1. What is Yin Deficiency? Li Lao believes that “Yin” is not an empty term, but refers to all bodily fluids. The Daoist scripture states: “Tears, saliva, essence, fluids, sweat, blood, and other liquids all belong to Yin.” Li Lao considers Yin to be the moisture present in all body tissues. The term “deficiency” means insufficiency. The body’s moisture is generally fixed, accounting for about two-thirds of body weight. This moisture is continuously consumed and replenished through diet, which is a normal phenomenon. If consumption exceeds replenishment, physiological functions will be affected when the moisture is depleted by about 10%. This leads to noticeable changes, which Li Lao identifies as the symptoms of Yin Deficiency. Specifically, insufficient lung fluids indicate Lung Yin Deficiency, insufficient kidney essence indicates Kidney Yin Deficiency, insufficient heart fluids indicate Heart Yin Deficiency, insufficient liver fluids indicate Liver Yin Deficiency, and insufficient spleen fluids indicate Spleen Yin Deficiency. Generally, Yin Deficiency is primarily focused on the lungs, spleen, and kidneys, while Heart and Liver Yin Deficiencies are categorized under Blood Deficiency due to their emphasis on blood. 2. Causes of Yin DeficiencyLi Lao identifies the following causes:1. Congenital insufficiency: This is the root cause of all deficiency syndromes, especially Yin Deficiency.2. Chronic illness (such as febrile diseases, prolonged fevers, chronic cough, chronic diarrhea, chronic dysentery, chronic malaria, etc.): This is a significant cause of Yin Deficiency.3. Excessive sweating or purging (such as overuse of diaphoretic or purgative herbs): This is also a cause of Yin Deficiency, particularly affecting the heart, spleen, and kidneys.4. Carelessness in sexual activity: This is a major cause of Kidney Yin Deficiency.5. Excessive consumption of tobacco, alcohol, spicy, and hot foods: This is a primary cause of Lung Yin Deficiency, as excessive heat leads to Yin Deficiency.6. Overthinking: This is a primary cause of Heart Yin Deficiency.7. Long-term emotional distress: This is a primary cause of Liver Yin Deficiency.8. Excessive fatigue: This is a primary cause of Spleen Yin Deficiency.In summary, excessive indulgence in alcohol and sexual activity is the most common cause of Yin Deficiency. This is due to the fact that fewer people practice moderation while many indulge excessively. Furthermore, a single factor alone will not quickly lead to Yin Deficiency; it often requires a combination of excessive indulgence, overthinking, or congenital insufficiency to manifest. Even if it does occur, it is usually easy to treat, as the root cause remains intact.3. Changes Caused by Yin DeficiencyIn summary, there are about 20 changes:1. Yin Deficiency leads to heat.This explains the phenomenon of body heat, bone steaming, five hearts feeling hot, and all heat syndromes caused by Yin Deficiency.2. Yin Deficiency leads to blood deficiency. This is because bodily fluids are a major component of blood.3. Yin Deficiency leads to blood dryness.The first two points explain the menstrual irregularities and all dryness syndromes caused by insufficient blood.4. Yin Deficiency leads to fluid deficiency.5. Yin Deficiency leads to insufficient bodily fluids.The above two points explain the symptoms of dry mouth, thirst, dry nose, and dry throat caused by insufficient moisture due to Yin Deficiency.6. Yin Deficiency leads to essence deficiency.This explains the symptoms of low essence, sparse essence, and unstable essence.7. Yin Deficiency leads to excessive heat.8. Yin Deficiency leads to active fire.9. Yin Deficiency leads to excessive fire.10. Yin Deficiency leads to excessive Yang.11. Yin Deficiency leads to blazing fire.The above five points explain all fire phenomena caused by Yin Deficiency, such as bitter mouth desiring cold, dry tongue, and dry throat.12. Excessive fire due to Yin Deficiency leads to the consumption of bodily fluids, resulting in phlegm.13. Active fire due to Yin Deficiency leads to water accumulation resulting in phlegm.The above two points explain the phlegm syndromes caused by Yin Deficiency.14. Excessive fire due to Yin Deficiency leads to blood being forced out of various orifices.This explains the various bleeding syndromes caused by Yin Deficiency.15. Yin Deficiency leads to empty fire rising.16. Yin Deficiency leads to empty Yang rising.17. Yin Deficiency leads to empty Yang reversing.The above three points explain the phenomena of facial redness, red lips, red cheeks, dry cough, and vomiting caused by Yin Deficiency.18. Yin Deficiency leads to empty marrow, with fire sinking into the bones.This explains the symptoms of bone steaming and cold skin caused by Yin Deficiency.19. Yin Deficiency leads to Yang having no support.20. Yin Deficiency leads to Yang being violently exhausted.The above two points explain the symptoms of sudden dizziness, loss of voice, and absence of heat in the body caused by Yin Deficiency.4. Symptoms of Yin Deficiency(1) Symptoms of Yin Deficiency in various body partsHead: dizziness, headache.Face: red face and cheeks.Eyes: blurred vision, red eyes.Ears: tinnitus, deafness (Yin Deficiency fire rising can lead to deafness).Nose: dry nose, nasal congestion, breath like fire, nosebleeds.Oral cavity: dry mouth, thirst, vomiting blood, spitting blood, vomiting.Tongue: dry tongue, painful tongue, tongue bleeding.Teeth: loose teeth, bleeding gums.Throat: dry throat, sore throat, loss of voice, throat ulcers.Chest and abdomen: fullness in the chest, internal heat, abdominal fullness (Zhongchun says: Spleen deficiency leads to fullness, called static night drama, Spleen Yin Deficiency as well).Lower back: back pain.Genital area: blood in urine, painful urination, or urinary retention, men with nocturnal emissions, women with irregular menstruation, blood depletion leading to amenorrhea, pain during intercourse.Rectal area: constipation, rectal bleeding, diarrhea.Limbs: leg cramps, dry heat in the soles of the feet, heel pain, heat in the palms and soles, nails dry and brittle.Hair: hair loss, hair disorders.Skin: night sweats, dry and rough skin.Muscles and bones: bone steaming at night, widespread muscle and joint pain, or pain like fractures.Diet: lack of taste, prone to hunger.Breathing: breathlessness, chest tightness, wheezing, dry cough, coughing blood.Sleep: insomnia.These symptoms, if not correctly identified, may lead to misdiagnosis of Yang Deficiency, Qi Deficiency, Blood Deficiency, or false heat as Yin Deficiency, as different syndromes may present similar symptoms. We must carefully analyze the specific situation, its progression, and any accompanying symptoms to accurately differentiate the syndrome.(2) Main symptoms of Yin Deficiency1. Afternoon body heat.2. Five hearts feeling hot.3. Weak and thin pulse.4. General symptoms are more severe at night or lighter in the morning.5. Feeling of heat, preferring cool foods, but eating does not resolve the issue.(3) Accompanying symptoms of Yin Deficiency1. Lung Yin Deficiency(1) Chronic cough that has not healed.(2) Producing thick phlegm, or dry cough with little phlegm, or phlegm with blood.(3) Nasal discharge like fire, or nosebleeds.(4) Chest fullness, breathlessness, inability to sleep on one side, or wheezing, or hoarseness.2. Spleen Yin Deficiency(1) Reduced appetite.(2) Fatigue in the limbs.(3) Muscle wasting.(4) Diarrhea.3. Kidney Yin Deficiency(1) Pain in the lower back and legs.(2) Nocturnal emissions.(3) Dry heat in the soles of the feet.(4) Heel pain.(5) Urinary retention.(6) Tinnitus and deafness.(7) Loose teeth.