人身如树分冬春，脉胳为干心为根，心涵灵液注经隧，大而祖络微而孙。枝枝叶叶尽渗漉，如缦如网如丝
纶。俨然春华得生意，土膏暗润潜无痕。络穷四末复回溯，更以灵液还天君，又如冬林气萧瑟，直驱膏向根
屯。屯久气转渐牙茁，升降往返侔旋轮。脑为觉元神所尊，有如群岳宗昆仑。鼓 元牝出
奥窍，容纳万象栖神魂。上仙葆此大丹就，泥丸宫破通天门。下愚生为二竖据，懵懂劣似刘家豚。人生思索必
抚脑，心囟上下交氤氲。《黄庭》宗旨苍颉字，古人卓识超群伦。惜哉黄帝与岐伯，方书久已遗三坟。詹詹
《灵枢》数番纸，多半赝鼎非原文。所以扁鹊至今千百载，上池之水流常浑。欧罗此一编，创论何纷坛。一一
目亲睹，疏瀹入骨筋。华佗之稿尚未焚，流落海外随烟云。畅观快极复生妒，疑阵又欲张吾军。心
何为兮倚杵？脾何为兮横陈？将军仓廪位置倒，婴儿 女谁为婚？吾非丹元子，又非龙烟神，安能入肺腑，持
炬照覆盆？八尺之士纵可剖而视旋机，一驻气早亡陶熏。胡为行度考校乃尔确，无乃如柱胶瑟如治丝而棼！我
欲广集中外议，汰其糟粕留其醇。使人垣洞见 结，昭揭日月殊 扪。譬如管辂论天象，但以区落言星辰。至
于阴阳呼召可会不可说，默而成者存其人。学问要当贵适用，岂以畛域生区分？君不见三角八线传自利玛窦，
仁庙研究穷朝昏，圣人门户之见何尝存！
望闻问切名曰四诊，人皆知之。夫诊者审也，审察病情，必四者相合而可断其虚实寒热之何因也。然望者
不仅望其面色也，五官、须发并宜审也，而舌本、苔色尤为至要，此古人未发之奥。王氏《准绳》、张氏《医
通》、叶氏《温热论》诸书，皆须熟玩。更有诸书所未言者∶淡白舌苔，亦有热证，黄浓满苔，亦有寒证，舌
绛无津，亦有痰证，当以脉证、便、溺
参勘自得。若灯下看黄苔，每成白色，谚云∶“灯下黄金似白银”是也。白苔啖酸物，能染为黑，均不可不知。
至于危疑大证，虽吐出之痰血、接出之便溺，亦当令病家取至庭中，望其色而审之，不可嫌秽，庶无讹传误听
之弊也。治小儿则审三关为要。
（注）白苔食橄揽即黑，食枇杷即黄。此名染苔，抹之即去。
字义有不可执一者，如知字从口，以口能知味也。然望而知之者目也，岂可谓目无所知哉！故闻字虽从耳，
而四诊之闻，不专主于听声也。戴麟郊先生《广温疫论》辩证最细，谓疫证必有秽浊之气，鼻观精者可以闻而
知之也。愚谓闻字实有二义。虽非疫证，凡入病室，五官皆宜并用，问答可辨其口气，有痰须询其臭味，榻前
虎子，触鼻可分其寒热，痈疡脓血，审气即知其重轻，余如鼾息、肠鸣、矢气之类，皆当以耳闻者。古人但主
乎呼、歌、呻、哭数字，固矣。
问诊之法，最要详细。虽证因错杂，但贵心有权衡，则可审其轻重真伪，而折衷于当矣。景岳《十问篇》
，人皆服其周匝，而犹未尽善也。如问寒热首二条皆是伤寒，若发热不恶寒者，温病也，纵挟新感风寒而起，
先有恶寒，迨一发热，则必不恶寒矣。此伏气温病也。外感风温，热邪首先犯肺，肺主皮毛，热则气张而失清
肃之权，腠理反疏，则凛冽恶寒，然多口渴易汗，脉证与伤寒迥异。终云∶气盛身寒，得之伤寒，气虚身热，
得之伤暑。所谓身寒者，寒邪在表，虽身热而仍恶寒也。暑为阳邪，发热即恶热，亦有背微恶寒者，曰微，仍
不甚恶寒也。况但在背与周身恶寒迥别，可不细问哉？第三条内证发热，亦不可专属阴虚。香岩先生云∶或食
积，或瘀血，或痰
凝气滞，皆能发热，必辨证明白，庶不误治。
问头身第三条阴虚头痛。叶氏云∶多属阳亢，未可竟补，须兼滋阴降火为治。第四条阳虚头痛，百无一、二
之证，至于眩运，不可与头重混同立论。如体肥过食浓味醇酒，胃中必有痰饮，随肝火升腾而作晕者，余每用
二陈加栀、连、柴、芍、天麻、钩藤而愈者多，虚则加参、术，瘦人胸无阻滞，胃中无痰，可用地黄汤加柏、
芍之类。盖此证因痰火者多，长沙治眩亦以痰饮为先也。头重则属湿者多，火盛者用清凉以降之。经云∶邪之
所在，皆为不足。上气不足，脑为之不满，耳为之苦鸣。是言邪乘虚客之，非竟言虚也。景岳于二证皆主上虚
清阳不升，亦百中一、二耳。
（刊）头项、脊背、腰膂、臂腿诸疼，有内伤、外感之别。内伤多虚，亦属气不宣行；外感多实，总由客
邪阻气。李晋恒别驾谓督是一身总气管，知此可悟其治法矣。
问便云中气不足溲便为之变，不可因溺黄而谓之火，强逼枯汁以毙人。叶氏谓妄用通利，则逼枯汁。如养
阴清热，何至逼枯？若经言变者，非云小溲黄赤也，统指二便异于常时也。小溲或不禁，或淋漓短少频数，或
清而多，大便或滑泄，或燥结∶皆异于平日之调和，故谓之变。况劳倦、焦思、泻利、酒色为虚火，若暑热下
痢、小溲淋痛乃邪火，当分别而治，不可云无火而用温补以误人。经言∶邪之所在，皆为不足。因不足
而邪客之为病。后人脱却上文邪之所在句，竟言虚而用补，谬矣。大便亦要调和，若愈固者，乃燥结也，当濡
养为主。或固结在老年，防有噎膈之患，不可云弥固弥良。愚谓大便固结，
必胸腹舒泰，饮食能安，圊不努挣者，始为可喜。溏而频解，解而腹中始快者，此《内经》所云∶得后与气，
则快然而衰也。非痰饮内阻，则气郁不宣。即泄泻，在温热、暑疫诸病，正是邪之去路，故不可一闻溏泻，辄
