Library

Teng Dangong was a native of Nanchang, Yuzhang. At the age of five, his mother suffered from a febrile disease and craved cold melons (Han Gua), which were not produced in the local customs. Dangong searched everywhere but could not find any. Soon he encountered a Buddhist monk (Sangmen) and asked him about it. Dangong explained the situation in detail. The monk said, "I have two melons; I will give you one." Dangong took it back to his mother, and the whole family was astonished. Later, they searched for the monk but could not find where he had gone. (From *History of the Southern Dynasties*.)

Emperor Wuzong of Tang suffered from a heart-heat disease, to which many physicians failed to respond. Xing Daoren from Qingcheng Mountain administered juice extracted from purple pear (Zi Hua Li), after which the illness was cured. Later, when seeking treatment again, there was a苦 shortage of this specific pear. Suddenly, a single tree appeared in Changshan, so the fruit was sealed and presented to the Emperor. After consuming much of it, his irritability was instantly relieved. (From *Continued Compilation of Medical Sayings*.)

Zihehe treated the wife of Chang Zhongming, who experienced heat and pain in both hands whenever winter cold arrived. He stated, "The four limbs are the root of all Yang meridians. In summer, when Yang Qi disperses, there is no pain; but in autumn and winter, when Yang Qi converges, pain occurs." (From *Essential Words Without Triviality*.) He used Sanhua Shenwan (Three-Flower Divine Pill) to vigorously purge, after which the heat was eliminated.

Li Dongyuan treated Zhao Jun, a Jiedushi (Military Commissioner), who was nearly seventy years old. His symptoms included body heat and numbness, weakness in the thighs and knees, sweating during meals, unprovoked laughter, excessive hunger, difficulty with phlegm and saliva, a stiff tongue making speech difficult, hoarseness, and inability to speak clearly. The pulse at the left Cun position was surging (Hong) and large, yet forceful, indicating that pathogenic heat had lodged within the meridians. The three Yang meridities of the hand ascend from the hand to the head; Yin remains latent internally while Yang merges externally, creating an intense fire. Thus, pathogenic heat wanders and scatters throughout the body, causing heat and numbness. Stomach heat causes worms to move; their movement opens the Lianquan acupoint, leading to salivation. Heat damages Yuan Qi, causing weakness in the thighs and knees. When food enters the stomach, Wei Qi does not follow its normal course, causing excessive sweating. Excessive Heart Fire leads to unprovoked laughter. Spleen-Stomach heat leads to rapid digestion and hunger. Decline of Lung Metal leads to voicelessness. Zhang Zhongjing said, "With a subtle and rapid pulse, moxibustion must be strictly avoided, as it can scorch bones and injure sinews, making blood recovery difficult." Zhao Jun's lifestyle involved rich and greasy foods, and he was inadvertently subjected to fire toxins. It was clear that heat damaging the meridians caused this illness. *Neijing* states: "When heat and dampness prevail, treat with bitter-cold herbs, assist with sweet-purgative herbs, and use sour herbs to astringe." Therefore, Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), being bitter-cold, should be the Sovereign herb to purge fire evil and strengthen sinews and bones. Huangqi (Astragali Radix) and Sheng Gancao (Raw Glycyrrhizae Radix), being sweet-cold, should assist in purging heat and consolidating the exterior. Wuweizi (Schisandrae Fructus), being sour, stops sweating and supplements insufficient Lung Qi, serving as the Minister herb. Zhi Gancao (Honey-fried Glycyrrhizae Radix) and Danggui (Angelicae Sinensis Radix), being sweet and acrid, harmonize blood and moisten dryness. Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), being bitter and neutral, target the Shaoyang and Yangming meridians, ascending from earth to heaven, using bitterness to disperse, serving as the Assistant herb. These were chopped and decocted together; the clear liquid was taken orally. Additionally, Miao Ci (miraculous puncture) was applied to the four limbs to drain the roots of all Yang meridians, allowing the twelve meridians to connect and drain fire evil. Within ten days, he recovered completely. This formula was named Qingshen Bqi Tang (Clear Spirit and Replenish Qi Decoction). (From *Shi Xiao Fang*.)

