更有一等内伤日久，元阳久虚，而五脏六腑之元气，已耗将尽，满身纯阴，先天一点真火种子，暴浮于上，欲从两耳脱出，有现红肿痛极欲死者，有耳心痒极欲死者，有兼身痒欲死者。其人定见两尺洪大而空，或六脉大如绳而弦劲。唇舌或青，或黑，或黄，或白，或芒刺满口，或舌苔燥极，总不思茶水，口必不渴，即渴喜极滚热饮，二便如常，甚者爪甲青黑，气喘促，或兼腹痛。此等病情，法宜大剂回阳，不可迟缓，缓则不救。大凡现以上病情，不独耳疾当如是治，即周身关窍、百节地面。或疮或痛，皆宜如是治。如白通、四逆、回阳等方，急宜进服，以尽人事，勿谓之小疾耳。[眉批]耳之部，左右皆属少阳。一见耳病肿痛，用少阳方小柴胡汤治之，似无不效。饮安复指出多般耳证治法，各不相同，辩认均有凭据。如按中或言肝胆风火，或言忿怒抑郁，或言阳虚阴上，或言水虚火上。岂出六经之外而别具手眼乎？非也。耳本少阳之部，一定不移，而少阳之气机升降，则随所感而变见于耳部，其病情决不相类。良以少阳之气，根于至阴。识得至阴之气，发为少阳之气，随所感而变见，又必有阴阳变证之凭
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据可察。故治法虽多，或进而从阳，外因外治也，或退而从阴，外因内治也，总是治少阳耳病之一法。盖得六经之根底，从仲景不言之奥，充类至尽，神明变化而出，可谓善读古书者矣，学者读其书，通其意，临证审察，就其所已言，而更穷其变，将必愈有通于其所未言者，而生出治法，以活人病，快何如之，故饮安小注补出，不独耳病当如是治云云，是又在学者之善读钦安者耳。
近来市习，一见耳肿，不问虚实，不辩外内，即以人参败毒散，加大力、连翘、银花、蒲公英，外敷三黄散，与蓝靛脚之类。果系外感风热闭塞而成，立见奇功。若系内伤阴阳大虚，元气外越之候，则为害最烈。
更有耳鸣耳聋，辩认不外阴阳两法。但耳聋一证，老人居多，由肾阳久亏，真气不充于上故也。定不易治。若由外感时气，卒然闭塞清道者，进邪一去，渐渐能聪，不药可愈。亦有痰火上升为鸣为聋，定有痰火情形可征，按痰火法治之必效。理本无穷，举其大纲，苟能细心研究，自然一见便识也。
鼻 流 清 涕
按鼻流清涕一证，有从外感而致者，有从内伤而致者。
从外感而致者，感受外来之客邪，客于肺经，闭其清道，肺气不得下降，清涕是出。其人定现发热，恶风、恶寒，头疼身痛等情。法宜宣散，如桂枝汤、麻黄汤、葛根汤之类。
从内伤而得者，由心肺之阳不足，不能统摄津液。而清涕出。市人称为肺寒，称为陈寒，由其不知阳衰而阴寒即生也。肾络通于肺，肾阳衰而阴寒内生，不能收束津液，而清涕亦出。其人定无外感足征，多困倦无神，或忿嚏不休，或畏寒，或两脚冷，法宜扶阳，如麻黄附子细辛汤、姜桂汤、阳旦汤之类。若久病之人，忽然清涕不止，又见壮热，汗，气喘唇青，脉劲浮空，乃亡阳欲脱之候，争宜回阳。缓则不救。然亦十中
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仅救一二。[眉批]知非氏曰：夫涕，本脏腑所生，皆阴类也。《经》曰：水宗也，积水也。积水者，至阴也。至阴者，肾之精也，指涕泣而言。又曰，宗精之水，所以不出者，是精持之也，辅之裹之，故水不行也。指平人不流始涕而言。又曰：涕泣者，脑也。脑者，阴也。髓者，骨之充也。故脑渗为涕。志者，骨之主也。是以水流而涕从之者，其行类也。此指人之所以有涕而言。以外感论，客邪中其经，闭其清道，则阳气并于上而下降，阴气并于下而不升。阳并于上则火独亢也。阴并于下则脚寒，脚寒则胀也。夫一水不胜五火，故鼻流清涕，盖气并于鼻，冲风涕下而不止。以内伤论，夫水之精为志，火之精为神，七情所感，神志纷弛，水火不济，阴精失守，久而津液无所统摄，故清涕亦出。此神之伤，志之夺也。钦安论治，洞达本原，明晰旁流，推及渊浊二证，甚则流红，皆此物此志也，学者入理深造，譬[1]之射矢诸正鹄，医之正宗在此。
查近来市习，一见鼻流清涕，不分内外，一味发散，多经参苏饮、人参败毒、九味羌活、辛夷散等方，外感则则可，内伤则殆。
其中尚有鼻渊、鼻浊二证，俗云：，髓之液也。不知髓乃人身立命之物，岂可流出乎。然二证虽有渊渊者，流清涕，经年累月不止。浊浊者，其色如米泔，或如黄豆汁，经年累月不止。之分，缘由素禀阳虚，心肺之阳衰，而不收束津液故也。不能统摄津液，治之又一味宣散，正气愈耗而涕愈不休。清者，肺寒之征；肺阳不足也。浊者，肺热之验。但肺热者，必有热形可征，如无肺热可征，则是上焦化变之机失职，中宫之土气上升于肺，肺气大衰，而化变失权，故黄涕作。治之须有分别。予治此二证，每以四砂一两、黄柏五钱、炙草四钱，安桂、吴萸各三钱治之。一二剂即止。甚者，加姜、附二三钱，屡屡获效。即甘草干姜汤，加桂尖、茯苓亦可。
又尚有鼻血一证，有由火旺而逼出，定有火形可征，如口渴饮冷，大小便不利之类。法宜清火攻下，如大小承气、犀角地[2]黄汤、导赤散之类。
[1] 譬原本作"譬"，据文义改。
[2] 地原本作"此"，据文义改。
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有元[1]阳久虚，不能镇纳僭上阴邪，阴血外越，亦鼻血不止。不仅鼻血一端，如吐血、齿缝血、耳血、毛孔血、便血等。其人定无火形可征，二便自利，唇舌淡白，人困无神。法宜扶阳收纳，如潜阳、封髓、甘草干姜或加安桂、吴萸之类。学者切切不可一味见病治病，务要将内外病形，阴阳实据，熟悉胸中，方不致误人性命也。[眉批]医之本领，人之性命，端在于此，故于学者三致意焉。
鼻 孔 煽 动
按鼻孔煽动一证，有因外感风寒闭塞而致者，有因胃中积热而致者，有元气将绝而致者。
因外邪闭塞而致者，由外感风寒之邪，闭其肺经外出之气机，气机欲出而不得出，壅于肺窍，呼吸错乱，而鼻孔煽动，其人定见发热身疼。法宜宣散，如荆防败毒散、麻黄汤、定喘汤，皆可选用。[眉批]鼻孔而致煽动，其势亦云亟矣，虽因外感，用药深皆留神。
因积热上攻而致者，或由饮食停滞中脘，或由过食煎炒椒姜，胸中素有蓄热，热攻于肺，气机错乱，而鼻孔煽动。法宜清热，如大小承气、三物备急丸之类。
因元气欲绝而致者，由其人元气久虚，或又大吐大泻，大热汗出，面白无神，奄奄欲绝，而见鼻孔煽动。法在不治。欲救之，急宜回阳收纳，温固脾肾元气，十可救一二。惟此条证候，小儿居多，大人却少，医者切切不可一味宣散，总要细细区分，辩明为准。[眉批]分阴分阳，医之要者，故致叮咛。
