This lesson I shared several of my clinical secret prescriptions, without reservation, laying it all out, this is the teacher’s attitude towards students.[Original Text] Damp-heat syndrome for three to four days leads to locked jaw, limbs being pulled and stiff, and in severe cases, the body bends backward. This is due to damp-heat invading the meridians and collaterals, and it is advisable to use fresh Di Long (Earthworm), Qin Jiao (Gentiana macrophylla), Wei Ling Xian (Clematis), Hua Shi (Talc), Cang Er Zi (Xanthium), Si Gua Teng (Luffa), Hai Feng Teng (Cayratia), and Jiu Chao Huang Lian (Stir-fried Coptis) among others.Self-note: This entry refers to dampness combined with wind; wind is the energy of wood, and when wind moves, wood expands. If it enters the Yangming meridian, it leads to locked jaw, and if it invades the Taiyin channel, it causes stiffness. Therefore, the medicine not only overcomes dampness but also emphasizes the use of wind-relieving herbs. One reason is that wind herbs can overcome dampness, and another is that wind herbs can soothe the liver. The selection of Di Long and various vines is intended to promote the flow through the meridians. Some may ask, regarding Zhang Zhongjing’s treatment of spasms, there are indeed Gui Zhi (Cinnamon Twig) plus Gua Lou Gen (Trichosanthes) and Ge Gen Tang (Kudzu Decoction). Is it not suitable for ancient times but not for today? Today’s spasms are connected with syncope; Zhang Zhongjing did not believe in syncope, could it be that the Jin Kui has omitted texts? I say, no, the medicine is used according to the disease; since the source of the disease is different, the treatment method must also differ. The spasms from cold damage come from the outside, and the treatment focuses on dispersing external pathogens, while the spasms from damp-heat arise from within, affecting the Taiyang, and the treatment focuses on calming internal wind. The three jiaos and the liver and gallbladder share the same fire. If the middle jiao’s damp-heat is unresolved, then heat accumulates internally, and the fire becomes strong, leading to movement and the generation of wind, causing muscle spasms and rapid pulse. Wind stirs the fire, leading to confusion and disorientation, and the body’s energy rises with the wind and fire, with no descent, resulting in a complete loss of normalcy, making the body appear like a corpse. The internal classic states that blood and qi both rise, leading to violent syncope. If it invades the meridians externally, it leads to spasms; if it invades the center, it leads to syncope. Spasms and syncope often appear together; if the righteous qi still exists, then qi can recover and regenerate. If the stomach’s fluids cannot support, then syncope does not return and death ensues. Therefore, spasms and syncope are often connected. The spasms from cold damage come from the outside; how can this be so? In the hot months, the spasms arise from the same source as cholera. Wind arises from fire, and when fire emerges, it follows the wind into the Yangming, leading to vomiting, and if it invades the Taiyin, it leads to diarrhea, which is called cholera. If it invades the muscles, it causes stiffness, and if it flows into the meridians, it leads to spasms. However, spasms often have syncope, while cholera has little syncope. This is because spasms are caused by wind and fire being blocked and stagnant, and the stagnation leads to more severe evil forces, which inevitably confuses the spirit. Therefore, there is often syncope. Cholera, on the other hand, allows wind and fire to leak out, and when it leaks, the evil force resolves externally, thus leading to little syncope. This is the distinction between spasms and cholera. However, the evil stagnation in the three jiaos leads to stagnation, and the three jiaos are responsible for transformation. When wind gains fire, it stirs and forces into the center, leading to violent syncope. Cholera’s evil runs through the spleen and stomach, and the spleen and stomach are responsible for damp transformation. If the evil lingers due to dampness, it leads to stagnation and stiffness. Fire stagnation leads to syncope, and fire running leads to spasms. Thus, the aftermath of spasms and syncope