Chiness Medical PDF

InternationalStandardLibraryofChineseMedicine
Chinese Medical Classics:

Selected Readings
I
InternationalStandardLibraryofChineseMedicine
Chinese Medical Classics:

Selected Readings
ChenMing(),Ph.D.TCM
ProfessorofShngHnLn,
BeijingUniversityofCM,
Beijing,China
PaulF.Ryan,M.S.,Dipl.OM,L.Ac.
(NY,CA,China)
AcupuncturePreceptor,
LutheranMedicalCenter,
DepartmentofNeurology,
Brooklyn,NewYork,USA
ZhouGang(),Ph.D.TCM
LecturerofShngHnLn,
BeijingUniversityofCM,
Beijing,China
Associateeditor
WangXin-pei(),M.S.TCM
Professor,BeijingUniversityofCM,Beijing,China
ZhouFa-xiang(),M.S.TCM
Professor,HenanUniversityofTCM,Zhengzhou,China
ZhaoYan-song(),Ph.D.TCM
Professor,BeijingUniversityofCM,Beijing,China
III
CIP
=Chinese medical classics
selected readings
/ , .
2014

ISBN 978-7-117-18931-6
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PrintedinThePeoplesRepublicofChina
Contributors
TheYellowEmperor'sInnerClassicsectionwas TheEssentialsfromtheGoldenCabinetsection
compiledby wascompiledby
ZhouFa-xiang(),M.S.TCM WangXin-pei(),M.S.TCM
Professor,HenanUniversityofTCM,Zhengzhou, Professor, Beijing University of CM, Beijing ,
China China
CuiShan-shan(),B.A. ZhengFeng-jie(),Ph.D.TCM
Associate Professor, Henan University of Associate Professor, Beijing University of CM,
TCM,Zhengzhou,China Beijing,China
LCui-tian(),Ph.D.TCM
Associate Professor, Henan University of
TCM,Zhengzhou,China
TheTreatiseonColdDamagesectionwascompiled TheWarmDiseasessectionwascompiled
by by
ChenMing(),Ph.D.TCM ZhaoYan-song(),Ph.D.TCM
ProfessorofShngHnLn,BeijingUniversity Professor, Beijing University of CM, Beijing,
ofCM,Beijing,China China
TangEr-qun(),Ph.D.TCM GaoWei-ping(),Ph.D.TCM
Associate Researcher, China Academy of Lecturer,HenanUniversityofTCM,Zhengzhou,
ChineseMedicalSciences,Beijing,China China
Translators
ZhouGang(),Ph.D.TCM WuYu-feng(),M.D.,Ph.D.TCM
LecturerofShngHnLn,BeijingUniversity Lecturer,AcademicAfairsOfce,Beijing
ofCM,Beijing,China UniversityofCM,Beijing,China
BrendaHood,Ph.D.,L.Ac. WangYing(),M.D.,Ph.D.
AssociateProfessor,NationalCollegeof AssociateProfessor,SpecializinginClinical
NaturalMedicine,Portland,Oregon.B.S. FoundationofChineseMedicine,College
TCM,BeijingUniversityofChineseMedicine. ofPreclinicalMedicine,ZhejiangChinese
Ph.D.Daoism:InnerAlchemy,Chinese MedicalUniversity,Hangzhou,China
AcademyofSocialSciences.Post-Doctorate
ChineseMedicine,GuangzhouUniversityof
ChineseMedicine
V
LiXiao-li(),M.D.,Ph.D.TCM PaulFrancisRyan,M.S.,Dipl.OM,L.Ac.
AssociateProfessor,SchooloftheHumanities, (NY,CA,China)
B eijing Universit y of Chinese M edicine, AcupuncturePreceptor,LutheranMedical
Beijing,China Center,DepartmentofNeurology,Brooklyn,
NewYork,USA
English Editors
PaulFrancisRyan,M.S.,Dipl.OM,L.Ac. KatieSpillane,B.A.
(NY,CA,China) B.A. in East Asian Studies (Mc Gill University,
A cupuncture Preceptor, Lutheran Medical Canada), BCL / LIB Candidate 2014 (Mc Gill
Center, Department of Neurology, Brooklyn, University,Canada)
NewYork,USA
M i c h a e l R . B e r g e r, M . S . , L . A c . D i p l . A c . WangYing(),M.D.,Ph.D.
(NCCAOM) AssociateProfessor,SpecializinginClinical
B.A. English, M.S.Medicine,Acupunctureand FoundationofChineseMedicine,College
Tuina ofPreclinicalMedicine,ZhejiangChinese
Z h e j i a n g C h i n e s e M e d i c a l U n i v e r s i t y, MedicalUniversity,Hangzhou,China
Hangzhou,China
CouncilMember,WorldFederationofChinese
MedicineSocieties(WFCMS)
To d d R u h l e n , M . S . , D i p l. O M ( N CC AO M ) ,
L.Ac.
Licensed Acupuncturist (California), M.S.
TCM,AmericanCollegeofTradifionalChinese
MedicineinSanFrancisco,USA
VI
About the Authors
Dr. Chen Ming, MD, Ph.D., professor and doctorate

advisor from Beijing University of Chinese Medicine
(BUCM), studied under a nationally distinguished expert
on Shng Hn Ln, Professor Liu Du-zhou. Dr. Chen
is dedicated to teaching, researching, and practicing
TCM, and his specialty is the four classics of TCM. He
has published 13 academic books, including the Clinical
GuidanceSeriestotheFourChineseMedicineClassics,andmore
than70journalarticles.Heisfamousforhisclinicalexpertise
in the treatment of internal, gynecological, pediatric, and
dermatologicaldisorderswithclassicformulas. Chen Ming
Paul Francis Ryan trained and practiced Chinese

medicine (CM) professionally in China where he lived
for 18 years. He is the first westerner to graduate from
a medical school in China with a master s degree in
a c u p u n c t u r e , a n d h e c o m p l e t e d t w o a c u p u n c t u r e
apprenticeships, one with the founder of Abdominal
Acupuncture, Dr. Bo Zhi-yun, and the other with Dr. Zuo
Chang-boforMasterTungsPoints.
P a u l h a s t a u g h t a n d p r a c t i c e d C M i n B e i j i n g ,
Shanghai, Guangzhou, Hong Kong and Macau and for the
University ofVermont and Loyola University. In 2011 he Paul F. Ryan
was recruited by the Guangdong Provincial Hospital of
TCM to teach and practice acupuncture. He has also acted as Cross-Cultural Liaison
andProjectDirectorinChinafortheQiProjectofHarvardUniversity.
Paul maintains a private practice in NewYork City and works as an acupuncture
preceptor for the Lutheran Medical Center and the Pacific College of Oriental
Medicine.
VII
Dr.Zhouiscurrentlyalectureron ShngHnLnatthe
School of Basic Medical Sciences of BUCM. In 2002 he began
his postgraduate study of Shng Hn Ln at BUCM with the
mainresearchfocusofusingclassicformulastotreatdifficult
and complicated diseases. After he received his doctoral
degree in 2007, he became a lecturer for BUCM. He has
translatedseveraltextbooksonChinesemedicalclassics,such
asClinicalFundamentalsofTraditionalChineseMedicine,oneof
the nationally planned university textbooks for international
traditional Chinese medicine education. He is also dedicated
to practicingTCM and good at treating patients with classic
Zhou Gang
formulas.
VIII
Editorial Board for International Standard Library of Chinese Medicine
ExecutiveDirectors
LiZhen-ji() HuGuo-chen()
ViceChairmanandSecretary-general,World PresidentandEditor-in-Chief,PeoplesMedical
FederationofChineseMedicalSocieties,Beijing, PublishingHouse,Beijing,China
China
Directors
YouZhao-ling() XieJian-qun()
Former President and Professor of Chinese PresidentandProfessorofChineseInternal
Medical Gynecology, Hunan University of Medicine, Shanghai University of TCM,
TCM,Changsha,China Shanghai,China
GeneralCoordinator
LiuShui()
DirectorofInternationalTCMPublications,PeoplesMedicalPublishingHouse,Beijing,China
Members(Listedalphabeticallybylastname)
ChangZhang-fu() ChenHong-feng(),Ph.D.TCM
ProfessorofChineseMateriaMedica,Beijing Professor of Chinese External Medicine,
UniversityofCM,Beijing,China ShanghaiUniversityofTCM,Shanghai,China
ChenJia-xu(),Ph.D.TCM ChenMing(),Ph.D.TCM
Pro fe s s o r o f TC M D i a gn o s t i c s, B e i j i n g ProfessorofShngHnLn,BeijingUniversity
UniversityofCM,Beijing,China ofCM,Beijing,China
CuiHai(),Ph.D.TCM DengZhong-jia()
AssociateProfessorofTCM,CapitalMedical Professor of Chinese Medicinal Formulae,
University,Beijing,China ChengduUniversityofTCM,Chengdu,China
DingXiao-hong() DouglasEisenstark,L.Ac.
Associate Professor ofTui Na, International Professor of Chinese Medicine, Emperors
Education College, Nanjing University of College,LosAngeles,USA
TCM,Nanjing,China
StephenX.Guo(),M.A.International HanChou-ping()
Afairs AssociateProfessor,InternationalEducation
Director of Jande International, NewYork, College,ShanghaiUniversityofTCM,Shanghai,
USA China
IX
HuJun(),B.A.MedicalEnglish HuKe-xin(),Ph.D.TCM
CurrentlyPursuingMastersDegreeofSciencein ProfessorofOtorhinolaryngology,KeelungCity
SocialHistoryofMedicine,PekingUniversity, MunicipalHospital,Taiwan,China
Beijing,China
HuZhen() HuangFei-li()
ProfessorandHeadofDepartmentofTraditional ProfessorofCosmetology,HongKongBaptist
ChineseMedicine,WenzhouMedicalCollege, University,HongKong,China
Wenzhou,China
RussellWilliamJames,M.S.TCM JiaDe-xian(),Ph.D.TCM
IELTSExaminerMarker,Beijing,China ProfessorofChineseMateriaMedica,Beijing
UniversityofCM,Beijing,China
JinHong-zhu() LixingLao(),Ph.D.MB,L.Ac.
ProfessorofAcupunctureTuiNa,Nanjing Professor and Director, School of Chinese
UniversityofTCM,Nanjing,China Medicine,TheUniversityofHongKong,Hong
Kong,China
AdjunctProfessor,CenterforIntegrativeMedicine,
UniversityofMaryland,Baltimore,Maryland,
USA
PastCo-PresidentoftheSocietyforAcupuncture
Research
VicePresident,WorldFederationofAcupuncture-
MoxibustionSocieties(WFAS)
HonK.Lee(),Dipl.OM,L.Ac. LiDao-fang(),Ph.D.TCM
Director of the Jow Ga Shaolin Institute, PresidentofFloridaAcupunctureAssociation;
Herndon,Virginia,USA ExecutiveBoardDirector,NationalFederation
of ChineseTCM Organizations, Kissimmee,
USA
MeiLi(),M.S.TOM,L.Ac. LiMing-dong(),Ph.D.OMD,L.Ac.
TranslatorandEditor,PeoplesMedicalPublishing ProfessorofChineseInternalMedicine,YoSan
House,Beijing,China University ofTraditional Chinese Medicine,
LosAngeles,USA
LiWan-ling() LiangLi-na(),Ph.D.TCM
QiGongandTCMTranslator,Beijing,China Associate Professor of Ophthalmology, Eye
HospitalofChinaAcademyofChineseMedical
Sciences,Beijing,China
X
LiuZhan-wen() LMing()
ProfessorofChineseMedicine,BeijingUniversity ProfessorofTuiNa,ChangchunUniversityof
ofCM,Beijing,China CM,Changchun,China
Mark L. Mondot, B.A. Chinese Language, Jane Lyttleton, Hons, M Phil, Dip TCM,
L.Ac. CertAc.
TranslatorandEditor,PeoplesMedicalPublishing Lecturer,UniversityofWesternSydney,Sydney,
House,Beijing,China Australia
JulieMulinQiao-Wong() AndyRosenfarb,M.S.TOM,L.Ac.
Professor of Chinese Medicine, Victoria AcupunctureHealthAssociates,NewJersey,
University,Melbourne,Australia USA
Pa u l F. R y a n , M . S . D i p l . O M , L . Ac . ( N Y, Martin Schweizer, Ph.D. Molecular Biology,

CA,China) L.Ac.
Acupuncture Preceptor, Lutheran Medical Emeritus Professor of Medicinal Chemistry,
Center,DepartmentofNeurology,Brooklyn, UniversityofUtah,USA
NewYork,USA
SecondoScarsella,MD,DDS SunGuang-ren()M.S.TCM
VisitingProfessorofTuiNa,Nanjing Professor ofTCM Fundamentals, Shandong
UniversityofTCM,ChinaDepartmentof UniversityofTCM,Jinan,China
MaxillofacialSurgery,SanSalvatoreHospital,
L'Aquila,Italy
TsaiChun-hui,Ph.D. TuYa()
Associate Professor of Pediatrics, School of ProfessorofAcupunctureandMoxibustion,
Medicine, University of Colorado, Denver, BeijingUniversityofCM,Beijing,China
USA
WangShou-chuan() WeiQi-ping()
ProfessorofTCMPediatrics,NanjingUniversity ProfessorofOphthalmology,BeijingUniversity
ofTCM,Nanjing,China ofCM,Beijing
DouglasWile,Ph.D. JaneFrancesWilson,M.S.,L.Ac.
FormerProfessorofHistoryPhilosophyof Senior Lecturer of School of Life Sciences,
ChineseMedicineandofChineseLanguageat UniversityofWestminster,London,UK
PacifcCollegeofOrientalMedicine,NewYork,
USA
Professor of Chinese Language at Alverno
College,Milwaukee,USA
XI
XiaoPing() Xu Shi-zu (), M.A. Chinese Martial
AssociateProfessor,HunanUniversityofTCM, Arts
Changsha,China ChineseTraditionalSportsandHealth
CultivationInstructor,SchoolofPhysical
Education,WenzhouMedicalCollege,
Wenzhou,China
YanDao-nan() YeQiao-bo(),Ph.D.TCM
ProfessorofOtorhinolaryngology,Nanjing LecturerofChineseMedicinalFormulae,
UniversityofTCM,Nanjing,China ChengduUniversityofTCM,Chengdu,China
ZhangJi() ZhangJi(),Ph.D.TCM
ProfessorofAcupunctureandMoxibustion, ProfessorofChineseMateriaMedica,Emperors
BeijingUniversityofCM,Beijing,China CollegeofOrientalMedicine,Alhambra
University,DonggukUniversity,LosAngeles,
USA
HelenQ.Zhang(),Ph.D.TCM,L.Ac. ZhangQing-rong()
DirectorofQiTCMClinic,NewYork,USA Professor ofTCM Fundamentals, Liaoning
UniversityofTCM,Shenyang,China
ZhaoBai-xiao(),Ph.D.TCM ZhaoXia(),Ph.D.TCM
ProfessorofAcupunctureandMoxibustion, P r o f e s s o r o f TC M Pe d i a t r i c s , N a n j i n g
Dean,SchoolofAcupunctureandMoxibustion, UniversityofTCM,Nanjing,China
BeijingUniversityofCM,China
ZhouGang(),Ph.D.TCM GregoryZimmerman,M.S.,L.Ac.
LecturerofShngHnLn,BeijingUniversity Lecturer, Southern California University of
ofCM,Beijing,China HealthSciences(FormerlyLACC),California,
USA
SponsoredbyWorldFederationofChineseMedicalSocieties
XII
Preface
The series is designed for Chinese medicine (CM) education in English-speaking

countriesandforforeignstudentsandbilingualeducationinChina.
In May 2009, the Peoples Medical Publishing House (PMPH) held the first
meetingoftheInternationalEnglishCMTextbookEditingCommittee.Thecommittee
was given the mission of producing high-quality English CM textbooks for the
promotion and development of CM education worldwide.With the establishment of
thecommittee,19groupsfromthevariousdisciplinesofCMwereformedtocompile
thecontent of thetextsin Chinese.The guideline for compiling the texts wastouse
the latest syllabi from courses in the CM bachelor of medicine programs in China
whiletakingintoconsiderationtheneedsofCMinternationaleducation.
ThistextbookonCMclassicscombinestheessentialpassagesoftheancienttexts
with interpretive information from CM professors across China.The information
is presented in a systematic, comprehensive, and orthodox way. It attaches great
importance to the connection between theory and practice.The nature, objectives,
subject depth, and areas covered in this textbook were determined with respect to
international student needs. In particular, explicit interpretation is presented on the
basictheories,knowledge,andskillsintheCMclassicstoensuretheappropriateness
ofthetextforaninternationalreadership.
ChinesemedicineclassicsincludeTheYellowEmperorsInnerClassic(HungDNi
Jng,),TreatiseonColdDamage(ShngHnLn,),Essentialsfromthe
Golden Cabinet (Jn GuYo L, ) and theStudy ofWarm Diseases (Wn
Bng,).ThesefourclassicsareconsideredthepillarsofCMandthefoundationof
its theory and clinical practice.This textbook selects original passages from them in
thefollowingeditions:
TheYellowEmperorsInnerClassic:BasicQuestions(HungDNiJng-SWn,
).The edition used for this textbook is the Gu Cong-de version,
MingDynasty.
TheYellow Emperors Inner Classic:The Spiritual Pivot (Hung D Ni Jng-Lng
Sh,).TheversionusedistheJuJing-tangofZhaosResidence
edition,MingDynasty.
Treatise on Cold Damage. The version used is the Zhao Kai-mei version, Ming
Dynasty,andbasedonCorrectionsandAnnotationstoTreatiseonColdDamage
(ShngHnLnJioZh,)byProf.LiuDu-zhou.
XIII
EssentialsfromtheGoldenCabinet.TheversionusedistheDiscussiononNew
CompilationofEssentialsfromtheGoldenCabinet(XnBinJnGuFngLn,
), which is aYuan Dynasty edition (Deng Zhen version) copied from
theSongDynasty.
TheWarmDiseasessectionofthebookisbasedonExternally-ContractedWarm-
Heat Diseases (Wi GnWn R Pin, ) byYe Xiang-yan and Damp-
Heat Diseases (Sh R Bng Pin, ) by Xue Sheng-bai as recorded in
WarpandWoofofWarm-HeatDiseases(WnRJngWi,)byWangShi-
xiong,andSystematicDifferentiationofWarmDiseases(WnBngTioBin,
) compiled under the National New-Millennia Higher-Education Chinese
MedicineUniversityWarmDiseasesTextbookCommittee.
The contents of this textbook are divided into four sections based on the four
classics.Eachsectionisdividedintochaptersorganizedbysubjectwithinthesource
text.Tomakethematerialmoreaccessible,itispresentedinthefollowingway:
S ource text: contains the English translation of the selected passage of classic
text.Thisistheessenceofthistextbook.
ForTheYellowEmperorsInnerClassic,thesourcetextsarearrangedaccording
to topic and divided into eight categories by chapter: yin and yang and
the five phases, organ manifestation, essence, qi and spirit, etiology and
pathodynamics,diagnostictechniques,principlesandmethodsoftreatment,
lifecultivation,andneedlingtechniques.
For the Treatise on Cold Damage, the selected source texts are arranged
accordingtosixchannelpatterndifferentiationorder,andthenumberingof
eachlineisbasedontheZhaoKai-meiedition.
SimilararrangementsareusedfortheselectionsfromtheEssentialsfromthe
GoldenCabinetandtheStudyofWarmDiseasestexts.
Interpretation: contains a full interpretation and/or notes and explanations
ofthesourcetext.Itisthefocusofthistextbook.Itoffersconcise,reasonable,
wellacceptedinterpretationsofthesourcetextwithanemphasisonproviding
insightsintohowtoapplyancienttheoriestomodernclinicalpractice.
Clinical application: provides clinical information relevant to the pattern
and formula discussed, and, wherever possible, uses existing case reports by
prominent physicians to help readers complete the link between the patterns
andformulasinthesourcetextandtheirapplicationtodiseasesseeninclinical
practice. Case reports offer unique insight because they either use the exact
formulasfromtheclassicsormodifedonesbasedonthem.
Accordingtotheeditorsexperienceteachingtheclassics,thisformattingmethod
isthebestwaytofacilitatelearning.
This textbook has been created by a team.The editor-in-chief, Prof. Chen Ming
XIV
from Beijing University of Chinese Medicine (BUCM), supervised the compiling
and editing of Chinese texts. Dr. Zhou Gang (BUCM) was in charge of the English
translation team. Paul F. Ryan, of the Lutheran Medical Center (Brooklyn NY, USA)
and graduate of BUCM, was responsible for translation accuracy and the English
editingteam.
TheYellowEmperorsInnerClassicwascompiledbyProf.ZhouFa-xiang,Prof.Cui
Shan-shan and Dr. L Cui-tian from Henan College ofTCM and translated by Dr.
Brenda Hood.The Treatise on Cold Damage was compiled by Prof. Chen Ming from
BUCM and Dr.Tang Er-quan from China Academy of Chinese Medical Sciences, and
translatedbyDr.ZhouGang.EssentialsfromtheGoldenCabinetwascompiledbyProf.
Wang Xin-pei and Dr. Zheng Feng-jie from BUCM, and translated by Dr. Li Xiao-li
(BUCM).TheWarm Diseases section was compiled by Dr. ZhaoYan-song and Dr. Gao
Wei-ping from BUCM, and translated by Dr.WuYu-feng (BUCM). For each section,
translations were reviewed and revised for accuracy and English readability by Mr.
Ryan.
Despite the hard work from these team members, there may still be mistakes
in this textbook due to our limitations.We will continue to update and revise this
textbookinthefutureandwelcomeyourcommentsandcriticisms.
ChenMing
March,2014
BeijingUniversityofChineseMedicine
XV
Chief English Editors Note
Ourmissionincreatingthisbookwastobringtheknowledgefromclassicaltexts
to the modern clinic of English speaking Chinese medicine (CM) practitioners.The
Peoples Medical Publishing House (PMPH) emphasized the importance of a fluent
English translation of the source text to allow readers to focus on the connection
betweenthecontentofthesourcetextanditsclinicalapplication.Todothiswefaced
several challenges, not the least of which being the poetic and elliptical nature of
classical Chinese writing that renders it open to multiple interpretations.The chief
editor,ProfessorChenMing,choseasingleinterpretationformatforthesourcetext.
Theinterpretationisbaseduponthegeneralconsensusamongscholarsoftraditional
Chinese medicine in Chinese universities today.To make that interpretation easily
understood to the readers, the translation and editing team have added supportive
wordstothesourcetext.Becausetheaimofthetranslationisclinicalapplicability,the
conventionalbracketingofthesewordsisnotusedinmostcases.
A second challenge is choosing the English terminology to be used for the
translationofCMterms.Forthemostpart,thetermsinthistextcomefromthePMPH
Standardized Chinese-English MedicalTerminology Lexicon.The lexicon is an in-
house database developed over several years with experts from CM universities and
foreign translators working for PMPH. It is a broad lexicon, with approximately
10,000 terms that are commonly used in translations. Because our team translated
classicaltext, we occasionally came across obscure terms that were not found in the
lexicon. In such instances, our team researched, discussed, debated and chose our
owntermstosupplementthelexicon.
As the chief English editor, it was a formidable challenge for me to maintain a
similar style both in language and formatting through this work.The four sections
oftheoriginal text were prepared by selected authors and compilers, each of whom
contributedauthoritativeexpertisetotheirsectionofthetext.Whilewemadesome
effort for stylistic conformity among the four sections, our overriding concern was
to correctly comprehend what our experts were saying and to clearly express those
meaningstoourreaders.
Something unique to this text on classical Chinese medicine is the use of the
headerInterpretation rather thanCommentar y following each section of
the source text.While for some sections the headerCommentary may be more
appropriate like for the Treatise on Cold Damage section, theWarm Diseases
XVI
section,ontheotherhand,ismoreofaretranslationoftheclassictextwithaspecific
interpretation.
This book could not have been completed without the dedicated effort of our
editingteamwhoworkedcloselywithmetobringeachsectiontocompletion:thank
you to Mr. Micheal Berger and Dr.WangYing for their work on theWarm Diseases
section, toTodd Ruhlen and Katie Spillane for their work on theEssentials from the
Golden Cabinet section, and to Dr. Brenda Hood for her effort beyond the role of a
translatorworkingcloselywithmeonalmosteverylineofTheYellowEmperorsInner
Classic section. And I offer a special thank to Mr. Harry Lardner for his support and
guidancethroughouttheentireeditingprocessofthisbook.
Ultimately, this is a textbook: an entry level text on classical CM designed to
enablereaderstoaccesstheancientsourcesofCMwhosetheoryandskillstheyuse
today.Itdoesthisbyincludingrealcasereportsconnectingthecontentofthesource
texttoclinicalapplication.Wehopeitservesreadersandtheirclinicalpracticeswell.
PaulF.Ryan
March,2014
LutheranMedicalCenter
XVII
Table of Contents
Volume OneSelected Readings from The

Yellow Emperors Inner Classic
(Hung D Ni Jng , )...................... 1
Chapter1 GeneralIntroduction....................................................................................... 2
Chapter2 YinandYangandtheFivePhases............................................................ 38
Chapter3 OrganManifestation..................................................................................... 57
Chapter4 Essence,QiandSpirit. ................................................................................ 77
Chapter5 EtiologyandPathodynamics. ..................................................................... 92
Chapter6 DiagnosticTechniques............................................................................... 111
Chapter7 PrinciplesandMethodsofTreatment. .................................................... 130
Chapter8 LifeCultivation............................................................................................. 142
Chapter9 NeedlingTechniques.................................................................................. 155
Volume TwoSelected Readings from

Treatise on Cold Damage
(Shng Hn Ln, )............................... 179
Chapter1 GeneralIntroduction................................................................................... 182
Chapter2 Pulse,Pattern,andTreatmentofTaiyangDisease.............................. 195
Section1 OutlineofTaiyangDisease...................................................................... 197
Section2 PatternsofTaiyangDisease. ................................................................... 199
Section3 TransmutedPatternsofTaiyangDisease. .............................................. 219
Chapter3 Pulse,Pattern,andTreatmentofYangmingDisease.......................... 261
Section1 OutlineofYangmingDisease. ................................................................ 263
Section2 PatternsofYangmingDisease............................................................... 264
Section3 TransmutedPatternsofYangmingDisease........................................... 281
Chapter4 Pulse,Pattern,andTreatmentofShaoyangDisease.......................... 284
Section1 OutlineofShaoyangDisease.................................................................. 286
Section2 PatternsofShaoyangDisease. ............................................................... 288
Section3 ConcurrentandTransmutedPatternsofShaoyangDisease................ 292
Chapter5 Pulse,Pattern,andTreatmentofTaiyinDisease.................................. 305
XVIII
Section1 OutlineofTaiyinDisease......................................................................... 307
Section2 PatternsofTaiyinDisease........................................................................ 309
Chapter6 Pulse,PatternandTreatmentofShaoyinDisease............................... 314
Section1 OutlineofShaoyinDisease..................................................................... 316
Section2 PatternsofShaoyinDisease.................................................................... 318
Chapter7 Pulse,Pattern,andTreatmentofJueyinDisease. ............................... 337
Section1 OutlineofJueyinDisease........................................................................ 339
Section2 PatternsofJueyinDisease. ..................................................................... 340
Volume ThreeSelected Readings from

Essentials from the Golden
Cabinet
(Jn Gu Yo L , )................... 353
Chapter2Pulses,Signs,andSequenceofBowelandViscera,
andChannelandCollateralDisease....................................................... 364
Chapter3Pulses,Signs,andTreatmentofTetany,Dampness,
andSummerheatStroke............................................................................ 369
Chapter4 Pulses,Patterns,andTreatmentofJoint-RunningDisease............... 375
Chapter5Pulses,Patterns,andTreatmentofBloodB and
Deficiency Taxation..................................................................................... 380
Chapter6Pulses,Patterns,andTreatmentofLungWi,LungAbscess,
andCoughingwithQiAscent. .................................................................. 394
Chapter7Pulses,Patterns,andTreatmentofChestB,HeartPain,
andShortnessofBreath............................................................................ 401
Chapter8Pulses,PatternsandTreatmentofVisceralWindandCold,
AccumulationsandGatherings. ............................................................... 414
Chapter9Pulses,PatternsandTreatmentofPhlegm-Rheumand
Coughing...................................................................................................... 419
Chapter10Pulses,Patterns,andTreatmentofWasting-Thirst,Inhibited
Urination,andStrangury. ........................................................................ 427
Chapter11 Pulses,PatternsandTreatmentofWaterQiDiseases. .................... 432
Chapter12 Pulses,Patterns,andTreatmentofJaundice. .................................... 450
Chapter13Pulses,PatternsandTreatmentofRetching,Vomiting,
HiccoughandDiarrhea............................................................................ 463
Chapter14Pulses,PatternsandTreatmentofDiseasesin
Pregnancy.................................................................................................. 473
Chapter15 Pulses,PatternsandTreatmentofPostpartumDiseases................ 482
XIX
Chapter16Pulses,Patterns,andTreatmentofMiscellaneousDiseases
inWomen................................................................................................... 494
Volume FourSelected Readings from

Warm Disease Theory
(Wn Bng , )..................................................... 505
Chapter2PatternDifferentiationTheoryandTreatmentPrinciplesfor
WarmDisease............................................................................................. 509
Section1Wei-Qi-Ying-BloodPatternDiferentiationand
TreatmentPrinciples............................................................................... 509
Section2SanjiaoPatternDiferentiationandTreatmentPrinciples. ................... 514
Chapter3 CommonDiagnosticMethodsUsedinWarmDiseases...................... 520
Section1 ObservationoftheTongue..................................................................... 520
Section2 InspectionoftheTeeth. .......................................................................... 531
Section3 DiferentiatingMacula,Papule,andMiliariaAlba. ............................... 534
Chapter4 Warm-FebrileTypeWarmdisease. ......................................................... 542
WeiLevelPatternsandTreatment.......................................................... 542
Section1
QiLevelPatternsandTreatment. ........................................................... 548
Section2
Ying-BloodLevelPatternsandTreatment............................................. 560
Section3
ConsumptionofTrueYin........................................................................ 568
Section4
Chapter5 Damp-heatTypeWarmDisease.............................................................. 578
Section1 TherapeuticPrinciplesandMethods...................................................... 578
Section2 PatternsandTreatmentoftheUpperJiao............................................. 584
Section3 PatternsandTreatmentoftheMiddleJiao............................................ 592
Section4 PatternsandTreatmentoftheLowerJiao............................................. 612
Glossary. .................................................................................................................. 615
AppendixMeasurements in the Essentials

from the Golden Cabinet .................................... 624
General Index.................................................................................................... 627
XX
VolumeOne
Selected Readings from TheYellow
EmperorsInnerClassic
(HungDNiJng,)
2
Chapter 1
Chapter1
General Introduction
TheYellowEmperorsInnerClassic(HungDNiJng,),oftenreferredto
simply as the Inner Classic, is the earliest extant medical work in China.The present
Inner Classic is divided into two sections, respectively called Basic Questions (S
Wn, ) and the The Spiritual Pivot (Lng Sh, ), each of which comprises
81 chapters for a total of 162 chapters. 1 This book brings together and reflects
the medical achievements of ancient China, establishes the theoretical system
underlying the practice of Chinese medicine and sets the base for its continued
development.
The Inner Classic summarizes medical experience prior to the Qin and Han
dynasties, drawing on this experience and fusing it into a coherent system that
encompasses achievements from ancient philosophy and natural science. It adopts
a macrocosmic viewpoint in addressing the interconnectedness of heaven, earth
and humankind in its discussion and analysis of the most fundamental problem of
medicinetheunderlyinglawsoflifeandthengoesontoestablishprinciplesand
techniques for a corresponding theoretical system and the prevention of disease.
For over 2000 years, doctors have continuously used the theoretical principles,
techniques, and methodology contained in the Inner Classic as a basis to explore,
experiment,andrecreatetheirunderstandingsofmedicine.Thisinturn,hasenabled
thefieldofChinesemedicinetorefreshandrenewitselfwitheachgenerationensuring
its continued development. It is mainly for this reason that the Inner Classic has
historicallybeencalledtheancestorofmedicine.Eventoday,the InnerClassicholds
an important position as a guide for both research into and the practice of Chinese
medicine.
Interestingly, the Inner Classic is not just a work of medicine; it also contains an
abundance of philosophy, as well as information from ancient astronomy, geology
andotherfieldsofinquiry.Itisarelativelyconcentratedreflectionoftheintellectual
paradigms of the Chinese people, shining with the light of Eastern wisdom, and for
this reason is being taken increasingly more seriously by academia both East and
West.
1 Thenumberofchaptersissomewhatmisleadingastwoofthechapterswerelosttohistoryevenbefore
theTang Dynasty. All that is left of them is their names. Regardless, in all Chinese texts on this matter, they
regardthebookasstillhaving162chapters.
VolumeOne:Chapter1 GeneralIntroduction 3
Formation, Revisions, and Development of the Inner Classic
Chronology of Its Formation

ThereisagreatdealofcontroversyoverwhentheInnerClassicactuallycameinto
existenceand,historicallyspeaking,therehavebeenmajordivergencesonthismatter
among both doctor practitioners and scholars.Their various stances can be divided
intofourdiferentperspectivesontheoriginoftheInnerClassic:
*itcameintobeingduringthetimeoftheYellowEmperor(circa26972599BCE);
*itisaworkoftheWarringStatesPeriod(circa476221BCE);
* it was written around the end of the Qin Dynasty (circa 221206 BCE) and the
beginningoftheHan(circa202BCEto202AD);or
*itisaproductoftheHanDynasty,especiallytheWesternHan(circa202BCEto
9AD),withsomeofthechapterswrittenduringtheEasternHan(circa25220AD).
Textualresearch,however,showsthatthe InnerClassicisclearlynottheworkofa
singleperiodoftime,norisittheworkofdoctorsfromagivenarea.Ratheritsbasic
content was worked out during theWarring States Period with later additions made
during the Qin and Han dynasties.With regard to when the material was actually
compiled into a book, this most probably happened in the first century AD in the
latterpartoftheWesternHanDynasty.
Revisions and Development

Accordingtotextualresearch,theearliestmentionof TheYellowEmperorsInner
Classic is seen in Ban Gus Eastern Han Dynasty work,The Book of the Han Dynasty:
RecordofArtsandLiterature(HnSh-YWnZh,).Thisworkdidnot,
however, indicate that the Inner Classic was comprised of Basic Questions and The
Spiritual Pivot. It was not until Huang-fu Mi in the Jin Dynasty (317430 AD) that its
twocomponentswerementioned,thoughhereferredtothemasBasicQuestionsand
TheAcupunctureClassic(ZhnJng,).1InhisintroductiontoTheSystematicClassic
ofAcupunctureandMoxibustion(ZhnJiJiYJng,),Huang-fuMiwrote:
InaccordancewiththeeighteenscrollsoftheSevenStrategies,theRecordofArtsandLiterature
andTheYellowEmperorsInnerClassic,todaywehavetheninescrollsofTheAcupunctureClassic
andtheninescrollsofBasicQuestionsforatotaloftwotimesnineoreighteenscrollsthatmake
up the Inner Classic. (
)
1 TheAcupunctureClassicisanalternatenameforTheSpiritualPivot.
4 Chinese Medical Classics: Selected Readings
Interestingly, the name of the first componentBasic Questions was seen even
earlierthanitsmentioninTheSystematicClassicofAcupunctureandMoxibustion(Zhn
Ji JiY Jng, ).The first mention of the componentBasic Questions
was in a late Eastern Han Dynasty work by Zhang Zhong-jing called the Treatiseon
ColdDamageandMiscellaneousDiseases(ShngHnZBngLn, ).Inthe
introductiontohisworkZhangstates:
In addition to knowledge of the pulse and knowing disease patterns, I drew from Basic
Questions,theNineScrolls,1TheYellowEmperorsClassicofEighty-oneDifficultIssues,TheGreat
TreatiseonYinandYang,andtheRecordoftheInitialTransmissionofHerbstowritethe16scrolls
oftheTreatiseonColdDamageandMiscellaneousDiseases.(
)
DuringtheQi (479502 AD) Liang (502557 AD) period of the Southern Dynasty,
a man by the name of QuanYuan-qi fully annotated and explained Basic Questions,
though at that time there were only eight scrolls (the seventh scroll had been lost).
QuanYuan-qiwastheearliestannotatorof BasicQuestions.Hisannotatedworkwas,
however, lost to history after the Song Dynasty (9601279 AD). In the Sui Dynasty
(581618 AD),Yang Shang-shan compiled and annotated Grand Simplicity ofThe
Yellow Emperors Inner Classic(Hung D Ni JngTi S, ), an act that
helpedtopreservetheoriginaltextoftheInnerClassic.Unfortunately,aftertheSong
Dynasty,onlyremnants of his original work remained. In theTang Dynasty (618907
AD),Wang Bing commented on the then state of Basic Questions by saying:The
circulating version of Basic Questions is full of mistakes, many of the chapters are
reduplicated,thereisnoordertothelines,andthecontentseemstojusthangisolated
from any real meaning.Wang took the content and emended it to produce a work
of24scrolls.In the second year of Ren Zong Jia-you (1057 AD) of the Song Dynasty,
thecountryestablishedanationalmedicaltextbureauandentrustedGaoBao-heng,
LinYi, and others to make extensive revisions. Still in circulation today, Augmented
andWidelyAmendedAnnotatedYellowEmperorsInnerClassicofMedicine(ZngGung
B Zh Hung D Ni Jng SWn, ) isWang Bings compiled
version, a version that was reworked and amended in the Song Dynasty by LinYi,
etal.
The earliest name of The Spiritual Pivot was the Nine Scrolls (Ji Jun, ).
This name was first seen in the preface of the late Han Dynasty work by Zhang
Zhong-jing, TreatiseonColdDamageandMiscellaneousDiseases.IntheJinDynasty,
Wang Shu-he also referred to The Spiritual Pivot as the Nine Scrolls, but in the
1 AreferencetoTheSpiritualPivot.
Jin Dynasty work The Systematic Classic of Acupuncture and Moxibustion, Huang-
fu Mi began to refer to it as The Acupuncture Classic. Examination of his text
reveals that the name The Acupuncture Classic appears in the first chapter, Nine
Needles,Twelve Origins (Ji Zhn Sh rYun, ), in the phrasefirst
know The Acupuncture Classic. When Huang-fu Mi wrote The Systematic Classic
ofAcupunctureandMoxibustionhedrewonmaterialfromTheAcupunctureClassic.
When compared to present editions of The Spiritual Pivot, much of the material in
TheSystematicClassicofAcupunctureandMoxibustionisthesame,provingthatwhat
he referred to as The Acupuncture Classic is in fact The Spiritual Pivot.The name
The Spiritual Pivot was first seen in the preface ofWang BingsTang Dynasty Inner
Classic:The Yellow Emperors Inner Classic comprises 18 scrolls, the nine scrolls of
Basic Questions and the nine scrolls of The Spiritual Pivot, hence the number (18).
()Later
oninhistext,healternatesthenamesTheSpiritualPivotandTheAcupunctureClassic,
once again showing that the two are the same text. In the eighth year of the Song
DynastyYuan-You period (1093 AD), the country now known as Korea made an
offeringof TheYellowEmperorsAcupunctureClassictotheemperorZheZong,who
then promptly ordered distribution of the book throughout the country, giving the
textverywidedistribution.TheversionofTheSpiritualPivotpresentlycirculatingwas
first published in the Southern Song Shao-XingYi-hai year (1155 AD). At that time,
Shi Songproofread and revised the nine scrolls of an old version of The Spiritual
Pivotthathadbeenkeptinthefamily.Hedivideditinto81chaptersandaddednotes
on pronunciation and meaning attaching them to the end of the scrolls. His work
eventuallycameto24scrolls.(
)Thisworkisstillincirculationtoday.
The Basic Theoretical System of Thought in the Inner Classic
Formation of the Theoretical System in the Inner Classic

Thehistoryofsciencetellsusthatthebirthofanytheoryortheformationofany
fieldofstudyistiedtothesociety,culture,andtechnologicaldevelopmentsthatform
itshistoricalbackground.Inthesameway,theformationofthetheoreticalsystemthat
underpins the Inner Classic is inseparable from social developments, accumulations
ofmedicalexperience,andthethencontemporaryinfluencesofthenaturalsciences
andtechnology.The difference between the unique theory that underpins the Inner
Classic and other fields of scientific study is that, more than any other such field, its
close connection to philosophy is particularly obvious as is the influence of ancient
astronomy.
SocialChangesandAdvances
During the Spring and AutumnWarring States Period (circa 770-221 BCE) of
Chinesehistory,feudalismwasintheprocessofreplacingthepreviousslavesociety.
The structural changes in social relationships greatly promoted production and the
economy flourished.This resulted in concurrent advances in science and culture.
After Qin Shi-huang united China and established a centralized government, he
standardized writing, the width of carriage wheels, the currency, laws, as well as
weights and measurements.With regard to the intellectual and philosophical milieu
oftheperiod,theWarringStatesPeriodsawtheriseofinnumerablescholarsandthe
soundsofhundredsincontention,aclassicreferencetoaflurryofintenseintellectual
debateanddiscussion.Thishadastimulatingeffectonthedevelopmentofmedicine
and weakened the hold that shamanism had on society. Medicine began to teach
peoplethatwhenonewassick,therewasnouseinseekingrecoursetoshamanism,
astrological augury, petitioning the emperor or using spirits to relieve the suffering.
This promoted the development of a medicine that met the needs of a flourishing
society.TheauthorsoftheInnerClassicwereabletobreakfreefromthecageoffeudal
superstition and spiritual authority and established a fresh new line of thinking that
emphasized:Those who hold to treating through the media of ghosts and spirits
cannot talk of highest virtue. 1 The appearance of the Inner Classic symbolically
markedthepartingofthewaysformedicineandshamanism.
AccumulatedMedicalExperience
Researchintothehistoryofmedicinehasshownthatwherevertherearepeople,
there is the whole process of living, and there is necessarily some form of medicine
andtheexpressionofaccumulatedmedicalexperience.FromveryearlyoninChina,
there have been myths and stories about medicine and related activities.These
stories include how during the time of theYellow Emperor there were government
officials in charge of medical studies, and how the Divine Husbandman, Shen Nong,
encountered 72 poisonous herbs daily when he was tasting thehundred herbs. 2
InearlyliteratureliketheClassicofPoems(ShJng,),therearemanyreferences
to ancient disease names and symptoms, as well as mentions of how to prevent
disease and safeguard health.The Classic of the Mountains and Seas (Shn Hi Jng,
) 3 mentions more than one hundred medicinals as well as more than thirty
1 .Areferencetotheideathatshamanismandancestorworshipwasnotthe
highestformofmedicine.
2 When the termhundred herbs appears in this way, it is generally understood as referring to a large
numberofherbsandnotspecifcallytoonehundred.
3 Abookoffantasticlegendsandstories.
different diseases. In 1973, at the Mawangdui archeological dig 1 in Changsha,

numerous medical texts were unearthed from theWestern Han Dynasty, including
TheMoxibustionClassicoftheElevenFootandArmVessels(ZBShYMiJiJng,
),TheMoxibustionClassicoftheElevenYinandYangVessels(YnYngShY
MiJiJng,),andFormulasforFifty-twoDiseases(WShrBngFng,
).Theunearthedtextstouchonthepreventionandtreatmentofdiseasein
suchvariedareasasinternalmedicine,surgery,gynecology,pediatrics,andthesense
organsaswellasthechannelsrelatedtothesefields.Thecontentofthesetextsismore
thansufficienttoconvincescholarsthatevenpriortothewritingof InnerClassicthere
wasafourishingandsophisticatedunderstandingofmedicine.
Inaddition,duringtheWarringStatesPeriodmanypeoplewerekilledintheendless
wars.Thisprovidedanopportunityforthestudyofanatomyandinvestigationsofthe
morphologicalstructureofthehumanbody.TheInnerClassicitselfmentions:
Ifthereisamanabouteightchitall(approx.sixfeettall)withalltheskinandmuscles,then
external measurements can be taken to obtain (knowledge of the inner structures) and after
death,onecancutintohimandlooktoseewhatisthere,toseethefirmnessorbrittlenessof
hiszang-organs,thesizeofhisfu-organs,howmuchhehaseaten,thelengthofhisvessels,the
clarityorturbidityofhisbloodallofthesecanbeenumerated.(

)
During the time of the Inner Classic, not only were people attentive to taking
detailed measurements of the exterior of the body, but because of the advances in
anatomical skills they also made inroads researching the inner organs. In addition,
prior to the Inner Classic there was extensive medical literature in circulation that
establishedabasisforcreatingthe InnerClassic.Anynaturalscienceisconnectedto
previous achievements and it is not possible for any major work to just appear out
ofnowhere.WorksreferencedintheInnerClassicalsosupportthis.TheInnerClassic
referencesmorethan20worksofmedicine,includingTheUpperClassic(ShngJng,
),TheLowerClassic(XiJng,),GreatEssentials(DYo,),RootDisease(Bn
Bng,),ExtraordinaryEnduring(QHng,),andEstimations(KuDu,).
Unfortunately,allofthesevaluableworkshavebeenlosttohistory.
InclusionofAncientPhilosophy
Einstein once said:If a theory in the natural sciences has no proof, then it is
unsustainable. 2 In the Qin Dynasty, there were sophisticated theories on the
1 AnarcheologicaldigcontainingthetombsofthreepeoplefromtheWesternHanDynasty(206BCEto9
CE):MarquisLiCang,hiswife,andamalebelievedtohavebeentheirson.
2 Translatorsnote:ThisquoteisretranslatedfromtheChinesesoitmaynotbeEinsteinsactualphrasing.
nature and workings of the natural world as well as highly developed philosophical
traditions.Thesetraditionscameabouttoalargeextentfromobservationsofnature
and human behavior. In turn, thinkers used the philosophical ideas of the time with
their underlying ontology and epistemology to further explore and explain nature.
From a modern perspective, it was this ancient and unique way of thinking that
createdthetheoryunderlyingancientChinesenaturalsciences.Thetheoreticalsystem
containedintheInnerClassicisespeciallypronouncedinthisaspect.Ideassuchasqi-
basedmonism,1yinandyangtheory,andfivephasestheoryhadaprofoundeffecton
theformationoftheInnerClassic.
Qi-based monism, also known asprimal qi theory, is a major aspect of ancient
Chinese philosophy.This theory was conceived of prior to the Qin Dynasty and
matured during theWarring States Period, Qin and Han dynasties. Qi-based monism
holdsthatqiformstherootofallphenomena.Itsaysthatqiisnotanemptydelusion,
but is within ones ability to perceive. It is a substance in constant motion and in
variousdegreesofconcentrationanddiffusion,whichgivesrisetothetwocategories
of formed and formless phenomena.There is no unbridgeable gap between the
formedandtheformless, and the two canat any time transform into their opposite.
The generation, change, strengthening, and weakening of any phenomena are all
dependentonthemovementandtransformationofqi.TheauthorsoftheInnerClassic
drew on this idea, referred to in philosophy as qi-based monism, to explain the
materialanddynamicnatureoflife.Theyalsousedtheconceptofqiasamediatorto
explaintheholisticnatureofandconnectionsbetweenmanandnature.Theseideas
were further developed to explain physiological phenomena and the pathological
processesseeninhumans.Onecouldsayqi-basedmonismformsthecornerstoneof
thetheoreticalsystemfoundintheInnerClassic.
Discussions of yin and yang were first seen in the Shang Dynasty (16001046
BCE)andZhouDynasty(1046256BCE),butthetheoryitselfdidnotmatureuntilthe
Qin and Han dynasties.Yin and yang theory looks at the development and changes
that occur in the natural world and relates the end results to the dynamics of the
interactionbetweendiametricallyopposedyinandyangcomponents.TheInnerClassic
tookyinandyangtheoryanduseditasamethodologytoexplainthevitalactivities
of the human body; it used the inherent relationships of diametrical opposition,
union, waxing and waning, transformation, and resonance and coordination seen
between yin and yang and then used them to describe the structures of the human
body,tosummarizeitsphysiologicalfunctions,andtogiveguidancetothediagnosis
and treatment of diseases.The ideas found in theInner Classic were built from this
1 Theideathateverythingtracesbacktoqiasthesinglefundamentalunderlyingnature/structureofthe
universe.
basicstructure.
Five phases theory was very influential during the time from theWarring States
Period to the Qin and Han dynasties.The ancients divided many phenomena into
five groups depending on the special characteristics considered to be inherent in
each of the five component phases.They felt that the relationships between these
categories were characterized by mutual generation, control, regulation, and
transformation, wherein the individual phases endlessly cycle between themselves,
forming a holistically interconnected dynamic model and an abstraction of the
phenomenological world.This theory was quite useful and underpins much of the
InnerClassicsinternaltheoreticalsystem.
InfuencesfromtheDevelopmentoftheNaturalSciences
AncientChineseastronomywasquitedeveloped.FromtheWarringStatesPeriod
through to the beginning of the Han Dynasty, calendar makers invented the four-
divisions calendar 1 wherein onereturn year was calculated to be 365.25 days long,
andoverthecourseof19greatyinyearssevenextralunarmonthswouldbeadded
atvariouspointstomakeupthedifference.Thisfour-divisioncalendarcombinedthe
dual characteristics of the lunar calendar and that ofreturn years to create ayin
and yang lunisolar calendar, i.e., one based on both lunar and solar cycles. In Basic
Questions,thefivemovementsandthesixqi(wynliq,)calendarused
in theseven great treatises 2 on qi movement is in fact a further continuation and
developmentofthisyinandyanglunisolarcalendar.
The Inner Classic emphasizes the influence of the energies of the entire universe
on human beings. Basic Questions Chapter 25 Discourse onTreasuring Life and
Completing the Physical Form (SWn-Bo Mng Qun Xng Ln,
) states:Humans are born of the qi of heaven and earth and are completed by the
laws of the four seasons. ()When talking about the
movementsoflifeandthelawsofpathodynamicchange,itemphasizesthatonemust
takeintoconsiderationthegreaterenvironment.BasicQuestionsChapter69TheGreat
TreatiseonQiExchangeandChange(SWn-QJioBinDLn,)
states:Withregardtotheway,knowtheheavensabove,knowtheearthbelow,and
know man and his affairs in the middle; in this way one can be eternal. (
)These quotes serve to remind us that
Chinese medical theory is intimately connected with astronomy, geology, and social
knowledge.
1 Thefour-divisioncalendar(sfnl, )isalsoknownasthequarterremaindercalendar.
2 SevenchaptersoftheInnerClassicarespecificallyfocusedonthemovementsofqi(Chapters66-71and
74).They are considered very important though quite abtuse and so are here referred to asgreat treatises.
These chapters contain more advanced level ideas relating the cycling of nature and the environment to both
changesinthehumanbodyaswellasdiseasesprocessesthatmightthereofoccur.
The Construction of Chinese Medicine Theory

Chinese medicine theory originated naturally from the thought processes of the
ancientChinese.Thephilosophicaltheoriesthathadaprofoundinfluenceonmedical
theoryincludeqi-based monism, yin and yang theory, and five phases theory.These
philosophies were not simply world views hiding in the background, but were
important methods actively used to construct various Chinese medicine theories,
theories that include the relationship between the five phases and the five organs.
In the end, along with other important ways of thinking in Chinese medicine, like
holism,systems,anddialecticaldifferentiation,thetheoriesnotonlycametoserveat
thehighestlevelofthemedicinetradition,butcanretrospectivelybeunderstoodto
have extended the ancient philosophical theories themselves.This way of thinking
embodies an ancient worldview that is summarized asthe unity of heaven and
earth and contemplates howheaven (the whole universe with all its myriad
aspects) influences humankind; it sparkles with the wisdom of Eastern civilization.
It also correctly and profoundly recognizes the link between Chinese medicine and
Chinese culture.Without an understanding of this foundation, any examination of
Chinese medicine is just like looking at flowers in a fog-fuzzy images, blurry ideas
andadeepsenseofmystery.
ThecontentofChinesemedicinemethodologyisextremelyrichandmultileveled.
Undertheguidanceoftheabovementionedphilosophies,Chinesemedicineusesthe
unusualmethodsofproficiencyinreadingexternalsignstomakeconjecturesabout
the internal condition,taking an object and comparing across categories, direct
apprehensionandinsight,anddiscriminationoftheunusualfromthenormal.
Proficiency in Reading External Signs to Make Conjectures about the Internal
Condition(SWiChuiNi,)
Pre-QinDynastyscienceearlyondiscoveredthattherewasaconnectionbetween
internal phenomenon and external expressions or manifestations. For example in
Guanzi Earth Numbers (Gun Z-D Sh Pin, ) it records:If there is
cinnabarsandabove,thentherewillbeyellowgoldbelow.Ifthereismagnetiteabove,
thentherewillbecopperbelow.()
Similarly,TheSpiritualPivotChapter45ExternalConjectures(LngSh-WiChui,
)usestheexamplesofthecauseandeffectrelationshipofformandshadow
andresonanceandsoundtoexpresstheideaofproficiencyinknowingtheinternal
conditiontomakeconjecturesabouttheexternalsigns 1andproficiencyinreading
externalsignstomakeconjecturesabouttheinternalcondition.Medicalpractitioners
of the time absorbed these ideas into the field of medicine, and used qualia on the
1 Theideathatoneknowswhatsignsagiveninternalchangecouldproduceontheexterior.
outsideofthebodytogetanunderstandingofthepatternoftheinternalpathological
changesthatwerehappening.Thiswasdonethroughapprehensionofallaspectsin
a living body and analysis of the reactions that occurred in the physical body under
differentenvironmental conditions and with different external stimuli to understand
the laws of physiology and pathology.This is whatproficiency in reading external
signstomakeconjecturesabouttheinternalconditionrefersto.In BasicQuestions
Chapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena(SWn-YnYng
YngXingDLn,)thestatementUsetheexteriortoknowthe
interioralsoreferstothisidea.
With regards to the Chinese medicine meaning oforgan manifestation (zng
xing, ), Zhang Jie-bin gives the most lucid explanation:Manifestation refers
toformandappearance.Thatwhichisstored1insidethebodyisgivenformthatcan
be seen on the outside, therefore it is referred to asorgan manifestation. 2 Organ
manifestationtheoryinChinesemedicinedirectlyusesthetechniquesofproficiency
inreadingexternal signs to make conjectures about the internal condition anduse
the exterior to know the interior to investigate the mutual relationship between
manifestationandzang-organtobettergraspthelawsoflife.
The method ofproficiency in reading external signs to make conjectures about
the internal condition is one of the most important methodologies underlying
the establishment of Chinese medicine and is similar to the idea of the black box
seenincontroltheory.Becausetherearenodismemberableobjectcorrespondences
or destructively interfering object correspondences in this methodology, loss of
veracity is relatively slight thereof enabling the methodology to obtain much
informationotherwiseunattainableusingregressionanalysis.Additionally,itenables
a comprehensive grasp of the intricacies of the connections between the objects of
correspondenceaswellastheirchanges.Inthiswaythemethodologycanbeseento
haveadistinctsuperiority.
ComparingQualiaacrossCategories(QXingBLi,)
Comparing qualia across categories is also referred to ascomparing an object
acrosscategories.Thespecialfeaturesofthismethodologyisthecomparisonoftwo
objectsorphenomenonbymakingaconnectionbetweenthemandlookingforsimilar
innate qualities. By using that which is already known about the innate qualities of
one of the things knowledge which is based on a large volume of apprehended
information from previous experience with the known object and applying said
1 The original meaning ofzang-organ in the Inner Classic is actually a reference to storage, especially
storage of essence. Later the flesh radical was added to distinguish it from the more ordinary meaning of
storage.
2 This could also be translated asdepository manifestion.This translation conveys the idea that the five
zang-organsarerepositoriesofessence.
knowledge to the unfamiliar thing, one can see similarity in the innate qualilies the
two things possess. In this way, knowledge of the innate qualities in the unfamiliar
thing can be learned and its nature in the large body of growing apprehended
knowledge determined: In Basic Questions Chapter 76 Discourse on Explicating
Compliance Patterns (SWn-Sh Cng Rng Ln, ) it states:The
variationsofthemethodologyoftakinganobjectandcomparingitacrosscategories
areinexhaustible():thisstatementisoftenusedtoshowthatthis
methodologyisaverycommonlyusedtechniqueinChinesemedicine.
For example, The Spiritual Pivot Chapter 55 Counterflow and Flow (Lng Sh-
N Shn, ) uses military strategy as an analogy for needle therapy. For
instance, in the text it says:The Art ofWar states:Do not go up against a powerful
force;donotattackawell-orderedlargearmy.TheMethodofNeedlingstates:Donot
needleifthereishighfever;donotneedleifthereisprofusesweating.(
)Inthecomparison
ofwarfaretoneedletherapyintreatingdisease,bothfacetheproblemofcomingup
againstanopposingforceagainstwhichtheymusttesttheirstrength.Theyhavethis
certainsimilaritysotheycanbecompared.Duringwarfare,iftheenemyhaspowerful
decisivestrengthofforce and its militaryformationsarewellordered, thenit is folly
toinitiateanattackagainstthem.Inthesameway,whenneedling,ifthepatienthasa
highfeverorissweatingprofusely,itisanindicationthatthepathogenicqiorforceof
thediseaseisquitepowerfulandoneshouldnotneedle.Inthiscase,itisnecessaryto
waitfortheforceofthediseasetosubsidebeforeneedling.
The famous German philosopher Kant once said:If our thoughts lack reliable
reason, then analogy can often enable us to advance. 1 Chinese authors are good
at finding similarities between seemingly unrelated things and, from this, making
analogiestoexplorenewideas.
DirectApprehensionandInsight(ZhJuLngW,)
Directapprehensionandinsightreferstoinspiredthoughtthatrisesoutofadeep
understanding of the phenomenon at hand and which then further allows one to
suddenly intuit some common objective order or pattern. Direct apprehension and
insightiscreativeinitsdirectobservationandthistypeofthoughtischaracterizedby
closeobservationofbeautyprecipitatinginsightareferencetoa-conceptualand
a-logicalsensoryrevelation.WhenChinesemedicinetheorywasestablished,thiskind
ofthinkingwasthemostrepresentative.
InBasicQuestionsChapter26TheEightProper(Directionsand)SpiritualBrilliance
1 Retranslated from the Chinese, so the translation may not be the standard English translation of this
sentence.
(SWn-B Zhng Shn Mng Ln, ) 1 there is a wonderful section

thatdescribesspirit:
The Emperor asked:What is spirit? Qi Bo replies:To talk of spirit; spirit, ah, spirit.The
earscannothearitbuttheeyesbecomebright,the heartopensandthewilladvances;wisdom
suddenlyonitsownintuitsthatwhichcannotbespokenof;thosewithcompletevisionalone
seethatwhichistheretosee;theproperstateisasifdimormuddled,whenthelightshines,it
shines for one alone, like the wind blowing cloudsthis is spirit. (

)
Theancients used the phraseyin and yang cannot measure it2 to explain spirit.
With regard to the recognition of the underlying order of things, it is only great
wisdom whereinwisdom suddenly on its own intuits, andwhen the light shines,
itshinesforonealone;andsuddenlylikethewindblowingcloudsonecanachieve
instant insight.This kind of thinking does not totally rely on logical processes but is
ratheraprocessinvolvingthefullnessofthesoulinapprehendingandgivinginsight.
Thissaid,however,itdoesnotmeanthinkingwhateveronewantsorfoolishthoughts
and ideas.This kind of thinking process is not easily brought about but is rather
generatedoutofabilityandskillinusinga-logicalthoughtprocesses.Itrequiresfar-
reachingand deep knowledge; it is rooted in reality to which it closely cleaves in its
investigationsofthequestionathand.
Direct apprehension and insight are important methods of creative thinking and
were instrumental in the formation of the theories of Chinese medicine. Of course,
there is a certain amount of uncertainty involved when using this method to grasp
underlyingtruths,andsotoraiseituptoamorevaluabletheoreticallevel,itmustbe
usedinconjunctionwitheitherpracticalexperienceand/orrigorouslogicalreasoning.
DiscriminationoftheUnusualfromtheNormal(KuDuQHng,)
The termdiscrimination of the unusual from the normal refers to the idea of
using comparison to evaluate whether something is extraordinary or common.The
Chinese characters translated here asdiscrimination (ku du, ) more literally
meanconjecture, orestimate.The terms translated asunusual andnormal
refer to the idea of using the general situation (normal, literallyeternal) and a
special situation (unusual, literallystrange) and making a comparison of the two
tofindthedifferencebetweenthemandconfirmthepresenceofsomethingoutofthe
1 The eight proper directions refer to north, south, east, west, northeast, northwest, southeast and
southwest.TheseareimportantinChinesemedicineasthedirectionofwindincombinationwiththeseasonat
handisanindictionofproperorevil(pathogenic)qi.
2 Inthisphrase,yinandyangmayrefertophenomena.Itcouldalsomeanthatwhichisdividedcannot
beusedtomeasurethatwhichiswhole.
ordinary.Inthis regard, by comparison to a state of health, illness isunusual, while

a healthy state isnormal.When comparing disease states, those disease states not
normally seen would be consideredunusual while more common disease states
wouldbetermednormal. Chinese medicine uses thediscrimination of the unusual
fromthenormalmethodtoassistindiscovery,confirmationandintheevaluationof
allkindsofnormalandunusualphenomenon.
As an example, in Chinese medicine the breathing rate of a healthy individual is
usedtodeterminewhetherthepulseofapatientisfastorslow.
InBasicQuestionsChapter18DiscourseonQiManifestationinaHealthyPerson(SWn-
PngRnQXingLn,)itsays:Apersoninhalesandthepulsebeatstwice,
exhalesandthepulsebeatstwiceagain;acompletebreathfixesthepulseatfivebeats.Theextra
beatisbecauseofthegreatceasing1andthisiswhatisreferredtoasanormalpersonanormal
personbeing a reference to one who has no disease.Itisusualthatonewhohasnodisease
addresses the sick; in this, the physician, who is not ill, therefore uses the method described
abovetoestablishabaseline.(
)
Inthisexample,acomparisonisfirstusedtodeterminethebreathingrateofahealthy
personanditsrelationship to the beating of the pulse; this standard is then used to
evaluate a patients pulse.This is the so-calledone who has no disease addresses
theonewhoisill of the quote above.The quote from Basic Questions Chapter 20
DiscourseontheThreeSectionsandNineIndicators(SWn-SnBJiHuLn,
)Firstknowthechannelsandvesselsandthenknowadiseasedpulsealso
basicallyreferstothistypeofmethod.
Bothdiscrimination of the unusual from the normal andcomparing qualia
across categories are comparative logic methods used in the field of Chinese
medicine.Things in the phenomenological world have a certain similarity as well
as their obvious differences; additionally, at ever finer levels of discrimination,
within their similarities there are differences and within these differences there are
similarities.This is the fundamental nature of the phenomenological world and
the objective basis of the comparative method. Developments in science are now
exploring the differencesfoundinsimilarity and the similarities found in differences
seeninobjectsofcognition.Thesimilaritiesanddifferencesthattheyarediscovering
areevergreaterinnumberandsophisticationandexplorationsintothebasicnatureof
thephenomenologicalworldgoeverdeeper.Duringtheprocessofexploringhuman
physiologyandpathology,theauthorsofChinesemedicineconsciouslyadoptedthe
comparative method using it widely and creating the methods ofdiscrimination of
1 Thepausebetweenthebreaths.
theunusualfromthenormalandcomparingqualiaacrosscategories.
Special Characteristics of the Theory Found in the Inner Classic

The structure of the theoretical system found in the Inner Classic dictated its
scholarlynature,anaturethatcanbedescribedbythreecharacteristics:holisticgrasp
ofthelawsoflife,differentiationoflifeactivitiesandencapsulatingtheessenceoflife
viafunctionalphenomenon.
HolisticGraspoftheLawsofLife
During the course of its inquiries into the laws of life, the Inner Classic did not
divide the human body into disparate parts and analyze them independent of each
other.Rather,thebodywasrecognizedandunderstoodfromtheinterconnectedness
ofitsinnerstructures and its connectedness with the larger natural world around it.
Inthisway,notonlyisahumanbeingseenasanorganicwhole(thefivezang-organs
are one body), but also humankind and nature are a unified whole (heaven and
humankinduniteintoone).
(1)Thefvezang-organsareonebody(wzngyt,)
The Inner Classic holds that a human being is an organic whole and that the
organs and tissues that constitute that whole are connected structurally and
functionally. The organs mutually coordinate: functionally speaking, they are
interdependent; pathodynamicly speaking, they also mutually influence each other.
Theiractualincarnationisintheonenessofthefive zang-organsandtheunityofform
andspirit.
Inner Classic organ manifestation theory holds that the five zang-organs are the
heart of five functional systems, and that, via the channels and collaterals, connect
thesix fu-organs, the five bodies, five sense organs, nine orifices, four limbs and the
hundredbones1ofthewholebodyintooneentity.Forexample:
HeartSystem:HeartSmallIntestineBloodVesselsTongueFace
LiverSystem:LiverGallbladderSinewsEyesNails
SpleenSystem:SpleenStomachFleshMouthLips
LungSystem:LungsLargeIntestineSkinNoseBodyHair
KidneySystem:KidneysBladderBoneMarrowEarsHair
Although the zang-fu organs and tissues have different functions, the heart
dominates them all and each of the zang-fu organs is intimately coordinated into
an organic whole. A human being is the harmonious unification of form andspirit:
spirit cannot exist separately from form, there is form and therefore there is spirit;
conversely, without spirit to rely on, form is nothing but an empty husk. Harmony
between form and spirit is an indication of health, while its loss is a sign ofdisease
1 Hundredbeingaeuphamismformany.
and illness.The unification of form and spirit is the underlying life view of Chinese
medicineandisalsothetheoreticalbasisofthesayingheartandbodyareunified.
(2)Heavenandhumankinduniteintoone(tinrnhy,)
Heaven refers to nature and the meaning ofheaven and humankind unite into
oneisthathumankindandnatureareaunifiedwhole.Humankindisaphenomenon
inthisuniverseandalongwithalltheotherphenomenabetweenheavenandearth,
wearegeneratedandcompletedfromthesamesource.In BasicQuestionsChapter
25DiscourseonTreasuringLifeandCompletingthePhysicalForm(SWn-BoMng
Qun Xng Ln, ) it says:The qi of heaven and earth unite and
this is called man (); andman is born of the qi of heaven and
earth and completed through the laws of the four seasons. (
) Humans are generated in the natural world and rely on conditions
in the natural world for birth and maturation.The life activities of a human are
necessarily controlled and influenced by natural phenomena and, as humans live in
theqiexchangeofheavenandearth,thelivingphenomenaofahumanbeingcanbe
consideredasonepartofnature.Forthisreason,certainoftheprinciplesunderlying
changesinnature are the same as those in principles underlying human physiology.
This is the basis of howheaven and humank ind unite into one came to be
establishedastheoryintheInnerClassic.InTheSpiritualPivotChapter79Discourseon
theDewoftheSeasons(LngSh-SuLLn,),itstates:Manmutually
participates with heaven and earth; man responds to the sun and the moon. (
)
Ideas found in the Inner Classic all start from the basic recognition of a human
being as a whole and require physicians to not only look at a localized area when
diagnosing,butjustasimportantly,toconsiderhowthewholeinfluencesthislocalized
area; it asks that a physician not only pay attention to changes seen in the patients
body,butespeciallytoinfluencesarisingfromconnectionstothenaturalenvironment
andsociety.Diagnosisofdiseaserequiresexaminationofboththeinsideandoutside
oftheindividual,andtonotmissanythingthatmightbebeneficialtotheindividuals
qi.Duringthecourseoftreatment,atreatmentprotocolmustbeestablishedwhichis
beneficialtothetimeandtheplaceofthetreatment,itisnecessarytoconsiderthe
qi of the season and to not fight against the harmony of heaven. Failure to do this
willresultintheproblemthatthetreatmentisnotinaccordancewiththeperiodof
heaven 1 or does not take into account the specifics of earth; this will be calamitous
1 Inthechapterthatthisquotecomesfrom(BasicQuestionsChapter5TheGreatTreatiseonYinandYang
CorrespondenceinPhenomenon),Heavenissaidtohaveeightsolartransitionswhichrespectivelycorrespondto
changesbetweenandwithintheseasonsSpringEstablished,SummerEstablished,AutumnEstablished,Winter
Established, Spring Divide (Spring Equinox), Autumn Divide (Autumn Equinox), Summer Arrival (Summer
Solstice)andWinterArrival(WinterSolstice).Thisquotebasicallysaysthatthetreatmentmusttakeintoaccount
theseason(andbyextensiontheweather),aswellasthespecifcsofwherethepersonlives.
and result in harm to the individual. Life cultivation practices must:obey the laws
of yin and yang and harmonize the art and the numbers;1 one mustaccommodate
oneselftothechangesofthefourseasonsandadapttowintercoldandsummerheat,
toharmonizehappinessandangerandlivepeacefully,tomoderateyinandyangand
regulatehardnessandsoftness;ifoneisabletodothis,thenperniciousevilswillbe
unabletoreach(you);youwilllivelongandyourseeingbeprolonged.2
DiferentiationofLifeActivities
The theoretical system in the Inner Classic is intimately connected to ancient
Chinese philosophy and pays great attention to the use of differentiation in its
dealings with life processes.The Inner Classic not only holds that all things have a
common origin, but also that all things change, that nothing is independent, that
everything is interconnected and is mutually influential. It looks at life, health and
diseaseashavingcommonordinaryconnectionsandeternalmovementandchange.
TheInnerClassictakesancientyinandyangtheoryandusesittoexplainthelaws
ofpolarizedoppositionandholisticunitythatexistinthelifeactivitiesofthehuman
body.Withregardtothestructureofthehumanbody,BasicQuestionsChapter4True
WordsfromtheGoldenCabinet(SWn-JnGuZhnYnLn,)states:
Whentalkingoftheyinandyangofaperson,theexteriorisyangandtheinterioryin.
Withregardtotheyinandyangofthehumanbody,thebackisyangandtheabdomen
isyin.Withregardtotheyinandyangofthezang-andfu-organs,thezangareyinand
thefuareyang(
) Regardless of how complicated
the human body is, it can still be divided into yin and yang and then divided again
as yang within yin and yin within yang, and infinitum. From the point of view of
humanlifeprocesses, the contradictions inherent in diametrically opposed activities
produces disappearance in one place and growth in another and flourishing here
andweakeningthere,processesthatmaintainthehumanmechanisminanunending
dynamic balance. For example, the transformation that occurs between matter and
function,apairofoppositesmovingfrombalancetoimbalance,playsoutaceaseless
process of rebalancing of yin and yang in the dance between polar opposition and
unity.Yang transforms into qi, yin creates form, is to say that going from matter
that has form to matter that has no form is a process ofqi transformation, the end
resultofusingyang.Conversely,goingfrommatterthathasnoformtomatterthat
has form is the end result of usingyin. Between yin and yang qi transformation
1 In this phrase,art refers to proficiency with a specific skill, whilenumbers refers to the use of
Chinesenumerologyasacompletesystemofsymbolstoexplainallphenomena.
2 There is much discussion about what the phrase translated asyou will live long and your seeing be
prolonged( ),actuallymeans.Thisisespeciallytrueaboutwhatyourseeingbeprolongedmeans.
Mostannotationsregardthetwohalvesofthephraseasbothmeaninglongevity.
and the creation of form, endlessly generating and endlessly transforming, normal
physiological processes are maintained. If ever yin and yang fail to interact
harmoniously,thenthisisadiseasestate.Ifyinisvictorious,yangbecomesdiseased;
if yang is victorious, then yin becomes diseased. If yang is victorious, there is heat;
if yin is victorious, there is cold. Reduplicated cold results in heat; reduplicated heat
resultsincold.Reduplicatedyangresultsinyin;reduplicatedyinresultsinyang.If
yin and yang separate, then essence is finished.The theoretical system in the Inner
Classic uses this understanding of the dance between polar opposition and unity to
analyzeandexplainphysiologicalandpathologicalphenomenon.Theoccurrenceand
continued developmentofdiseaseisbydefinition caused by an imbalance between
yinandyangandthereforeredressingtheimbalanceisthebasicprincipleunderlying
alltreatmentprotocols.
Movementisanattributeofmaterialthings.The InnerClassicholdsthattheliving
processesseeninthestagesofbirth,growth,vigorandageareeternalmovementsand
thenfurtherusesthisrecognitionofmovementandchangetounderstandquestions
of man and nature well as disease and treatment. For example, in the natural world
Theqiofheavendescendsdownward,flowingontotheearth;theqiofearthascends
upward, steaming toward heaven.Therefore high and low call to each other, rising
and descending result in each other, and from this change occurs. (
)Inthehumanbody,
clearyangcomesoutoftheupperorifices,turbidyincomesoutofthelowerorifices;
clear yang vents from the interstices, turbid yin runs through the five depositories
[i.e., the zang-organs], clear yang fills the four limbs, turbid yin returns to the six
clearinghouses [i.e., the fu-organs, or bowels]. (
)Withregardtodisease,Dayoneofcold
damage,thegiantyang1isaffectedDaysixandthejueyinisaffected.(
)Withregardtotreatment,thisunderstandingisreflected
intheconceptsofsamediseasebutdifferenttreatmentsanddifferentdiseasesbut
thesametreatment.InBasicQuestionsChapter68TheGreatTreatiseontheSixSubtle
Profundities(SWn-LiWiZhDLn,)itsays:Successorfailure
depends on the hidden movements of life, movements that never cease; therefore
changehowyouact(treat).()
EncapsulingtheFundamentalSubstanceofLifeViaFunctionalPhenomenon
In the Inner Classic, understanding of the fundamental substance of life and its
patterns was mostly garnered from the observation of natural phenomenon and
human physiology and pathology and the subsequent summarization of these
observationsintogeneralizedtheories.The zang-fuorgansarehiddendeepwithinthe
1 Anolderalternatenameofthegreateryangortaiyangchannels.
body,and,forthisreason,thephysicianhasnowaytounderstandtheirphysiological
activities; however, one can observe physiological phenomenon that occur on the
exteriorofthebodytogainunderstandingofthefundamentalsubstanceoflifeandits
patterns.TheformationofthetheoreticalsystemfoundintheInnerClassicisaresult
of the experience garnered from our forefathers long struggle with life and disease;
it is what they found when they looked up to the heavens, when they looked down
inobservationoftheearth,whentheylookedafaratallthingsandwhentheylooked
closely at the body. According to research, the formation of organ manifestation
theory as seen in the Inner Classic was not only based on rudimentary autopsies of
humancorpses,butevenmoreimportantlywasbasedoncarefuldynamicobservation
of living bodies and analysis of the differing changes a person was seen to exhibit
in response to differing environmental conditions and external stimuli. From this,
the patterns of life were learned and understood. In other words, the ancients went
frommanifestation to an understanding oforgans.The meaning expressed in
BasicQuestionsChapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena
(SWn YnYngYng Xing D Ln, ) when it saysuse the
exterior to know the interior as well as in The Spiritual Pivot Chapter 45 External
Conjectures(LngShWiChui,)whenitsaysbeproficientinreading
externalsignstomakeconjecturesabouttheinternalconditionisthesame.
The Scholarly Value of the Inner Classic

EstablishesaUniqueTheoreticalSystem
There have been many traditional medicines throughout the history of world
medicine; Greek, Roman, Indian, Egyptian, and Arabic medicines are but a few.
WiththeexceptionofChinesetraditionalmedicine,however,allofthemhaveeither
become relegated to the status of folk medicine or have out and out disappeared.
Chinese traditional medicine has had its share of difficulties, but because it is such
anoutstandingsystemofmedicine,notonlyhasitcontinuedasamajormodalityof
medicine, but is enjoying increasing attention from people around the world. In the
historyofmedicine,thissituationisverymuchworthyofcontemplation.Inaddition
to the extraordinary efficacy of its treatments, it also has a unique and relatively
complete theoretical system based on the contents found in TheYellow Emperors
InnerClassic.Thus,Chinesetraditionalmedicinehascontinueditsdevelopmentover
millenniawithoutweakeningandisalsothemainreasonthatitistheoneremaining
fagonthepoleofworldtraditionalmedicines.
The Egyptians once had an unrivaled system of medicine, but, after the country
was subjugated by the Macedonian king Alexander the Great in 332 BCE, its culture
and traditional medicine began the process of becoming Hellenized. Following
subsequent invasions by the Romans, fragments of Egyptian culture were slowly
melded into Christian and Islamic cultures, leaving behind only the pyramids and
mummiestoponder.
Traditional Indian medicine was once rich in content, but following the Aryan
invasionofabout1500BCE,itwasdestroyed.
Ancient Greek and Roman medicine flourished in the wake of the rise of their
respective countries; later, following the decimation caused by foreign invasion,
their pre-eminence waned. More recently, inWestern countries, ideas found in their
traditional medicines have been devalued and discarded and, like Arabic medicine,
haveforthemostpartbeencompletelysupersededbymodernmedicine.
There are actually two reasons that Chinese medicine has been able to survive
until today.The first is its value as a medical treatment modality; Chinese medicine
has provided indelible service to the Chinese people as they prospered over the
centuries.Thesecondistheundiminishedattractionofitsguidingtheories,theories
whose value to this day cannot be underrated. Following the Inner Classic, each
subsequent dynasty further developed the theories of Chinese medicine; the rise of
manydifferentschools of thought has ensured that now there are enough books on
thesubjecttofillalibrary.Mostinterestingofallthough,isthatallofthesedifferent
theories,schoolsofthought,andtextsstilltracebacktotheInnerClassic.
Utilizes the Concept ofHeaven, Earth, and Humankind theThree Realms (Sn
Ci,)
There is a great difference between Chinese and Western medicine, though,
objectively speaking, both have their advantages. At present, theWestern medicine
market is larger, but from a medical model point of view Chinese medicine has a
definite superiority. In its formative years,Western medicine was strictly a biological
model of medicine and, with the help of microscopes, discovered microorganisms.
It quickly discovered that if one were able to find a way of killing off pathogenic
microorganisms, then one could treat disease. Subsequent medical experience
showed, however, that this was not always efficacious in treating disease and that
there were many disorders not associated with microorganisms.Without doubt, the
biological model of medicine was a major impetus not only in the development of
Westernmedicinebutalsointheestablishmentofthehealthindustry.Especiallywith
regard to the treatment and prevention of acute contagious and parasitic diseases,
this model of medicine was responsible for major decreases in the occurrence and
mortality associated with such diseases. Clinically, the Western medical model
and practices that have as their basis studies in microbial pathology have enabled
definitivediagnosisforcertaindiseases;ithasenabledtheuseofsterileprocedures,
anesthesia and antibiotics, the combination of which has reduced the pain and
suffering of surgery, and which effectively prevents infection of the incision and
increasesthecurativeefect.
That said, however, one needs to see howreductionism andmind-body

dualism have influenced this model, leaving it reductionist and one -sided in
many ways. Firstly, in a purely biomedical model, research into health and disease
is conducted only from the biological perspective addressing only the biological
nature of the body and discounting the psychosocial nature of humans. Secondly,
in a clinical setting the biological mechanisms of the body are emphasized at the
expenseofpsychologicalandpsychosocialcausesofdisease.Thirdly,researchfocuses
mostly on biological activities and processes with little research done on behavior
or psychological processes. Lastly, this model of medicine has inherent within it a
formalizedwayofthinkingthatgoesIfnotA,thenB(ifitisnotadisease,thenitis
health). For these reasons, it becomes difficult to fully understand certain functional
or psychological disorders and even more difficult to satisfactorily treat them.This
model is necessarily unable to fully elucidate human health or the complete nature
ofdisease.Fortunately, the old model of biomedicine is already starting to shift to a
biological-psychological-socialmodelofmedicine.
TheInnerClassicholdsthathumanbeingsareaproductofthenaturalworldand
thathumanlifeisbutonepartofallofnaturalphenomenon,emphasizingthathuman
beings and nature are inseparable parts of a whole and that both are subject to the
samenaturallaws.
In the Inner Classic it says:The qi of heaven and earth unite and this is called
man.()The natural world is filled with qi, qi that can be further
dividedintoyinqiandyangqi.Thejoiningtogetherandexchangeofyinqi(earthqi
inthisinstance)andyangqi(heavenqiinthisinstance)iswhatformsahumanbeing.
TheInnerClassicusesqiasthemediumtolinkmanandheavenandearth;itsaysthat
man and heaven and earth correspond, pointing out that changes in the natural
environment and changes in the physiology of a human being are tied together in
a thousand and one ways. Consequently, the text takes the natural and the social
environmentsintoconsiderationwheninvestigatingthelawsoflivingprocesses.The
heaven-earth-humankindthreerealmsmodelisaholisticsystemwhoseconstituent
parts are inseparable.The Inner Classic requires that every physicianAbove, know
thewritingsofheaven[i.e.,astronomy,astrology];below,knowthetexturesofearth
[i.e., geology, geomancy]; in the middle, know the affairs of man.Thewritings of
heaven andthe textures of the earth generally refer to all factors from the natural
environment;the affairs of man is a general reference to social and interpersonal
matters,thegreaterofwhichincludesocialpolitics,economics,culture,andcustoms,
thelesserofwhichreferstotheadministrationofdisease,economicposition,affairs
of the family and personal history, all of which are intimately connected to the
mental and physical health of any individual.The heaven, earth, humankindthree
realms medical model permeates the entirety of the Chinese medicine theoretical
system,providingguidanceinthepracticalmedicalactivitiesofrecognitionofhuman
physiology, diagnosis of disease and the prevention of disease and maintenance of
health.
Thethree realms model of medicine instructs physicians to not only pay
attentiontothediseasethepatienthas,butmoreimportantly,topayattentiontothe
person;toknowwhoitisthathasthisdisorderassometimesthisismoreimportant
than knowing what disease the person is presenting with. Disease is nothing more
thantheorganicreactionthebodyhastosomedisease-causingfactoranddifferent
bodieswillhavedifferentreactionstothisfactor.Theindividualalwaysreactstoand
experiences disease based on their personal constitution and check-ups will reveal
all kinds of symptoms.The fact that the Inner Classic has theories of physical and
bioenergeticconstitutionthatparticularlyemphasizethisideaisbasedonthis.
One of the things that people find surprising is that thethree realms model of
medicine found in the Inner Classic and the social-psychological-biological model
that recent advances in the medical world has put forward have basically the same
point of view.This shows that the two do not regard the individual as an island
entirely separable unto him or herself, but rather that the individual is regarded as
a constituent member of a greater natural and social order. Once this is realized,
recognizing health and disease is no longer a matter of simply looking at the
individual,butalsoinvolveslookingattheconnectionsbetweenmanandthelarger
naturalandsocialenvironments.Inadditiontothis,thetwosystemsofthoughtalso
pay attention to the spiritual and psychological factors that influence health and
disease and emphasize the importance of psychosocial factors.This enables better
recognition and management of health and disease and an escape from the dead-
endtrapofunderstandingbasedonpurelybiologicalfactors.Thishasthebenefitof
providingguidancetothedevelopmentoftheartofChinesemedicineimprovingits
abilityindiagnostics,treatment,andpreventionofdisease.
SynthesizesMultipleFieldsinitsMedicalResearch
The human body is very complicated and it is this complexity that determines
thebroadconnectionsbetweenmedicineandotherfieldsofenquiry.Advancesmade
in other fields often act to further the development of medicine: for example, once
X-rayswerediscovered,theysoonbecameusedinamedicalsetting;aftertheadvent
of computers, the CT was invented; and further developments in organic chemistry
enabled the development of biochemistry and molecular biology.These examples
showhowmedicineabsorbsknowledgefromotherfieldsandthemorefieldsitdraws
uponthebetterableitistorevealandexplainthelifeprocesses.
Openupthe InnerClassic anditisimmediatelyobviousthatitscontentsarenot
restrictedtothesinglefieldofmedicine;thebookhasabsorbedthephilosophiesand
scientific achievements of ancient workers and scientists in the fields of astronomy,
calendar science, meteorology, biology, geology, psychology and philosophy.The

contributionsofthe InnerClassiclienotonlyinthefactthatitbringstogetherallof
themedicalknowledgepriortotheQinDynasty,butalsothatitisamodelofwhatit
meanstobringmultiplesciencestogetherintothefeldofmedicalresearch.
For example, the Inner Classic records Spring and AutumnWarring State Period
achievementsinthefieldofmeteorology:inBasicQuestionsChapter9Discourseon
theSexagenaryCyclesandOrganManifestation(SWn-LiJiZngXingLn,
) it says:Five days are called ahou-period,1 three hou-periods are called
a qi-period, 2 six qi-periods are called a season and four seasons are called a year.
()Thementioninthebookofthe
fourseasons,theeightsolarterms,3andthe24seasonaldivisions4arerelativelyearly
recordsthatgointodetailabouttherelationshipbetweenchangesintheweatherin
theirrelationshiptohumanhealthanddisease;fromtheserecords,theancientscience
ofmeteorologythetheoryofqimovementwascreated.
InBasicQuestionsChapter12DiscourseonDifferingTreatmentsandAppropriate
Strategies (SWn-Y F FngY Ln, ) there is a discussion of the
differing geology and environment, climate, customs of the time, dietary practices,
constitutionalcharacteristics,commonlyseendiseasesandtheirappropriatetreatment
foundinthefivedirectionsnorth,south,east,westandcenter.Thisdiscussionisthe
nascentinceptionofmedicalgeography.
The Inner Classic pays great attention to the relationship between psychology
and health and disease. It notes the relationship between how the emotions affect
physiology from how they first affect physiology to how they result in disease and
itsdetaileddiscussionoftheseissuesestablishedtheuniquefieldofChinese medical
psychology.
TheInnerClassicalsohasrichrecordsregardingthebiologicalclock,recognizing
thattheinnerorgans,channelsandqiandbloodchangesarefunctionallyrhythmical
1 Hu meansmanifestationorhowsomethingappears,soahou-periodimpliesaperiodoftimewherein
thereissomecontinuitytohowtheweatherappears.
2 Q isthesamewordasisoftentranslatedasenergyorbreath.Aqi-periodisaperiodoftimewherin
thereissomecontinuitytothequalityoftheqi.Notethataqi-periodis15daysorhalfalunarmonthinlength
andusuallycorrespondstoaseasonaldivision.
3 Theeight solar terms, a subsection of the 24 seasonal divisions, refer to eight pivotal solar transition
points in the year: Spring Established, Summer Established, Autumn Established,Winter Established, Spring
Divide (Spring Equinox), Autmn Divide Autumn Equinox, Summer Arrival (Summer Solstice) and Winter
Arrival(WinterSolstice).
4 The 24 seasonal divisions in order are Spring Established, RainWater, Awakening from Hibernation,
Spring Divide, Clear Bright, Grain Rain, Summer Established, Small Fullness, Grain in Beard, Summer Arrived,
Lesser Summerheat, Great Summerheat, Autumn Established, Dwelling in Summerheat,White Dew, Autumn
Divide, Cold Dew, Frost Descends,Winter Established, Lesser Snow, Greater Snow,Winter Arrived, Lesser Cold,
andGreatCold.
innature,cyclingaccordingtocircadianrhythms,tidalrhythms,andmonthlyaswell
asyearlyrhythms.Workingwiththesechangingrhythmsisofbenefitinmaintaining
oneshealth,whilegoingagainsttheserhythmscanresultindisorderanddisease.
This type of synthesized multidisciplinary research found in Chinese medicine
reflects on the one hand, a lack of detailed differentiation by the ancient scientists,
whileatthesametimepointingouttheconnectionsandinterpenetrationthatexists
between medicine and the other natural sciences and philosophy.This kind of
multidisciplinaryapproach,withitsconnections,interpenetrationandsyncretization,
ispreciselywhatgavebirthtonewtheoriesandopenedupimportantnewavenuesof
thought;itisanimportantprincipleinthedevelopmentoflearningandknowledge.
Thus, the theoretical principles determined in the Inner Classic have life and vigor
to this day.The reason that modern day fringe sciences like medical meteorology,
chrono-medicine,socialmedicine,andmedicalpsychologycanfindembryonicforms
intheancientclassicsisthattheunderlyingreasoningisthesame.
EstablishesChannelTheoryandAcupunctureandMoxibustionTherapies
The modern phenomenon whereinChinese medicine is a hot field is perhaps
better phrasedacupuncture and moxibustion are hot fields as Chinas traditional
medicine was guided to the world stage by acupuncture. It was this phenomenon
ofacupuncture is a hot field that has led to the intensive research into the actual
natureofthechannelsthemselves.Channeltheoryandtheinventionofacupuncture
are now listed along with the original four great inventions of Chinathe compass,
gunpowder, paper and printingas its fifth great invention; and the maturation of
channeltheoryandthepracticeofacupuncturecanbetracedbacktotheInnerClassic.
Examination of historical documents prior to the Inner Classic indicates that
the development of channel theory and acupuncture therapy underwent a lengthy
historical process. From bin-stones 1 to the nine needles, 2 from local stimulation
to the discovery of the transmission of sensation along the course of the channel,
connecting the points into a line orfirst there were the channels and then the
pointsthevesselsgraduallymorphedintotheideaofchannels.Beforetheinception
oftheInnerClassic,however,cumulativeexperienceandtheorywasfragmentedand
extremelyscattered,notyetformedintoacoherenttheory.Proofofthiscanbeseenin
theWesternHanDynastytextTheMoxibustionClassicoftheElevenFootandArmVessels
(ZBShYMiJiJng,)andTheMoxibustionClassicoftheElevenYin
1 Bin-stonesarecrudelongshapedstonesthatarethickerononeendthantheotherlookingsomewhat
likeaveryverythickneedle.Itislikelytheywereusedforacupressureorheatedandheldonanafictedarea.
2 ThereareninetypesofneedlesmentionedintheInnerClassiclargeneedle(dzhn, ),longneedle
(chngzhn, ),fliformneedle(hozhn, ),roundsharpneedle(yunlzhn, ),swordneedle(p
zhn, ),triplesidedneedle(fngzhn, ),ballpointneedle(chzhn, ),roundneedle(yunzhn, ),
andplowshareneedle(chnzhn, )collectivelytheyarereferredtoasthenineneedles.
andYangVessels (YnYngShYMiJiJng,)foundinTheImperial
BookofChannelsandVessels(BShJngMi,)pulledfromtheearthinthe
Mawangdui archeological dig.These texts record eleven unconnected channels and
itwasntuntiltheInnerClassicthattherewasrecordoftheinterior/exteriorconnected
system of regular channels, the extraordinary channels, the divergent channels,
the divergent collaterals, the channel sinews and the cutaneous regions.This more
complete system unequivocally describes howthe channels and collaterals are
mutually linked like a ring with no endpoint.The channels and collaterals came to
beunderstoodasthebodysinternalsystemofmessagingandthewebthroughwhich
thebodywasintimatelyconnectedtothelargerexternalenvironment.
Thephenomenonofthechannelsandcollateralsisoneofthegreatdiscoveriesof
Chinesemedicine;itusedsimplemorphologytoexplicateandprovethatthehuman
bodypossessedmanyandvariedinternalconnectionsthatformedacompleteunified
andcoherentsystem.ChanneltheoryfocusesonandembodieshowChinesemedicine
usestheideaofacompletesystemtoobservethehumanbodyandtreatitsdisorders.
If there were no record of the channels in the Inner Classic, this way of not only
explicating life activities but also of using the channel system to provide guidance
inthetreatmentofdiseasewouldperhapsneverhavebeendiscovered,amatterthat
wouldhavebeendeeplyregrettableforthehumanrace.
Research into the phenomenon of the channels continues to attract more and
morescholarsusingmethodsfromsuchvariedfieldsaselectro-biology,anatomy,and
neurology.They have used electro-measurement on cutaneous acupoint locations,
thermo-measurement and photography, liquid cr ystal thermal imaging, laser
photographyandothertechniques toprovetheobjectiveexistenceofthechannels.
Such investigations into the nature of the channels have become a hot topic in the
world of research.To date, however, the actual nature of the channels remains a
mystery.Giventhis,inresponsetothosewhosaythatChinesemedicinelagsbehind
thedevelopmentsofmodernscience,itmightbebettersaidthatmodernmedicineis
notyetequaltothetaskofunderstandingandinterpretingthetreasurediscoveredby
theancestorsoftheChinesepeople.
Theoretical Content of the Inner Classic

There is rich content in the Inner Classic; in addition to the medical knowledge
containedtherein,ittouchesonotherareasofknowledgesuchasastronomy,calendar
making, meteorology, geology, psychology, and biology.With regard to only the
medical knowledge, it can be further divided into the two large categories of basic
theory and medical practice. Historically, doctors have divided the information
contained in the Inner Classic into categories as a way of adding commentary and
facilitating research. Speaking only of the theories contained in the book, they can
generallybedividedintothefollowingcategories:
Life Cultivation
Lifecultivation(yngshng,)isalsoreferredtoinChineseaslifemaintenance
(shshng,),lifeprotection(wishng,)orthewayoflife(doshng,).In
the Inner Classic, the underlying preventative focus of life cultivation is particularly
emphasized in the phrasedo not treat that which is already diseased, rather, treat
that which has yet to become diseased.TheInner Classic holds that the purpose of
life cultivation should be to maintain harmony between man and nature, between
the form and the spirit, between the zang-fu organs, the qi and blood and yin and
yang which in the end all act to maintain health and extend ones longevity.There
isalottolifecultivationbutitsmostimportantaspectscanbedescribedasfollows:
emulate the waxing and waning of the natural rhythms of the four seasons and yin
and yang to nurse the body; ones emotions should be tranquil and one should be
contentwithonescircumstancesaswellaslivinginastatewherethe spiritwatches
internally; food should be regulated and the five flavors carefully harmonized; the
physicalformshould not be worked into exhaustion and one shouldavoid entering
the bedchamber intoxicated and with the desire of exhausting ones essence and
thus frittering away ones true (substance); and one should proactively partake in
healthy activities like do yn (guiding and drawing) exercises and massage.These
methods can be further grouped into two larger categoriescultivating the form
and cultivating the spirit.Their most fundamental principles are that for cultivating
theformitisofbenefittomove,tocultivatethespiritoneshouldbestill;inthisway,
with movement and stillness each addressed, thenform and spirit will both be
(appropriately) present and one can finish out ones allotted years.Theories on life
cultivationfoundintheInnerClassicareofgreatimportancetoresearchinthefields
ofpreventativeaswellasrehabilitativemedicine.
Yin Yang and the Five Phases

The concepts of yin and yang belong to the field of ancient Chinese philosophy.
The ancients used yin and yang to explicate the fundamental nature of things in
the natural world as well as to explain the principles of their development and
change.Afterthis theory was absorbed into the field of Chinese medicine, the Inner
Classic decreed that all things possessed the contradictory nature of yin and yang,
and that everything was controlled by the principles of yin and yang.The bilateral
responsiveness, interdependent use, waxing and waning and transformation into
theirrespectiveoppositeofyinoryangwastheultimaterootsourceofthegeneration,
development, change and withering away of all things in the world for the very
reasonthatyinandyangareconsideredtobetheultimatelawbehindthemovement
andchangesoftheuniverse.
IntheInnerClassic,yinandyangareusedtoexplicatethetissuestructureofthe
human bodyWhat form man has is never separated from yin and yang indicating
that the human form and its zang-fu organs and tissues all possess the intertwined
relationshipsofoppositionandmutualrootednessseeninyinandyang.Thenormal
functioningofthelifeprocessesinthehumanformareinseparablefromthemutual
regulatingandpromotingactionsofyinandyang;yangtransformsintoqi,whileyin
becomes form is the main form of material metabolism in the body.Yin is smooth
while yang is dense () is a sign of health and if yin and yang lose their
inter-regulationthenthisisthebasicmechanismbehindtherising,developmentand
pathological changes of disease.The phraseinspect the color, feel the pulse, first
distinguishyinandyangreferstotheideathatyinandyangasthetwocomponents
of the unity of the observed phenomenon are the foundational bedrock underlying
diagnostic differentiation.The phrasecarefully look to see where yin and yang are
andregulatethem,hopingtoreturnthemtonormalemphasizestheideathatbasic
goal of disease treatment lies in coordinating yin and yang and returning them to
harmony.
Five phases theory, which is closely related to yin and yang theory, uses the five
elementsofwood,fire,earth,metalandwateraswellasthecyclesofgenerationand
controlthatexistbetweenthemtoexplainthecomplicatedconnectionsbetweenthe
various components of the objective world. As far as the Inner Classic is concerned,
the phenomena that exist within the natural world are not chaotic and without
order,but,basedoncertainformandqualitycharacteristics,canbedividedintofive
large groups.These five large groupings obey certain laws of movement.The cycles
of generation and control that exist between objective phenomena are precisely
what impel life and growth, the important propulsion behind the cycles of life and
their eternal restarting.The authors of the Inner Classic used five phases theory to
construct an overarching picture of how each of the phases generated the next and
at the same time indicated which of the five zang-organs, fu-organs, bodies, sense
organs, emotions, and fluid types belonged to each category.This established five
physiologicalsystemsatwhoseheartwererespectivelythefive zang-organs.Itisalso
consideredthattherelationshipsofgenerationandcontrolbetweenthesefiveactto
maintainthe life activities of the human form. In theInner Classic, it is held that the
fivephasessystem seen in the natural environment and that in the human body are
verycloselyinterrelated,mutuallycommunicatingandresonatingandthereofforma
unifedwhole.
Yinandyangandfivephasestheorieseachhavetheirownspecialcharacteristics,
butintheInnerClassictheyareoftenusedtogethertoexplainsomerelevantmedical
problem.Forexample,in TheSpiritualPivotChapter73AppointedAbilities itsays:

Speakingofyinandyang,theycometogetherinthefivephases,thefivedepositories
and six clearinghouses and that which they store, the four seasons and the eight
winds are fully yin and yang. (
) Once yin and yang and five phases theories were absorbed into the
fieldofChinesemedicine,theybecameanimportantpartofthetheoreticalsystemof
theInnerClassic.
Organ Manifestation Theory

In the Inner Classic, organ manifestation theory is seen to be at the core of
understanding human physiological activity. Simply speaking,organ manifestation
theory is a theory based on the investigation of the mutual interrelatedness of
appearance,qualia ormanifestation andorgan. 1The structure and functioning
of the human body are extremely complex and the appearance of the human
phenomenon of life is based on an integrated and animated functionality. Although
structureandfunctionareintimatelyrelated,inthe InnerClassicorganmanifestation
theory does not focus on the small anatomical details of physical form, rather it
explicatestherulesofthenormallifeactivitiesofthehumanbody,lifeactivitiesthat
manifest in all kinds of qualia on the surface of the body but which can in turn be
usedtosummarizeandexplainthetrueconditionoftheinternalorganicfunctioning
ofthelivingform:itusestheinterconnectednessofnatureandmantograsptherules
oftheactivitiesoflife.
Organmanifestationtheoryusesthefivezang-organsasacentralreferencepoint
toclassifythetissuesoftheentirebody,includingthesix fu-organs,thefivebodies,
thefivesenseorgans,thenineorifices,thefourlimbsandthehundredbones,intofive
largesystems.Thesesystemsarenotindependentofeachotherbut,viatheweb-like
interconnectionsofthechannelsandvesselsandtheflowingmovementsoftheqiand
blood,aremutuallyconnectedandformawhole.Oneaspectoforganmanifestation
theoryinvestigatesthephysiologicalfunctioningofthezang-fuorgans,thechannels
andcollaterals,thesenseorgansaswellastheqi,bloodandbodyfluids.Anotheraspect
takesamoreoverallviewpointandlooksatthecomplicatedrelationshipbetweenthese
things as well as the principles of their living movement.The theory also concerns
itself with how phenomenon from the natural world like the weather, climate, and
geologicallocationaffectslivingprocesses.Thisrevealsitselfinsuchholisticideasas
theqiofthezang-organsmimicstheseasonsandtheyinandyangofthefivezang-
1 In other locations, the term here translated asorgan is translated aszang-organ. Because the
five zang-organs are the center of each of their respective physiological systems, they are also the centralized
referencepointtowhichorganmanifestationtheoryrefersinitsexplanations.
organsinthefourseasons.
IntheInnerClassic,organmanifestationtheoryholdsaveryspecialveryimportant
place and is the core of the theoretical system seen in theInner Classic. It is also an
importantunderpinningofclinicaldiferentialdiagnosisandtreatment.
Blood, Qi, Essence, and Spirit

InTheSpiritualPivotChapter47RootZang-Organ(LngSh-BnZng,)
it says:The blood, qi, essence, and spirit of man offer up life and circulate through
boththataspectofoneslifeforcethatisfixedandthatwhichissubjecttochange.(
)The human body has qi and blood as its
root,usesessenceandspiritandthesearethefoundationsofoneslifeforces.
InBasicQuestionsChapter62DiscourseonRegulatingtheChannels(SWn-Tio
Jng Ln, ) it categorically states:That which man possessesnaught
but blood and qi.() Blood and qi are the most fundamental
materials maintaining ones life activities.The concept of qi originated in ancient
philosophyand,afterhavingbeenabsorbedintothefieldofChinesemedicine,itwas
given medical significance:That man has a body is completely dependent on qi.
The qi found in the human body is compounded of and sources from the essence-
qi 1 of the kidney, the qi transformed and generated by the spleen/stomach as well
as the clear qi inhaled by the lung.The phases of human lifebirth, growth, able-
bodied, old, weakare all dependent on the existence of qi. Qi transformation is a
special kind of qi movement and is the simple recognition seen in the Inner Classic
ofthecomplicatedmetabolicprocessesthattakeplaceinsidethebody.Bloodcomes
fromthemiddlejiao where the spleen/stomach take in food and water, absorb their
essence and then change and transform the resultant essence into blood and other
vital substances. Blood circulates in the vessels, internally reaching the five zang-
organsandsixfu-organs,andexternallyreachingtheskin,flesh,sinewsandbones.It
nourishesandmoisturizes,guaranteeingnormallifefunctioning.
Blood is considered yin in relation to qi which is yang.The mutual rooting and
use of qi and blood and the harmonious balance between qi, blood, yin and yang
are symbols of health. If this is not true, ifblood and qi are not harmonious, then
1 Translatorsnote:Thecharacters (jngq)aretranslatedhereasessence-qiwhileinotherplacesin
the text are translated as essential qi.There is a certain amount of discussion as to whether the first character
is a noun or an adjective which gives rise to the problem.The Peoples Medical Publishing House standard of
translationisessentialqi,butIfeelthatitisnotappropriateinallplaces,especiallywherethereferenceseems
mostclearlytorefertoessenceasanoun.Inthislocation,referencetothekidneywouldseemtoindicatethat
itisreferringtotheactualessencestoredinthekidney,whichaccordingtotheclassictextscantransforminto
qi,thereofgivingrisetothetermessence-qi.Inareaswhereitmayindeedbeanadjective,Ihaveusedtheterm
essential-qi.
the hundred diseases will transform and arise from this. 1 For this reason,Course
the blood and qi, ensure that they are regulated and arrive where they should and
from this there will be harmony and peace [i.e., health]. 2This is a major principle of
treatingdisease.
Essence-spirit,oftensimplycalledspirit,referstothe sevenemotionshappiness,
anger, worr y, thought, sorrow, fear and star tlement, five mental activities
consciousness,etherealsoul,corporealsoul,intentionandwill,andallother essence-
spiritactivities.Abroaddefinitionof spiritpointstoallthelifeactivitiesofthehuman
body.The activities of the spirit not only have the zang-fu organs, qi and blood as
their material foundation but their relative state also reflects the living functioning
of the zangfu organs, qi and blood.Blood and qithe spirit of man. 3The five
spirits are separately housed in the five zang-organs and are alternatively called the
five spirit zang. Man has fivezang-organs which transform the five qi and thus are
generated happiness, anger, sorrow, worry and fear. 4The flourishing or weakness
of the spirit directly reflects the flourishing or weakness of ones vital functioning,
Thosewithspiritflourish,thosewithoutdie.Forthisreason,the InnerClassiclooks
oncultivating the spirit andtreating the spirit as works of primary importance;
additionally,whenitdiscussesmethodsofcultivatingthespirit,itsayssuchthingsas
accumulate essence to complete the spirit,the four qi regulate the spirit,guard
internally the essence and the spirit andabove all else guard the spirit. For those
ofustodaywho are interested in life cultivation and health, this provides important
guidance.
Channel Theory
Channelsandvessels(jngmi,)alsoknownaschannelsandcollaterals(jng
lu,)arethesystemthroughwhichthehumanbodymovesqiandbloodthereof
enabling the exterior and the interior and the upper and lower to communicate
and connecting the zang-fu organs and the tissues.The channel system includes
the channels, the collaterals, the channel divergences, the channel sinews and
the cutaneous regions. Channel theory researches the physiological functioning,
pathologicalchangesandtheconnectionsbetweenthezang-fuorgansandtheqi,blood
andfluids.Thechannelsystemwasoriginallyconsideredpartoforganmanifestation
theory,butbecauseofitsspecialnature,wasseparatedoutfordiscussion.
Therearefourmaincomponentsofthechannelsystemthechannels,thecollaterals,
theinternal zang-fu organ attachments and the external connections on the surface
1 BasicQuestionsChapter62DiscourseonRegulatingtheChannels
2 BasicQuestionsChapter74GreatTreatiseontheEssentialsofUltimateTruth
3 BasicQuestionsChapter26DiscourseontheEightProperDirectionsandSpiritualBrilliance
4 BasicQuestionsChapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena
of the body.The channels can be divided further into the twelve regular channels,
the extraordinary channels; and the collaterals into the divergent collaterals, the
superficial collaterals and the minute collaterals.The twelve regular channels are
each directly connected to a zang-fu organ and comprise a complex system that
interconnectsthezang-fuorgansandthechannelsthemselves.Theconnectivesystem
of the channels and collaterals that connects the superficial tissues of the body is
comprised mostly of the twelve channel sinews and the twelve cutaneous regions.
Inaddition,theInnerClassicrecordsthedistributionoftheback-shpointsandtheir
respectivetherapeuticuses.
Theappearanceofacupunctureintheworldnotonlyintroducedandestablished
thetheoretical basis for the skill of acupuncture needling, but also occupies a major
positioninthetheoreticalsystemoftheInnerClassic.InTheSpiritualPivotChapter10
ChannelsandVessels(LngSh-JngMi,)itsays:Thereasonthechannels
and vessels can decide life or death and eliminate the hundred diseases is that they
regulate deficiency and excess; they must remain unblocked. (
)
Etiology and Pathodynamics

TheInnerClassicrecognizesthatabnormalchangescausedbyexternalnaturalqi 1
and internal stimulus from emotions are the two main pathogenic factors that can
resultindisease;theformerisreferredtoasthesixpathogenicfactorswhilethelatter
is referred to as the seven emotions. In addition to these, poor lifestyle habits and
externalwoundscanalsoresultinhealthissues.
The termsix pathogenic factors, which includes wind, cold, summerheat,
dampness, dryness and fire, is the general term for the six externally contracted
pathogenic factors.While each of the six is different with respect to the nature of
the problems they cause, they hold in common seasonality. For example, in the
spring there are more wind related diseases, in the summer more summerheat
relateddiseases,inthelongsummermoredampnessrelateddiseases,intheautumn
more dryness related diseases and in the winter more coldness related diseases.
Additionally,theyarealsorelatedtolocality;inBasicQuestionsChapter70TheGreat
TreatiseontheAdministrationoftheFiveConstantsitsays:Theearthhashighandlow;
qihaswarmandcool.Inthehighreaches,theqiiscold;inthelow,theqiishot.(
)
The seven emotions include happiness, anger, worry, excessive mental activity,
grief, fear, and startlement. In most situations, they fall within the scope of normal
physiological activity and do not cause disease. However, the long term stimulation
1 Mostlyreferstoweatherandexternalclimateconditions.
ofthespiritorasuddenextremestimulationcandamagethespiritbygoingbeyond
theabilityofnormalphysiologicalprocessestoregulateandcanresultindysfunction
oftheqiandbloodandthezang-fuorgansandchannelsandcollaterals.
Whetherornotapathogenicfactoractuallyresultsindiseaseisgreatlyrelatedto
therelativestrengthorweaknessofthehealthyqi,thepeculiaritiesoftheindividual
inquestionandtheirmindstate.The InnerClassicpointsout:Ifhealthyqiispresent
inside, then pathogenic qi cannot broach(),If pathogenic
qi pools and causes disease, the qi of the individual is necessarily deficient.(
)These statements show how important the Inner Classic believes
healthyqitobe,emphasizingthathealthyqimustfirstbeweakinorderfordiseaseto
encroach.TheInnerClassicalsousestheanalogyofanaxefellingwoodtoexplainthe
relationshipbetweenconstitutionandgettingsick.
With regard to its understanding of pathodynamic, the Inner Classic basically
considerstherelativeweaknessorstrengthofhealthyand pathogenicqi,imbalances
betweenyinandyang,andlossofregulationbetweenrisingandsinking.Itfamously
points out:When pathogenic qi is vigorous there is excess; if essence-qi has been
taken,thereisdeficiency()aswellasThehundreddiseases
are born of qi. () In Basic Questions Chapter 74 GreatTreatise on the
EssentialsofUltimateTruth(SWnZhZhnYoDLn,)ithas
thenineteenlinesonpathodynamicswhichleadsthewayinthestudyandanalysis
ofpathodynamics.Withregardtochangestoandthetransmissionofdiseasetoother
channels and organs, exceptforsayingthat certainsudden onset diseases have no
fixed pattern of transmission and change, the Inner Classic stresses many modes of
disease movement including transmission from exterior to interior and vice versa,
transmission to other channels, movement between zang-fu organs and movement
following the cycles of generation and control between the five phases, all of which
showgivenpatterns.
Disease Patterns
IntheInnerClassic,themeaningsofdiseaseanddifferentiatedpatternsarestrictly
delineated. Disease patterns are the processes wherein pathogenic factors under
certainconditionscausethedysfunctionofthezang-fuorgansandqiandbloodinthe
humanbody.
The Inner Classic is rich in content regarding disease patterns; a rough estimate
indicatesthatthereareover300diseasepatternnamesofwhichcough,wastingdisease,
bsyndrome,winddisease,hotdisease, 1malaria-likediseases,lossof consciousness,
wasting thirst, swelling and edema, mania, boils and ulcers, accumulations as well
1 Diseasesassociatedwithfever.
as pain all have their own monographs.The disease patterns mentioned in the text
touch on such diverse clinical departments as internal medicine, external medicine,
gynecology,pediatricsandthesenseorgans.IntheInnerClassic,diseasesaredivided
into the two categories of externally contracted and internal damage. Externally
contracteddiseasesarethosewhereinanexternalpathogenicqiinvadesandresultsin
disease;internaldamageresultsfromtheemotions,diet,overworkorexcessivesloth
orfromdeficiencyandweaknessofhealthyqiwhichinturncausesthe zang-fuorgans
to become deregulated. Specifically, they can be divided into six pathogenic factors
disease patterns, zang-fu organ disease patterns, disease patterns of the physical
body,andsenseorgandiseasepatterns.Diseasepatternnamesareforthemostpart
assignedaccordingtothefollowingfourprinciples:1.Basedonthepathogenicfactor,
e.g.,colddamagediseasesorsummerheatdisease;2.Basedonthemainsymptom,e.g.,
hotdiseases(thosepresentingwithfever)andcough;3.Basedonthepathodynamic,
e.g., b syndrome and loss of consciousness; 1 and 4. Location of the problem, e.g.,
headache, rib pain, lumbar back pain. Many doctors in later eras further explicated
thecontentoftheseexplanationandthenameshavebeenpasseddownandarestill
inusetothepresentday.
TherearemanymonographsintheInnerClassicthatexclusivelydiscussaspecific
diseasepattern,forexample,Chapter38DiscourseonCough,Chapter43DiscourseonB-
Syndrome,Chapter44DiscourseonWasting,Chapter45DiscourseonLossofConsciousness,
Chapter42DiscourseonWind,andChapter39DiscourseontheIssueofPain.2Eachof
thesemonographsgoesintotheetiology,pathogenesis,symptompatterncategories,
transmissionofthedisease,treatmentprinciples,aswellasnursingandrecoveryfrom
theirrespectiveproblem.Patternsymptomcategoriesaredividedaccordingtozang-fu
organ,channelandpathogenicfactor;theseweretheembryonicformsofthepatterns
thatinlatergenerationsbecamezang-fuorgandifferentiation,channeldifferentiation
and pathogenic factor differentiation.The theory of disease patterns seen in the
InnerClassicreflectstheclinicallevelofthetimeandopenedthegatestothefurther
developmentoftheseclinicalsciencesinlatergenerations.
Diagnostic Techniques
Althoughtherearediscussionsofallofthefourdiagnostictechniquesobservation,
listeningandhearing,questioningandpalpationinthe InnerClassic,thereismore
discussionofobservationandpalpation,amatterofgreatpracticalimportance.
Observationisatechniquewhereinsaythefaceisobservedtodeterminethe
1 The type three naming pattern is not obvious when this name is translated into English. A translation
that more closely mirrors the original Chinese would bereversal disease.The main symptom is loss of
consciousnessandsothestandardEnglishtranslationislossofconsciousnessorsometimessyncope.
2 NotethatallofthesechaptersarefoundinBasicQuestions.
relative qualitygood or badof the color changes, from which one can deduce
issues with the zang-fu organs as well as the prognosis of any associated disease.
Observationoftheposturesofthephysicalformenablesonetodeterminetherelative
strengthorweaknessofthepatientsconstitutionandtheseverityofthediseasethe
individualsuffersfrom.InBasicQuestionsChapter17DiscourseonSubtleDetailsof
Pulse Essentials (SWn-MiYo JngWi Ln, ) it states:Know
clearlythefivecolors,theyaretheflowersofqi.()Ifthecolors
are bright and moist, then this shows that the essence-qi of the zang-fu organs is
replete;ifthecolorisdry,dullanddark,thenthisindicatesthattheessence-qiofthe
zang-fuorgansisweak.TheSpiritualPivotChapter72CommunicatingwithHeaven(Lng
Sh-TngTin,)introducesthephysicalcharacteristicsofthefiveyinand
yangtypesofmorphologyinpeopleandthengoesontoreflectontheconstitutional
characteristics of each. In the text, palpation is given a fairly detailed description
and explanation.There are a number of methods of diagnosing from the pulse
including whole body pulse diagnosis, 1 the three sections and nine indicators pulse
diagnosis, 2 carotid artery and radial artery pulse diagnosis.The Inner Classic also
detailsamethodusingthepaceofnormalbreathingtodeterminewhetherthepulse
ofapatientisfastorslow.Thiswasreferredtoasonewhohasnodiseaseaddresses
theonewhoisill.Theprinciplebehindusingtheradialpulsetomakeadiagnosis,as
wellasdescriptorsofthepulsecharacteristicsofmorethantwentymajordiseases,the
pulsecharacteristicsofthetrue zang-organpulse,diseaseprognosisandimportant
considerationswhentakingthepulseareallgivenarelativelysystematicexplanation.
TheInnerClassic emphasizes that when diagnosing disease thefour diagnostics
mustbeconsideredtogether.InTheSpiritualPivotChapter4PathogenicQiandthe
PathogenicFormoftheZangandFuOrgans(LngSh-XiQZngFBngXng,
),itsays:
Observethecolorandknowthedisease,thisiscalledclarity;palpatethepulseandknow
the location of the disease, this is called spirit; ask of the disease and know its location, this
is called basic skill It is said knowing one thing is skill, knowing two is called spirit while
knowing three is both spirit and clarity. (
)
1 Thereisapalpablepulseonalltwelveoftheregularchannels.Traditionallyspeaking,wholebodypulse
diagnosisisunderstoodtomeantakingthepulseatthehead,thewristandthefoot,butinmoreextremecases,
thepulsemaybetakenatalltwelveoftheselocations.AftertheClassicofDifficultIssuesindicatedthatoneneed
onlytakethepulseontheradialsideofthewrist,thismethodallbutdisappeared.Notethatintheannotations
tothistechnique,itisnotalwaysclearwhatthedifferencebetweenwholebodypulsediagnosisandthreesection
nineindicatorpulsediagnosisis.
2 Thistechniquecomprisestakingthepulseatthesuperficial,middleanddeeplevelsofthecarotidartery
(neck),theradialartery(wrist)andthedorsalispedisartery(foot).
BasicQuestionsChapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena(S
WnYnYngYngXingDLn,)pointsoutthat:
Those who are skilled at diagnosis check the color and take the pulse first differentiating
yin and yang. Check the color and know location,observethebreath,listentoitssoundand
know where it is distressed; observe, evaluate, measure and know where the disease rules,
take the pulse observing its depth or superficiality, its slipperiness or roughness and know
how it came to be. For there to be no mistakes in treatment, there must be no mistakes in
diagnosis.(
)
Thesetwoquotesabovebothemphasizethefourdiagnostictechniquesofobservation,
listening and hearing, questioning and palpation and how their combined use is
necessarytomakinganaccuratediagnosis.
Principles and Methods of Treatment

In the Inner Classic, discussion of treatment includes both treatment principles
as well as treatment methods. The prerequisite to treating disease is accurate
diagnosis while the practical application of treatment principles also requires a
certaintherapeuticactiononthehumanbodytoeffectthecurativeresult.Thereare
manytreatmentmethodsrecordedintheInnerClassic,includingbin-stonetherapy,
acupuncture, moxibustion and cauterization, medicines, steaming, hot medicinal
compresses, medicinal patches, massage, do yn exercises, diet and psychological
therapy. Discussions on acupuncture in particular are exhaustively detailed and go
into equipment, principles of choosing effective points, hand techniques, scope of
therapy,indicationsandcontraindicationsaswellaspointselectionbasedondisease.
Ontheotherhand,intheentirebookthereismentionofonlythirteenherbaltherapy
formulas.Fromthisitcanbeconjecturedthatatthetime,theyweredetailed(intheir
knowledgeof )acupunctureandlesssoaboutherbs.
ThevalueoftheInnerClassicliesinthefactthatitputsforthacompletetheoretical
system. For example, it talks of early treatment of disease, proposinga superior
doctor treats that which is not yet diseased and emphasizing thatthose who are
good at treating (disease), treat when the problem is superficial.The basic goal of
treatment is tocarefully look to see where yin and yang are and regulate them,
hopingtoreturnthemtonormalandcoursethebloodandqi,ensurethattheyare
regulated and arrive where they should and from this there will be harmony and
peace [i.e., health]. From a holistic point of view, treatment principles include such
thingsasfordiseasesabove,treatthelowerpartofthebody;fordiseasesbelow,treat
the upper part of the body, anddraw yang from within yin, draw yin from within
yang. Elimination of disease pathogenic qi involves working with the forces of

location,i.e.,Ifitishighinthebody,thenexpressitout;ifitislowinthebody,then
draw it out and exhaust it.The book also holds thatwhen treating disease, treat
theroot.Afteranalyzingtherelativeurgencyofthedisease,thetreatmentprinciple
issuchthatifthediseaseisbetween,thentreatboththerootandthemanifestation;
if it is extreme, then treat only one. During the course of treatment, one must pay
attention to seasonal weather, geographical peculiarities (like being near the ocean
or in a desert) as well as constitutional factors to formulate the most appropriate
treatmentstrategy.Inthetext,thisisindicatedbythestatementWhenthesagestreat
disease, they must know heaven and earth, yin and yang, and the warp and weft of
thefourseasonsemphasizingthebenefitsoftreatmentprotocolsbasedonspecifics
of time, location and the individual concerned.With regard to the actual treatments
themselves, they can be divided into two main categoriesdirect treatment and
reversetreatment.Directtreatmentincludessuchtechniquesasifthereiscold,then
heat.Ifthereisheat,thencool.Reversetreatment,1ontheotherhand,isatechnique
whereinifthereisacoldfactorthenusecold;ifthereisaheatfactor,thenuseheat.
Thetreatmentprinciplesandtechniquesdescribedabovearestillappropriateinthe
practicalapplicationofChinesemedicinetherapeuticstothisday.
The Five Movements and the Six Qi

The termthe five movements and the six qi(w yn li q, ) is often
simply referred to as movement of qi (yn q).The guiding thought behind qi
movementtheoryisthatthereisacorrespondencebetweenhumankindandheaven
and earth.This field of study uses yin and yang and five phases theories to describe
thebasicstructureofthiscorrespondence,andtheheavenlystems(tingn,)and
earthlybranches(dzh,)assyllogistictoolstoexclusivelyinvestigatethechanges
andlawsofnatural celestial and atmospheric phenomenon and their relationship to
theincidenceofdiseaseanditsspread.
Qimovementtheoryusesstemsandbranchesannalstomakecalculationswithin
a sexagenary (60 year) cycle.The system relates the ten heavenly stems to the five
movementsandthetwelveearthlybranchestothesixqiand,becauseofthedifferential
cycling of the two major aspects of the system, sixty different types of atmospheric
variationsarerecognized.Atmosphericvariationsdirectlyinfluencethephenomenon
ofgeneration,growth,transformation,harvestandstorageseeninthenaturalworld
aswellasthehealthofhumankindandthespreadofdisease.Qimovementtheoryis
directlyrootedinthelogicofmanisthesamedisciplineasheavenandearth,taking
1 Reversetreatmentisoftenusedwhentherearefalsesignsofcoldorheatbuttheunderlyingproblemis
trueheatortruecoldrespectively.
weather, natural phenomenon and disease symptoms and using the same rules of
analysis to research the problem; in this system one year is considered a small cycle
andsixtyyearsalargeone.Notonlycantheweatherandpatternsofdiseasespread
foreachyearbededucedusingqimovementtheory,butthetheorycanalsoprovide
valuable insight into prevention of disease and clinical diagnosis.This is what is
referred to asFirst know the changes of the times and do not contend against the
harmonyofheaven.1
Qimovementtheorywasusedasancientmedicalclimatologyandwasoneofthe
components of the theory seen in the Inner Classic. Today is a valuable reference in
researchontherelationshipbetweenmedicineandtheclimate.
1 .ThisquoteisfoundinBasicQuestionsChapter70TheGreatTreatiseontheAdministration
oftheFiveConstants.Muchofthechapterisgivenovertodiscussionofthefvemovementsandthesixqi.
38
Chapter2
Yin and Yang and the Five Phases
Source Text 1

()
Yinandyangarethewayofheavenandearth,theguidinglawofthemyriadthings,
the father and mother of change and transformation, the root and beginning oflife
anddeath,andtheclearinghouse1ofspiritbrilliance.Intreatingdisease,onemustseek
theroot.(BasicQuestionsChapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena)
Interpretation
Worldly phenomenon are endlessly changing, regenerating, and disappearing.
Yin and yang is the fountainhead of all movement and developmental changes in
the world.They are the general underlying principle and law of the movement of
the natural world and the universe, the guiding structure underlying the changes
involvedinthegeneration,growth,waning,anddisappearanceofallthings,andthe
basis of their potential development and change. All of these are predicated on the
unifiedoppositionofyinandyangmovement.Together, yinandyangaretheinnate
dynamicthatdrivesthemovementandchangeofallthings.
Clinical Application
Yin and yang exist within the human body: the mutual rooting and use of yin
and yang and their unified opposition guarantee the yin and yang balance of the
organism. If this balance is thrown off for some reason, then this will influence their
regulated waxing and waning, changes will be seen in the organism, and these
changes will result in organic dysfunction and eventually in disease. If the organism
is yang deficient with yin overly exuberant, one should warm and supplement yang
andeliminateyin-cold,toregulatethebalanceofyinandyangandtherebyenablethe
organismtoreturntonormal.
CaseReport
Male,age33.Initialconsultation:March5,1993.
1 The character (f) is often translated aspalace in other texts.Clearinghouse is chosen here to
emphasizethatitistheinterplayofyinandyangthatmanifeststheactivityofspiritbrilliance,thattheyarethe
mechanism by which its movement is created and expressed, rather than there is a magnificent hall in which
somethingcalledspiritresides.
VolumeOne:Chapter2 YinandYangandtheFivePhases 39
The patient reported that two months previous, he had inadvertently fallen into
a river while at work. Subsequently, he felt cold throughout his body and limbs and
haderectiledysfunction.Hedescribedthesesymptomsasgettingworsedaily.Atthe
timeofdiagnosis,thepatientpresentedwithobviouscoldsensationsthatextended
tohissubcostalarea,overhisentirebackside,andreachedhislowerabdomen.Other
symptoms and signs included clear urine, tasteless, white complexion with dark
circlesaroundtheeyes,darknails,andweaklibido.Thetonguewaspurpleanddark
with a thin, white coating.The pulse was deep, wiry, and forceful. Blood, urine, and
liver function tests were normal. Ultrasound showed no abnormalities of the liver,
kidneys,orureters.Thispatientexhibitedcoldcongealedinthelivervesselwithyang
qi obstruction.Treatment called for warming the liver and eliminating cold, and the
formula selected was a modification ofNun Gn Jin(Liver-Warming Decoction,
).
rugu 5g CortexCinnamomi
wyo 5g RadixLinderae
chnxing 5g LignumAquilariaeResinatum
xiohuxing 5g FructusFoeniculi
shngjing 5g RhizomaZingiberisRecens
guzh 10g RamulusCinnamomiCassiae
flng 10g Poria
dnggu 10g RadixAngelicaeSinensis
guqz 10g FructusLycii
ynynghu 10g HerbaEpimedii
Aftersevenpacksofmedicinals,thesymptomsweregreatlyalleviated,andaftera
furthersevenpacks,thepatientreportedbeingcompletelybetter.Asix-monthfollow-
upsawnorelapseofthesymptoms.
[Reference:ZhangYong-shui.TheSignificanceofTreatingtheLiverinImpotence.
JournaloftheZhejiangCollegeofTCM.1996;6(3):18.]
Source Text 2

()
Yang accumulation becomes/is heaven, yin accumulation becomes/is earth; yin
calms, while yang excites; yang generates, while yin grows; yang kills, while yin
stores; yang transforms into qi, while yin completes form. Extreme cold gives rise
to heat; extreme heat gives rise to cold. Cold qi produces turbidity; hot qi produces
clarity.When clear qi is below, it generates diarrhea with undigested food.When

turbid qi is above, it generates bloating and distention.This is reversal of yin and
yang,theoriginofcounterflowdiseases. (BasicQuestionsChapter5TheGreatTreatiseonYin
YangCorrespondenceinPhenomena)
Interpretation
Yinandyangarepresentintheuniverse.Theyangqiofheavenandearthislight
andclearinnature.Thatwhichislightandcleartendstoriseup,anditaccumulates
to become yang-heaven.The yin qi of heaven and earth is heavy and turbid in
nature.That which is heavy and turbid tends to sink down, and it congeals to form
yin-earth.
Fromtheviewpointofthespecialnaturesofyinandyang,calmnessandstillness
areyinwhileagitationandmovementareyang.Yinandyangcanalsobefoundinthe
changesofthefourseasons.Oneoftherelationshipsthatcharacterizeyinandyangis
theirmutualinter-rootedness.Thatis,whenyangqiincreases,yin-fluidsalsoincrease;
whenyangqieliminatesandkills,yin-fuidsreduceanddrawin.
Yang governs movement and upward rising and is able to transform into qi.Yin
governs calmness and stillness and can become form.The qi in a person is yang in
nature,whiletheessence,blood,andfluidsareyin.Coldandhotcanbeunderstood
torefectthemutualtransformationsofyinandyang.
With regard to the four seasons, the coldest time of winter is also the time that
yang qi begins to rise up, and the hottest time of summer is the time when yin qi
is conceived and begins its ascension. If the human body is damaged by cold, then
the disease condition manifests as heat, because cold transforms into heat disease
patterns. If inner heat is extreme, symptoms of aversion to cold and shaking can
appear, because extreme heat transforms into cold. Cold qi is categorized as yin
because yin condenses and collects but does not emit or spread out; that which
accumulates becomes heavy turbid qi.Hot qi is categorized as yang because yang
governsrisingbutdoesnotcongealorcollect;thereof,thiskindofqibecomeslight,
clearqi.
In the body, light, clear qi rises up, but if this light, clear yang qi is weak or
insufficient to the point of being unable to rise, then there will be weakness below
that manifests as swill-like diarrhea, stools that contain undigested food, or loose,
unformedstools.Ifheavyturbidyinstagnatesintheupperpartofthebodyanddoes
notmovedown,theremaybesuchsymptomsasabdominaldistentionorabdominal
fullness. Both types of symptoms reflect abnormalities in yin and yang wherein the
transportfunctions of yin and yang manifest as disease phenomenon resulting from
counterfowabnormalities.
There is order to the rising and falling actions within an organism and this
guaranteesitsnormalfunctioning.Iflight,clearyangqiisweakenedorreduced,then
itisunabletoriseproperly.Thismaypresentclinicallyasabdominalpainordiarrhea
and may be diagnosed asdiarrhea ordysentery.The underlying pathodynamic
is often deficient and weak spleen and stomach with clear yang unable to rise. In
Chinese medicine, treatment involves supplementing and augmenting middle jiao
yangqiandensuringtheyangqirises.Overall,regulatingyinandyangandrestoring
the normal rising and falling actions of yin and yang are the key principles of
treatment.
CaseReport
Female,age20.Initialconsultation:September6,1989.
Chief complaint: frequent bouts of diarrhea for the past six months with only
a few intermittent days of normal stools.The patient passed stools three to four
times a day with fluid and solids clearly distinguishable and with much undigested
food. Several laboratory exams of her stools all came back negative. She was given
a tentative diagnosis of chronic colitis. She has taken streptomycin orally as well
as numerous digestive enzymes and anti-diarrheal drugs, but none provided any
obviousrelief.
At the time of diagnosis the patient was tired and felt generally weak all over.
Shereportedyellowurine,abittertasteinhermouth,andnoappetite.Overtime,the
patienthadbecomequitethinandwasextremelysusceptibletocatchingcoldssaying
shewouldcatchjustaboutanythingthatwasgoingaround.Thetonguewaspalewith
awhiteandslightlygreasycoating,theleftpulsewaswirybutforceless,andtheright
pulsewassunkenandweak.
Thispatternisspleenandstomachdeficiencyandweaknesswithclearqiunable
to ascend. Additionally, there is a pattern of bound and constrained damp heat.
The primary treatment is to fortify the spleen and boost qi, raise yang and stop the
diarrhea.The secondary treatment is to clear and drain damp heat.The prescription
givenwasShngYngYWiTng(Yang-RaisingandStomach-BoostingDecoction,
),initsoriginalform.
dngshn 15g RadixCodonopsis

bizh 15g RhizomaAtractylodisMacrocephalae
hungq 20g RadixAstragali
hunglin 10g RhizomaCoptidis
bnxi 10g RhizomaPinelliae
chnp 15g PericarpiumCitriReticulatae
flng 15g Poria

zxi 15g RhizomaAlismatis
fngfng 10g RadixSaposhnikoviae
hngzo 5pcs FructusZizyphiJujubae
Theprescriptionwasonepackofmedicinalsperdayboiledinwater.OnSeptember
20,1989,afterhavingtakentwelvepacksofmedicinals,thepatientcameforasecond
consultation.Atthistime,thediarrheahadstoppedandshewaspassingstoolsonly
once a day, though they were still quite loose. Her urine was pale yellow, food was
tastyagain,andshegraduallyfeltherstrengthreturning.Thepatientsfaceregained
luster, the greasy tongue slowly transformed, and the pulse was forceful though
deep. An additional twelve packs of the same formula were prescribed. Following
this, the patients stools and urine became normal, her appetite greatly increased,
her complexion was rosy and moist, and she appeared to be putting on weight.
Modified versions of the above formula were given for another month or so.The
patient regained her previous state of health, whereupon she stopped taking the
decoctions.
[Reference:ZhangQi. CollectedEssentialsofZhangQisClinicalExperience .
Beijing:ChinaPharmaceuticalTechnologyPress;1998.p.257-258.]
Source Text 3

(
)
Clear yang becomes heaven, while turbid yin becomes earth. Earth qi rises to
become clouds, heaven qi falls to become rain; rain emerges from earth qi, clouds
emerge from heaven qi.Therefore, clear yang emerges from the upper orifices, and
turbid qi emerges from the lower orifices; clear yang vents from the interstices, and
turbid yin goes to the five depositories; clear yang fills the four limbs, turbid yin
returnstothesixclearinghouses.1 (BasicQuestionsChapter5TheGreatTreatiseonYinYang
CorrespondenceinPhenomena)
Interpretation
Yin and yang are evident in the natural universe.Within it, light, clear yang qi
risesuptobecomeheavenwhileheavy,turbidyinqidescendstobecomeearth.Earth
is below, but when the qi of earth rises up, it becomes clouds. Heaven is above, but
1 The five depositories is a more literal translation ofzang-organs; the six clearinghouses is a more
literaltranslationoffu-organs.
whentheqiofheavendescends,itbecomesrain.Thisisthetrendofmovementand
thetransformativeprocessofyinandyanginnature,heavenandearth.
Like the natural universe, the human body is also divisible into heaven and
earth.Theupperpartofthehumanbodyislikeheavenwhilethelowerislikeearth.
Additionally, the changes in yin and yang ascending and descending in the human
bodyarealsoliketheqitransformationsseenintheuniversalprocessesofheavenand
earth.Thus,thelight,clearyangqiofthehumanbody,asintheenteringandexiting
ofthebreathviatheupperpartofthebodythroughthemouthandnose,isafunction
of the head.This light, clear yang qi (as represented by the breath) gets distributed
throughtheupperrealms,especiallytheheadandface,andactsastheessentialbasis
for functions such as producing sound, seeing, smelling, tasting and hearing.The
heavy,turbidqiofthebodycongealsandcollectsasyin-fluidsandmovesdownward,
as is commonly observed in the lower orifices of the body in the secretions emitted
fromtheanus,vagina,andurethra.
Thedefensiveqiofthebodymovesoutsideofthevesselswithaswiftandsmooth
nature.Defensiveqiisconsideredtobeatypeofyangqi,movingthroughtheexterior
of the body in the skin and interstices.The exterior of the body is categorized as
a yang location. Essence, blood, and body fluids are all thick and viscous; rich in
nutrition, they lubricate and nourish the organism.They are considered yin-fluids
and move through the inner organs of the body.The organs are considered the
interior of the body and the space they occupy is also categorized as a yin location.
The food and liquid ingested and digested by the human organism is considered
transformedintomaterialessence;itisasubstancerichinnourishmentbutrelatively
speaking is also considered clear in nature.The leftovers from the digestive process
are considered dregs and relatively speaking are turbid. Clear is considered yang,
while turbid is considered yin: clear yang materials are transported to all corners of
theorganismtoprovidenourishment,whileturbidyinmaterialsarepushedthrough
thegastrointestinaltracttoeventuallybeeliminatedfromthebody.
Source Text 4

()
Ifexitingandenteringcease,thenthetransformationofthespiritdiesout;ifascending
anddescendingarenomore,thenqibecomesisolatedandindanger.Therefore,ifthere
is no exiting and entering, then there is no generation, growth, maturing, aging, or
dying;ifthere is no ascending and descending, then there is no generation, growth,
transformation,collection,orstorage.Thisisbecausetheqidynamicinallcontainers
alwaysincludesascending,descending,exitingandentering. (BasicQuestionsChapter68
TheGreatTreatiseontheSixSubtleProfundities)
Interpretation
Movement underlies the makeup of material existence and is also its inherent
nature. All things in the world exist in a permanent state of unceasing motion that
is the underlying order of all things. If there were no rising and falling, exiting and
entering, then this would create a situation wherein life would cease. If there were
no rising and falling, exiting and entering, no transport and distribution of material
thingsinalivingentity,thentherewouldbenowaytonourishthebodyorguarantee
thattheorgansandtissuesofthebodywouldbeabletocontinuefunctioning.Such
alossoffunctioningwouldmeanthattheorganswouldnotbeabletomanufacture
newmaterialsortoeliminateoldmaterialsinthemetabolicprocess,norwouldthey
beabletopromotegrowthanddevelopment.Thisinturnwouldleavetheorganism
unabletogrow,strengthen,orage.Alllivingentitiesinthenaturalworldconformto
thiskindoforder.
Source Text 5

()
Heavenandeartharetheupperandlowerofthemyriadthings;yinandyangare
the male and female1 of blood and qi. Left and right are the routes of yin and yang.
Waterandfireare signs of yin and yang.Yin and yang are progenitors of the myriad
things.Therefore it is said, yin is inside and acts as the defender of yang; yang is
outsideandactsastheenvoyofyin. (BasicQuestionsChapter5TheGreatTreatiseonYinYang
Interpretation
Yin and yang are seen in both the natural world and in the human body.The
position of heaven above is yang, while the position of earth below is yin; heaven
covers while earth supports. All things are born between the two, making heaven
and earth, respectively, above and below all things. In humankind, yin and yang are
reflected in the male and female halves of the species, with males considered yang
andfemalesyin.The movement of qi and blood in the body is also divisible into yin
andyang,withqiconsideredyangandbloodconsideredyin.Withregardtoposition,
leftandrightareyangandyin,respectively.Inthenaturalmaterialworld,fireisyang
and water is yin.Yin and yang are names that are used to describe the qualitative
1 Thecharacter orderin thesourcetext ismale andfemale;logically,however,itshouldbefemaleand

maletocorrespondwiththeideaofyinandyang.
natureofavastrangeofphenomena.Itshouldbepointedout,however,thereisno
specific thing that is yin, nor any specific thing that is yang. In other words, there is
no single thing in the world we can point to and say,This is yin orThat is yang.
Theclosestwecancomeistoevokethephenomenaoffireandwaterwhichpossess
thespecial,relative,qualitativecharacteristicsofyinandyangmostpurely.Therefore,
theyareusedassymbolsandpre-monitorsofyinandyang.Thegenerationofthings
in the world as well as their ultimate return can also be seen as yin and yang.The
relationshipbetweenyinandyangisextremelycloseandtheyfeedoffeachotherin
an endless cycle.Yin governs inner stillness and acts as the protector of yang; yang
governsoutermovementandactsasenvoyforyin.Yinandyanginseparablyrelyon
eachother.
Source Text 6

(
)
Whentalkingoftheyinandyangofaperson,theexteriorisyangandtheinterior
is yin.When talking of the yin and yang of the human body, the back is yang and
theabdomenisyin.Whentalkingoftheyinandyangofthebodysdepositoriesand
clearinghouses, the depositories are yin, while the clearinghouses are yang. Liver,
heart,spleen,lung,andkidneyarethefiveyindepositories;thegallbladder,stomach,
large intestine, small intestine, bladder, and sanjiao are the six yang clearinghouses.
And what of yin within yin and yang within yang? It is that winter diseases are in
yin, summer diseases are in yang, spring diseases are in yin and autumn diseases
areinyang.Looktowherealloftheseare,andthenuseneedleorstone.Thebackis
yang, and heart is yang within yang; the back is yang, and lung is yin within yang.
Theabdomenisyin,kidneyisyinwithinyin;theabdomenisyin,liverisyangwithin
yin; the abdomen is yin, spleen is ultimate yin within yin.These are the mutual
correspondencesofyinandyang,ofsurfaceandinterior,ofinternalandexternal,and
ofmaleandfemaletheyallresonatewiththeyinandyangofheaven. (BasicQuestions
Chapter4TrueWordsfromtheGoldenCabinet)
Interpretation
Differentlocationsonthebodyhavedifferentyinandyangcorrespondences.For
example, the exterior of the body is considered yang, while the inner organs are
consideredyin.Goingthroughtherestofthebody,frontandbackarerespectivelyyin
and yang: the back is considered yang, while the abdomen yin.The inner organs of
thebodyarealsodivisiblebyyinandyang:thefive zang-organsareyin,whilethesix
fu-organs are yang.Yin and yang can continue this type of division and infinitum as
anotherlevelofyinandyangcanalwaysbefoundwithinsomethingalreadyascribed
ayinoryangcategorization.Thisislikethefourseasons:autumnandwinterareyin,
with winter being yin within yin and autumn yang within yin; spring and summer
areyang,withsummerbeingyangwithinyangandspringyinwithinyang.
Theheart,whichattachestotheback,ispositionedintheupperhalfofthetrunk;
to the exterior, it resonates with summer. Of the five zang-organs, the heart is yang
withinyang.
Thelungs,whichattachtotheback,arepositionedintheupperhalfofthetrunk;
totheexterior,theyresonatewithautumn.Ofthefivezang-organs,theyareyinwithin
yang.
The kidneys, which attach to the abdomen, are located in the lower part of the
trunk;totheexteriortheyresonatewithwinter.Ofthefivezang-organs,theyareyin
withinyin.
The liver, which attaches to the abdomen, is located in the lower part of the
trunk;totheexterior,itresonateswithspring.Ofthefivezang-organs,itisyangwithin
yin.
The spleen, which attaches to the abdomen, is located in the lower part of the
trunk;totheexterior,itresonateswithlongsummer.Itispositionedatthechangeof
seasons,whereitcomesfromyangtoenteryinandsoisultimateyinwithinyin.
These are the exterior/interior attributions of yin and yang, attributions that
delineateinteriorlocationinthebodyofagivenzang-organanditsexteriorresonance
withagivenseasonoftheyear;thespecialcharacteristicsoftheirrespectiveattributes
arethesameasthosefoundinheavenandearth.
Source Text 7

(
)
The essence of the relationship between yin and yang is that if yang seals, there
is stability. If the two are not in harmony, it is like there is spring but no fall, winter
but no summer. Restoring harmony between them is called following the sagely
measure.Thus,ifyangistoopowerfultoseal,thenyinqiwillbecomeexhausted.Ifyin
isbalancedandyangcontains,essenceandspiritareinorder.Ifyinandyangseparate,
then essence-qi will end. (Basic Questions Chapter 3 Discourse on the Generation of Qi and
CommunicatingwithHeaven)
Interpretation
The most important aspect of the yin and yang relationship is maintaining a
balance.Yang qi and yin essence together are the cornerstones and the actors in a
danceofmutualpromotion.Inthisdance,yangqiisdenseontheoutside,protecting,
andguardingyinessenceontheinside.Iftheharmonybetweenyinandyangwereto
belost,thentheircloserelationshipwouldbecomechaoticandtheywouldloseany
senseoforder.Takentoanextreme,thiswouldmeandissolutionoftheentity.
Totakethechangesofthefourseasonsasanexample,thiswouldbelikehaving
springbutnofallgentlewarmthleadingtotheheatofsummerwithnocorresponding
coolingoffintheautumn.Oralternatively,iftherewerewinterbutnosummer,there
would be snow and ice everywhere with no corresponding heat of the summer to
balanceit.Oncethisisunderstood,itcanbeseenthattheessenceofyinandyanglies
in their regulation and the maintenance of a harmonious balance between the two.
Thisisconsidered sagely wisdom and is the principle to which yin and yang adhere.
Ifyangqiisinexcessandmovesanddrainstotheoutsideandisthereofunabletoseal
inyinessence,thenthiswillresultinyinessencedrainingtotheoutsideandbecoming
reduced.Ifyinandyanglosetheirbalancedharmony,withoneortheotherseparating
awayorbecomingexcessive,thiscanleadtothedestructionoftheirrelationshipandloss
oftheirmutualconnection.Iftheyinandyangrelationshipcollapsesandtheyseparate,
essenceandqiwillbeconsumedandscattered,andtherewillbelossanddeath.
The key to yin and yang balance is seen in the phrase,If yang seals, there is
stability,aphrasethatemphasizestheimportanceoftheyangqifunctionofholding
yin-fluids. Clinically, whenever conditions involving fluid loss are s eenexcess
sweating,nipple discharge, continuous vaginal spotting, or urinary incontinence, for
examplethefirstthingthatshouldcometomindisprotectingandnursingyangqi
andsupplementingqitoproperlycontainthejn-fuidsandtheblood.
CaseReport
Thepatienthasthreechildren,buthasnotbeenpregnantformorethan10years.
The patientreports havingdischarge from both nipples for the previous six months.
Shesaidalthoughthevolumewasnotgreat,thedischargewasconstantandclearin
color and that during the day it would soak her clothes, requiring that she change
twotothreetimesaday.Atnightthedischargeceased,enablingagoodnightssleep.
The patient reported that her breasts were neither distended nor painful. She also
reported that previous treatments for the problem had been ineffective.The patient
feltthatherlimbswereweakandherspiritslow.Shecravedsleep,wasdisinclinedto
talk,andhadaversiontocoldwithalikingforwarmth.Thevolumeofhermenstrual
flowhaddecreased,withnoperiodinthepasttwomonths.Thetonguewaspalered
withathinwhitecoating,andthepulsewassunkenandmoderate.Treatmentcalled
for warming yang to restrain yin to stop the discharge from the breasts. A modified
version of Gu Zh Ji F ZTng (CinnamonTwig Decoction with Added Aconite,
)wasused:
guzh 9g RamulusCinnamomi
bisho 15g RadixPaeoniaeAlba
shfpin 6g RadixAconitiLateralisPraeparata
dunlngg 18g OsDraconis(calcined)
dunml 18g ConchaOstreae(calcined)
miy 20g FructusHordeiGerminatus(raw)
dzo 10pcs FructusJujubae
After six packs were taken, the discharge was reduced by half. However, the
patient now felt thirsty with a desire to drink.The previous formula was modified
byeliminatingshngjing,lngg,mlandguzh,halvingtheamountoffz,and
adding9gramsofmidngand3gramsofbirnshn.Ninepackswereprescribed.

shfpin 3g RadixAconitiLateralisPraeparata
midng 9g RadixOphiopogonis
miy 20g FructusHordeiGerminatus(raw)
birnshn 3g RadixGinsengAlba
In the following check-up, the nipple discharge had completely ceased and
the patients spirits were improving. Her menstruation had started and all other
symptomswerealleviated.
[Reference:ChenMing.SelectedCaseStudiesfromFamousShangHanSchoolPhysicians
.Beijing:AcademyPress;1998.p.26.]
Source Text 8
(
)
Ifyinpredominates,itleadstoyangdisease.Ifyangpredominates,itleadstoyin
disease. If yang predominates, there will be heat; if yin predominates, there will be
cold.Extremecoldgivesrisetoheat;extremeheatgivesrisetocold. (BasicQuestions
Chapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena)
Interpretation
Overly abundant yin qi can have a restraining effect on yang qi.This can create
a situation wherein yang qi becomes depleted or insufficient, thereby resulting in
a disease condition. Overly abundant yang qi can have a restraining effect on yin
essencethatcreatesasituationwhereinyinessencebecomesdepletedorinsufficient,
therebyresultingindisease.
If yang qi is excessively active and abundant, then the internal yang qi of the
organismwillbeatadecidedadvantage.Becauseyanggovernsheat,suchasituation
willmanifestasfever,redface,sweating,rapidpulse,andothersuchyangsymptoms.
Ifyinessenceisexcessivelyactiveandabundant,thentheinternalyinessenceofthe
organism will be at a decided advantage. Because yin governs cold, such a situation
will manifest as aversion to cold, white facial color, lack of sweat, tight pulse, and
othersuchyinsymptoms.
Indiseasedevelopment, whencoldreachesanextreme thereisatransformation
ofyinintoyang.When this happen in conditions of extreme cold there will be signs
of heat.The same holds true for heat patterns.When heat reaches an extreme, yang
transformsintoyinandtherewillbesignsofcold.Therelationshipdepictedhereisa
reflectionoftheintertransformationalrelationshipthatexistsbetweenyinandyang,
heatandcold.
Generally speaking, when yang qi predominates there is fever, and conversely
when yin qi predominates there are chills. Should yang qi reach an extreme, it will
transform into a yin pattern. For example, when an individual is stricken with
heat stroke on a hot summer day, she/he might experience high fever and copious
sweating,but excessive sweating can resultin escaping yang, whereupon symptoms
ofyangqidefciencyandweaknesswouldappear.
Another example is if an individual suffers a mild chill in the wintertime, she/
he might subsequently have an aversion to cold. If on the other hand the individual
catchesaseverechill,she/hemightpresentwithhighfever.
With these kinds of yin and yang conversions, one must pay special attention to
differentiating situations of true cold from false heat and true heat from false cold.
The pathodynamic is that when yang qi reaches an extreme it isolates yin on the
exterior,socoldsymptomsappear.Whenyinqireachesanextremeitisolatesyangon
theexterior,sofeverandheatsignsappear.
CaseReport
Female,mid50s.
Chief complaint: feelings of extreme heat in her feet during the winter months.
Duringthisseason,thepatientreportsfeelingasthoughherfeetwerebeingroasted,
and felt a need to soak them in ice water before going to bed. During this time her
appetitealsowaned,butwhensummerarrivedhersymptomsgotbetter.Thepatient
wenttomanydoctors,butnoneofthetreatmentsweresuccessful.Afriendintroduced
hertoMasterShiGuan-qingfortreatment.Examinationshowedthepatienttobeas
describedabovealongwithaslipperytongueandslowpulse.Previousprescriptions
all contained bitter, cold, yang-punishing medicinals. Master Shi diagnosed the
conditiontobeoneofoverabundanceofyinisolatingyangintheexterior,whereupon
heusedSNTng(FrigidExtremitiesDecoction,)totreattheproblem.
Thefriendwhointroducedthepatientrepeatedlytoldthedoctorandhisstudents
thatpreviousdoctorshadalsoconsideredthatitwasacaseofoverabundanceofyin
isolatingyang,but,becausehercasedidnotseemtofitanyofthethreefamiliesofS
NTng patterns described by Zhang Zhong-jing, the previous doctors rejected this
diagnosis.
Tng Mi S NTng (Channel-Unblocking for Frigid Extremities Decoction,
) is used for treating overabundant yin and weakened yang where yang is
isolatedintheexteriorbyanoverabundanceofyin-cold,manifestingwithnoaversion
to cold, red face, and cold hands and feet. BiTngTng (ScallionYang-Freeing
Decoction,)treatsoverabundantyininthelowerpartofthebodythatisolates
yangintheupperbody,resultinginthepatternofupwardcarryingofyang(diyng,
).BiTngJiZhDnZhTng(ScallionYang-FreeingDecoctionwithaddedPig
Gall,)treatsdeficientyangisolatedintheupperpartofthebodyby
overabundantyin.Inthiscase,thedefcientyangfoatsup.
In none of these cases is there any mention that the feet are hot. Master Shi
explained:Overabundanceofyinisolatingyangcanmanifestwiththeredfaceseen
intheupwardcarryingofyangpattern.Itcancauseharassmentinthe zang-andfu-
organs with repeated dry retching and it can also manifest with yang being forced
intothefourextremities.
The friend then asked:In cases where overabundance of yin isolates yang, the
patient should desire warmth, but in this case the patient craved cold. How can
this be? Master Shi responded:The Inner Classic repeatedly teaches:Extremes of
cold generate heat; extremes of heat generate cold.The Inner Classic describes the
wayofmedicinewithitsgreatestanddeepestessencefoundintheconceptheaven
andhumankindareone. BasicQuestionsChapter5TheGreatTreatiseonYinYang
CorrespondenceinPhenomenastates:Whenyinisoverlyabundantthenoneisable
totoleratesummer,butnotwinter.
In this case, there are three indicators of overabundant yin isolating yang.The
first is the symptoms were worse in the winter and cleared up during the summer.
The second point is that the patient had a slow pulse. Basic Questions Chapter 3
DiscourseontheGenerationofQiandCommunicatingwithHeavenstates:Ifyinisunable
to conquer yang, then the pulse is flowing, thin, and rapid. In this case, the slow
pulse reflects overabundant yin. 1The third factor in making this diagnosis was that
thetonguecoatingwasslippery.BasicQuestionsChapter5TheGreatTreatiseonYin
Yang Correspondence in Phenomena states:Yang transforms into qi; yin transforms
into form.The slippery tongue coating is a sign that yang is not transforming into
qi.Giventhesethree,eventhoughthepatientpresentedwithhotfeet,thissymptom
was caused by overabundant yin isolating yang. Tng Mi S NTng and BiTng
TngaretheformulasthatZhangZhong-jingusedtotreatoverabundantyinisolating
yang and deficient yang floating up. In this particular case, while there is clearly
overabundant yin isolating yang, yang insufficiency is also apparent, and therefore
S NTng is required to directly disperse the frosty yin and strengthen yang qi.This
treatmentenablestheyangthatwasisolatedontheoutsidetoretreatandreturntoits
propercommand.
For this patient, S NTng was given in its original form with the only concern
thatitwouldberejectedbecauseofthestrengthofthepathogenicstate,sothepatient
was instructed to take a small amount of the decoction several times a day. She
finishedthefirstpackthatnightandearlythenextmorningreturnedforacheckup.
Bythattimeherfeethadbecomecoolandshehadnotneededtousetheicebathfor
herfeet.Anothertwopacksoftheoriginalformulawereprescribedwithanincrease
intheamountsofthemedicinals.Threedayslater,arelativeofthepatientwashappy
toreportthatshewasnowsleepingcoveredwithablanket.Threemorebatcheswere
prescribedandthisintractableproblemwascompletelyresolved.
[Reference: Zhou Fa-xiang. Crown of the Almond Forest: Shi Guan-qing .
JournaloftheHenanCollegeofTCM.2004;6(3):2.]
Source Text 9

