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The myriad diseases of humans all arise from unregulated emotions of joy and anger, inappropriate diet, discomfort with cold and warmth, and injury caused by overwork. These lead to a deficiency of Middle Qi (Middle Jiao Qi), causing the Five Zang and Six Fu organs to be affected.

[Note: The original text contains significant corruption and disjointed phrases here, making a coherent translation difficult. The following is a best-effort interpretation based on available context.]

...Heat flaring upward, Ying Qi (Nutritive Qi) damage... Head top brightness covering... Remaining food and drink... Cold damage diarrhea... Shortness of breath... Internal injury bone consumption... Bedridden heart Qi... Consuming water... Heart fire Stomach together... Stomach not... Then receiving emitting... Human Spleen method... Four limbs fever. Or loose stools in the large intestine, or dry and withered skin and hair loss. Treat with Huangqi Jianzhong Tang (Astragalus Decoction for Replenishing the Middle). If the pulse is deficient and blood is weak, select one or two herbs from Siwu Tang (Four Substances Decoction) and add them to the primary herbs for the obvious symptoms. If True Qi is weak, and there is shortness of breath and a weak pulse, treat with Sijunzi Tang (Four Gentlemen Decoction). Or if urine is scanty, astringent, and red/yellow, remove Gui Zhi (Cinnamon Twig) from Wuling San (Five-Ingredient Powder with Poria) and add one or two herbs to the main prescription. The above five medicines should be modified according to accompanying symptoms within the primary syndrome. For example, if there is spontaneous sweating due to exterior deficiency, add Huangqi (Astragalus Root) in spring and summer, and Guizhi (Cinnamon Twig) in autumn and winter. If there is abdominal cramping or a wiry pulse, add Fangfeng (Saposhnikovia Root); if severe, add Gancao (Licorice Root). If the abdomen feels narrow and tight, or there is shortness of breath, add these as well. Do not add if there is abdominal fullness and stagnant Qi. Although they can be used frequently, add one part to five parts of Gancao... If Lung Qi is short or insufficient, add Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome). Remove if there is abdominal tightness and cramping. Sour flavors... Curving and straightening produce sourness; sour belongs to Wood (Jia). Add Guizhi. Lethargy and desire to lie down indicate dampness; if Stomach deficiency causes thirst, add it. If Qi is weak, add Baifuling (White Poria) and Renshen; if Qi is excess, add Chifuling (Red Poria) and Suasharen (Amomum Fruit). If abdominal Qi cannot transport and there is heat, slightly add Huanglian (Coptis Rhizome). Add if there is mental restlessness. ...Self-flowing. If not thirsty but urine is blocked and unpassable, add fried Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). If urine is astringent, add fried Huashi (Talc). If urine is dribbling, add Zexie (Alisma Rhizome). Moreover, Wuling San treats thirst with urination not... Huangbai and Zhimu clear dryness-heat in the Kidney. For Heart heat, use Qian's formula... Pi (Bark) three. For shortness of breath with frequent urination, Si... Abdominal stabbing pain or whole-body stabbing pain indicates interior urgency. Or blood and Qi deficiency affecting the eyes... If only headache, add Xixin (Asarum Root). This is Shaoyin (Lesser Yang) headache. For hair loss and pain below the umbilicus, add Shudihuang (Prepared Rehmannia Root). Regulate the Spleen and Stomach... Modify among these five medicines. If one or two symptoms appear mutually among the Five Zang syndromes, adding herbs against each symptom will be effective. However, it ultimately cannot restore complete health. Recurrence is also due to pathogenic factors in the Du, Ren, and Chong meridians, all caused by Stomach Qi weakness. Although treatment follows symptom modification, adhering to formulas relies on the principles of the Suwen (Basic Questions). Therefore, reviewing the Nanjing (Classic of Difficult Issues), Suwen, and Huangdi Zhenjing (Yellow Emperor's Classic of Acupuncture) states that the root of Spleen and Stomach deficiency is Yang Qi insufficiency and Yin... Should follow the insufficiency of the Six Qi and methods of floating/sinking and ascending/descending, treating according to symptoms. Generally, Spleen and Stomach deficiency differs from other Zang organs because it has no fixed form. Lung and Kidney excess or deficiency may be tonified or purged, but herbs benefiting the Spleen and Stomach are most crucial. The classics state: "Arriving but not arriving" is termed