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Xia Ziyi recorded in *Qiji Fang* (Treatise on Strange Diseases): A person suffered from an abdomen hard as iron and stone, with fluid oozing from the umbilicus, gradually transforming into a sensation resembling insects crawling, surrounding the body biting and pecking, causing unbearable itching and pain, which could not be relieved by scratching or sweeping. They were bathed in a strong decoction of *Cangzhu* (Rhizoma Atractylodis), and then cured by taking *Cangzhu* powder mixed with a small amount of *Shexiang* (Moschus) dissolved in water.

[Shen Yuan’s Commentary] The *Classic of Internal Medicine* states: "Cold causes firmness." It also states: "Dampness generates parasites." This condition, with fluid oozing from the umbilicus and transforming into a crawling insect sensation surrounding the body biting, is precisely dampness generating parasites. Generally, because dampness makes the abdomen hard as iron and stone, this is what is meant by "cold causes firmness," due to internal cold coexisting. Therefore, the parasites do not originate internally but rather externally. Parasites born of dampness require the blowing of Yang Qi to generate; this fluid in the abdomen originally possessed the vitalizing Qi, showing signs of parasite generation, but due to exogenous cold invading internally, the Qi fails to transform, resulting only in fluid flowing outwards, further stimulated by the blood and Qi of the skin to generate parasites. *Cangzhu* dries dampness and disperses cold; thus, it is decocted for external washing to remove the already exuded fluid, and made into powder with *Shexiang* for internal administration to eradicate the root. *Shexiang* opens all orifices, warms the Water Organ (Kidney), and can kill parasites, making its use appropriate.

It is also recorded: A person suffered from *Shijue* (Corpse-like Fainting/Syncope), suddenly appearing dead, with gas moving in the abdomen like thunder. One tael of *Liuhuang* (Sulfur) and five qian of *Yanxiao* (Niter) were finely ground, divided into three doses, decocted in good wine until smoke rose, then stopped, cooled to warm, and administered. After a moment, another dose was given, bringing peace.

[Shen Yuan’s Commentary] The *Lingshu Jing* (Spiritual Pivot) states: "Evil Qi invades the collaterals of Hand-Taiyin, Foot-Taiyin, Foot-Shaoyin, and Foot-Yangming, converging in the ears, and connecting upwards to the left corner of the head. If organ Qi interacts mutually, or exogenous evil strikes, Qi becomes obstructed and cannot flow, the five collaterals are severed, all meridians hide, causing the whole body's pulses to move while the form remains unconscious. Its state resembles a corpse, hence named *Shijue*." This is caused by contracting abnormal Qi, suddenly leading to cold extremities, gooseflesh on skin, cyanotic and black face, unsettled spirit, clenched teeth and jaw, coma, dizziness, and collapse. This often occurs when mourning, entering temples, or encountering sudden fright/attacks. Urgently administer *Suhe Xiang Wan* (Styrax Pill). Another method: urgently decoct half a cup of ginger juice with half a cup of wine, boil, and administer. Moxibustion on Baihui (GV20) 49 moxa cones, Qihai (CV6) and Dantian (CV17) 200-300 moxa cones; stop when the body feels warm, then treat as Yin Toxin syndrome. This is a syndrome of deficient-cold of the zang organs. Laypeople fail to recognize it, often treating it as Wind-Stroke, rarely surviving. There is also Qi Jue (Qi Syncope) caused by emotional injury, sudden Qi rebellion, cold stiff body, clenched jaw, flooding phlegm-saliva, and coma. This often results from excessive anger. Do not mistake it for Wind-Stroke and use wind-dispersing herbs; urgently administer *Suhe Xiang Wan*. Upon regaining consciousness, regulate descending Qi with *Bawei Shunqi San* (Eight-Ingredient Qi-Regulating Powder) or *Muxiang Tiaoqi San* (Aucklandia Qi-Regulating Powder). For phlegm, use *Siqi Tang* (Four-Substance Decoction) with *Nanxing* (Arisaema Cum Bile) and *Muxiang* (Aucklandiae Radix). However, some cases of sudden syncope resolve without treatment. For example, during the reign of Emperor Renzong of Song, his Noble Consort suddenly collapsed while eating, her body becoming cold. Sun Shangdu was summoned and stated it was Qi Jue; she would recover after vomiting. She indeed recovered later. The *Suwen* states: "Jue syndrome may cause abdominal fullness, or sudden unconsciousness, lasting half a day to a day before recovery. Excess Yin above leads to deficiency below, causing abdominal fullness; excess Yang above leads to heavy downward Qi rebelling upward, causing evil Qi reversal, chaotic Yang Qi, and unconsciousness." It also states: "When Blood and Qi rush together upwards, it is Great Jue, causing sudden death; if Qi returns, life is preserved; if not, death ensues." There is also Food Jue (Food Syncope) after overeating/drinking, or contracting wind-cold/emotional stress, leading to sudden coma, inability to speak or move limbs. This is due to food stagnation in the chest, blocking Yin and Yang, preventing ascending and descending. Mistaking this for Wind-Stroke and using wind-dispersing agents severely damages Stomach Qi, leading to imminent death. One should induce vomiting with ginger-salt soup, then regulate with *Pingwei San* (Peace the Stomach Powder) plus *Fuling* (Poria), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Maiya* (Hordei Fructus Germinatus), and *Banxia* (Pinelliae Rhizoma). If wind-cold remains, use *Huoxiang Zhengqi San* (Agastache Qi-Regulating Powder); for Qi stagnation, use *Bawei Shunqi San*.

