Library

It is not a case of excess fire burning internally, but rather the floating and outward deviation of deficient Yang. This condition arises from internal injury caused by grief and fatigue. Grief injures the Lung (Lung), and fatigue injures the Spleen (Spleen). When the Spleen is deficient, it cannot generate Lung Qi; when the Lung is deficient, it cannot generate Kidney Qi. Consequently, the storing and securing functions become unconsolidated, leading to the ascent of deficient Yang and the dysfunction of ascending and descending mechanisms. This causes turbid Qi to ascend, resulting in rebellious Qi in the Stomach (Stomach), manifesting as hiccups (hiccups); and Fire wandering upward, manifesting as irritability and thirst. The treatment principle should employ warming and tonifying agents to guide the Qi downward according to its nature, after which all symptoms will naturally subside. Administered *Renshen Guizhi Lizhong Tang* (Ginseng, Cinnamon Twig, and Poria Decoction), the patient recovered after five doses.

Wu Hongxian suffered for seven days with alternating chills and fever resembling malaria, numbness in the hands and feet, profuse sweating like pouring water, palpitations, and mental confusion. The pulse at the Cun (inch) position was empty and large, while the Guan (bar) and Chi (cubit) positions were deficient and choppy. It was stated: "This syndrome is often mistaken by people for external contraction of Wind-Cold, but it is actually an internal injury due to fatigue." A large pulse at Cun and a choppy pulse at Guan and Chi indicate that the Qi of the Spleen and Lung is depleted, and the Yin of the Heart and Kidney is also dried up. Due to Qi deficiency, it cannot ascend and reach the exterior; when Yin overcomes this deficiency, cold sensations arise. Due to Yin deficiency, it cannot nourish internally; when Yang overcomes this deficiency, heat sensations arise. Palpitations and mental confusion occur because Yin fails to govern its functions while Yang disturbs internally. Profuse sweating occurs because Yang fails to govern its functions while Yin escapes externally. Numbness in the hands and feet results from the dual deficiency of Yin and Yang, where both Qi and Blood fail to nourish the limbs. The primary formula used was *Danggui Buxue Tang* (Angelica Sinensis and Astragalus Decoction), supplemented with two qian of Renshen (Ginseng) to tonify the Yang of the Spleen and Lung; Rougui (Cinnamon Bark) and Huanglian (Coptis Rhizome), each 7 fen, to facilitate the interaction between Kan (Water/Kidney) and Li (Fire/Heart); and Guangpi (Tangerine Peel) and Zhigancao (Honey-fried Licorice Root) to tonify the Stomach and harmonize the middle. After one dose, the patient fell into a deep sleep; after the second dose, the sweating stopped. Subsequently, *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) was used to raise and diffuse Yang Qi, combined with Chanshanjia (Pangolin Scales) to dispel internal pathogens, which halted the chills and fever and normalized the pulse. However, upon heavy pressure, the pulse felt slightly weak, and mild hiccups appeared. A large dose of *Guifu Lizhong Tang* (Aconite, Cinnamon, and Poria Decoction) with Dingxiang (Clove) and Banxia (Pinellia Tuber) was administered, leading to recovery after several doses.

Wang Yilin suffered from fatigue-induced illness, characterized by fever, mental cloudiness, and lethargy, persisting for half a month. All treatments had been directed at external contractions without success. The pulses on both sides were floating and deficient, with the right side being significantly more so. This indicated irregular diet and excessive labor, causing Spleen deficiency which led to Stomach Qi deficiency. Instead of ascending to the Yang aspect, the Qi sank into the Yin, generating fever. As Dongyuan explained in detail, internal injuries of the Spleen and Stomach differ from external contractions of Wind-Cold. External contraction injures the form and constitutes an excess syndrome; internal injury injures the Qi and constitutes a deficiency syndrome. Excess syndromes require purgation (sweating, vomiting, purging, or reducing methods); deficiency syndromes require tonification (warming, harmonizing, regulating, and supplementing methods). The Classics state: "For exhaustion, use warmth; for loss, use warmth." And: "For insufficiency of upper Qi, push and elevate it." "For Spleen insufficiency, tonify with sweet flavors." Therefore, acrid-sweet-warm formulas should be used to tonify the center and raise the Yang. *Buzhong Yiqi Tang* was prescribed. After ingestion, slight sweating occurred, but this was not induced sweating; rather, it was the natural discharge of sweat due to the harmony of Yin and Yang. After one dose, the fever subsided; after two doses, clarity of mind returned, and within a few doses, the patient recovered better than before. (Note: Renshen [Ginseng] and Huangqi [Astragalus] are used for Qi deficiency; Shengma [Cimicifuga Rhizome] and Chaihu [Bupleurum Root] are used for sinking Qi. This is the essence of *Buzhong Yiqi Tang*. If Yin Qi is also deficient, Shengma and Chaihu must be used with caution.)

