Library

Xue Shengbai said: For syndromes suitable for the vomiting method, one must observe the color of the phlegm. If the phlegm is spat onto a wall and, after drying, shows a lustrous appearance like snail slime, regardless of which meridian the phlegm resides in, the vomiting method can be used. However, if there is no lustrous color after the phlegm dries, the vomiting method must strictly be avoided. They examine the phlegm stains; we examine the tongue coating. Those who use the vomiting method should bear this in mind.

Furthermore, He Bao stated: Zhang Zihe achieved efficacy in treating diseases by using the sweating, vomiting, and purging methods, regardless of the syndrome. There is profound logic in this. Generally, all diseases are either heat or cold. Cold causes Qi stagnation and obstruction due to lack of movement; heat also causes Qi congestion and lack of movement. When Qi does not move, heat stagnates and generates phlegm, blood stasis occurs, and food retention accumulates, leading to various obstructions in the middle jiao. The Qi and Blood in the human body value unobstructed flow rather than blockage. How else can they be unobstructed without these three methods? Moreover, eliminating pathogenic factors is equivalent to supporting healthy Qi; once pathogens are removed, healthy Qi naturally recovers. With simple dietary regulation, spirit and vitality will flourish within a few days. Therefore, women suffering from infertility may conceive after applying this method, indicating harmonious Yin and Yang. The sudden arousal of yang energy in men is clear evidence of this. Later generations, failing to understand the principle, dared not use it, believing warm tonification to be safe, resulting in countless deaths—a lamentable situation! Wang noted: He's statement is based on the "Inverting the Stomach" method.

Article 32 Damp-heat syndrome: Menstruation has just begun, accompanied by high fever, thirst, delirium, and coma, chest and abdominal pain, or a tongue with no coating, and a slippery, rapid pulse. This indicates the pathogen has sunk into the Ying (Nutrient) level. Use large doses of: Rhinoceros Horn (Xi Jiao), Arnebia Root (Zi Cao), Rubia Root (Qian Gen), Agastache (Guan Zhong), Forsythia (Lian Qiao), Fresh Acorus (Xian Chang Pu), and Honeysuckle Dew (Yin Hua Lu).

Wang Shiyong noted: People only know the method of Xiao Chai Hu Tang (Minor Bupleurum Decoction) and do not distinguish between Shang Han (Cold Damage) and Wen Shu (Warmth and Summerheat) diseases. Why is this? Gan noted: Rubia Root (Qian Gen) is inferior to replacing it with Moutan Cortex (Dan Pi) and Red Peony Root (Chi Shao).

Heat entering the Blood Chamber is not exclusive to women; men can also suffer from it. It requires not only cooling the blood but also detoxifying. However, heavy doses are necessary for efficacy. Zhang Zhongjing stated that in Yang Ming disease, bleeding and delirium indicate heat entering the Blood Chamber. This refers specifically to men, hence the absence of the phrase "menstruation has just begun."

Article 33 Heat syndrome: Bleeding from above and below, or sweating blood, where toxic pathogens have deeply entered the Ying level and are moving about seeking exit. Use large doses of: Rhinoceros Horn (Xi Jiao), Rehmannia Root (Sheng Di), Red Peony Root (Chi Shao), Moutan Cortex (Dan Pi), Forsythia (Lian Qiao), Arnebia Root (Zi Cao), Rubia Root (Qian Gen), and Honeysuckle (Yin Hua).

Wang Shiyong noted: These four articles are absent in Wu's edition. Although Moutan Cortex (Dan Pi) cools the blood, its aromatic nature promotes dispersion and can induce sweating; it is suitable only for blood heat with stasis. It may also easily induce vomiting and should be avoided in those with weak stomachs.

