答曰：此服药不当，酿成血脱之候也。夫产后之人，血暴下注，每多血虚，即有瘀滞、腹痛、乳肿、血晕之症，只宜温中、活血、行气之品，不可大施破血、破滞之味，昧者专以破瘀滞为主，不知气得温而瘀滞自行，血得活而瘀滞自散。此病因误服消导，酿成坏症，独不思产妇血既大虚，全赖扶阳气以生之，今不扶其阳而更耗其阳，阳气既耗，阴血何由得生？瘀滞何由得行？今成血脱，而元气无依，周身散漫，故肿胀丛生。此刻只宜收纳元阳，犹虑不及，尚服见肿消肿之药，更加乳肿，肛门逼胀欲死，其下脱之机已经暴露。法宜峻补其血，血得补而气有所依，气有依而肿胀自然不作。方用当归补血汤，加鹿茸、黑姜、麦芽、甘草、葱酒。
当归四钱黄芪一两鹿茸三钱麦芽五钱黑姜四钱炙草二钱甜酒半杯葱头子四个
用药意解
按补血汤一方，乃活血、行气之方，实补气、补血之方也。夫当归味苦入心能补心，心者生血之源也；黄芪甘温补肺，肺者正气之宗也。当归得黄芪而血有所附，黄芪得当归而气有所依，即名补血汤亦可，即名补气汤亦可。古人称为补血汤者，取阳生阴长之义。余谓气血双补，欲补气者，当倍当归而轻黄芪，从阴以引阳法也；欲补血者，当倍黄芪而轻当归，从阳以引阴法也。此方倍黄芪，故名补血汤。今产妇病四十馀日，既酿成血虚欲脱而未脱之际，忽得补血之品，而血虚可复，又得补气之物，而血有统制。血既有统，而欲下者不下，则肛门逼胀之症可除。加鹿茸者，取纯阳之质，以助真阳之气；佐姜、草者，有温中之功，又有化阴之意；用葱头以降离阴而下交；用甜酒以鼓坎阳而上行，使麦芽从中以消散其壅滞之气血，不寒不燥，故治此病易也。况当归重用，有活血之能，黄芪重用，有行气之妙。前贤往往用于血虚发热之症颇效。余谓血虚气虚，皆可，不必固执。
问曰：病人口臭、色黄，饮冷，呃逆不休，水泻不止，步履如常者，何故？
答曰：此元阴不足，而胃火旺甚也。夫口臭有二，有先天精气发泄者，口虽极臭，而舌滑润微黄，人无神而阴象全现，决不饮冷。胃火旺者，口臭，舌必干黄，口渴饮冷。呃逆者，火之上冲，泻不止者，火之下降，步履如常者，火之助也。法宜下夺为主，方用大承气汤主之，解见上。此条上、中、下三部俱备，学者不必定要全见，而始用此方，活法圆通，人贵于知机耳。
问曰：平人干咳无痰者，何故？
答曰：此元阴不足，而肺燥也。夫肺为金，生水之源也。元阴不足，由于肺燥不能生水，肺燥实由于元阴不足而邪火生，火旺克金，故肺燥。肺气燥，斯干咳作矣。法宜苦甘化阴养血为主，方用甘草干姜汤，合当归补血汤，加五味子治之。
用药意解
按甘草干姜汤一方，乃辛甘化阳之方，亦苦甘化阴之方也。夫干姜辛温，辛与甘合则从阳化，干姜炮黑，其味即苦，苦与甘合则从阴化。仲景以此方治误吐逆烦躁而厥者，取大甘以化热、守中而复阳也。
又治吐血，治中寒，取辛甘以化阳。阳气也，气能统血，阳能胜寒，阳能温中也。又用以治拘急，治筋挛，治肺痿，治肠燥，取苦甘以化阴。阴血也，血能胜热，血能润燥，血能养筋也。今病人既现干咳无痰，肺气之燥明矣。即以化阴之法，合当归补血汤，加五味子治之，俾燥热解而肺气清，肃令行而干咳自不作矣。
【阐释】笔者对治多种肺、胃虚寒病症，常用甘草干姜汤加味而获效。对治血症，无论其为血热妄行，或阴虚火动，或阳不统血，皆先选用甘草干姜汤加血馀炭，以止其血，然后才对症下药，屡屡获效。
问曰：妇女病，忽喜忽笑，言语异常，似颠非颠，似狂非狂者，何故？
答曰：此真水不能上交于心，心热生而神无主也。夫人一身，全赖水、火两字，水、火相依而行，彼此互为其根，火下降则肾脏温，水上升则心脏凉，此阴、阳颠倒之妙也。今病人所现症形，明系真阴不足，不能上交于心，则心热生。心者，神之主也，热甚则神昏，故喜笑言语异常，而人若颠也。诸书称为热入血室，尚未窥透此理，不知心者，生血之源也，血室者，冲脉之所居也。冲为血海，即有热入，未必即若颠狂也，当以热甚神昏为确。法宜养阴清热，交济阴、阳为主，方用栀豉汤主之。
栀子一两豆豉二两
用药意解
按栀豉汤一方，乃坎、离交济之方，非涌吐之方也。夫栀子色赤、味苦、性寒，能泻心中邪热，又能导火热之气下交于肾，而肾脏温。
豆形象肾，制造为豉轻浮，能引水液之气上交于心，而心脏凉。一升一降，往来不乖，则心、肾交而此症可立瘳矣。仲景以此方治汗、吐、下后虚烦不得眠，心中懊憹者，是取其有既济之功。前贤以此方列于涌吐条，未免不当。独不思仲景既列于汗、吐、下后虚烦之症，犹有复吐之理哉。
问曰：每日早饭后即咳吐黄痰数口，五心潮热，心烦、口渴，大热饮冷，六脉细、数者，何故？
答曰：此元阴虚极，火旺而津液欲竭也。夫大热、口渴、饮冷，心烦、咳吐黄痰，症象白虎之形，然六脉细、数，细为血虚，数为血热，明明血虚生内热，则又非白虎之的症也。医于此际，不可猛浪，务要审确。余细推究病情，伤寒阳明症之烦躁、口渴、饮冷、发热，是从外感得来，脉必长大，定有头疼、身痛、恶寒等情。血虚之大渴、饮冷、烦躁、发热，从内伤得来，或吐血，或久咳，或产后血暴虚，或抑郁损伤心脾，脉必细微，甚则细、数，定少头疼、身痛、恶寒等情，切切不可轻用白虎。误用白虎，为害匪轻。法宜峻补真阴为主，方用独参汤，或当归补血汤亦可，解见上。
人参即以洋参代之洋参二两
用药意解
按独参汤一方，乃补阴之第一方也。今人用为补阳、回阳，大悖经旨，由其不知水、火立极之妙，药性功用之专。余为活人计，不得不直切言之。夫人身所恃以立命者，惟此水、火而已，水、火即气、血，即阴、阳，然阳之根在乎坎，天一生水，一点元阳含于二阴之中是也；阴之根在乎离，地二生火，一点元阴藏于二阳之内是也。水、火互为其根，乾、坤颠倒，各有妙用。故经云："善补阳者，于阴中求阳；善补阴者，于阳中求阴。"今人罕明此理，一见阳虚症，用药即着重心，而不知着重肾；一见阴虚症，用药即着重肾，而不知着重心。究其所用药品，阳虚重在人参，阴虚重在熟地。查熟地甘寒补阴，尚不为错，而人参甘寒，近来所出洋参味苦，苦寒之品，皆补阴之品，非补阳之品。故仲景不用参于回阳，而用参于大热亡阴之症以存阴，如人参白虎汤、小柴胡汤之类是也。大凡药品，性具苦、寒、酸、濇、咸味者，功专在阴；具甘、温、辛、淡、辣味者，功专在阳。今人着重在后天坎、离之阴、阳，而不知着重坎、离中立极之阴阳，故用药多错误也。