無或曰:局方用藥多是溫補，或以為未合中道。積熱痼冷二門，其制作其取用吾子，其無以議之矣。予曰：張仲景言一百八病，五勞六極七傷與婦人共三十六病，孫真人言四百四病，凡遇一病須分寒熱，果寒耶則熱之，果熱耶則寒之，寒熱甚耶，則反佐而制之，今列病之目僅十有餘，而分積熱痼冷兩門，何不思之甚也，要略，中風脈緊為寒，浮為虛，肺痿吐涎不能欬，不渴，必遺溺，此為肺中冷，甘草乾薑湯溫之。腹滿痛，時減如故，此為寒，宜溫之。下利，欲嚏不能，此腹中寒也。脅下偏痛，脈弦緊，此寒也，宜大黃附子細辛湯溫之。痰飲，脈雙弦者，寒也。黃疸發熱，煩喘胸滿，口燥，又被火劫其汗，病從濕得，身盡熱而黃，此熱在內，宜下之。下利脈數而渴，設不差，則圊膿血，以其有熱也。婦人能食，病七八日而更發熱者，此為胃實氣熱，宜大承氣下之。產後七八日，若太陽證，小便堅滿，此惡露不盡，不大便四五日，發熱脯，時煩燥，食則妄言，此熱在裏，結在膀胱，宜大承氣利之安。婦人，或中風，或傷寒，經水適來適斷，有寒熱，皆為熱入血室，今局方不曾言病，而所謂寒與熱者，其因何在，其病何名，果無雜合，所受邪果無時令資稟之當擇耶？據外證之寒熱，而遂用之，果無認假為真耶？果以是為非耶？
無或曰::以寒熱為篇目，固未合經意，若其諸方果有合乎？予曰：以積熱為篇目，固有可議，若諸方之制作取用，儘有妙理，吾其為子發明前人之意，恐可為用方者涓埃之助，夫紫雪者，心脾肝腎胃經之藥也。通中散，洗心散，表裏血氣之藥也，涼膈散，心肺脾胃之藥也。龍腦飲子，勝冰丹，真珠散，靈液丹，上中二焦之藥也。碧雷雞蘇丸，三黃丸，八正散，三焦藥也。甘露丸，心脾肝之藥也，涼膈丸，心脾胃之藥也，抱龍丸，麥門冬散，心肺肝之藥也。妙香丸，疏腸快胃，制伏木火藥也，甘露飲，心肺胃藥也。五淋散，血而裏藥也。消毒飲，氣而表藥也。麻仁丸，氣而裏藥也。導赤丸，氣與血而裏藥也。導赤散，心小腸藥也。有升有降，有散有補，有滲導，有驅逐，有因用，有引經，或緩之以甘，或收之以酸，或行之以香，或因之以蠟，或燥之以苦，觀其立方，各有所主，用方之人宜求其意，若夫痼冷門，尤有可議者，冷即寒也，內經以寒為殺厲之氣，今加痼於冷之上，豈非指身惡寒，而口喜熱之病耶，若以此外證，便認為痼冷宜乎？夏英公之常餌，烏附常御綿帳，不知濕痰積中，抑遏陽氣不得外泄，身必惡寒。經曰：亢則害，承乃制，又劉河間曰：火極似水，故見此證。當治以鹹寒，佐以甘溫，視標本之先後，正邪之虛實，孰緩孰急為之治法，何至類用烏附丹劑，僭燥之藥，抱薪救火，屠劊，何異古人治戰慓，有以大承氣湯下之而愈者。惡寒戰慄，明是熱證，亦有因久服熱藥而得之者，但有虛實之分耳。進士周本道，年近四十，得惡寒證，服附子數日而病甚，求余治診，其脈弦而似緩，遂以江茶入薑汁香油些少，吐痰一升許，減綿大半，又與通聖散去麻黃，大麻，芒硝。加當歸，地黃，百餘帖而安，又一色目婦人，年近六十六，月內常覺惡寒戰慄，喜痰熱，御綿多汗如雨，其形肥肌厚，已得附子三十餘，但渾身痒甚，兩手脈沉澀，重取稍大。知其熱甚而血虛也，以四物湯，去川芎倍地黃，加白朮，黃耆，炒蘗，生甘草，人參，每帖二兩重，方與一帖，腹大泄，目無視，口無言，予知其病熱深而藥無反佐之過也，仍取前藥熟炒與之，蓋借火力為嚮導，一帖利止，四帖精神回，十帖病全安。又蔣氏婦，年五十餘，形瘦面黑，六月喜熱惡寒，兩手脈沉而澀，重取似數，以三黃丸下以薑汁，每三十粒，三十帖微汗而安，彼以積熱痼冷為敘方之篇目，其得失可知矣。泄痢一門，其用鍾乳健脾丸，朝真丸，駐車丸，呵梨勒丸，大溫脾丸，黃連阿膠丸，胡粉丸，桃花丸，訶梨勒散，木香散，七棗湯，赤石脂散，養臟湯，御米湯，金粟湯，狗頭骨丸，豆蔻丸，肉豆蔻散，三神丸，丁香豆蔻散，止瀉丸，皆用熱藥為主治，以澀藥為佐使，當為腸虛，感而成滑痢者設也，彼瀉痢者將無熱證耶？將無積滯邪？內經曰：春傷於風，夏為膿血，多屬滯下，夫瀉痢證，其類尤多，先賢曰：濕多成瀉，此確論也。曰風曰濕固不可得而通治矣。況風與濕之外，又有雜合受邪，似難例用澀熱之劑，今方中書證，有兼治裏急者，有兼治後重，有兼治裏急後重者，此豈非滯下之病乎，今瀉利與滯下混同論治，實實虛虛之患，將不俟終日矣。
