大医精诚中医普及丛书
医法圆通
清·郑寿全著
大医精诚中医在线版权所有
2004年10月3日
卷一
用药弊端说
用药一道，关系生死。原不可以执方，亦不可以执药，贵在认证之有实据耳。实据者何？阴阳虚实而已。阴阳二字，万变万化。在上有在上之阴阳实据，在中有在中之阴阳实据，在下有在下之阴阳实据。无奈仲景而后，自唐宋元明以逮本朝，识此者固有，不识此者最多。[眉批]医不执方药，在平日求至理而探玄奥。一得上中下阴阳实据，用药即不误人。病家知此理法，延医入门，以此审其高下，决其从违，《万病回春》立说之功不浅。此先医医，而后医病家。具见良工心苦。其在不识者，徒记几个汤头，几味药品，不求至理，不探玄奥，自谓知医。一遇危症，大海茫茫，阴阳莫晓，虚实莫辩，吉凶莫分。一味见头治头，见脚治脚。幸而获效，自夸高手。若不获效，延绵岁月。平日见识用尽，方法使完，则又藉口曰：病入膏肓，药所难疗。殊不知其艺之有未精也。更有一等病家，略看过几本医书，记得几个汤歌药性，家人稍有疾病，又不敢自己主张，请医入门开方去后，又或自逞才能，谓某味不宜，某味太散，某味太凉，某味太热，某味或不知性，忙将《本草备要》翻阅，看此药能治此病否。如治与病合则不言，不与病合则极言不是，从中添减分两，偶然获效，自矜其功，设或增病，咎归医士。此等不求至理，自作聪明，每每酿成脱绝危候。虽卢缓当前，亦莫能治，良
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可悲也。更有一等富贵之家，过于把细些小一病，药才入口，稍有变动，添病减病，不自知也，又忙换一医，甚至月延六七位，每每误事。[眉批]学养兼到之医，方能识此火候，太非易易。不知药与病有相攻者，病与药有相拒者，岂即谓药不对证乎？何不多延数时，以尽药力之长哉。
予观古人称用药如用兵。有君臣，有佐使，有向导；用缓攻，有急攻，有偷关；有上取，有下取，有旁取；有寒因寒用，热因热用，塞因塞用，通因通用诸法。岂非知得药与病有相拒相斗者乎？予愿富贵之家，不可性急，要知病系外感，服一三道发散药，有立见松减些者。气滞、食滞、腹痛、卒闭之症，服行气消导开窍之品，有片刻见效者。若系内伤空虚损日久，误服宣散、清凉、破气、滋阴等药、酿成咳嗽白痰，子午潮热，盗汗骨蒸，腹胀，面肿，气踹等症，又非三五剂可见大功。所以古人治病，有七日来复之说，或三十剂、五十剂，甚至七八十剂，始收全功者矣。
最可怪者，近之病家，好贵恶贱，以高丽参、枸杞、龟、鹿、虎胶、阿胶、久制地黄、鹿茸等品，奉为至宝。以桂、麻、姜、附、细辛、大黄、芒硝、石膏等味，畏若砒毒。由其不知阴阳虚实至理，病之当服与不当服耳。〔眉批〕扪虱而谈，其言侃侃，有旁若无人之概。病之当服，附子、大黄、砒霜，皆是至宝。病之不当服，参、芪、鹿茸、枸杞，都是砒霜。无奈今人之不讲理何，故谚云：参、芪、归、地，治死人无过；桂、附、大黄，治好人无功。溯本穷源，实由于不读仲景书，徒记几个幸中方子，略记得些各品药性，悬壶于市，外著几件好衣服，轿马往来，目空一世。并不虚心求理，自谓金针在握。仔细追究，书且点不过两篇，字且画不清几个，试问尚能知得阴阳之至理乎？东家被他桂、附治死，西家被他硝、
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黄送命。相沿日久，酿成此风。〔眉批〕淋漓尽致。所以病家甘死于参、芪、归、地之流，怕亡于姜、附、硝、黄之辈。此皆医门之不幸，亦当世之通弊也。
予愿业斯道者，务将《内经》、《难经》、仲景《伤寒》、《金匮》、孙真人的《千金》、《翼》诸书，与唐、宋、金、元，朱、张、刘、李并各后贤医书，彼此较量，孰是孰非。更将予所著《医理真传》并此《医法圆通》，留心讨究。阴阳务求实据，不可一味见头治头，见咳治咳，总要探求阴阳盈缩机关，与夫用药之从阴从阳变化法窍，〔眉批〕医学骨髓，尽此一语，学者潜心。而能明白了然，经方、时方，俱无拘执。久之，法活圆通，理精艺熟，头头是道，随拈二三味，皆是妙法奇方。观陈修园先生《三字经》，列病数十条，俱言先以时方治之，不效，再求之《金匮》，明是知道近日医生之胸中也。然时方如四君、六君、四物、八珍、十全、归脾、补中、六味、九味、阴八、阳八、左归、右归、参苏、五积、平胃、柴苓、逍遥、败毒等方，从中随证加减，亦多获效。大抵利于轻浅之疾，而病之深重者，万难获效。修园所以刻《三字经》与《从众录》之意。不遽揭其非，待其先将此等方法用尽，束手无策，而后明示曰，再求《金匮》，是教人由浅而深，探求至理之意也。窃以《金匮》文理幽深，词句奥古，阅之未必即解其至理，诚不若将各证外感内伤阴阳实据，与市习用药认证杂乱处搜出，以便参究。予岂好辩哉？予实推诚相与，愿与后世医生同入仲景之门，共用仲景之法，〔眉批〕一片婆心。普济生灵，同登寿域，是所切望也。
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各症辩认阴阳用药法眼
心血不足为病者， 血不足则火必旺。 其人多烦，小便短赤而咽中干，肌肤枯槁憔悴，而神不大衰，甚则狂妄喜笑，脉必细数，或洪大，喜食甘凉、清淡、油润之品者是也。
心气不足为病者，气，阳也。气衰则血必旺。其人少神，喜卧懒言，小便清长，或多言多劳力、多用心一刻，心中便潮热而自汗出。言者，心之声也。汗者，血之液也。多言、劳力及用心太过，则心气耗。气耗则不能统血，故自汗出。〔眉批〕心气即心阳，所谓神也。神伤则精散，精散则不能统血，气液脱而为潮热、自汗，此是阳不能统阴，阴无所制。阴证蜂起，正本澄源，立法亲切，于治此病乎何有？甚至发呕欲吐，心阳一衰，阴气上偕，故发呕。脉必细微，抑或浮空，喜食辛辣煎炒极热之品者是也。
目下市习，不辩阴阳，听说心不安宁，一味重在必血不足一边，故治之有效，有不效。其所用药品，无非人参、酸枣、茯神、远志、琥珀、龙骨、朱砂、地黄、当归、元肉之类，与夫天王补心，定志宁神诸方。然此等方药，全在养血，果系心血不足则甚宜。若系心阳衰败则不当。此属当世混淆莫察之弊，不忍坐视不言，姑酌一治心阳虚方，以补市习之漏。
