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He Baizhai said: The ministerial fire of the lower extremities belongs to the Gallbladder, paired with the Liver, and governs Blood; the ministerial fire of the upper extremities belongs to the Sanjiao (Triple Burner), paired with the Mingmen (Gate of Life) of the Kidney, and governs Essence. Both the Liver and the Mingmen belong to Wind-Wood. Within Wood there is Fire, so there is heat qi within Essence and Blood. However, Essence and Blood are moist in nature and belong to Water. Fire and Water coexist, thus they do not flare up. When they flare up as heat syndromes, it is all due to the depletion of Essence and Blood, like dry wood catching fire easily. Therefore, diseases where ministerial fire flares up are difficult to treat. Currently, diseases such as deficiency consumption and bone-steaming fever are all syndromes of ministerial fire heat. Small urine cannot extinguish great fire; the method should be to tonify Yin, then the heat will recede naturally. This criticizes the error of Danxi's advocacy for cold and cool herbs. The viscera and bowels of humans take the Spleen and Stomach as their root, because human food enters the Stomach and is transported by the Spleen, akin to the earth. However, whether the Spleen and Stomach can digest depends on the two qi of Water and Fire, not merely on the Spleen and Stomach themselves. Excess Fire causes the Spleen and Stomach to be dry; excess Water causes them to be damp; neither can transform substances, leading to various diseases. The syndrome of edema is generally due to excess Water and Fire's inability to transform it. With deficient Fire failing to vaporize Water, water entering the Spleen and Stomach seeps into the blood vessels, muscles, and bones, and Blood transforms into Water, causing swelling. This is a natural principle. To drain the Water and tonify its Fire, bringing the two qi into harmony, the disease will be eliminated. Danxi claimed that Spleen failure in transportation and transformation is due to Liver Wood overacting on Spleen Earth, and thus sought to clear Heart Fire so that Lung Metal could take command to control the Liver source. This is pedantic and impractical.

Liu Hejian stated that tonifying or purging the root of the Spleen and Stomach lies in the neutral qi of the Spleen and Stomach. Drying dampness is purging; moistening dryness is tonifying.

Danxi said that "Qi has no tonification method" is a vulgar opinion. Because of fullness and obstruction, it seems difficult to tonify. One does not know that when Zheng Qi (Upright Qi) is deficient, Zhuo Qi (Turbid Qi) stagnates. When Zheng Qi is tonified, it performs its vigorous transportation function, and Zhuo Qi descends naturally, eliminating fullness. If Qi deficiency is not tonified, how will pathogenic factors retreat? The *Neijing* states: Those who are strong recover when Qi moves; those who are weak develop disease when Qi stagnates. To break stagnant Qi and eliminate distension, one must tonify Spleen Qi. This is the precise and appropriate method, unknown to superficial understanding.

Generally, in cases of bleeding, the pulse is always flooding and forceless, which is the Kou (Hollow) pulse. Since Yin Blood is depleted, Yang has no foundation and floats outward, hence this manifestation. Mistaking this for Excess Fire is a major error.

Zhang Sanxi said: Generally, deficiency consumptions should be divided into two categories: one is Middle Qi deficiency, belonging to internal injury, with a slow or empty-large and forceless pulse, which is treatable; the other is True Yin depletion, with Yin deficiency and Fire hyperactivity, with a wiry-rapid and forceless pulse, which is difficult to treat.

He also said: Damage to the Heart and Lungs leads to deterioration of complexion; damage to the Kidneys and Liver leads to emaciation and flaccidity.

Jaundice has Yin and Yang types: Earth of Heaven Five, burned by Fire, is Yang Jaundice; Fire of Earth Two, drowned by Water, is Yin Jaundice.

In mild deficiency consumption, True Fire still exists, and taking cold/cool herbs is acceptable; in severe deficiency consumption, True Fire is already depleted. How can cold/cool herbs transform into Essence and Blood to tonify the deficiency? Within the human body, there are three Treasures stored: Yuan Jing (Primordial Essence), Yuan Qi (Primordial Qi), and Yuan Shen (Primordial Spirit). Essence is the true substance of the viscera, not comparable to Ying Blood, hence called Tian Gui (Heavenly Puberty). Qi is the great channel of the viscera and the master of movement and stillness, hence called Shen Ji (Spirit Mechanism). The pulse is the great atmospheric qi of Tian Zhen (Natural Truth); its mechanism of movement and rotation follows Qi and is nourished by Blood. Essence and Qi originate and generate each other without loss, nourishing the whole body, serving as the life governor of humans. If Essence is insufficient, Qi loses its resource for transformation; if Qi is insufficient, Blood loses its nourishment; if Blood is insufficient, Qi has no attachment. Tian Zhen scatters, and disease arises.