以为虚寒，而妄投温补止涩也。须问其解之热与不热，色之正与不正，必不觉其热，而稀溏色正者，始可断为
中气不足也。更有痈疽、痘疹将发而吐泻先作者，前辈皆不帮助，故详赘之。
问饮食谓得食稍安者，必是虚证，未尽然也。痰火证、虫证皆得食稍安，而痰火证更有初服温补极相安者。
其中消善食属于火者，是实证矣，亦有火盛反不能食者，胃热不杀谷也。更有阴液久耗，胃阳陡越之除中证，
能食善饥，俨如消证，但脉必虚大，按之细软无神，纵与大剂填阴，亦不救也。虽不多见，不可不知。至于热
证喜饮，寒证恶饮，人皆知之，而热证夹湿夹痰者，亦不喜饮，或喜沸饮，皆不可误指为寒也。喜饮而不多者，
古人但以为阴虚，而不知亦有挟痰饮者。
问胸。叶氏云∶胸腹胀满，固不可补，不知饥饱，似胀非胀，是浊气不清，但当理滞气，不宜骤用参、术，
补住浊气而为胀满，经云∶浊气不降，则生 胀。即宜补者，须分气血。虚而兼滞者，疏补宜兼。俗云虚不受
补者，未知疏补兼行之法耳。愚谓胸次如天，天空则生气流行不息，然虚痞可补之证，间亦有之，气虚者宜温
补，阴虚者宜滋填。若痰饮凝聚，饮食停滞，及温热疫证，邪踞募原者，皆宜开泄为先，不但补药忌
投，即凉润之品，亦在所禁。恐病患言之未确，医者必手按其胸腹有无坚硬拒按，始可断其邪之聚散，最为诊
要。更有内痈一证，尤当留意。
问聋。此证在伤寒为邪传少阳，在久病为精脱。景岳颟顸
而论，大是误人。且考古更有耳聋治肺之法。一瓢先生云∶金之结穴在耳中，名曰笼葱，专主乎听。故热证耳
聋，皆为金受火烁，治当清肺，不可泥定少阳一经，而再以小柴胡汤益其病也。
（刊）友人沈君辛甫患温耳聋，四明医人胡士扬用柴胡药多剂，其聋日甚。胡谓进则病进，径投补剂。后
服清解，病愈而聋成锢疾，是肺络之热为补药壅塞，竟无出路也。然景岳书之贻误于后世，此犹其小者已。
问渴谓喜热饮为中寒水亏。叶氏云∶水亏则内热，岂有中寒之理？凡喜热饮，皆郁滞不通畅，故得热则快
，得冷则遏。并非水亏也。若水涸精亏者，宜滋阴，反用热药，是杀之也。
（刊）渴喜热饮、渴不多饮，温热证多有之，皆属痰饮阻遏气机。景岳书偏尚温补，世多尚之。叶天士先
生《景岳发挥》、尤在泾《医学读书记》、章虚谷《医门棒喝》皆力辨其非，学人不可不读也。
女子病首须问带。盖带者，女子生而即有，故越人作女科称带下医也。下多即为病矣。十二岁以外者，问
其月事行否，未行而肤色淖泽者，虽逾笄不为病，设肤色憔悴，人不长成，是劳损也，已行之女与妇人，则询
其汛之迟速、血之紫淡，虽患外感，亦当问明 期远近，然后审证用药，庶无碍血伤胎之患。盖 期有禁用之
药，胎孕有难凭之脉也。产后则恶露之多少，腹块之有无，首宜究诘，然胎产诸证，笔难尽罄，总宜审问详明，
处方灵活，不可稍有执滞，庶不误人。
（校）天地生机，皆在灵空。女子之象，离中虚也，故能孕育。若脂满胞中者，不能有妊，此理之常也。
况胎元初结，月事即停，气有余为火，血有余为水，火盛搏水则成痰，呕吐肿
满诸病由此而生，补药最宜慎用。古云“胎前无滞，产后无虚”是已。然有极虚之妇，受胎后即须培补，始能
长养者，分娩时必须峻补，始能诞育者，既产之后，血气必虚矣。丹溪先生垂大补气血之训，而竟不尽然者，
以张景岳之偏尚温补犹知其非，可见治胎产病之难也。且一人有一人之胎气，荆人举六子，皆二百七十六日而
生，庆儿、双儿、琳儿并殇，龙儿、华儿、如儿佥无夭相，是儿休之坚脆，不必在胎日数之多寡分也。故七、八
个月生者亦育，十余月生者亦有不育。尝见同胞数人，发肤悉白皙如羊者，断非均于社日受孕，殆亦胎气使然
耳。又周缝人妻患经阻而腹胀渐甚，诸药无效，年余如抱瓮、如铁石矣。日夜呻吟，欲其夫以槌击腹若擂鼓然，
始觉稍舒。最后求老医浦沛霖先生治之。浦诊视良久，细诘病情，曰∶买不相欺，愧未识其病也。容我归去讨
究书籍，再为汝治。数日后果来复诊，服药仍不应。缝人终日捶妻之腹，不能成衣，医药力竭，遂听之待死而
已。至两年余，忽举一子，而胀病如失。其子甚短小，取名关保。余常见之，至十余岁而夭。胎孕之奇有如是
者，诚非笔所能罄也。
（刊） 期有禁用之药，世俗惟知禁用寒剂，因不知血分有火，或营分伏暑者，不但禁用热药，即温动之
品亦禁。宜寒宜凉，对证者并不禁也。第必取其有流利之性，而无凝滞之偏者为良药耳。粗工泥于经产之禁，
而不详审证因。且古书每于方后注云，妇人加当归。不知变通者，遂胶柱以鼓瑟。徐月岩令正，年逾四旬，暮春
患痰嗽发热。医者询知病当汛后，于荆、防发散中加当归、姜、枣为方。服三剂，血随痰溢，口舌起 如紫蒲
桃者八颗，下唇右角肿凸如姆指大，色如黑枣，咽疼碍饮。或云瓜瓤瘟，或云蒲桃瘟，或云玳瑁瘟，或云捻颈
瘟，或云翻唇疔，医
皆望而却走。月岩追忆乙巳之病，浼余往视。口秽喷人，颊 如漆，舌紫而苔色如靛，臂斑或黑或蓝，溲若沸
油，渴呃多汗，脉形细涩，数夜无眠。此乃阴分素亏，热伏营分，气机郁结，痰阻上焦。询其胸背，斑已遍身
，幸而血溢汗多，毒邪犹有出路，故不昏陷，尚可望生。令取锡类散吹喉，并以童溺、藕汁、梨汁频灌。随用
元参、丹参、紫草、花粉、银花、栀子、鲜斛、大青、竹茹、枇杷叶、夏桔草、蔷薇根、海 、煎调神犀丹。
