典藏书目

The term "Yin syndrome" (Drinking disease) is recorded in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), but the classic text mainly discusses the principles of Si Tian and Zai Quan (ruling and ruling-under influences) and Sheng Fu (overcoming and counteracting) within the Five Movements and Six Qi theory, merely outlining the general framework. Zhang Zhongjing, in the *Jingui Yufan Jing* (Essential Prescriptions from the Golden Cabinet), elucidated the pathogenesis and detailed treatment methods with clear categorization, providing a basis for later generations to follow, which can be considered highly fortunate. The classic states: "Water and fire are the manifestations of Yin and Yang." Water belongs to Yin, Fire belongs to Yang; thus it is evident that Drinking pathogens belong to the Yin category. The cause of disease must be a deficiency of the body's Yuan Qi (Original Qi), leading to an excess of Yin and decline of Yang, stagnation of Jin Ye (Body Fluids), failure to distribute them, and retention in the chest, causing the clear parts to transform entirely into turbid substances. If Zhen Qi (True Qi) were sufficient, water entering the stomach would allow Jing Qi (Essence Qi) to overflow and ascend, transmitting to the Spleen; the Spleen would scatter essence, ascending to return to the Lung; the Lung would regulate the water passages, transmitting downward to the Bladder. What harm could there be? The classic further states: "Yang transforms Qi, Yin forms shape." Qi is water, water is Qi. Qi can transform into water, and water can transform into Qi. Now, however, Yin mist pervades, and water essence condenses. Is this not due to the decline of Yang, where Qi lacks the power to transform water?

There are three locations of Yang Qi in the human body: First, the Yang of Dan Zhong (Conception Vessel / Chest Center). Like the sun shining brightly without cloud obstruction, if the Yang of Dan Zhong is deficient, turbid Yin will invade upward, usurping the position of Yang. This is what is meant by "turbid Qi residing above causes distension." Second, the Yang of the Kidney. Like the fire beneath a pot cooking food, if the Yang of the Kidney is deficient, it is like having no fire under the pot; food will never cook. This refers to the lack of transformation into fire between Wu and Gui, and the absence of steaming and changing power in the Ming Men (Gate of Life) Yang. Third, the Yang of the Bladder. The Bladder is the official of the Zhou Du (State Capital), storing Jin Ye (Body Fluids); only through Qi transformation can they be excreted. Dan Zhong is located inside the diaphragm, while the Bladder is inside the abdomen. When Bladder Qi transforms normally, the Qi of Dan Zhong can descend; if Bladder Yang is deficient, Qi fails to transform, losing its function of regulating water passages.

In childhood, one is neither harmed by sexual indulgence nor disturbed by emotional fluctuations. From where then does the deficiency of Yang in Dan Zhong, Kidney-Ming Men, and Bladder arise? From where does the Drinking disease originate? Could it not be the fault of injuring oneself with raw fruits and cold foods? Qi Bo (referring to the dialogue between the Yellow Emperor and Qi Bo) emphasized dietary nourishment with grains, meats, fruits, and vegetables after treating diseases, not implying that fruits are inedible, but rather that eating must be moderate and not excessive. Excess leads to injury. This child had a weak constitution and a habitual preference for fruits, injuring Stomach Yang and thereby forming Drinking pathology. Sugarcane has a cold nature that clears the Stomach, as the *Shi Jing* (Classic of Poetry) mentions "the grand officials still have cold sugarcane juice." In past summers, consuming sugarcane juice triggered this chronic illness, causing fullness and support in the chest and diaphragm, gurgling sounds internally, mental distress, and vomiting cold water in bowls and basins. Prescriptions such as Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction), Li Zhong Tang (Regulate the Middle Decoction), and Liu Jun Zi Tang (Six Gentlemen Decoction) were administered to unblock Yang and wash away Drinking. After more than a month of administration, efficacy was finally achieved. Subsequently, a pill formula to warm and strengthen the Spleen and Stomach was formulated, and instructions were given to avoid raw and cold foods, hoping to eradicate the root of the disease. In mid-autumn, the illness recurred, and I was consulted. It was learned that the pills were not taken, and pears and water caltrops were eaten again; this was self-inflicted error, not medical fault.