仲景一生学问，即在这先天立极之元阴、元阳上探求盈虚消长，揭六经之提纲，判阴阳之界限，三阳本乾元一气所分，三阴本坤元一气所化，五脏六腑，皆是虚位，二气流行，方是真机，阴阳盈缩，审于何部，何气所干，何邪所犯，外感由三阳而入内，六客须知，内伤由三阴而发外，七情贵识，用药各用实据，如六经主方是也。然补坎阳之药，以附子为主；补离阴之药，以人参为先，调和上下，权司中土，用药又以甘草为归。此皆立极药品，奈人之不察何！余细维世之用人参以补心，即为补阳也，不知心虽属阳，外阳而内阴，功用在阴，周身阴血俱从火化得来，故色赤。经云："心生血"。又曰："火味苦。"以苦补心，即是补离中之阴也，而非补真阳也。千古以来，用参机关，惟仲景一人知之，而时珍本草云："能回元气于无何有之乡"。推斯意也，以为水火互为其根。经云："阳欲脱者，补阴以留之"，独参汤是也。"阴欲脱者，补阳以挽之"，回阳饮是也。至于阴盛逼阳于外者，用参实以速其阳亡也。阳盛灼阴将尽者，回阳实以速其阴亡也。凡用参以冀回阳，总非至当不易之理，学者宜知。若此症所现，乃阳旺阴虚之甚，正当用参以扶立极之元阴，元阴盛而周身之阴血自盛，血盛而虚者不虚，病者不病矣。
问曰：酒客病，身大热而喘，口渴饮冷，无头疼、身痛、畏寒者，何故？
答曰：此积湿生热，热盛而伤血也。夫嗜酒之人，易生湿热症，因酒性刚烈发散，入腹顷刻，酒气便窜于周身皮肤，烈性一过，湿气便留中脘。中土旺者，湿气易去；中气弱者，湿气难消，久久中气更虚，湿气因而成疾，湿气流注四肢，便成痰火手脚。医生一见痰火手足，便照痰火治之，鲜有愈者。以余主治，法宜温中除湿，辛甘化阳之品。若此症由湿聚日久，因而生热，热气逼肺，则喘症生，热伤津液，则口渴作。法宜清热、燥湿、升解为主，方用葛根黄连黄芩汤。
古方葛根用至半斤，芩、连、草各二两，因太阳桂枝症误下，邪陷于中土，下利不止，脉促喘汗者，内陷之邪，尚欲从肌腠而外出不能出，涌于脉道，则脉促，涌于华盖，则气喘。仲景故用葛根以升腾胃气，鼓邪仍从外出，佐以芩、连之苦，苦以坚之，坚毛窍以止汗，坚肠胃以止泻，又以甘草调中，邪去而正立复，病自不难解矣。今改用分两，借以治酒客之积湿生热，大热而喘者，亦更妙也。
用药意解
按葛根黄连黄芩汤一方，乃表里两解之方，亦宣通经络、燥湿、清热之方也。夫葛根气味甘辛，禀秋金之气，乃阳明胃经主药也。阳明主燥，肌肉属阳明胃，胃热甚故肌肉亦热，胃络上通心肺，热气上涌于肺故喘，热伤脾中阴血故渴。今得葛根之升腾，宣通经络之邪热，热因湿积者，热去而湿亦去矣。况得芩、连之苦，苦以清热，苦能燥湿，复得甘草和中以培正气，内外两解，湿热自化为乌有矣。此方功用尚多，学者不可执一。
问曰：老人大便艰涩不出者，何故？
答曰：此血虚甚而不能分润沟渠也。夫年老之人，每多气、血两虚，气旺则血自旺，气衰则血自衰。然年老之人，禀赋原有厚薄，不得概谓气血两虚。亦有素禀阳旺者，精神不衰，出言声厉，饮食不减，此等多由火旺阴亏。亦有禀赋太薄，饮食不健，素多疾病，乃生机不旺，运化太微，阴血渐衰，不能泽润肠胃，肠胃枯槁，此真血虚之侯。
二条乃言老人之禀赋。亦有因外邪入阳经，变为热邪，伏于肠胃而闭结者。亦有阴盛阳微，下焦无阳，不能化阴而闭结者，亦有肺内伏热而闭结者，认症总宜清耳。若老人大便艰涩，无外症者，即是血枯居多，法宜苦甘化阴为主，方用当归补血汤加蜂蜜，或甘草干姜汤，解见上。或麻仁丸。
麻仁二两芍药八钱枳实八钱大黄一两六钱厚朴二钱杏仁一两白蜜一两
用药意解
按麻仁丸一方，乃润燥行滞之方，实苦甘化阴之方也。夫人身精血，俱从后天脾胃化生，脾与胃为表里，胃主生化，脾主转输，上下分布，脉络沟渠，咸赖滋焉。今胃为伏热所扰，生化之机不畅，伏热日炽，胃土干燥，渐渐伤及脾阴，脾阴虚甚，津液不行于大肠，肠、胃火旺，积粪不行，故生穷约。穷约者，血枯而无润泽，积粪转若羊矢也。故仲景立润肠一法，使沟渠得润，穷约者，自不约也。药用麻仁、杏仁，取多脂之物，以柔润之，取大黄、芍药之苦，以下降之，取厚朴、枳实之苦温，以推荡之，使以白蜜之甘润，与苦合而化阴。
阴得化而阳生，血得润而枯荣，肠胃水足，流通自如，推荡并行，其功迅速。此方宜用为丸，缓缓柔润，以治年老血枯，实为至当之法。
今改用分两为汤，取其功之速，亦经权之道也。
问曰：男子阳物挺而不收者，何故？
答曰：此元阴将绝，阳孤无匹也。夫阳物之举，乃阳旺也。阳旺极宜生阴，阴生阳自痿，乃阴阳循环不易之理。今出乎至理之外，挺而不收，明明有阳无阴象也。此际法宜救阴，大补先天元阴为主，方用独参汤主之，解见上。或六味地黄汤亦可。
用药意解
按地黄汤一方，乃利水育阴之方也。夫地黄甘寒，滋肾水之不足；二皮酸寒，敛木火之焰光；山药、茯苓，健脾化气行水，泽泻甘寒，补养五脏，又能消湿。此病由水虚而火旺，又加木火助之，故不收。
今得地黄补水，又能滋肝，肝主宗筋，乃阳物之根也。宗筋得润，而阳物立痿，佐二皮一敛一泻，火光即灭。又得山、苓、泽泻，健脾化气以行津液，庶几此病易瘳。古人云："补阳以配阴"，乃为阳痿不举（柱）〔注〕脚，为一切阳虚（柱）〔注〕脚。"补阴足以配阳"，乃为阳挺不收（柱）〔注〕脚，为一切阴虚（柱）〔注〕脚。此条应专以滋阴为是。不应利水，利之似反伤阴，不知用利药于地黄之内，正取其利，以行其润之之力也。学者不可执一，分两与古方不同，改用也。
