Library

Bu Da Bian (Constipation) refers to the inability to pass stool. This is generally caused by heat accumulating in the Stomach, causing the Stomach Earth to dry and crack, consuming body fluids (Jin Ye), thereby leading to constipation. If symptoms such as thirst, delirium (Zhan Yu), tidal fever (Chao Re), spontaneous sweating, a solid pulse, and abdominal fullness are observed, one of the Three Chengqi Decoctions should be selected for use. If constipation persists after purgation or diaphoresis, this indicates exhaustion of internal body fluids; Honey Suppository (Mi Dao) or Pig Bile Suppository (Dan Dao) method is appropriate. If accompanied by vomiting, the pathogen has not fully entered the Fu organs; although Yangming syndrome symptoms are present, attack methods (purgatives) must not be used. If urine is clear, it is known that the pathogen is not in the interior but remains in the exterior, so attack methods must not be used. If food is consumed too early after recovery, and the Stomach Qi fails to transport and transform, leading to constipation, treatment should focus on resolving stagnation based on severity. If blood deficiency follows illness, causing dryness and astringency in the intestines and stomach leading to constipation, nourishing and moistening methods should be applied according to the patient's age and constitution.

In Taiyang syndrome, if there is heat in the Lower Jiao, the lower abdomen will necessarily be full. Normally, urination should be difficult; however, if urination is now free, this is a definitive sign of Blood Stasis (Xue Zheng). Dihuang Tang (Dihuang Decoction) is the primary formula. In Yangming syndrome with spontaneous sweating, sweating should normally lead to reduced urine output; if urination is now free, it indicates exhaustion of internal body fluids. Even if the stool is hard, it must not be attacked with purgatives; Honey Suppository (Mi Dao) method is appropriate. In Shaoyin syndrome, if urination is free, it is a deficiency-cold syndrome; Sini Tang (Sini Decoction) is the primary formula.

The Bladder is the residence of body fluids; it can excrete them only through Qi transformation. If heat accumulates in the Lower Jiao and dampness harbors in the Middle Jiao, Qi is injured by heat, knotting and failing to disperse. In severe cases, this leads to hardness, fullness, and pain in the lower abdomen, and complete obstruction of urination. If excessive water is drunk, or if jaundice due to damp-heat occurs, promoting urination should be prioritized. However, if body fluids are lost after sweating, or if there is excessive sweating in Yangming syndrome, promoting urination is contraindicated.

The Classics state: "Yin deficiency leads to difficulty in urination." Yin deficiency means Yang inevitably encroaches upon it. This is because the Bladder is heated, thus causing urination □ to be unable to flow smoothly.

Frequent urination indicates deficiency of both the Kidney and the Bladder, compounded by invading external heat (Ke Re). Since these two meridians are deficient, they are susceptible to external heat. Deficiency prevents control over water, causing frequency. Frequent urination causes water flow □; □ leads to incomplete emptying/discomfort during urination, hence the frequency.

Si Ni (Four Extremities Cold) refers to the limbs being cold and not warm. Jue (Cold Reversal) refers to cold hands and feet, which is more severe than Si Ni. Jie'an stated: When pathogen is in the Exterior, hands and feet are hot; when in Half-Exterior Half-Interior, hands and feet are warm; when in Yin meridians, hands and feet are cold and reversed. However, progression from heat to warmth, and from warmth to cold, indicates pathogen transmission via meridians. For mild cases, Sini San (Sini Powder) is used; for severe cases, Chengqi Tang is used. If pathogen directly strikes Yin meridians, cold reversal appears immediately upon onset. For mild cases, Lizhong Tang (Lizhong Decoction) is used; for severe cases, Sini Tang is used. For Yang Jue (Yang-type Cold Reversal), initial symptoms include headache, body ache, fever, aversion to cold, preference for cold drinks, constipation, delirium, exposing hands and arms, thirst, and a deep, rapid pulse; Chengqi Tang is used. For Yin Jue (Yin-type Cold Reversal), initial symptoms lack headache and fever, featuring only fear of cold, shivering, fatigue, desire to sleep, diarrhea with undigested food, pulling clothes/blankets to cover oneself, and a deep, slow pulse; Sini Tang is used. The Sini San formula uses Chai Hu (Bupleuri Radix), Zhi Shi (Aurantii Fructus Immaturus), Shao Yao (Paeoniae Radix Alba), and Gan Cao (Glycyrrhizae Radix et Rhizoma), all cold-natured herbs, yet treats Si Ni disease. This proves that transmitted pathogen syndromes are not deficiency-cold, so warm-toning agents are contraindicated. By distinguishing between transmitted and direct-strike syndromes into Yin Jue and Yang Jue, the distinction between Si Ni and Jue becomes clear.