两剂后舌本转赤，苔色见黄。四剂后血止咽松，脉转弦数。六剂便行，而口秽始减， 平而唇肿亦消。八剂嗽
平而苔退脉柔，斑回而痕如黑漆。始改轻清善后，径愈。又内子月事素调，春仲患上龈右痛不肿，痛连额角，
鼻亦右塞，目中出火，齿缝流血，苔黄滑而不渴，痛甚则肢冷面赤，口涎大流，胸次不舒，便坚溲热，脉至缓
滑，汛事逾期不至。亦是热伏营分，痰阻气机也。以小陷胸加元参、紫苑、菖蒲、竹茹、枳实、旋复花，煎调
神犀丹。四服便行，经至而瘳。聊附二案，以见大意。又张氏妇，年五十岁，自季夏患呕吐，渐难饮食，食必
膈痛，倾囊而出，夹以痰水，多药罔效。至盂冬，汛愆一度，以后仍行而痛吐不已，人渐委顿，不能起榻，大
便甚艰，咸谓噎膈已成。迨初春，胎坠而病若失。盖其年逾七七，天癸未绝，既未停经而患痛吐，初不料为恶
阻也。古云∶“宁治十男子，莫治一妇人”，其以此夫？胎前最忌渗利，无湿者虽茯苓亦须避之。室女眼药，
禁用虎骨，恐初娩时交骨难开也。相传人之胚胎，鼻先受形，而泰西书云∶胚胎三十日具有眼模，六十日始有
耳鼻。余按《佩 集》吉凶形兆谓之联。 字从目。所云眼模，正 兆之初萌也。其言颇有
理。惟婴几倒植在腹之说，恐未必尽然耳。
又沛翁令郎上林先生世其业。忆嘉庆己卯春，先府君病温而大便自利，诸医皆宗陶氏伤寒书者，悉用柴、
葛升提下陷之邪，屡服不应。或云漏底证，渐进温补，病日以剧，将治木矣。父执翁七丈荐上林先生来视，其
年甚少。诊毕曰∶温证也，殆误认伤寒而多服温燥之药耶？幸而自利不止，热势尚有出路，否则早成灰烬矣，
[Background Information]
Book: *Chongqing Tang Suibi* (Random Notes from Chongqing Hall)
Chapter: Reading *Quanti Xinlun* (New Treatise on the Whole Body) (1/2)
Category: Comprehensive
The human body is like a tree, divided into winter and spring. The meridians are the trunk, and the heart is the root. The spiritual fluid contained within the heart is poured into the meridian tunnels; the large ones are called ancestral collaterals (Zu Luo), and the small ones are called grandchild collaterals (Sun Luo). Every branch and leaf is permeated and moistened, like a net, like silk threads. Just as spring flowers gain vitality, the soil is secretly moistened, leaving no trace. When the collaterals reach the extremities, they retrace their path, returning the spiritual fluid to the Heavenly Lord (Heart). It is like a winter forest where the atmosphere is bleak; the essence is driven directly to accumulate at the root. After accumulating for a long time, the Qi transforms, gradually sprouting shoots, ascending and descending in cycles like a rotating wheel. The brain is revered by the Yuan Shen (Original Spirit) as the seat of awareness, just as all mountains look up to Mount Kunlun. Stirring the Yuan Pin (Life Source) from profound apertures, it accommodates all phenomena and houses the Hun and Po (Soul and Corporeal Soul). Immortals preserve this Great Elixir, breaking through the Niwang Palace to open the