Zhu Danxi treated a patient who originally suffered from internal injury. After sweating and purging therapies, he developed delirious speech. Initially, he could recognize people, but after three days, he spoke nonsense. This indicated that the Spirit was not residing in its house; aggressive attack therapies should be avoided. The pulse was mostly fine and rapid, insomnia was present, feet were cold, breathing was short, complexion was dark brown and bluish, and the nose was dry. *Buzhong Yiqi Tang* was used with half a liang of Renshen (Ginseng) and thirty slices of Zhuye (Bamboo Leaf), decocted and taken, resulting in efficacy.

Miao Zhongchun treated a thirty-three-year-old man who developed symptoms after straining. He experienced fullness in the chest and pain extending down to the umbilicus, where the abdomen felt rigid. The hypochondriac regions felt hollow and loose beyond description. Cold in the abdomen made him seek fire; when warmed, he could sleep briefly and the pain ceased. Bowel movements were obstructed, and urination was scanty and dark like old tea. He could not lie down day or night. By the fifth week, his appetite gradually increased, though attacks persisted. This was attributed to his preference for alcohol, anger, and hard work. The prescription included Dangguishen (Angelica Sinensis Root Body) 5 qian, Niuxi (Achyranthes Root) 4 qian, Maidong (Ophiopogon Tuber) 5 qian, Jiushaoyao (Wine-processed White Peony Root) 5 qian, Zhigancao (Honey-fried Licorice Root) 7 fen, Wuweizi (Schisandra Berry) 1 qian, Juhong (Tangerine Red Peel) 2 qian, Maogen (Imperata Rhizome) 1.5 qian, and Shengdi (Rehmannia Root) 3 qian. He was advised to eat plenty of leeks, infant urine, and walnut meat. (From *Guang Biji*).

Yu Zhongfu suffered from eye pain, feeling as if the eyeballs would fall out, indicating Liver Fire rushing upward. His chest, diaphragm, and back felt as if beaten to pieces, indicating blood stasis due to anger. He coughed day and night, indicating Lung injury due to sorrow. Sleep and appetite were lost, and he despaired of survival. Miao ordered him to drink three large bowls of infant urine. Over seven days, countless amounts of black blood were passed, and the pain ceased. However, cough and fever persisted. A subsequent prescription included Dong'ershen (Tianmen Dong and Maidong), Beimu (Fritillaria Bulb), Suzi (Perilla Seed), Juhong, Shaoyao (Peony Root), Biejia (Turtle Shell), Qinghao (Artemisia Annua), Sangbaipi (Mulberry Bark), Wuweizi, Baibu (Stemona Root), Pipaye (Loquat Leaf), Zhuli (Bamboo Juice), and infant urine. Recovery was slow. The family suspected deficiency and urged the use of Renshen (Ginseng) and Huangqi (Astragalus). Miao refused but secretly added Huangqin (Scutellaria Root) 2 qian to the previous decoction for trial. The patient experienced whole-night stuffiness and heat, unable to close his eyes, finally believing Miao's judgment correct. Adhering strictly to the original formula and taking *Qinhua Wan* (Holding-and-Melting Pill) continuously, he recovered after a month. Yu's illness originated from excessive grief and anger, not deficiency. The Lung was hot and excess, and Liver Fire rushed upward, making Renshen and Huangqi unsuitable. *Qinhua Wan* ingredients: Boheye (Mint Leaf) 3.5 liang, Baibu (wine-soaked, heart removed) 3.5 liang, Maidong 2 liang, Tian Dong (Asparagus Tuber) 2 liang, Mi Zhi Sangbai Pi (Honey-fried Mulberry Bark) 3 liang, Mi Zhi Pipaye (Honey-fried Loquat Leaf) 3 liang, Beimu 2 liang, Jiegeng (Platycodon Root, steamed in rice wash water) 1 liang, Zhigancao 7 qian, Tianhuafen (Trichosanthes Root) 2 liang, Xuanshen (Scrophularia Root) 1 liang, Mi Zhi Wuweizi (Honey-fried Schisandra) 1 liang, Kuidonghua (Farfara Flower) 2 liang, Ziwan (Aster Root) 8 qian, Zhen Shishuang (True Persimmon Frost) 2 liang, Juhong 1 liang. Ground into powder, formed into pill-sized balls with honey, to be held in the mouth and melted before bed.

