答曰：医门一十三科，皆内科之恒事，不独眼科为然也。目病一切，皆从五脏、六腑发出，岂有能治内症，而不能治眼症者。然目之为病，亦千变万化，有工于此者，取其专于此，而辨症清，用药有据，无奈今之眼科主，有眼科之名，无眼科之实者多矣。目症有云七十二症，有云三百六十种，名目愈多，旨归即晦。今为之总其大纲，括以阴、阳两字为主，余不足录。阳症两目红肿，羞明，眵翳障雾，赤脉贯睛，目泪、痛甚，小便短，大便结，喜冷饮者是也。阴症两目微红，而不羞明，即红丝缕缕，翳雾障生，而不觉痛甚，二便如常，喜饮热汤者是也。务看先从何部发起，即在此处求之便了。部位亦不可不知，上眼皮属胃，下眼皮属脾，白睛属肺，黑睛属肝，瞳子属肾，两眦属心。再审系外感时气传染者，照外感发散、升解、清凉法治之，亦必有发热、头疼、身痛可凭。审是内伤，以致清气不升，浊阴不降而作者，看何部之病情独现，即在此求之，或宜甘温，或宜辛温，或宜收纳，或宜降逆，如法施之，便可尽目之事矣。
切脉约言
切脉一事，前贤无非借寸口动脉，以决人身气血之盛衰耳。盛者气之盈，脉动有力，如洪、大、长、实、浮、紧、数之类，皆为太过、为有馀、为火旺，火旺则阴必亏，用药即当平其有馀之气，以协于和平。衰者气之缩，如迟、微、沉、细、濡、弱、短、小之类，皆为不及、为不足、为火虚，火虚则水必盛，用药即当助其不足之气，以协于和平。只此两法，为切脉用药至简至便至当不易之总口诀也。后人未解得人活一口气之至理，未明得千万病形，都是这一个气字之盛衰为之，一味在后天五行生克上讲究，二十八脉上揣摹，究竟源头这一点气机盈、缩的宗旨，渐为诸脉所掩矣。
三指说
前人于寸口之动脉，以三指按之，分出上、中、下，是将一气分为三气，三气即天、地、水，分而为三，合而为一。又于三部，而分出浮、中、沉，合三三如九之数，亦有至理，法亦可从，不得为错。
其意欲借此以穷人身在上、在中、在下之脏腑、经络，以决人之疾病，可按法而治之，实属大费苦心。但理愈多，而旨愈晦，且纷纷聚讼。
有云左心、小肠、肝、胆、肾，右肺、大肠、脾、胃、命；有云左心、膻中、肝、胆、肾，右肺，胸中、脾、胃、命；有谓小肠当候于左尺，大肠当候于右尺；有云左尺候肾之元阴，右尺候肾之元阳；互相矛盾，教后人果何遵从，余更不能无疑也。疑者何？疑分配之未当也。后天以子午立极，左寸候心火，左关候肝木，左尺候肾水，是子午对针，不为错，肝布于左，居左关，合法，肺布于右，何不居右关，而居右寸，是子午对针，而卯酉不对针也。又可疑者，左尺候肾之元阴，右尺候肾之元阳，查人身二气合一，充塞上下四旁，阴、阳打成一片，何尝定要分左、右之阴、阳乎？既分左为阳，元阳应在左尺候之，右为阴，元阴应在右尺候之，何左右候之不相符也？总而言之，阴阳气机出入之道不明也，千古混淆，不得不急正之。
拙见解
夫人身立命，本乾元一气，落于坤宫，二气合一，化生六子，分布上、中、下，虽有定位，却是死机，全凭这一团真气运行，周流不已。天开于子，人身这一团真气，即从子时发动，自下而中而上，上极复返于下，由上而中而下，循环出入，人之性命赖焉。切脉一事，无非定这一点气盛衰耳。查后贤分配脏腑脉图，与一元真气、出入之机不符，余意当以仲景六经次序排之，方与一元真气出入之机相符。
然仲景虽未论脉，而六经流行之气机，即脉也。今人不识一元之义，以两手寸口动脉，将阴阳分作两道看，不知左右固有阴阳之分，其实二气浑为一气，何尝分为二道也？不过真气运行，先从左而后及于右，从右而复及于左。左手属三阳，三阳用事，阳在外，而阴在内，当以立极之¤|卦形之。右手属三阴，三阴用事，以阴在上而阳在下，当以立极之¤￥卦喻之。脉体左手当以浮分取三阳，沉分取三阴，右手当以浮分取三阴，沉分取三阳，庶与气机出阴入阳，出阳入阴之理相合，亦不致将一元分作二道看也。是否有当，高明斧正之。附气机循环图于下。
再解古脉说
古来圣圣相传，原不专在切脉一事，其要在望而知之，闻而知之，称为圣、神，为上一等说法也。问而知之，切而知之，称为工、巧，为下一等说法也。然考分配脉图，却不与六经气机相合。若与六经气机相合，则医家治伤寒方有实据，余甚不解何以不如斯也。再三追索，以为心肺居膈膜上，法天，故配之于寸，以为上者上也，胸喉中事也；脾胃居膈膜下，至脐，法地，故配之于中，中也者，上下之枢机也；肝肾居脐下，法水，故配之于下，以为下者下也，少腹、腰、股、膝、胫、足中事也。此是就后天生成之定位言之，理实的确可从，即以仲景六经排之，差错不远。余按后天生成定位，乃是死机，全凭这二五合一，这一团真气，呼吸运用，方是真机。五行充塞二气之中，二气即在五行之内。二气盛，则五行之气即盛；二气衰，则五行之气即衰；二气亡，则五行之气即亡。溯治病之要，望色以有神无神，定气之盛衰；闻声以微厉，判气之盈缩；问病以饮热饮冷，知气之偏盛；切脉以有力无力，知气之虚实。以此推求，万病都是一个气字，以盛、衰两字判之便了，即以一气分为三气，以定上、中、下之盛衰，亦可。
诸脉纷纷摹揣，试问天下医生，几人将二十八脉明晰？以余拙见，有力无力尽之矣。不必多求。论分配脏腑，《内经》不差；论气机出入，一定法则，仲景六经为最。从《内经》也可，从仲景也可，余不敢以己见臆说为即是，姑存之，以与来者共商。
五行说
