Qianghuo, Fangfeng, Gancao equal parts, double Huangqi, taken before sleep.

Pulse-heat and body-heat modification methods are in the Fever chapter.

The "Forbidden Treatment Chapter" states: Restricting a prescription is like tying a bag; if full and untied, it leaks. If a prescription is made but not restricted, Spirit and Qi will not accompany it. One who restricts before fullness can be a doctor, but not a teacher for the world. This is why Sages retreat from excess and advance toward insufficiency, aiming for balance. Generally, flavors have toxicity or non-toxicity, which should be regulated. Thus, highly toxic drugs treat disease until 60% resolved; commonly toxic until 70%; slightly toxic until 80%; non-toxic until 90%. Remaining health is restored by grain, meat, vegetables, and fruits. Do not overdo it to damage Righteous Qi. Regarding prescriptions: Monarch 1, Minister 2 is Odd (Qi) system. Monarch 2, Minister 4 is Even (Ou) system. Near and Odd/Even, make dosage small. Far and Odd/Even, make dosage large. Large means few ingredients, small means many (up to 9, minimum 2). Tonifying/curing Upper Jiao uses slow preparation; tonifying/curing Lower Jiao uses rapid preparation. Rapid means strong flavor/aroma; slow means weak. Lower Jiao does not use Even systems exclusively; exterior release does not use Odd exclusively. Follow the pathogen's location (high/low, shallow/deep, heavy/light, empty/full), acting like an echo, ensuring success; this is called the Middle Path, worthy of being a teacher. If syndrome is large but decoction is small, pathogen only partially retreats, drug power is exhausted, and treatment stops? Like one cup of water saving a cart of firewood; fire remains unextinguished. This is insufficiency; cannot be a teacher, only a doctor. If syndrome is small but decoction is large, pathogen submits, but drug power remains after pathogen is gone, risking damage to Righteous Qi? Like fire burning Kun Gang, jade and stone burn together; unstoppable. This is excess; cannot be a doctor, only a crude physician. Among these three, only the Middle is correct. Excess and insufficiency are both deviations. However, excess is worse than insufficiency. Why? Insufficiency (indulgence) allows pathogen to overcome Righteous Qi, resulting in labor without benefit, yet still adjustable to balance. Excess (harshness) damages Blood and Qi, leading to emaciation, danger, or death, causing harm rather than benefit; this is why excess is worse. Beware! Examining Zhang Zhongjing's works: Cheng Qi Tang purges interior, stating "stop after bowel movement." Gui Zhi Tang releases exterior, stating "slight sweat is best, do not let it drip like water." Both follow the subtle principles of Xuanyuan and Qibo.

[Zhang Zhongjing] Crushing to hemp-head size is equivalent to "Ju" (chewing). Ju is an ancient method. Ancient times had no iron blades; herbs were chewed fine to hemp-head size, forming coarse powder. Decocting makes the liquid clear; drinking it in the abdomen allows easy ascending and dispersing. This is Ju. Today, people crush with knives to hemp-head size, making Ju easier. If all ground to fine powder, clear and turbid are not separated. The Classic says: Clear Yang emerges in Cou Li (pores); Turbid Yin enters Five Zang. What does this mean? It also says: Clear Yang fills Four Limbs; Turbid Yin returns to Six Fu. Ju-ed herbs' juice easily travels through meridians. For highest diseases, add wine for decoction; for dampness, add Shengjiang; for tonifying Yuan Qi, add Dazao; for dispersing wind-cold, add Congbai; for removing phlegm above diaphragm, add Mi. Fine powder does not follow meridians, only removing accumulation in Stomach and Zang-Fu. Strong aroma/flavor: mix with white water; weak aroma/flavor: decoct and take with dregs. For lower body diseases, pills are large, smooth, and round; for Middle Jiao, smaller; for Upper Jiao, very small. Use thick flour paste for slow dissolution reaching Lower Jiao. Wine or vinegar for gathering/scattering intent. Banxia, Nanxing for dampness: use Shengjiang juice thin paste for easy dissolution. Water-soaked overnight steamed cake pills dissolve easily. Drop-water pills dissolve easily. Refined honey pills for slow dissolution and meridian circulation. Wax pills for difficult dissolution and gradual effect. Generally, Tang (decoction) sweeps away long-standing diseases. San (powder) disperses acute diseases. Wan (pill) is slow, for diseases not quickly removable, taking advantage of gentle treatment. Disease in Xin Shang (upper heart): food then medicine. Disease in Xin Xia (lower heart): medicine then food. Disease in Four Limbs: hungry state in morning. Disease in Marrow: full state at night. Ancient measurements differ from today. One Sheng is now a large white cup. One Cun is six Zhu, i.e., 2.5 Qian. Twenty-four Zhu is one Liang. Three Liang is now one Liang. Two Liang is now 6.5 Qian. Large dosages need only one-third. Dahuang may damage Stomach Qi if too cold; must be baked. Chuanwu, Fuzi must be roasted to control toxicity. Huangbai, Zhimu are Lower Jiao drugs; for chronic weak persons, combine them, soak in wine and dry to avoid cold damaging Stomach Qi. Shu Dihuang washed in wine similarly. Danggui soaked in wine aids dispersion.

[Li Dongyuan] In June of Gengchen year, Xu Bowei, age 54, had weak Middle Qi and contracted Cold Damage for 8-9 days. Physicians saw intense heat and purged with cold drugs. He ate 3-4 pears, injuring Spleen/Stomach, causing cold limbs and occasional fainting. I palpated his pulse: beating then stopping, returning occasionally, a Jie (knotted) pulse. Heart palpitations, continuous belching. Complexion changed to green-yellow, spirit decreased, eyes unwilling to open, tired lying down, aversion to people speaking/laughing. Treated with Zhi Gancao Tang. Cheng Wuji said: Tonification removes weakness; sweetness of Renshen and Dazao tonifies insufficient Qi. Pungency of Guizhi and Shengjiang benefits Righteous Qi. Five Zang atrophy, Ying-Wei drying up, moist agents moisten them; thus sweetness of Huren, Ejiao, Maimendong, Dihuang moistens channels, benefits Blood, restores pulse, opens Heart. Added Renshen and Guizhi to urgently support Righteous Qi; reduced Sheng Dihuang by half to avoid damaging Yang Qi. Decocted one Liang dose, ineffective. I waited again; pulse and symptoms matched. Was the drug old/stale? Bought fresh, strong-aroma drugs, decocted and took; symptoms halved, cured after second dose. All drugs, insects/plants, have origin places; roots/leaves/flowers/fruits have harvest times. Wrong place alters nature/flavor slightly; wrong time loses aroma/flavor completely. New vs old, fine vs coarse vary. If not selected, ineffectiveness is doctor's fault. Neijing says: Prepare goods according to years, essence of aroma/flavor is concentrated. Mixing requires caution.

Patients taking drugs must choose trustworthy, sincere people for decoction. Decoction vessels must be clean, free of grease/fishy smells; use new, pure, sweet water. Measure water, simmer slowly, filter dregs with gauze, take clear juice; invariably effective.