疟有中三阳者。有中三阴者。在太阳为寒疟，在阳明为热疟，在少阳为风疟，在三阴为湿疟，远者为痃疟。症有表里寒热虚实之分。己丑冬，余居里门，及门刘子铣患疟，间日一发，人见形体瘦弱，井有盗汗，疑为虚象，与以补剂。旬余，病益剧。余诊之，面色晦浊，脉象浮紧而弦，知是表邪尚盛，治不可补，补之适助其邪，用小柴胡汤去人参，合香苏散以疏解之，数剂即愈。丙申冬，余至天津，刘君斐然患三阴疟，已经数月，迭进疏解药，盗汗体疲，饮食减少，夜寐不安。来延余诊，脉象虚弦，知是正气亏极，阴分亦损，用补中益气汤加桂枝干姜地黄鳖甲，十数剂而治愈。以上二症，一表一里，一实一虚，表实则祛邪，里虚则补正，皆治疟常法，然又有始疟而不终于疟者，似疟而不得为疟者。壬辰冬，余客津门，周庚五观察之夫人，患疟七日，忽然神昏，气促汗多，谵语不已，来延余诊。脉虚微漏数，审是少阳客邪，袭入血室所致。用小柴胡汤去甘草、半夏，加生地，丹皮、桃仁，红花，一剂，谵语平，诸症减。再承前意加味补益之，数剂即安。其后周君谓余曰；当初诊之夕，药虽煎就，吾疑此方与疟邪不合，及既饮以后，乃知此药竟神效非常，道之所以异于人者，固如此乎。答曰：何异之有，不过随时论症耳。此症初起，邪在少阳，故寒热往来，继则少阳客邪，乘月水之来，潜入血室，所以神昏谵语，至气促汗多，非气虚所致，即药误使然，如法而治，应手何疑。所虑者，人之执一不通耳。丁酉四月杪余客津门，小站右营文案丁君铁臣，患病十余日，口渴烦躁，胸腹拒按，溺赤便结，寒热间日一发，症势颇危，以车速余往诊。际疾无伦，约有十至，知是温邪夹滞，由少阳侵入少阴，所以寒热如疟。用元丹汤、羚地枳实汤、承气汤等方，出入加减治之而愈。若以小柴胡常法治，其能转危为安乎。
内为胀，外为肿。其症，有气、有血、有虫、有单腹，不独水之一症也。而一症中，又有阴阳虚实新久之殊。治法总以健脾为主。余随症之所因，按症施治可矣。丙中秋，余客部门，有罗某患水肿半年，转重转剐。余治之，用五皮饮加白术等味，补益而愈。丁酉夏，余客天津，吕鹤孙别驾患水肿症，初从腹起，继则头面四肢皆肿。余切其脉，浮举缓大，沉按细弱，知是脾虚湿侵，用黄芪建中汤理中汤五皮饮五苓散加减治之而愈。此皆阴水为患，故治从乎阳，若系阳水为患，又治从乎阴。甲午，余客都门，正月初，叶茂如中翰邀余往，为温姓治一水肿症。据云：向有痰饮，时发时愈。去年秋冬之交，痰饮又发，初起咳嗽气喘，继而头面四肢浮肿，缠绵三阅月，愈治愈剧，今则胸闷腹胀，饮食不进，饮水即吐，溺涩便结，烦躁不寐，已十余日，诸医束手，以为不治，奄奄一息，将待毙矣。切其脉，细涩沉数，舌苔微腻而黄。余思此症，外象虽危，并非败象，不过正虚邪盛，治少专方耳，合加味肾气丸，舟车丸、五皮饮、麦门冬汤法，以意去取，配成一方。明日，主人贻余一纸书曰：昨晚服药后，至今晨，病已愈十之三四。并约再诊。余视之，病势果轻。仍用前方加减，又服三剂，病情大减。或问其故，余曰：此症始终不外脾土一藏，牌土之用，可借西医之说明之，西医言近胃处，有甜肉一条，甜肉汁入胃，饮食自化。夫甜肉即睥，脾本甘所生也，甜肉汁即脾中精汁。盖脾脉至舌本以生津液，便是精汁也。凡人饮食入胃，全赖牌中精汁，入胃为之运化。此汁苟亏，阴不济阳，阳气上蒸，痰饮发矣。令人一见痰饮，便用白术、半夏等药以燥土，土中精汁，被药却干，生气全无，堤防失职，肿胀成矣。又用猪苓、泽泻等药以导水，贼水未除，真水已竭，其始不过脾土阴伤，未几土不生金，金不能制木，木克土矣，又未几金不生水，水不能制火，火，刑金矣。睥肺肾三藏俱病，危症所以丛生。余以益睥土之阴为君，以养肺金为臣，以滋肾水为佐，更以通调二便为使，是即朱丹溪治肿胀之意，又即《内经》洁净府、去菀陈菀之意。盖治水之法，如治河然，既补虚以厚其堤，腹泻实以导其流，水自安澜，无虞泛溢矣，后承是方，随症轻重缓急治之，月余而痊。惟此等重症，痊后，当加意调补，务使起居如昔，饮食胜常，方为复元。否则正气未充，旧恙易泛，发一次，重一次，虽有神丹，恐难为力。慎之戒之。
自汗，有心肝脾肺肾之分，又有阳虚、阴虚、亡阳、卫不固、外感风湿、内因痰火、阴盛格阳诸症。而世之遇自汗者，概作阳虚治。虽曰古法，未免执一不通。辛卯春，余客济南，陈巽卿观察自汗不止，来延余诊。脉象虚微，是为阳虚，势将汗脱，以十全大补汤加味，温补收涩而愈。夏，又患自汗，复延余诊。脉象细数，是为阴虚，与前此阳虚迥别，即以洋参石斛汤加味，清理滋养而愈。拽前后症，出自一人，而前为阳虚，后为阴虚，不同如此。然则春秋寒暑，天时犹有常也，南北高下，地宜犹有常也，贫富劳逸，人事犹有常也。即如春夏有时暴寒，秋冬有时忽温，西北有地向阳，东南有地背阴，贫贱有事快心，富贵有事劳力，天地人虽错综变化，犹可以常理测也，独至随时论症，随症论治，诚有可意会不可言传者。若胶柱而鼓瑟，毫厘之差，即千里之谬矣。
盗汗血虚非祟证
盗汗，有血虚证，有血热证，有少阳证，有阳明证，有酒客睡中多汗证，或因汗出台目后，井见谵语等情，遂以邪祟疑之，愚甚矣。丁亥，同里俞道生之母，来乞《易经》一部。据云：儿病月余，初起头痛，继而盗汗，延今，神昏谵语，目上视，食不进，溺器如新，无秽浊气，病势已危。昨延巫问之，巫盲有鬼为祟，禳之不应，思有以镇之，并求治于余。余审是血虚所致，以十全大补汤去肉桂加五味麦冬为方，一剂，谵语乎，二剂，盗汗止，调养旬余而愈。愈后，或问巫言有鬼，信否?余曰，鬼胡为乎来哉，人苟此心常存，临天帝，质神明，魁将敬惮不遑，安得而祸福之。惟其人乞怜昏暮，蓄计阴私，无时不与鬼为缘，鬼于是侮之弄之，时而为福，时而为祸。若夫平人，疾痛疴痒，乃事之常，千鬼何与，而有时求神祷庙，亦足愈病者。盖病家藉此收心养性，较诸庸医误药，犹胜一筹也。此不服药为中医之说也。
厥逆血虚证
厥有寒厥、热厥、痿厥、痹厥、煎厥、薄厥、风厥、暴厥、骨厥，肝厥之分，或表或里，或气或血，或虚或实，辨清施治，危者可安，特恐躁心乘之，必多贻误。壬辰八月，天津有某姓子，病经月余，厥逆时作，而且两腮肿胀，饮食不进，来速余诊，脉象虚浮细数，知是阴虚生热，热甚生风，并感时气所致，以滋养兼清化法治之。两服后，肿消厥止，又用滋补法调理之。未及两旬，眠食俱安而愈。惟病愈后，两目有时昏暗。余云：此系真阴不足，非调养半年，不能如常，朱丹溪所谓阴虚难疗是也。主人以为迂阔，误听入言，求神可速效，设坛千家，专服乩方。又八阅月而殒。呜呼甚哉!邪说之足以惑众也。如神仙可召而来，丹药可求而得，则汉武诸人，虽至今存可矣。而不然者，书符弄鬼，直妖孽耳。驱而逐之，亦不为过，而人顾信此，以殒其身。命乎，非命乎。
