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I consider that the One Yuan True Qi (Yi Yuan Zhen Qi) is the Taiyang (Greater Yang). As Taiyang progresses further, it differs; progressing even further, it differs again. As it retreats one step, it differs; retreating two steps, it differs yet again. The form changes with every step, and the name changes with every step, containing many profound principles. Both external contraction diseases (Wai Gan) and internal injury diseases (Nei Shang) are fundamentally due to the damage of this One Yuan True Qi. What is most despicable is that people today claim that Zhang Zhongjing's formulas were established solely for winter cold damage (Shang Han), and not for internal injuries or miscellaneous diseases. Let me ask: Have cases of internal injury leading to blood loss or lung atrophy (Fei Wei) been cured by Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction)? Have vomiting and diarrhea been cured by Lizhong Tang (Regulate the Middle Decoction)? Have depression and liver qi stagnation causing distending pain in both hypochondria been cured by Xiaochaihu Tang (Minor Bupleurum Decoction)? Have nocturnal emission and spermatorrhea been cured by Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell)? Have kidney yang deficiency failing to warm, leading to water flooding and transforming into phlegm, been cured by Zhenwu Tang (True Warrior Decoction)? Have cold-dampness lower back pain been cured by Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction)? Have shortness of breath, reluctance to speak, fatigue, drowsiness, cough, and tidal fever been cured by Xiaojianzhong Tang (Minor Construct the Middle Decoction)? Have early-stage warm diseases (Wen Bing) been cured by Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), Ji Zi Huanglian Tang (Chicken Egg and Coptis Decoction), or Sini Tang (Recover the Extremities Decoction)? Have dysentery cases been cured by Baitouweng Tang (Pulsatilla Decoction) or Taohua Tang (Peach Kernel Decoction)? Have abdominal pain, vomiting, diarrhea, and cholera been cured by Lizhong Tang or Wuzhuyu Tang (Evodia Decoction)? Have women during menstruation or pregnancy been cured by Guizhi Tang (Cinnamon Twig Decoction)? Have early-stage smallpox/rash cases been cured by Guizhi Tang or Shengma Gegen Tang (Cimicifuga and Pueraria Decoction)? Have elderly patients with difficult, dry bowel movements been cured by Maren Wan (Semen Cannabis Pill)? Have yang deficiency leading to bloody stools been cured by Sini Tang? Have yin deficiency leading to purulent and bloody stools been cured by Ji Zi Huanglian Tang? People today do not carefully contemplate; they merely memorize a few generic formulas, applying Formula A to Disease A by increasing ingredients, or Formula B to Disease B by decreasing ingredients, and nothing more. They completely fail to understand the profound principles of yin and yang, and rarely comprehend the changes of the Six Channels (Liu Jing). Their skills deteriorate progressively, becoming utterly unacceptable.

Attached is a seven-character quatrain:

"Shang Han" establishes the bridge for diagnosis and treatment, hiding the wondrous principles of the six qi cycle.
If Changsha [Zhang Zhongjing] had not left this ray of hope,
How could there be medical practitioners today?

A question is asked: "Winter injury from cold leads to spring warm disease." What is the reason for this?

The answer is: "Winter injury from cold" refers to injury from the Taiyang Cold Water qi. Winter is when yang qi hides and stores, which is precisely the time of "Heaven generates One Water" (Tian Yi Sheng Shui). Young people, lacking wisdom, cannot restrain their desires. [Marginal Note: "Restraining desire" does not refer exclusively to sexual excess, but includes all matters that consume spirit and qi.] When Yuan Jing (Primordial Essence) is dissipated, it means Tian Yi is lost. Once Yuan Jing is dissipated, the essence is not stored in winter. If true water cannot be generated, the Dry Metal qi cannot be restrained. Therefore, when spring arrives, warm disease immediately arises. The second month belongs to Mao; Mao and You correspond to Yangming, where Dry Metal governs. If one can seal and store tightly—meaning storing essence in winter—Yuan Jing can generate true water, and Dry Metal will dare not act recklessly. Thus, one will not contract warm disease in spring. At this moment, using acrid-warm root-fortifying medicines should not be done hastily; treating according to the method of transmission on the second day is acceptable. Although so, one must seek details carefully, and cooling substances should not be used recklessly. Although the patient presents with high fever, thirst for cold drinks, and delirium, one must examine whether the pulse and voice have Shen (Spirit/Essence). [Marginal Note: Lack of Shen is not warm disease; presence of Shen is.] Observe the quantity of cold drink intake, whether stool is solid or not, and whether urination is free or obstructed. If there is Shen, Maxing Shigan Tang may be given; if there is no Shen, methods of returning yang and gathering/collecting may be used, thus avoiding fatal errors.

