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On Treating Excess Pathogens

The Heavenly Master said: Excess diseases are not all the same and there are many types; I will now mention only one or two. For instance, some people endure labor and hardship throughout the year without fear, can consume large amounts of cold-natured foods, but cannot tolerate pungent and hot-flavored foods. This is an example of excess syndrome. However, the invasion of pathogenic factors should not be viewed uniformly. When I speak of the abundance of excess diseases, I am referring to the abundance of pathogenic factors. Few people have true excess (of healthy Qi), while many are deficient. The treatment for the invasion of pathogens has its own specific methods and should not be mixed into this category. If a person appears robust and radiant, with extreme internal heat, seeking a prescription, give them this formula: Chenpi (Tangerine Peel) 1 qian, Shenqu (Medicated Leaven) 1 qian, Maiya (Sprouted Barley) 1 qian, Huangqin (Scutellaria Root) 1 qian, Houpo (Magnolia Bark) 1 qian, Tianhuafen (Trichosanthes Root) 1 qian, Gancao (Licorice Root) 5 fen, Shaoyao (Peony Root) 2 qian, Shanzha (Hawthorn Fruit) 10 seeds, Zhike (Aurantium Fruit) 5 fen, Danggui (Angelica Sinensis) 2 qian, Fuling (Poria) 1 qian. Decoct in water and take orally. Such formulas are only for backup use, to treat those with surplus constitution (excess syndrome), and should not be used to govern the treatment of everyone in the world. After all, among every hundred people, only one or two have excess syndrome, while deficiency is widespread. How can the Qi of Heaven and Earth be overly dense? Moreover, few are nurtured, while many are depleted. This formula is established merely to define a therapeutic approach for this category, not to teach physicians to rigidly apply it for digestion and guiding out stagnation.

Lord Zhang said: Benevolence and skill are both evident in this formula. Excess syndromes are rare; when the Heavenly Master says "many," he refers to the excess of pathogens, not the excess of healthy Qi. The excess of pathogens is most common in the Shanghan (Cold Damage) category. When the Heavenly Master mentions specialized books, he refers to texts on Shanghan. If a patient suffers from excess pathogens, fortunately, they can be treated by consulting the Shanghan section, ensuring no deviation. Books on Shanghan are voluminous and cannot be fully recorded here.

Lord Hua said: I did not inherit this.

On Hematemesis, Epistaxis, Eye Swelling, and Mouth/Tongue Ulcers

The Heavenly Master said: The Cold Treatment method involves using cold-natured herbs to suppress flourishing fire. For example, patients suffering from eye pain, mouth and tongue ulcers, epistaxis (nosebleed), or hematemesis (vomiting blood). These symptoms arise because fire Qi is stagnant and vigorous in the Upper Jiao (Upper Burner), unable to disperse. Severe cases surge upward, causing hematemesis and epistaxis; mild cases present as eye pain and mouth/tongue ulcers. The method should employ cold-natured substances to clear the blazing momentum of the fire and drain its inflammatory power rising to the vertex. Use Dihuang (Rehmannia Root) 1 liang, Danggui (Angelica Sinensis) 1 liang, Chuanxiong (Ligusticum Rhizome) 5 qian, Xuanshen (Scrophularia Root) 5 qian, Huangqin (Scutellaria Root) 3 qian, Sanqi (Notoginseng Root) powder 3 qian, Gancao (Licorice Root) 1 qian, Jingjie (Schizonepeta Spike) stir-fried 1 qian. Decoct in water and take orally. The brilliance of this formula lies not in purely using cold herbs to drive away fire, but in using slightly cold herbs to nourish Yin. When Yin Qi generates, Yang Qi naturally descends. It is particularly ingenious to use Jingjie (Schizonepeta Spike) to guide blood back to its vessels, use Sanqi (Notoginseng Root) powder to intercept new bleeding pathways above, and add Huangqin (Scutellaria Root) to slightly clear the surging momentum. One must fear that excessive coldness might cause a clash between cold and heat, so Gancao (Licorice Root) is added to harmonize. This is the most clever and exquisite method for treating heat. If one were to simply use cold herbs to suppress the fire, although it might bring temporary relief, once the fire subsides but water/Yin is insufficient, the fire will have no place to reside, still generating flames and wind, likely becoming worse than before. By the time clearing and tonifying herbs are used to rescue the situation, the Stomach Qi would already be deficient and unable to cope. Therefore, using this at the onset is the key.

