Differentiation of Yin–Yang and Prescriptions for Some Common Diseases

Restless Heart (So-Called Heart Palpitations, 心病不安)

Heart palpitations are a condition in which the patient consciously feels heartbeat, palpitations, and anxiety as a syndrome. There are two different kinds of palpitations: one is lack of Heart blood and the other is lack of Heart Qi. The former is due to Yin deficiency; the latter, Yang deficiency.

Lack of Heart blood (in case of lack of blood, the Heart Fire must be strong) is usually more serious, with sparse dark-yellow urine, dry throat, withered skin, and loss of vigor. However, one’s spirit and energy are usually not seriously affected and the patient may still be cheerful. The pulse is weak and fast, flood; the patient prefers cold, light, and oily food.

Patients with lack of Heart Qi (Qi is Yang, Qi deficiency will strengthen blood) usually exhibit a lack of energy and spirit, preferring to lie down and keep quiet, and will have clear and abundant urine. If it is necessary to talk, it requires a little more effort or concentration (this will consume Heart Qi); the patient will feel hot and sweaty (Qi inefficiency will lose the control of blood, and therefore sweating occurs), and even vomiting occurs (Heart Yang deficiency will cause Yin rising, leading to vomiting). In this case, the pulse may be weak or floating, and the patient prefers very spicy, fried, and extremely hot food.

Today’s secular treatments usually do not understand and differentiate the blood, Qi, Yin, and Yang, which can all be treated with nourishing herbs, or tranquil, calm and methods of relief; therefore, the results of secular treatments will be effective for patients with blood deficiency, but not very helpful for patients with Yang deficiency. For the latter case, one should increase or compensate for the Kidney Fire in order to strengthen the Heart Fire. Use Bukanyili Dan (89), the pungency and hotness of Guizhi  and Fuzi  to compensate for true Yang, and use the saltiness of Gefen  to compensate for the true Yin; it will make the blood move with the Qi circulation and Qi attached to the blood circulation. In addition, add Shengjian (ginger, ) and Gancao to reconcile the whole body from top to bottom. The treatment is relatively simple, but very effective and fast due to treating the illness with appropriate herbs based on the real situations of Yin and Yang, Fire and Water. Therefore, the Yang deficiency and Heart blood deficiency can be cured in this way by knowing “weakening the Fire will block the rising of Water.” Arrhythmia such as tachycardia, bradycardia, atrial fibrillation, heart failure, myocarditis, and pericarditis, which are caused by a variety of reasons according to modern medicine, actually all fall into this category.

In a case of myocarditis, the patient exhitibed a pale face, a lacklustre appearance, and a slow or irregular pulse. These are the symptoms of Heart Yang deficiency, and therefore this method was used to treat and cure it. Using Fuzilizhong Tang (95) combined with Dangguibuxue Tang, all symptoms disappeared. As for palpitations, they refer to a syndrome where the patient is consciously feeling heartbeat discomfort, palpitations, and anxiety. Patients often have palpitations, shortness of breath, asthma, chest tightening and chest pain, fear of cold, swollen face and limbs, pale face, light-purple tongue, white moss, weak and slow pulse, or hesitating pulse. One male patient was in his 60s and had the following symptoms: atrial fibrillation at 120 times per minute, pale face, lack of spirit and energy, swollen legs, extreme fear of cold (the feet were cold even in the hottest summer time), dry and bitter mouth, dry throat, less body fluid but no desire to drink, pink tongue with white and slippery moss, asthma with any movement, and extremely irregular heartbeat with weak pulse. This was a case of Heart Yang deficiency according to the syndromes, so treatment involved two large doses of Bukanyili Dan (89). The patient felt that the dry throat was relieved, having some fluid. Then the Fupian dose was increased. The patient felt more energy and spirit after taking eight doses, the swollen feet disappeared, fear of cold disappeared, there was more saliva in the mouth, and the dry and bitter taste disappeared. The asthma was also relieved and atrial fibrillation stabilized at 100 times per minute. The same treatment was continued, plus herbs for Kidney supplements such as Gejie, Sharen, Buguzhi, and Yizhiren. This gentleman was cured after ten doses. In such a case, the heavy dose of Fuzi is to supplement the true Fire, and strong true Fire will lead to strong Heart Fire. And the Kidney is the house for both Water and Fire; when true Fire rises, true Water also rises and meets at the Heart. The Heart and the Kidney intersect. Water and Fire help each other, and therefore the illness can be cured.

Coughs （咳嗽）

Coughs are due to lung disease arising from internal and external causes. Cough symptoms may arise from an external invasion of the body, or an internal condition. Either of the factors inhibits the Taiyang meridian, blocks Qi’s path, and impedes Qi circulation. Qi accumulates in the Lung and diaphragm, where it causes cough. External factors causing cough include excess in the six climate factors: wind, cold, heat, damp, dry, fire, which are not strictly related to seasons. For example, febrile cough, which occurs in all seasons, is most common.

(1)Coughs caused by internal factors include:

Yang deficiency, which occurs in 80–90% of internal diseases. The symptoms include fatique, weak limbs, weak voice, unemotional demeanor, weak pulse, colorless lips, hot drink preference, inadequate food consumption, fragile emotions, and fever (if any) in the afternoon.

Deficient Heart and Lung Yang, which cannot ventilate, dredge, or dissolve meridian Yin, and therefore Yin accumulates in the chest. (Some practitioners diagnose this as “Cold invading the Lung,” but cardiopulmonary Yang deficiency causes Cold from the inner body.) The symptoms include inability to exert physically or mentally, hot flashes upon over-exertion sweating, more severe cough, and more phlegm with white foam.

Deficient Spleen and Stomach Yang, which cannot convert and transport nutrients. The symptoms include a painfully full feeling in the Stomach, poor appetite, cold saliva, clear phlegm, and preference for hot, spicy food.

Deficient Liver and Kidney-Yang, which cannot collect Water Yin in the Liver and Kidney. Uncollected Water blocks circulatory channels. The symptoms include lower back or hypochondriac pain with cold feet and knees, red zygomaticus, increased phlegm at night, and dry throat without thirst. (Thirst for cold drinks indicates Yin deficiency with hyperactive Fire.)

(2) Coughs caused by secondary internal factors (disease in another organ) are 70–80%Yin excess, and difficult to cure. The internal organ must be treated for a cough caused by:

Yin-deficient Kidney, which is the most intractable of the five internal-organ-caused coughs. Increase Yin and purge Fire.

Yang-deficient Kidney, which is incurable unless the Fire is promoted with sweet, warm herbs like aconite (Fu Zi), and ginger (Jiang).

Yang-deficient Heart and Lung, which generates cold, and cannot be cured by common treatments to clear the cold.

Exhausted essence Qi and Kidney-Yang, which is only cured with very high doses of a Yang formula, such as Si Ni Tang (48) or Shen Fu Tang (102) with Shenmai San in an emergency.

Bladder Qi rising, which is cured by treating the lower Jiao with one dose of Wu Ling San (24) plus a high dose of Rougui.

(3) Coughs caused by external factors:

Wind moderates when scattered by treating with Guizhi Tang (118) or Qu Feng San (128). The symptoms include spontaneous sweating and wind aversion.

Cold moderates when scattered by treating with Mahuang Tang (151) or Xiaoqinglong Tang (20). The symptoms include no sweating, but cold aversion.

Heat moderates when scattered by treating with Yiyuan San (134) or Qing Shu Tang (162). The symptoms include thirst, cold drink preference, and a tired feeling.

Damp moderates when removed by treating with Erchen Tang (1) or Guiling Zhugan Tang (120). The symptoms include a heavy limb feeling, whole body chills, and a slight fever.

Dry moderates when moistened by treating with Gan Ju Tang (40) or Maidong Yin (77). The symptoms include sticky mucus and cold drink preference.

Fire moderates when scattered and cleaned with Daochi San (73) or Gegen Chen Lian Tang (164). The symptoms include anxiety, a strong pulse, limited reddish urination, and cold drink preference.

Deficient Heart and Lung Yang moderate with treatments such as Jiang Gui Fu Ban Tang (112) or Wen Fei Yin (166).

Deficient Spleen and Stomach Yang moderate with Spleen and Stomach dredging to promote Yang, by treating with Banxia Ganjiang Tang (62), Xiangsha Liujun Tang (110), or Gacaoganjiang Tang (42).

Failure of Liver and Kidney Yang to transport Water recovers with Kidney warming by treating with Zhenwu Tang (130), Zishen Wan (156), Qianyang Dan (168) plus Wuzhuyu.

Deficient Yin improves with Ji Zi Huanglian Tang (92) or Liuweidihuang Tang (35) to increase Fire and results in better appetite, strengthened voice and spirit, more patience, stronger slower pulse, greater tolerance for spicy hot food, and greater tolerance for a cool environment; and to decrease Water and results in reduced irritability, less adhesive phlegm, and less dry rough skin.

Coughing Due to Consumptive and Carbuncle Lung Disease （肺痿肺痈）

(1) Consumptive lung disease is due to deficient Lung Yang’s inability to move body fluid, and manifests as turbid foamy sputum, blood poisoning, bad breath, no thirst, and urinary diuresis. Consumption is caused by:

Cold-Damp begins as Lung cold and is treated with acrid and sweet decoctions, such as Gan Cao Gan Jiang Tang (42), to activate Yang.

Dry-Heat is treated by clearing Heat, and promoting moisture with Gan Cao Tang in mild cases, and Maimen Dong Tang in severe cases.

Cold-Dry is treated by increasing warmth and moisture to activate Qi flow with Sheng Jiang Gan Cao Tang in mild cases, and Zhi Gan Cao Tang in severe cases.

(2) Carbuncle lung disease is due to accumulated and excessive wind-Heat damage to Yin. Deficient Lung Yin is then unable to inhibit dry pathogens. Western medicine’s pulmonary abscess is similar to a Lung carbuncle, and is a multi-secondary pyogenic infection in the Lungs. The chief causes include exogenous disease, internal injuries, and inadequate or incorrect treatment. For the cough:

The manifestations are dense bloody vomit, chest pain, and discomfort when lying down or sitting.

The treatment is to open the carbuncle-caused obstruction with Zao Jia Wan (Gleditsia pills) and salt; reduce pulmonary Heat, and nourish Yin with sweet and cold herbs and honey; and calm the Stomach with dates.

The stages are: (i) without pus, excess Heat, therefore use Yinqiao San plus Diding, Tufuling, Xiakucao, and Beimu to begin with; if edema with asthma, Tingli Dazao Xiefei Tang or Jiegang Bai San for excessive Heat, excessive phlegm, and chest pain and oppression.

(ii) if pus forms, use Jiegeng Gancao Tang and Weijing Tang plus Yinhua, Lianqiao, Baijiang, and Yuxingcao.

The three phases of treatment include reducing the initial painful cough, labored breathing, by Heat clearing, and toxin removal.

Mid-stage carbuncle accumulation: The symptoms include inability to lie down, very painful chest, foul sputum, and bloody vomit, which requires that the practitioner drain pus and remove toxins with Weijing Tang;

An improved carbuncle condition requires that when the pus is dry, the pain has stopped, and the illness is better, the practitioner should clear the pulmonary cavity, and invigorate deficient Qi and blood with new Shen Qi — Gan Ji Tang.

Gastric Pain and Food Intolerance （胃病不食）

Patients will suffer more if it is assumed that this is a weakness of the Spleen and Stomach, or is treated with common prescriptions to promote digestion, regulate Qi, or clear stagnation. Differentiate interior/exterior causes, Yin/Yang predominance, and do detailed tests for exterior pathogens, cold stagnation, Yang or Yin deficiency, and damage by excess of the seven emotions.

For Yin deficiency with food intolerance and

External pathogens in the Yang meridian: transmit Heat injury to the blood, use Renshen Baihu Tang (5), Da Chengqi, and Xiao Chengqi Tang (18, 21).

Exhausted body fluid: use vigorous sweet-warm herbs, because a severely Yin-deficient patient may die immediately with bitter-cold herbs; and bitter-sweet herbs or spiritless sweet herbs are too little, too late.

External factors: use herbs based on syndromes of six Qi and six meridians.

Severe injuries: do injury site examination, and specific injury treatment.

Cold food stagnation: one should generally use Ping Wei San (37), Shen Zhu San (171), Bao He Wan (172), Zhi Zhu San (173), etc.

Yang deficiency: one should promote Yang and reduce Yin to increase food intake.

Upper body deficiency: use Ping Wei San (37) plus Renshen, Huangqi.

Mid body deficiency: use Ping Wei San plus Ganjiang, Gancao, or Li Zhong Tang (149).

Lower body deficiency: use Ping Wei San plus Guizhi, Fuzi, or Fuling Sini Tang plus or minus.

Due to excessive sexual activity: use Fuzilizhong Tang double Fuzi  plus Rougui , Sharen  to nourish the Kidney. Real-Yang weakness cannot steam the Spleen, because the middle body is closed to circulation, nourishment does not flow, and the belly is sometimes swollen or stagnant with pain.

Case study

A male patient less than 50 years of age was impotent, pale, greenish, weak, and thin; was cold-intolerant, nauseous, and eating nothing. Herbs used at first to promote digestion, regulate Qi, break stagnation, etc., had no effect. After the use of Fuzilizhong Tang plus Rougei, Sharen, and a few doses of villosum, the food intake increased, and impotence improved. The patient was continued on Sini Tang (48) plus 10 doses of Kidney-nourishing herbs such as Gegai (Gecko), Congron (Cistanche, ), Xianmao (Curculigo, ) and Yizhiren (Alpinia, ), and his impotence was healed.

Diarrhea and Vomiting from Spleen Disease （脾病呕吐泄泻）

Vomiting and diarrhea are diseases of the Stomach, pancreas, intestine, colon, and the entire digestive system. External factors include wind, cold, heat, wet, dry, fire, and the pox, measles, and spotted fever. Internal factors include food stagnation and Yang/Yin imbalance. The categories include productive vomit with sound, productive vomit without sound, and gagging. “Vomiting and diarrhea diseases seek the Taiyin meridian,” or explore for gas accumulated in the upper, middle, and basic Qi of the Taiyin meridian. Treat patients with:

Guizhi Tong (118) plus Gegen (Puerarin) in cases of vomiting without diarrhea, where the trouble lies with the Stomach; diarrhea without vomit, where the trouble lies with the Spleen; and vomiting with diarrhea, where the trouble is with the Stomach-Spleen intersection.

Lizhong Tang (149) or Wuzhuyu (Evodia) Tang (84), for symptoms such as dampness, severe vomit or diarrhea, cold limbs, and green lips.

Wuling Tang (24), Siling Tang (47), or Huanglian Wuzhu (Coptis Evodia) Tang (142) for Heat, vomiting, diarrhea, and thirst.

Remedies for Heat or Cold Diseases for vomit or diarrhea accompanied by severe abdominal pain, perhaps from cholera, food contamination, or sudden valve closure or duct blockage (Zu Bi); treat vomit caused by spotted fever as having latent Heart and avoid warming the middle body; treat vomit caused by stagnated food due to Yang-deficient Stomach cold by warming the middle body; and fill Mingmen ) with Fire.

If Yin/Yang differentiation is correct, induce vomiting or diarrhea to help Meridian occlusions resist cold or Heat syndromes. Stomach and Spleen conditions are important, but disease differentiation also requires the monitoring of internal/external, cold/heat, deficiency/excess, and moisture/dryness factors. Dabanxia (Robust Pinellia) Tang and Qige Yin (62) are effective prescriptions.

Spasm of Muscles and Tendons （肝病痉挛）

The Inner Canon of the Yellow Emperor says that “the Liver dominates the sinews and tendons of the body” and that Liver function is revealed in the tendons. Therefore, if the Liver is:

weak	the tendons will not easily flex;
too warm	the tendons will dry, tighten, and spasm; or
too cold	the tendons will spasm and the bones will be painful.

When limb tendons shrink, tighten, and convulse, they cannot propel freely. The problem is lack of fluid nutrients due mostly to external cold and damp, or blood shortage, or liquid deficiency.

Differentiate Yin from Yang Causes, because the usual papaya, Lycopodium clavatum, or Clematis will not work. Also, if accompanied by anger, Heat from depression, or excess Heat from infected/tainted blood, treat the cause.

If the condition is a result of cholera, vomiting, and diarrhea, stabilize the middle body by using Wuzhuyu Tang (84) or Lizhong Tang (149); If the misuse of herbs for sweating damages the blood and causes cramps, promote Yin, using Shaoyao Gancao (Paeonia Licorice) Tang (74); Yang deficiency and blood loss — promote Yang using great bitter–sweet herbs such as Fuzigancao (Aconite and Licorice) Tang (94) or Gancao Ganjiang (Licorice and dried Ginger) Tang (42).

Yin deficiency with meridian and internal organ Fire — raise Yin and clear Fire by using Jizi Huanglian (Egg Coptis) Tang (92), Liuwei Wan (Six Herbs including Rehmannia) (35), and Shengdi Siwu Tang (Radix Rehmanniae) (57).

Very rare, severe Yin deficiency, in which there is long-term lack of energy and/or sickness, depleted Qi, and inability to generate body fluid; only 10% may be healed.

Kidney Illness with Lower Back Pain （肾病腰痛）

Lower back pain is caused by:

Yang Deficiency, which may cause mental strain, depleted Heart-Yang, poor appetite, loss of Spleen-Yang, excess sexual activities, or loss of Kidney-Yang.

Lower Body Yang Deficiency, which signals impaired Yang energy, and therefore lumbar disease attacks the lower body (lower Jiao). Promote Yang by using Yang Dan Tang (72), Zhufu Tang (Atractylodes Aconite) (44), or Qianghuo Fuzi Tang (Notopterygium Aconite) (99). The symptoms include a heavy body sensation, cold intolerance, and mental fatigue.

Yin Deficiency, which signals too much fiery Kidney-Yang, which injures the blood, dries up Yin, leaves real Yang unbalanced, and generates lower back pain. Promote Yin using Liuwei Wan (Rehmannis) (35), Fengsui (Myeloid) Dan (106) with double Huanbei (Philodendron) plus Quan Pi. The symptoms include reddish urine, dry throat, easily irritated genitals, and Heat aversion.

External (Exogenous) Cold, a Yin, has invaded from the exterior Taiyang to the interior Shaoyin meridian, a Yin organ. The converging Yin closes Kidney-Yang’s function and generates low back pain. Warm the meridian and exhale the cold, using Mahuang Fuzixixin Tang (Ephedra asarum, aconite) (155), Fuqiang Tang (Aconite Notopterygium) (93), etc. The symptoms include fever, cold intolerance, body pain, dry throat without thirst, and periods of sleepiness.

Internal Moisture Stagnation, which happens when Taiyin passes undissipated damp into the Kidney, obstructs its operation, and causes low back pain. This is common among physical laborers working on wet or low-lying land. Warm the meridian using Shenzhuo Tang (96), Guilingshugan Tang (120) plus Fuzi and Xixin (Aconite, Asarum, ), etc.

The symptoms include feeling heavy-limbed, cold inside, more severe on rainy days, and knots in the Stomach.

Yin or Yang deficiency needs warm herbs to promote Kidney-Yang. The Kidney is a Yin, whereas one congenital, real Yang hides in two Yin parts. “Yin deficiency” refers to deficient Kidney Water, but is really deficient Kidney-Yang. Increasing Water increases Yin and dampness, shuts out Yang, and promotes lower back pain. Herbs to increase Water, such as Eucommia, Morinda officinalis, Cistanche, and Dodder, may not work.

