问曰：病人舌忽不能转动，肢忽不能升举，睡中口流涎不觉者，何故？
答曰：此阴盛而元阳不固不运也。夫人一身关节窍道，全赖真气布护运行。真气健旺，则矫捷自如，出纳有节，焉有舌不能转，肢不能举，睡中流涎不觉者乎？余故直决之曰：阴盛而元阳不固不运也。
或又曰：中风中痰，亦能使人舌不能转，肢不能举，先生独重阳虚阴盛，不能无疑。曰：子不知中风、中痰之由乎？风由外入，痰因内成，总缘其人素禀阳虚，损伤已极，而外之风邪始得乘其虚隙而入之。阳衰在何处，风邪即中何处，故有中经、中腑、中脏之别。阳虚则中宫健运之力微，中宫之阴气即盛，阴气过盛，而转输失职，水谷之湿气，与内之阴气相聚，而为涎为痰。久久阳微，寒痰上涌，堵塞清道，遂卒倒昏迷，而曰中痰也。此病可与附子理中汤加砂半，方解见上。中风者，按陈修园《医学三字经》法治之。中痰者，可与姜附茯半汤治之。
用药意解
按姜附茯半汤一方，乃回阳降逆，行水化痰之方也。夫生姜辛散，宣散壅滞之寒；附子性烈纯阳，可救先天之火种，真火复盛，阴寒之气立消；佐茯苓健脾行水，水者痰之本也，水去而痰自不作；况又得半夏之降逆化痰，痰涎化尽，则向之压于舌本者解矣。清道无滞，则四肢之气机复运，而伸举自不难矣。
答曰：此阴盛而真气上脱，已离乎根，危之甚者也。夫喉痛一症，其在各经邪火所作，必不上热下寒，即来亦不骤。今来则急如奔马，热上寒下，明明一线之阳光，为阴气所逼，已离乎根也。或又曰：既言平人，何得即谓之阳欲脱乎？曰：子不知人身所恃以立命者，其惟此阳气乎？阳气无伤，百病自然不作；阳气若伤，群阴即起。阴气过盛，即能逼出元阳，元阳上奔，即随人身之脏腑经络虚处便发。如经络之虚通于目者，元气即发于目；经络之虚通于耳者，元气即发于耳；经络之虚通于巅者，元气即发于巅，此元阳发泄之机。学者苟能识得一元旨归，六合妙义，则凡一切阳虚之症，皆在掌握也。兹虽云平人，其损伤原无人知晓，或因房劳过度，而损肾阳；或因用心太过，而损心阳；或因饮食失节，而损脾阳。然亦有积久而后发者，元气之厚也；有一损而即发者，元气之薄也。余常见有平人，日犹相见，而夜即亡者，毋乃元气之薄，而元阳之脱乎？医亦尚不知，而况不知医者乎？
此一段已将阳虚合盘托出，学者务宜留心体之可也。方宜潜阳丹主之，解见上。
问曰：咳嗽、喘促，自汗，心烦不安，大便欲出，小便不禁，畏寒者，何故？
答曰：此真阳将脱，阴气上干清道也。夫咳嗽、喘促一症，原有外感内伤之别。经云："咳不离肺"。肺主呼吸，为声音之总司，至清至虚之府，原着不得一毫客气，古人以钟喻之，外叩一鸣，内叩一鸣，此内外之分所由来也。外感者，由风、寒、暑、湿、燥、火六气袭肺，阻肺经外出之气机，气机壅塞，呼吸错乱，而咳嗽作，兼发热、头疼、身痛者居多，宜解散为主。解散之妙，看定六经，自然中肯。
内伤者，因喜、怒、悲、哀、七情损伤真阳、真阴所作，亦有发热者，却不头疼、身痛，即热亦时作时止。损伤真阳之咳者，阴气必盛，阴盛必上干清道，务要看损于何脏何腑，即在此处求之，用药自有把握。
若真阴损伤之咳者，阳气必盛，阳盛亦上干清道，亦看损于何脏何腑，即在所发之处求之，用药自有定见。要知真阳欲脱之咳嗽，满腹全是纯阴，阴气上腾，蔽塞太空，犹如地气之上腾，而为云为雾，遂使天日无光，阴霾已极，龙乃飞腾。龙者，即坎中之一阳也，龙奔于上，而下部即寒，下部无阳，即不能统纳前后二阴，故有一咳而大便欲出，小便不禁者，是皆飞龙不潜致之也。世医每每见咳治咳，其亦闻斯语乎？法宜回阳降逆，温中降逆，或纳气归根。方用四逆汤、封髓丹、潜阳丹，解见上。
问曰：胸腹痛甚，面赤如硃，不思茶水，务要重物压定稍安，不则欲死者，何故？
答曰：此元气暴出而与阴争也。夫胸腹痛一症，原有九种，总不出虚、实两字。实症手不可近，虚症喜手揉按，此则欲重物压定而始安，更甚于喜手揉按，非阳气之暴出而何？或又曰：重物压定而稍安，其理何也？曰：子不观火之上冲乎，冲之势烈，压之以石，是阻其上冲之气机也。气机得阻，而上冲者不冲。今病人气机上涌，面色已赤如硃，阳与阴有割离之象，故痛甚。重物压之，亦如石之压火也。此病非纳气归根，回阳降逆不可，方用加味附子理中汤，或潜阳丹，解见上。
【阐释】胸腹痛一症，原有九种，陈修园《医学三字经》有说，即"一虫痛，乌梅丸；二注痛，苏合研，三气痛，香苏专；四血痛，失笑先；五悸痛，妙香诠；六食痛，平胃煎；七饮痛，二陈咽；八冷痛，理中全；九热痛，金铃痊。"对九症各有处方，特转录以供参考。郑氏总其要为虚、实两症，实症拒按，虚症喜手揉按。此症胸腹痛甚，须重按压始安，而且面赤如硃，断为阳气暴出而与阴争，阴与阳有割离之象，是确切精当的。故非纳气归根，回阳降逆，不能治愈。
答曰：此肾气不藏，而肾水汜溢也。夫吐清水一症，胃寒者亦多，今服一切温中补火之品不效，明明非胃寒所作，故知其肾水汜溢也。
