少腹正中，为任冲分野，厥傍，为厥阴肝经分野，其痛满有三，曰燥结，曰热结，曰血结，皆为内有留着，非虚气也。甲午，都中有胡某，少腹气痛，上冲两胁，日夕呻吟，甚且叫号，并见面赤汗淋，溺少便结等症，宋延余诊。切其脉，痛极而伏，按之许久，指下隐隐见细数而浮之象。审是阴不济阳，阳气炽张，横逆无制所致，法当敞通下窍，使浊阳不上千，诸症斯已。用清润汤加羚羊角，一剂，二便通，痛遽平。后承是方加减而愈。时有自命为知医者，进而问曰；热则流通，通则不痛，凡治腹痛，总以温痛为宜，今用清利，其偶然乎?答曰；固哉，予之论治病也。夫热则流通一证，是与寒则凝滞对待而言；通则不痛一语，是统言寒热虚实，通字当作和字解，犹言和则不痛也。今子牵合言之，是诬书之通者而不通矣，其能令病之不通者而通乎。且温通与清利，治法何常之有。子谓治腹痛总以温痛为宜，此等识见，真如井底蛙。蛙日处井中，因以为天极小，只有寒气与湿气，殊不知井以外，风火燥暑四气，较寒湿而倍之。并寒湿二气，久之亦从火化乎。况乎五志之火，六欲之火，七情之火，入固无在不与火为缘乎。惟寒邪初中，寒食留结，或房劳致损，或力役致伤，与夫病久误治致虚，则不得用清利之剂，又当温而通之，更温而补之。总之病无定悄，治无定法，可温则温，可清则清，可通则通，可补则补，随症论治而已，若执一见以治病，其不误人者几希。
疝痛新久虚实证
《内经》云：任脉为病，男子内结七疝，冲疝、狐疝，癞疝、瘕疝、溃疝，水疝、厥疝是也。又有偏坠、膀胱气、小肠气，其病亦与疝等。或因寒积，或因湿热，或为气，或为血，或为虚。或为实，治之者，明辨无讹，可矣。乙未，余寓上海，有宁波孙某患疝症，据述腰以下，牵引作痛，丸囊皆肿，午前轻，午后重。病经四年，赝治不效。余切其脉，虚数细弱，知是下焦湿浊，未能早除，留恋四年，真元受损巳极，非大为补正，更佐温化不可。用十全大补汤加川楝子、橘核、吴萸为方，数十服而愈。丙申春，王君舒仲患左丸偏坠，有筋作痛，牵连及腰，脉来沉数，尺较有力，知是湿热蕴伏下焦，非急为清化不可。余用大力军汤加川黄柏、制僵蚕为方，十数服而愈。庚寅夏初，余客天津，杨艺芳观察之族侄某，病小腹痛，牵引辜丸，转侧呻吟，势不可忍，井时见吐逆等症。医与温补药，不效，饮食少进，夜寐不安，病情尤剧，宋延余诊。脉象迟缓而涩，余思温补颇是，而不见效，缘桂附不得干姜不热也，仍前方加干姜五分，服后，吐逆即平，惟少腹及肾丸痛如故，而脉象顿数，盖前此火为寒郁，今则寒从火化。治盲先清而后温者，亦有先温而后清者。阳以济阴，阴以济阳，调剂焉底于平而已。用地黄汤去山茱加川连、黑栀，数服而愈。以上三证，一则温而补之，一则清而道之，一则始温补而终清理之，均应手而效。可知疝症虽小，不能执一法相绳也。
腿痛一症，有气血风湿寒热虚实之跦，治法，亦有标本之别。戊子冬，吾同里友杨怀冰，因母患腿膝痛，不能屈伸，稍动，即酸楚难忍，经数医诊治，饮食减而神益疲，邀余往诊。余切其脉，虚数而涩，知是衰年气分不足，偶因劳乏，经络停瘀所致。用补中益气汤桃仁四物汤加减为方，两剂后，痛若失，屈仲自如，饮食增，精神亦振。或问其故，余曰；治病之道，譬如行路，由东至西，咫尺间事耳，君子遵道而行，顷刻可到，若令盲者处此，东西迷于所向，虽劳劳终日，卒不能尽其程。无他，明不明之分也。夫人当半百以后，中气就衰，勉力劳役，停瘀致痛，症虽实而气益虚，彼误为痛风者无论矣-其明知血瘀作痛，恣用破耗之剂，而不见效者，亦治其末，未顾其本，犹之以寇治寇，恶者未能去，善者已罗其殃，究非上策。余用补中益气法，以扶其正气，更佐养血行瘀法，以祛其邪滞，正固而邪自去，邪去而正益理，所谓仁至义尽，王者之师，犹有不获安全者，无是理也，
痢疾表里寒热虚实证
今之痢疾，即古之肠擗，其症有表里寒热气血虚实之殊。辛卯秋，入都应试毕，李新吾太史宋速余诊。据云；腹痛后重，下痢甚剧，五月初起，绵延至今，百有余日，日十数次，似脓似血。前医曰烂肠瘟，时用附子，时用大黄，时用人参，时用莱菔子，温凉补泻，诸法迭试，均不见效。余诊之，脉象细疾，面色黑瘦异常，舌苔黄薄贴紧，知是邪盛正虚，垂危之症，用神效治痢散补中益气汤加减治之，共三阅月而安。壬辰夏季，佑三观察至北通州，适病痢，以书速余往，黄昏时，余始至。诊其脉，滑而数，知是跋涉长途，感受时令湿热所致，与以葛根治痢散加味，天甫明，痢已愈。合观二症，可知治新病易，久病难矣。然而治痢之难，犹有数端，一刚宿恙除根，一则刻期奏效，一则老年不能食，一则孕妇胎下坠，庚寅，余客天津，刘伟斋大令患血痢，已七年，医药不效。秋七月，问治于余。切其昧，虚细弦数，知是宿垢未清，本原已弱，合益气汤地黄汤神效治痢散治之，服二十余剂而愈。嗣后，旧恙竟不复发。乙酉，应试金陵，七月杪，秦君湘臣病痢甚剧，日夕数十遍，盛君葵臣代延余诊。