When heat forces bleeding from above and below, or sweating blood, the condition is extremely critical yet does not immediately deteriorate because the toxin exits through the blood, preserving the vital potential. Administer large amounts of blood-cooling and detoxifying agents to preserve Yin and drain pathogens. Once pathogens are resolved, bleeding stops naturally. After bleeding ceases, Ginseng (Ren Shen) and American Ginseng (Xi Yang Shen) should be administered for convalescence. Wang noted: Convalescent care should also include nourishing blood. Sweating blood is what Zhang referred to as "cutaneous purpura" (Ji Nu). The *Nei Jing* states: "When heat dominates internally, treat with salty-cold substances." Salty-cold herbs should be added to the formula. The source of this note is unknown, but it is reasonable. Wang noted: Oyster Shell (Mu Li) can be added for its sweating-stopping effect; its astringent nature is acceptable. This annotation was appended by later generations. Comments not mixed into original notes in other articles are merged with them and cannot be separated.

Wang Shiyong noted: The original text here only says "Heat Syndrome," indicating contraction of summerheat without dampness. Summerheat qi easily damages the Ying level, causing such symptoms. Zhang claimed that "damp-heat" mentioned in this chapter refers to summerheat. If so, why does this article say "heat" instead of "damp-heat"? What disease would that be? The *I Ching* describes cold and summerheat as reciprocal movements. Later theorists speculating arbitrarily truly do not understand cold and heat. Xin Fu agreed: Correctly discerned.

Article 34 Damp-heat syndrome: After seven or eight days, the patient is not thirsty, cannot speak, and does not refuse food or drink.

Wang Shiyong noted: Wu's edition includes the phrase "bowel movements and urination are normal." The patient remains silent, unconscious, and unresponsive to acrid-aromatic, cool-draining, or fragrant-purgative treatments. This indicates the pathogen has entered the Jue Yin (Liver) meridian, affecting both host and guest energies. Imitate Wu Youke's San Jia San (Three Shells Powder): Drunk Ground Beetle (Zui Di Bie Chong), Vinegar-fried Turtle Shell (Cu Chao Bie Jia), Earth-fried Pangolin Scales (Tu Chao Chuan Shan Jia), and Fresh Silkworm (Sheng Jiang Can).

Wang Shiyong noted: This ingredient is absent in Wu's edition. Add Bupleurum Root (Chai Hu) and Peach Kernel Paste (Tao Ren Ni).

Summer-dampness first injures the Yang level. However, if the disease persists, it inevitably affects the Yin level. Both Yin and Yang are exhausted, Qi becomes sluggish, blood stagnates, and summer-dampness cannot be excreted externally.

Wang Shiyong noted: According to Zhang, this is Xue's self-commentary. However, repeatedly mentioning both summerheat and dampness to explain damp-heat syndromes raises the question: if summerheat inherently contains dampness, what is the "dampness" under "summerheat"? Absurd. I fear confusing students, hence my verbosity. Thus, the pathogen deepens into Jue Yin, causing collateral stasis, preventing the mild Yang of Shaoyang from sprouting. Yang Qi descends but does not ascend; the Heart Master is obstructed, spiritual Qi fails to circulate, resulting in unclear consciousness, coma, and silence. Breaking stagnation and unblocking stasis allows collaterals to open and pathogens to resolve.

Xu Yizhai of Haichang stated: This article resembles Bai He Bing (Lily Disease) in Shang Han; Zhao Yi De, Zhang Lu Yu, and Tao Nong Tang considered it a Heart disease. Xu Zhong Ke considered it a Lung disease. This chapter proposes Jue Yin treatment because all vessels share one origin and are affected together; Yuan Qi fails to distribute, and pathogens linger. Following Zhang Zhongjing's method, using agile substances of different kinds: Turtle Shell enters Jue Yin, guided by Bupleurum, driving Yin pathogens to the exterior. Ground Beetles enter the Blood, guided by Peach Kernels, draining Blood-level pathogens downward. Pangolin scales enter collaterals, guided by Silkworm, dispersing Collateral pathogens via Wind transformation. Since long-standing disease causes Qi sluggishness and blood stasis, standard methods are insufficient. Wang noted: The presence of coma distinguishes this from Bai He Bing. Treating Bai He Bing should primarily target the Lung.

