Library

The residual part of fluid metabolism enters the bladder to become urine. If the bladder is deficient and cold, failing to constrain and control the fluids, and is further invaded by pathogenic factors, it leads to involuntary urination (enuresis).

He Bing (simultaneous involvement of two or three meridians) can also present with enuresis. Symptoms include abdominal distension and body stiffness/tightness.
The verse states: Enuresis requires caution regarding Wind-Warmth syndromes; purgatives for the intestines are contraindicated. Abdominal distension and body stiffness belong to the simultaneous involvement of the Yang meridians. Failure of the Lower Jiao to secure and retention of blood stasis are involved. Maniacal speech indicates Kidney Qi exhaustion; these symptoms must be differentiated in detail through mutual corroboration.

Yang Ming disease presents with headache, fever, and dry mouth. Patients who only rinse their mouths with water but do not wish to swallow will likely experience epistaxis (nosebleed). If the patient has no exterior syndrome, no chills or fever, but experiences chest and abdominal fullness.
The verse states: Rinsing the mouth without swallowing is a sign of Yang Ming epistaxis; headache, dry mouth, and heat generating muscle issues. Mania without chills or fever indicates blood stasis; treatments like Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) or Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) can be inferred by analogy.
Another discussion states: Dry lips and mouth also occur in blood syndromes, where patients desire water for rinsing. However, why rinse without swallowing? Generally... [text missing, likely implying thirst is not due to true fluid deficiency but obstruction]. Pulse... stool... pill.

Hua Tuo stated: Patients who unconsciously grasp at the seams of their clothing (Xun Yi Mo Chuang) have an untreatable condition; occasional survival is mere luck. After emesis or purgation, if the condition does not resolve, with multiple days of constipation and tidal fever in the late afternoon...
Combined with Tai Yang disease, using moxibustion/fumigation can lead to jaundice. Excess Yang desires epistaxis; Yin deficiency leads to difficult urination. Deficiency of both Yin and Yang leads to dry and rough skin, sweating on the head and neck, dry mouth and rotting throat, abdominal fullness with slight panting, or constipation, and delirium. Severe cases may present with vomiting and hiccups, grasping at clothing and bedrails. This syndrome is treatable if urination is free.
The verse states: Grasping at clothing and delirium is most worrying; after purgation, if the pulse is wiry and Yang, the disease can heal. A choppy pulse indicates Yin exhaustion and ultimate non-recovery; for jaundice, one must observe if urine flows freely.

(Attached Discussion)
It is stated: Gui Zhi Tang (Cinnamon Twig Decoction) is originally intended to release the muscle layer (Jie Ji). If the patient has a floating-tight pulse, fever, and no sweat, Gui Zhi Tang must not be given. One must always remember this to avoid error.
Cannot induce sweat... therefore... emesis/purgation... use Gui... therefore... Acrid. Warm. Acrid-Sweet... Body Fluids... please...
It is also said: Light and clear herbs can dispel excess; Ephedrae Herba (Mahuang) and Puerariae Radix (Gegen) are examples. "Excess" refers to Cold pathogens on the exterior, where the skin and pores are firm, Ying and Wei Qi circulation is blocked, and body fluids are depleted internally.
Monarch herb... Gui Zhi serves as Minister because Wind pathogens are on the exterior, and in those with loose skin and open pores, Gui Zhi is needed to release the muscle layer. Thus, Gui Zhi is used as Minister. When Cold pathogens are... as Minister... used to... must... then Wei Qi becomes solid and Ying Qi becomes weak. Zhang Zhongjing's statement about "sweating and aversion to wind" refers to this state of weak Ying and strong Wei. Therefore, Shaoyao (Paeonia Lactiflora) is added to Gui Zhi Tang to harmonize Ying Qi.
Ma Huang Tang treats Shang Han (Cold Damage). Cold injures Ying Qi; when Cold pathogens merge into Ying, Ying becomes solid and Wei becomes weak. As stated in the *Nei Jing*: Qi aggregation leads to Blood deficiency, and Blood aggregation leads to Qi deficiency. Thus, Xingren (Apricot Seed) is added to Ma Huang Tang to promote Qi movement. The subtle principles of prescription formulation require wise scholars to study carefully to see their efficacy.
