Welcome to Millwoods Acupuncture Centre
 

首页
      English
Millwoods Acupuncture Center
102, 2603 Hewes Way
Edmonton AB,   Canada

Phone: (780) 466-8683
www.acupuncture123.ca
 







 

 

医理真传

Yi Li Zhen Chuan

原著       ·  郑钦安

Author; Zhen Qin-An (Qing dynasty, China)

医理真传卷二

Volume 2

医学一途,至微至精,古人立法立方,皆原探得阴阳盈虚消长,生机化机至理,始开渡世之法门,立不朽之功业,诚非易事也。全碌碌庸愚,何敢即谓知医,敢以管见臆说,为将来告。

The medicine is a very acute and fine knowledge area. The old Chinese set up the diagnosis and treatment principle for the reason that they find the secrete for the Yin-Yang transfer and transformation in the nature and in the body. For this reason, they dare to open their clinic, and to write books, contribute huge to the human health. It is not a easy thing. If they are only a ordinary doctor, not knowing clearly the meaning of the structure and function of the human body, how dare they to publish their idea to affect the future doctor’s practice.  

窃念一元肇始,人身性命乃立,所有五脏六腑,九窍百脉,周身躯壳,俱是天地造成,自然之理。但有形之躯壳,皆是一团死机,全赖这一团真气运用于中,而死机遂转成生机。奈人事不齐,不无损伤,真气虽存,却借后天水谷之精气而立(经云:"无先天而后天不立,无后天而先天亦不生")。故先天之本在肾(即真阳之寄处),后天之本在脾(即水谷之寄处),水谷之精气,与先天之真气,相依而行,周流上下四旁,真是无微不照者也。盖上下四旁,即三阴三阳六步,其中寓五行之义,各有界限。

I believe that, from the beginning of the Yuan Qi, the life starts. All the organs, body structure, are created by the nature. However, the material structure of the body is a dead, no-life mass. It depends on the True Qi in the body to activate, to govern, to promote, to maintain and to adjust the body function. It is the True Yang in the Kidney that no-life into life. During life, it is not possible to avoid various damage or hurt to us, physically and emotionally. Though our True Qi is still in our body, the True Qi needs the later Food-Water nutrition to nourish it (Medical bible said: “if no inherit True Qi, there will no later life. If there is no later water-food nutrition, the inherit True Qi would not be able to exist in the body). This is why we say: the most important inherit source of life is in the Kidney (e.g. the True Yang, the True Qi stores in the Kidney), and the most important later source of life is in the Spleen (e.g. the Spleen supplies water-food nutrition to the whole body, as well as to maintain the inherit True Yang in the Kidney). The water-food nutrition Qi and the inherit True Yang Qi move accompanied in whole of  the body, everywhere. The upper and lower, the left and the right side of the body, e.g. the three Yin and the three Yang stages/layers, all bear the five elements, and have different meaning.     

 

发病损伤,即有不同,总以阴、阳两字为主。阴盛则阳必衰,阳盛则阴必弱,不易之理也。然阴虚与阳虚,俱有相似处,学者每多不识,以致杀人。全不佞,采取阳虚、阴虚症各数十条,作为问答,阴、阳二症,判若眉列,以便学者参究,知得立解之意,则不为他症所惑,非有补于医门者哉?

Though the damages and diseases in the body is various, all can be classified into the Yin or the Yang conditions. If the Yin is overwhelming, the Yang must be in a decline condition. If the Yang is in overwhelming, the Yin must be in a declined condition. This is true for ever. However, there are much similarity between the Yin deficiency and the Yang deficiency. Ordinary doctors usually do not know the identification diagnosis, so causing death in the treatment. Here I will try to list several clinic conditions as examples for the Yin deficiency and the Yang deficiency, with the hope for clinic doctors to study and to make as a reference. Therefore, in clinic, it would be clear in their mind to recognize the real Yin deficiency and the Yang deficiency, not be confused by other clinic conditions. Would this way not be a good supplement to the medicine?

 

阳虚症门问答

Questions and answers for Yang deficiency.

问曰:头面畏寒者,何故?

Q: The head and the face feel chilly, why?

答曰:头为诸阳之首,阳气独盛,故能耐寒。今不耐寒,是阳虚也。法宜建中汤加附子,温补其阳自愈。

A: The head is the leader of every Yang Qi in the body. The Yang Qi is overwhelming in the head, so it can endure cold. Now, it cannot endure cold, suggesting the Yang Qi in the head is in deficiency. The treatment principle should be to use Jiangzhong Tang jia Fuzi, to warm and supply Yang Qi in the heat.

建中汤

(Jiangzhong Tang)

桂枝九钱   白芍六钱   甘草六钱 ()  生姜九钱   大枣十二枚  饴糖五钱  附子三钱

(For the ingredient and the dose of the herb formula, check <<Shanghan Lun>> in this website).

用药意解

The idea to use this formula:

按桂枝辛温,能扶心阳。生姜辛散,能散滞机。熟附子大辛大热,足壮先天元阳。合甘草、大枣之甘,辛甘能化阳也。阳气化行,阴邪即灭,气机自然复盛,仍旧能耐寒也。但辛热太过,恐伤阴血,方中芍药苦平,饴糖味甘,合之苦甘能化阴也。此病重在阳不足一面,故辛热之品多,而兼化阴,亦是用药之妙也。此方乃仲景治阳虚之总方也,药味分两,当轻当重,当减当加,得其旨��,可即此一方,而治百十余种阳虚症候,无不立应。

Guizhi is spicy and warm, works to support the Heart Yang. Shenjiang is spicy and disperse, can release the stagnated Qi. Shou Fuzi is very spicy and hot, can support the inherit Yuan Yang. The Gancao (Licorice root) and the Chinese date is sweet. The spicy and the sweet work together to create Yang Qi. When the Yang Qi is created, the Yin Qi is reduced to disappear, the Qi Ji (function of the Qi) is restored certainly. The head so can endure the cold. To prevent the overworking of the spicy hot, which may exhaust the Yin blood, the herb Shaoyao is used. Shaoyao is bitter, Yitang is sweet. Bitter-sweet creates Yin. The emphasis of this condition is the short of the Yang Qi, so more spice-hot herbs are used, with little creating Yin. This is so smart way to solve the problem without creating new side effect. This is a quite common rule in establishing Chinese herbal formula. This formula is the major and principle herbal formula used to solve the Yang deficiency by Master Zhang Zhongjing. The dose of the herb ingredients, which ingredient should be more, which should be less, how to add, and how to remove one or more of the herbal ingredients, are important. If you know how to adjust this, you can use only one formula to treat hundreds of the Yang deficiency conditions.

【阐释】小建中汤由桂枝汤倍芍药加饴糖组成,取温以祛寒,辛以宣通,甘以缓急之义,一般用于太阳病及脾阳虚的病症。实则凡身体虚弱有腹痛、心悸、盗汗、衄血、梦遗、手足烦热、四肢倦怠疼痛、尿频数且量多等,均可应用。现代有人用以治虚弱小儿的感冒,夜尿、糖尿病、肺结核、贫血、胃炎。加淫羊藿治阳痿,加茵陈治黄疸,加龙齿治高血压,均获显著效果。若加当归、黄芪,更具滋养强壮之效,诚不愧为治阳虚之要方。

Further explanation: This formula… is generally used for the Taiyang stage or Spleen Yang deficiency. Whenever a patient has abdomen pain, palpitation, night sweat, nose bleeding, wet dream (nocturnal emission), annoying hot in the hands and feet, tiredness and pain in the extremes, frequent urine and large volume of urine, etc., this herb formula can be applied. Such conditions can be seen in the common cold in weak child, night urine, diabetes, lung tuberculosis, anemia, gastritis, etc.[1] With addition of Yinyanghuo, this mixture can treat impotency; with Yinchen, for ther treatment of jaundice; with Longci, for high blood pressure. All work very good. If with Danggui, Huangqi, the formula bears much more nourishing effect, becoming really very important formula for the treatment of Yang deficiency.

笔者用建中汤加丁香以治各种胃痛症,屡获良效,实由丁香辛温,能温中降逆,暖胃助阳之故。加破故纸,益智仁,桑螵蛸治老年人尿频数,小儿遗尿,十用九效,实由三药皆能补肾、命门之不足,益精气而固肾、有缩小便之功。

The editor also used the Jiangzhong Tang jia Dingxiang for the treatment of various gastric pain with pretty good result. One of the important reasons is the use of Dingxiang in the formula, which can warm the middle body, reducing up-reverse-moving Qi, warm the stomach and help the Yang Qi. With addition of Poguzi, Yizhiren, Sanpiaoxiao, it can be used for the treatment of frequent urine in elderly and child. It works for ninety percent of the cases, for the reason that three herbs can supply kidney, mingmen, help Jing Qi, stronger the kidney and shrink the urine.

问曰:畏寒与恶风有别否?

Q: Is there any difference between chilly and dislike wind?

答曰:恶风者,见风始恶,非若畏寒者之不见风而亦畏寒也。恶风一症,兼发热、头项强痛、自汗者,仲景列于太阳风伤卫症,主桂枝汤。畏寒一症,兼发热、头项强痛、无汗者,仲景列于太阳寒伤营症,主麻黄汤。若久病之人,无身热、头痛等症,而恶风者,外体虚也(卫外之阳不足也)。而畏寒者,内气馁也(元阳衰于内,而不能充塞也)。恶风者可与黄芪建中汤,畏寒者可与附子甘草汤。新病与久病,畏寒恶风,有天渊之别,学者务宜知之。

A: For wind-dislike feeling, it means a person hates the wind when there is a wind (or air conditioning, or other kind of fast air moving environment). For chilly feeling, the person feels cold even without exposure in wind. The wind-dislike feeling, together with fever, tight and stiff in the head and neck, and self sweat, are listed in the Taiyang Wind-invasion condition by Master Zhang Zhongjing. Main herb formula should be used is Guizhi Tang. The chilly feeling, together with fever, tight and stiff head and neck, but no sweat, is listed as Taiyang Cold-invasion stage by Master Zhang Zhongjing. The main herb formula should be used is Mahuang Tang. For a person with long term of disease, if he has no fever, no headache, but feels dislike of wind, it means his body is in a surface weakness condition (the Yang Qi for outside defense is in weakness). If he feels mostly chilly, it means his inside boy is in Yang deficiency (the Yuan Yang is weak in the inside, cannot to fill up the inside organs). For wind-dislike condition, use herb Huangqi Jianzhong Tang. For the chilly feeling, use Fuzi Gancao Tang. The meaning of the wind-dislike and the chilly is different depending on if it happens in acute condition on in chronic disease course. Beginners must know this.

桂枝汤

Guizhi Tang

桂枝九钱  白芍六钱  甘草六钱〔炙〕生姜九钱  大枣十二枚

(The ingredient of the Guizhi Tang)

麻黄汤

Mahuang Tang

麻黄六钱  桂枝三钱  杏仁二钱  甘草二钱〔炙〕

(The ingredient of the Mahuang Tang)

黄芪建中汤

Huangqi Jianzhong Tang

(同上加黄芪一味)

(Add Huangqi into the Xiao Jianzhong Tang)

附子甘草汤

Fuzi Gancao Tang

附子一两   甘草六钱炙

(Ingredient of the Fuzi Gancao Tang)

用药意解

The meaning of the herb formula

按桂枝汤一方,乃协和营卫之剂也。桂枝辛温,能化太阳之气;生姜辛散,能宣一切滞机。桂枝与生姜同气相应,合甘草之甘,能调周身之阳气,故曰辛甘化阳。阳气既化,恐阴不与之俱化,而邪亦未必遽出也,又得芍药之苦平,大枣之甘平,苦与甘合,足以调周身之阴液,故曰苦甘化阴。阴阳合化,协于中和,二气流通,自然无滞机矣。故曰营卫协和,则病愈。仲景更加服粥以助之,一取水谷之精以为汗,一是壮正气而胜邪气也。

The Guizhi Tang is the formula to balance the Yin Qi and Wei Qi in the body. Guizhi is spicy and warm, able to create Taiyang Qi; Shengjiang (fresh ginger) is spicy and dispersing, can loose every stagnated Qi. Guizhi and the Shenjing works the same direction. Together with the Gancao, the sweet, all work to promote the Yang Qi movement in the body, so it is said that the spicy-sweet can create Yang Qi. Once the Yang Qi is created, but fearing the Yin still remained, the Xie Qi might not leave out of the body, so add the Shaoyao for its bitter nature, and add the Chinese date for its sweet. The bitter works with the sweet to stir the Yin liquid in the whole body, so it is called the bitter-sweet create the Yin. Both the Yin and the Yang are created, harmonized in the middle of the body, the Yin Qi and the Yang Qi move smoothly in the body, so there is no stagnation of Qi. This is so called the Ying Qi and Wei Qi harmonization. The disease is so solved. The Master Zhang Zhongjing also add the rice soup after the herb intake. First, it is to get more water-food nutrition for promoting sweat. Second, it is to supply more defense Zheng Qi to combat the Xie Qi.

按麻黄汤一方,乃发汗之峻剂也。因寒伤太阳营分,邪在肤表(肌腠浅一层,肤表深一层),表气不通,较桂枝症更重,故以麻黄之轻清,大开皮毛为君,皮毛大开,邪有路出,恐不即出,故以杏仁利之,气机得利,邪自不敢久停,复得甘草和中以助其正,更佐桂枝,从肌腠以达肤表,寒邪得桂枝辛温,势不能不散,遂从肤表达肌腠而出也。仲景不用服粥,恐助麻黄而发汗太过也。(发汗二字,大有深义。汗本血液,固是养营之物,何可使之外出也。不知寒邪遏郁,气机血液不畅,则为病。此际之血液,不能养营,必使之外出,即是除旧布新之义也。病家切不可畏发汗,汗出即是邪出也。医家切不可不发汗,当知有是病,即当用是药。总之认症贵宜清耳)

Mahuang Tang is a strong sweat-creating herb formula. The Cold invades the Taiyang Ying layer, the Xie Qi remains in the skin surface, the surface Qi is blocked. This is a condition deeper and more severe than the Guizhi Tang condition. So, in this formula, the Mahuang is used for its light taste nature, to open the surface skin holes. With the open of the skin holes, the Xie Qi has door/pathway to leave the body. To pushing the Xie Qi out, add the Xinren to promote the movement of the body defense Qi. The Defense Qi moves easier and fast and quick, the Xie Qi dares to stay longer. The herb Gancao (licorice) is to help the defense energy, and to help the Guizhi to work from the muscle layer to the skin layer. The Cold Xie Qi meets the Guizhi. For the spicy and warm nature of the Guizhi, the Xie Qi has to be dispersed out, so to move from the muscle to the skin surface to leave out of the body. Here, the Master Zhang Zhongjing did not use the rice soup, for fear of creating too much sweat to damage the body Zheng Qi. (The word “Creating-sweat” bears great meaning. The sweat is created from the blood. It is the nutrition material, how can we let it go out of the skin? People do not know that the Cold Xie blocked the body Qi, the Qi and the Blood become stagnated to cause the disease condition. In this case, the blood can not nourish the Ying Qi, so it should be removed from the body. This means to remove an Old but supply with a New. Patient should not worry the sweat. The out of sweat means the out of the Xie Qi from the body. Doctor should not deny to use the sweat therapy, since if there is condition that need the sweat therapy, the sweat therapy should be used. All in all, it is important to understand this information.)

按黄芪建中汤一方,乃桂枝汤加饴糖、黄芪耳。夫桂枝汤乃协和营卫之祖方也,复得黄芪能固卫外之气。饴糖一味有补中之能。若久病恶风之人,皆原中气不足,卫外气疏,今得桂枝汤调和阴阳,黄芪、饴糖卫外守中,而病岂有不愈者乎?

Huangqi Jianzhong Tang is the Guizhi Tang plus Yitang and Huangqi. The Guizhi Tang is the mother-herbs for balancing the Ying Qi and Wei Qi in the body. The addition of Huangqi enhances the Weiqi and the Yitang supports the middle Qi. For person for a long history of disease with dislike-wind syndrome, which is due to the weakness in the middle Qi and out Weiqi, now he is given the Guizhi Tang to adjust the Yin and Yang, and given the Huangqi and Yitang to guide the inside and outside of the body, how would the disease not be solved?

按附子甘草汤一方,乃先后并补之妙剂也。夫附子辛热,能补先天真阳,甘草味甘,能补后天脾土,土得火生而中气可复(附子补先天之火,火旺自能生脾土,故曰"中气可复")。若久病畏寒之人,明系先天真阳不足,不能敌其阴寒之气,故畏寒。今得附子而先天真火复兴,得甘草而后天脾土立旺,何患畏寒之病不去乎?

The herb Fuzi Gancao Tang is a very smart herb formula to support both inherited and the later life energy. The Fuzi is spicy and hot, able to supply inherited True Yang, and the Gancao is sweet, can supply the later Spleen Soil. When the Soil is warmed with Fire, the middle Stomach-Spleen Qi can be restored. (The Fuzi supply the innate Fire. When the Fire is enough, it can nourish the Soil, so that it is said “the middle Stomach-Spleen Qi can be restored). For person with a long history of chilly, it is clear that he is under True Yang deficiency, hard to combat the Yin Cold Qi, so the person feels chilly. With Fuzi in the formula, the innate True Fire is restored. With the Gancao, the acquired Spleen Soil becomes supplied. So no worry that the chilly will not go away.

附伏火说

Appendix: the meaning of the covering Fire.

世多不识伏火之义,即不达古人用药之妙也。余试为之喻焉:如今之人将火煽红,而不覆之以灰,虽焰,不久即灭,覆之以灰,火得伏即可久存。古人通造化之微,用一药、立一方,皆有深义。若附子甘草二物,附子即火也,甘草即土也。古人云:"热不过附子,甜不过甘草"。推其极也,古人以药性之至极,即以补人身立命之至极,二物相需并用,亦寓回阳之义,亦寓先后并补之义,亦寓相生之义,亦寓伏火之义,不可不知。

Ordinary people do not understand the meaning of the covering Fire, so they cannot understand the ingenious meaning of herbs used by Old people. Let me try to make an explanation: Nowadays, people burn the fire, but not cover the fire with ash (soil). So though the fire is in flame, it dies soon without leave warm. If the fire is covered with ash, the warm can be kept for a long time. Old people understand the nature very well, so when they use a herb, a formula, all bear great meaning. For the Fuzi Gancao Tang, the Fuzi is as the fire, and the Gancao is as the ash (Soil). Old people said: “Fuzi is most hot, and Gancao is most sweet”. It means to explain their strong nature. Old people used the extreme nature of the herb, to supply the body extreme nature. The two herbs work together, meaning to save the Yang Qi, meaning to supply the innate and the acquired Yang Qi same time, meaning they create each other, also meaning to save the fire for a long time. This should be known.

