答曰：此血虚阳旺也。夫人身以阴、阳两字为主，阳生于子至已时，属三阳用事，正阳长阴消之时，阴虚不能配阳，阳旺故发热。至午即愈，乃阴长阳消，阳不胜阴，故热退。世人以为午后发热为阴虚，是未识阴、阳消长之道也。余治一易姓妇，每日午初，即面赤发热，口渴喜热汤，至半夜即愈，诸医概以补阴不效，余以白通汤，一服而愈。此病法宜补阴以配阳为主，方用补血汤，或地黄汤，解见上。
问曰：秋月人忽然腹痛水泻，日数十次，完谷不化，精神不倦者，何故？
答曰：此肺中之元阴不足，肺气燥甚也。夫大便水泻至完谷不化，谁不以为脾胃之败也。不知肺气燥极，亦有此症。肺与大肠为表里，大肠主传送，饮食入胃，不待消化，随燥热之气下降，而直趋大肠，故日泻数十次，腹痛饮冷不倦。若果脾败完谷不化，精神之倦极可知，决然病久非暴也。至于水泻一症，有泻出色黄极者，胃火旺也。泻出色白者，下元无火也。泻出色青者，厥阴之寒化也。泻出色如酱汁者，太阴之湿化也。泻出如溏鹜者，脏有寒也。亦有泻出色白如涎者，肺有热也。有泻出淡赤色者，阳不统阴也。以上数症，临症时再察虚、实、新、久，脉息有神、无神，用药自有据也。此症法宜清燥为主，方用甘桔汤，加二冬、地骨、桑皮、黄芩、杏仁、白蜜治之。
甘草一两桔梗八钱天冬四钱麦冬四钱地骨三钱桑皮三钱黄芩二钱杏仁二十粒白蜜五钱
用药意解
按甘桔汤一方，乃苦甘化阴之方也。此方仲景用以治少阴之咽痛症，因少阴之火上浮于咽，少阴之络挟咽故也。得甘桔之合化，而少阴得养，故愈。今用以治太阴，取桔梗之苦以开提肺气，而伏热立消，取甘草之甘，大甘足以化热，苦与甘合，又能化阴，化阴足以润肺，又加以二冬、二皮、黄芩、杏仁、白蜜，一派甘寒、苦降之品以助之，而肺燥立止，水泻自不作矣。
答曰：此元阴虚不能润肺，肺燥而不能行津液于皮肤也。夫病人干咳，乃血虚肺燥之验。肺主皮毛，肺气清，则节令行而不乖，脏腑咸赖；肺气燥，则节令失，而津液不行，百病丛生。津液不行于内，则肺痿、脏结、肠燥、痿躄、筋挛、骨蒸等症即起；津液不行于外，则皮毛、肌肤、爪甲、枯搞、燥痒之症立作。此条言血虚肺燥，有如是等症，法宜清燥、养营为主，方用补血汤，合甘草干姜汤，加五味、白蜜治之，解见上。业斯道者，须知人身气血运用机关，气血之根皆在下，培养在中，发用在上。根即此○也，培养即此◎也，发用即此⊙也。肺主气，即发用之外圈，心主血，即发用之内圈。外圈本乾体所化，内圈本坤体所生，天包乎地，地成乎天，混然一物。地气上腾，指坎中一阳，由下而中而上，一呼即起；天气下降，指离中真阴，由上而中而下，一吸即入。故曰呼、吸者，阴、阳之橐籥也。呼则气行而血随，吸则血行而气附。呼吸虽判乎阴阳，其实升则二气同升，降则二气同降，升降循环不已，故即上、下以判阴、阳也。先圣恐人不明，故画卦以明阴、阳，乾坤则称为先天，六子乃为后天，今人专在后天论阴阳生克固是，而不在先天论阴阳盛衰，是知其末，而未知其本也。苟有知得阴阳升降之道者，庶可与共学适道矣。
问曰：筋缩不伸者，何故？
答曰：此血虚不能养筋，筋燥故也。夫筋之燥也有由生，虽云水能生木，其实水、火之功用在心、肺，肺主气，心主血，肺气行于五脏，血亦行于五脏，肺气行于六腑，血亦行于六腑。肺气燥极，则运用衰，津液不润于筋，则筋燥作。筋燥甚，故缩而不伸也。法宜清燥养血为主，方用芍药甘草汤主之，或加二冬、白蜜亦可。
用药意解
按芍药甘草汤一方，乃苦甘化阴之方也。夫芍药苦平入肝，肝者阴也。甘草味甘入脾，脾者土也。苦与甘合，足以调周身之血，周身之血既调，则周身之筋骨得养，筋得血养而燥气平，燥气平则筋舒而自伸矣。然亦不必拘定此方，凡属苦甘、酸甘之品，皆可以化阴。活法圆通之妙，即在此处也，学者须知。
答曰：此元阴虚极，而神无主也。夫心生血，神藏于血之中，神者火也、气也，即坎中一阳，而寓于血之中，气与血相依，故别其名曰心藏神，即此可知鬼神之用也。书曰："鬼神者，二气之良能也。"良能二字，即真阴、真阳之本性也，神禀阳之灵，天体也，位尊，故曰神；鬼禀阴之灵，地体也，位卑，故曰鬼。人之为善，则性从阳，光明气象；人之为恶，则性从阴，黑暗气象。人死而为神，为鬼，即在平日修持上判也。将死之际，善气重者，元神从天门而出，定为神道；恶气重者，元神从地户而入，定为鬼道。若老人气血已衰，精神自然不足，不足故神昏也。然又非热甚神昏之谓也，法宜养血为主，气、血双补亦可。方用补血汤、独参汤，或参枣汤亦可，补血、独参二汤，解见上。
用药意解
按参枣汤一方，乃苦甘化阴，酸甘敛阴之方也。因元阴虚极，不能养神，神无所主，故时明时昧，犹若残灯将灭，而火光不明，苟能更添其膏，火光自然复明也。今以洋参之甘苦，枣仁之酸敛，以扶其元阴。元阴敛而真气即敛，故曰藏神。又得猪心同气相求，庶几心神明而不昧。复取甘草从中合化，而真血有源源不竭之妙也。此方不独治老年健忘，凡属思虑损伤阴血者，皆可服也。
答曰：此元阴不足于肺，肺火旺而大肠之火亦旺也。夫脱肛一症，原有阳虚阴虚之别。阳虚之脱肛者，由元气衰极，不能约束也。其人必困倦无神，渴必饮热，阴象全见，法宜温中。阴虚之脱肛者，由于下焦火旺，逼出也。其人精神不衰，渴喜饮冷，热象全见。然此二症，多起大泻大痢之后，治者务要认定阴、阳实据，自然获效。此症即阴虚火旺也，火上逼肺，故喘，火下逼肠，故肛出。法宜滋阴泻火，方用大黄黄连泻心汤，或葛根黄连黄芩汤亦可，解见上。
用药意解