(8) Bone steaming and internal heat.Note: The above three types of Yin Deficiency are not completely fixed or distinctly separated; there are often overlapping situations. However, we can determine the main and secondary treatments based on the severity of each part of the disease.5. Diagnosis of Yin DeficiencyDiagnosis of this condition, like other diseases, involves using the four diagnostic methods: observation, listening, inquiry, and palpation, along with various experiential methods for examination.1. Recognizing from the main symptoms. This is the primary diagnostic method for all diseases, as every disease has its fixed main symptoms.2. Comparing similar symptoms. After identifying the main symptoms, to avoid errors, it is necessary to compare symptoms that are similar to the main symptoms, making the comparison more accurate.For example, the main symptom of Yin Deficiency is afternoon body heat, but we cannot assume it is Yin Deficiency just because of this symptom; we must first compare it with the “afternoon body heat” of warm diseases to see if there are any changes in climate or external factors. This comparison can help reduce errors. From a treatment perspective, ancient texts state: “If it is not cool, it is because there is no water.” Also: “If internal heat does not resolve, repeatedly cooling it will not reduce the fire, indicating insufficient Yin.” It is also stated: “If the exterior pathogen does not resolve, repeatedly dispersing it will not lead to sweating, indicating that Yin Qi cannot reach.” According to the proportion of the disease, Gu’s theory states: “Yin Deficiency accounts for 80-90%, while Yang Deficiency accounts for 10-20%.” This method is only used for distinguishing between Yang Deficiency and Yin Deficiency, and serves as a helpful guide when other methods are unclear, rather than being universally applicable.6. Treatment methods for Yin DeficiencyThe treatment methods for Yin Deficiency mainly consist of three parts:(1) Treatment methods for Lung Yin Deficiency1. Clear the lungs and moisten dryness (Clear Metal and moisten the lungs): This is the primary method for treating Lung Yin Deficiency, such as with Qingjin Decoction, Baxian Yuye, etc. When taken for a long time, care should be taken not to be overly simplistic to avoid causing diarrhea or reduced appetite.2. Clear the lungs and nourish the kidneys: This is the method for treating Lung Deficiency with concurrent Kidney Yin Deficiency, such as with the formulas using Er Dong and Er Di, or using lung-clearing herbs (like Qingjin Decoction) in the morning and kidney-nourishing herbs (like Liuwei Dihuang Wan) in the evening, but the focus should be on the lungs. When Lung Yin Deficiency is at its most severe, regardless of whether Kidney Yin Deficiency symptoms are present, it is essential to nourish Kidney Yin, as the kidneys are the root of congenital essence, while also being careful not to harm the spleen.3. Clear the lungs and tonify the spleen: This is the method for treating Lung Yin Deficiency with concurrent Spleen Yin Deficiency, such as with Jiawei Qingning Gao. Treating both meridians is more challenging, as the lungs prefer moisture while the spleen prefers dryness; tonifying the spleen can hinder the lungs, while tonifying the lungs can hinder the spleen. If lung-moistening herbs are used excessively, appetite may decrease, or diarrhea may worsen; if spleen-tonifying herbs are overused, dry cough symptoms may worsen. Therefore, in treating Lung Yin Deficiency, regardless of whether there are signs of Spleen Deficiency, it is crucial to always be vigilant to prevent Spleen Deficiency from arising.(2) Treatment methods for Kidney Yin Deficiency1. Nourish Yin and tonify the kidneys (Nourish water and control fire): This is the general method for treating Kidney Yin Deficiency with fire, such as with Liuwei Dihuang Wan, Zuogui Yin, etc. Yin Deficiency must have fire; as Yin becomes more deficient, fire becomes more intense. However, this fire is different from excess fire and cannot be treated with bitter cold herbs, as using bitter cold will not only be ineffective but may even worsen the condition. Therefore, for fire symptoms that do not respond to bitter cold herbs or worsen, this method is most appropriate.2. Nourish Yin and lower fire (Nourish Yin and subdue Yang): This is the method for treating Kidney Yin Deficiency with upward-reversing fire or slight excess fire, such as with Zhibai Dihuang Wan, Dabuyin Wan, or Liuwei Dihuang Wan with modifications. Since excessive fire often reverses upward, it is often accompanied by excess fire, but if it is lighter, the method of nourishing water and controlling fire is sufficient to extinguish the fire.3. Nourish Yin and clear the lungs: This is the method for treating Kidney Yin Deficiency with concurrent Lung Yin Deficiency, such as with Maiwei Dihuang Wan. This is because Kidney Yin Deficiency easily affects the lungs, leading to cough and other symptoms.4. Nourish the kidneys and regulate the spleen: This is the method for treating Kidney Yin Deficiency with concurrent Spleen Yin Deficiency. When both meridians are Yin Deficient, the treatment should focus on the spleen; otherwise, if the spleen is deficient, it cannot absorb, and even the best medicines will not be effective. Therefore, when treating Kidney Yin Deficiency, it is essential to pay attention to diet.(3) Treatment methods for Spleen Yin DeficiencyThe main treatment method requires the use of neither overly dry nor overly moist herbs, as the spleen prefers dryness and dislikes moisture, while Yin Deficiency prefers moisture and dislikes dryness. This condition is the most challenging to treat with herbs. Li Lao believes that the most effective herbs include Shan Yao, Lian Rou, Bian Dou, and Yi Ren, or combined with Bai He, Dong Hua, Pa Ye, and Mai Dong to treat concurrent Lung Yin Deficiency symptoms, such as with Jiawei Qingning Gao. Alternatively, after stopping diarrhea, one can take Liuwei Dihuang Wan in the morning and evening to treat concurrent Kidney Yin Deficiency symptoms.In general, Yin Deficiency should use sweet and cold herbs, and avoid bitter and cold herbs, as bitter and cold herbs are drying and can harm Yin. It is also necessary to decoct for a long time, as Yin Deficiency requires heavy and turbid herbs, so it should be decocted longer. Previous practitioners have suggested using large doses to nourish Yin, but Li Lao found in practice that small doses taken frequently over a long time are more beneficial than harmful. This is because taking nourishing Yin herbs is most likely to harm Spleen Yang, leading to diarrhea and loss of appetite; large doses are more likely to cause this issue. In treatment, moxibustion should not be used. Zhongjing stated: “Even a slight fire can cause internal damage, harming bones and muscles, making it difficult for blood to recover.” In terms of herbs, Sheng Ma and Zi Su should not be used. Gu’s theory states: “If Yin Deficiency is misused, it will cause Yin fire to rise, leading to increased coughing and bleeding.”7. Formulas for Yin DeficiencyLi Lao commonly uses the following formulas to nourish Yin:(1) Formulas for treating Lung Yin Deficiency1. Qingjin Decoction: Treats Lung Yin Deficiency cough, whether with phlegm, dry cough, phlegm with blood, or pure blood. Ingredients: 7.5g Sang Pi, 6g Di Gu Pi, 6g Mai Dong, 30g fresh Bai He, 6g Dong Hua, 6g Chuan Bei, 6g Xing Ren, 6g Zhi Pa Ye, 3g Zhi Cao. If there is blood, add 9g Bai Mao Gen, half a teacup of lotus juice and child urine, and decoct with water for consumption.2. Baxian Yuye: Treats Lung Yin Deficiency cough with blood. Ingredients: 2 cups lotus juice, 1 cup each of pear juice, sugarcane juice, reed root juice, and Bai Mao Gen decocted into a concentrated juice, 1 cup each of human milk and child urine, 3 raw egg whites, mixed and taken frequently. For better results, add 30g Yi Ren, 60g Bai He, and 10 pieces of Pa Ye, decoct into 1 bowl of concentrated juice and mix with 15g Chuan Bei and 15g Persimmon Frost.3. Guben Wan: Treats elderly patients with Yin Deficiency cough and constipation. Ingredients: 60g Tian Dong, 60g Mai Dong, 60g Sheng Di, 60g Shu Di, 30g Ren Shen. Grind into powder and form honey pills. Each dose is 9g, taken with warm water. The role of Ren Shen in this formula is to prevent reduced appetite and diarrhea.4. Jiawei Qingning Gao: Treats Lung Yin Deficiency cough with blood, combined with reduced appetite and increased diarrhea. Ingredients: 120g Mai Dong, 300g fresh Bai He, 60g Kuan Dong Hua, 15g mint powder, 150g Zhi Pa Ye, 15g Ju Hong, 60g Chuan Bei (ground into powder), 30g Fu Ling, 120g Yi Ren, 60g Longan meat, 60g fried Bai Shao, 15g Zhi Cao. Except for mint and Chuan Bei, all other herbs are boiled into a paste, then add the powdered mint and Chuan Bei, and mix with 360g rock candy until dissolved and stirred evenly. Each dose is 1 teaspoon, taken with warm water.