Library

Five qian (3 grams), Guixin (Cinnamomi Cortex, 桂心) one qian (0.6 grams), named Qushi Baotuo Decoction (Decoction to Expel Dampness and Preserve Vitality). Taking it continuously for ten doses can prevent the shedding of toes. This is what the proverb calls "Tuo Jiao Shang Han" (Shedding-Toe Cold Damage), which is also something one must know. If although a large amount of cold drinks are consumed, sweat is also profuse, there will certainly be no subsequent complications.

Liu Baozhi's commentary: Treating heat with cold is a fixed principle. Nowadays, when treating the initial onset of warm diseases, people see the use of cooling and resolving methods and immediately claim it suppresses the pathogen; they simply do not understand this principle.

The *Ling Shu* states: When the color of the Taiyang meridian manifests on the cheekbones, it indicates a heat disease. If Ying Qi has not yet interacted with the pathogen, it is said that if sweat can be obtained now, recovery will await the appropriate time. If symptoms appear simultaneously with the Jueyin meridian, death will occur within three days, as the heat disease internally connects to the Kidney.

Zhang Xugu says: This discusses conditions where external contraction and latent pathogens interact, which shares similarities but also differences with the "Liang Gan" (Double Contraction) in the *Re Bing* chapter. In Liang Gan, both internal and external aspects are affected by pathogens simultaneously, leading inevitably to death. Here, external contraction occurs first, and the latent pathogen emerges later, allowing for survival. If they emerge simultaneously, death will occur within three days. "Taiyang meridian" refers to the pathogen affecting the Taiyang meridian, meaning on the first day, the Great Yang receives the pathogen, causing headache, stiff neck, and back stiffness. "Color manifesting on cheekbones" refers to a fresh, lustrous red color appearing on the cheeks. The cheekbones are the root of bone, and bones are governed by the Kidney. Since the latent pathogen in the Kidney has moved, the red color follows the Ying blood to manifest on the cheekbones. "Ying Qi has not yet interacted, if sweat can be obtained now, await the time" means that Taiyang and Shaoyin are exterior-interior pairs. The pathogen externally contracted on the Taiyang meridian and the latent heat in the Shaoyin Ying have not yet interacted. If sweat can be induced, the external pathogen is resolved first, which is what is meant by "within three days, sweating is indicated." The internally latent pathogen emerges later and resolves when the Zang organ qi is prosperous, such as in Kidney Heat Disease, which resolves with profuse sweat on Ren and Gui days. Similarly, puncturing those who show red color is called "treating before illness," which is also applicable. However, if symptoms appear simultaneously with the Jueyin meridian, both Liver and Kidney have internal pathogenic heat, which will inevitably combine with the external Taiyang pathogen and become intractable, thus dying faster than Liang Gan. Liang Gan originates from meridians and requires six days for Stomach Qi to exhaust before death. Here, heat pathogen internally connects to the Kidney, and since the root vitality is severed, death occurs within three days.

When the color of the Shaoyang meridian manifests on the front of the cheeks, it indicates a heat disease. If Ying Qi has not yet interacted with the pathogen, it is said that if sweat can be obtained now, recovery will await the appropriate time. If symptoms appear simultaneously with the Shaoyin meridian, death will occur within three days.

Zhang Xugu says: Previously, it was stated that Liver Heat Disease causes redness on the left cheek first. The Liver is Jueyin, and the Gallbladder is Shaoyang, which are exterior-interior pairs. External pathogens affect the Shaoyang meridian, while the color of latent heat in the Liver manifests on the front of the cheeks. If external and internal pathogens have not yet interacted, inducing sweat now resolves the external pathogen. The internally emerging heat resolves when the Zang organ qi is prosperous. If symptoms appear simultaneously with the Shaoyin meridian, Liver heat connects to Kidney heat, and the external and internal pathogenic forces inevitably interact and become difficult to resolve; death occurs within three days. Generally, if external and internal pathogens emerge sequentially without interacting, rescue is possible; thus, the key lies in the phrase "Ying Qi has not yet interacted." The disease name "Yin Yang Jiao" (Interaction of Yin and Yang) mentioned below implies that Ying Qi has already interacted with the pathogen. The text only cites Taiyang and Shaoyang cases, omitting Yangming and Taiyin combined diseases, because Yangming Fu organs can be treated with purgative methods, avoiding inevitable death. This differs from Taiyang-Shaoyin and Shaoyang-Jueyin, where heat pathogens merge without an exit route, leading inevitably to death.

