〔一〕医事难矣哉。学识荒陋者无论矣。其在术精名重。日诊百十人。精神不逮。大意处辄复误人。盖晨夕酬应。
无少息时。索索无精思。昏昏有俗情。虽贤哲不免也。徐悔堂听雨轩杂记云。乾隆壬申。同里冯姓馆于枫桥蔡姓家。
夏日蔡自外归。一蹶不起。气息奄然。因以重金急延薛生白先生诊。至则蔡口目悉闭。六脉皆沉。少外家泣于旁。亲
朋议后事矣。薜曰。虚厥也。不必书方。且以独参汤灌之。遽拱手上舆而别。众相顾。莫敢决。再延一苻姓医入视。苻
曰。“中暑也。当服清散之剂。参不可用。”众以二论相反。又相顾莫敢决。冯曰。“吾闻六一散能祛暑邪。盍先试
之。”乃以苇管灌之。果渐苏。苻又投以解暑之剂。病即霍然。夫薛氏为一代之名医。只以匆匆一诊。未遑细审。并
致疑于少外家之在旁。误以中暑为虚脱。几伤其生。医事不诚难乎其难哉。又类案载曾世荣先生治船中王氏子。
头痛额赤。诸治不效。动即大哭。细审知为船篷小篾。刺入囟上皮内。镊去即愈。苟不细心审视。而率意妄治。愈治
愈坏矣。是故医家临诊辨证。最要凝神定气。反复推详。慎毋相对斯须。便处方药也。
〔二〕熊三拔泰西水法云。凡诸药系草木果 谷菜诸部具有水性者。皆用新鲜物料。根据法蒸馏得水。名之为露。
以之为药。胜诸药物。何者。诸药既干既久。或失本性。如用陈米为酒。酒力无多。若以诸药煎为汤饮。味故不全。间
有因煎失其本性者。若作丸散。并其渣滓下之。亦恐未善。（然峻历猛烈之品。不得不丸以缓之。）凡人饮食。盖有三化。
一曰火化。烹煮熟烂。二曰口化。细嚼缓咽。三曰胃化。蒸变传化。二化得力。不劳于胃。故食生冷。大嚼急咽。则胃
受伤也。胃化既毕。乃传于脾。传脾之物。悉成乳糜。次乃分散。达于周身。其上妙者。化气归筋。其次妙者。化血归
脉。用能滋益精髓。长养脏体。调和营卫。所谓妙者。饮食之精华也。故能宣越流通。无处不到。所存糟粕。乃下于大
肠焉。今用丸散。皆干药合成。精华已耗。又须受变于胃。传送于脾。所沁入宣布。能有几何。其余悉成糟粕下坠而已。
若用诸露。皆是精华。不待胃化脾传。已成微妙。且蒸馏所得。既于诸物体中最为上分。复得初力。则气浓势大。不见
烧酒之味 于他酒乎。按古人丸散汤饮。各适其用。岂可偏废。诸药蒸露。义取清轻。大抵气津枯耗。胃弱不胜药力者。
最为合宜。其三化之说。火化口化。不必具论。胃化一言。深可玩味。盖饮食药物入胃。全赖胃气蒸变传化。所以用药
治病。先须权衡病患胃气及病势轻重。此古人急剂缓剂大剂小剂之所由分也。如骤病胃气未伤。势又危重。非用大
剂急剂不可。杯水舆薪。奚济于事。一味稳当。实为因循误人。倘或病患胃气受伤。无论病轻病重。总宜小剂缓剂。
徐徐疏瀹。庶可渐望转机。以病患胃气已伤。药气入胃。艰于蒸变传化。譬如力弱人。强令负重。其不颠踣者几希。
〔三〕上条言诸药蒸露。为轻清之品。气津枯耗。胃弱不胜药力者。最为合宜。请更申其说焉。元仪曰。“阴虚有三。
肺胃之阴。则津液也。心脾之阴。则血脉也。肝肾之阴。则真精也。液生于气。惟清润之品可以生之。精生于味。非粘
腻之物不能填之。血生于水谷。非调中州不能化之。”是则人身中津液精血。皆属阴类。津液最轻清。血则较 。
精则更加浓矣。读内经“腠理开发。汗出溱溱。是谓津。谷入气满淖泽。注于骨。骨属屈伸泄泽。补益脑髓。皮肤润
泽。是谓液。”则知津与液较。液亦略为 浓矣。窃谓津者。虽属阴类。而犹未离乎阳气者也。何以言之。内经云。“
三焦出气。以温肌肉。充皮肤。为其津。其流而不行者为液。”岂非液则流而不行。津则犹随气流行者乎。内经又
云。“上焦开发。宣五谷味。熏肤充身泽毛。若雾露之溉。是谓气。”雾露所溉。万物皆润。岂非气中有津者乎。验之
口中气呵水。愈足征气津之不相离矣。气若离乎津。则阳偏胜。即“气有余。便是火”是也。津若离乎气。则阴偏
胜。即水精不四布。结为痰饮是也。蒸露以气上蒸而得露。虽水类而随气流行。体极轻清。以治气津枯耗。其功能
有非他药所能及。泰西赞谓不待胃化脾传。已成微妙。余谓病患胃弱。不胜药力者。最为合宜。然其力甚薄。频频
进之可也。其气亦易泄。新蒸者为佳。余治伤阴化燥证。清窍干涩。每用之获效。内经谓“九窍者。水注之器。”清窍
干涩者。病患自觉火气从口鼻出。殆津离乎气。而气独上注欤。
〔四〕时毒瘟疫。口鼻吸受。直行中道。邪伏募原。毒凝气滞。发为内斑。犹内痈之类。其脉短滑。似躁非躁。口
干目赤。手足指冷。烦躁气急。不欲见火。恶闻人声。耳热面红。或作寒噤。昏不知人。郑声作笑。治宜宣通气血。解
毒化斑为主。得脉和神清。方为毒化斑解。但其斑发于肠胃嗌膈之间。因肌肤间不可得而见。往往不知为斑证而误治者
多矣。
〔五〕治痰气壅塞。悉尼汁一杯。生姜汁四分之一。蜜半杯。薄荷细末一钱。和匀器盛。重汤煮一时。任意与食。
降痰如奔马。此方出幼幼集成。甘寒辛润。邪袭于肺。泄肺降痰。试用良验。
