When Wind pathogen attacks the Wei (Defensive) level, exhalation is easy but inhalation is difficult (Qi becomes floating due to Wind, making exhalation smooth but inhalation difficult).

When Heat pathogen excessively invades the Ying (Nutritive) level, inhalation is easy but exhalation is difficult (Blood becomes stagnant due to Heat, preventing Qi from extending).

If the Lungs are injured, Wei Qi fails to circulate smoothly, and pathogenic factors obstruct the orifices, leading to breathing difficulties.

If the Spleen and Stomach are damaged, Ying Qi fails to ascend, and pathogenic factors block the apertures, leading to obstruction.

**Bi Yuan (Nasal Polyps/Sinusitis):** Thick, foul-smelling nasal discharge, caused by Damp-Heat in the Lung system.

For yellow nasal discharge, **Fangfeng Tongsheng San** (Saposhnikovia Decoction for Unblocking the Intestines and Releasing the Exterior) is effective.

For clear, odorless nasal discharge, differentiate between Deficiency and Cold patterns.

For turbid nasal discharge that is not dry, the primary formula is **Cang'er San** (Xanthium Powder).

**Thirst:**

Thirst syndromes are mostly caused by damage to body fluids due to excessive sweating, vomiting, or purging, leading to Stomach dryness.

Thirst caused by Yang pathogens invading the Three Yin meridians: Taiyin syndrome causes dry throat; Shaoyin syndrome causes dry mouth; Jueyin syndrome causes Xiao Ke (Wasting-Thirst).

Yang pathogens are Heat, which damages body fluids, thus causing thirst.

**Thirst caused by Yang pathogens invading the Three Yang meridians:**

For thirst in Taiyang syndrome, use **Wuling San** (Five-Ingredient Powder with Poria), because water stagnates in the Lower Jiao causing difficult urination.

For thirst in Yangming syndrome, use **Baihu Tang** (White Tiger Decoction), because Stomach Heat causes continuous drinking.

For Shaoyin syndrome with alternating cold and heat, accompanied by vexation and thirst, use **Xiaochaihu Tang** (Minor Bupleurum Decoction) removing Banxia (Pinellia Rhizome) and adding Huafen (Trichosanthes Root).

**Three Xiao (Wasting-Thirst) Syndromes:**

**Shang Xiao (Upper Wasting-Thirst):** Unrelenting thirst, located in the Lungs, with increased drinking but normal bowel movements. (Caused by Heart Heat transferring to the Lungs).

**Zhong Xiao (Middle Wasting-Thirst):** Hunger immediately after eating, located in the Stomach, with increased drinking but scanty, dark urine. (Caused by Yangming Dryness-Fire).

**Xia Xiao (Lower Wasting-Thirst):** Drinking one part results in urinating two parts, located in the Kidneys. Urine is initially turbid; after standing, a paste-like sediment forms at the bottom. (Caused by Shaoyin Yin Water deficiency failing to control Fire, and Yang Fire deficiency failing to transform Water).

Upper and Middle Xiao belong to Heat patterns. Only Lower Xiao involves both Cold and Heat, along with sexual exhaustion consumptive disease. The urine is not only odorless but sweet-tasting. This indicates the Qi of the Kidney and Earth descending and leaking through the urine. If the face appears puffy like fat, this signifies Kidney failure and uncontrolled essence, which is incurable.

**Toothache:**

Teeth generally belong to the Kidneys but are divided into upper and lower. The upper teeth belong to the Stomach, and the lower teeth belong to the Large Intestine.

Swollen and red gums belong to Yangming syndrome.

Rotting teeth with a tight jaw belong to the Heart and Gallbladder.

Bleeding from the gum roots without swelling indicates Rising Deficient Fire from the Kidney meridian.

**Hiccups:**

Hiccups refer to Qi reversing upward from the abdomen, reaching the throat, producing several consecutive short, abrupt sounds.

If caused by Excess Heat in the Stomach due to failure to purge earlier, use **Liange San** (Cooling the Diaphragm Powder) to eliminate Heat.

If caused by excessive intake of cold medicines leading to Cold deficiency in the Stomach, use warming methods to dispel Cold.

If caused by Phlegm-Fire in the Stomach reversing upward, use methods to open and resolve phlegm.

If caused by fluid retention, use diuretic methods to separate and drain.

If caused by food stagnation blocking the interior, use digestion-promoting methods.

In all cases, use methods to guide Qi downward, descend rebellion, and push out the pathogen.

