因元阳将脱而喘者，由其人阳衰阴盛已极，逼阳于外，阳气不得下趋潜藏，阴阳两不相接，呼吸错乱，而喘促立生。必现面白唇青，口舌黧黑，人无生气，全是一团纯阴。此刻有大烧、汗出之，可畏。法宜回阳收纳，如吴萸四逆汤加丁香、胡椒、砂仁之类。尚可十中救一二。[眉批]知非氏曰：孟子云，今夫厥者趋者，是气也。又曰：夫志，气之帅也。又曰：持其志，勿暴其气，此理可通乎治喘？彼趋与厥，皆令人气喘，以其升降纡徐之机，为作劳所迫促，然一经静镇而即乎？今气之喘，不由作劳而亦迫促不舒，且非静而能镇，是孰使之然哉？诚有如钦安所论五因，各因皆有辩认阴阳虚实之凭据，可谓详矣。惟元阳将脱之喘，用回阳收纳之法，未免骇人。殊不知志为气帅，持其志，勿暴其气，正合用姜险之机宜。神机化灭，升降将息，火用不宣，水体不动，惟有用姜、附以养帅，帅如能振，气即随之而号令，庶几中与，可冀此炼石补天之技，出人头地之医，学者视姜、附退热为泻火，学者视姜、附为凉药，则更妙矣。呵呵。
凡治喘证，切不可猛浪，先将阴阳情形审明，然后施治，切不可一味治喘，妄以苏子降气汤，麻黄定喘汤投之。风寒可施，内伤则殆。
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汗 证
按汗证一条，有阳虚者，有阴虚者，有太阳风伤卫者，有阳明热盛者。
因阳虚者，由人素秉阳虚，或用心过度而损心阳，心阳衰，不能统摄心中之液而汗出。或脾胃阳衰，不能收摄脾胃中之血液而汗出。或肝肾阳衰，不能收束肝肾中血液而汗出。上中下三部阳衰，皆能出汗，统以阳名之。其人定多嗜卧，少气懒言为准。法宜扶阳，阳旺始能镇纳群阴，阴气始得下降，阳气始得潜藏，乃不外亡。法宜回阳、收纳、温固为要，如封髓丹，潜阳丹，黄芪建中汤，回阳饮之类。
因阴虚者，则为盗汗。由其人血液久亏，不能收藏元气，元气无依而外越，血液亦与俱出，多在夜分。夜分乃元气下藏之时，而无阴以恋之，故汗出也。非汗自出，实气浮之征也。法宜养血，如当归六黄汤、封髓丹倍黄柏加地骨皮之类。
更有一等阴盛隔阳于外之证，夜间亦汗出，此为阳欲下交而不得下交，阳浮于外，故汗出。法宜扶阳，阳旺而阴不敢与争，阳气始得下交，如白通汤、补坎益离丹之类。
务要知得阴虚、阴盛之旨，阴虚则火旺，其人定然有神，烦渴饮冷为据。阴盛则阳衰，其人定然无神，少气懒言，不渴不食，即渴喜滚为据。
因风伤太阳卫分者，由太阳之气不足，不能充周于腠理，毛窍空疏，风入于内，风为阳邪，善行而动，卫外血液不得潜藏，随发热之气机而外出，故自汗淋漓。法宜扶太阳之气，太阳气旺，始能胜邪，仲景之桂枝汤是也。
因阳阴火旺而致者，由胃中有火，热蒸于外，大汗如雨。非若久病大汗亡阳之证。此则其人大渴饮冷，二便闭塞，烦
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躁身轻，气粗口臭。法宜专清胃热，如人参白虎汤、大小承气汤之类是也。
更有一等汗证，如战汗、狂汗、黄汗、热汗、冷［1］汗、上身汗、下身汗、头汗、饮酒食肉汗出之例，亦不可不知。夫曰战汗者，由正气鼓动，与外入之邪气相攻，客邪外越，骤然战慄不已，汗大出，汗止而战慄自然不作，病即立瘳。瘟疫证中有此一证。又曰狂汗者，由外邪入内，随热而化，热乘于心，神识不明，当正邪相攻，客邪突出，心神不定，其人如狂，大汗如注，邪尽汗止，而病可立瘳。又曰黄汗者，汗出沾衣，而衣皆黄也。由脾液发泄不藏，法宜收纳脾胃之元气，如姜、砂、草、理中汤之类。又曰热汗者，阳分之征。冷汗者，阴分之验。上身独汗者，阳竭于上也。下身独汗者，阴脱于下也。上下二证，是为久病虚极者言也，总以收纳为要。若病未大虚，而上身汗者，责在气分有热，下身汗者，责在血分有火，不可拘执，务在这阴阳互根处理会。至于头汗出至颈而还，有风淫于上，有湿热蒸于上，有蓄血生热而蒸于上，须当变通。若是饮酒食肉而即汗出者，多由其人素缘胃热，一遇饮酒食肉，胃气即动，热气沸腾，薰蒸于上，而汗出于外，不药无伤。此有余之候，非不足可比。［眉批］此等之人，汗不是病，乃精不深藏，神不内敛，气易外越。夏固如此，冬亦皆然，主潦倒一生，此又相法之可通于医者。尚有一等绝证，汗出如珠、如油、如雨，种种不治之证。予曾经验，急以仲景回阳汤饮救之，十中每痊四五。当此时也，病家亦委之命而莫救也，医家亦委之于绝而莫救也。虽曰天命，又何妨力尽人事哉。但欲开方，务在单上批写明白，告诫病家，设或追之不及，不得归咎于医药，以免后人借为口实。
[1] 冷原本作"令"，据文义改。
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目下，世人畏附子、干姜，不啻砒毒，［眉批］世人畏姜、附，庸医误之也。医生畏姜、附，火字误之也。即有当服附子，而亦不肯服者，不胜屈指矣。嗟呼!阴阳不明。医门坏极，喜清凉而辛温，无怪乎阴盛阳衰矣。［眉批］知非氏曰：汗者，涣也。《易》曰：汗涣具大号气机之外出者然也。然有病有不病焉。阴阳本是一个，动为阳，静为阴，外为阳，内为阴，出则俱出，入则俱入，相随不离，故曰互根。又曰：一而二，二而一，性兼寒热，热则动，寒则凝，机缄本乎自然。故夏则多汗，冬则无汗，劳则多汗，逸则无汗，此不病之常也。病则无冬无夏，无劳无逸，皆有外越之机，身体秘见不安之状。或因阳虚，或因阴虚，或太阳中风，或阳明热越，临证处方，万举万当，何多求焉。