〔六〕滑脉多主痰。以津液凝结故也。然有顽痰阻阂气机。脉道因之不利。反见涩脉者。开通痰气。脉涩转滑。见
之屡矣。又现证脉象的是痰证。而病患言无痰。服药后渐觉有痰。亦见之屡矣。阅孙文宿医案治庞姓。遭跌胁痛。服
行血散血药多剂。痛不少减。孙诊脉左弦右滑数。曰。“此痰火症也。”庞曰。“躯虽肥。生平未尝有痰。徒以遭跌
积瘀血。于胁间作痛耳。”孙曰。“痰在经络间。不在肺。故不咳嗽。而亦不上出。脉书有云。滑为痰。弦为饮。据脉实
痰火也。如瘀血。脉必沉伏。或芤或涩也。面色亦不带黄。前医以瘀血治者。皆徇公言。不以色脉为据耳。”乃用大栝蒌
带壳者二枚。重二两。研碎。枳实。甘草。前胡。各一钱。贝母二钱。初服腹中漉漉有声。超时大泻一二次。皆痰无
血。痛减大半。再服又下痰数碗许。痛全止。三服腹中不复有声。亦不泻。盖前由痰积泻也。今无痰故不泻。观此。则
诊病虽须详问。又当色脉合参。不可徇病患之言。为其所惑。又嘉言喻氏亦谓“痰到胃始能从口吐出。到肠始
能从下泻出。”
〔七〕本经曰。“五味子气味酸温无毒。主益气。咳逆上气。劳伤羸瘦。补不足。强阴。益男子精。”卢子繇乘雅半
偈曰。“五味俱全。酸收独重。故益降下之气。咳逆上气者。正肺用不足。不能自上而下以顺降入之令。劳伤羸瘦者。
即内经云。烦劳则张。精绝使人煎厥内铄也。此补劳伤致降令之不足。与补中益气之治不能升出者相反。能降
便是强阴。阴强便能益精。设六淫外束。及肺气焦满。饵之反引邪入脏。永无出期。纵得生全。须夏火从中带出。或
为斑疹。或作疮疡。得汗乃解。倘未深解病情。愿言珍重。”按此则五味子之功能。的在降入。凡病情涉于宜升宜
出者。视为戈戟矣。盖肺统五脏六腑之气而主之。肾受五脏六腑之精而藏之。肾气原上际于肺。肺气亦下归于
肾。一气自为升降者也。故上而咳逆上气。由六淫外束。饵此则外邪不特不能升。不能出。直引之及肾。而渐成虚
损。倘同熟地麦冬等用。酸而兼腻。不啻锢而闭之。卷一第十一条所谓不虚而做成虚。不损而做成损者。此类是
也。若六淫七气有以耗散之。致肺失其降。而不归肺之气。因耗散而日虚。肾之精。因不藏而日损。此际不用五味
子而谁用乎。五味子能收肺气入肾。肺气收。自不耗散。入肾。则五脏六腑之精。肾得受而藏之矣。虽然。论药则得
一药之功能。论方则观众药之辅相。凡药皆然。试即于五味子发其凡。可乎。五味子之功能在降入。病情宜升宜
出者。不可用。固已。第执此说以论药则可。若执此说以论方。则金匮要略中射干麻黄汤浓朴麻黄汤小青龙加
石膏汤等方之用五味子。其说遂不可通。殊不知古人治病用药。每于实中求虚。虚中求实。不比后人之见虚治
虚。见实治实。补者一味补。散者一味散。攻者一味攻也。故杂五味子于麻黄细辛桂枝生姜诸表药中。杂五味子
于射干紫菀款冬杏仁半夏诸降气降逆药中。杂五味子于石膏干姜。诸寒热药中。杂五味子于小麦白芍甘草
大枣诸安中药中。不嫌其夹杂。而于是表散药。得五味子不致于过散。降气降逆药。得五味子更助其降令。而且
寒热药得五味子寒不伤正。热不劫津。安中药得五味子相得益彰。综而言之。用五味子意在保肺气。不使过泄。
然皆辅相成方。非君药也。至桂苓味甘汤之治气冲。加减者四方。苓甘五味姜辛汤。苓甘五味姜辛半夏汤。苓甘
五味加姜辛半夏杏仁汤。苓甘五味加姜辛半杏大黄汤。以小青龙方中虽有五味子辅相之。究竟辛散之力大。
能发越外邪。亦易动人冲气。冲气者。冲脉之气也。冲脉起于下焦。挟肾上行者也。气既冲矣。非敛不降。桂苓能抑
冲气。甘草坐镇中宫。而敛降之权。当属之五味子矣。所以四方减去者惟桂枝。而加味以治咳满。以去其水。以治
形肿。以治胃热冲面。至于五味子收敛肾气。屹然不动。不使其气复冲。苓甘若为之辅相者。终不易也。以是知一
药有一药之功能。一方观众药之辅相。不识药性。安能处方。不识方义。安能用药。凡药皆然。岂特一五味子。试即
以五味子发其凡。词费之诮。奚辞哉。
〔八〕邹润安本经疏证论五味子与干姜同用。设为问答曰。“伤寒论中凡遇咳总加五味子干姜。岂不嫌其表
里无别耶。曰。经云。脾气散精。上归于肺。是故咳虽肺病。其源实主于脾。惟脾家所散上归之精不清。则肺家通调
水道之令不肃。后人治咳。但知润肺消痰。殊不知润肺则肺愈不清。清痰则仅能治脾。于留肺者。究无益也。干姜
温脾肺。是治咳之来路。来路清。则咳之源绝矣。五味使肺气下归于肾。是开咳之去路。去路清。则气肃降矣。合两
物而言。则为一开一阖。当开而阖。是为关门逐贼。当阖而开。则恐津液消亡。故小青龙汤小柴胡汤真武汤四逆
散之兼咳者皆用之。不嫌其表里无别也。”按此论颇透彻。嘉言喻氏谓“干姜得五味能收肺气之逆。”是浑
而言之也。陈修园不论虚实证。遇咳辄用五味干姜。是浑而用之也。金匮桂苓味甘加干姜细辛。干姜为热药。服
之当遂渴。干姜为热药。仲圣已有明文矣。外感之由于暑燥火。内伤之涉于阴亏。虽同五味或辅相药。终不宜用