If there is discomfort in the chest and diaphragm, and hiccups originate from the chest, it indicates Disharmony between the Lungs and Stomach; use Apricot Kernel and Cinnamon Twig to moisten the Lungs.

If there is abdominal fullness and distension, and hiccups originate from the abdomen, it indicates Stomach Qi rebelling upward; add Licorice and White Peony Root to harmonize the Stomach. (From *Bianzheng Huibian*, Volume 3).

**Belching:**

Belching occurs when eating too quickly causes food Qi to reverse upward.

It is due to weak and disharmonious Stomach Qi, causing the Triple Burner to fail in its duties. Thus, Clear Qi has no place to return and cannot ascend, while Turbid Qi has no place to accept and cannot descend. It lingers, causing belching of sour taste, fullness, and chest discomfort. The primary formula is **Chenpi Zhuru Tang** (Tangerine Peel and Bamboo Shavings Decoction).

**Hiccup/Regurgitation (Note: Yi)**

"Hui" (a type of hiccup/regurgitation) resembles dry heaving. "Hui" has a turbid, long sound, while dry heaving has a short, small sound. Both produce sound but no substance.

If Stomach Qi is originally deficient and damaged by excessive sweating or purging, leading to Cold deficiency in the Stomach;

Or if excessive consumption of cold water causes Water-Cold to clash, resulting in Cold in the Stomach;

Or if Heat Qi is constrained in the upper part, causing blockage.

"Yi" (belching/burping) refers to Qi in the chest unable to descend smoothly, with no sound or substance. It occurs because Cold pathogen lodges in the Stomach, causing Jue reversal Qi to rise and exit through the Stomach. If caused by food injury, the belch will have an offensive odor.

**Vomiting:**

"Ou" (vomiting) involves both sound and substance, emerging gradually.

"Tu" (spitting up/vomiting) involves substance without sound, emerging suddenly.

"Gan Ou" (dry heaving) involves sound without substance.

**Differentiation of Dry Heaving:**

Caused by pathogenic factors in the epigastrium, where Heat Qi combines with Grain Qi, reversing upward to the chest.

For Taiyang syndrome with sweating and dry heaving, use **Guizhi Tang** (Cinnamon Twig Decoction).

For Shaoyin syndrome with diarrhea and dry heaving, use **Jiangfu Tang** (Ginger and Aconite Decoction).

For Jueyin syndrome with spitting of saliva/froth and dry heaving, use **Wuzhuyu Tang** (Evodia Decoction); once the pathogen is eliminated, vomiting stops naturally.

"Ou" (vomiting) occurs when exterior pathogen enters the interior, and interior Qi rejects it, causing upward rebellion. This is considered a Shaoyang syndrome, treated with **Xiaochaihu Tang** (Minor Bupleurum Decoction).

**List of Vomiting Differentiations:**

Exterior pathogen entering the interior with Qi rebellion: Hardness below the heart with vexation, or constipation, treated with **Dachaihu Tang** (Major Bupleurum Decoction).

Vomiting due to unresolved exterior syndrome belongs to Taiyang, treated with **Guizhi Tang** (Cinnamon Twig Decoction).

Desire to vomit after eating grains belongs to Stomach Cold, treated with **Wuzhuyu Tang**. Vomiting after drinking soup belongs to Exterior Heat, treated with **Gegen Banxia Tang** (Kudzu and Pinellia Decoction).

Vomiting without diarrhea indicates Qi stagnation belonging to Shaoyin, treated with **Zhenwu Tang** (True Warrior Decoction).

Drinking leads to vomiting, or vomiting leads to desire to drink; these mutually reinforcing symptoms indicate Water Retention, treated with **Wuling San** (Five-Ingredient Powder with Poria).

**Differentiation of Spitting Up:**

Cold invasion causing vomiting, inability to eat, and cold extremities indicates Deficiency-Cold vomiting, treated with **Wuyou Lianli Tang** (Evodia and Coptis Combined Decoction) or **Lizhong Tang** (Regulate the Middle Decoction).

Thirst with ability to eat, followed by vomiting, indicates Fire vomiting.

For Excess Heat, use **Huanglian Jiedu Yin** (Coptis Decoction for Resolving Toxins).

For Deficient Heat, use **Ganjiang Huangqin Huanglian Renshen Tang** (Ginger, Scutellaria, Coptis, and Ginseng Decoction) or **Zhuye Shigao Tang** (Bamboo Leaf and Gypsum Decoction).

Thirst, drinking, then thirst again, indicates Water Rebellion, treated with **Wuling San** (Five-Ingredient Powder with Poria).