無或曰::然則瀉痢與滯下為病不同，治法亦別，吾子其能通之乎？予曰：經曰暴注下迫，皆屬於熱。又曰暴注屬於火，又下痢清白屬於寒。熱，君火之氣，火，相火之氣，寒，寒水之氣，屬火熱者二，屬水寒者一，瀉痢一證，似乎屬熱者多，屬寒者少，詳玩局方，專以熱澀為用，若用之於下痢清白而屬於寒者，斯可矣。經所謂下迫者，即裏急後重之謂也，其病屬火，相火所為，其毒甚於熱也，投以澀熱，非殺之而何，謹按仲景之法，謂下痢脈滑而數者，有宿食，當下之，下痢脈遲而滑者，實也，痢為未止，急下之，下痢脈反滑，當有所去，下之安，下痢不欲食，有宿食者，當下之。腹滿痛為寒為實，當下之。下痢腹堅實，當下之。下痢譫語有燥矢，當下之。下痢二部皆平，按之心下堅急，當下之。下痢巳差，至其時復發者，此為下未盡，更下之安。下痢脈大浮弦，下之當自愈，風寒下者，不可下，下後心下堅痛，脈遲，此為寒，宜溫之，脈浮大，此為虛，強下之故也。設脈浮革者，因而腸鳴，當溫之，下痢脈遲緊，痛未欲止，當溫之。下痢心痛急，當救裏，可與理中四逆附子輩，下痢大孔痛，宜溫之，觀仲景可下蓋十法，可溫者五法，謂之下者，率用承氣加減，何嘗以砒丹巴碙，決烈燥熱重毒之劑，謂之溫者，率用薑附為主，何嘗用鍾乳，龍骨，石脂，粟殼緊澀燥毒之劑，
無或曰::可下者，豈非腸胃有積滯乎？不用砒丹巴碙，恐積滯未易行也，吾子以為未然，發明承氣之意可乎？予曰：大黃之寒，其性善走，佐以厚朴之溫，善行滯氣，緩以甘草之甘，飲以湯液，灌滌腸胃，滋潤輕快，無所留滯，積行即止，砒丹巴碙，毒熱類聚，劑成丸藥，其氣凶暴，其體重滯，積垢雖行，毒氣未過，譬如強暴貪賊，手持兵刃，其可使之徘徊顧瞻於堂奧間乎？借使有愈病之功，其腸胃清淳之氣，能免旁損暗傷之患乎？仲景治痢，可溫者溫，可下者下，或解表，或利小便，或待其自已，區別易治難治不治之證，至為詳密，然猶與滯下混同立方，命論其後，劉河間分別在表，在裏，挾風，挾濕，挾熱，挾寒，挾虛，明著經絡，隄防傳變，大概發明滯下證治，元為切要，有行血則便自安，調氣則後重自除，此實盲者之日月，聾者之雷霆也，
無或曰::局方治法，將終不能彷彿仲景之方耶，予曰：圓機活法，內經具舉，與經意合者，仲景之書也，仲景因病以製方，局方製藥以俟病，若之何，其能彷彿也，宋命近臣，讎校方書，彼近臣者，術業素異，居養不同，焉知為醫之事哉，雖然知尊仲景矣，亦未嘗不欲效之也，徒以捧心效西施爾，觀桃花丸一方可見矣，即要略桃花湯也。仲景以治便膿血，用赤石脂丸者，乾薑粳米同煮作湯，一飲病安便止後，藥意謂病屬下焦，血虛且寒，非乾薑之溫，石脂之澀，且重不能止血，粳米味甘，引入腸胃，不使重澀之體，少有凝滯，故煮成湯液，藥行易散，餘毒亦無，局方不知深意，不造妙理，但取易於應用，喜其性味溫補，借為止瀉良方，改丸藥劑以麵糊，日與三服，其果能與仲景之意合否也，
無或曰:，河間之言滯下，似無挾虛挾寒者，然乎？否乎？幸明以告我。予曰：泄痢之病，水殼或化或不化，並無努責，惟覺困倦，若滯下則不然，或膿或血，或膿血相雜，或腸垢，或無糟粕，或糟粕相混，雖有痛不痛大痛之異，然皆裏急後重，逼迫惱人，攷之於經，察之於證，似乎皆熱證實證也。余近年涉瀝亦有大虛大寒者，不可不知，敢筆其略，以備釆覽，余從叔，年踰五十，夏間患滯下病，腹微痛，所下褐色，後重頻，併穀食大減，時有微熱，察其脈皆弦而澀，似數而稍長，卻喜不甚浮大，兩手相等，視其神氣大減，余曰：此非滯下憂慮所致，心血虧，脾氣弱耳，遂與參朮為君，當歸身陳皮為臣，川芎炒白芍藥茯苓為佐使，時暄熱甚，加少黃連，與兩日而安。梅長官年三十餘，奉養厚者，夏秋間，患滯下，腹大痛，有人教服，單煮乾薑，與一帖痛定，少頃又作，與又定，由是服乾薑至三斤，八日後，予視之左脈弦而稍大似數，右脈弦而稍大減亦似數，重取之似緊，余曰：此必醉飽後，喫寒冷太過，當作虛寒治之，因其多服乾薑，遂教四物湯去地黃，加人參，白朮，陳皮，酒紅花，茯苓，桃仁，煎入生薑汁飲之，至一月而安，金氏婦，年近四十秋，初尚熱，患滯下，腹但隱痛，夜重於晝，全不得睡，食亦稍減，口乾不飲，已得治痢靈砂二帖矣。余視之，兩手脈皆澀，且不勻，神思倦甚，飲食全減，因與四物湯，倍加白朮為君，以陳皮佐之，與十數帖而安，此三病者，若因其逼迫而用峻劑，豈不誤人，
無或曰:局方諸湯，可以清痰，可以消積，可以快氣，可以化食，口鼻既宜，胸膈亦紓，平居無事，思患預防，非方之良者乎？予曰：清香美味，誠足快意，揆之造化，恐未必然。經曰：陰平陽秘，精神乃治，氣為陽宜降，血為陰宜升，一升一降，無有偏勝，是謂平人，今觀諸湯，非豆蔻縮砂，乾薑良薑之辛宜於口，非丁香沉檀，蘇桂之香宜於鼻，和以酸鹹甘淡，其將何以悅人，奉養之家，閑佚際主者，以此為禮，賓朋以此取快，不思香辛升氣，漸至於散，積溫成熱，漸至鬱火，甘味戀膈，漸成中滿，脾主中州，本經自病，傳化失職，清濁不分，陽亢於上，陰微於下，謂之陰平可乎，謂之陽秘可乎，將求無病，適足生病，將求取樂，反成受苦，經曰：久而增氣，物化之常，氣增而久，天之由也，其病可勝言哉，