Heavenly Gate. The foolish are born with two "Shu" (demons of illness) occupying them, ignorant and inferior, like the pigs of the Liu family. Humans must stroke their brains when thinking; the Heart and Fontanelle interact above and below in a misty vapor. The purport of the *Huangting Jing* (Yellow Court Classic) is like Cangjie creating characters; the ancients' insight surpassed the masses. Alas, Huangdi and Qibo, their medical texts were long lost in the "Three Fens" (ancient books). The *Lingshu* (Spiritual Pivot) spans only a few sheets of paper, mostly forgeries rather than original texts. Thus, Bian Que's lineage has been turbid for thousands of years. This European book creates theories so complex. I have seen them with my own eyes, dredging deep into muscles and sinews. Hua Tuo's manuscripts were not yet burned, drifting overseas with smoke and clouds. Viewing them freely brings joy mixed with jealousy; a fog of doubt arises, wanting to deploy my army. Why does the Heart lean on the pestle? Why does the Spleen lie horizontally? The positions of the General (Liver) and Granary (Spleen) are inverted; who marries the Infant (Kidney Water) and the Maiden (Heart Fire)? I am neither Dan Yuanzi nor Long Yanshen, how can I enter the viscera, holding a torch to illuminate the overturned basin (darkness)? Although an eight-foot man can be dissected to view the mechanism, if Qi stagnates early, one dies from heat. Why are measurements and examinations so accurate? Is it like gluing a lute or sorting tangled silk? I wish to gather Chinese and foreign opinions, discarding dregs to keep the pure. Let people see clearly through the throat, revealed like the sun and moon. Like Guan Lu discussing celestial phenomena, speaking only of regions and stars. As for Yin-Yang summoning, it can be understood but not spoken; silent accomplishment resides in the person. Learning should value applicability; why distinguish by boundaries? Have you not seen that trigonometry and geometry came from Matteo Ricci? Renmiao studied day and night; did the Sage ever harbor sectarian views!