【阐释】关于桂枝、麻黄二汤之应用,须遵守一定的标准。近代名医恽铁樵之说可供借鉴。其说谓:"太阳病发热,形寒,头痛,项强,口中和,汗自出,始可用桂枝汤。口中和就是舌面润,舌质不绛,唇不干绛,不渴,如其口渴,舌干,唇绛,即是温病,桂枝是禁药。"用麻黄汤之标准,"除恶寒、发热,头痛、身痛等,更须注意两点:第一是无汗,第二是口中和。如其有汗,麻黄是禁药,如其口渴、舌干、唇绛,桂枝也是禁药。只要是真确无汗,口中和,此方是唯一无二的妙法,可以药到病除。"(见恽著《伤寒论辑义按》)何公度悼恽氏文谓恽氏三子皆死于伤寒,其第四子又病危,群医束手,恽氏乃自处麻黄汤方,虽分量极轻,而其子竟得救,于是乃益精研《伤寒论》,终至成为名家。但至今仍有惧用此方者,恽氏之说,实足为郑氏"认症贵宜清"之助,故摘录以资参考。

Further explanation: There are some rule in the use of the Guizhi Tang and the Mahuang Tang. Later famous doctor Yun Tiejiao has some reasonable comment. He said: “If the Taiyang stage with fever, chilly, headache, stiff neck, self-sweat, but no problem in the mouth, then the Guizhi Tang can be used. Here, no problem in the mouth means the tongue is not in pure, the tongue is not dry, the lips is not purple or dry, no thirsty. If the person has thirsty, dry tongue, purple in lips, it indicates that the condition is Wen bing, not the Shanghan disease. The Guizhi Tang is forbid to use. The rule for the use of the Mahuang Tang, “beside the chilly, fever, headache and pain in the body, more attention should be paid: first, the body should have no sweat; second, no problem in the mouth. If there is sweat, the Mahuang is forbidden. If there is thirsty, dry tongue, the Guizhi Tang is also forbidden to use. If there is really no sweat, and no problem in the mouth, these two formula are the only ingenious herb formula. They work very fast to cure the disease. …

久病之恶风,多无身热、头痛等症,而系由于中气不足,卫外气疏,故主以黄芪建中汤。因本方系由桂枝汤加黄芪、饴糖组成,桂汤枝以调和阴阳,黄芪、饴糖以卫外而守中,中气卫气均固,自然不会畏风了。至于久病恶寒,明系元阳不足,不同于表症恶寒之重被不温,而是得暖即解,两者极易区别。郑氏主以附子甘草汤,药仅二味,具见精义。以附子辛热补先天真阳,甘草味甘补后天脾土,火生土而中气可复,土覆火而火得久存,故久病之恶寒可以痊愈。伏火说所论各点,妙喻精义,别开生面,其他医家少有论及。

The wind-disliking feeling in the person with a long disease history, is usually not accompanied with fever or headache. It is due to the deficiency of the middle Stomach-Spleen Qi, and the out-defense Qi. So the Huangqi Jianzhong Tang is used. Because it is the mixture of the Guizhi Tang and Huangqi and Yitang, Guizhi Tang works to adjust the Yin and Yang. Huangqi and Yitang work to enhance the out and inside defense system. When both defense systems (the Qi) are enhanced, of course there will have no wind-dislike feeling. For the chilly feeling with a long time disease history, it is due to the Yuan Yang deficiency. It is deference from the chilly due to a common cold. In the common cold, the chilly cannot be reduced by heavy covering. Chilly feeling during a long disease course, however, is easy to solve by more warm covering. Doctor Zhen used the Fuzi Gancao Tang. It contains only two herb ingredient. It is very smart formula. The Fuzi support the innate True Yang, and the Gancao supply the acquired Spleen Soil. The Fire creates the Soil so that the middle Qi can be restored. The Soil covers the fire, so that the Fire can be saved for a long time. So that the long term chilly can be solved. The explanation above for the fire covering is very interesting and useful in the understanding of the herbs. This is rarely mentioned in any other medical books.  

问曰:头面忽浮肿,色青白,身重欲寐,一闭目觉身飘扬无依者,何故?

Q. The face and head suddenly becomes swelling, with blue-white color. The patient feels heavy in the body, tends to lie down. Once close the eye, the patient feels his/her body floating without anywhere to attach. What is this condition?

答曰:此少阴之真气发于上也。原由君火之弱,不能镇纳群阴,以致阴气上腾,蔽塞太空,而为浮肿。所以面现青黑,阴气太盛,逼出元阳,故闭目觉飘扬无依。此际一点真阳,为群阴阻塞,不能归根,若欲归根,必须荡尽群阴,乾刚复振。况身重欲寐,少阴之真面目尽露,法宜潜阳,方用潜阳丹。

A: This is due the Shaoyin True Qi floats up. It is originally due to the weak of the King Fire (the Heart Fire), which fails to suppress various Yin Qi, so that the Yin Qi float and jump up, block the sky, cause the floating. So, the person shows blue-black color in the face. The Yin Qi is overwhelming, forces the Yuan Yang out of the Kidney, so the person feels floating without anywhere to touch, when closed eyes. At this movement, the little True Yang is blocked by various Yin, cannot return to the Kidney. To help the True Yang to return, it is needed to clear the various Yin Qi, restore the Yin and Yang rule in the body. The person feels heavy in the body and tends to lie down, clearly suggesting the Shaoyin condition. The treatment principle is to dive and bring the Yang Qi back. Use Qian Yang Dan.

潜阳丹

Qian Yang Dan

西砂一两    姜汁炒    附子八钱    龟板二钱    甘草五钱

Sharen 30 gram, Fresh ginger juice,  Fuzi 24 gram, Guiban 6 gram, Gancao 15 gram.

用药意解

The meaning of the herb formula:

按潜阳丹一方,乃纳气归肾之法也。夫西砂辛温,能宣中宫一切阴邪,又能纳气归肾。附子辛热,能补坎中真阳,真阳为君火之种,补真火即是壮君火也。

况龟板一物,坚硬,得水之精气而生,有通阴助阳之力,世人以利水滋阴目之,悖其功也。佐以甘草补中,有伏火互根之妙,故曰潜阳。

The Qian Yang Dan, is the herbal formula to collect the Qi into the Kidney. The Sharen is spicy and warm, able to clear various Yin in the middle space of the body, able to hold and bring the Yang Qi back to the Kidney. The Fuzi is spicy and hot, able to supply the True Yang in the Kidney. The True Yang is the seed of the King Fire in the Heart. So, supply the True Yang in the Kidney is also to supply the King Fire in the Heart.

【阐释】潜阳丹,笔者曾用此方治愈头痛如裂(即一般所说之脑震荡)患者多人,即以其无外感可凭,有阳虚之症状足征,而断为阴气逼阳上浮,用潜阳丹一服即效,数剂痊愈。

Further explanation: The editor has used this formula to many patients with severe headache (e.g. the patient with cerebral confusion). The headache is so severe that the patient feels the head to split open. It is based on the fact that, there is no evidence for a common cold, but more evidence for a Yang deficiency. So the condition is diagnosed as the Yin Qi presses the Yang Qi floating. One dose of the Qian Yang Dan solved the problem, and several more doses bring to cured.

问曰:病将瘥,一切外邪悉退,通身面目浮肿者,何故?

Q: The disease is under recovery course. Various outside Xie Qi is under retreat. But the face and the body of the person all suddenly become swelling. Why?  

答曰:此中气不足,元气散漫也。夫病人为外邪扰乱,气血大亏,中气未能骤复。今外邪虽去,而下焦之阴气,乘中土之虚,而上下四窜,故通身浮肿。虽云君火弱不足以制阴,此症实由脾土虚不能制水,而水气汜溢,可名水肿。一者脾土太弱,不能伏火,火不潜藏,真阳之气外越,亦周身浮肿,可名气肿。总而言之,不必定分何者为气肿、水肿,要知气行一寸,水即行一寸,气行周身,水即行周身,是元气散漫,而阴水亦散漫也。治病者不必见肿治肿,明知其土之弱,不能制水,即大补其土以制水,明知其元阳外越,而土薄不能伏之,即大补其土以伏火。火得伏而气潜藏,气潜藏而水亦归其宅,何致有浮肿之病哉!经云:"火无土不潜藏",真知虚肿之秘诀也。而余更有喻焉:试即蒸笼上气,而以一纸当气之上,顷刻纸即湿也。以此而推,气行则水行,气伏则水伏,可以无疑矣。此症可用理中汤加砂、半、茯苓温补其土,自愈。

A: This is due to the weak in the middle Stomach-Spleen Qi, so the Yuan Qi is dispersing and scattering.  The patient is disturbed by the invading Xie Qi, the Blood and the Qi is in disorder and the middle Stomach-Spleen Qi has not been restored yet. Now, the invading Xie Qi is leaving, but the Yin Qi in the lower Jiao runs everywhere and causes the swelling, taking the chance in which the middle Qi is in weak. Though this condition can be understand as the weaken King Fire, which can not suppress the Yin, but it is actually due to the Spleen weakness, which cannot control the water, so the water floods, causes the swelling. In one way, the Spleen Soil is to weak to cover and to save the Fire, so the True Yang in the Kidney escapes out, also causes swelling in the body, but it is called Qi swelling (The swelling is as with air under the skin, not as water under the skin). However, it is not need to verify if the swelling is water-swelling or air-swelling. If should be known that, one inch the Qi moves in the body, the water will move one inch in the body. The Qi moves all over the body, so will the water. Therefore, when the Yuan Qi is dispersed in the body, the water will disperse in whole of the body too. Medical practitioners do not neet to treat the swelling upon seeing a swelling. If he/she knows the reason being the weak Spleen, which cannot conrol the water, he/she should supply the Soil to control the Water. If he/she also knows that the Yuan Yang (the True Fire) is floating, but the Soil (the Spleen) is weak to cover and to save it, he/she should supply the Soil to save the Fire. With enough Soil, the Fire can be saved and stored, so the Qi can be hidden in the Kidney again. The Qi is bring back to the Kidney, the Water will go back to the Kidney too. This is the secret to treat the swelling. I have more examples to show: if you put a paper over the water-steaming oven, the paper will become wet very soon, indicating that with the Qi moving, the Water will move too. If the Qi is hidden, the water will stay quiet too. No any more doubt. For this condition, use Lizhong Tang, plus Sharen, Banxia, and Fuling to warm the Soil.

理中汤

Lizhong Tang

人参四钱   白术一两   干姜一两   甘草三钱〔炙〕西砂四钱   半夏四钱   茯苓三钱

Ginsheng 12 gram, Baizhu 30 gram, Ganjiang 30 gram, Zhi Gancao 9 gram, Sharen 12 gram, Banxia 12 gram, and Fuling 9 gram.

用药意解

The meaning of the Lizhong Tang

按理中汤一方,乃温中之剂也。以白术为君,大补中宫之土;干姜辛热,能暖中宫之气;半、茯淡燥,有行痰逐水之能,西砂辛温,有纳气归肾之妙。但辛燥太过,恐伤脾中之血,复得人参微寒,足以养液,刚柔相济,阴阳庶几不偏。然甘草与辛药同用,便可化周身之阳气。阳气化行,而阴邪即灭,中州大振,而浮肿立消,自然体健而身安矣。

The herb formula Lizhong Tang is to warm the middle. The herb Baizhu is the King in the formula, to supply middle Soil; the Ganjiang (dried Ginger) is spicy and hot, able to warm the middle Qi; Banxia and Fuling is mild in taste and dry in nature, able to remove phlegm and deplete water; Sharen is spicy and warm, able to bring the Qi back to the Kidney. If the spicy and dryness is too much, it may damahge the blood in Spleen. Ginsheng is mild cold, it is used to nourish the Yin liquid, so that the herb formula can supply both the Yin and the Yang. The use of the Gancao and the spicy herbs together can create Yang Qi in whole body. When the Yang Qi is created, the Yin Xie disappears, the middle Qi starts to function again, so the swelling declined, and the body gets recovered. 

【阐释】笔者常用理中汤加丁香治慢性胃病,患者大多胃胀痛或隐痛,饮食减少,人困无神,可说屡治屡效。

Further explanation: the editor usually used the Lizhong Tang plus Dingxiang in the treatment of chronic gastric disease. Patients commonly feel stomach bloating and mild pain, with less appetite, tired, no energy. The herbs work with pretty high success rate.

问曰:眼中常见五彩光华,气喘促者,何故?

Q: There are always colorful light in the eyes, with short of breath and asthma, why?

答曰:此五脏之精气发于外也。夫目窠乃五脏精华所聚之地,今病人常见五彩光华,则五气之外越可知,而兼气喘,明系阴邪上干清道,元阳将欲从目而脱,诚危候也。法宜收纳阳光,仍返其宅,方用三才封髓丹。

A: This is due to the spill of the Jing Qi of the five organs. The eyes are the space where the essence of the organs accumulated. Now, the patient feels colorful light in the eyes, suggesting the organ Qi is spilling. Together with short of breath, asthma, it more clearly indicates that the Yin Xie is floating and pushing up to the organs in the head, and that the Yuan Yang is escaping from the eyes. This is a terrible dangerous condition. The treatment principle is to contract, to collect, and to bring back the Shushine (the True Yang) into the Kidney. The formula is Fengsui Dan.

封髓丹

Fengsui Dan

黄柏一两   砂仁七钱   甘草三钱炙

Huangbo 30 gram, Sharen 21 gram, Zhi Gancao 9 gram.

用药意解

The meaning of the herbal fomula.

按封髓丹一方,乃纳气归肾之法,亦上、中、下并补之方也。夫黄柏味苦入心,禀天冬寒水之气而入肾,色黄而入脾,脾也者,调和水火之枢也,独此一味,三才之义已具。况西砂辛温,能纳五脏之气而归肾,甘草调和上下,又能伏火,真火伏藏,则人身之根蒂永固,故曰封髓。其中更有至妙者,黄柏之苦,合甘草之甘,苦甘能化阴。西砂之辛,合甘草之甘,辛甘能化阳。阴阳合化,交会中宫,则水火既济,而三才之道,其在斯矣。此一方不可轻视,余常亲身阅历,能治一切虚火上冲,牙疼,咳嗽,喘促,面肿,喉痹,耳肿,目赤,鼻塞,遗尿,滑精诸症,屡获奇效,实有出人意外,令人不解者。余仔细揣摹,而始知其制方之意,重在调和水火也,至平至常,至神至妙,余经试之,愿诸公亦试之。

The Fengsui Dan is a formula to bring the Qi back to the Kidney. It is also a supplementary formula to supply the upper, the middle and the lower part of the body the same time. The herb Huangbo is bitter in taste, able to nourish the heart. It bears the Cold-Water Qi, so able to bring the Qi into the kidney. It is yellow in color. The yellow color is the Spleen, which is the hub for the Water and the Fire. You see, this her alone can supply the upper, the middle and the lower part of the bdy. The Sharen is spicy and warm, able to bring the five organ Qi back to the Kidney. The Gancao adjusts the upper and the lower part of the body. It is also able to cover and save the Fire. When the True Fire is saved in the Kidney, it means that the root of the life is saved and folded. Therefore the herb formula is called Fengsui Dan. (In Chinese, the word Feng here means fold and seal.). More interesting is that, the herb Huangbo is bitter and the Gancao is sweet. The bitter-sweet creates Yin in the body. The Sharen is spice and the Gancao is sweet. The spice-sweet creates Yang in the body. The created Yin and the Yang mixes in the middle part of the body, so that the Water and the Fire becomes harmony in the body. This herbal formula should not be neglected or looked down at all. My experience is that, this formula can treat all the condition with the Xu Fire floating, such as teethache, cough, asthma, swelling in the face, chronic throat pain, ear swelling, red eyes, stiff nose, urine leak at night, spermtorrhea, etc. The results are very fantastic usually and very surprising. I have tried to find the reason for this formula. Now I understand that, it is to adjust the Water and the Fire in the body. The ingredient is very ordinary, but the function is so marvelous. Hope you to try it.

附七绝一首

阴云四合日光微,转瞬真龙便欲飞(真龙即真火,或上或下,皆能令人病。在上则有牙疼、喘促、耳、面肿诸症,在下则有遗尿,淋、浊、带诸症,学者苟能识得这一点真阳出没,以此方治之,真有百发百中之妙)。 识得方名封髓意,何忧大地不春归。

(This is a poem).

【阐释】眼中常见五彩光华而兼气喘促,郑氏断为五脏之精气外越,元阳将从目脱的危候,而治以三才封髓丹。方中西砂辛温,合甘草辛甘化阳以纳气;黄柏苦寒,合甘草苦甘化阴以伏火。阴阳合化,水火交济,会于中宫,则人身之根蒂永固,故曰三才封髓。郑氏曾亲身经历用此方治一切虚火上冲、咳、喘等症,屡获出人意外之效,经仔细揣摩,始悉立方之意重在调和水火,故以至平至常之药,而有至神至妙之用。此种经验,真堪宝贵。笔者治肾虚牙疼,常以此方治之取效。但须先用松针泡酒噙之,使吐出涎沫,痛即暂止,再服封髓丹,其效始著,屡试屡验。

Further explanation: Patient frequently sees color light in eyes, with short of breath and asthma. This condition is diagnosed by Dr. Zhen as spilling or escaping of essence Qi of the organs from the eyes. He believes that this is a life-threatening condition. For the treatment, he uses Fengsui Dan…. He experienced the use of this formula for the treatment of various Xu Fire floating, cough, asthma, etc., with excellent results. … the editor also used this formula for the treatment of teethache due to Kidney deficiency. It worked too. However, it should be prepared first to put the needle leaves of pine tree into wine. Hold such wine in mouth for a while, then spil out the saliva to make the pain stop for a movement. Then take the Fengsui Dan to work for longer time. Every time tried, every time succeeded.

问曰:两目忽肿如桃,头痛如裂,气喘促,面、唇青黑者,何故?

Q: The eyes suddenly become big swelling as a peach. The head is ache as to cut apart, with short of breath, the face and lips blue and black in color. Why?