《内经》论头眩，多属于木，以木能生风，风主运动，故时目旋而头眩也。其症有阴阳虚实之分。乙末舂，余寓上海，有程姓闺嫒，早起必头眩欲呕，甚至呕吐酸水，饮食不进，患已多年，医药罔效。曾请治于西入，饮以药水，似效又不甚效。来延余诊，脉象左部弦数，知是肝阴不足，与以益阴汤加味，投剂辄效。丙申冬，余至天津，陈特夫大令室，病经二年，转重转剧，头晕目干，胸胁攻痛，心中荡漾，不自主持。来延余诊，脉象洪数，知是肝阳有余，用羚羊清血汤法，出入加减，调治而愈。乙未冬，余客上海，钱君昕伯病偏中风，言蹇足痿，神疲食减，医治两月，忽患头眩甚重，卧不能转，稍动即旋，来延余诊。脉左三部虚细，右关尺数大，左象为阴虚，右象为阳盛，遂用羚芍地黄汤以益其阴，参连和中汤以治其阳，二剂，头眩若失，起坐自如。此三症也，或为不足，或为有余，或为不足中又有余邪未净，要皆风木为患，治法故大同小异。然更有太阳漏汗不止而头眩，阳明风病善食而头眩，汗吐下后气虚而头眩，素因怯弱血少而头眩，火载痰上而头眩，正气虚脱而头眩，妇人经水适来而头眩，易病真元耗脱而头眩。寒热虚实，各自不同，未可以一法尽矣。
目赤有三，一曰时眼，二曰热壅，三日气毒，古书用羌活吐湿汤、蝉化无比散、龙胆汤、蕤仁膏等方，大率辛凉苦寒之味为多，病久致虚。又有明目地黄汤，益气聪明汤，与一切养阴理气之剂，他若四生丸。补肾丸，夜光椒红丸等方。大抵治肾中火衰，目无精光之宿疾，非治新害赤眼也。而余谓病无定情，治无定法，目症亦然。丙申秋，余入都，吾友赵剑秋病目，红而不肿，溺赤便结，脉来软盘，知是暑火内伏，凤火外然所致，余用凉膈散去芒硝加元参、麦冬、僵蚕，数服即痊。越半月，圈劳复发，误饮人耗散之剂，以致流泪羞明，较前更剧，又延余诊。切其际，濡细而数，盖缘病后写作过劳，又因误药却伤真阴所致，是为重虚，非急与滋补不可。以羚羊、地黄、阿胶、白芍、麦冬、生草，蒺藜、花粉、车前为方。数剂，病势渐平，胃气不旺。仍前方去花粉、车前，加党参、白术，调理而愈。甲午秋，都中有戚某害眼颇重，潘君爽卿代延余诊。两胞赤肿，痛极羞明，珠旁有浮白痕，若生翳然，脉来虚迟细弱。审知此人气血本虚，由虚致寒，适因脑怒动肝，肝木虚火，上乘本窍以致赤肿，所谓真虚似实，真寒似热，此症是已。法当引之使下，非若外感之火，可用清下法析之也。遂以熟地、吴萸，干姜，肉桂、当归、牛膝为方，并嘱冷饮，两服即平。后又加黄芪，党参。白水、炙草，补益而愈。此二症也，前用古人目赤法治之，后取火衰宿疾意治之，病皆应手而效，可知症之寒热虚实有必辨，而新久之说，可不拘已。
咽喉虚实证
咽喉二窍，同出一脘，异途施化。喉在前，连接肺本，为气息之路，主出：咽在后，下接胃本，为饮食之路，主纳，故经云；咽喉者，水谷之道也，喉咙者，气之所以上下也。其症有寒热虚实之分。辛卯春，余客济南，高君仲闻之妾，患咽痈，饮食不进，夜寐不安，身热便闭，病势颇危，用符祝针砭法治之。不应，来延余诊。脉象洪大，审是温邪内蕴，不能下达，迫而上升所致。用三黄泻心汤加石羔，小生地，一剂，痛减，二剂，痛平。后以清养药，调理而愈。乙未夏，余寓上海，有张姓某喉辣心震，举发不时，病由劳怒后得，已经半年，问治于余。余切其脉，浮细而数，知是藏液不充，虚阳上乘所致。以四君子汤加白芍、山茱为方；数剂，症减，后更调治而愈。此二症也，一用苦降，一用甘温，俱应手奏效，乃咽喉病之轻者。他如缠喉风、走马喉风，双单乳蛾、喉疗、兜腮痈、喉疮、喉窟、肺绝喉痹，经闭喉肿、梅核气诸症，轻者亦易疗，重者则至险。考古治法，皆急于治标，而缓于治本。以咽喉为要隘之地，缓则伤人，故治标为急耳。
牙跟肿痛风火证
牙痛，不外风火虫虚，肿痛连腮，风火为多，时症常有之。世每疑为外症，误矣。丙申冬，余客都门，王荩臣大令左偏牙限，连腮肿痛，延余往诊，脉数，左尤有力，审是外风引动内风，兼挟痰火为患。泊以加味元丹汤，二剂，肿消痛止。惟牙跟有粒未消如豆，王君疑是外症，令外科治之。复肿如前，烦躁不安，又延余诊。脉象绝滞，舌苔灰腻，知为误药所致。仍用前法，二剂即平，再加调理而愈。盖病发于表，根则在里，无论非外症也。即遇外症，凭理立方，亦能奏效。丁亥，余授徒于家，及门李浩泉少腹生一疽，跟盘约四寸许，外科名为肚痈，贴以膏药。余知之，令去膏药，治以白虎涤邪汤法，二剂即消。乙未夏，余寓上海，有李姓某左腿生疽二，一大如碗，一小如杯，痛疼异常，坐卧不便。余切其脉，滑大而数，与以一甲黄龙汤法，一剂，已成脓者溃，未成脓者消。丁酉春季，余寓天津，有事至武备学堂，适崔君少和病海底肿痛不堪，有类悬痈。余诊之，脉右关尺数大沉实，知是肠胃湿热下注，治以黄龙解毒汤，二服即平。此三症也，均属外症，以内症法治之，随手奏功，可知外象悉本内因，内患既平，外虞自弭。凡事如是治病其小焉者耳。
阴症辨诬证
Malaria may involve the three Yang meridians or the three Yin meridians. When in the Taiyang (Greater Yang) meridian, it is called Cold Malaria; when in the Yangming (Bright Yang) meridian, it is called Heat Malaria; when in the Shaoyang (Lesser Yang) meridian, it is called Wind Malaria; when in the three Yin meridians, it is called Dampness Malaria; and when prolonged, it is called Xuan Malaria (malaria with palpable masses). Symptoms are classified into exterior and interior, cold and heat, deficiency and excess patterns. In the winter of the Jichou year, residing in my hometown, my student Liu Xi suffered from malaria, occurring every other day. Observers noted his emaciated and weak physique along with night sweats, suspecting a deficiency pattern, and administered tonifying agents. After more than ten days, the condition worsened. Upon examination, I observed a dull and turbid complexion and a floating, tight, and wiry