天地化生五行，故有青、黄、赤、白、黑之说焉。肝青象木，主东方春令；肺白象金，主西方秋令；心赤象火，主南方夏令；肾黑象水，主北方冬令；脾黄象土，主中央湿令。五行各司一气，各主一经，① 经云"望而知之谓之神，闻而知之谓之圣"，此处"神"、"圣"二字疑次序颠倒各有生克制化。《内经》云："肝布于左，肺布于右，心布于表，肾布于里，脾为四方之使"，历代注家，俱在方位上论，而不在一气上论，五行之实义，渐不明矣，余特直解之。夫人身与天地无异，天地以五行之气，塞满乾坤，人身以五脏之气，塞满周身，何也？骨本属肾，而周身无处非骨；筋本属肝，而周身无处非筋；血本属心，而周身无处非血；肌肉本属脾，而周身无处非肌肉；皮毛本属肺，而周身无处非皮毛。以此推之，五行原是一块，并非专以左肝、右肺、心表、肾里、脾中为主。盖以左肝、右肺、心表、肾里、脾中者，是就五行立极之处言之也。若执五方以求五行，而五行之义便失，以五行作一块论五行，而五行之义即彰。五行不出二气之中，二气即在五行之内，二气乃人身立极主宰，既生五行，又以五行为归。然五行之要在中土：火无土不潜藏，木无土不植立，金无土不化生，水无土不停蓄。故曰：土为万物之母，后天之四象咸赖焉。不独后天之四象赖之，而先天立极之二气，实赖之也。故经云："无先天而后天不立，无后天而先天亦不生"，后天专重脾胃。人日饮食水谷入脾胃，化生精血，长养神气，以助先天之二气，二气旺，脾胃运行之机即旺，二气衰，脾胃运行之机即衰。然脾胃旺，二气始能旺，脾胃衰，二气亦立衰，先后互赖，有分之无可分，合之不胜合者也。至于用药机关，即在这后天脾土上，仲景故立建中、理中二法。因外邪闭其营卫，伤及中气者，建中汤为最；因内寒湿气，伤及中气者，理中汤如神。内、外两法，真千古治病金针，医家准则，惜人之不解耳。况一切甘温苦寒之品，下喉一刻，即入中宫，甘温从阳者，赖之以行，苦寒从阴者，赖之以运，故曰中也者，上下之枢机也。后贤李东垣立补中汤，以治劳役伤脾，是套建中汤之法也，亦可遵从。俗语云：百病从口入，是伤中之意也。
余谓凡治一切阴虚、阳虚，务在中宫上用力。以上三法，皆可变通，但阴虚、阳虚，辨认不可不澈，上卷辨认法，切切熟记。
问曰：《内经》言"冬伤于寒，春必病温"，可另有说乎？
答曰：冬月既伤于寒，岂有延至春月始发之理？然亦有说焉。以为天地闭塞，阳气潜藏，人身之气机亦潜藏，感之轻者，随气机而潜藏，不即为病，至春日春风和畅，气机发泄于外，这点寒邪种子亦向外，故病作。如春日布种，而夏日收割，夏日布种，而秋日收割，病温之说，其意如斯也。推之"春伤于风，夏生飧泄，夏伤于暑，秋必痎疟，秋伤于湿，冬必咳嗽"，理无二义也。余亦有说焉。夫冬月寒令，天地之气寒，人身之气亦寒，潜藏是天地自然之机，人身同然，此正气也。客寒乃外之贼邪，邪正原不两立，无论一丝一毫客邪，着于人身，未有不即病者。感之即轻，不能闭塞气机，遇经气旺时，邪亦可以默化，感之若重，邪气即能蔽束气机，未有不即病者。况冬月伤寒而死者亦多，以此推之，此说殊不尽然。余再三追索，疑是内伤于生冷之寒湿，不能闭其卫外气机，故不即病，伏于其中，感天地闭塞，潜藏之气机裹束，不能发泄，延至春月，寒气化为热邪，随气机发泄而外出，春月温和，故名之曰温病。如此推求，方得冬伤于寒，春必病温实据。诸书纷纷言温，而曰风温、寒温、温热、湿温、温燥，更立大头、杨梅、捻颈、软脚诸瘟，难以尽举。各家之说，以春为风温，夏为温热，长夏为湿温，俱在六气节候上论之。余意春月温和节令，而加以温之名方妥，外此候而名温，即属不当。所谓寒温者，指发病之来脉说也。所谓风温者，指发病之时令言之也。所谓温热者，指寒变为热言之也。所谓湿温者，指挟内湿言之也。所谓温燥者，指邪入阳明燥地，伏而不出言之也。如此言温，而温之名始不错，舍此而在六气节候上言温，而温之名即诬，六气各有发病，试问又当何名？
再按温病初起，先憎寒而后发热，以后但热而不恶寒，明明是春月温和节中不正之气则为温邪，温字即热字看，先犯太阳，太阳为寒水之区，热不胜寒，故直趋阳明，伏于膈间，阳明主燥，燥亦热也，此刻温燥混为一家，故但热不憎寒，乃为阳明的确不易之症。仲景立麻杏石膏甘草汤，早已为此等症候具法也。按麻黄开腠里，杏仁利气机，石膏清阳明之肌热，甘草和中，俾邪之从太阳而入者，仍从太阳而出，真丝丝入彀之方也。后人立升降散一法，解表清里，而曰此为风温设也，不知此刻气机，气即是温，温即是气，气即是风也，何必多方立名？后人不得其旨归，即以此方为风温设，而不知与麻杏石甘汤同一法也。他如白虎汤、人参白虎汤、苍术白虎汤，因其所兼而用之也。
温病总是一热病，是二阳之正病也。他书纷纷讲解，愈出愈奇，不可为法，学者须知。
认病捷要总诀
发热类发热而身疼者，外感也（自汗桂枝汤，无汗麻黄汤）。发热而身不疼，饱闷吞酸者，内伤于食也（平胃散加消食行气之药）。发热身疼，不恶寒，舌黄而饮冷者，热伤于里也（白虎汤加桂枝、干葛）。发热身疼，恶寒，口不渴者，邪入少阴也（麻黄附子细辛汤）。素禀不足，无故身大热，舌青欲饮极热者，元阳外越也，亦有口不渴者，皆同（吴萸四逆汤）。小儿发热，气粗口热者，表里俱病，内有热也（人参败毒散加芩、连、栀子）。发热出气微温，而口不热，小便清长，大便不实，素有疾者，元气不固也（理中汤、六君子汤之类）。
疟疾寒热往来而有定候者，真疟也。一日一发而在上半日者，邪在三阳为病也（宜小柴胡加桂、葛）。一日一发而在下半日者，邪在三阴为病也（宜理中汤加柴、桂）。二日一发者，病深一层也（按寒热轻重治之）。单热无寒，渴饮冷不休者，病在阳明也（宜白虎汤）。单寒无热，欲饮热者，病在太阴也（宜理中汤）。饱闷不舒，而发寒热者，食疟也（平胃散加查曲、柴胡）。先吐清水，而后发寒热，欲饮极热汤者，脾阳外越，似疟而实非疟也（宜吴萸四逆汤）。