答曰:此先天真火缘肝木而上,暴发欲从目脱也。夫先天之火,原寄于肾,病人阴盛已极,一线之元阳,即随阴气而上升。水为木母,母病及子,故缘肝木而上,厥阴脉会顶巅,真气附脉络而上行,阳气暴发,故头痛如裂。肝开窍于目,故肿如桃。气喘促者,阴邪上干清道,上下有不相接之势也。面、唇青黑,皆系一团阴气。元阳上脱,已在几希之间。此际若视为阳症,而以清凉发解投之,旦夕即死也。

A: This is due to the True Fire floating along with the Liver Wood. The True Fire is to escape from the eyes. The True Fire is originally located and saved in the Kidney. When the Yin is overwhelming, the slight amount of the True Fire floating with the Yin Qi up. The Water is the mother of the Wood. The mother is sick, and her sickness passes into the child, the Wood, the Liver, so the True Fire climbs up along with the Liver meridian to the top of the head. The Yang Qi exploded to cause heavy head pain. The eye is the opening part of the Liver, so it becomes big swelling.  The short of breath and asthma is due to the Yin Xie floating up to block the inhalation tract, the upper and the lower part of the air conduct has tendency not to connect each other. That the face and lips are blue-black, is due to the overwhelming of Yin Qi. The Yuan Qi is escaping from up, the life is in very dangerous status. At this movement, if it is still regarded as a Yang condition, using fire-clearing and cold therapy, the life will be lost soon. 

法宜四逆汤以回阳祛阴,可愈。

In this condition, herb Sini Tang should be used to save the Yang Qi. This is a condition that can be cured.  

四逆汤

Sini Tang

附子一枚    干姜一两五钱   甘草二两炙

Fuzi 30 gram, Ganjiang 45 gram, Zhi Gancao 30 gram.

用药意解

The meaning of the herb Sini Tang

按四逆汤一方,乃回阳之主方也。世多畏惧,由其不知仲景立方之意也。夫此方既列于寒入少阴,病见爪甲青黑,腹痛下利,大汗淋漓,身重畏寒,脉微欲绝,四肢逆冷之候,全是一团阴气为病,此际若不以四逆回阳,一线之阳光,即有欲绝之势。仲景于此,专主回阳以祛阴,是的确不易之法。细思此方,既能回阳,则凡世之一切阳虚阴盛为病者,皆可服也,何必定要见以上病情,而始放胆用之,未免不知几也。

The herb Sini Tang is the main formula to restore the Yang Qi. However, most of the ordinary doctors dared not to use it, since they do not know the meaning of the herb formula set by Master Zhang Zhongjing. This formula is listed and introduced in the Shaoyin stage of the Shanghan disease. That is a stage in which the patient has blue-black color in the nail, stomach pain with diarrhea, heavy sweat, heavy body, chilly, reverse cold in the hands and feet. The pulse is mild, weak to disappear. All show as a mass of Yin Qi in the body. At this movement, if not use the Sini Tang to restore the Yang Qi, the mild and weak Sunshine would disappear soon. For this, Master Zhang Zhongjing focuses on the restore of the Yang Qi for the aim to remove the Yin Qi. No any other alternative therapy for this condition. Since this formula is to restore the Yang Qi, so whenever the body has evidence of Yang deficiency and Yin overwhelming condition, the formula can be used. No reason to wait for the condition in this question to use it.

夫知几者,一见是阳虚症,而即以此方在分两轻重上斟酌,预为防之,万不致酿成纯阴无阳之候也。酿成纯阴无阳之候,吾恐立方之意固善,而追之不及,反为庸庸者所怪也。怪者何?怪医生之误用姜、附,而不知用姜、附之不早也。仲景虽未一一指陈,凡属阳虚之人,亦当以此法投之,未为不可。

For people knowing the mechanism, once seeing condition of Yang deficiency, start to use this formula, with variation of its dose. In this way, it is to prevent the Yang Qi escape. Once the condition has been developed into the pure Yin condition, I doubt that this herb formula may not work properly, though the meaning of the herb formula is pretty reasonable. If it happens as this, ordinary people may blame the formula not work. The may blame the doctor mis-used the Jiang, Fuzi. They do not know that the Ganjiang and the Fuzi should be used earlier. Though the Master did not point out for us in detail, I believe that, whenever a patient is in Yang deficiency, this formula should be used right away. No need to wait.  

所可奇者,姜、附、草三味,即能起死回生,实有令人难尽信者。余亦始怪之而终信之,信者何?信仲景之用姜、附而有深义也。考古人云:"热不过附子",可知附子是一团烈火也。凡人一身,全赖一团真火,真火欲绝,故病见纯阴。仲景深通造化之微,知附子之力能补先天欲绝之火种,用之以为君。又虑群阴阻塞,不能直入根蒂,故佐以干姜之辛温而散,以为前驱。荡尽阴邪,迎阳归舍,火种复兴,而性命立复,故曰回阳。阳气既回,若无土覆之,光焰易熄,虽生不永,故继以甘草之甘,以缓其正气,缓者即伏之之意也。真火伏藏,命根永固,又得重生也。此方胡可忽视哉?

It is very interesting that, with only the Shengjiang (fresh ginger), the Fuzi and the Gancao (licorice), the herb formula can save life! It is really hard to be believable. I myself also doubt it before but believe it now. What I believe? I believer that there is very deep meaning that Master Zhang Zhongjing used these herbs. Old Chinese said: “The herb Fuzi is the most hottest herbs”. Apparently, the Fuzi is as a mass of Fire. The life of the body depends on the True Fire. The True Fire is to die, so there show lots of Yin Qi in the body: the pure Yin condition. The Master knows the deep meaning of the nature, knows that the Fuzi can supply the innate Fire seed, so use it as the King in the formula. Considering that the Fire may be clocked by the overwhelming Yin Qi to come back the Kidney, hard to be restored in the deep of the Kidney, so he used Ganjiang (spicy and warm) to disperse the Yin Qi and to welcome the Yang Qi back. When the Fire is restored, the life is saved. So, it is called to “restoring Yang Qi”. If the Yang is restored, but there is no Soil to cover it for protection, the Fire is easy to die again, not stay for long time. So, use the Gancao (sweet in herb nature, work as Soil), to harmony the body defense Qi (Zheng Qi) and to keep the True Fire for a long time.  See, how can we neglect this formula?

迩来世风日下,医者不求至理,病家专重人参。医生入门,一见此等纯阴无阳之候,开口以人参回阳,病家却亦深信,全不思仲景为立法之祖,既能回阳,何为不重用之,既不用之,可知非回阳之品也。查人参,性甘微寒,主补五脏,五脏为阴,是补阴之品,非回阳之品也,明甚。千古混淆,实为可慨。

Nowadays, the social atmosphere is declining. Doctor does not study in detail the medicine, and patient only believes Renshen (ginsheng). Once a doctor sees such a pure Yin condition, he prescribed Renshen right away to the patient to restore the Yang Qi. The patient also believes deeply for the prescription. They all do not think that, if we respect the Master Zhang Zhongjing is the supervisor of Chinese medicine, and if the Genshen can restore Yang Qi, why he did not use it for such pure Yin condition? That he did not use it for restoring Yang Qi, suggests that it would work to restore Yang Qi. Check the Genshen, it is sweet and mild cold in herbal nature, it mostly supply the five major organs, the five organs belong to the Yin, so the Renshen is to supply more Yin, not more Yang to the body. It is so clear. It has been misused for thousands of year. It is so pity.

【阐释】附子为热药之冠,能补欲绝之火种,又必佐干姜之辛散以荡尽阴邪,始能迎阳归舍,故曰回阳。阳回而无土覆,则光焰易熄,虽生不永,故以甘草之甘缓而伏之,使药效长留,命根永固。故凡阳虚阴盛为病,皆可放胆使用,能早用善用,即不致酿成危候。按四逆汤据现代的研究应用,能升血压,改善微循环,具有强心与镇静作用,被视为治疗休克的专方,治疗小儿腹泻亦具卓效。即改为注射液,功效亦与《伤寒论》原方所述相吻合。并经实践证明,附子与干姜、甘草同煎,能减附子之毒,而强心之作用更显著。可见郑氏在百余年前,对此汤之应用解说,实有其独到之处。笔者数十年临床经验,凡遇阳虚症,无论一般所称之肾炎、肝炎、肺炎、心肌炎、胃炎等等,只要临床症状有阳虚之实据,即不考虑炎症,辄以四逆汤加味治疗,取得满意效果。

Further explanation by the editor: … The modern medical research found that, Sini Tang can increase blood pressure, improve micro-circulation, enhance the heart function and excute calm function. It is regarded as the formula for the treatment of shock. It also works for child diarrhea. When prepared as intravenous infusion, it still works well as described in the book <<Shanghan Lun>>. Clinic experience proved that, used with the Ganjiang and Gancao, the toxic nature of the Fuzi can be reduced, but the cardiac enhancing effect is increased. Clearly, doctor Zhen has found the truth for this formula hundred years ago. His explanation about the use and the mechanism of this formula is really unique. For my own several tens of years of experience, this formula can be used in various clinic condition of Yang deficiency, no matter if they are nephrotitis, hepatitis, neomonia, cardiac infection, gastritis, etc. Once there is the evidence for the Yang deficiency, no need to think about inflammation or not, just use the Sini Tang (with some modification). The results are very good.

问曰:病人两耳前后忽肿起,皮色微红,中含青色,微微疼,身大热,两颧鲜红,口不渴,舌上青白胎,两尺浮大而空者,何故?

Q:  Patient has swelling in the front and the back of the ear, on which the skin color is slight red but with purple tint, with slight pain. The patient has high fever. His two cheek are fresh red in color. He has no thirsty. His tongue covering is white-blue. The pulse is floating, big but feels hollow. What condition it is?

答曰:此先天元阳外越,气机附少阳而上也。夫两耳前后,俱属少阳地界,今忽肿微痛,红色中含青色,兼之两颧色赤,口不渴,而唇、舌青白,知非少阳之风火明矣。如系少阳之风火,则必口苦、咽干,寒热往来,红肿痛甚,唇舌定不青白。今见青白苔,而阳虚阴盛无疑。身虽大热,无头疼、身痛之外感可据,元阳外越之候的矣。况两尺浮大而空,尺为水脏,水性以下流为顺,故脉以沉细而濡为平。

A: This is a condition, in which Yuan Yang is escaping, along with the Shaoyang. The front and the back side of the ear belong to Shaoyang area. Now, it suddenly swells, with red color and blue tint, with red color in the cheeks, no thirsty, with the lips and tongue blue in color, all clearly suggesting that it is not the Shaoyang Wind. If it is Shaoyang Wind-Fire condition, the patient should feel bitter taste in mouth, dry in throat, cold-hot shift feeling, strong red color and swelling on the swelling area, and the tongue and the lips must not be white-blue. Now, it shows white-blue color, so no doubt it is Yang deficiency and Yin overwhelming condition. Though the body has fever, there is no evidence for a common cold, such as headache and no body pain. So, it should be diagnosed as the Yuan Yang escaping condition. Together with the pulse: the Chi position is floating and big and hollow in feeling. The Chi position is the Organs belonging to Water (Kidney). The nature of Water is to flow downwards, so the pulse should be deep, thin and soft, as in a normal condition.

今浮大而空,则知阴气太盛,一线之阳光,附阴气而上腾,有欲竭之势也。此际当以回阳祛阴,收纳真气为要。若不细心斟究,直以清凉解散投之,旦夕即亡。方宜白通汤主之,或潜阳丹亦可,解见上。

Now the pulse is floating, big and hollow in feeling, so it should be known that the Yin Qi is too much in the body. The slight Sunshine (the Yang Qi, the True Yang in the Kidney) is floating up and tends to escape. In this movement, the Yang restoring and Yin depleting therapy should be used. The main aim is to restore the Yang Qi. If doctor is not very careful and use Cold herbs, the death will happen soon. The herb formula should be Baitong Tang, or use Qianyang Dan (see above).

白通汤

Baitong Tang

附子一枚生    干姜二两    葱白四茎

Fuzi 30 gram, Ganjiang 60 gram, Green Onion stem, 4 stems.

用药意解

The meaning of the formula:

按白通汤一方,乃回阳之方,亦交水火之方也。夫生附子大热纯阳,补先天之火种,佐干姜以温中焦之土气,而调和上下。葱白一物,能引离中之阴,下交于肾,生附子又能启水中之阳,上交于心。阴阳交媾,而水火互根矣。仲景一生学问,就在这阴、阳两字,不可偏盛,偏于阳者则阳旺,非辛热所宜;偏于阴者则阴旺,非苦寒所可。偏于阴者,外邪一入,即从阴化为病,阴邪盛则灭阳,故用药宜扶阳;邪从阳化为病,阳邪盛则灭阴,故用药宜扶阴。此论外感从阴从阳之道也。学者苟能于阴阳上探求至理,便可入仲景之门也。

Baitong Tang is the formula to restoring Yang Qi, and also to harmonizing the Fire and the Water. Fuzi in it is hot and is pure Yang in herbal nature. It supplies innate Fire. Helped by Ganjiang to warm the middle Soil, the Fuzi can adjust and conduct the upper (Fire) and the lower (Water) part of the body. The green onion is able to bring the Yin in the Li Gua (Heart) to conduct to the Kidney. The Fuzi is able to bring the True Yang in the Kidney to move up conducting with the Heart. So, the Yin and the Yang conducts each other, and the Fire and the Water are the roots of each other. The most importance of the knowledge and experience of the Master Zhang is these Yin and the Yang. None should be extreme. Extreme towards the Yang, the Yang is overwhelming, spicy and hot herbs should not be used. Extreme towards the Yin, the Yin is overwhelming, Cold and bitter herbs are not suitable. When the body is in a Yin overwhelming condition, invaded Xie Qi will turn into the Yin to cause Yin condition. The Yin is overwhelming, so herb should be used to supply more Yang. If the Xie Qi turns towards the Yang, along with the pre-existing Yang condition in the body, the Yang will be overwhelming, so the Yin is to exhaust off, the herbs should be used to supply more Yin. This is to explain the rule when a outside Xie Qi transforms in the body, depending on the original Yin or Yang conditions. If the doctor can try to understand the Master from the Yin and the Yang, he will come into the door of the Master’s kingdom of medicine.

【阐释】此间各种症象比较复杂,一般不易明辨。郑氏层层分析,断为元阳随阴气附少阳经而上越的危症,急需回阳祛阴,故主以白通汤或潜阳丹。白通汤即四逆汤去甘草而加葱白,以葱白辛温,合姜、附能通周身上下之阳气,为治阳隔于上的要药。本病主要由于在里之阴寒太盛,致上越之阳不能与下焦残存之阳相续,葱白能引心阴下交于肾,附子能启肾阳上交于心,阴阳交媾,水火互根,格越之症,自可立解。潜阳丹如前所解,有纳气归肾,伏火互根之妙用,故亦能治此病。笔者用白通汤治疗发高烧不退,取得满意效果。患儿张××9 岁,高热摄氏39 度以上,注射针药已四日,高烧不退。来诊的前夜,哭闹不宁,将转为抽风。余以手摩小儿头部及上身,热可烫手,但腿部以下渐凉,至脚冰冷。此为阴阳相格,上下不通,虽发高烧,却非凉药可治。因白通汤虽能宣通上下之阳,但必须加猪胆汁或童便乃能入阴,故为之处方如下:附片30 克干姜20 克葱白30 克童便引。病者一剂减轻,二剂痊愈。以后凡治此类患者发高烧,久治不愈者,即以此方轻重上斟酌治之而愈,其例不下十数。

Further explanation by the editor: this is a complex clinic condition, usually hard to make diagnosis. Dr. Zhen made analysis step by step, diagnosed as that Yuan Yang floats with the Yin Qi, along the Shaoyang meridian. He suggested to use Baitong Tang or Qianyang Dan to have a urgent restoring Yang therapy. The Baitong Tang is developed from the Sini Tang by removing Gancao, but adding green onion. The green onion is spicy and warm in herbal nature. It works with the Ganjiang and Fuzi to conduct the Yang Qi between the upper and the lower part of the body. It is the Key herbs to treat the condition, in which the Yang Qi is blocked in the upper part of the body. The condition introduced here is due to overwhelming of Yin Qi in the body, which makes the floating Yang Qi fails to conduct with the remaining slight Yang Qi in the Kidney. The green onion can conduct the Heart Yin down to the Kidney. The Fuzi can conduct the Kidney Yang Qi up to the Heart. So the Yin and Yang in both Heart and the Kidney conduct each other. The Yang blocking condition is so solved. The herb formula Qianyang Dan, as introduced above, can also bring the Qi back to the Kidney, so able to solve this problem too. The editor himself has used this formula in fever condition with very good result. Child Zhang, 9 years of old. He had fever over 39 degree. He had been treated by western medicine for 4 days without any improvement. The night before visit, the child cried a lot and got spasm. When touched the head, the head is terribly hot, but the leg is very cold. The feet are as ice. This condition was diagnosed as the Yang blocking condition. The Yin and the Yang fails to conduct each other. Though having fever, no cold herbs could solve this condition. The Baitong Tang can solve this problem, but it needs the help of child urine or pig gall bladder juice as guider of the herbs. The herbs were prescribed as: Fuzi 30 gram, Ganjian 20 gram, green onion 30 gram, child urine being used as herb guider (drinking the tea with addition of the child urine). One dose reduced the fever. The second dose solved the condition completely. Later, whenever meeting such fever condition, the editor used the same way with the slight variation of the dose of each herbs in the formula. It has worked in more than ten patients.  

问曰:病人素缘多病,两目忽陷下,昏迷不醒,起则欲绝,脉细微而空者,何故?

Q: The patient has long time history of disease. He/she suddenly has eyes shrunk and falls into coma. If gets up, he may feel to die. The pulse is thin, mild and hollow. Why?

答曰:此五脏之真气欲绝,不能上充而下陷,欲从下脱也。夫人身全赖一团真气,真气足则能充满,真气衰则下陷,此气机自然之理。今见昏迷,起则欲绝,脉微,明是真气之衰,不能支持也。法宜峻补其阳,方宜四逆汤以回其阳,阳气复回,而精气自然上充也。方解见上。

A: This is a condition, in which organ True Qi is to disappear, hard to move up but fall down. The True Qi is to escape from the lower part of the body. The life depends simply on the mass of True Qi. If it is full and sufficient, it can fill up every part of the body. If the True Qi is insufficient, it will shrink. This is the natural rule of the condition of Qi in the body.  Now the person is in coma, hard to get up, with weak pulse. All suggest that the True Qi is weak, hard to support the life. The treatment principle is to make urgent supply to the Yang Qi, use herb formula Sini Tang. If the Yang Qi is restored, the True Qi will certainly be sufficient to fill up every part of the body.  

问曰:病后忽鼻流清涕不止,忿嚏不休,服一切外感解散药不应而反甚者,何故?

Q: After a disease, a person suddenly has continuous running nose, and continuous sneeze. No any herbs or drug used for the treatment of common cold would work, even make things worse. Why?