pulse, indicating that the exterior pathogenic factor remained strong. Treatment should not involve tonification, as doing so would only assist the pathogen. I prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Ginseng removed, combined with Xiang Su San (Fragrant Perilla Powder) to disperse and resolve the exterior. After several doses, he recovered. In the winter of the Bing Shen year, I traveled to Tianjin, where Liu Feiran suffered from Three-Yin Malaria for several months. Repeated use of dispersing and resolving medications led to night sweats, fatigue, reduced appetite, and insomnia. Upon consultation, his pulse was deficient and wiry, indicating extreme depletion of righteous Qi and damage to the Yin aspect. I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) supplemented with Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), Di Huang (Rehmannia Root), and Bie Jia (Turtle Shell). After more than ten doses, he was cured. The above two cases represent one exterior and one interior, one excess and one deficiency. For exterior excess, expel the pathogen; for interior deficiency, tonify the righteous Qi. These are standard methods for treating malaria. However, there are cases that begin like malaria but do not conclude as such, or appear like malaria but are not. In the winter of the Ren Chen year, staying in Tianjin, the wife of Inspector Zhou Gengwu suffered from malaria for seven days. Suddenly, she experienced coma, shortness of breath, profuse sweating, and incessant delirium. Upon examination, her pulse was deficient, minute, and irregularly rapid. Careful analysis revealed that this was caused by a guest pathogen in the Shaoyang invading the Blood Chamber (Xue Shi). I used Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Gan Cao (Licorice Root) and Ban Xia (Pinellia Tuber), adding Sheng Di Huang (Rehmannia Root), Mu Dan Pi (Tree Peony Bark), Tao Ren (Peach Kernel), and Hong Hua (Safflower). After one dose, the delirium ceased and other symptoms subsided. Subsequently, following the original principle, I added ingredients to tonify, and after several doses, she stabilized. Later, Mr. Zhou told me: "On the night of the initial diagnosis, although the medicine was prepared, I doubted whether this formula matched the malaria pathogen. Only after drinking it did I realize its extraordinary efficacy. This is indeed how the 'Dao' differs from ordinary practice." I replied: "What difference is there? It is merely syndrome differentiation according to timing and presentation." Initially, the pathogen was in the Shaoyang, causing alternating chills and fever. Subsequently, the Shaoyang guest pathogen, taking advantage of menstruation, penetrated the Blood Chamber, causing coma and delirium. The shortness of breath and profuse sweating were not due to