Observing the symptoms, they were worse than before: not only vomiting cold water, but also the epigastrium and throat felt cold as ice, ginger did not taste spicy, and urine was cloudy like rice washings. The classic states: "Deficiency of Middle Qi leads to changes in urination and defecation." All fluid pathologies that are clear, pure, and cold belong to Cold. Initially, Stomach Yang was injured, subsequently affecting the Bladder and Kidney-Ming Men. Cold reaching this degree is indeed terrifying. Dried Ginger, Sichuan Pepper, Cinnamon Twig, and Prepared Aconite Root were repeatedly administered without response. I considered consulting the use of Liu Huang Wan (Sulfur Pill), which is intensely hot and purely Yang, potentially offering relief. However, this medicine was hard to find in our local market. As a last resort, I increased the dosage of Fu Zi (Prepared Aconite Root) to five qian per day in the prescription, administering it continuously for twelve doses, until signs of Yang recovery appeared. Carefully analyzing this disease, there must be a "Ke Nang" (Nest-like accumulation) attached to the diaphragm, like bandits relying on mountainous terrain to form a stronghold, appearing and disappearing unpredictably. The concept of "Ke Nang" was discussed by Xu Shuwei previously and detailed by Yu Jiayan later; this follows ancient wisdom rather than fabrication. Previously, the condition was mild, requiring treatment of the Spleen after the acute phase. Now, the condition is severe, necessitating treatment of the Kidney after the acute phase. Therefore, imitating the method of Shen Qi Wan (Kidney Qi Pill), I instructed him to take it urgently and strictly, advising against any fruit intake and even cold-natured vegetables.

Unexpectedly, bystanders, being ignorant and suspicious, saw the increased dosage of Fu Zi in the prescription and clamored that it was toxic and should not be taken in large amounts. This caused doubt and fear despite the medication showing efficacy. The pill formula I established was set aside according to the custom of "not daring to taste what one does not understand." Unfortunately, although the illness temporarily subsided, the root remained. Upon entering spring, it stirred up, resulting in vomiting half a bucket of water overnight. Water, as a substance, does not flow unless pits are filled; accumulating over time, it eventually pours out completely. Failing to understand the cause of the "Ke Nang," they blamed the warming medicines. Alas! The *Rites of Zhou* records collecting poisonous drugs at the Winter Solstice for medical use. All drugs that attack diseases are toxic, not just Fu Zi. If the disease matches the indication, the drug's nature attacks the cold so urgently that it has no time to become toxic. It is like using soldiers; soldiers are dangerous tools. Yet, suppressing rebels requires their use. Using soldiers without cause brings disaster. But using soldiers to suppress rebels and secure the people means not only avoiding their danger but benefiting from them. Thus, one should discuss whether the usage is appropriate, not whether the drug is toxic. If used inappropriately, even non-toxic drugs become highly toxic; if used appropriately, even toxic drugs become non-toxic.

In Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), formulas like Si Ni Tang (Frigid Extremities Decoction) restore Yang and rescue emergencies, using one raw Fu Zi. Today's cultivated Fu Zi has weaker potency, and furthermore, processed with child's urine and Licorice, its power is even milder. The formula utilizes the weakened state to attack the disease; why worry about toxicity harming the person? Consider that in one month, over a jin (approx. 500g) of Fu Zi was consumed. If it were mismatched to the syndrome, internal disaster would have occurred long ago. Why were there no sore throats or mouth ulcers afterward? How can one view it as arsenic or poison, remaining obstinate? If one truly doubts warming medicines are incorrect, why not invite another physician? Another doctor's case notes diagnosed "Stomach Cold Qi Pain," prescribing Evodia Fruit and Clove, mixed with Immature Bitter Orange, Magnolia Bark, Reed Rhizome, and Dendrobium. Having previously shared rapport with him, I could not remain silent and truthfully informed him that the syndrome belonged to Cold Coagulation and Drinking Accumulation. After several episodes of excessive vomiting damaging the Stomach, not only are cold-cooling herbs contraindicated, but Immature Bitter Orange and Magnolia Bark, which consume True Qi, are also inappropriate. This time the illness flared up mildly, likely due to the restorative Yang power of previous warming medicines. Noting thirst immediately after vomiting, the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states regarding Drinking syndromes that thirst indicates impending resolution. Recovery is near; medication may not even be necessary. However, unless the Ke Nang is removed, it remains a future hazard.

