Inheriting the fire of Qi Huang, a public account with substance and warmth.
Ai Yu Xiang Tang
The “Huangdi Neijing” (Yellow Emperor’s Inner Canon) is one of the four classic texts of Traditional Chinese Medicine (TCM) (the “Huangdi Neijing”, “Nanjing”, “Shanghan Zabing Lun”, and “Shennong Bencao Jing”). It is the earliest existing medical classic in our country’s medical treasure trove. Theoretically, it established the “Yin-Yang and Five Elements Theory”, “Pulse Theory”, and “Zangxiang Theory” in TCM. It is divided into two parts: “Lingshu” and “Suwen”, traditionally attributed to the Yellow Emperor Xuanyuan, passed down orally through generations, and later supplemented and developed by physicians and medical theorists, culminating in written form during the Spring and Autumn and Warring States periods. Through dialogues and Q&A between the Yellow Emperor, Qi Bo, and Lei Gong, it elucidates the mechanisms and pathology of diseases while advocating for the treatment of diseases before they occur, as well as promoting health preservation, longevity, and vitality. It is indeed the outline of TCM!
【Summary】 As long as it is a problem with the tendons, treating the liver is correct.As long as it is a problem with the bones, treating the kidneys is correct.As long as it is a problem with the muscles, treating the spleen and stomach is correct.As long as it is a problem with the blood vessels, treating the heart is correct.As long as it is a problem with skin diseases and hair, treating the lungs is correct.【Five Organs】 1. Heart: The heart is the residence of the spirit, the master of blood, and the root of the pulse. It belongs to fire in the Five Elements; physiological functions: ① governs blood vessels; ② governs consciousness; the heart opens to the tongue, connects with the pulse in the body, its manifestation is on the face, in emotions it corresponds to joy, and in fluids, it corresponds to sweat. The heart and small intestine are interrelated.2. Lung: The lung is the place of the corporeal soul, the master of qi, belonging to metal in the Five Elements; physiological functions: ① governs qi and controls respiration; ② governs the dispersing and descending of qi; ③ regulates the water pathways; ④ governs the hundred vessels and regulates their flow (stagnation); assists the heart in regulating the circulation of qi and blood; the lung connects to the throat, manifests on the skin, its manifestation is in hair, opens to the nose, in emotions it corresponds to worry, and in fluids, it corresponds to mucus; the lung and large intestine are interrelated.3. Spleen: The spleen is the source of qi and blood transformation, the foundation of postnatal life, and stores intention, belonging to earth in the Five Elements. Physiological functions: ① governs transportation and transformation; ② governs the rising of clear qi; ③ governs the containment of blood; opens to the mouth, connects with the flesh, governs the four limbs, its manifestation is on the lips, in emotions it corresponds to thought, and in fluids, it corresponds to saliva; the spleen and stomach are interrelated.4. Liver: The liver is the place of the ethereal soul, the storehouse of blood, and the root of tendons. It belongs to wood in the Five Elements, governing the rising and movement. Physiological functions: ① governs the smooth flow of qi; ② stores blood; opens to the eyes, connects with the tendons, its manifestation is in the nails, in emotions it corresponds to anger, and in fluids, it corresponds to tears; the liver and gallbladder are interrelated.5. Kidney: The kidney is the foundation of pre-natal essence, stores will, and the waist is the organ of the kidneys, belonging to water in the Five Elements; physiological functions: ① stores essence, governs growth, development, and reproduction; ② governs water; ③ governs the reception of qi; in the body, it corresponds to bones, governs the production of marrow, its manifestation is in hair, opens to the ears and the two yin (anus and perineum), in emotions it corresponds to fear, and in fluids, it corresponds to saliva; the kidney and bladder are interrelated.【Six Bowels】 1. Gallbladder: Physiological function: stores and excretes bile, the gallbladder governs decision-making.2. Stomach: Physiological function: receives and digests food and drink, the stomach descends to harmonize.3. Small intestine: Physiological function: governs the reception and transformation of substances, separates the clear from the turbid, “the small intestine governs fluids”.4. Large intestine: Physiological function: transmits and transforms waste, the large intestine governs fluids.5. Bladder: Physiological function: stores and excretes urine, relying on the kidney’s qi transformation function.6. San Jiao: Physiological function: facilitates the flow of original qi, governs the qi mechanism and transformation, and serves as the pathway for the movement of water and fluids.