鼓胀单腹胀而四肢不胀，舌青欲饮热者，阴邪伏于中而闭塞清道也（宜理中汤、或吴萸四逆汤）。单四肢胀，而腹不胀者，脾阳不固，发散于四末也（宜理中汤加西砂）。有周身鼓胀，不渴不欲食者，元气涣散也（宜收纳，切忌消肿，如理中、回阳之类）。有胀而皮色如血者，阴乘于上而作也（宜补阳以消阴，如阳旦汤、潜阳丹）。有胀而皮色如水晶，内无他病者，水气散于皮肤也（宜五皮饮）。胀病亦多，握定阴、阳辨诀治之，决然不错。
Answer: The thirteen departments within the medical profession are all routine matters of internal medicine, not just ophthalmology. All eye diseases originate from the Five Zang Organs and Six Fu Organs; how can one be able to treat internal conditions but unable to treat eye conditions? However, eye diseases are also ever-changing. Those skilled in this field focus on it, with clear syndrome differentiation and evidence-based medication. Unfortunately, many modern ophthalmologists have the title but lack the substance. Eye syndromes are said to number seventy-two or three hundred and sixty; the more names there are, the more obscure the essence becomes. Now, summarizing the main outline, taking Yin and Yang as the primary categories, the rest are not worth recording. Yang syndromes manifest as redness and swelling of both eyes, photophobia (sensitivity to light), excessive discharge obscuring vision, red vessels penetrating the eyeball, tearing, severe pain, short urine, constipation, and a preference for cold drinks. Yin syndromes manifest as slight redness of both eyes without photophobia; even if there are red filaments, nebulae, or obstructions, there is no severe pain, bowel and bladder functions are normal, and there is a preference for hot drinks. It is essential to observe which part initiates the condition and seek the cause there. One must also know the anatomical locations: the upper eyelid belongs to the Stomach, the lower eyelid to the Spleen, the sclera (white of the eye) to the Lung, the cornea/pupil area to the Liver, the pupil to the Kidney, and the canthi (corners of the eyes) to the Heart. Further investigate whether it is an external contraction of seasonal pathogens; if so, treat according to methods of dispersing, ascending, resolving, and cooling for external contractions, which should present with fever, headache, and body ache as evidence. If it is an internal injury causing clear Qi to fail to ascend and turbid Yin to fail to descend, look at which specific location shows symptoms and seek the treatment there, using either Sweet-Warm, Pungent-Warm, Gathering/Retaining, or Descending-Reverse methods as appropriate. Following these methods will resolve eye issues.