If stopping medication leads to stability within days, and one consults on post-treatment strategies, mentioning "Wu Qi Chao Yuan Dan" (Five Qi Gathering at the Origin Pill), I had previously considered this. However, since the cold signs have diminished this time, warming medicines should be slightly reduced. Purely Yang and rigid medicines seem unnecessary. Moreover, Ke Nang diseases cannot be cleared rapidly. Overly harsh drug properties risk increasing Qi heat over time. Previously, only Fu Zi was used, and everyone criticized its toxicity; now, introducing Sulfur would be even more shocking. It is better to continue treating external Drinking by focusing on the Spleen and internal Drinking by focusing on the Kidney, maintaining balance and harmony, like Yu the Great taming the waters—acting naturally, removing the disease without damaging Yuan Qi. This is perfection. Treating Drinking with warming methods is indeed straightforward, but one must know that although the disease arises from deficiency, it is not a complete excess suitable for direct attacking and purging. Nor is it a complete deficiency suitable for exclusive warming and tonifying. Moderately adding guiding agents to warming medicines prevents Drinking stagnation, aligning with the principle of "warming and harmonizing."

Examining the *Jingui Yaolue*: "Phlegm-Drinking in the heart region, with fullness and support in the chest and hypochondrium, dizziness, is treated with Ling Gui Zhu Gan Tang." "Branch-Drinking in the heart region, is treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction)." Originally, Phlegm-Drinking arises from Spleen-Stomach Yang deficiency and turbid Yin condensation. Treatment methods involve drying dampness, raising Yang, and guiding out Drinking pathogens. Generally, Cold in the Stomach generates Phlegm, Warmth in the Stomach dissipates Phlegm; Dampness in the Spleen retains Drinking, Dryness in the Spleen eliminates Drinking. Although these two formulas treat Branch-Drinking, they are applicable to various Drinking pathologies. Consulting Xu Shuwei's *Benshi Fang* (Formulas from the Cabinet of Abilities), he used solely Cang Zhu (Atractodes Rhizome) to treat Phlegm-Drinking Ke Nang. In Yu Shi's *Yuyi Cao* (Grass of Meaningful Thoughts), there is a record of Lady Hua taking Bai Zhu (Atractodes Macrocephala), with remarkable efficacy. The sages and worthies share the same insight: treating external Drinking via the Spleen should be done thus. The *Jingui Yaolue* also states: "Shortness of breath with slight Drinking, should be eliminated via urination; Ling Gui Zhu Gan Tang governs this, and Shen Qi Pill also governs this." Generally, treating Drinking prioritizes raising Yang and drying earth, but eliminating via urination is even more urgent. Ling Gui Zhu Gan Tang is also a diuretic agent. If a person's Kidney Yang is insufficient, they cannot tolerate it, hence Shen Qi Pill is prescribed, adding Cinnamon Twig and Prepared Aconite Root to the six-ingredient Kidney-tonifying base. This benefits the source of Fire, steams and warms the Middle Jiao Yang, facilitating Stomach digestion and Spleen transportation, thus preventing Drinking retention. Furthermore, Poria and Alisma in the formula have light渗 (percolating/drainage) abilities to remove water pathogens, adhering to the "warm and harmonize" intent, differing significantly from other warming-tonic formulas. Regrettably, good quality Cinnamon Twig is scarce today, and cultivated Fu Zi is weak. Even assisted by Gou Qi Zi (Goji Berry) and Tu Si Zi (Dodder Seed), efficacy may fall short. Adding Ban Long Jiao (Deer Antler Glue), a blood-and-flesh substance with pure Yang warmth to nourish the奇经 (Extraordinary Vessels), supplements the deficiency below Yu Tang and Guan Yuan. Red Peony Root is omitted in the formula to avoid clearing Ministerial Fire. Thus, treating internal Drinking via the Kidney is indeed appropriate.

An Bo comments: This can be called perfect in every respect.