The *Ping Re Bing* chapter states: The Yellow Emperor asked: There is a patient with a warm disease whose fever returns immediately after sweating, with a rapid and restless pulse that does not weaken due to sweating, accompanied by delirium and inability to eat. What is this disease named? Qibo answered: The disease is named Yin Yang Jiao (Interaction of Yin and Yang); "Jiao" implies death.

Zhang Xugu says: Yin and Yang Qi naturally interact. Now, pathogenic momentum is pervasive; the external Yang-pathogen mixes indistinguishably with the internally emerging Yin-heat, causing the root vital Qi to cease. Thus, "Jiao implies death" refers to this pathological mixing, not the harmonious interaction of healthy Yin and Yang. Below is the explanation of the rationale.

Human sweat is generated from grain (food), and grain essence is generated from Jing (Essence). When pathogens struggle in the muscles and bones and sweat is produced, it indicates that the pathogen is retreating and Essence is prevailing. If Essence prevails, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates the pathogen; sweat indicates Essence. Now, sweating followed immediately by fever indicates pathogenic victory. Inability to eat means Essence lacks support. If the disease lingers, life can be lost instantly. Furthermore, the *Re Lun* states: "Sweating followed by a still restless and vigorous pulse indicates death." Now, the pulse does not correspond with the sweat, indicating the body cannot overcome the disease; death is evident. Delirium indicates loss of Zhi (Will/Spirit); loss of Zhi leads to death. Seeing three signs of death and no sign of life, even if improvement seems apparent, death is certain.

Zhang Xugu says: "Sweat comes from grain, grain from Essence" means that original Essence transforms food into fluids, which emit as sweat. Pathogens are expelled with sweat, so pathogen retreats and Essence prevails. Now, sweating followed by fever and inability to eat indicates pathogenic victory and lack of fluid support. If the disease lingers, life will end shortly. Delirium and loss of Will is one sign; recurrent fever after sweating is two; pulse not corresponding with sweat is three. Seeing three signs of death and no sign of life, even if seemingly improved, death is certain.

The *Su Wen · Yangming Mai Jie* chapter states: When the Foot-Yangming meridian is diseased, the patient fears people and fire, and is startled by the sound of wood, but not by bells or drums. Why is one startled by the sound of wood? Qibo said: Yangming is the Stomach meridian, and the Stomach belongs to Earth. Thus, fearing the sound of wood is because Earth fears Wood. The Yellow Emperor said: Good! Why fear fire? Qibo said: Yangming governs flesh, and its meridian has abundant Qi and Blood. When pathogens invade, heat arises; excessive heat causes fear of fire. The Yellow Emperor said: Why fear people? Qibo said: Yangming reversal causes panting and distress; distress causes aversion to people. The Yellow Emperor said: Some die from panting, some survive. Why? Qibo said: Reversal connecting to Zang organs leads to death; connecting to meridians leads to survival.

Zhang Xugu says: Earth fears Wood domination, hence the startle at the sound of wood. Excessive heat causes fear of fire, which is Zhongjing's statement of "no aversion to cold but aversion to heat." Pathogens knot in the Stomach causing Qi reversal, leading to panting and mental restlessness (Ao Nan), which is aversion to seeing people. Internal knotting of pathogenic heat blocks Qi flow, causing panting. Failure to reach the exterior via meridians leads to cold limbs, as limbs receive Qi from Spleen and Stomach. Pathogens entering internally connect to Zang organs, causing death; exiting externally connect to meridians, allowing survival.

The Yellow Emperor asked: In severe illness, patients discard clothes and run, climb high places and sing, or go several days without eating, climbing walls and roofs—places they could never reach normally. Why can they do these things contrary to their usual ability? Qibo said: Limbs are the root of all Yang. Excess Yang makes limbs solid and strong, enabling climbing. The Yellow Emperor asked: Why discard clothes and run? Qibo said: Excessive heat in the body causes discarding clothes and running. The Yellow Emperor asked: Why delirious speech, cursing, ignoring kinship, and singing? Qibo said: Excess Yang causes delirious speech, cursing, ignoring kinship, and unwillingness to eat. Unwillingness to eat leads to erratic running.