(2) Formulas for treating Kidney Yin Deficiency1. Liuwei Dihuang Wan: Treats all symptoms of Kidney Yin Deficiency. Ingredients: 240g Shu Di, 120g Shan Yu Rou, 120g Sheng Shan Yao, 90g Dan Pi, 90g Fu Ling, 90g Ze Xie. Grind into fine powder and form honey pills the size of Wutong seeds. Each dose is 9g, taken with warm water. It can also be taken as a decoction. Modifications: If there is fever and thirst, add Sheng Bie Jia, Hua Fen, and Er Dong; if there is Qi stagnation, add Chen Xiang, Sha Ren, and Mai Dong; if there is phlegm cough, add Bei Mu, Bai He, and Mai Dong; if there is sore throat and tongue pain, add Sheng Ji Zi, Yuan Shen, and Mai Dong; if there is bleeding from the gums, add Mai Dong and child urine, or add Ren Zhong Bai and Mai Dong; if there is loose teeth, add Ren Shen, Mai Dong, Wu Wei Zi, Lu Rong, Zhu Sui, Long Chi, and Mu Li; if there is leg and calf pain, add Niu Xi, Du Zhong, Gou Qi, and Gui Ban; if there is blood in urine, add Shan Yu Rou, Er Dong, lotus juice, and Gan Cao; if there is loss of voice, add Mai Dong and Sheng Ji Zi; if there is dry heat in the soles of the feet, add Er Dong, Niu Xi, and Gui Ban. (Note: Any modifications must be appropriate and cannot be rigidly fixed. They must be based on the syndrome.)2. Zuogui Yin: Treats the same symptoms as Liuwei Dihuang Wan, with superior Yin tonifying power, which is Liuwei Dihuang Wan minus Ze Xie and Dan Pi, adding Gou Qi and Zhi Cao. Modifications: If there is lung heat and restlessness, add Mai Dong; if there is lung heat with much coughing, add Bai He; if there is blood deficiency, add Dang Gui; if there is blood stagnation with heat, add Dan Pi; if there is Yin Deficiency with restlessness, add Nu Zhen Zi; if there is blood heat causing excessive movement, add Sheng Di; if there is spleen heat causing easy hunger and excessive sweating, add Bai Shao; if there is heart heat causing dryness, add Yuan Shen; if there is kidney heat causing bone steaming, add Di Gu Pi; if there is fluid depletion causing thirst, add Hua Fen; if there is excess above and deficiency below, add Niu Xi.3. Zhibai Dihuang Wan: Treats bone atrophy, marrow depletion, labor heat, night sweats, deafness, easy erections, painful urination, and all symptoms of excessive fire due to Yin Deficiency. This is Liuwei Dihuang Wan plus Zhi Mu and Huang Bai. Each dose is 9g, taken with warm water.4. Dabuyin Wan: Treats all symptoms of excessive fire due to Yin Deficiency. Ingredients: Huang Bai (salt-fried), Zhi Mu (salt-fried), Shu Di, and Zhi Gui Ban, ground into fine powder, mixed with pig spinal marrow, and refined honey into pills the size of Wutong seeds. Each dose is 15g, taken with warm water.5. Maiwei Dihuang Wan: Treats chronic cough due to Yin Deficiency or phlegm with blood streaks. This is Liuwei Dihuang Wan plus Mai Dong, Shi Hu, Sheng Shan Yao, Sheng Yu Shu, Sheng Bian Dou, Sheng Lian Rou, Xi Yang Shen, Mai Dong, Jin Shi Hu, and Zhi Cao. Dosage varies according to the syndrome, taken as a decoction.8. Yin Deficiency HerbsHere are the commonly used herbs for nourishing Yin by Li Lao:(1) Key herbs for Lung Yin DeficiencyTian Dong: Nourishes Lung Yin, moistens dryness, clears Lung heat. It is cold and slippery, and should not be used in cases of Spleen Deficiency with reduced appetite and diarrhea.Mai Dong: Nourishes Lung Yin, moistens dryness, clears Lung heat. It should not be used in cases of diarrhea, but can be used with Yi Ren, Shan Yao, and Fu Ling without issue.Bai He: Used for cough. Fresh white flowers are better.Zhi Pa Ye: Lowers Qi and stops cough. It can be used in cases of Qi reversal.Sang Pi: Clears Lung fire. It should not be used in cases of Lung Deficiency without fire or in cases of wind-cold cough.Chuan Bei: Can be used for turbid phlegm with white foam; it should not be used for clear phlegm or no phlegm.Bo He: Disperses heat and clears the lungs. It can be used in cases of slight wind-heat.Sha Shen: Nourishes Lung Yin.Pear: Moistens the lungs and clears heat.Wu Wei Zi: Astringes Lung Qi and Kidney Qi. It can be used for prolonged cough, Qi depletion, and unstable sweat glands, or for Kidney Qi rising.Dong Hua: Can be used for cough.Shi Frost: Clears heat and transforms phlegm.Bai Mao Gen: Sweet and cold, it clears internal heat, stops bleeding, and resolves stasis.Lotus Root: Clears heat, stops bleeding, and resolves stasis.Child Urine: Nourishes Yin and lowers fire. It is most suitable for bleeding syndromes and for those who do not respond to general medications. It should be avoided in cases of Yin Deficiency without fire, undigested food, or intestinal issues.Zhi Mu: Clears the lungs and nourishes the kidneys. It can be used when phlegm has an unpleasant odor. It can nourish Yin and lower fire when used with Huang Bai. However, long-term use may lead to diarrhea, so it should not be used in cases of Spleen Deficiency with reduced appetite and diarrhea.Ren Shen: A key herb for Lung Deficiency. However, it should not be used in cases of Lung Yin Deficiency with excessive heat. It can be used with Er Dong and Er Di to prevent Spleen damage and issues with appetite and diarrhea in cases of Spleen and Kidney Deficiency.Xi Yang Shen: It is colder than Ren Shen and is better for those with Yin Deficiency and heat.(2) Key herbs for Kidney Yin DeficiencyShu Di: Nourishes the kidneys and benefits Yin. This is a key herb for nourishing Kidney Yin and can treat essence deficiency, marrow deficiency, and blood deficiency. However, it is slightly warm and can stagnate, so it should be used with Sheng Di and other nourishing Yin herbs. In cases of Yin Deficiency with excessive phlegm and Qi stagnation, it should be avoided or used with Chen Xiang, Sha Ren, Mai Dong, and Chuan Bei.Sheng Di: Nourishes Yin and cools the blood. It can be used in cases of heat, but should not be used in cases of reduced appetite and diarrhea.Bie Jia: Nourishes Yin and subdues Yang. It can be used in cases of Yin Deficiency with alternating cold and heat, or internal heat.Gui Ban: Nourishes Yin and subdues Yang, and can reduce bone steaming. It should not be used in cases of Kidney Deficiency without heat.Dan Pi: Can be used for five hearts feeling hot, bone steaming, and internal heat. It can be used in cases without sweating to clear Liver and Kidney heat.Di Gu Pi: Can be used for five hearts feeling hot, bone steaming, and internal heat. It can be used in cases with sweating to lower hidden fire in the lungs.Gou Qi, Du Zhong: Treat Kidney Deficiency and back pain.Pig Kidney, Pig Spinal Marrow: Boil in soup to treat back pain.Lotus Stamen: Can be used for unstable essence.Zi He Che: Strongly nourishes essence and blood. It can be used for deficiency syndromes.Nu Zhen Zi: Suitable for Kidney Yin Deficiency with heat. Long-term use may cause abdominal pain and diarrhea.Shan Yu Rou: A nourishing herb. It can be used for unstable essence, excessive sweating, and urinary incontinence. It should not be used in cases of heat in the bladder or difficulty urinating.(3) Key herbs for Spleen Yin DeficiencySheng Shan Yao: Nourishes the spleen, lungs, and kidneys. It is most suitable for those with Yin Deficiency, diarrhea, and loss of appetite.Fu Ling: Can be used in cases of diarrhea and reduced urination. It should not be used excessively in cases of Yin Deficiency, as it may harm moisture.Yi Ren, Lian Rou, Bian Dou: All can be used for diarrhea.Sheng Bai Zhu: A key herb for tonifying the spleen. It is most suitable for diarrhea and reduced appetite, but in cases of severe Yin Deficiency, it may be too drying; it can be replaced with Yi Ren or Shi Hu.Sheng Bai Shao: Can be used for abdominal fullness (more severe at night), abdominal pain, sweating, diarrhea, and Qi stagnation. It should not be used in cases of cold abdominal pain or diarrhea.Shi Hu: Suitable for those with internal or muscular heat.9. All Prohibitions for Yin DeficiencyDuring treatment, strict adherence to prohibitions is essential; otherwise, it will affect treatment. The key prohibitions are as follows:1. Absolute prohibition of tobacco and alcohol.2. Regarding ginger, scallions, and garlic, a small amount can be used to enhance flavor, but caution is needed in severe cases.3. Absolute prohibition of all spicy foods (such as chili, pepper, and mustard).4. Absolute prohibition of all raw, cold, slippery, or hard foods, as they may harm the stomach and intestines.Sexual desire is a major cause of Yin Deficiency and must be