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用药意解：夫曰：补坎益离者，补先天之火，以壮君火也。真火与君火本同一气，真火旺则君火始能旺，真火衰则君火亦即[1]衰。真火藏于水中，二气浑为一团，故曰一元。[眉批]造化机械，阴阳根柢，露于腕下，作一幅活太极图观之，便得医之真实际也。真火上腾，真火，天体也。其性发，用故在上。必载真水上升，以交于心，故曰离中含阴。又曰：气行血随，水既上升，又必复降下。水，地体也。随气而至离宫。则水气旺极，极则复降下也。水下降，君火即与之下降，故曰阴中含阳。又曰：血行气附，主宰神明，即寓于浑然一气之中，昼则出而听政以从阳。阳在上也，曰离。夜则入而休息以从阴，阴在下也，曰坎。此人身立命指归，医家宜亟讲也。今病人心不安宁，既服养血之品而不愈者，明是心阳不足也。心阳不足，固宜直补其心阳。而又曰补坎者，盖以火之根在下也。予意心血不足与心阳不足，皆宜专在下求之，何也？水火互为其根，其实皆在坎也。真火旺则君火自旺，心阳不足自可愈，真气升则真水亦升，心血不足亦能疗。其所以服参、枣等味而不愈者，是未知得火衰[2]而水不上升也。方用附、桂之大辛大热为君，以补坎中之真阳。细查坎阳，乃先天乾金真气所化，故曰金生水。后人见不及此，一味补土生金，补金生水，着重在后天脾肺，不知坎无真气上腾，五脏六腑皆是死物。前贤叫人补脾者，先天赖后天以辅也，先天为体，后天为用。故《经》云：无先天而后天不立，无后天而先天亦不生。教人补金，是教人补先天真金所化之真气也。道家称取坎填离，即是盗取坎中一点金气也。予恒曰：人活一口气，即此。考桂、附大辛大热，辛即金之味，热即纯阳之性也。仲景深通造化，知桂、附能回阳，故立白通、四逆回阳诸方，起死回生，其功迅速，实非浅见可测。[眉批]乾分一气，落于坤中而成坎，乾即金也，坎即水也。坤中得阳即是火，火曰炎上，故能启示上升而交于心。心属火为离，离中得水，水曰润下，又燃火而下降，全是一金为之斡旋。桂、附、辛归金而热归火，大能升水降火，交接心肾。先生独得仲
[1] 即原本作"郎"，据文义改。
[2] 衰原本作"衰"，据文义改。
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景之秘，不惜金针暗度，知非再表而彰之，俾医门悉知仲景之微理，大阻用附，桂以起死回生，病家放心，服桂、附以疗生而救死，熟谓病风不可挽。复取蛤粉之咸以补肾，肾得补而阳有所依，自然合一矣。附、桂补坎中之阳。阳，气也。蛤粉补坎中之阴。阴，血也。气行血随，血行气附，阴阳合一，升降不乖，何心病之能治乎。此方功用最多，凡一切阳虚诸症，皆能奏功，不独此耳。况又加姜、草调中，最能交通上下，故曰中也者，调和上下之枢机也。此方药品虽少，而三气同调，学者务在药之性味与人身之气机， 何品从阳，何品从阴，从阴、从阳，旨归不一，有从元阴、元阳者，坎离之说也。有从太阳、太阴、少阳、少阴、阳期、厥阴者，六步之谓也。其中之浅浅深深，药性各有专主，须要明白。如何为顺，如何为逆，顺者，是顺其气机之流行。逆者，逆其气机之欲往。把这病之阴阳实据，与夫药性之阴阳实据，握之在手，随拈一二味，皆能获效。匪彝[1]所思，子阅之久矣。[眉批]从阴从阳，顺往逆来，是用药调气机之手眼，亦医门讲理法治病之权衡。夫人自出母腹，元阴元阳变为坎离，其根落在坤中，由是气传子母，应天度而化生，六经上下往来，表里雌雄相输应，二六不停。水火者，气液也，随呼吸而升降，布五行而有部分，医能明此，号曰上工。钦安酌此一方，名曰补坎益离丹，以治心阳虚证，深得太阳与少[1]阴为表里之机关，窥见岐黄根柢，从桂枝汤变化而出，直透仲景之心法，且不惮烦劳，于辩证用药中，剖明阴阳大旨。学者入理深谈已有把握。知非更拈出仲景治少阴、太阴两大法门，真武何以用附子而不用干姜，理中何以用干姜而不用附子，其四逆附子、干姜并用，何以又独称为救里，而治无专经。此间阴阳奥妙，进退出入，包含气机不少，如何用药认证，以合气机。此皆六步之中，亦有从阴从阳之浅深，药性亦各有专主，均可变化推衍，增减随宜。知非不能明辩，愿以俟学者之深参而有得焉。
奈世人沉溺莫挽，深为可慨，兹特再即此方之理推之，与仲景之白通汤同法也；桂枝龙骨牡蛎汤同法也；大、小建中汤同法也；即与后贤之参附汤、封髓丹、阳八味皆同法也。
[1] 彝通"夷"，常理。
[2] 少原本作"必"，据文义改。
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古人立方，皆是握定上中下三部之阴阳，而知药性之浅深功用，故随手辄效，得以名方。今人只徒口涌心记，而不识至理攸关，无怪乎为方药所囿矣。更可鄙者，甘草仅用数分，全不知古人立法立方，其方皆有升降，皆用甘草，诚以阴阳之妙，交会中宫，调燮之机，专推国老。何今之不察，而此风之莫转也。
肺 病 咳 嗽
按咳嗽一证，有从外而入者，有从内而出者。从外而入者，风寒暑燥火之邪干之也。六客各有节令不同，须知。客邪自外而入，[眉批]客邪者。每年六步客气之邪也。闭其太阳外出之气机，气机不畅，逆于胸膈。胸中乃肺地面，气欲出而不出，咳嗽斯作矣。定有发热、头疼、身痛一段。风邪干者，兼自汗恶风；寒邪干者，兼无汗恶寒；暑邪干者，兼口渴饮冷，人困无力；湿邪干者，兼四肢沉重，周身觉冷而酸疼，不甚发热；燥邪干者，兼吐痰胶粘，喜饮清凉；火邪干者，心烦脉洪，小便短赤饮冷。从内而出者，皆是阳虚阴盛之候。阴虚也有，十中仅见一二。因阳虚者，定见困倦懒言，四肢无力，人与脉息无神，唇舌青淡白色，而喜热饮，食少心烦，身无发热痛苦。即有烧热，多在午后，非若外感之终日发热无已时也。因心肺之阳不宣，不能化其本经之阴邪，逆于胸而作者，其人无外感可征。
凡事不能用心劳力，稍用心力一分，心便潮热，自汗出，咳嗽更甚，多吐白泡清痰。近市医家，每称为陈寒入肺，其实不知心肺阳衰，而内寒自[1]生也。[眉批]辩证的小注辩理确，小注补法清。因脾胃之阳不足，不能转输津液水谷而作者，其人饮食减少，腹
[1] 自 原本作"白"，据文义改。
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Da Yi Jing Cheng TCM Popularization Series
*Yi Fa Yuan Tong* (Medical Methods Round and Through)