近来市习，一见汗出，多以麻黄根、冬桑叶、浮麦、参、芪之类治之，不在阴阳互根处理会，每多不效。
按健忘一证，固有阳虚、阴虚之别，然亦不必拘分，统以精神不足为主。凡人禀二气以生。二气即阳精、阴精也。二气浑为一气，神居二气之中，为气之宰，故曰：精、气、神。二气贯于周身，精气足，则神自聪明，故无所不知不晓。精气衰，则神昏，故时明时昧，犹若残灯之火，欲明不明，不能照物。比病老年居多，少年却少，即有如斯之少年，其所伤损不异乎老人也。此病法宜交通阴阳为主，再加以调养胎息之功，摄心于宥密之地，久久行之，亦可复明，如将竭之灯，而更添其膏也。方用白通汤久服，或桂枝龙骨牡蛎散，三才，潜阳等汤，缓缓服至五六十剂，自然如常，切勿专以天王补心，宁神定志诸方［1］，与参、枣、茯神、远志、朱砂一派可也。［眉批］邵子诗云：耳目聪明男子身，鸿钧赋于不
[1] 方原本作"古"，据文义改。
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为贫，病至健忘，赋畀之良危矣。钦安定以精神不足，透出神昏之所以然，理明法立，非浅见寡闻者所能窥测。苟能按方用药，可疗此疾，又何必深究所以。此一段乃性灵文字，不在医例，亦不得作医书观。夫神与气、精，是三品上药，独神是火，为先天之元阳，不但统制气、精，而气、精皆神所生。故此火宜温不宜凉，宜养不宜折。病人但能存此火烧火，尚可施治。此火一灭，精气绝而其人死矣，岂但健忘一证，即一部《医法圆通》之死证，皆此火之衰绝耳。凡医因何而不敢放胆用姜、附以活人耶!全龙点睛正在此处，学者着眼至摄心有密，乃培养此火种之法。钦安之医、之心、之学，亦于是乎在。
按惊悸一证，名异而源同，同在心经也。惊由神气之衰，不能镇静；悸由水气之忧，阴邪为殃。二证大有攸分，不得视为一例。予意当以心惊为一证，心悸为一证，临证庶不至混淆，立法治之，方不错乱。
夫曰惊者，触物而心即惶惶无措，偶闻震响而即恐惧无依，此皆由正气衰极，神无所主。法宜扶阳，交通水火为主，如白通汤，补坎益离丹之类，多服自愈。悸者，心下有水气也，心为火地，得阴水以扰之，故心不安。水停心下，时时荡漾，故如有物忡也。法宜行水为桂苓术甘汤，泽泻散之类。若悸甚而心下痛甚，时闻水声，又当以十枣汤，决堤行水，不可因循姑惜，以酿寇仇也。［眉批］知非氏曰：《经》曰：阳气者，欲如运枢，起居如惊，神气乃浮。钦安分惊为一证，以为正气衰微，神无所主，法宜扶阳，与《内经》吻合，自是方家举止。分悸为一证，指为心下有水气，亦合仲景之法。凡医皆能如此认证，言言有物，谓有不愈之病，吾不信也。
近来市习，一见惊悸，并不区分，概以安魂定魄为主，一味以龙骨、朱砂、茯神、远志、枣仁、参、归治之。治惊之法，尽于斯矣。
[2] 夫原本作"大"，据文义改。
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不 卧
按不卧一证，有因外邪扰乱正气而致者，有因内伤已久，心肾不交而致者，有因卒然大吐、大泻而致者，有因事势逼迫，忧思过度而至者。
因外感而致者，由邪从外入，或在皮肤，或在肌肉，或在经输，或在血脉，或在脏腑，正气受伤，心君不宁，故不得卧。必须去其外邪，正复神安，始能得卧。医者当审定邪之所在，如汗出不透者运之，可吐者吐之，可下者下之，可温者温之，可凉者凉之，按定浅深病情提纲，自然中肯。
因内伤而致者，由素秉阳衰，有因肾阳衰而不能启真水上升以交于心，心气即不得下降，故不卧；有因心血衰，不能降君火以下交于肾，肾水即不得上升，亦不得卧。其人定见萎靡不振，气短神衰，时多烦躁。法宜交通上下为主，如白通汤，补坎益离丹之类。
因吐泻而致者，由其吐泻伤及中宫之阳，中宫阳衰，不能运津液而交通上下。法宜温中，如吴茱萸汤，理中汤之类。
因忧思而致者，由过于忧思，心君浮燥不宁，元神不得下趋，以交于阴，故不得卧。此非药力可医，必得事事如意，神气安舒，自然能卧。若欲治之，亦只解郁而已，如归脾汤、鞠郁丸之类。
近来市习，一见不卧，便谓非安魂定魄不可。不知外感、内伤，皆能令人不卧，不可不辩也。［眉批］知非氏曰：不卧一证，属少阴，于何征之？仲景《伤寒论》曰：少阴之为病，脉微细，但欲寐也。但欲寐者，但想卧而不得卧，即不卧之深文［1］，故属少阴。学者凡遇不卧之证。拿定
[1] 文疑误，据文义当为"也"。
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提纲，再审所因，罔不中肯，此扼要之法也。
痢 证
按痢证一条，舒驰远先生为四纲，曰秋燥，曰时毒，曰滑脱，曰虚寒，甚为恰切。予谓此四法中，燥证十居其八，时毒十居二三，滑脱与虚寒十居四五。但辩察之间，不可无法。