也。考金匮五味同干姜用者七方。皆有咳满证。不同干姜用者二方。射干麻黄汤证。亦见咳而上气。虽不同干姜
而同生姜用。其义仍在治肺。独桂苓味甘汤方治气冲。其义在治肾。然肺与肾一气。自为升降者也。治肺即所以治肾。
治肾即所以治肺。不过因病处方。注意或在肺。或在肾耳。或曰。黑地黄丸中。五味干姜并用。治在肺欤。曰。论
金匮方用五味意义。大抵如此。至后人用五味。其方不可胜数。岂能一一印证。若五味并熟地用。乌得谓不治肾。
黑地黄丸。乃治脾湿肾燥方。一刚一柔。一润一燥。熟地五味治肾燥。苍术干姜治脾湿。此分头治法也。熟地苍术。
益肾阴而兼运脾阳。苍术五味流脾湿。即以润肾燥。此交互治法也。嘉言喻氏谓此方超超元箸。岂虚誉耶。若不
综观全方。寻绎意义。徒沾沾于某药入某经。某药治某病。则自窒灵机矣。
〔九〕钱塘赵恕轩。名学敏。一字根据吉。撰利济十二种。其串雅一种。书分内外两编。类皆草泽医所传诸方法。世
所谓走方。手持虎刺。游食江湖者是也。虎刺一名曰虎撑。以铁为之。形如环盂。虚其中窍。置铁丸。周转。摇之有声。
相传始于宋李次口行山逢虎。啮刺于喉。求李拔。置此器于虎口。为拔去之。其术乃大行。流传至今。其术治外以针
刺蒸灸。治内以顶串禁截。取其速验。不计万全。药上行者曰顶。下行者曰串。顶药多吐。串药多泻。顶串而外。则曰
截。截绝也。如绝害然。走医以顶串截为三大法。末流妄定有九顶。十三串。七十二截等目外。又有九种。十三根等
法。能拔骨髓诸毒外出。然不肖疡科。每窃以取利。种毒留根。变小成大。为害不浅。又有禁法。禁法之大。莫如水法。
次则祝由。近于巫觋。且有变病法。如约脾丸中用木瓜露以闭溺窍。掩月散中用鲤脊鳞以遮瞳神。取贝母中之
丹龙睛。以弛髓脉。剔刺 中之连环骨。以缩骨筋。外科则用白朱砂以种毒。蛇蕈灰以种疮。即九种十三根之类。
更有合扁豆膏以留疟。曼陀酒以留癫。甚则醉兽散之可以病马牛。金针丸之可以困花木。种种不仁。愈降愈甚。
良由操技不精。欲藉此遂其罔利之心耳。恕轩取其所授。为芟订之。名曰串雅。不欲泯其实。并欲矫奇。而俾归于
[1] The practice of medicine is indeed difficult. Those with shallow learning and sparse knowledge need not be mentioned. Even for those who are skilled in technique and renowned, if they diagnose a hundred or more patients daily, their mental energy will be insufficient, and they often err due to carelessness. Because of busy day-and-night social engagements, with no time for rest, their thinking becomes mechanical and lacks profound contemplation; their minds are dull and clouded by worldly concerns. Even the wise and virtuous cannot avoid this. Xu Huitang recorded in *Zayu Xuan Zaji* (Miscellaneous Records from the Listening Rain Pavilion): In the Renshen year of the Qianlong reign, a man surnamed Feng, a tutor from the same hometown, was employed by a family surnamed Cai at Fengqiao. One summer day, Mr. Cai returned from outside and suddenly collapsed, unable to rise, his breath faint and life hanging by a thread. Heavy gold was offered to urgently invite Mr. Xue Shengbai for diagnosis. Upon arrival, Mr. Xue found Mr. Cai’s mouth and eyes tightly closed, with all six pulses sunken. Beside him, the daughter-in-law (or son-in-law) was weeping, and relatives and friends were discussing funeral arrangements. Mr. Xue said, "This is a deficiency syncope (Xu Jue). There is no need to write a prescription. Administer Dushen Tang (Single Ginseng Decoction) immediately." He then bowed, boarded his sedan chair, and departed. The crowd looked at each other, daring not to decide. Another doctor, surnamed Fu, was invited to examine the patient. Doctor Fu said, "This is heatstroke. One should take clearing and dispersing agents; ginseng must not be used." The two opinions being contradictory, the crowd again looked at each other, unsure what to do. Mr. Feng said, "I have heard that Liuyi San (Six-to-One Powder) can dispel pathogenic heat. Why not try it first?" Thus, Liuyi San was administered via a reed tube. Indeed, the patient gradually revived. Doctor Fu then administered heat-clearing agents, and the illness vanished instantly. Mr. Xue was a famous physician of his generation, but due to a hasty single consultation without adequate detailed examination, and ignoring the presence of the relative beside him, he mistook deficiency collapse for heatstroke, nearly costing the patient his life. If medical practice is not sincere and cautious, how much more difficult can it be? Another case record mentions Mr. Zeng Shirong treating a boy named Wang on a boat. The patient had a headache and a red forehead; various treatments failed, and he cried loudly whenever moved. Upon careful examination, it was discovered that a small bamboo splinter from the boat canopy had pierced the skin of the fontanelle. Removing it with tweezers cured him immediately. If one does not examine carefully but treats arbitrarily, the condition worsens with treatment. Therefore, when diagnosing and differentiating syndromes, a physician must concentrate their spirit and calm their mind, repeatedly analyzing and detailing the situation. They must never consult for a mere moment and then hastily prescribe medication.