Article 35 Damp-heat syndrome: Thirst, yellow tongue coating with prickles, wiry-slow pulse, scrotal retraction, stiff tongue, delirium, unconsciousness, and hand spasms. This indicates dried-up fluids and stagnant pathogens. Use fresh Rehmannia Root (Xian Sheng Di), Reed Rhizome (Lu Gen), Raw Polygonum Multiflorum (Sheng Shou Wu), and fresh Rice Roots (Xian Dao Gen). If the pulse is forceful and constipation exists, Rhubarb (Da Huang) may be added.

Wang Shiyong noted: Wu's edition lacks this article. Wang noted: Polygonum Multiflorum (Shou Wu) is astringent and seems inappropriate.

Stomach fluids are depleted, and heat pathogens reside internally. Without moistening purgation to drain pathogens, they cannot be expelled. Thus, imitating Cheng Qi Tang, using sweet-cool instead of bitter-cold, fearing damage to Stomach Qi and failure to restore Stomach fluids.

Article 36 Damp-heat syndrome: Spasms, picking at empty air, coma, laughing delirium, dry yellow tongue coating with prickles turning black, and constipation. This indicates heat pathogens closing and knotting in the Stomach Fu organs. Use Cheng Qi Tang to purge.

Wang Shiyong noted: The following eleven articles were supplemented from Wu's edition.

Picking at empty air indicates either extreme excess or extreme deficiency. Deficiency leads to scattered spirit and risk of collapse. Excess forces spirit, causing agitation. Here, dry yellow prickly tongue coating and constipation clearly indicate internal heat knotting and Yang Ming Fu heat. Merely clearing heat drains superficial collateral heat but cannot remove internal Stomach accumulation. Hence, Cheng Qi Tang is borrowed to open the pathways. However, if the tongue is not dry yellow with prickles, do not administer it.

Wang Shiyong noted: Article 28 mentions prior use of opening/drainage methods, implying damp-heat can sometimes require purging. However, if dampness has not transformed into dryness and Fu organ excess is not formed, purging is contraindicated; it will cause persistent diarrhea. If dryness has formed, urgent purging is required; otherwise, turbid steaming will obscure spirit, rot intestines, and consume fluids, irreversibly worsening the condition faster than delayed purging in Shang Han. Yang commented: Profound insight.

Cheng Qi Tang uses Mang Xiao (Mirabilite) and Da Huang (Rhubarb) to drive out Yang Ming dry-fire excess heat, originally unsuitable for damp-heat stagnation. However, when Stomach fluids are consumed by heat, leading to picking at empty air and dry yellow prickly tongue, Stomach heat is extreme and fluids exhausted. Damp-fire transforms into dry-fire. Cheng Qi Tang is used to attack and preserve the last thread of surviving Yin. Wet-warm disease reaching this stage is critical! Wang noted: Treating warm-heat differs from Shang Han, but severe complications often resemble Shang Han.

Wang Shiyong noted: Dong Feiweng said: External pathogens, unable to penetrate from the Yuan Fu, move inward to void spaces. Among the twelve Zang-Fu, only the Stomach is the Sea of Water and Grain, open at top and bottom, most vulnerable and receptive, allowing all pathogens entry. Pathogen entry makes the Stomach full; fullness dries fluids; dried fluids lead to death. Yang Cheng Liu said: This explains the root cause of death in external contraction diseases. Those recklessly using wind-drying agents deplete fluids and shorten lives due to ignorance of this principle. I believe treating external diseases requires assessing Stomach fluid abundance. If pathogens transform into heat, moisten the Stomach to allow flow, providing an exit for heat and protecting fluids. Relying on Cheng Qi Tang as a last resort is too late, like failing to remove firewood before a chimney fire. Yang commented: Chen Xiuyuan claimed decades of studying *Shang Han Lun* led him to realize "preserve fluids," yet his prescriptions remained acrid-drying. What did he realize? Meng Ying's clarification helps lost students awaken. Wang noted: Every word hits the mark. Yang's comment is excellent. Preserving fluids is crucial for warm-heat/summerheat, but not solely reliant on Cheng Qi Tang's urgent purging.