insufficiency. The conquered element suffers disease; the conquering element attacks. "Arriving but not arriving" refers to virtual evil coming from behind. Heart and Small Intestine attacking the Spleen and Stomach... Pulse appears floating, large, and wiry. Symptoms include irritability, confusion, four-limb fever, dry mouth/tongue/throat. Heart governs Fire; Small Intestine... attacking the Earth position combines dampness and heat, causing irritability. Four limbs belong to Spleen and Stomach; Fire attacking causes limb fever. Diet and overwork injure Spleen and Stomach, leading to weakness, which is a blood-related disease governing saliva flow. Hence dry mouth/throat. Patients might mistakenly treat with Wuling San, thinking it stops thirst/dryness, but it worsens them, depleting fluids further, leading to danger. The classics say: "Deficiency tonifies its mother." Small Intestine tonifies the root of Spleen and Stomach. Sweet-warm herbs are the Sovereign (Chief), bitter-cold herbs are the Envoy (Guide), sour herbs are the Minister (Deputy). Heart governs relaxation; urgently eat sour to astringe. Excess Heart Fire harms Lung Metal; if Metal is deficient, tonify with sour. Next, use sweet-warm and sweet-cold herbs to drain excessive Heart Fire, treating the root. "Conquered element acting wildly" means excess Heart Fire makes the Mother (Liver Wood) excess. Liver... acting without fear. Thus Spleen and Stomach suffer first. Symptoms include heavy body, wandering pain, likely damp-heat clashing with Wind... extending. Attaching to form. Often angry. If wind-heat does not sink into the earth, eye diseases or internal cataracts occur. Spleen envelops Blood, governs vessels; vessels are the mansion of Blood. Some say Heart governs Blood, others say Liver governs Blood; Liver opens into the eyes. Hallucinations, four-limb fullness/closure, tendon spasms are all Liver Wood/Fire excess becoming pathogenic. May develop Wei syndrome (flaccidity), Dan syndrome (feverishness), Jue syndrome (cold extremities), stroke, Kidney Wei syndrome, upper heat/lower cold. Pathogens vary, all due to wind-heat failing to ascend, trapped by Wood/Fire in form... Lung suffering Earth/Fire/Wood pathogens damages clear/descending Qi. Chest fullness, shortness of breath: Lung governs all Qi, Five Zang... Yang pathways fail. Cough with chills/fever: damp-heat invading internally. "Unconquered element attacking" means Water attacking wild Wood... Kidney entering Heart becomes sweat, entering Liver becomes tears, entering Lung becomes saliva/phlegm, entering Spleen becomes phlegm/cough/runny nose/sneezing/water from nose. Another view: Lower Yuan Earth excess... Water, causing Du, Ren, Chong meridians to be full. Fire boiling water attacks Spleen/Lung. External genitals cold, legs unable to support body, hidden pain in soles, or Water following Wood rising... Disease externally. Spleen/Stomach deficiency leads to blood disease, Yang insufficiency, Yin... In blood, Yin blood受热 (heat pathogen) becomes Yin excess; Yin excess attacks Yang division, blocking Yang pathways... Orifices. Yin Qi attaches to form/substance. Like Yin attaching to Earth, Yang rises to Heaven... Warm herbs are not used alone; bitter/great-cold agents are also not used alone. With wine entering lower Kidney/Liver, this is the way of ascending/descending/floating/sinking, from even to odd, odd to... Use wind herbs to raise Yang Qi to nourish Liver/Gallbladder function, allowing Yang to rise and emerge... Greatly dispersing in Yang division, moving through nine orifices. Classics: Food enters Stomach, scatters essence into... Essence flows into vessels, vessel Qi flows through meridians, Meridian Qi returns to Lung, Lung faces hundred vessels, transmits essence to... Stomach first moves Yang pathway, Yang Qi floats/rises. Floating means Yang Qi fills skin/hair, rising... Unregulated damaging Stomach Qi, unable to transform/scatter to Liver, return to Heart, overflow to Lung. Food... temporarily relieved, thus knowing ascending Qi fails. Drink enters Stomach, overflows essence, transports up to Spleen, Spleen scatters essence, returns up to Lung. Patient drinks, feels it reach below navel, desires small... Throat dry, Yin Qi too excess, logic easy to know. Otherwise incorrect. Spleen/Stomach deficiency is Fire unable to generate...

Baizhu (Sovereign) Renshen (Minister) Gancao (Assistant) Shaoyao (Assistant) Huanglian (Envoy) Huangqi (Minister) Sangbaipi (Assistant)

All wind herbs win dampness with wind. All sweet-warm herbs work. Heart Fire excess attacking Spleen/Stomach position is also "arriving but not arriving," termed insufficiency.