Zhang Sanxi said: Labor injuries to the five viscera all become Zhai (Consumption/Tuberculosis), but only Lung Zhai is incurable. Due to coughing, hemoptysis, rising Yin Fire, worsening at dusk, and eventually ulcers in the throat, sleeping on one side (left or right), using cold/cool yin-nourishing herbs damages the Spleen and increases diarrhea, while using Ginseng and Atractylodes to tonify Qi aids Fire and increases cough. Adding diarrhea and asthma brings death near. Generally, a fine-rapid pulse, bone-steaming, dry cough with hoarseness are incurable. This is True Yin depletion, disease in the Gao Huang (deep interior), beyond the reach of medicine. For those with tidal fever, laypeople use cooling herbs, not knowing that Yin deficiency generates internal heat, which cannot be treated with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Anemarrhenae Rhizoma (Zhimu), or Phellodendri Cortex (Huangbai). If it is external heat pathogen, heat stops when pathogens clear; if it is food retention fever, heat stops when stagnation resolves. This Yin deficiency is not formed overnight; quiet mind can nourish Yin, but it fully relies on diet generating Yin Blood from the Stomach. If one ignores the Spleen and Stomach and only focuses on Kan-Li (Heart-Kidney interaction), Yin may not be nourished, heat may not be removed, the Spleen and Stomach will be further damaged, and heat-cough will worsen.

Dongyuan said: Hundred diseases worsen during the day and are quiet at night; this is Excess Yang, meaning Qi disease without Blood disease. Worsening at night and quiet during the day is Excess Yin, meaning Blood disease without Qi disease. Fever during the day and quiet at night means Yang is flourishing in the Yang division. Quiet during the day and fever at night means Yang Qi sinks into Yin, named Re Ru Xue Shi (Heat Entering the Blood Chamber). Fever and irritability both day and night mean Double Yang without Yin; one must urgently purge Yang and vigorously tonify Yin. Chills at night and quiet during the day means Yin Blood flourishes in the Yin division. Quiet at night and chills during the day means Yin Qi overflows into Yang. Chills both day and night mean Double Yin without Yang; one must urgently purge Yin and vigorously tonify Yang. Chills during the day, irritability at night, and inability to eat is named Yin-Yang Interlacing, which is fatal.

Dongyuan said: Solid pulses in both Cun positions indicate Yang Excess and Yin Deficiency; purgation leads to recovery. Empty pulses in both Cun positions indicate both Yin and Yang Deficiency; tonifying Yang exhausts Yin, tonifying Yin exhausts Yang; one should harmonize with Sweet Herbs. Insufficient pulses in both Cun positions should be sought in the Earth, which is the Spleen and Stomach; one should draw Yang from Yin. Short/small pulses in both Cun positions indicate Yang Qi insufficiency and disease in the lower part, named Yin Excess and Yang Deficiency; acupoints Xiaguling (Lower Ridge, likely referring to Zusanli ST-36 area contextually or specific point) and Sanli should be selected. Tonification and purgation without form is called guiding Qi and securing Essence; treatment methods are taken from the "Five Chaos" category. This is a deficiency disease; one should select acupoints on the abdomen, Qihai (CV-6). In severe cases, select Zusanli (ST-36) and Qichong (ST-30), guiding with filiform needles. Solid pulses in both Guan positions, not reaching the extent of sweating or purging stool, should be treated with Shaoyao Tang (Peony Decoction) to purge Earth Excess. Empty pulses in both Guan positions with deep-fine pulses should be treated with Lizhong Tang (Regulate the Middle Decoction). Wiry-slow pulses should be treated with Jianzhong Tang (Establish the Middle Decoction), possibly adding Astragali Radix (Huangqi) and Aconiti Lateralis Radix Praeparata (Fuzi). Solid pulses in both Chi positions indicate Yin Excess and Yang Deficiency; purgation leads to recovery. Empty pulses in both Chi positions should be treated with Jiangfu Tang (Ginger and Aconite Decoction) to tonify Yang. Question: Why tonify Yang for Yin Deficiency? Answer: Yin originates from Yang. Zhang Zhongjing said: For empty pulses in both Chi positions, purgation is contraindicated; purgation is contrary and leads to death. If pulses in both Chi positions are absent or short/small, the disease is in the Upper (Heaven); seek it in the Back-Shu points of the five viscera. Or if there is latent fire in blood collaterals and meridians, this is Yin Fire in Heaven, causing Yang not to store. Also, the *Nanjing* states: No pulse in the lower part, or exhaustion of both Chi pulses, indicates food blockage; vomiting is indicated.

