因元气将绝而致者，盖以元阳将绝，群阴顿起，阻其升降交接之机，其人或大汗自汗出，或气喘唇青，或腹痛囊缩，或爪甲青黑，或头痛如劈，目皆欲裂，耳肿喉痛，种种病情，皆宜大剂回阳降逆，十中亦可救二三，如吴萸四逆汤，白通汤之类。［眉批］钦安论此一条，不在证名上论治，专在所因上谈法，是一段聪明文字，是此证聪明治法，学者能识此聪明之理法，便是良医。
近来市习，一见呃逆，阴阳不分，一味以橘皮、半夏、竹茹、丁香、柿蒂等药治之，亦有见效，终不若辩明阴阳治之为当也。
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反 胃
按反胃一证，有阳虚、阴虚之别。
因阳虚者，盖以阳衰则不能镇纳僭上之阴，阴邪过盛，势必与阳相拒，一切经火烹调之物，皆不能容，故下喉数刻，或二三时乃仍吐出。其人定见脉大而空，或劲如石，言语一切无神，困倦喜卧。法宜回阳降逆为主，如吴萸四逆汤、半夏生姜汤之类。
诸书亦云：朝食暮吐，为命门无火，不能薰蒸，果称灼见，但用药多以阳八味，大补元煎治之，为补命门必用之药，舍此二方，无从下手。予尝试之，多不见效。所以然者，二方概以熟地为君以补阴，枣皮以滋阴，丹皮以泻火，用桂、附仅十中之二三。试问：既曰命门无火，理宜专用桂、附以补火，何得用地、枣以滋阴，丹皮以泻火乎？此皆景岳不读仲景之书，而未明阴阳之道也。在景岳以为，善补阳者，于阴中求阳，故用一派养阴之药，杂一二味补火之品于中，而谓阴中求阳，至极无二之法，独不思仲景为立法之祖，于纯阴无阳之证，只爱管闲事发附、草三味，即能起死回生，并不杂一养阴之品，未必仲景不知阴中求阳乎？仲景求阳，在人身坎宫中说法，景岳求阳，在药味养阴里注解。相隔天渊，无人窥破，蒙蔽有年，不忍坐视，故特申言之。［眉批］知非氏曰；斯文宗孔孟，讲武宗孙子，注疏宗程朱。百家众技者流，咸存而不论，以故朝野相安，道一风同，称郅治焉。独至于医，为斯世所不可缺。虽穷乡僻壤，亦有囊中而趋向各不相侔，圣凡迄无定论，草菅人命，亦不为怪。此段疑案，悒于怀抱［1］久矣，欲互相商榷，又少知音。今于批评钦安书，至反胃一证，其驳景岳用药，大为有理。因思市医宗后世诸家者多。后世诸家之书，双多于古人。古人分六经，后人分五经。古人立方不讲药性，后人立方专究药性。古人方效，
[1] 抱原本作"泡"，据文义改。
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而今人不用。后人方不效，今人乐于从事，反诋古人之方为太重，后人之方为轻而合宜。古人不立证名，后人多立证名。古人不以脉定证，后人能以脉知病、古人只论六阴阳，后人论千阴阳、万阴阳。群言淆乱，衷诸圣，今人竟舍古人而从后人，视古人为不可知，后人乃可法，反觉后来居上。以故《灵》、《素》、《难经》及《伤寒》成为畏途，而人命直为儿戏矣。余诚不知医，鄙意总以能读古人之书，得古人之心法，有古人之方，治今人无误，方为医者，未知是否，祈阅者教之。
因阴虚者，盖以阴衰不能制火，火拒于中，气机有升无降，故饮食下喉一刻，仍然吐出。其人定见精神不衰，声音响亮，烦燥不宁，关脉必洪大有力。法宜苦寒降逆为主，如大小承气汤之类。他书议论纷纷，愈出愈奇，去理愈远，不可为法。其中因受虽异，总以一逆字定之，逆则以阴阳判之便了。
癫 狂
按癫狂一证，名异而源同。同者，同在心经也。癫虚而狂实。癫为心阳之不足，神识昏迷。癫者，言语重复，喜笑无常，作事无绪，皆由心阳不足，神识不清，寒痰易生，上闭心窍，亦能使人癫癫倒倒。然专于治痰，便是舍本逐末，不可为法。交通上下，是为治本握要法，宜细心体会之。狂乃邪火之横行，神无定主。狂者，本由邪火乘心，乱其神明，神无所主，砐大叫狂妄，登高弃衣，亲疏不避，治之专以下夺、清热为主。治癫贵以养正，兼以行痰。治狂务于祛邪，灭火为要。白通、枙、鼓，主于交通，阴癫、阳癫可疗。大小承气，专行政下，狂妄能医，其中尚有夙孽冤凭，尤当急作善功忏悔。［眉批］知非氏曰：扶正治癫，下气治狂，名论不刊。
近来市习，治癫专以祛痰安魂定魄，治狂每以清水降痰，亦多获效。终不若握定金针，临证有据也。
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胀 满
按胀满一条，诸书分别有肤胀、腹胀、水胀、气胀、血胀、盐毒之名，总无一定之旨归。予仔细推究，因太阳失职，气化失化而致者，十居七八。因吐泻伤中，克伐元气而致者，十居四五。若蛊毒则另有由致。
所谓因太阳失职者何？盖以太阳为一身之纲领，主皮肤，统营卫，脏腑、经络、骨节，莫不咸赖焉。太阳居坎宫子位，一阳发动，散水精之气于周身，乃众阳之宗，一元之主也。故称之曰太阳，至尊无二之意也。乃人不知保护，内而七情损之，外而六客戕之，以致一元伤损，运化失于皮肤，则肤胀生；运化失于中州，则腹胀作；运化失于下焦，则阴囊、脚胀起。水逆于肺，则生喘咳；水逆于肠，则生泄泻；水注于左，注于右，留于上，留于下，留于中，化而为痰，则有五饮之说。水胀之源，皆本于斯。
至于气胀者，乃元气散漫之征。多起于大病、久病，或吐泻，或过于克伐，伤于一元。