Article 37 Damp-heat syndrome: High fever, thirst, spontaneous sweating, heaviness, chest stuffiness, and surging-long pulse. This is Taiyin Dampness combining with Yang Ming Heat. Use Bai Hu Jia Cang Zhu Tang (White Tiger plus Atractylodes Macrocephala Decoction).

Fever, thirst, and sweating indicate Yang Ming Heat. Chest stuffiness and heaviness indicate concurrent Taiyin Dampness. Surging-long pulse confirms damp-heat stagnating in Yang Ming channels. Cang Zhu Bai Hu Tang clears heat and disperses dampness, suitable for heat-dominant, damp-minor cases.

Wang Shiyong noted: Xu stated: If summerheat does not carry dampness, Cang Zhu is forbidden.

Zhang Zhongjing used Bai Hu Tang to clear formless dry-heat in Yang Ming. For dried Stomach fluids, add Ginseng to generate fluids, named Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction).

Wang Shiyong noted: For me, in blood deficiency, I add Sheng Di (Rehmannia); in essence deficiency, Gou Qi (Goji); with phlegm, Ban Xia (Pinellia); with chronic bi-syndrome, Gui Zhi (Cinnamon Twig) to unblock collaterals, named Gui Zhi Bai Hu Tang (Cinnamon Twig White Tiger Decoction), though the intent is clearing Stomach heat. Hence, later practitioners used Bai Hu Jia Ren Shen Tang for summerheat injuring Qi with fever/thirst, and Bai Hu Jia Gui Zhi Tang for fever/thirst/sweating with limb pain. For chest stuffiness/heaviness, add Cang Zhu to Taiyin dampness. For alternating chills/fever, add Chai Hu to half-exterior/half-interior pathogens.

Wang Shiyong noted: For intense summerheat with fever/thirst/sweating/stuffiness/qi stagnation, Bai Hu Jia Hou Po Tang (White Tiger plus Magnolia Bark Decoction) is highly effective. All these involve Yang Ming heat dominance with concurrent symptoms, so Bai Hu clears heat while adjusting for specific signs. Yang commented: Flexible theory, illustrating ancient prescription modifications. Bai Hu Tang is contraindicated without fever/thirst/sweating and surging pulse. Differentiation and pulse diagnosis must be meticulous. Wang Shiyong noted: For fever/thirst/sweating with deficient pulse, use sweet medicines to nourish Lung/Stomach fluids. Wang noted: If massive sweating, deficient pulse, cool body, no heat, moist mouth, no thirst, it is Yang collapse. Only Shen Fu Tang (Ginseng and Aconite Decoction) can rescue. Hui Xi Medical Discourses state: If Yang is not collapsed, use cool herbs to stop sweat; if Yang is collapsed, use hot herbs. The distinction is subtle and precise. Students should study this carefully.

Article 38 Damp-heat syndrome: Damp-heat injuring Qi, fatigue in limbs, reduced spirit, body heat, high temperature, irritability, dark urine, thirst, spontaneous sweating, and deficient pulse. Dong Yuan prescribed Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction).

Same fever/thirst/sweating, but with deficient pulse and fatigue indicates Middle Qi injury, not Yang Ming constrained heat. Qing Shu Yi Qi Tang was formulated by Dong Yuan. It contains many ingredients; students should select appropriately during clinical practice.

Wang Shiyong noted: This pulse/syndrome suits Qing Shu Yi Qi Tang, but Dong Yuan's formula has the name "clearing summerheat" but lacks the substance. Cases by Jiang Nan Zhong and Cheng Xingxuan prove this. Selection is necessary. Wang noted: Hui Xi criticized its messy ingredients; claiming it lacks actual summerheat-clearing power is accurate. I usually treat such cases with Xi Yang Shen (American Ginseng), Shi Hu (Dendrobium), Mai Dong (Ophiopogon), Huang Lian (Coptis), Zhu Ye (Bamboo Leaf), He Gan (Lotus Stem), Zhi Mu (Anemarrhena), Gan Cao (Licorice), Jing Mi (Rice), and Xi Gua Cui Yi (Watermelon Rind) to clear summerheat and boost Yuan Qi, achieving immediate results. Wang noted: This formula is better than Dong Yuan's, but Huang Lian dosage needs caution.

