治风热燥火寒湿之中，尤必以真阴为先务。治寒湿温燥之中，尤必以真阳为先务。然风热燥火，亦有亡阳者，阴虚阳无所附也。寒湿亦有亡阴者，阳虚阴必走也。
厚味之人，不妨消导，然情欲过度，又宜慎之。藜藿之人，最忌消导，然淡食形盛，又在不禁。
凡病烦躁而愈者，以邪气盛时，正不能与之争，反相安于无事，及其正复而与邪争故烦躁也。以此知瘫痪不随之证，无痛痒反难瘳，以正为邪并学而能复耳。
病有在下者，其见证反在上，蓄血发狂是矣。在上者，其见证反在下，肺气壅，大便频，肺气虚，小便数是矣。在表者，其见症反在里，如三阳合病下利是矣。里者其见症反在表，如热深厥亦深及面反戴阳是矣。
风温、温疟，得之冬，中于风寒，遇温而发，其气自内而达于外，故多汗。不比风寒外束，闭其营卫，当须发汗解肌也。故以发汗为逆，然其邪自内出。若因汗而骤加敛表之药，邪不得越，为害匪轻，务必相其人之虚实，清解得宜。
气有余便是火，气焉能有余?惟是少一分之阴，便多一分之气，此一分之气，无所归宿，而为火矣。
张汉瓿曰：血阴气阳，二者属人，未见其有余。少一分阴，便多一分火，火有余则似气有余也。如此说方透。
阴阳有偏胜为病者，有偏负为病者，然偏胜之中，往往有偏负之假象，补之则益胜。偏负之中，往往有偏胜之假象，泻之则益负。
清气不升，浊气不降，七情六淫，气血饮食痰皆能为之，苟不求其本而但利其气，气之升降得乎。
疟疾无汗，要有汗固矣。至于有汗要无汗，此亦不可不斟酌也。虽疟邪有虚实之不同，其始未有不因暑邪，内藏阴邪，外束所致，邪气乘阳则阳盛，阳盛则外热，热则腠理开。又暑为阳邪，阳邪多汗，故疟症往往多汗，数发之后，邪气渐衰者，亦以邪从汗解，所以疟疾虽众，不救者少，亦以此故也。岂可因其多汗，而遂加以固表之药，邪无从解矣。故古人但言扶正为主，亦未尝言固表也。余谓汗少不妨更汗，若汗多不必更发汗，似为得之。
医家要明不可治之病。而后知有可治之病，不可治之病，真阴元阳虚极故耳。如形盛脉细，少气不足以息者，死。形瘦脉大，胸中多气者，死。世人徒读其文，而不绎其义，岂知形盛脉细，元阳虚也，少气不足以息，虚之极也，故死。形瘦脉大，真阴虚也，胸中多气，虚之极也，亦死。又如温病，穰穰大热，脉反静者，死。下利脉反大者，死。又皆正气虚，而邪气实也。正不胜邪，故死。可见，凡病之不可治者，由真阴元阳之虚，则其可治者可意会也。
邪气之所凑，其气必虚，故曰：不能治其虚焉。问其余，然亦不可执也。岂无壮年之人，违年之和，遇月之虚，及思虑应酬之间为虚邪贼风所乘，又因脾气健旺，过啖甘肥炙焯酿成胶痰实火，则发表攻里．如河间之推陈致新，有何不可?因循顾忌，则反累伤正气，所谓五虚死，五实亦死。又云：毋实实，毋虚虚。今又不论虚实，动手便用补益，自谓调元之手，亦胶柱而鼓者耳。
庸工但执热则流通，寒则凝滞二语。一遇诸腹胀大，痰气阻滞，与夫大小便秘，遂行温利之药，不知寒热虚实是病皆有。如诸腹胀大皆属于热，在心曰热痰。气有余便是火，热则燥涩为癃。此等可温利乎?夫水下二刻，一周循环，此阴阳相抱之气而然，偏阴偏阳能之乎?故曰气化则出，其旨深矣。
鬼贼相刑，固为恶候，然于理为顺，微邪薄所不胜，由己之虚也。于理为逆，所以病亦有微邪而笃者，贼邪而愈者。
营卫之或疾或徐，脾胃之或寒或热，痰因之而中积，血因之而留止，不亟为开囊活血，陈者不去，新者不生，始因虚而致实，终因实而致虚，此攻击之品，不能无也。
肝欲散，急食辛以散之，肝之实也。肝苦急，急食甘以缓之，肝之虚也。推之他脏，亦然。
女人血结胞门，则上焦之阳不得入于阴，在下则小腹里急，五液时下，在上则孤阳独浮而为发热，为掌上烦，为唇口干燥，又宜先开痹破阴结引阳下行，不徒专恃滋阴。
风湿症以去苍术加白术冲和汤为当。风寒症亦有风，有时开其腠理而自汗者。四时伤风，亦有自汗者，耆芍宜慎。
风火皆阳，能开其腠理，皆自汗多汗，一则桂枝，一则白虎，不可紊也。廉泉开有中焦郁热者，有中风舌纵者。
营卫受气于中，中有所阻，则营虚发热，卫虚恶寒，故气血饮食痰皆能寒热者质此。
青筋症，面青唇黑，手足厥冷，气逆血冲使然。医者，意中不先有此一症，鲜不认作阴经伤寒也。
膈间有热痰，热气上蒸，脉道壅塞，故令人头风目昏。治以酒蒸大黄，自上抑之，所谓鸟集高巅，射而落之也。此症甚多，眼科未尝载，予每治验。
