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为了继承老年中医的学术经验，现将我省已故著名老中压、原云南省卫生厅副厅长戴丽三同志的部分诊疗经验(包括论著及医案两部分)，由其子女组成整理小组，辑成《戴丽三医疗经验选》一书。
戴丽三同志，家学渊源，继承祖传医学，积四十余年丰富的理论与临症经验，学术造诣较深，在我省人民群众中享有一定的声誉。本书论著部分选收了戴老医师的部分学术论文，从中可以看出他对祖国医学的刻苦钻研，以及某些独到见解，从而易于了解他的学术思想及临症经验。医案部分包括了内、妇、儿科及其他各科的一些疑难重症，藉此可以窥见作者是如何应用其精湛的中医学术理论指导临床实践，以解决临床中的复杂问题，使不少险恶重症得以转危为安。由此亦可得知作者遵古而不泥于古，灵活精当地运用辨证施治规律于临床实践，体现了防微杜渐，一切从病员实际出发，具体问题具体分析等卓越的医疗思想，以及许多难能可贵的独到经验，可供中西医务人员研究参考，亦资后学者临床借鉴。
云南省卫生局 一九七九年七月
前 言 《戴丽三医疗经验选》一书，是戴丽三老医师临症四十余年的部分学术研究成果和医疗经验，包括论著和医案两部分。
他生平治学谨严，除继承其父戴显臣学术思想和临症经验外，并努力钻研四大经典和历代名家著述及医案。他自己的论著中，持论客观，有继承有发展，临症一丝不苟，不固执己见；遵古而不泥古，强调从病员实际出发，灵活运用中医理论，立方遣药以喻嘉言“先议病，后议药，有是病，用是药”的思想作指导。因此，能做到经方时方并用，并能灵活化裁。基本上做到了病有千变而方亦有千变，体现了祖国医学的整体观及审证求因、辨证施治的精神。所辑存之医案及按语如实地记录了患者之病情经过和原委；阐明了每一病案所运用的理、法、方、药的关键所在，如同病异治，异病同治，上病下取，正治、逆治等治疗法则的具体运用。
医案和按语的初稿，是他生前在原省卫生厅的直接领导与支持下整理出来的。但因他不幸于一九六八年患脑溢血病逝，此稿遂搁置至今。
本书定稿时，承蒙许子建老师和个旧云锡职工医院张震医师审阅并提出宝贵意见，特此致谢。
由于我们经验不足，水平有限，错误和不足之处，望同志们批评指正。
整理者 戴慧芬戴天载 严继林戴若碧
一九七九年七月于昆明
桂枝汤是《伤寒论》的代表方之一，仲景方约二百余首，其中用桂枝汤加减变化而出者，计有二十八方，约占七分之一。此方不仅用于外感风寒表虚证，且大量用于临床各科之无表证者。前人柯韵伯、王子接、郑钦安都谈到本方既是解表剂，又是和里剂，尤其王子接论述伤寒方，列桂枝汤为和剂祖方。历代医家称誉此方为仲景“群方之冠”。实践证明，桂枝汤功用既能调和营卫，又能燮理阴阳，与麻黄汤之专于发表，及三承气汤之专于攻里者不同。正因为它具有解表和里的功效，因此，可用于营卫失调，营卫不足及阴阳失调所导致的许多病症。但是，历代注解《伤寒论》的某些医家，大多将它局限于治太阳表虚证。现代出版的某些方剂专书亦只强调其解表的一面，而忽视其更为重要和里的一面，易使读者产生桂枝汤仅能用于外感表证的错觉，限制了该方对许多里证的运用。特别是晋朝王叔和“桂枝下咽，阳盛则毙”一语出来后，有的医家临证时不加分析，有的甚至对桂枝的使用都望而生畏。因而不敢使用本方，或将之人为地划了禁区。
实践证明，《伤寒论》所载之方剂，是有理论根据的，并有严谨的法度可循。如离开理论而谈方剂的效能和运用，必·将成为无源之水，无本之木，至有“千方易得，一效难获”之叹。古代方剂，特别是经方，其组成一般都贯穿着理、法、方、药的有机联系。方与药，蕴藏着质量互变的规律；证与方，体现着异病同治、同病异治的辩证思想。掌握方剂的运用，必须首先掌握制方的原理，只有在理论的指导下，方能使治法、方剂和药物相互紧密联系起来，从而在中医辨证论治过程中体现出理、法、方、药的统一性。所谓善学者，取其法，而不泥其方。这说明重视理论学习，掌握精神实质的重要性。只有如此，才能真正理解和掌握经方的效用，扩大其治疗范围，突破人为的局限。一、营卫概要
桂枝汤主要功效是调和营卫，燮理阴阳，它不仅用于外，感表虚证，更重要的是用于内伤营卫不和，阴阳失调的许多疾病，这就有必要系统而概要地回顾一下有关营卫方面的理论，以加深对桂枝汤方义的理解，更好地掌握其临床运用。
