师训者，查了吾先生麈头之言，而慎柔述之者也。刻慎柔五书，而先之以师训者，志所
。应酬驳剧，随感随发，非着撰也。晨昏风雨，随闻随述，非笺疏也。故其言多直率而不文
，其词章多琐屑而无脊，然正如道家之丹源，禅家之宗旨，得其单词短语，即可该贯万理。
今又错综原文，根据类连举，稍加序秩，无伦次而有伦次，庶几学人，便于观览焉。是编出，
不但慎柔祖述了吾之言在是，而慎斋先生之源流，亦可窥豹一斑矣。
夫地黄丸，为肾家之主剂。盖肾水枯，则肝木不荣；木不荣，则枯木生心火。（五行字面，
乃医家循例之词，读者当随文而各求其义。此所谓肾水即津液也，肝水即血汁也，心火即亢
燥之热气也。津不濡血而血滞且干矣。血不涵气而气亢愈悍矣。故曰∶枯木生心火。）故用
熟地以滋肾，用泽泻以去肾家之邪，则地黄成滋肾之功。肾所恶者土也，脾家有湿热，则能
克肾水，故用山药补脾，用茯苓以去脾家之湿，则山药成补脾之功。木枯则耗水，以山茱萸
敛火以润肝；火炽亦能涸水，以丹皮泻心火而补心。心足则火不妄起，且下降与肾交，而补
肾之功愈成矣。此即《难经》东方实，西方虚，泻南方，补北方之义；又《素问》亢害承制
凡两手俱数，大便燥者，八物汤。洪大有力，地黄汤；无力，大补汤。脾燥，加山药；
脉弦，加芍药；右关浮无力，加丁香；沉无力，加干姜。
内伤，寸脉大于尺脉，此阳盛脉也，宜用保元汤加归、芍引下，则大脉去，而阳气亦内收矣
。此从阳引至阴分之法。（用意甚是而药不合， 升胃阳，归升肝阳，非能降也。凡引下法
有三∶有直用清肃，有从下滋填，有从下温补，更有宣其上而大气自降者，各因其病本也。）
内伤，右尺弦弱，不宜用寒凉，以命门火虚故也。
右关缓有力，缓则为湿，又寸尺弱者，用补中汤加赤茯、苡仁。盖补中补寸弱，赤茯、
苡仁行中焦湿，又能使中焦之气下行，而尺脉自和。
右关缓无力，用参苓白术散加黄 ，以补上而益下。凡在右，以四君子汤加减。欲上，用黄
；欲下，赤苓、苡仁。在左，以四物汤调理。若左寸洪有力，加木通、黄连、赤苓之类
。盖木通泻小肠火，小肠为心之腑，黄连泻心，赤苓者，赤入丙丁也。
左关浮，用羌活、防风。左关沉有力，用山栀、柴胡、知、柏之类。左尺有力，加柏以泻其
有余。盖左有泻而无补，右有补而无泻，则命门火重矣。（此谬语也。左右俱有水火，太过
俱宜泻，不及俱宜补。即如本文左尺有力，加柏以泻有余，何尝不是泻火？倘右尺太过，岂可复补之？）
凡内伤发热、口干，乃下焦虚寒，火不归元，阳气在上故耳。须温下焦，使阳气下降，则口
干自愈。（此即所谓从下温补也，是下焦虚寒，
格阳于上。所以然者，下焦之气不续升，气无所接引，不得顺降，久结于上，化为燥火。）
凡内伤，火在上，水在下，故发咳嗽而喘，此皆滋阴降火所致也。初用桂制白芍、吴茱萸
少许，及甘草、人参、五味、半夏、破故纸、杜仲，一温则火下行，水上升。如或作泻，则
阳下行，而胃中所积宿食水谷行动矣。（因滋阴降火而发咳喘，乃阳为阴抑，水上火下之咎也
。用辛温拨其阴而伸其阳，生气勃发，而败气败津举无所容矣，故或汗或泻也。内郁热甚者
，略佐清降，恐郁火之发太骤为患也，曾屡见之。）
凡虚损，肺脉大，气喘，下部脉弦细弱微，此皆阳上越而不降，内寒外热，上热下寒之症，
用人参一钱，桂制白芍一钱，干姜三分，半夏一钱，五味子十五粒，甘草生炙二分，使温中
内收，阳气降下。（虚损气喘∶有气痹，有气越。气痹有清湿外侵，有卫阳内陷；气越有内
寒格热，有阴虚阳泛。阳陷寸脉短弱，而邪侵反弦紧；阳泛寸浮散，而格热反洪实，以纯虚
与夹实之故。纯虚可任补敛，夹实有温宣、温降诸法，未可专任补敛，其吉凶全视尺脉有根
、无根，相称、不相称以决之。何者？纯虚肺气弱，夹实肺气困，补敛固以振弱，亦以增困
，上焦气闭，三焦大气举为其所吸摄，不得动转顺降，所谓宗气反聚也。气化不通，升降不
续，喘逼反甚，故治法须有以开为敛、以降为补之妙用。）
凡久病服寒凉克伐过多，以致三阳气衰，致痰凝气滞，以调元之剂治之。阳气一动，则少阳
先升，少阳欲先出，前有太阳，后有阳明，遏截不能伸，少阳之气至太阳，太阳与之并则寒
，与阳明并则热，遂成寒热疟状，非真疟也。其太阳气达，遂有伤风之状，鼻塞、恶风寒之
症见矣。阳明气达，则有作泻之症。此时正当调脾补元，分头施治，则旧病尽脱矣。（此条
开人神智不少。）
凡服寒凉克伐之过，遂成血凝气滞，用温补之剂，其痰决行，脉气渐和，须预言将来或
有凝血少许。此乃通经，气壮而血行也。（此可悟叶天士久病通络之义。）
凡脉细数，肾虚；弦数，肝虚；短数，肺虚。此为病重之脉，有胃气则生，无胃气则死。散
数则为心虚。诸数之中，尚有舒徐和缓之意者，是云有胃气也。（来高去深，旋转不躁，是为舒缓。）
凡虚损脉数十数至，尚不细短，按之有一条者，可服独参汤一二两，然后调理。（此脉
率因下寒格阳不能归窟，宜附子加龟板以招安之。）