人身中有形之物皆属阴，故曰瘦人血虚。然肥人亦有痰生热，热生风，风生燥，燥则伤阴，往往亦有阴虚者，不可不知。
痰之汹涌上焦，结聚胸中，皆由于气。故治痰莫先于治气，治气又莫先于降火，破气清火则痰自消，此则言乎六淫七情，怫郁暴积之痰耳。若日积月累，老痰凝结，又当积渐以消释之，更当相其人之阳虚阴虚，助以调补。苟如前法，将见痰未降而气已消，为患不可胜言矣。医者晓得当汗而汗，当下而下不难。晓得当汗而不能汗，当下而不可下为难。仲景之可与不可，宜详玩。富贵之人，恣情纵欲，自揣不足，求补于味，不知肾虚则胃弱，不能消磨其厚味，不生津液而反为痰涎，中州不运矣，气愈弱矣。病者不察虚中有实，医者又不识实中有虚，攻之不安，补之无益，聊藉参耆，苟延岁月，一旦奄逝，自谓其命，宁不悲哉!
按之痛者为实，不痛为虚。夫按则气散，即实亦有因之而痛减者；虚则气壅而为痛，复按之气愈壅，即虚亦有因之而益痛者。正未可执此而定其虚实也。若以热手久按痛止为寒，不止为热，此则差可必耳。
七情所伤，动乱其火而伤阴，此易知也。七情所伤，动乱其神而损气，此难知也。要知神乃气之帅，神乱则气自损耳。
疏其气血，令其调达，而致和平
膏粱厚味之人，形盛气衰，以气不足以充故也。然气不足则生痰，以为气不足而补之，则痰气愈滞，胸膈不利，营卫不通，加之以肾元衰耗，厥气上逆，诸病丛生，故善治者补益之中不可不兼之伐痰。然端本澄源，又在远房帏，断厚味为先务也。
五脏各有专司，六府互为输泻，不啻百僚帅师矣。十二经以行于表里上下，十五络以络之奇经八脉，以藩蔽之，不啻金城汤池矣。然主不明则十二官危，土崩瓦解之势一朝而至。可见，善养生者，全在收摄此心。程子曰：心要在腔子里。朱子曰：必使道心，尝为一身之主，而人心每听命焉，则天地万物位且育，岂但区区却病而已。
刘澹庵曰：人身别有一主，非心也。谓之君主之官，当与十二官平等，不得独尊心之官为主。若以心之官为主，则下文主不明则十二官危，当云十一官矣。此赵无闾所见甚超也。阴虚则阳无所附，气有升无降，法当以滋阴之药为君，敛降之药为佐，苟徒降其气则浊未必降，而清且随之矣。阳虚则此气中断，气有降无升，法当以补中药为君，升举之药为佐，苟徒升其气，则清未必升，而浊日随干矣。此治阴阳偏虚不易之理外，此或七情逆滞，或气血饮食痰阻碍中焦，妨其升降出入之路，其人元气未亏，不妨升之降之可也。
然以上悉指后天有形气血而言。若论先天元阴元阳，则阴虚阳必薄，阳虚阴必乘，此时但当峻补其阴阳，无暇为升降治标计也。
八珍汤固是阴阳平补之剂，然人禀受不同，岂无偏胜遍虚?则知少补一分之阳，不足以配阴；少补一分之阴，不足以配阳。多补一分之阳，则阴气耗竭一分；多补一分之阴，则阳气牵滞一分。此调理不足之症，最为棘手，况乎体虚之人，外淫易犯，内情易起，饮食易停，痰血易滞，尤不可仅责其所无而不求其所有也。
阴虽主降，然必欲从天而降，阳虽主升，然必欲从地而升，方谓之阴阳相抱。故用苦寒以治火之王，辛温以治水之王，病未去而寒热反增。
邪正相搏则痛。若正不胜邪，不妨补之，然须佐以去邪之药。若正气太虚，又不妨纯补，俟其正复，然后加以去邪之药。兵法云：先为不可胜，以待敌之可胜。又曰：善战者，立于不败之地而不失，敌之所以败也。
虚痛虽有气血寒热之分，然皆主于气郁滞，气不滞则痛无由生。气虚则气行迟，迟则郁滞而痛；血虚则气行疾，则前气未行，而后气又至，亦令郁滞而痛。故气虚补气，血虚补血，俾阴中有阳，阳中有阴，反其漏下二刻一周，循环之常，痛自愈也。
适事为故
世间病之杀人者十三，而药之杀人者十七，皆由不知阴阳虚实之理也。如劳瘵未必遽死也。欲退其蒸，频用寒凉，则脾泄而不可救矣。膈噎末必遽死也，欲开其郁，频用香燥，则三阳结而津液竭矣。水肿未必遽死也，欲利其水，频用淡渗，则阴亡而成阳水矣。如此之类，未易枚举。操司命之权者，岂可不知中病即止之理!
反佐以取之
阳虚而见阳热之症，此是真火无根而脱出也。阴虚而见阳热之症，此阴虚阳无所附而然也。阳盛而见阴寒之症，阳盛拒阴也。阴盛而见阳热之证，阴盛格阳也。四者用药差讹，死生反掌。
阳虚阴必走，水无气以鼓之，不能周流循环，是以走也。故有阳虚失血者，然血本水类，水就下，既无气运之上行，则当从二阴之窍脱出。今阳虚之血，往往见为吐衄者何也?要知命门火衰之人，真阳脱出，浮游于上，阴血扰乱不宁，亦从而脱出也。海藏云：激而为吐血、衄血者有之，心肺受邪也。下而为便血、溺血者有之，肾肝受邪也。其言可想。