無或曰::舍利別非諸湯之類乎，其香辛甘酸，始有甚焉，何言論弗之及也？予曰：謂之舍利別者，皆取時果之液，煎熬如餳而飲之，稠之甚者，調以沸湯，南人因名之曰煎味，雖甘美，性非中和，且如金櫻，煎之縮小便，杏煎，楊梅煎，蒲桃煎，櫻桃煎之發冒，火積而至久，濕熱之禍，有不可勝言者，僅有桑椹煎無毒，可以解渴，其餘味之美者，並是嬉笑作罪，然乎？否乎？
無或曰::婦人一門，無非經候，胎產帶下，用藥溫暖，於理頗通，吾子其無忘言乎？予曰：婦人以血為主，血屬陰，易於虧，久非善調攝者，不能保全也。餘方是否，姑用置之，若神仙聚寶丹，則有不能忘言者，其方治血海虛寒，虛熱盜汗，理宜補養，琥珀之燥，麝香之散，可以用乎，面色痿黃，肢體浮腫，理宜導濕，乳香沒藥，固可治血，可以用乎，胎前產後，虛實不同，逐敗養新，攻補難並，積塊堅癥，赤白崩漏，宜於彼者，必防於此，而欲以一方通治乎，世人以其貴細溫平，又喜其常服可以安神，去邪令人有子，殊不知積溫成熱，香竄散氣，服者無不被禍，自非五臟能言，醫者終不知覺，及至變生他病，何曾歸咎此丹，余姪女，形色俱實，以得子之遲，服此藥，背上發癰，證候甚危，余診其詠散大而澀急，以加減四物湯百餘帖，補其陰血，幸其質厚，易於收救，質之薄者，悔將何及，若五積散之治產後餘血作痛，則又有不能忘言者，以蒼朮為君，麻黃為臣，厚朴枳殼為佐，雖有芍藥當歸之補血，僅及蒼朮三分之一，且其方中言，婦人血氣不調，心腹撮痛，閉而不行，並宜服之，何不思產後之婦，有何寒邪，血氣未充，似難發汗，借曰推陳致新，藥性溫和，豈可借用麻黃之散，附以蒼朮枳朴，虛而又虛，禍不旋踵，率爾用藥，不思之甚，
A person asked: The prescriptions in *Ju Fang* (Formulas of the Imperial Medical Bureau) mostly use warming and tonifying herbs, which some believe does not conform to the Golden Mean. Regarding the two categories of "Accumulated Heat" (Ji Re) and "Chronic Cold" (Gu Leng), their preparation and usage—Sir, please do not comment on them. I said: Zhang Zhongjing mentioned one hundred and eight diseases, along with Five Exhaustions (Wu Lao), Six Extremes (Liu Ji), Seven Injuries (Qi Shang), and thirty-six diseases specific to women. Whenever encountering a disease, one must distinguish between cold and heat. If it is truly cold, treat with heat; if truly heat, treat with cold. If cold or heat is severe, employ counter-assistance (Fan Zuo) to control it. Now, listing only more than ten disease names, yet dividing them into merely two categories of Accumulated Heat and Chronic Cold—is this not considering things too superficially? In *Jin Gui Yao Lue*, wind-stroke with a tight pulse indicates cold, while a floating pulse indicates deficiency. Lung atrophy presenting with salivation and inability to cough, without thirst, inevitably leads to urinary incontinence; this is cold in the lungs, treated with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to warm it. Abdominal fullness and pain that occasionally subsides