1. Harmonizing Yin and Yang is the Method of Treating Disease Frequent urination, irritability, and leg cramps are interconnected symptoms that testify to the deficiency of Yin in the Ying (nutritive) aspect. When Ying Yin is deficient, it generates internal heat; this internal heat forces Yin to descend, leading to frequent urination. Internal heat disturbs the heart, causing irritability, and frequent urination exacerbates the deficiency of Ying Yin, resulting in muscle cramps, manifesting as leg cramps. Although there may be a floating pulse (indicating strong Wei Yang) and spontaneous sweating (indicating weak Ying Yin) with mild aversion to cold (indicating an exterior syndrome), it is not appropriate to use Guizhi Decoction to attack the exterior. Because Ying Yin is already deficient, and Wei Yang lacks support, using Guizhi to attack the exterior will inevitably lead to the loss of Yang, resulting in symptoms such as cold extremities, reverse Qi flow, dry throat, irritability, and vomiting, which indicate a syndrome of dual deficiency of Yin and Yang. This syndrome cannot be treated with Shaoyao to support Yin, as supporting Yin will not restore the Yang, and vomiting will persist. Therefore, we first use Gancao and Ganjiang Decoction to restore Yang. Conversely, if one uses Guizhi and experiences cold extremities, this is clear evidence of Guizhi damaging Yang. The pulse for Guizhi Decoction is floating and weak, with spontaneous sweating, and there should be no frequent urination or leg cramps indicating Ying Yin deficiency. Therefore, Guizhi Decoction is used to promote the discharge of excess Wei Yang and to supplement the weak Ying Yin with Shaoyao, facilitating the harmony of Ying and Wei, leading to recovery. As stated in the classics, “In Taiyang disease, if there is fever and sweating, this indicates weak Ying and strong Wei, hence sweating occurs.” How to resolve this? Guizhi Decoction is appropriate to “restore sweating; when Ying and Wei are harmonized, recovery occurs.” How is Ying and Wei harmonized? It is through Shaoyao and Gancao supplementing the insufficient Ying Yin, and Guizhi promoting the discharge of excess Wei Yang, assisting the body in achieving harmony between Ying and Wei, leading to recovery. Guizhi-type formulas for treating deficiency labor also harmonize Yin and Yang: for acute deficiency labor, Xiao Jianzhong Decoction is a representative formula. Xiao Jianzhong Decoction presents signs of strong Yang Qi, such as palpitations, limb pain, and heat in the hands and feet; it also shows signs of Yin deficiency, such as epistaxis, abdominal pain, nocturnal emissions, and dry throat with a dry mouth. Therefore, Guizhi promotes the discharge of excess external Yang Qi, while Shaoyao and Gancao supplement the insufficient internal Yin Qi, promoting internal and external harmony, leading to recovery. For chronic deficiency labor, Shuyu Wan is a representative formula. Shuyu Wan similarly uses Guizhi, Chaihu, Da Dou Huang, Juye, Xingren, and Fangfeng to promote the discharge of excess Yang Qi, while Danggui, Dihuang, Gancao, Ren Shen, Shaoyao, Maidong, Ejiao, and Dazao supplement the insufficient Yin Qi. A hundred pills are used as a dose for long-term regulation. Deficiency labor can be acute or chronic. Not all deficiency labor is chronic, nor is it always a case of dual deficiency of Yin and Yang. If acute deficiency labor receives timely and correct treatment, it can prevent the development into chronic disease. The principle of treating all diseases is to observe their Yin and Yang, to drain what is excessive and to supplement what is insufficient, aiming for the harmony of Yin and Yang, leading to recovery.2. The Harmony and Disharmony of Yin and Yang, Focused on the Hands and Feet In reviewing medical cases, one often sees records such as: cold extremities, limbs cold above the knees, limbs cold above the elbows, and a cool body. Touching a normal person’s body usually feels cool. Elderly people often say, “Good child, cool as a coin,” meaning that touching the skin of a healthy child feels as cool as touching a coin. Therefore, when medical records describe a cool body, is