Zihehe said, "In the past, while campaigning upstream on the Jiang River, I treated a boatman. My diagnosis revealed a Five Excess syndrome (Wu Shi). Since childhood, I had studied medical classics and remembered these five excess symptoms, but had never encountered them. Upon seeing the patient, I privately speculated that this could not be treated by standard methods. I prescribed a large dose of purgatives, but the patient showed no reaction. Exhausted in wisdom and resources, I knew not what to do. Suddenly remembering Taohua E Wan (Peach Blossom Calyx Pill), I immediately administered 70-80 pills. He defecated over 200 times, expelling both the previous medicine and new matter. The patient fell into a coma and lethargy, lasting several days before stopping. Because the major illness had departed, natural rest was required. Otherwise, the illness would not subside. Subsequently, I used medicines to harmonize Stomach Qi, gradually increasing rice gruel, until he recovered. (The Five Excesses refer to: surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and mental confusion/oppression.)"

Jiang Zhongfang treated Lady Xiao, who was in her twenties and constitutionally weak. She had suffered from a febrile disease for nearly a month. One night, she suddenly collapsed (Jue). Bamboo sap (Zhuli), ginger juice, and Jiaoxin (Centelli Herba) decoction were forced down her throat. A short while after swallowing, she moved slightly. Upon close examination, severe abdominal pain was found. Asking about her bowel movements, she replied that she had not eaten or passed stool for twenty days. She was given Dahuang (Rhei Radix et Rhizoma) 1 liang, Mangxiao (Natrii Sulfas) 5 qian, Taoren (Persicae Semen) 3 qian, and Danggui (Angelicae Sinensis Radix) 3 qian. The crowd was horrified, saying, "She is constitutionally weak and has been ill for a long time; how can she tolerate this?" I said, "There is another method." Forcing her to take it, she expelled half a bucket of black matter. Immediately afterwards, Renshen (Ginseng Radix) 5 qian was decocted in water to tonify. Because she was originally weak, tonification was necessary after vigorous purging. After more than a month of regulation, she recovered and has since borne three children. This illustrates the error of other physicians who, seeing deficiency, failed to treat the excess.

The wife of Yelü Xiezhen, Vice Director of Military Affairs, suffered from severe melancholy (Chen Yu). Several physicians failed to cure her. Yelü Dilu diagnosed her, stating, "Heat is accumulated in the Heart; drugs cannot reach it. It must be treated with intention." Because of her melancholy, stimulating her to induce madness could vent the toxicity and cure her. He ordered loud drumming in front of her. The next day, she indeed became mad, shouting and cursing, until her strength was exhausted, after which she recovered. (From *History of Liao*, also seen in *Chu Ji*.)

Liu Gongyuan from Shangyang went to Dongting Mountain to treat patients. One patient appeared to have lost their breath (Qi Jue). Liu said, "Do not fear, I will revive him immediately." However, he insisted on watching a drama that night, specifically a martial play. Complying, he had the patient wrapped in felt mats and placed on the stage. Soon, drums and gongs clamored loudly, and the patient stretched and yawned, reviving. (Zhangshi Zhiyan notes: His treatment method is similar to the previous case, so the condition must also be similar.)

Wan Mizhai treated Hu Yinglong, who contracted a febrile disease in May and had not recovered after half a month of treatment. The pulse was wiry (Xian) and rapid (Shu), with nasal bleeding (Bi Nu) occurring every three to four days, and left hypochondriac pain preventing side-lying. First, one fried Zhizi (Gardeniae Fructus) was burned with women's hair to preserve its nature, then blown into the nose to stop the bleeding. Next, Danggui Longdan Wan (Angelica and Gentian Pill) formula was made into a decoction; one dose stopped the hypochondriac pain. Re-examining the pulse, it was wiry, floating, and rapid. He said, "It should be resolved through sweating." This is because Wei Qi does not harmonize with Ying Qi. Guizhi Tang (Cinnamon Twig Decoction) should be used to treat the Yang aspect. Now, since Ying Qi does not harmonize with Wei Qi, Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) combined with Baihu Tang (White Tiger Decoction) should be used to treat the Yin aspect. Harmonizing Ying and Wei allows sweating and recovery. The two decoctions were mixed and drunk. He warned beforehand, "You will experience chills and sweating; do not be alarmed." After two doses, he indeed sweated and recovered.

Hu Longjia contracted a febrile disease in June with high fever, spontaneous sweating, extreme thirst, and a desire to strip naked. The pulse was wiry, large, and empty. Wan formulated a prescription: extracting Zhimu (Anemarrhenae Rhizoma) and Gancao (Glycyrrhizae Radix) from Xiaochaihu Tang (Minor Bupleurum Decoction) and Renshen Baihu Tang, and Dan Douchi (Fermented Soybean) from Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), totaling five ingredients, decocted with Dan Zhuye (Lophatheri Folium), named Sanhe Tang (Three-Harmony Decoction). One dose resulted in recovery.