阴阳格拒，药用反佐，谓之反治可也。至于真寒而见假热，真热而见假寒，药用反佐，其实正治也。
血脱益气，是阴虚阳无所附，故不得不先补其阳，然后徐调其阴，此从权之治。寻常阴虚劳瘵，不得以之藉口，而以参耆为家常茶饭。
热则生风，虽有虚实之不同，然皆为假象也。只是古方养血清热之中，而以风药为佐，此不可不深惟其义。夫风者，肝木之气，少阳之火系焉，喜条达而恶抑遏，火动风生，失其条达而抑遏也，佐以风药，以辛利之，而复其性耳。
黄连、苦参，久服而反热；附子、干姜，多饮而反寒，虽云久而增气，反招见化之尤。究不外寒之不寒是无水也；热之不热是无火也。
痉证在外，阳病者仰而不能俯；在内，阴病者俯而不能仰，此不易之论也。而海脏附子散方下云：治伤寒阴痉，手足厥冷，筋脉拘急，汗出不止，头项强直，头摇口噤。夫头项强直则非俯而不能仰也。奈何?阴病亦然。意者，阴盛格阳于外，阳经热盛，故如此。如厥阴经，热深厥亦深，亦舌卷囊缩，此又是热乘其本，而阴反走于外也。予曾见头项强直之证，有与寒凉而随毙者，盖未达此理故耳。
肾者，胃之关，从阳则开，从阴则阖。阳太胜则开而为消，阴太胜则阖而为水明矣。仲景治水肿，主之以肾气丸，而治消渴亦然。甯不与阳盛有乖乎?予谓：此之消是肾中阳虚不能收摄也。此之渴是肾虚引水自救也。俞嘉言谓：肾水下趋，故消；肾气不上腾，故渴。均用此丸，蒸动肾气，恐未必然。
上虚，固是阳虚，以身半已上同天之阳也。下虚多是阴虚，以身半以下同地之阴也。然一阳根于地下，而水出自高原，阳虚则有降无升，或虚之极而真阳脱出，阴虚则有升无降，或虚之极而真阴四射，又不可不进求焉。
阳中不可无阴者何?无阴则不能降也。阴中不可无阳者何?无阳则不能升也。故目：天以阳生阴长，地以阳杀阴藏。
渴而汗出，小便利，大便硬，似不宜更利小便，重伤津液也。然仲景又有宜五苓散者，此盖通因通用，其小便利乃是热邪偏渗于小肠，故行乘势利导之法，如下利之用承气也。
燥与湿不两立之势，然湿则郁，郁则热，热则燥生，有不得不然之理，亦湿位之下，风气承之，风生燥也。仲景诸黄猪膏发煎，茵陈五苓散，分治气血分之燥旨哉!
截疟劫嗽，本非王道，亦有不能不用。如疟邪已去八九，胸中有痰癖留恋，其邪斯时不暇，顾其余而直攻其痰，则邪无留恋之处而病自愈。设邪气方张，则驱邪之未遑，正气已脱，则补救之未遑，敢用截药乎?咳嗽邪已去八九，而肺气虚耗，虚则气逆，斯时亦不暇顾虑，其邪之未散，而直收涩之收，以止逆涩以固脱，则正气复而余邪自解。设邪未去八九，而虚邪逆上，敢用劫药乎?
从少从多观其事也
伤寒黄连汤，因其人本虚寒，阳邪传里，兴胸中之阳，两阳相合故为上热。下焦之寒则自若也，所以上热下寒，斯时已成，乖否之象，病可愈乎?是汤之不可缓矣。
六气相合，有差多差少，有真象有假象。真假之中，又复有差多差少，所以不可不知，从治之法也。
In the treatment of diseases caused by wind, heat, dryness, fire, cold, and dampness, it is particularly essential to prioritize the preservation of True Yin (the fundamental yin fluid of the body). In the treatment of conditions involving cold, dampness, warmth, and dryness, it is particularly essential to prioritize the preservation of True Yang (the fundamental yang qi of the body). However, in cases of wind, heat, dryness, and fire, there are instances of Yang collapse (sudden depletion of yang qi), which occurs because yin deficiency leads to yang having no foundation to attach to. In cases of cold and dampness, there are instances of Yin collapse (depletion of yin fluids), which occurs because yang deficiency leads to yin failing to be secured and leaking out.
Individuals with robust constitutions may tolerate digestive-promoting methods; however, if they have overindulged in sexual desire, such methods should be used cautiously. Individuals with poor constitutions should strictly avoid digestive-promoting methods; yet, if they consume bland food but remain obese, such methods need not be prohibited.
When a patient experiences irritability followed by recovery, it is because during the peak of pathogenic factors, the healthy qi was insufficient to contend with them, resulting in a temporary stalemate. When the healthy qi recovers and contends with the pathogens, irritability ensues. From this, we can understand that paralysis without accompanying symptoms, especially if pain or itching is absent, is difficult to cure because the healthy qi has been compromised by the pathogens and struggles to recover.
Diseases located in the lower part of the body may manifest symptoms in the upper part, such as blood stasis causing mania. Diseases located in the upper part may manifest symptoms in the lower part, such as lung qi stagnation causing frequent bowel movements, or lung qi deficiency causing frequent urination. Diseases located in the exterior may manifest symptoms in the interior, such as simultaneous involvement of the three yang meridians causing diarrhea. Diseases located in the interior may manifest symptoms in the exterior, such as deep-seated heat causing severe cold limbs (deep heat leads to deep cold) or false flushing of the face (false yang floating upward).