()
Yin stores essence and rises quickly. 2 Yang protects the exterior and creates
stability. If yin fails to dominate its corresponding yang, then the movement of qi
andbloodinthevesselsbecomesthinandrapid;whenthereisrepletion,thenthere
is mania; if yang does not dominate its corresponding yin, then the qi of the five
1 In this case, yin is so abundant that even though the patient has abundant heat symptoms, the pulse
refectstheunderlyingcoldconditionandnottheyangwhichisforcedtotheoutside.
2 Some commentators indicate that this passage should be translated asYin stores essence giving rise
toqi.Thebasisforthisunderstandingrefersbackto BasicQuestionsChapter5TheGreatTreatiseonYinYang
CorrespondenceinPhenomenawhereitstates:Essencetransformsintoqi.
depositories contend with each other and the nine orifices no longer remain open.
(BasicQuestionsChapter3DiscourseontheGenerationofQiandCommunicatingwithHeaven)
Interpretation
There is a very close relationship between yang qi and yin essence in the body:
yin essence provides the material basis for yang qi to function and is constantly
respondingtoyangqi.Yangqi,ontheotherhand,constantlypromotestheformation
ofyinessenceandmaintainsitscontinuedpresenceinthebody.Astable,harmonized
balance is the best state for yin and yang in the body.The balance should not be
slantedtoonesideortheother,suchaswhenyangisoverabundant.Inthissituation,
itlosesitsharmonizedbalancewithyinandover-expressesyangcharacteristics.This
condition promotes the rapid movement of blood with a palpable sense of urgency.
Inseriouscaseswhenyangbecomesevenmoreextreme,itcancausetheracingand
disordered flow of qi and blood that results in mania. On the other hand, if yin is
overabundant and has lost its harmonized balance with yang, yin characteristics
becomeover-expressed.Yinessenceisbynaturestill,andtoomuchyininthebalance
can cause a slowing or stagnation of qi and blood, creating a situation wherein the
functioningofthefivezang-organslosesregulation,theqimechanismlosesharmony,
the movement of qi and blood is no longer smooth and beneficial, and the sense
organs,orifces,channelsandcollateralsbecomeblocked.
This passage exposes how the yin and yang relationship has aspects of both
mutual control and mutual rooting. At the same time, it points out that the
functioningofthelimbsandthenineorificesbothrequiretheyinandyangwarming
and nourishing actions of the zang- and fu-organs. In the event that yin and yang
become unbalanced, not only would the five zang-organs lose regulation, but this
imbalance would result in diseased conditions of the limbs and/or nine orifices.The
symptoms of such conditions might include mania, vertigo, tinnitus, deafness and
nasalstuffiness.The clinical presentation determines whether one should clear yang
heatfromtheorgansorwarmtheyangqioftheorgans.
CaseReport
Male,age29.
Chief complaint: deafness. The patient reported that a month previous he
suddenly went deaf and remained so.Treatment by another doctor using such
formulas asY Q Cng MngTng (Qi-Boosting Intelligence Decoction, )
wasineffective.Thepatientcontinuedtosuffergreatlyandsosoughttreatmentwith
other physicians. At the time of our diagnosis, the patient reported an inability to
hearalongwithafeelingthathisheartwasnotbeatingwithmuchforce.Hewasmildly
aversetocold,histonguewaspaleredwithathin,whitecoating,andhispulsewas
thin,soft,andforceless.Detailedquestioningdeterminedthathissymptomsbeganafter
hecaughtacoldandhadexcessivesweating.Basedonhispulseanddiseasepatternthe
diseasedifferentiationwasheartyangdeficiency;hewasprescribedamodificationof
GuZhGnCoTng(CinnamonTwigandLicoriceDecoction,).

zhgnco 8g RadixetRhizomaGlycyrrhizaePraeparatacumMelle
shchngp 4g RhizomaAcoriTatarinowii
Thepatienttooktwopacksinitiallyandsubsequentlyfeltthathishearingandheart
palpitations had substantially improved as well as his feelings of cold disappeared.
Themedicinalswereappropriateforhisconditionandsohewasgivenanadditional
twopacks,whichcompletelyresolvedhisdeafnessandallothersymptoms.Thisisan
excesspatternofyangfailingtodominateoveritsyinandqiofthefivezang-organs
contending,theresultofwhichwasthatthenineorifcesbecameblocked.
Source Text 10

()
Those who are good at diagnosis examine the patients color and palpate the
pulses.Firsttheydistinguishyinandyang.Theyexaminetheclearandtheturbidand
know how they are distributed.They observe the patients panting and breathing,
andlistentohistoneofvoicetoknowhissuffering.Theyobservethebalanceandits
measuretoknowhowthediseaseisaffectingthepatient.Theypressonthechand
cn areas to observe floating, sinking, slipperiness and roughness in the pulses and
knowfromwherethediseasecameintobeing.Theytreatwithouterrorbecausethere
arenomistakesintheirdiagnoses. (BasicQuestionsChapter5TheGreatTreatiseonYinYang
Interpretation
Doctorswhoaregoodatclinicaldiagnosisinspecttheskinandfacialcolor.They
palpate the pulse and know the pulse signs. Both the color and pulse have yin and
yang aspects. A relaxed, glowing and bright facial color is yang, while a dark, grey,
pinched looking face is yin. An excessively fast pulse is yang, while one that is too
slowisyin.Based on what is found in the color and pulse, a doctor can differentiate
whethertheconditionisyinoryang.
Whenexamining the face, one should not only look at the clarity and brightness
ordullnessandturbidityofthefacetodistinguishyinandyang,butthisinformation
shouldalsobecombinedwithzang-fuorgancorrespondencestodiagnosethelocation
ofthecondition.
Changes in the breath like panting must be observed along with changes in the
voice.Thelightnessorheavinessanddepthorshallownessofthebreathareusefulin
diagnosingdisease.Ifthebreathiswheezyandloudandthebreathinghasstrength,
thisisasignofheart-lungexcess;ifthesoundofthewheezingislowandthebreath
hasnostrength,thisisasignofliver-kidneyinsufciency.
Pulsesareanextremelyvaluablediagnostictoolandobservationofseasonalpulse
changescanhelponetoknowthestateofadisease.Takingthepulseatthethreepulse
positionsthecn,thegunandthechandthenfeelforsinking,floating,slippery
orroughpulsesenablesonetoknowthenatureofthepatientsproblem.Therecanbe
nomisdiagnosisifonecorrectlyperformseachaspectofthediagnosis.
Source Text 11

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Yin flavors exit the lower orifices, while yang qi exits the upper orifices. Strong
flavors are yin, while mild flavors are yang within yin. Strong qi is yang, while thin
qi is yin within yang. Strong flavors drain, while mild ones open.Thin qi enables
outward draining, while strong qi brings forth heat. 1The qi of robust fire weakens,
whiletheqiofmoderatefirestrengthens.Arobustfireconsumesqi,whereasqifeeds
offamoderatefire.Arobustfirescattersqi,whereasamoderatefiregeneratesqi. (Basic
QuestionsChapter5TheGreatTreatiseonYinYangCorrespondenceinPhenomena)
Interpretation
Foodandmedicinalshavebothanenergeticnatureandaflavororflavors.Flavors
thatarerich,strongandintenseareyininnature,whilethosethataremildandsubtle
are yang within yin. Qi that is pure and powerful is yang in nature, while qi that is
thin(lackinginrichnessordensity)isyinwithinyang.
Yin flavors move through yin positions, mostly moving downward and passing
through the lower yin orifices.Yang flavors move through yang positions, mostly
movingupwardandreachingtheupperorifices.Dhung(RadixetRhizomaRhei)is
1 The characters variously translated here asstrong and as eithermild orthin refer to the density
of the qi involved:strong necessarily being the dense orthick expression andmild orthin the more
sparselycompacted.
anexampleofamedicinalwithastrongflavor.Itsmedicinalenergeticnaturemoves
downward and its effects are felt in the lower part of the body, as indicated by its
abilitytocausediarrhea.
Mild, subtle flavors are yang within yin; they have the yang characteristic of
movementand are good at increasing flow and opening.They do not work to drain,
butrathertocourseandopenqiandblood.Mhung(HerbaEphedrae)isanexample
of a medicinal whose qi is thin. Its medicinal energetic nature moves upward and
outward,anditseffectsarefeltintheupperpartofthebody,asindicatedbyitsability
topromotesweating.
Powerful qi is yin within yang; its ability to emit and scatter is not particularly
obvious, but its energetic nature mainly works to warm or assist in warming.
Medicinalsandfoodthatarepureyangareconsideredtoberobustfire,whilethose
withgentlewarmthareconsideredtobelesserfire.Ifapureyangqiorflavorisused
inappropriately, it can result in a weakening of healthy qi. On the other hand, if the
gentlewarmingoflesserfirefoodsormedicinalsisused,itwillgraduallysupplement
andaugmenthealthyqi,enablingqitobuildprogressively.Thishappensbecausethe
gentleactions of lesser fire enable qi to generate in a gradual manner and the body
toslowlybecomemorerobust.Ontheotherhand,thingswhichhaverobustfirecan
ablateandconsumehealthyqi.Forthisreason,ifonewantstoincreasehealthyqi,one
shouldrelyonlesserfre.
Source Text 12

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Wood encounters metal and is stricken down. Fire encounters water and is
extinguished.Earthencounterswoodandispenetrated.Metalencountersfireandis
lessened.Waterencountersearthandisexhausted.Themyriadthingsarealllikethis;
one must neither overly subdue nor exhaust. (Basic Questions Chapter 25 Discourse on
TreasuringLifeandCompletingthePhysicalForm)
Interpretation
Among the five phases seen in the natural worldmetal, wood, water, fire and
earththere exists mutual relationships of generation and control.Within the five
phases,wood is subject to the control of metal, much like a sharp metal axe can fell
atree.Fireissubjecttothecontrolofwater,muchlikewatercanputoutafire.Earth
issubjectto the control ofwood,much liketreesdrive their roots deep into the soil
therebyfirmingitandpreventingerosionandalsobylooseningthesoilandmakingit
softer.Metalissubjecttothecontroloffire,muchlikefirecanbeusedtosmeltmetal
intovariousthings.Finally,waterissubjecttothecontrolofearth,muchlikeearthcan
absorbandcontainwater.Thecomplicatedrelationshipsbetweennaturalphenomena
arealsolikethis,withpatternsofgenerationandcontrolthatensurenosingleelement
everbecomesoverlystrong.Ifthiswerenotso,thenrelationshipswouldlosebalance
andtheorderedstateamongthingswouldbecomechaotic.
57
Chapter3
Organ Manifestation
Source Text 1

(
)
Ihaveheardtheesotericmastersspeak,someconsiderthebrainandmarrowtobe
depositories,otherstheintestinesandstomachtobedepositories,yetothersconsider
them to be clearinghouses. Dare I ask about these contradictions?They all claim to
be right. I do not understand their way of reasoning and would like to hear your
explanation.
Qi Bo replied:The brain, marrow, bone, blood vessels, gallbladder, and the
womans pouch (uterus), these six are all generated from earthly qi; their storing
functionisassociatedwithyinandresemblesearth.Thereforetheystoreanddonot
drain;theyarecalledtheextraordinaryenduringplacesofstorage.
Asforthestomach,largeintestine,smallintestine,sanjiao,andbladder,thesefive
aregenerated from heavenly qi and their qi resembles heaven.Therefore, they drain
anddonotstore;theytakeontheturbidqiofthefivedepositoriesandaretherefore
referred to as clearinghouses of transmission and transformation. In these organs,
nothingcanberetainedforlongsincetheyareorgansoftransportanddrainage.The
residue gate [i.e., the anus] is the passageway of the five depositories as water and
grainmaynotbestoredforlong.
Theso-calledfivedepositoriesstoreessence-qianddonotallowittodrainaway;
they can therefore be replete but never full.The six clearinghouses transfer and
transformbutdonotstore;theycanthereforebefullbutnotreplete.Forthisreason,
whenwaterandgrainenterthemouth,thestomachbecomesfullandtheintestines
empty;asthefoodmovesdown,theintestinesbecomefullandthestomachempty.
Thereforeitissaidthattheyarerespectivelyfullbutnotreplete,repletebutnotfull.
(BasicQuestionsChapter11FurtherDiscourseontheFiveZang-Organs)
Interpretation
Chinese medicine believes that the inner organs of the body can respectively be
dividedinto zang-organsand fu-organs. Heart, liver, spleen, lungand kidneyarethe
five zang-organs, whilegallbladder,stomach, large intestine,small intestine,sanjiao
andbladderarethesixfu-organs.Inadditiontothese,therearealsotheextraordinary
organsthebrain,themarrow,thebones,thebloodvessels,thegallbladderandthe
uterus.These organs store essence-qi much like it is the nature of the earth to store
things.Thischaracteristicisconsideredyinbecauseitconsolidates,absorbsandstores
essence-qi,notallowingittodrainaway.
Allofthesixfu-organsarehollowandaregeneratedofheavenqi,mimickingthe
heavenlikecharacteristic of enveloping all things; for this reason they can transport
and transform but do not store essence-qi.They are also calledfu-transport-organs
with food or liquid flowing and moving through them. Food and liquid cannot
remainintheseorgansun-transported, and sofu-transport-organs arecharacterized
bycontinualtransportandeliminationoffoodandwater.
The anus is where the body voids unwanted solids.Whether or not they are
eliminateddependsontheregulationandguidanceofzang-fuorganqi;thefu-transport-
organs cannot remain constantly full [i.e. filled with solids], but must alternate with
periodsofemptiness.
Thespecialcharacteristicofthefivezang-organsistostoreessence-qi.Therespective
repleteness[i.e.,repletenessofessence-qioftheorgans]isguaranteedbytheproper
functioning of all the organs wherein the essence-qi is not allowed to drain away or
becomereducedinvolume.Thefive zang-organsarerepletewithessence-qibutare
notflledwithfoodorwater.
Thesixfu-organsareholloworgansthatcanbefilledwithfoodandmoveitalong
as required.This function is maintained by and relies on the nourishing actions of
the essence-qi of the five zang-organs properly performing their functions of filling
with, and emptying out, food and liquids.This process starts at the mouth with
food and liquid entering in and filling the stomach.When the stomach is full, then
relativelyspeaking,theintestinesareempty.Whenthestomachsendsthefoodonto
theintestines,emptyingoutandfillingtheintestines,thentheintestinesarefulland
thestomachtemporarilyempty.Thisfull-emptyexchangeistheresultofthetransport
functionsofthesixfu-organs.
Ifthesixfu-organslosetheirabilitytofunctionproperly,thiscanresultinavariety
ofgastrointestinaldiseases.Clinically,theproblemmightpresentasdistentionofthe
stomach,lossofinterestineating,reductionoffoodintakeorevennausea,vomiting,
VolumeOne:Chapter3 OrganManifestation 59
belching, and hiccups; there can also be diarrhea, loose stools or constipation.The
majorpathodynamicofthesedisordersisabnormalitiesinthetransportfunctioningof
thesixfu-organs;themostappropriatetreatmentistofortifythetransportfunctions
ofthespleenandstomachtobetterdigestfoodandguideoutstagnationinthehopes
ofreturningnormalfunctioningtothesixfu-organs.
CaseReport
Female,age44.
Chiefcomplaint: frequent belchingfor the past three years.The patient reported
thatforthepasttwomonthsthebelchinghadbeenaccompaniedbypaininthelower
abdomen.The patient said she was depressed, though restless and easily angered.
After eructation, she felt better; the sound of the belching was high and loud. Her
stoolsweredry and constipated.The tongue was pale red with a thin white coating,
thepulsewiryandthin.ShehadbeengivenaWesternmedicinediagnosisofchronic
erosivegastritis.AccordingtoChinesemedicine,thedifferentialpatterncorresponded
to liver qi stagnation with upward counterflow qi.The appropriate treatment was to
softentheliverandharmonizethestomach.Aformulawasprescribedasfollows:
gnco 10g RadixetRhizomaGlycyrrhizae
cchih 10g RadixBupleuri(vinegar-fried)
xunh 20g RhizomaCorydalis
xingf 10g RhizomaCyperi
chunxing 10g RhizomaChuanxiong
shdhung 6g RadixetRhizomaRhei(cooked)
hup 10g CortexMagnoliaeOfcinalis
zhsh 15g FructusAurantiiImmaturus
dnshn 10g RadixetRhizomaSalviaeMiltiorrhizae
yjn 10g RadixCurcumae
fxiomi 30g FructusTriticiLevis
ml 20g ConchaOstreae
Atthesecondconsultation,shereportedthebelchingwaslessfrequentand,while
thedistendingpaininherlowerleftabdomenwasstillpresent,herbowelmovements
were now regular.The tongue was red with a thin yellow coating and the pulse was
wiryandthin.Thefollowingchangesweremadetoherformula:
Removed:dzo.
Added:
ggn nodosageindicated RadixPuerariaeLobatae

xikco nodosageindicated SpicaPrunellae
One week later the symptoms had subsided and in a six-month follow-up, the
patientindicatedthattheyhadnotreoccurred.
[Reference: Xia Jin-yu. Cheng Li-fangs Five Resolutions inTreating Spleen and Stomach
Diseases. ChineseIntegratedChineseandWesternMedicineSpleen
andStomachMagazine.2000;8(3):172.]
Source Text 2

()
Iwouldliketohearofthemutualengagementofthetwelvedepositories:whatis
theirrespectivenobilityandbaseness?
Qi Bo replied:An encompassing question well asked! Listen as I respond to my
utmostability.
The heart holds the position of ruler;spirit brilliance comes from here.Thelung
holds the position of counselor assistant; order and regularity come from here.The
liver holds the position of general, planning and deliberation come from here.The
gallbladder holds the position of central correctness; decisiveness comes from here.
Dn zhng 1 holds the position of minister envoy; happiness and joy come from
here. Spleen and stomach hold the position of granary storehouse; the five flavors
comefromhere.Thelargeintestineholdsthepositionof transporteralongtheway;
change and transformation come from here.The small intestine holds the position
of accepting and holding; transformation of things happens here.Thekidney holds
the position of wielder of force; skill and technique originate from here.The sanjiao
holdsthepositionofdredgingditch;thewaterwayscomethroughhere.Thebladder
holds the position of regional capital; jn- and y-fluids are stored here, and after
being transformed by qi, they are able to exit.These twelve positions must not lose
1 Mostannotatorssaythatthisisthepericardium.DnZhngisalsothenameofRN17,thoughinfactthe
nameimpliesthatitisthecentralpointofalargerarea.
their mutual engagement. As is such, if the ruler is enlightened, the other officials
areatpeace.Inthisway,cultivationoflifeleadstolongevity,therebeingnodanger
untilonepassesawayfromthisworld,generationaftergenerationflourishinggreatly
under the heavens. If the ruler is not enlightened, then the twelve officials are in
danger,closingthechannelsandrenderingthemimpassable(blockingthem),greatly
damagingthephysicalbody.Ifoneweretocultivatefromthisstate,thentherewould
be grave misfortune, and for those who would serve under heaven their purpose
would be in great danger. Avoid this! Avoid this! (Basic Questions Chapter 8 Discourses
fromtheSecretClassicoftheMiraculousOrchid)
Interpretation
Thetwelveorgansofthehumanbodyallhavetheirownfunctions,thoughthese
functions are interconnected and mutually reliant in their operations. Not all of the
functions of the organs are of similar importance and the respective roles that they
playinthebodymaintainaninnatehierarchy.
The heart is the great ruler of the five zang-organs, acting much like the ruler
of a country. As the ruler of the organism and the fivezang-organs, thiszang-organ
modulatesandadministersthefivezang-andsixfu-organsenablingthespiritstobe
full,andtheqiandbloodtobevigorous,thereofenablingtheindividualtobehealthy.
The lung governs and drives the breath, helping the heart circulate the qi and
blood through the individual.This helps the heart to better perform its actions of
ruler,muchlikeachancellorassiststheprimeministerofacountryinhis/herduties.
The liver governs coursing and discharging, ordering and freeing the movement
ofbloodandqithroughoutthebody,muchasageneralarrangestroopsthroughout
a country.The harmonious flow of liver qi ensures the smooth flow of qi and blood
throughoutthebodyenablingtheorganismtofeelcalmandpeacefulandthereforeto
beabletoplanandutilizewisdom.
The liverandthe gallbladderareintimately connected. Gallbladder qi assists the
liverinmaintainingthesmoothflowofqiwhiletheliverensuresthatgallbladderqiis
properlyreleased.Ifliverandgallbladderqiarevigorousandqiandbloodharmonious
andfowsmoothly,thenwhenoneisstrategizing,decisionsandchoicescanbemade.
The pericardium from whence RN 17 (dn zhng) exits is the external protector
oftheheart, much like a counselor protects a ruler by passing on messages, making
reports and carrying out any orders the ruler may give. If the qi of RN 17 (the area)
is even and harmonious it helps to ensure that the qi of the heart is relaxed and
expansiveandthattheessence-spiritoftheorganismishappyandjoyful.
The spleen governs movement and transportation, while the stomach governs
acceptanceandreceiving;thespleen-stomacharethezang-andfu-organsthatmove
and transform food and water, participating in their digestion and absorption.The
moving and transforming qi of the spleen-stomach enables food to be transformed

into nourishing essence and to thereof be utilized by the organism; the spleen-
stomachareliketheministerinchargeofgrainstorage.
The large intestine forms the lower end of the gastrointestinal tract and is
relatively less participatory in the actual digestive and absorption processes. Its
majorfunctionistotransporttheremnantsoffoodandtochangethemintofeces;its
function is much like the minister in charge of canal shipping.The small intestine is
locatedjustbelowthestomach;itreceivesfoodandwater(chyme)fromthestomach,
furtherdigestingitandabsorbingitsnutrition.
Thekidneystoresessence;essencegeneratesmarrowwhichinturnfillsthebones.
Ifkidneyessenceisplentiful,thenbonemarrowwillbeplentifulandifthisissothen,
in turn, the bones will be hard and the body strong with strength surpassing most.
Marrowfillsthebrainandifkidneyessenceisplentiful,thenbrainmarrowwillbeas
well,resultingincleverness,agoodmemoryandthegenerationofwisdom.
The sanjiao is divided into three sectionsupper, middle and lowerand is an
openroadforthetransportationofwaterandfluid.Iftheqiofthe sanjiaoisopenand
flowing,thenwaterandfluidsmovefreelyandarebeneficiallydistributedthroughout
thebody.
The urinary bladder is the organ that stores urine as water accumulates here in
thebody.Itsfunctionismuchlikethewaterworksdivisionofacityinhowitcontrols
theeliminationofwater;ifbladderqitransformationmovesthewater,thenitcanbe
voidedfromthebody.
Therolesplayedandrelativepositionsadoptedbythetwelve zang-fuorgansnot
onlyreflecthow they realize the management of their functions, but also show how
mutualcoordinationbetweenthevariousorgansensuresthattheorganismdoesnot
loseitsnormalstableandharmoniousstate.Thetwelveorgansco-existinahierarchy.
It is absolutely necessary that the heart, as the ruling ruler and emperor, maintains
normal functioning and coordinates the organs; this enables the organs to remain
calmintheirappointedpositionsperformingtheirfunctions.Itisonlyinthiswaythat
theycanprotectthebodyandensureitsproperlongevity,notallowingtheoccurrence
ofanyseriousmorbidconditionsjustasthesagelyclarityofarulerensuresthata
countryispeacefulandprosperous.Iftheheartbeginstomalfunctioninanywayand
isnolongerabletoensureitspositionasrulerincoordinatingthefunctioningofthe
otherorgans,thenitisentirelylikelythattheotherorganswillalsobegintofunction
abnormally.Ifthisweretohappen,theharmoniousconnectionsbetweentheorgansof
theorganismwouldbegintomanifestproblemsthatwouldinturnresultindamage
tothephysicalformandultimatelytodisease.Thediseaseprocessasdescribedhere
isanalogoustoanineptrulerwhosechargeoveracountryresultsinunrestandsocial
turmoil and perhaps even loss of the rulers leadership over the countrya very
dangeroussituationindeed.
Theheartisthegreatrulerofthefivezang-andsixfu-organs,governingtheblood
and vessels as well as housing the spirit. If the hearts ability to house thespirit is
compromised,thiscanleadtotheappearanceofabnormalitiesofspiritconsciousness
like insomnia, much dreaming, restlessness of spirit, delirium and mania; it may also
leadtolistlessness,delayedreactionsandcoma.Thisproblemcanalsoinfluencethe
functioning of the other zang-fu organs perhaps even to the point of endangering
life. Clinically speaking, the most important treatment principle revolves around
nurturingandcalmingthespirit,atechniqueusedinthehopesofre-establishingthe
heartsfunctionofhousingthespirit.
CaseReport
Female,age58.Initialconsultation:April4,1978.
Thepatientcomplainedofrestlesssleepwithmanydreams.Shealsosaidshehad
drymouth,generalrestlessness,fearfulheartpalpitations(jngj,)withsweating,
brainfog,andblurredvision.Thepatientsspiritswerelowandherurineyellow.The
tonguewasredwithathinwhitecoatingandthepulsewiryandthin.Thesymptoms
werefromwork-relatedstressthatthenresultedinemptyfireharassing,movingand
disturbingthe heart spirit. Nourishing the heart, calming the spirit and tranquilizing
wasdeemedtheappropriateapproach.Aformulawasgivenasfollows:
yjiotng 18g CaulisPolygoniMultifori

hhunhu 12g FlosAlbiziae
chozorn 18g SemenJujubae(fried)
zhfshn 15g SclerotiumPoriaePararadicisPreparatacumCinnabaris
zhmidng 12g RadixOphiopogonisPreparatacumCinnabaris
shh 9g CaulisDendrobii
hp 1g Succinum
bizrn 9g SemenPlatycladi
zhy 9g FoliumPhyllostachydisHenonis
linqio 15g FructusForsythiae
zsgng 6g CaulisPerillae
jigng 6g RadixPlatycodonis
zhnzhm 30gpre-boil ConchaMargaritiferaeUsta
Threepacksoftheaboveformulatobeboiledinwaterandingestedweregiven.
At her next consultation she reported that the previously described symptoms of
headacheanddizziness,manydreamsandfearfulheartpalpitationsweresomewhat
alleviated, but she had now developed an urge to vomit. Her tongue coating was
thinwhiteandherpulseremainedwiryandthin.Amodifiedversionoftheprevious
formulawasgivenasfollows:
zhnzhm 30g ConchaMargaritiferaeUsta

xikco 12g SpicaPrunellae
sngy 9g FoliumMori
jhu 9g FlosChrysanthemi
hngbisho 12g RadixPaeoniaeAlba(producedinHangzhou)
fshn 15g SclerotiumPoriaePararadicis
chozorn 18g SemenJujubae(dry-fried)
gungchnp 9g PericarpiumCitriReticulatae(producedinGuangdong)
zhr 6g CaulisBambusaeinTaenia
Threepacksofmedicinalsweregiven.Atthenextconsultation,thepatientindicated
that the frightful palpitations had not reoccurred, the dizziness and insomnia had
improved and her spirits were relatively good. She had a thin white tongue coating
andherpulsewasthin.Thepreviousformulawasgivenagain,modifedasbelow:
Removed:
sngy FoliumMori
jhu FlosChrysanthemi
zhnzhm ConchaMargaritiferaeUsta
linqio FructusForsythiae
Added:
zshyng 9g Fluoritum
gutng 9g RamulusUncariaeCumUncis
hp 1gwasheddownwithdecoction Succinum
zhsh 1gwasheddownwithdecoction Cinnabaris
Threepacksweregiven.
[Reference:SunYi-min.ClinicalPatternswithMedicalCasesandFormulas.Zheng
Zhou:HenanScienceandTechnologyPress;1981.p.33.]
Source Text 3

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)
Whatisorganmanifestation?
Qi Bo replied:The heart is the root of life, manifesting changes of the spirit. It
flowers in the face and fills the blood vessels; it is greater yang within yang and
connects with the qi of summer.The lung is the root of qi and the location of the
corporeal soul (p, ). It flowers in the body hair and fills up the skin; it is greater
yin within yang and connect with the qi of autumn.The kidney governs dormancy;
itistherootofsealingupandstoringaswellasthelocationoftheessence.Itflowers
in the hair and fills the bones; it is greater yin within yin and connects to the qi of
winter.The liver is the root of endurance and the location of the ethereal soul (hn,
).Itflowersinthenails,fillsthesinewsandcangeneratebloodqi.Itsflavorissour
and its color is dark green. It is lesser yang within yang and connects with the qi of
spring. Spleen, stomach, large intestine,small intestine,sanjiao, and bladder are the
rootofstorage,theresidenceofnourishment.Theyarecalledcontainersandareable
to transform draff; they are organs where flavors change and there is entering and
exiting;theyflowerinthelipsandsurroundingareaandtheyfilltheflesh;theirflavor
is sweet, and their color yellow.They are ultimate yin and connect with the qi of
earth.Alloftheseelevenorgansrelyongallbladderfortheirexecution. (BasicQuestions
Chapter9DiscourseontheSexagenaryCyclesandOrganManifestation)
Interpretation
Organ manifestation refers to the idea that signs reflecting the physiological
functioninganddiseasechangeswithinthehumanbodycanmanifestoncorresponding
partsoftheexteriorofthebody.Theorgansofthebodyhavetheirownphysiological
functions, along with forms which are linked to them and external expressions of
theirflourishing(orfailuretoflourish).Atthesametime,theyinandyangofthefour
seasonsconnectstoandisreflectedinthisexpression,thereforecompletingChinese
medicinesunderstandingoffvezang-organsystemfunctioning.
Theheartistherootoflifeandmastersoveroneslife.Itisalsothecontrolcenter
for changes to the physical body.The heart manifests externally in the face; the qi
andbloodmovedandcirculatedbytheheartfillsandnourishesthebloodvesselsof
theentirebody.Thenatureoftheheartisyangwithinyang;heartqiflourishesinthe
summermonthsbecauseitsharesthesameqidynamicastheblazinghotyangqiof
summer.
Thelungistheorganofbreathing,governingqimovementthroughouttheentire
body. It houses the corporeal soul and manifest in the skin and body hair as lung qi
fills and nourishes the skin.The lung is yin within yang and lung qi flourishes in the
autumn, because it shares the same qi dynamic as the contracting/inward-drawing
movementofqiofautumn.
Kidney qi governs closed storage and storage of essences, it being beneficial to
close and consolidate and not recklessly drain; thus it has the nameroot of sealing
and storage. Externally, the kidney flowers in the hair of the head and their qi fills
and nourishes the bones.The kidney is yin within yin, kidney qi flourishing in the
winterbecauseitsharesthesameqidynamicasthecoldqiofthewintermonths.
The liver stores blood and houses the ethereal soul. Externally, it flowers in the
nails, its qi fills and nourishes the sinews which control movement. If liver qi is
abundant then movement is nimble and one does not get tired.The liver is yang
withinyin,liverqiflourishesinthespringandconnectswiththegenerativeoutgoing
qi of the spring months.The flavor that corresponds to the liver is sour, while its
correspondingcolorisgreen/blue.
The spleen, stomach, large intestine, small intestine, sanjiao and the bladder are
respective components of the gastrointestinal and water metabolism systems.The
organsofthissystemareconsideredtobeholloworgansabletoholdandcarryfood
aswellasdigestandabsorbit.Theremainingfoodbecomesunwantedrefusethatis
eliminatedfromthebody.Thespleen-stomachtransportsandtransformsfood,much
likegrainstoragehandlinginalargebasecamp,andforthisreasonisreferredtoas
therootstorehouseandgranary.Oncefoodhasbeendigestedandtransformedinto
nutritionallyusefulnutritiveqi,itisthenpouredintothebloodvessels.Externally,the
spleenflowersinthelips,anditsqifillsandnourishestheflesh.Thespleenisultimate
yinwithinyin,itsqiflourishingduringthelongsummerbecauseitsharesthesameqi
dynamic as the damp qi of the long summer months.The flavor that corresponds to
thespleenissweetwhileitscorrespondingcolorisyellow.
The gallbladder has qi which corresponds to shaoyang upward rising spring qi;
if the qi of spring rises up then all things are transformed and the qi of the organs
followssuitingenerativetransformation;forthisreasonthesproutinggenerationof
organqiisdependentongallbladderqi.
Inthebody,thelungunitestheskinandbodyhair.Physiologicallyandpathologically
the functioning of the skin and sweat glands as well as the moistness and glow of
theskinareallintimatelyconnectedtothelung.Ifthelungsabilitytounitetheskin
and body hair is somehow compromised, the skin may become dark and dry, the
bodyhairsyellowandbrittle;thebodysabilitytofendoffinvadersmayalsobecome
compromised and external pathogenic qi may be able to easily enter the interior of
thebody.Clinically,allskinandbodyhairdisorderscanbeaddressedbytreatingthe
lung.
CaseReport
Male,adult.
Chiefcomplaint:intermittenthivesoverentirebodyforonemonth.
Thepatientreportedthatoverthepastmonth,hehashadintermittentepisodesof
hivesonvariousareasofhisskin.Hedescribestheconditionaslikethebillowingof
cloudsat any given location they would appear and sometime later disappear. He
describesthehivesasveryitchy,andreportsthatduringanepisodicattack,theywere
accompanied by chest stuffiness and difficulty catching the breath.The patient had
previously been diagnosed at a hospital withurticaria, and, in addition to being
given a number ofWestern medications to address the problem, he was prescribed
morethantwentypacksofChineseherbsforactivatingbloodandeliminatingwindto
useasanexteriorwash.Thepatientsaidthatnoneofthesemeasuresprovedeffective.
His hives continued to appear and disappear, and in the evening they became
particularly acute to the point that he tossed and turned in bed and was unable
to sleep. His stools were hard and constipated.The tongue was red with a yellow
coatingandthepulsefloatingandfast.Theappropriatetreatmentisbaseduponthe
principleofopeningoutlungqi,andhewasgivenamodifiedformofGGnXiBi
Sn (White-Draining Powder with Puerariae, ) to be boiled in water, as
follows:
ggn 30g RadixPuerariaeLobatae

sngbip 12g CortexMori
xngrn 10g SemenArmeniacaeAmarum
dgp 12g CortexLycii
mhung 7g HerbaEphedrae
chntu 10g PeriostracumCicadae
chundhung 9g RadixetRhizomaRhei(Sichuan)
After six packs of medicinals, the hives disappeared, the itching stopped and
no new hives arose. At the same time, his constipation was resolved and his chest
stuffiness was greatly alleviated.To consolidate the effectiveness of the treatment,
he was given three more packs of the same formula. A month later in a follow up
appointmentheindicatedthathewascompletelynormal.
(Reference:SunJi-fen. MedicalTalkfromtheYellowRiver .Beijing:BeijingScienceand
TechnologyPress;1994.p.5.)
Source Text 4

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Food enters the stomach, spreads essence to the liver, and the excess qi to the
sinews.Foodentersthestomachandtheturbidqihomestotheheartwhiletheexcess
essencegoestothevessels;thevesselqiflowsthroughthechannelsandthechannel
qihomestothelung.Thelunglinksthehundredvesselsandtransportsessencetothe
bodyhairandskin.Thebodyhairandvesselsunitetheiressence 1andmoveqitothe
fu-palaces. 2 If the palaces are replete with essence, and the spirit brilliance 3 remains
inthefourdepositories,4thentheqiwillreturntomeasuredbalance.Ifthemeasured
balanceissmooth,eventhoughthepassofqi5isnotmuchmorethanonecun,fromit
lifeordeath[canbe]determined. (BasicQuestionsChapter21FurtherDiscourseontheChannels
andVessels)
Interpretation
Foodentersthestomachandthespleenmovesandtransportsit.Whenitspreads
the cream of the nourishment to the liver, filling and nourishing it with essence-qi,
thelivercanthenusethistonourishthesinews.Whenitspreadsittotheheart,filling
andnourishingitwithessence-qi,theheartcanthenuseittonourishthevesselsand
vesselqicancirculate,pouringintothechannelsoftheorganism;whenthebloodof
thevesselscomes together in the lung, filling and nourishing it with essence-qi, the
lungcanthennourishthebodyhair(i.e.,thesurfaceofthebody).Thelungmovesqi,
1 Lung governs the body hair, heart governs the blood vessels; lung stores qi, heart stores blood.The
bodyhairandbloodvesselscombineessencereferstothecomingtogetherofqiandblood.
2 Manyannotatorsindicatethatfureferstodnzhngorthecenterofthechest.Otherscommentthatitis
areferencetotheyangor fu-organsastheywouldbethefirsttoreceiveyangqi.Athirdcampholdsthatitrefers
totheporesofthebody.Intheinterpretationgivenabove,thewritersofthetextseemtofallintothethirdcamp.
Herethetermisdeliberatelyleftuntranslatedtogivereadersmorescopeforinterpretation.
3 Spiritbrilliancerefersheretonormalfunctioningwithoutdisorder.
4 Thefvezang-organsminusthespleen.
5 Theradialpulseposition.
theheartmoves blood, and qi and blood unite together pouring through the whole
bodyandspreadingtothezang-fuorgans;whenthishappens,themovementofqiis
moderateandwithforce,andthetransportofbloodisopenandbeneficial.Thestate
ofqiandbloodcanbefeltintheconditionoftheradialpulseatthewrist,givingan
indicationoftheconditionofthebodyandhelpingtoprovidecluesastothechanging
stateofhis/herhealth.
Insufficiency of zang-fu organ qi can result in a slowing of or marked decline in
the functioning of the zang- and/or fu-organ in question.The pathodynamic of qi
deficiencycaninvolveallaspectsofthebody.Clinicallyitcanmanifestaslistlessness,
disinterest and fatigue, lack of strength in the limbs, spontaneous sweating,
susceptibility to colds and flu, headaches, dizziness, cough and wheezing, edema,
numbness, heart palpitations, abdominal pain, belching, vomiting and diarrhea,
prolapsed anus, frequent urination, bleeding, impotence, stroke, and paralysis.
Supplementationandaugmentationofqiisofprimaryimportance.
CaseReport
Female,age34.Initialconsultation:October3,1976.
Thepatientschiefcomplaintwasperiodiccheststuffinessandheartpalpitations,
symptomsthathadgoneonformorethanhalfayear.Shereportedtheproblemhad
appearedafteracold-inducedfever.Afterthecoldwasbetter,shewasleftwithheart
palpitations, shortness of breath and heart rate of 50 beats per minute. A previous
hospital had diagnosed her with viral carditis and sinal brachycardia.The primary
symptoms were accompanied by dizziness and an inability to turn quickly (which
would make it worse), poor sleep, tiredness, and a feeling of physical heaviness and
shortness of breath when exercising.The patient said she had an aversion to cold
andpoorappetite.Bowelmovementsweredifficult,occurringonlyonceeveryseven
or eight days. Her throat was moderately dry, but there was no desire to drink. Her
facial color was a withered yellow and her spirits low; vocalization lacked force and
she appeared nervous and afraid to move.The tongue was tender and pale with a
thin sticky coating; the pulse was thin and slow with occasional stops. Analysis of
conditionindicatedqiandyindeficiencyresultinginheartpalpitationsinthiscase,
theheartqiinsufficiencyisespeciallypronounced.Treatmentcallsforaugmentingqi
and nourishing the nutritive, calming the heart and pacifying the spirit.The formula
chosenwasamodificationofBoYunTng(Original-Qi-PreservingDecoction,
)combinedwithLngGuGnZoTng(Poria,CinnamonTwig,LicoriceandJujube
Decoction,)asfollows:

zhhungq 12g RadixAstragaliPraeparatacumMelle
flng 10g Poria
chomidng 10g RadixOphiopogonis(dry-fried)
fshu 10g(slices) FructusCitriSarcodactylis
Fivepacksboiledinwater.
Athersecondconsultation,sheindicatedthatshefeltthesymptomswerenotas
severe.Afterafurthertwentyfivepacksoftheaboveformula,herheartpalpitations
had disappeared and the stuffiness in her chest had all but disappeared; the only
problemremainingwasthatwhensheover-exertedherselfshecouldfeelatightness
inherchest,thoughthisdisappearedaftersherested.Herbowelmovementsgradually
normalizedandherappetiteandsleepingpatternsalsoreturnedtonormal.Herface
had a rosiness to it and she had put on a bit of weight. She continued to take the
formula for another ten packs and a follow-up ECG came back normal with a heart
rateof70bpm.ShewasthengivenRnShnYngRngWn(GinsengSupportingand
NourishingPill,)toconsolidatethetreatment.
[Reference:DingGuang-di.Collectionof100FamousChineseMedicineCliniciansfromthePast100
Years: Ding Guang-di -. Beijing: China Press ofTraditional
ChineseMedicine;2001.p.36.]
Source Text 5

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Liquidenters the stomach; overflowing essence-qi is transported upwards to the
spleen,wherethespleenqispreadstheessence;upwardsstill,ithomesonthelung,
which by opening and regulating the waterways, transports the water downwards
to the urinary bladder.Water essence is distributed to the four corners of the body,
moving together with the five channels. It joins with the yin and yang of the four
seasonsandfive depositories, with regulation as its norm. (BasicQuestionsChapter21
FurtherDiscourseontheChannelsandVessels)
Interpretation
After water/liquid enters the stomach, undergoing the stomachs functions
of accepting and receiving and the spleens transport and transformation, it then
becomesavailabletothebodyashighlynutritiousbodyfluids.Bodyfluidsaremoved
up and out, distributed by the spleen and then collected in the lung.The lung is
locatedintheupperpartofthebodyandlungqiismuchliketheqiofheaveninthat
ithasadownwardoutwardmotion.Whenbodyfluidsflowwithinthewaterpassages
they are regulated and controlled by the lung which distributes these fluids to all
cornersofthebody.Thefluidsthathavebeenusedbythebodyaredistributedtothe
lowerpartofthebody,collectinginthebladderandareeventuallyeliminated.
The process of water metabolism relies on the qi propulsion mechanism of
the body to distribute water throughout the body, nourishing and moistening the
skin and body hair, and pouring it into the five zang-organs and nourishing them.
Watermetabolisminthebodyisalsotiedtoseasonalyinandyangchangesandthe
flourishingstrengthofthefivezang-organsandissuppliedthroughouttheorganism
tomeetitsneedsinappropriatemeasure.
The metabolism of the body fluids is a complicated physiological process tied to
andcompletedbythecoordinatedfunctioningofmultipleorganssuchasthespleen,
lungandkidney. If a problem arises inthe metabolism of bodyfluids it can result in
a production, distribution or elimination disorder/blockage, and manifest as thirst,
edema,frequenturinationordiarrhea.Thepathodynamicsaremostlyinsufficiencyof
productionorblockagesindistributionorelimination.Treatmentinvolvesnourishing
yin-fuidsandopeningandregulatingwater.
CaseReport
Male,age7.Initialconsultation:May2,1988.
Itwasreportedthatthepatienthadbeensufferingfromglomerularnephritisfor
adurationofthreeyears.Hehadhadmultiplestaysinhislocalcountyhospital,and,
while there had been some improvement, he continued to have protein in his urine
and repeatedly had mild facial edema that was aggravated if he caught cold. At the
time of his first consultation, his face was bright white with mild edema and mildly
swolleneyelids.Thepatienthadnoenergyorappetite,hisstoolswerelooseandurine
moderatelyyellow;thetonguewaspaleandfatwithagreasywhitecoatingandthe
pulsewasdeepandmoderate.Urinalysisresultsshowedprotein(+++)andWBC(0-2).
His condition was differentiated to be spleen deficiency with dampness stagnation
resulting in edema.The formula Wn DiTng (Discharge-Ceasing Decoction,
)augmentedwithqinco(RadixetRhizomaRubiae)waschosenfortreatment.A
formulawasprescribedasfollows:
huishnyo 15g RhizomaDioscoreae

cngzh 15g RhizomaAtractylodis
chqinz 15g SemenPlantaginis
qinco 10g RadixetRhizomaRubiae
chih 10g RadixBupleuri
jngjitn 10g HerbaSchizonepetaeCarbonisatum
Sevenpacksofmedicinalsweregiven.
Atthenextconsultation,theedemahadsubsided,hisappetitehadimprovedand
hisurinetestcamebacknegative.Anadditionaltenpacksoftheaboveformulawere
givenandallofhissymptomsdisappeared.Theformulawasthenmadeintopowder
and taken for an additional two weeks.To date, follow-up inquires have revealed no
re-occurrenceoftheproblem.
[Reference:ZhouHan-qing.2NewApplicationsofWnDiTng.NewChinese
Medicine.1991;(1):48.]
Source Text 6

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The five depositories ordinarily open into the upper seven orifices.The lung
is connected to the nose and if lung qi is in harmony, then the nose can perceive
fragrance and stench.The heart is connected to the tongue and if the heart is in
harmonythenthe tongue can perceive the five flavors.The liver is connected to the
eyes and if the liver is in harmony, then the eyes can distinguish the five colors.The
spleen is connected to the mouth and if the spleen is in harmony, then the mouth
canperceivethe five grains.The kidney is connected to the ears and if the kidney is
in harmony, then the ears can hear the five sounds. If the five depositories are out
ofharmony,thenthesevenorificeswillbeobstructed;ifthesix fu-organsareoutof
harmony,thentheywillretainfoodandbecomepustulant.(TheSpiritualPivotChapter17
MeasureoftheVessels)
Interpretation
Theessence-qiofthefivezang-organsfillsandnourishesthevarioussenseorgans
of the body, and in Chinese medicine each of the fivezang-organs governs its own
senseorgan.Thefunctioningofthesenseorgansisdependentontheabundanceor
paucityoftheessence-qiofthefivezang-organs,andzang-fuorgandisharmonycan
reflect in their respective associated sense organ or orifice. Lung qi diffuses to the
nose,andharmonioussmoothlungqiensuresthatthenosehasakeensenseofsmell
enabling one to differentiate among various odors. Heart qi diffuses to the tongue,
and harmonious smooth heart qi ensures that the tongue body is red and moist, its
movementagile,andthatitisabletodistinguishflavors.Liverqidiffusestotheeyes,
and harmonious smooth liver qi ensures that the eyes are nourished properly, that
visionisnormalandoneisabletodistinguishthevariouscolors.Spleenqidiffusesto
themouth,andharmonioussmoothspleenqiensuresthatonehasatasteforfood,a
goodappetite,andthatoneisabletodifferentiatethefivegrainsandotherliquidand
solidfoods.Kidneyqidiffusestotheears,andharmonioussmoothkidneyqiensures
thattheearsarekeenandabletodistinguishthefivesounds.Ifthefivezang-organs
becomedysfunctional,itcanresultinabnormalitiesintheprovisionofqiandblood
tothesenseorgans,whichinturncanresultinabnormalfunctioning.Problemswith
thesixfu-organscanalsoresultinstagnationofqiandblood,(resultingin)knotting
andheat.Ifthereisthiskindofheat,thenfeshcanrotandbecomepustulant.
The spleen opens into the mouth, and the flavor of food is closely related to its
functionsoftransport andtransformation.Ifthespleenand stomach losetheability
to transport in a healthy manner, ones sense of taste can be altered leaving food
blandandflavorless,orperhapsleavingasweetsticky,bitterorsomeotherabnormal
tasteinonesmouth.Itisalsopossiblethatonemightdevelopmouthulcersorsome
problemwiththemouthorlips.Inthesecasesitispossiblethatthepathogenesisis
related to spleen losing its function of healthy transport, or perhaps topathogenic
qitroubling the spleen. In such cases, treatment calls for re-invigorating the healthy
transport function of the spleen and/or eliminating the pathogenic qi, ultimately
reviving the transport and transformation functions of the spleen and ensuring the
normalfunctioningofthemouthandlips.
CaseReport
Male,adult.
The patient reported suffering from coronary heart disease for several years,
but that it had been greatly alleviated with Chinese herbal medicine treatment.The
only remaining symptom was a sense ofsweetness in the mouth that was difficult
to eliminate.This is splenic pure heat (p dn, ) and is a manifestation of spleen

heatwithaninabilitytotransformdampturbidity.TreatmentcalledforLnCoTng
(EupatoriiandLycopiDecoction,).Aformulawasprescribedasfollows:
piln 10g HerbaEupatorii

zln 10g HerbaLycopi
Sevenpacksweregiven,preparedanddrunkliketea,onepackperday.Severaldays
later,thetasteofsweetnessinhismouthdisappeared.
[Reference:WangHong-tu,ZhanHai-hong. EssentialsoftheYellowEmperorsMedicalArtsand
ClinicalPatterns.Beijing:HuaxiaPublishingHouse;1993.p.149.]
Source Text 7

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Allvesselsconnecttotheeyes;allmarrowrelatestothebrain;allsinewsrelateto
thejoints;allbloodrelatestotheheart;allqirelatestothelung:thisisthemorning
and evening tides of the eight streams.1When a person lies down, blood returns to
theliver,andastheliverreceivestheblood,thenonecansee;whenthelegsreceive
blood,theycan then walk; when the palms receive blood, they can then hold; when
thefngersreceiveblood,theycanthenpinch. (BasicQuestionsChapter10DiscourseontheCreation
andFormationoftheFiveZang-Organs)
Interpretation
The essence-qi of the five zang- and six fu-organs passes through the twelve
channel vessels and can upwardly pour into the eyes.The spinal marrow connects
tothebrainaboveandcollectsinthebrain.Theligamentsandtendonsjointogether
the bone joints, connecting the bones and enabling the joints to move at will.The
heartgovernsblood fluid and acts to propel the blood in an endless circuit through
thebody,nourishingtheorgansandthetissues.Thelunggovernstheregulationand
rhythm of qi of the whole body sustaining the movement of qi throughout. From
morning to night in the body, qi and blood ceaselessly circulate, pouring into the
joints,bloodvessels,marrowandfascia,actingmuchlikemorningandeveningtides
intheirendlessnourishmentoftheorgansandtissues.Duringperiodsofwakefulness
and activity, qi and blood are transported throughout the whole body; when one
restsorsleeps,aportionofbloodfluidsreturntoandarestoredintheliver.Theliver
governs the storage of the blood, guaranteeing that blood fluids are regulated and
1 Theelbows,wrists,kneesandankles.
rhythmic;theliveralsopoursblooduptotheeyes,ensuringthatonehasgoodvision;
itsendsblooddowntothefeet,ensuringthatthelimbsarenimbleandabletowalk;it
sendsbloodtothepalmsofthehands,ensuringthattheyhavestrengthandareable
to hold things; and it sends blood to the fingers, ensuring that they are nimble and
abletopickupthings.
Bloodactstonourishandmoistentheorgansandtissuesofthebody.Ifinsufficient
bloodisproducedorifitisdamagedtooquickly,thiscanweakenitsnourishingand
moisteningactions.Thisinturncanresultinallkindsofblooddeficiencychangesthat
can manifest clinically as dizziness and blurred vision, withered yellow complexion,
dry hair, dry skin, or numbness in the limbs. If blood flow is slow or somehow
impeded, this can result in local pain, swelling, scaly skin, a dark (black) cast to the
face,anddark/purplelipsandtongue.Theprimarypathodynamicisblooddeficiency
orbloodstasisresultinginaninability(oftheblood)tocarryoutitsnormalfunctions.
Treatmentcallsforsupplementingandaugmentingyinblood,oractivatingbloodand
dispellingstasis.Regardlessofwhichoftheseiscalledfor,however,theprimarygoal
isalwaystoreinstatethenormalfunctionsofnourishingandmoistening.
CaseReport
Male,age20.
The patient reported having a weak constitution and for the past month having
episodicperiodsofnumbnessinhislimbswithoccasionalspasm.Testingatanother
hospitalshowedthathisbloodlevelcalciumwasabitlowandhewasdiagnosedwith
hypocalcaemia. AWestern prescription of calcium supplements proved ineffective
inalleviatingthesymptoms.Atthetimeofthisconsultation,hislimbswerenumbas
before but appetite, urine and stools were all normal; the tongue was pale red with
a thin greasy coating and the pulse wiry. His differential pattern was determined
to be blood deficiency resulting in the channels and vessels failing to be nourished,
complicatedbywinddampness.Treatmentcalledfornourishingthebloodandsoothing
thesinews,eliminatingwindanddampness.Hewasgivenaformulaasfollows:

chobisho 30g RadixPaeoniaeAlba(dry-fried)
jimgu 10g FructusChaenomelis(alcohol-fried)
jxutng 30g CaulisSpatholobi
qnjio 10g RadixGentianaeMacrophyllae
fngj 10g RadixStephaniaeTetrandrae
sngzh 30g RamulusMori

shngml 60g ConchaOstreae(crushandpre-boil)
Sixpacksweregiventobeboiledinwater,onepackperday.Hewasalsoinstructed
to avoid wind and cold, and told not to consume raw cold foods or to contact cold
water.Aftertakingtheherbs,thenumbnessinhislimbsbecamegreatlyreducedand
hehadnomoremajorepisodesofspasms.Histonguecoatingwaswhiteandgreasy,
his pulse wiry and moderate. Six packs of a modified version of the original formula
weregiven:
Reduceddosages:
Added:

flng 20g Poria
Athisnextconsultation,heindicatedthathisnumbnessandexperiencesofspasms
had continued to improve, but that they had not totally disappeared. His pulse
was wiry and moderate, and his tongue pale red with a thin white coating. Again a
modifcationoftheoriginalformulawasgiven:
Removed:cngzh.
Added:
shnghungq 15g RadixAstragali

Sixmorepacksweregivenfollowingwhichhisbodyreturnedtonormal.
[Reference:ChangZhang-fu,YanZheng-hua.TheFlowerofYanZheng-huasClinicalExperience
.Beijing:AcademyPress;1996.p.94-95.]
77
Chapter4
Essence, Qi and Spirit
Source Text 1

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I have heard that a person has essence, qi, thin fluids, thick fluids, blood, and
vessels;Ithoughtthatthesewereoneqialone,buttodaytheyhavebeendistinguished
bysixdiferentnames.Idonotknowthereasonforthis.
QiBoreplied:Twospiritscometogetherincombat,theyjoinandbecomeform;
theyprecedethebirthofthebodyandarecalledessence.
WhatthenisQi?
Qi Bo replied: The upper jiao opens and vents, distributing the five flavors,
steamingtheskin,fillingthebody,moisteningthebodyhair,muchlikethewatering
actionsoffoganddew;thisiscalledqi.
Whatthenisthinfuids?
Qi Bo replied:The interstices vent open and drain, and sweat flows out; this is
calledthinfuids.
Whatthenisthickfuids?
Qi Bo replied:Grain enters and qi becomes replete; [its] thick slippery rich
portionflowsintothebones[enabling]thebonestoflexandextend;[atthesametime]
itpoursintothebrainandmarrowandlubricatestheskin:thisiscalledthickfuids.
Whatthenisblood?
Qi Bo replied:The middle jiao receives qi and takes out its juices, changing and
transformingthemtored:thisiscalledblood.
Whatthenarevessels?
Qi Bo replied:[That which can] contain and hold back nutritive qi, giving it no
placetoescape;thesearecalledthevessels. (TheSpiritualPivotChapter30Differentiating
Qi)
Interpretation
Essence, qi, thin fluids, thick fluids, blood and vessels comprise the body and
arethematerialbasisoftheorganism.Essencepre-existstheformationofthebody,
comingfromtheunionoftheessencesofmanandwoman.Whenamanandwoman
engageinsex,the essences produced by their respective sexualorganssperm and
ovaare brought together and unite; this then is both the beginning of a new life
and its foundation.Qi refers to that subtle substance in the body possessing
a strong life force; it moves up, down, in and out, and pushes material form in
transportation and distribution.When qi moves in the upper parts of the body, it
distributes fine nutritious matter to the skin, muscles, hair, and all over the body,
like the fine mist of an early morning, moisturizing the organism.Body fluids are
normal fluids in the body though they have slightly different natures and functions.
Thin fluids are clear and thin with high motility acting to moisturize the interstices
and skin; via sweating they can be pushed outside the body.Thick fluids are more
viscous with less motility.They function to lubricate and nourish the tissues of the
zang-fu organs, the brain, the bones and the joints, ensuring that the flexing and
extending actions of the joints maintain their facility, that the marrow of the brain
remains replete, and that the skin remains moist. Blood is produced from the fine
materialnutritionthatisabsorbedfromthedigestionoffoodandwater.Itcirculates
through the blood vessels of the whole body to nourish all the tissues of the body.
The vessels are called thepalaces of blood as they hold the liquid, acting as a
restraining conduit through which it flows, much like the banks of a river act as a
damtoholdthewaterin.
Thebodyfluidsacttonourishandlubricatetheorgansandthetissuesofthebody.
Ifthemovementofthesefluidsaroundthebodyisabnormal,itcanresultinstoppage
and accumulation, which in turn can result in pathodynamic states involving water,
dampness,phlegmandrheum.Clinically,suchstatescanpresentasfluidbuild-upin
variouspartsofthebodyandavarietyofothersymptoms.Forexample, waterrheum
blocking the lung could result, manifesting with fullness in the chest, cough and
wheezing,andaninabilitytolieflat.Waterrheuminvadingtheheartandmanifesting
with heart palpations and heart pain could also result. Another possible result is
water rheum halted and stagnant in the middle jiao and manifesting with dizziness,
tiredness, stomach and abdominal distention, nausea and vomiting. If water rheum
halts in the limbs, then there will be edema, difficult movement, and a feeling of
heaviness in the limbs.Treatment of such conditions requires application of the
main principle of opening out and moving the water and fluids with an eye to the
ultimate goal of restoring the proper movement and distribution of fluids in the
body.
VolumeOne:Chapter4 Essence,QiandSpirit 79
CaseReport
Male,age62.Initialconsultation:September12,1995.
Chief complaint: recurrent episodes of swelling with fluids in the face and
lower limbs for three months.The patient reported the swelling was somewhat
alleviatedbymovementbutgotworseifheremainedstill.NeitherWesternmedicine
prescribeddiureticsnortheChinesemedicineprescribed ZhnWTng(TrueWarrior
Decoction,)orWPYn(Five-PeelBeverage,)wereeffectiveinresolving
the problem. All relevant labs, ultrasound and CT scans were normal.The only
abnormalitydiscoveredwasarteriosclerosisinthebaseofhiseyes.Atthetimeofthis
consultation,hisfaceandlowerlimbswereswollenandindentationswereleftwhen
pressed; all else was normal.The tongue was pale with a thin white coating and the
pulsedeep,thinandforceless.Treatmentcalledforactivatingbloodandtransforming
stasis, warmingyangandbenefitingqi, and promoting urination to reduce swelling.
Aformulawasprescribedasfollows:
torn 6g SemenPersicae
zln 10g HerbaLycopi
ymco 15g HerbaLeonuri
chsho 15g RadixPaeoniaeRubra
flng 10g Poria
tngco 5g MedullaTetrapanacis
wjip 12g CortexAcanthopanacis
chunnix 12g RadixCyathulae
Aftertakingfourpacksoftheformula,hisedemawasgone.Hecontinuedtotakefive
morepacksoftheformulatostabilizetheresultandatwo-monthfollow-upindicated
norecurrenceoftheproblem.
[Reference: ChenYing-yi, Chen Jing. Clinical Experience of Obstinate Edema .
ZhejiangCollegeofTCMPaper.1996;10(5):54.]
Source Text 2

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)
The six qi have both excess and insufficiency; as well, the varying amounts of qi,
the emptiness or fullness of brain marrow, and the clarity or turbidity of blood and
vessels.Howcanoneknowthesethings?
QiBoreplied:Ifessencecollapses,thentheearsbecomedeaf.Ifqicollapses,then
the eyes are not bright.1 If thin fluids collapse, then the interstices open and sweat
poursout.Ifthickfluidscollapse,thentheflexingandextendingofthebonesbecome
difficult,onescolorlooksdeathly,brainmarrowisconsumed,thecalvesache,andthe
earsrepeatedlyring.Ifbloodcollapses,thenonescoloriswhiteanddeathlywithno
luster and the pulse is empty and vacuous.These are their signs. (The Spiritual Pivot
Chapter30DiferentiatingQi)
Interpretation
Essence, qi, thin fluids, thick fluids, blood and the vessels are all generated out
of various processes of qi transformation. In the body, these six are varied in their
amounts as well as in their deficiencies or excesses, and large scale consumption of
any of them can result in pathodynamic changes in the body. If a large volume of
essenceislost,thenitcannolongerfillthebrain;andifbrainmarrowisinsufficient,
then hearing ability will slowly decrease, even to the point of deafness. If a large
volume of qi is lost, then it loses the ability to transform and generate essence and
negatively affects the ability of the material aspects of blood to fill out and nourish
theeyes.Thisthenleadstoareductioninvisualacuity.Ifthewateryfluidsinsidethe
body are lost in large volumefor example, if the interstices of the body open and
sweatpoursoutinlargeamountthenthefluidswillnolongerbeabletolubricate
the limbs, organs or brain and (in turn) could result in stiffening of the joints, dry
face, insufficiency of brain marrow, dizziness and vertigo, tinnitus and aching and
discomfortofthe limbs. If a large volume of blood is lost, and the body is no longer
nourishedsufficiently,thenthefacewillbewhiteandhaggardlooking,greyanddark
withnoluster,andinthepresenceoftheblooddeficiency,thepulsewillnolongerbe
full.
Ifthebloodisdeficientandunabletonourishandlubricatetheorgansandtissues,
clinically this can manifest as pale facial color; pale, lusterless lips, tongue and
nails; tiredness and lack of strength; and movement that results in wheezing and
easy sweating.The general treatment principle for this condition is to nourish yin
1 Dontseewell.
and supplement blood with an eye to returning blood to its proper fullness, and
lubricatingandnourishingthewholebody.
CaseReport
Female,age36.Initialconsultation:August23,1977.
Chiefcomplaint:dizzinessformorethanayearaccompaniedbyheartpalpations,
lack of strength, dry mouth, heat in the palms and soles, sore lumbar area and poor
sleep.The patient reported the time between her periods was foreshortened, with
muchbleedingandhermostrecentperiodwasstillflowingmorethan20daysafter
it started. Her appetite was fine and her stools and urination regular. Observation
showed the tongue to be pale with a thin white coating and the pulse to be deep
and thin. Blood pressure was 110/70 mmHg with hemoglobin at 70 g/L. She was
differentiallydiagnosedwithblooddeficiencyresultingindizziness.Treatmentcalled
fornourishingbloodandregulatingtheperiod.Aformulawasprescribedasfollows:

nzhnz 12g FructusLigustriLucidi
tsz 18g SemenCuscutae
chunxdun 15g RadixDipsaci
sngjshng 18g HerbaTaxilli
zngltn 9g PetiolusTrachycarpiCarbonisatus
iytn 5g FoliumArtemisiaeArgyiCarbonisatum
shngjio 6g Colla Corii Asini (melted and taken with the rest of the
decoction)
shnyru 12g FructusCorni
dzo 18g FructusJujubae
After three packs of the above formula, she reported her period had ceased, the
lumbarpainimprovedandthedizzinessdiminished.Atthisconsultation,thetongue
waspalewithathinwhitecoatingandthepulsedeepandthin.Amodifiedversionof
the above formula was given. After twelve packs of this second formula, she had no
obvious dizziness or heart palpations, the hot feeling in her hands and feet was less
severe,andhersleepwasmuchimproved.Herperiodhadnotyetarrived.Thetongue
was pale with a thin white coating and the pulse deep and thin. Hemoglobin was
105g/L.Shecontinuedtheformulatostabilizetheefectsofthetreatment.
[Reference:WengWei-liang.Collectionof100FamousChineseMedicineCliniciansfromthePast100
Years:GuoShi-kui.Beijing:ChinaPressofTraditionalChinese
Medicine;2001.p.23.]
Source Text 3

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)
Themiddle jiaoisalsowherethe stomachis.Aftermovingdownfromthe upper
jiao,themiddlejiaoiswheretheqiisreceived;itexcretesthedregs,steamsthebody
fluids and transforms refined essence. Upwardly it pours into the lung vessels, and
thereitistransformedandbecomesbloodwhichthenservesthewholebody.Thereis
nothingmorepreciousthanthisandsoitaloneflowsthroughthechannels;itisgiven
thenameyingqi. (TheSpiritualPivotChapter18GenerationandComingTogetherofNutritiveand
Defensive[Qi])
Interpretation
The sanjiao is divided into the upper, middle and lower jiao wherein the qi of
the middlejiaois below that of the upperjiao. Its qi exits from the centralstomach
cavity and it is at this location that food is transported and transformed, where the
finematterofnutritionisabsorbed,andtheremainingportionofthefoodbecoming
draff to be excreted.The finer parts of material nutrition are considered clear and
move upward, pouring into the lung. Lung qi helps heart qi transform blood, which
circulates throughout the body to provide nourishment. Blood is the nourishing
andmoisteningmaterialsubstancethatthehumanbodyrelieson;itisanimportant
material basis for the human body and for this reason flows through vessels which
restrict and control its movements, ensuring that it is better able to fulfill its duties.
Thenourishingaspectofbloodisreferredtoaseitheryingqiornutritiveqi.
Ying qi is one of the important substances comprising blood. Its formation is
related to the functioning of the heart, spleen and lung. If the functioning of the
spleenandstomachiscompromised,thenthefineessenceoffoodandwatercanno
longer be transformed into nutritive qi and blood.This in turn will result in dual
deficiencyofbothqiandblood,manifestinginsymptomslikelowenergywithadis-
inclination to talk, tiredness, spontaneous sweating, weight loss, dry skin, white or
dry yellow facial complexion, pale lips and nails, numbness in the limbs, dizziness,
visualdifficulties, heart palpations, and insomnia.The basic treatment principle is to
supplementqiandbenefitbloodwiththeintentofreturningthespleenandstomach
tonormalfunctioningandtherebyfllingoutblood.
CaseReport
Female,age32.
Thepatientreportedhavingtwomiscarriagesin1951and1952,respectively.She
said that at the time, she bled profusely and ever since has had heart palpations,
shortnessofbreath,dizziness,restlessness,disturbedsleep,notastetoherfood,loose
stools,heatinthepalmsandsoles,andoccasionalspontaneoussweating.Thepatient
saidherjobrequiresalotofmentalworkandshehasrecentlybeguntofeelthather
memoryisfailing.Shealsoindicatesthatshehasbeenfeelingtiredtothepointwhere
shehastakentimeofffromworktorest.Atthetimeoftheconsultation,herfacewas
white and anemic, the tongue pale and the pulse deep and faint. She was given a
differentialdiagnosisofqiandblooddeficiency.Treatmentcallsforregulatingtheqi
andnourishingtheblood,fortifyingthespleen,strengtheningtheheartandcoursing
theliver.Aformulawasprescribedasfollows:
cchih 5g RadixBupleuri(vinegar-fried)
shngml 12g ConchaOstreae(pre-boil)
shnglngg 12g OsDraconis(pre-boil,bundletogetherwithml)
zbich 10g ConchaMauritiae(pre-boil)
zshyng 10g Fluoritum(pre-boil,bundletogetherwithzbich)
ynflng 10g Poria(producedinYunnan)
cngzhtn 6g RhizomaAtractylodisCarbonisatum
sngzh 15g RamulusMori
ynfshn 10g SclerotiumPoriaePararadici(producedinYunnan)
bizhtn 6g RhizomaAtractylodisMacrocephalaeCarbonisatum
ljiojio 6g CollaCornusCervi(meltandtakewiththerestofthe
decoction)
zhup 5g CortexMagnoliaeOfcinalis
choyunzh 10g RadixPolygalae(dry-fried)
didihu 5g FlosDolichoris
miguihu 5g FlosRosaeRugosae
Aftersixpacksoftheformula,shesaidherspiritsimproved,thenumberofbowel
movementsshehadperdaywasreducedandherappetiteimproved.Shereportedthat
heronlyremainingsymptomswereheartpalpations,shortnessofbreath,interrupted
sleeping patterns and whole body pain.The following changes were made to her
formula:
Added:
chodngshn 10g RadixCodonopsis(dry-fried)

jioyyrn 25g SemenCoicis(scorch-fried)
xuytn 10g CrinisCarbonisatus
Removed:didihu,miguihu,andzbich.
After eight packs of this second formula, she said her sleep improved, her heart
palpations and shortness of breath were not so severe, her daily bowel movements
declined in number and the stools were no longer loose, and there was no more
spontaneous sweating.The patient indicated that she wanted to return to the
countryside to recuperate and that a decoction was not very convenient so her
formula was made into pills. She was told to take the formula for another 100 days
whereuponshecouldlookforwardtobeingcompletelycured.
[Reference: Shi Jin-mo. Shi Jin-mos Collected Clinical Experience. Beijing:
PeoplesMedicalPublishingHouse;1982.p.155-157.]
Source Text 4

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Heaven manifests in self as virtue, while earth manifests in self as qi. If virtue
flowsandqiclasheswithit,thenthereisgeneration.Thesourceoflifeis essenceand
when two essences commingle then this is referred to as spirit.That which follows
the comings and going of spirit is called ethereal soul; that which accompanies the
exitingandenteringofessenceiscalledcorporealsoul;andthatwhichisresponsible
for taking care of things is called heart.That aspect of heart that is remembrance is
called mind; that aspect of mind that stores ideas, and memories is called will; and
whenwillstoresandchanges,thisiscalledthought.Whenthoughtisusedfordistant
plans,thisiscalled considering; when considering is used to deal with affairs, this is
calledwisdom.Wisdomcultivateslifeandisnecessaryifoneistoaccommodateones
selftothechangesofthefourseasonsandadapttowintercoldandsummerheat,to
harmonize happiness and anger and live peacefully, to moderate yin and yang and
regulate hardness and softness. If you are able to do these things, then pernicious
evils 1 will be unable to reach you; you will live long and your seeing will be
1 Pathogenicqi.
prolonged.1(TheSpiritualPivotChapter8RootSpirit)
Interpretation
Heaven and earth provide humankind with an environment and conditions
for living, for example, weather, sunlight soil, and grains.There must be free and
unimpededinterminglingoftheqiofheavenandearth,intertwiningofyinandyang
and rising and sinking of the qi of heaven and earth in order for the material world
to support life. Humans and all of the myriad other living beings on the planet rely
onthenatural world for their survival.The very inception of the human form begins
withtheunitingofthereproductiveessencesofthespermandtheegg.Theseessences
aretheveryrootoflifeandcomefromtheunionofthegenerativeessenceofyinand
yang/male-female;togethertheyproducealivingbodywithapowerfullifeforce.
Following the union of these two, not only is there the formation of a physical
body,thereisalsoformationofanon-material spiritconsciousnessthatcanperceive
andapprehendthingsaswellasinitiatemovementcreatinganappropriateresponse.
The heart holds the position of ruler, governing the spirit and the body; knowledge
of the outside of the body and response to outside stimuli are both related to it.
The activities of the spirit consciousness are completed in the end by the activities
of memory, intention, will, thought, pondering, and wisdom.The first action is
apprehensions of the external worldseeing, hearing, smelling, perceptions of
all sortsand their storage in the memory banks of the brain which forms the
basis of memory. Focusing on them, strengthening these memories, then forms a
kind of consciousness; furthering of this kind of consciousness in turn results in
discrimination and opinion; if discrimination and opinion become resolute, then
this is will. Discrimination and opinion, however, are also based on verification and
repetition, repeated consideration and deliberationwhich are the processes of
thought.Furtherthinkingon,andanalysisof,thesameideaispondering.Intheend,
this process leads to a mature analysis that can be used to further understand and
dealwithproblemsthisiswisdom.
We humans live between heaven and earth, and as a consequence should study
and observe natural phenomenon.We must learn how to live in harmony with the
naturalworld;thosewhodosocanbeconsideredwise.Thewiseknowtheprinciples
oflifecultivationandunderstandhowtoadapttothechangesoftheseasonsandto
thevariouschangesintheweather.Theyknowhowtoregulatetheiremotions,how
tolivepeacefullyinsuitableplaces,andareabletomaintaintheyinandyangoftheir
1 There is much discussion about the phrase translated asyou will live long and your seeing be
prolonged( ),especiallyaboutwhatyourseeingbeprolongedactuallymeans.Mostannotatorsregard
thetwohalvesofthephraseasbothmeaninglongevity.
bodiesinperfectbalance.Thus,theyliveinharmonywithallthings.
Ifonesdietand lifestyle do not violate the principles of heaven and earth or yin
andyang,thenlifewillbewellnursedandonewillbelonglived.
Thehearthousesspiritandisthemostimportantorganinvolvedintheactivities
of essence-spirit, consciousness and thinking. If there is a problem that affects the
heartsabilitytohousespirit,clinicallythiscanmanifestas insomnia,vividdreaming,
restlessness, delirium, mania, mental malaise, slowed reactions, coma and other
such symptoms. Clinically speaking, whenever there are mental and/or emotional
abnormalities,forthemostparttheiretiologyisdiscussedfromthepointofviewof
theheart.Themajortreatmentprinciplecallsforregulatingandnourishingtheheart
spiritwithaneyetorestoringtheheartsabilitytohousethespirit.
CaseReport
Female,age35.Initialconsultation:April,1984.
The patient reported her problem began when she was in the hospital for birth
controlsurgery.While she was in the hospital, she saw a patient with his leg cut off;
thisfrightenedherandshookherspirittotheextentthatshelosttheabilitytocontrol
herself.Gradually,thisfrightchangedintopalpationsandshebecameunabletoleave
herhomeonherowninitiative.Whenshewenttothemarketinthemorningtobuy
vegetables,andwhenshewaswalkingonthestreetorinaquietplace,shefeltthat
therewassomeonebehindherabouttograbher;sheoftenfelttheneedtobeonthe
lookout;herspiritandetherealsoulwereunsettled;atnightshehadnightmares,often
waking up yelling with fright. At the time of the initial consultation, this had gone
on for ten days. Her pulse was thin and rapid, the edges and tip of her tongue were
red and there was a thin coating.The patients pattern is heart blood insufficiency
withthespiritno longer housed. She was given six packs of augmented C ZhWn
(LoadstoneandCinnabarPill,)
lngcsh 30g Magnetitum
zhsh 1.5g Cinnabaris
zhnzhm 30g ConchaMargaritiferaeUsta
shnglngg 20g OsDraconis
shngd 20g RadixRehmanniae
zorn 15g SemenJujubae
yunzh 9g RadixPolygalae
On her return consultation, she still felt that her heart was empty and fearful,
fullofparanoia.Itwasdecidedthatthepatienthadaconstitutionalweaknessofthe
heartandtimidity,andthatthetreatmentneededtobechangedtoaddressthis.The
treatmentnowcallsforsupplementingdeficiency,nourishingtheheartandcalmingthe
spirit.TheformulausedwasmodifedRnShSn(CookedKernelPowder,):

shdhung 30g RadixRehmanniaePraeparata
tizshn 30g RadixPseudostellariae
flng 24g Poria
wwiz 10g FructusSchisandraeChinensis
zhqio 12g FructusAurantii
rugu 3g CortexCinnamomi
Shetooksixpacksofthisformulaandnolongerhadthefeelingofbeingafraidand
her spirits improved. She was then given Yng Xu n ShnWn (Blood-Nourishing
andSpirit-CalmingPill,)topreventtheproblemfromre-occurring.
[Reference: Chen Ming. Essentials of Clinical Patterns in theYellow Emperors Inner Classic of
Medicine.Beijing:AcademyPress;2006.]
Source Text 5

(
)
Liverstoresblood.Bloodhousestheetherealsoul:ifliverqiisdeficient,thenthere
isfear;ifitisinexcess,thenthereisanger. Spleenstoresthenutritive,whichhouses
the intention: if spleen qi is deficient, then the four limbs are unable to move and
the five depositories uneasy; if it is in excess, then the abdomen will be distended,
defecation and urination difficult, and a womans period abnormal. Heart stores the
vessels.The vessels house the spirit: if heart qi is deficient, then there is grief; if it is
in excess, then there will be laughter without cease. Lung stores qi. Qi houses the
corporeal soul: if lung qi is deficient, then the nose will be stuffed and there will be
shortnessofbreath;ifitisinexcess,thentherewillbewheezing,afeelingoffullness
inthechestand(aneedto)reclinefaceuptobreath.Kidneystoresessence.Essence
houses will: if kidney qi is deficient, then the hands and feet will be cold; if it is in
excess,thenthere will be distention and the five depositories uneasy. It is necessary
to examine the disease form affecting the five depositories to know their relative
deficiencyorexcess;fromthis,onemusttakecautionandregulatethem. (TheSpiritual
PivotChapter8RootSpirit)
Interpretation
Theliverhousesbloodandisabletoadjustthedistributionofbloodduringtimes
of activity and times of stillness.The livers role in housing blood is a completion of
thematerialbasisofhigherlevelspiritualandmentalactivities.Ifthereisinsufficient
liver essence-qi, then fear is easily generated; if there is excess liver qi, then there is
emotionalinstabilityandexpressionsofanger.
The spleen transpor ts and transforms water and food thereof generating
nutritional substances; from this nutritive qi fills the blood and forms the material
basis of the cognitive activities of the brain. If spleen qi is insufficient and the
generation of available nutritional substances lacking, then this will result in lack
of strength in the limbs and a wasting away and withering of the flesh; and if the
essence-qi of the zang-fu organs is insufficient, then their function will become
impaired.Ifthespleenandstomachareblockedinanexcesspattern,thentherewill
be problems with digesting food. If this happens, symptoms can include distention
andperhapsevendiscomfortoftheabdominalregion,irregularmenstruationand/or
difcultiesdefecatingorurinating.
The heart governs the blood and the vessels and propels the liquid blood
throughout the body. If heart blood is sufficient, then it can transform and nourish
spirit;ifheartqiisinsufficient,onecanfallpreytosadnessanddespair.Excessheart
qi,ontheother hand, leaves one easily subject to uncontrolled emotional outbursts
andlaughterthatdoesnotstop.
Thelunggovernsqiandregulatesthebreathing;indoingsoitnotonlyregulates
andcontrolsthemovementofqithroughouttheentirebody,butisalsoresponsible
for the movement of fluids and blood and for ensuring the movement of the body.
If there is insufficient lung qi then this can result in a failure of the wei qi, and
becausethenoseandthelungaredirectlyconnected,whenonecontractsanexternal
pathogenic qi, there can also be stuffy nose, lack of strength to breathe and weak
voice. If lung qi is in excess, however, this can cause problems with the proper flow
ofqithroughthelungandtherecanbewheezing,dyspnea,feelingsoffullnessinthe
chest,andheadanglingbackwardtobreathe.
The kidney governs the storage of essence, and essence is responsible for the
promotion of generation, growth and development as well as sexual development.
It promotes the maturation of the body and aids in the stabilization of thought,
intention and willpower. If there is insufficient kidney qi/insufficient kidney yang,

then it can result in cold hands and feet; while if there is too much kidney qi, then
this can impede the qi mechanism manifesting in the lower part of the body as
feelingsoffullnessandblockage.Ifthisstateisallowedtocontinue,thenitcancause
irregularitiesinthefunctioningofthezang-fuorgans.
In the course of treating a disease, it is necessary to accurately differentiate the
deficiency or excess of the organs, and whether or not their functioning is normal,
tobetterunderstandthechangesinthecourseofdiseasedevelopmentandtomore
timelyregulateandrebalancetheproblem.
Approached from a holistic perspective, Chinese medicine considers that all
mental and emotional activities are a reflection of the functioning of the fivezang-
organs.Ifthefunctioningoftheseorgansbecomesdisturbedinsomewaytheremay
be such symptoms as insomnia, fear, desire for sleep, or schizophrenia.The main
treatment principle is to regulate and nourish the five zang-organs with an eye to
harmonizingtheiroverallfunctioning.
CaseReport
Female,age76.Initialconsultation:January14,1981.
Chiefcomplaint:Uncontrollable,intermittentlaughterforsixmonths.Thepatient
reported that six months previous, she accidentally bumped into the bedroom door
whenurinatingwhereuponshebegantolaugh.Eventuallythelaughterbecamecrazy
laughter that wouldnt stop.The problem got worse by the day and was particularly
bad at night. Each time she would laugh for 23 minutes. During an episode, she
was clear and in her right mind and after the laughter stopped she would wet her
pants, a problem that frequently happened several times a day.Western medicine
diagnosticswas unable to turn up any unusual lab results. At the time of diagnosis,
the cn and gun positions of her pulse were surging, while the ch positions were
deep and fine; her tongue was red with a thin coating, with the root position thin
yellow and slightly greasy.The differential diagnosis was heart and kidney failing
to communicate with phlegm heat obstructing the collaterals.Treatment called
for communicating and pacifying the heart and kidney and cracking phlegm and
openingthecollaterals.
Theformulagivenwasasfollows:
chunhunglin 4.5g RhizomaCoptidis(Sichuan)

guxn 4.5g CortexCinnamomi(addneartheend)
zhbnxi 9g RhizomaPinelliaePraeparata
flng 15g Poria
zshyng 30g Fluoritum(pre-boil)
CZhWn 9g LoadstoneandCinnabarPill(wraptoboil)
MngShGnTnWn 12g ChloritePhlegm-RemovingPill(wraptoboil)
Fivepacks.Inaddition,shewasgiventwovialsofWnShNiHungQngXnWn
(MasterWans Bovine Bezoar Heart-Clearing Pill) and told to take 60 of a vial each
time.
On her return visit, it was noted that the daytime laughing had ceased, though
she still sometimes broke out into laughter at night when she woke to urinate; her
incontinencewasalsogreatlyimproved.Theaboveformulawasmodifedasfollows:
Removed:zhbnxiandlinqio.
Added:
dnshn nodosagegiven RadixetRhizomaSalviaeMiltiorrhizae

dunlngg nodosagegiven OsDraconisPraeparatum
dunml nodosagegiven ConchaOstreaePraeparatum
After five packs of this new formula, the laughing stopped and the incontinence
was less.The original yellow root of her tongue and its coating were improved; the
cnandgunpositionsofthepulsebecameharmoniousandmoderate.
Herformulawasonceagainmodifedandwasasfollows:

chobizh 12g RhizomaAtractylodisMacrocephalae(dry-fried)
flng 15g Poria
dlng 15g Pheretima
csh 30g Magnetitum
hunglin 4.5g SichuanRhizomaCoptidis
guxn 4.5g CortexCinnamomi(addedneartheend)
Fivepacksweregiven.Intotal,shetook15packsofmedicinalsandwascompletely
cured.Athree-monthfollow-upindicatednorecurrence.
[Reference: LiuYu-shu, Su Gen-yuan. Unlocking the Ancient and Modern Cures of Unusual
Symptoms.Beijing:ChinaPressofTraditionalChineseMedicine;1995.p.50.]
92
Chapter5
Etiology and Pathodynamics
Source Text 1
()
When wind is dominant, then there is movement.When heat is dominant, then
there is pustulation.When dryness is dominant, then there is desiccation.When
cold is dominant, then there is swelling.When dampness is dominant, then there is
weepinganddraining. (BasicQuestionsChapter5TheGreatTreatiseonYinYangCorrespondencein
Phenomena)
Interpretation
There are four seasonal changes in the natural world that generate the various
weather phenomena of wind, cold, heat, dryness, and dampness. If any of these
phenomenaareexcessiveinanyway,theybecomepotentialpathogenicfactorsinthe
rise of disease. If this occurs, then the seasonal changes fall within the scope of the
exteriorandclimaticallynaturedsixpathogenicfactors.
The six pathogenic factors invades the body and firstly manifests as damage to
the physical body. For example, when the pathogenic factor of wind is in excess, it
canmanifestasshakingandtremblingofthelimbsorvertigo;whenheatpathogenic
qi is excess, ying qi can stagnate and congeal into carbuncles, ulcers, redness and
swelling; when dryness is in excess, internal and external dryness and a deficiency
of fluids can manifest; when cold is in excess, yang qi is damaged; this now
damaged or deficient yang qi then loses the ability to properly move the fluids
around the body leading to accumulations of water and swelling; and, finally, when
dampness is in excess, this can retard the functioning of the spleen and negatively
influence its ability to transform and transport food and water, in turn resulting in
diarrheaorloosestools.
When wind heat invades the body it can create a situation where heat toxins
accumulateresultinginred,swollen,hotandpainfulareasonthesurfacemusculature
of the body. If this happens, the major treatment principle calls for scattering wind
and draining heat, releasing the toxins and dispelling the accumulation. Overall, the
keytreatmentprinciplesrequireeliminatingthepathogenicqiandreturningthebody
tohealth.
VolumeOne:Chapter5 EtiologyandPathodynamics 93
CaseReport
Chief complaint: Bilateral swelling and pain of the parotid glands for one day.
This was accompanied by fever, loss of appetite and marked pain when chewing
or on opening the mouth. It was established that the patient had come in contact
with another child with mumps at the kindergarten he attended. At the time of this
consultation, his temperature was 37.7C, and there was marked bilateral swelling
and pain centered near the lobes of the ears (the swelling was about the size of a
chickens egg with indistinct borders), in addition to tight shiny skin, pain when
pressed, but no redness. Blood tests showed a totalWBC count of 610 9 /L, with
neutrophil levels of 0.52 and lymph cells at 0.48.Western medicine diagnosed this
case as contagious mumps and Chinese medicine diagnosed it as mumps cheek
(zh si, ).Treatment called for clearing heat and releasing toxins, transforming
stasis and eliminating swelling.The formula chosen was r Hung Bng Di Sn
(TwoYellow, Borneo and Indigo Powder, ). A formula was prescribed as
follows:
dhung nodosageindicated RadixetRhizomaRhei
hungbi nodosageindicated CortexPhellodendriChinensis
bngpin nodosageindicated BorneolumSyntheticum
qngdi nodosageindicated IndigoNaturalis
ydnqng nodosageindicated Duckeggwhite
The above mixture was externally applied to the area of swelling and pain three
timesaday.Onedayafterthetreatmentstarted,thelocalizedpaindisappearedand
after two daystheswellingwasgreatly reduced and the body temperature returned
to normal. After three days of this regime, the once swollen parotid glands had
completelyreturnedtotheirnormalsizeandthepatientwascured.
[Reference:ZhejiangCollegeofTCMPaper.1996;12(6):15.]
Source Text 2

()
Yang qi is like heaven and the sun. If they were to lose their positions, then life
would be shortened and unable to flourish. It is that the cycles of heaven are based
on the light of the sun.Thereof when yang relates to superior aspects, it defends
the exterior; when it addresses cold, it moves as shutters do protecting the body, if,
however, ones lifestyle is stressed, then spirit-qi1 will float. In this situation, if there
isthepathogenicfactorofsummerheat,therewillbesweating;andifirritatedaswell,
therewillbewheezingandthirst,andwhenstill,muchtalk;thebodywillfeellike it
isbeingroasted,therewillbesweatingandyangwillscatter.Ifthepathogenicfactor
is dampness, the head will feel as if wrapped in a cloth; if the damp heat is not
eliminated, then the large sinews will shrink and shorten while the small tendons
will fall slack and elongate. Shrinking and shortening mean inflexibility while
slackening and elongating mean wasting weakness. If the pathogenic factor is qi, 2
then there will be swelling.The four limbs will be progressively affected and yang
qiexhausted. (BasicQuestionsChapter3DiscourseontheGenerationofQiandCommunicating
withHeaven)
Interpretation
Yang qi is very important to the normal functioning of the body. In the human
body,yangqiislikethesunintheheavensabove:itisthesourceofenormousenergy
aswellasthesourceof life itself.The celestial bodies in our solar systemnecessarily
relyontheregulatedbutunceasingmovementofthesuntoilluminateandshine;all
phenomena are dependent on it (the sun) in their transformations, generations and
evolutions.Thehumanbodyisinmuchthesamewaydependentonyangqiinorder
that it may move and remain open, in order that it can maintain vitality and energy
andahealthystatus.
In the human body, yang qi expresses upward and outward in all directions, and
hastheimportantfunctionsofprotectingandconsolidatingtheexteriorofthebody
and guarding against the incursions of external pathogenic qi. If yang qi is replete,
thentheintersticesaresolidandfirm;evenifpathogenicqiweretoinvade,itwould
not easily lead to disease.When yang qi circulates throughout the interior, it is
orderedandfreefowing.
If ones lifestyle and activities are abnormal, resulting in extremes within the
mechanisms of the body and/or excessive behavior, then this can in turn result in a
disorderingoftheopeningandclosingactionsofyangqi,causingittofloat,scatteror
insomeotherwaybecomedamaged,theultimateresultofwhichwillbedisease.
For example, let us examine the contracting of summerheat pathogenic qi.
Summerheatisyangpathogenicqiwhosenatureisupwardflamingheatwhichforces
the expression of fluids to the exterior and harasses and rocks the heart and lung.
Clinicalsymptomsincludeprofusesweating,irritation,difficultbreathingandforceful
1 Herespiritisunderstoodasreferringtoyang.
2 Some commentators think this refers to yang qi, others like Zhang Jie-bin thinks that defensive qi,
nutritiveqiandtheqiofthezang-fuorgansareallincluded.Intheinterpretationtextgiveninthisbook,however,
theauthorsinterpretqiaswind.
wheezing.Ifsummerheatharassesandrocksthespiritconsciousness,thentherecan
becoma,delirium,abodyhottothetouchwithhighfever,profusesweating,andthe
consumptionofqi.
If one contracts dampness, on the other hand, it is yin pathogenic qi which
impedestheproperupwardmovementofyangqileavingitunabletorisetotheface
andhead.Ifthisoccurs,thentheheadfeelsheavyandperhapsasifitwerewrapped
round with something. Damp pathogenic qi is sticky and impedes movement. Over
time, it can transform into heat and create a problem of damp heat, which in turn
canimpedethesinewsandvesselsandresultinasituationwhereinqiandbloodare
unabletoreachtheareastheyaresupposedtonourishandmoisten.Ifthishappens
and the sinews and vessels become malnourished, then the sinews and vessels
can shorten and/or spasm or become flaccid and useless. Both of these results are
pathodynamicchangesofthelimbsresultinginimpededmovement.
Ifwindweretoinvadethebody,itmightresultinalockdownoflungqi.Thelung
governsthemovementofwater,andiftheirabilitytoregulatethewaterpassagesis
negativelyimpactedinsomeway,itcanresultinswellingoftheheador,inextreme
cases,thewholebody.
The weather of each of the four seasons is associated with its own particular
climaticallynaturedpathogenicqiknowntoharmthehumanbody.Eachofthesecan
resultinaweakeningandreductionofyangqiandamultitudeofdiseaseconditions.
This passage discusses the pathogenic peculiarities of the abnormal qi of each
season. For example, if cold invades and encounters wei qi then there will be high
fever. In this case it is best to use warm sweat-inducing herbs to treat the problem.
Summerheat pathogenic qi is characterized by their ability to damage the fluids
and consume qi. Dampness is characterized by heaviness and turbidity. These
known characteristics of the six pathogenic qi are of considerable importance in
theclinic.
CaseReport
Male,age50.Initialconsultation:mid-winter.
Chief complaint: fever and general malaise from common cold.The patient
reported that the day prior, while away on a work related trip he contracted wind-
cold and that last night ran a fever of 39.8C accompanied by a severe aversion to
cold.Hereportedpilingontwothickquiltsbuteventhiswasinsufficienttoalleviate
his aversion to cold. He continued to shake and said that every joint in his body
ached.Hisskinwasburningtothetouchandhehadaseverecough.Examinationof
the patient showed a thin white coating on the tongue; his pulse was floating, tight
and forceful.This is an exterior excesstaiyang cold damage pattern.Treatment calls
forpungentwarmingherbstopromotesweating,thereofreleasingtheexteriorcold
anddispellingit.TheformulausedwasMHungTng(EphedraDecoction,).
Onepackwasgiven.
After taking the formula, he covered himself warmly with a quilt and not long
afterwardhebrokeafullbodysweatandwascured.
[Reference: Chen Ming. Selected Effective Clinical Cases of Liu Du-zhou .
Beijing:AcademyPress;1996.p.1.]
Source Text 3

()
Iknowthatthehundreddiseasesarebornoutofqidisorders: angercausesqito
ascend;happinesscausesqitoslow;griefconsumesqi;fearcausesqitodescend;cold
causesqitodrawin; heatcausesqitodrainout;being startledcausesqitobecome
disordered;laborexpendsqi;andthought/worryknotsqi.Thesenineqiaredifferent.
Howisittheygiverisetodisease?
Qi Bo replied:Anger causes qi to counterflow, sometimes even to the point of
vomiting blood and causing diarrhea with undigested food; therefore, it is said qi
ascends.1 Happiness causes the qi to harmonize, the will to arrive, 2 and the nutritive
and defensive to freely flow; therefore, it is said qi slows. If there is grief, then the
heartsystemisstressed,thelobesofthelungsriseupandtheupperjiaoisnotopen,
there is a failure to distribute the nutritive and defensive, and heat qi forms in the
middle; therefore, it is said qi is consumed. If there isfear, then essence declines; if
essence declines, then the upper jiao becomes blocked; if the upper jiao is blocked,
1 Ascends because it rises up to invade the spleen, negatively affecting its function and resulting in
diarrheawithundigestedfood.
2 Tohaveasenseofsatisfaction.
then qi returns; if qi returns, then the lower jiao becomes distended; therefore, it
is said qi does not move. If there is cold, then the interstices close and qi does not
move;therefore,itissaidqiisdrawnin.Ifthereis heat,thentheintersticesopen,the
nutritiveanddefensiveopenlyflow,andthereisprofusesweating;therefore,itissaid
qidrains(out).Ifonehasbeenstartled,thenthehearthasnothingtoreclineon,spirit
hasnoplacetoreturnto,andonesconsiderationshavenofocus;therefore,itissaidqi
becomesdisordered.Ifonelabors,thenthereislaboredbreathingandsweating,both
insideandoutside,andtheqiisoverlyutilized;therefore,itissaidqiisexpended.If
there isexcessive thinking/worry, then the heart has a place to keep itself, the spirit
has a place to return; however, healthy qi loiters and does not move; therefore, it is
saidqiknots.(BasicQuestionsChapter39DiscourseontheIssueofPain)
Interpretation
Theqiofthehumanbodyisthebasicsubstancethatbothformsthebodyaswell
as maintains its vital functions. Qi circulates ceaselessly, promoting and regulating
theinternalprocessesofmetabolism;andthiscirculationisdistributedallthroughout
thebodyup,down,insideandout.Ittakestheformofascendinganddescending,
entering and exiting, the ordered movement ceaseless, guaranteeing the metabolic
processes of the physical body as well as the energy of the individual. In this way,
qimaintainsnotonlythenormalfunctioningoftheorgansbuttheharmonyoftheir
interactionsaswell.
The vital functioning of the inner organs, channels and collaterals, forms, and
senseorgansnecessarilyrelyonthemovementofqiinorderthattheybecomplete.
Such things as contraction of one or more of the six external pathogenic factors,
internal damage by the emotions and will, and overwork can disrupt the healthy
movementofqi,disorderingthefunctioningoftheorgansandresultindisease.
Peoplegothrougharichvarietyofemotionalchanges,includinghappiness,anger,
worry,contemplation,sorrow,fearandstartlement.Theseemotionalchangesuseqias
theirsubstantivefoundation;inmostsituations,emotionalchangesdonotengender
disease. However, if the emotion is sudden, extreme, or continues over an extended
periodoftimeandthereforeexceedsanindividualsabilitytoregulateitseffects,then
thatindividualsqimovementwillbecomedisrupted.
Great anger can result in upward surges of counterflow qi as well as disrupting
the flow of blood. If the blood follows qi as it counterflows upward, such symptoms
asaredfaceandeyesanddizzinesswithfeelingsoftheroomspinningcanoccur.Ifit
issevere,onemightalsovomitblood.If liverqicounterflowsupwardly,theeffulgent
woodcanstrikedownearth;inthiscase,thedamagedonetothespleenandstomach
canbeobservedinthesymptomoflientericdiarrhea.
Joyandhappinessarenormallybeneficialemotionalstates,butinexcesseventhey
can manifest in problems. Appropriate levels of happiness ensure the harmonized

smooth flow of qi and blood and the open facilitation of the movement of the
defensiveandnutritiveqi.Excessivehappinessorjoy,ontheotherhand,canresultin
themeltingawayandscatteringofqi,andconsequentlytheessenceandspiritbecome
scatteredandunabletodrawtogetherinacohesivewhole.
Excessivegriefandsorrowcanresultintheoverconsumptionofqi,andconsequently
the contracture of the lung and heart becomes inhibited, which in turn negatively
influencestheabilityoftheupperjiaotoproperlydisseminatenutritiveanddefensive
qi.
Whenqibecomesstuckand/orknottedup,itbeginstogenerateheat;whenthis
happensintheupperjiaoasdescribedaboveitcanultimatelyconsumeandburnup
the essence-qi of the lung. Excessive fear can damage kidney qi leaving the kidney
unable to consolidate, resulting in qi draining out from below. If this happens, the
individualmaysuferfromnocturnalemissionsand/orspermatorrhea.
If there is insufficient essence below, there would be insufficient kidney essence
tonourishtheheartandthiswouldresultinblockagebothaboveandbelow.Theqi
isunabletomoveaboveresultinginblockageandstagnationbelowandinthe lower
jiao abdomen becoming distended and uncomfortable. Being excessively startled
resultsinarockingoftheheartspiritsuchthatitisnolongerabletofindpeace.Ifone
weretobestartledintheextreme,thishasthepotentialtoscattertheheartqimaking
itchaotic,causingonesbehaviortoloseanysenseoforder,andmaketheqiflowin
reverseorbecomedisordered.
Thesixexternalpathogenicfactorscanalsoinfluencethemovementandchanges
ofqi.Forexample,coldcancloseoffandcontractqi;onemanifestationofthisisthe
closingandblockingofsuperficialinterstitialspacesrenderingthe defensiveqiunable
todisseminate.Whenthishappens,thereisaversiontocold,lackofsweating,atight
pulse and other symptoms all considered to be due to contraction of external cold.
The nature of heat is to rise up and spread in all directions. If it were to invade the
body,thesuperficialinterstitialspacesmightopenupresultingincopioussweating;
thisinturnwouldcreateapatternofdisharmonywhereinqiwouldbeconsumedand
thethinfuidsdamaged.
Excessivetirednessconsumesthebodysstrength;theconsumptionandscattering
of the bodys qi easily leads to a situation wherein there is insufficient qi and
symptoms such as shortness of breath, rough breathing, and unstoppable sweating.
Suchsymptomsarisebecausetheqiisinsufficientlystrongtoproperlyfixthesweat,
and this then creates a situation wherein there is damage to substances both inside
andoutsidethebody.
Whenthemindbecomesfixatedwithexcessivethinkingandworry,ithindersthe
freefowofqiandeventuallyleadstostagnationandblockageintheqimechanism.
Anger,whichdamagestheliver,canresultintheliverlosingitsabilitytomaintain
thefreeflowofqi.Ifthishappens,qicounterflowsupwards,andtherecanbecough,
hemoptysis, dizziness, headache, vomiting, hiccups, or hematemesis. In these cases,
the major treatment principle calls for soothing the liver and regulating qi, calming
thesurginganddownbearingthecounterflow.Overall,theessenceofthetreatment
shouldfocusonre-establishingthesmoothregularfowoftheqimechanism.
CaseReport
Female,age52.Initialconsultation:June6,1992.
The patient described herself as having become angry with a domestic issue
and the extreme over-stimulation of this resulted in aheadache and dizziness that
continuedunabatedforaweek.Shedescribedafeelingofheatandpaininherhead,
unclear vision, agitation and anger. Her stools were dry and her blood pressure was
170/95 mmHg. In addition to this, she had lumbar pain and reduced appetite.The
pulse was deep, wiry and thin; and the tongue was red with a white coating.The
symptomsfittedthepatternofdistressedliverqiwithliveryangrising.Treatmentcalled
forrelaxingtheliverandregulatingqiandcalmingtheliverandsubmergingyang.
Aformulawasprescribedasfollows:
lngdnco 10g RadixetRhizomaGentianae

zhz 10g FructusGardeniae
csh 30g Magnetitum(preboil)
lngg 30g OsDraconis
nix 15g RadixAchyranthisBidentatae
dlng 10g Pheretima
dhung 10g RadixetRhizomaRhei(addlater)
shnzh 12g FructusCrataegi
Six packs were given to be boiled in clear water, one lot to be taken each day
dividedmorningandevening.
After taking the formula, the patient reported that the severity of the headache
decreasedasdidthefeelingofheatinsideherhead.Shesaidshewasstilldepressed,
continued to have dry constipation (one movement every three or four days), and
still didnt have an appetite.The tongue was red with a thin yellow coating; and the
pulsethinandrough.Yjn(RadixCurcumae,nodosageindicated)wasaddedtothe
above formula and an additional six packs of medicinals were given. Following this
allofhersymptomsweregreatlyalleviatedandshewasaskedtotake QJDHung
Wn(LyciumBerry,ChrysanthemumandRehmanniaPill,)alongwiththe
followingformulatoensurethetreatmentheld:
csh nodosageindicated Magnetitum

xikco nodosageindicated SpicaPrunellae
nix nodosageindicated RadixAchyranthisBidentatae
chunxing nodosageindicated RhizomaChuanxiong
jumngz nodosageindicated SemenCassiae
While a subsequent consultation saw the disappearance of all the patient's

symptoms,shestilloccasionallyhadheadachesandherappetitewaspoor,soshewas
askedtocontinuewithherbstosupplementthekidneyandnourishyin,cleartheliver
andharmonizebloodtoconsolidatetheefficacyofthetreatment(noherbalformula
indicated).
[Reference:ZhangXue-wen.TreatmentofDifficultDiseasePatterns .Beijing:Peoples
MedicalPublishingHouse;1996.p.148.]
Source Text 4

()
Iwouldliketohearyoutalkofpathodynamics.
Qi Bo replied:All wind diseases with movement 1 and dizziness are related to
liver. All cold, contraction and pulling in are related to the kidney. All qi distention
andstagnationarerelatedtothe lung.Alldampness,swellingandfullnessarerelated
to the spleen. All heat diseases with visual disturbances 2 and spasms are related to
1 This movement can include trembling, shaking, and tics with the idea being that it is not under one's
control.
2 The character motranslated hereasvisual disturbances actually meant reduced visual acuity in
itsearliestform.Lateronitalsocametobeusedtomeanmentalconfusion.Thismeansthatitisalsopossibleto
translatethesentenceasAllheatdiseaseswithmentalconfusionandspasmarerelatedtofre.
fire. All painful itchy sores 1 are related to heart. All cold limbs, 2 hardnesses 3 and
draining 4 are related to the lower. All atrophy, wheezing and vomiting are related
to the upper. All locked jaw, teeth chattering and shivering, and behavior as though
one had lost collection of ones spirit,5 are related to fire. All clonic convulsions and
stiffneckarerelatedto dampness.Allcounterflowandupwardrushingarerelatedto
fire. All distention and abdominal increases are related to heat. All agitation, mania
and behavioral excess are related to fire. All sudden spasms are related to wind. All
diseasesassociatedwithsound,wherewhentheafflictedareaisstruckmakeasound
like a drum, are related to heat. All ulcerations and swellings, pain, aches, and fright
are related to fire. 6 All twistings, reversals and inability to straighten accompanied
by turbid water 7 are related to heat. All water fluid diseases with thin clear and cold
liquid 8 are related to cold. All retching and vomiting of acid, and sudden urgent
diarrhea,arerelatedtoheat.GreatEssentialsthereforestates:Takecareindiagnosing
the pathodynamics of a problem; each has a factor related to it: differentiate what
is present, what is absent; determine what is in excess, what is deficient. First find
the affected zang-organ, course its blood and qi, ensure it is regulated and restore
harmony.(BasicQuestionsChapter74GreatTreatiseontheEssentialsofUltimateTruth)
Interpretation
Whatisthemechanismthatgeneratesdisease?Infact,researchintotheetiology
or pathodynamic of any given disease is the root of grasping the meaning of that
disease. Pathodynamic refers to the occurrence, development and underlying
mechanismsofdiseases.Itincludessuchthingsaslossofregulationbetweenyinand
yang,thestrugglebetweenhealthyqiandpathogenicqi,aswellasdisorderingofthe
normalrisingandfallingactionswithinthebody.ItisthesemechanismsthatChinese
medicinefocuseson.Toinvestigatethepathodynamicsofdiseases,onemusthavean
understandingofthesixpathogenicfactorsofthenaturalworldandhowtheyaffect
thehumanbody.Eachofthesixpathogenicfactorshasitsownspecialcharacteristics.
1 Sores here include the idea of boils, carbuncles and furuncles in addition to open sores. An alternate
translationofthelineis:Allpain,itchinessandsoresareascribedtotheheart.
2 Here,theterm ju canmeaneithercoldlimbsorsyncope,bothofwhichcanbemanifestasaresult
ofthereversaloftheproperfowofqi.
3 Usuallyannotatedasconstipation.
4 Usuallyannotatedasdiarrhea.
5 Uncontrollable,perhapsevenwildbehavior.
6 Thecharacter fmeans swelling. In ancienttimes,however,itwascommonlyusedasasubstitute
character for both skin (often related to some sense of ulceration) and foot (especially the top of the foot). In
thissentenceitcouldmeananyofthese;annotationsvary,butmostfocusonulcerationandswellingfromfire
followingthechannelsandcontinuetheexplanationwithfredisturbingtheheartandcausingfright.
7 Usuallyannotatedasurine.
8Discharges.
When wind invades the body, for example, it most easily incites pathodynamic
changes in theliver. Alternately, it can manifest as damage to the tissues or orifices
associated with the liver and result in trembling or shaking of the limbs, tremors,
a sense of the world turning around oneself, an inability to stand stably, or other
symptomsofvertigo.Thusitissaidintheclassicthatclinicallyspeaking,shakingand
dizziness are symptoms manifested by wind and are mostly seen as pathodynamic
changesintheliver.
When cold invades the body, it most easily manifests as pathodynamic changes
in the kidney. Because the nature of cold is contractive, in conditions where cold
qi is abundant, it can cause contracture and spasm of the tendons and vessels or
difficultyinflexingand/orextendingalimb.Thesetypesofproblemsarisebecauseof
contractingcoldqiandaremostlyrelatedtopathodynamicchangesofthekidney.
Thelunggoverns and drive inhalation and exhalation; they also govern the qi of
the whole body and most pathodynamic changes that affect the qi mechanism are
related to the lung. If an externalpathogenic qi invades the lung, lung qi can seize
upandbecome stuck. If this happens, it iscommon to see wheezing and feelings of
fullnessorblockageinthechest,and/oraroundthediaphragm.Theseareconsidered
tobepathodynamicchangesinthelung.
Abnormal dampness most easily damages the spleen and results in abnormal
transporting and transforming. If this happens, there is no impetus behind water
distribution and there can be swelling and distention as well as feelings of fullness
and stagnation in the abdomen.These symptoms are seen as mostly relating to the
spleen.
Fire heat pathogenic qi is categorized as yang pathogenic qi.When it damages
thebody,theyang of the body revolts and there is fever or more literally heat. Heat
pathogenic qi usually affects the upper parts of the body such as the clear orifices
and the head and face. Clinically, it can cause syncope and, if heat pathogenic qi
damagesthefluidsleavingthesinewsandvesselsundernourished,thentherecanbe
convulsions.These types of pathodynamic changes are said to be manifestations of
frepathogenicqi.
In the five phases system, heart is categorized as fire and is said to govern the
blood and vessels. If heart fire is excessive, it can follow the course of the channels
burning them as it goes.This can cause the flesh to putrefy and pustulate resulting
inallmannerofulcerationsandpustulationssuchascarbuncles,cellulitis,boils,and
furuncles.Thesetypesofpathodynamicchangesareallsaidtopertaintotheheart.
Iftheyangqiofthehumanorganismisinsufficient,weaknessinthelowerpartof
thebodycanresultinreversalcoldnessofthefourlimbs.Ifthe yinqioftheorganism
isweakinthelowerpartofthebodyandheatqiupwardlyattacks,thiscanresultin
qireversalsyncope(lossofconsciousnessduringafaint).Bothtypesofproblemsarise
because the yin and yang of thekidney in the lower part of the body have become
deregulated.These disorders are said to pertain to pathodynamic changes in the
kidney.
Diseases in the lower part of the body are related to the kidney, bladder and
large intestine. If there is an inability to pass stools and/or urine or their voiding is
uncontrollable, then this is a result of a failure of the kidney to control thetwo yin
orifices,thebladdertotransformqi,and/orthelargeintestinetoproperlymoveand
transport. Given this, pathodynamic changes resulting in cold reversal disease and
inabilitytovoid or excessive voiding are mostly pathodynamic changes of the lower
partofthebody.
Theheartandlungarelocatedintheupperpartofthebody;thelungissuperior
to the heart and is also referred to as theflowery covering (hu gi, ), a term
also used for the canopy over an imperial carriage.The lung governs diffusion and
downward dissemination, distributing essence, blood, body fluids throughout the
entirebody. If there is heat in the lungand its lobes are scorched then all fivezang-
organs will become dry and scorched resulting in a wasting pattern. Wheezing
or panting is also one of the major manifestations of pathological changes of the
lung, though it can also be a symptom of heart qi blockage.Vomiting is mostly a
manifestationoftheupwardcounterflowofstomachqi.Thehandtaiyinlungchannel
wraps around the mouth of the stomach 1 and so if lung qi counterflows upward,
then it can sometimes induce the upward counterflow of stomach qi and result in
vomiting. For these reasons, many kinds of wasting, wheezing and vomiting are
consideredtobeissuesoftheupperpartofthebody.
If one observes a situation where the mouth is locked shut and unable to open
andthereischatteringoftheteeth,thefirstthingtodoistodeterminewhetherthe
underlyingproblemiscoldorheat.Iftheproblemisoneofcontractedcoldpathogenic
qi, then there will be cold shaking but the spirit will be clear, i.e., the patient will
be fully present. If, onthe other hand,the problem is one where heatpathogenic qi
has become locked inside and is unable to escape to the exterior, then there will be
agitationanddelirium.Thislattercaseisamanifestationoffrepathogenicqi.
Clinically speaking, many types of spasms like stiff neck and opisthotonus are a
result of dampness combined with wind or dampness combined with heat entering
thetaiyangchannelandblockingtheflowofchannelqi.Thesetypesofproblemsare
consideredtobedampnessproblems.
Fire pathogenic qi by its very nature flares upward and easily attacks the upper
part of the body.The heat of fire is scorching and forces the qi mechanism of the
organs to counterflow upward manifesting as dry heaves, vomiting, belching or
1 TheSpiritualPivot:Chapter10ChannelsandVessels
hiccups.
Whenexternalheatpathogenicqiinvadesthebody,itmovesfromtheexteriorinto
theinterior.Ifheat pathogenic qi becomes entangled in the intestines, the resultant
malfunctioning of the qi mechanism can result in abdominal distention, bulging,
excruciating pain that refuses touch, and/or impassable stools. All of these arise
becauseheatpathogenicqihasresultedinstagnationblockingtheintestines.
Thenatureoffireistomoveandeasilydamagesthebodyandharassestheheart
spirit.This results in restless agitation, crazy talk and swearing, hitting others and
breakingthings.Theseareallaresultoffrepathogenicqi.
The nature of wind is to move easily.Therefore, when wind invades the body, it
movesaboutquicklydoingdamagetothebody.Winddiseasesthustendtobevery
sudden in their expression.Wind resonates with wood and liver unites with wood,
so when wind pathogenic qi is contracted there can be internal damage to the liver
andthesinews,whichinturnresultsinstiffnesswithnosofteningandaninabilityto
extendorfex.
When heat pathogenic qi enters deep into the zang-fu organs, perturbing the
stomachandintestines,itcanleadtolossofnormalfunctioningintheirtransporting
and transforming functions.There can be loud grumbling noises and feelings of
distentioneventhoughtheintestinesareempty.
Ifpainfulorsoreredswollenulcerationsappearonthesurfaceofthelimbs,thisis
aproblemofstuckandstagnatingheatpathogenicqirottingthefeshandpustulating.
If heat pathogenic qi attacks the internal organs, it can rock the heart spirit
manifestingasfearanduneasiness,withaninabilitytosettledown.Heatpathogenic
qibraisestissuesandrisesupwardly,actionsthatbothconsumeanddamagetheyin;
thiscausesdrynessofthebloodandaninabilitytomoistenandnourishthetendons
and vessels.When this happens the limbs can spasm and contract, or result in a
situationwhereincontractionandrelaxationarenolongerinbalance,andthesinews
twist,sometimeseventothepointofarchingthebackorrenderingitunabletoextend
and flex. If heat pathogenic qi cooks the fluids, on the other hand, it can result in a
darkeninginthecoloroftheurineaswellasinmakingitcloudyandunclear.
Whencoldpathogenicqienterstheinterioritcandamageyangqi.Thiscanthen
result in the fluids inside the body no longer being transformed by the steaming
actions of yang qi and thus they drain downward as copious urine that is clear in
additiontotherebeingloosesloppystools.
Whenheatpathogenicqiinternallyattacksthe stomachandintestines,hotqican
enter the stomach and counterflow upward resulting in vomiting and acid reflux.
If heat qi enters the small and large intestines, then the small intestines ability to
separate the clear from the turbid will be affected and the large intestine will no
longerbeabletotransportfooddregsnormally.Inthiscasetherewillbesuddenacute
diarrheathatexplodesout,andafeelingofheataroundtheanus.Itcanalsohappen
that heat toxins create knots in the intestines and there is a feeling of desperately
needingtovoid,butaninabilitytoactuallydoso;inthiscaseitalsohappenstheanus
isextremelypainful.
These are the most important contents of the nineteen lines describing various
pathodynamics. Clinically, when trying to determine which pattern one is facing,
the above descriptions should be religiously considered in pattern differentiation.
Deficiency and excess need to be determined. One should have a solid grasp of the
six pathogenic factors of the natural world and know how they influence the inner
organs. Additionally, one should know the relationship between the organs and the
patternsofdiseasetransmissionandtransformation.Onlywhenthepatternhasbeen
determined,canonethengoontoopenoutandbenefittheqimechanism,regulating
and ensuring the free flow of qi and blood.The best of course, is to prevent disease
pathogenic qi from causing problems in the first place, so one should focus on
maintainingtheproperyinandyangbalanceoftheorganismtopreservehealth.
Liver yang rising and liver fire flaring up can result in the generation of internal
wind.Clinically,thiscanmanifestasheadache,dizzinessandspasmsinthelimbs.The
principletreatmentcallsfornourishingyin,smoothingtheliverandsubmergingyang.
CaseReport
Female,age50.Initialconsultation:July11,1980.
The patient indicated having high blood pressure for more than 10 years. Most
recently, her head felt foggy and distended, her balance was off when walking, she
felt nauseous to the point of wanting to vomit, and was unable to eat.The tongue
was red with a white coating and the pulse was wiry, thin and rapid. Blood pressure
was 190/110 mmHg. She was differentially diagnosed as having liver yang rising.
Treatment called for smoothing the liver and submerging yang. A formula was
prescribedasfollows:

gutng 12g RamulusUncariaeCumUncis(addedneartheendofboiling)
dlng 12g Pheretima
hizo 15g Sargassum(pre-washandwrapseparately)
shjumng 30g ConchaHaliotidis(wrapseparatelyandpre-boil)

dizhsh 30g Haematitum(wrapseparatelyandpre-boil)
dzhng 15g CortexEucommiae
Aftertwopacks,thepatientsaidhersymptomswerebetterandherbloodpressure
was 180/100 mmHg. After another four packs, she reported all of her symptoms
disappearedand her blood pressure was 150/90 mmHg.The following modifications
weremadetotheaboveformula:
Removed:shjumng.
Added:
zorn 10g FructusJujubae

hshuw 15g RadixPolygoniMultifori
Shewasgiventwopacksofthisnewformula.Herbloodpressurestabilizedaround
150/90mmHgandshewasabletoreturntowork.
[Reference:DengWei-li.TreatingHypertensionwithHngLngXiHiTngModifications
.JournalofSichuanTraditionalChineseMedicine.1986;(2):35.]
Source Text 5
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Wherever pernicious evils 1 accumulate, the qi is necessarily deficient. If yin
is deficient, yang necessarily accumulates. (Basic Questions Chapter 33 Discourse on
DiscriminatingHotDiseases)
Interpretation
The Chinese medicine recognition of disease process emphasizes the invasion of
pathogenic factors as well as the powers of healthy qi in preventing their invasion.
After a pathogenic factor has invaded the body, healthy qi and pathogenic qi begin
to combat each other: pathogenic qi tries to damage healthy qi, and healthy qi
tries to resist it, even trying to expel it, to protect the body and return it to health.
The state of the bidirectional relationship between healthy qi and pathogenic qi
influences the progression of a disease in that not only is the strength or weakness
of an individuals healthy qi is a key factor in disease onset, it is also of primary
importanceindeterminingthedevelopmentandchangesthattakeplaceduringthe
courseofadisease.Pathogenicqicanonlyinvadethebodyif healthyqiisweakand
too powerless to fend it off.When healthy qi is weak, then pathogenic qi can take
1 Morecommonlyreferredtoaspathogenicqi.Thetranslationfollowstheoriginalmeaninginthetext.
advantage of the opening created by the vacuum of healthy qi and invade. Once
inside, and if healthy qi is insufficient, and its ability to foster and regulate the vital
functioningoftheorgansandchannelsisdepressed,pathogenicqicouldpotentially
godeeperand a complicated pathodynamic could develop.This could further result
inorganandchanneldysfunctionsaswellasinhibitthemetabolismofessence,blood
andfuidsenablingaseriousdiseasetodevelop.
Iftheqiofanorganismisdeficient,pathogenicqicaneasilyinvadetheorganism
andcausedisease,producingsuchsymptomsasspontaneoussweating,nightsweats,
colds,headaches,dizziness,andcough.Themaintreatmentprincipleinsuchcasesis
toconsolidatetheexteriorandbenefitqi:itisessentialtoaugmentdefensiveqiand
therebyincreasetheimmunologicalresponseoftheindividual.
CaseReport
Female,age52.
Chiefcomplaint:malaisefrominfuenzaforonemonth.
The patient reported that a month prior she had developed an aversion to cold,
fever, and whole body aches. She said she went to several doctors for treatment,
but throughout the process neither her aversion to cold nor her fever abated. More
recently she began to have bouts of spontaneous sweating, aversion to wind, stuffy
chest, stomach distention, shortness of breath, heart palpitations and insomnia.
The tongue coating was thin and white and all six pulse positions were empty, soft,
and without force. Her differential diagnosis is constitutionally deficient central
qi, with the exterior empty and unconsolidated.Treatment calls for regulating and
harmonizing the nutritive and defensive, consolidating and nursing the interstitial
spaces,andaugmentingcentralqi.Aformulawasprescribedasfollows:

choguzh 3g RamulusCinnamomi(dry-fried)
flng 10g Poria
huphu 4.5g FlosMagnoliaeOfcinalis
shngjing 2slices RhizomaZingiberisRecens
miguihu 4.5g FlosRosaeRugosae
After four packs of the above formula, the patient reported the sweating was
significantlyreduced,herspiritsgreatlystrengthened,andherappetiteincreased.She
indicated, however, that her sleep disturbance, heart palpitations and shortness of
breathremainedasbefore.Shealsostillhadperiodichotandcoldflashesandshenow
experiencedshootingpainsinherribs.Theaboveformulawasmodifedasfollows:
Removed:wwiz.
Added:
chih 4.5g RadixBupleuri

shm 12g SemenSetariaitalica
chobnxiq 10g MassaRhizomaePinelliaeFermentata(dry-fried)
Afterfivepacksofthisnewformula,herhotandcoldflusheswererelievedandher
appetitegreatly improved.When she went out for a walk, however, she still sweated
easily.
[Reference: Shi Jin-mo. Shi Jin-mos Collected Clinical Experience. Beijing:
PeoplesMedicalPublishingHouse;1982.p.7-8.]
Source Text 6
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Where pernicious qi 1 is abundant, there is excess. If healthy qi has been stolen
away,thenthereisdefciency. (BasicQuestionsChapter28DiscourseonOverallDiscriminationof
DefciencyandExcess)
Interpretation
Duringthecourseofadisease,thebodysdiseasefightingpowersandthedisease
causing pathogenic qi struggle for dominance. As that struggle for dominance
playsout,itdefinesthedeficiencyorexcessnatureofthedisease.Thatistosay,the
progression of a disease is a manifestation of the relative dominance and strength
of healthy and pathogenic qi at any given time during their struggle.The relative
1 Alsoknownaspathogenicqi.
strength of these two is not unchangeable, but rather can wax and wane as the
struggle continues. If during the struggle pathogenic qi is stronger than healthy qi,
thentheabilityofpathogenicqitomanifestdiseasewillbestrong.Ifhealthyqiisnot
weakenedinitsabilitiestoresistdisease,thenitwillactivelyandaggressivelytakeup
thefightwith pathogenic qi.The fight between them will be intense and the bodys
reactions obvious. Clinically, this can produce a constellation of intense excess type
symptoms like high fever, severe agitation, a loud or high voice, rough breathing,
abdominal painthatrefusestouch,constipation and inability to urinate, full forceful
pulse and a thick greasy tongue coating. If bodys healthy qi is deficient, then the
strugglewithpathogenicqiwillbelessobviousbecauseits(thehealthyqis)reduced
strengthisinsufficienttoproduceintensemanifestationsofthestrugglebetweenthe
two.Clinically,thisismarkedbyaseriesofempty,weakanddeficientsymptomsthat
wouldbecategorizedasadeficientexteriorpattern.Symptomscanincludetiredness,
dispiritedness, lack of good facial luster, shortness of breath, spontaneous sweating,
night sweats or, perhaps, vexing heat in the five centers (chest, palms and soles) or
aversiontocold,coldlimbsandanemptyforcelesspulse.
Whenaperson has contracted a particularly virulent heat pathogenic qi, healthy
and pathogenic qi struggle fiercely to overcome each other. Clinically, this can
manifest as high fever, severe agitation, and rapid forceful pulse. In such cases,
treatmentcallsforclearingheatandventingoutthepathogenicqi.Themostessential
partofthetreatmentiseliminatingtheexternalpathogenicqi.
CaseReport
Male,age1.Initialconsultation:February7,1990.
Chiefcomplaint: feverforfivedays.Theparentsreportedthat fivedaysprevious,
theinfantbegantodevelopafeverinresponsetoacold.Thehighesttemperaturewas
40C.Hewastakentoadoctorandgivenspiramycinorallyandaninjectionof400,000
unitsofpenicillinintramuscularly.Thetreatmentwasnotparticularlyeffective.Atthe
timeofthisconsultation,histemperaturewas39C,heseemeddispiritedandhadno
appetite, and his lips and face were red.The tongue was red with little coating, and
thelinesonhisfingerswerepurpleandstagnant.Treatmentcallsforclearingheatand
relieving toxins, venting out the pathogenic factors and guiding the stagnation.The
formulagivenwasasfollows:
jngji 9g HerbaSchizonepetae
shgo 30g GypsumFibrosum
qngho 30g HerbaArtemisiaeAnnuae

lgn 30g RhizomaPhragmitis
shnq 12g MassaMedicataFermentata
hufn 15g RadixTrichosanthis
hungqn 10g RadixScutellariae
bnlngn 30g RadixIsatidis
After one pack, his fever abated and his spirits returned. Following a period of
nursing,hewascompletelycured.
[Reference:ZhangFeng-qiang,ZhengYing.SelectedEfficaciousSecretFormulasfromthePractices
oftheFirstBatchofStateRecognizedFamousChineseMedicineDoctors.
Beijing:ChinaInternationalCulturePressLimited;1996.p.322.]
111
Chapter6
Diagnostic Techniques
Source Text 1

()
Whatisahealthyperson?
QiBoreplied:Inoneexhalationthepulsebeatstwice,andinoneinhalationthe
pulsealsobeatstwice.Inaregularbreath,withaslightextensionoftheinhalationand
exhalation,thepulsemaybeatfivetimes;thisextrabeatiscalledthegreatceasing,
andthisiswhatiscalledahealthyperson.
A healthy person is one without disease. Normally, one who has no disease
addressestheonewhoisill.Adoctorhasnodiseaseandcanadjusttheirbreathingto
theevenbreathingofthepatientasadiagnostictechnique. (BasicQuestionsChapter18
DiscourseonQiManifestationinaHealthyPerson)
Interpretation
Duringthecourseofdiagnosis,checkingthepatientspulseenablesthephysician
tolearntheconditionofthemovementoftheqiandbloodandthefunctioningofthe
zang-fu organs.This is very important in the diagnosing of the disease condition. In
those who are healthy and free from disease, their pulse is even and with force: the
pulse is even and in the space of one inhalation and one exhalation, it beats four or
fivetimes.This standard of 14 or 15 is the same today and still used clinically. If
thepulseis slower than this ratio, it is considered slow; if it is faster, it is considered
fast.Thismethodofusingthebreathtomeasurethepulsetojudgeanordinarypulse,
a diseased pulse, and one that indicates an incurable condition, is not only easy to
understand but is also a basic requirement for pulse diagnosis. It is a simple yet
powerfultoolforstudentsoftheart.
Source Text 2

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How is it that the pass of qi 1 can itself alone reflect the condition of the five
depositories?
QiBoreplied:Thestomachistheseaofwaterandgrainandthegreatfountainhead
of the six clearinghouses.The five flavors enter the mouth and are stored in the
stomach to nourish the qi of the five depositories.The pass of qi is also taiyin.That
is,theqiandflavorsofthefivedepositoriesandsixclearinghousesallcomefromthe
stomachandtheirchangesarereflectedatthepassofqi. (BasicQuestionsChapter11
FurtherDiscourseontheFiveZang-Organs)
Interpretation
Clinicallyspeaking,themostimportantpulsepositionistheradialpulseposition,
alternativelyknowninChineseasqku(passofqi,2),miku(pulsepass,),
orcnku(cn-inchpass,).Thispulseislocatedatthedistalmedialendofthe
radiusjustproximaltothewrist.Takingthepulseatthispositionissufficienttoaidin
diagnosingdiseasebecauseitliesonthe handtaiyinlungchannel.Thelunggoverns
qiandthehundredvesselsconvergethere.Thechannelitselforiginatesinthe middle
jiaointhespleenandstomach.Thespleenandstomacharetheseaofwaterandgrain
andarethereceptacleforfoodanddrink;theyalsotransformandtransportthefine
essencesoffoodandwater,latertransformingandgeneratingheavenessence-qiand
nourishingthefivezang- and sixfu-organs as well as all the rest of the body. In this
waythespleenandstomacharethesourceoftheessence-qithatfillsthezang-andfu-
organs.Thespleenandstomachsabilitytotransportandtransformnecessarilyrelies
onthelungsfunctionsofdisseminatinganddownbearingtoensurethattheessence-
qireachesallcornersofthebody.Forthisreason,therelativestrengthorweaknessof
theessence-qioftheorgansisnotonlyconnectedtotheqiofthespleenandstomach,
but is also a reflection of the relative state of the repleteness of lung qi and the
condition of its related channel.These relationships provide the underlying reasons
why the radial pulse can be used as a barometer of the relative deficiency or excess
conditionofthezang-andfu-organessence-qi.
The hand taiyin lung channel passes over the radial pulse and the fullness
or deficiency of the pulse is intimately connected to the functioning of the lung,
especially the function of assembling or converging the hundred vessels. If this
aspectoflungfunctionbecomesabnormalitcanbediagnosedviathetakingofthe
1 Theradialpulse.
2 These three variations can also be translated asqi opening,pulse opening orcn-inch opening
respectively.
VolumeOne:Chapter6 DiagnosticTechniques 113
pulse at the radial artery near the wrist.This is particularly true for changes in the
blood vessels such that when treating a disorder of the blood vessels, in addition
to considering the heart, it is also necessary to consider changes in lung function.
Considerthefollowingcase:
CaseReport
Chiefcomplaint:rightupperextremityparesthesiaforoverayear.
At the time of this consultation, the patient reported that his right hand was
numb,cold,andtherewasnopulse.Hesaidthatwhenhewastiredorgotachill,the
symptoms would worsen and that they would be accompanied by tight cramping
paininhisback.Rainydaysseemedtoparticularlyaggravatetheproblem.Sixmonths
priortothisinitialconsultation,aprovinciallevelhospitalhadgivenhimadiagnosis
ofTakayasu arteritis. 1 At the time of this consultation, blood pressure in his left arm
was150/97.5mmHg,whiletherewasnodiscernablebloodpressureinhisrightarm.
Thetonguewaspaleredwithathinwhitecoatingandtherewasnopulseinhisright
wrist.The Chinese medicine diagnosis is mi b (vessel b-obstruction, ) falling
into the pattern of disharmony of the nutritive and defensive qi deficiency with
bloodstasisandblockageofthepathwaysoftheblood.Treatmentcallsforregulating
and harmonizing the nutritive and defensive, supplementing qi and warming yang
to move the b-obstruction. An augmented form of Hung Q Gu ZhWWTng
(Astragalus and CinnamonTwig Five Substances Decoction, ) was
prescribedasfollows:

hnghu 10g FlosCarthami
Theaboveformulawastobeboiledinwater,onepacktakenperday.
After taking six packs, the patient reported that the feeling of numbness was
lessening.Therewasalsoafaintpulsethatcouldbedetectedattheright radialpulse
position.The cramping and pain in his back had made marked improvement.The
formula was working, so only minor modifications to increase its blood activating
propertiesweremadetoitasfollows:
1 Alsoknownasaorticarchsyndromeoraorto-arteritis.
Added:

Anadditionaltwelvepacksweregiven.
Aftertakingthemodifiedformula,thepatientreportedthatthenumbnessinhis
righthandandthebackcrampingandpainweregone.Examinationshowedthathis
rightradialpulsewasnowpalpable.Tothispoint,hehadtakenlessthan20packsyet
hewascompletelysymptomfree.
[Reference:ChenMing.EssentialsofClinicalPatternsintheYellowEmperorsInnerClassi
.Beijing:AcademyPress;2006.]
Source Text 3

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Diagnostic techniques are commonly employed in the early morning beforeyin
qi has begun to move and yang qi 2 has yet to scatter, food and drink have yet to
1
be ingested, the channels andvessels are not yet completely full, the collaterals are
regulatedandeven,andtheqiandbloodarenotdisordered.Atthistimeitispossible
to diagnose a pulse that is in excess. Feel the movement and stillness of the pulse,
look at the essence in the eyes, and examine the five colors to know the [relative]
excessordeficiencyofthefivedepositoriesandsixclearinghouses,andthestrength
or weakness of the form. Combine these [examinations] together to determine the
quantityoflifeormorbidity. (BasicQuestionsChapter17DiscourseonSubtleDetailsofPulse
Essentials)
Interpretation
There is a certain amount of diagnostic skill that must be mastered when taking
the pulse.The flow of qi and blood in any given individual will exhibit different
statesatdifferenttimes,andatthesametime,thepulsewillbeinfluencedbyexercise,
emotion,andfoodintake.
For example, in the early morning, before a person has arisen and before any
movement, just at that moment when one has awoken from sleep, the qi and blood
havenotyetbeguntomovequicklythroughthebodyandareinarelativelyquiescent
state:yinqihas not yet been disturbed, yang qi has not yet begun to be consumed,
1 Mostcommentatorsindicatethathereyinqireferstonutritiveqi.
2 Mostcommentatorsindicatethathereyangqireferstodefensiveqi.
andthemovementsofqiandbloodhavenotyetbeeninfluencedbyemotion,foodor
any other external stimulus.The qi in the channels and vessels is still regulated and
harmonious; the movement of qi and blood is still ordered and undisturbed. It is in
this state that one can really use the pulse to determine the actual condition of the
body.
Of course, it is not realistic to think one can take the pulse early in the morning
whenitisrelativelyundisturbed.Mostofthetime,physicianstakethepulseatother
times.Thisis okay. However, it is important to make sure that the patient is calm for
theconsultation.Maintainingapeacefulenvironmentiskey.Byfollowingthesebasic
rules,itisnotnecessarytoinsistonaspecifctime.
Taking the pulse helps the physician more completely understand the state of
the patients qi, blood, and organ function. It is not, however, the only specialized
diagnostic method in Chinese medicine and it is necessary to combine it with
information obtained via observation, listening and smelling and questioning.
That is to say, all four of the diagnostic methods must be united into a coherent
understanding. Observation must include looking at the facial color, the form of the
body,itsposturesandmovements;smellingmustincludenoticeofunusualodorsor
theodorsofanyexcretions;andquestioningmustelicitinformationaboutthehead,
chest, abdomen and limbs. If all of this information can be obtained and combined
together, then one can say one has completely grasped the information necessary
for a pattern diagnosisthat one has understood the strength or weakness of the
essence-qi of the organs, the physical form, the qi, the blood and the fluids.When
all this information is combined together and the relationship between healthy and
pathogenicqi is known, only then can an accurate judgment of the progression and
prognosisofthediseaseathandbemade.
Source Text 4

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The vessels are thepalace of the blood. If the pulse is long, then the qi is
regulated;ifthepulseisshort,thentheqiisdiseased;ifthepulseisrapid,thenthere
willbeirritation;ifthepulseislarge,thenthediseasewillworsen;ifthetoplevelof
the pulse 1 is full, then the qi will be high; 2 if the bottom level of the pulse 3 is full,
thentherewillbeabdominaldistention;ifthepulseisintermittent,thenqiisweak;if
1 Thecnposition,closesttothewristcrease.
2 Wheezingandchestfullness.
3 Thechposition,furthestfromthewristcrease.
thepulseisthin,thenqiislacking;ifthepulseisrough,thentherewillbeheartpain;
ifthepulseisroilingandrapidlikeabubblingspring,thenthediseaseisadvancingand
thepatientscolordeathly;andifthepulseisthreadylikeastringabouttobreak,this
isamorbidcondition.(BasicQuestionsChapter17DiscourseonSubtleDetailsofPulseEssentials)
Interpretation
Thevesselsarelikethepalaceoftheblood.Ifthevesselsarefullwithbloodfluids,
thenthroughpulsediagnosis,onecanfeelinthepower,size,andspeedofthepulse
whether or not and how the blood is flowing through the vessels.This provides
the information one needs to know the fullness of the blood and whether or not
pathogenicqihasinvadedthebody.
The normal distribution of the pulse at the radial artery is divided into the three
positions of cn, gun and ch, which, starting from the wrist crease respectively,
correspond to the positions of the index, middle and ring fingers if they are placed
distal to proximal. In a normal individual with no disease, the pulse should be
palpableatallthreepositions.
If the pulse extends beyond these positions, then this is referred to as a long
pulse and reflects harmony between the qi and blood and a disease-free condition.
If the pulse is not palpable in all three positions, then this reflects qi deficiency and
is a diseased condition. If the pulse beats five times or more for each breath, this is
referredtoasarapidpulseandreflectsthecontractionofaheatpathogenicqithathas
causedthebloodtoheatandspeeditsflow.If,inasituationofexternalcontraction
of pathogenic qi, the pulse is surging, large and forceful, this most often indicates a
condition wherein the pathogenic qi is effulgent and replete, and that the diseased
conditionwillcontinuetodevelop.
Thethreepositionscn,gunandchcaneachbefurtherdividedintoupper,
middle and lowerjiao. If the pulse at thecn position is effulgent and forceful, this
reflects that there is pathogenic qi stagnating in the heart and lung area; clinically
onewouldseewheezing,roughbreathingandfullnessinthechest.Ifthe chorthird
pulsepositioniseffulgentwithforce,thisreflectsthefactthatthepathogenicqihas
becomestagnantinthelowerpartofthebody;inthiscaseoneshouldseesymptoms
of abdominal distension and fullness. If the pulse is moderate but weak with a
regulated pause every few beats, this would indicate thatzang-organ qi is deficient
and weak. If the pulse is thin like a thread of silk, this would indicate deficiency,
taxation and damage, and that the blood is deficient and qi lacking. If the pulse is
roughandstagnant,feelinglikeabladescrapingalongastickofbamboo,thiswould
indicatebloodandqideficiencyorqistagnationwithbloodstasis;andsincetheheart
governsthebloodandvessels,ifthemovementoftheqiandbloodisnotfree-flowing
thentherecanbepainintheareajustanteriortotheheart.Ifthepulseisroilinglike
surging water with a kind of bounding energy, this would indicate that pathogenic
qiwaseffulgentandthatthediseasewasworsening.Ifthepulseisfaint,thinandfelt
asthoughitisabouttostop,asthoughitistherebutnotquite(likethefadingnoteof
apianowire),thenthisisanindicationthathealthyqiisextremelydeficientandthe
diseaseconditionquitedangerous.
The above source material is the core of the Inner Classics discussion on pulse
diagnosis. It could be said that this is the passage that laid the foundation for the
study of pulses in Chinese medicine for all those who followed. For example, as
discussed above, a large and forceful pulse is most likely a reflection of effulgent
pathogenic qi and that the disease is progressing. A rapid pulse, on the other hand,
indicatesthatthereisinternalheat.Herewewillgiveanexampleofacaseexhibiting
alargepulsetohelpelucidatepulsetheory.
CaseReport
Male,age48.Initialconsultation:earlyautumn.
Chief complaint: high fever for one week.The patient reported he caught a cold
and developed a fever that would not break. At its highest point the fever reached
39.8C.Hewenttothelocalhospitalandwasgivenaninjectionofaminophenazone
toreducethefeverwhichresultedinthefeverthencomingandgoing.Afterfouror
fivedays,hisfeverroseto40C.Heexperiencedgreatthirstandwasdrinkingcopious
amounts of water. Occasionally he would break into a sweat but his hands and feet
would be icy cold. At the time of the consultation, his tongue was crimson with a
yellowcoatingandhispulsewasslipperyandlarge.Thisfollowsapatternofyangming
effulgentheatintheinterior.Thepatternalsoshowstheisolatingofyintotheexterior
andiswhatistermeda rju()orheatreversal;inthispatternyinandyangno
longersmoothlyinterfacewitheachother.Treatmentcallsforacridcold-clearingheat,
generatingfluidsandstoppingthirst,toenableyinandyangtoproperlyre-interface
andtonolongerexistinaconditionwheretheyareisolatingeachother.Hewasgiven
anemergencyinfusionofBiHTng(WhiteTigerDecoction,)asfollows:
shngshgo 30g GypsumFibrosum

zhm 9g RhizomaAnemarrhenae
jngm Abighandful SemenOryzaSativa
Aftertwopacksoftheaboveformula,hisfeverandthecoldnessofhislimbsabated
andhisproblemwasresolved.
Source Text 5

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Essence brightness1 and the five colors are the flower of qi. Red should look like
cinnabar wrapped in white silk and not like red ochre;2 white should look like the
wings of a goose and not like salt; green/blue should have the sheen of green jade
and not be blue; yellow should look like realgar wrapped in fine brocade and not
like yellow earth; black should look like black lacquer and not like the black earth.
If the subtle essence of the five colors has manifested in an obvious way, then ones
longevity will not be long.3 Essence brightness is used to see things, to discriminate
blackandwhite,toknownearandfar;iftheycontrarilymistakefarfornear,mistake
white for black, then this indicates that essence is weak. (Basic Questions Chapter 17
DiscourseonSubtleDetailsofPulseEssentials)
Interpretation
Therelativeabundanceorpaucityofapersonszang-fuorganessence-qiaswellas
thestrengthorweaknessofthezang-fuorgansfunctioningcanallexpressthemselves
ontheexteriorviatheactionsoftheqiandblood.Theeyesrelyonthe essence-qiof
the zang-fu organs for moisture and nourishment and are where essence brightness
resides.The blood vessels of the head are particularly abundant and the blood and
qioftheentirebodypoursintotheface.Thismeansthatitispossibletoobservethe
colorandlusterofthefacetogetanideaofthefunctioningofthezang-fuorgansand
observation of the face is very important clinically. A normal healthy face is bright
and moist but restrained in its coloration. If the color becomes dark, then this is a
reflectionofaweakeningoftheessence-qioftheinternalorgansandtheprognosis
is not good.The classic descriptions of facial color as red like cinnabar wrapped in
white silk, white like the wings of a goose, green like the sheen of jade, yellow like
realgar wrapped in fine brocade, and black like lacquer all reflect lustrous color
andagoodprognosisforanydiseasecondition.If,ontheotherhand,thecolorsare
dull like hematite, or table salt, or the grey blue of the indigo plant, or the color of
yellowearthortheblackofdust,thenthesekindsoflusterlesscolorsindicatethatthe
1 The brightness and strength of the eyes. Also note that the head is considered the palace of essence
brightness.
2 Thatistosay,itshouldhavelusterandnotbedull;sameforthefollowingcolors.
3 Essence should be stored in thezang-organs and the colors should thereof be subtle. If this is not the
case,thenthereisanimbalancethatwillshortenoneslifespan.
prognosisofthediseaseconditionispoor.Whentheessence-qiofthezang-fuorgans
manifests in the face and all the colors are dark, it indicates that the disease has
enteredadangerousstateandthatthepatientwillnotlivelong.Inadditiontocolor,
observationofthespiritandcoloroftheeyescanalsoindicatetherelativestateofthe
essence-qi.Iftheeyeshavespiritandvisionisgoodclearlyabletodistinguishcolors,
thenessence-qiisabundantandnotweakened.Ontheotherhand,ifthereisnospirit
in the eyes and it is difficult to distinguish large and small or black and white, then
thisindicatesthatessence-qiisweakened.Observationoffacialcolorand/ortheeyes
arecriticalelementsofclinicaldiagnosisinChinesemedicine.
The above source passage explicitly points out the importance of the diagnostic
observation.Observationofthefacialcolorandtheeyeshelpsonetogarnerimportant
informationthatoneshouldbequitefamiliarwithintheclinic.Ifthefaceisred,this
ismostoftenrelatedto heartfire;ifthefaceisblue-greenandwithoutluster,thisis
mostoftenaliverdisease;andifitisblack,thenthisismostlyakidneyproblem.
CaseReport
Female,adult.
Chiefcomplaint:severalyearhistoryofchronicnephritis.
Over the past few months, the symptoms worsened considerably, and one week
agoshefellintoacomaaccompaniedwithsevereagitation.Althoughmanymethods
were attempted, they were unable to bring her back to consciousness. Her blood
pressure varied between 170~190/100~120 mmHg. Her facial color was black.There
was so much phlegm that she sounded like she was using a saw. Her breathing was
rough,therewasthescentofurine,hermouthwasdryandherteethlookedwithered.
Her tongue coating appeared dirty and sticky and the tongue itself was pale and
fat with deep impressions on the sides. Her pulse was wiry, hard and large.This
patternisoneofseriouslydeficienthealthyqiandexcess pathogenicqiwithphlegm
turbiditycloudingtheinterior.Itcallsforanemergencytreatmentofcleansingaway
the phlegm and opening the orifices, supporting the healthy qi and expressing the
pathogenicqi.ShewasfirstgivenonepillofSHXingWn(StoraxPill,)
whichwasfollowedbythefollowingformulatobeboiledinwater:
chunguzh 9g RamulusCinnamomifromSichuan
mfngj 18g RadixCocculiTrilobi
jlnshn 9g RadixGinsengfromJilin
After taking the pill, she spat out more than a bowl full of white cruddy phlegm
anditseemedshewasclearer.Aftertakingthedecoction,shewasabletolieflatand
fallasleep.Herbloodpressurefellandafterwakingshewasabletoeatabowlofrice
congee.
[Reference:ChenMing.SelectedCaseStudiesfromFamousGoldenCabinetSchoolPhysicians
Source Text 6

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Thefivedepositoriesarethestrengthofthebody.Theheadisthepalaceofessence
brightness;ifoneisunabletoraiseonesheadandtheeyesaresunken,theessence
andspiritareindangerofescape.Thebackisthepalaceofthechestcenter;iftheback
is humped and the shoulders drooped, this palace will soon fall to ruin.The lumbar
area is the palace of the kidney; if it is unable to flex and turn properly, then the
kidneywillsoonfail.Thekneesarethepalaceofthesinews;iftheyareunabletoflex
orextend,thenonewilllimpandrequiresupportwhenwalking,andthesinewswill
becomefatigued.Bonesarethepalaceofthemarrow;ifoneisunabletostandforlong
periodsoftimeorwalkwithouttremblingandshaking,thentheboneswillsoonfail.
Thosewhogainstrengthlive,thosewholosetheirstrengthdie. (BasicQuestionsChapter
17DiscourseonSubtleDetailsofPulseEssentials)
Interpretation
Thehumanbodyismadeupofnumerousorgans,formsandsensoryorgans.Each
oftheseparticipatesintheorganicwholethatmakesanindividual,andeachisable
tocommunicatewitheveryother.Inthisstructure,thefivezang-organsmakeupthe
centerofthesystemandviathechannelsconstitutethesystemwhereintheinterior
pertainstothezang-andfu-organswhiletheexteriorisinterconnectedtothelimbs
andjoints.Thisentiresystemispartofthephysiologyofthefvezang-organs.
Iftheessence-qiofthefivezang-organsisrepletethenitisabletofillandnourish
thephysicalbodyandthesenseorgansmakingthebodystrong.Theessence-qiofthe
zang- and fu-organs pour upward to the head, filling and nourishing the five sense
organsandsevenorificesenablingthemtoproperlyperformthefunctionsofseeing,
listening, smelling and tasting.The head is where essence and qi accumulate, being
storedinthebraininteriorlyandopentothesevenorificesexteriorly.Thus,thehead
iscalledthepalaceofessencebrightness.
If essence-qi is flourishing, then observation of the head and face should show
lively expressions, spirit in the eyes and agile movement. If, on the other hand, the
essence-qioftheorgansisdeficientandthereforetheirabilitytoproperlyfillthesea
ofmarrowthatthebrainiscompromised,thentheindividualwillfindhis/herheadto
beheavyandhardtoholdup,andtheeyeswillappearsunkenandhavenospirit.
The heart and lung are in the upper part of the torso in the chest cavity.They
respondtotheexterioroftheback;and,indeed,theirrespectiveback-shpointsare
there as well.The back is considered to be the palace of the heart and lung, and if
thereissomesortofcurvatureofthebackleavingtheindividualunabletostraighten
up and the arms to fall to the side unable to lift up, then this is reflection of an
inabilityoftheessence-qioftheheartandlungtoproperlyfilltheshouldersandback,
andisconsideredaweaknessoftheiressence-qi.
The kidneys are stored in the lumbar area of the back which is considered the
palaceofthekidney.Ifkidneyessence-qiisreplete,thenthewaistandlowerbackwill
bestrongandagile.If,ontheotherhand,thelowerbackispainfulandmovementis
difcult,thisisrefectionofinsufcientkidneyessence-qi.
Thekneesareoneofthelargerjointsofthebodyandtheyarealsoanareaofhigh
concentrationofsinews;theyareoftenreferredtoasthepalaceofthesinews.GB34
(ynglngqun),locatedjustbelowtheknee,isthe hui-meetingpointofthesinews.
Thekneeisnormally able toagilely sustainrunningand jumping, butif itisdifficult
to extend or bend the knee and/or to turn it, perhaps even to the point where one
must hold on to something to walk, then this is an expression of the sinews having
lostthelubricationandnourishmentofessence-qiandthereforeweakening.
Kidney essence transforms and generates marrow which ensures that the bones
arehardandstrong;thebonesarethuscalledthe palaceofthemarrow.Ifthebones
are soft and one cannot stand for long periods of time, or if one sways from side to
side when walking, then this is a reflection of insufficient kidney essence-qi and a
weakeningofboneqi.
Iftheessence-qioftheorgansisstrong,thentheformandsensoryfunctioningof
theindividualwillbenormal,iftheyareweak,thentheformwillweaken.
Thekidneystoresessence,essencegeneratesmarrowandmarrowfillsthebones.
Ifkidneyessenceisdeficientordamaged,thentheboneswillbeweakenedandempty
andmovementwillbeunstable.
CaseReport
The patient reported that in August of 1989 he began to experience dizziness,
vomiting, double vision, difficulty swallowing, and loss of strength in his limbs
manifestingasarighthemipareticgait.Itwassuspectedthattherewerepathological
changesintheleftcerebellumsohewasadmittedtothesurgicalwardofthehospital
for tests and treatment. Repeated testing eliminated this diagnosis and so he was
transferred to the neurological ward and diagnosed withdemyelinating disease,

inflammation of the brain stem and multiple sclerosis. He was given steroids and
assorted vitamin supplements as well as symptomatic treatment. After nearly three
monthsoftreatment,thediseaseconditionshowedsomesignsofimprovementand
hewassenthomewithmedication.Unfortunately,hediscoveredthatanyloweringin
thedosageofhissteroidmedicationwouldresultinaworseningofhissymptoms.He
decidedatthispointtoturntoChinesemedicinetotreathisproblem.
Atthetimeofthisconsultation,thepatientwasobservedtobeoverweightwitha
rounded face, his entire body was in pain and distressed, with his right hand numb
and flaccid and his gait awkward and unstable. His pulse was thin, wiry and rough,
histonguefatandtenderwithathinwhitecoatinganddry.Thisisanextremekidney
qideficiencypattern.Withthekidneyqisodeficient,thebonesbecameweak,andthe
qideficiencyledtobloodstagnation.Thesituationcalledfortreatingthekidneyalong
with augmentation of the qi and activating the blood. A formula was prescribed as
follows:
tindng 6g RadixAsparagi
chodzhng 12g CortexEucommiae(dry-fried)
dlng 9g Pheretima
The formula was boiled in water and one pack taken per day. After taking this
formula for two months, his symptoms showed marked improvement and he was
ordered to begin decreasing his dosage of steroids. Once he began decreasing his
steroids,hisappetitedecreasedslightlyandhislegweaknessgotabitworse.Healso
feltthattheskintemperatureonhisrightarmwasslightlylowerthanthatofhisleft.
Hisformulawasmodifedasbelow:
Added:
xinlngp Nodosageindicated HerbaEpimedii

rucngrng Nodosageindicated HerbaCistanches
These two herbs were added to regulate yin and yang.The following two herbs
wereaddedoccasionallytoincreasetheqi-movingandblood-activatingactionsofthe
formula:
chunxing Nodosageindicated RhizomaChuanxiong

xingf Nodosageindicated RhizomaCyperi
After four months of this formula, he was able to completely stop the steroids
and his symptoms stabilized. He continued the formula for an additional six weeks,
andallofhis symptoms disappeared. His life and work both returned to normal and
he was able to attend athletic activities. He was given formulas to supplement and
augmentkidneyandspleentofurtherconsolidatetheefect.
[Reference: Chen Ming. Essentials of Clinical Patterns inTheYellow Emperors Inner Classic of
Source Text 7
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Thosewhogainspiritflourish,thosewholosespiritdie. (BasicQuestionsChapter13
DiscourseonMovingEssenceandChangingQi)
Interpretation
Thereisbothabroadandanarrowconcepttothemeaningof spirit.Initsbroadest
sense, spirit refers to that which governs all the living or vital activities of a person
as well as all of their outward expressions.This includes all physiological activities,
commandofpsychologicalactivities,andtheexternalexpressionofvitalityaswell.The
narrower meaning of spirit refers to the essence-spirit: consciousness, thought and
emotionalactivity,andparticularcharacteristicsofonespersonality.Theharmonious
actions of the five zang-organs, the proper storage and distribution ofessence, qi,
bloodandfluids,aswellastheexpressionofemotionsallrelyontheleadershipand
regulationofspiritassodefned.
At its root, spirit is transformed and generated from the subtle substances of
essence, qi, blood and fluids, while at the same time it also reflects the state of the
bodys metabolic formation and control of these substances.The essence-qi of the
organs guarantees the functioning of the organs as well as the transformation and
generation of the spirit.This essence-qi responds to outside stimulation and the
reactiveresultisanexpressionofspirit,consciousnessandthoughtprocesses;thesein
turnproducedifferentemotionalactivities.Allofthisintotalconstitutesthevarious
aspectsofspirit.
Thisshowsthatthereisacloserelationshipbetweenthemanifestationofspiritand
organessence-qiphysiology.The spiritabideswithinthephysicalformandshouldit
leave,thephysicalformwouldnolongerexist.Therelativefullnessofthesubtleand
notsosubtlephysicalsubstancesofthehumanformdirectlyinfluencestheproduction
ofthevitalactivitiesofthebody.Theirrelativestatecanbeobservedinthecolorseen
on the physical form, in spirit expressed through the eyes, in speech (both sound
and content), in facial expressions, responses, actions, spirit (in the narrower sense),
emotions,sounds,breathingandthepulse.Ifthevitalsubstancesofthebodyarereplete
and the functioning of the organs healthy, then the spirit will be strong. If the vital
substancesaredeficientorexhaustedandthefunctioningoftheorgansisthusgreatly
weakened,thenthespiritwillbeweak.Spiritisthemostbasicmarkerofthepresence
oflife,andinChinesemedicineobservationofspiritisconsideredtobeanessential
componentofdiagnosis.Takentogetherwiththeotherclassicdiagnosticparameterslike
sound,smelling,andpulse,itisavitalfactorindeterminingthestrengthorweaknessof
theessence-qioftheorgans.Itisalsoausefulfactorinmakingaprognosisofadisease.
If there is a yin disease with yang qi deficiency and weakness of the heart and
kidney,thiscancauseextremewitheringoftheessence-spirit.IntheTreatiseonCold
Damageitreferstothisasonlywantingtosleep.Considerthefollowingcase:
CaseReport
Female,ageover30.
Itwasreportedthatduringhermensessheinadvertentlygotwetandthatnight
she suddenly had chills which continued until she passed out, totally unresponsive,
withapulsethat was faint, thin, and felt as though it were about to stop; her hands
andfeetwerecold.Atthetime,DU26(rnzhng)andM-UE-1(shxun)werebled
the blood that was let was dark purple and difficult to express out. At the time of
thebleedingprocedure,shewasabletocalloutinpainandregainedconsciousness
somewhat, but shortly thereafter fell back into a comatose state.These symptoms
can be explained by effulgent yin-cold with severely weak yang qi combined with
congealingofqiandblood.Emergencytreatmenttowarmthechannels,dispersecold
andsupportyangqiwascalledfor.Shewasgivenastrongformulationof SNTng
(FrigidExtremitiesDecoction,)asfollows:
pofz 24g RadixAconitiPraeparata
bignjing 12g RhizomaZingiberis