*Qiji Fang* states: A person felt itching in the intestines and stomach with nowhere to scratch, feeling as if they had no place to stand. This is due to Fire stagnating and not dispersing. The method is to use exterior-releasing herbs; taking several doses of *Huayang Tang* (Itch-Dissolving Decoction) cures it spontaneously.

It also states: A person’s umbilicus bled incessantly without pain or itch, a strange disease. The formula uses *Liushi Tang* (Six-Ingredient Decoction) plus one qian of *Gusuibu* (Drynariae Rhizoma). Drinking it cures it. The umbilicus is the location of the Kidney Meridian; bleeding indicates Kidney Fire escaping outward. *Liushi Tang* nourishes Water, extinguishing Fire; *Gusuibu* specifically stops bleeding from orifices, making it suitable.

It also states: A person’s umbilicus suddenly grew two inches long, resembling a snake tail, without pain or itch. This is due to Phlegm-Qi stagnation in the Ren and Dai meridians. The method uses one fen of *Pengsha* (Borax), one qian each of *Baizhi* (Angelicae Dahuricae Radix) and *Xionghuang* (Realgar), one fen of *Bingpian* (Borneolum Syntheticum), and two qian of *Ercha* (Camelliae Semen), all ground fine. Prick the tail to bleed; if dizzy and near death, apply medicine instantly, turning it into black water. Take three qian of *Baizhi* decocted in water to cure. If uncured, do not treat further; this is a karmic illness, untreatable by medicine.

It also states: A person had a snake growing in the abdomen. This is identified by the body being dry as firewood, with scales, indicating snake poison. The formula uses *Baizhi* powder taken daily with rice water to cure.

Previously, a patient ate normally but acted like a madman when attacking, with a blue-yellow face and lower abdominal fullness resembling pregnancy. The pulse and symptoms did not match, making treatment difficult. An old mountain man said: "In the sixth year of Kaihuang, someone at Ba Bridge contracted this by eating celery by the water on March 8th." Someone knowledgeable said: "This is Dragon-Jiao Disease. The dragon swims on celery; eating it causes disease." They used *Hanshi Tang* (Cold Food Candy), five he per dose, taken for several doses, expelling a small object resembling a dragon-jiao, curing the patient.

[Shen Yuan’s Commentary] Zhang Zhongjing states: "In spring and autumn, dragons carry essence into celery. Humans who mistakenly eat it develop a blue face, abdominal fullness like pregnancy, and unbearable pain. This is an internal Dragon-Jiao. Taking two to three sheng of hard candy three times a day, expelling a lizard, cures it."

Hua Tuo stated: A person suffered intermittent epigastric pain, worse when hungry, fearing extreme cold, suffering daily. I administered three taels of garlic crushed into juice. Suddenly, a three-chi long snake was vomited, and the patient was cured. Snakes fear garlic scent most; this was my personal case.