Inspection, Auscultation-Olfaction, Inquiry, and Palpation are called the Four Diagnostic Methods, which everyone knows. Diagnosis means examination. To examine the condition, all four methods must be combined to determine the cause of deficiency, excess, cold, and heat. However, inspection is not merely looking at the complexion; the five sense organs, beard, and hair should also be examined, while the tongue body and coating color are particularly crucial. This is an obscure point not previously expounded by the ancients. Works such as Wang Shi's *Zhunsheng*, Zhang Shi's *Yitong*, and Ye Shi's *Wenre Lun* must be studied thoroughly. There are things not mentioned in these books: a pale white coating may indicate heat; a thick, yellow, full coating may indicate cold; a crimson tongue without moisture may indicate phlegm. One must cross-reference pulse signs, urination, and defecation to gain understanding. If viewing a yellow coating under a lamp, it often appears white; as the proverb says, "Gold looks like silver under a lamp." White coatings eaten with sour substances can turn black; these facts must not be ignored. For critical and doubtful major conditions, even vomited phlegm-blood or excreted urine and feces should be brought to the courtyard by the patient's family for color observation and examination. Do not disdain filth, lest errors be transmitted and heard. In treating children, examining the Three Gates (finger veins) is essential.
(Note) White coatings turn black after eating olives and yellow after eating loquats. This is called a stained coating, which disappears upon wiping.
Character meanings cannot be rigidly interpreted. For example, "Zhi" (know) contains the mouth radical because the mouth tastes flavors. However, knowing through inspection comes from the eyes; how can one say the eyes lack knowledge? Therefore, although "Wen" (hear/smell) contains the ear radical, the "Wen" in the Four Diagnostics is not solely about hearing sounds. Mr. Dai Linjiao's *Guang Wen Yi Lun* (Broadened Discussion on Warm Epidemics) provides the most detailed differentiation, stating that epidemic diseases must have turbid qi, which those with keen noses can detect. I believe "Wen" has two meanings. Even if not an epidemic disease, upon entering a sickroom, all five senses should be used. Questions and answers can distinguish breath odor; if there is phlegm, its smell must be asked about; the chamber pot by the bed can be smelled to distinguish cold and heat; abscess pus and blood can be assessed by odor to know severity. Others, such as snoring, borborygmus, and flatulence, should be heard with the ears. The ancients focused mainly on sighing, singing, groaning, and crying, which was indeed correct.
The method of inquiry is most important when detailed. Although symptoms and causes are mixed, having mental balance allows one to judge severity and authenticity, reaching a proper compromise. Jingyue's *Ten Questions Chapter* is admired for its comprehensiveness but is not perfect. For instance, the first two questions on cold and heat relate to Cold Damage (Shanghan). If fever occurs without aversion to cold, it is a Warm Disease (Wenbing). Even if triggered by new Wind-Cold invasion with initial aversion to cold, once fever sets in, aversion to cold ceases. This is latent heat Warm Disease. Exterior Wind-Warmth invades the Lung first; the Lung governs skin and hair. Heat causes Qi expansion and loss of clear descending function, making pores loose, leading to chilling aversion to cold. However, there is usually thirst and easy sweating, with pulses and signs distinct from Cold Damage. Finally, it states: Excess Qi with cold body indicates Cold Damage; Deficient Qi with hot body indicates Summerheat Injury. "Cold body" means exterior cold pathogens; although the body is hot, aversion to cold persists. Summerheat is a Yang pathogen; fever brings aversion to heat, though slight back aversion to cold exists. "Slight" means not severe. Moreover, back-only aversion differs greatly from whole-body aversion; must one not ask carefully? Internal fever in the third question is not exclusively Yin deficiency. Xiangyan (Ye Tianshi) said: Food stagnation, blood stasis, or phlegm-Qi stagnation can all cause fever. Signs must be clarified to avoid mis-treatment.