Shaoyao (Assistant) Shigao (Assistant) Huanglian (Sovereign) Zhimu (Assistant) Huangbai (Minister) Gancao (Envoy) Shengdihuang (Minister) Huangqin (Assistant)

Abdominal urgent pain

Qianghuo (Assistant) Fangfeng (Minister) Shengma (Envoy) Chaihu (Sovereign) Duhuo (Assistant) Shaoyao (Minister) Gancao (Minister) Baizhu (Assistant)

Xixin Manjingzi

Lung Metal suffers pathogen because Spleen/Stomach weakness fails to generate Lung, suffering disease from arrival. Hence cough, shortness of breath, rising Qi, skin/hair unable to resist cold, spirit/Qi scarce...

Renshen (Sovereign) Baizhu (Assistant) Baishaoyao (Assistant) Juapi (Minister) Qingpi (to break stagnant Qi) Huangqi (Minister) Guizhi (Assistant) Jiegeng

Above three flavors

Kidney Water counter-attacks Earth, conquered element acts wildly. Produces saliva/clear nasal discharge/sputum, excessive sputum/urination with aversion to cold. Earth/Fire retaliates, and Three Meridians appear.

Baizhu (Minister) Cangzhu (Assistant) Chuanwutou (Minister) Ganjiang (Sovereign) Rougui (Assistant, peel off a little) Fuling (Assistant) Zexie (Envoy)

When food enters Stomach, Yang Qi moves up, fluids and Qi enter Heart, penetrate Lung, fill skin/hair, scatter to hundred vessels. Spleen receives Qi from Stomach, irrigating... Dividing tonifying Yang Qi, governing floating, wind herbs, root pulse, should address two syndromes, upper wheezing, pulse combined with...伏炽 (hidden blazing), suppose adding time, non-toxic, using Qi's Yang, cold warms...

