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The disease of Qiangzhong (Strong Middle) is characterized by persistent erection of the penis without flaccidity and spontaneous emission of essence. This is caused by taking Wushi San (Five-Mineral Powder) in one's youth; the heat of the five minerals remains stagnant in the kidneys, causing deficiency-heat in the lower jiao. In one's prime, when blood and qi are abundant, they can restrain the effects of the five minerals. However, as one ages and declines, blood and qi diminish, and kidney deficiency renders it unable to control the essence. If the essence is exhausted, various diseases will arise.

Regarding the "San Mai" (Powder Pulse), it may be surging and solid; or intermittent and insufficient, resembling a death pulse; or fine and rapid; or wiry and fast. This is because sitting, lying, and daily activities involve different violations of dietary and behavioral restrictions, so the pulse has no fixed pattern, making it difficult for physicians to identify. When heat is excessive, the pulse is wiry and rapid; when there are masses, the pulse is surging and solid; when there is acute pain, the pulse is intermittent. The pulses induced by Hanshi San (Cold-Food Powder) are generally like this. If there is no suffering, it is not a death sign. Diligently adhering to regulation and restraint prevents death; failure to do so leads to death.

To take the powder, one should diagnose the pulse; carefully examine the pulse signs, and only then can recovery be achieved. A deep and rapid pulse indicates difficulty in the medicine's activation; if difficult to activate, purgatives should be administered repeatedly. A floating and large pulse indicates ease of activation. Some people take two or three doses of the powder without activation; this is because their pulse is deep and hard to activate. The activation does not make them feel it; the medicinal force acts internally but does not manifest externally. To observe if the medicine is effective: the first sign is increased appetite; the second is downward movement of qi with a harmonious and pleasant complexion; the third is itching of the head, face, and body; the fourth is periodic aversion to wind; the fifth is drowsiness. Those with these signs indicate that the medicine is activating the internal organs without external manifestation. Follow the method of taking the powder without doubt. Repeated purgation causes internal deficiency, leading to natural activation.

Different prescriptions vary: Huangfu Mi advocated only cold methods, while Lord Linqiu advocated warm methods. This largely relates to emotional states. People of the world have not grasped its profound interest, so few use it correctly. However, their methods are incomplete, discussing only the initial stage of taking medicine and the degree of care, but not what happens after activation. The appropriate treatments are often lacking. Dao Hong Daoren from Jiangzuo deeply understood the principles and methods. His cures were miraculous. He formulated the *Jie San Dui Zhi Fang* (Formula for Counteracting Powder Activation), stating:

Zhuru (Stalactite) counters Baizhu (Atractylodes Macrocephala Rhizome) and Gualou (Trichosanthes Fruit). It mainly treats the lungs, connecting to the head and chest. Baizhu stirring Zhuru causes chest fullness and shortness of breath; Zhuru stirring Baizhu causes headache and eye pain. Although Zhuru does not counter Haige (Clam Shell), Haige stirring Zhuru causes eye pain and shortness of breath. Sometimes Baizhu stirring Zhuru directly causes headache and chest fullness. The ailments caused by Zhuru and Baizhu are limited to this. Although the ailments differ, the treatment is the same. At the beginning of activation, investigate the cause. If you feel abnormal sensations corresponding to the above ailments, quickly consume Congbai Chi Tang (Scallion White and Fermented Soybean Decoction).

Also: Huang (Sulfur) counters Fangfeng (Saposhnikovia Root) and Xixin (Asarum Root). It mainly treats the spleen and kidneys, connecting to the waist and legs. Fangfeng and Xixin stirring Huang causes painful irritation and lower back pain, or erratic emotions, or uncontrollable diarrhea. Fangfeng and Xixin can stir Huang, but Huang cannot stir them. At the first sign of activation, consume Duzhong Tang (Eucommia Bark Decoction).

