水离乎气，便是纯阴；人离乎气，即是死鬼。二物合而为一，无一脏不行，无一腑不到，附和相依，周流不已。气无形而寓于血之中，气法乎上，故从阳；血有形而藏于气之内，血法乎下，故从阴。此阴、阳、上、下之分所由来也。其实何可分也？二气原是均平。二气均平，自然百病不生，人不能使之和平，故有盛衰之别，水盛则火衰，火旺则水弱，此阴症、阳症所由来也。二气大象若分，其实未分，不过彼重此轻，此重彼轻耳。千古以来，惟仲景一人，识透一元至理，二气盈虚消息，故病见三阴经者，即投以辛热，是知其阳不足，而阴有馀也，故着重在回阳；病见三阳经者，即投以清凉，是知其阴不足，而阳有徐也，故着重在存阴。要知先有真火而后有君火，真火为体（体，本也，如灶心中之火种子也）,君火为用（用，末也，即护锅底之火，以腐熟水谷者也），真火存则君火亦存，真火灭则君火亦灭。观仲景于三阴阴极之症，专以四逆汤之附子，挽先天欲绝之真火，又以干姜之辛热助之，即能回生起死，何不曰补木以生火，用药以补心乎？于三阳阳极之症，专以大承气汤之大黄，以救先天欲亡之真阴，又以芒硝之寒咸助之，即能起死回生，何不曰补金以生水，用药以滋阴乎？仲景立法，只在这先天之元阴、元阳上探取盛衰，不专在后天之五行生克上追求，附子、大黄，诚阴阳二症之大柱脚也。世风日下，稍解一二方，得一二法者，即好医生也。究竟仲景心法，一毫不识，开口即在这五行生克上论盛衰，是知其末而未知其本也。余为活人计，不得不直切言之。余再不言，仲景之道，不几几欲灭乎？余更有解焉。人身原凭二气充塞上下四旁：真阳或不足于上，真阴之气即盛于上而成病，用药即当扶上之阳以协于和平；真阳或不足于中，真阴之气即盛于中而成病，用药即当扶中之阳以协于和平；真阳或不足于下，真阴之气即盛于下而成病，用药即当扶下之阳以协于和平。此三阳不足，为病之主脑也。阴气或不足于上，阳气即盛于上而成病，用药即当扶上之阴，而使之和平；阴气或不足于中，阳气即盛于中而成病，用药即当扶中之阴，而使之和平；阴气或不足于下，阳气即盛于下而成病，用药即当扶下之阴，而使之和平，此三阴不足，为病之主脑也。二气之不足，无论在于何部，外之风、寒、暑、湿、燥、火六气，皆得乘其虚而入之以为病。
凡外感之邪，必先犯皮肤。皮肤为外第一层，属太阳（太阳为一身之纲领，主皮肤、统营卫故也）。次肌肉（肌肉属胃），次血脉（血脉属心），次筋（筋属肝），次骨（骨属肾）。乃人身之五脏，又分出五气。五行皆本二气所生，二气贯通上中下，故三焦又为一经，而成六步也。外邪由浅而始深，内伤则不然。七情之扰，重在何处，即伤在何处，随其所伤而调之便了，此论外感、内伤之把握也。学者苟能体会得此篇在手，庶可工于活人，而亦可与言医也。
医理真传卷三
阴虚症门问答
问曰：头脑独发热，心烦热，小便短赤，咽干者，何故？
答曰：此心热移于小肠，小肠热移于肾也。夫肾上通于脑，脑热由肾热也。肾为水脏，统摄前后二阴，前阴即小肠膀胱，后阴即阳明大肠。肺与大肠为表里，心与小肠为表里。今因心热移于小肠，小肠受热，故便短；小肠血液为热所灼，势必乞救于肾水，热及于肾。肾水为邪火所扰，不能启真水上腾，故咽干；真水不能上交于巅，故脑热。法宜养阴、清热、降火为主，方用导赤散。
导赤散
生地一两木通五钱甘草三钱淡竹叶二钱
用药意解
按导赤散一方，乃养阴、清热、降火和平之方也。夫生地黄甘寒入肾，凉血而清热，肾热清而脑热自解。木通甘淡，能降心火下行，导热从小便而出，故曰导赤。竹叶甘寒，寒能胜热。甘草味甘，最能缓正，亦能清热。此方行气不伤气，凉血不伤血，中和之剂，服之无伤，功亦最宏，苟能活法圆通，发无不中也。
问曰：两上眼皮红肿痛甚，下眼皮如常，渐渐烦渴，饮冷者，何故？
答曰：此元阴不足于胃之上络，胃中之火，遂发于上而津液伤也。
夫上眼皮属阳明胃，下眼皮属太阴脾。今病在胃而不在脾，故上肿而下不肿，胃火太盛，渐伤津液，故口渴饮冷。然未至饮冷，阴血尚未大伤；若已至饮冷，阳明之腑症悉具。苟谓风、寒之时气所作，必有风、寒之实据可验。此则无故而发，现于阳明地界，故知其元阴不足于胃之上络，胃中之火，得以袭之也。法宜灭火救阴为主，方用人参白虎汤。
人参白虎汤
如无人参，即以洋参、沙参代之。
人参五钱石膏八钱知母六钱甘草二钱粳米一撮
古方分两，石膏用至一斤，知母六两，人参三两，甘草二两，米六合。因阳明胃火燎原，盘踞中宫，周身精血，顷刻有灼尽之势，非杯水可救，故施猛剂，取其速灭也。若此病虽属胃火，不得照此例以施之，故改用分两，不失经旨，可也。
用药意解
按人参白虎汤一方，乃灭火救阴之神剂也。夫病人所现病形，未见阳明之实据，不得妄施；若已现阳明之实据，即当急投。今病人上眼皮红肿痛甚，又见口渴饮冷，明明胃火已盛，津液已伤，此际若不急用人参以扶元阴，石膏以清胃热，知母以滋化源，甘草、粳米以培中气，势必灼尽津液，为害匪轻。此等目疾，不得不用此方。若视此方专为伤寒之阳明症立法，则为固执不通。不知仲景立法，方方皆是活法，凡属阳明之燥热为病者，皆可服也。妙处即在分两轻重上颠倒。
今人过畏石膏不用，往往误事，实由斯道之不明，六经之不讲也。
问曰：两耳前后红肿痛甚，口苦者，何故？
答曰：此元阴不足于少阳之经，少阳经之阳气旺而为病也。夫两耳前后，俱属少阳地界，今红、肿、痛甚，少阳之火旺可知。如系风、寒阻滞所作，必现头痛、身痛、寒热往来之候；内有抑郁所作，必有忧思不解之情；审察内外无据，则元阴之不足无疑。元阴之不足，亦有由生。有因脾胃久伤，而生化太微；有因房劳过度，元阳不足，而转运力微，阴血渐虚，即不能滋荣于木，木燥而木病丛生，此红、肿、疼、痛、耳聋、口苦、胁痛、筋挛诸症作矣。兹揭出于两耳前后，不言胁痛、筋挛，举一隅也。其中更有至要者，人身上下四旁，全凭元阴、元阳二气充塞，元阴不足，无论在于何部，元阳之气即旺于元阴不足之部而成病。元阳不足，亦无论在于何部，元阴之气即旺于元阳不足之部而成病。然二气寓于凡精凡气之中，凡精气盛，元阴元阳自盛，凡精气衰，元阴元阳自衰，此二气盈虚消息机关，发病主脑。论二气，论部位，六经自在其中；验外感，察内伤，戕伐之机关自定。
知得此理，仲景之心法可通，明澈无疵，调和水火之方有据。此病可与小柴胡汤倍人参、黄芩。
小柴胡汤
人参八钱柴胡六钱黄芩七钱半夏四钱甘草三钱大枣四枚生姜三钱
古方柴胡用至半斤，黄芩三两，人参三两，甘草二两，生姜三两，半夏半升，大枣十二枚，是因寒伤太阳之气，不能从胸出入，逆于胸胁之间，留于少阳地界，少阳居半表半里之间，从表则热，从里则寒，故少阳主寒热往来。今为太阳未解之邪所侵，中枢不运，仲景立小柴胡一法，实以伸少阳之木气，木气伸，而太阳未解之邪，亦可由中枢之转运而外出矣。
