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Any febrile disease where the patient prefers hot food and drink, cannot sleep or lie down comfortably, and cannot bear clothing or bedding, is a disease of Yang deficiency. (Bingzhang notes: This cannot be taken as an absolute basis. Those with phlegm-fluid retention in the chest often prefer hot drinks; if mistakenly treated as Yang deficiency with hot herbs, harm will inevitably result over time.)

In cases of diarrhea and intestinal wind, the small intestine is thin and unable to transport waste properly, causing it to seep into the large intestine.

In cases of dryness, the large intestine is deficient and unable to moisten, resulting in constipation and difficulty in defecation.

Spleen deficiency leads to indigestion; retained food causes sourness. Stomach deficiency leads to inability to digest fluids; retained fluids cause epigastric discomfort (clanging sensation).

When the Spleen is excess, food is digested and muscles are smooth and lustrous. When the Spleen is deficient, the body is emaciated, and the limbs are weak and difficult to move.

Sweat stopping at the neck indicates that Yang Qi is not dispersing; sweat stopping at the navel indicates that Yang Qi is about to move; sweat reaching the feet indicates that Yang Qi is circulating throughout the body, and the disease will heal spontaneously.

Lung disease results in a lack of control over the whole body; Spleen disease results in the inability to move the limbs.

Generalized distension and pain belong to Blood deficiency in the Yin aspect. High fever also belongs to the Blood aspect. Mild chills and fever, persistent fever, or sweat stopping at the neck belong to the Qi aspect. For Qi aspect disorders, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable, modified according to symptoms; for Blood aspect disorders, Xionggui Tang (Peony and Angelica Decoction) with Rougui (Cinnamon Bark) or Siwu Tang (Four Substances Decoction) with Mahuang (Ephedra) and Rougui (Cinnamon Bark) is suitable. For chest fullness, Siwu Tang (Four Substances Decoction) with Sujing (Perilla Stem) is used.

Loss of taste may be due to excess heat or deficient heat. Loss of taste for grain foods indicates Middle Jiao deficiency. Grain Qi enters the Spleen and Stomach, and Middle Qi relies on it for nourishment; if one does not desire food, it is surely due to insufficiency. These two conditions are distinct: when Middle Qi is excess, it is empty, allowing free communication between upper and lower; when Middle Qi is deficient, it becomes obstructed, leading to phlegm condensation and Qi stagnation. For example, after trauma, if blood-breaking herbs fail to resolve stasis, abdominal fullness will form because toxic factors enter the Spleen.

All exterior syndromes belong to interior deficiency. (Wang Xushan states: This implies that all pathogenic excess stems from root deficiency, teaching students that treatment must seek the root. However, this view merely serves as a rigid footnote, failing to honor Zhou Shenzhai's compassionate intent to save lives, and inviting criticism from unskilled practitioners. Bingzhang notes: This view is ultimately incorrect. If it were truly interior deficiency, tonification should be used; how can tonification cure an exterior syndrome? Even Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was not originally designed for external contraction. Misinterpreting this causes significant harm. Although Mr. Wang Xushan tried to justify it to suit the times, it does not cover his error.)

Spontaneous heat, steaming fever, and apparent irritability without true restlessness are treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Chills and fever resembling malaria are treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Erchen Tang (Two-Cured Decoction). Mild chills and fever indicate deficiency of Yang within Yin, requiring tonification of the Upper Jiao using Bazhen Tang (Eight Treasures Decoction) plus Huangqi (Astragalus). If the chest and diaphragm feel constricted, add phlegm-resolving herbs. Spontaneous sweating with mild heat indicates deficiency of Yin within Yang, treated with Bazhen Tang (Eight Treasures Decoction) plus Rougui (Cinnamon Bark). If there is abdominal pain, add Ganjiang (Dried Ginger) and Wuzhuyu (Evodia Fruit).