[1] 元原本作"光"据文义改。
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唇 口 红 肿
按唇口红肿一证，有胃火旺极者，有元阳浮者。
因胃火旺而致者，其人定见烦渴饮冷，恶热，或二便不利，或由积滞太重，抑郁生热，或过食醇醴辛辣，不尽属外邪而成。若兼外感，必有外感可征。挟外感者，可与麻杏石甘汤、升麻葛根汤。无外感者，可与人参白虎、凉膈散、大小承气之类。积滞者，可与平胃加莪术、丑牛、大黄之类。
若久病之人，元阳外越，气机上浮，其人定见满身纯阴实据。其中唇色有红而含青、含黑、惨红、老红、嫩红等形。亦有兼见面如桃花，面色光泽夺目，人困无神，皆是脱绝危候。法在不治之例。若欲救之，急宜收纳为主，如潜阳、回阳、白通、金匮肾气等方，服一二剂。如红光彩收回，可许重生[1]，否则旦夕之间耳。切宜早推，勿治为上。[眉批]知非氏曰：唇字从辰从口，其气机从寸地而发至于辰，辰为春三月，于卦为夬，阳气上胜之象，唇口即其部位也。知其部属阳，其气喜升，不受阴寒凝滞，故见红肿之疾，甚则糜烂而痛，决非实证，钦安示人审兼证通其变也。知非从而切其源，谓其独也。通其变，识其独，知其生，决其死，[2]医之法亦基之矣。
近来[ 2 ]粗工，一见唇口红肿，不辨虚实，即以大黄、石膏等治之，实症立生，虚症立毙，不可不知也。其中尚有兼见流口水不止者，即在口气冷热处与病形求之，便得阴阳之实据也。
齿 牙 肿 痛
按齿牙肿痛一证，诸书有十二经之分，其实在可从不可从之例。总之以有余、不足为主。然有因风火抑郁而致者，
[1] 生原本作"主"，据文义改。
[2] 死原作"免"，据文义改。
[3] 来原本作"不"，据文义改。
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有因胃中积热而致者，有真阳虚而队气上攻者，有元阴虚而元阳为害者。
因风火抑郁而致者，先有发热、身痛可征。法宜宣散，中、如升阳散火汤、消风散、清胃散、麻杏汤之类。
因积热上攻而致者，定多饱闷吞酸，口渴饮冷，面赤唇红，气粗蒸手。法宜去其积滞为主，如平胃散加大黄、石膏、丑牛、槟榔之类。
因真阳虚而阴气上攻者，其人齿牙虽痛，面色必青白无神，舌多青滑黑润、黄润、白黄而润，津液满口，不思荼水，口中上下肉色，多滞青色而不红活，或白惨黄而无红色。以上等情，不仅此症，一切阳虚病多见此情。法宜扶阳抑阴，如[1]白通汤、姜桂饮、阳八味、潜阳丹之类。
因阴虚而火邪为病者，其人定多心烦饮冷，便赤等情。法宜养阴，如六味地黄汤、鸡子黄连汤、导赤散之类。
近来市习，一见牙肿齿疼，便以生地、细辛、防风、荆芥、石斛、知母、石膏、玄参、 丹皮、狗地牙等治之。风火则可，阳虚则殆。[眉批]齿牙肿痛，本属小证，然有经年累月而不愈者，平时若不究明阴阳虚实，治之未能就痊，未免贻笑大方，学者勿因其小而失之。
口 臭 附口苦、口酸、口辛、口甘、口淡、口糜
按口臭一证，有胃火旺极而致者，有阴盛而真精之气发泄者。
因胃火旺而致者，其人必烦躁恶热，饮冷不休，或舌苔芒刺，干黄、干黑、干白等色，气粗汗出，声音响亮，二便不利，法宜专清胃火，如人参白虎、大小承气、三黄石膏汤之类。
[1] 如原本作"却"，据文义改。
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因精气发泄而致者，由其人五脏六腑元阳已耗将尽，满身纯阴，逼出先天立命一点精气，势已离根欲脱，法在不救。口虽极臭，无一毫火象可凭，舌色虽黄，定多滑润，间有干黄、干黑，无一分津液于上，而人并不思茶水，困倦无神，二便自利，其人安静，间有渴者，只是喜饮极热沸汤。以上等形，俱属纯阴。若凭口臭一端，而即谓之火，鲜不为害。予曾治过数人，虽见口臭，而却纯阴毕露，即以大剂白通、四逆、回阳等方治之。一二剂后，口臭全无，精神渐增，便可其可愈。若二三剂后，并不见减，十中仅求得一二，仍宜此法重用多服，此是病重药轻，不胜其任也。昧者只图速效，服一二剂未见大效，便即更医，如此之情，举世皆然，岂真医药之不良哉。[眉批]知非氏曰：气之香薰者，清阳之气也。气之臭恶者，浊阴之气也。口臭缘浊阴极盛，阳气之用不宣，多有涎垢浊腻，譬如暑天，阴雨过甚，天阳被郁，凡物发霉起涎，其气臭恶，若得数日炎热，臭气顿失。人身遍体纯阴，所以真阳厥脱之候，往往现此证象。医识此理，便能治此证。钦安窥见其微，故按中反复征引言之，学者不可忽略看过。
查近市习，一见口臭，并不辩明阴阳，便以生地、二冬、知母、花粉、石膏、大黄之品投之，阳盛则生，阳盛则毙，不可不知也。
其中尚有口苦者，心胆有热也。心热者，可与导赤散、黄连汤。胆热者，可与小柴胡汤倍黄芩，或泻肝汤。口酸者，肝有热也，可与当归芦荟散、龙胆泻肝汤。口辛者，肺有热也，可与泻白散、清肺饮。口甘者，脾气发泄也，可与理中汤、六君子汤。口淡者，脾气不足也；可与归脾汤、参苓白术散。口糜者，满口生白疮，系胃火旺也，可与甘露饮、凉膈散。以上数证，皆宜知之。总在考究阴阳实据为要。予尝治阳虚阴盛之人，投以辛甘化阳二三剂，即有现口苦、口酸、
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口淡、口辛、口甘等味，又服二三剂，而此等病形即无。予仔细推究，皆缘真阳失职，运转力乖，兼之服药停积未法，令得辛甘化阳之品，运转复行，积滞即去，故口中一切气味出矣。[眉批]真阳变动，露出真面，辛甘助化，易危为安，药之为力不浅，然此等至理，少有见到者。昧者不识此理，见酸即治酸，见苦即治苦，鲜不增病，医理之微，不诚难哉。
舌肿、舌痛、重舌、舌强、舌麻、舌木、舌缩
按舌证虽有数端，不外阴阳两法。如肿痛与重者，气之有余也。气有余，便是火，必有火形可征。如缩与强，麻木者，气之不足也，气不足，便是寒，定有阴寒情形可验。治肿痛与重，不外清热一法，如黄连解毒汤、导赤散、大小阴气、黄连泻心汤之类。治缩与麻木、强，不外扶阳祛阴，化痰降逆一法，如白通汤、姜桂饮、黄芪建中汤、麻黄附子细辛汤、半夏干姜汤之类。[眉批]化痰何以不用橘皮、南星、礞石、须知仲景六经方中无此品类，或者汉时尚未出此药耶一噱。