凡脾脉细弦而涩，则中气虚寒，宜温。直用温药则火起，须益智温之，更用山药以养脾，则
益智之温，退居下焦，补命门，火生土，遂成连珠之补，而火不起矣。（直用温药则火起，
血虚不能涵之也。宜介类、如龟板、鳖甲、牡蛎之属同用，非益智所能为功。能任益智者，其阴虚犹未甚。）
虚损大便燥者，用杏仁、枳壳、苏梗，则能去宿粪。
尝诊一人，脉右关浮大，乃阳气浮上，症当中寒，果然肚疼作泻，宜用建中汤，收阳入内，而中温矣。
凡持斋人，所食之物皆淡渗，所食之油皆属火。渗淡泻阳，阳虚则火起。此东垣云∶持斋之
人多胃虚。（渗淡泻阳四字极是。故风湿在表、寒湿在里者，均不可率利小便也。阳虚火起
，亦有理而欠发明。盖火性宣发，遂其宣发之性，即不见火矣。故《内经》五脏苦欲补泻之义最宜讲究。）
凡久病，用补脾、补命门之药，皆燥剂，须用当归身以润肝，恐燥能起肝火故也。（立意极
是，而以当归为能润肝燥，贻误非浅，其辛温正起肝火也。血分虚寒宜之。虚燥者复与燥剂
同用，必致头眩、肋胀，不若鳌甲、牡蛎，介类潜阳而又清灵不腻）。
一痰症，曾有人病痴，寸脉不起，脚冷，关脉沉洪，此阳气为痰所闭，宜升、宜降、宜开。用
紫苏、陈皮、半夏、赤芍、赤苓、枳壳、干葛、石菖蒲、远志、人参之类。其病欲言而讷，
但手指冷。（冷字疑误，或者物字，或者空字。此心系、脑络、脊髓之间有瘀痹之脉，阻其
神机不能灵转也。属血，加桃仁、丹参；属痰，加如下方。）此乃痰闭阳气之病，治宜归脾
汤去枣仁、圆眼、黄 ，加石菖蒲、远志、半夏，一补一开一行，后用全料归脾汤，久自愈。
病患久虚，内有宿积旧痰，用参、术补之，久乃吐出臭痰，或绿色痰，当不治。盖积之久，
而脾胃虚极不运，故郁臭耳。（此症有因蛮补而然者，或可治，或不治，须别视见证决之。）
一人常梦遗，诊其脉，关中有动脉如大豆圆，此痰凝中焦，幸梦遗，免鼓症。（梦遗之
多，而总归于心肝二气之下陷。但有下虚而陷者，有脾虚而陷者，有心肝自虚而陷者，有外
感遏制肺与膀胱之气而陷者，有痰涎遏制脾胃之气而陷者，
各以其脉与兼证别之。关动如豆，胃有死血也。曾见梦泄人，舌心
如钱大光滑无苔，即同此诊。）且寸尺俱不起，补中加茯苓、半夏、石菖蒲，亦一升一降之道也。
一人久悲郁，先前五、六月倦甚，寻得痴症，只以手空指，人问为何？曰∶我欲言而不能也
，（欲言属心，不能属脑，脑络有痹而然。）诊其脉，二尺微而不起，二关洪缓，此阳郁而不
能升不能降也。用二陈汤加人参，以开疟助脾，益以升、柴助阳，石菖蒲、远志、赤茯苓以
利湿降痰降火，四剂即安，缓服丸剂而愈。
吐血症，初六脉俱洪数，须用茯苓补心汤。盖白茯苓能守五脏真气，能泄肾中伏火，能泻脾
湿以健脾。二三剂后，数脉稍退，尚洪，以地黄丸纳气；洪稍减，至弱，以四君子加减，补
脾生肺，肺生水之义。如或见血，加丹皮、熟地。右关有火，加山药；左关有火，加山茱萸
；左关左尺有火，加茯苓、泽泻、熟地。
一人吐血后，右关、尺洪，大便燥，口干，用白芍、甘草、人参、苏梗、归身各五分，
枳壳五分，杏仁四粒，黄柏二分。二剂。下即润，诸症即退。
凡欲止吐血，须炒黑干姜、五味子二物。以干姜性温，且血见黑即止；五味子味酸，能收逆气。
一人头面俱痛，服寒凉药多，其脾胃脉细涩，左尺亦涩，左寸、关洪，此下焦寒而火邪逆上
之故也。用羌活五分，酒炒防风五分，酒连一分，酒苓三分，白茯苓一钱，人参二钱，甘草
五分，半夏一钱，破故纸一钱，枸杞子一钱。二服，脉即粗而不细，而头痛亦除。
治梅核气，用四七汤加人参一钱、干姜三分、细辛二分、桂芍一钱、半夏一钱，此皆下气散
痰温中升阳之剂。非细辛之升阳，上焦无阳，则痰气焉能得动。（此症因忧郁而成者，因禀
赋不足伤于房室与劳倦而成者，十居八九，与痰何涉？即以为痰，亦是燥痰，未可用辛燥也
。此非喉中多一物，乃其处无血温养，木而不仁，遂如有别物附之。由于任脉血虚不周于上，
督脉气虚不交于前，气血两脱于上也。下焦燥盛者，龟、鹿大剂急施，久服或可挽回，兼溏
泄者万无生理。）
凡痨疰病，须用金银藤叶煎汤药。如肺虚，加保元、五味子；心脾虚，归脾汤。六脉俱
有火而虚，八珍；脾肺虚，补中；肾脉洪大，地黄汤。
凡病久呕，用补脾下气之药，其中须用当归钱许，以润下枯。盖气在上，久而不下，下
无津液，故用润之。然脾胃虚而呕者，又忌当归。（肝热与中焦湿热为患者并忌之。）
五月火月，六月湿月，火旺则生湿，二者相并，肺金受克，则热伤气，而痿倦之疾作矣。故
设清暑益气之法。黄 助肺，人参助元气，甘草泻心火，则元气复而肺气清；湿热盛而胃气
不清，故加苍术；湿热在中而饮食不化，故加陈皮、青皮以开胸膈，加神曲以助消饮食；小
便赤涩，加泽泻以去下焦之湿；口渴，加葛根以解肌热，又能接胃家津液上润；胃家湿热盛
，则肾水受克，加黄柏以救肾水；湿热盛则阳道遏而身热，加升麻以升阳，又走表以益阳；