按大黄黄连泻心汤一方，乃泻火之方也。仲景以此方治心下痞满，按之濡者。是因无形之热邪，伏于心下，而以此方泻之也。今借以治此症，似亦未切，不知大黄、黄连苦寒，能泻三焦邪热，此病既因热上攻肺，而喘症生，热下攻肠，而脱肛作，得大黄、黄连之苦寒泻火。火邪一去，上下自安，亦握要之法也。
因邪犯太阳，从太阳之标阳而化为热邪，伏于膀胱，故口渴、饮冷而便痛，法宜化气行水，方用五苓散主之。其实近似淋症，淋症亦皆膀胱之症也。前贤有血淋、气淋、沙淋、石淋、劳淋五淋之别，总而言之，不出阴、阳两字。有阳衰不能化停滞之精而作者，十有七八。推其源，多起于梦中遗精，忽觉而提其气以留之，不能复位，发泄不畅，当心气下降而便溺，败精欲出而不能出，故小便痛甚，此受病之根也。
此病法宜大助元阳，鼓之化之，俾气化行而精气畅。世人一见便痛为火，不敢轻投桂、附，是未识透此中消息也。亦有精停日久，阻滞气机，郁而为热，灼尽膀耽阴血，败精为邪火所熬，故有砂、石之名，总缘火由精停起见。阳虚之人，得此者多，方宜白通汤、三才、潜阳诸方。阴虚之人，火旺太甚，宜滋肾丸、六味丸、五苓散之类，解见上。或附子泻心汤亦可。
用药意解
按五苓散一方，乃化气行水之方也。因寒伤太阳之腑，气化不宣，水道不利而生邪热。热伤津液，不能上升，故渴；气化不行，尿欲出而不即出，故痛。今得二苓、术、泽，专行其水以培中，最妙在桂枝一味，化膀胱气机，气机化行，自然郁热解而寒邪亦解。此方重在化气，不重在去热一面，可知气化行，即是去热也，世多不识。
按附子泻心汤一方，乃寒、热并用之方也。仲景以此方治心下痞，而复恶寒、汗出者，是少阴无形之热，伏于心下而作痞，复见太阳之寒，又见汗出，有亡阳之虑，故用芩、连、大黄以泻少阴无形之伏热，又用附子以固根蒂而追元阳，寒热互用，真立方之妙也。今借以治停精而生热为淋者，用附子以鼓先天之阳，佐芩、连、大黄以泻伏热，是不固之固，不利之利也。方书多用利水清热之品，是治热结一法，而遗化精一法。余意方中再加安桂二、三钱，以助附子之力，而又能化气，气化精通，热解邪出，何病淋之患哉？如三才封髓丹加安桂，滋肾丸倍安桂，皆可酌用，切勿专以分利为主也。
问曰：五更后常梦遗精，或一月三、五次，甚则七、八次者，何故？
尿窍易开，精窍不易启。然二窍之开阖，总属心气下降，轻重、浅深不同耳。然而梦遗之症，诸书所论纷纷，未有实据，以余细揆其理，人身以神为主，神居二气之中，昼则寄于心，夜则寄于肾。遗精之症，戌亥以前者，病在于肾，子时以后者，病在于心，此人神从阴、从阳之道也。人身上下关窍，总在一神字统之。神即火也，气也，坎中之真阳也。真阳配真阴，神始有主；真阴配真阳，神始有依。梦遗之病，务审究在上半夜，或下半夜，以定神之所在。病于上半夜者，主阴盛阳衰，阳虚不能统摄精窍，而又兼邪念之心火动之，故作，法宜扶阳为主，如潜阳丹、白通汤、桂枝龙骨牡蛎汤之类是也。病在下半夜者，主阳盛阴衰，阴虚不能配阳，阳气既旺，而又有邪念之心火助之，神昏无主，而不能镇静，故作，法宜扶阴以抑阳，如封髓丹倍黄柏、参枣汤加黄连，补血汤、将军蛋、洋参蛋之类是也。其中受病之根，由于素多淫念，或目之所见而心思，耳之所闻而慕切，念头辗转不断，一片淫情，不觉已固结于神之中也。一经熟睡，元神游于梦幻之乡，或有见，或有闻，或有交，邪念一动，心火下流，兼以相火助之，直冲精窍，窍开而精自泄也。此病而云血虚神无主者，是遗泄在五更后，正阳长阴消之时，故知其血虚也，法宜补阴以配阳，方用参枣汤，解见上。
问曰：平人精神不衰，饮食健旺，常口渴而欲饮冷，小便亦常觉不快，夜夜遗尿者，何故？
答曰：此元阴不足，而下焦有伏热也。世多以遗尿属下元无火，其实不尽然。有真下元无火者，乃阳虚不能统束关窍，其人必精神困倦，饮食减少，有阳虚之实据可凭，法宜收纳元阳，补火为要。此则精神不衰，饮食如常，定是膀胱素有伏热，亦有心移热于小肠，肝移热于脬而遗者，是热动于中，关门不禁也。即在心、肝两部脉息上求之便了。若果心移热而作者，导赤散可用；肝移热于脬而作者，小柴胡倍黄芩亦可医。再审其上半夜与下半夜，以探阴阳消长机关，而按法治之，必不失也。此症直决为膀胱伏热，是因其人精神饮食有余，渴常饮冷，便常不快，是以知之也。法宜滋肾、泻火为主，方用六味地黄汤，加知、柏，解见上。
问曰：两足冷如冰，不能步履，服桂、附、除湿药不效，而更甚者，何故？
夫人身上下，全赖二气布护，真阳不足，亦有冷者，服桂、附以助之即愈。脾虚不能转运水湿而作者，服健脾除湿药必效。此则不然，知非阳虚湿盛，乃由血虚肺燥也。肺乃百脉之宗，出治节者也。肺气行，则津液流通贯注，百脉增荣；肺气燥，则津液不行，百脉失养。今两足冷如冰，乃水衰火极之象，人身水居其一，火居其二，火甚则津枯而骨髓失养，其实由肺之燥而津液不充，津液不充，邪火立起。火未甚时，犹觉内热；火既极时，却又作冷。古人云："阳极生阴，阴极生阳。"病机之颠倒如是，浅见者何能一一周知。此病法宜苦甘化阴润燥为主，方用芍药甘草汤，或六味地黄汤，加二冬、白蜜，或黄连阿胶汤俱可，解见上。
问曰：四肢肌肉皮肤干粗瘦削，奄奄欲绝，常思冷饮，人俱以为疳病也，不知是否？
