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Any formula that possesses the functions of aromatic opening of orifices, acrid-cool penetrating of collaterals, strengthening of the heart mechanism, and excitation of nerves is referred to as the "Kaitou Method" (Opening and Penetrating Method). The distinction lies in that one removes excess to penetrate pathogenic factors, while the other tonifies deficiency to lift sunken qi. This is a crucial method for treating critical conditions such as warm-heat latent pathogens sinking internally leading to coma, obstruction, and collapse. Emergency rescue cannot be achieved without this method. Although these critical conditions arise from pathogenic accumulation in the pericardium, lungs, heart, stomach, liver, inner kidneys, Chong vessel, and Du vessel, they are invariably related to the brain and its system (the brain system, called "nerves" in Western medicine and "Shenjing" in Eastern medicine). This is because the brain is the mansion of the primordial spirit (Yuan Shen), and the heart is the organ storing the spirit. The mind's clarity depends on the brain to remain ethereal and unclouded, enabling wisdom and self-awareness, possessing various principles to respond to myriad situations. However, if steamed by pathogenic heat, confused by phlegm-dampness, obscured by blood-heat stasis, or attacked by blood toxins, the mind may become confused, even leading to manic confusion, dizziness, dullness, closure, spasms, or syncope, with a complete loss of consciousness; if syncope does not recover, it must be due to internal closure and external collapse. Why? Human spirit resides in the heart, and the heart's agility relies on Qi. If brain Qi is weak and Lung Qi collapses, the heart will inevitably paralyze and die; thus, both Eastern and Western physiology correctly identifies the heart, lungs, and brain as the three major essential meridians of the human body. Treatment should first address the cause, resolve accumulations, tonify deficiencies, and lift sunken qi to restore the heart master's spiritual clarity. This is why the Kaitou Method can bring the dying back to life and is considered the most urgent and precious excellent method. Its strategies are listed below:

