用药意解
按四逆汤一方，乃回阳之主方也。世多畏惧，由其不知仲景立方之意也。夫此方既列于寒入少阴，病见爪甲青黑，腹痛下利，大汗淋漓，身重畏寒，脉微欲绝，四肢逆冷之候，全是一团阴气为病，此际若不以四逆回阳，一线之阳光，即有欲绝之势。仲景于此，专主回阳以祛阴，是的确不易之法。细思此方，既能回阳，则凡世之一切阳虚阴盛为病者，皆可服也，何必定要见以上病情，而始放胆用之，未免不知几也。夫知几者，一见是阳虚症，而即以此方在分两轻重上斟酌，预为防之，万不致酿成纯阴无阳之候也。酿成纯阴无阳之候，吾恐立方之意固善，而追之不及，反为庸庸者所怪也。怪者何？怪医生之误用姜、附，而不知用姜、附之不早也。仲景虽未一一指陈，凡属阳虚之人，亦当以此法投之，未为不可。所可奇者，姜、附、草三味，即能起死回生，实有令人难尽信者。余亦始怪之而终信之，信者何？信仲景之用姜、附而有深义也。考古人云："热不过附子"，可知附子是一团烈火也。凡人一身，全赖一团真火，真火欲绝，故病见纯阴。仲景深通造化之微，知附子之力能补先天欲绝之火种，用之以为君。又虑群阴阻塞，不能直入根蒂，故佐以干姜之辛温而散，以为前驱。荡尽阴邪，迎阳归舍，火种复兴，而性命立复，故曰回阳。阳气既回，若无土覆之，光焰易熄，虽生不永，故继以甘草之甘，以缓其正气，缓者即伏之之意也。真火伏藏，命根永固，又得重生也。此方胡可忽视哉？迩来世风日下，医者不求至理，病家专重人参。医生入门，一见此等纯阴无阳之候，开口以人参回阳，病家却亦深信，全不思仲景为立法之祖，既能回阳，何为不重用之，既不用之，可知非回阳之品也。查人参，性甘微寒，主补五脏，五脏为阴，是补阴之品，非回阳之品也，明甚。千古混淆，实为可慨。
【阐释】附子为热药之冠，能补欲绝之火种，又必佐干姜之辛散以荡尽阴邪，始能迎阳归舍，故曰回阳。阳回而无土覆，则光焰易熄，虽生不永，故以甘草之甘缓而伏之，使药效长留，命根永固。故凡阳虚阴盛为病，皆可放胆使用，能早用善用，即不致酿成危候。按四逆汤据现代的研究应用，能升血压，改善微循环，具有强心与镇静作用，被视为治疗休克的专方，治疗小儿腹泻亦具卓效。即改为注射液，功效亦与《伤寒论》原方所述相吻合。并经实践证明，附子与干姜、甘草同煎，能减附子之毒，而强心之作用更显著。可见郑氏在百余年前，对此汤之应用解说，实有其独到之处。笔者数十年临床经验，凡遇阳虚症，无论一般所称之肾炎、肝炎、肺炎、心肌炎、胃炎等等，只要临床症状有阳虚之实据，即不考虑炎症，辄以四逆汤加味治疗，取得满意效果。
问曰：病人两耳前后忽肿起，皮色微红，中含青色，微微疼，身大热，两颧鲜红，口不渴，舌上青白胎，两尺浮大而空者，何故？
答曰：此先天元阳外越，气机附少阳而上也。夫两耳前后，俱属少阳地界，今忽肿微痛，红色中含青色，兼之两颧色赤，口不渴，而唇、舌青白，知非少阳之风火明矣。如系少阳之风火，则必口苦、咽干，寒热往来，红肿痛甚，唇舌定不青白。今见青白苔，而阳虚阴盛无疑。身虽大热，无头疼、身痛之外感可据，元阳外越之候的矣。
况两尺浮大而空，尺为水脏，水性以下流为顺，故脉以沉细而濡为平。
今浮大而空，则知阴气太盛，一线之阳光，附阴气而上腾，有欲竭之势也。此际当以回阳祛阴，收纳真气为要。若不细心斟究，直以清凉解散投之，旦夕即亡。方宜白通汤主之，或潜阳丹亦可，解见上。
用药意解