[2] Xiong Sanba, in *Taixi Shuifa* (Western Methods of Water), states: For any medicinal materials derived from plants, fruits, grains, or vegetables that possess water properties, fresh materials should be used. According to specific methods, distillation yields a liquid called "Lu" (Dew/Essence). Using this as medicine surpasses other forms. Why? Because dried medicines, over time, may lose their original nature. For instance, wine made from aged rice has weak potency. If medicines are decocted into soups or drinks, their flavors are incomplete, and some may lose their true nature due to boiling. If made into pills or powders, ingesting the dregs along with them is also not ideal. (However, for harsh and potent drugs, pill form is necessary to moderate their strength.) Human digestion involves three processes: Fire transformation (cooking until soft), Oral transformation (chewing slowly and swallowing gently), and Stomach transformation (steaming and transporting). If the first two are effective, the stomach is spared labor. Eating raw or cold food and gulping it down damages the stomach. After stomach transformation is complete, substances are transmitted to the spleen. What reaches the spleen becomes chyle, which then disperses throughout the body. The finest part transforms into Qi and enters the tendons; the next finest transforms into blood and enters the vessels. This nourishes essence and marrow, grows organ tissues, and harmonizes Ying and Wei (Nutritive and Defensive Qi). This essence is the quintessence of food, capable of circulating freely everywhere. The remaining dregs descend to the large intestine. Pills and powders today are made from dry herbs; their essence is already depleted. They must undergo change in the stomach and transmission by the spleen; how much essence actually penetrates and distributes? The rest becomes dregs and descends. Lu (distilled essences), however, contain pure essence, requiring no stomach or spleen transformation, becoming subtle immediately. Distillation extracts the highest quality from materials, retaining initial potency, resulting in concentrated Qi and strong action, unlike cloudy spirits mixed with other wines. Ancient people used pills, powders, decoctions, and drinks appropriately for different needs; why discard any? The purpose of herbal Lu is clarity and lightness, most suitable for those with depleted Qi and fluids, or weak stomachs unable to tolerate strong medicines. Regarding the "Three Transformations," fire and oral transformations need not be discussed in detail; the concept of "Stomach Transformation" is worth pondering. Food and medicine entering the stomach rely entirely on Stomach Qi for steaming, transforming, and transporting. Thus, treating disease with medicine requires weighing the patient's Stomach Qi and the severity of the illness. This explains why ancients distinguished between urgent/mild and large/small doses. For sudden illness with unharmed Stomach Qi and critical severity, large and urgent doses are necessary; otherwise, it is like a cup of water on a cartload of fuel—useless. Seeking safety through caution is actually negligence harming the patient. If Stomach Qi is injured, regardless of illness severity, small and mild doses are appropriate, slowly resolving stagnation to hope for gradual improvement. Since injured Stomach Qi struggles to transform medicine, forcing it is like making a weak person carry heavy loads; falling is likely.