Qi deficiency but rather a result of incorrect medication. If treated correctly, efficacy is assured. What is worrying is people's rigidity and inability to adapt. At the end of April in the Ding You year, staying in Tianjin, Mr. Ding Tiechen, clerk of the Right Camp at Xiaozhan, had been ill for over ten days with thirst, irritability, abdominal tenderness, red urine, constipation, and alternating chills and fever every other day. The condition was critical, and he was summoned urgently. His pulse was extremely rapid, approximately ten beats per respiration, indicating warm pathogen complicated by stagnation, penetrating from Shaoyang to Shaoyin, hence the malaria-like chills and fever. I treated him using variations of Yuan Dan Tang, Ling Di Zhi Shi Tang, and Cheng Qi Tang (Order the Qi Decoction), and he recovered. Had I used the standard Xiao Chai Hu Tang method, could he have turned from critical to safe?
Edema: Yang Deficiency and Yin Deficiency Patterns
Internal distension and external swelling constitute edema. Symptoms include Qi edema, Blood edema, parasitic edema, and isolated abdominal distension; it is not solely water retention. Within this single symptom category, there are distinctions of Yin/Yang, deficiency/excess, and acute/chronic conditions. The treatment principle generally focuses on strengthening the Spleen. I treat according to the specific cause and symptoms. In autumn of the Bing Wu year, staying in the capital, a certain Mr. Luo suffered from edema for half a year, worsening progressively. I treated him with Wu Pi Yin (Five-Peel Decoction) plus Bai Zhu (Atractylodes Macrocephala Rhizome) and other herbs, achieving recovery through tonification. In summer of the Ding You year, staying in Tianjin, Lv Hesun, a local official, suffered from edema starting in the abdomen and spreading to the head, face, and limbs. His pulse was slow and large on superficial pressure, but fine and weak on deep pressure, indicating Spleen deficiency with damp invasion. I treated him with modifications of Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle), Li Zhong Tang (Regulate the Middle Decoction), Wu Pi Yin (Five-Peel Decoction), and Wu Ling San (Five-Ingredient Powder with Poria), resulting in recovery. These were cases of Yin Water (cold-type edema), so treatment focused on Yang. If it were Yang Water (heat-type edema), treatment would focus on Yin. In spring of the Jia Wu year, staying in the capital, Ye Maoru invited me to treat an edema case for a Mr. Wen. He had a history of Phlegm-Fluid retention, recurring intermittently. In late autumn/winter last year, it recurred with cough and asthma, followed by edema of the head, face, and limbs, persisting for three months and worsening despite treatment. Currently, he had chest oppression, abdominal