典藏书目

Warm pathogenic factors enter from above, first attacking the Lung. If the condition worsens reversely, it transmits to the Pericardium. The Lung governs Qi and belongs to the Wei (Defensive) level; the Heart governs Blood and belongs to the Ying (Nutritive) level. Differentiating between Ying, Wei, Qi, and Blood levels is similar to that in Cold Damage (Shanghan), but regarding treatment methods, they are vastly different. This is because the pathogenic factors of Cold Damage remain at the exterior initially, then transform into heat and enter the interior. Warm pathogenic factors, however, have the fastest rate of heat transformation; before transmitting to the Pericardium, the pathogen remains in the Lung. The Lung governs Qi and connects with the skin and hair, so it is said to be at the exterior. In the initial stage at the exterior, light acrid-cool formulas are used. If accompanied by Wind, herbs such as Bohe (Menthae Haplocalycis Herba) and Niuxibang (Arctii Fructus) are added; if accompanied by Dampness, herbs such as Lugeng (Phragmitis Rhizoma) and Huashi (Talcum) are added. Alternatively, wind can be vented outside the heat, or dampness can be seeped out below the heat, preventing them from clashing with the heat, causing the pathogens to become isolated. Otherwise, wind carrying warm-heat will generate dryness, causing the clear orifices to become dry. This is because the Qi of Water cannot ascend to nourish, resulting in the mutual depletion of two Yangs (Wind and Heat). When warmth combines with dampness, steaming and stagnation occur, clouding the upper clear orifices, leading to obstruction and blockage of the clear orifices due to turbid pathogens harming the clear. The disease resembles Cold Damage. The method to verify and distinguish is: Cold Damage often has changing symptoms, whereas warm-heat diseases, even if prolonged, remain fixed in one meridian without shifting, which serves as the basis for differentiation.

Previously mentioned using acrid-cool herbs to disperse wind and sweet-bland herbs to drive away dampness. If the disease still does not resolve, it indicates the pathogen is gradually entering the Ying level. Heat in the Ying level injures the blood, causing mental restlessness, worsening at night with insomnia, or faint rashes appearing. At this point, Qi-level herbs should be withdrawn. If entering from Wind-Heat, use Xijiao (Rhinocerotis Cornu) and Zhuye (Bambusae Folium); if entering from Damp-Heat, use Xijiao and Hualu (Floral Dew), incorporated into cooling-blood and clearing-heat formulas. If irritability and constipation are added, Jinzhi (Human Feces Fermented) can also be added. For the elderly or those with a chronic cold constitution, Renzhonghuang (Coptidis Rhizoma processed with human feces) is used instead. Urgently eliminating rashes is essential. If rashes appear but heat does not resolve, it indicates the exhaustion of Stomach Yin. The main treatment is sweet-cold herbs; severe cases use Yunu Jian (Jade Woman Decoction), mild cases use Pear Skin and Sugarcane Juice. If Kidney Water is deficient, although the lower Jiao is not yet involved, the patient may already feel anxious. For pathogens lingering in the Qi level, one may hope for a battle-sweat to vent the pathogen. The method should benefit the Stomach, allowing the pathogen to exit with sweat, heat reaches the interstices, opening them, and the pathogen exits via sweat. After resolution, Stomach Qi is empty, leading to cold skin for one day and night; waiting for Qi to return, warmth will normalize. Since battle-sweat resolves the condition, pathogen retreats and Zheng (Upright) Qi is deficient, Yang escapes with sweat, hence gradual skin coldness; this does not necessarily constitute Collapse Syndrome. At this time, let the patient lie quietly and comfortably to nourish the recovery of Yang Qi. Bystanders must not panic or call frequently, disturbing the Yuan Shen (Original Spirit) and causing irritability. Only diagnose the pulse; if it is deficient, soft, and slow, despite fatigue, lying down, silence, sweating, and cold skin, it is not Collapse Syndrome. If the pulse is rapid, with restlessness and inability to lie down, and profuse sweating on the skin, it is Qi Collapse Syndrome. Furthermore, there are cases where pathogen is excess and Zheng Qi is deficient, unable to resolve in one battle-sweat, requiring another after one or two days to heal; this must be known.