Because sustained Yang deficiency, where uncontrolled Yin rises, is the same as the pressure of a heavy stone, and the head feels like it is splitting open, weak Yang nearly escapes from the top of the head. Delayed or faulty treatment contributes to death overnight. If headache is accompanied by the following symptoms, treat at once, and use large doses of Baitong Tang (54), Sini Tang (48), etc., for stereotypical asthma symptoms, blue-and-black lips and tongue and thirst for hot liquid; the Eupatorium Decoction for stabbing Stomach pain, caused by sharp choppy spasms, blood congestion in the area, black stools, and an uneven or floating pulse.

Zelan Tang can be used; for Qi stagnation, stabbing back pain that moves around quickly and a rapid stringy pulse, use Juhe Wan; for Kidney deficiency, and exogenous cold, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, Asarum) (155), Sini Tonga (48) plus Duzhong , Rougui , Eucommia, Cinnamon, and Yanhusuo , repeatedly, for recovery.

Headaches （头痛）

Headaches are always caused by (a) interior Yang or Yin deficiency, or (b) deficient inner healthy Qi which cannot fill the whole body, and therefore the body is attacked by exterior wind evils.

(a) With Yang or Yin deficiency, six exogenesis, external winds can invade Yang meridians’ most important position at the top of the head, and the only position which can be invaded by wind. Using light/clear herbs such as Chuanxiong , Baizhi (Angelica dahurica, ), Jingjie (Nepeta, ), Fangfeng , Manjing , Gaoben  Qianghuo (Notopterygium, ), Tianma (Gastrodia, ), Xinyi , or Canger (Xanthium, ) to remove wind from the Three Yang meridians is advised. However, it is dangerous and harmful if used to heal syndromes of Three Yin Qi depletion!

(b) Headaches from deficiency of inner healthy Qi may arise from internal or external causes, which include wind, cold, heat, damp, dry, fire, and interference in the Three Yang meridians. When the Three Yang Meridians fully support Qi flow, disease does not enter, nor is it carried by the Three Yin.

The following medications improve direct energy flow within the respective meridians:

(1)For Yang dysfunction, resolve exterior causes, before pathogens enter.

For Taiyang meridian headaches, use Guizhi Tang (Cinnamon twigs) (118) when the headache is accompanied by a floating pulse, stiff neck, severe fever, cold and wind intolerance, and spontaneous sweating; Mahuang Tang (Ephedra Decoction) (151) for the above Taiyang symptoms, but without sweat.

For Yangming meridian headaches, use Gegen Tang (Pueraris Decoction) (163) when the headache is accompanied by eyebrow pain, a severe swollen feeling in the orbital area, a long pulse, and Heat intolerance.

For Shaoyang meridian headaches, use Xiao Chaihu Tang (Small Bupleurum Decoction) (22) when the headache is accompanied by bilateral severe fluctuation between Cold and Heat, and a strong bitter taste.

(2) Internally caused headaches may have no exopathic syndromes for internal injury, Yang or Yin deficiency, or Seven Emotions excess. About 80% of patients may be dizzy or faint, while only 20–30% have headache. Headache causes include happiness, anger, grief, worry, obsession, fear, Yang deficiency, and Yin deficiency.

Yin Meridian Headaches pulse through their pathways, but only the Jueyin meridian reaches the top of the head. For the other three Yin meridian headaches, which turn back at the neck, the best solution is to warm, dry, and promote discharge from the inside. For Taiyin, use Lizhong Tang (149) to warm and dry the midbody if seen with no desire to eat, heavy numb sore limbs, chilling, and vomiting with a full Stomach.

Shaoyin meridian headaches: use Jizi Huanglian Tang (Egg Coptis soup) (92) to moisturize and nourish Yin if seen with dry throat, dry skin, dark-brown urine, dispirited demeanor, and almost totally non-verbal communication; Mahuang Fuzixixin Tang (Ephedra, Aconite, Asarum Decoction) (155) to warm and support Yang if accompanied by a weak pulse, heavy limbs, excessive sleepiness, almost totally non-verbal communication, and a dry throat without thirst.

Jueyin meridian headaches can reach the top of the head because their elements, wind and wood, allow light and clear wind to enter Jueyin, the most Yin place, to transform into many diseases. Use Wuzhu (Evodia) Sini Tang (85) if the headache is accompanied by severe pain at the top of the head, retching, spitting, blue nails and lips, cold limbs, and abdominal pain.

Yin deficiency headaches: unlike the externally caused day-long headache, they have sporadic symptoms caused by Fire rising, followed by headache. Commonly used herbs for expelling the wind, such as Fangfeng, Manjing, Notopterygium, Gastrodia, and Angelica dahurica, cause great harm when the Three Yin are escaping. Use Liuwei Pills, Baweis Pills (71), etc., if sporadic symptoms, not exopathogenic, include dry throat, reddish urine, dispirited demeanor, preference for cold drinks, burning sensation on the soles, or in the Stomach, or above the navel, stretching to the head.

Yin excess headaches: use robust spicy and robust sweet herbs if the symptoms include quiet demeanor, non-dry throat, non-red urine, cold drink intolerance, inability to speak, blue lips and tongue, and a burning feeling all over.

Yin upsurge headaches: when fever rises but syndromes are counter-indicative, use spicy and sweet herbs.

Yang deficiency headaches: promote Yang with large doses of Sini Tang and Baitong Tang, as an emergency measure when the symptoms include a splitting headache and blue or black lips.

Thunder headaches with Wind: when due to Upper head Qi congestion with Liver Fire, use Qingzheng Tang (158). If the symptoms include thunder-like reverberations and ringing sounds, use Xiao Chaihu Tang (small Bupleurum) (22), plus Danshen and Zhizi (Paeonol, ), and Gardenia, ) for head rolls; if there is forceful interior wind, use Yangxue Tang (135), if the symptoms include head tremors; for excess moisture in the head, use Feng Sanshi Tang (129); if the symptoms include a heavy sensation in head, one-sided headache, for left headache use Siwu Tang (46) plus, for right use Sijun Tang (51) plus, or for both use Fengsui Dan (106) plus Wuzhu and Rougui.

Infection with a swollen head, and impaired digestion headache.

For infection caused by three Yang blockage by Pandora Exogenous disease, use Puji Xiaodu (Disinfect) Yin (167) if the symptoms include a swollen head.

For impaired digestion headache from steamed and dredged Stomach Qi, use Pingwei San (37) plus digestion herbs.

For wind attack caused by Qi deficiency, use Sijunzi Tang (51) plus wind herbs.

(3) External and internal injuries: Treat the injury before addressing the headache.

Case study

(a) A patient exhitibited a splitting headache, insomnia, whole body pain, cold lower body skin, and severe cold intolerance. He was treated by many Chinese and Western medical doctors for months without any effect. After our comprehensive analysis, and diagnosis of Yang deficiency, the illness was successfully treated using more than ten doses of Sini Tang (48), Wuzhuyu Tang (84), Mafuxixin Tang (Ephedra, Aconite, Asarum) (155), and Baitong Tang (54). Lastly, Lizhong Tang (95) was taken to prevent relapse.

(b) A headache caused by middle body Yang deficiency was successfully treated using four doses of Small Jianzhong Tang (23) and two doses of Lizhong Tang (95).

(c) A headache with severe pressure and a heavy full feeling had been treated as a neurosis by a Western medical doctor, and been given dozens of doses of ineffective Chinese herbs. More than 1 kg of Tianma (Gastrodia) stewed with chicken was used but there was no relief.

We used several large doses of Qingzhen Tang. The recipe is: Cangshu (Atractylodes) 100 g to scatter Wind and remove Cold-dampness; Shingma (Cimicifuga) 60 g to promote clear Yang; Heyie (lotus leaf) 30 g to clean the head and eyes; Shengma and Cangshu (Cimicifuga and Atractylodes) to push up Stomach Qi, and drive out Wind and Wet. The patient recovered in a short period.

Eye Disease （模病）

There are 72 different kinds of eye diseases, distinguished as exogenous or internal injuries. “Neijing” holds that “Qi of organs rises to the eyes, and reflects their fundamental nature.” This relationship was later clarified to include meridians, and was published as Five Wheels and Eight Profiles, a guide to clinical practice. The guide regards eye diseases as exopathic or internal injuries.

The Five wheels are organs related to specific eye components, as follows:

Heart — to the two canthi (the corners on each side of the eye).

Lung — to the whites of the eyes.

Liver — to the iris.

Kidney — to the pupil.

Spleen — to the lids.

The Eight profiles have many theories, but the latest research indicates relationships between the eye’s other components and their meridians, as follows:

Gall Bladder — to a place above the white of the eye.

Stomach — to a place at the bottom.

Large Intestine — to a place on the nasal side.

Small Intestine — to a place on the temporal side.

Bladder — to a place above the nose.

Triple Burner (San Jiao) — to a place above the temporal.

Pericardium — to a place below the nose.

Mingmen — to a place below the temporal.

(1) Exopathic disease is examined by injury site, but is mostly caused by weather. Use prescriptions to expel the Wind and clear the Heat, according to the seasons and positions. Common symptoms include wind and chills aversion, heat aversion, headache, sore red bulging eyes, light sensitivity, and red veins in the eyes.

(2) Internal injury disease sites can also be determined for the organs by the five colors of the eyes. Internal injuries are often caused by the seven passions, which drain the spirit and cause blood loss. If there are no exopathic symptoms, treat according to the Yin or Yang deficiency, using a dozen prescriptions of Bukanyili Dan (89) and Guizhi Longmu Tang (119) for a Heart injured; Wumei Wan (28) for a Liver injured; Jianzhong Tang (23) and Lizhong Tang (149) for a Spleen injured; Qianyang Dan (168), Zhenwu Tang (130), and Fengsui Dan (106) and for a Kidney injured; Jianggui Tang (111) and Guiling Jiangban Tang (122) for a Lung injured; and Huiyang Yin (64) and Baitong Tang for real Yang escape. If it is really the blood deficiency and Yang excess, it should have Fire symptoms, and Qijudihuang Tang (35) Danzhi Siwu Tang (33), etc. can be selected.

Case study

A 10-year-old girl arose early one day with a headache, a stiff inflexible neck, and double vision. Her light-red tongue had a bit of yellowish-white coating, like grassy moss. She also had cold aversion. A cold disease had attacked from the Taiyang meridian, invaded the Hand Taiyin Lung meridian, and caused double vision. Maxuang Tang (Ephedra Decoction) (151) plus was used to dispel the cold and wet, support Lung Qi, and dredge the meridians. After one dose of the treatment, the headache, stiff neck, and cold intolerance were cured. After two more doses, her vision returned to normal. The prescription is as follows: Mahuang (Ephedra, ) 8 g, Xingren (Pinellia, ) 12 g, Banxia (almonds, ) 12 g, Xixin (Asarum, ) 2 g, Guizhi (Presl.) 8 g, Shengjiang (ginger, ) 10 g, Gancao (licorice, ) 10 g.

Swollen Sore Ears, Tinnitus, and Deafness （耳病肿痛）

(1) Swollen sore ears may be caused by:

Liver/gall-bladder diseases of Wind and Fire: use Xiaochaihu Tang (22) with doubled Chaihu (Bupleurum) and Huangqin (Scutellaria), plus Maiya (baicalin malt, ), Xiangfu (Cyperus, ) when external wind and heat merge to cause very painful, red and swollen ears, alternate chills and fever, dry throat, and bitter taste.

Anger or depression: use Shengdi Siwu (Radix Rehmanniae) Tang, doubled, or add Chaihu (Bupleurum), Qingpi (Green Orange peel, ), Maiya (malt, ), Xiangfu (Cyperus, ), etc., to dredge the Liver and rearrange the Liver Qi, injured by merging anger and depression, which causes red and swollen ears, pain on both sides of the chest, and a tendency to sigh.

For renal deficiency and Fire rising, there is no spirit. The treatment should support the Yang, such as Fengsui Dan (106), double Sharen and plus Rougui, Wuyu or Qianyang Dan (168) plus Wuyu, Yangdan Tang (72) plus Xiangfu, Maiya; use Liuweidihuang Tang (35) plus Guiban (turtle shell), Wuweizi (Schisandra), baishao (Paeonia), or Zishen Pills (156), doubled Zhimu , Huangbe (Philodendron, ), etc. to nourish the Yin and reduce Fire for symptoms that include sore swollen ears, bulging Stomach, thirst, unsettled demeanor, and rather stiff genitals. When Kidney-Yang fails, Yin is uncontrolled and causes typically red, swollen, painful, unnatural growths on the ears with servile itch, the pulse in Chi being super and empty or full and string-tight, pale tongue and lips or blue, black or yellow, low spirits.

Long-term Yang deficiency: should use large doses of herbs such as Baitong Tang (54), Sini Tang (48), or Huiyang Tang (64), without any delay, as delay may cause death. It is safe to use this treatment to recover the Yang not only for the ear, but for all others with serious pain, such as whole body clearance, opening, and all bone joints.

(2) Tinnitus and deafness happen because the ears are open to invasion at the opening to the external, and the place of Yang intersection, and can become stagnated by Wind and Heat evils, including Kidney failure and uncontrolled Fire, or Kidney deficiency and Qi cold. “The treatments release Yang, overwhelm Yin, nourish the Kidney, promote the Heart, and clean the gall bladder, etc.” They may also cure deafness in the elderly.

Nasal Conditions （鼻流清涕）

(1) Exogenous causes: use Guizhi Tang (118), Mahuang Tang (Ephedra Decoction) (151),and Gegen Tang (Pueraria Decoction) (163) to scatter the congestion and open the Lung and other airways for Lung Qi.

The symptoms include clear mucus, fever, intolerance to wind and cold, headache, and body aches.

(2) Yang deficiency: use one or two doses of Qianyang (168), and Fengsui (106) plus Xixin (Asarum), and Wuyu (Evodia) to support the Yang, control fluid, reduce turbid discharge, and clear nasal congestion.

With long-term illness and a sudden outflow of clear mucus, this often means that Yang is nearly exhausted. Only 10–20% of such cases can be saved, but more harm can be done blindly without by recognition of Yin–Yang and scattering the evil, thinking that the clear mucus comes from cold in the Lung.

With insufficient Kidney-Yang, this impairs the meridian connected to the Lung, produces Yin cold, and therefore mucus is not diluted and drained.

With insufficient Cardio-Lung Yang, this occurs because as Yang declines, endogenous Yin grows cold. Use Mafu Xixin Tang (Ephedra, Aconite, Asarum Decoction) (155), Ganjiang Guizhi Tang (111), and Yang Dan Tang (72) to support Yang. The Symptoms include tiredness, dispirited demeanor, or nonstop sneezing, or cold intolerance, or cold feet. For rhinitis, anti-inflammatory herbs are not indicated, because they have a short-term effect only, and do not cure.

(3) Nosebleeds: if caused by strong Fire, treat by clearing Fire; if caused by long-term Yang deficiency and Yin excess, one needs to supply Yang immediately.

Trembling Nostrils （鼻孔煽动）

(1) Exogenous evil occlusion needs Jingfangbaidu San (108), Mahuang (Ephedra) Tang (151), and Dingchuan Tang (98) to unblock Qi in the Lung meridian, scatter the evil caused by exogenous Wind and Cold, and clear up respiratory disorders, trembling nostrils, fever, and body aches.

(2) For stagnation of accumulated heat, one needs to clear the stagnated food in the Stomach.

(3) A life-threatening case needs large doses of Fuzi (Aconite) Lizhong Tang to recover and restore Yang, and to warm and consolidate Kidney and Spleen vigor. (Because more children have this condition, carefully determine the herb dosage by the patient’s disease condition.)

(4) For too much fried pepper and ginger spice food consumption, one needs Dachengqi Tang (18), Xiaochengqi Tang (21), Sanwubaiji Wan (14), etc. to clear Heat, when Heat has already accumulated in the chest, Heat is attacking the Lungs, Qi is disordered, and the nostrils are trembling.

(5) For collapse at the end of life, one needs, urgently, to recover and restore Yang, warm and consolidate the vigor of the Kidney and Spleen, but do not scatter the evils. 10–20% of these cases may be cured.

The symptoms include long-term strength deficiency, considerable vomit and diarrhea, a lot of hot sweat, and a white dispirited face.

Swollen lips （唇口红肿）

Some herbs for treating red and swollen lips will heal less urgent cases, but an urgent case will soon die with inappropriate treatment. If accompanied by incessant drooling, check for hot or cold breath, and other syndromes to differentiate Yin/Yang. The syndromes include:

(1) Very strong stomach fire, whose cause is exogenous with exopathic syndromes — use Maxingshigan Tang (153) and Shengma Gegen Tang (Cimicifuga Puerarin Soup) (32).

Stomach Fire without exopathic syndromes — use Ginseng Baihu Tang (5), Liang Ge San (138), Dachengqi Tang (18), and Xiaochengqi Tang (21); food stagnation — use Pingwei San (37) plus Erzhu (Curcuma), Chouniu, and Dahuang (rhubarb); stereotypical polydipsia.

The symptoms include thirst for cold drinks, Heat aversion, or discomfort with bowel or bladder movement, or a lot of stagnated food, or Heat from depression, or too much spicy food and alcohol or sweet wine.

(2) Yang Qi rising for escape, which requires immediate doses of one or two Qianyang Dan (168), Huiyang Yin (64), Baitong Tang (54), Shenqi Wan (71), etc., because the patient is almost dead. If the red glaze disappears, the patient may be cured.

The symptoms include lips that are red with blue, or with black, or dark red, or faded red, or light red, or soft as a peach flower, and glazed over the face.

(3) Children drooling

Incessantly: one needs Tiaoweichengqi Tang to reduce Stomach Heat accumulation.

Severely and incessantly: one needs Small Banxia (Pinellia) Tang plus Fuling (Poria), and Baizhu (Atractylodes) if accompanied by a pale face and cold breath.

Sore Teeth （齿牙肿痛）

Dental specialists, with independent prescriptions, unfortunately do not consider Yin/Yang, and are less effective. Folk doctors may simply use Radix Rehmanniae, Asarum, Fangfeng, Nepeta, Dendrobium, Zhimu, gypsum, Scrophulariaceae, Paeonol, Goudiya, etc. for swelling and pain, which works in cases of Wind and Fire, but allows the patient to die in cases of Yang deficiency.

Differentiations include:

(1) Depression caused by excessive Wind and Fire, which needs Shengyangsanhuo Tang (31), Xiaofeng San (128), Qingwei San (159), Maxingshigan Tang (153), etc. to scatter evil.

The symptoms include fever and body aches.

(2) Stomach heat accumulating and rising, which needs Pingwei San (37) plus Dahuan (Rhubarb, ), Shigao (gypsum, ), Binlang (betel nuts ), etc. to get rid of food stagnation.

The symptoms include a full sensation in the Stomach, acidic saliva, thirst, preference for cold drinks, red face and lips, and rough hands (as if steamed).

(3) Real Yang deficiency and rising Yin, which needs Baitong Tang (54), Jianggui Yin (111), Yang Bawei (71), and Qianyang Dan (168) to promote Yang.