而门冬清心，五味敛肺，恐湿热伤肺故耳。
五苓散为四、五、六月时令之药，（五苓散非可常服之药，令人畏发散而喜利小便，其祸甚
大。盖人之病，从毛窍来者十九，即从呼吸入者，亦借发散之功以鼓动阳气，俾得吐故纳新
。若利小便，必病从下而上及饮酒饮水得之者可耳！过用即伤膀胱元气，三焦下陷不可复
元矣，曾屡见之。）盖湿热盛，则三焦气不清，上咳中满下泻等症作矣。猪苓清上焦，茯苓清
中焦，泽泻清下焦，恐湿热盛而不化，故用白术以健脾。然阳气不到，则湿不去，譬如日所不
照处，地不易干，用官桂之辛升至表，引表之阳气入里，里得阳气，而湿即行矣。此方可升
可降可吐。欲吐，先煎前散冷服，次饮热汤一碗，即吐；欲利小便，温饮；欲发汗，热饮。
去湿，湿去则金清，金清则降下之令复，譬如主人久不在家，家中秽污所塞，须扫除秽污心俟主人回之意。
截疟方，用白术五钱，当归三钱，陈皮二钱，雄丁香五枚，乌梅三枚，母丁香四枚。水一大
碗，浸露一宿，五更，去渣取汁温服。盖凡久疟则内伤，五脏俱虚，内起火，发热。火所畏者
水也，以水浸药，略温服之，则火见水而火退矣，火退则诸药皆能成功。白术补脾，当归润
肝，陈皮消痰，丁香温胃，乌梅敛肺润下，其病痊矣。露一宿以收清阳之气，五更服者，子
一阳生，至寅三阳足矣。（久疟可用，初疟再加散邪之药。）
凡右关浮缓，此阳气在上，中已虚寒，主肚疼之疾，秋来主有疟痢。盖内已虚寒，受邪已深
，至秋，阳气下降入腹，而正气已旺，宿邪不能容，故发此二疾。邪轻则疟，重则痢，皆正
疟疾，二尺细，此下焦寒也，温下则疟可以去矣。不然，亦成胀。
凡豁大脉，久病按下尚浑浑一条，此阴阳未离，犹可治之。若下无一条，开在两边，此阴阳
已离，法不可治。此脉常主作泻，盖豁大阳虚不能固下，而阴与阳不相合，故下不禁而作泻
也。（卧病日久，不宜此脉，若带病作劳，身燥、气促而脉散者，未可径汗之。）
凡久病患，脉大小、洪细、沉浮、弦滑，或寸浮尺沉，或尺浮寸沉，但有病脉，反属可知。
如久病浮中沉俱和缓，体倦者决死。且看其面色光润，此精神皆发于面，决难疗矣。（此条
Shi Xun (Master's Instructions) consists of the remarks of Mr. Zha Liaowu, recorded and compiled by Hu Shenrou. When publishing *Shen Rou Wu Shu* (Five Books of Shen Rou), Shi Xun is placed first to record the lineage of transmission. These contents were recorded spontaneously amidst busy social engagements; they are not formal compositions. They were noted down upon hearing them in the morning, dusk, wind, or rain; they are not commentaries on classics. Therefore, the language is often straightforward and unadorned, and the phrasing is trivial and lacks structure. However, just as the source of alchemy in Daoism or the core tenets of Chan Buddhism, grasping even a few words or phrases can encompass universal principles. The original text has now been synthesized, categorized, and slightly reorganized for order, appearing disordered yet actually ordered, making it convenient for students to study. With the publication of this compilation, not only does Shenrou demonstrate his adherence to the words of Liaowu, but the academic lineage of Mr. Shen Zhai (Hu Shenrou's pseudonym) can also be glimpsed.
