Library

[Background Information]
Book: *Jingyue Quanshu* (Complete Works of Jingyue)
Author: Zhang Jiebin (Zhang Jingyue)
Dynasty: Ming
Chapter: Discussion on External Prepared Formulas / Scriptural Principles / Syndrome Differentiation (Total five items)
Category: Comprehensive

Weiai San (Heat 71), Qutan Wan (Harmony 103), Xiangsha Liujunzi Tang (Tonify 7).

The *Suwen: Zhi Zhen Yao Da Lun* (Treatise on the Most Essential and Important Aspects of True Necessity) states: "Various vomiting and regurgitation of sour fluid, sudden diarrhea with tenesmus, all belong to Heat." When Shaoyang (Lesser Yang) pathogenic factors prevail, symptoms include vomiting sour fluid and excessive hunger.

Regarding the syndrome of vomiting sour fluid, Liu Wansu considered it a Heat syndrome, while Li Dongyuan considered it a Cold syndrome. The principle should be fixed; how can there be such a gross discrepancy? Can the principle change because of these two physicians? It must be that one of them deviates from the truth. This is why I cannot remain silent; I consider Li Dongyuan correct and Liu Wansu incorrect. How do I know this? Liu Wansu's theory is actually based on the *Neijing*. The Classic says: "Various vomiting and regurgitation of sour fluid, sudden diarrhea with tenesmus, all belong to Heat." Therefore, in his *Yuan Bing Yuan Shi* (Source Book of Pathogenesis), Liu interpreted all pathomechanisms as Fire (Fire-Heat pathogen) and strongly opposed interpreting them as Cold. However, he did not realize that this discussion in the *Neijing* summarizes disease manifestations according to the Five Movements and Six Qi, and does not mean that all vomiting and diarrhea are internal Heat diseases. If it were purely Heat, then why does it also say: "When Cold pathogen lodges in the Stomach and Intestines, causing rebellious Qi to rush upward, pain and vomiting occur"? And again: "When Taiyang (Greater Yang) reversion qi acts up, Cold generates in the Heart and Stomach, causing disharmony in the chest, spitting clear water, and producing hiccups and belching." This describes vomiting due to Cold; how can they all be Heat? It also says: "When Taiyang pathogenic factors prevail, Cold enters the Lower Jiao and transforms into Ru Xie (loose stools)," describing diarrhea due to Cold; how can this also be Heat? From this perspective, saying Heat here and Cold there seems self-contradictory and erroneous. In fact, the principles of the *Neijing* are comprehensive and detailed, covering both constant patterns and variable changes, normal conditions and reverse conditions, incomplete discussions supplemented elsewhere, and general categories elaborated in detail. This profundity makes it inexhaustible. Therefore, those who are good at observing must understand its origins and flow, examine its divisions and unions. Broadly speaking, one must see the myriad variations; concisely speaking, one must grasp the unity of the underlying principle. Only then can one be called a perceptive person. If one cannot comprehend the beginning and end, but only sees a fragment through a tube, how can one exhaust its subtleties? Moreover, there are many who ignore the main purport, speak recklessly against reason, and erroneously borrow scriptural texts to prove their biased views, which are too numerous to list and discuss here. Since we are discussing the theories of these two physicians, I mention them together and elaborate below for readers to examine carefully.