(一)营卫的生成 《灵枢·营卫生会篇》云：“人受气于谷，谷入于胃，以传心肺，五脏六腑，皆以受气，其清者为营，浊者为卫，营在脉中，卫在脉外，营周不休，五十而复大会。阴阳相贯，如环无端。”具体地描述了营卫的生成，来源于饮食物经过中焦脾胃的吸收转化而成的“精气”(指具有营养价值者)，通过心肺的气化作用则化为营气与卫气。
(二)营卫的分布与生理功能 《素问·痹论篇》云：“荣者(荣与营通用)，水谷之精气也，和调于五脏，洒陈于六腑，乃能入于脉也。故循脉上下。贯五脏，络六腑也。卫者，水谷之悍气也，其气馔疾滑利。不能入于脉也，故循皮肤之中，分肉之间，熏于盲膜，散于胸腹。”指出了营与卫性质不同，故功能和分布也不同。《灵枢·邪客篇》云：“营气者，泌其淖液，注之于脉，化以为血，以营四末，内注五脏六腑，以应刻数焉。卫气者，出其悍气之懔疾，而先行以分肉四末皮肤之间而不休者也”。指出了营气系精气之柔和成分，是水谷入胃，借中焦热能，吸取其汁液，流注于脉中，化而为血，故常营血并称。卫气乃水谷入胃，是中焦之热能所蒸发出的气体，属精气之雄厚成分，不能入于血脉之中，只能循宗气而分布于血脉之外，运行于皮肤，分肉和四末，故常肺卫并称。但两者之间是相互为用，不可分割的，正如张景岳所说：“卫主气而在外．然亦何尝无血，营主血而在内，然亦何尝无气。故营中未必无卫，卫中未必无荣，但行于内者，便谓之荣，行于外者，便谓之卫。此人身阴阳之道，分之则二，合之则一而已。”这更加具体地论述了营、卫、气、血的实质与功能及其分布的不同。
(三)营卫与脏腑的关系 《难经》第三十二难云：“心者血，肺者气，血为荣，气为卫，相随上下，谓之荣卫，通行经络，营周于外。”具体的指出了心肺与气血荣卫的密切关系。由于心主血，肺主气，营卫统掇气血，心肺为之主宰，经气的环流，促进了营血运行全身，揭示了营卫直接与心肺的关系，与气血相连。营卫与气血，营卫与心肺，均存在着内在的紧密关系。
若进一步加以探讨，心主血，肝藏血，脾统血，根据营卫统摄气血及张景岳所云：“血中有气，气中有血”的理论，血液的进行和统摄，必须靠气的推动，才能发挥作用，才能保持一定的温度。如果营卫调和，营卫不虚，则心、肝、脾功能正常；否则易导致这些内脏功能的紊乱。脾不仅能统血，还能益气，因能益气，才能使水谷精微化生营卫。故金元四大家之一的李东恒说：“胃为卫之本，脾乃营之源。”说明脾胃乃营卫生化之源。
肾主诸阳，卫为气，属阳，卫阳与肾阳相通，营卫虽生化于中焦，但属阳气的卫气却出于下焦” (见《灵枢·营卫生会篇》)，可见卫气与肾密切相关。
综上所述，营卫与心、肺、肝、肾、脾胃有着十分密切的关系。换句话说，调和营卫和补养营卫，有助于这些畦腑功能活动的加强。亦可以说，这些脏腑的某些疾病，当反应出营卫失调或营卫不足时，通过调和营卫或补养营卫，即可得到纠正或恢复。
(四)营卫的病理表现
营卫的生理功能正如前述，当其功能正常时，由于有营血荣养，卫气卫外，则无病理状态出现。一旦营卫失调或不足．则产生病理反应。如“卫气失司”，临床就产生风邪伤卫的太阳表虚有汗的桂枝汤证。如营虚不和，临床就容易产生寒邪伤营的太阳表实无汗的麻黄汤证，这仅只是风、寒二邪侵犯营卫在病机上的区别之一。但“风雨寒热，不得虚，邪不能独伤人”。 (见《灵枢·百病始生篇》)。宋代医家严用和说：“大抵人之有生，以元气为根，营卫为本，根本强壮，营卫和平，腠理致密，外邪客气，焉能为害。”指出了元气和营卫乃人之根本，营卫和平，则外邪难犯。
营卫久虚，还可出现某些较为严重的疾病。《素问·逆调论》指出：“荣气虚则不仁，卫气虚则不用，荣卫俱虚，则不仁且不用，肉如故也。”指出临床上许多肢体麻木，运动受障的某些病证的发生，与营卫俱虚有密切的关系。
除上述者外，有些慢性病的某一阶段，营病及卫，卫病及营，二者不可截然分开。但临床往往易被忽视，或不易鉴别，营卫失调和营卫气化功能不足又是某些疾病发展变化的关键所在。只要纠正了营卫失调或增强了营卫功能，疾病就可逐渐趋向好转。如忽视了调整营卫功能，疾病就可逐渐转向纵深发展或日趋严重。因此紧紧掌握增强营卫功能的调治方法，对疾病的发展变化起着决定性的作用。二、桂枝汤方解