distension, inability to eat, vomiting upon drinking, scanty urination, constipation, irritability, and insomnia for over ten days. Physicians gave up, deeming it incurable, and he was near death. His pulse was fine, choppy, deep, and rapid; tongue coating was slightly greasy and yellow. I reasoned that although the exterior appearance was critical, it was not a collapse pattern, but rather righteous Qi deficiency with pathogenic excess, requiring a specialized formula. I synthesized principles from Jia Wei Shen Qi Wan (Modified Kidney Qi Pill), Zhou Che Wan (Boat Cart Pill), Wu Pi Yin (Five-Peel Decoction), and Mai Men Dong Tang (Ophiopogon Decoction), selecting appropriate components. The next day, the host sent a letter: "After taking the medicine last night, by morning, the illness had improved by 30-40%." Upon re-examination, the condition had indeed lightened. I continued with modified prescriptions, and after three doses, the condition significantly improved. When asked why, I said: "This case revolves entirely around the Spleen Earth organ. Its function can be explained via Western medicine concepts. Western medicine notes a 'sweet meat' (pancreas) near the stomach; its juice aids digestion. This 'sweet meat' is the Spleen, born of sweetness. Its juice is the Spleen's essence fluid. The Spleen meridian reaches the root of the tongue to generate fluids, which is this essence fluid. Food entering the stomach relies entirely on this Spleen essence fluid for transformation. If this fluid is depleted, Yin cannot nourish Yang, Yang steams upward, and Phlegm-Fluids arise. People seeing Phlegm-Fluids often use Bai Zhu and Ban Xia to dry dampness, drying out the Spleen's essence fluid, extinguishing vital Qi, causing the 'dam' to fail and edema to form. Using Zhu Ling and Ze Xie to drain water removes the pathogen but depletes true water. Initially, it is Spleen Yin injury; soon, Earth fails to generate Metal, Metal fails to control Wood, and Wood attacks Earth; then Metal fails to generate Water, Water fails to control Fire, and Fire scorches Metal. Spleen, Lung, and Kidney are all diseased, leading to critical symptoms. I used tonification of Spleen Yin as the sovereign herb, nourishment of Lung Metal as the minister, nourishment of Kidney Water as the assistant, and regulation of bowels/bladder as the courier. This follows Zhu Danxi’s method for swelling and the Nei Jing’s principle of 'cleansing the fu organs and removing accumulated matter.' Treating water is like managing a river: tonify deficiency to thicken the dam, drain excess to guide the flow, and the water will settle without flooding." Following this prescription, adjusted for severity, he recovered in over a month. Severe cases require careful post-recovery tonification to restore normal routine and diet; otherwise, insufficient righteous Qi leads to relapse, each time more severe. Caution is advised.
