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10. Abdominal Fullness, Cold Hernia, and Food Retention Disease Pulse Diagnosis and Treatment
Original Text: “The pulse at the Fu Yang (足阳) position is weak and wiry; it indicates abdominal fullness. If there is no fullness, there will be difficulty in defecation, and pain in both sides of the abdomen. This is due to deficiency cold rising from below. One should use warming herbs for treatment.”
The Fu Yang pulse refers to the spleen and stomach pulse. A weak pulse indicates deficiency, while a wiry pulse is similar to a tight pulse, indicating cold excess. Since the stomach is deficient and cold, it leads to abdominal fullness. Because of the stomach deficiency, cold rises to attack upwards, causing pain in both sides (the hypochondria), and qi rises instead of descending, leading to difficulty in defecation. Warming herbs should be used, which is a double entendre; for abdominal fullness, warming herbs are also needed, and for cold attacking upwards, warming herbs are required. What warming herbs should be used? It is not specified.
Original Text: “If the patient has abdominal fullness, pressing it does not cause pain, indicating deficiency; if it hurts, it indicates excess, and one can purge it. If the tongue is yellow and has not been purged, the yellow will naturally go away after purging. If abdominal fullness decreases and then returns, this indicates cold, and warming herbs should be used.”
Abdominal fullness can be either excess or deficiency. If pressing causes pain, it indicates excess in the stomach; if there is no pain, it indicates deficiency. Excess can be purged, while deficiency cannot be purged.
A yellow tongue coating is a symptom of internal excess. After purging, if the excess is resolved, the abdominal fullness will disappear, and the yellow tongue coating will naturally resolve. Here, two diagnostic patterns are presented: pressing and tongue coating. It does not specify how to treat specifically. The previous section discussed deficiency and excess, and the next part continues with “If abdominal fullness decreases and then returns, this indicates cold, and warming herbs should be used.” This belongs to cold, and warming herbs should be used.
Original Text: “If the patient is emaciated and yellow, restless but not thirsty, with cold excess in the chest, and continuous diarrhea, they will die.”
“Restless” should refer to dryness; “chest” should be “abdomen”; these two characters may have been copied incorrectly. “If the patient is emaciated and yellow, restless but not thirsty,” dry and not thirsty indicates heat excess in Yangming disease, while restless but not thirsty indicates cold excess in Taiyin. “Continuous diarrhea without thirst belongs to Taiyin,” as there is cold inside, and no fluids are produced, food is not digested, qi is not generated, and the mouth is dry, but due to the cold, there is no thirst, which is a sign of cold excess. If diarrhea does not stop, it indicates collapse, leading to death.
Original Text: “If the pulse at the cun kou (寸口) position is wiry, it indicates pain and tightness under the ribs, and the person is fearful of cold.”
The pain under the ribs mentioned above is similar to the symptoms of Xiao Chai Hu Tang (小柴胡汤). This also has a wiry pulse, which does not necessarily indicate cold; it refers to Shaoyang disease.
The wiry pulse at the cun kou position, pain and tightness under the ribs, fullness in the chest and ribs, indicates that the evil has entered the Shaoyang. However, “the person is fearful of cold” indicates that the exterior has not resolved, and both Taiyang and Shaoyang are affected, indicating that the internal cold is from the exterior, transmitted from the exterior to half interior and can also transmit to the interior.
Original Text: “In cases of middle cold, the person yawns, has clear nasal discharge, and experiences fever and swelling.”
Middle cold refers to being affected by wind-cold. Yawning is common. When initially affected by wind-cold, not only do they yawn, but they also sneeze. If it has not reached the interior, it can only cause obstruction in the nine orifices, hence the yawning and sneezing, indicating that it is real and in the exterior.
Original Text: “In cases of middle cold, the person has diarrhea due to internal deficiency, and desires to sneeze but cannot; this indicates cold in the abdomen.”
In cases of middle cold, due to internal deficiency, cold takes advantage of the deficiency and invades the interior, leading to diarrhea. At this point, it has left the exterior, and they no longer sneeze, hence “desires to sneeze but cannot; this indicates cold in the abdomen.” These are all principles.
Original Text: “In cases of emaciated individuals with pain around the navel, there must be wind-cold, and food qi is not moving. If purged, the qi will surely rise; if it does not rise, there will be fullness under the heart.”
Individuals with internal cold and dampness will experience pain around the navel. Both cold and heat can cause pain, especially cold. Emaciated individuals with pain around the navel make sense; understanding these sentences together is sufficient. Such cases can only use warming herbs. If the doctor purges, the cold will rise further, or even if it has not reached the stage of rising qi, there will definitely be fullness under the heart (referring to Gan Cao Xie Xin (甘草泻心), Ban Xia Xie Xin (半夏泻心), etc.). The above repeatedly discusses differentiation of syndromes.