答曰：此胃有伏热，而食尽脾阴之血液也。夫周身肌肉，统于脾胃，脾气充则肉盈，脾阴足则肉活，周身肌肉红活充盈，乃后天健旺之征。脾与胃为表里，彼此皆不可偏，偏则病作。今病人四肢干枯饮冷，干枯乃火之象，亦不足之象，饮冷是病之情，亦阴枯乞救之情，以此推求，知其胃有伏热未解，食尽脾阴所致。此等病症，小儿居多，由饮食损伤脾胃，久久元气日落，或食生冷鲜物，停滞于内，邪热丛生，服药未当，渐渐而成者，十居其八。妇女忧郁，损伤肝脾，渐渐而成者亦多。世医一见枯槁，便以疳症目之，而立五疳之名，总非至当。此症法宜甘润养阴为主，方用甘草黑姜汤，加五味，解见上。如因内有积热者，审轻重治之。
Answer: This is blood deficiency with hyperactive Yang. The human body's physiological activities are primarily governed by Yin and Yang. Yang Qi grows from Zi hour to Si hour, a period when the three Yang meridians are in charge, representing the time when Yang increases and Yin decreases. If Yin deficiency fails to restrain Yang, hyperactive Yang causes fever. By Wu hour, the heat naturally subsides because Yin begins to grow and Yang begins to decrease, so Yang cannot overcome Yin, hence the heat recedes. People generally believe that afternoon fever indicates Yin deficiency; this is a failure to understand the laws of Yin-Yang waxing and waning. I treated a remarried woman who, every day around noon (approximately 11:00–13:00), developed facial flushing, fever, thirst, and a preference for hot drinks, recovering only by midnight. Various physicians failed to cure her using Yin-nourishing methods. I used Baitong Tang (White Pass Decoction), and she was cured after one dose. The treatment principle for this condition should focus on nourishing Yin to harmonize with Yang. The formula used is Xuebu Tang (Blood-Nourishing Decoction) or Dihuang Tang (Rehmannia Decoction); explanations are found in the preceding text.
Question: In autumn, a person suddenly experiences abdominal pain and watery diarrhea, occurring dozens of times a day, with undigested food in the stool, yet their spirit remains unweary. What is the cause?
Answer: This is due to insufficiency of the primal Yin in the Lung and extreme dryness of Lung Qi. Watery diarrhea with undigested food is commonly attributed to Spleen-Stomach collapse. However, extreme dryness of Lung Qi can also produce these symptoms. The Lung and Large Intestine are interior-exteriorly related; the Large Intestine governs transmission. Food entering the stomach, without sufficient digestion, descends with dry-heat Qi directly into the Large Intestine, causing dozens of daily bowel movements, abdominal pain, and a desire for cold water without weariness. If it were truly Spleen collapse