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Li Dongyuan described fever, aversion to heat, unquenchable great thirst, irritability, heat in the muscles and skin yet a desire not to be near clothing, with a pulse that is large (Hong) but empty upon deep pressure, or without eye pain and nasal dryness; this does not constitute a Baihu Tang (White Tiger Decoction) syndrome. This is dryness arising from Blood deficiency, and should be primarily treated with Danggui Buxue Tang (Dangui Tonifying Blood Decoction). There are also cases of heat due to Fire constraint (Huoyu), such as inability to eat accompanied by heat, spontaneous sweating, and shortness of breath, which indicate deficiency. One should use sweet-cold agents to drain heat and tonify Qi, unlike cases where one can eat, has heat, dry mouth and tongue, and difficult defecation, for which cold purgative methods may be used.

There are also cases of weak and flaccid legs and knees, coldness in the buttocks and perineum, sweaty and foul-smelling genitalia, seminal emission and insecurity, with a deep (Chen) and rapid (Shu) pulse that is forceful; this indicates Fire constrained within, forcing Yin outward, i.e., Yang excess rejecting Yin. In such cases, bitter-cold drugs should be used to purge downwards. These are subtle signs of Water and Fire, and the profoundness of pulse-syndrome treatment examples, worthy of being taken as principles.

In summer, Fire attacks the Earth position, and damp-heat combine. Diseases often present with irritability and confusion, heat in the four limbs, or heaviness of the body with wandering pain. All these result from damp-heat struggling and constraining, unable to extend, thus causing heat. The *Neijing* describes nineteen pathogenesis items, five of which belong to Fire: namely, various heat syndromes causing mental confusion (mao), sudden aphonia, coma and ignorance, restlessness and madness, cursing and fright, swelling and painful soreness, rebellious Qi rushing upward, trembling and fear as if losing spiritual control, panting and vomiting, sores and ulcers, throat obstruction, tinnitus, deafness, vomiting and gurgling, inability to eat, blurred vision, acute diarrhea, sudden illness, and sudden death—all belong to Fire. The *Yuanbing Shi* explains these in great detail.

Zhu Danxi said: Ministerial Fire (Xianghuo) rises easily. The Jueyang Fire of the Five Natures fans each other, leading to reckless movement. Fire arises from recklessness, changing unpredictably. It constantly fries the True Yin; Yin deficiency leads to disease, Yin exhaustion leads to death. The Qi of Sovereign Fire (Junhuo) is spoken of in the Classics as Summerheat and Heat. The Qi of Ministerial Fire is spoken of in the Classics simply as "Fire," likely to express its ferocity, cruelty, and destructiveness, which exceed those of Sovereign Fire. Therefore, although Shaoyang Ministerial Fire follows Jueyin Wind-Wood in governing sixty days, Ministerial Fire actually moves upon any trigger throughout all four seasons, not just between spring and summer. However, it is true that when Heat, Summerheat, and Dampness combine, Ministerial Fire is particularly prone to movement.

Huanglian drains Heart Fire, Huangqin drains Lung Fire, Shaoyao drains Spleen Fire, Chaihu drains Liver Fire, Zhimu drains Kidney Fire; these are all bitter-cold flavors capable of draining excessive Fire. If dietary irregularity and overwork cause internal injury to Yuan Qi, and Fire opposes Righteous Qi, resulting in a Yang deficiency disease, one should eliminate it with sweet-warm agents, such as Huangqi, Renshen, and Gancao. If Yin is slight and Yang is strong, with Ministerial Fire blazing and attacking Yin positions, gradually frying the body, resulting in a Blood deficiency disease, one should subdue it with sweet-cold agents, such as Danggui and Dihuang. If Heart Fire is extremely hyperactive with internal constraint and heat, resulting in a Yang-excess disease, one should break it with salty-cold agents, such as Dahuang and Poxiao. If Kidney Water is injured and True Yin is lost, leading to rootless Fire, resulting in a Yin deficiency disease, one should restrain it with agents that strengthen Water (nourish Yin), such as Shengdihuang and Yuanshen. If the Fire of the Gate of Vitality (Mingmen) in the right Kidney declines, resulting in a Yang collapse disease, one should assist it with warm-hot agents, such as Fuzi and Ganjiang. If Stomach deficiency leads to excessive consumption of cold foods, suppressing Yang Qi in the Spleen-Earth, resulting in a Fire-constraint disease, one should disperse it with ascending-dispersing agents, such as Shengma and Gegen. If one does not understand and master these, what basis is there for treating major diseases?