Wind-warmth and warm malaria are contracted from wind-cold in winter and triggered by warmth. The pathogenic qi moves from the interior to the exterior, hence sweating is common. This differs from external wind-cold binding the exterior and obstructing Ying and Wei (nutritive and defensive qi), which requires sweating to release the muscle layer. Therefore, forcing sweat in wind-warmth and warm malaria is contraindicated, as the pathogen exits from within. If astringent surface-tightening herbs are abruptly used due to sweating, the pathogen cannot escape, causing significant harm. One must assess the patient’s deficiency or excess and appropriately clear and resolve the pathogen.
Weak constitution unable to tolerate tonification indicates excess pathogen. Excess condition unable to tolerate purgation indicates weak healthy qi.
"Excess qi becomes fire." How can qi be in excess? It is merely that for every unit less of yin, there is an extra unit of qi. This unanchored qi transforms into fire.
Zhang Hanbu stated: Blood belongs to yin, qi belongs to yang. These two rarely exist in true excess. Less yin results in more fire; apparent excess of fire resembles excess of qi. This explanation clarifies the matter.
Diseases caused by yin-yang imbalance include those due to excess and those due to deficiency. Within excess conditions, there are often false signs of deficiency; tonifying in such cases exacerbates the excess. Within deficiency conditions, there are often false signs of excess; purging in such cases worsens the deficiency.
Failure of clear qi to ascend and turbid qi to descend can be caused by seven emotions, six climatic factors, as well as disorders of qi, blood, diet, and phlegm. If one does not address the root cause but merely promotes qi movement, can the ascending and descending of qi be restored?
Malaria without sweat requires inducing sweat. Conversely, when there is sweat, stopping it requires careful consideration. Although malaria pathogens vary in deficiency and excess, they initially stem from summerheat invading internally while cold binds externally. Pathogens attacking yang cause yang excess, leading to external heat and open pores. Since summerheat is a yang pathogen causing sweating, malaria often presents with sweating. After repeated attacks, pathogens decline as they exit via sweat, explaining why few die despite many cases. Thus, adding surface-stabilizing herbs to stop sweat prevents pathogen resolution. Ancients emphasized supporting healthy qi rather than stabilizing the surface. I suggest that mild sweating may require further diaphoresis, but profuse sweating should not be induced further.
Physicians must understand untreatable diseases to recognize treatable ones. Untreatable diseases result from extreme deficiency of True Yin and Primordial Yang. For example, a robust physique with a fine pulse and shortness of breath indicates death. A emaciated physique with a large pulse and chest fullness indicates death. People read these texts without understanding their meaning. Robust physique with fine pulse indicates primordial yang deficiency; shortness of breath indicates extreme deficiency, hence death. Emaciated physique with large pulse indicates true yin deficiency; chest fullness indicates extreme deficiency, hence death. Similarly, in warm diseases, high fever with a quiet pulse indicates death. Diarrhea with a large pulse indicates death. These represent weak healthy qi and strong pathogens; healthy qi fails to overcome pathogens, leading to death. Thus, untreatable diseases stem from True Yin and Primordial Yang deficiency, implying that treatable diseases involve different dynamics.
Where pathogens gather, qi is necessarily deficient. Hence, "if you cannot treat the deficiency, do not ask about the rest." However, this should not be applied rigidly. Are there no young adults who violate seasonal harmony, encounter lunar deficiencies, or suffer from emotional stress, allowing empty pathogens and thieving winds to invade? If their spleen qi is strong but they overconsume sweet, fatty, and roasted foods, generating sticky phlegm and solid fire, using exterior-releasing and interior-purgative methods, like Liu Hejian's "pushing out the old to bring in the new," is acceptable. Indecision harms healthy qi. As stated, "Five deficiencies lead to death; five excesses also lead to death." Also, "Do not tonify excess; do not purge deficiency." Today, ignoring deficiency/excess and blindly using tonics, claiming to master yuan qi regulation, is merely stubborn ignorance.