The symptoms include a bluish or whitish drab complexion, a greenish/whitish, or black/wet, or yellow/wet, or white/yellow/wet tongue, a watery mouth: intolerance for liquid, blue, or white with solid yellow, without vivid red mouth flesh (as occurs in most Yang deficiency diseases).

(4) Real Yin deficiency and Yang rising, which needs Liuweidihuang Tang (35), Jizi Huangli Tang (Egg Coptis Soup) (92), Daochi San (73), etc. to nourish Yin.

The symptoms include very unsettled demeanor, irritability, desire for cold liquid, and dark-brown urine.

(5) Cavities and tooth decay, which need Wumeihuachong San  or powdered Chuanjiao (Sichuan pepper,  and Xionghuang (Realgar, ) in the cavity.

(6) Gum pain and loose teeth from Kidney Yang deficiency, which need Baitong Tang, followed by Fengsui Dan and Qianyang Dan.

Case study

(a) A patient with dental pain, loose teeth, low spirits, and spermatorrhea 7–8 times per month had all symptoms cleared.

(b) A patient with dental pain for more than a month had been treated in accordance with Fire, and given ineffective cool herbs. A diagnosis of Kidney-Yang deficiency and two doses of Qianyang Dan provided a cure.

Foul Breath with a Bitter, Sour, Pungent, Sweet, Flat Taste, or Thrush (Mycotic Stomatitis) （口臭，苦，酸，辛，甘，淡，糜）

(1) Halitosis: may be caused by extreme Stomach Fire, and should be treated to clear the Stomach Fire, using Ginseng Baihu Tang (5), large and small Chengqi Tang (18 or 21), Sanhuang Shigao Tang (Plaster Soup) (12), etc.

The Symptoms include irritability, Heat aversion, preference for cold drinks, or a prickly tongue with a dry yellow, dry black or dry white tongue coating, sweat, a rude loud voice, and difficult urination and bowel movement.

(2) Yin overpowering even the true Yang nearly escaped

This is almost impossible to cure if all organs are Yang-depleted, the whole body is enshrouded in pure Yin, the innate essence is gone, the congenital essence and Qi have left the root (Kidney), and Yang is almost non-existent. The symptoms, all pure Yin syndromes, include lethargy, uncontrolled urination and bowel movement, quiet demeanor, very bad mouth odor, few symptoms of Fire, yellow wet tongue or dry yellow or black tongue, without thirst, or thirst only for warm drinks.

Fire cannot be presumed by bad breath alone. Several patients with bad breath, but pure Yin, recovered after one or two large doses of Baitong Tang (54), Sini Tang (48), Huiyang Drink (64), etc. If after two or three doses the syndromes are still not reduced, only 10–20% of these cases may be cured, but continue with larger doses.

If practitioners detect bad breath, do not distinguish Yin and Yang, and immediately use Radix Rehmanniae, Erdong, Zhimu, Pollen, Gypsum, Rhubarb, etc., the Yang-predominate patient may live, but the Yin-predominate patient may die immediately!

(3) Taste differentiations

A Bitter Taste is associated with Heat in the Heart and gall bladder, which can be treated with Daochi Powder (73) and Huanglian Tang (Coptis Decoction) (141); Small Chaihu (Bupleurum) Tang (22) with doubled Huangqin (Scutellaria), or Xiegan Tang (116).

A Sour Taste is associated with Heat in the Liver, which can be treated with Danggui Luhui San (Angelica Aloe Powder) (68) and Longdanxiegan Tang (45).

A Pungent Taste is associated with Heat in the Lung, which can be treated with Xiebai Powder (115) and Qingfei Drink (160).

A Sweet Taste is associated with Spleen Qi exiting, which can be treated with Lizhong Tang (149) and Liujunzi Tang (36).

A Flat Taste (unleavened) is associated with insufficient Spleen Qi, which can be treated with Guipi Tang (59) Shenling Baizhu San (104).

(4) Thrush (micotic stomatitis, oral ulcer, white sores in the whole mouth) stems from strong Stomach Fire, which can be treated with Ganlu Drink (41), Liangge Powder (138), or a Western anti-inflammatory for temporary healing, but white sores will recur if the patient eats spicy fried food.

(5) Yang-deficient and Yin-abundant: patients who use two or three doses of spicy and sweet herbs to increase Yang may temporarily have a bitter, sour, pungent, or two or three sweet taste.

Case study

In one case of thrush, the patient’s symptoms included a pale face, dispirited demeanor, fatigue, and very serious cold intolerance. These syndromes are purely Yin, even though the mouth is full of ulcers. The patient was given two doses of Paojiang Gancao (Ginger Licorice) Tong plus Jiegeng (Campanulaceae, ), followed by four doses of Fuzi Lizhong Tang (149), and finally four doses of Qianyang Dan. The patient has not relapsed, even after eating spicy fried food. This prescription has cured dozens of such patients.

The Tongue is Swollen, or Painful, or Heavy, or Stiff, or Numb, or Slow, or Retracted （舌肿，舌痛，重舌，舌强，舌麻，舌木，舌缩）

The Miraculous Pivot says, “Heart Qi passes on the tongue; Heart in peace, then the tongue is able to taste the five flavors.” Although the Heart is a Fire, when a swollen tongue is treated as Fire, without analysis of syndromes, there could be errors. The tongue, the planet of the Heart, is linked with the Spleen and Stomach. When they are peaceful, the tongue tastes the five flavors.

Tongue sickness is related to organ, color, and tongue as follows:

Tongue sickness is related to condition and appearance as follows:

Condition	Appearance
Qi-deficient	Soft and slippery
Yang-deficient	Tired, cold, no spirit
Yin-deficient	Fresh, red, solid
Heat	Rigid and dry
Cold	Blue or black

Case study

A patient who preferred cold sleeping quarters slept through a sudden storm with a rapid temperature drop. Upon awakening the patient had difficulty speaking; looking in the mirror, the patient found a small tongue growing under the normal tongue. Herbs to detoxify and clear the Heat were without effect. The symptoms included a floating tight pulse and aversion to the smell of fat frying. The patient was healed with two doses of Mafu Xixin Tang (Ephedra, Aconite, Asarum Decoction) (155), because the condition was caused by cold.

Throat Edema Like a Moth （喉蛾）

This syndrome may be so severe that the patient can hardly eat or drink. Herbs which are generally used for breathing or eating disorders are appropriate, because many of them cool the body, or clear the Fire in an emergency. The disease may be:

Caused by Shaoyin (Heart) Fire, escaped Kidney-Yang, rising accumulated Stomach Heat, or anger that triggers rising Liver Fire.

Treated by methods to dispel the Wind, clear the Heat, dislodge retained food, and deplete the Fire with diarrhea.

Recognized by symptoms which include emotional upset, scant brown urine, thirst, and preference for cold drinks.

When accompanied by:

Wind and Heat, dispel the Wind and clear the Heat using Daochi Powder (73) plus Jinjie (Schizonepeta), Fangfeng, Yinhua (Schizonepeta), Fangfeng, Yinhua (Honeysuckle), etc.

The symptoms include fever, body pain, and headache.

No Wind and Heat, but very powerful Fire, in light cases use Ganju Tang (40), in serious cases use Huang Jiedu Tang (143), etc.

As a result of escaped Kidney-Qi, never hiding and rising to the throat, these belong to Yin syndromes, but not Yin deficiency with strong Fire. These syndromes have weak Yang and strong Yin, as differentiated from the appearance and pulse. Promoting Yang uses Fengsui Dan (106), Jianggui Yin (111), Baitong Tang (54), Qianyang Dan (168), etc. When the symptoms including flesh color within the mouth, pain, pharyngitis, or throat inflammation are similar, but herbs to clear Heat or reduce inflammation will not heal. Warm herbs may heal quickly, so proceed with methods to promote Yang. For a Western medicine diagnosis of pharyngitis, or laryngitis that will not be easily healed by Western medicine, we first use Paojian Gancao (Ginger, Glycyrrhiza) Tang (42) plus Jiegeng (Campanulaceae, ). If the sickness does not worsen, then use repeated doses of Aconite Lizhong Tang (149) plus Jiegeng. Qianyang Dan is sometimes also used.

Two Arms Pain （两手臂痛）

Two arms pain due to:

Meridians occluded by exogenous Wind-Cold now needs to be scattered, using Gui Zhi Tang (118), Qianghuo Fuzi Tang (Notopterygium, Aconite Decoction) (99), Mafu Xixin Tang (Ephedra, Aconite, Asarum Decoction) (155), etc.

The Symptoms include cold intolerance, wind intolerance, fever, and headache.

Insufficient Qi, with Cold blocked inside needs to have the middle body warmed and the Qi moved, using 2–3 times the normal amount of Jianzhong Tang (23), doubling the Guizhi, Fuzi (Aconite), or Buzhongyiqi Tang (88) plus Qianghuo (Notopterygium), Fuzi (Aconite), or Lizhong Tang (149) plus Guizhi, Xiangfu (Cyperusthe). The condition is usually observed in women during their menses beginning in middle age, due to working with cold water and being not able to raise their hands because of arm pain, triggered by the cold. The traditional prescription uses Gancao Ganjiang (Glycyrrhiza, Ginger) Tang (42) plus Lurong (Pilose), Guizhi, Fuzi (Aconite), Cung (green onion root), and wine. Because Pilose is very expensive today, switch to Gancao Ganjiang (Glycyrrhiza, Ginger) Tang (42) plus Lujiaoshuang, Mugua (papaya), Yanhusu, with Fuzi (Aconite), etc.

The symptoms include a spiritless pale face, limited eating, severe symptoms on gloomy rainy days, and light symptoms on sunny days.

Insufficient Qi, which causes interior Cold, needs to be treated in regard to meridians obstructed by exogenous wind or cold. Treat middle-aged men and women with Mafu Xixin Tang (Ephedra, Aconite, Asarum Decoction) (155) plus Chuanwu (Sichuan Aconitum), Caowu (Kusnezoffii), Guizhi, Yanhusu, Gansong (Nard), etc.

Finger numbness is due to insufficient Spleen Qi, which cannot absorb phlegm and moisture. Warm the middle body and move Qi using Guipi Tang (Guipi Pills) (59), Sijun Tang (51), Liujun Tang (36), and Jianzhong Tang (23 or 17).

Heart Pain （心痛）

Heart pain has two kinds of Cold or Heat syndromes, so use Cold and Heat symptoms to differentiate. For:

Heat rising, it is necessary to nourish Yin and clear Fire, using Huanglian Muxian (Coptis, Moka) Tang (145), Daochi Powder (73), Danggui San (Angelica Powder) (65), etc. for symptoms that include a red face, upset demeanor, hot scant brown urine, thirst, and preference for cold drinks.

Cold Yin rising, one needs to promote Yang and reduce Yin, using Gancao Ganjiang (Glycyrrhiza, Dried Ginger) Tang (42), plus herbs to move Qi such as Ganjiang (Ginger), Guizhi, or Wuyu (Rutaecarpa).

The symptoms include a green face, white lips, a blue or black tongue, preference for hot drinks and massage, as opposed to cold drinks, and uncontrolled urine and stools.

Very Cold Yin, rising and attacking the Heart, there is no cure, but large doses of prescriptions to recover Yang may help 10–20% of these cases.

The symptoms include a black nose, swarthy lips, blue or black nails, and the whole body being covered with pure Yin.

Errors arise when Heart and Stomach syndromes are not distinguished, and when Qi is just moved to break stagnation, without careful study of Yin and Yang. First, differentiate Heart pain from Stomachache, and reject the idea that there is only pain in the pericardium, but not in the Heart, and the idea that any pain is due to Qi inversion. There are only two sources of Heart pain:

(1) Excess Qi heat, which needs the practitioner to nourish Yin and clear Fire.

(2) Weak Qi cold, which needs the practitioner to promote Yang and reduce Cold Yin. By using large doses of prescriptions to recover Yang, 10–20% of these cases may be cured.

True Heart pain is Cold evil attacking the Heart, and making Fire, which may cause death by the evening if it is severe in the morning. Warm with large doses of Mahuang (licorice, ), Ganjiang (ginseng, ), plus a small amount of Rougui (Cinnamon, ), and Doukou (cardamom, ).

The symptoms include hands and feet that are blue, especially at the joints.

Jue Heart pain is caused by Cold in the middle body, which causes Qi to invert. Treat it immediately with Zhufu (Atractylodes, Aconite) Tang (44) to warm the body. The symptoms include hands and feet that are cold while the body sweats, and back pain and spasm.

Decline of Predominate Fire signals near-death, and unrestrained blood attacking the Heart, but may be treated with Pig Heart Soup boiled with Mahuang (Ephedra, ), Guizhi  Fuzi (Aconite, ), and Ganjiang (dried Ginger, ). The symptoms include an overwhelming chill, sudden severe pain, silent demeanor, a green face, cool breath, sweating all over, hands and feet that are blue and cold over the joints.

The Lingshu states: The Kidney, Stomach, Spleen, and Lung problem could cause Heart pain; the “Jue” Heart pain related to back pain, often with spasm. The “Real” Heart pain with the hands, feet, and joints blue, which is the Cold evil hurting the Fire of the Heart, symptoms of which are similar to today’s angina pectoris, and myocardial obstruction. Immediately utilize pungent herbs to warm the Heart meridians.

Stomach Pain （胃痛）

The Inner Canon of the Yellow Emperor refers to “The Stomach pain at the Heart place.” Stomach pain generally refers to the Stomach area, but is related to the Heart, Spleen, pancreas, and intestine, with pain in the chest and belly. It is differentiated by causes including food, cold/hot, weak/strong, and Qi circulating into the Stomach. The principles of the Stomach pain treatments by our predecessors are “If caused by Cold evil then warm it, if caused by Heat evil then clean it, if there is sputum then convert it, if caused by blood stasis then eliminate it, if caused by Qi stagnation then circulate it, if caused by insects then kill them, if caused by food then help digest it, if caused by deficiency then tonify it.” Stomach pain caused by:

Food stagnation interrupts smooth Qi circulation. Promote digestion, and break up stagnation, using Houpu (Magnolia) Qiwu Tang (105), Pingwei San (37) plus Xiangfu (Cyperus, ), Maiya (malt, ), etc.

The symptoms include a stuffed feeling, an acid taste, smelly belching, and soreness to the touch.

Insufficient Stomach-Yang from the flu or from eating cold raw food results in middle body cold. Use Xiangsha Liu Jun Tang (110), Lizhong Tang (149) plus Rougui (Cinnamon), Sharen (villosum), Xiangfu (Cyperus), Muxiang (Costus), etc. to warm the middle body and circulate Qi.

The symptoms include relief with pressure, preference for hot drinks, drooling, white face, and blue lips.

Accumulated damp and Heat in the Stomach is produced by over-eating greasy food, giving rise to Heat, or Qi stagnation. Use laxatives to clear the Heat, such as Tiaoweichengqi Tang (140), Dahuang Muxiang (Rhubarb, Costus) Tang (19), or Simo Tang (50).

The symptoms include irritability, red lips, bad breath, and hard stools.

Cardiac Stomach pain is strong Yin forcing Yang out. Treat urgently to promote Yang and dispel Yin.

The symptoms include a cinnabar-red face and demand for heavy pressure massage.

Case study

The same patient suffered from the same condition three times, but had different etiologies, and different treatments.

The patient had Stomach pain, due to insufficient Stomach Yang, and immediately vomited water or herbal medicines. One dose of Small Banxia Tang (Pinellia Decoction) (62) warmed the Stomach and stopped the vomiting. Then two doses of Lizhong Tang (149) dispelled the Cold, plus Rougui (Cinamon), Xianfu (Cyperus) circulated the Qi, and stopped the pain. Then, because the Yang in lower and middle Jiao meridians was still insufficient, Fuzi Lizhong Tang (149) plus Rougui (cinnamon), Dingxiang (clove) treated lower limb coldness, and inability to eat much food at one time.

Ten months later, the Stomach pain resumed, and was diagnosed as the flu and the merging of outside and inside cold. Two doses of Maguigeban Tang (118 and 151) dispelled exopathic wind and cold. Lizhong Tang (149) plus Gancao Ganjiang Tang (Licorice, Dried Ginger Decoction) (42) reduced the pain and the patient recovered.

One year after the Stomach pain recurred, the diagnosis was internal injuries due to raw and cold food stagnation. First, Dahuang Fuzixixin Tang (Rhubarb, Aconite, Asarum Decoction), a warm laxative, unblocked the stools, and reduced the pain. Then two doses of flavored Lizhong Tang (95) supported the Yang of the Spleen-Stomach. With that the patient recovered.

Umbilical Pain （脐痛）

The umbilicus is situated at the body’s juncture of Yin and Yang, and therefore umbilical pain will have a Yin or Yang character. Pain above the navel (the Yang part of the body) relates to the Spleen and Stomach, while pain below the navel (the Yin part of the body) relates to the Liver and Kidney. If the pain extends both above and below the umbilicus, all four organs are involved. In this case it is important to discern which of the meridians is most seriously affected. If pain is felt only above the umbilicus, the Qi of both the Spleen and the Stomach have become stagnant. It is then the practitioner’s task to determine the type of stagnation: Cold, Heat, food or depressive Heat.

If the patient feels full and stuffy, and has acid regurgitation, it is due to food and Qi stagnation. The patient’s digestive function and Qi system can be activated and regulated with herbs such as Pingwei San (Powder to Neutralize the Stomach (37) plus Xiangfu (Cyperus tuber, ), Maiya (Germinated barley, ), or Zhike (Bitter orange peel, ) in this regard.

In cases where the patient likes hot drinks and the pain is reduced by the pressure of massage, it is due to the inability of deficient Spleen- and Stomach-Yang to release pathogenic Yin-Cold. The treatment is then needed to warm the Middle Jiao. Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (149)), Xiangsha Liujunzi Tang (Six Gentlemen Decoction with Aucklandia and Amomum (110) or Gancao Ganjiang Tang (Licorice and Ginger Decoction (42)) with added Xiangfu (Cyperus tuber, ), Guizhi (Cinnamon twig, ), Dingxiang (Cloves, ), and similar herbs are appropriate.

If the patient dislikes warm drinks and the pressure of massage, and experiences more pain with the application of Heat, then there is Qi stagnation and depressive Heat in the Spleen and Stomach. Treatment should consist of the application of herbs that help relieve depressive Heat and promote the circulation of Qi. The herbs of Houpo Qiwu Tang (Seven Substance Decoction with Magnolia Bark,  (105)) with added Maiya (Germinated barley, ), fried Zhizi (Cape jasmine fruit, ) and Xiangfu (Cyperus tuber, ) can be used effectively to treat such a case.

There are also cases in which a pathogen in the Taiyang (Bladder or Small Intestine) Meridian has not been resolved and, in fact, incorrect treatment has trapped the pathogen in the Spleen. Inappropriate purgation can lead to pain above the navel. If the patient also has a fever, aversion to cold, and head or neck stiffness and pain, taking a purgative-type laxative formula, Guizhi + Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb,  (123) can provide the necessary healing warmth and pain relief.