There is another category where internal injury has persisted for a long time, the Primordial Yang (Yuan Yang) has been deficient for a long time, and the Yuan Qi (Original Qi) of the five zang organs and six fu organs has been exhausted. The entire body presents as pure Yin. The seed of the True Fire (Zhen Huo) of the congenital constitution floats violently upwards, seemingly about to escape through the ears. Some present with severe redness, swelling, and pain in the ears, even life-threatening; some present with extreme itching in the ear canal, even life-threatening; some are accompanied by whole-body itching, even life-threatening. These patients will definitely show two Chi (Cun Guan Chi pulse positions at the wrist) pulses that are surging but empty, or all six pulses that are large like ropes and wiry and tense. The lips and tongue may be blue, black, yellow, or white, or covered with prickles throughout the mouth, or the tongue coating is extremely dry, yet there is no desire for tea or water, and the mouth is certainly not thirsty. Even if thirsty, they prefer extremely hot drinks. Urination and defecation are usually normal. In severe cases, the fingernails turn blue-black, there is rapid breathing, or abdominal pain accompanies it. For such conditions, the treatment principle should employ large doses of formulas to restore Yang and rescue from collapse, without delay; delay means non-survival. Generally, for any condition presenting as above, not only ear diseases should be treated thus, but also any lesions on the joints, bones, muscles, skin, whether sores or pain, should be treated this way. Formulas such as Baitong Decoction (Bai Tong Tang), Sini Decoction (Si Ni Tang), and Yang Hui Jiu Ni Decoction should be administered urgently to do one's utmost, and should not be dismissed as minor ailments. [Marginal Note] The ear region belongs to the Shaoyang (Lesser Yang) channel on both sides. Upon seeing ear disease with swelling and pain, using the Shaoyang formula Xiaochaihu Decoction (Xiao Chai Hu Tang) seems invariably effective. Yin Anfu pointed out various methods for treating different types of ear syndromes, which differ from each other, and each identification has its basis. If following TCM theory, some say it is Wind-Fire of the Liver and Gallbladder, some say it is anger and depression, some say it is Yang deficiency with Yin counterflow, some say it is Water deficiency with Fire hyperactivity. Does this go beyond the Six Channels differentiation? No. The ear inherently belongs to the Shaoyang channel, which is fixed. However, the Qi mechanism of Shaoyang ascends and descends, changing and manifesting in the ear region according to the pathogenic factors received, so the clinical presentations are definitely not similar. This