Qing Dynasty · Zheng Shouquan, Author
Copyright of Da Yi Jing Cheng TCM Online
October 3, 2004
Volume I
On the Drawbacks of Medication Administration
The art of medication administration concerns life and death. One should not rigidly adhere to fixed prescriptions nor stubbornly cling to specific herbs; rather, the key lies in having solid evidence for syndrome differentiation. What constitutes such solid evidence? It is merely Yin and Yang, and Deficiency and Excess. The terms "Yin" and "Yang" undergo infinite transformations. There are specific Yin-Yang evidences for the upper part of the body, for the middle part, and for the lower part. Regrettably, since Zhang Zhongjing, from the Tang, Song, Yuan, and Ming dynasties up to our current dynasty, although there were those who understood this principle, the majority did not. [Marginal Note: A physician should not be attached to formulas or herbs but must seek profound truths and explore esoteric mysteries in daily practice. Once the solid Yin-Yang evidence of the upper, middle, and lower regions is grasped, medication will not harm patients. If patients understand this principle and method, they can use it to assess a physician's competence when inviting them, deciding whether to follow or reject their advice. The theoretical contribution of *Wan Bing Hui Chun* (Ten Thousand Diseases Returning to Spring) is significant. This is treating physicians first, then patients. It fully reveals the painstaking effort of skilled practitioners. Those who do not understand the principles merely memorize a few decoction songs and herb names, seeking no profound truth, exploring no mystery, yet claiming to know medicine. When encountering critical conditions, they are lost like in a vast ocean, unable to discern Yin and Yang, distinguish deficiency and excess, or determine auspiciousness and peril. They treat symptoms superficially—headaches for head pain, foot pain for foot pain. By chance, if effective, they boast of being experts. If ineffective, the condition drags on for years. When their usual knowledge and methods are exhausted, they make excuses: "The disease has entered the epigastrium and pericardium; drugs find it hard to cure." Little do they know that their skills are simply not refined enough. There is another type of patient who has read a few medical books, memorized some decoction songs and herb properties. When family members fall slightly ill, they dare not take charge themselves, so they invite a physician to prescribe. Afterwards, they sometimes show off their own knowledge, saying certain herbs