Brief Remarks on Pulse Diagnosis
The art of pulse diagnosis by the sages of old was merely to use the radial artery at the Cun Kou position to determine the flourishing or declining state of Qi and Blood in the body. Flourishing means Qi is abundant; the pulse beats strongly, such as in Hong (Surging), Da (Large), Chang (Long), Shi (Excess), Fu (Floating), Jin (Tight), Shu (Rapid) pulses, etc. These indicate excess, surplus, and hyperactive Fire. When Fire is hyperactive, Yin must be deficient; medication should calm the excess Qi to restore harmony. Declining means Qi is contracted; such as Chi (Slow), Wei (Micro), Chen (Deep), Xi (Fine), Ru (Soggy), Ruo (Weak), Duan (Short), Xiao (Small) pulses, etc. These indicate insufficiency, deficiency, and deficient Fire. When Fire is deficient, Water must be abundant; medication should support the deficient Qi to restore harmony. These two methods constitute the simplest, most convenient, most appropriate, and unchangeable general principle for pulse diagnosis and medication. Later generations failed to understand the profound truth that life depends on a single breath of Qi, and did not realize that all myriad disease forms are caused by the flourishing or declining state of this one Qi. They focused solely on the generation and restriction cycles of the Five Elements in acquired constitution and speculated upon the Twenty-Eight Pulses, gradually obscuring the fundamental principle of Qi mechanism expansion and contraction at the source.
On the Three-Finger Method
Ancients used three fingers to press the Cun Kou arterial pulse, dividing it into Upper, Middle, and Lower levels, effectively dividing one Qi into three Qis, corresponding to Heaven, Earth, and Water—divided into three, united as one. Furthermore, dividing each of the three positions into Floating, Middle, and Deep depths results in nine combinations, which also has profound logic and valid methodology; it cannot be considered wrong.
Their intention was to use this to exhaustively understand the Zang-Fu organs and meridians in the upper, middle, and lower parts of the body to diagnose diseases and treat them according to method. This is indeed painstaking effort. However, the more theories there are, the more obscure the essence becomes, leading to endless disputes.