with undigested food, extreme mental fatigue would be evident, indicating a chronic rather than acute onset. Regarding watery diarrhea: yellow discharge indicates Stomach fire hyperactivity; white discharge indicates absence of fire in the lower Jiao; green discharge indicates Cold transformation of the Jueyin meridian; sauce-like discharge indicates Damp transformation of the Taiyin meridian; loose duck-dung-like discharge indicates Cold in the Zang organs; white discharge like saliva indicates Heat in the Lung; pale red discharge indicates Yang failing to control Yin. During clinical practice, one must observe deficiency/excess and new/chronic conditions, and assess whether the pulse has Shen (spirit/vitality). Medication will then have a basis. The treatment principle should prioritize clearing dryness. Use Ganjie Tang (Licorice and Platycodon Decoction) plus Tian Dong (Asparagus Root), Mai Dong (Ophiopogon Tuber), Digupi (Dogwood Bark), Sangpi (Mulberry Bark), Huangqin (Scutellaria Root), Xingren (Apricot Seed), and Bai Mi (White Honey).
Ganjie Tang
Gancao (Licorice Root) 1 liang, Jiegeng (Platycodon Root) 8 qian, Tiandong (Asparagus Root) 4 qian, Maidong (Ophiopogon Tuber) 4 qian, Digupi (Dogwood Bark) 3 qian, Sangbai Pi (Mulberry Root Bark) 3 qian, Huangqin (Scutellaria Root) 2 qian, Xingren (Apricot Seed) 20 grains, Bai Mi (White Honey) 5 qian.
Explanation of Medication Intent
Ganjie Tang is a formula that transforms Yin through the combination of bitter and sweet flavors. Zhang Zhongjing used this formula to treat throat pain in Shaoyin disease, caused by Shaoyin Fire floating up to the throat where the Shaoyin collateral passes. The harmonization of Gancao and Jiegeng nourishes Shaoyin, leading to recovery. Here, it is applied to Taiyin disease. Jiegeng’s bitterness lifts Lung Qi, eliminating latent heat; Gancao’s sweetness resolves heat. Bitter and sweet combined generate Yin, which moistens the Lung. Added Tiandong, Maidong, Sangbai Pi, Huangqin, Xingren, and Bai Mi form a group of sweet-cold and bitter-descending herbs that assist in stopping Lung dryness and resolving watery diarrhea.
Question: A patient suffers from dry cough and generalized skin itching. What is the cause?