或又曰：胃寒与肾水汜溢，有分别否？曰：胃寒者，关脉必迟，唇口必淡白，食物必喜辛辣热物。肾水汜溢者，两尺必浮滑，唇口必黑红，不思一切食物，口间觉咸味者多。胃寒者，可与理中汤。肾水汜溢者，可与滋肾丸，桂苓术甘汤。
用药意解
按滋肾丸一方，乃补水之方，亦纳气归肾之方也。夫知母、黄柏二味，气味苦寒，苦能坚肾，寒能养阴，其至妙者，在于安桂一味，桂本辛温，配黄柏、知母二物，合成坎卦，一阳含于二阴之中，取天一生水之义，取阳为阴根之义，水中有阳，而水自归其宅，故曰滋肾。此病既非胃寒，而曰水（滥）〔汜〕，虽曰土不制水，亦因龙奔于上，而水气从之。今得安桂，扶心之阳，以通坎中之阳，阳气潜藏，何致有吐水之患哉？或又曰：水既汜溢，而又以知、柏资之，水不愈旺，吐水不愈不休乎？曰：子不知龙者水之主也，龙行则雨施，龙藏则雨止，若安桂者，即水中之龙也，知、柏者，即水也。水之放纵，原在龙主之。龙既下行，而水又安得不下行乎？此方非独治此病，凡一切阳不化阴，阴气发腾之症，无不立应。
按桂苓术甘汤一方，乃化气、行水之方也。夫桂枝辛温，能化膀胱之气，茯苓、白术，健脾除湿。化者从皮肤而运行于外，除者从内行以消灭于中，甘草补土又能制水。此病既水汜于上，虽肾气之发腾，亦由太阳之气化不宣，中土之湿气亦盛。今培其土，土旺自能制水，又化其气，气行又分其水，水分而势孤，便为土所制矣。余故列于此症内。但此方不惟治此症，于一切脾虚水肿，与痰饮咳嗽，更为妥切。
【阐释】口吐清水，饮食减少，有由于胃寒及肾水泛溢之别，两者在脉象、味觉及唇口颜色诸方面都容易区分。由于胃寒者，以理中汤温健脾胃，即能痊愈。由于肾水泛溢者，服一切温中补火药，自然不会有效。郑氏治以滋肾丸或桂苓术甘汤，可谓善用成方。查滋肾丸系李东垣所订，本以治下焦湿热，小便癃闭，故用知、柏苦寒，清热、燥湿而兼滋阴，更配少许肉桂温养肾阳蒸水化气，而小便自通。郑氏取其一阳含于二阴之中，阳为阴根，能引水归宅，水得下行，口吐清水自止。实由于知、柏二味，苦能坚肾，寒能养阴，更得辛温之肉桂，扶心阳以通肾阳，使水有所归，又有所制，自不会汜溢为病。故凡一切阳不化阴，阴气发腾之症，皆可以本方施治。至于桂苓术甘汤，自《伤寒论》、《金匮》起，即视为治痰饮、水湿的要方。郑氏用以治此症，系取其能化气行水，使水从皮肤蒸发，小便利出，而口吐清水自止。又因其能补土以制水，故可推广以治一切脾虚水肿与痰饮咳嗽。现代应用范围更广，有人用以治高血压、脑震荡、目翳、带下、溃疡、风湿性关节炎及心力衰竭诸病，均取得满意的效果。
问曰：病后两乳忽肿如盘，皮色如常，微痛，身重喜卧，不思一切饮食者，何故？
答曰：此阴盛而元气发于肝、胃也。夫病后之人，大抵阳气未足，必又重伤其阳，阳衰阴盛，一线之阳光，附于肝胃之经络而发泄，故色如常而微痛。况身重喜卧，乃阳衰阴盛之征，乳头属肝，乳盘属胃，故决之在肝胃也。若乳头不肿，病专于胃；乳头独肿，病专于肝。虽两经有分司，而病源终一。知其一元之发泄，治法终不出回阳、纳气、封髓、潜阳诸方。苟以为风寒、气滞所作，定有寒热往来，头疼身痛，红肿痛甚，口渴种种病形，方可与行气、活血、解散诸方治之。此病当与附子理中汤加吴茱萸，方解见上。
问曰：两胁忽肿起一埂，色赤如硃，隐隐作痛，身重，爪甲青黑者，何故？
答曰：此厥阴阴寒太盛，逼出元阳所致也。夫两胁者，肝之部位也，今肿起一埂如硃，隐隐作痛，近似肝经风火抑郁所作，其实不然。
若果系肝经风火，则必痛甚，身必不重，爪甲必不青黑。今纯见厥阴阴寒之象，故知其元阳为阴寒逼出也。粗工不识，一见肿起，色赤如硃，鲜不以为风火抑郁所作，而并不于身重、爪甲青黑、不痛处理会，直以清凉解散投之，祸不旋踵。法宜回阳祛阴，方用四逆汤，重加吴茱萸。解见上。
问曰：病人头面四肢瘦甚，少腹大如匏瓜，唇色青滑，不思食物，气短者，何故？
答曰：此阳虚为阴所蔽也。夫四肢禀气于胃，胃阳不足，而阴气蔽之，阳气不能达于四末，故头面肌肉瘦甚，阴气太盛，隔塞于中，而成腹胀，实不啻坚冰之在怀也。身中虽有微阳，亦将为坚冰所灭，安望能消化坚冰哉（坚冰喻阴盛也）！法宜峻补其阳，阳旺而阴自消，犹日烈而片云无。方用四逆汤，或附子理中汤加砂、半。方解见上。或又曰：腹胀之病亦多，皆阳虚而阴蔽乎？曰：子不知人之所以立命者，在活一口气乎？气者阳也，阳行一寸，阴即行一寸；阳停一刻，阴即停一刻。可知阳者，阴之主也。阳气流通，阴气无滞，自然胀病不作。