切其脉，浮紧沉数，知是浊邪内蕴，寒邪外束，合香薷饮治痢散加减治之，约以七日为期，至八月初四日，果大便如常，眠食俱安而愈。是年，即举孝廉。壬辰，天津官电局书吏沈姓母，患痢月余，日念余遍，食少神疲，用八珍汤加味而愈。己丑，同城小河沿酒业王姓妇，孕已数月，腹痛下痢，胎动欲坠，用补中益气汤加味而愈。此数症者，皆投剂辄效者也。又有以重药治重病，似不效而实效者。甲午秋，应试都门，有余某患痢旬余，予诊之，脉来滑实，知是浊滞内蕴已深。治用毒痢捷效汤。服后，腹痛异常，至明晨，病已愈十之五六，再服，腹不痛而痢即止。可知驱邪如驱贼，贼势大盛，非力能攻而克之。彼必负固不服，迨夫巨魁既拜，协从自散，与虚症之遍地疮痍，急需抚养者情形又大不同，然则痢乌可以一法治乎。虽然，痢之不能以一法治者，非迭用温凉补泻，以药试病之谓也，使以药试病，今日一法，明日一法，后日又一法，法愈多，病愈不可为矣。譬如有人于此，患一虚病，吾治之，自初诊至复元，只有补之一法，即或改方加减，亦如行路然，数武一曲，数里一折，吾不过循由折而奔赴之，无用别户门径耳。设治病者，一方补之，更一方泻之，又”一方温之清之。是犹行路者不识东西南北，往来踯周于其途，迨急不能择，铤而走险，遗祸可胜言哉。丁酉夏初，余客天津，叶君云青之室病剧，来速余诊。据云：向有肠澼宿恙，是年三月，旧恙又发，延今两旬，胸闷腹痛，上吐下痢，日夕数十次，呻吟转侧，食不进，卧不安，症势颇危。余切其脉，疾，右尤盛，知是新邪引动旧邪，中更停滞所致，用枳水和中汤三黄解毒汤等方，加减治之而愈。按此症，痢疾转霍乱，较疟疾转痢疾，更为危险，然而治效不难者，识路故也。
《内经》论泄泻，或言风，或言湿，或言热，或言寒，又言清气在下，则生飧泄。要皆以脾土为主，然泻久未有不伤肾者。且肾伤，又有阴阳之异。肾阳伤，人皆知之，肾阴伤，人海忽焉。辛卯夏，余客济南，奇太守病发热恶寒，头痛身痛，腹满便泄。旬有余日，来延余诊。脉大而缓，舌苔白腻，知是内伤寒湿，井非外感风寒。用理中汤加苍术附片等味，数服而愈。丙申夏，余入都，畅艺芳观察病泄泻，日夕十数次，饮食减少，烦躁不安，延余往诊。脉数，尺尤实，知是暑湿为患。惟年逾花甲，以顾正气为要，先合三黄汤六一散加白术陈皮砂仁为方。二剂，便泄顿止，即改用补益法，不数日而康健如恒，若未病然。秋初，陶端翼主政之子，年十二，大便溏泄，已经数月，食少气弱，病情颇剧，问治于余。切其脉，濡而缓，知是气血两虚，由虚致寒，用补中益气汤加熟地、牛膝、附子、干姜，数十剂而治愈。此三症：—为寒，一为热，一则脾伤及肾为阳虚。寒者温之，热者清之，阳虚者补之。治泻常法，所谓人皆知之者也。至人所忽焉不察者。则有养阴一法，丙申冬，余将出都，有陈姓室，患泄数月，每日必泄五六次，医以为脾土虚寒，用白术以补土，附子以回阳，木香以止泻，便泄如故，而面烧口燥足冷，饮食减少，夜寐不安等证迭见，大似上热下寒，阳虚重症。余切其脉，两寸微甚，左关尺濡迟少神，右关尺滑数有力，乃知证系阴虚，非阳虚也。遂用生地炭壹两，炒怀药、酸枣仁、丹皮，白芍。牛膝数钱，炙草。砂仁、黄柏数分，人参、煨葛根各一钱为方。一剂，泻愈三分之二，脉象俱和。再剂，夜寐安，口燥润。三四剂，饮食甘，面烧平，两足俱温。或问病情奚似，余曰：此症如灯膏然，阳为灯，阴为膏，有关尺为灯，左关尺为膏，脉有力为灯有余，脉无神为膏不足。前用术附等药，譬如膏欲尽而频桃其灯，灯火上炎，膏脂下竭，因见上热下寒之假象。使再燥脾补火，势必膏尽灯灭，阴竭阳亡。余为益阴以称阳，阴复其元，阳得所附，诸症以严，脉象亦起，所谓膏之沃者灯自光也。渠又问用药法，余曰：治病无成法，随时论症，随症论治而已。如必以古法绳之，此即六味地黄汤。补中益气汤合用之意乎。以六味益阴为君，故重用地黄，以补中益气为佐，故不用黄芪，以方中有人参，故用六味汤而去山茱，以方中有地黄，故用补中汤而去当归。恐真阴不固，加黄柏以坚之，恐清阳下陷，加葛根以升之。盖葛根一味，为泄痢圣药。昔张石顽治虚损症，欲用补中益气方者，往往以葛根代升柴，缘升柴劫阴，阴伤者禁用故也。此制方之微权也。
大便不通虚寒证
大便不通，有风秘、痰秘、热秘、冷秘、实秘、虚秘之分。风痰实热，可用润肠丸、控诞丹、四顺清凉饮等方；若冷而虚，当用四神丸之类。壬辰七月，余至天津，杨鹤年之室，病大便不通，旬有余日，人见舌苔微黄，唇口微焦，拟用下药，来延余诊，切其脉，沉而迟。余曰：沉迟为里寒，寒甚则水冻冰凝，投以大剂热药，犹恐不及，若之何下之乎?人曰，时当夏秋，似非冬月可比，大火炎炎，何至中寒若此。余答曰：舍时从症，古有明文，如谓燥热时必无寒症，则严寒时当无热症，昔仲景制大小承气汤，何以治冬令伤寒。可知夏热冬寒者，时之常，而冬不必热，夏不必不寒者，病之变。至唇舌焦黄，又真寒似热之假象。倘误认为热，投以硝黄，热将不救。王太仆曰：承气入胃，阴盛以败，其斯之谓欤。用四逆汤、四神丸意，并加当归半硫丸为方。三剂，便闭依然。主人讶甚，嘱余改方。余曰：坚冰凝结，非用火煎熬至六七昼夜之长，其冻不解。仍前方倍与之，又三剂，夜半，腹中忽痛，大便始通。时有识者愕然曰：如此炎热，吾谓热中者必多，不料此症腹中，一寒至此，然则君子何待履霜，始知坚冰之至哉，后于热剂外，又佐补剂，调治月佘而安。使误认实热；用清下法，寒者必冰结愈坚，虚者即取快一时，来日必复秘愈甚。欲再通之，虽铁石亦难为功，可不慎哉。