桂枝汤由桂枝、杭芍、甘草、生姜、大枣五味药物组成。因其配伍巧妙，具有滋阴和阳、调和营卫、增强营卫功能等功效，本方刚柔相济，补散兼施，扶正祛邪，堪称制方典范。
桂枝味辛，性温，阳也。有助阳化气，温通经脉，化湿利水之功效，尤能助心肺之阳。其归经入心、肺、膀胱。如临床常用之五苓散，因配伍桂枝助膀胱之气化功能，五苓散才能起通调水道的作用。概括其功用，具有和营、通阳、利水、下气、行瘀、补中等六大功效。
杭芍味酸，性寒，阴也。取味酸能收敛营阴(即止汗、止血、止津液耗散)，性寒能入营，具补血、平肝、止痛之效。
生姜味辛辣，性温，发散风寒，温中止呕，配桂枝增强助卫阳，解肌表，除外邪之功。二者合用为姜桂汤，辛甘化阳，以调周身之阳气。
大枣昧甘，性温，配芍药补营阴，二者配伍，酸甘化阴，以滋周身之阴液。
甘草昧甘，性平，通行十二经，有护卫中气，调和诸药，安内攘外之功。配桂枝为桂枝甘草汤，能温补心阳；配芍药为芍药甘草汤，能和营养阴，舒挛止痛。
总之，从桂枝汤的两味主药来看，桂枝辛温．助卫阳发汗，芍药酸收助营阴止汗，两药相合，在于通过桂枝助卫阳、发汗之功，使外邪随汗而解，通过杭芍的助营阴止汗之功，保护营阴不致被再度损伤。二者配合是发汗之中寓敛汗之旨，既发汗，又止汗，既矛盾，又统一的作用，揭示了营卫的功能与作用以及桂枝汤一表一里，一阴一阳，故谓之和剂。前人所谓桂枝汤“外证得之解肌和营卫，内证得之化气调阴阳”之论，颇符合临床实践。三、临床运用
以桂枝汤加减在临床上的运用比较广泛，今择其常见者，简介如下：
(一)更年期营卫失调 《素问·上古天真论》云。“女子六七，三阳脉衰于上，面皆焦，发始白，七七，任脉虚，太阳脉衰少，天癸竭，地道不通，故形坏而无子也。”论述妇女年进四十以后生理上的变化过程，由于营卫与心肺相连，与气血相关，心主血脉，肝主藏血，肾主藏精，气血精液逐渐衰退，冲任二脉失于滋养之源，出现月经紊乱，营血不足，时而潮热、出汗，时而畏寒、恶风，血不养心，时而心悸，时而虚烦不眠，营虚不与卫和，则见肌肉跳动，四肢痠胀，浮肿等症。从病理变化过程来看，初期由于营卫不和，舌多淡润，脉多弦虚或浮虚。可用桂枝汤倍芍药，加香附，麦芽、乌梅、冰糖，和营之中寓调气养肝，进而用新加汤助营加香附、麦芽，疏理气机。如四肢疫胀较重者，本方再加桑枝以活络。至于月经紊乱．或前或后，或一月二次，淋漓不尽，或腰痠腹痛，或数月一次，可用《金匮》大温经汤。因该方有桂枝汤增强营卫为基础，用治寒凝经脉，木郁不舒，肝气下陷所致之经漏淋漓，腹痛腰瘥，脉多沉迟或弦紧者。此方全在桂枝配芍药，于化气通阳之中寓敛阴之旨。
(二)外伤或术后营卫虚损
由于外伤或术后，营卫虚损，营虚不与卫和所致低热，用桂枝汤倍芍药加乌梅、知母、冰糖，助营退热。如肢体麻木者，用参芪归桂枝汤加香附、麦芽，和营助卫之中兼补气血而行滞气。
(三)营虚肌肉跳动
此症多见于老年妇女，因其营血不足而致肌肉跳动，有时兼有麻木，状似风湿，但与风湿有别。风湿麻木跳动，或疼痛多在关节，营血不足麻木跳动多在肌肉与筋膜；风湿多有苔，营血不足多无苔。治疗风湿宜驱风除湿，治疗营血不足始终宜在调和营卫的基础上着重补养气血，处方以大剂量新加汤加桑枝，或用参芪归桂枝汤。此证忌用祛风除湿发散之药，因风药辛燥更伤营阴。
Preface
In order to inherit the academic experience of elderly Traditional Chinese Medicine (TCM) practitioners, a compilation team formed by the children of the late distinguished senior TCM physician and former Deputy Director of the Yunnan Provincial Health Department, Comrade Dai Lisan, has compiled his partial clinical experience (including theoretical writings and medical cases) into the book *Selected Medical Experience of Dai Lisan*.
