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Deficiency of the True Yang (Zhen Yang, True Fire) in the Kidney (Shen, 肾) (the source of congenital vitality). Once True Yang declines, Yin pathogens (Yin Xie, 阴邪) rise like a swarm of bees, thus presenting with tidal fever at Zi (子, 11 PM - 1 AM) and Wu (午, 11 AM - 1 PM) hours. These two periods are when Yin and Yang intersect. If Yang cannot descend to interact with Yin, Yang Qi floats and fails to store, generating tidal fever. If Yin cannot ascend to interact with Yang, Yin Qi rises without Yang to anchor and consolidate it, also generating tidal fever. Physicians who do not comprehend this profound principle, upon seeing tidal fever, immediately diagnose Yin Deficiency (Yin Xu, 阴虚) and use a regimen of Yin-nourishing herbs, often precipitating critical conditions of Yang collapse (Yang Tuo, 阳脱), which is truly lamentable.

Spontaneous sweating (Zi Han, 自汗) and night sweats (Dao Han, 盗汗) occur together. All spontaneous and night sweats are signs of Yang Deficiency. Various texts attribute night sweats to Yin Deficiency because they occur at night. Night is when Yang Qi should be stored; however, at night, Yin is actually abundant. Excess Yin can force Yang outward. As Yang floats and escapes externally, Blood (Xue, 血) follows and exits as sweat, termed night sweat. Physicians fail to recognize this as Yang Deficiency, unable to anchor Yin Qi, causing Yin to escape externally and Blood to follow. When Yin excess repels Yang to the exterior, preventing Yang from storing, sweating also occurs. This principle is subtle; scholars must understand it through the concept of mutual root (Hu Gen, 互根) of Yin and Yang.

Coughing up white phlegm: Once True Yang declines, Yin pathogens reverse upward, causing cough due to rebellious Qi. Although white phlegm is not blood, it is related to blood. Due to deficient Ming Men Fire (Ming Men Huo, 命门火), transformation functions fail, and Essence (Jing, 精) is not refined by True Fire, hence its color is not red. Recently, many call this "old cold entering the Lung" (Fei, 肺), which is laughable.

Abdominal fullness without hardness: Caused by Yin Qi obstruction and weak Yang failing to transport.

Yellow complexion and emaciation: When True Fire declines, Spleen Earth loses vitality. Earth Qi dissipates and tends to escape externally, causing a yellow complexion. As Earth declines, muscles waste away because the Spleen governs muscles.

Intermittent abdominal pain: Yang decline causes Cold (Han, 寒) to block the middle Jiao (San Jiao, 三焦), obstructing movement. Pathogenic and righteous Qi resist each other, causing pain that comes and goes. Loose stools result from insufficient Stomach Yang and excessive Spleen dampness.

Fatigue, drowsiness, shortness of breath, and reluctance to speak are all signs of Qi weakness. Various symptoms are too numerous to list. The only method is Sweet-Warm Yuan-Solidifying (Gan Wen Gu Yuan, 甘温固元), which is indeed a spiritual elixir for treating Consumption (Xu Lao, 虚劳). [Marginal Note]: Zhi Fei says: In Consumption, the Five Spirits (Wu Shen, 五神) have no master, and the Four Elements (Si Da, 四大) are uncontrolled. The Five Spirits are the spirits of the five sense organs; they cannot function independently but require a master. The *Immortal Classic* states: It is like manipulating puppets, where an internal mechanism controls them. The Four Elements refer to Earth, Water, Fire, and Wind. Hair, nails, skin are Earth; fluids, saliva are Water; movement and operation are Wind; warmth is Fire. However, these four entirely require Primordial Spirit (Yuan Shen, 元神) and Primordial Qi (Yuan Qi, 元气) as masters to control them. In Consumption, Yuan Shen is confused and scattered, vision and hearing are mixed, meaning the Five Spirits lack a master. Yuan Qi is depleted, movements are weary, meaning the Four Elements are uncontrolled. The body's Primordial Yang is the root, generating True Qi. When True Qi gathers, there is health; when weak, disease arises. In Consumption, True Qi scatters, Primordial Yang flees. When Primordial Yang is exhausted, Pure Yin remains, leading to death. Qin An points out the major principle: only Sweet-Warm Yuan-Solidifying works, using Gan Jiang (Dried Ginger), Fu Zi (Aconite), and Gan Cao (Licorice), not Ren Shen (Ginseng), Huang Qi (Astragalus), or Bai Zhu (Atractylodes). Scholars must know this.

Ignorant practitioners often advocate dual tonification of Qi and Blood, some recommend large doses of Yin-nourishing herbs, others focus on clearing and moistening, others on resolving stagnation, etc. These methods kill people instantly. I am not boasting or arguing vainly; I must refute this.