Original Text: “If the patient has abdominal fullness, fever for ten days, a floating and rapid pulse, and normal appetite, Hou Po Qi Wu Tang (厚朴七物汤) is indicated.”
Abdominal fullness with fever is a manifestation of Yangming disease, with fever lasting for about ten days, but the pulse is floating and rapid, which is also a pulse of Taiyang disease; the disease is still in the exterior. Using Gui Zhi (桂枝) to replace Shao Yao (芍药) due to qi rising, removes Shao Yao to resolve the exterior, while Hou Po treats the interior, addressing both exterior and interior. The article is quite exquisite; to study the Golden Chamber, one should first be familiar with the Treatise on Cold Damage. As for the modifications after this formula, they should not be made; if there is vomiting, add Ban Xia (半夏), which is acceptable. If there is diarrhea, remove Da Huang (大黄); how can there be diarrhea? True diarrhea with abdominal fullness is definitely not excess fullness; if it were excess fullness, there would be no reason to remove Da Huang, so this is nonsense. If there is much cold, add Sheng Jiang (生姜) up to half a pound; if there is much cold, Hou Po Qi Wu Tang cannot be used, which is also nonsense.
At this point, the treatment of abdominal fullness is complete, but there is no treatment for deficiency fullness; it only states that warming herbs should be used in principle. In the Treatise on Cold Damage, if there is diarrhea and abdominal fullness, along with body pain, one should rescue the interior using Si Ni Tang (四逆汤). Deficiency cold abdominal fullness cannot be treated by rescuing the interior first; this is one. Secondly, in the Treatise on Cold Damage, Ban Xia Hou Po Sheng Jiang Gan Cao Ren Shen Tang (半夏厚朴生姜甘草人参汤) is also a warming tonic for the stomach and relieves fullness. Although there are no formulas for deficiency cold in the book, they can certainly be applied according to the syndrome. In summary, use warming herbs, such as Si Ni Tang (四逆汤), Wu Yao Tang (吴茱萸汤), etc., which are warming herbs. For example, in the case of abdominal fullness, adding a relieving herb is also acceptable, such as adding Hou Po (厚朴) and Zhi Shi (枳实) for vomiting and headache with abdominal fullness.
This book discusses the principles briefly, hence it is called the Essentials of the Golden Chamber.
Original Text: “If there is cold qi in the abdomen, with thunder-like pain, fullness in the chest and ribs, vomiting, Fu Zi Jiang Mi Tang (附子粳米汤) is indicated.”
Cold qi in the abdomen, along with water qi, causes bowel sounds and pain. This formula treats cold hernia; it is not just for cold hernia, but can also be used for general deficiency cold abdominal pain. Fu Zi (附子) dispels cold. For cold hernia, merely dispelling cold is not enough. Cold hernia includes many diseases; the first is small intestine hernia, where the body is weak, and the tissues are lax, causing a part of the intestine to drop down, resulting in severe pain, known as small intestine hernia. There may also be a piece of fat stuck there, causing pain; this is not related to cold, but mainly due to deficiency. Using Fu Zi (附子) and Wu Tou (乌头) can revitalize the tissues. Another type of hernia pain is severe pain that does not occur daily but is easily triggered by cold. There is also intestinal obstruction, where the intestines are lax, and during hernia pain, the limbs become cold, indicating a state of deficiency cold. This is an organic disease change, not just a cold issue. Worm hernia, especially roundworms, can cause pain when they enter the bile duct; ancient people called this worm hernia, and Da Jian Zhong Tang (大建中汤) should be used, which includes Shu Jiao (蜀椒) and others. Worms encounter Shu Jiao and Gan Jiang (干姜) and often come out. This cold hernia, combined with modern issues like intestinal obstruction and intestinal folding, is essentially intestinal blockage. Western medicine would immediately perform surgery, but Chinese medicine does not. Fu Zi Jiang Mi Tang has the effect of treating cold hernia. Ban Xia (半夏) dispels water to treat vomiting, while Fu Zi revitalizes the functions that have declined, tightening the laxity. This effect does not necessarily mean it is warming; using other warming herbs is not effective. Gan Cao (甘草), Da Zao (大枣), and Jiang Mi (粳米) are all sweet and mild pain-relieving herbs.
Original Text: “If there is pain and closure, Hou Po San Wu Tang (厚朴三物汤) is indicated.”
Pain, abdominal fullness, and constipation. Use Hou Po San Wu Tang, which consists of Hou Po (厚朴), Zhi Shi (枳实), and Da Huang (大黄). This formula is similar to Xiao Cheng Qi Tang (小承气汤), but the quantities of Hou Po and Zhi Shi are increased. This formula is primarily based on Hou Po, while Xiao Cheng Qi Tang is primarily based on Da Huang.
Original Text: “If pressing the heart area causes fullness and pain, this indicates excess; one should purge it, and Da Chai Hu Tang (大柴胡汤) is appropriate.”
