精，神施发泄之令。气动而精自不藏，若云神令未施，而精自泄，必无此理。又曰：魂者，神之使也。[眉批]知非氏曰：此按心肾不交，是客从俗情也，神魂不藏，是主谈至理也。凡遇遗精之人，以心肾不交，或因于湿热极不通之语，告之无不者，肯语以欲炽所致，即弗贴然，又必从而多方文致，故钦安姑存其说，以作陪衬，留病人地步，学者不可不知。人之遗精，每每五更近天明时者居多，此刻神已居在寅卯界内。寅卯属木，系藏魂之所，魂喜动，而木喜发泄，木中有火，浊火易乱其神明，邪忘之念偶萌，精神自不能守住，白昼不梦，但心邪思淫，阳物即举，精即离位，况在梦乎！故一发即泄，迅速难留。因其目瞑必未清，肝火最烈，故发速，非若白昼神在离。总而言之，神不清而气虚好色者，十居其八。此证少年最多。神魂不藏，是其本者。[眉批]得时而旺，虚灵显应，浊火一入，丧却他家至重珍，深为可惜。《阴符经》云：沉木入火，自取灭亡。盖言木得火而焚也。此段此理说待如吴钩出匣，寒光逼人，病者若见此书，熟读百回，右当百贴清凉饮，定点勿药有喜。欲使封固，如三才封髓丹、桂枝龙骨牡蛎汤、白通汤，皆可服也。此三方者，皆是交济阴阳之功，但非一二剂可见大功，总要信心得专，多服十余剂，无不灵应。
近来，通称龙、牡涩精，尚未窥透其中至妙，多经金樱、粟壳、枸杞、巴戟、莲须之类治之，每多不效，由其不知封固这有要也。
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卷二
大 便 不 利
因阳虚者，由下焦火衰，不能化下焦之阴，阴主静而不动，真气不能施其运行之力，故大便不利。其人定见无神，面目唇口青黑，满口津液，不思茶水，虽十余日不便，而并无腹胀、烦燥不安等情。即有渴者，定喜热汤，冷物全然不受，他书称为阴结寒闭者，即此也。法宜扶阳，如回阳饮加安桂、砂仁、白通汤，附子甘草汤之类。
因阴虚者，由火旺伤血，血液枯稿，肠中之糟粕干涩不行，如船舟之无水而停滞不动也。其人定多烦躁，声音响亮，渴欲饮冷，吐痰干黄，脉或洪大细数。他书称为热结阳秘者，即此也。法宜养血清热，如润燥汤、麻仁丸、养血汤，加麦芽、香附、蜂蜜之类。
因阳明胃实者，由外邪入胃，从胃热而化为热邪，热甚则胃中津液立亡，故不利。其人定见恶热，口臭，身轻，气粗饮冷，与夫狂妄谵语，痞满实燥坚等情。法宜急下以存阴，如大小承气汤之类。
因肺移燥者，由燥邪乘肺，肺与大肠为表里，表分受邪，渐及里分，其势自然。其人定多烦渴，皮肤不泽，大便胀甚，欲下不下。法宜清燥为主，如甘桔二冬汤，益元散之类。
以上治法，不拘男妇老幼，皆宜如此。故曰：有是病，
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宜是药，切勿惑于老幼、附子、大黄之说也。[眉批]知非氏曰：细维大肠主糟粕，原自胃中传入，其热颇顺。《经》曰：胃实则肠虚，肠实则胃虚。指糟粕出入而言。其所以运化糟粕，则在元气，元气出入升降，运化精微。今病人大便不利，仍是气机不利，总贵在病机病情上求之。学者肌要先明理法，然后临证审察的确，或回阳，或清热，或急下，方有胆量把握。不然误下误清，虽不遭谤，倘用回阳，岂不惑已惑人？钦安指点亲切，当细必讲究，亦不可恃有此按，不揣病源，致临机而仍蹈徒法，不能以自行之弊也。
近来市习，一见大便不利，多用大黄与滋阴润肠之香油、蜂蜜、麻仁、郁李、归、芍之类，并不问及阴阳，受害实多，而人不察，良可悲也。
小 便 不 利
按小便不利一证，有阳虚，阴虚，心移热于小肠，与太阳腑证中之蓄尿、蓄热、蓄血、癃闭诸证。
因阳虚而致者，由下焦阳微，阴寒阻截膀胱之路，阻微无力，不能化之，故小便不利。其人定无力无神，两尺必浮空，或极劲，口并不渴，即有渴者，必喜热汤。法宜扶下焦之阳，如桂苓术甘汤，倍桂，加白蔻、砂仁，或桂枣丸加胡椒、丁香之类。
因阴虚而致者，由下焦血液不足，邪热遂生，须知焦思则生心火，忿怒生肝火，思淫动相火，火动于中，不独此疾，皆是由一念而生，其旨甚微，切不可慨谓由外而生。热结于尿隧，闭其水道流行之机，故不利。其人多烦躁，口渴饮冷，小便或能滴几点，或短赤而热痛。法宜扶下焦之阴，如四苓滑石阿胶汤，益元散之类。
因心移热而致者，由心火太旺，或焦思太甚，而生心火。心与小肠为表里，心热甚而小肠受之，热伏小肠，伤及血液，流行失职，而小便遂不利也。其人病情多与阴虚法同。法宜清心，如黄连解毒汤加滑石、木通，或导赤散倍生地之类。
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至于太阳腑证中之蓄尿、蓄热、蓄血、癃闭等证，已详《医理真传》，兹不具载。[眉批]知非氏曰：前证言胃传糟粕于二肠，得元气运化而出。膀胱主溺，与二肠无涉。知非细维其原，在胃阳明为海，生糟生血，化气行水之宗。具脾为胃行津液，脾能行水，由水道达于膀胱，膀胱有下口而无上口，须气化渗泌而出。今病人小便不利，明是二土失职，中宫少运。《经》曰：阳明主阖。又曰：脾胃同处中州。又可见脾不为胃行津液，故水道不利。如此溯本穷源，阳虚阴虚，一切移热、蓄热、蓄尿、蓄血、癃闭诸证，有由来矣。再观仲景五苓散方中用桂枝、白术通阳和脾，义极精微，大具神通手眼。钦安按中执定阴阳实据，加以温中行气治之，必无不效也。