阳气不足，稍有阻滞，百病丛生，岂独胀病为然乎？他如诸书所称气胀、血胀、风胀、寒胀、湿胀、水胀、皮肤胀，是论其外因也。如脾胀，肾胀、肺胀、肝胀、心胀，是论其内因也。外因者何？或因风寒入里，阻其气机，或因暑湿入里，阻其升降，或因燥热入里，阻其往来，延绵日久，精血停滞。感之浅者，流于皮肤，感之深者，流于腹内，若在手足骨节各部，便成疮疡疔毒。阻在上焦，胸痹可决；阻在中焦，中满症属；阻在下焦；腹满症作。内因者何？或因脾虚日久，而脾气散漫；或因肾虚日久，而肾气涣散；或因肝虚日久，而肝气欲散；或因肺虚日久，而肺气不敛；或因心虚日久，而心气发泄。凡此之类，皆能令人作胀。大抵由外而入者，气机之阻，由内而出者，气机之散也。阻者宜开，调气行血，随机斡运为要；散者宜收，回阳纳气温补为先。然胀与肿有别，胀者从气，按之外实而内空；肿者从血，按之内实而外亦实。治胀者，宜养气、宜补气、宜收气，忌破气、忌耗气、忌行气，尤贵兼养血。治肿者，宜活血、宜行血、宜破血，忌凉血、忌止血、忌敛血，尤须兼行气。学者欲明治胀之要，就在这一气字上判虚实可也。
问曰：前后二便不利，三五日亦不觉胀，腹痛，舌青滑，不思饮食者，何故？
答曰：此下焦之阳虚，而不能化下焦之阴也。夫一阳居于二阴之中，为阴之主。二便开阖，全赖这点真阳之气机运转，方能不失其职。
今因真气太微，而阴寒遂甚，寒甚则凝，二便所以不利也。况舌青、腹痛、不食，阴寒之实据已具。法宜温补下焦之阳，阳气运行，阴寒之气即消，而病自愈也。方用四逆汤加安桂，解见上。若热结而二便不利者，其人烦躁异常，定见黄白舌苔，喜饮冷水，口臭气粗可凭。
学者若知此理，用药自不错误也。
【阐释】二便不利，有热结与阳虚之不同，须细审各种兼症而分别用药。此病腹痛、舌青、食少，纯是一片阴寒景象，而断为下焦阳虚不能化阴，故治以四逆汤加桂。四逆汤已属回阳救逆之主方，更加辛热之肉桂以助其祛寒消阴之力，而取效益速。若其人烦躁异常，现黄白舌苔，喜饮冷水，口臭气粗，则属于热结。大便不利者，法宜养血、清热、润燥，麻仁丸主治之；小便不利者，法宜养阴、清热，导赤散主之。
问曰：病人每日交午初即寒战，腹痛欲死，不可明状，至半夜即愈者，何故？
答曰：此阳虚而阴盛，阻其气机也。夫人身一点元阳，从子时起，渐渐而盛，至午则渐渐而衰，如日之运行不息。今病人每日交午初而即寒战腹痛者，午时一阴初生，正阳气初衰之候，又阴气复旺之时。
Q: A patient's tongue suddenly becomes immobile, limbs suddenly cannot be lifted, and they drool in their sleep without awareness. What is the cause?
A: This is due to excessive Yin causing Yuan Yang (the body's fundamental Yang energy) to fail in its securing and transporting functions. The joints and orifices of the entire body rely entirely on the distribution, protection, and movement of Zhen Qi (True Qi, the fundamental energy sustaining life). When Zhen Qi is robust, the body is agile and free, with regulated intake and output; how could there be immobility of the tongue, inability to lift limbs, or unaware drooling during sleep? Therefore, I directly conclude: this is caused by excessive Yin and the failure of Yuan Yang to secure and transport.
Another might say: Stroke (Zhong Feng) or Phlegm obstruction (Zhong Tan) can also cause immobility of the tongue and inability to lift limbs. Why do you exclusively emphasize Yang deficiency and Yin excess, raising no doubts? I reply: Do you not know the origins of stroke and phlegm obstruction? Wind enters from the exterior, while phlegm forms internally. Ultimately, it is because the person has a constitutional Yang deficiency and extreme