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I believe that the syndrome of Phlegm-Fire (Tan Huo) originates from blood loss and essence depletion. Essence and blood are both True Water (Zhen Shui) and True Yin (Zhen Yin), which have form and substance, are difficult to generate but easy to deplete. The term "Phlegm-Fire" refers to the branch (biao) while forgetting the root (ben). Since True Water is depleted, Ministerial Fire (Xiang Huo) flares up accordingly, forcing body fluids to condense into phlegm; thus, it is said that "phlegm is the manifestation of fire." However, regarding the syndrome of Tuberculous Consumption (Lao Zhai), describing it as "Yin Deficiency with Fire Hyperactivity" (Yin Xu Huo Dong) seems to encompass both the root and branch of the disease in a single phrase. The *Nei Jing* states: "Yin deficiency generates internal heat." Heat is the mild degree of fire, while fire is the extreme degree of heat. When fire forces body fluids to become phlegm, "Yin deficiency" is precisely the root cause leading to fire and phlegm generation. Is this not what Li Dongyuan meant by "the initially affected pathogen is the root, and the subsequently affected is the branch"?

Current practitioners merely advocate clearing phlegm and descending fire, which severely violates the principle that treating a disease requires seeking its root. One might ask: Although nourishing Yin and descending fire is appropriate, examining the prescribed formulas reveals they are mostly Si Wu Tang (Four Substances Decoction) augmented with bitter-cold herbs such as Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian). They fail to realize that Yin fluid diminishes further when exposed to cold, and the Spleen deteriorates when exposed to cold. Would not patients taking these suffer from reduced appetite, abdominal distension, and diarrhea? Would they not experience Yin consumption and emaciation?

However, "nourishing Yin and descending fire" implies benefiting Water to overcome Fire. The Fire of Dragon and Thunder (Long Lei Zhi Huo, referring to deficient fire rising from the lower Jiao) cannot be subdued by water nor directly broken. The method should employ sweet-warm herbs to tonify the Mother organ (Spleen), such as Ginseng Radix et Rhizoma (Renshen), Dioscoreae Rhizoma (Shanyao), and Schisandrae Fructus (Wuweizi); use bitter herbs to firm Yin, such as Anemarrhenae Rhizoma (Zhimu); and use bitter assistants, such as Phellodendri Cortex (Huangbai). Have you not heard of the fire at Xiao Qiu? Examining ancient formulas for treating consumption, few omit Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). This is because ancients believed that in cases of blood loss, one should benefit Qi, following the principle that "Yin relies on Yang for generation." For example, when women suffer excessive postpartum blood loss, leading to panting and impending death, named "Solitary Yang and Absolute Yin," this represents extreme Yin deficiency. The treatment should tonify Yin, yet instead of using Si Wu Tang, they used Shen Su Yin (Ginseng and Dalbergia Odorifera Decoction), primarily utilizing only Ginseng Radix et Rhizoma (Renshen) and Dalbergia Odorifera Xylum (Sumu). Was this ancient foolishness? No, it followed the tenets of the *Nei Jing*.

The abuse of bitter-cold herbs stems from a mistaken statement by Wang Haozou (or a Wang physician), becoming a hindrance for generations. I consulted *Bencao Zheng* which states: For Yin deficiency with fire hyperactivity, labor cough, hematemesis, and hemoptysis, do not use bitter-cold herbs. Because Ginseng Radix et Rhizoma (Renshen) enters the Taiyin Lung Meridian and tonifies [Qi/Fire contextually], it is contraindicated for those with Lung fire pathogens; [text gap inferred] if Yin is consumed, only bitter-sweet-cold herbs should be used to generate blood and descend fire. People who do not understand this often die from mistakenly using Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) as tonics.

Wenren said: Sun Simiao took three doses of Sheng Mai San (Generate Pulse Powder) and Shen Li Tang (Kidney Drip Decoction) in summer, preventing all diseases. Li Dongyuan also stated that Sheng Mai San and Qing Shu Yi Qi Tang clear fire and benefit Metal (Lung Qi); how could they cause heart fire accumulation or heart pain? Zhang Zhongjing treated abdominal cold qi rushing upward, with sensations of heads and feet, upper and lower pain, untouchable, vomiting and inability to eat, using [Fuzi Lizhong Tang category], which can tonify Lung fire. For Yin deficiency with fire hyperactivity and bleeding disorders, taking it would be fatal. Both schools' views are biased. In fact, Ginseng Radix et Rhizoma (Renshen) tonifies Primordial Yang, generates Yin blood, and drains Yin fire, assisting Li Dongyuan's theories. Zhang Zhongjing added Ginseng Radix et Rhizoma (Renshen) for blood loss and blood deficiency. He also said for Lung cold, remove Ginseng Radix et Rhizoma (Renshen) and add dried ginger to prevent Qi stagnation. Zhu Danxi also stated that deficient fire can be tonified with Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), while excess fire can be drained with Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian). These two schools failed to examine the subtleties of the three masters (Zhang, Li, Zhu) and claimed Ginseng Radix et Rhizoma (Renshen) tonifies fire, which is absurd!