Spontaneous Sweating: Yin and Yang Deficiency Patterns
Spontaneous sweating involves the Heart, Liver, Spleen, Lung, and Kidney, and includes patterns of Yang deficiency, Yin deficiency, collapse of Yang, insecure Wei (Defensive) Qi, exterior wind-dampness, internal phlegm-fire, and Yin excess repelling Yang. Yet, spontaneous sweating is often universally treated as Yang deficiency. While this is an ancient method, it is rigid. In spring of the Xin Mao year, staying in Jinan, Inspector Chen Xunqing suffered from incessant spontaneous sweating. His pulse was deficient and minute, indicating Yang deficiency with risk of sweat collapse. I used Shi Quan Da Bu Tang (Great Tonifying Ten-Ingredient Decoction) with additions, applying warming, tonifying, and astringent methods, resulting in recovery. In summer, he suffered again. His pulse was fine and rapid, indicating Yin deficiency, distinct from the previous Yang deficiency. I used Yang Shen Shi Hu Tang (American Ginseng and Dendrobium Decoction) with additions, applying clearing and nourishing methods, resulting in recovery. The same patient presented differently: first Yang deficiency, then Yin deficiency. Thus, seasons, geography, and social status have constants, yet sudden weather changes and individual circumstances vary. While heaven, earth, and humanity follow general principles, syndrome differentiation according to timing and presentation requires intuitive understanding beyond words. Rigidity leads to error; a slight deviation causes great mistake.
Night Sweating: Blood Deficiency, Not Ghost Possession
Night sweating includes blood deficiency, blood heat, Shaoyang, Yangming, alcohol-induced night sweating, or post-sweat exposure leading to delirium, often mistakenly attributed to ghosts. In the Ding Hai year, Mrs. Yu Daosheng sought help for her son, ill for over a month with headache progressing to night sweating, coma, delirium, upward-gazing eyes, anorexia, and clear urine without odor. A shaman claimed ghost possession; prayers failed. I diagnosed blood deficiency and prescribed Shi Quan Da Bu Tang (Great Tonifying Ten-Ingredient Decoction) removing Rou Gui (Cinnamon Bark), adding Wu Wei Zi (Schisandra Berry) and Mai Dong (Ophiopogon Tuber). One dose stopped delirium; two doses stopped night sweating. Recovery occurred after ten days of care. Asked about the ghost claim, I replied: "Why would ghosts come? One who maintains reverence faces heaven and earth without fear of misfortune. Only those engaging in secret, shameful acts invite spiritual harassment. Illness is natural; seeking temples may aid mental peace, surpassing quackery. This aligns with the saying 'not taking medicine is the best medicine.'"