are unsuitable, too dispersing, too cooling, too heating, or unknown in nature. They hurriedly consult *Ben Cao Bei Yao* (Essentials of Materia Medica) to see if the drug treats the disease. If it matches, they remain silent; if not, they vehemently criticize, arbitrarily adding or subtracting dosages. If by chance it works, they claim credit; if it worsens the illness, they blame the physician. Such people, seeking no profound truth and acting smartly on their own, often precipitate critical collapse. Even if Lu Dan (Bian Que) or Hua Tuo were present, they could not treat it. Truly pitiable. Then there are wealthy families who are overly meticulous about minor ailments. As soon as medicine enters the mouth, any slight change in symptoms—worsening or improving—is unnoticed by them, leading them to hastily switch doctors, sometimes employing six or seven physicians in a month, often causing delays. [Marginal Note: Only physicians with both learning and cultivation can recognize these nuances of timing; it is not easy.] Do you not know that drugs may conflict with diseases, and diseases may resist drugs? Does this immediately mean the prescription does not match the syndrome? Why not allow more time to fully exert the drug's efficacy?
I observe that ancients compared medication administration to military strategy. There are Sovereign, Minister, Assistant, and Courier roles; there are slow attacks, urgent attacks, and bypassing strongholds; there are approaches from above, below, and sides; there are methods like using cold for cold, heat for heat, obstruction for obstruction, and unblocking for unblocking. Is this not acknowledging that drugs and diseases may resist or contend with each other? I hope wealthy families will not be impatient. Understand that if the disease is an external contraction, taking one to three doses of diaphoretic medicines may bring immediate relief. For Qi stagnation, food stagnation, abdominal pain, or sudden closure, administering Qi-moving, digestion-promoting, and orifice-opening agents may yield results within moments. However, if it is internal injury due to long-term emptiness and deficiency, and one mistakenly takes dispersing, cooling, Qi-breaking, or Yin-nourishing drugs, it may lead to coughing with white phlegm, tidal fever at Zi and Wu hours, night sweats, bone-steaming fever, abdominal distension, facial edema, and panting. Such conditions cannot be cured in just three or five doses. Therefore, ancient healers spoke of recovery after seven days, or required thirty, fifty, even seventy or eighty doses to achieve full success.