血胀者，周身浮肿而皮色紫红，是气衰而阴乘于上也。亦有周身浮肿，而小腹硬满，小便短赤，是阳衰于下，而阴不化也。
总而言之，万病起于一元伤损。分而言之，上中下各有阴阳，十二经各有阴阳，合而观之，一阴一阳而已。更以阴阳凝聚而观之，一团元气而已。至于受病，浅深各有旨归，然分类以治之，未始不当，但方愈多而旨愈乱，若不再行推醒，拈出旨归，将来后学无从下手。当今之际，谁非见肿治肿，见胀消胀者哉。予意此病治法，宜扶一元之真火，剑已散之阳光，俾一元气复，运化不乖，如术附汤，姜附汤，真
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武汤，桂苓术甘汤，附子理中汤，麻黄附子细辛汤，附子甘草汤之类。以上数方，各有妙用，肤胀、水胀、气胀、血胀、腹胀皆能奏功，［眉批］知非氏曰：中寒生胀满，胀满属太阴，此病根也。试取譬焉，人身尤葫芦，葫芦有前面，腹为阴也；葫芦有后面，背为阳也；葫芦有上面，头为诸阳之首，乾也，葫芦有下面，戌亥子丑，两阴交尽，二阳初生之地，坎也，坤也；斗胆言乎中，葫芦里面有金丹，金者，乾也，丹者，坎为月也。月本无光，借日而有光，盖乾交乎坤，三索而得男哉，生明矣，三五而盈，三五而缺，识此之故，所谓天道下济而光明也。胀满本属阴寒为病，必阳先虚而不运，斯阴始实而成胀。欲消此胀，必先扶阳。岐伯曰：阴病治阳。仲景曰：太阴之为病，腹胀满而用干姜，早为万世之梯航，何待饶舌。然而时医不知身中阴阳上下往来为病之消息，不得不将古法今朝重提起。钦安推本太阳，知非更进少阴。少阴者。君火也，主弱则臣强，臣强必欺主。是故少阴之君火衰微，则各路之烟尘四起。或阴明之燥金一强，主膀胱不利。或少阳之相火一强，主胸膈胁肋胀满。或阴明之燥金一强，主肌肉胀满。或太阴之湿土一强，主单腹胀满，有大如瓮者。或厥阴之风木一强，主少腹阴囊及脚腿胀满。独少阴之君火一强，则群阴见睍，秋阳当空，万魔潜消矣。故仲景以脉微细，但欲寐，称为少阴不足之病。三急下法存少阴将绝之阴。由此推之，六经皆能为胀，六经之方各有治胀之妙，神而明之，存乎其人耳。
总而言之，元阳为本，诸阴阳为标。能知诸阴阳皆为元阳所化，一元阳变而为诸阴阳。元阳即是诸阴阳，诸阴阳仍是元阳，而又非诸阴阳之外。另有一元阳，元阳之外，另起诸阴阳。阴阳又不是混作一团［1］，又不能打成一片，则治病不难而可悬壶于市矣。再能知六经中有主脑，六阴阳中有窍妙，斯真凿破鸿濛，辟开太极，医道特其余事，又多能云尔。
唯蛊毒则另有法治。然蛊有自外、自内之别。自外者何？埋蛊厌人一法，蛮方最多。或蛇，或虫，或龟，或鳖炼而成之，或于食物放之，或于衣被放之。人中之者，久久面黄肌瘦，腹大如鼓，不久即死。蓄蛊之人，家道顺遂，自喜术灵，而不知造孽已深，不可解也。汇参辑成《石室秘录》，稆家书上，皆有妙方，兹不具载。自内者何？若《易》云：山风蛊，
[1] 团原本作"国"，据文义改。
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为女惑男，因少男配长女，阴阳失常，尊卑紊乱，不思各正其性，艮则安止，巽则顺从，久而败坏，蛊乃生焉。治之之法，于止而不动者动之，柔而不振者振之，使之各有向背，不失其正，庶几天地泰而阴阳不偏矣。然则治法奈何？宜苦［1］宜辛尽之矣。
予尝治一男子，腹大如鼓，按之中空，精神困倦，少气懒言，半载有余。予知为元气散漫也，即以大济吴萸四逆汤治之，一二剂而胀鼓顿失矣。又治一男子，腹大如鼓，按之中实，坚如石块，大小累累，服破气行血之药，已经数月，予知为阴积于中，无阳以化之也，即以附子理中汤加桂、叩、砂、半、丁香，一二剂而腹实顿消。二证虽不足以蛊论，然而治蛊之法，未始不可以二证概也。另有虫蛊一证，又不可不知也。
小 儿 抽 掣俗作惊风
按小儿抽掣一条，有外感内伤之别。因外感而致者，由其感受外来之风寒，闭其经络运行之气，现角弓反张，壮热自汗者，风伤太阳之卫也，桂枝汤可与之。角弓反张，壮热无汗，而畏寒者，寒伤太阳之营也，麻黄汤可与之。若壮热，燥躁口渴，气粗蒸手，二便不利者，热淫于内也，白虎、调胃承气可与之。稍轻者，导赤散加荆、防、虫退、茯苓亦可与之。
因内伤而致者，或饮食伤中，颧大吐后，或大泻后，或久病后，或偶受外邪，发散太过，或偶停滞，消导克伐太过，积之既久，元气日微，虚极而生抽掣。诸书称慢脾风者是也。其人定见面白唇青，饮食减少，人困无神，口冷气微，
[1] 苦 原本作"若"笔误，据文义改。