Answer: This is due to improper medication, which has led to a critical condition of blood depletion. Postpartum women, having suffered massive blood loss, mostly present with blood deficiency; even if accompanied by symptoms such as blood stasis, abdominal pain, breast swelling, and syncope due to blood, only warming the middle, invigorating blood, and moving qi should be employed. One must not heavily use herbs that break blood or break stagnation. Quacks focus solely on breaking stasis, failing to understand that when qi is warmed, stasis naturally moves, and when blood is activated, stasis naturally disperses. This illness arose from mistakenly taking digestive aids,酿成 (brewing) a disastrous syndrome. Have they not considered that since the parturient's blood is severely deficient, it relies entirely on supporting yang qi to generate yin blood? Now, instead of supporting yang, they further consume it. Once yang is consumed, how can yin blood be generated? How can stasis move? Now, having formed blood depletion, yuan qi has no anchor, scattering throughout the body, thus causing swelling to arise. At this moment, one should only gather the yuan yang, worrying it might be too late, yet they still administer drugs for reducing swelling upon seeing it, exacerbating breast swelling, and causing unbearable anal urgency and distension, revealing the mechanism of downward collapse. The method should be to vigorously tonify blood; once blood is tonified, qi has an anchor; once qi has an anchor, swelling will naturally cease. Use Danggui Buxue Tang (Dongquui Blood-Nourishing Decoction), adding Rusa (Deer Antler), Heijiang (Black Ginger), Maiya (Malt), Gancao (Licorice), and Congjiu (Scallion Wine).
Danggui Buxue Tang (Dongquui Blood-Nourishing Decoction)
Danggui (Angelicae Sinensis Radix) 4 qian, Huangqi (Astragali Membranacei Radix) 1 liang, Lurong (Cervi Cornus Degelatinati) 3 qian, Maiya (Hordei Fructus Germinatus) 5 qian, Heijiang (Zingiberis Rhizoma Carbonisatum) 4 qian, Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) 2 qian, Tianjiu (Sweet Wine) half cup, Congtouzi (Allii Fistulosi Bulbus) four.
Explanation of Medicinal Intent
Regarding the formula Danggui Buxue Tang, it is a formula for invigorating blood and moving qi, but essentially it is a formula for tonifying qi and blood. Danggui enters the heart via its bitter taste and can tonify the heart; the heart is the source of blood generation. Huangqi is sweet and warm, tonifying the lung; the lung is the master of righteous qi. When Danggui obtains Huangqi, blood has something to attach to; when Huangqi obtains Danggui, qi has something to rely on. Thus, naming it Blood-Nourishing Decoction or Qi-Tonifying Decoction is both acceptable. The ancients called it Blood-Nourishing Decoction, taking the meaning of "yang generates yin." I believe that for dual