Di Huang Wan (Rehmannia Pill) is the principal formula for treating Kidney diseases. When Kidney Water (Jin Ye, body fluids) is depleted, Liver Wood fails to flourish; when Liver Wood fails to flourish, dry wood generates Heart Fire. (The terminology of Five Elements is a conventional term used by physicians; readers should seek its meaning within the context. Here, Kidney Water refers to Jin Ye, Liver Water refers to Blood, and Heart Fire refers to hyperactive, dry heat. When Jin Ye cannot moisten Blood, Blood stagnates and dries up; when Blood cannot nourish Qi, Qi becomes hyperactive and fierce. Hence it is said: "Dry wood generates Heart Fire.") Therefore, Shu Di Huang (Prepared Rehmannia Root) is used to nourish the Kidney, and Ze Xie (Alisma Rhizome) is used to eliminate pathogenic factors in the Kidney, thereby achieving the effect of nourishing the Kidney. The element that the Kidney fears is Earth (Spleen); if there is Damp-Heat in the Spleen, it can overact on Kidney Water. Thus, Shan Yao (Dioscorea Rhizome) is used to tonify the Spleen, and Fu Ling (Poria) is used to eliminate Dampness in the Spleen, thereby achieving the effect of tonifying the Spleen. Dry Liver Wood consumes Kidney Water; Shan Zhu Yu (Cornus Fruit) is used to astringe fire and moisten the Liver. Blazing Heart Fire can also deplete Kidney Water; Mu Dan Pi (Moutan Cortex) is used to drain Heart Fire and nourish the Heart. When the Heart is sufficient, false fire will not arise recklessly, and it can descend to interact with the Kidney, further enhancing the effect of tonifying the Kidney. This aligns with the principle in *Nan Jing* (Classic of Difficult Issues): "East is excess, West is deficiency; drain South, tonify North"; and also with the concept of "Hyperactivity leads to disaster, control follows" in *Su Wen* (Basic Questions).
If both wrists show a rapid pulse (Shu) and the stool is dry, use Ba Wu Tang (Eight Substance Decoction). If the pulse is surging and forceful, use Di Huang Tang (Rehmannia Decoction); if forceless, use Da Bu Tang (Great Tonification Decoction). For dry Spleen, add Shan Yao; for a wiry pulse, add Bai Shao (White Peony Root); for a floating and forceless Right Guan pulse, add Ding Xiang (Clove); for a deep and forceless Right Guan pulse, add Gan Jiang (Dried Ginger).
In internal injury conditions, if the Cun pulse is larger than the Chi pulse, this indicates Excess Yang. It is appropriate to use Bao Yuan Tang (Preserve Origin Decoction) plus Dang Gui (Angelica Sinensis) and Bai Shao to guide the Qi downward. Then the large pulse will subside, and Yang Qi will be retained internally. This is the method of drawing from Yang to Yin. (The intent is sound, but the medication is inappropriate. Raising Stomach Yang and Liver Yang via Dang Gui does not truly descend. There are three methods of guiding downward: direct clearing and purging, nourishing and filling from below, warming and tonifying from below, and venting the upper to allow the Great Qi to descend naturally, depending on the root of the disease.)
In internal injury conditions, if the Right Chi pulse is wiry and weak, cold-natured herbs should not be used because of Deficient Fire of the Gate of Vitality (Ming Men).
If the Right Guan pulse is slow and forceful, slow indicates Dampness. If the Cun and Chi pulses are both weak, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chi Fu Ling (Red Poria) and Yi Yi Ren (Coix Seed). Bu Zhong Yi Qi Tang tonifies the weakness of the Cun pulse; Chi Fu Ling and Yi Yi Ren move Dampness in the Middle Jiao and cause Middle Jiao Qi to descend, harmonizing the Chi pulse.
If the Right Guan pulse is slow and forceless, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) plus Huang Qi (Astragalus Root) to tonify the Upper and benefit the Lower. For conditions on the right side, modify Si Jun Zi Tang (Four Gentlemen Decoction). To tonify the upper, use Huang Qi; to tonify the lower, use Chi Fu Ling and Yi Yi Ren. For conditions on the left side, regulate with Si Wu Tang (Four Substances Decoction). If the Left Cun pulse is surging and forceful, add Mu Tong (Akebia Caulis), Huang Lian (Coptis Rhizome), and Chi Fu Ling. Mu Tong drains Small Intestine Fire; the Small Intestine is the interior-exterior partner of the Heart; Huang Lian drains Heart Fire; Chi Fu Ling enters Bing-Ding (Fire elements).