He also stated: I treated a person with abdominal attacking pain for ten days, losing hair. I said: "The spleen is half-rotten; we must open the abdomen to treat it." After administering medicine to sleep, we opened the abdomen. The spleen was indeed half-rotten. We cut it with a knife, removed the foul flesh, applied ointment, and the patient recovered.

[Shen Yuan’s Commentary] Only this master could treat this condition. I record it so future generations with abdominal pain and hair loss will know it is spleen rot.

Chen Zhengmin’s *Dunzhai Xianlan* states: Yang Zhongnian had a strange disease where a small voice echoed in his abdomen, growing louder over time. A Daoist saw him and said: "This is the Echoing Worm." Read through the Materia Medica; treat those that do not respond. When reading about *Leiwang* (Wormseed), it did not respond. He took several pills and was cured.

*Bozhai Bian* states: Mao Jing, a military officer in Yongzhou, had an object in his throat echoing every time he spoke. A Daoist taught him to recite Materia Medica names. When he reached "Lan" (Isatis Root), he fell silent. He drank Lan juice and soon vomited a two-inch fleshy block with human features, curing him.

*Xiongshi Buyi* states: A person had sounds in the abdomen like ghost crying. Urgently decoct *Huanglian* (Coptidis Rhizoma) strongly and sip frequently to cure.

[Shen Yuan’s Commentary] All strange sounds in patients belong to worms. This ghost-crying sound is also a worm. Worms are generated by warmth-dampness; thus, *Huanglian* clears heat with cold and dries dampness with bitterness. Bitter-cold is heavy, yin, and肃杀 (destructive), harming harmonious Qi, like winter cold killing all worms.

*Liangfang* states: A pregnant woman had bell-like ringing in her abdomen. Two qian of soil from a mole hole (*Fenshu Kute*) powdered with a little *Shexiang*, taken in warm water, cures it instantly. Or decoct *Huanglian* strongly and have the woman sip frequently.

Question: Strange sounds belong to worms. Is the pregnant woman’s bell-ring also a worm? Answer: No. Sounds not fitting the five musical notes (Gong, Shang, Jue, Zhi, Yu) belong to organ diseases, not worms. Spleen belongs to Earth, its note is Gong (heavy and loud). Pregnant women’s abdominal ringing like a bell is the Gong note of Earth. This sound arises from depression/stagnation, which requires heat to manifest. The syndrome is due to pre-existing stagnant heat in Spleen Earth, exacerbated by the growing fetus compressing Qi. Stagnant Qi rebels and emits this sound (like thunder from trapped Yuan Yang Qi). Earth clears heat and directs Qi downward. Mole soil is extreme Yin earth, protecting *Shexiang* to reach Spleen Yin, dispersing Qi, clearing heat, and absorbing fragrance (earth absorbs fragrance), healing without harming the fetus. Alternatively, *Huanglian* clears Spleen Yin fire, extinguishing fire and dispersing Qi to cure.

The wife of Registrar Chen Zizhi had a strange disease: abdominal distension caused drum-like sounds audible outside, stopping when distension subsided, occurring once a month. Dozens of doctors failed to diagnose it.

Question: Why monthly? Answer: The Classic states all sounds belong to Heat. This drum-like sound is also Gong note. It is due to Spleen Earth deficiency with heat and stagnation. The monthly cycle relates to menstruation. Blood roots in Qi; Qi stagnates or condenses. Qi excess causes pain; Qi deficiency causes distension. On the expected date, if Qi is excessive, it moves with pain. If insufficient, Qi cannot circulate, filling and stagnating in the middle, causing distension. The stagnant Qi of Spleen Earth escapes with blood, creating the sound. As blood moves down, distension and sound cease. Thus, it happens monthly. If not related to menstruation, why this symptom? Treatment should clear/tonify Spleen/Stomach, harmonize blood, and regulate menstruation to cure.