is because the Qi of Shaoyang is rooted in Extreme Yin. Recognizing that the Qi of Extreme Yin manifests as the Qi of Shaoyang, changing and appearing according to the pathogenic factors, requires evidence of Yin-Yang transformation syndromes to observe. Therefore, although treatment methods vary, whether advancing to treat from Yang (addressing external causes via external therapy) or retreating to treat from Yin (addressing external causes via internal therapy), these are all methods for treating Shaoyang ear diseases. Essentially, mastering the foundation of the Six Channels, comprehending the profound secrets unspoken by Zhang Zhongjing, pushing the deduction to the limit, and achieving divine variation, one can be said to be good at reading ancient books. Students who read his works, understand their meaning, examine carefully during clinical practice, and explore variations beyond what is explicitly stated will surely gain deeper insight into what was not said, thereby generating new treatment methods to save patients. What joy could surpass this! Thus, Yin Anfu's marginal note supplements that not only ear diseases should be treated this way. This depends on whether students can skillfully read Qin'an's (Zheng Qin'an) works.
Recently, the common medical practice is: upon seeing ear swelling, regardless of deficiency or excess, internal or external, practitioners use Renshen Baidu San (Ginseng Detoxification Powder) added with Niu Bang Zi (Arctii Fructus), Lian Qiao (Forsythiae Fructus), Yin Hua (Lonicerae Flos), Pu Gong Ying (Taraxaci Herba), and apply San Huang San (Three Yellows Powder) externally, along with Lan Dian Jiao (Indigo Foot). If caused by external contraction of Wind-Heat blocking the pathways, miraculous effects are seen immediately. However, if it is due to internal injury causing severe deficiency of Yin and Yang, with Yuan Qi floating outward, the harm is most severe.
Furthermore, for tinnitus and deafness, differentiation does not exceed the two methods of Yin and Yang. Deafness is mostly seen in the elderly, caused by long-term deficiency of Kidney Yang, preventing True Qi from filling the upper orifices. This is definitely difficult to treat. If caused by external contraction of epidemic pathogens suddenly blocking the clear orifices, after expelling the pathogen, hearing gradually recovers, and it can heal without medication. There are also cases where Phlegm-Fire rising causes tinnitus and deafness; there must be signs of Phlegm-Fire, and treating according to Phlegm-Fire methods will be effective. The principles are infinite, but outlining the main points, careful study allows immediate recognition.
