Library

Damp-phlegm stirring internally causes coughing, but it is invariably triggered by the invasion of Wind, Fire, Heat, Dryness, or Cold. Although the pathogenic factors involved vary, they all ultimately impair the Lung. Understanding how these six qi (pathogenic factors) cause coughing allows one to reason by analogy and extend knowledge through association. Consequently, not only will one have a clear understanding of coughing, but also of myriad diseases, bringing clarity to the mind and heart.

Erni (hiccups), also known as "Yue" in the *Neijing* (*Inner Canon*), occurs when Qi rebels and rushes upward, producing audible hiccup sounds. The etiology is diverse: some cases arise from Stomach deficiency with Diaphragm heat; others from Stomach deficiency-cold; some from Kidney Qi deficiency with Yin fire rushing upward; some from Middle Qi insufficiency with a deficient and rapid pulse where breath fails to continue; some from Yangming internal excess due to failure to purge; some from excessive water intake causing water accumulation in the chest; and some from transmitted cold damage transforming into heat, where misapplication of warming herbs exacerbates fire pathogens and phlegm-fire transmission. Liu Zongnong stated that hiccups can be deficient or excess, involving fire, phlegm, or water qi, and should not be exclusively treated as cold patterns. The *Neijing* treats "Yue" by stimulating the nose with grass to induce sneezing, or by holding breath and rapidly guiding inhalation, which stops the symptom immediately; sudden shock can also stop it. Chen Wuyue equated "Yue" with cough-rebellion, while Li Dongyuan and Wang Haicang equated it with dry retching, both of which are erroneous. Dry retching involves vomiting without substance and is distinct from "Yue." Cough-rebellion refers to severe coughing, not hiccups. Xu Xueshi’s identification of "Yue" as hiccups aligns with canonical principles and is beyond doubt.

Wheezing, Asthma, and Belching: Wheezing is categorized into excess and deficiency. Excess wheezing results from pathogenic abundance, characterized by long, forceful respiration and a slippery, rapid, strong pulse. Deficiency wheezing results from healthy Qi depletion, characterized by short, discontinuous respiration and a weak, spiritless pulse. These differences in pulse and symptoms clearly distinguish excess from deficiency. Asthma is marked by sounds in the throat resembling a waterfowl's call, often triggered by impending rainy weather, leading to inability to sit or lie down comfortably and difficulty eating. This stems from cold-phlegm accumulated in the lung orifices, exacerbated by yin-cold entering from the back and nose during cloudy weather, causing lung distension and noise. Alternatively, it may result from lung injury by salt water, leading to chronic wheezing that may persist lifelong or be hereditary. Treatment must address excess or deficiency. Belching lacks explicit mention in classics; abdominal distension with belching is called "Yi Ni," and rising Qi is called "Yi." "Yi" refers to the sigh after a full meal, synonymous with belching. It often arises from Stomach deficiency with constrained fire, retained fluid in the chest, or inverted Yin Qi disturbing Yang, preventing proper transformation. In women with emotional stagnation, chest tightness may cause repeated belching until relief is felt. Therapeutic principles include tonifying deficiency, clearing heat, warming cold, and regulating Qi, leaving no aspect unaddressed.

Sighing, Sadness, and Shortness of Breath: Worry and thought cause the Heart vessels to contract, restricting Qi flow, leading to sighing for relief. Frequent sadness stems from Spleen stagnation failing to nourish the Lung (Earth generating Metal). The Lung governs grief. Correspondingly, in Heaven it relates to Dryness, in Earth to Metal, in emotion to Worry, and in sound to Crying. Women with Zang Dryness often weep and feel sad, confirming this link. Shortness of breath, characterized by insufficient vocal resonance and rapid breathing, indicates deficiency in the five Zang organs, primarily the Lung. The classics state: "Lung Qi deficiency leads to shoulder and back pain, aversion to cold, scanty Qi, and insufficient respiration." Thus, external six excesses and internal seven emotions can all deplete Qi. Those with shortness of breath must exercise extreme caution.

