Yin-Yang SectionIn diagnosing and treating diseases, one must first examine Yin-Yang, as it is the guiding principle of medicine. If Yin-Yang is not understood, how can treatment be accurate? Although the medical path is complex, it can be summarized in one phrase: Yin-Yang. Therefore, symptoms have Yin-Yang, pulses have Yin-Yang, and medicines have Yin-Yang. In terms of symptoms, the exterior is Yang, and the interior is Yin; heat is Yang, and cold is Yin; above is Yang, and below is Yin; Qi is Yang, and blood is Yin; movement is Yang, and stillness is Yin; talkativeness is Yang, and silence is Yin; brightness is Yang, and darkness is Yin. When Yang is weak, one cannot exhale; when Yin is weak, one cannot inhale; when Yang is ill, one cannot bend down; when Yin is ill, one cannot look up. In terms of pulses, floating, large, slippery, and rapid types are all Yang; sinking, fine, and choppy types are all Yin.In terms of medicines, those that ascend and disperse are Yang, while those that gather and descend are Yin; pungent and hot are Yang, while bitter and cold are Yin; those that move Qi are Yang, while those that move blood are Yin; those that are active and mobile are Yang, while those that are still and protective are Yin. These are all fundamental principles in medicine. Furthermore, within Yin there is Yang, and within Yang there is stillness; distinguishing between the two is crucial. If one fails to recognize this, it is easy to make mistakes, which is of utmost importance, yet it does not stray from the aforementioned principles. However, when the two energies coexist, one may have more of one and less of the other, leading to changes that can be measured by reason, which are evident and observable. If Yang is excessive and more Yang treatment is applied, then Yang will become more intense and Yin will diminish; if Yang is insufficient and more Yin treatment is applied, then Yin will become more abundant and Yang will perish. If one can clearly understand Yin-Yang, then although the principles of medicine may be profound, the essence of Yin-Yang is the same as the origin of Qi. Fire is the master of water, and water is the source of fire; they are inherently inseparable.How can this be observed? For example, water is Yin, and fire is Yang, symbolizing the division of ice and charcoal. What does it mean to share the same source? Fire is inherently hot; if there is no water in fire, its heat will be extreme, leading to the loss of Yin, and all things will be scorched. Water is inherently cold; if there is no fire in water, its coldness will be extreme, leading to the loss of Yang, and all things will perish. Can the energies of water and fire truly be separated? In the human body, this is the original Yin and original Yang, known as the pre-natal Yuan Qi. To attain the pre-natal state, one must consider the roots. The Mingmen (Gate of Life) is the portal of life, the home of water and fire, and this is the northern gate of pre-natal energy. Seeking elsewhere is like crossing the sea to ask for a ferry. Students should recognize this.For ordinary people, Yin-Yang is understood in terms of Qi and blood, organs, cold and heat; this is merely the post-natal, tangible Yin-Yang. As for the formless, pre-natal Yin-Yang, Yang is called Yuan Yang, and Yin is called Yuan Yin. Yuan Yang is the formless fire that generates and transforms, which is the divine mechanism. It is related to life, hence it is also called Yuan Qi. Yuan Yin is the formless water that nourishes and sustains, which is the heavenly essence. It is related to strength, hence it is also called Yuan Jing. Yuan Jing and Yuan Qi are the original spirits that transform and generate essence and Qi. The vital energy connects to heaven, relying solely on this. The classics say: “Those who possess spirit prosper; those who lose spirit perish.” This is what it means. Nowadays, many people harm their pre-natal energy with post-natal desires, and modern physicians only recognize tangible pathogenic Qi, neglecting the formless Yuan Qi. The tangible is the trace, its rise and fall is evident, and it is not difficult to recognize; the formless is the spirit, which changes rapidly, and recovery is not easy. Therefore, the classics say: “Guard the form roughly, and guard the spirit closely.” Alas! How can one have the ability to communicate with the spirit and perceive the formless, and discuss this path together?The way of Yin-Yang in heaven and earth values peace; thus, when Qi is regulated, all things thrive. This is the principle of creation and generation. However, Yang is the source of life, and Yin is the foundation of death. Therefore, Daoists say: “If Yin is not fully divided, one cannot become immortal; if Yang is not fully divided, one cannot die.” Hua Yuanhua says: “Those who obtain Yang live, and those who obtain Yin die.” Therefore, anyone who wishes to preserve life and value their existence should especially cherish Yang Qi, as it is the original spirit of life and transformation, and should not be neglected. In the past, Liu Hejian proposed that summer heat should be treated with cold, which severely harmed Yang Qi.Mr. Dongyuan argued that the fire of the spleen and stomach must be nurtured, yet he could not entirely dismiss one-sided fallacies. Then Danxi proposed the theory of Yin Deficiency and Fire Movement, creating formulas such as Da Bu and Da Bu pills, using Huang Bai (Phellodendron) and Zhi Mu (Anemarrhena) as the monarch, leading to the resurgence of cold and coolness. Those who were first harmed have already departed and cannot return. Those who later learned and used it are still confused and unaware. Alas! The higher the law, the greater the magic; if these two are not distinguished, is it not the magic of Xuanqi? I deeply mourn this, hence I write this directly, hoping to thoroughly cleanse accumulated errors to alleviate the crisis of life; it is truly unavoidable. Observers