Some say the Left Cun governs Heart, Small Intestine, Liver, Gallbladder, Kidney; Right Cun governs Lung, Large Intestine, Spleen, Stomach, Ming Men (Gate of Life). Others say Left Cun governs Heart, Dan Zhong (Chest Center), Liver, Gallbladder, Kidney; Right Cun governs Lung, Chest Center, Spleen, Stomach, Ming Men. Some claim Small Intestine should be palpated at Left Chi, Large Intestine at Right Chi. Others state Left Chi governs Yuan Yin (Primal Yin) of the Kidney, Right Chi governs Yuan Yang (Primal Yang) of the Kidney. These contradict each other, leaving later generations unsure whom to follow. I cannot help but doubt this. What do I doubt? I doubt the impropriety of the allocation. In acquired constitution, Zi and Wu establish the pole. Left Cun governs Heart Fire, Left Guan governs Liver Wood, Left Chi governs Kidney Water; this aligns Zi and Wu oppositely, which is correct. Liver distributes on the left, residing at Left Guan, conforming to law. Lung distributes on the right; why does it not reside at Right Guan but at Right Cun? This aligns Zi and Wu but fails to align Mao and You. Another point of doubt: Left Chi governs Yuan Yin of Kidney, Right Chi governs Yuan Yang of Kidney. Examining the human body, the two Qis unite, filling the upper, lower, and four directions, with Yin and Yang merged into one piece. Why must Yin and Yang be strictly divided between left and right? If Left is Yang, Yuan Yang should be governed at Left Chi; if Right is Yin, Yuan Yin should be governed at Right Chi. Why do the left and right palps not correspond? In summary, the path of Yin-Yang Qi mechanism entry and exit is unclear, causing confusion since ancient times, necessitating urgent correction.
My Humble Opinion
Human life originates from the Primal Qi of Qian, descending into Kun Palace. The two Qis unite, generating the six children, distributed in the upper, middle, and lower sections. Although they have fixed positions, this is a static mechanism; it relies entirely on this mass of True Qi circulating endlessly. Heaven opens at Zi hour; this mass of True Qi in the human body begins to move at Zi hour, rising from below to the middle and then above, returning from above back down, moving from above to the middle and then below, cycling in and out. Human life depends on this. Pulse diagnosis is nothing more than determining the flourishing or declining state of this Qi. Investigating the pulse maps allocated by later experts, they do not accord with the mechanism of the Primal Qi entering and exiting. I believe we should arrange them according to Zhang Zhongjing's Six Meridian sequence to accord with the mechanism of the Primal Qi entering and exiting.
Although Zhongjing did not discuss pulses, the Qi mechanism flowing through the Six Meridians *is* the pulse. Modern people do not understand the meaning of "One Qi," viewing the radial arteries of both hands as two separate paths of Yin and Yang. They do not realize that although left and right have Yin-Yang distinctions, the two Qis are actually one unified Qi, never divided into two paths. True Qi circulation simply starts from the left and reaches the right, then returns from the right to the left. The left hand belongs to the Three Yang; when Three Yang are active, Yang is outside and Yin is inside. This should be represented by the hexagram shape of Li (Fire) establishing the pole. The right hand belongs to the Three Yin; when Three Yin are active, with Yin above and Yang below, this should be represented by the hexagram shape of Kan (Water) establishing the pole. For the pulse body, the left hand should take Three Yang at the Floating level and Three Yin at the Deep level; the right hand should take Three Yin at the Floating level and Three Yang at the Deep level. This would harmonize with the principle of Qi mechanism exiting Yin to enter Yang, and exiting Yang to enter Yin, avoiding the division of the One Qi into two paths. Whether this is appropriate, I leave to the wise to correct. Attached below is the diagram of Qi mechanism circulation.
Re-interpreting Ancient Pulse Theory
Transmission from sage to sage originally did not rely solely on pulse diagnosis. The key lies in knowing through observation (Wang) and listening/smelling (Wen), termed Sage and Divine, representing the highest level of understanding. Knowing through inquiry (Wen) and pulse diagnosis (Qie) are termed Skilled and Ingenious, representing a lower level. However, examining the allocated pulse maps, they do not accord with the Qi mechanism of the Six Meridians. If they accorded with the Six Meridian Qi mechanism, physicians treating Cold Damage (Shang Han) would have solid evidence. I do not understand why it is not so. After repeated investigation, I believe the Heart and Lungs reside above the diaphragm, modeling Heaven, hence allocated to Cun (Upper), representing the upper region, affairs of the chest and throat. The Spleen and Stomach reside below the diaphragm to the navel, modeling Earth, hence allocated to Guan (Middle), representing the pivot between upper and lower. The Liver and Kidneys reside below the navel, modeling Water, hence allocated to Chi (Lower), representing the lower region, affairs of the lower abdomen, waist, thighs, knees, shins, and feet. This refers to the fixed positions of acquired constitution, and the logic is indeed acceptable; arranging them according to Zhongjing's Six Meridians would not be far off. However, I maintain that fixed positions of acquired constitution are a static mechanism. The true dynamic relies on the unity of Yin and Yang (Two Qis) and this mass of True Qi, utilized through respiration. The Five Elements fill the space between the Two Qis, and the Two Qis exist within the Five Elements. When the Two Qis flourish, the Qi of the Five Elements flourishes; when the Two Qis decline, the Qi of the Five Elements declines; when the Two Qis perish, the Qi of the Five Elements perishes. Tracing the essence of treatment: observing complexion determines Qi flourishing or declining based on spirit/luster; listening to voice judges Qi abundance or contraction based on strength; asking about drinking preferences (hot/cold) reveals biased Qi flourishing; palpating pulse determines Qi deficiency or excess based on strength. Using this deduction, all ten thousand diseases revolve around the concept of "Qi," judged by "Flourishing" and "Declining." Dividing this one Qi into three to determine flourishing/declining in upper/middle/lower is also acceptable.