This fullness specifically refers to the heart area, which is different from Cheng Qi Tang (承气汤). The Chai Hu formula is located between the ribs and the heart. Symptoms of Da Chai Hu Tang include vomiting, fullness in the chest and ribs, which is certainly present, but this fullness is in the heart area, between the ribs, not below. Pressing the abdomen does not cause much pain; using Cheng Qi Tang is ineffective, and using San Wu Hou Po Tang is also ineffective.
Original Text: “If abdominal fullness does not decrease, and the decrease is insignificant, one must purge it; Da Cheng Qi Tang (大承气汤) is indicated.”
The previous section states, “If abdominal fullness decreases and then returns, this indicates cold,” which is not excess; of course, it cannot be purged. If abdominal fullness does not decrease, even if there is some decrease, it is insignificant; one must purge it, indicating it is excess. Deficiency cold is formless, with nothing present, while this excess has something, indicating that it is a dry accumulation in that area. Therefore, one must purge it, and Da Cheng Qi Tang is indicated. The term “should” is not the same as “must”; it implies that based on the actual situation, Da Cheng Qi Tang should be used for a strong attack. Sometimes, Xiao Cheng Qi Tang or San Wu Hou Po Tang may suffice.
Next, we will study cold hernia. Cold hernia is a very important disease.
Original Text: “If there is severe cold pain in the chest and abdomen, vomiting, inability to eat, cold in the abdomen, and swelling of the skin, Da Jian Zhong Tang (大建中汤) is indicated.”
“Severe cold pain in the chest and abdomen” indicates cold attacking the heart and chest, causing severe cold pain. “Vomiting and inability to eat” indicates that there is cold and fluid in the stomach, preventing food intake. This severe cold in the stomach and intestines stimulates the stomach and intestines, causing the abdominal skin to move, with irregular rising and falling, creating lumps that feel like they have heads and feet, causing pain that cannot be touched. This refers to the so-called cold hernia, and Da Jian Zhong Tang is indicated. Da Jian Zhong Tang is different from Xiao Jian Zhong Tang (小建中汤); it is a great warming formula, using both Gan Jiang and Shu Jiao, while also providing great nourishment with Ren Shen (人参). Xiao Jian Zhong Tang is based on Gui Zhi Tang (桂枝汤), which resolves the exterior while adding the bitter cold Shao Yao (芍药). Da Jian Zhong Tang does not include Shao Yao. Additionally, it includes Yi Tang (饴糖), which can relieve pain. It is important to note that Gan Jiang treats vomiting, and both Gan Jiang and Fu Zi are great warming herbs; Gan Jiang is particularly effective for treating upper issues, so it must cause vomiting. Xiao Jian Zhong Tang does not cause vomiting; “if there is vomiting, it cannot be treated with Jian Zhong” refers to Xiao Jian Zhong Tang. This formula is used when there is significant cold and vomiting, and the heart and abdomen feel cold and painful. It does not necessarily have to have swelling of the skin; this medicine can be used. It is important to exclude heat; heat herbs are not suitable for treating heat conditions.
Original Text: “If there is lateral pain under the ribs, fever, and the pulse is tight and wiry, this indicates cold; warming herbs should be used to purge it, and Da Huang Fu Zi Tang (大黄附子汤) is indicated.”
“Lateral pain under the ribs” indicates pain on one side; this formula does not only treat lateral pain but is effective for any lateral pain. Ancient people believed that this disease is due to cold excess; heat can also cause excess, and cold can also cause excess.
A tight and wiry pulse indicates cold; a tight pulse indicates excess, while a wiry pulse indicates cold. For example, in Taiyang disease, a floating and tight pulse indicates excess, while a sinking and tight pulse indicates internal excess with much cold, which should be treated with warming herbs. Deficiency cold cannot be purged, and cold excess must be attacked, but warming herbs should be used to attack, hence Da Huang Fu Zi Tang is indicated. In clinical practice, it is often encountered that joint pain is biased to one side; generally, Gui Zhi Jia Shu Fu (桂枝加术附) is used. If the pain is biased to one side, Da Huang can be added, but the amount of Da Huang does not need to be large, especially in cases of bone hyperplasia, which often has lateral pain. Da Huang Fu Zi Tang consists of Da Huang, Fu Zi, and Xiao Xin (细辛), where both Fu Zi and Xiao Xin are warming herbs that dispel cold, while Da Huang is a purging herb. How to differentiate true cold excess? Ancient people derived a rule: any lateral pain is considered cold excess, so warming herbs should be used to purge it. Any lateral pain with a tight and wiry pulse indicates cold excess, and warming herbs can be used to purge it, such as Da Huang Fu Zi Xiao Xin Tang, but do not limit it to these few herbs. If it is joint pain on one side, add Shao Yao and Gan Cao (甘草).
Original Text: “If there is cold qi and reversal, Chi Wan (赤丸) is indicated.”