Comrade Dai Lisan came from a family with profound medical heritage, inheriting ancestral medical knowledge. He accumulated over forty years of rich theoretical and clinical experience, achieving deep academic attainments and enjoying a certain reputation among the people of our province. The theoretical section of this book selects some of Professor Dai's academic papers, through which one can see his diligent study of national medicine and certain unique insights, thereby facilitating an understanding of his academic thoughts and clinical experience. The medical case section includes some difficult and severe cases from internal medicine, gynecology, pediatrics, and other departments, allowing us to glimpse how the author applied his exquisite TCM theoretical knowledge to guide clinical practice, solve complex clinical problems, and turn many dangerous and severe conditions from peril to safety. From this, we can also learn that the author followed ancient traditions without being bound by them, flexibly and accurately applying the laws of syndrome differentiation and treatment in clinical practice. This reflects his excellent medical thoughts such as preventing diseases before they arise, proceeding from the actual condition of patients, and analyzing specific problems specifically, as well as many rare and valuable unique experiences. These can serve as research references for both Chinese and Western medical personnel and provide clinical reference for later learners.
Yunnan Provincial Health Department, July 1979
Foreword
The book *Selected Medical Experience of Dai Lisan* comprises part of the academic research results and medical experience of the old physician Dai Lisan from his more than forty years of clinical practice, including theoretical writings and medical cases.
He was rigorous in his scholarly pursuits throughout his life. In addition to inheriting the academic thoughts and clinical experience of his father, Dai Xianchen, he diligently studied the Four Great Classics and the writings and cases of famous doctors throughout history. His own theoretical writings were objective, featuring both inheritance and development; in clinical practice, he was meticulous and not stubborn in his opinions; he respected ancient methods without being rigidly attached to them. He emphasized proceeding from the patient's actual condition, flexibly applying TCM theory, and prescribing formulas and herbs guided by Yu Jiayan's thought of "first discuss the disease, then discuss the medicine; if there is the disease, use the medicine." Therefore, he could combine classical formulas (Jingfang) with contemporary formulas (Shifang) and flexibly modify them. Basically, he achieved the principle that as diseases change in thousands of ways, so do the formulas, reflecting the holistic view of national medicine and the spirit of examining syndromes to seek causes, and differentiating syndromes to determine treatments. The collected medical cases and annotations truthfully recorded the course and details of the patients' conditions; they clarified the key points of the principles, methods, formulas, and herbs used in each case, such as the specific application of treatment rules like treating the same disease differently, treating different diseases similarly, treating upper diseases by lowering, orthodox treatment, and counter-treatment.
The draft of the medical cases and annotations was compiled under the direct leadership and support of the former Provincial Health Department during his lifetime. However, due to his unfortunate death from cerebral hemorrhage in 1968, this manuscript was shelved until now.
When finalizing this book, we received valuable comments from Teacher Xu Zijian and Physician Zhang Zhen of Gejiu Yunxi Staff Hospital. We extend our special thanks here.
Due to our lack of experience and limited level, we hope comrades will criticize and correct any errors and deficiencies.