but remains like before (indicating preference for warmth and pressure) is cold, suitable for warming methods. Diarrhea where one wishes to sneeze but cannot indicates cold in the abdomen. Unilateral pain under the ribs with a string-tight pulse indicates cold, suitable for Dahuang Fuzi Xixin Tang (Rhubarb, Aconite, and Asarum Decoction) to warm it. Phlegm-fluid retention with double-stringy pulses indicates cold. Jaundice with fever, irritability, panting, chest fullness, dry mouth, exacerbated by fire-sweating therapy, originating from dampness, with whole-body heat and yellowing, indicates heat inside, suitable for purgation. Diarrhea with rapid and thirsty pulses, if unhealed, will lead to pus and blood in stool due to internal heat. Women who can eat but develop fever after seven or eight days have stomach excess and qi-heat, suitable for Dachengqi Tang (Major Order the Qi Decoction) for purgation. Seven or eight days postpartum, if there are Taiyang syndrome symptoms, hard and full urination indicates incomplete expulsion of lochia. Constipation for four or five days, afternoon fever, occasional irritability, and delirium upon eating indicate heat in the interior, binding in the Bladder, suitable for Dachengqi Tang to promote urination and relieve stagnation. For women with wind-stroke or cold damage, whose menstruation has just started or stopped, presenting with alternating chills and fever, all are termed Heat Entering the Blood Chamber. Now, *Ju Fang* does not specify disease names, nor explain the causes of cold and heat, nor name the diseases. Are there truly no mixed pathogenic factors? Do the contracted pathogens truly lack distinctions based on seasonal timing and constitutional endowment that require selection? Relying solely on external manifestations of cold and heat to administer drugs—is this truly mistaking the false for the true? Is this truly treating the incorrect as correct?