tonification of qi and blood, to tonify qi, one should double Danggui and lightly use Huangqi, a method of drawing yang from yin; to tonify blood, one should double Huangqi and lightly use Danggui, a method of drawing yin from yang. This formula doubles Huangqi, hence named Blood-Nourishing Decoction. Now, the parturient has been ill for over forty days, reaching a stage where blood deficiency is about to collapse but has not yet done so. Suddenly receiving blood-nourishing agents restores blood deficiency, and receiving qi-tonifying agents gives blood control. With blood controlled, what wants to descend does not, thus removing the anal urgency and distension. Adding Lurong takes advantage of its pure yang nature to assist true yang qi; assisting with Jiang (Ginger) and Cao (Licorice) provides warming of the middle and the intent of transforming yin; using Congtou (Scallion head) descends the yin of Li (Heart Fire) to interact below; using Tianjiu (Sweet wine) stimulates Kan (Kidney Yang) to ascend, allowing Maiya to dissipate stagnant qi and blood in the middle, neither cold nor dry, thus making treatment easy. Moreover, heavy use of Danggui has the ability to invigorate blood, and heavy use of Huangqi has the wonder of moving qi. Former sages often used it for blood deficiency with fever with good effect. I say it applies to both blood and qi deficiency; one need not be rigid.
Question: The patient has bad breath, yellow complexion, desires cold drinks, incessant hiccups, unceasing watery diarrhea, yet walks normally. What is the reason?
Answer: This is due to insufficiency of yuan yin and excessive stomach fire. There are two types of bad breath: one is the emission of congenital essence; although the mouth smells extremely foul, the tongue is slippery, moist, and slightly yellow, the person lacks spirit, and yin signs are fully manifest, and they absolutely do not desire cold drinks. In cases of strong stomach fire, there is bad breath, the tongue must be dry and yellow, and there is thirst with desire for cold drinks. Hiccups are fire rushing upward; unceasing diarrhea is fire descending; walking normally is fire assisting the body. The method should prioritize purging downward, using Dachengqi Tang (Major Order the Qi Decoction) as the main prescription, explanation seen above. This case presents symptoms in the upper, middle, and lower jiao simultaneously. Students need not wait for all symptoms to appear before using this formula; flexible application values understanding the disease mechanism.
