近来市习，一见舌痛，皆云舌乃心之苗，皆火为病也，即以冰硼散吹之，黄连解毒服之。有余立瘳，不足则殆。[眉批]知非氏曰：舌之所以能言者，气机之贯注也。何必执定舌乃心之苗一语。以治舌证。钦安不言之稳，知非饶舌点出，学者当亦豁然矣。
喉 蛾
按喉蛾一证，有少阴君火为病者，有肾气为病者，有胃中积热上攻而致者，有怒动肝火上攻而致者。
因少阴君火为病者，或由外挟风热，与君火协化，或本经素有火邪，发泄不畅，上刑于肺，少阴之脉挟咽喉，咽喉窄狭，火气太甚，欲发泄而不能，薰蒸于上，而生蛾子。其
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人定多心烦，小便知赤、口渴冷。若挟风热，多现发热，身疼，头痛。法当祛风清热，如导赤散加荆、防、银花之类。
无风热而独君火旺为病者，轻则甘桔汤，重则黄连解毒汤之类。
因肾气不藏，上攻于喉而致者，俗云：阴虚火旺，不知肾气以潜藏为顺，上行为逆，实由君火太弱，不能镇纳群阴，非阴之虚，实阴之盛，世人错认。原由君火弱而不能制阴，阴气上僭，逆于咽喉而生蛾子。其人口内肉色，必含青黑色，或惨黄淡白色，即或唇红甚，而口气温，痛亦不甚，人困无神，脉必浮空。法宜扶阳，如封髓丹，姜桂饮、白通、潜阳等方，皆可令服。
因积热上攻而致者，其人必过食厚味，或胃中素有伏热，上攻于肺，亦生蛾子。多烦渴饮冷，二便不利，口臭气粗，红肿痛甚。法宜去积热，如大小承气汤，或平胃散加丑牛、槟榔、大黄、三棱、莪术之类。
因怒动肝火，上攻于肺而生蛾子。其人两胁必痛，动辄躁烦，面青口苦，脉必弦洪。法宜清肝，如丹栀逍遥散、大青饮、柴胡汤加丹、栀之类。
总之，病情变化，非一二端能尽，其实万变万化，不越阴阳两法。[眉批]圆通一至。若欲逐经、逐脏、逐腑论之，旨多反晦，诚不若少之为愈也。[眉批]知非氏曰：喉至生蛾，其咽必肿痛而甚，有碍食饮，病家多惊恐，其证又因初起误治者多，在明医虽能剖析阴阳虚实，按经用药，而缓不济急，病家恐惴，如外科所配八宝红灵丹，亦不妨暂用吹喉，以解燃眉，略宽其心，病人得此，心神稍定，然后按法投方，易于奏效。此知非所经试，亦济世之婆心也。学者留意。至于理法，喉属少阴，钦安究及所因，实为详明，何多求焉。
近来市习，一见喉症，往往用吹喉散、冰硼散、开喉剑，一派寒凉之品，甚者刺之。阳证无防，阴证有碍，认证贵明，须当仔细。
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两手膀背痛
按膀背痛一证，有因外感风寒，闭塞经络而作者，有因中气不足，内寒阻滞而作者。
因外感风寒而致者，其人定多畏寒恶风，或发热而兼头疼。法宜宣散，如桂枝汤、羌活附子汤、麻黄附子细辛汤之类。
因中气不足而致者，由中宫素虚，真气不能充周四体，寒邪痰湿，亦得到阻滞经络，而痛立作矣。欺人定然面白少神，饮食减少，或逢晦明阴雨而更甚，丽照当空而觉轻。法宜温中行气为主，如建中汤倍桂、附，补中益气汤加羌、附，或理中汤加桂枝、香附。予恒见中年老妇，每多两手膀痛而不能举，时常作苦，究其受病之由，多起于少年天癸至时，不知保养，洗衣浆裳，辄用冷水，以致寒凉伤及经络，因而天癸不行者亦多。即或体强，而寒凉不能害，视为平常，不知人身真气有盛即有衰，气未衰时，寒凉虽侵，不即为害，迨至中年老时，本身正气已衰，或兼受一点寒邪引动，而痛于斯作矣。予每以甘草干姜汤加鹿茸、桂尖、附子、葱、酒治之多效。[眉批]夫兴少年作苦，恃勇力作，迨至中晚之岁，稍能逸豫，劳伤之疾徐发于内，痛苦立作，见于手膀腿者多。粗工不识，任治罔效，往往病人自能体会，何者今之痛处，皆昔之劳力处也。钦安此按，识见绝高，深合《内经》比类从容之法，非功力精到者，未易臻此，又医之一大法也，学者不可不知。
近来市习，一见两手膀痛，每以五积散、流气饮，与夫羌活、荆、防、伸筋、舒筋草、苏木、灵仙、松节之类，亦多获效。总不若辩明外感内伤，阴阳虚实为要。
更有手指麻木一证，属脾气不能充周者多，外感者少，兼痰湿亦多。不外温中行气为主，如归脾汤加天麻、半夏，
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六君、四君加附、桂、香、砂，建中汤倍桂、附加香附、当归之类。
心 痛
按心痛一证，有寒热之别。他书有云：心为君主之官，其可痛乎？所云痛者，实心包也，此说近是。予谓心肝脾肺肾并六腑周身经络骨节皮肤，有形之向躯壳，皆后天体质，全赖先天无形之真气以养之。真气二字，指真阴真阳也。真阴指母之精气，真阳指父之精气，二气浑为一气，周流上下四旁，主宰神明即寓于中。真气不足，无论在何部，便生疾病，何得有心无痛证之说。夫岂不见天之日月，常有食乎。凡认心痛一证，必先判明界限方可。心居膈膜之上，下一寸即胃口，胃口离心不远，胃痛而云心痛者亦多，不可不察。细思痛证一条，痛字总是一个逆字。气顺则气血流通，必无痛证。气逆则气血壅滞不通。故痛。无论逆在何处，皆能作痛，皆能伤心，其实非伤有形质之心，实伤无形中所具之真宰也。若执定有形质之心，是知其末也。心有心界限，包络为心之外垣，邪犯心包，即是犯心包，即是犯心章本，不必直云邪不犯心。犯心二字，是犯心君居处气也。试问：犯心与犯心包，以何区分？诸书并未剀切指陈。予谓人活一口气，气盛则为有余，为热邪。不独能致心痛。气衰则为不足，为阴邪。亦不独能致心痛之疾。热与阴上逆，皆能致心痛，当以寒热两字判之便了。若邪热上干而痛者，其人必面赤，心烦热，小便短赤，口渴饮冷。法宜养阴清火，如黄连木香汤、导赤散、当归散之类。若阴寒上干而痛者，其人多面青唇白，或舌青黑，喜热饮、揉按，二便自利。法宜扶阳祛阴为主，如甘草干姜汤，加行气药姜、桂、吴萸之类。亦有阴寒已极，上攻于心，鼻如煤烟，唇口黧黑，爪甲青黑，满身纯阴。法在不救，急
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以回阳诸方，大剂投之，十中可救一二。[眉批]知非氏曰：比段至理，乃造化根柢，性命之旨圭。奈何泄之于医，世人不识，反多皆议。余观一部《内经》，轩岐君臣皆是借天验人，以人合天，吴人各道。仲景太守《伤寒》一书，太阳太阴、少阳少阴、阳明厥阴六经，亦不过借天道之流行，暗合人身之度数，藉病谈机而已。钦安直笔于兹，毋乃太过乎？虽然医道理没久矣。如此发挥，守先圣之道，以待后之学者心存利济，亦不为罪。倘有能从此深造，治病动合机宜，立言彰，阐至理，将不失为轩岐功臣，斯世和缓，幸甚全甚。
近来市习，心胃莫分，一味行气破滞，并不察究阴阳，往往误事，一概委之天命，而人事之当尽，又不可废乎。
胃痛
按胃痛一证，有饮食、寒热、虚实之别，切不可执定有形质之胃，当于胃中往来之气机上理会方可。[眉批]于气机上理会，上乘妙法，《莲花经》也。夫人身内有胃，乃受饮食之具，譬如田地任人播种，秀实凭天。倘遇灾侵，而有黄落之恐，田地肯任其咎乎？古人拟胃曰阳土。钦安论治胃病，当理会气机，皆一定不易之理法也。学者即不能入理深谭，按定外内阴阳之法，总不至谬治误人。