近来市习，一见小便不利，便以木通、车前、滑石、黄连等治之，阳实易瘳，阳虚则贻，不可不知也。
淋 证
按淋证一条，诸书载有劳淋、砂淋、血淋、气淋、石淋之别，是因病情而立名者也。予欲求其一定之要，诸书俱未明晰，再三追索，统以阳不化阴，抑郁生热为主。大凡病淋之人，少年居多，由其世欲开，专思淫邪，或目之所见，耳之所听，心之所思，皆能摇动阴精，邪念一萌，精即离位，遂不复还，停滞精道，不能发泄，久久抑郁生热，熬干阴精，结成砂石，种种病形。当小便便时，气机下降，败精之结于经隧者，皆欲下趋。然尿窍与精窍，相隔一纸，精窍与尿窍异位同源。同从玉茎而出。尿窍易开，精窍不易启。不知好色之人，元阳日耗，封锁不固，当君火下照，尿窍已开，精窍亦启，尿欲速出，而精窍又开，两窍相启，彼此牵强，欲行不行，而痛故愈甚也。此二窍原不并开，此证全是并开之故，两相欲下，停精之结与未结，化与未化者，皆欲下趋也。精停而结者，有砂石之形，郁热熬而成之也。好色过度，精未化者，血淋之源也。治砂石，贵以清热为先，而化气之品亦
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不可少。治血淋，须以扶阳为重，交通上下，而固元尤当。知此病皆由自取，当其痛如刀割，虽云可怜，未始非好色之果报也。故方每以八阵、五淋散，功专清热，亦多获效。予意此证当于清热利水中，兼以化精、化气之品，鼓其元阳，俾二窍不同时并开为主。予治此证，尝以滋肾丸倍桂，多效。双尝以白[1]通汤，专交心肾，亦多效。又尝以大剂回阳饮加细辛、吴萸、安桂多效。是取其下焦有阳，而开阖有节，不至两相并启也。但服回阳等方，初次小便虽痛甚，而尿来觉快者，气机将畅，而病当解也。此道最微，理实无穷，学者须当细心求之，勿执予法为一定，恐未必尽善。[眉批]虚心人语，又是婆心人语。而辩认，总经阴阳两字，有神无神，两尺浮大，有力无力为准。[眉批]淋之一证，责在精道。予尝询之少年之人，其精中往往有了，早已廉得其情，百不失一。委是纵欲所致，譬如月缺难圆，金针暗失，人生不免殊为恨事，迨至病成痛作，尤征过纵，谓曰自取果报夫。夫也其何说之辞。治法扶阳抑阴，如其人神不大衰，加清上焦之邪火，佐以行气，并嘱其清心节欲[2]，自无不愈也。钦安抉破其情，论辩精详，自是方家举止，且为脑后痛下针砭，唤醒梦梦，以规戒为治法的是妙人，却与知非同为快人也，呵呵！
膝 肿 痛
按膝肿痛一证，有由外感寒湿之邪，闭塞关节者，有阳虚者，有阴虚者。
因外感寒湿而致者，或贪凉而足履冷水，而偶受寒邪，而经络闭塞，渐至两膝肿痛。诸书有历节风、鹤膝风之说。由其寒湿之邪，从外而入，闭其运行之机。膝处多空虚之地，最易
[1] 白原本作"百"，据文义改。
[2] 欲原本作"后"，据文义改。
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藏邪，气道壅滞，水湿渐臻，抑郁生热，而成膝肿疼痛之疾。法宜发汗行水为主，如小青龙汤，或麻黄汤加伏苓、泽泻之类。
因阳虚者，由其素秉不足，阴邪寒湿丛生，流入下焦关节屈伸之处，或胃阳不足，过于饮酒，酒湿之邪，流入关节，阻滞不行，而膝肿痛，但其证多皮色如常，漫肿微痛，实属阳微不能化阴。法宜温固脾肾之阳，如回阳饮加桂、苓、益智、故纸、茴香、砂仁之类。多服自愈，切不可性急而信心不坚。
因阴虚者，由其素秉阳旺，过食酿酒厚味，湿热毒邪流入下焦关节处，运行不畅，遏郁而红肿便生。法宜养阴清热，兼理气除湿为主，如黄连阿胶汤加苓、术，补血汤如秦芄、羌活、桑根、香附、麦芽之类。此数法不过明其阴阳大致，究竟认证，全在活法，神而明之。[眉批]知非氏曰：细玩易象，震孟，二阴上，一阳下，孔子取为足能走。夫阳动阴静，动而在下者，足也。震，动也，气之动于下者也。今膝肿痛，或脚气注痛，必不便于行，而阳先病矣。所以然者，不外内外二因，医先识此，知寒邪中于尔，则动于下之气机不利，而有肿块痛流注之证，乃于逐邪之中，审其阳气之衰盛，而多方照顾，预培其生机。毋使邪气克正，致势滔天，不可向迩，[1]矧可扑灭。滔水者，犯心之谓也。阳微不[2]能化阴之谓也。钦安谆谆于温固回阳，兼补发汗行水，除湿散结诸法者，通其源，正市场习之论者。节其流，学者洞晰源流，治膝肚子之工业化无余蕴，寿世活人，大为快事。
脚 气
按脚气一证，有由下而上冲作痛者，有只在下作痛者，有大病后，至午后脚底即发热作肿作痛，皮色如常，至天明即愈者，有天阴甚而痛反剧者。以上数证，悉属阳虚不能镇
[1] 迩音尔，近也。
[2] 不原本作"下"，据文义改。
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纳阴邪，阴气上腾，乃为大逆，犯心能今人死。法宜回阳收纳为要。如回阳饮加砂仁，故纸、益智、碎补，与白通汤之类。若只在下而作肿痛，挟湿亦多，加除湿必效。如或红肿痛甚，心烦口渴，小便短赤，乃湿热结聚下焦也。法宜除湿，湿去而热自消，如五苓散、鸡鸣散之类。更有红肿痛极欲死，气喘[1]唇青，小便清长者，乃是元气发外，从脚而脱也。法宜大剂回阳为要，切不可按寻常脚证治之。