Regarding the myriad pulses and speculation, I ask every doctor under heaven: how many clearly understand the Twenty-Eight Pulses? In my humble opinion, "Strength" and "Weakness" cover everything. No need for excessive complexity. Regarding organ allocation, the *Nei Jing* (Inner Canon) is accurate; regarding the rules of Qi mechanism entry and exit, Zhongjing's Six Meridians are supreme. One may follow either the *Nei Jing* or Zhongjing. I dare not claim my subjective view is absolute, but I preserve it here for discussion with future scholars.
Theory of Five Elements
Heaven and Earth generate the Five Elements, hence the concepts of Green, Yellow, Red, White, and Black. Liver is Green, resembling Wood, governing the East and Spring season. Lung is White, resembling Metal, governing the West and Autumn season. Heart is Red, resembling Fire, governing the South and Summer season. Kidney is Black, resembling Water, governing the North and Winter season. Spleen is Yellow, resembling Earth, governing the Central damp season. Each Element governs one Qi and one Meridian. The Classic states: "Knowing through observation is called Divine, knowing through hearing is called Sage." Here, the characters "Divine" and "Sage" seem reversed. Each has its own generation and restriction transformations. The *Nei Jing* states: "Liver distributes on the left, Lung on the right, Heart on the exterior, Kidney on the interior, Spleen is the envoy of the four directions."历代 commentators have discussed this in terms of spatial orientation rather than the unity of Qi, causing the true meaning of the Five Elements to become obscure. I specifically interpret this directly. The human body is no different from Heaven and Earth. Heaven and Earth are filled with the Qi of the Five Elements; the human body is filled with the Qi of the Five Zang Organs throughout. Why? Bones belong to the Kidney, yet there is no part of the body not made of bone. Tendons belong to the Liver, yet there is no part of the body not containing tendons. Blood belongs to the Heart, yet there is no part of the body not containing blood. Muscles belong to the Spleen, yet there is no part of the body not containing muscle. Skin and hair belong to the Lung, yet there is no part of the body not covered by skin and hair. Deduced from this, the Five Elements are originally one integrated whole, not primarily defined by Left-Liver, Right-Lung, Heart-Exterior, Kidney-Interior, Spleen-Center. The latter description refers only to where the Five Elements establish their poles. If one seeks the Five Elements by holding rigidly to the five directions, the meaning of the Five Elements is lost. If one discusses the Five Elements as an integrated whole, their true meaning is revealed. The Five Elements do not exist outside the Two Qis, nor do the Two Qis exist outside the Five Elements. The Two Qis are the master pole of the human body; having generated the Five Elements, they return to the Five Elements. However, the essence of the Five Elements lies in the Central Earth: Fire cannot hide without Earth, Wood cannot stand without Earth, Metal cannot transform without Earth, Water cannot accumulate without Earth. Thus it is said: Earth is the mother of all things, relying on which the Four Images of acquired constitution depend. Not only do the Four Images of acquired constitution depend on it, but the Two Qis establishing the pole of congenital constitution also truly depend on it. Hence the Classic states: "Without congenital constitution, acquired constitution cannot stand; without acquired constitution, congenital constitution cannot generate." Acquired constitution emphasizes the Spleen and Stomach. Daily food and drink enter the Spleen and Stomach, transforming into Essence and Blood, nourishing Spirit and Qi, assisting the Two Qis of congenital constitution. When the Two Qis are vigorous, the mechanism of Spleen-Stomach transport is vigorous; when the Two Qis decline, the mechanism declines. Conversely, when Spleen-Stomach are vigorous, the Two Qis can become vigorous; when Spleen-Stomach decline, the Two Qis immediately decline. Congenital and acquired rely on each other, inseparable in division, inseparable in union. As for the mechanism of medication, it lies precisely in this acquired Spleen Earth. Therefore, Zhongjing established the Jian Zhong (Build the Middle) and Li Zhong (Regulate the Middle) methods. For external pathogens closing Ying and Wei, damaging Middle Qi, Jian Zhong Tang is best. For internal cold-dampness damaging Middle Qi, Li Zhong Tang is miraculous. These internal and external methods are truly the golden needle of treatment for millennia, the standard for physicians, pitying that people do not understand. Moreover, all Sweet-Warm and Bitter-Cold substances, upon entering the throat, immediately enter the Middle Palace. Sweet-Warm substances following Yang rely on it to move; Bitter-Cold substances following Yin rely on it to circulate. Thus it is said: The Middle is the pivot of upper and lower. Later expert Li Dongyuan established Bu Zhong Yi Qi Tang to treat spleen injury from labor, applying the method of Jian Zhong Tang, which is also acceptable. The common saying goes: "A hundred diseases enter through the mouth," implying injury to the Middle.