Article 39 Summer months: Heat injures Yuan Qi, shortness of breath, fatigue, thirst, excessive sweating, Lung deficiency with cough. Use Ren Shen (Ginseng), Mai Dong (Ophiopogon), Wu Wei Zi (Schisandra). Wang noted: Xu Hui Xi said Mai Dong and Wu Wei Zi are contraindicated in cough; usable only if no cough.

This is *Qian Jin* Sheng Mai San (Generate Pulse Powder). Same Lung disease as Article 18, but coarse vs. short breathing distinguishes Lung Excess from Lung Deficiency. Excess is drained, Deficiency is tonified—fixed principle. The name "Generate Pulse" implies heat-injured Qi causing pulse near-collapse. Wang noted: Deficient pulse is diagnostic; wiry-rapid pulse should not be lightly treated.

Wang Shiyong noted: Xu Hui Xi said: This is a formula to preserve fluids after summerheat injury. None of the indications treat summerheat pathogens directly. Quack doctors misuse it for summerheat, causing great harm. Named after taking Ren Shen and Mai Dong from Fu Mai Tang (Restore Pulse Decoction), adding Wu Wei Zi to stop sweating. Modern people use it indiscriminately to trap pathogens, killing countless. Verify pathogen presence before use; do not blindly follow custom as a summerheat cure.

Article 40 Summer months: Cooling off and drinking cold drinks, Yang Qi suppressed by Yin-Cold, skin steaming heat, aversion to cold, headache/heaviness, spontaneous sweating, irritability/thirst, or abdominal pain/vomiting-diarrhea. Use Xiang Ru (Elsholtzia), Hou Po (Magnolia Bark), Bian Dou (Lablab Bean). Wang noted: Xiang Ru is suitable only for summer cold without sweat; use cautiously if sweating.

Caused by avoiding heat but contracting cold-dampness. Though occurring in summer, it is not true summerheat disease. Ancients called it "Yin Summerheat" instead of "Summer Shang Han Dampness," confusing later generations. Correcting this now: Xiang Ru's acrid-warmness disperses Yin pathogens and releases Yang Qi. Hou Po's bitter-warmness removes dampness and moves stagnant Qi. Bian Dou's sweet-blandness regulates water and harmonizes middle. If no exterior signs (aversion to cold/headache), Xiang Ru is unnecessary. If no interior signs (abdominal pain/diarrhea), Hou Po/Bian Dou are unnecessary. For severe heat/thirst, add Huang Lian (Coptis), named Si Wei Xiang Ru Yin (Four-Ingredient Elsholtzia Decoction). Remove Bian Dou, name Huang Lian Xiang Ru Yin. For internal dampness with bloating/diarrhea, remove Huang Lian, add Fu Ling (Poria) and Gan Cao (Licorice), name Wu Wu Xiang Ru Yin (Five-Ingredient Elsholtzia Decoction). For Middle deficiency/cowardly Qi/excessive sweating, add Ren Shen, Xi Yang Shen, Bai Zhu (Atractylodes), Ju Pi (Tangerine Peel), Mu Gua (Chaenomeles), name Shi Wei Xiang Ru Yin (Ten-Ingredient Elsholtzia Decoction). Xiang Ru is designed for external cold-damp invasion. Yang commented: Ancients said: Using Xiang Ru in summer is like using Ma Huang (Ephedra) in winter. Do not use for summerheat without cold-damp. Wang noted: Ten-Ingredient formula is too complex.