用药意解
按小柴胡汤一方，乃表里两解之方，亦转枢调和之方也。夫此方本为少阳之经气不舒立法，实为太阳之气逆胸胁立法。仲景以治太阳，实以之治少阳，治少阳即以治太阳也，人多不识。余谓凡属少阳经病，皆可服此方，不必定要寒伤太阳之气逆于胸胁，不能外出者可服。若此病红肿，确实已在少阳，无外感，无抑郁，非元阴之不足而何。将古方改用分两，以人参之甘寒为君，扶元阴之不足，柴胡苦平为臣，舒肝木之滞机，佐黄芩之苦以泻少阳之里热，佐半夏、生姜之辛散，以宣其胁聚之痰水，枣、甘为使，以培中气。然枣、甘之甘，合苦寒之品，可化周身之阴，合辛散之品，可调周身之阳，化阳足以配阴，化阴足以配阳，阴阳合配，邪自无容，故能两解也。然古方重柴胡，功在转其枢，此方倍参、芩，功在养阴以清其热。变化在人，方原无定。总在活活泼泼天机，阴阳轻重处颠倒，不越本经界限，可也。
问曰：鼻尖红肿，上牙龈肿痛，大便不利，烦躁谵语，口渴饮冷者，何故？
答曰：此元阴不足于胃，胃火旺盛，阴血又反伤也。夫元阴之气，若无一脏不足，必无红肿火症之虞，人只知为风邪、火邪所作，而不知元阴之早亏于内也。阴虚则火旺，故火症丛生。今病人所现症形，已具阳明之里症，此刻胃火旺极，阴血衰甚也。须知凡血之内寓元阴，凡气之内寓元阳，病人元阴先不足而火生，火生太烈，更足以伤其凡血。故曰："壮火食气"，食气者，食尽元阴之气也。世医以桂、附为壮火，不知桂、附补元阳之衰，阳虚人之要药，非阳旺阴虚之所宜也。
此病法宜泻火救阴为主，方用大承气汤主之。
大承气汤
芒硝六钱大黄五钱枳实三钱厚朴八钱古方厚朴用至半斤，大黄四两，枳实五枚，芒硝五合，是因太阳之邪流入燥地，已经化为热邪，大实、大满、大聚、大便不通，狂叫、腹痛，脉沉、实。阳明至此，非清凉、升散可解，惟有下夺一法。仲景故立此方，以为阳明之将坏立法。然未至里实之盛者，亦可改分两以施之，不失本经里症宗旨，可也。
用药意解
按大承气汤一方，乃起死回生之方，亦泻火救阴之方也。夫病人胃已经实，元阴将亡，已在瞬息之间，苟不急用大黄、芒硝苦寒之品，以泻其亢盛之热，枳实、厚朴苦温之味，以破其积滞之邪，顷刻元阴灼尽，而命即不生。仲景立法，就在这元阴、元阳上探盛衰，阳盛极者阴必亡，存阴不可不急，故药之分两，不得不重。阴盛极者阳必亡，回阳不可不急，故四逆汤之分两，亦不得不重。二方皆有起死回生之功，仲景一生学问，阴阳攸分，即在二方见之也。他如一切方法，皆从六气变化而出，六经主气为本，各有提纲界限；六气为客，各有节令不同，不得混视。至于此病，虽具阳明里症，尚未大实之甚，而即以此方改分两治之，不失本经里症治法，分两虽殊，时势亦异，学者苟能细心体会，变化自有定据也。
问曰：两目两眥，赤脉缕缕，痛甚，舌肿厚，小便不利者，何故？
答曰：此元阴不足，而少阴火沸也。夫大小眼角属心与小肠，二经之元阴不足，元阳之气便盛而为病，即为客邪，不必定要风寒闭塞而作，才为客气。知得此理，便得二气盈虚消息主客之道。况目窠乃五脏精华所聚之地，原著不得一毫客气，著一毫客气，则目病丛生。
客气二字，外指风、寒、暑、湿、燥、火时气，内指元阴、元阳偏盛所现，与风、寒、暑、湿、燥、火时气不同。从外感来者，必有发热、头痛、清涕、畏寒等情；从内二气发者，必无外形可征。元阴不足为病者，火必旺，即为实邪，多红、肿、痛甚；元阳不足为病者，阴必盛，即为虚邪，多不肿痛。即有肿痛甚者，乃元阳外脱之候，必现阴象以为据。若无阴象可验，便是实火，此认症之要也。目科虽云七十二种，总不出阴、阳、虚、实四字，目科以五脏所属，名为五轮。风轮主肝，黑珠也；血轮主心，两眦也；气轮主肺，白睛也；水轮主肾，瞳子也；肉轮主脾，上下皮也。又分八廓，八廓即乾、坎、艮、震、巽、离、坤、兑是也，其要原不在此，学者务要在二气偏盛上求之，六气上求之，可也。此病两眦与舌肿，小便不利者，心与小肠皆热也。
法宜养阴清热为主，方用大剂导赤散，加洋参、黄连主之，解见上。
问曰：咽喉痛，干咳无痰，五心烦热，欲饮冷者，何故？
答曰：此元阴不足，而少阴火旺逼肺也。夫少阴之脉挟咽喉，喉之痛由于火旺，肺之咳由于火逼，无痰者，火盛而津枯，五心烦热者，元阴虚而为邪火灼，欲饮冷者，阴欲阴以救也。法宜清热润燥救阴为主。方用黄连阿胶汤主之。
黄连阿胶汤
黄连四钱黄芩四钱芍药二钱阿胶二钱鸡子黄二枚
用药意解
按黄连阿胶汤一方，乃交阴阳之方，实养阴、清热之方也。夫此方本为少阴热化症而为心烦不得卧者立法。盖心烦者，坎中之精不能上交于心；不得卧者，离中之阴不能下降于肾。方中芩、连、芍药之苦，直清其热，又得鸡子黄以补离中之气，阿胶以补坎中之精，坎、离得补，阴、阳之气自调，升、降不乖，而水、火互为其根矣。今病人所现症形，全系元阴亏损，元阳变为客邪所作，故取苦寒柔润之品，以滋其枯涸之区，俾火熄而阴可立复，病可立瘳也。古方分两，立意不同，故所用甚重，今病势稍异，故改用之。
问曰：产妇二三日，偶有小疾，服行瘀破滞之药不效，延至月馀，酿成周身肿胀，又服消胀之药，更加乳肿不食，肛门逼胀，痛欲死者，何故？
When water separates from qi, it becomes pure yin; when a person loses qi, they become a dead ghost. The two (water and qi/blood) combine into one, without any zang organ that does not circulate it, without any fu organ that does not reach it; they support and rely on each other, flowing continuously. Qi is formless and resides within blood; qi follows the upper, thus belonging to yang. Blood is有形 (has form) and is stored within qi; blood follows the lower, thus belonging to yin. This is the origin of the division between yin, yang, upper, and lower. In reality, how can they