Another asked: Using cold and heat as chapter headings certainly does not align with the intent of the Classics. However, are those formulas indeed compliant with medical principles? I said: Using "Accumulated Heat" as a heading is certainly debatable. However, regarding the preparation and usage of these formulas, there are profound principles. I will elucidate the intentions of predecessors, hoping to provide even a slight assistance to practitioners. Zixue San (Purple Snow Powder) acts on the Heart, Spleen, Liver, Kidney, and Stomach meridians. Tongsheng San (Universal Salvation Powder) and Xixin San (Cleansing the Heart Powder) regulate exterior-interior and qi-blood. Liangge San (Cooling the Diaphragm Powder) acts on the Heart, Lungs, Spleen, and Stomach. Longnao Yinzi (Borneol Drink), Shengbing Dan (Ice-Conquering Pill), Zhenzhu San (Pearl Powder), and Lingye Dan (Spiritual Fluid Pill) act on the Upper and Middle Jiao. Bilei Jisu Wan (Green Thunder Musk Mallow Pill), Sanhuang Wan (Three Yellows Pill), and Bazheng San (Eight Upright Powders) act on the Triple Burner. Ganlu Wan (Sweet Dew Pill) acts on the Heart, Spleen, and Liver. Liangge Wan (Cooling Diaphragm Pill) acts on the Heart, Spleen, and Stomach. Baolong Wan (Embracing Dragon Pill) and Maidong San (Ophiopogon Powder) act on the Heart, Lungs, and Liver. Miaoxiang Wan (Wonderful Fragrance Pill) regulates the intestines and stomach, restraining Wood-Fire. Ganlu Yin (Sweet Dew Drink) acts on the Heart, Lungs, and Stomach. Wulin San (Five Strictures Powder) treats blood-level interior conditions. Xiaodu Yin (Detoxification Drink) treats qi-level exterior conditions. Maren Wan (Hemp Seed Pill) treats qi-level interior conditions. Daochi Wan (Guiding Red Out Pill) treats qi and blood interior conditions. Daochi San (Guiding Red Out Powder) acts on the Heart and Small Intestine. These formulas involve ascending and descending, dispersing and tonifying, leaching and draining, expelling and driving, utilizing causality, and guiding to meridians. Some are softened with sweet flavors, some gathered with sour flavors, some moved with fragrant flavors, some protected with wax, some dried with bitter flavors. Observing their composition, each has its specific indication. Practitioners should seek their underlying logic. As for the "Chronic Cold" category, it is particularly worthy of discussion. Cold is synonymous with Han (Cold). The *Neijing* regards Cold as a killing and harsh qi. Adding "Chronic" (Gu) before Cold—does it refer to diseases characterized by aversion to cold and preference for hot drinks? If one identifies such external symptoms as Chronic Cold, is it appropriate? Xia Yinggong frequently consumed Aconite and Typhonium, often taking them within cotton tents. He did not realize that damp-phlegm accumulation in the middle jiao suppresses Yang qi from venting outward, causing aversion to cold. The *Neijing* states: "Excess becomes harmful, restraint brings balance." Liu Hejian also said: "Extreme Fire resembles Water," hence such symptoms appear. One should treat with salty-cold herbs, assisted by sweet-warm ones, judging the priority of root and branch, and the deficiency-excess of righteous and pathogenic qi to determine treatment. Why resort to indiscriminately using Aconite, Typhonium, and cinnabar pills—overbearing and drying agents? This is like carrying firewood to save a fire, or wielding a butcher's knife—what is the difference? Ancients treated shivering/chills by purging with Dachengqi Tang, resulting in recovery. Aversion to cold and shivering is clearly a heat syndrome. It can also result from long-term consumption of hot herbs, differing only in deficiency vs. excess. Scholar Zhou Bendao, nearly forty, suffered from aversion to cold. After taking Aconite for several days, his condition worsened. Seeking my treatment, his pulse was stringy and seemingly slow. I used Jiangcha (River Tea) with a little ginger juice and sesame oil, inducing vomiting of about one liter of phlegm, reducing his need for heavy cotton clothing by half. Then I prescribed Tongsheng San minus Mahuang (Ephedra), Dahuang (Rhubarb), and Mangxiao (Mirabilite), adding Danggui (Angelica Sinensis) and Dihuang (Rehmannia). After over a hundred doses, he recovered. Another woman of foreign descent, nearly sixty-six, felt frequent chills and shivering within a month, preferred hot phlegm, sweated profusely in cotton clothes, had a fat and thick-fleshed body, had taken over thirty taels of Aconite, and suffered intense whole-body itching. Her pulses were deep and choppy bilaterally, slightly larger when pressed heavily. Knowing her heat was severe and blood deficient, I used Siwu Tang (Four Substances Decoction) minus Chuanxiong, doubled Dihuang, plus Baizhu (Atractylodes), Huangqi (Astragalus), Chao Huangbo (Fried Phellodendron), Sheng Gancao (Raw Licorice), and Renshen (Ginseng). Each dose weighed two taels. Given one dose initially, she suffered massive diarrhea, blindness, and muteness. I realized this was due to deep heat and the lack of counter-assistance in the prescription. I then gave the same herbs roasted, using the fire's energy as a guide. After one dose, diarrhea stopped; after four, spirit returned; after ten, she fully recovered. Another patient, Mrs. Jiang, over fifty, thin with dark complexion, preferred heat and feared cold in June. Pulses were deep and choppy, seemingly rapid when pressed heavily. I used Sanhuang Wan (Three Yellows Pill) administered with ginger juice, thirty pills per dose, thirty doses total, resulting in mild sweating and recovery. Their categorization of formulas by Accumulated Heat and Chronic Cold reveals their merits and faults.