Chills and fever resembling malaria indicate deficiency of Exterior Yang. Exterior Yang refers to the vigorous Wei Qi of the Stomach, which ascends to the crown and floats on the skin and hair. Ascending and floating Qi never ceases. When Stomach Qi is deficient, it sometimes fails to ascend and float, becoming stagnant in the Half-Exterior Half-Interior. Competing externally with the Taiyang channel causes chills; competing internally with the Yangming channel causes fever. Tonifying and ascending resolves these chills and fevers. If untreated for a long time, Stomach Qi's ascending function diminishes. Less ascending leads to weak Yang and chills; less descending leads to less Blood and fever. Treat with Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Ten Great Tonifying Decoction). Mild chills indicate Yang deficiency. Mild heat indicates Yin has no source to generate, leaving deficient Yang without attachment. Bazhen Tang (Eight Treasures Decoction) tonifies both Yin and Yang; adding Huangqi (Astragalus) increases the effect of tonifying Yang. Spontaneous sweating belongs to Yang deficiency, but if Jingye (Body Fluids) are scant, Yin becomes more deficient, causing mild heat. Bazhen Tang (Eight Treasures Decoction) plus Rougui (Cinnamon Bark) increases the effect of tonifying Yin.

Scholars often suffer from mental agitation, sweating, insomnia, diarrhea, or excessive phlegm. Though symptoms vary, they all originate from the Heart and Spleen. Excessive thinking causes Heart Fire to invade the Spleen; the Sovereign Fire loses its command, and Minister Fire takes over. If the source is not cleared and the root not corrected, Yang Qi sinks further, and pathogenic Qi grows stronger. Guipi Tang (Restore the Spleen Decoction) and similar formulas are appropriate. (Zhang Dongfu states: Heart Fire invading the Spleen damages Spleen Yin; one should tonify Spleen Yin, not Spleen Yang. In mutual invasion of the Five Zang organs, one must observe Yin and Yang; damage to Yin requires tonifying Yin, damage to Yang requires tonifying Yang. Misapplying Yin/Yang tonification causes great harm. Bingzhang notes: This annotation is also inaccurate; Guipi Tang (Restore the Spleen Decoction) alone cannot treat this. Excessive thinking depletes Heart Blood, leaving the Spleen without received Qi, causing Spleen deficiency. Guipi Tang (Restore the Spleen Decoction) specifically tonifies Spleen Yang and cannot treat this condition. Xue Yupeng treated Heart-Spleen disorders by combining Guipi Tang (Restore the Spleen Decoction) with Tianwang Buxin Dan (Emperor of Heaven's Special Pill to Nourish the Heart) into pills, which is closer to the truth. Zhang Dongfu's note is very refined...)

For those who think excessively at night, causing restless sleep, decocting Zhuyeqian (Bamboo Leaf) and Zaoren (Ziziphus Seed) provides relief.

For diseases of the Lower Jiao, Liuwei Wan (Six-Ingredient Pill with Rehmannia) can be generally used. However, in cases of diarrhea, the key lies in regulating Spleen and Stomach Yuan Qi, and Dihuang (Rehmannia Root) should not be used lightly. (Zhang Dongfu states: If Dihuang (Rehmannia Root) is prepared thoroughly, it will not damage Spleen Qi. It can be used for diarrhea when monitored with Shanyao (Dioscorea) and Fuling (Poria). Bingzhang notes: Diarrhea patients often have dampness; Shudi (Prepared Rehmannia Root) should be used with caution.)

Diarrhea belonging to the Spleen requires drying, as the Spleen dislikes dampness. Diarrhea belonging to the Kidney requires moistening, as the Kidney dislikes dryness. Kidney diarrhea results from the loss of the storing and grasping function, failing to control urination and defecation. (Wang Xushan states: The methods for treating diarrhea are fully stated here. Modern practitioners only know to treat the Spleen and ignore the Kidney, hence their mixed success and failure.)

In treating diseases, although many symptoms appear, vomiting should only be stopped with anti-emetics, and diarrhea only with anti-diarrheals. After stopping vomiting, Liujunzi Tang (Six Gentlemen Decoction) should be used for regulation. After stopping diarrhea, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) plus Muxiang (Vladimiria Root) should be used for regulation.

Diseases of the Upper Jiao should be opened and dispersed; diseases of the Middle Jiao should be harmonized; diseases of the Lower Jiao should be unblocked and eased.

Treating symptoms directly is a major taboo for physicians. Diseases have root (Ben) and branch (Biao) aspects. Often, the root disease is hidden while branch symptoms appear, or root and branch contradict each other. Treating only visible symptoms leads to errors. One must investigate the cause of the symptom to identify the root. For example, headache, fever, aversion to cold, and bone/joint pain are exterior excess syndromes. However, Yang deficiency causes aversion to cold, Yin deficiency causes fever, and Blood deficiency causes withered sinews/bones and pain. Stomach, Liver, and Kidney deficiencies can all cause headaches. (These are not exterior excess syndromes.) Silence, limb weakness, shortness of breath, and cold body temperature are interior deficiency syndromes. However, Stomach excess with Spleen failure to transport can cause silence; rising Yin Qi preventing Yang from commanding can cause cold body temperature. (These are not interior deficiency syndromes.) Transformations are countless: excess resembling deficiency, deficiency resembling excess, exterior resembling interior, interior resembling exterior. All require careful investigation of the root. The root has causes: cold/heat, food/Qi, excess/deficiency, or seasonal fluctuations. Treat cold with warming, heat with clearing, food stagnation with digestion, Qi stagnation with unblocking, excess with pacifying, and deficiency with tonifying, adjusted for seasonal tastes, and the disease resolves. (This method should be known.)