If the pain is located solely below the umbilicus, it is due to an impediment of Qi flow in the Jueyin (Liver) Meridian. If the patient feels irritable, and has a contracted scrotum and pain below the umbilicus, excessive Yin-Cold is blocking the Jueyin Meridian.Treatment can be applied to promote Yang and dispel Yin. Useful formulas are Sini + Wuzhuyu Tang (Decoction with Evodia Added to Treat Cold Limbs,  (85)) and Baitong Tang (White Penetrating Decoction (54)). However, if pathogenic Heat is residing in the Jueyin Meridian, it may attack upward to cause pharyngitis, or descend more deeply engendering additional Heat and countercurrent Qi flow, causing septic diarrhea, halitosis, and coarse respiration. In this case, one must promote Yin; Ejiao Huanglian Tang (Decoction of Donkey Hide Gelatin and Coptis Combination,  (92)), which contains nourishing chicken egg yolk, would be suitable.

One of our patients initially presented with a vague dull pain below the umbilicus. He had been out in heavy rain and his clothing, including his underwear, was thoroughly soaked. With pain getting worse, his complexion appeared dark and his expression seemed spiritless. A massage along with Heat treatment helped reduce the pain. The patient’s tongue coating was white and slippery, and his pulse was floating, tight and thin. This case was diagnosed as Cold Yin-Qi stagnating in the Jueyin (Liver) Meridian along with an attack of exterior Cold pathogens. The patient was first treated with two large doses of Mahuang Fuzi Xixin Tang (Ephedra, Aconite, Asarum Decoction,  (155)) to reduce the pain, with a larger dose of Fuzi (Aconite, ). Then his pain was reduced.Next, he was given large doses of Sini + Wuzhuyu Tang (Decoction to Treat Cold Limbs with Added Evodia,  (85)) plus Xiaohuixiang (Fennel,  and Yanhusuo (Corydalis tuber, ). After four doses were taken, the patient recovered.

Hernia （疝证）

Hernia mainly refers to male testicular disease. In TCM, the testicles are referred to as Wai Shen (“External Kidney”); this may be due to their shape being slightly similar to that of the Kidney and to their shared role in reproduction. When a pain occurs, the testicles shrink — commonly known as Zou Shen (“the Kidney Leaves”). Such conditions of testicular and scrotal shrinking or swelling and pain are generally known as hernia. TCM differentiates several types of hernia: Cold hernia (Han Shan), Water hernia (Shui Shan), Qi hernia (Qi Shan), and others (completely different definition than in Western, medicine, where hernia is a weakness in the abdominal muscle, and also may be congenital in girls).

It is believed in TCM that “the hernia has Cold symptoms and Warm symptoms….” Shrinking occurs when Yin is in relative excess, while redness and swelling indicate increased Heat. Swelling may also point to a surplus, such as an excess of Qi due to Fire. Treatment should be considered to break Yang and promote Yin. Shrinking points to deficiency; specifically, the deficiency may be due to Cold. In such a case, treatment should be considered to break Yin and recover Yang. Ancient treatments for hernia include regulating Qi, warming the Middle Jiao, clearing Dampness, reducing Heat, and moving Blood stasis. The most important factor in stopping pain is to regulate the circulation of Qi. This can be achieved by administering such formulas as Wuling Powder (Powder of Five Ingredients with Poria (24)) modified as necessary or San Ceng Huixiang Wan (Three-Layer Fennel Pill, ). The latter prescription is said to be able to heal even exceptionally protracted cases of chronic swelling hernia.

It is said that this prescription was used to treat a 30-year-old hernia. This method still shows its efficiency, elegance, and wisdom today.

Traditional medical records concerning Cold hernia treatment strategy point to warming the Middle Jiao and promoting Qi circulation. This is accomplished by administering Sini Tang (Decoction to Treat Cold Limbs (48)) with added Xiaohuixiang (Fennel fruit, ), Lizhihe (Litchi nut, ), Guizhi (Cinnamon, ) Gansongxiang, (Spikenard, ), and Yanhusuo (Corydalis tuber, ), and repeatedly applying a heated poultice of warmly fried salt, Hujiao (Black pepper), Xiaohuixiang (Fennel fruit), and Muxiang (Costus root, ), to the affected area.

As might be expected, swelling correlates with surplus and shrinking with deficiency. In addition, throughout the history of Chinese Medicine, reproductive function has been related to Kidney-Qi movement, Mingmen  fire, and Kidney-Fire. Therefore, hernia is also associated with the Liver and Kidney.

Spermatorrhea （遗精）

Spermatorrhea, or nocturnal emission, may occur with or without dreams. Although there are differences in the symptoms, the overall etiology and pathogenesis are basically the same. The pathological mechanism is always related to the Heart and Kidney. Previous expositions on this topic include “the Essence of the reservoir is the Kidney, but the master of the Essence is the Heart-Mind.”

“If the Heart-Mind is tempted, Kidney-Fire will also be moved and sperm will spontaneously leak.” “The Heart-Mind has its Monarch Fire, and the Kidney has its Premier Fire; if the Heart-Mind is tempted, the Kidney will react with it.” Thus, the main cause of spermatorrhea is a miscommunication between Heart and Kidney, which affects the ability of the Spirit (Shen) and the Soul (Hun) to be properly anchored in the body. “The Spirit controls Qi, and Qi supervises sperm. The Spirit issues a command to release, so the Qi moves and the sperm can no longer be contained …. Inappropriate sexual thoughts may accidentally arise and, if the Spirit is undisciplined, the sperm will be hard to retain and will be emitted rapidly.”

The three prescriptions used for spermatorrhea are Sancaifengsui Wan (Pills (106)), Guizhi + Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell (119)), and Baitong Tang (White Penetrating Decoction (54)). They are all based on cross-exchanging Yin and Yang, and treating both Heart and Kidney to achieve the desired result of retaining sperm. It is a different approach from using astringent herbs such as Jinying (Cherokee rose, also called Rosa laevigata, ), Yingsuqiao (Poppy capsule, ), or Lianxu (Lotus stamen, ) in combination with nerve-soothing herbs such as Fushen (Poria with host wood, ), Yuanzhi (Polygala root, ), or Suanzaoren (Wild jujube seed, ). However, in the clinical cases one should always thoroughly evaluate the patient’s Yin and Yang status, and the entire presenting condition before using the predecessors’, or even some patent herbal prescriptions.

TCM predecessors said, “Where spermatorrhea occurs with dreams, the Premier Fire is strong, and hence it is recommended to use Longdan Xiegan Tang (Decoction of Chinese Gentian Combination to Purge Liver Fire (45)) or the multipurpose Wubeizi Wan (Chinese Gallnut Pills, ). Spermatorrhea occurring without dreams indicates Qi deficiency, where Qi is unable to consolidate sperm, and it is recommended to use the modified Shiquan Dabu Tang (All-Inclusive Great Tonifying Decoction (4)). The herbs to be added are Longgu , Muli (Oyster shell, ), Lianxu (Lotus stamen, ), Wuweizhi (Schisandra fruit, ), and Huangbai (Phellodendron bark, ). If spermatorrhea is due to Kidney deficiency, then supplement the Kidney.”

When Kidney-Yang deficiency is the cause of spermatorrhea, a commonly used base formula is Fuzi Lizhong Tang (Prepared Aconite Decoction to Regulate the Middle Jiao,  (95)). This formula can be supplemented with such herbs as Buguzhi (Psoralea fruit, ), Xianmao (Curculigo rhizome, ), and Yizhiren (Bitter cardamom, ). In cases of Kidney-Yin deficiency, use Liuwei Dihuang Wan (Pills of Six Ingredients with Rehmannia combination,  (35)). There is an additional type of spermatorrhea, caused by faulty closing of the spermatic duct. Unfortunately, this condition is difficult to treat. However, formulas that hold sperm, such as Mijing Wan (Pills) and Jinsuo Gujing Wan (Pills to Fix Sperm), can be modified to meet the patient’s particular needs.

However, in addition to using herbal treatments, the patient must take an active role in becoming better, and should think and behave mindfully to reduce any inappropriate desire for sex by cultivating a healthy attitude toward sexuality, avoiding contact with sexually stimulating media, and focusing on recovering his health. It is also important to avoid consuming excess food and drink before going to bed, and to keep the feet warm without overheating the body during sleep.

Difficult Defecation （大便不利）

Difficult defecation cases typically relate to deficiency of Yang or Yin, fullness of the Yangming (Stomach) Meridian, or the transfer of Dry Heat from Lung to Large Intestine. If the condition is the result of Yang deficiency, namely “Yin stagnation and Cold constipation,” patients will exhibit a lack of Spirit, with a black or blue cast to their complexion and lips, excess saliva, and little or no desire to drink. In spite of not having had a bowel movement in as many as 10 days, patients will show no abdominal distention or irritability; if any thirst is present, patients will only want to drink hot water. Herbal formulas such as Huiyang Yin ( (64)) with added Sharen (Amomum fruit, ) and Rougui (Cinnamon bark, ), Baitong Tang (White Penetrating Decoction (54)), and Fuzi Gancao Tang (Prepared Aconite and Licorice Decoction (94)) are appropriate treatments. For consideration, there is a theory that states: “Cold constipation is a result of Cold Qi stagnating in the Stomach and Intestines, causing Yin consolidation and Body Fluid obstruction …. Use Huoxiang Zhengqi San (Powder of Agastache, , Combination to Regulate Qi (170)) with 1.5 g each of Zhike (Immature bitter orange, ), Guizhi (Cinnamon twig, ), and Liuhuang (Sulfur, ) to form pills.

While Hot herbs tend to cause constipation, only Liuhuang is warm and purgative; among the Cold herbs, which are mostly astringent, only Huanglian (Coptis root, ) lubricates the Intestines and stops diarrhea.”

If the condition is caused by Yin deficiency, it is termed “Syndrome of Yang gathering and Heat sealed”. The patient will be irritable or have a loud and clear voice, and will be thirsty for cold beverages and will expectorate dry yellow phlegm. The pulse will be either large or both small and rapid. Treatment should consist of herbs that nourish the Blood and clear Heat. Dr. Zheng suggested the use of Runzao Soup ( (131)), Maren Wan (Pills of Cannabis Seed Combination (152)) and Yangxue Plus Soup (135), all of which are capable of resolving this problem.

The predecessors also provided a breakdown of constipation syndromes and their appropriate care: constipation with pathogenic Wind can be treated with Soufeng Shunqi Wan (Pills, ) and Runchang Wan (Pills to Moisten the Intestine); constipation with Qi stagnation is resolved with Suzi Jiangqi Tang (Decoction of Perilla seed combination to Descend Qi (81)); constipation with food stagnation cases are advised to use Piji Wan (Pills) and Ganying Wan (Pills). Finally, patients with constipation of the Piyue (weak Stomach and strong Spleen, urine reduction, and very hard stools) type should receive Maren Wan (Pills of Cannabis Seed Combination to constrain the Spleen) and Shixuan Wan (Pills). Although not always being an exact fit to each particular situation, these references from TCM history remain excellent starting points for any type of constipation which a contemporary doctor would encounter.

If the constipation is caused by Yangming Stomach fullness, exogenous pathogens have invaded the Stomach and have transformed into Heat, thus consuming Body Fluid. Distension can result, with a feeling of fullness, dryness, and solidity in the Intestines. Urgent purgation is advised to save the Yin. Appropriate formulas are Da Chengqi Tang (Drastic Purgative Decoction (18)) and Xiao Chengqi Tang (Mild Purgative Decoction (21)).

If the constipation is caused by the transfer of pathogenic Dryness from Lung to Large Intestine, it is advised to clear the Dryness evil by using Ganjue Erdong Tang (Decoction (43)), Yiyuan San (Benefit the Source Powder (134)), or other similar formulas. There is a type of constipation caused by Blood and Qi deficiency. This condition is similar to Lung-Large Intestine Dryness. Administering herbal formulas such as Bazhen Tang (Decoction of Eight Treasures Ingredients (8)), Daozhi Tongyou Tang (Decoction), Roucongrong Runchang Wan (Cistanche, , to Moisten the Intestine Pills), Wuren Tang (Five-Seed decoction), or Shenqi Wan (Pills for Tonifying Kidney Qi (71)) is an effective treatment.

In the preceding paragraphs, four main types of constipation syndromes and related treatments have been described. It is important to note that, regardless of gender and age (either geriatric or pediatric), using the suggested herbal formulas according to the differentiated syndrome is correct. One must not be misled by the adage that women, the elderly, and children must not use Fuzi (Prepared aconite root, ) or Dahuang (Rhubarb, ). These herbs are appropriate when used with the TCM principles. In general, it must be emphasized that when a herbal treatment is applied, caution should be taken to distinguish between Yin and Yang so as to avoid harming the patient.

For patients with the constipation caused by “Yin gathering and Cold sealed,” most will show a lack of Spirit, having either a pale or dark complexion. The patients tend to have an aversion to cold and produce small, hard, and round stools much like sheep droppings.The first stage of treatment is to use Fuzi Lizhong Tang (Prepared Aconite Decoction to Regulate the Middle Jiao (95)) with added Dahuang (Rhubarb). As soon as the bowel moves, switch to Huiyang Yin (Drink (64)) with added Guizhi (Cinnamon twig, ) and Sharen (Amomum fruit, ), or to Fuzi Lizhong Tang (Prepared Aconite Decoction to Regulate the Middle Jiao (95)) with added Roucongrong (Cistanche, ) and Houmaren (Hemp seed, ). This combination of formulas and herbs will regulate the Intestines and resolve constipation.

Difficult Urination （小便不利）

The syndromes of difficult urination may relate to Yang or Yin deficiency, Heart-Heat transfer to the Small Intestine, retention of urine or Heat in the Bladder, and to Taiyang Fu Syndromes of the Bladder Meridian, which include Water Accumulation Syndrome and Blood Accumulation Syndrome.

If the condition is caused by Yang deficiency, difficult urination may occur because the Yang of the Lower Jiao is weak and Yin-Cold blocks the urinary tract in the bladder. When the Yang is weak, there is not enough power to dissolve the Cold, and urine cannot easily flow out. Patients will be weak with lack of Spirit, and both Chi (Kidney) pulses will be floating or strong. The patients will have very little thirst, wanting only small amounts of hot water. Treatment can be applied to support the Yang of the Lower Jiao with herbal formulas such as Guiling Zhugan Tang (Decoction (120)) with twice the usual amount of Guizhi (Cinnamon bark), plus Baidoukou (Round cardamom fruit, ) and Sharen (Amomum fruit, ) or Guizao Wan (Pills (121)) plus Huijiao (Black pepper, ), Dingxiang (Clove, ), and other similar herbs.

If the condition is caused by Yin deficiency due to a lack of Blood in the Lower Jiao, pathogenic Heat will be produced. (It is important to recall the key role that thoughts and emotions play in TCM pathogenesis: anxiety produces Fire in the Heart, anger produces Fire in the Liver, and sexual thoughts disturb Kidney Fire. However, a subtle Mind activity is considered to be powerful and capable of engendering all syndromes.) Thus, Fire disturbances can arise from endogenous sources, besides exogenous ones. Pathogenic Heat knots in the urethra, closes the urinary tract, and blocks Qi circulation, and thus hinders the smooth flow of urine. The patient will be irritable, thirsty for cold beverages, and produce only a few drops of urine at a time, brown in color or accompanied by hot pain. The treatment can be considered to support the Yin of the Lower Jiao with formulas such as Siling Huashi Ejiao Tang (Four-Fungus Talc and Donkey Hide Gelatin Decoction,  (53)) and Yiyuan San (Benefiting the Source Powder (134)).

Dysfunctional urination can also be caused by Heart-Heat migrating to the Small Intestine. If Heart-Heat becomes too intense, or if excessive anxiety is present, Heart-Fire may be produced. Heat or Fire from the Heart can easily flow to the Small Intestine, the interiorly paired organ of the Heart. If the Heat or Fire is allowed to reside in the Small Intestine, it will impair Blood circulation and prevent the free flow of urine. This syndrome manifests in a similar manner to Yin deficiency, as mentioned above. Appropriate treatment clears Heart-Heat with formulas such as Huanglian Jiedu Tang (Decoction of Coptis Combination for Detoxification (143)) with added Huashi (Talc, ) and Bayuezha (Akebia fruit, ), or Daochi San (Powder for Conducting the Fire Downward (73)) with twice the usual amount of Shengdihuang (Fresh Rehmannia root).

For the syndromes of urinary retention, Heat retention, and Water or Blood Accumulation Syndromes of the Taiyang (Bladder), it is said, “When Bladder-Heat knots, a mild case is the retention of urine with some leakage, and a severe one is complete urinary block-age….” The syndromes are usually excessive Heat knotting in the bladder. Patients suffering from severe syndromes feel urinary urgency, lower abdominal distension, and pain in the urethra. The Heat needs to be cleared with the TCM predecessors consisting of Bazheng San (Powder of Eight Ingredients to clear Heat and Dampness (7)), Wulin San(Five-Ingredient Powder for Painful Urinary Dysfunction (25)), and Daochi San (Powder for Conducting the Fire Downward (73)), adjusting the amount of herbs such as Cheqianzi (Plantago or Plantain seed, ), and Mutong (Akebia fruit, ), as each case requires.

Where dysuria is caused by tuberculosis or hemiplegia, Lizhong Tang (Decoction to Regulate the Middle Jiao (149)), Buzhong Yiqi Tang (Decoction to Reinforce the Middle Jiao and Tonify Qi (88)), Renshen Yangrong Tang (Ginseng Decoction to Nourish the Nutritive Qi), and Shenqi Wan (Pills to Tonify Kidney-Qi (71)) are suitable base prescriptions that can be tailored to each individual patient.

For pregnant women who experience bladder changes that disrupt urination, Buzhong Yiqi Tang (Decoction to Reinforce the Middle Jiao and Tonify Qi (88)) is recommended. There is a unique method of administering the formula in this case: after the patient takes the herbal medicine, she must induce vomiting (putting a finger in her throat). As with an eye dropper, when the bulb is compressed, no liquid will flow from the lower opening, but when the bulb is released, liquid will flow. Thus, when the blockage in the patient’s Upper Jiao is released, urine can flow properly from the Lower Jiao.

Conversely, there are disorders of too frequent urination. These conditions are caused by Cold in the Bladder and Kidney. Elderly patients typically suffer from this type of syndrome. Frequent nocturia (seven or more times a night) is a feature. It can be treated with large doses of Fuzi Lizhong Tang (Decoction with Aconite to Treat the Middle Jiao (95)) with added Xiaohuixiang (Fennel fruit, ), Guizhi (Cinnamon twig, ), and Yizhiren (Bitter cardamom, ), This herbal formula with modifications has an excellent history in case studies of normalizing urination in the elderly.

In addition, pediatric patients may suffer from enuresis or bed-wetting, due to deficiency Cold in the Bladder. The child’s Bladder may not yet be fully matured or may be of limited prenatal vigor, so the body cannot restrict the urine and it flows out unconsciously. While the Kidney famously dominates Water, it is important to recall that urine is derived not from Water but from Body Fluid, which is ruled by the Bladder. If weakness and inner Cold impair the Bladder’s function of restricting urine, it will flow uncontrolled from the body. This is termed “Cold enuresis.” Liuwei Huiyang Yin (Six-Flavor drink (64)) plus Xiaohuixiang (Fennel fruit, ) and Yizhiren (Bitter cardamom, ) should be used to resolve this problem. There is also a strong history in case studies of pediatric patients treated with this modified formula.