按白通汤一方，乃回阳之方，亦交水火之方也。夫生附子大热纯阳，补先天之火种，佐干姜以温中焦之土气，而调和上下。葱白一物，能引离中之阴，下交于肾，生附子又能启水中之阳，上交于心。阴阳交媾，而水火互根矣。仲景一生学问，就在这阴、阳两字，不可偏盛，偏于阳者则阳旺，非辛热所宜；偏于阴者则阴旺，非苦寒所可。偏于阴者，外邪一入，即从阴化为病，阴邪盛则灭阳，故用药宜扶阳；邪从阳化为病，阳邪盛则灭阴，故用药宜扶阴。此论外感从阴从阳之道也。学者苟能于阴阳上探求至理，便可入仲景之门也。
【阐释】此间各种症象比较复杂，一般不易明辨。郑氏层层分析，断为元阳随阴气附少阳经而上越的危症，急需回阳祛阴，故主以白通汤或潜阳丹。白通汤即四逆汤去甘草而加葱白，以葱白辛温，合姜、附能通周身上下之阳气，为治阳隔于上的要药。本病主要由于在里之阴寒太盛，致上越之阳不能与下焦残存之阳相续，葱白能引心阴下交于肾，附子能启肾阳上交于心，阴阳交媾，水火互根，格越之症，自可立解。潜阳丹如前所解，有纳气归肾，伏火互根之妙用，故亦能治此病。笔者用白通汤治疗发高烧不退，取得满意效果。患儿张××，9 岁，高热摄氏39 度以上，注射针药已四日，高烧不退。来诊的前夜，哭闹不宁，将转为抽风。余以手摩小儿头部及上身，热可烫手，但腿部以下渐凉，至脚冰冷。此为阴阳相格，上下不通，虽发高烧，却非凉药可治。因白通汤虽能宣通上下之阳，但必须加猪胆汁或童便乃能入阴，故为之处方如下：附片30 克干姜20 克葱白30 克童便引。病者一剂减轻，二剂痊愈。以后凡治此类患者发高烧，久治不愈者，即以此方轻重上斟酌治之而愈，其例不下十数。
问曰：病人素缘多病，两目忽陷下，昏迷不醒，起则欲绝，脉细微而空者，何故？
答曰：此五脏之真气欲绝，不能上充而下陷，欲从下脱也。夫人身全赖一团真气，真气足则能充满，真气衰则下陷，此气机自然之理。
今见昏迷，起则欲绝，脉微，明是真气之衰，不能支持也。法宜峻补其阳，方宜四逆汤以回其阳，阳气复回，而精气自然上充也。方解见上。
问曰：病后忽鼻流清涕不止，忿嚏不休，服一切外感解散药不应而反甚者，何故？
答曰：此非外感之寒邪，乃先天真阳之气不足于上，而不能统摄在上之津液故也。此等病近似寒邪伤肺之症，世医不能分辨，故投解散药不愈而反甚。不知外感之清涕忿嚏，与真气不足之清涕忿嚏不同。
外感之清涕忿嚏，则必现发烧、头疼、身痛、畏寒、鼻塞之情形。真气不足之清涕忿嚏，绝无丝毫外感之情状。况又服解散药不愈，更为明甚。法宜大补先天之阳，先天之阳足，则心肺之阳自足。心肺之阳足，则上焦之津液，必不致外越也。人身虽云三焦，其实一焦而已。
用药意解
按姜桂汤一方，乃扶上阳之方也。夫上焦之阳，原属心肺所主，今因一元之气不足于上，而上焦之阴气即旺，阴气过盛，阳气力薄，即不能收束津液。今得生姜之辛温助肺，肺气得助，而肺气复宣，节令可行。兼有桂枝之辛热以扶心阳。心者，气之帅也，心阳得补，而肺气更旺（肺居心上如盖，心属火，有火即生炎，炎即气也。肺如盖，当炎之上，炎冲盖底；不能上，即返于下，故曰："肺气下降"，即此理也）。肺气既旺，清涕何由得出。要知扶心阳，即是补真火也（二火原本一气）。嚏本水寒所作（肾络通于肺，肾寒，故嚏不休），方中桂枝，不独扶心阳，又能化水中之寒气，寒气亦解，而嚏亦无由生。此方功用似专在上，其实亦在下也。学者不可视为寻常，实有至理存焉。或又曰，扶心阳而肺气更旺，夫心火也，肺金也，补心火，而肺不愈受其克乎？曰：子不知五行禀二气所生乎!