This is too brief and may be incorrect. However, we should look at this formula and infer from it. The cold qi mentioned here is the same as the cold qi discussed in Fu Zi Jiang Mi Tang, which includes both cold and water qi, causing abdominal pain, and the limbs to feel cold and reversed. Chi Wan is indicated. Based on the herbs, it includes Fu Ling (茯苓) and Ban Xia, which dispel water, while Wu Tou and Xiao Xin are warming herbs that dispel cold. Therefore, there is both cold and water qi, abdominal pain, and cold limbs, indicating a reversal of cold. This is likely the situation. It is important to note that Ban Xia and Wu Tou are opposites; pharmacies do not allow them to be mixed, but ancient people used them this way without issues. Ban Xia can be used with Fu Zi, and using Chuan Wu (川乌) is fine, but using Cao Wu (草乌) is another matter.
Original Text: “If there is abdominal pain, with a wiry and tight pulse, a wiry pulse indicates that the defensive qi is not moving, and there is aversion to cold; a tight pulse indicates a lack of appetite. The evil and the righteous are clashing, indicating cold hernia. Cold hernia with pain around the navel, if it occurs, will cause white fluid to come out, and the hands and feet will feel cold. If the pulse is sinking and tight, Da Wu Tou Jian (大乌头煎) is indicated.”
Abdominal pain with a wiry and tight pulse indicates both cold and excess. A tight pulse indicates that the defensive qi is not moving, and a tight pulse indicates a lack of appetite. The cold evil is strong, and the stomach is deficient, causing the cold evil to rise to the upper abdomen, leading to severe abdominal pain. “Cold hernia with pain around the navel” indicates that if it occurs, it will cause cold sweat to come out, and the hands and feet will feel cold. If the pulse is sinking and tight, Da Wu Tou Jian is indicated, which is the strongest formula for treating cold hernia. “Do not take it twice a day.”
Using a large amount of Wu Tou can cause significant side effects, including dizziness and even vomiting. Honey decoction can relieve pain and detoxify Wu Tou.
Original Text: “For cold hernia with abdominal pain and lateral pain, Dang Gui Sheng Jiang Yang Rou Tang (当归生姜羊肉汤) is indicated.”
Lateral pain indicates deficiency. “Abdominal pain and lateral pain” indicates pain in both the abdomen and lateral sides, and the feeling of urgency indicates that there is not only cold but also blood deficiency. Dang Gui Sheng Jiang Yang Rou Tang is indicated. This formula is not commonly used, but it can occasionally be used to nourish blood. For cold hernia with abdominal pain, this is not good; Da Wu Tou Mi Jian is better.
Original Text: “For cold hernia with abdominal pain, reversal of cold, numbness in the hands and feet, and if there is body pain, acupuncture and herbs cannot treat it, Di Dang Wu Tou Gui Zhi Tang (抵当乌头桂枝汤) is indicated.”
This again refers to cold hernia with abdominal pain. “Reversal of cold, numbness in the hands and feet” indicates that the hands and feet do not feel pain or itch, or they feel tight. “Body pain” indicates that there is cold hernia in the interior, abdominal pain, and external pain, indicating that it is still in the exterior. “Acupuncture and herbs cannot treat it” indicates that it cannot be treated with general acupuncture or formulas; it must be treated with Di Dang Wu Tou Gui Zhi Tang.
This formula combines Gui Zhi Tang and Wu Tou Mi Jian, using Gui Zhi Tang to resolve the exterior and Wu Tou Mi Jian to resolve the internal cold hernia.
The previous section discussed small intestine hernia, where the tissues are lax, and the small intestine drops into the scrotum, causing severe pain. This formula can also treat it. As for intestinal obstruction, intestinal folding, or twisting, this formula is also effective. Ancient people referred to cold as a symptom; whether the symptom itself is cold is another matter. Chinese medicine emphasizes differentiation of syndromes; differentiation does not mean that there is a pool of cold inside. There was a report of a child eating melon seeds, which led to intestinal obstruction; this is certainly not a cold issue. However, the pain from intestinal obstruction aligns with the symptoms of cold hernia in Chinese medicine. Regardless of whether there is cold inside, it can be used and is effective. The effects of Fu Zi and Wu Tou can restore the laxity of the tissues to normal function. Once the function is restored, if the intestines are folded, they will open up, returning to their original state, thus preventing obstruction. Our previous understanding of Fu Zi and Wu Tou was limited; we only thought they were warming, but they also have the effect of restoring physiological functions, especially metabolic functions. For example, in cases of heart failure leading to no pulse, Fu Zi also plays a role; Si Ni Tang and Tong Mai Si Ni Tang are examples. This is not only for treating cold; it also strengthens the heart. Therefore, the effects of Fu Zi and Wu Tou are twofold: they are warming, and they can promote the recovery of physiological functions that have declined.
Original Text: “If the pulse is rapid and tight, it is wiry, resembling a bowstring; if pressed, it does not move. If the pulse is rapid and wiry, one should purge the cold; if the pulse is tight and large, there must be hardness under the heart; if the pulse is large and tight, there is yin within yang, and it can be purged.”