In the Diarrhea and Dysentery category, formulas such as Zhongru Jianpi Wan (Calcite Strengthen Spleen Pill), Zhaozhen Wan (Morning Truth Pill), Chuche Wan (Parking Cart Pill), Helile Wan (Chebulic Myrobalan Pill), Dawenpi Wan (Great Warming Spleen Pill), Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill), Hufen Wan (Lead White Pill), Taohua Wan (Peach Blossom Pill), Helile San (Chebulic Myrobalan Powder), Muxiang San (Costus Powder), Qizao Tang (Seven Jujube Decoction), Chishizhi San (Red Halloysite Powder), Yangzang Tang (Nourishing Viscera Decoction), Yumi Tang (Poppy Decoction), Jinshi Tang (Golden Millet Decoction), Goutougu Wan (Dog Head Bone Pill), Doukou Wan (Cardamom Pill), Roudoukou San (Nutmeg Powder), Sanshen Wan (Three Gods Pill), Dingxiang Doukou San (Clove and Cardamom Powder), and Zhixie Wan (Stop Diarrhea Pill) all use hot herbs as main treatments and astringent herbs as assistants. These seem designed for intestinal deficiency leading to slippery dysentery. But do patients with diarrhea/dysentery never have heat syndromes? Or accumulations? The *Neijing* says: "Spring wind injury leads to summer pus and blood," mostly belonging to Tenesmus (Zhixia). Diarrhea and dysentery syndromes are numerous. Ancients stated: "Dampness often causes diarrhea." This is an accurate theory. Wind and dampness certainly cannot be treated uniformly. Moreover, beyond wind and dampness, there are mixed pathogenic factors, making it difficult to uniformly apply astringent-hot agents. Current formula texts mention symptoms including tenesmus, heaviness in the rectum, or both. Are these not signs of Tenesmus? Mixing diarrhea with Tenesmus in treatment leads to the error of reinforcing excess and depleting deficiency, a disaster imminent.
Someone asked: Thus, diarrhea and Tenesmus are different diseases with different treatments. Can you clarify them? I said: The Classics state: "Sudden pouring diarrhea and tenesmus belong to heat." Also: "Sudden pouring belongs to Fire." And: "Clear white dysentery belongs to cold." Heat is the qi of Ministerial Fire (Jun Huo); Fire is the qi of Assistantial Fire (Xiang Huo); Cold is the qi of Cold Water. Two belong to Fire/Heat, one to Water/Cold. Diarrhea/Dysentery seems mostly Heat, rarely Cold. Studying *Ju Fang*, it exclusively uses hot-astringent methods. If applied to clear-white dysentery belonging to cold, it might be acceptable. The "tenesmus" mentioned in the Classics refers to urgency and heaviness in the rectum. This disease belongs to Fire, caused by Assistantial Fire, its toxicity exceeding mere heat. Administering hot-astringents would be fatal. According to Zhang Zhongjing's methods: Dysentery with slippery-rapid pulses indicates retained food, suitable for purgation. Dysentery with slow-slippery pulses indicates excess; if dysentery persists, urgent purgation is needed. Dysentery with unexpectedly slippery pulses indicates something to remove; purgation brings peace. Dysentery with loss of appetite and retained food requires purgation. Abdominal fullness/pain due to cold/excess requires purgation. Hard abdomen in dysentery requires purgation. Delirium with dry stools in dysentery requires purgation. Normal pulses bilaterally but hardness/tension in the epigastrium requires purgation. Recurrence of dysentery after apparent cure indicates incomplete clearance; purge again. Large-floating-stringy pulses in dysentery improve with purgation. Wind-Cold diarrhea is not suitable for purgation; if purged, epigastric hardness/pain with slow pulse indicates cold, suitable for warming. Floating-large pulse indicates deficiency caused by forced purgation. Floating-leather pulse with borborygmus requires warming. Slow-tight pulse with persistent pain in dysentery requires warming. Urgent heart pain in dysentery requires rescuing the interior, using Lizhong, Sini, or Fuzi types. Pain in the anus requires warming. Of Zhongjing's ten purgative methods, five are warming. Purgatives generally use Chengqi modifications, never arsenic, cinnabar, croton, or ammonium chloride (strong toxic hot agents). Warmers generally use Ginger and Aconite, never calcite, dragon bone, halloysite, or poppy shell (tight astringent toxic agents).