近来市习，一见脚肿却气发腾，不察虚实，每以苍术、苡仁、秦芄、防已[2]、木瓜、茯苓、桂枝、松节等药治之，湿邪易瘳，阳虚则贻。
喘 证
按喘促一证，有外感风寒而致者，有太阳证误下而致者有胃火上攻而致者，有湿痰水饮闭塞而致者，有元气欲脱而致者。
因风寒而致者，由风寒之邪，闭塞肺气，肺气发泄不畅，上壅而喘，必发热、头痛、身疼一段为据。如发热而无头疼、身疼，或见口唇青，脉劲之喘，必是元气外越，不得即以外感风寒闭塞目之，辩认留意切不可少。法宜宣散，如麻黄汤，定喘汤，小青龙汤之类。
因太阳误下而致，由太阳之邪未解，既已壅塞发泄不畅，仍宜大启其腠理，俾邪早出。医者不明其理，见其大烧，以为火旺，妄行攻下，客邪下陷，愈不得出，壅于胸膈，呼吸错乱，而喘证立生。法宜仍举其所陷之邪，如桂枝汤去芍药倍桂，或重加甘葛以举之类。俾欲出者，仍从外出，以解透为妙也。
[1] 喘原本作"湍"，据文义改。
[2] 已原本作"杞"，据文义改。
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因胃火上攻而致者，由胃中素有伏热，或与外来之热邪相协，或胃中有停滞生热，热甚则邪火上攻，热逼于肺，气无所主，呼吸错乱，而喘证立生，必有大渴饮冷，口臭气粗，二便不利等情。法宜攻下，如大小承气汤，白虎汤之类。
因痰湿水饮而致者，由太阳之气化偶乖，中宫之转输失职，水湿停滞不行，久久中气日衰，痰水日盛，渐渐上干清道，壅塞太甚，呼吸错乱，而喘证立生。其人定见食少痰多，清水上涌，喉中不利。法宜温中除湿，如桂苓术甘汤，理中加砂、半、茯苓之类。
Jing (Essence) is the product of Shen (Spirit) exerting its command to release. When Qi (Vital Energy) moves, Jing naturally cannot be retained; if one claims that the command of Shen has not been issued yet, but Jing leaks out on its own, this must be illogical. It is also said: Hun (Ethereal Soul) is the messenger of Shen. [Marginal Note] Zhi Fei Shi says: Interpreting this according to "Heart-Kidney Non-Interaction" caters to common secular understanding; discussing "Hun and Shen not being contained" expounds the profound truth. Whenever encountering patients with spermatorrhea, telling them it is due to "Heart-Kidney Non-Interaction" or "extreme damp-heat obstruction" meets with universal agreement; if told it is caused by intense desire, they refuse to accept it and will likely make various excuses. Therefore, Qin An temporarily retains the former explanation as a foil, leaving room for the patient's dignity; scholars must understand this. Patients' spermatorrhea often occurs mostly around the fifth watch, near dawn. At this moment, Shen resides within the Yin-Mao (3 AM to 7 AM) boundary. Yin-Mao belongs to Wood, which is where Hun is stored. Hun likes movement, and Wood favors expansion/release. Within Wood lies Fire; turbid Fire easily disturbs their Shenming (Spiritual Clarity). When evil thoughts occasionally arise, Jing and Shen naturally cannot hold fast. If there are no dreams during the day, but the heart