Question: Why does a healthy person suffer from dry cough without phlegm?
Answer: This is due to insufficiency of yuan yin and lung dryness. The Lung belongs to Metal and is the source of Water generation. Insufficiency of yuan yin results from lung dryness failing to generate water; lung dryness actually stems from yuan yin insufficiency generating pathogenic fire, where fire excess conquers metal, causing lung dryness. When lung qi is dry, dry cough occurs. The method should prioritize bitter-sweet transforming into yin and nourishing blood, using Gancao Ganjiang Tang (Licorice and Ginger Decoction) combined with Danggui Buxue Tang, adding Wuweizi (Schisandrae Fructus).
Gancao Ganjiang Tang (Licorice and Ginger Decoction)
Zhigancao (Prepared Licorice Root) 2 liang, Ganjiang (Dried Ginger Rhizome) 5 qian (prepared).
Explanation of Medicinal Intent
Regarding Gancao Ganjiang Tang, it is a formula for acrid-sweet transforming into yang, and also bitter-sweet transforming into yin. Ganjiang is acrid and warm; acrid combined with sweet transforms into yang. When Ganjiang is charred, its taste becomes bitter; bitter combined with sweet transforms into yin. Zhang Zhongjing used this formula to treat reversal and irritability after mistaken vomiting, taking the great sweetness to transform heat, guard the middle, and restore yang.
It is also used to treat hematemesis and interior cold, taking acrid-sweet to transform yang. Yang qi controls blood, yang overcomes cold, and yang warms the middle. It is also used to treat spasms, tendon cramps, lung atrophy, and intestinal dryness, taking bitter-sweet to transform yin. Yin blood overcomes heat, moistens dryness, and nourishes tendons. Now that the patient presents with dry cough without phlegm, lung dryness is evident. Using the method of transforming yin, combined with Danggui Buxue Tang and Wuweizi, resolves dryness-heat, clears lung qi, restores descending function, and stops dry cough.
[Interpretation] I frequently use modified Gancao Ganjiang Tang to treat various lung and stomach deficiency-cold conditions with success. For treating blood disorders, whether due to blood heat forcing reckless movement, yin deficiency with fire hyperactivity, or yang failing to control blood, I first select Gancao Ganjiang Tang plus Xuyutan (Carbonized Hair) to stop bleeding, then prescribe according to symptoms, achieving frequent success.
Question: A woman suffers from sudden laughter and crying, abnormal speech, seeming manic but not quite, seeming delirious but not quite. What is the reason?
Answer: This is because true water cannot ascend to interact with the heart, leading to heart heat and lack of mastery over the spirit. The human body relies entirely on Water and Fire. Water and Fire support each other and are roots of one another. When fire descends, the Kidney warms; when water ascends, the Heart cools. This is the wonder of yin-yang inversion. The patient's symptoms clearly show yuan yin insufficiency, unable to ascend to the heart, causing heart heat. The Heart is the master of Spirit; extreme heat causes spiritual confusion, leading to abnormal laughter, speech, and a manic appearance. Various books call this "Heat entering the Blood Chamber," but this does not fully penetrate the principle. The Heart is the source of blood generation; the Blood Chamber is the residence of the Chong Mai (Penetrating Vessel). The Chong is the Sea of Blood; even if heat enters, it may not necessarily cause mania. It is more accurate to attribute it to heat-induced spiritual confusion. The method should prioritize nourishing yin, clearing heat, and harmonizing yin and yang, using Zhichi Tang (Gardenia and Fermented Soybean Decoction) as the main prescription.
Zhichi Tang (Gardenia and Fermented Soybean Decoction)
Zhizi (Gardeniae Fructus) 1 liang, Douchi (Sojae Semen Praeparatum) 2 liang.
Explanation of Medicinal Intent
Regarding Zhichi Tang, it is a formula for the interaction of Kan (Kidney) and Li (Heart), not a vomitive formula. Zhizi is red, bitter, and cold; it can drain pathogenic heat from the heart and guide fire-heat qi down to interact with the Kidney, warming the Kidney.
Dou (Soybean) resembles the Kidney; processed into Douchi, it becomes light and floating, guiding water-fluid qi up to interact with the Heart, cooling the Heart. One ascends, one descends, moving without deviation, causing Heart-Kidney interaction and immediate recovery. Zhang Zhongjing used this formula to treat restlessness and insomnia with inner vexation after sweating, vomiting, or purging, utilizing its balancing function. Former sages incorrectly listed this formula under vomitives. Did they not consider that Zhang Zhongjing listed it for post-emetic/vomiting/purgative restlessness, implying no need for further vomiting?