Gonorrhea （淋病）

Gonorrhea belongs to diseases of the Lower Jiao, specifically the Kidney and Bladder. It is different from urinary dysfunction. Gonorrhea is mentioned in The Inner Canon of the Yellow Emperor. Medical books of later generations distinguish five types of gonorrhea: Stone (Shi), Labor (Lao), Qi, Blood (Xue), and Cloudy (Gao). The causes and treatments of various kinds of gonorrhea are similar and there is agreement among the various schools of Chinese medicine. The main cause is impaired Yang being unable to convert to Yin, leading to depressive Heat. It is said that in treating Stone gonorrhea one should first clear the Heat, then administer herbs to resolve Qi dysfunction.

To treat Blood gonorrhea, one should support Yang and allow Qi to freely ascend and descend, while consolidating Yuan Qi. Historically, the treatments of choice have been Zishen Wan (Pills to Assist Life (156)) with double the usual amount of Rougui (Cinnamon twig, ), Baitong Tang (White Penetrating Decoction (54)), and Huiyang Yin (Drink (64)) plus some necessary herbs and take effect.

The source of Cloudy gonorrhea is Yin Cold condensation, while Stone gonorrhea is due to simmering pathogenic Heat evil. It is a common mistake to consider Heat as the leading cause of gonorrhea; although Cloudy gonorrhea and Stone gonorrhea are similar syndromes, there are differences in their etiology.

Recently there have been frequent reports documenting the use of warming Yang methods to resolve urinary tract calculi. There are also claims that Kidney stones, which belong to Yin or a Yin organ, can be alleviated by warming Yang and nourishing the Kidney. For stones in the urethra and Bladder, which belong to Yang or a Yang organ, clearing Heat and Dampness will promote healing.

Wuling San (Powder of Five Ingredients (24)) with Guizhi added (Cinnamon twig, ) to resolve Qi dysfunction in the Bladder is the initial formula used in the treatment of Stone gonorrhea. One of our case studies shows that after administering two doses of this formula to one patient, he was able to pass a small amount of urine, and yet the pain remained. The second formula was based on Huiyang Yin (Drink (64)) plus Guizhi (Cinnamon twig, ), Xixin (Chinese wild ginger or Asarum, ), Wuzhuyu (Evodia fruit, ), and Fuzi (Prepared aconite root, ) dosage to 50 g. After two doses, the patient began to notice a slight alleviation in symptoms. The dosage was increased with Aconite tablets added to the higher dosage. After discharging urine, the patient reported that much pain had arisen. Then he was advised to drink more water and to urinate with force. Stones, one as large as a mung bean, were excreted, and the patient felt free urination, with the pain alleviated. He continued to take this prescription. With each subsequent urination, the urine appeared less turbid, with decreasing amounts of sandy sediment. The formula was continued with until the urine could finally be cleared without waste and without pain.

Painful Swollen Knees （膝肿痛）

Knee swelling and pain may be caused by exogenous pathogens or the deficiency of Yang or Yin. If the knee pain and swelling are caused by exogenous pathogens, appropriate treatment should cause diaphoresis and move out water. Therefore, Xiao Qinglong Tang (Decoction of Minor Blue Dragon Combination (20)), or Mahuang Tang (Ephedra Decoction,  (151)) plus Fuling (Poria, ), Zexie (Alismatis rhizome, ) and similar herbs are suitable. If the patient’s knees have gradually become sore, it may be due to the attack of exterior pathogenic Cold and Dampness on the body, closing the meridians and blocking their function. There are many empty spaces around the knee, making this area very vulnerable to the invasion of pathogenic factors, the obstruction of Qi circulation, and the accumulation of Dampness and Heat, all of which can contribute to localized swelling and pain.

Knee pain and swelling may be caused by Yang deficiency or the patient’s constitutional weakness. Thus, pathogenic Yin Cold and/or Dampness can breach the body and accumulate in the knee joints, then flow further downward. If a person’s Stomach-Yang is inadequate and he or she drinks excessive amounts of alcohol, pathogenic Dampness will flow into the joints, blocking Qi circulation. In cases where swelling occurs slowly and there is little pain with no color change in the surrounding skin, Yang is weak and cannot convert to Yin. Effective treatment must warm and consolidate Spleen- and Stomach-Yang, for example with the use of Huiyang Yin (Drink (64)) with additional Guizhi (Cinnamon twig, ), Fuling (Poria, ), Yizhiren (Bitter cardamom, ), Buguzhi (Psoralea fruit, ), Xiaohuixiang (Fennel fruit, ), and Sharen (Amomum fruit, ), Administering multiple doses will gradually induce healing. However, this disorder tends to require longer term treatment and one must manage the patient’s expectations. Encourage the patient to continue taking the herbs until healing is complete — there is no quick remedy.

Another cause of knee pain and swelling is Yin deficiency. The patient’s constitution will be strong, but by overindulging in fatty foods or wine, pathogenic Dampness and Heat flow into the joints of the lower body. As Qi circulation becomes sluggish, Heat accumulates, toxicity develops, and swelling occurs. The treatment should promote Yin and clear Heat, promote Qi circulation, and dispel Dampness. Examples of effective herbal treatment are Huanglian Ejiao Tang (Decoction of Donkey Hide Gelatin and Coptis Combination,  (92)) with added Fuling (Poria, ) and Baizhu (White Atractylodes, ) and Danggui Buxue Tang (Danggui, or Chinese Angelica, Decoction to Tonify Blood (87)) plus Qinjiu (Chinese gentian, ), Qianghuo (Notopterygium root, ), Sanggen (Mulberry root, ), Xiangfu (Cyperus tuber, ), and Maiya (Germinated barley, ). Since these suggested treatment plans are based only on Yin and Yang, one’s clinical treatment must be specific to each patient’s particular situation.

Conventional Western Medicine would recognize such lingering joint pain and swelling as rheumatoid arthritis or osteoarthritis. TCM would term the disorder a Bi Syndrome and treat it with Hot herbs. One of our case studies concerns a patient who suffered from this disease for 18 years. He had tried many types of Western medication, yet none provided relief. According to his file, his symptoms were described as “…. both wrists are stiff and cannot bend, one elbow and both ankles have ankylosed, knee pain has intensified, and other joints now experience more frequent pain than in the past. The pain is more serious when it rains. Gradually the muscles of all the limbs have atrophied.” Both arms and leg muscles shrank. According to our analysis of the case, the knee swelling and pain, the muscular atrophy, and the resulting functional impairment were originally caused by exposure to strongly blowing winds and the leaching of heavy rains. The joint pain and swelling gradually developed into a rigid ankylosis to the point where the patient had become bedridden.

We began treatment by administering a decoction of 250 g of Gancao (Licorice, ).The patient was instructed to drink the decoction in one dose for the purpose of eliminating drug toxicity resulting from nearly two decades of medication. The next step was to wash the joints of the limbs with a decoction of Shengjiang (Fresh ginger) and Congbai (Green onion). Then the patient was given five doses of Mahuang Fuzi Xixin Tang (Ephedra, Asarum, Aconite, ,Decoction (155)) plus 50 g each of Fuzi (Aconite, ) Slices and Chuan Wu (Sichuan aconite, ), and the knee pain and swelling were reduced. Basic physical therapy was initiated: the patient was helped out of bed and encouraged to stand. By leaning on tables and chairs, he was gradually able to support his own body weight. Subsequently, very Pungent and Hot herbs were used to both protect the Middle Jiao and recover Yang. A trace of Maqianzi (Nux vomica seed, ) was introduced to open the collaterals and stop pain, eliminate swelling, dissolve accumulations of pathogens, and regulate the tendons to stop spasms. After five more days of treatment, the patient defecated stools with bubbly mucus. Thereafter, he experienced a significant alleviation of symptoms. His physical therapy was continued and was made more challenging. He began to walk in his home by supporting himself with the help of the walls and furniture. The next herbal treatment consisted of taking Lizhong Tang (95) and combined with Angelica ) Buxue Tang (87) on alternating days for five days. At this point the patient’s symptoms were reduced and he was no longer in constant pain. After four months, he was able to regain much of his former mobility: he could get out of bed and walk unassisted, and even began to ride his bicycle. Finally, after three more months of the herbal formula and diligent exercise, the patient was able to return to work.

Beriberi （脚气）

Beriberi can manifest in many ways: pain may rise upward from the Lower Jiao or may remain in the Lower Jiao only; it may occur in the wake of serious illness, with the feet feeling Heat and pain — but showing no change in skin color — in the afternoon, which is relieved by the following morning; it may be more intense on overcast days.

All beriberi syndromes are, at root, Yang deficiency: Weak Yang cannot overwhelm Yin pathogens, and the Qi of the feet rises, causing pain. If the Yin pathogen rises to encroach upon the Heart, the patient can die. Treatment should recover and restore Yang. HuiyangYin (Drink (64)), plus Sharen (Amomum fruit, ), Buguzhi (Psoralea fruit, ), Yizhiren (Bitter cardamom, ), Gusuibu (Drynaria root, ), and Baitong Tang (White Penetrating Decoction (54)) are suitable.

Beriberi with adverse Qi can cause coldness in the limbs, or if it occurs with diarrhea, the Spleen and Kidney suffer from deficiency Cold. In these cases, one should modify the basic formula Sini Tang (Decoction to Treat Cold Limbs (48)) to fit the patient’s specific presentation. This is also consistent with the theory that Yang deficiency is resolved with warming herbs that nourish Yang.

If beriberi is caused by Damp-Heat gathered in the Lower Jiao, Wuling San (Powder of Five Ingredients with Poria (24)) or Jiming San (Powder (91)) will disperse Heat and drive out Dampness. It is important to understand that if the swelling and pain are excruciating, it is due to the vital Qi escaping through the feet. Only by using large doses of herbs that recover Yang can such patients be saved. It is paramount to be able to distinguish this condition from less serious forms of beriberi. Accurate diagnosis must be performed and suitable prescriptions must be used. It is not enough to simply copy our predecessors’ good work.

Asthma （喘证）

Asthma has many names in Chinese medicine: Chuan Xi (dyspnea), Chuan Cu (hasty panting), Chuan Hu (Asthma with sound), Chuan Ni (reverse wheezing), Shang Qi (rebellious Qi breathing), Duan Qi (shortness of breath). However, it is important to note that asthma is not a disease, but a symptom. Asthma can occur in many diseases, so diagnosis and treatment can be rather complicated.

Generally, asthma is divided into two main types: “solid” or substantial, when the attack is actually occurring, and “deficient” or insubstantial, for the periods between attacks. Solid asthma can be sub-divided into Wind-Cold and Fire pathogens. Deficient asthma can be sub-divided into Yang deficiency and Yin deficiency.

Five asthma patients will be described here. The first and second are afflicted with pathogenic Wind-Cold, which is sometimes the result of the misuse of purgative herbs. It is correct to disperse the pathogen rather than attempt to purge it downward from the body.

The third case is caused by pathogenic Heat and Fire. In this instance, it is appropriate to clear the Heat and Fire by purging via the stools. The fourth case is of Phlegm-Damp flooding, so it is desirable to warm the Middle Jiao to dispel the Phlegm and Dampness. The final case is a very serious one, related to an imbalance of Yang and Yin where Yang-Qi is almost exhausted. Very Hot herbs must be administered in this emergency situation. Even with the best medical care, not all patients can recover from this syndrome.

Asthma that is caused by the invasion of pathogenic Wind and Cold effectively obstructs the free flow of Qi in the Lung. The patient will have a fever, headache, and body pain. (These are points of differentiation from asthma due to vital Qi exhaustion where there is fever without headache and body pain, the lips have a greenish cast, and the pulse is forceful.) In this case, one must dispel the Wind and Cold pathogens. Mahuang Tang (Ephedra Decoction,  (151)), or Dingchuan Tang (Decoction to Relieve Asthma (98)), and Xiao Qinglong Tang (Decoction of Minor Blue Dragon Combination (20)) are capable of resolving this condition.

Caused by the misuse of stool-purging formulas for Taiyang Meridian syndromes, the next type of asthma is complicated, with an unresolved pathogen residing in the Taiyang Meridian. Congestion decreases the effectiveness of exhalation. The appropriate treatment is to release the pathogenic Cold through the striae of skin. However, since severe fever is one of the initial symptoms, many doctors will incorrectly assume that there is strong Fire in the body and prescribe purgative herbs. Unfortunately, the pathogen is driven deeper into the body and it becomes much more difficult to release it. The patient will then feel a knot in the chest which obstructs his or her breathing and asthma is triggered. The correct treatment will disperse the pathogen from the body. Two suitable formulas are Guizhi Tang (Cinnamon Twig Decoction (118)) minus the Baishao (White peony, ) and double the usual amount of Guizhi (Cinnamon twig) and Gegen Tang (Pueraria, , Decoction (163)) with additional Gancao (Licorice, ), Shengjiang (Fresh ginger, ), and Gegen (Pueraria, ).

In cases where Stomach-Fire damages the Lung, asthma happens quickly. The Stomach may accumulate Heat associated with attack by an external pathogen or endogenously via Stomach stagnation. Once Heat becomes excessive, it cannot be contained within the Stomach and is forced into the Lung, disturbing the flow of Qi and causing respiratory disorders. The patient will be very thirsty for cold beverages and will have halitosis, coarse respiration, and retention of urine and stools. In this case, it is appropriate to purge Heat from the body via the stools. Depending on the individual, Da Chengqi Tang (Drastic Purgative Decoction (18)), Xiao Chengqi Tang (Minor Purgative Decoction (21)), or Baihu Tang (White Tiger Decoction (55)) may be suitable.

The fourth type of asthma begins when the Middle Jiao is unable to properly manage its transportation and transformation functions. Stagnated Water and Dampness accumulate and transform into Phlegm-Dampness while the body’s Qi declines. The pathogens gradually grow and block the airways, setting off respiratory dysfunction in the form of asthma. The patient will have a depressed appetite, significant amounts of sputum and phlegm, and a sore throat. Treatment must address the root cause by warming the Middle Jiao and dispelling Phlegm-Damp. Guiling Zhugan Tang (Decoction (120)) and Lizhong Tang (Regulate the Middle Jiao Decoction (149)) with added Sharen (Amomum fruit, ), Banxia (Pinellia tuber, ), and Fuling (Poria, ) have this capability.

The fifth and final type of asthma is caused by the escape of Yuan-Qi from the body. The patient will have weak Yang and strong Yin, which will force out the Yang. As the Yin and Yang begin to separate, respiration is immediately affected. The patient’s complexion will be white and the lips green. The tongue will be dark and without spirit. Essentially, the balance of Yin and Yang is so disrupted that the patient is almost pure Yin. A raging fever and spontaneous sweating may break out. This is an extreme emergency and treatment must quickly recover and restore the Yang. Sini + Wuzhuyu Tang (Decoction with Evodia Added to Treat Cold Limbs,  (85)) plus Dingxiang (Cloves, ), Hujiao (Black pepper, ), and Sharen (Amomum fruit, ) is a useful formula, but it can save only about 10–20% of patients with this extreme type of asthma.

When confronted with a patient suffering from asthma, one must proceed with caution. It is necessary to keep in mind that asthma is a symptom and not a disease. Then one must carefully review all aspects of the presenting illness and give special attention to the state of the patient’s Yin and Yang. A precise diagnosis and a comprehensive treatment strategy will avoid the pitfalls of simply treating only the asthma. One must not simply react by treating asthma with typical remedies such as Suzi Jiangqi Tang (Decoction of Perilla Seed Combination to Descend Qi (81)) or Mahuang Dingchuan Tang (Ephedra Asthma Decoction (154)). It is necessary to look deeper so that the true nature of the illness is identified and resolved.

Diseases with Excessive Perspiration （汗证）

Hyperhidrosis, or excessive perspiration, can be caused by Yang or Yin deficiency, injury of Wei Qi by Wind, or Yangming (Stomach) with excessive Heat.

If it is due to Yang deficiency, the patient may lack intrinsic Yang or spend too much energy thinking. If there is an excessive loss of Heart-Yang, the Heart can no longer adequately control perspiration. If Spleen-Yang declines, it is unable to control the sweat within Blood in the Spleen and Stomach; if the Yang Qi of the Liver and Kidney declines, it will not be possible to control the Blood. Yang Qi failure of the Upper, Middle, and Lower Jiao can cause sweating. The term “Yang deficient” is used for all patients who are so fatigued as to prefer lying down and avoid talking. The right treatment is to support Yang, because only Yang Qi can control Yin and secure Yang within the body so that it does not escape. Representative formulas that accomplish this are Sancai Fengsui Dan (Pills for Promoting Curing (106)), Qianyang Dan (Submerge the Yang Pellets (168)), Huangqi Jianzhong Tang (Decoction with Astragalus to Restore Normal Function to the Middle Jiao (146)), and others.

Should Yin deficiency be the cause, night sweats, blood loss, and depletion of Essence Qi occur. Without sufficient Yin, there is loss of these vital elements. Treatment must, therefore, nourish Blood. Herbal formulas such as Danggui Liuhuang Tang (Chinese Angelica Root and Six Yellows Decoction (66)), and Sancai Fengsui Dan (Pills for Promoting Curing (106)) with a large dose of Huangbo (Phellodendron bark) and Digupi (Dan Parker Cortex) are recommended.

Night sweats also occur when Yang is driven to the exterior by Yin excess in the interior. The right treatment supports Yang so that it will return to the interior and become stable there. Typical formulas are Baitong Tang (White Penetrating Decoction (54)) and Bukanyili Dan (89). Patients with Yin deficiency show Spirit, extreme thirst, and a desire for cold beverages. In contrast, patients with excess Yin or Yang deficiency will be without Spirit, have no desire to speak, and either have no thirst or want only hot beverages.

When the Taiyang meridian is damaged by Wind, the striae of the superficial muscles relax and sweating occurs. Zhongjing’s Guizhi Tang (Decoction of Cinnamon Twig Combination (118)) is the appropriate formula to use in this case.

Yangming Heat caused by Stomach-Fire steams Water, causing drenching perspiration, a deep thirst for cold beverages, cessation of urination and bowel movement, irritability, a sensation of bodily lightness, coarse respiration, and halitosis. Treatment must clear the Stomach-Heat with formulas such as Renshen Baihu Tang (5) and Da Chengqi Tang (Drastic Purgative Decoction (18)) or Xiao Chengqi Tang (Minor Purgative Decoction (21)).

If “Yellow Sweat,” which discolors clothing and bedding, occurs, it is due to the Spleen and Stomach losing the ability to hold Qi. Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (149)) is the correct formula for this disorder.

When pathogenic sweating is confined to the upper part of the body, there is exhaustion of Yang or Heat in the Qi. When it occurs in the lower part of the body, Yin is escaping from below or there is Fire in the Blood. Thus, it is possible to readily recognize whether the root of the illness is Yin or Yang.

It is crucial to recognize serious illnesses, which are often fatal. These cases manifest with unusual types of perspiration: bead-like sweat, oily sweat, and rain-like sweat. Zhongjing’s Huiyang Tang (64) is the emergency formula to use. However, even with the best treatment, only 40–50% of patients may recover completely.

It is highly regrettable that many common doctors do not investigate fully and therefore cannot differentiate between Yin and Yang symptoms. When they see perspiration, they automatically but incorrectly treat with herbs such as Mahuang (Ephedra root), Sangye (Mulberry leaf), Fuxiaomai (Light wheat), Renshen (Ginseng), or Huangqi (stilbazolium). These herbs may have no effect at all or may even cause the patient harm.