harbors evil thoughts of lust, the penis erects, and Jing leaves its position; how much more so in dreams! Thus, emission happens immediately upon arousal, rapid and hard to retain. Because when eyes close, Shen is inevitably unclear, Liver Fire is at its fiercest, hence the rapid onset, unlike during the day when Shen is in Li (Fire/Heart). In summary, those with unclear Shen, Qi deficiency, and lustfulness account for eight out of ten. This condition is most common in youths. The root cause is Hun and Shen not being contained. [Marginal Note] Prosperous in its season, spiritually responsive; once turbid Fire enters, it loses the family's most precious treasure, deeply regrettable. The *Yin Fu Jing* states: "Wood sinking into fire, seeking destruction." This means wood burns when meeting fire. This passage explains principles as sharply as a Wu Hook sword drawn from its scabbard, with chilling light. If patients read this book carefully, reciting it a hundred times, they should apply Qingliang Yin (Cooling Drink) consistently, aiming for cure without medication. To seal and retain, formulas such as Sancai Fengsui Dan (Three Powers Sealing Marrow Pill), Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction), and Baitong Tang (White Unblocking Decoction) can be taken. These three formulas all possess the function of harmonizing Yin and Yang, but great results are not seen in one or two doses; one must maintain firm faith and take them for over ten doses, without fail achieving efficacy.
Recently, it is commonly believed that Longgu (Dragon Bone) and Muli (Oyster Shell) stop essence leakage, but the profound subtleties are not fully understood. Many use Jin Ying Zi (Cherokee Rose Fruit), Su Qiao (Poppy Shell), Gou Qi Zi (Goji Berry), Ba Ji Tian (Morinda Root), Lian Xu (Lotus Stamen), etc., with little effect, because they do not know the key to sealing and retaining.
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Volume 2
DIFFICULT DEFECATION
Regarding difficult defecation, there are distinctions between Yang Deficiency, Yin Deficiency, Yangming Stomach Excess, and Dryness Heat transferred from the Lung.