Question: Both bell and drum sounds are Gong (Earth), yet different sounds? Answer: This depends on Qi direction. Bell sound: Although from Spleen Earth, Qi rebels to Lung. Lung receives Qi, preventing dispersion, so it rings like a bell. If Lung does not govern upper jiao, Qi scatters like thunder. Lung belongs to Metal, note Shang. When Lung receives Qi, Shang note plays, creating the sound. Drum sound: Sound travels downward, covered by skin below, responding to lower jiao. Earth sound escapes downward, sounding like a drum.

*Zhouhou Fang* states: Sudden abdominal pain and distension, shortness of breath, rushing to chest/heart, attacking flanks, lumps rising, or pulling waist/spine. This is Corpse Ghost harm. Take thatch from the four corners of the roof, put in copper vessel, cover abdomen with red cloth, heat thatch in copper vessel, follow pain, stop when itchy.

It also states: Sudden severe abdominal pain after intercourse with a woman is Yin Toxin. Drink pig blood mixed with hot wine.

*Kou Shi Yan Yi* states: A child with umbilical bleeding/crying or fluid discharge. Apply *Baishizhi* (Alumen) powder warmly three times daily without disturbing to cure.

Sun Simiao stated: Mountain people who bite lice develop *Shixia* (Lice Mass) in the abdomen. Use one broken hair comb and one broken hairbrush. Boil one part in five sheng water to one sheng, take to expel.

*Kezuo Xinwen* states: Fu Shi of Qingyang, a physician, treated a scholar’s father with abdominal distension. Pulse was surging and large, indicating damp-heat generating worms. Diet normal, not edema/gu distension. Use east-facing roots of pomegranate and Chinese Toon, plus five qian each of *Binglang* (Arecae Semen), decocted in running water, taken fasting. Severe abdominal pain followed, expelling a one-zhang long worm, curing him.

Li Ziyu treated Xu Yong’s brother, Governor of Yuzhou, with heart-abdominal pain for ten years, nearly dead. One night, a ghost behind the screen told the abdominal ghost: "Tomorrow Li Ziyu passes, killing you with Red Poison." The abdominal ghost replied: "I fear not." Li arrived. Before entering, the patient heard groaning in the abdomen. Li diagnosed Ghost Disease. Administered *Badu Chi Wan* (Eight-Toxic Red Pill). Soon, rumbling diarrhea occurred, curing him.

Si Bo treated Zhang Jingsheng, 15, with abdominal distension and yellow face, unresponsive to drugs. Si Bo said: "This is Stone Roundworm (*Shi Hui*), hard to treat. Use a dead man’s pillow decocted." Expelled 5-6 sheng of large roundworms with stone-hard heads. Wang Yan asked why. Si Bo said: "Stone roundworms resist standard meds due to hardness. Ghost objects drive them out, then they disperse. Hence, dead man’s pillow."

Danxi examined a woman whose abdomen enlarged like pregnancy to ten months, seeking easy delivery herbs. Her complexion was difficult. Given herbs, she produced half a bucket of white worms in days. Due to severe Qi deficiency, congealed essence/blood failed to form a fetus, becoming filth. Long accumulation turned damp to heat, generating worms. This required ten months of Qi to manifest birth, a bad omen; she died before term. Damp-heat generating worms is like stagnant ditch water breeding worms.

A woman had a mass right of the umbilicus after aborting with toxic herbs. Mass pain caused chills/fever. Mass was one cun above umbilicus, tender, pulse surging-rapid. Zhu Danxi said: "Blood stasis overflowed into intestinal blind membranes, forming an abscess." Used tonifying Qi/Blood, resolving stagnation, draining pus formula. Punctured with needle after three days, profuse foul pus/blood expelled. Patient feared, but Zhu said Qi/Blood regeneration closes orifices; healed in ten days.

