Library

Zhang Lu stated: Restlessness and inability to lie down are signs of the floating away and exhaustion of Yang Qi in the Kidney. Generally speaking, diarrhea accompanied by cold extremities indicates a critical condition, as the four limbs are the root of all Yang meridians.

If fever, restlessness, and inability to lie down are added, not only does deficient Yang expose itself, but True Yin has also been completely consumed. How can death be avoided?

Vomiting with a weak pulse, frequent clear urination, slight body heat, and the presence of cold extremities indicate a difficult-to-treat condition; Sini Tang (Four Reversal Decoction) is the primary prescription.

[Annotation] In Jueyin disease, vomiting with a weak pulse usually involves frequent loose stools. Now, with frequent clear urination, slight body heat, yet the presence of cold extremities, this signifies that pathogenic factors are reversing upward while the lower Jiao suffers from deficiency-cold and failure to secure. This represents an advance of Yin and retreat of Yang, hence it is difficult to treat. The use of Sini Tang aims to urgently strengthen Yang; once Yang returns, survival is possible.

[Collected Annotations] Fang Youzhi said: Although a weak pulse seems to indicate declining pathogens, frequent clear urination indicates interior deficiency-cold. Hence it is said: the presence of cold extremities makes it difficult to treat. Because there is slight body heat, even with cold extremities, Sini Tang can be used to rescue Yang and restore it.

Cheng Zhi said: This discusses vomiting with cold extremities, which should be treated by warming the lower Jiao. Vomiting is caused by pathogenic reversal upward. A weak pulse and free urination indicate deficiency-cold manifesting in the lower part. Slight body heat suggests Yang pathogens in the exterior; however, the presence of cold extremities indicates Yin excess in the interior, causing concern that the slight Yang cannot sustain itself.

Wang Hu said: Examining various syndromes of cold extremities and diarrhea, they all involve severe loose stools. This clause focuses on vomiting as the main pathology, with unique clear urination and cold extremities, indicating that both upper and lower orifices fail to lock and secure. Sini Tang is used; Fuzi (Aconiti Lateralis Radix Praeparata) disperses cold, directs rebellious Qi downward, and assists the Fire of the Gate of Vitality (Mingmen). It eliminates vomiting above, secures urination below, and restores Yang to reverse cold extremities outside.

Dry retching with expulsion of saliva and froth, accompanied by headache, is primarily treated with Wuzhuyu Tang (Evodiae Fructus Decoction).

[Annotation] Taiyin disease involves vomiting food without the sound of retching; Shaoyin disease involves the desire to vomit without success, coughing, and vomiting; Jueyin disease involving cold extremities and vomiting involves vomiting roundworms. Dry retching here refers to having sound but no substance expelled; expelling saliva and froth means clear, cold saliva and froth are expelled with the retching. This is caused by Cold of the Jueyin meridian invading the Stomach. Headache in the Three Yang meridians is always accompanied by fever. Neither Taiyin nor Shaoyin meridians typically present with headache. Only the Jueyin meridian meets the Du Meridian at the vertex, thus presenting with headache but without fever. This occurs when Shaoyang disease remains unresolved and transmits to Jueyin; Yin pathogens reverse upward, causing vomiting and headache. Wuzhuyu Tang is used to treat the Jueyin root directly.

[Collected Annotations] Cheng Zhi said: This discusses vomiting with headache, which should be treated by warming the Middle Jiao and descending rebellious Qi.

Zhang Xiju said: Vomiting involves both sound and substance being expelled; "Tu" (vomiting/expelling) refers to expelling the substance. Thus, there is dry retching, but no "dry vomiting." Here, dry retching with expulsion of saliva and froth means the froth is expelled along with the retching action.

In cases of vomiting accompanied by abscess pus, one should not treat the vomiting directly; once the pus is exhausted, it will heal spontaneously.

[Annotation] Vomiting with mental restlessness is due to internal heat; vomiting after drinking water due to thirst is due to retained fluids. Now, vomiting with pus indicates an internal abscess. Therefore, it is said that treating the vomiting is contraindicated; one should wait for the pus to be vomited out completely for spontaneous healing. Since the putrid and foul matter of the abscess desires to exit via vomiting, treating the vomiting would go against this mechanism, causing heat pathogens to stagnate internally, blocking the exit route, preventing discharge, and inevitably leading to other complications. Thus, treating the vomiting is contraindicated; once the pus is gone, the heat leaves with it, and vomiting stops naturally.

[Collected Annotations] Wang Hu said: Lung or stomach abscesses arise when Wind-Cold accumulates in the meridians, pathogens stagnate in the Lung, or enter the Stomach organ, transforming into heat. Excessive heat causes Qi stagnation and blood accumulation, forming an abscess. "Abscess" (Yong) means blockage, referring to the accumulation of heat toxins forming pus.

Zheng Zhongguang said: Pathogenic heat reverses upward and knots to form internal abscesses, specifically lung and stomach abscesses.

In Jueyin disease contracted from Wind, a slightly floating pulse indicates impending recovery; if not floating, recovery has not yet occurred.

[Annotation] "Jueyin Zhong Feng" (Jueyin contracting Wind) here refers generally to Shanghan (Cold Damage) diseases. A weak pulse is characteristic of the Jueyin meridian; a floating pulse is characteristic of the Exterior-Yang meridians. If a Jueyin disease presents with a Yang-floating pulse, it indicates the pathogen has returned to the exterior, signifying impending recovery. If not floating, the pulse is deep. A deep pulse is characteristic of Interior-Yin; this indicates the pathogen remains in the interior, signifying non-recovery.

[Collected Annotations] Cheng Wuji said: A floating pulse is a sign that pathogens return to the exterior to sweat out, hence "impending recovery." If not floating, pathogens have penetrated deeply, and Zheng Qi may generate many variations, hence "not recovered."

Fang Youzhi said: Wind pathogens typically present with a floating pulse. Since the Jueyin baseline pulse is slightly slow and not floating, a slightly floating pulse indicates pathogens returning to the exterior, signifying impending recovery.

The time when Jueyin disease tends to resolve is from Chou hour to Mao hour.

[Annotation] The hours of Chou, Yin, and Mao are when the Wind-Wood Qi of Jueyin is prosperous. When Zheng Qi obtains this prosperity, pathogens recede naturally, leading to resolution.

[Collected Annotations] Fang Youzhi said: The resolution of Jueyin begins from Yin and Mao hours and ends there; the resolution of Shaoyang also begins from Yin and Mao hours. Yin hour is when Yang first moves while Yin is still strong; Mao hour is when Heaven and Earth open and Yin and Yang separate. Thus, these two meridians are prosperous simultaneously, and their resolution processes begin and end during this period.