Compilers: Dai Huifen, Dai Tianzai, Yan Jilin, Dai Ruobi
July 1979, Kunming
Harmonizing Ying and Wei and Guizhi Tang
Guizhi Tang (Cinnamon Twig Decoction) is one of the representative formulas of the *Treatise on Cold Pathogenic Diseases* (*Shanghan Lun*). There are approximately two hundred formulas by Zhang Zhongjing, among which twenty-eight are variations derived from Guizhi Tang, accounting for about one-seventh. This formula is not only used for exterior deficiency syndromes caused by external wind-cold but is also extensively used in various clinical specialties for conditions without exterior syndromes. Predecessors Ke Yunbo, Wang Zijie, and Zheng Qin'an all mentioned that this formula is both an exterior-releasing agent and an interior-harmonizing agent. Especially Wang Zijie, in discussing cold pathogenic formulas, listed Guizhi Tang as the ancestral formula for harmonizing agents. Doctors throughout generations have praised this formula as the "crown of all formulas" by Zhang Zhongjing. Practical evidence shows that the function of Guizhi Tang can not only harmonize Ying and Wei but also regulate Yin and Yang, differing from Mahuang Tang (Ephedra Decoction) which specializes in releasing the exterior, and the Three Cangqi Decoctions (Three Cangqi Decoctions) which specialize in purging the interior. Precisely because it has the effects of releasing the exterior and harmonizing the interior, it can be used for many conditions caused by disharmony or deficiency of Ying and Wei, and disharmony of Yin and Yang. However, some physicians who annotated the *Shanghan Lun* throughout history mostly confined it to treating Taiyang exterior deficiency syndromes. Some modern published monographs on formulas only emphasize its exterior-releasing aspect while ignoring its more important interior-harmonizing aspect, easily creating the illusion for readers that Guizhi Tang can only be used for external exterior syndromes, limiting the application of this formula to many interior syndromes. Especially after the statement by Wang Shuhe of the Jin Dynasty, "Once Guizhi enters the throat, if Yang is excessive, death ensues," some physicians did not analyze it when practicing clinically, and some even feared using Cinnamon Twig (Guizhi). Consequently, they dared not use this formula or artificially created taboos around it.
Practical evidence shows that the formulas recorded in the *Shanghan Lun* have theoretical basis and strict methodological standards. If one discusses the efficacy and application of formulas away from theory, it will inevitably become water without a source and a tree without roots, leading to sighs of "it is easy to get a thousand prescriptions, but difficult to obtain one effect." Ancient formulas, especially classical formulas, generally embody the organic connection between principles, methods, formulas, and herbs. Formulas and herbs contain the law of quantitative and qualitative changes; syndromes and formulas reflect the dialectical thinking of treating different diseases with the same method and the same disease with different methods. To master the application of formulas, one must first master the principles of formula composition. Only under the guidance of theory can treatment methods, formulas, and drugs be closely linked together, thereby reflecting the unity of principles, methods, formulas, and herbs in the process of TCM syndrome differentiation and treatment. It is said that good learners take the method but do not rigidly adhere to the formula. This illustrates the importance of valuing theoretical learning and grasping the spiritual essence. Only in this way can one truly understand and master the efficacy of classical formulas, expand their therapeutic scope, and break through artificial limitations. I. Overview of Ying and Wei
The main efficacy of Guizhi Tang is to harmonize Ying and Wei and regulate Yin and Yang. It is not only used for external exterior deficiency syndromes but, more importantly, for many internal injuries characterized by disharmony of Ying and Wei and disharmony of Yin and Yang. It is necessary to systematically and briefly review the theories related to Ying and Wei to deepen the understanding of the meaning of Guizhi Tang and better master its clinical application.
(1) Generation of Ying and Wei: The *Ling Shu · Ying Wei Sheng Hui Chapter* states: "Humans receive Qi from grain. Grain enters the stomach, transmits to the Heart and Lung, and all five Zang and six Fu organs receive Qi. The clear portion becomes Ying, the turbid portion becomes Wei. Ying is within the vessels, Wei is outside the vessels. Ying circulates without rest, meeting again every fifty cycles. Yin and Yang interpenetrate like a ring without end." This specifically describes the generation of Ying and Wei, originating from the "essence Qi" (referring to nutritious substances) formed by the absorption and transformation of food and drink by the Middle Jiao Spleen and Stomach, which is transformed into Ying Qi and Wei Qi through the Qi-transforming function of the Heart and Lung.