【Twelve Meridians Flow】 In one day, there are twelve time periods, each corresponding to a meridian, connecting end to end, like a loop without end. Mastering your own body means mastering the secret to longevity and health!Midnight: 23:00-1:00 Gallbladder Meridian: Deep sleep! The gallbladder needs metabolism; when a person sleeps at midnight, the gallbladder can complete its metabolism. At this time, the heart’s function is weakest, so if there are heart patients, prepare the emergency heart pill.Chou time: 1:00-3:00 Liver Meridian: Deep sleep! This is the best time for liver repair; the waste blood needs to be eliminated, and fresh blood needs to be produced, completed during this time. One must enter deep sleep to provide the liver with sufficient energy. If one does not sleep, the liver continues to output energy to support thinking and actions, making it impossible to complete metabolism, leading to liver disease.Yin time: 3:00-5:00 Corresponding Meridian: Lung Meridian: The transformation of yin and yang begins at this moment, transitioning from yin to yang. The human body also enters a time of yang flourishing and yin declining. At this moment, the lung meridian is most active. The liver provides blood to the lungs, which then distributes it throughout the body. At this time, the body requires a large amount of oxygen. Patients with lung diseases such as asthma should take their medication during this time for better efficacy than during the day.Yin time: 5:00-7:00 Large Intestine Meridian: Bowel movement! Drink a cup of warm water before defecation. At this moment, the large intestine meridian is vigorous, absorbing moisture and nutrients from food and expelling waste.Chen time: 7:00-9:00 Stomach Meridian: Don’t forget to have breakfast! At this time, gastric acid is continuously secreted; if one goes hungry for too long, it can lead to gastric ulcers, gastritis, duodenitis, and cholecystitis!Si time: 9:00-11:00 Spleen Meridian: Drink water! (Drink more water at this time) The spleen is the overall coordinator of digestion, absorption, and excretion. The spleen is the foundation of postnatal life. To nourish the spleen: barley, red bean, and yam porridge. Throughout the day, drink about 2000ml of water, approximately five bottles of mineral water, and continue to drink; do not drink any beverages.Wu time: 11:00-13:00 Heart Meridian: Take a short nap. The heart drives blood circulation, nourishes the spirit, qi, and tendons. A short nap can greatly benefit heart health, allowing one to be energetic in the afternoon and evening. *Napping should not exceed 30 minutes, as it may disrupt sleep and lead to insomnia at night.Wei time: 13:00-15:00 Small Intestine Meridian: The small intestine meridian adjusts the nutrition of the body throughout the day. If there is heat in the small intestine, the body will burp and pass gas. Therefore, lunch should be eaten before 1:00 PM to ensure that nutrients are absorbed into the body.Shen time: 15:00-17:00 Bladder Meridian: Urination! The bladder expels fluids from the body. If there is heat in the bladder, it can cause bladder cough, which is coughing and involuntary urination. The bladder is most active, so it is suitable to drink more water. At this time, do not hold urine, as it can lead to “urinary retention”.You time: 17:00-19:00 Kidney Meridian: The kidneys are the essence of reproduction and the essence of the five organs and six bowels. The kidneys are the root of pre-natal essence. After Shen time, the body expels fire and detoxifies, and the kidneys enter the time of storing essence. This is a time for men. For those with kidney function issues, massaging the kidney meridian at this time is most effective.Xu time: 19:00-21:00 Pericardium Meridian: At this moment, create conditions for peaceful sleep. Maintain a calm mindset.Hai time: 21:00-23:00 San Jiao Meridian: Time to sleep! This is when the San Jiao, the largest organ, operates, governing all qi and unblocking the water pathways. At Hai time, the San Jiao connects with the hundred vessels. One can rest and recuperate.Mechanism Analysis1. Adhere to the mechanisms of disease, each in its own categoryWhen studying diseases, it is essential to grasp the mechanisms of onset—whether they belong to a specific organ or are caused by cold or heat.The nineteen mechanisms of disease can generally be summarized into two aspects: the mechanisms of the five organs (heart, liver, spleen, lung, kidney, upper, lower) and the mechanisms of the six qi (fire, heat, wind, cold, damp). The mechanisms of the