Answer: This is due to primal Yin insufficiency failing to moisten the Lung, resulting in Lung dryness that prevents the distribution of Jin Ye (body fluids) to the skin. Dry cough is a sign of blood deficiency and Lung dryness. The Lung governs the skin and hair. When Lung Qi is clear, seasonal changes proceed normally, benefiting all Zang-Fu organs. When Lung Qi is dry, seasonal regulation fails, Jin Ye does not circulate, and various diseases arise. If Jin Ye fails to circulate internally, conditions such as Fei Wei (Lung萎/atrophy), Zang Jie (Zang knotting), Chang Zao (Intestinal dryness), Wei Bi (flaccidity), Jin Luan (tendon cramping), and Gu Zheng (bone steaming) may occur. If Jin Ye fails to circulate externally, the skin, muscles, and nails become withered, dry, and itchy. This section describes blood deficiency and Lung dryness manifesting with such symptoms. The treatment principle should prioritize clearing dryness and nourishing Ying (nutritive) Qi. Use Xuebu Tang (Blood-Nourishing Decoction) combined with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), plus Wuweizi (Schisandra Berry) and Bai Mi (White Honey); explanations are in the preceding text. Practitioners must understand the mechanism of Qi and Blood circulation: their root is in the lower body, cultivation in the middle, and expression in the upper body. The root is represented by ○, cultivation by ◎, and expression by ⊙. The Lung governs Qi (the outer circle of expression), and the Heart governs Blood (the inner circle of expression). The outer circle originates from Qian (Heaven), and the inner circle from Kun (Earth). Heaven envelops Earth, and Earth completes Heaven, forming a unified whole. Earth Qi ascending refers to the single Yang line in Kan (Water), rising from below through the center to above during exhalation. Heaven Qi descending refers to the true Yin in Li (Fire), falling from above through the center to below during inhalation. Thus, exhalation and inhalation are the bellows of Yin and Yang. Exhalation moves Qi, carrying Blood; inhalation moves Blood, attaching Qi. Although respiration distinguishes Yin and Yang, both Qi and Blood rise together and descend together in continuous cycles. Therefore, Yin and Yang are distinguished by upper and lower positions. The Ancient Sages drew hexagrams to clarify Yin and Yang. Qian and Kun are called Pre-Heaven, while the Six Children are Post-Heaven. While discussing Yin-Yang generation and restriction in the Post-Heaven context is correct, ignoring Pre-Heaven Yin-Yang waxing and waning means knowing the branch but not the root. Only those who understand the Dao of Yin-Yang ascent and descent can truly learn and follow the Great Way.
Question: Tendons contract and cannot extend. What is the cause?
Answer: This is due to blood deficiency failing to nourish the tendons, causing tendon dryness. Tendon dryness has specific causes. Although Water generates Wood, the functional roles of Water and Fire lie in the Heart and Lung. The Lung governs Qi, and the Heart governs Blood. Lung Qi and Blood circulate through the Five Zang organs and Six Fu organs. Extreme Lung dryness leads to diminished function, and lack of Jin Ye moisture causes tendon dryness. Severe tendon dryness results in contraction and inability to extend. The treatment principle should prioritize clearing dryness and nourishing blood. Use Shaoyao Gancao Tang (Peony and Licorice Decoction) as the main formula, or add Tiandong, Maidong, and Bai Mi.
Shaoyao Gancao Tang
Shaoyao (White Peony Root) 2 liang, Gancao (Licorice Root) 2 liang (roasted).
Explanation of Medication Intent
Shaoyao Gancao Tang is a formula that transforms Yin through bitter and sweet flavors. Shaoyao is bitter and neutral, entering the Liver (Yin organ). Gancao is sweet, entering the Spleen (Earth element). Bitter and sweet combined regulate the blood throughout the body. Once blood is regulated, the sinews and bones are nourished. Nourished sinews lose their dryness, allowing them to relax and extend naturally. However, one should not rigidly adhere to this formula; any bitter-sweet or sour-sweet combinations can transform Yin. The subtlety of flexible application lies here, which students must understand.
Question: Elderly people often suffer from forgetfulness and repetitive speech. What is the cause?