五脏只受得先天之真气，原受不得外来之客气。今所扶者是先天之真气，非外感之客气，既云受克，则肺可以不必居心上也。况此中之旨微，有不可以尽泄者。
【阐释】笔者在临症中，常见有鼻流清涕或浓涕，经年如此，中医俗称为脑漏。脑髓乃人身立命之物，岂可流出乎？现代医学检查为鼻窦炎，久治不愈者，多为上焦之阳不足，不能统摄津液，每以姜桂汤治之而获效。如病者林××患此症五年，服姜桂汤二剂见效。因其中下焦之阳亦显不足，故继以附子理中汤加补肾药，连服八剂而竟全功。
问曰：病人两耳心忽痒极欲死者，何故？
答曰：此肾中之阳暴浮也。夫两耳开窍于肾，肾中之火暴发于上，故痒极欲死。或又曰，肝胆脉亦入耳，肝胆有火，亦可发痒，先生独重肾气，而不言肝胆之火，未免固执。曰：子言肝胆有火，必不专在耳心，别处亦可看出，必不忽痒极欲死。今来者骤然，故直断之曰肾中之阳暴发也，法宜收纳真气为要。方用封髓丹，解见上。
【阐释】《内经》谓"肾主耳、肾气通于耳","肾和则耳能闻五音矣"，《圣惠方》谓"寻常耳痒有风有火，易于调治，甚有耳痒挑剔出血不能住手，此肾虚风火上攻"。亦以耳痒极为肾虚病。郑氏认此症为肾阳暴浮，治以封髓丹，是有卓见、亦是有根据的。至若肝胆有火，则多见头晕、目赤、耳肿痛、口苦、两胁胀痛、小便短赤、尿道涩痛等症，治宜清泻肝胆实火，如龙胆泻肝汤之类，与此症绝然不同。
问曰：病人两唇肿厚，色紫红，身大热，口渴喜热饮，午后畏寒，小便清长，大便溏泄，日二三次，脉无力者，何故？
答曰：此脾胃之阳，竭于上也。夫两唇属脾胃，肿而色紫红，近似胃中实火，其实非实火也。实火之形，舌黄而必干燥，口渴必喜饮冷，小便必短，大便必坚，身大热，必不午后畏寒。此则身虽大热，却无外感可据。午后畏寒，明明阴盛阳衰，口渴而喜热饮，中寒之情形悉具。兼之二便自利，又日泄三五次，已知土气不实，况脉复无力，此际应当唇白之候，今不白而反紫红肿厚，绝无阳症可凭，非阴盛逼出中宫之阳而何？法宜扶中宫之阳，以收纳阳气为主，方宜附子理中汤。
用药意解
按附子理中汤一方，乃先后并补之方也。仲景之意，原为中土太寒立法，故以姜、术温燥中宫之阳；又恐温燥过盛，而以人参之微寒继之，有刚柔相济之意；甘草调和上下，最能缓中。本方原无附子，后人增入附子，而曰附子理中，觉偏重下焦，不可以理中名。余谓先后并补之方，因附子之功在先天，理中之功在后天也。此病既是真气欲竭，在中宫之界，非附子不能挽欲绝之真阳，非姜、术不足以培中宫之土气，用于此病，实亦妥切。考古人既分三焦，亦有至理，用药亦不得混淆。上焦法天，以心肺立极；中焦法地，以脾胃立极；下焦法水，以肝肾立极。上阳、中阳、下阳，故曰三阳。其实下阳为上、中二阳之根，无下阳，即是无上、中二阳也。下阳本乎先天所生，中阳却又是先天所赖，中阳不运，上下即不相交。故曰："中也者，天下之大本也"。后天既以中土立极，三焦亦各有专司，分之为上、中、下，合之实为一元也。用药者，须知立极之要，而调之可也。
【阐释】理中汤本为中土太寒立法，加附子而温运之力更强，脾胃欲竭之阳得复，诸症自可立解。如断为实火，或寒热杂投，俱属误治。据郑氏嫡孙与笔者谈：其祖父晚年得子，父亲体虚多病，家中常备附子理中丸与服，身体始得日渐康复。笔者亦常用此方治疗脾肾阳虚，身体羸弱，反复感冒之患者，获得满意之效果。
问曰：满口齿缝流血不止，上下牙齿肿痛，口流清涎不止，下身畏寒，烤火亦不觉热者，何故？
答曰：此肾中之真阳欲绝，不能统肾经之血液也。夫齿乃骨之余，骨属肾，肾中含一阳，立阴之极，以统乎肾经之血液。肾阳苟足，齿缝何得流血不止？齿牙肿痛，明系阴气上攻，况口流涎不止，畏寒烤火亦不觉热，而真阳之火种，其欲绝也明甚。此症急宜大剂四逆汤，以救欲绝之真火，方可。若谓阴虚火旺，而以滋阴降火之品投之，是速其危也。四逆汤解见上。
【阐释】笔者在临症中，常见有患牙齿出血者，医者以为火重而治以清火之剂，多不见效，实由不知其为肾阳不足而致。余治此症，常先以炮姜甘草汤加血余炭以止血，继以四逆汤加补肾药而全愈。
问曰：病人口忽极臭，舌微黄而润滑，不思水饮，身重欲寐者，何故？
答曰：此先天真火之精气发泄也。夫臭乃火之气，极臭乃火之极甚也。火甚宜乎津枯，舌宜乎干燥而黄，应思水饮，身必不重，人必不欲寐。今则不然，口虽极臭，无胃火可凭，舌虽微黄，津液不竭，无实火可据。不思水饮，身重欲寐，明系阴盛逼出真火之精气，有脱之之意也。或又曰：真阳上腾之症颇多，不见口臭，此独极臭，实有不解。曰：子不观药中之硫黄乎！硫黄秉火之精气所生，气味极臭，药品中秉火气所生者亦多，而何不臭？可知极臭者，火之精气也。此等症乃绝症也，十有九死，法宜收纳真阳，苟能使口臭不作，方有生机。方用潜阳丹治之，解见上。
【阐释】笔者在临症中，若口臭无阴象，多为胃火旺极，用白虎加人参汤治之。亦有阴盛逼阳于外而口臭者，用大剂附子理中汤加味治之。
Aconiti Lateralis Radix Preparata (Fuzi, 附子) one piece (raw), Zingiberis Rhizoma (Ganjiang, 干姜) 1.5 qian, Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao, 炙甘草) 2 liang.