strictly prohibited, even to the point of avoiding any thoughts of desire. Gu’s theory states: “When desire arises, Yang fire surges; even without intercourse, essence is already consumed.” In severe cases, complete abstinence for three years is necessary.5. Anger harms the liver, and worry harms the spleen; one must always pay attention to these.6. Labor should be reduced. Excessive labor causes Qi to rise externally and essence to be exhausted internally, but light exercise is still necessary.10. Brief Discussion on Cold SyndromesWhat is “cold”? From a human perspective, cold is a comprehensive manifestation of insufficient heat. What is a “cold syndrome”? A cold syndrome refers to various symptoms caused by insufficient heat in the body. From a holistic perspective, there is exterior cold, interior cold, true cold caused by Yin evil penetrating, false cold caused by Yang deficiency, “hidden cold within fire,” and “fire stagnation resembling cold,” as well as “false cold due to Yang floating outward.” Among exterior cold, there are distinctions such as “wind-cold,” “cold-damp,” “Yin summer heat,” “cool dryness,” “cold damage,” and “cold invasion.” Among interior cold, aside from Yang deficiency causing internal cold, hidden cold within fire, and false cold due to Yang floating outward, the most common cause is due to consuming raw and cold foods, excessive use of cold herbs, or living in cold environments without proper clothing.Symptoms of cold syndromes include: exterior cold symptoms such as aversion to wind and cold, fever, preference for warmth, headache, neck stiffness, body pain, joint pain, tongue without coating, or a tongue coating that is pale white and thin, mouth not dry, not bitter, not thirsty, or nasal congestion with dry retching, or cough with thin phlegm, pulse floating and tight; interior cold symptoms include abdominal pain and fullness, vomiting and diarrhea, cold extremities, preference for warmth and aversion to cold, and reluctance to consume cold foods, as forced consumption worsens abdominal symptoms, with pulse being deep and tight or deep and slow. Throughout the year, symptoms are lighter in summer and heavier in winter, and during the day, lighter in the morning and heavier in the afternoon. Pure exterior cold or interior cold, true cold or false cold, are not difficult to distinguish, but in clinical practice, cold and heat often appear in mixed situations, making it crucial to discern the proportions of cold and heat, the authenticity of cold and heat, and the true and false nature of the symptoms, which is a key test of a physician’s diagnostic skills and affects the patient’s disease outcome.For example, a patient diagnosed by Western medicine as having sinusitis, with puncture showing pus, severe headache, yellow and thick nasal discharge, no dry mouth, not liking cold foods, abdominal fullness, and rib pain, with pale tongue and thin coating, pulse being wiry and tight, indicates a mixed cold-heat syndrome with Qi stagnation. Treatment with Xiaoyao San plus Lianhua, Lianqiao, Chuanxiong, Baizhi, Huangqin, and Ganjiang resulted in improvement after one dose and recovery after three doses. Another example involved a patient with a cough lasting over 20 days, presenting with fullness in both sides, easy expectoration of phlegm, dry throat, and bitter mouth, but not liking to drink, with accompanying headache. This was diagnosed as a mixed cold-heat syndrome with liver Qi stagnation. The treatment involved using both cold and warm methods, with Sang Pi, Bei Mu, Chai Hu, Xiang Fu, Ju Hong, Ban Xia, Fu Ling, Xing Ren, Ganjiang, and Huangqin to clear the lungs, warm the spleen, transform phlegm, resolve Qi stagnation, and balance cold and heat. Improvement was seen after one dose.When distinguishing between true and false cold and heat, it is crucial to observe the tongue coating’s dryness and whether the patient prefers cold drinks. If the answer is affirmative, it is undoubtedly a heat syndrome, even if cold symptoms are present; if negative, it is undoubtedly a cold syndrome. Diagnosing a disease is similar to recognizing a person; regardless of their clothing, one can identify them, indicating that the essential characteristics have been grasped. Diagnosing diseases also requires focusing on the essential characteristics rather than relying on superficial symptoms.For instance, a patient with a high fever and extreme thirst may seem to have a heat syndrome, but upon careful examination of the tongue, which shows no coating and is moist, and although thirsty, the patient does not prefer cold drinks, it is concluded that the heat is false, and true Yang deficiency with internal cold is present. Therefore, treatment with Zhenwu Decoction and similar herbs was effective.11. Cold with Fire and Fire with ColdLi Lao excelled in treating mixed syndromes, particularly in identifying the proportions of opposing symptoms within mixed syndromes and quantifying them for analysis, allowing for targeted treatment. In mixed cold-heat syndromes, he believed it was essential to distinguish between cold with fire and fire with cold. Cold with fire syndrome is primarily cold, with fire symptoms often not very prominent; fire with cold syndrome is primarily fire, with cold symptoms also often not very prominent. In such cases, how can one determine whether it is cold with fire or fire with cold? Li Lao believed that only through trial treatment can one clarify the diagnosis. Cold with fire syndrome does not respond to warming treatments, and may even exhibit fire symptoms; fire with cold syndrome does not respond to cooling treatments, and may even exhibit cold symptoms. As for clearly defined cold-heat mixed syndromes, using both cold and heat treatments at the beginning can naturally lead to recovery without needing to establish a separate name. When cold lingers in the lungs for a long time, it transforms into fire, thus treating it with fire methods is appropriate without concern for the cold. Coughing blood due to wind-cold is often caused by prolonged external invasion, leading to cold entering the lungs, which causes cold to generate fire, damaging blood vessels and resulting in a chronic cough. Physicians often misdiagnose cold with fire syndrome as primarily cold and treat it incorrectly, leading to severe consequences. Caution is advised!In clinical practice, Li Lao often used methods to clear stagnant fire for treating cold with fire syndrome, such as Xiao Chai Hu Decoction with Suzi and Kuan Dong Hua; and methods to eliminate lingering cold for treating fire with cold syndrome, such as the Qianjin Mai Dong Decoction (Mai Dong 30g, Sheng Di 30g, Jie Geng 20g, Sang Pi 30g, Ban Xia 20g, Zi Wan 30g, Zhu Ru 30g, Ma Huang 10g, Wu Wei Zi 10g, Sheng Jiang 3 slices, Gan Cao 10g). Although the Mai Dong Decoction employs both cold and heat, it primarily focuses on cooling and clearing fire, as wind-cold invades the lungs and generates phlegm, thus using Jie Geng, Sang Pi, Ban Xia, and Sheng Jiang to eliminate phlegm and fluid, while using Sheng Di, Zi Wan, Zhu Ru, Mai Dong, and Wu Wei Zi to clear and restrain fire. However, if the lingering cold is not eliminated, phlegm and fire will recur, thus using the warming Ma Huang to eliminate lingering cold. Gan Cao is used to harmonize the various herbs, and the combination of herbs aims to clear fire while eliminating lingering cold, achieving the goal of clearing fire and eliminating cold, and preventing phlegm and fire from recurring.12. Blood SyndromesWe generally refer to abnormal bleeding as blood syndromes, while Li Lao categorizes all blood-related conditions as blood syndromes, including blood heat, blood cold, blood deficiency, blood stasis, bleeding, and blood collapse. All six conditions present symptoms related to blood (including menstruation): Blood heat occurs when the temperature of the blood is excessive, leading to heat symptoms, characterized by a preference for cold and aversion to heat, dry mouth, and thirst for cold foods; blood cold occurs when the temperature of the blood is insufficient, leading to cold symptoms, characterized by a preference for heat and aversion to cold, and aversion to cold foods; blood deficiency refers to insufficient blood components, also known as anemia, characterized by pale complexion, reduced menstrual flow, pale