This section should not be here, or it may be entirely incorrect. This should be placed under Da Huang Fu Zi Tang, discussing the pulse. It states, “If the pulse is rapid and tight,” tight and wiry pulses are indistinguishable. If the pulse is both rapid and tight, it becomes wiry. “If pressed, it does not move” is a manifestation of a wiry pulse. “If the pulse is rapid and wiry, one should purge the cold; if the pulse is tight and large, there must be hardness under the heart; if the pulse is large and tight, there is yin within yang, and it can be purged.”
This section discusses cold hernia and specific treatments; placing this paragraph here is meaningless. It may have been added later, or it may be a later commentary on pulse diagnosis, especially from Wang Shuhe, who specialized in pulse diagnosis. If it is from the original text, it should be placed after or before the section on Da Huang Fu Zi Tang. The following additional formulas are also likely added later.
11. Five Organs Wind-Cold Accumulation Disease Pulse Diagnosis and Treatment
Ancient people believed that the cause of diseases is wind-cold, which is problematic. However, based on a comprehensive reading of Zhang Zhongjing’s writings, it does not seem to be his handwriting, as his differentiation methods and principles do not align with this, suggesting that it may have been mixed with Wang Shuhe’s opinions.
Original Text: “If there is wind in the lungs, the mouth is dry and wheezing, the body feels heavy, and there is swelling.”
Ancient people believed that the lungs are connected to the skin and the exterior; this principle is certainly valid. For example, if there is an external pathogen, qi cannot reach the sides, and it must be borne by the lungs, leading to coughing and wheezing. Ancient people referred to this phenomenon as the lungs being connected to the skin, which is now understood as upper respiratory tract infection. “The body feels heavy and swollen” indicates that movement causes heaviness, and the body may swell, indicating dampness or water retention; “swelling” refers to dizziness, indicating that water is retained above (in the lungs), causing dizziness.
Original Text: “If there is cold in the lungs, it causes the expulsion of turbid phlegm.”
Cold in the lungs has been discussed in the context of lung atrophy and lung abscess. In that section, it was mentioned that “lung atrophy causes the expulsion of foamy saliva without coughing,” indicating that there is cold in the lungs. Cold indicates the presence of water, which does not originate in the lungs but rises from the stomach, or it may be due to stagnant fluids in the stomach that rise to the lungs, affecting them. Therefore, ancient people referred to this as cold in the lungs. This section also discusses cold in the lungs, leading to the expulsion of turbid phlegm, which is a sign of cold in the lungs.
Original Text: “If the lung is dead, the pulse is floating and weak, pressing it lightly feels like a scallion leaf, and if there is no root, the person will die.”
This discusses the pulse. The pulse of the five organs cannot be solely determined at the cun kou position; it must rely on the stomach qi. If the true lung pulse is visible, the person is destined to die; this is called “lung death.” If the floating pulse is present without any softening, it indicates that the person is destined to die. This is a true lung pulse, indicating that there is no stomach qi left.
This is mentioned in the Inner Canon, with similar wording. This concludes the discussion on the lungs, covering wind, cold, and the dead lung pulse.
Original Text: “If there is wind in the liver, the head and eyes tremble, there is pain in both sides, and the person often bends over.”
Ancient people believed that the liver governs wind; if wind is excessive, it causes movement, leading to head and eye tremors. Tremors are associated with the liver, but this is not definitive; it serves as a reference. Ancient people believed that wind is associated with heat, and wind is a yang evil. The liver governs the tendons; if there is heat, the tendons become lax, leading to a hunched posture.
Original Text: “If there is cold in the liver, the arms cannot be raised, the tongue is dry, the person sighs frequently, there is pain in the chest, and they cannot turn to the side; if they eat, they will vomit and sweat.”
“If there is cold in the liver, the arms cannot be raised” indicates that cold constricts and causes the tendons to become tight, leading to blood stasis and qi stagnation. “The tongue is dry, and the person sighs frequently” indicates liver stagnation. This has been discussed in the Yangming section, where it was mentioned that if one desires to rinse the mouth but not swallow, it indicates dryness in the mouth, which is due to blood stasis and qi stagnation. “Pain in the chest” indicates that cold qi is attacking upwards, which has been discussed in the context of chest obstruction. This leads to an inability to turn to the side. “If they eat, they will vomit and sweat” indicates that liver disease often affects the stomach; due to liver deficiency, it cannot control the strong stomach, leading to disharmony, resulting in vomiting after eating.
Original Text: “If the liver is dead, the pulse is floating and weak, pressing it feels like a rope that cannot be grasped, or it may be curved like a snake; this indicates death.”