should understand and examine this, and not blame the predecessors for slander. How fortunate!1. Yin-Yang Deficiency-Excess.The classics say: Yang Deficiency leads to external cold, Yin Deficiency leads to internal heat; Yang Excess leads to external heat, Yin Excess leads to internal cold.The classics say: Yang Qi in excess causes body heat without sweating. This refers to the reality of exterior pathogens. It also states: Yin Qi in excess causes excessive sweating and body cold. This refers to the deficiency of Yang Qi.Zhongjing said: Fever and aversion to cold arise from Yang; no fever and aversion to cold arise from Yin. It also states: Extreme cold leads to sweating, and the body must be as cold as ice. This aligns with the essence of the classics.The classics say: Yin Excess leads to Yang disease, and Yang Excess leads to Yin disease. Yang dominance leads to heat, while Yin Excess leads to cold.Yin is rooted in Yang, and Yang is rooted in Yin. For diseases that cannot be treated directly, one should draw Yin from Yang and Yang from Yin, seeking their respective attributes to weaken them. For example, seeking sweat from blood is drawing Yin from Yang. Conversely, drawing fire back to its source and gathering Qi back to the kidneys is drawing Yang from Yin. This is the meaning of extracting fire from water and water from fire.Diseases of Yin come slowly and leave slowly; diseases of Yang come quickly and leave quickly. Yang is born from heat, and heat is slow; Yin is born from cold, and cold is rapid. Cold pathogens affect the lower body, while heat pathogens affect the upper body; dietary pathogens affect the center.According to the Zhong Cang Jing, Yang diseases are calm in the morning and restless at night; Yin diseases are calm at night and restless in the morning. Yang Deficiency prefers Yang assistance, hence it is light in the morning and heavy in the evening; Yin Deficiency prefers Yin assistance, hence it is heavy in the morning and light in the evening. This describes the deficiency of Yin-Yang. If there are real pathogenic factors, the opposite is true. For all Yang pathogens, they must be heavier in the morning and lighter in the evening; for all Yin pathogens, they must be lighter in the morning and heavier in the evening. This is Yang encountering Yang and Yin receiving Yin. If there are fluctuations between day and night, or if symptoms appear and disappear irregularly, it indicates that the righteous Qi cannot maintain order, leading to a mix-up of Yin and Yang. The focus should be on nurturing the righteous Qi, and then Yin-Yang will harmonize on its own. However, whether it is water or fire, one should seek according to deficiency and excess. The six transformations are (3).The six transformations refer to exterior-interior, cold-heat, deficiency-excess. This is the key in medicine. Understanding these six will point to all diseases.In terms of exterior and interior, wind, cold, summer heat, dampness, fire, and dryness are all external factors. In terms of interior, the seven emotions, overexertion, and dietary harm are all internal factors. Cold is a type of Yin. It can be internal or external, and cold is often associated with deficiency. Heat is a type of Yang. It can be internal or external, and heat is often associated with excess. Deficiency indicates insufficient righteous Qi, and diseases arising from within are often insufficient. Excess indicates an abundance of pathogenic Qi, and diseases arising from without are often excessive. The details of the six are listed as follows.Exterior Syndrome (4) refers to pathogens entering from the outside. All wind, cold, summer heat, dampness, fire, and dryness are due to improper Qi. The classics say: “When the clear wind arrives, it is the victory of dryness.” Wind and wood receive pathogens, leading to liver diseases. When heat arrives, it is the victory of fire. Metal and dryness receive pathogens, leading to lung diseases. When cold arrives, it is the victory of water. Fire and heat receive pathogens, leading to heart diseases. When dampness arrives, it is the victory of earth. Cold water receives pathogens, leading to kidney diseases. When wind arrives, it is the victory of wood. Earth and dampness receive pathogens, leading to spleen diseases. It also states: “In winter, one is harmed by cold, and in spring, one must suffer from warmth. In spring, one is harmed by wind, and in summer, one suffers from diarrhea. In summer, one is harmed by heat, and in autumn, one must cough and suffer from malaria. In autumn, one is harmed by dampness, and in winter, one suffers from cough.” It also states: “Wind that comes from the front is called Xu Feng, which harms people and is the master of killing and harming.” All of these refer to external pathogens. However, pathogens have distinctions of Yin and Yang, and the injuries they cause are also different. Although there are six pathogens, they transform into Yin and Yang. Yang pathogens transform into heat, which harms Qi; Yin pathogens transform into cold, which harms the form.Injuring Qi means that Qi connects to the nose, and the nose connects to the organs. Therefore, when one is externally harmed by summer heat, the disease arises from within, as heat pathogens injure Qi. Injuring the form means that if it is shallow, it affects the skin and hair; if it is deep, it affects the meridians. Therefore, when one is externally harmed by wind and cold, the disease manifests as body heat and pain, as cold pathogens injure the form. The classics say: “Cold closes the pores, and Qi cannot circulate, hence Qi is restrained. Heat opens the pores, and the nutritive and defensive Qi communicate, leading to excessive sweating, hence Qi is lost.” This is the distinction of the six energies of Yin and Yang. However, among the six external pathogens, wind and cold are the most significant. Wind is the leader of all diseases, and cold is