Xue Lizhai treated a patient with swelling below the ear due to fatigue, accompanied by aversion to cold, fever, headache, and thirst. The right hand pulse was large and soft, indicating a deficiency syndrome. *Buzhong Yiqi Tang* should have been taken. Instead, the patient took exterior-releasing medicines, leading to vomiting, after which he realized his error. He was treated with *Liujunzi Tang* (Six Gentlemen Decoction) and then *Buzhong Yiqi Tang*, resulting in recovery. Generally, in internal injury, Ying and Wei defenses are compromised. Without Qi nourishing the skin, the body cannot withstand Wind-Cold. Sinking of Stomach Qi leads to the rushing up of Yin Fire, causing asthma, fever, headache, thirst, and a large pulse—all signs of deficiency. Irregular diet and excessive labor often lead to internal injury deficiency syndromes. Mistaking these for external excess syndromes and using purgatives causes the disaster of "deficiency adding to deficiency." Dongyuan stated: In internal injury from diet and labor, the right-hand pulse is larger than the left; in external Wind-Cold, the left-hand pulse is larger than the right. This distinguishes them.

Ni Zhongxian treated Lin Zhong, who had fever due to fatigue. The fever fluctuated with the rising and setting of the sun, and food intake decreased. Ni diagnosed it as internal injury, where Yang Qi could not extend and Yin Fire gradually intensified. Heat aggravated it, while coolness relieved it. He administered internal-injury treating herbs, and the disease vanished. (From *Yuanji Qiuwei*).

Zhang Yitian treated a Mr. Zhong who, after lifting heavy weights, experienced slight hypochondriac pain. Days later, he developed fever and body ache, progressing to chest and hypochondriac stiffness. Taking *Da Xiaoxianxiong Tang* (Major and Minor Chest Binding Decoctions) worsened the condition. The left pulse was stiff and rapid; the right Cun and Chi pulses were floating, while the Guan pulse was deep and stagnant. The chest and hypochondrium rejected pressure, and the four extremities were cold. Although resembling *Jie Xiong* (Chest Binding), the failure of *Xianxiong Tang* suggested another cause. Observing yellowish discoloration in the arm muscles and orange-colored sputum, combined with the pulse and symptoms, Zhang determined that excessive effort injured the hypochondrium, causing blood stasis threatening jaundice—so-called "Blood Stasis mimicking Typhoid." Treatment required *Taoren Chengqi Tang* (Peach Kernel and Magnolia Bark Decoction) to purge. However, due to long-standing stasis and previous misuse of attacking/dispersing herbs, Yin Qi was severely damaged. Thus, nourishing Blood was prioritized. Prescription: Shengdi (Rehmannia Root) 2 liang, Danggui (Angelica Sinensis) 8 qian, Danshen (Salvia Root) 4 qian, Taoren (Peach Kernel) 3 qian, Dahuang (Rhubarb Root) 3 qian, Zhishi (Immature Bitter Orange) 2 qian, Mangxiao (Mirabilite) 2 qian, Gancao (Licorice Root) 8 fen. After ingestion, two episodes of purple-black blood clots were passed, fever subsided, and the chest relaxed. Mental clarity remained poor, and the pulse was wiry and soft, indicating injury to Yin collaterals and Spirit deficiency. Treatment with Yin-nourishing and collateral-relaxing herbs led to recovery. (Treating excess while considering deficiency is extremely thorough.)