five organs refer to their locations of disease, while the mechanisms of the six qi refer to their nature. The location of disease must have a corresponding nature, and the nature of disease cannot be separated from its location. Therefore, the mechanisms of the five organs are nothing but the changes of the six qi, and the changes of the six qi are pathological responses resulting from the imbalance of qi, blood, yin, and yang in the organs.For example, “all types of syncope belong to the lower”.Syncope can be divided into two types: one refers to the cold limbs due to the imbalance of yin, yang, qi, and blood. The other refers to fainting, where one loses consciousness. This is mostly related to liver and kidney changes. “Solid” refers to the inability to pass urine and stool. “Diarrhea” refers to the inability to hold urine and stool (some believe that solid and diarrhea refer to bowel movements). Solid and diarrhea are mostly related to changes in the large intestine, bladder, and kidneys, thus also belonging to the lower jiao.First, let’s discuss syncope.1. Cold SyncopeCold limbs, pale complexion, cold sweat occasionally, spirit is weak, and expression is dull, pulse is deep and thin. It can be divided into cold syncope and heat syncope.1. Cold SyncopeDue to the internal accumulation of cold, the yang qi is weak below, and the cold accumulation obstructs blood flow. The weakness of yang qi leads to an inability to warm and transport, resulting in cold syncope. The treatment should warm the center and disperse cold. Use Si Ni San with modifications for treatment.2. Heat SyncopeCommon in high fever diseases, excessive heat burns and consumes fluids, leading to a decline in yin qi below, while yang qi is overly vigorous. Extreme yang leads to counter-cold, with internal heat and external cold, resulting in sudden cold limbs and sweating. As stated in the “Shanghan Lun”, “if there is heat in the front, there must be syncope in the back; if the syncope is deep, the heat is also deep”. Symptoms include chest and abdominal heat, delirium, thirst, initial heat followed by syncope, red tongue, and rapid or deep and slow pulse. The treatment should revive yang and rescue the emergency, clear heat and detoxify. Use Shenfu Decoction with Huanglian, Huangqin, Muli, Longgu, etc. for treatment.2. FaintingRefers to sudden loss of consciousness, cold limbs, but with a chance of gradual awakening. The causes of this condition are numerous. The “Huangdi Neijing” records types of fainting such as violent fainting, boiling fainting, thin fainting, and corpse fainting. There are also qi fainting, blood fainting, pale fainting, and worm fainting. All are caused by the disorder of qi and blood, divided into deficiency and excess types.1. Excess Type① Liver Yang Excess: Violent anger harms the liver, liver qi reverses, blood follows qi upwards, qi and blood are obstructed, obscuring the clear yang. As stated in the “Suwen: Theory of Vitality”, “great anger leads to the cessation of qi, and blood accumulates above, causing fainting”. Clinical symptoms include sudden fainting, loss of consciousness, clenched teeth, purple lips, and red face, with a wiry pulse. First, use pungent and cool herbs to open the orifices, such as An Gong Niu Huang Wan, then use blood-activating and qi-regulating methods, such as Tong Yu Decoction (from “Jingyue Quanshu”) with Tianma, Gouteng, and Shijue Ming to treat.② Phlegm Turbidity Obstruction: Usually, there is excessive phlegm, and due to anger, qi reverses, phlegm rises with qi, obstructing the clear orifices, leading to sudden fainting, accompanied by phlegm sounds in the throat, foaming at the mouth, cold limbs, white and slippery tongue coating, and deep and slippery pulse. The treatment should move qi and resolve phlegm, using Guo Phlegm Decoction with Bai Jiezhi, Shichangpu, etc.③ Heat and Dampness: Usually, there is yin deficiency and yang excess, and exposure to heat and dampness disturbs the clear yang, leading to sudden fainting. As stated in the “Suwen: Theory of Vitality”, “yang qi, when overworked, becomes exhausted, accumulating in summer, causing fainting”. First, use An Gong Niu Huang Wan to open the orifices with pungent and cool herbs, and after awakening, use San Wu Xiangru Decoction with Dan Nanxing, Shichangpu, Huangqin, etc. to clear heat and benefit qi.2. Deficiency Type① Blood Deficiency Fainting: Seen in cases of excessive blood loss, qi follows blood loss, unable to ascend to the head, leading to fainting. Clinical symptoms include loss of consciousness, pale complexion, pale tongue, and deep and thin pulse. The treatment should use Ren Shen Yang Rong Tang to tonify qi and blood.