Brief Remarks on Differentiating Warm Diseases

Today, when people occasionally contract external pathogens in spring, presenting with fever, body ache, thirst for cold drinks, sweating, delirium, constipation, and aversion to heat, the whole world calls it "Warm Disease." They readily employ Dachuan Yin (Reach the Origin Decoction), Sanxiao Yin (Three Eliminations Decoction), Shengjie San (Ascend and Release Powder), Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), Da/Xiao Chengqi Tang (Major/Minor Order the Qi Decoctions), Puji Xiaodu San (Universal Benefit Detoxification Powder), and various other methods. I ponder that these treatments are all for treating Guest Pathogens (Ke Xie). [Marginal Note: "Guest Pathogen" means wind guest in spring, fire guest in summer, dampness guest in summer, consistent with the six qi climate theory.] From Taiyang moving to Yangming, lying dormant without transmitting, gradually entering the interior of Yangming, using these methods is indeed appropriate. One must absolutely not call it "Warm Disease," but rather say wind pathogen injured Taiyang, moving from Taiyang to Yangming. Wind is a yang pathogen; combining with Yangming's dry-heat, it transforms into a mass of heat pathogen. Heat excess injures yin, presenting as excess qi, excess pulse, light body, and coarse breathing. Only cooling, yin-nourishing, and purging methods are suitable. However, "Warm Disease" occurs because winter essence was not stored, damaging the root first. This bit of yuan qi vents out with wood qi. The condition resembles external contraction, but careless physicians fail to notice, treating with dispersing and cooling methods; nine out of ten die. I have practiced this profession for over thirty years and now begin to recognize the shape of the condition and the corresponding medication methods, stating them all here. When a patient first contracts the disease, they feel dizzy, lack strength throughout the body, have fever but no body pain, no thirst, feel drowsy, have no tongue coating, full mouth saliva, yet faint green light under the tongue; or if thirsty, prefer hot drinks; or if wanting cold drinks, only take one or two sips; or if delirious, the person is quiet with eyes closed; or if wanting to walk like a madman, the body is light and weak; or if bowels/bladder obstructed, lying tiredly, silent; or if sweating, the voice is low and breath short; or if face red, the breath is mild; the six pulses are surging but ultimately powerless; or if eyes red and throat dry, completely refusing cold drinks, loose stools, free urination. Even if taking cooling, purging, or ascending-releasing medicines, the heat never subsides, and the spirit never clears. Only returning yang and gathering methods can help.

I have experienced many such cases and know them at a glance. Severe cases require more than ten doses to show effect; mild cases resolve in one or two doses. It is a pity that the world fears Ginger and Aconite and lacks firm trust. Do they not recall the ancients saying, "Sweet-warm can remove great heat"? This was established for yuan qi venting outward, and thus for Warm Disease. Today's people do not distinguish yin and yang; when conditions appear similar, they treat indiscriminately. Seeing fever, they say "external contraction" and use Ascending-Release. Seeing fever persist, they use cooling-yin-nourishing and purging. Seeing bowel/bladder obstruction, they use draining methods. They kill patients without realizing it, due to insufficient knowledge. Here, I record dozens of yin-deficiency and yang-deficiency conditions for future reference.

Differentiating Conditions of Excess Evil, Blazing Heat, and Blood Injury

Unremitting Dry Retching

On the 2nd or 3rd day, fever persists, pulse and voice all show Shen, with unremitting dry retching. This is heat congestion in Yangming. The method should be releasing the muscle layer and clearing heat.

Wide-eyed Delirium

On the 4th or 5th day, fever and aversion to heat, restlessness, wide-eyed insomnia, occasional wild speech, with strong pulse. This is excess heat pathogen qi; qi tends to rise, hence wide-eyed insomnia and frequent delirium. This belongs to evil heat assaulting the heart, causing spirit confusion. The method should be clearing heat. Once heat clears and righteous qi recovers, wide-eyed delirium stops naturally. If eyes are closed while delirious, and pulse is empty/lacking Shen, one must return yang; nourishing yin is contraindicated.