Question: Every day after breakfast, the patient coughs up a few mouthfuls of yellow phlegm, experiences tidal heat in the five centers, irritability, thirst, intense heat with desire for cold drinks, and fine, rapid pulses in all six positions. What is the reason?
Answer: This is extreme insufficiency of yuan yin, with fire hyperactivity and impending exhaustion of body fluids. Intense heat, thirst, desire for cold drinks, irritability, and coughing yellow phlegm resemble Baihu Tang (White Tiger Decoction) syndrome. However, the pulses are fine and rapid; fine indicates blood deficiency, rapid indicates blood heat. Clearly, this is internal heat generated by blood deficiency, not the exact indication for Baihu Tang. Doctors must not act rashly here but must examine carefully. Upon detailed investigation, Yangming syndrome in Cold Damage involves irritability, thirst, desire for cold drinks, and fever arising from external contraction, with large and long pulses, definitely accompanied by headache, body ache, and aversion to cold. Blood deficiency involving intense thirst, desire for cold drinks, irritability, and fever arises from internal injury, such as hematemesis, chronic cough, postpartum blood depletion, or emotional depression damaging Heart and Spleen, with fine or fine-rapid pulses, definitely lacking headache, body ache, and aversion to cold. One must never lightly use Baihu Tang. Misusing Baihu Tang causes serious harm. The method should prioritize vigorously tonifying true yin, using Dushen Tang (Single Ginseng Decoction) or Danggui Buxue Tang, explanation seen above.
Dushen Tang (Single Ginseng Decoction)
Renshen (Ginseng Radix) - substitute with Yangshen (American Ginseng) 2 liang.
Explanation of Medicinal Intent
Regarding Dushen Tang, it is the primary formula for tonifying yin. Modern people use it to tonify yang and restore yang, greatly contradicting classic principles, due to ignorance of the wonder of Water-Fire establishing the pole and the specific functions of medicinal properties. For the sake of saving lives, I must speak plainly. What the human body relies on for life is only Water and Fire. Water and Fire are Qi and Blood, Yin and Yang. The root of Yang lies in Kan; Heaven generates one Water, containing a point of Yuan Yang within two Yins. The root of Yin lies in Li; Earth generates two Fire, hiding a point of Yuan Yin within two Yangs. Water and Fire are roots of each other; Qian and Kun invert, each having wonderful uses. Thus, the Classics state: "Those skilled in tonifying Yang seek Yang within Yin; those skilled in tonifying Yin seek Yin within Yang." Few today understand this. Seeing Yang deficiency, they focus on the Heart, ignoring the Kidney; seeing Yin deficiency, they focus on the Kidney, ignoring the Heart. Regarding materials, Yang deficiency focuses on Renshen, Yin deficiency on Shudi (Rehmanniae Radix Preparata). Shudi is sweet and cold, tonifying yin, which is not wrong. But Renshen is sweet and cold; modern Yangshen is bitter. Bitter-cold substances tonify yin, not yang. Therefore, Zhang Zhongjing did not use Shen for restoring yang, but for preserving yin in cases of extreme heat consuming yin, such as Renshen Baihu Tang and Xiaochaihu Tang. Generally, substances with bitter, cold, sour, astringent, salty tastes specialize in yin; those with sweet, warm, acrid, bland, spicy tastes specialize in yang. People today focus on post-heaven Kan-Li yin-yang, ignoring pre-heaven Kan-Li pole-establishing yin-yang, leading to errors. Zhang Zhongjing's learning explored the waxing and waning of pre-heaven Yuan Yin and Yuan Yang, outlining the Six Channels, judging yin-yang boundaries. Three Yang are divisions of Qian Yuan Qi; Three Yin are transformations of Kun Yuan Qi. Five Zang and Six Fu are empty vessels; the flow of two Qi is the true mechanism. Examining yin-yang fullness/emptiness by location, affected Qi, and invading pathogen: external pathogens enter via Three Yang; internal injuries manifest via Three Yin. Medications must have solid evidence, such as Six Channel main formulas. However, for tonifying Kan Yang, Fuzi (Aconiti Lateralis Radix Preparata) is primary; for tonifying Li Yin, Renshen is foremost; for harmonizing upper and lower and managing the Middle Earth, Gancao is the归宿 (destination). These are pole-establishing medicines, alas, people do not notice! I ponder that people use Renshen to tonify the Heart, thinking it tonifies Yang. But although the Heart belongs to Yang, it is exterior Yang and interior Yin, functioning in Yin. All body yin-blood comes from Fire transformation, hence red. The Classics say: "The Heart generates blood" and "Fire tastes bitter." Tonifying the Heart with bitter taste is tonifying the Yin within Li, not True Yang. Since antiquity, only Zhang Zhongjing understood the mechanism of using Shen. Li Shizhen's Bencao says: "It can return primordial energy from nowhere." Inferring this, Water and Fire are roots of each other. The Classics say: "When Yang is about to escape, tonify Yin to retain it," which is Dushen Tang. "When Yin is about to escape, tonify Yang to retrieve it," which is Huiyang Yin. If Yin excess forces Yang outward, using Shen accelerates Yang collapse. If Yang excess scorches Yin to near extinction, restoring Yang accelerates Yin collapse. Anyone hoping to restore Yang using Shen misunderstands the ultimate principle; students should know this. If the current symptom is extreme Yang excess and Yin deficiency, one should properly use Shen to support the pole-establishing Yuan Yin. When Yuan Yin is abundant, body yin-blood becomes abundant; when blood is abundant, deficiency is not deficiency, and the sick person is not sick.