Regarding Head and Body, Question 3 mentions Yin-deficiency headache. Ye said: Mostly due to Yang hyperactivity; do not simply tonify. Must combine nourishing Yin and descending fire. Question 4 mentions Yang-deficiency headache, which is rare (one in a hundred). Dizziness should not be conflated with heavy head. Obese individuals overeating rich foods and alcohol likely have Phlegm-Fluid in the stomach, rising with Liver Fire causing dizziness. I often cure this with Er Chen Tang plus Gardenia, Coptis, Bupleurum, Peony, Gastrodia, and Uncaria. If deficient, add Ginseng and Atractylodes. Thin people without chest obstruction or stomach phlegm can use Rehmannia Decoction plus Phellodendron and Peony. Most dizziness cases are due to Phlegm-Fire; Changsha (Zhang Zhongjing) prioritizes Phlegm-Fluid for dizziness. Heavy head is mostly dampness; fire excess uses cooling to descend. The Classic says: Wherever evil resides, there is deficiency. Upper Qi deficiency leads to incomplete brain filling and painful tinnitus. This means evil exploits deficiency, not that it is purely deficiency. Jingyue attributes both to upper deficiency and failure of Clear Yang to ascend, which is also rare.
(Published) Pain in head, neck, back, waist, arms, and legs differs between internal injury and external contraction. Internal injury is mostly deficiency, also due to Qi stagnation; external contraction is mostly excess, caused by pathogenic factors blocking Qi. Li Jinheng stated the Du Mai (Governing Vessel) is the main Qi pipe of the body; understanding this reveals treatment methods.
Regarding Bowels and Urine: The Classic says deficiency of Middle Qi causes changes in urination and defecation. One cannot assume fire just because urine is yellow, forcing dry fluids to kill the patient. Ye said reckless use of draining herbs forces dry fluids. If nourishing Yin and clearing heat, why force dry fluids? "Changes" in the Classic refer not just to yellow urine but to any deviation from normal bowel/urinary habits. Urine may be incontinent, scanty/frequent, or clear/profuse; stool may be loose or constipated. These differ from daily harmony, hence "changes." Fatigue, worry, diarrhea, and sexual excess cause deficiency-fire; summerheat dysentery and painful urination are pathogenic-fire. Treat separately; do not use warming tonics assuming no fire. The Classic says: Wherever evil resides, there is deficiency. Illness arises from deficiency allowing evil invasion. Later authors omitted "wherever evil resides," claiming pure deficiency and using tonics, which is erroneous. Stool should be harmonious; hardening indicates dryness, requiring moistening. In the elderly, fear of dysphagia; do not say harder is better. I believe hard stool is acceptable only if the chest/abdomen are comfortable, diet is good, and defecation requires no straining. Loose frequent stools bringing relief match the *Neijing*: "After evacuation and passing gas, one feels relieved and symptoms subside." Unless Phlegm-Fluid blocks internally or Qi stagnates, diarrhea in warm/damp-heat epidemics is the exit path for evil. Do not assume deficiency-cold and misuse warming/astringent herbs. Ask if stool is hot/cold and color normal/abnormal. Only if cool, loose, and normal-colored can one diagnose Middle Qi deficiency. Also, vomiting/diarrhea preceding carbuncles/rash eruption should not be suppressed; explained here for detail.
Regarding Diet: Feeling better after eating implies deficiency, but not always. Phlegm-Fire and Parasite conditions also feel better after eating; Phlegm-Fire may initially tolerate warming tonics. Polyphagia due to fire is excess, but excessive fire can prevent eating (Stomach heat fails to digest food). Severe Yin depletion with sudden Stomach Yang floating causes "Chu Zheng" (Elimination Syndrome): hungry/eating well like consumption, but pulse is empty/large, fine/soft without spirit. Even large doses of Yin-nourishing herbs cannot save. Rare but must be known. Heat patients prefer drinks; cold patients dislike them. But heat with damp/phlegm may dislike drinking or prefer boiling water; do not mistake for cold. Drinking little suggests Yin deficiency to ancients, but may involve Phlegm-Fluid.