So many doctors are afraid of using the very useful herb Ginger in its many forms, including Weijiang (Roasted ginger). This reticence, in combination with mistaking Yin for Yang, does patients a disservice. There was a case where the patient had caught a cold during the night and began sweating profusely, then suffered a collapse. In the morning, he was brought in with a headache, fever, aversion to wind, and non-stop sweating. He was successfully treated with three formulas, all of which contained Ginger. The first formula was Guizhi Tang (Decoction of Cinnamon Twig Combination (118)), followed by Huangqi Jianzhong Tang (Decoction with Astragalus to Restore Normal Function to the Middle Jiao (146)) and Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) to boost Spleen Yang. The patient was given only two doses of each formula and recovered completely.

Poor Memory （健忘）

Poor memory can be due to Yang or Yin deficiency, both of which lower one’s Spirit.

The population which suffers most from this disorder is the elderly. It is unusual to see an adolescent patient. We should strengthen communication between Yin and Yang. Diligent practice of Qigong exercises is recommended to reduce anxiety and worry, so as to quiet the mind and maintain emotional stability. Memory is improved and forgetfulness may disappear altogether.

If a patient’s memory is starting to dim, there are many formulas that can be used to support and maintain mental function. Baitong Tang (White Penetrating Decoction (54)) or Guizhi Longmu San (Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell (119)), Sancai Fengsui Dan (Pills for Promoting Cure (13)), Qianyang Dan (Submerge the Yang Pellets (168), and similar formulas should be used for a long period of time. It is not recommended to use Tianwang Buxin Dan (The Heavenly King’s Tonic Pills (27)), Ningshen Wan (61), and Dingzhi Dan (Settle the Emotions Pills (97)) with Renshen (Ginseng), Dazao (Jujube), Yuanzhi (Polygala root), and Zhusha (Cinnabar).

Palpitations and Fearfulness （惊悸）

Fright and palpitations may mean that the Heart is either disturbed or beating improperly. These two conditions arise from the same source. Fright may be due to a weakened, agitated Spirit, and palpitations brought on through interference from Yin’s mismanagement of Water vapor in the body. To resolve the sensation of fright, support Yang with Baitong Tang (White Penetrating Decoction (54)) or Bukanyili Dan (89); to release palpitations, accelerate water circulation with Guiling Shugan Tang (Fuling, Guizhi, Baizhu, Zhigancao (120)) or Zexie San (Alismatis Powder (100)). The least favorable recommendation would be Shizao Tang (Decoction of Ten-Jujube Combination (3)) to rid the body of Water. If the condition is caused by pathogenic Cold, it remains valid to follow Zhang Zhongjing’s method of using Guizhi Gancao Tang (Decoction of Cinnamon Twig and Licorice Combination), Zhigancao Tang (Decoction of Baked Licorice Combination (101)), and Sini Tang (Decoction to Treat Cold Limbs (48)) to treat the root cause.

If the condition is due to Heart-Blood deficiency, Yangxin Tang and Yangrong Tang should be used. When Heart-Qi deficiency timidity presents, the patient is advised to take Wendan Tang (Warm the Gall Bladder Decoction) or Xiao Jianzhong Tang (23). If there is evidence of Phlegm and Qi stagnation, Fuling Yin (47) or Siqi Jiawei Tang can be used.

Western medicine refers to palpitations due to fright or severe palpitations as cardiac disease, cardiac neurosis, and arrhythmia. It is possible to modify the above treatments based on this information.

There was a case where the patient was suffering from palpitations, fright, and suspicion and fear of others. His complexion had a dark-green tinge and he was lacking Spirit. The palpitations occurred with arrhythmia and his heartbeat was sometimes as high as 120 beats per minute. In addition, his appetite was reduced, he felt cold, and his mouth was dry but he felt no inclination to drink. The treatment was to use Bukanyili Dan (89) to benefit the connection between Heart and Kidney. The patient calmed down slightly. The next formula, Baitong Tang, was used, focusing on supporting Yang and encouraging Kidney-Water to rise up to meet the Heart, allowing improved Yin–Yang communication or intersection. Only 10 doses were used and the patient recovered.

Insomnia （失眠）

Insomnia has four main causes: invasion of the body by exogenous pathogenic factors, Yang deficiency, heavy diarrhea, and sadness or over-thinking.

When exogenous pathogenic factors invade the body, they may cause fever, pain, and systemic diseases which can disturb the Heart and Spirit, resulting in insomnia. The underlying reason must be determined for the particular situation, and then select the correct treatment. For general sweating, use Gegan Tang (Pueraria Decoction (163)); to clear Heat, use Baihu Tang (White Tiger Decoction (5)); to eliminate Qi stagnation, use Wuling San (Five-Ingredient Powder with Poria (24)). In cases of energy deficiency stagnation, Xiao Jianzhong Tang (Minor Decoction to Restore Normal Function to the Middle Jiao (23)) is appropriate; to induce vomiting to discharge Phlegm, Guadi San (Melon Pedicle Powder) can be used. Da Chengqi Tang (Drastic Purgative Decoction (18)) discharges Heat accumulation downward, while Ganjiang Fuzi Tang (Dried Ginger and Prepared Aconite Decoction) resolves daytime irritability and sleepiness occurring without the sensation of significant bodily Heat. In cases where pathogenic Cold causes a high fever, Huanglian Jiedu Tang (Decoction of Coptis Combination for Detoxification (143)) is suitable, and for Blood stagnation Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used. When the pathogenic factor has been resolved, the patient will naturally sleep soundly.

If insomnia is due to Yang deficiency, where the patient is without Spirit, has shortness of breath, and is irritable, Baitong Tang (White Penetrating Decoction (54)) and Bukanyili Dan (89) are used.

If heavy diarrhea is the cause of insomnia, there will be considerable injury to the Yang of the viscera. In this case, it is appropriate to warm the interior with formulas such as Wuzhuyu Tang (Decoction of Evodia Fruit Combination (89)) and Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (149)).

Sometimes insomnia is caused by sadness, or thinking or worrying too much. When this is the case, the patient should be encouraged to seek psychotherapy, and provide support with formulas such as Guipi Tang (Decoction to Strengthen the Spleen and Heart (59)) and Juyu Wan (169). This is much more effective than treating the symptom, employing formulas like Suanzaoren Tang or Yangxi Tang, which simply force the patient to sleep. For Heart- and Kidney-Yang deficiency, Bukanyili Dan (89) was used along with Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (149)) and Guizhi Muli Tang plus Fuzi (Prepared aconite root) to obtain satisfactory results.

Dysentery （痢证）

Dysentery syndrome is a gastrointestinal infectious disease exhibiting clinical symptoms such as abdominal pain, diarrhea, tenesmus, and bloody stools. Dysentery goes by several names in TCM: white diarrhea, red dysentery, and autumn dysentery. TCM books referred to it as “intestinal bleach” or “lag.” Even the ancient TCM scholars were aware of the seasonal and infectious characteristics of dysentery.

The treatment of dysentery varies, depending on whether it is an acute or chronic case. Dysentery typically begins with bloody stools due to stagnation of Heat and Damp-Heat. To clear Dampness, Wuling San (Five-Ingredient Powder with Poria (24)) is used, while Daochi San (Powder for Conducting the Fire Downward (73)), Gegen Huanglian Huangqin Tang (Pueraria, Scutellaria, and Coptis Root Decoction (164)) and Baitouweng Tang (Pulsatilla Decoction (56)) clear Heat. Zhishi Daozhi Wan (Immature Bitter Orange Pills to Guide Out Stagnation) and Da Chengqi Tang (Major Order the Qi Decoction (18)) are commonly used for food stagnation and Shaoyao Tang (Peony Decoction) and Dao Qi Tang (Conduct the Qi Decoction) can adjust Qi and Blood. Therefore, in the early acute stage of dysentery, the key treatment principles are clearing and purgation. Tonification is inappropriate at this time.

When dysentery lingers and becomes a chronic disease, the treatment principle changes to reinforcement and tonification to best resolve the root cause. Lizhong Tang (Regulate the Middle Jiao Decoction (149)), Buzhong Yiqi Tang (Decoction to Reinforce the Middle Jiao and Tonify Qi (88)), and Xiangsha Liujunzi Tang (Six Gentlemen Decoction with Aucklandia and Amomum (110)) are often used. To tonify the Kidney, Jingui Shenqi Wan (Kidney Qi pills from the Golden Cabinet) or Sishen Wan (Pills of Four Miraculous Ingredients) are recommended. In cases of seasonal dysentery, which may belong to Heat-Toxin damage syndromes, Ganjiang Erdong Tang (Dried Ginger, Asparagus and Ophiopogon Combination Decoction (43)), Renshen Baidu San (Ginseng Powder to Overcome Pathogenic Influences (6)), Gegen Huanglian Huangqin Tang (Pueraria, Scutellaria, and Coptis Root Decoction (164)) are used.

Dr. Zheng reasoned that, in cases of deficiency and Coldness, Fuzi Lizhong Tang (95) is suitable, except for patients with the great heat.

There is the example of a patient with chronic dysentery. He had been suffering for half a year, from summer to winter, with five or six daily bowel movements of runny stools. Greasy or cold food caused abdominal pain and diarrhea. The patient had a pale complexion and weak limbs. He was tired and lacking Spirit; his tongue was pale and his pulse sinking and thready. He was treated with Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) and recovered after 16 doses were taken.

Hiccups （呃逆）

Hiccups, with their short and frequent sound, are caused by involuntary contraction of the diaphragm. They may be due to Yang or Yin deficiency, or to near exhaustion of Essence Qi. Hiccups can be classified as either warm or cold hiccups, and treated with Da Chengqi Tang (18) or Xiao Chengqi Tang (21). Cold hiccups will manifest with numerous Yin symptoms, such as heavy sweating, cyanotic lips, or abdominal pain or testis shrinkage, or blue–black nails, splitting headache, swollen canthi and ears, sore throat, and so on. These emergency conditions must be dealt with by supporting Yang immediately with Wuzhu Sini Tang (Frigid Extremities Decoction with Added Evodia (85)) and Baitong Tang (White Penetrating Decoction (54). In spite of these emergency measures, only 20–30% those afflicted may survive.

Nausea （反胃）

Nausea can be classified as either Yin or Yang deficiency. It may look similar to dysphagia but there are tell-tale differences. The patient with dysphagia will be unable to either eat food or vomit; there is a blockage at the diaphragm and nothing can pass. In contrast, the patient with nausea can usually ingest food but will often, in a few hours after eating, vomit the contents of the Stomach. Chen Xiuyuan suggested the use of Wuzhuyu (Evodia fruit) or Dufu and Wan Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)), Liujunzi Tang (36) plus Ganjiang (Dried ginger) and Fuzi (prepared aconite root) to support the flagging Yang energy.

However, Zhang Zhongjing’s Sini Tang (Decoction to Treat Cold Limbs (48)) is stronger; therefore one can safely use Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) plus Wuzhuyu (Evodia fruit) and Banxia (Pinellia tuber).

As for Yin deficiency nausea, one can use Da Chengqi Tang (Drastic Purgative Decoction (18)) and Xiao Chengqi Tang (Minor Purgative Decoction (21)).

Manic-Depressive Psychosis （颠狂）

The medical experts of ancient times believed that the three epileptic disorders of manic-depressive psychosis were illnesses of the Heart Meridian (involving the cranial nerve system). Its symptoms are different, but are quite similar to those of epilepsy and various psychiatric illnesses. Modern research notes a high comorbidity of psychiatric disorders and epilepsy. The Han Dynasty’s Nan Jing delineates the differences between disproportional Yang and Yin influences on mental health. When Yang is excessively strong, mental illness takes the form of mania. On the other hand, when Yin is stronger, the disorder takes on the decidedly calmer condition of depression.

The treatment for the depressive should supply life Qi and clear sputum; for the manic it should eliminate the Fire. Baitong, Zhizi Douchi Tang (Gardenia and Prepared Soybean Decoction) could cure the Yin–Yang epileptic; Da Chengqi Tang (18) and Xiao Chengqi Tang (21) specifically in the capture of the manic. There was also successful experience with Zhibao pills. TCM predecessors were well aware that this disease could be treated with Guipi Tang or Yangxin Tang (Heart-Nourishing Decoction) with various additions and subtractions that effectively soothe the patient’s nerves. Xiexin Tang and Liangge San could clear the Fire. Ancient doctors and scholars have long recognized the psychosocial causes of this disease.

TCM has noted: for the sake of those who have hope of blossoming into good health, “one must understand the disease and its treatment, and be open to collaborating with other health professionals so as to maximize the validity of the treatment.” As a result of clinical experience of infections, wrong treatment or diet and drug poisoning, and fetal exposure to drugs and alcohol, our predecessors also dealt with appropriate treatment for every symptom.

Distension or Fullness （胀满）

Many diseases are able to produce this symptom. Lingshu of Neijing (Miraculous Pivot of the Inner Canon of the Yellow Emperor) points out this illness. Many books have described the manifestations of distension such as tumescence of the skin, bloating, edema, flatulence, extravasation of blood, and parasitic colonization, but all have separated the manifestations into two categories: Solid or Void. Dr. Zheng believes that both are due to internal injury or the escape of Yuan Qi, resulting in the stagnation of circulation. Treatment should support Yang Qi and release stagnation with formulas such as Zhufu Tang (44), Jiangfu Tang (Ginger and Aconite Decoction (113)), Zhenwu Tang (130), Guiling Zhugan Tang (120), Fuzi Lizhong Tang (95), Mahuang Fuzi Xixin Tang (Ephedra, Asarum, Aconite Decoction (155)), Fuzi Gancao Tang (Decoction of Licorice Combination with Aconite (94)), and so on.

In cases of rapid onset of Heat or Solid tumescence with constipation, reddish urine, a red complexion, coarse respiration, and a slippery but strong pulse, do not give the above prescriptions. Instead, use Houpo Qiwu Tang (Seven-Substance Decoction with Magnolia Bark (105)) or Houpo Sanwu Tang (Three-Substance Decoction with Magnolia Bark) appropriately. Liver and Spleen pathology, such as tumors or lesions, may cause tumescence and ascites. This can present as a discrete area of distension on the abdomen, and therefore one must be especially careful when diagnosing this situation.

One patient had a large, chronically distended abdomen, especially in the area 1 inch above the umbilicus, which was accompanied by genital shrinkage. He had been sick for several years, and no Western drug had provided relief. He experienced chills, had little appetite, and was unable to work. These symptoms added up to a diagnosis of Cold stagnation. Treatment strongly supported Yang. The first formula was four large doses of Sini Tang (Decoction to Treat Cold Limbs (48)) combined with Rougui (Cinnamon bark), followed by four doses of Danggui Sini Tang (Decoction of Chinese Angelica Combination to Treat Cold Limbs) with added Wuzhuyu (Evodia fruit), Ganjiang (Dried ginger) and Fuzi (Prepared aconite root). Next, four doses of modified Guizhi Tang (omitting Shaoyao but adding Mahuang, Xixin, and Fuzi) were given and, finally, Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)). The patient recovered his health with this combination of formulas in this order.

Another clinical example of distension presented with an even larger abdomen. The patient had been unable to sit down properly because of the extreme distension. Numerous Western prescriptions had been tried but had been ineffective. The diagnosis was excessive Water stagnation. The treatment began with large doses of Wupi Tang with additional herbs to clear excessive Water. However, this caused even more solid distension, because Yang was unable to clean the Water (Yin) with food stagnation. Therefore, Sini Tang (48) was alternated plus Rougui (Cinnamon bark) to support Yang with Da Chengqi Tang (18) to move the stagnation of food. After two doses, the disease was alleviated.

Rehabilitation was supported with Dahuang Fuzi Xixin Tang (Decoction of Rhubarb, Aconite, and Asarum Combination) and Fuzi Lizhong Tang (95). As soon as the Yang was strong enough, Shizao Tang (Decoction of Ten-Jujube Combination) was used for strong downward purgation. After voiding and defecating a dozen times, the patient was understandably very tired, and Renshen Tang (Ginseng Decoction) was then administered. The following day, the swelling was completely resolved.

Infantile Convulsions （小儿抽掣，俗作惊风）

This condition is generally referred to as either acute or slow Infantile Convulsions. Dr. Zheng said that the former are caused by exogenous pathogens and the latter by internal injury. If it is an exogenous cause, depending on the symptoms as described by Zhang Zhongjing, one could use Guizhi Tang (Decoction of Cinnamon Twig Combination (118)), Mahuang Tang (Ephedra Decoction (151)), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction (140)), or Modified Daochi San (Powder for Conducting the Fire Downward (73)) plus Jingjie (Schizonepeta), Fangfeng (Ledebouriella root), Chantui (Cicada slough), and Fuling (Poria). In the case of internal injury, one must support the Yang with Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) plus Sharen (Amomum fruit), Banxia (Pinellia tuber) or Huiyang Yin (64), plus Sharen and Banxia. It is inadvisable to use herbs to dispel Wind.

However, others suggest using modified Dihuang Tang for children with both Yin and Yang deficiency. There was a pediatric case of slow Infantile Convulsions: the patient’s eyes pulled to one side and his mouth was askew, and convulsions occurred every 2 or 3 min. His complexion was bluish and dark, his hands cold, and his nose runny. Warm water was used to help him take Fuzi Lizhong Wan (95), in small but frequent doses. The child’s condition subsequently improved and his hands and feet warmed slightly. Fuzi Lizhong Tang was modified by adding Sharen (Amomum fruit), Banxia (Pinellia tuber), and Hupo (Amber), eight doses were administered, and he finally recovered. This clinical experience has helped us to successfully treat dozens of children with this disorder.

Stroke （中风）

The Inner Canon of Yellow Emperor and the Treatise on Febrile Diseases generally attribute stroke to two causes: outside and inside. Dr. Zheng said, “Where there is disease, there must first be deficiency inside.” Therefore, patients in a coma can present with the mouth drawn to one side and the gaze at an angle or otherwise misaligned, or with weakness in one half of the body, or with tics and twitches over the entire body. This is mainly caused by Yang deficiency, so it is necessary to supply the Yang first. The Inner Canon of Yellow Emperor states, “Of all the sources of illness, Wind is the first.” Heat typically causes obstruction and should therefore be cleared first; Cold can cause prostration, which must be remedied with warming immediately.

Obstruction must be unblocked. Sanhua Tang can open the interior, while Xuming Tang (Prolong Life Decoction) opens the exterior. Phlegm or saliva blockage can be relieved with Xiyan San or Ditan Tang (Scour Phlegm Decoction). Prostration can be overcome with nourishing formulas such as Shenfu Tang (Ginseng and Prepared Aconite Decoction) to firm up the Kidney, Zhenfu Tang for the Spleen, and Qifu Tang (Astragalus and Prepared Aconite Decoction) and Guifu Tang to consolidate Wei and Rong Qi.

There was a case involving a 60-year-old man who had suffered multiple strokes. He had been left with hemiplegia for more than two years. Western medication had proven ineffective. The patient’s symptoms were strong aversion to Cold, a sensation of coldness below the hips (as if he were soaking in cold water up to his knees), weakness of the legs that did not allow him to stand, a thick, white, greasy tongue coating, and a thin, thready pulse. Altogether, the symptoms indicated Yang deficiency with Yin Cold and excess Water. Ten doses of Sini Tang (48) were first administered, plus Guizhi and Baizhu (White Atractylodes). His symptoms were slightly reduced, allowing him to stand and even walk a few steps, but he felt strong pain. The treatment was continued with Mafuxixin Tang (Mahuang and Asarum Decoction (155)) plus Baitong Tang (White Penetrating Decoction (54)) for a week. The patient improved to the point where he could walk well in the room but still felt cold. Finally, Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) was administered plus Rougui (Cinnamon bark) and Lurong (Pilose antler) for another week, and the patient recovered.