be separated? Qi and blood are originally balanced. When qi and blood are balanced, naturally no diseases arise. Humans cannot maintain their harmony, hence distinctions of excess and deficiency emerge: when water (yin) is excessive, fire (yang) is deficient; when fire (yang) is vigorous, water (yin) is weak. This is the origin of yin syndromes and yang syndromes. The macroscopic appearance of the two energies seems divided, but in essence, they are not divided; it is merely that one is heavy and the other light, or vice versa. Since ancient times, only Zhang Zhongjing has penetrated the ultimate principle of the One Origin, understanding the waxing and waning of the two energies. Therefore, when diseases manifest in the Three Yin meridians, he administered acrid-hot medicines, knowing that yang was insufficient and yin was excessive, thus focusing on restoring yang. When diseases manifested in the Three Yang meridians, he administered cooling medicines, knowing that yin was insufficient and yang was excessive, thus focusing on preserving yin. It must be known that True Fire (Mingmen Fire) exists first, then Ministerial Fire (Heart Fire); True Fire is the substance (ti, the root, like the seed of fire in a stove), and Ministerial Fire is the function (yong, the application, like the fire protecting the pot bottom to cook food). If True Fire exists, Ministerial Fire exists; if True Fire extinguishes, Ministerial Fire extinguishes. Observing Zhang Zhongjing's treatment of extreme yin syndromes in the Three Yin meridians, he specifically used Aconite (Fuzi) in Sini Tang to rescue the nearly extinct True Fire of the congenital foundation, assisted by the acrid-hot properties of Dried Ginger (Ganjiang), thereby reviving the dying. Why not say it supplements Wood to generate Fire, or uses medicine to tonify the Heart? For extreme yang syndromes in the Three Yang meridians, he specifically used Rhubarb (Dahuang) in Dachengqi Tang to save the perishing True Yin of the congenital foundation, assisted by the cold-salty properties of Mirabilite (Mangxiao), thereby reviving the dying. Why not say it supplements Metal to generate Water, or uses medicine to nourish Yin? Zhang Zhongjing established his principles by probing the excess and deficiency of the congenital Primal Yin and Primal Yang, rather than exclusively pursuing the generation and restriction cycles of the acquired Five Elements. Fuzi and Dahuang are indeed the main pillars for treating yin and yang syndromes respectively. As customs decline, those who understand just one or two formulas or methods are called good doctors. They know nothing of Zhang Zhongjing's core method; opening their mouths, they discuss