答曰:此非外感之寒邪,乃先天真阳之气不足于上,而不能统摄在上之津液故也。此等病近似寒邪伤肺之症,世医不能分辨,故投解散药不愈而反甚。不知外感之清涕忿嚏,与真气不足之清涕忿嚏不同。

A: This is not due to the Cold Xie Qi invasion from out of the body, but due to the insufficient innate True Yang in the body, which can not move to the head, can not govern the liquid in the upper body. This condition is similar to the Cold invasion to the Lung. It is hard to be diagnosed by ordinary doctor, so their treatment with ordinary herbs doesn’t work, even worse. They do not know that the running nose due to the Cold invasion and to the insufficient True Qi is different.

外感之清涕忿嚏,则必现发烧、头疼、身痛、畏寒、鼻塞之情形。真气不足之清涕忿嚏,绝无丝毫外感之情状。况又服解散药不愈,更为明甚。法宜大补先天之阳,先天之阳足,则心肺之阳自足。心肺之阳足,则上焦之津液,必不致外越也。人身虽云三焦,其实一焦而已。

The running nose and sneeze due to the invasion of Cold Xie is accompanied by fever, headache, pain in the body, chilly, stiff nose, etc. The running nose and sneeze due to insufficient True Qi is without any of such symptoms suggesting common cold. Together with the fact that the herbs used for the treatment of common cold does not work, all suggest that this is not a common cold. The treatment principle is to supply more innate Yang Qi. When the innate Yang Qi is sufficient, the Heart and Lung Yang Qi will be sufficient too. If the Heart Yang Qi and the Lung Yang Qi is sufficient, the liquid fraction in the upper body will not spill off. For the whole body, though we mention it has three Jiao space, it is actually the same one space.

方宜大剂四逆汤,或封髓丹亦可,方解见上。即姜桂汤亦可。

The herbs used should be large dose of Sini Tang, or use Fengsui Dan, or use Jianggui Tang.

姜桂汤

Janggui Tang

生姜一两五钱   桂枝一两

Fresh Ginger 40 gram, Guizhi 30 gram.

用药意解

The function of the herb formula:

按姜桂汤一方,乃扶上阳之方也。夫上焦之阳,原属心肺所主,今因一元之气不足于上,而上焦之阴气即旺,阴气过盛,阳气力薄,即不能收束津液。今得生姜之辛温助肺,肺气得助,而肺气复宣,节令可行。兼有桂枝之辛热以扶心阳。心者,气之帅也,心阳得补,而肺气更旺(肺居心上如盖,心属火,有火即生炎,炎即气也。肺如盖,当炎之上,炎冲盖底;不能上,即返于下,故曰:"肺气下降",即此理也)。肺气既旺,清涕何由得出。要知扶心阳,即是补真火也(二火原本一气)。嚏本水寒所作(肾络通于肺,肾寒,故嚏不休),方中桂枝,不独扶心阳,又能化水中之寒气,寒气亦解,而嚏亦无由生。此方功用似专在上,其实亦在下也。学者不可视为寻常,实有至理存焉。或又曰,扶心阳而肺气更旺,夫心火也,肺金也,补心火,而肺不愈受其克乎?曰:子不知五行禀二气所生乎!

The formula Jianggui Tang is to supply the Yang Qi in the upper Jao (the Heart and the Lung) . The Yang Qi in the upper Jiao is originally supplied, dominated, governed by the Heart and the Lung. Now, the Yang Qi is insufficient in the upper Jiao, the Yin Qi in the upper Jiao is so overwhelming, both of which cause the liquid fraction in the upper Jiao loses control. In this formula, the fresh Ginger is spicy and warm, able to help the Lung. The Lung is so able to function to distribute water in a proper manner. The Guizhi in the formula is also spicy and warm. It is good at supplying Yang Qi to the Heart. The Heart is the king of the Qi in the body. When the Heart is sufficient in its Yang Qi, it furthermore helps the Lung to function. (The Lung is located above the Heart, as a umbrella. The Heart belongs to Fire. Fire has flame. The Flame is Qi in nature. The Lung is as umbrella and is so in the top of the flame. The flame reaches the bottom of the umbrella, can not go up further, so return back downwards, So it is called “the Lung Qi is to fall down”. ). If the Lung Qi is sufficient, there would have no reason to have running nose. It should be known that, to supply the Heart Yang Qi is to supply the True Fire in the Kidney. (The Two Fire is originally one thing). Sneeze is caused by Cold-Water in the body. (Since the Kidney meridian conducts into the Lung. The Kidney is cold, so the sneeze is continuous. ). The Guizi in the formula not only supply the Heart Yang, but also remove the Cold from the Water. With the release of the Cold Qi, the sneeze should stop. The function of this formula appears at the upper body, but it also works in the lower part of the body. We should not regard this formula as a ordinary one without marvelous meaning. Someone may say that, it is hard to understand that to supply more Heart Yang Qi, the Lung Qi would be more, since the increased amount of the Heart Fire should combat against the Lung Metal (e.g. the according to the Five Element theory). The answer to this suspect is: all of the five elements are created by the two Qi (the Heart and the Lung). 

五脏只受得先天之真气,原受不得外来之客气。今所扶者是先天之真气,非外感之客气,既云受克,则肺可以不必居心上也。况此中之旨微,有不可以尽泄者。

All of the organs can only accept the innate True Qi, not the invading Xie Qi. This herb supplies and supports the innate True QI, not an invading quest Qi. If we believe that the Heart is against the Lung, we should not expect that the Lung is located above the Heart! There are some secret meanings among the Five elements, depending how you are going to understand it.  

【阐释】笔者在临症中,常见有鼻流清涕或浓涕,经年如此,中医俗称为脑漏。脑髓乃人身立命之物,岂可流出乎?现代医学检查为鼻窦炎,久治不愈者,多为上焦之阳不足,不能统摄津液,每以姜桂汤治之而获效。如病者林××患此症五年,服姜桂汤二剂见效。因其中下焦之阳亦显不足,故继以附子理中汤加补肾药,连服八剂而竟全功。

Further explanation by the editor: In my clinic, it is quite common to see patient with running nose. They have this problem years by years. In Chinese medicine, it is called “brain leakage”. Brain material is the life stuff. It should be wasted. The sinusitis diagnosed by western medicine usually belongs to the Yang deficiency condition in the upper Jiao space in the Chinese medicine. No enough Yang Qi in the upper space to control the liquid distribution and metabolism. It is commonly cured by the Jiang Gui Tang. For example, a patient (Mrs. Ling) suffered this problem for five years. After intake of the Jianggui Tang for only two doses, the problem was much improved. Additional Fuzi Lizhong Tang plus some Kidney supplying herbs were given, since his condition is diagnosed as the Yang deficiency in the lower Jiao as well. Continued eight doses solved his problem completely. 

问曰:病人两耳心忽痒极欲死者,何故?

Q: Patient suddenly feels very itch in the inside of the ears. The itch is so severe that the patient feels want to die. What’s this condition?

答曰:此肾中之阳暴浮也。夫两耳开窍于肾,肾中之火暴发于上,故痒极欲死。或又曰,肝胆脉亦入耳,肝胆有火,亦可发痒,先生独重肾气,而不言肝胆之火,未免固执。曰:子言肝胆有火,必不专在耳心,别处亦可看出,必不忽痒极欲死。今来者骤然,故直断之曰肾中之阳暴发也,法宜收纳真气为要。方用封髓丹,解见上。

A: This is a condition, in which the Yang Qi in the Kidney floats strongly up. The ear is the opening space for the Kidney. When the Kidney Fire flames strongly up, the ears feel very itch. Someone may think that, the Liver and the Gall bladder meridian also conducts into the ear and can also cause the itch. Why you only pay attention to the Kidney, not the Liver-Gall bladder system? Wouldn’t you be too stubborn? My answer is: if the reason for the ear itch is due to the Fire from Liver-Gall bladder system, the itch should be not only in the ear. There should be evidence in other part of the body to support the Fire in the Liver-Gall bladder system. And, the itch should not be so severe. Now, the itch comes very fast and suddenly, so it should be considered to be due to the expose of the Kidney Fire. The treatment principle should be to restore the True Fire back to the Kidney. The herbal formula should be the Fengsui Dan. (See the explanation for this formula above).

【阐释】《内经》谓"肾主耳、肾气通于耳","肾和则耳能闻五音矣",《圣惠方》谓"寻常耳痒有风有火,易于调治,甚有耳痒挑剔出血不能住手,此肾虚风火上攻"。亦以耳痒极为肾虚病。郑氏认此症为肾阳暴浮,治以封髓丹,是有卓见、亦是有根据的。至若肝胆有火,则多见头晕、目赤、耳肿痛、口苦、两胁胀痛、小便短赤、尿道涩痛等症,治宜清泻肝胆实火,如龙胆泻肝汤之类,与此症绝然不同。

Further explanation: … If the itch in the ear is due to the Liver system, the patient should have also dizziness, red eyes, swelling in the ear, bitter taste in mouth, fullness and pain the upper and side of stomach area, red and short urine, pain or burning sense in the urine tract, etc. The treatment principle should be to clear the Liver Fire, using Longdan Xiegan Tang, etc. It is a quite different clinic condition.

问曰:病人两唇肿厚,色紫红,身大热,口渴喜热饮,午后畏寒,小便清长,大便溏泄,日二三次,脉无力者,何故?

Q: The patient has swelling in the mouth lips, the color of which is red-purple. He has strong fever, thirsty but likes hot drinks, feels chilly in the afternoon. His urine is clear as water and long. His stool is soft without shape, two to three times a day. The pulse is weak. What’s this condition?

答曰:此脾胃之阳,竭于上也。夫两唇属脾胃,肿而色紫红,近似胃中实火,其实非实火也。实火之形,舌黄而必干燥,口渴必喜饮冷,小便必短,大便必坚,身大热,必不午后畏寒。此则身虽大热,却无外感可据。午后畏寒,明明阴盛阳衰,口渴而喜热饮,中寒之情形悉具。兼之二便自利,又日泄三五次,已知土气不实,况脉复无力,此际应当唇白之候,今不白而反紫红肿厚,绝无阳症可凭,非阴盛逼出中宫之阳而何?法宜扶中宫之阳,以收纳阳气为主,方宜附子理中汤。

A:  This is a condition, in which the Spleen-Stomach Yang Qi is escaping from the upper part of the body. The mouth lips belong to the Spleen-Stomach system. Its red-purple color looks as a Stomach Fire, but in fact it is not a real Fire. If it is a real Fire, the tongue should be yellow in color and dry; the patient should feel thirsty and like to drink cold water; his urine is short; his stool is hard; he has fever, does not feel chilly in the afternoon. Now, the patient has fever, but has no any evidence suggesting common cold. Chilly in the afternoon clearly indicates a Yang deficiency and Yin overwhelming condition. His thirsty but willing to drink hot water, suggests that he has cold in the middle body (the Stomach system). The diarrhea three to five times a day, and frequent urine, suggests the weak in the Soil in the body. The weak pulse should be followed by white lips, but now by a red-purple color and swelling in the lips, do not suggest a Yang condition, but a Yin overwhelming. The treatment principle should be to support the middle Yang Qi, restoring the middle Yang Qi. The herbal formula should  be Fuzi Lizhong Tang.

附子理中汤

Fuzi Lizhong Tang

附子一枚   白术五钱   干姜五钱   人参二钱   炙甘草三钱

Fuzi 30 gram, Baizhu 15 gram, Ganjiang 15 gram, Rensheng 6 gram, Zhi Gancao 9 gram.

用药意解

The meaning of the formila:

按附子理中汤一方,乃先后并补之方也。仲景之意,原为中土太寒立法,故以姜、术温燥中宫之阳;又恐温燥过盛,而以人参之微寒继之,有刚柔相济之意;甘草调和上下,最能缓中。本方原无附子,后人增入附子,而曰附子理中,觉偏重下焦,不可以理中名。余谓先后并补之方,因附子之功在先天,理中之功在后天也。此病既是真气欲竭,在中宫之界,非附子不能挽欲绝之真阳,非姜、术不足以培中宫之土气,用于此病,实亦妥切。考古人既分三焦,亦有至理,用药亦不得混淆。上焦法天,以心肺立极;中焦法地,以脾胃立极;下焦法水,以肝肾立极。上阳、中阳、下阳,故曰三阳。其实下阳为上、中二阳之根,无下阳,即是无上、中二阳也。下阳本乎先天所生,中阳却又是先天所赖,中阳不运,上下即不相交。故曰:"中也者,天下之大本也"。后天既以中土立极,三焦亦各有专司,分之为上、中、下,合之实为一元也。用药者,须知立极之要,而调之可也。

The Fuzi Lizhong Tang is a formula to supply both innate and acquired Yang Qi same time. The aim of the formula originally by the Master Zhang Zhongjing is to solve the condition, in which middle Soil is too cold. He used Ganjiang and Baizhu to warm and to dry the middle Yang; used Rensheng to prevent over warm and over drying. Gancao works to balance the upper and lower part of the body, to harmony the Qi in any part of the body. In original formula, there is no Fuzi. Later doctor added the Fuzi in the formula, so it is called Fuzi Lizhong Tang. Since the Fuzi works more in the lower part of the body, so the formula should not be continuously called as Lizhong Tang. I think that, this is a formula to supply both innate and acquired Yang Qi, since the Fuzi helps the innate Yang Qi, and the Lizhong helps the acquired Yang Qi. The condition introduced here is due to the exhaust of the Yang Qi in the middle part of the body. In the middle part of the body, the Fuzi must be used to bring the escaping Yang Qi back. Only the Ganjiang and Baizhu can help the middle Soil Qi. They are pretty suit in this condition. Old Chinese separate the body into three Jiao. There must have big meaning by such separation. The herbs used should also follow its meaning. The upper Jiao is associated with Sky, with the Heart and the Lung; the middle Jiao is associated with land, with the Stomach and Spleen; the lower Jiao is associated with water, with the Liver and the Kidney. So, they are the upper Yang, middle Yang and the lower Yang. So, they are called three Yang. In fact, the lower Yang is the root for the upper and middle Yang. Without the lower Yang, no meaning for the upper and middle Yang. The lower Yang originates from innate Yang but the innate Yang depends on the support from the Middle Yang to exist and to last in the body. So, if the middle Yang is insufficiency, the upper and the lower Yang would be able to conduct each other. So, it is said: “The middle is the key of the whole life, the Yang in the body.” The later life depends on the middle Yang, and the three Jiao each has their own functions, but all are actually also only one Jiao and one Yang. Doctors should know the key point for the innate and the later life, so to adjust them.

【阐释】理中汤本为中土太寒立法,加附子而温运之力更强,脾胃欲竭之阳得复,诸症自可立解。如断为实火,或寒热杂投,俱属误治。据郑氏嫡孙与笔者谈:其祖父晚年得子,父亲体虚多病,家中常备附子理中丸与服,身体始得日渐康复。笔者亦常用此方治疗脾肾阳虚,身体羸弱,反复感冒之患者,获得满意之效果。

Further explanation by the editor: The Lizhong Tang is originally set to solve the condition, in which the middle Soil is too cold. With the addition of herb Fuzi, the warming function of the formula is enhanced. Along with the restoring of Yang Qi in the middle part of the body (the Stomach and Spleen system), the disorders can be solved. If the condition belongs to real Fire, or the mixture of Fire and Cold, the use of this formula is a wrong decision. … The editor commonly used this formula for the treatment of Spleen-Kidney Yang deficiency. The patients are weak in the body, have common cold easily. The results are very good.

问曰:满口齿缝流血不止,上下牙齿肿痛,口流清涎不止,下身畏寒,烤火亦不觉热者,何故?

Q:  There are continueous bleeding in the gum, with swelling in the upper and lower gum. There are too much saliva in the mouth, that flows contineously out of the mouth. The lower part of the body feels chilly. It does not feel any warm even it faces a fire. What is this condition?

答曰:此肾中之真阳欲绝,不能统肾经之血液也。夫齿乃骨之余,骨属肾,肾中含一阳,立阴之极,以统乎肾经之血液。肾阳苟足,齿缝何得流血不止?齿牙肿痛,明系阴气上攻,况口流涎不止,畏寒烤火亦不觉热,而真阳之火种,其欲绝也明甚。此症急宜大剂四逆汤,以救欲绝之真火,方可。若谓阴虚火旺,而以滋阴降火之品投之,是速其危也。四逆汤解见上。

A: This is a condition, in which the True Yang in the Kidney is to die. It cannot control the blood in the Kidney meridian. The teeth are part of the bone. The Bone is associated with the Kidney. The Kidney contains the True Yang, which is the root of the Kidney Yin and which controls and governs the blood in the Kidney meridian. If the Kidney Yang is sufficient, how can the gum in between the teeth bleed? The swelling and pain of the gum clearly indicates the attacking of the Yin Qi up. Together with the continuous spill of saliva, and not feeling of hot when facing a fire, furthermore suggests the True Yang is to die. This is urgent and dangerous condition needing large dose of Sini Tang to save the True Yang. If this condition belongs to a Ying deficiency but Yang overwhelming, so use herbs to nourish the Yin, it will speed up the die of the Yang Qi to cause death.  

【阐释】笔者在临症中,常见有患牙齿出血者,医者以为火重而治以清火之剂,多不见效,实由不知其为肾阳不足而致。余治此症,常先以炮姜甘草汤加血余炭以止血,继以四逆汤加补肾药而全愈。

Further explanation by the editor: The editor commonly saw some patients with bleeding in the gum between the teeth. Other doctors believed it was a Fire condition, so used fire-clearing therapy, but quite commonly it did not work. They do not know it is a Kidney Yang deficiency condition.  When I met such condition, I normally firstly used Paojiang Gancao Tang plus Xueyutan to stop bleeding, followed by Sini Tang plus kidney-supplying herbs to cure.

问曰:病人口忽极臭,舌微黄而润滑,不思水饮,身重欲寐者,何故?

Q: Patient has very bad odor from the mouth. The tongue covering is slight yellow, wet and slippery. The patient has no desire to drink, and feels heavy in the body, wishes to have sleep. What’s this condition?