What is most strange is that recent patients prefer expensive over cheap, regarding Korean ginseng, Goji berries, turtle shell glue, deer antler glue, tiger glue, donkey-hide gelatin, long-processed Rehmannia root, and deer antler as supreme treasures. Conversely, they fear Cinnamon Twig, Ephedra, Ginger, Aconite Root, Asarum, Rhubarb, Mirabilite, and Gypsum as if they were arsenic. This stems from ignorance of the profound principles of Yin-Yang and deficiency-excess, knowing only what drugs are suitable or unsuitable for a disease. [Marginal Note: Speaking while scratching lice, his words are resolute, appearing as if he ignores everyone else. Drugs suitable for the disease, such as Aconite Root, Rhubarb, and Arsenic, are supreme treasures. Drugs unsuitable for the disease, such as Ginseng, Astragalus, Deer Antler, and Goji berries, are like arsenic.] Alas, how modern people disregard reason! Hence the proverb: "Ginseng, Astragalus, Angelica, and Rehmannia kill without fault; Cinnamon Twig, Aconite, and Rhubarb cure without merit." Tracing back to the source, this is truly because they do not read Zhang Zhongjing’s works, merely memorizing a few lucky prescriptions and vaguely remembering herb properties. They hang out their lanterns in the market, wear fine clothes, travel in sedan chairs and on horseback, and look down upon the world. They do not humbly seek truth, believing they hold the golden needle of healing. Upon close inspection, they cannot even read two chapters clearly, nor write a few characters legibly. How can they possibly understand the profound principles of Yin and Yang? The patient of the eastern house dies under his treatment with Cinnamon Twig and Aconite; the patient of the western house loses his life due to his use of Mirabilite and Rhubarb. This custom has persisted for a long time, fostering this trend. [Marginal Note: Described vividly and thoroughly.] Thus, patients willingly die from treatments involving Ginseng, Astragalus, Angelica, and Rehmannia, fearing death from Ginger, Aconite, Mirabilite, and Rhubarb. This is an misfortune for the medical profession and a common malady of the times.
I wish those engaged in this path would carefully compare the *Nei Jing* (Inner Canon), *Nan Jing* (Classic of Difficult Issues), Zhang Zhongjing’s *Shang Han Lun* (Treatise on Cold Damage) and *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), Sun Simiao’s *Qian Jin Fang* (Prescriptions Worth a Thousand Gold) and *Qian Jin Yi Fang* (Supplement to Prescriptions Worth a Thousand Gold), along with medical texts from the Tang, Song, Jin, and Yuan dynasties, and works by Zhu Zhenheng, Zhang Congzheng, Liu Wansu, Li Dongyuan, and other later sages. Determine who is right and who is wrong. Furthermore, study my *Yi Li Zhen Chuan* (True Transmission of Medical Principles) and this *Yi Fa Yuan Tong* (Medical Methods Round and Through) with care. Seek solid evidence for Yin and Yang; do not merely treat the head when the head hurts or the cough when coughing appears. Always explore the mechanisms of Yin-Yang expansion and contraction, and the subtle techniques of aligning medication with Yin or Yang. [Marginal Note: The marrow of medicine lies in this single sentence; let scholars ponder deeply.] Once understood clearly, neither classical formulas (Jing Fang) nor contemporary formulas (Shi Fang) need be rigidly adhered to. Over time, methods become flexible and thorough, principles precise, and skills mature. Every detail will be in order; picking just two or three herbs will yield miraculous methods and prescriptions. Observing Mr. Chen Xiuyuan’s *San Zi Jing* (Three Character Classic), which lists dozens of syndromes and states to first treat with contemporary formulas, and if ineffective, then seek guidance from *Jin Gui Yao Lue*, clearly shows he understands the mindset of modern physicians. Contemporary formulas such as Si Jun Zi Tang (Four Gentlemen Decoction), Liu Jun Zi Tang (Six Gentlemen Decoction), Si Wu Tang (Four Substances Decoction), Ba Zhen Tang (Eight Treasures Decoction), Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Gui Pi Tang (Restore the Spleen Decoction), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), Jiu Wei Qiang Huo San (Nine-Ingredient Notopterygium Powder), Yin Ba Wei Wan (Yin Eight-Ingredient Pill), Yang Ba Wei Wan (Yang Eight-Ingredient Pill), Zuo Gui Wan (Left Restoring Pill), You Gui Wan (Right Restoring Pill), Shen Su Yin (Ginseng and Perilla Drink), Wu Ji San (Five Accumulations Powder), Ping Wei San (Peaceful Stomach Powder), Chai Ling Tang (Bupleurum and Poria Decoction), Xiao Yao San (Free and Easy Wanderer Powder), Bai Du San (Resist Toxins Powder), etc., when modified according to syndromes, often yield good results. Generally, they benefit mild and superficial diseases, but for deep and severe illnesses, success is extremely difficult. This was likely Chen Xiuyuan’s intent in publishing *San Zi Jing* and *Cong Zhong Lu*: not to immediately expose errors, but to let practitioners exhaust these methods until helpless, and then explicitly state to seek *Jin Gui Yao Lue*. This teaches people to progress from shallow to deep, seeking profound truths. I believe *Jin Gui Yao Lue* has profound literary depth and archaic language; reading it may not immediately reveal its deepest principles. It is certainly better to extract the solid Yin-Yang evidence for various external and internal injury syndromes, and clarify the chaotic practices of diagnosis and medication in popular customs, for easier reference. Am I fond of debate? No, I sincerely wish to associate with future physicians, guiding them into Zhang Zhongjing’s school to utilize his methods, [Marginal Note: A heart full of compassion.] to universally benefit living beings and attain longevity together. This is my earnest hope.