Caused by Yang Deficiency: Due to decline of Fire in the Lower Jiao, failing to transform Yin in the Lower Jiao. Yin is static and inactive; Zhen Qi (True Qi) cannot exert its moving force, leading to difficult defecation. The patient definitely shows signs of lack of Shen, bluish-black complexion and lips, excessive saliva in the mouth, no desire for tea or water. Even if constipated for over ten days, there is no abdominal distension or restlessness. If thirsty, they prefer hot drinks and reject cold items entirely. Other texts call this "Yin Knot Cold Closure," which is this case. The treatment method should support Yang, such as Huiyang Yin (Return Yang Drink) plus Angui (An Gui/Cinnamon Bark), Sharen (Amomum Fruit), Baitong Tang, Fuzi Gancao Tang (Aconite and Licorice Decoction), etc.
Caused by Yin Deficiency: Due to Hyperactive Fire injuring Blood, causing blood to become dry and intestinal waste to be dry and stagnant, like a boat stranded without water. The patient is definitely irritable, voice loud, desires cold drinks, expectorates dry yellow phlegm, pulse may be flooding, large, fine, or rapid. Other texts call this "Heat Knot Yang Lock," which is this case. The treatment method should nourish Blood and clear Heat, such as Runzao Tang (Moisten Dryness Decoction), Maren Wan (Hemp Seed Pill), Xueyang Tang (Nourish Blood Decoction), plus Maiya (Malt), Xiangfu (Cyperus Rhizome), Honey, etc.
Caused by Yangming Stomach Excess: Due to external pathogens entering the Stomach, transforming into Heat Pathogen via Stomach Heat. Extreme Heat causes Stomach fluids to perish instantly, leading to difficulty. The patient definitely dislikes heat, has bad breath, feels light, breathes heavily, desires cold drinks, and exhibits mania, delirium, fullness, oppression, excess, dryness, hardness, etc. The treatment method should urgently purge to preserve Yin, such as Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction).
Caused by Lung Transferring Dryness: Due to Dryness Pathogen attacking the Lung. Lung and Large Intestine are exterior-interior pairs; pathogen affecting the exterior gradually involves the interior, which is natural. The patient definitely has irritability and thirst, skin lacks luster, severe abdominal distension in defecation, urge to defecate but unable. The treatment method should focus on clearing Dryness, such as Ganjie Erdong Tang (Licorice, Scutellaria, and Two Winter Melon Decoction), Yiyuan San (Benefit Origin Powder), etc.
The above treatments apply regardless of gender or age. Thus it is said: For this disease,
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use this medicine. Do not be confused by theories regarding children/elderly, Aconite, or Rhubarb. [Marginal Note] Zhi Fei Shi says: Carefully considering, the Large Intestine manages waste, originally transmitted from the Stomach, its heat flows smoothly. The *Classic* says: "When Stomach is excess, Intestine is empty; when Intestine is excess, Stomach is empty." Referring to the entry and exit of waste. The transformation of waste relies on Yuan Qi (Original Qi); Yuan Qi enters/exits and ascends/descends, transforming refined substances. Now the patient has difficult defecation, still due to unfavorable Qi mechanism. One must seek the pathology and symptoms. Scholars must first clarify principles and methods, then examine accurately in clinical practice. Whether using Return Yang, Clear Heat, or Urgent Purge, one gains confidence. Otherwise, mistaken purging or clearing may not invite slander, but if using Return Yang mistakenly, would it not confuse oneself and others? Qin An's guidance is intimate; one must study it carefully. Do not rely on this commentary to skip investigating the disease source, leading to rigid adherence to rules at the bedside.
Recently, market habits see difficult defecation treated mostly with Rhubarb and Yin-nourishing/moistening agents like Sesame Oil, Honey, Hemp Seed, Prunus Semen, Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), etc., without distinguishing Yin/Yang, causing much harm unnoticed, truly pitiable.
DIFFICULT URINATION
Regarding difficult urination, there are Yang Deficiency, Yin Deficiency, Heart transferring Heat to Small Intestine, and Sunyang Fu Syndrome cases including Urine Retention, Heat Accumulation, Blood Accumulation, and strangury.
Caused by Yang Deficiency: Due to weak Yang in Lower Jiao, Yin-Cold blocking the bladder pathway. Weak Yang lacks power to transform, causing difficult urination. The patient definitely shows weakness and lack of Shen, both Chikou (Kidney pulses) floating and empty or extremely tense, no thirst in mouth. If thirsty, they prefer hot drinks. The treatment method should support Lower Jiao Yang, such as Guiling Zhugan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction), doubling Guizhi, adding Baokou (Cardamom), Sharen, or Guizao Wan (Cinnamon and Jujube Pill) plus Hu Jiao (Pepper), Dingxiang (Clove), etc.