Runny Nose with Clear Discharge
Regarding runny nose with clear discharge, some are caused by external contraction, others by internal injury.
Those caused by external contraction result from external pathogenic factors lodging in the Lung meridian, blocking the clear orifices, preventing Lung Qi from descending, leading to the flow of clear nasal mucus. These patients definitely present with fever, aversion to wind, aversion to cold, headache, and body ache. The treatment principle is suitable for dispersing and releasing, such as Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), or Gegen Tang (Pueraria Decoction).
Those caused by internal injury result from insufficient Yang of the Heart and Lung, failing to control fluids, leading to the flow of clear nasal mucus. Laypeople call this "Lung Cold" or "Old Cold," because they do not realize that when Yang declines, Yin-Cold arises. The Kidney collaterals connect to the Lung; when Kidney Yang declines, internal Yin-Cold arises, failing to restrain fluids, leading to clear nasal discharge. These patients definitely lack signs of external contraction, often showing fatigue and lack of spirit, frequent sneezing, aversion to cold, or cold feet. The treatment principle is suitable for supporting Yang, such as Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), Jiang Gui Tang (Ginger and Cinnamon Decoction), or Yangdan Tang. If a patient with chronic illness suddenly has incessant clear nasal discharge, accompanied by high fever, sweating, shortness of breath, blue lips, and a wiry, floating, and empty pulse, this is a sign of Yang collapse impending. Urgent restoration of Yang is required; delay means non-survival. Yet, even then, only one or two out of ten might be saved. [Marginal Note] Zhi Fei said: Nasal mucus is generated by the zang-fu organs and belongs to Yin. The Classics state: Water is the source, accumulating water. Accumulating water is Extreme Yin. Extreme Yin is the essence of the Kidney, referring to nasal mucus and tears. It also states: The water of the ancestral essence, which does not flow out, is held by the essence, assisted and wrapped by it, so water does not flow recklessly. This refers to why normal people do not have runny noses. It also states: Nasal mucus and tears originate from the brain. The brain is Yin. Marrow fills the bones. Thus, brain seepage becomes nasal mucus. Will (Zhi) is the master of bones. Therefore, when water flows, nasal mucus follows, as their movement is similar. This explains why humans have nasal mucus. From the perspective of external contraction, pathogenic factors invade the meridians, blocking clear orifices, causing Yang Qi to gather above and fail to descend, while Yin Qi gathers below and fails to ascend. Yang gathering above leads to independent hyperactivity of Fire. Yin gathering below leads to cold feet and distension. One water cannot overcome five fires, hence the runny nose. It is because Qi gathers in the nose, and wind rushes down, causing unstoppable discharge. From the perspective of internal injury, the essence of Water is Will, and the essence of Fire is Spirit. Affected by the seven emotions, Spirit and Will become chaotic, Water and Fire fail to interact, Yin Essence is lost, and over time, fluids are uncontrolled, leading to clear nasal discharge. This is damage to Spirit and loss of Will. Qin'an's discussion of treatment penetrates the origin, clarifies the branches, and extends to the syndromes of Biandao (profuse discharge) and Bizhuo (turbid discharge), even bleeding, all based on this principle and intention. Students who delve deep into the principles are like archers hitting the bullseye; the orthodoxy of medicine lies here.
Checking recent common practices, upon seeing runny nose with clear discharge, regardless of internal or external, practitioners blindly use dispersing methods, mainly Can Su Yin (Ginseng and Perilla Infusion), Renshen Baidu San, Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), or Xinyi San (Magnolia Flower Powder). These are acceptable for external contraction but dangerous for internal injury.
Among these, there are also syndromes of Biyuan (nasal sinusitis) and Bizhuo (turbid nasal discharge), commonly said to be fluid from the brain marrow. But marrow is the vital substance of the human body; how can it flow out? Although these two syndromes differ, Biyuan involves clear discharge lasting years, while Bizhuo involves discharge colored like rice washings or soybean juice, also lasting years. The distinction arises from innate Yang deficiency, where Lung and Heart Yang decline, failing to restrain fluids. When fluids cannot be controlled, and treatment again uses blind dispersing, Zheng Qi (Upright Qi) is further depleted, and discharge continues. Clear discharge is a sign of Lung Cold; insufficient Lung Yang. Turbid discharge is a verification of Lung Heat. However, Lung Heat must have heat signs. If no Lung Heat signs are present, it indicates dysfunction of the Upper Jiao's transformation mechanism, with Middle Jiao Earth Qi ascending to the Lung, Lung Qi severely declining, and transformation losing authority, resulting in yellow discharge. Treatment must distinguish between them. I treat these two syndromes usually with Sisha (Four Sands) 1 liang, Huangbai (Phellodendri Cortex) 5 qian, Zhi Cao Gan (Honey-fried Licorice Root) 4 qian, An Gui (Cinnamon Bark) and Wuyu (Evodiae Fructus) 3 qian each. One or two doses stop it. In severe cases, add Sheng Jiang (Fresh Ginger) and Fu Zi (Aconite Root) 2-3 qian, repeatedly obtaining efficacy. Even Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) added with Guijian (Cinnamon Twig Tip) and Fuling (Poria) is also effective.