Miao Zhongchun treated Xin Hanyang, a Quansbu official, with a febrile disease located in the Yangming channel. Symptoms included headache, high fever, extreme thirst, vomiting, dry nose, and insomnia. The pulse was surging, large, and solid. Miao deliberately asked the attending physician, "Is this a Yangming syndrome?" The physician agreed. Asked what medicine was given, the physician replied, "Ge Gen Tang (Kudzu Decoction)." Miao said, "Incorrect." The physician asked, "Is Ge Gen Tang not a Yangming channel medicine?" Miao replied, "There are two exterior-resolving medicines for Yangming: one is Ge Gen (Puerariae Radix), the other is Baihu Tang. If there is no vomiting, Ge Gen Tang is used for exterior resolution. Now, vomiting is severe, indicating reversal of Yangming Qi. Ge Gen has ascending and dispersing properties, so it is unsuitable. Baihu Tang plus Maidong (Ophiopogonis Radix) and Zhuye (Lophatheri Folium), named Zhuye Shigao Tang (Lophatherum and Gypsum Decoction), should be used. Shigao (Gypsum Fibrosum) is acrid and cool, resolving the muscle layer and suppressing/phlegm-heat in the Stomach. Once the muscle layer resolves and heat dissipates, vomiting, irritability, and high fever will cease." He prescribed a large dose and warned the brother, "Attacking Lu Jing requires 600,000 troops; Li Xin with 200,000 will flee." He added, "If medicine is given now, recovery by fifth watch. If given at dawn, recovery by breakfast." This proved true. Someone asked why Banxia (Pinelliae Rhizoma) was not used for severe vomiting. Miao replied, "Banxia has three prohibitions: those with thirst, those with sweating, and those with blood deficiency. The patient is extremely thirsty and vomiting due to blazing Yangming pathogenic heat devouring fluids. Rising evil fire causes vomiting. Banxia is bitter, acrid, warm, and drying, and toxic; it is definitely unsuitable." Doubts arose regarding the omission of Gancao. Miao said, "Vomiters avoid sweet flavors; this is Zhang Zhongjing's rule."

Gong Zicai treated a woman who contracted a febrile disease in summer. Initially treated with formulas to balance Qi and Blood and clear heat/harmonize, but after 2-3 doses, there was no response. Heat increased, tongue coating turned scorched black, fire sensation in the diaphragm, rinsing water without swallowing. Both wrists had deficient and faint pulses, with the right wrist particularly weak. Within 6-7 days, delirium, grasping at empty air, and feeling along clothes/bed occurred, showing all malignant signs. Later, Siwu Tang (Four Substances Decoction) was used with additions: Huangqi (Astragali Radix), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), and Shu Fuzi (Prepared Aconiti Lateralis Radix). After 1-2 hours, sweating occurred and heat subsided. Fever returned the next day, subsiding again after another dose. On the third day, it recurred. Knowing the deficiency was severe, ten consecutive doses with Fuzi were administered, stabilizing the condition. (Li An notes: Febrile diseases sometimes present with such symptoms; this must be known.)