Caused by Yin Deficiency: Due to insufficient Blood in Lower Jiao, generating Evil Heat. Note: Anxiety generates Heart Fire, anger generates Liver Fire, lustful thoughts move Minister Fire. Fire stirring internally causes not only this disease but arises from a single thought; its meaning is subtle. Do not simply attribute it to external causes. Heat knots in the urinary tract, blocking water flow mechanism, causing difficulty. The patient is irritable, thirsty for cold drinks, urine may drip slightly or be short, red, hot, and painful. The treatment method should support Lower Jiao Yin, such as Siling Huashi Ejiao Tang (Poria, Polyporus, Alisma, Talc, and Donkey-Hide Gelatin Decoction), Yiyuan San, etc.
Caused by Heart Transferring Heat: Due to excessive Heart Fire or extreme anxiety generating Heart Fire. Heart and Small Intestine are exterior-interior pairs. Extreme Heart Heat affects the Small Intestine; Heat hides in Small Intestine, injuring Blood, disrupting flow, causing difficult urination. Patient symptoms align with Yin Deficiency methods. Treatment should clear Heart, such as Huanglian Jiedu Tang (Coptis Detoxification Decoction) plus Talc, Mutong (Akebia Stem), or Daochi San (Guide Red Powder) doubling Shengdi (Rehmannia Root).
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As for Sunyang Fu Syndrome cases like Urine Retention, Heat Accumulation, Blood Accumulation, and strangury, detailed in *Yili Zhenchuan*, they are not repeated here. [Marginal Note] Zhi Fei Shi says: Previous text stated Stomach transmits waste to two intestines, expelled by Yuan Qi transformation. Bladder governs urine, unrelated to two intestines. Zhi Fei reflects on the origin: Yangming Stomach is the sea, generating waste and blood, transforming Qi to move water. Spleen transports fluids for Stomach; Spleen moves water via water pathways to Bladder. Bladder has an outlet but no inlet; requires Qi transformation to secrete. Now patient has difficult urination, clearly indicating failure of Earth organs (Spleen/Stomach), lack of central movement. The *Classic* says: "Yangming governs closing." Also: "Spleen and Stomach reside in the Central Region." Thus, if Spleen does not transport fluids for Stomach, water pathways are blocked. Tracing to the source, Yang Deficiency, Yin Deficiency, all Heat Transfer, Heat Accumulation, Urine Retention, Blood Accumulation, strangury have origins. Observing Zhang Zhongjing's Wuling San formula using Guizhi and Baizhu to unblock Yang and harmonize Spleen reveals profound meaning and divine skill. Qin An insists on Yin/Yang evidence, treating with warming and moving Qi, ensuring efficacy.
Recently, market habits see difficult urination treated with Mutong, Cheqian Cao (Plantago Seed), Huashi (Talc), Huanglian (Coptis), etc. Yang Excess cases heal easily, but Yang Deficiency cases suffer harm; this must be known.
STRANGURY (LIN SYNDROME)
Regarding Lin Syndrome, texts record Lao Lin (Labor Strangury), Sha Lin (Sand Strangury), Xue Lin (Blood Strangury), Qi Lin (Qi Strangury), Shi Lin (Stone Strangury), named based on symptoms. I sought a definitive principle, but texts were unclear. After deep search, unified under "Yang fails to transform Yin, depression generates Heat." Most Lin patients are youths, driven by worldly desires and lustful thoughts. What eyes see, ears hear, mind thinks, all shake Jing Essence. Once evil thoughts arise, Jing leaves its position and does not return, stagnating in essence channels, unable to emit. Long-term depression generates Heat, boiling dry Yin Essence, forming sand/stones, presenting various forms. During urination, Qi mechanism descends;敗精 (defective essence) knotted in meridians tends to descend. However, urethral orifice and seminal orifice are separated by paper-thin distance, different positions but same source, both exiting from the penis. Urethral orifice opens easily; seminal orifice is hard to open. Lustful people consume Yuan Yang daily, seals loosen. When Lord Fire shines down, urethral orifice opens, seminal orifice also opens. Urine wants to exit fast, seminal orifice opens too. Both orifices opening together forces each other, wanting to pass but unable, pain increases. These two orifices originally do not open simultaneously; this syndrome is entirely due to simultaneous opening. Both want to descend; knotted/un-knotted, transformed/untransformed stagnant essence all tend downward. Essence stopping and knotting forms stones, boiled by depressed Heat. Excessive lust, untransformed essence, is the source of Xue Lin (Blood Strangury). Treating stone Lin prioritizes clearing Heat, but Qi-transforming agents are also essential. Treating Blood Lin emphasizes supporting Yang, communicating upper/lower, and securing Yuan. Knowing these diseases are self-inflicted; though pain like knife-cutting is pitiable, it is retribution