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或溏泄日三五次，或下半日微烧、微汗，抽掣时生，此是元气虚极，神无定主，支持失权，由内而出之候。只有扶元一法，如附子理中加砂、半，回阳饮加砂、半。昧者不知此理，一见抽掣，便称惊风。若妄以祛风之品施之，是速其已也。业斯道者，逢此等证候，务须细心斟酌阴阳实据，庶不致屈杀人命。予非言大而夸，其所目睹而亲见者，不胜屈指矣。病家于此，切切不可专求捷方。［眉批］知非氏曰：凡视小儿之病，虽曰哑科，而望、闻、问、切四诊，皆有凭据。青、黄、赤、白、黑，有神无神，形体之肥瘦厚薄，容貌之惨舒虚实，皆可目睹。所谓望也。声音之盛衰，气息之粗细，喘与不喘，微与不微，可以耳听，所谓闻也。腹痛则其哭也头必俯，项背痛则其哭也头必仰，小便数不数，大便调不调，其父母必能稔知，可以面讯，所谓问也。烧热不烧热。厥冷不厥冷，有汗无汗，可以手摸，两手之 ，可以指取，所谓切也。有此四诊，即得病情。至于抽掣，病在筋膜，主伤风木之气，风寒无疑，调和营卫足矣。再有他故，知犯何逆，以法救之，无不见效。钦安指示亲切，分辩详细，断不可照市医看法，单视虎口筋纹，定是何病，便处方药，紫纹冲上三关峭必定是危候，尤要在小儿抽掣，勿认是风，便用惊药，功德无量矣。况小儿阳气嫩弱，不胜风寒作崇，或发表太过，或经误下，往往筋惕瞤，振振动摇，不是惊风，养阴和阳，便不惊风。谓小儿火大者，是其父母欲自杀其儿，可辞云不治，尤为工嘱。须知小儿阳弱，火又能从内发。小儿无欲，火不能从外入，此是金针。
按中风一证，原有中经、中腑、中脏、闭、脱之情，陈修园先生《三字经》、《从众录》分辩甚详，可以熟玩。予更细为思之，夫人身原凭一气包罗，无损无伤，外邪何由而得入，内邪何由而得出。凡得此疾，必其人内本先虚，一切外邪始能由外入内，一切内邪始能由内出外，闭塞脏腑经络气机，皆能令人死。不得概谓皆由外致也。予常见卒倒昏迷，口眼㖞斜，或身软弱，或周身抽掣。众人皆作中风治之，专主
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祛风化痰不效。予经手专主先天真阳衰损，在此下手，兼看何部病情独现，用药即在此攸分。要知人之所以奉生而不死者，恃此先天一点真气耳。［眉批］知非氏曰：此解已透，然内本先虚，所谓本实先拨，即专主先天施治，未必十治十全。须知先天之阳不易回也，先与病家说明，愈是万幸，不愈医不任咎。若是回阳不愈，真阴不能自生，有人能治愈此病者，愿焚其书，愿铲其批。真气衰于何部，内邪外邪即在此处窃发。治之但扶其真元，内外两邪皆能绝灭。是不治邪而实以治邪，未治风而实以祛风。握要之法也。若专主祛风化痰，每每酿成脱绝危候，何也？正虚而邪始生，舍其虚而逐其末。况一切祛风化谈之品，皆是耗散元气之斤，未有不立增其病者。然而浅深轻重，步步有法，贵在圆通。予不过以鄙意之管见，以与同人共商之耳。
中 痰
Caused by the impending exhaustion of Yuan Qi (Original Qi), this condition arises because Yuan Yang (Original Yang) is on the verge of extinction. A sudden surge of Yin pathogens obstructs the mechanism of ascending and descending, and the intersection of Qi. Patients may present with profuse sweating or spontaneous sweating, panting with cyanotic lips, abdominal pain with retraction of the testicles, cyanotic and black fingernails, headache as if split open with eyes feeling as though they will burst, swollen ears, and sore throat. For all these various manifestations, large doses of formulas that restore Yang and direct rebellious Qi downward should be used. Perhaps two or three out of ten can be saved. Examples include Wu Zhu Yu Si Ni Tang (Evodia Four Reversal Decoction) and Bai Tong Tang (White Pass Decoction). [Marginal Note] Qin An discusses this point not by focusing on the name of the syndrome for treatment, but specifically on discussing methods based on the etiology. This is a passage of intelligent writing and an intelligent method for treating this syndrome. If students can recognize this principle of intelligence, they will become good physicians.