is also due to damp-heat generating wind. The turning of muscles in cholera is due to wind overcoming dampness. Spasms arise from the meridians affecting the organs, while cholera arises from the organs affecting the meridians, both stemming from damp-heat and wind, confusing the clear and turbid, leading to abnormal rising and falling. If there is more dampness and less heat, then wind enters the earth, causing cholera. If there is more heat and less dampness, then wind rides the three jiaos, leading to spasms and syncope. If syncope does not return, it leads to death, as the stomach’s fluids dry up, and the fire evil occupies. If the turning of muscles enters the abdomen, it leads to death, as the stomach’s fluids are depleted, and the wind evil is strong. Therefore, the fluids in the stomach are of great concern. For syncope, use pungent herbs to open and drain the invisible evil in the chest. For dry cholera, use emetics to drain the visible stagnation in the stomach. However, if the evil is drained and the stomach fluids do not rise, the heat evil increases, and if emetics are used and the stomach fluids do not distribute, the wind evil increases, ultimately leading to death. This must not be overlooked.[Original Text] Damp-heat syndrome causes spasms, confusion, and delirium, with a rapid and strong pulse. If purging does not work, it indicates damp-heat accumulation in the chest and diaphragm, and it is advisable to use Liang Ge San (Cool the Diaphragm Powder) as a reference. If there is constipation for several days, it indicates heat evil blocking the intestines and stomach, and it is advisable to use Cheng Qi Wei Xia (Mild Purging Decoction) as a reference.Self-note: This entry refers to Yangming excess heat, which may be blocked above or below. Clearing heat and draining evil can only disperse the heat flowing through the meridians and cannot eliminate the evil accumulated in the intestines. Therefore, the Yangming evil still relies on Yangming as the exit.[Original Text] Damp-heat syndrome causes spasms, confusion, and delirium, with a dry yellow tongue coating that may turn black, and constipation. This indicates heat evil blocking the stomach and intestines, and it is advisable to use Cheng Qi Tang (Purgative Decoction) to purge.Self-note: The condition of confusion indicates either great excess or great deficiency. If deficient, the spirit is scattered, and there is a risk of collapse. If excessive, the spirit is constrained, hence the chaotic symptoms. Now, the dry yellow tongue coating indicates heat evil internally accumulated, and the Yangming heat is evident. Merely clearing heat and draining evil can only disperse the heat flowing through the meridians and cannot eliminate the evil accumulated in the stomach. Therefore, it is advisable to use Cheng Qi to open the pathways, but if the tongue is not dry and yellow, it should not be used.[Original Text] Damp-heat syndrome causes thirst, with a yellow tongue coating, a wiry and weak pulse, a contracted tongue, and confusion with incoherent speech. The hands may tremble, indicating dryness of fluids and stagnation of evil. It is advisable to use fresh Lu Gen (Reed Root), Sheng Shou Wu (Fresh Fleeceflower Root), and fresh rice root among others. If the pulse is strong and there is constipation, Da Huang (Rhubarb) may also be added.Self-note: The stomach fluids are robbed, and the heat evil occupies internally. If not moistened and purged to drain the evil, it cannot be resolved. Therefore, it is advisable to use Cheng Qi as a reference, using sweet and cool herbs instead of bitter and cold ones, primarily to avoid injuring the stomach qi and preventing the recovery of stomach fluids.[Original Text] Damp-heat syndrome after several days, with sweating and heat not resolving, or spasms, suddenly leading to persistent headaches. This indicates great loss of nutritive fluids, with the yang and wind-fire rising. It is advisable to use Ling Yang Jiao (Antelope Horn), Man Jing Zi (Vitex), Gou Teng (Uncaria), Yuan Shen (Rehmannia), Sheng Di (Raw Rehmannia), and Nu Zhen Zi (Ligustrum) among others.Self-note: Damp-heat injures the nutritive qi, and liver wind rises, causing blood not to nourish the muscles, leading to spasms. When the yang rises to the top, it causes headaches. The heat qi has retreated, but the wood energy is still strong, hence spasms without syncope. The treatment should focus on calming wind as the primary goal and nourishing yin as the foundation.