[3] The previous section stated that herbal Lu are light and clear, most suitable for those with depleted Qi/fluids and weak stomachs. Let us elaborate further. Yuanyi said: "Yin deficiency has three types: Yin of Lung and Stomach is Jin-Ye (Body Fluids); Yin of Heart and Spleen is Blood-Vessels; Yin of Liver and Kidney is True Essence. Ye is generated from Qi, requiring only clear and moistening agents; Jing is generated from flavor, requiring sticky and cloying substances to fill it; Blood is generated from grain and water, requiring regulation of the Middle Jiao for transformation." Thus, Jin, Ye, Jing, and Blood all belong to Yin. Jin is lightest and clearest; Blood is thicker; Jing is even denser. Reading *Neijing*: "When couli open and sweat pours out profusely, this is Jin; when grain enters and Qi fills, becoming moist and penetrating bones, aiding flexion/extension and nourishing brain marrow and skin luster, this is Ye." Comparing Jin and Ye, Ye is slightly denser. I propose that although Jin belongs to Yin, it has not separated from Yang Qi. Why? *Neijing* says: "Sanjiao emits Qi to warm muscles and fill skin; this is its Jin; flowing but not moving is Ye." Does this not mean Ye flows but does not move, while Jin moves with Qi? *Neijing* also says: "Upper Jiao opens, disseminates grain flavors, warms skin, fills body, moistens hair, like mist and dew irrigation; this is Qi." Mist and dew moisten all things; does this not imply Jin exists within Qi? Testing breath condensing into water confirms Qi and Jin are inseparable. If Qi separates from Jin, Yang prevails excessively ("Excess Qi becomes Fire"). If Jin separates from Qi, Yin prevails excessively ("Water essence fails to distribute, condensing into Phlegm-Fluid"). Lu is obtained by Qi evaporating upward; though water-like, it moves with Qi, is extremely light and clear, and treats Qi/Jin depletion effectively, unmatched by other drugs. Westerners praise it as subtle without needing stomach/spleen transformation. I agree it suits weak stomachs. However, its power is thin; frequent dosing is advised. Its Qi dissipates easily; freshly distilled is best. I treat Yin-damage with dryness syndrome, where clear orifices are dry, using Lu with good results. *Neijing* states "Nine orifices are vessels for water." Patients with dry clear orifices feel fire exiting mouth/nose, likely because Jin left Qi, and Qi alone ascended.
[4] Seasonal toxins and epidemics enter via nose and mouth, traveling directly through the central pathway, hiding in the Mu Yuan (Root of Diaphragm). Toxin congeals and Qi stagnates, manifesting as internal macules (ban), similar to internal abscesses. Pulses are short and slippery, seemingly restless but not quite. Symptoms include dry mouth, red eyes, cold fingers/toes, irritability, rapid breathing, aversion to fire, dislike of human voices, hot ears, red face, or chills. Coma, delirious speech, or inappropriate laughter may occur. Treatment should focus on promoting Qi and Blood circulation, detoxifying, and resolving macules. Recovery is indicated by harmonious pulses and clear spirit. These macules appear between the intestines, stomach, throat, and diaphragm, invisible on the skin surface, leading to frequent misdiagnosis and mistreatment.
[5] For phlegm-Qi obstruction, use one cup of Sydney juice (likely a specific local herb juice, possibly referring to a specific plant extract in context, literally 'Sydney Juice'), 1/4 cup ginger juice, half cup honey, and one qian of fine mint powder. Mix well, store in a vessel, and boil in a double boiler for one hour. Administer freely. It reduces phlegm swiftly like a galloping horse. This formula comes from *Youyou Jicheng*. Sweet-cold and pungent-moistening, it clears Lung pathogen and descends phlegm. Trials show excellent efficacy.
[6] Slippery pulses usually indicate Phlegm due to fluid congealing. However, stubborn Phlegm blocking Qi mechanism can make pulses slippery turn choppy. Unblocking Phlegm-Qi restores the slippery pulse, a common observation. Also, pulse signs clearly indicate Phlegm, yet patients deny having Phlegm; after medication, they gradually feel Phlegm, also commonly seen. In Sun Wensu’s case records, a patient named Pang suffered rib pain after a fall. Multiple blood-invigorating prescriptions failed to reduce pain. Sun diagnosed left wiry, right slippery-rapid pulse, stating, "This is Phlegm-Fire syndrome." Pang replied, "Though fat, I never had Phlegm in my life. It is just blood stasis from the fall causing rib pain." Sun said, "Phlegm is in the collaterals, not the Lung, so no cough or expectoration. Pulse classics say: Slippery is Phlegm, Wiry is Fluid. The pulse confirms Phlegm-Fire. Blood stasis would present with deep, hidden, knotted, or choppy pulses, and yellowish complexion. Previous doctors treated stasis based solely on your words, ignoring color and pulse." He prescribed two large Trichosanthes fruits (with shell), weighing two liang, crushed, plus Zhi Shi, Gan Cao, Qian Hu (one qian each), and Bei Mu (two qian). First dose: rumbling in abdomen, followed by large bowel movement once or twice later, consisting of Phlegm, not blood; pain reduced significantly. Second dose: several bowls of Phlegm expelled; pain stopped completely. Third dose: no rumbling, no diarrhea. Previously, diarrhea was caused by Phlegm accumulation; now absent, so no diarrhea. This shows that while detailed inquiry is needed, color and pulse must be combined; one must not be misled by patient statements. Jiayan Yu Shi also stated, "Phlegm must reach the Stomach to be vomited from the mouth, and reach the Intestines to be purged from below."