Someone asked: Does "suitable for purgation" imply gastrointestinal accumulation? Not using strong toxins might make accumulation hard to move. You disagree; can you explain the logic of Chengqi? I said: Rhubarb's cold nature moves well. Assisted by Magnolia bark's warmth to move stagnant qi, and Licorice's sweetness to moderate, taken as a decoction, it irrigates and cleanses the intestines/stomach, moistening and lightening without retention. Once accumulated matter passes, stop. Arsenic, cinnabar, croton, and ammonium chloride cluster toxic heat. Formed into pills, their qi is fierce, weight heavy. Though accumulation may move, toxic qi remains. Like violent thieves with weapons, can they be allowed to linger in the inner chambers? Even if they cure disease, can they spare the pure qi of the intestines/stomach from collateral damage? Zhongjing treated dysentery by warming when appropriate, purging when appropriate, releasing the exterior, promoting urination, or waiting for self-resolution. He distinguished easy, difficult, and incurable cases meticulously. Yet he still mixed formulas for diarrhea and Tenesmus. Later, Liu Hejian distinguished exterior/interior, wind/damp/heat/cold/deficiency, clarified meridians, and prevented transmission, greatly elucidating Tenesmus treatment. "Moving blood relieves stool; regulating qi removes tenesmus." This is like sun/moon for the blind, thunder for the deaf.
Someone asked: Will *Ju Fang* treatments never resemble Zhongjing's formulas? I said: Flexible methods are detailed in the *Neijing*. Zhongjing's books align with Classic intent. Zhongjing formulated based on disease; *Ju Fang* prepares drugs awaiting disease. How can they resemble each other? Song dynasty appointed court officials to edit medical books. These officials had different skills and lifestyles; how could they know medicine? Although respecting Zhongjing, they tried to imitate him, but failed, like the woman with chest pain imitating Xi Shi. Observe Taohua Wan (Peach Blossom Pill): it is essentially *Jin Gui Yao Lue*'s Taohua Tang. Zhongjing used Chishizhi (Red Halloysite) pill for bloody stool, boiling Ganjiang (Dried Ginger) and Jingmi (Rice) into a soup. One drink cured it, then stopped. The logic: Disease in Lower Jiao, blood deficiency and cold. Without Ganjiang's warmth and Chishizhi's astringency, heavy substances cannot stop bleeding. Rice sweetness guides to intestines/stomach, preventing heavy/astringent herbs from causing stagnation. Boiling into soup ensures easy dispersion and no residual toxicity. *Ju Fang* ignored this depth, seeking ease of use, liking warm-tonifying properties for stopping diarrhea, changing to pills with flour paste, three times daily. Does this match Zhongjing's intent?
Someone asked: Hejian's view on Tenesmus seems to exclude deficiency and cold. Is this true? Please enlighten me. I said: Diarrhea involves undigested food, no straining, only fatigue. Tenesmus is different: pus or blood, mixed, or intestinal mucus, with or without residue. Regardless of pain severity, all feature tenesmus and distress. Examining Classics and symptoms, they seem mostly Heat/Excess. However, I have recently encountered severe Deficiency/Cold cases, which must be known. My uncle, over fifty, had Tenesmus in summer: mild abdominal pain, brown stool, frequent tenesmus, poor appetite, slight fever. Pulses were stringy-choppy, seemingly rapid-long, not floating-large, equal bilaterally. Spirit was diminished. I said: This is not Tenesmus anxiety, but Heart blood deficiency and Spleen qi weakness. I used Renshen and Baizhu as sovereign, Danggui and Chenpi as ministers, Chuanxiong, Fried Shaoyao, and Fuling as assistants. Due to heat, added small amount of Huanglian. Recovered in two days. Official Mei, thirty+, well-nourished, had Tenesmus in late summer/autumn: severe abdominal pain. Advised to take boiled Ganjiang alone. One dose stopped pain, returned shortly, repeated. Took three jin of Ganjiang. Eight days later, left pulse stringy-large-seemingly rapid, right pulse stringy-large-reduced-seemingly rapid, heavy press seemed tight. I said: Likely excessive cold intake after drunken feasting. Treat as Deficiency-Cold. Due to excessive Ganjiang, prescribed Siwu Tang minus Dihuang, plus Renshen, Baizhu, Chenpi, Wine Honghua, Fuling, Tao Ren, decocted with fresh ginger juice. Recovered in one month. Mrs. Jin, nearly forty, autumn onset, initial heat, Tenesmus: dull pain, worse at night, insomnia, reduced appetite, dry mouth without desire to drink. Had taken Zhili Lingsha (Stop Dysentery Cinnabar) for two doses. Pulses choppy, uneven, spirit tired, appetite gone. Prescribed Siwu Tang, doubled Baizhu as sovereign, Chenpi as assistant. Recovered in ten+ doses. These three cases: if treated with harsh agents due to urgency, it would harm people.