Question: A habitual drinker suffers from high fever and wheezing, thirst with desire for cold drinks, but no headache, body ache, or aversion to cold. What is the reason?
Answer: This is accumulated dampness generating heat, with heat excess injuring blood. People who love alcohol easily develop damp-heat syndromes. Because alcohol is fierce and dispersing, upon entering the stomach, its qi quickly spreads through the skin. After the fierce nature passes, dampness remains in the Middle Jiao. If Middle Earth is robust, dampness is easily removed; if Middle Qi is weak, dampness is hard to eliminate. Over time, Middle Qi becomes weaker, dampness becomes pathological, flowing into the limbs, causing Phlegm-Fire in hands and feet. Doctors seeing Phlegm-Fire in extremities treat it as such, rarely curing it. My method prioritizes warming the middle and removing dampness using acrid-sweet transforming into yang agents. If this syndrome arises from long-standing dampness aggregation generating heat, heat forcing the Lung causes wheezing; heat injuring fluids causes thirst. The method should prioritize clearing heat, drying dampness, and ascending-releasing, using Gegen Qinlian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction).
Gegen Qinlian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction)
Gegen (Puerariae Lobatae Radix) 1 liang, Huanglian (Coptidis Rhizoma) 5 qian, Huangqin (Scutellariae Radix) 5 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 5 qian.
In ancient formulas, Gegen was used up to half a jin, and Qin, Lian, Cao were each 2 liang. This was for Taiyang Guizhi Syndrome mistreated with purgatives, where pathogen sank into the Middle Earth, causing unceasing diarrhea, urgent pulse, wheezing, and sweating. The internalized pathogen still wanted to exit via muscle layers but could not. Surging into the pulse channel caused urgent pulse; surging into the Huagai (Lung) caused wheezing. Zhang Zhongjing thus used Gegen to ascend Stomach Qi, driving the pathogen out again. Assisted by the bitterness of Qin and Lian, bitterness firms the pores to stop sweating and firms the intestines/stomach to stop diarrhea. Gancao harmonizes the middle. Once the pathogen leaves, righteousness recovers, and the disease is easily resolved. Now changing the dosage to treat the habitual drinker's accumulated dampness generating heat, high fever, and wheezing, is even more ingenious.
Explanation of Medicinal Intent
Regarding Gegen Qinlian Huangqin Tang, it is a formula resolving both exterior and interior, and also unblocking collaterals, drying dampness, and clearing heat. Gegen is sweet and acrid, inheriting Autumn Metal Qi, being the main herb for the Yangming Stomach Meridian. Yangming governs dryness; muscles belong to Yangming Stomach. Severe Stomach heat makes muscles hot. Stomach collaterals connect to Heart and Lung; heat rushes up to the Lung causing wheezing; heat injures Spleen yin-blood causing thirst. Now, with Gegen's ascending action, it unblocks collaterals and expels pathogenic heat. Where heat is accumulated by dampness, removing heat removes dampness. Furthermore, assisted by the bitterness of Qin and Lian, bitterness clears heat and dries dampness. Gancao harmonizes the middle to cultivate righteous qi. Resolving both interior and exterior, damp-heat vanishes. This formula has many functions; students must not be rigid.
Question: Why does an elderly person suffer from difficult, obstructed defecation?
Answer: This is severe blood deficiency failing to moisten the channels. Elderly people mostly have both qi and blood deficiency. Strong qi leads to strong blood; weak qi leads to weak blood. However, elderly people have varying constitutions; one cannot generalize all as qi and blood deficiency. Some have innate strong Yang, undiminished spirit, loud voice, normal diet; these mostly stem from fire excess and yin deficiency. Others have thin constitutions, poor diet, frequent illness, weak vital energy, weak transportation, gradual decline of yin-blood, failing to moisten intestines and stomach, leading to dry intestines and stomach—this is true blood deficiency.