Yu Jiayan treated Wang Yuyuan, who had contracted an external pathogen years prior. Improper treatment caused all body fluids to be scorched by pathogenic heat. Residual heat remained for ten years, causing constant closure of the right ear canal. That summer, he contracted another external pathogen, lingering for over fifty days. Facial and foot edema, restless sleep, and a sensation of air pushing out from the ears occurred. New heat combined with old heat, creating mutual harm, making it difficult to eliminate. Physicians failed to understand the condition, treating blindly. By late autumn, when Metal was cold and Water was cold, the illness retreated naturally. Superficial cases retreat with time; deep ones do not retreat quickly. Yu said, "Facial and foot edema indicates Lung Metal Qi obstructed by heat, losing its clearing, descending, and purifying function. (Facial swelling is accurate; foot swelling is less so; ultimately, it is Yin deficiency with Blood failing to nourish Qi.) Restless sleep indicates dryness of Stomach fluids, failing to nourish Hun and Po. (This explanation is forced; it is due to Yin deficiency with Liver Fire floating into the pericardium collateral.) Fire qi rushing from the ear results from the long-closed orifice; previously unnoticed, now with body debility and no internal obstruction, rebellious Qi rushes upward, becoming noticeable. (Ultimately, it comes down to Yin deficiency.)" Although external symptoms healed, internal regulation via diet and medicine accounts for half the recovery. Two main points are highlighted to clarify post-infection care. After infection, Yuan Qi is deficient, and residual heat remains. Tonifying deficiency here removes heat poorly; clearing heat here burdens deficiency. Even splitting tonification and clearing is vague and misses the essence. However, apart from tonifying deficiency and clearing heat, no other method exists; careful observation is needed. There are two methods of tonifying deficiency: tonifying Spleen and tonifying Stomach. After malaria/dysentery, if digestion fails, tonify Spleen. After typhoid/fever, if Stomach fluids are depleted and new fluids not generated, tonify Stomach. These differ vastly. There are two methods of clearing heat: early-stage heat is excess heat, cleared with bitter-cold herbs; post-major illness heat is deficiency heat, cleared with sweet-cold herbs. (This explanation is profound.) They also differ vastly. The innate Qi of the human body resides in the Stomach mouth. Lack of fluids is deficiency; generating fluids is tonifying deficiency. (Xiong An notes: Eternal truth. Thus, fluid-generating herbs combined with sweet-cold heat-clearing herbs treat post-infection deficiency heat, e.g., Maidong, Shengdi, Mudanpi, Renshen, Pear Juice, Zhu Li. Zhang Zhongjing often uses Tianshui San to clear deficiency heat, taking advantage of the sweet-cool combination of Huashi and Gancao. Xiong An notes: Lung governs Qi of the body; skin/hair are its exterior. Post-infection, Qi recovers but Blood is deficient; foot edema occurs, but unresolved residual heat with Lung Qi stagnation is even more common. Also, if Stomach heat is unresolved, fluids do not return. Classic says: Disharmony of Stomach leads to restless sleep. Ear blockage requires clearing Lung; this differs from tinnitus requiring Yin nourishment.) Tianshui San clears deficiency heat via the sweet-cool principle of Huashi and Gancao. Mistakenly tonifying with Renshen, Huangqi, Fuling, Baizhu would tonify the pathogenic heat along with deficiency. Dietary tonification should focus on Qi, not flavor. Grains and vegetables provide Qi to nourish. During meals, fluid secretion and sweating occur, gradually transporting stored heat out through pores. How refreshing! People ignore this,急于 using rich/greasy foods to tonify. While spirits may seem robust initially, grease blocks meridians, trapping heat. Over time, consolidation makes escape impossible. Ancients, aware of this, preferred bland diets to allow temporary deficiency for easy heat release. This is precious.

Previous doctors attributed edema to Spleen, using Fuling and Baizhu, causing lingering residual heat. This stems from unclear principles of tonifying deficiency and clearing heat.

Note: *Yuyi Cao* contains many insights not previously expressed. However, it also has fragmented and forced explanations. In this case, using sweet-cold herbs to clear heat post-cold is most appropriate. However, distinguishing Spleen/Stomach tonification is vague. Xiong An notes: Treating Spleen and Stomach separately truly enlightens ages. Ye Tianshi benefited greatly from this, impressing Lingtai and Run'an. But it should be stated: Qi deficiency requires Qi tonification; Blood deficiency requires Blood tonification. Post-malaria/dysentery, poor digestion indicates Qi deficiency, suitable for Qi-class herbs like Renshen, Huangqi, Fuling. Post-infection, lack of fluids indicates Blood deficiency, suitable for Shengdi, Maidong, Pear, Bamboo. This is because residual heat remains post-infection. How clear, yet still somewhat biased. Wei's discussions on post-dysentery/malaria are precise. Dysentery leads to Yin loss via diarrhea; malaria leads to fluid consumption via sweating. Poor digestion often stems from ministerial fire excess and true Qi decline. Without large doses of Dong'Er Di (Dongguan, Maidong, Shengdi, Dihuang),缠绵 persists. Discussions on facial/foot edema and restless sleep are superficial.

Lu Yangyu treated Ling Biaobu Zhaoquan, who returned home in summer after excessive fatigue. Nighttime headache felt like breaking, internal heat like fire, insomnia, heavy sweating, short dark urine, yellow tongue coating, right hypochondriac distension/pain. Some suggested dispersing for headache/fever; others suggested tonifying after fatigue. Diagnosis: body heat, panting, shortness of breath, floating-rapid pulse, weak upon pressure. "Heat has damaged Yuan Qi." He used Hejian Guiling Ganlu Yin plus Renshen 1 qian. After a moment, sweating stopped, heat reduced, breathing stabilized, speech resumed. Another dose caused drowsiness. Next morning, floating pulse normalized, deep pulse wiry and forceful. Floating heat removed, internal heat remaining, causing slight hypochondriac/abdominal pain. Danggui Longdan Wan 1.5 qian was given fasting. By afternoon, after eating porridge, bowels moved with black stool, pain decreased. Regulated with Shenmai San.

