Library

[Background Information]
Book: Jingyue Quanshu (Complete Works of Zhang Jingyue) | Author: Zhang Jiebin (Zhang Jingyue) | Dynasty: Ming | Chapter: Bian Hejian (Differentiating He Jian, Item 28 of 9) | Category: Comprehensive

The pathogenesis listed in Liu Wansu's (He Jian) *Yuan Bing Shi* (Original Treatise on Disease Mechanisms) originally comes from the *Suwen: Zhi Zhen Yao Da Lun* chapter of the *Huangdi Neijing* (Yellow Emperor's Inner Canon). This chapter details the principles of the rise and fall, overcoming and retaliation of the Five Movements (Wu Yun) and Six Qi (Liu Qi), and summarizes the nineteen pathogenetic mechanisms at the end. It states: "For those that exist, investigate them; for those that do not exist, investigate them; excess should be drained, deficiency should be tonified, allowing harmony and smoothness to achieve peace." Thus, the discussed pathogenesis merely outlines the general principles of the movements and qi. The investigation of existence versus non-existence, and the differences between deficiency and excess, must be deeply examined, with peace being the ultimate goal. Therefore, the *Chang Wu Zheng Da Lun* chapter further elaborates on the differentiation of the Five Movements and Three Qi. The normal state of Fire is called *Sheng Ming* (Ascending Brightness); excessive Fire is called *He Xi* (Blazing Heat); deficient Fire is called *Fu Ming* (Hidden Brightness). The distinction between deficiency-fire and excess-fire is as different as ice and charcoal. The impartial way of the *Neijing* is indeed explained so clearly. However, He Jian failed to thoroughly understand the complete intent of this classic. He selectively extracted one hundred and seventy-six characters from the nineteen mechanisms, expanded them into two hundred and seventy-seven characters, failed to distinguish between deficiency and excess or examine rise and fall, and attributed all diseases to excess-fire, writing the *Yuan Bing Shi* which has been passed down to this day. While diseases caused by excess-fire are indeed fearful, diseases caused by deficiency-fire are even more so. Excess-fire is indeed suitable for cold-cooling treatments, and removing its root is not difficult; however, deficiency-fire strictly forbids cold-cooling treatments. If used recklessly, death is inevitable. Moreover, nowadays, people suffering from deficiency-fire are many, while those with excess-fire are few. Can they all be considered diseases of excess? How can one generally attribute them to fire? Looking back before the Tang and Song dynasties, medicine was never so biased. Since the emergence of the *Yuan Bing Shi*, Zhu Danxi obtained it in Dingcheng and regarded it as a supreme treasure. He subsequently wrote *Ju Fang Fa Hui* (Exposition of the Formulary) and theories such as "Yang is often in excess." Even Li Dongyuan, despite his brilliance, adopted the view that "fire and vital qi cannot coexist." Later, figures like Wang Jiezhai and Dai Yuanli followed this tradition, spreading it throughout the land. All current medical practitioners are essentially disciples of Liu Wansu and Zhu Danxi; they constantly talk about fire, unable to provide relief, often damaging patients' vital qi and destroying their primordial yang, killing people in the dark without anyone realizing it. Truly pitiable! Even if there are rare outstanding individuals who know it is wrong and cherish patients' yang qi, they will inevitably be attacked by those citing He Jian's theories. How can one distinguish right from wrong? Furthermore, pathogenesis serves as a guide for students; once they enter this school, they are like dreamers who cannot wake up, which is even more terrifying. No harm to the medical arts is greater than this. The source of this error must be investigated; therefore, I write this frankly and briefly differentiate it below.

1. He Jian discusses retching acid saying: "Acidity is the flavor of Liver Wood. It arises because excessive Fire controls Metal, failing to restrain Wood, causing Liver Wood to become excessive, thus manifesting as acidity." Yet common physicians advocate warming and harmonizing the Spleen and Stomach. Do they not know the classic states that when humans are injured by Cold pathogens, they develop heat diseases, etc.?
I believe that symptoms like retching acid and swallowing acid are entirely due to stagnation and failure to transform. And this stagnation and failure to transform is entirely due to Spleen-Stomach weakness. Since the Spleen Earth fails to transform, warming the Spleen and strengthening the Stomach is indispensable. How can this be considered excessive Fire? To recklessly cite classics as evidence, what error could be greater? This syndrome is detailed elsewhere in the section on Swallowing Acid; readers should cross-reference.