痔疮热毒重证
痔证有七，一曰牡痔，二曰特痔，三曰脉痔，四曰肠痔，五曰血痔，六曰酒痔，七曰气痔，有藏肛门内者，有突出于外者，各审所因治之可已。辛卯，应试都门，镇江葛某患痔颇剧，每便一次，肛门肿痛异常，必呻吟半日许，头面臂腕，遍发疮斑。入误认气虚下坠，用补中益气方，病加剧。问治于余。余切其脉，六部数大，知是湿热蕴结，久久不化，酿而为毒，即肠痔、酒痔之类，非急为荡涤不可。用大承气去川朴加川山甲、连翘、银花、生草为方。二剂，痛轻，又二剂，疮斑渐退。后合滋清法治之，月余而愈。惟愈后，当戒酒远色少劳茹淡方妙。若不守禁忌，后必复泛，久而不瘥，将变为漏。慎之戒之。
淋浊新久证
The center of the lower abdomen is the domain governed by the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel); its lateral sides are the domain governed by the Foot Jueyin Liver Meridian. There are three types of pain and fullness in the lower abdomen: dryness accumulation, heat accumulation, and blood accumulation. All of these are caused by pathogenic factors lingering inside the body, not by deficient qi. In the year Jiawu, a Mr. Hu in the capital suffered from Qi pain in the lower abdomen, with Qi rushing upward to both hypochondriac regions. He groaned day and night, and at times cried out loudly. He also presented with a red face, profuse sweating, scanty urination, and constipation. Song invited me to examine him. Upon palpating his pulse, it was hidden due to severe pain; after pressing for a long time, I faintly felt a fine, rapid, and floating quality beneath my fingers. Careful examination revealed that this was caused by Yin failing to control Yang, leading to blazing and rampant Yang Qi that was uncontrolled. The treatment method should be to open the lower orifices, allowing turbid Yang Qi not to invade upward, so that all symptoms would cease. I prescribed Qingrun Tang (Clearing and Moistening Decoction) added with Antelope Horn (Lingyangjiao). After one dose, bowel movements and urination became smooth, and the pain subsided immediately. Later, based on this formula with modifications, he recovered. At that time, someone who claimed to understand medicine approached and asked, "Heat leads to free flow, and free flow means no pain. Generally, treating abdominal pain favors warming and unblocking methods. Why did you use clearing and draining methods? Was it merely accidental effectiveness?" I replied, "Your view is too rigid! 