excess and deficiency based solely on the Five Elements' generation and restriction, knowing the branch but not the root. For the sake of saving lives, I must speak directly. If I do not speak again, will the Way of Zhang Zhongjing not be on the verge of extinction? I have further explanations. The human body relies on these two energies to fill the upper, lower, front, back, and sides. If True Yang is insufficient above, True Yin qi becomes excessive above, causing disease; medication should support the Yang above to restore harmony. If True Yang is insufficient in the middle, True Yin qi becomes excessive in the middle, causing disease; medication should support the Yang in the middle to restore harmony. If True Yang is insufficient below, True Yin qi becomes excessive below, causing disease; medication should support the Yang below to restore harmony. These three types of Yang insufficiency are the main focus of disease. If Yin qi is insufficient above, Yang qi becomes excessive above, causing disease; medication should support the Yin above to bring it to harmony. If Yin qi is insufficient in the middle, Yang qi becomes excessive in the middle, causing disease; medication should support the Yin in the middle to bring it to harmony. If Yin qi is insufficient below, Yang qi becomes excessive below, causing disease; medication should support the Yin below to bring it to harmony. These three types of Yin insufficiency are also the main focus of disease. Regardless of where the insufficiency of the two energies lies, the external Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) will take advantage of the deficiency to invade and cause disease.
All external pathogenic factors must first attack the skin. The skin is the first layer of the exterior, belonging to the Taiyang (Taiyang is the guideline of the whole body, governing the skin and controlling Ying and Wei). Next is muscle (muscle belongs to the Stomach), next is blood vessels (blood vessels belong to the Heart), next is tendons (tendons belong to the Liver), next is bone (bone belongs to the Kidney). These are the five Qi distributed from the five Zang organs. The Five Elements all originate from the Two Energies, which penetrate the upper, middle, and lower; thus, the Sanjiao is another meridian, forming six steps. External pathogens go from shallow to deep, whereas internal injuries are different. Disturbances from the Seven Emotions injure where they are most concentrated; one simply regulates according to the site of injury. This is the key to grasping external and internal injuries. If scholars can comprehend this passage, they may excel in saving lives and can be spoken to regarding medicine.
