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Tai Lao Xiansheng (Senior Gentleman). His spirit is inwardly guarded and retained. In all matters, he maintains an attitude of humility and retreat. Having reached the age of seventy (ancient term for old age), his appearance resembles that of a child. This is likely due to having received the full endowment from Heaven (Tian Quan) and not suffering damage from external pathogens. He has long suffered from weak Spleen Qi (Spleen energy). He exercises self-restraint regarding rich and heavy foods. Recently, he developed a hernia in the lower abdomen, shaped like a chicken egg. After several episodes, its shape gradually enlarged and lengthened. It descends easily from the lower abdomen into the scrotum, but returning it to its original position is difficult. Exposure of the lower body to even slight cold triggers an episode. During an attack, one must wait until the cold qi within the mass gradually turns warm before it can soften and retract. Otherwise, it swells at the narrow opening and cannot enter. Recently, the mass has become larger. During attacks, it feels like lying a wine bottle across the hip; half is in the lower abdomen, half in the scrotum. Its condition is hard and tight as stone. The qi bursts into the meridians connecting the lower back, waist, and navel, causing simultaneous distension. From there, it attacks upward into the Stomach, causing severe vomiting. From there, it attacks upward to the vertex, causing tremors and aversion to cold. Life and death depend on breathing. Last winter, witnessing a sudden violent onset, I knew this was Earth Qi (Yin-cold pathogen) attacking upward. I urgently administered a large dose of Renshen Tang (Ginseng Decoction) combined with Fuzi (Prepared Aconite Root), Shengjiang (Fresh Ginger), and Guizhi (Cinnamon Twig). One dose cured him. Since then, whenever an episode occurred, I used Guizhi Tang (Cinnamon Twig Decoction) and Fuzi with rapid effect. In late May this year, while I was away, his condition was aggravated by fatigue over several days. He took more than twenty doses of Shiquan Dabu Tang (Complete Great Tonifying Decoction), but the effect was very slow. However, he suspected the disease was severe, not that the medication was too mild. At that time, Mr. Yu, a family friend, was supervising grain transport in Zhejiang. Remote consultation also suggested that using Shiquan Dabu Tang for a hundred doses would naturally be effective. Thus, he resolved to take it. By mid-autumn, the condition relapsed. Upon recurrence, I again administered Shengjiang, Guizhi, Renshen, and Fuzi. His son, Jianshi Youweng (Censor Youweng), was doubtful of both approaches and did not know whom to follow. I requested to explain the principle deeply. When Yang Qi is insufficient, Si Jun Zi Tang (Four Gentlemen Decoction) is used. When Yin Blood is insufficient, Si Wu Tang (Four Substances Decoction) is used. When both Yin and Yang are insufficient, Si Jun Zi Tang and Si Wu Tang are combined and modified to form Shiquan Dabu Tang. This is the orthodox, balanced approach. However, if turbid Yin Qi accumulates in the lower abdomen, forming a tangible mass, Yin excess has reached its extreme. How can one treat this with methods for Yin deficiency? Doing so would only assist the pathogen and exacerbate the illness. Why do I say this? For pregnant women suffering from Shang Han (Cold Damage), when forced to use herbs like Mahuang (Ephedra Herba), Guizhi (Cinnamon Twig), Xiaoshi (Niter), or Dahuang (Rhubarb Root and Rhizome) which may harm the fetus, adding Si Wu Tang (Four Substances Decoction) prevents these harsh drugs from entering the uterus and harming the fetus. Does this mean that to eliminate pathogens in a mass, one should use Si Wu Tang (Four Substances Decoction) to protect them? This is one evidence. For those developing Jia and Pi masses (abdominal lumps), progressing to emaciation and blood depletion, various attempts to remove them fail to reduce the condition. Once Si Wu Tang (Four Substances Decoction) is used, the condition immediately worsens. Si Wu Tang (Four Substances Decoction) does not generate or invigorate blood; it merely increases affliction. This is another evidence. Human blood vessels rely entirely on dietary intake for nourishment and growth. Si Wu Tang (Four Substances Decoction) is cloying and obstructs the Spleen; it is originally not prized for men. Given that turbid Yin is extremely excessive, drawing Yin meridians at specific times and rushing straight into Yang collaterals, the danger of Earth Qi encroaching upward is significant. How can one use semi-Yin, semi-Yang herbs to delay and attempt resolution? The inappropriateness of Si Wu Tang (Four Substances Decoction) is beyond doubt. Even Si Jun Zi Tang (Four Gentlemen Decoction) is like a senior official; it cannot handle complex and severe administrative tasks. One must add fierce herbs like Shengjiang (Fresh Ginger), Guizhi (Cinnamon Twig), and Fuzi (Prepared Aconite Root) to overcome the disease. Why? Pathogenic Yin, when inactive, is fine; when active, it is violent. Observe: when Heaven Qi descends, clarity prevails; when Earth Qi ascends, obscurity ensues. The human body is roughly analogous. People see the stillness of Earth Qi but not its movement. Medical texts discuss the decline of Yin Qi but not the excess of Yin Pathogens. Physicians often do not know how to act when encountering diseases directly invading Yin meridians, let alone miscellaneous diseases. Please allow me to discuss the Dao of Heaven and Earth to clarify this. The principles of Heaven and Earth are exquisitely discussed in *Yuan Hui Yun Shi*. However, the principle of chaos during Xu and Hai hours is often ignored, under the assumption that Heaven and Earth merge into one, leaving nothing to discuss. This is incorrect. Heaven does not merge into Earth; rather, Earth merges into Heaven. If Earth Qi moves slightly, there are responses like mountain collapses and boiling rivers, shifting hills and changing valleys. How much more so when Earth Qi moves violently? The power of thunder and lightning strikes, numbering in billions, shakes the void, crashing