Theaboveherbswereboiledinwateranddividedintofourmeasurestobegiven
warm,halfanhourbetweeneachdose.Thefamilyaskedthat,giventheproblemwas
sosevere,toquicklysolvetheproblemwouldntitbebettertogivethemedicineallat
onceratherthandivideitintofourdoses?
The doctor responded that it was precisely because the problem was so severe
thatonemustchoosethemethodofseveredisease,slowinfusion.Thepointofthis
istoensurethatthestrengthofthemedicineismaintainedandactstoslowlyarouse
yang qi, and in this way to get rid of the yin-cold.This is like when spring comes
to the land, the snow naturally melts. If the medicine were to be given in one dose,
there would be a fear of thepulse suddenly exploding.This would be like if from
nowhere the day suddenly became very hot and the snow melted all of a sudden;
ratherthanbeingagoodthingthiswouldactuallyproduceadisaster.
Thefamilywasconvincedandgavethemedicineasinstructed.Thepatientslimbs
gradually warmed, her pulse returned and she awoke, regaining her former state
beforetheproblemarose.
.Beijing:AcademyPress;1998:p.405.]
Source Text 8

(
)
The five depositories are the defenders of the middle. If the middle1 is overly
full and stuffed, 2 if qi is victorious 3 and damagesfear, 4 if the words spoken are
muffledlikequietwordsspokeninanotherroom,thenthisismiddleqidampness.If
thevoiceistoosoftandlow,andittakesawhilebeforewordscanberepeated,then
thisisqisnatchedaway.Ifonedoesnotwearclothesorcoveroneselfwithblankets,5
and if one speaks ill without respect for the listener, then this is a disorder of the
spirit-brightness.Ifthegranaries6cannotstore,7thisisbecausethedoorsofthegates
donotcloseproperly.Ifthewaterspringdoesnotceaseflowing,thenthisisbecause
thebladderdoesnotstore.Thosewhoseorgansobserveproperfunctioninglive,those
1 Thespleenandstomach.
2 Notworkingproperly.
3 Thereisdistension.
4 Fearistheemotionofthekidneyandinthissentenceisaeuphemismforthekidney.
5 Knowsneithershamenorcold.
6 Spleenandstomach.
7 Onecanteatordrinkand/orhasuncontrolleddiarrhea.
whoseorgansloseproperfunctioningdie. (BasicQuestionsChapter17DiscourseonSubtle
DetailsofPulseEssentials)
Interpretation
Theorgansinsidethebodyareresponsibleforstoring essence-qi.Itisimportant
thattheystoreanddonotallowtheessence-qitodrainaway,andthatthisfunction
of guarding it is not disturbed in any way to ensure the proper functioning of the
organs.Differentiatingwhetherornottheorgansareproperlystoringessence-qican
bedonefirstbylisteningtothesoundsthepatientmakesandaskingafterthedisease
condition.
If the sounds that the patient makes are deep and stifled like they were coming
from inside a room and dont sound as though they are coming out freely, or if the
speechdoesntsound clear and penetrating, this indicates that there is some sort of
pathogenic qi stagnation.The sounds that people make originate from the kidney
andcomeoutthroughthelung,crossingoverintheearthofthemiddlejiaospleen.If
thesituationdescribedaboveweretoarise,itwouldprobablybeacaseof dampness
qi stagnating in the center earth spleen and stomach affecting the upward and
downwardqimechanismsothatitwasunabletoproperlyenablethelungandkidney
tocommunicate.
If a patient produces sounds that are low, faint and weak, speaking as though
thebreathwereunabletoflowoutinonecontinuousstream,andtakingalongtime
to speak a sentence, this is a pattern of weak and faint essence-qi and is caused by
exhaustionoftheqi.
If a patients behavior is different from the ordinary and his/her clothes are
unkempt, perhaps to the point of revealing the underlying flesh, but he/she is not
concerned or embarrassed about it, or if the patient speaks with foul language,
hitting others and breaking things, then this is clearly a pattern of essence-spirit
consciousnessormindbecomingdisordered,andisanexpressionofspiritbrightness
beingharassedbypathogenicqiandthelossofabilitytoproperlyguardtheessence-
qiintheorgans.
Ifapatientisunabletocontrolhis/herbowelspresentingwithdiarrhea,thenthis
is a pattern wherein the spleen has lost its ability to contain and the bowels are no
longer regulated. If urine leaks out unstoppably like spring water rising up from the
ground, this is a pattern wherein the kidney has lost its ability to properly contain
essence-qiandthebladderhaslosttherestraintsputonitbythekidney.Theessence-
qimustnecessarilyfillthefivezang-organssothattheyareabletofunctionnormally
and not weaken. It is only in this way that the symptoms described above will not
manifest.
Insummary,ifitbecomesthecasethattheorgansarenolongerabletostoreand
guardessence-qi,thentheqioftheorganswillweakenandtherewillnotbeagood
prognosisfortheindividualinquestion.
ThesourcetextabovestatesthatIfthewaterspringdoesnotceaseflowing,then
this is because the bladder does not store. However, there are many reasons that
thebladderdoesnotstore,reasonsthatarisefrombothdeficiencyaswellasexcess.
Kidney deficiency is one possible source of this problem, and pathogenic qi in the
taiyangchannelcanalsocausethisproblem.Itisnecessarytodoaproperdifferential
diagnosis.Considerthefollowingcase:
CaseReport
Thepatientsfathermadethefollowingreport:sixmonthsprevious,thechildhad
had a urinary tract infection, the symptoms of which included frequent urination,
urgency, and pain. After being treated with Chinese herbs, the urgency, and pain
disappeared,thoughtheproblemwithfrequenturinationdidnot.Forthepastmonth,
the frequency of the urination had gradually increased to the point where the child
neededtourinate35timesanhour.Atthistime,thechildalsofeltaversiontocold,
had spontaneous sweating and a history of wetting the bed.The tongue body was
palewithathinwhitecoatingandthepulsewasdeepandthin.Labtestsonhisurine
were all negative.Treatment called for supplementing the kidney and securing and
astringing.The formula chosen was augmented Su QunWn (Stream-Reducing
Pill). 1 After three packs of this formula, the urination problem was solved. Giving
considerationtothespontaneoussweating,GuZhTng(CinnamonTwigDecoction,
) was given to regulate the nutritive and defensive. A formula was prescribed
asfollows:
Thepacksweretobeboiledinwaterandonelottakenperday.Aftersixpacks,the
aversiontocoldandspontaneoussweatingdisappearedandhisurinaryfrequencyfell
tohalfofwhatiswasbefore.Theformulawaseffectiveandsoremainedunchanged.
Aftertakingafurthertenpacksoftheoriginalformula,hewascompletelycured.
1 SuQunWn(Stream-ReducingPill ):yzhrn(FuctusAlpiniae, ),wyo(RadixLinderae,

),shnyo(RhizomaDioscoreae, ).
[Reference: Chen Ming. Essentials of Clinical Patterns inTheYellow Emperors Inner Classic of
Source Text 9

(
)
Forthosewhotreatdisease,theymustexamineallaspectsofwhattheyseebefore
them,takethepulse,observethepatientsstateofmind,aswellasthemanifestations
of the disease.When treating those who believe in ghosts and spirits, one cannot
talktothemofhighestvirtue;whentreatingthosewhofearneedlesandbin-stone,
onecannottalkofhighestskill.Patientsthatdonotletyoutreatthemshouldnotbe
treated.Thereisnomeritindoingso. (BasicQuestionsChapter11FurtherDiscourseontheFive
Zang-Organs)
Interpretation
Duringtheprocessofdiagnosisintheclinic,itisnecessarytoincludeandanalyze
all of the patients presenting signs and symptoms, examining the pulse and various
appearances, upwardly examining rn yng (the pulse at the common carotid artery,
) and cn ku (the pulse at the radial artery, ) below.To understand the
situation,onemustcarefullyexaminetheconditionoftheorificesaboveandknowthe
functioningoftheorificesbelow.Oneshouldthentaketheinformationthusgathered,
putittogetherandgetacomprehensiveunderstandingofdiseasecondition.
Atthesametimeoneisdeterminingthepatientsphysicalcondition,oneshould
observe the patients mental and emotional condition. Patients with a positive,
optimistic attitude are able to easily rouse their inner healthy qi, which is beneficial
totherecoveryoftheirhealth.Thosewithapessimisticdespondentattitude,onthe
other hand, often appear deflated and struggle to arouse any energy; this makes it
difficulttorallytheirhealthyqiinthestrugglewithdiseaseandisdetrimentaltothe
recoveryoftheirhealth.
People are thinking feeling creatures, and a doctor cannot simply address
them mechanically and expect to resolve their health issues. It is also necessary to
understandthethinkingofthepatientandtreatthepatientaccordingly.Ifthepatient
believesinghosts,spiritsandothersuchthings,andhasabsolutelynocorrectrational
thinkingprocess,holdingtobeseechingthespiritworldforhelp,theninstructingthe
individualinanyphysicalpracticesthatmighthelpthemregaintheirhealthwillbeof
nouse.Ifthepatientdoesntbelieveinorisafraidofacupunctureorbin-stoneneedle
techniques,thentellinghimorherthatsuchtechniquesareeffectiveisalsoofnouse
as the individual will be unable to accept the idea. If the patient is pessimistic and
despairingoftheirdiseasecondition,feelingthatnothingwillbeofanyuseinsolving
theproblem,orbelievesinthepowerofghostsandspiritstosolvetheproblemrather
thaninanysolutionthatmightbeofferedbythephysician,thenthereisnothingthat
the physician can offer in response to the problem. Not only will the patient put up
resistance to the treatment, reducing or eliminating its efficacy, it will not even be
recognizedasatreatment.
For these reasons, a physician must not only know how to treat the various
diseasesthat come his or her way, buthe or she must also have a handle on how to
effectivelyinteractwithpatientsaccordingtowhoandwheretheyare,treatingthem
sothatthebestpossibleresultcanbeachieved.
130
Chapter7
Principles and Methods of Treatment
Source Text 1

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Ifthereiscold,thenheat.Ifthereisheat,thencool.Ifitisslight,thengoagainst
it.Ifitisextreme,thengowithit.Ifthereishardness,thenshaveitaway.Ifthereisa
guest, 1 then eliminate it. If something is overworked, then warm it. If something is
bound,thendissipateit.Ifsomethingloiters,thenpurgeit.Ifsomethingisdry,then
moistenit.Ifsomethingisurgent,thenslowit.Ifsomethingisscattered,thencollect
it.Ifsomethingisdamaged,thenwarmit.Ifsomethingislazy,thenmakeitmove.If
something is uneasy, then soothe it. If something counterflows up, then downward
reverse it. Massagethings,usemedicinal baths, use plasters, purge. Open things up,
makethingsradiateout.Usewhateverisappropriatetoeffectacure. (BasicQuestions
Chapter74GreatTreatiseontheEssentialsofUltimateTruth)
Interpretation
Withregardtothetreatmentofdisease,treatingtherootofagivendiseaseisthe
most fundamental guiding principle in Chinese medicine.When attempting to do
this,itisnecessarytodifferentiateclearlytheunderlyingdiseasemechanism,havea
solidgraspofthefundamentalnatureoftheproblemanddirectthetreatmentatthat
fundamental nature. In the clinic, diseases are complex and multifaceted and when
faced with a problem where the underlying pattern and the presenting symptoms
are in line with each other, one should use thenormal treatment principle.That is
to say, one should use prescriptions and herbs that are opposite in nature from the
pattern.This technique is sometime also referred to ascounter treatment. In the
clinic, the vast majority of illnesses fall within this category making this treatment
principlethemostwidelyused.Ifoneistreatingacoldpatternthenoneshoulduse
warm or hot herbs to treat. An example of this is using M HungTng (Ephedra
Decoction,)totreatanexteriorcoldpattern.Ifoneisfacingaheatpattern,then
one should use cold and cooling herbs to treat the problem. An example of this is
usingBiHTng(WhiteTigerDecoction,)totreatinteriorheat.Insituations
1 Externalpathogenicqi.
VolumeOne:Chapter7 PrinciplesandMethodsofTreatment 131
where the force of the disease is light and shallowly placed and if the disease
situation is one where the symptoms are simple with no false manifestations, then
the counter treatment should be used. If, on the other hand, the disease is serious,
and the disease complicated with numerous false manifestations, then one should
follow the false manifestations in the treatment.This type of treatment is called
conforming treatment (a detailed explanation of this follows the next passage of
sourcetext).
In situations where hard masses likezhng ji (masses and accumulations,)
haveappeared,oneshoulduseherbsthatpareandhackawaytheaccumulations.An
exampleofthiswouldbeusingBiJiJinWn(TurtleShellDecoctedPill,)
whichsoftenshardnessanddispersesknotstoeliminatetheinternalmasses.
In situations where external pathogenic qi has invaded and caused disease,
one must mostly address the problem by getting rid of the external pathogenic
qi. An example of this would be using Qing Hu Shng ShTng (Notopterygium
Dampness-DryingDecoction,)togetridofthewind-damp-coldnessinthe
limbs.
In a situation where excessive work has damaged the qi of the body resulting
in organ qi deficiency, one must give warm supplementing herbs to regulate. An
exampleofthiswouldbeusing BZhngYQTng(Center-SupplementingandQi-
Boosting Decoction, ) to augment middle jiao spleen and stomach qi to
treatspleenandstomachqidefciencycausedbyoverwork.
In a situation where the qi and blood are somehow obstructed and unable to
flow freely, where pathogenic qi has knotted up in the interior resulting in stuck qi
andbloodstasispathologies,thenoneshoulduseherbsthatacttowhittleawayand
disperse.The herbs used should regulate the qi and disperse stagnation or activate
thebloodandtransformstasistoreadjustthediseasecondition.Inasituationwhere
water and fluids or blood stasis have accumulated in a particular location, then one
shoulduseherbstoassaultandchaseawaytheaccumulationviadownwarddraining.
AnexampleofthisisusingDDngTng(ResistanceDecoction,)totreatblood
stasis.
In a situation where the body fluids are lacking and internal moisturizing and
nourishment is insufficient, one must use nourishing and lubricating herbs. An
exampleofthisisusingQngZoJiFiTng(Dryness-EliminatingandLung-Rescuing
Decoction,)totreatdrycough.
In a situation where the tendons and vessels spasm and/or shrink, one must use
herbsthathaverelaxingproperties.AnexampleofthisisusingShoYoGnCoTng
(PeonyandLicoriceDecoction,)totreatspasms.
Inasituationwherethe essence-qiisexhaustedandscatteredleavingitunableto
containthefluidsinthebody,theremaybemanifestationsoftheexternaldispersion
and loss of essence material to the outside of the body; in this case one should use
herbs that astringe. An example of this would be using M L Sn (Oyster Shell
Powder,)tostopsweating.
Inasituationwherethebodyisweakandtheessence-qisubstancesinsufficient,
one should use warm nourishing supplementing and augmenting herbs to nourish
andgenerateessence-qi.AnexampleofthiswouldbeusingRnShnYngRngWn
(Ginseng Supporting and Nourishing Pill, ) to treat deficient essence-qi
patterns.
Inasituationwhereqiandbloodhaveceasedmovingandarestagnatingandthe
impededflowisresultinginthewastingofthelimbs,oneshoulduseqimovingand
bloodactivatingherbstopromotethefreemovementofqiandblood.Anexampleof
thiswouldbeusing BYngHunWTng(Yang-SupplementingandFive-Returning
Decoction,)totreathemiplegiaandothersuchsymptoms.
In a situation where the heart spirit is uneasy and there are fearful palpitations,
oneshoulduseherbstosuppressthepalpitationsandcalmthespirit.Anexampleof
thiswouldbeusing ZhShnShnWn(CinnabarSpirit-CalmingPill, )
totreatinsomnia.
In situations where the disease is in a superior position, one should use herbs
whose energetic move upward and cause vomiting.These types of herbs help expel
the pathogenic qi upward and outward. An example of this would be Gu D Sn
(MelonStalkPowder,).
In a situation where the pathogenic qi is in the lower part of the body, one
should use herbs whose energetic movement is downward to expel the pathogenic
qi down and out. An example of this would be using W Lng Sn (Five Substances
Powder with Poria, ) to facilitate urination or one of the Chng QTng
(Purgative Decoction, ) family of decoctions to downward purge pathogenic
excess.
Intheclinic,basictreatmentprinciplesguidethemanyconcretetherapeuticslike
massage, acupuncture, herbal baths, external plasters or oral ingestions of herbal
decoctions in the elimination of pathogenic qi though the choice of any particular
methodisdependentontheactualsituation.
If there is blood stasis in the body, it can cause qi and blood stagnation in the
organs and tissues and the formation of lumps and masses. Symptoms of such
accumulationscanincludepalpablelumps,pain,blackfacialcolor,andadeeprough
pulse.Treatment calls for activating the blood and transforming stasis, opening the
collaterals and whittling away masses.The overarching treatment principle is to
eliminatestaticbloodandensuretheproperflowofbloodintheindividual.Consider
thefollowingcase:
CaseReport
Female,age46.
The patient came in with a palpable mass in the lower right abdomen.The
massfeltuncomfortablewhenpressedandhadbeenpresentforoverthreemonths.
A gynecological exam resulted in a diagnosis of uterine fibroids. Surgery was
recommended, but as the patient was unwilling to have the operation, she came to
this clinic to explore options. For the past year, her period had been irregular with
thelengthoftimeofeachcyclegettinglongerandlongerwithquiteheavyflowand
manyclots.For the past three months,it has been especially heavy and she has had
up to two periods in a month. Her pulse is wiry, slippery, thin and rapid with force.
Treatmentcallsforactivatingbloodandtransformingstasis.Theformulagivenwasas
follows:
chunlinz 10g FructusToosendan
snlng 6g RhizomaSparganii
zh 6g RhizomaCurcumae
mxing 10g RadixAucklandiae
qngp 10g PericarpiumCitriReticulataeViride
ymco 10g HerbaLeonuri
Theaboveformulawasusedforthreemonthsandatotalofoverfortypackswere
given.Overthecourseofthetreatment,herperiodreturnedtonormal,theabdominal
mass disappeared and there was no more pain upon palpation. A subsequent
gynecologicalcheck-upshowedthattheuterinefbroidhaddisappeared.
[Reference:PengJian-zhong,YangLian-zhu.SelectedCasesfromZhaoShao-qinsClinicalPractice
.Beijing:AcademyPress;1996.p.164-165.]
Source Text 2

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What is meant by countering and following? Qi Bo replied:Countering is

the straightforward treatment method; following is reverse treatment, how little
or how much one does depends on the situation.The Emperor asked:What is
reverse treatment Qi Bo replied:Apparent heat, but use heat to treat; apparent
cold, but use cold to treat; apparent blockage, but use blocking methods to treat;
apparent openness, but use opening methods to treat.The doctor must subdue the
commandingpathogenicqi,andprioritizetherealunderlyingcause.Inthebeginning,
itwillappearthatthetreatmentisthesameasthecause,butintheendtheywillbe
different.Thistechniquecanmakethatwhichwasbrokenapartcometogether;make
thatwhichhasulceratedstrongagain;makeqiharmonious;andcompletelycurethe
disease condition.The Emperor said:Well said. But how can one regulate qi and
completelysolvetheproblem?QiBoreplied:Counterit,followit,counterandthen
follow it, follow and then counter it; do what is necessary to course qi and rectify
it.Thisisthewayoftreatment. (BasicQuestionsChapter74GreatTreatiseontheEssentialsof
UltimateTruth)
Interpretation
Intheclinic,diseasepatternscanbequitecomplicatedandsometimesthedisease
presentationcanbetheoppositeoftheactualnatureofthepattern.1Ifthisisthecase,
thenonemustusetheprincipleofwhentreatingdisease,seektherootandstrictly
addressthebasicnatureofthediseaseandnotthesuperficialsymptoms.Inthiscase,
thenatureoftheformulaandherbsusedwillbethesameasthefalsemanifestations
ofthepatternbeingaddressed.Thistypeoftreatmentisatypeofreversetreatment
though it is also referred to asfollowing treatment. In these types of cases, even
though the herbs used seem to have the same nature as the symptoms the patient
is presenting with, in fact, they are directed at the actual nature of the underlying
pattern and are its opposite.This type of situation is not seen much in the clinic
and so the reverse treatment method is also not used much. Reverse treatment
therapies mostly fall into one of the following four categories: using hot herbs for
hot manifestations, using cold herbs for cold manifestations, using herbs that block
for manifestations of blockage and using herbs that open for manifestations of
inappropriateopenness.
Thetechniqueofusinghotherbsforhotmanifestationstreatsfalsemanifestations
of heat and is used in situations where yin is particularly effulgent and has isolated
yangtotheexteriorofthebody.Thisisaconditionoftruecoldandfalseheatwherein
1 Opposite in the sense that the underlying cause is, for example, cold and the symptoms all seem to be
heatsymptoms.Inthiscase,ifoneweretoclearheatwithcoldherbsorsomeotherdrainingtechnique,itwould
maketheunderlyingproblemworse.
yin-cold fills and blocks the interior forcing yang to float on the exterior. Symptoms
canincludenoaversiontocoldandaredfacelikeonehasputonmakeup,butatthe
sametimebecauseyinissostrongontheinterior,theremayalsobecoldsymptoms
like diarrhea with undigested food, cold hands and feet, a thin pulse that seems to
disappearandapaletonguewithawhitecoating.Itistheselastsetofsymptomsthat
callfortheuseofwarmingherbstotreatthecondition.
Thetechniqueofusingcoldherbsforcoldmanifestationsusescoldherbstotreat
falsemanifestationsofcoldandisusedinsituationswhereeffulgentyanghasisolated
yin in a true heat false cold pattern. In this case, the extreme heat in the interior of
the body locks the yang qi in the interior and it is unable to perform its function of
warming the exterior.The yin now isolated to the exterior causes false symptoms
of cold hands and feet and a deep hidden pulse. Regardless, because of the yang
heat trapped in the interior, there will also be such true symptoms as a hot torso, a
throwingoffofclothesandbedcovers,aversiontoheat,vexatiousthirst,adesirefor
colddrinks,shortdarkurination,aredorscarlettongueandayellowtonguecoating.
Thesetruesymptoms indicate that one must use cold and cooling herbs to properly
addressthedisorder.
The technique of using herbs that block for manifestations of blockage treats
blockage caused by deficiency patterns and is most often seen in patients with
a deficient and weak constitution where the organ essence and qi functions are
diminishedandthereareblockagesymptomsinatruedeficiencyfalseexcesspattern.
If a woman gets amenorrhea because of blood deficiency, it is because of lack of
sufficient blood and fluids where the source of transformation is deficient; in such
acaseonemustuseherbsthatsupplementandaugmentqiandbloodtofillupthe
sourceandnotopeningherbsthatactivatethebloodandtransformstasis.
The technique of using herbs that open for manifestations of inappropriate
openness treats conditions where there is inappropriate opening and draining. In
these conditions, pathogenic qi has lodged in the interior and is producing a true
excessfalsedeficiencypattern.Suchapatterncanbeseeninsomecasesofdiarrhea,
flooding and spotting (bng lu, ), and frequent urination.These conditions
usually call for stopping the draining or some sort of consolidation; however, given
thatitisapathogenicblockagethatiscausingtheinappropriatedraining,onemust
actuallyaddressthenatureofthepathogenicqitoresolvetheproblem.Iftheproblem
is caused by food stagnating in the interior blocking the intestines and resulting in
foul rotten egg smelling diarrhea, then one must whittle away the food, guide out
the stagnation and downward purge. Pushing out the accumulation and stagnation
istheonlywaytostopthistypeofdiarrhea.Inthebeginningstagesofusingreverse
treatment, the energetic nature of the herbs used will be the same as the false
symptoms; as the treatment continues, however, the false symptoms will disappear
andthetrueoneswillbegintoemerge;whenthishappens,thenatureoftheherbsand
thepatternwillstandinoppositionasisthemorenormalcaseintreatment.Clinically
speaking,regardlessofwhetheroneisusingregulartreatmentorreversetreatment,
bothaddressthebasicnatureoftheproblem.Theroutetheytakeisdifferentbutboth
windupatthesameplace.Theyaresubstantivelythesameandintheendbothwork
toeliminatepathogenicqi,regulateorganfunction,harmonizeqiandbloodandhelp
thebodyreturntohealth.
Ifaconditionofbloodstasishasariseninthebodyanditcausesobstructionand
downward draining in the channels and collaterals, this can in turn cause flooding
andspotting.Itisaconditionofinternalexcesspathogenicqimanifestingasblockage.
Treatment of thiscondition callsforeliminating the excess pathogenic qi, activating
the blood and dispelling stasis.The overall treatment principle calls for eliminating
excess pathogenic factors and opening out the flow of qi and blood. Consider the
followingcase:
CaseReport
Female,age43.Initialconsultation:March18,1977.
Chiefcomplaint: abnormal vaginal bleeding for one month.The patient reported
generally having a normal period, but in February though she began her period on
theeighthanditfinishedonthefifteenth,itbeganagainontheeighteenthandended
onthetwentythird.Thiswasfollowedbyperiodicspottingthathascontinuedupto
thetimeofthisconsultation.Theflowatthetimeofconsultationwasheavy,thecolor
redandtherewereclots.Accompanyingsymptomsincludedapainfulabdomenthat
was resistant to pressure and a sore back. Her pulse was deep wiry thin and rapid
(108bpm).Hertonguewasredwithapaleyellowcoatingandtherewerestasisspots
around the edges of the tongue. Her pattern is blood stasis flooding and spotting.
Treatmentcallsforactivatingtheblood,transformingstasisandstoppingtheblood.A
formulawasprescribedasfollows:
junbi 9g HerbaSelaginellae
zln 9g HerbaLycopi
wlngzh 9g FaecesTrogopterori
xdun 9g RadixDipsaci
phungtn 9g PollenTyphaeCarbonisatum
zngltn 9g PetiolusTrachycarpiCarbonisatus
After three packs of the above formula, the patient reported there was less pain
intheabdomenandtheflowwasreduced.Thecoloroftheflowwasstillredandshe
hadanaversiontocold.Shefeltdizzy,hadheartpalpitationsandshortnessofbreath.
Herpulsewasdeep,wiry,thinandsoft(80bpm),hertonguewaspaleredwithathin
yellowcoatingandhadscallopingaroundtheedges.Theabovemethodofactivating
thebloodandtransformingstasiswascontinuedwiththeadditionofsweetwarming
supplementingherbs:
Added:
jingtn 6g RhizomaZingiberisCarbonisatum
After three packs of this new formula, the patient reported that the vaginal
spottinghadessentiallydisappeared,thoughtherewasstillasmallamountofbloody
substance discharge. She reported that all symptoms were much better. Her pulse
wasdeepandthinandhertonguewaspaleredwithathinyellowcoating.Theblood
stasishadindeedbeencleared,butshehadnotrecoveredfromtheblooddeficiency.
Thetreatmentprotocolwaschangedtoactivatingtheblood,supplementingtheblood
and stanching bleeding. Modified Jio iTng (Donkey-Hide Gelatin and Mugwort
Decoction,)wasgivenasfollows:
jio 9g CollaCoriiAsini(melted)
jingtn 6g RhizomaZingiberisCarbonisatum
She was given three packs of this formula. In a follow-up a year later, it was
determinedthatthevaginalspottinghadcompletelystopped,theproblemhadnever
reoccurredandherperiodwasnormal.
[Reference: LiuYun-peng. Collection of 100 Famous Chinese Medicine Clinicians from the Past
100Years: LiuYun-peng . Beijing: China Press ofTraditional
ChineseMedicine;2001.p.8-10.]
Source Text 3

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Atthestartofadisease,onecanneedleanditwillbetakencareof;asitbecomes
stronger,onecanawaititsweakeningandthentakecareofit.Therefore,ifitismild,
thenonecanupwardlyraiseittoaddressit;ifitisserious,thenonecanreduceit;if
thepatientisweak,thenonecanmakehimstronger.Iftheformisinsufficient,then
warmitwithqi;ifessenceisinsufficient,thensupplementitwithflavor.Ifitishighin
thebody,thenexpressitout;ifitislowinthebody,thendrawitoutandexhaustit.If
themiddleisfull,thendrainitintheinterior.Ifthereisevil, 1thenuseherbalbathsto
steeptheformandforceasweat.Iftheproblemisintheskin,thensweatthepatient
toventitout.Ifthediseaseisswiftandurgent,then,basedontheparticularsofthe
situation, rein it in. If there is excess, disperse and drain it. Determine the yin and
yangdisharmonytodistinguishsoftandhard.Ifitisayangdisease,treatyin;ifitisa
yindisease,treatyang.Determineiftheproblemisintheqiorblood,andenableeach
to hold to their own territory. If blood is in excess, it is beneficial to dredge; 2 if qi is
deficient,itisbeneficialtopullandguideit. (BasicQuestionsChapter5TheGreatTreatiseon
YinYangCorrespondenceinPhenomena)
Interpretation
Thetreatmentofdiseasemusttakeintoaccounttherelativestrengthandweakness
ofthe healthy andpathogenic qiandthen, based on the deficiency or excess of the
disease condition, support and help the healthy qi and/or eliminate the pathogenic
qitochangetheproportionalstrengthofthehealthyandpathogenicqimovingfrom
astateofdiseaseandtowardfullhealth.Theoccurrenceofdiseaseinthebodyisan
expression of an imbalance and loss of harmony between yin and yang. It must be
addressedbyreestablishingthebalancebetweentheyinandyangofthewholebody,
1 Pathogenicqi.
2 Referstobloodletting.
rectifyingthebodyshyperorhyporesponse,eliminatingexcessesandsupplementing
deficienciestoreturnthebodytobalance.Atthesametime,issueswithessence,qi,
andfluidsmustalsobeaddressed,aswellasregulatingthefunctioningoftheorgans.
Alloftheseaspectsmustbeaddressedifonewishestotreattherootofthedisease.
Treatingalloftheseissuesrequirestheuseofavarietyoftreatmentmethods,butthey
shouldalwaysbeusedwithintheparameterssetoutbythetreatmentprinciples.
Intheinitialstagesofadisease,pathogenicqiisnotyetreacheditsfullstrength
andthusonecanuseacupuncturetodrainawaytheexcess.Ifthepathogenicqihas
already invaded the interior and has developed great strength then acupuncture
willnotbestrongenoughtodirectlyeliminatethepathogenicqi.Atthispointitwill
be necessary to wait for the strength of the pathogenic qi to subside before doing
acupunctureagain.Ifthediseasesituationisrelativelylightandthepathogenicqiis
not particularly strong or deep, then the treatment principle is to lightly force it out
and disperse it. If the disease situation is fairly severe and the pathogenic qi deep
and strong, then the principle is to drain and eliminate it. If, after the pathogenic qi
has been eliminated, the healthy qi has been weakened and is now deficient, then
one must use herbs to supplement and augment. If the yang qi of the individual is
insufficient,thenonemustuseherbstowarmandsupplementtheyangqi.Iftheyin
essenceisdeficient,thenonemustuseheavilyflavoredandrichnourishingherbsto
treattheproblem.
Ifthepathogenicqiisintheupperpartofthetorso,inthechestorabove,thenone
shoulduseemeticstoinducevomitingtoeliminatethem.Ifthepathogenicqiisbelow
theumbilicus,thenoneshouldfacilitateitsexitthroughthelowerorifices;andifthe
abdomen is full, distended, and uncomfortable with hardp-accumulation, then the
pathogenicqishouldbewhittledawayanddispersed.
If the pathogenic qi is loitering in the surface and skin of the body, then herbal
baths or steam may be used to promote sweating; once the patient sweats, the
pathogenicqiwillbeeliminated.
If the pathogenic qi is particularly virulent, then it will be necessary to be
very clear as to what the disease situation is and subdue the pathogenic qi. If the
pathogenicqiisstuckbothintheinsideandtheoutside,thenonemustusedispersion
ontheexterioranddrainingontheinteriortotreattheproblem.
In summary, when treating disease, one must take into account the relative
strength and weakness of the pathogenic qi, the location of the pathogenic qi and
howtheyin,yang,qiandbloodhavebeenaffectedandtreataccordingly.Techniques
to do this include: draw yang from yin, draw yin from yang, seek yang within yin,
seek yin within yang, warm yang to disperse cold, nourish yin to clear heat, activate
bloodtoeliminatestasis,andsupplementandaugmentqiandblood.Theuseofthese
andothermethodsenableonetoeventuallyachievethegoaloftreatingtherootof
theproblem,supporthealthyqiandeliminatepathogenicqi,regulateyinandyang,
harmonizetheqiandblood,andrectifythefunctioningoftheorgans.
If the disease is in the lower jiao and the pathogenic qi obstructs the bladder
adversely affecting its ability to transform qi, then this can result in dribbling and
difficultyurinating;inseriouscasesitcanresultinlngb()orurinaryretention.
In such cases, treatment requires the elimination of the excess pathogenic qi,
openingoutandfacilitatingthepassingofurineandultimatelyrestoringthenormal
functioning of the bladders qi transformation mechanism. Consider the following
case:
CaseReport
Chiefcomplaint:inabilitytourinateforfivedays.Thepatientcomplainedthatfor
the past several years, urination had gradually become more and more difficult and
that at times it required effort to pass at all. Five days previous, he said he suddenly
wasunabletourinateatallandhislowerabdomenbecamedistended.Hewenttoa
hospital;hewascatheterizedbuthewasstillunabletopassurinesotheyperformed
aurostomytofacilitatedrainingoftheurine.Twodayspriortothisconsultation,the
area around the incision became red swollen hot and painful and then susequently
began to suppurate.This was accompanied by a bitter taste in the mouth, dry
throat, and constipation. In a fit of anger, the patient had pulled out the tube and
his urination again became blocked.The patient voluntarily left the hospital to seek
help elsewhere. At the time of the initial consultation, his pulse was rapid and wiry,
his tongue red with a greasy yellow coating, and he had a temperature of 38C.The
pattern he presented with was damp heat blocking the liver channel, and bladder
inability to conduct qi transformation.Treatment called for draining the liver and
openingtheurinaryblockage.Theformulagivenwasasfollows:
lngdnco 6g RadixetRhizomaGentianae
shngzhz 10g FructusGardeniae
mtng 10g CaulisAkebiae
chqinco 12g HerbaPlantaginis
Succinum (ingested separately as powder with
hp 3g
therestofthedecoction)
Aftertakingonepack,thepatientwasabletopassasmallamountofurine.After
four packs, he was able to urinate normally and the redness, swelling, hotness and
painaroundtheincisionweremuchdiminished.Anadditionalfourpacksofmedicine
weregiventostabilizetheresults.
[Reference:YanGeng-fu.CollectedMedicalCasesofYanGeng-fu.Changsha:
HunanScienceTechnologyPress;1980.p.108.]
142
Chapter8
Life Cultivation
Source Text 1

()
It is that in far ancient times, the sages taught that all disease was because of
deficiency enabling the invasion of pathogenic evils and villainous winds. 1 Such
thingsaretobeavoided;onesemotionsshouldbetranquilandoneshouldbecontent
with ones circumstances from which true qi will follow, ones essence-spirit should
be retained internally, and if all these are done, from whence can disease arise?This
is because when the will is idle and the desires few, the heart is calm and unafraid,
the form worked but not made tired, then qi follows smoothly and all is as one
desires, obtaining what one wishes.Therefore, they consider their food delicious,
their clothing sufficient, and make joyful their customs: in this way, the exalted
and the lowly will not be envious of each other, and in this way the people will be
called simple. It is that desirable luxuries should not strain the eyes, wanton and
evil ways should not tempt the heart and none of the foolish, the wise, sages and
theunworthyshould fear for material goods: and in this way one can unite with the
Dao.
The reason all of those people were able to reach over one hundred years old
withouttheirmovementsfailingwasthattheirvirtueremainedintactandwasnever
imperiled.(BasicQuestionsChapter1DiscourseontheHeavenlyTruthofAncientAntiquity)
Interpretation
The meaning of protecting and cultivating the living body lies in preventing
theoccurrenceofdisease,inotherwords,protectingthehealthofthebodyandnot
gettingsickenablingonetoextendonesyearsandfinishoutonesallottedlifespan.
Howtoprotectandcultivateourlivesisfoundinpracticesthatregulateandprotect
ones actions to strengthen ones constitution, increasehealthy qi, and increase the
bodysabilitytoadapttotheexternalenvironmentanditsabilitytofightoffdisease,
1 Windsthatarenotintunewiththeseasonthattheyappearin.Generallyreferstounseasonalweather.
VolumeOne:Chapter8 LifeCultivation 143
reducingoravoidingoutrighttheoccurrenceofdisease.Anotherwayofdoingthisis
tobalanceouttheyinandyangofthebodyandensurethatthebody-mindco-exists
inthemostoptimalstate,andinthiswayslowtheagingprocess.
Theancientsweredeeplyversedinthewayoflifecultivationandtheseindividuals
earnestly taught the later generations and encouraged them to follow these
practices.The human race lives in the natural environment and as such must follow
and respond to the changes of its natural order adapting to the changes of the
seasons and actively adopting practices that foster and further the body. If this is
done, it will ensure that the physiological state of the body and the rhythms of the
natural environment resonate and have a harmonious order, thereby maintaining
health,increasingandstrengtheninghealthyqiandavoidingtheharmsofpathogenic
qi.
Emotional activities also directly affect the functioning of the zang-fu organs.
For example, if a given emotion is excessive, then not only could it directly damage
its respective organ, disrupting its functioning and causing disease, but at the same
time it could damage healthy qi and result in a reduced ability to self-regulate.
Accordingly, maintaining a balanced harmonious mood not troubled by greed and
desire or excessive emotional stimulation, and maintaining a calm heart and a cool
outlook with no worries or fears, helps the body to be worked but the spirit happy.
Thiscanhelptoensuretheharmonioussmoothfunctioningoftheqiandbloodofthe
zang-fuorgansandthefullnessandhealthofthespirit.
It thus becomes important to restrain desire and reduce the want for material
things,tocontrolthewillandavoidthespiritualburden,stressandpressurebrought
aboutbythewantonseekingofmaterialgoodsandpersonalbenefit.Itisimportant
tonotlookfordelicaciesthattemptthepalate,wantingatalltimesonlythosefoods
whicharedeliciousandtastesweettous.Withregardtoclothing,oneshouldnotseek
towearclothingthatisresplendentandbeautifulbutclothingthatiscomfortable.The
customs and habits of the people must be appropriate and adjusted and, no matter
whattheyare,shouldenableonetolivehappily.
Materialchangesintheexternalworldshouldnotrockthecalmnessandharmony
ofthespiritualworldofthemindandbody.Inthisway,nomatterthesocialposition
of the people in a societyhigh, low, rich or poorthey will be content in their
position with no jealousy or envy, no avarice or grasping: this generates a good,
simpleandhonestsociety.Itisasocietywhereinonewouldnottirethebodybecause
ofgreedanddesireorcreatechaosintheheartandmindbecauseoftemptation.In
this kind of society, men and women, the old and the young, those with spiritual
training and those without, would not be anxious and fearful because of greed for
materialthings or concern that they might lose what they already have. It is only by
maintainingthistypeofattitudethatoneisabletowalkthewayoflifecultivation,to
extend ones years with the body in good condition. Only in this way will one avoid
thetrialsofoldagewithoutdisease.
Intentandthethinkingactivitiescarriedoutbyonesmindhaveadefiniteeffecton
theworkingsofthezang-fuorgans.Forexample,ifthesevenemotionsareexcessive
then they will damage their corresponding organ. Clinically, this is seen as grief/
sorrow damaging the lung, thought/worry damaging the spleen, anger damaging
theliver,(excessive)happinessdamagingtheheart,andstartlement/frightdamaging
the kidney.The major methods of treatment call for regulation of the emotions and
harmonization of organ function with the ultimate goal being the return of normal
emotional expression and smooth regulated organ function. Consider the following
case:
CaseReport
Chiefcomplaint:disturbedsleepforoneyear.Ayearpreviousthepatientreported
having had a sudden fright following which she began to have nightmares. Her
period came every 23 months and her whole body felt tired. In August of 1976,
whileshewasridingherbicycletoworkatnightoneevening,shefellandfollowing
this accident was subsequently unable to sleep; as soon as she closed her eyes,
nightmarish images would fill her vision leaving her scared and uneasy.The patient
said she was irritable and sometimes if she fell asleep she would suddenly sit up
wander around for a while, and then lie down again. She was dizzy and headachy,
had no appetite, and was slow to respond to outside stimuli. However, she said if
she encountered some personal suffering (life difficulties), it would make things a
little better for a while. She felt achy and flabby with no strength, her lumbar area
and lower limbs felt heavy, her pulse was deep and wiry, and her tongue was pale
withathinwhitecoating.Westernmedicinediagnosedherwithhysteria,andthough
shehadundergoneseveralmonthsoftreatment,itprovedineffective.Shewasgiven
augmentedGnMiDZoTng(Licorice,WheatandJujubeDecoction,)
asfollows:
hhunhu 9g FlosAlbiziae
jinq 9g MassaMedicataFermentataFujianensis
gy 9g FructusSetariaeGerminatus
miy 9g FructusHordeiGerminatus
xdun 12g RadixDipsaci
chozorn 12g SemenJujubae(dry-fried)
zhnzhm 30g ConchaMargaritiferaeUsta(pre-boil)
[Reference:SunYi-min.ClinicalPatternswithMedicalCasesandFormulas.Zhengzhou:
HenanScienceandTechnologyPress;1981.p.34.]
Source Text 2

(
)
Whenafemaleissevenyearsold,herkidneyqiisvigorous,hernewteethemerge,
and her hair grows long. At two 7s, 1 the water of heaven arrives, 2 her ren mai
opens,herchongmaiflourishes,andhermonthliesflowregularly.Sheisabletohave
children. At three 7s, kidney qi evens out, her true teeth 3 grow out and her growth
reachesitslimit.Atfour7s,hersinewsandbonesharden,herhairgrowthreachesits
limitandherbodyisflourishingandstrong.Atfive7s,the yangmingvesselweakens,
her face starts to darken, and her hair starts to fall. At six 7s, the three yang vessels
1 Fourteen. In this passage all the numbering indicates multiplication. So in this way, two 7s is fourteen,
three7sistwentyone,etc.Thesamelogicappliestotheagesformaleswithtwo8sbeingsixteen,etc.
2 Pubertyandmenarche.Thecharacterstranslatedhereaspuberty, (tingu),meanheavenorcelestial
andtenthheavenlystem,respectively.Guiscategorizedasyinwatergivingpubertytheverypoeticaldescription
ofthearrivaloftheyinwatersofheaven.
3 Wisdomteeth.
weaken above, the face darkens, and the hair begins to turn white. At seven 7s, the
renmaiisempty,thegreatchongmaiisweakanditsflowsmall,thewaterofheavenis
exhausted,andtheearthroadcloses.Herformbeginstofallapart,andsheisunable
tohavechildren.
When a male is eight years old, his kidney qi is replete, his hair grows long and
hisnewteethemerge.Attwo8s,hiskidneyqiisflourishingandthewaterofheaven
arrives,essence-qi wells out and ejaculation occurs, yin and yang is in harmony, and
he can give children. At three 8s, his kidney qi evens out, his sinews and bones are
strongandpowerful,histrueteethgrowout,andhisgrowthreachesitslimit.Atfour
8s,hissinewsandbonesflourishandhismusclesandflesharefullandstrong.Atfive
8s, kidney qi weakens, his hair begins to fall and his teeth dry. At six 8s, his yang qi
weakensandbecomesexhaustedabove,hisfacedarkensandhishairandbeardcome
outwhite.Atseven8s,hisliverqiweakensandhissinewsarenolongerabletomove
asfreely.Ateight 8s, the water of heaven is exhausted, his essence small, his kidney
zang-organweak;hisformhasreacheditspeakandthereforehisteethandhairbegin
togo.
Kidneygovernswaterandabsorbstheessencefromthefivezang-organsandsix
fu-organs to store. In this way the five zang-organs flourish and can drain. Now the
five zang-organs are weak, the sinews and bones falling apart, the water of heaven
finished, and so the hair and beard become white, the body heavy, movement no
longercorrect,andheisunabletogivechildren. (BasicQuestionsChapter1Discourseonthe
HeavenlyTruthofAncientAntiquity)
Interpretation
The human formhasitssourcefrom earlier heaven essence. Before an individual
is born, this earlier heaven essence is an important substance for the formation of
life; it is the fountainhead of the structure of life. After an individual is born it forms
thematerialbasisofgrowthandreproductionofthehumanform,butitreliesonthe
ceaselessreinforcementoflaterheavengrainandwateressence.
Kidneygoverns the storage of essence; and while the structure of this essence is
basedonearlierheavenessence,laterheavenessenceisaddedtoittofillandnourish.
Kidney essence works to forward and promote the growth and development of the
organism as well as completing its reproductive functioning. If kidney essence is
replete and flourishing, then the transformation and generation ofkidney qi is also
ample; if kidney essence is deficient and drained, then kidney qi will be weak.The
livingprocessesofbirth,growth,aginganddeathaswellasonesreproductivepower
arealldependentontherelativestrengthandweaknessofkidneyessenceandkidney
qi.
Females have a basic seven-year cycle, while males have an eight-year one. At
differentagesandperiods,thebodychangesinaccordancewiththerelativestrength
or weakness of the individuals kidney essence and kidney qi, resulting in different
physiologicalchangesandstates.Attheageofsevenforfemalesandeightformales,
kidney qi gradually fills and flourishes. As young children, this manifests as rapid
developmentwiththehairgrowinglongandthick,thebabyteethchange,thebones
gradually grow and the body becomes taller.When kidney essence transforms and
generates blood fluids, this nourishes the hair as hair is the excess of blood.When
kidney essence transforms and generates marrow, marrow fills the bones.Teeth are
theexcessofboneandsofromtheconditionsofthehairandteethonecanknowthe
stateoftheindividualskidneyessenceandkidneyqi.
When females are fourteen and males are sixteen, they enter puberty and their
reproductive organs gradually develop and mature. When this development is
complete, they have the ability to reproduce. In females, this is marked by the
appearanceofmenarche,whileinmalesitismarkedbytheejaculationofsperm.
When females are twenty one and males twenty four, their kidney essence and
kidneyqiisreplete and flourishing.This manifests as completion of growth with the
bodyreachingafixedheightandtheeruptionofwisdomteeth.Whenfemalesreach
twentyeightandmalesthirtytwo,theyentertheirstrongestyearsaskidneyessence
and kidney qi reach their lifelong pinnacle.This manifests as strong and powerful
sinews and bones, black and shiny hair, a body that is strong and firm and full of
spirit.
Whenfemalesreachthirtyfiveandmalesforty,theirkidneyessenceandkidneyqi
beginstoweakenandtheqiandbloodoftheorgansarenolongerabletoadequately
supplythefaceandhair.Thismanifestsasadarkeningofthefaceandfallinghair.
When females reach forty two and males forty eight, their kidney essence and
kidney qi is weak and their yang qi deficient.They are unable to properly transform
and generate qi and blood, their blood becomes deficient and unable to nourish
properly.Thismanifestsasfurtherdarkeningofthefaceandwhiteningofthehair.
When females reach forty nine and males fifty six, they have entered old age; at
thistimetheir kidney essence and kidney qi is weak and frail. In a female, the blood
andqipouringfromherchongmaibecomesdepleted;atthispointherperiodceases
andshelosestheabilitytoreproduce.Foramale,hisliverandkidneyessencebecome
deficient and unable to fill and nourish the sinews and bones. His arms and legs
weaken and lose power and movement and walking becomes more difficult. At the
age of sixty four, males have entered old age, their kidney essence and kidney qi is
greatlydepletedandtheirkidneyfunctionweakandregressing.Theirformbecomes
weak and they are unable to do the things they used to, they begin to bald, their
reproductive functions are weakened and regressing and their reproductive organs
wither,sometothepointwheretheyhavelostallreproductivefunction.
A human beings birth, growth and development as well as his/her reproduction

is for the most part dependent on kidney essence and kidney qi. For this reason, if
kidney stores essence and further obtains the transformed essence of the fivezang-
and six fu-organs, then kidney essence will be replete and flourishing and able to
generate kidney qi.This qi can be divided into kidney yin and kidney yang. Kidney
yinformstherootoftheyinqiofthewholebody:iftheyinqiofthefivezang-organs
isunabletobesuppliedbykidneyyin,thentheorganswillnotbevigorous.Kidney
yangformstherootoftheyangqiofthewholebody:iftheyangqiofthefive zang-
organsisunabletobesuppliedbykidneyyang,thentheorganswillnotexpress.
Thereisaverycloserelationshipbetweenearlierheavenessenceandlaterheaven
essence.Laterheavenessenceisnourishedandmaderepletefromtheessenceofthe
five zang- and six fu-organs, promoting the proper functioning of these organs. Any
extraisstoredinthekidneyandhelpsthe earlierheavenessence.Kidneyessencealso
transformsandgenerateskidneyqiwhichisspreadviathe sanjiaotothefourcorners
of the body and all the organs, promoting and stimulating their functions. If kidney
essenceisweakorlow,thenthefivezang-organswillnothavesufficientnourishment
and the physical form will degenerate: the four limbs, sinews and bones will have
no strength and one will not want to move; reproductive function will diminish; the
sexual organs will wither and the individual will be unable to have or give children;
the face will age; the hair and beard will turn white; movement and walking will
becomeawkward;andallkindsofagerelatedweakeningwillmanifest.
If the kidney essence of the organism is deficient in puberty this will result in
decreased functioning of the reproductive organs, and potentially in the inability to
have or give children.Treatment for this issue calls for filling up and supplementing
kidneyessenceandstrengtheningtheprimalandbenefitingqi.Theessentialmethod
is to recover kidney essence and strengthen the functioning of the reproductive
organs.Considerthefollowingcase:
CaseReport
Male,age28.Initialconsultation:October3,1972.
Thepatienthadbeenmarriedforfiveyearsandhiswifehadnotbecomepregnant
during this time.Testing indicated that the problem did not lie with his wife, but
rather his tests results showed a sperm count of 1.05 x 10 8 /ml with 80 inactive
and thin seminal fluid; this was conclusive for a diagnosis of male sterility. He had
undergonemanydifferenttypesoftreatmenttoresolvetheproblem;none,however,
had proven effective. At the time of this consultation, he was quite thin, had a sore
lumbar area and heavy limbs, occasional dizziness, a normal sex drive, a thin, wiry
pulse with a rough pulse in the ch position, and a pale red tongue with thin white
coating.Uponinquiryheindicatedhisfatherhadmanyhealthproblems,thoughhis
motherwashealthy.Analysisofhissymptomsindicatedadiagnosisofearlierheaven
endowment insufficiency with later heaven failure to regulate and nourish resulting
in kidney essence loss.Treatment called for warming and nourishing kidney qi and
warming and supplementing essence and blood with an additional order to restrict
sexualactivity.Aformulawasgiventohimasfollows:
fz 9g RadixAconiti
rugu 3g CortexCinnamomi(infuse)
yngqsh 12g Actinolitum
lrng 1g CornuCerviPantotrichum(infuse)
zhch 3g PlacentaHominis(infuse)
bjtin 12g RadixMorindaeOfcinalis
tsz 15g SemenCuscutae
Boil in water, one pack per day, to be taken with the patent formula Gu Lng J
(MiraculousTurtle Collection, ).The patient came in every two months for a
check-up, and minor adjustments were made to the above formula. In May, 1973 he
retestedhissperm.Thespermcountwasthesame,buttheproportionoflivesperm
hadreachednormallevels.Hispulsewasmoderateandslightlywiry,the chposition
was no longer rough and his spirits were very good. He was told to stop taking the
medicineandobservehiscondition.Inthelatterhalfofthesameyearhiswifebecame
pregnantandcarriedamalechildtofullterm.
[Reference: DuYu-mao. Guide to Unusual and Difficult Clinical Patterns . Xian:
ShaanxiScienceandTechnologyPress;1993.p.222.]
Source Text 3


()
Thethreemonthsofspringarecalledexpellingtheold.Atthistimebothheaven
andeartharegenerating,andthemyriadthingsareflourishing.Onegoestobedlate
and rises early, widely strolling through ones courtyard, releasing the hair from its
confinementandrelaxingthebodytogeneratethewill.Thisisatimeofgeneration,
sodonotkill;ofgiving,sodonotsnatchaway;ofrewarding,sodonotpunish.Thisis
howtorespondtotheqiofspring,thewayofnurturinggeneration.Ifonebehavesin
oppositiontothisqi,thenliverwillbedamaged,andinthesummertherewillbecold
changesandlittletooferforgrowth.
The three months of summer are calledflourishing beauty.This is a time when
the qi of heaven and earth exchanges and the myriad things are flourishing and
replete. During this time, one should go to bed late and rise early, one should not
be averse to the sun. Ensure that the will feels no anger; ensure that the flowers are
beautiful;ensure that qi is able to drain properly. If one enjoys being outside, this is
howtorespondtotheqiofsummer,thewayofnurturinggrowth.Ifonebehavesin
oppositiontothisqi,thenheartwillbedamaged,andinthefalltherewillbemalaria-
like chills and fever; there will be little to offer for harvesting, and in the winter one
willbecomeveryill.
The three months of autumn are calledcontaining balance.The qi of heaven
is urgent, while the qi of earth is clear and crisp. During this time one should go to
bed early and rise early, rising with the crowing of the cock. Ensure that the will is
peaceful, and moderate fall punishments. Contain and restrain spirit qi, and ensure
thatinautumnonesqiiscalm.Donotaddressexternalissuestoensurethatlungqi
is clear.Thisishow to respond to the qi of autumn, the way of nurturing harvest. 1 If
onebehavesinoppositiontothisqi,thenlungwillbedamagedand,inwinter,there
willbediarrheawithundigestedfoodandlittletooferforstorage.
The three months of winter are calledclosed storage.Water is frozen and the
earth cracked; there is no harassment from yang. 2 During this time, one should go
to bed early and rise late, waiting for the sunlight. Ones will should rest in wait as
though hiding, as though being selfish, as though one has already obtained that
which was desired. Eliminate cold and seek warmth, do not drain from the skin 3
which repeatedly steals away qi.This is how to respond to the qi of winter, the way
of nurturing storage. If one behaves in opposition to this qi, then kidney will be
1 Togatherinasintheprocessofharvesting.
2 I.e.,everythingissmoothlyclosedinandstoredawayasitshouldbe.
3 I.e.,dontsweattoomuch.
damagedandinthespringtherewillbeweaknessofthehandsandfeetandfeelings
ofcoldnessasthereislittletoofferforgeneration. (BasicQuestionsChapter2GreatTreatise
onRegulatingtheSpiritintheFourSeasons)
Interpretation
Thewayoflifecultivationvaluesaboveallgoingwiththeflowofnature.Human
beingsandtheirnaturalenvironmentareintimatelyrelated,andoverthelongcourse
of living the human organism has developed good ability not only to adapt to the
surrounding environment but also to the changes of the seasons which manifest as
actualphysiologicalchangesinthebody.Inadditiontothebodyspassiveadaptation
totheenvironment,thereisalsonecessityforactivelyadaptingandadjustingtothe
changesoftheseasonsandtheweatherbasedonthenatureoftheseasonathand
spring generation, summer growth, autumn drawing in and winter storageand
changingonesdietandsleeppatternsaccordingly.Itisonlybyworkinginharmony
with the seasons that one can better protect and nurture ones life (forces), increase
andstrengthenhealthyqi,andprotectoneshealth.
The three months of spring include the six seasonal divisions 1 of spring
established(lchn,),rainwater(yshu,),awakeningfromhibernation(jng
zh,),springdivide(chnfn,),clearbright(qngmng,),andgrainrain
(g y, ). During this period the yang qi of the natural world begins to sprout,
spring qi begins to rise up, the myriad things recreate, breaking out of the old to
releasethenew.Innaturetheqiofgenerationandoutwardexpressionisvibrantand
flourishingandthemyriadthingsappeartojoyfullythriveinthisseason.Duringthis
seasontheyangqiofhumanbeingsalsobeginstosproutandriseup.Sleeppatterns
follow the glow of the early morning rise of yang qi and the individual wakes early.
Itisalsobeneficialtobreatheintheclear,clean,earlymorningair.Onecouldalsogo
forastrollortakeinsomeexercisetoopenoutthebody.Thiswouldpreventyangqi
frombeingtrappedinsideandallowittosmoothlyexpressitself,andthereforebetter
realizetherisingandexpressivenatureofyangqi.
Duringthisseasononeshouldalsomakeadjustmentstoonesemotionalstatein
accordancewith the regulatory and opening nature of spring qi, ensuring that ones
mood is comfortable and open with no depression or stoppages.This will help to
protectandfostertheliverandensurethatthelivercoursesasitshould,whichinturn
isofbenefttothecirculationofqiandbloodthroughoutthewholebody.
Thisisthewayofcultivatinglifeinthespring.Ifoneviolatesthesepractices,then
1 In the Chinese calendar, a two week period sees a change in the subtle energies of the season and is
givenanamewhichseemstobestreflecttheoverallnatureofthatparticularperiod.Thereare24suchperiodsin
theyearandthedatetheyfallonandspecifictimeoftransitiondifferfromyeartoyear.Theseseasonalperiods
haveaverylonghistoryandarestillinusetoday.
onewilldamagetheliverandcreateasituationwhereliverqistops,knots,anddoes
notcourseasitshould.Woodwillbeunabletogeneratefire,thebodysyangqiwill
thereforebeinsufcient,andwhensummerarrivesonewillgenerateinnercold.
The three months of summer include the six seasonal divisions of summer
established(lxi,),smallfullness(xiomn,),graininbeard(mngzhng,
), summer arrived 1 (xi zh, ), lesser summerheat (xio sh, ) and
great summerheat (d sh, ). During this time the yang qi of the natural world
is abundant and flourishing, the myriad things are in full luxuriant growth and
appealing, the natural scenes renewing and beautiful.The yin and yang of heaven
and earth steams and soars upward, intertwining, and, as it does, promoting the
blossoming and fruiting of plants, enabling them to flourish with the power of
growth.The yang qi of man also flourishes during this time.Yang qi spreads itself
overtheexteriorofthebodyandqiandbloodalsoracetotheexteriorofthemuscles.
At this time metabolism is very active.With regard to sleeping patterns, one should
rise in the early morning, adapting to the length of daylight hours to cultivate the
yang qi of the body. During the hot days of summer, one must pay attention to not
becomingexcessivelyagitatedoreasilyangered.Duringthistimeitisbesttokeepa
clearheadandcalmstate.Inthiswayonewillbeabletoensurethatonesspiritsare
kept at their flourishing fullest. At the same time one must protect and nourish the
heart,whichcorrespondstosummer,toprotectandnourishtheyangqioftheheart
andnotallowittodrainawayorbeconsumed.
Thisisthewayofcultivatinglifeinthesummer.Ifoneviolatesthesepracticesone
willdamagetheheart,causingdamagetotheheartqiandenablingsummerheatqito
stepintothevoidleftbehind.
When cool of autumn comes around, the cold and hot will contend, easily
resultinginmalaria-likepathogenicchanges.Thethreemonthsofautumnincludethe
six seasonal divisions of autumn established (l qi, ), dwelling in summerheat
(chsh,),whitedew(bil,),autumndivide(qifn,),colddew(hn
l, ), and frost descends (shung jing, ). During this time, the yin qi of the
naturalworldrisesupandthewindisforcefulandbrisk.Theqiofthemyriadthings
is clear, measured, inward moving and collected, forms are stable and no longer
fourishingorgrowing;infact,plantsarenowripeandawaitingharvest.
In the human body, yang qi is also following the movement of yang qi seen in
naturedrawinginandcollecting,movinginfromthesurfaceofthebody.Theopen
intersticesbegintocloseandqiandbloodruntowardstheinnerorgans.Withregard
tosleepingpatterns,oneshouldriseintheearlymorningwiththecrowingofthecock
and in the evening start ones rest earlier; in this way one will be in conformity with
1 ThiscorrespondstosummersolsticeintheWest.
the drawing-in nature of the proper qi of the season. Emotionally, one should try to
have a calm and peaceful mindset as this works with the forces of autumn; as well,
oneshouldcutbackonaggressiveqi,amelioratingitsinfluenceonthebody.Attention
shouldbegiventhatthecoolcrispairofautumndoesnotconsumeandscattertheqi
oftheorganism;andinaddition,payattentiontoprotecting,nourishing,clearingand
descendingthelungandlungqi,drawinginandcollectingitin,andtakingcarenot
toallowittobeoverlyconsumed.
Thisisthewayofcultivatinglifeintheautumn:ifoneweretogoagainstthisand
thereforedamagethelung,itwouldresultinlungqiinsufficiency.Thisinturnwould
mean that it would be unable to fill and nourish kidney qi, and then this in turn
wouldmeanthatthekidneywouldbedeficientandsusceptibletocold.Attheturnof
theseasonsfromautumntowintertherewouldbediarrheawithundigestedfood.
Thethreemonthsofwinterincludethesixseasonaldivisionsofwinterestablished
(ldng,),lessersnow(xioxu,),greatsnow(dxu,),winterarrived1
(dng zh, ), lesser cold (xio hn, ), and great cold (d hn, ). During
this time, the yang qi of the natural world is in retreat while yin qi is on the rise,
the generation mechanism of the myriad things lies hidden, and yang qi is stored
internally.Heaveniscoldandearthisfrozen,themyriadthingsaresealediniceand
their generation mechanism, in response to the sinking/storing nature of the winter
season,liesclosedandstoredaway.
In the same way, the yang qi of the human body also enters the zang-fu organs:
qi and blood responding to the winter forces of sinking and storage and returning
internallytotheorgans,yinessencesavingup,andyangqisinkingawayintostorage.
Emotionally,oneshouldpayattentiontocontainmentandmaintainapeacefulease,
notallowinghappinessorangertocauseanychangeoffacialcolor(i.e.,notexcessive)
or emotions to be expressed on the outside. During the cold days of winter, one
should pay attention to avoiding and eliminating cold qi, protecting and nourishing
theyangqiofthekidneythatresonateswiththetimeofwinter,andnotexcessively
sweatinganddrainingawayonesyangqi.
Thisisthewayofcultivatinglifeinthewinter.Ifoneweretogoagainsttheseand
thereforedamagethekidney,therebyresultinginkidneyqiinsufficiency,thenkidney
essencetransformationwillbedeficientandunabletogrowandnourishliveryinand
yang.This will in turn result in the liver losing its nourishment in the spring, leaving
it, the liver, either unable to govern the sinews which will then wither or have no
strength, or leaving it in yang deficiency whereby in the spring yang is not properly
distributedthroughoutthefourlimbsandthefourlimbsarecold.
Adaptationtothelawsoftheseasonalchanges,andregulatingonesrising,resting
1 ThiscorrespondstoWinterSolsticeintheWest.
andeating,aswellasonesemotionstofitthelifecultivationlawsoftheseasonsisthe
onlywaytoprotectoneshealthandcultivateoneslifeforces.
Ifoneisunableadapttotheweatherduringthesummermonthsandrepeatedly
exposesoneselftothehotraysofthesun,thenitiseasytogetheatstroke,todamage
the thin fluids and consume qi. In some extreme cases, it may even be that yang
becomes stuck inside unable to express itself on the exterior. If this happens, one
would see cold hands and feet, a condition referred to assummerheat syncope.
Considerthefollowingcase:
CaseReport
Female,age38.
During the summer months, following an afternoon nap, the patient swooned
and was unresponsive to the outside world. She had a fever, but her limbs were
cold.There was profuse sweating, rough wheezy breathing and her jaw was slightly
locked. Her tongue coating was yellow and dry, and her pulse surging, large and
hollow.Shewasdiagnosedwithsummerheatsyncope:theheatofsummerheatburns
the yangming and manifests in high fever; summerheat steaming the interior of the
bodyforcesthinfluidstodrainout,thuscausingprofusesweatingandroughwheezy
breathing;heatcausestheqidynamictostagnate,whichinturnresultsincoldlimbs;
heatascendsanddisturbsthespirit,thusresultinginfainting;andthesurging,large,
hollowpulseisamanifestationofhealthyqibeingunabletotriumphover pathogenic
qi.The proper treatment is to clear summerheat and drain excess, augment qi and
generate thinfluids.Theformulaselectedwas BiHJiRnShnTng (WhiteTiger
DecoctionPlusGinseng,),whichwasgivenasfollows:
rnshn 15g RadixetRhizomaGinseng

jngm 15g SemenOryzaSativa
Afteronepack,thepatientspulsereturnedtonormal,thesweatingstopped,and
herhandsandfeetwarmedup.Herspiritbecameclear,butsherepeatedlysighedand
wasthirstywithadesireforcolddrink.Shetookonemorepackandwascompletely
better.
155
Chapter9
Needling Techniques
Source Text 1

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)
TheYellow Emperor said:Needling the defensive is referred to asshaking off
the dust; to do this the master needles the superficial channels to eliminate yang
disease.Ido not know why it is referred to as it is. I would very much like to hear of
thisingreaterdetail.
QiBoreplied:Shakingoffthedustreferstoaconditionwhereinthereisamajor
counterflowofyangqi;itrisesuptothecenterofthechest,fillingitandresultingina
fixedstarerequiring a raising of the shoulders to breathe.There is cough, wheezing,
hacking,andaneedtositreclined.1Theproblemarisesbecausethepatienthasbeen
harmedbydustandsmokeresultinginchokingandinabilitytobreathe.Ifyouplease,
this is what is referred to asshaking off the dust as well as what it means to suffer
theillnessrisingdust.
TheYellowEmperorsaid:Excellent.HowdoItreattheproblem?
QiBoreplied:SelectcelestialappearanceSJ17(tinrng).
TheYellowEmperorasked:WhatpointsshouldIselectifthereiscough,extreme
difcultyspeakingandchestpain?
QiBoreplied:SelectcornerspringRN23(linqun).
TheYellowEmperorasked:Isthereanumberforhowlongtheneedleshouldbe
retained?
QiBoreplied:ForcelestialappearanceSJ17,retaintheneedlenolongerthanit
takestowalkoneli;forcornerspringRN23,retaintheneedleuntiltherearechanges
intheblood.2
TheYellowEmperorresponded:Excellent. (TheSpiritualPivotChapter75Needlingthe
TrueandthePathological)
1 Thepatientcantliefat.
2 Inthecomplexionoftheface.
Interpretation
Shakingoffthedustisoneoffiveneedlingtechniquesfoundin TheSpiritualPivot
Chapter 75 Needling theTrue and the Pathological.The five are respectively called:
shakingoffthedust(zhni,),releasingdarkness(fmng,),removingclaws
(qzhu,),penetratingthecovering(chy,)andresolvingdoubt(jihu,
).
ShakingoftheDust:
1. Meaning:The first of the two characters in the namezhnmeans to pluck
away or shake off, while the second characteri means dust.There are two levels
ofmeaningtoshakingoffthedustinacupuncture.Thefirstpointstothedepthofthe
disease.Inthiscase,thedepthisshallowlikedustthathasdriftedontothesurfaceof
something.Thesecondmeaningisthatwhenneedlingitisnotnecessarytoneedletoo
deeply,thatis,needletheshallowchannelsandvessels.
2. Indications:Chestfullnessandcongestionwithaneedtoelevatetheshoulders
when breathing, loud noisy wheezing, inability to lie flat, a feeling like there is
something stuck in the throat and difficulty breathing.The phrasethe patient has
beenharmedbydustandsmokereferstotheideathatthediseasehasbeentriggered
byexposuretodust,similartomoderndayallergicasthmabroughtonbydust.
3. Technique: Choose points from a yang channel (handtaiyang small intestine
channel,forexample)notthetaiyinlungchannel,and,inthiscase,mostimportantly
SJ 17 (tin rng). Retain the needles for about five minutes, about the time it would
taketowalkaChineseli(about500meters).
The lung governs qi and drives the breath, so when there is wheezing, chest
congestionanddifficultybreathingthisshouldbeconsideredapathologicalchangein
thelung.InBasicQuestionsChapter38DiscourseonCoughs(SWn-KLn,
)itsays:Thefivezang-organsandthesixfu-organscanallcauseapersontocough,
not just the lung. It also says:All that accumulates in the stomach is related to the
lung.Thisthenindicatesthatwhilepathodynamicchangesmanifestingaswheezing
andcougharerelatedtothelung,allzang-fudiseasescan,throughvariouspathways
affectthelungandresultincoughandwheezing.Italsoindicatesthattherearemany
factorsinvolvedinthepathodynamicchangesofacoughandwheezing.Forexample,
certaintypesofasthmacanbetriggeredbymanyallergens,andalthoughtheresulting
reactionscanbequitesevere,theseallergensareoftenmuchlikedustfloatingdown
ontothebodyandthereforeonecanusethetechniqueofshakingofthedust.
CaseReport
VolumeOne:Chapter9 NeedlingTechniques 157
Chief complaint: wheezing every fall for 28 years.The patient reported that
each year starting in the autumn, she would start wheezing.The problem would
last more than 100 days and then stop on its own in deep winter. For many years,
as soon as autumn arrived she would use chlorpheniramine, which moderated the
symptoms. She reports that at present, her symptoms are especially severe at night,
and every night she awakens because she cannot breathe. After she takes 2 tablets
of chlorpheniramine, about an hour later her symptoms are somewhat alleviated. In
the morning she takes 2 more tablets. In the day symptoms are relatively light, but
the patient still has slight difficulty breathing, mild cough, sneezing and clear nasal
discharge. She was examined for allergens at a hospital, and because all 10 of the
substances first checked were allergens for her, they did not bother to continue the
examination. Her tongue was red and her pulse was slightly fast.This pattern was
stagnant heat in the spleen and lung with aversion to dust and smoke.Treatment
called for clearing and draining the spleen and lung, and the method of shaking off
thedustwaschosen.
Points:SJ17(tinrng),LU7(liqu),SP6(snynjio)allbilateral,and RN23
(linqun);theneedleswereretainedfor20minutes.Thepatientwasalsoinstructed
tostoptakingchlorpheniramineifatallpossible.
Twodays later she returned for a second consultation. At this time she indicated
that the night following the treatment, she awoke during the night, yet she did not
take theWestern medicine and quickly fell back to sleep. She also did not have any
wheezing.The next day she did not take chlorpheniramine either. She was treated
again with the previous formula and was also given herbs.The formula chosen was
augmentedXiHungSn(Yellow-DrainingPowder,)asfollows:
huxing 10g HerbaAgastachis

chozhz 10g FructusGardeniae(dry-fried)
shngml 15g ConchaOstreae
bishshn 15g RadixGlehniae
chunbim 10g BulbusFritillariaeCirrhosae(Sichuan)
shungsngy 10g FoliumMoriFermentata
shnggnco 10g RadixetRhizomaGlycyrrhizae
Sixpacksweregiventobeboiledinwater,onepackperdaydividedmorningand
night. From that time into the winter, there was no recurrence of her wheezing and
cough.
[Reference:WangHong-tu.EssentialsofClinicalPatternsfromtheYellowEmperorsMedicalArts
.Beijing:HuaXiaPublishingHouse;1993.p.272.]
Source Text 2

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Thethreedepthsofneedlingarewhatallowsgrainqitocomeout.First,needle
shallowly through the skin to allow yang pathogenic qi to exit. A second prick will
allowyinpathogenicqitoexit;dothisbyslightlydeepeningtheinsertionbutdonot
gointotheunderlyingfleshitself.Onceintothefleshthenthegrainqiwillcomeout.
Thus,NeedlingTechniques1says:Atthestart,needleshallowlytoforcethepathogenic
qi out and bring blood and qi; afterward needle deeply to reach yin pathogenic qi;
andfinallyneedlemostdeeplytoreachthe grainqilevel.Thisiswhatitrefersto. (The
SpiritualPivotChapter7ApplyingtheNeedles)
Interpretation
Thethreedepths of needling divide the depth of needle penetration into three
levels: just within the skin, to the flesh, and deep into the flesh.The first needling
depthisashallowinsertionpassingjustthroughtheskin.Thesecondneedlingdepth
reachesthefleshbeneathbutdoesnotpenetratedeeper;thisismiddlelevelneedling.
Thethirdneedlingdepthpenetratesintothespacesbetweenthetendonsandbones
already dividing the flesh; this is deep level needling.The purpose of dividing the
depthofpenetrationintothesethreelevelsistoeliminateexternalpathogenicqi(yang
pathogenicqiandyinpathogenicqi)andtopreservegrainqi(healthyqi,thisisalsothe
qiatthepointoftheneedle,thatistosay,thatwhichproducestheneedlingsensation).
When needling, one goes from shallow to deep and at the end the needling
sensation can arise from contact with the grain qi. Initially, the needle passes just
throughthelayersoftheskintodrainyangpathogenicqiinthedefensivelayer.Next,
the needle goes slightly deeper and passes through the skin into the flesh to drain
yin pathogenic qi from the nutritive layer. Finally, the needle penetrates deeply into
the flesh where it will bring about needling sensations such as soreness, tingling, or
1 ItisunclearifthisisareferencetoanotherpartoftheInnerClassicdifferentlywordedorareferencetoa
textthathasnowbecomelost.
distention, sensations that arise from connecting into the grain qi. Ancient medical
textsstatethatatthebeginning,needlingthroughtheskincaneliminatepathogenic
qiinthesuperficial level and ensure that the qi and blood flow smoothly. Following
this,penetrationintoasomewhatdeeperlevelcanfacilitatethedispersionofinternal
pathogenicqi.Thefinalanddeepestinsertionpenetratestothespecifiedlevelandacts
toaccessandguidegrainqi,therebygeneratingtheneedlingsensationsandachieving
the goal of supplementing deficiency or dispersing excess.The gradual deepening
ofthethreeneedlingsfromshallowtodeepbasicallyactstostimulateandopenout
channel qi and to generate the needling sensations, truly manifesting the principle
captured in the saying:The essentials of needling are that when the qi arrives the
treatmentwillbeefcacious.
Of course, the distribution of grain qi, nutritive qi and defensive qi to different
levelsofthebodyisrelative;thereisnostrictdemarcationbetweentheirrespective
levels.Thismeansthatonemightsenseqiatvaryingdepthsofneedling,perhapsat
theshallowlevel,perhapsatthemiddlelevel,perhapsatthedeeplevel.Intheclinic,
the relationship between the depth of needle insertion and the needling sensation
can be felt at the shallow level and at the deep level, and there are times when the
needlingsensationisnotnecessarilyfeltatthedeeplevel.Sometimesithappensthat
theneedleisinsertedtoarelativelydeeplevelwithnoconcurrentneedlingsensation
obtained.When the needle is lifted out to a shallower depth, however, the needling
sensationisobtained.Thisisreferredtointhesayingskillandmasteryarefoundatthe
tipoftheneedle.Theimportanceofneedlingtechniquecannotbeoveremphasized.
The Ming Dynasty physician Xu Feng further developed the idea of thethree
depths of needling by borrowing the philosophical idea ofthethree realms 1 (sn
ci,)fromtheBookofChanges(YJng,).Xudividedthedepthofneedling
intothethreelevelsofheaven,earthandhumankindandreferredtotheseasthethree
realms.InhistextOdeoftheGoldNeedle(JnZhnF,)hestates:Theinitial
needlingpenetratestheskin;thisisreferredtoastheheavenrealm.Waitjustabitand
thenpushtheneedledeepersothatitreachestheflesh;thisiscalledthehumanrealm.
Onceagainwaitamomentandthenpushtheneedleevendeepersothatitreaches
theareabetweenthesinewsandthebones;thisiscalledthe earthrealm.Inthisway,
theleveltojust below the skin isheaven, the level in the flesh ishumankind, and
the level deep in the sinews and bones isearth; this is a de facto penetration from
shallow, middle and deep levels of the points. Nowadays most refer to these as the
heavenlevel,thehumanlevelandtheearthlevel.
Inclinicalpractice,usuallyonedoesnotneedtostrictlyadheretotheselevels,but
canjustdividethedepthofpenetrationintorelativeapproximations.Forexample,if
1 Amoreliteraltranslationofthecharactersusedwouldbethreetalentsorthreepotentials.
apointis1.5cundeep,then0.5cun(thetopthird)wouldbethelevelofheaven,1.0
cundeep(themiddlethird)wouldbethehumanlevel,and1.5cun(thebottomthird)
wouldbethelevelofearth.Itisdifficult,though,todeterminethesedifferinglevels
forpointslocatedinareaswherethereislittleflesh.Insomecircumstances,onlytwo
levels are addressedvariously referred to as the shallow and the deep, the level of
heaven and the level of earth, or the defensive level and the nutritive leveland in
thiscasetheyarenotreferredtoasthethreerealmsorlevels.Whenthethreelevels
ofheaven,earthandhumankindarepairedwithhandmanipulations,likeliftingand
thrusting and/or twirling, and repetitions of nine and six, then acupuncture hand
manipulations progress to the level offire to burn the mountain andcoolness to
penetratetheheavens.1
Source Text 3

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Therearefiveneedlingtechniquesthatresonatewiththefivestoragehouses.The
first ishalf needling. Half needling is a shallow insertion with quick withdrawal
andnoinsertionintothemuscles.Likepluckinghairs,thistechniquedrawsontheqi
oftheskinandresonateswiththelung.Thesecondtechniqueiscalledleopardspot
needling.Leopardspotneedlingplacesneedlestotheleftandright,frontandback,
affectingthecenterofthevessel.Thistechniquedrawsonthebloodofthechannels
and collaterals and resonates with the heart.The third technique is calledneedling
thepasses.Needlingthepassesisatechniquebywhichneedlesareinserteddirectly
leftandrightabovethetendonstoaddresssinewb-obstruction.Careshouldbetaken
not to cause bleeding.This technique resonates with the liver. It has the alternate
names of chasm needling and comfort needling.The fourth technique is called
converging valley needling. In converging valley needling, a needle is directed
leftandrightfrom the same point, like a chickens foot; the needle should go to the
division of the muscles to address muscle b-obstruction.This technique resonates
with the spleen.The fifth technique is calledtransport needling. In transport
needlingtheneedleisinsertedstraightinandwithdrawnstraightout,inserteddeep
enoughtoreachthebonestoaddress boneb-obstruction.Thistechniqueresonates
1 Fire to burn the mountain andcoolness to penetrate the heavens refer to very specialized needling
techniquesthatproduceasensationofheatorcold,respectively,inthepatient.
withthekidney.(TheSpiritualPivotChapter7ApplyingtheNeedles)
Interpretation
The five needling techniques are also called the five zang-organ needling
techniques.These techniques are derived from acupuncture needling techniques
that respectively address the five tissues associated with the fivezang-organsthe
skin,thevessels,theflesh,thesinewsandthebones.Thetechniquesthemselvesare
respectivelycalledhalfneedling(bnc,),leopardspotneedling(bownc,
),needlingthepasses(gunc,),convergingvalleyneedling(hgc,)
andtransportneedling(shc,).
1. Halfneedlingdescribesinsertingtheneedleonlypartwayandthenwithdrawing
itthat is to say, a shallow insertion through the skin with no further insertion and
a quick withdrawal.This is described as like plucking a hair where the follicle lies
just within the skin and not in the muscle.Thelung governs the skin and body hair,
andthefunctionofthehalfneedlingtechniqueistodispersepathogenicqifromthe
superfciallevels.Thus,thetechniqueissaidtoresonatewiththelung.
2. Leopardspotneedlingdescribesinsertingneedlesintomultiplelocationsand
allowingbloodtoflowout.Appearance-wisethislookssomethinglikethespotsofa
leopard.Thistechniqueuseseitherapointoradiseaselocusasacenterandneedles
intothatcenterfromthefront,back,leftandrightusingmultipleneedlestostimulate
the area.The needles target the central vessels, and there should be slight bleeding
when they are pulled out.The heart governs the blood and vessels and because
leopardspotneedlingdrainsbloodfromthechannelsandcollaterals,thistechniqueis
saidtoresonatewiththeheart.
3. Needling the passes describes inserting needles in areas near where the
sinewsattachtothebones.Thesinewscongregateneartothejoints,andtheendsof
ligamentsandtendonsaremostlyatthejointssothistechniqueiscalledneedlingthe
passes.Thetechniqueitselfcallsforeitherdirectinsertionoffiliformneedlesintothe
areawherethetendonsattach,orinsertionofneedlesleftandrightintothetendons
and ligaments. Needling the area near the joints typically goes quite deep and,
clinicallyspeaking,theneedlethreadingtechniqueismostcommonlyused.Examples
include: ST 35 (d b) threaded to EX-LE 5 (x yn); SP 9 (yn lng qun) threaded to
GB34(ynglngqun);andBL60(knln)threadedtoKI3(tix).Thelivergoverns
thesinewsandneedlingthepassesgetsridofb-obstructionandfacilitatesthesinews,
andsothistechniqueissaidtoresonatewiththeliver.
4. Converging valley needling does not refer to the point usually translated into
Englishasunionvalley LI4(hg),thoughthesametwocharactersareused,rather
it refers to a meeting point in the muscles. From this central position, the area of
stimulation is shaped like a chickens foot.This involves inserting a needle straight
anddeeplyintoalocation,drawingitouttoashallowpositionandthenreinsertingit
atananglerespectivelyleftandrightdeepintothetissue.Thetracesleftbehindbythe
needle would form achicken foot shape. Nowadays, this technique has morphed
intowhatisreferredtoassingleneedle,multipleanglestimulation. 1Thistechnique
stimulates in three directions from a single point, bringing togetherpathogenic qi
from the divisions between the muscles and then helping to drain it.This is the
reason it is called converging valley needling or, sometimes, convergent needling.
Thetechniquecanbeappliedmultipletimesuntilthepainhasbeenalleviatedorthe
symptomshave made a change for the better; needles should be retained for 1530
minutes.Thespleengovernstheflesh,andthistechniqueusesinsertionsdeepinthe
muscle divisions to treat muscle b-obstruction and so it is said that this technique
resonateswiththespleen.
5. Transport needling fosters open communication between the interior and the
exterior.Thetechniqueplacesspecialimportanceonstraightinsertionandwithdrawal
oftheneedle,aninsertionthatreachesthebonetotreatdeepdiseasepatterns.When
applyingthetechnique,theneedleisinsertedstraightintoreachtheboneandthen
hand manipulations like twirling and lifting and thrusting are used at the locus of
disease. An alternate method is to directly stimulate the periosteum, increasing the
needling sensation by continuous stimulation with the needle, and then directly
withdrawingthe needle when finished.The kidney governs the bones and this deep
techniquestimulatesthebonestotreatboneb-obstruction,andsothistechniqueis
saidtoresonatewiththekidney.
Half needling, leopard spot needling, needling the passes, converging valley
needlingandtransportneedlingrespectivelytreatthefivetissuesassociatedwiththe
fvezang-organsskin,vessels,fesh,sinews,andbones.
Withrespecttothemanipulationrequirementsofhalfneedling,theneedleshould
be inserted shallowly and then quickly withdrawn with no damage to the muscles
below.The hand manipulations should therefore be light and skillful and not overly
aggressivenoroverlydeep.Thehalfneedlingtechniquecanbeusedinthetreatment
of diseases in the superficial levels of the body or to treat diseases associated with
the lung. Such diseases could include wind-cold binding the exterior,fever, cough,
and wheezing.The stimulation provided by this technique is mild and the hand
manipulationsarelight,soitisusefulintreatmentsituationswhereitisnotbeneficial
toneedletoodeeplyaswithchildrenandthosewhosediseaseconditionhasleftthem
extremelyqiandblooddefcient.
1 Translator:Ihavealsoseenthistechniquecalledveneratedturtleexplorescave.
Leopard spot needling emphasizes letting multiple drops of blood emerge

from a single area; after needling, the blood drops should come out like spots on a
leopardskin.Itisnotgoodtoneedletoodeeplywiththistechniqueasoneneedsto
avoid needling larger arteries and causing a major loss of blood. Nowadays, heavy
strikingwithaplumblossomneedleorprickingwithathree-edgedneedleareoften
usedinstead.Leopardspotneedlingismostlyusedtodisperse pathogenicqithatis
cloggingthechannelsandcollaterals,totreataccumulatedheatintheheartchannel,
andtoaddressallkindsoftoxicswellingsandnumbness.
Needling the passes is mostly used to treat sinew b-obstruction, a pattern that
includes diseases of the tendons, sheathes and ligaments.These types of diseases
manifest with symptoms of pain in the joints and inability to properly flex and
extend the limbs. Nowadays, the technique is also used to treat stroke sequela like
the spasms and shrinking of tendons caused by the paralysis and any damage done
tothemusclesnearthejoints.Inthesecases,betterresultsareobtainedwithathicker
needle.Needlingthepassesisatechniquethatusesdeepneedlingorthreadingpoints
aroundthejoints;therearemanyarteriesnearjoints,andtherearealsospecialtissues
like cartilage and joint capsules comprising the joints, so care must be taken when
needling as carelessness may lead to bleeding or to leakage of synovial fluids. Basic
QuestionsChapter52DiscourseonNeedlingProhibitions(SWn-JnCLn,
):Whenneedlingthejoints,iffluidcomesout,thentherewillbedifficultyflexing
andextending,andif,whenneedlingthekneecap,fluidcomesout,thepatientwill
limp. For this reason care must be taken to avoid damaging the blood vessels and
jointtissuesduringthecourseofneedling.
Converging valley needling is used mostly to treat muscular diseases like muscle
spasm b-obstruction pain, obstructions to movement, muscle spasms, muscle
hardness,rheumatoidmuscularpain,externaltraumatothemuscles,andmyasthenia
gravis. Converging valley needling works the needles in multiple directions and
shouldthereforebeperformedinareaswherethetissueisabundant;areaswherethe
feshisthinorwastedawayarenotgoodplacestoutilizethistechnique.
Transport needling is mostly used in the treatment of bone spurs, inflammation
of the cartilage as well as the treatment of the pain, numbness and wasting seen in
kidney deficiency bone steaming, softening of the bones, and various other bone
disease. Any type of stubborn joint inflammation, like rheumatoid arthritis, for
example, can benefit from this technique. It should be noted, however, that while
transportneedlingisaneffectivewayoftreating boneb-obstruction,itrequiresthat
thepatientcommittoalongperiodoftreatmentforittobeefective.
Source Text 4


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Thenineneedlingtechniquesresonatewiththeninechangesofdisease.Thefirst
iscalledsh-transportneedling.Thetechniqueofsh-transportneedlingusesaying-
spring point in combination with azang-organ back sh point for any channel.The
secondkindofneedlingiscalleddistantpathneedling.Thistypeofneedlinginvolves
working on points on the lower part of the body to treat diseases in the upper.This
is done by needling fu-organ back sh points.The third type of needling is called
channel needling.This involves needling the great channels where thelu knot and
thechannelsdiverge.Thefourthkindofneedlingiscalled lu-networkneedling.This
type of needling involves pricking small networks of blood vessels.The fifth kind of
needlingiscalleddivisionneedling.Thistypeofneedlingpenetratesintothedivisions
between the flesh.The sixth kind of needling is called great draining needling.This
type of needling uses a p-needle. 1The seventh type of needling is called body hair
needling.This type of needling involves needling superficial b-obstructions in the
skin.The eighth type of needling is called opposite needling.This type of needling
involvesneedlingontherighttotreatproblemsontheleftandneedlingontheleft
totreatproblemsontheright.Theninthkindofneedlingiscalledhotneedling.This
typeofneedlinginvolvestheuseofaheatedneedletoeliminateb-obstruction. (The
SpiritualPivotChapter7ApplyingtheNeedles)
Interpretation
The nine needling techniques, which includesh-transport needling (sh c,
2
), distantpathneedling(yundoc,),channelneedling(jngc,),lu-
networkneedling(luc,),divisionneedling(fnc,),greatdrainingneedling
(d xi c, ), body hair needling (mo c, ), opposite needling (j c, )
andhotneedling(cuc,),aredesignedtotowardtreatingninedifferentkindsof
pathodynamicchanges.
1. Sh-transport needling is a type of point formula method that pairs point
types such as yng-spring points with back sh points zang-organ; the technique
derives its name from this.When a zang- or fu-organ becomes diseased, choose a
yng-springorash-streampointincombinationwithabackshpointfortherelated
organ. For example, if the liver is diseased, one could choose theyng-spring point
1 Alongfatneedlethatlooksabitlikeasword.
2 NotethatthecharactersusedintheChinesenameforthistechniquearethesameasforthetechnique
calledtransport needling in the previous quote. It has a slightly different meaning here and so has been
translatedassh-transportneedling.
LV2(xngjin)orthesh-streampointLV3(tichng)incombinationwithbacksh
pointfortheliverBL18(gnsh).Withthistypeofspecialpointformula,thezang-fu
organ channels and collaterals willmutually resonate above and below, within and
without.This technique is quite effective in treating pathological accumulations in
thezang-andfu-organs.
2. Distantpathneedling,referstochoosingpointsandneedlingfarfromthelocus
ofdisease.Inthisway,ifthediseaseisabove,choosepointsfrombelowtodrawaway
theproblem and exhaustits energies.Thetechniquerequires the useofpointsfrom
far away and so is called distant path needling.This technique is very effective for
treatingthefu-organsbecauseitusesthelowerhe-seapoints,whicharedistributedon
thelowerlimbsofthebodydistantfromtheirrespectivefu-organs.
3. Channel needling refers to needling places on the regular channels that have
becomeknotted up.When the channels become diseased, there can be symptoms
of blood stasis, tenderness on pressure, hardened masses or other signs of localized
accumulation. Finding and needling them can help to open up and regulate the
channelqi.Becauseitrequiresstraightneedlingofthegreaterchannels,thetechnique
is referred to as channel needling. Knots in the channels can include such things as
hardened tissue on the channels, areas of tenderness and distended blood vessels.
Such things can be seen in acute lumbar sprain and particularly distended veins
on the taiyang bladder channel in the popliteal fossa. Needling such areas provides
immediaterelieffromtheproblem.
4. Lu-networkneedlingisashallowtypeofneedlingwheretheneedleisinserted
intothesmallnetworkofbloodvesselsonthesurfaceoftheskintoletblood.Because
itfocusesonthesmallnetworkofbloodvesselsnearthesurfaceoftheskinitiscalled
lu-networkneedling.Forthemostpart,thistypeofneedlingusesathickfiliformor
three-edged needle to let blood, though a round sharp needle or hard striking with
aplumblossomneedlecanalsobeused.Theneedlingtechniquecanbedividedinto
pointneedling,scatteredneedling,andbunchedneedling.Inmodernclinic,alltypes
ofshallowbloodlettingfallwithinthiscategory.
5. Division needling is a type of needling that penetrates into the divisions
between the muscles and/or between the bones and the muscles. Most of the time,
however,itreferstoneedlingalongthebonewherethemusclesjoin.Thistechnique
treatsmuscleproblemsthatrequiredeepinsertionintothedivisionsofthemusclesto
effectacure,sothetechniqueiscalleddivisionneedling.Theactualmethodrequires
insertingtheneedledeepintothelayersofmuscleandmovingtheneedlebetween
the layers, twirling, twisting, lifting and thrusting, to obtain qi. According to the
depthandnatureoftheproblem,theinsertiondirectionanddepthareadjusted.This
isnotjustasimpleinsertion.Astronghandmanipulationshouldbeusedtoincrease
theneedlingsensationandensurethatthestimulusspreadsoutthroughthedeeper
layers.
6. Greatdrainingneedlingusesaknifeshapedneedletocutandpromotethefree
flow of fluids. It is often used to treat carbuncles and release pus, allowing pus and
bloodtoflowaway,hencegiventhenamegreatdrainingneedling.Historically,ap-
needle()aneedlewithaflat,oblongendlikeaspatulawasusedtofacilitate
thereleaseofbloodandpus.Theearlypractitionershadasaying:Profusepusisnot
tobefeared,simplyworktodrainitoutcompletely.
7. Bodyhairneedlinginvolvesashallowinsertionintothemostsuperficiallayers
of the skin such that it doesnt penetrate into the underlying flesh at all. In Chinese,
this is referred to as thebody-hair skin level, and so the technique is classically
called body hair needling. Nowadays it is referred to as skin stimulation technique.
Inthistechnique,insertionisonlyjustintotheskinandmostlypenetratesnodeeper
than the deepest layer of the skin itself. Historically, body hair needling was done
withachn-needle()aneedlewithaflat,diamond-shapedend;nowadaysa0.5
or1.0cunneedleissubstituted.Inthistechnique,alightshallowandspeedyinsertion
ismadeintotherelevantarea,onethatneitherpenetratesallthewaythroughtheskin
nor does it cause any bleeding. Alternately, 57 thin, short, filiform needles can be
tiedtogetherwiththetipsallatanevenlevelandthenusedtoquicklystriketheskin
surface.
8. Opposite needling requires that when the problem is on the left, needling is
doneontheright,andviceversa.Whenusingthistechnique,considertheprinciples
underlying the connections between the left and right sides of the channels and
collaterals. Mostly contralateral points that mirror the location of the disease pain
shouldbeneedled.Forcertainkindsofdiseasesthistechniqueisquiteeffectivepain
syndromes or numbness issues are good examples. (With these problems, if simply
needling the affected side is ineffective, then needle the corresponding area on the
healthyside.Thishasproventobeclinicallyeffective.)Inaddition,ifapatientsuffers
fromhemiplegiaafterastrokeandthe pathogenicqiisinthechannelsandcollaterals,
it is common practice to disperse the affected side and to supplement the healthy
side.Whenperformingthiskindofoperation,needlingtheaffectedsideisconsidered
primary needling, and needling the healthy side is adjunct needling.Treating in this
wayismoreefectivethansimplytreatingtheafectedsidealone.
9. Hotneedlinginvolvestakinganeedleandheatingituntilitisredhotandthen
with great speed inserting it into the flesh and immediately removing it.The point
of insertion and the area around it should be carefully sterilized.Then, the left hand
fixesthepointinplacewhiletherighttakestheneedleandthathasbeenheatedto
red hot over an alcohol lamp and quickly inserts and immediately removes it.The
depth of insertion depends on the problem addressed. Problems such as carbuncles
andscrofularequirearelativelydeepinsertionandinonequickmovementtheneedle
mustreachthedesireddepth.Winddampnessb-obstructionpainandstubborntinea,
ontheotherhand,requireshallowinsertionsuchthatagentletouchtothesurfaceof
theskinisallthatisrequired.
Sh-transportneedlingputstogetheranumberofspecificpointsinasetformula
and is used extensively in modern acupuncture. It is not limited to the treatment
of zang-fu organ diseases, but can also be used to treat a number of whole body
disorders.Aproblemashypertension,forexample,canbetreatedusingthepointsLV2
(xngjin),LV3(tichng)andBL18(gnsh)withquitesatisfactoryresults.
Distantpathneedlingaddressesthetreatmentofdiseasebyselectingpointsfrom
thelowerhalfofthebodytotreatproblemsintheupperhalf,pointsfromtheupper
to treat the lower, from the sides to treat the middle, from the outside to treat the
inside, starting from here to treat there; it does this via the special resonance of the
wholebody.Thetechniqueiswidelyusedtotreatdiseasesofthefivezang-organs,the
six fu-organs as well as all types of problems in the head, face and trunk. Physicians
whocameafterthe InnerClassicwereabletotaketheideaofdistantpathneedling
andexpanduponitbyusingpointsontheupperpartofthebodytotreatproblemsin
thelowerpartaswellassystematicallyincludingpointsbelowtheelbowsandwrists
in their treatment of internal organ issues.The benefit of this is that point selection
issimpleand quick, safe and effective; it is the most used technique in acupuncture
today.
In channel needling, needles are inserted into the muscles or fascia along the
channels to treat problems of pain or impeding movement. Needling the affected
areas brings obvious relief. Another manner of channel needling is to select
recognized points on the affected channel(s).This variation is used mostly to treat
pathodynamicchangesinthechannelsthemselves,whichareoftenproblemsarising
fromaccumulationsandblockagesbetweenthechannels,andincludesuchthingsas
pain,b-obstruction,tightness,bloodstasisanditchiness.
Lu-network needling acts to clear heat and drain fire, activate the blood and
transform stasis, open orifices and blockages, and eliminate swellings and disperse
accumulations.Mostly,thistechniqueisusedforexcessconditions,heatpatternsand
bloodstasispathologies.Withregardtodeficiencyconditionsandcoldpatterns,itcan
beusedwithcare,butitisprobablybesttoavoidit.Theneedlingtechniquemustbe
light and skillful, shallow and quick and care must be taken to avoid insertion into
largearteriesinthedeeperpartsofthebodysoasnottocauseamajorlossofblood.
Division needling is used mostly in the thick fleshy areas of the trunk and limbs.
Clinically,itisusedtotreatsuchmuscleissuesasb-obstructionandwastingpatterns,
which involve symptoms like the wasting away of muscle tissue, spasms, muscle
tremors,shaking,infammationofthemusculartissuesandfascia,andexternaltrauma.
Care should be taken with great draining needling to avoid large blood vessels
preventinglarge-scalebloodloss.Nowadays,thetechniqueisrarelyusedasexternal
surgeryhastakenitsplace.
Bodyhairneedlingcanbeusedtotreatamultitudeofchronicanddermatological
diseases.The stimulation provided by the technique is light and it is especially
suitable for use with children and the aged. Clinically, it is now mostly used for
dermatologicalproblems.Theneedlingtechniqueisdescribedpoeticallyasbeinglike
a bird pecking at fooddescribing the repeated light taps that are used. Repeated
needlingofthechosenareaisdoneuntilanerythmeticlikeresponsepresentsandone
shouldstopbeforeactualbleedingoccurs.Themodernrollingtubeneedleandthose
likeitweredevelopedbasedontheunderlyingprincipleofthistypeofneedling.
Opposite needling is mostly used to treat channel diseases. It is commonly
used for channel obstruction and obstruction in the flow of qi and blood that result
in pain in the limbs or problems with movement. Symptoms of such obstructions
includehemiplegia,numbnessofthefourlimbs,deviatedmouthandeye,migraines,
inflammation of the shoulder capsule, sciatica, and intercostal neuralgia. Clinically,
thereisanemphasisonusingmovementwithoppositionneedling,whichcombines
needlingcontralaterally to the affected area with active or passive movement of the
affected area. Its effect on treating various kinds of pain conditions as well as soft
tissueinjuryisexcellent.Itsuseforthispurposeiscountedasafurtherdevelopment
ofthisancienttechnique.
Thetermtranslatedhereashotneedlingisacombinationofthecharactersforto
temperandtoneedle,butinsometextsitisalsowrittenwiththecharactersforto
burnandtoneedle.TheGoldNeedlePlumBlossomPoemTranscription(JnZhnMi
HuShCho,) says:The burning needle [technique] requiresheating
theneedletillitisfieryhot[andtheninsertingit];itsabilitytoeliminateb-obstruction
and get rid of cold is extraordinary. Nowadays, this technique is referred to as fire
needle. Initially, the technique was used to treat cold-damp invasion and joint b-
obstruction,whicharetheunderlyingpatternsinsinewand boneb-obstructionpain,
bursitisoftheshoulder,andlumbarandlegpain.Nowadays,thetreatmentscopeof
fire needle is muchbroaderand itis themethod of choice in treating ofcarbuncles,
skinulcers,scrofula,andallkindsofdermatologicaldiseasebecauseithasprovento
beparticularlyefectivefortheseconditions.
Source Text 5

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Therearetwelvedivisionsofneedlingthatresonatewiththetwelvechannels.
The first is calledmatched pair needling. Matched pair needling asks that one
directthehandtotheheartaswellastothebacktofindpointsoftenderness.Directly
wherethepainis,useoneneedleinthefrontofthebodyandoneneedleintheback.
Thetechniqueisusedtotreat heartb-obstruction.Whenperformingthistechnique,
slantedinsertioniscalledfor.
The second type is calledrequited needling. Requited needling is for needling
pain of no fixed location. Follow the pain up and down and insert the needle
perpendicularly.Whileretainingtheneedleusethelefthandtofollowandpressthe
nextlocusofaffliction.Whenitisfound,withdrawtheneedleandreinsertinthenew
location.
The third type is calledexpansion needling. Expansion needling involves a
perpendicular insertion of the needle next to the disease locus and then moving it
backandforthinthesamepointtomagnifytheeffectonthedistressedsinews.This
techniqueisusedtotreatsinewb-obstruction.
The fourth is calledconcerted needling. Concerted needling involves insertion
directlyintoonepointandthenfurtherinsertionoftwomoreneedlesdirectlybeside
the first to treat cold qi that is localized but slightly deep. It is also called triple
needlingandusedtotreatb-obstructionqithatislocalizedbutslightlydeep.
The fifth is calledupraising needling. Upraising needling involves inserting a
needleinaprimarylocationandthenfourmoreneedlesareinsertedaroundittoraise
uppathogeniccold;itisusedtotreatcoldqioverawidearea.
The sixth type is calledstraight into needling. Straight into needling involves
pullingupontheskinandneedlingintoit;itisusedtotreatcoldqithatisshallow.
The seventh type is calledopen and transfer needling. Open and transfer
needling involves direct insertion and direct withdrawal.This disperses and enables
pathogenicqitoescapefromthedeeplevels;itisusedtotreatexuberanthotqi.
Theeighthtypeiscalledclosequarterneedling.Closequarterneedlingforbone
b-obstruction involves a slight rocking as the needle is inserted deeply to the bone
levelasthoughrubbingthebone.
The ninth is calledfloat needling. Float needling involves a slanted insertion
intotheshallowlayersofthebodytotreatmusclespasmandcold.
The tenth is calledyin needling. 1Yin needling involves needling on both the
leftandtherightsidesofthebodytotreatcoldsyncope;ifthereiscoldsyncopeinthe
center,addressshaoyinkidneychannelbehindthemalleolus.
The eleventh is calledadjunct needling. Adjunct needling involves inserting
a primary needle and then another beside it to treat localized long-standing b-
obstruction.
The twelfth isassistant needling. Assistant needling involves direct insertion
and direct withdrawal with multiple shallow insertions to let blood and treat
carbunclesandswelling.(TheSpiritualPivotChapter7ApplyingtheNeedles)
Interpretation
The twelve divisions of needling include matched pair needling (u c, ),
requitedneedling(boc,),expansionneedling(huc,),concertedneedling
(qc,),upraisingneedling(yngc,),straightintoneedling(zhzhnc,
),openandtransferneedling(shc,),closequarterneedling(dunc,),
floatneedling(fc,),yinneedling(ync,),adjunctneedling(bngzhnc,
)andassistantneedling(znc,).Theydescribeneedlingpatternsdivided
intotwelvedifferent techniques.These techniques address the depth of disease and
discomfortbycombiningneedlinginsertiontechniqueswithmanipulations.Theydo
not mechanically pair a particular technique with a particular channel; nevertheless,
becausetherearetwelvedivisionessentials,theyresonatewithdiseasesymptomsof
thetwelvechannelsandsoarecalledthetwelvedivisionsofneedling.
1. Matched pair needling is a yin-yang pairing technique whose special nature
involves needling on both the front and the back, with the two positions matched.
Thistechniqueisalsocalledyin-yangneedling.Inancienttimesitwasusedtotreat
heartpaindisorders.Todothistechnique,firstusethehandsonthechestandbackto
findtenderspotsandtheninthetenderorpainfulspotsthatseemmostrelatedtothe
probleminsertaneedlebothfrontandback.
2. Requited needling emphasizes creating a resonance between the needle
sensationandthe wandering pain.Without that, the pain will not cease.This can be
repeatedseveraltimesuntiltheresonanceiscreated.Inthisway,thetechniquealso
carriesthemeaningofrepeated.
3. Expansion needling treats muscle spasm and pain. In this technique, a needle
is inserted from multiple directions into the muscle or tendon using twirling, lifting,
and thrusting manipulations in combination with active movement of the affected
body part.This technique is also called multiple direction needling.The key is to
1 Yinofyinandyang.
find the exact location of the lesion in the muscles or tendons, which is usually the
most painful spot. If it is difficult to find, one can make the patient adopt a position
thatfacilitateslocatingit.Onceithasbeenlocated,aneedlecanbeinsertedstraight
orobliquelyintoit.Witheachthrust,however,theangleofinsertionchangestogive
multidirectional stimulation to the locus of pain or the tendons and muscles around
it.The needleshouldthenberetracted to just under the surface of the skin and the
patient asked to move his/her affected body part until the position with greatest
remainingpainisfound.Inthisposition,relocatethelocusofpain.Onceithasbeen
found, repeat the needling the technique above and the overall process until the
muscleshavereleasedandthepainhasdiminished.
4. Concerted needling is effective in treating deep pain in a small area. In this
technique,threeneedlesareinserteddirectlyintothelocusofdiseaseconcentrating
the stimulus in one small area. It requires finding tender spots for use as the main
stimulus location followed by the insertion of three filiform needles into it.The first
needleisinsertedstraightintothecenteranditismanipulateduntilthearrivalofqi
needlingsensationisobtainedandthenleftatthatdepth.Then,twomoreneedlesare
obliquelyinsertedeitheraboveandbelow,orleftandrightabout1.5 cunaway.These
twoneedlesaremanipulatedinturntoincreasetheneedlesensationandenableitto
deepenandspreadoutinthesurroundingarea.
5. Upraising needling involves shallow insertions in multiple locations using a
totaloffiveneedles.Itsalternatenameisyangneedling.1Inancienttimes,itwasalso
calledfiveneedling,andmoderndaypractitionerssometimesrefertothetechnique
asthefivetigercapturetechnique(whqnf,).Theareaofstimulationin
this technique is rather extensive which makes it useful in treating disease patterns
that have a large surface area like diffuse, superficial cold qi pain patterns. Prepare
five1to1.5cunfiliformneedles.Next,locatethecenteroftheareatobetreatedand
insert a needle shallowly directly into it. Manipulate the needle until the arrival of
qisensationisobtainedandleavetheneedleatitscurrentlysuperficialdepth.Then,
shallowlyinsertthefourotherneedlesaroundthefirsteitheranglingthemtowardthe
firstneedleinthecenterorthreadingthemsubcutaneouslytowardthecenter.Lastly,
twirltheneedlesoneatatimetospreadtheneedlesensationstillfurther.
6. Straight into needling, that is to sayneedle directly or straight towards the
locusofadisease,isatechniqueinwhichaneedleisinsertedtotraverseunderthe
surface of the skin.When performing this type of needling, gently pinch the skin
betweenthefingerssothatitispulledupandtheninserttheneedleintotheskinthat
is held up in this way so that it follows under the surface of the skin. It is inserted
directlyintothelocusofdiseaseandnotintothetissuesbelow.
1 Yangofyinandyang.
7. Openandtransferneedlingisastraightinsertion,straightremovaltechnique
thatfunctionstoopenanddredgechannelsandcollaterals.Itisusedtodisperseheat
and drain pathogenic qi.The technique is performed by inserting a needle directly
to relatively deep level. Once the qi arrives, the needle is immediately and directly
removedwithnoretention.Thespecialnatureofthistechniqueistousefewneedles,
makearelativelydeepinsertionandthenwithgreatspeedremovetheneedle.Inthis
wayonecandrawyangfrom/throughyinandtransferoutpathogenicheat.
8. Close quarter needling invokes the idea ofhand to hand combat or dealing
with the enemy at close range.The technique involves a slow insertion deep into
thebodyallthewhileshakingorrockingtheneedleasitgoesinuntilitreachesthe
periosteum.Withtheneedleattheperiosteum,gentlyliftandthrustitasthoughone
were rubbing orscrappingthebone.Thisstimulates the periosteum and produces a
feelingofheat.
9. Float needling is a superficial, transverse needling technique that in modern
timesiscalledoblique needling. In this technique, a filiform needle is inserted at an
acuteanglesothatittraversesjustundertheskinintheshallowlayersofthefascia;
the needle body may penetrate superficial muscles horizontally; twirling is used to
obtain the arrival of qi; and, once the needling sensation is obtained, the needle is
retained. During retention, the needle can be manipulated 23 times until the pain
easesand/orthesymptomsimprove.
10.Classically, yin needling was used mostly to needle points on yin channels
to address exuberant yin-cold reversal patterns.The technique requires needling
the same point bilaterally on a given yin channel to intensify needle sensation and
heighten the curative effect. For example, if the lower limbs are achy and cold with
little strength (cold reversal pattern), then one can simultaneously needle both KI 3
(tix)pointsonthefootshaoyinchannel;ifthestomachfu-organiscoldandthereis
pain because of it, one can simultaneously needle bothPC 6 (ni gun) points.This
wayofsimultaneouslyneedlingpointsontheleftandrightyinchannelsincreasesthe
warming,coldelimination,channelopeningandpainreliefpowerofthetreatment.
11. Adjunct needling involves perpendicular insertion of one needle followed
bytheobliqueinsertionofasecondneedleadjacenttoit.Thetwoneedlestogether,
oneprimarythe other secondary, are united in their action and so are referred to as
havinganadjuncteffect.Generally,anobvioustenderpointandapointproximaltoit
areused.Thefirstneedleisinserteddirectlyintothetenderspot,twirledtoobtainthe
arrivalofqiandthenleftatthesamelevelofdepth.Thesecondneedleistheninserted
obliquelyinapointfrom0.5to1cunawaywiththetipoftheneedleangledtoward
the center of the tender spot where the first needle is located; the second needle is
thentwirledtoobtainneedlesensationandleftatthesamelevelofdepth.Following
this,lightlyandgentlyuseonesfingerstotwistandshaketheneedlehandle,oruse
thesparrowpeckingmanipulation.However,careshouldbetakenthatthetipofthe
needledoesnotmovefromtheplacewherethearrivalofqiwasobtainedtoensure
thatthemanipulationwillpromoteanoutwardexpansionoftheneedlingsensation.
12. Assistant needling is a bloodletting technique.The technique calls for direct
insertion into and removal from a carbuncle swelling, a process repeated several
times.Theinsertionisshallowandintendedtoenablethereleaseofbloodtoeliminate
anddisperseheattoxins.Nowadaysintheclinic,becausemostcliniciansuseathree-
edgedneedleontheafflictedareaandmakemultipleshallowinsertions,itisreferred
toasadispersingneedlingtechnique.
The twelve divisions of needling do not mechanically pair a needling technique
with a particular channel; rather, they take the needling as primary and divide the
variousmethodsintotwelvedivisionsbasedonthedepthofthediseaseandhowthe
needlesarepairedandmanipulated.
Matchedpairneedlingcanbeusednotonlytotreatproblemswiththeheartand
chest,butcanalsobeusedtotreatproblemsintheabdominalcavity.Itisacommon
technique used in treating a variety of internal diseases. Later developments of this
division of treatment are the front and back pairing method and back-sh and front
m-alarmpoint pairing method.Thesetechniques are important in the treatment of
heart/chest, and abdominalzang-fu organ problems; clinically speaking, they enjoy
extensive use. For example, if there is a lung pathology involving cough, the lung
frontm-alarmpointLU1(zhngf)andback-shpointBL13(fish)canbeused.If
oneistreatingheartpain,theheartfrontm-alarmpointRN14(jqu)andback-sh
pointBL15(xnsh)canbeused.Ifoneistreatingvomiting(astomachproblem),the
stomachfrontm-alarmpointRN12(zhngwn)andback-shpointBL21(wish)
canbeused.
Allofthesepointpairingshaveonefrontandonebackpointthatarematchedand
pairedforneedling.Pairingsneednotalwaysbeback-shpairedwithfront m-alarm
points.They can include finding a tender spot in one location and needling both it
andareciprocalspotonthebackorfront,or(needling)areciprocalpointforeithera
frontorbackpointonachannel.Inthisway,frontandbackyinandyangchannelsare
needled in one treatment, facilitating the regulation of yin and yang and providing
aneffectivetreatmentforproblemswheretheqiandthebloodarenolongerworking
together properly.When performing this technique the needles should be inserted
obliquely as many of these pairings are performed on the chest or abdomen; the
deeper levels of these cavities are where some of the most important organs of the
humanbodyresideandcareshouldbetakennottoneedleintothem.
Requited needling is a technique used to treat wandering pain. Generally
speaking, ashi points are used in accordance with the ancient sayinguse pain as
your acupoint.When applying this technique, first find an obvious pathologically
tender spot and needle directly into it; after the needling sensation indicating the
arrivalofqihasbeenobtained,retaintheneedletofixthepaintothislocation.Then,
usingyourlefthandtofeelaboveandbelowthepoint,lookforanothertenderspot.
Once you have located one, remove the first needle from the initial point and insert
a needle into the newly found tender point.This process will need to be repeated
several times, each time finding and needling intoashi points.This technique has a
markedabilitytoopenchannelsandmoveqitostoppain.Itcanbeusedonanumber
of conditions where there are obvious tender spots due to a non-localized moving
b-obstruction pattern, including: shoulder bursitis, arthritis, stomachache, and
toothache.When using this technique to treat a b-obstruction pattern, care should
be taken to discern the direction the pain travels.This will determine the order of
needling. If the pain starts in a superior location and moves inferiorly, first needle
inferiorly and then superiorly; if the pain starts in an inferior location and moves
superiorly,thenfirstneedlesuperiorlyandtheninferiorly.Iftherearemultipletender
spots, start with the tenderest. In addition to needling tender spots, other types of
markers indicating pathology can be used, including things like nodules and ropy
feeling tissue.These can be needled multiple times. Clinically, it can be used in the
treatment of inflammation of the lymph nodes, painful nodules, nerve fibromas and
dermatological diseases. Requited needling can also be used to help extract a stuck
needle.Forthis,findatenderpointbelowthestuckneedleandinsertasecondneedle
thereoruseyourlefthandtorubandpressaboveandbelowthepoint.
Expansion needling is used to dredge out and open the flow of channel qi, and
torelaxspasmsandtensioninthesinews.Itisausefultechniqueinthetreatmentof
sinew b-obstruction (characterized by muscular and tendon spasms, limited range
of motion, and pain) as well as in the treatment of pain conditions such as those
caused by the inflammation of tissues surrounding the joints, back and lumbar pain
and ganglion cysts.When using this technique, the best results are obtained when
theneedlingiscombinedwiththepatientmovinghis/herbodypart:themovement
shouldbedoneonlyaftertheneedlehasbeenretractedtoashallowdepthtoavoid
bendingorbreakingtheneedle.
Concertedneedlingdredgesandopenstheflowofchannelqi,activatestheblood
and transforms stasis, moves qi and stops pain. It is mostly used in the treatment of
longstanding cold-dampness, localized fixed pain, and intransigent b-obstruction
pain.Tennis elbow is a good example of this kind of problem and it responds well
to this method. Damage to the piriformis muscle and/or gluteal muscle fascia, and
tendon sheath inflammation all respond well to this method. In addition, stubborn
internal gynecological ailments and diseases of the sense organs (like facial spasms,
sensorineuraldeafness,strokeinducedaphasia,dysmenorrheaandprolapseduterus)
canallbehelpedwithconcertedneedling.Themoderndaytechniquesofusingthree
needles directly into a point or three needles obliquely slanted into a point are also
calledconcertedneedling.Thistechniqueisbestusedonthelumbarareaorthelimbs,
anditisbesttoavoidusingitontheface;whenusingitonthechest,careshouldbe
takentomaketheinsertionsshallow.
Upraising needling is a method of needling used to treat localized pain caused
by cold pathogenic qi; its scope of use is quite broad as cold pathogenic qi can, for
example,lodgeintheexteriorsurfaceofthebodyresultingin b-obstructionpainor
numbness.Todaythistechniqueisalsousedtotreatdiseasessuchasneurodermatitis,
tenosynovitis, thecal cysts, and lateral femoral cutaneous neuritis.When applying
this technique it is best not to needle too deeply, stopping at the point where one
obtainsqi.Thefourneedlesaroundtheedgescanbeinsertedobliquelyorsothatthey
traversesubcutaneously;thiscanbedeterminedbasedonthesizeoftheareaaffected
and nature of the problem.This technique uses a relatively large number of needles
and so attention should be given to adequately disinfecting the skin.The tapping
techniques used with modern day plum-blossom and seven star needles are in fact
anextensionoftheupraisingneedlingtechnique:thesetechniquestakefiveorseven
needlesandtiethemtogethersotheymakeasinglebodywhichisthentappedonthe
skin,makingshallowpenetrationswhichactstoscatterthepathogenicqi.
Straight into needling technique is mostly used on superficial disease patterns
like cold invasion headaches, achy painful muscles, facial nerve paralysis, and
dermatological disorders. If back points on the foot taiyang bladder channel are
transversely needled, they can also be used to treat disorders of the internal organs.
Nowadays, this technique is referred to asfollowing the skin needling,horizontal
needling ortransverse needling threading the point(s). As this technique uses a
single needle inserted to follow under the skin, it is possible to thread two or more
pointstogether.Themoderndayschoolsofwristacupuncture,eyeacupunctureand
subdermal implant acupuncture all utilize transverse insertion just under the skin
layeranddonotrequireanynoticeablelocalizedneedlingsensation;theyareinfact
furtherdevelopmentsofthisoldertechnique.
Open and transfer needling is a technique that uses few needles, though the
onesusedareinsertedquitedeeply.Itisoftenusedtotreatexcessheatpatternslike
externally contracted hot diseases or pathogenic qi making a direct strike on the
channels and collaterals. Another way of understanding and using this technique is
thatafteraneedlehasbeeninsertedstraightintothepoint,waitforqitoarriveand
then slowly remove the needle, slowly drawing out the deep yang from the yin; this
reflects a certain similarity with the dispersing/reducing hand manipulation seen in
lifting,thrusting,supplementinganddispersing.
The technique called close quarter needling requires that one inserts the needle
while at the same time shaking or rocking it to increase the overall area of needling
sensation.The technique is typically used in the treatment of problems where the
disease locus is rather deep; bone b-obstruction (osteoarticular swelling and pain,
inability to move a joint and/or localized aversion to cold), softening of the bones,
andbonesteaming,forexample.Currently,thetechniqueisusedinthetreatmentof
periostitisandenthesitisandhasamarkedeffectonmusclestrain.Toachievethebest
results, needles with a diameter greater than 0.4 mm are necessary and they should
havegoodtensilestrengthandfexibility.
Float needling mostly focuses on shallow insertion into the superficial layers of
themusclesandisusedtotreatpathologicalchangesinthistissueincludingpainful
musclespasmsbroughtonbycoldpathogenicqicongealedinthemuscles.Clinically,
thismethodworkswellinthetreatmentofinflammationofthefascia,especiallywhen
thereispathologicalhardeningofthefascia.Whentreatingtheseconditions,athick
needleisusedtoflicktheskinmultipletimes,atechniquethatisoftenmoreeffective
thanothermodalitiesofneedling.Moderntimeshaveseenthefurtherdevelopment
oftheoriginaltechniqueinsubcutaneousneedlingandpress-tackneedling.
Yinneedlingisperformedbyneedlingthesamepointsontheleftandrightside
of the body.This technique is commonly used in modern times, especially in the
treatmentofallkindsofzang-fuorgandiseasepatterns.Mostofthetime,pointsfrom
belowtheelboworkneeareselected(thefivesh-transportpoints,forexample)and
itisnolongerrestrictedtojustpointsontheyinchannels.
Adjunct needling is useful in conditions where the pain is marked, localized and
fixed.This would include such problems as rheumatic myositis, soft tissue damage,
lumbarhyperosteogeny,heelpain,andnervousheadache.Itiscommonnowadaysto
usebothadeepandashallowinsertiontogetherwhichisafurtherdevelopmentofthe
originaltechnique.Additionally,thetechniquesofsurroundneedling,matchedneedle
needling,crossneedling and same point multiple needles needling1 are all evidence
thatthistechniqueiswidelyusedandisindeedworthyoffurthertransmission.
Assistantneedlingisusedinthetreatmentofcarbuncleswellings,anditsmultiple
shallow insertions enable the draining of the carbuncle with the expression of the
pus and dead blood.The needles are inserted to just below the skin. Regardless of
whetherornotthecarbunclehascometoaheadwithpus,thistechniquecanbeused.
Ithasadefniteefectonreducingtheinfammationandpain.
Source Text 6
()
1 Furtherdevelopmentsoftheoriginaltechnique.
Slow insertion, slow withdrawal: this is called guiding the qi. (The Spiritual Pivot
Chapter34FiveTurmoils)
Interpretation
Guiding the qi hand manipulation isslow insertion and slow withdrawal; no
matterwhetherinsertingtheneedleorretractingit,bothactionsareslowandeven.
Inthistechnique, once the arrival of qi needling sensation has been obtained, even,
slow, and balanced manipulations are used repeatedly, in a gentle way thrusting in
and out while simultaneously twirling the needle.The strength, degree and speed
of the upward lifting and the downward thrusting, the left twirling and the right,
shouldbethesametogenerateanevencomfortablefeelinginthepatient.Depending
uponthesituation,needlesmayberetained,usuallyfor1020minutes.Itisaneven
supplementationevendispersiontechnique.
The technique of guiding the qi generates an even and balanced needling
resonation referred to aseven supplementation, even dispersal.This technique can
beusedtoinduceandguidepathogenicqioutofthebody,andtodrawoutandguide
the restoration of healthy qi. For the most part, this technique acts to stimulate the
naturalabilitiesofthebodytoregulateitselfwiththeultimategoalofprotectingthe
essence-qiandrestoringbalancetothedisorderedqiandbloodinthebody.Forthis
reason,itisnotappropriatetouseitwhen pathogenicqipresentsinanexcesspattern,
nor where there is a deficiency pattern and general debility of healthy qi. It is most
appropriateforuseinrestoringorderandbalancetodisorderscausedbyatemporary
disorderingofqiandbloodwhereinchannelqiisblocked,withtheresultthatqiand
blood stagnate in the channels and collaterals and are unable to reach the organs.
Such disorders would include all kinds of sprains and strains, pain, uncomfortable
stiffeningandlossofmovement.Thistechniqueisespeciallysuitableforpatientswith
lumbar pain and stiffening. In these cases, choose local points and use a qi guiding
hand manipulation; it is common after the removal of the needles that the patient
hasasuddenfeelingofrelaxation.Inadditiontothis,theguidingqitechniqueisalso
usefulfortreatingthosewhoareparticularlysensitivetoneedlingsensationandare
unabletotoleratestrongstimulationfromtheneedles.
VolumeTwo
Selected Readings from Treatise on
ColdDamage
(ShngHnLn,)
GuZhTng(CinnamonTwigDecoction)Pattern..........................................................................................199
GuZhJiGGnTng(CinnamonTwigDecoctionplusPueraria)Pattern..........................202
GuZhJiHuPXngZTng(CinnamonTwigDecoctionplusOfcinalMagnoliaBarkand
ApricotKernel)Pattern.................................................................................................................204
GuZhJiFZTng(CinnamonTwigDecoctionplusAconite)Pattern................................206
GuZhXnJiTng(NewlySupplementedCinnamonTwigDecoction)Pattern........................208
MHungTng(EphedraDecoction)Pattern..................................................................................................210
GGnTng(PuerariaDecoction)Pattern........................................................................................................212
DQngLngTng(MajorGreenDragonDecoction)Pattern..................................................................... 214
XioQngLngTng(MinorGreenDragonDecoction)Pattern..........................................................216
WLngSn(PoriaFivePowder)Pattern...........................................................................................................220
ToHChngQTng(PeachKernelQi-CoordinatingDecoction)Pattern.................................222
DDngTng(ResistanceDecoction)Pattern..................................................................................................225
ZhZChTng(GardeniaandFermentedSoybeanDecoction)Pattern...........................................227
MXngShGnTng(Ephedra,ApricotKernel,GypsumandLicoriceDecoction)Pattern
..............................................................................................................................................................................229
GGnHungQnHungLinTng(Pueraria,Scutellaria,andCoptisDecoction)Pattern
....................................................................................................................................................................231
GuZhGnCoTng(CinnamonTwigandLicoriceDecoction)Pattern.....................................233
GuZhJiGuTng(CinnamonTwigDecoctionwithExtraCinnamon)Pattern.........................234
FLngGuZhBiZhGnCoTng(CinnamonTwig,Poria,AtractylodesMacrocephalaand
LicoriceDecoction)Pattern ...................................................................................................236
XioJinZhngTng(MinorCenter-FortifyingDecoction)Pattern...................................................238
GuZhRnShnTng(CinnamonTwigandGinsengDecoction)Pattern..................................240
ZhGnCoTng(Honey-FriedLicoriceDecoction)Pattern....................................................................... 242
DXinXingTng(MajorChestDrainingDecoction)Pattern............................................................244
XioXinXingTng(MinorChest-DrainingDecoction)Pattern.......................................................246
DHungHungLinXiXnTng(RhubarbandCoptisHeart-DrainingDecoction)Pattern
....................................................................................................................................................................248
FZXiXnTng(AconiteHeart-DrainingDecoction)Pattern.......................................................249
BnXiXiXnTng(PinelliaHeart-DrainingDecoction)Pattern..................................................251
ShngJingXiXnTng(FreshGingerHeart-DrainingDecoction)Pattern..............................253
GnCoXiXnTng(LicoriceHeart-DrainingDecoction)Pattern...............................................256
XunFDiZhTng(InulaandHematiteDecoction)Pattern......................................................258
BiHTng(WhiteTigerDecoction)Pattern...................................................................................................264
BiHJiRnShnTng(WhiteTigerDecoctionplusGinseng)Pattern...................................266
TioWiChngQTng(Stomach-RegulatingQi-CoordinatingDecoction)Pattern............................ 270
XioChngQTng(MinorPurgativeDecoction)Pattern......................................................................272
DChngQTng(MajorPurgativeDecoction)Pattern.........................................................................274
MZRnWn(CannabisFruitPill)Pattern..................................................................................................278
YnChnHoTng(VirgateWormwoodDecoction)Pattern...................................................................... 281
VolumeTwo SelectedReadingsfromTreatiseonColdDamage(ShngHnLn,) 181
XioChiHTng(MinorBupleurumDecoction)Pattern.....................................................................288
ChiHGuZhTng(BupleurumandCinnamonTwigDecoction)Pattern...............................292
DChiHTng(MajorBupleurumDecoction)Pattern.........................................................................294
HungQnTng(ScutellariaDecoction)Pattern.............................................................................................297
ChiHGuZhGnJingTng(Bupleurum,CinnamonTwigandDriedGingerDecoction)
Pattern.....................................................................................................................................................299
ChiHJiLngGMLTng(BupleurumDecoctionplusDragonBonesandOysterShell)
Pattern................................................................................................................................................301
MHungFZXXnTng(Ephedra,AconiteandAsarumDecoction)Pattern
............................................................................................................................................................................ 319
FZTng(AconiteDecoction)Pattern..............................................................................................................321
ZhnWTng(TrueWarriorDecoction)Pattern.............................................................................................323
SNTng(FrigidExtremitiesDecoction)Pattern...........................................................................................325
TngMiSNTng(Channel-UnblockingforFrigidExtremitiesDecoction)Pattern
..............................................................................................................................................................................327
HungLinJioTng(CoptisandDonkey-HideGelatinDecoction)Pattern..........................329
ZhLngTng(PolyporusDecoction)Pattern.................................................................................................331
SNSn(FrigidExtremitiesPowder)Pattern...................................................................................................333
WMiWn(MumePill)Pattern...........................................................................................................................340
GnJingHungQnHungLinRnShnTng(Zingiberis,Scutellaria,Coptis,andGinsengDecoction)
Pattern............................................................................................................................................................ 343
DngGuSNTng(ChineseAngelicaFrigidExtremitiesDecoction)Pattern..........................345
DngGuSNJiWZhYShngJingTng(ChineseAngelicaFrigidExtremitiesDecoction
plusEvodiaandFreshGinger)Pattern.....................................................................347
WZhYTng(EvodiaDecoction)Pattern................................................................................................348
BiTuWngTng(PulsatillaDecoction)Pattern......................................................................................350
182
Chapter1
TheTreatiseonColdDamageisthefirstmedicalclassicwhichcombinedclassical
theory with practical clinical experience. It systematically elucidates the diagnostic
andtreatmentrulesfordealingwithboth externally-contracteddiseasesand complex
internal diseases, thus establishing a sound foundation for the clinical practice of
Chinesemedicine.
The Author of the Treatise on Cold Damage

TheTreatiseonColdDamage,originallyentitledTreatiseonColdDamageandMiscellaneous
Diseases (Shng Hn Z Bng Ln, ), is authored by Zhang Zhong-jing.
Zhangs given name was Ji, and his honorary name was Zhong-jing. He lived during
the Eastern Han Dynasty (150219 AD) in Nanyang prefecture (today known as
Nanyang City in Henan Province).When he was young, he followed a mentor in
apprenticeship, studying the traditional medicine of the day. He was an avid learner
andthinker,andsoongraduatedwithskillsthatfarsurpassedthatofhisteacher,after
whichhebecamerenownedphysician.And,becauseofhistremendouscontribution
to the practice of clinical Chinese medicine, subsequent generations of doctors
honoredhimwiththetitleofPhysician-Sage.
Zhang Zhong-jing was a man of high moral standard with a strong sense of
medicalethicsinthatheinsistedonusinghisbrilliantmedicalskillstoserveordinary
folk, and he held those who blindly followed the trends of the times and sought
only fame and fortune in contempt. He opposed those who overemphasized the
importance of shamanism and underemphasized the importance of physicians, and
alsocalleduponsocietytocareabouthumanlifeandmedicalcare.Atthesametime,
he deeply resented and criticized those who practiced medicine in a careless and
routine fashion without taking personal responsibility for their actions, as well as
thosewhostuckconservativelytotheiroldways.
During the 2 nd century AD at the end of the Eastern Han Dynasty, an epidemic
spreadthatkilledcountlesspeople.ZhangZhong-jingwitnessedallofthis,andwith
greatdeterminationhewasinspiredtodiligentlyresearchthelessonsoftheancients
and draw from their vast breadth of formulas. By combining this knowledge with
hisownclinicalexperience,hewasabletocomposetheTreatiseonColdDamageand
ComplexDiseases.Indoingso,healsoestablishedasolidfoundationfortheclinical
practicemethodologyofChinesemedicineforfuturegenerations.
VolumeTwo:Chapter1 GeneralIntroduction 183
The Emergence and Development of the Treatise on Cold Damage

The setting in which Zhang Zhong-jing lived was dire. People were living under
warlords in feudal societies and, amidst such political darkness, were also plagued
year after year by war and epidemics that left many with no way to make their
livelihoods, and scores of people died.The Zhang family clan was unable to escape
the misfortune of the times, and within a ten year period, more than two-thirds of
theirover200familymembersdiedfromwarandillnessmostofthemfromillness.
Itwasthesufferingofthepeople,andespeciallyofhisfamily,thatgalvanizedZhang
to study medicine intensively and to pledge that he would author a text that could
savelivesinfuturegenerations.Hepreventedthelossofmedicalknowledgepriorto
theQinandHanDynastiesbycompilingthemosteffectivetherapiesandestablished
theorieswhiledrawingbroadlyfromthestrengthsofthevariousmastersofhistime,
ultimately combining this with his own clinical experience in pulse examination
and pattern differentiation. In approximately 200-210 AD, he completed the now
celebratedandunsurpassedmedicalclassic,theTreatiseonColdDamageandComplex
Diseases.
Not long after completion, due to looting during the chaos of wartime, the
contentsoftheTreatiseonColdDamageandMiscellaneousDiseaseswerescattered,
and some material was lost. It was during theWestern Jin Dynasty that Imperial
physicianWangShu-hecollectedthesectionsofthecolddamageportionofthetext,
compilingthemintoabookentitledTreatiseonColdDamage.Thisbooksurvivedand
was circulated among the common people until the Eastern Jin and North-South
Dynasties.DuringtheTangDynasty,thephysicianSunSi-miaowaswriting Important
FormulasWorthaThousandGoldPieces.Atthattime,hepossessedonlyaportionof
thecurrenttextoncolddamage,andthuswasonlyabletoincludefromthoseparts
in his compilation. It was not until near the end of his life, when he was writing the
SupplementtoImportantFormulasWorthaThousandGoldPieces(QinJnYFng,
)thathecollectedtheTreatiseonColdDamageinitsentirety,includingtheninth
andtenthscrolls.Thisversionisconsideredtobetheearliestcompletecompilationof
thematerial.
During the years of the Northern Song, Gao Bao-heng, Sun Qi, LinYi and other
scholarsreceivedimperialorderstoproofreadandprinttheTreatiseonColdDamage.This
versionwasprintedinthesecondyearoftheSongDynastyZhi-pingPeriod(1065AD),
becomingtheversionthatsuccessivegenerationsreferredtoastheTreatiseonColdDamage.
Since then, thecomplex diseases portion of the text was also recovered, organized,
proofedandprinted:thisworkisreferredtoasEssentialsfromtheGoldenCabinet.
ThetwocommonversionsoftheTreatiseonColdDamageincirculationtodayare
the Song Dynasty text, and Chengs annotated text.The former was proofed and
carvedforprintingbyLinYiandotherscholar-physiciansduringtheZhi-pingPeriod
oftheSongDynasty,buttheoriginalcarvedtexthasnotbeenpreserved.Theoldest
extant text is the Zhao Kai-mei reproduction carved in the 27 th year of theWan-li
Period of Ming Dynasty (1599 AD), referred to as theZhao version. Because the
Zhao version is almost identical to the Song Dynasty edition, it was widely used by
physician-scholarsthroughoutlatergenerations.Thelatterwascarvedinthe14 thyear
oftheShao-xingPeriod(1144AD)oftheSouthernSongDynasty.Itwasannotatedby
ChengWu-jiandthustitledTreatiseonColdDamageAnnotatedandExplained(ZhJi
ShngHnLn,),oftensimplyreferredtoasChengsannotatedversion.
And, because its Ming Dynasty reproduction in the Jia Jing Period was completed
under the supervision ofWang Ji-chuan, it is also referred to as theWang-proofed
edition.
The Subject Matter and Achievements of the Treatise on Cold

Damage
Subject Matter
TheoriginalTreatiseonColdDamageandMiscellaneousDiseaseshadatotalof16
scrolls.TheversionthatLinYicompiledandproofedentitled TreatiseonColdDamage
had10scrollsdividedinto22sections.
Thefrstscroll:
ThePrincipleofDiferentiatingPulses
ThePrincipleofNormalizingPulses
Thesecondscroll:
NotestoTreatiseonColdDamage
Pulses,SignsandTreatmentofTetany,DampnessandSummerheatStroke
PartOneofPulses,SignsandTreatmentofTaiyangDisease.
Thethirdscroll:PartTwoofPulses,SignsandTreatmentofTaiyangDisease
Thefourthscroll:PartThreeofPulses,SignsandTreatmentofTaiyangDisease
Theffthscroll:
Pulses,SignsandTreatmentofYangmingDisease
Pulses,SignsandTreatmentofShaoyangDisease
Thesixthscroll:
Pulses,SignsandTreatmentofTaiyinDisease
Pulses,SignsandTreatmentofShaoyinDisease
Pulses,SignsandTreatmentofJueyinDisease
Theseventhscroll:
Pulses,SignsandTreatmentofSuddenTurmoil
Pulses,SignsandTreatmentofYin-YangToxinExchangeandTaxationRelapse
Pulses,SignsandTreatmentofDiseasesthatCannotBeTreatedwithSweating
Pulses,SignsandTreatmentofDiseasesthatCanBeTreatedwithSweating
Theeighthscroll:
Pulses,SignsandTreatmentofDiseasesFollowingSweating
Pulses,SignsandTreatmentofDiseasesthatCannotBeTreatedwithEjection
Pulses,SignsandTreatmentofDiseasesthatCanBeTreatedwithEjection
Theninthscroll:
Pulses,SignsandTreatmentofDiseasesthatCannotBeTreatedwithPurgation
Pulses,SignsandTreatmentofDiseasesthatCanBeTreatedwithPurgation
The tenth scroll: Pulses, Signs andTreatment of Diseases Following Sweating,
EjectionandPurgation
The chapters The Principle of Differentiating Pulses and The Principle of
Normalizing Pulses discuss pulse theory and the diseases that are indicated by
various pulse manifestations.The section ofNotes to Treatise on Cold Damage
specifically discusses the pathomechanisms, etiological factors and classification of
patterns. Many annotators believe that these three sections were not authored by
ZhangZhong-jinghimself,andthattheywereactuallywrittenbyWangShu-hewhen
organizingtheTreatiseonColdDamage.
Pulses, Signs andTreatment ofTetany, Dampness and Summerheat Stroke is
transferredandincludedintheEssentialsfromtheGoldenCabinet.
TheeightsectionsfollowingPulses,SignsandTreatmentofDiseasesthatCannot
BeTreated with Sweating are all a reiteration of the previous sections, so starting
fromtheMingDynasty,theywerefrequentlyomitted.
Amongthetenremainingsections,intotalthereare398linesofstatementsand
113formulas(oneofwhichismissing).Thesetensectionsmakeuptheirownsystem
with a complete set of formulas and corresponding patterns.Thesix jng-channel
patterndifferentiationoftenreferredtobylatergenerationscomefromtheseten.They
arealsoourmainfocuswhenstudyingtheTreatiseonColdDamage.
The Academic Achievements of The Treatise on Cold Damage

1. Established the six jng-channel pattern differentiation medical system: the
TreatiseonColdDamagecompiledandorganizedthemedicalachievementspriortothe
HanDynastybybringingtogetherthetheoryofthemedicalclassicsschoolwiththe
clinicalexperienceoftheschoolofclassicalformulas.Indoingso,the sixjng-channel
pattern differentiation medical system was created. In it, diagnosis and treatment
whereintegratedintoawayofthinkinggoingfrom:
treatment principle treatment method choosing a formula selecting

medicinals
Manykindsof externally-contracteddiseaseswerediscussedalongwithavariety
of complex diseases. In this way, the six jng-channel pattern differentiation system
oftheTreatiseonColdDamagecanbeusednotonlytodiagnoseandtreatexternally-
contracteddiseases,butalsoforcomplexinternaldiseases.
2. Initiatedthepatternidentificationandtreatmentmodelfororganizingclinical
information while integrating classical theory. Chinese medicine continues to retain
thisasamainmodelfordiagnosisandtreatment.
3. Createdandpreservednumeroustypesofformulasandmedicinalforms:there
are 112 formulas, including those classified as master, current, especially efficacious,
and empirical formula types which come in the form of herbal decoctions, pills and
boluses,powders,lozenges,enemasandsuppositories.
In summary, the publication of theTreatise on Cold Damage was a milestone
for clinical Chinese medicine, with the tex t becoming a foundation for the
developmental study of individual medicinals, formulas, and the art of nursing in
Chinesemedicine.
The Treatise on Cold Damage Pattern Differentiation Methodology
The Meaning Of Cold Damage

The termcold damage has both a broad and a narrow usage.The general
meaning encompasses all externally contracted febrile diseases. Whether the
externalpathogenicqiiswind,cold,summerheat,dampness,drynessorfire,ifitcan
precipitate a febrile response in the body, this is called acold damage disease.The
narrow usage refers to conditions specifically associated with externally contracted
pathogeniccold.
TheFifty-EighthDifficultyinTheClassicofDifficultIssues(NnJng,)states,
Therearefivetypesofcolddamage:thereiswindstrike,colddamage,warm-damp,
heat disease, andwarm disease. From this explanation we can see that historically,
therehavebeenvariousmeaningsoftheterm.
Because theTreatise on Cold Damage discusses wind strike, cold damage and
warm disease, the termcold damage in this text is used in its more general sense.
However, considering how the term is used throughout the majority of the text, it
shouldbenotedthatthismostoftenreferstoanexteriorinvasionofpathogeniccold.
Additionally,theChineseterm shnghnalsoreferstothebiomedicaldiseaseof
typhoid;itdoesnothavethismeaninginthistext.
T h e M e a n i n g s o f t h e T e r ms S i x J n g - C h a n n e l , S i x J n g - C h a n n e l
Disease, and Six Jng-Channel Pattern Differentiation
TheTreatise on Cold Damage uses a six jng-channel (li jng, ) system for
diagnosis and treatment. However, it must be understood that the sixjng-channel,
six jng-channel disease (li jng bng, ), and the six jng-channel pattern
differentiations (li jng bin zhng, ) are different yet intimately related
conceptswithoverlappingcontentwhichcanbestratifedonthreelevels:
The six jng-channel, also called the three yin and three yang jng-channels, are
namedtaiyang,yangming,shaoyang,taiyin,shaoyinandjueyin.Whilethecharacters
areidenticaltothoseofthe12channelsofthechannelsystem,andeachjng-channel
containstwochannelsofthechannelsystem,the jng-channelcannotbeequatedto
themeridianchannels.A jng-channelgrouporgansandchannelsfunctionallybased
upon their clinical presentation and their nomenclature within the channel system.
Each of the six jng-channels contains both a hand and a foot channel and their
corresponding zang-fu organ.This unit of two channels and two organs is onejng-
channel. For example, thetaiyang jng-channel contains thetaiyangurinary bladder
channel,thetaiyangsmall intestine channel, and their respective fu-organ.Thus the
termsix jng-channel refers to a physiological system and not simply six meridian
channels.
Sixjng-channeldisease,ontheotherhand,referstosomethingpathological:the
signs and symptoms of six jng-channel diseases are the expressions of externally
contractedpathogenicqiovertheprogressivecourseofadisease,asgroupedintosix
distinctstages.Eachstageiscalledajng-channeldisease(e.g.taiyangdisease,shaoyang
disease etc.).The organization is based upon Chinese medical theories regarding
the analysis and conclusion of the meaning of the various symptoms and signs over
adiseasesprogression.Sixjng-channeldiseasescanbelookedataseitherpartofa
progressive change of a disease over time, or as an individual set of symptoms and
signsassociatedwitheachpresentation.Inanycase,thesixjng-channeldiseaseisa
larger concept which encompasses both the idea of a meridian channel pathway on
the body as well as a set of pathological changes that make up a particular six jng-
channel disease relative to the greater functional grouping of the sixjng-channels
describedabove.
Six jng-channel pattern differentiation is a system of diagnosis and treatment
based upon physiological functions and pathological change of thezang-fu organs,
meridian channels, qi, blood and jn-y fluids associated under the six jng-channel
rubric.Thissystemcombinesinformationontheagentofdiseaseandthehumanhost
on multiple levels, including: the nature of the etiological factor, the ability of the
bodytowardoffpathogenicqi,andtheimprovementandregressionofthepatients
condition.Fromwithinit,symptomsandsignsofexternally-contractedpathogensare
evaluatedandtheirmeaningdetermined;theseresultsarethenusedtoascertainthe
diseaselocation,characteristicsofthepathomechanism,therelativevigoranddecline
oftheuprightqiandpathogenicqi,andalistofchangesinsignsofheatandcold(all
within the six jng-channel disease model).This information becomes the basis for
correctdiagnosisandtreatment.Therefore,thesixjng-channelpatterndifferentiation
system is not only the guiding principle for diagnosis, but also the criterion for
determiningtreatment.
Basic Introduction To the S i x J n g - C h a n n e l P at t e r n D i f f e r e n t i at i o n