'Heat leads to free flow' is stated in contrast to 'Cold leads to stagnation'; 'Free flow means no pain' is a general statement covering Cold, Heat, Deficiency, and Excess. Here, the character 'Tong' (free flow/unblocking) should be interpreted as 'He' (harmonizing), meaning 'Harmonization leads to no pain.' You are forcing an interpretation, misunderstanding the 'Tong' in the text, thereby creating blockage yourself, how can you expect to make the patient's blockage flow? Moreover, what is fixed about Warming-Unblocking versus Clearing-Draining methods? To say that treating abdominal pain always favors warming is like a frog at the bottom of a well. The frog lives in the well all day and thinks the sky is tiny, containing only Cold and Dampness, unaware that outside the well, Wind, Fire, Dryness, and Summerheat are twice as prevalent as Cold and Damp. Furthermore, Cold and Dampness can transform into Fire over time. Besides, the Fire of the Five Emotions, the Fire of Six Desires, and the Fire of Seven Emotions, once entering the body, are everywhere connected with Fire. Only when Cold Evil initially invades, cold food remains, or damage occurs from sexual excess, physical labor, or prolonged illness treated incorrectly leading to deficiency, should one avoid clearing and draining agents, and instead use warming-unblocking methods, and even warming-tonifying methods. In short, diseases have no fixed patterns, and treatments have no fixed methods. One may warm if appropriate, clear if appropriate, unblock if appropriate, tonify if appropriate, treating according to the syndrome. If one clings to a single viewpoint to treat disease, few will avoid harming people."