答曰:此先天真火之精气发泄也。夫臭乃火之气,极臭乃火之极甚也。火甚宜乎津枯,舌宜乎干燥而黄,应思水饮,身必不重,人必不欲寐。今则不然,口虽极臭,无胃火可凭,舌虽微黄,津液不竭,无实火可据。不思水饮,身重欲寐,明系阴盛逼出真火之精气,有脱之之意也。或又曰:真阳上腾之症颇多,不见口臭,此独极臭,实有不解。曰:子不观药中之硫黄乎!硫黄秉火之精气所生,气味极臭,药品中秉火气所生者亦多,而何不臭?可知极臭者,火之精气也。此等症乃绝症也,十有九死,法宜收纳真阳,苟能使口臭不作,方有生机。方用潜阳丹治之,解见上。

A: This is a condition, in which the True Qi is escaping. The bad odor is the smell of Fire. Very bad odor means the Fire is very strong. Overwhelming Fire implies the liquid is to dry, the tongue should be dry and yellow in color; the patient should feel thirsty and want to drink; his body should not feel heay; he should not feel sleepy. Now, the condition is quite opposite. Though the mouth is with very bad odor, there is no evidence of Stomach Fire. Though the tongue is slight yellow, it is not dry. No strong evidence for a real Fire condition. No desire to drink and feeling heavy and sleepy, clearly indicate a Yin overwhelming condition, which pushes the True Qi of True Fire out. Readers may ask, there are many conditions in which the True Yang is escaping, but without very bad odor in mouth. In this condition, it is. It is hard to understand! My answer is: you should know the Liuhuang among herbs. The Liuhuang is created by the Jingqi of the Fire. It is with very bad odor. There are other herbs that are also created by the Fire, why they are not with bad odor? So, it is known that the herbs with very bad odor are the Jingqi of the Fire. This is a very dangerous condition. Nine out of ten persons would die. The treatment principle is to restore the True Yang, to stop the mouth odor. The herbs should be Qiyang Dan. See the explanation above.

【阐释】笔者在临症中,若口臭无阴象,多为胃火旺极,用白虎加人参汤治之。亦有阴盛逼阳于外而口臭者,用大剂附子理中汤加味治之。

Further explanation by the editor: In clinic, if the mouth odor is without evidence for a Yin condition, it in most cases belongs to Stomach Fire. Baihu jia Rensheng Tang is used. There is the mouth odor that is due to the Yin overwhelming, in which large dose of Fuzi Lizhong Tang is used.

问曰:病人舌忽不能转动,肢忽不能升举,睡中口流涎不觉者,何故?

Q: The patient’s tongue cannot move suddenly; the arm cannot lift; there is saliva flowing out of the mouth but he cannot feel. What is this condition?

答曰:此阴盛而元阳不固不运也。夫人一身关节窍道,全赖真气布护运行。真气健旺,则矫捷自如,出纳有节,焉有舌不能转,肢不能举,睡中流涎不觉者乎?余故直决之曰:阴盛而元阳不固不运也。

A: This is a condition, in which the Yin is overwhelming and the Yuan Yang is not moving. Every point in the body depends on the True Qi distribution in the body. If the True Qi is sufficient, the movement of the tongue is easy and flexible, as well as other joints in the body. For this condition, I can make a common right away: it is the Yin overwhelming and the Yang is not sufficient to control the joint including the tongue.

或又曰:中风中痰,亦能使人舌不能转,肢不能举,先生独重阳虚阴盛,不能无疑。曰:子不知中风、中痰之由乎?风由外入,痰因内成,总缘其人素禀阳虚,损伤已极,而外之风邪始得乘其虚隙而入之。阳衰在何处,风邪即中何处,故有中经、中腑、中脏之别。阳虚则中宫健运之力微,中宫之阴气即盛,阴气过盛,而转输失职,水谷之湿气,与内之阴气相聚,而为涎为痰。久久阳微,寒痰上涌,堵塞清道,遂卒倒昏迷,而曰中痰也。此病可与附子理中汤加砂半,方解见上。中风者,按陈修园《医学三字经》法治之。中痰者,可与姜附茯半汤治之。

The readers may also ask, wind attack and phlegm attack can also make the tongue not moving, arm and leg not lifting, why you only pay attention to the Yang deficiency and Yin overwhelming? The answer is: do you know the reason for the wind-attack and the phlegm-attack? The wind comes from outside, and the phlegm is created inside. They all depend on the weak of the Yang Qi in the body, which created the chance for the wind to come in. Where in the body the Yang Qi is weak, where the wind comes in, so that there are different locations of the wind-attack as the meridian-attack, organ-attack, etc. Since the Yang is weak, the middle part of the body has no enough energy to handle the digestion, so the Yin Qi in the middle space is overwhelming; the transport of the diet in the stomach-intestine is in disorder; the Wet Qi of the water-food is mixed with the original Yin Qi in the body, becomes the saliva and the phlegm. Along with the further weak of the Yang Qi, the Cold phlegm pushes up to block the openings in the head, causing coma. This is called phlegm attack. In this case, the herb Fuzi Lizhong Tang should be used, but with addition of Sharen and Banxia (see the explanation before). For the treatment of wind-attack, following the introduction of << Yixue Sanzi Jing>> by Dr. Chen Xiuyuan. For phlegm attack, use Jiangfufuban Tang.

姜附茯半汤

Jiangfufuban Tang

生姜二两取汁    附子一两    茯苓八钱    半夏七钱

Fresh ginger 60 gram (use its juice), Fuzi 30 gram, Fuling 24 gram, Banxia 21 gram.

用药意解

The meaning of the herb formula:

按姜附茯半汤一方,乃回阳降逆,行水化痰之方也。夫生姜辛散,宣散壅滞之寒;附子性烈纯阳,可救先天之火种,真火复盛,阴寒之气立消;佐茯苓健脾行水,水者痰之本也,水去而痰自不作;况又得半夏之降逆化痰,痰涎化尽,则向之压于舌本者解矣。清道无滞,则四肢之气机复运,而伸举自不难矣。

The Jiangfufuban Tang is to restoring Yang Qi and to deplete water-phlegm. The fresh Ginger is spicy and dispersing in herbal nature. It works to disperse the stagnated Cold. The Fuzi is strong Yang in herbal nature, able to save the innate Fire seed. When the True Fire is restored, the Yin Cold will be depleted quickly. Additionally the Fuling enhances the function of the Spleen system, able to remove extra water out of the body. The extra water is the source of phlegm. Without extra water, there would be no phlegm. Herb Banxia reverses the reversed phlegm. With the depletion of phlegm, no pressure on the tongue, so the function of the tongue restored.

问曰:平人忽喉痛甚,上身大热,下身冰冷,人事昏沉者,何故?

G: A person usually is no big health problem. He suddenly feels pain in the throat. His upper body is very hot but the lower part of the body is very cold. He is not clear in mind in emotion too. What ‘s this condition?

答曰:此阴盛而真气上脱,已离乎根,危之甚者也。夫喉痛一症,其在各经邪火所作,必不上热下寒,即来亦不骤。今来则急如奔马,热上寒下,明明一线之阳光,为阴气所逼,已离乎根也。或又曰:既言平人,何得即谓之阳欲脱乎?曰:子不知人身所恃以立命者,其惟此阳气乎?阳气无伤,百病自然不作;阳气若伤,群阴即起。阴气过盛,即能逼出元阳,元阳上奔,即随人身之脏腑经络虚处便发。如经络之虚通于目者,元气即发于目;经络之虚通于耳者,元气即发于耳;经络之虚通于巅者,元气即发于巅,此元阳发泄之机。学者苟能识得一元旨归,六合妙义,则凡一切阳虚之症,皆在掌握也。兹虽云平人,其损伤原无人知晓,或因房劳过度,而损肾阳;或因用心太过,而损心阳;或因饮食失节,而损脾阳。然亦有积久而后发者,元气之厚也;有一损而即发者,元气之薄也。余常见有平人,日犹相见,而夜即亡者,毋乃元气之薄,而元阳之脱乎?医亦尚不知,而况不知医者乎?

A: This condition suggests that the True Qi is escaping from the upper part of the body and it is leaving its root in the Kidney. This is a very dangerous condition to lose life. If the sour throat is due to the Xie Fire in various meridians, the patient should have no upper-hot-lower-cold condition. The pain should not come so quick either. Now, the pain comes as running horse; the body is hot in the upper part but cold in the lower part of the body, clearly suggesting that the slight Sunshine (the True Yang) is forced away from the Kidney and it is leaving the root. The readers may also ask: you mentioned it happens in ordinary person, how such person can have such Yang-escaping condition? The answer is: don’t you know that it is the Yang Qi that a person depends for life? If there is no damage to the Yang Qi, there should have no any diseases; when the Yang Qi is damaged, the crawed Yin will come up. When the Yin Qi is overwhelming, it can press the Yang Qi out of the Kidney; the Yuan Yang floats up, escaping from where ever in the body, in which there is weak in the meridians or organs. For example, if the meridian is weak and it conducts to the eye, the Yuan Qi will move to the eye; if the weaken meridian conducts to the ear, the Yuan Qi will go to the ear; if the weaken meridian conducts to the top of the head, the Yuan Qi will move to the top of the head. This is the mechanism for the escaping of the Yuan Yang. If the readers understand the one Yang in the body, then he/she should have ability to recognize various Yang deficiency conditions. Though we said the person has no big health problem, it means that damage in his body has not been known yet. The damage to the Yang Qi can be due to various reasons. Over sex activity damages the Kidney Yang Qi; over working/planning damages Heart Yang; irregular diet damages Spleen Yang. For some person, the Yang escaping condition happens gradually, since his innate Yang Qi is strong originally. Other may have such condition suddenly, since the innate Yang Qi is not strong. I usually see person who is pretty normal in daily life without severe disease. We meet in the day time, but he died at night. Is it because his innate Yang Qi is weak, and is easy to escape? For such condition, it is unknown even by a doctor, how could an ordinary person know?

此一段已将阳虚合盘托出,学者务宜留心体之可也。方宜潜阳丹主之,解见上。

This paragraph has explained well the Yang deficiency. Readers should pay much attention to understand it. The herb formula needed is Qiyang Dan. See the explanation above.

问曰:咳嗽、喘促,自汗,心烦不安,大便欲出,小便不禁,畏寒者,何故?

Q: Cough, short of breath (asthma), self-sweat, annoyed, feeling to have bowel movement, urine leak, chilly. What’s this condition?  

答曰:此真阳将脱,阴气上干清道也。夫咳嗽、喘促一症,原有外感内伤之别。经云:"咳不离肺"。肺主呼吸,为声音之总司,至清至虚之府,原着不得一毫客气,古人以钟喻之,外叩一鸣,内叩一鸣,此内外之分所由来也。外感者,由风、寒、暑、湿、燥、火六气袭肺,阻肺经外出之气机,气机壅塞,呼吸错乱,而咳嗽作,兼发热、头疼、身痛者居多,宜解散为主。解散之妙,看定六经,自然中肯。

A: This is also a condition, in which True Yang is escaping, Yin Qi floats up to block the opening holes of the body. For the cough and short of breath, they may be caused by invading Xie Qi, or by damage inside of the body. The medical bible said: “Cough cannot be without lung”. The Lung dominates and governs the breath, is the king of the voice, is the pure clear and pure hollow organ. It cannot endure even slight invading quest Qi (e.g. the invading Xie Qi). Old Chinese used the bell to mean the function of the lung: the bell sounds when beaten on its out surface; it also sounds when beaten from inside surface. It refers that, both the damages from outside and inside of the body can cause the cough of lung. The out reasons for the cough are the Wind, Cold, Hot, Wetness, Dryness, Fire. They invade in the lung, block the Qi movement in the lung, causing disorder in the breath, so the cough. In such case, the person usually has also fever, headache, pain in the body, etc. For the treatment, the dispersing therapy should be used. Check the six Jing chapter above.   

内伤者,因喜、怒、悲、哀、七情损伤真阳、真阴所作,亦有发热者,却不头疼、身痛,即热亦时作时止。损伤真阳之咳者,阴气必盛,阴盛必上干清道,务要看损于何脏何腑,即在此处求之,用药自有把握。

The inside reasons for the cough is the damage of the True Yang by happy, angry, sadness, sorrow, etc. such emotional stresses. When the True Yang is damaged, exhausted, the True Yin is floating up. The patient can also have fever, but no headache, no body pain. The fever is also from time to time, not continuous. The Yin Qi floats up to block the clear openings of the head (e.g. eyes, nose, ears, mouth, throat). The treatment depends on the location, the organs where the Yin Qi is accumulated.

若真阴损伤之咳者,阳气必盛,阳盛亦上干清道,亦看损于何脏何腑,即在所发之处求之,用药自有定见。要知真阳欲脱之咳嗽,满腹全是纯阴,阴气上腾,蔽塞太空,犹如地气之上腾,而为云为雾,遂使天日无光,阴霾已极,龙乃飞腾。龙者,即坎中之一阳也,龙奔于上,而下部即寒,下部无阳,即不能统纳前后二阴,故有一咳而大便欲出,小便不禁者,是皆飞龙不潜致之也。世医每每见咳治咳,其亦闻斯语乎?法宜回阳降逆,温中降逆,或纳气归根。方用四逆汤、封髓丹、潜阳丹,解见上。

On the other side, if the True Yin is damaged, the True Yang will be overwhelming. The Yang Qi will also float up to block the upper openings of the body. The treatment also depends on the location where the True Yang is accumulated and affected. It should be known that for the cough due to the True Yang escaping, the person’s whole abdomen is with pure Yin. The Yin Qi floats up, blocks the sky, as the Qi evaporates from the earth land to become fog and cloud, that block the sun and the sunshine. When the Yin is overwhelming, the Dragon flies up. The Dragon is the Yang in the Kan Gua. The Dragon flies up, the lower part would be cold, and have no warm sunshine, hardly control the front (urine) and the rear opening (the bowel movement). Therefore, when cough, there would have urine leak and stool to leak. All are due to the flying Dragon is away. Ordinary doctors treat the cough when they see a cough. Did they hear about the explanation here? In such conditions, the principle for the treatment should be to restoring the Yang Qi, reducing the reversed Yin Qi, warm the middle space of the body, or to attracting the Qi to its root. The formula should be Sini Tang, Fensui Dan, or Qiyang Dan (see explanations above).

问曰:胸腹痛甚,面赤如硃,不思茶水,务要重物压定稍安,不则欲死者,何故?

Q: Very severe pain in the chest and abdomen; the face is dark-red in color; no desire to eat or drink; and prefer to be pressed with heavy stuff, other wise will feel as to die. What’s this condition?

答曰:此元气暴出而与阴争也。夫胸腹痛一症,原有九种,总不出虚、实两字。实症手不可近,虚症喜手揉按,此则欲重物压定而始安,更甚于喜手揉按,非阳气之暴出而何?或又曰:重物压定而稍安,其理何也?曰:子不观火之上冲乎,冲之势烈,压之以石,是阻其上冲之气机也。气机得阻,而上冲者不冲。今病人气机上涌,面色已赤如硃,阳与阴有割离之象,故痛甚。重物压之,亦如石之压火也。此病非纳气归根,回阳降逆不可,方用加味附子理中汤,或潜阳丹,解见上。

A: This is a condition, in which Yuan Qi  break out to struggle with the Yin Qi. There are nine kinds of pain in the chest and abdomen. But they belong to either Xu (weak) or Shi (not weak) conditions. In the Shi condition, the patient cannot endure the touch by hands on to the painful area. In the Xu condition, the patient prefers to massage on the painful place, even likes to be pressed with heavy stuff on it. If it is not due to the Yang Qi break out, what it would be? Readers might ask: the pain feels released with heavy stuff press. How to understand it? The answer is: do you see the flame flushes up? The more vigorous the flush, the stone can press down the flame. Now, the patient’s Qi is flushing up; his face is dark red as vermilion, indicating that the Yin and Yang is separating, which causes the very much pain. Press heavy stuff on his chest is as to put stone on flame. For this condition, the only way to solve is to restore the Qi to its root, and to restore the Yang Qi  and reverse the reversed. The formula should be Fuzi Lizhong Tang with other more herbs, or use Qiyang Dan. See explanations above.

【阐释】胸腹痛一症,原有九种,陈修园《医学三字经》有说,即"一虫痛,乌梅丸;二注痛,苏合研,三气痛,香苏专;四血痛,失笑先;五悸痛,妙香诠;六食痛,平胃煎;七饮痛,二陈咽;八冷痛,理中全;九热痛,金铃痊。"对九症各有处方,特转录以供参考。郑氏总其要为虚、实两症,实症拒按,虚症喜手揉按。此症胸腹痛甚,须重按压始安,而且面赤如硃,断为阳气暴出而与阴争,阴与阳有割离之象,是确切精当的。故非纳气归根,回阳降逆,不能治愈。 宜用加味附子理中汤,或潜阳丹治之。

Further explanation by the editor: The pain in the chest and abdomen, there has been summarized as nine kinds. Dr. Chen Xiuyuan said in his book <<Yixue Sanzi Jing>> that “The first pain is due to worm. Herb formula Wumei Wan should be used. The second is block of blood vessel. Use Souhe Wan. The third is Qi pain. Use Xiansou San. The fourth is Blood Pain. Use Shixiao San. The fifth is palpitating pain. Use Biaoxiang San. The sixth is food pain. Use Pingwei San. The seventh is Water pain. Use Erchen Tang. The eighth is Cold pain. Use Lizhong Tang. The ninth is Hot pain. Use Jinglingzi San”. Here, Dr. Zhen summarized all as the Xu condition and the Shi condition. …… Use Fuzi Lizhong Tang or Qianyang Dan.

问曰:病吐清水不止,饮食减,服一切温中补火药不效者,何故?

Q: The patient spills clear saliva/water from mouth with reduced appetite. None of the herbs work, those are supposed to warm up the middle stomach. Why?

答曰:此肾气不藏,而肾水汜溢也。夫吐清水一症,胃寒者亦多,今服一切温中补火之品不效,明明非胃寒所作,故知其肾水汜溢也。

A: This is a condition, in which the Kidney Qi fails to hide, so the Kidney water floods. Water spilling condition can also be due to Cold in stomach. Now, none of the herbs for the Cold stomach work, suggesting that it is not due to the Cold stomach, but to the Kidney water flooding.

或又曰:胃寒与肾水汜溢,有分别否?曰:胃寒者,关脉必迟,唇口必淡白,食物必喜辛辣热物。肾水汜溢者,两尺必浮滑,唇口必黑红,不思一切食物,口间觉咸味者多。胃寒者,可与理中汤。肾水汜溢者,可与滋肾丸,桂苓术甘汤。

Readers may also ask: is there any difference between the Cold stomach and kidney water flooding? The answer is: for the cold stomach, the pulse in the Chun position must be slow; the mouth lips must be white; the patients like spicy and hot food. For kidney water flooding, the pulse in the Chi position must be floating and slippery; the mouth lips must be black and red in color; the patient has no desire to eat any food; most of the patients feel salty in mouth. For cold stomach, use Lizhong Tang. For kidney water flooding, use Sishen Wan or Lingguizhugan Tang.