[Explanation of Medicinal Intent]
Examining the Si Ni Tang (Four Reversal Decoction), it is the primary formula for restoring Yang and rescuing from collapse. People in the world often fear it because they do not understand Zhang Zhongjing's original intent in establishing this prescription. Since this formula is listed under conditions where cold pathogen invades the Shaoyin meridian, presenting with cyanosis of the fingernails and toenails, abdominal pain and diarrhea, profuse sweating, heaviness of the body with aversion to cold, a faint pulse nearly imperceptible, and cold limbs, these are entirely manifestations of an excess of Yin pathogenic factors. At this juncture, if one does not use Si Ni Tang to restore Yang, that single ray of sunlight-like Yang Qi faces the danger of extinction. Zhang Zhongjing here specifically advocates restoring Yang to dispel Yin; this is a definitive and unchangeable method. Upon careful consideration, since this formula can restore Yang, it can be used for all diseases in the world caused by Yang deficiency and Yin excess. Why must one wait until the aforementioned symptoms appear before daring to use it boldly? This shows a lack of understanding of perceiving subtle signs. One who understands subtle signs, upon seeing a Yang deficiency syndrome, will base their treatment on this formula, adjusting the dosage according to severity, to prevent proactively. They will never allow the condition to deteriorate into pure Yin without Yang. Once it deteriorates into pure Yin without Yang, I fear that although the original intent of the prescription was good, it would be too late, and one would instead be blamed by mediocre practitioners. Blamed for what? Blamed for misusing Ginger and Aconite, and for not using them early enough. Although Zhang Zhongjing did not specify every case, for anyone belonging to a Yang deficient constitution, employing this method is permissible. What is strange is that these three herbs—Ginger, Aconite, and Licorice—can revive the dying, which is truly hard to believe. I initially doubted it but eventually believed it. Why? Because I believe Zhang Zhongjing’s use of Ginger and Aconite holds profound meaning. Consulting ancient texts: "No herb is hotter than Aconite," indicating that Aconite is a mass of fierce fire. The human body relies entirely on a mass of True Fire (True Yang). When True Fire is about to extinguish, the disease manifests as pure Yin. Zhang Zhongjing deeply understood the subtleties of creation, knowing that Aconite’s power can supplement the primordial fire seed that is about to vanish, thus using it as the Sovereign herb. Fearing that the multitude of Yins might block direct access to the root, he supplemented it with the acrid-warm dispersing nature of Dried Ginger as a vanguard. Sweeping away all Yin pathogens, welcoming Yang back to its residence, the fire seed revives, and life is immediately restored; hence it is called "Restoring Yang." Once Yang is restored, if there is no Earth element to cover it, the flame will easily extinguish, and longevity will not be achieved even if survival occurs. Therefore, it follows with the sweet-natured Licorice to moderate the righteous Qi; "moderating" implies "securing/anchoring." When True Fire is secured, the root of life is permanently solidified, allowing for rebirth. How can this formula be ignored? Recently, social morals have declined; physicians do not seek ultimate principles, and patients overly value Ginseng. When a physician enters and sees such a syndrome of pure Yin without Yang, they immediately suggest Ginseng to restore Yang, and the patient believes it wholeheartedly, failing to consider that Zhang Zhongjing is the ancestor of legislation. If Ginseng could restore Yang, why wasn't it heavily used? Since it wasn't used, it is evident that it is not a Yang-restoring agent. Research shows Ginseng has a sweet, slightly cold nature and primarily tonifies the Five Viscera. The Five Viscera belong to Yin; thus, it is a Yin-tonifying agent, not a Yang-restoring one, which is very clear. Confusion throughout history is indeed lamentable.
Q: The patient suddenly develops swelling behind and in front of both ears, with slightly red skin color containing bluish hues, slight pain, high fever, bright red malar flush, no thirst, greenish-white tongue coating, and floating, large, and empty pulses at the Chi position (cun-kou pulse diagnosis). What is the cause?