Ancient sages said: Among Floating, Deep, Slow, Rapid, Slippery, and Rough pulses, there are crucial distinctions that differ greatly, which people often fail to recognize. Floating indicates Exterior, but in all Yin deficiency cases, the pulse is floating and forceless; thus, Floating cannot be generally termed Exterior, nor can dispersing methods be used indiscriminately? Deep indicates Interior, but in severe initial exterior pathogen attacks, if Cold constrains the skin and hair, preventing Yang from reaching the exterior, the pulse first appears Deep-Tight; thus, Deep cannot be generally termed Interior, nor can interior-purging methods be used? Slow indicates Cold, but after early-stage Shanghan recedes, residual heat remains, and the pulse is often Slow-Slippery; thus, Slow cannot be generally termed Cold, nor can warming middle methods be used? Rapid indicates Heat. But in deficiency consumption syndromes where Yin and Yang are both depleted and Qi and Blood are scattered, the pulse is necessarily Urgent-Rapid; the more rapid, the more deficient; the more deficient, the more rapid; thus, Rapid cannot be generally termed Heat, nor can cold/cool methods be used? Fine and Thin resemble Deficiency, but in extreme pain with obstruction, the pulse is often Hidden; thus, Hidden cannot be generally termed Deficiency, nor can sudden tonification be used? Flooding and Wiry resemble Excess, but in cases of severe True Yin depletion, the pulse is often restricted/reversed and double the normal rate; thus, Wiry cannot be generally termed Excess, nor can draining/purging methods be used? In this way, within the general principles, there are overarching principles. If doctors do not combine the Four Diagnostic Methods and act rashly, this is why pulse diagnosis is difficult to explain.

Wang Haogu said: When the pulse is not diseased, its Shen (Spirit) speaks for itself. When the pulse is diseased, one must seek whether the Shen within it exists or not. For example, Six Rapid or Seven Extreme pulses indicate Heat; if there is strength in the pulse, there is Shen. Three Slow or Two Debilitated pulses indicate Cold; if there is strength in the pulse, there is Shen. Heat with Shen: purge the heat, and Shen remains. Cold with Shen: remove the cold, and Shen remains. For Cold Jue pulses, if there is no strength and no Shen, what medicine can be used to drain heat and remove cold? Without knowing this, what basis is there for survival?

Kongtongzi said: Eight or nine out of ten cases of human disease involve Phlegm-Fire. The elderly should not rapidly descend Fire; the deficient should not completely eliminate Phlegm. Over-aggressive attack makes the disease worse and leads to danger; one should essentially consolidate Yuan Qi. Apply this logic to all diseases.

The *Guoxiao* has a method of treating Excess and Deficiency separately, stating that diseases arise from four factors: External contraction, Internal injury generating Fire, generating Dampness, generating Heat, and generating Phlegm. Examine if it is a young/new disease: if Dampness, dry it; if Fire, purge it; if Dampness generates Heat, dry Dampness and clear Heat; if Fire generates Phlegm, purge Fire and resolve Phlegm, leaving nothing unresolved. For the elderly with chronic illness, attack and tonify simultaneously: if Qi deficiency with Damp-Heat-Phlegm-Fire, use Sijunzi Tang (Four Gentlemen Decoction) to tonify Qi, while drying Dampness, clearing Heat, purging Fire, and resolving Phlegm; if Blood deficiency with Phlegm-Fire-Damp-Heat, use Siwu Tang (Four Substances Decoction) to tonify Blood, while draining Fire, resolving Phlegm, clearing Heat, and drying Dampness. Thus, attack and tonification are appropriate. Hence: For young/new diseases, attacking pathogens can be decisive; for elderly/chronic diseases, tonification comes first. As for Yin deficiency with Fire moving, and Spleen-Stomach deficiency: True Yin is Water, Spleen-Stomach is Earth. Earth likes Dryness, but too dry kills vegetation; Water likes Moisture, but too wet rots vegetation. Therefore, formulas tonifying Spleen and nourishing Kidney depend on appropriate dryness and moisture.

