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Q: The text above states that "heat" (Re) and "fire" (Huo) are different, yet now it is said that the heat generated by the Kidney also merges with the fire of the San Jiao (Triple Burner). Why is this?

A: This can be viewed separately or together; they are not strictly separated. The Yang Qi of Heaven can assist the Fire of Earth, and the Fire of Earth can assist the Yang Qi of Heaven. Therefore, the heat of Shao Yin (Heart and Kidney) can merge with the fire of the San Jiao, Liver, and Gallbladder, and the fire of the San Jiao, Liver, and Gallbladder can enter the Heart and Kidney of Shao Yin. Thus, all cases of summer-heat and plague are caused by contracting the hot Qi of Heaven. In the initial stage, fever and thirst indicate only "heat," treated with drugs like Shi Gao (Gypsum Fibrosum) to clear heat. Later, when it merges with the Gallbladder fire of the San Jiao and enters the Pericardium, it involves "fire." Treatment should use Niu Huang (Calculus Bovis), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), and Zhi Zi (Gardeniae Fructus). Niu Huang is a pathological product often found in the Liver and Gallbladder, or between the Heart and Diaphragm, or in the horns, which the ox can expel on its own. Since fire originates in the Liver and Gallbladder and moves through the membranous septa to reach the whole body, Niu Huang grows in不定 places, generated by the fire within these membranes. Because fire generates phlegm condensation resulting in yellow color, this is the ox's phlegmatic accumulation. Using the ox's phlegmatic accumulation to treat human phlegmatic accumulation is a subtle method of using similar Qi to attract and lure the enemy. The yellow color arises from fire, hence it tastes bitter like fire. Fire generates Earth; phlegm is also transformed from Spleen Earth, so it condenses into yellow and has an aromatic fragrance because it is formed by Earth. When Earth is established, Fire retreats; thus, it is used to drain fire from the human body. Fragrance travels easily, penetrating meridians and viscera without obstruction. Its ability to resolve phlegm stems from the principle that when fire descends, phlegm flows smoothly.

Q: How do we know that Niu Huang is born of the nature of fire?

A: If an ox has calculus, heating it causes the ox to place a basin of water in front of it. Unable to drink, the ox expels the calculus due to the pressure of fire. Thinking of water leads to expulsion, indicating that the calculus is generated by fire.

Q: Since it is a disease of the ox, why is it also a good medicine?

A: It possesses unique Qi and special flavors, so its spiritual transformation lies within the ox. Although it is a pathology in the ox, when used to treat humans, it becomes a fine medicine. For example, Ru Xiang (Olibanum) and Xue Jie (Sanguis Draconis) are resin exudates, representing tree diseases, yet they are immediately used as medicines. Jiang Can (Bombyx Batryticatus) dies from wind, representing insect disease, yet it is also a medicine. Generally, treatment relies on the interaction of Qi transformations, not being confined to physical traces.

Q: I have heard about drugs for external contraction by the six excesses. What about diseases arising internally from the seven emotions affecting the viscera? How should drugs be chosen?

A: The Qi transformations of the viscera discussed above...

Q: Ancients classified external contractions and internal injuries into separate categories. How can this omission exist today? Discussing diseases generated internally by the seven emotions requires distinct medication. I request further elucidation.

A: The principle is consistent, but symptoms may vary infinitely. It is impossible to state them repeatedly. Since you ask, I will briefly outline the general principles. You can follow Dan Xi’s method, categorizing them under four characters: Blood (Xue), Qi (Qi), Phlegm (Tan), and Stagnation (Yu). However, Blood and Qi were already discussed in detail in the first volume, so I do not wish to reiterate.

Q: Although Blood and Qi were discussed previously, that was in the context of both external and internal injuries. Now discussing internal injuries alone necessitates a detailed explanation of Blood and Qi again. Please elaborate for your disciple.

