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(Ascending) excessive, (descending) excessive then use Baihu Jia Xuanshen Xingren Tang. If it is stomach disease, it has been discussed in detail previously; warm diseases occurring in women before and after childbirth should be discussed separately. Zhu Danxi said: After childbirth, one should greatly tonify qi and blood; even if there are diseases, they should be treated from a secondary perspective. All diseases are mostly due to blood deficiency, and diaphoresis (releasing the exterior through sweating) should not be used. This originates from Zhang Zhongjing's rule of "forbidden sweating when blood is lost." Zhang Jingyue said: Exterior pathogens in postpartum cases should be resolved, fire pathogens should be cleared, and internal stagnation should be eliminated. This originates from Zhang Zhongjing's methods such as Xiaochaihu Tang and Chengqi Tang. The views of these two scholars should not be neglected. However, there is a wonderful method for postpartum cases. What is this wonderful method? It is "hand waving and eyes following" (a metaphor for precise and decisive treatment guided by deep understanding). What is treated under the hand is excess syndrome, but the mind must constantly focus on the fact that it is postpartum. Accurately identifying the symptoms and targeting the disease precisely allows for a single strike to cure. If the disease comes from the Upper Jiao, treating the Upper Jiao without affecting the Middle Jiao requires that the medication potency should not be light; one must adopt the method of preparing ample doses but administering small amounts frequently. Once the exterior pathogen is resolved, restore the deficiency. It is said that an army without provisions values speed in battle; if one fears postpartum weakness and uses medication too lightly, delaying for three or four days may result in the body being unable to tolerate the medication. If abdominal pain refuses pressure, resolve blood stasis; if it prefers pressure, nourish collaterals. It is fast like a turning pill. For diseases caused by the Six Qi, except for Cold Damage which follows Zhang Zhongjing, rescue should be conducted through the Three Jiao in the warm disease section, weighing severity and using urgently. This is what is meant by "having unique insights." Considering the difficulty of heat diseases after childbirth, there are further reasons. Because warming meridians drugs can often tonify deficiency, but tonifying deficiency substances cannot clear heat. Methods such as Fumai Tang and Sanjia Dingfeng can supplement what predecessors lacked, allowing for timely use in heat syndromes with severe yin deficiency after childbirth. As for symptoms similar to Baihu Tang syndrome, Li Dongyuan used Danggui Buxue Tang, which is the exact formula for qi damage due to overwork, and also a wonderful method for postpartum. For all diseases before childbirth, treat according to presenting symptoms: clear if necessary, purge if necessary, never sticking rigidly. Thinking half-way through is sufficient.

(1) Should be read together with the section on tongue coating in Ye Tianshi's *Wen Re Lun*.
(2) The four characters "hand waving and eyes following" are exquisite. Wang Xugao's annotation.

Question: In the *Nei Jing*, it says "all spasms and stiffness belong to dampness," what is the meaning behind this? Can Zhang Zhongjing's formulas for spasms summarize the essentials? Can today's treatment for spasms be applied universally? Where lie the distinctions between spasm (*jing*), epilepsy (*xian*), and syncope (*jue*)? Can the cold, heat, excess, and deficiency of spasm be clearly analyzed? Does spasm also arise from the Six Qi? Folk transmission says pediatric convulsion is clearly spasm, and postpartum convulsion is clearly spasm; can these be explained in detail? This condition is caused by seasonal pathogens, with many variations, requiring careful differentiation.