41. Phlegm Obstruction （痰闭）

This section details Phlegm obstruction, one of several Phlegm syndromes. Phlegm does not always appear gradually with the decline of Yang, but may suddenly occur and become Cold. Due to Qi stagnation, Cold Phlegm may rise up and cause unconsciousness. Treatment should support Yang first and resolve Phlegm later. Jiangfu Tang (Ginger and Aconite Decoction (113)), Jiangguifuban Tang (112), and Zhenwu Tang (130) may be used, and so on.

There was a case in which a 70-year-old professor suddenly collapsed and became unconscious. His limbs could not move, his tongue stiffened, saliva ran from his mouth, and a noise issued from his throat. In this case, the diagnosis was more sputum-related than actual stroke, due to pathogenic invasion and to the patient’s water drinking habit, which encouraged the accumulation of Cold and Water. The treatment was to support Yang by administering large doses of Sini Tang (Decoction to Treat Cold Limbs (48)) plus Fuling (Poria), Banxia (Pinellia tuber), and Shengjiang (Fresh ginger). While this combination diminished some of the patient’s symptoms, it did not dislodge the plug of Cold sputum. (For patients who are debilitated, first provide two doses of Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) to improve the patient’s condition.) Panshi Tang was then used to dislodge the sputum. After vomiting of water and phlegm with foam for half of a spittoon, the patient was fatigued but felt a tremendous sense of relief. Fuzi Lizhong Tang (95) was then modified; removing Renshen (Ginseng) and adding Guizhi (Cinnamon twig), Fuling (Poria), and Banxia (Pinellia tuber), after eight doses, the sputum was significantly reduced. At this point, the patient was again able to speak and sit up in bed. His hands and feet regained function. Next, four doses of Ling Gui Zhu Gan Tang (Decoction of Poria, Cinnamon Twigs, White Atractylodes, and Licorice) with added Fuzi (Prepared aconite root), Fangji (Tetrandra root), and Banxia (Pinellia tuber) allowed the patient to walk indoors, using furniture for support. He was also able to read books again, but he continued to be afflicted with both headache and body pain. After that, two doses of Mahuang Fuzi Xixin Tang (Ephedra, Asarum, Aconite Decoction) were administered, and not only was his pain greatly reduced but his appetite increased as well. Ling Gui Zhu Gan Tang, Xiao Jianzhong Tang (Minor Decoction to Restore Normal Function to the Middle Jiao (23)), and Huangqi Jianzhong Tang (Decoction with Astragalus to Restore Normal Function to the Middle Jiao (146)) were given repeatedly. Treatment lasted nearly half a year, but by the end of that time the patient’s appetite had returned, he could walk outdoors, read books, and take care of himself. At that point, medication was no longer necessary and was stopped.

Fresh Breath Stopped by Food Obstruction （食闭）

This rare disease manifests sudden onset closure and collapse. It is the result of Qi closure. Dr. Zheng said that Qi shortage and decline in Qi transportation is due to Qi deficiency. He advised of the need to vomit the Phlegm, and then warm the Spleen. Shenqu (Medicated leaven), Maiya (Germinated barley), Binlang (Areca seed), and Shanzha (Hawthorn fruit) are used to clear the stagnated food, and Ganjiang (Dried ginger) and Fuzi (Prepared aconite root) are then administered to warm the digestive system.

Rectal Prolapse （脱肛）

Rectocele is usually caused by Yang decline in the Lower Jiao. The patient is typically someone who likes eating hot spicy food. He or she will present with reduced energy, little desire to talk, a low Spirit, and apathy with a pale face and dark lips. The appropriate treatment is to strengthen Spleen- and Kidney-Yang with formulas such as Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) with added Gegen (Pueraria), Huangqi Jianzhong Tang (Decoction with Astragalus to Restore Normal Function to the Middle Jiao (146)), and Buzhong Yiqi Tang (Decoction to Reinforce the Middle and Tonify Qi (88)), and so on.

If Heat is to blame for the formation of the rectocele, it is necessary to clear the Heat stagnation. Formulas for this purpose are Huanglian Jiedu Tang (Decoction of Coptis Combination for Detoxification (143)) and Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction (12)).

In clinical experience with rectocele patients, most are affected with Yang decline in the Lower Jiao. Thus, modified Buzhong Yiqi Tang (Decoction to Reinforce the Middle and Tonify Qi) — Shengjiang (Fresh ginger) is replaced by Paojiang (Baked ginger); Fuzi (Prepared aconite root) and Yingsuke (Poppy capsule) are added — was used for treatment and met with success.

As for women suffering from uterine prolapse, the reasons for Yang deficiency are the same as those for rectocele. The treatment is also the same.

In other cases, children who had suffered from rectocele for more than two years with symptoms such as recurrent diarrhea and cold feet, known as Spleen- and Stomach-Cold, showed a lack of real Yang. Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) with added Wuzhuyu (Evodia fruit), Shengma (Medicated leaven), Yingsuke (Poppy capsule), and Gegen (Pueraria) improved the condition, but the patients were still weak. We recommended standard Fuzi Lizhong Tang and Danggui Buxue Tang (Decoction with Chinese Angelica Combination to Tonify Blood (87)) for rehabilitation. The patients have benefited from this combination of formulas.

Another case involved a woman with an exceptionally large uterine prolapse, which began postpartum a decade ago. The immediate cause was catching a cold after passing by a river. Many prescriptions were tried but none were effective. The treatment was first using Sensu Yin (103) to clear exopathic Cold, followed by Fuzi Lizhong Tong (95) with additional Wuzhuyu (Evodia fruit) and Rougui (Cinnamon bark) to warm the Yang. After the patient took Buzhong Yiqi Tang (88) with added Yingsuke (Poppy capsule), most of the symptoms were mitigated, but we also continued with the original prescription plus Longgu (Dragon bone) and Muli (Oyster shell). Soon after finishing this protocol, the patient was able to return to work. Two years later, she was able to conceive, carry, and give birth to a baby girl.

Hemorrhoids （痔疮）

TCM understands all hemorrhoids as originating from the same source of Yin or Yang Fire, although Western medicine distinguishes two types (internal and external). Fire due to Yang, or usually, a preference for ginger wine and spicy food heats up the stomach, and burns all through the digestion, resulting in hemorrhoids at the anus.

While hemorrhoids and anal swelling are undoubtedly very painful, there is no mental decline, no changes in the appetite, but often there is a preference for cold beverages. Treatment specifically focuses on clearing gastrointestinal Heat with formulas such as Da Chengqi Tang or Xiao Chengqi Tang (Drastic Purgative Decoction (18); Minor Purgative Decoction (21)), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction (140)), and Gegen Qinlian Tang (Pueraria, Scutellaria, and Coptis Root Decoction (164)). Cases of blockage due to exogenous or endogenous pathogenic Dryness must be remedied with such formulas as Huanglian Yuzhuerjiao Tang (147), Qing Zao Tang (Clear Dryness Decoction (161)), and Ganjierdong Tang (Combination Asparagus and Ophiopogon Decoction (43)). If Yin Fire or excessive sexual activity is the root cause, Fuzi Lizhong Tang (95) plus Gegen (Pueraria), Qianyang Dan (Submerge the Yang Pellet (168)), Huiyang Yin (64), or Fengsui Dan (106) plus Gancao (Licorice) and Sharen (Amomum fruit) are recommended.

Two Turbidities （赤白浊）

The Two Turbidities, or Red Turbidity and White Turbidity, are urinary disorders. According to the practice of our TCM predecessors, the main characteristics are pain during urination, frequent urination, and pus discharging occasionally from the urethra. If the infected urine is mixed with blood, it is referred to as Red Turbidity; infected urine without blood is called White Turbidity.

For interior Cold, Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) is recommended for the purpose of tonifying both Kidney and Spleen. Xiangsha Liujunzi Tang (Six Gentlemen Decoction with Aucklandia and Amomum (110)) is especially beneficial for the Spleen. If the focus is supporting Kidney-Yang, Sini Tang (48) plus Rougui (Cinnamon bark), Buguzhi (Psoralea fruit), Yizhiren (Bitter or Black cardamom), Xianmao (Curculigo rhizome), and Roucongrong (Cistanche), or Bawei Wan plus Longgu (Dragon bone), Muli (Oyster shell), Guizhi (Cinnamon twig), and Fuzi (Prepared aconite root) are useful.

Blood Diseases （血症）

Blood diseases encompass all abnormal bleeding, such as from the nose, teeth, pores or ears, and as found in stools or urine. When abnormal bleeding is encountered, we must determine the waxing and waning, i.e. the surplus and shrinking, of Yin and Yang. According to the literature of TCM, pathogenesis develops when Blood no longer flows properly within, but escapes from, the vessels.

If the bleeding is severe, one must use a large dose of Paojiang Gancao Tang (42) plus (Charred human hair) to arrest it. In cases where the bleeding is not serious, it is appropriate to first identify the root cause and then apply the differential treatment.

Maculae （发斑）

Maculae may have an exogenous or endogenous cause. Exopathogens can attack the exterior, and then hide in the Yangming meridian, which is related to muscles. After a period of stagnation in which the pathogens produce more Heat and Toxins, maculae may suddenly burst out. They can range from itchy rashes to reddish dots, to peach-colored petallike spots of different colors and sizes. Accompanying symptoms are coarse respiration, an unpleasant taste in the mouth, feeling hot and preferring cold beverages, and a large and solid pulse, or body pains and difficult urination and defecation. This is known as exopathic Yang macula. With appropriate treatment such as Shengma Gegen Tang (Cimicifuga and Pueraria Decoction (32)), Juban Tang (114), Xiaoban Tang (136), or Huaban Tang (Transform Blotches Decoction (29)), this disorder can be overcome.

Internal injury includes improper diet or fungal infections (such as the yeast Rhodotorula). The patient’s symptoms may be lassitude, disinclination to talk, preference for lying down, lack of thirst and appetite, and mental lethargy; the maculae may feel hot but painless as they emerge, without interfering with the patient’s activity. It is also possible for the maculae to emerge with no sensation of Heat but to be arranged in patches of delicate colors, some with the color blue. This condition is due to Yang deficiency. The appropriate treatment focuses on supporting Yang with formulas such as Sancai Fengsui Dan (Pills for Promoting Curing (106)) and Huiyang Yin (64).

In one case, one of the patients had endured many years of ineffective treatment, including skin damage from scarring moxibustion. His body was covered in scars, disfiguring marks, and blue spots. His voice was frail, thus confirming the diagnosis of Yang deficiency. The treatment was to use Yanghe Tang (Yang Heartening Decoction) plus Fuzi (Prepared aconite root). The first dose faded the blemishes; four doses enabled his complete recovery.

Flaccidity of the Limbs （痿躄）

Flaccidity of the limbs is due to weakness of the body, particularly the lower limbs. Muscular weakness and atrophy may significantly impair one’s mobility. Because the Yangming meridian is the true resource of energy, it must be treated to resolve this disorder.

Proper treatment should rehabilitate the Yang. Large doses of Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction (42)), Shen Fu Tang (Ginseng and Prepared Aconite Decoction (102)), Qifu Tang (Astragalus and Prepared Aconite Decoction (80)), Guifu Tang (60), or Zhufu Tang (44) are typically employed.

Flaccidity cases will present with multiple deficiencies and therefore must be tonified. A patient who suffered from flaccidity of the limbs had not been able to get up for four years. However, after he took Bawei Wan and Shiquandabu Tang (All-Inclusive Great Tonifying Decoction (4)) continuously for three months, his illness was successfully resolved.

Another case involved a man who appeared able bodied if he was sitting but was incapable of standing (even to urinate) without support. First, four doses of Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction (42)) were administered to rehabilitate the Yang, and a slight improvement was noted. After four large doses of Fuzi Lizhong Tang (Decoction with Aconite to regulate the Middle Jiao (95)) plus Lujiaoshuang (Degelatinized deer antler) and Niuxi (Cyathula root), the patient was able to stand and, using the walls for support, walk about 20 steps. Thirty doses of Fuzi Lizhong Tang, plus Danggui Buxue Tang (Decoction with Chinese Angelica Combination to Tonify Blood (87)) added or together with Lujiaojiao (Deer antler gelatin), Rougui (Cinnamon bark), and Gouqizi (Wolfberry fruit) resolved the illness and the patient was once again able to stand and walk completely unaided.

Consumptive Diseases （虚劳）

People afflicted with consumptive diseases show a deficiency of Yang, an impairment of Yin–Yang communication, and Yin excess. Hectic fever and night sweats are also signs of true Yang deficiency. A common mistake made by many contemporary TCM practitioners is to identify this condition as a Yin deficiency and treat it with cold medications. This will only make the patient sicker.

Some patients cough and produce white sputum; their abdominal pain is accompanied by runny stools or diarrhea, i.e. Stomach-Yang is insufficient and the Spleen is very damp; they are lethargic and prefer lying down, they have little energy and prefer not to talk. All of these symptoms point to Yang deficiency; appropriate treatment supports Yang.

In one case, the consumptive patient had been coughing up blood for five years, and yet no effective treatment had been found. He had recently vomited large amounts of blood twice, and his situation had become critical. After a comprehensive analysis of the case, the illness was diagnosed as Yang deficiency and treated accordingly. He was given large doses of Sini Tang (Decoction to Treat Cold Limbs (48)) and Baitong Tang (54) with added Tongbian (infant’s urine) when he experienced hot flashes, and Fuling (Poria) with excessive Heat and Dampness. When he had received 10 doses, the bleeding suddenly increased.The blood looked stagnated by Heat and was dark in color. For this emergency, 2 large doses of Gancao Paojiang Tang (Licorice and Dried Ginger Decoction (42)) were administered to stop the bleeding. And 16 doses of Sini Tang plus Rougui (Cinnamon bark, ) were used to support the Kidney, and Shengjiang (Fresh ginger, ), Fuling (Poria, ), and Baizhu (White Atractylodes, ) to strengthen the Spleen, and, finally, all syndromes improved markedly. And then Fengsui Dan (106) and Qianyang Dan (Submerge the Yang Pellets (168)) were used to reduce the side effects of Jiang and Fuzi, and served to satisfy the Kidney, and gradually improved the patient’s condition. For rehabilitation Ling Gui Zhu Gan Tang (Decoction of Poria, Cinnamon Twigs, White Atractylodes, and Licorice) was used. Within three months, and after more than 40 doses of herbal medicine, the patient’s symptoms were alleviated to the extent that he could take part in household chores.

Syncope （厥证）

Syncope can be divided into two types, depending on whether it is a deficiency of Yang or Yin, namely, Yang Jue and Yin Jue.

Yang Jue is due to the entry of exogenous pathogens, which generate Heat in the Yang meridians. Yang energy is then lodged in the interior while Yin energy is forced to the exterior, making the limbs cold and altering the pulse so that it becomes as light as silk or even imperceptible. This creates a paradoxical situation in which the person exhibits pure Yin on the exterior but also has remarkably warm hands, concentrated urine, and reasonably good energy. Treatment must clear the interior Heat. Da Chengqi Tang or Xiao Chengqi Tang (Drastic Purgative Decoction (18); Minor Purgative Decoction (21)), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction (140)), and similar formulas are most useful.

Yin Jue is marked by Yang energy deficiency and Yin excess. When Yang is weak and the meridians are occluded, little if any Yang can reach the limbs. Thus the limbs become cold, and the person becomes fatigued and lethargic, preferring to lie down and avoid speaking. Treatment should support Yang with formulas such as Sini Tang (Decoction to Treat Cold Limbs (48)) and Huiyang Yin (64).

The above are emergency situations — critical times of life or death — and there is no room for error in identifying the syndrome. While one must be careful in differentiating Cold and Heat syndromes in general, these conditions do present with complicated paradoxical evidence, and so one must recognize the significance of deep Heat and deep Jue disease. To reiterate: when the exterior shows pure Yin symptoms, and the patient has very hot hands, concentrated urine, and good energy, suspect Yang Jue. Treat by clearing Heat with Baihu Tang (55) and purging Heat with Da Chengqi Tang or Xiao Chengqi Tang (18, 21) and Tiaowei Chengqi Tang (140). Approach patients with delirium and spontaneous sweating carefully — it is entirely possible that they are suffering from a Yang disease. These are not necessarily hallmarks of a Yin disease.

Delirium （谵语）

Delirium may also be divided into Yin and Yang types. It generally shows signs of high fever. Dr. Zheng put forward evidence of Yin delirium, i.e. “Fading and Murmuring,” due to Yin excess, Yang deficiency, and loss of consciousness. It is vital to assess the quality of the patient’s Spirit, and verify whether there is aversion to Cold or Heat, whether the mouth is closed or open, and whether the patient is utterly fatigued or has enough energy to keep the eyes open. So long as there are Yin symptoms, even a desire to drink cold water, it is only a case of less critical Heat produced by excess Yin. The treatment still prevails with returning and strengthening Yang, and it would be a mistake to use cold herbs.

Yang delirium starts with exogenous pathogens causing Heat to travel to and disturb the Heart. The Mind becomes clouded, and the person babbles nonsense, and has coarse respiration and halitosis. The eyes remain open, the body feels light with an aversion to Heat, and although the patient has insomnia the Spirit is not bad. In mild conditions, Daochi San (Powder for Conducting the Fire Downward (73)) plus Huanglian (Coptis root, ) can be used, but in serious cases Da Chengqi Tang and Xiao Chengqi Tang (Drastic Purgative Decoction (18); Minor Purgative Decoction (21)) or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction (12)) are recommended.

When presented with Yin evidence of delirium, do not focus excessively on fever, sweating, delirium, thirst, or the preference for cold drinks, but carefully assess the patient’s Spirit. If it is lacking, administer a large dose of Huiyang Yin (64) to resolve this problem.

There was a patient with delirium who presented with the eyes staring straight ahead, ice cold legs below the knees, and a deep, thin, and slow pulse. It was determined to be genuine Yang escaping from the upper body — a very dangerous situation. The first formula introduced was a large dose of Gui (zhi) Gan (Cao), (Gan) Jiang, (Da) Zao Xin Ma Fuzi Tang (155). There was no adverse reaction to this prescription, but also no favorable progress. The treatment was processed by adding Sini Tang (48) with Rougui (Cinnamon bark, ) and Tongbian (Infant’s urine) to the first formula. After four doses, the delirium diminished and the patient was able to eat small amounts of food. Continuing with four doses of Fuzi Lizhong Tang (Decoction with Aconite to Regulate the Middle Jiao (95)) plus Rougui (Cinnamon bark, ) and Hupo (Amber, ), all symptoms were greatly reduced, but the patient’s legs still felt cold below the knees. Next, Fuzi Lizhong Tang plus Longgu (Dragon bone), Muli (Oyster shell), and Guiban (Tortoise plastron) were administered to guide Yang back to the interior. Steamed pork heart with Zhuchensha (Cinnabar, ) was recommended for dietary therapy. To finish the basic recovery, it was added to the last formula. To consolidate the curative effect, Fuzi Lizhong Tang (95) plus Fushen (Poria spirit) was used in the rehabilitation stage.