Zhang Xugu says: Limbs receive Qi from Spleen and Stomach; the Stomach is the sea of Zang-Fu, and Yangming circulates Qi through the Three Yang meridians, making limbs the root of all Yang. Pathogen excess in Stomach and Qi solidity in limbs enable climbing. Body heat excess causes discarding clothes and running. Pathogen disturbing Shen Ming (Spirit) causes delirious cursing. Stomach pathogenic excess causes unwillingness to eat. Strong limbs cause erratic running. This is a Da Cheng Qi Tang syndrome. If pathogens connect to meridians, the pulse will be slippery and large; purgation can save life. If pathogens connect to Zang organs, the pulse will be deep and fine. Zhongjing said: "Yang disease showing Yin pulse indicates death." Thus, even if purgation indications exist, purgation cannot be used.

Wang Mengyin said: Warm diseases mistakenly treated with hot tonics can also present these symptoms. Meridian-stage diseases may also warrant Bai Hu Tang. A deep and fine pulse can also result from heat pathogen obstruction; if physical signs and symptoms are substantial, purgation can save life. One cannot generally judge inevitable death solely based on a Yin pulse. Generally, when heat pathogens are congested, pulses are often fine, slow, and choppy. Clearing and resolving according to symptoms naturally results in a slippery and rapid pulse. This differs from deficiency patterns in internal injuries where taking cold medicines increases pulse rate.

The *Re Lun* chapter states: The Yellow Emperor asked: Heat diseases have healed, yet sometimes residual symptoms remain. Why? Qibo said: All residual symptoms occur because heat is severe and the patient forces food intake. In such cases, the pathogen has declined but heat remains hidden. Grain Qi struggles with residual heat, combining two heats, causing residuals. The Yellow Emperor said: Good! How to treat residuals? Qibo said: Observe deficiency and excess, regulate reversal and compliance, and the disease will surely heal. The Yellow Emperor asked: What should be forbidden during heat disease? Qibo said: When heat disease slightly improves, eating meat causes recurrence; overeating causes residuals. These are the prohibitions.

Liu Baozhi's commentary: This describes how, after initial heat pathogen resolution, residual heat remains uncleaned. Grain food aids Qi, causing the two heats to combine and flare up again. Observing that eating meat causes recurrence and overeating causes residuals, post-illness dietary regulation must be strict. Only light, thin porridge should be consumed for gradual nourishment.

The *Su Wen · Yu Ban Lun Yao* chapter: Qibo said: Patients with warm disease and extreme deficiency will die.

Liu Baozhi's commentary: The classic states, "Those who preserve Essence will not suffer warm diseases in Spring." Thus, anyone suffering warm disease clearly has prior Yin deficiency. If deficiency is not extreme, nourishing Yin and venting pathogens with proper treatment can still reverse the condition. However, if warm disease reaches extreme deficiency, heat pathogens disturb internally, Yin Essence dries up first, and the fire spreads uncontrollably, becoming incurable.

The *Ling Shu · Wu Jin* chapter: Qibo said: Heat disease with a quiet pulse, but a vigorous and restless pulse after sweating, is the first counter-indication (Ni).

Liu Baozhi's commentary: After sweating in heat disease, if the pulse becomes vigorous and restless, it indicates heat pathogens deeply hidden in Yin. Sweating activates the pathogenic mechanism, exposing it externally, implying heavy latent pathogens, hence termed "counter-indication."

The *Ling Shu · Re Bing* chapter states: On the third day of heat disease, if the Qi Kou pulse is quiet and the Ren Ying pulse is restless, puncture the Yang meridians using the Fifty-Nine Acupoints method to drain heat and induce sweat, solidifying Yin to supplement insufficiency.