1. Opening Orifices and Penetrating Collaterals: As Ye Tianshi stated, "Clearing collateral heat must include aromatics, opening interior orifices to clear spiritual consciousness." Interior orifices are the clear orifices through which the spirit enters and exits, belonging to the heart and brain. Since the spirit takes the heart as its residence and the fontanelle as its gate (according to *Liushu Jingyun*), the only orifice visible externally is the eye, because the heart meridian connects upward to the eye system, which in turn connects upward to the brain. Therefore, dilated pupils indicate vacuity and scattering of heart spirit; unclear vision indicates the brain being scorched by fire; sunken eye sockets indicate vacuity and collapse of brain Qi; fixed staring eyes indicate lack of Qi in brain marrow; pupils stopping rotation and stiff tongue unable to speak indicate simultaneous collapse of brain and heart spirit Qi, resulting in syncope resembling a corpse. Wang Qingren stated in *Yilin Gaicuo*: "If there is no Qi in the brain marrow for a moment, not only is there no spiritual mechanism, but death occurs immediately." This truly elucidates the essence of syncope and closure. Collaterals refer to collateral vessels (veins in Western medicine), divided into Yin and Yang collaterals: Yang collaterals are the great collaterals of the stomach; Yin collaterals are the interior collaterals of the lungs, spleen, pericardium, liver, kidneys, Chong, and Du vessels. Among interior collaterals, there are particularly many Sun collaterals (capillaries in Western medicine), situated between main collaterals, serving as fine blood vessels for communication. In the zang-fu organs, the pericardium and liver-Chong are the most abundant. Because the pericardium governs blood and vessels, spreading horizontally; the liver stores blood and governs venous return, connecting upward to the brain and then piercing the Du vessel; the Chong vessel is the sea of blood, guiding Qi upward and blood downward, attaching to the stomach and connecting to the uterus. From this, we see that pathogenic heat sinking into collaterals is not limited to the pericardium alone; even drugs clearing collateral heat have different focuses. However, rhinoceros horn, antelope horn, musk, borneol, toad venom, tortoise shell, and watermelon nitre are generally the most effective, with musk being the primary drug for opening orifices, penetrating collaterals, strengthening the brain, and refreshing the spirit. Thus, for treating pathogenic heat sinking internally, blocking interior collaterals, obstructing the orifices of spirit Qi entry and exit, causing coma regardless of obstruction or spasms/syncope, the priority is given to Guashuang Zixue (Fang Shengan's Formula) and Xipai Zhibao Dan (Lianchen's Verified Formula) as vanguard agents; Angong Niuhuang Wan (Ju Tong's Treatise Formula), Xin Ding Niuhuang Qingxin Wan (Wang Mengying's Formula), and Jufang Zixue (Yitong Revised Formula) follow; Niuhuang Gao (Hejian Liushu Formula) and Juezhuang Fanhun Dan (Zhunsheng Lei Formula) are next; finally, Jufang Miaoxiang Wan and Jufang Laifu Dan serve as rear support. In summary, for heat-sinking coma, one must first distinguish the depth of sinking and severity to determine the formula. If heat initially steams the Heart meridian, causing restlessness, excessive talking, and occasional confused speech, though the pathogen has sunk, it is still shallow and mild; simply using Danxi Qingxin Tang removing Mangxiao and Dahuang to drain Wei and penetrate Ying is sufficient. When the pathogen sinks into the pericardium, causing delirious speech and hallucinations, suspecting ghosts and spirits, the sinking is deeper and heavier; first use Chazhu Dengxin Tang (Fine bud tea 5 fen, curled bamboo leaf 30 pieces, rush pith two small brooms) to administer one to two pills of Wanshi Niuhuang Wan, which often proves effective. If still unconscious after administration, worsening into syncope and muteness with total loss of consciousness, the pathogenic heat has directly sunk into the heart, extremely deep and severe; urgently use Xin Ding Niuhuang Qingxin Wan or Angong Niuhuang Wan, or even mix Guashuang Zixue Dan into Shi's Xidi Tang decoction to open and penetrate, offering a slight chance of survival; or use Jiajian Fu Man Jian (Zhu Chunqu's Song Formula Collection) mixed with four or five pills of Juezhuang Fanhun Dan, also offering a slight chance. If ineffective, internal closure and external collapse will lead to death; this outlines the sequence of heat sinking depth and the method of medication dosage. However, although dullness stems from deep heat, it may involve accompanying turbid phlegm, damp filth, stomach excess, blood stasis, toxin attack, or Chong rebellion, all relating to nerves. Distributed in the Heart, Lung, and Stomach meridians is the tenth cranial nerve, the Vagus nerve, governing perception and movement of these organs; pathogenic accumulation here causes perceptual coma; even the Liver, Kidney, Chong, and Du have sympathetic reflex actions. Extending this logic, the Lung governs Qi; Qi closure causing mental confusion is due to turbid phlegm confusing nerves, hence called Phlegm Confusion or Phlegm Syncope. Treatment should first use Wolong Dan (Xihuang and Gold Leaf each 4 fen, Meibing, Jingjie, Yaoyanghua each 2 qian, Shexiang and Chen Sha each 5 fen, Zhu Ya Zaojiao 1.5 qian, Xixin 1 qian, Dengxin Hui 2.5 qian, ground to fine powder) insufflated into the nose to induce sneezing, opening Lung orifices; then use Daotan Kaiguan San (Guo Yushu's Liao Huibiao Formula) taken orally with boiled water, one qian, to vomit thick phlegm; if consciousness remains unclear despite vomiting, urgently use Xijiao Sanzhi Yin (Rhinoceros horn juice 5 spoons, raw radish juice half bowl, pear juice three scoops, snow water boiled three times, mixed with the three juices and taken immediately) mixed with