I assert that in treating all Yin Deficiency and Yang Deficiency, effort must be applied to the Middle Palace. The above three methods can be varied, but distinguishing Yin and Yang Deficiency must be thorough. Memorize the identification methods from the first volume carefully.
Question: The *Nei Jing* states "Injury to Cold in Winter leads to Warm Disease in Spring." Is there another explanation?
Answer: If injured by Cold in winter, how could it delay until spring to manifest? Yet there is an explanation. It is believed that when Heaven and Earth close up, Yang Qi hides internally, and human Qi mechanism also hides. Those lightly affected hide with the Qi mechanism, not becoming ill immediately. When spring arrives and winds are mild, Qi mechanism vents outward, and this seed of Cold Pathogen also moves outward, thus the disease manifests. Like planting seeds in spring and harvesting in summer, or planting in summer and harvesting in autumn, the meaning of Warm Disease is like this. Extending this: "Wind injury in Spring generates loose stools in Summer; Summer Heat injury in Summer leads to Malaria in Autumn; Dampness injury in Autumn leads to Cough in Winter." The logic is consistent. I have another view. In winter, the command is Cold; Heaven and Earth Qi is Cold, and human Qi is also Cold. Hiding is the natural mechanism of Heaven and Earth, and humans are the same; this is Zheng Qi (Upright Qi). Guest Cold is an external thief-pathogen. Pathogen and Upright Qi cannot coexist. Regardless of how slight the guest pathogen, once attaching to the human body, illness inevitably follows immediately. If the sensation is light, it cannot close the Qi mechanism; when meridian Qi is vigorous, the pathogen can silently transform. If the sensation is heavy, the pathogen can bind the Qi mechanism, and illness inevitably follows immediately. Moreover, many die from Cold Damage in winter. Deduced from this, this theory is not entirely accurate. After repeated investigation, I suspect it is internal injury from raw/cold dampness, which cannot close the defensive Qi mechanism, thus not causing immediate illness. It lies hidden within. Sensing the closing of Heaven and Earth, wrapped by the hiding Qi mechanism, it cannot vent. Delaying until spring, Cold Qi transforms into Heat Pathogen, venting outward with the Qi mechanism. Since spring is mild, it is named Warm Disease. Only through this deduction do we find the solid basis for "Winter Cold Injury leads to Spring Warm Disease." Various books discuss Warm diseases extensively, naming Wind-Warm, Cold-Warm, Heat-Warm, Damp-Warm, Dry-Warm, and further establishing plagues like Big Head, Yangmei, Neck-Twisting, Soft Leg, which are too numerous to list. Various schools discuss Spring as Wind-Warm, Summer as Heat-Warm, Late Summer as Damp-Warm, all discussing based on the Six Qi seasons. I believe adding the name "Warm" to the mild spring season is appropriate; naming other seasons "Warm" is inappropriate. "Cold-Warm" refers to the origin of the disease onset. "Wind-Warm" refers to the timing of onset. "Heat-Warm" refers to Cold transforming into Heat. "Damp-Warm" refers to accompanying internal Dampness. "Dry-Warm" refers to pathogen entering Yangming Dryness territory, lying hidden and not emerging. Speaking of Warm in this way makes the name accurate. Abandoning this to speak of Warm based on Six Qi seasons makes the name false. Each of the Six Qi has its own disease onset; what should they be named otherwise?