damage, allowing external wind pathogens to invade through their void spaces. Wherever Yang declines, the wind pathogen strikes that location, hence the distinctions of striking the meridians, fu-organs, or zang-organs. Yang deficiency weakens the transportation power of the Middle Jiao (Spleen and Stomach), leading to an abundance of Yin in the Middle Jiao. Excessive Yin impairs transport and transformation, causing dampness from food and fluids to gather with internal Yin to form saliva and phlegm. Over time, Yang becomes weak, cold phlegm surges upward, blocking the clear pathways (respiratory tract and upper orifices), leading to sudden collapse and coma, termed "Phlegm Obstruction." This condition can be treated with Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) added with Sharen (Amomum Fruit) and Banxia (Pinellia Tuber); the formula explanation is seen above. For stroke, follow the methods in Chen Xiuyuan's *Medical Three Character Classic*. For phlegm obstruction, use Jiang Fu Fu Ban Tang (Ginger, Aconite, Poria, and Pinellia Decoction).
Jiang Fu Fu Ban Tang
Fresh Ginger 2 liang (extract juice), Fuzi (Prepared Aconite Root) 1 liang, Fuling (Poria) 8 qian, Banxia (Pinellia Tuber) 7 qian.
Explanation of Medicinal Intent
Regarding Jiang Fu Fu Ban Tang, it is a formula to restore Yang, counteract rebellion, move water, and resolve phlegm. Fresh Ginger is pungent and dispersing,宣散 (dispersing) stagnant cold; Fuzi is acrid, hot, and purely Yang, capable of rescuing the fire seed of the先天 (Pre-Heaven/Kidney). When True Fire flourishes, Yin-Cold dissipates instantly. Assisted by Fuling to strengthen the Spleen and move water (for water is the root of phlegm; when water goes, phlegm ceases), and further aided by Banxia to counteract rebellion and resolve phlegm, once phlegm and saliva are resolved, the pressure on the base of the tongue is relieved. With clear pathways unblocked, the Qi mechanism of the four limbs resumes operation, making extension and lifting easy.