Treating "Prosperous Qi": Diseases have Yin and Yang; Qi has Decline and Prosperity. Not understanding decline/prosperity leads to worsened treatment. For Yang Excess and Yin Deficiency (Yin deficiency with Fire hyperactivity), if the practitioner does not tonify Yin but uses bitter-cold herbs to treat the prosperity, they do not know that bitter-cold herbs sink and descend. Sinking and descending destroys Yin; the more Yin is destroyed, the stronger the Fire. Hence, taking cold herbs results in more heat; Yin deficiency should not be descended. Similarly, for Yang Decline and Yin Excess (Qi weakness generating Cold), if the practitioner does not tonify Yang to dissipate Yin but uses pungent-warm herbs to treat Yin prosperity, they do not know that pungent-hot herbs scatter. Scattering destroys Yang; the more Yang is destroyed, the colder it becomes. Hence, taking hot herbs results in more cold; Yang deficiency should not be scattered. There is no other reason; this happens because one treats only the prosperous Qi, leading to opposition.

Yu Jiayan said: Violating Autumn Qi injures the Lung, causing Sundry Diarrhea (Sun Xie) in Winter. This differs from Spring Wind injury causing Summer Sundry Diarrhea. In wind-induced Sundry Diarrhea, Wind is primary (Wood); in Lung-injury induced Sundry Diarrhea, Lung is primary (Metal). Their signs differ. Wind pathogens enter hollow orifices, most notably the Spleen and Stomach. Once Wind resides there, its guidance is like sailing with the wind; it does not wait for Spleen transportation and transformation. Food enters and exits immediately, causing immediate defecation after eating. Unknowing people think it is Spleen deficiency with undigested food, similar to Long Summer洞泄 (cavity diarrhea) or Cold Center, and winter Sundry Diarrhea. They wrongly use rigid-drying Spleen-tonifying herbs, aiding the vigor of Wind, leading to endless diarrhea and helplessness. If one knew to treat according to Spring dynamics, using Guizhi Tang (Cinnamon Twig Decoction) to lead Wind out from the muscle layer, it could be cured in one or two doses. Autumn Lung injury is caused by Lung Dryness, same as Autumn Dryness injury causing Winter Cough. In the Lung it is Cough; in the Large Intestine it is Sundry Diarrhea. What the world calls "Lung transferring Heat to Large Intestine, becoming Chang Pi (Intestinal Dysentery/Feces with Blood) over time" is this disease. If Lung Heat does not transmit to the Large Intestine, Sundry Diarrhea stops naturally. Unknowing people only strive for astringency, adding Dryness to Dryness, is this not unjust?

Violating Winter Qi injures the Kidney, causing Wei Jue (Flaccidity and Cold Extremities) in Spring. Is it the same disease? Answer: Wei is Wei, Jue is Jue; originally two diseases. However, Wei inevitably leads to Jue, and Jue inevitably leads to Wei; ultimately, it is the same disease. But if Liver Qi loses support, Wei disease appears first; if sinews and vessels do not collapse, Jue disease appears first. Liver disease causes sinews to lose nourishment; if one has prior sinew issues, sudden Wei occurs. Liver Qi prefers free flow; chronic anger/stagnation causes Qi to flow irregularly and horizontally, gradually leading to Lower Deficiency and Upper Excess, Qi rising high and not returning, dizziness, unconsciousness, and Jue. Jue requires Qi connection to recover. These are diseases of failing to nourish viscera in Winter and insufficient Zheng Qi, unrelated to treating Phlegm or Wind. Solely tonifying Kidney Water, generating fluids, and nourishing Blood allows sinews to soften and Liver Qi to flow freely. If Essence is exhausted and Qi is diminished, it is difficult to manage.