Answer: This is due to extreme primal Yin deficiency, leaving the Shen (Spirit) without a master. The Heart generates Blood, and Shen resides within Blood. Shen is Fire and Qi, specifically the True Yang within Kan (Water), residing in Blood. Qi and Blood rely on each other, hence the term "Heart stores Shen." From this, we can understand the function of Ghosts and Spirits. The Book says: "Ghosts and Spirits are the excellent functions of the two Qi." "Excellent function" refers to the intrinsic nature of True Yin and True Yang. Shen inherits the spirituality of Yang (Heavenly body, high status), thus called Shen. Ghost inherits the spirituality of Yin (Earthly body, low status), thus called Ghost. Doing good aligns nature with Yang (bright aura); doing evil aligns nature with Yin (dark aura). After death, becoming a Shen or Ghost is determined by one's daily cultivation. At the moment of death, if Good Qi is heavy, Yuan Shen exits through the Heavenly Gate, destined for the Shen path. If Evil Qi is heavy, Yuan Shen enters through the Earthly Door, destined for the Ghost path. In the elderly, Qi and Blood are depleted, leading to natural insufficiency of Spirit, causing mental confusion. However, this is not confusion due to excessive Heat. The treatment should prioritize nourishing Blood; dual tonification of Qi and Blood is also acceptable. Use Xuebu Tang (Blood-Nourishing Decoction), Dushen Tang (Single Ginseng Decoction), or Shenzao Tang (Ginseng and Jujube Decoction); explanations for the former two are in the preceding text.
Shenzao Tang
Yangshen (American Ginseng) 1 liang, Zaoren (Semen Ziziphi Spinosae) 1 liang, Gancao (Licorice Root) 5 qian, Zhu Xin (Pig Heart) 1 piece.
Grind the first three ingredients into fine powder, stew with Pig Heart, or mix with Pig Heart and make into pills.
Explanation of Medication Intent
Shenzao Tang is a formula that transforms Yin via bitter-sweet and astringes Yin via sour-sweet. Due to extreme primal Yin deficiency failing to nourish Shen, Shen lacks mastery, causing alternating clarity and confusion, like a dying lamp. Adding oil restores the light. American Ginseng’s sweet-bitter and Jujube Seed’s sour-astringent properties support primal Yin. As primal Yin gathers, True Qi gathers, hence "storing Shen." Pig Heart seeks its own kind, ensuring Shen remains bright. Gancao harmonizes in the middle, ensuring a continuous supply of True Blood. This formula treats not only elderly forgetfulness but also any case of Yin-Blood damage due to overthinking.
Question: The large intestine prolapses several inches, the anus feels like burning fire, breathing is coarse and wheezy, and there is a desire to drink cold water. What is the cause?
Answer: This is insufficient primal Yin in the Lung, leading to hyperactive Lung Fire and consequently hyperactive Large Intestine Fire. Prolapse of the rectum can be due to Yang deficiency or Yin deficiency. Yang deficiency prolapse results from extreme Qi depletion failing to constrain; symptoms include lethargy, no spirit, thirst for hot drinks, and full Yin signs. Treatment should warm the Middle. Yin deficiency prolapse results from hyperactive Lower Jiao Fire forcing expulsion; symptoms include preserved spirit, thirst for cold drinks, and full Heat signs. Both often follow severe diarrhea or dysentery. Physicians must identify the definitive Yin or Yang evidence for efficacy. This case is Yin deficiency with Fire hyperactivity. Fire pressing upward on the Lung causes wheezing; fire pressing downward on the Intestine causes prolapse. Treatment should nourish Yin and purge Fire. Use Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Purging Decoction) or Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction); explanations are in the preceding text.
Dahuang Huanglian Xiexin Tang
Dahuang (Rhubarb Root) 1 liang, Huanglian (Coptis Rhizome) 5 qian.
Explanation of Medication Intent
Dahuang Huanglian Xiexin Tang is a Fire-purging formula. Zhang Zhongjing used it for epigastric fullness that is soft upon pressure, caused by formless Heat pathogens lurking in the epigastrium. Applying it here seems indirect, but Dahuang and Huanglian are bitter-cold, purging Sanjiao pathogenic Heat. Since Heat attacks the Lung (causing wheezing) and the Intestine (causing prolapse), the bitter-cold action purges Fire. Once Fire is removed, the upper and lower regions settle. This is a method grasping the essence.
Question: Urination is extremely painful, accompanied by thirst and a desire for cold water. Is this Lin Syndrome (Stranguria)? Or not?
Answer: This is insufficient primal Yin in the Bladder, scorched by pathogenic Fire, representing a severe case of Taiyang Fu syndrome. Pathogens invading Taiyang transform into Heat via Taiyang’s superficial Yang, lodging in the Bladder, causing thirst, desire for cold drinks, and painful urination. Treatment should promote Qi transformation and move Water. Use Wuling San (Five-Ingredient Powder with Poria). It resembles Lin Syndrome, which also involves the Bladder. Ancients classified five types: Blood Lin, Qi Lin, Sand Lin, Stone Lin, and Labor Lin. Ultimately, they fall under Yin and Yang. Seventy to eighty percent result from Yang deficiency failing to transform stagnant Essence. The root cause often lies in nocturnal emission followed by forcibly retaining Qi upon waking, preventing proper release. When Heart Qi descends for urination, damaged Essence tries to exit but cannot, causing severe pain. This is the root of the disease.