System
Taiyangdiseaseappearsintheearlystageofanexternally-contracteddisease.The
fundamentalsymptomsofataiyangdiseaseareafloatingpulse,painandstiffnessof
the head and nape, and anaversion to cold. So any externally contracted condition
that manifests with this pulse and/or these set of symptoms can be called a taiyang
disease.
Taiyang disease has both exterior and interior presentations: the exterior one
also can further be divided into wind strike and cold damage, depending on the
pathogenicqiincurredandtheconstitutionoftheindividual.
The main symptoms and signs of wind strike are aversion to wind, fever,
spontaneous sweating, and a floating-moderate pulse. Its pathomechanism involves
an invasion of external wind and insecurity of wei at the exterior, resulting in a
dischargeorlossofnutritive ying-yin.Themainsignsandsymptomsof colddamage
are fever, aversion to cold, pain and stiffness of the head and nape, generalized
soreness and lumbar pain, joint pain, absence of sweating, and panting; the pulse
quality is floating and tight.The pathomechanism involves wind-cold fettering the
exteriorandconstrainingwei-yang,leadingtosubsequentcongealingandstagnation
ofying-yin.
The taiyang interior patterns are also called taiyang fu-organ patterns, which
include taiyang water retention and blood retention patterns. In a water retention
pattern, if there is a pathogenic qi at the exterior which has not been relieved, the
pathogenicqicanalsoenterinteriorlytoreachthetaiyangfu-organ.Thepathogenicqi
bindswithwaterandcausesbreakdownofbladderqitransformation;manifestations
include a floating pulse, fever, thirst with desire to drink but with vomiting after
liquids are ingested, inhibited urination, and fullness in the lower abdomen. In the
retentionofbloodpattern,ifthereispathogenicqiattheexteriorwhichhasnotbeen
relieved, the pathogenic qi can follow the taiyang channel interiorly and transform
into fire; the blood and heat knot together and blood is retained in urinary bladder
of the lower jiao.The clinical presentation is acute with binding pain or hardness
andfullnessofthelowerabdomenanddifficultyevacuatingurine,theremayalsobe
manicbehaviororlashingoutviolently.
Additionally, taiyang disease hasconcurrent patterns, or taiyang patterns with
an evident complication. For example, taiyang patterns may present with panting
andprofusesweating,diffusepainorpaininthebackandextremities.Therearealso
transmuted patterns that result from misdiagnosis and treatment, including: chest
bind,p,1visceralbind,andfrecounterfow.
In yangming disease, the disease has reached the stage in which the upright qi
andthe pathogenic qi are fighting intensely.The predominant characteristics of this
patternaresignsofdryness-heatwiththepresenceofa solid mass in the intestines.
Therefore,therubricforthispatternisalsoreferredtoasabdominalfamilymasses.
The basic condition that needs to be present to determine a yangming disease is
the fusion of dryness-fire androtten dregs or feces in the intestines.This can be
differentiated into patterns primarily characterized by either internal heat or by the
solidmass.
Cases where abundant heat is present but not yet fused with intestinal feces
present with heat that spreads over the whole body like a high fever, spontaneous
sweating, and no aversion to cold but instead with aversion to heat, agitated thirst
withadesiretodrink,andasurgingpulse.Thisistheyangmingheatpattern.
If dryness-heat and intestinal feces fuse, dry feces will obstruct the colon and
bowel-qi will be blocked.The resulting clinical presentation includes tidal fever,
deliriousspeech,sweatingfromthehandsandfeet, abdominalfullnesswithhardness
andpain,absentdefecation,anda deepexcesspulse.Thisisthe yangmingabdominal
masspattern.
Shaoyang disease presents as the final stage of an externally contracted febrile
diseaseasitprogressesthroughthethreeyangdiseasestages.Whenthe pathogenic
qientersshaoyang,gallbladderfirebecomesconstrainedinternallyandthe shaoyang
pivotmechanismbecomesdisturbed.
The main signs include a bitter taste in the mouth, a dry throat, and a thin wiry
pulse,andthemainsymptomsofthispatternarealternatingchillsandfever,fullness
anddiscomfortofthechestandrib-sides,quietnesswithnodesireforfood,vexation,
frequentretching.Thereisawhitetonguecoating.
Therearenumerousconcurrentpatternsthatcanalsopresentincombinationwith
ashaoyangpivotmechanismdisturbance.
Ifcombinedwithataiyangexternalpattern,therewillbefever,slightaversionto
cold, agitating pain from the joints of the limbs, slight retching, and an obstructive
proppinguplikesensationintheepigastrium.
1 p( )(a.k.aglomus);seeppatternfordefnitioninglossary)
When combined with an internal yangming pattern, there may be alternating

fever and chills, incessant retching, distress in the epigastrium, or a hard p in the
epigastrium,depressionwithslightvexation,ortidalfeverwithconstipation.
With inhibited qi transformation, there may be alternating fever and chills,
vexation,fullnessofthechestandrib-sideswithaslightbindingsensation,inhibited
urinationandthirstbutwithnoretching,andsweatingonlyfromthehead.
If a shaoyang pattern is treated incorrectly with the purgative method, the
pathogenic qi will spread; this results in a condition that affects both interior and
exteriorwithaspectsofbothexcessanddeficiency.Manifestationsincludefullnessin
thechest,irritabilityandvexationwithfright,difficulturination,deliriousspeech,and
extremeheavinessofthewholebodywithdifcultyturningontoonessideinbed.
Taiyindiseaseisthefirststageofthethreeyindiseases.Whenadiseasetransmutes
into the taiyin stage, spleen yang is unable to transport water and food-essence,
resulting cold-dampness blockage as the main pathomechanism.Thus, the main
symptoms of this pattern are abdominal fullness with vomiting, a feeling of food
not descending into the abdomen from the stomach, and progressively worsening
diarrheawithintermittentabdominalpain.
This can also present in combination with an external pattern. In this case, a
floatingpulseandagitatingpainintheextremitiesarepresent.Inthetaiyinabdominal
painpattern,thereisabdominalfullnesswithintermittentorextremeexcess-typepain
in some cases. If the taiyin cold-dampness is not resolved, dampness may become
constrictedandyellowingmayappearontheexteriorofthebody,whichisreferredto
asataiyinyellowpigmentationpattern.
Whenadiseasereachestheshaoyinstage,ithasbecomeveryserious.Inshaoyin
disease,deficiencyaffectstheheart,kidney,yinandyang,andqiandblood.Therefore,
the main signs include a faint and thin pulse, and a constant desire for sleep. A
shaoyinpatterncantransmuteintoeitheraheatpatternoracoldpattern.Inthe cold
transmutation pattern, there the main presentation includesjue-reversal cold of the
handsandfeet,curlingupofthebodywhensleeping,diarrheawithundigestedfood,
frequent copious clear urination, and a deep faint pulse. In the heat transmutation
pattern,themainsignsandsymptomsincludevexationtothepointwhereonecannot
sleep,adryandpainfulthroat,occasionaldiarrheawiththirst,aredtonguewithlittle
ornocoating,andathinrapidpulse.
Jueyin disease is the final stage of the six jng-channel pattern cold damage
transmutation process. In jueyin disease, the liver fails to act freely and there is an
upward flaming of liver fire, and deficiency of the spleen causes failure to transport
the essence of food and water.With this pathomechanism, a pattern ofupper heat
andlowercoldisreadilyformed.Themainsignsincludexiok(wasting-thirst,),
qi rushing upward to the heart, heat-pain within the heart, and hunger without the
desiretoeat;whenfoodisconsumed,thereisvomitingofworms.Whenthepurgative
method is used for treatment, there is unremitting diarrhea. Combined, all of these
symptomsrefectthenatureoftheheat-coldcomplexcharacteristicofthispattern.
When pathogenic qi reaches jueyin, yin and yang are in disharmony and the
disease can develop from either: if pathogenic qi transforms from within yin, the
primarymanifestationwillbeacoldpattern;ifittransformsfromwithinyang,itwill
appearasaheatpattern.Thus,theformeriscalledajueyincoldpatternandthelatter
ajueyinheatpattern.
Thestrugglebetweentheuprightqiandthepathogenicqi,alongwiththewaxing
and waning of yin and yang, result in alternating periods of cold of the hands and
feetwithparoxysms of fever.This indicates a further complicationof thejueyin heat
pattern, referred to as ajueyincounterflow cold andfever overcoming or relapsing
pattern.Whenyin and yang qi cannot interconnect smoothly, the four extremities
will feel cold; this is called areversal counterflow cold pattern.Whenpathogenic qi
attacksjueyin,theliverqifailstoflowfreely,whichnegativelyaffectsthedescending
andascendingfunctionsofthespleenandstomach;inthiscasetherewillbevomiting,
hiccuppinganddiarrhea.
T h e T r a n sm i ss i o n and T r a n sm u t a t i o n of the Six Jng-Channel

Diseases
Transmissionandtransmutation(chunbin,)isoneofthecharacteristicsof
thesixjng-channeldiseases.Transmission(chun,)referstothefactthatthedisease
advancesandregressesfromonejng-channeltoanotherjng-channelinpatternswith
definitetendencies.Forexample,taiyangdiseasetransmitstoayangmingdisease,and
ayangmingdiseasetoashaoyangdisease.
Undercertainconditions,thenatureofadiseasemaychangesodramaticallythat
itprogressesoutsideoftypicalpatterntransmissiontendencies.Thuschange(bin,)
referstoatransmutationinnature.Forexample,a taiyangdiseasemaytransmutein
natureandbecomechestbindorvisceralbindpattern.
Becausethereisadefiniterelationshipbetweentransmissionandtransmutation
bothemphasizethegeneralprogressive,transformativeprocessofadiseaseclinically
speaking,transmissionandtransmutationareoftenusedintandem.
Whetherasixjng-channeldiseasetransmitsandtransmutesornotdependsupon
fourmainfactors:
1. Thestrengthoftheuprightqi.
2. Theseverityofthepathogenicqicontracted.
3. Whetherornotappropriatetreatmentisapplied.
4. Whether or not there is a pre-existing illness present and the general state of
healthoftheindividualattheincurrenceofthepathogenicqi.
Generally, for a disease to invade and advance from the exterior to the interior
(fromyangtoyin),thepathogenicqipredominatesovertherelativeweaknessofthe
uprightqi.Iftheuprightqirecoversandexpelsthepathogenicqioutward,thenthe
disease pattern will regress along patterns that move from interior to exterior (from
yintoyang).Soasthe pathogenicqipredominates,thediseasewilladvance,andas
pathogenicqiabates,thediseaseregresses.
However, it should be pointed out that yin jng-channel diseases can occur
directly, or without the normal progression through the yang jng-channels.This is
calledadirectattack.Inadirectattack,theuprightqiissoweakthatitcannotresist
theattackofthepathogenicqi,sothenormalprogressionofthestrugglebetweenthe
twofromtheearly-stagetaiyangjng-channelpatternthroughallthreestagesofyang-
patterntransmissionbeforereachingtheinteriorthreeyin-stagesisabsent.
Moreover, in addition to one jng-channel disease presenting individually, it is
alsopossiblefortwoorthreejng-channeldiseasestooccuratthesametime.Inthis
situationthetermscombineddisease(hbng,)andoverlappingdiseases(bng
bng,)maybeemployed.
Iftwoormorejng-channelsbecomediseasedatthesametime,anditisclearthat
this is not a matter of succession with one disease occurring first and transmitting
toanother,itis called acombined disease. For example,taiyang andyangming can
presentasacombineddisease,ascantaiyangandshaoyang,orevenallthreeyangjng-
channels.
On the other hand, if a disease pattern occurs in onejng-channel in succession
toanotheronewhichhasnotyetbeenresolved,thetwoofthemtogetherarecalled
overlappingdiseases.Similartotheexampleabove, taiyangandyangmingortaiyang
andshaoyangcanalsopresentasoverlappingdiseases.Ingeneral,combineddiseases
often present as primary ones and are usually more serious than overlapping ones,
whichcanusuallybeidentifedassecondarywitharelativelyslowerdiseaseprocess.
Treatment of the Six Jng-Channel Disease Patterns

In the Treatise on Cold Damage, the treatment principles for six jng-channel
disease patterns can be summarized simply as supporting the upright and expelling
the pathogenic qi.Within that, the spirit of reinforcing yang qi and retaining yin-
fluids is also pervasive. In this way, the goal ofexpelling the invader and calming
the citizens can be achieved. Specific application of these treatment principles can
take the form of any of the eight treatment methods: sweating, emesis, purging,
harmonizing,warming,heat-clearing,dispersing,andsupplementing.
Treatmentofthethreeyangdiseasesfocusesmainlyonexpellingthepathogenic
qi,butthedisparatenatureofthediseasesoftenrequiresappropriateapplicationof
different treatment methods. For example, in ataiyang exterior condition, resolving
the exterior isthe usual method; however, because the nature of the disease can be
differentiated into cold damage and wind strike patterns, the treatment method
appliedwillchangebaseduponthesituation.
Inayangminginternalheat-massdisease,thereisadifferentiationofpredominant
internalheatandanothermarkedbytheabdominalmass.Intheformer,heat-clearing
istheappropriatemethod,whileinthelatter,purgingisindicated.
Whenthepathogenicqientersshaoyang,thepivotmechanismisdisturbedwhere
a half-interior/half-exterior pattern manifests. In this case, the primary treatment
methodistoharmonize.
The three yin diseases are usually internal patterns of deficiency and cold.The
primarytreatmentprinciplehereistosupporttheupright.Forexample,inthecaseof
taiyindisease,thespleenexhibitsadeficiencypatternofcoldanddampness.Thus,the
correcttreatmentprinciplesaretowarmthemiddle,dispersecold,anddrydampness.
Shaoyin patterns primarily involve severe deficiency of the heart and kidney
with qi and blood insufficiency, where the condition manifests as either a cold-
transformation pattern or as a heat-transformation pattern.Treatment methods
are applied accordingly: for the shaoyin cold pattern, yang is reinforced and yin is
suppressed;fortheheatpattern,yinisnurturedandheatiscleared.
Jueyindiseasepatternsarehighlycomplex,thetreatmentmethodmustchangeas
thepatterntransforms.Forexample,ifaheatpatternpredominates,thenclearingheat
from below (the lower jiao) is appropriate; when cold predominates, warming and
supplementingmethodsarethenrequired.Inaheat-coldcomplexdualpresentation,
warmingmedicinalsandheat-clearingmedicinalsmustbeusedtogether.
As a disease changes over its course of development, it is often the case that
manyjng-channelpatternscanappearasmixedtogether.Whenexteriorandinterior
conditions present concurrently, it is necessary to look at the factors of timing (i.e.
which occurred first, and which followed in succession) and the nature of each
condition(i.e., which is more acute and thus needs to be addressed first) in order to
determinetheappropriatestrategyfortreatment.Suchstrategiesinclude:treatingthe
exteriorfirstandthentheinterior,treatingtheinteriorfirstandthentheexterior,and
treatingbothinteriorandexteriorsimultaneously.
In general, when interior and exterior diseases present simultaneously, the
preferredtreatmentprotocolistofirstreleasetheexteriorandthentotreattheinterior.
Successfullyreleasingtheexteriorbeforetreatingtheinteriorpreventsthepathogenic
qiattheexteriorfrombeingtransportedinteriorlybyvirtueofthedeeplypenetrating
natureofinteriortreatmentmethods;thisapproachalsopreventstransmutationofa
jng-channel pattern that would further complicate an interior condition. Even so, in
somecases,wheninternalpatternshavereachedacriticalstage,itisnecessarytotreat
theinteriorfrstandthentofollowbymanagingtheexterior.
The premise for treating the interior and exterior simultaneously is that by only
treating the exterior without the managing the interior, it may not be possible to
fullyresolvetheexteriorcondition.Likewise,ifonlytheinteriorpatternisaddressed
without including treatment for the external disease, then treatment of the interior
conditionmaynotbesuccessful.
Review Questions
1. DiscussyourgeneralunderstandingoftheTreatiseonColdDamage.
2. Writeashortessaysummarizingthehistoricalcontextandthedevelopmentof
theTreatiseonColdDamagestartingfromitsconception.
3. Writeashortessaysummarizingtheacademicoriginsandaccomplishmentsof
theTreatiseonColdDamage.
4. Whatarethevariousmeaningsofthetermcolddamage?
5. What is your understanding of the six jng-channel pattern differentiation
system?Writeabriefessayexplainingthemainideasofthissystem.
6. What are the meanings of the terms direct attack, combined disease, and
overlappingdiseases?
7. WriteashortessayexplainingtheprincipaltreatmentmethodsoftheTreatiseon
ColdDamage.
195
Chapter2
Pulse, Pattern, and Treatment of Taiyang
Disease
Taiyangincludesthefoottaiyangandhandtaiyangasassociatedwiththebladder
and small intestine channels respectively; it also constitutes the exterior level of the
interior-exterior relationship with foot shaoyin and hand shaoyin.The foot taiyang
bladder channel originates from the inner canthus, runs up through the forehead
convergingatthevertex,andcontinuesdownalongthebackoftheneckalongeither
sideofthespinetoreachthelowerbackwhereconnectsdirectlytothebladderand
collaterallywiththekidney.Thehand taiyangsmallintestinechanneloriginatesfrom
thelateralsurfaceoflittlefinger,runsalongthearmtotheshoulder,goesdownwards
toconnectwiththeheart,andhomestothesmallintestine.Thebladdergovernsthe
storing of bodily liquids and transforms qi to promote diuresis.The small intestine
governsthereceivinganddigestingoffoods,andtheseparationoftheclearandthe
turbid.
Taiyangisthefirstofthesixchannels.Itcommandstheyingandweiandgoverns
theexteriorofthebody.Whenanexternalpathogenicqiinvadesthebody,thetaiyang
channelisusuallythefirsttobeaffected;therefore,taiyangdiseaseistheinitialphase
of six-channel disease progression.When an external pathogenic qi attacks, the
uprightqiwillriseuptoresistit.Consequently,theyingandweifallintodisharmony,
theweiwillfailtoprotecttheexterior,andtheqiflowofthechannelwillbeinhibited.
As a result, signs like aversion to cold, headache and painful stiff nape and floating
pulses will develop.These signs and symptoms are the main manifestations of a
taiyangdisease.
The primary location of a taiyang disease is at the exterior, so it is also called an
exterior pattern. Due to the patients constitution and the nature of the pathogenic
qi, taiyang diseases can be differentiated into wind strike, cold damage, and warm
disease.
Whensomeonewithconstitutionalinsecurityoftheintersticescontractspathogenic
wind-cold,the weiwillnotsecuretheexterioras yingfailstobecontainedinteriorly.
Thesymptomsandsignshereincludefever,sweating,aversiontowind,andfloating
pulses.Thisisreferredtoasawindstrikepattern.
When someone with secure interstices contracts wind-cold, wei-yang will be
suppressed and ying-yin stagnated.There will be aversion to cold, fever without
sweating,headache,generalizedpain,andfloatingandtightpulses.Thisisreferredto
asacolddamagepattern.
Contraction of pathogenic warm-heat or constitutuional yang exuberance with
contraction ofwind-cold that transforms into heat can lead toying-wei disharmony
and impaired fluids. Symptoms then include high fever, mildaversion to cold, and
thirst.Thisisreferredtoaswarmdiseasepattern.
ConcurrentandTransmutedPatterns
Ataiyangconcurrentpatternisataiyangdiseaseconcurringwithotherpathodynamic
changes. For example, a taiyang wind strike pattern can be accompanied by a Gu
ZhJiGGnTng (CinnamonTwigDecoctionplusPueraria, )pattern
(channels inhibited), a Gu Zh Ji Hu P Xng ZTng (CinnamonTwig Decoction
plus Officinal Magnolia Bark and Apricot Kernel, ) pattern (lung
qi ascending), a Gu Zh Ji F ZTng (CinnamonTwig Decoction plus Aconite,
) pattern (yang deficiency with insecurity), a Gu Zh Q ShoYoTng
(CinnamonTwig Decoction minus Peony, ) or a Gu Zh Q Sho Ji F
ZTng (CinnamonTwig Decoction minus Peony plus Aconite, )
(devitalized chest yang) and a Gu Zh Xn JiTng (Newly Supplemented Cinnamon
TwigDecoction,)pattern(ying-yindepletion).
Transmuted taiyang disease patterns are new patterns caused by improper
treatment or by the natural progression of disease.The characteristics of a taiyang
disease are no longer present, and the tranmuted pattern can involve cold or heat
or deficiency or excess. Although transmuted patterns do not fall under the scope
oftaiyang disease,thefactthattheyarelistedwithintheChapterof taiyang disease
implies the potential complexities of exteriorly-contracted diseases. Meanwhile, this
emphasizesalsotheimportanceoftimelyandappropriatetreatmentduringtheearly
stagesoftaiyangdiseasesoastoavoidtransmutation.
Treatment
The general treatment principle for taiyang disease is to promote sweating and
resolvetheexterior.
Forwindstrike:dispelwind,resolvethefleshandregulateyingandweiwithGu
ZhTng(CinnamonTwigDecoction).
For cold damage: promote sweating, resolve the exterior, diffuse the lung and
calmpantingwithMHungTng(EphedraDecoction).
Forconcurrentpatterns:applyvariationstothemainindicatedformulas.
Fortransmuted patterns:observe thepulseand signs,knowwhat mistakeshave
beenmade,andtreataccordingtothepresentingpattern.
VolumeTwo:Chapter2 Pulse,Pattern,andTreatmentofTaiyangDisease 197
Outcome
Withappropriatetreatment,theexteriorcanberesolvedwithsweating.
If the exterior pathogenic qi remains unresolved, it can pass to other channels.
Shaoyinbeingthemostcommonlyafected.
Inappropriate treatment and constitutional factors can cause the arising of new
conditions,referredtoastransmutedoraggravateddiseases.
Section1 OutlineofTaiyangDisease
Source Text
Line1

Taiyangdiseasemanifestswithfloatingpulses,headache,apainfulstiffnape,and
aversiontocold.
Line2

Taiyang disease with fever, sweating, aversion to wind, and moderate pulses is
referredtoaswindstrike.
Line3

Taiyang disease with fever or an absence of fever, but certainly with aversion to
cold, generalized pain, retching couterflow, and tight pulses on both yin and yang
positionsisreferredtoascolddamage.
Line6

Taiyang disease with fever, thirst and no aversion to cold is referred to as warm
disease.
Interpretation
Line1isthegeneraloutlineoftaiyangdisease.
When wind-cold invades the body and upright qi rises up to contend with it,
pulseswillbe floating.Thetaiyangchannel passes through head and nape, so when
the channel-qi is restrained by exterior wind-cold, headache and painful stiff nape
appear.Weiqiissuppressedandfailstowarmthefleshyexterior,so aversiontocold
occurs.Thesearethemainpulsesandpresentingsignsoftaiyangdisease.Particularly,
the sign of aversion to cold usually occurs early, and it can be seen throughout the
whole progress of taiyang disease.This sign is the main diagnostic evidence for this
disease.
Line2discussesthepulsesandsignsassociatedwithtaiyangwindstrike.
Inadditiontothecharacteristicsoftaiyangdisease,iffever,sweating,aversionto
wind and moderate pulses are seen, this is referred to aswind strike.This is not the
sameaswindstrokediseasewhichischaracterizedbyasuddenlossofconsciousness
withdeviatedeyesandmouth.
When wind invades the exterior, wei qi rises up to contend with it, thus fever
occurs.Windisayang pathogenic qi with an opening and discharging nature.There
isinsecurityoftheweiandnon-containingofying,sosweatingoccurs.Theinterstices
becomeslackandcannotresisttheinvasionofwind;consequently,aversiontowind
arises. Sweating causesying-yin to discharge outwards, so pulses become slack and
moderate.Sincetheprincipalpulsefortaiyangdiseaseisfloating,thepulseinthiscase
shouldbefoatingandmoderate.
Sweating is the characteristic symptom of this condition. Aversion to wind and
moderatepulsesarebothrelatedtosweating.
Line3discussesthepulsesandsignsassociatedwithtaiyangcolddamage.
Aversion to cold is for sure to be seen in a taiyang disease.Whether fever will
developdependsontheindividualconstitution,andtheintensityofthecontraction.
Ifpathogenicwind-coldissevereandwei-yangisconstrainedheavily,feverwilloccur
relatively late. If wind-cold is slight, and the wei-yang is able to contend with the
pathogenicqi,thefeverwilloccurearly.Nevertheless,feverisverycommonlyseenin
taiyangdisease.
Due to the congealing nature of pathogenic cold, both wei-yang and ying-yin
will become constrained. In a cold damage pattern, taiyang channel-qi is blocked;
consequently,generalizedpainisoftenseen,andpulseswillbefloatingandtightat
all six positions. Retching couterflow is caused by wind-cold fettering the exterior
and by impaired harmonized downbearing of the stomach.The sign of absence of
sweating, however not mentioned in this line, is implied in this pattern such that it
involvesapathologicalmechanismwheredefensiveyangisconstrainedandnutrient
yinisstagnant.Meanwhileitisself-evidentwhencomparedwithLine2inwhichthe
nutrient cannot be contained interiorly due to the property of wind that is opening
anddischarging.Thesignsthatindicatestagnantandconstrainedfleshandexterior,
including absence of sweating, aversion to cold, general pain, and tight pulse, all
constitutethecharacteristicsofthetaiyangcolddamagepattern.
Line6outlinesthesignsandpulsesassociatedwithtaiyangwarmdisease.
Thewarmdiseasediscussedinthislineis,inbroadsense,onetypeofcolddamage.
Itisalsoanexternallycontracteddiseasecausedbypathogenicwarmthandheat,also
characterizedbyfever,thirst,andabsenceofaversiontocold.
Warmth is a yang pathogenic qi; when it affects the fleshy exterior and depletes
yin-fluids, fever and thirst will occur at the onset.Warmth and heat usually do not
causeaversiontocold;however, aversiontocoldisoneofthecharacteristicsignsof
taiyangdisease,whichisoftenobservedduringtheearlystagewhenthepathogenicqi
isstillattheweilevel.Therefore,warmdiseaseshouldmanifestwithaversiontocold
aswell,althoughitmaybelesssevereandofreducedduration.
Thetreatmentprinciplehereistoresolvetheexteriorwithacridityandcoolness.
Promotingsweatingwithacridityandwarmthisprohibited.
Review Questions
1. What are the main manifestations and basic pathomechanisms of taiyang
disease?
2. Howcanonediferentiatetaiyangwindstrikefromtaiyangcolddamage?
Section2 PatternsofTaiyangDisease
Wind Strike
PrimaryPattern
GuZhTng(CinnamonTwigDecoction)Pattern
Source Text
Line12

In taiyang wind strike, [pulses are] floating at the yang level and weak at the yin
level.With floating yang, heat is effused spontaneously; with weak yin, sweat is
dischargedspontaneously.Withhuddledaversiontocold,aversiontowindasifwet,
afeather-warmthfever,anoisynose,anddryretching,GuZhTng(CinnamonTwig
Decoction)isindicated.
Line13

For taiyangdisease with headache, fever, sweating, andaversion to cold,Gu Zh
Tngisindicated.
Formula
shoyo 3liang RadixPaeoniae
guzh 3liang RamulusCinnamomi(barkremoved)
zhgnco 2liang RadixetRhizomaGlycyrrhizaePraeparatacumMelle
shngjing 3liang RhizomaZingiberisRecens(cut)
dzo 12pcs FructusJujubae(split)
Cutthefirstthreeingredientsintosmallpieces.Decoctwith7shengofwateron
lowheatuntil3sheng remains. Discard the dregs.Take onesheng atan appropriate
temperature.
After a short while, take more than one sheng of hot thin porridge to reinforce
the medicinal effect. Cover up the patient for about two hours. Ideally, there will be
generalized drizzly sweating; if the sweating flows like water, the condition will not
beeliminated.
Ifsweatingoccursandtheconditionresolvesaftertakingoneportion,donottake
more.Theentiredecoctiondoesnotneedtobetaken.
Withnosweating,takeonemoreportionasperthepreviousinstructions.Ifthere
isstillnosweating,takeonemoreportionatashorterinterval.
Takethedecoctioninthreedividedportions,withinabouthalfaday.
If the condition is severe, take it throughout the day and night and observe the
patientthewholetime.Ifthesignsandsymptomsremainaftertakingtheentiredose,
decoct and take more. If there is still no sweating, one can take up to two or three
doses.
Raw,cold,stickyandslipperyfoods,meat,noodles,thefivespices,wine,koumiss,
andfoodswithapeculiarsmellareprohibited.
Interpretation
Line12discussesthepathodynamic,patternandtreatmentoftaiyangwindstrike.
In taiyang disease, contracting of pathogenic wind will cause the pulse to be
floating at the yang level and weak at the yin level.This refers to pulses that are
easily palpated at the superficial level and moderate under pressure.The reason for
floatingattheyanglevelisthatthedefensiveyangisinjuredbywind-pathogenbut
yet still contends with pathogen at the exterior, thus giving rise to fever.The reason
forweakattheyinlevelisthatthedefensiveyangisfetteredbypathogenicqiand
cannot protect the nutrient-yin; nutrient-yin thus flows outward and the interior is
weakened,consequentlysweatingarises.
Feverandsweatingindicateying-weidisharmony.Withthesesymptoms,thepores
openandtherewillbeaversiontocoldthatmakesthepersoncurlupforwarmth,and
aversiontowindasifbeingsoakedincoldwater.Whentheuprightandpathogenicqi
contendontheexterior,theheatislikebeingcoveredbyalayeroffeathers;therefore
it is referred to as afeather-warmth fever. Pathogenic wind affecting the lung can
leadtoanoisynose;andwhenitcausesthestomachqitoascend,therecanbedry
retching.
Thetreatmentprinciplehereistoresolvetheflesh,dispelwind,andregulate ying
andwei.GuZhTngisindicated.
Line13discussesthemainsignsandtreatmentofaGuZhTngpattern.
Intaiyangdisease,ifheadache,fever,sweating,andaversiontocoldoccur,GuZh
Tngcanbeapplied.Sweatingistherepresentativesignfortaiyangwindstrike.
This line reminds us that in clinical practice, one must pay attention to the chief
signorsymptom.
FormulaAnalysis
Gu zh is acrid and warm. It resolves the flesh, dispels wind, and assists wei to
dispelthepathogenicqi.
Sho yo is a slightly sour and cold. It supplements yin-blood to assist ying yin.
Whenpairedtogether,thesetwomedicinalsacttoregulateyingandwei.
Shngjingisacridanddissipating;itassistsguzhtodissipatethepathogenicqi.
Dzoissweetandwarming;itassistsshoyotonourishyin.
Zhgncoactstoharmonizeallformulamedicinals.
This formula is commonly applied to treat common cold, influenza, and upper
respiratory infections associated with wind-cold and exterior deficiency. It can
also be modified to treat neurosis, nervous headache, coronary heart disease, viral
myocarditis, Raynauds disease, eczema, erythema multiforme, urticaria, and allergic
rhinitiswhenassociatedwithying-weidisharmony.
CaseReport
Female,age53.
Chiefcomplaint:intermittentfeverandsweatingformorethanoneyear.
The condition would occur twice to three times a day. A previous physician
treateditasayindeficiencyfever,andaftermorethantwentydoses,therehadbeen
no observable effect.The patients diet, urination and defecation were normal. Her
tongueappearedpalewithawhitecoating;pulsesweremoderateandforceless.
Patterndiferentiation:ying-weidisharmony,weifailingtosecureying.
Treatmentprinciples:regulateyingandwei.
Formula:GuZhTng.
guzh 9g RamulusCinnamomi(barkremoved)
Two doses.Take some hot thin porridge after taking the medicine. Cover the
patienttopromoteslightsweating.Theconditionwasapparentlyresolved.
[Reference: Chen Ming. Selected Effective Clinical Cases of Liu Du-zhou.
Beijing:AcademyPress;1996.]
ConcurrentPatterns
Gu Zh Ji G GnTng (CinnamonTwig Decoction plus Pueraria)

Pattern
Source Text
Line14

For taiyang disease with stretched stiffness of the nape and back with abnormal
sweatingandaversiontowind,GuZhJiGGnTngisindicated.
Formula

ggn 4liang RadixPuerariaeLobatae
Decocttheggnwithonedouofwateruntil8shengremains.Scoopoffthefoam,
andaddtheothermedicinals.Decoctuntil3shengremains.Discardthedregs.
Take onesheng warm. Cover the patient to promote slight continuous sweating.
No need to take porridge.The other care-taking methods and prohibitions are as
thoseofGuZhTng.
Thislinediscussesthepatternandtreatmentoftaiyangwindstrikewithconcurrent
taiyangchannel-qiinhibition.
Taiyang disease with sweating and aversion to wind is wind strike pattern. All
taiyangdiseases share the symptoms of headache and a painfulstiff nape. Nowthat
thebackisalsoaffected,thisindicatesthatthewindpathogenicqihassettledinthe
taiyangchannel.Asthechannel-qibecomesinhibited,fluidsfailtobedistributed,and
channelsandvesselsfailtobenourished.Treatmentshouldresolveflesh,dispelwind,
upliftfuidsandsoothethechannels.GuZhJiGGnTngshouldbeapplied.
FormulaAnalysis
ThisformulaiscomposedofGuZhTngwithaddedggn.
GuZhTngresolvesfesh,dispelswind,andregulatesyingandwei.
G gn is sweet and neutral. It acts to uplift yang, diffuse the exterior and assist
Gu ZhTng in resolving the flesh while also uplifting fluids, soothing the channels,
and relaxing the tension of the nape and back. G gn has a very strong diffusing
actionandcaninvigoratestomachqi;thereforethereisnoneedtotakeporridgeafter
medication.
This formula has been reported as effective in the treatment of the common
cold, headache, dizziness, hemilateral facial edema, facial palsy, primary fremitus,
encephalitis B sequela, ankylosing spondylitis, myasthenia, chronic polymyositis,
diarrheaduetoexternalcontraction,andcervicalspondylitisthatareassociatedwith
ying-weidisharmonyandtaiyangchannelinhibition.
CaseReport
Male,age42.Initialconsultation:August20,2007.
Chief complaint: ank ylosing spondylitis for more than 3 years. Previous
treatments with penicillin and cyclophosphamide had produced no effect.The
condition could only be temporarily relieved by oral administration of prednisone.
The patient presented with a rigid and occasional painful neck, spontaneous
sweating, and limited mobility. His tongue coating was thin and white; the pulses
weremoderate.
Formula:GuZhJiGGnTng.
Onedecocteddoseperday.
Afterthreedoses,therewasslightsweatingonhisbackandthepatientfeltmuch
relief. After more than fifty doses, neck mobility was restored completely and there
wasnogeneralizeddiscomfort.Theconditionwasapparentlyresolved.
[Reference:Tang Dong-yi. AppliedVariations of Gu ZhTng . Shandong
JournalofTraditionalChineseMedicine.2008,27(4):278-279.]
Gu Zh Ji Hu P Xng Z Tng (Cinnamon Twig Decoction plus

Officinal Magnolia Bark and Apricot Kernel) Pattern

Source Text
Line43

Intaiyangdisease,slightpantingafterpurgationisduetoanunresolvedexterior.
GuZhJiHuPXngZTngisindicated.
Formula
hup 2liang CortexMagnoliaeOfcinalis(mix-fried,barkremoved)
xngrn 50pcs SemenArmeniacaeAmarum(peeledandtipremoved)
Decocttheaboveseveningredientswith7shengofwateronlowheatuntil3sheng
remains. Discard the dregs.Take onesheng warm. Cover up the patient to promote
slightcontinoussweating.
Interpretation
Thislinediscussesthetreatmentofpantingassociatedwithanunresolvedexterior
pathogenic qi with lung qi ascending following inappropriate purgation in taiyang
disease.
For a taiyang wind strike pattern, Gu ZhTng should be applied to resolve
exterior.Ifpurgation is applied instead, the exterior pathogenic qi may sink into the
chest and lung qi would ascend, causing panting. However in this case, the upright
qiwasnotweak,andtheexteriorpatternremained.Inothercases,pathogenicwind-
colddistressinginwardcanalsocauselungqiascendingwithpanting.GuZhJiHu
PXngZTngisindicated.
FormulaAnalysis
ThisformulaiscomposedofGuZhTngwithaddedhupandxngrn.
GuZhTngharmonizesyingandweitoresolvetheexterior.
Hupandxngrndownbearlungqitocalmpanting.
This formula is commonly applied to treat coughing and panting.With supplem
entation, it is indicated for coughing after common cold, chronic coughing, allergic
asthma,andbronchialasthmawhenaccompaniedbysweatingandmoderateweakpulses.
CaseReport
The patients constitution was normal.Two weeks ago, after tiring work, he
contractedwind-coldanddevelopedanaversiontocold,fever,panting,andcoughing
withexpectorationofphlegm.Seeingtheseverityofthecondition,hewenttosome
hospitalforasystemetictreatmentasaninpatient.
Bloodroutine:WBC12109/L,N0.80,L0.20.
Chest X-ray: blurred shadowing in the lower right lung. Previous treatments for
pneumoniaformorethan10days(medicationunknown)hadproducednoobservable
efect.
Atthisvisit,thepatientsbodytemperaturewas38.1.Othersignsandsymptoms
included panting, coughing, chest oppression, expectoration of white thin phlegm,
generalized pain, aversion to wind andcold, sweating, and a dark facial complexion.
Histongueappearedpaleredwithathinwhitecoating;pulseswerefloating,thready
andrapid.
Pattern differentiation: wind-cold fettering the exterior, impaired diffusing and
downbearingofthelung.
Treatment principles: resolve the flesh, dispel cold, calm panting and check
coughing.
Formula:GuZhJiHuPXngZTng.

Threedoses.
The fever, aversion to cold and generalized pain disappeared, and the coughing
andpantingwererelieved.Thepulsesbecamefloatingandweak.Anotherfivedoses
wereappliedtoreinforcethetreatmentefect.
Theconditionwasresolvedafteroneweek.
[Reference:WeiYan-zhi. Cases of Gu Zh Ji Hu P Xng ZTng inTreating Lung System
Diseases.ForumonTraditionalChineseMedicine.2001,16 (5):8.]
Gu Zh Ji F Z Tng (Cinnamon Twig Decoc tion plus Aconite)

Pattern
Source Text
Line20

Intaiyangdisease,afterpromotingsweating,ifincessantsweatleakingoccurs,and
the person develops aversion to wind, difficult urination, and slight hypertonicity of
thelimbswithdifcultybendingandstretching,GuZhJiFZTngisindicated.
Formula
fz 1pc RadixAconitiLateralis(blast-fried,peeled,splitintoeightpieces)
Decoct the above six ingredients with 7 sheng of water until 3 sheng remains.
Discardthedregsandtakeoneshengwarm.
ThisformulaisoriginallyreferredtoasGuZhTngwithSupplementalFZ.
Care-takingmethodsarethesameasmentionedpreviously.
Interpretation
This line discusses the pattern and treatment of yang deficiency with leaking
sweatduetoexcessiveapplicationofthesweatingmethod.
Intaiyangdisease,excessivesweatingwillimpairtheweiyang.Whentheexterior
is not secured, incessant leaking of sweat occurs, which causes exhaustion of yin-
fluids and an eventual result of yin and yang dual deficiency. Deficient yang causes
inhibited qi transformation, and deficient yin leads to scant fluids in the bladder,
therefore the urine is scant and inhibited.Yin and yang deficiency also causes
malnourishmentofthesinewsandvessels,leadingtoslighthypertonicityofthelimbs
withdifficultystretchingandbending.Aversiontowindthatappearsafterpromoting
sweatingindicatesthattheconditionhasbecomeaggravated.Yangisdamaged,and
theintersticesareinsecure.
Althoughthepathodynamichereisyinandyangdeficiency,theprincipalaspect
involvesyang deficiency with insecurity of the exterior.The treatment principle is to
supportyangandresolvetheexterior.GuZhJiFZTngisindicated.
FormulaAnalysis
Theformulaiscomposedof GuZhTngwithonepieceofblast-fried fzanda
heavierdosageofzhgnco.
Gu ZhTng resolves the flesh, dispels wind, and regulates ying and wei. F z
warmsthechannels,restoresyang,securestheexterior,andcheckssweating.
Oncethepathogenicqiiseliminatedandyangisrestored,bodyfluidswillrestore
spontaneouslyastheconditionresolves.
This formula is the most effective in treating yang deficiency with excessive
sweating.Inadditiontothecommoncold,indicationscanalsobeexpandedtoinclude
leakage of essence, fluids, and blood, such as exist in seminal emission, enuresis,
epistaxis, leukorrhea, and allergic rhinitis, as long as the pathodynamic involves
exterioryangdefciencywithinsecurity.
CaseReport
Male,age38.
Chiefcomplaint:highfever,aversiontocold,headache.
At2p.m.thepreviousday,thepatientwasprescribedasonedoseofDQngLng
Tng (Major Green Dragon Decoction,). His fever was slightly abated after
mild sweating.The family was eager for the fever to abate completely, so aWestern
physician was sent for, and nearly 1 g dipyrone was injected around 6 pm.This
resultedinincessantleakingofsweat.At12pm,thepatientpresentedwithabright
whitefacialcomplexion,generalizedcoldsweat,coldlimbs,soreachingbodyandlimbs,
huddledaversiontocold,slightlyrapidbreathing,andshortroughvoidingofurine.
T: 36.5, BP: 75/49 mmHg. His tongue appeared pale with a thin white and
slightlydrycoating;pulsesweredeepandthready.
Patterndifferentiation:taiyangandshaoyincombinationdisease,yindeficiencyand
fuiddamage.
Treatment principles: urgently warm the channels, restore yang, secure the
exterior,andchecksweating.
Formula:GuZhJiFZTng.
shngjing 6g RhizomaZingiberisRecens(cut)
hifz 15g RadixAconitiLateralisDenigrata
After one dose, the sweating was remarkedly reduced, and the limbs became
warmer.BP:94/60mmHg.
The next day, the dosage of f z was reduced to 9 g. After another dose, the
sweatingwascheckedcompletely.BP:101/72mmHg.
[Reference: ZhuYu-shan. Applied Gu Zh Ji F ZTng inTreating 100 Cases of Exterior
Deficiency with Leaking Sweat 100. Forum onTraditional
ChineseMedicine.1991,6(3):13.]
Gu Zh Xn JiTng (Newly Supplemented CinnamonTwig Decoction)

Pattern
Source Text
Line62

After a sweating treatment, with generalized pain and deep slow pulses, Gu Zh
XnJiTng(GuZhTngwithshoyo1liang,shngjing1liang,andrnshn3liang)
isindicated.
Formula

rnshn 3liang RadixetRhizomaGinseng
Decocttheabovesixingredientswithonedouand2shengofwateruntil3sheng
remains.Discardthedregs.Takeoneshengwarm.
Interpretation
This line discusses the pattern and treatment of qi and ying impairment that
resultsfromexcessiveapplicationofthesweatingmethod.
In taiyang disease, after sweating, the exterior pattern should be resolved and
thereshouldnotbegeneralizedpain.So,withtheprescenceofgeneralizedpain,the
pulsehastobetakenintoconsideration.Deeppulsesindicateinteriorconditions,and
slowpulses reflect deficiency of qi and blood.This shows us that after sweating, the
generalized pain is a result of deficient qi and blood that fails to nourish the limbs.
Propertreatmentshouldsupplementqiandbloodwhileregulatingyingandwei.Gu
ZhXnJiTngisindicated.
FormulaAnalysis
ThisformulaconsistsofGuZhTngwithrnshnandheavierdosageofshoyo
andshngjing.
GuZhTngharmonizesyingandwei,shoyonourishesyingblood,andrnshn
supplementsqi.
Shng jing guides the medicinal effect to the exterior in order to relieve the
generalizedpain.
The indication of this formula covers the following diseases with the pattern of
ying-weidisharmony,andqiandyingdeficiency:postpartumpain,senilegeneralized
pain, diabetes with generalized itching, morning sickness, and common cold due to
yangdefciency.
CaseReport
Female,age38.
One week after childbirth, the patient suffered from generalized muscle aching
that was aggravated by cold. Other signs and symptoms included hypertonicity and
painaroundtheumbilicusinthelowerabdomenthatcouldberelievedbywarmth,a
lusterlessfacialcomplexion,shortnessofbreath,fatigue,sweatingatslightexertion,
aversion to cold, and cold limbs.The patient reported profuse blood loss after
childbirthwith sweating, palpitations and shortness of breath. Her tongue appeared
palewithawhitecoating;pulsesweredeep,faint,andforceless.
Patterndifferentiation: ying-blooddeficiency,deficiencytaxationwithabdominal
urgency, malnourishment of sinews and vessels, exterior deficiency with aversion to
wind.
Treatmentprinciples:beneftqi,nourishying,relaxtension,andcheckpain.
Formula:GuZhXnJiTng.
shoyo 40g RadixPaeoniae

rnshn 15g RadixetRhizomaGinseng(decoctedseparatelyandinfusedlater)

Onedecocteddoseperday,takenintwodividedportions.
After five doses, the hypertonicity relaxed, and her physical strength, appetite,
sleepandfacialcomplexionimproved.
Theconditionresolvedcompletelyafteranotherfvedoses.
[Reference:LiuYing.AppliedGuZhJiShoYoShngJingGYLingRnShnSnLingXn
JiTng.ChineseCommunityDoctors.2009,25(5):20.]
Taiyang Cold Damage
PrimaryPattern
MHungTng(EphedraDecoction)Pattern

Source Text
Line35

Fortaiyangdiseasewithheadache,fever,generalizedpain,lumbarpain,jointpain,
aversiontowind,andpantingwithoutsweating,MHungTngisindicated.
Formula
mhung 3liang HerbaEphedrae(nodesremoved)
xngrn 70pcs SemenArmeniacaeAmarum(skinandtipsremoved)
Decoctthemhungwith9shengofwateruntil7shengremains.Scoopoffthe
foam,andaddtheothermedicinals.Decoctuntil2.5shengremains,anddiscardthe
dregs.Take8gewarm.Coverthepatienttopromoteslightcontinoussweating;noneed
totakeporridge.Theothercare-takingmethodsarethesameasthoseofGuZhTng.
Interpretation
Thislinediscussesthechiefmanifestationsandtreatmentoftaiyangcolddamage.
Whenwind-coldinvadesthetaiyangchannel,theexteriorisblockedandweiyang
isconstrained.Astheuprightqicontendswiththepathogenicqi,headache,feverand
aversiontowind-coldappear.Absenceofsweatingisthecharacteristicsignofacold
pathogenicqifetteringtheexteriorandconstrainingtheinterstices.
Coldisayinpathogenicqiwhichcausescontracture,thuscoldinvasionwilllead
to ying-yin stagnation, malnourishment of the muscles and joints, and channel-qi
inhibitionleadingtogeneralizedpain,lumbarpain,andjointpain.
Thelunggovernsqiandconnectstotheskinandbodyhair,sowind-coldattacking
the exterior will impair normal diffusing and downbearing of the lung and result in
panting.
RefertoLines1and3;theassociatedpulseforthispatternshouldbefloatingand
tight.MHungTngisselectedtopromotesweatingwithacridityandwarmth.
FormulaAnalysis
M HungTng is a drastic-acting formula used for resolving the exterior and
promotingsweating.
M hung promotes sweating with acridity and warmth, diffuses the lung, and
calmspanting.
Gu zh resolves the flesh, dispels wind, and asissts m hung in promoting
sweating.
Xngrndownbearsqi,calmspanting,andassistsmhungtocalmpanting.
Zh gn co harmonizes all formula medicinals while also preventing excessive
sweatingfromdamagingfuids.
Taiyang cold damage and wind strike are both exterior patterns. Taiyang cold
damage is characterized by panting with an absence of sweating, floating and tight
pulses, generalized pain, lumbar pain, and obvious joint pain. Taiyang wind strike
is characterized by spontaneous sweating and floating moderate pulses; with wind
strikethegeneralizedpainislesssevereandpantingisgenerallynotpresent.
ThispatternandtheGuZhJiHuPXngZTngpatternbotharecharacterized
bypanting.TheMHungTngpatternischaracterizedbypantingwithnosweating,
whiletheotherischaracterizedbypantingwithsweating.
Theindicationsforthisformulaincludethefollowingdiseasesasassociatedwith
patterns of wind-cold exterior excess: common cold, influenza, pediatric fever, and
bronchiaasthma.Itisalsoindicatedforrheumatoidarthritis,urticaria,psoriasis,acute
nephritis, lobar pneumonia, and trigeminal neuralgia when associated with patterns
ofwind-coldfetteringtheexteriorandimpairedlungdifusinganddownbearing.
CaseReport
Male,age50.
Thepatientcontractedwind-coldonabusinesstripinthewintertime.Hedeveloped
afeveratnightwithT39.8,severeaversiontocoldandshivering,generalized joint
pain,andincessantcoughing;therewasnosweating.Histonguecoatingwasthinand
white;pulseswerefoating,tightandforceful.
Patterndiferentiation:taiyangcolddamagewithexteriorexcess.
Treatment principles: promote sweating with acridity and warmth, resolve the
exterior,anddissipatecold.
Formula:MHungTng.
Onedose.Coverthepatientwithclothesandblankets.
Aftersweating,thepatientrecoveredimmediately.
ConcurrentPatterns
GGnTng(PuerariaDecoction)Pattern

Source Text
Line31

For taiyang disease with stretched stiffness of the nape and back, an absence of
sweatingandaversiontowind,GGnTngisindicated.
Formula

mhung 3liang HerbaEphedrae(noderemoved)
ggn 4liang RadixPuerariaeLobatae
Decoctthemhungandggnwithonedouofwateruntil8shengremains.Scoop
offthewhitefoamandaddtheothermedicinals.Decoctuntil3shengremains.Take
oneshengwarm.Coverthepatienttopromoteslightcontinuoussweating.
Thecare-takingmethodsandprohibitionsarethesameasthoseofGuZhTng.
Alltheotherdecoctionsarealsolikethis.
Interpretation
Thislinediscussesthepatternandtreatmentoftaiyangcolddamagewithtaiyang
channel-qiconstraint.
Anaversiontowindwithanabsenceofsweatingindicatestaiyangcolddamage.
Theinabilitytobendandstretchthenapeandbackindicateswind-coldfetteringthe
exterior,andobstructeddistributionofbodyfluids.Treatmentshouldresolvetheexterior,
promotesweating,upliftfuids,andsoothethechannels.GGnTngisindicated.
FormulaAnalysis
ThisformulaconsistsofGuZhTngwithaddedggnandmhung.
ThedosageofguzhandshoyoinGuZhTngisreduced;however,theadding
ofmhungenhancesthesweating-promotingandpathogenicqi-dispellingactionsof
theformula.
G gn uplifts fluids, soothes the channels and assists m hung and gu zh to
resolvetheexteriorandabatetheinternalheat.
Inthispattern,stretchedstiffnessinthenapeandneckispresent,buttheselected
formulaisnotMHungTngplusggn.ThereasonforthisisthatMHungTng
promotessweatingdrastically,andover-usecandamageyin.GuZhTngwithadded
ggnandmhungcandispelpathogenicwind-coldwithoutdamagingyinthrough
excessivesweating.
ThispatternandtheGuZhJiGGnTngpatterninLine14bothmanifestwith
stretchedstiffnessofthenapeandneck.Thekeyheretodifferentiateisthepresence
ofsweating.
Thisformulaiscommonlyappliedinthetreatmentofinfluenza,acutebronchitis,
pneumonia, allergic rhinitis, enteritis, intestinal cold, neuropathic headache, acute
lowerbackstrain,cervicalspondylosis,andfrozenshoulder.
CaseReport
Male,age38.
Chiefcomplaint:intractablehemicraniafor2years.
A right-side headache radiated to the forehead and eye bone. Other signs and
symptomsincludedaversiontocold,absenceofsweating,clearnasalmucus,vexation,
aredface,dizziness,blurredvision,andpoorsleep.
At the visit, the patient showed difficulty in turning his neck. He complained of
constanthypertonicityoftheneck,napeandbackthatbecameaggravatedwiththe
onset of the headache. His tongue appeared pale with a white coating; pulses were
foatingandslightlyrapid.
Patterndifferentiation:pathogeniccoldsettlinginthetaiyangchannel,channel-qi
inhibition.
Treatment principles: promote sweating, dispel pathogenic qi, and free the
channel-qi.
Formula:GGnTng.

dzo 12pcs. FructusJujubae
Decoctmhungandggnfirst.Scoopoffthefoam.Aftertakingthedecoction,
coverthepatientandavoidexposuretowindandcold.
After three doses, he reported a hot sensation on his back, followed by slight
generalizedsweatingafterwhichtheheadacheandhypertonicitywererelieved.After
15doses,allsymptomsresolvedcompletely.
DQngLngTng(MajorGreenDragonDecoction)Pattern

Source Text
Line38

For taiyang wind strike with floating and tight pulses, fever, aversion to cold,
generalizedpain,absenceofsweating,vexationandagitation,DQngLngTngisindicated.
Withfaintandweakpulses,sweating,andaversiontowind,donottakethisformula,
otherwise reversal counterflow cold of the limbs will occur with jerking sinews and
twitchingfesh.Thisshowsaggravation.
Formula

shgo 1pc GypsumFibrosum(egg-sized,crushed)
xngrn 40pcs SemenArmeniacaeAmarum(skinandtipremoved)
foam,andaddtheothermedicinals.Decoctuntil3 shengremains.Discardthedregs.
Takeoneshengwarm.
Promoteslightcontinuoussweating.Withprofusesweating,applywarmpowder.1
If sweating occurs after taking one portion, cease taking.Taking more will lead to
excessive sweating with yang collapse, and there will be deficiency with aversion to
wind,vexation,agitationandaninabilitytosleep.
Interpretation
Thislinediscussesthepatternandtreatmentoftaiyangcolddamagewithvexation
andagitationduetointernalheat.
Taiyangwindstrikeinthebeginningreferstoageneralcontractionofwind-cold
inthetaiyangchannel.Floatingtightpulses,fever, aversiontocold,generalizedpain
andabsenceofsweatingallindicatetaiyangcolddamage.MHungTngshouldbe
applied.However,withinappropriatetreatment, wind-coldremainsunresolved,yang
qiconstraintgraduallytransformsintoheatandharassestheheart,thusvexationand
agitationoccur.
The pattern involves exterior cold and interior heat, and dual excess of both
exterior and interior. D Qng LngTng should be applied to drastically diffuse the
exteriorpathogenicqiandtodischargeheat.
FormulaAnalysis
ThisformulaconsistsofMHungTngwithadoubleddosageofmhungand
theadditionofshgo,shngjinganddzo.
Mhung,guzhandshngjingpromotesweatingwithacridityandwarmth,and
dissipatecoldtoopentheexteriorblockage.
Shgoisacridandcold,actingtoclearinternalheatandeliminatevexation.Italso
opensyangconstraintalongwithmhungwhilerestrainingitswarminganddrying
nature.
Gncoanddzoharmonizethemiddleandnourishthesourceofsweat.
Working together, these herbs dispel exterior wind-cold, clear internal heat to
resolve all symptoms.The large dose of m hung in this prescription makes it a
drastic sweat-inducing formula, so the decocting and nursing methods should be
strictly followed and with a deteriorated pattern, and first aid should be applied
immediately.
This formula is commonly applied in treating the following diseases when
1 Warmpowder:Akindofpowerforexternaluseandcomposedofmedicinalsforstoppingsweating.
associatedwithexteriorwind-coldandinternalheat:commoncold,bronchitis,asthma,
epistaxis,sweatglandobstruction,andrheumatoidarthritis.
CaseReport
Male,age14.
Chiefcomplaint:aversiontocoldandfeverfor5days.
Western medicine to resolve fever and pain were applied along with JiWi
Qing HuTng (Nine Ingredients Notopterygium Decoction, ) with no
observableeffect.Therewasaversiontocold,fever(T39.1),headache,generalized
pain with no sweating, joint pain, a painful expression, vexation, agitation,
restlessness,andanoccasionalweakcough.Histonguewasredwithaslightlyyellow
coating;pulseswerefoatingandtight.
BloodroutinetestingandchestX-raysshowednoabnormality.
Pattern differentiation: pathogenic cold fettering the exterior with unresolved
interiorheat.
Treatmentprinciples:resolvetheexterior,andclearinternalheat.
Formula:DQngLngTng.
shngshgo 30g GypsumFibrosumCruda
shngjing 3pcs RhizomaZingiberisRecens
Onedecocteddose.
Thefeverabatedwithgreatgeneralizedsweating.Thecoughingwaschecked,and
vexationresolved.Theconditionwasconsideredcuredafterthreedaysofobservation.
[Reference: Zheng Pan. Zheng Qi-zhongs Experience of Applying M HungTng and Similar
Formulas . Chinese Journal of Information onTraditional Chinese
Medicine.2007;41(10):74.]
Xio Qng LngTng (Minor Green Dragon Decoction) Pattern

Source Text
Line40

For cold damage with an unresolved exterior, water-qi below the heart, dry
retching, fever with coughing, thirst, diarrhea, dysphagia, or inhibited urination,

fullnessinthelesserabdomen,orpanting,XioQngLngTngisindicated.
Formula

wwiz 0.5sheng FructusSchisandraeChinensis
gnjing 3liang RhizomaZingiberis
bnxi 0.5sheng RhizomaPinelliae(washed)
xxn 3liang RadixetRhizomaAsari
Decoctmhungwithonedouofwateruntil8shengremains.Scoopoffthefoam,
and add the other medicinals. Decoct until 3sheng remains. Discard the dregs.Take
oneshengwarm.
Interpretation
Thislinediscussesthepatternandtreatmentoftaiyangcolddamagewithwater-
rheumcollectinginternally.
Cold damage with an unresolved exterior suggests that the symptoms of
aversion to cold, fever, tight pulse and absence of sweating remain.Water-qi below
the heart refers towater-rheum collecting in the epigastrium. Cold-rheum harasses
thestomachandcausesstomachqiascending,and dryretchingresults.Exteriorcold
andinteriorrheumimpairthediffusinganddownbearingfunctionofthelung,hence
coughandpantingoccur.
Water-rheum is mobile, resulting in a variety of symptoms.When it collects
internally, qi transformation and fluid engendering is blocked, and thirst occurs.
Whenitmovesdownwardstothelargeintestine,diarrheaoccurs.Whenitblocksthe
qi dynamic and obstructs lung and stomach pathways in the upper body, dysphagia
occurs.When it collects in lower jiao and affects qi transformation of the bladder,
inhibitedurinationandlowerabdominalfullnessoccur.
Thepatternisexteriorcoldandinteriorwater-rheum.ApplyXioQngLngTng
todissipatecoldanddispersewater-rheum.
FormulaAnalysis
Mhungandguzhdissipatewind-cold.
Gnjingandxxnwarmthelungandresolverheum.
Bnxidownbearscounterfowandresolvesphlegm.
Gncosupportstheuprightandharmonizesthemiddle.
Thesemedicinalsareacrid,dissipatinganddrying.Sourandastringentwwiz
andshoyoareaddedtoprevent lungandkidneyyindepletionandtoprotectthe
uprightqi.
Asawhole,theprescriptiondispelsexteriorwind-coldandeliminatestheinterior
water.
This formula is commonly applied for respiratory system diseases associated
with patterns of exterior wind-cold and internal water-rheum: chronic bronchitis,
emphysema,pulmonaryheartdisease,bronchialasthma,bronchitis,lobarpneumonia,
tuberculo-pneumonia,andchronicrhinitis.
CaseReport
Maleage60.Initialconsultation:October8,2001.
Chiefcomplaint:chronicbronchitisformorethan10years;commoncoldforhalf
amonth.
Manifestations: fever, aversion to cold, coughing, expectoration of profuse thin
whitephlegm,shortnessofbreath,chestoppression,inabilitytolieflat,and absence
ofthirst.Thetonguecoatingwaswhiteandslippery;hispulsesweretight.
Pattern differentiation: wind-cold fettering the exterior, water-rheum collecting
internally.
Formula:XioQngLngTng.
gnjing 6g RhizomaZingiberis
xxn 3g RadixetRhizomaAsari
Aftertwodoses,thepatientwascompletelycured.
[Reference:WangZhen-ping.ClinicalApplicationandConsiderationsofXioQngLngTng
.ShanxiJournalofTraditionalChineseMedicine.2003;19(6):61.]
Review Questions
1. What are the clinical manifestations, pathomechanisms, treatment principles
andtheformulasfortaiyangwindstrike?
2. Whataretheadministrationandcare-takingmethodsforGuZhTng?
3. Whataretheconcurrentpatternsassociatedwithtaiyangwindstrike?Statethe
manifestations,pathomechanisms,treatmentprinciplesandformulas.
4. What are the manifestations, pathomechanisms, treatment principles and

formulasfortaiyangcolddamage?
5. What are the concurrent patterns oftaiyang cold damge with exterior excess?
Statethemanifestations,pathomechanisms,treatmentprinciplesandformulas.
6. HowcanonedifferentiateaGuZhJiGGnTngpatternfromaGGnTng
pattern?
7. WhatarethedifferencesbetweentheDQngLngTngpatternandtheXio
QngLngTngpattern?Comparetheirmanifestations,pathomechanisms,treatment
principlesandformulas.
Section3 TransmutedPatternsof
TaiyangDisease
Treatment Principles
Source Text
Line16

Threedaysaftercontractingtaiyang disease,whensweating,ejection,purgation,
orwarmingneedlemethodshavebeenappliedandtheconditionremains,thisisan
aggravated disease. Gu ZhTng can no longer be applied. Observe the pulse and
signs, know what mistakes have been made, and treat according to the presenting
pattern.
Interpretation
Thislinediscussesthecauses,characteristicsandtreatmentprinciplesfor transmuted
taiyangpatterns.
Severaldaysaftertaiyang diseaseoccurs,andaftersweating,ejection,purgation,
or warming needle methods have been already applied, if the condition remains,
this indicated an aggravated disease ortransmuted pattern. Such patterns are too
complexandvarioustobeclassifiedintothesixchannelpatterns.Theyarenolonger
taiyang exterior patterns, so Gu ZhTng and other exterior-resolving formulas
cannot be used. At this point, one should observe changes in the pulses and other
signs, and understand the progression following inappropriate treatments in order
todifferentiatethecauseofthetransmutedpatternandtoselectthepropertreatment
principlesandformulas.
Transmuted Patterns
WaterAmassment
WLngSn(PoriaFivePowder)Pattern

Source Text
Line71

Intaiyang disease,afterpromotingsweating,withgreatsweating,drynessinthe
stomach, vexation, agitation, an inability to sleep and a desire to drink water, give a
very small amount to drink. Once the stomach qi is harmonized, the condition will
resolve.Iftherearefloatingpulses,inhibitedurination,slightfeverandwasting-thirst,
WLngSnisindicated.
Line74

When wind strike with fever remains unresolved for six or seven days, and
vexation,exteriorandinteriorsigns,thirstwithadesiretodrinkwater,andimmediate
vomiting of ingested fluids are present, this is referred to aswater counterflow. W
LngSnisindicated.
Formula
guzh 0.5liang RamulusCinnamomi(barkremoved)
zhlng 18zhu Polyporus(barkremoved)
zxi 1liang6zhu RhizomaAlismatis
bizh 18zhu RhizomaAtractylodisMacrocephalae
flng 18zhu Poria
Choptheabovefveingredientsfnelyandpestleintopowder.
Take one square cun-spoonful with rice water, three times a day. Drink a great
amountofhotwater.Sweatingindicatesresolution.
Care-takingmethodsareasmentionedpreviously.
Interpretation
Line71discussestwopossibleoutcomesafterexcessiveuseofthesweatingmethod
in taiyang disease; it also states the causes, manifestations, and treatment ofwater
amassment.
Inappropriatesweatinginthetreatmentoftaiyangdiseasecanleadtotwotypesof
changes.First,thepatientpresentswithvexation,agitation,sleeplessness,andthirst
with adesiretodrinkwater.Thisisduetofluiddepletionthatdriesthestomachand
transformsintoheat.Givethepatientalittlebitofwatertoenrichthestomachdryness.
Oncethestomachliquidisrestoredandstomachqiregulated,allsymptomswillresolve.
The patient can also develop floating pulses and a slight fever which indicate
inappropriatesweatingandanunresolvedexteriorpathogenicqi;thirstwithprofuse
fluid intake and inhibited urination indicate an external pathogenic qi entering the
bladder along the foot taiyang bladder channels and resulting in water amassment.
Thisisadual disease of the exterior and interior.Treatment should transform qi and
disinhibitwaterwhilealsoresolvingtheexterior.WLngSnisindicated.
Line 74 discusses the clinical characteristics and treatment of severe water
amassment.
When wind strike with fever remains unresolved for six or seven days, vexation
develops.Feverisanexteriorsign,andvexationaninteriorsign.Thepresenceofthese
symptomsindicates a pathogenic qi contraction affecting both exterior and interior.
Thirstwithadesiretodrinkwaterandimmediatevomitingofingestedfluidsindicate
non-transformation of fluids and water-rheum ascending.This is also referred to
aswater counterflow.The pattern here is water amassment in the bladder and
impairedqitransformation;therefore, inhibitedurinationshouldalsobepresent. W
LngSnshouldbeappliedtoresolvetheexterioranddisinhibitwater.
FormulaAnalysis
Zhlngandzxipercolatedampnessanddisinhibitwater.
Flngandbizhfortifythespleenanddisinhibitdampness.
Guzhfreesyang,transformsqi,andresolvestheexterior.
This formula is commonly applied in the treatment of edema due to chronic
nephritisandhepatocirrhosisaswellasthefollowingdiseaseswhenassociatedwith
patternsofwater-dampnessorphlegm-rheumcollection:acutegastroenteritis,urinary
retention,hydrocephalus,andMenieresdisease.
CaseReport
Female,age25.
Chiefcomplaint:dribblingurinaryblockageafterherfrstchildbirth.
The condition was temporarily relieved by three catheterizations. Manifestations

included sweating, a slight fever ( T 37.5 o C), aversion to wind, lower abdominal
distention, tension of the abdominal wall, an inability to urinate, thirst, and profuse
fluid intake. Her tongue coating appeared thin white and slightly slimy; her pulses
werefoatingandrapid.
Patterndifferentiation:exteriorheatenteringthebladder,urinebindingwithheat,
fuidsfailingtoascend.
Formula:supplementedWLngSn.
zhlng 12g Polyporus
flng 30g Poria
Aftertakingtheformula,sherecoveredalmostimmediately.
[Reference: Jia Xiu-Lin, Jia Fang. Applied Six Channel Pattern Differentiation .
Beijing:PeoplesMedicalPublishingHouse;2002.]
BloodAmassment
To H Chng Q Tng (Peach Kernel Qi-Coordinating Decoction)

Pattern
Source Text
Line106

Inunresolvedtaiyangdisease,ifheatbindsinthebladder,thepersonactsmanic
andbloodexcretesspontaneously;theconditioncanberesolvedwiththeexcretion.
Withtheunresolvedexterior,theattackingmethodcannotbeappliedyet;theexterior
should be resolved first. After resolving the exterior, if there are no other symptoms
other than hypertonicity and binding in the lesser abdomen, then attacking can be
applied.ToHChngQTngisappropriate.
Formula
mngxio 2liang RhizomaAnemarrhenae

dhung 4liang RadixetRhizomaRhei
torn 50pcs SemenPersicae(skinandtipremoved)
Decoctalltheingredientsexceptforthe mngxiowith7shengofwateruntil2.5
shengremains.Discardthedregs,addthemngxio,putthepotbackonthestoveand
bring to a slight boil. Remove the pot from the stove.Take 5 ge warm before meals,
threetimesaday.
Thereshouldbeslightdiarrhea.
Interpretation
Thislinediscussesthepatternandtreatmentofmildtaiyangbloodamassment.
Astheunresolvedexteriorpathogenicqitransformsintoheat,itinvadesinwardly
alongthechannels,andbindswithbloodinthelower jiao.Thisisreferredtoasblood
amassement.
Pathogenic heat and blood contending with one another causes qi and blood to
stagnate,thushypertonicity,bindingandhardnessinthelowerabdomenoccur.The
heartgovernsblood,thevesselsandtheshen.Staticheatsurgingupwardstotheheart
and harassing the shen will cause manic-like behaviors. Other signs and symptoms
shouldincludethirstwithadesiretodrink,constipation,apurpletongue,andrough
deepexcesspulses.
Twodifferentoutcomesofthisconditionarepossible.Ifbloodbindingismild,the
amassedbloodcanbeexcretedspontaneously,andtheconditionwillberesolved.If
the condition is severe, blood-breaking and stasis-attacking method will have to be
applied.However,iftheexteriorisnotresolved,thenthepurgingmethodwillcause
the exterior pathogenic qi to fall inwardly.When the exterior is resolved and there
areonlymanifestationsofbloodamassmentremaining,ToHChngQTngcanbe
appliedtopurgethestaticheat.
FormulaAnalysis
Tornisbitterandneutral;itactstobreakbloodandexpelstasis.
Guzhisacridandwarming;itactstofreethechannelsandmoveblood,assisting
torn.
TioWiChngQTngisbitter,cold,andpurging;itactstoguidethestaticheat
downwards.
As a mild formula for treating blood amassment, this prescription mainly acts to
drainheatanddispelstasis.
Modern clinic indications for this formula cover nervous system diseases like
schizophrenia, post-traumatic brain pattern and stroke. It is also indicated for the
following diseases when associated with patterns of stasis binding with heat: acute
pelvic inflammation, chronic pyelonephritis, prolonged lochia, placenta remnants,
painfulmenstruation,andhysteromyoma.
CaseReport
The patient was excitable and delusional. She randomly grabbed things within
herreachwhiletalkingcontinuouslyandrepetitively.Sometimessheactedchild-like,
tendingtohuganymansheencountered.
She had suffered this recurrent psychopathy for 7 months, and it was strictly
relevant to her menstruation as it would begin and end along with her menstrual
period.Eachepisodelastedforabout2weeks,andthesymptomswerealwaysexactly
thesame.Atthisvisit,theepisodehadalreadylastedforthreedays.
Her facial complexion was reddish and light purple. Other signs and symptoms
included red eyes, a dry mouth, thirst with a desire for cold drinks, vexing heat,
agitation,distendingpainoftherib-sides,constipation,delayedmenstruation,scant
darkpurplemenseswithclots,andasaggingpainofthelumbusandlowerabdomen
at the onset of menstruation. Her tongue was dark red with a crimson tip and
greenish-purplespotsonthemargins,andthecoatingwasyellowanddry;herpulses
werewiry,slippery,andrapid.
Patterndiferentiation:staticheatharassingtheheart.
Formula:ToHChngQTng.
mngxio 15g RhizomaAnemarrhenae(infused)
guzh 9g RamulusCinnamomi(smashed)
dhung 30g RadixetRhizomaRhei(smashed,decoctedlater)
torn 18g SemenPersicae(smashed)
After one dose, she had slight diarrhea; the excited and maniac behavior was
slightlyrelieved.
Thedosageofmngxiowasreducedto10g.Afteranotherfourdoses,themania
and delirium was completely checked and her mental status was becoming more
normal.
Constraint-coursing, stasis-resolving, and menstruation-regulating medicinals
were then applied along with acupuncture treatment. After a total of 129 days of
treatment,hermenstruationwasregulatedandthemaniaanddeliriumdidnotrecur.
Theconditionwasconsideredtoberesolved.
[Reference:DingDe-zheng.ClinicalApplicationofToHChngQTngonPsychopathy
.HenanJournalofTraditionalChineseMedicine.2008;28(3):21-22.]
DDngTng(ResistanceDecoction)Pattern
Source Text
Line124

Sixorsevendaysaftertheonsetoftaiyangdisease,iftheexteriorpatternremains
andthepulseisfaintanddeep,butthereisanabnormalabsenceofchestbindandthe
personpresentsmania,thisisduetoheatinthelowerjiao.Thereshouldbehardness
and fullness in the lower abdomen.With uninhibited urination, the condition will
resolvealongwiththeexcretionofblood.Thereasonforthisisthatthepathogenicqi
movesalongtaiyangchannel,andthereisstaticheatpresentinteriorly.DDngTng
isindicated.
Formula
shuzh 30pcs Hirudo(stewed)

mngchng 30pcs Tabanus(wingsandfeetremoved,stewed)
dhung 3liang RadixetRhizomaRhei(washedwithwine)
torn 20pcs SemenPersicae(skinandtipsremoved)
Decocttheabovefouringredientswith5shengofwateruntil3shengremains,then
removethedregs.Takeoneshengwarm.Withnoexcretion,takemore.
Interpretation
This line discusses the origin, pathodynamic, pattern and treatment of severe
taiyangbloodamassment.
Sixorsevendaysaftertaiyangdiseaseoccurs,iftheexteriorpatternremains,the
pulseshouldbefloating.Faintanddeeppulsesindicateaninwardmovementofthe
pathogenicqi;however,thereisnohardness,fullnessandpainintheepigastricarea
anddiaphragm.Thisindicatesthatthepathogenicqiisnotbindingintheupperbody,
thusthepassagestatesthatthereisanabnormalabsenceofchestbind.
Delirium, mania, hardness and fullness in the lower abdomen and uninhibited
urinationindicatesthatthetaiyangchannelpathogenicqihasmovedinwardalongthe
channeltobindwithstaticbloodinthelowerjiao.Thisstasisandbindingobstructsqi
andblood,whichleadstofaintanddeeppulses.
To break blood, dispel stasis, purge heat, and expel pathogenic qi,D DngTng
canbeapplied.
FormulaAnalysis
Shuzhandmngchngareinsectmedicinalsthatbreakbloodandexpelstasis
drastically.
Dhungandtornreinforcetheblood-movingandheat-clearingeffectforthe
prescription.
Thisformulaisindicatedforcriticalbloodamassment.
Modern clinical application of this formula covers the following diseases when
associated with patterns of severe stasis-heat binding: severe hepatitis hemorrhage,
cerebralthrombosis,strokesequelae,hysteromyoma,amenorrhea,intractablepainful
menstruation,epilepsy,andbloodstasis-typemania.
CaseReport
Male,age58.
Chiefcomplaint:forgetfulnessfor3weeks.
Manifestations: vexation, agitation, forgetfulness, and continual talking. His
tongue appeared static and dark with a thick grimy and slightly yellow coating;
pulseswerewiryandthready.
Patterndiferentiation:staticheatharassingheart-shen.
Formula:DDngTng.
shuzh 9g Hirudo
mngchng 9g Tabanus
dhung 9g RadixetRhizomaRhei(washedwithwine)
Sixdoses.Onedecocteddoseperday.
The patients mental status and memory were greatly improved.The continual
speechsubsided,andhistongueandpulsewerealsoimproved.
After another six doses, he was instructed to take the formula in honey-pill form
foranotherthreemonths;theconditionwasconsideredtoberesolved.
[Reference: Jia Meng-hui, He Xiao-hui. Preventing andTreating Early Stage Senile Dementia
with D DngTng. Journal of SichuanTraditional
Medicine.2006;24(1):40-41.]
HeatPattern
Zh Z ChTng (Gardenia and Fermented Soybean Decoction) Pattern
Source Text
Line76

After sweating-promoting, ejection, and purgation,deficiency vexation occurs

with an inability to sleep. If the condition is severe, the person will toss and turn
incessantlywithanguishintheheart.ZhZChTngisindicated.
Formula
zhz 14pcs FructusGardeniae(split)

xingch 4ge SemenSojae(wrappedwithsilkfoss)
Decoct zh z with 4 sheng of water until 2.5 sheng remains. Add xing ch and
decoctuntil1.5shengremains.Discardthedregs.Divideintotwoportions.Takeone
portionwarm.(Ifvomitingoccurs,takenomore.)
With shortness of breath, Zh Z Gn Co Ch Tng (Gardenia, Licorice and
FermentedSoybeanDecoction)isindicated.
Formula

Decoctthezhzandzhgncowith4shengofwateruntil2.5shengremains.Add
thexing ch and decoct until 1.5sheng remains. Discard the dregs. Divide into two
portions,takeoneportionwarm.(Ifvomitingoccurs,takenomore.)
Withretching,ZhZShngJingChTng(Gardenia,FreshGingerandFermented
SoybeanDecoction)isindicated.
Formula

Decoctthezhzwith4shengofwateruntil2.5shengremains.Addthexingch
anddecoctuntil1.5shengremains,discardthedregs.Divideintotwoportions,take
oneportionwarm.(Ifvomitingoccurs,takenomore.)
Interpretation
This line discusses the pattern and treatment of heat harassing the chest and
diaphragmfollowingsweating,ejectionand/orpurgationmethods.
Exteriorpathogenicqiiscommonlytreatedwiththesweatingmethod;pathogenic
qi in the upper epigastric area is commonly treated with ejection, and pathogenic
qi in the abdominal area is commonly treated with purgation. After such treatment,
although the substantial pathogenic qi is eliminated, surplus heat may remain to
harass the chest and diaphragm with vexation and inability to sleep.With intense
vexingheatcausing severe restlessness,Zh Z ChTngcan be applied to clear heat
andeliminatevexation.
Shortness of breath indicates stomach heat damaging middle qi; Zh Z Gn Co
ChTngisindicated.
Retching and vomiting indicates stomach qi ascending with heat;Zh Z Shng
jingChTngcanbeapplied.
FormulaAnalysis
Zh z is bitter and cold. It clears heat, eliminates vexation and promotes the
downwardmovementofheartfre.
Duchresolvestheexterior,relievesfeveranddownbearsstomachqi.Asapair,
the two ingredients act effectively to clear constrained heat in the chest and treat
defciencyvexationwithanguish.
Zhgncobeneftsqiandharmonizesthemiddle.
Shngjingactstodownbearcounterfowandcheckvomiting.
Modernclinicalapplicationofthisprescriptioncoversthefollowingdiseaseswhen
associated with patterns of heat constraint in the chest and diaphragm: esophagitis,
gastritis,cholecystitis,andneurosis.
CaseReport
Male,age24.
Thepatientsufferedfromcolddamagewith aversiontocold,fever,andheadache
with no sweating. After one dose of M HungTng, he sweated and the condition
wasrelieved.
More than half a day later, he developed vexation and restlessness that became
aggravated over a short period of time, with tossing and turning.There was no
aversion to cold, no fever, and no discomfort in the chest and abdomen. His pulses
wereslightlyfloatingwitharapidquality,especiallyatthecnpositions.Thetongue
appearedredwithawhitecoating.
Patterndiferentiation:surplusheatharassingheart-shen.
Formula:ZhZChTng.
xingch 9g SemenSojae
Decoctthezhzfrst,beforeaddingtheduch.
After one portion, the vexation was slightly relieved. After another portion, all
symptomswereresolved.
[Reference: Health Department of Hubei Province. Selected Cases of Hubei Chinese Medicine.
VolumeOne.Wuhan:HealthDepartmentofHubeiProvince;1978.p.18.]
M Xng Sh GnTng (Ephedra, Apricot Kernel, Gypsum and Licorice
Decoction)Pattern
Source Text
Line63

After sweating is promoted, Gu ZhTng should not be further applied. For
sweatingwithpanting,andanabsenceofagreatfever, MXngShGnTngcanbe
applied.
Line162

After purgation, Gu ZhTng should not be further applied. For sweating with
panting,andanabsenceofgreatfever,MXngShGnTngcanbeapplied.
Formula
shgo 0.5jin GypsumFibrosum
xngrn 50pcs SemenArmeniacaeAmarum(skinandtipremoved)
foam,andaddtheotheringredients.Decoctuntil2shengremains.Discardthedregs,
andtakeoneshengwarm.
Interpretation
This line discusses the pattern and treatment of panting due to pathogenic heat
congestingthelungthatappearsfollowingsweatingandpurgationtreatment.
Beforesweatingorpurgationmethodsareapplied,thepatternisalreadytaiyang
windstrike,sothetreatmentprincipleistoresolvetheflesh,dispelwind,andregulate
yingandwei.Inappropriatesweatingorpurgationcancausethepathogenicqitofall
inwardandcausetransmutedpatterns.
Inthiscase,thepathogenicqifallsinwardandtransformsintoheatthatcongests
the lung.When the diffusing and downbearing function of the lung is impaired,
panting occurs, and sweating is a result of lung heat forcing fluids to discharge
throughpores.Anabsenceofgreatfeverreferstotheabsenceofobviousheatatthe
exteriorofthebody;however,feverorevenhighfeverisquitecommonlyseeninthe
clinic.
Absence of aversion to wind-cold indicates that the pathogenic qi has entered
the interior; it also means that this is not a Gu Zh Ji Hu P Xng ZTng pattern,
noraBiHTng(WhiteTigerDecoction,)pattern.Ratherthantoresolvethe
exterior, in this case the main treatment principle is to clear lung heat. M Xng Sh
GnTngisindicated.
FormulaAnalysis
Mhungandshgoclearlungheatandcalmpanting.Thelargerdosageofsh
gomodulatestheacridandwarmingpropertiesofmhung.
Xngrndifusesanddownbearslungqi,andassistsmhungtocalmpanting.
Gn co calms the stomach, harmonizes the middle and regulates all formula
medicinals.
Modernclinicapplicationofthisprescriptioncoversthefollowingdiseaseswhen
associated with patterns of lung heat congestion: common cold due to wind-heat,
pneumonia,bronchitis,colonitis,rubeola,andenuresis.
CaseReport
Female,age18.
Chiefcomplaint:pantingforfveorsixdays.
Thepatientslippedandfellintocoldwaterandcaughtacoldwhilehewasdrying
hisclothesonatree.Hewasprescribedaformulausingsweat-promotingmedicinals
by another doctor, which resolved the exterior but intense panting ensued. In a
follow-up visit, lung-clearing and qi-disinhibiting medicinals such as shng sh go
(GypsumFibrosum),xngrn(SemenArmeniacaeAmarum),xinppy(FreshFolium
Eriobotryae) were applied along with tin tng l z (Semen Lepidii) but without
observableefect.
On his first visit to my clinic, the patients pulse was slippery and rapid, and his
tonguecoatingwasslightlyyellow.Whileusingshngshgowascorrect,withoutm
hungitwouldbeunbletoalleviatethepanting.
Patterndiferentiation:lung-heat.
Medicinals:shngshgo,xngrn,tintnglz.Mhung4gaddedtotheoriginal
prescription.
Theconditionresolvedaftertwodoses.
[Reference: Chen Ming. Selected Clinical Cases of Liu Du-zhou . Beijing:
AcademyPress;1996.]
G Gn Hung Qn Hung LinTng (Pueraria, Scutellaria, and Coptis
Decoction)Pattern
Source Text
Line34

For a Gu ZhTng pattern of taiyang disease, if the physician inappropriately

applies purgation, and incessant diarrhea occurs with skipping pulses, the exterior
hasnotbeenresolved.Withpantingandsweating,GGnHungQnHungLinTng
isindicated.
Formula
ggn 0.5jin RadixPuerariaeLobatae
hungqn 3liang RadixScutellariae
hunglin 3liang RhizomaCoptidis
Decoct the g gn with 8 sheng of water until 6 sheng remains. Add all other
medicinals, and decoct until 2 sheng remains. Discard the dregs.Take warm in two
dividedportions.
Interpretation
This line discusses the pattern and treatment of diarrhea due to interior heat
accompaniedbyanexteriorpathogenicqi.
IfaGuZhTngpatternistreatedinappropriatelywithpurgation,thepathogenic
qi will sink inwardly to damage the stomach and intestines, causing incessant
diarrhea.To ascertain whether the diarrhea is caused by an exterior or interior
pathogenic qi, we should consider the pulses and other presenting signs and
symptoms.Ifthepulseisracingandskipping,orshortandskipping,eventhoughthe
stomachandintestinesaredamaged,theuprightqiisstillstrongenoughtocontend
withthepathogenicqi.Becausetheexteriorpathogenicqihasnotcompletelyentered
theinterior,aftertheexteriorhasbeenresolved,thediarrheawillcease.
Panting and sweating indicate that pathogenic heat has passed to the interior
causingtransportationfailureofthelargeintestine,hencethediarrhea.Thelungand
thelargeintestine are exteriorly-interiorly related, so the congestion of interior heat
steamsupwards to the lung to cause panting, while also steaming outward to cause
sweating. GGnHungQnHungLinTng shouldbeappliedtoresolveboththe
exteriorandinteriorandclearheat.
FormulaAnalysis
G gn is acrid and cooling. It resolves the flesh, outthrusts heat, and uplifts
stomach-intestinalfuidsandqi.
Hungqnandhunglinarebitterandcold.Theyacttogethertoclearheatand
fortifytheintestines.
Gncoharmonizesthemiddle.
Modern clinical applications of this formula cover various kinds of heat diarrhea,
for example: acute enteritis, infant summer diarrhea, acute bacillary dysentery, and
chronic non-specific ulcerative colitis. It is also indicated for the following diseases
when associated with patterns of exterior pathogenic qi accompanied by interior
heat: bronchial pneumonia, viral pneumonia, epidemic encephalitis B, and viral
encephalitis.
CaseReport
Female,age49.Initialconsultation:May4,1993.
Chiefcomplaint:ffth-watchdiarrheaformorethan3years.
The patient rushed to the bathroom immediately after arising each morning.
Previoustreatmentscouldonlybringtemporaryrelief.TheapplicationofSShnWn
(FourSpiritsPill,)hadonlyaggravatedthedisease.
Manifestations: vexation, agitation, profuse dreaming, a red tongue with a thick
roughyellowcoating,wiryrapidpulses.
Pattern differentiation: constrained wood restraining earth, heat distressing
yangming.
Treatment principles: course and regulate wood and earth, nourish yin, and
clearheat.
Formula:modifedGGnHungQnHungLinTng.
chochnp 6g PericarpiumCitriReticulatae(dry-fried)
dnggup 10g ExocarpiumBenincasae

zoxnt 10g TerraFlavaUsta
chny 6g PeriostracumCicadae
Tenpackswereprescribed.Richandgreasyfoodsandseafoodwereprohibited.
Theconditionwasconsideredtoberesolved.
[Reference:Yang Lian-zhu. Clinical Application of G Gn Hung Qn Hung LinTng
. Journal of Beijing University ofTraditional Chinese Medicine (Clinical Chinese
MedicineEdition).2003;10(4):46-48.]
DefciencyPatterns
Gu Zh G n Co Tng (Cinnamon Twig and Licorice Decoc tion)
Pattern
Source Text
Line64

Afterexcessively promoting sweating, if the person crosses his hands and covers
theheartarea,andtherearepalpitationsbelowtheheartthatdesirespressing, GuZh
GnCoTngisindicated.
Formula
guzh 4liang RamulusCinnamomi
Decoctthetwoaboveingredientswith3shengofwateruntiloneshengremains.
Discardthedregs.Takeasonesingledose.
Interpretation
This line discusses the pattern and treatment of excessive sweating damaging
heartyang.
Sweat is the humor of the heart. Promoting sweating excessively will lead to
heart yang leaking outward along with the sweat, which leads to palpitations with
apprehension.Withheartdeficiency,thepersonfeelstemporaryreliefwhenpressing
ontheheartareawithbothhands.GuZhGnCoTngshouldbeappliedtowarm
theheartyang.
FormulaAnalysis
Guzhentersthehearttoassistyang,andgncosupplementsqiandharmonizes
themiddle.
Combined, the two medicinals act together to transform yang with acridity and
sweetness.
Onceheartyangisrestored,thepalpitationswillresolve.
This is a basic formula for warming heart yang, widely used for cardiovascular
diseasessuchascoronaryheartdiseaseandpneumocardialdiseasewhenassociated
withpatternsofheartyangdefciency.
CaseReport
Male,age39.Initialconsultation:August10,1960.
Chiefcomplaint:palpitationswithheartpainthatrespondedwelltopressure.
Painkillers had produced no effect.The patients urination and defecation were
normal.Hehadfrequent spontaneoussweating.Hispulseswerefaintandmoderate;
thetonguecoatingwaswhiteandslippery.
Patterndiferentiation:defciency-typepain.
Formula:GuZhGnCoTng.
Hispaindisappearedafteronedose.
[Reference: Hu Meng-xian. Efficacy of Shng Hn Ln Formulas . Fujian
JournalofTraditionalChineseMedicine.1964;5:cover3.]
Gu Zh Ji GuTng (CinnamonTwig Decoction with Extra Cinnamon)

Pattern
Source Text
Line117

When warm needling is applied to force sweating, if the needling area contracts
cold and red nodes appear, running piglet disease will arise with qi surging upward
fromthelesserabdomentotheheart.Burnoneconeofmoxaoneachnode,andapply
GuZhJiGuTngwithanextratwoliangofguzh.
Formula

Decoct the five ingredients above with 7 sheng of water until 3 sheng remains.
Discardthedregs.Takeoneshengwarm.
Interpretation
This line discusses the pattern and treatment for running piglet disease due to
heartyangdefciency.
Inappropriateapplicationofwarm-needlingtoforcesweatingwillnotresolvethe
externalpathogenic qi.When pathogenic cold and wind enter through the needling
area,rednessandswellingoccur.Forcingsweatalsocausesheartyangdefciency.
Cold qi from the lower jiao ascends, and running piglet disease results; this is
characterized by a sensation of qi surging from the lower abdomen up to the chest
andthroat.Thepatientfeelsextremelyoppressedandsuffocated,andtheonsetofthis
disease is intermittent. One cone of moxa should be applied on each node to warm
yang and dissipate cold. Gu Zh Ji GuTng should also be applied to warm and
supplementheartyang,calmthesurginganddownbearcounterfow.
FormulaAnalysis
Gu zh, gn co, shng jing and d zo warm and supplement heart yang and
downbearsurgingcounterfowwithacridityandsweetness.
Shoyoandgncotransformyinwithsournessandsweetness.
This formula can be used to treat not only running piglet disease, but also other
patterns characterized by surging qi. In modern clinical practice, it is often used
to treat hysteria, neurosis, menopausal syndrome, externally contracted diseases,
diaphragmatic spasm, and Raynauds disease when the presenting pattern involves
heartyangdefciencyandsurgingqicounterfow.
CaseReport
Chief complaint: lumbar and abdominal pain for three years with recently
increasingepisodes.
At each onset there was throbbing in the left lower abdomen followed by qi
rushingupwardtotheepigastria.Therewerealsounbearablenausea,sweatingfrom
thehead,andlassitude.Afewsecondsaftertheinitialonset,therewouldbeqisurging
fromthelumbusalongthebackthatwoulddescendtothelumbusaftertenminutes.It
feltasifsomethingwasoppressingthelumbus,andonlyrubbingandpressurecould
bringtemporaryrelief.Sometimestheqisensationwouldsurgefromthelumbusfora
fewsecondsbeforethesurgingsensationinthelowerabdomenappeared.
During the previous three years, her condition appeared for more than ten days
each month. Over the last year, the frequency of onset had increased to twenty to
thirty times each day. Previous treatments with bothWestern and Chinese medicine
hadproducednoefect.
Accompanying symptoms included irregular menstruation, frequent urination,
and loose stools two or three times a day. Her tongue appeared pale with a white
coating;thepulseswerewiry.
Patterndiferentiation:runningpigletdisease.
Treatment principles: assist yang, disperse cold, calm surging qi, and downbear
counterfow.
Formula:GuZhJiGuTng.

19doses.
The surging qi subsided, and the sweating from the head ceased. Her urination
anddefecationalsobecameregular.
Menstruation-regulatingmedicinalswerethenadded.Afteranother19doses,the
surgingqiwascompletelyresolvedandhermenstruationreturnedtonormal.
Therewasonerelapsethatwastreatedwithmorethan20dosesofGuZhJiGu
Tng.Afterthistreatmentcourse,norelapseswerereported.
[Reference:ShaoGui-hua.FourCaseswith GuZhJiGuTng4.Journal
ofChineseFolkMedicine.2000;8(6):35.]
F L n g G u Z h B i Z h G n C o T n g (C i n n a m o n Tw i g, Po r i a ,

Atractylodes Macrocephala and Licorice Decoction) Pattern

Source Text
Line67

Incolddamage,afterejectionanddefecation,ifthereiscounterflowandfullness
belowtheheart,qisurgingupwardstothechest,dizzinessoftheheadwhengetting
up, and deep tight pulses, promoting sweating will disturb the channels and cause
shakingofthebody.FLngGuZhBiZhGnCoTngisindicated.
Formula
flng 4liang Poria
bizh 2liang RhizomaAtractylodisMacrocephalae
Decoct the above four ingredients with 6 sheng of water until 3 sheng remains.
Removethedregs.Takewarminthreedividedportions.
Interpretation
Thislinediscussesthepatternandtreatmentforspleen-stomachyangdeficiency
with water-qi surging upward that appears following inappropriate ejection and
purgationtreatmentofcolddamage.
Ejection and defecation can both damage spleen yang which leads to abnormal
fluid transportation. Dampness collects and forms phlegm and rheum; rheum and
coldaccumulatinginthemiddlejiaocausesdistention,fullness,andqicounterflowin
theepigastriumwithqisurgingupwardtothechest.Theheadistheconfluenceofall
yang channels.With spleen yang deficiency and rheum obstructing the middle jiao,
clearyangfailstoascendtothehead,thereforedizzinessoccurswithexertion.Deep
andtightpulsesalsorefecttheprescenceofwater-rheum.
Rheumisayinpathogenicqithatcanberesolvedbywarmingandassistingyang;
therefore, Lng Gu Zh GnTng is appropriate. Inappropriate sweating will further
damage yang and cause malnourishment of the channels with shaking of the body.
This is an aggravated pattern of spleen yang deficiency that has led to kidney yang
defciency;suchapatterncannolongerbetreatedwithLngGuZhGnTng.
FormulaAnalysis
FLngdisinhibitswaterwithblandpercolation.
Guzhwarmsyanganddownbearssurging.
Bizhandzhgncofortifythespleenandresolverheum.
Inmodern clinical practice, this formula is frequently applied in the treatment of
rheumatic heart disease, pneumocardial disease, myocarditis, pericardial effusion,
and cardiac failure when associated with water-qi intimidating the heart; acute
and chronic bronchitis due to phlegm and rheum affecting the lung; nephrotic
syndrome, glomerular nephritis and glomerular nephritis due to spleen deficiency
andwatercollection;anddizzinessandeyeproblemsassociatedwithphlegm-rheum
counterfow.
CaseReport
Female,age46.Initialconsultation:October,2004.
Chiefcomplaint:suddendizziness.
Accompanying symptoms included nausea, vomiting, sweating, palpitations and
tinnitus.Hercomplexionwaspale,andthetonguecoatingwaswhiteandgreasy.
Pattern differentiation: dampness obstructing the middle jiao, and clear yang
failingtoascend.
Treatment principles: warm yang, resolve rheum, fortify the spleen, and move
water.
Formula:supplementedLngGuZhGnTng.
flng 10g Poria
xunfhu 10g FlosInulae(wrapped)
Threedecocteddoses.
Thedizzinessdisappeared;atatwo-yearfollow-up,norelapseswerereported.
[Reference:LiXiao-ming.ClinicalCasesTreatedwithLngGuZhGnTng
.ChineseCommunityDoctors.2007;(24):42.]
Xio Jin ZhngTng (Minor Center-Fortifying Decoction) Pattern

Source Text
Line102

Twoorthreedaysaftercontractingcolddamage,withpalpitationsandvexation,
XioJinZhngTngisindicated.
Formula

ytng 1sheng SaccharumGranorum
Decoct the six ingredients above with 7 sheng of water until 3 sheng remains.
Discard the dregs. Add the y tng and return to low heat until dissolved.Take one
shengwarm,threetimesaday.
Forthosesufferingfromvomiting,JinZhngTngcannotbeappliedbecauseof
itssweetness.
Interpretation
This line discusses the pattern and treatment of cold damage due to interior
defciency.
Twoorthreedaysaftercontracting colddamage,whentherearepalpitationsand
vexationnotduetoinappropriatetreatment,thisindicatesqiandblooddeficiencyof
theheartandspleen.Thoughthereisanexteriorpatternpresent,thesweatingmethod
isprohibited.Treatmentshouldfortifythemiddleandregulateqiandblood,and Xio
JinZhngTngisindicated.
FormulaAnalysis
ThisformulaisGuZhTngwithadoubleddosageofshoyoandtheadditionof
ytng.
Gu ZhTng harmonizes ying and wei while also regulating the spleen and
stomach.
Thedoubleddosageofshoyoactstosupplementying-blood.
Y tng warms and nourishes the spleen and stomach, relaxes the middle and
supplementsdefciency.
In modern clinical practice, this formula is often used to treat peptic ulcer,
hyperacidity, hypoacidity, gastroptosis, chronic hepatitis, allergic purpura, anemia,
painful menstruation, childrens nocturia and frequent micturition when associated
withspleen-stomachdefciencyandinsufciencyofqiandblood.
CaseReport
Ms.Li,age38.
Excessivebloodlossduringchildbirthinextremelycoldweatherledtoabdominal
pain with a sensation of the abdomen twitching inwardly.This could be temporarily
relievedbyapplyingheat.Hertongueappearedsoftandpalewithathincoating;her
pulseswerewiryandthready.
Patterndifferentiation:deficientbloodfailingtonourishtheliver,liverrestraining
spleen.
Formula:modifedXioJinZhngTng.

ytng 40g SaccharumGranorum(infused)
Threedoses.
Her abdominal pain disappeared. Other qi and blood supplementing formulas
wereappliedtoreinforcetheefectoftreatment.
[Reference:LiuDu-zhou.NewlyOrganizedSimilarFormulasfromTreatiseonColdDamage
.Taiyuan:ShanxiPeoplesPublishingHouse;1994.p.24.]
Gu Zh Rn Shn Tng (Cinnamon Twig and Ginseng Decoction)

Pattern
Source Text
Line163

In taiyang disease, before the exterior pattern is eliminated, frequent purgagion
willleadtodiarrheawithinteriorheat.With incessantdiarrhea,glomusandhardness
below the heart, and unresolved interior and exterior, Gu Zh Rn ShnTng is
indicated.
Formula

Decoct four of the five ingredients above with 9 sheng of water until 5 sheng
remains.Add guzhanddecoctagainuntil3 shengremains.Discardthedregs.Take
oneshengwarm,twiceindaytimeandonceatnight.
Interpretation
Thislinediscussesthepatternandtreatmentforspleenqideficiency-coldaccom
paniedbyanexteriorpathogenicqiunresolvedfollowinginappropriatepurgation.
In taiyang disease, when the exterior pattern has not been resolved, applying
repeated purgation will impair spleen yang. With an unresolved exterior, fever
and aversion to cold will remain; deficiency of middle yang causes impaired
transportation and transformation which results in incessant diarrhea. Clear yang
failstoascend,andturbidyinfailstodescend;astheqimechanismstagnatesinthe
middlejiao,stomachandepigastricoppressionandfullnessappear.Treatmentshould
warmtheinteriorwhileresolvingbothexteriorandinterior. GuZhRnShnTngis
indicated.
FormulaAnalysis
Thisformulaiscomposedof LZhngTng(Center-RegulatingDecoction, )
withaddedguzh.
LZhngTngwarmsthemiddle,dissipatescoldness,andchecksdiarrhea.
Guzhresolvestaiyangexteriorpathogenicqi.
In modern clinical practice, this formula is widely used in the treatment of
common cold with a weak constitution, or a cold concurring with deficiency-cold
diarrhea. It can also be used to treat chest b-syndrome, chronic superficial gastritis,
atrophicgastritis, gastric and duodenal ulcers, chronic hepatitis, chronic pancreatitis
andchroniccolitiswhentheyareassociatedwithspleen-stomachdeficiencycoldand
turbiddampnessinternalobstruction.
CaseReport
Female,age63.
Thepatientreportedaconstitutionallyweakspleenandstomach.Aftercatchinga
cold,shedevelopedanaversiontocoldwithafever,headachewithnosweating,and
glomus and fullness in the epigastrium.The previous physician had applied acrid-
warmexterior-resolvingmedicinalsaswellasbitter-coldglomus-dispersingformulas.
Aftertakingthemedicinals,sweatingoccurredbuttheexteriorremainedunresolved;
there was frequent diarrhea, aggravated glomus and oppression, gradual loss of
appetite, abdominal pain, and limb reversal. Her tongue coating appeared slippery
andmoistened;pulsesweredeepandfaint.
Chronicspleenyangdeficiencyfollowedbytheinappropriateapplicationofcold
andbittermedicinalscausedthepathogenicqitofallinwards.Impairedspleenyang
aggravatedtheglomusandcausedincessantdiarrhea.
Treatment principles: course and dissipate the exterior, warm and fortify the
middle.
Formula:GuZhRnShnTng.
Twodoses.Drinkonecupofhotporridgeaftertakingtheformula.
Therewasslightsweating,theaversiontocoldandfeverdisappeared,theglomus
wasrelieved,andthediarrheareduced.
Afteranotherthreedoses,allsymptomsdisappearedandthediseasewascured.
[Reference:LiRui-wen,LiQiu-gui.TreatmentwithFormulasfromTreatiseOnColdDamage
.Beijing:ChinaScienceandTechnologyPress;2000.]
ZhGnCoTng(Honey-FriedLicoriceDecoction)Pattern

Source Text
Line177

Forcolddamagewithboundintermittentpulsesandthrobbingandpalpitationof
theheart,ZhGnCoTngisindicated.
Formula
shngdhung 1jin RadixRehmanniae
jio 2liang CollaCoriiAsini
midng 0.5sheng RadixOphiopogonis(coresremoved)
mzrn 0.5sheng FructusCannabis

Decoct eight of the nine ingredients with 7 sheng of clear wine and 8 sheng of
wateruntil3shengremains.Discardthedregs.Addjioanddecoctuntilcompletely
dissolved.Takeoneshengwarm,threetimesaday.
ThisformulaisalsoreferredtoasFMiTng(Pulse-RestoringDecoction,)
Interpretation
This line discusses the pattern and treatment of a cold damage pathogenic qi
passingtoshaoyinwithdefciencyofbothheartyinandyang.
In cold damage, if the pathogenic qi is in taiyang, the manifestations should be
as with an exterior pattern with aversion to cold, fever, and floating pulses. In this
case,abound intermittentpulse withheartthrobbing andpalpitations indicatethat
thepathogenicqihaspassedfromtaiyangtoshaoyin,causingdeficiencyofbothheart
yin and yang. Heartyin deficiencyleads to malnourishment of the heart; heart yang
deficiency causes an inability to invigorate the pulse-qi. Hence, applyZh Gn Co
Tngtosupplementyinandyang,regulateqiandblood,andrestorethepulse.
FormulaAnalysis
Zhgncoisthesovereignmedicinalusedtosupplementthemiddleandbenefit
qi.Onceqiandbloodaregenerated,thepulsecanberestored.
Rnshnanddzosupplementmiddleqiandengenderfuidstoassistzhgnco.
Shngd,midng,jioandmzrnnourishyinbloodandenrichheartyintofll
bloodvessels.
Guzhwarmsandfreestheheartyang.
Shngjingwarmsandfreesthebloodvessels.
Decocting the medicinals in clear rice wine reinforces the channel-coursing and
vessel-freeingactionsoftheformula.
This formula is commonly used in the treatment of a variety of arrhythmias
associatedwithqiandbloodinsufciencyanddualdefciencyofyinandyang.
CaseReport
Female,age73.Initialconsultation:November11,2001.
Chiefcomplaint:palpitationsandedemaofthelowerextremitiesfortwomonths.
One month before being admitted as an in-patient, she was diagnosed with
rheumaticheartdisease,atrialfibrillation,leftventriculardysfunctionandpulmonary
infection.Thepatientreportedthatshehadalsosufferedfromanexteriorlycontracted
condition.
After a half-month of treatment, there was still a lack of strength, fatigue,
an indifferent expression, somnolence, and a poor appetite; there were frequent
palpitations and shortness of breath with an inability to lie flat, edema of the lower
extremities, vexation, and insomnia.The tongue appeared pale and enlarged with a
thinwhitecoating;herpulseswerebound.
Lab tests showed electrolyte disturbances and hyponatremia. ECG showed
frequentsupraventricularprematurecontraction.
Diagnosis upon admission was rheumatic hear t disease, atrial fibrillation,
left ventricular dysfunction, pulmonary infection, electrolyte disturbances and
hyponatremia.
Patterndiferentiation:dualdefciencyofqiandyin.
Formula:modifedZhGnCoTng.

jio 12g CollaCoriiAsini
mzrn 6g FructusCannabis
shngdhung 30g RadixRehmanniae
Onedecocteddoseperday,combinedwithadditionalWesternmedicaltreatment.
After five doses, the palpitations decreased remarkably, and her appetite
increased.
All symptoms were resolved after another five doses.The ECG was normal and
theelectrolyteimbalancehadbeencorrected;sothepatientwasdischarged.
[Reference:ZhiKai-ye.ThreeKindsofNewClinicalApplicationsfor ZhGnCoTng
3.ShanxiTraditionalChineseMedicine.2007;23(4):65.]
ChestBind
D Xin XingTng (Major Chest Draining Decoction) Pattern

Source Text
Line135

Sixorsevendaysaftercontractingcolddamagewithchestbind,heatexcess,deep
tight pulses, and pain below the heart with hardness like a rock when pressing, D
XinXingTngisindicated.
Formula
dhung 6liang RadixetRhizomaRhei(peeled)

mngxio 1sheng NatriiSulfas
gnsu 1qian-spoonful RadixKansui
Firstdecoctthedhungwith6shengofwateruntil2shengremains.Addthemng
xio.Bringtooneortwoboils,thenaddgnsupowder.Takeoneshengwarm.
Ifuninhibiteddefecationoccurs,donottakemore.
Interpretation
Thislinediscussesthepatternandtreatmentofmajorchestbind.
Six or seven days after cold damage, exterior pathogenic qi starts to pass to the
interior. If the person has constitutionally exuberant yang qi, the pathogenic qi will
transformintoheat.Thepatternofchestbindwithexcessheatresultsfromheatand
water binding in the chest and diaphragm. Manifestations include pain in the chest,
diaphragm and epigastrium with hardness and fullness when pressed, and deep
tightpulses. Deep pulses are associated with the interior and water; tight pulses are
associatedwithexcessandpain. DXinXingTng shouldbeappliedtodischarge
heat,expelwaterandbreakbinding.
FormulaAnalysis
Gn su is a drastic medicinal for draining water and expelling rheum, especially
fordrainingaccumulatedwaterinthechestandabdomen.
Dhungdischargesheatandfushesoutexcess.
Mngxiosoftenshardnessandbreakshardness.
Thisformulaisoftenusedtotreatintestinalobstruction,acutecholecystitis,acute
pancreatitis and peritonitis when associated with excess heat, and phlegm-fluids
bindinginthechestandabdomen.Itcanonlybeappliedwhentheuprightqiisnot
defcient.
CaseReport
Female,age36.
Contraceptionwithtuballigationfor3years.OnJuly27,1997,therewassudden
abdominal pain and nausea. No effect was observed after takingWestern medicines
twice.The following morning, there was a fever of 38.5, nausea, vomiting for
six times, persistent dull pain of the entire abdomen, and distention of the upper
abdomenwithtendernessandmildabdominalwalltension.
WBC:22.0109/L,N:0.83.Serumamylase(Winslows):43000u/L.
The patient was admitted with a diagnosis of acute pancreatitis. After treatment
withWesternmedicinefor6days,herconditionshowednoimprovement.
Advice: Exploratory laparotomy; TCM treatment.The patient requestedTCM
treatmentfrst.
Manifestations included fever, nausea, fullness, distention and pain in the
epigastrium with tenderness, anguish, restlessness, thirst, and no defecation for 6
days. Her tongue appeared dry with a black coating; pulses were floating at the cn
positionanddeepatthegunposition.
The patient had a good consitution and a preference for raw cold foods.There
were signs of chronic phlegm and dampness. Her condition was due to substantial
pathogenicqicongealinginthechestanddiaphragm.
Treatmentprinciples:drainheat,expelwater,andbreakbinding.
Formula:DXinXingTng.
dhung 20g RadixetRhizomaRhei(peeled)

mngxio 20g NatriiSulfas
gnsu 6g RadixKansui
Decoctgnsuforfiveminutes.Adddhungandmngxio.Decoctonlowheat
foranotherfveminutes.Discardthedregsandtakewarminonesingledose.
Aftertwentyminutestherewasrumblingintheintestinesandthepatientbegan
to defecate.The first time there were ten pieces of dry hard stool, followed by six
movements of large brown watery stools.The abdominal fullness and pain were
immediatelyrelieved,andthetendernessdisappeared.
Two hours later, there was sense of hunger. After taking 200ml of porridge, the
patientreportedfeelingcomfortableandthenshefellasleep.Earlynextmorning,all
thesymptomswereresolved.
ThepatienttookonedoseofXingShLiJnZTng(CostusrootandAmomum
SixGentlemenDecoction, )toreinforcethetreatmenteffect.Follow-up
visitshaveshownnorelapseofthecondition.
[Reference:LiuHan-ming.TreatingAcutePancreatitiswithDXinXingTng
1.HenanTraditionalChineseMedicine.1999;19(3):14.]
Xio Xin XingTng (Minor Chest-Draining Decoction) Pattern

Source Text
Line138

Forminorchestbinddiseaselocatedjustbelowtheheart,withpainuponpalpation,
andfoatingslipperypulses,XioXinXingTngisindicated.
Formula
hunglin 1liang RhizomaPolygonati
gulu 1largepc FructusTrichosanthis
Decoctguluwith6shengofwateruntil3shengremains.Discardthedregs.Add
theotheringredients,anddecoctuntil2 shengremains.Discardthedregs.Takewarm
asthreedividedportions.
Interpretation
Thislinediscussesthepatternandtreatmentofminorchestbind.
This pattern is often caused by exogenous pathogenic qi passing to the interior,
inappropriate purgation for exterior patterns, or pathogenic heat sinking inwards
and binding with epigastric phlegm. Compared to the major chest bind pattern, the
pathogenic heat-type is less severe. Manifestations include hardness and fullness in
theepigastrium,andwithpainthatoccursonlyuponpressure.Floatingpulsesreflect
internalheat,andslipperypulsesreflectphlegm.Apply XioXinXingTng toclear
heat,fushphlegmandopenbinding.
FormulaAnalysis
Hunglindrainsepigastricheat.
Bnxifushesphlegm,resolvesrheumanddissipatesbind.
Guluresolvesphlegmandopensbindwithsweetness,coldnessandmoistening.
Thisformulaisoftenusedtotreatesophagitis,acuteandchronicgastritis,gastric
ulcer,duodenalulcer,cholecystitis,acuteandchronicbronchitisandacuteandchronic
pneumoniawhenassociatedwithphlegmandheatbindingintheepigastrium.
CaseReport
Male,age58.
Chief complaint: epigastric pain that became aggravated with palpation and
pressure.
There was a soft egg-sized lump at the painful area. Her tongue appeared white
withaslipperycoating;herpulseswerewiry,slipperyandforceful.Thepatientsdiet,
urinationanddefecationwerenormal.
Patterndifferentiation:phlegm-heatcongealinginternally,channelandcollateral
stagnation.
Formula:XioXinXingTng.
hunglin 9g RhizomaPolygonati
bnxi 10g RhizomaPinelliae(washed)
gulu 30g FructusTrichosanthis
Threedoses.
There was large amount of yellow mucus in the stool, her stomach pain ceased,
andthelumpresolved.Theconditionwasconsideredtobecured.
Glomus
D Hung Hung Lin Xi Xn Tng (Rhubarb and Coptis Hear t-

DrainingDecoction)Pattern
Source Text
Line154

Forglomusbelowtheheartthatfeelssoggywhenpressing,andfloatingpulsesat
thegunpositions,DHungHungLinXiXnTngisindicated.
Formula
Soak the two ingredients above in 2sheng of boiled water for a short period of
time.Squeezethedregsanddiscard.Takewarmintwodividedportions.
Interpretation
Thislinediscussesthepatternandtreatmentofheatglomus.
Thisconditionisduetoformlesspathogenicheatbindingintheepigastirum.The
gunpulseisassociatedwiththemiddlejiao,andpathogenicheatcongestinginthe
middleresultsinfloatingpulsesatthe gunposition.Thoughtheheatisexuberant,it
hasnotyetboundwithanysubstantialpathogenicqi.Therefore,thepatientonlyfeels
glomusandblockageoftheepigastriumthatissoftuponpalpation.Thereshouldalso
bevexation,thirstandredtonguewithayellowcoating.ApplyDHungHungLin
XiXnTngtoclearheatanddisperseglomus.
FormulaAnalysis
Dhungdrainsheat,harmonizesthestomach,andopensbinding.
Hunglinclearsheatintheheartandstomach.
Thelight-naturedqioftheselectedmedicinalsactstoclearthe formlesspathogenic
heatfromtheupperbody;toenablethisaction,themedicinalsaresoakedinboiled
waterinsteadofdecoctednormally.
Thisformulaisoftenusedtotreatconjunctivitis,leucitis,childrensacuteaphtha,
acute tonsillitis, acute and chronic gastroenteritis, dysentery, jaundice, epilepsia,
hysteria,hypertension,cerebrovascularaccidentandvariousskininfectionsassociated
withexcessheat.
CaseReport
Chief complaint: glomus and fullness in the epigastrium with no pain upon
palpation. Other signs and symptoms included no desire for food, short voidings
of red urine, dry stools, vexation, dry mouth, dizziness, and tinnitus. She was
diagnosed previously with a vegetative nerve functional disturbance. Her tongue
was red with a white and slippery coating; the pulses were deep, wiry, and slightly
rapid.
Patterndiferentiation:formlesspathogenicheatintheepigastrium.
Treatmentprinciples:dischargeheatanddisperseglomus.
Formula:DHungHungLinXiXnTng.
dhung 3g RadixetRhizomaRhei
Soakinboiledwaterforashorttime.Discardthedregsandtakewarm.
Allsymptomswereresolvedafterthreedoses.
F Z Xi XnTng (Aconite Heart-Draining Decoction) Pattern
Source Text
Line155

Forglomusbelowtheheartwithaversiontocoldandsweating,FZXiXnTng
isindicated.
Formula
fz 1pc RadixAconitiLateralis(blast-fried,peeled,split,decoctedseparately)
Cut the three ingredients. Soak in 2 sheng of boiled water for a short period of
time. Squeeze the dregs and discard. Addf zdecoction.Take warm in two divided
portions.
Interpretation
Thislinediscussesthepatternandtreatmentofheatglomuswithyangdefciency.
Epigastric glomus refers to the heat glomus as mentioned in the previous line.
Pathogenicheatblockstheqimechanismleadingtoepigastricglomusandblockage;
meanwhilethereisaversiontocoldandsweatingwhicharenotduetoanunresolved
exterior pattern, but rather due to yang deficiency in the lower jiao.There is heat in
the heart and stomach and kidney qi deficiency-cold in this case, which is a pattern
of upper body heat with lower body cold.Treat with simultaneous cooling and
warming.ApplyF Z Xi XnTngto drain heat, disperseglomus, support yang and
securetheexterior.
FormulaAnalysis
Dhung,hunglinandhungqnclearheatanddisperseglomus.Soakingthe
medicinalsintheboiledwaterhasthesamefunctionasinthepreviousformula.
Separatelydecoctedfzwarmsthechannelsandsupplementsyang.
Thisformulaisoftenusedtotreatacuteandchronicgastritis,uppergastrointestinal
bleeding,recurrentaphthaandnervousheadacheswhenassociatedwithpatternsof
upperheatwithlowercold.
CaseReport
Male,age28.
The patient suffered from a burning sensation on his back with upper body
sweating,bleedinggums,andvexation.Buthealsofeltcoldbelowthelowerabdomen
as if sitting in cold water.There was penile retraction and scrotum spasms, loose
stools,afrequenturgetourinate,andnocturnalemissionstwicetothreetimesaweek.
Histonguewasredwithawhiteslimyroot;pulseswereslipperyandmoderate.
Patterndiferentiation:upperbodyheatwithlowerbodycold.
Treatmentprinciples:cleartheupperandwarmthelower.
Formula:FZXiXnTng.
fz 12g RadixAconitiLateralis(blast-fried,decoctedonmediumheatfor40mins)
Soak the hung lin, hung qn, and d hung in boiled water for ten minutes.
Discardthedregs,andthenaddthedecoctedfz.
Theconditionwasresolvedaftersixdoses.
Bn Xi Xi XnTng (Pinellia Heart-Draining Decoction) Pattern
Source Text
Line149

Five or six days after contracting cold damage, when retching and fever which
indicate a Chi HTng (Bupleurum Decoction, ) pattern are present, but
purging medicinals are applied instead, if the Chi HTng pattern remains, then
apply Chi HTng. Although purgation is applied, the condition will not become
aggravated.There will be steaming heat effusion and quivering; the condition will
resolvewithfeverandsweating.
If there is fullness and hardness below the heart with pain, this is chest bind. D
XinXingTngisindicated.
If there is fullness without pain, this is glomus. Chi HTng cannot be applied.
BnXiXiXnTngisrecommended.
Formula

Decocttheaboveseveningredientswithone douofwateruntil6shengremains.
Discard the dregs. Decoct again until 3 sheng remains.Take one sheng warm, three
timesaday.
Interpretation
Thislinediscussesthreepossibleoutcomesofinappropriatepurgationtreatment
forashaoyangpattern.
The condition is originally cold damage with an exterior pathogenic qi. Five or
six days later, the pathogenic qi passes inwards, and retching and fever occur.This
indicatesashaoyangpattern,andthisshouldbetreatedwithXioChiHTng(Minor
Bupleurum Decoction,). If purgation is applied instead, there can be three
outcomes:
First, as the condition remains, retching and fever are still present. Chi HTng
canstillbeapplied.Aftertakingthedecoction,theuprightqirisesandcontendswith
the pathogenic qi, resulting in steaming heat effusion and quivering.Steaming
describes the manner in which heat spreads from the interior to the exterior.This
conditionwillresolvewithfeverandsweating.
Second,shaoyangpathogenicheatpassesinwardstobindwithwater-rheuminthe
chest and diaphgram.This is a majorchest bind pattern.There will be fullness and
hardnessintheepigastriawithpain.DXinXingTngisindicated.
Third, if spleen and stomach qi are damaged, the exterior pathogenic qi will
exploit the deficiency and invade inwardly.There will be disharmony of the spleen
and stomach, cold-heat complex, dysfunctional ascending and descending, and qi
dynamicblockagewhichleadtoaglomuspattern.Theglomusandfullnessislocated
intheepigastriaratherthaninthechestandrib-sides.Thisisnolongera half-exterior
half-interiorshaoyangcondition,thusXioChiHTngcannotbeapplied.BnXiXi
XnTng is selected to harmonize the middle, downbear counterflow, and disperse
theglomusandfullness.
FormulaAnalysis
Bnxiisthesovereignmedicinalwhichactstodownbearcounterflow,dissipate
binding,andcheckretching,andgnjingwarmsthespleenanddissipatescold.The
twomedicinalscombinedacttoopenbindingwithacridity.
Hunglinandhungqndownbearstomachqicounterflowwithbitternessand
coldness.
Rnshn,dzoandzhgncosupplementthespleenandstomach.
Thisformulaiscommonlyappliedinthetreatmentofgastroenteritis,pepticulcer,
dysentery, childrens indigestion and gastroptosia as associated with disharmony of
the spleen and stomach, cold-heat complex patterns, dysfunctional ascending and
descending,andqidynamicblockage.
CaseReport
Male,fondofliquor.In1969,hedevelopedretching,vomiting,glomusandoppression
belowtheheart,andsloppystoolsthatoccurredtwotothreetimesaday.Histongue
coatingappearedwhite;pulseswerewiryandslippery.
Patterndifferentiation:liquor-dampnessdamagingthestomach,phlegm-turbidity
aggravatingstomachdefciency.
Treatment principles: harmonize the stomach,downbear counterflow, eliminate
phlegm,anddisperseglomus.
Formula:BnXiXiXnTng.
Afteronedose,thepatientpassedalargestoolcontainingwhiteglueymucus.His
retchingandvomitingweregreatlyrelieved.
Theconditionwasresolvedafterfourdoses.
[Reference:LiuDu-zhou.NewlyOrganizedSimilarFormulasfromOnColdDamage.
Taiyuan:ShanxiPeople'sPublishingHouse;1994.p.93.]
Shng Jing Xi XnTng (Fresh Ginger Heart-Draining Decoction)
Pattern
Source Text
Line157

In cold damage, after sweating, the exterior is resolved; however disharmony in

the stomach, glomusandhardnessbelowtheheart, drybelchingwithfoodmalodor,
water-qibelowtherib-sides,thunderousrumblingintheabdomenanddiarrheacan
occur.ShngJingXiXnTngisindicated.
Formula

Decocttheeightingredientsabovewithone douofwateruntil6 shengremains.

timesaday.
Interpretation
Thislinediscussesthepatternandtreatmentofglomusduetostomachdeficiency
withwater-rheumandfoodstagnation.
Theexteriorpatternofcolddamagemayberesolvedbypromotingsweating,butthe
interiorqiisnotharmonized.Thiscanbeassociatedwithconstitutionallydeficientspleen
andstomachqi,orinappropriateuseofthesweatingmethodthatcausespathogenicqi
tofallinwards.Generallyspeaking,aglomuspatterniscausedbyformlessqiblockage;
it should be full, soft, and painless.Glomus and hardness indicate the presence of
substantial pathogenic qi involvingwater-rheum and food stagnation. However, it is
notpainfuluponpalpation,whichdiferentiatesitfromchestbind.
Water-qibelowtherib-sidessuggestsapathodynamicofwater-rheumcollecting
in the middle; it also refers to a gurgling sound below the rib-sides due to water
contendingwithqi.Spleenandstomachdeficiencywithclearqifailingtoascendand
turbidqifailingtodescendleadstodryretchingwiththemalodoroffood,rumbling
intestines, and diarrhea. Shng Jing Xi XnTng should be used to disperse food,
harmonizethestomach,dissipatewaterandresolveglomus.
FormulaAnalysis
This formula is Bn Xi Xi XnTng with a decreased dosage of gn jing and
addedshngjing.
Shngjingharmonizesthestomach,downbearscounterflow,anddissipateswater-
qitodisperseglomusfullness.Withbnxi,thepairingactstoenhancetheformula
actionofharmonizingthestomach,downbearingcounterfow,andresolvingrheum.
Thispatternandthe BnXiXiXnTngpatternarebothassociatedwitha cold-
heat complex affecting the middle jiao with impaired ascending and descending of
the spleen and stomach and qi dynamic blockage; they both manifest with glomus,
fullness, retching, and diarrhea. However, this pattern is accompanied by water-
rheumandfoodstagnation;themanifestationsincluderumblingintestines,water-qi
belowtherib-sides,anddryretchingwiththemalodoroffood.
Thisformulaiscommonlyappliedinthetreatmentofacuteandchronicgastritis,
acuteandchronicenteritis,pyloricobstruction,gastricandduodenalulcer,gastroptosis,
and vomiting in pregnancy as related to spleen and stomach dysfunction with food
stagnationandrheumcollection.
CaseReport
Male,age50.Initialconsultation:October,1988.
Chiefcomplaint:chronicgastritisandgastroptosisforseventoeightyears.
Recently,duetodietaryirregularities,thepatientexperienced glomusandfullness
belowtheheart as if an object was obstructing the movement of qi. He described it
asbeingasheavyasapieceoflead.Withexertion,therewouldbeagurglingsound.
Other signs and symptoms included retching, nausea, no desire for food, severe
distention after eating, putrid belching, a dry mouth with no desire to drink water,
anddiarrheatwoorthreetimesaday.Thesymptomswouldbecomeaggravatedafter
eatingrichorgreasyfoods.Hisabdomenwassoft,andtherewasagurglingsoundin
the epigastrium.The tongue tip was slightly red, and the tongue coating was white
andslimy;pulsesweredeepandwiry.
Patterndifferentiation:cold-heatcomplex,glomusinthemiddle,non-transformation
ofwater-rheum.
Treatmentprinciples:harmonizethestomachanddissipaterheum.
Formula:modifedShngJingXiXnTng.

fbnxi 10g RhizomaPinelliaePraeparatum
jnijn 10g EndotheliumCorneumGigeriaeGalli
flng 12g Poria
Sixdecocteddoses.
Thediarrheawascheckedanddistentionrelieved.Afterthreeweeksofregulating
medicinals,allsymptomswereresolved.
[Reference: Nie Hui-min. Main Points of Pattern Differentiation andTreatment with Heart-
DrainingDecoctions.WorldTraditionalChineseMedicine.2008;3(2):108-109.]
Gn Co Xi XnTng (Licorice Heart-Draining Decoction) Pattern

Source Text
Line158

For cold damage and wind strike, inappropriate application of purgation will
cause diarrhea for more than ten times daily with non-transformation of food,
thunderous rumbling in the abdomen, glomus, hardness and fullness below the
heart,dryretching,vexationandrestlessness.Ifthephysicianseesthe glomusbelow
the heart and concludes that the condition is not fully eliminated, and then applies
purgation again, the glomus will become aggravated.This is not binding heat, but
deficiencyinthestomachandguest-qiascendingthatcauseshardness. GnCoXi
XnTngisindicated.
Formula
Decoct the six ingredients above with one dou of water until 6 sheng remains.
Discardthedregs.
Decoctagainuntil3shengremains.Takeoneshengwarm,threetimesaday.
Interpretation
This line discusses the pattern and treatment of stomach deficiency with severe
diarrheaduetoinappropriatepurgation.
Forcolddamageorwindstrike,thetreatmentshouldresolvetheexterior.Mistakenly
applyingpurgationwillcausespleenandstomachdeficiency,andexteriorpathogenic
qi will fall inwards. Impaired transportation and transformation causes rumbling
intestinesandfrequentdiarrheawithnon-digestedfood.Turbidyinfailingtodescend
and deficiency qi ascending counterflow cause glomus, hardness and fullness in the
epigastrium,anddryretching,vexationandrestlessness.Ifonemistakenlyconsiders
thistobearesultofinteriorexcessandsofurtherappliespurgation,thiswillaggravate
thedefciencyandthecounterfow.GnCoXiXnTngisindicated.
FormulaAnalysis
This formula is made up of Bn Xi Xi XnTng with an increased dosage of zh
gnco.
Zhgncoharmonizesthemiddleandsupplementsdefciency.
The formula is especially suitable for severe glomus and diarrhea due to spleen
andstomachdefciency.
This formula can be used to treat acute and chronic gastroenteritis, moreover,
accordingtotheexpositiononthroat-anus-genital(hhu,)diseaseinEssentials
from the Golden Cabinet, it is also widely applied for skin and mucosal erosion and
ulceration such as in Behcets syndrome, gonorrhoea, condyloma acuminatum,
dentalulcersandchronicpharyngitisthatareassociatedwithspleenandstomachqi
defciencyanddamp-heatstagnation.
CaseReport
Chiefcomplaint:epigastricpainfortwoyears.
Theconditionwasmildatfirstandwouldonlyoccuralongwithdietaryirregularities.
Itgraduallybecameaggravated,andaftergastroscopicexaminationthepatient was
diagnosedwithchronicsuperfcialgastritis.
Manifestations:epigastricglomusandfullnesswithpain,chestoppression,retching,
hiccoughing,belching,apoorappetite,occasionalacidreflux,andfrequentdiarrhea.
He appeared thin with a pale white complexion, and a soft smooth abdomen with
slight tenderness around the umbilicus. His tongue was pale with a red tip, a thick
coatingandapaleyellowroot;pulsesweredeep,wiryandforceless.
Patterndifferentiation:spleen-stomachdisharmony, cold-heatcomplex,impaired
ascendinganddescending.
Treatmentprinciples:fortifythespleen,beneftqi,anddisperseglomus.
Formula:modifedGnCoXiXnTng.


flng * Poria
bizh * RhizomaAtractylodisMacrocephalae
shrn * FructusAmomi
*Nodosageindicatedinthecasereport.
Sevendoses.Onedecocteddoseperday,takenintwodividedportions.
Thepaindecreasedremarkablyaftertakingthedecoction,anddefecationbecame
normal.
Theformulawas applied for two months, and all symptoms were resolved.There
wasnoreportedrelapseata2-yearfollow-up.
[Reference: Nie Hui-min. Main Points of Pattern Differentiation andTreatment with Heart-
DrainingDecoctions.WorldTraditionalChineseMedicine.2008;3(2):108-109.]
Xun F Di ZhTng (Inula and Hematite Decoction) Pattern

Source Text
Line161

Incolddamage,afterpromotingsweating,ejectionorpurgation,iftheexterioris
resolved, but there isglomus and hardness below the heart andincessant belching,
XunFDiZhTngisindicated.
Formula
xunfhu 3liang FlosInulae

dizhsh 1liang Haematitum
Decocttheseveningredientsabovewithone douofwateruntil6shengremains.
timesaday.
Interpretation
Thislinediscussesthepatternandtreatmentofphlegm-qiglomus.
Incolddamage,althoughtheexteriorpatternhasbeenresolvedthroughsweating,
ejection and purgation, the spleen and stomach qi remain insufficient.This will lead
to impaired transportation and transformation where phlegm-rheum is engendered
internally. Stomach deficiency with qi counterflow results in glomus and hardness
in the epigastria. Stomach deficiency with liver qi ascending results in incessant
belching.XunFDiZhTngshouldbeappliedtoharmonizethestomach,downbear
counterfow,resolvephlegmanddescendqi.
FormulaAnalysis
Xunfhuresolvesphlegmanddescendsqi.
Dizhshsettlestheliveranddownbearscounterflow,alsoassistingxunfhu
tocheckbelching.
Bn xi and shng jing are acrid, warm and dissipating.They dispel phlegm-
rheumanddisperseepigastricglomusandfullness.
Rnshn,zhgncoanddzoacttosupplementdeficiencyofthespleenand
stomach.
This formula is commonly applied in the treatment of intractable hiccoughs,
vomiting, bile reflux gastritis, bile reflux gastritis, reflux esophagitis and morning
sickness when associated with stomach deficiency, phlegm obstruction and liver qi
ascending.
CaseReport
Male,age30.Initialconsultation:April4,1983.
Chiefcomplaint:frequenthiccoughingformorethanthreemonths.
The condition usually occurred after meal with a short and frequent sound with
occasional vomiting. His tongue coating appeared thin and white; the pulses were
wiry.
Pattern differentiation: liver exploiting the stomach, impaired harmonious
downbearingofthestomach.
Treatmentprinciples:settletheliveranddownbearcounterfow.
Formula:XunFDiZhTng.
Theconditionresolvedaftersixdoses.
[Reference:ChenMing.SelectedEfectiveColdDamageCasesfromRenownedPhysicians
Review Questions
1. What is an aggravated disease? How do you interpretobserve the pulse and
signs, know what mistakes have been made, and treat according to the presenting
pattern?
2. Whatisthebasicpathodynamicoftaiyangwateramassment?
3. WhyistherethirstintheWLngSnpattern?
4. WhyuseguzhinWLngSn?
5. Whatisthebasicpathodynamicfortaiyangbloodamassment?
6. WhyistheremaniaintheDDngTngpattern?
7. What are the manifestations, pathogenesis, treatment methods, and formula
medicinalsforthethreeZhZChTngpatterns?
8. InLines63and162,whyuseshgowhenthereisnogreatfever?Whyusem
hungwhenthereisalreadysweating?
9. M HungTng, Gu Zh Ji Hu P Xng Z Tng and M Xng Sh GnTng
patternsallmanifestwithpanting.Howaretheydiferentiated?
10. What are the pulses and signs, pathomechanisms, treatment methods, and
formulasfortheGGnHungQnHungLinTngpattern?
11. WhatarethemanifestationsandpathomechanismsofGuZhGnCoTng?
12. What is running piglet disease? State the pathodynamic and treatment
methods.
13. What are the pathodynamic, main symptom, treatment methods and
prohibitionsofLngGuZhGnTngpattern?
14. Whatarethepathodynamic,manifestationsandtreatmentmethodfortheGu
ZhRnShnTngpattern?
15. Whatarethepathomechanisms,manifestationsandclinicalapplicationforZh
GnCoTng?
16. Whatarethepathomechanismsandmanifestationsofmajorchestbind?
17. What are the pathomechanisms, manifestations and treatment methods for
minorchestbind?
18. What are the manifestations and pathomechanisms of the D Hung Hung
Lin Xi XnTng and F Z Xi XnTng patterns? Describe the administration
methodsforthesetwoformulas.
19. Whatarethesimilaritiesanddifferencesintheorigin,pathodynamic,patterns
andtreatmentmethodsfortheBnXiXiXnTng,ShngJingXiXnTngandGn
CoXiXnTngpatterns?
20. Howcan one differentiate theXun F Di ZhTngpattern from theShng
JingXiXnTngpattern?
261
Chapter3
Pulse, Pattern, and Treatment of Yangming
Disease
Yangmingincludesthefootyangmingstomachandhandyangminglargeintestine,
which stand in an interior-exterior relationship with the foot taiyin spleen and the
handtaiyinlung,respectively.
The foot yangming channel begins from the depressions at both sides of the
dorsum nasi, connects with the eyes, passes through supraclavicular fossa, and then
descendsalongthechestandabdomentoreachthefeet.Thehandyangmingchannel
startsfromthelateralsideoftheindexfingerandrunsalongthearmandneckuntilit
reachestheface.
Thestomachresidesinthecentralregionalongwiththespleen,andtheirchannels
connectthroughthecollateralsoftheirrespectiveorgans.Thestomachgovernsintake
anddecomposition,andthenormaldirectionofstomachqimovementisdescending;
it likes moisture and is averse to dryness.The spleen governs transportation and
transformation, and the normal direction of spleen qi movement is ascending; it
likesdrynessandisaversetodampness.Thelargeintestinegovernsconveyanceand
transformationofwaste,whichdependsuponthepurifyinganddescendingactionof
lungqiandthedistributionoffuids.
Therefore,onlywhen yangmingandtaiyincoordinateandassistoneanothercan
theprocessoffoodintakeandsubsequentdecomposition,absorptionandexcretion
becompleted;thus,theessenceoffoodcannourishtheentirebodyandpromotethe
transformationandengenderingofqiandblood.Forthisreason,yangmingisreferred
to as the channel most abundant in qi and blood, and the spleen and stomach are
consideredastherootofpost-heaven(thebasisoftheacquiredconstitution).
PathodynamicandPatterns
Yangmingisexuberantinyangqiandthuscontendswithpathogenicqiforcefully.
Whenpathogenicqiinvadesyangming,itfrequentlytransformsfromheattodryness.
Therefore,yangmingdiseaseisusuallycharacterizedbydryness-heatorexcessinthe
stomachandlargeintestine.Thepresentingpatterncanbefurtherdifferentiatedinto
twomaintypes:heatpatternsandexcesspatterns.
Ayangmingheatpatternischaracterizedbypathogenicheatspreadingthroughout
thebodywithstomachheatexuberance.Manifestationsincludegreatgeneralizedheat,
profusesweating,vexation,andthirst;pulsesarefoatingandslippery,orsurgingandlarge.
Whenpathogenicdryness-heatcontendswiththeintestinalwaste,drystoolsareformed
andbowel-qimovementisaffected;thisisayangmingexcesspattern.Manifestationsalso
include tidal fever, delirious speech, inability to defecate, and abdominal distention
and fullness with pain (also known as pain around the umbilicus). Pulses are deep,
excessandforceful.Theinabilitytodefecateisassociatedwithspleenconstraintorfluid
exhaustion,alsoascribedtotheyangmingexcesspattern.
Additionally,inyangmingdisease,whenunresolvedpathogenicheatcombineswith
taiyinspleendampness,damp-heatwillsteaminternallyandaffectthecoursingand
dischargingfunctionoftheliver;thegallbladderthenfailstomaintainitsnormalpathwayand
fowsoutwards.Asaresult,generalizedheat,yellowing,andinhibitedurinationmayoccur.
Whenintenseyangmingheatentersdeeplyintothebloodlevel,therewillbedry
mouth,washingthemouthwithwaterwithoutadesiretoswallowit,andnosebleed.
PassageandTransmutation
Yangmingdiseasecanbesummarizedasbelongingtotwogeneraltypes.
Thefirsttypeisaconditionthatoriginateswithinthechannel.Thesepatternsare
commonlyassociatedwithconstitutionalyangexuberanceanddryness-heatinvading
yangmingdirectly;alsoreferredtoaszhengyangyangming.
The other type involves channel passage. For example, improper treatment of a
taiyangdiseasecancausefluiddamagetransformingintodrynesswithpathogenicqi
passingtoyangming;thisisreferredtoastaiyangyangming.
Inappropriately promoting sweating and urination in the treatment of shaoyang
diseasecanalsodamagefluidsandtransformtheconditionintoayangmingdisease,
referredtoasshaoyangyangming.
Insometaiyindiseaseswhenthevisceralpathogenicqipassesbacktothebowels,
this is an internal condition reaching outward, a yin pattern changing into a yang
pattern.Inthiscasetherecanalsobehardboundstoolsthatindicateayangmingpattern.
TreatmentPrinciples
Thegeneraltreatmentprincipleforyangmingdiseaseistodispelthepathogenicqi.
Clearingandpurgingmethodsaremostcommonlyapplied.
For yangming heat patterns, apply the clearing method with Bi HTng (White
TigerDecoction,)andthelike.
Foryangmingexcesspatterns,applythepurgingmethodwiththethreetypesof
ChngQTng(Qi-CoordinatingDecoction,)1andthelike.
With fluid depletion and constipation, apply moistening and purging with M Z
1 D Chng QTng (Major Qi-Coordinating Decoction), Xio Chng QTng (Minor Qi-Coordinating
Decoction),andTioWiChngQTng(Stomach-RegulatingQi-CoordinatingDecoction).
VolumeTwo:Chapter3 Pulse,Pattern,andTreatmentofYangmingDisease 263
RnWn(CannabisFruitPill,)andthelike.
Withdamp-heatsteamingandyellowing,clearheatanddisinhibitdampnesswith
YnChnHoTng(VirgateWormwoodDecoction,)andthelike.
Withyangmingbloodamassment,clearheat,moveblood,andresolvestasis.
Withyangmingcoldpatterns,warmthemiddleanddispelcold.
Insummary,inyangmingdiseases,thekeyprincipleistopreservestomachqiand
savefuids.
Section1 OutlineofYangmingDisease
Source Text
Line180

Thediseaseofyangmingisastomach-familyexcess.
Line182

Question:Whataretheexternalsignsofyangmingdisease?
Answer:Generalizedheat,spontaneoussweating,andaversiontoheatinsteadof
aversiontocold.
Line186

Threedaysafterafictionbycolddamage,theyangmingpulseislarge.
Line188

Whencolddamagepassestoyangming,thepersonwillpresentwithslightstreaming
sweat.
Interpretation
Line180istheoutlineofyangmingdisease.Stomach-familyreferstothestomach
and the intestines, andexcess means an excess pathogenic qi.Stomach-family
excess summarizes the pathodynamic of the internal heat and the excess pattern
associatedwithyangmingdisease.
Thesignificanceofthislineinvolvesidentifyingthelocationofthe yangmingdisease
in the stomach and the large intestine, while also giving prominent emphasis to the
pathogenesisoftheexcesscondition.Itisboththefocalpointofpatterndifferentiation
andthecrucialpointintreatmentofyangmingdisease.
Line182demonstratestheexternalsignsofyangmingdisease.Yangmingdisease
refers to patterns involving the interior, heat and excess.The symptoms reflected
externally are calledexternal signs. In yangming disease, the exuberant interior
heattranspirestoexterior,whichmanifestsasgeneralizedheat.Excessivepathogenic
heat drives fluids to leak exteriorly, which manifests as sweating. Since there isno
aversion to cold, there is no taiyang exterior pattern, whereasaversion to heat
indicatesexuberantinternalheat.Aversiontoheatinsteadofaversiontocoldiswhat
diferentiatesyangmingfromtaiyangandshaoyangdiseases.
Line186isthemainpulseofyangmingdisease.Thecontendingbetweenexuberant
uprightqiandtheexcesspathogenicqiisreflectedbyalargepulse.Threedaysafter
beingafflictedby cold damage is a hypothesis. One should not be restricted by the
numbersstatedhere.
Line 188 is the clinical manifestation ofcold damage affecting yangming. Cold
damagewithoutsweatingistaiyangdisease.Ifthepathogenicqipassesto yangming,
thereiscommonlysweatingduetoheatforcingfluidsoutwards.Whenthepathogenic
qi fromtaiyanghasjust passedto yangming, interior heat has formed but is not yet
excessive; this causes the slight streaming of sweat instead of profuse sweating.The
sweatisslightandcontinuous,anothercharacteristicofyangmingdisease.
Thislinerefersonlyonesign,brieflypointingoutthatslightstreamingsweatisa
signofyangming;oneshouldseethisasasmallclueandthusapplyearlyprevention.
Review Questions
1. What isstomach-family excess?What are the significant guiding principles
forpatterndiferentiationandtreatmentofyangmingdisease?
2. Whatarethecausesandmainpatternsofyangmingdisease?
3. Whataretheexternalsignsofyangmingdisease?Whatisthemechanism?
4. Whataretheclinicalmanifestationsofcolddamagepassingtoyangming?
Section2 PatternsofYangmingDisease
Heat Patterns
BiHTng(WhiteTigerDecoction)Pattern

Source Text
Line176

Incolddamage,floatingandslipperypulsesareassociatedwithheatattheexterior
andcoldintheinterior.BiHTngisindicated.
Formula
zhm 6liang RhizomaAnemarrhenae
shgo 1jin GypsumFibrosum
jngm 6ge SemenOryzaSativa
Decoct the above four ingredients with one dou water until the rice is cooked.
Discardthedregs.Takeoneshengwarm,threetimesaday.
Interpretation
Thislinediscussesthepulse,patternandtreatmentofyangmingexterior-interior
heat.Colddamageinthislinereferstogeneralconditionsofexternalcontraction.
Cold in the interior is an unresolved question for cold damage commentators.
Speculating on the pattern according to the formula, a Bi HTng pattern is
characterized by exterior-interior heat.Therefore,cold in the interior should be
consideredasheatintheinterior.
Floatingpulsesindicateheatexuberanceattheexterior,andslipperypulsesindicate
heatscorchingtheinterior,whichshouldbethepriorityfortreatment.Clinically,there
should also be generalized heat effusion, spontaneous sweating, aversion to heat
instead of aversion to cold, vexation, a dry tongue and great thirst with a desire to
drinkwater.BiHTngisappliedtoclearheat,drainfire,engenderfluids,andcheck
thirst.
Shgoisacrid,sweetandgreatlycold;itactstoclear yangmingheatfromtheqi
level.Zhmisbitter,coldandmoistening.Thesetwoingredientsacttogethertoclear
heatsolelyexuberantinyangming,whilealsoengenderingfluidstomoistenbothlung
andstomachyin.
Jngmandzhgncobenefitsqiandharmonizesthemiddle,thuspreventingthe
stomachfrombeingimpairedbygreatlycoldformulas.
This formula can clear lung and stomach heat and nourish yin. It is indicated for
interiorexcessheatpatternscausedbyeitherexternalpathogenicqiorinternalinjury.
In modern clinical practice, this formula is used to treat not only exogenous
pathogenic heat disease, but also miscellaneous diseases due to internal injury
such as epidemic hemorrhagic fever, epidemic encephalitis B, bacterial or atypical
pneumonia,andleptospirosis,aswellasinfluenza,ileotyphus,septicemia,heatstroke,
andnervouspolyphagiaassociatedwithmiddledispersion.
CaseReport
Maleworker,age45.Initialconsultation:Jan19,2001.
The patientreceived2 ndand3 rddegree burns by steam on over 50 of his body.
He was treated with skin transplants on the 7 th day after the injury.Three days after
thesurgery,there was fever, thirst and large amount of fluid intake.With 8000 ml of
fluid infusion, the thirst could not be resolved, urinary output was 8000 ml within
24 hours.Western medical consultation diagnosed this asdiabetes insipidus, and
treatment with vasopressin and hydrochlorothiazide had no effect.Treatments with
Chinesemedicinalstoengenderfluidsandmoistendrynesswerealsounremarkable.
Thesymptomslastedformorethan10days.
At the visit, the surface of wound had mainly healed underneath the scab, and
skinelasticitywasgood.Thepatienthadthirstthatcouldnotberelievedbydrinking,
excessiveurinationbetterinthemorningandworseatnight,aversiontoheatalthough
in winter, a red face with a grimy complexion, a red tongue with dry yellow coating,
andarapidandlargepulse.
Patterndiferentiation:yangmingdryness-heat.
Formula:BiHTng.
Decoctedto300ml,andtakenasasingledose.
Histhirstwasgreatlyimprovedafter4hours,andaftertakinganotherdoseonthe
secondday,allsymptomswereeliminated.
[Reference:Jin Rui-ying. New Clinical ApplicationsoftheClassicalFormulaBi HTng
.GuangmingJournalofChineseMedicine.2007;22(7):37.]
BiHJiRnShnTng(WhiteTigerDecoctionplusGinseng)Pattern

Source Text
Line26

After taking Gu ZhTng and profuse sweating occurs, if there is great vexation
and thirst that cannot be resolved, and the pulses are surging large, Bi H Ji Rn
ShnTngisindicated.
Line168

In cold damage, if ejection or purgation is applied, and the condition remains

unresolvedforanothersevenoreightdayswithheatbindinginteriorlyandexterior-
interiorheatmanifestingwithfrequent aversiontowind,greatthirst,drynessonthe
surfaceofthetonguewithvexation,andthedesiretodrinkseveralshengofwater,Bi
HJiRnShnTngisindicated.
Line169

For cold damage with absence of great heat effusion, dry mouth with thirst,
vexation,andslightaversiontocoldontheback,BiHJiRnShnTngisindicated.
Line170

In cold damage, if there are floating pulses, heat effusion and an absence of
sweating, and the exterior is not resolved, Bi HTng should not be applied. For
thirstwithadesiretodrinkwaterandanabsenceofexternalsigns,BiHJiRnShn
Tngisindicated.
Line222

Ifthereisthirstwithdesiretodrinkwaterandadrymouthandtongue,BiHJi
RnShnTngisindicated.
Formula
shgo 1jin GypsumFibrosum(smashed,brocade-wrapped)
Decocttheabovefiveingredientswithone douof wateruntilthericeiscooked.