[Original Text] Damp-heat syndrome after seven to eight days, with no thirst, inability to speak, and no rejection of food and drink, remaining silent and confused. Spicy and aromatic herbs for cooling and draining are ineffective. This indicates that the evil has entered the Jueyin, affecting both the host and guest. It is advisable to use Wu You Ke San (Three-Arm Powder) as a reference, including drunken ground turtle, vinegar-fried turtle shell, and stir-fried pangolin, fresh silkworm, Chai Hu (Bupleurum), and peach kernel mud among others.Self-note: Summer dampness first injures the Yang aspect, but if the illness persists and does not resolve, it must affect the Yin. Both Yin and Yang are constrained, leading to stagnation of qi and blood, preventing summer dampness from leaking out. Thus, it deeply invades the Jueyin meridians, causing stagnation and preventing the emergence of Yang, leading to a lack of rising energy. The heart is obstructed, and the spirit is not clear, hence confusion and silence. Breaking stagnation and clearing blood stasis will allow the meridians to open and the evil to be resolved.[Original Text] Damp-heat syndrome after four to five days, with great thirst, chest tightness, dry retching, a thin and rapid pulse, and a tongue as bright as a mirror. The stomach fluids are robbed, and gallbladder fire rises. It is advisable to use watermelon juice, golden juice, fresh raw rehmannia juice, and sugarcane juice, grinding and taking with Yu Jin (Curcuma), Mu Xiang (Aucklandia), and Xiang Fu (Cyperus) among others.Self-note: This indicates a deficiency of the nutritive yin and an excess of wood-fire. The wood invades the Yangming, depleting its fluids. Fortunately, there is no drinking evil, hence it is necessary to clear the Yangming heat and disperse the Shaoyang evil without decocting, focusing on the complete essence.[Original Text] Damp-heat syndrome causes vomiting of clear water or excessive phlegm, with wood-fire rising. It is advisable to use Wen Dan Tang (Warm the Gallbladder Decoction) plus Gua Lou (Trichosanthes) and Bi Yu San (Jade Powder) among others.Self-note: This indicates a pre-existing phlegm condition, and both Yangming and Shaoyang are affected. Therefore, one should clear phlegm and descend the rebellious qi, treating similarly to the previous entry.[Original Text] Damp-heat syndrome injures qi, causing fatigue in the limbs, reduced spirit, body heat, irritability, yellow urine, thirst, and spontaneous sweating. The pulse is weak. It is advisable to use Qing Shu Yi Qi Tang (Clear Summer Heat and Benefit Qi Decoction) for treatment.Self-note: This indicates the same heat, thirst, and spontaneous sweating, but with a weak pulse and spirit fatigue, indicating injury to the middle qi, rather than Yangming excess heat. Qing Shu Yi Qi Tang is designed for yellow thirst and spontaneous sweating, and it is a formula created by Dong Yuan, with many medicinal ingredients. Practitioners should carefully consider which herbs to use in clinical practice.[Original Text] Damp-heat syndrome causes cough, with restlessness day and night, even leading to inability to sleep. This indicates summer evil entering the lung collaterals. It is advisable to use Ting Li Zi (Descurainia) and Pi Pa Ye (Loquat Leaf) with Liu Yi San (Six-One Powder) among others.Self-note: People only know that summer heat injures lung qi, leading to lung deficiency, but do not realize that summer stagnation in the lung collaterals leads to lung excess. Ting Li can guide and Talc can directly drain lung evil, thus resolving the illness.