Lianxiong Dan (Ming Xionghuang 1 fen, Yaxiao 6 fen, ground fine, melted in copper spoon over low heat, stirred evenly, when liquid, filtered clear into bowl, molded into sticks when solidifying) 3 or 5 li, slowly administered cold, three times a day, often resulting in the expulsion of several bowls of clear sticky phlegm and full recovery of consciousness; finally, use Pipa Ye Yinzi (Waitai Formula) mixed with Yanzhi Chuanbei (Gu Songyuan's Formula) one or two doses to remove residual phlegm and regulate Lung Qi, or use Erchen Tang for consolidation; this is the method for severe Phlegm Syncope. For milder cases, Jiawei Daotan Tang (Ganzheng Baofa Formula) is also effective. For damp-filth causing coma, due to extreme stagnation and steaming of damp-heat confusing nerves, called Damp Obstruction, treat with aromatic dispersal of filth and acrid-light opening of closure; Huopo Xialing Tang removing Doukou and Houpo, adding Xixin 3 fen, Baijiezi 8 fen, Lugeng 1 liang, Huashi 5 qian, decocted as water substitute, drunk hot, opening obstruction reliably; severely, mix Taiyi Zijin Dan one pill, universally effective. If heat is slightly heavier, use cooling heat-penetrating and aromatic orifice-opening Qingfang Touxie Tang (Fresh Shichangpu leaf 1.5 qian, Zelane leaf 2 qian, Bohe leaf 8 fen, Qinghao Nao 1.5 qian, fresh Maogen 40 stalks, Shuilugeng 1 liang, Jiedu Wanbing Dan one stick, i.e., Zijin Ding added with Xionghuang and Hupo each 5 qian. Xu Huixi's Verified Formula) also proves effective upon repeated use; Master Fan often uses Huopo Erchen Tang with similar success, or removes Zijin Pian from this formula, grinds and mixes Suhe Xiang Wan one pill, especially effective. For stomach excess causing coma, mostly due to stomach heat steaming the brain, causing inflammation of brain nerves, leading to dullness, head shaking, and staring eyes; extending to spinal cord nerve inflammation causes limb spasms and opisthotonos. Since the stomach is the sea of the five zang and six fu organs, its clear Qi flows upward to the eyes, its fierce Qi rushes upward to the head, follows the throat, ascends to empty orifices, follows the eye system, enters collaterals to the brain, which is the mansion of primordial spirit; thus, stomach heat steaming the brain invariably manifests as nervous diseases, a common pattern in warm-heat diseases, detailed in the Purging Interior chapter, not repeated here. For blood stasis causing coma, accumulated blood confuses nerves; accumulated blood in the upper jiao belongs to the pericardium, presenting with fine pulse, cold limbs, chest bi pain and syncope, hence called Blood Bi-Xiong. Treatment should spread laterally and reach sideways; Jiawei Guizhi Honghua Tang (Ye's Wenbing Lun Formula) and Sini San combined with Baiwei Tang (Lianchen's Verified Formula) are most effective; severely, mix five pills of Juezhuang Fanhun Dan, frequently effective; accumulated blood in the middle jiao belongs to the spleen collaterals, presenting with epigastric pain radiating to hypochondrium, choppy pulse, cold limbs, mostly distending pain in left hypochondrium, hence named Pi Zhang. He Xue Zhu Xie Tang (Bie Xue Chaihu, Jingjie Sui, Zhi Xiangfu, Nen Sugen, Qinjiao each 1.5 qian, Chuan Pu, Zhike each 1 qian, Fujiong 8 fen, Yimucao, Zelane each 3 qian, Jiangtong 1 qian, Shengjiang Pi 2 fen. Shen Yueguang's Verified Formula) is very effective; Wuzhi Songzhen Tang (Zisu Pangzhi 1.5 qian, Chuan Guizhi 5 fen, Camphor tree tender branch, Peach tree tender branch each 5 cun, Wine-fried Mulberry branch 2 chi, Green Pine needle 8 qian decocted as water substitute. Lianchen's Verified Formula) is also effective; severely, add Biejia Jian Wan (Zhang Zhongjing's Formula) 4-5 qian, or add Kuapeng San (Ye's Verified Formula) 1 qian, achieving rapid results; accumulated blood in the lower jiao belongs to the liver collaterals and Chong vessel, presenting with wiry-choppy left pulse, cold limbs, loose black stool, free urination, manic-like coma. Treatment should circulate Qi, resolve knots, penetrate collaterals, and unblock stasis; Ye's Jiajian Xiao Chaihu Tang (Tianshi's Lunwen 20 Rules Formula), Shushi Zengsun Xiao Chaihu Tang (Chi Yuan Shanghan Jizhu Formula), and Sini San combined with Baiwei Tang. Use three formulas酌情ly. Prolonged cases will transform into Gan Zhang and Xue Gu, treated with opening depression and penetrating collaterals; Xinjia Jiangfu Tang (Xu's Yixue Juyao Formula), Kaiyu Tongluo Yin (Xue Shouyin's Yizhui Formula), Kaiyu Zhengyuan San (Jinjian Fujke Xinfa Formula), Danggui Huoxue Tang (Yitong Formula), Dai Di Dang Wan (Hanwen Tiaobian Formula), Wuji Wan (Bencao Gangmu Formula), Huisheng Zhibao Dan (Hua's Fujke Yanfang Formula), Tao Ren Chengqi combined with Xiaoyao San modified (Wang Fuyuan's Verified Formula), etc., selected according to symptoms. For toxin attack causing coma, blood toxin attacking the heart, named Blood Bi, presents with three types: one is warm-toxin scorching blood, blood toxin attacking the heart, treatment requires drastic purging, detailed in the Purging Interior chapter; one is postpartum blood stasis, blood toxin attacking the heart, Huisheng Zhibao Dan is most efficacious, Heishen Wan (Huixi's Verified Formula) is most stable and effective; one is urinary toxin entering blood, blood toxin attacking the heart, even ascending to the brain, extremely critical, urgently need to open orifices, resolve closure, promote urination, and expel toxins; Daochi Xiexin Tang (Tao Jian'an's Shanghan Liushu Formula) mixed with Xipai Zhibao Dan, or Daochi San combined with Jiawei Huzhang San (Lianchen's Verified Formula) mixed with 2-3 qian of Jufang Laifu Dan, offering a slight chance of survival. These are all Kaitou methods for excess patterns. For Chong rebellion causing coma and spasms/syncope, the pattern belongs to Yin deficiency with Fire hyperactivity, treatment requires calming and subduing, not included here.