If various diseases do not resolve, one must look to the Spleen and Stomach to avoid error. Why? Because once the Spleen and Stomach are damaged, the Four Zang organs lose their vital energy, leading to disease. All things arise from Earth and return to Earth; tonifying the Spleen is superior to tonifying the Kidney. Many diseases resolve when attention turns to the Spleen and Stomach. For cough, spontaneous sweating, and fever caused by Lung deficiency generating phlegm, do not focus on resolving phlegm or clearing heat; strengthen Earth so phlegm dissipates and heat retreats. Use Sijunzi Tang (Four Gentlemen Decoction) plus Guizhi (Cinnamon Twig), Ganjiang (Dried Ginger), Chenpi (Tangerine Peel), and Beiwuweizi (Schisandra Berry), followed by Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for regulation. (Bingzhang notes: While knowing the root is correct, the Spleen and Stomach function through ascending/descending and transformation, crucial for moving Qi mechanism. Relying solely on Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction) is insufficient for comprehensive Spleen/Stomach treatment.)

Spleen and Stomach deficiency usually indicates Yang deficiency, but can also present with Yang hyperactivity, persistent heat, spontaneous sweating, aversion to cold, and limb fatigue. For Middle deficiency with exterior heat, tidal fever, or spontaneous sweating, do not depart from Middle-tonifying formulas. Add Qianghuo (Notopterygium Rhizome) for exterior heat; add Fuzi (Aconite Root), Jiang (Ginger), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit), Qingpi (Green Tangerine Peel), and Shenqu (Medicated Leaven) for abdominal fullness. For regulation, use Bazhen Tang (Eight Treasures Decoction); for Qi and Blood dual deficiency, use Shiquan Dabu Tang (Ten Great Tonifying Decoction); for Yin deficiency with fire hyperactivity and surging pulse without diarrhea, use Liuwei Tang (Six-Ingredient Decoction) plus Renshen (Ginseng); for aversion to cold, use Bazhen Wan (Eight Treasures Pills); for abdominal pain, use Lizhong Wan (Regulate the Middle Pills); for consumptive disease, use Huqian Wan (Tiger Crouching Pills). With diverse and confusing symptoms, regulation via the Spleen and Stomach is the orthodox method of Qi Bo and Huang Di.

For diseases with vomiting and diarrhea, do not forget the Spleen and Stomach; even with miscellaneous symptoms, treat the branch. Shortness of breath with a forceful pulse indicates excess; forceless pulse indicates deficiency. Long Qi and pulses are easy to treat; deficiency with rapid breathing is hard to regulate; chronic illness should not lead to emaciation. For internal injury deficiency, long-term administration is effective regardless of dosage; if medicinal power has not reached, success is impossible. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fuzi (Aconite Root); add Qianghuo (Notopterygium Rhizome) if no sweat; for spontaneous sweating and fever, use Baoyuan Tang (Preserve the Origin Decoction) plus Baizhu (Atractylodes Macrocephala), Gui (Cinnamon), Fu (Aconite), Danggui (Angelica Sinensis), Shaoyao (Peony), and Erchen Tang (Two-Cured Decoction) for certain cure. Chronic illness undoubtedly involves Yang deficiency due to loss of Stomach's generating Qi. Baoyuan Tang (Preserve the Origin Decoction) is a holy medicine for sweet-warm fever reduction; abandoning it for cold-bitter herbs guarantees death. Even with dry stool, if Yang is trapped in the Yin aspect, do not purge. Seeking the Spleen and Stomach in all diseases is Li Dongyuan's profound insight. The Stomach governs generating Qi; emotions and desires damage the Stomach. Lack of appetite indicates stagnation in any of the twelve meridians, halting generating Qi, depriving the Four Zang organs of vitality, and increasing disease. Physicians who fail to distinguish Qi/Blood, Cold/Heat, Excess/Deficiency, and ignore the Spleen and Stomach in prescribing cause harm nine out of ten times.