horizontally and vertically, imposing upon Heaven. Would this not cause Heaven to merge with Earth? Only at Zi hour does Heaven open, Earth Qi descends slightly, and the high-covering Heaven becomes visible. Only at Chou hour does Earth expand, Earth Qi returns to the ground, and the vast space clears. At this time, life cannot yet exist because Earth Qi descending from Heaven is not yet pure. Besides the nine Qi of green, yellow, red, purple, crimson, white, and turquoise, many fierce and malignant Qi descend from the sky, stretching thousands of zhang, falling like wood and stone, flowing like arrows. Life may sprout within, but it is destroyed by these violent Qi and cannot grow. Only at Yin hour do inferior Qi return to harmony, allowing life to survive and gradually flourish. The cruelty and violence of Yin Qi reach such extremes. No one in history has discussed this. How do I know? The Tripitaka details the formation and destruction of worlds but lacks this discussion, likely because it is included within Earth, Water, Fire, and Wind. Are any of these not Yin Pathogens? Group Yin Pathogens brew catastrophic eras. My statement that Earth Qi merges with Heaven is not baseless speculation. Feng Shui masters know to seek auspicious Heavenly Stems and avoid inauspicious Earthly Branches. Why does medicine, when facing symptoms of Earth Qi surging upward, fail to consider avoiding this disaster? Zhang Zhongjing of the Han Dynasty specifically wrote *Zhu Bing Lun* (Treatise on Acute Diseases) in sixteen volumes. After the An Lushan Rebellion, it was lost and never transmitted. Later generations could not see it. I thus realized the principle of Earth Qi merging with Heaven. Whenever I encounter symptoms of Yin Pathogen rushing upward and solitary Yang disturbing, I suddenly administer pure Yang medicines to urgently expel Yin Qi. The expulsion makes loud sounds and exits through major orifices, clearing Heaven and Earth like revealing the sun and moon. The efficacy is evident. For Tai Lao Xiansheng's case, repeatedly using Jiang (Ginger) and Fu (Aconite) achieved results. Do not view this as a temporary expedient; it is a permanent method for all ages. However, the fierce nature of these drugs seems unsuitable for daily use. Even when taken during attacks, they may cause dry mouth and bitter taste. Everyone knows not to use them lightly, but sometimes one has no choice. Just as weapons are toxic to the world, skillful use brings obedience, while poor use causes rebellion. Current anti-bandit armies are monitored and constrained excessively. Their fierce spirit transforms into weakness and perversity, forcing peace with bandits. Areas passed through are looted bare, thorns grow, signaling famine, and good people are driven to become bandits. The court cannot stop war and lacks strategy for war, similar to this situation. I request to deliberate medical methods alongside military strategy. The hard mass is far in the lower abdomen, with no clear timeline for resolution. Poisonous drugs enter via the throat to the Stomach, then to the Intestines, only then reaching downward. The old disease remains, new diseases arise. Here, the treatment method is: first, make small pills of Jiang (Ginger), Fu (Aconite), and Rougui (Cinnamon Bark), drying them until hard. Then, coat them with a thick layer of Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). This way, the throat and Stomach perceive Renshen and Baizhu, not Jiang, Gui, or Fu. The drugs are delivered to the accumulation site, where the fierce potency reveals itself. Thus, the hard mass may be reduced, and the nest emptied. Currently, supervisors fill the ranks. Soldiers' money fills others' bellies; lives hang in others' hands. Their failure to defeat bandits is inevitable. Their major flaw is that soldiers protect supervisors, not supervisors protect soldiers, hence no success. If our soldiers face bandits from all sides, while supervisors fortify positions near enemy borders, clear the fields, and train locals in farming-and-fighting tactics, coating our troops with strong supplies, we will not bind swift horses or strong warriors. Our troops can advance bravely, striking heads and tails, smashing centers, resting by day and fighting by night to disrupt their disorganized forces, achieving clearance naturally. Moreover, with supervisors protecting outside, incoming troops dare not mutiny. Thus, civilians won't become bandits, and bandits can return to being civilians. As a hermit, I know little of current affairs, but offering this medical analogy might have some merit, so I mention it.
Mr. Youchen asked: The "outer coating" theory is logical. Why is it not used in ancient methods? I replied: Many ancient methods use this. For example, coating pills with Cinnabar (Zhusha) utilizes the South's red color, corresponding to the Heart, to escort drugs to the Heart. Coating with Indigo Naturalis (Qingdai) uses the East's green color, corresponding to the Liver, to escort drugs to the Liver. For treating malignant ulcers, drugs are wrapped in Scallion Leaves (Congye), chewed with Congbai (Scallion White), applied, and swallowed to avoid damaging the throat and diaphragm, reaching the ulcer directly. Even decoctions use this: boil large doses of Fuzi (Prepared Aconite Root) and Guizhi (Cinnamon Twig), add raw Huanglian (Coptis Rhizome), boil briefly, remove, cool, and drink. The cooked drugs move inward and downward; the raw drugs move outward and upward. Is this not the meaning of outer coating? Zhang Zhongjing treated Yin-pattern Cold Damage by boiling whole taels of Fuzi (Prepared Aconite Root), then adding a few drops of fresh Pig Bile (Zhuke Dan). This shows that sage-like drug usage always follows principles. Mr. Youchen said: Excellent.
Mr. Hu Youchen said: My father possesses complete virtue and Dao. He was healthy throughout his life. At sixty, catching cold in winter, he developed hernia. Ten years have passed. Each episode involves vomiting and aversion to cold, after which he recovers fully. Now, aided by Jiayan (Yu Chang's courtesy name), the illness is gradually removing itself, improving day by day. My father is endlessly joyful. All thanks to your grace.