The Classics state: Frequent vomiting indicates Yangming syndrome, do not purge. Because Qi is rebellious and not yet gathered, it is not an Excess pattern.

**Further Differentiation of Vomiting:**

Stomach Heat vomiting: Pulse is wiry and rapid, with dry mouth and thirst.

Stomach Cold vomiting: Pulse is wiry and slow, with cold extremities.

Water-Qi vomiting: Thirst precedes vomiting, with palpitations in the diaphragm.

Pus and blood vomiting: Foul smell in the throat, blood reversing upward.

Vomiting clear water without thirst indicates Stomach Deficiency-Cold.

Vomiting sour or bitter tastes (sometimes caused by Wind) belongs to Stomach Heat. Treatment focuses on draining Liver Heat and calming the Stomach.

**Fan Wei (Reverse Stomach / Regurgitation):**

Fan Wei presents as morning food vomited in the evening, or evening food vomited in the morning, undigested. This is called Fan Wei, caused by Cold and lack of Fire. Analysis:

Triple Burner lacks Fire: If in Yangming, there is fullness (treat with **Wuzhuyu Tang**); if in Taiyin, there is abdominal fullness (treat with **Lizhong Tang**).

Fan Wei presenting as immediate vomiting upon ingestion is due to Heat. This is because the Stomach already has Heat, and upon eating, the two heats clash. Treat with **Banxia Xiexin Tang** (Pinellia Decoction for Draining the Epigastrium).

Alternatively, treat with **Huangqin Huanglian Ganjiang Renshen Tang** (Scutellaria, Coptis, Ginger, and Ginseng Decoction).

**Cough:**

Sound without phlegm indicates Lung Qi injury and lack of clarity.

Phlegm without sound ("Sou") is caused by Spleen Dampness generating phlegm.

Sound with phlegm ("Ke Sou") results from Spleen and Lung Qi injury driven by Spleen Dampness.

Essentially, Stomach turbidity and Spleen dampness prevent proper distribution of body fluids. When Clear and Turbid do not distribute properly, essence does not spread, forming the root of phlegm and the origin of cough.

**Differentiating Six Pathogens:**

Cold Cough: Frequent coughing, sneezing, nasal congestion, spitting saliva/phlegm. Treat with **Shufeng Shen Su Yin** (Wind-Dispersing Ginseng and Perilla Drink).

Wind attacking the Lungs: Cough with sweating, headache, and difficult phlegm. Treat with **Jinfei San** (Boiling Down Powder). For dispersing Cold, modify **Huagai San** (Canopy Powder).

Fire attacking the Lungs: Cough with panting, oppression, reversed Qi, bloody sputum, and itchy throat.

Fire Cough: Red face, dry throat, foul breath, thick yellow sticky phlegm, soft stool. Treat with **Jiawei Xiebai San** (Modified Draining White Powder). If stool is hard, treat with **Jiawei Liange San** (Modified Cooling Diaphragm Powder).

Lung Deficiency: Pale complexion, clear thin phlegm. Treat with **Erchen Tang** (Two-Aged Decoction). To tonify Lung, use **Ejiao Tang** (Donkey-Hide Gelatin Decoction). For elderly deficiency cough, use **Sanzi Yangqin Tang** (Three-Seed Nourishing Parent Decoction) or **Zhenwu Tang** (True Warrior Decoction).

**Consumptive Cough:**

The Liver is the Sea of Blood, governing the Ren and Wei vessels. Its blood nourishes skin and hair. During sleep, blood returns to the Liver. Now, due to Liver deficiency, it cannot integrate with the blood of Ren and Wei, which leaks out through the pores. Liver Qi rises from the Pericardium Meridian, causing bleeding before coughing. Internal Liver injury leads to Pericardium deficiency. Pericardium deficiency allows Fire to attack Metal (Lungs), causing cough. Since the Pericardium governs blood vessels, Blood deficiency causes night fever. Mild cases cough during the day; severe cases cough day and night with fever. First Blood is injured, then Qi, leading to exhaustion of Yin and Yang. This is Consumptive Cough.

**Wind Invasion:** Aversion to wind, spontaneous sweating, clear nasal discharge, floating pulse.

**Food Stagnation Generating Phlegm:** Heat steams, Qi is urgent, phlegm is congested, frequent cough, loose stool. Treat with **Qu Mai Erchen Tang** (Malt and Two-Aged Decoction). If stool is dry, use **Su Ting Guntan Wan** (Perilla and Sedum Rolling Phlegm Pill) to purge.