(2) Distribution and Physiological Functions of Ying and Wei: The *Su Wen · Bi Lun Chapter* states: "Ying (Rong, interchangeable with Ying) is the essence Qi of water and grain, harmonized among the five Zang organs, spread evenly to the six Fu organs, and then enters the vessels. Thus, it follows the vessels up and down, penetrating the five Zang and connecting the six Fu. Wei is the fierce Qi of water and grain; its Qi is swift and slippery. It cannot enter the vessels, thus it circulates among the skin, between the muscles, steams into the blind membranes, and scatters in the chest and abdomen." This points out that Ying and Wei have different natures, hence different functions and distributions. The *Ling Shu · Xie Ke Chapter* states: "Ying Qi secretes its muddy fluids, injects them into the vessels, transforms them into blood, nourishes the four extremities, and internally supplies the five Zang and six Fu organs, responding to the passage of time. Wei Qi, issuing its fierce and swift Qi, moves ahead unceasingly among the muscles, four extremities, and skin." This points out that Ying Qi is the gentle component of essence Qi. When water and grain enter the stomach, aided by the heat energy of the Middle Jiao, its juices are absorbed, flow into the vessels, and transform into blood, hence Ying and Blood are often mentioned together. Wei Qi is the gas evaporated by the heat energy of the Middle Jiao when water and grain enter the stomach; it belongs to the robust component of essence Qi, cannot enter the blood vessels, can only follow Zong Qi to distribute outside the blood vessels, and runs in the skin, muscles, and four extremities, hence Lung and Wei are often mentioned together. However, the two are mutually dependent and inseparable. As Zhang Jingyue said: "Wei governs Qi and is outside, yet how can there be no blood? Ying governs Blood and is inside, yet how can there be no Qi? Thus, there may be Wei in Ying, and Ying in Wei. What flows inside is called Ying, what flows outside is called Wei. This is the Dao of Yin and Yang in the human body; divided it is two, united it is one." This further elaborates on the substance, function, and distribution differences of Ying, Wei, Qi, and Blood.
(3) Relationship between Ying/Wei and Zang-Fu Organs: The *Nan Jing*, Difficulty 32, states: "The Heart is Blood, the Lung is Qi. Blood is Ying, Qi is Wei. They follow each other up and down, called Ying and Wei, circulating through the meridians and surrounding the exterior." This specifically points out the close relationship between the Heart and Lung and the Qi/Blood/Ying/Wei. Since the Heart governs Blood and the Lung governs Qi, and Ying and Wei control Qi and Blood, with the Heart and Lung as masters, the circulation of meridian Qi promotes the circulation of Ying Blood throughout the body, revealing the direct relationship of Ying and Wei with the Heart and Lung, and their connection with Qi and Blood. There is an inherent tight relationship between Ying/Wei and Qi/Blood, and between Ying/Wei and Heart/Lung.
If explored further, the Heart governs Blood, the Liver stores Blood, and the Spleen controls Blood. Based on the theory that Ying and Wei control Qi and Blood, and Zhang Jingyue's statement that "there is Qi in Blood, and Blood in Qi," the movement and control of blood must rely on the propulsion of Qi to exert its function and maintain a certain temperature. If Ying and Wei are harmonious and not deficient, then the functions of the Heart, Liver, and Spleen are normal; otherwise, it easily leads to dysfunction of these internal organs. The Spleen not only controls Blood but also tonifies Qi. Because it tonifies Qi, it enables the essence and micro-nutrients of water and grain to generate Ying and Wei. Thus, Li Dongyuan, one of the Four Great Masters of the Jin-Yuan period, said: "The Stomach is the root of Wei, the Spleen is the source of Ying." This indicates that the Spleen and Stomach are the source of the generation and transformation of Ying and Wei.
The Kidney governs all Yang. Wei is Qi and belongs to Yang. Wei Yang connects with Kidney Yang. Although Ying and Wei are generated in the Middle Jiao, the Wei Qi, which belongs to Yang Qi, originates from the Lower Jiao (see *Ling Shu · Ying Wei Sheng Hui Chapter*). Thus, it can be seen that Wei Qi is closely related to the Kidney.
In summary, Ying and Wei have a very close relationship with the Heart, Lung, Liver, Kidney, Spleen, and Stomach. In other words, harmonizing and tonifying Ying and Wei helps strengthen the functional activities of these Zang-Fu organs. It can also be said that when certain diseases of these organs manifest as disharmony or deficiency of Ying and Wei, they can be corrected or restored by harmonizing or tonifying Ying and Wei.
(4) Pathological Manifestations of Ying and Wei
As mentioned above, the physiological functions of Ying and Wei are such that when their functions are normal, due to the nourishment of Ying Blood and the defensive action of Wei Qi, no pathological state appears. Once Ying and Wei are disharmonious or deficient, pathological reactions occur. For example, "failure of Wei Qi governance" clinically produces the Guizhi Tang syndrome of Taiyang exterior deficiency with sweating caused by Wind Evil injuring Wei. If Ying is deficient and disharmonious, it easily produces the Mahuang Tang syndrome of Taiyang exterior excess without sweating caused by Cold Evil injuring Ying. This is just one of the differences in pathogenesis between Wind and Cold evils invading Ying and Wei. But "wind, rain, cold, and heat, if there is no deficiency, evil cannot harm alone" (see *Ling Shu · Bai Bing Shi Sheng Chapter*). Song Dynasty physician Yan Yonghe said: "Generally speaking, human life takes Yuan Qi as the root and Ying and Wei as the foundation. If the root is strong and Ying and Wei are peaceful, the pores are dense, and how can external evil guests cause harm?" This points out that Yuan Qi and Ying and Wei are the foundation of humans; if Ying and Wei are peaceful, external evils are hard to invade.