Someone asked: *Ju Fang* soups clear phlegm, resolve accumulation, move qi, transform food. Pleasant to mouth/nose, soothing chest/diaphragm. Preventive care in health—are they not good formulas? I said: Fragrant and delicious tastes are pleasing, but against natural laws, likely not so. *Neijing*: "Yin balanced, Yang secret, spirit governs." Qi (Yang) should descend, Blood (Yin) should ascend. Ascending-descending without bias is a healthy person. These soups use cardamom, sand ginger, dried ginger, high ginger—pungent for the mouth; cloves, agarwood, sandalwood, suzuki, cinnamon—fragrant for the nose. Mixed with sour, salty, sweet, bland flavors, how do they please people? Wealthy families, leisure hosts, use these as gifts/fun. They ignore that pungent-aromatics ascend qi, leading to dispersion; accumulated warmth becomes heat, leading to constrained fire; sweet flavors cling to diaphragm, leading to middle-fullness. Spleen governs the center, primary disease affects transformation, clearing/turbid separation fails, Yang hyperactive above, Yin weak below. Can this be called Yin balance/Yang secrecy? Seeking health creates illness; seeking pleasure creates suffering. *Neijing*: "Long-term increase of qi is normal transformation; prolonged increase leads to premature death." Can the diseases be enumerated?
Someone asked: Shelibie (Preserved Fruits) are not like these soups? Their pungent-sweet-sour flavors are extreme. Why omit them? I said: Shelibie uses fruit juices boiled to syrup, thick ones mixed with boiling water. Southerners call them "Jianwei." Though sweet, nature is not neutral. E.g., Jin Ying (Cherokee Rose) shrinks urine; Apricot, Bayberry, Grape, Cherry syrups cause head heat/fire accumulation. Long-term damp-heat disasters are incalculable. Only Sangshen (Mulberry) syrup is non-toxic, quenching thirst. Others are playful sins. True or false?
Someone asked: Women's category focuses on menstruation, pregnancy/birth/leukorrhea. Warming drugs seem logical. Sir, please speak. I said: Women prioritize blood. Blood is Yin, prone to deficiency. Without proper regulation, preservation is impossible. Other formulas aside, consider Shenxian Jubao Dan (Immortal Treasure Gathering Pill). It treats Blood Sea deficiency-cold, deficiency-heat night sweats. Tonification is appropriate. But Hupo (Amber) is drying, Shexiang (Musk) is dispersing—can they be used? Sallow complexion, edema requires damp-draining. Rushing and Myrrh treat blood—can they be used? Prenatal/postnatal states differ in deficiency/excess. Expelling stasis/nourishing new, attacking/tonifying are hard to combine. Masses, uterine bleeding require different approaches. Wanting one formula to treat all? People value its fine, warm,平和 (balanced) nature, believing regular use calms spirit, removes evil, aids conception. Ignoring that accumulated warmth becomes heat, aromatic penetration scatters qi. Users suffer. Unless organs speak, doctors remain unaware until other diseases arise. Never blaming this pill. My niece, solid constitution, delayed conception, took this pill, developed back carbuncle, critical condition. Pulse scattered-large-choppy-urgent. Used Modified Siwu Tang for 100+ doses to tonify yin-blood. Fortunately, her robust constitution allowed recovery. Thin constitutions would regret deeply. Regarding Wuji San (Five Accumulations Powder) for postpartum blood-stasis pain: Cangzhu (Atractylodes) as sovereign, Mahuang (Ephedra) as minister, Houpo (Magnolia Bark) and Zhike (Bitter Orange) as assistants. Despite Shaoyao and Danggui tonifying blood, they are only one-third of Cangzhu. Formula states: Women with qi-blood disharmony, abdominal cramping, closure without flow, all suitable. Did they not consider postpartum women have what cold pathogen? Qi-blood not filled, difficult to sweat-induce. Even if pushing old/new, mild nature, how can Ephedra's dispersion be borrowed, attached with Atractylodes, Magnolia, Bitter Orange? Void upon void, disaster follows swiftly. Rash medication, lacking thought, is extreme.