Treatment should greatly assist Primal Yang to鼓动 (rouse) and transform it, allowing Qi transformation to flow and Essence/Qi to circulate freely. People seeing pain assume Fire and dare not use Guizhi (Cinnamon Twig) or Fuzi (Aconite Root), missing the point. Long-standing Essence stagnation blocks Qi mechanism,郁 (stagnates) into Heat, scorching Bladder Yin blood, and damaging Essence is boiled by pathogenic Fire, creating Sand/Stone names. Fire arises from Essence stagnation. Yang-deficient individuals often get this; use Baitong Tang, Sancai Tang, or Qianyang Tang formulas. For Yin-deficient individuals with excessive Fire, use Zishen Wan (Kidney-Nourishing Pill), Liuwei Wan (Six-Ingredient Pill), or Wuling San; explanations are in the preceding text. Fuzi Xiexin Tang is also an option.
Wuling San
Baizhu (Atractylodes Macrocephala Rhizome) 1 liang, Fuling (Poria) 8 qian, Zhuling (Polyporus) 5 qian, Zexie (Alisma Rhizome) 5 qian, Guizhi (Cinnamon Twig) 6 qian.
Fuzi Xiexin Tang
Fuzi (Prepared Aconite Root) 1 piece, Huangqin (Scutellaria Root) 5 qian, Huanglian (Coptis Rhizome) 5 qian, Dahuang (Rhubarb Root) 1 liang.
Explanation of Medication Intent
Wuling San promotes Qi transformation and moves Water. Cold injuring the Taiyang Fu obstructs Qi transformation, causing waterway dysfunction and generating pathogenic Heat. Heat damages Jin Ye, preventing ascent (thirst); failed Qi transformation prevents immediate urination (pain). Er Ling (Poria and Polyporus), Baizhu, and Zexie move water to nourish the Middle. Guizhi is crucial for transforming Bladder Qi mechanism. Once Qi transforms, stagnant Heat and Cold resolve. This formula focuses on Qi transformation rather than just clearing Heat; moving Qi is clearing Heat, though many fail to recognize this.
Fuzi Xiexin Tang combines Cold and Hot herbs. Zhang Zhongjing used it for epigastric fullness with aversion to cold and sweating, indicating Shaoyin formless Heat causing fullness, coupled with Taiyang Cold and sweating (risk of Yang collapse). Huangqin, Huanglian, and Dahuang purge Shaoyin latent Heat; Fuzi secures the root and retrieves Primal Yang. This cold-hot interplay is a subtle prescription technique. Applied here to Lin syndrome caused by stagnant Essence generating Heat, Fuzi rouses Pre-Heaven Yang, assisted by Huangqin, Huanglian, and Dahuang to purge latent Heat. This is "securing through non-securing" and "benefiting through non-benefiting." Most books use diuretic and heat-clearing herbs, treating Heat consolidation but neglecting Essence transformation. I suggest adding An Gui (Cinnamon Bark) 2-3 qian to boost Fuzi and transform Qi. With Qi and Essence flowing, Heat resolves and pathogens exit, curing Lin syndrome. Sancai Fengsui Dan with An Gui, or Zishen Wan with doubled An Gui, are also options. Do not rely solely on diuresis.
Question: Frequent seminal emissions after dawn (Wugeng), three to five times a month, or even seven to eight times. What is the cause?
Answer: This is Primal Yang deficiency with Shen (Spirit) lacking mastery. Seminal emission differs slightly from urinary incontinence. The urethral orifice opens easily; the seminal orifice is difficult to open. Both opening/closing depend on Heart Qi descending, differing only in degree. Discussions on dream emission vary without solid basis. Analyzing the principle: Shen is primary, residing between the two Qi. Daytime, Shen resides in the Heart; nighttime, in the Kidney. Emissions before Xu-Hai hours (19:00–23:00) indicate Kidney pathology; after Zi hour (01:00+) indicate Heart pathology. This reflects Shen following Yin or Yang. All orifices are governed by Shen. Shen is Fire, Qi, and True Yang in Kan. True Yang pairing with True Yin gives Shen a master; True Yin pairing with True Yang gives Shen a foundation. For dream emission, determine if it occurs in the first half or second half of the night to locate Shen. First-half emissions indicate Yin excess/Yang deficiency; Yang fails to control the seminal orifice, aided by Evil Thought Heart Fire. Treatment: Support Yang (Qianyang Dan, Baitong Tang, Guizhi Longgu Muli Tang). Second-half emissions indicate Yang excess/Yin deficiency; Yin fails to match Yang, aided by Evil Thought Heart Fire, causing Shen confusion. Treatment: Support Yin to suppress Yang (Fengsui Dan with doubled Huangbo, Shenzao Tang with Huanglian, Xuebu Tang, Jiangjun Dan, Yangshen Dan). The root cause is habitual lustful thoughts or sensory stimulation, firmly binding to Shen. During sleep, Yuan Shen wanders in dreams; stimuli trigger Evil Thoughts, Heart Fire flows down, assisted by Minister Fire, rushing to the seminal orifice, opening it and causing emission. If described as blood deficiency/Shen lack of mastery, it refers to emissions after Wugeng (dawn), when Zheng Yang grows and Yin decreases, indicating blood deficiency. Treatment: Nourish Yin to match Yang. Use Shenzao Tang; explanation in preceding text.