2. He Jian discusses diarrhea and dysentery saying: "Diarrhea with white discharge indicates Cold; green, red, yellow, crimson, and black indicate Heat. The general principle is to promote urination. Clear and white without astringency indicates Cold; red indicates Heat. Also, undigested food with unchanged color, vomit and stool that are fishy and offensive, clear and cold urine without astringency, cool body without thirst, and slow, fine, and faint pulse indicate Cold syndrome; undigested food but color changes from white, irritability and thirst, red-yellow and possibly astringent urine indicate Heat syndrome. Whenever food is digested, regardless of color or other symptoms, it is Heat. There has never been a case of Cold diarrhea where food is digested. Or perhaps Fire governs speed, and when Heat is excessive, transportation and transformation become abnormal, leading to undigested food in diarrhea (Sun Xie), which is possible." He also said: "Dysentery is Heat. Heat accumulates in the intestines and stomach, stagnating and knotting to form. Those who say white dysentery indicates Cold are mistaken. If it were truly Cold, it could not digest food, how could it turn into pus? Just as grains, meats, fruits, and vegetables rot and turn into turbid water under severe Damp-Heat, so too does food in the abdomen, infected by Damp-Heat pathogens, naturally ulcerate and turn into pus and blood."

Based on He Jian's theory, it is plausible yet incorrect, misleading people significantly. Everyone knows that white diarrhea indicates Cold. Green discharge involves Liver pathogenic factors; some cases arise from Spleen deficiency, are these Heat syndromes? Red discharge results from organ damage; some cases involve injury to Yin collaterals, are they all Heat? Pale yellow discharge with semi-digested food exists, is this Heat? Black is the color of Water; cases of Primordial Yang deficiency exist, are these Heat? To call all these Heat is extremely unreasonable. Moreover, in diarrhea and dysentery, water flows into the Large Intestine, urine becomes scanty and astringent, fluids dry up, and urine/stool become yellow. Such yellow and astringent symptoms do not necessarily stem from Heat. Loss of fluids causes thirst; loss of Yin causes irritability. Such irritability and thirst are not always Heat. As for undigested food, clear and cold, this is indeed severe Cold. However, if a person is occasionally injured by Cold pathogens or eats raw/cold foods harming the Spleen, developing diarrhea/dysentery upon slight loss of warmth, this originates from Cold but may not be a severe Cold syndrome. If Spleen-Stomach is initially injured but Yang Qi remains, how can it suddenly become clear and cold, forming undigested food? If one waits until clear and cold undigested food appears to diagnose Cold, then Yang Qi is already severely defeated. Are there no cases of gradual Cold progressing rapidly to this state? Gradual Cold is simply a Cold syndrome. Many suffer from such conditions. If treated as Heat using cold-cooling herbs, after being injured by raw/cold foods previously, one is then ruined by cold-cooling herbs afterwards, suffering like ice enduring frost. These deaths are caused by this theory. Looking at his earlier statement, he said white diarrhea is Cold; looking at later statements, he said claiming white dysentery is Cold is an error. Thus, for treating this, apart from cooling, there are no Cold syndromes left. How erroneous! How erroneous! Furthermore, the ideas that Cold prevents digestion and that food turns into pus are particularly inappropriate. Food should digest quickly according to timing; this is the normal function of Stomach Qi, upon which life depends. If digestion seems slightly slow, it is a disease of Yang deficiency. Why wait until digestion fails to label it Cold? Moreover, the pus-like discharge is not derived from food. When food enters the Stomach, what transforms and nourishes Ying and Wei becomes essence and blood; what fails to transform and remains in the intestines/stomach is merely dregs. Essence and waste follow different paths; thus, dregs cannot turn into pus, as can be seen. Also, this discharge is not pus but the fat/grease of the intestines and organs. How do we know? Recently, someone taking minerals like Niter and Mirabilite had discharge resembling pus. Or someone with acute diarrhea developed this discharge within one or two days. Could heat-transformed pus appear so quickly? For chronic dysentery lasting years with daily pus-like discharge, could heat-transformed pus persist so long? Clearly, this is not pus. Knowing it is not pus, how can it all be called Heat? This is likely due to intestinal/organ injury causing grease to loosen and fall off. If one does not nourish the organ Qi but uses cold-cooling herbs to treat 'Heat', organ Qi will deteriorate daily, leading to death. Most critical dysentery cases today suffer from this harm; this must be carefully observed.