color, pale tongue with little coating, and thin pulse; blood stasis refers to the presence of clots in the blood, leading to symptoms of pain, menstrual clots, and purplish spots on the skin and tongue; bleeding refers to all bleeding outside of normal menstruation and the bleeding from the nose due to febrile diseases; blood collapse refers to excessive and uncontrolled bleeding, with weak pulse, or no pulse, or a large pulse without order.13. The Relationship Between Blood Stasis and the Five OrgansBlood stasis is a unique pathological phenomenon in Traditional Chinese Medicine, with two layers of meaning. First, blood stasis is a pathological product caused by various diseases for different reasons; second, the presence of blood stasis affects organ function and can lead to various diseases. The formation of blood stasis is primarily due to trauma, Qi deficiency, Yin deficiency, blood deficiency, Qi stagnation, cold congealing, and heat scorching. The normal generation and circulation of blood, as well as the production of blood stasis, are closely related to the five organs, which can be summarized as follows: blood is generated in the spleen, governed by the heart, stored in the liver, distributed by the lungs, and expelled by the kidneys.1. The Relationship Between Blood Stasis and the LiverThe liver is the key to the formation of blood stasis. If the liver does not regulate, Qi and blood will stagnate internally or overflow externally, leading to stasis wherever it is obstructed. If liver fire is excessive, blood can also be scorched and coagulated into stasis. The “Supplement to External Medicine” states: “In cases of trauma, if evil blood remains inside, it can obstruct all twelve meridians, and the liver is the main organ.” Clinically, blood stasis obstructing the liver often presents with symptoms of accumulation and distension.2. The Relationship Between Blood Stasis and the HeartThe heart also has a significant relationship with blood stasis. The circulation of blood is governed by the heart, and the heart’s ability to govern blood relies on its Yang being vigorous and its orifices being open. If heart Yang is weak, the pulse will be weak, leading to sluggish blood flow and stasis; if the orifices are obstructed, blood will also stagnate into stasis. The “Lingshu: Meridians” states: “If the hand Shaoyin (heart) Qi is exhausted, the pulse will not flow; if the pulse does not flow, blood will not circulate; if blood does not circulate, the complexion will be dark like lacquer, indicating that blood has died first.” Conversely, if heart fire is excessive, the Ying blood will be scorched and coagulated into stasis.Clinically, blood stasis obstructing the heart often presents with symptoms of chest obstruction, true heart pain, and palpitations.3. The Relationship Between Blood Stasis and the SpleenThe spleen is the organ responsible for generating and governing blood, and it has a closer relationship with the growth and decline of blood stasis. Tang Rongchuan stated: “Food enters the stomach, the spleen transforms it into essence, which is then sent to the heart, where it is transformed into blood. Therefore, when treating blood conditions, the spleen should be the primary focus.” Furthermore, blood is generated by heart fire and stored in the liver, while Qi is generated by kidney water and governed by the lungs, with the spleen being the hub for the movement of Qi and blood. If the spleen is unable to transform and transport the essence of food, it will be difficult for blood to be generated, and if blood is insufficient, it will not circulate smoothly, leading to blood stasis. Spleen deficiency and Qi weakness will hinder the movement of blood, leading to a mix of clear and turbid, causing obstruction and stagnation, which is the source of many diseases. The “Suwen: Taiyin and Yangming” states: “If the spleen cannot transport the fluids from the stomach, the four limbs will not receive the nourishment of water and food, leading to Qi decline and obstructed pulse pathways.” Blood stasis obstructing the middle burner often presents with symptoms of epigastric pain, abdominal pain, vomiting blood, and rectal bleeding.4. The Relationship Between Blood Stasis and the LungsThe lungs are responsible for respiration and governing Qi, and thus have a function in circulating blood. The “Lingshu: Meridians” states: “Food enters the stomach, turbid Qi returns to the heart, and the essence flows through the pulse, with the pulse Qi returning to the lungs, which governs the hundred vessels, distributing essence to the skin and hair, where the pulse and essence converge, allowing Qi to flow through the organs.” This indicates that the blood of all meridians flows through the lungs, and it is under the impetus of lung Qi that it can circulate throughout the body. If lung Qi is weak or obstructed, the hundred vessels cannot flow to the lungs, and the lungs cannot distribute blood throughout the body, ultimately leading to blood stasis.5. The Relationship Between Blood Stasis and the KidneysPeople often overlook the relationship between the kidneys and blood stasis, yet the key to removing stasis lies in the kidneys. Blood circulation is governed by the kidneys, which also control urination. Old blood and dead blood are expelled through the kidneys via urine or bowel movements. Fu Qingzhu stated: “The meridians originate from the kidneys, and the blood flowing through the five organs and six bowels can all return to the kidneys.” Since the kidneys can expel blood, new blood can continuously flow in, while old blood can be expelled, allowing for a continuous cycle of nourishment. If the kidneys fail to expel blood, old blood will have no way out, and new blood will not circulate, leading to stasis in the vessels. Additionally, any stasis in the body must also be expelled by the kidneys, which is why both ancient and modern physicians emphasize the importance of unblocking the large and small intestines to remove stasis. Zhang Zhongjing advocated using purgatives to eliminate stasis, stating that unblocking and dispersing will lead to smooth urination, and that blood stasis should not be overlooked.In cases of cold extremities, it is important to distinguish between Yang Deficiency and blood loss. Mixed syndromes of cold extremities are often due to spleen and kidney Yang Deficiency, where Yang Qi cannot reach the extremities, and the formula Si Ni Tang is used for treatment.In cases of blood loss, cold extremities are often a false cold syndrome caused by internal heat, with symptoms of coldness, dizziness, and faintness, or alternating cold and heat. If there is more cold than heat, it indicates a Yang extreme resembling Yin; if there is more heat than cold, it indicates that the heat is still shallow. This is because the cold in the liver channel can lead to gallbladder fire, and when the disease occurs, the fire can hide within the Yin, leading to cold extremities. The treatment should first focus on addressing the hidden fire, allowing the fire to emerge, and then transforming cold into heat. The formula used can be Qinghua Decoction combined with Shengjiang, or the Danggui Longhui Wan for treatment, and once the heat is transformed, the heat should be cleared. If the heat does not subside, then Da Bu Yin Wan or Di Huang Decoction should be used to nourish Yin and support recovery.14. The Use of Sweat TherapySweat therapy refers to the use of warm or cool herbs to promote sweating in the body, allowing pathogens to be expelled through sweat and thus alleviating exterior syndromes, also known as the method of resolving the exterior. In clinical applications of sweat therapy, it is essential to grasp the concept of “degree.” The best situation is to induce a slight sweat all over the body; if sweating is insufficient, or if there is excessive sweating, it is not advisable, as the former does not effectively expel pathogens, while the latter can easily deplete the body’s vital energy, leading to severe consequences.In the application of sweat therapy, several issues should be analyzed specifically:1. When sweating is expected but does not occur, what are the reasons?Aside from the herbs not matching the syndrome, if the herbs are appropriate but sweating does not occur, the reasons may include:(1) Quality of the herbs1. Impure varieties.2. Harvesting at the wrong time: for example, Gui Zhi should be harvested in spring; if harvested in autumn or winter, its efficacy is greatly reduced.3. Improper processing: for example, Jing Jie should be used fresh for inducing sweating, while if charred, it will be more effective for stopping bleeding. Ma Huang is strong for inducing sweating when fresh, but when honey-fried, its sweating effect is milder and more effective for moistening the lungs and relieving cough.4. Long-term deterioration: including mold, rot, and insect damage, which can lead to loss of efficacy.