Shen Mingsheng treated Xu Laiyi, who suffered from external fatigue from studying indoors and internal neglect of sexual restraint. In summer, he indulged in raw and cold foods, leading to abdominal distension, anorexia, borborygmus, and frequent vomiting. Urination was obstructed. Cooling and resolving herbs were ineffective. Shen advocated warming and tonifying, despite opposition. He wrote: "Although stagnation causes middle-fullness, does one not consider that insufficient Middle Qi causes easy abdominal distension and intestinal rumbling? Although rebellious Qi rushing upward is often Fire, does one not consider that Cold-Stomach failing to transform also causes vomiting? Although yellow-red urine indicates internal heat, does one not consider that failure of Qi transformation changes urine color?" Ultimately, diagnosis relies on the pulse. The pulse was deep and weak, with the right Guan position even more faint. Combined with a preference for warmth and fear of cold, this was clearly a deficiency-cold syndrome. First, *Liujunzi Tang* was used with Paojiang (Prepared Ginger) and Zhiren (Alpinia Oxyphylla Fruit). Then, *Bawei Wan* (Eight-Ingredient Pill) was administered, varying the dosage of Renshen, Huangqi, Guizhi, and Fuzi. Recovery occurred within ten days. Subsequent regulation improved his spirit and led to fatherhood.

Wu Qiao treated Chen Long, aged eighty, suffering from cloudy and uncontrollable urination. He sat leaning on a table day and night, avoiding bedding. The six pulses were deep and nearly imperceptible. The old man asked his grandson to help him rise and kneel, saying: "I am old, my descendants have just established themselves. Death is my time. My nephew Jiluan, forty years old, suffers critically from consumption (Phthisis). My family is very poor; five members await food. Please save him. Even if I die, it is better than living." Upon examining the nephew, the room was bare, with only two jars for cooking. The left pulse was level; the right pulse was deficient, large, and rapid. Wu diagnosed: "This is Spleen injury due to worry and thought. Supporting Spleen Earth offers hope. Treatment should tonify the Spleen and suppress the Liver." (This follows the method of *Jinkui Yaolue*). Hearing that Phthisis could be cured, the uncle was overjoyed. The uncle recovered after one or two doses. A month later, the nephew was well, and the couple bowed with their children in gratitude. (From *Taihan Ji*).

Wei Yuheng stated: Wang, a young nobleman in his twenties, enjoyed wrestling. Lifting a stone well curb caused fatigue injury. Later, he developed afternoon fever, cough, hypochondriac pain, pale-blue complexion, and dark circles under the eyes. Various treatments failed. The pulse was wiry and slightly rapid; the right Chi position was weak and choppy. Wei said: "The Kidney is the official of strength, injured by fatigue. The Lung is the mother of the Kidney; the child's disease exhausted the mother's Qi. The Liver is the son of the Kidney; the mother's disease deprived the son of nourishment. Metal fails to generate Water; Water fails to moisten Wood. Dry Wood generates Fire, which insults Metal above and overacts on Earth below. Hence, dark eye circles and cough appear." Prescribed Shengdi, Shudihuang (Prepared Rehmannia), Gouqi (Goji Berry), Shashen (Glehnia Root), Maidong, Digupi (Groundsel Root), and Nvzhenzi (Privet Fruit). After four doses, sudden night sweats poured like rain. The family doubted the medicine. Wei said: "This is a good omen. Fire-dryness damages fluids. Pure-Yin herbs moisten like water in a pot steaming and becoming moister. Thus, depressed heat clears and vessels recover." Asked if sweating could be stopped, Wei replied: "No. Convergence would trap Fire inside. Continue nourishing Metal and Water until Yin and Yang are balanced, and sweat will stop naturally." The patient recovered as instructed.

Sister Jiang, over fifty, became ill after her son suffered from Typhoid for twenty days. Her excessive anxiety triggered her own illness: chills, fever, headache, red face, oral ulcers, and insomnia for several nights. An old doctor diagnosed Shaoyang-Yangming heat and prescribed *Xiaochaihu Tang* combined with *Zhuyeshigao Tang*. The pulse was vast and boundless. Jiang firmly diagnosed it as deficiency Fire floating upward due to fatigue injury, presenting as Daiyang (floating Yang) false heat. Wrong medication would be fatal. She prescribed Shudihuang 1 liang, Rougui 1 qian, Zhigancao 1 qian, Maidong 2 qian, and Dangguishen 3 qian. After one dose, the patient slept soundly. Upon waking, the oral ulcers disappeared, and he recovered instantly. Looking back, *Yangqing Tang* (Nourish Clear Decoction) would have been most appropriate. Later, in her sixties, she suffered another deficiency syndrome. Misusing a single prescription of Huangqi boiled with dates caused generalized edema and shortness of breath upon movement. She recovered only after consuming several jin of Shudihuang.