A: Blood is the fluid essence from the Kidney ascending to the Stomach, merging with the juices transformed from the five grains, rising to the Lung, then entering the Heart, transforming into red color, thus becoming blood. The Heart corresponds to the Li Trigram. Fluid essence entering the Heart resembles the Yin line inside Li; transforming into red blood resembles the Yang line outside Li. Therefore, blood is Yin within Yang. Wood interacting with Fire transforms into blood. Western medicine believes blood contains iron qi and uses iron wine to tonify blood. I observe that Iron (Tie) possesses the nature of Water and Metal and belongs to the Kidney meridian. Blood containing iron qi means Kidney Water interacting with Fire to form blood. However, if Water Qi interacts with the Heart but Heart Fire cannot transform it, blood cannot be generated. Therefore, Zhang Zhongjing’s Fu Mai Tang uses E Jiao (Colla Corii Asini) and Di Huang (Rehmanniae Radix) to nourish Water, and Gui Zhi (Cinnamomi Ramulus) to assist Heart Fire, truly obtaining the method of generating blood. Western medicine uses iron and water, always prepared with wine, because wine is Yang and assists Heart Fire. Western medicine knows the necessity but not the rationale. Now pointing out the principle of blood generation, we see that Dang Gui (Angelicae Sinensis Radix) is indeed a blood-tonifying drug. Its taste is pungent and warm (Fire); its juice is oily and moist (Water). One substance possessing both is the product of Water interacting with Fire. This matches the generation of blood, so it primarily tonifies blood. Chuan Xiong (Ligustici Chuanxiong Rhizoma) is pungent and warm, possessing the aroma of Fire but lacking juice, so it can only assist Fire to move blood, not generate it. Di Huang has juice but is not pungent and warm, so it only benefits Water fluids and nourishes the source of blood, unable to transform into red color. Gui Zhi is red, enters the Heart, and assists Fire, exactly aiding the command to transform into red. Mu Dan Pi (Moutan Cortex) is red and bitter, draining fire, thus draining blood. Bai Shao (Paeoniae Radix Alba) is bitter, draining blood; its white color allows it to move Water in the Qi level. Hong Hua (Carthami Flos) is red, generating blood, but bitter, also draining blood. Tao Hua (Persicae Flos) is red, belonging to the Blood level; the kernel is in the pit, resembling the human heart; its bitter taste has bamboo-like air, entering the Heart directly, capable of moving and generating blood. The blood in the Heart contains spiritual light, which is Shen (Spirit). If Shen is disturbed by chaotic blood, mania and delirium occur. Moving Qi drugs enter the Heart to guide it. Yuan Zhi (Polygalae Radix), Chang Pu (Acori Tatarinowii Rhizoma), and She Xiang (Moschus) can open the orifices of the Heart, while Mu Dan Pi, Tao Ren (Persicae Semen), and Gan Qi (Resina Ferulae) can remove stagnant blood from the Heart. Cases of phlegm confusing the Heart Spirit are not included here. Xue Jie is formed by resin condensation; its aromatic dispersal resolves stagnant blood. Ru Xiang and Mo Yao (Myrrhae Resina) are resins, resembling human blood and aromatic, thus moving blood. Pu Huang (Typhae Pollen) grows in water; its flowers are yellow and fragrant, belonging to the Qi level, not Blood. Its hemostatic effect is because moving Qi moves Blood. Fire interacting with Water transforms into Qi; Qi attaching to matter returns to Water. Qi moving within blood surrounds it externally; thus, moving blood relies on moving Qi, and moving Qi is moving Water. Bai Mao Gen (Imperatae Rhizoma) promotes urination and moves Qi, thus moving blood. Hematemesis always involves coughing up phlegm; phlegm belongs to the Qi level. Only when Qi rebels and Water rises is blood expelled. Therefore, Bei Mu (Fritillariae Bulbus) and Xing Ren (Armeniacae Semen) are used to descend Qi and move phlegm; when Qi descends, blood descends. Qi stagnation and blood stasis, chills and fever, body pain, and amenorrhea in women require moving Qi within blood. Xiang Fu (Cyperi Rhizoma), Ling Zhi (Trogopterori Copra), Yuan Hu (Corydalis Rhizoma), Yu Jin (Curcumae Radix), Chuan Xiong, Ru Xiang, and Jiang Xiang (Aquilariae Lignum Resinatum) are main drugs. Leakage of fetal blood must first involve leakage of water, as Water Qi moves first, then Blood and Qi move. Sheng Ma ( Cimicifugae Rhizoma) and Ren Shen (Ginseng Radix) should be used to ascend and tonify. Zhu Ma Gen (Boehmeriae Caulis) nourishes it. Zhu Gen juice is originally white but turns red, thus generating blood, symbolizing Water interacting with Fire to transform blood. Ou Jie (Nelumbinis Node) is similar. Ou (Nelumbinis Rhizoma) grows in water but blooms upward; the flower bears Fire color, symbolizing Water interacting with Fire. Ou juice turning red symbolizes Fire transforming into blood. The Qi transformation of Ou juice is identical to human blood, clearing fire and resolving blood stasis. Drugs clearing fire represent Water interacting with Fire, thus stopping bleeding; Huang Qin and Huang Lian are examples. Drugs tonifying fire represent Fire transforming Water, thus moving blood; Sheng Jiang (Zingiberis Rhizoma Recens) and Ai Ye (Artemisiae Argyi Folium) are examples.