If the Left Guan pulse is floating, use Qiang Huo (Notopterygium Rhizome) and Fang Feng (Saposhnikovia Root). If the Left Guan pulse is deep and forceful, use Shan Zhi (Gardenia Fruit), Chai Hu (Bupleurum Root), Zhi Mu (Anemarrhena Rhizome), and Huang Bo (Phellodendron Bark). If the Left Chi pulse is forceful, add Huang Bo to drain the excess. Generally, the left side is drained rather than tonified, and the right side is tonified rather than drained; otherwise, the Fire of the Gate of Vitality will become excessive. (This statement is erroneous. Both left and right contain Water and Fire; excess in either requires draining, and deficiency in either requires tonifying. As stated in the text, adding Huang Bo to drain excess in the Left Chi is indeed draining Fire. If the Right Chi were excessive, could one still tonify?)
For internal injury fever and dry mouth, this is due to Cold-Deficiency in the Lower Jiao, Fire failing to return to its origin, and Yang Qi residing in the upper part. One must warm the Lower Jiao to cause Yang Qi to descend, and the dry mouth will heal itself. (This is what is meant by "warming and tonifying from below." It is Cold-Deficiency in the Lower Jiao repelling Yang to the upper part. This occurs because Qi in the Lower Jiao cannot ascend continuously, lacking guidance, failing to descend smoothly, accumulating above, and transforming into dry heat.)
For internal injury, with Fire above and Water below, coughing and wheezing occur; these are caused by nourishing Yin and draining Fire. Initially, use Gui Zhi processed Bai Shao (Cinnamon Twig processed White Peony Root), a small amount of Wu Zhu Yu (Evodia Fruit), along with Gan Cao (Licorice Root), Ren Shen (Ginseng), Wu Wei Zi (Schisandra Berry), Ban Xia (Pinellia Tuber), Po Gu Zhi (Cibotium Rhizome), and Du Zhong (Eucommia Bark). Warming causes Fire to descend and Water to ascend. If diarrhea ensues, it is because Yang descends, mobilizing accumulated food and fluids in the Stomach. (Cough and wheezing induced by nourishing Yin and draining Fire result from Yang being suppressed by Yin, causing Water above and Fire below. Using acrid-warm herbs to dispel Yin and extend Yang causes vigorous generation of healthy Qi, leaving no room for stale Qi and damaged fluids, hence sweating or diarrhea. If internal constrained heat is severe, slightly assist with clearing and descending herbs to prevent sudden flare-up of constrained fire, which I have witnessed frequently.)
For consumptive diseases, if the Lung pulse is large with wheezing, and the lower pulses are wiry, thin, weak, and faint, this indicates Yang floating upward without descending, internal Cold with external Heat, and Heat above with Cold below. Use Ren Shen (1 qian), Gui Zhi processed Bai Shao (1 qian), Gan Jiang (3 fen), Ban Xia (1 qian), Wu Wei Zi (15 grains), and raw/roasted Gan Cao (2 fen) to warm the center, retain Qi internally, and descend Yang. (Consumptive wheezing involves Qi obstruction or Qi floating. Qi obstruction arises from external invasion of clear-damp or internal sinking of defensive Yang; Qi floating arises from internal Cold repelling Heat or Yin Deficiency with Yang floating. Sinking Yang presents with short/weak Cun pulse but wiry/tight exterior pathogens; floating Yang presents with scattered/floating Cun pulse but surging/excess interior heat. Pure deficiency allows for tonifying and astringing; mixed deficiency-excess requires warming/dispersing or warming/descending methods, not solely tonifying/astringing. Prognosis depends on whether the Chi pulse has a root and matches the condition. Pure deficiency means weak Lung Qi; mixed deficiency-excess means困 (trapped) Lung Qi. Tonifying/astringing may strengthen weakness but also exacerbate trapping, closing the Upper Jiao and preventing the movement of Zong Qi (Gathering Qi). If Qi transformation is blocked and ascent/descent discontinues, wheezing worsens. Thus, treatment requires the subtle application of opening to astringe and descending to tonify.)
For long-term illness where excessive use of cold-draining and attacking herbs has depleted the Qi of the Three Yang meridians, leading to Phlegm condensation and Qi stagnation, treat with Tiao Yuan formulas. When Yang Qi moves, Shao Yang rises first. As Shao Yang attempts to emerge, it is blocked by Tai Yang ahead and Yang Ming behind. When Shao Yang Qi reaches Tai Yang, combination brings Cold; combination with Yang Ming brings Heat, resulting in alternating chills and fever resembling malaria, though it is not true malaria. When Tai Yang Qi reaches the surface, symptoms of wind-strike appear, such as nasal congestion and aversion to wind/cold. When Yang Ming Qi reaches the surface, diarrhea occurs. At this stage, one should harmonize the Spleen and tonify the Origin, treating separately, so that old illnesses resolve. (This section greatly enlightens the mind.)
Excessive use of cold-draining and attacking herbs leads to Blood stasis and Qi stagnation. Using warming-tonifying formulas resolves Phlegm and harmonizes the pulse. One should anticipate potential minor blood coagulation later. This represents unblocking the collaterals; strong Qi moves Blood. (One can comprehend Ye Tianshi's principle of unblocking collaterals in long-term illness from this.)
A fine-rapid pulse indicates Kidney Deficiency; a wiry-rapid pulse indicates Liver Deficiency; a short-rapid pulse indicates Lung Deficiency. These are pulses of serious illness. Life is possible if there is Stomach Qi; death if absent. A scattered-rapid pulse indicates Heart Deficiency. Among rapid pulses, if there is still a sense of leisurely moderation, it is said to possess Stomach Qi. (Coming high and going deep, rotating without agitation constitutes moderation.)