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Methods for Identifying Yin and Yang in Various Syndromes to Guide Medication
Heart Disease: Disquietude
Colloquially known as: Palpitations and Fright
Regarding Heart Disquietude, there are cases caused by Heart Blood Deficiency and cases caused by Heart Qi Deficiency.
In cases of Heart Blood Deficiency, insufficient blood leads to hyperactive Fire. The person is often irritable, with scanty dark urine and dry throat, withered and emaciated skin, though spirit is not greatly diminished. In severe cases, they may act wildly and laugh excessively. The pulse is definitely thready and rapid, or large and expansive. They prefer sweet, cool, light, bland, and oily foods.
In cases of Heart Qi Deficiency, Qi belongs to Yang. When Qi declines, Blood becomes relatively excessive. The person lacks spirit, prefers lying down and is reluctant to speak, with clear and profuse urine. Or, after speaking much, physical labor, or intense mental effort, they feel tidal heat in the chest and spontaneous sweating. Speech is the voice of the Heart. Sweat is the fluid of Blood. Excessive speech, labor, and mental strain deplete Heart Qi. When Qi is depleted, it cannot control Blood, hence spontaneous sweating. [Marginal Note: Heart Qi is Heart Yang, also referred to as Spirit. When Spirit is injured, Essence scatters; when Essence scatters, it cannot control Blood. Depletion of Qi and fluids leads to tidal heat and spontaneous sweating. This is Yang failing to control Yin, leaving Yin unchecked. Yin syndromes arise; rectifying the root and clearing the source, with precise legislation, makes treating this disease easy.] They may even vomit or feel like vomiting. When Heart Yang declines, Yin Qi ascends, causing vomiting. The pulse is definitely minute or floating and empty. They prefer spicy, fried, and extremely hot foods.
Current popular habits fail to distinguish Yin and Yang. Hearing of Heart disquietude, they blindly focus on Blood Deficiency. Thus, treatments sometimes work, sometimes do not. The herbs used are invariably Ginseng, Sour Jujube Seed, Poria, Polygala, Amber, Dragon Bone, Cinnabar, Rehmannia, Angelica Sinensis, Longan Aril, etc., along with Tian Wang Bu Xin Dan (Emperor of Heaven’s Pill to Nourish the Heart) and Ding Zhi Ning Shen (Calming Will and Calming Spirit) formulas. These formulas entirely focus on nourishing Blood. If it is indeed Heart Blood Deficiency, they are very suitable. If it is Heart Yang Decline, they are inappropriate. This confusion is a malady of our times. I cannot bear to sit idle without speaking. I hereby provide a formula for Heart Yang Deficiency to supplement the gaps in popular practice.
Formula for Supplementing Kan and Benefiting Li (Bu Kan Yi Li Dan):
Aconite Root (Fu Zi) 8 qian
Cinnamon Twig (Gui Xin) 8 qian
Clam Shell Powder (Ge Fen) 5 qian
Honey-fried Licorice Root (Zhi Gan Cao) 4 qian
Fresh Ginger (Sheng Jiang) 5 slices
Explanation of Medication Intent:
"Supplementing Kan and Benefiting Li" means supplementing the Primordial Fire (Zhen Huo) to strengthen the Monarch Fire (Jun Huo). Primordial Fire and Monarch Fire share the same Qi. When Primordial Fire is robust, Monarch Fire can flourish; when Primordial Fire declines, Monarch Fire also declines. Primordial Fire is stored in Water. The two Qi merge into one, hence called "One Origin." [Marginal Note: The mechanics of creation and the roots of Yin-Yang are revealed here. Viewing this as a living Taiji diagram allows one to grasp the true reality of medicine.] Primordial Fire ascends. Primordial Fire represents the Heavenly Body. Its nature is expansive, so its function is superior. It must carry True Water upward to interact with the Heart, hence "Li contains Yin." It is said: "Qi moves, Blood follows." Since Water rises, it must subsequently descend. Water represents the Earthly Body. Following Qi to the Li Palace, Water Qi becomes extremely vigorous. Extremity leads to reversal, so it descends. As Water descends, Monarch Fire descends with it, hence "Yin contains Yang." It is said: "Blood moves, Qi attaches." The ruler of Spirit and Consciousness resides within this unified Qi. During the day, it emerges to govern, aligning with Yang. Yang is superior, called Li. At night, it retreats to rest, aligning with Yin. Yin is inferior, called Kan. This is the destination of human life and destiny; physicians must urgently study it. Now, if a patient suffers from Heart disquietude and does not recover after taking Blood-nourishing drugs, it clearly indicates Heart Yang Deficiency. Heart Yang Deficiency naturally requires direct supplementation of Heart Yang. But why "Supplement Kan"? Because the root of Fire is in the lower part. My view is that both Heart Blood Deficiency and Heart Yang Deficiency should be sought specifically in the lower part. Why? Because Water and Fire are roots of each other, and both reside in Kan. When Primordial Fire is robust, Monarch Fire flourishes naturally, curing Heart Yang Deficiency. When True Qi ascends, True Water also ascends, curing Heart Blood Deficiency. The reason Ginseng and Jujube failed is ignorance that Fire decline prevents Water ascent. The formula uses Fu Zi and Gui Xin, great Acrid and Hot substances, as Sovereign herbs to supplement True Yang in Kan. Examining Kan Yang, it is transformed from the True Qi of Primordial Qian Metal, hence "Metal generates