(2) Quantity of the herbsInsufficient herbs for a severe illness.(3) Improper decoction methodOvercooking can cause the medicinal properties to evaporate. The herbs used in sweat therapy are generally light and agile, and prolonged decoction will reduce their efficacy.Note: Modern pharmacology has proven that the herbs used in sweat therapy contain abundant volatile oils that are sensitive to high temperatures, and prolonged decoction will lead to evaporation.(4) Improper administration1. The decoction should be taken warm.2. After taking the herbs, the patient should be kept warm and not exposed to wind.3. After taking the herbs, avoid consuming raw or cold foods, such as greasy foods.(5) Insufficient understanding of the patient’s specific condition1. In cases of warm diseases with insufficient Yin (Yin Deficiency), using warm or cool herbs to induce sweating will not yield results.2. In cases of chronic sores or ulcers.2. When sweating occurs but the exterior does not resolve, what are the reasons?Exterior syndromes refer to symptoms such as aversion to cold, fever, headache, and body pain. If sweating occurs and the exterior resolves, it indicates cold evil; if sweating occurs but the exterior does not resolve, it is likely due to wind or dampness.(Refer to the “Warm Disease Differentiation” in the sixth section.)3. What are the harms of not sweating when sweating is indicated?When sweating is indicated, but sweat therapy is not used, the evil cannot be expelled, and the exterior cannot resolve.4. What are the harms of sweating when it is not indicated?There are several reasons for inappropriate sweating:1. The evil is not in the exterior.2. Blood loss.3. Sores or ulcers.4. Pre-existing Yin Deficiency.In these cases, the Yin is already injured, and sweating should not be induced, as it will further harm the Yin fluids.In summary, sweat therapy is a means of inducing sweating to achieve the goal of resolving exterior syndromes. The presence or absence of sweating in clinical practice can also serve as a diagnostic basis, thus becoming a major symptom. For example, in cases of Taiyang disease, if sweating occurs, Gui Zhi Decoction is used; if sweating does not occur, Ma Huang Decoction is used. If sweating occurs, it is called wind-cold; if sweating does not occur, it is called cold damage. Similarly, in cases of Yangming disease, if sweating occurs, Bai Hu Decoction is appropriate; if sweating does not occur, Bai Hu Decoction is not suitable. In summer, excessive sweating is normal, while in winter, lack of sweating is normal; conversely, it indicates a pathological condition.15. Prohibitions for Nourishing YinNourishing Yin methods utilize sweet and cold herbs to nourish bodily fluids. Since warmth is a Yang evil, it easily depletes bodily fluids, thus nourishing Yin is a common method in treating warm diseases. However, it is important to note that in the following four situations, nourishing Yin is not advisable:1. If dampness has not been resolved and Yin fluids have not been harmed, using nourishing Yin will leave dampness lingering, making the disease difficult to resolve.2. If the disease is in the Qi level, even with high fever, if Yin fluids have not been harmed, nourishing Yin is not advisable, as it will lead to deeper penetration of the evil into the Ying and blood levels, worsening the condition.3. If the warm evil has just entered the Ying level, and the Qi level evil has not been resolved, nourishing Yin is not advisable, as it is necessary to first clear the Ying and release the heat to resolve the Qi level evil.4. Patients with Yang Deficiency should absolutely not use nourishing Yin, as it may further weaken Yang Qi, leading to separation of Yin and Yang, resulting in transformation.16. Supplementing the Heart and Nourishing the MotherLi Hanqing believes that Tian Wang Bu Xin Dan (Ren Shen, Dang Gui, Chao Jujube Seed, Wu Wei Zi, Yuan Zhi, Dan Shen, Fu Shen, Bai Zi Ren, Tian Dong, Mai Dong, Sheng Di, Yuan Shen, Jie Geng, and Zhu Sha) is a formula that supplements heart Qi, nourishes heart blood, generates fluids, clears heat, calms the heart, and settles the spirit. It is primarily used for conditions caused by excessive worry and overthinking, leading to heart blood deficiency, restlessness, forgetfulness, palpitations, insomnia, constipation, and short red urine, with a dry tongue and mouth sores. At the end of the modification section, Li Lao has an important note: “This formula should always include 3-5 qian of Zhi Cao to nourish the middle, as the spleen and stomach are the foundation of postnatal health. It is also the child of the heart, thus nourishing the child can also benefit the mother.”17. Differences in the Use of Purgatives in Warm and Cold DiseasesPurgatives are one of the eight therapeutic methods in Traditional Chinese Medicine, used to clear the intestines and expel retained food, dry stool, cold accumulation, blood stasis, phlegm, and stagnant water through the lower orifices. However, the application of purgatives in warm and cold diseases has distinct characteristics, and clear differentiation is necessary for appropriate use.In cold diseases, the following characteristics apply:1. In cold diseases, purging is not considered late; early purging may cause the exterior evil to penetrate, so if there is any exterior syndrome, it is still advisable to treat the exterior first, hence purging is not considered late.2. Cold diseases involve purging stagnation, thus often using products like Zhi Pi (but there are exceptions, such as in the case of Tiao Wei Cheng Qi Decoction).3. In cold diseases, purging must wait until the exterior syndrome is completely resolved before proceeding.4. In cold diseases, if there is evil in the upper body, it cannot be purged.5. In cold diseases, purging should be stopped immediately; cases requiring continuous purging are rare.6. Cold diseases are caused by Yin evils, which have not yet transmitted to the intestines to generate heat, thus caution is advised against early purging.In contrast, the characteristics of purging in warm diseases are as follows:1. In warm diseases, purging is not considered early.2. Warm diseases involve purging accumulated heat, thus avoiding the use of bitter and drying herbs like Zhi Pi, and instead using Nao Huang (though there are some exceptions, but they are less common; the use of Tiao Wei Cheng Qi Decoction is rare, while Tiao Wei Cheng Qi Decoction is more common).3. In warm diseases, it does not matter whether the exterior evil has resolved; as long as there are interior symptoms, purging can be performed.4. In warm diseases, as long as there are indications for purging, even if there is evil in the upper body, purging can still be performed.5. In warm diseases, purging is often repeated, sometimes up to 10-20 doses.6. Warm diseases are Yang evils, and fire must overcome metal, thus they first invade the lungs, and the fire nature rises, making it difficult to descend. Using purgatives to expel heat from the intestines is the path to recovery.18. Emphasis on Regulating the Spleen and Stomach in Clinical UseLi Lao placed great importance on the spleen and stomach in treatment. He stated: “The spleen and stomach are the foundation of postnatal health, the source of Qi and blood generation, and nourish the five organs and six bowels.” He also stated that the health of the spleen and stomach not only affects the health of the body but also the preservation of life. Therefore, in clinical medication, emphasizing the spleen and stomach is crucial for improving clinical efficacy. Li Lao’s treatment of the spleen and stomach generally includes methods such as tonifying Qi, nourishing Yin, lifting, warming the middle, clearing heat, regulating