A: This is the outward deviation of primordial Yuan Yang, with Qi mechanism attaching to the Shaoyang meridian and ascending. Both areas behind and in front of the ears belong to the Shaoyang domain. Now, sudden swelling and slight pain, redness containing blueness, combined with red cheeks, no thirst, and blue-white lips and tongue, indicate clearly that this is not Wind-Fire of the Shaoyang meridian. If it were Wind-Fire of Shaoyang, there would necessarily be bitter taste in the mouth, dry throat, alternating chills and fever, severe redness, swelling, and pain, and the lips and tongue would certainly not be blue-white. Seeing the green-white coating now, Yang deficiency and Yin excess are undeniable. Although the body has high fever, there is no evidence of external contraction such as headache or body ache; it is definitively a sign of Yuan Yang deviating outward.
Moreover, the Chi pulses are floating, large, and empty. The Chi position corresponds to the Water Viscera (Kidney). Water nature flows downward smoothly, so a normal pulse should be deep, fine, and soft.
Now, with floating, large, and empty pulses, we know Yin Qi is excessively strong. That single ray of sunlight (Yang Qi) attaches to the Yin Qi and ascends, showing a trend toward exhaustion. At this moment, the priority must be to restore Yang, dispel Yin, and gather True Qi. If one does not carefully investigate and directly administers cooling and resolving agents, death will occur within a day or two. The appropriate formula is Bai Tong Tang (White Passages Decoction), or Qian Yang Dan (Submerge Yang Powder) may also be used; explanations are found above.
Bai Tong Tang
Aconiti Lateralis Radix Preparata (Fuzi, 附子) one piece (raw), Zingiberis Rhizoma (Ganjiang, 干姜) 2 liang, Allii Fistulosi (Congbai, 葱白) four stalks.
[Explanation of Medicinal Intent]
Examining Bai Tong Tang, it is a formula for restoring Yang and also for harmonizing Water and Fire (Heart-Kidney interaction). Raw Aconite is extremely hot and purely Yang, supplementing the primordial fire seed. It is assisted by Dried Ginger to warm the Earth Qi of the Middle Jiao, thereby harmonizing the upper and lower. Allii Fistulosi (Green Onion White) alone can draw the Yin from Li (Fire/Heart) to descend and interact with the Kidney. Raw Aconite can also stir the Yang within Water (Kidney) to ascend and interact with the Heart. Yin and Yang couple, and Water and Fire become mutually rooted. Zhang Zhongjing’s lifelong scholarship lies in these two characters: Yin and Yang. Neither should prevail excessively. If prevailing in Yang, Yang becomes strong, and acrid-hot herbs are unsuitable; if prevailing in Yin, Yin becomes strong, and bitter-cold herbs are unsuitable. If prevailing in Yin, once external pathogens enter, they transform into disease following Yin; when Yin pathogens are excessive, they extinguish Yang, so medication should support Yang. If pathogens transform into disease following Yang, when Yang pathogens are excessive, they extinguish Yin, so medication should support Yin. This discusses the principle of external contractions transforming via Yin or Yang. Scholars who can explore the ultimate truth through Yin and Yang can enter the door of Zhang Zhongjing.
[Interpretation] The various symptoms here are complex and generally difficult to distinguish. Zheng analyzes layer by layer, concluding it is a critical syndrome where Yuan Yang follows Yin Qi up along the Shaoyang meridian. Urgent restoration of Yang and dispelling of Yin is required, hence the primary use of Bai Tong Tang or Qian Yang Dan. Bai Tong Tang is Si Ni Tang minus Licorice plus Green Onion White. Because Green Onion White is acrid-warm, combined with Ginger and Aconite, it can unblock Yang Qi throughout the body, making it a key medicine for treating Yang repulsion in the upper burner. The main cause of this disease is excessive internal Cold-Yin, preventing the ascending Yang from connecting with the residual Yang in the Lower Jiao. Green Onion White draws Heart Yin down to the Kidney, while Aconite stirs Kidney Yang up to the Heart. Yin and Yang couple, Water and Fire are mutually rooted, and the repulsion syndrome can be resolved immediately. As explained previously, Qian Yang Dan has the wonderful effect of gathering Qi into the Kidney and anchoring Fire, so it can also treat this disease. I used Bai Tong Tang to treat persistent high fever with satisfactory results. Patient Zhang XX, 9 years old, had a fever above 39°C. After four days of injections, the fever persisted. The night before consultation, the child was restless and crying, on the verge of convulsions. Touching the head and upper body felt scalding, but the legs cooled gradually, becoming ice-cold at the feet. This is Yin-Yang repulsion, lack of communication between upper and lower. Despite high fever, it cannot be treated with cooling medicines. Although Bai Tong Tang can disseminate Yang up and down, it must be added with Pig Bile or Child’s Urine to enter Yin. Thus, I prescribed: Prepared Aconite Slice 30g, Dried Ginger 20g, Green Onion White 30g, guided by Child’s Urine. Symptoms alleviated after one dose, cured after two doses. Since then, for similar cases of persistent high fever refractory to other treatments, I have adjusted the dosage of this formula with success, numbering over ten cases.