Baishiying (White Quartz) counters Fuzi (Prepared Aconite Lateralis Radix). It mainly treats the stomach, connecting to the spleen and kidneys. Fuzi stirring Baishiying causes irritability and abdominal distension; Baishiying stirring Fuzi causes vomiting and inability to eat, or locked jaw, or difficulty speaking, or pain in hands and feet. At the first sign, consume Sheng Maidong Tang (Fresh Ophiopogon Decoction).

Zishiying (Purple Quartz) counters Renshen (Ginseng Radix et Rhizoma). It mainly treats the heart and liver, connecting to the waist and legs. Renshen stirring Zishiying causes heart anxiety and pain, or palpitations and insomnia; or confusion and forgetfulness, madness; or depression and sleepiness, or irritability and laughter; or fluctuating improvement and worsening, alternating chills and fever; or deafness and dim vision. Although Fangfeng does not counter Zishiying, it can stir it, and Zishiying, due to Fangfeng, stirs Renshen. Stirred Renshen also causes heart pain, irritability, and stiffness of the head and neck. At the first sign, it is suitable to consume Mahuang Tang (Ephedra Decoction).

Chishizhi (Red Halloysite) counters Jiegeng (Platycodon Root). It mainly treats the heart, connecting to the chest and back. Jiegeng stirring Chishizhi causes heart pain, locked jaw, cold extremities, and mental restlessness; Chishizhi stirring Jiegeng causes headache, red eyes, and high fever. At the first sign, drink with warm wine, taking several cups as tolerated. The effect of the wine resolves the condition. Alternatively, consume Damai Liang (Barley). If unresolved, take again.

Baizhu counters Zhuru. Activation of Baizhu causes headache, red eyes, or generalized high fever. The resolution is the same as for Zhuru.

Fuzi counters Baishiying and also Chishizhi. Activation of Fuzi causes vomiting, pain in hands and feet, body stiffness, joint pain, stiff neck, and swelling of the face and eyes. Eating and drinking wine heals it. If not healed, use the resolution for Baishiying.

Renshen counters Zishiying. Activation of Renshen causes irritability and stiffness of the head and neck. The resolution is the same as for Zishiying.

Jiegeng counters Chishizhi, also Fuling (Poria), and Muli (Oyster Shell). Activation of Jiegeng causes headache, red eyes, and high fever. The resolution is the same as for Chishizhi.

Ganjiang (Dried Ginger) has no specific counter-agent.

Some say: Herbal medicines act quickly and stop easily; mineral medicines act slowly and are hard to stop. When taking medicine, herbs and minerals are swallowed together, but their momentum rises and falls with a sequence. Initial efficacy is due to herbs being dominant first, while minerals take time to induce. Herbs stop when small in amount, while mineral momentum has not yet formed. Those who do not understand the waxing and waning of disease think the medicine has completely stopped and take more; or believe the disease is stubborn and the medicine weak, increasing minerals; or mix various minerals. The nature of minerals: their essence combines with the Five Elements, benefiting the five zang organs; their dregs are like ash and soil. Patients with deficient blood and qi cannot circulate freely. Mixing mineral natures suddenly combines them, creating turbid stagnation and firm accumulations. Patients do not realize it is mineral incompatibility, lack of essence release, and inability to generate heat to eliminate disease. They mistakenly believe it is severe cold accumulation and continue taking it. They do not know that minerals have a cold body and hot nature. If the essence does not release, it feels cold as ice. Once minerals enter the abdomen, they become hot. If not immediately hot, taking more worsens the condition. Thus, those with cold accumulation dare not eat cold foods but take large amounts of minerals, worsening their condition due to un-released mineral nature. Some mix mineral pills and wines, taking single minerals initially without stopping, just using the quantity of Da San (Great Powder). These harms lead to many symptoms.