Article 41 Damp-heat stagnating in Taiyin, lingering into Dysentery (Zhi Xia), with chest stuffiness/abdominal pain, tenesmus, thick sticky pus/blood, internal binding/heaviness, and soft-rapid pulse. Use Hou Po, Huang Qin (Scutellaria), Shen Qu (Medicated Leaven), Guang Pi (Tangerine Peel), Mu Xiang (Vladimiria), Bing Lang (Areca Nut), Chai Hu, Wei Ge Gen (Baked Kudzu), Yin Hua Tan (Charred Honeysuckle), Jing Jie Tan (Charred Schizonepeta). Wang noted: Chai Hu and Ge Gen are questionable. Fever/rapid pulse is common; in dysentery, it indicates severity.

Ancient "Zhi Xia" is modern Dysentery. Caused by damp-heat pathogens hiding in Taiyin, obstructing Qi mechanism, impairing Taiyin transportation and Shaoyang dispersion. Heat stagnation and damp steaming disrupt transmission, fermenting into foul pus/blood, descending to anus, causing tenesmus and frequent ineffectual defecation. Qi injury yields white discharge; Blood injury yields red. Both injured yield mixed red/white. Extreme damp-heat yields five-colored dysentery. Wang noted: Theory of red=heat/white=cold is false. Dysentery is mostly summerheat; cold causes less than 1 in 1000. Red belongs to Blood, White to Qi is definitive. Hou Po removes dampness and moves Qi; Bing Lang directs rebellious Qi and breaks knots; Huang Qin clears Metal heat; Mu Xiang/Shen Qu smooths Middle Qi stagnation; Ge Gen lifts sinking Stomach Qi; Chai Hu lifts Wood Qi from Earth. Wang noted: Blind lifting is harmful. For heat invading Blood causing bloody stool, use Yin Hua/Jing Jie to clear Ying heat. Wang noted: Di Yu Tan (Sanguisorba Charcoal) and Dan Pi Tan (Moutan Charcoal) are also usable. For internal heat excess, use Huang Lian. For severe excess/pain, increase Da Huang to expel pathogens. Zhang Jie Gu created Shao Yao Tang (Peony Decoction) for bloody dysentery using Dang Gui, Shao Yao, Huang Qin, Huang Lian, Da Huang, Mu Xiang, Bing Lang, Gan Cao, Gui Xin (Cinnamon Heart). Named after Shao Yao because treating blood loss requires regulating the Liver (storage organ). It drains Wood from Earth and astringes Liver/Yin. However, Shao Yao's sour-astringency is unsuitable for internal damp-heat. Wang noted: Shao Yao Gan Cao Tang is a holy medicine for dysentery abdominal pain, harmless to damp-heat. For chronic dysentery with Middle deficiency, Shao Yao/Gan Cao harmonize Earth, but harsh cold/bitter drugs (Huang Qin/Lian/Huang/Da Huang) and Qi-breaking drugs (Mu Xiang/Bing Lang) may be intolerable. In early dysentery with strong damp-heat, Bai Shao's astringency traps pathogens; absolutely contraindicated. Wang noted: Early use is harmless and doesn't trap pathogens, tested repeatedly. Though an ancient proven formula, I dare not set it as a model for students.

Wang Shiyong noted: Avoid Mu Xiang with nausea/vomiting. Wang noted: Tenesmus requires Mu Xiang. Combine with anti-emetics. Avoid Chai Hu/Ge Gen without exterior signs. Wang noted: Even with exterior signs, use cautiously. Stomach prefers descending; dysentery involves turbid matter wanting to descend but Qi stagnating. Adding ascending drugs reverses turbid Qi upward, causing vomiting. Wang noted: Ascending clear/descending turbid is correct; reversing turbid upward is absurd. Gui Xin in Zhang Jie Gu's Shao Yao Tang requires careful judgment. If internal heat is strong, even controlled by Huang Qin/Lian/Huang/Da Huang, Gui Xin may cause rebellion. Shao Yao's sourness is merely accompanying bitterness. *Ben Jing* states it treats blood bi, breaks accumulations, and resolves hernias/masses, astringing Liver Qi and breaking blood clots. Zhang Zhongjing used it frequently for abdominal fullness/pain. In Taiyin disease with weak pulse and spontaneous loose stools, reduce Da Huang/Shao Yao to protect weak Stomach Qi. Da Huang opens Yang...