There is also epistaxis (nosebleed). Some are forced out by excessive Fire, definitely having fire signs, such as thirst preferring cold drinks, and difficulty in urination and defecation. The treatment principle is suitable for clearing Fire and purging, such as Dachengqi Tang (Major Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), or Daochi San (Guiding Out Red Powder).
Some have long-term deficiency of Yuan Yang, unable to anchor and suppress rebellious Yin pathogens, causing Yin Blood to float outward, leading to incessant nosebleeds. Not just nosebleeds, but also hematemesis (vomiting blood), bleeding from gum fissures, ear bleeding, pore bleeding, and hematochezia/melena. These patients definitely lack fire signs, have normal urination and defecation, pale lips and tongues, and look fatigued and listless. The treatment principle is suitable for supporting Yang and anchoring, such as Qianyang Dan (Subduing Yang Pill), Fengsui Dan (Sealing Marrow Pill), Gancao Ganjiang Tang, or adding An Gui and Wuyu. Students must absolutely avoid merely treating the symptom without addressing the root. They must familiarize themselves with internal and external pathological forms and substantial evidence of Yin and Yang in their minds to avoid fatal errors. [Marginal Note] The doctor's skill and human life depend on this, hence the repeated emphasis to students.
Flaring Nostrils
Regarding flaring nostrils, some are caused by external contraction of Wind-Cold blocking, some by accumulation of Heat in the Stomach, and some by impending exhaustion of Yuan Qi.
Caused by external pathogen blocking: External Wind-Cold pathogens block the Qi mechanism exiting the Lung meridian. The Qi mechanism wants to exit but cannot, stagnating in the lung orifices, causing disordered respiration and flaring nostrils. These patients definitely present with fever and body pain. The treatment principle is suitable for dispersing, such as Jingfang Baidu San (Aster and Saposhnikovia Detoxification Powder), Mahuang Tang, or Dingchuan Tang (Stopping Asthma Decoction), all of which can be selected. [Marginal Note] Flaring nostrils indicate an urgent situation. Although caused by external contraction, medication requires great caution.
Caused by accumulated Heat attacking upward: Due to food stagnation in the Middle Jiao, or excessive consumption of fried, spicy, ginger, and pepper foods, with pre-existing Heat in the chest, Heat attacks the Lung, causing disordered Qi mechanism and flaring nostrils. The treatment principle is suitable for clearing Heat, such as Dachengqi Tang, Xiaochengqi Tang, or Sanwu Beijji Wan (Three-Ingredient Emergency Pill).
Caused by impending exhaustion of Yuan Qi: Due to long-term deficiency of Yuan Qi, or massive vomiting and diarrhea, profuse sweating, pale face without spirit, near death, presenting with flaring nostrils. The treatment principle falls under untreatable. To attempt rescue, urgent restoration of Yang and anchoring is needed, warming and consolidating Spleen and Kidney Yuan Qi; one or two out of ten might be saved. This syndrome is mostly seen in children, rarely in adults. Doctors must absolutely avoid blind dispersing; careful differentiation and clear identification are essential. [Marginal Note] Differentiating Yin and Yang is crucial for doctors, hence the earnest admonition.
Redness and Swelling of Lips and Mouth
Regarding redness and swelling of lips and mouth, some are due to extreme Stomach Fire, others due to floating Yuan Yang.
Caused by Stomach Fire: These patients definitely present with irritability, thirst preferring cold drinks, aversion to heat, or difficulty in urination and defecation, or due to severe stagnation generating Heat from depression, or excessive consumption of rich wine and spicy foods, not entirely caused by external pathogens. If accompanied by external contraction, external signs must be present. With external contraction, Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) or Shengma Gegen Tang (Bupleurum and Pueraria Decoction) can be used. Without external contraction, Renshen Baihu Tang (Ginseng White Tiger Decoction), Liangge San (Cooling Diaphragm Powder), Dachengqi Tang, or Xiaochengqi Tang can be used. With stagnation, Pingwei San (Maintain the Stomach Powder) added with Ezhu (Curcuma Rhizome), Qiuniu (Morning Glory Seed), and Dahuang (Rhubarb Root) can be used.