Mediocre doctors cling to "heat flows, cold stagnates." Upon encountering abdominal distension, phlegm-qi obstruction, or constipation, they use warming and purgative herbs, unaware that cold, heat, deficiency, and excess coexist in diseases. Abdominal distension often relates to heat, specifically heat-phlegm in the heart. Excess qi becomes fire; heat causes dryness and urinary retention. Can these be treated with warming purgatives? Water circulation completes a cycle in two hours, driven by the embrace of yin and yang. Can extreme yin or yang achieve this? Thus, "qi transformation allows excretion," a profound principle.
Heat in palms/soles and night fever can be deficiency or excess; do not fixate on yin deficiency.
"Ghost thief punishment" (mutual counteraction in Five Elements) is a severe condition but logically consistent; minor pathogens attacking what they cannot overcome indicate self-deficiency. Logically inconsistent cases exist where minor pathogens cause severe illness or major pathogens heal.
Variations in Ying and Wei speed, and spleen-stomach cold or heat, lead to phlegm accumulation and blood stasis. Without urgent opening and blood-invigorating measures, old blood remains, new blood fails to form. Initially due to deficiency becoming excess, finally due to excess worsening deficiency, attack-type herbs are necessary.
The liver desires dispersion; urgently eat pungent substances to disperse it (liver excess). The liver suffers from tension; urgently eat sweet substances to relax it (liver deficiency). This applies to other organs as well.
In women, blood stagnation in the uterus prevents upper jiao yang from entering yin. Below, lower abdominal urgency and fluid leakage occur. Above, isolated yang floats causing fever, palm heat, and dry lips/mouth. Treatment should first open blockages and break yin knots to guide yang downward, relying solely on yin tonification is insufficient.
Low urine volume can also result from lung heat failing to regulate water passages.
For wind-dampness, removing Cang Zhu and adding Bai Zhu in Chonghe Tang is appropriate. Wind-cold conditions also involve wind; sometimes opening pores induces spontaneous sweating. Seasonal wind-cold also involves spontaneous sweating; Huang Qi and Bai Shao should be used cautiously.
Wind and fire are both yang, opening pores and causing sweating. One uses Guizhi Tang, the other Baihu Tang; do not confuse them. Lianquan point issues arise from middle jiao depression-heat or stroke-induced tongue flaccidity.
Deficiency fails to transform essence, leading to heat accumulation, causing Yin Jaundice (cold-damp jaundice).
Tightness and contraction characterize dryness. Wind dominance mimics this, influenced by its overcoming element.
Ying and Wei derive qi from the middle jiao. Obstruction there causes Ying deficiency fever and Wei deficiency aversion to cold. Thus, qi, blood, diet, and phlegm can all cause chills and fever.
Green vein syndrome, with blue face, black lips, and cold extremities, results from qi reversal and blood rushing. Physicians unaware of this often misdiagnose it as yin meridian cold damage.
Heat-phlegm in the diaphragm steams upward, blocking vessels, causing headache and blurred vision. Treat with wine-steamed Da Huang to suppress from above, like shooting birds off high peaks. This case is common but omitted in ophthalmology texts; I treat it successfully.
有形 objects in the body belong to yin, hence thin people have blood deficiency. However, fat people can generate phlegm-heat, heat-wind, wind-dryness, damaging yin, leading to yin deficiency. This must be known.
Surging phlegm in the upper jiao and chest stagnation stems from qi disorder. Treating phlegm starts with treating qi; treating qi starts with clearing fire. Breaking qi and clearing fire eliminates phlegm. This applies to acute phlegm from six evils and seven emotions. Chronic, condensed phlegm requires gradual resolution and adjustment based on yin/yang deficiency. Blind application leads to qi depletion before phlegm resolves. Knowing when to sweat or purge is easy; knowing when NOT to is hard. Study Zhang Zhongjing's indications carefully. Wealthy individuals indulge desires, feeling deficient, seeking rich tonics. Kidney deficiency weakens the stomach, failing to digest rich food, generating phlegm instead of fluids, paralyzing the middle jiao and weakening qi. Patients miss deficiency-excess complexity; doctors miss excess-deficiency complexity. Purging disturbs; tonifying helps little. Relying on Ren Shen and Huang Qi prolongs life briefly until sudden death. Is this not tragic?
