Library

Zhongshan Wang Zhifu's second son, Xue Li, was thirteen years old. In June, heavy rain caused pond water to overflow, and he played in the water, getting his clothes completely wet. His mother reprimanded him. By evening, he felt mentally confused and lethargic, sluggish and sleepy. The next day, he developed headache, feverish body sensation, and heaviness in the legs and feet. A physician administered diaphoretic (sweating-inducing) medicine, instructing him to close doors and windows and cover himself with quilts to induce sweating. This resulted in unbearable heat, leading to delirious speech; he wanted to remove the quilts but could not. That night, he sweated profusely until the fourth watch (around 1-3 AM), soaking his bedding. The following day, he exhibited symptoms of searching for clothes and picking at empty air (a sign of severe mental confusion). Another physician then administered Chengqi Tang (Cathartic Decoction) to purge the bowels. Subsequently, his speech gradually ceased, his limbs became unable to grasp objects, and occasionally his neck became stiff. His hands and feet experienced spasms and convulsions, his eyes deviated to the left with excessive sclera visible, his lip muscles twitched, food intake decreased, and his physique emaciated suddenly. Later, Luo Qianfu was consulted, who reviewed the previous history. It was determined that this was due to injury from dampness compounded by improper excessive sweating.

Human Yuan Qi (Original Qi) originates from the moving qi between the kidneys below the navel, circulating throughout the body and penetrating all vessels. At this time of midsummer heat, inducing excessive sweating leads to loss of Yang Qi, causing stagnation in the vessel flow. Consequently, the Qi of the Sanjiao (Triple Burner) cannot ascend to nourish the Heart and Lungs. Heart Fire becomes hyperactive while Lung Qi scorches. Furthermore, due to internal accumulation of fear and fright, as stated in the *Neijing* (Inner Canon): "Fear causes Qi to sink." Yang governs voice; since Yang has been lost, voice production fails. Yang Qi, in its refined aspect, nourishes the Shen (Spirit); in its soft aspect, it nourishes the sinews. Excessive sweating now depletes both Qi and Blood, leaving the sinews without nourishment. The pathology manifests as neck stiffness and limb spasms/constrictions. The eyes connect to the Liver, which is the convergence of sinews. With sinews dried and lacking moisture, the eyes deviate left with exposed sclera. Muscles belong to the Spleen; Spleen Heat causes muscle twitching, hence the occasional lip movement. The Classics state: "Flesh Wei (Flaccidity) arises from damp ground." Spleen Heat causes muscle insensibility, manifesting as Flesh Wei. Wei denotes weakness and lack of strength. Now, Qi is nearly exhausted, and Heat remains in the Spleen, rendering the four limbs unusable. This is clearly a complicated disease (Huai Zheng) resulting from dampness injury followed by excessive sweating. Treatment should clear the current Heat, replenish the source of Water (Kidney Yin), rescue the rebellious Qi, and tonify the ascending and generating Qi. The *Neijing* states: "For excessive Heat, treat with Sweet-Cold herbs, and use Sour herbs to astringe." Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root), being Sweet-Warm, tonify deficient Qi and relieve urgent spasms, thus serving as the Sovereign (Jun) herbs. The Kidney dislikes dryness; urgently consume Pungent herbs to moisten it. Sheng Gan Cao (Raw Licorice Root), Sweet-Slightly Cold, and Huang Bo (Phellodendron Bark), Bitter-Pungent-Cold, rescue Kidney Water and generate fluids, serving as the Minister (Chen) herbs. Dang Gui (Angelica Sinensis Root), Pungent-Warm, harmonizes blood vessels; Ju Pi (Tangerine Peel), Bitter-Pungent; Bai Zhu (Atractylodes Rhizome), Bitter-Sweet; Zhi Gan Cao (Honey-fried Licorice Root), Sweet-Warm, tonify the Spleen and Stomach and promote appetite. The Lung desires astringency; urgently consume Sour herbs to gather it. Bai Shao Yao (White Peony Root), Sour-Slightly Cold, gathers dissipating Qi and tonifies Lung Metal, serving as the Assistant (Zuo) herb. Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root), Bitter-Neutral, lift the insufficient ascending and generating Qi, serving as the Envoy (Shi) herb. This is called "drawing Yang from Yin." Administer one dose morning and evening. After three days, speech gradually returned, walking ability improved slightly, limbs became supple, and diet increased. Thus, this formula was recorded as Renshen Yiqi Tang (Ginseng Qi-Boosting Decoction).