Q: Hair is named "Blood Remainder" (Xue Yu). When pulling out hair roots, there is slightly white water but no blood. Why?

A: This principle is subtle. Knowing the generation of hair reveals the origin of blood. Human blood, derived from postnatal dietary juices, enters the Heart, transforms red, follows the Chong and Ren meridians down to the Uterus, interacts with prenatal Kidney Water, transforms into Essence (Jing), enters the spine via the Kidney system, ascends to the Brain, transforms into Marrow (Sui), and generates bone. Hence, after death, flesh decays but bones remain. Flesh and blood may be generated solely by Qi (transforming in Yin) or solely by Blood (transforming in Yang). Only bone, generated from marrow essence, possesses complete Qi and Blood, hence does not decay. Tonifying bone requires tonifying marrow, which requires tonifying essence. Lu Rong (Cervi Cornu Pantotrichum) is supreme in Qi and Blood, strengthening the Kidney meridian, thus tonifying marrow essence to strengthen bone. Di Huang and Huang Qi (Astragali Radix) tonify both Qi and Blood, transforming essence to tonify marrow. Cow bone marrow and Pig spinal cord tonify marrow with marrow. Tonifying marrow begins with tonifying essence, which is transformed from Qi and Blood. Shen Qi Wan (Kidney Qi Pill) and Tu Si Zi (Cuscutae Semen) tonify both Qi and Blood and transform essence. Essence transforms into marrow. If cold exists in brain marrow, Fu Zi (Aconiti Lateralis Radix Preparata) and Xi Xin (Asari Radix et Rhizoma) are used to ascend to the brain via the Du Meridian, entering from the Qi level. If wind and heat exist in brain marrow, Ling Yang Jiao (Capricornis Cornu), Xi Jiao (Rhinocerotis Cornu), Wu Zhu Yu (Evodiae Fructus), Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), Tian Ma (Gastrodiae Rhizoma), Huang Bo, Qing Hao (Artemisiae Annuae Herba), and Cang Er Zi (Xanthii Fructus) are used, ascending to the brain via the Jue Yin Liver Meridian from the Blood level. This is the treatment for brain marrow, though you did not ask. However, since marrow is a combination of Qi and Blood, and I am discussing the principle of Blood combining with Qi, I mention it together. Marrow stores essence and governs memory; when Heart Spirit combines with marrow essence, knowledge and function arise. If marrow Qi is unclear, Shen is chaotic, leading to much mania; if marrow is insufficient, knowledge is weak. Treatment can seek similar drugs to guide upwards. Bone possesses both Qi and Blood, hence does not decay. Hair also does not decay in soil. Blood is generated postnatally, belongs to the Ren Meridian, interacts downward with the Uterus, combines with Qi to transform essence, generating marrow. Qi is generated prenatally, residing in the Kidney. Qi generated prenatally belongs to the Kidney Meridian, interacts downward with the Uterus, combines with Blood to transform essence, reaching the Chong and Ren meridians. Transforming and ascending along meridians, it grows beard around the lips. Filling skin and hair, it grows body hair. Ascending with the Tai Yang Meridian to the head, it grows scalp hair. Corresponding to the Liver's location, it grows armpit and genital hair. The face and forehead belong to the Lung; eyes belong to the Liver; eyebrows sit above eyes at the junction of Liver and Lung. Liver governs Blood, Lung governs Qi; their interaction produces eyebrows. All hair is Blood transformed by Qi, hence named "Blood Remainder" because it is born of Blood. Pulling hair roots yields only white water; water is Qi, verifying that Qi transforms Blood. Thus, hair possesses complete Qi and Blood, hence does not decay. Prepared as medicine, it can tonify Blood as the remainder of Blood. It can also promote urination as it is transformed by Qi. The *Shennong Ben Cao Jing* says "returns to spirit, transforms." No one understands these four characters. Spirit is governed by the Heart. It means hair's nature returns to the Heart as Spirit, then transforms blood to interact downward with Water, forming a cycle. Plants are the same. Yang wood transforms in Yin; Yin wood transforms in Yang. Only Zong (Arecae Catenuatae Pericarpium) resembles human hair and does not decay in soil. Plants also have Qi and Blood; what inherits from Heaven is Qi, what inherits from Earth is Blood. Zong resembles hair and possesses complete plant Qi and Blood, born of Yin-Yang interaction, hence does not decay. Moreover, Zong's nature is similar to hair; it promotes urination and stops bleeding. This reveals the principle of Qi and Blood combining. Other drugs treating blood and transforming Qi can be inferred similarly.