Case Records

Patient 1: Left Cun pulse is slightly rapid at middle pressure, powerless and unclear at heavy pressure. Guan pulse is forceful at middle and deep pressure. Chi pulse is deep, fine, and forceful. Right Cun pulse is choppy at middle pressure, invisible at heavy pressure. Guan pulse seems forceful at middle pressure but unclear below. Chi pulse is deep, rapid, and powerless. This is an internal injury deficiency syndrome affecting the Spleen and Lung channels. Treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to allow Yang to generate and Yin to grow. Add 2 fen of Salt-fried Huangbai (Phellodendron Bark) to rescue the Kidney, and 1 qian of Zaoren (Ziziphus Seed) to calm the Spirit. If urine is hot or difficult, add 5 fen of Yuanzhi (Polygala Root) and Lianxu (Lotus Stamen) to unblock. (Bingzhang notes: Treatment should never rely solely on pulse without symptoms, nor solely on symptoms without pulse; both must be combined for truth. Without knowing the symptoms, the pulse suggests Earth excess, Wood weakness, and Kidney Water deficiency. How can the patient tolerate the ascending and dispersing action of Shengma (Cimicifuga) and Chaihu (Bupleurum)? Even with 2 fen of fried Huangbai (Phellodendron Bark), it is insufficient to rescue the Kidney.)

Patient 2: Left Cun pulse is short and choppy, indicating Heart Blood deficiency. Guan pulse is slightly wiry and powerless. Left Chi pulse is deep and fine. Right Cun pulse is slightly floating and scattered. Right Guan pulse feels forceful upon pressing but insufficient upon lifting and powerless/unclear upon heavy pressing. Right Chi pulse is deep and powerless. Attribute this to lack of Fire. Tonify Qi and Blood greatly with Shiquan Dabu Tang (Ten Great Tonifying Decoction).

Patient 3: 58 years old. Right pulse is slightly wiry; left pulse is hollow, large, and forceful. Wiry is the Wood pulse; appearing on the right hand indicates Stomach deficiency due to Wood overacting. Left pulse being hollow, large, and forceful indicates flourishing pathogenic fire. Incurable. (Bingzhang notes: This appears incurable, and certainly cannot be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).)

Patient 4: Female, 30 years old. Left Cun is floating and large; Left Guan is large; Left Chi is surging and large. Right Cun is floating and large; Right Guan and Chi are deep, fine, and powerless. Prescription: Shanzhuyu (Cornus Fruit), Baifuling (Poria with White Part), and Shengdihuang (Raw Rehmannia Root) 1 qian each; Zexie (Alisma) and Chenpi (Tangerine Peel) 5 fen each; Chuannaofu (Processed Aconite) and Shenggancao (Raw Licorice Root) 2 fen each. Decoct with Ginger and Jujube. Floating and surging/large pulses belong to Fire; thus, strengthen Water to control Fire. Zexie (Alisma) and Baifuling (Poria with White Part) guide Fire downward. Deep, fine, and powerless Guan/Chi pulses indicate insufficient True Fire; thus, add Fuzi (Aconite Root)...

Patient 5: Female. Six pulses are purely Yin. Intervals of 2-3 or 4-5 beats show pauses. This is Qi deficiency within Blood. Sijunzi Tang (Four Gentlemen Decoction) plus Shaoyao (Peony) and Rougui (Cinnamon Bark) regulates Spleen and harmonizes Liver. Form pills with Shanyao (Dioscorea) paste. Qi within Blood is governed by the Spleen; when Spleen Earth is robust, Upper Jiao Lung Qi is sufficient. Both Spleen and Lung are Taiyin, relying on Yang for generation. Using Gui (Cinnamon) warms Earth and prevents Metal from becoming cold, allowing natural generation of Qi and Blood.

Patient 6: Both Chi pulses are deep and faint; Spleen/Stomach pulses are weak; Lung pulse is choppy at middle pressure. This indicates Fire failing to generate Earth, Cold in the Lower Jiao, and Phlegm in the Upper Jiao. Cough will likely develop, after which Yang Qi generation is a good sign. The subtlety of medication lies in applying effort to deficiency; once applied to excess, progress is difficult. (Bingzhang notes: Based on the pulse, the discussion is not erroneous, but adding that one must always focus on deficiency regardless of pulse or symptom seems to imply...)