Interpretation
Line26discussesthepatternandtreatmentmethodsforexuberantheatdamaging
fuidsafterpromotingsweating.
Forthetaiyangwindstrokepattern,GuZhTngshouldbeappliedtoresolvethe
musclelayer,promotesweating,andharmonize yingandwei.However,thesweating
produced should be generalized and mild. Profuse sweating indicates an improper

application of the sweating method.The body fluids are impaired by exuberant
internalheat.
Great vexation and thirst refers to severe vexation and thirst that cannot be
resolved by copious fluid intake.This sign, along with the surging and large pulses
indicate heat exuberance with fluid-qi damage. Although Bi HTng acts to clear
heatwithacridityandcoldness,thefluidandqimaybedifficulttorestore.Therefore,
rnshnisaddedtobeneftqiandengenderfuids.
Line168discussesthepatternandtreatmentofheatbindinginteriorlyanddamaging
fluids. Cold damage should be resolved by promoting sweating. Inappropriate
application of ejection or purgation will lead the external pathogenic qi inward to
damagefluids.Aftersevenoreightdays,theunresolvedinternalheatwillbespread
totheexterior,thusexterior-interiorheatsignswillappear.
Exteriorheatmanifestswithexternalsignsasgeneralizedheateffusion,sweating,
and aversion to heat instead of aversion to cold. Interior heat manifests with a dry
tongue,greatvexationandthirstthatdonotresolve,andadesiretodrinkseveralsheng
ofwater.Thesignoffrequentaversion to wind is associated with excessive sweating
damagingweiqi.
Bi H Ji Rn ShnTng can be applied to clear heat, benefit qi and engender
fuids.
Line169isasupplementtothepatternandtreatmentofyangmingheatexuberance
with fluid and qi damage. Cold damage with no great heat refers to an absence of
greatheateffusionattheexterior;apathogenicqiintheyangmingcausesexuberant
interiorheat.Whenthisheatdamagesfluids,drymouthwiththirstoccurs;whenthe
heatpathogenicqiascendsupwards,vexationandrestlessnessoccur.
Aversion to cold in such a pattern of great heat is associated with excessive
sweating that impairs exterior qi.Thisaversion to cold is usually mild and localized,
most commonly seen on the back.This manifestation should be differentiated from
theaversiontocoldintaiyangdisease,whichiscommonlyseenwithfloatingpulses,
headacheandapainfulstifnape.
Line170discussestheprohibitionsandcontraindicationsforBiHTng.
Incolddamage,floatingpulses,heateffusionandanabsenceofsweatingindicate
anunresolvedexteriorpattern.Thepropertreatmentmethodistopromotesweating
andresolvetheexterior.Ifinteriorheatwithvexationandthirstarepresent,treatment
should still expel the pathogenic qi outwardly, or proper treatment should resolve
boththeexteriorandinterior.BiHTngwillcausepathogenicqitoremaindeeply
within,andtheunresolvedheatwillleadtotransmutation.
When the exterior pattern is resolved and exuberant interior heat is manifesting
withvexation,thirstandadesiretodrink,onlythenshould BiHJiRnShnTng
beapplied.
Line222discussestheindicationsforBiHJiRnShnTngonceagain.
Incolddamage,afterpurgationisapplied,ifpathogenicheatsettlesintheupper
jiao, this is deficiency vexation. If pathogenic heat settles in the middle jiao with
manifestationsofthirstwithadesiretodrinkwaterandadrymouthandtongue,this
isexuberantheatdamagingfuids.BiHJiRnShnTngisindicated.
This formula is widely applied for diabetes mellitus, thyroid crisis, severe hunger
disease, atrophy patterns, and summerheat syncope. Indicators include a vigorous
fever, thirst, vexation, profuse sweating, a red dry tongue, and surging large pulses.
Therecanevenbeshortnessofbreath,lazinesstospeak,andfatigue.
CaseReport
Female,age26.
Thepatient was admitted to surgery for hyperthyroidism. 24 hours after surgery,
the patient suddenly developed vexation, restlessness, delirious ravings, and water-
like diarrhea. Accompanying symptoms included high fever, thirst with desire for
drink,andprofusesweating.Thetongueappearedredwithscantliquidandayellow
coating.Pulseswererapid,defcient,large,andforceless.
Diagnosis:yangmingheatexuberancewithqiandfluiddamage(hyperthyroidism
andpostoperativethyroidcrisis).
Treatmentprinciples:clearheat,eliminatevexation,beneftqi,andengenderfuids.
Formula:BiHJiRnShnTng.
After one dose, all symptoms were greatly relieved. Another three doses were
applied,allsymptomswereeliminatedandthepatientwasdischarged.
[Reference:ZhangBo-ming.2CriticalCasesTreatedwith BiHJiRnShnTng
.HunanJournalofTraditionalChineseMedicine.1990;(3):39.]
Excess Patterns
TioWiChngQTng(Stomach-RegulatingQi-CoordinatingDecoction)

Pattern
Source Text
Line207

Inyangmingdisease,withnoapplicationoftheejectionorpurgationmethods,if
thereisvexation,TioWiChngQTngcanbeapplied.
Line248

Three days after the onset of taiyang disease, if promoting sweating does not
resolve the condition, and there is steaming heat effusion, this is ascribed to the
stomach.TioWiChngQTngisindicated.
Line249

In cold damage, if there is abdominal distention and fullness following ejection,
applyTioWiChngQTng.
Formula

mngxio 0.5sheng NatriiSulfas
dhung 4liang RadixetRhizomaRhei(washedwithclearliquor)
Cutthethreeingredientsabove.Decocttwomedicinalswiththreeshengofwater,
reducetoone shengandremovethedregs.Addthe mngxio;bringtooneortwo
boilsoverlowheat.
Takewarmasasingledosetoregulatestomachqi.
Interpretation
Line207discussesthepatternandtreatmentofanexternalpathogenicqidirectly
invadingyangmingandtransformingtodrynessandexcess.
In yangming disease, if ejection or purgation methods have not been applied
and there is vexation with no vomiting or defecation, this is yangming dryness-heat
harassing the heart.There will also beabdominal fullness and distention.TioWi
ChngQTngcanbeusedtodrainheat,harmonizethestomach,moistendrynessand
softenhardness.
Line 248 discusses the pattern and treatment of taiyang disease transforming to
yangmingafterpromotingsweating.
If a taiyang disease remains unresolved after promoting sweating, this indicates
thatthepathogenicqiispassingtotheinterior.Theclinicalmanifestationsshiftfrom
fever with aversion to cold to steaming fever, which refers to exuberant interior
heat steaming outwardly. From this, we can presume that there will also be slight
streamingsweating.
Although the disease has transformed into a yangming condition, the dryness-
heat has just begun to bind in the stomach and intestine; there is no tidal fever or
abdominal fullness with pain.Therefore, simply useTioWi Chng QTng to drain
heatandharmonizethestomach.
Line249discussesthepatternandtreatmentofabdominalfullnessduetoyangming
dryness-excess.
Incolddamage,theexcesspathogenicqiintheupper jiaomayberesolvedwith
ejection, but the heat accumulation in the large intestine will remain. Ejection also
damages fluids, where dryness easily transforms into excess. Manifestations include
abdominal distention and fullness that is aggravated by pressure and constipation.
TioWiChngQTngcanbeappliedtodrainandpurgethedryness-excess.
If abdominal distention occurs with alternating intensity and a liking of warmth
andpressure,thisindicatesinteriordefciency.TioWiChngQTngisprohibited.
FormulaAnalysis
Dhungfushesexcessheatwithbitternessandcoldness.
Mngxiodrainsheatandmoistensdrynesswithsaltinessandcoldness.
Gncorelaxestensionandharmonizesthemiddle.
Thesethreeingredientscombinedcandrainyangmingdryness-heatinthestomach
andlargeintestine,softenhardness,andfreedefecationwithoutharmingstomachqi.
There are two ways to take this formula; one is totake a small amount warm.
This method is for stomach qi disharmony with delirious speech due to excessive
intake of warming and drying medicinals.With this method of administration, the
stomachqiisharmonizedmoderately.
The other method is totake warm as a single dose as mentioned in Line 207.
This method is for yangming dryness-excess manifesting with abdominal distention,
constipation, vexation, and steaming fever. In this way, dryness-heat can be drained
moredrasticallyincasesofgreaterexcessandfullness.
In modern clinical practice, this formula is commonly applied for diseases
associated with dryness-heat bind and stomach qi disharmony conditions including
acute cholecystitis, chronic cholecystitis with an acute onset, biliary ascariasis, and
acutepancreatitis.
Withsupplementation,thisformulacanalsobeusedtotreatvariousdermatological
diseasesassociatedwithdamp-heatorinternalexcessincludingeczema,urticaria,and
tineapedis.
Diabetes mellitus with yangming interior excess can also be treated with this
formula.
CaseReport
A few days previously the patient had consumed a large amount of cold drinks
and fruits that caused abdominal distention and fullness that were aggravated
with pressure; there was also no defecation for three days. At the visit, the patient
presented a red face and eyes, abdominal distention with pain that was aggravated
with pressure, a red tongue with a yellow slimy coating, and wiry slippery pulses.
X-rayoftheabdomenrevealedseveralfuidlevels.
Pattern differentiation: food stagnation and bowel qi obstruction (intestinal
obstruction).
Formula:TioWiChngQTng.
dhung 30g RadixetRhizomaRhei(washedwithclearwine)
Decoctquicklywith500mlofwater.Take150ml;use200mlforretentionenema.
One hour after administration, a large amount of foul-smelling stools were
passedandtheabdominaldistentionwasrelieved.Therewasfrequentflatus,andthe
epigastricareawassoothed.X-ray(-).Theobstructionwasobviouslyresolved.
[Reference: Cui Su-zhi, Li Fu-qiang.Three Cases of Effective Clinical Application of TioWi
ChngQTng3.TraditionalChineseMedicalScienceForum.1999;14(2):12.]
XioChngQTng(MinorPurgativeDecoction)Pattern

Source Text
Line213

In yangming disease, if the person sweats profusely, as the fluids exit outwardly
the stomach will become dry inside and there will be hard stools.With hard stools,
there will also be delirious speech. Xio Chng QTng is indicated. If the delirious
speechceasesaftertakingoneportion,donottakemore.
Line214

Foryangmingdiseasewithdeliriousspeech,tidalfever,andslipperyracingpulses,
XioChngQTngisindicated.
Formula

hup 2liang CortexMagnoliaeOfcinalis(mix-fried,skinned)
zhsh 3largepcs FructusAurantiiImmaturus(mix-fried)
Decoctthethreeingredientsabovewithfourshengofwateruntiloneshengand
twogeremains.Removethedregs.Takewarmintwodividedportions.
After taking the first portion, there should be defecation; otherwise, take the
remainder.Ifdefecationoccurs,donottakemore.
Interpretation
Line213discussesthepatternandtreatmentofyangmingdiseasewithhardstools
anddeliriousspeech.
Inyangmingdisease,whenexuberantinteriorheatforcesfluidstoleakoutwardly
in the form of sweat, the stomach and intestine become dry, and hard bound stools
occur. Obstructed bowel-qi leads toturbid heat ascending andharassing the heart-
spirit;asaresult, deliriousspeechoccurs.Oncethe dryness-heatisdrainedwith Xio
ChngQTng,thedeliriousspeechwillcease.
Line214discussesthetreatmentofmildyangmingbowelexcesspatterns.
Delirious speech and tidal fever in yangming disease indicates bowel excess and
dryness binding. In theory, this should be treated with D Chng QTng. However,
theslippery,racingandrapidpulsessuggestthatthedryness-excessbindingisrelatively
mild.Therefore,XioChngQTngisappliedinstead.
FormulaAnalysis
Dhungdrainsheatandeliminatesexcess.
Hupandzhshmoveqianddispersefullnesstoassistdhunginpromoting
defecation.
A Xio Chng QTng pattern is milder than that of D Chng QTng, and the
dosagesofzhshandhuparealsosmaller.Therefore,thisformulaisreferredtoas
MinorQi-CoordinatingDecoction.
In modern clinical practice, this formula is commonly applied for intestinal
obstruction, stomach volvulus, acute pancreatitis, acute cholecystitis, acute biliary
ascariasis,ileotyphus,gastriculcer,persimmonstoneinthestomach,acutegastroenteritis,
cerebral thrombosis, Parkinsons disease, bronchial asthma, epidemic meningitis,

encephalitisB,edema,jaundice,urticaria,herpeszoster,andhigh fever, convulsions,
stagnation and accumulation in children, as long as they are associated with mild
interior heat binding in the stomach and intestine. It is also commonly applied for
post-operativecarefollowingabdominalsurgery.
CaseReport
Male,age28.
The patient had been diagnosed with pandemic encephalitis B. Six days after
onset,heat-clearing,toxin-resolvingandyin-nourishingmedicinalshadnoobservable
effect. At consultation, his body temperature was 40.3. Manifestations included
abdominal fullness and slight hardness, incessant hiccoughing, red eyes that were
unabletoclose,anabsenceofsweating,freneticmovementofthelimbs,vexationand
restlessness as if on the verge of mania, a clouded spirit withdelirious speech and
slightreversalcoldofthelimbs.Histongueappearedfreshlyyellowwithafoulslimy
coating;pulsesweredeep,rapidandforceful.Thepatienthadexcretedgreenishblack
waterthepreviousday.
Althoughapathogenicqiresidedintheyangmingwithheatbindandcircumfluence,
thiswasnotgreatexcessandfullness;alsothecoloroftonguecoatingwasfresh. D
ChngQTngwasnotyettobeapplied,ratherXioChngQTngwasprescribedfor
mildharmonization.
After medication the hiccoughing was checked, the stool freed, sweating
promoted and heat abated.The patient regained full consciousness.Yin-nourishing
and stomach-harmonizing medicinals were then applied for further regulation.The
conditionwasthenconsideredtobecured.
[Reference:ChenMing.SelectedCaseRecordsofColdDamagefromRenownedPhysicians
DChngQTng(MajorPurgativeDecoction)Pattern

Source Text
Line238

Inyangmingdisease,afterpurgation,ifthereisanguishandvexationintheheart
anddrystoolinthestomach(family)1,attackingmethodscanbeapplied.
1 TheChineseliterallysays,drystoolinthestomachusingthecharacter wi.Asabove,itreferstothe
spectrumofyangmingdiseaseinthestomach-family.Inthiscasespecifically,fromthenatureofthediseaseand
theformulauseditisclearlyreferringtothelargeintestine.Forconvenienceandclarity,inthesubsequenttext,it
willbetranslateddirectlyasintestine.
With mild abdominal fullness, and stools that are hard at first and sloppy later,
attackingisprohibited.
Iftherearedrystools,DChngQTngisrecommended.
Line239

If the patient has not defecated for five or six days and there is a regular onset
of pain around the umbilicus with vexation and agitation, this indicates dry stool
causinganinabilitytodefecate.
Line215

In yangming disease, delirious speech, tidal fever and an abnormal inability to

eatindicatesfiveorsixpiecesofdrystoolintheintestine.Ifthepatientisabletoeat,
thereisonlyhardness.DChngQTngisrecommendedforpurgation.
Line241

After great purgation, if there is an inability to defecate for six or seven days,
unresolved vexation and abdominal fullness with pain, this indicates dry stool.The
reasonforthisispre-existingabidingfood.DChngQTngisrecommended.
Formula
dhung 4liang RadixetRhizomaRhei(washedwithliquor)

hup 0.5jin CortexMagnoliaeOfcinalis(mix-fried,skinned)
zhsh 5pcs FructusAurantiiImmaturus(mix-fried)
mngxio 3ge NatriiSulfas
Decoct two of the four ingredients above with one dou of water until 5 sheng
remains. Remove the dregs. Add d hung, and decoct until two sheng remains.
Removethedregs.Addmngxio,andbringtooneortwoboilsoverlowheat.Divide
andtakewarm.
Whendefecationoccurs,donottakemore.
Interpretation
Line 238 discusses the pattern differentiation and treatment of remaining dry
stoolsafterpurgation,andstoolsthatareatfrsthard,thenbecomingloose.
Yangmingbowelexcessshouldberesolvedbypurgation.However,oncepurgation
is applied, anguish and vexation then occur.This indicates unresolved turbid heat
that ascends to harass the heart.Therefore, we can conclude that there isdry stool
intheintestine. Accompanying symptoms should include abdominal distention and
fullness, pain around the umbilicus, constipation, or tidal fever. D Chng QTng
is indicated. If there is anguish without abdominal distention and fullness or bound
stoolsafterpurgation,thisisdefciencyvexation.ZhZChTngisthenindicated.
Iftheabdominalfullnessismildandthestoolisatfirsthardandthenloose,this
indicatesspleendefciencywithtransportationfailure.Attackingisprohibited.
Line239diferentiatesthepatternofdrystoolbindinginteriorly.
Painaroundtheumbilicusindicatesdrystoolobstruction;thisisoneofthemain
indicators of yangming bowel excess formation.Vexation and agitation indicate
yangmingturbidheatascendingandharassingtheheart.Regularonsetreferstothe
conditionbecomingaggravatedaroundthelateafternoonwatch(3-5pm).Duringthis
periodoftimetheqiofyangmingismosteffulgent,andthecontentionbetweenthe
uprightandthepathogenicqiismostintense.
This line does not point to any formula; however, D Chng QTng is clearly
indicated.
Line215diferentiatestheseverityofyangmingbowelexcessanddryboundstools.
Deliriousspeech andtidal fever indicates the formation ofbowel excess. Usually,
stomachheatwillcauseswiftdigestionandrapidhungering.However,withdrystool
obstructing qi there will be an inability to eat.D Chng QTng recommended for
purgationshouldbeputbehindfveorsixpiecesofdrystoolintheintestine.
Ifthepatientisabletoeat,thismeansthatthestoolisonlyhardinsteadofdryand
bound,andalsothattheqiobstructionofthestomachandintestineisnotsosevere.
XioChngQTngorTioWiChngQTngcanbeusedformildpurgation.
Line241discussesthepatternandtreatmentofdrystoolbindingagainfollowing
purgation.
Yangming bowel excess can be resolved after one purging. In other cases, the
pathogenicheatmaynotbeeliminatedcompletely,andwithinappropriatecare,the
foodthathasbeentakenwithinthepastsixorsevendayscaneasilycombinewiththe
remainingheattocausebindinganddrystools.DChngQTngcanstillbeapplied
fordrasticpurgation.
In taiyang disease, if the exterior remains unresolved after one application of
thesweatingmethod,itcanbeappliedagain.Justlikein yangmingdisease,if bowel
excessremains,thepurgingmethodcanbeappliedonemoretime.Whetherornotto
applythesweatingorpurgingmethodagaindependsonthepulsesandsigns.
FormulaAnalysis
Dhungwashedwithliquoractstodrainheat,eliminateexcess,removetheold
andengenderthenew.
Mngxiomoistensdryness,softenshardness,andpromotesdefecation.Hup
movesqiandeliminatesfullness.
Zhshbreaksqianddispersesglomus.
Thewholeformulaactstodrasticallypurgeandfushthedrynessbind.
TioWiChngQTng,XioChngQTngandDChngQTngareallindicated
for yangming excess patterns.TioWi Chng QTngfocuses on purging heat; it is
thus more appropriate for those with exuberant dryness-heat. Xio Chng QTng
focuses on freeing the bowels; it is more appropriate for bowel-qi obstruction. D
ChngQTngbothdrainsheatandfreesthebowels;itcanbeappliedforthosewith
intensedryness-heatbindandbowel-qiobstruction.
In modern clinical practice, this formula is commonly used to treat severe
gastrointestinal cases due to excess heat obstruction including encephalitis B, viral
hepatitis, epidemic hemorrhagic fever, bacterial dysentery, acute pancreatitis, acute
intestinalobstruction,acuteappendicitis,adhesiveintestinalobstruction,biliarytract
infection,cholelithiasisandacuteleadpoisoning.
CaseReport
Male,age15.
Thepatienthadheateffusion,thirst,coughing,anddefecationoncethreeorfour
days that could not be treated by previous physicians for more than ten days. After
applying D Chi HTng (Major Bupleurum Decoction, ), the heat abated
andthepatientwasabletoeatriceandvegetation.
Aftertwodays,hehadtoomuchtoeatfordinner.Atmidnight,intenseabdominal
pain suddenly occurred with agitated movement of the limbs; he was picking at the
bedclothes and biting his clothing. At a noon visit the next day, there was agitated
movement of the limbs, fear, unsettlement, and closed eyes.When his eyes were
forcedopen,onlythewhitepartscouldbeseen.Allthiswasduetointense yangming
heatthathadmovedupwardstoafecttheorifcesandpullontheeye-tie.
DChngQTngwasappliedimmediately;onlywithprofusedefecationcouldthe
patientsurvive. One dose was taken at 3 pm. By 4 pm, there was still no defecation,
andanotherdosewasapplied.Withnoresultby5pm,thedosagewasincreasedand
anotherdosewasapplied.Around7pmtherewasathunderingsoundintheabdomen
and the passing of flatus.This indicated that he was on the verge of defecation.
Although purgation could have been applied again,D Chng QTng had already
beentakeninlargeamounts.Halfofthedregswereplacedontheumbilicus,andthe
otherhalfusedtofumigatetheanus.Inlessthan20minutes,alargeamountofblack
mushyfecesappeared.Thelimbssettledandthepatientsleptquietlythatnight.
The next day, the patient regained consciousness. However, his pupils were still
notvisible.Theintenseheathadbeenabated,andtherewasnoneedtopurgeagain.
However, the yin had been damaged in the head, and dryness had damaged the
collaterals. Damaged yin failed to nourish the sinews, so the eye-tie was still tense.
Thetreatmentprinciplesatthispointweretocleartheeyesandnourishyin.
ZhY Sh GoTng (Lophatherum and Gypsum Decoction, ) with
removed bn xi (Rhizoma Pinelliae) and addedzh r (Caulis Bambusae inTaenia),
HungLinJioTng(CoptisandDonkey-HideGelatinDecoction,),and
ShoYoGnCoTng(PeonyandLicoriceDecoction,)withaddedzhr
(Caulis Bambusae inTaenia) ands gu lu (Retinervus Luffae Fructus) were applied
alternately.Theconditionresolvedafterseveraldays.
[Reference:ChenMing.SelectedCaseRecordsonColdDamagefromRenownedPhysicians
MZRnWn(CannabisFruitPill)Pattern

Source Text
Line247

Whenthefuyangpulseisfloatingandrough,floatingreflectsstrongstomachqi,
and roughness reflects frequent urination. Floating contends with roughness; 1 the
stoolbecomeshardandthespleenconstrained.MZRnWnisindicated.
Formula
mzrn 2sheng FructusCannabis

shoyo 0.5jin RadixPaeoniaeAlba
zhsh 0.5jin FructusAurantiiImmaturus(mix-fried)
dhung 1jin RadixetRhizomaRhei(skinremoved)
hup 1chi CortexMagnoliaeOfcinalis(mix-fried)
Semen Armeniacae Amarum (sk in and tip removed, stewed
xngrn 1jin
separatelywithfat)
Grindthesixingredientsaboveintopowderandmakepillsthesizeofatungtree
seedwithprocessedhoney.Taketenwithwater,threetimesaday.
Graduallyincreasethedosageuntilthestoolisfreed.
Interpretation
This line discusses the pulse, pattern and treatment of astrained spleen.The f
yngpulsecanbepalpatedatthepulsationonthedorsumoffootwhereST42(chng
yng)islocated;thispulsepositionisascribedtotheyangmingstomachchannel.F
yngpulsesreflectthestatusofstomachqi:floatingindicatesexcessivestomachheat,
1 Floatingpulseandroughpulsearepresentatthesametime.
and roughness indicates insufficient spleen yin.When stomach heat strains splenic
functioning and forces fluids to leak into the bladder, frequent urination results;
whenthefluidsfailtoreturntotheintestine,hardstoolsoccur.Therelativelystrong
stomach with a weak spleen is referred to asstrained spleen. Although the stool is
dryandboundanddefecationisabsentfortendays,thepatientdoesnotexperience
discomfort.There is no tidal fever, no delirious speech, and no abdominal fullness
or pain.This fact makes it simple to distinguish the condition from a Chng QTng
pattern.
FormulaAnalysis
MZRnWniscomposedofXioChngQTngwithaddedmzrn,xngrn
andshoyo.
Mzrnmoistenstheintestinesandfreesthestool.
Xngrndownbearslungqiandmoistenstheintestines.
Shoyonourishesyinandharmonizesying-blood.
XioChngQTngbreaksstagnationandfreesthestool.
This formula is commonly used in various internal medical diseases with the
symptomofconstipation;moreover,itcouldbeappliedforrecuperativecareinheat
diseases caused by exogenous pathogenic factors.The formula can be also used to
treat patterns of stomach heat with intestinal dryness and deficiency of body fluids,
includingcoughingcausedbydryness;alsoapplicableforbothurinaryincontinence
orretentionofurinewhenassociatedwiththispattern.
CaseReport
Female,age60.Admitted:April20,2007.
The patient had an 18 year history of diabetes. She had been fatigue with no
obvious cause for a half month, and her blood sugar levels were fluctuating. Blood
glucose:10.2mmol/Lonanemptystomach,16.5mmol/Lafterameal.
Other signs and symptoms included thirst, profuse drinking, fatigue, dry bound
stools, no defecation for five days, abdominal distention, torpid intake, frequent
urination,andasoftabdomenwithnotenderness.Hertonguewasdarkredwithdry
yellowcoating.Pulseswerewiryandfoating.
Physico-chemicalexam:HbA1c7.2,TG3.12mmol/L,CHOL8.04mmol/L.
Treatmentprinciples:nourishyin,drainheat,moistentheintestines,andfreethe
stools.
Formula:modifedMZRnWn.
mzrn 15g FructusCannabis(liquid-fried)

xunshn 15g RadixScrophulariae
Onedecocteddailydose.
Insulinpumpswereappliedconcurrentlytocontrolbloodglucoselevels.
Defecation occurred after two days. After fifteen doses, her excessive thirst and
fluidintakewereeliminated.Defecationoccurredonceeverytwodays,andurination
becamenormal.
Examination showed blood glucose 6.8 mmol/L on an empty stomach and 8.3
mmol/L2haftereating.Atathreemonthfollow-up,norelapseswerereported.
[Reference:ChiYan,GaoTian-shu.ExperienceofProf.GaoTian-shuinTreatingDiabeticConstipation
withMZRnWn.JilinJournalofTraditionalChinese
Medicine.2008;28(2):88.]
Review Questions
1. What are the origins, pathomechanisms, clinical manifestations, treatment
principlesandformulaingredientsofBiHTngandBiHJiRnShnTng?
2. What are the origins, pathomechanisms, clinical manifestations, treatment
principlesandformulaingredientsofTioWiChngQTng,XioChngQTngand
DChngQTng?
3. WhatisthemainindicationforMZRnWn?
4. Upon which prescription is To H Chng QTng and M Z RnWn based?
Explainthediferencesbetweentheefectsofthetwoformulas.
5. What is the main difference between strained spleen and Chng QTng
patterns?
6. DistinguishtheapplicationsofDChngQTngandXioChngQTng.
Section3 TransmutedPatternsof
YangmingDisease
YnChnHoTng(VirgateWormwoodDecoction)Pattern
Source Text
Line236

Inyangmingdisease,feverandsweatingindicatesthatheathasgoneastray,and
this prevents yellowing. Sweating only on the head, no generalized sweating or
sweating below the neck, inhibited urination, and thirst when taking water indicate
stagnated interior heat. Generalized yellowing will occur. Yn Chn HoTng is
indicated.
Line260

Insevenoreightdaysafterbeingafflictedbycolddamage,ifthereisgeneralized
tangerine-colored yellowing, inhibited urination, and mild abdominal fullness, Yn
ChnHoTngisindicated.
Formula
ynchnho 6liang HerbaArtemisiaeScopariae

zhz 14pcs FructusGardeniae
Decoctynchnwithonedouandtwoshengofwateruntilsixshengremains.Add
the other two ingredients, and decoct until three sheng remains. Remove the dregs.
Takewarminthreeportions.
The urine should be disinhibited with bright red urine that resembles gleditsia
juice. The abdomen should reduce overnight and the yellowing eliminated by
urination.
Interpretation
Line 263 discusses the pattern and treatment of yellowing due to damp-heat
bindingandbrewinginternally.
In yangming disease, if there is heat effusion and sweating, the heat pathogenic
qi can be discharged by sweating.Therefore, jaundice will not occur. Sweating only

from the head and an absence of generalized sweating indicates that the yangming
heathascombinedwithdampnessandsteamedupwards.Dampnessobstructingthe
waterways leads toinhibited urination. Internal heat causes excessive drinking, and
inhibitedurinationaggravatesthedampness,causingjaundice.
Yn Chn HoTng is applied to clear heat, disinhibit dampness, and abate
yellowing.
Line 260 is a supplementary statement on yellowing due to damp-heat binding
andbrewinginternally.
Line236focusesontheorigin,whilethislineliststhemainsignsandsymptoms.
Yellowing with a bright tangerine-like color is referred to asyang yellowing, which
is characterized by yellowing of the body, eyes, and urine. Damp-heat brewing
internallyobstructsthestomachandintestineandleadstoabdominalfullness.
FormulaAnalysis
Yn chn is bitter, neutral and mildly cold; it clears heat, disinhibits dampness,
andcoursestheliverandgallbladder.Itisanessentialmedicineforclearingheatand
eliminatingyellowing.
Zhzisbitterandcold;itclearsdamp-heatfromthesanjiaoandeliminatesdamp-
heatthroughurination.
Dhungisbitterandcold;itconductsheatdownwardanddischargesdamp-heat
andturbidity.
Thethreeingredientscombinedacttoeliminatedamp-heatandabatejaundice.
In modern clinical practice, this formula is frequently applied for damp-heat
accumulation conditions including acute icterohepatitis, acute hepatitis, hepatic
encephacopathy, hepatapostema, hepatic cirrhosis, cholelithiasis, biliary tract
infection,andhyperbilirubinemia.
CaseReport
Three years previously, the patient sweated profusely after taking a shower.
Aftereatingtwotangerines,therewasasuddenscorchingsensationinhischestand
abdomen.Fromthenon,hehadnotbeenabletoeatgrainormeatproductsoreven
drinkhotwaterbecausetheywouldtriggerthescorchingsensation.Thepatientcould
only drink cold water, even in winter. Physical examination and lab tests showed no
abnormality.
The patient complained of chronic dr y mouth and throat with abdominal
distention,shortvoidingofyellowurineanddrystoolsonceseveraldays.Histongue
wascrimsonwithawhitegreasycoating.Pulseswerewiryandfoating.
Pattern differentiation: pure heat due to damp-heat of the spleen and stomach.
(EssentialsfromtheGoldenCabinetreferstothisasgrainjaundice.)
Treatment principles: clear heat, disinhibit dampness, course the liver and
gallbladder.
Formula:ChiHYnChnHoTng (BupleuriandVirgateWormwoodDecoction,
).

ynchn 15g HerbaArtemisiaeScopariae
After seven doses, there was relief of the stomach discomfort; the foul turbidity
waseliminatedgreatlythroughdefecation,andtheabdominaldistentionandfullness
was relieved by half. However, his thirst with a desire for cold drinks, red tongue
withagreasywhitecoatingandrapidfloatingpulsesremained,indicatingthatsome
damp-heatremained.
Treatment principles: resolve turbidity with aromatics, clear heat with bitterness
andcoldness.
Formula:

hungbi 10g CortexPhellodendriChinensis
After another seven doses, the thirst and desire for cold drinks were resolved,
andthetongueandpulseimagesbecamenormal.Thepatientsabilitytoeatwasalso
restored.
Review Questions
1. Whatarethepathomechanisms,clinicalmanifestationsandtreatmentofaYn
ChnHoTngpattern?
2. Statetheoriginofyangmingyellowing,andthekeypointsintreatingyangming
diseases.
284
Chapter4
Pulse, Pattern, and Treatment of
Shaoyang Disease
Physiology
Shaoyangreferstothefootshaoyanggallbladderchannel,thehandshaoyangsanjiao
channel,andtherelatedfu-organs:thegallbladderandsanjiao.
The foot shaoyang gallbladder channel begins near the outer canthus of the
eye, ascends to the corner of the forehead, curves posteriorly behind the ear to
the shoulder and enters the supraclavicular fossa. It then descends into the chest,
crossesthediaphragm,connectswiththeliveranduniteswiththegallbladderbefore
descendingalongthelateralaspectofthebody.
Thehand shaoyangsanjiaochannelbeginsattheendoftheringfinger,ascends
along the lateral aspect of the arm to the shoulder and enters the supraclavicular
fossa.Itthendispersesinthechest,connectswiththepericardium,descendsthrough
thediaphragmanduniteswiththesanjiao.
Abranchfromthechestascendsthroughthesupraclavicularfossa,risesalongthe
necktotheposterioraspectoftheear,enterstheear,emergesinfrontoftheearand
terminatesattheoutercanthusoftheeye,whereitintersectswiththefoot shaoyang
gallbladderchannel.
Thefootshaoyanggallbladderbowelnetstotheliver,storesbile-essence,housesthe
ministerial fire, and governs decisiveness. Its nature is free-flowing and discharging.
Only when the gallbladder bowel is clear and uninhibited will liver qi have orderly
reaching;withoutthis,thespleenandstomachcanalsobeeasilyexploited.
Theshaoyangsanjiaoistheenvoyoftheoriginalqiandthepathwayforwaterand
grains.Itmanagesqitransformation,governssluices,andregulatesthewaterways.
Thefootandhandshaoyangchannelsareinterrelated.Whengallbladderqiflows
freely, the pivot revolves, the sanjiao is free, and the ascending and descending of
waterandfireandtheqidynamicarenormal.Therefore,theupper jiaocanbelikened
untoamist,themiddlejiaolikefoam,andthelowerjiaoasluice.
Pathodynamic
When an exterior pathogenic qi invadesshaoyang, gallbladder fire flares up and
the pivot mechanism will dysfunction, which in turn influences spleen and stomach
transportationandtransformation.Manifestationsincludeabittertasteinthemouth,
VolumeTwo:Chapter4 Pulse,Pattern,andTreatmentofShaoyangDisease 285
drythroat,dizzyvision,alternatingchillsandfever,fullnessinthechestandrib-sides,
quietness with no desire for food, vexation, frequent retching, and wiry pulses.This
presentationisreferredtoasshaoyangdisease.
Origins
There are two main causes of shaoyang disease. One is the shaoyang channel
contracting a pathogenic qi; the patient usually has a weak constitution that fails
to resist the pathogenic invasion.The other is a pathogenic qi passing from other
channels; this is commonly caused by inappropriate treatment of a taiyang disease.
Also, because shaoyang and jueyin stand in an exterior-interior relationship, when
theuprightqiisrestoredwithinjueyin,thepathogenicqicanreturntoshaoyangasit
movesoutward.
Manifestations
Shaoyang is located between the exterior and the interior.The manifestations of
shaoyangdiseasearevarious,andthereareseveralcommonlyconcurrentpatterns.
Concurringwiththetaiyangexteriorpattern,therecanbefever,slightaversionto
cold,vexingpaininthelimbsandjoints,slightretching,andaproppingandbinding
sensationintheepigastria.
Concurringwithyangminginteriorexcess,therecanbeincessantretching,distress
intheepigastria,depression,slightvexation,ortidalfeverandhardstools.
Concurring with impairedsanjiao qi transformation and fluid distribution, there
can be fullness and slight binding in the chest and rib-sides, inhibited urination,
thirstwithnoretching,sweatingfromtheheadonly,alternatingchillsandfever,and
vexation.
Inappropriatetreatmentofshaoyangpatternscanleadtothespreadingofpathogenic
qi,adeficiency-excesscomplex,anddualdiseaseoftheexteriorandinterior.Manifestations
includechestfullness,vexation,fright,disinhibitedurination,generalizedheaviness,and
inabilitytoturnthebodynormally.
TreatmentPrinciples
Thetreatmentofshaoyangdiseaseshouldfocusonharmonizing,andXioChiH
Tng(MinorBupleurumDecoction, )istherepresentativeformula.Sweating,
ejection and purgation methods are all prohibited. Sweating damages the exterior,
andejectionandpurgationdamagetheinterior;allofthesecanleadtothepathogenic
qi passing inwardly. However, if the condition changes and concurrent patterns
are present, other treatment principles can be applied in addition to harmonizing
methods.
Withataiyangexteriorpattern,applytheexterior-resolvingmethodwithChiH
GuZhTng(BupleurumandCinnamonTwigDecoction,).
With yangming interior excess, apply drainage with D Chi HTng (Major
Bupleurum Decoction, ) or Chi H Ji Mng XioTng (Minor Bupleurum
DecoctionplusNatriiSulfas,).
With impaired sanjiao qi transformation and fluid distribution, transform qi and
move water with Chi H Gu Zh Gn JingTng (Bupleurum, CinnamonTwig and
DriedGingerDecoction,).
With the spreading of pathogenic qi, deficiency-excess complexes, and dual
disease of the exterior and interior, treat by freeing yang, discharging heat, settling
frightandcalming the shen with Chi H Ji Lng G M LTng (Minor Bupleurum
DecoctionplusDragonBonesandOysterShell,).
If shaoyang disease is treated without delay and with the correct treatment
principles,thentheexteriorwillbereleased,theinteriorharmonized,andthepatient
willrecover.Iftreatment is delayed or inappropriate, then there will be transmission
and progressive changes in the nature of the pattern. Inappropriate treatment of
shaoyangdiseasecandamagefluidsandleadtodrynessasthepathogenicqimaypass
totheyangmingbowel.Delayedtreatmentcandamageyang,thepathogenicqimay
passtothetaiyangorgan,andjueyindiseasemayalsoarise.Inothercases,transmuted
patternsmanifestingwithchestbind,glomus,heartpalpitations,vexationandfright
mayoccur.
Section1 OutlineofShaoyangDisease
Source Text
Line263

Thediseaseofshaoyangmanifestswithabittertasteinthemouth,drythroat,and
dizzyvision.
Interpretation
Thislinediscussesthegeneralpatternofshaoyangdisease.
Whenexteriorpathogenicqiinvadestheshaoyang,gallbladderfireflaresupand
manifestswithabittertasteinthemouth;thefluidsaredamaged,whichcausesdry
throat.Thefootshaoyanggallbladderchannelbeginsneartheoutercanthusoftheeye,
andtheliveralsoopenstotheeyes.Whengallbladderfireascendsalongthechannel,
dizzyvisionoccurs.
These three symptoms involve the pathodynamic characteristics of shaoyang
diseaseandcanbeconsideredasitsgeneraloutline.
Contraindications
Line264

Forshaoyangwindstrikewithdeafnessinbothoftheears,redeyes,andfullness
inthechestwithvexation,ejectionandpurgationareprohibited;otherwisetherewill
bepalpitationsandfright.
Interpretation
Thislinepointsoutthatejectionandpurgationareprohibitedinthetreatmentof
shaoyangdisease.
The footshaoyang channel begins near the outer canthus of the eye, ascends to
thecorneroftheforehead,andcurvesposteriorlybehindtheear.Thehandshaoyang
channel rises along the neck to the posterior aspect of the ear, enters the ear and
emergesinfrontoftheear.Theflaringupofshaoyangwindandfireharassestheclear
orifices;hencedeafnessandredeyesoccur.Pathogenic bindinginthechestandrib-
sidesobstructchannelqi,whichthenleadstofullnessinthechestandvexation.
The correct treatment method is harmonization. If one mistakenly presumes
that the fullness and vexation is due to accumulation and stagnation and thus
appliesejectionandpurgation,qiandbloodwillbedepletedandtheheartwilllack
nourishment.Thiswillmanifestaspalpitationsandfright.
Line265

Cold damage with wir y and thready pulses, headache, and fever belong
to shaoyang. Shaoyang disease should not be treated with sweating, otherwise
delirious speech will occur.This condition belongs to the stomach. If the stomach is
harmonized,theconditionwillresolve;ifthestomachisnotharmonized,therewillbe
vexationandpalpitations.
Interpretation
This line points out that the sweating method is prohibited in the treatment of
shaoyangdisease.
Headacheandfevercanbeseeninanyoftheyangchanneldiseases.Withfloating
pulses,theconditionistaiyangandshouldthusberesolvedwithsweating.Withlarge
orslipperyandrapidpulses,theconditionisyangminganditshouldberesolvedwith
clearing and purging of interior heat.With wiry and thready pulses, the condition is
shaoyang;inthiscasesweatingcannotbeappliedasthismayresultinfluidleakage
anddrynessinthestomach.Whenfluidsaredamagedandheatflaresuptodisturbthe
shen,deliriousspeechoccurs.Treatmentshoulddrainheatandharmonizethestomach.
If the stomach is not harmonized, the delirious speech will become aggravated and
vexationandpalpitationswilloccur.
Review Questions
1. Describethegeneraloutlineofshaoyangdisease.
2. What are the contraindications in the treatment ofshaoyang disease? Explain
why.
Section2 PatternsofShaoyangDisease
XioChiHTng(MinorBupleurumDecoction)Pattern

Source Text 1
Line96

Fiveorsixdaysaftercolddamageorwindstrike,iftherearealternatingchillsand
fever, fullness in the chest and rib-sides, reticence with no desire for food, vexation,
frequent retching, or vexation in the chest with no retching, or thirst, or abdominal
pain,orglomusandhardnessbelowtherib-sides,orpalpitationsbelowtheheartand
disinhibited urination, orabsence of thirst and slight generalized heat, or coughing,
XioChiHTngisindicated.
Formula
chih 0.5jin RadixBupleuri

Decocttheseveningredientsabovewithonedouand2shengofwateruntil6sheng
remains.Discardthedregs.Decoctagainuntil3shengremains.Takeoneshengwarm,
threetimesaday.
Interpretation
Thislinediscussespatternandtreatmentofshaoyangdisease.
Fiveorsixdaysaftertheonsetoftaiyangcolddamageorwindstrike,thepathogenic
qicanpasstoshaoyang.Whenshaoyangisaffected,thepivotbecomesdysfunctional,
andtheuprightqicontendswiththepathogenicqiinbetweentheexteriorandinterior.
If the upright qi prevails, there will be fever; if the pathogenic qi prevails, there will
be aversion to cold.Therefore, alternating chills and fever result. Stagnation of the
shaoyang qi dynamic leads to fullness in the chest and rib-sides, and the patient
appears quiet with a hazy countenance. Gallbladder constraint and liver stagnation
can affect the spleen, leading to a reduced appetite. Upward flaring of gallbladder
fire harasses the heart-spirit which leads to vexation. Gallbladder fire affecting the
stomach affects harmonized descending, which leads to retching and vomiting.
Thesearethemainsymptomsof shaoyangdisease,andthetreatmentprincipleisto
harmonizeshaoyang.XioChiHTngisindicated.
Shaoyangdiseasecanbeaccompaniedbyavarietyofsymptoms:
When constrained fire harasses the chest and diaphragm but not the stomach,
therewillbevexationinthechestwithnovomiting.
Withheatdamagingfuids,therewillbethirst.
Severe gallbladder qi constraint can damage the spleen collaterals and result in
abdominalpain.
Whenshaoyangchannelqiisobstructedbelowtherib-sides,therewillbe glomus
andhardnessinthatarea.
Shaoyangpivotdysfunctionwithirregularitiesofthewaterpathwayscanleadto
water-rheum that moves along with the qi dynamic.When it collects in the upper
jiaoandcoldrheumshootsintothelung,therewillbecoughing.Whenitcollectsin
themiddlejiao,waterqiintimidatestheheartandtherewillbepalpitationsaffecting
the epigastria.When it collects in the lower jiao, qi transformation of the bladder is
afectedanddifculturinationresults.
Iftheexteriorpathogenicqiremainsunresolved,andthefluidsarenotdamaged,
thentherewillbemildfeverwithanabsenceofthirst.
ModifcationsofXioChiHTngshouldbeapplied.
FormulaAnalysis
XioChiHTngistherepresentativeformulaforharmonizingshaoyang.Itdispels
pathogenicqi,supportstheupright,andtreatsliverandspleensimultaneously.
Chihandhungqnarethesovereignmedicinals.Chihisbitterandslightly
cold with a light and clear smell. It acts to course and harmonize shaoyang and
outthrustpathogenicheat.Hungqnisbitterandcoldwitharelativelyrichersmell.It
clearsanddischargespathogenicheatinthegallbladder.
Bnxiandshngjingharmonizestomachqi, downbearcounterflowandcheck
retching.
Rn shn, zh gn co and d zo benefit qi, harmonize the middle, support the
upright,anddispelpathogenicqi.
Looking synergistically at the herbs in this formula, chi h (Radix Bupleuri) and
hung qn (Radix Scutellariae) clear and descend pathogenic qi with their bitter and
cold properties, while the acridness of bn xi (Rhizoma Pinelliae) and shng jing
(RhizomaZingiberisRecens)openanddispersepathogenicqi.Alsothesweetnessof
rnshn(RadixetRhizomaGinseng),gnco(RadixetRhizomaGlycyrrhizae)andd
zo(FructusJujubae)supplementandharmonizethemiddle.
This formula uses herbs with both cold and warm properties, both ascending
and descending functions, and both reinforcing and eliminating effects in order to
harmonize the shaoyang pivot mechanism.The formula frees the transformation
functionofthesanjiao,andrestoresthesmoothflowofqibetweentheupperandthe
lowerportionsofthebody.Italsoopensupthepathwaysforanunimpededflowofqi
betweentheinteriorandexterior,andthusharmonizingallactivitiesofthebodysqi
mechanism.
Because of these effects, Xio Chi HTng (Minor Bupleurum Decoction) is the
representativeprescriptionforharmonizingqi.
In the original formula, the directiondisgard the dregs and decoct again is
given in order to concentrate the decoction. Following this also further harmonizes
thecoldandwarmproperties,thebitter,acridandsweetflavors,andtheeliminating
andreinforcingactionsoftheformula.Thisisimportantinordertoachievetheeffect
of expelling pathogenic qi outward without retaining any pathogenic qi within the
interior.
Thisformulaiscommonlyappliedforicterohepatitis,chronichepatitis,cholecystitis,
influenza, acute gastritis, dysentery, coronary heart disease, heat entering the blood
chamber, and intractable insomnia.With modifications, it can be applied for any
condition of external contraction with internal damage associated with shaoyang qi
stagnationandheat.
CaseReport
Male,age37.
Chiefcomplaint:feverfor3months.
In the mornings, his body tempreture was around 37C, and it would gradually
riseduringtheafternoonupto38-39C.Therewouldbe aversiontocoldbeforefever.
The temperature would gradually decrease at night. Other signs and symptoms
included lack of strength, fatigue, a bitter taste in the mouth, dry throat, epigastric
oppression and distention, occasional nausea, poor appetite, dry stools and reddish
yellowurine.
Liver function and biliary drainage testing showed no abnormality. Previous
treatmentswithvariousantibioticswereinefective.
Atthevisit,inadditiontothesymptomslistedabove,healsopresentedwithared
tonguewithayellowslimycoating;pulseswerewiry,threadyandrapid.
Patterndifferentiation:XioChiHTngpatternwithexterior-interiordisharmony
anddamp-heatbrewinginternally.
Treatmentprinciples:harmonizetheexteriorandinterior,andcleardamp-heat.
Formula:XioChiHTngplusynchn.
After six doses, the fever was gone. At the second consultation, all symptoms
were resolved except for the fatigue. WWiY Gng Sn (Five Ingredients Special
AchievementPowder,)wasapplied.Theconditionwasthenconsideredto
beresolved.
[Reference: Zhu Chen-yu. Contemporary Applications of Classical Formulas .
ChineseJournalofMedicine.1979;(10):46-47.]
Source Text 2
Line101

For cold damage or wind strike with a Chi HTng pattern, one symptom is
sufficientfordiagnosis;notallsignsandsymptomsneedtobepresent.Inall ChiH
Tng diseases, if purgation is applied and the pattern remains, apply Chi HTng.
There will be steaming heat effusion with quivering, and the condition will resolve
withfeverandsweating.
Interpretation
Thisline discusses the application ofXio Chi HTng as well as the associated
patternandtreatmentfollowinginappropriatepurgationinshaoyangdisease.
Themanifestationsofshaoyangdiseasecanbecomplex;ifonewaitsforallofthe
associated signs and symptoms to manifest, effective treatment could be delayed.
Therefore it is stated,one symptom is sufficient for diagnosis; not all signs and
symptomsneedtobepresent.TheindicatingsignsandsymptomsarelistedinLines
263and96.
Purgation is prohibited in the treatment of shaoyang disease. However, if the
condition remains after purgation, Chi HTng can still be applied. After taking
thedecoction,theuprightqirisesandcontendswiththepathogenicqi,resultingin
steaming heat effusion and quivering with aversion to cold.Steaming describes
the way in which heat spreads from the interior to the exterior.When the upright qi
prevails, the aversion to cold will be relieved.The condition will then resolve with
feverandsweating.Thisprocessisreferredtoasshiversweating.
Review Questions
1. Statethepathomechanisms,manifestations,andtreatmentprinciplesforaXio
ChiHTngpattern.
2. StatethemeaningbehindthemedicinalcombinationsinXioChiHTngand
themethodsofmodifcation.
3. State your understanding of the harmonizing method.Why should shaoyang
diseasebetreatedwithharmonization?
4. What is the meaning of the passageone symptom is sufficient for diagnosis;
notallsignsandsymptomsneedtobepresent?
Section3 ConcurrentandTransmuted
PatternsofShaoyangDisease
Chi H Gu ZhTng (Bupleurum and CinnamonTwig Decoction)

Pattern
Source Text
Line146

Sixorsevendaysaftercontractingcolddamagewithfever,mildaversiontocold,
vexing pain in the limbs and joints, slight retching, and propping bind below the
heart, where the exterior pattern has not been eliminated, Chi H Gu ZhTng is
indicated.
Formula
chih 4liang RadixBupleuri

guzh 1.5liang RamulusCinnamomi(barkremoved)
hungqn 1.5liang RadixScutellariae
shoyo 1.5liang RadixPaeoniae
rnshn 1.5liang RadixetRhizomaGinseng
bnxi 2.5ge RhizomaPinelliae(washed)
shngjing 1.5liang RhizomaZingiberisRecens(cut)
Decoct the above nine ingredients with 7 sheng of water until 3 sheng remains.
Interpretation
Thislinediscussesthetreatmentofshaoyangdiseaseconcurringwithanexterior
pattern.
Six or seven days after the onset of a cold damage pattern, the taiyang exterior
patternremainsanda shaoyang patternisalsopresent.Fever,mild aversiontocold,
and vexing pain in the limbs and joints indicate a taiyang exterior pattern. Slight
retching and vomiting with a propping sensation and epigastric distention indicate
thatthepathogenic qi has just passedto shaoyang. Chi H Gu ZhTng should be
appliedtobothharmonizeshaoyangandresolvetheexterior.
FormulaAnalysis
ThisprescriptioniscomposedofXioChiHTngandGuZhTngwithhalved
dosages.Itresolvestheflesh,dispelswind,andregulatesyingandweiattheexterior
whilealsoharmonizingshaoyanginteriorly.
Thisformulaiscommonlyappliedforcommoncold,influenza,urticaria,pneumonia,
pleurisy, gastric ulcer, duodenal ulcer, epilepsy, hysteria, and neurosis that are
associatedwithdualdiseaseoftaiyangandshaoyang.
CaseReport
Male,age33.
Chief complaint: for more than ten years there were nasal obstruction, sneezing
andnasaldischargewhenencounteringwind,cold,orpollen.
The patient had been diagnosed with allergic rhinitis and treated withWestern
medicinefor a few years, with no observable effect. Chinese medicine treatments to
dispelwind,dissipatecold,andnourishbloodwerealsounremarkable.
The patient tended to fear cold, also experiencing nasal obstruction and nasal
discharge whenever exposed to wind and cold. Accompanying symptoms included
adryanditchingthroatwithdiscomfortandfullnessinthechest.Histonguecoating
appearedthinandwhite;pulseswerewiryandmoderate.
Patterndiferentiation:dualdiseaseoftaiyangandshaoyang.
Formula:ChiHGuZhTng.

zhbnxi 10g RhizomaPinelliae(mix-fried)
Sevendoses.
After taking the formula for more than half a month, he reported that when he
caught a cold, the only presenting symptom was mild nasal obstruction without
sneezingorarunnynose.Allothersymptomswereresolved.
[Reference: Shen Xiao-feng. AppliedChi H Gu ZhTng. Nei Mongol
JournalofTraditionalChineseMedicine.2008;11(21):66-67.]
DChiHTng(MajorBupleurumDecoction)Pattern

Source Text
Line103

In taiyang disease, at more than ten days after channel passage, if inappropriate
purgationisappliedmorethanonceandtheChiHTngpatternremainsafterfour
orfivedays,firstapplyXioChiHTng.Incessantretching,distressbelowtheheart,
depressionandslightvexationindicatenon-resolvingofthecondition.Apply DChi
HTng,andthentheconditionwillresolvewithpurgation.
Formula

zhsh 4pcs FructusAurantiiImmaturus(mix-fried)
Decoctthesevenmedicinalsabovewithonedouand2shengofwateruntil7sheng
remains.Discardthedregsanddecoctagain.Takeoneshengwarm,threetimesaday.
Anotherversionoftheformulacontainsadded2liangofdhung.Ifnotadded,
thentheformulawouldnotlikelytobetheauthenticDChiHTng.
Interpretation
Thislinediscussesthepatternandtreatmentofshaoyangdiseaseconcurringwith
yangminginteriorexcess.
Taiyang disease refers to the origin of the disease,channel passage implies
that the exterior pattern is no longer present, andmore than ten days suggests
that the duration of the condition is relatively long.Thus, we know that thetaiyang
exterior pathogenic qi has long passed to shaoyang and that it should be treated
with harmonizing. However, the doctor in this case applies purgation repeatedly.
Fortunately,theuprightqiisexuberantenoughtokeepthepathogenicqifromsinking
inward,andthe shaoyangpatternisstillpresentafterfourorfivedays. XioChiH
Tngcanstillbeapplied.
If after applying Xio Chi HTng the condition remains, and if incessant
retching and vomiting, epigastric hypertonicity and pain, depression, vexation and
agitationoccur,thisindicatesthattheshaoyangconstrainedfireandpivotdysfunction
havebecomeaggravated.Thepathogenicheathaspassedfromshaoyangtoyangming,
transformedintodryness,excess,andobstructedbowelqi.
Purgationisprohibitedinthetreatmentofshaoyang;however,yangminginterior
excessdoesrequirepurgation.DChiHTngisappliedtosimultaneouslyharmonize
andpurge.
FormulaAnalysis
Thisformulais XioChiHTngwithrnshnandzhgnco removed,added
shoyo,zhshanddhung,andanincreaseddosageofshngjing.
Xio Chi HTng harmonizes shaoyang.The increased dosage of shng jing
enhances the action of harmonizing the stomach and downbearing counterflow
in order to treat incessant retching. Sho yo harmonizes ying, frees the collaterals,
relaxes tension, and checks pain to treatdistress below the heart.Zh shdescends
qi, disperses glomus, opens constraint and breaks binding to treatdepression and
slightvexation.Dhungenhancestheactionofheat-drainingandbind-opening.
Rnshnandzhgncoareremovedbecausethisformulafocusesmoreonthe
dispellingofpathogenicqithanonsupportingtheupright.
DChiHTngandXioChiHTngpatternsarebothassociatedwithinternal
constraintofshaoyanggallbladderfireanddysfunctionalpivoting.However,XioChi
HTng pattern is the primary pattern ofshaoyang disease, while D Chi HTng
is a shaoyang disease with yangming internal excess. It manifests with more severe
vomiting, distress, hardness, fullness and pain in the epigastrium, dry bound stools
orheatdysentery.Thereisaredtonguewithyellowdrycoating;pulsesarewiryand
rapid.
For a Xio ChiHTngpattern,treatment should harmonize shaoyang, support
theuprightandoutthrustthepathogenicqi,whereasfortheDChiHTngpattern,
treatmentshouldharmonizeshaoyangwhilealsopurgingyangminginternalexcess.
This formula is commonly applied for cholecystitis, cholelithiasis, acute and
chronicpancreatitis,acutegastritis,acuteperitonitis,hepatitis,andinfluenzathatare
associatedwithshaoyangconstrainedfrewithinternalexcess.
CaseReport
Chief complaints: pain and distress in the epigastric region from 7am with
frequentretching,vexation,agitation,restlessness,abittertasteinthemouth,andan
absenceofdefecationforthreedays.
Thepatientwaspreviouslydiagnosedbyphysicianswithacutegastritis,although
withantibiotictreatmenttherewasnoimprovement.At4pm,hersymptomsbecame
aggravated.
Atthevisit,thepatientpresentedwithfullnessoftheupperabdomen,chest,and
rib-sides, with glomus and hardness in the epigastric area that was aggravated by
pressure. Her tongue was red with a thick slimy coating; her pulses were wiry and
forceful.
Patterndiferentiation:dualdiseaseofshaoyangandyangming.
Formula:DChiHTng.

Threedoses.Onedailydecocteddose.
After one dose, the patient had one bowel movement and all symptoms were
relieved.The condition resolved completely after three doses. A follow-up one week
latershowednorecurrence.
[Reference:WuDe-qing,YanChun-lan.ClinicalApplicationof DChiHTng
.JournalofIntegrativeMedicineTreatmentforCerebrovascularDisease.2006;4(5):469.]
HungQnTng(ScutellariaDecoction)Pattern
Source Text
Line172

Fordualdiseaseoftaiyangandshaoyangwithspontaneousdiarrhea,applyHung
QnTng.
Formula
Decoct the four above ingredients with onedou of water until 3 sheng remains.
Discardthedregs.Takeoneshengwarm,twiceinthedaytimeandonceatnight.
Withretching,HungQnJiBnXiShngJingTng(ScutellariaDecoctionplus
PinelliaandFreshGinger)isindicated.
Formula
Decoct the above six ingredients with one dou of water until 3 sheng remains.
Discardthedregs.Takeoneshengwarm,twiceinthedaytimeandonceatnight.
Interpretation
This line discusses the pattern and treatment of diarrhea or retching due to
shaoyangpathogenicheatdistressingyangming.
Indualdiseaseoftaiyangandshaoyang,whenconstrainedshaoyangstagnatedheat
prevails and distresses yangming and forces fluids to move downwards; the large
intestinefailstoconveyproperlyanddiarrheaoccurs.Sincetheconditionisassociated
with internal heat, the diarrhea should be accompanied by foul smell, scorching
heat of the anus, abdominal pain, and reddish-yellow urine.Hung QnTng should
be applied to secure yin and check diarrhea by clearing heat with bitterness and
coldness.
Fire is upward-flaring in nature. Shaoyang pathogenic heat can also harass the
stomachandimpairitsharmonizeddownbearing,resultinginretchingandvomiting.
Shngjingandbnxishouldbeaddedtodownbearcounterfowandcheckretching.
FormulaAnalysis
Hungqnclearsshaoyangconstrainedfrewithbitternessandcoldness.
Shoyoissour,bitterandslightlycold.Itdischargesheat,constrainsyin,relaxes
tension,andcheckspain.
Gncoanddzobeneftqi,harmonizethemiddle,andsupplementuprightqi.
This formula is especially effective for treating heat dysentery characterized by
abdominalpainwithasaggingsensationandungratifyingdefecation.Manyformulas
fortreatingheatdysenterysuchasShoYoTngarebasedonthisformula.Physician
WangAngreferstothisformulaastheancestorformulafortreatingdysenteryinall
timeinhisbook,MedicalFormulasCollectedandAnalyzed(YFngJJi,).
HungQnJiBnXiShngJingTngactstocheckretchingandvomiting;the
formulaiscomprisedofHungQnTngwithaddedbnxiandshngjing.
These two formulas are commonly applied for bacillary dysentery, amoebic
dysentery, acute and chronic enteritis, infectious mononucleosis, jaundice, and
dysfunctional uterine bleeding when associated with shaoyang pathogenic heat
distressingyangming.
CaseReport
Male,age30.
The patient suffered from aversion to cold followed by a vigorous fever. Other
signs and symptoms included red eyes, vexation, agitation, restlessness, red and
slightly dark purple dysentery, urgency and pain in the abdomen with a desire and
inabilitytodefecate.Histonguewascrimson;pulsesweresurgingandexcess.
Treatmentprinciples:clearheatandresolvetoxins.
Formula:HungQnTng.

Twodoses.
Thepatientsshenwascalmer,feverhadabated,andpainrelieved.Afterthreedoses
ofHngLZoHuTng(),theconditionwasconsideredtoberesolved.
[Reference:ChenMing.SelectedColdDamageCasesfromRenownedPhysicians.
Chi H Gu Zh Gn Jing Tng (Bupleurum, Cinnamon Twig and
DriedGingerDecoction)Pattern
Source Text
Line147

Fiveorsixdaysaftercontractingcolddamage,whensweatinghasbeenpromoted
andfollowedbypurgation,ifthereisfullnessandslightbindinginthechestandrib-
sides, disinhibited urination, thirst with no retching, sweating only from the head,
alternating chills and fever, and vexation, this indicates non-resolution. Chi H Gu
ZhGnJingTngisindicated.
Formula
guzh 3liang RamulusCinnamomi(bark-removed)
gulugn 4liang RadixTrichosanthis
ml 2liang ConchaOstreae(stewed)
Decocttheabovesevenmedicinalswithonedouand2shengofwateruntil6sheng
remains.Discardthedregs.Decoctagainuntil3shengremains.Takeoneshengwarm
threetimesaday.
Ifthereisslightvexationafterthefirstportion,andsweatingaftersecondportion,
theconditionwillresolve.
Interpretation
This line discusses the pattern and treatment of shaoyang disease with internal
bindingofwater-rheum.
When cold damage has lasted five or six days and both sweating and purgation
methods have been applied, the disease can pass toshaoyang.This manifests with
alternatingchillsandfever,fullnessinthechestandrib-sidesandvexation;thereare
no signs of an exterior pattern.With dysfunction of the shaoyang pivot, the sanjiao
failstoregulatethewaterways,and water-rheumcollectsinternally.Whentherheum
combines with shaoyang pathogenic qi below the rib-sides, there is fullness and
discomfortinthechestandrib-sides.Whenthe sanjiaoisaffected,waterandfluidsfail
to move downward, and disinhibited urination occurs.Water-rheum also obstructs
the qi dynamic and fluids cannot be transformed, therefore thirst appears. However,
stomach qi is not yet impaired, so there is no retching.Yang qi fails to diffuse
outwards and steams upwards instead, resulting in sweating only from the head.
ChiHGuJingTngshouldbeappliedtoharmonize shaoyangwhilewarmingand
transformingwater-rheum.
FormulaAnalysis
Chihandhungqnharmonizeshaoyang,clearandcourseconstrainedfire,and
regulatetheshaoyangpivotmechanism.
Guzhandgnjingfreeyangandresolverheum.
Mlandgulugnopenbindingandexpelrheum.
Zhgncoharmonizesallformulamedicinals.
Modern clinical indications for this prescription include chronic hepatitis,
early stage hepatocirrhosis, cholecystitis, gastroptosis, erosive gastritis, bronchitis,
pneumonia, pleurisy, influenza, and c yclomastopathy when associated with
constrained shaoyang fire with water collection, or when manifesting with the signs
andpulseimagesasdescribedinLine147.
CaseReport
Female,age52.
Chief complaint: epigastric pain for more than one year, previously diagnosed as
erosivegastritis.
Her condition had worsened within the past month, and was accompanied by
fullnessandoppressioninthechestandrib-sides,poorappetite,nausea,adrymouth,
thirst,gurglingsoundsintheepigastrium,vexation,andoccasionallyloosestools.Her
tongueappearedpaleredwiththinwhitecoating;pulseswerethreadyandforceless.
Pattern differentiation: constrained heat in the liver and gallbladder, devitalized
spleenyang,failureoftransportationandtransformation,water-rheumaccumulating
intheepigastrium.
Treatmentprinciples:cleartheliverandgallbladder,warmthespleen,andresolve
rheum.
Formula:ChiHGuJingTng.

gulugn 15g RadixTrichosanthis
flng 20g Poria
Afterfourdoses,shereportedthatherstomachachewasgreatlyrelieved;thethirst
andepigastricgurglingsoundswereresolved.
Afteranothereightdoses,theconditionwascompletelyresolved.
Follow-upinahalf-yearshowednorecurrence.
[Reference:YangChun-yan.ClinicalApplicationofChiHGuJingTng.
ChineseandWesternMedicine.2009;1(10):109.]
Chi H Ji Lng G M LTng (Bupleurum Decoction plus Dragon
BonesandOysterShell)Pattern
Source Text
Line107

Eight or nine days after contracting cold damage, if following purgation there is
chest fullness, vexation, fright, disinhibited urination, delirious speech, generalized
heaviness,andaninabilitytoturnnormally,ChiHJiLngGMLTngisindicated.
Formula
chih 4liang RadixBupleuri

lngg 1.5liang OsDraconis
hungqn 1.5liang RadixScutellariae
qindn 1.5liang Minium
rnshn 1.5liang RadixetRhizomaGinseng
bnxi 2.5ge RhizomaPinelliae(washed)
fling 1.5liang Poria
ml 1.5liang ConchaOstreae(stewed)
Decoct the eleven ingredients with 8 sheng of water until 4 sheng remains. Add
dhungthathasbeencutintochesspeice-sizedportions.Bringtooneortwoboils.
This formula is originally referred to as Chi HTng with added lng g and
othermedicinals.
Interpretation
This line discusses the pattern and treatment of vexation, fright, anddelirious
speechduetothespreadingofshaoyangpathogenicqi.
Eight or nine days after the onset of cold damage, although the pathogenic qi
tends to transform into heat and sink inward, it should still be treated withexterior-
resolvingmethods.Purgationwilldamagetheuprightqiandcausepathogenicqito
sink inward.The shaoyang channel travels along the chest and spreads out over the
rib-sides.When the pathogenic qi enters shaoyang, channel qi is obstructed where
fullness and oppression in the chest and rib-sides appear. Gallbladder fire flaring
upwardandsteaming stomach heat will harass the heart-shen; in milder cases there
willbevexation,inmoreseverecasestherewillbedeliriousspeech.
Inappropriate purgation damages the upright qi and leads to deficient heart
qi. Along with pathogenic heat, there will be fear and fright. Heat spreading in the
sanjiaoobstructsthewaterwaysandresultsin disinhibitedurination.Whenyangqiis
constrained,thereisgeneralizedheavinessanddifficultyinturningthebody. ChiH
JiLngGMLTngshouldbeappliedtoharmonizeshaoyang,freeyang,discharge
heat,andquietentheshen.
FormulaAnalysis
The formula is composed of Xio Chi HTng with removed zh gn co and
addedlngg,ml,qindn,guzh,flnganddhung.
XioChiHTngclearsandresolvesconstrainedshaoyangheatandregulatesthe
sanjiaopivotmechanism.
Dhungdrainsyangmingdryheat.
Lngg,mlandqindnareheavysettlersthatdispelphlegm,calmfrightand
quietentheshen.
Guzhandflngfreeyang,transformqi,dispelphlegmandmoverheum.
Gncoisremovedsothattheformulacantakeefectmorequickly.
Modernclinicalindicationsforthisformulaincludemania,epilepsy,palpitations,
insomnia,somnambulism,schizophrenia,neurosis,Menieresdisease,hyperthyroidism,
heart disease, and hypertension as associated with shaoyang pivot dysfunction and
pathogenicheatspreadinginthesanjiao.
CaseReport
Male,age34.
Chiefcomplaint:frightfollowedbyepilepsy.
During the onset there would be screaming, convulsion of the limbs, foaming
at the mouth, and sweating. Other signs and symptoms included fullness in the
chest and rib-sides, disturbing dreams, talking in his sleep, disquieted shen, and
ungratifying defecation. He had a greenish facial complexion with a dull expression.
Thetongueappearedredwithayellowandwhitecoating;hispulsesweredeepand
wiry.
Patterndifferentiation:liverandgallbladderqiconstraintaccompaniedbyyangming
bowelheatandinternalphlegm-fre.
Treatmentprinciples:coursetheliver,drainthestomach,flushphlegm,clearfire,
calmfright,andquietenshen.
Formula:ChiHJiLngGMLTng.
lngg 15g OsDraconis
qindn 3g Minium(wrapped)
dhung 6g RadixetRhizomaRhei(decoctedlater)
Afteronedose,theungratifyingdefecation,fullnessinthechestandrib-sidesand
talkinginhissleepwerealleliminated.Hisshenwascalmandquiet.However,there
wasretchingandclamoringofthestomach. Zhr(CaulisBambusaeinTaenia)16g
and chn p 10 g were added to the formula. After another dose, the condition was
resolvedcompletely.
Review Questions
1. Statethepathomechanisms,manifestations,treatmentprinciples,andformulas
fortheChiHGuZhTngpattern,theDChiHTngpattern,theHungQnTng
pattern,theChiHGuJingTngpattern,andtheChiHJiLngGMLTng
pattern.
2. StatethedifferencesbetweentheDChiHTngpatternandtheXioChiH
Tngpattern;alsodifferentiatetheDChiHTngpatternfromtheChiHGuZh
GnJingTngpattern.
305
Chapter5
Pulse, Pattern, and Treatment of Taiyin
Disease
Taiyinconsistsofthefoottaiyinspleenchannel,thehandtaiyinlungchannel,and
their related organs. However, this chapter mainly discusses pathodynamic changes
of the foot taiyin spleen channel; pathodynamic changes of the hand taiyin lung
channelarediscussedinthe taiyang chapter,asboththelungandbladderchannels
areassociatedwiththeexterior.
Physiology
Thefoottaiyinspleenchannelbeginsatthemedialsideofthetipofthebigtoe,
passesthemedialmalleolus,andascendsinthefrontmedialaspectofthelegtothe
lower abdomen before entering the spleen and connecting with the stomach. Due
totheexterior-interiorrelationshipbetweenthefootyangmingstomachchanneland
thefoottaiyinspleenchannel,thespleenandstomachworktogetherphysiologically
whilealsosharingpathogenicinfuences.
The spleen and stomach both reside in the middle jiao.The spleen governs
transportation and transformation, ascending of the clear, and also the muscles
and limbs.The stomach governs the processing of foods and the descent of turbid
substances.When the spleen and stomach act in harmony, the clear ascends and
the turbid descends thus allowing essence to reach the entire body; the organs are
nourishedinternallyandthelimbsexternally.Hence,thespleenandthestomachare
referred to as the root of the acquired constitution; spleen-stomach function is also
mostimportantformaintainingnormalactivityoftheqidynamic.
Pathodynamic
Pathodynamicchangesoftaiyincanresultfrom:
Constitutionalspleen-stomachdefciencywithcold-dampobstruction
Cold-dampnessinvadingtaiyindirectly
Inappropriatetreatmentofthethreeyangdiseases
Anyofthesecandamagespleenyang,impairtransportationandtransformation,
and lead to cold-damp exuberance manifesting with abdominal fullness, vomiting,
inabilitytoingestfoodnormally,diarrhea,andoccasionalabdominalpainalongwith
awhitegreasytonguecoatingandweakmoderatepulses.Thisisreferredtoas taiyin
disease.To sum up, taiyin disease is characterized by spleen yang deficiency and
stagnationofcoldanddampness.Itsbasicnatureisinternal,involvingdeficiencyand
cold.
There are mainly three ways in which taiyin disease is formed: where deficient
spleen yang is unable to stop a direct invasion of cold and dampness into taiyin; a
raw and cold diet, excessive anxiety or physical fatigue damaging the spleen yang
anditstransportationandtransformationfunctions;pathologicalchangesoftaiyang,
shaoyang,yangmingwhichareuntreatedortreatedinappropriatelythuscausinginjury
tospleenyangwhichallowsthepathogentotransferintotaiyin.
The most commonly seen taiyin disease is a taiyin organ pattern characterized
by internal deficiency and cold. As the condition progresses, there can also be a
taiyin channel pattern characterized by abdominal fullness with frequent or great
excess-type pain with an absence of vomiting or diarrhea. If cold-damp remains
unresolved internally, yellowing may result.This is referred to as a taiyin yellowing
pattern.
Treatment
Totreattaiyinorganpattern,ZhangZhong-jingsuggestedthewarmingmethod,
whichmeanstowarmthemiddle,dissipatecold,fortifythespleenanddrydampness.
Commonly applied formulas include L ZhngWn (Center-Regulating Pill, )
andSNTng(FrigidExtremitiesDecoction,).
As for the taiyin channel pattern, Gu Zh Ji ShoYoTng (CinnamonTwig
DecoctionplusPeony,)andGuZhJiDHungTng(CinnamonTwig
Decoction plus Rhubarb, ) are recommended for coursing and freeing
thespleenchannelandcollaterals.
For the taiyin yellowing pattern, primarily treat the cold and dampness by
warmingyang,dissipatingcoldandeliminatingdampnesstoabateyellowing.
Prognosis
With proper treatment, as spleen yang recovers and the internal dampness and
accumulationresolve,diarrheawillalsocease.
However, if yang becomes excessive and dampness transforms to dryness, the
pathogenicqicanpassfromtheorganstothebowelstocauseyangmingdisease.
Longstandingdeficiency-coldwithdiarrheacanpassto shaoyinandaffectkidney
yang.
VolumeTwo:Chapter5 Pulse,Pattern,andTreatmentofTaiyinDisease 307
Section1 OutlineofTaiyinDisease
Source Text
Line273

Disease of taiyin manifests with abdominal fullness, vomiting, inability to ingest
food normally, aggravated spontaneous diarrhea, and frequent abdominal pain. If
purgationisapplied,therewillbebindingandhardnessbelowthechest.
Interpretation
Thislinediscussesthebasicoutlineandcontraindicationsfortaiyindisease.
Taiyinisascribedtothespleen.Ifanexternallycontractedorinternallyengendered
pathogenicqidamagesspleenyang,apatternofspleendeficiencyand cold-dampness
will result.The spleen governs the greater abdomen. Dampness obstructing the qi
dynamic in the middle jiao will cause abdominal fullness with frequent pain.Turbid
yin ascending counterflow leads to vomiting. Impaired splenic transportation leads
to an inability to ingest food normally.When spleen yang fails to ascend and cold-
dampness pours downwards, there will be diarrhea. Incessant diarrhea further
damages spleen yang and aggravates the condition.Treatment should warm the
middle and dissipate cold. Although no indicated formula is mentioned, L Zhng
WnorLZhngTng(Center-RegulatingDecoction,)canbeapplied.
If one mistakenly considers the abdominal fullness, vomiting, inability to ingest
foodnormallyandabdominalpaintobeanexcesspatternandthenappliesoffensive
purgation with cold and cooling medicinals, the pathogenic qi will sink inwards,
pathogenic cold-dampness will congeal, and binding and hardness below the chest
willresult.
FormulaAnalysis
AlthoughLZhngWn(Tng)isdiscussedindetailintheSuddenTurmoilchapter
oftheTreatiseonColdDamage,itisactuallyachiefformulafortaiyindeficiency-cold.
It consists of rn shn (Radix et Rhizoma Ginseng), gn jing (Rhizoma Zingiberis),
bi zh (Rhizoma Atractylodis Macrocephalae) and zh gn co (Radix et Rhizoma
GlycyrrhizaePraeparatacumMelle).
Rnshnandzhgncobeneftqiandfortifythespleen.
Gnjingwarmsthemiddleanddissipatescold.
Bizhfortifesthespleenanddriesdampness.
Combined together, these four medicinals enhance the functions of replenishing
qi,warmthemiddle,invigoratethespleenandresolvedampness,allofwhichmakes
theformulasuitableforspleen-stomachdeficiency-coldpatternsandpatternsofcold-
dampnessencumbering.
This formula is commonly applied for chronic gastritis, digestive ulcers, chronic
enteritis,andchroniccolonitisthatareassociatedwithspleendeficiencywithinternal
cold. It is also indicated for chronic nephritis, chronic renal dysfunction, chronic
bronchitis and coronary heart disease when associated with spleen deficiency with
cold-dampness,andphlegm-rheumcollectinginternally.
CaseReport
Male,age45.
Chiefcomplaint:incessantabdominalpainanddiarrheafor5years.
When his diet was irregular or when he ate certain kinds of foods, there would
be diarrhea, abdominal distention and fullness with dull pain that liked warmth and
pressure, aversion to cold, cold limbs, vomiting, fatigue, no desire to drink water,
and long voidings of clear urine.The condition would be temporarily relieved after
defecation.Therewasnomucus,pusorbloodinthestool.Histongueappearedpale
withawhiteslipperycoating;pulsesweredeep,thready,slow,andmoderate.
GI endoscopy showed chronic super ficial gastritis and chronic colonitis.
Gastroenterography showed moderate gastroptosis. Cultivation of pathogenic
bacteria from the stool was negative. Hepatic and renal functions, amylase levels in
bloodandurinewerenormal.Eosinophilratiointhebloodroutinetestwas0.05.
Pattern differentiation: deficiency cold of the spleen and stomach (allergic
gastroenteritis).
Formula:LZhngTng.
gnjing 10g RamulusCinnamomiCassiae
Onedailydecocted dose. Decoct on low heat until 300500 ml remains.Take in

threedividedportions.
After 15 doses, all symptoms resolved. Eosinophils in the blood routine returned
tonormal,andthediseaseneverrecurred.
[Reference:ZhangLing-fang.TreatingAllergicGastroenteritiswithLZhngTng
.JournalofPracticalTraditionalChineseMedicine.2005;21(12):754.]
Review Questions
1. Analyzethegeneralsymptomsoftaiyindisease.
2. Analyzethecontraindicationsintreatingtaiyindisease.
Section2 PatternsofTaiyinDisease
Taiyin Organ Pattern
Source Text
Line277

Spontaneousdiarrheawithanabsenceofthirstisassociatedwithtaiyin,andisdue
tocoldintheorgans.Warmingshouldbeapplied. SNTngandsimilarformulasare
recommended.
Formula

gnjing 1.5liang RamulusCinnamomiCassiae
fz 1pc RadixAconitiLateralisPraeparata
Decoctthethreemedicinalsabovewith3shengofwateruntiloneshengand2ge
remain.Discardthedregs.Takewarmintwodividedportions.
Forthosewithastrongconstitution,useonelargepieceoffzand3liangofgn
jing.
Interpretation
This line discusses the chief symptoms, pathodynamic, and treatment principles
fortaiyindisease.
Patientswithmiddlejiaodeficiency-coldoftenpresentwithdiarrheaandanabsence
ofthirst.Thisisthecontrarytodiarrheawiththirstin shaoyindiseaseandyangming
interior heat pattern.The diarrhea in taiyin disease is commonly accompanied by
abdominalfullness,vomiting,inabilitytoingestfoodnormallyandfrequentabdominal
painasmentionedinLine273.
SNTngandsimilarformulasincludeLZhngTngandvariousmodifications
ofSNTng.Attheinitialstageof taiyindiseasewithmildspleenyangdeficiency, L
ZhngTngcanbeappliedtowarmthemiddleandfortifythespleen.Iftheduration
of the condition is long, and the kidney is affected, or when spleen yang deficiency
is relativelysevere, useSNTng to warm spleen and kidney yang, supplement fire,
andengenderearth.
L ZhngTng, S NTng and F Z L ZhngTng can be used to treat various
types of chronic diarrhea and various chronic deficiency conditions such as chronic
gastritisandchronicnephritis.
CaseReport
Male,age5.
Chiefcomplaint:diarrhea.
Historyofpresentcondition:thepatientsufferedfromvomiting,intensefeverand
diarrhea. After the fever was abated and vomiting checked, there was still diarrhea
and mild dehydration. After another seven days of treatment, the dehydration was
resolved,butthediarrheapersisted.Anotherfourteendaysoftreatmentreceivedno
efect.
Atthevisit,thepatientpresentedfatigue,lackofstrength,apalewhitecomplexion,
lackofwarmthinthelimbs,anabsenceofthirst,andclearthinstools.Histonguewas
palewithawhitecoating;pulsesweredeep,weak,andslow.
Patterndiferentiation:spleen-stomachdefciencycold.
Treatment principles: warm the middle, dispel cold, supplement the spleen and
stomach.
Formula:
pojing 5g RhizomaZingiberis(blast-fried)
rugu 3g CortexCinnamomi(wrapped,decoctedlater)
pofz 5g RadixAconitiLateralis(blast-fried)
shrn 3g FructusAmomi
flng 10g Poria
Theconditionresolvedaftertwodoses.
[Reference: Cui Zhao-lan. Clinical Indications for L ZhngWn . Hebei
JournalofTraditionalChineseMedicine.2000;(9):686.]
Taiyin Channel Pattern
Source Text
Line279

If taiyang disease is treated inappropriately with purgation, and abdominal

fullnesswithfrequentpainoccurs,thisistaiyin.GuZhJiShoYoTngisindicated.
Formula

guzh 3liang RamulusCinnamomiCassiae(barkremoved)
Decoct the five ingredients above with 7 sheng of water until 3 sheng remains.
Withgreatexcesspain,GuZhJiDHungTngisindicated.
Formula

guzh 3liang RamulusCinnamomiCassiae(barkremoved)
Decoct the six ingredients above with 7 sheng of water until 3 sheng remains.
Interpretation
This line discusses the pattern and treatment for abdominal pain due to
inappropriatepurgationintaiyangdiseasewithpathogenicqipassingtotaiyin.
When taiyang disease is inappropriately treated with purgation, the pathogenic
qi will sink to the taiyin channel and cause abdominal fullness in mild cases, and
abdominal pain in severe cases. If the qi and blood of the channel is completely
blocked, great excess pain will result; this is referred to as ataiyin channel pattern.
Treatment should free yang, benefit the spleen, disinhibit the collaterals, and check
pain.GuZhJiShoYoTngisindicated.
FormulaAnalysis
ThisformulaconsistsofGuZhTngwithadoubleddosageofshoyo.GuZhTng
harmonizesthespleenandstomach,freesyang,andbenefitsthespleen.Theincreased
dosageofshoyoactstobeneftyin,harmonizeyang,relaxtensionandcheckpain.
Great excess pain is more severe thanabdominal fullness with frequent
pain.The pain is usually aggravated by pressure and accompanied by constipation.
It is caused by severe spleen damage and qi stagnation and collateral blockage
accompaniedbyasubstantialexcesspathogenicqi.Dhungisaddedtotheformula
abovetoenhancethefunctionofresolvingstasisandfreeingthecollaterals.
Thesetwoformulasarecommonlyusedtotreatgastralgia,post-surgeryabdominal
pain, chronic diarrhea or constipation, chronic hepatitis, chronic cholecystitis, and
chronic pancreatitis that are associated with spleen deficiency, qi stagnation and
collateraldamage.
CaseReport
Chiefcomplaint:diarrheaforoneyear.
Previous treatments with various types of antibiotics had no effect.The watery
diarrheaoccurred3to6timeseachday,containingsmallamountsofbloodandpus.
Accompanying symptoms included abdominal urgency,rectal heaviness, abdominal
tendernessespeciallyintheleftlowerabdomen,aversiontocold,andfever(37.5).
Histongueappearedredwithawhitecoating;pulsesweredeepandwiry.
Microscopic examination of the stool showed red blood cells, white blood cells,
andafewphagocytes.
Pattern differentiation: qi stagnation, blood congealing in the spleen, and wood
constrainingearth(chronicbacillarydysentery).
Treatmentprinciples:courseandfreeqiandblood,regulatespleenyinandyang,
andrestrainwoodfromattackingearth.
Formula:

Aftertwodoses,thefrequencyofdiarrheawasremarkablyreducedandtheabdomen
wasrelaxed.Afteranotherdose,thestoolwasbasicallyfirmandabdominalurgency
disappeared.Theconditionresolvedafterfourdoses.
Review Questions
1. How do you understandspontaneous diarrhea with an absence of thirst is
associatedwithtaiyin?
2. How do you understandwarming should be applied; S NTng and similar
formulasarerecommended?
3. When taiyang disease is treated with purgation,abdominal fullness with
frequent pain andgreat excess pain may occur.What are the characteristics of
these two manifestations?What are the associated treatment principles and the
formulas?
314
Chapter6
Pulse, Pattern and Treatment of Shaoyin
Disease
Physiology
Shaoyinincludesthefootshaoyinkidneychannel,thehandshaoyinheartchannel
and their related organs, the kidney and heart; also associated are their interiorly-
exteriorly related channels, the foottaiyang bladder channel and the handtaiyang
small intestine channel.The footshaoyin kidney channel starts from beneath of the
littletoe,crossesthesoleofthefoot,runsposteriortothemedialmalleolus,ascends
along the posteromedial border of the lower limb, and passes through the vertebral
columnwhereitpertainstothekidneyandconnectswiththebladder.Meanwhile,the
channelalsopassesthroughtheabdomenandrunstothechest,passesthroughthe
liverandentersthelungwhereitemergestojointheheartandthenrunsalongthe
throat.
The hand shaoyin heart channel originates from the heart; it emerges from and
spreadsovertheheartsystem,passesthroughthediaphragmandthenconnectswith
thesmallintestine.
Thefootshaoyinkidneybelongstowater,anditstoresessence.Trueyangandyin
reside within it; therefore it is referred to as the residence of water and fire and also
as theroot of the congenital constitution.The handshaoyin heart belongs to fire; it
governsboththebloodvesselsandthespirit-brightness.
The heart-fire resides in the upper body, and kidney-water in the lower body.
Heart-fire descends and warms kidney-water, while the kidney-water ascends to the
heart to prevent hyperactivity of the heart-fire.This balance is referred to as heart-
kidney interaction. As water and fire assist and constrain one another, yin and yang
remainbalancedwithinthebody.
Pathodynamic
Pathogenicqienteringshaoyincaneasilydebilitatetheheartandkidney.Thechief
manifestations includefaint and thready pulses and a desire only to sleep; this is
referredtoasshaoyindisease.Becauseyangqiisdeficientandyin-bloodisinsufficient,
thisisthemostcriticalstageintheprogressionofdisease.
Therearetwocausesofshaoyindisease.Externalpathogenicqicandirectlyinvade
shaoyin,andthisismostcommonlyseenamongelderlypatientswithweakconstitutions
VolumeTwo:Chapter6 Pulse,PatternandTreatmentofShaoyinDisease 315
or chronic kidney yang deficiency.With inappropriate treatment, the pathogenic qi

canalsopasstoshaoyinfromotherchannels.Duetotheexterior-interiorrelationship
between taiyang and shaoyin, when there is shaoyin yang qi insufficiency, a taiyang
pathogenicqicaneasilypasstothischannel.Whenthereislongstandingdiarrheadue
totaiyindeficiency-cold, the kidneycan become impaired so that the pathogenic qi
passestoshaoyin.
Shaoyindiseaseinvolvesdebilitationofheart-kidneyyinandyang,especiallythe
kidney yang. Due to different causes and constitutions, this can be categorized into
twopatterns:coldtransformationandheattransformation.
Yang deficiency cold transformation patterns result from yang qi deficiency and
yin-cold exuberance.This is characterized by an absence of fever,aversion to cold,
sleepingincurled-upposture,vomiting,clear-fooddiarrhea,clearwhiteurine,reverse-
flowofthelimbs,fatigue,apaletonguewithawhitecoating,anddeepfaintpulses.If
exuberantyin-coldforcesdeficientyangtofloatastraytotheexterior,therecanbea
red face, vexation, restlessness, and an abnormal absence ofaversion to cold.This is
referredtoastruecoldwithfalseheat.
Yindeficiency heattransformationpatternsarecommonlyassociatedwithheart-
kidneyyindeficiency.Asdeficiencyheatengendersinternally,yinbecomesdeficient
in the lower body, and heart fire becomes hyperactive in the upper. Manifestations
includevexation,sleeplessness,aredtonguewithascantcoating,andthreadyrapid
pulses.
Treatment
The general treatment principles for shaoyin disease are to support yang and
foster yin, but for a cold transformation pattern, treatment should support yang
and suppress yin. Representative formulas include S NTng (Frigid Extremities
Decoction, ), ZhnWTng (TrueWarrior Decoction,), and F ZTng
(AconiteDecoction,).
With true cold false heat and exuberant yin repelling yang, use a larger dosage
of gn jing (Rhizoma Zingiberis) and f z (Radix Aconiti Lateralis Praeparata) to
break yin and restore yang. Occasionally, salty and cold medicinals can be used
as a paradoxical assistant. Tng Mi S NTng ( Vessel-freeing Frigid Extremities
Decoction,),BiTngTng(ScallionYang-FreeingDecoction,),Bi
TngJiZhDnZhTng(ScallionYang-FreeingDecoctionplusPigsBile,
)canbeapplied.
For a heat transformation pattern, treatment should foster yin and clear heat.
Hung Lin JioTng (Coptis Donkey-Hide Gelatin Decoction, ) is
indicated.
For yang constraint with reversal, the treatment principle is to regulate the qi
mechanism and outthrustconstrained yang.S N Sn (Frigid Extremities Powder,

)isindicated.
Inaddition,ifapersonwithshaoyinyangdeficiencycontractsanexternalpathogenic
qi,thisusuallyleadstotaiyin-shaoyindualcontractionintheinitialstageof shaoyin
disease.Thetreatmentprinciplehereistowarmthechannelsandresolvetheexterior
withMHungFZXXnTng(Ephedra,AconiteandAsarumDecoction,
)andsimilarformulas.
Inbrief,shaoyindiseaseisassociated interiordeficiency,eitheryangqideficiency
or yin deficiency with fire hyperactivity. Sweating and purgation methods are
prohibited.
Section1 OutlineofShaoyinDisease
Source Text
Line281

Thediseaseofshaoyinmanifestswith faintandthreadypulses,anda desireonly
tosleep.
Interpretation
Thisistheoutlineofshaoyindisease.
Shaoyin includes the heart, the fire-organ, and the kidney, the water-organ.The
heart governs the spirit and the blood vessels, and the kidney stores essence where
trueyangandtrueyinreside.
When a pathogenic qi enters shaoyin, heart and kidney function will become
debilitated.Yin, yang, qi and blood all become insufficient. As a result, faint thready
pulsesarepresentandthereisadesiretosleep.
Faint pulse refers to a pulse image that is weak, forceless, and indistinct.This
indicates heart and kidney yang debilitation with failure to invigorate the pulse.
Thready pulse refers to a thin, small, and thread-like pulse shape.This indicates
insufficient heart and kidney blood failing to fill the vessels.When pulses are both
faint and thready, yin, yang, qi and blood have all become deficient. However, the
placing offaint beforethready in this line emphasizes that yang deficiency is
predominant.
Adesire only to sleep refers to fatigue with a desire for sleep as well as an
inabilitytosleep.Thisindicatesheartandkidneyyangdebilitationandqiandblood
defciency.
Contraindications
Source Text 1
Line285

Inshaoyindisease,thready,deepandrapidpulsesreflectthatthediseaseresides
interiorly.Promotingsweatingisprohibited.
Interpretation
Thislinepointsoutthatthesweatingmethodiscontraindicatedinthetreatment
ofshaoyindisease.
In shaoyin heat transformation, deep pulses are associated with the interior, and
thready and rapid pulses indicate yin deficiency and heat. Inducing sweating could
exhaust yin and disturb the blood. In cold transformation, deep pulses are also
associated with the interior, and thready and rapid pulses indicate deficient yang
foatingastray.Sweatinginthiscasecouldleadtoyangcollapse.
There are exceptions, however, when the sweating method must be applied. If
shaoyin yang deficiency is accompanied by exterior excess with no sweating, one
should resolve the exterior and restore yang by simultaneously promoting sweating
and warming the channels. In this case, M Hung F Z X XnTng can be applied.
However,aftertheexteriorisresolved,iftheshaoyinpatternremains,oneshouldtreat
theshaoyinpatternwithoutfurtherapplicationofthesweatingmethod.
Source Text 2
Line286

In shaoyin disease with faint pulses, promoting sweating is prohibited because
yangwillcollapse.Ifyangisalreadydeficient,andpulsesareweakandroughatboth
chpositions,purgingisalsoprohibited.
Interpretation
Thislinepointsoutthatsweatingandpurgingareprohibitedinthetreatmentof
shaoyindisease.
Faint pulses reflect deficiency of yang qi; weak and rough pulses at the ch
positionsreflect scanty yin-blood. In this case, promoting sweating will lead to yang
collapse,andpurgingwillleadtoyinexhaustion.
Review Questions
1. Whyaretherecoldandheattransformationsinshaoyindisease?
2. Analyzethemainpulseimagesandpatternsassociatedwithshaoyindisease.
3. Whatarethecontraindicationsforshaoyindiseasetreatment?Explainwhy.
Section2 PatternsofShaoyinDisease
Shaoyin Cold Transformation
Source Text
Line282

In shaoyin disease, the desire and inability to vomit, vexation, desiring only to
sleep, and spontaneous diarrhea with thirst after five or six days are associated with
shaoyin. Because of deficiency, the taking of fluids provides relief.Withclear urine,
the manifestations of shaoyin disease are all present.The clear urine results from
deficiencyandcoldinthelowerjiaowiththeinabilitytorestrainwater;thisiswhythe
colorisclear.
Interpretation
Thislinediscussesthemanifestationsandpathodynamicofshaoyincoldtransformation.
Theshaoyincoldtransformationpatternisassociatedwithlowerjiaoyangdeficiency
and internal yin-cold exuberance. Kidney yang deficiency and turbid yin ascending
counterflow result in the desire to vomit; however, the stomach is empty so there is
theinabilitytovomit.Whenyinisexuberantinthelowerjiao,deficientyangharasses
upwardly, and vexation occurs. Severe yang deficiency manifests as fatigue and
malnourishmentoftheshen,thusthereisaconstantdesireforsleep.Theseareearly
manifestationsofshaoyinyangdefciency.
Yang-warmingmedicinalsshouldbeappliedpromptly.Otherwise,afterfiveorsix
days, the pathogenicqiwillpassmoredeeply into the interior, and kidney yang will
bemoredebilitated;asspleen-earthfailstobewarmedandtransformed, spontaneous
diarrheawilloccur.
With yang deficiency, fluids fail to transform and spread normally, causing thirst.
Theconditionisrootedinthekidney,andforthisreasonthepassagestatesthatthe
condition isassociated with shaoyin.Because of deficiency, the taking of fluids
providesrelieffurtherexplainsthatthethirstisduetokidneyyangdeficiency.Clear
urine refers to long voiding ofclear urine; this is a key symptom for differentiating
shaoyinyangdeficiencywithcoldexuberance.Forthisreasonthepassagestates,With
clearurine,themanifestationsofshaoyindiseaseareallpresent.
M Hung F Z X XnTng(Ephedra, Aconite and Asarum Decoction)
Pattern
Source Text
Line301

Intheinitialstageofshaoyindisease,whenforthecontradictorypresenceoffever
anddeeppulses,MHungFZXXnTngisindicated.
Formula
fz 1pc RadixAconitiLateralisPraeparata(blast-fried,peeled,splitinto8pcs)
Decoctthemhungwithonedouofwateruntil8shengremains.Scoopoffthe
foam,andadd the other ingredients. Decoct until 3 sheng remains, then discard the
dregs.Takeoneshengwarm,threetimesaday.
Interpretation
Thislinediscussesthepatternandtreatmentof shaoyindiseaseaccompaniedbyan
exteriorpattern.
Theprincipalnatureofshaoyindiseaseinvolvesinteriordeficiencyandcold,and
thereshouldnotbefever.Inthiscasethereisacontradictoryclinicalpresentationof
fever, indicating there is a concurrenttaiyang exterior pattern present, with a deep
pulse, associated with the interior, it reflects shaoyin yang qi deficiency. One should
treattheexteriorandinteriorsimultaneouslybywarmingthe shaoyinchannelandby
promotingsweating.MHungFZXXnTngisindicated.
FormulaAnalysis
M hung dissipates wind-cold to resolve the taiyang exterior pathogenic qi. F
zwarmsandsupplementskidneyyangtodispeltheshaoyincold.Xxnispungent,
warm and moves vigorously; it helps f z to warm the channels and supplement
yang,whilealsoassistingmhungtoreleasetheexteriorcold.Theentireformulaacts
toresolvetheexteriorwhilewarmingyang.
Thisformulaiswidelyappliedinclinic,notonlyfor shaoyindiseasewith exterior
patterns, but for any condition associated with yang qi deficiency and stagnation of
internalcold.Itisindicatedforlungconditionssuchasthecommoncold,bronchitis,
pneumonia, emphysema, and bronchial asthma; also for various types of pain or
paralysis such as sciatica, vascular or nervous headache, muscle neuralgia, facial
paralysis, and lumbar spondylitis. It can be used to treat renal and urogenital
disorderssuchasacuteandchronicnephritis,urinaryretentionandrenalcolic,heart
diseases such as arrhythmia, rheumatic heart disease, and sick sinus syndrome, as
wellasurticaria,breastdiseases,allergicrhinitis,andaphonia.
CaseReport
Female,age64.Retiredworker.
The patient contracted influenza in January of 2001. Manifestations included
distendingsensationsinthehead,headache,arunnynosewithclearsnivel,anaversion
to cold mainly affecting the back, and a low fever with generalized discomfort. Cold
capsulesandAPCwereinefective.
Afteramonth,shedevelopeddeficiencysignsandsymptomssuchasclearsnivel,
coldnessofthebody,aversiontocold,fatigue,alusterlessfacialcomplexion,andlow
quiet voice.The fever was usually around 37.4C.The patient then sought Chinese
medicinetreatment.
Headache,clearsnivelandaversiontocoldindicatedthecommoncold;thefatigue,
cold limbs, low fever, deep faint pulses, and thin white tongue coating indicated
debilitatedyangfailingtoresistpathogenicqi.
Patterndiferentiation:severecommoncoldwithyangdefciency.
Formula:MHungFZXXnTng.
fz 9g RadixAconitiLateralisPraeparata
Threedoses.
The patient came to the hospital after three days and reported that all her
symptomshadresolved.
[Reference:Yu Shu-xia. Clinical Applications of M Hung F Z X XnTng
.ChinaMedicineHygiene.2005;6(1):71.]
FZTng(AconiteDecoction)Pattern
Source Text
Line304

Oneortwodaysaftercontractingshaoyindisease,withharmonyofthemouthand
aversiontocoldontheback,moxibustionshouldbeapplied;FZTngisindicated.
Line305

Forshaoyindiseasewithgeneralizedpain,coldextremities,jointpain,andadeep
pulse,FZTngisindicated.
Formula
fz 2pcs RadixAconitiLateralisPraeparata(peeled,splitinto8pcs)
flng 3liang Poria
Decoct the five above ingredients with 8 sheng of water until 3 sheng remains.
Interpretation
Line304discussesthekeypointforpatterndifferentiationandtreatmentofyang
defciencywithcolddampness.
Oneortwodaysaftercontractingshaoyindisease,theconditionisstillinitsinitial
stage.Harmony of the mouth refers to an absence of dryness, thirst or bitterness
inthemouth,whichindicatesabsenceofinteriorheat. Aversiontocoldaffectingthe
backisduealossofwarmthduetoyangdefciency.
F ZTng is selected to warm the channels, support yang, dissipate cold and
eliminatedampness.Meanwhile,moxibustioncanbeappliedatDU14(dzhu),RN4
(gunyun),andRN6(qhi).
Line305discussesthepatternandtreatmentofgeneralizedpainassociatedwith
yangdefciencyandcolddampness.
When shaoyin yang qi is too deficient to reach the extremities, cold extremities
occur; deficient yang fails to transform cold dampness, which then stagnates in
the tendons, muscles and joints to cause generalized pain and joint pain.The deep
pulseisassociatedwiththeinterior,aswellaswithcolddampness.FZTngisthe
selectedformula.
FormulaAnalysis
Inthisformula,sothatyangqicanprevailoveryin-cold,alargedosageoffzis
prescribed.
Rnshnandbizhbeneftqiandfortifythespleen.
Flngfortifesthespleenanddisinhibitsurinewithsweetandblandproperties.
Shoyoharmonizesying-bloodandfreesblood-blockage,whilealsomodulating
thedryingpropertiesoffz.
Inthemodernclinic,thisformulaisusedtotreatvariouspainpatternsasassociated
withyangdeficiencyandcold-dampnessstagnation,suchasarthralgiaduetorheumatism
andrheumatoidarthritis,anginaofcoronaryheartdisease,abdominalpaincaused by
acuteandchronicgastritis,hypertensionandnervousheadache,andlimbpaindueto
sciaticaorvasculitis.
CaseReport
Male,age41.
Chiefcomplaint:stomachpainfortwoyears.
Over the past half-year, the condition had become aggravated with increasingly
frequentonsets.Thepatienthadadecreasedappetite,perniciousanemia,emaciation
and difficulty walking.There was a little improvement after treatment.There was
also constipation, with bowel movements occurring every three or four days.The
patientrecentlyfeltnumbnessintheleftbodyeverynight;othersignsandsymptoms
included pain in the joints, insomnia, dizziness, heart palpitations, a bright white
complexion,palelipsandcoldextremities.Histonguewaswhitewithathincoating;
thepulsewasdeep,threadyandweak.
Formula:FZTng.
pofz 15g RadixAconitiLateralisPraeparata(blast-fried)
flng 10g Poria
Afteronedose,thenumbness,pain,dizziness,andheartpalpitationsallimproved;
hispaincompletelydisappearedafteranotherthreedoses.
[Reference:ZhangZhi-min.UsagesofPrescriptionsfromTreatiseonColdDamage.
Hangzhou:ZhejiangScienceandTechnologyPress;1984.]
ZhnWTng(TrueWarriorDecoction)Pattern
Source Text
Line316

If shaoyin disease has remained for two or three days, and on the fourth or fifth
day, abdominal pain,inhibited urination, heaviness and pain of the extremities and
spontaneousdiarrheaoccur,thisisdue to the presence of water-qi.The person may
developcoughing,oruninhibitedurination,ordiarrhea,orretching.ZhnWTngis
indicated.
Line82

In taiyang disease, if the condition remains after promoting sweating, and the
person still presents with fever, palpitation below the heart, dizziness in the head,
generalizedtwitchingandtremblingwithalossofbalance,ZhnWTngisindicated.
Formula
flng 3liang Poria(cut)
shoyo 3liang RadixPaeoniae(cut)
fz 1pc RadixAconitiLateralisPraeparata(blast-fried,peeled,splitinto8pcs)
Decoct the above five ingredients with 8 sheng of water until 3 sheng remains.
Discardthedregs.Take7gewarm,threetimesaday.
Interpretation
Line316discussesthepatternandtreatmentofyangdefciencywater-fooding.
Bythefourthorfifthdayaftercontracting shaoyindisease,thepathogenicqihas
alreadyenteredtheinterior.Aspathogeniccolddamageskidneyyang,anddeficient
yang fails to constrain water, pathogenic water-flooding occurs.This condition is
also referred to aswater-qi.Water-rheum obstructing in the abdomen leads to
abdominal pain, andwater-rheum affecting qi transformation of the bladder causes
inhibitedurination.Whenitspreadstothefleshandmuscles,therewillbeheaviness
and pain of the limbs. When it soaks the stomach and intestines, there will be
diarrhea.Water-rheumshootingintothelungcausescoughing.Deficientkidneyyang
failingtoconstrainyinleadsto uninhibitedurination,andwhen water-rheumaffects

the stomach, there will be retching.These signs and symptoms reflect that water-
rheum is mobile, and that it will move along with the qi dynamic of the three jiao.
ZhnWTngshouldbeappliedtowarmyang,transformqiandmovewater.
Line82discussesthepatternandtreatmentofpathogenicqientering shaoyinwith
yang deficiency water-flooding due to inappropriate sweating in the treatment of
taiyangdisease.
When treating taiyang disease, promoting sweating should be applied; however,
if it is applied to those with constitutional deficiency or applied excessively,shaoyin
yangqicanbeaffected.Insufficientshaoyinyangfailstotransformqiandmovewater,
thus water-rheum collects internally.When it harasses the heart, palpitations occur;
when it obstructs the clear yang from ascending, dizziness and blurred vision occur;
whenitspreadstotheflesh,muscles,channelsandvessels,therewillbe generalized
twitching, trembling and a loss of balance. Fever in this case does not indicate an
unresolvedexteriorpattern;insteaditisassociatedwithdeficientyangstrayingtothe
exterior.Therefore the yang-warming, qi-transforming, and water moving action of
ZhnWTngisindicated.
FormulaAnalysis
Fzispungentandhot.Itactstowarmthekidney,invigorateyangand constrain
water.
Bizhisbitterandwarming.Itactstofortifythespleen,drydampness,warmthe
channels,andeliminatecold-dampness.
Shngjingispungentandwarming.Itactstodissipatewater-qi.
Flngdisinhibitswaterwithblandness.
Shoyoharmonizesyingwhilealsomodulatingthedryingpropertiesoffz.
Inmodernclinicalpractice,thisformulaisfrequentlyappliedforchronicoracute
heart failure and renal failure as associated with yang deficiency water-flooding
which manifests with panting, palpitation, edema and difficult urination. It can also
be applied for hypertension, Menieres disease, cervical spondylopathy, exudative
pleurisy and chronic gastroenteritis as associated with yang deficiency rheum-
collection.
CaseReport
The patient had suffered from recurring palpitations, shortness of breath, chest
oppressionandalackofstrengthformorethanthirtyyears.Inthepastfiveyears,the
condition had become aggravated with generalized edema. He was diagnosed with
rheumaticheart disease, mitral incompetence, chronic right ventricular failure, rapid
auricularfibrillatin, and class III cardiac function. Previous treatments with Dn Shn
Pin(SalviaTablets),sodiumferulateanddigoxinwereinefective.
Upon presentation, there was pitting edema of the face and limbs, inhibited
urination, fatigued limbs, and lack of strength. His tongue was pale purple with a
whiteslightlygrimycoating.Thepulsewasdeepandintermittent.
Pattern differentiation: edema due to spleen-kidney yang deficiency and water-
dampcollecting.
Treatment principles: warm yang, transform qi, disinhibit water, and procolate
dampness.
Formula:supplementedZhnWTng.
fz 10g RadixAconitiLateralisPraeparata(blast-fried,decoctedfor30minsfrst)
flng 15g Poria
Take150mldecoctionwarm,threetimesaday.
Symptoms improved after three doses. After another fifteen doses, all symptoms
disappearedandneverrecurred.
[Reference: Chen Li. Clinical Application ofZhnWTng as the SameTreatment for Different
Diseases.JournalofPracticalTraditionalChineseMedicine.2009;25(2):101.]
SNTng(FrigidExtremitiesDecoction)Pattern
Source Text
Line323

For shaoyin disease with a deep pulse, urgently apply warming. S NTng is
recommended.
Formula
gnjing 1.5liang RhizomaZingiberis(cut)
fz 1pc RadixAconitiLateralisPraeparata(raw,peeled,splitinto8pcs)
Decoctthethreeingredientsabovewith3shengofwateruntiloneshengand2ge
remains.Takewarmintwodividedportions.Forthosewithastrongconstitution,use
alargerpieceoffzwiththreeliangofgnjing
Interpretation
Thislinediscussesthepatternandtreatmentofshaoyinyangdeficiencywithyin
exuberance.
Decidingtoapplywarmingmethodsurgentlyaccordingtothepulseimagealone
seemstobebothhastyandnotcompletelyconsistentwiththeprincipleofcorrelating
pulses and signs. However, since this line discussesshaoyin disease, we should
take the principal pulses and also the signs associated with shaoyin disease into
consideration.Thedeep pulse here should be deep, faint, and thready, and should
beaccompaniedbyaconstantdesiretosleep.Thesesignsandsymptomsindicategreat
deficiencyofshaoyinyangqiwithexuberanceofyin-cold.Withoutpropertreatment,
aversion to cold, curling of the body, vomiting, diarrhea, and reversal of the limbs
willoccursoon.Incriticalcases,repellingyangoryangcollapsewillresult.SNTng
shouldbeappliedtourgentlyrestoreyang.
FormulaAnalysis
Freshfzisextremepungentandhot.Itactstodispelcoldandrestoreyang.
Gn jing is pungent and warm. It acts to secure the middle and assist f z to
warmkidneyyanganddispelcold.
Zhgncoissweetandwarming.Itassistsfzandgnjingtowarmthekidney
andrestoreyang,whilealsomodulatingthedryingpropertyoffz.
Thewholeformulaactstowarmthekidney,restoreyangandstemcounterfow.
In the modern clinic, this formula is frequently applied for various critical
conditions including shock, heart failure, kidney failure and respiratory failure. It
is also indicated for chronic diarrhea and other chronic conditions such as chronic
gastritisandchronicnephritisasassociatedwithkidneyyangdeficiencyand yincold
exuberance.
CaseReport
Male,age75.
The patient caught a cold in the wintertime which led to headaches, fever and
runny nose with clear snivel. After takingLng Qio Ji DWn (Antelope Horn and
ForsythiaToxin-ResolvingPill)athome,he experienced fatigue and cold extremities.
Uponpresentation,therewerefatigue,lassitudeandreticence,adesiretosleep,and
coolhands.Thetonguewaspale,tenderandwhite;hispulsewasdeep.
Patterndiferentiation:shaoyincolddamage(kidneyyangdefciency).
Treatmentprinciples:urgentlywarmshaoyin.
Formula:SNTng.
Afteronedose,thepatientsspiritimproved.Withtheseconddose,hisextremities
turnedwarm,andthediseasewascured.
Tng Mi S N Tng (Channel-Unblock ing for Frigid Ex tremities
Decoction)Pattern
Source Text
Line317

Inshaoyindisease,ifthereisclear-fooddiarrhea,interiorcoldwithexteriorheat,
reverse-flow of the extremities, afaint pulse on the verge of expiration, an atypical
absenceofaversiontocold,andthepersonhasaredfacialcomplexion,orabdominal
pain, or dry retching, or sore throat, or non-emerging of the pulse after diarrhea
ceases,TngMiSNTngisindicated.
Formula
fz 1largepc RadixAconitiLateralisPraeparata(raw,peeled,splitinto8pcs)
gnjing 3liang RhizomaZingiberis(4liangforthosewithstrongerconstitutions)
Decocttheabovethreeingredientswith3shengofwateruntiloneshengand2ge
remains. Discard the dregs.Take warm in two divided portions. If the pulse emerges
promptly,theconditioncanbeconsideredascured.
Interpretation
Thislinediscussesthepatternandtreatmentofexuberantyinrepellingyang.
Inshaoyindisease,clear-fooddiarrhea,reverse-flowoftheextremities,andafaint
pulsevergingonexpiryindicateyin-coldexuberanceandgreatdeficiencyofyangqi.
Pathogenic cold damaging spleen and kidney yang result in clear-food diarrhea. As
yangisdeficientandfailstospreadnormally,thereisreverse-flowintheextremities
andfaintpulsesvergingonexpiry.Deficientyangisrepelledtotheexterior,resulting
inanatypicalabsenceofaversiontocold;whenrepelledtotheupperbody,thereisa
redfacialcomplexion.
Interior cold with exterior heat refers to interior true cold and exterior false
heat.When kidney yang is debilitated, spleen yang will be affected, and there will
beabdominalpain.Whenshaoyincold-qiaffectsthestomach,stomachqiwillascend
and there will be dry retching. As deficient yang floats upwards along the channel,
it becomes constrained in the throat, causing a sore throat.With yang deficiency, qi
failstotransformfluids;withfrequentdiarrhea,fluidsarealsodamaged.Thisleadsto
yin-humorexhaustionandextremedeficiencyofyangqi,soevenwhenthediarrhea
stops, the pulse remains impalpable. S NTng may no longer be efficient, so Tng
MiSNTngisindicated.
FormulaAnalysis
This formula is S NTng with increased dosages of f z and gn jing. It has a
strongeryang-warmingandcold-dispellingeffect.Whenyangisrestored,thevessels
willbefreed.
Similarly to S NTng, this formula is frequently applied in clinic for various
critical conditions including shock, heart failure, kidney failure and respiratory
failure. It is particularly effective for those with fever due to infection as associated
withexuberantyinrepellingyang.
CaseReport
Female,age24.
The patient had a weak constitution and a history of anemia and miscarriage. In
herthirdmonthofpregnancyshesuddenlybledprofuselyfromthevagina,andwas
hospitalizedimmediately.Othersignsandsymptomsincludedpalpitations,dizziness,
vexation, and agitation.The pulse was large, gaping, and hollow. Blood-nourishing
shen-quietening medicinals were then prescribed. Before the decoction process was
finished, the patient developedreversal cold of the extremities, vexation, agitation,
generalized fever, spontaneous sweating, bright red cheeks, and dry mouth and
tongue, indicating imminent desertion. Her pulse was faint, thready and verging on
expiry.ThesystolicBPdroppedto67mmHgfrom94mmHguponadmission.
Patterndiferentiation:interioryinexuberancerepellingyangtotheexterior.
Rn shn powder 3 g was given promptly, followed byTng Mi S NTng. The
patientcalmeddownaftermedication,herextremitiesturnedwarm,thefeverabated,
herbodycooled,andthefacialcomplexionwaslessred.
[Reference:XingXi-bo.ClinicalApplicationsofTreatiseonColdDamage.Tianjin:
TianjinScienceandTechnologyPress;1984.p.261.]
Shaoyin Heat Transformation Patterns
Hung Lin JioTng (Coptis and Donkey-Hide Gelatin Decoction)
Pattern
Source Text
Line303

Morethantwoorthreedaysaftercontractingshaoyindisease,withvexationand
aninabilitytosleep,HungLinJioTngisindicated.
Formula

jzhung 2pcs GalliVitelllus
Decoctthreeoftheingredientswith5shengofwateruntil2shengremains.Discard
the dregs, and add the jio and dissolve completely. Allow the decoction to cool
slightly,addthejzhungandmixwell.Take7gewarm,threetimesaday.
Interpretation
Thislinediscussesthepatternandtreatmentofshaoyinheattransformation.
More than two or three days after contracting shaoyin disease, the symptoms of
vexationandaninabilitytosleepindicateheatharassingheart-shen.Thisisassociated
with kidney-water deficiency in the lower body, heart-fire exuberance in the upper
body,andnon-interactionoftheheartandkidney.Inadditiontovexationintheheart
andaninabilitytosleep,thereshouldalsobeadrythroat,thirst,aredtonguewitha
scantcoating,andthreadyrapidpulses.ApplyHungLinJioTngtonourishyin
andclearheat.
The inability to sleep in this pattern is different from that in the Zh Z ChTng
pattern, which is associated with formless pathogenic heat harassing the chest and
diaphragm. In that pattern, only the qi level is affected, and the yin-humor is not
damaged.The tongue coating is most likely to be thin and yellow.Treatment here
shouldacttoclearanddifusetheconstrainedheat.
FormulaAnalysis
Hung lin and hung qn are bitter and cold.They drastically clearheart-fire to
eliminatevexingheat.
jio,shoyoandjzhungenrichkidneyyinandnourishyingblood.
Thewholeformulaactstoenrichkidney-wateranddownbearheart-firetopromote
heartandkidneyinteraction.
This formula is commonly applied for insomnia; in addition, there are many
clinical reports of using this formula to treat various conditions associated with
effulgentyindeficiencyfireincludingbleeding,coughingblood,dysentery,hematuria
and spotting, as well as atrophic gastritis, intractable aphonia, cirrhosis, impotence
and epilepsy syncope that are associated with heart-fire exuberance and kidney yin
depletion.
CaseReport
Duetoconsistentandtaxingwork,thepatientsufferedfromasevereanxietyand
insomnia. After taking 12 mg of estazolam, she could temporarily fall asleep, but
therewouldbeprofusedreamingandfrequentawakening.Herconditionhadbecome
aggravatedformorethanamonth.Thepatientstayedupallnight,andinthedaytime
there would be dizziness, blurred vision, fatigue, lack of strength, and forgetfulness.
EEGshowednoabnormality.
Previous treatments with Yng Xu n Shn Pin (Blood-Nourishing Shen-
QuieteningTablet, ), Gu PWn (Spleen-Restoring Pill, ), and Wi
LnBZh(DitiaminsandSodiumPhosphateSyrup,)wereinefective.
The patient also had dark urine and dry bound stools.The tongue was red with
littlecoating;herpulsewasthreadyandrapid.
Pattern differentiation: sleeplessness due to non-interaction of heart and kidney,
freharassingheart-shen.
Treatmentprinciples:promoteheart-kidneyinteraction,drainfire,andcalmshen
whilenourishingyinandenrichingthekidney.
Formula:supplementedHungLinJioTng.
lngch 30g DensDraconis

Aftersixdoses,hersleepqualityimproved.
Secondconsultation:Theformulawasmodifiedtomorestronglysupplementyin
andnourishthekidney.
lngch 30g DensDraconis
tinmndng 15g RadixAsparagi
Afteranotherfvedoses,allsymptomsdisappeared.
[Reference:DaiSu-tao.ClinicalApplicationsofHungLinJioTng.
HebeiJournalofTraditionalChineseMedicine.2005;(27)10:758.]
ZhLngTng(PolyporusDecoction)Pattern
Source Text
Line319

For shaoyin disease with diarrhea for six or seven days and coughing, retching,
thirst,vexation,andaninabilitytosleep,ZhLngTngisindicated.
Formula
zhlng 1liang Polyporus
flng 1liang Poria
hush 1liang Talcum(smashed)
zxi 1liang RhizomaAlismatis
Decoctfouroftheingredientswith4shengofwateruntil2shengremains.Discard
thedregs.Addthejioanddissolvecompletely.Take7gewarm,threetimesaday.
Interpretation
This line discusses the pattern and treatment of yin deficiency with heat, and
waterandheatbindingtogetherinthelowerjiao.
Diarrheainshaoyindiseaseiscommonlyassociatedwithdeficiencycold.However,
in this line, it isaccompaniedbycoughing, retching, thirst, vexation and an inability
tosleep.Thus,thepatternhereiskidneyyindepletionwithwaterandheatbindingin
thelowerjiao.
Water-qi collects and leaks to the large intestine resulting in diarrhea; when it
impairs the diffusing and downbearing function of the lung, there will be coughing;
whenitimpairstheharmoniousdownbearingofthestomach,therewillberetching.
Waterandheatbindinginthelower jiaoaffectstheqitransformationofthebladder,
liquidfailstoascend,thusthirstoccurs.Yindeficiency-heatdisturbsthe shen,which
leads to vexation and insomnia.Zh LngTng is selected to nourish yin, clear heat
anddisinhibitwater.
FormulaAnalysis
In this formula, zh lng, f lng and z xi are sweet and bland.They act to
procolatedampness,disinhibitwateranddischargeheat.
jioissweetandneutral.Itactstofosteryinandmoistendryness.
Hu sh is sweet and cold. It acts to clear heat, eliminate dampness, free the
orifces,anddisinhibiturine.
Allingredientscombinedacttofosteryin,moistendryness,clearheatanddisinhibit
water.
Thisformulaiscommonlyappliedfordifficultordribblingurinationaccompanied
bythirstwithadesiretodrink.Itcanalsobeappliedforchronicnephritis,hematuria,
lumbar pain, chyluria, diarrhea, coughing, and ascites due to cirrhosis as associated
withyindefciencyandwaterandheatbindingtogether.
CaseReport
The patient had suffered with diabetes for four years. After takingXio KWn
(ConsumptiveThirst Pill, ), the increased eating, rapid hungering, and lack
of strength were improved. Fasting and postprandial blood glucose levels were
normal, but there was thirst with profuse drinking.The patient always suffered from
unbearablethirst,andwouldfeelvexedandagitatediftherewasnowateravailable.
After drinking, there would be frequent urination. Occasionally there would be
nausea and a lack of strength due to excessive water intake, but the desire to drink
remained.Hehad to get up three or four times to drink water each night, otherwise
therewouldbegreatthirst,vexation,andaninabilitytosleep.
PrevioustreatmentwithMiWiDHungTng(Ophiopogonis,ChineseMagnolivine
Fruit and Rehmannia Decoction, ), Y N Jin (Jade Lady Decoction,
),YQunWn(JadeSpringPill,),YQunTng(JadeSpringDecoction,
), Sh Shn Mi DngTng (Glehniae and Ophiopogonis Decoction,
), kidney-supplementing and astringing medicinals, and various types ofWestern
medicinewereinefective.
Upon presentation, there was emaciation, a red tongue with thin yellow coating
thatwaspeeledinthemiddle,andwiryrapidpulses.
Pattern differentiation: constitutional yin deficiency, water-rheum collecting
internally,waterandheatbindingtogether.
Treatment principles: nourish yin, moisten dryness, clear heat, and disinhibit
water.
Formula:supplementedZhLngTng.
zhlng 15g Polyporus
flng 20g Poria
hush 30g Talcum
wwizi 15g FructusSchisandrae
wmi 15g FructusMume
Afterninedays,histhirstanddesireforwaterwereremarkablyimproved.Hung
q (Radix Astragali) 20 g and dn shn (Radix et Rhizoma Salviae Miltiorrhizae) 20 g
wereaddedtothepreviousformula.
Allsymptomsdisappearedafteranothertwelvedoses.
[Reference:LiuJian-gang.ExamplesofCuringDifficultCaseswithZhLngTng
.HenanTraditionalChineseMedicine.2006;25(8):15-16.]
Shaoyin Yang Constraint Pattern
SNSn(FrigidExtremitiesPowder)Pattern
Source Text
Line318

Inshaoyindiseasewithcounterflowofthefourextremities,thepersonmaypresent
with cough, or palpitations, or inhibited urination, or abdominal pain, or diarrhea
withlowerheaviness.SNSnisindicated.
Formula
zhgnco 10fen RadixetRhizomaGlycyrrhizaePraeparatacumMelle
zhsh 10fen FructusAurantiiImmaturus(split,soakedinwater,frieduntildry)
chih 10fen RadixBupleuri
shoyo 10fen RadixPaeoniae
Poundandsifttheabovefouringredients,mixwithasquare-cunspoonfulofrice
soup,andtakethreetimesaday.
Interpretation
Thislinediscussesthepatternandtreatmentof counterflowreversalduetoliver
andstomachqistagnationandyangconstraint.
Counterflowreferstoreversalcoldoftheextremities,aresultofstagnatedheart
and kidney yang failing to reach the extremities.This pattern is essentially different
from shaoyin disease reversal cold which is associated with yang deficiency and
yin exuberance; the manifestations are relatively mild, with no other symptoms of
defciencycoldpresent.
Shaoyin yang constraint and qi obstruction can lead to pathogenic rheum; when
affectingthelung,coughingoccurs;whenaffectingtheheart,palpitationsoccur;when
affectingbladderqitransformation, difficulturinationoccurs.Whenaccompaniedby
yangdeficiency,middlecoldandqistagnation,therecanbeabdominalpain,diarrhea
and abdominal urgency with rectal heaviness.Treatment should regulate the qi
mechanismandoutthruststagnatedyang.SNSnisindicated.
FormulaAnalysis
Chi h is uplifting; it acts to course the liver, resolve constraint and outthrust
yang.
Zh sh is downbearing; it moves qi, dissipates binding, and frees the stomach
collaterals.
Shoyoandzhgncoemolliatetheliver,regulatethespleen,supplementyin
andrelieveurgency.
The formula medicinals combined act to course the yang qi of the heart and
kidneybycoursingtheliverandregulatingqi.
This formula is frequently used to treat a variety of qi dynamic stagnation
patternsmanifestingwiththefollowingconditions:duodenalulcer,chronichepatitis,
cholecystitis, pancreatitis, cholelithiasis, esophagism, gastrointestinal neurosis,
ulcerative colitis, dysentery, appendicitis, intercostal neuralgia, sexual dysfunction,

scrofula, costal cartilage inflammation, premature ventricular contraction, and
functionalhypotension.
CaseReport
Male,age32.
Chiefcomplaint:sweatingfromtheextremitieswithreversalcoldandnumbness.
The amount of sweating increased with the severity of the reversal cold.Yang-
restoring medicinals such as f z (Radix Aconiti Lateralis Praeparata) andgn jing
(RhizomaZingiberis)werenoteffective.Thepersonhadastrongphysiqueandround
cheeks, which is atypical of cold reversal; however, his hands were very cold to the
touch.Thetonguewasredwithawhitecoating;hispulseswerewiryandforceful.
Thispatternwasnotcoldreversalduetoyangdeficiency,norheatreversaldueto
yangexuberance.Thewirypulseindicatesyangconstraint.Whenyangwasconstrained
intheinteriorandfailedtoreachtheextremities,thesignsofcoldreversalappeared.
Constrainedyangalsoforcedyintoleakoutwards,resultinginsweating.Withgreater
yangconstraint,thereversalcoldoftheextremitiesandsweatingwouldbecomemore
severe.
Formula:SNSn.
Aftertakingthedecoction,therewasasensationofqidescendingwithsomeslight
twitching below the umbilicus.The patient felt immediately relief; his extremities
turnedwarm,andthesweatingstopped.However,aftertwodoses,the reversalcold
andsweatingrecurred.
Second consultation: gu zh (Ramulus Cinnamomi) and m l (Concha Ostreae)
wereaddedtothepreviousformula.Guzhpairedwithshoyocanharmonizeying
andwei;mlpairedwithshoyocanconstrainsweatandsecureyin.
Another two doses were taken.The extremities became warm and the sweating
reduced. However, taking more doses did not reinforce the treatment effect.The
reoccurrenceofthisconditionwasinfactquiteintriguing.
AsWang Bing once pointed out, todisperse the shroud of yin, one must boost
the source of fire, and torestrain the brilliance of yang, one must invigorate the
governor of water. In this case, the constrained yang required coursing, and the
deficient yin needed to be rescued. Insufficient yin fails to restrain yang; so instead,
it was forced to leak outwards in form of sweat.The treatment principles were then
changedtotreattheliverandkidneysimultaneously,toregulateqi,andtoenrichyin.
Formula: S N Sn with Li Wi D HungTng (Six Ingredients Rehmannia
Decoction).
Aftersixdoses,thereversalcoldextremitieswascured,andthesweatingstopped.
Atafollow-up,thediseasehadneverrecurred.
[Reference: Liu Du-zhou.Commentary onTreatiseonColdDamage.Tianjin:Tianjin
ScienceandTechnologyPress;1993.p.74.]
Review Questions
1. Withashaoyin cold transformation pattern, what different patterns are there?
Whataretherespectivepathogeneses,clinicalmanifestations,treatmentmethodsand
formulas?
2. Whatdifferentformulasarethereforthetreatmentofshaoyinheattransformation
patterns?Whataretherespectivepathogeneses,clinicalmanifestations,treatmentmethods
andformulas?
3. WhatarethepathomechanismsandclinicalmanifestationsofaSNTngpattern?
WhataretheappropriatemodifcationsforSNTng?
337
Chapter7
Pulse, Pattern, and Treatment of Jueyin
Disease
Physiology
Jueyin consists of the foot jueyin liver channel, the hand jueyin pericardium
channel, and their related organs the liver and pericardium.The two channels also
have respective exterior-interior relationships with the foot shaoyang gallbladder
channelandthehandshaoyangsanjiaochannel.
Thefootjueyinliverchanneloriginatesfromthebigtoe,ascendsalongthemedial
aspect of the leg and encircles the genitals to enter the lower abdomen.Then the
channelcontinuesupwardtocurvearoundthestomachbeforeenteringtheliverand
connecting with the gallbladder. It crosses the diaphragm and spreads in the costal
andhypochondriacregionthenascendstolinkwiththetissuessurroundingtheeye
tie, and continues over the forehead to the vertex, where it intersects with the du
channel.
Thehandjueyinpericardiumchanneloriginatesinthecenterofthechest,enters
the pericardium, and descends to connects with the upper, middle and lowerjiao.
Onebranchrunsfromtheinsideofthechesttotheaxilla,descendsalongthemedial
aspectofthearmtothecubitalfossaoftheelbow,andtravelstoandfromthepalmto
terminateatthetipofthemiddlefnger.
The liver dwells at the rib-side and connects with the gallbladder by collaterals.
It stores blood and governs coursing and discharging. It likes orderly reaching and
isaversetoconstraint.Itisconnectedwithsinews,opensattheeyes,andplaysakey
roleinregulationoftheqidynamicandthereceptionanddigestionfunctionsofthe
spleenandstomach.
Thepericardium is the protector ofheart, and it utilizes the hearts function.The
pericardiumfiredescendstothelowerjiaoandwarmskidney-watertomoistenliver-
wood.Thus the upper jiao remains clear, the middle jiao warm, and the qi dynamic
smoothsothatthebodycanfunctionnormallyasawhole.
Pathodynamic
Whenpathogenicqiinvadesjueyin,theliverqidynamicbecomesobstructed,and
thepericardiumisalsoafected.Therecanbethreetypesofclinicalmanifestations:
Pathogenic cold leads to deficiency-cold of the liver and stomach and turbid
yin ascending counterflow. Manifestations include pain at the vertex, retching, and
drool with foaming at the mouth. Cold can also lead to blood deficiency with cold
congealing, manifesting with reversal cold of the limbs and thready pulses on the
vergeofexpiration.
Pathogenicheatoftenleadstoliverheatdistressingthelargeintestine,manifesting
withdiarrhea,abdominalurgencyandrectalheaviness.
When pathogenic heat sinks inward, pericardium fire flares upward; there will
be heat in the upper body and cold in the lower.This cold-heat complex usually
manifestswithdispersion-thirst,qibumpingupwardsagainsttheheart,painandheat
intheheart,andhungerwithnodesireforfood.
Therearethreemainoriginsforjueyindisease:
Withinappropriatetreatment,thepathogenicqicanpassfrom taiyang,yangming
orshaoyangtothethreeyinchannels.Thepathogenicqiofshaoyangismostlikelyto
afectjueyinbecausethesetwochannelsstandinanexterior-interiorrelationship.
Iftaiyinorshaoyindiseasesbecomeaggravated,thepathogenicqicanpassinwards
tojueyin.
Lastly, with a weak constitution and weak organ-qi, the pathogenic qi can strike
jueyindirectly.However,thisconditionisrarelyseenintheclinic.
Treatment
The general treatment principle for jueyin disease is towarm the cold and clear
theheat.Sometimes,warmingandclearingmethodscanbeappliedsimultaneously.
Forupperheatwithlowercold,cleartheupperandwarmthelower.WMiWn
(MumePill,)isindicated.
For a jueyin cold pattern, warm the channels and nourish blood, or warm the
stomach and downbear counterflow. Dng Gu S NTng (Chinese Angelica Frigid
ExtremitiesDecoction,)andWZhYTng(EvodiaDecoction,)
areindicated.
Forajueyinheatpattern,useBiTuWngTng(PulsatillaDecoction,)to
cooltheliverandresolvetoxins.
Prognosis
Duetotheexterior-interiorrelationshipof jueyinandshaoyang,pathogenicqiin
thesetwochannelsmaypassfromonetotheother.Passingfromshaoyangtojueyin
indicatesaggravation;onthecontrary,whenajueyinpathogenicqimovestoshaoyang,
thisisfavorable.
VolumeTwo:Chapter7 Pulse,Pattern,andTreatmentofJueyinDisease 339
Section1 OutlineofJueyinDisease
Source Text
Line326

Jueyin disease manifests with dispersion-thirst, ascending qi striking the heart,
burningsensationsintheheart,andhungerbutwithnodesiretoeat.Thepatientmay
vomit roundworms after eating, and if the disease had been treated by purgation,
therewillbeendlessdiarrhea.
Interpretation
Thislineprovidesasynopsisofjueyindisease.Jueyin-liverisassociatedwithwind
andwood,governsthefreeflowofqi,andconnectswiththeministerialfireinternally.
Pathogenicinvasionintojueyinwillcauseimpairedqiflow.Ononehand,constraintof
qitransformsintofireandflamesupwardtothestomach,whichiscalledupperheat.
Ontheotherhand,excessliverqiflowstransverselytothespleentocreatelowercold.
Constraint of liver qi transforms into fire, burns body fluids and causes dispersion-
thirst.
Thefootjueyinliverchannelcurvesaroundthestomachandcrossesthediaphragm,
so when the liver fire ascends along the channel, ascendant qi attacking the heart
results burning sensations in the heart region.When liver fire invades the stomach,
digestion is accelerated and this causes feelings of hunger, but as excess liver qi
restricts the spleen, spleen qi deficiency cold leads to impaired transportation and
transformation,hencethereisnodesiretoeat.Spleendeficiencyandintestinalcold
causearepelling between the upper heat and lower cold. If the patient eats against
his will, he or she will vomit. Roundworms are fond of food and prefer warmth over
cold, so if roundworms are present the patient may vomit roundworms after eating.
Ifthediseasehadbeenpreviouslytreatedbypurgation,middleqiwillbeinjuredand
thelowercoldworsened,andlong-lastingdiarrhearesults.
The dispersion-thirst mentioned in this line should be differentiated from that
of a taiyang water amassment pattern. In this line, thirst occurs as a result ofliver
fire burning the body fluids. An upper heat pattern is often companied with red
tongue, yellow coating and burning feelings in the heart. According to theclearing
the upper and warm the lower principle, W MiWn (Mume Pill) is the selected
formula. In a taiyang water amassment pattern, impaired qi activity of the bladder
causes water amassment and qi stagnation where fluids fail to ascend normally.
Theremaybeurinaryretentionwithtensioninthelowerabdomenandfever,andthe
pulseisfloating.Towarmyang,transformqi,anddisinhibitwater,WLngSn(Five
SubstancesPowderwithPoria)istheselectedformula.
Review Questions
1. Whatisyourunderstandingoftheoutlineofjueyindisease(Line326)?
2. How can one differentiate dispersion-thirst in jueyin disease from that of a
taiyangwateramassmentpattern?
Section2 PatternsofJueyinDisease
WMiWn(MumePill)Pattern

Source Text
Line338

If cold damage manifests with faint pulses and reversal, and after seven or eight
days, cold skin occurs and the person is agitated with not a moment of calm, this
is organ reversal, not roundworm reversal.With roundworm reversal, the person
shouldvomitroundworms.
Nowthatthepatientisquiet,andexperiencingfrequentvexation,thispatternis
associated with cold of the organs. Roundworms move upwards to the diaphragm,
therefore vexation occurs; after a short while this will cease.When eating, there will
beretchingandrecurringvexation.Thisisduetothemovementoftheroundworms
atthesmelloffood.Thepersonoftenspontaneouslyvomitsroundworms.
Forroundwormreversal,WMiWnisindicated.Itisalsoindicatedforlongstanding
diarrhea.
Formula
fz 6liang RadixAconitiLateralisPraeparata(blast-fried,peeled)
dnggu 4liang RadixAngelicaeSinensis
shjio 4liang PericarpiumZanthoxyli(sweated)
wmi 300pcs FructusMume
hungbi 6liang CortexPhellodendriChinensis
Poundnineoftheingredientsseparatelywithapestle.Sift,andmixwell.Soakthe
wmiinvinegarovernight.Removethepits,andsteamunder5douofrice.Afterthe
riceiscooked,poundthe wmiintopaste,andmixwellwiththeothermedicinals.
Placethisinamortar,andpoundittwothousandtimeswithhoney.Thenmakepills
ofthesizeofphoenixtreeseeds.Taketenpillsbeforemealswithwater,threetimesa
day.Thedosagecanbegraduallyincreasedtotwentypills.
Raw,cold,orslipperyfoodsandstrong-smellingfoodsareprohibited.
Interpretation
Thislinedifferentiates organreversaland roundwormreversal,anddiscussesthe
treatmentmethodsforroundwormreversal.
In cold damage,faint pulses andlimb reversal indicate yang debilitation and yin
exuberance.Aftersevenoreightdays,restlessnessandgeneralizedcoldskinindicate
trueyangonthevergeofexpirationandorgan-qidebilitation.Thisis organreversal,
whichisaverycriticalcondition.
Regarding roundworm reversal,inaddition to the ejection of roundworms, there
are also similarities to organ reversal.When there is heat in the upper body and
deficiencycoldintheintestines,theroundwormsmoveupwardwhichresultsinboth
vexation and the vomiting of roundworms. After a short while, the roundworms will
becometemporarilyquiet,untilthepatienteats.Theqidynamicisobstructedbythe
movement of the roundworms and yang qi fails to reach the extremities, therefore
reversalcoldlimbsoccur.WMiWnistheselectedformula.
FormulaAnalysis
WMiWnisbothcoolingandwarming.Itisalsoindicatedforchronicdiarrhea
associatedwithcold-heatcomplexpatterns.
W mi is sour. It restrains hyperactive liver fire, calms roundworms and relieves
pain.
Shjioandxxnareacrid.Theyacttofreeyang,coursetheliver,dissipatecold
andkillroundworms.
Fz,gnjingandguzharehotandwarm;theyacttosupportyang,thushelping
yangtoprevailoveryin-cold.
Hunglinandhungbiarebitterandcold.Theyclearheat,promotethedownward
movementofroundworms,andcheckvomiting.
Rnshnsupplementsqiandfortifiesthespleen,anddnggusupplementsliver
blood.Combinedtogether,thesetwomedicinalsacttosupporttheupright.
This formula is commonly used to treat roundworm ileus and biliary ascariasis
causedbyupperheatwithlowercoldandroundwormsharassinginternally.Itisalso
indicatedforchronicdiarrheaandchroniccolonitisassociatedwithcold-heatcomplex
patterns.
CaseReport
Chief complaint: frequent abdominal pain around the umbilicus, where a lump
could be palpated.The painful area was relieved by warmth and pressure. During
theonsetofpain,therewouldbevomiting,andononeoccasionshevomitedasingle
roundworm.
Othersignsandsymptomsincludedadrybittermouth, reversalcoldofthelimbs,
apalewhitecomplexion,andgreatsweating.Hertongueappearedredwithawhite
slimycoatingandscantyfuids;pulseswerewiryandthready.
Patterndiferentiation:roundwormreversal.
Formula:WMiWn.
shjio 3g PericarpiumZanthoxyli
wmi 15g FructusMume
Decocttwice.Takewarmassixdividedportions.
The vomiting and sweating were checked, the abdominal pain was relieved, and
her limbs became warm. Her tongue was red with a moist white coating, and her
pulsewassoggy.
Afterthreemoredoses,andtwoalbendazoletablets,thepatientwascompletely
recovered.
[Reference: Zhang Li. Clinical Usage of W MiWn . Chinese Journal of
InformationonTraditionalChineseMedicine.2005;12(3):86.]
GnJingHungQnHungLinRnShnTng (Zingiberis,Scutellaria,
Coptis,andGinsengDecoction)Pattern
Source Text
Line359

In cold damage, if cold diarrhea is already present, and the physician further
applies ejection and purgation, repelling cold would aggravate the vomiting and
diarrhea.Withimmediatevomitingofingestedfood, GnJingHungQnHungLin
RnShnTngisindicated.
Formula
Discardthedregs.Takewarmintwodivideddoses.
Interpretation
This line discusses the pattern and treatment of cold and heat repelling one
another.
For patients with chronic diarrhea due to spleen-stomach deficiency cold and
recently attracted exterior pathogenic qi, if the physician inappropriately treats this
withejectionorpurgation,spleen-stomachyangqiwillbeweakenedandlowercold
worsened; the pathogenic heat would sink inward, leading to upper heat and lower
coldrepellingoneanother.Thisisreferredtoasrepellingcoldinthestatement.
Upper heat causes stomach qi reversal and immediate vomiting. Lower cold
causessplenicfailureoftransportationandtransformation,hencediarrhea.Treatment
shouldcleartheupperandwarmthelower.GnJingHungQnHungLinRnShn
Tngistheselectedformula.
FormulaAnalysis
Hungqnandhunglinclearupperheattocheckvomiting.
Gnjingdispelslowercoldwithacridityandwarmth.
Rnshnsupplementsmiddleqiandinvigoratesthespleentocheckdiarrhea.
Inclinicalpractice,thisformulaisusuallyusedtotreatpatternsofupperheatand
lowercoldassociatedwiththefollowingconditions:vomitinginpregnancy,vomiting
due to wind damaging the stomach or food accumulation, epigastric pain, blood
ejection,anduremia.
CaseReport
Male,age51.
Chief complaint: nausea, vomiting, and an ammonia-like taste in the mouth for
morethantendays.
Thepatienthadbeensufferingfromchronicrenalfailureforthreeyears.Forabout
a month he had a poor appetite, nausea, vomiting, acid regurgitation, a clamoring
stomach, belching, fatigue, lack of strength, a yellow complexion with deficiency-
type puffiness, slight edema of the lower limbs, and soft yellow stools. His urination
wasrelativelynormal.Histongueappearedpaleredandswollenwithaslimyyellow
coating;thepulsesweresoggyandslippery.
Pattern differentiation: damp-heat obstruction, dysfunctional spleen-stomach
ascendinganddescending.
Treatment principles: open with acridity, downbear with bitterness, and regulate
spleenandstomach.
Formula:supplementedGnJingHungQnHungLinRnShnTng.
jnijn 10g EndotheliumCorneumGigeriaeGalli
jioshnzh 12g FructusCrataegi(scorch-fried)
sy 10g FoliumPerillae
jioshnq 12g MassaMedicataFermentata(scorch-fried)
wzig 30g EndoconchaSepiae
sgng 10g CaulisPerillae
After seven days, the vomiting, clamoring stomach and acid regurgitation were
checked. However, some nausea and poor appetite remained.The formula was
continued for more than a month, after which all digestive symptoms and fatigue
wererelieved.
[Reference:LanHua-sheng.TenCasesof GnJingHungQnHungLinRnShnTnginthe
TreatmentofUraemicGastritis10.LiShi-zhenMedicine
andMateriaMedicaResearch.2002;13(1):50.]
Dng Gu S NTng (Chinese Angelica Frigid Extremities Decoction)
Pattern
Source Text
Line351

Forreversalcoldoftheextremitiesandthreadypulsesonthevergeofexpiration,
DngGuSNTngisindicated.
Formula

tngco 2liang MedullaTetrapanacis
Decocttheaboveseveningredientswith8shengofwateruntil3shengremains.
Interpretation
Thisline discusses the pattern and treatment of reversal due to blood deficiency
and cold congealing.The reversal cold of the limbs in this condition is caused by
deficiencycoldwithcontractionofcoldandcoldcongealinginthechannels.Deficient
jueyinliver-bloodfailstofulfillthevessels,thereforethepulsesappearthreadyasif on
thevergeofexpiration.DngGuSNTngcanbeappliedtonourishblood,dissipate
cold,warmthechannelsandfreethevessels.
FormulaAnalysis
ThisformulaisGuZhTngwithremovedshngjing,anincreaseddosageof d
zo,andaddeddnggu,xxnandtngco.
Dngguandshoyonourishbloodandharmonizeying.
Guzhandxxnwarmthechannelsanddissipatecold.
Zhgncoanddzosupplementmiddleqi.
Tngcofreesthebloodvessels.
Thisformulaisusuallyusedtotreatblooddeficiencyandcoldcongealingpatterns
associated with the following diseases: migraines, cluster headaches, psychomotor

epilepsy, sciatica, peripheral neuritis, Raynauds disease, chilblain, thromboangiitis
obliterans,rheumatoidarthritis,dysmenorrhea,infertility,andpelvicinfammation.
CaseReport
Chiefcomplaint:repeatedepisodesofpalereddish-purplecolorappearingonthe
hands. After the finger temperature recovery time and provocation tests in another
hospital,shehadbeendiagnosedwithRaynaudsdisease.
Abouttwomonthsbefore,thesymptomshadgottenworse.Ateachepisode,her
fingersturnedpaleatfirst,thenthepalmsandfingersbothbecamepurple;therewas
alsoregionalnumbnessandcold-typepain.Everyepisodelastedfor10to20minutes,
with no relief until both of hands were put into warm water.With the warmth, the
purpleskinwouldturnredalongwithburningandstabbingpains,thenreturningto
anormalcolor.Shetriedsympatheticblockersandothervasodilatorswithoutsuccess.
Her tongue appeared dark red with a white coating and static spots on the margins
andtip;herpulseswerethreadyandrough.
Patterndifferentiation:blooddeficiencyandcoldconstraint,stagnationofqiand
blood.
Treatment principles: nourish blood, free the collaterals, warm the channels and
dissipatecold.
Formula:modifedDngGuSNTng.

mtng 6g CaulisAkebiae
dlng 10g Pheretima
Afterfvedoses,allpainwasrelievedandtheskincolorwasnormal.
[Reference:JinXin,YinXiao-xing.ClinicalUsagesofDngGuSNTng
.LiaoningJournalofTraditionalChineseMedicine.2008;28(6):440.]
Dng Gu S N JiW ZhY Shng JingTng (Chinese Angelica
Frigid Extremities Decoction plus Evodia and Fresh Ginger) Pattern

Source Text
Line352

Ifthepersonhas chronicinternalcold, DngGuSNJiWZhYShngJing
Tngisrecommended.
Formula

wzhy 2sheng FructusEvodiae
guzh 3liang RamulusCinnamomi(bark-removed)
shngjing 0.5jin RhizomaZingiberisRecens(cut)
tngco 2liang MedullaTetrapanacis
Decocttheabovenineingredientswithmixtureof6shengofwaterand6shengof
clearwineuntil5shengremains.Discardthedregs.Takewarminfveportions.
Interpretation
Thislinediscussesthepatternandtreatmentofblooddeficiencyandcoldreversal
withchronicinternalcold.
Forreversalcoldofthelimbsduetoliverblooddeficiencycold,ifthereischronic
cold in the organs, Dng Gu S NTng can be applied with added w zh y and
shngjinginordertowarmthemiddleanddissipatecold.
The indications are the same as for Dng Gu S NTng pattern, but with more
severecoldsigns.
CaseReport
Female,age18.
Chiefcomplaint:abdominalpainbeforeandduringmenstruationsfor5years.
Painkillers could bring temporary relief; however, the condition had become
aggravated.Inthepastfourmonths,menstruationstartedarrivingearlywithintense
abdominal pain usually accompanied by vomiting.The pain could be temporarily
relievedbyheat.The menses were scant and dark purple with clots. Her complexion
was pale white, her tongue was pale and dusky, and the pulse wiry and thready.
Previous treatment with Dng Gu Pin (Chinese AngelicaTablets, ), W J
Bi FngWn (Black-Boned Chicken Pill, ) and Wn JngTng (Channel-
WarmingDecoction,)wereinefective.
Pattern differentiation: painful menstruation due to blood deficiency and cold
congealing.
Treatmentprinciples:warmthechannels,dissipatecold,resolvestasis,andcheck
pain.
Formula:DngGuSNJiWZhYShngJingTng.

jibisho 15g RadixPaeoniaeAlba(wine-fried)
wzhy 6g FructusEvodiae
mtng 9g MedullaTetrapanacis
Onedecocteddoseaday.
Thepatientwasalsoinstructedtotakegingerandbrownsugarmixedwithwater.
After five doses of the prescription, her abdominal cold and pain were remarkably
relieved, and her limbs became warm. After another ten doses, she was completely
recovered.
She was instructed to take five more doses starting seven days before her next
period.Follow-upathalfayearshowednorecurrence.
[Reference: Huang Zeng-qiang.Treating Dysmenorrhea with Dng Gu S N JiW ZhY
Tng.ShandongJournalofTraditionalChineseMedicine.2003;22(11):645.]
WZhYTng(EvodiaDecoction)Pattern

Source Text
Line378

Fordryretchingwith droolingandfoamingatthemouthandheadache, WZh
YTngisindicated.
Formula
wzhy 1sheng FructusEvodiae(washed)
Discardthedregs.Takesevengewarm,threetimesaday.
Interpretation
This line discusses the pattern and treatment ofliver-cold invading the stomach
andturbidyinascendingcounterfow.
Liver-coldinvadingthestomachimpairsharmoniousdescendingofthestomach,
andretchingoccurs.Italsocausesimpairedstomachtransportationandtransformation
and fluid retention.When the fluids ascend along with the qi counterflow, there is
droolingandfoamingatthemouth.
Thefootjueyinliverchannelcrossestheforeheadtothevertex,andintersectswith
the du mai.When yin-cold ascends along the channel, headache occurs, especially
aroundthevertex.Treatmentshouldwarmtheliverandstomach,dissipatecold,and
downbearturbidity.WZhYTngisindicated.
FormulaAnalysis
W zh y and shng jing are acrid and hot.They enter the liver and stomach
channelstowarmtheorgansanddownbearcounterfow.
Rnshnanddzosupplementdefciencyandwarmthemiddle.
This formula is commonly applied to treat acute and chronic gastritis, gastric
ulcer, neurogenic headache, Menieres disease, hypertension, cardiac diseases, and
morning sickness as associated withliver-cold invading the stomach andturbid yin
ascendingcounterfow.
CaseReport
Female,age40.Initialconsultation:December7,2003.
Chiefcomplaint:repeatedonsetofdizziness,blurredvision,nauseaandvomiting
formorethanthreeyears.Thepatientfeltlikeshewassittinginarockingboatwhenever
shetriedtoturn.
Accompanying signs and symptoms included severe aversion to cold and a low
faint voice.The tongue coating was white; her pulses were thready.Transfusion,
sedation,antiemeticandotherWesternmedicaltreatmentmethodshadproducedno
observableefect.
Patterndifferentiation:pathogeniccoldinvadingthestomach,turbidyinharassing
upwards(Menieresdisease).
Treatment principles: warm the middle, dissipate cold, downbear counterflow,
andcheckvomiting.
Formula:WZhYTng.

hngshn 10g RadixetRhizomaGinsengRubra
Threedoses.Onedecocteddoseperday.
Afteronedose,thevomitingwasstopped.Afterthreedoses,shewascompletely
recovered.Follow-upaftertwoyearsshowednorecurrence.
[Reference: Liang Ai-zhi. Clinical Applicatios of Four Cases withW ZhYTng
4.ShanxiJournalofTraditionalChineseMedicine.2008;24(11):55.]
BiTuWngTng(PulsatillaDecoction)Pattern

Source Text
Line371

Forheatdiarrheawithrectalheaviness,BiTuWngTngisindicated.
Line373

Diarrhea with adesire todrink wateris associated with the presence of heat.Bi
TuWngTngisindicated.
Formula
bituwng 2liang RadixPulsatillae
hungbi 3liang CortexPhellodendriChinensis
qnp 3liang CortexFraxini
Discardthedregs.Takeoneshengwarm.Iftheconditionremains,takeanothersheng.
Interpretation
Line371discussesthepatternandtreatmentforjueyinheatdiarrhea.
Thediarrheaisaccompaniedbyabdominalurgencyandaheavysaggingsensation
oftheanus.Thisisassociatedwithjueyinliverchanneldamp-heatmovingdownwards
anddistressingthelargeintestine.Treatmentshouldclearheat,drydampness,coolthe
liverandresolvetoxins.BiTuWngTngisindicated.
Line373isasupplementtothe jueyinheatdiarrheapatternandtreatment. Jueyin
heatscorchesfuidstocausethirstwithadesiretodrinkwater.
FormulaAnalysis
Bituwngisbitterandcold.Itentersthebloodleveltoclearheat,resolvetoxins,
coolblood,andcheckdysentery.
Hunglinandhungbiarebitterandcold.Theyacttoclearheat,drydampness,
thickentheintestines,andcheckdysentery.
Qnpisalsobitterandcold.Itclearsdamp-heatintheliverandgallbladder,cools
blood,andsecurestheyinofthelowerjiao.
Inclinicalpractice,thisformulaiseffectiveforbacillarydysentery,amoebicdysentery,
acuteenteritisandchronicnonspecificcolonitis.Itisalsousedtotreatexcesspatterns
of heat or dampness associated with the following diseases: urinary tract infection,
pelvicinfammationandmetrorrhagia.
CaseReport
Chiefcomplaint:abdominalpainanddiarrheafor2days.
The abdominal pain and diarrhea began immediately after she ate some sweet
melon,afterwhichshehadtogotothebathroom4to5timesaday.
Accompanying signs and symptoms included vexing heat in the chest and
epigastria, scorching heat of the anus, and thirst. Her tongue was red with a yellow
coating;herpulseswererapid.
Patterndiferentiation:damp-heatdysentery(acuteenteritis).
Treatment principles: clear heat, dr y dampness, resolve toxins, and check
dysentery.
Formula:modifedBiTuWngTng.
bituwng 15g RadixPulsatillae

qnp 10g CortexFraxini
jnynhu 15g FlosLoniceraeJaponicae
Onedecocteddoseaday.
Afterthreedoses, her pain, diarrhea, vexation and thirst were gone, and she was
completelyrecovered.
[Reference:Wang Gai-min. Clinical Usage of BiTuWngTng . Gansu
JournalofTraditionalChineseMedicine.2007;20(1):18.]
Review Questions
1. Whatisroundwormreversalandorganreversal?Howcantheybediferentiated?
2. Statetheorigin,pathodynamic,patterns,treatmentandformulaanalysisforthe
WMiWnpatternandtheGnJingHungQnHungLinRnShnTngpattern.
3. State the clinical manifestations, pathodynamic, treatment principles and
formulas for the Dng Gu S NTng pattern and the Dng Gu S N JiW ZhY
ShngJingTngpattern.
4. HowcantheDngGuSNTngpatternandtheTngMiSNTngpattern
bediferentiated?
5. State the manifestations, pathodynamic, treatment principles, and formula
analysisoftheWZhYTngpattern.
6. State the pathodynamic, manifestations, treatment principles and formula for
theBiTuWngTngpattern.
VolumeThree
SelectedReadingsfromEssentials
fromtheGoldenCabinet
(JnGuYoL,)
MHungJiZhTng(EphedraplusAtractylodesMacrocephalaDecoction)Pattern
369
MHungXngRnYYGnCoTng(Ephedra,ApricotKernel,CoixSeedandLicorice
Decoction)Pattern 372
GuZhShoYoZhMTng(CinnamonTwig,Peony,andCommonAnemarrhenaRhizome
WTuTng(AconiteDecoction)Pattern 377
HungQGuZhWWTng(AstragalusandCinnamonTwigFive-SubstanceDecoction)
Pattern 380
GuZhJiLngGMLTng(CinnamonTwigDecoctionplusDragonBoneandOysterShell
XioJinZhngTng(MinorCenter-FortifyingDecoction)Pattern 384,461
HungQJinZhngTng(AstragalusCenter-FortifyingDecoction)Pattern 387
SunZoRnTng(SourJujubeDecoction)Pattern 389
DHungZhChngWn(RhubarbandEupolyphagaPill)Pattern 390
MiMnDngTng(OphiopogonDecoction)Pattern 394
TngLDZoXiFiTng(LepidiumandJujubeLung-DrainingDecoction)Pattern
396
ShGnMHungTng(BelamcandaandEphedraDecoction)Pattern 398
GuLuXiBiBiJiTng(Trichosanthes,ChineseChiveandWhiteWineDecoction)Pattern
401
GuLuXiBiBnXiTng(Trichosanthes,ChineseChiveandPinelliaDecoction)Pattern
404
ZhShXiBiGuZhTng(ImmatureBitterOrange,ChineseChiveandCinnamonTwig
Decoction)PatternRnShnTng(GinsengDecoction)Pattern
405
FlngXngRnGnCoTng(Poria,AlmondandLicoriceRootDecoction)Pattern
JZhJingTng(TangerinePericarp,ImmatureOrangeFruitandFreshGinger
WTuChShZhWn(AcomiteandHalloysitePill)Pattern 411
XunFHuTng(InulaDecoction)Pattern 414
GnJingLngZhTng(Licorice,DriedGinger,PoriaandWhiteAtractylodesDecoction)
Pattern 416
LngGuZhGnTng(Poria,CinnamonTwig,AtractylodesMacrocephalaandLicorice
GnSuBnXiTng(GansuiRootandPinelliaRhizomeDecoction)Pattern...........................421
XioQngLngTng(MinorGreenDragonDecoction)Pattern 423
XioBnXiJiFLngTng(MinorPinelliaRhizomeplusPoriaDecoction)Pattern
424
ShnQWn(KidneyQiPill)Pattern 427
GuLuQMiWn(TrichosanthesandDianthusPill)Pattern 429
VolumeThree SelectedReadingsfromEssentialsfromtheGoldenCabinet(JnGuYoL,) 355
FngJHungQTng(StephaniaRootandAstragalusDecoction)Pattern 432
YuBTng(MaidservantfromYueDecoction)Pattern 436
FngJFLngTng(StephaniaRootandPoriaDecoction)Pattern 440
QShoGuJiTng(Astragalus,WhitePeony,CinnamonandVinegarDecoction)Pattern
442
GuZhQShoYoJiMXnFZTng(CinnamonTwigDecoctionremovingPeonyplus
Ephedra,AsarumandAconiteDecoction)Pattern 445
ZhZhTng(ImmatureBitterOrangeandAtractylodesMacrocephalaDecoction)Pattern
447
YnChnHoTng(VirgateWormwoodDecoction)Pattern 450
XioShFnShSn(PotassiumNitrateandAlumPowder)Pattern 452
ZhZDHungTng(GardeniaandRhubarbRootDecoction)Pattern 455
YnChnWLngSn(FiveSubstancesPowderwithPoriaplusVirgateWormwood)Pattern
457
XioBnXiTng(MinorPinelliaDecoction)Pattern 463
DBnXiTng(MajorPinelliaDecoction)Pattern 465
DHungGnCoTng(RhubarbandLicoriceDecoction)Pattern 467
JPTng(TangerinePericarpDecoction)Pattern 469
JPZhRTng(TangerinePericarpandBambooShavingsDecoction)Pattern
471
GuZhFLngWn(CinnamonTwigandPoriaPill)Pattern 473
JioiTng(Donkey-HideGelatinandMugwortDecoction)Pattern 477
DngGuShoYoSn(ChineseAngelicaPeonyPowder)Pattern 480
DngGuShngJingYngRuTng(ChineseAngelica,FreshGingerandLambDecoction)
Pattern 482
ZhShShoYoSn(ImmatureBitterOrangeandPeonyRootPowder)Pattern
484
XiYXuTng(LowerBloodStasis-PurgingDecoction)Pattern 486
ZhPDWn(BambooShavingsBigPill)Pattern 488
BiTuWngJiJioGnCoTng(PulsatillaplusDonkey-HideGelatinandLicoriceRoot
BnXiHuPTng(PinelliaandOfcinalMagnoliaBarkDecoction)Pattern
494
GnMiDZoTng(Licorice,WheatandJujubeDecoction)Pattern 496
WnJngTng(Channel-WarmingDecoction)Pattern 499
DngGuShoYoSn(ChineseAngelicaandPeonyRootPowder)Pattern
502
356
Chapter1
The Evolution of Essentials from the Golden Cabinet

TheTreatiseonColdDamageandMiscellaneousDiseases(ShngHnZBngLn,
) was written by Zhang Zhong-jing around 205 AD. It was the first book to
combine disease diagnosis with medicinal formula treatment in Chinese medicine.
Thebookconsistedofsixteenvolumes,includingtenvolumesoncolddamageandsix
volumes on miscellaneous diseases. Unfortunately, the original manuscript was lost
duringtimesofwar.
FollowingWangShu-heseffortstocollectandeditextantpiecesofthetextduring
theWestJinDynasty(265-316AD),onlythetenvolumesoftheTreatiseonColdDamage
wererecoveredandreturnedtocirculation.Passagesfromthemiscellaneousdiseases
section of the original text were only to be found scattered throughout a variety of
medicaltextsincludingThePulseClassic(MiJng,),ImportantFormulasWortha
ThousandGoldPieces(QinJnYoFng,),ArcaneEssentialsfromtheImperial
Library (WiTi MYo, ) and Treatise on the Origins and Manifestations of
VariousDiseases(ZhBngYunHuLn,).
WangZhu,ascholaroftheImperialAcademyduringtheNorthernSongDynasty
(960-1127AD)reignofEmperorSongRen-zong(1023-1063AD),foundathree-volume
versionoftheTreatiseonColdDamageandMiscellaneousDiseaseswithabookentitled
EssentialsfromtheGoldenCabinetandJadeSheath(JnGuYHnYoLFng,
) in a stash of discarded texts at the Imperial Academy. According to his
accounts,Volume discussed cold damage,Volume, miscellaneous diseases and
Volume ,recordsoftheformulasandtreatmentofgynecologicaldiseases.However,
it appeared to be an abridged version or compilation of excerpts. He noted that in
several places there waseither a pattern description lacking a formula or a formula
lacking a pattern description.Therefore he said that,The text is not adequate as a
manualfortreatingdiseases.
The imperial government of the North Song Dynasty assigned LinYi and Sun
Qi to sort out excerpts and compile them into a book.The two left theTreatise on
Cold Damage out of the compilation as that work was already available.Volume
andVolume were reorganized into one work consisting of three volumes with
the missing formulas reinserted underneath the corresponding pattern descriptions
for theconvenience of access in emergency.Toenrich the contents, at the end
VolumeThree:Chapter1 GeneralIntroduction 357
of each chapter they also attached the various formulas by Zhang Zhong-jing for
miscellaneousdiseasescitedinotherbooks.
ThisnewbookwasnamedDiscussiononGoldenCabinetFormulas(JnGuFngLn,
),orDiscussiononEssentialsfromGoldenCabinetFormulas(JnGuYoL
FngLn,),abbreviatedasEssentialsfromtheGoldenCabinet.
Itisunfortunatethatamongtheancienttextsthathavesurvivedtomoderntimes,
thereisnoSongeditionoftheEssentialsfromtheGoldenCabinetinexistence.Today,we
onlyhavereprintsproducedaftertheSongDynasty.
Taken as a whole, the history of the formation of our current version of the
EssentialsfromtheGoldenCabinetcanbedividedintofourstages:itsoriginalformation,
followed by its disappearance, its reappearance after a period of collection and
revision,andfnallyreprintingandwiderdistribution.
AJn Gu is a golden cabinet where crucial treasures and imperial decrees are
preserved. Significant works were sometimes entitledJn Gu orSh Sh (stone
chamber)toindicatetheirvalueandimportance.
Yo L literally meansconcise strategy. Practitioners of traditional Chinese
medicineliketomakeananalogybetweendoctorstreatingdiseasesandgeneralsfighting
wars.Onlybyconstructingalogicalandmethodicalstrategy,basedonasoundgraspof
foundationalconcepts,canageneralwinawarandapractitionercureadisease.
The Contents and Advancements of the Essentials from the Golden