Unremitting Thirst for Cold Drinks

On the 6th or 7th day, fever persists, pulse is surging and forceful, with unremitting thirst for cold drinks. This is extreme evil heat injuring fluids. The method should focus on extinguishing fire and preserving yin.

Profuse Sweating Like Rain

On the 6th or 7th day, fever with sweating like rain, large forceful pulse, bad breath, coarse breathing, loud voice, thirst for cold drinks. This is heat steaming internally, stomach fire blazing. The method should urgently clear muscle-layer heat. This is an excess syndrome, not comparable to prolonged illness losing yang.

Dry Yellow Tongue Coating with Restlessness

On the 7th or 8th day, fever persists, dry yellow tongue coating, restlessness, strong pulse, light body, intestines/stomach already solid. This is excessive stomach fire, fluids about to dry up. Urgently prioritize nourishing yin and purging.

Mad Shouting Ignoring Kinship

On the 8th or 9th day, fever persists, coarse breathing, light body, strong pulse, mad shouting, ignoring kinship, discarding clothes and running. This is extreme evil fire disturbing the spirit, leaving it without master. Urgently apply cooling and purging to extinguish the evil fire; do not delay.

Obstruction of Bowels and Urine

On the 7th or 8th day, fever and aversion to heat, restlessness, thirst for cold drinks, strong pulse, light body, obstruction of bowels and urine. This is evil heat injuring yin, blood unable to moisten the channels, the whole body a mass of evil fire. Urgently purge; do not delay.

Nose Like Coal Smoke

On the 8th or 9th day, fever persists, restlessness, thirst for cold drinks, chest fullness, anorexia, bad breath, coarse breathing, suddenly nose appears black like coal smoke. This is due to extreme evil fire flaming upward. Urgently purge.

Anus Feeling Like Scalding

On the 10th+ day, fever persists, strong pulse, coarse breathing, restlessness, incessant drinking, feeling anus is scalded. This is evil heat attacking the Large Intestine downward, with true yin facing imminent destruction [1]. Urgently purge; do not procrastinate or show mercy.

Dribbling Painful Urination

On the 8th or 9th day, fever and aversion to heat, irritability/thirst for cold drinks, yellow tongue with prickles covering the mouth, strong pulse, light body, dribbling painful urination. This is evil heat trending downward to the Small Intestine, knotting in the Bladder. Urgently clear heat and promote urination.

Vomiting Immediately After Eating

Fever and aversion to heat, bad breath, coarse breathing, strong pulse, vomiting immediately after eating. This is evil heat lurking in the stomach opening, blocking its descending mechanism. Heat tends to rise; currently evil heat dominates, rising more than descending, hence vomiting after eating. Urgently attack the evil fire; once extinguished, food will descend naturally.

Coma and Unconsciousness

On the 8th or 9th day, body [2] fever persists, coarse breathing, dry tongue, short dark urine, very yellow loose stool, or clear/bloody water, pulse strong or fine as a thread, or four [3] limbs cold [4]. Though comatose, breath feels hot to touch, tongue root is red and lively, even if tongue is black with prickles. This is evil heat entering the interior, lurking inside. Urgently purge and clear the interior; absolutely do not recklessly use acrid-warm herbs.

Afternoon Fever, Thirst for Cold, Delirium About Gods/Spirits

On the 8th or 9th day, or 10+ days, external pathogen unresolved, entering the interior. Body has fever, worse in the afternoon, incessant thirst for cold drinks, delirium about gods/spirits. This is severe heat injuring blood, spirit confused and masterless. Urgently nourish blood and yin. This is not comparable to yin fire soaring or yuan qi venting outward.

Unremitting Hiccups

On the 8th or 9th day, fever persists, thirst increases, drinking continues, suddenly hiccups occur continuously. This is due to evil heat blocking the middle, obstructing the communication of qi mechanism. The method should be purging.

Nosebleed Like a Spout

Fever, irritability, obstruction of bowels/urine, bad breath, coarse breathing, suddenly nosebleed like a spout, fever worsening. This is due to extreme evil fire forcing blood to move recklessly. The method should clear heat and purge. If bleeding stops heat and bowel movement resumes, it is a good omen of recovery.