滋肾丸

Zishen Wan:

黄柏一两炒  知母八钱  安桂三钱

Cao Huangbo 30 gram; Zhimu 24 gram, Rougui 9 gram.

桂苓术甘汤

Lingguizhugan Tang

桂枝八钱    茯苓二两    白术一两    甘草五钱

Guizhi 24 gram, Fuling 60 gram, Baizhu 30 gram, Gancao 15 gram.

用药意解

The meaning of the formula:

按滋肾丸一方,乃补水之方,亦纳气归肾之方也。夫知母、黄柏二味,气味苦寒,苦能坚肾,寒能养阴,其至妙者,在于安桂一味,桂本辛温,配黄柏、知母二物,合成坎卦,一阳含于二阴之中,取天一生水之义,取阳为阴根之义,水中有阳,而水自归其宅,故曰滋肾。此病既非胃寒,而曰水(滥)〔汜〕,虽曰土不制水,亦因龙奔于上,而水气从之。今得安桂,扶心之阳,以通坎中之阳,阳气潜藏,何致有吐水之患哉?或又曰:水既汜溢,而又以知、柏资之,水不愈旺,吐水不愈不休乎?曰:子不知龙者水之主也,龙行则雨施,龙藏则雨止,若安桂者,即水中之龙也,知、柏者,即水也。水之放纵,原在龙主之。龙既下行,而水又安得不下行乎?此方非独治此病,凡一切阳不化阴,阴气发腾之症,无不立应。

Zishen Wan is the formula to supply more water to body. It is also to attract Qi back to the Kidney. The herb Zhimu and Huangbo is bitter and cold in herb nature. Bitter can strength the Kidney; Cold can nourish the Yin. Most interesting is tha use of Rougui, which is spicy and warm in nature. Working with the Zhimu and Huangbo, all the three form a Kan Gua, meaning there is one Yang in the two Yin, which again means the Water creation. It bears the meaning that the Yang is the root of the Yin; there is Yang in the Water and the Water will return back the its home, e.g. the Kidney, so the herbal formula is called Zishen Wang. Zi here means nourish. Shen here means Kidney in Chinese. This condition is not due to Cold stomach, but due to the Water flood. Though it is due to the failure of Soil (the Spleen) to control the Water (Kidney), it is also due to the Dragon hurries up and the water follows. Now the herb Rougui supports the Heart Yang and conducts the Yang in the Kan Gua. When the Yang Qi is restored back to the Kidney, how could be the problem of water spilling? The readers might also ask: now the water is flooding. You use the Zhimu and Huangbo to supply more water. The water should be overwhelming, would the water spilling be worse? Answer: don’t you know that the Dragon is the boss of the water? When the Dragon is moving, the rain starts. When the Dragon is hidden and has rest, the rain stops (no rain). The Rougui is as the Dragon in the water. The herb Zhimu and Huangbo are as the water. That the water is flooding is originally due to the moving of the Dragon. When the Dragon is moving down for rest, how would the water not move down too? This formula does not only work for this disease. It works for any conditions, in which the Yang fails to melt the Yin so the Yin Qi is floating. It really works.

按桂苓术甘汤一方,乃化气、行水之方也。夫桂枝辛温,能化膀胱之气,茯苓、白术,健脾除湿。化者从皮肤而运行于外,除者从内行以消灭于中,甘草补土又能制水。此病既水汜于上,虽肾气之发腾,亦由太阳之气化不宣,中土之湿气亦盛。今培其土,土旺自能制水,又化其气,气行又分其水,水分而势孤,便为土所制矣。余故列于此症内。但此方不惟治此症,于一切脾虚水肿,与痰饮咳嗽,更为妥切。

The herb Lingguizhugan Tang is to disperse the Qi and conduct the Water. The herb Guizhi is spicy and warm in herbal nature. It can melt the Qi in the urine bladder. The Fuling and Baizhu can nourish the Spleen and remove Wetness. Disperse means to remove water through the skin. The remove means to deplete water through urine. The herb Gancao nourishes the Spleen, the Soil, so able to control the water. The condition here is due to the Water flooding in the upper part of the body (mouth), which though is due to the Kidney Qi floats up, but it is also due to the failure of the dispersing function of the Taiyang, so that the Wetness is overwhelming in the middle space of the body. Now, the formula nourishes and supports the middle Soil. When the Soil is stronger, it can control the Water flooding. It also works to improve the disperse function, to remove the water out of the body through the skin and urine. This formula does not only work for the condition here. It works for all conditions, in which the Spleen is deficient and the Water is overwhelming, as well as the conditions with phlegm-induced cough.

【阐释】口吐清水,饮食减少,有由于胃寒及肾水泛溢之别,两者在脉象、味觉及唇口颜色诸方面都容易区分。由于胃寒者,以理中汤温健脾胃,即能痊愈。由于肾水泛溢者,服一切温中补火药,自然不会有效。郑氏治以滋肾丸或桂苓术甘汤,可谓善用成方。查滋肾丸系李东垣所订,本以治下焦湿热,小便癃闭,故用知、柏苦寒,清热、燥湿而兼滋阴,更配少许肉桂温养肾阳蒸水化气,而小便自通。郑氏取其一阳含于二阴之中,阳为阴根,能引水归宅,水得下行,口吐清水自止。实由于知、柏二味,苦能坚肾,寒能养阴,更得辛温之肉桂,扶心阳以通肾阳,使水有所归,又有所制,自不会汜溢为病。故凡一切阳不化阴,阴气发腾之症,皆可以本方施治。至于桂苓术甘汤,自《伤寒论》、《金匮》起,即视为治痰饮、水湿的要方。郑氏用以治此症,系取其能化气行水,使水从皮肤蒸发,小便利出,而口吐清水自止。又因其能补土以制水,故可推广以治一切脾虚水肿与痰饮咳嗽。现代应用范围更广,有人用以治高血压、脑震荡、目翳、带下、溃疡、风湿性关节炎及心力衰竭诸病,均取得满意的效果。

Further explanations by editor: … the Zishen Wan can be used in various conditions, in which the Yang cannot melt the Yin; the Yin is overwhelming. The herb Lingguizhugan Tang is regarded as the key formula for the treatment of phlegm and water-wetness in the body, from the beginning of the book <<Shanghan Lun>> and <<Jingkui>>. Dr. Zheng used this formula for its ability to melt the Qi and Water, making the water evaporated from the skin and leave out of the body through the urine, so that to stop the saliva spill. Furthermore, for its ability to support the Soil, so the Soil is able to control the Water, it can be used in various swelling, cough, or phlegm due to Spleen deficiency. Currently, some doctor also uses it for the treatment of high blood pressure, cerebral concussion, cataract, discharge, ulcer, joint pain, heart failure, etc. with satisfied results.

问曰:病后两乳忽肿如盘,皮色如常,微痛,身重喜卧,不思一切饮食者,何故?

Q: After a severe disease, the patient suddenly has swelling in both breasts, which is big as a plate. The color of the breasts is normal, and the person has slight pain only. The patient feels heavy in the body and has willing to lie down, but not desire for eating or drinking. What is this condition?   

答曰:此阴盛而元气发于肝、胃也。夫病后之人,大抵阳气未足,必又重伤其阳,阳衰阴盛,一线之阳光,附于肝胃之经络而发泄,故色如常而微痛。况身重喜卧,乃阳衰阴盛之征,乳头属肝,乳盘属胃,故决之在肝胃也。若乳头不肿,病专于胃;乳头独肿,病专于肝。虽两经有分司,而病源终一。知其一元之发泄,治法终不出回阳、纳气、封髓、潜阳诸方。苟以为风寒、气滞所作,定有寒热往来,头疼身痛,红肿痛甚,口渴种种病形,方可与行气、活血、解散诸方治之。此病当与附子理中汤加吴茱萸,方解见上。

A: This is a condition, in which the Yin Qi is overwhelming and the Yuan Qi is floating to the Liver and Stomach area. After a severe disease, patient’s Yang Qi is depleted. For some reasons, his Yang Qi is furthermore damaged, to cause overwhelming of Yin Qi, which presses the Yang Qi out of the Kidney. The Yuan Yang floats out and up along the Liver and Stomach meridian to the breasts. Since it is not a real Fire, the breasts are with normal color and with little pain only. Additionally, the willing to lie down, feeling of heavy body, both suggest the Yin overwhelming and Yang deficiency. The nipple belongs to the Liver; and the body of the breast belongs to the Stomach. There are for the reason for this condition need to be search in the Liver and the Stomach. If the nipple is not swelling, the reason originated in the Stomach; if only the nipple is swelling, the disease is in the Liver meridian. Though it relates to two meridians, the very original reason is the same. If you know that the reason is due to the escaping of Yuan Yang from the Kidney, the treatments would be the use of either Yang restoring therapy, Qi attracting therapy, Fengsui Dan, and Qiyang Dan, and so on. This case can be solved by using Fuzi Lizhong Tang plus Wuzhuyu. I believe, if this condition is caused by Wind invasion and/or Cold invasion, the person must have cold-hot shift feeling, headache, pain in the body, thirsty, as well as the breasts would be red in color, swelling with very much pain. If it is really due to this Wind-Cold invasion, use the Qi improving, Blood circulation enhancing, and dispersing therapy.  

问曰:两胁忽肿起一埂,色赤如硃,隐隐作痛,身重,爪甲青黑者,何故?

Q: There is suddenly a hill mound of swelling, the color of which is dark red. It is slightly pain. The person feels heavy in the body. His nails are purple-blue-black. What is this condition?

答曰:此厥阴阴寒太盛,逼出元阳所致也。夫两胁者,肝之部位也,今肿起一埂如硃,隐隐作痛,近似肝经风火抑郁所作,其实不然。

A:  This is a condition, in which the Jueyin Yin Cold is too much, which presses the Yuan Yang out. The side of the chest and the abdomen belongs to the Liver. The mass arises in the side is dark red in color with slight pain, suggesting Wind-Fire in the Liver system. But it is actually not.

若果系肝经风火,则必痛甚,身必不重,爪甲必不青黑。今纯见厥阴阴寒之象,故知其元阳为阴寒逼出也。粗工不识,一见肿起,色赤如硃,鲜不以为风火抑郁所作,而并不于身重、爪甲青黑、不痛处理会,直以清凉解散投之,祸不旋踵。法宜回阳祛阴,方用四逆汤,重加吴茱萸。解见上。

If it is really due to the Wind-Fire in the Liver, the pain should be very severe; the body is not felt heavy; and the nails should not be blue-dark. Now, all conditions indicate a Yueyin Yin Cold condition, so it is known due to the Yin Cold, that forces the Yuan Yang out. Ordinary doctors do not know this. They contribute the condition to the Wind-Fire in the Liver meridian, the soon they see the swelling, red color in the skin of the side of the body. They neglect the heavy body, blue-dark nail and not major pain. They are so ready to use Fire-clearing therapy. Various mis-treatments would have not to not happen. In fact, in this condition, the herbs needed are Sini Tang plus Wuzhuyu. See explanation above.

问曰:病人头面四肢瘦甚,少腹大如匏瓜,唇色青滑,不思食物,气短者,何故?

Q: The patient is very slim in the head, face, arms and legs. The lower abdomen however is very big as a melon. His lips are blue-black and slippery. He has no desire to eat and feel short of breath. What is this condition?

答曰:此阳虚为阴所蔽也。夫四肢禀气于胃,胃阳不足,而阴气蔽之,阳气不能达于四末,故头面肌肉瘦甚,阴气太盛,隔塞于中,而成腹胀,实不啻坚冰之在怀也。身中虽有微阳,亦将为坚冰所灭,安望能消化坚冰哉(坚冰喻阴盛也)!法宜峻补其阳,阳旺而阴自消,犹日烈而片云无。方用四逆汤,或附子理中汤加砂、半。方解见上。

A: This is a condition, in which the Yang is deficient and it is blocked by the overwhelming Yin Qi. The arms and the legs depend on the Stomach Qi to nourish. If the Stomach Yang Qi is not sufficient, it would be blocked or clouded by the Yin Qi, so the Yang Qi can not come to the arms and legs, causing slim in the head, face, arms and legs. The Yin Qi is overwhelming, stagnated in the middle of the body, resulting in fullness and bloating in the abdomen, similar to the ice in the abdomen. For the treatment, the therapy should focus on the supply of Yang. When the Yang is sufficient, the Yin will naturally disappear. This is as the big sun in the sky but no cloud. The herb formula is Sini Tang, or Fuzi Lizhong Tang plus Sharen and Banxia. See the explanation to the formula above.

或又曰:腹胀之病亦多,皆阳虚而阴蔽乎?曰:子不知人之所以立命者,在活一口气乎?气者阳也,阳行一寸,阴即行一寸;阳停一刻,阴即停一刻。可知阳者,阴之主也。阳气流通,阴气无滞,自然胀病不作。

It might be asked: there are many diseases with abdomen bloating, how can we regard all of them the Yang deficiency? The answer is: don’t you know that, the human life depends all on the bit of Qi? Qi means the Yang. One step the Yang moves, one step the Yin follows; One step the Yang stops, one step the Yin stops too. So it is known, that the Yang is the king, the boss, and the governor of the Yin. Whenever the Yang Qi is in a well circulation, there should have no stagnation of the Yin Qi, so no any bloating symptoms.

阳气不足,稍有阻滞,百病丛生,岂独胀病为然乎?他如诸书所称气胀、血胀、风胀、寒胀、湿胀、水胀、皮肤胀,是论其外因也。如脾胀,肾胀、肺胀、肝胀、心胀,是论其内因也。

If the Yang Qi is not sufficient, even a slight stagnation would cause lots of various disease, not to speak of the bloating. Other books mentioned the Qi bloating, Blood bloating, Wind bloating, Cold bloating, Wetness bloating, Water bloating, or Skin bloating, all meaning the outside reasons. The Spleen bloating, Kidney bloating, Lung bloating, Liver bloating, or the Heart bloating, all mean the insde reasons for the bloating.

外因者何?或因风寒入里,阻其气机,或因暑湿入里,阻其升降,或因燥热入里,阻其往来,延绵日久,精血停滞。感之浅者,流于皮肤,感之深者,流于腹内,若在手足骨节各部,便成疮疡疔毒。阻在上焦,胸痹��决;阻在中焦,中满症属;阻在下焦;腹满症作。

What’s the exogenous reason for the bloating? It can be the Wind-Cold invasion that blocks the Qi movement. It can be due to the Summer Wetness invasion; to the Dry-hot invasion too. The invading Xie Qi blocks the Jing and Blood movement. If the invasion is shallow, the disease is in the skin level; if it penetrates deeper, the problem occurs in the inside organs; if it is stagnated in the hands, foot, bone joints, it causes ulcer and so on. If it blocks in the upper Jiao, it is Chest Bi syndrome; in the middle Jiao, it is bloating or fullness in the abdomen; if it in the lower Jiao, it causes lower part bloating.

内因者何?或因脾虚日久,而脾气散漫;或因肾虚日久,而肾气涣散;或因肝虚日久,而肝气欲散;或因肺虚日久,而肺气不敛;或因心虚日久,而心气发泄。凡此之类,皆能令人作胀。大抵由外而入者,气机之阻,由内而出者,气机之散也。阻者宜开,调气行血,随机斡运为要;散者宜收,回阳纳气温补为先。

What is their inside reasons? It can be due to long term of Spleen insufficiency, so the Spleen Qi is scattering. It can be due to the long term of Kidney insufficiency, so the Kidney Qi scattering; or due to the long time of Liver insufficiency, so the Liver Qi is scattering; to the long time of the Lund insufficiency, so the Lung Qi fails to hold; to the long time of Heart insufficiency, so the Heart Qi is scattering. All can cause bloating feeling. Basically, the invading Xie Qi cause Qi stagnation, and inside insufficient condition cause Qi scattering. For the stagnated Qi, it needs to be opened; for the scattered Qi, it needs to be attracted back, using Qi attracting therapy and warm supplying therapy.

然胀与肿有别,胀者从气,按之外实而内空;肿者从血,按之内实而外亦实。治胀者,宜养气、宜补气、宜收气,忌破气、忌耗气、忌行气,尤贵兼养血。治肿者,宜活血、宜行血、宜破血,忌凉血、忌止血、忌敛血,尤须兼行气。学者欲明治胀之要,就在这一气字上判虚实可也。

However, the bloating is different from the swelling. The bloating is due to the Qi; it feels tight on the surface but hollow when press to the inside; the swelling is associated to the Blood. If feels hard both on the surface and inside. For the treatment of the bloating, it is needed to nourish Qi, supply Qi, contract Qi, but avoid break the Qi, exhaust Qi, or to push the Qi. It is better with the blood nourish in the treatment for the Qi disorders. For the treatment of swelling, it is better to activate the blood, move the blood, but avoid to break the blood, to cool the blood, to stop the blood, or to contract the blood. It is better also to move the Qi during the treatment for the blood. If the readers want to understand the key word for the treatment of the bloating, jus pay attention to the Qi, for its Xu and Shi conditions.

问曰:前后二便不利,三五日亦不觉胀,腹痛,舌青滑,不思饮食者,何故?

Q: There is difficult in the urination and the bowel movement. No bloating feelings even if there is no bowel movement for three to five days. There is pain in the abdomen. The tongue is blue and slippery. No desire to eat. What is this condition?

答曰:此下焦之阳虚,而不能化下焦之阴也。夫一阳居于二阴之中,为阴之主。二便开阖,全赖这点真阳之气机运转,方能不失其职。

A: This is due to the Yang deficiency in the lower Jiao space, which fails to govern the Yin in the lower Jiao of the body. The one Yang is located in the two Yin. The Yang there is the boss of the two Yin there. The functions of the urination and the bowel movement depend on the movement of the True Yang there.

今因真气太微,而阴寒遂甚,寒甚则凝,二便所以不利也。况舌青、腹痛、不食,阴寒之实据已具。法宜温补下焦之阳,阳气运行,阴寒之气即消,而病自愈也。方用四逆汤加安桂,解见上。若热结而二便不利者,其人烦躁异常,定见黄白舌苔,喜饮冷水,口臭气粗可凭。学者若知此理,用药自不错误也。

Now, the True Yang is too weak, so the Yin is overwhelming. The Cold causes freeze, so that the two functions do not function well. In addition to the blue tongue, pain in the abdomen, no desire to eat, all suggest the Yin Cold. The treatment principle should be to warm the Yang in the lower Jiao of the body, to improve the Yang Qi movement. Once, the Yang is in proper function, the Yin will subside and the disease is cured. The herb formula should be Sini Tang plus Rougui. See the explanation above. If the dysfunction of the urination and the bowel movement are due to the Hot-stagnation in the lower Jiao of the body, the patient is very annoyed. His tongue covering is yellow-white in color. He likes to drink cold water, the mouth odor is very bad. If readers understand this, there should have no mistake.