The *Nei Jing* states: "All spasms and stiffness belong to dampness." This character "dampness" is a transcription error for "wind." The manifestations of spasm are images of the rigidity and inflexibility of Wind-Wood. Dampness descends and is soft; Wood ascends and is rigid. While dampness does not cause spasm, the word "dampness" cannot encompass all spasm formulas. Of the eighteen articles on spasm, except for two from *Su Wen* and *Qian Jin*, the rest are words of Zhang Zhongjing. Two articles discuss pulse: spasm pulse is tight and wiry; spasm pulse is hidden, firm, and straight—all are images of Wind-Wood. The remaining fourteen articles: ten are wind-cold causing spasm; one forbids sweating for wind families; one forbids sweating for sores/fistulas; two forbid sweating for new postpartum blood loss—all are internal causes. Understanding this makes it clear that both external and internal factors can cause spasm. Why could this not be applied to modern treatment? The terms "spasm, epilepsy, syncope" must be distinguished. Spasm refers to stiffness and straightening, what later generations called "opisthotonos," and ancient times called "spasm"; *Chi* (twitching/clonic movements) refers to writhing and contraction, what later generations called "clonic jerking," and ancient times called "*Chi*"; clonic jerking occurs intermittently, recurring after days or months, stopping spontaneously without treatment, is epilepsy; limbs cold as water is syncope; limbs hot as fire is also syncope. Zhang Zhongjing said: "When yin and yang qi do not connect, it is called syncope." *Su Wen* says "Sun Tai arrival causes spasm, Shao Yang arrival causes *chi*." Generally, spasm belongs to Water and *chi* belongs to Fire; one is due to cold, the other to heat, each independent. Broadly, spasm, *chi*, epilepsy, and syncope should all be differentiated by cold, heat, excess, and deficiency. Six淫 (pathogens) causing spasm is excess syndrome; postpartum blood loss, chronic illness causing spasm, mistaken purgation in wind cases, mistaken sweating in warm diseases, sweating in sore cases all lead to deficiency spasm; wind-cold-dampness causing spasm is cold spasm; wind-warmth, wind-heat, wind-summerheat, dryness-fire causing spasm is heat spasm; folk-transmitted slow convulsion is deficiency-cold spasm; yin fluid deficiency leading to primary organ self-disease is deficiency-heat spasm. Later generations named them all spasm, but actually cold is spasm and heat is *chi*. Zhang Zhongjing's discussion of rigid and flexible spasm was for Cold Damage, not discussing *chi* disease, so holding *chi* in the Cold Water category, combined with wind becomes flexible spasm with sweating. It is essentially cold and excess. Except for cold spasm, all are *chi* disease, excess and heat. Treating spasm should use rigid and warm methods; treating *chi* should use soft and cool methods. Spasm combined with *chi* is water extreme resembling fire. *Chi* combined with spasm is fire extreme resembling water. This is the general outline. To subdivide the categories of Six Qi and internal injury, one must first clarify the nine major outlines of spasm and *chi*. What are the nine outlines? One is cold spasm: Zhang Zhongjing's Taiyang disease, body stiffness, yet pulse deep-slow with sweating is flexible spasm, because wind is more than cold, use Guizhi Tang with modifications. No sweating is rigid spasm, belonging to cold, use Gegen Tang, containing Mahuang and Guizhi, but not named after them because the disease has reached Yangming. If cold wind cough causes spasm, use Xingsu San. One is wind-warm spasm, which is *chi* syndrome. When yang qi is venting, during the time of Sovereign Fire ruling, mild cases use acrid-cool light agent Yinqiao San, severe