Q: A healthy person suddenly suffers severe throat pain, intense heat in the upper body, ice-cold lower body, and mental confusion. What is the cause?
A: This is due to excessive Yin causing Zhen Qi to escape upward, having already detached from its root, which is extremely critical. Throat pain, if caused by pathogenic fire in various meridians, will not present as upper heat and lower cold, nor will it arise so abruptly. Now, it arises as swiftly as a galloping horse, with heat above and cold below, clearly indicating that the single ray of sunlight (Yang) is forced out by Yin and has detached from its root. One might ask: Since it is called a "healthy person," how can it immediately be termed Yang about to escape? I reply: Do you not know that what the human body relies upon for life is solely this Yang Qi? If Yang Qi is undamaged, hundred diseases naturally do not arise; if Yang Qi is damaged, groups of Yin rise. Excessive Yin can force out Yuan Yang, which then rushes upward, manifesting wherever the meridians and organs are deficient. If the deficiency connects to the eyes, Yuan Yang manifests in the eyes; if it connects to the ears, it manifests in the ears; if it connects to the vertex, it manifests at the vertex. This is the mechanism of Yuan Yang emission. If scholars can understand the destination of the One Yuan and the profound meaning of the Six Directions, then all conditions of Yang deficiency will be within their grasp. Although here we speak of a "healthy person," their damage was unknown to anyone, perhaps due to excessive sexual activity damaging Kidney Yang, excessive mental effort damaging Heart Yang, or irregular diet damaging Spleen Yang. However, some manifest only after accumulation over time, indicating thick Yuan Qi; others manifest immediately upon damage, indicating thin Yuan Qi. I often see healthy people who meet during the day but die at night; this must be due to thin Yuan Qi and the escape of Yuan Yang. Doctors may not even realize this, let alone those unfamiliar with medicine.
This section has fully exposed Yang deficiency; scholars must pay close attention to comprehend it. The appropriate formula is Qianyang Dan (Hidden Yang Powder); the explanation is seen above.
Q: Cough, panting, spontaneous sweating, restlessness, sensation of needing to defecate but unable to, urinary incontinence, and aversion to cold. What is the cause?
A: This is due to impending escape of True Yang and Yin Qi interfering with the clear pathways. Cough and panting originally have distinctions between exterior contraction and interior injury. The Classics state: "Cough never leaves the Lung." The Lung governs respiration and is the master of voice, a most pure and empty residence, originally tolerating no foreign Qi. Ancients compared it to a bell: struck externally, it rings; struck internally, it rings. This derives from the distinction between interior and exterior. Exterior contractions involve the six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) attacking the Lung, obstructing the outward flow of Lung Qi. Qi stagnation causes disordered respiration and cough, often accompanied by fever, headache, and body ache, best treated primarily with dispersing methods. The subtlety of dispersing lies in identifying the Six Meridians, ensuring accuracy.
Interior injuries result from Seven Emotions (Joy, Anger, Worry, Grief, Fear, Fright, Shock) damaging True Yang and True Yin. There may be fever, but without headache or body ache; even if fever occurs, it comes and goes. Cough caused by damage to True Yang involves excessive Yin, which inevitably interferes with the clear pathways. One must determine which Zang or Fu organ is damaged and seek treatment there, ensuring confidence in medication.
If cough is caused by damage to True Yin, Yang will be excessive, and Yang excess will also interfere with the clear pathways. Similarly, identify the damaged Zang or Fu organ and treat accordingly. Know that cough due to impending escape of True Yang is filled with pure Yin. Yin Qi surges upward, obscuring the sky like earth vapor forming clouds and fog, blinding the sun, reaching extreme gloom, causing the Dragon (Kan Yang) to fly. As the Dragon flies upward, the lower part becomes cold. Without Yang in the lower part, it cannot control the anterior and posterior orifices, leading to urge to defecate and urinary incontinence upon coughing. This is all caused by the Dragon failing to submerge. Physicians often treat cough merely as cough; have they heard this teaching? The method should be to restore Yang, counteract rebellion, warm the middle, counteract rebellion, or guide Qi back to its root. Use Sini Tang (Frigid Extremities Decoction), Fengsui Dan (Seal Marrow Pill), or Qianyang Dan; explanations are seen above.
Q: Severe chest and abdominal pain, face red as cinnabar, no desire for tea or water, relief only when pressed firmly with heavy objects, otherwise feeling like dying. What is the cause?