Yi Li Zhen Chuan, Volume 3
Q&A on Yin Deficiency Syndromes
Question: Why does the head alone feel hot, with mental restlessness, heat sensation, short dark urine, and dry throat?
Answer: This is due to Heart Heat transferring to the Small Intestine, and Small Intestine Heat transferring to the Kidney. The Kidney connects upward to the brain; brain heat arises from Kidney heat. The Kidney is the Water Organ, governing the anterior and posterior orifices. The anterior orifice includes the Small Intestine and Bladder; the posterior orifice is the Yangming Large Intestine. The Lung and Large Intestine are interior-exterior pairs; the Heart and Small Intestine are interior-exterior pairs. Now, because Heart Heat transfers to the Small Intestine, the Small Intestine receives heat, resulting in short urine. The blood in the Small Intestine is scorched by heat, inevitably seeking rescue from Kidney Water, so heat reaches the Kidney. Kidney Water is disturbed by evil fire and cannot ascend the True Water, causing dry throat; True Water cannot ascend to the crown, causing head heat. The treatment method should prioritize nourishing Yin, clearing heat, and descending fire, using Daochi San.
Daochi San (Cinnamon Twig Decoction variant / Guide Out Red Powder)
Shengdi Huang (Rehmanniae Radix Preparata) 1 liang, Mutong (Akebiae Caulis) 5 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 3 qian, Dan Zhuye (Lophatheri Folium) 2 qian.
Explanation of Medication Intent
Regarding Daochi San, it is a harmonious formula for nourishing Yin, clearing heat, and descending fire. Sheng Di Huang is sweet and cold, entering the Kidney, cooling blood and clearing heat; once Kidney heat is cleared, brain heat resolves naturally. Mutong is sweet and bland, capable of descending Heart Fire and guiding heat out through urination, hence named "Guide Out Red." Zhu Ye is sweet and cold; cold overcomes heat. Gancao is sweet, best at moderating the righteous Qi, and also clears heat. This formula moves Qi without damaging Qi, cools Blood without damaging Blood; it is a neutral agent, safe to take, and highly effective. If applied flexibly, it will hit the mark every time.
Question: Why are both upper eyelids severely red, swollen, and painful, while the lower eyelids are normal, gradually leading to mental restlessness, thirst, and desire for cold drinks?
Answer: This is due to Primal Yin being insufficient in the upper collaterals of the Stomach, causing Stomach Fire to flare upward and damage fluids.
The upper eyelid belongs to the Yangming Stomach, and the lower eyelid belongs to the Taiyin Spleen. Now the disease is in the Stomach, not the Spleen, so the upper swells while the lower does not. Stomach Fire is too vigorous, gradually damaging fluids, hence thirst and desire for cold drinks. However, if there is no desire for cold drinks yet, Yin Blood has not been greatly damaged; if there is already a desire for cold drinks, all Yangming Fu syndromes are present. If one claims this is caused by Wind-Cold seasonal pathogens, there must be concrete evidence of Wind-Cold. Here, it arises without cause, appearing in the Yangming territory, so we know it is Primal Yin insufficiency in the upper Stomach collaterals, allowing Stomach Fire to invade. The treatment method should prioritize extinguishing fire and saving Yin, using Renshen Baibu Tang.
Renshen Baibu Tang (Ginseng and White Tiger Decoction)
If Renshen (Ginseng Radix) is unavailable, substitute with Yangshen (American Ginseng Radix) or Shashen (Glehniae Radix).
Renshen 5 qian, Shigao (Gypsum Fibrosum) 8 qian, Zhimu (Anemarrhenae Rhizoma) 6 qian, Gancao 2 qian, Jingmi (Oryza Sativa) a pinch.
In ancient formulas, Shigao was used up to 1 jin, Zhimu 6 liang, Renshen 3 liang, Gancao 2 liang, and rice 6 he. Because Yangming Stomach Fire rages like a prairie fire, occupying the central palace, the essence and blood of the whole body are on the verge of being scorched away instantly; a cup of water cannot save it. Thus, strong agents are used to achieve rapid extinguishment. If this disease belongs to Stomach Fire but does not fit this pattern, do not apply it blindly. Modifying the dosage to suit the condition, while adhering to the classic principles, is acceptable.