[Original Text] In the hot months, excessive drinking of cold beverages leads to the yang qi being restrained by yin cold, causing skin steaming heat, chills, headaches, spontaneous sweating, thirst, or abdominal pain and diarrhea. It is advisable to use Xiang Ru (Elsholtzia) and Hou Po (Magnolia Bark) with Dou Dou (Hyacinth Bean) among others.Self-note: This is due to avoiding summer heat and being affected by cold damp evil. Although the illness occurs in summer, it is not a summer disease. Ancient people did not say summer heat injures cold damp, but rather yin summer, leading to confusion and significant errors. Now, I specifically correct this. The use of Xiang Ru’s pungent warmth disperses the yin evil and promotes the yang qi, while Hou Po’s bitter warmth eliminates damp evil and promotes the flow of stagnant qi. Dou Dou is sweet and bland, harmonizing water. If there are no external symptoms of severe cold and headache, then Xiang Ru’s pungent aroma should not be used. If there are no symptoms of abdominal pain and diarrhea, then Hou Po and Dou Dou should not be used. Therefore, if there is severe thirst, add Huang Lian (Coptis) to clear summer heat, named Si Wei Xiang Ru Yin (Four-Flavor Xiang Ru Decoction). If Dou Dou is removed, it is named Huang Lian Xiang Ru Yin. If there is excessive dampness in the interior and abdominal distension and diarrhea, remove Huang Lian and add Fu Ling (Poria) and Gan Cao (Licorice), named Wu Wu Xiang Ru Yin (Five-Flavor Xiang Ru Decoction). If there is middle deficiency, qi deficiency, and excessive sweating, add Ren Shen (Ginseng), Huang Qi (Astragalus), Bai Zhu (Atractylodes), Chen Pi (Tangerine Peel), and Mu Guo (Papaya), named Shi Wei Xiang Ru Yin (Ten-Flavor Xiang Ru Decoction). However, the use of Xiang Ru is primarily for cold damp evils invading from the outside and should not be used to treat summer heat without cold damp.[Original Text] After more than ten days of damp-heat syndrome, with a left guan pulse that is wiry and rapid, abdominal pain at times, blood in the stool, and heat and pain in the anus. This indicates that the heat evil has transmitted into the Jueyin syndrome, and it is advisable to use Bai Tou Weng Tang (Pulsatilla Decoction) as a reference.Self-note: Heat entering the Jueyin and causing diarrhea does not lead to blood in the stool, and it should also follow Zhang Zhongjing’s method for treating heat diarrhea. If it enters the nutritive yin, how can one not use Bai Tou Weng Tang to cool the blood and disperse the evil? If heat enters the Yangming and causes diarrhea, it should also follow Zhang Zhongjing’s method for treating diarrhea with confusion, using Xiao Cheng Qi Tang (Minor Order the Qi Decoction).[Original Text] Damp-heat stagnation in the Taiyin, long-term stagnation leads to downward stagnation. The symptoms include chest fullness, abdominal pain, a feeling of heaviness, purulent blood, and a feeling of heaviness in the anus. The pulse is soft and rapid. It is advisable to use Hou Po (Magnolia Bark), Huang Qin (Scutellaria), Shen Qu (Fermented Barley), Guang Pi (Citrus Peel), Mu Xiang (Aucklandia), Bing Lang (Areca), Chai Hu (Bupleurum), Wei Ge Gen (Prepared Kudzu), Yin Hua (Honeysuckle), Charred Jing Jie (Schizonepeta), and Charred herbs among others.Self-note: The ancient term for downward stagnation refers to what is now called dysentery, caused by damp-heat evil internally hidden in the Taiyin, obstructing the qi mechanism, leading to Taiyin’s inability to transport. The Shaoyang loses its ability to disperse, and heat stagnates and steams, leading to foul and turbid discharge, purulent blood entering the anus, hence the feeling of heaviness and qi stagnation. If qi is injured, it leads to white discharge; if blood is injured, it leads to red discharge. If both qi and blood are injured, it leads to both red and white discharge. If damp-heat is severe, dysentery can present in five colors, hence the use of Hou Po to eliminate dampness and promote the flow of qi, Bing Lang to break the stagnant qi, Huang Qin to clear the heat, Mu Xiang and Shen Qu to promote the flow of stagnant qi, Ge Gen to lift the stomach qi, and Chai Hu to raise the wood energy in the middle. If heat invades the blood aspect, leading to blood in the stool, it is advisable to use Yin Hua and Jing Jie to clear heat in the nutritive aspect. If the heat is severe internally, Huang Lian should be used to clear heat. If there is great excess and pain, Da Huang should be increased to expel the evil. In the past, Zhang Jiegu used Shao Yao Tang to treat blood dysentery, using Gui Shao, Qin Lian, Da Huang, Mu Xiang, Bing Lang, Gan