it cold or cool? It is not clear. A normal person’s body is generally warmer in the upper limbs and cooler in the lower limbs, with the elbows cooler than the arms and the knees cooler than the legs. The knees are the coolest part of the body. Thus, when medical records describe cold extremities, limbs cold above the knees, and limbs cold above the elbows, it is not standardized. Because it is common to find cold knees and warm feet, and cold elbows and warm hands. In the “Shanghan Lun,” it only states, “hands and feet are cold, hands and feet are warm, hands and feet are hot”; it does not mention “cold extremities, limbs cold above the knees, limbs cold above the elbows.” In the “Jinkui Yaolue,” it also mentions “body cool and harmonious.” Body cool and harmonious means that the body temperature has returned to normal. The harmony of body coolness means normality. The temperature of the hands and feet is a very important basis for judging whether a person’s Yin and Yang Qi are harmonious or not. Generally, when the hands and feet change from hot to warm or from cold to warm, it indicates harmony of Yin and Yang. Hot hands and feet indicate strong Yang Qi. Cold hands and feet indicate Yang stagnation and cold, blood deficiency and cold, or Yang deficiency and cold. Commonly, cold hands and feet are often due to Yang stagnation and cold or blood deficiency and cold. If Yang is deficient and cold, the condition becomes serious. Common diseases with hot hands and feet: Strong Wei Qi and stagnant heat in the stomach. Strong Wei Qi and stagnant heat indicate conditions such as Taiyang cold damage, Taiyang wind, and deficiency labor with strong Yang. In Taiyang cold damage, the pulse is floating and tight or floating and rapid, with no sweating, aversion to wind and cold, and pain in the head and body, with a stiff neck and back. The treatment should induce sweating and release the exterior, using formulas like Ma Huang Decoction or Ge Gen Decoction. In Taiyang wind, the pulse is floating and weak or floating and rapid, with sweating, aversion to wind and cold, headache, and stiff neck and back. The treatment should induce sweating and release the muscles, using formulas like Guizhi Decoction or Guizhi plus Ge Gen Decoction. For deficiency labor with strong Yang, symptoms include lower abdominal tension, palpitations, epistaxis, abdominal pain, nocturnal emissions, limb pain, dry throat, and dry mouth, and the formula of choice is Xiao Jianzhong Decoction. Symptoms include lower abdominal tension, cold in the Yin region, dizziness, hair loss, nocturnal emissions in men, and dream intercourse in women, with a pulse that is wiry or moving or weak or tight. The formula of choice is Guizhi Longgu Muli Decoction. For strong heat in the stomach, symptoms include abdominal distension, frequent urination, hard stools, and a red tongue with a yellow coating, and the treatment should drain heat and open the bowels, using formulas like Chengqi Decoction. Common diseases with cold hands and feet: Shaoyang Qi stagnation, Shaoyang heat stagnation, blood deficiency with internal cold, and Yang deficiency with internal cold. For Shaoyang Qi stagnation, symptoms include fullness in the chest and ribs, belching, vomiting, diarrhea, or coughing, palpitations, or difficulty urinating, with a white tongue coating and wiry pulse. The treatment should open Yang and resolve stagnation, using Sijunzi Decoction. For Shaoyang heat stagnation, symptoms include body heat with sweating, facial dirtiness, dry and thick tongue coating, and slippery and rapid pulse. The treatment should clear heat and drain fire, using Baihu Decoction. For blood deficiency with internal cold, symptoms include cold body and pain, relief of pain with warmth, pale red tongue, thin white and moist coating, and thin pulse. The treatment should warm and nourish the blood vessels, expel cold and harmonize Ying, using Danggui Sijunzi Decoction. If there is internal cold for a long time, with cold pain in the lower abdomen, or dry vomiting, or foamy saliva, add Wuzhuyu and Shengjiang to warm the liver and stomach, dispel cold and descend Qi. For Yang deficiency with internal