Explanation of Medication Intent
Regarding Renshen Baibu Tang, it is a miraculous agent for extinguishing fire and saving Yin. If the patient's symptoms do not show concrete evidence of Yangming excess, it must not be used recklessly; if Yangming excess evidence is present, it should be administered urgently. Now, the patient has severe redness, swelling, and pain in the upper eyelids, along with thirst and desire for cold drinks. Clearly, Stomach Fire is vigorous and fluids are damaged. At this moment, if Renshen is not urgently used to support Primal Yin, Shigao to clear Stomach Heat, Zhimu to nourish the source of transformation, and Gancao and Jingmi to cultivate Middle Qi, fluids will surely be scorched away, causing grave harm. Such eye diseases necessitate this formula. Viewing this formula as exclusively legislated for the Yangming syndrome of Shanghan (Cold Damage) is rigid and inflexible. One must not know that Zhang Zhongjing's legislation consists of living methods; any disease caused by Yangming dryness-heat can take it. The subtlety lies in the inversion of dosage weights.
Modern people fear Shigao excessively and do not use it, often causing errors, truly due to ignorance of this principle and neglect of the Six Meridians.
Question: Why are both areas in front of and behind the ears severely red, swollen, and painful, with a bitter taste in the mouth?
Answer: This is due to Primal Yin being insufficient in the Shaoyang meridian, causing Shaoyang Yang Qi to become vigorous and cause disease. Both areas in front of and behind the ears belong to the Shaoyang territory. Now, with severe redness, swelling, and pain, it is evident that Shaoyang Fire is vigorous. If caused by Wind-Cold obstruction, there would necessarily be headache, body ache, and alternating chills and fever; if caused by internal depression, there would necessarily be unresolved sorrow and worry. Examining internal and external factors yields no basis, confirming Primal Yin insufficiency. Primal Yin insufficiency also has origins. Some arise from long-term Spleen-Stomach injury, leading to insufficient transformation and production; some arise from excessive sexual exertion, causing Primal Yang insufficiency and weak transport, gradually depleting Yin Blood, which fails to nourish Wood. Wood becomes dry, and Wood diseases proliferate, resulting in these symptoms of redness, swelling, pain, deafness, bitter taste, hypochondriac pain, and tendon spasms. Here, only the ear symptoms are listed, omitting hypochondriac pain and tendon spasms, to illustrate by analogy. There is a more crucial point: the entire body relies on Primal Yin and Primal Yang to fill the spaces. If Primal Yin is insufficient anywhere, Primal Yang Qi becomes vigorous in that deficient area, causing disease. If Primal Yang is insufficient anywhere, Primal Yin Qi becomes vigorous in that deficient area, causing disease. However, these two energies reside within ordinary Essence and Qi. When ordinary Essence and Qi are abundant, Primal Yin and Yang are naturally abundant; when they are depleted, Primal Yin and Yang are naturally depleted. This is the mechanism of the waxing and waning of the two energies, the main focus of disease onset. Discussing the two energies and their locations encompasses the Six Meridians; examining external infections and internal injuries determines the mechanism of destruction.
Understanding this principle allows one to comprehend Zhang Zhongjing's core method, achieving clarity without flaw, and providing a basis for formulas that harmonize Water and Fire. This disease can be treated with Xiaochaihu Tang, doubling the dosage of Renshen and Huangqin.
Xiaochaihu Tang (Minor Bupleurum Decoction)
Renshen 8 qian, Chaihu (Bupleuri Radix) 6 qian, Huangqin (Scutellariae Radix) 7 qian, Banxia (Pinelliae Rhizoma) 4 qian, Gancao 3 qian, Dazao (Ziziphi Jujubae Fructus) 4 pieces, Shengjiang (Zingiberis Rhizoma Recens) 3 qian.
In ancient formulas, Chaihu was used up to half a jin, Huangqin 3 liang, Renshen 3 liang, Gancao 2 liang, Shengjiang 3 liang, Banxia half a sheng, and Dazao 12 pieces. This was because Cold injured Taiyang Qi, preventing it from exiting via the chest, reversing into the chest and hypochondrium, and remaining in the Shaoyang territory. Shaoyang resides between the exterior and interior; following the exterior brings heat, following the interior brings cold, hence Shaoyang governs alternating chills and fever. Now invaded by unresolved Taiyang pathogens, the central pivot fails to operate. Zhang Zhongjing established Xiaochaihu Tang to extend Shaoyang Wood Qi. Once Wood Qi extends, the unresolved Taiyang pathogens can also exit via the central pivot's transport.