② Qi Deficiency Fainting: Due to deficiency of the source element, insufficient original qi, or qi deficiency leading to downward descent, clear yang fails to rise, resulting in sudden fainting, pale complexion, sweating, and cold limbs, with a deep and weak pulse. First, use Shenfu Decoction to tonify qi and revive yang, then use Ba Zhen Tang to tonify both qi and blood.3. Solid and Diarrhea1. Clinical Analysis of ConstipationConstipation formation mainly occurs in the large intestine. As stated in the “Suwen: Linglan Secret Classic”, “the large intestine is the organ of transmission, where transformation occurs”. It is also related to the spleen, stomach, and small intestine. The food and drink undergo fermentation in the stomach, transformation in the spleen, and separation of clear and turbid in the small intestine, with the waste transmitted to the large intestine, where water is absorbed to form stool. Therefore, the “Lingshu: Nutritional Health” states, “food and drink reside in the stomach, forming waste, and both descend to the large intestine”. If there is cold or heat in the large intestine, its function may be either excessive or deficient, affecting stool formation. Additionally, during the process of food and drink transformation, the spleen, stomach, and small intestine are involved, and any dysfunction or invasion of external pathogens can affect stool formation.① Heat Constipation: Due to heat accumulation in the stomach and intestines, or during the course of a febrile disease, or residual heat after a febrile disease, which scorches fluids, leading to dryness in the intestines and resulting in constipation. Symptoms may include fever, red face, bad breath, dry throat, short and red urine, yellow and dry tongue coating, and a strong and forceful pulse. The treatment should use Ma Zi Ren Wan to clear heat and moisten the intestines.② Cold Constipation: Due to yang deficiency or cold in the organs, intestinal qi stagnation, internal cold, and failure of yang qi to move, leading to dryness in the intestines, resulting in difficult bowel movements, clear and long urine, pale tongue, and a deep and slow pulse. The treatment should warm the intestines and expel cold, using Wen Zhong Tang with Da Huang, adding warming and moistening herbs such as Dang Gui, Rou Cong Rong, and Xing Ren.③ Deficiency Constipation: Due to dryness of blood and fluids or prolonged illness leading to qi deficiency, resulting in weak transmission. Those with blood deficiency often have a pale complexion and may feel dizzy and have palpitations. Those with qi deficiency may have a pale complexion, shortness of breath, and sweating. For blood deficiency, use Run Chang Wan to nourish blood and moisten the intestines (see “Shen’s Respect for Life Book”). For qi deficiency, use Huang Qi Tang to benefit qi and moisten the intestines (see “Jin Kui Yi”).Analysis: Due to intestinal obstruction, clear qi fails to rise, turbid qi fails to descend, clear and turbid mix, obstructing the intestines, leading to abdominal distension, hard and painful stools, and accompanied by loss of appetite, vomiting, white and greasy tongue coating, and a tight pulse. The treatment should use Mang Xiao Tong Jie Tang to open the obstruction.2. Clinical Analysis of DiarrheaDiarrhea is like water leaking, the force is gentle, while diarrhea is direct and urgent, with slight differences, clinically referred to as diarrhea. Diarrhea is also related to changes in the functions of the spleen, stomach, large intestine, and small intestine, or the invasion of wind, cold, and dampness, affecting digestive function, especially dampness is the most important. As stated in the “Huangdi Neijing”, “excessive dampness leads to leakage”; excessive dampness harms the spleen, and water and dampness fail to transform, leading to diarrhea, while spleen yang relies on the fire of life to warm; insufficient fire can also lead to diarrhea.① Food Diarrhea: Due to spleen deficiency and liver excess, the spleen governs transformation, and the liver governs smooth flow. If the liver is excessive, it invades the spleen, and if the spleen is deficient, it fails to transform, leading to undigested food and diarrhea. Clinical symptoms often include watery stools, undifferentiated food, abdominal distension, and intermittent pain and diarrhea, with pain not relieved after defecation. The treatment should use the Painful Diarrhea Formula with additions of Ge Gen and Sheng Ma to support the spleen and suppress the liver.② Damp-Heat Diarrhea: Often due to overeating or consuming spoiled food, damaging the spleen and stomach, leading to spleen deficiency and dampness stagnation, food accumulation transforms into heat, damp-heat accumulates and descends into the large intestine, resulting in diarrhea. Clinical symptoms include loose stools, foul-smelling, intermittent pain and diarrhea, burning sensation in the anus, and may be accompanied by fever, yellow and thick tongue coating, and a rapid pulse. The treatment should use Qin Lian Ge Gen Tang to clear heat and drain dampness.