In recent times, the habit among city doctors is that upon seeing hiccups (inverted stomach qi), they do not distinguish between Yin and Yang, and blindly use herbs such as Chen Pi (Tangerine Peel), Ban Xia (Pinellia Rhizome), Zhu Ru (Bamboo Shavings), Ding Xiang (Clove), and Shi Di (Persimmon Calyx). Although there are cases where it is effective, it is ultimately not as appropriate as treating after clearly distinguishing Yin and Yang.
Regurgitation (Fan Wei)
Regarding the syndrome of Regurgitation, there is a distinction between deficiency of Yang and deficiency of Yin.
When caused by Yang deficiency, it is because Yang is weak and cannot suppress and assimilate the Yin that rebels upward. When Yin pathogens are excessively strong, they inevitably resist Yang. Consequently, all foods cooked by fire cannot be tolerated. Thus, food swallowed may still be vomited up after a few moments or two to three hours. Such patients will definitely present with a pulse that is large and empty, or hard like stone; their speech will lack spirit; they will feel fatigued and prefer lying down. The treatment method should focus on restoring Yang and directing rebellious Qi downward, using formulas such as Wu Zhu Yu Si Ni Tang (Evodia Four Reversal Decoction) and Ban Xia Sheng Jiang Tang (Pinellia and Fresh Ginger Decoction).
Various medical books also state: "Vomiting in the evening what was eaten in the morning" is due to the lack of fire in the Gate of Life (Ming Men), which fails to steam and digest. This is indeed a profound insight. However, medications often used are Ba Wei Wan (Eight-Ingredient Pill) and Da Bu Yuan Jian (Great Tonification Decoction), considered essential medicines for tonifying the Gate of Life. Without these two formulas, one does not know where to begin. I have tried them, and they mostly show no effect. The reason is that both formulas use Shu Di Huang (Prepared Rehmannia Root) as the sovereign herb to tonify Yin, Shan Zhu Yu (Cornus Fruit) to nourish Yin, and Mu Dan Pi (Moutan Bark) to drain fire, while Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) constitute only two or three parts out of ten. Let me ask: Since it is said that there is no fire in the Gate of Life, logic dictates using Gui Zhi and Fu Zi exclusively to tonify fire. Why use Di Huang and Shan Zhu Yu to nourish Yin, and Mu Dan Pi to drain fire? This is because Zhang Jingyue did not read Zhongjing's books and failed to understand the Way of Yin and Yang. In Zhang Jingyue's view, those who are good at tonifying Yang seek Yang within Yin. Therefore, he uses a batch of Yin-nourishing drugs mixed with one or two fire-tonifying items, calling it "seeking Yang within Yin," which he considers the ultimate and unparalleled method. He fails to realize that Zhongjing, the ancestor of legislation, for syndromes of pure Yin without Yang, merely took the liberty of using three herbs—Fu Zi (Aconite Root), Gan Jiang (Dried Ginger), and Gan Cao (Licorice Root)—to bring the dying back to life, without mixing any Yin-nourishing products. Is it possible that Zhongjing did not know how to seek Yang within Yin? Zhongjing seeks Yang by speaking from the perspective of the Kan Palace (Kidney/Water) in the human body; Zhang Jingyue seeks Yang by annotating within the context of Yin-nourishing herbs. They are separated by heaven and earth. No one has penetrated this secret, and it has been obscured for years. I cannot bear to sit idly by, so I specially elaborate on this. [Marginal Note] Zhi Fei says: Literature follows Confucius and Mencius, martial arts follow Sun Tzu, and annotations follow Cheng Yi and Zhu Xi. Those of the hundred schools and various skills are preserved but not discussed, thus maintaining peace between court and commoners, unifying the Way and custom, achieving great governance. Only in medicine, which is indispensable to this world, even in remote villages, practitioners have different orientations. There is no fixed conclusion between sage and ordinary person, and disregarding human life is not strange. This doubtful case has been郁结 (depressed) in my heart for a long time. I wanted to discuss it mutually but lacked kindred spirits. Now, while criticizing Qin An's book, regarding the syndrome of Regurgitation, his refutation of Zhang Jingyue's medication is very reasonable. I think that many city doctors follow later generations' masters. Later generations' books are mostly more numerous than the ancients'. The ancients divided into Six Channels, while later generations divided into Five Channels. The ancients formulated prescriptions without focusing on herb properties, while later generations specialized in studying herb properties. Ancient prescriptions were effective, yet modern people do not use them. Later prescriptions are ineffective, yet modern people are happy to practice them, instead