Explanation of Medication Intent
Regarding Xiaochaihu Tang, it is a formula for resolving both exterior and interior, and also for turning the pivot and harmonizing. This formula was originally legislated for Shaoyang meridian Qi stagnation, but effectively legislates for Taiyang Qi reversing in the chest and hypochondrium. Zhang Zhongjing used it to treat Taiyang, but essentially treats Shaoyang; treating Shaoyang is treating Taiyang, yet few recognize this. I believe any Shaoyang meridian disease can take this formula, not just cases where Cold injured Taiyang Qi, reversed in the chest and hypochondrium, and failed to exit. If this disease involves redness and swelling, definitely located in Shaoyang, with no external infection or depression, is it not Primal Yin insufficiency? Modifying the ancient formula's dosage: using Renshen's sweet-cold nature as the Sovereign herb to support Primal Yin insufficiency; Chaihu's bitter-pungent nature as the Minister herb to soothe Liver Wood stagnation; assisting with Huangqin's bitterness to drain Shaoyang interior heat; assisting with Banxia and Shengjiang's pungency to disperse phlegm-fluids gathered in the hypochondrium; Dazao and Gancao as the Envoy herbs to cultivate Middle Qi. However, the sweetness of Dazao and Gancao, combined with bitter-cold agents, can transform Yin throughout the body; combined with pungent-dispersing agents, it can regulate Yang throughout the body. Transformed Yang sufficiently matches Yin; transformed Yin sufficiently matches Yang. Yin and Yang match, leaving no room for pathogens, hence dual resolution. Ancient formulas emphasized Chaihu to turn the pivot; this modified formula emphasizes Renshen and Huangqin to nourish Yin and clear heat. Variation depends on the practitioner; formulas have no fixed form. It always lies in the lively Heavenly Mechanism, inverting the weight of Yin and Yang, without crossing the boundaries of the original meridian.
Question: Why is the nose tip red and swollen, upper gums swollen and painful, stool difficult to pass, mental restlessness, delirium, thirst, and desire for cold drinks?
Answer: This is due to Primal Yin being insufficient in the Stomach, Stomach Fire being vigorous, and Yin Blood being conversely injured. If Primal Qi were not insufficient in any Zang organ, there would be no danger of redness, swelling, or fire syndromes. People only know it as Wind or Fire pathogens, unaware that Primal Yin was already deficient internally. Yin deficiency leads to Fire hyperactivity, hence Fire syndromes proliferate. The symptoms presented now fully constitute Yangming Interior Syndrome; at this moment, Stomach Fire is extremely vigorous, and Yin Blood is severely depleted. Know that Yuan Yin resides within Blood, and Yuan Yang resides within Qi. The patient's Primal Yin was first insufficient, generating Fire; Fire generated too fiercely, further injuring ordinary Blood. Hence it is said: "Vigorous Fire consumes Qi." Consuming Qi means consuming Primal Yin. Modern physicians consider Guizhi (Cinnamomi Ramulus) and Fuzi as Vigorous Fire, not knowing that Guizhi and Fuzi are essential medicines for tonifying Primal Yang deficiency, suitable for Yang deficiency, not for Yang excess and Yin deficiency.
This disease's treatment method should prioritize draining fire and saving Yin, using Dachengqi Tang as the main prescription.
Dachengqi Tang (Major Order the Qi Decoction)
Mangxiao (Natrii Sulfas) 6 qian, Dahuang (Rhei Radix et Rhizoma) 5 qian, Zhishi (Aurantii Fructus Immaturus) 3 qian, Houpo (Magnoliae Officinalis Cortex) 8 qian. In ancient formulas, Houpo was used up to half a jin, Dahuang 4 liang, Zhishi 5 pieces, Mangxiao 5 he. This was because Taiyang pathogens flowed into the dry earth, transforming into Heat pathogens, causing great excess, fullness, accumulation, and constipation, screaming, abdominal pain, and deep, solid pulse. Reaching Yangming at this stage, cooling and ascending-dispersing methods cannot resolve it; only purgation works. Zhang Zhongjing established this formula for Yangming nearing collapse. However, if interior excess is not yet extreme, modifying the dosage is acceptable, adhering to the principles of interior syndromes in this meridian.
Explanation of Medication Intent
Regarding Dachengqi Tang, it is a formula for reviving the dying and draining fire to save Yin. The patient's Stomach is already excess, and Primal Yin is about to perish, within moments. If Dahuang and Mangxiao (bitter-cold) are not urgently used to drain excessive heat, and Zhishi and Houpo (bitter-warm) are not used to break stagnant pathogens, Primal Yin will be scorched away instantly, and life will be lost. Zhang Zhongjing's legislation probes excess and deficiency in Primal Yin and Yang. When Yang is extremely excessive, Yin must perish; saving Yin cannot be delayed, hence dosages must be heavy. When Yin is extremely excessive, Yang must perish; restoring Yang cannot be delayed, hence dosages in Sini Tang must also be heavy. Both formulas have the power to revive the dying. Zhang Zhongjing's lifelong scholarship distinguishes Yin and Yang, visible in these two formulas. All other methods emerge from the changes of the Six Qi. The Six Meridians' principal Qi is the root, with specific outlines and boundaries; the Six Qi as guests have different seasons, and must not be confused. As for this disease, although it presents Yangming interior symptoms, it is not yet extremely excess. Treating it with this formula, modified for dosage, adheres to the interior syndrome treatment principles of this meridian. Dosages differ, circumstances vary; if scholars carefully comprehend this, variations will have definite bases.
Question: Why are the inner and outer canthi of both eyes filled with red veins, severely painful, tongue swollen and thick, and urination difficult?