cold, symptoms include cold pain in the lower back and knees, or diarrhea with clear stools, or joint pain, pale tongue with thin white coating, and deep pulse. The treatment should restore Yang and rescue from reversal or warm Yang and dispel cold, using Sijunzi Decoction or Fuzheng Decoction.3. Excessive Yang Qi is a Pathological State Strong Yang Qi is a pathological state, not a normal state. As stated in line 247: “The pulse of the foot Yang is floating and rough; floating indicates strong stomach Qi, and rough indicates frequent urination; floating and rough together lead to hard stools, indicating that the spleen is constrained.” A floating pulse in the foot Yang indicates strong stomach Qi; when stomach Qi is strong, spleen Qi is relatively weak, leading to disharmony between the spleen and stomach. “The spleen governs the stomach’s movement of its fluids” (from the Huangdi Neijing). If the spleen and stomach are not harmonious, the spleen cannot move the stomach’s fluids, leading to frequent urination and hard stools. Similarly, if Ying and Wei are not harmonious, Ying Qi is relatively weak; “when Yin is weak, sweating occurs spontaneously, and when Yang is floating, heat occurs spontaneously,” which is the pathogenesis explained in the “Shanghan Lun,” indicating that the pulse is floating, fever, and sweating occur due to weak Ying and strong Wei. When Ying Yin is weak, spontaneous sweating occurs, which is similar to the frequent urination seen with weak spleen Yin; both spontaneous sweating and frequent urination are pathological phenomena of “Yang being strong and unable to contain, leading to the exhaustion of Yin Qi” (from the Huangdi Neijing), meaning that excessive Yang Qi forces Yin Qi to leak out, and the pathogenesis is that Yin is weak and Yang is strong, leading to disharmony between Yin and Yang. The basic definition of Yin and Yang: the internal is Yin, the external is Yang; the lower is Yin, the upper is Yang. Therefore, excessive diarrhea indicates loss of Yin, and excessive sweating indicates loss of Yang. Loss of Yang indicates Yang deficiency. As stated in line 286: “In Shaoyin disease, the pulse is weak; sweating cannot be induced, as it is due to loss of Yang. If Yang is already deficient, and the pulse at the wrist is weak and rough, it cannot be purged.” Loss of Yang (Yang deficiency) presents in two forms: One is deficiency cold, as stated in line 38: “If there is no sweating and irritability, Da Qinglong Decoction is the main treatment; if the pulse is weak and sweating occurs with aversion to wind, it cannot be taken. If taken, it will lead to reversal, muscle twitching, and convulsions, which is a reversal.” Taking Da Qinglong Decoction when sweating leads to loss of Yang, resulting in a deficiency cold syndrome of Yang deficiency and reversal. The other is excess heat, as stated in line 111: “In Taiyang disease with wind, sweating is induced by fire. The evil wind is heated by fire, and blood and Qi overflow, losing their normal state, leading to mutual burning of both Yangs, resulting in yellowing of the body. When Yang is excessive, it leads to epistaxis, and when Yin is deficient, it leads to difficulty in urination. When both Yin and Yang are exhausted, the body becomes dry, with only head sweating, and the rest of the body remains dry. Symptoms include abdominal fullness, slight shortness of breath, dry mouth, and sore throat, or constipation; if prolonged, it leads to delirium, and in severe cases, it leads to convulsions, restlessness of hands and feet, and fidgeting with clothes and bed. If there is frequent urination, the person can be treated.” Taiyang wind with fire-induced sweating leads to loss of Yang, resulting in excess Yang and deficient Yin heat syndrome. Yang deficiency (loss of Yang) is easily understood as deficiency cold; Yang deficiency (loss of Yang) as excess heat is not easily understood. In fact, as long as one understands what Yang is, then the manifestations of Yang deficiency as deficiency cold and excess heat become easy to understand. What is Yang? The external is Yang, the upper is Yang. As the classics say, “Ying is in the pulse, Wei is in the