Yu Zhen notes: Ancient cases treating dampness diseases rarely contain profound theories or miraculous formulas; thus, I selected only this case as a model for syndrome differentiation and prescription. Currently, there are many excellent cases in *Lin Zheng Zhi Nan* (Guide to Clinical Practice), worthy of private emulation. To eliminate Dampness from the Qi level, use Shi Gao (though text says Hua Shi/Talcum here, context implies clearing damp-heat via light aromatic/diuretic methods, specifically Hua Shi/Talcum, Bai Kou Ren/Amomum Fruit, Xing Ren/Almond, Ban Xia/Pinellia Tuber, Hou Po/Magnolia Bark, Gua Lou Pi/Bitter Melon Rind) as main ingredients. If Heat is present, add Zhu Ye (Bamboo Leaf), Lian Qiao (Forsythia Fruit), Lu Gen (Reed Rhizome), etc., utilizing exclusively light and clear substances to move the Qi mechanism and dispel Dampness. If Damp-Heat is severe with white tongue coating, yellow eyes, thirst, and dark urine, use Gui Zhi Mu (Cinnamon Twig Wood), Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), Hua Shi (Talcum), Fu Ling Pi (Poria Peel), Han Shui Shi (Halloysitum), Sheng Bai Zhu (Raw Atractylodes Rhizome), Yin Chen (Artemisia Capillaris). This is a modification of Guiling Ganlu Yin (Cassia-Agaricus Sweet Dew Decoction). For Damp-Heat causing fullness and clouded consciousness, use Ren Shen (Ginseng), Qin (Scutellaria Root), Lian (Coptis Rhizome), Zhi Shi (Immature Bitter Orange), Sheng Gan Jiang (Raw Ginger), Sheng Bai Shao (Raw White Peony Root). This is a modification of Xiexin Tang (Drain the Epigastrium Decoction). For epigastric obstruction and pain with unsatisfactory stool, use Dou Chi (Fermented Soybean), Zhi Shi (Immature Bitter Orange), Chuan Lian (Coptis Rhizome), Jiang Zhi (Ginger Juice), Fu Ling (Poria), Ban Xia (Pinellia Tuber). If Heat is mild, remove Chuan Lian, add Yu Jin (Curcuma Tuber), Ju Hong (Red Tangerine Peel), Yi Yi Ren (Coix Seed), Xing Ren (Apricot Seed). This is the treatment method for Dampness injuring Qi obstruction. If Heat is severe, use Chuan Lian (Coptis Rhizome), Sheng Zhu (Raw Atractylodes Rhizome), Hou Po (Magnolia Bark), Ju Bai (White Tangerine Peel), Dan Sheng Jiang Zha (Light Ginger Residue), Jiu Wei Da Huang (Wine-processed Rhubarb), made into pills with water. This treats Qi blockage and unsmoothness, applying the principle that treating the Fu organs requires unblocking. For Dampness injuring Spleen Yang causing abdominal distension, use Wu Ling San (Five-Ingredient Powder with Poria) and Er Zhu Gao (Two-Atractylodes Paste). For Damp-Heat overflowing affecting pulses, pores, and abdomen, use Xiao Wen Zhong Wan (Minor Warming Middle Pill). For epigastric fullness and loose stools, use Ling Gui Zhu Gan Tang (Poria-Cinnamon-Atractylodes-Glycyrrhiza Decoction). For acid regurgitation and aversion to cold, use Ling Jiang Zhu Gui Tang (Poria-Ginger-Atractylodes-Cinnamon Decoction). Although these are established ancient methods, applied effortlessly, they fit perfectly. For Wet Warmth with fever and coma, use Xi Jiao (Rhinoceros Horn - note: modern substitute often used), Xuan Shen (Scrophularia