Malaria: This belongs to the Shaoyang syndrome. Shaoyang resides at the half-exterior, half-interior level. Pathogens lurking here clash with Yin to produce chills and with Yang to produce fever. The Shaoyang meridian ascends to the head and angles, causing unilateral headache. Its branch enters the ear via the Tinggong (SI19) acupoint, causing deafness. It descends through the chest, pierces the diaphragm, and follows the hypochondrium, causing chest and hypochondriac pain. Shaoyang corresponds to Jia Wood. Wood pathology affects its controlling element, Earth (Spleen/Stomach), leading to disharmony and vomiting. Gallbladder bitterness manifests as a bitter taste. Mild cases occur daily; severe cases occur every other day. Pathogens in Qi manifest earlier; those in Blood manifest later. Zhang Zhongjing stated: "Malaria pulses are naturally wiry. Wiry-rapid indicates heat; wiry-slow indicates cold; wiry-small-tight suggests purging is appropriate; wiry-slow suggests warming; wiry-tight suggests sweating (or acupuncture); floating-large suggests emesis; wiry-rapid indicates wind-pathogen, manageable with dietary regulation." These seven phrases encompass sweating, emesis, purging, harmonizing, and warming methods. Other types—Dan Malaria, Wen Malaria, Mu Malaria, and Mother Malaria—all seek treatment within the Shaoyang framework. The *Lingshu*, *Suwen*, and *Jingui Yaolue* contain relevant texts, yet few grasp their essence. Cases with more heat than chills, irritability, and insomnia belong to the Heart, termed Wen Malaria. Cases with more chills than heat, lower back pain, and cold feet belong to the Kidney, termed Han Malaria. Cases with initial chills followed by high fever and cough belong to the Lung, termed Dan Malaria. Cases with prolonged heat, short chills, and muscle spasms belong to the Liver, termed Feng Malaria. Cases with equal chills and heat, vomiting of phlegm-foam belong to the Spleen, termed Shi Malaria. This classification of Five Zang Malaria originated from Chao Yuanfang’s *Zhubing Yuanhou Lun*. Later scholars believed he elucidated the *Neijing*, unaware that malaria pathogens do not originate from the Zang organs, a theory absent in the *Neijing* and merely speculative by Chao.

Dysentery: Referred to as Chang Pi or Zhixia in the *Lingshu* and *Suwen*. It typically results from exposure to Wind, Cold, Summerheat, Dampness, and irregular diet damaging the Spleen and Stomach, leading to retention and stagnation. Symptoms include tenesmus (urgent desire to defecate with little output), abdominal pain, and discharge varying in color: white, red, mixed, pure blood, bean curd-like, fish-brain-like, house-leakage-like, dust-rot-like, pure black, or pure red. Some present with rectal prolapse like a bamboo tube. Anorexia with dysentery is called Jin Kou Li (Closed Mouth Dysentery); intermittent episodes are called Xiu Xi Li (Resting Dysentery). Severity depends on pathogen strength and depth of accumulation. Treatment distinguishes between Qi and Blood disorders. Zhu Danxi noted: White dysentery involves Qi disorder from the Large Intestine; red involves Blood disorder from the Small Intestine; mixed involves both. Historically, treatments included clearing heat, warming cold, purging early excess, sweating exterior syndromes, and promoting urination for dark/scanty urine. These five methods are widely accepted. However, Ni Shi identified four contraindications: 1. Contraindication of Warming Tonification: Dysentery stems from damp-heat stagnation. Early use of warming tonics solidifies pathogens and intensifies internal heat, potentially leading to fatal organ damage. 2. Contraindication of Severe Purging: Similar to clearing blocked drains, gentle dredging is needed. Severe purging damages Stomach and Original Qi without removing stagnation, potentially leading to closed-mouth dysentery and death. 3. Contraindication of Sweating: Chills, fever, headache, and dizziness in dysentery stem from internal heat steaming outward, not exterior pathogens. Sweating consumes healthy Qi, allowing pathogens to spread, and drying/warming wind herbs exacerbate internal heat, creating exterior deficiency and interior excess. Survival is mere luck. 4. Contraindication of Promoting Urination: While effective for watery diarrhea, promoting urination in dysentery further depletes fluids already dried by heat-stagnation, worsening obstruction and prolonging the disease. Knowing these contraindications guides proper treatment. Moxibustion points aim to guide fire and transform Qi, unlike reckless use of hot herbs that burn the intestines.