cases use acrid-cool heavy agent Baihu Tang. Damaged fluids add Diguzi (Di Gu Pi / Rehmanniae Radix Preparata - Note: Text says Di Dong, likely typo for Di Gu Pi or similar cooling herb, translating as Di Dong based on text); confusion of spirit use aromatic opening of Pericardium, such as Qinggong Niuhuang Wan or Zixue San; after recovery use Sancai Liuwei to restore fluids; cough use Sangju Yin; this syndrome strictly forbids acrid-warm. One is warm-heat spasm, this disease occurs before Summer Solstice, six-pathogen fire energy consumes true yin causing this syndrome, heavier and more common than previous, treatment method same as above, only depth and weight of medicine depend on depth and weight of disease. One is summerheat spasm, symptoms occur after Summer Solstice, at this time two energies vent, pathogen comes like galloping horse, transmission like lightning. If fever, headache, neck stiffness, no sweating, summerheat combined with wind-cold, use Xiangru Yin. With sweating, use Yinqiao heavily adding Sangye; cough use Sangju; heavy sweating use Baihu; pulse hollow and panting use Renshen Baihu Tang; body heavy little sweating use Cangzhu Baihu Tang; pulse hollow, red sweat, talking much, panting cough, impending collapse use Shengmai; unclear consciousness use Qingying adding Gou Teng, Lingjiao, Mudanpi; confusion use Zixue Niuhuang; mild severity use Qingluo Yin. One is damp spasm, symptoms have cold and heat, cold-damp diarrhea long-term becomes epilepsy, Wuling San or Saren Tang; damp-fire entering Pericardium, Qinggong removing Lianmei adding Chixiaodou, severe cases Zixue, Yinqiao, Mabo, Weijing adding Huashi, Xingren; cold-damp white coating meridian constriction Guizhi, Jiangfu; others see yellow coating limbs *chi* use Huanglian Xiexin Tang also cures. One is dryness spasm, dryness transforms into fire consuming fluids, naturally causing spasm, symptoms slightly similar to wind-warm, exactly autumn cool wind covering syndrome, should use acrid-cool moistening, if latent summerheat then combined with damp, should use bitter-acrid bland drying-transforming cold rib pain vomiting method, use bitter-warm assisted by sweet-acrid. One is internal injury diet spasm, which is folk slow convulsion. Must first be due to vomiting/diarrhea damaging spleen/stomach, some specifically damage spleen yang, some specifically damage stomach yang, some damage kidney yang, Shenling Baizhu, Sijunzi, Liujun, Yigong, Buzhong Yiqi, Lizhong etc. can be selected, severe deficiency-cold Lizhong adding Dingxiang, Rougui, Rouguo, Heleizi, due to other diseases cold-damage cooling also same example. One is guest fright spasm, this is caused by fright. Because children's spirit is timid and qi weak, seeing unusual objects, hearing unusual sounds, or falling empty one in hundred, if saying all caused by fright is wrong. Symptoms fever face cyanosis muttering, limbs writhing, use Fumai removing Renshen, Guizhi, Jiang, Zao, adding Danpi, Danshen, Xijiao, tonifying heart substance matching heart function, constipation add Yuanshen, loose stool add Muli, heavy sweating spirit unrest fear add Longgu, Zheng Hupo, Zhusha, but must get exact situation then use. One is primary organ self-disease spasm, treating this primarily focuses on nourishing yin and softening liver. Above mentioned external spasm is today folk transmitted pediatric convulsion spasm. Above mentioned internal spasm is today folk transmitted postpartum convulsion spasm. Reason children easily spasm: one by skin thin, organs tender small, transformation fastest; one by recent times not understanding Six Qi, seeing exterior immediately giving releasing exterior, after spasm heavily using bitter-cold, even strong men strong women, mistaken sweating causing spasm many.

