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Article 338
The pulse is weak and there is cold extremities; after seven or eight days, the skin is cold, and the person is restless without any moment of peace. This is called organ cold, not intestinal cold. In intestinal cold, the person should vomit the intestinal contents. The patient should be kept calm, but if they become agitated again, this indicates organ cold. The cold rises to the diaphragm, causing agitation; it may stop momentarily, but if they eat, they will vomit again, and if they are agitated, it indicates that the intestinal contents are reacting to the smell of food. In cases of intestinal cold, the Wu Mei Wan (Mume Pill) is the main treatment. It also treats prolonged diarrhea.
The first sentence indicates a weak pulse, which signifies deficiency; the cold extremities indicate severe deficiency. The ‘organ’ mentioned refers to the stomach, which in ancient terms refers to the spleen and stomach. After seven or eight days, the skin becomes cold, indicating that not only the limbs are cold, but also the protective and nutritive qi is not functioning, leading to cold skin all over the body. The person is restless without any moment of peace; this restlessness is the worst! As we discussed earlier, restlessness indicates excess heat, and this person is overwhelmed by evil qi, unable to resist it. If the person is only restless and not agitated, this is the worst condition. Moreover, the absence of any moment of peace indicates organ cold, a type of cold qi deficiency. This implies a critical condition. This is what we discussed earlier regarding the failure of stomach qi, which cannot be classified as intestinal cold. It is evident that intestinal cold is a manifestation of the Jueyin disease, where the stomach qi has truly decayed and is no longer functioning.
Now we discuss intestinal cold, where the person should (self) vomit the intestinal contents. This intestinal cold not only requires vomiting, but the patient should also be kept calm. If the patient’s qi is not severely deficient, they may be very calm, without the restlessness mentioned earlier. Why do they sometimes become agitated again? This indicates organ cold, which means there is cold in the stomach. This cold attacks upwards, similar to what we discussed regarding the Jueyin disease outline. This is organ cold; the cold rises and attacks the diaphragm, forcing the intestinal contents to move upwards, causing agitation. This is the nature of the agitation; it is brief and may stop momentarily. When the cold does not rise as much, the agitation ceases. Unlike the previously mentioned organ cold, where the stomach qi has decayed, leading to constant agitation rather than mere restlessness. Why is vomiting necessary? If they eat, they will vomit. This indicates that the intestinal contents have moved to the diaphragm; upon smelling food, they react and move upwards, causing nausea and vomiting. The person often self-vomits the intestinal contents. Therefore, intestinal cold is indeed vastly different from organ cold. Intestinal cold can be treated with Wu Mei Wan. It also treats prolonged diarrhea. The Wu Mei (Mume) is not only effective for intestinal cold but can also be used for conditions of deficiency and cold.
This section is well articulated. I am discussing Jueyin disease, but this Jueyin disease has no symptoms of thirst; it does not align with the outline. Therefore, Zhang Zhongjing emphasizes this stage of cold extremities and its relation to Jueyin disease, and he provides a specific treatment for intestinal cold. If we place this at the beginning of the Jueyin disease outline, it does not fit together, indicating that this outline and this section were not created by the same person. This formula is excellent; it truly treats prolonged diarrhea due to deficiency and cold, and it also has a certain effect on expelling intestinal contents. It requires the use of warming herbs such as Fu Zi (Aconite), Shu Jiao (Sichuan Pepper), Gan Jiang (Dried Ginger), and Xi Xin (Asarum) to warm the middle and dispel cold, as the stomach yang is not functioning. Additionally, Huang Lian (Coptis) and Huang Bai (Phellodendron) are used to resolve agitation and treat counterflow. Although Huang Lian and Huang Bai are bitter and cold herbs, they are drying and can treat diarrhea. Diarrhea rarely requires the use of Qiang Lian (Scutellaria) and Lian Qiao (Forsythia), and they also help with agitation. Although they are drying, they can alleviate agitation. The main issue is that the stomach is not functioning well; the stomach is deficient, and the blood is also deficient. We discussed earlier that Jueyin disease involves deficiency of body fluids and blood. This deficiency of body fluids and blood cannot support the stomach. Therefore, we use these warming herbs, and we also add Ren Shen (Ginseng) for blood support, and Dang Gui (Angelica) to nourish qi and blood. This is still centered around strengthening the stomach. The most remarkable aspect is Wu Mei, which is the main herb. Wu Mei is a sour herb that has astringent properties; it is used in large quantities. The sourness can alleviate thirst, and Wu Mei is a sour astringent herb that can stop thirst. However, it does not treat thirst due to diabetes. Additionally, this sour astringent property can control the warming herbs like Xi Xin, Gan Jiang, Fu Zi, and Shu Jiao, preventing them from dispersing too much. This is important for treating yin deficiency; excessive dispersal is not good, as it can lead to excessive sweating. Wu Mei can also restrain excessive dispersal, and when combined with Qiang Lian, it can better treat diarrhea. Wu Mei is an excellent remedy for diarrhea. Therefore, it is used as the monarch herb, serving multiple purposes. Furthermore, it is made into pills with honey, which also nourishes and supplements deficiency. Although this formula uses both cold and hot herbs, they do not interfere with each other. This is an ancient formula; it is not like modern practices where any heat illness immediately requires cold herbs. In ancient times, they based their formulas on extensive practice. This formula is effective for prolonged diarrhea; you can try it, but do not use decoctions; pills are more effective. Of course, this formula can also be used for cold extremities and vomiting intestinal contents.
Today’s discussion ends here; it is very interesting. The more we discuss, the clearer it becomes, and we can see that this is unrelated to Jueyin disease. However, the earlier parts are still related. We discuss cold extremities, which are not solely related to Jueyin disease. For instance, heat extremities indicate that there is no heat in yin disease. Heat disease does not have yin symptoms; this is what his book states. Therefore, heat extremities are certainly not related to Jueyin. This discussion of symptoms and treatments is somewhat related to Jueyin disease. Although it is said to treat cold extremities, this type of cold extremity requires the use of this treatment. However, the symptoms and treatments align with Jueyin. Therefore, the intention behind this is profound. Everyone should take a look. Class dismissed.
There are many discussions regarding cold extremities in this section, 528? pages. Today, we must finish discussing cold extremities. In June, we will complete the discussion. (In July, it will be hot, and you won’t be able to discuss it; your body won’t be able to handle it.)
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