If a patient with chronic illness has Yuan Yang floating outward and Qi mechanism floating upward, they definitely present with substantial signs of pure Yin throughout the body. Among these, lip colors may be red with hints of blue, black, pale red, old red, or tender red. Some may also have a peach-blossom complexion, dazzling luster, yet look fatigued and listless; these are all critical signs of collapse. The treatment principle falls under untreatable. To attempt rescue, urgent anchoring is primary, such as Qianyang Dan, Yanghui Jiuniu Tang, Baitong Tang, or Jin Kui Shenqi Wan, taken for one or two doses. If the red luster recedes, recovery is possible; otherwise, death comes within days. Early judgment is essential; abstaining from treatment is preferable. [Marginal Note] Zhi Fei said: The character 'Chun' (lip) consists of 'Chen' (dragon/9-11 am) and 'Kou' (mouth). Its Qi mechanism originates from Cun/Di and reaches Chen. Chen represents the three spring months, corresponding to the Gua hexagram Duan (Breakthrough), symbolizing Yang Qi overcoming above. Lips and mouth are its location. Knowing it belongs to Yang, its Qi likes to ascend and cannot tolerate Yin-Cold stagnation, hence redness and swelling diseases, even ulceration and pain, are definitely not Excess syndromes. Qin'an shows people to examine accompanying symptoms and understand variations. Zhi Fei further cuts to the source, calling it unique. Understanding variations, recognizing uniqueness, knowing life, deciding death—medical methods are based on this.
Recently, crude practitioners, upon seeing redness and swelling of lips and mouth, without distinguishing deficiency or excess, use Dahuang (Rhubarb Root) and Shigao (Gypsum) to treat. Excess syndromes improve immediately, deficiency syndromes die immediately. This must be known. Among these, some also have incessant drooling. By checking the temperature of breath and pathological forms, one can obtain substantial evidence of Yin and Yang.
Swelling and Pain of Teeth and Gums
Regarding swelling and pain of teeth and gums, various books differentiate by the twelve meridians, but this is debatable. The main principle is always sufficiency (Excess) or insufficiency (Deficiency). However, some are caused by Wind-Fire depression,
some by accumulated Heat in the Stomach, some by True Yang deficiency with Yin Qi attacking upward, and some by Yuan Yin deficiency with Yuan Yang causing harm.
Caused by Wind-Fire depression: Initially presenting with fever and body pain. The treatment principle is suitable for dispersing, such as Shengyang Sanhuo Tang (Raise Yang Scatter Fire Decoction), Xiaofeng San (Dispel Wind Powder), Qingwei San (Clear Stomach Powder), or Maxing Tang.
Caused by accumulated Heat attacking upward: Definitely presenting with fullness, acid regurgitation, thirst preferring cold drinks, red face and lips, coarse breathing feeling hot to touch. The treatment principle focuses on removing stagnation, such as Pingwei San added with Dahuang, Shigao, Qiuniu, and Binglang (Areca Seed).
Caused by True Yang deficiency with Yin Qi attacking upward: Although teeth and gums hurt, the complexion is definitely blue-white and listless. The tongue is often blue, slippery, black, and moist; yellow and moist; or white-yellow and moist, with saliva filling the mouth, no desire for tea/water. The flesh inside and outside the mouth is mostly stagnant blue, not vibrant red, or pale yellow without redness. These conditions, not limited to this symptom, are common in all Yang deficiency diseases. The treatment principle is suitable for supporting Yang and suppressing Yin, such as Baitong Tang, Jiang Gui Yin, Bajawei (Eight-Ingredient Pill), or Qianyang Dan.
Caused by Yin deficiency with Fire Pathogen disease: Definitely presenting with heart vexation, thirst preferring cold drinks, red urine, etc. The treatment principle is suitable for nourishing Yin, such as Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), Jizi Huanglian Tang (Chicken Egg and Coptis Decoction), or Daochi San.
Recent common practice: Upon seeing swollen gums and toothache, practitioners use Shengdi (Rehmannia Root), Xixin (Asarum Root), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Shihu (Dendrobium Stem), Zhimu (Anemarrhenae Rhizome), Shigao, Xuanshen (Scrophulariae Radix), Danpi (Moutan Cortex), and Goujiya (Dog Tooth Grass). This works for Wind-Fire but is dangerous for Yang deficiency. [Marginal Note] Swelling and pain of teeth and gums are minor syndromes, yet some last years without healing. If Yin/Yang and deficiency/excess are not investigated beforehand, treatment fails to cure, bringing ridicule to experts. Students should not neglect them because they seem small.
Bad Breath, including Sour/Bitter/Pungent/Sweet/Mundane Taste and Oral Thrush
Regarding bad breath, some are caused by extreme Stomach Fire, others by Yin excess causing emission of True Essence Qi.
Caused by Stomach Fire: These patients definitely present with irritability, aversion to heat, incessant cold drinking, or prickly tongue coating, dry yellow, dry black, dry white, etc., coarse breathing, sweating, loud voice, difficulty in urination and defecation. The treatment principle focuses on clearing Stomach Fire, such as Renshen Baihu Tang, Dachengqi Tang, Xiaochengqi Tang, or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction).