Wu Juzhong said: Restless Ren Ying pulse indicates pathogen in the Upper Jiao; thus, puncturing Yang meridians drains the pathogen. When Yang Qi flows freely, sweat follows. Yang excess leads to Yin decline; draining Yang allows Yin to settle in its position, hence "solidifying Yin." Draining Yang excess supplements Yin insufficiency, hence "supplementing insufficiency." Warm-heat diseases invariably injure Yin; "solidifying Yin to supplement insufficiency" is the crucial outline for treating warm diseases.

If body heat is severe but both Yin and Yang pulses are quiet, do not puncture. For those suitable for puncture, act urgently; if no sweat occurs, use draining methods. "Do not puncture" applies to those showing signs of death. On the seventh or eighth day of heat disease, if the Mai Kou pulse moves, with panting and shortness of breath, puncture urgently; sweat will likely emerge spontaneously. Puncture shallowly between the big toe (Shaoshang point). On the seventh or eighth day, if the pulse is minute and small, and the patient has hematuria and dry mouth, death occurs in one and a half days; if the pulse is intermittent (Dai), death occurs in one day. If heat disease has sweated, but the pulse remains restless, with panting and recurrent fever, do not puncture the skin; severe panting indicates death.

Liu Baozhi's commentary: Severe heat with restless and floating pulse allows puncture; urgent puncture allows heat pathogens to resolve via sweat. If Yin and Yang pulses are both quiet, it is a Yang disease showing Yin pulse, indicating death signs, so do not puncture. Moving Mai Kou pulse with panting and shortness of breath indicates heat congestion in the Lung. Puncturing Shaoshang, the Lung's Shao-Shang point on the big toe, opens Lung heat obstruction, allowing sweat and resolution. Heat pathogen scorching the Blood level causes hematuria; Yin fluids scorched cause dry mouth. Lower Jiao Yin injury is severe, and with a minute/small pulse, not only is Yin exhausted, but Yang is also damaged, hence fatal. Having sweated but pulse remaining restless, with panting and recurrent fever, indicates heat does not subside with sweat and the source of transformation is failing, hence death.

There are nine types of heat disease unsuitable for puncture: 1. No sweat, red cheekbones, and hiccups indicate death; 2. Diarrhea with severe abdominal fullness indicates death; 3. Unclear vision with persistent heat indicates death; 4. Elderly and infants with heat and abdominal fullness indicate death; 5. No sweat, vomiting, and lower bleeding indicate death; 6. Rotten tongue base with persistent heat indicates death; 7. Coughing with epistaxis, no sweat, or sweat not reaching the feet indicate death; 8. Marrow heat indicates death; 9. Heat with spasms indicates death, presenting as opisthotonos, convulsions, and locked jaw. None of these nine should be punctured.

Liu Baozhi's commentary: Red cheekbones with hiccups indicate Kidney Yin exhaustion and floating Yang escaping upward, hence death. Diarrhea with persistent abdominal fullness indicates downward leakage of Yin and unremoved pathogen, similar to heat not subsiding with sweat, hence death. Unclear vision indicates Yin collapse; Yin collapse with persistent heat leads to death. Heat and fullness require draining, but elderly and children cannot withstand attack, leaving heat with no outlet, hence death. Heat accumulation with no sweat reverses upward causing vomiting, presses downward causing bleeding; upper and lower conflict easily consolidates Yin fluids, a death sign. Rotten tongue base indicates Fire of Kidney knotting, different from Stomach heat causing oral ulcers. If rotten and heat persists, it is a death sign. Sweat not reaching feet indicates Lung Qi failing to descend and source of transformation nearing extinction. Cough and epistaxis indicate pathogen closed above; no sweat means pathogen cannot exit externally, plus signs of failing transformation source, hence death. Marrow heat resembles bone-steaming consumption, indicating pathogen heat deeply entered the Kidney. Heat with spasms causing opisthotonos indicates pathogen heat deeply entered the Liver. Kidney and Liver scorched by heat pathogens lead to death.

Wu Juzhong said: This section lists death signs of heat disease to prohibit puncture, mostly due to Yin exhaustion. Although puncture is contraindicated, some cases can be cured with medicine. Puncture excels at draining and unblocking, rapidly opening pathogenic heat knots; however, benefiting Yin and preserving fluids is the weakness of puncture and the strength of decoctions.