Gynecology （妇科证）

Case study

A healthy and strong middle-aged woman normally had her period on time; however, on this occasion, as the period was approaching, she ate a large amount of watermelon to cool down. The cold closed the Qi channel of Rongwei, and her period did not come for 50 days. The treatment was to use Ma Fu Xixin Tang (155) to warm the menstruation and remove the Cold; it took effect with two doses. However, when the menstruation came, the bleeding did not stop. Based on that symptom, it could be that the vital energy is too weak and cannot contain or control the situation. Some cases occur because the Chong and Ren meridians have Heat and force the blood to flow irregularly. The others may be because of the vital Qi deficiency, vomiting, diarrhea, dissipation, too much sex, worrying too much, and so on; all can cause this problem.

The patient’s activities, living, tranquility, movements, and even pulse were all lacking energy and strength. The treatment for this symptom should be focused on warming up, consolidating, and strengthening, using formulas like Fuzi Lizhong (95), Huangqi Jianzhong (146), or Xiangsha Liujun (110). Some other cases occur because the Chong and Ren meridians have Heat, and the since the Heat is moving internally the blood has nowhere to hide. The patient’s activities, living, tranquility, movements, and even pulse are all full of energy and strength, and the treatment for this symptom should be focused on strengthening Yin and removing Heat, using formulas like Huanglian Xiexin Tang (144) or Shengdi Qian Lian Tang (58). We should really understand the Yin and Yang behind symptoms to provide the right treatments.

(1) Nonstop bleeding during menstruation

There are two different causes: one is vital Qi deficiency and the other is because of the Heat forcing blood to move irregularly. One should treat these two cases with different formulas. In one patient with an irregular period, the period cleaned for two-to-three days and then came again, and kept bleeding for seven-to-eight days or even two weeks. The patient’s face was pale, she looked tired and sleepy, she ate little, her pulse was thin and deep, and she was diagnosed with Yang Qi deficiency, and could not contain and control Yin blood. The treatment was to first use Paojiang  Gancao Tang with Zongtan  to stop the bleeding, then take four doses of Fuzi Lizhong Tang (95) consecutively (this stopped the bleeding), and finally take the original Danggui Buxue Tang (87) to enhance the result. The menstruation returned to normal four to five days after the treatment stopped.

(2) Menstruation with purple color and excessive lumps of blood

In the case of purple lump menstruation, many books say that it is because of too much Fire and too much Heat. The treatments usually are Liangxue Tang (139) and Shengdi Siwu (57) with Huangqian and Huanglian, etc. They can be referenced if the symptoms can be confirmed as Heat. If the symptoms do not show Heat, and the patient has coma, feels sleepy, and prefers lying down, with shortness of breath and being tired of speaking, an extreme lack of energy and spirit, and due to vital energy deficiency and blood stagnation, the Yang cannot dissolve the Yin, and the Yin coagulates, and so the color is purple and blocks are formed. One must not treat with a cooling formula and should warm and strengthen the vital energy or Yang Qi. The correct treatments should be Lizhong Tang (149), Gancao Ganjiang Tang (42), Jianzhong Tang (23), etc. In conclusion, even if everybody says that it is Fire, we should not dare to say that it is Fire right away; it all depends on whether the patient has strong vital energy spirit or not, and we will observe very carefully and then make the right diagnosis.

In the case of lack of vital energy or Yuan Qi causing purple lump menstruation, the patient usually shows a pale or dark face, lassitude and lack of Spirit, loss of appetite, loose stools, fear of cold, menstrual pain, and a thin pulse. These are symptoms of Yang deficiency and insufficient Fire, and can be treated with Fuzi Lizhong Tang (95) with Sharen and Xiangfu.

(3) Sparse menstruation with a light color

In the case of sparse menstruation with a light color, many books call it blood deficiency and treat it mainly with Siwu Renshen Tang (52). The idea is to supplement the blood in case of blood deficiency; however, this may not always be the case and one should diagnose carefully. It could be because of lack of Fire, a symptom of Yang deficiency. When Yang Qi is strong the blood is red, and when Yang Qi is weak the blood is light-colored. The more Yang Qi there is, the more the blood has a red color, and vice versa. When Yang Qi is weak, the blood color is light. This is certainly the reason, and the treatment should focus on strengthening Yang and generating more blood. How come some are using Siwu Renshen Tang (52) and the cold medicines only? The mistreatment is all because the successors do not understand the Yin and Yang theory, and so they make the wrong diagnosis. The right treatment should be Huangshi Jianzhong Tang (146), Danggui Buxue Tang (87) with Fuzi, or Gancao Ganjiang Tang (42) and Danggui Buxue Tang (87) to avoid mistreatment.

This symptom is most likely because of Yang deficiency and lack of Fire, and the diagnosis is unique. We usually use this formula more or less to treat this symptom, and use Fuzi Lizhong Tang (95) and Danggui Buxue Tang (87) to treat patients.

(4) Pre-menstrual abdominal pain

In the case of abdominal pain when menstruation approaches, many books call it blood stagnation. Usually, we treat it with Tongzhi Tang (127) and Taoren Siwu Tang (125). These two formulas both focus on the blood stagnation. If it is hot stagnation, the formulas should be able to treat it. In the case of Cold pathogen stagnation, or eating cold or raw food, the treatment should focus on warming up and circulating the blood, and we should not use these two formulas only. One should treat it according to different symptoms as described above to avoid mistreatment.

In clinical cases, Cold stagnation is the most serious. We have treated several patients like this. The patients had severe abdominal pain before menstruation. It was so painful that eating or drinking caused vomiting. The treatment is to use Fuzi Lizhong Tang (95) with Fuling , Banxia , Xuanhu  and a heavy dose of Xiaohuixiang . Two treatments can cure it. To improve the results, tell the patient not to eat cold or raw food, especially before menstruation, and she should not wash clothes with cold water, and should take four doses of the above formula. After she has taken the doses for a few months, there will be no more pre-menstrual abdominal pain.

(5) Post-menstrual abdominal pain

In the case of abdominal pain after menstruation, many books call it vital energy deficiency and stagnation. The treatment formula is Bazhen Tang (8) with added Xiangfu. It seems reasonable. However, when one thinks carefully, there must be a reason for the abdominal pain after menstruation; if it is not caused by external wind or cold, it must be the internal Yang deficiency and should not all be treated as Qi and Blood deficiency with stagnation. Observe the symptoms carefully. If it is caused by external cold or wind, the patient must have symptoms such as aversion to wind or cold, fever, and body pain, with the proper treatment being to expel them, such as by using Guizhi Tang (118). If it is because of internal Yang deficiency, and the Cold is generated from the inside, then the patient will like massage and warming up. The proper treatment should be warming up internally by using Fuzi Lizhong Tang (95) with Dingxiang  and Sharen . We have treated patients with abdominal pain, pale face and light lip color after menstruation using Gancao Ganjiang Tang (42) with Dingxiang and Guangui , or Buxue Tang (87) with Angui, and it is very effective.

One such patient felt abdominal pain regularly, having a cold abdomen, and such intense pain after menstruation that it could not be tolerated. She had to have injections of dipyridamole as analgesic. She showed lassitude and lack of Spirit with a pale face, white tongue, and thin pulse. This is because of internal Yang deficiency and blood deficiency after menstruation; one should enhance Yang and generate blood to stop the pain. The treatment was to use Fuzi Lizhong Tang (95) and Danggui Buxue Tang (87) with Xiaohui and Xuanhu; the pain was reduced after one treatment and stopped after two treatments. We have always used this formula since this case, with satisfactory results.

(6) Amenorrhea

Amenorrhea refers to no menstruation for 40–50 days or even 2–3 months. It is a very serious condition, and one must pay special attention in inquiry, observation, and diagnosis. If diagnosed as pulse stagnation and being not strong, it is amenorrhea. If the pulse is strong and fluent, and back and forth are all hitting the fingers, this is a sign of pregnancy.

There are different reasons for amenorrhea. It may be from taking a cold shower during menstruation, from eating cold food right before menstruation, from experiencing anger when menstruation is about to come, from intrinsic or internal Qi deficiency and weak metabolism, or from catching a cold; so the causes are not always clear.

For the case of amenorrhea caused by taking a cold shower, it is because menstruation is flowing under warm conditions; the cold temperature will stop the flow and coagulate the menstruation. If the cold water intrudes, the channel closes and blood cannot flow; the treatment should be to warm up the channel using Mahuang Fuzi Xixin Tang (155), Yangdan Tang (72), or Buxue Tang (87) with Dingxiang and Rougui.

In the case of amenorrhea caused by eating cold or raw food, if the cold and raw food is accumulated at the center of the body (abdomen), it closes the flow channel, and therefore forces the blood down. The treatment should be to warm up the center body (abdomen) using formulas such as Lizhong Tang (149) with Sharen, Dingxiang and Rougui, or Gancao Ganjiang Tang (42) with Dingxiang  and Hujiao 

For cases of amenorrhea caused by anger, these are because anger makes the Qi depressed, which causes Qi stagnation and makes blood not flow, and therefore gives rise to amenorrhea. The treatment is to dredge the Qi channel and Liver, using formulas such as Xiaochaihu Tang (22) with Xiangfu, Chuanxong, and Maiya . Widow’s amenorrhea is most likely caused by depression, so the treatment should be to open the channel and dissolve the stagnation using Xiaochaihu Tang (22) with Xiangfu and Chuanxong, or Xiaoyao San (133) with Xiangfu, Taoren, and Chuangong to cure it.

For cases of amenorrhea caused by intrinsic or vital energy deficiency and weak metabolism, these are because people with intrinsic energy deficiencies are usually prone to sickness, and they have more sputum, eat less, have more diarrhea, more sweating, lose more vital energy, and accumulate less; so menstruation cannot come regularly. One should know that the more blood there is, the easier to get it down, and the less blood there is, the more difficult to get it down. We must diagnose the symptoms correctly and treat them accordingly. We should pay attention that some cases should be treated by herbs with sweet warm, some with pungent warm, and some with bitter warm.

For amenorrhea caused by catching a cold, treatment based on the Six meridians theory should be fine. In cases of amenorrhea, one should not be in a hurry to solve the problem with guessing or trial and error. This will be very harmful.

Amenorrhea is a condition for which we should diagnose carefully, according to the above five causes, treating with proper formulas to get the best results. Among these five causes, the most common one is intrinsic or internal energy deficiency and weak metabolism, usually treated with Fuzi Lizhong Tang (95) and Danggui Buxue Tang (87) with Sharen, Dingxiang, and Gansong . This is highly effective.

(7) Metrorrhagia and metrostaxis

For cases of metrorrhagia and metrostaxis, some are caused by Yang deficiency and some by Yin deficiency. What is Yang deficiency? It is a lack of intrinsic or vital energy, with inadequate intake; or having irregular menstruation, overdosed with cooling formulas; or catching a cold, over-dissipation; or having too much sex without constraint, so that the vital energy is consumed. Such a person’s living, movement and staying, talking, pulse, complexion, and everything else have no spirit, and the vital energy is too weak and cannot control or contain the Yin blood flooding down, which becomes metrorrhagia and metrostaxis. It is truly the symptom of severe exhaustion, and has to be saved with heavy treatment of warmth, such as a large dose of Huiyang Yin (64) and Gancao Ganjiang Tang (42). Any blood cooling or blood stopping formula is forbidden and should not be used for such a case.

What is Yin deficiency? It is caused by the Fire being too strong. This could be angergenerated Liver Fire, or too much worry causing Heart Fire, or drinking too much alcohol, causing Stomach Fire. Such a person’s spirit, eating and drinking, movement and staying, and everything else have more than enough energy pushed by the Fire pathogen. The Fire moves internally, burning the blood, hurting the Yang meridians, moving upward, and then hurting the Yin meridians, moving downward, and flooding out like a river bursting its banks. It should be treated with blood cooling formulas such as Shihui San (2) and Liangxue Tang (139) immediately to stop it. One must not use strong warming-up formulas. One should note that at this moment the pathogen Fire is moving strongly. Once the pathogen Fire is gone, treat with mild warm and cooling formulas to confirm and consolidate, but not too much. One should also note that losing blood is losing vital energy (Yuan Qi), and may turn into vital energy deficiency, and so it is necessary to be very careful and considerate, and do not mistreat or overtreat.

A middle-aged woman had metrorrhagia and metrostaxis; her face looked dark, and she was extremely afraid of cold, especially in the feet. In the hot summer, she wore fleece, had a pale tongue with a little black, and her pulse was fine. She was treated with a large dose of Gancao Ganjiang Tang (42) with Xueyutan  and Zongtan  to stop bleeding, then used Huiyang Yin and a heavy dose of Dangshen . She was cured after a few treatments, and was told not to eat raw and cold food, and to pay attention to conditioning her diet so as to consolidate the effect.

(8) Leukorrhagia

In the case of leukorrhagia, many books say that the Dai Meridian is hurt. However, if one considers it carefully, the Yang symptom counts 50–60%, which is wet Heat flowing downward. The Yin symptom counts about 60–70%, which is lack of Fire in the lower body. In the case of wet Heat flowing downward, the person may like spicy food, alcohol, pepper, and ginger, or have anger and violence, or simulate the Fire due to lust, and flow down to the lower Jiao combined with the moisture from the food and the Spleen. It flows down continuously from time to time; the shape is like a stripe, so-called Leukorrhea (“stripe” in Chinese). The patient usually is irritable, with a good spirit and appetite, and a strong pulse, and the leukorrhea is sticky and very smelly. The treatment is to remove moisture and clear Heat using Gegen Qian Lian Tang (164) and Huanglian Xiexin Tang(144) with Fuling, Zexie, and Huashi .

In the case of lack of Fire in the lower body, it could be intrinsic or vital energy deficiency and over worry hurting the Yang of the Heart; or it could be being hurt occasionally by food, over-digestion, and harming the Yang of the Stomach and Spleen; or it could because of excessive venery, the essence or semen flowing down and hurting the Yang of the Kidney. Such patients may be dizzy, have a reduced intake of food, limb weakness, and pulse on 2 Cun strong and on 2 chi weak, floating at the top and not sinking down. The leukorrhea must be light and cold, not sticky and with no smell. The treatment should be to enhance the vital Yang energy and contain the Qi of the Kidney by using Qianyang Dan (168) with Guzhi and Yizhi, Huiyang Yin (64) with Fuling and Angui , or Guiling Shugan Tang (120) with Fupian and Sharen . In the case of multi-colored vaginal discharge, there is no need to find magic formulas; always treat it with warm and sweet herbs, containing and consolidating vital energy. All the books can be referenced selectively.

One leukorrhea patient had the problem for three years; she had taken several pounds of Wuzigu (cuttlefish bones), but had not seen any effect. In fact, that made it even worse. She was observed to have sticky leukorrhea with coughing and phlegm. The treatment was to use a heavy dose of Ma Fu Xixin Tang (155) first to cure her coughing, then four doses of Fuzi Lizhong Tang (95), and finally Qianyang Dan (168) to contain the Qi in the Kidney so as to cure the patient. There was another case of a 16-year-old middle school student with irregular menstruation; her leukorrhea was more coplous and clear, cold with a weak pulse, diagnosed as vital yang energy deficiency. The symptom improved when she was treated with a heavy dose of Fuzi Lizhong Tang (95).

Later the patient felt the Cold pathogen getting into three Yin meridians, had back pain, cough and phlegm, and was treated with a heavy dose of Ma Fu Xixin Tang (168), and finally with Fuzi Lizhong Tang with Guizhi and Yizhiren , and was cured after two treatments. Three years later, when she was in college, she came again with the leukorrhea symptom. However, her situation was totally changed this time; it was diagnosed as moisture Heat flowing down and treated with a heavy dose of Gegen Qian Lian Tang (164), and she was cured after four treatments. Therefore, the treatment could be totally different even for the same patient, with the same symptoms.

Notes on Surgical Problems

The so-called surgical is more referring to sore skin ulcer subjects in TCM. When there is a sore, no matter which part of the body it is on, we can always diagnose it based on Yin and Yang. In the case of Yin symptoms, the sore skin complexion looks normal, swelling gradually with slight pain, and the ulcer is mostly water, or clean pus, yellow water, blood water, soybean water, or smelly water. The patient’s speech, voice, pulse, activities, and motions all lack energy and spirit. He or she does not feel thirsty, desiring only hot drinks if any; the tongue is dark and slippery; and urination is automatic; all these are because the internal vital energy deficiency, or extreme Yang deficiency, cannot dissolve the Yin stagnation, and so they generate a sore. Strong Yin and weak Yang cannot dissolve Yin blood and become an ulcer, and thus they show the above symptoms. The proper treatment should be to focus on pungent and sweet to generate and enhance Yang.

Transforming Yin Qi into Yang Qi: When Yin Qi is dissolved, the vital energy will be restored automatically, the ulcer will condense, the soreness will converge, and the disease will cure itself. No matter where the sore shows up originally, treat it using Guizhi Tang (118) with Xiangfu, Maiya, and Fuzi  to adjust and harmonize the Qi of Ying Wei, adding Xiangfu and Maiya to flow the stagnation and dissolve the clot. Adding Fuzi warms the meridians and disperses the Cold. Or use Mahuang Fuzi Xixin Tang (155) and Yangdan Tang (72). In the case of a light ulcer, one can use Huangqi Jianzhong Tang (146) and Fuzi Lizhong Tang (95). If the Yin is extremely strong, one can consider using Huiyang Yin (64), Baitong Tang (54), or Huangqi fermented rice stewed with pig’s trotters, and Mautton Shengjiang Tang.

In the case of Yang symptoms, the sore is red and swollen, and very painful. The patient is irritable, prefers cold and dislikes hot, has solid feces and red and short urine, a normal diet and spirit, a strong pulse and loud voice, and the ulcer is thick pus. This kind of sore is the easiest to cure; it is all because of pathogen Fire inside, the strong Fire hurting the blood. The treatment should be focused on using sweet and bitter to generate and enhance Yin. Generating Yin is done by transforming Yang Qi into Yin Qi. When Yang Qi is dissolved, the vital energy will be restored automatically, the sore will converge, and the disease will cure itself. No matter where the sore shows up originally, treat it with Guizhi Tang (118) with double Baishao  and add Xiangfu, Maiya, and Zhizi , or use Maxing Shigan Tang (153), or Renshen Baidu San (6) with Lianqiao and pollen .

An ulcer can be treated with Danggui Buxue Tang (87) with Yinhua, Shengdi and Baishao , or use Buzhong Yiqi Tang (88) with Shengdi and Yinhua , etc. In summary, once one understands the theory of Yin and Yang, the treatment will be automatically defined and the right medicine will easily be chosen.

There was another case, where true Yang suddenly broke away, and the sore came suddenly. In this case, no matter from which part of the body it happened, the sore was so painful that it was like cutting with a knife, and a swelling appeared quickly, was red in color and had dark in it. Such a patient is very tired, and sleepy, with no spirit; the pulse is floating and hollow, or as big as a string, or as strong as a stone; and the lips, mouth, and tongue are dark and black. The diagnosis should be focused on the pulse, voice, and color, observing and searching carefully to identify these symptoms. One must not just focus on the sore itself. Usually this kind of case happens in the morning and the patient dies at night. Therefore, the only effective treatment is to restore the Yang immediately, possibly saving two or three in ten cases. If treated as a normal sore case, the patient will die quickly.