Medicine conquers disease, but if the Spleen and Stomach cannot withstand the medicine, and one fails to observe, Yuan Qi is ruined, and many variable symptoms appear. For example, Spleen deficiency with shortness of breath, unable to continue, transforming into apparent panting; yet using Qi-descending and pantling-stopping herbs is applied. Spleen deficiency with Wei Qi not circulating, transforming into edema; yet using Qi-consuming and diuretic herbs is applied. Spleen deficiency with stagnation, transforming into alternating chills and fever; yet treating as external contraction with exterior-dispersing herbs is applied. Deficiency becomes more deficient, directly leading to Qi exhaustion and death, without repentance, and applying this method to others, perpetuating harm, how can this be pardoned?

The location of Human True Qi has three meanings: Upper, Middle, and Lower. The Upper receives from Heaven and facilitates respiration; the Middle is born from water and grain and nourishes Ying and Wei; the Lower is transformed from Essence, stored in the Mingmen, and serves as the root of the Sanjiao. Thus, there is an Upper Qi Sea, called Shanzhong (CV-17), governed by the Lung; there is a Middle Sea of Water, Grain, Qi, and Blood, called Zhong Qi, governed by the Spleen and Stomach; there is a Lower Qi Sea, called Dantian, governed by the Kidney. Humans rely only on this Qi. Qi gathers, and life exists; Qi scatters, and death occurs. Thus, the Yellow Emperor said Qi is the inner treasure. This is indeed the most important term and the most urgent principle for physicians. Current physicians only see disease and treat disease, initially failing to understand the human root. In the world, how can there be success if the root is injured?

False Deficiency syndromes are rare, but False Excess syndromes are common; False Cold syndromes are not hard to treat, but False Heat syndromes are often mismanaged. Generally, Excess involves Heat, and Deficiency involves Cold. Danxi said: "Excess Qi is Fire," so Excess can tolerate Cold. I add: "Deficient Qi is Cold," so Deficiency can tolerate Heat. Those in the world who do not understand the truth and falsehood of origins and branches cannot be considered knowledgeable physicians.

Yu Jiayan said: True Yang in the Kidney is aided by Water, lingering and not escaping; dammed by Earth, hibernating and not revealing. Hand and Foot Yang serve it, flowing through the body, securing the Cou Li (pores/skin-muscle spaces), and defending externally. Yang in the Spleen follows Heaven's vigor, digesting food, distributing fluids, and operating internally. Yang in the Chest is like the sun driving the chariot, shining brightly, dissipating Yin and removing obscurity, announcing upwards. These three are abundant and peaceful, allowing True Yang in the Kidney to enjoy peace. Only when Yang in position, above, and in the middle declines and fails, does Yin Qi gain power. Skin cold and not warm, gradually becoming hard and inflexible, Wei Yang fails; indigestion, gradually vomiting, diarrhea, fullness, Spleen Yang fails; chest obstruction, gradually blocking open, Chest Yang fails. Then taking Yang sealed in Water and Earth to emerge and act: Head and face get Yang and turn red; skin gets Yang and becomes dry; Spleen and Stomach get Yang and suffer Chu Zhong (Elimination of Middle); how long can this last?

Pang Anchang said: There is Yin Water insufficiency, Yin Fire rising, Lung suffering Fire insult, unable to descend clearly and purely. Consequently, fluids condense turbidly to generate Phlegm instead of Blood. This should be treated with moistening agents plus Ophiopogonis Radix (Maidong), Rehmanniae Radix (Dihuang), and Lycii Fructus (Gouqi) to nourish Yin, allowing the rising Fire to return to its home and rest, then Phlegm clears naturally. Administering Erchen Tang leads to immediate danger. There is Kidney deficiency failing to grasp Qi and return it to the origin; Qi goes out but does not gather, accumulates but does not disperse, generating Phlegm. Bawei Wan (Eight-Ingredient Pill) is indicated. This syndrome is very difficult.

The Heart is the master of Blood, the Liver is the residence of Blood; the Lung is the master of Qi, the Kidney is the residence of Qi. Truly these words! Students only know Blood originates from the Heart, not knowing Blood is stored in the Liver; only know Qi originates from the Lung, not knowing Qi is stored in the Kidney. For example, Bloody Dysentery caused by illness, treated with Blood-moving and accumulation-expelling formulas, but pain persists because the storage of Blood lacks nourishment; one must assist with Liver-nourishing herbs, then pain stops. For panting, coughing, and wheezing, treated with Qi-regulating and Phlegm-resolving formulas, but Qi never descends because the storage of Qi lacks a place to return; one must assist with Kidney-calming herbs, then Qi returns to its origin. This is the crucial method of transmitting the heart-mind.