It is also said: Qing Long (Azure Dragon) corresponds to the East, Wood Deity, Spring, and Liver, governing growth and distribution of Ying. Just as sprouts split, the liver has two lobes corresponding to wood leaves. Hence "Qing Long" because it disperses pathogens injuring both Ying and Wei, aligning with the nature of Liver Wood. Gui Zhi Tang treats Zhong Feng (Wind Strike); Ma Huang Tang treats Shang Han. These are pure dispersing formulas. Da Qing Long Tang (Major Azure Dragon Decoction) is different. Although it induces sweat, it treats... Wind combined with Cold, Cold combined with Wind. It must be treated specifically with Da Qing Long Tang. Seeing such pulse and signs, although one might want to use Gui Zhi Tang to release the muscle and dispel Wind, if Cold is not removed, the disease remains; or if one wants to use Ma Huang Tang to induce sweat and disperse Cold, if Wind is not removed, the disease remains. This is why Zhang Zhongjing established Da Qing Long Tang to resolve both Wind and Cold. Mahuang is sweet and warm; Guizhi is acrid and hot. Cold injures Ying, requiring Sweet herbs to moderate; Wind injures Wei, requiring Acrid herbs to disperse. This is Wind and Cold injuring both Ying and Wei. Thus, Sweet and Acrid are combined to form a dispersing agent. For exterior deficiency with loose skin, Guizhi is primary; Guizhi first, then Mahuang, so Guizhi is Monarch, Mahuang is Minister. For exterior excess with tight pores, Mahuang is primary; Mahuang first, then Guizhi, so Mahuang is Monarch, Guizhi is Minister. Gancao (Licorice Root) is sweet and neutral; Xingren is sweet and bitter, assisting Mahuang to release the exterior; Dazao (Jujube) is sweet and warm; Shengjiang (Fresh Ginger) is acrid and warm, combining to assist Guizhi in releasing the muscle layer. Shigao (Gypsum Fibrosum) is sweet, acrid, and slightly cold. Wind is Yang pathogen, Cold is Yin pathogen. Wind injures Yang, Cold injures Yin. When Ying, Wei, Yin, and Yang are injured by Wind and Cold, light agents alone cannot disperse them. Heavy and light agents must be combined to disperse both Yin and Yang pathogens and harmonize Ying and Wei Qi. Thus, Shigao is used as Envoy, a heavy agent reaching the muscle layer. Da Qing Long Tang is a heavy sweating agent. Overuse leads to loss of Yang. The *Jing* says: If the pulse is faint, with sweating and aversion to wind, do not administer. Administration causes cold limbs and muscle twitching (Jin Ti Rou Tiao). This is a counter-indication. It also says: Stop subsequent doses if sweating occurs after the first dose. Overuse causes excessive sweating and loss of Yang; Yang deficiency leads to aversion to wind, irritability, and insomnia. Thus, the weight of the dosage is evident. Physicians should examine carefully.
It is also said: Qing Long symbolizes the bifurcation of Liver Wood, treating dual injuries. Wind strike showing Cold pulse, or Shang Han showing Wind pulse, indicates dual injury of Ying and Wei. Therefore... and not... Ma... as... Cold-fluid injuring Lung causes cough, wheezing, and rebellious Lung Qi. The *Nei Jing* says: Lung desires consolidation; urgently eat Sour to consolidate. Ganjiang (Dried Ginger), Xixin (Asarum), and Banxia (Pinellia) serve as Envoys. Water retention in the Heart causes Kidney dryness. The *Nei Jing* says: If Kidney is dry, urgently eat Acrid to moisten. Thus, Ganjiang and Banxia are used as Envoys to disperse Cold-fluid rebellious Qi. Once Cold-fluid disperses and fluids flow, sweating resolves the condition. Water-Qi in the Heart spreads differently, so symptoms are modified. If thirsty, remove Banxia and add Gualougen (Trichosanthes Root). Water retention blocks fluids, causing Qi dryness and thirst. Banxia is acrid and warm, drying fluids. Remove it... Ma... Exterior... . Middle Cold... unfavorable... can sweat... therefore remove... suitable... Bitter-Warm.
It is also said: Da Cheng Qi Tang (Major Order the Qi Decoction): "Cheng" means to follow/obey. When Shang Han pathogens enter the Stomach, it is called entering the Fu organs. "Fu" implies gathering. The Stomach is the sea of water and grain... and for... use. With Sour... inside... treat... Jaundice... Heat... Only administer if there is dry feces. If not major fullness, Cold syndromes may persist and the disease not be cured. How much more so if there is no fullness/excess, leading to Jie Xiong (Chest Binding) and Pi Qi (Glomus)? Thus, the *Mai Jing* states: There are warnings against using Cheng Qi Tang in Shang Han; ancients were particularly cautious.
It is also said: Da Chai Hu Tang (Major Bupleurum Decoction): The *Jing* says: Tonify deficiency, drain excess. Physicians must weigh the severity. Major fullness and hardness... only... large... not... Hu... Hu... Shaoyao... Excess... Qi must be Sweet. Thus, Banxia, Shengjiang, and Dazao are used as Envoys. One formula adds Dahuang (Rhubarb Root) because Dahuang has the function of... Without adding Dahuang, it may fail to hit the pathology; thus Dahuang must be used as Envoy. Practitioners should exercise judgment to achieve perfection.