Q: The Qi-tonifying effects of Ren Shen and Huang Qi were clearly stated in the first volume. Why is Fu Ling (Poria) also said to transform Qi?

A: Qi is the Yang within Water. When humans drink water, Kidney Yang transforms it; water quality descends while Qi ascends. Fu Ling inherits the essence of Earth, has a bland taste, and promotes urination. When water moves, Qi ascends. There is Fu Ling below and Wei Xi Zhi (Poria with Pine Root) above; Wei Xi Zhi is the sprout of Fu Ling on pine tops, distinct from Fu Ling itself. Although Fu Ling is in the earth, its Qi naturally penetrates it. This is why Fu Ling's Qi can ascend and why its nature transforms Qi. However, it does not generate primal Qi as well as Ren Shen, nor support primal Qi as well as Huang Qi.

Q: The Classics say "Strong Fire consumes Qi, Mild Fire generates Qi." What is this saying?

A: Qi is transformed from Water and returns to Water. Excreted from mouth and nose as saliva, from skin as sweat, from bowels and bladder as fluid. If Fire is too strong, damaging fluids, harmony is lost. Qi deficiency causes panting; Wu Wei Zi (Schisandrae Fructus) and Mai Dong (Ophiopogonis Radix) moisten it. Qi leakage causes night sweats; Sheng Di Huang (Rehmanniae Radix), Mu Dan Pi, Fu Xiao Mai (Tritici Fructus Levigatus), Di Gu Pi (Lycii Cortex), and Long Gu (Os Draconis) clear and astringe it. Qi stagnation causes difficult urination; Rou Cong Rong (Cistanches Radix), Dang Gui, Huo Ma Ren (Cannabis Semen), and Xing Ren are used to lubricate it. If Kidney Yang is excessive and Yin Qi cannot contain it, panting, coughing, and consumptive syndromes arise, requiring massive Yin tonification. Thus, Shu Di Huang (Prepared Rehmanniae Radix), Gui Ban (Testudinis Carapax et Plastrum), and Xuan Shen (Scrophulariae Radix) are used to pair Water with Fire, preventing Strong Fire from consuming Qi, allowing Qi to be retained. Drinking water enters the Stomach, seeps into the San Jiao membranes, and descends to the Bladder. The True Fire of Ming Men, originating from the uterus, steams Bladder water, causing Qi to emerge. This True Fire ascends with Qi; its path is within the Jiao membranes. Wherever water passes, Fire steams it, transforming it into Qi to fill the body. Hence, young people with vigorous Qi have less urine because water is transformed into Qi. This True Fire is neither cold nor fierce, called "Mild Fire," the source of generating Qi in the body. Observing Zhang Zhongjing’s Ba Wei Wan (Eight-Ingredient Pill with Rehmannia), named Kidney Qi Pill, it contains Gui Zhi and Fu Zi along with Shan Zhu Yu (Corni Fructus) and Di Huang. The Yang within Yin is truly a formula for Mild Fire generating Qi. Gui Zhi transforming Qi follows this logic. It is warm but not fierce, black entering the Kidney, truly generating Qi. Gui Zhi and Fu Zi are fierce; they must be balanced with Yin drugs. However, if a person inherently has Yin Cold, pure Yang drugs like Gui Zhi and Fu Zi are needed to transform it. Furthermore, Qi escaping upward causes panting, belonging to Yin deficiency; tonifying Yin to restrain True Fire is appropriate. Qi escaping downward causes sweating and incontinence, belonging to Yang deficiency; tonifying Fire to gather primal Qi is appropriate. Regardless of Yin or Yang, promoting urination is necessary. When Water transforms, Qi generates; Fire interacting with Water results in Qi transformation. Understanding this allows one to probe the subtleties of creation.