燥证这痢，里急后重，日虽数十次，精神不衰，喜饮清凉。法宜清润，始甘桔二冬汤是也。
时毒之痢，里急后重，多见发热身疼，一乡一邑，病形皆相似也，乃是时行不正之气，由外入内，伏于肠胃，与时令人燥气相合，胶固肠胃而成痢。法宜升解，如人参败毒散，葛根芩连之类。
滑脱与虚寒之痢，二证情形虽异，病原则同，总缘中宫阳衰，运转力微，阴邪盘踞肠胃，阻滞元气运行之机，虽有里急后重之势，粪出尚多，非若秋澡时毒之痢，每次便时，不过几点而已，其人多见面白无神，四肢困倦。法宜温固为主，如附子理中汤，理脾涤饮之类。
总之，白痢、赤痢，痛甚，里急后重剧者，燥热之征。不痛，里急后重微者，虚寒之验。他如纯白如鱼脑，如猪肝，如尘腐，大热不休，口噤不食，呃逆频添，种种危候，虽在死例，然治得其法，十中亦可救二三。予亦尝遇此等危证，审无外感，无邪热，每以回阳收纳法治之多效。但大热大休一条，审察其人烦燥饮冷有神者，以调胃承气治之。若无神，安静不渴，急以回阳大剂治之，亦易见效。若妄以为阴虚，而以养阴法治之，百无一生。［眉批］知非氏曰：夫痢，险［1］症也，最多危候。
[1] 险原本作"脸"，据文义改。
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庸手无论矣，历来诸名家，亦少会归，惟陈修园先生《时方妙用》中论痢最佳。缘熟习《伤寒》所论治法，推本六经，方是仲景方，法是仲景法，未尝于仲景外稍参时法，分经治病，而不治痢，其得力于《伤寒》者深矣。予恒遵用其法，百发百中。人咸讶其神奇。其实以古方治今病，今月古月，岂有异乎？在有心人自为领取耳。钦安所论为详尽，鄙心炎之止快。
近来市习，一见痢证，便以黄芩芍药汤与通套痢疾诸方治之，究其意见，无非清热导滞，调气行血而已，不知气血之不调，各有所因。知其所因而治之，方是良相，不知其所因而治之，皆是庸手。
呃 逆
因阳虚者，由中宫之阳不足，以致阴邪隔据于中，阻其呼吸往来接续之机，其人定见无神，安静，不食不渴。法宜温中降逆为主，如理中汤加吴萸、半夏之类。
因阴虚者，盖以阴虚由于火烧火旺，火邪隔拒于中，阻其上下交接之气。其人定见躁暴，饮冷恶热，精神不衰，二便不利。法宜苦寒降逆为主，如大小承气汤之类。
For panting caused by the impending collapse of Yuan Yang (Primordial Yang), it is due to the patient's extreme decline in Yang and excess of Yin, forcing the residual Yang to float outward. The Yang Qi cannot descend and hide, leading to a disconnection between Yin and Yang, chaotic breathing rhythms, and the sudden onset of panting. At this moment, one must observe pale complexion, cyanotic lips, blackish-brown tongue and mouth, lack of vitality, presenting a picture of pure Yin. If large doses of diaphoretic herbs are used at this time, causing profuse sweating, it is extremely dangerous. The treatment principle should be to restore Yang and rescue from collapse, and to gather floating Yang. Formulas such as Wuzhuyu Sini Tang (Evodia Four Reversal Decoction) with added Dingxiang (Clove), Hujiao (Black Pepper), and Sharen (Amomum Fruit) can be used. This might save one or two out of ten cases. [Marginal Note] Zhifei Shi said: Mencius stated, "What is called Jue Ni (reversal) and Qu Xing (advancing movement) are manifestations of Qi." He also said, "Zhi (Will) is the commander of Qi." And