for lust. Formulas like Bazhen San or Wulin San, specializing in clearing Heat, often work. My view: treat Lin by clearing Heat and promoting urination, combined with essence-transforming and Qi-transforming agents, boosting Yuan Yang, ensuring orifices do not open simultaneously. I treated this with Zishui Wan doubling Guizhi, often effective. Sometimes used Baitong Tang to communicate Heart-Kidney, often effective. Also used large dose Huiyang Yin plus Xixin (Asarum), Wuyu (Evodia), Angui, often effective. This utilizes Lower Jiao Yang to regulate opening/closing, preventing simultaneous opening. Taking Huiyang etc., initial urination may be very painful, but if urine flows fast, Qi mechanism is smoothing, disease resolving. This path is subtle, principles infinite. Scholars must seek carefully, not rigidly adhere to my methods, lest they be imperfect. [Marginal Note] Words of a humble person, words of a compassionate person. Diagnosis relies on Yin/Yang, presence/absence of Shen, Chikou pulse floating/large, strength/weakness. [Marginal Note] Lin syndrome responsibility lies in essence channels. I asked youths; their essence often had issues, I knew their situation, never wrong. Truly caused by indulgence, like moon hard to restore, golden needle lost secretly, life's regret. When disease forms and pain starts, proves excessive indulgence, calling it self-inflicted retribution. What excuse remains? Treatment supports Yang, suppresses Yin. If Shen not greatly declined, add clearing Upper Jiao evil Fire, assist with moving Qi, advise clearing Heart and restraining desire, surely healing. Qin An exposes the emotion, debates precisely, acting like a master physician, striking the back to wake the dreamer, using admonition as treatment—truly a wonderful person, happy alongside Zhi Fei, haha!
KNEE SWELLING AND PAIN
Regarding knee swelling and pain, causes include external Cold-Damp pathogen blocking joints, Yang Deficiency, and Yin Deficiency.
Caused by external Cold-Damp: Greasing coolness, feet stepping in cold water, accidentally contracting Cold Pathogen, blocking meridians, gradually causing bilateral knee swelling/pain. Texts mention Lijie Feng (Joint Wind) and Hexi Feng (Crane Knee Wind). Cold-Damp enters externally, blocking movement mechanism. Knees are hollow places, easily hiding pathogens, Qi pathways congested, water-damp accumulates, depression generates Heat, causing knee swelling/pain. Treatment focuses on sweating and moving water, such as Xiaoqinglong Tang (Minor Green Dragon Decoction), or Mahuang Tang (Ephedra Decoction) plus Fuling (Poria), Zexie (Alisma), etc.
Caused by Yang Deficiency: Constitutionally deficient, Yin-Cold-Damp grows, flowing into Lower Jiao joint flexion/extension areas. Or Stomach Yang insufficient, excessive drinking, wine-damp flows into joints, blocking movement, causing knee swelling/pain. Symptoms usually normal skin color, diffuse swelling, slight pain, truly Yang weak failing to transform Yin. Treatment warms and secures Spleen-Kidney Yang, such as Huiyang Yin plus Guizhi, Fuling, Yizhi Ren (Alpinia Katsumada Seed), Guzhi (Psoralea Fruit), Huixiang (Fennel), Sharen, etc. Take many doses to self-heal; do not be impatient or lack faith.
Caused by Yin Deficiency: Constitutionally Yang hyperactive, overeating rich/heavy foods, Damp-Heat-Toxin flows into Lower Jiao joints, poor circulation, suppression causes redness/swelling. Treatment nourishes Yin, clears Heat, regulates Qi, removes Damp, such as Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) plus Fuling, Baizhu, Xueyang Tang (Nourish Blood Decoction) like Qinjiao (Gentiana Macrophylla), Qianghuo (Notopterygium Root), Sanggen (Mulberry Root Bark), Xiangfu, Maiya, etc. These methods clarify Yin/Yang generally; accurate diagnosis relies on flexible application, spiritual understanding. [Marginal Note] Zhi Fei Shi says: Studying Yi images, Zhen trigram, two Yin above, one Yang below, Confucius took as foot walking. Yang moves, Yin still; moving below is foot. Zhen means movement, Qi moving below. Now knee swelling/pain or gouty pain makes walking difficult, Yang sick first. Why? Internal/external causes. Doctor must recognize this, knowing Cold attacks, Qi movement below unfavorable, causing mass/pain/flowing symptoms. While expelling pathogen, assess Yang strength, care for vitality, prevent pathogen overcoming righteousness,势头滔天 (momentum overwhelming), impossible to approach, let alone extinguish. Tao Shui (flooding water) means attacking Heart. Yang weak failing to transform Yin. Qin An earnestly advocates warming/securing/returning Yang, supplementing sweating/moving water, removing Damp/resolving masses, tracing source, correcting market habits. Controlling flow, scholars clarify source/stream, treating knee industrialization has no hidden depths, saving world/living people, great joy.