因饮食停滞于胃，胃中之气机不畅而致者，其人定见饱闷吞酸嗳气[1]，痛处手不可近。法宜消食行滞，如厚朴七物汤，平胃散加香附、麦芽之类。
因胃阳不足，复感外寒生冷食物，中寒顿起而致者，其人必喜揉按，喜热饮，或口吐清水，面白唇青。法宜温中行气，如香砂六君汤，理中汤加官桂、砂仁、香附、木香之类。
因积湿生热，与肠胃素有伏热，过食厚味而生热；气郁不舒而生热所致者，其人定多烦躁，唇红气粗，大便坚实等情。法宜下夺，清热为主，如调胃承气汤、大黄木香汤、四磨汤之类。
[1] 气 原本作"夫"，据文义改。
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更有一等，心胃腹痛，面赤如朱，欲重物压定稍安者，此是阴盛逼阳于外之候。法宜扶阳祛阴为急，切不可照常法治之。
近来市习，多以元胡、乳、没、二皮、术、棱、五香、枳壳、厚朴之味投之。果有积滞，主立奇功。若胃肠素亏，必增其害，不可不知也。
脐 痛
按脐痛一证，有阴阳之别。脐居阴阳交界之区，脐上属脾胃，脐下属肝肾。痛在脐上，著重脾胃。痛在脐下，著重肝肾。脐上下俱痛者，脾胃与肝肾病也。此处又宜分别何经受病为要。若脐上独痛，是脾胃之气有所滞也。因寒、因热、因食、因抑郁又宜知。审是饱闷吞酸，便知饮食停而气滞也。急以消食行滞之品施之，如平胃散加香附、麦芽、枳壳之类治之。
审是喜热饮，揉按而痛即减者，知是脾胃之阳不足，不能化其阴寒之邪也。法宜温中，如理中汤，香砂六君，甘草干姜汤，加香附、安桂、丁香之类。
审是不喜热饮摩按，得热而反剧者，知是脾胃有郁热而气滞也，即以开郁行滞之法治之，如厚朴七物汤，麦芽、炒栀、香附之类是也。
亦有太阳之邪未解，误下而邪陷于脾，以致脐上痛者，其人必先有发热恶寒，头项强痛之候，因下后方见此痛者，便以桂枝大黄汤治之。
若脐下独痛，是厥阴之气不宣也。审是烦满囊缩，脐下病痛者，厥阴之阴寒太甚也。法宜回阳祛阴，如吴萸四逆汤，白通汤之类是也。审是厥阴热邪伏而不宣，又或上攻为喉痹、下攻便脓血，热深厥深，口臭气粗之类。法宜扶阴，如鸡子
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黄连[1]汤之类。[眉批]知非氏曰：三阴之病，本从肚脐而分，然痛在脐上，有太阴、阳阴之不同，一腑一脏之悬绝，故钦安以饱闷吞酸，定阳明肺病，而用行消之法，若稍上，又是太阳地，而有风寒之判，皆有痛证，且有气血之区别。学者平时若不详细讲究，临证必多疑似，处方不无模棱，断难万举万当。熟玩此按，悉心讨论，目得真诠。
近来市习，一见脐痛，不按界限，一味调气行血，每以木香、小茴、当归、白芍、川芎、枳壳、沉香之类，故有效与不效。诚不若辩明上下阴阳，治之为当也。
疝证
按疝证一条，有去左为膀胱气，右为疝气，痛时睾丸上行入腹，或右丸上行而左丸不上行，或左丸上行而右丸不上行，或两丸并上行。他书有寒疝、水疝、筋疝、血疝、气疝、狐疝、阴疝、痜疝、心疝、肝疝之异，名目虽多，总无一定不易之理。予细维此病，究竟只在厥阴一经也。[眉批]此按落落大方，深入显出。不愧为医，一语成铁案，谁敢再翻异。余深服此老吏。虽形象、病情不同，而睾丸与阴囊，其理断无可移者。予意睾丸与阴囊上缩，必是阴盛；睾丸与阴囊红肿，必是热增。治缩者，重在破阴以回阳，吴萸四逆加桂、砂、小茴，或乌梅丸倍阳药之类。治肿者，法宜破阳以扶阴，鸡子黄连与泻肝汤可施。须知肿缩二字，即盈虚之宗旨，肝气有余便是火，即囊丸肿的实据；肝气不足便是寒，即囊丸缩的实据。[眉批]醒豁透露。
又可疑者，今人皆云：两丸为外肾，何男子有而女子无乎？此理举世罕言要晰。予思天一生水，其卦为坎，二阴夹一阳，腰间二肾与背脊督脉似之。男女皆具，理实可从。若此二丸，男有女无，非无一定之理，惜后贤窥之未及也。后天
[1] 连原本作"运"，据文义改。
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既以坎离立极，坎离即是乾坤，是坎离已得一二之数，故复申之曰：天三生木，木有阴木、阳木之别，阳木曰三，为长男，二阴一阳，今之呼外肾者，即此也，故男子独具；阳木曰三，为长女，二阳一阴，其缺在下，今之呼阴户者，此也。[眉批]阐发至理，畅所欲言，然似断鳌立极，却是叫人何处住脚。余谓医道，须是知得一步，方许再进一步，终身门外，正不知几许人也。
夫乾坤交媾，首生长男长女，后天以坎离代乾坤，而天三生木之旨，即在此处便见，而玉茎、阴户，亦于此攸分。故仲景配此处属厥阴，取其至阴阴极也。玉茎之举，必须心火下照，又可见天三生木之机，此就其形体而言，其中之精义实微，未可尽泄。堪笑今人以外肾呼之，真是说梦话也。[眉批]再接再厉，乃一读一击节，以高唱入云之笔，绘天地生发之机，斟酌饱满，尽态极妍，可谓写生妙手。发挥阴得阳而兴之理，尤见精致。然非学养功深，不能道其只字。
查近来市方，一见疝证，便以小茴、荔枝核、橘核、安桂、附子、麝香之类，屡屡获效，究其所用，皆是温肝之品，取核者时，核以入核之意，理实可从。至于囊丸红肿，此法断不可施，务在阴阳攸分处理会可也。[眉批]结亦含着不尽，《唐诗》曰：欲穷千里目，更上一层楼。如熊氏歌曰：要知返本还原法，须认吾身大药王。
遗 精
按遗精一证，诸书分别有梦而遗，无梦而遗，用心过度而遗，见色而遗，闻女声而遗，无故自遗，种种分别，总无一定不易之法。予谓不必细分，统以心肾不交，神魂不藏为主。夫人之立身，原以为主，肾气上腾，指坎气也。载水气以交于心，而心脏凉。心气下降，使君火以入肾，而肾脏温。神居二气之中，昼则从离，夜则从坎，神宰乎气，气统乎
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近来世俗医风，一见到舌痛，便都说舌头是心的苗窍，都是火邪致病，于是就用冰硼散吹喉，服用黄连解毒汤。若是实证（有余），病立刻就好；若是虚证（不足），病人就会陷入危险。[眉批]知非氏说：舌头之所以能说话，是因为气机的贯通灌注。何必死守“舌乃心之苗”这一句话来治疗舌部病症。卢崇汉医生不言自明的稳妥之处，知非氏多嘴点破，学者应当豁然开朗了。
喉蛾
考察喉蛾这一病症，有因少阴君火为病的，有因肾气为病的，有因胃中积热上攻而导致的，有因愤怒触动肝火上攻而导致的。
因少阴君火为病者，有的是外感挟带风热，与君火协同化火；有的是本经素来有火邪，发泄不畅，向上刑克肺金。少阴经脉夹持咽喉，咽喉狭窄，火气太盛，想要发泄而不能，熏蒸于上，从而生出喉蛾。这类病人往往心烦，小便色赤，口渴喜冷饮。如果挟带风热，多出现发热、身疼、头痛。治法应当祛风清热，如导赤散加荆芥、防风、金银花之类。
没有风热而单纯君火旺盛为病者，轻症用甘桔汤，重症用黄连解毒汤之类。