Cabinet
Contents
The Essentials from the Golden Cabinet is the earliest known monograph on
miscellaneousdiseasesstillinexistencetoday.Themaincontentsofits22chaptersare
asfollows:
Chapter1:GeneralPrinciples
This chapter discusses the general rules of pattern differentiation and the
treatment of miscellaneous diseases. It outlines principles of etiology, pathogenesis,
diagnosis, treatment, and prevention through examples and a question and answer
format.
Chapter217:InternalDiseases
Convulsion Abdominaldistentionandfullness
Dampness Coldshn(hernia,)
Summerheatstroke Foodretention
Lilydisease P(stufness,)pattern
Throat-anus-genitalpattern Phlegmrheum
Yinandyangtoxin Xiok(wasting-thirst,)
Malaria Difculturination
Windstroke Strangury
Wanderingjointpain Fluidretention
Bloodimpediment Jaundice
Consumptivedisease Palpitationsduetofright
Lungatrophy Hematemesisandepistaxis
Lungabscess Bloodystool
Cough Fullnessinthechest
Abnormalupwardmovementofqi Bloodstasis
Qiup-rushingdisease Vomiting
Chestb Hiccup
Heartpain Diarrhea
Chapter18:ExternalDiseases
Externalinjuries Abdominalabscesses
Soresandabscessesontheskin Immersingskindisease(JnYnDisease)
Chapter19:MiscellaneousDiseases
Difcultyinmoving Yininguinalhernia
Swollenfngersandarms Ascariasis
Spasm
Chapter2022:GynecologicalObstetricalDiseases
Morningsickness Postpartumdepression
Abdominalpainduringpregnancy Heatenteringthebloodchamber
Inter-menstrualbleeding Irregularmenstruation
Difculturinationduringpregnancy Leukorrhea
Postpartumconvulsions Spotting
Postpartumfainting Bladdercolicanddysuriainpregnancy
Postpartumconstipation Plum-stoneqi(globushystericus)
Postpartumabdominalpain Visceralagitation(hysteria)
Windstroke Diseasesoftheexternalgenitalia
Diarrhea
Advancements
AlongwiththeTreatiseonColdDamage,theEssentialsfromtheGoldenCabinetis
consideredtobeoneofthemostimportanttextsthathaveestablishedthefoundation
ofChineseclinicalmedicine.
Disease Identification and Pattern Differentiation: the creation of a diagnostic
andtherapeuticsystemthatfocusesondiseaseidentificationcombinedwithpattern
diferentiation
In clinical practice, an accurate diagnosis allows for a clear understanding of the

pathogenesis, pathomechanism, development, and prognosis of a disease. At any
givenstageofadisease,precisepatterndifferentiationisthekeytounderstandingthe
nature, location, and relationship between the upright and pathogenic qi. Pertinent
treatment cannot be provided without disease identification, while a lack of pattern
diferentiationleadstoaninadequateunderstandingtothedevelopmentofadisease.
To emphasize the importance of integrating disease identification and pattern
differentiationwithacomprehensiveanalysisofthefourexaminations,eachchapter
title of Zhang Zhong-jings work ends withbng, mi, zhng, zh literally meaning
disease,pulse,pattern,andtreatment.
Taking jaundice as an example, we can see that it is classified into four distinct
categories:dietaryjaundice,alcoholicjaundiceandjaundiceduetosexualintemperance.
Afifthcategory,damp-heatjaundice,canbedifferentiatedintothreefurtherpatterns
accordingtothedegreeofdampnessandheatpresent(dampnesspredominatingover
heat, heat predominating over dampness, equal dampness and equal heat). Only by
identifyingtheonset,prognosis,andpathologicalchangesateachstageofjaundice,
canweachieveasatisfactoryefect.
GuidingPrinciples:confirmingtheprimacyofviscera-channelpatterndifferentiation
andestablishingtheconceptofholism
The concept of using holism as a guiding principle is reflected in every chapter
ofEssentialsfromtheGoldenCabinetunderscoredbycorrespondencesbetweenman
and nature and the unity of opposites created by the generative and restrictive
relationshipsofthefivezang-organs.Usingthisconceptofholism,ZhangZhong-jing
elaborateduponthesix-channelpatterndifferentiationofthe TreatiseonColdDamage
to establish a leading role for viscera-channel pattern differentiation in diagnosis
and treatment.Wind stroke, for instance, can be investigated from the perspectives
of invasion of the collaterals, channels, zang-organs, and fu-organs. Once applied
to clinical practice, viscera-channel pattern differentiation developed to become the
primarymethodofpatterndiferentiation.
TreatmentStrategiesforClinicalPractice
Zhang Zhong-jing proposed various rules and strategies for the treatment of
diseasesuchas:
Preventativecare Treatingincontinencepatternswith
dredging
Controllingtheprogressionof Relievingtheupperbytreatingthelower
anexistingdisease
Reinforcinguprightqitoeliminate Relievingthelowerbytreatingtheupper
pathogenicqi
Eliminatingpathogenicqito Treatinginternaldiseasewithexternal
reinforceuprightqi applications
Diferenttreatmentsforthe Treatingexternaldiseasewithinternal
samedisease treatments
Similartreatmentfordiferentdiseases Guidingadiseasealongitscourseof
development
Treatingobstructivepatternswithtonics
Today,thesestrategiesremainefectiveinclinicalpractice.
PulseDiagnosis:theory,methodandapplication
Zhang Zhong-jing inherited the pulse theories laid out in TheYellow Emperors
Inner Classic. He further developed these theories for diagnosis in clinical practice
using the pulse to conjecture the cause of disease, confirm disease location, explain
pathodynamics, guide treatment, and evaluate prognosis.There are 145 entries in
Zhang Zhong-jings monograph discussing the pulse, and these account for more
thanonethirdof the total number of entries in the book. In regards to pulse-taking
locations, Zhang Zhong-jing simplified thethree positions and nine indicators
methodofTheYellowEmperorsInnerClassictodevelopasystemconsistingofthecn
ku,anteriortibial,andshaoyinpulse-takingmethods.Hisnewsystemofpulsetheory
greatlyadvancedthestudyofpulses.
Formulas:meticulousprescriptionformulationformiscellaneousdiseases
EssentialsfromtheGoldenCabinetconsistsof22chapters,including205formulas
(four of which are not accompanied by ingredients) taking great strides forward
from TheYellow Emperors Inner Classic.The formulas apply all the eight medicinal
treatment methods of sweating, emesis, purging, harmonizing, warming, heat-
clearing,dispersing,andsupplementing.
Sweating MHungTng(EphedraDecoction,)
Emesis GuDSn(MelonStalkPowder,)
DChngQTng(MajorPurgativeDecoction,)
Purging
XioChngQTng(MinorPurgativeDecoction,)
Harmonizing XioChiHTng(MinorBupleurumDecoction,)
Warming DWTuJin(MajorAconiteDecoction,)
Heat-Clearing XiXnTng(Heart-DrainingDecoction,)
BiJiJinWn(TurtleShellDecoctedPill,)
Dispersing Zh ZhWn (Immature Bitter Orange and Atractylodes Macrocephala Pill,
)
Supplementing HungQJinZhngTng(AstragalusCenter-FortifyingDecoction,)
Therearealsoothermethodsusedinformulasincludingreleasingboththeexterior
andinterior,removingdampness,moisteningdryness,regulatingblood,securingand
astringing.
Someformulasarestillpopularamongclinicalpractitionerstoday,including:
Formula Pathology
GuLuXiBiBiJiTng
(Trichosanthes, Chinese Chive andWhiteWineDecoction, Abdominalabscesses
)
DHungMDnTng
Intestinalabscess
(RhubarbRootandTreePeonyBarkDecoction,)
YnChnHoTng
Jaundice
(VirgateWormwoodDecoction,)
WMiWn(MumePill,) Ascariasis
BnXiHuPTng
Plum-stoneqi
(PinelliaandOfcinalMagnoliaBarkDecoction,)
GnMiDZoTng
Visceralagitation
(Licorice,WheatandJujubeDecoction,)
GnCoXiXnTng Fox-creeperdisease(hhubng,
(LicoriceHeart-DrainingDecoction,) )
Zhang Zhong-jings formulas are well designed and composed. They use
appropriately selected medicinals and are subject to flexible modification. For
example, Xio Chng QTng (Minor Purgative Decoction, ), Hu P Sn
WTng (Officinal Magnolia Bark andThree Substances Decoction, )
and Hu P D HungTng (Officinal Magnolia Bark and Rhubarb Decoction,
) consist of the same ingredients in different dosages, which best illustrates
that the actions of the medicinals can be used for different applications. In terms of
preparation forms, there are medicinal forms for oral administration (decoctions,
pills, powders, wines, and pastes) and external use (massage material, suppositories,
fumigation,andwashing,andeardrops).
MajorDevelopmentsintheChineseMateriaMedica
163herbscanbefoundinZhangZhong-jingsworkTreatiseonColdDamageand
EssentialsfromtheGoldenCabinet.Only111oftheseherbsarefoundinShenNongs
ClassicoftheMateriaMedica(ShnNngBnCoJng,),anearlierclassic
onChineseherbs. Of these 111 herbs, several had been applied in new ways. Zhang
Zhong-jings work thus represents a considerable addition to and enrichment of the
contentofShenNongsClassicoftheMateriaMedica.
Detailedtreatisesonthemodification,processing,decoction,andtheeffectsofthe
medicinalsarealsoincludedinthebook.Forexample,thebooktellsusthattorestore
yang and prevent it from collapse, raw f z (Radix Aconiti Lateralis Praeparata)
should be used in combination with gn jing (Rhizoma Zingiberis). However, w
tu (Aconite), is used for pain relief because it is a better pain reliever. Moreover, to
reducethetoxiceffectsandprolongbeneficialeffectsofwtu,themedicinalshould
beusedwithhoney.
Many of the processing methods presented greatly enrich the information
providedinShenNongsClassicoftheMateriaMedica.Notableadditionsincludethe
instructions to remove the nodes of m hung (Herba Ephedrae) and to steam d
hung; to scrape off the peel and stir fry zo ji (Fructus Gleditsiae) with butter; to
stir-fry tng l z (Semen Descurainiae seu Lepidii) until it is yellow; to roastyn m
(Muscovitum)for48hours;toremovethecenterpartof mdnp(CortexMoutan);
and to boil to rn (Semen Persicae) to remove its outer coating.These processing
methodsestablishedagoodfoundationforthefurtherdevelopmentofChineseherbal
medicine.
ContributionstoEmergencyMedicineandTreatment
EssentialsfromtheGoldenCabinetremainsamodelforthetreatmentofcomplexand
acute diseases. It provides solutions not only to common and frequently-occurring
diseases, but also to complex diseases and acute diseases as well. For example, D
Chng QTng is indicated for convulsive disease marked by fullness in the chest,
insomnia, foot spasms and teeth clenching. WTu Ch Sh ZhWn (Aconite Root
and Halloysite Pill, ) is indicated for chest impediment and heart pain
manifesting as pain in the chest and back. D Hung M DnTng is used for acute
abdominal abscess. Perhaps most impressively, Essentials from the Golden Cabinet
recommends emergency procedures for reviving a hanging victim that are the same
as those for external cardiac massage and mouth-to-mouth resuscitation methods
usedinWesternmedicinetodaymethodsthatwereclearlyextremelyadvancedfor
thesecondcenturyAD.
Gynecology:majorcontributionstoChinesemedicine
Zhang Zhong-jing is one of the earliest masters of gynecology in Chinese
medicine.Thethreechaptersofhisbookdedicatedtogynecologicaldiseasesprovide
brilliant expositions on commonly-seen gynecological diseases.The therapeutic
principles and methods are still used to effectively guide pattern differentiation and
treatment of gynecological diseases today.The main principles of Chinese medicine
gynecology, protecting and nourishing the fetus, are reflected in the diagnosis and
treatment of morning sickness, abdominal pain during pregnancy, vaginal bleeding,
difficult urination, and edema during pregnancy.These principles are of great
signifcanceintheclinicalpracticeoftraditionalChinesemedicine.
Inthediagnosisandtreatmentofpostpartumdiseases,ZhangZhong-jingpointed
out that the postpartum condition of women is characterized by general deficiency,
blood loss and fluid damage commonly accompanied by stagnation.Therefore,
deficiency complicated by excess is the most common pattern after deliver y.
Therefore, the warm tonic Dng Gu Shng JingYng RuTng (Chinese Angelica,
Fresh Ginger and Lamb Soup,) is indicated for abdominal pain due
toblooddeficiencywithinteriorcold.Likewise,bitter,cold,andpurgative DChng
QTngisindicated for blood stagnation in ayangming fu-organ excess pattern.Xi
Y Xu Tng (Removing Blood Stasis Decoction, ) breaks and expels blood
stasistopromoteregeneration.Perhapsthemostimportantprincipleheestablished
isthatinthetreatmentofpostpartumdiseases,whileitisimportanttorememberthat
thepatientsconditionisanoutcomeofthelabor,itisalsoimportantnottolimitones
consideration of the manifestations of her condition to labor.This principle is still
appliedtodayintreatingpostpartumdiseases.
Many theories and methods for the treatment of gynecological diseases were
established.ZhangZhong-jingpresenteddetaileddiscussionsofcommongynecological
diseasessuchasthepatternofheatinvadingthebloodchamber,irregularmenstruation,
amenorrhea, metrostaxis, and leukorrhea. He also established methods for warming
channels, nourishing blood, stopping bleeding, activating blood and dredging
channels,andexpellingwaterthroughpurgationandthebreakingupofbloodstasis.
Hewasalsothefirstdoctortoapplytheexternaladministrationofsuppositoriesand
lotionstothetreatmentofgynecologicaldiseasesbesidesoraladministration.
Inconclusion,eventoday,theEssentialsfromtheGoldenCabinetisstillconsidered
an outstanding guide to the diagnosis and treatment of miscellaneous diseases.
Withstandingthetestoftime,thisbookcontinuestobeoneofgreatimportancefor
practitioners of traditional Chinese medicine.The theories and principles presented
herein have penetrated every aspect of traditional Chinese medicine educational
systems, becoming the foundation of traditional Chinese medicine theory and the
bedrock of guiding principles of clinical practice. Retaining its limitless vitality, this
workcontinuestopromotethemomentumoftraditionalChinesemedicine.
364
Chapter2
Pulses, Signs, and Sequence of Bowel
and Viscera, and Channel and Collateral
Disease
Basic Principles of Organ Interrelationship and Treatment
Source Text 1
Line1

Question:Superiorpractitionerstreatdiseasesbeforetheyarise.Whyisthis?
The master said,Treating disease before it arises means that when one sees a
liver condition for example, one will know that the liver condition will pass to the
spleen,andalsothatspleenmustfirstbefirmed.Whenthespleenremainseffulgent
attheendofeachseason,itwillnotcontractevil,soitneedsnottobesupplemented.
Ordinary practitioners do not know about the passage of disease.When they see a
liver condition, they do not understand the need to firm the spleen, so they simply
treattheliver.
Forliverconditions,supplementwithsourness,assistwithburntorbitterflavors,
and benefit and regulate with sweet-flavored medicinals. Sourness enters the liver,
burntandbitterfavorsentertheheart,andsweetnessentersthespleen.
The spleen can damage the kidney, and when kidney qi is weak, water fails to
move.When water fails to move, heart-fire becomes exuberant and damages the
lung.When the lung is damaged, metal qi fails to move, and when metal qi fails to
move,liverqibecomesexuberant.Therefore,firmthespleenandtheliverwillrecover
spontaneously.This describes the principal mystery of treating the liver through
supplementationofthespleen.Forliverdeficiency,applythismethod;donotapplyit
VolumeThree:Chapter2 Pulses,Signs,andSequenceofBowelandViscera,andChannelandCollateralDisease 365
forexcesspatterns.
The classic states,Do not drain deficiency or replenish excess. Supplement the
insufficiency,andreducethesuperabundance.Thisisthemeaning;italsoappliesto
theotherviscera.
Interpretation
Theideathatsuperiorpractitionerstreatdiseasesbeforetheyariseisgrounded
in a holistic perspective that permeates the theory and clinical practice of Chinese
medicine. Similar statements can also be found in ancient classics like TheYellow
EmperorsInnerClassicandTheClassicofDifcultIssues(NnJng,).
For example, in one chapter ofBasic Questions (SWn,), titledTreatise on
RegulatingSpiritintheFourSeasons(SQTioShnDLn,),itstates:For
thisreason,asagedoesnotwaituntildiseasehasmanifestedtotreatit,buttreatsit
beforeithasmanifested.Justasawisestatesmanmanagesaffairsbeforetheonsetof
chaos.
Thequestionsofwhethertosupplementandwhichorgantosupplement,depend
upontheassessmentofnotonlythepatternofdeficiencyorexcessintheparticular
organ manifesting the obvious disharmony, but also that organs relationship to the
otherorgans.
Physiologically, the organs inter-generate and inter-restrict each other in order
to perform the life giving activities of generation, development, transformation,
and storage.When one organ is diseased, other organs will be affected.Therefore, a
holistictreatmentshouldtreatthenotyetdiseasedorganstopreventthetransmission
ofdiseases.
Whenawisedoctortreatsliverdisease,heconsidersthepossibilitythatpathogenic
qifromthelivercouldinvadethe spleen.Heknowsthisbaseduponthe fiveelement
relationship that liver-wood restricts spleen-earth.Thus he would supplement the
spleen while treating the liver to prevent transmission ofliver disharmonies to the
spleen.
However,ifthespleenisstronginthepatientandmaintainsnormal transformation
and transportation functions then bolstering the spleen might not be necessary.
Therefore, treatment methods should be flexible, not fixed or mechanical.
Nevertheless, in many cases, treating the liver only, without bolstering the spleen,
wouldnotachievethemostefcaciousresults.
Deficiencyandexcesspatternsshouldbedifferentiatedindiagnosisandtreatment.
The discussion above speaks first to the treatment method for liver excess patterns
and then to the treatment of liver deficiency patterns.When the liver is deficient, it
should be supplemented by using its corresponding flavor. Sour flavors enter the
liver,sosourmedicinalsshouldbeusedtosupplement.
Likewise, scorched and bitter medicinals act on theheart.The heart is the child
phaseofliver;supplementingthechildcouldstrengthenthemother,soscorchedand
bittermedicinalscouldbeusedasassistants.Sweetflavorsaremildinnatureandcan
moderatethefunctionofthespleen.
Chapter14ofTheClassicofDifficultIssuesstates:Moderatethemiddlejiaototreat
adamagedliver.Thussweetmedicinalscanbeusedtoregulateandsupplementthe
liver.Thisisthetreatmentprincipleforliverdefciency,notforliverexcess.
Do not drain deficiency or replenish excess. Supplement the insufficiency, and
reducethesuperabundance.Thisstatementmeanssupplementingiscontraindicated
forexcesspatternsandpurgingiscontraindicatedfordefciencypatterns.
Thissuccinctlysummarizesthedifferentialtreatmentofnotonlyliverexcessand
defciencypatterns,butthatofotherorgansaswell.
Source Text 2
Line2

Human beings are endowed with the five natural laws, and they also grow
through the influence of wind-qi.Wind-qi can engender the myriad of things, but it
isalsocapableofcausingharmtothemyriadofthings;justaswaterhelpsaboatto
stayafloat,itcanalsocauseittosink.Ifthe trueoriginofthefivevisceraisfree,then
apersonwillbeinharmony.Guestqiandpathogenicwindmaystrike,oftenleading
todeath.Forthousandsofdisasters,thecausesincludenotmorethanthreeaspects.
Firstly, the channels and collaterals contract pathogens which later enter the viscera
andbowels;thisisaninternalcause.Secondly,thepassageofbloodinthevesselsof
thefourlimbsandnineorificesbecomescongested;thisisduetopathogenstriking
theskinattheexterior.Thethirdincludessexualintemperance,incisedwounds,and
animalandinsectwounds.Measuringthesethree,allcausesofdiseaseareincluded.
If a person can nourish himself and remain cautious, and not let evil wind
invade the channels and collaterals, or if he can treat the evil as soon as it strikes
the channels and collaterals before it has passed to the viscera and bowels, or if he
applies conduction exercises, exhaling and inhaling, acupuncture and moxibustion,
ormedicinalpasterubbingassoonassensationsofheavinessandstagnationoccurin
the four limbs, the nine orifices would not become blocked. Furthermore, he should
obey the laws and avoid animal harm, restrain sexual activity, regulate heat, cold,
bitterness, sourness, acridity, and sweetness with clothing and diet, and not let his
bodybecomedebilitated;thendiseaseswillhavenoaccesstothe interstices(cul,
).Cuistheplacewherethesanjiaoconnectwiththetrueorigin;itisalsofrom
whenceqiandbloodspring.Listhetextureoftheskinandorgans.
Interpretation
Usingaholisticapproachandreferencingthecloserelationshipbetweenhumans
and nature, this passage explains: (1) the three types of factors that can precipitate
disease response; (2) that the original qi should be cultivated; and (3) that disease
preventionandearlytreatmentaretheoptimalapproaches.
The normal qi of the natural environment can generate all creatures.Aberrant qi
can harm all creatures.This is similar to the effect of water on a boat; it can keep a
boat afloat orcapsizeit.Manlivesbetween heaven and earth and is affected by the
qi of the natural environment. Man should follow the seasonal changes of qi, pay
attentiontothecultivationoforiginalqi,andmaintainthesmoothmovementof ying
(nutritiveqi)andwei(defensiveorprotectiveqi)topreventthenegativeinfluenceof
anyaberrantqiinthenaturalenvironment.
Whentheuprightqiofthebodyisinsufficient, pathogenicqicanattackthebody,
resulting in disease or even death. Although there are various types of disease, the
factors initiating disease can be divided into three categories.The first category of
factorsconsistsofinternalcausespathogenaffectsthechannelsandcollateralsorthe
organs.The second category consists of external causespathogen attacks through
theskin,andleadstothestagnationandobstructionofqiandbloodinthevesselsand
limbs.The third category is injury either from excessive sexual intercourse harming
theliverandkidney;fromasharpbladeharmingthesinews,bones,qiandblood;or
fromtoxicinsectandanimalbites.Thelastcategoryisclearlydistinctfromtheother
two.
Source Text 3
Line15

For intractable disease accompanied by a sudden illness, one should primarily
treatthesuddenillness,andthentheintractabledisease.
Interpretation
This text presents the principle of treatment sequence when chronic disease is
complicatedbyacutedisease.Chronicdiseaseisdifficulttotreat,sincepathogenhas
already entered the interior and is often difficult to expel in a short period of time.
Acute disease refers to a recent, sudden illness.When chronic and acute diseases
arepresentsimultaneously,the acutediseaseshouldbetreatedfirst,andthe chronic
diseasedealtwithlater.
This is due to the fact that despite the inveterate nature of chronic disease, its
presentationdoesnotrequireurgenttreatment,norisiteasytocureinashortperiod
of time.Thus, it is often said that theroot of a chronic disease isdeeper in the
body. Acute disease comes on suddenly and requires urgent care. It is relatively
superficial and thuseasytoexpel.Therefore, acute disease should be treated first in
ordertopreventinteriortransmission,furthercomplicatingthechronicconditionand
renderingtreatmentmoredifcult.
Chapter3
Pulses, Signs, and Treatment of Tetany,
Dampness, and Summerheat Stroke
M Hung Ji ZhTng (Ephedra plus Atractylodes Macrocephala
Decoction)Pattern
Source Text
Line20

For a person who suffers from dampness that manifests with vexation and
generalized pain, it is recommended to promote sweating with M Hung Ji Zh
Tng.Becautious,anddonotattackwithfre.
Formula
mhung 3liang HerbaEphedrae(knotremoved)
guzh 2liang RamulusCinnamomi(skinpeeled)
xngrn 70pcs SemenArmeniacaeAmarum(skinpeeledandtipremoved)
Use9shengofwatertocooktheabovefivemedicinals,puttinginthe mhung
first.Whenthewaterisreducedby2sheng,removethefoamfromthesurfaceandput
theothermedicinalsintothepot,boilingtoobtain2.5shengofdecoction.Removethe
dregsanddrink8geofthedecoctionwhileitiswarm.
Coverupandresttopromoteslightsweating.
Interpretation
PatternAnalysis
This text discusses the treatment and contraindications for the pattern of cold-
dampness in the exterior.Vexation and generalized pain refers to a kind of severe
achingalloverthebodythatisaccompaniedbyafeelingofannoyanceorirritation.
Thispatterniscausedbycold-dampstagnatingintheexteriorwei-yangandinhibiting
the flow of the channels. A wind-cold exterior pattern may also be present (i.e.
aversiontocold,fever,absenceofsweating).
Exteriorpatternsshouldbetreatedbypromotingsweating,butexcessivesweating
iscontraindicatedfordampnesspatterns.OnlyMHungJiZhTngcanrelievethe
exterior by expelling wind while at the same time treating the interior by resolving
dampness.
FormulaAnalysis
Intheformula,bizhpreventsexcessivesweatingbyrestrainingthediaphoretic
effect of m hung.The combination thus produces a light to moderate sweat.
Likewise, bi zh, with the help of m hung, can expel both exterior and interior
dampness.Therefore, this medicinal pairing is not only suitable for expellingcold-
dampnessintheinterior,butalsoforrelievingthedampnessintheexteriorthrough
lightsweating.
Attacking with fire (using cauterizing moxibustion, cupping, and fire needles
to rid the body of pathogens 1 ) will lead to excessive sweating which can help to
expel wind but not to resolve dampness.The result will be a failure to eliminate the
disease.Complicationslikejaundiceorbleedingmayalsoariseasheatcombineswith
dampness in the body.Therefore caution must be taken when using this method of
treatment.
MainIndications
CM:bpatterns2ofwind,coldanddampness,especiallywhencoldanddampness
predominate.
WM: arthritis, pneumonia or urticaria due to exterior cold and dampness with
lungqifailingtodiffuse,resultinginadisharmonyofyingandweiandobstructionof
thebodyswaterpassages.
Modifications: for patients with significant dampness, f lng (Poria) and y y rn
(SemenCoicis)canbeadded.Fngfng(RadixSaposhnikoviae)andqinghu(Radix
et Rhizoma Notopterygii) are indicated for significantwind manifestations, whilex
xn (Radix et Rhizoma Asari) and f z (Radix Aconiti Lateralis Praeparata) or w tu
canbeusedwhencoldpredominates.
CaseReport
Female,age43.Initialconsultation:December1989.
1 The explanation in the above text was provided by Essentials of the Golden Cabinet Department at
the Beijing University of Chinese Medicine. An alternative explanation provided by other scholars at the same
universityisthatfiretherapyreferstoasauna-liketherapyinwhichdryheatisusedtoinduceheavysweating.
One description of this method entailed the burning of wood and possibly medicinal plants in the stove of
the patients home to heat the kng (a style of hollow clay bed used in northern China with an inner chamber
connected to the house stove for warmth at night). Lying well-covered on the hot kng, the patient would
eventuallysweatprofusely.
2 Alsoknownasbsyndrome.Seebsyndrome(bzhng, ).
VolumeThree:Chapter3 Pulses,Signs,andTreatmentofTetany,Dampness,andSummerheatStroke 371
Thepatientreportedsufferingfromwanderingpaininthejointsalloverherbody
for about one year. She said at first, she didnt pay much attention to the problem.
But during the winter her symptoms became much worse and thus she has sought
medicalintervention.Labtestsshowedanerythrocytesedimentationrate(ESR)of38
mm/h,anti-streptolysinO(ASOtiter)of833,andpositiverheumatoidfactor(RF).
Theclinicalpresentationincluded:wanderingpaininthejoints,aversiontowind
and cold, lack of warmth in the hands and feet,dry and withered skin, andinability
toproduceasweat.Thetonguebodywastenderandredwithawhitetonguecoating.
Thepulsewasthreadyandmoderate.
Treatment principles: promote sweating to expel wind anddisperse coldness to
draindampness.
Formula:modifedMHungJiZhTng.

qinghu 12g RadixetRhizomaNotopterygii
dhu 12g RadixAngelicaePubescentis
Aftertakingtheaboveformulaforsevendays,thepatientsjointpainwasgreatly
relieved. She also felt warmth return to her hands and feet, and noticed sweating
from the soles of her feet. Her ESR and ASO titer returned to normal ranges. For
moreconvenient consumption, the herbs of the following formula were ground into
powderandtakenatadosageof10g,twiceperday.

Aftertakingtheaboveformulaforabouttwomonths,thepatientspaincompletely
disappeared,andRFlabtestswerenegative.
[Reference: SongWen-dong,WangYao. Classic Formula in theTreatment of B-syndrome: 4
Cases.JiangxiJournalofTraditionalChineseMedicine.2002;33(5):58.]
M Hung Xng RnYY Gn Co Tng (Ephedra, Apricot Kernel,

CoixSeedandLicoriceDecoction)Pattern
Source Text
Line21

Apatientwithgeneralizedpainandfeverthatincreasesduringthe lateafternoon
watchissufferingfromwind-dampness.Thisisattributedtosweatingwithexposure
towind,orextendedexposuretocoldintendingtocooloneselfdown.MHungXng
RnYYGnCoTngcanbeapplied.
Formula
mhung 0.5liang HerbaEphedrae(knotremoved,soaked)
yyrn 0.5liang SemenCoicis
xngrn 10pcs SemenArmeniacaeAmarum(skinpeeledandtipremoved,fried)
Chopuptheabovemedicinalsandsievetheingredientsuntiltheybecomethesize
ofsesameseeds.Take4qianbi 1andcookwithoneandahalfzhan2ofwateruntil8
fen(80)remains.Removethedregsandtakewarm.
Therewillbelightsweating.Avoidexposuretowindaftertakingthedecoction.
Interpretation
PatternAnalysis
Thistextdiscussesthecause,pattern,andtreatmentofexteriorwind-dampness.
Wind-dampness in the exterior causes generalized pain of the body. Dampness
tendstotransformintoheatandtocausefeversaggravatedinthelateafternoon.This
disease is often caused by exposure to wind while sweating or repeated indulgence
in environments too cold for the body in order to avoid feeling hot (e.g. in ancient
times sleeping or residing in cold, damp places like caverns and caves where the
earths coldness surfaces in cool winds, or, in modern times, using low temperature
airconditioning to cool down after exercise or to avoid summerheat).Exterior wind-
dampnessneedstobetreatedbyslightsweating.
1 4spoonfuls.
2 Zhanreferstoasmallcup,approximately100ml.Thesizeofa zhanvariedinancienttimessoitisdifficult
togiveaprecisemeasurement.
VolumeThree:Chapter3 Pulses,Signs,andTreatmentofTetany,Dampness,andSummerheatStroke 373
FormulaAnalysis
M Hung Xng RnYY Gn CoTng is used to disperse wind, relieve the
exterior, and expel dampness. In the formula, m hung and gn co work together
topromoteslightsweating. Xngrnandyyrnmoveqiandexpeldampness.This
formulaisactuallyamodifiedMHungTng(EphedraDecoction).Yyrnreplaces
guzh,andtheformulachangesfromacrid,warm,anddispersingtoacrid,cool,and
exterior-relieving.
MainIndications
CM:wind-dampexteriorexcessbpatternwithatendencytotransformintoheat,
manifesting as generalized pain, difficulty in stretching the joints, and fever in the
late afternoon; wind-water type edema (when the lung fails to diffuse and descend,
causingwatertoaccumulateintheskin)orvariouskindsofskindisorders.
WM: ar thritis, rheumatoid ar thritis, thin flat war ts, and psoriasis with the
correspondingunderlyingpattern.
CaseReport
The patient reported a more than ten-year history of rheumatoid arthritis. Five
days prior to its onset, she had caught a cold after sweating. All her joints were
painful,andthepainwasnotrelievedbymedicationslikeaspirin.Thesymptomsand
signsattheinitialvisitwere:generalmusclesoreness,achingjoints,puffyeyes,slight
swellinginthelowerextremities,swollenankles, afeverishsensation, aggravationin
theafternoon,vexation,andirritability.Shehadapale-redtonguewithawhitishand
greasytongue coating. Her pulse was slippery and rapid. She was diagnosed with b
syndrome.The pattern was considered to be wind-damp obstructing the collaterals
withsignsofsuppressedheatdeveloping.
Thefollowingprescriptionwasused:
shngyyrn 60g SemenCoicis
flng 30g Poria
mgu 15g FructusChaenomelis
wilngxin 15g RadixetRhizomaClematidis
The patient was instructed to decoct 3 packs of the above Chinese medicinals
in water and was told to avoid exposure to wind after taking the decoction. On the
second visit, the patient reported marked relief from joint pain. J xu tng (Caulis
Spatholobi) 30 g was added to the above formula. The modified formula was
administered for another 15 days. Upon follow-up, the patient reported that all
symptomshaddisappeared.
[Reference: Liu Jie-xiang, SunYu-xin. Application ofM Hung Xng RnYY Gn CoTng
.TraditionalChineseMedicinalResearch.2005;18(11):46-47.]
375
Chapter4
Pulses, Patterns, and Treatment of Joint-
Running Disease
G u Zh ShoYo Zh MTng (CinnamonTwig, Peony, and Common
AnemarrhenaRhizomeDecoction)Pattern
Source Text
Line8

Forjointpaininallthelimbs,anemaciatedbody,swollenfeetthatfeeldetached,
dizziness, shortness of breath and desire to vomit, Gu Zh ShoYo Zh MTng is
indicated.
Formula
gnco 2liang RadixetRhizomaGlycyrrhizae
mhung 2liang HerbaEphedrae
shngjing 5liang RhizomaZingiberisRecens
fngfng 4liang RadixSaposhnikoviae
fz 2pcs RadixAconitiLateralisPraeparata
Use 7 sheng of water to cook the above nine medicinals to obtain 2 sheng of
decoction.Drink7geofthedecoction,warm,threetimesaday.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofjoint-runningdiseaseinawind-damppattern.
Wind-dampness attacks the sinews and joints, causing stagnation of qi and blood,
leading to pain and swelling in the joints of the limbs. If the pain persists for a
prolongedperiodoftime,thenuprightqiwillbedamagedandbecomedeficientand
pathogenic qi will grow increasingly stronger.The physique will becomeemaciated
and dizziness results from pathogenic wind attacking the upper part of the body.
Shortnessofbreathandnauseaoccurduetodampnessstagnatinginthemiddlejiao.
Dampnesscannotleavethebody,soitflowsdownwardintothelowerlimbs,causing
severeswellingandnumbnessinthefeet,whichlookasiftheywillfallofthebody.
Thispatternisacombinationofpathogenicwind,cold,anddampness.Thethree
attack the exterior and slowly transform into heat, which damages yin. Gu Zh Sho
Yo Zh MTng is applied to expel wind, eliminate dampness, warm the channels,
dissipatecold,nourishyin,andclearheat.
FormulaAnalysis
The formula uses gu zh and m hung to dispel wind and activate yang. F z
warmsthechannels,dissipatescoldness,andrelievespain.Bizhandfngfngare
appliedtoexpelwindandeliminatedampness.Zhmandshoyoareusedtoclear
heatandnourishyin.Shngjingandgncoareincludedtoharmonizethestomach
andregulatethemiddle.
MainIndications
CM: b syndrome with joint-running disease, emaciation, joint swelling and
deformity,severejointpain,dizziness,andshortnessofbreath;apaletonguebody;a
whitish, greasy tongue coating,witha slightly yellowish tint; and a soggy, moderate
pulse; wind-cold-damp obstructing the sinews and channels, complicated with yang
defciencyandthetransformationofqiandbloodstagnationintoheat.
WM:rheumatoidarthritiswiththecorrespondingunderlyingpattern.
CaseReport
The patient reported suffering from chronic pain in multiple joints for some
time. Upon her initial consultation, she complained of a recent acute burning pain
and swelling of the knee and ankle joints, occurring after she had been caught in a
rain.The patient had difficulty in walking due to the joint pain. Her affected joints
appearedredand swollen. Lab tests showed an ASO of 1/1600 and ESR of 35 mm/h.
ShehadbeendiagnosedwithrheumaticfeverbyaWesternmedicinepractitionerand
treatedwith800,000Upenicillinmuscularinjections,twiceaday.Followingoneweek
oftreatment,herconditionhadnotimproved,sosheturnedtoChinesemedicine.
Symptomsandsignsonthefirstvisitwere: paininthekneeandanklejointsand
difficulty walking.The affected joint areas were visibly red and swollen and warm
upon palpation.The tongue body was red with a greasy tongue coating.The pulse
was slippery and rapid.The patient was diagnosed with heat b pattern and was
treatedwithGuZhShoYoZhMTng.
VolumeThree:Chapter4 Pulses,Patterns,andTreatmentofJoint-RunningDisease 377
Formula:

ThepatientwasinstructedtodecoctonepackoftheaboveChinesemedicinalsin
watereachday.Shewasinstructedtodrinkthedecoctiontwiceaday.Aftersixdays,the
swellingandpainofthejointsweregreatlyrelieved,andthepatientcouldwalkfreely
again.Afterabout20daysoftreatment,thepatientreportedacompleterecovery.
[Reference: Song Cui-li. Classic Formula intheTreatmentofMultipleJointPains .
LiaoningJournalofTraditionalChineseMedicine.2003;30(5):411.]
WTuTng(AconiteDecoction)Pattern
Source Text
Line10

Forjoint-runningdiseasewithaninabilitytobendandstretchwithpain, WTu
Tngisindicated.
,
WTuTngisindicatedforpainfullegqiwithaninabilitytobendandstretch.
Formula

shoyo 3liang RadixPaeoiae
hungq 3liang RadixAstragali
chunw 5pcs RadixAconiti
Use 2 sheng of honey to simmer the chopped chun w until 1 sheng of honey
is left. Remove the chun w and keep the honey. After chopping up the other four
medicinals cook them in 3sheng of water to obtain 1 sheng of decoction. Filter the
decoction, remove the dregs, and add the former 1 sheng of honey and cook the
resultingmixtureagain.Drink7geofthefinaldecoctionasthefirstdose.Ifthepatient
isnotresponsivetothefrstdose,heshoulddrinktheremainder.
Interpretation
PatternAnalysis
This text discusses the treatment of joint-running disease with a cold-damp
pattern.
Internal excess of cold-damp and external wind pathogen attack and obstruct
thetendonsandjoints,leadingtothe stagnationofyangqi.Theclinicalpresentation
includes: a feeling of cold joints with severe joint pain, restricted movement, a pale
tongue body with a white, greasy tongue coating, and a slow, wiry pulse. Cold-
dampnessinthejointsobstructsthechannels,causingstagnationofqiandblood,the
jointsthusbecomeseverelypainfulandareunabletobendorstretch. WTuTngis
appliedtowarmthechannels,dissipatecold,andremovedampnesstorelievepain.
FormulaAnalysis
Theformulausesmhungtodiffusebbyinducingsweating,wtutoexpelcold
andrelievepain,andshoyoandzhgncotorelaxtension.Inthisformula,hung
qboostsqi,consolidateswei,helpsmhungandwtutowarmthechannelsand
relievespainallwhilepreventingmhungfromoverdiffusing.Honey,characterized
bysweetnessandmildness,isusedtocounteractthetoxicityofthewtu.
The formula can be applied toexpel cold-dampness through moderate sweating
while protecting upright qi. Special attention should be paid to the use of w tu
because of its toxicity. After taking the decoction, be aware of the presence of
numbness of lips, tongue, and limbs. More serious side effects from toxicity include
dizziness, vomiting,and diarrhea.Ifvitalsignslikeheartrate,breathing,andstateof
consciousness remain normal, the above symptoms are within the safety range and
signsofefficacy.Anincreaseinheartandbreathingratescoupledwithanintermittent
pulsesignoracomatosepatientindicatewtupoisoningandemergencytreatment
shouldbestartedimmediately.
MainIndications
CM:bsyndrome,allpains,andlegqi(edemainthelegs)duetochannelstagnation
bycold-dampness.
WM: musculoskeletal pain and/or arthralgia with restricted movement with the
CaseReport
The patient reported suffering fromrheumatic arthritis for two years.Two weeks
priortothefrstconsultation,shehadarelapseafterwadingincoldwater.
Symptoms and signs on the first visit included:pain in the knee and ankle joints
VolumeThree:Chapter4 Pulses,Patterns,andTreatmentofJoint-RunningDisease 379
with restricted movement that worsened with exposure to cold and was relieved by
warmth.Thepatientneededtowearthicktrouserseveninwarmweather.Hertongue
bodywaspaleredwithathin-whitetonguecoatingandadeepslowpulse.Shewas
givenaChinesemedicaldiagnosisofcoldbsyndromeandwastreatedwithWTu
Tng.

shoyo 15g RadixPaeoiae
chunw 25g RadixAconiti
She was instructed to decoct one pack of the above medicinals with water each
dayandtoldtodrinkthedecoctionintwodoses.The chunwneededtobecooked
foralongertimeinordertoreduceitstoxicity.Aftertwodaysoftreatmentshebegan
sweating,andhersymptomsimproved.Aftertaking20packsofherbs,sherecovered
andreportednorelapseduringayearoffollow-up.
[Reference: Song Cui-li. Classic Formula in theTreatment of B-syndrome .
380
Chapter5
Pulses, Patterns, and Treatment of
Blood B and Deficiency Taxation
H ung Q Gu ZhWWTng (Astragalus and CinnamonTwig Five-

SubstanceDecoction)Pattern
Source Text
Line2

For blood b with dual debilitation of yin and yang, faint pulses at the cn ku 1
andgunpositions,smallandtightpulsesatthechposition,andtheexternalsignof
generalized numbness resembling that of wind b, Hung Q Gu ZhWWTng is
indicated.
Formula
hungq 3ling RadixAstragali

shoyo 3ling RadixPaeoiae
guzh 3ling RamulusCinnamomi
shngjing 6ling RhizomaZingiberisRecens
Use 6 sheng of water to cook the above five medicinals to obtain 2 sheng of
decoction.Drink7geofthedecoctionwarm,threetimesaday.
Interpretation
PatternAnalysis
This text discusses the treatment of blood b. Dual debilitation of yin and yang
referstodeficiencyofthecollateralvesselsintheskinwithdeficienciesofying,wei,qi,
andblood.
The faint pulses at the gun and cn ku positions are a manifestation of yang
deficiency.Thetightpulseatthechpositionindicatesyinbloodstagnationduetoan
externalpathogenicinvasion.
1 Cnku:wristpulse,referstothepulsationatthewrist. Gun(gate),isthemiddleposition; cn(front,

mostdistal);ch(back,mostproximal).
VolumeThree:Chapter5 Pulses,Patterns,andTreatmentofBloodBandDefciencyTaxation 381
Qi deficiency and blood b lead to a failure to nourish the skin.Therefore, blood

b is mainly characterized by localized numbness of the muscles.When the external
pathogenispowerful,sorenessandpainmayalsoresult.Thatiswhythepresentation
ofthisdisease may also look like wind b. However, these two diseases are different:
bloodbischaracterizedbynumbness,whilewindbischaracterizedbypain.
FormulaAnalysis
HungQGuZhWWTngisappliedtowarmyangandremoveb.Compared
with Gu Zh Tng (Cinnamon Twig Decoction), Hung Q Gu Zh W W Tng
uses more shng jing, removes gn co (Radix et Rhizoma Glycyrrhizae), and adds
hungq.
Inthisformula,sweetandwarmhungqactstosupplementweiqi.
Thelargedoseofshngjingisaddedtohelpguzhtoactivateyangandmoveweiqi.
Shngjinganddzoareusedtogethertoharmonizetheyingandwei.
Shoyoisusedtoharmonizeyingtoeliminatebloodb.
Gncoisremovedbecauseitsmoderatingnaturetendstocausestagnationinthe
middle.
As a whole, the formula can boost qi, activate yang, harmonize ying, and move
stasis.
MainIndications
CM:bloodb,windb.
WM:periarthritisoftheshoulderjoints,peripheralpolyneuritis,sciatica,rheumatic
arthritis, rheumatoid arthritis, and sequelae of apoplexy with the corresponding
underlyingpattern.
CaseReport
Male,age43.
The patient reported feeling numbness and prickling pain in the fingers of his
twohandsandhisrightlowerlimbfollowinganexposuretowindaftersweating.He
was averse to cold.The symptoms in his hands and leg were exacerbated on cloudy
days and by exposure to cold.The symptoms were relieved by physical exercise, but
overexertionaggravatedthenumbness.Westernmedicinesforperipheralpolyneuritis
andvitaminswereused,buttheyyieldedlittleefcacy.
Symptoms and signs on the first visit included: numbness and prickling pain
with a lusterless complexion, joint pain without redness or swelling, a pale red
tongue body with a thin white tongue coating, and the pulse was thready. He was
given a Chinese medical diagnosis ofblood b and then treated with Hung Q Gu
ZhWWTng.
shoyo 20g RadixPaeoiae
The patient was instructed to decoct one pack per day of the above medicinals
with water, and to drink the decoction twice a day. After two packs, his symptoms
were somewhat relieved. Af ter about 30 packs, the symptoms disappeared
completely.
[Reference: Song Cui-li. Classic Formula in theTreatment of B-syndrome .
G
u Zh Ji Lng G M L Tng (Cinnamon Twig Decoction plus

DragonBoneandOysterShellDecoction)Pattern
Source Text
Line8

A person who suffers from seminal loss will present with tension and urgency of
the lower abdomen, cold in the glans penis, 1 dizzy vision, and hair loss. Extremely
deficient, hollow, and slow pulses indicate that clear-food diarrhea, blood collapse,
and seminal loss may occur. Hollow, throbbing, faint, or tight pulses reflect seminal
lossinmen,anddreamingofintercourseinwomen. GuZhJiLngGMLTngis
indicated.
AHumbleJudgmentontheClassicalFormulasstates,Withdeficiency,floatingheat,
andsweating,removeguzhandaddbiwi(RadixetRhizomaCynanchiAtrati)and
fz3fenrespectively.ThisiscalledrJiLngGTng(SecondVariationofDragon
BoneDecoction).
1 Yntuhn( )explicitlyreferstothemalesexorganandimpliesthatthisconditionismorepredominant
inmenthanwomen,andreflectsageneralculturalandliterarybiastowardsthemasculine.However,itcanbe
discernedbyreadingtherestofthelinethatthispatternofinvoluntarylossofjngisalsoexperiencedbywomen
(thoughthroughdreamsofsexualintercourseinsteadofseminalemission),andthussimilarcoldsensationsmay
befeltintheexternalgenitaliaofwomenaswell.
Formula

lngg 3liang OsDraconis
ml 3liang ConchaOstreae
Use 7 sheng of water to cook the above seven medicinals to obtain 3 sheng of
decoction.Dividethedecoctionintothreedosesandtakewarm,threetimesaday.
Interpretation
PatternAnalysis
This text discusses the treatment ofseminal emission. A person may suffer from
seminal loss via either nocturnal emissions or spermatorrhea. Because patients lose
toomuchofthisessentialfluid,yinbecomesdeficienttothepointthatitaffectsthe
yang, also leading to tension and urgency of the lower abdomen as well as a cold
sensationintheexternalgenitaliaofeithermenorwomen.Theexhaustionofessence
andlackofbloodleadstodizzinessandhairloss.
A pulse that is extremely weak, hollow, and slow indicates not only excessive
seminal emission, but also diarrhea with undigested food and loss of blood.These
pulse signs are all indicators of deficiency. A pulse that is hollow throbbing but also
shortandtightmayalsobeseenindefciencytaxations.
From the analysis above, it is clear that seminal emission or dreaming of
intercourseisamanifestationofyinandyangdualdefciency.
FormulaAnalysis
GuZhTngisappliedtoharmonizeyinandyang.
Inthisformula,lnggisusedtofixandstabilize,andmlisusedtocontainthe
essenceinternallyinordertopreventitsloss.
MainIndications
CM:defciencyofbothyinandyang.
WM: seminal emission, dreaming of sex, and hear t palpitations with the
CaseReport
Female,age29.
The patient was admitted to the hospital for insomnia, profuse dreaming,
dizziness,andfatiguereportedtohavelastedforthreeyears.Shewasdiagnosedwith
a severe anxiety disorder. She was first treated with Gu PTng (Spleen-Restoring
Decoction, ) plus lng g and m l for about a month, with little effect. A
second regimen of XioYo Sn (FreeWanderer Powder, ) plus y jio tng
(Caulis Polygoni Multiflori) andh hun p (Cortex Albiziae) was prescribed; this was
againinefective.
During the consultation, the doctor asked the patient what her dreams were
about, and the patient was initially hesitant to reply. Finally, she revealed that from
theminuteshefellasleep,nomatterwhetheritwasdayornight,shealwaysdreamed
ofhavingsex.Additionally,shefeltfeverishandsweatyduringthenight.Hertongue
waspaleredwithathinwhitecoating.Herpulsewashollow.
Theprescribedformulawasasfollows:
lngg 30g OsDraconis
Aftertakingsixpacks,thepatientreportedthatallofhersymptomshadimproved.
Six more packs were prescribed. During the course of treatment, the sexual dreams
ceased.Shethenfeltcompletelyrecoveredandwasdischargedfromthehospital.
[Reference: Zhong Xin-shan.Two Cases of ClinicalVerification of Zhang Zhong-jings Formulas
2.JournalofHunanCollegeofTraditionalChineseMedicine.1991;11(3):32.]
X io Jin ZhngTng (Minor Center-Fortifying Decoction) Pattern

Source Text
Line13

For deficiency taxation with abdominal urgency, palpitations, nosebleed,
abdominal pain, dream emission, soreness, and pain of the four limbs, vexing heat
of the extremities, and dryness of the throat and mouth, Xio Jin ZhngTng is
indicated.
Formula

Decoctthefirst6medicinalsin7shengofwatertoobtain3shengofdecoction.
Removethedregs.Addtheytngtothedecoctionandcookovermoderateheatto
dissolvethesugar.Drinkoneshengwarm,threetimesaday.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofdeficiencytaxationduetodeficiencyofboth
yin and yang.Yin and yang are interconnected parts of a whole, and thus changes
in one will affect the other. Deficiency of both yin and yang can develop from
either yin deficiency affecting yang or a yang deficiency affecting yin. Despite the
dual deficiency, the relative prevalence of yin or yang will lead to corresponding
manifestationsofdeficientheatandcoldpatterns.Therefore,acoldandheatcomplex
patternisoftenpresentincombinedyinandyangdefciencypatterns.
Ifyindeficiencyproducesheat,itleadstonosebleed,vexingheatoftheextremities,
and dryness of the throat and mouth.Yang deficiency engendering cold leads to
abdominal spasms or pain. When deficient yang prevails,abdominal urgency
orabdominal anxiety (spasms of the abdominal organs without stiffness of the
abdominal muscles) may be present. Palpitations are due to heart blood deficiency,
while uncontrolledseminalemissioniscausedby kidneyyindeficiency.Whenblood
andqiaredeficientandfailtonourishthefourlimbs,sorenessandpainensue.These
areallsignsofdefciencyofbothyinandyang.
Treatment, therefore, cannot rely on simple applications of warming methods to
treatcoldpatternsorcoolingmethodstotreatheatpatterns. PersonalStandardsfor
theEssentialsfromtheGoldenCabinet(JnGuYoLXnDin,)states
thattoseektheharmonyofyinandyang,primarilyestablishmiddleqi.Toseekthe
establishmentofmiddleqi,primarilyselectXioJinZhngTng.
FormulaAnalysis
XioJinZhngTngusessweetmedicinalssuchasgnco,dzoandytngto
establishmiddleqiandtorelievespasms.
Shngjingandguzhareusedtoactivateyangandregulateweiqi.
Shoyoissourandcanhelptoastringeandregulateyingqi.Theabovemedicinals
canestablishandmovethemiddleqiaswellasregulateyinandyang.
Once yin and yang are harmonized, the cold and heat complex pattern will
disappear.
MainIndications
XioJinZhngTngisindicatedfordeficiencyofbothyinandyang,andcoldand
heat complex patterns. However, this formula is more suitable for yang deficiency
patterns.
CM:abdominalpainorstomachacheduetospleenandstomachdefciency
WM: diseases of the digestive system: gastrointestinal ulcer, stomach prolapse,
stomach pain in early stomach cancer, chronic gastritis, chronic dysentery, chronic
hepatitis, and dyspepsia; hematological disorders: aplastic anemia, hemolytic
jaundice, and iron deficiency anemia; miscellaneous diseases: neurasthenia, fever of
unidentifedorigin,lowgradefeverindiabetes,andpostpartumillnesses.
CaseReport
Male,age40.Initialconsultation:January17,2005.
The patient complained of abdominal pain that could be relieved by pressure,
aversion to cold and raw foods, diarrhea, dryness of the throat and mouth, vexing
heatinthehandsandfeet, palpitations,insomnia,andsorenessofthefourlimbs.His
tonguewasredwithlittlecoating;thepulsewasdeepandfine.Noabnormalsignsor
labtestresultswerefound.Hisconditionwasconsideredtobeafunctionaldisorder
ratherthananorganicdisease.
Pattern differentiation: deficiency taxation due to dual deficiency of yin (blood)
andyang(qi).
Formula:XioJinZhngTng.
guzh 10g RamulusCinnamomiCassiae
gnco 10g RadixetRhizomaGlycyrrhizaePraeparatacumMelle
ytng 30g SaccharumGranorum
The patient was instructed to take one pack of decocted herbs per day in two
portions. After 15 packs, all symptoms resolved. No relapse was reported at a six-
monthfollow-up.
[Reference: Hu Min-feng. Examples of Using Classic Formulas in the Clinic .
HenanJournalofTraditionalChineseMedicine.2007;27(12):14.]
H ung Q Jin ZhngTng (Astragalus Center-Fortifying Decoction)
Pattern
Source Text
Line14

,
Fordeficiencytaxation,abdominalurgency,andthevariouskindsofinsufficiency,
HungQJinZhngTngisindicated.
Formula
zhhungq 1.5liang RadixAstragaliPraeparatacumMelle
Add1.5liangofhungqtoXioJinZhngTng,andfollowtheabovepreparation
method.
Withshortnessofbreathandfullnessinthechest,addshngjing.
Withabdominalfullness,removedzoandadd1.5liangofflng(Poria).
For treating patterns of lung deficiency, detriment, and to supplement qi, add 3
liangofbnxi(RhizomaPinelliae).
Interpretation
PatternAnalysis
Thistextalsodiscussesthetreatmentofpatternsof yinandyangdualdeficiency.
The manifestations are associated with deficiencies of yin, yang, qi, and blood.
Symptoms and signs include emaciation with a sallow yellow facial complexion,
reducedappetite,anddull stomachacherelievedbyeating,warmth,orpressure.The
tongueispalewithathinwhitecoating.
FormulaAnalysis
HungQJinZhngTngissweetandwarm.Thesweetflavorcanrelievespasms,
whilethewarmpropertiessupplementdefciency.
Hungqsupplementsqi,andytngwarmsthemiddle,supplementsdeficiency,
andrelievespain.
A large dose of sho yo is used to astringe yin, and gu zh warms yang. When
combinedwithsour shoyo,sweetzhgncocannourishyinandrelieve urgency
and pain; when combined with gu zh, activates yang, warms the middle, and
supplementsdefciency.
Shngjingworksintheexteriortoassistweiyang,whiledzoentersthespleen
toboostying-yin.
Oncethemiddlejiaoisstrengthened,qiandbloodcanbeengenderedinorderto
addressthevariousmanifestationsofdefciencytaxation.
MainIndications
CM:stomachacheduetodefciency-coldofthespleenandstomach.
WM:gastricconditionswiththecorrespondingunderlyingpattern.
CaseReport
The patient reported suffering from gastritis for four years. Symptoms and signs
on the first visit included a dull stomachache with preference for warm pressure,
vexinghungerwithout appetite,abdominal bloating after eating, dry mouth, lack of
acid regurgitation, vexation, insomnia, loose stools, fear of cold, fatigue, a withered
complexion,apaletonguebodywithlittlecoating,andathinweakpulse.Endoscopy
showedatrophicgastritis.
Pattern differentiation: dual deficiency of yin and yang and dysfunction of the
spleenandstomachduetochronicstomachproblems.
Treatmentprinciples:supplementthemiddledefciencyandrelievethepain.
Formula:supplementedHungQJinZhngTng.

guzh 6g RamulusCinnamomi(skinpeeled)
ytng 20g SaccharumGranorum
Aftertakingfivepacks,thedullstomachpainwasrelievedandtheappetiteimproved.
Aftertakingtheformulaformorethanonemonth,allofthesymptomsresolved.
[Reference:CaoTie-gong.TheClinicalApplicationofHungQJinZhngTng
.ChineseJournalofClinicalMedicineResearch.2007;13(20):2985.]
S unZoRnTng(SourJujubeDecoction)Pattern
Source Text
Line17

Fordeficiencytaxationwithdeficiencyvexationcausinganinabilitytosleep,Sun
ZoRnTngisindicated.
Formula
sunzorn 2sheng SemenZiziphiSpinosae
flng 2liang Poria
chunxing 2liang RhizomaChuanxiong
Oftheabovefiveherbs,firstuse8shengofwatertoboilthesunzorntoyield
6shengofdecoction.Addtheotherfourmedicinals;boiltoyield3 sheng.Takewarm,
threetimesaday.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofdefciencyvexationandinsomnia.
Thepattern here is deficiency of liver yin and heart blood. Deficiency of liver yin
engendersinternalheat,anddeficiencyofheartbloodcausesvexationandinsomnia.
SunZoRnTngisindicated.
FormulaAnalysis
Thisformulausessunzorntonourishtheliveryinwithflngandgncoto
calmtheheartandtranquilizethemind.
Chun xing regulates blood and soothes the liver, and zh m acts to clear
defciencyheat.
Togethertheyacttonourishyin,clearheat,calmtheheart,andtranquilizethemind.
MainIndications
CM:insomniaduetoblooddefciencyoftheheartandliver.
WM: neurasthenia, depression, anxiety, neurosis, or paranoid-type schizophrenia
withthecorrespondingunderlyingpattern.
CaseReport
Male,age24,student.
The patient reported suffering from insomnia for several years. He was once
diagnosed with neurasthenia by a practitioner ofWestern medicine.To help him to
sleepbetter,tranquilizerswereadministeredandoccasionallyseemedtobemoderately
effective.Recentlyunderthestressofgraduationexaminations,hisinsomniabecame
aggravated. During the day, there would be dizziness, headaches, somnolence,
and inability to concentrate. During the night, there would be sleeplessness and
compulsivethinkingaboutthepast.
Other symptoms and signs included a bitter taste in the mouth, vexation, and
dark-coloredurine;thetonguebodywasredwithathinyellowcoating,andthepulse
was wiry, thready, and rapid.When yin-blood is deficient, the mind is unsettled.
Therefore,thetreatmentplancalledfornourishmentof yin-bloodtorestoretheroot,
andclearingofdefciencyheattocalmthemind,thusimprovingsleep.
Formula:supplementedSunZoRnTng.
sunzorn 15g SemenZiziphiSpinosae

flng 18g Poria
zhy 4.5g FoliumPhyllostachydisHenonis
zhsh 1.5g Cinnabaris
Aftertakingsixpacksoftheformula,thepatientssleepqualityimprovedandhe
feltrelieffromthedizzinessandheadaches.Afterninemorepackswereadministered,
hissleepqualityreturnedtonormal.Hethentooktwo TinWngBXnDn(Celestial
EmperorHeart-SupplementingElixir, )pillseverynighttofurthermanage
hiscondition.
[Reference:YangYi-ya.TraditionalChineseMedicineSelf-StudyBooks:JnGu.
Hebei:HebeiSciencePress;1985.p.153.]
D Hung Zh ChngWn (Rhubarb and Eupolyphaga Pill) Pattern

Source text
Line18


For the five taxations with extreme deficiency, emaciation, abdominal fullness
withaninabilitytoeatordrink,fooddamage,anxietydamage,drinkdamage,sexual
intemperancedamage,hungerdamage,taxationdamage,channel-collateraland ying-
wei damage, internal dry blood, encrusted skin, and darkened eyes, the treatment
principleistoslowlydispelstasiswhilealsosupplementingthedeficiency. DHung
ZhChngWnisindicated.
Formula
dhung 10fen RadixetRhizomaRhei(steamed)

torn 1sheng SemenPersicae
xngrn 1sheng SemenArmeniacaeAmarum
gndhung 10liang RadixRehmanniae
gnq 1liang ResinaToxicodendri
mngchng 1sheng Tabanus
shuzh 100pcs Hirudo
qco 1sheng LarvaHolotrichiae
zhchng 0.5sheng EupolyphagaseuSteleophaga
Grind the above 12 medicinals into powder. Use honey to make pills the size of
smallbeans.Takefvepillswithricewine,threetimesaday.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofdefciencytaxationwithinternaldryblood.
Extremedeficiencywithsevereemaciationrepresentsthefinalstageofdeficiency
taxation.Abdominalfullnessandinabilitytoeatordrinkindicateabnormalityofthe
spleenandstomachfunctionsoftransformationandtransportation. Drybloodresults
from a qi and blood movement disorder due to long-term deficiency taxation.The
bloodstasisstaysinthebodyandaffectsqimovement,thefunctionofthespleen,and
theproductionofnewblood.Dryroughandscalyhardenedskinand darkenedeyes
(thewhitesoftheeyesbecomebluish-green)areindicationsofblooddeficiencydue
tobloodstasis.DHungZhChngWnshouldbeappliedtorelievethemiddlejiao,
supplementdefciency,activateblood,andresolvestasis.
Since patterns of deficiency and blood stasis are both severe, it is important to
supplement deficiency and dispel stasis at the same time.Slowly dispel stasis has
twomeaningshere.Thefirstreferstothemethodoftreatment.Drybloodtakesalong
timetoform,soitalsotakestimetoeliminate.Furthermore,attackingdrybloodtoo
quicklycausesdamagetotheuprightqi.
The second meaning refers to the preparation method. Prepared pills are more
convenientforchronicpatientsbecausethemedicinalsneedtobetakenoveralong
period of time.The effect is expected to be relatively slow, because only five bean-
sizedpillsaretakeneachtime.Theformulaitselfisharshandattacking,sothisform
ofadministrationcanalsopreventdamagetouprightqi.
FormulaAnalysis
Intheformula,dhung,zhchng,torn,mngchng,shuzh,qcoandgnq
canactivatebloodandresolvestasis.
Shoyoanddhungsupplementbloodanddefciency.
Xng rn regulates qi, and hung qn clears heat while gn co and honey boost
middleqiandharmonizethemiddlejiao.
Thisisamildformulaforchronicdiseasewithbloodstagnation.Itcansupplement
andpurgeatthesametime.Itachievesthisbyputtingthepotent,purgingmedicinals
into the form of large, honey ball pills moderating the intensity of the medicinal
efects.Thus,thisformulacansupplementhealthyqiwithoutretainingbloodstasis.
MainIndications
CM:variousdiseaseswithchronicbloodstasis.
WM: diseases of the digestive system: enlargement of the liver and spleen,
abscess of the appendix, intestinal adhesion, active hepatitis, chronic cholecystitis,
gastrointestinal neurosis; disorders of the nervous system; hematological disorders:
sequelaeofviralmeningitis,autoimmunethrombocytopenicpurpura,thromboangitis
obliterans; gynecological disorders:uterine fibroids,vesicular moles,cervical cancer,
infertility due to chronic pelvic inflammatory diseases; miscellaneous diseases:
nephritis, melanosis faciei feminae, psoriasis, ichthyosis, with the corresponding
underlyingpattern.
CaseReport
Female,age29.Initialconsultation:January7,1998.
The patient complained of having distending pain in the lower abdomen, lower
back soreness, and excessive leukorrhea for over six months. During the first visit,
the patient also reportedirregular menstruation,fatigue,tenesmus, anddifficulty in
defecating. Her tongue was dusky red with a greasy, yellow coating, and her pulse
wasslippery.Agynecologicalexamrevealedatenderenlargementoftherightannex.
Anultrasounddetectedanenlargementoftherightovaryandafluidsonolucentarea
22 mm in diameter in the cul-de-sac. Antibiotics such as norfloxacin, metronidazole,
and erythromycin were used with some effect, but relapse could not be prevented,
especially when the patient was very stressed. D hung Zh Chng Wn was
administeredinthree6gdosesperday.Aftertwoweeks,thesymptomswererelieved
significantly, and after another two weeks the symptoms disappeared entirely. A
follow-upultrasounddidnotindicatethepresenceofeitherenlargementoftheovary
orpelvicefusion.
[Reference:Tang Zhi-min. D Hung Zh ChngWn inTreating Gynecological Diseases: Case
Reports .JournalofHunanCollegeofTraditionalChineseMedicine.2000;
16(3):59-60.]
394
Chapter6
Pulses, Patterns, and Treatment of Lung
Wi, Lung Abscess, and Coughing with
Qi Ascent
MiMnDngTng(OphiopogonDecoction)Pattern

Source Text
Line10

For fire counterflow with qi ascent and inhibition of the throat, the treatment
methodistocheckcounterfowanddownbearqi.MiMnDngTngisindicated.
Formula
mimndng 7sheng RadixOphiopogonis
bnxi 1sheng RhizomaPinelliae
Decoctthe6ingredientsinonedouand2shengwateruntil6shengremains.Take
oneshengwarm,threetimesduringthedayandonceintheevening.
Interpretation
PatternAnalysis
Thislinediscussesthepatternsandtreatmentofcoughingandpantingasassociated
withdefciencyheat.
The deficiency heat arises from the lack of body fluids in the lung and stomach.
Coughing and panting are characteristic symptoms of lung qi failing to descend.
Althoughtheprincipalorganmanifestingthesymptomsisthelung,thedisharmony
can originate in the stomach. Over time, damage to stomach fluids will lead to yin
deficiency that if left unresolved, will affect lung fluids and eventually manifest as
lungyindeficiency.Theyindeficiencyconditionoftheseorgansallowsfor deficiency
VolumeThree:Chapter6 Pulses,Patterns,andTreatmentofLungWi,LungAbscess,andCoughingwithQiAscent 395
heattoflameupwardsandcounterflowqiascend,principallymanifestingascoughing
andpanting.
Themainsymptomsofthisconditionarecoughingwithdifficultyinexpectorating
sputum, panting, andthroat discomfort due to the presence of thick sticky phlegm.
Othersymptomsinclude drymouth,washingthemouthwithwaterwithoutdesireto
swallowit,aredtonguebodywithlittlecoating,andaweakandrapidpulse.
FormulaAnalysis
The formula Mi Mn DngTng clears and nourishes the lung and stomach,
checksthecounterflowofqiandactstodescendqi.Alargedoseofmimndngis
prescribed to moisten the lung, nourish the stomach and clear deficiency fire. Even
thoughbnxiisverydryinnature,asmallamountofitisusedtocheckcounterflow
qiascentanddissolvephlegm.
Itsdryingeffectsaremoderatedbytheclearingandmoisteningeffectsofrnshn,
gnco,dzo,jngmwhichnourishthestomachandreplenishqitoengenderfluids.
Restored body fluids enable deficiency fire to withdraw and contain itself.With
the resolution of deficiency fire, the symptoms from the counterflow qi ascent will
disappear.Zhyandshgocanbeappliedinthecaseofseverefrecounterfow.
MainIndications
CM: mainly patterns of yin deficiency fire and lung wilting; also, deficiency-
taxation cough and vomiting due to stomach yin deficiency, difficulty in swallowing
withunderlyingfluidexhaustion,drythroat,andshortnessofbreathduringrecovery
fromseveredisease.
WM: chronic phar yngitis, chronic bronchitis, whooping cough, pulmonar y
tuberculosis, and lung silicosis when the pattern of lung-yin deficiency and upward
flaming deficiency-fire is present. Due to its ability to nourish stomach yin, this
formula can also be used to treat diseases like chronic gastritis and stomach yin
defciencytypegastricandgastroduodenalulcers.
CaseReport
Male,age9.
The patient repor ted suffering from recurrent year-round fits of coughing
withoutseasonaldifferences.Hesaidthecoughoftencameoninsuddenandintense
paroxysms, each lasting about 30 minutes and then disappearing on its own. His
symptomsweremoresevereatnightthanduringtheday.
When he visited the clinic his complaints were: fits of coughing lasting several
days with small amounts of yellow and sticky sputum, discomfort in the throat and
drynessinthemouthandnose.Hehadaredtonguewithlittletonguecoating,anda
thinandrapidpulse.
Previous physicians had diagnosed and treated the patient for pharyngitis, but
the treatment hadbeen completely ineffective.The cough was considered to be the
result oflung yin deficiency with deficiency fire scorching the lung, and fire flaming
upwardharassingthethroat.Thetreatmentmethodchosenwastomoistenthe lung
andrelievecoughing,andMiMnDngTngwasprescribed.
mimndng 70g RadixOphiopogonis

gnco 4g RadixGlycyrrhizae
After taking one pack of decoction, all symptoms diminished. Upon taking a
secondpack,thecoughdisappearedcompletely.
[Reference:LiYong-chao.ClinicalExperiencesofProfessorChenJi-ting:CaseReports
.SichuanJournalofTraditionalChineseMedicine.2007;25(11):12-13.]
T ng L D Zo Xi Fi Tng (Lepidium and Jujube Lung-Draining

Decoction)Pattern
Source Text
Line11

Forlungabscesswithpanting[thatresultsin]aninabilitytolieflat,TngLDZo
XiFiTngisindicated.
Line15

For welling-abscess of the lung manifesting with fullness and distention in the
chest, puffy swelling of the face, eyes, and body, nasal congestion, a runny nose
with clear snivel and an inability to smell fragrance, foulness, sourness, or acridity,
coughing and counterflowqi ascent, panting, and rales with distress,Tng L D Zo
XiFiTngisindicated.
See the formula above.Take one dose every three days; as many as 3 or 4 doses
may be taken in total. However, first take one dose of Xio Qng LngTng (Minor
Blue-GreenDragonDecoction);thisformulacanbefoundinthesectiononcoughing.
Formula
Semen Descurainiae seu Lepidii (boiled until yellow,

tngl noamountmentioned
poundedintobullet-sizedpills)
Decoctthedzowith3shengofwateruntil2shengremains.Removethedzo
andaddthetngl.Decoctagainuntiloneshengremains.Takeasonedose.
Interpretation
PatternAnalysis
This text discusses the treatment of severe panting in an excess pattern of lung
abscess. Pathogen attacking the lung results in lung qi stagnation, which manifests
as fullness and distention in the chest and an inability to lie flat.The lungs failure
to regulate waterways and disperse fluids gives rise to puffiness throughout the
body, face, andeyes.Theorificeofthe lung, (the nose), is blocked and a runny nose
with clear discharge and loss of smell thus ensue.The lungs failure to disperse and
descend results in coughing with a wheezing whistling sound, and breathing is
distressedduetocounterfowqiascent.
FormulaAnalysis
Thetreatmentprincipleforthisconditionistoopenandfree lungqi,movewater,
andexpelrheum.TngLDZoXiFiTngisindicated.
Tnglzispungent,bitter,andcold.Itopensandfreeslungqitoresolvephlegm.
However,ifused alone, the harsh bitter cold nature of this medicinal would damage
theuprightqi.Dzoisthereforeaddedtomoderatethepurgativeeffectoftnglzin
themiddlejiao.
MainIndications
WM: exudative pleuritis, asthmatic bronchitis, pulmonary heart disease, cardiac
failure, rheumatic heart disease, and heart failure with the underlying patterns.
Important symptoms and signs of the clinical presentation include cough, panting,
inabilitytolieflat,chestfullnessandtightness,expectoratingcopiousphlegmy-saliva,
andgeneralpufnessandswellingofthefaceandeyes.
CaseReport
Thepatientreportedsufferingfromcoughingandchestpainfortwomonths.He
saidhischest pain was brought on by coughing, accompanied by slight tightness in
the chest and hasty breathing. He complained of fatigue, poor appetite, and scanty
urination. Chest X-rays indicated exudative pleuritis with moderate amounts of
pleuralefusion.
Symptoms and signs included: a poor general state, tenderness in the chest,
shortness of breath, and disappearing breath sounds at the base of the lungs.The
tonguebodywaslightpurplewithathinwhitecoating.Thepulsewasmoderate.
Patterndiferentiation:coldretainedfuidshiddeninthelung(exudativepleuritis).
Treatmentprinciples:drainthelungandexpelwater,warmthelung,anddissolve
phlegm.
Formula:supplementedTngLDZoXiFiTng.
tnglz 15g SemenDescurainiaeseuLepidii

bijiz 15g SemenSinapis
flng 20g Poria
One pack of the above Chinese medicinals was decocted with water and taken
twicedailyforthreedays,afterwhichthepatientexperienceddiminishedchestpain.
Thetightnessinhischestandhislaboredbreathingalsodisappeared.
After six more packs of herbs were administered, the symptoms were almost
completely gone, and less pleural effusion was detected in a second chest X-ray.
Xngrnandmhungwereremovedfromtheformula,andanothertenpackswere
prescribed.
Following treatment, the pleural effusion abated completely. A year later, the
patientreportednorelapse.
[Reference:DaiTing-hua.ExamplesofUsingTngLDZoXiFiTng
.JilinJournalofTraditionalChineseMedicine.2004;24(9):54.]
S h Gn M HungTng (Belamcanda and Ephedra Decoction) Pattern

Source Text
Line6

Forcoughingwithqiascentandafrog-likeraleinthethroat, ShGnMHung
Tngisindicated.
Formula
shgn 13pcs RhizomaBelamcandae

zwn 3liang RadixetRhizomaAsteris
kundnghu 3liang FlosFarfarae
wwiz 1/2sheng FructusSchisandraeChinensis
bnxi 8pcs RhizomaPinelliae
Useonedouand2shengofwatertodecoctthemhung.Scoopthefoamatthetop
andaddthe other medicinals. Decoct again until 3 sheng remains.Take warm, three
timesaday.
Interpretation
PatternAnalysis
This text discusses the treatment of coughing and counter flow qi ascent
manifestingwithafrog-likeraleinthethroat.Thisdescribesthecontinuousrattling
sound made in the throat by air contacting phlegm lodged in the airways.These
symptoms are commonly seen in a pattern of cold rheum constrained in the lung.
Clinically,thesesymptomsarecharacteristicofasthmapatients.
FormulaAnalysis
ShGnMHungTngdissipatescold,diffusesthelung,downbearscounterflow,
andresolvesphlegm.
Sh gn acts to eliminate phlegm, and m hung diffuses the lung and relieves
panting.
Shngjingandxxndissipatecoldandmovewater.
Kundnghu,zwnandbnxidownbearqiandresolvephlegm.
Wwiztogetherwithmhung,xxn,shngjingandbnxiastringelungqi
withoutdamagingtheuprightqi.
D zo harmonizes all medicinals, and assists to eliminate the pathogen while
supportingtheuprightqi.
MainIndications
WM: asthma, asthmatic bronchitis, bronchial pneumonia, and whooping cough
characterizedbycough,pantingorwheezingwithasoundofphlegmrattlinginthethroat
andexpectorationofwhitesputum.Theformulacanbeusedforpatientsofanyage.
CaseReport
Male,age50.Initialconsultation:November19,1990.
The patient reported a more than 20-year history ofasthma. He said during the
threeyearspriortopresentation,hisconditionworsened,especiallyduringthewinter
whenhewouldexperiencefrequentattacks.Symptomsincluded: laboredbreathing,
chest constriction, panting, and coughing with profuse white sputum. During the
most serious bouts of coughing, the patient experienced sweating on his head and
faceandwasunabletoliefatonhisback.
On the first visit, symptoms and signs included: labored breathing with phlegm
rattling in the throat, a puffy swollen face with difficultly opening the eyes, poor
appetite,andnormalurination.Histonguewaswhitewithagreasycoating.Hehada
slipperyandrapidpulse.
The pattern was lung qi counterflow caused by cold invading the lung with
accumulation of phlegm and fluid.The selected treatment method was to warm the
lung,resolvephlegm,descendqi,andstoppanting.
Themedicinalsusedintheformulawereasfollows:
shgn 9g RhizomaBelamcandae
flng 15g Poria
bim 9g BulbusFritillaria
lifz 9g SemenRaphani
dizhsh 9g Haematitum
After five packs, the panting disappeared and the coughing diminished.The
patient coughed up less sputum, enabling him to lie down to sleep, which in turn
improvedhissleepandhisappetite.
Atthispoint,dizhshwasremovedfromtheformula,and9gofshnq(Massa
MedicataFermentata)andzhsngbip(honey-friedCortexMori)wereadded.The
patient was administered four packs of this modified formula. Upon finishing the
prescription,allsymptomsweregone.
Norelapsewasreportedinthefollowingfouryears.
[Reference: Ba Ha-er. Examples of Sh Gn M HungTng . Xinjiang
JournalofTraditionalChineseMedicine.1996;(3):58-59.]
401
Chapter7
Pulses, Patterns, and Treatment of Chest
B, Heart Pain, and Shortness of Breath
G u Lu Xi Bi Bi JiTng (Trichosanthes, Chinese Chive andWhite
WineDecoction)Pattern
Source Text
Line3

Forthediseaseofchestbmanifestingwithpanting,coughing,spitting,paininthe
chestandback,shortnessofbreath,deepandslowpulsesat cnkuandsmall,tight,
andrapidpulsesatthegunposition,GuLuXiBiBiJiTngisindicated.
Formula
gulu 1pc FructusTrichosanthis(pounded)

xibi 1/2jin BulbusAlliiMacrostemi
biji 7sheng Fermentedricewine
Decocttheabovethreemedicinalstogethertoobtain2 shengofdecoction.Take
warmintwodividedportions.
Interpretation
PatternAnalysis
Thislinedescribesthetypicalclinicalpresentationandcorrespondingformulafor
chestb.
Panting, coughing, spitting, pain in the chest and back, shortness of breath
are the cardinal signs of chest b.The principal pathodynamic behind all of these
symptoms is yang qi deficiency which allows for a qi blockage in the chest that
presentsaspainand shortnessofbreath.Whenthe yangqiofthechestisimpeded,
the ability of the lung qi to diffuse and descend will naturally be affected.This
manifestsaspanting,coughing,andspitting.
It should be noted that the two key symptoms identifying a chest b pattern
are shortness of breath and pain in the chest and back.While panting, coughing
and spitting are common concurrent symptoms, they are also seen in many other
patterns when lung qi fails to diffuse and descend. Alone, they are insufficient to
identifychestb.
The cn ku pulse is also important in identifying this pattern. A deep and slow
pulse indicates yang deficiency in the upper jiao and chest yang torpidity.This is
consistent with the principal pathodynamic stated above. However, there is also a
smalltenseandrapidpulseatthegunposition.Thisisthesignofexcessivecoldyin
interiorly,withaccumulatedrheuminthemiddlejiao(stomach).Takenasawhole,the
pulsepatternimpliesthateventhoughyangqideficiencywithblockageinthechestis
theprincipalacutepattern,aconcurrentpatterninvolvinganaccumulationofrheum
andphlegminthemiddlejiaoexists.
Therefore the overall pattern includes a deficient yang pattern and an excessive
yin pattern.We will see below that this means the presence of an excess-deficiency
complexpatternandtheneedfortreatmentdiferentiation.
Atthispointintheclinicalpresentation,theacuteyangdeficiencyandqiblockage
of the chest should receive prioritized treatment.Therefore, Gu Lu Xi Bi Bi Ji
Tngisapplied.
FormulaAnalysis
Gu Lu Xi Bi Bi JiTng is the hallmark formula for this pattern, using acrid
and warm medicinals to activate and open the flow ofyang qi in the chest. It can
unbindthechestbymovingyangqi,eliminatingphlegm,anddescendingqi.
Intheformula,thecold,bitter,andpurgativenatureofguluopensthechestand
eliminates phlegm, while the warm nature ofxi bi activates yang, frees the chest,
andrelievesimpedimentpain.
The light, ascending, and moving nature of bi ji aids the other medicinals in
activatingyanganddifusingimpediment.
The above three medicinals mutually assist and support each other to eliminate
impediment and obstruction. Once chest yang is diffusing normally, all symptoms
willberelieved.
MainIndications
CM:qistagnationandchestpainduetotorpidityofyangqiinthechestwithan
invasionofandblockagebyphlegm.
WM: cardiopulmonary diseases likecoronary angina pectoris, bronchial asthma,
intercostal neuralgia, soft tissue injury of the chest wall and suppurative costal
chondritiswiththecorrespondingunderlyingpattern.
CaseReport
Male,age55.
Thepatientreportedsufferingfromfullnessandpaininthechestwithpalpitations
VolumeThree:Chapter7 Pulses,Patterns,andTreatmentofChestB,HeartPain,andShortnessofBreath 403
forthreeyears.Hesaidthesymptomsusuallyworsenedinthesummer.Onthebasis
ofanEKG,hewasdiagnosedwithcoronaryheartdiseasein1979.Hewasadmittedto
ahospitalinearlyJulyof1982foraggravatedsymptomsofchestfullness,shortnessof
breathandasensationasiftherewasablockageinsidehisheart.
Thepatientsdietwasexcessiveinheavyandgreasyfood.Hewasoverweight,his
complexionwaspale,andhefeltatinglingpaininthechestwhenunderexertionor
stress. He also felt dizzy and suffered from insomnia. His appetite was good and his
bowel movements and urination were normal. His pulse was thready and weak, and
histonguebodywaspalewithawhitegreasycoating.
Patterndiferentiation:chestbfromafailureofheartyangtodifusenormally.
Treatmentprinciples:activateyanganddifuseb.
Formula:modifedGuLuXiBiBiJiTng.
xibi 10g BulbusAlliiMacrostemi
biduku 3g FructusAmomiKravanh
flng 12g Poria
The above medicinals were cooked with water and one cup of vinegar. After
taking seven packs of the decoction (one pack of the decocted herbs, taken twice a
day),thepaininthechestandbackweremuchrelieved.Thepatientstonguecoating
becamethin,heraldingagoodprognosis.
Theaboveformulawasmodifiedasfollows:hupandbidukuwereremoved,
and12gofdnp(CortexMoutan)and10gofchsho(RadixPaeoniaeRubra)were
added.
Thisprescriptionwascontinuedfor20days,anduponcompletionthesymptoms
disappeared.To maintain the effects and assist the long-term, overall recovery,
modifiedWnDnTng(Gallbladder-WarmingDecoction,)andSunZoRn
Tng(SourJujubeDecoction,)wereprescribed.
[Reference:TuYong-hong.ClinicalApplicationof GuLuXiBiBiJiTng:CaseReports
.HubeiJournalofTraditionalChineseMedicine.1990;(2):16.]
G u Lu Xi Bi Bn Xi Tng ( Trichosanthes, Chinese Chive and

PinelliaDecoction)Pattern
Source Text
Line4

Forchestbmanifestingasaninabilitytoliedownandheartpainpullingtheback,
GuLuXiBiBnXiTngisindicated.
Formula
xibi 3liang BulbusAlliiMacrostemi
bnxi 1/2sheng RhizomaPinelliae
biji 1dou Fermentedricewine
Cooktheabovefourmedicinalstogethertoobtain4shengofdecoction.Takeone
shengwarm,threetimesaday.
Interpretation
PatternAnalysis
Thistextdiscussesthepatternandtreatmentofchestbduetophlegmexuberance.
AsdiscussedinthelineaboveonGuLuXiBiBiJiTng,thechiefsymptomsare
panting,coughingwithspitting, paininthechestandback,and shortnessofbreath.
However,inthiscase,thesymptomsaresoseverethatthepatientcannotliesupine.This
indicatesamoreseriouscaseofyangqiblockagecausedbyapathogenicyininvasion
fromthemiddlejiao.Exuberantphlegm-rheumobstructstheqidynamicinthechest,
manifestingaspantingandcoughingsoseverethatthepatientcannotliedown.Severe
yangqiblockageinthechestandbackpresentsasheartpainradiatingtotheback.
FormulaAnalysis
Because the key factor in this pattern is the obstruction caused by exuberant
phlegm-rheum, bn xi is added to Gu Lu Xi Bi Bi JiTng to eliminate rheum
anddownbearcounterflow.Othermodificationsincludeincreasingtheamountof bi
jitoonedouandincreasingthefrequencyofadministrationfromtwicetothreetimes
aday.Thesemodifcationsarenecessarytoaccommodatetheseverityofthedisease.
MainIndications
CM: panting with an inability to lie down, heart pain penetrating through to the
back,andagreasytonguecoatingduetochestyang b-impedimentpatterncausedby
exuberantphlegm-rheum.
WM: angina pectoris, bronchitis, chronic obstructive pulmonary disease (COPD),
intercostal neuralgia, distending breast pain, chronic cholecystitis, chronic gastritis,
andpericarditiswiththecorrespondingunderlyingpattern.
CaseReport
Female,age35.
The patient presented withchest distention and fullness,heart pain penetrating
through the back, adverse upward movement of qi manifesting as severe panting,
dyspnea,anddyschezia.Shehadadeepandslipperypulseandawhitegreasytongue
coating.
Patterndifferentiation:obstructionofchestyangandimpairmentoftheascending
and descending qi dynamic of the chest from turbid yin (rheum and phlegm)
counterfowandcongestedqiintheupperjiao.
Treatmentprinciples:openthefowofyanganddirecttheturbidyindownward.
Formula:modifedGuLuXiBiBnXiTng.
gulu 9g FructusTrichosanthis(pounded)
fbnxi 6g RhizomaPinelliae
zhsh 4.5g FructusAurantiiImmaturus
xngrnn 6g SemenArmeniacaeAmarum(mud)
guzh 4.5g RamulusCinnamomi
jp 5g PericarpiumCitriReticulatae
The above medicinals were decocted with water. After taking 4 packs (one pack,
twiceaday),thepatientwascompletelystabilized.
(Reference: Lai Liang-pu. PuYuan Medical Records . Nanchang: Jiangxi Peoples
PublishingHouse;1965.p.84.)
Z h Sh Xi Bi Gu ZhTng (Immature Bitter Orange, Chinese Chive
and CinnamonTwig Decoction) Pattern Rn Shn

Tng(GinsengDecoction)Pattern
Source Text
Line5

Forchestbmanifestingwithglomusintheheart,lodgingqibindinginthechest,
fullnessinthechest,andqicounterflowingfrombelowtherib-sidestotheheart,Zh
ShXiBiGuZhTngisindicated.RnShnTngisalsoindicated.
ZhShXiBiGuZhTng:
zhsh 4pcs FructusAurantiiImmaturus

hup 4liang CortexMagnoliaeOfcinalis
xibi 1/2jin BulbusAlliiMacrostemi
Decoctzhshandhupwith5shengofwateruntil2shengremains.Discardthe
dregs, add the other ingredients, and boil for a short time. Divide and take warm,
threetimesdaily.
RnShnTng:

gnco 3liang RadixGlycyrrhizae
Decocttheabovefourmedicinalswith8shengofwateruntil3shengremains.Take
oneshengwarm,threetimesaday.
Interpretation
PatternAnalysis
This text discusses the treatment of chest b with emphasis on the need to
differentiatebetweendeficiencyandexcesspatterns.Italsoshowstheimportanceof
themiddlejiaointhemanifestationofachestbcondition.
While the immediate symptoms of chest b are considered a manifestation of
chestyangqitorpidity,thispatternisactuallyanexcessdeficiencycomplexpatternin
whichthedegreesofexcessyin-coldanddefciencyyangneedtobediferentiated.
Accordingtothelineoftext,thecardinalsymptomsofchest bareaccompanied
by symptoms such as glomus and fullness in the heart, a binding and fullness of
thechest,andaradiatingsensationfromthecostalregiontotheheart,indicatingqi
counterflowfromthemiddlejiao.Inotherwords,boththemiddleandupper jiaosare
involved in this pattern, but the appropriate treatment method can only be chosen
afterrelativepatternsofexcessanddefciencyaredetermined.
FormulaAnalysis
In the case of an excess pattern of exuberant yin-cold, the above symptoms are
acute and may be accompanied by abdominal bloating, dyschezia, a thick greasy
tongue coating, and a wiry tight pulse.These are signs of excessive yin-coldness.
In this case, the branch excess condition should be dealt with immediately.The
treatment method should be activating yang, dissipating glomus, purging fullness,
anddownbearingcounterfow.ZhShXiBiGuZhTngisindicated.
Theformula is based on Gu Lu Xi Bi Bi JiTng. Bi ji is removed because
of its ascending and dispersing nature.Gu zh is added to activate torpid yang and
transformstagnantqiwhilecalminganddescendingtheadverseupwardmovement
of qi. Zh sh and hu p work together to regulate qi, disperse glomus, and purge
fullness.Together the ingredients of the formula unbind and open up the qi of the
chestresolvingglomusandconstrictionwhichinturneliminatephlegmturbidityand
allowyangqitoreturntothechestandmiddlejiao.
Foradeficiencypattern,thechestbsymptomsdescribedintheoriginaltextshould
berelativelymildbutalsochronic.Symptomsofmiddlejiaoyangqideficiencyandqi
stagnationfromcongealingcoldshouldbepresent,including:coldextremities,fatigue,
shortnessofbreath,loosestools,apaletongue,andaweakandslowpulse.
In this case, the root deficiency condition should be addressed first because of
its moderate nature.The treatment method should supplement the middle, while
assistingandinvigoratingyangtoeliminateyin-cold.RnShnTngisindicated.
Inthisformula,rnshn,bizhandzhgncosupplementthemiddlejiao,and
gn jing warms the middle jiao and assists yang.Together, they activate yang qi to
eliminateyin-cold.Incontrasttoitsdrainingcounterpart,thisformulaactstosupport
theuprightqiandeliminatepathogens.
CaseReport
Female,adult.
The patient complained of a two-year history of palpitations, chest fullness, and
chest pain. She was diagnosed as having coronary heart disease with ventricular
prematurebeat(VPB).ShehadbeentakingWesternmedicinesincludingnitroglycerin,
isosorbidedinitrate,andmexiletinum,withanunsatisfactoryefect.
Recently she had been suffering from severe palpitations, chest fullness, and
chest pain together with other symptoms such as shortness of breath, fatigue, cold
extremities,aswellaspoor dream-disturbedsleep.Shehadapaleredtonguewitha
whitish greasy coating and a deep intermittent pulse. An EKG showed ST-T change
and7-8VPBperminute.
Patterndifferentiation:chestbwithtorpidyangandphlegmturbidityobstructing
theheart.
Treatment principles: warm and activate chest yang, transform phlegm, and
dredgethecollaterals.
Formula:modifedZhShXiBiGuZhTng.

jingxing 10g LignumDalbergiaeOdoriferae
chozorn 15g SemenZiziphiSpinosae(dry-fried)
ynlng 15g Poria
Aftertakingsevenpacksoftheaboveformula(onedecoctedpack,takentwicea
day), the patients chest fullness and pain were much relieved, but the palpitations
andfatiguewerestillpresent.
Forthenextformula,jigngwasremovedandthedosageofzhshwasreduced
to8g.15goftizshn(RadixPseudostellariae)wereaddedandanothersevenpacks
wereadministered.Theresultwassignifcantrelieffromthesymptoms.
Another modified formula was prescribed for two weeks after which a follow-up
EKGshowedthattherewasstillachangeintheST-TbutnoevidenceofVPB.
[Reference: Feng Jun-ping. Clinical Application ofZh Sh Xi Bi Gu ZhTng
.ChineseMedicineModernDistanceEducationofChina.2006;4(5):41-42.]
F lng Xng Rn Gn Co Tng (Poria, Almond and Licorice Root

Decoction) Pattern J Zh JingTng (Tangerine

Pericarp,ImmatureOrangeFruitandFreshGingerDecoction)Pattern

Source Text
Line6

Forchestbmanifestingwithqiblockageinthechestandshortnessofbreath,F
lngXngRnGnCoTngisindicated.JZhJingTngisalsoindicated.
FlngXngRnGnCoTng:
flng 3liang Poria

xngrn 50pcs SemenArmeniacaeAmarum
Decoctinonedouwateruntil5shengremains.Takeoneshengwarm,threetimes
daily.Anotherdosemaybetakenifneeded.
JZhJingTng:
jp 1jin PericarpiumCitriReticulatae
zhsh 3liang FructusAurantiiImmaturus
shngjing 1/2jin RhizomaZingiberisRecens
Decoct the three medicinals above with 5 sheng of water until 2 sheng remains.
Takewarm,twiceaday.
Interpretation
PatternAnalysis
Thistextdiscussesthedifferentiatedtreatmentofmildchestbandchestbwithqi
blockage. Similar to the previous text, the location of the disharmony is primarily in
themiddlejiaobutmanifestsintheupperjiao.Inthiscase,rheumaccumulationand
qistagnationaretheprincipalfactorsinvolved.
Ithasbeenemphasizedthatchestpainandshortnessofbreathduetotorpidyang
qiinthechest are the key presentation symptoms in chest b. But in this line,chest
pain is substituted withqi blockage.This indicates that only a little or even no
chestpainispresent.Thus,chestbwithqiblockageisamildcondition.
Thetwochiefsymptomsofthistypeofchestbmanifestfromthecombinationof
rheumaccumulationandqistagnation.However,thepatternmustbedifferentiatedto
determinewhichisrelativelymoreprevalent,and,fromthat,whichistheappropriate
formula to use. Hence, in this case, we make full use of the principle oftreating
similarconditionswithdiferentmethods.
FormulaAnalysis
Rheum:excessiverheuminvadingupwardtoaffectthelungwithqiblockageand
shortnessofbreath(oftenaccompaniedbycoughingandcounterflow,droolfoaming
at the mouth, and difficult urinating) should be treated by dispersing thelung and
resolvingrheum.FLngXngRnGnCoTngisindicated.
Inthisformula, xng rn disperses lung qi, f lng dissolves phlegm and removes
rheum,andgncoharmonizesthemiddlejiao.Thethreeingredientsworktogetherto
eliminaterheumandensurethefree-flowofqithatleadstoalleviationandrecovery
fromallofthesymptoms.
Qi stagnation: when qi stagnation is the prevalent factor, the central part of the
pathodynamicinvolvesstomachqifailingtodescend.Inadditiontoqiblockageand
shortnessofbreath,glomusintheareabelowtheheartandvomitingareseenassigns
of qicounterflow.The treatment method is to move qi, transform rheum, harmonize
thestomach,anddescendcounterfowqi.JZhJingTngisindicated.
In this formula, j p regulates qi, harmonizes the stomach, and disperses and
unblockstheqidynamicofthemiddlejiao.Zhshdescendsqiandeliminatesphlegm
while shng jing transforms rheum, harmonizes the stomach, and descends qi
counterflow.Thethreeingredientsworktogethertomoveqiandeliminaterheum.In
thiswaythesymptomsofcheststufnessandglomuswillnaturallydisappear.
MainIndications
CM: chest b with qi blockage manifesting with short and rapid breathing with
expectorationofprofuse,foamysalivaorthinsputum.
WM: coronary heart disease, pulmonary heart disease, rheumatic heart disease,
bronchitis,bronchialasthma,intercostalneuralgia,andcystitiswiththecorresponding
underlyingpattern.
Forchestbwithqiblockageandfullnessinthechest,JZhJingTngisindicated.
It can be used to treat patients with biomedical diagnoses of coronary angina
pectoris,rheumaticheartdisease,pulmonaryheartdisease,bronchialasthma,chronic
bronchitis,and chronicgastroenteritispresentingwiththeappropriateqistagnation
pattern.
CaseReport
Male,age56.
The patient had been diagnosed with coronary heart disease for three years
prior to presentation. He continued with his daily work because his symptoms were
mild and he only experienced occasional palpitations, stuffiness, and fullness in the
chest.Inthetwomonthspriortopresentationhehadbeensufferingfrom bronchitis,
presentingwithcoughandexpectorationofwhitefoamysputum.Hehadasignificant
sensation of stuffiness and fullness in the chest, a slightly reduced appetite, slight
swelling in the lower extremities, normal defecation, and reduced urination. He
had a pale tongue with a thin white coating, and a slippery rapid pulse.The pattern
identifiedwaschestbwithtorpidheartyangduetointernalaccumulationofphlegm-
rheum.
A combined formula of F Lng Xng Rn Gn CoTng and r ChnTng (Two
MaturedSubstancesDecoction)wasadministered:
flng 30g Poria
zhbnxi 10g RhizomaPinelliaePraeparata
hngzo 5pcs FructusJujubae
Fivepacksofmedicinalswereprescribed.Thepatientwasinstructedtodecoctone
packeachdayandtakehalfofthedecoctioninthemorningandtheotherhalfinthe
evening.
Uponcompletionofthetreatmentcourse,thepatientreportedthatthe stuffiness
and fullness of the chest were much relieved as was the swelling of the lower
extremities.Urinationhadalsoincreased.
The following two medicinals were then added and another seven packs were
prescribed:
Following this treatment, the patient started to cough less, and the amount of
white sputum decreased.The same formula was prescribed, but the amounts of the
medicinalswereincreasedbytentimestobemadeintosmallwaterpills.Thepatient
was asked to take 6 g of pills at one time, two times a day. He was able to work
normallywhiletakingthepills.
(Reference:LiWen-rui.DecoctionPatternTreatmentofEssentialsfromtheGoldenCabinet
.Beijing:ChinaPublishingHouseofScienceTechnology;1993.p.291.)
W
Tu Ch Sh ZhWn (Acomite and Halloysite Pill) Pattern
Source Text
Line9

Forheartpainpullingtheback,orbackpainpullingtheheart, WTuChShZh
Wnisindicated.
Formula
shjio 1liang PericarpiumZanthoxyli
wtu 1fen1 RadixAconiti(processed)
fz 1/2liang RadixAconitiLateralisPraeparata
chshzh 1liang HalloysitumRubrum
1Here fen meansportion orpiece rather than a specific measurement. One piece of w tu is about
one-halfliangor7g.
Grindtheabovefivemedicinalsintopowder,mixwithhoney,andmaketheminto
pillsthesizeoffirmianaseeds.Takeonepillbeforemeals,threetimesaday.Ifunable
todiscernareaction,increasethedosageslightly.1
Interpretation
PatternAnalysis
Thistextdiscussesthepatternandtreatmentofheartpainduetoyin-coldcongealing
andbinding.Heartpainpenetratingtotheback,orbackpainpenetratingtotheheart
describes pulling pain of both the heart and back. In this pattern,rebellious yin-
cold has risen up and usurped the yang throne, or excessive yin-cold has invaded
upwardlyblocking the flow of qi and blood. Although not mentioned in the original
text,patientswiththistypeofpatternshouldalsoexhibitcoldofthehandsandfeet,
especiallythefngersandtoes(fourextremitiesreversalcold)andadeeptensepulse.
FormulaAnalysis
Forthispattern,theappropriatetreatmentistowarmyangandvigorouslyexpel
yin-cold. WTu Ch Sh ZhWn is indicated. In the formula, highly acrid and hot
medicinals like w tu, f z, gn jing and sh jio are used for their potent cold-
expellingandpain-relievingefects.
Chshzhisastringentandcanconstrainyangqiaswellasharmonizethemiddle
jiao.Whenyinpathogenisdispersed,itssurgingattackwillbepacifiedandtheheart
painwillcease.
MainIndications
CM:severepullingpainbetweentheheartandback,constantpainintheepigastric
region or stomach accompanied by cold extremities, cold sweat, rapid breath, pale
complexion, cyanosed lips, a pale tongue with a white slippery coating, and a deep
hiddenpulse.
WM: coronary angina pectoris, myocardial infarction, rheumatic heart disease,
arrhythmia,heartfailure,andshockwiththecorrespondingunderlyingpattern.
CaseReport
Male,age47.
The patient had a history of myocardial infarction and was observed to have a
yang deficient constitution. He expressed a strong aversion to cold environments;
recurrent stabbing pain behind the sternum and sometimes pain as if he was under
thepressureofaheavyobject.Hecomplainedofaconstant,uncomfortable fullness
1 Firmiana seeds are very small, thus a dosage of one such size pill is very small.This formula
containsseveralmedicinalsthataretoxicandsocautionmustbeusedinitsadministration.
acrossthechestwithpainradiatingtotheleftshoulderinepisodicattacks.
Other signs and symptoms upon presentation included: cyanosed nails and lips,
a normal appetite, constipation, a deep fine pulse, and a white tongue coating.The
patternwasidentifedaslowerjiaoyin-coldcounterfowattackingchest.
TheoriginalWTuChShZhWnwasprescribed:
shjio 30g PericarpiumZanthoxyli

wtu 15g RadixAconiti
chshzh 60g HalloysitumRubrum
Theaboveformulawasmadeintohoneypillsweighing6geach.Thepatientwas
asked to take two pills, four times a day after meals. Following completion of this
prescription, chest fullness was significantly relieved and there was no reoccurrence
ofchestpain behind the sternum. A second course of treatment was prescribed and
thecyanosis,chestconstriction,pain,andconstipationalldisappeared.
Thepatientthenwasaskedtotake hngshn(RadixetRhizomaGinsengRubra)
powderwithGuLuXiBiBnXiTng(Trichosanthes,ChineseChive,andPinellia
TuberDecoction)foranothertwomonths.Hisconditionremainedstableuponfollow-up.
[Reference:WangXu-dong.TheClinicalApplicationofWTuChShZhWn
.HubeiCollegeofTraditionalChineseMedicineJournal.1983;(2):30-32.]
414
Chapter8
Pulses, Patterns and Treatment of
Visceral Wind and Cold, Accumulations
and Gatherings
XunFHuTng(InulaDecoction)Pattern

Source Text
Line7

Withliverfixity,thepersonoftendesirestramplingonthechest.Beforetheacute
stage,heonlydesireshotdrinks.XunFHuTngisindicated.
Formula
xunfhu 3liang FlosInulae

cng 14stems BulbusAlliiFistulosi
xnjing smallamount RadixetRhizomaRubiae
Decoctallthreeingredientswith3shengofwateruntiloneshengremains.Takeas
onedose.
Interpretation
PatternAnalysis
Thistextdescribesthetreatmentofliverfxity.
Liverfixityoccurswhenbothqiandbloodbecomestagnantandwhenpathogens
invadetheliverchannel disordering the flow of qi.Theliver channel passes through
the chest and flanks.Therefore this pattern is characterized by sensations of glomus
distendingorstabbingpaininthechestandflanks.Rubbingandpoundingthechest
frees the flow of qi and blood to temporarily relieve the condition which is why the
patientdesirestohavetramplingonhischest.
At the initial stage, the disease is located at the qi level, so hot drinks can assist
yang to disperse cold and regulate qi movement. However, as qi stagnation leads
to blood stagnation and channel stasis,liver fixity is formed and drinking hot water
is no longer effective.Xun F HuTng is thus selected to move qi, activate blood,
invigorateyanganddissipatebinding.
VolumeThree:Chapter8 Pulses,PatternsandTreatmentofVisceralWindandCold,AccumulationsandGatherings 415
In the formula, the chief medicinal xun f hu acts to regulate qi and unblock
stagnationintheliverchannelsandcollaterals. Xnjing(alsocalledqinco)actsto
invigoratebloodanddissolvestasis.Cngwarmsyanganddissipatesbinding.When
qi moves, blood flows.When yang qi flows, stagnation is dispelled. In this way liver
fxitycanbecured.Toimproveitsefects,thewholedecoctionistakeninonedose.
MainIndications
CM: generalized chest and hypochondriac pain, plum-stone qi, postpartum
foodingandcoughduetobloodstasis.
WM: intercostal neuralgia, chronic gastritis, chronic hepatic diseases, coronary
heartdiseasewiththecorrespondingunderlyingpattern.
CaseReport
Female,age49.Initialconsultation:February,2003.
Thepatient complained of recurrentshooting pain between her third and fourth
right ribs, and presented with a previous diagnosis of intercostal neuralgia.The
symptom, which had a duration varying from several seconds to ten minutes, was
often triggered by fatigue or mood swings. She had been taking painkillers and
vitaminBforthepainwithlittleeffect.ShecameforChinesemedicinetreatmentafter
routinemedicationwasinefectiveintreatinganotherattack.
Signs and symptoms on the first visit included:shooting pain in the right chest
with no chest oppression or palpitations. She had a dull tongue body with whitish
coatingandafineweakpulse.Thepatternidentifiedwasbloodstasisintheliverand
gallbladderchannelsduetoqiandblooddeficiency.Thepainwasthemanifestation
oftheblockedchannels.
TheprescriptionwasamodifcationofXunFHuTng:
xunfhu 10g FlosInulae

qinco 10g RadixetRhizomaRubiae
bhe 10g HerbaMenthae
chozhqio 10g FructusAurantii(dry-fried)
dnggux 10g RadixAngelicaeSinensis
cngbi 3stems BulbusAlliiFistulosi
After three packs, her symptoms disappeared. After ten packs of the same
formula,norelapsewasreported.
[Reference:ZuoMing-yan,XuCongLian,YanYi.ClinicalApplicationsofXunFHuTng:Case
Reports.HubeiJournalofTraditionalChineseMedicine.2008,30(1):49-50.]
G n Jing Lng Zh Tng (Licorice, Dried Ginger, Poria and White

AtractylodesDecoction)Pattern
Source Text
Line16

A person suffering from kidney fixity experiences generalized heaviness and
lumbar coldness as though sitting in water.The symptoms may resemble those of
water conditions, but there is an absence of thirst with uninhibited urination, and
with eating and drinking as normal.This indicates that the disease is attributed to
the lower jiao. Sweating during physical labor leads to cold and wetness inside the
clothes. Over a long period of time, the condition develops and manifests with cold
painbelowthewaist,andabdominalheavinessasifcarryingfivethousandcoins. Gn
JingLngZhTngisindicated.
Formula
flng 4liang Poria
Decoctallfouringredientsin5shengofwateruntil3shengremains.Divideand
takewarm,threetimesdaily.
Thelumbusshouldbegintofeelwarmimmediatelyafteringestion.
Interpretation
PatternAnalysis
Thistextdiscussesthepatternandtreatmentofkidneyfxitydisease.
Kidney fixity is characterized by cold-damp b lodged in the lumbar region.
Because in Chinese medicine,the waist houses the kidney, this disease is thus
termedkidney fixity.The disease often starts with excessive sweating occurring
duringphysicallaborthatsoakstheclothesandlumbarregion.Iftheclothesarenot
VolumeThree:Chapter8 Pulses,PatternsandTreatmentofVisceralWindandCold,AccumulationsandGatherings 417
removed and the back dried in a timely fashion, the prolonged contact allows cold-
damp pathogens to enter the lumbar area.Yang qi then becomes obstructed and
stagnated,manifestingasheavinessandlumbarcoldness.
Several descriptors, includingas if sitting in water ,resembles a water
condition,andasifcarryingfivethousandcoins,areusedtodescribethesensation
ofcoldnessandheavinessinthewaist.Atthisstage,thedisharmonyisisolatedinthe
lowerjio,soonlythechannelsandmusclesofthelumbarregionareaffected.There
isnointernaldamagetothevisceraandthusnoabnormalsignsofthirst,appetite,or
urination appear.Therefore there is no need to supplement the kidney directly and
treatments that dispel cold and dampness from the channels using awarming the
earthtocontrolwatermethodaresufcient.
FormulaAnalysis
GnJingLngZhTngusesalargedoseofgnjingcombinedwithgncoto
warmthemiddleanddissipatecold.Flngandbizhacttogethertofortifythespleen
andpromoteurination.Becausetheactionsofthemedicinalsinthisformulaaresowell
suitedtothispattern,theformulaisalsocalledtheKidneyFixityDecoction.
CaseReport
Male,age29.
Thepatientreportedsincehavingsurgeryforureteralcalculiin1958,hehadbeen
sufferingfromfrequentdistendingdiscomfortintherightlowerabdomen,radiatingas
sorenesstothelumbarregionwithafeelingofcoldnessandheavinessbelowthewaist.
Othersignsandsymptomsincluded:constipationandfrequent,yellowturbidurine,
absenceofthirst,poorappetite,anddifficultyinfallingasleep.Thepatientstonguehad
agreasythickwhitishcoatingandhispulsewasdeep,thready,andchoppy.
Urineanalysisshowedawhitishpositivepresenceofproteins(+++),erythrocytes
(+++)andepithelialcells(+).Thepatientwashospitalizedandreceivedantibiotics.
AChinesemedicineconsultationwasconductedonDecember14,1960.
Pattern differentiation: kidney fixity disease due to dampness damaging the
kidney.
Formula:GnJingLngZhTng.
pojing 6g RhizomaZingiberisPraeparatum
ynlng 9g Poria
dzhng 9g CortexEucommiae
Aftertakingonepackeachdayfor24consecutivedays,thepatientfeltmuchrelief
in the abdomen, lower back, and lower limbs, with no more distension or soreness.
His bowel movements had returned to normal, and the deep choppy pulse had
improved.Hewasgenerallymuchbetterinspirits.Hisfoodintakeandsleephadalso
improved.Urinalysisturnedouttobewithinnormalrange.
[Reference:ChenMing.CollectionofFamousDoctorsSuccessfulCasesofEssentialsfromtheGolden
Cabinet.Beijing:AcademyPress;1999.p.347.]
419
Chapter9
Phlegm-Rheum and Coughing
L n g G u Z h G n T n g ( Po r i a , C i n n a m o n Tw i g , A t r a c t y l o d e s
MacrocephalaandLicoriceDecoction)Pattern
Source Text
Line16

For phlegm-rheum below the heart manifesting with propping fullness in the
chestandrib-sideswithdizzyvision,LngGuZhGnTngisindicated.
Formula
flng 4liang Poria
Decocttheabovefouringredientsin6shengofwateruntil3shengremains.Take
warm,inthreeportions.Urinationistobeexpected.
Interpretation
PatternAnalysis
Thistextdiscussesthepatternsandtreatmentofphlegm-rheumbelowtheheart.
The areabelow the heart corresponds to the epigastrium and stomach region.
Rheum accumulating in the stomach, chest, and flanks will obstruct qi movement.
This abnormal obstruction of qi prevents clear yang from ascending and turbid yin
from descending, leading to dizziness and distention in the flanks.This phlegm-
rheumpatternisalsooftenrelatedtospleenandstomachyangdefciency.
FormulaAnalysis
LngGuZhGnTngisusedtowarmyang,eliminaterheum,fortifythespleen,
anddisinhibiturination.
Intheformula,blandflngactstoeliminateexcessfluidaccumulationbypromoting
urination,whilepungentandwarmguzhhelpstofreeyang.Thecombinationofthese
twoherbsfunctionstowarmyangandresolverheum.Bizhcanfortifythespleenand
drydampnesswhilegncoharmonizesthemiddleandboostsqi.Whencombined,these
medicinalsacttoconstrainwaterbyfortifyingearth.
MainIndications
Lng Gu Zh GnTng can be used for a variety of problems in the clinic.The
underlying pattern is spleen yang deficiency and accumulation of phlegm-rheum
manifesting with dizziness, palpitations, shortness of breath, cough, panting, clear
foamy expectoration, marked uncomfortable distension in the chest and costal or
epigastric regions, and nausea or a localized cold sensation (about the size of ones
hand)ontheback.
CaseReport
Fivedayspriortothevisit,thepatientsaidhesuddenlydevelopeddizzinessand
vertigo,whichworsenedwithmovementandwasaccompaniedbynausea,vomiting,
and tinnitus.The patient was overweight, also presenting with a pale complexion, a
paleredtonguewithagreasywhitishcoating,andadeepthreadypulse.
His blood pressure was 115/70 mmHg. A routine blood test, cervical X-ray and
cranial C T all showed no signs of abnormality. He was diagnosed by Western
medicinephysiciansashavingMenieresdisease.
Patterndifferentiation:phlegm-rheumcollectinginthebrainleadingtoafailureof
clearyangtodifuseproperly.
Treatmentprinciples:warmyang,resolvephlegm-rheum,promoteurination,and
opentheorifces.
Formula:modifedLngGuZhGnTng.
flng 20g Poria

jingbnxi 10g RhizomaPinelliae(preparedwithginger)
tinm 10g RhizomaGastrodiae
One pack of the formula was taken twice daily. After three packs, the patients
dizzinesswasrelievedandthevomitingceased.Anotherfourpackswereadministered.
VolumeThree:Chapter9 Pulses,PatternsandTreatmentofPhlegm-RheumandCoughing 421
Aone-yearfollow-upwasconducted,andnorelapsewasreported.
[Reference: Kong Hong-bing. Successful Case Reports of Ma Jun Using Lng Gu Zh GnTng
.JournalofClinicalTraditionalChineseMedicine.2005;17(3):208-209.]
G n Su Bn XiTng (Gansui Root and Pinellia Rhizome Decoction)
Pattern
Source Text
Line18

When a patient presents with a hidden pulse, spontaneous diarrhea, an atypical

sense of relief after diarrhea yet with continual hardening and fullness below the
heart,thisisattributedtolodgedrheumvergingonresolution.GnSuBnXiTng
isindicated.
Formula
gnsu 3pcs(large) RadixKansui

bnxi 12pcs RhizomaPinelliae
shoyo 5pcs RadixPaeoniae
gnco 1pc(fnger-sized) RadixetRhizomaGlycyrrhizae
Decoctallfouringredientsin2shengofwateruntil1/2shengremains;discardthe
dregs.Decoctagainwith1/2shenghoneyuntil8geremains.Takeasonesingledose.
Interpretation
PatternAnalysis
This text discusses the patterns and treatment of lodged rheum.When rheum
accumulates and lodges inside the body, yang qi becomes blocked and manifests
with a hidden pulse. If spontaneous diarrhea appears without purgative treatment
and temporary relief is felt following defecation, this indicates that the lodged
rheum is being passed and eliminated along with the stools. Even so, the internal
rheum accumulation is only partially resolved and continues to collect as it is only
partially resolved.This is indicated by the presence ofhardening and fullness below
theheart.
This pattern is characterized by a type of excess lodging of rheum.With healthy
qiunharmed,thebodyisabletoeliminatethepathogenthroughdefecation.Because
healthyqiisnotdeficient,andthelodgedrheumalreadyshowsatendencytomove,
treatmentmustutilizeanattacking,purgative,andexpellingformulatoeliminatethe
rheum.GnSuBnXiTngisthusselected.
FormulaAnalysis
Intheformula,gn suacts to expelwater-rheum, andbn xidisperses binding
andresolvesphlegm.
Thecombinationofthesweetandsourpropertiesofshoyo,gnco,andhoney
functiontomoderateandastringe,andtherebyharmonizethemiddlejiao.
Althoughaccordingtotherecognized18herbantagonismsgncoantagonizes
gnsu,itcaninthiscaseeliminaterheumwhenusedincombination.
MainIndications
CM:rheumorphlegm-damplodginginthegastrointestinaltractorthechestwith
evidentuprightqiremainingreasonablystrong.Manifestationsincludespontaneous
diarrhea, glomus often accompanied by pain, local fluid accumulation, inhibited
urination,athickgreasytonguecoating,andadeepwiryandforcefulpulse.
WM:Thispatternmaybeevidentinvariousseriousanddifficulttotreatdiseases
includingpersistentdiarrhea,coughing,wheezing,amenorrhea,gastralgia,ascitesin
liver cirrhosis, pulmonary heart diseases, pericardial effusion, kidney hydrocele, and
uremicedema.
CaseReport
The patient reported that in May 1968, she used a home remedy [mixing 4
liang (200 g) each of brown sugar, honey and lard, taken warm) to treatinsufficient
lactationfollowinglabor.Uponfinishingtwo-thirdsoftheremedy,shebegantohave
diarrheawhichwaslaterdiagnosedasdiarrheanervosa.Varioustreatmentshadbeen
tried with no significant effect. She described her symptoms as diarrhea beginning
immediately after waking in the morning and reoccurring three to five times
throughouttheday.
Hercomplexionwaspale,herbodyemaciatedandslightlyedemic.Shecomplained
of pain in the epigastric region with a gurgling sound. She had no pain while
emptyingthebowels.Shealsosufferedfromfatigue,shortnessofbreath,drymouth
with no desire to drink, nausea without vomiting, and spontaneous sweating in the
upper part of the body, especially on the head. Her pulse was deep and hidden. On
the right side, it was so thready and faint that it was sometimes impalpable. On the
left,therewasasubtlepresenceofthreadinessandslipperiness.Hertonguecoating
waswhiteandglossy.
Initially,herpatternwasmisdiagnosedaschronicdiarrhealeadingtoyindesertion
and eventual yang damage. A modification of Li Jn Z Tng (Six Gentlemen
Decoction) was prescribed with an increased dosage of rn shn (Radix et Rhizoma
Ginseng) to strengthen the middle. However, the patients condition worsened after
the initial treatment. On her second visit, she presented with increased fullness and
pain in the epigastric region with discomfort upon palpation and frequent diarrhea
(asoftenastentimesaday).Herintoleranceofthemedicine,togetherwithherother
signsandsymptoms(mouthdrynesswithnodesiretodrinkandthepulsedescribed
above),identifedarheumpattern.
Thepotentpurgingformula,GnSuBnXiTngwasthenprescribed:
gnsu 3.5g RadixKansui
fngm 150g Mel
Gn Co, bn xi and sho yo are cooked first with water until 100 ml of the
decoction remains. Honey and gn su in powder form are then added into the
decoctionwhichisthensimmeredoverlowheat.
Thedecoctionwastakeninonedoseonanemptystomach.Onthethirdvisit,the
patientreportedthatshortlyaftertakingthemedicine,theabdominalpainlessened
considerablyandthegurglingsoundbelowtheheartincreasedsignificantly.Abouttwo
hoursaftertreatmentshestartedevacuatingwatery,purulentstools.Sheexperienced
seven or eight of these evacuations. Her symptoms were so much relieved after the
evacuationsthatshenolongercomplainedofanydiarrheaorotherdiscomfort.Herbal
medicinetreatmentwascontinuedforanothermonthtohelpherrecoverfully.
[Reference:Yi Cheng-huan. Successful Case Reports ofTreating Chronic Diarrhea, Acute Filthy-
Attack Disease, and Mania Due to Blood Stasis . Shanghai Journal of
TraditionalChineseMedicine.1980;(3):17.]
X io Qng LngTng (Minor Green Dragon Decoction) Pattern
Source Text
Line35

Forcoughingwithcounterflowandproppedbreathingwithaninabilitytolieflat,
XioQngLngTngisindicated.Seetheformulaabove.
Interpretation
PatternAnalysis
This text discusses the treatment of a pattern of thoracic rheum.This pattern
occurs in patients that have rheum already present in the upper jiao either due
to a previous illness that was treated improperly, or due to lifestyle leading to a
constitutional imbalance. In this pattern, the rheum is activated by an invasion of
external cold. Coughing, dyspnea, and the inability to lie down are the cardinal
symptoms.XioQngLngTngisindicated.
FormulaAnalysis
Inthisformula,mhungtogetherwithguzhactstoinducesweatingtorelease
theexterioranddifusethelungtoeliminaterheum.
The warming medicinals x xn, gn jing and bn xi act to warm and dissolve
cold-rheum,downbearcounterfow,andcheckcoughing.
Sho yo and w wi z are sour and astringent and can balance the diffusing
effectsofthemedicinalsmentionedaboveinordertopreventexcessivediffusionand
warmingwhichcandamagelungqi.
Sweet zh gn co assists sour sho yo to generate yin-fluids, thus preventing
damagetobodyfuidsbythepungentandwarmmedicinals.
In combination, this formula combines pungent and warm medicinals to resolve
exteriorcoldandeliminaterheumwithsweetandsourherbstopreventharmtolung
qiandyin-fuids.
RefertotheTreatiseonColdDamagesectionofthisbook.
X io Bn Xi Ji F Lng Tng (Minor Pinellia Rhizome plus Poria

Decoction)Pattern
Source Text
Line30

Suddenretchingandvomitingwithglomusbelowtheheartindicateswaterinthe
diaphragm;withdizzinessandpalpitation,XioBnXiJiFLngTngisindicated.
Formula

shngjing 0.5jin RhizomaZingiberisRecens
flng 3liang Poria
Decoct all three ingredients in 7 sheng of water until 1 sheng and 5 ge remains.
Divideandtakewarmtwice.
Interpretation
PatternAnalysis
This passage addresses the pattern and treatment of vomiting due to thoracic
rheum manifesting with glomus, dizziness, and palpitations. Rheum collected in
the diaphragm often disturbs the functions of the heart and stomach.When the
rheum invades the stomach, stomach qi fails to descend, and sudden vomiting
appears. Accumulated rheum can induce qi stagnation manifesting as glomus and
congestionbelowtheheart. Rheumattackingtheheartisexperiencedbythepatient
as palpitations. All of these symptoms arise from water collected in the diaphragm.
Vomitingisusuallythechiefcomplaint.XioBnXiJiFLngTngisindicated.
FormulaAnalysis
Bnxiis used to resolve phlegm,directcounterflow qi downward, and disperse
stagnated qi in the middle jiao. F lng fortifies the spleen and promotes urination,
allowingfortheeliminationofpathogenicturbidyin.
With shng jing, the three medicinals combine to dispel cold and regulate qi
movement, thus relieving the symptoms seen here.Together they act to eliminate
rheum,harmonizethemiddlejiao,settletheheart,andcalmthemind.
MainIndications
WM: pernicious vomiting during pregnancy, uremia in nephritis, acute/chronic
gastritis,cardiacspasm,intestinalobstructionduetopyloricinsufficiency,malignant
tumorduringchemotherapy/radiotherapy,vomitingduetomotionsickness,dizziness
or distending headache caused by vestibular neuritis, labyrinthitis or hypertension,
andpalpitation caused byviral myocarditis,heart failure inpulmonary heart disease
withthecorrespondingunderlyingpattern.
CaseReport
The patient was admitted to the hospital after vomiting more than ten times in
two days.The vomitus was clear and watery. He also complained of discomfort in
theupperabdomen,coldnessontheback,dizziness,andablandtasteinthemouth
withoutdesirefordrink.Hehadnofever,headache,ordiarrhea.Thesesymptomshad
occurredaroundthesametimeforthetwoyearspriortopresentation,andaweekof
intravenoustreatmentwouldrelievethecondition.Physicalexaminationshowedthe
patientwasconsciousbutlethargicwithapalecomplexion,apaletonguewithawhite
moistcoating, slight abdominaldistention without tendernessonpalpation,audible
borborygmus,andadeeppulsewithnocardiovascular,pulmonaryornervoussystem
abnormalities.Thepatternidentifedwasvomitingduetophlegm-rheum.
Theprescriptionwasasfollows:

flng 15g Poria
Thepatientwasaskedtotakesmalldosesofthedecoctionfrequently.
After taking the first dose, the patient vomited immediately. He was advised to
continue, and vomiting stopped after the first pack was finished.Two more packs
were administered to reinforce the effects. A year later, the patient presented with
thesamecondition,andthreepacksofthesameformulawereprescribedtostopthe
symptomscompletely.
[Reference:Liu Chun-lian.Treating RecurrentVomitingwithXioBnXiJiFLngTng
.GuangmingJournalofChineseMedicine.2006;21(8):44-45.]
427
Chapter10
Wasting-Thirst, Inhibited Urination,
and Strangury
ShnQWn(KidneyQiPill)Pattern
Source Text
Line3

Formenwithxiokyetwithprofuseurinationwhodrinkonedouofwaterand
urinateonedou,ShnQWnisindicated.
shnyo 4liang RhizomaDioscoreae
shnzhy 4liang FructusCorni
zxi 3liang RhizomaAlismatis
mdnp 3liang CortexMoutan
flng 3liang Poria
fz 1liang RadixAconitiLateralisPraeparata
Grind the eight ingredients, knead with honey, and make into pills the size of
firmiana seeds. Begin treatment by taking 15 pills with rice wine, working up to as
manyas25pillstakentwotimesperday.
Interpretation
PatternAnalysis
This text discusses the pattern and treatment of lower jiao wasting-thirst due to
kidneydeficiency,particularlyinmen.Thekidneyistheorganofbothtruewaterand
true fire.Therefore, kidney yin deficiency, kidney yang deficiency or a simultaneous
deficiencyinbothcouldleadtothispattern.Thispassagefocuseson lowerjiaowasting-
thirst associated withkidney yang deficiency.Kidney qi is theroot qi for men, and
overindulgenceinsexoralcoholconsumptioncaneasilyleadtokidneyqideficiency.
For this reason, the text specifically describes men withxio k. However, it is also
certainlypossibletoseekidneyyangdefciencyinwomenresultinginwaisting-thirst.
Kidney deficiency with extreme debilitation of yang qi compromises the ability
ofthisviscustotransformqi.Thisresultsinbothafailuretomoistenabove,because
the kidney is unable to carry body fluids upward, and a state in which the amount
ofevacuatedurine is equal to the amountof fluid taken in. Because the fluids taken
in are large in quantity and because the kidney fails to contain water, the text thus
says,drinkonedouofwaterandurinateonedouTogether,persistentthirstand
urinationarethecardinalsignsofwaisting-thirstandkidneyyangdeficiencypattern.
ShnQWnisthesuggestedtreatment.
FormulaAnalysis
Inthisformula,gndhung,shnyo,andshnzhyareusedtonourishkidney
yininordertosavekidneyyangandtransformkidneyqi.
Zxiandflngarebothblandinfavor,actingtodraindampness.
Mdnpclearsdefciencyheatbysimultaneouslysupplementinganddraining.
Thiscombinationensuresthattheformulasupplementswithoutbeingcloying.
Small amounts of gu zh and f z are used to invigorate yang qi in order to
promote fire which, in turn, encourages qi generation.This is calledmild heat
engenderingqi.
Taken with warming rice liquor, the medicinals in this formula act to warm and
invigoratekidney yang while supplementing kidney deficiency.This is accomplished
through the nourishment of kidney yin which, in turn, restores the transforming
functionofkidneyqiandrelieveslowerjiaowaisting-thirst.
MainIndications
CM:kidneyqiandyangdefciencypatternsincludinglowerjiaowaisting-thirst.
WM: diabetes mellitus and diabetes insipidus with the corresponding underlying
pattern.
CaseReport
Thepatientreportedamorethan10-yearhistoryofdiabetesmellitus.Shehadbeen
taking Xio KWn (Wasting-Thirst Pill, ) and JingTng Sh (Hypoglycemic
Pill, ), but her fasting blood sugar level remained around 10.2 mmol/L. Her
glucosuriatestwasalsopositive(++++++).
Upon presentation, signs and symptoms included frequent thirst and hunger,
frequent urination at night, emaciation, fatigue, and pallor. She reported weakness
andsorenessinthewaistandknees,lackofwarmthinthefourextremitiesandslight
edemainthelowerextremities.Shehadapaletonguewithadrywhitecoating,anda
VolumeThree:Chapter10 Pulses,Patterns,andTreatmentofWasting-Thirst,InhibitedUrination,andStrangury 429
deepfneandweakpulse.
Thetreatmentmethodincludedsupplementingthe kidneyandsupportingyang,
boostingqiandnourishingyin.
Modified Jn Gu Shn QWn (Golden Cabinets Kidney Qi Pill,) was
prescribed:
rugu 4g CortexCinnamomi(infused)
dnp 10g CortexMoutan
flng 15g Poria
shnyo 12g RhizomaDioscoreae
Aftertakingthreepacksoftheformula,thepatientexperiencedlessurinationat
nightanddecreaseddrynessinthemouth.Herfastingbloodsugarleveldroppedto8.4
mmol/Landherglucosuriadecreased(++).Ruguwasincreasedto6g.
Hertreatment wascontinued with an additional15packsand diet management.
Hersymptomsofthirstandhungerimprovedandtheedemainherlowerextremities
wasresolved.
The same treatment was administered for another month with follow-up testing
showingfastingbloodsugarlevelsat5.2mmol/L,andglucoseurinetestsproducing
negativeresults. Chinese medicinal treatment was discontinued and the patient was
instructedtofollowadiabetes-sensitivediet.Atwo-yearfollow-upfoundnorelapsewith
bloodsugarlevelswithinthenormalrangeandglucosuriastabilizedbetween0and+.
[Reference:GuoZhi-lin.ClinicalApplicationof JnGuShnQWn.Fujian
G
u Lu Q MiWn ( Trichosanthes and Dianthus Pill) Pattern
Source Text
Line10

Inhibitedurinationindicateswater-qi;thepersonalsosuffersfromthirst. GuLu
QMiWnisindicated.
Formula
gulugn 2liang RadixTrichosanthis

flng 3liang Poria
shy 3liang RhizomaDioscoreae
fz 1pc RadixAconitiLateralisPraeparata
qmi 1liang HerbaDianthi
Grind the ingredients,kneadwithhoney, and make into pills the size of firmiana
seeds.Take3pills,threetimesdaily.
Increaseto7or8pillsifnoeffectsareobserved.Continueuntilsmoothurination
andabdominalwarmthappears.
Interpretation
PatternAnalysis
Thistextdiscussesthepatternandtreatmentof inhibitedurinationdueto upper
jiaodrynessandlowerjiaocoldness.Thekidneygovernswaterandqitransformation.
If kidney qi fails to transform water, urination will be inhibited and this leads to
water rheum.When qi is unable to transform water, fluids fail to bear upward, dry
heatdevelops,andthepatientexperiencesextremethirst.Anappropriatetreatment
method aims to transform qi to promote urination, moisten dryness, and generate
fuidstoalleviatethirst.GuLuQMiWncanbeused.
FormulaAnalysis
Intheformula,guluandshypromotefluidsandmoistendrynesstoquench
thirst.Qmiandflngareblandinflavorandcanpercolate,bindwith,andmove
water,therebypromotingurination.Processedfzisusedtowarmyangandtransformqi
sothatmoisteningbodyfuidscanascendandwaterqicanbeevacuateddownandout.
The passage states,Continue until smooth urination and abdominal warmth
appears.This implies that the patients signs and symptoms include either feeling
cold in the lower abdomen, edema below the waist, or both.These are common
manifestationsof lowerjiaoyang deficiency with water-rheum.The text also implies
that specific changes in these symptoms are, along with increased urine output, the
signsofareturntonormalqitransformation,unimpeded yangqiflow,eliminationof
cold,andmovementofwater.
MainIndications
CM:xiokwithcorrespondingunderlyingpattern.
VolumeThree:Chapter10 Pulses,Patterns,andTreatmentofWasting-Thirst,InhibitedUrination,andStrangury 431
CaseReport
Female,age36.Initialconsultation:December20,1994.
After half a month of suffering from thirst with profuse drinking and urination,
thepatientwasadmittedtoalocalmunicipalhospitalforaweek.Alllaboratorytests
failedtoshowanyabnormalityandshewasdiagnosedwithpsychologicalthirst.She
tookoryzanolandvitaminB1withlittleeffectandhadthusbeenreferredtoChinese
medicinehospital.
Atthetimeofhervisit,shecomplainedofthirstwithprofusedrinking(approximately
fourthermosesoverthecourseof24hours)andincreasedclearurine(approximately
twopots).Shealsoreportedsorenessinthelowerbackandcoldnessintheknees.Her
appetitewaspoor.Shehadapaleredtonguewithasparsethinyellowcoating,anda
deepfnepulse.
Basedonfourexaminations,shewasdiagnosedwith xiokwithlowercoldness
and upper dryness due to kidney yang deficiency. Kidney yang deficiency and
coldness fail to warm and transform water to carry fluids upward, which leads to
dryness and heat in the upper jiao.The patient suffered from thirst, yet could not
restrainherfuidintake.Thisresultedinexcessiveclearurine.
GuLuQMiWnwasmodifiedandadministeredasadecoctiontowarmthe
lowerandmoistentheupperjiao:
gulugn 30g RadixTrichosanthis

qmi 15g HerbaDianthi
huishnyo 20g RhizomaDioscoreae
Radix Aconiti Lateralis Praeparata (decocted separately for
zhfz 10g
halfanhourfrst)
flng 20g Poria
Aftertakingfivepacks,thepatientsthirstwasmuchrelieved.Shewasabletohalve
both her fluid intake and her urine output. Her appetite returned to normal.These
changesweresignsofkidneyyanginvigorationwithnormalqitransformation.Another
fivepacksclearedawaythesymptomsofthirstandexcessiveurination.Furtherintake
of five packs eliminated the symptoms of soreness in the waist and coldness in the
knees.Thediseasewascuredwithnoreportofrelapseinthefollowingyear.
[Reference:LiKun.SuccessfulCaseReportsofGuLuQMiWnintheTreatmentofWasting-
Thirst.JournalofSichuanTraditionalMedicine.1996;14(11):39.]
432
Chapter11
Pulses, Patterns and Treatment of Water
Qi Diseases
Fng J Hung QTng (Stephania Root and Astragalus Decoction)

Pattern
Source Text
Line22

Forwindwatermanifestingwithfloatingpulses,generalizedheaviness,sweating,
andaversiontowind,FngJHungQTngisindicated.
Withabdominalpain,addshoyo.
Formula
fngj 1liang RadixStephaniaeTetrandrae
chognco 5liang RadixetRhizomaGlycyrrhizae(dry-fried)
bizh 7.5qian RhizomaAtractylodisMacrocephalae
() hungq(qyl) 1liang1fen RadixAstragali(extrastemsremoved)
Shred the ingredients until bean-sized, take 5 qian-spoons as one dose. Decoct
with4slicesofshngjingandonepieceofdzoin1.5cupswateruntil8fenremains.
Discardthedregs,servewarm,andrepeatlater.
Withpanting,addmhung1/2liang.
Withstomachdisharmonyaddbisho3fen.
Withqisurgingupward,addguzh3fen.
Withchroniccoldofthelowerbody,addxxn3fen.
After drinking the decoction, the patient should feel as if insects are moving
withinhisskin,andwithanicycoldsensationfromthewaistdown.Heshouldsiton
a blanket and wrap himself with another blanket below the waist, keeping himself
justwarmenoughtoinducemildsweating;thiswillbringrecovery.
Interpretation
PatternAnalysis
ThisLinediscussesthetreatmentofwind-watercombinedwithexteriordeficiency
VolumeThree:Chapter11 Pulses,PatternsandTreatmentofWaterQiDiseases 433
usingFngJHungQTng.Thelungandspleenaretheprimaryorgansimplicated
in this pattern. Both have underlying qi deficiencies. Lung qi deficiency leads to wei
qideficiency,leavingthefleshyexteriorsusceptibletoinvasionbypathogenicwind.
Once invaded, the lung is unable to perform its diffusing and descending functions
and,because the bodys ability to regulate waterways is compromised, fluids cannot
beproperlydistributedthroughoutthebody.Atthesametime,withqideficiency,the
spleen cannot control water and loses its ability to transport fluids.The dysfunction
of the two viscera leads to stagnation and internal accumulation of fluids, flooding
thespacebetweentheskin,flesh,channels,andcollaterals.Thissubcutaneouswater
accumulationiswind-water.Thispatternfallsintothecategoryofpatternscombining
bothrootdefciencyandbranchexcess.
Thechiefsignsofwind-wateraresweating,aversiontowind,afeelingofheaviness,
andafloatingpulse.Sweating,aversiontowind,andinsecurityoftheintersticesare
manifestationsoftheinvasionofaninsecureexteriorbypathogenicwind.Edemaand
a feeling of heaviness are signs of disharmony between the channels and collaterals
due to water stagnation in the muscles and interstitial spaces. A floating pulse
indicateswindinvadingtheexterior.
A wind- damp exterior pattern should be treated by promoting sweating.
However, intense diaphoresis will lead to further weakening of the exterior, which
in turn increases susceptibility to wind invasion.While this condition does call for
consolidating the exterior, this action alone neither dispels pathogenic wind nor
eliminates dampness.Therefore, in accordance with the principle ofsupplementing
uprightqiandeliminatingpathogenstosimultaneouslyaddressthedeficientrootand
excess branch, a multi-prong approach is called for and should aim to consolidate
theexteriorbyboostingqiandtopromotethefowoffuidsbydispellingwind.
FormulaAnalysis
Fng j is bitter and acrid in flavor and cold in nature. It enters the lung, spleen,
and bladder channels. Its bitter flavor and cold nature can descend and discharge,
promoting urination to expel dampness. Its acrid flavor helps dispel wind from the
exterior.
Hungqissweetandwarm.Itentersthelungandspleenchannels.Itsascending
and diffusing properties can boost qi to raise yang, consolidate the exterior to stop
sweating and promote urination to relieve dampness. In particular, it is best to use
shng hung q (raw), one of the most important medicinals for treating exterior
deficiency-typeedema.Itsefficiencycomesfromtheqi-boostingactionsmostevident
inthefleshyexterior.Incombinationwith fngj,themedicinalssimultaneouslyboost
qi,promoteurination,andexpelwind.
Bi zh is bitter, sweet, and warm. It enters the spleen and stomach channels.
Its sweet flavor and warm nature can supplement the spleen and its bitterness can
dry dampness, making it an essential medicinal for a deficient and damp spleen. Its
pairingwithhungqfurtherstrengthenstheconsolidationefectoftheweiqi.
Zh gn co and d zo are sweet and warm.They supplement the spleen and
harmonize the stomach and ying qi, providing a general qi boost.While hung q,
bizh,gncoanddzoallfortifythespleentoboostqi,theyalsosupportthelung
throughthegenerative cycle of the five phases. In Chinese, this is calledcultivating
earthtogeneratemetal.
Finally,acridandmildlywarming shngjingcandissipatecoldandassist fngj
inexpellingwind.Itcanalsodispersedampnesstohelp fngjandhungqpromote
urination.
All together, the six medicinals can boost lung and spleen qi, consolidate the
exterior, and dispel dampness.This formula is thus indicated for wind water or wind
dampnessinwhichthereisarootdefciencywithexcessmanifestation.
Note:Thesourceofthispassageisgenerallybelievednottobepartoftheoriginal
EssentialsfromtheGoldenCabinetbecauseitdoesnotreadlikeatypicalHanDynasty
text, especially in its use of qian, given that measurement was not used during the
HanDynasty.WhatiswidelyconsideredtobetheoriginalformulaisfoundinSunSi-
miaosImportantFormulasWorthaThousandGoldPieces(seeendnote1ofthischapter).
The formula is included in this book because it was included in the Song Dynasty
versionoftheEssentialsfromtheGoldenCabinetuponwhichthistextbookisbased.
MainIndications
CM:edema,profusesweating,andskindiseasewithapatternofqidefciency.
WM: edema, arthritis, acute or chronic nephritis, and skin disease with the
CaseReport
Thepatientcomplainedofgeneralizedheavinessandfatigue.Shereportedhaving
had pain and swelling in the knees as well as edema in her legs for the past month.
This elderly, female patient was overweight (72 kg), exhibited flaccid muscles, and
skin moist to the touch due to light perspiration. She had a puffy face and thinning
hair. She said she sweated easily and was often thirsty despite having no desire to
drink. Her sleep was disturbed by bouts ofgastric reflux andacid regurgitation with
a sour sensation in her esophagus. She had to use several pillows and lie in semi-
reclining position to feel at ease.There was a dull pain on her right flank near the
gallbladderregion.Thepainabatedafterdefecation.Anultrasoundofthegallbladder
revealedthepresenceofstonesofamuddypigment.Bothofherlegswereswollen,
hertonguewaspalewithawhitecoatingandshehadafoatingpulse.
Patterndifferentiation:spleenandlungqideficiencywithdampnessstagnatingin
themuscles,interstitialspaces,andjoints.
Treatment principles: supplement the lung and spleen qi, warm wei yang and
dispeldampness.
Formula:modifedFngJHungQTng.

hnfngj 15g RadixStephaniaeTetrandrae
flng 15g Poria
Thepatient was asked to take the formula above twice a day for seven days. She
was instructed to cover herself with a blanket after taking the decoction in order to
warmherselfandinduceamildsweat.Duringtheday,shetookherbalteamadeofjn
qinco(HerbaLysimachiae)50gtoaidgallbladderfunction.
OnJuly27,thepatientcameforasecondvisit.Afterthefirstthreedaysoftaking
theformula,shereportedmoderaterelieffromthepainandtheswellinginherknees,
asubsidingofhergastricreflux,andtwokilogramsofweightloss.Afteranotherfour
days,thegastricrefluxdisappeared.Theremainingsymptomswerealackofappetite,
abdominal distention worsened by fluid intake,profuse sweating, aversion to wind
and newly-occurring canker sores. Her tongue body was light red with a slightly
greasycoating,andshehadafoatingpulse.
Theformulawasmodifiedtoreinforcethewind-dispellingandheat-clearingeffects.
Thedoseofhungqwasincreasedto20g.10gofbothfngfng(RadixSaposhnikoviae)
andlinqio(FructusForsythiae)wereadded.
Thepatientwasaskedtotakethisformulaforanothersevendays.

flng 15g Poria
At the third visit on August 3, the canker sores were gone and the aversion to
windhadsignificantlydecreased.Onlysomeslightkneepainandmoderateedemaof
the legs remained. Following a five-day discontinuation of the medicine, the canker
sores reappeared.The patients tongue was red with a white coating and her pulse
waswiry.
Amodifiedformulaadding10gofhungqn(RadixScutellariae)and10gofshn
zh(FructusGardeniae)wasadministeredforanother14days.

flng 15g Poria
shnzh 10g FructusGardeniae
Afterthisseriesoftreatments,thepatientsconditionimprovedandthetreatment
wasdiscontinuedalthoughthepatientdidexperienceoccasionalrelapses.Whenever
she did, a modified Fng J Hung QTng was used and desirable results were
obtained.
[Reference:ChengQian.AcasestudyofFngJHungQTng1.Guangming
JournalofChineseMedicine.2008;12(23):2008.]
YuBTng(MaidservantfromYueDecoction)Pattern

Source Text
Line23

For wind water manifesting with aversion to wind, generalized swelling, floating
pulses, an absence of thirst, intermittent spontaneous sweating, and an absence of
greatheat,YuBTngisindicated.
TextNote
Floatingpulses,anabsenceofthirst:PersonalStandardsfortheEssentialsfromthe
GoldenCabinetstates,foatingpulsesandthirst.
Formula
shgo 0.5jin GypsumFibrosum
Decoctthemhungin6shengofwater.Skimthefoam,addtheotheringredients,
anddecoctuntil3shengremains.Takewarminthreeportions.
Foraversiontowind,addapieceofblast-friedfz.
Forwindwater,addbizh(RhizomaAtractylodisMacrocephalae)4liang.(Ancient
andModernRecordsofProvenFormulas,GJnLYnFng,)
Interpretation
PatternAnalysis
Thistextdiscussesthepatternandtreatmentof wind-watercombinedwithheat.
The interaction of the different pathogenic factors is complex and must be inferred
fromtheoriginaltext.
The phrasewind-water manifesting with aversion to wind indicates that the
natureofthe disease is acuteand powerful, andthatpathogenic wind is the culprit.
Generalizedswellingsuggeststhatweiqiisobstructedbywindwhichleadstowater-
dampness stagnating in the fleshy exterior. An additional attack ofpathogenic wind
induces the water in the exterior to flood interstitial spaces and spread throughout
thebodyasgeneralized swelling.The obstructedwei yang also gives rise to internal
constrainedheat.
Spontaneous sweating can be interpreted as either constant or intermittent
spontaneous sweatingboth of which are clinically significant.This sweating is
a manifestation of the struggle between wind and constrained heat.The struggle
forces body fluids to be expelled through sweating. From this analysis, we can see
that this kind of spontaneous sweating is much different from sweating due to wei
qi deficiency with an insecure exterior. Because sweating helps release some of the
internallyconstrainedheat,thesepatientspresentwithoutahighfever.
Tosummarizethepathodynamic:failuretoproperlydiffuseanddisperseexterior
windandwaterleadstoconstrainedweiyangwhichtransformsintopathogenicheat.
Yu BTng, which simultaneously dispels exterior dampness and clears constrained
heat,isindicatedforthispattern.
FormulaAnalysis
In this formula, m hung and shng jing combine to dispel dampness and
eliminate edema.When mhungiscombinedwithasmallerdosageof shgo,m
hung can clear the constrained heat in the lung and stomach to eliminate thirst as
wellastoresolvedampness.
Gncoharmonizesthemiddlejiaoandthepropertiesofallmedicinals(hotand
cold,moderateandstrong)tobalancetheactionsoftheformula.
D zo supplements the spleen with its sweet flavor. Its warm property prevents
coldnaturedshgofromdamagingthestomach.
For patients with more serious dampness, bi zh can be added to reinforce
the edema-eliminating effects of the formula. Bi zh also fortifies the spleen, thus
addressingtherootspleendefciencycondition.
Asaresultofweiexteriorinsecuritywithyangdeficiency,severeaversiontowindcan
beseeninpatientswithprofusesweating.Thistendstoresultinfurtherdamagetoyang
qi.Inthiscase,fzcanbeaddedtowarmthechannels,restoreyang,andstopsweating.
MainIndications
CM:puffyface,edemaintheextremities,fever,aversiontocold,aredtonguebody,
afoatingpulse.
WM:early-stageacuteglomerulonephritis,asthma,chronicbronchitis,emphysema,
andrenaledemaduringpregnancywiththecorrespondingunderlyingpattern.
CaseReport
Male,age12.Initialconsultation:June3,1992.
Two weeks prior to the consultation, the patient came down with tonsillitis with
ahighfeverandsorethroat.Thesymptomswererelievedbymedicaltreatment.1On
the day prior to presentation, his face became puffy and swollen.The swelling was
especiallysevereinthemorning.Thepreviousnight,hehaddeveloped edemainhis
feet,andhisurinewasscantyandbrown.
Urinelabtestresults:
RBC WBC(HPF)* proteinuria

throughoutvisualfeld 10-20 ++
*higherpowermagnifcationfeld
At the time of the visit, his signs and symptoms included: a puffy face, dysuria,
heaviness, fatigue, a red tongue with a thin white coating, and a floating slippery
rapidpulse.
This pathogenic wateroverflow pattern was identified as wind-heat invading
the lung.This rendered the lung incapable of governing descent, regulating the
1 The type of medical treatment is not mentioned in the article. Most likely it was intravenous antibiotic
treatment.
waterways and diffusing wei qi and water.The hematuria was a sign that heat had
damagedtheyincollateralsforcingbloodtoleakintotheurine.
The treatment method aimed to diffuse the lung to disperse dampness, clear
heattoeliminatetoxins,coolthebloodtostanchbleeding,andpromoteurinationto
removeedema.
The formula used was a modifiedYu BTng(Maidservant FromYue Decoction)
combined with MHungLinQio Ch Xio DuTng (Ephedra,Weeping Forsythia
Capsule and Adzuki Bean Decoction) and S Lng Sn (Four-Substance Powder with
Poria).Thepatientwasaskedtotakethedecoctiontwiceperday.

chxiodu 15g SemenPhaseoli
flng 30g Poria
jngjisu 12g SpicaSchizonepetae
xioj 30g HerbaCirsii
bimogn 30g RhizomaImperatae
cbitn 20g CacumenPlatycladiPraeparata
bihushshco 30g HerbaHedyotisDifusae
bijingco 15g HerbaPatriniae
OnJune8,thepatientcameforasecondvisit.Aftertakingtheaboveformulafor
fvedays,hisurinationincreasedandtheedemawassomewhatrelieved.
RBC(HPF) WBC(HPF) proteinuria

5-20 0-5 +
The formula was modified as follows: jng ji su was removed. 15 g of sng bi

p (Cortex Mori) and 20 g of jn yn hu (Flos Lonicerae Japonicae) were added.The
patientwasaskedtotakethemodifedformulaforsevendays.
AtthethirdvisitonJune16,theedemahadalmostdisappeared.
RBC(HPF) WBC(HPF) proteinuria
0-2 0 +
The formula was again modified. Bi jing co and bi hu sh sh co were

removed. 20 g of dn shn (Radix et Rhizoma Salviae Miltiorrhizae) were added.The
patienttookthismodifedformulaforsevendaysandallsymptomsimproved.
Duringaone-yearfollow-up,norelapsewasreported.
[Reference: DengYi, HanTao. Experience ofTreating Nephritis withYu BTng
.JournalofGansuCollegeofTraditionalChineseMedicine.2001;18(4):24-26.]
Fng J F LngTng (Stephania Root and Poria Decoction) Pattern