Q: The patient, prone to illness, suddenly has sunken eyes, is comatose and unconscious, feels like dying upon rising, with fine, minute, and empty pulses. What is the cause?
A: This is the impending extinction of the True Qi of the Five Viscera, unable to ascend and fill, instead sinking and threatening to escape from below. The human body relies entirely on a mass of True Qi. When True Qi is sufficient, it fills the body; when deficient, it sinks. This is the natural law of Qi mechanism.
Seeing coma and feeling like dying upon rising, with a minute pulse, clearly indicates True Qi deficiency and inability to sustain. The method should be to vigorously tonify Yang. The appropriate formula is Si Ni Tang to restore Yang. Once Yang is restored, Essence and Qi will naturally ascend. Formula explanation is found above.
Q: After an illness, the patient suddenly suffers from continuous runny nose with clear mucus and incessant sneezing. Taking any external-contracting resolving medicines fails and worsens the condition. What is the cause?
A: This is not an external Cold pathogen, but rather insufficient Primordial True Yang Qi in the upper part, failing to control the fluids in the upper region. This condition resembles Lung injury by Cold pathogen. Physicians of the world fail to distinguish them, so administering resolving medicines does not help but makes it worse. They do not know that clear mucus and sneezing caused by external contraction differ from those caused by True Qi deficiency.
Clear mucus and sneezing from external contraction must present with fever, headache, body ache, aversion to cold, and nasal congestion. Clear mucus and sneezing from True Qi deficiency have absolutely no signs of external contraction. Furthermore, taking resolving medicines fails, which is even more evident. The method should be to greatly tonify Primordial Yang. When Primordial Yang is sufficient, Heart and Lung Yang become sufficient. When Heart and Lung Yang are sufficient, Upper Jiao fluids will not overflow externally. Although the human body is said to have Three Jiaos, essentially there is only one Jiao.
The appropriate formula is a large dose of Si Ni Tang, or Feng Sui Dan (Seal Marrow Powder) may also be used; formula explanation is found above. Jiang Gui Tang (Ginger and Cinnamon Twig Decoction) is also acceptable.
Jiang Gui Tang
Zingiberis Rhizoma Recens (Shengjiang, 生姜) 1.5 liang, Cinnamomi Ramulus (Guizhi, 桂枝) 1 liang.
[Explanation of Medicinal Intent]
Examining Jiang Gui Tang, it is a formula to support Upper Yang. The Yang of the Upper Jiao is originally governed by the Heart and Lung. Now, due to insufficiency of the One Prime Qi in the upper part, Yin Qi of the Upper Jiao becomes prosperous. Excessive Yin Qi and weak Yang Qi cannot bind the fluids. Now, receiving the acrid-warm assistance of Fresh Ginger helps the Lung Qi; Lung Qi is aided and recovers its diffusing function, allowing seasonal functions to proceed. Coupled with the acrid-hot Guizhi to support Heart Yang. The Heart is the commander of Qi. When Heart Yang is supplemented, Lung Qi becomes stronger (The Lung sits atop the Heart like a lid; Heart belongs to Fire. Where there is Fire, there is Flame/Heat, which is Qi. The Lung is like a lid above the Flame. If Flame rushes against the bottom of the lid, Qi cannot ascend and returns downward, hence saying: "Lung Qi descends," which is this logic). Once Lung Qi is strong, how can clear mucus emerge? Know that supporting Heart Yang is equivalent to supplementing True Fire (Two Fires originate from one Qi). Sneezing is produced by Cold-Water (Kidney collaterals connect to the Lung; Kidney Cold causes incessant sneezing). In this formula, Guizhi not only supports Heart Yang but also transforms Cold Qi in Water. With Cold Qi resolved, sneezing has no source. The function of this formula seems focused on the upper part, but actually involves the lower part. Scholars must not view it as ordinary; there is profound truth within. Someone might ask: Supporting Heart Yang strengthens Lung Qi. But Heart is Fire and Lung is Metal. Supplementing Heart Fire, doesn't Lung suffer more from being controlled? I reply: Do you not know that the Five Elements are born from two Qi? The Five Viscera only receive Primordial True Qi; they originally do not receive exogenous Guest Qi. What is supported here is Primordial True Qi, not exogenous Guest Qi. If one says it suffers control, then the Lung need not reside above the Heart. Moreover, the essence herein is subtle, with aspects that cannot be fully revealed.