Pain upon pressure indicates excess; no pain indicates deficiency. Pressure disperses qi; even excess pain may lessen. Deficiency causes qi congestion and pain; pressing increases congestion, worsening pain. Do not rely solely on this for diagnosis. Using hot hands: pain relief indicates cold; persistence indicates heat. This is reliable.
Seven emotions disturb fire, damaging yin (easy to know). They disturb spirit, damaging qi (hard to know). Spirit commands qi; spirit disturbance damages qi.
Unblock qi and blood, ensure smooth flow, achieve harmony.
Rich diet individuals have robust bodies but weak qi due to insufficiency. Qi deficiency generates phlegm; tonifying qi worsens phlegm stagnation, chest discomfort, and Ying-Wei blockage. With kidney decline and rebellious qi, diseases multiply. Good treatment combines tonification with phlegm-resolving. Root cause lies in abstaining from sex and rich food.
Five zang have specific functions; six fu exchange transport. Like officials and generals. Twelve meridians run interior-exterior; fifteen collaterals link extraordinary vessels. Like fortified cities. If the ruler (heart) is unclear, twelve officials face danger. Collapse comes suddenly. Good health depends on mind control. Cheng Zi said: "Keep the mind in place." Zhu Xi said: "Let Dao Xin (Way Mind) rule, letting Ren Xin (Human Mind) obey." Then all things thrive, not just curing disease.
Liu Dan'an said: There is another master besides the heart. Called the Ruler Official, equal to the twelve officials, not supreme alone. If heart were supreme, "ruler unclear" would affect eleven officials. Zhao Wulü's view is superior. Yin deficiency leaves yang unattached; qi rises only. Treat with yin-nourishing sovereign herbs and descending assistant herbs. Pure descending fails to lower turbid and clears clear qi. Yang deficiency interrupts qi; qi descends only. Treat with middle-tonifying sovereign herbs and ascending assistant herbs. Pure ascending fails to raise clear and dries turbid. Besides treating yin-yang deficiency, if seven emotions or phlegm-blood obstruct middle jiao, and yuan qi is intact, ascending/descending is permissible.
Above refers to postnatal qi-blood. Pre-natal Yuan Yin/Yang: yin deficiency makes yang press; yang deficiency makes yin invade. Here, strongly tonify yin/yang; no time for symptom management.
Bazhen Tang balances yin-yang. But constitutions vary. Slight yang tonification doesn't match yin; slight yin tonification doesn't match yang. Excess yang depletes yin; excess yin stagnates yang. Managing deficiency is tricky. Weak bodies face external pathogens, internal emotions, dietary stagnation, phlegm-blood stasis. Don't blame absence; seek presence.
Yin governs descent but must come from heaven; Yang governs ascent but must rise from earth. This is yin-yang embrace. Using bitter-cold for fire kings and acrid-warm for water kings fails; disease persists, cold/heat increase.
Pathogen-healthy qi struggle causes pain. If healthy qi loses, tonify with pathogen-resolving assistants. If healthy qi is very weak, pure tonification first, then resolve pathogen. Strategy: "Be unconquerable, wait for enemy's vulnerability."
Deficiency pain varies by qi/blood/cold/heat but centers on qi stagnation. No stagnation, no pain. Qi deficiency slows movement, causing stagnation/pain. Blood deficiency speeds movement, causing collision/stagnation/pain. Tonify qi/blood to balance yin-yang, restoring circulation, relieving pain.
Handle according to circumstances.
Diseases kill 30%; medicines kill 70%. Ignorance of yin-yang/deficiency-excess. Tuberculosis may not kill immediately; frequent cold herbs cause spleen failure. Dysphagia may not kill immediately; frequent aromatic-dry herbs exhaust fluids. Edema may not kill immediately; frequent diuretics destroy yin, creating yang edema. Countless examples. Life-deciding physicians must know "stop when effective."
Use counter-agents to obtain effect. Yang deficiency with heat signs indicates rootless true fire escaping. Yin deficiency with heat signs indicates yin deficiency leaving yang unattached. Yang excess with cold signs indicates yang rejecting yin. Yin excess with heat signs indicates yin repelling yang. Medication errors here mean life or death.