It is also said: Xiao Chai Hu Tang (Minor Bupleurum Decoction): For Shang Han pathogens on the exterior, release via sweating; for pathogens in the interior, purge via bowel movements. Its... Exterior-Interior... then Ban... Qin as... for it... to disperse... therefore... Qi already... to harmonize Exterior... to defend against it... then Heat... remove it... person. Should be unobstructed; Cold causes pain. Pathogens entering the interior, with insufficient Interior Qi, cause abdominal pain due to Cold stagnation. Huangqin (Scutellaria Root) is bitter and cold; its bitterness is hardening and cold damages middle. Thus remove it... Hard. Remove Dazao, add Muli (Oyster Shell). The *Nei Jing* says: Sweet causes abdominal fullness. Dazao is sweet and warm; removing it dissipates hardness. Sour consolidates; Muli is sour, salty, and cold; adding it resolves glomus and hardness. If palpitations in the Heart and difficult urination, remove Huangqin, add Fuling (Poria). Palpitations and difficult urination indicate water retention. The *Nei Jing* says: Kidney desires firmness; urgently eat Bitter to firm it. Huangqin is bitter and cold; removing it allows retained water to flow. The *Nei Jing* says: Bland taste promotes leaching and draining (Yang). Fuling is sweet and bland; adding it promotes fluid flow. If not thirsty, with slight external heat, remove Renshen (Ginseng Root), add Guizhi (Cinnamon Twig). No thirst means sufficient fluids; remove Renshen as it acts internally. Slight external heat means many exterior signs; add Guizhi to induce sweating and disperse pathogens. If coughing, remove... Five... person... Heat.
It is also said: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). The *Nei Jing* says: For high pathogens, induce vomiting (Yue); for low pathogens, guide downward and purge; for central fullness, purge from within. Pathogens... transmitting to interior... Pathogen... Qi remaining in the Chest due to deficiency is called Empty Irritation (Xu Fan). Zhi Zi Chi Tang should be used to vomit. Zhi Zi Chi Tang treats empty irritation in the Chest. Zhi Zi is bitter and cold. The *Nei Jing* says: Sour and Bitter induce vomiting and purging (Yin). "Yong" means vomiting. To vomit empty irritation, Bitter is primary; thus Zhi Zi is Monarch. Irritation is caused by Heat excess. To vomit Heat, Bitter is required; to overcome Heat, Cold is required. Xiang Chi (Fermented Soybean) is bitter and cold, assisting Zhi Zi to vomit empty irritation; thus Xiang Chi is Minister. The *Nei Jing* says: Qi has height and depth; diseases have distance and proximity; signs have interior and exterior; treatments have lightness and heaviness. Understanding the principle of treatment and acting accordingly makes a good physician.
It is also said: Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium). Jian Xiong Tang attacks binding; Xie Xin Tang attacks glomus. Pathogens binding and not dispersing, obstructing and not flowing, become Jie Xiong... referred to... Epigastric region... therefore... urgently eat... Dazao... referred to as Central... Qi harmonizes, Upper...
It is also said: Gua Di San (Melon Spittle Powder) is fragrant. Hua Tuo said: If pathogens are in the Chest for four days, they can be vomited. This is the method of meeting and seizing. *Qian Jin Fang* said: Qi floating to the upper part requires... time... . Monarch... Chi flavor... Phlegm-Heat in the Chest is vomited out. For those with blood loss or deficiency, it is not given because Gua Di San is a harsh agent that severely depletes fluids. Blood loss...
It is also said: Da Xian Xiong Tang (Major Trap the Chest Decoction). In Jie Xiong, pathogens are in the Chest, a high position. Pathogens bind here, seemingly suitable for vomiting. However, the "binding" refers to tight binding that cannot separate. Yang receives Qi in the Chest; pathogens bind with Yang and cannot separate, blocking Qi in the Epigastrium, causing hardness... . Bitter nature... Monarch. ... as Envoy.
It is also said: Yin Chen Hao Tang (Artemisiae Scopariae Spica Decoction). *Yu Han Jing* says: For mild heat, cool to harmonize; for severe heat, use Cold to resolve. Jaundice is extreme heat... person with... Qi... Heat must...
It is also said: Bai Hu Tang (White Tiger Decoction). Bai Hu is the Western Metal Deity, corresponding to Autumn and returning to the Lung. For heat severe internally, use Cold to purge; for heat severe externally, use... Qi... Heat... To thoroughly clear internal heat, Sweet-Cold is needed as assistance; thus Shigao is Minister. Gancao is sweet and neutral. The *Jing* says: Heat injures Qi; Cold overcomes it; Sweet moderates it. Use neutral substances to moderate the center; thus Gancao and Jingmi (Rice Grain) are Envoys. This clears Tai Yang... obtaining this decoction sweeps it away; heat meets White Tiger and vanishes. Do not use after Start of Autumn, as Yin Qi is half-present. Bai Hu is a Great Cold agent; in deep Autumn, if taken without tolerance, it causes hiccups, inability to eat, and many cases of deficiency and emaciation.