FOOT GOUT (JIAOQI)
Regarding Foot Gout, some ascend from below causing pain, some only pain below, some after major illness, afternoon sole heats/swells/pains, skin normal, heals by dawn, some cloudy weather pain worsens. Above cases all belong to Yang Deficiency failing to suppress
[1] Er sounds like Er, near.
[2] Bu originally written as Xia, corrected per context.
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Yin Pathogen, Yin Qi ascending, constitutes great reversal, attacking Heart can kill people. Treatment prioritizes returning Yang and receiving/containing. Such as Huiyang Yin plus Sharen, Guzhi, Yizhi, Sui Bu (Drynaria), and Baitong Tang. If only swelling/pain below, often carries Damp, adding Damp-removal effective. If red/swollen/pain severe, irritability/thirst, short red urine, Damp-Heat knotting Lower Jiao. Treatment removes Damp, Heat dissipates, such as Wuling San, Jiming San. More cases red/swollen/pain extreme, death-like, panting[1], blue lips, clear long urine, Yuan Qi escaping outward, departing from feet. Treatment prioritizes large dose returning Yang, do not treat as ordinary foot syndrome.
Recently, market habits see foot swelling/Qi rising, ignoring deficiency/excess, treating with Cang Zhu (Atractylodes), Yiren (Coix Seed), Qinjiao, Fangji[2] (Stephania Root), Mugua (Chaenomeles), Fuling, Guizhi, Songjie (Pine Joint), etc. Damp pathogen heals easily, Yang Deficiency suffers harm.
ASTHMA (CHUAN SYNDROME)
Regarding panting/asthma, causes include external Wind-Cold, mistaken purgation in Taiyang syndrome, Stomach Fire attacking, Wet-Phlegm/Water-Drink blocking, Yuan Qi about to collapse.
Caused by Wind-Cold: Wind-Cold blocks Lung Qi, Lung Qi release不畅 (not smooth), upward congestion causes panting. Must have fever, headache, body ache as basis. If fever without headache/body ache, or blue lips, tense pulse panting, must be Yuan Qi escaping outward, do not mistake for external Wind-Cold blockage. Differentiation attention crucial. Treatment disperses, such as Mahuang Tang, Dingchuan Tang (Stop Asthma Decoction), Xiaoqinglong Tang.
Caused by Taiyang Mistaken Purgation: Taiyang pathogen unresolved, already congested/smooth release hindered, still should open pores greatly, letting pathogen exit early. Doctor unaware of principle, sees high fever, thinks Fire Hyperactivity, wrongly purges, guest pathogen sinks, harder to exit, congests chest/diaphragm, breathing chaotic, asthma arises. Treatment lifts sunken pathogen, such as Guizhi Tang removing Shaoyao doubling Guizhi, or heavily adding Gan Ge (Pueraria) to lift. Let desired exit still exit outward, resolution penetration ideal.
[1] Chuan originally written as Tuan, corrected per context.
[2] Yi originally written as Qi, corrected per context.
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Caused by Stomach Fire Attacking: Stomach has latent Heat, or combines with external Heat, or Stomach stagnation generates Heat. Extreme Heat pushes Evil Fire up, Heat逼迫 (forces) Lung, Qi has no master, breathing chaotic, asthma arises. Must have extreme thirst for cold drinks, bad breath, heavy breathing, difficult urination/defecation. Treatment purges, such as Dachengqi/Xiaochengqi Tang, Baihu Tang (White Tiger Decoction).
Caused by Phlegm-Damp/Water-Drink: Taiyang Qi transformation occasionally abnormal, Central Palace transport fails, water-damp stagnates, long-term Middle Qi declines, Phlegm-Water increases, gradually disturbing clear pathways, severe congestion, breathing chaotic, asthma arises. Patient definitely eats little, much phlegm, clear water surging, throat discomfort. Treatment warms Center, removes Damp, such as Guiling Zhugan Tang, Lizhong Tang plus Sharen, Banxia (Pinellia), Fuling, etc.