New and Old Syndromes of Hernia Pain
The *Neijing* states: When the Ren Mai is diseased, men suffer from seven internal hernias: Chong Hernia, Fox Hernia, Zha Hernia, Jia Hernia, Kui Hernia, Water Hernia, and Jue Hernia. There are also Prolapse, Bladder Qi, and Small Intestine Qi, which are similar to hernias. Causes may include Cold accumulation, Damp-Heat, Qi stagnation, Blood stasis, Deficiency, or Excess. The practitioner must distinguish clearly without error. In the year Yiwu, I resided in Shanghai. A Mr. Sun from Ningbo suffered from a hernia. He reported pulling pain below the waist, swelling of the scrotum, mild symptoms in the morning, and severe symptoms in the afternoon. Having been ill for four years with no effect from various treatments, I palpated his pulse: deficient, rapid, fine, and weak. I knew this was Damp-Turbidity in the Lower Jiao that had not been cleared early, lingering for four years, severely damaging the True Yuan. It required major tonification of Zheng Qi (Upright Qi) assisted by warming transformation. I prescribed Shiquan Dabu Tang (Ten Great Tonifying Decoction) added with Chuan Lianzi (Sichuan Chinaberry Seed), Juhe (Tangerine Seed), and Wuyu (Evodia Fruit). After dozens of doses, he recovered. In the spring of Bing Shen, Mr. Wang Shuzhong suffered from left-sided testicular prolapse with tendon pain radiating to the waist. His pulse was deep and rapid, with the Chi position relatively strong. I determined this was Damp-Heat lurking in the Lower Jiao, requiring urgent clearing and transformation. I used Dali Jun Tang (Great General Decoction) added with Chuan Huangbai (Phellodendron Bark) and Zhi Jiangcan (Processed Silkworm). After ten-plus doses, he recovered. In early summer of Geng Yin, I was in Tianjin. A nephew of Inspector Yang Yifang suffered from lower abdominal pain radiating to the testicles, groaning upon turning, unbearable in intensity, accompanied by vomiting. Previous doctors used warming-tonifying medicines without effect; his diet decreased, sleep was restless, and the condition worsened. Song invited me to examine him. The pulse was slow and choppy. I thought warming-tonification seemed correct but failed because Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) do not generate sufficient heat without Ganjiang (Dried Ginger). I added 5 fen of Ganjiang to the previous prescription. After taking it, vomiting ceased, but lower abdominal and testicular pain remained, and the pulse suddenly became rapid. This indicated that previously, Fire was constrained by Cold, but now Cold transformed into Fire. Treatment sometimes clears first then warms, sometimes warms first then clears. Yang nourishes Yin, and Yin nourishes Yang; proper regulation achieves balance. I used Dihuang Tang (Rehmannia Decoction) removing Shanzhuyu (Cornus Fruit), adding Huanglian (Coptis Rhizome) and Heizhi (Black Gardenia). After several doses, he recovered. The above three cases were treated with warming-tonification, clearing-guiding, and starting with warming-tonification ending with clearing-regulation, respectively, all effective. Thus, although hernia is a minor disease, one cannot adhere to a single method.
Deficiency and Excess Syndromes of Leg Pain
Leg pain has distinctions of Qi/Blood, Wind/Damp, Cold/Heat, and Deficiency/Excess; treatment methods also differ between root and branch. In winter of Wuzi, my fellow townsman Yang Huaibing sought help for his mother, who suffered from leg and knee pain, unable to flex or extend. Slight movement caused unbearable soreness. After several doctors treated her, her diet decreased and spirit faded. I palpated her pulse: deficient, rapid, and choppy. I diagnosed insufficient Qi in the Qi aspect due to advanced age, combined with meridian stasis from occasional fatigue. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Taoren Siwu Tang (Peach Kernel Four Substances Decoction) with modifications. After two doses, the pain vanished, flexibility returned, diet improved, and spirit revived. Someone asked why. I said, "Treating disease is like walking; going east to west is a short distance. A gentleman follows the path and arrives quickly. If a blind person were there, lost in direction, despite all-day toil, they would never finish. It is simply a matter of clarity. After fifty, Zhong Qi (Middle Qi) declines. Forcing labor causes stasis and pain. Although the symptom appears Excess, the Qi is increasingly Deficient. Those who mistake it for Gout are beyond discussion. Even those who know it is Blood stasis pain but recklessly use breaking-and-exhausting agents see no effect; this treats the branch while ignoring the root, like using bandits to fight bandits—the evil is not removed, and the good suffers. It is not the best strategy. I used Buzhong Yiqi method to support Zheng Qi, assisted by Blood-nourishing and Stasis-resolving methods to remove pathogenic stagnation. When Zheng is solid, Xie (Pathogens) leave naturally; when Xie leaves, Zheng is further regulated. This is benevolence and righteousness to the utmost, like the King’s army—there is no reason for failure to achieve safety."