The *Neijing* states: Various dampness-induced swellings and fullness all belong to Spleen-Earth. The *Yuanbing Shi* states: Various spasms and rigidity, accumulated fluids and diaphragmatic obstruction, central fullness with Huoluan vomiting and diarrhea, heavy body, edema with flesh soft like mud and leaving an indentation upon pressure—all belong to Dampness. The *Maijing* states: A pulse that comes slippery and rapid, with body heat, irritability, panting, chest fullness, dry mouth, and jaundice, indicates damp-heat. A pulse that is large and slow indicates both Yin and Yang deficiency, with damp-heat becoming severe. A pulse that is large and moving indicates a disease of damp-heat.

The *Neijing* says that contracting dampness feels like the head is wrapped. Zhu Danxi explained this clearly: Dampness is the turbid Qi of Earth. The head is the meeting place of all Yang meridians; its position is high, its Qi is clear, its structure is hollow, so hearing and vision depend on it. Turbid Qi steams upward, blocking the clear orifices, causing heaviness and difficulty, as if covered by something. If neglected and untreated, dampness constrains into heat, and heat remains. When large tendons shorten, it is because heat injures Blood, failing to nourish tendons, thus causing contracture. When small tendons relax and lengthen, it is because dampness injures tendons, failing to bind bones, thus causing flaccidity.

Swelling caused by Qi stagnation is also clarified by Wang Bing's commentary: One who usually suffers from Qi disorders, when added with damp-heat, experiences contention among Qi, dampness, and heat, thus causing swelling. As evil Qi gradually increases and Righteous Qi gradually diminishes, Yang Qi becomes scarce, allowing evil to attack Righteousness. Qi fails to circulate freely, thus causing swelling in the four extremities. All Yang meridians receive Qi from the four limbs. Therefore, when people today see swelling and pain in the knee joints and treat them entirely as Wind, are they not mistaken?

The primary causes of damp diseases differ between internal injury and external contraction, let alone the distinctions among cold-damp and wind-damp. In summer, the three pathogens combine to cause disease, differing only slightly in degree and sequence.

People only know the majesty of Wind-Cold, but do not know the scorching nature of Summerheat-Dampness, which infects humans imperceptibly. The *Yuanbing Shi* states: Various forced accumulation and fluid retention syndromes all belong to Dampness. If there is swelling, fullness, body coldness, and water retention, but urination is red, scanty, obstructed, or turbid, this indicates deep internal accumulation of heat, not a cold disease.

Generally, treatment methods should prioritize regulating the Spleen, clearing heat, and promoting urination. Therefore, treating dampness without promoting urination is incorrect; one should use Guiling Ganlu San augmented with Muxiang, Tinglizi, and Mutong. Liu Shouzhen said: Tingli Muxiang San and Xia Shenxiong Wan, these drugs drain damp-water, reduce swelling, promote urination, and regulate the Spleen and Stomach; nothing surpasses them. For severe abdominal distension and leg edema, Zhouche Wan should be used to purge. For deep internal damp-heat causing jaundice, Yinchin Tang should be used to purge, or supplemented with Fangji Huangqi Tang; differentiation should be based on pulse and syndrome. If the pulse is slippery and rapid, with red, astringent urination and thirst, purgatives are not suitable.

The Wet-Warm syndrome occurs when dampness is contracted followed by Summerheat. Treatment focuses on the Taiyin; sweating must not be induced. If sweat is induced, the patient will inevitably lose speech ability, become deaf, and be unaware of pain location, named Zhongming. Such deaths are caused by the physician. (See Volume 1 for details.)

Zhongshi (Mid-Dampness) can resemble Fengzhong (Wind-Stroke); its pulse must be deep, choppy, or deep and fine. Due to chronic Spleen deficiency with accumulated phlegm, accidental contact with seasonal damp-heat internally agitates the phlegm, causing salivary congestion in the chest and heart, deviation of the mouth and eyes, hemiplegia, and coma. Treatment also focuses on the Taiyin; if treated as Wind-Stroke, the Spleen Qi will immediately decline, also leading to death. (Summerwind is seen later in this section.)