③ Cold-Damp Diarrhea: Due to the invasion of cold and dampness, harming the spleen and stomach, obstructing the spleen’s healthy function, leading to the failure to differentiate clear and turbid, and running into the large intestine, resulting in diarrhea. Clinical symptoms include watery stools, black and clear like water, with some formed stools resembling duck droppings, accompanied by clear and long urine, and cold limbs. The treatment should use Fuzi Lizhong Tang combined with Pingwei San to warm the center, dispel cold, strengthen the spleen, and drain dampness.④ Damp Diarrhea (also known as watery diarrhea): Usually due to spleen deficiency, and then encountering dampness, leading to internal stagnation of water and dampness, resulting in diarrhea. Clinical symptoms include watery stools, shooting out like water, color like muddy water, no abdominal pain, accompanied by heaviness and chest tightness, and reduced urination. The treatment should use Weiling Tang to warm the spleen, dry dampness, and promote urination.⑤ Slippery Diarrhea: Due to qi deficiency leading to downward descent, the large intestine becomes slippery, and qi fails to restrain. Clinical symptoms include both food and fluids passing down, diarrhea like a torrent, no abdominal pain, with intermittent occurrences, and lingering symptoms. The treatment should use Buzhong Yiqi Tang with additions of He Zi and Rou Dou Kou to tonify the center and prevent descent.⑥ Early Morning Diarrhea: Due to the decline of the life fire, the fire fails to warm the earth, and the transformation is weak, occurring at dawn when yang qi should rise but has not yet risen, and the extreme yin qi invades the large intestine, leading to diarrhea. Clinical symptoms include early morning bowel sounds and diarrhea, with relief after defecation, cold limbs, pale tongue, and deep and thin pulse. The treatment should use Si Shen Wan to warm and tonify the life fire.3. Clinical Analysis of Urinary RetentionRetention also includes urinary retention. Retention refers to difficulty urinating, with a slow onset; closure refers to the desire to urinate but being unable to do so, with bladder distension and urgency, and a more acute condition. They are often referred to together as retention and closure. The occurrence of retention and closure mainly involves the kidneys and bladder.As stated in the “Suwen: Linglan Secret Classic”, “the bladder is the organ of the state, where fluids are stored, and when qi transforms, it can be expelled”. Due to damp-heat in the bladder or obstruction in the bladder, the bladder loses its function of storing fluids, leading to urinary retention. However, the root of qi transformation lies in the kidneys, which govern the two yin and control qi transformation. When kidney yang is deficient, qi transformation fails, and the opening and closing functions are abnormal, leading to urinary retention. Additionally, difficulty urinating is closely related to the spleen and lungs; the lungs are the upper source of water. If heat obstructs the lungs, the lungs fail to clear and regulate fluids, preventing them from descending to the bladder, which can also lead to urinary retention. The spleen is the middle state, governing the transformation of water and dampness; if heat accumulates, the circulation of fluids is obstructed, preventing fluids from descending to the bladder, resulting in urinary retention.① Lung Heat Qi Obstruction: Clinical symptoms include dripping urination, yellow and red color, accompanied by fever, shortness of breath, dry throat, thin yellow tongue coating, and rapid pulse. The treatment should use Qing Fei Yin to clear lung heat and promote urination.② Damp-Heat Accumulation in the Middle Jiao: Due to damp-heat accumulation in the middle jiao, the San Jiao water pathways are obstructed, and qi transformation fails, leading to difficulty urinating. Often accompanied by abdominal distension and thirst. Damp-heat steaming the skin may also lead to yellowing of the face, thick yellow tongue coating, and slippery and rapid pulse. The treatment should use Yin Chen Wu Ling San to clear heat, strengthen the spleen, and drain dampness.③ Damp-Heat Accumulation in the Bladder: Due to damp-heat accumulation in the bladder, obstructing qi transformation, clinical symptoms include difficulty urinating, abdominal distension, bladder urgency, thirst, red tongue, thick yellow tongue coating, and rapid pulse. The treatment should use Ba Zheng San to clear heat, drain dampness, and promote urination.