1. Refuting Liu Wansu's Theory on Vomiting Sour Fluid. According to Liu Wansu: "Sourness is the flavor of Liver Wood. It arises because excessive Fire controls Metal (Lung), failing to subdue Wood (Liver), causing Liver Wood to become hyperactive, thus manifesting as sourness, just as food becomes sour when heated by heat." Some say vomiting sour fluid is due to Cold, which is wrong. Those who wrongly claim it is Cold argue that it results from damaging hard, sticky, or cold foods, leading to belching and acid regurgitation, so folk doctors advocate warming the Spleen and Stomach. They fail to know the scripture says: "When humans are injured by Cold, they develop Heat diseases." Thus, for those who internally damage themselves with cold substances, some may suffer Yin excess and Yang deficiency manifesting as Cold disease, while others may experience Cold and Heat clashing, causing stagnation of Yang Qi in the Stomach and Intestines resulting in Heat. There are also cases where internal damage from cold/raw food leads to Heat disease, cured by profuse sweating, allowing Heat to dissipate with the sweat and body temperature to normalize. If one constantly craves sourness without cessation, warming is inappropriate; instead, Cold herbs should be used to purge, followed by cooling herbs to regulate. Once stagnation clears and Heat dissipates, Qi harmony is restored.
These are all Liu Wansu's views. Whenever I encounter them, I sigh deeply. Looking at his pathomechanism, it proceeds from Fire to Metal, from Metal to Wood, from Wood to Spleen, generating sourness. If analyzed minutely, could the reasoning really turn out like this? It would be like calling a deer a horse, finding excuses wherever possible. Because he insists on Heat, he has to twist the logic thus. If I say it is Cold, it is different. Sourness is the flavor of Liver Wood. Why not say that insufficient Fire fails to generate Earth (Spleen), leading to Spleen Qi deficiency and Liver Evil overacting, thus generating sourness? Would this not be a clearer and more direct explanation, rather than twisting the logic so much? Furthermore, the *Neijing* statement "humans injured by Cold develop Heat diseases" refers to exterior Cold pathogens causing Fever in the Three Yang channels, and later transmitting inward to cause Interior Heat in Yangming. Does it mean internal damage from cold food also causes Heat disease? Are there cases where internal damage from cold food is resolved by sweating? Even in robust individuals, occasional injury from cold/raw food lingering and stagnating into Heat might occur due to long-term stagnation transforming into Heat, but is it truly caused by cold becoming hot? Moreover, the *Neijing* originally referred to external contraction, yet Liu Wansu cites it to prove internal injury, which is a great error. This not only severely harms the teachings of Huangdi and Qibo but also gives future generations an excuse, leading to what consequences?

2. Affirming Li Dongyuan's Theory on Vomiting Sour Fluid. According to *Yi Xue Fa Ming*: "The *Neijing* states various vomiting and regurgitation of sour fluid belong to Heat; this is due to external pathogenic factors affecting the Upper Jiao. The Stomach Qi rejects the external pathogen, causing vomiting; Zhang Zhongjing treated this with Sheng Jiang (Fresh Ginger Rhizome) and Ban Xia (Pinellia Tuber)." Discussing miscellaneous diseases, vomiting sour water, if severe, the sour water immerses the Heart; if less severe, sour water is vomited, making upper and lower teeth feel sour and astringent, unable to meet. Treating with major Acrid-Hot herbs will surely reduce symptoms. Sourness is the gathering energy, corresponding to the prosperity of Western Lung Metal. Cold Water is the child of Metal; the child can make the mother full/excess. Therefore, use major Salty-Hot agents to drain the child (Kidney Water), assisted by Acrid-Hot herbs, to drain Lung Excess. Interpreting this as Heat to be attacked in the *Pathogenesis* book is erroneous. Generally, in miscellaneous diseases, acid reflux (vinegar heart) involves turbid Qi failing to descend, threatening central fullness; how can Cold herbs treat this?
This is Li Dongyuan's view, which I consider most reasonable. However, his expression is too obscure. Concepts like 'gathering energy,' 'Western Metal prospering,' and 'Water being the child of Metal' are often misunderstood and ignored. Even Zhu Danxi said Li Dongyuan did not mention external Wind-Cold but established his theory on 'gathering energy' to drain Lung Metal excess, and claimed Cold herbs cannot treat sourness, using Anwei Tang and Modified Erchen Tang, both containing Ding Xiang (Clove Bud), lacking methods to treat Damp-Heat stagnation, thus not fully aligning with scriptural intent. Examining Zhu Danxi's treatment methods, he used Zhulian Wan and Erchen Tang, stating: "Use fried Wu Zhu Yu (Evodia Fruit) to follow its nature and counteract it, which is a counter-assistance method; Huang Lian (Scutellaria Root) must be used as the sovereign herb." Zhu Danxi's intention also emphasizes Heat, opposite to Li Dongyuan. Using Huang Qin (Scutellaria Root) and Huang Lian to treat vomiting sour fluid requires careful differentiation. Therefore, I elucidate Li Dongyuan's theory.
What is meant by 'gathering energy' is Metal Qi, i.e., Autumn Qi. The *Neijing* says: "Autumn Qi begins from above." Gradual increase of Yin starts in Autumn because Yang Qi is retreating. Gradual increase of Cold/Sternness starts from above because Yang Qi descends daily. Saying 'Metal prospers' does not mean Lung Qi is solid/abundant, but rather that Cold Qi is excessive. Saying 'child makes mother full' means because Cold is in the Upper Jiao, gathering energy is intense, so treatment uses Salty-Hot agents to drain the child, which is essentially supporting Yang and suppressing Yin, very appropriate. Zhu Danxi failed to understand this and criticized him, why? Take Ding Xiang (Clove Bud): its flavor is Acrid and refreshing, non-toxic, most suitable for Middle Jiao Cold stagnation and Qi maladjustment. Why warn against 'using' it so strictly, making people fear it like tigers? Zhu Danxi only knew Ding Xiang should not be used, but did he realize Huang Lian and Huang Qin are also not suitable for lightly treating acid regurgitation? Although stated thus, the argument is incomplete regarding Cold vs. Heat, leaving doubts. I will continue the discussion below.