Exterior-Interior, Cold-Heat, Deficiency-Excess Syndromes of Dysentery
Modern dysentery is ancient Chang Pi (Intestinal Diarrhea/Dysentery). Symptoms vary by Exterior-Interior, Cold-Heat, Qi-Blood, and Deficiency-Excess. In autumn of Xinmao, after completing imperial examinations in the capital, Grand Historian Li Xinwu urgently summoned me. He reported abdominal pain, tenesmus, severe dysentery starting in early May, lasting over 100 days, occurring ten-plus times daily, resembling pus and blood. Previous doctors called it 'Rotting Intestine Plague,' alternating Fuzi, Dahuang, Renshen, and Laifuzi, trying warming, cooling, tonifying, and purging methods without success. My diagnosis: pulse fine and rapid, face dark and emaciated, tongue coating yellow, thin, and tightly adhered. This indicated Exuberant Pathogen and Deficient Zheng Qi, a critical condition. I used Shenxiao Zhili San (Divine Efficacy Dysentery Powder) combined with Buzhong Yiqi Tang with modifications. After three months, he stabilized. In summer of Renchen, Inspector You San came to Beizhouzhou and fell ill with dysentery. He wrote to summon me; I arrived at dusk. Pulse slippery and rapid; I attributed this to traveling long distances and contracting seasonal Damp-Heat. I gave Ge Gen Zhili San (Kudzu Root Dysentery Powder) with modifications. By dawn, the dysentery had healed. Comparing these two cases shows treating new diseases is easy, old diseases difficult. However, difficulties in treating dysentery include: eradicating chronic conditions, achieving prompt results, elderly patients unable to eat, and pregnant women with fetal descent. In Geng Yin, in Tianjin, Magistrate Liu Weizhai suffered from bloody dysentery for seven years with no medical effect. In July, he sought my treatment. Pulse deficient, fine, wiry, and rapid. I diagnosed retained filth not cleared and weakened constitution. I combined Yiqi Tang, Dihuang Tang, and Shenxiao Zhili San. After twenty-plus doses, he recovered, and the old ailment never recurred. In Yiyou, during examinations in Jinling, late July, Qin Xiangchen suffered severe dysentery, dozens of times daily. Sheng Kuichen summoned me. Pulse floating-tight and deep-rapid. I diagnosed internal turbid pathogens and external Cold constraint. I used Xiangru Yin Zhili San (Mosla Drink Dysentery Powder) with modifications, setting a seven-day deadline. On August 4th, stool normalized, sleep and diet were peaceful, and he recovered. That year, he passed the Xiaolian exam. In Renchen, the mother of a clerk at the Tianjin Telegraph Bureau suffered dysentery for over a month, frequent stools, poor appetite, and fatigue. She recovered with Bazhen Tang (Eight Treasures Decoction) with modifications. In Jichou, Mrs. Wang of the Xiaoheyan brewery in the same city, pregnant for several months, suffered abdominal pain and dysentery with threatened abortion. She recovered with Buzhong Yiqi Tang with modifications. These cases responded immediately to medication. There are also cases where heavy medicines treat severe illnesses, appearing ineffective but actually effective. In autumn of Jiawu, during capital examinations, Yu suffered dysentery for ten days. Pulse slippery and solid; I diagnosed deep internal turbid stagnation. I used Dulie Jie Xiao Tang (Poisonous Dysentery Rapid Effect Decoction). After ingestion, abdominal pain intensified. By next morning, 50-60% of the illness had resolved. After another dose, abdominal pain stopped, and dysentery ceased. Expelling pathogens is like expelling thieves; when the thief force is strong, only powerful attack can conquer them. They resist firmly until the leader surrenders, then followers scatter. This differs from deficiency syndromes with widespread sores needing nurturing. Thus, how can dysentery be treated with one method? However, saying dysentery cannot be treated with one method does not mean repeatedly using warming, cooling, tonifying, and purging to test drugs. Testing drugs means changing methods daily, leading to more methods and worse outcomes. It is like a person with a deficiency disease; my treatment from first visit to recovery uses only tonification. Even with formula adjustments, it is like walking: winding paths, bending routes, I follow the bends to the destination, not opening new doors. If a doctor tonifies with one formula, purges with another, warms/clears with yet another, it is like a traveler confused by directions, wandering back and forth. When urgent and unable to choose, they take desperate risks, causing unspeakable disaster. In early summer of Dingyou, in Tianjin, Mrs. Ye Yunqing was critically ill. She had a history of Chang Pi. In March of that year, it relapsed, lasting twenty days, with chest tightness, abdominal pain, vomiting, and diarrhea, dozens of times daily, groaning, unable to eat or sleep, very dangerous. Pulse rapid, especially on the right. I diagnosed new pathogens triggering old ones, with middle Jiao stagnation. I used Zhi Shui Hezhong Tang (Bitter Orange Harmonize Middle Decoction) and Sanhuang Jiedu Tang (Three Yellow Detoxification Decoction) with modifications, and she recovered. Note: Dysentery transforming into Cholera is more dangerous than Malaria transforming into Dysentery, yet treatment was not difficult because the 'path' was known.