3. He Jian said: "Suppose dysentery with red and white discharge; laypeople say this is mixed Cold and Heat. This view is especially wrong. Do they not know that Water/Fire, Yin/Yang, Cold/Heat are like a balance beam; high implies low, excess implies deficiency. How can Cold and Heat both be excessive in the intestines/stomach simultaneously causing dysentery? For example, heat-generated sores producing white pus—can white be considered Cold? Because it is in the skin layer, belonging to Lung Metal, hence white. In blood vessels, belonging to Heart Fire, hence blood boils. In muscles, belonging to Spleen Earth, hence yellow pus. In tendons, belonging to Liver Wood, hence greenish pus. Deep in bones, belonging to Kidney Water, hence purple-black blood. Each follows the Five Zang locations showing five colors; this is the branch (Biao). The root (Ben) is solely Heat, differing only in depth. General principles: tenesmus, urgency, pain, red/astringent urine all belong to Dryness-Heat. White dysentery is very common, yet it is clearly Heat."

According to this, differentiating five colors by five Zang organs has some logic. But claiming the root is solely Heat is highly unreasonable. Regarding the five colors corresponding to five Zang organs, there is profound meaning; I will elaborate following his theory. Diarrhea originates from Zang organs, fundamentally rooted in Spleen-Stomach. Spleen-Stomach injury can be caused by any of the Five Qi. Thus, red involvement indicates Spleen-Heart syndrome; green indicates Spleen-Liver; white indicates Spleen-Lung; black indicates Spleen-Kidney; pure yellow indicates the Spleen itself. If Spleen involves Heart, Fire attacks Earth, Earth is hot, so calling it Fire is acceptable. If Spleen involves Liver, Earth is controlled, Earth is damaged, not Fire. If Spleen involves Kidney, Water counter-controls, Earth is cold, not Fire. If Spleen involves Lung, Mother Qi leaks, Earth is deficient, not Fire. Spleen self-disease, Spleen injured, Earth is damp, not Fire. The rise and fall of these combined syndromes have such reversals. Moreover, strong Spleen-Kidney have Excess Heat; weak Spleen-Kidney have Deficiency Cold; this distinguishes Organ Qi. Fire is inherently Hot, yet differs in Deficiency vs Excess Fire; Wind is inherently Yang, yet differs in Wind-Heat vs Wind-Cold; Earth is Central Qi, yet differs in Damp-Heat vs Damp-Cold. Metal's Cold and Water's Cold return to Northwest transformation, implying more Cold than Heat, which is logical. How can one say all five-Zang dysenteries originate solely from Heat? This causes Cold syndromes to suffer injustice; this statement bears responsibility. The meaning of red and white is detailed in the subsequent Danxi section.

4. He Jian said: "To treat various dysenteries, nothing is better than bitter-pungent-cold herbs, or slightly adding pungent-hot auxiliaries. Pungent-hot disperses and opens stagnation; Bitter dries Dampness; Cold overcomes Heat, making Qi smooth and peaceful. Examples include Qian Yi's Xiang Lian Wan. Thus, for dysentery, Huang Lian (Coptis Rhizome) and Huang Bo (Phellodendron Bark) are sovereign herbs, extremely bitter and cold, primarily treating Damp-Heat diseases."

This view is most harmful to dysentery treatment. In his materia medica notes, he says most bitter-cold herbs drain. Only Huang Lian and Huang Bo are cold and drying. Since Danxi, this has been transmitted. Worldwide, dysentery is treated with cold-cooling herbs due to this error. Let us analyze just the phrase "Bitter dries Dampness," revealing He Jian's major error. The theory of five flavors comes from the *Neijing*. The *Neijing* says: "Use Bitter to dry," referring to the drying nature of Bitter. He Jian failed to investigate thoroughly, assuming all Bitter dries, unaware that the *Neijing* describes two natures and six functions of Bitter. E.g., "Fire generates Bitter," "Its category is Fire, its flavor is Bitter," "Shaoyang in泉 transforms as Bitter, Shaoyin in泉 transforms as Bitter," "Dampness invading interior, treat with Bitter-Hot; Dryness invading interior, treat with Bitter-Warm." These refer to the Yang aspect of Bitter. "Sour and Bitter induce vomiting/draining are Yin," "Dampness governs Earth, Heat counter-wins, treat with Bitter-Cold," "Dampness transforms from Heaven, Heat counter-wins, treat with Bitter-Cold." These refer to the Yin aspect. These are the two natures. Also: "Use Bitter to vent, Bitter to dry, Bitter to warm, Bitter to firm, Bitter to drain, Bitter to purge." These are the six functions. Bitter-venting includes Ma Huang (Ephedra Herba), Bai Zhi (Angelicae Dahuricae Radix), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix). Bitter-drying includes Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Mu Xiang (Aucklandiae Radix), Bu Gu Zhi (Psoraleae Fructus). Bitter-warming includes Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), Wu Zhu Yu (Evodiae Fructus), Dou Kou (Myristicae Semen), Qin Jiao (Gentianae Macrophyllae Radix). Bitter-firming includes Xu Duan (Dipsaci Radix), Di Yu (Sanguisorbae Radix), Wu Wei Zi (Schisandrae Fructus), He Zi (Terminalia Chebulae Fructus). Bitter-draining includes Zhi Zi (Gardeniae Fructus), Bo (Phellodendri Cortex), Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Mu Tong (Akebiae Caulis), Dan Cao (Gentianae Radix). Bitter-purging includes Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas). The way of Qi transformation: only Yang dries, only Yin moistens; this is immutable. How can sinking, Yin-descending herbs like Huang Lian and Huang Bo, being extremely bitter and cold, still be said to dry? This only knows "Bitter dries" but ignores Bitter-vent, Bitter-warm, Bitter-firm, Bitter-drain, Bitter-purge. Medical errors often claim something is so without knowing why, similar to this. Consequently, later doctors treating dysentery often fail to distinguish Cold/Heat/Deficiency/Excess, blindly applying He Jian's methods. Near death, they say, "Blood color is like this, how dare I use Warmth?" "Abdominal pain is like this, how dare I use Tonification?" They die unawakened, deeply lamentable. Whose fault is it? Whose fault is it?