[Interpretation] In clinical practice, I often see patients with chronic clear or thick nasal discharge, known in TCM colloquially as "Brain Leak." Brain marrow is the foundation of life; how can it flow out? Modern medical examination identifies this as sinusitis. Cases refractory to long-term treatment are mostly due to insufficient Upper Jiao Yang failing to control fluids. I often treat them with Jiang Gui Tang with good effects. For example, patient Lin XX suffered this for five years and showed improvement after two doses of Jiang Gui Tang. Because his Lower Jiao Yang was also evidently insufficient, I subsequently administered Lizhong Decoction with Aconite plus Kidney-tonifying herbs for eight doses, achieving complete recovery.
Q: The patient experiences extreme itching in the center of both ears, to the point of wanting to die. What is the cause?
A: This is the sudden floating of Yang within the Kidney. The ears open into the Kidney. When Fire within the Kidney erupts upward, it causes extreme itching. Someone might say: The Liver and Gallbladder meridians also enter the ear. Fire in the Liver and Gallbladder can also cause itching. Why does Mr. focus solely on Kidney Qi and ignore Liver/Gallbladder Fire, appearing stubborn? I reply: You say Liver/Gallbladder has Fire, it would not be confined only to the ear center; other places would show signs, and it would not suddenly cause extreme itching. Since the onset is abrupt, I directly diagnose it as the eruption of Yang within the Kidney. The method should prioritize gathering True Qi. Use Feng Sui Dan; explanation is found above.
[Interpretation] *Nei Jing* states: "The Kidney governs the ears, Kidney Qi connects to the ears," and "When the Kidney is harmonious, the ears can hear the five tones." *Shenghui Fang* states: "Common ear itching is due to Wind or Fire, easy to treat; however, some have ear itching so severe they pick until bleeding won't stop, this is Kidney Deficiency with Wind-Fire attacking upward." Extreme ear itching is also considered a Kidney Deficiency disease. Zheng recognizes this symptom as sudden floating of Kidney Yang and treats it with Feng Sui Dan, demonstrating unique insight and basis. If it were Liver/Gallbladder Fire, symptoms would typically include dizziness, red eyes, swollen/painful ears, bitter taste, distending pain in hypochondrium, short dark urine, and dysuria. Treatment should involve clearing and draining Liver/Gallbladder Excess Fire, such as Long Dan Xie Gan Tang, which is completely different from this syndrome.
Q: The patient has thick, swollen lips with purple-red color, high fever, thirst preferring hot drinks, aversion to cold in the afternoon, clear and copious urination, loose stools two to three times daily, and a powerless pulse. What is the cause?
A: This is the exhaustion of Spleen and Stomach Yang in the upper part. The lips belong to the Spleen and Stomach. Swelling with purple-red color approximates Stomach Excess Fire, but it is actually not Excess Fire. The manifestation of Excess Fire includes yellow, dry tongue coating, thirst preferring cold drinks, short urine, firm stool, high fever, and definitely no aversion to cold in the afternoon. Here, although there is high fever, there is no evidence of external contraction. Aversion to cold in the afternoon clearly indicates Yin excess and Yang decline. Thirst preferring hot drinks presents all signs of Middle Jiao Cold. Combined with free urination and loose stools several times a day, we already know the Earth Qi is not solid. Moreover, the pulse is powerless. At this time, the lips should be white. Now they are not white but purple, red, swollen, and thick, with absolutely no Yang syndrome evidence. Is this not Yin excess forcing the Yang of the Central Palace outward? The method should support the Yang of the Central Palace, focusing on gathering Yang Qi. The appropriate formula is Fuzi Lizhong Tang (Aconite and Magnolia Bark Decoction).
Fuzi Lizhong Tang
Aconiti Lateralis Radix Preparata (Fuzi, 附子) one piece, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) 5 qian, Zingiberis Rhizoma (Ganjiang, 干姜) 5 qian, Ginseng Radix (Renshen, 人参) 2 qian, Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao, 炙甘草) 3 liang.
[Explanation of Medicinal Intent]
Examining Fuzi Lizhong Tang, it is a formula tonifying both Pre-Heaven and Post-Heaven. Zhang Zhongjing’s original intent was to legislate for excessive Cold in the Central Earth, hence using Ginger and Atractylodes to warm and dry the Yang of the Central Palace. Fearing excessive warmth and dryness, he followed with the slightly cold Ginseng, embodying the idea of balancing rigid and flexible qualities. Licorice harmonizes upper and lower, best moderating the middle. This formula originally lacked Aconite; later generations added Aconite and named it Fuzi Lizhong, feeling it leans too heavily on the Lower Jiao to be called Lizhong. I consider it a formula tonifying both Pre-Heaven and Post-Heaven, because Aconite’s function lies in Pre-Heaven, while Lizhong’s function lies in Post-Heaven. Since this disease involves True Qi nearing exhaustion within the Central Palace realm, only Aconite can salvage the impending True Yang, and only Ginger and Atractylodes are sufficient to cultivate the Earth Qi of the Central Palace. Using it for this disease is truly appropriate. Examining the ancients' division of the Three Jiaos also contains profound truth; medication must not be confused. The Upper Jiao models Heaven, establishing polarity with Heart and Lung; the Middle Jiao models Earth, establishing polarity with Spleen and Stomach; the Lower Jiao models Water, establishing polarity with Liver and Kidney. Upper Yang, Middle Yang, Lower Yang—thus called Three Yangs. Actually, Lower Yang is the root of Upper and Middle Yangs. Without Lower Yang, there is no Upper or Middle Yang. Lower Yang originates from Pre-Heaven generation, yet Middle Yang is relied upon by Pre-Heaven. If Middle Yang does not transport, upper and lower do not intersect. Hence: "The Center is the great root of the world." Since Post-Heaven establishes polarity with Central Earth, and the Three Jiaos each have specific duties, divided into Upper, Middle, and Lower, united they are essentially One Prime. Those using medication must know the essentials of establishing polarity and regulate accordingly.