**Cold Invasion:** Aversion to cold, no sweating, clear nasal discharge, tight pulse.

**Panting Syndrome:**

Panting refers to Qi reversing upward, with急促 (rapid/urgent) breathing.

Inability to distribute breath upon exhalation indicates Excess Pathogen.

Inability to continue breath due to Qi deficiency indicates Deficient Pathogen.

Thick phlegm and hard stool indicate Heat Pathogen.

Clear/cold phlegm and fluid retention indicate Cold Pathogen.

In the Five Zang, Lung Qi should be clear and descend. Why does panting occur? It is because Fire scorches True Qi, leading to Qi deficiency and panting.

Causes of panting: Excess in the Lungs, Deficiency in the Kidneys. As a guideline, there are four types:

1. Excess Cold: Must carry congealed phlegm and retained fluid interfering with Qi. Use **Xiao Qinglong Tang** (Minor Green Dragon Decoction) plus Houpo (Magnolia Bark) and Xingren (Apricot Kernel).

2. Excess Heat: Not outside the dampness-constrained pathogen steaming phlegm into Fire. Use **Ma Xing Gan Shi Tang** (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) or **Qianjin Weijing Tang** (Millennium Reed Shoot Decoction).

**Distinction between Essence Injury and Qi Collapse:**

1. Essence Injury: Tonify essence and calm/restrain Kidney Qi. Choose based on following Yang or Yin, e.g., **Suzi Jiangqi Tang** (Radish Seed Descending Qi Decoction).

2. Qi Collapse: Root floats, inspiration injures the Source Sea, danger is imminent. Use Ginseng, Placenta Humanis (Ziheche), Schisandra (Wuweizi), Quartz (Shiyin), etc.

**Asthma (Xiao):**

Asthma is characterized by急促 (rapid) breathing with audible sounds in the throat. Qi is coarse, chest is full, and breath cannot be distributed.

Often caused by Cold pathogen latent in the Lungs and Phlegm nests结 (knotted) in the lung membranes, responding internally and externally.

**Phlegm and Fluid Retention:**

External contraction by the Six Evils injures the Lungs, Lung Qi fails to circulate smoothly, generating phlegm.

Internal cause: Dampness injures the Middle Earth (Spleen), Spleen Qi condenses turbidity, generating phlegm.

Phlegm-Fluid syndrome is Water Qi flooding upward. When acted upon by Yang, it boils and thickens into Phlegm. When acted upon by Yin, it coagulates and thins into Fluid. This syndrome is caused by weak Mingmen Fire and不振 (lack of vigor) of Spleen Yang.

**Differentiation of Phlegm:**

Thick and turbid is Heat Phlegm, belonging to the Heart.

Clear foam is Cold Phlegm, belonging to the Kidney.

Scanty, sticky, and difficult to expectorate is Lung Dryness Phlegm.

Abundant and easy to expectorate is Dampness Phlegm, belonging to the Spleen.

Convulsions and dizziness are Wind-Phlegm, belonging to the Liver.

**Differentiation of Fluid:**

Fullness above the diaphragm, vomiting saliva/phlegm: This is retained fluid in the diaphragm, named **Fu Yin** (Hidden Fluid).

Panting, cough, facial swelling, inability to lie down: This is retained fluid in the Lungs, named **Zhi Yin** (Supporting Fluid).

Heavy pain in limbs and body: This is fluid retained in the limbs, moving through the body, named **Yi Yin** (Overflowing Fluid).

Cough drawing pain in ribs: This is fluid retained under the ribs, named **Xuan Yin** (Hanging Fluid).

Thin body with gurgling sounds, water moving in the diaphragm: This is fluid retained in the intestines and stomach, named **Tan Yin** (Phlegm-Fluid).

Generally, food/fluid retention in the chest and lungs causes panting and fullness. Qi retention in the diaphragm causes palpitations below the heart, or coldness in the back.

**Lung Distension, Lung Withering, Lung Abscess:**

**Lung Distension:** Flaring of nostrils, profuse sweating like flowing, urgent and rapid Lung pulse.

**Lung Withering:** Dry withering, lack of nourishment, depletion of fluids, scorching of the Lung. Often caused by prolonged Cold and Deficient Fire.

**Lung Abscess:** Obstruction and blockage, Heat accumulation leading to Lung ulceration. Abscesses are often caused by prolonged Wind-Heat knotting.

Severe Lung disease causes back pain when bowing the head.

(End) Postscript: This copy seems incomplete. Only one version was collected. Judging by the content, there should be a continuation. It is regrettable that it could not be fully obtained.

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