Long-term deficiency of Ying and Wei can also lead to certain more serious diseases. The *Su Wen · Ni Diao Lun* points out: "Deficiency of Ying Qi leads to insensibility; deficiency of Wei Qi leads to immobility. Deficiency of both Ying and Wei leads to insensibility and immobility, while the flesh remains unchanged." This points out that the occurrence of many clinical conditions involving limb numbness and motor impairment is closely related to the deficiency of both Ying and Wei.
Besides the above, in certain stages of some chronic diseases, Ying pathology affects Wei, and Wei pathology affects Ying; the two cannot be completely separated. However, in clinical practice, this is often overlooked or difficult to differentiate. Disharmony of Ying and Wei and insufficiency of their Qi-transforming function are key factors in the development and change of certain diseases. As long as the disharmony of Ying and Wei is corrected or the function of Ying and Wei is enhanced, the disease can gradually tend towards improvement. If the adjustment of Ying and Wei function is ignored, the disease may gradually develop deeper or become increasingly severe. Therefore, firmly mastering the methods of regulating and treating by enhancing Ying and Wei function plays a decisive role in the development and change of diseases. II. Analysis of Guizhi Tang Formula
Guizhi Tang consists of five medicinal materials: Cinnamon Twig (Guizhi), Hang Shaoyao (White Peony Root), Licorice Root (Gancao), Fresh Ginger (Shengjiang), and Jujube (Dazao). Due to its clever compatibility, it has effects such as nourishing Yin and harmonizing Yang, harmonizing Ying and Wei, and enhancing Ying and Wei function. This formula combines hardness and softness, tonification and dispersion, supporting healthy Qi and expelling evil, and can be regarded as a model of formula composition.
Cinnamon Twig (Guizhi) tastes pungent and is warm in nature, belonging to Yang. It has the effects of assisting Yang to transform Qi, warming and unblocking meridians, transforming dampness and promoting urination, and especially assisting the Yang of the Heart and Lung. Its meridian tropism enters the Heart, Lung, and Bladder. For example, in the commonly used Wuling Powder (Wuling Powder) in clinical practice, because Cinnamon Twig is combined to assist the Qi-transforming function of the Bladder, Wuling Powder can play the role of unblocking and regulating water passages. Summarizing its functions, it has six major effects: harmonizing Ying, unblocking Yang, promoting urination, descending Qi, moving blood stasis, and tonifying the Middle.
Hang Shaoyao (Paeoniae Radix Alba) tastes sour and is cold in nature, belonging to Yin. Taking advantage of its sour taste to astringe Ying Yin (i.e., stop sweating, stop bleeding, prevent loss of body fluids), and its cold nature entering Ying, it has effects of tonifying blood, soothing the Liver, and relieving pain.
Fresh Ginger (Shengjiang) tastes pungent and spicy and is warm in nature. It disperses wind-cold, warms the Middle and stops vomiting. Combined with Cinnamon Twig, it enhances the function of assisting Wei Yang, releasing the muscle layer, and expelling external evils. The combination of the two forms Jianggui Tang, where pungent and sweet transform Yang to regulate the Yang Qi of the whole body.
Jujube (Dazao) tastes sweet and is warm in nature. Combined with Shaoyao to tonify Ying Yin, the combination of the two uses sour and sweet to transform Yin to nourish the Yin fluids of the whole body.
Licorice Root (Gancao) tastes sweet and is neutral in nature, circulating through the twelve meridians. It has the functions of protecting Middle Qi, harmonizing various herbs, and stabilizing the interior while repelling the exterior. Combined with Cinnamon Twig, it forms Guizhi Gancao Decoction (Guizhi Gancao Decoction), which can warm and tonify Heart Yang; combined with Shaoyao, it forms Shaoyao Gancao Decoction (Shaoyao Gancao Decoction), which can harmonize Ying and nourish Yin, relieve spasms, and relieve pain.