[7] *Benjing* states: "Wuweizi (Schisandra Fruit) is sour, warm, non-toxic. It benefits Qi, treats cough and rebellious Qi,劳伤 (labor injury) and emaciation, supplements deficiency, strengthens Yin, and benefits male essence." Lu Ziyao in *Chengya Banji* said: "Among the five flavors, sour astringency is predominant. Thus, it benefits descending Qi. Cough and rebellious Qi indicate insufficient Lung function to descend naturally. Labor injury and emaciation correspond to *Neijing*'s 'excessive fatigue causes expansion, essence exhaustion leads to burning厥 (Jue) and internal melting.' This supplements the lack of descending function caused by labor injury, opposite to Buzhong Yiqi Tang which treats inability to ascend. Descending is strengthening Yin; strong Yin benefits Essence. If constrained by Six Evils or Lung Qi scorching/fullness, taking it draws pathogens into organs, offering no escape. Even if saved, Summer Fire must emerge from within, causing macules/rashes or sores, resolving only with sweat. Without deep understanding of pathology, heed these words carefully." Thus, Wuweizi’s function is specifically descending. For conditions requiring ascending or releasing, it is contraindicated. Lung governs Qi of all organs; Kidney stores Essence of all organs. Kidney Qi ascends to Lung; Lung Qi descends to Kidney. One Qi rises and falls. Upper cough/rebellious Qi due to Six Evils: taking Wuweizi prevents expulsion, drawing pathogens to Kidney, forming deficiency. Combined with Shudi/Maidong, its sour/cloying nature seals closure. As noted in Vol 1, Art 11, creating deficiency/damage where none existed. However, if Six Evils/Seven Emotions cause dispersion, leading to Lung losing descent and Kidney failing to store, Wuweizi is essential to gather Lung Qi into Kidney, preventing dispersion and storing Essence. While a drug has one function, a formula relies on mutual assistance. All drugs work this way. Using Wuweizi as an example: Its function is descending; contraindicated for ascending/releasing conditions. This holds for individual drugs, but applying it rigidly to formulas contradicts *Jinkui Yaolue* formulas like Shegan Mahuang Tang, Houpo Mahuang Tang, Xiao Qinglong Jia Shigao Tang, which use Wuweizi. Ancients sought deficiency in excess and excess in deficiency, unlike later doctors who simply tonified deficiency or drained excess. Mixing Wuweizi with Ma Huang, Xi Xin, Gui Zhi, Sheng Jiang (releasing herbs) prevents excessive dispersal. Mixing with Shegan, Zi Wan, Kua Dong, Xing Ren, Ban Xia (descending herbs) aids descent. Mixing with Shi Gao, Gan Jiang (cold/hot herbs) prevents cold from injuring Righteous Qi and heat from consuming fluids. Mixing with Xiao Mai, Bai Shao, Gan Cao, Da Zao (calming herbs) enhances synergy. Overall, Wuweizi protects Lung Qi from excessive leakage, acting as an assistant, not sovereign. In Guiling Ganwei Tang treating Chong Qi (Pulsating Qi), and variations (Ling Gan Wuwei Jiang Xin Tang, etc.), although Xiao Qinglong Tang uses Wuweizi, the pungent-dispersing power is strong, potentially stirring Chong Qi (from Chong Mai, rising from Lower Jiao alongside Kidney). Once Chong Qi surges, astringency is needed to descend. Guiling suppresses Chong Qi, Gan Cao stabilizes Middle Jiao, but Wuweizi holds the power of astringing and descending. Hence, Gui Zhi is removed in variations, adding ingredients for cough/fullness, water retention, edema, or Stomach Heat. Wuweizi firmly astrings Kidney Qi, preventing resurgence. Ling Gan assists. Thus, knowing drug functions and formula synergies is crucial. How can one prescribe without knowing drug nature? How can one use drugs without knowing formula meaning? This applies to all drugs, not just Wuweizi.