Regarding Chest: Ye said chest/abdominal fullness cannot be tonified. Unknown hunger/fullness, distension-like but not true distension, indicates turbid Qi not clearing. Regulate stagnant Qi; do not suddenly use Ginseng/Atractylodes to trap turbid Qi. Classic: Turbid Qi not descending causes distension. If tonification is needed, distinguish Qi/Blood. Deficiency with stagnation requires both dispersing and tonifying. "Deficiency cannot accept tonification" means ignorance of combined methods. Chest is like sky; emptiness allows vital Qi flow. Occasionally, deficiency distension needs tonification: Qi deficiency needs warming tonification; Yin deficiency needs moistening filling. If Phlegm-Fluid accumulates, food stagnates, or warm/epidemic evil occupies Mouyuan (Mouli), opening/draining is priority. Tonics are forbidden; even cooling/moistening herbs are prohibited. Patients may speak inaccurately; doctors must palpate chest/abdomen for hardness/rejection to judge evil accumulation. Internal abscesses require special attention.
Regarding Deafness: In Cold Damage, evil transmits to Shaoyang; in chronic illness, it is Essence depletion. Jingyue's vague discussion misleads people. Ancient texts also treat deafness via the Lung. Yipiao (Yu Jiayan) said: Metal's knot is in the ear, named Longcong, governing hearing. Heat-deafness is Metal scorched by Fire; treat by clearing Lung. Do not stick to Shaoyang and worsen with Xiao Chai Hu Tang.
(Published) Friend Shen Xinpu had warm-deafness. Doctor Hu Shiyang from Siming used many Bupleurum doses, worsening deafness. Hu claimed progression required tonics. Later cleared with resolving herbs; disease cured but deafness became fixed. Lung collateral heat was blocked by tonics, having no exit. Jingyue's book misleads later generations; this is minor.
Regarding Thirst: Preferring hot drinks indicates Middle Cold and Water Deficiency. Ye said: Water deficiency causes internal heat, how can it be Middle Cold? Preferring hot drinks indicates stagnation; heat brings relief, cold causes blockage. Not Water deficiency. If Water exhausted/Essence depleted, nourish Yin; using hot drugs kills.
(Published) Thirst preferring hot drinks/drinking little is common in warm diseases, due to Phlegm-Fluid blocking Qi. Jingyue's book favors warming tonics, widely followed. Ye Tianshi's *Jingyue Fa Hui*, You Zaijing's *Yixue Dujilu*, and Zhang Xugu's *Yimen Banghe* refute this strongly; students must read.
Women's diseases must first ask about Leukorrhea (Dai). Dai exists from birth; Yue Ren called gynecology "Daixia Yi" (Doctor of Below-the-Belt). Excess is pathology. Over twelve, ask about menstruation. If not started but skin is lustrous, not pathological even past marriage age. If sallow/stunted, it is consumptive damage. For women with periods, ask timing, blood color/purple. Even with exterior infection, clarify cycle length before prescribing to avoid harming blood/fetus. Certain drugs are forbidden during menses; pregnancy pulses are unreliable. Postpartum, ask lochia amount and abdominal masses. Fetal/obstetric cases are too numerous to list; inquire thoroughly, prescribe flexibly, avoid rigidity to prevent harm.
(Corrected) Heaven and Earth's vitality lies in spiritual emptiness. Women's image is Li (Fire) with inner void, enabling conception. Uterus filled with fat cannot conceive. When fetus forms, menstruation stops. Excess Qi becomes Fire, excess Blood becomes Water. Fire battling Water creates Phlegm, causing vomiting/swelling. Tonics must be used cautiously. Ancients said: "No stagnation before birth, no deficiency after birth." Yet extremely deficient women need tonification after conception to nurture; severe tonification at delivery to birth. Postpartum, Qi/Blood are definitely deficient. Danxi taught great tonification of Qi/Blood, but it's not absolute. Jingyue's bias for warming tonics shows difficulty in obstetrics. Each person has unique fetal Qi. Jingren had six sons, all born at 276 days. Qing, Shuang, Lin died young; Long, Hua, Ru survived. Child strength depends not on gestation days. Born at 7-8 months survive; 10+ months may not. Siblings with white skin/hair likely conceived around same time, due to fetal Qi. Zhou Fengren's wife had amenorrhea with abdominal swelling, unresponsive to drugs for over a year, hard as stone. Screamed for husband to beat abdomen like drum for relief. Old doctor Pu Peilin diagnosed after long study, returned days later, meds failed. Husband beat abdomen daily, gave up medicine, awaited death. Two years later, gave birth to short son named Guanbao, who died at ten. Fetal wonders are beyond words.