Caused by emission of Essence Qi: Due to exhaustion of Yuan Yang in the five zang and six fu organs, the entire body is pure Yin, forcing out the congenital vital essence. The situation is detached from the root and impending collapse. The treatment principle falls under untreatable. Although the breath is extremely foul, there is not a trace of Fire signs. Although the tongue color is yellow, it is definitely slippery and moist. Occasionally dry yellow or dry black, with no moisture above, yet the person has no desire for tea/water, looks fatigued and listless, has normal urination/defecation, remains quiet. Occasionally thirsty, they only prefer boiling hot water. All these forms belong to pure Yin. If judging solely by bad breath as Fire, harm is almost inevitable. I have treated several people with bad breath but pure Yin exposure, using large doses of Baitong Tang, Sini Tang, and Yanghui Jiu Ni Tang. After one or two doses, bad breath disappeared completely, spirit increased, and recovery was possible. If after two or three doses there is no reduction, only one or two out of ten might be saved; still, this method should be reused with higher doses. This is because the disease is severe and the medicine is light, unable to bear the burden. Ignorant people seek quick results; if one or two doses don't show major effect, they change doctors. This is universal. Is it really the fault of medicine? [Marginal Note] Zhi Fei said: Fragrant air is Clear Yang Qi. Foul air is Turbid Yin Qi. Bad breath arises from extreme Turbid Yin, with Yang Qi function obstructed, often with sticky phlegm/dregs. Like summer, excessive rain depresses Heavenly Yang, causing mold and slime, smelling foul. After a few hot days, the smell vanishes. The human body is entirely pure Yin, so in cases of True Yang collapse, this symptom often appears. Doctors who understand this can treat it. Qin'an perceived its subtlety, repeatedly citing it in annotations. Students must not ignore it.
Checking recent common practices, upon seeing bad breath, without distinguishing Yin/Yang, practitioners administer Shengdi, Er Dong (Ophiopogon and Asparagus roots), Zhimu, Huafen (Trichosanthes Root), Shigao, Dahuang. Yang excess leads to life, Yang deficiency leads to death. This must be known.
Among these, bitter taste indicates Heat in Heart and Gallbladder. Heart Heat: Daochi San, Huanglian Tang (Coptis Decoction). Gallbladder Heat: Xiaochenghu Tang with doubled Huangqin (Scutellaria Root), or Xiegan Tang (Drain Liver Decoction). Sour taste indicates Heat in Liver: Danggui Luehui Wan (Angelica and Aloe Pill), Longdan Xiegan Tang (Gentian Drain Liver Decoction). Pungent taste indicates Heat in Lung: Xiebai San (Drain White Powder), Qingfei Yin (Clear Lung Drink). Sweet taste indicates Spleen Qi emission: Lizhong Tang (Regulate Middle Decoction), Liujunzi Tang (Six Gentlemen Decoction). Mundane/bland taste indicates Spleen Qi insufficiency: Guipi Tang (Restore the Spleen Decoction), Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). Oral thrush (white sores throughout mouth) indicates Stomach Fire: Ganlu Yin (Sweet Dew Drink), Liangge San. All these syndromes should be known. The key is always investigating substantial evidence of Yin and Yang. I once treated a person with Yang deficiency and Yin excess. After two or three doses of Xin Gan Hua Yang (Pungent-Sweet Transforming Yang) herbs, they exhibited bitter, sour, bland, pungent, sweet tastes. After another two or three doses, these symptoms vanished. I carefully deduced this was due to True Yang dysfunction and impaired transport, combined with undigested medication residues. The Xin Gan Hua Yang herbs restored transport, removed stagnation, and thus all oral odors disappeared. [Marginal Note] True Yang changes, revealing its true face. Pungent-Sweet aids transformation, turning danger to safety. The power of medicine is profound, yet few see this truth. Ignorant people, not understanding this, treat sour with sour remedies, bitter with bitter remedies, rarely without increasing the disease. The subtlety of medical principles is indeed difficult.
Swollen Tongue, Tongue Pain, Double Tongue, Stiff Tongue, Numb Tongue, Wooden Tongue, Retracted Tongue
Regarding tongue syndromes, although there are several types, they do not exceed the two methods of Yin and Yang. Swelling, pain, and double tongue indicate Qi Excess. Qi Excess is Fire, definitely having Fire signs. Retraction, stiffness, and numbness indicate Qi Insufficiency. Qi Insufficiency is Cold, definitely having Yin-Cold signs. Treating swelling, pain, and double tongue relies on clearing Heat, such as Huanglian Jiedu Tang (Coptis Detoxification Decoction), Daochi San, Dachengqi/Xiaochengqi Tang, or Huanglian Xiexin Tang (Coptis Draining Epigastrium Decoction). Treating retraction, numbness, and stiffness relies on supporting Yang, dispelling Yin, resolving Phlegm, and directing rebellious Qi downward, such as Baitong Tang, Jiang Gui Yin, Huangqi Jianzhong Tang (Astragalus Building the Middle Decoction), Mahuang Fuzi Xixin Tang, or Banxia Ganjiang Tang (Pinellia and Dried Ginger Decoction). [Marginal Note] Why not use Chenpi (Tangerine Peel), Nanxing (Arisaema Rhizome), Mengshi (Calamine) for resolving Phlegm? Know that Zhang Zhongjing's Six Channel formulas do not include these categories. Perhaps these herbs had not emerged in the Han Dynasty—a joke.