These two points discuss elderly constitutions. Some have external pathogens entering Yang channels, transforming into heat, lurking in intestines/stomach causing obstruction. Some have Yin excess and Yang weakness, no Yang in Lower Jiao, failing to transform Yin causing obstruction. Some have latent heat in the Lung causing obstruction. Diagnosis should always prioritize clearing. If an elderly person has difficult defecation without external symptoms, it is mostly blood exhaustion. The method should prioritize bitter-sweet transforming into yin, using Danggui Buxue Tang plus honey, or Gancao Ganjiang Tang, explanation seen above. Or Maren Wan (Hemp Seed Pill).
Maren Wan (Hemp Seed Pill)
Maren (Cannabis Fructus) 2 liang, Shaoyao (Paeoniae Radix Alba) 8 qian, Zhishi (Aurantii Fructus Immaturus) 8 qian, Dahuang (Rhei Radix et Rhizoma) 1 liang 6 qian, Houpo (Magnoliae Officinalis Cortex) 2 qian, Xingren (Armeniacae Semen) 1 liang, Baimi (Mel) 1 liang.
Explanation of Medicinal Intent
Regarding Maren Wan, it is a formula for moistening dryness and moving stagnation, truly a bitter-sweet transforming into yin formula. Human essence and blood are generated from post-heaven Spleen and Stomach. Spleen and Stomach are exterior-interior pairs; Stomach governs transformation/generation, Spleen governs transportation/distribution. Upper and lower distribution, collaterals and channels, all rely on nourishment. Now, the Stomach is disturbed by latent heat, transformation/generation is sluggish, latent heat intensifies daily, Stomach Earth dries, gradually injuring Spleen Yin. Severe Spleen Yin deficiency prevents fluids from reaching the Large Intestine. Intestinal/Stomach fire excess, accumulated feces do not move, causing "Qiong Yue" (severe constipation). Qiong Yue means blood exhaustion without moisture, feces turning like sheep droppings. Thus, Zhang Zhongjing established the method of moistening intestines, allowing channels to be moistened, so Qiong Yue is no longer constricted. Medicinals: Maren and Xingren, taking fatty substances to soften and moisten; Dahuang and Shaoyao, taking bitterness to descend; Houpo and Zhishi, taking acrid-warm bitterness to push and荡 (cleanse); Bai Mi, taking sweetness and moisture to combine with bitterness and transform into yin.
Yin transformed, Yang generates; blood moistened, dryness flourishes. Intestinal/Stomach water sufficient, circulation free, pushing and cleansing together,功效 (efficacy) is rapid. This formula is suitable as pills, slowly and softly moistening, truly the appropriate method for elderly blood exhaustion.
Now changing dosage to decoction for faster efficacy, this is also a method of flexibility.
Question: Why does a man's penis remain erect and not retract?
Answer: This is impending exhaustion of yuan yin, with isolated Yang having no match. Erection of the penis indicates Yang excess. Extreme Yang excess should generate Yin; when Yin generates, Yang naturally flaccids. This is the unchanging principle of yin-yang cycle. Now, deviating from this principle, remaining erect and not retracting clearly shows Yang without Yin. At this moment, the method should save Yin, primarily vigorously tonifying pre-heaven Yuan Yin, using Dushen Tang as the main prescription, explanation seen above. Or Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) is also acceptable.
Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill)
Shudi (Rehmanniae Radix Preparata) 1 liang, Zaopi (Corni Fructus) 8 qian, Huaiyao (Dioscoreae Rhizoma) 5 qian, Fuling (Poria) 5 qian, Danpi (Moutan Cortex) 6 qian, Zexie (Alismatis Rhizoma) 3 qian.
Explanation of Medicinal Intent
Regarding Dihuang Tang, it is a formula for promoting urination and nurturing yin. Dihuang is sweet and cold, nourishing insufficient Kidney Water; Zaopi (and similar bark) is sour and cold, restraining Wood-Fire flames; Shanyao (Dioscorea) and Fuling strengthen Spleen, transform Qi, and promote fluid movement; Zexie is sweet and cold, nourishing Five Zang, and eliminating dampness. This disease stems from Water deficiency and Fire excess, aided by Wood-Fire, hence non-retraction.
Now obtaining Dihuang to supplement Water and nourish Liver. Liver governs the Sinews (Zongjin), which are the root of the penis. When Sinews are moistened, the penis flaccids immediately. Assisted by Zaopi, one astringes, one drains, extinguishing fire light. Further assisted by Shanyao, Fuling, Zexie, strengthening Spleen, transforming Qi, and moving fluids, this disease is easily cured. Ancients said: "Tonify Yang to match Yin" is for impotence (failure to erect), for all Yang deficiency cases. "Tonify Yin sufficiently to match Yang" is for penile erection without retraction, for all Yin deficiency cases. This case should specifically focus on nourishing Yin. Promoting urination seems contrary, as it might injure Yin. However, using draining herbs within Dihuang utilizes their draining action to facilitate the moistening power. Students must not be rigid; dosages differ from ancient formulas, modified here.
Question: The patient, every day around midnight, experiences intense heat in both feet rising to the knees like fire, irritability, which resolves by noon. What is the reason?