因肾气不藏，上攻于喉而致者，俗话说是阴虚火旺，却不知道肾气以潜藏为顺，上行就是逆。这实际上是由于君火太弱，不能镇纳群阴，并非阴液之虚，而是阴气之盛，世人错误地认识了。原由君火弱而不能制约阴寒，阴气上僭，逆于咽喉而生出喉蛾。这类人口内肌肉颜色，必定含有青黑色，或惨黄淡白色，即使嘴唇很红，但口气温和，疼痛也不剧烈，人困倦无神，脉象必定浮空无力。治法适宜扶阳，如封髓丹、姜桂饮、白通汤、潜阳丹等方，都可以让病人服用。
因积热上攻而致者，这类病人一定过食肥厚滋味，或者胃中素来有伏热，上攻于肺，也生出喉蛾。多烦渴饮冷，大小便不利，口臭气粗，红肿疼痛剧烈。治法适宜去除积热，如大承气汤、小承气汤，或平胃散加牵牛子、槟榔、大黄、三棱、莪术之类。
因愤怒触动肝火，上攻于肺而生出喉蛾。这类病人两胁必定疼痛，动不动就烦躁，面色青，口苦，脉象必定弦洪。治法适宜清肝，如丹栀逍遥散、大青饮、柴胡汤加牡丹皮、栀子之类。
总之，病情变化，不是几方面能说完的，其实万变万化，不离阴阳两法。[眉批]圆通到了极点。如果想逐经、逐脏、逐腑来论述，旨意多了反而晦涩，实在不如简略为好。[眉批]知非氏说：喉咙长到生蛾，咽喉必定肿痛得很，妨碍饮食，病人大多惊恐，而且这个病症因为初起时误治的很多，在明医虽然能剖析阴阳虚实，按经络用药，但缓不济急，病人恐怕惊慌，像外科所配的八宝红灵丹，也不妨暂时用来吹喉，以解燃眉之急，稍微宽慰其心，病人得到这个，心神稍定，然后按法投药，容易奏效。这是知非亲自经验过的，也是济世救人的婆心啊。学者要注意。至于理法，喉属少阴，卢崇汉探究病因，确实详细明白，何必多求呢。
近来世俗医风，一见到喉症，往往用吹喉散、冰硼散、开喉剑，一派寒凉的药物，严重的甚至刺破放血。阳证没有妨害，阴证就有碍害，辨证贵在明确，必须仔细。
两手膀背痛
考察膀背痛这一病症，有因外感风寒，闭塞经络而发作的，有因中气不足，内寒阻滞而发作的。
因外感风寒而致者，这类病人一定多畏寒恶风，或者发热兼头疼。治法适宜宣散，如桂枝汤、羌活附子汤、麻黄附子细辛汤之类。
因中气不足而致者，由于中宫素来虚弱，真气不能充周全身，寒邪痰湿，也能阻滞经络，疼痛立刻发作。这类病人一定面色白少神，饮食减少，或者逢阴雨天气更严重，丽日当空就觉得轻快。治法适宜温中行气为主，如建中汤倍用桂枝、附子，补中益气汤加羌活、附子，或理中汤加桂枝、香附。我常看见中年老妇人，很多两手膀痛不能举起，时常受苦，究其得病的原因，多起于少年天癸来时，不知道保养，洗衣浆裳，常用冷水，以致寒凉伤及经络，因而天癸不行的也很多。即使身体强壮，寒凉不能伤害，视为平常，不知道人身真气有盛就有衰，气未衰时，寒凉虽侵入，不立即为害，等到中年老了，本身正气已衰，或者兼受一点寒邪引动，而疼痛在这里发作了。我常用甘草干姜汤加鹿茸、桂尖、附子、葱、酒治疗，大多有效。[眉批]那些少年时作苦力，倚仗勇力干活，等到中晚年岁数，稍微能安逸享乐，劳伤的疾病慢慢发于内部，痛苦立刻发作，见于手膀腿部的很多。粗劣的医生不认识，随便治疗无效，往往病人自己能体会，哪个是现在的痛处，都是过去的劳力处啊。卢崇汉的这个按语，见识极高，深合《内经》比类从容的方法，不是功力精到的，不容易达到这个境界，又是医学的一大法则，学者不可不知道。
近来世俗医风，一见到两手膀痛，常用五积散、流气饮，以及羌活、荆芥、防风、伸筋草、舒筋草、苏木、威灵仙、松节之类，也多获效。总不如辩明外感内伤，阴阳虚实为重要。
更有手指麻木这一病症，属于脾气不能充周的多，外感的少，兼痰湿的也多。不外乎温中行气为主，如归脾汤加天麻、半夏，六君子汤、四君子汤加附子、桂枝、香附、砂仁，建中汤倍用桂枝、附子加香附、当归之类。
心痛
考察心痛这一病症，有寒热的区别。其他书有说：心是君主之官，怎么会痛呢？所说的痛，其实是心包络，这种说法接近正确。我认为心肝脾肺肾并六腑周身经络骨节皮肤，都是有形的躯壳，全赖先天无形之真气来滋养它。“真气”二字，指真阴真阳。真阴指母亲的精气，真阳指父亲的精气，二气浑为一气，周流上下四旁，主宰神明即寓于其中。真气不足，无论在何处，便生疾病，怎么能有心无痛证的说法呢？难道没看见天上的日月，常有食缺吗？凡是认定心痛这一病症，必须先判明界限才可以。心居膈膜之上，下一寸就是胃口，胃口离心不远，胃痛而说是心痛的也很多，不可不察。仔细思考痛证一条，“痛”字总是一个“逆”字。气顺则气血流通，必无痛证。气逆则气血壅滞不通，所以痛。无论逆在何处，皆能作痛，皆能伤心，其实不是伤有形质的心，实伤无形中所具的真宰。如果死守有形质的心，是知道它的末节。心有心界限，包络为心的外垣，邪犯心包，即是犯心包，即是犯心之本，不必直说邪不犯心。“犯心”二字，是犯心君居处之气。试问：犯心与犯心包，用什么区分？诸书并没有恳切指明。我认为人活一口气，气盛则为有余，为热邪。不独能致心痛。气衰则为不足，为阴邪。也不独能致心痛之疾。热与阴上逆，皆能致心痛，应当以寒热两字判断就可以了。若邪热上干而痛者，这类病人一定面赤，心烦热，小便短赤，口渴饮冷。治法适宜养阴清火，如黄连木香汤、导赤散、当归散之类。若阴寒上干而痛者，这类人多面青唇白，或舌青黑，喜热饮、揉按，大小便自利。治法适宜扶阳祛阴为主，如甘草干姜汤，加行气药姜、桂、吴茱萸之类。也有阴寒已极，上攻于心，鼻如煤烟，唇口黧黑，爪甲青黑，满身纯阴。治法在不救，急以大剂回阳诸方投之，十中可救一二。[眉批]知非氏说：这段至理，乃是造化根柢，性命之旨圭臬。奈何泄露之于医，世人不识，反而多被议论。我看一部《内经》，轩辕岐伯君臣皆是借天验人，以人合天，吴越之人各道其理。张仲景太守《伤寒论》一书，太阳太阴、少阳少阴、阳明厥阴六经，也不过借天道之流行，暗合人身之度数，藉病谈机而已。卢崇汉直笔于此，莫非太过分了吗？虽然医道理没久矣。如此发挥，守先圣之道，以待后之学者心存利济，也不算有罪。倘若有能从此深造，治病动合机宜，立言彰显，阐发至理，将不失为轩辕岐伯的功臣，世间和缓再世，幸甚全甚。
近来世俗医风，心胃莫分，一味行气破滞，并不察究阴阳，往往误事，一概委之天命，而人事之当尽，又不可废乎。
胃痛
考察胃痛这一病症，有饮食、寒热、虚实的区别，切不可死守有形质的胃，应当在胃中往来之气机上理会才可以。[眉批]于气机上理会，上乘妙法，《莲花经》也。人身内有胃，乃受饮食之具，譬如田地任人播种，秀实凭天。倘若遇灾侵，而有黄落之恐，田地肯任其咎乎？古人拟胃曰阳土。卢崇汉论治胃病，当理会气机，皆一定不易之理法也。学者即不能入理深谭，按定外内阴阳之法，总不至谬治误人。
因饮食停滞于胃，胃中之气机不畅而致者，这类病人一定见饱闷吞酸嗳气，痛处手不可近。治法适宜消食行滞，如厚朴七物汤，平胃散加香附、麦芽之类。
因胃阳不足，复感外寒生冷食物，中寒顿起而致者，这类病人一定喜揉按，喜热饮，或者口吐清水，面白唇青。治法适宜温中行气，如香砂六君汤，理中汤加官桂、砂仁、香附、木香之类。
因积湿生热，与肠胃素有伏热，过食厚味而生热；气郁不舒而生热所致者，这类病人一定多烦躁，唇红气粗，大便坚实等情。治法适宜下夺，清热为主，如调胃承气汤、大黄木香汤、四磨汤之类。