pulse exterior,” Ying Qi in the pulse is Yin, and Wei Qi in the pulse exterior is Yang. “If the complexion is bright red, it indicates that Yang Qi is stagnated at the surface,” and “if the complexion is bright red, it indicates that blood is stagnated at the surface, and Yang Qi is also blood stagnated at the surface.” Line 46: “In Taiyang disease, the pulse is floating and tight, with no sweating, fever, and body pain, and if it does not resolve after eight or nine days, the exterior syndrome still exists, it is necessary to induce sweating. If the medicine has slightly reduced symptoms, and the person becomes irritable and has closed eyes, it is likely to lead to epistaxis, which indicates resolution. This is because Yang Qi is heavy.” Inducing irritability and closed eyes likely leads to epistaxis, indicating heavy Yang Qi, which is also blood stagnation at the surface. From the original text of the “Shanghan Lun,” it can be seen that the blood at the surface is Yang Qi. Therefore, loss of Yang indicates the loss of blood at the surface. Loss of blood at the surface leads to blood deficiency at the surface, losing the ability to return to the interior to rescue the Qi and blood of the interior, leading to increased cold in the interior, becoming a Shaoyin deficiency cold syndrome, as stated in line 38; if the interior is hot, it becomes a Yangming excess heat syndrome, as stated in line 111. Due to the different physical states of patients, if the interior is cold, inducing sweating and losing Yang will lead to a Shaoyin deficiency cold syndrome; if the interior is hot, inducing sweating and losing Yang will lead to a Yangming excess heat syndrome. As stated in line 124, the pulse is “weak and deep” indicating Yang deficiency, and the person becomes delirious, with a hard and full lower abdomen, and frequent urination indicates internal heat. The “Jinkui Yaolue” states that “when Yang Qi declines, it leads to madness,” which is also a Yang deficiency internal heat syndrome. The “Huangdi Neijing” states, “When Yang Qi is heavy and excessive above, moxibustion will lead to Yang Qi entering Yin, and if it enters, it will lead to paralysis; if it is bled, it will lead to Yang Qi being deficient, and if it is deficient, it will lead to madness.” Bled Yang Qi deficiency indicates that using stone needles or stone pieces to draw blood leads to deficiency of Qi at the surface, losing the ability to return to the interior, resulting in increased internal heat, leading to madness. From the discussions in the “Shanghan Lun” and the “Huangdi Neijing,” it can be seen that Yang Qi is the Qi at the surface, which is the Qi that moves outward from the interior; Yin Qi is the Qi within, which is the Qi that moves inward from the exterior. Therefore, strong stomach Qi indicates that there is excess Qi in the interior, leading to stagnation and blockage; strong Wei Qi indicates that there is excess Qi at the surface, leading to stagnation and blockage at the surface. Thus, formulas like Guizhi Decoction and Ma Huang Decoction are used to release the Qi at the surface to relieve stagnation. When surface stagnation is removed, Wei Qi changes from strong to balanced. The mechanism of action of Guizhi and Ma Huang is to deplete the external Qi, which is to deplete the excess Yang at the surface. Therefore, those with surface deficiency should be cautious when using Guizhi and Ma Huang formulas. As stated in the “Jinkui Yaolue,” Guizhi Lingwuwei Gancao Decoction removes Guizhi, adding Ganjiang and Xixin, because “when the Qi is low, it leads to more coughing and fullness in the chest.” When the Qi is low, it leads to more coughing and fullness in the chest, indicating that the upper is deficient and the chest is cold, hence Guizhi is removed and Ganjiang and Xixin are added. Line 111 states, “When Yang is excessive, it leads to epistaxis,” which is due to fire-induced sweating leading to excessive Yang evil, not excessive Yang Qi. As the “Huangdi Neijing” states, “When the strong fire Qi declines, the weak fire Qi becomes strong. Strong fire consumes Qi, and Qi consumes weak fire. Strong fire disperses Qi, and weak fire generates Qi.”