Qi, dispelling dampness, purging, and digesting, each with its main formulas and accompanying medications.For example, in cases of Qi deficiency in the spleen and stomach, he often uses Si Jun Zi Tang as the main formula; for Yin deficiency in the spleen and stomach, he often uses Yang Wei Tang as the main formula; for Spleen Yang deficiency, he often uses Li Zhong Tang as the main formula; for middle Qi deficiency, he often uses Bu Zhong Yi Qi Tang as the main formula; for liver-spleen disharmony, he often uses Shu Gan He Wei Wan as the main formula; for Spleen heat, he often uses Da Huang Huang Lian Xie Xin Tang as the main formula; for excess in the intestines, he often uses San Cheng Qi Tang for heat excess; for excess in the intestines, he often uses Wen Pi Tang for cold excess; for combined purging and tonifying, he often uses Zeng Ye Cheng Qi Tang; for food stagnation in the spleen and stomach, he often uses Bao He Wan for mild cases and Mu Xiang Bing Lang Wan for severe cases.19. The Importance of Using Purgatives with CautionPurgatives consist of strong-acting herbs that clear the intestines, expel stagnation, and eliminate water and phlegm. The purging method is one of the eight therapeutic methods, and in cases of interior excess, including Qi stagnation, blood stasis, water accumulation, food stagnation, constipation, and parasitic accumulation, appropriate use can often yield miraculous effects, saving lives in critical situations. However, if the diagnosis is incorrect and the method is improperly applied, it can harm the body’s vital energy and even endanger the patient’s life. Therefore, the use of purgatives, especially strong purgatives, should be approached with caution, requiring both courage and discernment.Courage refers to clear diagnosis; particularly in cases of significant interior excess and urgent conditions, decisive action should be taken to aggressively purge, and the dosage should not be too small. For example, Da Huang should be used in larger doses; there is no need to worry about excessive diarrhea, as the evil heat will stop after being expelled.Discernment refers to accurate diagnosis, while also paying special attention to the presence of contraindications to prevent misapplication.Discernment is the prerequisite for courage; one must have discernment to have courage. Li Lao placed great emphasis on the use of purgatives throughout his life, and his clinical experience with the use of Cheng Qi formulas can be summarized in the following two points:1. Usage StandardsClinically, if fever and constipation occur for more than two days, or if there is a bowel movement but the stool is hard and dry, with abdominal burning and slight pain upon palpation, and the tongue coating is dry and yellow, with a thick root, it is appropriate to use purgatives boldly.2. Key Points in Medication(1) The dosage should not be too small. Generally, the dosage of purgatives should not be less than 9g, with Da Huang being more suitable for larger doses. There is no need to worry about excessive diarrhea, as the evil heat will stop after being expelled.(2) It can be combined with moistening purgatives. For example, Li Lao often used Purgative and Moisteners together for better results.(3) It can be used with detoxifying herbs. If the exterior evil has not resolved or if there is heat toxin in the diaphragm, such as in cases of mumps, measles, or throat infections, detoxifying herbs such as Geng Ying, Di Ding, Yin Hua, and Lian Qiao can be added.(4) It can be used with heat-clearing herbs. For high fever with delirium and confusion, it is advisable to remove the warming and drying properties of Zhi Pi and use cooling herbs such as Shi Gao, Zhi Mu, Sheng Di, Huang Lian, Huang Qin, and Huang Bai.(5) It can be used with nourishing Yin and generating fluids. For high fever damaging Yin, leading to dryness, it should be combined with Sheng Di, Mai Dong, Yuan Shen, and Shi Hu.(6) After purging, it is advisable to continue with harmonizing herbs. If the stool is foul after purging, it indicates that the herbs have reached the disease; one can take 1-2 more doses to prevent the heat from re-accumulating; if the stool is clear and not foul or only slightly foul, it is advisable to stop and continue with harmonizing herbs to protect the stomach Qi.(7) Pay attention to the false appearance of purging. Even if the above symptoms are present, if there is abdominal distension and increased bowel sounds, it indicates a false appearance of purging, and caution should be exercised.20. The Importance of Precise FormulationLi Lao believed that the quality of a formula greatly impacts clinical efficacy, so it is essential to pay attention when prescribing. He stated: “Every formula should be an orderly individual, not a haphazard mix. Each formula should be understood in terms of its main indications, the properties and pathways of each herb, which herbs have the most prominent effects, which herbs have less prominent effects, what new effects can arise from the combination of herbs, which combinations have been established by predecessors, and what their indications are, as well as the overall trend of cold or heat, rising or sinking, tonifying or purging, and the special effects of each herb. The impact of changing the dosage form on the entire treatment should also be considered.” He believed that achieving this requires effort in two areas: first, thorough study of pharmacology, avoiding rote memorization, and focusing on comparisons to identify similarities and differences; second, extensive reading of formula texts, comparing formulas with similar indications, compositions, and uses to identify their commonalities and characteristics. With such efforts over several years, one can achieve a clear understanding. Therefore, someone once asked Li Lao, “Why do your formulas work so effectively?” Li Lao replied: “Every time I prescribe, I ensure that the formula matches the syndrome, the herbs match the syndrome, the combinations match the syndrome, the dosage forms match the syndrome, and the dosages match the syndrome.”21. The Concept of “Formulas within Formulas”Li Lao believed that typically, a formula consists of one or more herbs, especially classical formulas, which are often tightly composed. For example, the Da Qinglong Decoction actually contains the Ma Huang Decoction, the Ma Xing Shi Gan Decoction, and the Gui Zhi Gan Cao Decoction, but its indications differ from all three. Therefore, the herbs in classical formulas should not be arbitrarily added or subtracted, as this can lead to significant changes in the original indications, or even completely transform it into another formula.22. The Concept of “Herbs within Formulas”Li Lao stated: “The formulas for warming the meridians and rescuing the Yang do not necessarily have to use Ma Huang Decoction; one can also use Chai Jiang Decoction or Hu Jiao Decoction. The key is to understand the indications and the context of the disease.”In summary, the concepts of “formulas within formulas” and “herbs within formulas” reflect Li Lao’s high-level understanding of the relationships between herbs, dosages, and effects in the application of formulas. Therefore, when selecting formulas and herbs, one should start from clinical practice, adhering to the rules when necessary and making adjustments when necessary. As Li Lao stated: “Using fixed formulas to treat diseases is like tearing down an old house to build a new one; without the hands of a skilled craftsman, how can it be done properly? Therefore, when using formulas, one must avoid simply copying them; classical formulas cannot fully address modern diseases… If any aspect does not match, appropriate adjustments must be made. This applies to both warm diseases and mixed syndromes. In summary, formulas must match the syndrome; I often use ancient formulas in clinical practice, and I also often apply the spirit of ancient formulas flexibly, achieving the same effects. This is the principle.”23. The Importance of Learning from Classical FormulasUsing classical formulas to treat diseases is like tearing down an old house to build a new one; without the hands of a skilled craftsman, how can it be done properly? Li Lao believed that classical formulas cannot fully address modern diseases, and using classical formulas requires careful