Wang Shishan treated a 50-year-old pale, irritable man. Verbal disagreement caused shouting, Qi decline, vomiting. Sudden pain under left breast. Later, fatigue/anger caused foul Qi rushing up, coughing/vomiting, dry cough, hematemesis, malaria-like episodes. Malaria/phlegm/Qi treatments failed. Pulse floating-thin, slightly wiry-rapid. Wang said: "Earth deficiency, Wood hyperactivity." Irritability/anger causes Liver Fire movement, leading to breast pain (Liver Qi stagnation). Foul Qi rushing is Liver Fire insulting Spleen/Stomach. Hematemesis is Liver failing to store blood due to Fire. Cough is Metal lacking nourishment and controlled by Fire. Vomiting is Spleen deficiency failing to transport food, generating phlegm. Chills/fever are Water/Fire conflict. Treat by purging Liver excess, tonifying Spleen deficiency, clearing Lung dryness. Formula: *Qingpi* (Citri Reticulatae Pericarpium Viride), *Shanzhi* (Gardeniae Fructus) 7 fen; *Baishao* (Paeoniae Radix Alba), *Huangqin* (Scutellariae Radix) 1 qian; *Guishen* (Angelicae Sinensis Radix), *Ejiao* (Asini Corii Colla) 8 fen; *Gancao* (Glycyrrhizae Radix), *Wuweizi* (Schisandrae Fructus) 5 fen; *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Maidong* (Ophiopogonis Radix) 1.5 qian; *Renshen* (Ginseng Radix) 3 qian. Decocted for over a month, symptoms resolved.

A thin, weak man had left abdominal fullness, grain Qi flowing right only, poor diet, constipation. Wang’s pulse floating-slow-weak. Wang said: "Earth deficiency, Wood excess." Use *Renshen* to tonify Spleen; *Zhishi* (Aurantii Fructus Immaturus) to purge Liver; *Shaoyao* to guide Metal to drain Wood; *Danggui* (Angelicae Sinensis Radix) to harmonize blood/moisten; *Houpo* (Magnoliae Officinalis Cortex), *Chenpi* (Citri Reticulatae Pericarpium) to relieve distension; *Chuanxiong* (Ligustici Chuanxiong Rhizoma), *Shanzhi* to open stagnation. After ten doses, slight relief. Craved human milk due to stool binding. Wang warned of slippery bowels. Stopped milk, continued formula adding 4-5 qian *Renshen* per dose. Later craved aromatic/dry foods. Wang said: "Spleen disease with Qi knot, aromatic/dry is safe." Ate 10-20 dry *Feizi* (Torreya Seeds) and roasted steamed cakes daily to aid medicine, stable after a year.

A woman near 50 had abdominal pain. Started with cold in right fingers, spreading to head like cold water pouring. Severe abdominal pain caused whole-body heat; heat retreat, pain stops. Pain regardless of eating. Occurred yearly, recently every 2-3 days, max 6-7 days. *Siwu Tang* + *Chaihu*/*Xiangfu* failed. *Sijunzi Tang* + *Muxiang*/*Binglang* failed. *Erchen Tang* + *Zisu*/*Doukou* failed. *Qi Qi* formulas failed. Wang’s pulse微弱 (weak/faint), intermittent, indicating severe Yang deficiency. *Dushen Tang* (Single Ginseng Decoction) 5 qian, *Chenpi* 7 fen, decocted for ten doses, cured. Limbs are ends of Yang; head is meeting of Yang. Classic: "Yang deficiency causes aversion to cold." "One excess, one deficiency. Yang deficiency/Yin excess causes cold. Yin deficiency/Yang excess causes heat." Cold fingers to head indicate Yang defeat/Yin excess. Yang defeat fails to move, causing pain. Pain followed by heat is reversal at extremes. When Yin/Yang Qi decline and stop fighting, heat/pain cease. Spleen/Stomach have much Qi, little Blood; Qi generates Blood. Qi deficiency means Blood deficiency. Zhongjing: "Tonify with Ginseng for Blood/Qi deficiency." Thus, *Dushen Tang* cured years of pain.

Qian Zhongyang treated a boy with good-colored pox, but one abdominal sore painful, color turning purple, returning to normal when pain stopped. Pulse surging-large. Ten days in, pustules filling but not crusting. Used medicine to evacuate blood stasis; sore improved and healed.

Yu Jiayan treated Ye Maoqing’s son. Pox not fully formed into pustules, shell thin. Two months later, some attached to flesh not shedding. One night, severe abdominal pain, screaming, fainting. Gave pear juice in warm water, briefly revived, then fainted again. Decocted two taels of *Huangqin* (Scutellariae Radix) with pear juice, pain stopped. Ordered frequent paste intake, refused. Later, abdomen became enormously distended. One night...