更有一等，心胃腹痛，面赤如朱，欲重物压定稍安者，这是阴盛逼阳于外之候。治法适宜扶阳祛阴为急，切不可照常法治之。
近来世俗医风，多以元胡、乳香、没药、二皮、白术、三棱、五香、枳壳、厚朴之味投之。果有积滞，主立奇功。若胃肠素亏，必增其害，不可不知也。
脐痛
考察脐痛这一病症，有阴阳的区别。脐居阴阳交界之区，脐上属脾胃，脐下属肝肾。痛在脐上，着重脾胃。痛在脐下，着重肝肾。脐上下俱痛者，脾胃与肝肾病也。此处又宜分别何经受病为要。若脐上独痛，是脾胃之气有所滞也。因寒、因热、因食、因抑郁又宜知。审是饱闷吞酸，便知饮食停而气滞也。急以消食行滞之品施之，如平胃散加香附、麦芽、枳壳之类治之。
审是喜热饮，揉按而痛即减者，知是脾胃之阳不足，不能化其阴寒之邪也。治法适宜温中，如理中汤，香砂六君，甘草干姜汤，加香附、安桂、丁香之类。
审是不喜热饮摩按，得热而反剧者，知是脾胃有郁热而气滞也，即以开郁行滞之法治之，如厚朴七物汤，麦芽、炒栀、香附之类是也。
亦有太阳之邪未解，误下而邪陷于脾，以致脐上痛者，这类病人必先有发热恶寒，头项强痛之候，因下后方见此痛者，便以桂枝大黄汤治之。
若脐下独痛，是厥阴之气不宣也。审是烦满囊缩，脐下病痛者，厥阴之阴寒太甚也。治法适宜回阳祛阴，如吴萸四逆汤，白通汤之类是也。审是厥阴热邪伏而不宣，又或上攻为喉痹、下攻便脓血，热深厥深，口臭气粗之类。治法适宜扶阴，如鸡子黄连汤之类。[眉批]知非氏说：三阴之病，本从肚脐而分，然痛在脐上，有太阴、阳阴之不同，一腑一脏之悬绝，故钦安以饱闷吞酸，定阳明肺病，而用行消之法，若稍上，又是太阳地，而有风寒之判，皆有痛证，且有气血之区别。学者平时若不详细讲究，临证必多疑似，处方不无模棱，断难万举万当。熟玩此按，悉心讨论，目得真诠。
近来世俗医风，一见脐痛，不按界限，一味调气行血，每以木香、小茴、当归、白芍、川芎、枳壳、沉香之类，故有效与不效。诚不若辩明上下阴阳，治之为当也。
疝证
考察疝证一条，有去左为膀胱气，右为疝气，痛时睾丸上行入腹，或右丸上行而左丸不上行，或左丸上行而右丸不上行，或两丸并上行。其他书有寒疝、水疝、筋疝、血疝、气疝、狐疝、阴疝、痜疝、心疝、肝疝之异，名目虽多，总无一定不易之理。我细思此病，究竟只在厥阴一经也。[眉批]这个按语落落大方，深入显出。不愧为医，一语成铁案，谁敢再翻异。我深深佩服这位老吏。虽形象、病情不同，而睾丸与阴囊，其理断无可移者。我的意思睾丸与阴囊上缩，必是阴盛；睾丸与阴囊红肿，必是热增。治缩者，重在破阴以回阳，吴萸四逆加桂、砂、小茴，或乌梅丸倍阳药之类。治肿者，法宜破阳以扶阴，鸡子黄连与泻肝汤可施。须知肿缩二字，即盈虚之宗旨，肝气有余便是火，即囊丸肿的实据；肝气不足便是寒，即囊丸缩的实据。[眉批]醒豁透露。
又可疑者，今人皆云：两丸为外肾，何男子有而女子无乎？此理举世罕言要晰。我想天一生水，其卦为坎，二阴夹一阳，腰间二肾与背脊督脉似之。男女皆具，理实可从。若此二丸，男有女无，非无一定之理，惜后贤窥之未及也。后天既以坎离立极，坎离即是乾坤，是坎离已得一二之数，故复申之曰：天三生木，木有阴木、阳木之别，阳木曰三，为长男，二阴一阳，今之呼外肾者，即此也，故男子独具；阳木曰三，为长女，二阳一阴，其缺在下，今之呼阴户者，此也。[眉批]阐发至理，畅所欲言，然似断鳌立极，却是叫人何处住脚。我认为医道，须是知得一步，方许再进一步，终身门外，正不知几许人也。
夫乾坤交媾，首生长男长女，后天以坎离代乾坤，而天三生木之旨，即在此处便见，而玉茎、阴户，亦于此攸分。故仲景配此处属厥阴，取其至阴阴极也。玉茎之举，必须心火下照，又可见天三生木之机，此就其形体而言，其中之精义实微，未可尽泄。堪笑今人以外肾呼之，真是说梦话也。[眉批]再接再厉，乃一读一击节，以高唱入云之笔，绘天地生发之机，斟酌饱满，尽态极妍，可谓写生妙手。发挥阴得阳而兴之理，尤见精致。然非学养功深，不能道其只字。
查近来市方，一见疝证，便以小茴、荔枝核、橘核、安桂、附子、麝香之类，屡屡获效，究其所用，皆是温肝之品，取核者时，核以入核之意，理实可从。至于囊丸红肿，此法断不可施，务在阴阳攸分处理会可也。[眉批]结亦含着不尽，《唐诗》曰：欲穷千里目，更上一层楼。如熊氏歌曰：要知返本还原法，须认吾身大药王。
遗精
考察遗精一证，诸书分别有梦而遗，无梦而遗，用心过度而遗，见色而遗，闻女声而遗，无故自遗，种种分别，总无一定不易之法。我认为不必细分，统以心肾不交，神魂不藏为主。人之立身，原以为主，肾气上腾，指坎气也。载水气以交于心，而心脏凉。心气下降，使君火以入肾，而肾脏温。神居二气之中，昼则从离，夜则从坎，神宰乎气，气统乎
Recently, the common medical practice is that upon seeing tongue pain, everyone claims that the tongue is the sprout of the heart and that it is a disease caused by fire. They immediately use Bingpeng San (Ice and Borax Powder) for insufflation into the throat and administer Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity). If there is excess [pathogenic factor], recovery is immediate; if there is deficiency, the patient faces danger. [Marginal Note] Zhi Fei Shi said: The reason the tongue can speak is due to the penetration and infusion of Qi mechanism. Why stick rigidly to the phrase "the tongue is the sprout of the heart" when treating tongue disorders? Lu Chonghan's steady approach speaks for itself; Zhi Fei's extra words point it out. Scholars should be suddenly enlightened.
Throat Moths (Tonsillitis/Pharyngitis with exudates)
Regarding the syndrome of Throat Moths, some are caused by Ministerial Fire of Shaoyin, some by Kidney Qi, some by accumulated heat in the Stomach attacking upwards, and some by Liver Fire stirred by anger attacking upwards.