[Interpretation] Lizhong Tang was originally legislated for excessive Cold in Central Earth. Adding Aconite strengthens the warming and transporting power. When the impending Yang of the Spleen and Stomach is restored, various symptoms can resolve immediately. If diagnosed as Excess Fire, or mixing cold and heat treatments, it constitutes erroneous therapy. According to Zheng’s direct grandson speaking with me: His grandfather had a son in his old age; his father was physically weak and prone to illness. The family kept Fuzi Lizhong Wan ready for consumption, and his health gradually recovered. I also frequently use this formula to treat patients with Spleen-Kidney Yang deficiency, physical emaciation, and recurrent colds, achieving satisfactory results.
Q: Bleeding continues incessantly from the gums throughout the mouth, upper and lower teeth swell and hurt, clear saliva flows continuously from the mouth, the lower body feels cold, and even sitting by the fire does not feel warm. What is the cause?
A: This is the impending extinction of True Yang within the Kidney, unable to control the blood of the Kidney Meridian. Teeth are the surplus of bone; bone belongs to the Kidney. Within the Kidney resides one Yang, standing at the extreme of Yin, to control the blood of the Kidney Meridian. If Kidney Yang were sufficient, how could the gums bleed incessantly? Tooth swelling and pain clearly indicate Yin Qi attacking upward. Moreover, continuous flow of saliva, aversion to cold, and lack of warmth even by the fire make it evident that the fire seed of True Yang is nearing extinction. This symptom urgently requires a large dose of Si Ni Tang to save the impending True Fire. If one claims it is Yin Deficiency with Fire Hyperactivity and administers Yin-nourishing and Fire-descending agents, this accelerates danger. Explanation of Si Ni Tang is found above.
[Interpretation] In clinical practice, I often see patients with gum bleeding. Physicians assume heavy Fire and treat with fire-clearing agents, often without effect. This is truly due to ignorance that it is caused by Kidney Yang deficiency. I treat this symptom by first using Pao Jiang Gan Cao Tang (Roasted Ginger and Licorice Decoction) plus Cacciae Carbo (Hair Charcoal) to stop bleeding, followed by Si Ni Tang plus Kidney-tonifying herbs to achieve cure.
Q: The patient’s breath suddenly becomes extremely foul, the tongue is slightly yellow and slippery, there is no desire for water, the body feels heavy, and there is a desire to sleep. What is the cause?
A: This is the emission of the Essence-Qi of Primordial True Fire. Odor is the Qi of Fire; extreme odor is the extremity of Fire. Extreme Fire should lead to fluid depletion, a dry and yellow tongue, desire for water, heavy body should not occur, and one should not desire sleep. Now it is otherwise. Although the breath is extremely foul, there is no evidence of Stomach Fire. Although the tongue is slightly yellow, fluids are not exhausted, and there is no evidence of Excess Fire. No desire for water, heavy body, desire to sleep—clearly indicates Yin excess forcing out the Essence-Qi of True Fire, suggesting a tendency toward collapse. Someone might say: There are many symptoms of True Yang ascending, none showing bad breath, yet this one is extremely foul, which is truly不解 (ununderstood). I reply: Have you not observed Sulfur in medicines! Sulfur is generated bearing the Essence-Qi of Fire, with an extremely foul odor. Many medicinal materials bear Fire Qi, yet why are they not foul? It is known that extreme odor is the Essence-Qi of Fire. Such symptoms are terminal syndromes; nine out of ten result in death. The method should be to gather True Yang. If the bad breath can be stopped, there is hope for life. Use Qian Yang Dan to treat it; explanation is found above.
[Interpretation] In clinical practice, if bad breath occurs without Yin signs, it is mostly due to extreme Stomach Fire, treated with Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction). There are also cases of bad breath due to Yin excess forcing Yang outward, treated with large doses of Fuzi Lizhong Tang modified.