Frequent Eruption of Macules/Rashes

Fever persists, irritability, thirst for cold, coarse breathing, strong pulse, loud voice, irritability/thirst for cold, occasional trance, dry cough, sticky saliva. This is fire excess/fluid depletion, heat pressing on the lungs. Prioritize moistening dryness, clearing metal, and purging fire.

Throat Pain and Cold Extremities

On the 8th or 9th day, fever persists, or no body heat, strong pulse, light body, extremely hot breath, short dark urine, declining spirit, dry/coarse skin, suddenly throat pain and cold extremities. This is evil entering Jueyin, deep heat causing deep cold, attacking upward causing throat bi. Urgently prioritize clearing/moistening, purging fire, and nourishing yin.

Unremitting Downward Flow of Pus and Blood

On the 8th or 9th day, body fever persists, or no body heat, intermittent irritability/thirst, intermittent cold extremities, restlessness. This is Jueyin evil heat attacking the intestines downward. The method should prioritize clearing fire and nourishing yin.

Dry/Coarse Skin and Hair

On the 7th or 8th day, fever persists, or no body heat, necessarily irritability/energy decline, short urine, dry throat, suddenly dry/coarse skin, withered hair. This is evil fire injuring yin, blood losing circulation. Urgently prioritize purging fire and nourishing yin.

Tendon Cramping and Contraction

On the 7th or 8th day, or 10+ days, fever persists, or no body heat, irritability/thirst/dry throat, short dark urine, aversion to heat/preference for cold, suddenly limbs contract and become insensible. This is due to evil fire injuring yin, blood failing to nourish tendons, hence contraction. The method should prioritize nourishing yin and purging fire.

Scrotum Like a Bucket

On the 10+ day, body heat unresolved, or no body heat, strong pulse, light body, heart vexation/thirst, loud voice, suddenly scrotum red/swollen, large as a bucket, extremely painful. This is heat pathogen attacking the Zongjin (Girdle Vessels); the Zongjin meridians pass through the scrotum. Urgently prioritize purging fire, nourishing yin, and nourishing liver.

Red Patches All Over Body

Body heat, strong pulse, restlessness, suddenly red patches all over body, extremely painful/itchy. This is evil heat congested in muscles. Prioritize releasing muscle layer, clearing heat, and purging fire.

Body Cold as Ice, Form Like a Dead Person

On the 8th or 9th day, initially fever/thirst/cold drinks, obstruction of bowels/urine, restlessness/delirium, suddenly body cold as water, form like a dead person. This is extreme heat lurking internally, yang qi unable to reach the exterior, syndrome resembling pure yin. Examining and treating now requires care; seek clues in the breath and bowels/urine. I have experienced many cases: though breath is faint, it is extremely hot to touch, tongue root is red not cyan, urine is short/dark. Urgently purge; do not procrastinate. Absolutely do not recklessly use Ginger/Aconite.

Head/Face Swelling and Pain

On the 2nd or 3rd day, head/face swelling/pain. This is evil heat congested in the Three Yang channels. Urgently prioritize scattering/clearing heat.

The above dozens of items briefly outline the general situation; there are many other fire syndromes. Some require sweet-cold yin-nourishing methods, some bitter-cold purging-to-preserve-yin methods, some cooling-yin-nourishing methods, some diuretic-yin-nourishing methods, some moistening-dryness-saving-yin methods, some sweet-warm returning-yang-saving-yin methods. Various and numerous, relying entirely on temporary adaptation. In short, Righteous Qi sustains life, Evil Qi causes death. Using yin-nourishing methods etc. is stated for Yang Syndrome Evil Fire, not for Yin Qi soaring Yin Fire. Know that Yang Syndrome Evil Fire presents with Shen in pulse, breath, and voice. If Yin Qi soaring Yin Fire, pulse, breath, and daily activities all lack Shen, with full yin signs. This is the key to differentiation, which must not be ignored.

Differentiating Conditions of Yin Excess/Yang Deficiency and Yang Collapse

Splitting Headache

Those with inherent yang deficiency, having no other suffering, suddenly experience splitting headache. Often lips/clavicles are cyan/black, or gasping asthma, or floating/empty pulse, or hard as stone. This is yang exhaustion at the upper part. Urgently return yang and gather; 4-5 out of 10 may be saved.