again, "Maintain your Will, do not let Qi become violent." Can this principle be applied to treating panting? Those advancing movements and reversals all cause panting because the mechanism of slow ascent and descent is forced by labor; however, does it resolve once quieted? Current panting is not caused by labor yet is urgent and uncomfortable, nor can it be controlled by stillness. Who causes this? Indeed, as Qin'an discussed regarding the five causes, each has criteria for distinguishing Yin-Yang and Deficiency-Excess, which is quite detailed. However, using methods to restore Yang and gather for panting due to impending Yuan Yang collapse may seem shocking to some. Little do they know that since Zhi (Will) commands Qi, maintaining the Will and preventing Qi from becoming violent aligns perfectly with the critical timing for using the potent nature of Jiang (Dried Ginger) and Fu (Aconite). When the Shen Ji (Spiritual Mechanism) perishes, ascent and descent cease, Fire function fails to circulate, and Water function stagnates, only by using Jiang and Fu to nourish the Commander can the Commander rally, allowing Qi to follow orders. Thus, one might hope to achieve the skill of mending the heavens, becoming an outstanding physician. If scholars view Jiang and Fu as clearing heat by purging fire, or regard them as cooling herbs, that would be even more absurd. Hehe.
In treating panting syndromes, one must never act rashly. First, clearly ascertain the Yin-Yang situation before applying treatment. Do not blindly treat only the symptom of panting by recklessly administering Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) or Mahuang Dingchuan Tang (Ephedra Asthma-Curing Decoction). These are applicable for Wind-Cold but dangerous for Internal Injury.
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Sweating Syndrome
Regarding Sweating Syndrome, there are types due to Yang Deficiency, Yin Deficiency, Wind damaging the Wei (Defensive) level of the Taiyang (Greater Yang) channel, and Excessive Heat in the Yangming (Yang Brightness) organ.