denouncing ancient prescriptions as too heavy and later prescriptions as light and appropriate. The ancients did not establish syndrome names, while later generations established many. The ancients did not determine syndromes by pulse, while later generations can know diseases by pulse. The ancients only discussed Six Yin-Yangs, while later generations discuss thousands and tens of thousands of Yin-Yangs. With confused voices, relying on the sages, modern people abandon the ancients and follow the later generations, viewing the ancients as unknowable and the later generations as models, feeling that later ones surpass earlier ones. Thus, Ling Shu, Su Wen, Nan Jing, and Shang Han Lun have become paths of fear, and human life is treated like child's play. I truly do not understand medicine. My humble opinion is that one must be able to read the ancients' books, obtain the ancients' mental methods, possess the ancients' prescriptions, and treat modern people without error to be considered a physician. I wonder if this is correct; I request readers to instruct me.
When caused by Yin deficiency, it is because Yin is weak and cannot control Fire. Fire rebels in the middle, and the Qi mechanism ascends but does not descend. Therefore, food swallowed is still vomited up after a moment. Such patients will definitely show undiminished spirit, loud voice, restlessness, and irritability. The Guan pulse will definitely be surging, large, and forceful. The treatment method should focus on bitter-cold herbs to direct rebellious Qi downward, such as Da Cheng Qi Tang (Major Order the Qi Decoction) and Xiao Cheng Qi Tang (Minor Order the Qi Decoction). Discussions in other books are chaotic, becoming increasingly bizarre, moving further from truth, and cannot serve as standards. Although the causes differ, they are all determined by the character "Ni" (Rebellious). By determining Yin and Yang, the issue is resolved.
Mania and Depression (Dian Kuang)
Regarding the syndrome of Mania and Depression, the names differ but the source is the same. The similarity lies in their connection to the Heart Channel. Dian (Depression/Melancholia) is deficient, while Kuang (Mania) is excess. Dian is due to insufficiency of Heart Yang, leading to confusion of the Shen (Spirit). Dian manifests as repetitive speech, inappropriate laughter, and aimless actions, all caused by insufficient Heart Yang, unclear Shen, and the easy generation of Cold Phlegm that closes the Heart orifices from above, causing erratic behavior. However, treating solely for phlegm is abandoning the root for the branches and cannot be a standard. Facilitating communication between the upper and lower is the essential method for treating the root; one should carefully comprehend this. Kuang is the rampant spread of Evil Fire, with the Shen having no master. Kuang originates from Evil Fire attacking the Heart, disturbing the Ming (Brightness/Spirit), leaving the Shen without a master, resulting in shouting wildly, climbing high, discarding clothes, and ignoring distinctions between close and distant relations. Treatment focuses on purging downward and clearing heat. Treating Dian values nourishing righteousness while simultaneously moving phlegm. Treating Kuang requires dispelling evil, with extinguishing fire as the priority. Bai Tong Tang (White Pass Decoction) and Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) primarily facilitate communication between upper and lower, treating both Yin-Dian and Yang-Kuang. Da Cheng Qi Tang (Major Order the Qi Decoction) and Xiao Cheng Qi Tang (Minor Order the Qi Decoction) specialize in purgation, curing mania and madness. Among these, there are also karmic debts and冤凭 (spiritual attachments); one must urgently perform good deeds and repent. [Marginal Note] Zhi Fei says: Nourishing righteousness to treat Dian, descending Qi to treat Kuang, is an immortal famous theory.
Recently, the habit among city doctors is to treat Dian solely by dispelling phlegm and calming the soul, and to treat Kuang mainly by clearing water and reducing phlegm. Although this often yields results, it is ultimately not as reliable as grasping the golden needle (key principles) and having evidence in clinical practice.
Distension and Fullness (Zhang Man)
Regarding distension and fullness, various books distinguish it into skin distension, abdominal distension, water distension, Qi distension, blood distension, and salt poison, but there is no consistent guiding principle. After careful investigation, I find that seven or eight out of ten cases are caused by the failure of the Tai Yang (Greater Yang) channel to perform its duties, leading to a loss of Qi transformation. Four or five out of ten cases are caused by vomiting and diarrhea damaging the Middle Jiao and depleting Yuan Qi. Gu Du (Gu Poison) has other specific causes.