A: This is due to Yuan Qi violently emerging and contending with Yin. Chest and abdominal pain originally has nine types, all falling under Deficiency and Excess. Excess conditions reject touch; deficiency conditions welcome rubbing. Here, relief requires heavy pressure, worse than welcoming rubbing, indicating violent emergence of Yang. One might ask: Why does heavy pressure bring slight relief? I reply: Have you not observed fire rushing upward? Its momentum is fierce; pressing it with stone blocks its upward Qi mechanism. Once blocked, the upward rush stops. Now, the patient's Qi surges upward, face red as cinnabar, showing separation of Yang and Yin, hence severe pain. Heavy pressure acts like stone suppressing fire. This condition requires guiding Qi back to its root and restoring Yang to counteract rebellion. Use Jiawei Fuzi Lizhong Tang (Modified Aconite Decoction for Regulating the Middle) or Qianyang Dan; explanations are seen above.
[Interpretation] Chest and abdominal pain has nine types, as stated in Chen Xiuyuan's *Medical Three Character Classic*: "1. Worm pain, Wumei Wan; 2. Invasion pain, Suheli [San]; 3. Qi pain, Xiangsu [San]; 4. Blood pain, Shixiao San; 5. Palpitation pain, Miaoxiang [San]; 6. Food pain, Pingwei San; 7. Fluid pain, Erchen [Tang]; 8. Cold pain, Lizhong [Tang]; 9. Heat pain, Jinlingzi [San]." Each has a prescription, transcribed here for reference. Zheng summarizes them into Deficiency and Excess. Excess rejects pressure; deficiency welcomes rubbing. This case involves severe pain requiring heavy pressure and red face, diagnosed as Yang violently emerging and contending with Yin, showing separation of Yin and Yang. This diagnosis is precise. Thus, only guiding Qi back to its root and restoring Yang to counteract rebellion can cure it. Use Jiawei Fuzi Lizhong Tang or Qianyang Dan.
Q: Continuous vomiting of clear fluid, reduced appetite, ineffective treatment with all warming-middle and fire-supplementing medicines. What is the cause?
A: This is due to Kidney Qi failing to store, causing Kidney Water to overflow. Vomiting clear fluid is common in Stomach Cold, but since warming-middle and fire-supplementing medicines failed, it is clearly not Stomach Cold, thus identified as Kidney Water overflow.
One might ask: Is there a difference between Stomach Cold and Kidney Water overflow? I reply: In Stomach Cold, the Guan pulse is necessarily slow, lips and mouth pale white, and food preference leans toward spicy and hot items. In Kidney Water overflow, both Chi pulses are floating and slippery, lips and mouth blackish-red, no desire for any food, and frequent salty taste in the mouth. Stomach Cold is treated with Lizhong Tang. Kidney Water overflow is treated with Zishen Wan (Nourish Kidney Pill) or Guiling Zhugan Tang (Cinnamon Twig, Poria, Atractylodes, and Licorice Decoction).
Zishen Wan
Huangbai (Phellodendron Bark) 1 liang (stir-fried), Zhimu (Anemarrhena Rhizome) 8 qian, Angui (Cinnamon Twig) 3 qian.
Guiling Zhugan Tang
Guizhi (Cinnamon Twig) 8 qian, Fuling (Poria) 2 liang, Baizhu (Atractylodes Macrocephala Rhizome) 1 liang, Gancao (Licorice Root) 5 qian.
Explanation of Medicinal Intent
Zishen Wan is a formula to nourish water and guide Qi back to the Kidney. Zhimu and Huangbai are bitter and cold; bitterness strengthens the Kidney, cold nourishes Yin. The subtle brilliance lies in Angui (Cinnamon Twig). Cinnamon is pungent and warm; combined with Huangbai and Zhimu, it forms the Kan trigram (☵), with one Yang contained within two Yins, embodying the principle of "Heaven generates One, Water" and "Yang is the root of Yin." With Yang within Water, Water returns to its home, hence "Nourishing Kidney." Since this is not Stomach Cold but Water Overflow, although Earth fails to control Water, it is also because the Dragon (Kidney Yang) flees upward, taking Water with it. Now, with Angui supporting Heart Yang to unblock Kan Yang, Yang submerges, preventing water vomiting. One might ask: If Water overflows, adding Zhi and Bo (bitter/cold) won't make Water more vigorous and vomiting ceaseless? I reply: Do you not know the Dragon is the master of Water? When Dragon moves, rain falls; when Dragon hides, rain stops. Angui is the Dragon in the Water; Zhi and Bo are the Water. Water's indulgence depends on the Dragon. If the Dragon descends, how can Water not descend? This formula treats not only this disease but all conditions where Yang fails to transform Yin and Yin Qi erupts, yielding immediate results.