Cold is spasm and heat is *chi*, one phrase hits the mark. Wang Xugao's annotation.

Question: Wet-warm disease, what is the cause of its formation? Wet-warm presenting symptoms, which syndrome is the outline? Why can it not heal quickly? Why forbid sweating? Why forbid purgation? Why forbid clearing-moistening? Treatment should use which formula as main formula? Upper Jiao variation symptoms which formula?? Middle Jiao disease what symptoms which formula? Its spreading Three Jiao disease also divides qi-blood, treating qi branch which formula? Treating blood branch which formula? Wet-warm combined treatment which formula? Disease reaching Lower Jiao difference with warm-heat disease where? When managing which formula? This disease people now confuse call Dan Malaria long time, must distinguish clearly, hopefully save world error.

Summerheat combines damp and heat. Lean dark black person yin deficiency fire hyperactive, feeling summerheat heat immediately erupts, is Summer-warm. Fat white yellow face person, feeling summerheat damp not immediately erupt, until autumn after erupts, called Wet-warm. People now wrongly say Dan Malaria, actually all Wet-warm. Wet-warm formation, damp heavy heat light heat hiding in damp forming. Presenting symptoms headache, aversion to cold, chest oppression, no hunger, afternoon body heat, appearance like yin deficiency, but must take white tongue not thirsty, fine soggy pulse, pale yellow face as outline. Because aversion to cold, body pain, headache, fever, resembles Cold Damage, pulse soggy distinguishes from Cold Damage. White tongue not thirsty, yellow face, then not summerheat injuring偏向 fire, this Wet-warm exact symptom. Damp closing clear yang path, then chest oppression no hunger. Damp is yin evil, yin evil prospers in yin division, so same as yin deficiency, afternoon fever, damp nature misty sticky, not like cold evil one sweat resolving, warm evil one cooling retreating, its symptoms compared to warm disease trend slowest but actually heavy, so hard to speedily end. World doctors not knowing Wet-warm, seeing aversion to cold, headache, body heat, thinking Cold Damage, then sweating it. Sweating damages heart yang. Damp follows acrid-warm exterior medicine steaming upward reverse, internally confusing clear orifices, then spirit confusion; upper confusing clear orifices, then deafness eye closing. Not speaking wet syndrome reason forbidding sweating, seeing middle full no hunger, thinking stagnation then heavily purging it. Mistaken purgation then damages yin and heavily suppresses spleen yang ascending. Spleen qi turns sinking, damp evil internal soaking, thus hole diarrhea, wet syndrome reason forbidding purgation. Seeing afternoon body heat, thinking yin deficiency then using soft medicine moistening it, damp is glue-stagnant yin evil, again adding soft-moistening yin medicine, two yins combining, same qi seeking, thus having locked knot unresolvable trend, wet syndrome reason forbidding clearing-moistening. Treatment method, should Saren Tang, using Xing, Kou, Hou, Ban etc. first open Upper Jiao lung qi. Lung rules whole body qi, qi transforming then damp also transforming. Using Huashi, Tongcao equal parts benefiting Lower Jiao, this treating damp correct formula. Damp qi permeating, originally formless quality, most forbids using heavy turbid greasy medicine treating it, the more treating the worse. Those with heat sensing lung-stomach Ying branch, throat obstruction diaphragm pain, Yinqiao, Mabo, Niubang, Shegan. Damp stagnant Qi branch, for hiccups Xuanbi method, using Shegan, Pipaye, Yujin, Xiangchi. Panting, Weijing adding Xingren, Huashi, this all Upper Jiao variation symptoms treatment methods. Middle Jiao disease slightly same as summer disease, no eating, no hunger, no bowel movement, due to turbid phlegm condensing orifices becoming痞, should Ban, Zhi opening Qi branch damp knot, Qin, Lian opening Qi branch heat knot, Xingren opening lung-large intestine bi. If spreading Three Jiao, tongue slippery slight yellow, pathogen in Qi branch, still using Hand Taiyin one channel as key point. Because lung and large intestine one family, qi transforming then summer-damp all transforming, lung can regulate water passages, descending to bladder. Lung bi opening then bladder also opening. Treating lung while stomach and bladder all in treatment middle, this Sanshi Tang, slightly bitter acrid cold, using Huashi, Hanshui Shi, Shigao, Xing, Cao promoting Qi branch use, using Zhuru connecting collaterals, Jinzhi Yinhua defeating summer heat toxin and combining aromatic treatment. If pathogen staying long, tongue crimson little coating, heat gathering blood branch, using bitter-acrid-cold method, Qinggong Tang adding Zhimu, Yinhua, Zhuli, to treat blood branch, this summer disease extending Three Jiao qi-blood branch treatment method. Wet-warm transforming fire, also should follow this using. If latent summerheat white tongue, chest痞, spontaneous diarrhea, vomiting nausea, damp presenting symptoms, tidal fever, vexing thirst, sweating, short urine, heat presenting symptoms, heat in damp, damp accumulating generating heat, damp-heat mixing, not biased cold biased heat can treat, using Xingren, Huashi, Tongcao, promoting lung-bladder damp, Houkou bitter-warm draining damp full, Qin Lian clearing inside stopping damp-heat diarrhea, Yujin aromatic walking orifices opening closed knot, Ju Ban transforming phlegm stopping vomiting, Three Jiao pathogen all can decompose, this Wet-warm combined treatment formula. If disease reaching Lower Jiao, damp evil deeply invading Jueyin Liver, Shaoyin Kidney, same method as Summer-warm. If yin division greatly deficient, then same method as damp-heat Lower Jiao disease. Besides if healthy qi mistakenly injured by medicine, pathogen secretly occupying middle, locked knot unresolved, attacking tonifying difficult applying, must rotate clear-turbid method, then Laifu Dan restoring yang below, cold-heat matching, yin-yang mutually assisting, has supporting danger saving reversal merit. Yin fluid and yuan qi both injured, can use Sancai combining tonifying yang; if drinking staying hypochondrium, suddenly Su Zi Shuang Erchen, severe Kongyan Dan, this all Wet-warm and warm-heat different places, also is managing method. And why people now confuse call Dan Malaria, not knowing this syndrome and yin qi first deficient, yang qi alone erupting principle completely different, carefully distinguishing, waiting for knowledgeable ones judging.

Also there is kind rich food loving wine fat body person, time value late spring summer-autumn, touching infecting warm pathogen combining with damp, also belongs Wet-warm. Wang Xugao annotation.

Question: Damp constitution what thing can detail speak? Zhongjing discussing damp dozen articles, mostly using warm medicine, isn't damp body originally cold? Or separately have damp-heat presenting symptoms? Damp in human has middle injuring, has exterior contracting called Wind-Damp, has direct hitting called Damp-Bi, has internal generating called Phlegm-Damp, can itemize clearly its reason? Damp in Upper Jiao injuring Lung presenting symptoms how? Should what treatment method? Damp in Middle Jiao injuring Stomach Yin presenting symptoms how? Injuring Stomach Yang presenting symptoms how? Injuring Spleen Yin presenting symptoms how? Injuring Spleen Yang presenting symptoms how? Should each detail treatment method. Damp in Lower Jiao injuring Liver-Kidney presenting symptoms how? Should detail treatment method. Try distinguishing clearly.

