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Left ascent is excessive, right descent is insufficient; which meridian's disease is this? It is said: The right belongs to the Lung (Fei, 肺), the left to the Liver (Gan, 肝). When the Lung and Liver are diseased together, natural ascent and descent become disordered. However, the Lung is the canopy of the five zang organs (Huagai, 华盖), and the Liver meridian spreads over both hypochondriac regions. Thus, from the perspective of location, the left ascent belongs only to the Liver, while the right descent belongs to the Lung. Why is this? Generally, the substance of the Liver is on the side, and the substance of the Lung is above; this refers only to anatomical position. If discussing their physiological functions, the *Neijing* (Yellow Emperor's Inner Canon) states: The Liver resides on the left of the human body, and the Lung on the right. The failure of the right to descend precisely indicates a loss of the Lung's clear and purifying function (Qing Su, 清肃); the excessive ascent on the left indicates that the Liver generates excessive rebellious qi (Ni Qi, 逆气). The rebellious pathogenic factor attacks the seat of purity and clarity. Wood lacks fear of Metal and counter-attacks it (Wood insulting Metal, 木侮金). No wonder the qi on the left half of the body rotates to the right; it cannot penetrate upwards nor contract downwards. Sometimes, due to the struggle between pathogens, it swirls in the hypochondriac region, and only after passing flatus (Shi Qi, 矢气) does one feel relieved. In cases of deficiency, Wood ultimately cannot overcome Metal upwards but still controls Earth downwards. Earth is characterized by sowing and reaping (Jia Se, 稼穑) and produces sweetness; Wood is characterized by bending and straightening (Qu Zhi, 曲直) and produces sourness. Why is there a sweet taste with sourness in the mouth, and similarly in phlegm and saliva? Is it not the fault of Earth being overwhelmed by Wood, and Wood being too rigid? Who can soften it? Only the formula Zuojin Wan (Left Golden Pill) can serve as a method to control Wood. Then Wood will correct its nature, and Metal will utilize its function. Would one still worry about ascent and descent failing to return to normal?

Zuojin Wan (Left Golden Pill)

Continuing from the previous letter, I am deeply grateful for your kind concern. Thank you! Carefully analyzing the source of the disease, the symptoms described as "qi and fire becoming increasingly fierce" correspond to the ancient saying: "Excess qi becomes fire." Qi arising from the left side is Liver Fire (Gan Huo, 肝火), which should be treated primarily with Zuojin Wan (Left Golden Pill); Danggui Longhui Wan (Angelica Sinensis and Picrorhiza Pill) is also applicable. However, Zuojin Wan alone is like water thrown on stone, suitable initially. Using Danggui Longhui Wan subsequently is also a valid method. If one were to use Danggui Longhui Wan immediately to merely comply with your request, it would be acceptable. Yet, you mentioned, "One must prevent abscesses (Yong Ju, 痈疽) and bleeding," which is certainly not baseless talk. Upon encountering experts, I was initially startled, then bewildered, not knowing where to begin writing. However, physicians diagnosing from afar are eager and value speed. I, too, have no leisure, working day and night, seeking what exists and creating what does not, striving for a crucial method that suits both left and right. My reply is not delayed intentionally but awaits the right moment. On the Dragon Boat Festival, few visitors came, and my junior disciples gathered to discuss that all diseases arise from qi, leading to the theory of nine different types of qi. Qi is originally one, but divided into nine based on emotional triggers. Anger and contemplation are two of these nine. Contemplation causes qi stagnation (Qi Jie, 气结), as annotated in the *Neijing*: Contemplation fixes the mind and spirit, causing righteous qi to remain stagnant and not flow, thus resulting in qi stagnation. You already suffer from this. As for anger, it causes qi to ascend; severely, it leads to vomiting blood. Fear causes qi to rebel and tendons to relax; externally manifesting as abscesses. Ancient texts record "qi gates" to show that pathogenic stagnation inevitably transforms, and chronic illness enters the collaterals (Luo Mai, 络脉); this is not without significance. Your erudition anticipated this, and my disciples asked out of strong memory. From this, I realized: Anger may manifest externally or internally. External manifestation often stems from violent anger (Bao Nu, 暴怒), which injures Yin (Shang Yin, 伤阴). Internal manifestation is called depressed anger (Yu Nu, 郁怒), which injures the Liver. Observing behavior carefully, injury to Yin from violent anger may not exist; however, injury to the Liver from depressed anger, despite calm speech, surely exists. Due to depression, Wood cannot flourish and spread freely, instead rebelling horizontally. Thus, qi stagnating internally inevitably causes fire blazing upward. Metal suffers from fire punishment, having ascent but no descent. Phlegm, blood, and heat differentiation shows one disease in the Lung; distension, fullness, and blockage shows a second disease in the Spleen. With Spleen and Lung diseased together, the Stomach lacks strength to digest phlegm and food, and the Gallbladder's water and fire harmonize accordingly. Future blood extravasation into abscesses and swelling in collaterals will create new diseases. Indeed, one must prepare for rain before it falls (Wei Yu Chou Mou, 未雨绸缪). However, the branches of abscesses and bleeding still stem from fire rooted in qi depression. Treating disease requires addressing the root. Therefore, recalling the section on "qi arising from the left," there is text stating: "For chronic qi stagnation unresponsive to various medicines, first take Chenxiang Huaqi Wan (Aucklandia Qi-Transforming Pill) to open the stagnation." This not only prevents future complications but also addresses current rising qi and fire. Moreover, a wiry and strong right pulse indicates using the method of "draining earth stagnation" (Tu Yu Duo Zhi, 土郁夺之), which is indeed prudent. But Chenxiang Huaqi Wan is a heavy dose and a temporary measure; it cannot be used excessively for patients with primordial deficiency and chronic illness. Take only 0.8 fen in the morning, and regulate with Xiaoyao San (Free and Easy Wanderer Powder) and Liujun Zi Tang (Six Gentlemen Decoction) at night, as a strategy to protect deficiency amidst excess. I wonder if this is correct?

Take Chenxiang Huaqi Wan (Aucklandia Qi-Transforming Pill) in the morning, and Xiaoyao San (Free and Easy Wanderer Powder) and Liujun Zi Tang (Six Gentlemen Decoction) [with Radix Glehniae (Beishashen, 北沙参) and Rhizoma Pinelliae (Banxia, 半夏) replacing Radix Nardostachyos (Chuanbeimu, 川贝)] in the evening.