When caused by Ministerial Fire of Shaoyin, it may be due to external wind-heat clashing with Ministerial Fire to transform into fire, or because the meridian originally harbors fire pathogen that fails to vent smoothly, attacking the Lungs from above. The Shaoyin meridian flanks the throat; the throat is narrow, and when Fire Qi is too excessive, wanting to vent but unable to do so, it steams upwards, generating moths. Such patients often experience mental restlessness, dark urine, and thirst for cold drinks. If accompanied by wind-heat, fever, body ache, and headache often appear. The treatment method should be to dispel wind and clear heat, such as Daochi San (Guide Out Redness Powder) added with Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), and Yinhua (Lonicerae Japonicae Flos).
When there is no wind-heat but only excessive Ministerial Fire causing the disease, mild cases use Ganjie Tang (Licorice and Platycodon Decoction), and severe cases use Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity).
When caused by Kidney Qi failing to store and attacking upwards to the throat, it is commonly said to be Yin deficiency with Fire hyperactivity. However, one does not know that Kidney Qi follows the principle of submergence and storage; upward movement is contrary. This is actually due to weak Ministerial Fire, which cannot suppress and assimilate the Yin pathogens. It is not a deficiency of Yin, but an excess of Yin, which people mistakenly recognize. The root cause is weak Ministerial Fire failing to control Yin, allowing Yin Qi to usurp upwards and reverse in the throat, generating moths. Patients will have mucous membranes in the mouth containing bluish-black hues, or pale yellow/dull white. Even if lips are very red, the breath is warm, pain is not severe, the person is listless without spirit, and the pulse is floating and empty. The treatment method should support Yang, such as Fengsui Dan (Seal the Marrow Pill), Jianggui Yin (Ginger and Cinnamon Drink), Baitong Tang (White Pass Decoction), or Qianyang Dan (Submerge Yang Pill). All these formulas can be administered.
When caused by accumulated heat attacking upwards, the patient has likely overconsumed rich foods or has latent heat in the Stomach attacking the Lungs, also generating moths. Symptoms include irritability, thirst for cold drinks, difficulty in urination and defecation, foul breath, coarse breathing, severe redness, swelling, and pain. The treatment method should remove accumulated heat, such as Dachengqi Tang (Major Order the Qi Decoction), Xiaochengqi Tang (Minor Order the Qi Decoction), or Pingwei San (Calm the Stomach Powder) added with Qiuniu (Pharbitidis Semen), Binglang (Arecae Semen), Dahuang (Rhei Radix et Rhizoma), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma).