the most harmful energy. The human body has internal organs and external meridians; all pathogenic Qi that enters the body must first settle in the skin and hair. If it lingers and does not leave, it then enters the sub-branches; if it lingers and does not leave, it enters the meridians; if it lingers and does not leave, it enters the channels, and then connects to the five organs, dispersing into the intestines and stomach. Both Yin and Yang are affected, and the five organs are harmed. This is the sequence of external pathogens entering from the outside. However, if the pathogenic Qi is in the exterior, there must be exterior symptoms. Once exterior symptoms are evident, one must not attack the interior. If one mistakenly attacks it, not only will it not be effective, but it may also lead to the internal deficiency allowing the pathogenic Qi to invade further. Once the exterior symptoms are clear, the interior symptoms can be resolved accordingly. Therefore, the distinction of exterior symptoms must be prioritized.The internal organs are within, while the meridians are outside; thus, the organs are the interior, and the meridians are the exterior. In the exterior, the hands and feet each have six meridians, which constitute the twelve meridians. Dividing the twelve meridians into Yin and Yang, the six Yang belong to the organs and are the exterior, while the six Yin belong to the organs and are the interior. In dividing the twelve meridians into hands and feet, the foot meridians are long and far-reaching, extending from above to below, connecting throughout the body, hence they can be palpated to examine diseases throughout the body. The hand meridians are short and close, all entering and exiting between the foot meridians; therefore, when diagnosing exogenous cold and external pathogens, one only speaks of the foot meridians and not the hand meridians.However, the six foot meridians are also divided into three Yang as the exterior and three Yin as the interior. Among the three Yang meridians, the Tai Yang is the exterior among the Yang, as its pulse travels along the back, which is Yang. The Yang Ming is the interior among the Yang, as its pulse travels along the abdomen, which is Yin. The Shao Yang is half exterior and half interior, as its pulse travels along the sides, and the three Yang meridians spread out and gradually enter the three Yin meridians. Therefore, anyone wishing to examine exterior symptoms should only divide them into front, back, left, and right, and focus on the foot three Yang meridians. Among the three Yang meridians, only the Tai Yang meridian envelops the shoulders and back, serving as the external framework of the entire body, while internally connecting to the five organs and six bowels. This is the main energy of all Yang, akin to a thoroughfare. Therefore, when one is harmed by wind and cold, it often begins with the Tai Yang meridian.All three Yin meridians originate from the foot to the abdomen; although they are also between the skin and the surface, the three Yin primarily govern the interior. Any wind and cold entering from the exterior must first enter through the Yang meridians before entering the Yin divisions. If it does not enter through the Yang meridians directly into the three Yin, it must connect to the organs. Therefore, the Yin meridians cannot be based on exterior symptoms.When cold pathogens are in the exterior, there must be body heat without sweating, as the pathogens close the skin and hair.When cold pathogens invade the meridians, there must be body pain, or stiffness and soreness, as the pathogenic Qi disrupts the nutritive Qi, and blood circulation is impeded.When cold pathogens are in the exterior and cause headaches, there are four meridians involved. The foot Tai Yang meridian runs along the top of the head, the foot Yang Ming meridian ascends to the head, the foot Shao Yang meridian ascends to both temples, and the foot Jue Yin meridian meets at the crown, all of which can cause headaches. Therefore, only the Tai Yin and Shao Yin do not have headache symptoms.When cold pathogens are in the exterior and cause aversion to cold, those harmed must detest this, known as aversion to food and aversion to cold.When pathogenic Qi is in the exterior, the pulse must be tight and rapid, as the nutritive Qi is disturbed by the pathogen.The Tai Yang meridian begins at the inner canthus of the eye, ascends to the crown, descends to the neck, and runs along the spine to the waist; therefore, when the pathogen is in the Tai Yang, there must be aversion to cold, fever, and accompanying headache, stiffness in the waist and spine, or soreness in the knees.The Yang Ming meridian begins below the eye, follows the face and nose, and travels through the chest and abdomen; therefore, when the pathogen is in the Yang Ming, there must be fever with slight aversion to cold, along with eye pain and nasal dryness, leading to insomnia.The Shao Yang is a half exterior and half interior meridian, its pulse winds around the ears, descending from the shoulder to the ribs; therefore, when the pathogen is in the Shao Yang, there must be fever with accompanying deafness, rib pain, bitter taste, and vomiting, or alternating chills and fever.All of the above are exterior symptoms of the three Yang meridians; when exterior symptoms are evident, one must not attack the interior. One may either release the exterior, slightly resolve it, warm and disperse, cool and disperse, warm the interior and support the exterior to create a non-dispersing dispersion, or supplement Yin and assist Yin to create a vaporization of rain. Alas! It is difficult to fully express this intention. Only the wise can comprehend it.Regarding the pulse of exterior symptoms, Zhongjing said: “The pulse at the cun position is floating and tight; floating indicates wind, tight indicates cold. Wind harms the defensive Qi, cold harms the nutritive Qi; when