In short, looking at the two main herbs of Guizhi Tang, Cinnamon Twig is pungent and warm, assisting Wei Yang to induce sweating; Shaoyao is sour and astringent, assisting Ying Yin to stop sweating. The combination of the two lies in using the function of Cinnamon Twig to assist Wei Yang and induce sweating to resolve external evils with sweat, and using the function of Hang Shaoyao to assist Ying Yin and stop sweating to protect Ying Yin from being damaged again. The cooperation of the two implies the purpose of astringing sweat within inducing sweat, both inducing and stopping sweat, both contradictory and unified. This reveals the function and role of Ying and Wei, and that Guizhi Tang addresses both exterior and interior, Yin and Yang, hence it is called a harmonizing agent. The previous saying that Guizhi Tang "when obtained for exterior syndromes, releases the muscle and harmonizes Ying and Wei; when obtained for interior syndromes, transforms Qi and regulates Yin and Yang" is quite consistent with clinical practice. III. Clinical Application
The application of modified Guizhi Tang in clinical practice is relatively extensive. Here are introduced some common ones:
(1) Disharmony of Ying and Wei during Menopause: The *Su Wen · Shanggu Tianzhen Lun* states: "When women reach sixty-seven, the pulses of the three Yang decline upwards, the face becomes withered, and hair begins to turn white. At seventy-seven, the Ren Mai is deficient, the Taiyang pulse declines, Tian Gui exhausts, the earthly pathway does not flow, thus the form deteriorates and childbearing ends." This describes the physiological changes in women after the age of forty. Since Ying and Wei are connected to the Heart and Lung and related to Qi and Blood, and the Heart governs blood vessels, the Liver stores Blood, and the Kidney stores Essence, the gradual decline of Qi, Blood, Essence, and fluids leads to the Chong and Ren meridians losing their nourishment source. This results in menstrual disorders, deficiency of Ying Blood, alternating hot flashes and sweating, aversion to cold and wind, palpitations due to Blood not nourishing the Heart, vexation and insomnia due to deficiency, muscle twitching, limb soreness and distension, edema, etc., due to Ying deficiency failing to harmonize with Wei. From the perspective of pathological changes, in the early stage, due to disharmony of Ying and Wei, the tongue is often pale and moist, and the pulse is often wiry-deficient or floating-deficient. One can use Guizhi Tang with doubled Shaoyao, adding Cyperi Rhizoma (Xiangfu), Hordeum Vulgare Sprout (Maiya), Mume Fructus (Wumei), and Rock Sugar. This harmonizes Ying while containing the regulation of Qi and nourishment of the Liver. Subsequently, Xinjia Tang (New Added Decoction) can be used to assist Ying, adding Xiangfu and Maiya to soothe and regulate Qi mechanism. If limb soreness and distension are severe, add Mulberry Twig (Sangzhi) to the formula to activate collaterals. As for menstrual disorders, whether early or late, twice a month, dripping continuously, or lower back soreness and abdominal pain, once every few months, Da Wenjing Decoction (Da Wenjing Decoction) from the *Jin Gui Yao Lue* can be used. Because this formula is based on Guizhi Tang to enhance Ying and Wei, it is used for cold coagulation in meridians, liver Qi stagnation, and sinking of Liver Qi causing continuous uterine bleeding, abdominal pain, and lower back soreness, with pulses often deep-slow or wiry-tight. This formula relies entirely on the combination of Cinnamon Twig and Shaoyao, implying the purpose of astringing Yin within the transformation of Qi and unblocking Yang.
(2) Deficiency and Damage of Ying and Wei after Trauma or Surgery
Due to trauma or post-operative states, deficiency and damage of Ying and Wei, where Ying deficiency fails to harmonize with Wei, causing low-grade fever, one can use Guizhi Tang with doubled Shaoyao, adding Wumei, Anemarrhena Rhizoma (Zhimu), and Rock Sugar to assist Ying and reduce fever. If there is limb numbness, Shenqi Guizhi Tang (Codonopsis, Astragalus, and Cinnamon Twig Decoction) can be used, adding Xiangfu and Maiya to harmonize Ying and assist Wei while simultaneously tonifying Qi and Blood and moving stagnant Qi.
(3) Muscle Twitching due to Ying Deficiency
This symptom is more common in elderly women, caused by deficiency of Ying Blood leading to muscle twitching, sometimes accompanied by numbness, resembling wind-dampness but different from it. Wind-dampness numbness and twitching, or pain, are mostly in the joints; Ying Blood deficiency numbness and twitching are mostly in the muscles and fascia; wind-dampness often has a tongue coating, while Ying Blood deficiency often has no coating. Treatment for wind-dampness should dispel wind and remove dampness; treatment for Ying Blood deficiency should always focus on tonifying Qi and Blood on the basis of harmonizing Ying and Wei. The prescription uses a large dose of Xinjia Tang plus Sangzhi, or Shenqi Guizhi Tang. This condition contraindicates the use of wind-dispelling and dampness-removing diaphoretic drugs, because wind drugs are pungent and dry, further damaging Ying Yin.
(4) Skin Itching due to Joint Deficiency of Ying and Wei