When caused by Liver Fire stirred by anger attacking the Lungs and generating moths, the patient’s hypochondrium must be painful, prone to irritability, with a blueish face and bitter taste in the mouth. The pulse must be wiry and surging. The treatment method should clear the Liver, such as Danzhi Xiaoyao San (Moutan and Gardenia Rambling Powder), Daqing Yin (Great Blue Drink), or Chaihu Tang (Bupleurum Decoction) added with Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus).
In summary, disease conditions change; they cannot be exhausted in a few points. In reality, ten thousand changes do not exceed the two methods of Yin and Yang. [Marginal Note] Ultimate flexibility. If one wishes to discuss by meridian, organ, and fu-organ, having too many principles becomes obscure; it is indeed better to keep it concise. [Marginal Note] Zhi Fei Shi said: When moths grow in the throat, the pharynx must be swollen and painful to a severe degree, hindering eating and drinking. Patients are often terrified, and this condition is frequently mistreated at the onset. Although a skilled physician can analyze Yin/Yang and deficiency/excess and prescribe according to meridians, it is too slow for emergencies. To alleviate patient anxiety, using Baobao Hongling Dan (Eight-Treasure Red Spirit Pill) prepared by surgeons for temporary throat insufflation is acceptable to solve urgent needs and slightly calm the mind. Once the patient’s spirit settles, prescribing according to method yields results easily. This is based on Zhi Fei’s personal experience, a compassionate heart for saving the world. Scholars should pay attention. As for theory and method, the throat belongs to Shaoyin. Qin’an investigated the causes, which are indeed detailed and clear. Why seek more?
Recently, common medical practice for throat diseases often uses Chuihou San (Blow-Throat Powder), Bingpeng San, and Kaihoujian (Open-Throat Sword), all cold and cooling substances. Severe cases even involve pricking/bloodletting. For Yang syndromes, there is no harm; for Yin syndromes, it is detrimental. Accurate differentiation is crucial and must be careful.
Pain in Both Arms and Shoulders
Regarding pain in the arms and shoulders, some are caused by external contraction of wind-cold blocking the collaterals, and some by deficiency of Middle Qi with internal cold obstruction.
When caused by external wind-cold, the patient usually fears cold and dislikes wind, or has fever accompanied by headache. The treatment method should be to disperse and release, such as Guizhi Tang (Cinnamon Twig Decoction), Qianghuo Fuzi Tang (Notopterygii and Aconite Decoction), or Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction).
When caused by deficiency of Middle Qi, since the Middle Palace is originally deficient, True Qi cannot circulate throughout the four limbs. Cold pathogen, phlegm, and dampness can also block the collaterals, causing immediate pain. Such patients definitely have a pale face lacking spirit, reduced appetite, and symptoms worsen during cloudy/rainy weather but feel lighter under bright sunshine. The treatment method should focus on warming the Middle and moving Qi, such as Jianzhong Tang (Establish the Middle Decoction) with doubled Guizhi and Fuzi, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Qianghuo and Fuzi, or Lizhong Tang (Regulate the Middle Decoction) added with Guizhi and Xiangfu. I often see middle-aged elderly women suffering from arm and shoulder pain unable to lift their arms, constantly distressed. Investigating the cause, it often starts when Tian Gui (menstruation) begins in youth, lacking proper care, washing clothes in cold water, causing cold damage to the collaterals, leading to cessation of Tian Gui in many cases. Even if the constitution is strong and cold does not harm, treating it as normal ignores that True Qi has prosperity and decline. When Qi is prosperous, cold invasion does not immediately cause harm. But when middle-aged and old, the body’s righteous Qi declines, or a slight cold pathogen triggers it, pain arises here. I often treat this with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) added with Lurong (Cervi Cornu Degelatinatum), Guijian (Tip of Cinnamon Twig), Fuzi (Aconiti Lateralis Radix Praeparata), Congbai (Allii Fistulosi Bulbus), and wine, with good effect. [Marginal Note] Those who suffer hardship in youth, relying on strength and labor, find that when reaching middle or late age and enjoying leisure, injuries from labor slowly manifest internally, causing immediate pain, often seen in arms, shoulders, and legs. Crude physicians do not recognize this, treating blindly with no effect. Often, patients themselves understand: the current painful spot is the past site of labor. Qin’an’s commentary shows exceptionally high insight, deeply conforming to the method of analogy and leisurely discussion in Neijing. Only those with profound skill can reach this level. It is another major medical law; scholars must not ignore it.
Recently, common practice for arm and shoulder pain often uses Wuji San (Five Accumulations Powder), Liuxue Yin (Flowing Qi Drink), and herbs like Qianghuo (Notopterygii Radix), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Shenjin Cao (Lycopodii Herba), Shujin Cao (Dipsaci Radix), Sumu (Sappan Lignum), Lingxian (Saussureae Radix), and Songjie (Pinus Resina). These often achieve efficacy. However, distinguishing between external contraction and internal injury, Yin and Yang, deficiency and excess, is essential.
Furthermore, numbness in fingers mostly belongs to Spleen Qi failing to circulate fully, with few external cases, often combined with phlegm-dampness. The method is not outside warming the Middle and moving Qi, such as Guipi Tang (Restore the Spleen Decoction) added with Tianma (Gastrodiae Rhizoma) and Banxia (Pinelliae Tuber), Liu Jun Zi Tang (Six Gentlemen Decoction) or Si Jun Zi Tang (Four Gentlemen Decoction) added with Fuzi and Guizhi, Xiangfu and Sharen, or Jianzhong Tang with doubled Guizhi and Fuzi added with Xiangfu and Danggui.