Cao, and Gui Xin among others. The name Shao Yao Tang indicates that to treat blood in the stool, one must regulate the organs that store blood, hence it is used as the monarch. It is not only to want the earth to drain the wood but also to rely on it to nourish the liver and harmonize the yin. However, Shao Yao’s sour taste is astringent and is not suitable for those with internal damp-heat. If dysentery persists and the middle is deficient, it is advisable to use Shao Yao and Gan Cao to transform the earth. However, if dysentery occurs at the beginning and damp-heat is strong, white peony should be used to astringe the evil, and it must not be used. Although this has been tried and established by ancient practitioners, I do not dare to take it as a model for future students.[Original Text] Long-term dysentery injures Yang, with a weak and slippery pulse. It is advisable to use Ren Shen Yang Zang Tang (Ginseng Nourish the Organs Decoction), adding Gan Cao and Dang Gui (Angelica Sinensis) and Bai Shao (White Peony).Self-note: If the spleen yang is deficient, it should be supplemented and warmed. However, the formula includes Mu Xiang, indicating that abdominal pain has not stopped, hence it also promotes the flow of stagnant qi. The inclusion of Dang Gui and Bai Shao indicates that the yin aspect is deficient, hence it also harmonizes the nutritive yin. However, dysentery is a spleen disease, and it must also affect the kidneys, as the kidneys are the gate of the stomach, controlling the lower jiao and opening the two yin. Moreover, fire is the mother of earth, and to warm the yang in the earth, one must supplement the fire of the Mingmen. If there is severe deficiency and slippery pulse, Aconite should be added to supplement the yang, and yin herbs must not be mixed in.[Original Text] Long-term dysentery injures yin, with a feeling of needing to defecate for a long time. It is advisable to use Shu Di Huang (Rehmannia) stir-fried with Dang Gui, stir-fried Bai Shao, and roasted Gan Cao, along with Guang Pi and similar herbs.Self-note: If there is a desire to defecate but unable to do so for a long time, it is called a feeling of needing to defecate. Generally, the condition of needing to defecate is mostly due to excess fire, which transmits quickly, stagnating in the large intestine, leading to a feeling of urgency to defecate but unable to do so. Therefore, in dysentery, Huang Qin is often used to clear fire, and for the kidneys, Da Huang is used to expel heat. If dysentery persists and blood is deficient, leading to heat, there is also a sense of urgency to defecate, but one can only sit for a long time without being able to defecate. This heat arises from blood deficiency, hence the treatment should focus on nourishing blood as the main approach. The distinction between needing to defecate and feeling heavy is different; the former indicates urgency to defecate, while the latter indicates heaviness in the anus. The distinction between excess and deficiency is crucial; excess indicates residual fire, while deficiency indicates insufficient yin. The distinction between heaviness and urgency is also important; heaviness indicates obstruction due to evil, while urgency indicates qi deficiency. Therefore, the treatment for needing to defecate differs from that for heaviness, with the former focusing on clearing heat and nourishing yin, while the latter focuses on moving qi and tonifying. The distinction between excess and deficiency must be clear.[Original Text] Damp-heat syndrome causes cold limbs, a thin pulse, sweating, chest fullness, thirst, and a white tongue. This indicates that damp evil injures yang, and it is advisable to use Ren Shen (Ginseng), Bai Zhu (Atractylodes), Fu Zi (Aconite), and Fu Ling (Poria) with Yi Zhi Ren (Alpinia) among others.Self-note: This entry indicates that damp evil injures yang, and it is appropriate to support yang and expel dampness. Thirst indicates a Shaoyin syndrome; how can one recklessly use cold and cool herbs?[Original Text] Summer dampness invades, causing abdominal pain and diarrhea, with a slow pulse. This indicates that damp turbidity obstructs the Taiyin, and it is advisable to use Suo Pi Yin (Suo Pi Decoction).Self-note: This indicates that summer dampness and turbidity injure the Taiyin qi, leading to the earth not being able to express itself. Therefore, aromatic herbs are used to clear the turbid and dry dampness.