Source Text
Line24

Forskinwaterdiseasemanifestingwithswellingofthefourlimbs,andwater-qiin
theskincausingslighttwitchingofthefourlimbs,FngJFLngTngisindicated.
Formula
fngj 3liang RadixStephaniaeTetrandrae
flng 6liang Poria
Decoctallfiveingredientswith6 shengofwateruntil2shengremains.Takewarm
inthreeportions.
Interpretation
PatternAnalysis
This text discusses the treatment of skin water.The underlying pattern is spleen
yangdefciencyandafailureofyangqitodifuseproperlyintheexterior.
The spleen governs the four limbs and the lung governs the skin.Thus, the
locationoftheedema,undertheskinofthefourlimbs,indicatesthatboththespleen
and lung are involved. An excess water condition indicates a yang deficiency, which
manifestsinthecompromised spleenfunctionsoftransportingandtransformingand
theinabilityofweiqitodiffusewaterintheexterior.Thisleaveswaterstrandedunder
theskinandintheinterstitialspacesoftheextremities.Edemaensues.Thepresence
ofedemaconstrainsyangqiandthecontentionbetweentheuprightqiandpathogen
manifests asslight twitchinga feeble vibrating sensation or the sensation of
insectscreepingintheinterstitialtissuesintheextremities.
The appropriate treatment method for this pattern should fortify the spleen and
supplementlungqi.Thetreatmentmethodshouldunblockyangandtransformqito
draindampness.FngJFLngTngisthusindicatedforthispattern.
FormulaAnalysis
In this formula, fng j and hung q work together to expel water through the
exterior and thereby resolve edema. Gu zh and f lng work in tandem to unblock
yang,promotewatertransformationandremovewaterthroughurination.Thepairing
ofhungqwithguzh,promotesweiyangcirculationintheexteriortoresolvethe
slighttwitching.
Inadditiontoservingasaharmonizingmedicinal, gncocombineswith hung
q to fortify the spleen. Fortification improves the transporting and transformation
functionsofthespleenandrestrainskidneywaterfromoverflow.Earththusrestricts
waterwhichwouldotherwiseexacerbatetheedema.
MainIndications
CM:waterqidiseasesassociatedwithspleenyangdeficiencyandinsecurityof wei
qidifusionconstitutetheprincipalpattern.
WM:nephritis,chronicrenalinsufficiency,ascitesduetocirrhosis,uremia,arthritis,
nutritional edema, andpulmonary heart disease with cardiac insufficiency with the
CaseReport
Female,age35.
The patient was admitted to the hospital in 2003.Ten years prior she had been
diagnosed with rheumatic heart disease accompanied by chest oppression and
panting. When she arrived in the emergency room, she presented with cough,
distressed breathing, and generalized edema. She said she had been attacked by
cold. On the basis of electrocardiogram and chest x-ray results, she was diagnosed
with rheumatic heart disease complicated by third-stage heart failure. After she
was stabilized in the emergency room using conventionalWestern medicine, she
was referred to the Chinese Medicine Department for treatment of her apparently
worseningedema.
The clinical presentation included: dyspnea when lying down, general pitting
edemamostevidentinthelowerextremities,lossofappetite,abdominaldistention,
loose stools and scanty urination, a pale complexion and dark lips. She had an
enlarged and slightly purple tongue body with a white and greasy tongue coating.
Herpulsewasfoatingandthready.
Pattern differentiation: yang deficiency of the spleen and kidney, with water
overwhelmingandcounterfowingupwardtoattacktheheartandlung.
Treatmentprinciples:warmthekidneyandfortifythespleentopromoteurination
andqitransformation.
Formula: Fng J F Lng Tng modified with Zhn W Tng ( True Warrior
Decoction,).
fzpin 10g RadixAconitiLateralisPraeparata(sliced)
flngp 15g CutisPoriae
dnggup 15g ExocarpiumBenincasae
After three days, the patient experienced some relief. Her urination increased
significantly and the edema subsided. By the time she had taken another ten packs
of this formula, the edema had disappeared completely and the coughing and
palpitationsweregreatlyrelieved.
[Reference:WangWei-hong.CaseStudiesoftheClinicalApplicationof FngJFLngTng
.HenanTraditionalChineseMedicine.2005;25(7):47.]
Q Sho Gu JiTng (Astragalus,White Peony, Cinnamon andVinegar

Decoction)Pattern
Source Text
Line28

Question:Yellow sweat disease manifests with generalized swelling [another
version reads heaviness], heat effusion, and sweating with thirst; this condition
resembles wind water. Sweat soaks through the clothes with a full yellow color
resembling hung bi (Cortex Phellodendri Chinensis) juice, and the pulses are
sunken.Howdoesonedevelopthiscondition?
The master says:When sweating, if one takes a bath, water enters through the
pores;thisishowonecontractsthisdisease.QShoGuJiTngisindicated.
Formula

Decoctthethreeingredientswithoneshengofvinegarand7shengofwateruntil3
shengremains.Takewarminthreeportions.
Therewillbeheartvexation,butthisshouldresolveaftertakingthedecoctionfor
six or seven days. If the heart vexation persists, this is due to obstruction resulting
fromvinegar.
Interpretation
PatternAnalysis
Thistextdescribesindetailthepatternandtreatmentofyellowsweatdisease.
Thetextclearlydefinesthemainsignsandsymptomsasadeeppulseand sweat
soakingthrough the clothes with a full yellow color resembling hung bi juice.The
pathodynamic arises from the obstruction of ying and wei circulation by dampness
invading the skin and interstitial spaces. Wei yang is inhibited and, thus, dampness
andheatstruggleintheskinandinterstitialspaces.
The clinical presentations of yellow sweat disease (generalized edema, fever,
sweating, and thirst) resemble those of wind-water but can be differentiated in the
followingrespects:
SymptomorSign Wind-water YellowSweatDisease

cnkupulse foating deep
aversiontowind yes no
sweatcolor clear yellow(stainsclothes)
Thetreatmentmethodforthispatternconsolidatestheexterior,dispelsdampness,
clearsheatfromtheying,andharmonizesyingandwei.
FormulaAnalysis
QShoGuJiTngisamodifiedHungQGuZhWWTng(Astragalusand
CinnamonTwigFive-SubstanceDecoction)withshngjinganddzoremovedand
vinegaradded.
In this formula, hung q is combined with acrid and sweet gu zh to warm wei
yangandmovethestagnantwater-dampness.
Shoyoandvinegararesourinflavor,andtheirastringenteffectscontainyinto
stopsweating.
Equal amounts of gu zh and sho yo harmonize the ying and wei. These two
medicinalsalsoassistvinegarbyreinforcingtheactionofclearingconstrainedheatin
theying.
When dampness is eliminated, the flow of qi and blood are unimpeded, and the
yellowsweatconditionisresolved.
MainIndications
CM:yellowsweatdisease.
WM: acute icterichepatitiswithyellow sweat with the corresponding underlying
pattern.
CaseReport
Female,age48.Initialconsultation:June,1979.
The patient reported that in late autumn of the previous year, she had caught a
cold while swimming in a river after finishing farm work. She said since that time,
herskinhadtakenonayellowhueandshehaddeveloped pittingedemaalloverher
body.Shepresentedwithweaknessintheextremities,a coldsensationinthecalves,
sweatinglimited to the upper body which stained her underwear yellow, wandering
painnearthekidneys,vexation,alowfeverinlateafternoon,andinhibitedurine.She
hadathin,whitetonguecoatingandadeepandtightpulse.
Formula:QShoGuJiTng.

mc 1/2teacup vinegar
The instructions for preparation were as follows: cook the three medicinals with
halfacupofricevinegarandtwoteacupsofwater.Simmeruntilroughlyonecupof
liquid remains, then pour into a separate bowl while filtering out the dregs yielding
one cup of decoction. Cook the same medicinals again with two cups of water to
obtain another cup of decoction. Mix the two decoctions and divide the resulting
liquidintotwoequalportions.Drinkoneportiontwiceeachday:onceinthemorning
andonceintheevening.
After taking this formula for six days, the patients generalized edema subsided
signifcantly,herskincolorreturnedtonormal,andherappetiteimproved.
[Reference: Liu Jing-qi.TreatingYellow Sweat:Three Cases . Journal of Shandong

UniversityofTraditionalChineseMedicine.1980;(2):55.]
G
u Zh Q ShoYo Ji M Xn F ZTng (CinnamonTwig Decoction
removing Peony plus Ephedra, Asarum and Aconite Decoc tion)

Pattern
Source Text
Line31

Whenqileveldiseasemanifestswithhardnessbelowtheheartthesizeofaplate,
and with margins like an upside-down cup, this is a result of water-rheum. Gu Zh
QShoYoJiMHungXXnFZTngisindicated.
Formula
fz 1pc RadixAconitiLateralis
Decoctthemhungin7shengofwater,skimofthefoam.Addtheothermedicinals
anddecoctagainuntil2shengremains.Takewarminthreeportions.
The patient will sweat and also feel as if insects are crawling under his skin; this
indicatesrecovery.
Interpretation
PatternAnalysis
This text discusses the treatment of a yang qi deficiency pattern with cold
retained fluids stagnating at the qi level.When the termqi level is used to discuss
waterretentionpatterns,includingedema,itreferstoatypeoffluidstagnationthat
disturbsthebodysmovementofqi.Symptomatically,itischaracterizedbydistention
and fullness. In other words, any water retention pattern in which the principal
manifestationsarefullnessanddistentionarecalledqilevelwaterretentionpatterns.
The pathodynamic behind this can be explained as follows: when a qi level
retained fluid pattern occurs in the chest, it is a sign that ancestral qi is insufficient
andtooweaktocirculatetheqiofthebody.Thisresultsinpathogenstagnatinginthe
chest.Whencombinedwith heartyangqideficiency,coldyinwillaccumulateinside
the chest as retained fluid.The combination of stagnated qi,heart yang deficiency,
and cold retained fluids present as glomus.This pattern is usually accompanied by
symptomslikecoldnessandnumbnessintheextremities,deficiency-typeabdominal
fullness,andpersistentborborygmus.
In such cases, the strong cold expelling formula, Gu Zh Q ShoYo Ji M Xn
FZTng,thecombinationofGuZhQShoYoTng(CinnamonTwigDecoction
removing Peony) and M Hung F Z X XnTng (Ephedra, Aconite and Asarum
Decoction),canbeused.
FormulaAnalysis
Inthisformula,mhungpromotestheflowbetweenheartqiandlungqitoexpel
cold.
Guzhwarmsheartyangtopromotewatertransportation.
Shngjingdissipatesdampness.
Fzwarmsyangtofortifytheheart.
Xxnguidestheotherherbaleffectstotheheartchanneltodispelcoldandunblock
theorifces.
Zhgnco,pairedwithdzo,warmsthemiddle jiaotopromoteflowwiththe
upperandlowermiddlejiao.
Themedicinalsinthisformulaworktogethertoconnecttheinteriorandexterior,
promoteyangqitransportation,anddissipatecoldanddampness.
After taking this formula, patients should sweat moderately and feel as if there
areinsectscrawling on or under their skin. Not only is this is a sign that yang qi has
been reinforced and begun tocirculate throughout the body, also indicates that the
congealingcoldisdissipating,meaningrecoveryisnear.
MainIndications
CM:edemainthepatternofcongealingcoldduetoyangdefciency.
WM:edemaduetodecliningfunctionofinternalorganssuchas rheumaticheart
disease,pulmonaryheartdisease,andascitesduetocirrhosiswiththecorresponding
underlyingpattern.
CaseReport
Male,age62.
Thepatientwasobeseandpresentedwithayangdeficientconstitution.Afterarecent
periodofemotionaldepression,hedevelopedabdominaldistentionthatwashardwhen
palpated.Thepatientreportedadecreaseinthefrequencyandquantityofhisurination
andpresentedwithgeneralizededema.Hisleftpulsewasbigandwirywhiletheright
pulsewasdeepandwiry.Histonguecoatingwasyellow,thick,andgreasy.
Qi movement was obstructed leading to a failure to distribute fluids. Interior

stagnationwasexternallyexpressedasgeneralizededema.
Formula:GuZhQShoYoJiMXnFZTng.
mhung 1.5g HerbaEphedrae
dnfz 3g RadixAconitiLateralisPraeparata
Aftertakingtheaboveformulaforthreedays,theedemainthepatientsextremities
subsided. His abdominal distention was alleviated and his abdomen was no longer
harduponpalpation.Thepatientsfacewasstillpuffyandhiscomplexionsallow.Other
clinicalsignsincludedapoorappetite,adeepandwiryleftpulse,asoftrightpulse,and
ayellowgreasytonguecoating.Theformulawasmodifiedbyadding12gofddujun
(SemenSojaeGerminatum)and15gofdklu(RaphanussativusL.).
After taking the modified formula for five days, the patientsfacial puffiness and
abdominal bloating disappeared.The prescription was then changed to include the
Chinese patent medicines J Shng Shn QWn (Life-Saving Kidney Qi Pill) and Sn
MioWn(ThreeWonderfullyEffectivePill).Thepatientwasaskedtotake9gofeach
formulatwiceaday.
[Reference:Wei Chang-chun. Clinical Administration of Gu Zh Q ShoYo Ji M Xn F
ZTng . Journal of Zhejiang College ofTraditional Chinese
Medicine.1985;9(5):36-37.]
Z h ZhTng (Immature Bitter Orange and Atractylodes Macrocephala
Decoction)Pattern
Source Text
Line32

Hardnessbelowtheheartthesizeofaplatewithamarginresemblinganupside-
downplateresultsfromwater-rheum.ZhZhTngisindicated.
Formula

Decoctthetwoingredientsin5shengofwateruntil3shengremains,takewarmin
threeportions.
Softeningoftheabdomenindicatesdispersionoftherheumandhardness.
Interpretation
PatternAnalysis
Thislinediscussesanothertreatmentofqileveldisease.
The main symptoms here are qi and water stagnation in the epigastric and/or
other abdominal regions (hardness below the heart).This qi and water stagnation
isamanifestationofadeficiencyofboth spleenqiandspleenyang.Whenthespleen
is weak, its ability to transform, transport, and distribute water is compromised.
This can lead to qi stagnation, congealment of yin-cold and rheum. Invoking the
metaphoric description of a large plate and, in particular, the glomus having edges
like those of a plate, conveys that the problem is more diffuse, that qi stagnation is
prominent and that the rheum is milder and more transient than in theGu Zh Q
ShoYoJiMXnFZTngpattern.
FormulaAnalysis
Inthisformula,theratioofzhshtobizhis2:1.Thelargedoseofzhshaimsat
utilizingitsbitterfavoranddischargingpropertytomoveqiandeliminateglomus.
Bi zh is used to fortify the spleen and dry dampness in order to promote
urination.
Thiscombinationcandissolveqistagnation,eliminatehardness,fortifyspleenqi,
andeliminatewaterretention.
Inthiscontext,belowtheheartrefersnotonlytotheepigastricregion,butalso
totherestoftheabdomen.
MainIndications
CM: hardness and/or fullness below the heart caused by qi stagnation due to
spleendefciency.
WM:gastroptosisandindigestionwiththecorrespondingunderlyingpattern.
CaseReport
Eightmonthspriortopresentation,afteraneveningofexcessivealcoholconsumption,
the patient developed an intensely uncomfortable, protruding sensation of fullness.
Theaffectedareawasroughlythesizeofthepalmofhishandandwaslocatedinthe
centerofhischestaroundtheareaoftheheart.Atfirstheexperiencedthediscomfort
onlyaftermeals,andhewasabletoprovidesomerelieffromthefullnessbyreducing
his food intake by 20 to 30 percent. But as time went by, the sensation worsened
and became more frequent.The severity of the sensation increased to the extent
thatthepatientexperiencednoreliefevenafterreducinghisfoodintakeby50to60
percent.The patient remained uncomfortable no matter what position his body was
in,andhisappetite and sleep were suffering. Because the bloating sensation was so
uncomfortable he became afraid to eat anything and so, for more than ten days, he
tookonlyonesmallbowlofricecongeeateachmeal.
The patient had taken medicines like Xing ShYngWiWn (Costusroot and
Amomum Stomach-Nourishing Pill) and Chn Xing Do ZhWn (AquilariaWood
Stagnation-Moving Pill). Sometimes these pills were effective, but the symptoms
wouldrecommenceoncetheformulaswerediscontinued.
During the visit, the patient reported general good health and no history of
digestiveproblemspriortothisailment.Hecomplainedthathisepigastricregionwas
hard to the touch.This was confirmed during physical exam palpationswhile the
areadidfeelhardandslightlytender,noactualmasswasfound.Otherclinicalsigns
includeddryconstipationandnormalurination.Thepatienthadaredtonguewitha
white,greasy,andglossycoating.Hispulsewasdeepandwiry.
Thepatternwasidentifiedas middle jiaoimpairment,causedby alcohol-induced
injury,resulting inrheum accumulating in thestomach. His condition accorded with
thedescriptionofthepatternforusingZhZhTngintheEssentialsfromtheGolden
Cabinet.
Thusthepractitionerprescribedthefollowingformula:

Thepatientwasassuredoftheefficacyofthisformula,andinstructedtotakeitfor
twodays.
Onthethirdday,thepatientcamebackforafollow-up.Hewasdelightedbythe
disappearance of the fullness andepigastric distention. He felt no obstruction in his
chest and his appetite had returned. Upon palpation, no hardness or fullness could
befeltinhisgastricorabdominalareas.Inlieuofmedication,thepatientwasasked
to regulate his condition through dietary therapy. In the several years following the
treatment,norelapsewasreported.
[Reference: Qi Qun-chang.TwoVerified CasesTreated with Classic Formulas .
TianjinJournalofTraditionalChineseMedicine.1995;12(2):37.]
450
Chapter12
Jaundice
Y n Chn HoTng ( VirgateWormwood Decoction) Pattern

Source Text
Line13

The disease of grain jaundice manifests with aversion to cold and fever, an
inability to eat, dizziness following eating, and disquietude in the heart and chest.
After a long period of time, yellowing occurs.This is grain jaundice. Yn Chn Ho
Tngisindicated.
Formula
ynchnho 6liang HerbaArtemisiaeScopariae
Decocttheynchnhoin10shengofwateruntil4shengremains.Addtheother
two ingredients and decoct again until 3sheng remains. Discard the dregs and take
warm,threetimes.
Urination will be disinhibited with a texture resembling gleditsia juice, with a
full red color.The size of the abdomen will decrease overnight as the yellowing is
eliminatedbyurination.
Interpretation
PatternAnalysis
This text discusses the treatment of grain jaundice due to excessive dampness
andheat.Grainjaundiceoftendevelopsfromtheexternalcontractionof pathogenin
combination with internal harm from dietary irregularities.When the transportation
and transformation functions of the spleen and stomach are impaired, damp-
heat accumulates internally and cannot be evacuated through the bowels.The
fermentationprocessofthefecalmatterleadstojaundice.
VolumeThree:Chapter12 Pulses,Patterns,andTreatmentofJaundice 451
The pathodynamic behind theaversion to cold and fever mentioned in the

source text is different from that of a common exterior pattern. In this case, it is the
resultofastrugglebetweendampnessandheat,astrugglewhichleadstodisharmony
andobstructionoftheyingandwei.
The inability to eat is a manifestation of spleen and stomach disharmony in
which the clear ascending and turbid descending functions become entangled by
the internally accumulated heat. If the patient is forced to eat, the food cannot be
digested.This increases dampness and produces more internal heat, which quickly
leads to damp-heat rushing upwards and dizziness. Disquietude in the heart and
chestoccurs.
It should be noted that in order for the internal damp-heat to spread across the
skinandappearas jaundice,thereisoftenalonglatencyperiodinwhichthedamp-
heatisstifledandsteaminginside.Thisiswhythetextstatesthat,Afteralongperiod
oftime,yellowingoccurs.
When the formula Yn Chn HoTng is introduced, the original text states that
after taking the decoctionurination should be promoted (increase).This implies
that additional symptoms for patients with grain jaundice often include abdominal
fullness and inhibited urination.These symptoms are signs that the damp-heat has
inhibited sanjiao qi movement.The treatment method should clear and discharge
damp-heatusingYnChnHoTng.
FormulaAnalysis
Inthisformula,ynchnclearsheatandpromotesurinationtorestorenormalskin
color.Zhzclearssanjiaodamp-heat,anddhungenterstheyangmingchanneland
eliminatesstagnatedheattorelievefullnessandstagnationofthestomachandlarge
intestine.Thesethreemedicinalstogethercanclearthedamp-heatthroughtheurine
andfeces.
Thusthetextstatesthataftertakingthedecoction,thepatientsurinewouldbe
as dark as Chinese honey locust fruit liquid, because the yellow color is eliminated
throughurination.
In modern clinical practice, this formula is frequently applied for damp-heat
accumulation conditions including acute icterohepatitis, acute hepatitis, hepatic
encephacopathy, hepatapostema, hepatic cirrhosis, cholelithiasis, biliar y tract
infection,andhyperbilirubinemia.
X io Sh Fn Sh Sn (Potassium Nitrate and Alum Powder) Pattern

Source Text
Line14

A person suffering from yellowing typically presents with heat effusion in
late afternoon; but if aversion to cold occurs instead, this indicatessexual taxation
jaundice. Urgency of the bladder, fullness of the lesser abdomen, generalized
yellowing,darkeningoftheforehead,andheatontheundersidesofthefeetleadto
black jaundice.Those with abdominal distention that resembles water swelling will
presentwithblackstoolsthatareoftensloppy.Thisindicatessexualtaxationjaundice,
notwater.Thosewithabdominalfullnessaredifficulttotreat.XioShFnShSnis
indicated.
Formula
xiosh NatriiSulfas
fnsh Alumen(burnt)
Grind equal portions of the ingredients.Take one square inch-spoonful of the

powderwithbarleycongee,threetimesaday.
Thediseasetoxinswilldrainoutintheformofyellowurineandfullblackstools.
Interpretation
PatternAnalysis
This text discusses the pattern and treatment of sexual taxation jaundice and its
transmutationintoblackjaundicewithsignsofdamp-heatandbloodstagnation.The
dispersionmethodisindicated.
Thistextbeginsbystatinganimportantdifferencebetweensexualtaxationjaundice
and other jaundice conditions like grain jaundice and liquor jaundice. In general,a
personsuffering from yellowing refers to any patient suffering fromjaundice over a
longperiodoftimewhoisunabletorecoverdespitereceivingtreatment.
Patients with damp-heat binding in yangming should experience late afternoon
tidalfeverwithoutaversiontocold.Thisisbecauseyangmingqiisinvigoratedduring
thetimeperiodof3-5pm.Duringthisperiod,thestrugglebetweentheuprightand
pathogenisintense.Patientspresentwithfeverwithoutaversiontocoldbecausethe
fevercomesfromjaundiceduetoyangmingdamp-heat.
However,ifpatientswithyellowingsufferfrom aversiontocoldinlateafternoon,
accompaniedbyurgencyofthe bladder,fullnessof the lower abdomen,generalized
yellowing, darkening of the forehead, and heat on the undersides of the feet, then
stagnant blood and damp turbidity are binding the kidney.This binding paralyzes
the original yang, rendering it unable to generate warmth.The wei qi, which is thus
unabletodistributewarmthtotheexterior.Thisparalysismanifestsastheabnormal
aversion to cold in the afternoon and is an important sign for differentiatingsexual
taxationjaundicefromyangmingdamp-heat.
Another important distinguishing sign ofsexual taxation jaundice can be found
here:Those with abdominal distention that resembles water swelling will present
with black stools that are often sloppy.This indicates sexual taxation jaundice, not
water.This statement not only clarifies the symptoms and signs of this type of
jaundice, it also reveals the key manifestations indicating the transmutation of the
patternintoblackjaundicewithexcesstypebloodstagnation.
Urgency of the bladder, fullness of the lower abdomen, generalized yellowing,
darkeningoftheforehead,andheatontheundersidesofthefeetallpointtokidney
and lower jiao patterns.When kidney yin is deficient, deficiency heat can rise and
afflict the bladder manifesting asurgency of the bladder.When deficiency heat
afflicts theuterus or the essence chamber, the binding of stagnated blood and heat
appears as fullness of the lower abdomen.When it affects the bladder channel, it
canappearasa blackishdiscolorationorevenasadarkmaculaonthecenterofthe
forehead.Thislastmanifestationdeservesfurtherexplanation.
The character forforehead (, ) refers to the center of the forehead, also
knownastheCelestialPalace(tintng,).Thetintngareaisalsocalledyn(),
referring to the place where the sun rises in the south and, hence, corresponding to
theheart.Infacialdiagnosis,thisplacealsocorrespondstotheheart.Thecolorblack
correspondstothedarkyincolorofthenorthandisthevisceralcolorofthekidney.
The foot taiyang bladder channel passes through the forehead. If kidney yin is
damageddue to sexual intemperance, deficiency fire can ascend by flaming upward
throughthebladderchanneltoattacktheheartandappearastheblackishcolorinthe
center of forehead. In all, the color and its location indicate the stagnation resulting
fromthecontentionbetweenbloodandfamingdefcientkidneyfre.
Generalizedyellowingincludesthefaceandeyes,allofwhichwillhavebecome
darkyellow.However,somepatientsmightexhibitanalternatediscoloration,presenting
withasallowcomplexionaccompaniedbydarkspotsonthegums,lips,nipples,orpalm
creases.Thisisasignoftheseriousqiandbloodstagnationofblackjaundice.
Theheat on the undersides of the feet is a sign of kidney yin deficiency.
Altogether, these symptoms manifest as discordance between fire and water in the
kidneyduetodeficiencyfire.Bindingheatandbloodstagnationdevelopsandcombines
withdampturbidity.This is the pathodynamic behind black jaundice. At some point

during the disease progression, abdominal distention may create an impression of
significant water retention. However, the distention has nothing to do with a simple
waterretentionpattern.Ifabdominalfullnessoccursinthelatestagesofthisdisease,it
isduetokidneyandspleenfunctionfailure.Inthiscase,theprognosisisunfavorable.
FormulaAnalysis
Xio Sh Fn Sh Sn is indicated for kidney deficiency combined with dampness
andbloodstagnation.Itcanfreebloodstagnation,clearheatanddispeldampness.Itis
contraindicatedforabdominalfullnessinanextremekidneyandspleendefciencypattern.
In this formula,xio sh refers to hu xio, which, with its salty flavor and a cold
nature,isabletoenterandinvigoratethebloodtounblockstagnation.
Fnsh(alsocalledmngfn)caneliminatetheinveterateheatlodgedinthebone
marrow,andpromoteurinationtodispeldampness.
Barley porridge is used to protect stomach qi because mineral medicinals can
easilydamagestomachqi,impairingitsfunction.
According to the experience of past physicians, if sexual taxation jaundice
develops from kidney deficiency alone (i.e. without blood stagnation), it should be
treatedbysupplementingthekidney.
Ifpatientsaremoredeficientin kidneyyin, LiWiDHungWn (Six-Ingredient
Rehmannia Pill) or Zu GuWn (Left-Restoring Pill) can be administered. If patients
aremoredeficientinkidneyyang,ShnQWn(KidneyQiPill)orYuGuWn(Right-
RestoringPill)areoftenadministered.Ifbloodstagnationsubsequentlydevelops,then
simultaneoustreatmentofboththerootdefciencyandbranchexcessmaybeapplied.
CaseReport
Male,age53.Initialconsultation:December5,1979.
The patient was afflicted with icteric hepatitis in the spring of the previous year
and then treated with Chinese medicinals to clear heat and promote urination.The
jaundiceabated completely following treatment but adistending pain over the liver
areapersisted,requiringintermittentmedicationtosoothetheliverandrectifyqi.In
theautumn,thejaundicerelapsed.Chinesemedicinetreatmentprovedlesseffective
this time and the jaundice never completely subsided. Earlier in the winter, the
patienthadbeendiagnosedwithearlystagecirrhosis;atthetimeofconsultation,the
conditionhadregressedmoreseverely.
Upon the first visit, the patient presented with icteric sclera, low appetite, loose
stools, epigastric and abdominal distension, and distending pain on the right flank.
He had a purple macula on the edge of his tongue, which also had a white greasy
coating.Thepractitioneridentifiedthepatientspatternassexualtaxationjaundicein
whichthepathogenicqioftheaccumulatingdamp-heat,firstmanifestingasjaundice,
eventually transmuted and entered the blood.The result was a stagnant blood and
lodgeddampnesspatterninthelowerjiao.
ThetreatmentadministeredwasXioShFnShSn.3gofxioshand3goffn
shweregroundintoafinepowderandpackedintocapsulestobetakenthreetimesa
daywithbarleyporridge.
Anadditionalformula(seebelow)wasprescribedtobetakenasadecoction,one
packperdayfor20days:

flng 15g Poria
biji 15g CarapaxTrionycis
Whiletakingthedecoction,thepatientsjaundicegraduallysubsidedandhisother
symptoms improved. After another 20 packs, the jaundice was completely resolved
andthepatientsdigestionandappetitewererestored.Thepatientwasaskedtotake
XioShFnShSnforthenextsixmonthstostabilizetheeffectofthetreatment.No
relapsewasreportedduringthistime.
[Reference:ChenYu-hua.ClinicalApplicationsofXioShFnShSn.
NeiMongolJournalofTraditionalChineseMedicine.1987;3:17.]
Z h Z D Hung Tng (G ardenia and R hubar b R oot D ecoc tion)
Pattern
Source Text
Line15

For liquor jaundice manifesting with anguish or heat pain in the heart,Zh Z D
HungTngisindicated.
Formula

dnduch 1sheng SemenSojaePraeparatum
Decoctallfouringredientsin6shengofwateruntil2shengremains.Takewarmin
threeportions.
Interpretation
PatternAnalysis
This text discusses the pattern and treatment of liquor jaundice combined with
exuberantheat.
Liquorjaundiceisatypeofjaundiceresultingfromimpairmentofthe spleenand
stomachduetodietaryandalcoholicintemperance.Damageofthespleenandstomach
leadstodisturbanceoftheirtransportationandtransformationfunctions,allowingheat
toaccumulateinthemiddlejiao.Theheatgoesupwardsteamingtheheartandinducing
a feeling of vexation in the heart. Accompanied by dampness, the heat disturbs qi
movementandmanifestsasburningpaininthechest. ZhZDHungTngisindicated
toclearheartheatandreleasevexation.
Inadditiontoanguishorheatpainintheheart,symptomssuchasfever,restlessness,
insomnia,inhibitedurination,constipation,andorange-yellowcoloredskinaregenerally
present.
FormulaAnalysis
Zhzandduchclearheartheatandrelievevexation.
Dhungandzhshremovestagnationtopurgeheat.
MainIndications
CM: constrained heat in the heart channel due to excessive heat complicated by
moderatedampness.
WM:liverandgallbladderdiseasesor constraintheatintheheartchanneldueto
excessiveheatcomplicatedwithmoderatedampness.Forexample:severedamp-heat
jaundice,contagioushepatitis,and damp-heatpatternnon-icterichepatitiswithheat
bindinginthestomachandattackingupwardtoharasstheheart.Thistypeofdamp-
heatjaundicemostlyinterfereswiththechestorepigastricarea.
CaseReport
Male,age39.Initialconsultation:December11,1967.
Thepatienthadbeenanalcoholicforalongtime,fallingasleepalmosteverynight
inahalf-drunkenstupor.Thenightpriortopresentation,hefeltrestlessandagitated
afterdrinkingandcouldnotfallasleep.Thenextmorninghefoundhisskinhadturned
an orange-yellowish color. He was nauseated, had a vexing feeling in his heart, and
wasoverwhelmedbyindescribableagitation.Heimmediatelysoughtmedicalcare.At
thetimeofpresentationhistonguebodywasredwithagreasyyellowcoatingandhis
pulsewaswiryandslippery.Thepractitionerdiagnosedhimwithliquorjaundice.
TheformulausedwasamodifcationZhZDHungTng.

chozhsh 10g FructusAurantiiImmaturus(dry-fried)
duch 6g SemenSojaePraeparatum
Radix et Rhizoma Rhei (added during the last five minutes
shngdhung 4g
ofdecoction)
Thepatientwasaskedtotakethedecoctiontwiceadayforfivedays.Hewasalso
instructedtostopdrinkingandavoidoilyfood.
After taking the above decoction for five days, the patients jaundice and other
symptomsweresignifcantlyrelieved.
Atthesecondvisit,duchwasremovedfromtheformulaand18gofLiYSn
(Six-to-One Powder) (wrapped separately for cooking with other herbs) was added.
LiYSncontainshush(Talcum)andgnco(RadixetRhizomaGlycyrrhizae).
chozhsh 10g FructusAurantiiImmaturus(dry-fried)
shngdhung 3g RadixetRhizomaRhei
hush 15g Talcum
Aftertakingtheformulaaboveforsevendays,thepatientsjaundicedisappeared
andhishealthwasrestored.
[Reference:ZhangXiao-ping.ClinicallyInspiredIlluminationonEssentialsfromtheGoldenCabinet
.Hefei:AnhuiScienceandTechnologyPress;2001.p.357.]
Yn ChnW Lng Sn (Five Substances Powder with Poria plusVirgate
Wormwood)Pattern
Source Text
Line18

Forjaundicedisease,YnChnWLngSnisindicated.
Another version states thatYn ChnTng (VirgateWormwood Decoction) and
WLngSn(FiveSubstancesPowderwithPoria)arebothindicated.
Formula
ynchnho 10fen HerbaArtemisiaeScopariae(powdered)

WLngSn 5fen Five-SubstancePowderwithPoria
SeetheformulaWLngSninthesectionPhlegm-rheum.
Mixthepowderandtakeonesquareinch-spoonfulbeforemeals,threetimesaday.
PatternAnalysis
Thistextdiscussesthetreatmentof early-stagejaundicewheredampnessismore
predominantthanheat.
Accordingly, aclearing method with the principal aim of draining dampness is
employed. By promoting urination, heat is cleared, the exterior is harmonized, and
thejaundicewillabate.
Thelinedoesnotclearlydescribetheclinicalsignsandsymptoms,buttheselected
medicinals indicate that a pattern of damp-heat jaundice with prevailing dampness.
Manifestations should include headache, aversion to cold and fever, a bright yellow
coloring of the eyes and skin, thirst, mild abdominal fullness, epigastric distention,
succussionsplash,swellinginthelowerlimbs,scantydarkurineanddifficultyvoiding,
agreasyyellowtonguecoating,andafoatingmoderatepulse.
Thistypeofjaundiceisaresultofdamp-heatsteaminginthebloodandinhibiting
theabilityoftheliverandgallbladdertogovernqimovement.However,thecondition
hasnotreachedthepointatwhichanaccumulationexcesspatternhasformed.
FormulaAnalysis
Inthisformula,ynchnexcelsatpromotingurinationtoclearheatanddisinhibit
dampness.The percolating and transforming actions of the bland medicinals of
W Lng Sn drain dampness by promoting urination and qi transformation while
harmonizingtheexterior.TheratiobetweenynchnandWLngSnis2:l.
MainIndications
CM:jaundiceinwhichdampnessismoresignifcantthanheat.
CaseReport
Male,age45.
Upon first consultation, the patient complained of yellow-colored skin, icteric
sclera, and dark yellow urine.Three days prior, the patient had noticed that his
urine had become very yellow, bordering on dark red. He also lost his appetite, was
fatigued, and felt a dull pain in his right flank. His tongue coating was yellow, thick,
and greasy. His pulse was wiry and slippery. A physical examination revealed adark
yellow skin color and severe icteric sclera.The liver was palpable 4 cm below the
costal region. It was stiff, tender, and blunt-edged. A percussion pain test over the
hepaticareawaspositive.Labtestresultswereasfollows:
UrineAnalysis:
Glucose(GLU-U) Bilirubin Ketonebodies Protein

+ +++ + ++
SerumHepatitisB:
HepatitisB HepatitisB HepatitisBE HepatitisB HepatitisB

surfaceantigen surfaceantibody antigen Eantibody coreantibody
(HBsAg) (HBsAb) (HbeAg) (HBeAb) (HBcAb)
+ + +
LiverFunction:
Anine Aspartate Alkaline

Directbilirubin Totalbilirubin
aminotransferase aminotransferase phosphatase
(DBIL) (TBIL)
(ALT) (AST) (ALP)
3030U/L 1340U/L 120U/L 280mol/L 86mol/L
ColorUltrasound:
Bladder Gallbladder Kidneys Liver Pancreas Spleen

Cholecystitis Diffuse damage of parenchyma;
Normal Normal Normal Normal
cholelithiasis smallcyst
The patient was diagnosed at aWestern medical hospital with acute icteric
hepatitis B. In Chinese medicine, his pattern was identified as yang jaundice with
severedampnessandmoderateheat.Thetreatmentmethodaimedtodraindampness,
promoteurinationandclearheat.
TheformulausedwasamodifcationofYnChnWLngSn:

ynlng 30g Poria
zhlng 30g Polyporus
qngdi 6g IndigoNaturalis
shngzhz 30g FructusGardeniae
qgu 30g FructusLycii

guji 30g CarapaxetPlastrumTestudinis
bihushshco 10g HerbaHedyotisDifusae
Aftertakingtheaboveformulafortwoweeks,thepatients ictericscleraandskin
discolorationdecreasedsignificantly.Hebecamemorevigorousandhisurinewasless
dark.
LiverFunction:
ALT AST ALP DBIL TBIL

450U/L 78U/L 80U/L 15mol/L 76mol/L
Theprescribedformulawasmodifiedbyreducingthedosageofynchnto60g
andremovingshnyo,zxiandqngdi.
After taking this adjusted formula for six days, the yellowness in his face and
urinebecameevenlighter.Hislabtestresultswereasfollows:
UrineAnalysis:
Glucose(GLU-U) Bilirubin WBC Protein

+ +
LiverFunction:

109U/L 42U/L 75U/L 10.8mol/L 65.3mol/L
Theformulawasmodifedagainbyreducingtheamountofynchnto45g.
Aftertakingthelatestformulaforsevendays,theabnormalyellowingoftheskin,
sclera,andurinedisappeared.Thepatientreportedthathissenseoftasteandappetite
werestillpoorandthathefeltparoxysmaldiscomfortintheareaoftheliver.Labtests
revealedconsistentresultsforurineanalysisaswellas:
WBC Protein
+ +
LiverFunction:

54U/L 34U/L 69U/L 5.9mol/L 16.9mol/L
Over the following two months, the formula was adjusted according to the
progressionofthedisease.Bytheendoftreatmentthepatientreportednosignificant
discomfort.Urineanalysisshowednoabnormalities.
Otherlabresultswererecorded:
LiverFunction:
ALT AST ALP TBIL
23U/L 25U/L 50U/L 9.1mol/L
SerumHepatitisBTest:
HBsAg HBsAb HbeAg HBeAb HBcAb
+ + +
Thepatientwasaskedtomaintainahealthydietandtoavoideatinggreasyfood
orphysicallyoverstraininghimself.Sixmonthslater,labresultsfromafollow-upvisit
revealedHBsAb(+)andnormalliverfunction.
[Reference:Yuan Hui-fang, Zhang Xue. Experience ofTreating Acute Icteric Hepatitis B with
Yn Chn W Lng Sn . Guangming Journal of Chinese
Medicine.2007;20(6):34-35.]
X io Jin ZhngTng (Minor Center-Fortifying Decoction) Pattern
Source Text
Line22

For a man with yellowing and uninhibited urination, Xio Jin ZhngTng for
defciencytaxationshouldbeapplied.
SeetheformulainthesectionDefciencyTaxation.
Interpretation
PatternAnalysis
Thistextpresentstheappropriatetreatmentforpatientswithyellowingdiscoloration
associatedwithspleendefciencyratherthandamp-heat.
All of the preceding jaundice condition patterns have an element of damp-heat.
Mostofthemalsoinvolveinhibitedurination.Incontrast,thedistinguishingsymptom
of this pattern is normal urination. Normal urination indicates that theyellowing is
attributedtodampnessandthatitshouldberecognizedas spleendeficiency.Spleen
deficiency develops both yin and yang deficiency such that qi and blood cannot be
distributedtothefaceorotherpartsofthebody.Thislackofqidistributionleadstoa
sallowappearance.Theyellowishcolorofthispattern,usuallylessbrightthanthatin
damp-heatpatterns,isoftencalledwitheredyellow.
Thetextparticularlysinglesoutmalesforthispattern.Womencanexhibitasimilarly
sallow complexion due to blood deficiency from menstruation and childbirth. In
malepatients,however,suchdiscolorationscaneasilybemistakenas damp-heattype
jaundicesinceblooddefciencytendstoberareamongthispopulation.
Whiletheauthoremphasizesuninhibitedurinationasakeysymptomdifferentiating
thispatternfromdamp-heatjaundicepatterns,normalurinationcanalsoaccompany
sexual taxation jaundice. However, other symptoms of sexual taxation jaundice are
verydifferentfromsymptomsinthe spleendeficiencypattern.Therefore, uninhibited
urination is the key symptom differentiating a yellow complexion from damp-heat
jaundice,andcold-dampjaundice.
XioJinZhngTngcansupplementthespleenandfortifythestomachtoengender
qiandbloodformation.
CaseReport
Male,age35.Initialconsultation:July,1982.
The patient presented with dark yellowish discoloration of the skin and icteric
sclera. He also suffered from fatigue, nausea and vomiting. His tongue body was
lightredandcoveredwithatender,thin,whitecoatingwhichwaspatchyandwhite,
glossy and grimy.The pulse was deep, slow, and weak. He was diagnosed with
yin jaundice and treated with Yn Chn Zh FTng ( VirgateWormwood,White
Atractylodes,andMonkshoodDecoction)and YnChnSNTng (FrigidExtremities
Decoction plusVirgateWormwood). However, following treatment, the dusky yellow
colorofhisskindidnotsubsideandhisconditionworsened.
Xio Jin ZhngTng was then applied. Soon after administration, the patients
jaundice subsided significantly, his vomiting stopped, and his appetite returned to
normal. Several days later, his health was restored. Hung q (Radix Astragali) and
zh f z (Radix Aconiti Lateralis Praeparata) were added to the previous formula to
reinforcethetreatmentefect.
[Reference:ZhangEr-xin.ExperienceofTreatingYinJaundicewithXioJinZhngTng
.GansuJournalofTraditionalChineseMedicine.1996;9(2):24.]
463
Chapter13
Retching, Vomiting, Hiccough and
Diarrhea
XioBnXiTng(MinorPinelliaDecoction)Pattern
Source Text
Line12

For all vomiting with an inability to keep food down, Xio Bn Xi Tng is
indicated.
Formula

Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofvomitingduetocoldretainedfluid.Although
thecausesarecomplex,thecorepathodynamicis stomachqiascendingcounterflow.
Cold,heat,deficiency,excess,andphlegmneedtobedifferentiatedforspecificpattern
identifcation.
Vomiting is commonly seen in many diseases.While the phrase for all vomiting
inmanydiseasescanbeusedfordifferenttypesofvomiting,itshouldnotbetakento
meanthatthisformulacantreatallkindsof vomiting.Aninabilitytokeepfooddown
resultsfromretentionofcoldfluidsinthestomach.Thisretentionpreventsthestomach
fromtakinginfoodand,thus,foodanddrinkcannotmovedownwardtothestomach.
FormulaAnalysis
XioBnXiTngisusedtotreatvomitingbecauseitcanharmonizethestomach,
directcounterfowdownward,dissipatecold,anddissolverheum.
The formula uses bn xi to direct qi downward while dissipating rheum and
masses.
Shngjingisusedtodissipatecoldandharmonizethestomachtostopvomiting.
MainIndications
This formula excels at harmonizing the stomach and directing qi downward.
Bnxiandshngjingarefundamentalmedicinalsfortheseactions.Thisformulais
commonlyusedtotreat vomitingduetofluidretention.Amongpractitioners,ithasa
reputationofbeingefectivetotreatmachfromvomitingformulas.
CaseReport
The patient reported suffering from dizziness and frequent vomiting for three
days. She said the vomit was clear and watery with foamy drool.The quantity could
fillabasin.Thepatienthadtolieinbedandwithhereyesclosedtorelievetheintense
dizziness.The patient stated that these episodes occurred several times a year, each
time lasting for a month.The patient was given aWestern medical diagnosis of
Menieres disease. At the time of the visit, her tongue coating was thin, white, and
greasy.Herpulsewasdeep,soft,andslippery.Shewasobese.
The vomiting was considered to be the result of water retention in the stomach
andturbidpathogenicqiattackingthehead.Theselectedtreatmentmethodaimedto
harmonizethestomachanddissolverheum.Allsymptomswereexpectedtoberesolved
oncetherheumhadbeendissolvedandtheturbidpathogenexcreteddownward.
TheformulausedwasXioBnXiTng:

On May 13, after taking the formula for two days, the patient came for a second
visit and reported that her dizziness and vomiting had been resolved.The formula
wasmodifiedbyaddingflngandthepatientwasinstructedtocontinuetakingthis
formulafortwomoredays.
flng 12g Poria
AmodifiedChnTng(TwoMaturedSubstancesDecoction)wasalsoprescribed
andmadeintopillsforlong-termefects:
bnxi * RhizomaPinelliae
shngjing * RhizomaZingiberisRecens
flng * Poria
gnco * RadixetRhizomaGlycyrrhizae
shngjing * RhizomaZingiberisRecens
VolumeThree:Chapter13 Pulses,PatternsandTreatmentofRetching,Vomiting,HiccoughandDiarrhea 465
bizh * RhizomaAtractylodisMacrocephalae
jingzh * SuccusRhizomatisZingiberis
*Appropriateamountsformakingpillsforlong-termadministrationshouldbeused.
Overtwoyearsoffollow-up,thepatientdidnotexperienceanyfurtherepisodes.
[Reference:ChenMing.CollectionofFamousDoctorsSuccessfulCasesofEssentialsfromtheGolden
Cabinet.Beijing:AcademyPress;1999.p.368.]
DBnXiTng(MajorPinelliaDecoction)Pattern
Source Text
Line16

Forstomachrefuxwithvomiting,DBnXiTngisindicated.
The Important FormulasWorth aThousand Gold Pieces for Emergency states:
indicated for stomach reflux with inability to receive food and immediate vomiting
ofingestedfood.
TheArcaneEssentialsfromtheImperialLibrarystates:indicatedforvomitingand
hardglomusbelowtheheart.
Formula

fngm 1sheng Mel
Decoctallthreeingredientsin12shengofwater,stirwithwhitehoney240times;
decoctuntil2.5shengremains.Takeoneshengwarm;taketherestintwodoses.
Interpretation
PatternAnalysis
Thistext discusses the treatment method for deficiency typestomach qi reversal
with retching or vomiting. Prolonged vomiting or improper treatment leads to
stomach qi deficiency. A deficient stomach fails to move downward, which results
in deficiency vomiting.The clinical manifestations include: vomiting in the evening
of food eaten in the morning, or vomiting in the morning of food eaten in the
evening,undigestedfoodinthevomit,lassitude,fatigue,weaknessandaslowpulse.
Symptoms may also include a feeling of stuffiness below the heart and stool that is
dry like sheep excrement.Treatment methods should direct counterflow downward,
stopvomiting,boostqi,andnourishyin.
FormulaAnalysis
TheformulausestwicetheamountofbnxirecommendedinXioBnXiTng,to
directcounterflowdownward,disperseglomus,andstopvomiting.Rnshnisusedto
boostqi,harmonizethestomach,andpromotefluidproduction.Fngmmoistensand
dredgesthebowels,eliminatestoxinsandrestrictsthewarmnessanddrynessofbnxi.
Themixtureisstirred240timestodissipatethesweetflavoroffngmintothewater,
enhancingitstherapeuticeffects.Incombination,thethreeherbssupplementqiandyin,
moveqiinthebowels,anddownbearstomachqitoresolvevomiting.
MainIndications
This formula directs counterflow downward, dissipates masses, checks vomiting,
fortifesthespleen,beneftsqi,andnourishesyin.
CM: vomiting accompanied by a pattern of root spleen deficiency, depletion of
bodyfuidsandbranchphlegm-fuidstagnation.
WM: gastric ulcer, cardiospasm, pyloric obstruction, volvulus of stomach and
conceptionwiththecorrespondingunderlyingpattern.
CaseReport
The patient reported suffering from epigastric pain for years. He said he had
been vomiting for one year and reported that his symptoms had worsened in the
four months prior to presentation. His vomit consisted of mucus and food. He also
complained of constipation lasting three to four days and a dull burning pain in the
epigastricarea.Histonguecoatingwaswhiteandhehadalarge,defcientpulse.
He received aWestern medical diagnosis of partial pyloric obstruction and a
Chinese medicine diagnosis of spleen deficiency complicated by rheum and chronic
vomitingleadingtoyindamage.

fngm 60g Mel
The patient was instructed to take one pack of the decocted herbs, twice a day.
After two packs, his vomiting and dull burning pain were relieved. His bowel
movements returned to normal. After six packs, the symptoms were eliminated
completely.
[Reference: Hu Lan-gui. Zhu Jin-zhongs Experience of Using D Bn XiTng
.ShanxiJournalofTraditionalChineseMedicine.1999;15(6):1-2.]
D Hung Gn CoTng (Rhubarb and Licorice Decoction) Pattern
Source Text
Line17

Forvomitingimmediatelyaftereating,DHungGnCoTngisindicated.
ThisformulaisfromArcaneEssentialsfromtheImperialLibrary,alsoindicatedfor
vomitingofwater.
Formula
Decoctthetwoingredientsin3shengofwateruntiloneshengremains.Takewarm
intwoportions.
Interpretation
PatternAnalysis
This text discusses the treatment of vomiting due to ascending counterflow of
excess heat in the stomach and intestines. Because normal stomach and intestinal
function is characterized by free-flowing downward movement, if excess heat
obstructs and congests these organs, the qi of the bowels becomes blocked.This
blockageleadstoafailureoftheintestinalfunctionsofconductingandtransmitting,
manifestingasconstipationbelowandnoappetiteabove.Whenthefireisurgentand
famingupward,vomitingshortlyaftereatingisseen.
D hung is indicated to purge heat as this vomiting is caused by excess heat
blockingthestomachandintestines.
FormulaAnalysis
In the formula, a large dose of d hung is used to drain heat and unblock the
bowels through defecation.This is referred to as treating the upper by acting on
thelower.Gncoisusedtorevivethecenterinordertoregulatestomachqiandto
antagonizetheefectsofdhungsoasnottodamagethestomach.
MainIndications
CM: vomiting, hiccough, eye pain, nosebleed, mouth sore, toothache due to fire
famingupward,andexcessheatinstomachandintestines.
WM: acute gastritis, acute hepatitis, acute cholecystitis, intestinal obstruction,

upper gastrointestinal bleeding, oral ulcer, epidemic hemorrhagic fever, Menieres
disease,etc.withthecorrespondingunderlyingpattern.
CaseReport
Thepatientreportedsufferingfrom dizziness, vomiting,and tinnitusforoverten
yearsandhadbeendiagnosedwithMenieressyndromebyalocalhospital.Treatment
throughtranquilization,dehydration,andbloodvesseldilationprovedunsatisfactory.
SheturnedtotraditionalChinesemedicineontheseventhdayofthecurrentepisode.
Atthetimeofthevisit,thepatientpresentedwithdehydration,dizziness,vomiting,
and difficulty in food and drink intake. Her stool was dry and she had not had a
bowelmovementforfivedays.Thebodyofhertonguewasredwithaslightlyyellow,
greasycoating.Herpulsewasthreadyandwiry.
She was initially diagnosed as having a shaoyang pattern and was prescribed
a modified Xio Chi HTng (Minor Bupleurum Decoction) which proved to be
ineffective. On her second visit she was diagnosed with ascending counterflow of
turbid phlegm and Bn Xi Bi ZhTin MTng (Pinellia,White Atractylodes and
GastrodiaDecoction)wasprescribed.Thisapproachdidnotworkeither.
Onthethirdvisitthepatternwasdiagnosedasturbidpathogenicqiaccumulating
intheintestines and bowels, flaming upward and attacking the head.The treatment
methodaimedtoclearuptheheatanddredgethebowels.
DHungGnCoTngwasadministered:
Aftertakingonepack,thepatientpassedalargeblackfoul-smellingstool,andthe
vomitingceasedimmediately.Shefeltgreatrelieffromherdizziness.Theamountofd
hungwasreducedto10gandtwomorepackswereprescribed.Aftertakingtwopacks,she
feltmuchbetterandherappetiteincreased.Shecontinuedtoexperienceslightdizziness.
Hertonguebodywaspalewithathin,moistcoating.Herpulsewasdeepandthready.
The pattern was identified as blood deficiency and qi weakness, leading to
undernourishmentofthebrain.
Aformulacalled WWiZTng(ChineseMagnolivineFruitDecoction)wasthen
prescribed:
lngynru 10g ArillusLongan
shnyo 20g RhizomaDioscoreae
Aftertakingthreepacks,allofthesymptomsdisappeared.Inordertoenhancethe
effectsofthetreatment,shewasaskedtotakeanother10packsandtobegindietand
stressmanagement.Inaone-yearfollow-up,thepatientreportednorelapses.
[Reference:ZhuShu-kuan.FourExamplesofUsingDHungGnCoTng4.
NewJournalofTraditionalChineseMedicine.2007,39(7):80-81.]
JPTng(TangerinePericarpDecoction)Pattern
Source Text
Line22

With dry retching and hiccough, if there is also reversal of the extremities, J P
Tngisindicated.
Formula
jp 4liang PericarpiumCitriReticulatae
Decoctbothingredientswith7shengofwateruntil3shengremains.Takeonesheng
warm.
Theconditionwillresolveimmediatelyfollowingadministration.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofdryretchingorhiccoughduetostomachcold
with qi counterflow. Retching and hiccough refer to two different symptoms; both
include audible sound without vomitus. In retching, there is an upward reversal
movementofqiandasoundisheardwithexhalation.Inhiccough,inhaledaircannot
descend properly.When qi reaches the diaphragm (or sometimes the throat), qi
reversaloccursandthecharacteristicsoundismade.Both retchingand hiccoughare
amanifestationofstomachqidisharmonyandqicounterflow.Whileadifferentiation
should be made prior to treatment, it should be noted that neither is as serious as
vomiting.
In a serious case of retching or hiccough, qi reversal in the chest and diaphragm
prevents qi from reaching the distal parts of the four extremities andreversal of the
hands and feet can be seen. Regardless of whether hiccough and retching present
independentlyorsimultaneously,thispatternisoneofstomachcoldqicounterfow.
Reversal of the hands and feet in this pattern is quite different from that in S N
Tng (Frigid Extremities Decoction) pattern in terms of severity.The former is mild
whilethelatterissevereduetoyinexuberancewithdebilitationofyang.
FormulaAnalysis
J P Tng is selected to dissipate cold and rectify qi, invigorate yang and
harmonizethestomach.
J p is used to rectify counterflow qi stagnated in the middle and unblock the
stomachcollaterals.
Shngjingisusedtodirectcounterflowdownwardtostop nauseaandvomiting
aswellastoinvigorateyangqitodissipatecold.Yangqiinthemiddleandupperjiao
isdiffused,qimovementisregulated,stomachqiisdirecteddownward,and reversal
ofthehandsandfeetisrelieved.
MainIndications
CM:retchingandvomitingduetostomachcoldcausingqicounterfow.
WM:retchingandvomitingwiththecorrespondingunderlyingpattern.
CaseReport
Female,age18.
At the first visit the patient complained of having a loud hiccough accompanied
by chest pain.The symptoms had lasted half a day and had begun after the patient
inhaled cold air in the morning after rains. She had a normal complexion and state
of mind. Her tongue was pale with a greasy, white coating. Her pulse was wiry and
slippery.
Thishiccough was considered to be cold invading the diaphragm, so to direct qi
downwardanddissipatecold,shewastreatedwithamodifcationofJPTng:

jingbnxi 15g RhizomaPinelliaePraeparatum
flng 12g Poria
Thepatientwastoldtotakeonepackofthemedicinalsabovebeforecomingback
intwohoursforasecondvisit.Shereportedthatthe hiccoughstoppedhalfanhour
aftermedication and that her chest pain was relieved. Her tongue body and coating
didnotchange,andherpulsewasslippery.Shewastoldtofinishtheremainingpacks
toenhancethetherapeuticeffectsoftheformula.Norelapsewaseverreportedinthe
follow-up.
[Reference:WangTing-fu.GuidetoEssentialsfromtheGoldenCabinet .Chengdu:
SichuanScienceandTechnologyPress;1986.p.396.]
JPZhRTng(TangerinePericarpandBambooShavingsDecoction)
Pattern
Source Text
Line23

Forhiccoughandcounterfow,JPZhRTngisindicated.
Formula
jp 2sheng PericarpiumCitriReticulatae
zhr 2sheng CaulisBambusaeinTaenia
Decoctallsixingredientswithonedouofwateruntil3shengremains.
Takeoneshengwarm,threetimesaday.
Interpretation
PatternAnalysis
This text discusses the treatment of qi deficiency combined with heat and
ascendingcounterflowofstomachqimanifestingashiccough.Thoughthedescription
in the text is brief, analyzing the composition of the formula ingredients allows for
speculationaboutthepattern.
This type of hiccough is commonly seen in patients with weak constitutions or
patients in the wake of chronic disease, serious vomiting, or diarrhea.The hiccough
is intermittent. Signs and symptoms include a low voice, combined with deficiency
vexation and agitation, shortness of breath, dryness in the mouth with little desire
to drink, feverishness in the palms and soles of the feet, a tongue with thin or little
yellowcoating,andarapiddefcientpulse.
FormulaAnalysis
JPZhRTngisusedtosupplementqiandclearheat,harmonizethestomach
anddirectqidownward.
Jpandshngjingareusedtorectifyqi,harmonizethestomachanddirectqi
downward.
Zhrisusedtoclearheatandharmonizethemiddle.
Rnshn,gncoanddzoareusedtosupplementdefciency.
Once the deficiency heat is cleared, stomach qi is directed downward and the
hiccoughwillberelieved.
MainIndications
Thisformulaiswidelyusedinthetreatmentofhiccough.
CaseReport
Femaleage48.Initialconsultation:October5,1986.
Afterbeingexposedtocoldduringacoldmealthreemonthspriortopresentation,
the patient had a low grade fever, poor appetite, constipation, lassitude, lack of
strength, poorsleep, shortnessofbreathafterexertion, drynessinthemouthwitha
desire for cool drinks, and hiccough. Dng Xing Sh DTng (Clove and Persimmon
Decoction)wasadministeredbutprovedinefective.
At the time of the visit, the patients pulse was thready and slightly rapid. Her
tonguewasredwithlittlecoating.Thepatternwasthensurmisedtohaveitsrootin
stomach yin deficiency, triggered by a cold meal.Hiccough occurred because of the
conflictbetweencoldandheatinthestomachanddisorderedqimovement(ascending
anddescending).
JPZhRTngwasprescribed:
xinjp 90g PericarpiumCitriReticulatae(fresh)

Thepatientwasinstructedtodecoctonepackofthemedicinalsabovetoobtain
400 ml of decoction. She was instructed to divide the decoction to be drunk warm,
fourtofvetimesadayforthreedays.
Upon the second visit her hiccough was gone and her appetite improved. She
was prescribedfivemorepacksofthesame formula. On the third visit her lowfever
(decreasingfrom37.8tobelow37)andothersymptomshadbeenrelieved.
[Reference:LZhi-jie.TheCompleteBookonDiscucssionandTreatmentofMiscellaneousDiseases
fromtheGoldenCabinet.Beijing:TraditionalChineseMedicineClassicsPress;1995.
p.394.]
473
Chapter14
Diseases in Pregnancy
G u Zh F LngWn (CinnamonTwig and Poria Pill) Pattern
Source Text
Line2

Among women with a histor y of concretions, if within three months after

menstruation ceases, incessant spotting and fetus stirring above the umbilicus
appears,thisindicatesdamagefromanintractableconcretion.Ifthefetusstirsinthe
sixth month of pregnancy, and menstruation was uninhibited in the three months
beforeitceased,thisindicatespregnancy.Descentofbloodisattributedtocoagulated
bloodinthethreemonthsfollowingmenstrualcessation.Incessantbleedingiscaused
byremainingconcretions,whichshouldbepurged.GuZhFLngWnisindicated.
TextNotes
Concretions: a kind of abdominal mass accompanied by pain and distention,
usuallywithadefniteformandafxedlocation.
Coagulatedblood:refersgenerallytostaticblood,darkpurpleincolor;inthiscase
associatedwithconcretion.
Formula
guzh RamulusCinnamomi
flng Poria
mdnp CortexMoutan(coreremoved)
torn SemenPersicae(skinandtipremoved,boiled)
shoyo RadixPaeoniae
Grind equal amounts of each ingredient, knead with honey, and make into pills
thesizeofrabbitdroppings.Takeonepillbeforemealseachday;withnoobservable
efect,increaseto3pills.
Interpretation
PatternAnalysis
This line discusses differentiation methods as associated with the fetus and
concretions,aswellasthepatternsandtreatmentofconcretions.
Tofacilitatecomparison,theinterpretationbelowisdividedintothreesections.
Concretionsaremostoftensignsofbloodstasiswithaccumulationofcongealed
turbid phlegm.Within three months after menstruation ceases means amenorrhea
hasbeenpresentforlessthanthreemonths.Incessantspotting(luxi,)refers
to prolonged scanty uterine bleeding.The author also points out that the feeling of
fetus stirring above the umbilicus.This is significant for two reasons. First, it is
impossible for fetal movement to be present prior to three months of amenorrhea
becauseittakesthreemonthsforafetustoform.Secondly,evenifthemovementwas
fetalitwouldbefeltinferiortotheumbilicusratherthansuperiortoit.
The feeling offetus stirring above the umbilicus can be understood as a paired
manifestation of (1) the downward movement of the coagulated blood from the
concretion during bleeding which leads to (2) qi activity in the abdomen.This may
lead a wishful orinexperiencedpatienttobelieve that she is pregnant and feeling a
fetusmoving.
Ifthebleedingisduetoaconcretion,symptomswillinclude:apatternofpiercing,
gripping lower abdominal pain, abdominal tenderness and guarding to prevent
othersfromtouchingtheabdomenaswellasmenstrualdischargethatisdarkpurple
with clots.This pain and bleeding is relieved once the clots are removed. Patients
exhibitingthispatternusuallyhaveadarkpurpletonguebodywithstasisspotsanda
wiry,roughpulse.
Aftersixmonths,thefetushaslongbeenformedandmovementbeloworaround
the umbilicus is to be expected. Additionally, smooth and regularmenstruation for
three months prior to conception indicates harmony of menstrual blood and this
is a sign that the woman is fertile and pregnancy is plausible. Additional signs of
normal pregnancy include gradual growth of the belly as well as softness and lack
of tenderness when the abdomen is palpated. Any internal movement of the fetus
wouldbeconsiderednormal.Thelastsentencediscussesthetreatmentofconcretions
accompaniedbybleeding.TheformulaGuZhFLngWnremovesconcretionsand
stopsbleeding.
Ifvaginalbleedingoccursthreemonthsafterthecessationofawomansmenstrual
cycle, a differentiation must be made between acceptable discharge as a result of
pregnancyandthepresenceofafetus,or,alternativelythepresenceofcoagulatedblood
andconcretions.Ifmenstruationwasirregularorinhibitedpriortocessation,thendark
purplemenseswith bloodclots, irregularenlargementoftheuterus,and tenderness
VolumeThree:Chapter14 Pulses,PatternsandTreatmentofDiseasesinPregnancy 475
totouchareconsiderednottobesignsofvaginalbleedingduringpregnancy1.Onthe
contrary,thesesignsandsymptomsindicatethepresenceofconcretions.Inthiscase,
eventhoughfetal-likemovementmaybereported,itislocatedabovetheumbilicus.
Thelocationofthemovementthusfurtherconfirmsthediagnosis.Thefactthatthereis
bleedingandthatitisincessantmayseeminconsistentwithabloodstagnationcase.
ZhangZhong-jingexplainsthatthebleedingispreciselyamanifestationofthefailureto
removetheconcretion.Coagulatedbloodpreventsfreshbloodfromenteringtheuterus
andbeingpresentinmenstruation.Thisleadstotheformationofmorestasis,phlegm,
wateranddampness.Onlybyexpellingtheconcretionscannewbloodbeproduced
andahealthyreproductivesystemrestored.
Insummary,thefirsttwolinesofthetextarejuxtaposedforacriticaldifferentiation:
the former indicates bleeding from a concretion while the latter indicates true fetal
movement due to a natural, normal pregnancy. In ancient times, the symptoms of
the first line might have been confused with pregnancy.Without the use of modern
diagnostic instruments, the symptoms described in the first line might be confused
withpregnancy.
FormulaAnalysis
Gu Zh F LngWn is used to invigorate blood circulation and dissolve stasis;
dispelphlegmandpromotewaterfow;dispersetheconcretion;andstopbleeding.
Mdnpandtornareusedtoinvigoratebloodcirculationaswellasdissolve
stasis,attackingtheintractableconcretion.
Gu zh circulates blood through the channels and harmonizes the wei-defensive
level;shoyoregulatestheying-nutrientlevelandstopspain.
Flngregulatesthemiddlejiaoandstabilizesqi,resolvingphlegmanddraining
waterbypromotingurination.
In concert, these five medicinals expel the old and bring in the new to gradually
dissolveandeliminatetheconcretion.Oncebloodstasisisremovedandnewbloodis
producedformenstruation,bleedingwillstopofitsownaccord.
MainIndications
CM:bleedingduetobloodstasisorcolddampcongealedstagnation.
WM: uterine fibroids, chronic pelvic cellulitis with discharge, endometrial
displacementordystopia,appendicitis,postpartumurineretention,oviductobstruction
giving rise to infertility, ectopic pregnancy, retention of lochia, dysmenorrhea,
miscellaneousgynecologicaldisorders,repeatedmiscarriage,skindiseaseswithyellow
1 TheChinesetermistilu( ;Wiseman:fetalspotting):seeglossaryentryforvaginalbleedingduring
pregnancy.
faceandbrownmarkswiththecorrespondingunderlyingpattern.
CaseReport
Female,age37.Initialconsultation:February,2002.
The patient reported her menstruation had been regular up until the previous
year. In the year prior to consultation she started to suffer from abdominal pain
duringmenstruationwithdistensiononbothflanks,copiousdarkmenseswithclots,
and profuse, odorless white vaginal discharge. Her tongue body was dark in color
withathinyellowcoating.Herpulsewaswiryandslippery.
An abdominal ultrasound showed an anechoic mass of 3.8 cm x 3.2 cm in the
regionoftheappendixandontheleftsidewithaclearborderandenhancedechoin
theposteriorwall.Theimagingdiagnosisshowedacystontheleftfallopiantube.
This case was considered to be a damp-heat pattern, with qi stagnation,blood
stasis and a concretion.The treatment method here aims to clear heat and drain
dampness, promote blood circulation, remove blood stasis, soften hardness and
dissipateconcretions.
TheformulaprescribedwasasupplementedGuZhFLngWn:

flng 20g Poria
snlng 10g RhizomaSparganii
dbi 10g BulbusFritillaria
yyrn 30g SemenCoicis
Thepatientwasaskedtotakethedecoctionabove,whileitwaswarm,onceaday.
Upon her second visit, half a month later, there was much improvement.The same
formula was administered again but made into pill form by grinding the ingredients
intofnepowder.Thepatientwasinstructedtotake6gthreetimesaday.
Aftercontinuingthemedicationfortwomonths,asecondultrasoundexamination
revealedtheabsenceofechoconcretionsintheovariesandappendix.
[Reference: DingYan-ling, Ding Fu-min, Wang Li-dong, et al. Gu Zh F Lng Wn in the
Treatment of Gynecological Disease . Chengde Medical College
Journal.2006; 23(3):269-271.]
J io iTng (Donkey-Hide Gelatin and Mugwort Decoction) Pattern
Source Text
Line4

The master said:Among women, there could be spotting, late miscarriage

followedbyincessantblooddescent,orblooddescentinpregnancy.Ifabdominalpain
occursduringpregnancy,thisisuterineobstruction.JioiTngisindicated.
Formula
chunxing 2liang RhizomaChuanxiong
iy 3liang FoliumArtemisiaeArgyi
Decocttheseveningredientsin5shengofwaterwith3shengofclearwineuntil3
shengremains.Discardthedregs,addjiotothedecoction,andcompletelydissolve.
Takeoneshengwarm,threetimesaday.
Repeatthetreatmentifnoobviousimprovementisobserved.
Interpretation
PatternAnalysis
This text discusses the treatment of gynecological bleeding problems in a blood
deficiencywithcoldcongealingpattern.Ingeneral,therearethreecommontypesof
spotting:prolongedscantyuterinebleedingatvariousintervalsduringthemenstrual
cycle, uterine bleeding in the fourth and fifth months of pregnancy (miscarriage),
bleedingwithabdominalpainduringpregnancy(tilu).
Althoughthethreetypesoffemininebleedinghavedifferentnamesandetiologies,
theyoftensharethesamepatternofadeficiencyatrenmaiandchongmaiwithyinqi
unabletoretainitselfinteriorly.
The chong mai, called thesea of twelve channels and thesea of blood, stores
thebloodandqiofthetwelvechannels.Therenmaiisthegovernorofallyinchannels
ofthebody.Itistheplacewhereallyinchannelsmeetandisthereforecalledthesea
ofyinchannels.Sincetherenmaicannourishthefetus,itissaidthattherenmaiis
inchargeofthefetus.
Ifchongmaiandrenmaiareaffectedbydeficiencycold,therewillbeadisharmony
ofqiandbloodintheuterus.Deficiencywillresultinthefailureofqitocontrolblood.
This causes uterine bleeding. Cold will congeal qi movement leading toabdominal
pain during pregnancy.Fetus malnutrition, caused by disharmony ofchong mai and
renmaitogetherwithvaginaluterinebleeding,willslowthenormaldevelopmentof
thefetus.Thereforethesyndromeisalsocalledvaginalbleedingduringpregnancy.
The treatment method should regulate and supplement the chong mai and ren
mai,securethemensestostopbleedingandwarmtheuterustocalmthefetus.The
formulausedisJioiTng.
FormulaAnalysis
TheformulaSWTng(FourSubstancesDecoction),includingdhung,shoyo,
dngguandchunxing,nourishesandharmonizestheblood.
jio nourishes yin to stop blood. i y warms the uterus and thus regulates
menstruation.
Allofthemedicinalsareharmonizedbygncoandstrengthenedbyricewine.
Allmedicinalsworktogethertoharmonizeandstopblood,warmtheuterus,and
regulatemenstruation as well as alleviateabdominal pain and calm the fetus.This is
anessentialformulaforgynecologicaldiseases.
However, doctors should pay special attention to the usage ofchun xing and
dng gu in the formula as the two medicinals tend to activate the movement of qi
andbloodwhichcoulddo harmtothefetusqi.Thereforetheformulashouldnotbe
prescribedifuterinebleedingofvariousintervalsisnotcausedbybloodstasis.
MainIndications
CM:stirringfetus,threatenedmiscarriage,habitualabortion,menstrualirregularities,
spottingduetoyinandblooddefciency,anddamageofchongmaiandrenmai.
WM: same as above plus dysfunctional uterine bleeding, abdominal pain during
pregnancyandpostpartumhemorrhagewiththecorrespondingunderlyingpattern.
CaseReport
Female,age26.
The patient complained of vaginal bleeding. She said it started on Oct 14, 1998
followingafamilyvisitonOct12.OnthebasisofapositiveHCGtest,alocalhospital
diagnosed a potentialmiscarriage.The volume of blood increased around 3 pm and
thediagnosiswaschangedtomiscarriage.
The patients symptoms and signs included: emaciation, red lips, fatigue, and a
low voice. She had a red tongue with a thin coating, and a fine slippery pulse.The
patient had begun menstruating at 14 and had married at 25. Her last menses had
occurredonAugust26,1998.Hermenstrualcyclewas6/26-30days.Atthetimeofthe
visit,thepatientscolporrhagiavolumewasheavy.
The Chinese medicine diagnosis was vaginal bleeding during pregnancy due to
qiandblooddeficiency.Thereforethetreatmentmethodcalledfornourishingqiand
bloodtocalmthefetus.
Formula:
shshn 30g RadixAdenophoraeseuGlehniae
uji 30g NodusNelumbinisRhizomatis
Thepatientwasinstructedtodecocttheabovemedicinals,exceptjio,with600ml
ofwatertoobtain300mlofdecoction.Shewasinstructedtodissolve jiointothe
decoctiontomakeonedaysdosage.Thepatientwasinstructedtotake100mlofthe
decoctedherbsthreetimesadayfortwodays.Thepatientwastoldtorestinbed.
DuringthepatientsfirstreturnvisitonOct15,shereportedthather bleedinghad
decreasedandthatsheneededonlytwosanitarynapkinseachday.HerHCGtestwas
stillpositive.Othersymptomsshereportedwerepoorappetiteandthinsloppystools.
Thepatient continued to take the decoction with sh rn (Fructus Amomi) added to
strengthenthespleenandcalmthefetus.
On her second return visit on Oct 17, the patient had a healthy complexion, no
uterinebleeding, and an improved appetite. An additional 20 packs were prescribed
beforestoppingtreatment.
In May, an ultrasound revealed that the fetus was alive and had a normal fetal
heartrate.Thepatientgavebirthtoaboyatfullterm.Boththepatientandtheinfant
werefnefollowingdelivery.
[Reference: Li Ai-ding, LiYou-ding.Jio iTng inTreatingThreatened Abortion and Habitual
Abortion: Case Report 130. Journal of Sichuan Traditional
Medicine.2002;20(10):57-58.]
D ng Gu ShoYo Sn (Chinese Angelica Peony Powder) Pattern

Source Text
Line5

Forincessantabdominalpainamongpregnantwomen,DngGuShoYoSnis
indicated.
Formula
shoyo 1jin RadixPaeoniae
chunxing 0.5jin RhizomaChuanxiong
flng 4liang Poria
zxi 0.5jin RhizomaAlismatis
Pestleallingredients;mixonesquareinch-spoonwithwine.Takethreetimesaday.
Interpretation
PatternAnalysis
This text discusses the treatment of liver-spleen disharmony manifesting as
abdominal pain in pregnancy.The liver corresponds to the wood element of the
fivephasesand is responsible for the smooth and unimpeded flow of qi throughout
the body.The spleen corresponds to earth and it governs the transportation and
transformation of water-dampness.Whether disharmony is due toliver excess over
restricting the spleen and leading to middle jiao qi stagnation and dampness, or
whether the disharmony is due to a weak and damp spleen vulnerable to normal
liver qi restriction, the disharmony between the two can result in stagnation of
qi and blood in the abdomen manifesting as persistent dull pain.Therefore the
treatment method should restrict the liver and strengthen the spleen, regulate qi
anddraindampness.
FormulaAnalysis
Theformulausesshoyoasitschiefmedicinaltocalmtheliverandalleviatepain.
Dngguandchunxingareusedtoregulateqiandblood.
Bizhfortifesthespleen.
Flngandzxicombinetoinducediuresistodraindampness.
MainIndications
CM: abdominal pain associated with liver depression with spleen deficiency and
qistagnationwithdampnessobstruction.
WM:abdominalpainwiththecorrespondingunderlyingpattern.
CaseReport
Thepatientwasinhereighthmonthof pregnancyandcomplainedof abdominal
painwithpersistent lumbarpainandsoreness.Shewas unabletosleeponherback.
She had receivedWestern medical treatment consisting of an infusion of vitamin E,
medroxyprogesterone,andantibiotics.After15daysoftreatmentwithnoeffect,the
patientturnedtoChinesemedicine.
Atthetimeofhervisit,thepatienthaddull, persistentpaininthelowerabdomen,
asensationofheavinessasifshewasbeingdraggeddownward,anddullachingpain
inthewaist.Shewasstillunabletoliefat.
Other symptoms and signs included: a slippery and rapid pulse and a light red
tongue with a slightly white thick coating. Ultrasonography showed that the fetus
wasinahead-downpositionanditsheartratewas118bpm.
The patient was diagnosed with abdominal pain caused by liver constraint and
spleendefciency.
DngGuShoYoSnwasprescribed.

flng 12g Poria
The patient was instructed to grind three packs of the above medicinals into a
powdertobetakeninthree9gdoseseachday.
Thepatientstartedtakingthemedicineat6pmthatsamedayandsheexperienced
relief from theabdominal pain by midnight.Three days after beginning medication,
thepainhaddisappeared.Thepatientreportednorelapseaftertendaysandmedication
wasthereforediscontinued.Accordingtoafollow-upvisitwiththepatient'sfather,a
healthyboywaslaterbornatfullterm.
[Reference: Sheng Sheng-kuan, Sheng Quan-cheng. Dng Gu ShoYo Sn in Treating
Abdominal Pain during Pregnancy . Liaoning Journal ofTraditional
ChineseMedicine.2008;35(10):1594-1595.]
482
Chapter15
Postpartum Diseases
D ng Gu Shng JingYng RuTng (Chinese Angelica, Fresh Ginger

andLambDecoction)Pattern
Source Text
Line4

Forincessantpostpartumabdominalpain, DngGuShngJingYngRuTngis
indicated.Thisformulaisalsoindicatedforabdominalcoldshn,deficiencytaxation,
andinsufciencypatterns.
Formula
yngru 1jin CapraeseuOvisCaro
Decoctthethreeingredientsabovein8shengofwateruntil3shengremains.Take7
gewarm,threetimesaday.
Withseverecoldness,increaseshngjingtoonejin.
Withintensepainandretching,add2liangofjp,andoneliangofbizh.
If shng jing is added, use 5 sheng more water. Decoct until 3sheng and 2 ge
remains.
Interpretation
PatternAnalysis
This text discusses the treatment of abdominal pain in a blood deficiency and
interiorcoldpatternafterlabor.
Women are usually deficient after labor. Pathogenic cold can take advantage of
thisdeficiencyandinvadetheinteriorresultinginthestagnationofqiandbloodand
manifestingascontractingpainintheabdomen.Becausethisisadeficiencycoldpattern,
thepainisusuallydullandpersistentwithreliefcomingfrompressureandwarmth.Cold
shn(contracting,colickyabdominalpain)isasimilarpattern.Patientswithlong-term
VolumeThree:Chapter15 Pulses,PatternsandTreatmentofPostpartumDiseases 483
defciencyortaxationmayalsopresentwiththistypeofabdominalpain.
The treatment method should aim to warm channels, nourish blood, dissipate
cold,andsupplementdefciency.
FormulaAnalysis
Intheformula,dnggunourishesbloodandsupplementsdeficiencywhile shng
jingwarmsthemiddlejiao,dissipatescoldandmovesqi.
Withitswarmnatureandstrongflavor,thesizableamountof yngruisusedto
supplement deficiency, warm the middle, and relieve pain, using animal flesh and
bloodtonourishthebodybacktohealth.
Thisformulacantreatnotonlyabdominalpainduetoblooddeficiencyandinterior
cold after labor, but also cold colicky abdominal pain due to blood deficiency and
abdominalpainduetotaxation.
MainIndications
CM:dysmenorrheaduetoyangdeficiencyandbloodcold,delayedmenstruation,
infertility,andpaininthestomachandabdomen.
WM:tobeusedasdiettherapyforconditionswiththecorrespondingunderlying
pattern.
CaseReport
Female,age33.Initialconsultation:November20,2004.
Thepatientcomplainedofdeepchillingcoldinherbody.Thediseasemanifested
six years prior to the consultation.When riding a bike in late winter on the 40th day
followinglabor,thepatientfeltchilledtothebone.Afterthat,shegraduallyfelther
insidesbecomecolderandcolderovertime.
Atthetimeofherfirstvisittotheclinic,shereported coldpainalloverherbody
and especiallyinherhead.Hermusculature was sensitive to the slightest touch and
shesufferedfromaheavyacheinherlowerback.Shealsoexperiencedshortnessof
breath, oppression in the chest andtinnitus. She presented with a pale tongue with
thinwhitecoatingand,especiallyatthechposition,asunkenandfnepulse.
The pattern identified was blood deficiency and congealing cold.The chosen
treatment method aimed to warm the channels and dissipate cold, warm yang and
supplementdefciency.
ShewastreatedwithDngGuShngJingYngRuTng:

yngru 500g CapraeseuOvisCaro
She was instructed to cook the above three ingredients together in the amounts
prescribed,removethesolidswhenthemuttonhadcooked,anddrinkthesoupoffand
onthroughouttheday.Shewasaskedtorepeattheprocedurefortwoconsecutivedays.
Two days later, the patient reported no significant change in her condition.
20gofjp(PericarpiumCitriReticulatae)and10gofbizh(RhizomaAtractylodis
Macrocephalae)wereaddedtothepreviousformulaandthepatientwasinstructedto
continuethemodifedtreatmentfortwomoredays.
Thepatientthoughtherillnessmightlastawhileandthattakingtheprescription
foronlytwodayswouldprobablyproveinsufficient.Shecontinuedthetreatmentfor
eightdayswithgoodeffect.Whenshecametothenextvisit,her shortnessofbreath
wasgone,andhergeneralizedpainwasgreatlyrelieved.Sheexperiencedasignificant
decreaseinthecoldsensationinherheadand,withtheexceptionofherlowerbackand
hips,generalcold.Herpulsehadtakenafavorableturnandhercomplexionwasrosy.
Thepatientwasagaininstructedtotake50gofdnggu,60gofshngjing,and
200gofyngru.
Threedayslater, all the remaining symptoms had lessened and even thetinnitus
hadmarkedlydecreased.Thepatientwastoldtocontinuethetreatmenttoenhance
theefects.
[Reference:MaGuo-zhen.EffectiveTreatmentwithDngGuShngJingYngRuTng:Case
Report.HenanTraditionalChineseMedicine.2007;27(11):15.]
Z h Sh Sho Yo Sn (I mmature Bitter Orange and Peony Root

Powder)Pattern
Source Text
Line5

For postpartum abdominal pain, vexation, fullness, and inability to lie down, Zh
ShShoYoSnisindicated.
Formula
FructusAurantiiImmaturus(burnedtodarkcolor
zhsh 1portion
withoutcharring)
shoyo 1portion RadixPaeoniae
Pestle equal portions of the two ingredients.Take one square inch-spoon, three
timesdaily.
Alsoindicatedforwelling-abscesseswithpus.Takewithbarleygruel.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofpostpartumabdominalpainasassociatedwith
qiandbloodstagnation.
Postpartum abdominal pain patterns can be differentiated into deficiency and
excesspatterns.Ifapatientdoesnotpresentwithvexationandfullness,sheprobably
suffers from deficient cold. However, the patient described in the text presents
vexation, fullness, and inability to lie down. Vexation is a sign of qi stagnation
transformingintoheatandleadingtoheartqirestlessness.Fullnessisamanifestation
of qi stagnation. Abdominal pain is a sign of qi binding and even some blood
coagulating in the abdomen, hence the pain produced by blockage. Other common
signsareredtonguewithlittlecoatingandawirypulse.
Theoverallpathodynamicisqistagnationandsomebloodstasis.TheformulaZh
ShShoYoSnisusedtobreakupqistagnation,dispersebinds,harmonizeblood,
andrelievepain.
FormulaAnalysis
Intheformula,zhshischarredsothatitcantakeitseffectintheblood,breakup
qistagnation,andmoveblood.
Sho yo moves and harmonizes the blood to relieve pain, its astringent flavor
preventingexcessdissipationofthezhsh.
Taken with barley congee, these two medicinals harmonize theliver qi, nourish
theheartandspleen,andfortifystomachqi.
Theformulacantreat welling-abscessesbecause abscessesareformedfromblood
andqistagnationandbothaspectsoftheformulaspecifcallymovestagnation.
CaseReport
Sevendaysafterlabor,thepatienthadstoppeddischarging lochiaandstartedto
havedullpaininthelowerabdomen.
At the time of the visit, she presented with severe pain in the lower abdomen
refusing pressure. Her complexion was pale with a bluish-green hue and her facial
expressionshowedherpain,vexation,andagitation.Shereportedfeelingsoffullness
and oppression, and an inability to lie down. Her tongue was slightly purple with a
thinwhitecoating.Shehadasunkenandwirypulse.
The patternidentifiedwasqistagnation and blood congestion, so the treatment
method aimed to break qi, dissipate binds, harmonize blood, and relieve pain. She
wastreatedwithZhShShoYoSn:

She was instructed to boil the medicinals with water. After taking one pack that
night,thepainwasgone.
[Reference:Yin Guang-hou.Treating Abdominal Pain after Labor with Zh Sh ShoYo Sn:
CaseReports.JournalofSichuanTraditionalMedicine.1986,11:38.]
X iY XuTng (Lower Blood Stasis-Purging Decoction) Pattern

Source Text
Line6

The master said,As a rule, postpartum abdominal pain is treated with Zh Sh
ShoYoSn.Iftheconditionisnotrelieved,thisindicatesdrybloodfixedbelowthe
umbilicus. XiY XuTng is then recommended.This formula is also indicated for
inhibitedmenstruation.
Formula

torn 20pcs SemenPersicae
zhchng 20pcs EupolyphagaseuSteleophaga
Grindthethreeingredients,kneadwithhoney,andmakeinto4pills.Boilonepill
withoneshengofwineuntil8geremains.Takeasonedose.
Thecolorofthefreshlypurgedbloodshouldresemblethecolorofapigliver.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofpostpartumabdominalpainasassociatedwith
staticbloodbindinginternally.
If a patient experiencespostpartum abdominal pain, it is usually a manifestation
ofqistagnationwithsomebloodstagnation.Insuchacase,theformulaZhShSho
Yo Sn is indicated to move qi and harmonize blood. However, if the abdominal
pain is not cured after taking the powder, this indicates that the problem is not
primarily a qi stagnation pattern, but one of significant blood stasis accumulation
obstructing the uterus.This is an excess pattern of internal stasis-heat binding, and
is therefore more severe than a Zh Sh ShoYo Sn pattern. In the latter situation,
the necessary treatment method should break up blood and expel stasis, crack
hardness and dissipate binds with some flushing of heat.The indicated formula is
XiYXuTng.
FormulaAnalysis
This for mula is modified from D Hung Zh Chng Wn (R hubar b and
EupolyphagaPill).
Dhungfushesheatandexpelsstasis.
Tornmoistensdryness,dissipatesbinds,activatesblood,andresolvesstasis.
Zhchnghasavigorouspenetratingnatureandworksspecificallyonbloodlevel
stasissoitisgoodatbreakingupdrybloodandcrackinghardness.
Whenthethreearecombined,theirefficacyinbreakingupbloodismuchstronger.
Fearingthatsuchacombinationmaybetoostrongandcoulddamagethemiddleand
upper jiao, the formula is administered via honey pills which are used to moderate
andextendthedurationoftheefects,thuspreventinganysideefects.
MainIndications
CM: abdominal pain from internal blood stasis obstruction usually presents with
the following symptoms: stabbing pain fixed in the lower abdomen and refusing
pressure, presence of a palpable hard mass, and a bluish purple tongue with stasis
spotsandspeckles.
WM:hepatocirrhosis(orascites), severebloodstasisinpatientswithfairlystrong
constitutions,coronaryheartdisease,anginapectoris,menstrualdisordersorpostponed
menstruation,dysmenorrhea,sequelaeofstrokeorconcussionwiththecorresponding
underlyingpattern.
CaseReport
Onthefifthdayfollowingherlabor,thepatientsufferedfromgeneralizedbleeding.
Shewashospitalizedandtreatedwithantibiotics,hemostatics,transfusion,andChinese
medicinals,allofwhichprovedineffective.Whenaskedaboutthehistoryofherpresent
illness, her family members said she had taken 15 g of x yng shn (Radix Panacis
Quinquefolii) because she had been afraid that she might be too weak for the birth.
The following day she had drunk half a bowl of chicken wine1. Soon afterwards she
developedafever.Shewenttothehospitalwhereherfeverwasdiagnosedashaving
comefromexternalpathogen.Shewastreatedwithantipyretics(ofanunknownname),
whichcausedspontaneoussweatingfollowedbyhematemesisandepistaxis.
At the visit, she presented with the following symptoms: pale complexion,
hematemesis, epistaxis, generalized purple patches on her skin, purple rings around
her eyes, purple nails, listlessness, shortness of breath, a low voice, dry lips with no
desireforwater,vexation,restlessness,andnoappetite.Shehaddistentionandfullness
1 PresumablyaChinesepeasantfolkremedymadesomehowfromchickens.
inthelowerabdomenwhichproducedastabbingpainwhenpalpated.Shehadscanty
urination,sparselochialdischargeandhadhadnobowelmovementsforseveraldays.
Hertonguewasredwithlittlecoatingandshehadaslightlyroughpulse.
The etiology of the pattern was discerned to be the misuse of supplementing
medicinals leading to internal stasis and obstruction which then transformed into
heat.The previous doctors use of antipyretics induced excessive sweating thereby
damagingyinandproducingintenseheatwhichtransformedintofire.Fireisbehind
thefreneticmovementofblood,whichmanifestedhereashematemesisandepistaxis.
Thispatternwascriticalandshouldbetreatedwith XiYXuTngtotakeaway
thefrewoodfromunderthecauldronandthustreatthediseaseatitsroot.
Formula:
zhchng 6g EupolyphagaseuSteleophaga
Thepatientwasinstructedtogrindthethreemedicinalsintopowder,andthenboil
them in 25 g of honey.The decoction was to be divided and taken four times. After
following these instructions, the patient defecated two times and herhematemesis
andepistaxiswererelieved.Thelochia,however,remainedblocked.Theformulawas
modifedasfollows:
zhchng 10g EupolyphagaseuSteleophaga
Atthesecondvisit,thepatientwasinstructedtoadd30gofhoneywhenboiling
themedicinals.Thepatientwasaskedtodivideandtakethedecoctionfourtimes.
Aftermedication,her lochiadischargegraduallyincreasedandmanypurpleclots
werepassed.Herothersymptoms,includinghematemesisandepistaxis,disappeared.
The patient spent more than a month rebuilding her health through the regulation
and nourishment of her heart and spleen. The result of CBC was normal upon
reexamination.
[Reference:LinShang-qing.ClinicalApplicationofXiYXuTng:CaseReports
.NewJournalofTraditionalChineseMedicine.1986;6:47-48.]
ZhPDWn(BambooShavingsBigPill)Pattern

Source Text
Line10

For deficiency among breastfeeding women with vexation, derangement, and
retchingcounterfow,quietenthemiddle,andsupplementqiwithZhPDWn.
Formula
shngzhr 2fen CaulisBambusaeinTaenia
shgo 2fen GypsumFibrosum
guzh 1fen RamulusCinnamomi(skinremoved)
gnco 7fen RadixetRhizomaGlycyrrhizae
biwi 1fen RadixetRhizomaCynanchiAtrati
Grindtheingredientsandmixwithdzo(FructusJujubae)tomakesmallbullet-
sizedpills.Takeonepillwithwaterthreetimesduringthedayandtwiceintheevening.
Withheatefusion,doublethedosageofbiwi.
Withvexationandpanting,addonefenofbish(SemenPlatycladi).
Interpretation
PatternAnalysis
This line discusses the patterns and treatment of postpartum conditions as
associatedwith middlejiao deficiency and internal heat with impaired downbearing
ofthestomach.
Womentendtobefluidandblooddeficientafterlabor.Breastfeedingcanfurther
weaken qi and blood.Yin deficiency can engender internal heat, which harasses the
center.Thisleadstostomachqidisharmonywhichmanifestsasretchingcounterflow.
Theinternalheatharassesthespirit-brightnessandheart-spiritthuslosesitsmaster,
which manifests as vexation and derangement.Therefore, this pattern presents as
vexation,derangement,andretchingcounterfow.
Accordingtotheformula,patientsexhibitingthispatternshouldalsopresentwith
fever, dry mouth, thirst, and a rapid, deficient pulse.The formula indicated isZh P
DWntoclearheat,descendcounterfow,quietenthecenter,andboostqi.
FormulaAnalysis
Intheformula,shgoandzhrworktogethertoclearheat,descendcounterfow,
andstopretching,andbiwiclearsdefciencyheat.
Thesweetnessandacridityofguzhandgncoworktogethertoengenderqi.A
largedoseofgncoisusedtoquietenthecenterandsupplementqiwhilethemeatof
Chinesedatessupplementsandboostsmiddleqi.Administeringthemedicinalsinpill
formmoderatesandextendstheefectsoftheformula.
Bothwarmandcoldmedicinalsareusedinthisformula.Theyareusedtoenhance
and control one another so as to take advantage of their properties and functions
whilemoderatingtheeffectsoftheircounterpartstoavoidsideeffectsandinjuryto
thepatientsuprightqi.Forexample, shgoisusedtoclearheatinthe stomachbut
couldalsopotentiallydamagestomachyangifnotcombinedwith guzhtomoderate
itsefects.
MainIndications
CM:visceralagitation,vexation,derangement,andretchingcounterflowinwomen
duringmenstruationorafterlabor.
WM:menopausalsyndromewiththecorrespondingunderlyingpattern.
CaseReport
The patient reported for more than two years she had suffered from vexation,
derangement, a feeling of emptiness in the epigastric region andoppression in the
chest.Thesymptomsconsistentlyoccurredfivetosixdayspriortohermenstruation,
plungingherintoagonizingpain.Shesoughttreatmentwithnoefect.
Uponherfirstvisit,thepatientpresentedwiththefollowingsignsandsymptoms.
Hermenstrualcyclewasnormal,thedischargescantanddarkwithnoclots.Following
menstruationshehadadrycoughbutnoretchingcounterflow.Hereating,urination,
anddefecationpatternswerenormal.Hertonguehadaslightlyyellowanddrycoating.
Herpulsewaswiryandrapid.Fouryearspriorshehadgivenbirthtoababygirl.
Thispatternwasidentifiedasharassmentoftheinteriorbydeficiencyheatandqi
excessinthechongmai.Thechosentreatmentmethodwastoclearheatandquieten
thecenter.
Formula:ZhPDWn.

biwi 15g RadixetRhizomaCynanchiAtrati
She was provided with three packs of herbs and instructed to decoct one pack
per day in water. She was instructed to boil the above medicinals twice in water,
combinethetwodecoctions,dividethemixtureintotwoequaldoses,anddrinkone
dose in the morning and the other in the evening. She was instructed to do this for
three consecutive days, starting seven days prior to her period. She followed the
instructionsfortwomonthsandwascured.
[Reference:ZhangXian-zheng.SongJian-minsExperienceofApplying ZhPDWn
.ShandongJournalofTraditionalChineseMedicine.1993;12(1):49.]
B iTuWng Ji Jio Gn CoTng (Pulsatilla plus Donkey-Hide
GelatinandLicoriceRootDecoction)Pattern
Source Text
Line11

Forpostpartumdiarrheacausingextremedeficiency, BiTuWngJiGnCo
JioTngisindicated.
Formula
bituwng 2liang RadixPulsatillae
qnp 3liang CortexFraxini
bip 3liang CortexPhellodendriChinensis
Decoctallingredientsexceptforjioin7shengofwateruntil2.5shengremains.
Add the jio and decoct until completed dissolved. Divide and take warm, three
timesaday.
Interpretation
PatternAnalysis
This line discusses the patterns and treatment of postpartum heat diarrhea
damagingyin.
Heat diarrhea refers to the principal symptom of dysentery. After labor, women
arealreadydeficientinqiandblood.Diarrheafurtherdamagesyin.Thus,awomanin
thissituationisseverelyemaciatedandweak.
The principal formula used for heat pattern dysentery is BiTuWngTng.
However,becausethewomaninthissituationisinastateofqiandblooddeficiency,
theformulamustbemodified.ThereforejioandgncoareaddedtomakeBiTu
WngJiJioGnCoTng.
FormulaAnalysis
Intheformula,bituwngclearsheatandresolvesdiarrhea.
jioandgncoworktogethertonourishbloodandmoderatethemiddle.
MainIndications
CM:postpartumheattypediarrhea,yindeficiency,andbloodweaknesscausedby
heattypediarrheaandrectalheaviness.
WM:chronicdysenterywiththecorrespondingunderlyingpattern.
CaseReport
Female,age24.
Thepatientcomplainedoflochiadischarge.Duringthesummerpriortopresentation,
the patient had been attacked by summerheat-dampness. At the end of autumn,
she had profuse lochia discharge after she delivered. It was surmised that latent
summerheathadlodgedinthemembranesource(myun,)andwasmanifesting
as diarrhea when the body attempted to discharge the heat through the bowels.
The onset of this disease followed childbirth. Additionally, the woman was losing
consciousness more than ten times per day and looked so ill she could have been
mistakenforacorpse.
At the visit, she presented with the following symptoms: red and white loose
stools with over 40 bowel movements per day, abdominal urgency, and rectal
heaviness.Shealsoreportedabdominalpainsosevereastoleadtounconsciousness,
anextremebittertasteinthemouth,anda desirefordrinkingwater.Whenpalpated,
her chest and abdomen feltscorching hot. Her pulse was fine and rapid; the fine
pulseindicatedyindefciency,andtherapidpulseindicatedheat.
TheformulausedwasalargedosageofasupplementedBiTuWngTng.
bituwng 4qian RadixPulsatillae

qnp 2qian CortexFraxini
hungbi 2qian CortexPhellodendriChinensis
jnynhu 6qian FlosLoniceraeJaponicae
hunglin 1qian RhizomaCoptidis
jio 1qian CollaCoriiAsini
hungqn 2qian RadixScutellariae
bisho 3qian RadixPaeoniaeAlba
chobisho 3qian RadixPaeoniaeAlba(dry-fried)
YYunSn 3qian OriginalQi-BoostingPowder
xinhy 1pc FoliumNelumbinis(fresh)
The next day, during the patients second visit to the hospital, the pain was
resolved and no further loss of consciousness had occurred.The dysentery had also
lessened.
To moisten her damaged yin, the patient was treated with sweet-flavored and
cool-natured medicinals such as xin sh h (Caulis Dendrobii, fresh), xin shng d
(RadixRehmanniae,fresh),xinuru(RhizomaNelumbinis,fresh),xinlinz(Semen
Nelumbinis,fresh),andgnzh(CaulisSacchari).
Aftertakinganotherfvepacksofmedicinals,shewascured.
[Reference:HeLian-chen.ReprintofEfectiveandCategorizedCasesofNationallyRenownedDoctors
.Shanghai:ShanghaiScientifcandTechnicalPublishers;1960.p.129.]
494
Chapter16
Miscellaneous Diseases in Women
B n Xi Hu PTng (Pinellia and Officinal Magnolia Bark Decoction)

Pattern
Source Text
Line5

Whenawomanfeelsasifthereisapieceofgrilledmeatinherthroat,BnXiHu
PTngisindicated.
Formula
hup 3liang CortexMagnoliaeOfcinalis
flng 4liang Poria
gnsy 2liang FoliumPerillae
Decocttheingredientsin7 shengofwateruntil4shengremains.Takewarmfour
times;threetimesduringthedayandonceintheevening.
Interpretation
PatternAnalysis
This text discusses the treatment of congealing phlegm and qi stagnation in the
throat.
Feelinglikehavingapieceofgrilledmeatinthethroatmeansthepatientfeelsthat
thereissomethingstuckinherthroatthatcannotbeswallowedorexpectorated.This
feelingisworsewhenthepatientdrinkswaterorswallowssalivabutthepatienthas
nodifcultyorpaininswallowing.Thisdiseasewaslaternamedplum-pitqi.
Theunderlyingpatternofthisafflictionisconstraintandsuppressionoftheseven
emotionswhichleadstoinhibitedqimovement.Qistagnationandcongealingphlegm
thatlodgesinthethroatproducesthecharacteristiclodgedplum-pitsensation.Itshould
benotedthatwhilethisafflictionalsooccursinmen,itismostcommonlyseeninwomen
VolumeThree:Chapter16 Pulses,Patterns,andTreatmentofMiscellaneousDiseasesinWomen 495
because,atleastinChineseculture,theyinternalizetheiremotionsmorethanmen.
Thetreatmentmethodaimstoopenbind,resolvephlegm,anddescendcounterflow
by making qi follow its appropriate path downwards.The formula used is Bn Xi
HuPTng.
FormulaAnalysis
Bn xi harmonizes the stomach, descends qi counterflow, resolves phlegm, and
opens binds. Hu p is warm in nature with bitter and pungent flavors.These can
moveqi,relieveconstraint,downbearqi,anddisperse fullness.Hupcanalsohelp
bnxitodownbearcounterfowanddissipatebinds.
Flngissweetandblandinflavor.Itcandraindampness,fortifythespleenand
helpbnxiresolvephlegm.Thepungentflavorandwarmpropertiesofshngjing
havedispersingandmovingeffectswhichcanhelpbnxitoharmonizethestomach
andstopvomiting.
Aromaticsydiffusesthelungandsoothesthe liver.Workingtogetherwith hu
pitregulatestheliverandlungqi.
The combination of qi ascending and descending medicinals is based on the
principlethattreatingphlegmwithouttreatingqiisnottreatingitcorrectly.
MainIndications
ModifedvariationsofBnXiHuPTngcanbeusedtotreat:
CM:diseasescausedbyqistagnationandcongealingphlegm.
WM: chronic pharyngitis, vomiting and stomach discomfort of unknown origin,
chronic hepatitis, hysteria, esophageal spasm, bronchitis, depression, aphonia after
cold,asthma,pertussis,morningsickness,gastroptosis,gastroatonia,andedemawith
thecorrespondingunderlyingpattern.
CaseReport
Male,age40.
Thepatientreportedforninemonthshehadfeltsomethingblockedinhisthroat
whichhecouldneitherswallownorspitout.Onemonthpriortohisconsultation,he
took five packs of modified Bn Xi Hu PTng supplemented with w yo (Radix
Linderae),xingf(RhizomaCyperi)andjigng(RadixPlatycodonis).Themedicine
furtheraggravatedthesensation.
Uponhisvisit,thepatientreportedthathis throatwascongested.Thepatientalso
reported a feeling of phlegm blocked in the throat, which, when forcefully spit out,
provedtobestickyyellow sputum.Thepatientalsoreportedyellowurineand chest
oppression.Hehadaredtonguewithathickandslipperyyellowcoatingandawiry,
slipperyandrapidpulse.
Themechanismofthisdiseasewasphlegmobstructingthemovementofqiwhich,
overtime,transformedintoheatandleadtoobstructioninthethroat.
AmodifiedBnXiHuPTngwasappliedtoregulateqi,dissolvephlegm,clear
heat,anddissipatebinds.
zsy 9g FoliumPerillae
zhbim 9g BulbusFritillariaeThunbergii
flng 12g Poria
rndngtng 12g CaulisLoniceraeJaponicae
hungyoz 6g RhizomaDioscoreaeBulbiferae
Thepatientsthroatcongestiondisappearedaftertaking10packsofthemedicinals,
butthefollowingsymptomsremained: sporadicfeelingsofobstructioninthethroat,
sticky yellow sputum, slight oppression in the chest, a red tongue with a slippery
yellow coating, and a slightly rapid slippery pulse.The pattern was identified as
lingeringphlegm-heatandqimovementdisorder.
Theformulawasthereforemodifiedbyremoving hungyozandadding6gof
piln(HerbaEupatorii)toresolvedampnessandturbidity.12gofhifsh(Pumex)
werealsoaddedtodescendfreanddissolvephlegm.
Aftertaking12packsinsuccession,thesensationofobstructiondisappeared.
[Reference:PengShu-xian.ClinicalApplicationofBnXiHuPTng:CaseReports
.LiaoningJournalofTraditionalChineseMedicine.2003;30(7):583-584.]
G n Mi D ZoTng (Licorice,Wheat and Jujube Decoction) Pattern

Source Text
Line6

For women with visceral agitation who display frequent sorrow with a desire to
weep,appearas though possessed by a spirit, and frequently yawn and stretch,Gn
MiDZoTngisindicated.
Formula

xiomi 1sheng FructusTritici
Decoct the ingredients with 6 sheng of water until 3 sheng remains.Take warm
threetimesdaily;thisformulaalsoactstosupplementspleenqi.
Interpretation
PatternAnalysis
Thistextdiscussesthetreatmentofvisceralagitation.
Emotional trauma, excessive thinking orunremitting sorrow often precedes this
malady.Allofthesefactorscanrenderthe liverunabletomaintainthefreeflowofqi
inthebodywhich,whenconstrainedlongenough,transformsintofireanddamages
bodyfluids.Theheartandspleenarebothaffectedandeventuallybecomedeficient.
Heartspiritisharassedandthus,patientspresentwithfrequent,uncontrollablebouts
ofsorrowanddesiretoweep.Whenthespleenisdeficientitissusceptibletoattackby
theliver,andwhenthemiddlejiao,liver,andgallbladderchannelsareindisharmony,
stretchingandyawningbringsometemporaryrelief.
Additional symptoms like unexplainable, unexpected emotional outbursts of
laughter,crying,joyoranger,vexationandinsomnia,absorptioninexcessivethought
duringthedayandexcessivedreamingatnight, auditoryand/orvisualhallucinations,
a sensation like ants crawlingonthe skin,profuse sweating,lack of thirst or hunger,
dry mouth, constipation, preference for darkness and refusal of any light or sound
maybepresentinsomecombination.
FormulaAnalysis
Thispatternisadualdeficiencyofthe spleenandheart.Theformula GnMiD
ZoTngisusedtosupplementtheheartandspleen,whilealsoquieteningtheheart.
Intheformula,gncoanddzoarebothneutralandsweetand,thus,ableto
replenishspleenessence,moistendrynessandrelaxtension.
Xiomicannourishthehumoroftheheart,quieten heartspirit,andsootheliver
depression.
Thisformulacansupplementtheheartandspleenqibyusingsweetandmoderate
propertiestoharmonizethemiddle.
MainIndications
CM:visceralagitationduetodualdefciencyoftheheartandspleen.
WM: hysteria, emotional attacks of hysteria, depression type of schizophrenia,
perimenopausal syndrome, and neural weakness with the corresponding underlying
pattern.
CaseReport
Female,age43.Initialconsultation:earlyJune,2007.
Threedayspriortopresentation,thepatienthadlostconsciousnessforhalfanhour
whenquarrelingwithacolleague.Aftershecame,shecriedandrantedunremittingly.
Whenshedidfinallycalmdown,shebecamespeechlessandexpressionless,hereyes
glazedover.Shewasvexed,restless,grieved,andirresponsivetoquestions.Shehada
tendencytoweepandsigh,wasdizzyandcomplainedofheadaches,fatigue,weakness,
and a poor appetite. Despite taking large doses of a sedative she reported having
insomnia. She was constipated and her urine was dark-yellow. Her tongue was thin
withawhitecoatingandshehadafneandwirysunkenpulse.
Thiswasyindeficiencyvisceralagitation,long-termliverconstraint,anddeficiency
firescorchingyin.Therootofthepatternwastreatedbynourishingyinandquietening
thespiritwhilethebranchesofthepatternweretreatedbysoothingandregulatingqi
stagnation.
AmodifcationofGnMiDZoTngwasprescribed.

huixiomi 30g FructusTritici
gutng 10g UncariaeCumUncis
Thepatientwastoldtotakeiteasyandavoidgettingangry.Shewasalsoinstructed
toabstainfrompungentandfriedfoods.
On the second visit, she felt lighter in mood. Hervexation andrestlessness were
relieved and her dizziness, chest oppression, and sighing had all improved. Her
fatiguewasreducedwithhersleepandappetitemuchimproved.Hermouthwasnot
dry.Herurineandstoolwerenormal.Hertonguewasredwithathinyellowcoating
andherpulsewaswiry,slippery,andslightlyrapid.
Shewasprescribedthefollowingmodifedformula:

huixiomi 30g FructusTritici
shnglngg 30g OsDraconis
Allthesymptomswererelievedaftertakingfvepacksofthisformula.
Thepatientwascuredaftertakinganothertenpacks.
[Reference: Hao Jun-qing, HouYan. Experience ofTreatingVisceral Agitation with Gn Mi
DZoTng .JournalofShaanxiCollegeofTraditionalChineseMedicine.
2008;9(6):36.]
WnJngTng(Channel-WarmingDecoction)Pattern
Source Text
Line9

Question:If a woman around age fifty suffers from incessant diarrhea for more
than ten days, and in the evening there is fever, urgency in the lesser abdomen,
abdominalfullness,vexingheatinthepalms,anddrylipsandmouth,why?
Themastersaid:Thisisattributedtowomensdiseases.
Whyisthat?
There is a history of late miscarriage and static blood remains in the lesser
abdomen.
Howcanoneknowthis?
Thepatternmanifestswithdrynessofthelipsandmouth;thatishowoneknows
this.WnJngTngisindicated.
Formula
wzhy 3liang FructusEvodiae

xingqing 2liang RhizomaChuanxiong
mdnp 2liang CortexMoutan(coreremoved)
bnxi 0.5sheng RhizomaPinelliae
mimndng 1sheng RadixOphiopogonis(coreremoved)
Decocttheingredientsin10shengofwateruntil3shengremains.Takewarm,three
times.
This formula is also indicated for women with cold in the lesser abdomen and a
longstanding inability to conceive. Also treats blood loss due to flooding, excessive
menstrualfow,ordelayedmenstruation.
Interpretation
PatternAnalysis
Thislinediscussesthepatternsandtreatmentoffloodingandspottingasassociated
withdefciencycoldofchongmaiandrenmaiwithstaticblood.
The first line describes the clinical manifestations of this pattern.Diarrhea
shouldbeunderstoodhereasblooddescent.AccordingtothetheoryinTheYellow
Emperors Inner Classic, women stop menstruating at the age of 49. If there is any
bleedingthatoccursaftertheageof50,thisisconsidered spotting.Ingeneral,long-
termflooding(profuseuterinebleeding)andspottingcanleadtoyin-blooddamage
andbloodstasis.Thebindingofthebloodrendersitincapableofnourishingyangand
characteristiceveningfeversresult.Themechanismbehindthisisanimbalanceofyin
andyang.Intheevening,yangqiiswaningandshouldwithdrawintotheyinasthe
bodycoolsandpreparestorestforthenight.Butbecauseyinisbounditisunableto
containyang.Freed,yangfoatsintheexteriorandmanifestsasfeversatdusk.
Theyangmingchannelrunsaroundlips,andthelipsdependonthenutrient-qiof
thespleenandstomach.Becausebothchongmaiandrenmaiaredeficient,theblood
stagnatesandyin-fuidsfailtomoistenandnourishthelips.
Palmsareascribedtotheheartandvexingheatinthepalmsisacommonsignof
yin-blooddeficiencyheatconditionsaffectingtheheart.Thechongmaiandrenmaistart
intheuterus,thefootjueyinliverchannelrunsaroundthegenitalstolowerabdomen.
Whenthesechannelscannotbewarmedandnourished,theybecomedeficientandcold.
When blood stasis dries and obstructs qi and blood flow, then symptoms likelower
abdominalurgency,fullnessandstabbingpainrefusingpressuremaybepresent.
Thesecondhalfofthetextexplainstheetiologyofthediseaseandthenecessary
treatment method.Wind-cold pathogen invades the weak uterus, leading to cold
stagnationinthelowerabdomen.Yin-bloodfailstogoupwardtomoistenthelipsand
sothelipsaredry.Thetextstressesthatdrylipsarethecardinalsignofstaticblood
in the lower abdomen.The formula Wn JngTng is used to warm channels and
dissipatecold,nourishbloodanddispelstasis.
FormulaAnalysis
In this formula, w zh y, gu zh and shng jing work together to warm the
channelsanduteruswhiledissipatingcoldinblood.
Dnggu,chunxinganddnpworktogethertoactivatebloodandresolvestasis.
Shoyoandjionourishnutrient-yinandbloodtostopbleeding.
Rnshnandmidngsupplementqiandengenderfuidtomoistendryness.
Shngjing,bnxiandgncocalmstomachqi.
Inthisformula,bothyinandyangareconsideredandfouroftheeightmedicinal
application methods are used: warming, clearing, reducing, and supplementing.The
formula focuses primarily on nourishing blood, dissipating cold, dispelling stasis,
and unblocking channels.The several warming and supplementing medicinals are
balanced by adding a few cold and cool ones to make the whole formula warm but
notdryinnature,thuscreatingawarming,nourishingandunblockingformula.
MainIndications
CM:deficientcoldinchongmaiandrenmai,bleedingduetoobstructionofstatic
bloodanddebilitationofchongmaiandrenmai.
WM: dysfunctional uterine bleeding, chronic pelvic inflammation, habitual
abortion, ovariancyst, hysteromyoma, uterinehypoplasia, infertility, perimenopausal
syndrome,andirregularmenseswiththecorrespondingunderlyingpattern.
CaseReport
The patients chief complaint was a three-year history of lower abdominal pain
during menstruation. Five years prior to presentation, the patient had eaten a lot
of cold food just prior to menstruation. She then experienced with abdominal pain
during menstruation and delayed menstruation, symptoms which grew worse and
worseovertheyears.
Uponherfirstvisit,thepatientreportedthatshewasonherfirstdayofmenstruation,
but that the menstruation had been delayed for three days.The previous day she
had felt cold and dullpain in her lower abdomen. She presented with the following
symptoms:aggravatedpaininthelowerabdomen,scantyandpalemenseswithsmall
clots, lack ofwarmthinthelimbs, fatigue and lack of strength, a pale tongue with a
thinwhitecoating,andasunken,fneandroughpulse.
Thepatientwasdiagnosedwithdysmenorrheaduetocolddeficiencyofchongmai
andrenmaiandstaticbloodobstruction.
Formula:
jiozh 10g CollaCoriiAsiniPilula
mdnp 6g CortexMoutan
The patient was prescribed three packs of medicinals and instructed to take one
packdecoctedwithwaterperday.
Upon her second visit the patient reported significant relief from the abdominal
painandcomparativelysmoothmenstruation.Hertonguewaspalewithathinwhite
coatingandshehadasunkenandfinepulse.Theformulawasmodifiedbyremoving
dngguandchunxingandthepatientwasaskedtotakeanotherthreepacks.
On the third visit the patient reported that herabdominal pain had disappeared
andallhersymptomswererelieved.Thepatientwastoldtotakethepreviousformula
fivedaysbeforemenstruationforthreemenstrualcycles.Thereafter,thepaindidnot
reoccur.
[Reference:ShenYing.ExperienceofApplyingWnJngTng:CaseReports.
D ng Gu ShoYo Sn (Chinese Angelica and Peony Root Powder)

Pattern
Source Text
Line17

Forvariousdiseasesandpainintheabdomenamongwomen,DngGuShoYo
Snisindicated.
Formula
SeetheprevioussectionPregnancy.
Interpretation
PatternAnalysis
This text discusses a treatment method for varying types of abdominal pain in
women.
There are patterns of disharmony that manifest as abdominal pain, but the most
commononeinwomenisliver-spleendisharmony.
In a liver-spleen disharmony, liver qi constraint leads to qi stagnation and blood
stasis. Liver qi fails to support the transforming and transporting functions of the
spleen.This lack of support manifests as spleen deficiency and internal stagnation
of water-dampness.The abdominal pains referred to in this text are a sign of qi
stagnation,bloodstasis,anddampness.
DngGuShoYoSnisusedtoregulatetheliverandspleen,harmonizeqiand
blood,anddrainwater-dampness.Oncetheharmonybetweentheliverandspleenis
restored,qiandbloodmovementwillbesmooth,waterstagnationanddampnesswill
beresolvedandthepainwilldisappearofitsownaccord.
A careful study of the effects of the medicinals reveals that symptoms like
inhibited urination, mild distention and abdominal fullness, and a slight swelling of
limbsandheadcouldbepresent.
CaseReport
Female,age35.
Thepatientreportedexperiencingfrequentdistendingpaininherlowerabdomen
sincethepreviousautumn.Thetwo gunpositionsofhercnkupulsewerewiryon
theleftandsunkenontheright.Hertonguecoatingwasthinandslimy.
The pattern was considered to be one of inhibited qi and blood movement and
turbid dampness stagnating interiorly. Following Zhang Zhong-jings approach, the
followingformulawaschosen:
chodnggu 12g RadixAngelicaeSinensis(dry-fried)

chobisho 18g RadixPaeoniaeAlba(dry-fried)
flng 15g Poria
Theabdominalpainwascuredafter14packs.
[Reference:Wu Xiao-ming, Zhang Zhuo-wen. Professor Lian Jian-weis Experience of Applying
DngGuShoYoSn:CaseReports.JournalofPracticalTraditional
ChineseInternalMedicine.2007;21(4):16-17.]
VolumeFour
SelectedReadingsfromWarmDisease
Theory
(WnBng,)
506
Chapter1
What Are Warm Diseases And Warm Disease Theory?

The term warm diseases refers to a class of acute, febrile diseases that are
precipitated by the contraction of external-heat pathogenic qi, and whose principal
symptom is fever.They often manifest with other signs of heat, and dryness
the sign of damage to yin that readily evolves as the disease progresses. Other
common characteristics of these diseases are that they are contagious, seasonal,
regional, and spread epidemically. In addition to fever, other potential heat signs
include: vexation, agitation, or mental confusion; a red tongue and rapid pulse;
thirst, dry lips, constipation, and scanty urination. According to traditional Chinese
medical theory, warm disease pathogenic qi includes wind-warmth, spring warmth,
summerheat-warmth, damp warmth, latent summerheat, autumn dryness, warm
toxin, and pestilence (virulent disease).Their counterparts in biomedicine are acute,
communicablediseasesandinfectiousdiseases.Forexample:
Acutecommunicablediseases:influenza(e.g.,SARS,avianflu,H1N1influenza),
epidemiccerebrospinalmeningitis,epidemicencephalitisB,measles,rubella,epidemic
parotitis or mumps, dengue fever and dengue hemorrhagic fever, infectious
mononucleosis, typhoid fever, paratyphoid fever, salmonella infections, leptospirosis
andepidemichemorrhagicfever;
Acuteinfectiousdiseases:lobarpneumonia,bronchialpneumonia,septicemia;
Asmallnumberofnon-infectiousacutefebrilediseases:heatstroke,subsepsis
allergica,andacuteleukemia.
Because these diseases have clinical presentations similar to warm diseases in
Chinesemedicine,theyarethereforediagnosedandtreatedwithwarmdiseasetheory.
Warm disease theory is the area of medicine that studies the patterns of disease
development, diagnosis, and the treatment methods for all warm diseases. It is
foundational for the practice of Chinese medicine and is one of the cornerstones of
theChinesemedical classics. Although the dissemination of vaccines and antibiotics
can control some infectious diseases effectively, pattern differentiation theory and
treatment principles for warm diseases are still an efficacious alternative treatment
method for many acute, externally contracted febrile diseases.This is because new
types of pathogenic microorganisms are constantly appearing; more and more
organismsarebecomingdrugresistant,andpharmaceuticalsoftenhaveundesirable
VolumeFour:Chapter1 GeneralIntroduction 507
sideeffects.Furthermore,warmdiseasetheorycanbeappliedtoguidethediagnosis
and treatment of related diseases in other departments, such as difficult cases in
internal medicine, surgery, gynecology, and pediatrics, making it a practical and
valuablesystem.
The Development of Warm Disease Theory

Warm disease theory developed progressively over more than two millennia of
Chinaslonghistory.Generally,thisdevelopmentcanbedividedintofourperiods:the
seminalperiod,fromtheWarringStatesPeriodtotheTangDynasty;thedevelopmental
period, during the Song, Jin, andYuan eras; the formative period, during the Ming
and Qing Dynasties; and the new developmental period, from the establishment of
thePeoplesRepublicofChinatothepresent.
For example, Liu He-jian, one of the four great physicians of the Jin andYuan
Dynasties, proposed the idea that all six qi (wind, cold, summerheat, dampness,
dryness and fire) can develop from (or as the Chinese would saytransform from)
fireandheat,cantransformintofireandheat,andeachcantransformintotheother
undertheinfluenceoffireandheat.Headvocatedthatthesetypesofdiseasesshould
betreatedbymedicinalsthatarecoolorcoldinnature,andthatitwaswrongtouse
acrid-warmherbs at the beginning of a heat disease. 1 Later doctors regarded him as
theoriginatoroftheSchoolofCooling.
At end of theYuan Dynasty, DoctorWang An-dao furthered the theoretical
demarcationbetweenwarmdiseasesandcolddamagebyobservingthedifferencesin
theiretiology,pathomechanisms,andtreatmentprinciples.InhisDiscourseonTracing
BacktotheMedicalClassics(YJngSHuJ, ),hestronglyadvocatedthat
warm and febrile diseases should not be misidentified ascold damage. From then
on,warmdiseasetheorybecameindependentfromthecolddamagesystem.
DuringtheMingandQingDynasties,acoreofpatternidentificationandtreatment
principlesforwarmdiseasesdeveloped,followingthefour-levels(wei-qi-ying-blood,
also referred to as defensive, qi, nutritive, and blood levels) and sanjiao (or triple
burner). Many warm disease masters and their writings came forth, such as the
TreatiseonWarm-HeatDiseases(WnRLn, )andCaseRecordsAsaGuideto
ClinicalPractice(LnZhngZhNnYn,)authoredbyYeTian-shi,the
DifferentiationofDamp-HeatDisorders(ShRBngBin,)byXueSheng-bai,
SystematicDifferentiationofWarmDiseases(WnBngTioBin,)byWuJu-
1 Here the wordheat is used instead of febrile in order to include a subgroup of internal damage heat
diseasesinwhichnofeverisexhibited.Inthiscohort,althoughthepatientsfeelwarmandhavesignsofdeficient
heat,theyexhibitnofever.Ingeneral,externallycontractedheatdiseasesandmostinternaldamageheatdisease
allhavefeverastheirprincipalclinicalsignandthereforeinthistextaretranslatedasfebriledisease.
tong,andWarpandWoofofWarm-HeatDiseases(WnRJngWi,)byWang
Meng-ying. Later generations considered these four men to be the four great warm
diseasemasters.
Otherwarmdiseasetextsinclude:theTreatiseonWarm-HeatPestilence(WnYLn,
)writtenbyWuYou-ke,thePreceptsforPhysicians(YMnFL,)by
YuJia-yan,SystematicAnalysisofColdDamageandWarm-HeatPestilence(ShngHn
WnYTioBin,)byYangLi-shan,Externally-ContractedWarmDiseases
(WiGnWnBngPin,)byChenPing-bo,AchievementsintheTreatment
ofEpidemicRashes(YZhnYD,)byYuShi-yu,EncounteringtheSourcesof
Warm-HeatDiseases(WnRFngYun, )byLiuBao-yi,TreatiseonSeasonal
Diseases (Sh Bng Ln, ) by Lei Shao-yi, thePopular Guide to theTreatise on
ColdDamage(TngSShngHnLn,)byYuGen-chu,andtheExpanded
TreatiseonWarm-HeatDiseases(GungWnRLn,)byDaiTian-zhang.
509
Chapter2
Pattern Differentiation Theory and
Treatment Principles for Warm Disease
Wei-Qi-Ying-BloodLevelPatternDiferentiationandTreatmentPrinciples
SanjiaoPatternIdentifcationanditsTreatmentPrinciples
For the wei-qi-ying-Blood level diagnostic model, the source text discusses the
order of the levels and their corresponding treatment methods.This is further
expandeduponintheinterpretationwherethemechanismsandtreatmentprinciples
are explained in comparative manner. In thesanjiao section, the disease mechanism
ofwarmdisease,thephysiologicalcharacteristicsanddiseasemanifestationsforeach
jiao,andtheircorrespondingtreatmentprinciplesarediscussed.Ofparticularinterest
istheemphasis placed on how the physiological nature of each jiao influences their
respectivetreatmentstrategies.
Section1 Wei-Qi-Ying-BloodPattern
DiferentiationandTreatmentPrinciples
Source Text

(8)
Lookingatthetheoryingeneral,onlyaftertheweiistheqidiscussed;onlyafter
theyingistheblooddiscussed.Whenwarm pathogenicqiisatthewei,thesweating
method is appropriate; only when it reaches the qi can the heat-clearing method
beused;evenifitenterstheying,onecanstillventheatthroughtheqi;inthiscase
substances like x jio (Cornu Rhinocerotis), xun shn (Radix Scrophulariae), and
lng yng jio (Cornu SaigaeTataricae) can be used. If pathogenic qi enters the
blood level, one fears that it will consume blood and move blood (cause bleeding);
one should immediately cool blood and disperse blood; substances like shng d
(R adix Rehmanniae), m dn p (Cortex Moutan), jio (Colla Corii Asini), and
ch sho (Radix Paeoniae Rubra) can be used. If one does not follow the method of
prioritization,onemightmakemistakesandbecomedisconcerted. (TreatiseonWarm-Heat
Diseases,entry8)
Interpretation
Generally,warmfebrilediseasedevelopsatthe weilevelfirst,thengoesintotheqi
level,followedbytheyinglevel,andfinallyaserious bloodlevelpatternappears.The
treatmentprinciplesforeachofthefourlevelsarediferent.
Weilevelpatterns:
In wei level patterns, an exterior-relieving and heat-discharging method should
be chosen. Acrid-cool and light herbs are used to harmonize the qi mechanism of
thelungandweiqibyopening-upanddiffusingthelunganddispersingtheweiqi,
resulting in the warm pathogenic qis venting from the body through the wei level.
A light sweat should appear after the medicine is taken, but do not force excessive
diaphoresiswithacrid-warmmedicinals.
Qilevelpatterns:
Whenadiseaseenterstheqilevel,oneshouldclearandreleasepathogenicheat.
Because qi level patterns contain many possible disease locations, there are also a
number of different treatment methods, including, but not limited to: clearing heat
fromtheqilevel,purging,transformingdampness,andharmonizing.
Yinglevelpatterns:
When pathogenic qi enters the ying level, the focus should be on clearing the
ying and nourishing yin. Dr.YeTian-shi mentioned some commonly used herbs for
yingleveltreatment,suchasxjio,xunshn,andlngyngjio.However,whenthe
pathogenic heat has just entered the yin, 1 its location is not deep; this is a unique
stage during which one applies the novel treatment of venting heat from the ying
level through the qi level. In other words, acrid-cool herbs such as yn hu (Flos
Lonicerae),linqio(FructusForsythiae)andzhy(FoliumPhyllostachydisHenonis)
that clear and discharge qi level heat should be added to a formula that clears and
purgesheattoxinintheyinglevel.Inthisway,theheattoxincanbevented through
theqilevel.
Bloodlevelpatterns:
The pathodynamic of blood level patterns is heat toxin entering theblood and
forcing blood out of the vessels, along with the binding conglutination of heat and
bloodstasis.Itsprincipalclinicalsignsarebleedinganderuptionofmaculae.Serious
bleeding will jeopardize a patients life.Therefore, cooling blood and dissipating
bloodstasisarethefocusesoftreatment.Chinesemedicinalssuchas xjio,shngd,
1Yin:weiandqiareyanglevelsandyingandbloodareyin.
VolumeFour:Chapter2 PatternDiferentiationTheoryandTreatmentPrinciplesforWarmDisease 511
chsho,andmdnpcanclearandremoveheattoxinsfromthebloodlevel,nourish
bodyfuids,invigoratebloodanddissolvestasis.
Thechoiceofappropriatetreatmentshouldbebasedupon:
Theorderinwhichthepatternspresent.
Theirlocation,whetherdeeporshallow.
Their nature, whether chronic or acute, severe or mild, aggressive or non-
aggressive.
For example, if a warm disease pattern presents as relatively mild (i.e., it is
superficialandofnon-aggressivenature),thentheappropriatetreatmentis relieving
the wei and releasing the exterior. Cold medicinals that clear qi level heat should
not be used excessively; otherwise, wei qi will be obstructed by the cold, which
would delay the dispersal of pathogenic qi through the exterior. On the other hand,
when treating a warm febrile disease with a serious heat toxin that can quickly
transmute and transmit more deeply into the interior, in addition to medicinals
that can release pathogenic heat from the wei level, a moderate amount of qi level
heat-clearing herbs should be added, to cut off any further inward invasion of
pathogenicheat.
CaseReport
Male,age61.Admitted:November12,2005.
ThepatienthadbeenworkinginBangladeshfortwomonthsandwasexposedto
manymosquitobites.Hisco-workerhadbeendiagnosedwithdenguefeveratabout
the same time.The patient left Bangladesh on November 2 and traveled for seven
days throughThailand and Hong Kong, before arriving in Guangzhou, China. On
November8heexperiencedafeverof39C,withnoobviouscause.Othersymptoms
and signs included: an aversion to cold, headache, joint and muscle aches over his
whole body, hyperemia of the conjunctiva; hyperemia of the face, as if intoxicated;
light, drycough; no signs of skin rash or bleeding. Previously, he had experienced a
bout of cold sweating, bluish-green complexion, andnausea with a desire tovomit.
Hewasadmittedasaninpatientfortreatment.
Upon admission, his symptoms were recorded as follows: conscious with mental
clarity but fatigued; aversion to cold with fever; sweating, especially after activity;
achinginallhisjointsandmuscles,andheadache;noskinrash;decreasedfoodintake
anddrymouthwithbittertaste;normalurinationandfrequentdefecation.Histongue
body was crimson, with a white and slightly greasy coating. His pulse was slippery
andrapid.
Routinebloodtestresults:
WBC N L BPC
9 9 9
1.7110 /L 0.78310 /L 0.10910 /L 95.9109/L
Vitalsigns:
Temp HR R BP
138/87mmHg
37.3C 105bpm 20times/min
(18.4/11.6kPa)
Physical examination: no signs of jaundice, no mucocutaneous hemorrhage,

no swelling of lymph nodes; light conjunctival hyperemia; inflamed, hyperemic
pharyngealwall;notonsilarswelling;normalheartandlungs;flatandsoftabdomen
with no tenderness to palpation; borborygmus; liver and spleen not palpable below
theribs,noedemainthelowerextremities,nopercussiontendernessineitherkidney
area,andnoabnormalneurologicalsigns.
DiagnosisinWM:denguefever.
DiagnosisinCM:latentsummerheat,withtheweiandqilevelsbothaffected,and
astrongpotentialforthepathogenicqitoentertheyinglevel.
Treatment principles: clear summerheat, resolve dampness, cool the ying level,
andventheatfromtheyingleveloutthroughtheqilevel.
Formula:modifedQngYngTng(YingLevelHeat-ClearingDecoction).
qngho 10g HerbaArtemisiaeAnnuae(decoctedtowardstheend)

zco 10g RadixArnebiae
qngtinku 10g FoliumNerviliaFordii
hush 20g Talcum(decoctedfrst)
dqngy 15g FoliumIsatidis
jnynhu 15g FlosLonicerae
Fourpacksofherbsweregiven.Onepackwastobedecoctedinwaterfororalintake
onceaday.
The patient was kept away from mosquitoes to prevent further transmission. At
thesecondconsultation,onNovember16,thepatientpresentedasfollows:mentally
clear, no fever or aversion to cold, no more aching joints and muscles, and no
headache.Asystemicskinrashhadappearedonedaypriortotheconsultation,which
lookedlikeneedlepricksdenselycoveringtheskin,withoutprotrusionfromtheskin
surface or depigmentation with pressure. He had sweating, decreased food intake,
dry mouth with a bitter taste, normal urination, and loose stools 2 times a day. His
tonguewascrimson,withawhiteandslightly greasycoating.Hispulsewas slippery
andrapid.Aroutinebloodtestfromthediseasecontrolcentercamebackpositivefor
denguefeverantibody.
Bloodchemistrytestresults:
ALT AST GLU GGT CK CK-MB LDH

1116.89nmols1/L 2067.08nmols1/L 7.75mmol/L 76U/L 177U/L 26U/L 299U/L
Thepatientsskinrashwasdueto pathogenicheatintheqilevelspreadingtothe
ying level.The treatment principle was to focus on clearing heat from the qi level,
assisted by cooling the blood and clearing ying level heat. By using this method,
the pathogenic qi could be resolved through the qi level.The formula used was as
follows:
dnzhy 10g HerbaLophatheri
xinhco 10g HerbaAgrimoniae
qngho 10g HerbaArtemisiaeAnnuae(decoctedtowardstheend)
Sevenpacksofherbswereprescribed:onepackdecoctedinwaterfororalintake
once a day.The treatment continued for 10 days.The patient recovered and was
dischargedfromhospital.
[Reference: LiuYe, Zhong Jia-xi, Ruan Jing.TCM Identification andTreatment of Dengue Fever
.NewTraditionalChineseMedicine.2007;39(11):97-98.]
Section2SanjiaoPatternDiferentiation
andTreatmentPrinciples
Source Text 1

(
)
Warm diseases enter through the mouth and nose. Nose qi connects with the
lung and mouth qi connects with the stomach. If a lung disease undergoes reverse
transmission,it will affect thepericardium. Ifupperjiao disease is not treated, it will
transmit to the middle jiao, which is the stomach and spleen. If middle jiao disease
is not treated, it will transmit to thelower jiao, which is the liver and kidney.Warm
diseasesstartfromtheupperjiaoandendinthelowerjiao. (SystematicDifferentiationof
WarmdiseasesMiddlejiao[commentary])
Interpretation
Cold damage occurs whenpathogenic qi invades the body through the skin and
bodyhair,whilewarmpathogenicqioftenentersthroughthemouthandnose,which
connectwiththestomachandlungrespectively.Thelunggovernstheskinandbody
hair, as well as ventilating and dispersing wei qi. At the onset of the disharmony,
eventhoughan upperjiaoexteriorlung-weipatternisprimary,the pathogenicheat
hasalreadybeguntoinfluencetheinterior:thelungzang-organandthestomachfu-
organ.Iftheexteriorpatternisnotreleased, pathogenicheatenterstheinteriorfrom
theexterior,andoneoftenseesalungexuberantheatobstructionpattern.Becausethe
lungandlargeintestinehaveaninterior-exteriorrelationship,andbothconnecttothe
stomachchannel,pathogenicheatinthelungiseasilytransmittedtothe middlejiao
fromtheupperjiao,andmanifestsasastomachorintestinalpattern.
Pathogenicdampnesscaneasilyattackthespleenandstomach.Atthebeginning
itmanifestsasatransitory weiexteriorpattern,butitquicklytransformstoapattern
of dampness encumbering and disturbing middle jiao. However, in certain cases, if
thepatientalreadysuffersfrominsufficiencyofheartqi,andthepathogenicphlegm
isrelativelyexuberant,orthepathogenicheatisexcessivelyexuberant,thepathogenic
qimaydirectlyinvadethepericardiumfromthelung-wei,withouttransmittingtothe
middlejiao.Thenserioussymptomsandsignsappear,suchasdeliriumanddelirious
speech.Thisiscalledreversetransmission.
Middle jiao patterns are often seen during the most intense period of a disease,
when the struggle between upright qi and pathogenic qi is severe. If the disease is
prolonged,uprightqiisunabletocounteractthepathogenicqi,andthelowerjiaocan
beaffected.Forexample,inanexcessyangmingfu-organpatterninwhichthebowels
arenotevacuatingproperly,thelowerjiaoliver-kidneyyincanbedamaged.Generally
speaking,thetransmissionofwarmdiseasesoftenbeginswiththeupperjiaoandends
withthelowerjiao.
Source Text 2

()
Qi in the upper jiao is like mist.To expel pathogenic warmth, one should ascend
it,aswellasresolvetoxins.Theqiinthemiddlejiaoislikefermentedfoam.Toexpel
pathogenicwarmth,oneshoulddredgeanddriveitout,aswellasresolvetoxins.The
qiinthelowerjiaoislikethedregsinaditch.Toexpelpathogenicwarmth,oneshould
breakitupanddriveitout,aswellasresolvetoxins. (TracingBacktotheTreatiseonCold
DamageDetailedDiscussiononWidespreadWarmPestilencetoClarifyDoubts)
Interpretation
Eachofthesanjiaohasitsownphysiologicalcharacteristics.Whentreatingsanjiao
patterns in warm diseases, one should work in concert with these characteristics to
dispelwarmpathogenicqi,atthesametimeasoneclearsheat,andremovestoxins.
The heart and lung reside in the upper jiao.The lung governs qi, and the heart
governs blood.When they perform their functions of diffusing and dispersing, they
are able to transport and distribute qi and blood, which warms and nourishes the
skin, sinews, and bones, and opens and regulates the interstices, just as the fog and
dewmoistentheearth.Therefore,thetreatmentshouldbetodiffuseanddisperse,in
ordertoventthepathogenicqi.
The middle jiao spleen and stomach decompose water and grain, transform
them into essence, and then transport this to the lung.This function is just like
making wine.Therefore, to treat pathogenic qi in the middle jiao, one should focus
ondispersing and unblocking its qi mechanism.That is to say one should utilize the
stomachs descending function to dispel both the formless pathogenic heat and the
solid heat accumulation, 1 and one should take advantage of the transporting and
transformingfunctionsofthespleentodispeldamp-heat.
The functions of the lower jiao are urination, via the kidney and bladder, and
1 This could include any of the following: phlegm-heat, stagnant blood heat, heat-bound dry stool, or
heat-boundundigestedfood.
defecation through the intestines.The treatment process is just like dredging an

irrigationsystem;oncetheimpedimentisremoved,thewaterwaywillflowunimpeded.
Since urination and defecation are important pathways for the elimination of
pathogenicqi,inordertotreatlowerjiaodisorders,thefocusshouldbeondredging
and unblocking the urination and defecation to expel pathogenic qi. Maintaining
normalevacuationofstoolandurineisalsobeneficialwhendispellingpathogenicqi
intheupperandmiddlejiao.
Source Text 3
(
)()
()()()(
)
Whentreatingexternallycontracteddiseaseonemustactlikeageneralspeed
is of the utmost importance in war; the principles of action are time tested and the
methods are adaptable; pathogenic qi must be dispelled completely; the aftermath
must be handled with care; and generally, the earlier the patient recovers, the less
harmhesufers.
When treating internal damage one should act like a wise minister governing a
kingdomassumecommandcalmlyandunhurriedly;havewonderfulforesightand
devise strategies silently; it may appear as if there are no achievements to speak of
andnomeritstobeseen,butthepeopleliveinpeaceandreachaheartyoldage.
Whentreatingtheupperjiaoonemustactlikeafeathermedicinalsorformulas
thatarenotlight in nature do not lift up.Treating themiddle jiao, one must act like
balancing the arm of a steelyard if the medicinals or formulas are not balancing
thennoeasecanberestored.
Whentreatingthelowerjiao,onemustactlikeaweightonthearmofasteelyard if
medicinalsorformulasarenotheavy,thentheydonotsinkdown. (SystematicDifferentiation
ofWarmDiseasesVol.4MiscellaneousWritingsDiscussiononTreatmentPrinciples)
Interpretation
The treatment principles of externally contracted diseases and internal damage
are different. A doctor should pay more attention to dispelling pathogenic qi when
treating externally contracted diseases, and more attention to harmonizing yin and
yang, qi and blood, when treating internal damage. Just as a general leads an army,
a doctor should make use of all kinds of treatment methods to dispel pathogenic
qi completely and rapidly. After recovery, he should carefully guide the patient in
managing diet and lifestyle, as well as giving supportive treatment to regulate all
aspectsofbodyandmind.Theearlierthepathogenicqiisdispelled,thelessharmthe
patientsufers.
The process of treating those with internal damage can be likened to a minister
devisingstrategieswithinacommandtent.Adoctorslineofthinkingshouldbeclear,
deliberate, and thorough, in order to safely and gently bring the patient back to qi-
bloodandyin-yangharmony.Inthisway,thecurativeeffectsmayonlybenoticeable
after a prolonged period of treatment and self-care, so even though the life of the
patient is prolonged, the doctor earns no great fame for his care. In other words,
whenadoctortreatsinternaldamage,heshouldneverbeeagerforquicksuccessand
instantresults;ifadoctortriestoacquireaninstantcurativeeffectanduseswarming
andsupplementingorpurgingmedicinalsexcessively,theqiandbloodofthepatients
zang-fuorganswillbeinjuredevenmore.
Theupperjiaoistheuppermostofthesanjiao.Totreatproblemsofthisjiao,the
doctor should choose medicinals that can float up like a feather.That is to say that
thepropertiesandflavorsofthemedicinalsshouldbelightandascendinginnature,
not bitter, cold, or descending; the dosage should not be heavy, and the decocting
time should not be long. If there is a serious illness, one should not use a single,
excessively large dose, but rather the medicine should be given in small, frequent
doses.Otherwise,thepropertyofaformulabecomesdescending,anditgoesdirectly
tothemiddleandlowerjiaoanddoesnotreachtheupperjiao.
A steelyard represents balance. When pathogenic qi in the middle jiao is
excessive,andupright qiisstillstrong,thetreatmentprincipleistoreduceandexpel
the pathogenic qi. A doctor should not choose light and ascending medicinals, or
heavy and descending ones. At the same time, damp-heat can easily obstruct the
middlejiao.Adoctorshouldassessthedegreeofdampnessandheatandchoosethe
amountsofbitter-cold,heat-clearingherbsandbitter-warm,dampness-dryingherbs
accordingly.
The sliding weight of a steelyard represents heaviness. For example, lower jiao
patterns of liver-kidney true yin exhaustion manifest as stirring wind due to yin
deficiency.Therefore, choose heavy medicinals that directly enter the lower jiao to
nourishtrueyin,anduseheavysedativestoextinguishwind.
Another important aspect of the lower jiao, the descending and eliminating
function of the large intestine and the treatment principle used in its blockage is
discussed in the next excerpt along with the introduction of the concept of the
membranesource.
Source Text 4

()
Drynessaccumulates in the intestines and stomach; the lower jiao is stuck; there
is constraint and stagnation of middle jiao qi, and upper jiao qi cannot descend.
Consequently, accumulation appears. If pathogenic qi lingers in the membrane
source,1itcannotadvanceorretreat(i.e.,itisstuck),thusitobstructstheexteriorand
theinterior,theupper,middle,andlower jiao,andthereforea p-fullness,dry-excess
patternappears.Adoctorshoulduse DChngQTng(MajorPurgativeDecoction).
This is what is called,if one orifice is unblocked, the others will also be unblocked,
or,ifthebiggateisunblocked,thenthehundredgateswillalsobeunblocked. (Treatise
onWarm-HeatPestilenceDiscussiononAbsurdUsageofBreakingStagnatedQiMedicinals)
Interpretation
Whendryfecesaccumulateandbindtheintestinesandstomach,thelowerjiaois
blocked,whichfurtherleadstomiddlejiao qimechanismconstraintandstagnation.
Simultaneously, qi of the upper jiao cannot descend to the lower jiao, and as the
obstructionofqigetsworse,ageneralobstructionofthesanjiaoqimechanismappears.
At this point, if there is residual pathogenic qi in the half-exterior and half-interior
membrane source, it is unable to transmit further interiorly due to the obstruction,
until it becomes a situation of exterior and interior, upper, middle and lowersanjiao
qi mechanism obstruction.Therefore, an abdominal p-fullness, 2 dry-excess 3 pattern
appearswhichcanbetreatedwithDChngQTng.Thelower,posteriororificeisan
importantorificeofhumanbody.Iftheqimechanismofthisorificeisunobstructed,
theotherorificeswillalsobeunobstructed.Thistreatmentprincipleaccountsforthe
importanceofkeepingbowelmovementsunobstructed,whentreatingsanjiaodisorders.
Clinicalnote:asdamp-heatpathogenicqihasthecharacterofsuffusingandoften
lingeringintheqilevel,itisdifficulttoidentifythelocationofthediseaseby zang-fu
patternidentificationorbyfour-levelpatternidentification.Therefore,sanjiaopattern
identifcationismorecommonlyusedtodiferentiatedamp-heatwarmdiseases.
CaseReport
Thepatientschiefcomplaintwasalowfeverofmorethanthreemonthsduration,
which occurred every afternoon, would gradually recede after midnight, and was
1 Seemembranesource(myun, )fordefnitionincludedinglossary.
2 Alsoknownaspsyndrome(pzhng, ).Seeppatternforthedefnitiontoincludeintheglossary.
3 Thecharactertranslatedhereasexcess(sh, )hasmultiplemeaningsinChinese.InChinesemedicine,
itisusuallytranslatedasexcessasopposedtodeficiencyanditdoeshavethatmeaninghere.Italsomeanssolid,
true,orreal.Inthecontextofayangmingexcesspattern,itreferstothephysicalpresenceofsolidmassblocking
thepassagewayofthelargeintestineaswellasanoverallexcesspattern.
alleviated in the morning.This was the basic pattern that recurred on a daily basis.
Her body condition was emaciated and weak.The patient had received treatment in
manyhospitals,buthadbeengivennospecificdiagnosis.Theexaminationrevealeda
lateafternoonlowertidal fever(3838.5C),withoccasional aversiontocold, nausea
and vomiting. Her face was emaciated, with the look of yin deficiency. Her tongue
hadayellow-white,thick,greasycoating,andtheedgesofthetonguebodywerered.
Herpulsewasthready,soggy,andrapid.
Patterndifferentiation:dampnessandturbidityencumberingthe middlejiaoand
obstructingtheqimechanisminthemembranesource.
Treatmentprinciples:disperse,regulate,andventfromtheexterior.
Formula:modifedMr.Leisdifusingandexpellingmethod.
chunp 3g CortexMagnoliaeOfcinalis
bnglng 6g SemenArecae
Threepackswereadministered.
Second consultation: the patient felt looser in chest, though she still had afever
every day, the temperature was lower and the duration shorter. Her tongue coating
appearedtobelighterandwasdissipating.Cogu(FructusTsaoko)4gwasaddedto
theformula.Threepackswereadministered.
Thirdconsultation:thepatientsspiritswerebetter.Hercoldandfeverwereunder
control. Her tongue coating was getting looser, though her appetite was not good.
Middleharmonizingmedicinalsweregiven.
chunphu 4g FlosMagnoliaeOfcinalis
shngyrn 15g SemenCoicis
gy 15g FructusSetariaeGerminatus
Sevenpackswereadministered.Followingthistreatmentthepatientsillnesswas
completelyresolved.
[Reference:YangJin,WuCheng.MengShu-jiangsChineseMedicineAcademicConferenceSyllabus
.BeijingScientifcandTechnicalPress;2000.p.41-42.]
520
Chapter3
Common Diagnostic Methods Used in
Warm Diseases
ObservationoftheTongue
InspectionoftheTeeth
DiferentiatingMacula,Papule,andMiliariaAlba
Inthewarmdiseasesystem,changesinthetongue,teeth,andskinareimportant
sources of information for gaining insight in the nature and location of the disease.
For the tongue, the coating is particularly important. In addition to color, texture
andthickness,themoistureofthetongueisobservedverycarefullybecauseitisthe
moisture that determines whether or not yin is damaged; this is key to determining
thedepthofpathogenicqipenetrationandwhetherthetreatmentneedonlyclearor
ventheat,orshoulditalsosupporttheuprightqiandcontainmoisteningmedicinals
to nourish the yin.The teeth are related to the stomach and kidney.Their color and
moisture distribution are important in determining the nature of the disease (e.g.,
stomach heat and/or damage to kidney yin) and the severity of the condition.The
sectiononmaculae,papulesandmiliariaalbacontainsdetaileddescriptionsofthese
skinlesionsrespectiveclinicalpresentations,commonlocationsandthesignificance
of their various manifestations (e.g., color, size, location, and amount) in relation
to various patterns of disharmony. Readers should pay particular attention to the
differences in presentation between maculae, papules, and miliaria alba, what it
means whether they present singularly or in combination, and the similarities and
diferencesintheunderlyingpatternsbehindtheirpresentation.
Section1 ObservationoftheTongue
Source Text 1

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VolumeFour:Chapter3 CommonDiagnosticMethodsUsedinWarmDiseases 521
Athick,white,anddrycoatingindicatesstomachdrynessandqidamage.Gnco
shouldbeaddedtothenourishingandmoisteningmedicinals,inordertoretainthe
sweetfavortoreplenishbodyfuids.
Athin,whitecoatingindicatesexternallycontractedwind-cold,andthetreatment
should be to disperse and dissipate. A thin, white, and dry coating indicates lung
fluiddamage,andthedoctorshouldchooselightandclearingmedicinals,suchas mi
dng(RadixOphiopogonis),hul(flowerdistillate),andlgnzh(SuccusRhizoma
Phragmitis).Inthisway,upperpatternsaretreatedbyupper(light)medicinals.
A crimson tongue with a white coating indicates dampness trapping hidden
(deep-lying) heat. Initially, the treatment should be to discharge dampness to vent
heat. One should prevent the coating from getting dry during the treatment. If it
doesturndry, do not worry. Secondly, one should vent heat from the interior to the
exterior.It(thecoating)willreturntomoistwhenthedampnessisdischargedandthe
heatisvented.
If at the beginning of a disease, the tongue is dry but the patient has not lost
consciousness, medicinals that nourish upright qi and vent pathogenic qi should be
addedrightaway;ifconsciousnessislost,thenthepathogenicqihassunkeninward,
andthereisnomedicinethatcansavethepatient.(TreatiseonWarm-HeatDiseases,entry19)
Interpretation
Athick,white, and dry tongue coating indicates stomach fluid and qi deficiency.
Since gn co has the characteristics of guarding and not leaving, if it is added to
sweet moistening medicinals, it can guard the middle and nourish qi to recuperate
bodyfluids.Athin,whitecoatingindicatesexternalcontractionofwind-cold,andthe
treatmentshouldbetodispersewindanddissipatecoldtorelievepathogenicqi.
A thin, white, and dry coating indicates lung fluid damage.The doctor can add
lightmedicinalsthatareabletoclearheat,suchas midng,hul,andlgnzh.
Becausethelocationoflungdiseasesisrelativelyhighinthebody,lightandascending
medicinals,whichcantreatupperjiaodisorders,shouldbechosen.
A crimson tongue, with a white,greasy coating, indicates a damp-heat pattern.
Becausedampnessisobstructingtheexterior,heatcannotbeventedandissuppressed
in the interior, which manifests as hidden heat. Initially, the treatment should be to
removedampnesssothattheheatcanventoutthroughtheexterior.Aromatic,drying
herbs are often used to dispel dampness. One should not use them excessively to
preventthemedicinalsfromdamagingbodyfluids,whichmanifestsasadrycoating.
But,evenifapatientbeginstopresentwithadrycoating,oneneednotworrytoomuch,
forassoonasdampnessisdispelledandheatisvented,thebodyfluidswillrecoverby
themselvesanddistributenormally.Thecoatingwillnaturallyregainitsmoisture.
If at the beginning of a warm-heat disease a patients tongue is very dry and
crimson red with little to no coating, then it indicates intense pathogenic heat and
seriousyin-fluidsdamage.Itmayalsobethatthe yin-fluiddamageisamanifestation
of a yin deficient constitution in combination with the intense pathogenic heat. In
either case, if this tongue appears in the preliminary stages of a warm disease in a
patient who has not lost consciousness, then medicinals that nourish yin, replenish
qi and vent pathogenic qi should be used immediately. If the patient has lost
consciousness,thenthisisincurable,becauseitindicatesacollapseofbodyfluidsand
qi.Theuprightqicannotvanquishthepathogenicqi,anditsinksinward.
Source Text 2

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Ifthetonguecoatingisnotdry,andthepatientfeelsextremeoppression,thisis
intense spleen dampness. Sometimes there are scars and blood stains on the skin.
It must be asked whether scratching caused them. One cannot consider it to be a
withering pattern just because one sees blood; the patient can still be treated for
dampness. Additionally, if a patients consciousness is clear and alert, but he has a
swollen tongue that he cannot stick out of his mouth, this is spleen dampness and
stomachheat,underextremeconstraintittransformsintowindandtoxicityreaching
themouth.Grounddhung(RadixetRhizomaRhei)shouldbeaddedtotheformula,
andtheswollentonguewillrecedebyitself.(TreatiseonWarm-HeatDiseases,entry21)
Interpretation
When a patient suffers from a warm disease, but his tongue and coating are not
dry,andhefeelsextremeoppressioninthechestandp-blockageandfullnessinthe
abdomen (sometimes heaviness of the limbs is also present), this indicates intense
dampnessencumberingthespleen.Iftherearescarsand bloodstainsonthechestor
limbsofapatient,oneshouldinquireastowhetherornottheyresultfromscratching
duetothephysical discomfort of the disease. If so, do not think that it is an intense
yin-blooddepletionpatterncausedbyexcessiveheator bleeding.Thepatientshould
stillbetreatedbydispellingdampness.Somepatients,whoareconsciousbuthavea
swollentonguethattheycannotstickoutoftheirmouth,aresufferingfromextreme
constraintofspleendampnessandstomachheattransformingintowind.Theswollen
tongueisduetodamp-heattoxintravellingupwardsalongthespleenchanneltothe
tongue.Groundshngdhung(RadixetRhizomaRhei)shouldbeaddedtoaformula
thatcanclearandtransformdamp-heat.Dhungwillnotonlydrainfireandresolve
toxins directly, it will also guide the fire downward.Then the swollen tongue will
recedebyitself.
Source Text 3