[1] Lung (Fei) originally written as "", corrected according to context.
[2] Si Da originally written as "Ya", corrected according to context.

**Jue Syndrome (Reversal Condition)**

Regarding Jue Syndrome, there are Yang Jue and Yin Jue. What is Yang Jue? External pathogens enter internally, combining with heat transformation in Yang meridians. Extreme heat generates Yin phenomena; Yang is trapped internally, while Yin manifests externally, causing cold limbs, thread-like pulse, or absent pulse. Although the exterior appears purely Yin, the breath is hot to the touch, urine is short and red, and energy is not depleted. The treatment should focus on clearing heat and purging downward, such as Da Cheng Qi Tang (Major Order the Qi Decoction), Xiao Cheng Qi Tang (Minor Order the Qi Decoction), or Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).

What is Yin Jue? Righteous Qi is already deficient, Yin-Cold rises everywhere, Yin is excess and Yang is weak, blocking meridians so Yang cannot reach the limbs, causing cold limbs. The patient closes their eyes, lies fatigued, has shortness of breath, and reluctance to speak. Treatment should restore Yang and dispel Yin, such as Si Ni Tang (Four Reversals Decoction) or Hui Yang Yin (Restore Yang Drink). This concerns life and death between Yin and Yang, requiring distinction. [Marginal Note]: Zhi Fei says: Yin syndrome Jue indicates extreme internal injury; most can recognize it, and treatment is rarely wrong. Only Yang syndrome Jue, where extreme heat becomes cold, is misunderstood. Zhang Zhongjing has clauses for using Bai Hu Tang (White Tiger Decoction) for Jue, but few distinguish it. Qin An’s argument contrasts both, emphasizing Heat Jue. If scholars can identify Heat Jue, the reviewer is comforted.

**Delirious Speech (Chan Yu, 谵语)**

Regarding Chan Yu, there are Yin and Yang distinctions. Yang Chan Yu results from external pathogens trapping heat, which attacks the Heart (Xin, 心). Turbid fire disrupts the Spirit (Shen, 神), which loses mastery, causing random speech. Symptoms include wide-open eyes, insomnia, foul breath, coarse breathing, light body, aversion to heat, and preserved spirit. Mild cases may use Dao Chi San (Guide Out the Red Powder) plus Huang Lian (Coptis); severe cases may use Da/Xiao Cheng Qi Tang or San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction).

Yin Chan Yu results from deficient righteous Qi and sudden rise of Yin pathogens. The Spirit is blocked by Yin, causing unclear consciousness. The patient speaks randomly with closed eyes, has weak limbs, lies fatigued, fears cold, feels heavy, and sweats. Even if they desire one or two sips of cold water, the lack of spirit dictates restoring Yang. Do not assume cold water desire means using cooling herbs, or you will harm many. Accumulated Yin generates slight heat; once Yin transforms, heat vanishes. Treating here is superior.

I have successfully treated many cases regardless of fever, sweating, delirium, or thirst for cold water, provided there is a lack of spirit, using large doses of Hui Yang Yin. Hundred cures, hundred recoveries. [Marginal Note]: Zhi Fei says: Delirium is essentially spirit confusion and Qi depression; this theory is precise, treatment excellent. The statement "regardless of symptoms" is decisive. Seeing lack of spirit shows clear vision. Using large doses shows swift hands. Hundred cures show certain efficacy. Scholars must learn this skill and insight.