Guiling Zhugan Tang transforms Qi and moves Water. Guizhi is pungent and warm, transforming Bladder Qi; Fuling and Baizhu strengthen Spleen and remove Dampness. Transformation moves outward through skin; removal eliminates inwardly. Gancao tonifies Earth and controls Water. Here, Water overflows upward due to Kidney Qi eruption, but also because Taiyang Qi transformation is not unimpeded and Middle Earth Dampness is abundant. By strengthening Earth, Earth controls Water; by transforming Qi, Qi moves and divides Water. Divided Water becomes isolated and controlled by Earth. Hence included here. This formula treats not only this condition but is particularly suitable for all Spleen Deficiency edema and Phlegm-Fluid cough.
[Interpretation] Vomiting clear fluid and reduced appetite differ between Stomach Cold and Kidney Water Overflow, distinguishable by pulse, taste, and lip/mouth color. Stomach Cold heals with Lizhong Tang warming and strengthening Spleen/Stomach. Kidney Water Overflow responds poorly to warming-middle/fire-supplementing drugs. Zheng uses Zishen Wan or Guiling Zhugan Tang, skillfully applying established formulas. Zishen Wan, formulated by Li Dongyuan, originally treated Lower Jiao Damp-Heat and urinary retention using bitter-cold Zhi/Bo to clear heat, dry dampness, and nourish Yin, plus small amount of Rougui (Cinnamon Bark) to warm Kidney Yang and steam Water to transform Qi, enabling urination. Zheng utilizes the concept of one Yang within two Yins, Yang as Yin's root, guiding Water home. Bitter Zhi/Bo strengthen Kidney/nourish Yin; warm Rougui supports Heart Yang to unblock Kidney Yang, giving Water a home and restraint, preventing overflow. Thus, it treats all Yang failing to transform Yin and Yin erupting. Guiling Zhugan Tang, from *Shanghan Lun* and *Jingui Yaolue*, is a key formula for Phlegm-Fluid and Water-Dampness. Zheng uses it to transform Qi and move Water, evaporating Water through skin and promoting urination, stopping vomiting. Its ability to tonify Earth to control Water allows extension to Spleen Deficiency edema and Phlegm-Fluid cough. Modern applications include hypertension, concussion, corneal opacity, leukorrhea, ulcers, rheumatoid arthritis, and heart failure, with satisfactory results.
Q: After illness, breasts suddenly swell like plates, skin color normal, slight pain, heavy body, preference for lying down, no desire for any food. What is the cause?
A: This is due to excessive Yin and Yuan Qi emitting through Liver and Stomach meridians. Post-illness patients generally have insufficient Yang, easily re-injuring Yang. Yang decline and Yin excess cause the single ray of sunlight to attach to Liver/Stomach meridems and emit, hence normal color and slight pain. Heavy body and preference for lying down signal Yang decline/Yin excess. Nipples belong to Liver, breast disks to Stomach, hence diagnosis in Liver/Stomach. If nipples don't swell, disease is specific to Stomach; if only nipples swell, disease is specific to Liver. Though meridians have distinct functions, the source is one. Knowing this is Yuan Qi emission, treatment remains within restoring Yang, guiding Qi, sealing Marrow, and hiding Yang formulas. If mistaken for Wind-Cold or Qi Stagnation, one would expect alternating chills/fever, headache/body ache, severe red swelling/pain, thirst, etc., treatable with Qi-moving, Blood-invigorating, or dispersing formulas. This case uses Fuzi Lizhong Tang added with Wuzhuyu (Evodia Fruit); explanation seen above.
Q: Sudden swelling of a ridge in both hypochondriums, red as cinnabar, dull pain, heavy body, blue-black nails. What is the cause?
A: This is caused by excessive Jueyin Yin-Cold forcing out Yuan Yang. Hypochondriums are Liver territory. Swelling red as cinnabar with dull pain resembles Liver Meridian Wind-Fire depression, but it is not.
If truly Liver Wind-Fire, pain would be severe, body not heavy, nails not blue-black. Pure Jueyin Yin-Cold signs indicate Yuan Yang forced out by Yin-Cold. Crude physicians, seeing swelling and redness, rarely fail to diagnose Wind-Fire depression, ignoring heavy body, blue-black nails, and lack of severe pain, blindly administering cooling/dispersing drugs, bringing disaster quickly. Method: Restore Yang, dispel Yin. Use Sini Tang heavily added with Wuzhuyu; explanation seen above.
Q: Patient's head, face, and limbs are emaciated, lower abdomen swollen like a gourd, lips blue and slippery, no desire for food, shortness of breath. What is the cause?