consideration. For example, when using Zhang Zhongjing’s classical formulas, one must verify that the pulse, symptoms, and disease mechanisms match completely; only then will it be effective. If the formula is used for a different syndrome, it will not yield significant results, as the dosage of the herbs may be reduced. If the formula is used for a different syndrome, it may even cause harm. Therefore, when learning classical formulas, one must grasp the principles and methods, and it is not necessary to use the original herbs and dosages. For example, what is the function of Ma Xing Shi Gan Decoction, and under what circumstances can it be used? When encountering such symptoms in clinical practice, it can be applied flexibly. Li Lao often used the Shi Gao Aspirin Decoction in accordance with this principle. Additionally, when warming and inducing sweating, it is not necessary to use Ma Huang Decoction; Chai Jiang Decoction or Hu Jiao Decoction can also be used. The key is to grasp the main points and understand the spirit of the formula, adjusting according to the syndrome to achieve effective results. For example, when treating abdominal distension, use Chuan Pi as the main herb; if there is deficiency, add Ren Shen; if there is vomiting, add Jiang Xia. This reflects the principles of the classical formulas. If it is a case of excess distension, add Zhi Shi and Da Huang; if it is cold, add Gan Jiang; if it is mixed cold and heat, often use Gan Jiang and Huang Lian together, imitating the principles of the Xie Xin Decoction and Huang Lian Decoction. As long as the principles are grasped and adjustments are made according to the syndrome, effective results can be achieved.24. The Relationship Between Formula Meaning and Modification MethodsFormula meaning indicates the main treatment direction of each formula. If one correctly grasps this direction, it will yield good results not only for diseases within the main treatment range but also for diseases outside the main treatment range, often achieving certain effects. If one deviates from this direction, treatment will be misguided, leading to ineffective results for both diseases outside the main treatment range and those within the main treatment range.Modification methods serve two purposes. One is to help practitioners address common diseases that fall outside the main treatment range. In the early stages of clinical practice, when encountering diseases outside the main treatment range, practitioners often struggle to take action, as no disease is completely isolated; there are always interconnections. The modification methods provide a guide for practitioners to follow when using herbs based on the syndrome.The other purpose is to help practitioners address many uncommon syndromes, as human diseases are infinite, and it is impossible to document every single one. The modification methods can inspire practitioners to draw parallels or make inferences to find appropriate solutions.This section on “Formula Meaning and Modification Methods” was written on the cover of “Li Hanqing’s Materials 50.” This material records 26 warm disease formulas, with each formula detailing its meaning, indications, herbs, modification methods, preparation methods, contraindications, and general usage. The meaning of the formula is listed first, indicating that Li Hanqing had a clear understanding of the principles of formula studies. This is also vividly demonstrated in his manuscript “Clinical Experience with 113 Formulas from the Treatise on Cold Damage,” which scholars can study in detail. The emphasis on modification methods reflects Li Lao’s academic thoughts on diagnosis and treatment, particularly his focus on mixed syndromes. By emphasizing modifications based on the main formula, Li Lao’s academic thoughts exhibit both principles and flexibility.25. Clinical Application of Si Wu DecoctionSi Wu Decoction originates from the Song Dynasty’s “Taiping Huimin Heji Ju Fang” and functions to nourish blood and regulate menstruation, serving as a foundational formula for treating various blood deficiency syndromes.[Historical Experience Summary]“Ju Fang”: Treats all blood deficiency, blood heat, and blood dryness syndromes.Ke Yunbo: This formula is a specialized agent for regulating blood in the liver channel, not the primary formula for generating blood in the heart channel.This formula can nourish tangible blood in normal times but cannot generate intangible blood in emergencies. In cases of blood collapse or fainting, Si Wu cannot quickly replenish and may instead assist in sliding away.Tang Rongchuan: Si Wu is a general agent for nourishing and regulating blood. Regulating blood cannot be achieved solely by consuming Si Wu.XU Lingtai: This is the main formula for blood diseases.Chen Xiuyuan: Treats all blood syndromes. It is purely a stagnation product and cannot treat the source of blood… It is essential to master the methods of modification for effectiveness.Huang Gongxiu: The blood in the Ying level cannot be generated without this formula.[Herbs]Dang Gui 9-15g, Shu Di 9-15g, Chuan Xiong 4.5-7.5g, Bai Shao 9-15g[Modification Methods]If there is blood deficiency, add Ren Shen and Huang Qi (named Sheng Yu Decoction).If there is blood stasis or stasis, it is advisable to remove Bai Shao and add Chi Shao, remove Dang Gui and add Gui Wei, or add Tao Ren and Hong Hua.If there is blood blockage or blood flow issues, or if there is a need to add Da Huang or Mang Xiao.If there is blood cold, add Rou Gui or Fu Zi.If there is blood heat, remove Shu Di and add Sheng Di or add Huang Qin, Huang Lian.If there is bleeding, it is advisable to remove Chuan Xiong, or add San Qi, or add various charcoal herbs.If there is blood deficiency with aversion to cold, it is advisable to combine with Ma Huang Decoction.If there is blood deficiency with aversion to wind and heat, it is advisable to combine with Gui Zhi Decoction.If there is blood deficiency with Shaoyang cold-heat alternation, it is advisable to combine with Xiao Chai Hu Decoction.If there is blood deficiency with Yangming heat syndrome, it is advisable to combine with Tiao Wei Cheng Qi Decoction.If there is excessive blood without heat, add E Jiao and Ai Ye.If there is excessive blood with heat, add Huang Qin and Bai Zhu.If there is excessive blood with clots, and the color is purple and thick, it indicates internal blood stasis, add Tao Ren and Hong Hua.[Effects]Nourishes blood and regulates blood.[Indications]All symptoms of Ying blood deficiency, women’s menstrual irregularities, abdominal pain, and bleeding during menstruation.[Contraindications]In cases of vomiting blood, nosebleeds, cough, or vomiting, all cases of Yin Deficiency with blood heat should avoid Dang Gui and Chuan Xiong, as both are warm in nature. In cases of diarrhea, avoid Dang Gui, as it is oily and slippery.In cases of blood collapse or fainting, avoid using Si Wu, as it may assist in sliding away.26. Usage and Cautions for San Cheng Qi DecoctionBan Xia San Cheng Qi Decoction, Sheng Jiang San Cheng Qi Decoction, and Gan Cao San Cheng Qi Decoction have similar compositions, with only one herb differing or only the dosage varying. Although they all aim to harmonize cold and heat and regulate the stomach, their main indications differ significantly, and careful differentiation is necessary when applying them. When using Sheng Jiang San Cheng Qi Decoction, the clinical symptoms should include hardness and fullness in the heart area, foul-smelling belching, water retention in the sides, abdominal rumbling, and diarrhea. It is most suitable for cases with a yellow and turbid tongue coating, clear and smooth bowel movements, and no signs of heaviness.In cases of cold and heat, the dosage should be adjusted accordingly. For example, if the symptoms are more severe, the dosage should be increased; if the symptoms are milder, the dosage should be reduced. In cases of severe symptoms, it is advisable to use a larger dosage of Ban Xia and Gan Cao, while in cases of milder symptoms, a smaller dosage is sufficient.In summary, the treatment of Yin Deficiency requires a comprehensive understanding of the syndrome, its causes, and the appropriate treatment methods. By applying the principles of Traditional Chinese Medicine, one can effectively address Yin Deficiency and its associated symptoms.