“Liver death” is similar to “lung death”; if the true liver pulse is visible, the person is destined to die. The liver pulse cannot be seen independently; it must rely on stomach qi. If the floating pulse is present without any softening, it indicates that the person is destined to die. “Floating and weak” indicates that the pulse is soft and weak, and if pressed lightly, it feels like a rope that cannot be grasped. The liver pulse is typically a wiry pulse, which should be straight; if it is not straight, it indicates that the true liver pulse is present, indicating death.
Original Text: “If there is stagnation in the liver, the person often desires to step on their chest; before feeling pain, they desire to drink hot water; Xuan Fu Hua Tang (旋覆花汤) is indicated.”
This section mentions a disease called liver stagnation. Stagnation refers to obstruction; if the liver qi is stagnant, it leads to a feeling of oppression in the chest. “The person often desires to step on their chest” indicates that the liver qi desires to flow; if blood stagnates and qi is obstructed, it leads to a feeling of oppression, which is the opposite of the liver’s desire to flow.
“Before feeling pain, they desire to drink hot water” indicates that when the stomach is in pain, they desire to drink hot water. Xuan Fu Hua Tang is indicated, which consists of Xuan Fu Hua (旋覆花), Cong Bai (葱白), and Xin Jiang (新绛). This formula is used to promote qi and invigorate blood, relieving stagnation in the liver, which is appropriate. However, using this formula in gynecology is not appropriate (as it will be discussed later in gynecology). In gynecology, it is said that “women with bleeding and collapse” should not use qi-promoting herbs.
Original Text: “If there is wind in the heart, there is a feeling of heat, and the person cannot rise; they feel hungry, and if they eat, they will vomit.”
This heart wind indicates that wind affects the heart. “There is a feeling of heat, and the person cannot rise” indicates that this is an exterior symptom; the body feels pain, and heat injures qi, affecting the heart, leading to qi deficiency. If the heart is deficient, it feels hungry, but this does not refer to the stomach; there is a saying in the Inner Canon that “the heart is suspended, like being hungry.” The heart feels empty, indicating heart deficiency, and the heart is suspended, similar to the feeling of hunger. “If they eat, they will vomit” indicates that the stomach is also disturbed by heat.
Original Text: “If there is cold in the heart, the person suffers from a feeling of pain in the heart, which is severe, and if it is severe, it will cause pain in the back, like being poisoned. If the pulse is floating, they will vomit and recover.”
The heart is a fire organ; if it is bound by cold, heat accumulates internally, leading to a feeling of pain in the heart. “If it is severe, it will cause pain in the back, like being poisoned” indicates that the pain radiates from the heart to the back, causing severe pain. If the pulse is floating, they will vomit and recover. This is similar to the previous discussion on chest obstruction, which resembles modern angina pectoris. Warming herbs can be used, such as Gui Zhi Zhi Shi Sheng Jiang Gan Cao Tang (桂枝枳实生姜甘草汤), or Ban Xia Guo Lou Xie Bai Jiu (半夏栝篓薤白白酒), where Xie Bai (薤白) relieves pain, and Guo Lou (栝篓) is not a warming herb but is not a bitter cold herb either.
Original Text: “If the heart is injured, the person feels fatigued, with a red face and heavy lower body, heart pain, and restlessness, with fever, and the pulse is wiry; this is caused by heart injury.”
“Heart injury” indicates that it is neither due to wind nor cold, but rather due to internal injury. The heart governs fire; if the heart is deficient, yang easily moves, leading to fatigue and a red face. “Heavy lower body” indicates that heart qi is deficient and does not reach the lower body, causing the heart’s yang to be weak, leading to pain and restlessness. “The pulse is wiry” indicates that the pulse is tight, indicating that the heart is injured.
Original Text: “If the heart is dead, the pulse is floating and hard, pressing it feels like a round bean, and if pressed, it becomes more agitated; this indicates death.”
In summer, the heart pulse should be abundant, but it should not be overly abundant. If there is no softening, it is problematic; this is referred to as the true heart pulse. The true heart pulse is floating, indicating that it is hard and feels like a round bean, with no softening. “If pressed, it becomes more agitated; this indicates death.”
Original Text: “If evil crying causes the soul to be unsettled, it indicates a deficiency of blood and qi; if blood and qi are deficient, it belongs to the heart. If the heart qi is deficient, the person will be fearful, wanting to close their eyes and sleep, dreaming of distant journeys, and the spirit will be scattered, causing the soul to wander. If the yin qi is weak, it leads to epilepsy; if the yang qi is weak, it leads to mania.”
This continues from the previous section, where “evil crying” refers to inexplicable sadness, causing the soul to be unsettled. This situation indicates a deficiency of blood and qi, which is insufficient to nourish the heart, leading to the aforementioned symptoms. “If blood and qi are deficient, it belongs to the heart.” The previously discussed lily disease also indicates unsettled soul and blood deficiency, which also belongs to the heart. “If the heart qi is deficient, the person will be fearful,” as ancient people viewed the heart as the ruler of the body, leading to excessive fear and anxiety. “Wanting to close their eyes and sleep, dreaming of distant journeys” indicates that the spirit is scattered, and the soul wanders. “If the yin qi is weak, it leads to epilepsy; if the yang qi is weak, it leads to mania.” The yin qi refers to the blood aspect, leading to epilepsy due to blood deficiency, while the yang qi refers to the fluid aspect, leading to mania due to deficiency of qi.