A: This is Yang deficiency obscured by Yin. Limbs receive Qi from Stomach. Insufficient Stomach Yang obscured by Yin prevents Yang from reaching extremities, causing emaciation of head/face muscles. Excessive Yin blocks internally, causing abdominal distension, like holding solid ice. Even slight Yang inside would be extinguished by ice; how could it digest ice (Ice symbolizes Yin Excess)? Method: Vigorously tonify Yang. When Yang flourishes, Yin dissipates, like strong sun clearing clouds. Use Sini Tang or Fuzi Lizhong Tang added with Sharen and Banxia; explanation seen above. One might ask: Are all abdominal distensions due to Yang deficiency and Yin obscurity? I reply: Do you not know life depends on one breath? Qi is Yang. Yang moves one inch, Yin moves one inch; Yang stops one moment, Yin stops one moment. Yang is master of Yin. If Yang flows, Yin has no stagnation, and distension does not occur.
Insufficient Yang with slight blockage breeds hundred diseases, not just distension. Other texts mention Qi, Blood, Wind, Cold, Damp, Water, Skin distensions (external causes); Spleen, Kidney, Lung, Liver, Heart distensions (internal causes). External causes: Wind-Cold entering interior blocking Qi; Summerheat-Damp blocking ascent/descent; Dry-Heat blocking movement. Long duration leads to Essence/Blood stagnation. Superficial affects skin; deep affects abdomen; joints become sores/carbuncles. Blockage in Upper Jiao determines Chest Bi; Middle Jiao determines Fullness; Lower Jiao determines Abdominal Fullness. Internal causes: Spleen deficiency spreading Qi; Kidney deficiency scattering Qi; Liver deficiency dissolving Qi; Lung deficiency failing to astringe Qi; Heart deficiency emitting Qi. All cause distension. External entry blocks Qi mechanism; internal exit scatters Qi Mechanism. Blocked needs opening, regulating Qi/moving Blood, adapting to circumstances. Scattered needs gathering, restoring Yang/guiding Qi/warming tonification. Distension differs from Edema. Distension follows Qi: firm outside, hollow inside. Edema follows Blood: firm inside and out. Treat Distension: nourish, tonify, gather Qi; avoid breaking, consuming, moving Qi; preferably combine with nourishing Blood. Treat Edema: invigorate, move, break Blood; avoid cooling, stopping, astringing Blood; preferably combine with moving Qi. Scholars seeking mastery of distension should judge Deficiency/Excess based on this one Qi character.
Q: Difficulty in urination and defecation, no bloating felt after 3-5 days, abdominal pain, blue-slippery tongue, no desire for food. What is the cause?
A: This is Lower Jiao Yang deficiency failing to transform Lower Jiao Yin. One Yang resides within two Yins, mastering Yin. Opening/closing of bowels/bladder relies entirely on this True Yang Qi mechanism to function properly.
Now, True Qi is too weak, Yin-Cold becomes severe. Severe cold congeals, causing difficulty in excretion. Blue tongue, abdominal pain, anorexia confirm Yin-Cold. Method: Warm-tonify Lower Jiao Yang. As Yang operates, Yin-Cold dissipates, curing the disease. Use Sini Tang added with Angui (Cinnamon Twig); explanation seen above. If Heat Constriction causes difficulty, patient is extremely restless, yellow-white tongue coating, desires cold water, foul breath and coarse breathing are evident.
Scholars knowing this will not err in medication.
[Interpretation] Difficulty in excretion differs between Heat Constriction and Yang Deficiency; differentiate by accompanying symptoms. This case shows abdominal pain, blue tongue, low appetite, purely Yin-Cold scene, diagnosed as Lower Jiao Yang deficiency failing to transform Yin, treated with Sini Tang plus Gui (Cinnamon). Sini Tang is main formula for restoring Yang/rescuing from reversal; adding hot Gui enhances cold-dispelling/Yin-resolving power for faster effect. Restlessness, yellow-white coating, cold water desire, foul breath indicate Heat Constriction. Constipation: nourish Blood, clear Heat, moisten Dryness, use Maren Wan (Ephedra Seed Pill). Dysuria: nourish Yin, clear Heat, use Daochi San (Guide Out Redness Powder).
Q: Patient experiences chills and abdominal pain resembling death every day around midday (Wu hour), resolving by midnight. What is the cause?
A: This is Yang deficiency with Yin excess, blocking Qi mechanism. The body's single Yuan Yang grows from Zi hour (11 PM-1 AM), peaks, then declines at Wu hour (11 AM-1 PM), like the sun's movement. Patient experiencing chills/pain at Wu hour indicates Wu hour is when one Yin is born, Yang begins to decline, and Yin becomes prosperous again.