Heart Pain
Regarding Heart Pain, there is a distinction between cold and heat. Other books say: The Heart is the Monarch Official, how can it hurt? The pain mentioned is actually in the Pericardium. This view is close to correct. I believe the Heart, Liver, Spleen, Lungs, Kidneys, Six Fu-Organisms, whole-body collaterals, bones, joints, and skin are all formed physical shells, entirely reliant on the innate formless True Qi for nourishment. "True Qi" refers to True Yin and True Yang. True Yin refers to the mother’s essence and Qi; True Yang refers to the father’s essence and Qi. These two energies merge into one Qi, circulating up, down, left, and right. The ruling spirit resides within. If True Qi is insufficient, disease arises wherever it is lacking. How can there be a saying that the Heart does not have pain syndromes? Have we not seen that the sun and moon in heaven often undergo eclipses? When identifying Heart Pain, one must first clarify the boundaries. The Heart sits above the diaphragm; one cun below is the stomach opening. The stomach opening is not far from the Heart. Many cases of Stomach pain are called Heart pain; this must be observed carefully. Thinking deeply about pain syndromes, the character "pain" essentially means "reversal." When Qi is smooth, Qi and Blood flow freely, and there is no pain. When Qi reverses, Qi and Blood stagnate and obstruct, causing pain. Regardless of where the reversal occurs, it can cause pain and affect the Heart. Actually, it does not injure the formed physical Heart, but the true ruler within the formless. Clinging to the formed physical Heart is knowing only the branch. The Heart has its boundaries; the Pericardium is the outer wall of the Heart. Pathogen invading the Pericardium is invading the Pericardium, which is invading the Heart’s origin. There is no need to directly say pathogen does not invade the Heart. "Invading the Heart" means invading the Qi of the Heart Monarch’s residence. Ask yourself: How to distinguish between invading the Heart and invading the Pericardium? Books do not clearly state this. I believe humans live by one breath. Abundant Qi means excess, leading to Heat Pathogen. It not only causes Heart pain. Deficient Qi means deficiency, leading to Yin Pathogen. It also does not only cause Heart pain. Heat and Yin reversing upwards both cause Heart pain. One should judge them by the characters "Cold" and "Heat." If pain is caused by Evil Heat attacking upwards, the patient must have a red face, mental restlessness and heat, short dark urine, and thirst for cold drinks. The treatment method should nourish Yin and clear fire, such as Huanglian Muxiang Tang (Coptis and Costus Decoction), Daochi San (Guide Out Redness Powder), or Danggui San (Angelica Powder). If pain is caused by Yin-Cold attacking upwards, the patient usually has a blueish face and white lips, or blue-black tongue, prefers hot drinks and rubbing/pressing, and urination/defecation are free. The treatment method should support Yang and dispel Yin as primary, such as Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) added with Qi-moving herbs like Jiang (Zingiberis Rhizoma), Guizhi (Cinnamomi Ramulus), and Wuyu (Evodiae Fructus). There are also cases where Yin-Cold is extremely severe, attacking the Heart, with nose like coal smoke, black lips/mouth, blue-black nails, and pure Yin throughout the body. Treatment is hopeless; urgently administer large doses of Huayang (Return Yang) formulas. One or two out of ten may be saved. [Marginal Note] Zhi Fei Shi said: This passage contains profound truth, the foundation of creation, and the gist of life and nature. Alas, it is leaked into medicine. People of the world do not understand and instead criticize. I observe the Neijing; Emperor Xuanyuan and Qibo used heaven to verify man, aligning man with heaven. Each region has its own way. Zhang Zhongjing’s Taishou “Shanghan Lun” uses the six meridians (Taiyang, Taiyin, Shaoyang, Shaoyin, Yangming, Jueyin) borrowing the circulation of Heavenly Dao, secretly matching human body measures, discussing mechanisms through disease. Qin’an writes frankly here; is it not too much? Although the Way of Medicine has been lost for a long time. Such exposition, guarding the Way of Sages, waiting for future scholars with a mind for benefit and relief, is not a sin. If anyone can deepen study from this, treating diseases in accordance with opportunity, establishing words to manifest truth, expounding ultimate principles, they will not fail to be meritorious officials of Xuanyuan and Qibo. The world experiencing He Huan (Bian Que) again would be fortunate.
Recently, common practice confuses Heart and Stomach, blindly using Qi-moving and stagnation-breaking methods, not investigating Yin and Yang, often causing mistakes, leaving everything to Heaven’s Mandate, while human effort should not be abandoned.
Stomach Pain
Regarding Stomach Pain, there are distinctions of diet, cold/heat, and deficiency/excess. One must not cling to the formed physical Stomach. One must understand the Qi mechanism moving within the Stomach. [Marginal Note] Understanding via Qi mechanism is a superior method, akin to the Lotus Sutra. Inside the human body, the Stomach is the vessel receiving food and drink, like fields allowing sowing and harvesting depending on heaven. If disaster strikes, fearing crop failure, would the field accept blame? Ancients described the Stomach as Yang Earth. Qin’an’s treatment of Stomach disease emphasizes understanding Qi mechanism, which is an unchanging principle. Scholars who cannot delve deep into theory should follow the method of external/internal Yin and Yang to avoid erroneous treatment harming people.
When caused by food stagnation in the Stomach blocking Qi mechanism, the patient definitely experiences fullness, acid regurgitation, belching, and tenderness where touch is unbearable. The treatment method should digest food and move stagnation, such as Houpo Qi Wu Tang (Magnolia Bark Seven-Ingredient Decoction) or Pingwei San (Calm the Stomach Powder) added with Xiangfu and Maiya.
When caused by insufficient Stomach Yang compounded by external cold and raw/cold food, sudden Middle Cold arises. The patient definitely likes rubbing/pressing, prefers hot drinks, may spit clear fluid, and has a pale face with blueish lips. The treatment method should warm the Middle and move Qi, such as Xiangsha Liu Jun Zi Tang (Costus and Amomum Six Gentlemen Decoction) or Lizhong Tang (Regulate the Middle Decoction) added with Guigui (Cinnamomi Cortex), Sharen (Amomi Fructus), Xiangfu, and Muxiang.
When caused by accumulated dampness generating heat, combined with latent heat in intestines/stomach, overconsumption of rich foods generating heat, or Qi depression failing to soothe generating heat, the patient is often irritable, with red lips, coarse breathing, and solid stool. The treatment method should purge downwards, focusing on clearing heat, such as Tiaoweichengqi Tang (Regulate the Stomach Major Order the Qi Decoction), Dahuang Muxiang Tang (Rhubarb and Costus Decoction), or Simo Tang (Four-Mortar Decoction).
There is another type: Heart-Stomach-Abdomen pain, face red as vermilion, feeling relieved by heavy pressure. This is a sign of Yin Excess forcing Yang outward. The treatment method should urgently support Yang and dispel Yin. Do not treat with usual methods.
Recently, common practice often uses Yuanhu (Corydalis Rhizoma), Ruxiang (Olibanum), Moyao (Myrrha), Erpi (Pericarpium Citri Reticulatae and Cortex Aurantii), Zhu (Atractylodis Rhizoma), Leng (Sparganii Rhizoma), Wuxiang (Aquilariae Lignum Resinatum), Zhike (Aurantii Fructus Immaturus), and Houpo (Magnoliae Officinalis Cortex). If there is actual stagnation, they achieve miraculous results. If intestines/stomach are originally deficient, they inevitably increase harm. This must be known.
Umbilical Pain
Regarding Umbilical Pain, there is a distinction of Yin and Yang. The umbilicus is in the junction area of Yin and Yang. Above the umbilicus belongs to Spleen/Stomach; below belongs to Liver/Kidney. Pain above focuses on Spleen/Stomach. Pain below focuses on Liver/Kidney. Pain both above and below involves Spleen/Stomach and Liver/Kidney pathology. Here, it is important to distinguish which meridian is diseased. If pain is solely above the umbilicus, it is Stomach/Spleen Qi stagnation. Whether due to cold, heat, food, or depression must be known. If diagnosed as fullness, acid regurgitation, it indicates food stagnation and Qi blockage. Urgently apply food-digesting and Qi-moving agents, such as Pingwei San added with Xiangfu, Maiya, and Zhike.
If diagnosed as preferring hot drinks, with pain relieved by rubbing/pressing, it indicates insufficient Spleen/Stomach Yang failing to transform Yin-Cold pathogen. The treatment method should warm the Middle, such as Lizhong Tang, Xiangsha Liu Jun Zi, Gancao Ganjiang Tang, added with Xiangfu, Angui (Cinnamon), and Dingxiang.