both the nutritive and defensive Qi are ill, there is pain in the bones and joints, and one should induce sweating.” The annotations of the Pulse Classic state: “Wind is Yang, cold is Yin, the defensive Qi is Yang, and the nutritive Qi is Yin. Wind harms Yang, cold harms Yin, each harms according to its type. Therefore, when the defensive Qi encounters wind, it becomes hot; when the nutritive Qi encounters cold, it becomes painful. When both the nutritive and defensive Qi are ill, it leads to pain in the bones and joints, and one should induce sweating to resolve the exterior and recover.”Floating pulses are inherently associated with the exterior, which is certainly true. However, if there is a strong initial invasion of cold, it may bind the defensive Qi, preventing the pulse from reaching, thus it must be sinking and tight. This should be examined in conjunction with symptoms such as fever and body pain, and can be discerned accordingly. If blood deficiency causes blood movement, the pulse must be floating and large. If Yin deficiency leads to water depletion, the pulse must be floating and large. If internal fire is blazing, the pulse must be floating and large. If the Yin is obstructing the Yang, the pulse must be floating and large. In such cases, one cannot generalize floating as exterior symptoms; one must consider the presence or absence of external symptoms in conjunction with the form, Qi, and disease. If it is not an exterior symptom, but is mistakenly considered as such, it could lead to death in an instant.When external cold pathogens are present, a large pulse indicates that the disease is progressing, as the pathogenic Qi is increasing daily. However, it must be large and tight to indicate disease progression. If it starts small and then becomes large, or gradually becomes larger and more relaxed, this indicates a transition from Yin to Yang, suggesting that the stomach Qi is gradually returning, indicating a sign of resolution.If cold pathogens have not resolved, and the pulse is tight and weak, there is no period of recovery. Why? Because tightness indicates pathogenic Qi. Strength indicates original Qi. If it is tight and weak, then pathogenic Qi is excessive and original Qi is insufficient. If original Qi is insufficient, how can one expel the pathogen? In this case, one must gradually strengthen the original Yang, so the pulse gradually becomes strong, from small to large, from deficient to solid, until it becomes smooth and flowing, indicating that Yang Qi is gradually reaching, and the exterior will resolve. If one sees a continuous lack of strength, and tightness increases over several days, it indicates a sign of danger and demise.The disease must enter from the exterior to be called an exterior symptom; if it arises from within and affects the exterior, it is not an exterior symptom. The classics say: “If it arises from within and affects the exterior, treat the interior; if it arises from the exterior and affects the interior, treat the exterior. If it arises from within and is strong externally, treat the interior first and then the exterior; if it arises from the exterior and is strong internally, treat the exterior first and then regulate the interior.” This is the order of internal and external that must not be overlooked.Wind injury and stroke, although both have the name wind, cannot be treated as exterior symptoms. The disease of wind injury arises from external invasion and can be dispersed or warmed. This is an exterior symptom. The disease of stroke, although the symptoms appear similar to wind, is actually caused by internal injury. There is no external pathogen, hence it cannot be treated as an exterior symptom. The law is detailed in this section.Fever and similar conditions are fundamentally fire symptoms, but one must distinguish between exterior and interior. If the pathogenic Qi is in the exterior and causes fever, it is exterior heat with no internal heat; this is due to cold pathogens, and treatment should focus on dispersing. If the pathogenic Qi is in the interior and causes fever, there must be internal heat first, which then affects the exterior; this is a fire symptom, and treatment should focus on cooling. All of these can be discussed in terms of pathogenic heat. If Yin deficiency leads to water depletion and causes bone steaming and night heat, this is deficiency heat. One cannot use pathogenic heat as an example; only strong water and nourishing Yin can treat it.Dampness and dryness, although also external pathogens, have Yin and Yang distinctions. Dampness from Yin is cold dampness, while dampness from Yang is damp heat. Dryness from Yang is due to fire, while dryness from Yin arises from cold. Heat harms Yin, which must connect to the organs. Cold harms Yang, which must connect to the meridians. This is why dampness and dryness both have exterior and interior aspects, and must be clearly distinguished for treatment.The distinction of dampness symptoms must be differentiated between exterior and interior. The classics say: “Dampness causes a wrapping sensation.” It also states: “Those harmed by dampness first receive it below.” If one is exposed to wind and rain while traveling, or if one is overexerted and sweats, this is dampness entering from the outside. If one indulges in alcohol and cold foods, leading to diarrhea, jaundice, and swelling, this is dampness arising from within. If it is above and outside, it should be slightly resolved through sweating; if it is below and within, it should be divided and drained. Damp heat should be cleared and drained; cold dampness should be used to tonify the spleen and warm the kidneys.The distinction of dryness symptoms also has exterior and interior aspects. The classics say: “When the clear Qi arrives, it is the victory of dryness; wind and wood receive pathogens, leading to liver diseases.” This is related to wind. When dryness prevails, Yin is