Furthermore, regarding the initial stage of Warm Disease, it first presents with aversion to cold followed by fever, then only fever without aversion to cold. Clearly, the abnormal Qi in the mild spring season is the Warm Pathogen. "Warm" is equivalent to "Heat." It first attacks Taiyang. Taiyang is the zone of Cold Water. Heat cannot overcome Cold, so it rushes directly to Yangming, hiding in the diaphragm. Yangming governs Dryness, and Dryness is also Heat. At this moment, Warm and Dry merge as one family, hence only fever without aversion to cold. This is the definitive, unchangeable symptom of Yangming. Zhongjing established Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), which already provides the method for such syndromes. Ephedra opens the pores, Apricot Kernel benefits Qi mechanism, Gypsum clears Yangming muscle heat, Licorice harmonizes the Middle, allowing the pathogen entering from Taiyang to exit via Taiyang. Truly a precise formula. Later generations established Sheng Jiang San (Ascending and Descending Powder) to release the exterior and clear the interior, claiming it is for Wind-Warm. They do not realize that at this moment, Qi is Warm, Warm is Qi, and Qi is Wind. Why create so many names? Later generations, failing to grasp the essence, set this formula for Wind-Warm, unaware it shares the same method as Ma Xing Shi Gan Tang. Others, such as Bai Hu Tang (White Tiger Decoction), Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction), Cang Zhu Bai Hu Tang (Atractylodes White Tiger Decoction), are used based on accompanying factors.
Warm Disease is essentially a Heat Disease, the proper disease of the Two Yang (Taiyang and Yangming). Other books explain it increasingly strangely, which cannot serve as a model. Students must know this.
Essential Quick Guide to Recognizing Diseases
**Fever Category:**
Fever with body ache indicates External Contraction (Spontaneous sweating: Guizhi Tang; No sweating: Mahuang Tang).
Fever without body ache, with fullness, bloating, and acid regurgitation indicates Internal Food Injury (Pingwei San plus digestive-promoting and Qi-moving herbs).
Fever with body ache, no aversion to cold, yellow tongue coating, and desire for cold drinks indicates Heat injuring the Interior (Bai Hu Tang plus Guizhi and Gegen).
Fever with body ache, aversion to cold, and no thirst indicates Pathogen entering Shaoyin (Mahuang Fuzi Xixin Tang).
Constitutional deficiency, sudden high fever, blue tongue, desire for extremely hot drinks indicates Yuan Yang floating outward (also cases with no thirst are similar) (Wuyu Sini Tang).
Children with fever, coarse breathing, and hot mouth indicate Exterior and Interior simultaneously diseased, with internal Heat (Renshen Baidu San plus Huangqin, Huanglian, Zhizi).
Fever with slightly warm exhalation, cool mouth, clear long urine, loose stools, in those with chronic illness indicates Unsecured Original Qi (Lizhong Tang, Liujunzi Tang, etc.).
**Malaria:**
Alternating chills and fever with regular intervals indicates True Malaria.
Once daily in the morning indicates Pathogen in Three Yang (Xiaochaihu Tang plus Guizhi and Gegen).
Once daily in the afternoon indicates Pathogen in Three Yin (Lizhong Tang plus Chaihu and Guizhi).
Every two days indicates deeper disease (Treat according to severity of chills/fever).
Only fever, no chills, continuous thirst for cold drinks indicates Disease in Yangming (Bai Hu Tang).
Only chills, no fever, desire for hot drinks indicates Disease in Taiyin (Lizhong Tang).
Fullness, discomfort, with chills and fever indicates Food Malaria (Pingwei San plus Shan Zha, Qu, Chaihu).
First vomiting clear water, then chills and fever, desire for extremely hot soup indicates Spleen Yang floating outward, resembling malaria but not true malaria (Wuyu Sini Tang).
**Distension/Tympanites:**
Abdominal distension only, limbs not distended, blue tongue, desire for hot drinks indicates Yin Pathogen hiding in the middle, blocking clear pathways (Lizhong Tang or Wuyu Sini Tang).
Limbs distended only, abdomen not distended indicates Spleen Yang not secured, scattering to the extremities (Lizhong Tang plus Xi Sha).
Whole body distension, no thirst, no appetite indicates Scattered Original Qi (Use gathering methods, absolutely avoid reducing edema; e.g., Lizhong, Huiyang).
Distension with skin color like blood indicates Yin attacking upward (Tonify Yang to dissipate Yin; e.g., Yangdan Tang, Qianyang Dan).
Distension with skin color like crystal, no other internal illness indicates Water Qi scattering in the skin (Wupi Yin).
There are many types of distension; grasping the Yin-Yang differentiation principles for treatment ensures accuracy.