2. Strengthening Heart and Refreshing Spirit Method: Applicable after warm-heat diseases have undergone sweating, purging, clearing, and penetrating treatments, causing internal injury to Qi, Blood, and Spirit, where the patient gradually becomes lethargic, then comatose, representing a critical state of severe deficiency impending collapse. Urgent strengthening of the heart mechanism and excitation of nerves is required. One must devise a special, potent tonifying and lifting method within the Kaitou framework, so that the nearly dead might survive, distinct from ordinary regulation and tonification. There are four methods:

First, strengthening heart and brain: Such as Shen Gui Rongsun Tang (Nie Jiuwu's Formula) mixed with one scoop of wine (widely used by East and West doctors to strengthen brain and refresh spirit); Renshen Yangrong Tang (Hejiju Formula) mixed with one scoop of Deer Horn Wine; Buzhong Yiqi Tang added with 3 fen of Deer Horn Blood slices (Cheng Zuzhi's Medical New Report Formula), etc. These three formulas are the most powerful and fastest acting for treating brain Qi weakness and heart spirit vacuity, serving as potent emergency remedies for severe deficiency and dullness.

Second, emergency rescue of Yin and Yang: Such as Tao's Huiyang Jiuji Tang (Hei Fu Kuai, Anbian Gui, Chuan Jiang each 5 fen, Biezhi Shen, Huguang Zhu, Chen Fushen each 1 qian, Jiang Banxia, Chao Jubai each 7 fen, Zhi Gancao 5 fen, Wuweizi 3 fen, Shexiang 3 li mixed in) is exquisite. It is highly effective for treating warm-heat diseases where excessive cooling and purging have damaged Primordial Yang, leading to Yang deficiency and spirit scattering. This is an outstanding formula from the renowned physician Tao Jian'an, brilliant in combining Ginseng, Aconite, Cinnamon, and Musk. While laypeople know Musk as a Qi-scattering and orifice-opening drug, they do not realize it is actually a key drug for strengthening the brain and supplementing spirit, as confirmed by Ding's Experimental Chemistry New Materia Medica and Cao's Musk Discrimination, yet our medical community largely ignores this. Secondly, Feng's Quanzhen Yiqi Tang (Biezhi Shen 2 qian, Ti Maidong 5 qian, Bei Wuwei 3 fen, Da Shudi 5-7 qian to 1 liang, Jiangxi Zhu 3 qian, Dan Fupian 1 qian, Wine-steamed Huainiuxi 2 qian) is also good, proving effective for damp-heat syndromes where劫伤 (severe damage) leads to Yin injury affecting Yang, causing dullness and muteness. This is Chu Zhan's secret weapon, working by nourishing Yin fluids while utilizing the Qi transformation of Ginseng and Aconite, allowing upper dispersion of fluids to the Lungs and lower transmission of essence to the Kidneys. With Aconite guided downward by Niuxi, it avoids becoming a destructive Fire and instead becomes a generating Young Fire, creating the miracle of clouds rising to bring rain, thus rescuing Yin rapidly. Although both Tao and Feng formulas are excellent for emergency Yin-Yang rescue, one emphasizes Yang Qi and the other Yin Qi; clinical application requires careful attention.

Third, restoring pulse and revitalizing spirit: Such as Fumai Tang mixed with one scoop of Shen Gui Yangrong Wine achieves rapid results; secondly, Qianjin Shengmai San decocted and mixed with one scoop of Deer Horn Wine is also effective. The efficacy of these two formulas lies in wine's ability to refresh spirit and stimulate blood circulation, thereby strengthening the heart mechanism and restoring meridian operation, preventing pulse cessation and clarifying spirit.