The pulse is similar; within the blood vessels, it is the blood aspect, referred to as the nutrient aspect, while outside the blood vessels, it is the qi aspect, referred to as the fluid aspect. If the fluid aspect is deficient, it leads to hard stools and results in Yangming disease, leading to mania. For example, Tao He Cheng Qi Tang (桃核承气汤) and Di Dang Tang (抵当汤) are examples of internal excess. In the Treatise on Cold Damage, if the pulse is weak, it indicates a lack of yang; if the pulse is weak, it indicates a lack of qi. Later medical texts have overly simplified the concepts of yin and yang, equating yin with cold and yang with heat, which is incorrect.
Original Text: “If there is wind in the spleen, there is a feeling of heat, and the person appears drunk, with heaviness in the abdomen, and the skin and eyes tremble, with shortness of breath.”
The spleen governs the muscles; if there is wind in the spleen, it indicates that the muscles are not in harmony, leading to a feeling of heat, similar to that of wind-cold. “The person appears drunk” indicates vomiting and dizziness, which are signs of stagnant water. “Heaviness in the abdomen” indicates that there is internal fluid accumulation, leading to heaviness. This indicates that the spleen’s function of transporting fluids is impaired, leading to water accumulation, which can cause vomiting and pressure on the diaphragm, making breathing difficult, leading to dizziness. This will be discussed further in the section on water qi.
Original Text: “If the spleen is dead, the pulse is floating and hard, pressing it feels like an inverted cup, and if it trembles, it indicates death.”
The spleen pulse should be soft and weak. If it is “floating and hard,” it indicates that the pulse is hard and large. If pressed lightly, it feels like an inverted cup, indicating that there is no stomach qi left; this is the true spleen pulse, indicating death.
Original Text: “The pulse at the Fu Yang (趺阳) position is floating and rough; floating indicates strong stomach qi, while rough indicates frequent urination. Floating and rough pulse indicates that the large intestine is dry, leading to hard stools; this indicates that the spleen is deficient, and Ma Zi Ren Wan (麻子仁丸) is indicated.”
This is copied from the Yangming section. The Fu Yang pulse indicates the stomach; diagnosing stomach diseases can be done by examining the Fu Yang point. The Fu Yang pulse is floating and rough; floating indicates heat, not necessarily indicating the exterior, while stomach heat indicates strength; rough indicates deficiency of fluids. Why is there fluid deficiency? Because of frequent urination. These two issues combined are called “floating and rough pulse,” indicating that the fluids are deficient, leading to dry intestines and hard stools. This symptom is called spleen deficiency syndrome. Ma Zi Ren Wan is a modified Xiao Cheng Qi Tang (小承气汤) with the addition of Ma Zi Ren (麻仁), Shao Yao, and Xing Ren (杏仁), which are all nourishing and fluid-replenishing herbs, while also having a purging effect, treating Yangming disease. However, this Yangming heat is mild, not heat that is firmly established in the interior. Although the stools are hard, the person does not feel uncomfortable, and Ma Zi Ren Wan is suitable for treating habitual constipation, which is also applicable to elderly constipation. This formula is beneficial and does not cause harm; it does not have a purging effect.
Original Text: “If there is stagnation in the kidneys, the person feels heavy, with cold in the waist, as if sitting in water, and the body appears water-like, with no thirst, frequent urination, normal appetite; this disease belongs to the lower burner, with labor leading to sweating, and the clothes are cold and damp. If this persists, there will be cold pain below the waist, and the abdomen feels heavy like carrying five thousand coins; Gan Jiang Ling Zhu Tang (甘姜苓朮汤) is indicated.”
In the spleen, there is a middle wind, and in the kidneys, there is no cold or wind, so this is written incompletely. This “kidney stagnation” refers to the area of the waist, which is related to the kidneys. “The person feels heavy” indicates that there is dampness and water in the tissues. “Cold in the waist” indicates that water is in the stomach, causing cold in the back. “As if sitting in water” indicates that there is cold water present. Sometimes there may be slight edema, and sometimes there may not be.
The water qi disease indicates that water is generally associated with difficulty urinating and thirst; this is the opposite, as there is no thirst and frequent urination. Additionally, “normal appetite” indicates that the disease is not in the stomach, but rather in the lower burner. “Labor leading to sweating, and the clothes are cold and damp” indicates that this disease is common among laborers. Due to labor, they sweat and soak their clothes, and when they cool down, they feel cold and damp. If this persists, it will lead to cold pain below the waist, and the abdomen will feel heavy, as if carrying five thousand coins. This can be treated with Gan Jiang Ling Zhu Tang, which is effective. This formula consists of Gan Cao, Gan Jiang, and Ling Zhu, which warm the interior and dispel cold, while also treating frequent urination. If there is blood deficiency, it can be combined with Dang Gui (当归) and Shao Yao.