What is meant by "failure of Tai Yang"? Tai Yang is the guideline of the whole body, governing the skin and regulating Ying (Nutritive) and Wei (Defensive) Qi. All organs, meridians, and joints rely on it. Tai Yang resides in the Kan Palace (North/Winter), where one Yang initiates movement, scattering the essence of water throughout the body. It is the patriarch of all Yangs and the lord of the One Yuan. Hence it is called Tai Yang, implying supreme uniqueness. However, people fail to protect it. Internally damaged by Seven Emotions, externally injured by Six Evils, the One Yuan is damaged. If transformation fails in the skin, skin distension arises; if it fails in the Middle State (Spleen/Stomach), abdominal distension occurs; if it fails in the Lower Jiao, swelling of the scrotum and legs appears. Water rebelling against the Lung causes wheezing and coughing; water rebelling against the Intestines causes diarrhea; water accumulating on the left, right, top, bottom, or center transforms into phlegm, leading to the concept of Five Drinks. The source of water distension lies here.
As for Qi distension, it is a sign of scattered Yuan Qi. It often starts after severe or chronic illness, vomiting/diarrhea, or excessive depletion, damaging the One Yuan.
Blood distension presents as generalized edema with purple-red skin color, indicating Qi deficiency with Yin pathogens prevailing upwards. There are also cases of generalized edema with a hard and full lower abdomen and scanty dark urine, indicating Yang deficiency in the lower part with failure of Yin transformation.
In summary, all diseases arise from damage to the One Yuan. Specifically, Upper, Middle, and Lower each have Yin and Yang; the Twelve Meridians each have Yin and Yang. Viewed together, it is simply one Yin and one Yang. Viewing it through the condensation of Yin and Yang, it is merely a ball of Yuan Qi. Regarding disease contraction, depth and superficiality have their own principles. Classifying and treating them is not inappropriate, but as formulas increase, the principles become confused. If we do not reawaken and highlight the core principles, future students will not know where to start. Today, who does not treat swelling by reducing swelling and distension by eliminating distension? My opinion is that the treatment for this disease should support the true fire of the One Yuan and gather the scattered sunlight (Yang Qi), allowing the One Yuan Qi to recover and transformation to function normally. Formulas such as Zhu Fu Tang (Atractylodes and Aconite Decoction), Jiang Fu Tang (Ginger and Aconite Decoction), Zhen Wu Tang (True Warrior Decoction), Gui Ling Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction), Fu Zi Li Zhong Tang (Aconite Center-Regulating Decoction), Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction), and Fu Zi Gan Cao Tang (Aconite and Licorice Decoction) are examples. The aforementioned formulas have unique efficacies and can treat skin distension, water distension, Qi distension, blood distension, and abdominal distension. [Marginal Note] Zhi Fei says: Cold invading the middle generates distension; distension belongs to Tai Yin; this is the root of the disease. Consider this analogy: The human body is like a gourd. The front of the gourd is the abdomen, which is Yin; the back is the back, which is Yang; the top is the head, the chief of all Yangs, representing Qian (Heaven); the bottom corresponds to Xu, Hai, Zi, Chou, where two Yins end and two Yangs begin, representing Kan (Water) and Kun (Earth). Speaking boldly about the center, inside the gourd is the Golden Elixir. Metal represents Qian; Dan (Elixir) represents Kan as the Moon. The moon has no light of its own but borrows it from the sun. This is because Qian interacts with Kun, and through three solicitations, a son is born, bringing brightness. Waxing and waning occur every fifteen days. Understanding this cause is what is meant by "Heaven's Way descends to benefit and shines brightly." Distension fundamentally belongs to Yin-Cold pathology. It requires Yang to be initially deficient and unable to transport, allowing Yin to become solid and form distension. To eliminate this distension, one must first support Yang. Qi Bo said: "Treat Yang for Yin diseases." Zhongjing said: "For Tai Yin disease, characterized by abdominal fullness, use Dried Ginger." This has long been the ladder and ferry for ten thousand generations; why add unnecessary words? However, contemporary physicians do not understand the fluctuations of Yin and Yang moving up and down within the body. They are forced to revive ancient methods today. Qin An traces back to Tai Yang, while Zhi Fei advances to Shao Yin (Lesser Yin). Shao Yin governs Ministerial Fire. If the Ruler is weak, the minister becomes strong, and the strong minister bullies the ruler. Therefore, when the Ministerial Fire of Shao Yin declines, smoke and dust rise from all directions. If Yangming's Dry Metal becomes strong, it affects Bladder function. If Shaoyang's Ministerial Fire becomes strong, it causes chest, diaphragm, and hypochondriac distension. If Yangming's Dry Metal becomes strong, it causes muscle distension. If Taiyin's Damp Earth becomes strong, it causes single-sided abdominal distension, large as a jar. If Jueyin's Wind Wood becomes strong, it causes lower abdominal, scrotal, and leg distension. Only when the Ministerial Fire of Shao Yin becomes strong do all Yin pathogens vanish like dew in the autumn sun, and ten thousand demons dissipate. Thus, Zhongjing described the Shao Yin deficiency syndrome with a faint pulse and desire to sleep. The Three Urgent Purging Methods preserve the nearly extinct Yin of Shao Yin. From this, we can infer that all Six Channels can cause distension, and the formulas of the Six Channels each have subtle effects on treating distension. Spiritual understanding depends on the individual.