(Published) Forbidden drugs during menses: Laypeople forbid cold herbs, unaware of Blood/Fire or Ying/Summerheat. Hot/warming herbs are also forbidden. Cold/cool herbs matching syndrome are allowed. Good drugs have flowing nature without stagnation. Crude doctors stick to prohibitions without examining causes. Ancient formulas note "add Danggui for women." Rigid users play lute with glued bridges. Xu Yueyan's wife, over 40, had phlegm-cough/fever in late spring. Doctor knew period ended, added Danggui/Ginger/Jujube to Jingjie/Fangfeng dispersion. After 3 doses, blood mixed with phlegm erupted; 8 purple-grape-like spots on mouth/tongue; lower lip swollen like thumb, black date colored; sore throat. Diagnosed various plagues (Melon Rind, Grape, Tortoise, Neck-Twisting, Lip Carbuncle); doctors fled. Yueyan recalled Bing Si illness, asked me to visit. Bad breath, cheeks black, purple tongue/indigo coating, arm spots black/blue, urine like boiling oil, thirst/belching/sweating, fine/choppy rapid pulse, insomnia. Yin deficiency, heat hidden in Ying, Qi stagnation, Phlegm blocking Upper Jiao. Spots covered body; blood/sweat provided exit for toxin, avoiding collapse, hope remains. Apply Xi Lei San to throat; frequent灌 Tong Ni (Child's Urine), Lotus Root Juice, Pear Juice. Then Xuan Shen, Dan Shen, Zi Cao, Fen Hua, Yin Hua, Zhi Zi, Xian Hu, Da Qing, Zhu Ru, Pi Pa Ye, Xia Ku Cao, Qiang Wei Gen, Hai Ge Ke, decocted with Shen Xi Dan. After 2 doses, tongue red/coating yellow. After 4 doses, bleeding stopped/throat relaxed, pulse wiry/rapid. After 6 doses, stool passed/bad breath reduced, face calm/lip swelling gone. After 8 doses, cough stopped/coating receded/pulse soft, spots faded/black lacquer marks. Switched to light/clear follow-up, cured. My wife, regular cycles, right upper gum pain/swelling in mid-spring, radiating to temple, right nasal congestion, eyes fiery, gum bleeding, yellow slippery coating/no thirst, cold limbs/red face with severe pain, drooling, chest discomfort, hard stool/hot urine, slow/slipping pulse, delayed period. Heat hidden in Ying, Phlegm blocking Qi. Use Xiao Xian Xiong Tang plus Xuan Shen, Zi Yuan, Chang Pu, Zhu Ru, Zhi Shi, Xuan Fu Hua, decocted with Shen Xi Dan. After 4 doses, stool passed/period arrived/cured. Attached two cases to show main idea. Mrs. Zhang, 50, vomiting since late summer, difficulty eating, chest pain after eating, vomiting everything with phlegm-water, drugs failed. By early winter, missed period once, then continued painful vomiting, emaciation, unable to rise, severe constipation. All thought dysphagia formed. Early spring, miscarriage occurred, illness vanished. Age past 7x7, Tian Gui not gone, no amenorrhea but pain/vomiting, initially not suspected morning sickness. Ancients said: "Better treat ten men than one woman." Is this why? Prenatal stage forbids draining/diuretics; even Poria avoided if no dampness. Virgins' eye drops forbid Tiger Bone, fearing difficult labor bone separation. Embryo theory: Nose forms first; Western books say eye mold at 30 days, nose/ears at 60. *Peiwen Yunfu* says omens are Lian. Lian contains Eye radical. Eye mold is initial Lian manifestation. Reasonable. Fetus upside-down theory likely false.
Mr. Shanglin, son of Pei Weng, inherited profession. Recall Ji Mao Spring, Father had Warm Disease with spontaneous diarrhea. Doctors following Tao's Cold Damage used Chaihu/Gegen to lift sinking evil, ineffective. Some called "Leaking Bottom Syndrome," progressed to warming tonics, disease worsened, near death. Father's friend recommended Shanglin. Young doctor diagnosed: Warm Disease, mistaken for Cold Damage, overdosed with warm/dry drugs. Lucky diarrhea continues, heat has exit; otherwise ash already.