Yin-Yang, Cold-Heat, Deficiency-Excess Syndromes of Diarrhea
The *Neijing* discusses diarrhea regarding Wind, Damp, Heat, and Cold, stating that if Clear Qi sinks below, Sundun Diarrhea (undigested food in stool) occurs. All primarily involve Spleen Earth, but prolonged diarrhea inevitably damages Kidney. Kidney damage differs in Yin and Yang. Everyone knows Kidney Yang damage, but often overlooks Kidney Yin damage. In summer of Xinmao, in Jinan, Governor Qi suffered fever, aversion to cold, headache, body ache, abdominal fullness, and diarrhea. After ten-plus days, he summoned me. Pulse large and slow, tongue coating white and greasy. I diagnosed internal Cold-Damp, not exterior Wind-Cold. I used Lizhong Tang (Regulate the Middle Decoction) added with Cangzhu (Atractylodes Rhizome) and Fupian (Prepared Aconite Child). After several doses, he recovered. In summer of Bing Shen, in the capital, Inspector Chang Yifang suffered diarrhea, ten-plus times daily, reduced diet, irritability. Pulse rapid, Chi particularly solid. I diagnosed Summerheat-Damp. Due to being over sixty, protecting Zheng Qi was priority. I first combined Sanhuang Tang (Three Yellow Decoction) and Liuyi San (Six-to-One Powder) added with Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), and Sharen (Amomum Fruit). After two doses, diarrhea stopped immediately, then switched to tonification, recovering fully in a few days. Early autumn, son of Zhu Zheng Tao Duan yi, aged twelve, had loose stools for months, poor diet, weak Qi, severe condition. Pulse soggy and slow. I diagnosed Qi and Blood dual deficiency, Cold from Deficiency. I used Buzhong Yiqi Tang added with Shudi (Prepared Rehmannia Root), Niuxi (Achyranthes Root), Fuzi, and Ganjiang. After dozens of doses, he recovered. These three cases: one Cold, one Heat, one Spleen damage affecting Kidney Yang Deficiency. Cold is warmed, Heat is cleared, Yang Deficiency is tonified. This is the common method for treating diarrhea, known to all. What is overlooked is the method of Nourishing Yin. In winter of Bing Shen, before leaving the capital, a Mrs. Chen suffered diarrhea for months, five-six times daily. Doctors considered Spleen Earth Cold-Deficiency, using Baizhu to tonify Earth, Fuzi to restore Yang, Muxiang to stop diarrhea. Diarrhea persisted, with burning face, dry mouth, cold feet, reduced diet, insomnia, resembling Upper Heat/Lower Cold, severe Yang Deficiency. Pulse: Cun positions slightly extreme, Guan-Chi on left soggy-slow lacking spirit, Guan-Chi on right slippery-rapid strong. I realized it was Yin Deficiency, not Yang Deficiency. I used Shengdi Tan (Charred Rehmannia Root) 1 liang, Chao Huaiyao (Stir-fried Chinese Yam), Suanzaoren (Ziziphus Seed), Danpi (Moutan Cortex), Baishao (White Peony Root), Niuxi several qian, Zhigancao (Honey-fried Licorice Root), Sharen, Huangbai (Phellodendron Bark) several fen, Renshen (Ginseng Root), Weigenqin (Calcined Kudzu Root) each 1 qian. After one dose, diarrhea improved by two-thirds, pulse harmonized. After two doses, sleep peaceful, mouth moist. After three-four doses, appetite sweet, facial heat subsided, feet warm. Asked about the pathology, I said, "This case is like a lamp oil. Yang is the wick, Yin is the oil. Right Guan-Chi is the wick, Left Guan-Chi is the oil. Strong pulse is excess wick, spiritless pulse is insufficient oil. Previous use of Baizhu/Fuzi was like trimming the wick frequently when oil was nearly gone, causing flame to rise and oil to deplete, creating false Upper Heat/Lower Cold. Further drying Spleen and boosting Fire would exhaust oil and extinguish wick, leading to Yin exhaustion and Yang collapse. I nourished Yin to match Yang. Once Yin restored, Yang found attachment, symptoms resolved, pulse revived. As the saying goes, abundant oil makes the lamp shine brightly." Asked about medication principles, I said, "Treatment has no fixed formulas; treat symptoms according to time and condition. If forced to use ancient methods, this combines Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang. Using Six-Ingredient to nourish Yin as Sovereign, hence heavy Dihuang; using Buzhong Yiqi as Minister, hence no Huangqi; since formula contains Renshen, Dihuang Tang removes Shanzhuyu; since formula contains Dihuang, Buzhong Yiqi Tang removes Danggui. Fearing True Yin instability, add Huangbai to firm it; fearing Clear Qi sinking, add Genqin to raise it. Genqin is the holy herb for diarrhea/dysentery. Zhang Shiwan, treating deficiency consumption, often replaced Shengma and Chaihu in Buzhong Yiqi Tang with Genqin, because Shengma/Chaihu consume Yin, contraindicated in Yin deficiency. This is the subtle balance of formula creation."