Diarrhea: Known in antiquity as Xia Li. Zhu Danxi cited causes: Dampness, Qi deficiency, Phlegm, Fire, Food stagnation. Dai Fuyan stated: Watery diarrhea with abdominal pain indicates Dampness; immediate post-prandial evacuation of undigested food indicates Qi deficiency; paroxysmal abdominal pain, borborygmus, and diarrhea indicate Fire; variable frequency/volume indicates Phlegm; severe abdominal pain relieved by defecation indicates Food stagnation. Dai further classified five diarrheas based on Dampness: Sun Xie (undigested food, Damp-Wind); Tang Xie (sticky residue, Damp-Heat); Xie Xie (clear/cold stool, clear urine, Damp-Cold); Ru Xie (heavy limbs, weakness, profuse water, severe Dampness); Hua Xie (incontinence, Dampness overwhelming Qi). Additionally: Yellow undigested food indicates Wei Xie (Stomach); abdominal distension, vomiting after eating indicates Pi Xie (Spleen); urgency, white stool, cutting pain indicates Da Chang Xie (Large Intestine); pus/blood in stool, lower abdominal pain indicates Xiao Chang Xie (Small Intestine); tenesmus, inability to pass stool, urethral pain indicates Da Jia Xie. For diarrhea with scanty urine, promote urination first. For food stagnation, purge food first. For elderly/deficient diarrhea, tonify Spleen. For post-illness diarrhea, regulate Stomach. Treat the root. Do not assume all diarrhea requires diuresis.

Jaundice: Caused by damp-heat steaming. Classified into five types: Huang Han (Yellow Sweat), where sweat stains clothes like cypress juice; Huang Dan (Jaundice), with yellow skin/sclera and urine, but no sweat; Gu Dan (Grain Jaundice), from dietary spleen injury; Jiu Dan (Wine Jaundice), from dampness after drinking; Nu Lao Dan (Female Labor Jaundice), from sexual exhaustion damaging Yin. All fall under Yin or Yang patterns. Yang patterns are excess-heat; Yin patterns are deficiency-cold. Luo Qianfu detailed these distinctions.

Xiao Ke (Wasting-Thirst): Divided into Upper, Middle, and Lower. Upper Xiao: Extreme thirst, drinking constantly, pathology in Lung. Middle Xiao: Polyphagia without weight gain, pathology in Spleen. Lower Xiao: Dark/scanty turbid urine like paste/fat, dark face, sunken eyes, emaciation, pathology in Kidney. Classics state: "Binding of Two Yangs causes Xiao." Also: "Diseases of Two Yangs affect Heart and Spleen, transmitting as Feng Xiao." "Heart transferring cold to Lung causes Lung Xiao: drink one part, urinate two parts; fatal." "Heart transferring heat to Lung causes Ge Xiao." Do not rigidly apply Danxi’s unified treatment for the five jaundices without differentiation.

Tan Yin (Phlegm and Fluid Retention): Distinct yet related. Yin stems from food stagnation, primarily affecting Spleen/Stomach. Tan moves with Qi, appearing everywhere. "Phlegm generates hundred diseases" means diseases generate phlegm, not that all diseases stem from phlegm. Etiologies include external pathogens and internal injuries. For external causes, guide the pathogen; once expelled, phlegm resolves. For internal causes, treat the underlying imbalance; upon Qi transformation, phlegm dissipates. Treating phlegm alone without addressing the root is ineffective.

Bu Mei (Insomnia): Caused by excess pathogens disturbing the Spirit or deficiency of True Yin failing to anchor the Spirit. Both reduce to Excess and Deficiency. Huangdi asked why some sleep excessively. Qibo replied: Such individuals have large intestines, damp skin, and unresolved intermuscular spaces. Wei Qi travels Yang during day, Yin at night. Sleep begins when Yang exhausts; waking begins when Yin exhausts. Prolonged retention of Wei Qi in Yin causes excessive sleep.

Zheng Chong (Palpitations): Characterized by palpitations, anxiety, and restlessness. Jing (Startle) is sudden external stimulation. Ao (Agitation) is deep frustration and distress. Ji (Frightened Palpitation) is fear-induced trembling, akin to being hunted, caused by Heart deficiency and Gallbladder timidity. Jian Wang (Amnesia) stems from Heart and Spleen deficiency. Meng Yan (Nightmares) results from Heart-Kidney non-interaction and scattered Spirit; treatment involves nourishing Heart and Kidney for peace.