In consumptive disease, if the pulse beats dozens of times without being thin or short, and feels continuous under pressure, Du Shen Tang (Single Ginseng Decoction) of 1-2 liang can be taken, followed by regulation. (This pulse rate results from Lower Cold repelling Yang, preventing it from returning to its cavity. Fuzi (Aconite Lateral Root) plus Gui Ban (Turtle Shell) should be used to pacify it.)
A fine, wiry, and choppy Spleen pulse indicates Deficient-Cold of Middle Qi, requiring warming. Direct use of warming herbs may stir Fire; instead, use Yi Zhi Ren (Alpinia Oxyphylla Fruit) to warm, and Shan Yao to nourish the Spleen. The warmth of Yi Zhi Ren retreats to the Lower Jiao, tonifying the Gate of Vitality; Fire generates Earth, forming a linked chain of tonification without stirring Fire. (Direct warming stirs Fire due to Blood Deficiency failing to anchor it. Shellfish-type minerals like Gui Ban, Bie Jia (Softshell Turtle Shell), and Mu Li (Oyster Shell) should be used together; Yi Zhi Ren alone is insufficient. Only those with mild Yin Deficiency can tolerate Yi Zhi Ren.)
For constipation in consumptive disease, use Xing Ren (Apricot Seed), Zhi Ke (Bitter Orange Fruit), and Su Geng (Perilla Stem) to evacuate accumulated feces.
I once diagnosed a patient with a floating-large Right Guan pulse, indicating floating Yang. The symptom was abdominal pain and diarrhea due to internal Cold. Jian Zhong Tang (Establish the Middle Decoction) was indicated to draw Yang inward and warm the center.
Vegetarians consume bland, leaching foods, while oils consumed belong to Fire. Bland-leaching foods drain Yang; Yang Deficiency leads to Fire arising. This aligns with Li Dongyuan's statement that vegetarians often have Stomach Deficiency. (The phrase "bland-leaching drains Yang" is very accurate. Therefore, cases of Wind-Damp on the exterior or Cold-Damp in the interior should not be treated indiscriminately with diuretics. Yang Deficiency leading to Fire arising is logical but under-expounded. Fire nature is expansive; following its expansive nature prevents visible signs of Fire. Thus, the meanings of "bitter-desire-tonify-drain" for the Five Zang in *Nei Jing* deserve careful study.)
For long-term illness, tonifying Spleen and Gate of Vitality herbs are drying agents. Dang Gui Shen (Body of Angelica Sinensis) must be used to moisten the Liver, fearing that dryness may stir Liver Fire. (The intention is excellent, but regarding Dang Gui as capable of moistening Liver dryness is misleading; its acrid-warm nature actually stirs Liver Fire. It is suitable for Blood Deficiency-Cold. Using it with drying agents for dryness-deficiency will cause dizziness and rib distension. Bie Jia and Mu Li, mineral/shell types, subdue Yang and are clear-lifting without cloying.)
A case of Phlegm disorder: a patient suffered from dementia, with non-rising Cun pulse, cold feet, and deep-surge Guan pulse. This indicates Yang Qi obstructed by Phlegm, requiring ascending, descending, and opening. Use Zi Su (Perilla Leaf), Chen Pi (Tangerine Peel), Ban Xia, Chi Shao (Red Peony Root), Chi Fu Ling, Zhi Ke, Gan Ge (Kudzu Root), Shi Chang Pu (Acorus Rhizome), Yuan Zhi (Polygala Root), and Ren Shen. The patient wanted to speak but was hesitant, with only cold fingers. (The word "cold" here might be an error for "object" or "empty". This indicates stasis-obstruction in the meridians connecting the Heart system, brain collaterals, and spinal cord, blocking spiritual mechanism. If Blood-related, add Tao Ren (Peach Kernel) and Dan Shen (Salvia Root); if Phlegm-related, add the following prescription.) This is a disease of Yang obstruction by Phlegm. Treat with Gui Pi Tang (Restore the Spleen Decoction) removing Zao Ren (Jujube Seed) and Yuan Yan (Longan Aril) and Huang Qi, adding Shi Chang Pu, Yuan Zhi, and Ban Xia. One tonifies, one opens, one moves. Later, use the full Gui Pi Tang for long-term recovery.
A chronically deficient patient with old accumulated Phlegm, after being tonified with Ren Shen and Bai Zhu, eventually vomited foul-smelling or green Phlegm. This is generally untreatable. Accumulation over time leads to extreme Spleen-Stomach Deficiency and failure to transport, causing郁 (stagnant) odor. (Some cases arise from reckless tonification; prognosis varies and depends on specific manifestations.)
A patient with frequent nocturnal emissions had a pulse with a distinct, bean-sized arterial beat at the Guan position, indicating Phlegm condensation in the Middle Jiao. Fortunately, nocturnal emissions prevented abdominal distension (Drum Distension). (Frequent nocturnal emissions generally归结 to sinking of Heart-Liver Qi. Causes include Lower Deficiency sinking, Spleen Deficiency sinking, intrinsic Heart-Liver Deficiency sinking, external pathogen suppressing Lung/Bladder Qi sinking, or Phlegm-fluid suppressing Spleen-Stomach Qi sinking. Differentiate by pulse and accompanying symptoms. Guan pulse like a bean indicates dead Blood in the Stomach. I have seen patients with nocturnal emissions having a smooth, tongue-root-like patch on the tongue center without coating, similar to this diagnosis.) Since Cun and Chi pulses were non-rising, Bu Zhong Yi Qi Tang plus Fu Ling, Ban Xia, and Shi Chang Pu was used, representing a method of ascending and descending.