Sweating due to Yang Deficiency arises from innate Yang deficiency or excessive mental exertion damaging Heart Yang. When Heart Yang declines, it cannot control the fluids within the Heart, leading to sweating. Similarly, if Spleen-Stomach Yang declines, it cannot contain blood/fluids within the Spleen-Stomach; if Liver-Kidney Yang declines, it cannot restrain blood/fluids within the Liver-Kidney. Decline of Yang in the Upper, Middle, and Lower Jiao (Triple Burner) can all cause sweating, collectively termed Yang Deficiency. Such patients typically exhibit lethargy, shortness of breath, and reluctance to speak. The treatment principle is to support Yang. Only when Yang is robust can it suppress and gather the myriad Yins, allowing Yin Qi to descend and Yang Qi to hide, preventing external loss. Key treatments include restoring Yang, gathering, and warming/consolidating, such as Fengsui Dan (Seal the Marrow Pill), Qianyang Dan (Submerge Yang Pill), Huangqi Jianzhong Tang (Astragalus Building the Middle Decoction), or Huyang Yin (Restore Yang Drink).
Sweating due to Yin Deficiency manifests as Night Sweats (Dao Han). This occurs because chronic blood deficiency fails to anchor Yuan Qi (Primordial Qi), causing Qi to float outward without attachment, taking blood with it, usually occurring at night. Night is when Yuan Qi should descend and hide, but without Yin to retain it, sweat ensues. This is not spontaneous sweating but a sign of floating Qi. The treatment principle is to nourish Blood, using formulas like Danggui Liuhuang Tang (Angelica Six-Huang Decoction) or Fengsui Dan with increased Huangbai (Phellodendron Bark) and Digupi (Dogwood Root Bark).
There is another type where Excess Yin repels Yang to the exterior. Patients sweat at night because Yang desires to descend and interact with Yin but cannot, so Yang floats externally. The treatment principle is to support Yang. When Yang is strong, Yin dares not contend, allowing Yang to descend and interact, using formulas like Baitong Tang (White Tongue Decoction) or Bukan Yili Dan (Tonify Kan Enrich Li Pill).
One must understand the distinction between Yin Deficiency and Yin Excess. Yin Deficiency leads to Fire Prosperity; the patient will have spirit/vitality, evidenced by irritability, thirst, and preference for cold drinks. Yin Excess leads to Yang Decline; the patient will lack spirit/vitality, with shortness of breath, reluctance to speak, no thirst, no appetite, or if thirsty, preferring hot drinks.
Sweating due to Wind damaging the Taiyang Wei level occurs because Taiyang Qi is insufficient to fill the Couli (pores/cutaneous interstices), leaving pores open. Wind enters internally; as a Yang pathogen, it moves rapidly. Defensive blood cannot hide and exits with the heat-generating Qi mechanism, causing spontaneous profuse sweating. The treatment principle is to support Taiyang Qi. When Taiyang Qi is strong, it overcomes the pathogen. Zhang Zhongjing's Guizhi Tang (Cinnamon Twig Decoction) is indicated.
Sweating due to Yangming Fire Prosperity results from Fire in the Stomach steaming outward, causing profuse sweating like rain. This differs from prolonged illness with Yang collapse via sweating. Such patients exhibit extreme thirst for cold drinks, constipation and urinary retention, irritability, light body sensation, coarse breathing, and foul breath. The treatment principle is to clear Stomach Heat exclusively, using Ren Shen Baizhu Tang (Ginseng White Tiger Decoction) or Da/Xiao Chengqi Tang (Major/Minor Order the Qi Decoctions).