deficient; when Yin is deficient, blood is scarce, leading to either pulling or stiffness, or the skin and pores drying up, or the organs becoming dry and hard. This is dryness arising from Yang, leading to insufficient nutritive Qi, which harms the interior. Treatment should focus on nourishing the nutritive Qi and supplementing Yin. If autumn is excessive, the metal Qi prevails and wind follows, leading to lung diseases. This is related to wind and cold binding the Qi, hence it may manifest as body heat without sweating, or as coughing and wheezing, or nasal congestion and hoarseness, or throat dryness. This is dryness arising from Yin, where the defensive Qi is harmed, leading to exterior symptoms. Treatment should focus on lightly dispersing and warming the lungs to eliminate cold.Interior Symptoms (5) refer to diseases within the organs. Any disease arising from within may be due to the seven emotions, overexertion, dietary harm, or being trapped by lust; all of these are interior symptoms. In this regard, it is easy to see; however, between internal injury and external invasion, in cases of doubt, if there is any ambiguity, one may mistakenly treat exterior as interior and interior as exterior, leading to great harm. Therefore, detailed differentiation is necessary.Even if the body is slightly warm, if sweating does not stop, and there is no body soreness or stiffness, and the pulse is not tight and rapid, this heat is not in the exterior. Symptoms may resemble external invasion, but there is no aversion to cold, rather aversion to heat, and there are absolutely no exterior symptoms; this indicates that the heat is strong internally.For any disease with exterior symptoms, if urination is clear and smooth, it indicates that the pathogen has not entered the interior.If exterior symptoms are present, but dietary habits remain unchanged, and there is no obstruction in the chest and abdomen, the disease has not reached the interior. If one experiences nausea, bitter taste, or fullness and heaviness in the chest, it indicates that the exterior pathogen has transmitted to the chest and gradually entered the interior. If one experiences restlessness, insomnia, thirst, delirium, abdominal pain with diarrhea, etc., it indicates that the pathogen has entered the interior. If one experiences abdominal distension, fullness, constipation, tidal heat, yellow spots, and a slippery and solid pulse, this indicates a solid interior condition of the Yang Ming stomach and intestines, which can be purged.The seven emotions causing internal injury: excessive joy harms the heart and disperses Qi. When heart Qi is dispersed, it must be gathered and nourished. Excessive anger harms the liver and causes Qi to rebel; when liver Qi rebels, it must be subdued. Excessive thinking harms the spleen and causes Qi to stagnate; when spleen Qi stagnates, it must be warmed and resolved. Excessive worry harms the lungs and causes Qi to sink; when lung Qi sinks, it must be relaxed and lifted. Excessive fear harms the kidneys and causes Qi to weaken; when kidney Qi weakens, it must be stabilized and strengthened.Dietary internal injury, when Qi stagnates and accumulates, indicates fullness of the spleen; it should be resolved and expelled. If it cannot be transformed, it indicates deficiency of the spleen; it should be warmed and assisted.Alcohol and dampness harm Yin, leading to heat and fullness; this is damp heat disease, which should be cleared and drained. Alcohol and dampness harm Yang, leading to abdominal pain, diarrhea, and nausea; this is cold dampness disease, which should be warmed and supplemented.Overexertion harms the spleen, as the spleen governs the four limbs; it is necessary to supplement the central Qi.Sexual desire harms the kidneys, leading to Yang Deficiency without fire; it is necessary to cultivate Qi and blood. If there is Yin Deficiency with fire, it is necessary to purely supplement the true Yin.Phlegm and fluid conditions must have a basis; one must seek the origin for effective treatment. If one only treats the symptoms, it is not a good method. This is detailed in this section.The five organs are not easy to differentiate; however, if there are internal issues, they must manifest externally. Therefore, if there is liver disease, the eyes cannot see and may appear blue; if there is heart disease, the tongue cannot speak and may appear red; if there is spleen disease, the mouth cannot taste and may appear yellow; if there is lung disease, the nose cannot smell and may appear white; if there is kidney disease, the ears cannot hear and may appear black.Deficiency-Excess (6) refers to excess and deficiency. There are exterior and interior deficiencies and excesses, as well as deficiencies and excesses of Qi and blood, and deficiencies and excesses of organs. Generally, diseases arising from external factors are often excessive, while those arising from internal factors are often deficient. When it is excessive, it indicates that the pathogenic Qi is real and should be drained; when it is deficient, it indicates that the righteous Qi is weak and should be supplemented. Anyone wishing to discern deficiency and excess must understand the fundamental nature of the condition, and whether to attack or supplement is appropriate. The reality of the disease is indeed concerning, but the deficiency of original Qi is even more concerning.Therefore, anyone diagnosing diseases must first examine the original Qi as the primary focus, and then seek the disease. If it is real and mistakenly supplemented, it can be resolved; if it is deficient and mistakenly attacked, it cannot be saved. However, in summary, the key to deficiency and excess cannot escape the pulse. If the pulse is truly strong and spirited, it is a true excess; if the pulse seems strong and spirited, it is a false excess; if the pulse is weak and spiritless, leading to complete weakness and spiritlessness, this