④ Kidney Yang Deficiency: Due to insufficient life fire, qi transformation fails, and clear fluids cannot rise while turbid fluids cannot descend to the bladder, leading to oliguria and urinary retention. Often accompanied by sore lower back and weak knees; if water overflows the skin, it leads to edema, pale tongue, and deep and thin pulse. The treatment should use Ba Wei Wan or You Gui Yin to warm yang and promote water.⑤ Bladder Obstruction: Due to blood stasis and failure of essence, obstructing the lower jiao, leading to difficulty urinating, or urination in a thin stream, or urine containing sand and stones, often accompanied by painful urination and lower abdominal pain. The treatment should use Ba Zheng San combined with Shi Wei San with modifications (Jinqian Cao, Bian Xu, Qu Mai, Shi Wei, Dong Kui Zi, Hai Jin Sha, Huai Niu Xi, Ji Nei Jin) to clear heat, drain dampness, and promote urination. For those with blood in the urine, add Xiaoci and Huanlian Cao.2. Those who have it seek it, and those who do not have it seek itAfter the original text of the nineteen mechanisms of disease in the “Suwen: The True Essentials of the Great Discussion”, there is a passage stating, “Adhere to the mechanisms of disease, each in its own category; those who have it seek it, and those who do not have it seek it”. The first two sentences have been analyzed above, and it is not difficult to understand what “those who have it seek it, and those who do not have it seek it” means. I believe this sentence is a further summary and extension of the nineteen mechanisms of disease. Clinical analysis must grasp the mechanisms of onset—whether the nature of the disease is cold or heat, and whether the location is upper or lower, and also study the symptoms that have appeared and those that are about to appear.Here, we can take a few examples of the mechanisms of disease caused by fire from the nineteen mechanisms.1. All types of heat, dizziness, and convulsions belong to fireDizziness refers to unclear vision, and severe dizziness leads to a feeling of heaviness in the heart, accompanied by varying degrees of mental disturbance. Convulsions refer to muscle and tendon stiffness and spasms. This sentence indicates that high fever, mental confusion, stiffness, and convulsions are mostly related to the mechanism of heat. Zhang Jingyue believes that “heat evil harms the spirit, leading to dizziness, and excessive yang harms the blood, leading to convulsions”, all caused by excessive heat.Why does excessive heat lead to mental disturbances and convulsions? The head is the meeting place of all yang and the residence of the six spirits; when the clear yang rises to the head, the spirit is clear and the vision is bright. If excessive heat rushes upwards, disturbing the clear yang, it leads to mental confusion and dizziness. This is often seen in severe cases of excess heat. In warm diseases, it is often due to heat entering the nutrient blood, and the evil transmitting to the heart protector. The heart protector has the function of replacing the heart in governing the spirit, and the heart governs clarity; thus, the evil transmitting to the heart protector can disturb the spirit, leading to mental confusion and disturbances. Excessive heat burns and consumes fluids, leading to blood dryness and fluid deficiency, which in turn fails to nourish the tendons, causing stiffness and convulsions.Clinical manifestations include:① Excessive heat and yang: External invasion of summer heat, or prolonged external evil transforming into fire, excessive heat burns and rushes upwards, leading to symptoms such as agitation, delirium, and mental confusion. Accompanied by high fever, red tongue, yellow and dry tongue coating, and a strong and rapid pulse. Excessive heat harms the blood, and the tendons lose nourishment, leading to convulsions. The treatment should use Huanglian Jiedu Tang to clear the heart and drain fire. If jaundice occurs due to damp-heat, it is advisable to add Yin Chen, Bai Jiang Cao, Water Buffalo Horn, Xuan Shen, and Peony Root to clear heat, drain dampness, and reduce jaundice.② Qi and nutrient heat: Evil invading during warm diseases, clinical symptoms include high fever and delirium, red tongue, and convulsions. Heat injures the blood vessels and may lead to rashes; the treatment should use Qingying Tang with modifications to clear the heart, open the orifices, and cool the nutrient blood.