One herb contains all rational properties,主治 (main treatment), emerging from this. Suppose treating exterior excess with Mahuang (Ephedra Herb), Gegen (Kudzu Root); exterior deficiency with Guizhi, Huangqi. Interior excess with Zhishi (Immature Bitter Orange), Dahuang (Rhubarb Root); interior deficiency with Renshen, Shaoyao. Heat with Huangqin, Huanglian; Cold with Ganjiang, Fuzi (Aconite Root) as Sovereign. Sovereign herb dosage is largest, Minister next, Envoy least. Minister must not exceed Sovereign. Sovereign and Minister orderly, mutually regulating, can repel pathogen and cure disease. If pulse is choppy and Yin pulse wiry, law dictates abdominal cramping. Use Shaoyao's sourness to drain Wood from Earth as Sovereign. Yitang (Maltose), roasted Gancao sweet-warm, tonify Spleen/Stomach as... Thirst unceasing, Hanshuishi (Calcium Carbonate), Shigao equal parts, give sparingly, i.e., Qian's Formula Ganlu Yin (Sweet Dew Drink), governing great body heat and frequent urination, or drinking above/urinating below, this is dryness-heat. Qi dryness add Bai Kuihua (White Chrysanthemum Flower), Blood dryness add Chi Kuihua (Red Chrysanthemum Flower). If wiry pulse only add wind herbs, do not use Wuling San. If urination increases pathology, this is internal dryness/fluids failing to stay, must generate fluids, add fried Huangbai, Chi Kuihua. Epigastric stuffiness add Huanglian 1, Huangqin 3, reduce sweet herbs. Unable to eat, epigastric soft/stuffy, Gancao Xiexin Tang heals. Wheezing/fullness add roasted Houpo (Magnolia Bark). Urinary difficulty, do not add, forbidden herb. Stomach weak/stuffy add Gancao. Wheezing with urinary difficulty add Ku Tingli (Periploca Seed). Shortness of breath/weakness with slight abdominal fullness, do not remove Renshen, remove Gancao add Houpo. Better than bitter taste draining without moving stool. If slight abdominal fullness and Qi not turning, add it. Full middle, remove Gancao double Huanglian add Huangbai. Add small amount of Sanwei Wuling San. Though this disease suits raising/sweating, if sweating excessively loses Yang add Huangqi. Four-limb muscle heat/restlessness, with Qianghuo, Chaihu, Shengma, Gegen, Gancao heals. Runny clear nose/aversion to wind, or vertex/back/spine stiffness/pain, Qianghuo, Fangfeng, Gancao equal parts, Huangqi double, take before sleep. Great heat, large forceful pulse, add bitter-cold agent but heat remains, add Shigao. If heat in Spleen/Stomach, add fried Huanglian, Gancao. Treating this disease, rapid pulse use Huangbai, or slightly add Huanglian, with Chaihu, Cangzhu, Huangqi, Gancao plus Shengma, obtain sweating then pulse must drop, this is "Fire depression release it." If symptoms recede but pulse remains rapid, not large/fast/forceful, greatly reduce bitter herbs add Shigao. If stool soft/loose, add Jiegeng, take after meal. Misuse of this drug causes great harm, add gradually. If eating little, do not use Shigao. Shigao removes rapid pulse disease; if symptoms recede but pulse remains rapid, death untreatable. If not greatly thirsty, also do not use. If wiry/rapid pulse, this is Yin Qi. Wind herbs raise Yang to release Fire depression, then rapid pulse drops sharply. Wind-Cold sweating shoulder/back pain, Stroke frequent urination/yawning, Wind-Heat attacking Lung, causing Lung Qi depression. Must purge Wind-Heat, use Tongqi Fangfeng Tang as main. Urinary incontinence is Lung Qi deficiency, suitable rest/nourish Qi/prohibit overwork, tonify with Huangqi, Renshen etc. Not healed, blame heat add Huangbai, Shengdihuang. Shoulder/back pain unable to look back, Hand Taiyang Qi depressed/not moving, disperse with wind herbs. If spine pain/neck stiffness, waist like breaking neck... Ji half qian, mild Fuzi, heavy Chuanwutou slightly, as guide to move meridians. If lying down with many terrors, dribbling urine, pathogen in Shaoyang/Jueyin, also use Taiyang meridian herbs, add Chaihu half qian. If dribbling add Zexie half qian, this is Lower Jiao three meridians Wind-Cold combined disease. Liver/Kidney diseases same treatment, both in Lower Jiao, must use wind herbs to move meridians. If white pus after stool, or only white pus, due to overwork/Qi deficiency injuring Large Intestine, tonify with Huangqi, Renshen Tang. If tenesmus frequent, Blood deficiency, add Danggui (Angelica Sinensis). If Lung distension bloating/wheezing/cough, chest/diaphragm Qi full/blocking/rushing up, add much Wuweizi (Schisandra Berry), Renshen next, Maidong (Ophiopogon Tuber) next, slight Huanglian, severely crossing hands and blurred vision, True Qi greatly deficient. If shortness of breath add Huangqi, Wuweizi, Renshen; Qi excess add Wuweizi, Renshen, Huangqin, Jingjiesui (Perilla Leaf tip). Winter remove Jingjiesui add Caodoukou (Black Cardamom Seed). If throat pain/jaw swelling, neck/shoulder/elbow/arm outer rear edge pain, red face/large forceful pulse, use Qianghuo, Fangfeng, Gancao, Bencao (Ligusticum Chuanxiong) to open meridian blood, add Huangqin, Huanglian to reduce swelling, use Renshen, Huangqi to benefit Yuan Qi and purge Fire pathogen. If tight pulse is Cold, or yellow face sneezing often, or white face aversion to cold, also add Qianghuo etc. four flavors. Must purge Foot Taiyang, do not use Lian/Qin, slight Fuzi to open pulse. White face much sadness/fear, add Gui/Fu. If white pus slippery, frequent soiling clothes, Qi collapse add Fuzipi (Aconite Peel), severely add rice/grain. If Qi astringent, only use sweet herbs to tonify Qi, rest still to nourish Qi.

If Spleen/Stomach weak, Upper Jiao Qi must be insufficient. Meeting summer hot weather damages Yuan Qi, lethargy/desire to lie down, four limbs not gathering, spirit insufficient... Two deficiencies, constipation blockage, immediately full, entirely attacked by heat, or three parts. If headache eyes... Original two parts, nine. Such as Huang half qian, use other drugs, single blood drug decoction, remove drug too points.