A patient with long-term grief and depression felt extremely fatigued in the fifth and sixth lunar months, developing dementia-like symptoms, pointing emptily with hands. When asked, he replied, "I want to speak but cannot." (Speaking belongs to Heart; inability belongs to Brain; brain collaterals are obstructed.) Pulse: both Chi positions were faint and non-rising; both Guan positions were surging and slow. This indicates constrained Yang unable to ascend or descend. Er Chen Tang (Two Cured Decoction) plus Ren Shen was used to open and aid Spleen, supplemented by Sheng Ma (Cimicifuga Rhizome) and Chai Hu to assist Yang, and Shi Chang Pu, Yuan Zhi, and Chi Fu Ling to drain Dampness, descend Phlegm, and drain Fire. After four doses, peace returned; continued administration of pills led to cure.
For hematemesis (vomiting blood), if all six pulses are surging and rapid initially, Fu Ling Bu Xin Tang (Poria Nourishing Heart Decoction) is required. Bai Fu Ling (White Poria) guards the True Qi of the Five Zang, drains latent Fire in the Kidney, and drains Spleen Dampness to tonify the Spleen. After 2-3 doses, if the rapid pulse subsides slightly but remains surging, use Di Huang Wan to gather Qi; if it reduces to weak, modify Si Jun Zi Tang to tonify Spleen and generate Lung (Lung generates Water). If bleeding persists, add Mu Dan Pi and Shu Di Huang. If Fire exists at Right Guan, add Shan Yao; if at Left Guan, add Shan Zhu Yu; if at Left Guan and Left Chi, add Fu Ling, Ze Xie, and Shu Di Huang.
After hematemesis, if Right Guan and Chi pulses are surging, stool is dry, and mouth is dry, use Bai Shao, Gan Cao, Ren Shen, Su Geng, and Dang Gui Shen (each 5 fen), Zhi Ke (5 fen), Xing Ren (4 grains), and Huang Bo (2 fen). Two doses. Bowels become moist, and symptoms recede.
To stop hematemesis, charred Gan Jiang (Dried Ginger) and Wu Wei Zi (Schisandra Berry) are essential. Gan Jiang is warm, and blood stops when blackened; Wu Wei Zi is sour and can restrain rebellious Qi.
A patient with head and face pain took many cold-natured herbs. Spleen-Stomach pulse was fine and choppy; Left Chi was choppy; Left Cun and Guan were surging. This is Lower Jiao Cold with Fire pathogen rebelling upward. Use Qiang Huo (5 fen), wine-fried Fang Feng (5 fen), wine-fried Huang Lian (1 fen), wine-fried Fu Ling (3 fen), Bai Fu Ling (1 qian), Ren Shen (2 qian), Gan Cao (5 fen), Ban Xia (1 qian), Po Gu Zhi (1 qian), and Gou Qi Zi (Goji Berry, 1 qian). After two doses, the pulse became coarse rather than fine, and headache ceased.
For Plum Pit Qi (Globus Hystericus), use Si Qi Tang plus Ren Shen (1 qian), Gan Jiang (3 fen), Xi Xin (Asarum, 2 fen), Gui Shao (Cinnamon and Peony, 1 qian), and Ban Xia (1 qian). These are formulas to descend Qi, scatter Phlegm, warm the middle, and raise Yang. Without Xi Xin raising Yang, if Upper Jiao lacks Yang, how can Phlegm-Qi move? (This condition is mostly caused by melancholy or innate insufficiency exacerbated by sexual excess and fatigue, rarely related to Phlegm. Even if considered Phlegm, it is Dry Phlegm, unsuitable for acrid-drying herbs. It is not an extra object in the throat, but lack of blood nourishment causing insensitivity, feeling like an attached object. Due to Ren Mai Blood Deficiency failing to circulate above and Du Mai Qi Deficiency failing to connect frontally, Qi and Blood are depleted above. For severe Lower Jiao dryness, large doses of Gui (Turtle) and Lu (Deer) antler should be administered urgently; long-term use might reverse it, but with loose stools, there is no hope.)
For tuberculosis-like diseases (Lao Zhu), decoct Jin Yin Teng Ye (Honeysuckle Vine and Leaf). If Lung Deficient, add Bao Yuan Tang and Wu Wei Zi; if Heart-Spleen Deficient, use Gui Pi Tang. If all six pulses show Fire but are deficient, use Ba Zhen Tang (Eight Treasures Decoction); if Spleen-Lung Deficient, use Bu Zhong Yi Qi Tang; if Kidney pulse is surging and large, use Di Huang Tang.
For chronic vomiting, use Spleen-tonifying and Qi-descending herbs, including about 1 qian of Dang Gui to moisten lower dryness. Qi resides above and fails to descend for a long time; the lower part lacks Jin Ye, hence moistening is needed. However, for vomiting due to Spleen-Stomach Deficiency, Dang Gui is contraindicated. (Also contraindicated in Liver Heat and Middle Jiao Damp-Heat.)