[8] Zou Run'an, in *Benjing Shuzheng*, discusses Wuweizi with Gan Jiang via Q&A: "In *Shanghan Lun*, Wuweizi and Gan Jiang are added for every cough. Isn't this lacking distinction between exterior and interior? Answer: Classics state 'Spleen Scatters Essence, sending it up to Lung.' Thus, cough is Lung disease, but source lies in Spleen. If Spleen's scattered essence is unclear, Lung's water passage regulation is unsound. Later doctors only moisten Lung and resolve Phlegm; moistening makes Lung less clear, resolving Phlegm only treats Spleen, benefiting nothing for Lung retention. Gan Jiang warms Spleen/Lung, clearing the source of cough. Wuweizi sends Lung Qi down to Kidney, opening the exit. Clearing both source and exit achieves opening and closing. Closing when should open traps thief; opening when should close consumes fluids. Thus, Xiao Qinglong Tang, Xiao Chaihu Tang, Zhen Wu Tang, Si Ni San with cough use both, ignoring exterior/interior distinction." This argument is thorough. Jiayan Yu Shi said "Gan Jiang with Wuweizi restrains rebellious Lung Qi," speaking generally. Chen Xiuyuan used Wuweizi/Gan Jiang indiscriminately for cough regardless of deficiency/excess. *Jinkui* Guiling Ganwei adds Gan Jiang/Xi Xin; Gan Jiang is hot, causing thirst post-ingestion, confirmed by Zhong Jing. External pathogens from Summer-Heat/Dryness/Fire or internal injury from Yin Deficiency should not use these, even with assistants. Seven *Jinkui* formulas use Wuweizi+Gan Jiang for cough/fullness; two do not. Shegan Mahuang Tang uses Sheng Jiang instead of Gan Jiang, still treating Lung. Only Guiling Ganwei Tang treats Chong Qi/Kidney. Lung/Kidney Qi interact; treating one treats the other. Prescription focuses on Lung or Kidney depending on disease. Some ask about Hei Di Huang Wan using Wuweizi+Gan Jiang for Lung? Answer: *Jinkui* usage principles are as described. Later formulas are countless. Using Wuweizi with Shudi clearly treats Kidney. Hei Di Huang Wan treats Spleen Dampness and Kidney Dryness. Hard/Soft, Moist/Dry. Shudi/Wuweizi treat Kidney Dryness; Cang Zhu/Gan Jiang treat Spleen Dampness (separate approaches). Shudi/Cang Zhu benefit Kidney Yin and transport Spleen Yang; Cang Zhu/Wuweizi drain Spleen Dampness and moisten Kidney Dryness (interactive approach). Jiayan praised this formula highly. Not viewing the whole formula leads to rigid thinking on meridian entry and specific indications.
[9] Zhao Shuxuan of Qiantang, name Xuemin, courtesy name Genji, wrote *Liji Shierzhong*, including *Chuan Ya*. Divided into Internal/External volumes, it contains methods from folk/herbal doctors, known as "Walking Doctors" holding Tiger Support (Hu Chenggeng). Made of iron, ring-shaped with a hollow center containing a clapper, shaking produces sound. Legend says Song Dynasty Li Cikou met a tiger biting his throat; he placed the device in the tiger's mouth to remove the thorn, popularizing the method. Techniques include external acupuncture/moxibustion, internal Ding (topping/vomiting), Chuan (stringing/purging), and Jie (cutting/blocking). Fast results prioritized over safety. Upward-moving drugs are Ding (often induce vomiting); downward-moving are Chuan (often induce purging). Outside these is Jie (cutting off harm). Walking doctors use Ding, Chuan, Jie as main methods. Corrupt practitioners invented Nine Dings, Thirteen Chuans, Seventy-Two Jies, Nine Types, Thirteen Roots to draw out bone marrow toxins. Malicious surgeons used these for profit, planting toxins, worsening conditions. Forbidden methods included Water Magic and Zhuyou (incantations), bordering on witchcraft. Disease-changing methods included using Papaya Dew in Yuepi Wan to block urination, Carp Scale Mask to obscure vision, Dragon Eye in Fumu to relax marrow vessels, Chain Bone in Thorns to shrink tendons. Surgeons used White Cinnabar to plant toxins, Snake Mushroom Ash to plant sores (Nine Types/Thirteen Roots). Others used Bean Paste to retain Malaria, Datura Wine to retain Epilepsy. Worst, Drunken Beast Powder sickened horses/cattle, Golden Needle Pill stunted plants. Such cruelty escalated due to poor skills and greed for profit. Shuxuan collected and edited these teachings, naming it *Chuan Ya*, preserving truth while correcting eccentricities, guiding them back...