【阐释】二便不利,有热结与阳虚之不同,须细审各种兼症而分别用药。此病腹痛、舌青、食少,纯是一片阴寒景象,而断为下焦阳虚不能化阴,故治以四逆汤加桂。四逆汤已属回阳救逆之主方,更加辛热之肉桂以助其祛寒消阴之力,而取效益速。若其人烦躁异常,现黄白舌苔,喜饮冷水,口臭气粗,则属于热结。大便不利者,法宜养血、清热、润燥,麻仁丸主治之;小便不利者,法宜养阴、清热,导赤散主之。

Further explanation by the editor: … If the disorder of the bowel movement is due to the Hot-stagnation in the lower Jiao of the boy, use Maren Wan to nourish the blood, clear the hot, wet the dryness. For the Hot stagnation caused urination disorder, use herb Daochi San to nourish the Yin, and clear the hot.

问曰:病人每日交午初即寒战,腹痛欲死,不可明状,至半夜即愈者,何故?

Q: Patient feels chilly every day when it is to the noon. He feels terrible pain in the stomach, but all sysmptoms subside at the middle night. What is this condition?

答曰:此阳虚而阴盛,阻其气机也。夫人身一点元阳,从子时起,渐渐而盛,至午则渐渐而衰,如日之运行不息。今病人每日交午初而即寒战腹痛者,午时一阴初生,正阳气初衰之候,又阴气复旺之时。

A: This is a condition, in which the Yang is insufficient and the Yin is overwhelming, that blocks the Qi movement in the body. The Yuan Yang in the body starts from the Zishi (between 11 pm and 1 am), increases along the morning, reaches peak at the noon. It circles as such every day. No he feels pain everyday at noon, at which the one Yin starts and the Yang Qi starts to subside.

病者之阳不足,复遇阴盛,阴气盛而阻其阳气运行之机,阴阳相攻,而腹痛大作,实阳衰太盛,不能敌其群阴,有以致之也。法宜扶阳抑阴,方用附子理中汤加砂、半,方解见上。

The patient’s Yang Qi is not enough. Now it meets the Yin overwhelming. The Yin Qi blocks the Yang Qi function, struggling against each other to cause the pain in the stomach. All are due to the Yang is too weak and the Yin is too strong. For the treatment, it should be used the herb formula Fuzi Lizhong Tang plus Sharen and Banxia. See explanation above.

问曰:平人觉未有病,惟小便后有精如丝不断,甚则时滴不止者,何故?

Q: The person is farely health. The only wrong feeling is a string of sticking and adhering sperm-liquid drops after urine. It would stop sometime. What is this condition?

答曰:此先天之阳衰,不能束精窍也。夫精窍与尿窍有别,尿窍易启,只要心气下降,即开而溺出。精窍封锁严密,藏于至阴之地,非阳极不开。今平人小便后有精不断者,其人必素禀阳虚,过于房劳,损伤真气,真气日衰,封锁不固,当心火下降,溺窍开而精窍亦与之俱开也。法宜大补元阳,交济心肾为主。方用白通汤,解见上。

A: This is a condition, in which the patient is weak in his Yang Qi innate, that fail to control the sperm-liquid. There is difference between the opening of the urine and the sperm-liquid. The urine is easy to open. Once the Heart Qi falls down to the urine bladder, the urine comes out. The sperm-liquid however is hidden tight in the pure Yin place of the body. It would not open without extreme amount of Yang Qi. The symptoms of this person are due to his innate Yang insufficient. His over sex activity damaged his True Yang furthermore, so there is no enough True Yang to control the expel of the sperm-liquid. So, when the Heart Fire falls down, both the opening for the urine and the sperm-liquid open. For the treatment, use Baitong Tang to supply Yuan Yang, conduct the Heart and the Kidney. See explanation above.

问曰:病后两脚浮肿至膝,冷如冰者,何故?

Q: After a severe disease, the patient has his feet swelling to the knee, that feels cold as ice. What is this condition?

答曰:此下焦之元阳未藏,而阴气未敛也。夫人身上、中、下三部,全是一团真气布护。今上、中俱平,而下部独病。下部属肾,肾通于两脚心涌泉穴,先天之真阳寄焉,故曰阳者,阴之根也。阳气充足,则阴气全消,百病不作;阳气散漫,则阴邪立起,浮肿如冰之症即生。古人以阳气喻龙,阴血喻水,水之汜滥,与水之归壑,其权操之龙也。龙升则水升,龙降则水降,此二气互根之妙,亦盈虚消长之机关也。学者苟能识得元阳飞潜之道,何患治肿之无方哉?法宜峻补元阳,交通上下,上下相交,水火互根,而浮肿自退矣。方用白通汤主之,解见上。

A: This is a condition, in which the Yuan Yang in the lower Jiao has not been restored, and the Yin Qi has not been contracted back yet. For the upper, the middle, and the lower part of the body, all depend on the same Yang Qi to distribute and to nourish. Now, the upper and the middle parts are normal, only the lower part is sick. The lower part belongs to Kidney. The Kidney meridian conducts to the middle of the feet, the Yunquan point, that is the place where the True Yang lives. So it is said, the Yang is the root of the Yin. If the Yang is sufficient, the Yin Qi subsides and not any disease; if the Yang Qi is insufficient or scattered, the Yin Qi comes out right away and the conditions, such as the ice feeling starts. The old Chinese implies the Yang Qi as Dragon and the Yin Blood as the Water. The flood of the water and the control of the water both are controlled by the Dragon. When the Dragon rises, the Water rises; when the Dragon falls, the Water falls too. This is the mechanism by which the Qi and the Blood couple each other, and by which the transfer of the Yin and Yang each other. If the readers understand the mechanism for the Yuan Yang to fly, how it would be difficult for the treatment of swelling? In this case, the principle for the treatment should be to supply Yuan Yang, and to conduct the upper and the lower. When the upper and lower part conducts, the Water and the Fire conducts, the swelling disappears. The herbal should be the Baitong Tang. See the explanation above.

问曰:少阴病吐利,手足逆冷,烦躁欲死者,以吴茱萸汤主之,其故何也?

Q: The disease is in the Shaoyin stage, the patient has vomiting and diarrhea. His hands and feet are reverse cold. He is very annoyed to die. It is said to use Wuzhuyu Tang. Why?

答曰:吐则亡阳���阳指胃阳),利则亡阴(阴指脾阴),中宫之阴阳两亡,阳气不能达于四末,故逆冷。中宫为上下之枢机,上属手少阴君火离也,而戊土寄焉(戊土属胃)。下属足少阴肾水坎也,而己土寄焉(己土属脾)。二土居中,一运精液于上而交心,一运精液于下而交肾,今因吐利过盛,二土骤虚,不能运精液而交通上下,故烦躁欲死。盖烦出于心,躁出于肾,仲景所以列于少阴也。使吐利不至烦躁欲死,亦不得以少阴目之。主以吴茱萸汤,其旨微矣。

A: Vomiting can cause death of Yang (the Yang means stomach Yang); diarrhea can cause death of the Yin (the Yin here means the Spleen Yin). The Yin and Yang in the middle palace of the body both die, there would have no Yang Qi to the end of the arms and legs, so there is the reverse cold syndrome. The middle palace of the body is the hub of the body upper Qi and the lower Qi. The upper part of the body belongs to the Shaoyin King Fire, which is the Li Gua. The Wu Soil (the stomach Soil) lives there. The lower part belongs to the Feet Shaoyin Water, the Kan Gua, where the Spleen Soil lives. The two Soil lives in the middle part of the body. One is to transport Jing liquid up to the Heart; another is to transport the Jing liquid down to the Kidney. Now, due to over vomiting and diarrhe, the two Soils are insufficient suddenly. It is not enough to transport the Jing liquid to the Heart or to the Kidney. So the patient feels annoyed to die. The annoyed feeling comes from the Heart. Agitation comes from the Kidney. This is the reason that the Master Zhang Zhongjing list them in the Shaoyin stage. If the vomiting and the diarrhea do not cause the feeling to die, they should not be listed in the Shaoyin stage. The herb formula suggested is the Wuzhuyu Tang. The meaning is very cute.

吴茱萸汤

Wuzhuyu Tang

吴萸一升  人参三两  生姜六两  大枣十二枚

Wuzhuyu 50 gram, Rensheng 45 gram, Fresh ginger 90 gram, Chinese date 60 gram.

用药意解

The meaning of the formula:

按吴茱萸汤一方,乃温中、降逆,补肝之剂也。夫吴萸辛温,乃降逆补肝之品,逆气降而吐自不作,即能补中。肝得补而木气畅达,即不侮土,又与生姜之辛温同声相应,合大枣之甘,能调胃阳,复得人参甘寒,功专滋养脾阴。二土得补,皆具生机,转运复行,烦躁自然立止。此方重在补肝降逆以安中,中安而上下自定,握要之法,与理中汤意同而药不同也。理中汤浅一层,病人虽吐利,未至烦躁,故酌重在太阴;此方深一层,病人因吐利而至烦躁欲死,烦属心,躁属肾,故知其为少阴病。总由吐利太甚,中土失职,不能交通上下。其致吐之源,却由肝木凌土而成,故仲景主以吴茱萸汤,温肝降逆以安中,是的确不易之法,亦握要之法也。

The herb formula Wuzhuyu Tang is to warm the middle, to depress the reversed Qi, and to nourish the Liver. Herb Wuzhuyu is spicy and warm in herbal nature. It is the depressing the reverse and nourishing liver herb. When the reversed Qi is depressed down, there should have no vomiting, meaning it can nourish the middle. The Liver is nourished, the wood would be smoothly stretching, so the Liver will not depress the Soil. Together with the fresh ginger, for its spicy and warm as the nature of the Wuzhuyu, plus the sweet nature of the Chinese date, all work to adjust the Stomach Yang Qi. With the involvement of the Renshen in the formula, of sweet and cold in herbal nature, it can nourish the Spleen Yin. When the two Soil are nourished, both can turn the metabolic circle in the body, so the annoyed soon stop. This formula focuses to supply the Liver, depress the reversed so to calm the middle part of the body. The middle part is in harmony, the upper and the lower part of the body would also be in calm. The meaning is the same as the Lizhong Tang, thought the herb ingredients are different. The Lizhong Tang condition is somehow less severe than the Wuzhuyu Tang, since the patient with the Lizhong Tang condition has no annoyed feeling though he has also vomiting and diarrhea. So, his condition, the Lizhong Tang condition, is in the Taiyin stage. When the patient is very annoyed to die due to the vomiting and diarrhea, the annoyed belongs to the Heart and the irritability belongs to the Kidney, so that the condition belongs to the Shaoyin. All are due to the too much vomiting and diarrhea, which causes the disorder in the middle part of the body, that fails to conduct the upper and the lower part of the body. The reason for the vomiting, however, is due to the assault of Soil by the Liver Wood. For this reasons, the Master Zhang Zhongjing mostly used the Wuzhuyu Tang. It is really a herb formula needs to be used without other choice. It touches the point.  

问曰:病人牙齿肿痛二三日,忽皮肤大热,而内却冷,甚欲厚被覆体,有时外热一退,即不畏寒者,何故?

Q: The patient has pain and swelling in the teeth gum for two to three days. He suddenly feels high fever, but feels cold inside, has willing to cover heavily on the body. Sometime, when the fever subsides, he would not feel chilly. What is this condition?  

答曰:此元气外越而不潜藏故也。夫病人牙齿肿痛二三日,并无阳症可凭,已知其阴盛而元气浮也。以后皮肤大热,而内冷甚,明明元气尽越于外,较牙痛更加十倍。有时外热一退,即不畏寒者,是阳又潜于内故也。病人若恶寒不甚,发热身疼,即是太阳寒伤营卫之的症。畏寒太甚,而至厚被覆体,外热又甚,即不得以伤寒目之,当以元气外浮为主,用药切不可错误。此症又与上热下寒同,但上、下、内、外稍异耳。病形虽异,总归一元。法宜回阳,交通上下为主。方用白通汤、四逆汤,解见上。若兼头、项、腰、背痛,恶寒,于四逆汤内稍加麻、桂、细辛亦可。医于此地,不可猛浪,务要察透,方可主方,切切留意。

A: This is a condition, in which the Yuan Qi is escaping, not hidden in the body. The patient has pain in the teeth without any evidence for a Yang condition, so it is known that this teeth pain is due to Yin overwhelming. Later, when he feels fever on the skin, but the cold inside, it is clearly indicating the condition of Yuan Qi floating. The condition is more than ten times severe than the teeth pain. When the fever subsides without chilly, suggests that the Yuan Qi dives into the body again. If the patient has kind of chilly, fever, and pain in the body, it is the condition of Taiyang disorder. If the chilly is very severe, the patient likes to cover his body with heavy covering, and if there is at the same time a fever, the condition should not be regarded as Taiyang Shanghan disease. It should at this time be regarded as the Yuan Yang floats. The herb use should be very careful. This is condition similar to the upper-hot-lower-cold condition. The slight difference is only the upper and the lower, and the outside and the inside. The express of the disease is different but the reason and the mechanism is same. The treatment principle is to restore the Yang, conduct the upper and the lower. The herbs should be the Baitong Tang, Sini Tang. See the explanation above. If the patient has, at the same time, pain in the head, neck, lower back, or back, has chilly, the herb Mahuang, Guizhi, Xixing can also be added to the Sini Tang. Upon meet such condition, doctors should not be careless. Pay attention to the difference between the various conditions and their treatment principles.

问曰:大病未愈,忽呃逆不止,昏沉者,何故?

Q: The patient has his disease not cured yet. He suddenly has contineous hiccup and has coma. What is this condition? 

答曰:此元气虚极,浊阴之气上干,脾肾欲绝之征也。夫病人大病已久,元气之不足可知。元气之根在肾,培根之本在脾。脾肾欲绝,其气涣散,上干清道,直犯胃口,上下气机有不相接之势,故呃逆不止。人事昏沉,由元气衰极,不能支持。此等病形,阴象全现,非若胃火之呃逆,而饮水亦可暂止。法宜回阳降逆为主,方用吴萸四逆汤,或理中汤加吴萸亦可,解见上。

A: This is a condition, in which the Yuan Qi is extremely weak, so the muddy Yin floats up. It is the sign showing the die of the Spleen and Kidney. Since the patient has been in a severe disease, it is certain that his Yuan Qi is insufficient. The root of the Yuan Qi is in the Kidney but its nourishment depends on the Spleen. When the Kidney Qi and the Spleen Qi both are insufficiency, the Qi is scattered and floats up to block the upper openings on the head, and attacks the stomach, causing the upper Qi and the lower Qi fails to conduct each other, so causing the hiccup. Coma suggests that the Yuan Qi is very insufficient. All evidence indicate the Yin condition. It is not as a hiccup due to Stomach Fire, which can be stop for a movement by drinking water. In this case, the herb used should be Wuzhuyu Sini Tang, or Lizhong Tang plus Wuzhuyu, to restore the Yang Qi and depress the reversed Qi.  

问曰:病人腰痛,身重,转侧艰难,如有物击,天阴雨则更甚者,何故?

Q: The patient feels pain in the lower back, heavy in the body, hard to turn the body. His back feels as being beaten by something. Such feeling is more in raining and cloudy weather. What is this condition?

答曰:此肾中之阳不足,而肾中之阴气盛也。夫腰为肾之府,先天之元气寄焉。元气足则肾脏温和,腰痛之疾不作。元气一亏,肾脏之阴气即盛。阴主静,静则寒湿丛生,元气微而不运,气滞不行,故痛作。因房劳过度而损伤元气者,十居其八;因寒邪入腑,阻其流行之机者,十有二三。由房劳过度者,病人两尺必浮空,面色必黑暗枯槁。由感寒而成者,两尺必浮紧有根,兼发热、头痛、身痛者多。凡属身重,转侧艰难,如有物击,天雨更甚之人,多系肾阳不足所致,寒湿所致亦同,总在脉色上求之。若阴虚所致,必潮热口干、脉细微、内觉热,逢亢阳更甚。元气亏者,可与潜阳丹;湿气滞者,可与肾着汤;由感寒者,可与麻黄附子细辛汤;肾虚者,可与滋肾丸、封髓丹、潜阳丹。解见上。

A: This is due to the deficiency in Kidney Yang Qi. The Kidney Yin Qi is overwhelming. The lower back is the place there the Kidney locates and the Yuan Qi stays. If the Yuan Qi is sufficient, the Kidney would be warm, and there would have no pain in the lower back. If the Yuan Qi is not enough, the Yin Qi in the Kidney would be overwhelming. Yin is associated to quiet. When in quiet, the Cold and the Wetness occur easily; the Yuan Qi is not sufficient to move, so the pain happens. Eight out of ten cases, the reason is due to over sex activity. Two to three out of ten cases, it is due to the invasion of the Cold, that blocks the Qi movement. If it is due to the over sex activity, the pulse in the Chi position is floating and hollow in feeling. His face must be dark and withered. If it is due to the Cold invasion, the pulse in the Chi position mush be floating and tight with a root in feeling. The patient also commonly has fever, headache and pain in the body. When the patient feels heavy in the body, hard to turn the body, feels as beaten by a stuff; the pain becomes severe in cloudy and raining weather, it is mostly due to the Kidney Yang deficiency or to the Cold invasion. Pay attention to the pulse to identify them. If the pain is due to a Yin deficiency, the patient must feel waving hot, dry mouth, feels hot inside of the body, the pulse is thin and weak. Such feeling is worse in high sunshine weather.

  If the reason is the Kidney Yuan Qi deficient, use Qian Yang Dan; if it is due to Wetness invasion, use Shenzhe Tang; if it is due to Cold invasion, use Mahuang Fuzi Xixing Tang; if it is due to Shen deficiency, use Zisheng Wan, Fengsui Dan, or Qiyang Dan. See the explanations above.

肾着汤

Shenzhe Tang.

白术一两  茯苓六钱  干姜六钱  炙草三钱

Baizhu 30 gram, Fuling 18 gram, Ganjiang 18 gram, Zhi Gancao 9 gram.

麻黄附子细辛汤

Mahuang Fuzi Xixing Tang

麻黄八钱  附子六钱  细辛三钱

Mahuang 24 gram, Fuzi 18 gram, Xixing 9 gram.