③ Heat causing liver wind: High fever burns, extreme heat transforms into fire, and wind assists, disturbing the clear yang, leading to mental confusion. Excessive heat and wind lead to convulsions, and severe cases may present with opisthotonos, red tongue, and wiry and rapid pulse. The treatment should use Qingwen Baidu San with modifications to clear heat, drain fire, and calm the liver.2. All types of restrictions, such as mouth closure and fear, belong to fire“Restriction” refers to the inability to open the mouth, teeth clenched, and inability to speak clearly. “Fear” refers to shivering and trembling. “Restriction” refers to the inability to open the mouth. “Fear” refers to anxiety and restlessness, where the spirit is not in control. This clause indicates that if symptoms such as mouth closure, trembling, and anxiety appear, the mechanism of the disease is mostly related to fire.These symptoms often manifest before high fever, during the stage of conflict between righteousness and evil, when the external evil invades the body, and the evil desires to penetrate, while the righteous desires to resist the evil, leading to a struggle between yin and yang, with external yin evil prevailing, and yang qi being restrained, leading to symptoms such as mouth closure, trembling, and anxiety. When yang prevails and yin retreats, the yang qi is released, leading to heat. As stated in the “Suwen: Malaria Theory”, “it starts at the hair, and then the body aches, with trembling and shivering, and when the cold leaves, both inside and outside become hot, with a headache like breaking, and a thirst for cold drinks”. During the time of excessive heat, the disturbance of the spirit leads to feelings of anxiety and restlessness. This is often seen in the stage of conflict between righteousness and evil before high fever.3. All types of upward counterflow belong to fireVarious symptoms of upward counterflow are mostly related to heat. “Counterflow” refers to the reversal of direction, while “upward counterflow” means sudden upward movement. The functions of the organs and bowels in the human body have specific directions of operation, known as “qi mechanism”. If the qi mechanism is disordered, it is termed “qi counterflow”; for example, if stomach qi counterflows, it leads to vomiting, belching, and hiccups; if liver qi counterflows, it leads to liver fire rising and liver yang excess; if lung qi counterflows, it leads to coughing and wheezing… Among the symptoms listed above, only some are caused by heat. However, “excess qi is fire”; fire is a yang evil, with heat signs, and its nature is upward. Fire evil breaking counterflow can cause qi to reverse and rise as a disease. For example, under physiological conditions, the qi of the lung and stomach descends smoothly; if subjected to fire evil, it can cause qi to reverse and rise as a disease.Clinical analysis:① Vomiting: The mechanism is generally due to stomach qi counterflow, divided into excess heat and deficiency cold types. If fire evil rises, it belongs to excess heat, and vomiting often occurs suddenly or immediately after eating, with a strong force and loud sound, yellow tongue coating, and a large pulse. The treatment should clear heat, descend counterflow, and stop vomiting.② Belching: The disease belongs to stomach qi deficiency and cold, with qi stagnation and poor flow, leading to abnormal transformation. If it is due to fire, phlegm and fire may be excessive in the stomach, leading to foul-smelling belching, accompanied by abdominal distension. The treatment should use Er Chen Tang with Chuan Huanglian to clear fire, descend counterflow, and resolve phlegm; it may also be seen in cases of overeating, often belching after meals, accompanied by sour swallowing and noisy stomach sounds. The treatment should tonify the spleen and harmonize the stomach, aiding digestion and descending counterflow.③ Hiccups: If the condition is due to heat, it is often due to internal heat of the yangming, with constipation, and stomach qi counterflow. Clinical symptoms include strong hiccups, the treatment should use Zhuye Shigao Tang to clear the stomach and descend counterflow. If the condition is due to deficiency cold, it is often seen in spleen and kidney yang deficiency, with counterflow of qi, low and weak hiccups, and the condition is often severe. The treatment should tonify the spleen and kidney, harmonize the stomach, and descend counterflow, using Xuanfu Dai Zhe Tang with additions of Fuzi, Ganjiang, and Wuzhuyu.4. All types of agitation and mania belong to fire“Agitation” refers to restlessness, with hands and feet in turmoil, and internal and external unrest. It differs from “annoyance”, which refers to anger in the chest without external manifestation, but both involve abnormal spirit. “Mania” refers to wild and unrestrained behavior, with little sleep and unrest, often caused by phlegm-fire disturbance and unsettled spirit.Clinical analysis:① Phlegm-fire disturbing the heart: Due to emotional distress, phlegm transforms into fire, burning fluids and generating phlegm, which obstructs the heart orifices, leading to mania. Clinical symptoms include unpredictable crying and laughing, incoherent speech, singing loudly, and running away, often seen in schizophrenia or manic-depressive disorders. The treatment should use Longshi Guo Phlegm Wan combined with Qingxin Wan to clear the heart, resolve phlegm, and open the orifices.