Question: A healthy person with unweary spirit and robust appetite constantly desires cold drinks, feels discomfort in urination, and experiences nightly urinary incontinence. What is the cause?
Answer: This is primal Yin deficiency with latent Heat in the Lower Jiao. People often attribute incontinence to Lower Yuan Fire absence, but this is not always true. True Lower Yuan Fire absence involves Yang deficiency failing to control orifices, with symptoms of fatigue and reduced appetite; treatment requires gathering Primal Yang and tonifying Fire. This case, however, shows robust spirit and appetite, indicating latent Heat in the Bladder, possibly Heart transferring Heat to Small Intestine or Liver transferring Heat to Bladder. Heat agitates internally, failing to close the gate. Check pulses at Heart and Liver positions. If Heart transfers Heat, Daochi San is suitable. If Liver transfers Heat to Bladder, Xiaochaihu Tang with doubled Huangqin works. Assess first vs. second half of the night to probe Yin-Yang waxing/waning mechanisms. This case is diagnosed as Bladder latent Heat due to robust spirit/appetite, cold drink desire, and urinary discomfort. Treatment: Nourish Kidney and purge Fire. Use Liuwei Dihuang Tang plus Zhimu (Anemarrhena Rhizome) and Huangbo (Phellodendron Bark); explanation in preceding text.
Question: Cold feet like ice, unable to walk, worsening despite Guizhi, Fuzi, and dampness-draining herbs. What is the cause?
Answer: This is not Yang deficiency with Damp invasion, but blood deficiency and Lung dryness failing to transport Jin Ye to the lowest parts. The body relies on two Qi for protection. True Yang insufficiency causes cold, resolved by Guizhi/Fuzi. Spleen deficiency causing dampness retention responds to Spleen-strengthening/damp-draining herbs. This case is different: not Yang deficiency/Damp excess, but blood deficiency/Lung dryness. The Lung is the master of all vessels and regulator. Lung Qi movement circulates Jin Ye, enriching vessels. Lung dryness stops Jin Ye, starving vessels. Ice-cold feet indicate Water exhaustion and Fire extremity. Water is one part, Fire is two parts. Extreme Fire dries Jin Ye, starving marrow. Actually, Lung dryness prevents Jin Ye replenishment; lack of Jin Ye allows pathogenic Fire to rise. Mild Fire feels like internal heat; extreme Fire feels cold. Ancients said: "Extreme Yang generates Yin, extreme Yin generates Yang." Disease mechanisms invert thus; superficial observers miss this. Treatment: Bitter-sweet to transform Yin and moisten dryness. Use Shaoyao Gancao Tang, or Liuwei Dihuang Tang plus Tiandong, Maidong, Bai Mi, or Huanglian Ejiao Tang; explanations in preceding text.
Question: Dry, rough, emaciated limbs and skin, near death, craving cold drinks. People call this Glandular Disease (Kan Bing). Is this correct?
Answer: This is latent Heat in the Stomach consuming Spleen Yin and Blood. Muscles are governed by Spleen/Stomach. Spleen Qi fills muscles; Spleen Yin makes them supple. Red, plump muscles indicate robust Post-Heaven health. Spleen and Stomach are exterior-interior; imbalance causes disease. Dryness indicates Fire and insufficiency; craving cold indicates Yin exhaustion seeking rescue. Thus, Stomach latent Heat consumes Spleen Yin. This is common in children due to dietary injury, chronic Qi decline, or cold/raw food stagnation generating Heat, compounded by improper medication. Eighty percent are due to this. Women with depression damaging Liver/Spleen also develop it gradually. Physicians seeing emaciation diagnose Kan Bing and classify five types, which is inaccurate. Treatment: Sweet-moistening to nourish Yin. Use Gancao Heijiang Tang (Licorice and Blackened Ginger Decoction) plus Wuweizi; explanation in preceding text. If internal accumulated Heat exists, treat according to severity.