[Original Text] Excessive drinking of cold beverages in summer leads to cold dampness remaining internally, causing vomiting and diarrhea, with cold limbs and a floating pulse. It is advisable to use Da Shun San (Great Smooth Powder).Self-note: In the hot months, excessive indulgence in coolness leads to cold dampness invading from the outside. For vomiting and diarrhea with cold limbs and a floating pulse, it indicates that the spleen and stomach’s yang is covered by cold dampness, preventing it from rising. Therefore, it is advisable to use warming herbs to regulate the spleen and stomach, promote qi, and dispel cold. However, Guang Pi and Fu Ling should not be omitted, as this is the method Zhang Zhongjing used to treat internal invasion of yin evil in cholera.（46）Abdominal pain and diarrhea, chest fullness, irritability, thirst, rapid and large pulse, and a hollow feeling upon palpation indicate the use of Leng Xiang Yin Zi (Cold Fragrance Drink). This not only indicates that damp evil injures the spleen but also that cold evil injures the kidneys. Irritability and thirst resemble a Yang evil disease, but the rapid and large pulse, which feels hollow upon palpation, indicates that it is a manifestation of virtual yang rising externally, rather than internal heat evil disturbing. Therefore, this formula is taken cold, allowing the cold qi to dissipate, and the heat nature to emerge, ensuring that the medicinal qi and the disease qi do not conflict.[Original Text] Abdominal pain and diarrhea, chest fullness, irritability, thirst, rapid and large pulse, and a hollow feeling upon palpation indicate the use of Leng Xiang Yin Zi (Cold Fragrance Drink).Self-note: This not only indicates that damp evil injures the spleen but also that cold evil injures the kidneys. Irritability and thirst resemble a Yang evil disease, but the rapid and large pulse, which feels hollow upon palpation, indicates that it is a manifestation of virtual yang rising externally, rather than internal heat evil disturbing. Therefore, this formula is taken cold, allowing the cold qi to dissipate, and the heat nature to emerge, ensuring that the medicinal qi and the disease qi do not conflict.[Original Text] After several days of damp-heat syndrome, with a feeling of dampness and heaviness in the abdomen, knowing hunger but not eating, indicates that damp evil is wrapping around the three jiaos. It is advisable to use Huo Xiang Ye (Agastache Leaf), Bo He (Mint Leaf), Xian He Ye (Lotus Leaf), Pi Pa Ye (Loquat Leaf), Pei Lan Ye (Eclipta Leaf), and Dong Gua Ren (Winter Melon Seed) among others.Self-note: This indicates that damp-heat has resolved, but residual evil is obscuring the clear yang, preventing the stomach qi from being comfortable. It is advisable to use very light and clear herbs to promote the yang qi of the upper jiao. If heavy herbs are used, they will not relate to the condition.This entry must be compared with the thirty-first entry, as the former refers to the initial excess evil, hence it is advisable to purge. This light prescription does not correspond, and it must also be compared with the following entry, as the treatment methods differ between the upper and middle jiao, which must be carefully examined in clinical practice.[Original Text] Damp-heat syndrome, after purging and draining, with all evil symptoms resolved, but the spirit is still unclear, fatigue, lack of appetite, frequent urination, dry lips, and the stomach qi is not distributed, and the lung qi is not dispersed. This indicates a great loss of original spirit, and it is advisable to use Ren Shen (Ginseng), Mai Dong (Ophiopogon), Shi Hu (Dendrobium), Mu Guo (Papaya), Sheng Gan Cao (Fresh Licorice), and Sheng Gu Ya (Fresh Grain Sprout) among others.Self-note: After purging and draining, with all evil symptoms resolved, the righteous qi is also greatly injured, hence the symptoms of qi deficiency are evident. It is advisable to clear and tonify the original qi, but one should not use greasy and stagnant yin herbs to avoid further depletion.