Regarding Qi-level diseases, some do not transmit to the Blood level but the pathogen remains in the Triple Burner, similar to Shaoyang disease in Cold Damage. That involves harmonizing half-exterior and half-interior; this involves dispersing the momentum of upper and lower parts, changing methods according to symptoms, such as using Xingren (Armeniacae Semen Amarum), Houpo (Magnoliae Officinalis Cortex), Lingzhi (Poria) etc., or formulas like Wendan Tang (Bile-Removing Decoction) for draining. Because the pathogen is still in the Qi level, there is still hope for resolution via battle-sweat. Generally, the progression is: after Wei comes Qi, after Ying comes Blood. In Wei, sweating is appropriate; at Qi, clearing heat is appropriate; entering Ying, one can still vent the trend to turn back to Qi, using Xijiao, Yuanshen (Scrophulariae Radix), Lingyangjiao (Saigae Tataricae Cornu); entering Blood, fear of consuming and moving blood arises, so cooling blood and dispersing blood is required, using Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Ejiao (Colla Corii Asini), Chishao (Paeoniae Radix Rubra). Otherwise, failing to follow the method of priority and urgency leads to errors and panic. Moreover, Dampness in our Wu region harms people most widely. For those with pale complexions, Yang Qi must be protected; excessive dampness leads to weak Yang. Treatment should be cooling, but when reaching 60-70% efficacy, it must not be overly cold-cooling, lest success be abandoned. Why? Once damp-heat is removed, Yang Qi also declines. For those with dark complexions, Yin fluids must be protected. When cooling reaches 60-70%, often heat decreases and body feels cold; one must not claim deficiency-cold and administer tonics, fearing that although the stove smoke has ceased, embers still hold fire. Careful observation is needed before administering small amounts; rash advancement must be avoided. Those who drink alcohol have abundant internal dampness; external pathogens entering the interior combine with internal dampness. In constitutions with strong Yang, Stomach dampness is abundant; in constitutions with strong Yin, Spleen dampness is considerable, but their transformation into heat is the same. Treating heat diseases is relatively easy; unblocking Yang is the hardest. Nourishing Yin lies not in blood but in preserving fluids and stopping sweat; unblocking Yang lies not in warming but in promoting urination, though this differs from miscellaneous diseases.

New diseases involve Yin-Yang disharmony; correcting imbalance requires using biased herbs. Chronic diseases involve Yin-Yang gradually returning to balance; supporting Yuan Qi and nurturing Zheng Qi requires using balanced herbs. If chronic diseases are mistakenly treated with heavy drugs, it increases the risk of exhaustion and collapse. Generally, treating Yin diseases, if they transform into Yang diseases, may heal spontaneously without medicine. Even if not, using one dose of Yin-nourishing herbs, such as Siwu Erlian Tang (Four Substances and Two Lian Decoction) or Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), to adjust the bias ensures healing.

Currently, many exogenous diseases are combined with endogenous injuries; medication must be differentiated. If 70% exogenous and 30% endogenous, exogenous treatments should use mild and small doses, with Ginger and Jujube to harmonize the Middle as guides, avoiding major disturbance of Qi and Blood. If 70% endogenous and 30% exogenous, treatment focuses mainly on endogenous injury, adding only one surface-releasing herb, taken hot to assist medicinal power, so exogenous pathogens dissipate naturally. Because those with endogenous injuries develop illness immediately upon slight exposure, unlike robust individuals who require deep infection for disease manifestation. The *Neijing* states: "For excess, blame the pathogen; for deficiency, blame the constitution." Mr. Ping now only blames the pathogen's excess, ignoring constitutional deficiency, contradicting the *Neijing*. I smiled and said: I do not forget the root; the profound meaning here, I do not state explicitly, nor do I pass on the golden needle blindly. The reason is that Pingshu's external pathogen was not in Taiyang but in Yangming. Thus, he not only lacked aversion to cold but also had no high fever of transmission; occasionally showing tidal fever, resembling endogenous heat fever. Mistakenly using Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) to tonify left the pathogen with no exit. Over time, it merged with Yuan Qi like lead and copper poured into silver, losing its purity, causing mental confusion and muteness. Yangming is the head of the twelve meridians, smoothing sinews and bones and facilitating joints. Untreated Yangming leads to malnourished sinews and restless trembling. Pingshu's disease trapped external pathogens in the Central Earth (Spleen/Stomach), turning the earth into scorched soil by fire, not fertile soil; into dry soil mixed with ash and sand, not pure soft soil. Scorched and dry soil lack vitality; how can plants grow? Seizing a breath of vitality, I heavily used bitter-cold herbs, drawing Northern Water to moisten the withered state. After more than ten doses, his tongue stopped sucking inward. This is "when water arrives, the channel forms." Then three doses of sweet-cold herbs followed. Thereafter, no prescriptions were given, knowing that food enters the Stomach, distributing essence to the Spleen, like continuous rain, day after day, sufficiently nourishing, requiring no artificial irrigation, allowing Central Earth to resume farming. Understanding this, one knows my previous abuse of bitter-cold was precisely to cultivate vital energy. When vital energy returns, deficiency becomes sufficiency. How could I not know his original deficiency and harm life?

Shuxiu was young and powerful. Powerful people, due to not storing Essence in winter, have deficient constitutions unable to withstand pathogens. I saw him with his head heavy on the pillow, body heavy on the mat, unable to turn, breathing barely a thread, unable to speak, afraid of sound. In the exterior-releasing sweat formula, I used 7 fen of Renshen. His cousin-in-law, Shi Jiqing, fearing family women would know, did not administer the medicine, secretly increasing Renshen. After taking it, sweating decreased significantly. The next day, in a harmonizing formula, I increased Renshen by 1 qian. After taking it, he had one bowel movement and felt refreshed. However, suspecting the laxative was too early, he sent someone to ask. I informed him that the exterior was resolved, the interior harmonized, and he would recover soon, needing no further worry.