Eye swelling and pain are also fire syndromes, but one must observe if there is much discharge and tearing, with redness, swelling, and pain as if pricked by objects. Use Chaihu (Bupleurum Root) 3 qian, Gancao (Licorice Root) 1 qian, Zhizi (Gardenia Fruit) stir-fried 3 qian, Banxia (Pinellia Tuber) 1 qian, Bijieli (Tribulus Fruit) 3 qian. Decoct in water and take orally. The妙处 (brilliance) of this formula lies entirely in directly dispersing the stagnant fire of the Liver and Gallbladder. When the fire disperses, the heat retreats naturally. This indirect attack surpasses direct attack, and indirect purgation surpasses direct purgation. One dose is sufficient for efficacy; further doses are unnecessary.

Mouth and tongue ulcers should not be treated thus. They result from stagnant heat in the Heart Fire, and since the tongue is the sprout of the Heart, symptoms appear there first. The method uses Huanglian (Coptis Rhizome) 2 qian, Shichangpu (Acorus Rhizome) 1 qian. Decoct in water and take orally. One dose cures it; it is a miraculous formula. Its wonder lies not in Huanglian (Coptis Rhizome), but in Shichangpu (Acorus Rhizome). Shichangpu (Acorus Rhizome) guides medicine into the Heart Meridian. Although Huanglian (Coptis Rhizome) also enters the Heart Meridian, it inevitably affects the Liver and Spleen meridians as well, unlike Shichangpu (Acorus Rhizome) which enters only the Heart. Furthermore, by not mixing it with herbs for other meridians, it advances alone into the heart of the disease, leaving no room for doubt. This is why its effect is as immediate as an echo. If one does not understand the divine mechanism of herb selection and lightly mixes in Liver and Spleen herbs, although it may work, it will never be as swift as a drumstick striking a drum. This is another method for treating heat.

Lord Zhang said: The Cold Treatment method is widely used by people, but I do not adopt it. Today, the Heavenly Master's method compels my admiration. Using cold yet avoiding the pitfalls of cold, using dispersion yet avoiding the pitfalls of dispersion, truly combining ingenuity with effectiveness, and integrating attacking and tonifying methods. What more need I say? If pressed, here is another formula. Used when fire pathogens are just beginning, before manifesting in the head, eyes, mouth, or tongue, it can transform existence into non-existence. Use Chaihu (Bupleurum Root) 2 qian, Baishao (White Peony Root) 3 qian, Gancao (Licorice Root) 1 qian, Zhizi (Gardenia Fruit) stir-fried 3 qian, Banxia (Pinellia Tuber) 1 qian, Qianghuo (Notopterygium Rhizome) 5 fen, Fuling (Poria) 3 qian. Decoct in water and take orally. One dose disperses the fire. The formula is named Xianjie Tang (First-Resolution Decoction). It resolves the issue before external symptoms appear. This is also a strategy to seize the initiative; physicians should pay attention.

Lord Hua said: He did not transmit this to me either.

Sun Simiao said: I have a formula for hematemesis passed down to my descendants. Dihuang juice (Rehmannia Juice) one bowl. If fresh Dihuang (Rehmannia Root) is unavailable, use dried Dihuang (Rehmannia Root) 1 liang, decoct until half a bowl remains, then mix with Sanqi (Notoginseng Root) powder 3 qian and Paoliuhui (Charred Ginger) powder 5 fen. Take one dose to stop bleeding immediately. It is highly effective for hematemesis and can also treat epistaxis. Marvelous.