There are other types of sweating syndromes, such as Zhan Han (Battle Sweat), Kuang Han (Mad Sweat), Huang Han (Yellow Sweat), Re Han (Hot Sweat), Leng Han (Cold Sweat) [1], upper body sweat, lower body sweat, head sweat, and sweating after drinking alcohol or eating meat, which must be known. Zhan Han occurs when Righteous Qi mobilizes to attack invading pathogens; the pathogen moves outward, causing sudden shivering followed by profuse sweating. Once sweat stops, shivering ceases, and the disease resolves immediately. This appears in Plague syndromes. Kuang Han occurs when external pathogens enter internally, transform with heat, and affect the Heart, clouding consciousness. During the struggle between Righteous Qi and Pathogens, the pathogen breaks through, unsettling the Heart Spirit, causing madness-like behavior and profuse sweating. When pathogens are exhausted, sweat stops, and the disease resolves. Huang Han refers to sweat staining clothes yellow, caused by Spleen fluids leaking and failing to store. Treatment involves gathering Spleen-Stomach Primordial Qi, using Jiang (Ginger), Sharen (Amomum), Cao (Licorice), and Lizhong Tang (Regulate the Middle Decoction). Re Han (Hot Sweat) is a sign of Yang aspect; Leng Han (Cold Sweat) is a sign of Yin aspect. Sweat only on the upper body indicates Yang exhaustion above; sweat only on the lower body indicates Yin collapse below. These two conditions refer to prolonged severe deficiency, where gathering is key. If not severely deficient, upper body sweat indicates Heat in the Qi aspect; lower body sweat indicates Fire in the Blood aspect. One must not be rigid but understand the mutual root of Yin and Yang. Head sweat stopping at the neck may be due to Wind excess above, Damp-Heat steaming above, or Blood stasis generating heat steaming above; flexibility is required. Sweating immediately after alcohol/meat consumption stems from innate Stomach Heat; upon intake, Stomach Qi activates, heat boils and steams upward, causing sweat. This requires no medication as it is an Excess condition, not Deficiency. [Marginal Note] For such people, sweat is not the disease; rather, Essence is not deeply stored, Spirit is not inwardly contained, and Qi easily escapes. This happens in summer and winter alike, destined for a life of destitution. Physiognomy principles apply here. There are also terminal signs: sweat like pearls, oil, or rain, indicating untreatable conditions. I have experienced these; urgently using Zhang Zhongjing's Huyang Tang/Yin can save 40-50% of cases. At this point, families often resign to fate, and physicians deem it hopeless. Though called Heaven's Will, one must strive fully. Prescriptions must clearly warn families to avoid blame if efforts fail.
[1] "Leng" was originally "Ling", corrected based on context.
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Currently, people fear Fuzi (Aconite) and Ganjiang (Dried Ginger) as if they were arsenic. [Marginal Note] People fear Jiang/Fu due to quack doctors' errors. Doctors fear them due to misunderstanding the "Fire" character. Even those who should take Fuzi refuse, countless in number. Alas! Ignorance of Yin-Yang has ruined medicine. Preferring cooling to acrid-warm explains why Yin is excess and Yang is deficient. [Marginal Note] Zhifei Shi said: "Han" (Sweat) means dispersion. The I Ching states: "Dispersion implies great power, the outward movement of Qi mechanism." Yet there are pathological and non-pathological differences. Yin and Yang are one; movement is Yang, stillness is Yin; exterior is Yang, interior is Yin; they exit/enter together, inseparable, hence "mutual root." They are one divided into two, two united as one, possessing both cold and heat natures; heat causes movement, cold causes coagulation, mechanisms are natural. Hence, summer has more sweat, winter less; labor causes more sweat, rest less. This is normal health. Disease brings external escape tendencies regardless of season or activity, causing bodily discomfort. Whether due to Yang Def, Yin Def, Taiyang Wind, or Yangming Heat, precise diagnosis yields correct prescriptions. Why seek further?
Recent trends see practitioners using Mahuang Gen (Ephedra Root), Dong Sang Ye (Mulberry Leaf), Fu Mai (Floating Wheat), Renshen (Ginseng), Huangqi (Astragalus) for any sweating, ignoring Yin-Yang mutual rooting, often resulting in failure.
Forgetfulness
Regarding Forgetfulness, while distinctions exist between Yang and Yin Deficiency, it is primarily treated as Spiritual Insufficiency. Humans are born from Two Qi: Yang Jing (Essence) and Yin Jing. These merge into one Qi, with Shen (Spirit) residing within as master. Thus: Jing, Qi, Shen. When Jing-Qi fills the body, Shen becomes bright, knowing all. When Jing-Qi declines, Shen dims, alternating clarity and confusion, like a dying lamp unable to illuminate. This affects the elderly more than youth; young cases suffer similar damage. Treatment focuses on communicating Yin and Yang, combined with Taixi (Fetal Breathing) cultivation and focusing the mind in seclusion. Long practice restores clarity, like adding oil to a dying lamp. Use Baitong Tang long-term, or Guizhi Longgu Muli San (Cinnamon Twig, Dragon Bone, Oyster Shell Powder), Santang Tang (Three Talents Decoction), Qianyang Dan, taken slowly for 50-60 doses. Do not solely rely on Tianwang Buxin Dan (Heavenly Emperor Nourishing Heart Pill), Ningshen Dingzhi formulas, or herbs like Renshen, Zao (Jujube), Fushen (Poria with Hostwood), Yuanzhi (Polygala Root), Zhusha (Cinnabar). [Marginal Note] Shaozi's poem: "Ears and eyes bright, a man's form, endowed by the Great Harmony..."