If diagnosed as not preferring hot drinks/massage, with pain worsening upon heat, it indicates Stomach/Spleen郁热 (depressed heat) and Qi stagnation. Use methods to open depression and move stagnation, such as Houpo Qi Wu Tang, Maiya, Chaozhi (Fried Gardeniae Fructus), and Xiangfu.
There are also cases where Taiyang pathogen is unresolved, mistaken purging causes pathogen to sink into the Spleen, resulting in upper umbilical pain. The patient must first have fever, aversion to cold, and stiffness/pain in head/nape. If this pain appears after purging, treat with Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction).
If pain is solely below the umbilicus, it is Jueyin Qi failing to diffuse. If diagnosed with irritability, fullness, scrotal retraction, and lower abdominal pain, it is excessive Jueyin Yin-Cold. The treatment method should return Yang and dispel Yin, such as Wuyu Sini Tang (Evodia and Counterflow Decoction) or Baitong Tang (White Pass Decoction). If diagnosed with Jueyin Heat Pathogen latent and undiffused, or attacking upwards causing throat bi, attacking downwards causing pus/blood in stool, deep heat with deep cold extremities, foul breath, coarse breathing, etc., the treatment method should support Yin, such as Jizi Huanglian Tang (Chicken Egg and Coptis Decoction). [Marginal Note] Zhi Fei Shi said: Diseases of the Three Yin originate from division at the navel. However, pain above the navel differs between Taiyin and Yangming, a vast difference between one Fu and one Zang. Thus, Qin’an uses fullness and acid regurgitation to determine Yangming/Lung disease and uses digestion/moving methods. Slightly higher up is Taiyang territory, with judgment of wind-cold. All have pain syndromes and Qi/Blood distinctions. If scholars do not study in detail normally, clinical diagnosis will have much doubt, prescriptions will be ambiguous, and achieving perfect accuracy will be difficult. Familiarize yourself with this commentary, discuss carefully, and obtain the true interpretation.
Recently, common practice sees umbilical pain, ignoring boundaries, blindly regulating Qi and moving Blood, often using Muxiang, Xiaohui (Fennuli Fructus), Danggui, Baishao (Paeoniae Radix Alba), Chuanxiong (Chuanxiong Rhizoma), Zhike, Chenxiang (Aquilariae Lignum Resinatum). Thus, efficacy varies. It is certainly better to differentiate upper/lower Yin and Yang for appropriate treatment.
Hernia Syndrome
Regarding Hernia Syndrome, going left is Bladder Qi, right is Hernia Qi. During pain, testicles ascend into the abdomen, or right ascends while left does not, or left ascends while right does not, or both ascend. Other books distinguish Cold Hernia, Water Hernia, Sinew Hernia, Blood Hernia, Qi Hernia, Fox Hernia, Yin Hernia, Tu Hernia, Heart Hernia, Liver Hernia. Though names are many, there is no unchanging principle. I carefully consider this disease; ultimately, it lies only in the Jueyin Meridian. [Marginal Note] This commentary is generous and profound. Truly worthy of being a doctor. One sentence becomes an iron case; who dares to overturn it? I deeply admire this old official. Although images and conditions differ, the logic regarding testicles and scrotum cannot be moved. My opinion: Testicular/scrotal retraction must be Yin Excess; testicular/scrotal redness/swelling must be Heat Increase. Treating retraction focuses on breaking Yin to return Yang: Wuyu Sini Tang added with Guizhi, Sharen, Xiaohui, or Wumei Wan with doubled Yang-tonifying herbs. Treating swelling uses methods to break Yang to support Yin: Jizi Huanglian Tang and Xiegan Tang (Drain Liver Decoction). Know that "swelling" and "retraction" are the essence of fullness and emptiness. Liver Qi excess is Fire, the real evidence of scrotal/testicular swelling; Liver Qi deficiency is Cold, the real evidence of scrotal/testicular retraction. [Marginal Note] Clear and revealing.
Another doubt: Today people say: Two balls are external kidneys. Why do men have them and women not? This principle is rarely clarified in the world. I think Heaven generates Water, its trigram is Kan, two Yin lines sandwiching one Yang line. The two kidneys at the waist and the Du Meridian on the back resemble this. Men and women both possess it; the logic is acceptable. If these two balls, men have and women do not, there is a definite principle, pitying later sages did not explore it. Post-heaven establishes Kan and Li as poles. Kan and Li are Qian and Kun. Kan and Li already obtain the numbers one and two, so it reiterates: Heaven generates Wood. Wood has Yin Wood and Yang Wood distinctions. Yang Wood is called three, representing the Eldest Son, two Yin one Yang. What is now called external kidney is this, thus unique to men; Yang Wood is called three, representing the Eldest Daughter, two Yang one Yin, missing below. What is now called yin house is this. [Marginal Note] Expounding ultimate truth, speaking freely, yet like cutting the turtle’s legs to stand firm, where does one stand? I say the Way of Medicine requires knowing one step before taking the next. Many remain outside the door for life.
When Qian and Kun interact, they first generate Eldest Son and Eldest Daughter. Post-heaven uses Kan and Li to replace Qian and Kun. The principle of Heaven generating Wood is seen here, and the penis and yin house are distinguished here. Thus, Zhongjing assigns this area to Jueyin, taking its extreme Yin and extreme polarity. Erection of the penis requires Heart Fire shining down, showing the mechanism of Heaven generating Wood. Speaking of form, the essence is subtle and cannot be fully revealed. Laughable that today people call it external kidney; truly talking in dreams. [Marginal Note] Continuing vigorously, reading and applauding, singing to the clouds, painting the generative mechanism of heaven and earth, balanced and expressive, a master of sketching. Expounding the principle of Yin rising with Yang is particularly refined. However, only those with deep learning and skill can utter a word.
Checking recent market prescriptions, upon seeing hernia, they often use Xiaohui, Lizhihe (Litchi Seed), Juzhe (Citrus Seed), Angui, Fuzi, Shexiang (Moschus). They often achieve efficacy. Investigating their use, all are Liver-warming substances. Using seeds follows the principle of seed entering seed; the logic is acceptable. However, for scrotal/testicular redness and swelling, this method must not be applied. One must handle it by distinguishing Yin and Yang. [Marginal Note] The conclusion holds endless meaning. Tang Poetry says: To see a thousand miles, go up another floor. Xiong’s song says: To know the method of returning to origin, recognize the Great Medicine King within oneself.
Nocturnal Emission
Regarding Nocturnal Emission, books distinguish dream emission, non-dream emission, emission from overuse of mind, emission upon seeing color, emission upon hearing women’s voices, spontaneous emission without cause. Various distinctions total no unchanging method. I believe there is no need to细分 (subdivide); unify it primarily as Heart-Kidney Non-Interaction and Hun/Shen Not Storing. Human establishment relies on... Kidney Qi ascending refers to Kan Qi. Carrying Water Qi to interact with Heart, making Heart cool. Heart Qi descending allows Ministerial Fire to enter Kidney, making Kidney warm. Shen resides between these two energies. Daytime follows Li, nighttime follows Kan. Shen rules Qi, Qi commands...