**Women's Medicine Section**

Women's medicine differs slightly from men's due to their Kun-Yin constitution and reproductive nature, specifically regarding menstruation, pregnancy, and postpartum conditions; otherwise, they are the same. Books detail this well. I have some insights into women's medicine and discuss them here to supplement existing texts. [Marginal Note]: Zhi Fei says: Women suffer more diseases than men due to extra organs. Though five leaks exist, ears and breasts need not be treated; menstruation is key. Treatment depends on knowing the root, which is Tai Yin (Spleen/Lung). Tai Yin corresponds to the moon. Fullness represents Yin advancing to Yang, governing growth; emptiness represents Yang retreating to Yin, governing decline. Growth requires Yang movement. Growth alone without release leads to life; decline alone without retention leads to death. Menstruation occurs monthly. Monthly descent is normal health. If Yang fails to move healthily, Kun-Yin essence does not store, leading to early periods. This is insufficient sun influence, weak Yang within Yin, not fire excess; do not use Huang Qin, Huang Lian, Zhi Mu, or Huang Bo. Late periods indicate insufficient sun influence, Yang deficiency within Yin; do not assume cold, avoid Si Wu Tang, Gui Zhi, or Fu Zi. Prolonged bleeding is not necessarily Bing (flooding); flooding is heavy and continuous, caused by Yuan Yang failing to exercise virtue, leading to uncontrolled essence flow. Do not judge solely by heat. Purple clots or pale color both indicate Yang insufficiency. Abdominal pain before or after menstruation indicates Yang deficiency and Qi stagnation. Virgin or married women with amenorrhea are due to deficiency; first support Yang, then promote circulation. Use Tao He Cheng Qi Tang (Peach Pit Order the Qi Decoction) relentlessly. Indulgence leads to Consumption in 100 days, incurable. Is this not the doctor's fault? Leukorrhea affects virgins and married women, not classified under menstrual disorders, nor Dai Mai (Belt Vessel) disease. It is either Bai Yin (white turbidity) or Cold-Dampness, foul and unbearable. Treatment should lift and disperse, not dry and parch, to avoid burning Yin essence. This is the decision for treating the root. Internal injuries and external infections can also damage Tai Yin. Apply these principles flexibly. Qin An categorizes meticulously, demonstrating broad knowledge. His brilliance lies in penetrating the mystery of Yang failing to transform Yin. He emphasizes "Yang," establishing strict laws, surpassing contemporary schools. Zhi Fei deeply admires this. Prenatal conditions return to Six Meridians; postnatal conditions exhaust Yin-Yang methods. Zhi Fei has nothing more to add.

**Early Menstruation**

Early menstruation (e.g., 17-18 days, 24-25 days) is often attributed in books to deficiency with heat, excess Qi, and treated with Si Wu Tang plus Huang Qin, Huang Lian, E Jiao, assuming blood heat clears and menstruation normalizes. I argue it is not always heat. Often, Yuan Qi is too deficient to carry blood, causing early descent. Patients show pale face, lack of spirit, shortness of breath, palpitations upon exertion, fine/weak or floating-empty pulses. Treatment should warm and solidify Yuan Qi, avoiding Huang Qin/Huang Lian/Si Wu Tang. If Si Wu Tang with Huang Qin/Huang Lian is appropriate, the patient must have robust spirit, frequent anger/depression, and energetic behavior. Distinguish carefully to avoid error.

**Late Menstruation**

Late menstruation (e.g., 37-38 days, 40-50 days, 2-3 months) is often attributed to deficiency with cold, contracted Qi, and treated with Si Wu Tang plus Gui Zhi/Fu Zi, assuming blood cold disperses with warmth. I argue it is not always cold. There are hidden bleedings. Hidden bleeding includes spontaneous sweating, night sweats, epistaxis, hematemesis, diarrhea, or poor appetite. Such patients must not be treated with standard regimens to induce menstruation. Assess the cause. If sweating occurs 4-5 days before menstruation, Qi floats upward instead of descending; sweat implies blood loss. If Wei Yang is insecure, secure it with Qi Fu Tang or Jian Zhong Tang. If internal heat steams outward causing sweat, cool it with Yi Yuan San or Sheng Di Si Wu Tang.

For night sweats, if Yin excess repels Yang, preventing storage and causing Qi float, treat with收纳 (collection), e.g., Feng Sui Dan or Qian Yang Dan. If blood heat steams outward, treat with clearing/moistening, e.g., Ji Zi Huang Lian Tang.

For epistaxis/hematemesis, if fire excess forces blood outward, use cooling herbs like Tao Ren, Di Huang, Xi Jiao Tang. If Yang deficiency fails to anchor Yin, causing blood rebellion, treat by supporting Yang and suppressing Yin, warming the middle and solidifying earth, e.g., Gan Cao Gan Jiang Tang, Qian Yang Tang, or Jian Zhong Tang.

For chronic diarrhea/poor appetite, Yuan Qi leaks downward, consuming Yin blood. Treat by warming the middle and consolidating. Poor appetite weakens transformation; Tian Zhen fluid fails to flow. Do not simply use standard methods for late menstruation.

External cold binding Ying and Wei Qi can also delay menstruation. Treat according to Six Meridians outlines. Eating cold/raw food or washing with cold water near menstruation can also delay it; inquire carefully.

**Prolonged Menstruation**

Prolonged menstruation involves Yuan Qi deficiency failing to control, or Chong/Ren vessel latent heat forcing blood recklessly.

If Yuan Qi is weak (due to vomiting/diarrhea, overuse of dispersing/draining herbs, sexual excess/worry), the patient lacks spirit in movement, pulse, and voice. Treat by warming/solidifying, e.g., Fu Zi Li Zhong Tang, Huang Qi Jian Zhong Tang, or Xiang Sha Liu Jun Zi Tang.

If Chong/Ren latent heat moves internally, preventing blood storage, the patient retains spirit. Treat by nourishing Yin and clearing heat, e.g., Huang Lian Xie Xin Tang or Sheng Di Qin Lian Tang. Grasp Yin/Yang to avoid error.