Water." Later generations lacked this insight, focusing solely on tonifying Earth to generate Metal, and Metal to generate Water, emphasizing postnatal Spleen and Lung. They did not realize that without True Qi ascending from Kan, the Five Zang and Six Fu organs are dead matter. Ancients advised tonifying the Spleen because the prenatal relies on the postnatal for assistance. Prenatal is Substance (Ti); Postnatal is Function (Yong). Thus, the *Canon* states: "Without Prenatal, Postnatal cannot stand; without Postnatal, Prenatal cannot generate." Advising to tonify Metal means advising to tonify the True Qi transformed from Primordial True Metal. Daoists call this "Extracting Kan to Fill Li," which is stealing a point of Metal Qi from Kan. I often say: Human life depends on one breath, which is this. Studying Gui Xin and Fu Zi, they are Great Acrid and Hot. Acrid corresponds to the flavor of Metal; Heat corresponds to the nature of Pure Yang. Zhang Zhongjing deeply understood creation. Knowing Gui Xin and Fu Zi can restore Yang, he established formulas like Bai Tong Tang and Si Ni Tang to restore Yang, bringing the dead back to life with rapid effect. This power is immeasurable by shallow views. [Marginal Note: Qian divides into one Qi, falling into Kun to form Kan. Qian is Metal, Kan is Water. Obtaining Yang in Kun creates Fire. Fire flares upward, inspiring ascent to interact with the Heart. Heart belongs to Fire, called Li. Li receives Water. Water moistens downward, igniting Fire to descend. All is mediated by Metal. Gui Xin and Fu Zi: Acrid returns to Metal, Heat returns to Fire. They greatly ascend Water and descend Fire, connecting Heart and Kidney. The Master alone obtained Zhang Zhongjing’s secrets, not sparing the 'golden needle' passed secretly. Knowing it needs proclamation to make the medical community aware of Zhang Zhongjing’s subtle principles, thereby encouraging the use of Fu Zi and Gui Xin to save lives, giving patients confidence to take them for healing and rescue. Who says wind diseases cannot be reversed?] He also uses Ge Fen (Clam Shell Powder), salty in flavor, to tonify the Kidney. When the Kidney is tonified, Yang has a foundation, achieving natural unity. Fu Zi and Gui Xin supplement Yang in Kan. Yang is Qi. Ge Fen supplements Yin in Kan. Yin is Blood. Qi moves, Blood follows; Blood moves, Qi attaches. Yin and Yang unite, ascent and descent proceed correctly. How can Heart disease not be cured? This formula has many functions. It benefits all Yang Deficiency syndromes, not just this one. Moreover, Ginger and Licorice harmonize the Middle, facilitating communication between Upper and Lower. Thus, "Zhong" (Middle) is the pivot harmonizing Upper and Lower. Although this formula has few ingredients, it regulates three Qi simultaneously. Scholars must understand the relationship between herb properties/flavors and human Qi mechanisms. Which herbs align with Yang? Which with Yin? Aligning with Yin or Yang has different purposes. Some align with Primal Yin and Primal Yang (Kan-Li theory). Some align with Taiyang, Taiyin, Shaoyang, Shaoyin, Yangming, Jueyin (Six Steps theory). The depths vary; each herb has specific dominance. One must understand what is smooth and what is reverse. Smooth means following the flow of Qi mechanism. Reverse means opposing the Qi mechanism's direction. Grasping the solid Yin-Yang evidence of the disease and the solid Yin-Yang evidence of herb properties in hand, picking one or two herbs yields results. Unimaginable, you have read for a long time. [Marginal Note: Aligning with Yin/Yang, following/reversing flow, is the skill of regulating Qi mechanism via medication, and the standard for discussing principles and methods in treating diseases. From birth, Primal Yin and Yang transform into Kan and Li, rooted in Kun. Qi transmits through mother-son cycles, responding to heavenly degrees for generation. Six Channels move up and down, exterior-interior and male-female correspond. Two-six cycles never stop. Water and Fire are Qi and Fluids, ascending and descending with breathing, distributing Five Elements with specific parts. A physician who understands this is called a Superior Physician.] Qin An deliberated this formula, naming it Bu Kan Yi Li Dan, to treat Heart Yang Deficiency. It deeply grasps the exterior-interior relationship between Taiyang and Shaoyin, glimpsing the roots of Qi and Huang. It evolves from Gui Zhi Tang, penetrating Zhang Zhongjing’s core methods. Not shunning labor, it clarifies major Yin-Yang principles in syndrome differentiation and medication. Scholars entering deep discussion now have assurance. Knowing that if not highlighting Zhang Zhongjing’s two major gates for Shaoyin and Taiyin—why Zhen Wu Tang uses Fu Zi but not Gan Jiang, why Li Zhong Tang uses Gan Jiang but not Fu Zi, why Si Ni Tang uses both but is uniquely called "Saving the Interior," and why treatment lacks a specific channel—the profound Yin-Yang mysteries,进退出入 (advancing/retreating/exiting/entering), contain much Qi mechanism. How to use medication and differentiate syndromes to align with Qi mechanism? These are within the Six Steps, involving深浅 (depths) of aligning with Yin/Yang. Herb properties have specific dominance, allowing variation and derivation,增减 (adding/subtracting) as appropriate. I am not unable to distinguish clearly; I leave it for scholars to deeply participate and gain insights.