用药意解

The meaning of the herb formula:

按肾着汤一方,乃温中除湿之方也。此方似非治腰痛之方,其实治寒湿腰痛之妙剂也。夫此等腰痛,由于湿成,湿乃脾所主也。因脾湿太甚,流入腰之外府,阻其流行之气机,故痛作。方中用白术为君,不但燥脾去湿,又能利腰脐之气。佐以茯苓之甘淡渗湿,又能化气行水,导水湿之气,从膀胱而出。更得干姜之辛温以暖土气,土气暖而湿立消。复得甘草之甘以缓之,而湿邪自化为乌有矣。方中全非治腰之品,专在湿上打算。腰痛之由湿而成者,故可治也。学者切不可见腰治腰,察病之因,寻病之情,此处领略方可。

The Shenzhe Tang works to warm the middle and deplete the Wetness from the body. It seems not a special formula for the treatment of the lower back pain, but in fact it is a very smart formula for the lower back pain. Such lower back pain is due to the accumulation of Wetness in the lower back. The Wetness is associated with the Spleen. It is due to the overwhelming of the Wetness in the Spleen system, which flows into the lower back, blocks the Qi movement there to cause pain. The herb Baizhu in the formula is the major part. It works to dry the Spleen, depletes the Wetness, clears the lower back block and promotes the Qi movement there. The herb Fuling is sweet the dispersing in herbal nature. It works to promote the Qi movement and Water metabolism, to remove the extra water out of the body through urine. The herb Ganjiang is spicy and warm in herbal nature. It works to warm the Soil. When the Soil is warm, the Wetness disappears. In addition, the herb Gancao is sweat and humanizing in herbal nature, able to melt the Wetness off. None of the ingredients in the formula focus on the lower back, but all work to remove the extra Wetness. The readers should not treatment pain in the lower back, as soon as see a pain in the lower back. You should really search the reason for the lower back pain and solve the reason.

按麻黄附子细辛汤一方,乃交阴阳之方,亦温经散寒之方也。夫附子辛热,能助太阳之阳,而内交于少阴。麻黄苦温,细辛辛温,能启少阴之精而外交于太阳,仲景取微发汗以散邪,实以交阴阳也。阴阳相交,邪自立解,若执发汗以论此方,浅识此方也。又曰温经散寒:温经者,温太阳之经;散寒者,散太阳之寒。

The formula Mahuang Fuzi Xixing Tang is to conduct the Yin and Yang in the body. It is also a formula to warm the meridian and deplete the Cold. The herb Fuzi is spicy and warm, able to help the Yang Qi in the Taiyang stage, making it conduct with the Yang in the Shaoyin. The herb Mahuang is bitter and warm; the Xixing is spicy and warm. Both can conduct the Ying Qi in the Shaoyin with the Taiyang. The Master Zhang Zhongjing seemed to use to create mild sweat, but actually he used to conduct the Yin and the Yang. When the Yin and the Yang conducted, the Xie Qi will be solved right away. If only understand the formula as a sweating therapy, you look down the effect of this formula. When we say that this formula is to warm the meridian, it means to warm the Taiyang meridian; to deplete Cold, means to deplete the Taiyang Cold.

若此病腰痛,乃由寒邪入太阳之外府,阻其少阴出外之气机,故腰痛作。少阴与太阳为一表一里,表病及里,邪留于阴阳交气之中,故流连不已。今得附子壮太阳之阳,阳旺则寒邪立消。更得麻、细二物,从阴出阳,而寒邪亦与之俱出。阴阳两相鼓荡,故寒邪解而腰痛亦不作矣。

If the lower back pain is due to the Cold invasion into the Taiyang outside level, the invaded Cold Xie blocks the Qi movement out of the Shaoyin, the pain will happen. The Shaoyin and the Taiyang stage is the inside and outside couple. The Cold Xie Qi moves from the surface layer into the inside layer, shifting in between the inside and the outside layer, so the pain continues. Now, with the herb Fuzi in the formula to enhance the Taiyang Yang Qi, and with the stronger the Yang Qi, the Cold Xie Qi melts away soon. In addition with the herb Muhuang and Xixing, promote the Yang Qi moving from the Shaoyin to the Taiyang, so the Cold Xie Qi moves out along with the Shaoyin Yang Qi out. The Yin and Yang layer work together, so the Cold Xie is solved and the pain disappears.

问曰:病人先二三日发吐未愈,遂渐畏寒,又二三日逢未刻即寒冷,冷后即发热,大汗出,至半夜乃已,日日如是,人渐不起,气促,诸医照疟症治之不效者,何故?

Q: The patient had vomiting for two to three days. He gradually had chilly. Later additional two to three days, he felt chilly upon Weishi (1 pm to 3 pm) every day, then fever, then heavy seat. All of these symptoms stop at the middle night. It appeared as such everyday. The perosn felt more and more fatigue, hard to get up, felt short of breath. He has been treated as malaria without any help. What is this condition?

答曰:此由吐伤胃阳,胃阳欲亡也。夫病初起即发吐,病根已在于太阴。太阴与胃为表里,里病及表(胃为表,主容受;脾为里,主消磨。脾气不运,非因食伤,即因气阻。阻太过甚,则上逆而吐,吐则胃伤,过伤则亡阳),故吐。

A: This is a condition, in which the vomiting has damaged the Stomach Yang Qi. The Stomach Yang is to die off. For this person, he has vomiting in the very early day of the disease. It indicates that his disease root is in the Taiyin stage. The Taiyin (Spleen) and the Stomach is the inside and outside couple relationship. The inside Taiyin disease affects the outside partner, e.g. the Stomach, so the person had vomiting.

吐则亡阳,故畏寒。复又大热出汗者,亡阳之征也。逢未而病起,至半夜而病止者,阳衰于午未,而生在子也。人事昏沉,气促渐不起,阳将亡而未亡也。诸医不察受病之根,专在寒热上分辨,故照疟法治之不愈。然疟症有外感、内伤之别,外感者,其人必发热、头痛、身痛,汗、吐、下后,而邪未尽,邪附于少阳,少阳居半表半里之间,邪出与阳争则热(阳指阳明),邪入与阴争则寒(阴指太阴),寒疟(单寒无热)、热疟(单热无寒),即在此处攸分。亦有因饮食停滞中脘,气机遏郁不行,逢阳则热,逢阴则寒,其人必饱闷吞酸嗳腐为据,即食疟。若此病先由发呕吐(呕吐有因厥阴之气上干者,有胃欲绝者),渐冷、渐发热、出汗、气促、人沉迷,明明吐伤胃阳,故断之曰胃阳欲亡也。法宜急降逆温中回阳为主。回阳者,非回先天坎中之阳,而专回胃阳者(阳本一分而为三也)。方用吴茱萸汤,或吴萸四逆汤,或理中汤加吴萸俱可,解见上。

Vomiting causes death of the Yang Qi, so the person feels chilly. The following hot and sweat is actually a sign Yang to die. The disease starts at 1 pm and stop at 1 am. It follows the pattern of the Yin developing in the body: the Yin starts from 1 pm and stop at the 1 am. Coma and short of breath and hard to get up, all suggest the Yang Qi is to die, but not die yet. Doctors do not search the root of the disease, but only pay attention to the cold and fever, so treat the patient as malaria without any improvement. Even for the malaria, the reason can be from outside or inside of the body. If it is caused by invading Xie Qi, the patient must have fever, headache, and pain in the body first. After sweat therapy, vomiting therapy or bowel-cleansing therapy, the Xie Qi was not depleted clearly out of the body yet. The Xie Qi attaches to the Shaoyang meridian/level/stage. The Shaoyang stage is the space in between the out layer and the inside layer of the body. If the Xie Qi comes out to the out layer, struggling with the defense energy, the body feels hot. If it goes deeper to the inside of the body, struggling with the Yin Qi inside (the Taiyin Qi), the body feels cold. This is the way to identify the Cold malaria (with cold feeling only) and the Hot malaria (with hot feeling only). There are some people, who also feel the hot-cold shift feeling. Their condition is however due to the stagnation of food in the middle stomach, which blocks the Qi movement. So, they feel hot in hot weather or warm room, but cold in cold weather or cold room. They must have fullness, nausea, and hiccup with rotten food smell. This condition is called Food malaria. If the patient has vomiting first, then gradually chilly, gradually hot, sweat, short of breath, falling into coma, it indicates the damage of Stomach Yang. Therefore this condition is diagnosed as the Stomach Yang is to die. The treatment principle is to restore the Yang and warm the middle. Restoring Yang does not mean to restore the innate Yang in the Kan, but the Yang in the Stomach. The herbal formula should be the Wuzhuyu Tang, or Wuyu Sini Tang, or use Lizhong Tang plus Wuzhuyu. See the explanation above.

【阐释】此症先呕吐二三日,遂渐恶寒,继复大热汗出,渐至气促昏沉,程度逐渐加甚,郑氏辨明其与寒、热、食三种疟疾病象之不同,而断为吐伤胃阳,阳欲亡,半夜较轻,不过暂时宁静,实有独到之见。其治法是急降逆温中以回胃中之阳,故所出之方俱重用吴萸。诸医按疟疾施治,实有毫厘千里之谬,自无怪其不效。至于疟病,因其寒热之往来而决之于少阳也,故用小柴胡汤加减为正治。笔者经验若发热多于发冷,汗出多,口渴甚,脉弦数者,加知母、石膏、花粉、黄连之类。若发冷多于发热,口渴不甚者,脉弦迟,加附子、干姜、桂枝。至于食疟,则用保和丸治之。无论其为热重、寒重或食疟,均于方中加入常山,其效更著。

Further explanations by the editor: … For the malaria, it is treated as Shaoyang condition, for its cold-hot shift syndrome. The herb formula needed is the Xiao Haihu Tang. The editor’s experience is: if the hot is more than the cold, with more sweat and heavy thirsty, string and frequent pulse, add herb Zhimu, Shigao, Tianhuafeng, Huanglian, etc. If the cold is more than the hot; the mouth is not so thirsty; and the pulse is string but not frequent, add herb Fuzi, Ganjiang, or Guizhi to the formula. For Food-malaria, use herb formula Baohe Wan. No matter the hot is more or the cold is more, and no matter it is the Food-malaria, add herb Changshan to the formula will be much better.

问曰:病人前两月,上牙两边时时作疼,肝脉劲如石,脾脉亦有劲象,但不甚于肝部,后忽左边手足软弱,不能步履,麻木冷汗出,〔右边〕伸缩尚利,言语饮食如常者,何故?

Q: A patient for two months, had pain in the upper side of the teeth; his pulse for Liver is strong as touching a stone; the pulse for Spleen had also kind of such strong feeling but not as strong as the pulse for the Liver. Later, his left hand and feet is weak, so cannot walk. He felt numb and cold sweat but the right side is normal. His speaking and eating is as normal. What’s this condition?

答曰:此先天真气已衰,将脱而未脱之候也。近似中风,其实非中风也。夫病人上牙时时作疼,原系真气不藏,上冲所致,肝脾脉劲如石,先天之阳,欲附肝脾而出,暴脱之机关已具。后忽左边软弱,不能步履,麻木冷汗出者,是先天真气已衰于左,不复充盈。右边伸缩尚利者,后天脾胃之阳尚充,故也。昧者若作风治,更发散以耗其中气,中气立衰,命即不永。此际急宜保护后天,后天健旺,先天尚可复充。法宜先后并补为主,方用附子甘草汤,或加姜、桂、砂、半,缓缓调服,月余可瘳。解见上。

A: This is a condition, in which the innate True Qi is insufficient. It is to escape or to deplete but not deplete off yet. It appears as Wind-attack stroke, but it is actually not. The pain in the two side of the upper teeth had already suggested that the True Qi is not hidden. It is rushing up. The Liver pulse and the Spleen pulse feel strong as a stone, suggesting the innate Yang is attaching with the Liver and Spleen to deplete. There has been such evidence for the Yang to escape suddenly. Later, the left side is weak, fails to walk, has numb and cold sweat, all suggest that the True Qi is weak in the left side now, cannot fill up the left side of the body. The ride side is ok for feeling and movement, indicating that the right side has enough Spleen and Stomach Qi. If a doctor does not know this, and treat such condition as a stroke, the treatment will deplete the True Qi further more, the middle Qi will die soon to cause death. We should protect the acquired middle Qi. With enough acquired middle Qi, the innate Qi will get supply too. The treatment principle should be to supply the innate and the acquired Qi the same time. Use herb formula Fuzi Gancao Tang, or add the herb Ganjiang, Rougui, Sharen, or Banxia in the formula. It needs several months to cure.           

以上数十条,专论阳虚,指出先天真气上浮,反复推明。真气命根也,火种也,藏于肾中,立水之极,为阴之根,沉潜为顺,上浮为逆。病到真气上浮,五脏六腑之阳气,已耗将尽,消灭削剥,已至于根也。经云:"凡五脏之病,穷必归肾",即此说也。然真气上浮之病,往往多有与外感阳症同形,人多忽略,不知真气上浮之病大象虽具外感阳症之形,仔细推究,所现定系阴象,绝无阳症之实据可验,学者即在此处留心,不可猛浪。细将上卷辨认阳虚、阴虚秘诀熟记,君、相二火解体贴,则阳虚之病于在上、在中、在下,阴虚之病于在上、在中、在下,皆可按法治之也。

The above paragraphs focus on the discussion of Yang insufficiency, repeatedly pointing out the True Qi floating conditions. The True Qi is the life root, is the seed of the Fire. The Fire seed is hidden and stored in the Kidney. It is the root of the Water. It is normal that it dives and hides down, but abnormal if it floats up. When a disease develops into a stage, in which the True Qi is floating, it suggests that the organ Yang Qi is exhausted to the root level. It is said in the medical bible: “in the last stage of the diseases, no mater from which organs, the disease will affect the Kidney.” It means what we are discussing here. However, in clinic, the True Qi floating condition has much similarity to the early stage of Yang conditions, which is due to the invasion of out Xie Qi. It is easy to be omitted or neglected. Doctors usually do not know that, though the True Qi floating condition is similar to the common cold-like conditions, but if we pay much detailed attention, we can still find evidence for evidence indicating a Yin condition, but cannot find concrete evidence for a Yang condition. Beginners must be careful in the diagnosis. You should remember the principle in the diagnosis of the Yin insufficiency and the Yang insufficiency, really understand the meaning of the King Fire and the Xiang Fire. Then no matter such condition is in the upper, middle or the lower part of the body, you know know how to solve it.  

阳虚篇内所备建中、理中、潜阳、回阳、封髓、姜桂诸方,皆从仲景四逆汤一方搜出。仲景云:"三阳经病者,邪从阳化,阳盛则阴必亏,以存阴为要",滋阴降火说所由来也;"三阴经病,邪入多从阴化,阴盛则阳必衰,以回阳为先",益火之源以消阴翳所由起也。

In the above paragraphs, we introduced the herb formula Jiangzhong Tang, Lizhong Tang, Qianyang Dan, Guiyang Yin, Fengsui Dan, and Jianggui Tang, etc. All are induced from the Master Zhang Zhongjing’s Sini Tang. The Master said: “For the three Yang meridian diseases, the Xie Qi melts with the Yang. When the Yang is overwhelming, the Yin must be exhausted. So it is important to save the Yin”. The theory to nourish the Yin and clear the Fire comes from this concept. He also said: “For the Three Yin meridian diseases, the Xie Qi mostly melts with and into the Yin. When the Yin is in overwhelming, the Yang will be exhausted off. It should be urgent to save the Yang.” This is the origin of the idea to solve the Yin overwhelming by supplying more Yang.

大凡阳虚之人,阴气自然必盛,阴气盛必上腾,即现牙疼、龈肿、口疮、舌烂、齿血、喉痛、大小便不利之病,不得妄以滋阴降火之法施之。若妄施之,是助阴以灭阳也,辨察不可不慎。总在这阴象上追求,如舌青、唇青、淡白无神之类是也。

Generally speaking, people with the Yin overwhelming usually have too much Yin Qi in the body. The overwhelming Yin Qi must float and soar up, causing teethache, swelling in gum, ulcer in mouth and tongue, bleeding in gum, sour throat, difficult in urine or bowel movement, etc. We should not use the Yin-nourishing therapy to reduce the Xu Fire. Otherwise, the Yang Qi will be killed. Doctors must know this. We should pay much attention to search the evidence for the Yin overwhelming, such as blue-purple tongue, blue lips, white face, less vigor.

千古以来,混淆莫辨,含糊不清,聪明颖悟之人,亦仅得其半而遗其半,金针虽度,若未度也。故仲景一生心法,知之者寡。兹采取数十条,汇成一册,以便后学参究。其中一元妙义,消长机关,明明道破。至于仲景六经主方,乃有一定之至理,变方、加减方,乃是随邪之变化而用也。三阳之方,以升散、清、凉、汗、吐、下为准。三阴之方,以温中、收纳、回阳、降逆、封固为要。阴阳界限,大有攸分。以三阳之方治三阳病,虽失不远;以三阳之方治三阴病,则失之远矣。世之业斯道者,书要多读,理要细玩,人命生死,在于反掌之间,此理不明,切切不可妄主方药,糊口事小,获罪事大。苟能细心研究,自问无愧,方可言医。

For thousands of years, this is unclear in clinic work. Even a very cleaver doctor could realize part of the truth. This is the reason why Master Zhang Zhongjing’s contribution, that he spend whole of his life summarized, was not recognized by most people. Here I listed tens for the examples together, for the aim to help the later doctors as a reference. The meaning of the One-Qi theory, the mechanism for the Qi movement and transformation, all are explained clearly. For the main formula introduced by Master Zhang Zhongjing, that are used in each meridian/stage, bears great meaning and significance. Their variations depend on the change of the Xie Qi in the body, in different stage. The formula used in the three Yang stages should function to disperse, to clear, to cool, to create sweat, to create vomit, or to promote a bowel movement, so to expel the Xie Qi out of the body. The formula used in the three Yin condition/stage, should focus to warm the middle of the body, to contract, to restore the Yang Qi, to suppress the reverse and to hide the Yang Qi in the Kidney. There are clear separations for the herbs used in the Yang and in the Yin stages. If the herb formula supposed for the Yang stage is mis-used in some situations of the Yang condition, it does not create severe problem. If they are used in Yin conditions, it would be a severe mistake. People committing the healthcare service should read more books, consider and think in detail the reasoning of the saying in the books. The life of people is in your hands. If we do not understand the medicine, we should not give prescription carelessly. Earning less life is not a big problem, but it would be a big problem if your practice causes a death. You can start the medical practice, only after you have tried your best to study and understand the medicine.



[1] Readers should know that it dose not mean that this herb formula can be used in all patients with such “disease” diagnosed by western medicine. You should not say that the Jiangzhong Tang is used for diabetes, or tuberculosis. It is actually, as you learned here, for the treatment of Yang deficiency, regardless of the patient with the Yang deficiency is diagnosed as what kind of disease by western medicine.