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...poverty. When forgetfulness strikes, the endowed goodness is endangered. Qin'an attributes it to Spiritual Insufficiency, revealing the cause of Shen dimness. Principles are clear, laws established, beyond shallow understanding. Following prescriptions cures the disease; deep inquiry is unnecessary. This passage is spiritual writing, not strict medical example, nor to be read merely as a medical book. Shen, Qi, Jing are the highest medicines. Shen alone is Fire, the Primordial Yang of Pre-Heaven. It controls Qi and Jing, which are born from Shen. Therefore, this Fire should be warmed, not cooled; nourished, not suppressed. If the patient retains this Fire, treatment is possible. Once extinguished, Jing-Qi ends, and death follows. Not just forgetfulness, but all fatal cases in *Yifa Yuantong* result from this Fire's decline. Why do physicians dare not use Jiang/Fu to save lives? The crucial point lies here. Scholars must focus on "focusing the mind in seclusion" to cultivate this Fire seed. Qin'an's medicine, heart, and learning reside here.
Palpitations and Fright
"Fright" and "Palpitations" differ in name but share the same source: the Heart Channel. Fright arises from Shen-Qi decline, inability to stabilize; Palpitations arise from Water Qi anxiety, Yin pathogen harm. These are distinct and should not be conflated. I propose treating "Heart Fright" and "Heart Palpitation" separately to avoid confusion.
Fright involves sudden panic upon stimuli or loud noises, due to extreme Righteous Qi decline and Shen having no master. Treatment supports Yang and communicates Water-Fire, using Baitong Tang or Bukan Yili Dan.
Palpitation indicates Water Qi beneath the Heart. Heart is Fire Earth; disturbed by Yin Water, it feels uneasy. Water stagnation causes rippling sensations. Treatment promotes Water flow using Guiling Zhugan Tang (Alisma, Poria, Atractylodes, Licorice Decoction) or Zexie San (Alisma Powder). If palpitations are severe with chest pain and audible water sounds, Shizao Tang (Ten Jujube Decoction) is needed to drain water decisively, avoiding delay. [Marginal Note] Zhifei Shi said: *Neijing* states: "Yang Qi should rotate like a pivot; if daily life startles, Shen Qi floats." Qin'an separates Fright as Yang decline/Shen lacking master, aligning with *Neijing*. Separating Palpitation as Water Qi beneath Heart aligns with Zhang Zhongjing. If physicians diagnose thus, speaking substantively, no disease is incurable.
Recent trends treat all palpitations/fright with Soul-Calming/Pacifying methods, using Longgu (Dragon Bone), Zhusha (Cinnabar), Fushen (Poria), Yuanzhi (Polygala), Suanzaoren (Ziziphus Seed), Renshen (Ginseng), Danggui (Angelica). This limits Fright treatment to mere sedation.
[2] "Fu" was originally "Da", corrected based on context.
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Insomnia
Insomnia arises from: External pathogens disturbing Righteous Qi; Chronic internal injury causing Heart-Kidney non-interaction; Sudden severe vomiting/diarrhea; or Stress/worry.
External cause: Pathogens enter skin, muscle, channels, vessels, or organs, injuring Righteous Qi, disturbing Heart Monarch, preventing sleep. Must expel pathogen; once Righteous Qi recovers and Shen calms, sleep returns. Physicians must locate pathogen: dissipate if sweat is incomplete, induce emesis if appropriate, purge if indicated, warm or cool accordingly. Following depth/pathology guidelines ensures accuracy.
Internal cause: Innate Yang decline. Kidney Yang failure prevents True Water ascending to communicate with Heart, so Heart Qi cannot descend. Or Heart Blood decline prevents Minister Fire descending to communicate with Kidney, so Kidney Water cannot ascend. Both cause insomnia. Symptoms: listlessness, shortness of breath, Shen fatigue, frequent irritability. Treatment communicates Upper/Lower using Baitong Tang or Bukan Yili Dan.
Vomiting/Diarrhea cause: Damage to Middle Jiao Yang. Middle Yang decline fails to transport fluids for Upper-Lower communication. Treatment warms the Middle using Wuzhuyu Tang or Lizhong Tang.