Alas, the world is sunk and unrecoverable, deeply lamentable. Here, extending the logic of this formula, it shares the same method as Zhang Zhongjing’s Bai Tong Tang; Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction); Da Jian Zhong Tang and Xiao Jian Zhong Tang (Major and Minor Construct the Middle Decoctions); and even later sages’ Shen Fu Tang (Ginseng and Aconite Decoction), Feng Sui Dan (Seal Marrow Pill), and Yang Ba Wei Wan (Yang Eight-Ingredient Pill).
[1] Yi is interchangeable with "Yi", meaning common sense.
[2] Shao originally written as "Bi", corrected according to context.
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Ancient formula construction always grasped the Yin and Yang of the Upper, Middle, and Lower sections, knowing the depth and function of herb properties, thus achieving immediate effect and earning fame. Modern people merely recite and memorize without understanding the crucial principles, no wonder they are confined by formulas and drugs. More despicable is using only a few fen of Licorice Root, completely unaware that ancient legislative formulas all involve ascent and descent, utilizing Licorice Root. Indeed, the wonder of Yin and Yang meets in the Central Palace; the mechanism of regulation is entrusted to the "State Elder" (Licorice). Why do modern people fail to observe this, and why can this trend not be reversed?
Lung Disease: Cough and Phlegm
Regarding Cough and Phlegm, some originate from outside, some from inside. Those from outside are caused by Wind, Cold, Summerheat, Dryness, and Fire pathogens interfering. The six guest pathogens differ by season; this must be known. Guest pathogens enter from outside, [Marginal Note: Guest pathogens refer to the annual six-step guest Qi pathogens.] blocking the outward Qi mechanism of Taiyang. Qi mechanism is not smooth, reversing in the chest and diaphragm. The chest is the domain of the Lung. Qi desires to exit but cannot, so cough arises. There will definitely be a phase of fever, headache, and body ache. If Wind pathogen interferes, accompanied by spontaneous sweating and aversion to wind; if Cold pathogen interferes, accompanied by no sweating and aversion to cold; if Summerheat pathogen interferes, accompanied by thirst, desire for cold drinks, fatigue, and weakness; if Dampness pathogen interferes, accompanied by heavy limbs, feeling cold and achy throughout the body, with little fever; if Dryness pathogen interferes, accompanied by sticky phlegm, desire for cool drinks; if Fire pathogen interferes, accompanied by irritability,洪 (large) pulse, scanty dark urine, and desire for cold drinks. Those originating from inside are signs of Yang Deficiency and Yin Excess. Yin Deficiency exists but is rare, seen in one or two out of ten. Because in Yang Deficiency, one definitely sees fatigue, reluctance to speak, weak limbs, lack of spirit in person and pulse, bluish-pale-white lips and tongue, desire for hot drinks, poor appetite, irritability, and no fever or pain. Even if there is burning heat, it mostly occurs in the afternoon, unlike external contractions which cause continuous fever all day. Because Lung and Heart Yang are not disseminated, they cannot transform the Yin pathogens of their own meridians, which reverse in the chest and cause cough. Such persons have no signs of external contraction.
One must not exert mental or physical labor. Applying even a small amount of mental effort causes tidal heat in the heart, spontaneous sweating, worsened cough, and expectoration of clear, bubbly white phlegm. Recent popular physicians often call this "Old Cold Entering the Lung," but actually do not know that Lung and Heart Yang Decline causes internal Cold to arise spontaneously. [Marginal Note: The marginal notes in syndrome differentiation confirm the reasoning; the supplementary notes clarify the methods.] Because Spleen and Stomach Yang is insufficient, it cannot transport fluids and grain, causing the person to have reduced diet, abdominal...
[1] Zi originally written as "Bai", corrected according to context.
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