Deficiency-Cold Syndrome of Constipation
Constipation distinguishes Wind, Phlegm, Heat, Cold, Excess, and Deficiency types. Wind, Phlegm, Excess, Heat may use Runchang Wan (Moisten Intestines Pill), Kongxian Dan (Control Saliva Pellet), Sishun Qingliang Yin (Four-Smooth Cooling Decoction). Cold and Deficiency should use Sishen Wan (Four-Essence Pill). In July of Renchen, in Tianjin, wife of Yang Henian suffered constipation for ten-plus days. Others saw slight yellow tongue coating and scorched lips/mouth, intending to use purgatives. I palpated pulse: deep and slow. I said, "Deep-slow indicates Interior Cold. Severe Cold freezes water; even large doses of hot medicine may be insufficient, how can purgatives be used?" People said, "It is Summer/Autumn, not Winter. With blazing fire, how could Interior Cold be this severe?" I replied, "Abandoning season for symptoms has ancient precedent. If heat seasons have no Cold, cold seasons have no Heat. Why did Zhang Zhongjing create Dachengqi Tang and Xiaochengqi Tang to treat Winter Cold? Summer heat/Winter cold are normal seasons; Winter need not be hot, Summer need not be cold are disease variations. Scorched lips/tongue are true Cold mimicking Heat. Mistaking for Heat and using Xiaoshi (Mirabilite) and Huanglian (Coptis) will fail to save. Wang Taipu said: Chengqi enters stomach, Yin Excess destroys it. This is what he meant. I used Sini Tang (Reverse-Recovery Decoction) and Sishen Wan intent, plus Danggui Banxiu Wan (Angelica Half-Sulfur Pill). After three doses, constipation persisted. Owner was surprised, asked to change formula. I said, "Frozen ice requires fire boiling for six-seven days to melt." I doubled the previous dose, another three doses. At midnight, sudden abdominal pain, then stool passed. Observers marveled, "So hot, I thought many Heat cases, didn't expect such Cold inside. Shouldn't gentlemen predict hard ice from seeing frost?" Later, tonics were added to hot medicines, regulating for over a month to recover. Mistaking for Excess-Heat and using clearing-purging would make Cold ice harder, Deficiency quick relief but worse recurrence later. Re-establishing passage would be impossible even with iron/stone. Caution is essential.
Severe Heat-Toxin Syndrome of Hemorrhoids
There are seven types of hemorrhoids: Mu, Pin (original text Te, likely typo for Pin), Mai, Chang, Xue, Jiu, Qi. Some inside anus, some protruding externally. Treat according to cause. In Xinmao, in capital, Ge from Zhenjiang suffered severe hemorrhoids. Each bowel movement caused extreme anal pain/swelling, groaning half a day, with sores/rashes on head, face, arms, wrists. Previous doctors mistook for Qi Deficiency sinking, used Buzhong Yiqi Tang, worsening condition. I palpated pulse: all six positions rapid and large. Diagnosed Damp-Heat accumulation, unresolved long-term, brewing into toxin, similar to Chang/Jiu hemorrhoids. Urgent purification needed. Used Dachengqi Tang removing Houpo, adding Chuanshanjia (Pangolin Scale), Lianqiao (Forsythia Fruit), Yinhua (Honeysuckle Flower), Shengcaoga (Raw Licorice Root). Two doses, pain lightened; two more doses, sores receded. Later combined with Ziqing (Nourishing-Clearing) method, recovered in a month. Post-recovery, must abstain from alcohol, sex, overwork, and eat bland diet. Without taboos, relapse likely, becoming fistula if chronic. Beware.
New and Old Syndromes of Strangury and Turbid Urine