Fire and Yuan Qi (Primal Qi) cannot coexist; when Yuan Qi prevails, fire pathogens recede. If Ginseng Radix et Rhizoma (Renshen) tonifies Yuan Qi, how could it tonify fire pathogens? It would be like a fickle person, how can it be grouped with Glycyrrhizae Radix et Rhizoma (Gancao), Poria (Fuling), and Atractylodis Macrocephalae Rhizoma (Baizhu) to form Si Jun Zi Tang (Four Gentlemen Decoction)? Nevertheless, their words should not be entirely discarded. Their statements were limited, so adherents became rigid, viewing Ginseng Radix et Rhizoma (Renshen) as venom, which is incorrect. Those with white, yellow, or cyan faces appearing haggard have insufficient Spleen, Lung, and Kidney Qi and may use Ginseng Radix et Rhizoma (Renshen). Those with red or black faces, strong Qi and spirit, should not use it. Pulses that are floating and knotted, soggy, deficient, large, slow, weak, deep, delayed, choppy, thin, intermittent, or forceless indicate deficiency and may use Ginseng Radix et Rhizoma (Renshen). Pulses that are string-taut, long, tight, solid, slippery, rapid, or forceful indicate internal fire stagnation and excess, and should not use it.

Jiegu (Zhang Yuansu) said avoid Ginseng Radix et Rhizoma (Renshen) for panting and cough due to phlegm excess and Qi stagnation. But for Kidney deficiency causing shortness of breath and panting, it must be used. Zhang Zhongjing said avoid Ginseng Radix et Rhizoma (Renshen) for cold Qi panting, referring to cold binding heat pathogens stagnant in the Lung cough. But for spontaneous sweating, aversion to cold, and cough, it must be used. Li Dongyuan said avoid Ginseng Radix et Rhizoma (Renshen) for fire stagnation in the Lung, meaning fire is stagnant internally, suitable for dispersal not tonification. But for Lung deficiency with fire hyperactivity, shortness of breath, and spontaneous sweating, it must be used. Zhu Danxi said avoid sudden use of Ginseng Radix et Rhizoma (Renshen) for various pains, meaning pathogens are sharp, suitable for dispersal not tonification. But for interior deficiency with vomiting/diarrhea, chronic stomach weakness, and deficiency pain preferring pressure, it must be used. Jiezai (Yu Tun) said avoid Ginseng Radix et Rhizoma (Renshen) for Yin deficiency with fire hyperactivity, referring to blood deficiency with fire hyperactivity, good appetite, string-taut and rapid pulse, where cooling harms Stomach and warming harms Lung, making it unable to accept tonification. But for shortness of breath, cold limbs, and deficient pulse, it must be used. Such detailed examination clarifies half the logic of when Ginseng Radix et Rhizoma (Renshen) is applicable.

Li Dongyuan and Jiezai's theories originated from Haicang (Wang Haozou), but their arguments were overly radical. Zhu Danxi said deficient fire can be tonified with Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). He also stated for Yin deficiency tidal fever, panting, cough, hemoptysis, and night sweats, use Si Wu Tang plus Ginseng Radix et Rhizoma (Renshen), Phellodendri Cortex (Huangbai), and Anemarrhenae Rhizoma (Zhimu). He also said for those indulging in sex, damaging Lung and Kidney, with persistent cough, use Qiongyu Gao (Jade Pearl Paste), indicating that for Yin deficiency consumption, Ginseng Radix et Rhizoma (Renshen) was indeed used. Jiezai, a private disciple of Danxi, contradicted him so sharply. Once this saying spread, it fixed later generations' perspectives. Encountering these symptoms, regardless of suitability, they used it as an excuse, hampering skilled physicians who sought only to avoid patient resentment. Patients, holding this view, endured bitter-cold herbs even until vomiting, diarrhea, and near-death, without realizing their error. In treating consumption since ancient times, none surpassed Ge Kejiu. His Du Shen Tang (Single Ginseng Decoction) and Bao Zhen Tang (Preserve Truth Decoction) never abandoned Ginseng Radix et Rhizoma (Renshen). Jiezai's view lacked deep thought.

Yang Qi said: Ginseng Radix et Rhizoma (Renshen) is recorded in Bencao, known to all. Recently, due to patients being stingy with money and despising doctors, and doctors calculating costs and sparing expenses, refusing to use Ginseng Radix et Rhizoma (Renshen) for treatment, mild cases became severe, and severe cases became critical. However, for Lung cold, Lung heat, middle Jiao fullness, and blood deficiency, one should only disperse cold, reduce swelling, and tonify Ying Blood. Omitting Ginseng Radix et Rhizoma (Renshen) here would be wrong. Ancient formulas for Lung cold used Wen Fei Tang, for Lung heat Qing Fei Tang, for middle Jiao fullness Fen Xiao Tang, for blood deficiency Yang Ying Tang, all containing Ginseng Radix et Rhizoma (Renshen). As stated: "Where pathogens gather, Qi is deficient." And "Nourish righteousness, and pathogens will eliminate themselves." When Yang is vigorous, Yin blood is generated; the key lies in proper combination. Quack doctors often say Ginseng Radix et Rhizoma (Renshen) should not be used lightly; truly, they are quacks. Benevolent gentlemen should not slight life or despise doctors; doctors should not calculate profit and refuse treatment. Patients despising doctors actually slight their own lives; doctors acting unethically for profit violate their professional conduct. I write this to encourage, hoping no one calls it pedantic.