*Duan Ju Fang* (Short Drama Formula) states: Dao Hong Daoren formulated *Jie San Dui Zhi Fang*, explaining the harmony of herbs and minerals, some of which can activate symptoms. People follow easy methods, failing to reflect on ancient and modern formulas. When powder activates, they take remedies hastily, failing to cure the disease and shifting blame. Da San has always been difficult to manage. Those who haven't taken it are cautious. Those expecting benefits take it rashly. Those who have taken it should study rescue methods to save themselves. Having five-mineral medicine at home but no rescuer, trusting new counter-formulas, and following easy methods instead of correct ones wastes life and misuses drugs. Checking *Shennong Bencao Jing*, herb and mineral properties and flavors have no counter-harmony or explicit activation statements. The counter-harmony is based on Bencao. *Da San Fang* discusses main ailments and notes drugs but doesn't explain treatment or activation properties. Huangfu Shi'an's *Jie San Shuo* and guidelines also lack such statements. Lord Linqiu used warm methods to treat discoloration but lacked counter-activation statements. If relative drug properties were divine, Gualou hating Ganjiang would be a major harm. Dao Hong discussed counter-treatment but didn't distinguish this; how can his formula be followed? Now, we do not follow it. Follow Huangfu's guidelines and change Gualou, which is good. For heat ailments, don't take the medicine; only cold ailments take it, naturally removing Gualou. For deficiency consumption and weak legs, replace Gualou with 10 parts Shihu (Dendrobium Stem). For wind-cold upper qi cough, replace Gualou with 10 parts Ziwan (Aster Root). Both methods are excellent. For miscellaneous chronic ailments, just remove Gualou; do not add other things.

Huangfu said: Hanshi medicine is unknown to the world. Some say Hua Tuo, others Zhang Zhongjing. Examining reality: Hua Tuo's subtleties involved simple and concise formulas, while Zhang Zhongjing's classics include Hou Shi Hei San (Black Powder of Hou Shi) and Zishi Ying Fang (Purple Quartz Formula), involving multiple ingredients with similar guidelines. Thus, Hanshi herb and mineral formulas originate from Zhang Zhongjing, not Hua Tuo. Hua Tuo's treatments included surgery and organ washing, not relying solely on formulas. Zhang Zhongjing was refined but inferior to Hua Tuo. Yet, in examining drug properties and discussing herb/mineral suitability, he surpassed other physicians. Hanshi therapy is extremely difficult to manage and care for. Recently, Minister He Yan, indulging in pleasure, took this medicine. His mind became clear, and strength increased. The capital admired and transmitted it. Years of illness were cured in less than a day. People liked immediate benefits, ignoring later disasters. After He Yan's death, users multiplied. I participated. Some suffered sudden attacks, shortening lives. My cousin Chang Hu had his tongue retract into the throat; Wang Liangfu of Donghai had abscesses sinking into his back; Xin Changxu of Longxi had rotting spinal flesh; Zhao Gong Lie of Shu lost six relatives. All were caused by Hanshi San. Some decades later, some within five to six years. Though I survive, I am mocked for loving danger. Sick people fail to learn this lesson. Those losing discipline ask me. I sigh: Current physicians are less skilled in formulas than Hua Tuo and less adept in diagnosis than Zhang Zhongjing, yet they compete to take difficult drugs, inviting severe suffering. Deaths are countless. In the fourth year of Xianning, Liu Tai, Governor of Pingyang, suffered this and asked for rescue advice. Previously, Jiang Zi was saved by me from drug-induced coma, so I was consulted. I myself bear toxicity. Though talented, I cannot write; though eloquent, I cannot speak. If I fail to consider, death comes instantly. Am I daring to teach? Reluctantly, I reflected, sought *Bencao*, examined *Suwen*, looked for historical precedents, analyzed qi and substance interactions, listed four directions' bases, annotated below, and compiled them for him. Not claiming ability, but knowing "three broken arms make a doctor," learning is not innate; trial and error is secondary.