Once read *Yi Jing* saying: Water flows to damp, damp's constitution is water. In heaven yang time is rain-dew, yin time is frost-snow, in mountain is spring, in river is water. Contained in earth is damp. In human then combines with Lung-Stomach-Spleen-Liver-Kidney, because human and heaven-earth different origin same source, earth is mixed qi water is heaven-one generated, nowhere not combining. Now people compete hate damp patient, not knowing human is insect leader also. Earth also, relies on damp for growing. So Yu Shi has lean person regarding damp as treasure theory, not exploring root cannot speak. Zhongjing discussing damp ten-plus articles, its issuing formulas have four: Guizhi Fuzi Tang, Guizhi Baizhu Tang, Mahuang Baizhu Tang, Gancao Fuzi Tang. Mostly combining wind disease many, its called wind then cold wind, so mostly using warm method. Its Damp-Bi one syndrome staying in joints, using benefiting urination as main, hidden not Wuling in words below. Its body color like smoked yellow, belongs heat, hidden not Mahuang Chixiaodou Tang, severe Zhizi Bo Pi Tang, Yinchenshao Tang in words below, its dantian has cold, chest has heat, thirst wanting water one syndrome, has Xiexin Tang meaning in words below, these three all damp-heat, reading Zhongjing book can not distinguish clearly? Or asking middle damp, wind-damp, injuring damp difference, Zhang Shiwan said: Mountain marsh rain-yin steaming qi, human qi deficient and冒袭, called middle damp, spleen-kidney suffering disease. Its presenting symptoms or body pain, or body color like smoked yellow, pulse slow, treating using drying overcoming damp, combining benefiting urination. Sweating out facing wind, damp stagnant pores, called wind-damp, this bladder-stomach receiving damp. Its symptoms aversion to wind not wanting removing clothes, joint pain, pulse floating rough, treating using wind overcoming damp combining taking slight sweat. If grain-water internal storing, lung deficient cannot transform qi, spleen deficient cannot scatter fluid, or drinking cold drinking cold, or wine guest middle deficient, inside-outside combining, guest pathogen already from surface entering, latent pathogen also from inside erupting, this spleen-stomach receiving damp, its symptoms or痞满, or vomiting, abdominal distension, stool diarrhea, treating using harmonizing spleen-stomach, this outside treating damp method. In Upper Jiao offending Lung, qi cannot transform water counter-offering fire, lung disease heart also disease, rescuing Upper Jiao using opening lung qi, rescuing heart yang as main, *Jin Gui* Taiyin middle, body heat pain, pulse weak slight, this summer month injuring cold water, water running skin middle causing, using Gouti vomiting it, this damp stagnant in lung one syndrome. Also cold-damp injuring yang, shape cold pulse slow, tongue pale white slippery, no cough, meridian constriction, GuShu JiangFu Tang, this also damp stagnant in lung one syndrome. All belong Upper Jiao Middle Jiao disease, earth most hates damp, treatment method not outside opening ditch, transporting middle yang, worshipping rigid earth, making dike. If injuring Stomach Yin, then mouth thirsty no hunger, tidal fever, getting food vexation adds. Restoring Stomach Yin nothing better than sweet-acid transforming yin, using Maidong, Maziren, Baishao, Shouwu, Wumei, Zhimu. Injuring Stomach Yang, vomiting no eating, diaphragm distension, chest pain, thirst not wanting drink, taste sour changing turbid, Jiajian Renshen Xiexin Tang. Damp injuring Spleen Yang, in middle then not transporting,痞满, using Fu Ban cultivating yang earth absorbing yin earth damp, Houkou bitter-warm draining damp full, Lian using seeping damp Tongcao benefiting water, if wood coming overcoming earth, abdominal distension, urination涩, stool loose seeming stagnation, Siling adding Houkou Qinpi. Damp trapping Spleen Yang severe, limb cold, coating gray, spontaneous diarrhea, tongue stiff, spirit confusion, Siling adding Mugua, Caoguo, Houkou. If Middle Jiao痞滞, Caoguo Yinchens Tang, severe face