Library

When the condition is urgent and difficult to treat with mild methods, heavy doses are required to match the excess pathogenic factors. Utilizing Lizhong Tang (Regulate the Middle Decoction) and Chengqi Tang (Descend the Qi Decoction) to mediate and differentiate between excess and deficiency, when applied correctly, yields miraculous results. The method of峻治 (Jun Zhi, vigorous/intensive treatment) determines life or death; one who masters its application can be considered a superior physician (Shang Gong). Furthermore, in cases resembling Shaoyang disease (Taiyang disease) where sweating should have been induced but was not, and the condition remains unresolved with severe restlessness and irritability in the chest, the situation is critical. It is appropriate to use a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), added with Ephedrae Herba (Mahuang, 麻黄), Zingiberis Rhizoma Recens (Jiangsheng, 生姜), and Aconiti Lateralis Radix Preparata (Fuzi, 附子); relief may occur after a single dose. This constitutes one method of vigorous treatment.

Initial assessment often makes it difficult to distinguish truth from falsehood, leading to hesitation between using purgative (Gong) or tonifying (Bu) methods. Relying entirely on careful palpation to ascertain whether the pattern is Excess (Shi) or Deficiency (Xu) is the subtle strategy of a skilled physician. In treating any illness, if internal and external causes are not differentiated, and Excess and Deficiency are not distinguished, arbitrary administration of drugs cannot guarantee the absence of adverse effects. Physicians who are adept at flexible adaptation, when examining the pulse, inquire about the medications and regimens used by previous doctors. If they indeed identify errors in the previous treatment, they will prescribe according to the current syndrome, ensuring success. (Wang Xushan stated: When previous prescriptions fail, succeeding physicians often seek to overturn the previous case to demonstrate superiority, applying hot remedies for chronic cold, cold remedies for chronic heat, tonics for chronic diarrhea, and purgatives for chronic over-tonification, as a clever tactic. However, the pulse and etiology remain. If one examines the pulse and investigates the cause, confirming the previous physician's lack of insight, one ought to change course to correct the error. If, without examining the pulse and cause, one fabricates divergent theories merely to differ from predecessors for personal gain, disregarding the patient's prognosis, their intentions are questionable.) Alas! The initial treatment is the most difficult, as one hesitates between the paths of Excess and Deficiency. (Zhang Dongfu said: The ancients knew it was difficult and treated it with caution; moderns know it is difficult yet treat it lightly, or do not even recognize its difficulty. How unjust!) Those who understand the timing harmonize with intention, like tuning a lute or zither; when the medicine matches the syndrome, the Qi and Blood become peaceful, which is the natural law. Although Excess patterns can tolerate Cold, and Deficiency patterns can tolerate Heat, the secret of employing purgatives and tonics lies herein.

When Excess and Deficiency are mixed, the Yuan Yang (Primal Yang) is damaged; when employing both purgative and tonifying methods, careful deliberation is required. Regulating the Spleen and Stomach first is paramount; as long as Qi flows without stagnation, what harm is there in tonification? The method of combined treatment involves using both purgative and tonifying actions simultaneously, presenting symptoms such as abdominal pain or fullness and oppression in the chest and hypochondrium. Anger combined with food stagnation injures the Liver, all damaging the Middle Qi. Even if there are concurrent internal injuries and external exhaustion manifesting as headache and fever, regulating the Spleen and Stomach must be the priority. For conditions such as vomiting, diarrhea, abdominal pain, and fullness, initially use warm tonification, adding aromatic and acrid-hot herbs such as Cyperi Rhizoma (Xiangfu, 香附) and Amomi Fructus (Sharen, 砂仁), until the symptoms subside and the Spleen Qi functions normally. Subsequently, use pure tonifying medicines, awaiting resolution through sweating. As the ancients said: When Qi stagnation and material injury coexist, tonification should be combined with digestion-promoting methods; this is what is meant.