Worry cause: Excessive worry makes Heart Monarch restless, Yuan Shen cannot descend to interact with Yin. Medication alone cannot cure; requires favorable circumstances and Shen comfort. If treating, resolve depression using Guipi Tang or Juyu Wan.
Recent trends assume all insomnia requires Soul-Calming, ignoring External/Internal distinctions. [Marginal Note] Zhifei Shi said: Insomnia belongs to Shaoyin (Lesser Yin). How verified? *Shanghan Lun* states: "Shaoyin disease: pulse faint/fine, only desiring sleep." "Desiring sleep but unable" is the deeper meaning of insomnia, thus belonging to Shaoyin. Scholars facing insomnia must grasp the guideline and investigate cause.
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Dysentery
Shu Chi Yuan categorized Dysentery into four patterns: Autumn Dryness, Seasonal Toxin, Slippage, and Deficiency-Cold. I agree, noting Dryness accounts for 80%, Seasonal Toxin 20-30%, Slippage/Deficiency-Cold 40-50%. Distinction is crucial.
Dryness Dysentery: Tenesmus, frequent stools, preserved spirit, preference for cool drinks. Treatment clears and moistens using Shiganjie Erdong Tang (Initial Sweet & Bitter桔 Two Winter Decoction).
Seasonal Toxin Dysentery: Tenesmus, fever, body ache, epidemic similarity. Caused by irregular seasonal Qi entering internally, lodging in intestines, combining with dryness. Treatment lifts and resolves using Renshen Baidu San (Ginseng Rescue Detoxification Powder) or Gegen Qinlian Tang (Kudzu Coptis Scutellaria Decoction).
Slippage/Deficiency-Cold Dysentery: Similar pathology despite different presentations. Middle Jiao Yang decline, weak rotation, Yin pathogen occupying intestines, blocking Qi movement. Unlike Dryness/Toxin dysentery (few drops), stool volume is significant. Symptoms: pale face, no spirit, limb fatigue. Treatment warms and consolidates using Fuzi Lizhong Tang or Lipi Diyin Tang.
Summary: White/Red dysentery, severe pain, intense tenesmus indicate Dryness-Heat. No pain, mild tenesmus indicate Deficiency-Cold. Critical signs: white like fish brain/liver dust, high fever, locked jaw, anorexia, frequent hiccups. Though often fatal, proper treatment saves 20-30%. I have treated these with Restoring Yang/Gathering methods, effective if no external pathogen or Evil Heat exists. For high fever/thirst with spirit: use Tiaowei Chengqi Tang. For no spirit, quiet, no thirst: urgently use large dose Restoring Yang formula. Mistaking for Yin Deficiency and using Nourishing Yin guarantees death. [Marginal Note] Zhifei Shi said: Dysentery is a dangerous syndrome with many critical signs.
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Quacks need not be mentioned. Past masters rarely converged, except Chen Xiuyuan's *Shifang Miaoyong*, which best discusses dysentery. Familiar with *Shanghan Lun* methods, tracing back to Six Channels, using Zhang Zhongjing's formulas/methods strictly, deriving benefit from *Shanghan*. I follow his methods with 100% success. People marvel at the magic. Actually, ancient formulas treat modern diseases identically. It depends on the insightful practitioner. Qin'an's discussion is thorough, bringing me joy.
Recent trends use Huangqin Shaoyao Tang (Scutellaria Peony Decoction) and standard dysentery formulas, aiming only to clear heat, guide stagnation, regulate Qi, move Blood. Ignoring that Qi-Blood disharmony has specific causes. Treating the cause makes one a good minister; ignoring it makes one a quack.
Hiccups
Hiccups involve Yang Deficiency, Yin Deficiency, or Impending Collapse of Primordial Qi.
Yang Deficiency Hiccups: Middle Jiao Yang insufficiency allows Yin pathogen to block the middle, obstructing respiratory continuity. Symptoms: no spirit, quiet, anorexia, no thirst. Treatment warms middle and descends rebellion using Lizhong Tang plus Wuzhuyu (Evodia) and Banxia (Pinellia).
Yin Deficiency Hiccups: Yin Deficiency leads to Fire Prosperity. Fire pathogen blocks the middle, obstructing Upper-Lower Qi connection. Symptoms: irritability, cold drink preference, heat aversion, preserved spirit, urinary/bowel obstruction. Treatment uses bitter-cold to descend rebellion using Da/Xiao Chengqi Tang.