Cold Extremities: Blood Deficiency Pattern
Cold extremities (Jue) include cold, heat, flaccidity, obstruction, frying, pressing, wind, sudden, bone, and liver types, varying by exterior/interior, Qi/blood, deficiency/excess. Accurate differentiation ensures safety; impatience leads to error. In August of the Ren Chen year, a boy in Tianjin suffered monthly episodes of cold extremities with swollen cheeks and anorexia. His pulse was deficient, floating, fine, and rapid, indicating Yin deficiency generating heat, heat generating wind, compounded by seasonal qi. I used nourishing and resolving methods. Swelling and cold extremities resolved after two doses; subsequent tonification restored health within twenty days. However, vision remained dim due to true Yin insufficiency, requiring six months of care, as Zhu Danxi noted regarding difficult-to-treat Yin deficiency. The owner, dismissing my advice, sought quick fixes via spirit writing. The patient died eight months later. Heresy confuses the masses; if immortals and elixirs existed, historical figures would still live. Exorcism is mere superstition; belief in it costs lives. Is this fate or folly?
Vertigo: Yin and Yang Deficiency and Excess Patterns
The Nei Jing attributes vertigo primarily to Wood, as Wood generates Wind, which causes motion, leading to spinning sensations. Patterns vary by Yin/Yang and deficiency/excess. In spring of the Yi Wei year, in Shanghai, a young woman suffered morning vertigo and vomiting of sour fluid for years, unresponsive to treatments. Her left pulse was wiry and rapid, indicating Liver Yin deficiency. I prescribed Yi Yin Tang (Nourish Yin Decoction) with additions, yielding immediate results. In winter of the Bing Shen year, in Tianjin, Mrs. Chen Tefu suffered two years of worsening vertigo, dry eyes, chest/hypochondriac pain, and palpitations. Her pulse was surging and rapid, indicating Liver Yang excess. I used Ling Yang Qing Xue Tang (Antelope Horn Clearing Blood Decoction) with modifications, achieving recovery. In winter of the Yi Wei year, in Shanghai, Mr. Qian Xinbo suffered hemiplegia with speech difficulties and leg weakness. After two months of treatment, he developed severe vertigo. His left pulse was deficient and fine; right Guan/Cun pulses were surging and large, indicating Yin deficiency and Yang excess. I used Ling Shao Di Huang Tang (Antelope Horn, White Peony, and Rehmannia Decoction) to nourish Yin and Shen Lian He Zhong Tang (Ginseng, Coptis, and Middle-Harmonizing Decoction) to regulate Yang. Two doses eliminated vertigo. These cases, whether deficiency, excess, or mixed, involve Wind-Wood pathology, sharing similar treatments. Other causes include Taiyang leak sweating, Yangming wind-pathogen, post-emesis/purgation Qi deficiency, inherent blood deficiency, fire-carrying phlegm, righteous Qi collapse, menstruation onset, or chronic disease depletion. Cold/heat/deficiency/excess differ; one method cannot suffice.
Red Eyes: Cold, Heat, Deficiency, and Excess Patterns
Red eyes include epidemic eye disease, heat congestion, and qi toxicity. Ancient texts use Xin-Lian-Ku-Cold formulas like Qiang Huo Tu Shi Tang, Chan Hua Wu Bi San, Long Dan Tang, and Rui Ren Gao. Chronic cases become deficient. Formulas like Ming Mu Di Huang Tang and Yi Qi Cong Ming Tang nourish Yin/Qi. Others like Si Sheng Wan and Ye Guang Jiao Hong Wan treat Kidney fire deficiency and dull vision, not acute red eyes. Disease lacks fixed forms; treatment lacks fixed methods. In autumn of the Bing Shen year, friend Zhao Jianqiu had red, non-swollen eyes with red urine and constipation. Pulse was soft and slippery, indicating internal summer-heat/fire and external wind-fire. I used Liang Ge San (Cool the膈 Decoction) removing Mang Xiao, adding Xuan Shen, Mai Dong, and Jiang Can, curing him in several doses. Half a month later, recurrence due to labor and mistaken dispersing herbs caused tearing and photophobia. Pulse was soggy, fine, and rapid, indicating double deficiency from labor and erroneous medication. I used Ling Yang, Di Huang, E Jiao, Bai Shao, Mai Dong, Sheng Gan Cao, Ji Li, Hua Fen, and Che Qian Zi. Condition stabilized, but Stomach Qi was weak. I removed Hua Fen and Che Qian Zi, adding Dang Shen and Bai Zhu, achieving recovery. In autumn of the Jia Wu year, a relative had severe eye disease with red/swollen lids, pain, photophobia, and corneal opacity. Pulse was deficient, slow, fine, and weak, indicating Qi/Blood deficiency leading to cold, exacerbated by anger stirring Liver fire. This is true deficiency resembling excess, true cold resembling heat. I used Shu Di, Wu Zhu Yu, Gan Jiang, Rou Gui, Dang Gui, and Niu Xi, advising cold intake. Two doses resolved it. Later, Huang Qi, Dang Shen, Fu Ling, and Zhi Gan Cao restored health. Former case used classical red-eye methods; latter used fire-deficiency principles. Both succeeded, proving the necessity of differentiating cold/heat/deficiency/excess over rigid acute/chronic classifications.