5. He Jian's swelling section says: "Swelling: Excessive Heat causes swelling. Like June when Damp-Heat is extreme and all things flourish, the meaning of edema is clearly visible."

Is this true? Swelling diseases caused by Heat exist, but those caused by Cold are no less frequent. Heat-induced swelling is due to Damp-Heat obstruction blocking Yin pathways; Cold-induced swelling is due to Cold-Damp stagnation preventing Yang transformation. Hence the classic says: "Cold in Zang generates fullness diseases." And: "Cold in Stomach causes distension." These are words of Yellow Emperor and Qi Bo. Thus, is all distension a Heat disease? Comparing flourishing things to robust physique is okay, but comparing it to swelling pathology is crude.

6. He Jian said: "Trembling and shaking are images of Fire. 'Li' refers to shivering from cold. Some say cold chills are Spleen Cold, misunderstanding transformation. This is due to excessive Heart Fire, hyperactive trembling, counter-assimilating Water transformation to control it, hence cold shivering. However, cold shivering arises from Fire appearing like Water; it is not actually accompanied by Cold pathogen."

If so, all cold chills are Fire syndromes. Yet the classic says: "Yin excess leads to Cold." "Yang deficiency fears external Cold." "Yang deficiency and Yin excess, lack of external Qi, hence first cold shivering." "Yangming deficiency leads to cold shivering and jaw quivering." All these are classic statements, yet He Jian attributes them all to Fire. Whether correct is evident.

7. He Jian said: "Jing (Fright) is sudden heart movement and unrest. 'Fear leads to fright': Fear injures Kidney, Water declines, Heart Fire becomes excessive, hence prone to fright."

Regarding "Fear leads to fright, Fear injures Kidney": The classic says: "Liver Qi deficiency leads to fear," and "Fear causes Qi to sink, Fright causes Qi to scatter." If Liver Qi is deficient and Kidney Qi injured, resulting in sinking and scattering Qi, these are injuries to Yang Qi. With injured Yang Qi, how can Heart Fire suddenly become excessive and all fright be attributed to Fire? Even if Fear injures Kidney, failing to nourish Liver Wood, leading to Liver deficiency and fright, is this not valid? Cases of isolated Kidney Water decline exist; does Water decline always mean Fire excess? Often, frightened people show impotence and enuresis, indicating deficiency. While Fire entering Heart causing fright exists, attributing all fright from fear to Fire contradicts reason greatly.

8. He Jian said: "Delusion: Excessive Heart Fire causes Kidney Water decline and unfocused Will (Zhi), leading to abnormal spirit/mind, seeing ghosts/spirits. Some say ghosts are Yin, seeing them means Extreme Yin releasing Yang and lacking Yang Qi; this is speculative nonsense."

If so, all delusions from lost spirit/mind are Fire syndromes, which is incorrect. Excessive evil fire causing mania and seeing ghosts exists. But do cases of extreme Yang deficiency with Yin pathogens manifesting as ghosts not exist? The *Nan Jing* says: "Loss of Yin causes blindness. Loss of Yang causes seeing ghosts." Hua Yuanyou said: "Gain Yang to live, gain Yin to die." Are these all speculative nonsense? Why such arrogance?