Fourth, opening closure and securing collapse: Two symptoms exist: Internal closure with external collapse, where internal closure refers to collateral blockage and external collapse refers to Qi collapse. Ye Tianshi said: "Normally, if the heart is deficient with phlegm, once external heat sinks, interior collaterals close, leading to immediate syncope and spasms." If closure is not urgently opened, or opened improperly, Heart Qi and Lung Qi will fail to connect smoothly, resulting in cold sweat, restlessness, inability to lie down, fine and rapid pulse, indicating Qi collapse. The emergency method at this time is to urgently open internal closure and secure external collapse, such as Ye's Jiajian Fumai Tang removing Yiren and Pipa Ye, adding Mianpi 1.5 qian and Beiwuweizi numerous grains, mixed with Niuhuang Qingxin Wan; severely, Tao's Huiyang Jiuji Tang mixed with Ye's Shenxi Dan, offering a slight chance of survival. External closure with internal collapse: External closure means pathogen binding and Yang depression; internal collapse means Yang excess and Yin exhaustion. Often caused by warm-heat diseases complicated by wind and cold, where wind-cold is not first dispelled to release the exterior, and bitter-cold descending drugs are used early, leading to unresolved exterior and sinking pathogen. At this time, use light and ascending releasing agents to resolve the exterior and prevent closure, such as Shao's Reyu Tang or Wuye Lugeng Tang; use heat-clearing and Yin-preserving agents to rescue the interior and prevent collapse, such as Zhuye Shigao Tang or Jiajian Zhuye Shigao Tang; select appropriately. Combined formulas, such as Waitai Sanhuang Shigao Tang or Yang's Zengsun Sanhuang Shigao Tang. If chest/abdominal fullness, pain with refusal to press, and constipation occur, urgent purging is needed, detailed in the Purging Interior chapter. These are all tonifying deficiency and lifting sunken methods. Though distinct from Kaitou methods, the intent is the same. However, treating external closure with internal collapse is not included here. The following describes patterns suitable for Kaitou and lifting methods:

Pattern of Pathogenic Heat Initially Steaming Heart Meridian: Restless spirit, frequent dreaming and talking in sleep, clear upon waking; severely, increasing irritability and talkativeness, but speech concerns daily affairs without confusion; occasional delirium at night, but mostly coherent speech; red tongue with sticky coating, yellow-red urine, heavy interior heat with lighter exterior heat, chest stuffiness and discomfort.

Pattern of Pathogen Sinking into Pericardium, Deep Heat with Deep Cold Limbs: Coma and delirium, excessive delusional speech and hallucinations, suspecting ghosts and spirits, seeing/hearing things unseen/unheard by others, but responsive to calls; crimson tongue with sticky coating resembling moss but not quite, dry to look at but moist to touch, red corners of eyes, red lips, deafness, burning pain in chest refusing pressure but soft, cold limbs, purple-black nails, loose black foul-smelling stool or fresh blood, yellow-red painful urination.

Pattern of Pathogenic Heat Deeply Entering Heart: Coma and muteness, loss of consciousness, like a drunkard, resembling corpse-syncope, smiling face, fixed staring eyes, stiff or short curled tongue, red coating with black spots or black coating with red spots, cold body and limbs, isolated heat in chest burning to touch, spirit awake but sleeping, snoring sounds, gum crusts purple like dried lacquer.
Note: Although these signs indicate imminent organ failure, if the scrotum is not retracted, face not blue, breath not high, throat not straight, nose not flaring, ears not scorched, no fish-eye appearance, no crow-beak mouth, there is still a glimmer of hope. Large dose emergency rescue, frequent administration, if medicine reaches the stomach, there is a slight chance of survival. If eyeballs do not rotate, pupils dilated, pale grey tongue lacking spirit, enuresis and spontaneous sweating, death is certain and untreatable.

Pattern of Heat Sinking with Phlegm Confusion: All-day coma and somnolence, seeming asleep but not quite, or irritable manic speech, erroneous muttering, solitary talking as if seeing ghosts, frog-like sound in throat, mute like corpse-syncope, spitting sticky saliva, chest full/painful but soft on pressure, nasal flaring and rapid breathing, crimson moist tongue sticky to touch, or tongue wanting to extend but hitting teeth difficult to extend quickly, severely chaotic convulsions resembling epilepsy.

Pattern of Heat Sinking with Damp Obstruction: Chest/diaphragm stuffiness, vexation and oppression, eyes wanting to close, coma and delirium, white slippery coating or yellow-greasy coating, short/scanty yellow-hot urine, loose unsatisfactory stool, oily complexion, foul breath, deafness, dry retching.

Pattern of Heat Sinking with Blood Syncope: Coma like drunkenness, awakening upon call, aware of people when spoken to; if allowed to sleep freely, then coma and delirium; severely syncope and muteness, heavy body, chest pain, cold limbs, hard stool but easy passage, purple-black color, free urination, purple-dark moist tongue.

Pattern of Pathogenic Heat Knotting Stasis, Blood Toxin Attacking Heart: Coma like mania or epilepsy, laughing/cursing, wanting to bite people, purple-dark tongue, locked jaw difficult to open, or limb spasms.