Root), Lian Qiao Xin (Forsythia Heart), Shi Chang Pu (Acorus Rhizome), Yin Hua (Honeysuckle Flower), Ye Chi Dou Pi (Wild Red Bean Skin), decocted and administered with Zhi Bao Dan (Treasure Preserving Pill). This is the method of clearing Heat, opening orifices, using aromatic substances to expel turbidity. More remarkably, for Wet Warmth with head distension, deafness, hiccup, epistaxis, white tongue coating, and closing throat, it is said that pathogenic factors obstruct the empty spaces of the upper orifices, not treatable by bitter-cold herbs entering directly into the Stomach. Instead, use Lian Qiao (Forsythia), Niu Bang Zi (Arctium Fruit), Yin Hua (Honeysuckle), Ma Bo (Malabar Nut Seed), She Gan (Belamcanda Rhizome), Jin Zhi (Gold Juice). This is beyond the imagination of ordinary people. For anorexia, insomnia, abdominal pain, and constipation with slow, small, choppy pulse, it is attributed to habitual alcohol consumption and grain deficiency, where Dampness congeals and injures Yang, causing Cold-Damp turbid Yin to gather and cause pain. Treat with Chao Hei Sheng Fu Zi (Charred Raw Aconite), Chao Hei Chuan Jiao (Charred Sichuan Pepper), Sheng Dan Gan Jiang (Raw Light Ginger), Cong Bai (Green Onion White), mixed with Pig Gallbladder Juice. This is Jiawei Baitong Tang (Modified Baitong Decoction), also miraculous and inconceivable. Furthermore, for alcoholics with chest fullness, lack of hunger, closure of all three burners, and inability to urinate or defecate, use Banshen Wan (Half-Sulfur Pill). For those eating rich flavors during illness, causing intestinal stagnation where purging leaves residual Dampness, resulting in anal dragging pain, gastric aversion to food, and white rot on the tongue, use Pingwei San (Calm the Stomach Powder) removing Gan Cao, adding Ren Shen (Ginseng), Pao Jiang (Roasted Ginger), Chao Hei Sheng Fu (Charred Raw Aconite). These two cases do not mistake alcohol/meat-induced conditions for Damp-Heat, but instead use Bitter-Pungent-Warm herbs to unblock Yang and seize Dampness, showing superior insight. Regarding Yang injury causing flaccidity, Dampness causing numbness, even with hemorrhoids using Ginger, Aconite, Poria, Sheng Bai Zhu. For white tongue, body pain, dorsal foot edema, and fluid flowing like a spring from Taixi point, indicating Dampness lurking in Foot Shaoyin, use Lu Rong (Deer Antler Velvet), Dan Fu Zi (Mild Aconite), Cao Guo (Black Cardamom), Fu Ling (Poria), Tu Si Zi (Dodder Seed), to warm and vaporize Yang Qi. These are beyond the reach of shallow knowledge. When Dampness persists, Spleen Yang declines, and Kidney Essence exhausts, leading to infertility in middle age, use Fu Shen (Poria with Hostwood), Tu Si Zi (Dodder Seed), Cang Zhu (Atractylodes Lancea), Jiu Zi (Leek Seed), Da Hui (Fennel), Lu Rong (Deer Antler Velvet), Fu Zi (Aconite), Hu Lu Ba (Fenugreek), Bu Gu Zhi (Psoralea Fruit), Chi Shi Zhi (Red Halloysite), imitating Anshen Wan (Calming Kidney Pill). Treating disease and regulating Yuan Qi become complementary, evoking admiration. Attaching these cases to the Dampness chapter makes the methods comprehensive.