Yang deficiency causes yin leakage; water lacks qi propulsion, failing to circulate. Yang deficiency bleeding usually exits via lower orifices. Why hematemesis/nosebleeds? Mingmen fire decline causes true yang to float up, disturbing yin blood, causing upper bleeding. Haizang said: Heart/lung pathogens cause upper bleeding; liver/kidney pathogens cause lower bleeding.
Yin-yang repulsion uses counter-agents, called reverse treatment. True cold with false heat, true heat with false cold, using counter-agents is actually correct treatment.
Blood loss benefits from qi tonification because yin deficiency leaves yang unattached. Tonify yang first, then slowly adjust yin. This is emergency measure. Common yin deficiency tuberculosis should not use this excuse to overuse Ren Shen/Huang Qi.
Heat generates wind, appearing real but being false. Ancient formulas use wind herbs in blood-nourishing/heat-clearing prescriptions. Wind is liver wood qi linked to Shaoyang fire. It likes freedom, hates suppression. Fire moves wind, suppressing it. Wind herbs restore nature via pungency.
Huang Lian/Ku Shen long-term use causes heat; Fu Zi/Gan Jiang excessive use causes cold. Long-term use increases qi but alters transformation. Ultimately, "cold not cold means no water; heat not hot means no fire."
Spasm exterior: yang disease looks up, cannot bow. Interior: yin disease bows, cannot look up. Unchangeable theory. Haizang's Fuzi San treats yin spasm with stiff neck/head. Stiff neck implies looking up, contradicting yin disease. Perhaps yin excess repels yang outward, causing yang meridian heat. Jueyin disease: deep heat, deep cold, curled tongue/shrink testicles. Heat attacks root, yin goes outward. I saw stiff neck cases dying from cold herbs due to misunderstanding.
Kidney is stomach gate. Opens with yang, closes with yin. Yang excess opens causing consumption; yin excess closes causing edema. Zhang Zhongjing uses Shenqi Wan for edema and consumption. Contradicts yang excess? Consumption here is kidney yang deficiency failing to secure. Thirst is kidney deficiency seeking water. Yu Jiayan said: Kidney water sinks causing consumption; kidney qi fails to rise causing thirst. Using this pill to vaporize kidney qi may not be certain.
Upper deficiency is yang deficiency (upper body matches heavenly yang). Lower deficiency is yin deficiency (lower body matches earthly yin). One yang roots underground; water originates high. Yang deficiency descends only; extreme deficiency causes true yang escape. Yin deficiency ascends only; extreme deficiency causes true yin scattering. Must investigate deeply.
Why yang needs yin? Without yin, cannot descend. Why yin needs yang? Without yang, cannot ascend. Heaven generates yin growth with yang; earth kills/hides yin with yang.
Thirst, sweating, frequent urination, hard stool suggests avoiding diuretics to spare fluids. Yet Zhang Zhongjing recommends Wuling San. This is "treat similar with similar." Frequent urination indicates heat draining to small intestine. Guide momentum like using Chengqi Tang for diarrhea.
Dryness and dampness oppose. Dampness stagnates, stagnation creates heat, heat creates dryness. Necessity. Below dampness, wind prevails, wind creates dryness. Zhang Zhongjing's Pig Fat and Hair Decoction and Yinchen Wuling San treat dryness in qi/blood levels wisely.
Stopping malaria/cough is not kingly way but sometimes necessary. If malaria pathogen 80-90% gone, phlegm remains. Attack phlegm directly; pathogen has nowhere to stay, disease heals. If pathogen strong, focus on expelling; if healthy qi collapses, rescue fails. Dare not use stopping drugs? Cough pathogen 80-90% gone, lung qi weak, rebellion occurs. Focus on astringing to stop rebellion/securing collapse; healthy qi recovers, residual pathogen resolves. If pathogen not gone, dare not use stopping drugs?
Observe matters from few to many.
Shanghan Huanglian Tang: Patient originally cold-deficient. Yang pathogen transmits inward, raising chest yang. Two yangs combine causing upper heat. Lower jiao cold remains. Upper heat/lower cold forms Pi hexagram image. Disease curable? Decoction cannot be delayed.
Six qi combinations vary in degree. True/false signs exist. Within true/false, degrees vary. Must know reverse treatment method.