It is also said: Wu Ling San (Five Ingredient Powder with Poria). "Ling" means order/command, promoting fluid flow, overcoming Kidney pathogens, serving as a command; this is the merit of Fuling. Among Wu Ling... Fuling... Leaching as... Monarch. Zhu (Atractylodes Macrocephala Rhizome) as... Acrid flavor... Zhi (Cinnamon Twig) as...
It is also said: Li Zhong Wan (Regulate the Middle Pill). Heart and Lung above the Diaphragm are Yang; Kidney and Liver below are Yin; these are Upper and Lower Zang. Spleen and Stomach correspond to Earth, located in the Central Region... Sweet to... Warm Middle... person with... Middle Jiao... Pathogen... Qi stagnation... must... Ginger... Sage... Retain without leaking. Some say: Dampness excess causes loose stools; Zhu specializes in removing dampness, thus added for frequent diarrhea. Palpitations add Fuling; fluid accumulation causes palpitations; Fuling is sweet, leaching hidden water is appropriate. Thirst desiring water adds Zhu; fluid insufficiency causes thirst; Zhu is sweet to replenish fluids. Abdominal pain adds Renshen; deficiency causes pain. *Ben Cao* says: Renshen is sweet and warm; tonification removes weakness, similar to Renshen and mutton. More Cold adds Ganjiang; Acrid disperses. Abdominal fullness removes Zhu, adds Fuzi (Aconite Lateralis Radix Praeparata). The *Nei Jing* says: Sweet causes abdominal fullness. Zhu is sweet and cloying; remove for abdominal fullness. Fuzi is acrid and hot; Qi stagnation causes abdominal fullness; Heat overcomes Cold, Acrid disperses fullness, thus add Fuzi. The *Nei Jing* says: Heat with Cold, Cold with Heat; this is what is meant.
It is also said: Si Ni Tang (Four Reversals Decoction): Limbs are reversed and cold. Limbs are the root of all Yang. Yang Qi is insufficient, compounded by Yin Cold, Yang Qi does not flow smoothly... Sweet flavor... Internal... Acrid to moisten, opening pores to allow fluid flow. Warming muscles and meridians relies on Great Heat; thus Fuzi is Envoy. This is a unique large-dose formula. Si Ni belongs to Shao Yin; Shao Yin is Kidney. Kidney and Liver are distant; only large doses can reach them. The *Nei Jing* says: Distant and odd/even, make the dose large; this is what is meant.
It is also said: Zhen Wu Tang (True Warrior Decoction). Zhen Wu is the Northern Water Deity, belonging to Kidney, used to treat Water. Water-Qi is in the Heart, extending to the exterior and belonging to Yang... Wu Zhi... Sweet to... Nei Jing... Says... Therefore... Wu Wei Zi (Schisandra Fruit) is Sour and consolidating. Lung dislikes Cold; moisten with Acrid; Xixin and Ganjiang are Acrid and moistening. If urination is free, remove Fuling, focusing on leaching. If diarrhea, remove Shaoyao, add Ganjiang. Sour nature leaks; remove Shaoyao because Sour leaks. Acrid nature disperses; add Ganjiang to disperse Cold. Vomiting: remove Fuzi, add Shengjiang. Rebellious Qi causes vomiting; Fuzi tonifies Qi, Shengjiang disperses without damaging, so Qi becomes smooth. The merit of modification is understood only by Great Harmony.
It is also said: Jian Zhong Tang (Establish the Middle Decoction). The *Nei Jing* says: Liver grows on the left, Lung stores on the right, Heart is above, Kidney is below. The four Zang occupy left, right, above, and below... then... Jing says... Disperse... Gui... Scorched... Combine... Many times... Shaoyao... to strengthen... .
It is also said: Pi Yue Wan (Spleen Constraint Pill). "Yue" means constraint. The *Nei Jing* says: Drink enters Stomach, essence floats up to Spleen, Spleen Qi scatters essence... Constraint... Warm... With Sweet... With Moistening... Dahuang... Convenient stool.
It is also said: Di Dang Tang (Break Through Accumulation Decoction). What humans possess is Qi and Blood. Qi is Yang; Qi flows but if stagnant it easily scatters, because Yang diseases are easy to treat... When it... Must... Meng Chong (Blister Beetle) as Minister. Tao Ren (Peach Kernel) is bitter, sweet, and neutral. Liver is the source of Blood; Blood binding causes Liver Qi dryness. The *Nei Jing* says: Liver suffers from urgency; urgently eat Sweet to moderate it. Disperse Blood... Blood drives out... Assist it.