3. Vomiting Sour Fluid Syndromes. Those claiming it is Heat each have their arguments. Liu Wensu said: "Food becomes sour when heated." Dai Yuanli said: "Grains and meats in containers become sour under Damp-Heat." Another traditional view: "Brewing wine: cool production yields sweetness, overheating yields sourness; isn't sourness caused by Heat?" These arguments seem credible, making it hard not to agree. All seemingly plausible but false statements are of this type. Like archery: if one stays within front/back/left/right bounds, claiming mastery, ignoring these four directions, can one really talk about archery? Theories of various schools are similar.
How do I know? Observing patients requires observing by principle; observing principle requires observing truth. Food sourness due to heat seems logical, but food in a pot, if transformed quickly, doesn't sour; this is because strong fire digests it rapidly without retention. If removed to a container, it sours after time; this is sourness due to stagnation, not heat. I have seen cold liquids stored for a long time always turning sour; is this Heat? No, it is due to stagnation. Brewing wine: heating makes it sour, seems logical, but it takes 2-3 days of stagnant heat to sour; immediate heating doesn't cause sourness. Human Stomach Qi is naturally warm, digesting three meals instantly; this reflects true Yang fire function. If like brewing, taking all day, one wouldn't eat again, exhausting Stomach Qi. If cold production doesn't sour implies no fire, then digestion would take ten days, exhausting Stomach Yang Qi. Thus, Stomach Qi prefers warmth, slight coolness is bad; wine jars prefer ventilation, stagnation is bad. Wine jar transformation cannot match Stomach Qi speed; Stomach Qi vigor cannot match wine jar slowness. Their natures differ vastly, obvious without debate. Food in Stomach values rapid transformation. If Stomach Yang Qi is unimpaired and functions normally, where is sourness? If fire power is insufficient, transformation is slow; slow transformation leads to stagnation, becoming sour and putrid; sourness is the beginning of decay. Patients with acid regurgitation often show poor appetite, discomfort eating, progressing to central fullness, epigastric obstruction, diarrhea. Isn't this Spleen Qi weakness and Epigastric Yang Deficiency, mistakenly identified as Fire? In Yanjing, I treated a scholar insisting on Heat based on the wine analogy. Unable to refute him, he died from Huang Qin/Huang Lian treatments, never realizing his error. Tragic! Thus, observing truth is crucial. False beliefs lead to disaster. Such plausible fallacies must be辨析 (analyzed/differentiated).

4. Swallowing Sour Fluid vs. Vomiting Sour Fluid. There are three types: First, belching in the throat with sour fluid soaking the Heart, unbearable嘈杂 (burning/discomfort), named Swallowing Sour Fluid (commonly 'making acid'). This occurs at the highest point of the Upper Wan (Upper Stomach), appearing intermittently with uneasiness. Second, not as close as swallowing, located between Middle Jiao and Epigastrium, frequent nausea/vomiting of sour fluid, named Vomiting Sour Fluid, characterized by stagnation/sluggishness. Third, originally no swallowing/vomiting sour fluid, but occasionally vomited due to other causes, tasting sour, bitter, or unpleasant. These transform from Phlegm-Fluid accumulation in Stomach and Intestines, having foul odors, located below the Middle Wan. If flowing down smoothly, unnoticed; if rebelling upward, intolerable to throat/mouth. For the first two types in Upper/Middle Wan, it is invariably Spleen-Stomach Deficiency-Cold failing to transport/transform; treatment must use Warming methods. For the third type occurring occasionally in Lower Wan, both Cold and Heat exist; treat the vomiting according to syndrome. Once vomiting stops, sour/bitter taste disappears. Although this is my argument requiring detailed explanation, practically, strong Stomachs don't worry about sour/bitter tastes. Having sour/bitter tastes implies stagnation. One must examine syndromes. Without Heat signs/pulses, insisting on Damp generating Heat and using Cold/Cooling herbs regardless of strength will inevitably cause errors.