Taking Hanshi San: Two liang per dose, divided into three portions. Take one portion with warm mellow wine in the early morning. Walk one zhang, take another portion. Walk two zhang, take the last portion. Finish three portions. Shortly after, wash hands and feet with cold water. When medicinal qi circulates, slight numbness occurs. Remove clothes and bathe thoroughly with cold water. Medicinal force increases, whole body cools, mind clears, and illness heals. Even weak patients bedridden recover within a day. Strength and drug tolerance vary. Weak patients should eat slightly before taking; strong patients need not eat. If after three doses the medicine doesn't work, and the patient has old masses, do not take it immediately. First take Xiaoshi Da Wan (Large Pill of Potassium Nitrate) to purge, then take the powder.

After taking medicine, engage in activity. If too weak to walk, support and make them walk. Always wear cold clothes, drink cold liquids, eat cold food, and sleep in cold conditions. Extreme cold is beneficial.

If medicine hasn't dispersed, do not bathe; bathing causes cold retention, preventing medicine activation, leading to shivering. Use warm wine and food, jump, grind grain, exert effort to warm up, then bathe. Stop when resolved; don't overdo it. Eat frequently, day and night. Six or seven times a day. Hunger causes cold; eating brings warmth.

Elderly and children intolerant to medicine reduce dose by two liang; strong individuals exceed two liang.

Children with vigorous qi, postpartum women unable to rise, those keeping hats on, or wearing thick clothes near fire: after taking powder, remove clothes and hats, apply cold methods as prescribed without doubt. Deficient persons can also be treated; this medicine suits them. Excess persons should not take it. Though good, it doubles energy, but care is difficult. Key lies in proper regulation, careful observation, avoiding disappointment, and cutting off social engagements. Only those bedridden, unable to speak, weary of illness, and fully committed to understanding the medicine should take it. Those with minor illnesses unable to exert themselves lose discipline; do not take it.

For Shanghan (Cold Damage), take it after severe purgation, drinking cold water excessively. For postpartum women with wind-cold, body stiffness, and immobility, take one dose with warm water, then bathe in cold water to heal. If numbness persists after bathing, wash with cold water thoroughly. Initially slightly cold, eat and drink wine as desired. If still confused and uncomfortable, bathe in cold water again. For severe cases, water stays on the body. If medicine concentrates in one area causing pain, cold, heat, numbness, dizziness, or abdominal fullness, wash with water until clear. Wash day and night until medicinal force ends.

This medicine does not cause vomiting or purging; all illnesses heal. If upper jiao fullness causes urge to vomit, eating brings relief. After taking medicine, stool turns dark green/black due to dye; do not be surprised. If mild urge to vomit, allow vomiting but not excessively. Take again next morning.

If bathing late, medicinal force won't circulate; cold bathing is unsuitable. Don't force it; retake medicine as prescribed. Bathing too early prohibits cold; too late causes vomiting chaos. Don't miss timing. Cold requires exertion in washing; vomiting requires quick cold food/drink. Hunger feels like cold; food warms. Always maintain cold; don't use heat. Warm clothes, food, and sleep cause vomiting and reversal. Frozen drinks/food and cold baths heal.

All food/drinks must be cold; wine temperature is optional. Resolution takes one month or twenty-plus days. Drink wine to maintain slight intoxication. Drink mellow wine, not thin white wine. Heavy internal feeling causes chaos. If not activating, purge first, then take.

With proper regulation, Hanshi medicine resolves in one month or twenty days. Tolerance to warmth but not cold indicates resolution signs.

Losing regulation causes splitting headaches, masses from warm food/medicine; purge urgently.

Eyes bulging due to liver heat; purge quickly, apply cold to stop.

Severe lower back pain from warm clothing; bathe cold, apply cold stone compress.

Dizziness and fainting from hot clothes; shower head, wash cold.

Lower back breaking pain from sitting on warm surfaces; wash bed with cold water regularly.

Abdominal distension threatening rupture, breaking belt, from long sitting on warm places, getting warm, missing meals/washing/walking. Eat cold, wash cold, stand in wind.