Cracking Eye Pain

Examined as not external contraction, not evil fire attacking upward, or pulse same as above, condition similar in 1-2 aspects. Urgently return yang. If nourishing yin and releasing, death ensues.

Ear Itching to Death

Examined as no bitter taste/dry throat, alternating chills/fever, thus not Liver/Gallbladder disease. This is Kidney qi soaring, attempting to escape via ears. Must have sufficient yin signs. Urgently return yang and gather.

Forehead Bright as Mirror

In prolonged illness with extreme deficiency, suddenly forehead bright as mirror. This is yang exhaustion at the upper part, sign of imminent death. If not thoughtfully rescued, urgently use large dose to return yang and gather. If brightness收敛s and diet gradually increases, spirit strengthens after 7 days, there is vitality. Otherwise, do not promise.

Lips Red as Vermilion

In prolonged illness with extreme deficiency, no evil fire signs, suddenly lips red as vermilion. This is true yang escaping via lips, sign of imminent death. Urgently take returning yang medicine; 2-3 out of 10 may be saved.

Red Cheekbones

Prolonged illness or inherent insufficiency, red cheekbones. This is true yuan exhausted at the upper part. Urgently return yang and gather; mis-treatment leads to death.

Runny Nose

In prolonged illness with extreme deficiency, suddenly runny nose. This is yuan qi about to collapse, sign of imminent death. Urgently return yang and gather; perhaps 1-2 saved.

Mouth Open, Air Escaping

In prolonged illness with extreme deficiency, suddenly mouth open with air escaping. This is yuan qi about to cease, sign of imminent death. Treatment is considered untreatable; if wishing to save, urgently return yang and gather to do one's utmost.

Sunken Eye Bags

In prolonged illness, suddenly sunken eye bags. This is five zang yuan qi exhausted at the lower part, imminent death. Treatment is untreatable. If wishing to save, urgently use large dose returning yang; perhaps 1-2 out of 10 saved.

Blue White of Eye Wheel

In prolonged illness with deficiency, suddenly blue white of eye with no spirit in person. This is true yang extremely depleted, sign of death. Urgently return yang; 5-6 out of 10 may be saved.

Eyes Swollen Like Peaches

Prolonged illness or inherent insufficiency, suddenly eyes swollen like peaches, whole body pure yin, no trace of evil fire/wind-heat danger. This is yuan qi escaping from eyes. Urgently return yang and gather; safety can be ensured.

Constant Staring Eyes

In prolonged illness with extreme deficiency, suddenly constant staring eyes. This is true qi about to cease, unable to move, treated as death case. If wishing to save, urgently return yang; perhaps 1-2 out of 10 saved.

Brilliant Light in Eyes

Prolonged illness or inherent insufficiency, constantly seeing five-color brilliance before eyes. This is five zang essence/qi venting outward, yang qi not storing, also a death case. Urgently return yang and gather; 5-6 out of 10 may be saved.

Radiant Complexion

In prolonged illness with deficiency, suddenly radiant complexion, like a healthy person. This is true yang exhausted at the upper part, sign of imminent death. If wishing to save, urgently return yang. If brightness收敛s and spirit slightly strengthens, unchanged after 7 days, then there is vitality. Otherwise, untreatable.

Face Like Withered Bone

In prolonged illness with extreme deficiency, suddenly face like withered bone. This is true yuan ceased, essence/qi completely gone, sign of imminent death. Prepare funeral arrangements; urgently take returning yang; perhaps 1-2 out of 10 saved.

Face Red as Vermilion, Face Red Like Bruise, Face White as Paper, Face Black Like Coal, Face Cyan Like Withered Grass.

In prolonged illness with extreme deficiency, no evil fire signs, suddenly face red as vermilion. This is true yang exhausted at the upper part. Treatment is untreatable; only returning yang method might save 1-2 out of 10. Others like bruise, paper, coal, withered grass are all death cases; do not force treatment.

Tooth/Gum Bleeding

Those with inherent yang deficiency, no evil fire signs, full yin signs, suddenly gums/tooth bleeding. This is kidney yang deficiency, unable to control blood, yin blood overflowing. Only supporting yang and gathering is best. Treating with yin-nourishing Liuwei Dihuang Tang accelerates danger.

Gum Swollen Like Eggplant