② Heat disturbing the spirit: Often seen during the course of warm diseases, with excess heat disturbing the spirit, such as yangming interior excess, abdominal fullness, dry constipation, agitation, delirium, and even wandering and restlessness, with yellow tongue coating and rapid pulse. The treatment should use Da Chengqi Tang with modifications to drain heat and preserve yin. If the warm evil reverses to the heart protector, disturbing the spirit, leading to agitation, delirium, and mental confusion, accompanied by thirst, red tongue, yellow coating, and rapid pulse. The treatment should use Qingying Tang to clear the heart and open the orifices, cooling the blood and detoxifying.5. All types of swelling, pain, and fright belong to fire“Swelling” has two interpretations: ① edema, ② swelling of the dorsum of the foot. The “Dictionary of Words” records: “Swelling refers to the foot.” “Pain” refers to pain that is not severe but difficult to describe. This clause is more appropriate for swelling of the dorsum of the foot, as “edema” has already been discussed in “All types of damp swelling belong to the spleen”, so it should not be repeated, and swelling due to edema is rare. Therefore, it can be interpreted as swelling of the dorsum of the foot accompanied by pain, heat, and even fright.Unexplained swelling and pain of the dorsum of the foot, even with heat and fright, are often due to internal accumulation of heat, stagnation of qi and blood, mostly belonging to surgical diseases.In the mechanism of “all types of restrictions belong to fire”, the appearance of symptoms such as mouth closure and trembling is due to the struggle between yin and yang, where yang desires to express, and yin desires to restrain, leading to a temporary phenomenon where yang is overwhelmed by yin. However, as the disease progresses, what symptoms will appear? The fire evil disturbing the spirit will lead to feelings of heaviness and confusion. Or due to heat damaging fluids, leading to dryness and fluid deficiency, resulting in stiffness and convulsions. Additionally, it is possible that fire heat will lead to symptoms of “agitation and mania”.Therefore, Zhang Ji believes that each of the nineteen mechanisms of disease only illustrates one aspect of symptoms, and does not comprehensively discuss the mechanism of “fire”. Thus, it is necessary to study why this symptom appears and what other symptoms may arise, hence the phrase “those who have it seek it, and those who do not have it seek it”. This encourages a comprehensive analysis and understanding of the mechanisms of disease, rather than isolating one aspect for consideration.This article is excerpted from “Acupuncture and Medicine for the World: Zhang Ji”【Conclusion】 The basic spirit and main content of the “Huangdi Neijing” include: holistic concepts, yin-yang and five elements, zangxiang and meridians, etiology and pathogenesis, diagnostic methods and treatment principles, prevention and health preservation, and the theory of qi and climate. The “holistic concept” emphasizes that the human body and nature are a whole, and that the structure of the body and its various parts are interconnected. The “yin-yang and five elements” theory explains the relationship of opposition and unity between things. The “zangxiang and meridians” study the physiological functions, pathological changes, and interrelationships of the five organs and six bowels, twelve meridians, and eight extraordinary meridians.The “etiology and pathogenesis” elucidates the internal mechanisms of disease occurrence and change after various pathogenic factors act on the human body. The “diagnostic methods and treatment principles” are the basic principles of TCM for understanding and treating diseases. The “prevention and health preservation” systematically expounds the theories of health preservation in TCM, summarizing important experiences in disease prevention. The “theory of qi and climate” studies the impact of natural climate on human physiology and pathology, and uses this as a basis to guide people in seeking benefits and avoiding harm.This is for clinical reference only; non-professional doctors should not attempt acupuncture or medication.
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Ai Yu Xiang Tang
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