The fifth lunar month is the Fire month; the sixth is the Damp month. Excess Fire generates Dampness. Together, they overcome Lung Metal, injuring Qi with Heat, leading to flaccidity and fatigue syndromes. Thus, the method of Clearing Summerheat and Augmenting Qi is established. Huang Qi assists Lung; Ren Shen assists Yuan Qi; Gan Cao drains Heart Fire, restoring Yuan Qi and clearing Lung Qi. For excessive Damp-Heat clouding Stomach Qi, add Cang Zhu (Atractylodes Lancea Rhizome). For Damp-Heat in the middle hindering digestion, add Chen Pi and Qing Pi (Green Tangerine Peel) to open chest-diaphragm, and Shen Qu (Medicated Leaven) to aid digestion. For red/scanty urination, add Ze Xie to remove Lower Jiao Dampness. For thirst, add Ge Gen (Kudzu Root) to relieve muscle heat and connect Stomach Jin Ye to moisten upwards. For excessive Stomach Damp-Heat overcoming Kidney Water, add Huang Bo to save Kidney Water. For Damp-Heat obstructing Yang channels causing fever, add Sheng Ma to raise Yang and reach the exterior to benefit Yang. Mai Dong (Ophiopogon Tuber) clears Heart; Wu Wei Zi astringes Lung, fearing Damp-Heat injures Lung.
Wu Ling San (Five Ingredient Powder with Poria) is a seasonal medicine for the fourth, fifth, and sixth lunar months. (Wu Ling San is not for regular use; instilling fear of dispersing and preference for diuresis causes great harm. Nineteen percent of diseases enter through hair pores; even respiratory entry relies on dispersing to boost Yang for exhaling old and inhaling new. Diuresis is only suitable for diseases entering from below or from drinking alcohol/water. Overuse injures Bladder Yuan Qi and causes sinking of San Jiao, irreparable. I have witnessed this often.) When Damp-Heat is excessive, San Jiao Qi is unclear, causing cough above, fullness in middle, and diarrhea below. Zhu Ling (Polyporus) clears Upper Jiao; Fu Ling clears Middle Jiao; Ze Xie clears Lower Jiao. To prevent Damp-Heat from failing to transform, Bai Zhu is used to tonify Spleen. However, without Yang Qi reaching, Dampness does not leave; like ground not dried by sun. Guizhi (Cassia Twig) acridity ascends to the exterior, drawing exterior Yang inward; receiving Yang, Dampness moves. This formula can ascend, descend, or induce vomiting. To vomit, decoct powder cold, then drink hot water; to promote urination, drink warm; to induce sweat, drink hot. Removing Dampness clears Metal; cleared Metal restores descending function. Like a host away long, house filled with filth; filth must be cleared before the host returns.
Anti-Malaria Formula: Bai Zhu (5 qian), Dang Gui (3 qian), Chen Pi (2 qian), Xiong Ding Xiang (Male Clove, 5 pieces), Wu Mei (Mume Fruit, 3 pieces), Mu Ding Xiang (Mother Clove, 4 pieces). Soak in one large bowl of water overnight exposed to dew. Take warm decoction filtered from residue at wu geng (3-5 AM). Long-term malaria causes internal injury and Five Zang Deficiency, generating internal Fire and fever. Fire fears Water. Soaking herbs in water and taking them slightly warm makes Fire see Water and retreat. Once Fire retreats, all herbs succeed. Bai Zhu tonifies Spleen; Dang Gui moistens Liver; Chen Pi eliminates Phlegm; Ding Xiang warms Stomach; Wu Mei astringes Lung and moistens downward. Disease cures. Overnight dew collects pure Yang Qi; taking at wu geng corresponds to Zi hour birth of one Yang, reaching Yin hour completion of three Yangs. (Suitable for long-term malaria; for initial malaria, add dispersing pathogen herbs.)
Floating-slow Right Guan pulse indicates Yang above and Middle Deficient-Cold, predicting abdominal pain, and malaria/dysentery in autumn. Internal Deficient-Cold implies deep pathogen invasion. In autumn, Yang descends into abdomen while Zheng Qi is strong; old pathogens cannot remain, triggering these diseases. Light pathogen causes malaria; heavy causes dysentery. Both are typical malaria/dysentery. Fine Chi pulses indicate Lower Jiao Cold; warming below removes malaria. Otherwise, distension ensues.
A wide/large pulse in long-term illness, if still continuous and浑浑 (turbid/unified) under pressure, indicates Yin-Yang not separated, still treatable. If no continuous line underneath, splitting to sides, Yin-Yang separated, untreatable. This pulse often predicts diarrhea; wide/large indicates Yang Deficiency failing to secure below, Yin and Yang not combining, causing uncontrollable diarrhea. (For long bedridden patients, this pulse is unfavorable. If working while ill, with dry body, short breath, and scattered pulse, do not induce sweat directly.)
For long-term illness, regardless of pulse size, surging/thin, floating/deep, wiry/slippery, or Cun floating/Chi deep vice versa, pathological pulses are recognizable. If floating/middle/deep are all moderate/slow in long-term illness with fatigue, death is certain. Also check complexion luster; spirit manifests in the face, making cure difficult. (This section...)