must not be overlooked in clinical practice.Exterior excess may manifest as fever, body pain, aversion to heat, or aversion to cold. If cold is bound in the exterior, there is no sweating; if fire is excessive in the exterior, there are sores. If there is redness and pain, it indicates heat in the nutritive and defensive Qi; if there is stiffness and soreness, it indicates cold in the meridians.Interior excess may manifest as distension or pain, or as fullness or hardness, or as obstruction or constipation, or as wheezing or fullness, or as restlessness, or as irritability and insomnia, or as Qi and blood accumulation, stagnation in the abdomen, or deep retention of cold pathogens and heat toxins within the organs.Yang Excess indicates excessive heat and aversion to heat. Yin Excess indicates pain, fullness, and cold. Qi Excess indicates shortness of breath and a loud voice. Blood Excess indicates blood coagulation, pain, and hardness.When the exterior is deficient, it may manifest as excessive sweating, or as muscle trembling, or as fear of cold, or as dim vision, or as deafness and dizziness, or as frequent numbness in the limbs, or as inability to withstand fatigue, or as dry hair and emaciated muscles, or as a pale complexion and a listless spirit.When the interior is deficient, it may manifest as palpitations, anxiety, restlessness, or insufficient body fluids. It may also manifest as inability to eat due to hunger, or as aversion to cold drinks, or as fear of bright lights, or as fear of loud noises. If the upper body is deficient, it may lead to inability to transform food, or excessive vomiting and fullness in the middle. If the lower body is deficient, it may lead to incontinence, prolapse, or diarrhea and nocturnal emissions. In women, it may lead to blood deficiency, amenorrhea, and miscarriage.Yang Deficiency indicates deficiency of fire, leading to insufficient spirit and energy, blackening of the eyes, dizziness, or excessive cold and fear of cold. Yin Deficiency indicates water depletion, leading to blood loss, loss of Yang, or bone steaming and labor heat. Qi Deficiency indicates a weak voice and shortness of breath. Blood Deficiency indicates dry skin and muscle spasms.Heart deficiency indicates Yang Deficiency and excessive sadness. Liver deficiency indicates inability to see clearly, or Yin contraction and spasms, leading to fear. Spleen deficiency indicates weakness in the limbs, or inability to digest food, or excessive distension and worry in the abdomen. Lung deficiency indicates shortness of breath and dry skin. Kidney deficiency may lead to obstruction of the two Yin, or incontinence, or excessive leakage, or inability to bend or straighten the waist, leading to bone soreness and weakness.All pains that can be pressed are deficient, while those that resist pressing are excessive.The distinction of distension and fullness: Zhongjing said: “If abdominal fullness does not decrease, it indicates that it is excessive; if it decreases, it indicates that it is insufficient and should be purged. If abdominal fullness decreases and then returns, this indicates cold, and should be treated with warming medicine. If it decreases and does not return, it indicates that there is no real excess in the abdomen, hence it may decrease at times. If it decreases and then returns, it indicates that spleen Qi is deficient and cold, hence it should be treated with warming medicine, which also implies supplementation.”The Nei Jing discusses the spirit and Qi. The spirit and Qi are original Qi. When original Qi is complete, the spirit flourishes, and there is no need to speak further. If original Qi is slightly deficient, the spirit is slightly diminished; if original Qi is greatly deficient, the spirit is completely lost. When the spirit is lost, the mechanism ceases; can one not be afraid? The Pulse Essentials states: “Those who are clear-minded can see all things, distinguish black and white, and discern long and short. If one sees long as short and white as black, then the essence is depleted. If one speaks faintly and repeats words all day, this is Qi depletion. If clothing is not gathered, and speech avoids relatives and friends, this is the disorder of the spirit. If the granary does not store, this is the neglect of the gates. If the spring does not flow, this is the bladder not storing. Those who can guard will live; those who lose their guard will die.”The five organs are the strength of the body; the head is the residence of the spirit. If the head tilts and the gaze is deep, the spirit will be lost. The back is the residence of the chest; if the back curves and the shoulders droop, the residence will be damaged. The waist is the residence of the kidneys; if one cannot turn and shake, the kidneys will weaken. The knees are the residence of the feet; if one cannot bend and stretch, one will stoop and bow, leading to bone weakness. The bones are the residence of the marrow; if one cannot stand for long, one will tremble and fall, leading to bone weakness. If one gains strength, one will live; if one loses strength, one will die. This is the essence of the Nei Jing regarding deficiency symptoms, which must be understood.Deficiency should be supplemented, while excess should be drained; this is easy to understand. However, one must also know that within excess there is deficiency, and within deficiency there is excess. Therefore, when a disease arises from extreme deficiency, it may appear vigorous; when a disease arises from extreme excess, it may appear weak. This cannot be overlooked. For example, if a disease arises from the seven emotions, or from hunger, overexertion, or being harmed by lust, then it often leads to body heat and fullness, Yang excess, and symptoms of madness, which seem to indicate excess, but the cause is actually deficiency. If the physician does not recognize the cause and mistakenly drains, it will surely lead