Spleen/Stomach weakness, meeting June/July, river flood rain, all things moist/humid, sweat soaking clothes, heavy body/shortness of breath, severely four limbs flaccid, walking... Make Geng Jin dry, take more fire Gan Chang said Zhongshu (Summerstroke). Disease must headache/aversion to cold, body shape stiff, make whole body Yang Qi unable to extend/transcend, intention mostly Dashun San main. Zhongre (Mid-Heat), disease must bitter headache/dry heat/aversion to heat, touch... Exterior injury Lung Qi, Cangzhu Baihu Tang main. Jiegu says disperse. Zhongre is Yang syndrome, Heat damages Yuan Qi, not reason lost, violate season transformation, must fatigue/powerless, lazy speech foggy like smoke, not know body possession. Must have sweat heavy, joint times annoying pain, or whole body pain, or thirsty... Upper heat blockage, mouth/nose shortness of breath/rush, body/mind annoyed/confused have... Liver as Wei Jue syndrome, four limbs like in fire is Re Jue (Heat Jue), heat, because Spleen governs four limbs. If muscle rot/ulcer bi regulate, Qi rush chest, all Jue syndrome. Wei syndrome four reverse, therefore called Jue Ni (Reversal Cold), its Jue Bi mostly mutual. In Huang Zexie four fen, Zhuling one fen, Baizhu one fen, such as wet, if walking not correct, foot/knee flaccid two feet slanting surge out strength. If sweat large leakage fluid escape, urgent hinder food, should use mind consider, if hinder food then stop. Person, at Sanli point below three cun Shanglian point bleed, prohibit Yuan Qi exhaust become soft paralysis, must waist below not move. Heat command retreat time, or increased disease Qi retreat, not Zhu drug, only according to original disease syndrome modify, constant take add辛温 (acrid-warm) purge it. If dampness excess wind syndrome not retreat, inside below, get time one choppy, its syndrome four limbs full closure, joint annoying pain, difficult flex/extend, body heavy, annoyed heart uneasy, suddenly fat suddenly thin, four limbs lazy tired, mouth lose flavor, abdomen difficult stretch, large/small urine clear benefit and frequent, or drink above stool below, or stool choppy not move, one two days see once, Summer month Sunxie (Morning sickness/Digestion disorder), grain not digest, or stool after see blood see white pus, chest full shortness of breath diaphragm throat not pass, or phlegm cough thick sticky mouth foam, food enter reverse out, ear ring deaf, eyes tear, vision dim, meat red silk, heat block head/eyes, not able sleep, desire lie down powerless, not think eat, Tiaozhong Yiqi Tang main. Qi deficiency body heat get of Shangshu (Summer Heat), Heat damages Qi thus. Have long walk fatigue, meet big heat and thirst, thirst then Yang Qi internal attack, internal attack then heat lodge in Kidney, Kidney is Water store, now Water not defeat Fire, then bone wither marrow empty, feet not bear body, emit Wei Bone syndrome, born from big heat. This warm-heat become Wei, make people bone lack power, therefore treat Wei alone take Yangming. Time when Longxia (Late Summer), damp-heat great victory, steaming blazing, people feel mostly Qi high and wheeze, body heat and annoyed heart膨闭 (distended closed), urine yellow and frequent, stool loose and frequent, or dysentery out yellow like millet paste, or like rice water color, or thirsty or not thirsty, not think eat, self-sweat body weight or... Must add slow, slow although exchange little difference, its heaven heat damp command same. Suitable use Qingzao (Clear Dryness) agent treat. Yang Qi guards outside and solidifies, is then Qi leak let Summer Evil invade Guard, therefore body heat self-sweat, use Huangqi sweet-warm tonify as Sovereign, Renshen, Juapi, Danggui, Gancao, sweet-mild-warm tonify middle benefit Qi as Minister, Cangzhu, Baizhu, Zexie seep-benefit and remove damp, Shengma, Gegen, sweet-bitter flat good resolve muscle heat, again use wind win damp. Damp excess then food not digest become痞满 (stuffiness/fullness), therefore fried Qu (Medicated Leaven) sweet-acrid Qingpi acrid-warm digest food fast Qi, Kidney hates dryness urgently eat acrid to moisten, therefore use Huangbai bitter-acrid-cold borrow sweet taste purge heat replenish water, deficient tonify its source of transformation, use Renshen, Wuweizi, Maidong, sour-sweet-mild-cold, save heaven heat injury on Geng Metal as Assistant, named Qingxu Yiqi Tang (Clear Summer Heat Benefit Qi Decoction). This disease all by diet overwork damage Spleen/Stomach, ride heaven heat and disease act. But drug offend Zexie, Zhuling, Fuling, Dengcao (Juncus Effusus), Tongcao (Tetrapanax Pith), Mutong (Akebia Caulis), light-seep benefit urine category, all from season旺气 (prosperous Qi) to purge Spleen/Stomach