**Heavy Menstruation with Purple Clots**

Books attribute purple clots to excessive fire/heat, treating with cooling blood herbs like Sheng Di Si Wu Tang plus Huang Qin/Huang Lian. This may be correct if excess signs are present. However, if the patient is comatose, fatigued, short of breath, and spirit-depleted, it is Qi deficiency with blood stasis, Yang failing to transform Yin, causing Yin coagulation and purple color/clots. Do not use cooling herbs. Treat by warming/solidifying Yuan Yuan, e.g., Li Zhong Tang plus Xiang Fu, Gan Cao Gan Jiang Tang, or Jian Zhong Tang. While others say it is fire, I hesitate; judgment depends on the presence or absence of spirit. Careful analysis prevents error.

**Scanty Pale Menstruation**

Books attribute scanty pale menstruation to Blood Deficiency, treating with Si Wu Tang plus Ren Shen. I argue this indicates insufficient fire transformation and Yang decline. Strong Yang produces red blood; weak Yang produces pale blood. Abundant Yang yields abundant blood; deficient Yang yields scarce blood. This is a fixed principle. Treatment should support Yang to generate blood, following the principle of "Heaven One Generates Water." Why use only Si Wu Tang and Ren Shen (sweet-cold herbs)? Later generations failed to understand Yin/Yang balance. I recommend Huang Qi Jian Zhong Tang, Dang Gui Bu Xue Tang plus Fu Zi, or Gan Cao Gan Jiang Tang combined with Bu Xue Tang.

**Abdominal Pain Before Menstruation**

Books attribute pre-menstrual pain to blood stagnation, using Tong Zhi Tang or Tao Ren Si Wu Tang. These target blood stagnation. If heat stagnation, they work. If cold obstruction or raw food intake, prioritize warming the middle and moving stagnation. Do not rigidly apply these formulas. Distinguish to avoid error.

**Abdominal Pain After Menstruation**

Books attribute post-menstrual pain to deficiency with stagnation, using Ba Zhen Tang plus Xiang Fu. I consider post-menstrual pain has specific causes: external wind-cold or internal Yang weakness. Do not assume general Qi/Blood deficiency. If external wind-cold, expect aversion to wind/cold, fever, body ache; use dispersing methods like Gui Zhi Tang. If internal Yang deficiency, cold generates internally; expect preference for rubbing/warming; use interior-warming methods like Fu Zi Li Zhong Tang plus Ding Xiang and Sha Ren.

I often treat post-menstrual pain with pale face/lips using Gan Cao Gan Jiang Tang plus Ding Xiang and Guan Gui, or Bu Xue Tang plus An Gui, with certainty of effect.

**Amenorrhea**

Amenorrhea is critical. Diagnosis requires care. Slow/choppy pulses indicate amenorrhea. Smooth/vibrant pulses suggest pregnancy; do not announce pregnancy immediately. Verify marital status. If husband is present, confirm wife's status before mentioning pregnancy. If widow or husband absent long-term, or virgin past marriage age, verify carefully. Even with pregnancy pulse, if phlegm-fluid signs are absent (phlegm pulses are slippery), suspect amenorrhea. Within 2-3 months, use blood-breaking/fetus-consuming herbs to prevent conception, preserving family honor (merit). If treatment fails and fetus develops, it is unavoidable evil accumulation. If the family explains the situation, secretly help preserve dignity. For virgins nearing marriage, abortion may be necessary to avoid lifelong dependence and scandal. Choosing one over the other, though sinful, is excusable by circumstance. Sages weigh human emotion and heavenly principle.

Causes of amenorrhea vary: washing with cold water during period, eating cold food before period, anger/stress, inherent Spleen Qi deficiency, or external wind-cold.

**Cold Water Exposure:** Blood flows with warmth, congeals with cold. Cold water blocks Qi mechanism, stopping blood flow. Treat by warming meridians, e.g., Ma Huang Fu Zi Xi Xin Tang, Yang Dan Tang, or Bu Xue Tang plus Ding Xiang/Rou Gui.

**Raw Food Intake:** Tian Zhen fluid relies on Middle Jiao rotation for blood flow. Raw food accumulates in Middle Jiao, blocking rotation, preventing blood descent. Treat by warming the middle, e.g., Li Zhong Tang plus Sha Ren/Ding Xiang/Rou Gui, or Gan Cao Gan Jiang Tang plus Ding Xiang/Hu Jiao.

**Anger/Stress:** Anger causes Qi depression and stagnation. Stagnant Qi stops blood flow, causing closure. Treat by regulating Qi and soothing Liver, e.g., Xiao Chai Hu Tang plus Xiang Fu, Chuan Xiong, Mai Ya.