Heart pain like stabbing from skipping meals/washing, cold-heat knotting, qi blockage in heart, locked jaw, breathing difficulty. Force open mouth, give hot wine according to tolerance, allowing wine qi to circulate, qi flows freely. Burp, then soak hand towel in cold water, apply to painful area, replace with warm one, self-resolves. Quickly eat cold food afterward; more is better. Among pains, heart pain is most urgent; rescue like rushing into fire/water.

Qi interruption, unconsciousness, occasional fainting, mouth closed, unawareness. Requires bystander rescue. Hot wine is life-saving. If unable to swallow, cut teeth, pour wine into throat. If wine enters stomach and comes back out, keep pouring. Out and in, possibly half a day. Wine down, qi revives; wine not down, death ensues.

Diarrhea like cold invasion from walking/stopping/eating/drinking violating heat rules. People suspect cold disease. Stagnant masses also from heat violation. Don't doubt; quickly remove clothes, eat/drink cold, wash cold.

Joint soreness from thick bedding, warm quilts, warm clothes not removed. Sleep on very thin cloth, no cotton. Old, dirty clothes preferred over new. Even in winter cold, expose head to wind, apply cold stone compress, loosen belts.

If suffering sourness/stuffiness, bathe in cold water; don't endure illness fearing bathing.

Shivering and aversion to cold like Shanghan, or fever like malaria, from missing meals/hunger, cold washing ineffective. Also from eating smelly food. Urgent cold wash and walking.

Aversion to food smelling like rotten matter from warm food masses; purge urgently. Without purging, ten thousand cures won't heal.

Throat pain, nasal congestion, clear runny nose from warm clothes near fire. Remove clothes, wash cold, stand in wind, apply cold stone compress to throat/pharynx five to six times, self-heals.

Chest/hypochondriac qi rebellion, dry heaving from hunger without eating, medicinal qi steaming diaphragm. Eat cold, frozen drinks, wash cold, heals.

Food passes through immediately, unable to sit still, masses present; purge.

Difficulty urinating from sitting in warm places or riding saddles, heat entering bladder. Eat cold, wash lower abdomen with cold water, apply cold stone compress, stops in one day.

Constipation, abdomen hard like snake coil, from warming, accumulation in abdomen, dry feces not expelled. Melt butter/ghee, take one to two sheng cold, moistens and moves; if not, take more, heals.

Chills and head shaking, unable to support self, from little eating, medicinal qi moving in skin/muscle, five zang losing control, hundred vessels shaking, competing with healthy qi. Force drink hot wine to harmonize vessels; force cold food/drinks to settle zang; force walk to adjust joints. Wine circulates, food fills, joints adjust, washing completes. "Complete" means sickness removes severely, spirit becomes clear.

Joint stiffness, inability to bend/extend, from long rest, lack of exertion, medicinal qi stopping, collaterals knotting, stagnating in blood. Warm self by effort, wash cold, heals. "Warm self by effort" means moving and exerting generates warmth, not from thick clothes/near fire.

Thick/frequent urination from hot food and heat-containing items like cakes/millet. Wash lower abdomen with cold water, take Zhizi Tang (Gardenia Decoction), heals.

Uncontrollable flatulence from warming and irregular washing. Cold wash induces cold, stops.

Involuntary defecation from long sitting on warm surfaces, heat qi entering stomach, large intestine failing to control. Cold wash heals.

Eye pain like stabbing from heat, heat qi rushing to liver, ascending to eyes. Frequent cold eating, wash with warm urine in early morning, heals within three days.

Tinnitus like wind sound, discharge, from overexertion, immoderate sexual activity, qi bursting into ears. Good diet, gradual walking, frequent eating, regulating emotions, stops.

Mouth injury, stiff/rotten/dry tongue, unable to eat, from little eating, grain qi insufficient, medicine in stomach. Make Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) urgently.

Asymmetric pain in hands/feet, joint separation, body abscesses/hard knots, from long lying unmoved, sudden heat concentrating in one place.