Original Text: “If the kidney is dead, the pulse is floating and hard, pressing it feels chaotic like rolling pills, and if it sinks to the wrist, it indicates death.”
The kidneys govern winter; the kidney pulse should be sinking. If it is “floating and hard,” it indicates that the pulse is hard. “Pressing it feels chaotic like rolling pills” indicates that it is very hard. “If it sinks to the wrist and is hard, it indicates death.” The true kidney pulse is visible, indicating death. This concludes the discussion on the five organs and wind-cold. This does not resemble Zhang Zhongjing’s tone, but there are some references worth considering, such as the treatment method for kidney stagnation being quite good.
Original Text: “Question: What does it mean when the three burners are exhausted, and the upper burner is exhausted, leading to belching?”
Teacher: “The upper burner receives qi from the middle burner, which is not harmonized, leading to an inability to digest food, hence the belching.”
“The lower burner is exhausted, leading to incontinence and loss of bowel control; the qi is not harmonized, leading to an inability to self-regulate. There is no need for treatment; it will improve over time.”
“The three burners are exhausted” refers to the exhaustion of the three burners in different areas. “The upper burner receives qi from the middle burner, which is not harmonized, leading to an inability to digest food, hence the belching.” If the qi of the middle burner is not harmonized, it cannot digest food and supply qi to the upper burner, leading to deficiency in the upper burner and causing belching.
“The lower burner is exhausted, leading to incontinence and loss of bowel control; the qi is not harmonized, leading to an inability to self-regulate. There is no need for treatment; it will improve over time.” The middle burner is the source of life; the lower burner also receives qi from the middle burner. If the lower burner is deficient, it leads to incontinence and loss of bowel control. This does not require treatment; it will improve over time.
Original Text: “Teacher: If there is heat in the upper burner, it leads to coughing and lung atrophy; if there is heat in the middle burner, it leads to hardness; if there is heat in the lower burner, it leads to blood in the urine, which can also cause difficulty in urination. If there is cold in the large intestine, it leads to diarrhea; if there is heat, it leads to constipation. If there is cold in the small intestine, it leads to heavy stools with blood; if there is heat, it leads to hemorrhoids.”
“Teacher: If there is heat in the upper burner, it leads to coughing and lung atrophy; this has been discussed previously. If there is heat in the middle burner, it leads to hardness, indicating that the stomach is overheated, leading to hard stools and Yangming disease. If there is heat in the lower burner, it leads to blood in the urine, which can also cause difficulty in urination. If there is cold in the large intestine, it leads to diarrhea; if there is heat, it leads to constipation. If there is cold in the small intestine, it leads to heavy stools with blood; if there is heat, it leads to hemorrhoids. This summarizes the conditions of the three burners and their associated symptoms.”
Original Text: “Question: What does it mean when there is accumulation, aggregation, and food qi?”
Teacher: “Accumulation refers to organ disease, which does not move; aggregation refers to bowel disease, which occurs intermittently, causing pain to shift and is treatable. Food qi refers to pain under the ribs, which resolves with pressure and recurs, indicating digestive issues.”
Original Text: “The major methods for accumulation: if the pulse is fine and attached to the bone, it indicates accumulation. If the pulse is at the cun kou position, it indicates accumulation in the chest; if it slightly exceeds the cun kou position, it indicates accumulation in the throat; if it is at the upper guan position, it indicates accumulation in the abdomen; if it is slightly below the guan position, it indicates accumulation in the lower abdomen; if it is at the chi position, it indicates accumulation in the qi. If the pulse is on the left, it indicates accumulation on the left; if the pulse is on the right, it indicates accumulation on the right; if the pulse is on both sides, it indicates accumulation in the center. Each should be treated according to its location.”
“If there is accumulation, aggregation, and food qi, the teacher explains that accumulation refers to organ disease, which does not move; aggregation refers to bowel disease, which occurs intermittently, causing pain to shift and is treatable. Food qi refers to pain under the ribs, which resolves with pressure and recurs, indicating digestive issues.”
“The major methods for accumulation: if the pulse is fine and attached to the bone, it indicates accumulation. If the pulse is at the cun kou position, it indicates accumulation in the chest; if it slightly exceeds the cun kou position, it indicates accumulation in the throat; if it is at the upper guan position, it indicates accumulation in the abdomen; if it is slightly below the guan position, it indicates accumulation in the lower abdomen; if it is at the chi position, it indicates accumulation in the qi. If the pulse is on the left, it indicates accumulation on the left; if the pulse is on the right, it indicates accumulation on the right; if the pulse is on both sides, it indicates accumulation in the center. Each should be treated according to its location.”