to death. Similarly, if external pathogens have not been eliminated and remain in the meridians, or if food and drink stagnate and accumulate in the organs, or if there is stagnant Qi that cannot disperse, or if stubborn phlegm and blood stasis are retained, leading to prolonged illness, it may seem like deficiency, but the disease has not been eliminated, and treatment should focus on the root. If one mistakenly uses supplements, it will only worsen the disease. This is what is meant by having no real excess or deficiency, harming the insufficient while benefiting the excessive; in this way, the patient dies, and the physician is responsible for the death.Appendix: The Great Discussion on Deficiency and Excess by Hua Yuanhua states: “Diseases can be due to organ deficiency or organ excess, bowel deficiency or bowel excess, upper deficiency or upper excess, lower deficiency or lower excess, each with different manifestations, requiring deep investigation. If there is rumbling in the intestines, cold feet and hands, inability to eat, vomiting and regurgitation at any time, skin and hair are emaciated, muscles are wrinkled, ears and eyes are blocked, speech is broken, walking is labored, and the spirit is not collected, this indicates deficiency of the five organs. When diagnosing the pulse, if it is floating and slippery, pressing it lightly reveals it is weak, and one must determine which organ it is affecting. If it is pressed and is sinking, small, weak, short, choppy, or soft, all indicate organ deficiency. If there is excessive food intake, difficulty with bowel movements, fullness and heaviness in the chest, joint pain, and a heavy body, or if the head feels heavy and dizzy, or if the lips and mouth are swollen, or if the throat is blocked, or if there is urgent gas in the intestines, or if the skin is numb, or if there is sudden shortness of breath, or if there are sores and boils, or if emotions fluctuate, or if there is weakness or excessive strength, or if Qi is not smooth and blood does not circulate, this indicates organ excess. When diagnosing the pulse, if it is floating and strong, this indicates excess. If it is pressed lightly, it is slippery; if pressed heavily, it is flat, indicating organ deficiency. One must determine which meridian it is affecting and correct it accordingly.Cold-Heat (7) refers to the transformation of Yin and Yang. When Yin is insufficient, Yang prevails, leading to heat; when Yang is insufficient, Yin prevails, leading to cold. Therefore, when Yin is dominant, Yang is ill, and Yin dominance leads to cold. When Yang is dominant, Yin is ill, and Yang dominance leads to heat. Extreme heat leads to cold, as it is the result of excessive heat; extreme cold leads to heat, as it is the result of excessive cold. When Yang is deficient, it leads to external cold, which must harm Yang; when Yin is deficient, it leads to internal heat, which must harm Yin. When Yang is excessive, it leads to external heat, which belongs to the Yang division; when Yin is excessive, it leads to internal cold, which belongs to the Yin division. Cold harms the form, which refers to the exterior; heat harms the Qi, which refers to the interior. Therefore, when fire is abundant, Yang is excessive, leading to heat disease; when water is abundant, Yang is insufficient, leading to cold disease. Diseases of human affairs arise from within, while diseases of Qi exchange arise from without. The distinctions of cold and heat in exterior and interior must be understood, and the distinctions of cold and heat in deficiency and excess must also be discerned.When heat is in the exterior, it manifests as fever and headache, as well as red rashes and yellow spots, leading to the desire to remove clothing. When heat is in the interior, it manifests as dizziness, fullness, thirst, or wheezing and fullness, or as agitation and restlessness.When heat is in the upper body, it manifests as headache and red eyes, as well as throat sores and toothaches, leading to various upward disturbances and a preference for cold food. When heat is in the lower body, it manifests as swelling and pain in the waist and feet, or as constipation and painful urination, or as hot and red urine.When cold is in the exterior, it manifests as aversion to cold, body coldness, swelling, a pale complexion, and cold extremities.When cold is in the interior, it manifests as cold throat, rumbling intestines, nausea and vomiting, abdominal pain, and aversion to cold with a preference for warmth.When cold is in the upper body, it manifests as sour regurgitation, esophageal obstruction, inability to digest food, and abdominal distension.When cold is in the lower body, it manifests as inability to distinguish between clear and turbid, abdominal pain and diarrhea, impotence, incontinence, and cold knees and feet.When a patient has a high fever but desires to be close to clothing, it indicates that heat is in the skin, while cold is in the bones; when a patient has a high fever but does not want to be close to clothing, it indicates that cold is in the skin, while heat is in the bones; this is the distinction of exterior symptoms. If there is excessive internal heat, one often fears cold; this must be examined in conjunction with pulse and symptoms.True cold pulses must be slow, weak, and spiritless; true heat pulses must be rapid, solid, and strong.People with Yang organs tend to be hot, while those with Yin organs tend to be cold. Those with Yang organs often prefer cold and fear heat, eating cold food daily without any illness; this indicates an abundance of Yang. Those with Yin organs, when exposed to cold, will harm the spleen and kidneys; this indicates a deficiency of Yang. Generally, those with strong Yang are few, about 20-30%; those with weak Yang are many, about 50-60%. However, those who rely on strength often become ill, while those who fear weakness often find peace. If one sees their