In summary, Yuan Yang is the root, and the various Yin-Yangs are the branches. Knowing that all Yin-Yangs are transformed by Yuan Yang, and that One Yuan Yang transforms into various Yin-Yangs, means Yuan Yang is the various Yin-Yangs, and the various Yin-Yangs are still Yuan Yang, yet not separate from them. There is not another Yuan Yang outside the various Yin-Yangs, nor do various Yin-Yangs arise separately outside Yuan Yang. Yin and Yang are neither mixed into a lump nor fused into a single piece. If one understands this, treating diseases will not be difficult, and one can practice medicine in the market. Furthermore, knowing that the Six Channels have a main brain, and the Six Yin-Yangs have subtle mechanisms, is truly breaking through the primordial chaos and opening the Taiji. Medicine becomes a secondary matter, and one can claim much more.
However, Gu Poison has a different treatment. Gu can come from outside or inside. What is external Gu? Burying Gu to curse others is most common in barbarian regions. It is made from snakes, insects, turtles, or tortoises, placed in food or clothing. Those infected gradually become yellow-faced and emaciated, with bellies large as drums, dying soon after. Those who hoard Gu prosper, proud of their magic, unaware of their deep sin, which is irredeemable. Compiling references into *Shi Shi Mi Lu* (Secret Records of the Stone Chamber), folk books contain excellent formulas, which are not listed here. What is internal Gu? As stated in the *I Ching*: Mountain Wind Gu.
[1] "Pao" in the original text is corrected to "Bao" based on context.
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It refers to women bewitching men. Because a young man is paired with an older woman, Yin and Yang are abnormal, hierarchy is chaotic. Not thinking to rectify their natures, Gen (Mountain) should remain still, Xun (Wind) should be compliant. Over time, decay sets in, and Gu arises. The treatment method is to move what is stagnant and unmoving, and invigorate what is soft and inactive, making each have direction and alignment, not losing correctness, so that Heaven and Earth are peaceful and Yin and Yang are balanced. So, what is the treatment method? It should be bitter and pungent.
I once treated a man with a belly large as a drum, hollow upon pressure, fatigued spirit, shortness of breath, and reluctance to speak, for over half a year. I knew it was scattered Yuan Qi, so I used a large dose of Wu Zhu Yu Si Ni Tang (Evodia Four Reversal Decoction). After one or two doses, the drum-like distension disappeared instantly. I also treated a man with a belly large as a drum, solid upon pressure, hard as stones, lumps of various sizes. He had taken Qi-breaking and Blood-moving medicines for months. I knew it was Yin accumulation in the middle, lacking Yang to transform it. I used Fu Zi Li Zhong Tang (Aconite Center-Regulating Decoction) plus Gui Zhi (Cinnamon Twig), Sha Ren (Cardamom), Ban Xia (Pinellia), and Ding Xiang (Clove). After one or two doses, the abdominal solidity vanished instantly. Although these two cases are not sufficient to discuss Gu, the method of treating Gu can be summarized by these two cases. There is also Worm Gu, which must be known.
Pediatric Convulsions (Commonly Known as Jing Feng / Wind Shock)
Regarding pediatric convulsions, there is a distinction between external contraction and internal injury. When caused by external contraction, it is due to contracting external Wind-Cold, blocking the Qi flow in the meridians. Presenting with opisthotonos (arching back), high fever, and spontaneous sweating indicates Wind injuring the Wei (Defensive) level of Tai Yang; Gui Zhi Tang (Cinnamon Twig Decoction) can be used. Opisthotonos, high fever, no sweat, and aversion to cold indicate Cold injuring the Ying (Nutritive) level of Tai Yang; Ma Huang Tang (Ephedra Decoction) can be used. If there is high fever, restlessness, thirst, coarse breathing hot to the touch, and difficulty urinating and defecating, it is Heat flooding internally; Bai Hu Tang (White Tiger Decoction) and Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) can be used. For milder cases, Dao Chi San (Direct Out the Red Powder) plus Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Chan Tui (Cicada Slough), and Fu Ling (Poria) can be used.
When caused by internal injury, it may result from dietary damage to the middle, severe vomiting, severe diarrhea, chronic illness, or accidental external pathogen invasion treated with excessive dispersing, or accidental stagnation treated with excessive digestive and purging measures. Accumulated over time, Yuan Qi diminishes daily. Extreme deficiency leads to convulsions. Various books call this Man Pi Feng (Slow Spleen Wind). Such patients definitely present with pale face and cyanotic lips, reduced appetite, fatigue and lack of spirit, cold breath,
[1] "Ku" originally written as "Ruo" is a pen error, corrected to "Ku" based on context.