Throat and Pharynx: Deficiency and Excess Patterns
The throat (Hou) connects to the Lung, governing respiration (exit); the pharynx (Yan) connects to the Stomach, governing ingestion (entry). Symptoms vary by cold/heat/deficiency/excess. In spring of the Xin Mao year, in Jinan, Concubine of Gao Zhongwen suffered throat abscess with anorexia, insomnia, fever, and constipation. Initial cupping/acupuncture failed. Pulse was surging and large, indicating internal warmth pathogen forcing upward. I used San Huang Xie Xin Tang (Three-Yellow Draining Heart Decoction) plus Shi Gao and Xiao Sheng Di Huang. Pain subsided in one dose, resolved in two, followed by clearing/nourishing herbs. In summer of the Yi Wei year, in Shanghai, Mr. Zhang suffered burning throat and heart pain after labor/anger for six months. Pulse was floating, fine, and rapid, indicating insufficient Yin fluids and floating Yang. I used Si Jun Zi Tang (Four-Gentlemen Decoction) plus Bai Shao and Shan Zhu Yu. Symptoms improved in several doses. These mild cases responded to bitter-draining and sweet-warming methods respectively. Severe cases like缠喉风 (Wind-Entangling Throat) or 走马喉风 (Running-Horse Throat) are dangerous. Ancient methods prioritize symptomatic relief (biao) over root treatment (ben) due to the throat's critical location.
Gum Swelling: Wind, Fire, and Toxin Patterns
Toothache stems from wind, fire, parasites, or deficiency. Swelling connecting to the cheek is usually wind-fire. In winter of the Bing Shen year, in Beijing, Magistrate Wang Jincheng had left-sided gum/tooth swelling and pain. Pulse was rapid, stronger on the left, indicating external wind triggering internal wind with phlegm-fire. I used Jia Wei Yuan Dan Tang. Swelling/pain resolved in two doses, but a bean-sized nodule persisted. Surgical intervention caused recurrence and irritability. Pulse became stagnant; tongue coating gray/greasy, indicating medication error. I repeated the internal method, resolving it in two doses. Disease appearing on the surface has internal roots; internal treatment works even for external appearances. In the Ding Hai year, student Li Haoquan had an abdominal carbuncle. I ordered removal of plaster and treatment with Bai Hu Di Xie Tang (White Tiger Eliminating Pathogen Decoction), resolving it in two doses. In summer of the Yi Wei year, in Shanghai, Mr. Li had two leg carbuncles (one bowl-sized, one cup-sized) with severe pain. Pulse was slippery, large, and rapid. I used Yi Jia Huang Long Tang (Yellow Dragon Decoction with Turtle Shell). One dose drained pus and resolved unripe ones. In spring of the Ding You year, in Tianjin, Cui He suffered painful perineal swelling resembling a suspended abscess. Pulse right Guan/Cun was surging, large, deep, and solid, indicating damp-heat sinking from intestines/stomach. I used Huang Long Jie Du Tang (Yellow Dragon Detoxification Decoction), resolving it in two doses. These external cases treated internally succeeded, proving external signs stem from internal causes. Healing the internal resolves the external.
Refutation of Misconceptions Regarding Yin Syndromes