Answer: This is due to Primal Yin insufficiency and boiling Fire of the Shaoyin. The inner and outer canthi belong to the Heart and Small Intestine. When Primal Yin of these two meridians is insufficient, Primal Yang Qi becomes vigorous and causes disease, becoming a guest pathogen. It does not require Wind-Cold blockage to be considered a guest pathogen. Understanding this principle reveals the way of host and guest in the waxing and waning of the two energies. Moreover, the eye socket is the gathering place of the essence of the five Zang organs. Originally, it should not harbor even a trace of guest pathogen; harboring a trace causes eye diseases to proliferate.
"Guest Pathogen" externally refers to Wind, Cold, Summer-heat, Dampness, Dryness, and Fire seasonal pathogens; internally, it refers to manifestations of Primal Yin and Primal Yang imbalance, differing from the external seasonal pathogens. Those coming from external infections necessarily present fever, headache, clear nasal discharge, aversion to cold, etc.; those arising from internal two-energy imbalances necessarily lack external signs. When Primal Yin insufficiency causes disease, Fire must be vigorous, constituting an Excess Pathogen, often presenting with redness, swelling, and severe pain. When Primal Yang insufficiency causes disease, Yin must be excessive, constituting a Deficiency Pathogen, often lacking swelling and pain. Even if there is severe swelling and pain, it is a sign of Primal Yang escaping outward, necessarily presenting Yin signs as evidence. If no Yin signs can be verified, it is Excess Fire; this is the key to syndrome differentiation. Although ophthalmology mentions seventy-two types, they all fall under Yin, Yang, Deficiency, and Excess. Ophthalmology names the Five Wheels according to the five Zang organs. Wind Wheel governs the Liver (black pupil); Blood Wheel governs the Heart (canthi); Qi Wheel governs the Lung (white sclera); Water Wheel governs the Kidney (pupil); Flesh Wheel governs the Spleen (upper and lower eyelids). It is also divided into Eight Palaces (Bagua): Qian, Kan, Gen, Zhen, Xun, Li, Kun, Dui. The essence does not lie here; scholars must seek it in the imbalance of the two energies and the Six Qi. This disease involves red canthi, swollen tongue, and difficult urination, indicating Heat in the Heart and Small Intestine.
The treatment method should prioritize nourishing Yin and clearing heat, using a large dose of Daochi San, added with Yangshen and Huanglian. Explanation seen above.
Question: Why is there sore throat, dry cough without sputum, heat sensation in the five centers (palms, soles, chest), and desire for cold drinks?
Answer: This is due to Primal Yin insufficiency and vigorous Fire of Shaoyin forcing the Lung. The Shaoyin meridian flanks the throat; throat pain is due to vigorous Fire, lung cough is due to Fire forcing. No sputum indicates Fire is vigorous and fluids are dried up. Heat in the five centers indicates Primal Yin deficiency scorched by evil Fire. Desire for cold drinks indicates Yin seeking Yin to save itself. The treatment method should prioritize clearing heat, moistening dryness, and saving Yin, using Huanglian Ejiao Tang.
Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction)
Huanglian (Coptidis Rhizoma) 4 qian, Huangqin (Scutellariae Radix) 4 qian, Shaoyao (Paeoniae Radix Alba) 2 qian, Ejiao (Colla Corii Asini) 2 qian, Ji Zi Huang (Ovi Gallus Albumen) 2 pieces.
Explanation of Medication Intent
Regarding Huanglian Ejiao Tang, it is a formula for interacting Yin and Yang, actually a formula for nourishing Yin and clearing heat. This formula was originally legislated for Shaoyin Heat Transformation Syndrome presenting with mental restlessness and inability to sleep. Mental restlessness occurs because the Essence in Kan (Water/Kidney) cannot ascend to Heart; inability to sleep occurs because the Yin in Li (Fire/Heart) cannot descend to Kidney. The bitterness of Huangqin, Huanglian, and Shaoyao directly clears heat; combined with Ji Zi Huang to supplement Qi in Li, and Ejiao to supplement Essence in Kan, Kan and Li are supplemented, Yin and Yang Qi naturally harmonize, ascent and descent are orderly, and Water and Fire become roots of each other. Now the patient's symptoms are entirely due to Primal Yin depletion, with Primal Yang transforming into a guest pathogen. Thus, bitter-cold and soft-moist agents are taken to nourish the withered areas, extinguishing Fire so Yin can immediately recover and the disease heal. Ancient formula dosages had different intents, hence used heavily; current disease patterns differ slightly, hence modified dosages are used.
Question: A postpartum woman, after two or three days, accidentally contracted a minor illness. Taking blood-invigorating and stasis-resolving medicines was ineffective. Delayed for over a month, it developed into generalized edema. Taking distension-resolving medicines made breast swelling worse, loss of appetite, anal bearing-down sensation, and excruciating pain. What is the reason?