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or loose stools three to five times a day, or slight fever and sweat in the afternoon. Convulsions occur spontaneously. This is a sign of extreme Yuan Qi deficiency, Shen having no master, loss of support authority, emerging from within. The only method is to support Yuan Qi, such as Fu Zi Li Zhong Tang plus Sha Ren and Ban Xia, or Hui Yang Yin (Restore Yang Decoction) plus Sha Ren and Ban Xia. Ignorant people do not understand this principle. Upon seeing convulsions, they immediately call it Wind Shock. If they recklessly apply wind-dispelling products, it accelerates death. Practitioners encountering such syndromes must carefully deliberate on the substantial evidence of Yin and Yang, lest they wrongfully kill lives. I am not exaggerating; those I have witnessed personally are countless. Families, please do not solely seek quick remedies. [Marginal Note] Zhi Fei says: Whenever examining children's illnesses, although it is called the "mute department," the four diagnostic methods—Inspection, Auscultation/Olfaction, Inquiry, and Palpation—all have evidence. Colors green, yellow, red, white, black; presence or absence of spirit; fatness or thinness of the body; severity or comfort of appearance—all can be seen. This is Inspection. Strength or weakness of voice, thickness or thinness of breath, wheezing or not, subtle or not—all can be heard. This is Auscultation/Olfaction. If abdominal pain, crying head bows down; if neck/back pain, crying head tilts back; frequency of urination, regularity of bowel movements—parents surely know. This can be asked face-to-face. This is Inquiry. Hot or not, cold or not, sweat or not—all can be felt by hand. Pulse at both wrists—all can be taken by fingers. This is Palpation. With these four diagnostics, one obtains the condition. As for convulsions, the disease is in the sinews and fascia, governed by Wind-Wood Qi. Wind-Cold is certain; harmonizing Ying and Wei is sufficient. If there are other causes, knowing what deviation occurred and saving it with appropriate methods, all will be effective. Qin An's instructions are intimate and detailed. One must absolutely not follow city doctors' views, looking only at the tiger-mouth vein pattern to determine the disease and prescribe drugs. Purple veins rushing up to the third gate cliff definitely indicate a critical prognosis. Especially in pediatric convulsions, do not assume it is Wind and immediately use shock-calming drugs; this merit is immeasurable. Moreover, children's Yang Qi is tender and weak, unable to withstand Wind-Cold harassment. Or if exterior-releasing is excessive, or mistaken purgation occurs, often muscles twitch and tremble. This is not Wind Shock. Nourishing Yin and harmonizing Yang prevents Wind Shock. Claiming children have excessive fire is like parents wanting to kill their children; one can refuse saying "untreatable," which is especially important advice. Know that children's Yang is weak, and fire can originate from within. Children have no desires, so fire cannot enter from outside. This is the golden needle.
Stroke (Zhong Feng)
Regarding the syndrome of Stroke, there are originally conditions of striking the channels, striking the viscera, striking the zang organs, closure, and collapse. Mr. Chen Xiuyuan's *Three Character Classic* and *Cong Zhong Lu* distinguish them in detail, which can be studied thoroughly. I ponder it further. The human body relies on one Qi encompassing everything, undamaged and unharmed. How can external evils enter? How can internal evils exit? Anyone contracting this disease must have internal deficiency first. Only then can external evils enter from outside, and internal evils exit from inside, blocking the Qi mechanism of organs and meridians, all leading to death. One cannot generally say it is all caused by external factors. I often see sudden collapse and coma, crooked mouth and eyes, or bodily weakness, or generalized convulsions. Everyone treats it as Stroke, focusing solely on dispelling wind and resolving phlegm, but it is ineffective. In my cases, I focus primarily on the decline of congenital True Yang, starting treatment there, while also observing which part shows unique symptoms. Medication differs based on this. Know that what sustains life and prevents death is this bit of congenital True Qi. [Marginal Note] Zhi Fei says: This explanation is thorough. However, internal deficiency being primary means the root is already shaken. Focusing solely on congenital treatment may not cure ten out of ten cases. Know that congenital Yang is not easily restored. Explain this to the patient's family beforehand. Recovery is a miracle; non-recovery is not the doctor's fault. If restoring Yang fails and True Yin cannot generate itself, if anyone can cure this disease, I wish to burn their books and erase their notes. Where True Qi declines, internal and external evils secretly emerge. Treatment only supports the True Yuan, and both internal and external evils can be extinguished. This is treating evil by not directly treating evil, and dispelling wind by not directly treating wind. It is the method of grasping the essentials. If focusing solely on dispelling wind and resolving phlegm, it often酿成 (brews) critical collapse conditions. Why? Because righteous deficiency allows evil to arise. Abandoning deficiency to chase the branch. Moreover, all wind-dispelling and phlegm-resolving products are axes that consume and scatter Yuan Qi. None do not immediately worsen the disease. However, depth, superficiality, severity, and lightness have methods step by step. Roundness and flexibility are valued. I merely share my humble opinion for discussion with colleagues.
Phlegm Strike (Zhong Tan)