Lu Xiaoyu treated Lady Shidongting. In April, she had headache and fever. Pulse surging-rapid at Qi Kou. Two doses of clearing/resolving herbs (Chaihu, Ge Gen, Zhizi, Huangqin) were used. One physician argued that headache/fever is Taiyang syndrome; using Chaihu/Ge Gen prematurely draws pathogen into Yangming/Shaoyang. Using cold Zhizi/Huangqin before sweating prevents exterior resolution and drives pathogen inward. (According to orthodox Shanghan Lun, this is correct.) Two doses of Da Qinglong Tang were prescribed. Family gave only one dose. Nighttime: body felt like ants crawling, thirst, dry throat, delirium. Next day, diagnosed as gout, not Shanghan. (The person reads books but treats rashly; perhaps thin fortune and floating Qi, or shallow knowledge and fickle will?) Used Qianghuo, Duhuo, Shouwu, Niuxi for two doses. Result: singing on heights, running naked, cursing without discrimination. Re-diagnosis: female attendants restrained him. Told Shidongting, "This is Yang syndrome; agitation worsens it. Comfort him verbally." He stopped. Sugar water was administered to ease tension. Then Baihu Tang plus Yuanming Fen, Huangqin, Huanglian, Gualou Ren, Xijiao for several doses, stopping cursing. Occasional delirium indicated constipation. Runzi Wan 3 qian was given; 20 dry stools passed at night. Delirium persisted. Previous decoction continued, plus 2 qian pill; more dry stools and some loose stool passed. Three days later, desired porridge. Regulated with Qingqi Yangying Tang.

Lv Dongzhuang treated a servant of Wu Huaya, who contracted heat syndrome while working on a lake in summer, with dysentery of pus/blood and body burning like charcoal. (Since it is heat syndrome, otherwise dysentery with fever is incurable.) "This is Yangming disease, not dysentery. Tongue will be black and dry; delirium at night." This occurred. Pulse was chaotic, intermittent, like sparrow pecking, untreatable. Wu insisted. Reluctantly, Shudi 1 liang, Shengdi, Maidong, Danggui, Baishao, Gancao, Gouqi were used. Warned, "Recovery depends on sweating." Night: heat unchanged, delirium worse, but bloody dysentery stopped. After medicine, slight sweat appeared briefly. Pulse connected clearly, surging-rapid and pounding. "He will live." Same formula, remove Shengdi, add Zaoren, Shanyao, Mudanpi, Shanzhuyu. (Modifications were inappropriate.) Six doses. Family requested change due to severe confusion/heat. Lv told them to wait, promising life. Re-pulse: gathered and round. "Now I will remove the disease." Sishun Qingliang Yin plus Shudi 1 liang, Dahuang 5 qian administered. Dozens of black stools passed, symptoms resolved. Two days later, dusk: sudden madness, fever, panting, thirst. This was returning Yang to produce sweat. Baizhu 1 liang, Huangqi 1 liang, Ganjiang 3 qian, Gancao 1 qian, Danggui, Baishao 3 qian each. Full dose: profuse sweating, slept soundly till dawn, recovered suddenly.

Note: Tonify then purge, then tonify then sweat. Treatment is good. However, in early stages, combining with Tianshui Xiexin might have prevented such danger.

Yang Chengliu's clan brother suffered heat syndrome for 6-7 days without relief. Thirst, constipation, madness climbing walls/roofs, running naked, delirious cursing, discarding covers, refusing clothing, for five days. Yang returned from trial in Zhaoshang. Patient said, "The saving star has arrived." Asked who, replied, "Brother Yunfeng is back." Yang arrived, family amazed. Observation: face lacked spirit, eyes staring fixedly, speech/movement strong/powerful. Thought: Stomach heat overwhelming Heart, confusing spirit. Otherwise, why thirst, constipation, White Tiger/Liangge symptoms? Pulse: vast and boundless, empty upon deep pressure. Tongue: yellow with black, moist not dry. Diagnosis: Yin excess internally forcing Yang outward. Strength is false heat, true cold internally. Yang Qi severely deficient, Spirit not housed, Primordial Spirit fleeing, hence anticipating arrival. Yangrong Tang plus Fuzi, doubled Zaoren, Wuweizi, Baishao, decocted thickly. One dose: madness ceased, exhaustion, slept fully, thirst stopped, appetite returned, bowels moved. Continued with Buzhong Yiqi Tang plus Baishao, Wuweizi for recovery.