strength and fears their weakness, it is no different from a dwarf watching a performance or an ugly woman imitating a beauty.True and False Cold-Heat (8) refers to Yin symptoms resembling Yang and Yang symptoms resembling Yin. When Yin is extreme, it can cause agitation and heat, leading to internal cold and external heat, which is true cold and false heat. When Yang is extreme, it can cause cold and weakness, leading to internal heat and external cold, which is true heat and false cold. False heat is most averse to cold, while false cold is most averse to warmth. The method of discerning this should focus on the pulse’s deficiency and excess, strength and weakness.False heat is often mistaken for fire. For any disease of cold injury, or mixed symptoms, if one has a constitution that is inherently weak and cold, and occasionally encounters pathogenic Qi, or if one has overexerted, or if one has indulged in alcohol and lust, or if one has been harmed by the seven emotions, or if one is not truly a fire symptom but mistakenly takes cold and cool medicines, this can lead to false heat. True heat arises from heat, while false heat also arises from heat. The symptoms may include flushed face, agitation, constipation, or shortness of breath, or agitation and restlessness, or fever with a tight and rapid pulse. If the physician sees this and mistakenly believes it to be heat, and recklessly administers cold and cool treatments, it will surely lead to death.One must understand that even if there is heat in the body, if the interior is cold and obstructing Yang, or if Yin is not contained, there are many such symptoms. However, the internal symptoms indicate that although the mouth is dry and thirsty, one does not prefer cold; if one prefers cold, they may drink little, or have hard stools followed by loose stools, or frequent clear urination, or Yin depletion leading to yellow and red, or shortness of breath and lethargy, or dark complexion and spiritlessness, or sudden outbursts of anger, which is different from the agitation of a person climbing high and cursing. This is false agitation; or if there are spots resembling mosquito bites that are light red and fragmented, this is different from the deep red of extreme heat. The pulse of false heat must be sinking, thin, slow, or even if it is floating, large, tight, and rapid, it lacks strength and spirit. This indicates that heat is in the skin, while cold is in the organs, hence it is said that aversion to heat is not true heat, but rather a Yin symptom.When one sees internal fatigue and internal obstruction, if one only knows to attack the pathogen, there will be no one who does not die. One must urgently use formulas such as Si Ni, Ba Wei, Li Yin, and Hui Yang to replenish true Yang, guiding fire back to its source, ensuring that original Qi gradually recovers, leading to the retreat of heat and self-healing of the disease. This is the meaning of fire returning to dryness. Therefore, when one sees body heat and a rapid pulse, if pressing does not yield a strong response, this indicates that Yin is excessive and obstructing Yang, hence it is not true heat. Zhongjing treated Shao Yin symptoms with a flushed face using Si Ni soup with scallions as the main treatment. Dongyuan said: “If the face is red and the eyes are red, with agitation and a desire to drink, and the pulse is 7-8 beats, if pressing yields a dispersing response, this indicates that there is no root fire.” Using Jiang Fu soup with ginseng as the main treatment. The Wai Tai Mi Yao states: “When Yin is excessive and causes agitation, it is called Yin Zao, and if one wishes to sit in a well, it is advisable to treat it with warming medicines.”False cold is often mistaken for water. For any cold injury, if sweating is insufficient, leading to excessive Yang and internal obstruction, it can lead to body heat and cold extremities, resulting in symptoms resembling Yin. True cold fears cold, while false cold also fears cold; this indicates that heat is deep and cold is deep, and extreme heat can also transform into cold. Generally, this symptom must be loud and strong, with a robust voice; or if the lips are dry and the tongue is black, or if there is thirst for cold drinks, or if there is red and hard stools, or if there is foul-smelling gas, the six pulses must all be sinking, slippery, and strong, indicating that this is a Yang symptom. For any internal excess, one should select San Cheng Qi soup for use. For tidal heat, one should use Da Chai Hu soup to resolve and purge. For internal deficiency, one should use Bai Hu soup to clear.If mixed symptoms of false cold arise, one may experience aversion to cold or shivering; this is due to extreme heat within and cold invading from the outside, leading to a conflict between cold and heat, resulting in shivering. This indicates that cold is in the skin, while heat is in the bone marrow, hence it is said that aversion to cold is not true cold, but rather a heat symptom. However, when examining internal symptoms, one may experience a preference for cold, or constipation, or hot and dry urination, or foul breath and agitation. The pulse must be sinking, slippery, and strong. When one sees this symptom, one should use cooling medicines such as Qing Ge and Qin Lian to assist Yin and clear the fire, ensuring that internal heat is eliminated, leading to the resolution of external cold. This is the meaning of water flowing and dampening.False cold and false heat, if mistakenly treated with hot or cold medicines, should be tested with a small amount of cold water. False heat must not prefer water; if there is a preference, or if symptoms arise after taking, it indicates that warming medicines should be used to resolve. False cold must prefer water; if there is a preference, or if symptoms arise after taking, it indicates that cooling medicines should be used to resolve.This article is from: Chuan Zhong Lu
