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The syndrome of Fanwei (Regurgitation) is not explicitly detailed in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). However, four profound principles are expounded in the chapter on Vomiting. Both its pulse and symptoms are based on the theory of declining Yang Qi (Vital Energy), yet these are presented implicitly. Here, they are specifically elucidated and placed after the section on Middle Jiao Cold to highlight the critical importance of Yang Qi in the human body. It also demonstrates that the Yang Qi in the chest differs from the True Yang in the Kidneys, making the mechanism for treating cold diseases clear in mind and eye.

Question: The patient has a rapid pulse. A rapid pulse indicates Heat, which should lead to efficient digestion of food and increased thirst; why does regurgitation occur instead? The Master said: This is due to excessive sweating, which caused Yang Qi to become weak and Diaphragm Qi to be deficient, resulting in a rapid pulse. This rapidness represents Guest Heat (transient or external heat), which cannot digest food, because the Stomach is deficient and cold. A wiry pulse indicates deficiency; there is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, transforming into Weifan (Stomantic Regurgitation). Cold is located in the Upper Jiao, but the physician incorrectly used purgatives, causing the pulse to become wiry; thus it is named "Deficiency."

This passage by Zhang Zhongjing describes the variations of pulses and symptoms with utmost subtlety. Generally, an excess of Yang results in a rapid pulse, while an excess of Yin results in a slow pulse. If a person's Yang Qi is already weak, how can the pulse be rapid? If the pulse is rapid, how can there be stomach cold and regurgitation? One must seek the cause. The rapidity of the pulse stems from the misuse of acrid-warm dispersing agents, leaving behind Guest Heat. The coldness of the stomach stems from insufficient Yang Qi generating internal cold. The physician, failing to understand flexibility and adaptation, seeing the rapid pulse, wrongly used cold medicines to purge non-existent heat, damaging both upper and lower Yang. Consequently, the pulse changed from Yin characteristics to a wiry quality. Insufficiency of Yang in the Upper Jiao means food consumed before noon cannot be digested. Insufficiency of Yang in the Lower Jiao means that after dusk, Yang does not enter Yin, and waste products are not transported to the Large and Small Intestines. What enters the mouth only exits through the mouth; hence, it is said that Stomach Qi has no surplus. This means the Yang Qi within the Stomach is barely preserved, leading to Fanwei, where food eaten in the morning is vomited in the evening.

At the Cun Kou (Radial Artery at the wrist), the pulse is faint and rapid. Faint indicates lack of Qi; lack of Qi leads to Ying Deficiency (Nutritive Qi Deficiency); Ying Deficiency leads to Blood insufficiency; Blood insufficiency leads to coldness in the Chest.

This clause focuses solely on pulse theory. Although it does not explicitly state symptoms, it implicitly contains the symptoms of Fanwei mentioned in the previous clause, merely omitting repetition. The pulses of the human body: Yang follows Heaven and moves vigorously; Yin follows Earth and gathers/contracts. When harmonized, they are neither rigid nor soft, neither fast nor slow, possessing a balanced purity. How could disease exist? Now, a faint pulse indicates Yang fails to move vigorously; a rapid pulse indicates Yin fails to gather quietly. Both Yin and Yang deviate from their proper degrees, Ying and Wei (Defensive Qi) are insufficient, leading to coldness in the chest. This is worse than the Guest Heat mentioned in the previous clause. The Qi of Ying and Wei enters and exits the Zang-Fu organs and flows through the meridians. They originate from Grain (food) and help metabolize it. Thus, Ying and Wei require Grain to be sufficient, and Grain requires Ying and Wei to be transformed. Since the chest is cold, the Stomach certainly cannot receive and discharge grain, forming the syndrome of Fanwei. Is there any doubt?

At the Zu Yang (Dorsalis Pedis Artery), the pulse is floating and choppy. Floating indicates deficiency; choppy indicates Spleen injury. When the Spleen is injured, it cannot grind food. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Undigested old grain remains, named Weifan. If the pulse is tight and choppy, the disease is difficult to treat.

When Spleen Qi moves, the pulse is not choppy; when Stomach Qi is firm, the pulse is not floating. Currently, a floating pulse indicates Stomach Qi deficiency, unable to rot and ripen water and grain; a choppy pulse indicates Spleen Blood injury, unable to digest and break down water and grain. Therefore, food entering during Yang hours is expelled during Yin hours; food entering during Yin hours is expelled during Yang hours. Because two deficiencies do not interact, there is no way to transport downward into the Large and Small Intestines. He Jian believed that a tight Zu Yang pulse indicates abundant internal dryness and deficient dampness. Hence, it is difficult to treat. It can be seen that a floating pulse, once the disease forms, must change to a tight pulse. Moreover, if tightness appears with choppy texture, Blood has been lost. If Blood is lost in the Shang Wan (Upper Orifice), dryness and chappedness in the diaphragm prevent food entry; if Blood is lost in the Xia Wan (Lower Orifice), the Large and Small Intestines will also wither, preventing food descent; thus, it is difficult to treat.

Vomiting accompanied by a weak pulse, free urination, slight fever, and appearance of Jue (Cold Extremities) is difficult to treat; Si Ni Tang (Frigid Extremities Decoction) should be administered. (15)

Vomiting prevents Grain Qi from nourishing the pulse, hence the pulse is weak. Weakness indicates Yang Qi deficiency, unable to fill the interior and exterior. Lower Jiao deficiency causes cold urine and spontaneous flow; Upper Jiao deficiency causes turbid Qi to rise, forcing Yang outward. Although there is apparent heat externally, internally there is true cold. The syndrome becomes Jue Ni (Reversal Cold), and the outgoing Yang separates instantly and does not return; treatment is indeed difficult. Only Si Ni Tang can overcome Yin and restore Yang, offering some hope. Vomiting combined with Jue Ni and diarrhea represents extreme Yin-Cold. Yang Qi decline is evident. It can be known that vomiting in Fanwei is actually Guan Ge (Obstruction and Reversal) vomiting. Yin and Yang pathologies are distinctly different from diarrhea and Jue Ni. It is unclear why the *Jingui Yaolue* re-recorded a Jue Yin Syndrome clause from the *Shanghan Lun* and placed it in the Fanwei category. Did it mistakenly consider vomiting and Fanwei as the same syndrome? The obscurity of medicine has existed since ancient times, which is lamentable. Here, distinctions are clarified to show that the Yang Qi in the chest is vastly different from the Yang Qi in the Kidneys. The Yang Qi in the chest is like the sun in the sky; its relationship to the pathways of Ying, Wei, and grain intake is most crucial, as stated in the first three clauses. The chest connects downward to the Spleen and Stomach; if Yang Qi is deficient, Yin Blood must also be deficient. One should only use mild and harmonizing formulas to balance the Zang-Fu and nourish Ying and Wei. Medicines that are purely pure and refined should not be used. The Yang Qi in the Kidneys is like cutting a turtle shell to establish the foundation; its relationship to the life root and survival is particularly grand, as stated in the last clause. The Kidneys store True Yang internally; if this Yang escapes outward, Yin Qi must be extremely abundant. Only fierce and potent medicines can charge forward, overcome Yin, and restore Yang. Without a direct approach, this method cannot be executed. Reading these four chapters in this manner, one may understand the weighing of therapeutic methods, becoming even clearer despite the erroneous compilation.