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Inanothersituation,ifapatientstonguecoatingiswhite,stickyandgreasyandhe
spitsoutthickturbidsaliva,itissurethathewillalsohaveasweettasteinhismouth.
This is splenic pure heat 1 disease.This is damp-heat-qi accumulation, entangled
withfoodqi.Thespleenearthisinexcess.Inundated,itoverflowsabove.Oneshould
usethearomaticandacridlydispersingpropertiesofxngtuco(i.e.,piln,Herba
Eupatorii)todispelthepathogenicqi.Ifthecoatingonthetongueisencrusted,like
alkali, then there is long standing stagnation, together with turbid filth constrained
andhiddeninthestomach.Oneshouldimmediatelyopenwithacridmedicinalsand
dischargewithbittermedicinals.Otherwisepathogenicqiwillbeblockedandbound
in the middle jiao and cannot make its way out of the membrane source. (Treatise on
Warm-HeatDiseases,entry22)
Interpretation
If a patient has a white, sticky, and greasy tongue coating, is spitting out thick
turbidsaliva,andhasasweettasteinhismouth,thisindicatesasplenicpureheat(one
ofthediseaseswrittenaboutinBasicQuestionsDiscussiononRareDiseases,SWn
QBngLn,).Thisdiseaseisoftenduetoanaddictiontoeatingsweet
andfattyfoods,whichleadstodamp-heatgenerationinthespleen.Whenthedamp-
heatcombines with ingested food, spleen qi is obstructed and fails to transport and
transform,andtheturbidqiinundatesandoverflowsabove.Suchaconditionshould
be treated by pi ln to enliven the spleen, promote digestion, clear heat, resolve
dampness, and dispel turbidity.Then the greasy, sticky tongue coating and turbid
fuidscanberesolved.
If a patients tongue coating is white, thick, turbid, and crude, like alkali, this
indicatesfoodstagnationinthestomach,combinedwithdamp-heatturbidpathogenic
qi, constrained, and hidden in the membrane source.The membrane source is the
half-exterior, half-interior space of the human body, and it is closely related to the
bodysurface and the stomach. According toWuYou-ke, it extends from the anterior
of the spine to the posterior wall of stomach: it is the space between the stomach
and spine.To treat a pattern of hidden pathogenic qi in the membrane source, one
should immediately treat the qi mechanism by opening it with acrid medicinals and
dischargeitwithbittermedicinalstoexpeldamp-heat,turbidpathogenicqi,promote
1 Seesplenicpureheat(pdn, )fordefnitionincludedinglossary.
digestion and remove stagnation. Otherwise, the pathogenic qi will be blocked by

normalfoodinthemiddlejiaostomachandfndnowayoutofmembranesource.
Source Text 4

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In another situation, a yellow, not very thick coating that is glossy means that
bodyfluidshavenotbeendamagedbyheatyet.Onecanstillclearheatandventthe
exterior.Ifthecoatingisthinbutitisdry,itmeansthateventhoughthepathogenic
qi has been expelled, the body fluids have been damaged. Bitter, heavy medicinals
shouldbeprohibited;sweet,cold,andlightformulascanbeused. (TreatiseonWarm-Heat
Diseases,entry13)
Interpretation
A yellow, greasy, glossy, and not very thick coating indicates that though the
pathogenicheat has passed into the qi level and that body fluids have not yet been
damaged.Atthispoint,onecanfocustreatmentonventingheatthroughtheexterior
using light, clearing and venting heat medicinals. If the coating is thin and dry, it
indicates that the pathogenic qi has been largely resolved, but the body fluids have
beendamaged.Inthissituation,thetreatmentneedstoconsiderusingsweetandcold
medicinals,inlightdosestonourishyin.Onlybynourishingyinincombinationwith
some venting of the remaining pathogenic heat can the pattern be resolved. If one
were to use bitter and cold medicinals, the drying nature of the bitter flavor would
furtherdamageyin-fuidsandcomplicationswouldresult.
CaseReport
The patient had come to Shanghai from Hong Kong. He had been admitted to
the hospital and diagnosed with severe acute respiratory syndrome (SARS). His
temperatureatonepointhadreached39.Othersymptomswerecoughwithphlegm
and difficult breathing. An X-ray revealed shadows in both lungs.The treatment
protocol included steroids, antibiotics, and an artificial respirator. His temperature
dropped to 37.5, while the shadows in his lung enlarged. An expert in integrated
ChineseandWesternmedicinewasinvitedforaconsultation.
At the time of the examination, the patients whole face was crimson. He had
a low grade fever with no aversion to cold, thirst with desire to drink, dry lips,
sweating,coughwithdifficultbreathing;white,greasyphlegm;littlenausea,andtwo
defecations a day. His tongue was red, with a yellow greasy coating. His pulse was
threadyandwiry.
Patterndifferentiation: pathogenicheatandepidemictoxindirectlyinvadingthe
lung and stomach, with exuberant and congested lung heat and lung qi failing to
disperseanddescend.
Treatmentprinciples:clearheatandresolvetoxin,removeturbiditywitharomatic
medicinals,anddrainthelungandharmonizethestomach.
Formula:modifedSngBiPTng(WhiteMulberryRoot-barkDecoction).

shnzhz 10g FructusGardeniae
yxngco 30g HerbaHouttuyniae
sz 10g FructusPerillae
Secondconsultation:April21.Thelunginflammationhadbeenreduced.Breathing
had improved, and the low fever had disappeared.The formula was modified by
removingszandadding10gofchsho(RadixPaeoniaeRubra).Thenewformula
still focusedonclearingheatandresolving toxicity, with the support of cooling and
activatingtheblood.Fourpacksweregiven.
Third consultation: April 25.The patients breathing was normal.There was
less inflammation in the lungs and remarkably less sweating. Defecation was once
a day.The patient was feeling worn out. Because his condition was stabilizing, the
steroiddosagewasreduced.Thepatternidentificationwasthatthepathogenicqihad
been thwarted and was withdrawing; the upright qi had been suppressed and was
fatigued.The treatment mainly focused on reinforcing upright qi by replenishing qi
and nourishing yin.The secondary treatment principle was to dispel pathogenic qi
by resolving toxin, clearing heat, activating blood and dredging the collaterals. Four
packsweregiven:


sgulu 6g RetinervusLufaeFructus
dngguz 15g SemenBenincasae
Endothelium Corneum Gigeriae Galli Praeparata
zhjnijn 10g
(liquid-fried)
yzh 10g RhizomaPolygonatiOdorati
Fourthconsultation:April29.Thepatienthadbeentakenofftheartificialrespirator.
An X-ray showed that the shadow in lungs had been obviously reduced.There was
nocough,phlegm,ordifficultybreathing.Thepatientsthirstwasabating.Urineand
stool were normal. His tongue was light red, with a thin, white coating.These signs
indicated that the patient was in convalescence, and the treatment should primarily
reinforce upright qi. However, there was some concern that there might be some
residualpathogenic qi;justasYeTian-shisaid:Althoughthesmokeinthe stovehas
beenextinguished,onefearsthatthereisstillfireinashes.Therefore,thedoctorkept
dispelling pathogenic qi in mind and considered the possibility of a disharmony of
thelungcollateralsbyincreasingtheblood-activatingactionoftheformula.

sgulu 6g RetinervusLufaeFructus
EndotheliumCorneumGigeriaeGalliPraeparata
zhjnijn 10g
(liquid-fried)
yzh 10g RhizomaPolygonatiOdorati
hungjng 10g RhizomaPolygonati
Fivepacksweregiven.
Fifthconsultation:May9.Thepatientwasinstablecondition,andhismentalstate
was clear and alert.Two tests for coronary virus antibodies were positive.The X-ray
on May 8 showed that the shadow in his lungs had disappeared completely.The
doctorsuggestedthepatientbegivendngchngxico(Cordyceps),1geveryday,in
athickdecoction.Itwasselectedforitsabilitytosupplementthelungandboostthe
kidney,inordertocompletehisrecovery.
[Reference: XuYing, Chen Xiao-rong, ZhangYun-peng. Analysis on Cases of SARSTreatment
.ChineseJournalofTraditionalChineseMedicineandPharmacy.2003;
18(5):265-266.]
Source Text 5

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Ifthetonguecoatingisblackandglossy,itmeanswaterisrestrictingfire;thisisa
yinpatternanditshouldbewarmed.Ifashortened,contractedtongueisseen,thisis
exhaustion of kidney qi and is difficult to treat. If you want to try to save them, add
rn shn (Radix et Rhizoma Ginseng) and w wi z (Fructus Schisandrae Chinensis)
butthehopeofsavingthemisoneintenthousand.Ablackanddrytongue[means
that] fluid is exhausted and fire is burning intensely.To treat this, urgently drain
thesouthandsupplementthenorth.Adrytonguewithathickcoatinginthecenter
indicates dry earth and exhaustion of water. Urgently purge with salty and bitter
medicinals.(TreatiseonWarm-HeatDiseases,entry24)
Interpretation
Ablackandglossytonguecoatingindicatesdeficiencyanddeclineofkidneyyang
due to intense yin-cold in the interior. It should be treated by a formula that warms
andnourisheskidneyyang.Ifthetongueisalsoshort,itindicatesaseriousdeficiency
and decline of kidney yang, and is a portent of kidney qi exhaustion.To rescue a
patient from this, rn shn and w wi z can be added to the formula.There is slim
chanceofsavingthem.
A black and dry (though not thick) coating indicates exhaustion of kidney yin
inthelowerjiaoandexuberanceofheartfireintheupperjiao.Oneshouldclearand
drainheartfireandsupplementkidneyyin,usingaformulasuchasHungLinJio
Tng (Coptis and Donkey-Hide Gelatin Decoction).When the dry coating is thick in
thecenter,itindicatesapatternofyangmingfu-organexcessinwhichexuberanceof
dry-heat consumes kidney water.This is described byYeTian-shi as,earth dryness
and water exhaustion and is due to a failure to purge when it was necessary.The
appropriate treatment now is to purge immediately using a salty and bitter-cold
formula [e.g., one of the various Chng QTng (Purgative Decoctions)]. Clinically, a
formula as ZngY Chng QTng (Humor-Increasing and Qi-Guiding Decoction) is

highlyrecommendedbecauseithasthefunctionofpurgingheatbindof yangming,
andenrichingandnourishingyin-fuidssimultaneously.
Source Text 6

(15)
A crimson tongue color with a dry center indicates exuberant fire in the heart
andstomachburning up the body fluids. Hung lin (Rhizoma Coptidis) and sh go
(GypsumFibrosum)canbeadded.Ifapatienthasvexingthirstandvexingheat,and
histonguecenterisdry,withredsidesandacenterthatisyelloworwhite,these[signs
indicate that] pathogenic qi is not in the blood level.They are due to qi level heat
exhausting body fluids in the upper jiao. Ling G Sn (Diaphragm-Cooling Powder)
shouldbeappliedimmediatelytodisperseformlessheat,andthentreataccordingto
changes. Be cautious not to use blood level medicinals, because their enriching and
cloying properties can make it difficult to disperse pathogenic qi. As for a crimson
tonguethatlooksdrybut[feels]moistwhenitistouched,this[indicates]abodyfluid
deficiency,withdamp-heatfumigatingandsteaming,andwillbecometurbidphlegm
cloudingthepericardium.(TreatiseonWarm-HeatDiseases,entry15)
Interpretation
Acrimsontongue witha dry centerindicatesintenseheat inthestomachand in
the heart-ying, which exhausts the body fluids.This belongs to a pattern of blazing
fireinboththeqiandyinglevels.Inadditiontomedicinalsasxjio,shngdandlin
qiothatfunctiontocleartheyinglevel,nourishyinandventheat,qi-levelclearing
medicinalslikehunglinandshgocanbeaddedtoclearanddrainstomachfirein
ordertosimultaneouslyclearqiandying.
If a patients tongue center is dry, with red sides and a yellow or white center,
andatthesametimethepatienthasvexingthirstandvexingheat,thisindicatesthat
the pathogenic qi is not in the ying or blood levels; it is exuberant heat consuming
and scorching the body fluids in the upper jiao qi level. Ling G Sn should be
immediatelyappliedtodisperseinvisibleheat,andthenoneshouldtreataccordingto
anychangesinthepatientscondition.Becarefulnottomistakeredtonguesidesasa
signthatthepathogenicqihasenteredtheyingbloodandwronglyuseblood-cooling,
yin-nourishing medicinals. Because such medicinals are cloying, they may easily
inducepathogenicheataccumulation,whichisdifculttoresolve.
If a crimson tongue looks dry, but is moist when touched, this indicates entry of
pathogenic qi into the ying level, with damp-heat fumigating and steaming, which
suggests damp-heat brewing into phlegm, and that a pattern of turbid phlegm
clouding the pericardium will appear.To treat this, one should clear the ying and
vent heat, along with clearing heat and resolving dampness, aromatically removing
turbidity, clearing up phlegm, and opening with acrid medicinals and discharging
withbittermedicinals.
CaseReport
Male,age62.Initialconsultation:October1998.
The patient complained of suffering from a fever for more than one month.
The patient had gone to Hainan Island two months before, and two weeks after he
returned,hecamedownwithahighfever,withoccasional aversiontocold.Hisfever
was treated symptomatically by inducing sweating, which reduced the fever, but it
would relapse each time, followed by occasional aversion to cold.The patient had
heart disease, and after changing the antiarrhythmic drug that he was taking, his
aversion to cold disappeared, but the high fever was unbearable, with outbursts of
scarletmaculaeand papules,anditching,especiallyatnight.Hewasdiagnosedwith
allergicdrugeruptions,butanantianaphylacticdrugwasinefective.
Atthetimeofhisconsultation,hissymptomswereasfollows:occasionalsweating,
coughing and spitting thick phlegm, distension, and fullness of the abdomen, no
appetite,nostoolforseveraldays,bittertasteinthemouth,andyellowurine.Histongue
wascrimson,withathick,yellow,greasycoating.Hispulsewasslipperyandrapid.
DiagnosisinCM:latentsummerheat.
ThepathodynamicwasthathecontractedsummerheatanddampnessinHainan,
whichbecamelatentpathogenicqiinsideofhim,andthenexpresseditselfduringthe
Beijingautumn.Asasideeffectoftheantiarrhythmicdrug,thesummerheatinternally
distressedtheyingandbloodevenfurther.Pathogenicdampnesswasobstructingthe
qilevel.Therewasdamp-heatbinding,aswellasdysfunctionofthesanjiao.
Treatmentprinciples:dredgeandpromoteqimovementinthesanjiao,clearand
removedamp-heat.
Formula:

dfp 10g PericarpiumArecae
cogu 6g FructusTsaoko

bikurn 10g FructusAmomiRotundus
Fourpacksweregiventobedecoctedinwater:onepackperday,dividedintosix
doses,onedosetakeneveryfourhours.
Secondconsultation:thepatients feverwasnotreducedaftertakingtheformula,
and the maculae and papules could still be seen. However, the distension in his
abdomen was reduced, and his appetite got better. His stool had begun moving
normally, but it was greasy. His tongue coating was thin. The damp-heat was
graduallybeingremoved,thoughtheheatinyingandbloodhadnotyetbeencleared
andvented.Thesecondformulawasasfollows:

jingcn 15g BombyxBatryticatus
Sixpackswereadministered.
The patients body temperature had cooled down to 38 after three packs, and
mostofthemaculaeandpapuleshaddisappeared.Aftertakingtherestoftheformula,
the patients fever withdrew and he sweated normally.The bitter taste in his mouth
abated, though his cough was as before. His tongue was red, with a thin, greasy
coating.Hispulsewasslippery.
Third consultation: the patient had caughtfever again (38.2C). He had acough,
stuffy chest, dry stool, yellow urine, red tongue, with a thin, yellow, greasy coating,
andafoating,rapidpulse.
Patterndiferentiation:depressedheatwithdampnessinthelungandstomach.
Treatmentprinciples:diffusethelungandclearthestomach;usearomaticmedicinals
toremovedampness.
Formula:
zsy 10g FoliumPerillae
zsgng 10g CaulisPerillae
sngy 10g FoliumMori
nibngz 10g FructusArctii
jingcn 15g BombyxBatryticatus
bhe 10g HerbaMenthae
Fivepacksweregiven.Follow-uprevealedthatthepatientmadeafullrecovery.
[Reference:GuXiao-hong,ZhaoZhan-rong.DiscussiononDifficultFebrileDiseasesDifferentiated
andTreatedwithTheoriesofLatentPathogenicQiofWarmDiseases
.JournalofBeijingUniversityofTraditionalChineseMedicine.2001;24(3):1-2.]
Section2 InspectionoftheTeeth
Source Text 1

(31)
Forwarmdisease,toothinspectionisnecessaryfollowingtongueinspection.Teeth
are the surplus of the kidney, and gums are the collateral of stomach. Ifpathogenic
heat does not dry the stomach fluid, it will consume the kidney fluid. Furthermore,
thebloodofboththestomachandkidneychannelsgoestotheseplaces[theteethand
gums]. Serious disease will induce bleeding and little petal-like gores on the gums.
Thecolorofyang bloodmustbepurplelikedrylacquer;thecolorof yinbloodmust
beyellowlikebeanpaste.Ifyang bloodappears,calmingthestomachistheprimary
[treatment]; if yin blood appears, saving the kidney is most important. However, [if
the blood is] the color of bean paste, it is usually [a sign of ] danger. If the patients
pattern is not unfavorable, [he] can be treated; otherwise it is difficult to treat him.
What is the reason? Because yin is exhausted below, and yang is reversing upwards.
(TreatiseonWarm-HeatDiseases,entry31)
Interpretation
YeTian-shi (Qing Dynasty, 1667-1746) was the originator of tooth inspection
and made it an integral part of the warm disease diagnostic system. Its theoretical
foundations are evident in the relationships between the kidney and the teeth, and
thestomachandthegums.Thekidneygovernsbone,anditssurplusqigeneratesthe
teeth. In the original text it says,gums are the collateral of stomach, which means
thegumsarepartofthecollateralnetworkofthestomachchannel.Additionally,both
yangming channels and the kidney channel pass through the teeth and gums.This
makes the relationship between these channels and organs relatively intimate, and
thuschangesintheirclinicalpresentationcanbeusedtoconjecturechangestotheir
correspondingzang-fuorgans.
Since warm pathogenic qi consumes the yin, and this ensuing damage primarily
affects the stomach and kidney fluids, observation of the teeth and gums is crucial
to determine the degree of the yin-fluid consumption. Potential patterns that may
manifestasbloodcollateraldamage,andhencegumbleeding,are:
1. Yangmingstomachheatattackingupwards.
2. Consumptionofkidneyyin.
3. Waterdefciencyandfreexcess,withdefciencyfrefamingupwards.
Congealed blood on the gums is calledpetal-like gores.The color of petal-like
goresinayangmingstomachheatpatternisoftenpurple,sometimesevenresembling
dry, purple lacquer.This is indicative of anexcess pattern and is calledyangblood.
Thetreatmentistoclear stomachheatandtopromotefluidproduction.Incontrast,
thecolorofpetal-likegoresfoundinkidney yindeficiencywithdeficientfireflaming
upwardisadarkyellowishcolor,similartosoybeanpaste.Thisindicatesadeficiency
patternandiscalledyinblood.Thispatternsuggestsacriticalsituation.Nourishing
the kidney and replenishing yin should be applied immediately. If the patient does
not show unfavorable symptoms, he might still be saved. Ifyin and yang separate
fromeachother(i.e.,kidneyyinisexhaustedandyangreversesupward),thereislittle
hopeofsavinghim.
Source Text 2

(32)
Those whose teeth are smooth and dry like stones suffer from serious stomach
heat.Ifthereisnosweating[but]aversiontocold,itisduetoabnormaldominanceof
thewei.Acrid-coolherbstodischargethewei,primarilybyinducingsweatingshould
beused.If[theteethcolor]resemblesthecolorofdriedbone,itindicatesexhaustion
ofkidneyfluidanditisdifficulttotreat.If[only]theupperhalfoftheteeth(proximal
halves) are moist, it is due to water failing to moisten above and heart fire flaming
upward. Clearing heart (fire) and saving water (kidney fluid) should be applied
immediately,untilthedrylowerhalfturnsmoist.(TreatiseonWarm-HeatDiseases,entry32)
Interpretation
Thispassagefocusesonthemoistureoftheteethanditsrelationshiptoweiqiand
theyinofthestomachandkidney.Thosewhoseteetharesmoothanddrylikestones
are usually suffering from stomach heat with stomach fluid damage. If a patients
teetharedry,butshehasanaversiontocoldandnosweating,itisduetoconstrained
yang heat inside and obstruction and stagnation of the wei qi. Acrid-cool herbs can
disperseandunblockthewei.Afterweiqiisunblockedanddispersedbysweating,the
bodyfluidscan be transformed and distributed. If the color of the teeth is like dried
bone,thisindicatesexhaustionofkidneyfluidandapoorprognosis.Inthiscase,itis
necessarytonourishkidneyyin.
Ifthehalvesoftheteethmostdistaltothegumline(i.e.,nearthecuttingedgesof
theteeth)aremoist,whiletheproximalhalvesaredry,itisduetokidneywaterfailing
tomoistenitsrootsaboveand heartfireflamingupward.Clearingtheheartfireand
supplementing water (kidney fluid) should be simultaneously applied immediately.
When the natural balance between fire and water is restored so the kidney water
is able to moisten above, and heart fire descends.This prevents the yin from being
scorched,whichresultsinthedrylowerhalvesoftheteethnaturallyturningmoist.
Section3 DiferentiatingMacula,Papule,
andMiliariaAlba
Source Text 1

(27)
Generally when maculae and papules appear for the first time they appear
on the chest, back and both sides of the torso. Maculae are larger and on the skin.
Some say that the heads of papules are indistinct, others that they are tiny grain-
like eruptions. Seeing them (maculae and papules) is favorable, but seeing many
is not favorable. According to medical texts, red maculae belong to stomach heat;
purple ones, extreme heat; black ones, stomach decay. However, in order to identify
them correctly, they must be looked at in combination with the rest of the external
symptomsandsigns.(TreatiseonWarm-HeatDiseases,entry27)
Interpretation
When maculae and papules first appear, they are often on the chest, back and
the sides of the ribs.Therefore, during inspection of the skin, one should pay more
attention to these locations. Maculae are larger and more superficial on the skin.
Papulesaretiny,granulareruptionsthatappearinclustersandaresometimesdifficult
tosee.Theappearanceofmaculaeandpapulesindicatesthatthe pathogenicheatin
theyingandbloodlevelsisbeingtransportedoutward,soitissaidtobefavorable.
But numerous and dense maculae or papules indicates serious heat toxin in the
ying and blood levels, so it is said thatseeing many is not favorable. Red maculae
indicate stomach heat invading inwardly and forcing ying and blood out of the
channels.Purpleonesindicateextremeheat,andblackonesindicatestomachdecay
duetoextremeheat,whichisadangeroussituation.However,todeterminethetrue
significanceoftheirappearance,onemustconsidertheoverallsetofsymptomsand
signswithinthepattern,andthediagnosisshouldmatchtheoverallpresentation.
Source Text 2

(29)
Ifthecolorofthemaculaearepurpleandtheirsizeissmall,[itisdueto]pericardium
heat.Ifthesize[ofthemaculae]islargeandtheircolorispurple,[itisdueto]heatin
stomach.
Black and bright maculae indicate predominant heat and exuberant toxins.
Although this pattern is considered untreatable, if the patients qi and blood are
abundant, and he receives the appropriate treatment, sometimes he can still be
saved. If the maculae are black and tarnished, death is certain. If maculae are black,
indistinct,and red around the edges, it is due to constrained fire hidden within. Use
alargedosageofclearingandcoolingmedicinalstoventandexpelpathogenicqi.If
someturnred,thenthepatientcanbesaved.
Ifmaculaeandpapulesappeartogether,theyaretheresultofdifferentpathogenic
qi, each discharging according to its location. Most macular diseases belong to
the blood level, and most papular to the qi level. Both maculae and papules are
manifestationsofpathogenicqibeingreleasedexternally.Ifthepatientsconsciousness
is clear and fresh after the eruption, it means exterior release and interior harmony.
Ifheisunconsciousaftertheeruption,itmeanstherightqiisfailingtoovercomethe
pathogenic qi, and pathogenic qi is sinking inward, or the stomach fluid has been
exhausted.(TreatiseonWarm-HeatDiseases,entry29)
Interpretation
Ifthecolorofthemaculaeispurple,itisasignofdeep,seriouspathogenicheat.If
theyaresmall,itindicates pericardiumheat.Iftheyarelargeandtheircolorispurple,
itindicatesexuberantstomachheat.
Black maculae are darker than purple ones, and indicate the presence of even
more serious heat toxins in body. Black maculae that are bright or have a lustrous
appearanceindicatethatthepatientsqiandbloodarestillabundant.Insuchacase,
despitethedepthandseriousnessoftheheattoxin,thereisthepossibilityofexpelling
thepathogenicqiandsavingthepatient,iftheappropriatetreatmentisgiven.
If the black maculae are dark and dull, as if tarnished, it indicates a decline of
upright qi and serious internal heat toxin. In this case, the prognosis is unfavorable.
If the maculae are black, indistinct, and red around the edges, it is a manifestation
of latent, constrained pathogenic toxins unable to be reached and released through
theexterior.Inthiscase,largedosagesofheat-clearingand blood-coolingmedicinals
shouldbeappliedtoventandexpelthe pathogenicqithroughtheexterior.Ifduring
thisprocesssomeofthemaculaeturnred,thentheprognosisisgood.
If maculae and papules appear at the same time, the pathogenic heat should
be expelled using various methods, according to the locations of thepathogenic qi.

Maculae are manifestations of yangming heat toxin that has invaded the ying and
bloodlevelsandhaseruptedthroughthemusclelayer.Papulesaresignsofheatinthe
qilevelofthelungchannelspreadingtotheyinglevelanderuptingfromthe blood
collaterals. A case of macular eruptions with some papules is due to exuberant heat
toxinintheqi,ying,andbloodlevels.Thetreatmentofthelungandstomachshould
bediferentiated,andthefocusoftreatmentshouldbeonthemaculae.
The eruption of maculae and papules is a sign that pathogenic qi reaching the
exteriorandbeingexpelledfromthebody.Ifthepatientsconsciousnessismadeclear
and fresh and his pulse and body temperature are normal after eruption promoting
treatment,itindicatesareleaseofpathogenicheatviatheexteriorandinteriorzang-
fu, qi, and blood harmony. In contrast, if he is unconscious afterwards, it indicates
deficient upright qi failing to overcome the pathogenic qi, with pathogenic heat
sinking inward, or stomach fluid exhaustion, with water failing to control fire and
overly exuberant fire toxin.This indicates an unfavorable prognosis. In clinical
practice,apatientsprognosiscanbedeterminedbyhisstateofconsciousnessandthe
intensityoftheheat.
CaseReport
Male,age18.Admitted:July4,1989.
Chiefcomplaint:itchy,red maculaeandpapulesappearingonhisentirebodyfor
10days.
Casehistory:thepatienthadinjuredhisrightmiddletoeanditbecameinfected10
daysago.Hewasexperiencingintensepain.Hehadtwochloramphenicolinjections,
andonthenextday,diffuse,redspottedandfoliatedmaculaeandpapulesappeared
on his right limbs and then spread to his entire body and face, accompanied by
fever. On the fourth day, the patient was diagnosed by hospital doctors as having
anaphylactoid purpura and was treated with intravenous dexamethasone, para-
aminomethylbenzoicacid,andbenzylpenicillininstillation.After6daysoftreatment,
the disease became worse, with a body temperature from 38.0~39.0, red urine,
bloodinthestool,tenesmus,headache,dizziness,andastasia.Thepatientdischarged
himselffromthefrsthospitalandsoughttreatmentatthishospital.
Physicalexam:T 39.0, BP 19/12 kPa (1 kPa=7.5 mmHg), conscious, conjunctival
congestion,HR120bpm,diffuseredandpurple-redfoliatedandspottedmaculaeand
papulesoverthewholebody.WBC10.8109/L,RBCinurine(+++),RBCinstool(+++).
A red crimson tongue, a yellow coating in middle of the tongue, and aslippery and
rapidpulse.
DiagnosisinCM:warmdisease,maculareruptionwithblazingofbothqiandblood.
Treatmentprinciples:clearheatandremovetoxins,coolbloodandstopbleeding.
Formula: modified QngWn Bi DYn (Epidemic-Clearing andToxin-Resolving
Beverage,).
shunijio 30g CornuBubali(decoctedfrst)

bituwng 15g RadixPulsatillae
xuytn 10g CrinisCarbonisatus
huihu 15g FlosSophorae
dy 15g RadixSanguisorbae
One bag per day, decocted and taken in two doses. Additionally, for oral
administration:babyurine(ofahealthyboylessthan6monthsold),aboutahalfbowl
(approximately 300-400 ml). Dexamethasone 5 mg/day, benzylpenicillin intravenous
instillation4800000U.
On the next day, the patients temperature was 38.0~38.5. His headache and
dizziness were reduced. He took the above medicines for 3 more days, and his body
temperaturewasreducedtoanormallevel.Nonewhemorrhagicspotsappearedon
hisbodyorface,andtheoriginalmaculaeandpapulesturnedpurpleordarkpurple.
The dexamethasone and benzylpenicillin was stopped.The shu ni jio and baby
urine was removed from the above prescription, and the following four herbs were
added:bij(RhizomaBletillae),qincogn(RadixetRhizomaRubiae),dj(Herba
Cirsii Japonici) and xio j (Herba Cirsii).The patient took the formula for one week.
A follow-up exam revealed that his blood pressure, urine, and stool had returned
to normal; the dark purple maculae and papules had shrunk and faded away.The
patient continued taking the above modified formula for several days. He recovered
andwasdischargedfromthehospitalonJuly21.
[Reference:HeXiang-guang. TreatmentofWarmDiseasewith QngWnBiDYn
. ChineseJournalofIntegratedTraditionalChineseandWesternMedicineinIntensiveand
CriticalCare.1996;3(10):46-47.]
Source Text 3


()
Papulesappearontheskin,granular,likemillet,[and]using[ones]handtotouch
them, [they] feel like sharp spikes.This is different frommaculae, which are flat and
onthemuscle.Maculaecomefromyangmingstomachheat;papulesarisefromwind-
warmthinvadingthelung.[If ] maculaeappearinadeficiency-cold yinpattern,[then]
warmingandsupplementingcanbeused.Thereareveryfewpapular[diseases]that
do not come from pathogenic fire; they rarely appear as a symptom of a yin-cold
[pattern].Therefore,themethodfortreating papulesdoesnotextendbeyondclearing
andexpellingwith acrid-cool [herbs], ventilating the lung and removing pathogenic
qi.Warming and supplementing herbs are prohibited. (A Handbook on Cold Damage
DeterioratedPatternonColdDamage,commentedbyShaoXian-gen)
Interpretation
This passage further reiterates and clarifies the difference betweenmaculae and
papules, particularly as they feel to the touch.The original text clearly identifies
the underlying pathogenesis, and emphasizes that papules, unlike maculae, are
rarelyseeninyin-coldpatterns,andthusanimportantindicationof pathogenicfire.
Treatmentrequirestheclearingandcoolingpropertiesofacrid-coolmedicinalherbs
toventthelungandextinguishthefre.
Source Text 4

(30)
There is another kind of small, crystal-like granule called miliaria alba.This is
damp-heat damaging the lung. Even though the pathogenic qi has been vented,
the patients qi and fluids have been damaged. He must receive sweet herbs for
supplementation. If the disease is not prolonged but there is still damage to qi and
fluids, this is dampness-stagnation in the wei level, which is caused by hindered
sweating.The treatment should be regulating pathogenic qi in the qi level. If their
coloriswhite,likedrybone,inmostcasestheprognosisisinauspicious.Itisasignof
qiandfuidexhaustion.(TreatiseonWarm-HeatDiseases,entry30)
Interpretation
Miliaria alba is a smaller type of crystal-like granule arising from the skin, which
containsfluid.Itisduetodamp-heatconstrainedintheqilevelandobstructionofthe
lungqi.Ifthediseaseisprolonged(evenifthepathogenicqiisresolved),thepatients
qi and fluids will already have been damaged.The patient must be given sweet,
light,nourishingherbstoincreaseqiandfluids.Ifmiliariaalbaoccursinadiseaseof
shortduration,itisduetodamp-heatstagnatingintheskinandweilevelandlungqi
failing to fully disperse, which hinders sweating and further worsens the condition.
Thetreatmentshouldbefocusedonclearingdamp-heatfromtheqilevel.Ifthecolor
of the miliaria alba is like dry bone, it indicates a dangerous pattern, because the
patientsqiandfuidsareexhausted.
Source Text 5

()
Whenmiliariaalbaappearsinawarm-febrilediseaseduringsummerandautumn,
it is often seen in either warm-damp or latent summerheat patterns. During spring
andwinter,sometimesitcanalsobefoundinawind-warmthwithdampnesspattern.
Inthebeginning, miliaria alba is from dampness constrained within the skin and
hindered sweating.The color is usually white, like crystal. For treatment, one only
needs to disperse lung qi with light herbs, opening and discharging the wei level.
For example, WY L GnTng (Five Leaves Reed Rhizome Decoction) obtains
the most consistent and efficacious results. If the disease is prolonged, qi and fluids
aredamaged, and the whiteness of the miliaria alba is like dry bone, this is often an
ominoussign.Inthiscaseimmediatelyusesweet,moisteningherbstonourishqiand
fluids,suchasMiMnDngTng(OphiopogonDecoction)andQngZoJiFiTng
(Dryness-Relieving and Lung-Saving Decoction), which offer a one in ten thousand
chance of saving the patients life. Absolutely avoid using dry, warm and ascending
herbs,astheywouldexhaustqiandfluidandleadtodeath. (RevisedandExpandedTreatise
onWarm-HeatDiseasesIngeniousUsesofProvenFormulas)
Interpretation
Whenmiliariaalbaispresentinwarmdisease,itoftenappearsinpatternssuchas
damp-warmth disease and latent summerheat in summer and autumn. Occasionally,
it can also be found in wind-warmth with dampness patterns in spring and winter.
Initially, miliaria alba is caused by dampness constrained in the skin and hindered
sweating.Mostofthelesionsofmiliariaalbaarevesicles,likesmallblistersofcrystal-
like fluid.The treatment should be to disperse lung qi with light herbs to clear heat
and to resolve dampness, using a formula such as WY L GnTng (Five Leaves
Reed Rhizome Decoction).This formula is safe and effective and is recorded in
SystematicDiferentiationofDamp-HeatDisorderswrittenbyXueSheng-bai.
Ifthediseaseisprolongedandthepatientsqiandyinaredamaged,thecolorof
the miliaria alba is often like dry bone.This is a dangerous sign. Sweet, moistening
formulas,suchasMiMnDngTng(recordedinEssentialsfromtheGoldenCabinet)
and Qng Zo Ji FiTng created byYu Jia-yan, should be immediately applied to
nourish qi and fluids.This might possibly save the patients life. Avoid using dry,
warm, and ascending herbs by all means, as this would exhaust the patients qi and
fuidsandleadtodeathmorequickly.
CaseReport
Female,age26.Admitted:August9,1988.
Chief complaint: aversion to cold with fever for one week, accompanied with
distendingpain in head, nausea, vomiting.The patient was diagnosed as having a
damp-warmdisease.
Physical examination:T 40.3, HR 118 bpm, conscious, clear and present, red
face, coarse breathing, thirst with desire to drink, heavy body feeling, and stomach
cavity p 1 .The patients liver could not be palpated below her ribs; her spleen
could be felt 2 cm below her ribs but was not hard. Her tongue had a dry, thin, and
yellow coating, and her pulse was slippery and rapid.WBC 3.210 9/L; eosinophilic
granulocyte 0.02810 9/L;Widals reactionO1/160;H1/160. After admission, the
patients body temperature fluctuated continuously around 40.The patients skin
feltscorchinghot to the touch, with no presence ofsweating. Energetically, she was
listless and dispirited and she had a poor appetite with low food intake. Four days
after being admitted to the hospital, the patients fever had still not gone down,
despitetreatment by antibiotics,Yn Qio Bi HTng(Loniceraand ForsythiaWhite
TigerDecoction)andlngyngjio(CornuSaigaeTataricae).
OntheeveningofAugust13,10gofxyngshn(RadixPanacisQuinquefolii)was
addedtoherprescription.Itwasdecoctedandtakenseparately.Shecontinuedtaking
aformulatoclearheatandpromotefuidproduction.
Theformulawasasfollows:
() shngshgo(xinjin) 60g GypsumFibrosum(decoctedfrst)

1 See(pzhng, )fordefnitiontoincludeinglossary.

Aftertaking two packs, the patientbegan to sweat a little, and scattered miliaria
albaappearedonherneckandcheek.Themiliariaalbafeltabrasivetothetouchand
thecolorwaswhite,thoughnotcrystal.
ThreepacksofamodifedBiHTng(WhiteTigerDecoction)wereadministered:
() shngshgo 60g GypsumFibrosum(decoctedfrst)

(xinjin)
tinhufn 10g RadixTrichosanthis
xyngshn RadixPanacisQuinquefolii(decocted
() 10g
(lngjindich) separatelyforteadrink)
Themiliaria alba still were present on the 17 th, but their color turned crystal-like.
The patients body temperature was reduced to 38.7. She continued taking the
above herbs to clear heat and resolve dampness, assisted by nourishing yin and
promotingfluidproduction,for3days.Thepatientsconditionwasimprovedandher
temperature was normalized.Then a modified ZhY Sh GoTng (Lophatherum
andGypsumDecoction)wasusedtoclearandexpelresidual pathogenicqi,replenish
qiandpromotefluidproduction.Thepatientrecoveredandwasdischargedfromthe
hospital.
[Reference: Feng Li-ping,Yang Dan-hong. 78 Cases withViral FeverTreated byYn HTng
78.JournalofZhejiangCollegeofTraditionalChineseMedicine.1996;20(5):21.]
542
Chapter4
Warm-Febrile Type Warm disease
WeiLevelPatternsandTreatment
QiLevelPatternsandTreatment
Ying-BloodLevelPatternsandTreatment
Warm-febriletypewarmdiseasereferstoonekindofacute,externallycontracted
febrilediseaseinwhichwarmpathogenicqiisuncomplicatedbydampness.Themain
typesofpathogenicqiincludewind-heat,warm-heat,summerheat,anddry-heatand
thecorrespondingprincipalpatternsare wind-warmth,spring-warmth,summerheat-
warmthandautumndryness.Thepathogenicqiinthesetypesofpatternsareallyang
in nature, and manifest with fever and other intense and vigorous symptoms and
signs.Sowarm-febriletypewarmdiseaseismostlycharacterizedbyasuddenonset,
obvious heat symptoms, damage to body fluids, and rapid pattern change and level
transmissionwithatendencytowardinwardinvasionandpatterntransmutation.The
treatment principle focuses on clearing heat and dispelling pathogenic qi. However,
it is also important to be mindful of yin-fluids during the disease progression and
treatment.
The pathogenic qi in warm-febrile type warm disease can have both functional
and substantial adverse effects. Functional impairments can be categorized into the
weiandqilevels,whilesubstantialonesintotheyingandbloodlevelswhendamage
tonutritivesubstancesisseen.Becauseofthesemanifestations,mostdoctorswhouse
warmdiseasetheoryfromantiquitytothepresentusethefour-leveldiagnosticmodel
ofwei,qi,yingandbloodtojudgetheseverityofdisease,analyzingitsdevelopment
andprognosis,andestablishingtheappropriatetherapeuticprinciple.
Section1 WeiLevelPatternsandTreatment
Source Text 1

()
When taiyin wind-warmth, warm-febrile, warm epidemic, and winter warmth
diseasebeginForapatientwithfeverwithoutaversiontocold,whofeelsthirsty,the
acrid-coolandmoderating formula,Yn Qio Sn(Lonicera and Forsythia Powder), is
VolumeFour:Chapter4 Warm-FebrileTypeWarmdisease 543
indicated. However, warm toxins, summerheat-warmth, damp-warmth, and warm

malariaarenotinthiscategory. (SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpper
Jiao)
Formula
linqio 1liang FructusForsythiae

jnynhu 1liang FlosLoniceraeJaponicae
jigng 6qian RadixPlatycodonis
bhe 6qian HerbaMenthae
zhy 4qian FoliumPhyllostachydisHenonis
shnggnco 5qian RadixetRhizomaGlycyrrhizae
jngjisu 4qian SpicaSchizonepetae
dnduch 5qian SemenSojaePraeparatum
nibngz 6qian FructusArctii
Interpretation
When taiyin (lung channel) wind-warmth, warm-febrile, warm epidemic, and
winter warmth diseases begin, if a patient develops a fever without aversion to
cold and feels thirsty, Yn Qio Sn, an acrid-cool and moderating formula, can
be applied to treat it, though a different treatment method should be applied for
warm toxin, summerheat-warmth, damp-warmth and warm malaria.This pattern
is external contraction of wind-warmth, with constrained heat in the lung wei.
The symptoms are moderate fever and mild aversion to cold, mild thirst and sore
throat, a tongue with red edges and tip with a thin yellow coating, and a floating
and rapid pulse. This pattern belongs to the wei level, and the corresponding
formula is in accordance with one of the rules written in TheYellow Emperors
Inner Classic:Excessive interior wind should be treated by acrid-cool substances,
assisted by bitter-sweet ones. Excess interior heat should be treated by salty-cold
medicinals, assisted by bitter-sweet ones. It also followsYu Jia-yans doctrine of
driving out filth with aromatic medicinals.This formula can release the exterior
with acrid-cool herbs, drive out filth with aromatic herbs, as well as clear heat, and
resolvetoxins.
Thisformulahastwoimportantcharacteristics:
1.Becausejnynhuandlinqiohavebothcoldandaromaticproperties,they
are able to not only clear heat and resolve toxins in the lung, but also to reach the
exterior and smooth and diffuse qi movement: they mutually reinforce each other
to simultaneously clear and dispel, relieve constraint, and clear heat. In this way,
they will not obstruct the qi and harm the body fluids as they clear heat and expel
pathogenicqi.
2. Amongthe many acrid-cool herbs in the formula there are small quantities of
acrid-warm herbs (e.g. jng ji su and dn du ch), which give the formula a warm
butnotdryingquality.Thereasonforaddingtheseherbsisnottoinducesweatingto
dispelpathogenicqi,buttodischargeconstrainedqiinordertosmoothqimovement,
which facilitates the expulsion of pathogenic qi, while not undermining the overall
acrid-coolaimoftheformula.
Historically, scholar physicians such as Zhao Shao-qin have remarked that this
formula,Clearstheexteriorandharmonizestheinterior,smoothestheyingandwei
and thus enables the body fluids to be distributed.The patient will naturallysweat
slightly and recover. In this way, the goal of inducing sweating, without applying
the-sweatinginducingmethod,canbeachieved.Thisisthetrueessenceof weilevel
sweating. Another scholar,Wu Ju-tong (Qing Dynasty, 1758-1836) pointed out:
The formulas wondrous effects lie in its ability to specifically clear the upper jiao
without disturbing the middle or lower jiao and thus clear while guarding against
exacerbating the patients deficiencies. In this way, there is no risk ofcourting
disaster by opening the door and inviting in robbers. The formula uses light herbs
to rid excess, and it will naturally be successful if applied correctly. In general, this
formula by itself, or with some modification, can be used at the onset of externally
contracted wind-heat disease and when pathogenic qi is in the wei level of warm
disease.
CaseReport
Male,age4.
Chief complaint: red maculae, papules, and vesicles appearing on the patients
toesandfngersfor3days.
Clinicalpresentation:fever,drymouth,sorethroat,nausea,andanorexia.
Physical examination:T 38.2C, red blisters on the throat; red rice-size or yellow
soybean-sizemaculaeandpapulesonthefingersandtoes,oneortwoofwhichalso
had small blisters on them; the water blisters were not broken; the tongue was red,
with a thin and greasy yellow coating; the pulse was thready and rapid. Standard
bloodtestswerenormal.
DiagnosisinWM:hand-foot-mouthdisease.
Diagnosis in CM: a pattern of wind-heat invading the lung, with disharmony of
thewei.
Treatmentprinciples:diffusethelung,releasetheexterior,clearheat,andresolve
dampness.
Formula:modifedYnQioSn.
bhe 3g HerbaMenthae
jngji 6g HerbaSchizonepetae
hush 6g Talcum
flng 9g Poria
The above medicinals were decocted into 150-200 ml of water, and taken three
timesaday,forthreedays.Thepatientsfeverabatedandhispapulesweregradually
reduced,and became light purple in color.The above formula was then modified by
removingjngjiandaddingmdnp(CortexMoutan)andzco(RadixArnebiae),9g
each.
Aftertakingthreepacks,thepatientrecovered.
[Reference:Yu Li-qun. Clinical Application of Yn Qio Sn Modification in Pediatrics
.Yunnan Journal ofTraditional Chinese Medicine and Materia Medica.
2008;29(11):32-33.]
Source Text 2
(
)
For taiyin wind-warmth, with only a cough, low fever, and mild thirst, the acrid-
coolandlight formula,Sng JYn (Mulberry Leaf and Chrysanthemum Beverage) is
indicated.(SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpperJiao)
Formula
xngrn 2qian SemenArmeniacaeAmarum

linqio 1.5qian FructusForsythiae
bhe 0.8qian HerbaMenthae
sngy 2.5qian FoliumMori
jhu 1qian FlosChrysanthemi
gnco 0.8qian RadixetRhizomaGlycyrrhizae
lgn 2qian RhizomaPhragmitis
Theaboveherbsaredecoctedwithtwocupsofwaterdowntoonecup,whichis
dividedintotwodosesperday.
Interpretation
Fever and thirst are clinical symptoms of wind-warmth disease.The existence of
internalheatisdeterminednotonlybythepresenceofthirst,butalsobythedegree
ofthirst.Inacasesuchasthis,lowfeverandmildthirstindicatethatthepathogenic
qi is light and has not penetrated too deeply, and that it is in both the exterior and
interior.This pattern is a mild wind-warmth pattern whose principle symptom is
coughing.The coughisduetowarm-heatinvadingthelunganddamagingthelung
collaterals.SincethebodysymptomsaremilderthanthoseforYnQioSn(Lonicera
andForsythiaPowder) pattern, it can be treated by the acrid-cool and light formula,
Sng JYn, which focuses on dispersing wind and clearing heat, diffusing the lung
andeliminatingthecough.
Themaincharacteristicsofthisformulaare:
1. Simultaneous treatment of the lung and liver.Wind-warmth disease often
occursinspringwhenvigorousliverwoodcounter-restrictsmetal,andboththelung
and liver become diseased. It is excessive liver qi that ascends and counter-restricts
the lung. At the same time, the common saying,when warm febrile pathogenic qi
invades above, it first attacks the lung, also applies here; the pathogenic qi renders
thelungunabletogovernpurificationanddescentandleadstocough.Therefore,sng
yandjhuareusedasthechiefmedicinalsandbhe,whichisacrid-cool,isusedas
adeputymedicinalbecausetheyallenterthelungandliverchannels.Thesecanclear
anddisperseheatinthelungcollateralsandpacifyandcontrol pathogenicqiinthe
liver channel, allowing wind to be dispersed from the liver and heat ventilated from
thelung,thusefectivelyendingthewind-warmthdisease.
2. Simultaneous application of ascending and descending qi functions. In this
formula, ji gng ascends qi and xng rn descends it. Ascending qi diffuses and
disperseslungqitoreleasetheflesh;descendingqipurifiesanddescendslungqito
pacify the liver.When the lung regains its function of diffusing and descending, the
pathogenicqiwillbedispelledandthecoughwillstop.
3. Promotion of fluid production while clearing heat.Warm-heat pathogenic qi
caneasilyharmandexhaustthebodyfluids.Themoreexuberanttheheatthegreater
theharm.Therefore,linqioassistssngyandjhutoclearanddispelpathogenic
heat from the upper jiao. L gn not only clears heat, but also nourishes yin and
promotesfluidproduction.Oncelungyinisprotected,theconditionsforself-clearing
andpurifyingcanbeobtainedandhealthylungfunctionrestored.
The last characteristic mentioned is very important in treating lung cough in
warmdisease,forthefollowingreason:ifthelungfluidsaredamaged,oracridwarm
medicinalsare applied in error, the condition will be exacerbated. Physician scholars

have commented this last point on over the ages. For example,Wu Ju-tong said in
hisSystematicDifferentiationofWarmDiseases,Thoughwind-warmthcoughisamild
disease, it is often mistakenly treated by acrid, warm, and heavy medicinals, which
consumethelungfluidsandleadtolong-termcough.Asageiscarefulnottooverlook
subtle details so doctors should pay more attention to such things. In clinical
practice,nomatterifitiswind-warmthobstructingthelung,orexternallycontracted
wind-cold transforming into heat, if the main symptom iscough, or residual cough
following a common cold, Sng JYn can be applied for those with wind-warmth
patterns.
CaseReport
Thepatientcomplainedofsorethroatforthreedays,togetherwiththroatitching,
cough,anddrymouth.Shehadtakencoshnh(HerbaSarcandrae)andtheChinese
patent medicine Gn Mo Qng (Clearing Common Cold) on her own but saw no
improvement. Her sleep was not good, though her appetite was fairly good, and
urinationanddefecationwerenormal.
Physical examination: Acute hyperemia of the pharyngeal mucous membrane,
scatteredlymphfollicularhyperplasiaontheposteriorwallofthepharynx,funiculus
lateralis hyperemia, pale red tongue with a thin yellow coating, and floating and
rapidpulse.
Pattern differentiation: wind-heat pathogenic qi toxin invading the lung-wei and
harassingthethroatabove.
Treatmentprinciples:dispersewindandclearheat,detoxify,andpacifythethroat.
Formula:supplementedSngJYn.
sngy 10g FoliumMori
bhe 6g HerbaMenthae
Onepackofherbswasgivenperday,firstusingthedecoctionforsteaminhalation
therapyforherthroat,thentakingthedecoction.Thepatientreturnedafterthreedays
andreportedthatthesorethroatwasreduced,thoughthethroatwasstillitchy,and
thatthecoughanddrymouthwerebetterthanbefore.Withoutchangingtheformula,
thepatienttooktwomorepacksandrecoveredcompletely.
[Reference:WangYa-ling. Application ofSngJYninE.N.TDepartment
.HebeiJournalofIntegratedTraditionalChineseandWesternMedicine.1998;4:571.]
Section2 QiLevelPatternsandTreatment
Source Text 1

()
Intaiyinwarmdisease,whenthereisafloatingandsurgingpulse,yellowcoating,
great thirst, profuse sweating, red face, and aversion to heat, the acrid-cool, heavy
formula,BiHTng(WhiteTigerDecoction)isindicated.
Formula
shngshgo 1liang GypsumFibrosum(ground)

zhm 5qian RhizomaAnemarrhenae
bijngm 1ge SemenOryzaSativa
Theabovemedicinalsaredecoctedwitheightcupsofwaterdowntothreecups,
whicharedividedintothreedosesperday,takenwarm.
If the patient recovers, there is no need to take the rest of the decoction. If not,
continuetakingtheformula.(SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpperJiao)
Interpretation
When warm disease is located in the hand taiyin lung channel, a floating and
surging pulse, yellow dry tongue coating, great thirst and sweating, red face, and
aversion to heat indicate that one can use the acrid, cold, and heavy formula, Bi
HTng (WhiteTiger Decoction).This pattern can arise from either a cold damage
patternthattransformsintoheatandtransmitsintotheinterior,becomingayangming
pattern, or warm disease pathogenic qi transmitting into the qi level. In clinical
practice,themainpatternidentificationpointsarehighfever,profusesweating,great
thirst,andafloating,surgingpulse.Thechiefmedicinal,shgo,acridandverycold,
isusedtorestrictheatintheyangming(qilevel).Zhmnotonlyhelpsshgotoclear
lungandstomachheat,butalsomoistensdrynesstonourishyin. Gncoandjngm,
both assistant medicinals, can benefit the stomach and protect the body fluids, and
alsocanpreventdamagetothemiddlejiaobythecoldmedicinals.Thisformulaisthe
chiefformulafortreatingyangmingheatpatternsintheTreatiseonColdDamage,while
inwarmdisease,thisformulaisarepresentativeformulafortreatingqilevelpatterns.
Both of these patterns are interior heat patterns.The dosage of sh go needs to be
largetoachievegoodcurativeefect.
CaseReport
Male,age28.
Wind-warmth case (lobar pneumonia).The patient came down with a high fever
withshivering,headache,cough,chestpain,andspittingpinkishphlegmonOctober6,
1955.Hewasadmittedintothehospitalonthe7thatmidday.
Physical examination:T 39.7, an acute, serious and complicated condition,
painful expression, urgent respiration, flaring of nostrils, blistering around the lips,
and restricted breathing movement in the right lung, with auscultation showing
diminishedbreathingsounds.
Laboratoryexamination:WBC2.510 9/L,monocyte95,diplococcuspneumoniae
foundonphlegmsmear.
X-ray examination: the anterior chest image revealed a uniformly dense, turbid
shadow,withaclearlydemarcatedsuperioredgeinthemiddlelobeoftherightlung;
thelateralpositionimagewasidentical.
Formula:BiHTng,decoctedinwater.
Thepatientstemperaturecooleddowntonormalafter68hours.Hiswhite blood
cell count normalized within five days, and the rest of his symptoms disappeared
within7days.Thepatientrecoveredandwasdischargedfromthehospital.Thetotal
courseoftreatmentwas12days.
[Reference: PanTai-jie,Tao Ke-wen,Wang Xin-tao. Efficacy Observation of 9 Case with Lobar
PneumoniaTreatedbyChineseMedicinals9. ShanghaiJournal
ofTraditionalChineseMedicine.1957;(4):23.]
Source Text 2

()
When in taiyin warm disease, [there is a] floating and hollow pulse, profuse
sweating, mild panting, and when serious, nostril flaring, Bi H Ji Rn ShnTng
(WhiteTiger Decoction plus Ginseng) is indicated. If the pulse is big and scattered,
use the formula immediately, doubling the amount of rn shn (Radix et Rhizoma
Ginseng).(SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpperJiao)
Formula
shngshgo 1liang GypsumFibrosum(ground)

bijngm 1ge SemenOryzaSativa
rnshn 3qian RadixetRhizomaGinseng
Interpretation
When there is warm disease in the hand taiyin lung channel, and symptoms
include a floating and hollow pulse, profuse sweating, mild panting, and in more
serioussituationstheremayevenbeflaringofthenostrils,theappropriateformulais
BiHJiRnShnTng.Ifthepatientspulseisbigandscattered,theformulashould
beappliedimmediatelyandthedosageofrnshnshouldbedoubled.Afloatingand
hollowpulse,likeascatteredpulse,indicatesgreatdeficiencyofbodyyin-fluidsand
yang qi failing to gather inside.Thejurisdiction of yin-supplementing medicinals
istoofarawaytobeeffectiveinpromotingfluidproduction(thisisduetothetime
requiredforsubstancesofform,likefluids,tobeproduced,andtheexcessheatneeds
tobeaddressedimmediately).SoBiHTngisusedtoexpelpathogenicheatonthe
qi level. Rn shn consolidates and contains yang qi, which in turn will promote the
production of yin-fluids.The profuse sweating, flaring of the nostrils, and scattered
pulsearesignsoffailureoftheoriginofqiand blood(i.e.,thespleenandstomach).
Adding rn shn to Bi HTng to supplement qi and promote fluid production
createsanidealmethodforsavingtheoriginfromcollapse.
CaseReport
Female,age38.
Onesummerafternoonfollowinganap,thepatientlostconsciousness.Herbody
felt hot, but her limbs were cold. She had profuse sweating, heavy breathing, and
slight trismus. Her tongue had a yellow and dry coating, and her pulse was surging
andhollow.
Patterndiferentiation:summerheatsyncope.
Insummerheatsyncope,summerheatscorchestheyangming,whichleadstothe
bodyfeelinghot. Summerheat also steams inwards and drives body fluids outwards,
sothepatientexperiencesprofusesweatingandheavybreathing.Theheatconstrains
the bodys qi movement, so the patients limbs become cold.The heat also disturbs
mental activity/mind/spirit above, which leads to syncope. A surging and hollow
pulseindicatesuprightqifailingtoovercomepathogenicqi.
Treatment principles: clear summerheat, supplement qi, and promote fluid
production.
Formula:BiHJiRnShnTng.
choxinbishn 15g RadixGinsengAlba(Korean)

shgo 30g GypsumFibrosum(ground)
After taking the first pack of herbs, the patients pulse became normal and her
sweating ceased. Her limbs became warm, she regained consciousness, her mind
became clear and alert, and she was thirsty with a desire to drink cold water.The
patientrecoveredafteronemorepack.
[Reference: Li Shao-bi. Case Records of Cold Damage from Li Bi-liu .
GuangdongMedicine:ChineseMedicineEdition.1963;(1):36.]
Source Text 3

()
In yangming warm disease, with no upper jiao pattern and no defecation for
several days, the purgative method should be applied. If the patient has a yin
deficient constitution, then Chng QTng (Purgative Decoction) category formulas
cannotbeusedandZngYTng(Fluids-IncreasingDecoction)isindicated.(Systematic
DiferentiationofWarmDiseases,Vol.2,ChapterMiddleJiao)
Formula
xunshn 1liang RadixScrophulariae

midng 8qian RadixOphiopogonis
shngd 8qian RadixRehmanniae
Decocttheaboveherbswith8cupsofwaterdownto3cups.Drinkallofitwhen
onesmouthisdry.
Whenfnished,ifthereisstillnodefecation,makeandtakethedecoctionagain.

Inyangmingwarmdisease,ifpurgationisunsuccessfulitisbecauseofadeficiency
of body fluids, orwhen there is no water, the boat will stop. If after taking Zng
YTng a few times and there is still no defecation, ZngY Chng QTng (Fluids-
Increasing and Qi-Guiding Decoction ) is indicated. (Systematic Differentiation ofWarm

Diseases,Vol.2,ChapterMiddleJiao)
Interpretation
Ingeneral,thecauseofconstipationin warmdiseaseiseitherheatbindingoryin-
fluid deficiency. If the condition is a yangming fu-organ 1 solid-mass, heat binding,
excess pattern, the Chng QTng category formulas can be used to clean out the
intestines. In these cases, using strong purgation to quickly resolve heat binding
can help to preserve yin-fluids. However, if the constipation is primarily due to dry
intestines resulting from deficiency of body fluids and only in small part to binding
heat, then such a formula will only further damage yin-fluids and exacerbate the
condition, which would be contrary to the basic principles of treatment theory by
purgingdeficiency.Inordertomovethebowelsincasesofdeficiencyonemustincrease
fluids.Hence,theuseofcommonsayingssuchasthereisnotenoughwater to float
theboatandincreasethewatertofoattheboat.
In the original text above, despite the presence of an excess yangming fu-organ
pattern,thereisanunderlyingyindeficiencyinthepatientsconstitution,andtherefore
theoverallpatternisanexcess-deficiencycombinedpattern.Therefore,nourishing yin
andmoisteningdrynessshouldbeutilized.ZngYTngcanbeadministered.Inthis
formula, xun shn, salty and cold, acts as the chief medicinal to moisten the lower
jiao.Itisassistedby midng, whichissweetandcoldandcanmoisten,and shng
d, which can nourish yin and strengthen water (kidney).Though this formula has
nopurgativeherbs,theseherbsarecoldandrichinjuice,whichcanhelptopromote
bodyfluidproduction and indirectly result in purgation.Wu Ju-tong once said,This
formulacontainspurgingwithinnourishing,usingtheformofnourishingmedicinals
to obtain the function of purging.Later generations regard this formula as the
representativeformulaforincreasingwatertofloattheboat.Thedosageofherbsin
thisformulashouldbelarge,otherwiseitmaynotbeeffective.Ifnopurgativeeffect
isobtained,itmightbeduetoextremelydryintestines.Inthatcase,dhung(Radix
etRhizomaRhei)andmngxio(NatriiSulfas)canbeadded.Theresultingformulais
calledtheZngYChngQTngandcanbeappliedtotreatconstipationcausedby
exhaustionofbodyfuids.
CaseReport
Case#1
1 Yangmingfu-organreferstothelargeintestinehere.
The patient had suffered constipation for more than four years, defecating only
onceevery5to6days,withadifficultdefecationthatlasteduptoonehour.Herstool
was dry, resembling goat stool, and the quantity was small. Defecation caused anal
pain, and the stool sometimes carried some blood. Occasionally, other symptoms
occurredsuchasabdominaldistension,poorappetite, headache,dizziness,insomnia,
hotsensationsinherpalmsandsoles, drymouthandwakingatnighttodrinkwater.
Thepatientstonguewaslightred,withathinyellowcoating.Herpulsewasthready
andrapid.
Theformulagivenwasasfollows:

shnghshuw 15g RadixPolygoniMultifori
Onepacktakenperday.Theaboveherbsweredecoctedwith500mlwaterdown
to 240 ml, which was divided into three doses for morning, midday, and evening, to
betakenaftermeals.7dayslater,thepatientsdaughtercametotellthedoctorsthat
the patients constipation and hot palms and soles were getting better.The above
formulawasmodifedasfollows:

shnghshuw 15g RadixPolygoniMultifori
tindng 25g RadixAsparagi
After7days,thepatientdefecatedeverydayoreveryotherday,herinsomniaand
poorappetiteimprovedandsymptomssuchashotpalmsandsolesdisappeared.She
remainedhealthyduring14monthsoffollow-upvisits.
[Reference:LJin-xian.88ConstipationCasesTreatedwithZngYTngSupplementation
88.HubeiJournalofChineseMedicine.1994;(3):25.]
Case#2
She had suffered canker sores for several years, sometimes worse, sometimes
better.The patient had sought treatment at many hospitals but could not be cured
completely.Themostrecentattackofulcerationsbegan5daysago.Thepatienthad
takenWestern and Chinese medicines with no obvious curative effect.There were

scatteredulcersunderneathandontheedgesofthepatientstongue.Shecomplained
of severe pain, diminished food intake, thirst with desire to drink, and chronical dry
stools.The patients tongue was red and crimson, with a peeled coating. Her pulse
wasthreadyandrapid.
Accordingto a comprehensive analysisof the four examinations, the patient was
diagnosedwithaphthousstomatitis.Thepatternidentificationwasdrystomachand
fuiddefciency,withturbidheatsteamingupwards.
Treatmentprinciples:nourishyinandmoistendryness;purgebelowanddescend
turbidity.
Formula:ZngYChngQTng.
() dhung(huxi) 10g RadixetRhizomaRhei(addedtowardsend)
Thepatientpassedseveraldry,ball-likestoolsafter2packs.Theformulawasthen
modifiedbyremovingmngxioandadding12gofylrn(SemenPruni),andthree
morepackswereprescribed.
Following the treatment, the patients defecation returned to normal and her
canker sores healed. She continued to take M Z RnWn (Cannabis Fruit Pill) in
decoctionform.Thepatientdidnotrelapseduringthenext4years.
[Reference: Liu Zhen-hu. New Application of ZngY Chng QTng . New
ChineseMedicine.1994;(2):56.]
Source Text 4
(
)
Forallrushingandconstrainedqi,allatrophy,pantingandvomitingthatisdueto
dryness,Mr.YusQngZoJiFiTng(Dryness-RelievingandLung-SavingDecoction)
isindicated.(SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpperJiao)
Formula
shgo 2.5qian GypsumFibrosum

gnco 1qian RadixetRhizomaGlycyrrhizae
sngy 3qian FoliumMori
rnshn 0.7qian RadixetRhizomaGinseng
mrn 1qian FructusCannabis
jio 0.8qian CollaCoriiAsini
ppy 0.6qian FoliumEriobotryae
Abowlofwater,togetherwiththeabovemedicinals,isboileddownto60ofthe
originalfuid.Takethedecoctionwarm,frequently,atleasttwotothreetimesaday.
Interpretation
In autumn, dryness and heat pathogenic qi can constrain lung qi, leading to
symptomssuch as flaccid limbs, heavy breathing, andvomiting. Such symptoms can
be treated with Qng Zo Ji FiTng, created byYu Jia-yan.This formula can treat
severe patterns of warm-dryness damaging the lung.When metal (lung) is dry and
not moist, the lung qi cannot descend and body fluids cannot be distributed, which
leadstocough, dyspnea,vomiting and flaccid limbs.The focus of this formula, then,
istoeliminatedrynessandmoistenthelung.
In order to achieve this, the dosage of sng y, is large, and it acts as the chief
medicinal.Shgoassiststhechiefmedicinaltoclearandprotectthelung(metal).Mi
dng,jio,andmrnnourishandmoistenlungmetal.Rnshnandgncocanshore
uptheearthtogeneratemetal.Allofthesemedicinalsworktogethertoconsolidate
the root of lung metal. Xng rn and p p y can purify and descend lung qi and
inhibitqicounterflowtoresolvethelungbranchpattern.Consideringthisformulaas
awhole,itsfunctionsareclearing,ventilating,andmoistening,whileatthesametime
supplementing qi and yin.The characteristics of this formula are clearing without
damaging the middle, diffusing the lung without damaging qi, and moistening
withoutcloying/stickingupthediaphragm.
QngZoJiFiTngisoneoftheformulasintreatingwarmdryness.Ingeneral,all
medicinalsusedinwarmdrynessareinsmallamounts.Thisisbecausethepathogenic
qiofdry-heatrarelyinitiatesaseverepatterninwarmdiseasetheory.Inthisformula:
sngyisusedaschiefmedicinalinordertoventdry-heatfromthelung;shgois
acrid and sweetaswellascoldinnature; mi dng is sweet and cold, these two are
usedasdeputiesinordertoclearlungheat,andnourishyintomoistenthelung.
The formula was first recorded in Precepts for Physicians. In this book, it was
suggestedtouse dunshgo(GypsumFibrosumPraeparatum)andnotraw shgo.
Thepurpose for doing this might havebeen to reduce its cold and heavy properties
inordertoprotectmiddlejiaoqiandcounteractthediffusinganddispersingeffects
ofsngy.However,itisnotappropriatefromamodernperspective. Dunshgois
only used for external lesions because of its strong astringing function. If it is used
internally,notonlycanitnottreatthedisease,butitalsorisksaggravatingit.
Lastly,whenWuJu-tongrecordedtheformulatotreatwarmdrynessin Systematic
DifferentiationofWarmDisease,hehadalreadymadethecorrection:heusedshngsh
goinsteadofdunshgo.
CaseReport
Male,age29.
The patient had been suffering from a cough induced by a common cold for
more than one year. He complained about phlegm in his throat and that he could
expectorate copious white, frothy catarrh, but that it did not relieve his discomfort.
Additionalsymptomsincludedchestoppression,shortnessofbreath, drymouth,and
normal defecation. His tongue was red, with a mild yellow,greasy coating. His pulse
waswiryandslippery.
DiagnosisinCM:dry-heatcough.
DiagnosisinWM:upperrespiratorytractinfection.
Treatmentprinciples:clearheatandmoistendryness.
Theformulawasasfollows:

sngy 12g FoliumMori
() jio(ynghu) 10g CollaCoriiAsini(melting)
hizhma 10g SemenSesamiNigrum
ppy 10g FoliumEriobotryae
shndugn 10g RadixetRhizomaSophoraeTonkinensis
Theaboveformulawasdecoctedtogetherwith15gofDiGSn(IndigoNaturalis
GeckoPowder).Sevenpacksweregiventobetakenoveraperiodofsevendays.
Second consultation: the patients symptoms were improved. Seven more packs
weregiven.
Third consultation: the patients symptoms were improved, but he still felt
discomfortinhisthroat.10gofchunbim(BulbusFritillariaeCirrhosae)andxun
shn(RadixScrophulariae)wereaddedtotheaboveformula.10packsweregiven.
Fourth consultation: almost all the patients symptoms had disappeared, though
therewaslittlecoatingonhistongueandhehadathready,rapidpulse.Sevenpacks
oftheoriginalformulawereadministeredtoconsolidatethetreatment.
[Reference: Wang Shi-ya, Chen Qing-ping.Yin Hui-hes Experience on Application of Qng Zo
JiFiTng.ChineseJournalofMedicine.1997;32(10):50.]
Source Text 5
()
()
PJXioDYn(UniversalReliefToxin-RemovingInfusion)mainlytreatsaversion
tocold,heavyfeelings,swellingintheheadandface,difficultlyinopeningthe eyes,
panting,throatdiscomfort,anddrytongueandmouth.Colloquiallyitiscalleddtu
tinxng(bigheadspreadingundertheheavens).([Li]Dong-yuansProvenFormulas,Vol.9)
Formula
hungqn 5qian RadixScutellariae(stir-friedwithyellowChinesericeliquor)
hunglin 5qian RhizomaCoptidis(stir-friedwithyellowChinesericeliquor)
chnp 5qian PericarpiumCitriReticulatae
xunshn 2qian RadixScrophulariae
chih 2qian RadixBupleuri
linqio 1qian FructusForsythiae
bnlngn 1qian RadixIsatidis
mb 1qian LasiosphaeraseuCalvatia
jingcn 0.7qian BombyxBatryticatus
shngm 0.7qian RhizomaCimicifugae
Theabovemedicinalsaregroundintopowder,tobetakenfrequentlydissolvedin
hotwaterormixedwithhoneytomakepillstobedissolvedinthemouth.Sometimes
d hung (Radix et Rhizoma Rhei) is added to the formula to treat constipation (if
present).Inthiscase,itshouldbewineinfusedorroasted.

()
Sometimesinwarm toxin invasion, the throat will be sore and swollen, the areas
infrontofandbehindtheearswillbeswollen,thecheekswillbeswollen,andtheface
willbered.Sometimesthethroatisnotsore,butthesidesareswollen.Inseriouscases
therecanevenbedeafness.Colloquially,itiscalledbigheadwarmthortoadwarm
disease.Thiscan be treated withP J Xio DYnafterchi h andshng mhave
been removed. On the first and second day after the disease attacks, hung qn and
hunglinareremoved;onthethirdandfourthday,thesetwoherbscanbereturned
totheformula.(SystematicDiferentiationofWarmDiseases,Vol.1,ChapterUpperJiao)
ThemodifedPJXioDYnfromwhichchih,shngm,hungqnandhung
linhavebeenremovedisasfollows:
linqio 1liang FructusForsythiae

mb 4qian LasiosphaeraseuCalvatia
jngjisu 3qian SpicaSchizonepetae
jingcn 5qian BombyxBatryticatus
xunshn 1liang RadixScrophulariae
jnynhu 1liang FlosLoniceraeJaponicae
bnlngn 5qian RadixIsatidis
jigng 1liang RadixPlatycodonis
The above medicinals are ground into crude powder.Take 6 qian of the powder
for each dose, 8 qian for serious cases.The powder is decocted along with freshl
gn(RhizomaPhragmitis),thedregsareremoved,andthedecoctionistakenevery4
hours,orevery2hoursforseriouscases.
Interpretation
PatternAnalysis
Warm toxindiseasesymptomsinclude: sore and swollen throat, preauricular and
postauricularswelling,cheekswelling,redface;sometimesthethroatisonlyswollen
andnotsore,andinseriouscasesevendeafnesscanbeseen.Thisiscommonlycalled
big head warmth and it includes theWestern medicine disease epidemic parotitis
(mumps). P J Xio DYn can be applied for treatment. If at the beginning of this
diseasetheheattoxinisnotintense,then hungqnandhunglincanberemoved.
Theunmodified formula treats wind-heat epidemic toxin obstructing the upper jiao,
whose main clinical symptom is swelling of the head and face, hence the colloquial
name, big head warmth or, in modern laymans termsswollen-head infection.
Importantclinicalsymptomsare feverwithaversiontocold;red,painful,andswollen
headandfacewithdifcultlyinopeningtheeyesandthroatdiscomfort.
FormulaAnalysis
Because the basic cause of this disease is wind-heat epidemic toxin, the
characteristicsofthemedicinalsusedtotreatitareclearingheat,resolvingtoxins,and
dispersingwind-heat.
Hungqnandhunglinareusedtoclearanddescendheattoxinfromthehead.
Iftheherbsarestir-friedinwine,theirefcacyisquicker.
Xunshn,bnlngnandmbcanassistthem.
Linqio,nibngz,bheandjingcncandispersewind-heatfromtheheadand
face.
Gncoandjigngcanassistthemandalsoclearthethroat.
Shngmandchihhavetwofunctions:first,theydispersewind-heatandeven
constrainedfirewhenitispresent.Second,theirascendingnatureallowsthemtoact
asmedicinalenvoysguidingtherestoftheherbsdirectlytotheheadforimmediate
efcacy.
Additionally, the combination of the acrid and ascending nature of these herbs
with the bitter-descending nature of hung qn and hung lin prevents excessive
ascendinganddispersing.Astochnp,itcanrectifyqiandresolveconstraint,prevent
heat obstruction and qi stagnation, and protect stomach qi by preventing the cold
herbsfromdamaging the stomach. In modern times, this formula is commonly used
forheat-toxindiseasesoftheheadandface,suchasthemumpsandfacialerysipelas,
withremarkableresults.
CaseReport
Female,age5.
At the onset of the disease, the patient suffered fever with aversion to cold,
headache, sore and swollen throat, difficult swallowing, drooling, productive cough,
fushedcomplexion,andvexationandagitationforthreedays.
Physicalexamination:bilateralswollentonsilswithwhite,pus-likeexudate;uvula
and soft palate hyperemia, with redness and swelling; bilateral anterior cervical
lymph node swelling; many scarlatiniform exanthema post aur, and on the neck,
chest, and back; obvious thread-like exanthemas bilaterally on the axillary fossa,
antecubital fossa, and groin.The patients tongue was crimson red, with a greyish
whitecoating.Herpulsewasfoatingandrapid.
Shewassubsequentlydiagnosedwithscarletfever.
Bloodtest:WBC13109/L,N0.80,L0.20;urineprotein(+),C-reactiveprotein(+).
Treatment principles: dispel and ventilate pathogenic qi, clear and resolve heat
toxin.
P J Xio DYn was administered to the patient. It was decocted in water, and
one pack was given per day continuously for five days. For the external treatment,
XLiSn(Galenite-likePowder)wasblownintothepatientsthroattocleanoutthe
putridphlegmandtoresolvepernicioustoxins.
After 5 days, the patients fever was reduced, her throat was comfortable, and
her scarlitiniform exanthemas were exfoliating. Blood and urine tests were normal.
Treatment was continued by administeringYngYn Qng FiTng (Yin-Nourishing
andLung-ClearingDecoction),inordertoreinforcethecurativeefect.
[Reference:ZhangFu-rong.ApplicationofPJXioDYninAcuteInfectiousDiseases
.JournalofEmergencyinTraditionalChineseMedicine.1994;(2):74.]
Section3 Ying-BloodLevel
PatternsandTreatment
Source Text 1

(4)
As stated previously, acrid-cool medicinals disperse wind; bland, sweet ones
expel dampness; if through this treatment disease is still unresolved, it is because
it is about to enter ying.When the ying level receives heat the blood is robbed, and
theheart-spiritisnotatpeace,resultinginserioussleeplessnessatnight;sometimes
indistinct maculae appear on the skin; in this case, medicinals for treating qi should
be removed. If the condition results from wind-heat pathogenic qi from the exterior
moving inward, use medicinals like x jio (Cornu Rhinocerotis) and zh y (Folium
Phyllostachydis Henonis); if it follows the deepening ofdamp-heat pathogenic qi,
usemedicinalslike xjioandflowerdistillatetomodifythebasicformulaofcooling
bloodandclearingheat.Ifthereisrestlessagitation,thenjnzhcanbeadded.Forthe
elderlyorthosewithcoldconstitutions,rnzhnghungcanbeusedtoreplaceit(jn
zh).Whatismostimportantistoquicklyventthemaculaethroughthesurfaceofthe
skin.(TreatiseonWarm-HeatDiseases,entry4)
Interpretation
Asmentionedintheprevioussection,patientswhopresentwithpatternsofeither
warm-febrilediseasemixedwithwindorwarm-febrilediseasemixedwithdampness
can be treated by dispersing pathogenic wind with acrid-cool herbs, or expelling
pathogenicdampnesswithblandsweetones.Ifusedproperly,thesewillresolvethe
pathogenicqi.However,iftheconditionisnotresolvedbutworsens,thepathogenic
qicouldentertheyinglevel.Ifitenterstheyinglevel,yingyinwillbedamaged.Since
theheartgovernsthebloodandvessels,itissaidthatthe ying-bloodlevelisrelated
to the heart.This explains why heat in the ying level will lead to disturbance of the
heart-spirit and sleeplessness.Ying and blood travel together within the vessels, so
heatintheyinglevelwillaffectblood.Whenthebloodisaffectedbyyinglevelheat,it
will be forced into extravasation from the vessels, eventually erupting as subdermal
maculae.Theclinicalpresentationalsoincludes:feelinghot,especiallyatnight;thirst
without a desire to drink; delirious speech; a crimson colored tongue; and a rapid
thready pulse. Medicinals for wei and qi levels should be removed in this condition,
and the therapeutic principle should then be to cool the blood and vent ying level
heat. If the pattern manifests as wind-heat pathogenic qi, then use medicinals like
x jio and zh y to clear and expel the pathogenic qi; if it manifests as damp-heat
pathogenic qi, then use x jio and some aromatic substances like flower distillate
(honeysuckleflowerdistillateorteachrysanthemumdistillate)toclearandtransform
the pathogenic qi (i.e., with x jio to clear heat and flower distillate to transform
dampness). In patients where the heat toxin is in extreme excess manifesting as
restlessagitationandconstipation,thenitisnecessarytoadd jnzh1toclearfireand
remove toxic heat. However, because jn zh is extremely cold in nature, rn zhng
hung 2 (yellow Radix et Rhizoma Glycyrrhizae) can be used to replace it in elderly
patientswithyangdeficiencyorforthosepatientswithdeficientcoldconstitutions.By
utilizingthismethod,theinteriorheatcanbereleasedduetotheopeningof fu-organ
1 AccordingtheMingDynastytext,jnzhorgoldenjuiceisthefluidofdecomposedfeces.Itisbelievedthat
thesubstanceismadebyburyingthefecesundergroundforaprolongedperiodoftimeuntilithasdecomposed
tothepointthatonlyfuidremains.Itsnatureisextremelycold.
2 Rnzhnghungisamedicinalthatisrecordedinmanybooksonherbalmedicine.Itsalternativename
isgncohung.IntheChineseMateriaMedica,itspreparationmethodisexplainedas:putgnco(Radixet
Rhizoma Glycyrrhizae) powder into a tube-shaped container made from bamboo; pack the powder in tightly
leaving a space of about 0.3 cm below the mouth of the container; use zh r (Caulis Bambusae inTaenia) to
cover the gn co powder and use a wood plug to bung the container tightly; seal it with rosin and hang the
whole container in a cesspool to soak for 49 days; take it out and put in running water to rinse for another 49
days;afterbeingexposedtothesunshineandnightdewforsevendays,itcanbeused.(Generallyspeaking,itis
suggestedtobepreparedduringwintertimeandtakenoutforusageinspring.)Itsnatureiscold,butcompared
tojnzhitismilderandbetterforelderlypatientswithyangdefciency.
qi,theresultbeingthemaculaecanthenbeventedsuccessfully(wheninteriorheatis
noteasilyexpelled,promotingbowelmovementshouldbeconsidered.)Insummary,
theguidingprincipleistocoolying-bloodtoensurethatthemaculaewillbevented
successfully. In other words, re-establish harmony of the qi mechanism between the
interiorandexteriorbyexpellingpathogenicheat.
Source Text 2

()
Symptoms like a deficient pulse, sleeplessness at night, vexation and thirst, red
tongue, delirious speech sometimes, and eyes that open but don't close or closed
eyesthatdon'topenindicatethatsummerheatentersthehandjueyin.Summerheat-
warmth of the hand jueyin can be treated with QngYngTng (Ying Level Heat-
ClearingDecoction)exceptforthosewhopresentwhiteglossytongues(methodthat
combinessalty,cold,sweetandbittermedicinals). (SystematicDifferentiationofWarmDisease,
Vol.1,ChapterUpperJiao)
Formula
xjio 3qian CornuRhinocerotis

shngd 5qian RadixRehmanniae
yunshn 3qian RadixScrophulariae
zhyxn 1qian FoliumPleioblasti
dnshn 2qian RadixSalviaeMiltiorrhizae
hunglin 1.5qian RhizomaCoptidis
jnynhu 3qian FlosLoniceraeJaponicae
Use8cupsofwatertocookthemedicinals;cookuntil3cupsofdecoctionremain
andtakeonecupthreetimesaday.
Interpretation
When pathogenic summerheat enters the hand jueyin pericardium channel,
patientswillpresentsymptomsthatincludeathreadyandfeeblepulse,sleeplessness
at night, vexation with thirst, occasional delirious speech, and difficulty in either
closing the eyes or opening them.This condition should be treated with QngYng
Tng,whichisdesignedforpatternsof pathogenicheatenteringtheyinglevel.Heat
enteringtheyinglevelischaracterizedbybodyheatand fever(morepronouncedat
night), vexation and sleeplessness, delirious speech, maculae, a crimson dry tongue,
and a rapidandthreadypulse.Treatment should focus on clearing and ventingying

levelheat,nourishingyinandpromotingfuidproduction.
ItissaidinTheYellowEmperorsInnerClassic:BasicQuestionsthattotreattheinternal
invasionofpathogenicheat,usesaltyandcoldmedicinals,tobesupplementedbysweet
andbitterones.Inthisformula,saltycoldxjioandsweetcoldshngdareusedas
sovereignsinordertocleartheyinglevelandcoolblood;yunshnandmidngare
usedasministersinordertonourishyinandclearheat.Externally-ContractedWarm-
heat(WiGnWnRPin,)byYeTian-shipointedoutthatthemethod
ofventingheatfromtheyinglevelthroughtheqilevelcanstillbeappliedtodealwith
heatenteringtheyinglevel.Thatistosay,whenheatenterstheyinglevel,inaddition
to using medicinals to clear ying and cool blood, light herbs to disperse qi should
alsobeappliedsoastotransport pathogenicheatfromtheyingleveltotheqilevel,
thus allowing pathogenic heat to be released via the qi level. According to clinical
observation, qi level patterns and ying level patterns often appear simultaneously
when pathogenic qiis transmitting and changing from the qi level to the ying level.
Alternatively stated, symptoms of heat entering the ying level begin to appear with
heatintheqilevelthathasnotcompletelydisappeared.Inthiscondition,treatment
with medicinals to simply clear the ying and cool blood may result in pathogenic qi
beingfrozeninsidethebody,incapableofbeingexpelled.Addingmedicinalstovent
heat,however, can help to transport pathogenic heat to the qi level where it can be
eventuallyreleased.Basedonthistheory,jnynhu,linqio,hunglin,andzhy
in the formula are used as assistants to clear heat and remove toxins,venting heat
from the ying level through the qi level. Additionally, to prevent the possibility of
heat binding with blood stasis, dn shn is added to invigorate blood so as to clear
stagnated heat. In combination, the medicinals in the formula achieve the goal of
clearing the ying level, venting qi (venting heat from the ying level through the qi
level),nourishingyinandinvigoratingblood.
Whenprescribingthisformula,doctorsshouldpayparticularattentiontopatients
tongue manifestation.This formula is appropriate for those who have crimson dry
tongueswithlittleornocoating.Awhiteglossycoatingindicatesexcessivedampness,
sosofteningandmoisteningmedicinalsshouldbeprohibited.Instead,thetherapeutic
principles for damp-heat type warm disease, rather than QngYngTng, should be
followed.
CaseReport
Female,age14.
Upon admission, the patient had presentedfever, pharyngalgia, cough, epistaxis
and bleeding gums for more than 20 days, and had been admitted due to APL
(acute promyelocytic leukemia). She had received anti-leukemia chemotherapy

before admission (no further information regarding the chemotherapy process
available). After admission, she had presented remittedfever (41.7C) for more than
20 days. Symptoms included: fever, headache, bleeding gums, vexation, thirst, and
sleeplessnessatnights.
Vitalsigns:
T HR BP RP
41.7C 120bpm 18.0/10.0kPa 24tpm
Physical examination: clear mind, poor spirit, a normally developed figure, oral
mucosal hemorrhage, scattered hemorrhagic spots on lower limbs, no jaundice, no
other mucocutaneous hemorrhage, no swelling or tenderness on superficial lymph
nodes,regularcardiacrhythmwithoutpathologicalnoiseinauscultatoryvalveareas,
coarse respiratory noise in both lungs, no dry or moist rale, no wheezing sound,
softabdomenwithnotendernessorreboundtenderness,tendernesswithtenacious
texture 3 cm below the liver xiphoid, spleen not palpable, swelling redness and
scorchingpainaroundtheanuswithasmallamountofsecretionandlocalbleeding,a
crimsontonguewithyellowcoating,andawiryrapidandslipperypulse.
Laboratorytestresults:
WBC HB Blastcells BPC
7.4109/L 75g/L 78 10109/L
Bone marrow test: active proliferation, abnormal proliferation of granulopoiesis,

promyelocyte and myelocyte occupying 78, irregular size of cyton, vacuolated
degeneration of cyton and cytoplasm, inhibited development of erythrocytes and
megakaryocytes, only one megakaryocyte visible in the whole view. Blood culture:
growthofbacilluscoli.
DiagnosisinWM:acutepromyelocyticleukemia;septicemia.
Diagnosis in CM: winter-warmth (heat toxin entering ying-blood); consumptive
disease(defciencyofbothqiandblood).
Treatmentprinciples:cool blood,dissipatebloodstasis,nourishyin,clearheatand
resolvetoxin.
Formula:modifedQngYngTng.
shunijiofn 30g CornuBubali(powder)


zhyxn 9g FoliumPleioblasti
Medicinals were decocted in water for oral intake, one pack per day. Ampicillin
(6g)anderythromycin(IV2,400,000units)werealsoadministered,onceaday.After
havingbeentreatedforsevendays,thepatientsbodytemperaturebegantodrop;24
dayslater,itreturnedtonormal,andhemocultureturnedtonegative.
[Reference:Tang Xu-dong.TangYou-juns Experience onTreatment of Acute Leukemia Fever
with QngYngTng . Shandong Journal ofTraditional
ChineseMedicine.2003;22(9):559.]
Source Text 3
(
)
Symptoms that include a desire to rinse the mouth with water but no desire to
swallow, and smooth stool that is black in color indicatesblood stasis, which can be
treatedbyXJioDHungTng(RhinocerosHornandRehmanniaDecoction)(method
ofcombinationsweet,saltyandmildbittermedicinals). (SystematicDifferentiationofWarm
Disease,Vol.3,ChapterLowerJiao)
Formula

shngbisho 3qian RadixPaeoniaeAlba
dnp 3qian CortexMoutan
xjio 3qian CornuRhinocerotis
andtakeonecuptwiceaday.Thenaddenoughwatertotheremainingdregstodecoct
againuntilonecupofthedecoctionremains,andtakeit.
Interpretation
Patients whose primary symptoms include a dry mouth with a desire to merely
rinseratherthantoactuallyswallow,accompaniedbysmoothstoolthatisverydark
or black in color indicates the presence of blood stasis, which can be treated by X
Jio D HungTng.This formula was originally designed for the treatment of blood
amassment, nosebleed, and vomiting of blood that has resulted from a failure to
releasetheexterioratthepropertimeincolddamageorwarmdisease.Later,scholar-
physiciansofwarmdiseaseregardedthisasarepresentativeformulafortreatingheat
enteringthebloodlevel.Itsindicationsinclude:
1.Variousbleedingduetoinjuryofbloodvesselsbyheat;
2. Heat harassing the heart and ying level manifesting delirious speech, loss of
consciousnessandacrimsontonguewithpricksindicativeofheat;
3. Pattern of blood amassment caused by static heat harassing the interior,
manifesting mania and forgetfulness, a desire to rinse the mouth with water but no
desire to swallow, smooth and black tarry stool, and spasmodic pain in the lower
abdomen.
Once heat has entered the blood level, blood stasis continues to exist at various
degrees due to either boiling blood and/or the forcing out of blood from the
vessels by pathogenic heat. In this condition, treatment with medicinals to simply
clear ying and cool blood may result in pathogenic heat being frozen inside the
body and thus not being expelled.This formula is characterized by a combination
of medicinals that function to clear heat by cooling blood, as well as to invigorate
blood while nourishing yin in order to disperse blood stasis. As concluded byYe
Tian-shi:Ifpathogenicqientersthebloodlevel,onefearsthatitwillconsumeblood
and move blood (cause bleeding); one should immediately cool blood and disperse
blood.
Intheformula,xjioandshngdfunctiontoclearheatandcoolblood,whilesho
yoanddnpnotonlyintensifytheeffectsofclearingheatandcoolingbloodbyx
jioandshngd,butalsodispersebloodstasis,soastopreventbindingofheatand
bloodstasis.Additionally,chshocanbesubstitutedforbisho,whichwillfurther
enhancetheeffectsofclearingheatandcoolingandinvigoratingblood.Shunijiois
typicallyusedinlargerdosageamountstoreplace xjio,whoseuseisprohibitedin
moderntimes.
CaseReport
The patient had a history of thrombopenia essentialis for 30 years with repeated
bouts of bruising on the skin.Three days prior to her consultation, the contusions
had become aggravated and appeared all over the body, accompanied with severe
bleedingofthegums,fatigue,andhotsensationsinthepalmsandsolesofthefeet.A
routinebloodtestonMay18thshowedplateletlevelstobe4610 9/L.Symptomswere
recorded as follows: purple red petechia and ecchymosis present all over the body,
especially on the lower limbs; a red tongue with thin yellow coating, and a thready
rapidpulse.
Pattern differentiation: contusions, pattern of blood heat accompanied by yin
defciency.
Formula:modificationofXJioDHungTngandQinGnSn(IndianMadder
RootPowder).
shunijiopin 30g CornuBubali(sliced)
qincotn 15g RadixRubiae(charred)
zhztn 10g FructusGardeniae(charred)
jiozh 15g CollaCoriiAsiniPilula
cbitn 10g CacumenPlatycladi(charred)
xinhco 10g HerbaAgrimoniae
Ten packs were given to be decocted in water for oral consumption. Acrid-warm
anddryness-heatfoodsweretobeavoided.
Secondconsultation:June3,2007.Thepatientsgumshadstopped bleeding,and
overallcontusionshadbeeneliminated,althoughfatiguewasstillpresent.Hertongue
was red with a thin yellow coating, and the pulse was thready and slightly rapid. X
yngshn(RadixPanacisQuinquefolii)wasthenaddedtotheformulatosupplement
qi,andzco(RadixArnebiae)andphungtn(charredPollenTyphae)wereadded
tocoolblood,dispelstasisandstanchbleeding.Tenpackswereadministered.
Thirdconsultation:June17,2007.Bothsymptomsofbleedinggumsandcontusions
hadnotrecurred,althoughmentalfatigueandlackofstrengthhadnotbeenrelieved.
AccordingtoaroutinebloodtestonJune14th,plateletlevelswere:74109/L.Physical
examination showed that bruising on the skin was faint in color, but it still existed.
The tongue was red with thin yellow coating and the pulse was thready. With
consideration given to the deficiency of qi and blood, the treatment was primarily
basedonShngYTng(SageCureDecoction),modifiedwith zcoandqincoin
ordertostanchbleeding,resolvestasisandeliminatecontusions.
xyngshnpin 10g RadixPanacisQuinquefolii(sliced)


chunxing 8g RhizomaLigusticiChuanxiong
qincotn 15g RadixetRhizomaRubiae(charred)
Tenpacksweregiven.
[Reference: NieYa. Experience of Professor Xiong Ji-bai onTreating Suggillation
.GuidingJournalofTCM.2008;14(5):18-19.]
Section4 ConsumptionofTrueYin
Source Text 1

()
Indiseasesofwind-warmth,warmfebrile,warmepidemic,warmtoxinandwinter
warmth, if pathogenic heat has lingered at yangming for a prolonged period with
symptoms as follows: generalized heat, reddish complexion, dry mouth and tongue,
or even black teeth with cracks on the lips, with a deep excess pulse, purgative
method can be used regardless of whether or not it has already been applied. If the
pulseisdeficientandlarge,andaccompaniedbyhotsensationsinpalmsandsolesof
thefeetthataremoreobviousthaninthedorsumofhand,JiJinFMiTng(Pulse-
RestoringVariantDecoction)governs(methodofsweetandmoist[medicinals]tosave
fuid).(SystematicDiferentiationofWarmDisease,Vol.3,ChapterLowerJiao)
Formula
zhgnco 6qian RadixetRhizomaGlycyrrhizaePraeparatacumMelle

gndhung 6qian RadixRehmanniae
midng 5qian RadixOphiopogonis(withpit)
Use8cupsofwatertocookthemedicinals;cookuntil80of3cupsofdecoction1
remainandtakeequalamounts,lessthanonecupthreetimesaday.Inseverecases,
gncocanbeincreasedto10qian,dhungandbishoto8qian,andmidngto7
qian.Takethedecoctionthreetimesduringthedayandonetimeatnight.
Interpretation
JiJinFMiTngisderivedfromZhGnCoTng(Honey-FriedLicoriceDecoction)
intheTreatiseonColdDamage,andisdesignedfortreatinglowerjiaodiseasepatterns
in later stage warm disease due to heat damaging liver and kidney yin-fluids, which
canbedefnedasconsumptionoftrueyin.
Dhungandjioareusedtosupplementtrueyin,whileshoyoandmidng
nourishyinandpromotefuidproduction.
Gncoisaddednotonlytoharmonizetheothermedicinals,butalsotoeliminate
coldcausedbydhungandshoyo.
Thisformulaisespeciallyusefultonourishyin,andissuitableforseveredepletion
ofyin-fuidsinwarmdisease.
CaseReport
The patient had a history of coronary artery disease and hypertension for over
10 years.There was no complaint of obvious discomfort in his daily life, except for
dizziness,chestoppressionandshortnessofbreathduringactivity.Hehadexperienced
sudden syncope twice since 2007 during defecation due to straining.The provincial
hospitalwherehehadbeenreferredforemergencytreatmentmadethediagnosisof
acute myocardial infarction. Coronary arteriography indicated stenosis of branches
ofthecoronaryartery,themostseverebeingthatoftherightbundlebranch,inwhich
the diameter was narrowed by 96.The patient subsequently underwent surgery
of percutaneous coronary artery stent implantation. Following the surgery, he took
Westernmedicine regularly as orderedfor three months. However, discomfort in the
precordiumwithdullpaincontinuedtoexistoccasionally,accompaniedbyshortnessof
breathwhileclimbingthestairs.Othersymptomsincludeddrymouthanddrystool.
Inspection: pale complexion, emaciation, dry skin, a crimson tongue with little
coating,andathreadyandpowerlesspulse.
Patterndiferentiation:depletionoftrueyinresultinginfailuretonourishthebody.
Treatment principles: nourish yin and supplement blood, diffuse and unblock
1 Theexactmeaningof (bfnsnbi)isunclear.However,theliteraltranslationis,eightparts
threecups,thereforeitistranslatedas80of3cups.
heartyang.
Formula:modifedJiJinFMiTng.
RadixetRhizomaGlycyrrhizaePraeparata
zhgnco 10g
cumMelle
gndhung 24g RadixRehmanniae
shngbisho 15g RadixPaeoniaeAlba
CollaCoriiAsini(meltedandinfusedinto
jio 10g
decoction)
mrn 10g FructusCannabis
qungulu 24g FructusTrichosanthis
Fivepackswereinitiallyadministered,afterwhichthedullpainintheprecordium
was relieved and defecation became unobstruc ted. Following the previous
prescription, five more packs were administered, and after taking all five packs, all
symptomswereeliminatedandthepatientfeltquitewell.
However, two days without herbs resulted in a reoccurrence of dry stool, so Ji
JinFMiTngwasadministratedagain.

gndhung 24g RadixRehmanniae
jio 10g CollaCoriiAsini(meltedandinfusedintodecoction)
Five packs were given for oral ingestion. Doctors advice: get more rest, and eat
food that can nourish yin and promote fluid production; exercise appropriately. All
symptomssubsequentlydisappeared.
[Reference:Chen Jing-fang. Clinical ApplicationofPulse-RestoringVariantDecoction
.JiangsuJournalofTraditionalChineseMedicine.2008;40(3):12-13.]
Source Text 2
()
Symptomsofnightfeverabatingatdawnandfeverthatdiminisheswithoutsweating
indicates that pathogenic heat comes from the yin level, and Qng Ho Bi JiTng
(SweetWormwood andTurtle Shell Decoction) governs (method of combination
ofacrid-coolandsweet-coldmedicinals). (SystematicDifferentiationofWarmDisease,Vol.3,
ChapterLowerJiao)
Formula
qngho 2qian HerbaArtemisiaeAnnuae
biji 5qian CarapaxTrionycis
xshngd 4qian RadixRehmanniae
dnp 3qian CortexMoutan
andtakeonecuptwiceaday.
Interpretation
Ifthepatient presentsfeverat night, and a normal bodytemperatureduringthe
day,withanabsenceofsweatingwhenfeverdecreases,itindicateslatentpathogenic
heatattheyinlevel,whichcanbetreatedwithQngHoBiJiTng.Thisformulais
designedforyindeficiencyaccompaniedbylatentpathogenicqi,whichmaymanifest
in later stage warm disease. It is characterized by night fever that abates at dawn,
feverthatdecreaseswithoutsweating,aredtonguewithlittlecoating,andathready,
rapidpulse.
In this case, because latent pathogenic heat remainshiding at the yin level,
clearing and venting is the only alternative left to expel pathogenic qi through the
exterior.This is due to the fact that yin depletion results in no source of fluids for
sweating. Consequently, no other method remains to recover the yin other than to
enrich and nourish (thereby replenishing the fluids).WuTang designed this formula
toventlatentpathogenicheatthatremainshiddenatthe yinlevelbydischargingit
viatheyanglevel.
In the formula, bi ji goes directly to the yin level, a process described byWu
Tang asentering the collaterals to search for pathogenic qi. It also functions to
enrich yin and subdue yang.The aromatic nature of qng ho functions to assist
movement outward to the yang level, so that pathogenic qi can be vented to the
exterior.WuTangreferredtothisphenomenainthisinterpretationoftheformula:The
magicofthisformulaisfirstin-lastoutmeaningthat:qnghocannotgodirectlyto
the yin level without the guidance of bi ji, while bi ji cannot move exteriorly to
theyanglevelwithouttheguidanceofqngho.Inaddition,shngdisusedtoassist
biji innourishing yintopromotefluidproduction; zhm teamswith qnghoto
vent pathogenic qi and enrich yin. Dn p is added as it can assist in both aspects:
clearinglatentheatatbloodlevel,andventinglatentpathogenicqiattheyinlevel.In
combination,allofthemedicinalsworktogethersynergisticallyservingtoenrich yin
andventpathogenicqi,soastotreattherootandbranchsimultaneously.
CaseReport
Female,age12.Initialconsultation:February20,1993.
The patients chief complaints were fever and edema lasting for more than four
months in duration.The patient was first admitted to the hospital on February 20,
1993. Four months prior, she began to present fever, mouth ulcerations, arthralgia,
and edema with no determination of cause. She was diagnosed with systemic lupus
erythematosus(SLE).Afterbeingtreatedwithpredisone60mgperday,herarthralgia
was relieved, but her fever, oral ulcers and edema showed no improvement, so she
returnedtothehospitalforfurthertreatment.
Inspection:feverof38.5Cwithmoreaggravationintheafternoon,mild aversion
tocold,edemaonthefaceandlowerlimbs,moonshapedface,extremelydebilitated,
inability to walk, sweating, a dusky-red tongue with a slightly greasy, white/yellow
coating,andawiry,thready,andslightlyrapidpulse.
Laboratoryexaminationresults:
ANA ds-DNA ESR C3 C4 CH50 HGB

1/80 + 121mm/h 0.4g/L 0.09g/L 50kU/L 8g/L
Urineprotein Cast Urineproteinin24hours A/G

++++ ++ 5.6g 0.7/1
DiagnosisinWM:systemiclupuserythematosus(SLE)(activestage).
Diagnosis in CM: latent summerheat (latent pathogenic qi in the yin level with
consumptionofqiandyin).
Treatmentprinciples:boostqiandnourishyin,resolvetoxinsandventpathogenicqi.
Formula:
qngho 10g HerbaArtemisiaeAnnuae(addedtowardsend)
dgp 15g CortexLycii
ymx 20g StigmaMaydis

gngmign 20g RadixIlicisAsprellae
Fourteen packs were given for routine decoction and intake. (Doses of hormone
medicationweredecreasedgradually).
Second consultation: March 6, 1993. Patients fever diminished, her spirit was
improved,andtherewasslightrednessonthetipandedgesofhertongue;herpulse
waswiry,threadyandrapid.Onthebasisoftheformerformula,qngho,dqngy,
gngmignandjigngwereremoved,whilehungq(RadixAstragali),jxutng
(CaulisSpatholobi)andwshosh(Zaocys)wereaddedforanothertwelvepacks.
Formula:
dgp 15g CortexLycii
wshosh 12g Zaocys
Third consultation: March 19, 1993. Low-grade fever (37.2) reoccurred, with
relatively normal spirit and appetite; the tongue was slightly red with a dry thin
coating, and the pulse was wiry, thready, and slightly rapid. Results of laboratory
examinationimproved.Thereoccurrenceoffeverwasduetosupplementingthebody
too early while pathogenic qi still existed.Therefore treatment should still focus on
boostingqiandnourishingyin,whileresolvingtoxinsandventingpathogenicqi.
Formula:
qngho 6g HerbaArtemisiaeAnnuae(decoctedlast)
dgp 15g CortexLycii
dnp 2g CortexMoutan
biji 30g CarapaxTrionycis(decoctedfrst)
Afterhaving taken the medicinals for three days, her body temperature returned
tonormal.
After six months of treatment with modification of this formula, laboratory
examinationresultsbecamenegative,andherintakeofhormonetherapywasreduced
from60mgperdayto15mgperday.Moreover,allsymptomsdisappeared;herspirit
andactivitywerebacktonormal,andshewasabletoreturntoschoolforclasses.
Laboratoryexaminationresults:
ANA ds-DNA ESR C3 C4 CH50 HGB Urineprotein

- - 28mm/h 1.8g/L 0.43g/L 80kU/L 11.1g/L -
[Reference:ZhongJia-xi,LiangXue-feng.ClinicalApplicationofQngHoBiJiTng
.JiangsuJournalofTraditionalChineseMedicine.2008;40(3):10-11.]
Source Text 3

()
When pathogenic heat lingers internally for a long time, if this condition is
mistreated with exterior-releasing or purgative methods, it will lead to fatigue of
spirit and convulsions, a deficient qi pulse, acrimson tongue with little coating, and
signs of progression to yinexhaustionandyangdesertionatanytime,forwhichD
DngFngZh(MajorWind-StabilizingPearl)governs(methodofsour,sweetandsalty
medicinals).(SystematicDiferentiationofWarmDisease,Vol.3,ChapterLowerJiao)
Formula
shnggubn 4qian PlastrumTestudinis
gndhung 6qian RadixRehmanniae

wwiz 2qian FructusSchisandraeChinensis
shngml 4qian ConchaOstreae
midng 6qian RadixOphiopogonis(withpith)
zhgnco 4qian RadixetRhizomaGlycyrrhizaePraeparatacumMelle
jzhung 2mei Yolkofegg
biji 4qian CarapaxTrionycis
Use8cupsofwatertocookthemedicinals;cookuntil3cupsofdecoctionremain;
remove dregs and add j z hung in decoction to mix them together, and take the
decoctioninthreedoses.
Interpretation
When pathogenic heat lingers internally for a prolonged period of time, it robs
trueyin.Inthatsituation,ifexterior-releasingmethodorpurgativemethodisapplied
(as a therapeutic method) by mistake, the result will be mental-emotional fatigue
and convulsions, a feeble pulse, a crimson tongue with little coating and signs that
a sudden collapse of healthy qi can occur at any time.This condition can be treated
withDDngFngZh.
DDngFngZhwasderivedfromJiJinFMiTngandSnJiFMiTng
(Three Shells Pulse-Restoring Decoction), and the three formulas developed in one
continuousline.DDngFngZhwasdesignedforseveredepletionoftrue yinwith
defcientwindstirringinternally.
Pathogenic heat lingering continuously can penetrate deeply into the lower
jiao to scorch liver and kidney yin; since liverblood and kidney yin share the same
source, damage to liver and kidney yin leads to water failing to nourish wood and
yin failing to restrain yang which may give rise to liver yang being hyperactive and
transforming into wind.These contribute the occurrence of deficient wind stirring
internally.Thekeypointsforpatterndifferentiationintheclinicaredisturbedorloss
ofconsciousness,convulsions,acrimsontonguewithlittlecoating,afeeblepulse,and
signsof(qi)collapseatanytime.
Severedepletionoftrueyinshouldbetreatedbyrecoveringtrueyin,whiledeficient
wind stirring internally should be treated by subduing yang and tranquilizing the
liver to extinguish wind.Therefore, this formula is based on Ji Jin F MiTng to
rescue true yin; j z hung and w wi z are added to enrich and nourish original
essenceandastringetrueyinwiththeconsiderationthattheefficacyof JiJinFMi
Tnginrecoveringyinmightbenotstrongenough;threeshells,includingshngml,
gubnandbiji,arecombinedtonourishyin,subdueyang,andextinguishwindto
stopconvulsion.The entire formula can treat the root and branch simultaneously by
supplementingyinandextinguishingwindatthesametime.
CaseReport
Female,age18.
The patient contracted spring warmth with fever more than one month ago.
The condition began with aversion to cold, fever and cough, which was regarded
as a common external condition that was not treated in time. After a few days of
no treatment, the patient presented continuous high fever between 38.5~40C,
accompanied with cough and panting, chest pain, an obstructed sensation with
coughing of sputum, vexation and disturbed sleep, and even delirious speech at
night.
She was sent to a hospital for examination and treatment. Chest X-rays showed
a large dense shadow in the lower left lung; blood tests indicated thatWBC was
21000 mm 3 , with 93 of neutral and 7 of lymph.With the diagnosis of severe
pneumonia,thetreatmentcombinedWesternmedicinewithChinesemedicinals.The
former included a transfusion and large dosages of antibiotics and hormones; the
latterfocusedonthreeaspects:sngy,jhu,jnynhuandlinqiotoreleasethe
exteriorwiththeiracrid-coolnature;shgo,zhm,hungqnandhunglintoclear
heatandresolvetoxins;shngd,xunshn,shshnandmidngtonourishyinand
removeheat.Followingthistreatmentmethod,herhighfeverabated,andhercough
and panting, vexation and delirious speech were gradually alleviated. Chest X-ray
indicatedmostoftheinflammationinthelunghadbeenabsorbed,andbloodtestalso
showedatendencytoreturntonormal.
However, a low grade fever between 37.3~38C failed to be cleared. Inspection
at present: fever (37.8C) with sweat, red complexion, dry lips, occasional vexation,
dizziness and inability to sit up, drooping spirit, lack of clarity of mind, cold limbs,
sweating, occasional convulsions, a dry crimson tongue with cracks in the middle,
scantycoating,athreadyandfaintpulsetendingtoexpire,andsignsofcollapseatany
time.Thisindicatedthelaterstageofwarmdisease,withexhaustionofliverandkidney
yin,deficientwindstirringinternally,whichwasacrisissignforseparationof yinand
yang.Therefore,DDngFngZhwasprescribedtobeadministratedimmediately.

midng 18g RadixOphiopogonis(bigger)
shnggubn 15g PlastrumTestudinis(decoctedfrst)
shngbiji 15g CarapaxTrionycis(decoctedfrst)
shnglngg 15g OsDraconis(decoctedfrst)

shngml 15g ConchaOstreae(decoctedfrst)
xiomi 1gathering FructusTritici
jzhung 2mi Yolkofegg(infused)
Return consultation: after having taken the medicinals, her low grade fever
was cleared gradually, her spirit returned to normal, and convulsions of the limbs
disappeared, while there was still a feeling of oppression in the abdomen, poor
appetite, vexation and insufficient sleep, a bright red tongue with little moisture
and cracks in the middle, and a moderate pulse.The improvement of the symptoms
indicatedthattrueyinwaspronetorecover,thatdeficientwindwasbeingsubdued,
and that floating yang was being astringed as necessary.The remaining symptoms
wereduetoafailureofthespleenstransportingandtransformingandfailureofthe
spirittokeeptoitsabode.Sincetheformulahadbeeneffective,afurthertreatment
wasgivenonthebasisoftheformermethod.

dmidng 15g RadixOphiopogonis(bigger)
shnglngg 24g OsDraconis(decoctedfrst)
shngml 24g ConchaOstreae(decoctedfrst)
bindu 10g SemenLablabAlbum
Endothelium Corneum Gigeriae Galli Praeparata
zhnijn 10g
cumMelle
shnggy 10g FructusSetariaeGerminatus
Fivepacksweregiven.
After taking the medicinals, her appetite was improved, vexation tranquilized,
andsleepbecamepeaceful.
The treatment continued until the patient had taken a total of thirty packs. All
discomfortsubsequentlydisappearedstepbystep.
[Reference:Wang Hong-hua.Wang De-yuansClinicalExperience . Journal
ofTraditionalChineseMedicine.1989;(4):17.]
578
Chapter5
Damp-heat Type Warm Disease
Section1 TherapeuticPrinciples
andMethods
Source Text 1

(9)
Dampness harms people most often. In treating patients with a pale white
complexion,theiryangqimustbeprotectedbecausepredominantdampnessweakens
yang.Whencoolingtherapyisapplied,itshouldonlybeusedatapercentageofsixty
or seventy, which means that the medicinals should not be excessively cold which
wouldresultintreatmentfailure.Why?Becausewhileusingastrongcoolingmethod
can remove damp-heat, it will also lead to yang qi debilitation. In treating patients
withabluishandpalecomplexion,theirbodyfluidsmustbeprotected.Whencooling
methodisappliedatsixtytoseventypercentonthosepatients,generally,thepatients
fever will decrease and his body will generally cool down. At that time, patients
should not be regarded as having a deficiency-cold pattern and then treated with a
supplementingformula,forfearthatthereisstillaflameintheash,eventhoughthe
fire appears to have been extinguished. Practitioners should carefully observe and
analyze the symptoms and then apply therapeutic methods cautiously and not with
recklessness.The entering of pathogenic (damp) qi in alcoholics who usually have
a constitution of excess internal dampness will lead to a combination of external
and internal dampness. In people with yang predominant constitutions,stomach
dampness is common, while in those with yin predominant constitutions,spleen
dampnessiscommon. However, both stomach dampnessand spleen dampness can
eventually transform into heat. In warm disease, while it is relatively easy to rescue
VolumeFour:Chapter5 Damp-heatTypeWarmDisease 579
yin, unblocking yang is the most difficult.The method used to rescueyin is not to
nourishbloodbutrathertoreplenishfluidsandpreventthelossoffluidsviasweating.
To unblock yang, do not use the warming method, but instead promote urination.
Thesetwokindsoftreatmentsaredifferentfromthoseusedinmiscellaneousdisease.
Interpretation
Dampness attacks people most frequently, and therefore causes considerable
disease. It complicates the primary condition, and therefore it is present in a wide
variety of patterns. People with pale white complexions usually have a constitution
with yang deficiency. Once they are affected by dampness, their disease patterns
can easily change into deficiency-cold patterns, because dampness suppresses yang
qi even more.Therefore, practitioners should take note to protect yang qi when
treatingthesepatients.Ifthecoolingmethodisdeemedmandatory,itshouldbeused
cautiously so as to avoid over dosage. In other words, the use of cooling medicinals
should be reduced from the routine application, with particular consideration given
to medicinal property, dosage, and duration of medication in order to avoid severe
impairment of yang qi.This can ultimately result in a situation where although
damp-heatisremoved,yangqiisconsequentlydebilitatedoreveninastateoftotal
collapse.
Peopleofthinfigurewithabluishandpalecomplexionusuallyhaveaconstitution
of vigorous fire due to yin deficiency. An attack of dampness on these people
is easily transformed into dr yness and consequently damages yin. Therefore,
practitioners should pay particular attention to the protection of yin-fluids, and
should not rashly apply warm supplementation to treat them. Even if fever abates
andthebodycoolsdowninlaterstagediseasepatterns,donotconsideritasacold-
deficiency pattern and apply warm supplementation, as remaining pathogenic
qi may not be fully eliminated, and a subsequent resurgence may result. Most
alcoholics have a constitution with damp-heat. As an associated predominance of
internal dampness already exists, external dampness can easily combine with it,
manifestingasdisease.
Inpeoplewithayangpredominantconstitution,dampnessispronetotransform
intoheat,whichismostoftenrelatedtothe yangmingstomach,andthereforecalled
stomachdampness.Itischaracterizedbyapreponderanceofheatoverdampnessin
termsofpathodynamic,andapttotransformintodrynesswhicheventuallydamages
yin. People with a yin predominant constitution have an abnormal debilitation of
yangqiwithexuberantinternalphlegm-dampness.Wheninitiallyattackedbyexterior
dampness,pathogenicqiisrelativelyslowtoprogresstotransformintoheat.Ittends
to linger however, in the taiyin spleen, and therefore is calledspleen dampness. It
is characterized by a preponderance of dampness over heat. It should be noted that

bothtypesofconstitutionscouldtransformintoheatpatternsastheirpathodynamic
advances.
Nourishing yin is often applied in warm febrile disease because pathogenic
heat is prone to consume fluids.The basic therapeutic principle is to clear heat to
preserve fluids, and this is relatively easy to accomplish. Medicinals for nourishing
yin are sweet and cool in nature, which gives them the ability to clear heat.
Therefore, nourishing yin is an indicated treatment for warm febrile disease, in that
nourishing yin can result in fever abating, which in turn can facilitate further yin
recovery.
Unblocking yang is often used in damp-heat type warm disease. Medicinals to
unblock yang are partially warm in terms of property, however, which will assist
heat in damaging fluids once used inappropriately. Moreover, dampness is sticky
and greasy which lingers and is difficult to release, making it difficult for patients
with dampness to recover quickly.Therefore, it is saidto unblock yang is the
hardest.
It should be noted that the medicinals used in nourishing yin in warm febrile
disease differ from those associated with enriching and nourishing yin-blood in
miscellaneous disease to treat yin and blood deficiency patterns. Similarly, the
medicinals used in unblocking yang in damp-warmth disease differ from those
of warm supplementation in miscellaneous disease. In the former, they are used
to diffuse yang qi by transforming qi to promote urination. In this way dampness
pervadinginthesanjiaocanbedrivenoutandexpelledtogetherwithheat.
Source Text 2

(7)
In some qi level diseases, the pathogenic qi may remain in the sanjiao instead
of transmitting to the blood level. [A sanjiao pattern] belongs to shaoyang just as
[gallbladderpatterndoesin]colddamage.[Thetherapeuticmethodfor]ashaoyang
pattern in cold damage is to harmonize half exterior and half interior, while [the
method for pathogenic qi lingering in the sanjiao] is to disperse it from the upper
and the lower separately. [Specific] methods need to be varied according to pattern
differentiation. For instance, medicinals like xng rn (Semen Armeniacae Amarum),
hu p (Cortex Magnoliae Officinalis) and f lng (Poria) [are used commonly]
nowadays [for sanjiao pattern]; or Wn DnTng (Gallbladder-Warming Decoction)
whichfunctions to disperse and discharge [can also be used]. Since pathogenic qi is
still at the qi level, it can be expelled by means of [inducing] shiver sweating, or [by
therepeatedstrugglebetweenupright qiandpathogenicqiwiththemanifestationof
alternatingchillsandfever]similartomalaria.(TreatiseonWarm-HeatDiseases,entry7)
Interpretation
Whenwarmpathogenicqi(pathogenicdamp-heat)remainsattheqilevelforquite
alongtimewithoutbeingreleasedfromtheexteriorortransmittingtothe ying-blood
level, it usually lingers in the sanjiao. Sanjiao belongs to the hand shaoyang, which
functionstoregulateqimovementintermsofitsascending,descending,exitingand
entering,aswell as to control the movement of water passages. Once pathogenic qi
lingers in the sanjiao, it will cause constraint and stagnation of qi movement, which
will further lead to abnormal transportation and distribution of water with phlegm
anddampnessaccumulatinginside.Therefore,awarmfebrilepatterncomplicatedby
phlegm-dampresults.
Although the pattern of pathogenic qi lingering in thesanjiao mentioned above
is considered ashaoyang pattern, it is not the same as theshaoyangpattern in cold
damage. Accordingly, their treatment methods are different.The latter should be
treated with Xio Chi HTng (Minor Bupleurum Decoction) to harmonize half-
exterior and half-interior, while the former should be treated by dispersing and
dischargingpathogenicqiandphlegm-dampseparately.
However, specific methods of treatment will vary according to precise pattern
differentiation.Forinstance,medicinalslikexngrn,hup,andflngcanbeusedin
damp-heatpatternstoopentheupperjiao,disinhibitthemiddlejiao,andtopercolate
thelowerjiaosoastodisperseevilsthroughdifferentmeans,thusfurtheraidingthe
recovery of qi movement in the sanjiao. The formula Wn DnTng from Important
FormulasWorthaThousandGoldPiecesisabletodiffuseanddischargeqimovement
in the sanjiao by removing phlegm, clearing heat and draining dampness, which is
suitableforphlegm-heatlingeringinthesanjiao.Theformulaincludesthemedicinals
chn p (Pericarpium Citri Reticulatae), bn xi (Rhizoma Pinelliae), f lng, gn co
(Radix et Rhizoma Glycyrrhizae), zh r (Caulis Bambusae inTaenia), zh sh (Fructus
AurantiiImmaturus),anddzo(FructusJujubae).
Pathogenicqilingeringinthesanjiaobelongstotheqilevelandusuallylastsfora
moreprolongedperiodoftime.Iftreatedcorrectly,pathogenicqicanbeexpelledby
means of inducing shiver sweating, or bythe repeated struggle between upright qi
and pathogenic qi, which manifests with alternating chills andfever, much like the
symptomsindicativeofmalaria.
Source Text 3


(10)
[Ifpathogenicqiinthe]sanjiaocannotbereleasedfromtheexterior,itwillprogress
toforminternalbinding.Wherewillitbind?Thelocationsaretheyangmingstomach
andlargeintestine.Purgativemethodshouldbeused.Donotabandonthepurgative
method because the pathogenic qi is only in the qi level without signs of entering
thebloodlevel.Drasticpurgationshouldbeusedincolddamagebecauseofinternal
pathogenicheatrobbingandburningbodyfluids.However,thepattern[discussedin
thisentry]originatesbecausethedampnessisstrugglinginside.Therefore,purgation
with less force should be used. In cold damage, loose stool is a sign indicating that
thepathogenicqi hasbeentotally eliminated.Nomorepurgativemedicinalsshould
be applied. In damp-heat type warm disease, loose stool is a sign indicating that
pathogenic qi still remains. Purgative medicinals should be applied until the stool
is hard, because dry stool implies that no more dampness remains inside. (Treatise on
Warm-HeatDiseases,entry10)
Interpretation
In general, in warm febrile disease, when pathogenic heat damages fluid and
causesyangmingdrynessaccumulation,ifpurgationisnotappliedintime,pathogenic
heat will enter the ying and blood levels to consume blood or move blood, or sink
deeperintothelowerjiaotodamagetheyinofthekidneyandliver.Soonlyurgent,
drasticpurgationcandischargeheatandrescueyin.Inthiscase,thetreatmentshould
becontinueduntilthestoolbecomesextremelydryandisevacuated.
Pathogenicdamp-heat,ontheotherhand,tendstolingerattheqilevelforalong
timeanddoesnotentertheyingandbloodlevels.Additionally,becausepathogenic
damp-heatdoesnotgenerallydamage yin-fluids,alternativemethodsofclearingheat
and removing dampness are suggested. However, when damp-heat is complicated
byeitherfoodstagnationorphlegminthestomachandintestine,whichmeansthat
aninternalbindintheyangminghasformed,purgationstillneedstobeapplied,even
thoughthepathogenicqiisnotpronetoenterbloodlevel.
Therefore, when pathogenic damp-heat in the sanjiao is not released from the
exterior, moves into theyangming stomach and large intestine, combines with food
stagnationorphlegmandcreatesaninternalbind,itisknownasapatternof damp-
heat obstructing the stomach and intestine. Symptoms include loose stools with a
sensationofincompletedefecation,andyellowishjam-likestoolthatisextremelyfoul
smelling.Incontrast,thispatterndiffersfromthe yangmingfu-organpatternincold
damage,whichisduetodrystoolobstructingtheintestinewhenfluidsaredamaged
bypathogenicheat.
Because damp-heat is not only sticky and greasy, but also heavy and turbid, it
doesnotdissipatequickly.Therefore,forthisdamp-heatobstructingthestomachand
intestinepattern, mild purgation is needed, and can be induced multiple times until
the stool regains hardness and shape, which indicates that the dampness has been
completelyeliminated.Onlyatthispointshouldoneceasethepurgation.
Source Text 4

(11)
In the human body, the stomach cavity is located above the abdomen in the
middle[jiao].Whenthereispainwhilebeingpressed,orpain,orpanddistention[in
theareaofstomachcavity],itindicatesthatthepathogenicqiisclosetotheabdomen,
which should be treated by bitter discharging method. [In this condition], tongue
inspectionisparticularlyimportant.[Whenthecoatingis]yellowandturbid,[patients]
can be prescribed with Xio Xin XingTng (Minor Chest-Draining Decoction) or
Xi XnTng (Heart-Draining Decoction), and [specific] application [of these two
formulas]should be based on pattern differentiation. [Patients with a] white coating
butnotdry,oryellowandwhitecoating,orgrayandwhitecoatingwithoutafeeling
ofthirst,shouldnotbetreatedrecklesslywiththebitterdischargingmethod.
[Thethree patterns mentioned above] may be due to pathogenic qifailing to be
releasedfromtheexterior,andthenpenetratinginsideandaccumulatinginternally,or
duetoconstraintofpathogenicqiwhichhasnotextendedtothelimitsofitsreach,or
duetoaconstitutionofcoldnessinthechestcenter.[Underthesecircumstances],even
though[patientsfeel] pandstuffinessinthestomachcavity,itisappropriatetouse
the opening and discharging method (instead of bitter discharging) so as to diffuse
andunblockqistagnation.Thisresultsintheexpellingofthepathogenicqifromthe
lung. Slightly bitter and mildly acrid medicinals with the function of moving qi are
suitable,suchas xngrn (SemenArmeniacaeAmarum)and kurn (FructusAmomi
Rotundus),jp(PericarpiumCitriReticulatae)and jigng(RadixPlatycodonis),etc.
Interpretation
The stomach, which is located in the region of the upper abdomen, belongs to
the middle jiao. P obstruction patterns present with symptoms in the epigastric
region such as stomachache, tenderness upon palpation, orp and fullness with a
distendingandoppressivesensationshouldbetreatedwiththedischargingmethod
withbittermedicinals. Being that the stomach cavity is located inside the abdomen,
and its normal function is dependent upon the free flow of descending qi, bitter-
coldmedicinalsareusedtodischargeandpurgedamp-heatandturbidphlegminp
patterns.
Tongue inspection plays a critical role in differentiating p patterns. Binding of
damp-heat and turbid phlegm patterns present with a yellow and turbid tongue
coating.Thesepatternsshouldbetreatedbyutilizingthemethodofdischargingwith
bittermedicinals.Thiswillclearheat,dissolvephlegmanddischargedampness. Xio
Xin XingTng or Xi XnTng are common examples of formulas prescribed.The
formerisapplicabletophlegm-heatpatternswhilethelatterismoresuitedtodamp-
heatpatterns.
A white but not dry tongue coating indicates that phlegm-damp is obstructing
the chest cavity, and has not yet transformed into heat. A yellow and white coating
indicates that pathogenic qi in the exterior has not been released while pathogenic
heat has already accumulated internally. A gray and white coating in patients
without thirst implies that the congestion of pathogenic yin is suppressing yang qi
transformation,orthatthepersonhasaconstitutionofcoldnessinthechestcenter.
Althoughthethreepatternsmentionedaboveofteninvolvedampnessobstruction
with qi stagnation in the middle jiao, patients who experience a sensation ofp and
distention should not all be treated with the same method. Instead, the method of
opening with acrid medicinals and discharging with bitter medicinals should be
considered in accordance with pattern differentiation explained above, for example,
xng rn, ku rn, j p,and ji gng. For patients with excessive phlegm-dampness
patterns,medicinals for drying dampness and resolving phlegm such as bn xi and
cngzh(RhizomaAtractylodis)canbeaddedtotheformula.
Insummary,medicinalsthatarebitterandcoldinnatureareapplicabletopatients
with dampness transforming into heat, while medicinals to open and discharge
(having bitter and warm properties), are appropriate for patients whose dampness
doesnottransformintoheatorwhosedampnessispreponderantoverheat.
Section2 PatternsandTreatmentof
theUpperJiao
Source Text 1
(
)
()
In a summerheat-warmth disease of the hand taiyin, when the patient presents

similarsymptomstothosepresentedintheaboveentry,1andnosweating,XnJiXing
RYn (Newly Supplemented Mosla Beverage) is indicated (method of combination
of acrid-warm medicinals and acrid-cool medicinals). (Systematic Differentiation ofWarm
Disease,Vol.1,ChapterUpperJiao)
Formula
xingr 2qian HerbaMoslae

ynhu 3qian FlosLoniceraeJaponicae
xinbinduhu 3qian FlosSemenLablabAlbum(fresh)
hup 2qian CortexMagnoliaeOfcinalis
Use5cupsofwatertocookthemedicinals;cookuntil2cupsofdecoctionremain.
Takeonecupfrst.
If there is sweating after drinking the first cup of the decoction, do not take the
other. If no sweating occurs, take the second cup. If patients still have no sweating
aftercompletelytakingtwocups,morepacksshouldbepreparedandcontinuetaking
themedicinals.
Interpretation
Ifpatientswithsummerheat-warmthinthehandtaiyinpresentwithanabsenceof
sweating,they should be treated with Xn Ji Xing RYn to clear summerheat and
release the exterior. Other symptoms may include headache, body pain, fever with
aversiontoco1dandsoon,whicharesimilartothoseoftaiyangcolddamagepattern.
However, this pattern is a manifestation of summerheat invading the exterior and
exteriorqiconstraint-blockage.
Xn Ji Xing RYn is a formula for early stage summerheat-warmth pattern
complicatedbyexternalcontractionofwind-cold,whichischaracterizedbyabsence
of sweating andlooking like taiyang cold damage pattern.This pattern is often to
beseenincommoncolddiseaseduringsummertime.
1 TheaboveentryfromSystematicDiferentiationofWarmDisease,Vol.1,ChapterUpperJiao,entry22)
T he above entry refers to Systematic Differentiation ofWarm Disease,Vol. 1, Chapter Upper Jiao, entry 22:
[Patients]looklike[undertheattackof ]colddamage,butpresentsymptomslikeasurging,bigandrapidpulseon
therighthand,withasmallerpulseonthelefthand;severethirst,redcomplexion,andgreat[profuse]sweating,
itis[adisease]namedsummerheat-warmth,[whichis]locatedinthehand taiyin,andBiHTng(WhiteTiger
Decoction) is indicated. [If ] the pulse is severely hollow,Bi H Ji Rn ShnTng (WhiteTiger Decoction plus
Ginseng)isindicated.
Inthispattern,symptomsofaversiontocoldandabsenceofsweatingaredueto
external contraction of wind-cold.Therefore, xing r is used as the chief medicinal
toinducesweatingtoreleasetheexterior,dispelsummerheatandremovedampness.
Acrid-cool and aromatic medicinals bin du hu, jn yn hu and lin qio are used
to clear and vent pathogenic summerheat. Normally, hu p (Cortex Magnoliae
Officinalis) is not appropriate to treat summerheat-warmth due to its acrid-warm
property. But in this pattern, patients commonly present with abdominal fullness
duetosummerheatwithdampness,so hupisaddedtoassistxingrinremoving
dampness and descending qi to relieve fullness. AsWu Ju-tong explained,Acrid-
warm medicinals are prohibited in treating warm diseases, except for summerheat-
warmth. Since summerheat is always accompanied by dampness, while dampness is
yinpathogenicqi,onlywithwarmmedicinalscanitberesolved.
To summarize, the formula is characterized by a combination of acrid-warm
medicinals and acrid-cool medicinals so as to expel pathogenic summerheat and
pathogenic wind-cold, just as described in the source text,method of combination
of acrid-warm and acrid-cool. It is suitable for summerheat-warmth complicated
byexternalcontractionofwind-cold,butisnotapplicableifthediseaseiscausedby
simplesummerheat,inwhichpatientspresentfeverandsweating.
CaseReport
Male,age16.Initialconsultation:July28,2003.
Threedaysprior,thepatienthadpresentedafeverduetoexcessiveintakeofcold
drinksandsleepingunderair-conditioning.EvenaftertreatmentwithWesterndrugs
and antibiotics and dexamethasone through IV-GTT, the fever had still fluctuated
between 38.5 and 40.0.Then, the patient chose CM for consultation. Symptoms
wereasfollows:fatigue,feverwithaversiontocold,nosweating, drymouthwithout
adesiretodrink, nausea,poorappetite,rednessonthetipofthetongue,whiteand
thicktonguecoating,andafoatingandrapidpulse.
Diagnosis in CM: summerheat-warmth complicated with external contraction of
wind-cold.
Treatment principles: dispel summerheat and release the exterior, clear heat and
removedampness.
Formula:modifedXnJiXingRYn.
xingr 10g HerbaMoslae

dnduch 10g SemenSojaePraeparatum
xinbindu 30g SemenLablabAlbum(fresh)

Fourpackswereadministered.
Secondconsultation:thefeverabatedwiththesweatinginducedbythemedicinals.
Twomorepackswereadministered,andthepatientcompletelyrecovered.
[Reference: ChenYin-huan, Chen Jing, Lin Xing-dong. Examples of Professor Zhong Jia-xis
ExperienceinTreatingFebrileDisease.NewJournalofTraditional
Source Text 2
()()
In dampness-warmth of the hand taiyin, if patients present with hiccups due to
a blockage in the qi level, Xun BTng (Painful Obstruction-Resolving Decoction)
is indicated (method of unblocking with bitter and acrid medicinals). (Systematic
DiferentiationofWarmDisease,Vol.1,ChapterUpperJiao)
Formula
ppy 2qian FoliumEriobotryae
yjn 1.5qian RadixCurcumae
shgn 1qian RhizomaBelamcandae
bitngco 1qian MedullaTetrapanacis(white)
xingduch 1.5qian SemenSojaePraeparatum
andtakeonecuptwiceaday.
Interpretation
Whenpathogenicdamp-heatobstructstheupperjiao,qimovementwillstagnate
andbecomeconstrained;passagesofclearyangbecomeblockedaswell.Asaresult,
theascendinganddescendingfunctionsofclearyangandturbidyin,respectively,will
bedisturbed.Consequentlythepresentationofhiccupsresults,duetotheascending
counterfowofstomachqi.ThisconditioncanbetreatedwithXunBTng.
Theformulaexcelsatdiffusingandremovingdampnessintheupperandmiddle
jiao.Therefore, the medicinals applied in this formula focus primarily on dispelling
dampness and unblocking qi movement in the lung and stomach. It is commonly
usedtotreatpatientswithdamp-heatobstructingintheupperandmiddlejiao.
CaseReport
Male,age28.
Thepatienthadpresentedthefollowingsymptomsforoneweek:aversiontowind
with fever, dizziness, headache, sore and itchy throat, cough, profuse sticky yellow
sputum that was difficult to expectorate, pain in the chest and hypochondrium, dry
mouth,aredtonguewithyellowcoating,andafoatingandrapidpulse.
Theconditionwasdeterminedtobealung-weipatternduetoanattackofpathogenic
wind-heatintheheadandthroat.Theattackofpathogenicqiattheweilevelresulted
in a failure of the lung to diffuse and govern descent; the invasion of wind-heat
resulted in body fluids being scorched into phlegm; counterflow of lung qi led to
cough.Therefore,thetreatmentprincipleshouldfocusonreleasingtheexteriorwith
acrid-coolmedicinals,difusingthelung,anddissolvingphlegm.
Formula:
duch 12g SemenSojaePraeparatum

Folium Eriobotryae Praeparata cum Melle (liquid-fried,
zhppy 12g
wrappedincloth)
zhshgn 12g RhizomaBelamcandaePraeparatacumMelle(liquid-fried)
bhe 9g HerbaMenthae(addedlater)
bim 10g BulbusFritillaria
wign 60g RhizomaPhragmitis
Afterthreepacksofmedicinals,allsymptomswerealleviated.The coughimproved
and the sputum became thinner. On the basis of the above formula, modifications
weremadebyremovingduchandbhe,andaddingsngy(FoliumMori)andsh
shn (Radix Adenophorae seu Glehniae).1 An additional three packs resulted in the
patientscompleterecovery.
[Reference: Zhao Chun-juan. Two Case Reports in Clinical Practice 2. Guangming
JournalofChineseMedicine.2008;23(11):1794.]
Source Text 3

()
1 Whethernorthernorsouthernshshnwasusedwasnotindicated.
Symptoms such as headache, aversion to cold, a heavy body with pain, white
tonguecoatingwithoutthirst,sallowcomplexion,chestoppressionwithoutafeeling
ofhunger,afternoon fever similar to yin deficiency, a wiry, thready and soggy pulse,
and a long course, indicate damp-heat type warm disease. If treated by inducing
sweating, there will be unconsciousness and deafness, and even blindness and loss
of speech in severe cases. If treated by purging, there will be through-flux diarrhea.
If treated by moistening, the disease will be aggravated instead of being cured. Sn
RnTng (Three Kernels Decoction) is indicated, regardless of whether the disease
happensinlatesummer,autumnorwinter. (SystematicDifferentiationofWarmDisease,Vol.1,
ChapterUpperJiao)
Formula

fihush 6qian Talcum
bitngco 2qian MedullaTetrapanacis(white)
bikurn 2qian FructusAmomiRotundus
zhy 2qian HerbaLophatheri
shngyyrn 6qian SemenCoicis
bnxi 5qian RhizomaPinelliae
Use 8 bowls of gn ln shu 1 to cook the medicinals; cook until 3 bowls of

decoctionremainandtakeonebowlthreetimesaday.
Interpretation
This entry discusses damp-heat type warm disease, which is due to pathogenic
dampness lingering at the qi level.When pathogenic dampness attacks people, it
accumulatesattheqilevelandlingersforaprolongedperiodoftime,thusaffecting
all of the upper, middle, and lower jiao.This pathogenic dampness results in failure
of the lung to diffuse and govern descent in theupper jiao, failure of the spleen to
transport and transform in the middle jiao, and failure of the kidney and bladder
to perform qi transformation in the lower jiao, which contribute to the symptoms
mentionedabove.
This pattern resembles early stage cold damage, with symptoms like headache,
aversion to cold, and a heavy body with pain; but a wiry and soggy pulse indicates
that it is not cold damage. Similarly, summerheat-warmth can also be eliminated,
1 Gn ln shu:This describes a process where water is repeatedly taken out of and poured back into a
containeruntiltherearelotsofbubblesrollingonthesurface.Thewateristhenconsideredtobeveryactivein
termsofitsproperty,whichcanenhancethefunctionofthemedicinalsinremovingdampness.
duetothepresentationofathinwhitetonguecoating,absenceofthirst,andasallow
complexion. Chest oppression without a feeling of hunger is due to obstruction of
qi movement by pathogenic dampness. Bodyfever that worsens in the afternoon is
attributedheretoamorevigorousstrugglebetweenupright qiandpathogenicqiin
theafternoon,althoughitresemblesayindefciencypattern.
In nature, dampness increases gradually in late summer, and has a thick, sticky
and greasy quality. Disease with an underlying pathogenic dampness pattern is
differentfromthatofeitherapathogeniccold(whichcanbereleasedfromtheexterior
by inducing sweating with acrid-warm medicinals), or a pathogenic warm-heat (in
whichfevercanbeabatedwithcold-coolmedicinals)pattern.
If damp-heat type warm disease is falsely diagnosed as exterior pattern of cold
damage because of their similar symptoms of headache, aversion to cold, and a
feeling of heaviness of the body with pain, and consequently treated with acrid-
warm medicinals to induce sweating, patients will present with unconsciousness
and deafness, and even blindness and loss of speech in severe cases.These are due
tothesevenorificesbeingcloudedbypathogenicdampness,becausetheapplication
ofacrid-warmmedicinals not only induces sweating, but also stimulates the upward
movementofpathogenicdampness.Ifthesymptomsofchestandstomachdistention
andfullness,withnodesiretoeat,aremistakenforfoodstagnationandtreatedwith
purgation, spleen yang will be damaged, which causes continuous diarrhea. If the
afternoonfever is improperly diagnosed asyin deficiency and treated by nourishing
methodwithgreasy,moistmedicinals,pathogenicdampnesswillbecomestickierand
thenmoredifculttoremove.
Only dispelling dampness and unblocking the stagnation of qi movement can
result in complete recovery.The treatment principle includes diffusing the lung and
venting pathogenic qi with light medicinals in the upper jiao, drying dampness and
clearing heat with bitter-warm medicinals in themiddle jiao, and percolating and
draining dampness with bland medicinals in the lower jiao.That is to say, in order
to dispel pathogenic dampness, one must identify its location, take advantage of
the various pathways through which the body normally expels it, and choose the
appropriatecorrespondingmethodtofacilitatetheexpulsion.
SnRnTng isarepresentativeformula.Thethreenutlets, xngrn,kurnand
y(y)rnareusedasthechiefmedicinalsinSnRnTng.Bitter-warmxngrnopens
theupperjiaolightlytodiffuseanddescendlungqienablingittorecoveritsfunction
offreeingandregulating the waterways; aromatic and bitter-acrid ku rn works on
themiddlejiaotofortifythespleenanddrywater-dampness;sweetandblandyyrn
dredgesthelowerjiaotodraindampnessandclearheat.Additionally, hupassiststo
rectifyqiandremovedampness,bnxidriesdampnesswithitsbitter-warmproperty,
andhush,tngcoandzhyfunctiontopercolateanddraindampnesswiththeir
bland property.The medicinals mentioned above are thus combined to successfully

diffuse the upper jiao, disinhibit themiddle jiao and percolate thelower jiao. When
qimovesfreely,dampnessisdispelled,andsanjiaorecoverstoanunobstructedstate;
all symptoms will consequently disappear. Clinically, in patterns of disturbance
of qi movement in sanjiao due to invasion of pathogenic dampness (either external
dampnessorinternaldampness),ifpatientspresentawhiteandgreasytonguecoating,
andasoggyandslipperypulse,theycanbetreatedwithmodifedSnRnTng.
CaseReport
One day in April, the patient presented chills and fever similar to malaria
symptomsduetocatchingacoldaftershampooinghishair.Hehadbeendiagnosed
as having contracted a common cold and treated by injection of penicillin and
streptomycin over the following two weeks, but thefever still existed. After that, he
went to CM and tried exterior-releasing formulas, but neither acrid-warm nor acrid-
coldmedicinalscouldbringarecovery.Thepatientsfeverhadnowlastedfortwenty-
five days. Present symptoms included: fever of 38.5 withaversion to cold, a heavy
body, foggy mind, blurred vision, thirst without a desire to drink, oppression in the
stomach cavity without appetite, soft stool, white and greasy tongue coating, and a
soggypulse.
Bothphysicalexaminationandauxiliaryexaminationwerenegative.
DiagnosisinCM:damp-heattypewarmdisease.
Formula:SnRnTng.

hush 15g Talcum
After one pack, the fever abated. Although the fever returned three days later, it
wasnotsevere.Afteronemorepackofmedicinals,thefeverdisappearedcompletely
andthepatienttotallyrecovered.
[Reference: CuiYing-min, Chen Ming.Shang Zhi-changs Experience in ApplyingSn RnTng
.HeilongjiangJournalofTraditionalChineseMedicine.1998;(5):2.]
Section3 PatternsandTreatment
oftheMiddleJiao
Source Text 1

(8)
Symptoms of chills and fever similar to malaria (symptoms) presented in damp-
heat pattern is due to obstruction of damp-heat in the membrane source, which is
advisedtobetreatedwithmedicinalssuchas chih(RadixBupleuri),hup(Cortex
MagnoliaeOfficinalis),bnglng(SemenArecae),cogu(FructusTsaoko),huxing
(HerbaPogoStemonis),cngzh(RhizomaAtractylodis),bnxi(RhizomaPinelliae),
gn chng p (Rhizoma Acori Calami) and LiY Sn (Six-to-One Powder), etc. (A
ChapterofWarpandWoofofWarm-HeatDiseasesChapterofDamp-HeatDiseases,entry8)
Interpretation
Patients with damp-heat disease often present symptoms of alternating chills
and fever, which resembles the typical symptoms of malaria. However, malaria is
characterizedbyregularalternationbetweenchillsand fever,whilenoregularitycan
be found in damp-heat pattern.The alternating chills and fever in this pattern are
duetoobstructionofdamp-heatinthemembranesource.Whenuprightqibattlesthe
pathogenicdamp-heatinthemembranesource,whichislocatedinthehalf-exterior/
half-interior,patientspresentwith aversiontocoldwhen pathogenicqiisdominant
andfeverwhenuprightqiisprevailing.
Additionally, the pattern is often accompanied by symptoms of damp-heat
retention in themiddle jiao (the stomach and spleen), such asp and fullness in the
stomachcavityandabdomen,awhitegreasy(tongue)coating,andevenacrimsonor
purplecrimsontonguefullofgrimewithaturbidcoating.
Regarding the treatment, it is advised to harmonize the exterior and interior,
dry dampness and transform turbidity, which follows the actions and indications
of DYunYn (Membrane Source-Reaching Decoction), designed byWuYou-ke.
Additionalmedicinalssuchaschih,hup,bnglng,cogu,huxing,cngzh,
bnxi,gnchngpandLiYSn,aswellasotherscanalsobeused.Chihisto
disperseandventpathogenicqisoastoharmonizetheexteriorandinterior; cngzh,
hup,cogu,bnglngandbnxiaretorectifyqianddrydampness;huxingand
gn chng p are to remove dampness and transform turbidity with their aromatic
property;LiYSnfunctionstocleardamp-heat.
CaseReport
Male,age28.Initialconsultation:July11,2002.
Patients chief complaint, as indicated by his family: severe chills and high
fever for 39 days, and mental disturbance for 3 days.Twenty days before, he had
been admitted to a hospital. No positive diagnosis could be determined, even after
examinations and tests such as chest X-ray, routine tests ofblood, urine and stool,
erythrocyte sedimentation rate, liver function test,Widals reaction test, malarial
parasite test, leishmanin test, blood culture and mid-stream urine culture.The
patient had been treated withWestern medications such as antibiotics, antiviral
and hormones, and even those indicated for tuberculosis, but his fever continued
to persist, fluctuating between 38.540.5. Moreover, he gradually demonstrated
increasedmentaldisturbancewithoccasionaldeliriousspeech.
Symptoms included: mental disturbance, continuing fever which was less
pronouncedatdawnandbecamemoreaggravatedatnight, headache,vexationand
agitation, chest oppression, nausea, dry lips with no desire to drink, foul smelling
sticky stool, scanty dark urine, a crimson tongue with a thick greasy white coating
(resembling a tongue being covered with flour), and a powerful and rapid surging
pulse. Additionally, the presentation of these symptoms was characterized by a
relatively regular sequential pattern: it began with severe chills, was followed by
high fever and delirious speech, then a few hours later, the fever abated following
perspiration.Eventually,thefeverreturnedandthecyclerepeateditself.
CM diagnosis:damp-heat typewarm disease, with a preponderance of heat over
dampness.
Patterndifferentiation:latentpathogenicqiinthemembranesourcewithdampness
trappinghiddenheat.
Treatmentprinciples:primarilytoopenthemembranesource,eliminatefilthand
transformturbidity,andsecondarily(ortoassist)byclearingheatanddrainingdampness.
Formula:modifedDYunYn(MembraneSource-ReachingBeverage,).


hush 12g Talcum
After taking three packs of the medicinals, the patient defecated three times
with brown mucoidstool.Thesymptomsoffever,chestoppressionandnauseawere
greatlyreduced; the thick, flour-like tongue coating was gradually resolved; mental
disturbance and delirious speech disappeared. All of these signs indicated that the
formulawasworking,sothreemorepackswithoutbnglngweregiven.
After that, the body temperature returned to 37 ; other symptoms such as
headache,chestoppression,andvexationandagitationwereeliminated;hisappetite
and sleep returned to normal; a red and crimson tongue without coating replaced
theflour-liketonguecoating.Hecomplainedofbeing thirsty,especiallyatnight.Six
packsofmodifedQngHoBiJiTngweregiven.
xyngshn 10g RadixPanacisQuinquefolii
All symptoms disappeared and the disease was cured following this treatment
protocol.
[Reference: Zhang Xiao-zhen, Zhang Xiao-hui. Examples of Zhang Zhi-yings Experience in
Treating Difficult and Severe Diseases . Gansu Journal ofTraditional
Source Text 2
(
)
Whendampnessobstructsthesanjiao(includesdamp-heatobstructingthemiddle
jiao),itwillresultinfailureofthespleenandstomachtoascendanddescend;andif
patientswiththispatternpresentsymptomsofdistentioninthestomachcavityand
abdomen, and incomplete defecation,Y Ji Jin Zhng Q Sn (Modified Agastache
Qi-CorrectingPowderNo.1)isindicated. (SystematicDifferentiationofWarmDisease,Vol.2,
ChapterMiddleJiao)
Formula
huxinggng 2qian HerbaAgastachis(stem)

flngp 2qian CutisPoriae
PericarpiumCitriReticulatae(producedin
gungp 1qian
Guangdong)
shnq 1qian5fen MassaMedicataFermentata
miy 1qian5fen FructusHordeiGerminatus
minynchn 2qian HerbaArtemisiaeScopariae
dfp 1qian PericarpiumArecae
Takeonecuptwiceaday.

Whenpatients with obstruction of dampness in the sanjiao (also refers to damp-
heatobstructinginthemiddlejiao)presentsymptomssuchasfullnessinthestomach
cavity, loose stool, body pain, white (tongue) coating and the pulse is obscure (a
sign of damp-heat obstructing the channels and collaterals), r Ji Jin Zhng Q
Sn (Modified Agastache Qi-Correcting Powder No. 2) is indicated (method of
combinationofbitter,acridandblandmedicinals).
Formula
PericarpiumCitriReticulatae(producedin
gungp 2qian
Guangdong)
mfngj 3qian RadixCocculiTrilobi
dduhungjun 2qian driedblacksoybeansprout
chuntngco 1qian5fen MedullaTetrapanacis(producedinSichuan)
yyrn 3qian SemenCoicis
8cupsofwaterareboileddownto3cups,dividedto3portionsandtakenthree
times.

Whenfilthydampnessobstructstheinterior,ifpatientspresentsymptomssuchas
fullnessinthestomachcavityandayellowtonguecoating,whichindicatethatheat
hasaccumulatedduetoaprolongedobstructionofqimovement,SnJiJinZhng
Q Sn (Modified Agastache Qi-Correcting Powder No. 3) is indicated (method of
combinationofbitter,acridandcoldmedicinals).
Formula
huxing 3qian HerbaAgastachis(includingstemandleaves)

gungp 1qian5fen PericarpiumCitriReticulatae(producedinGuangdong)
hush 5qian Talcum

Whenfilthydampnessfixesintheinteriorblockingtheqilevel,ifpatientspresent
symptomssuchasawhiteand slipperytonguecoating,anda moderatepulseonthe
righthand,SJiJinZhngQSn(ModifiedAgastacheQi-CorrectingPowderNo.4)
isindicated(methodofcombinationofbitter,acridandwarmmedicinals).
Formula

flng 3qian Poria
gungp 1qian5fen PericarpiumCitriReticulatae(producedinGuangdong)
cogu 1qian FructusTsaoko
() zhru(cho) 5qian FleshofFructusCrataegi(dry-fried)
shnq 2qian MassaMedicataFermentata
Pourouttheprepareddecoction,anduseenoughwatertocookthedregsagainuntil
onecupofdecoctionremains.Takeonecupthreetimesaday.

Whenfilthydampnessobstructstheinterior,ifpatientspresentsymptomsasfullness
inthestomachcavityanddiarrhea,WJiJinZhngQSn(ModifiedAgastacheQi-
Correcting Powder No. 5) is indicated (method of combination of bitter, acrid and
warmmedicinals).
Formula

gungp 1qian5fen PericarpiumCitriReticulatae
flngkui 3qian PiecesofPoria
dfp 1qian5fen PericarpiumArecae

gy 1qian FructusSetariaeGerminatus
cngzh 2qian RhizomaAtractylodis
Interpretation
Although the source text mentions obstruction by dampness in the sanjiao, it
alsorefersinparttothe middlejiaobeingblockedby pathogenicdamp-heat.When
the middle jiao is obstructed, the spleen and stomach will fail in ascending and
descending normally, which will give rise to distention and fullness in the stomach
and abdomen, and loose stools with a sensation of incomplete defecation. In this
condition,YJiJinZhngQSncanbeused.Inthisformula,huxingisusedto
remove dampness and transform turbidity with its aromatic property; hu p, chn
p,flngpanddfpareemployedtodrainthedampnessinthemiddlejiaoand
relievedistentionandfullness; xngrnpromotesqimovementofthelungandlarge
intestine;shnqandmiyharmonizethespleenandstomachqi;ynchnassiststo
removedampness.Thereasonforusinghuxinggng(thestemofhuxing)isthatit
worksonthemiddlejiaobutnotontheexterior;flngpisusedbecauseitisbetterat
drainingwaterthanflng.
When dampness obstructs in the sanjiao (middle jiao), the spleen and stomach
cannot ascend and descend normally, therefore, patients will present symptoms of
fullnessinthestomachcavityandloosestool.Additionally,thepresentationof body
pain is due to constraint of pathogenic dampness in the fleshy exterior disturbing
channelqi;a white and greasy tonguecoating, and a soggy and moderate pulse are
manifestationsforpathogenicdampness.Patientswiththispatterncanbetreatedwith
rJiJinZhngQSn.Inadditiontothemedicinalsashuxinggng,hup,chnp
andflngp,whichareusedinYJiJinZhngQSn,fngjisaddedtoeliminate
dampnessinthechannelsandcollaterals.Tngcoandyyrnareaddedtopromote
urination so as to harden the stool, since compared with a sensation of incomplete
defecation presented in the pattern above, loose stool indicates more severe
pathogenicdampness.Dduhungjunhelpstoregulatethespleenandstomachqi
so as to transformdamp-heat.Therefore, this formula is stronger in percolating and
drainingdampnesswithblandmedicinalsthantheformulamentionedabove.
Symptomsasfullnessinthestomachcavityandayellowtonguecoatingindicate
that heat has accumulated due to an obstruction of qi movement by dampness.
Moreover, patients may presentfever, as heat is progressing internally.This pattern
canbetreatedwithSnJiJinZhngQSn.Inadditiontothemedicinalshuxing(in
thisformula,theuseofboththestemandleavesof huxingisrecommended),hu
p,chnp,flngp,andxngrnareusedtopromotetheqimovementofthelung,
whileacrid,blandandcoolhushisaddedtoclearheat,draindampness,andassist
huxingindifusingqimovement.
Symptoms that include a white and slippery tongue coating, and a soggy and
moderatepulseontherighthand,indicatethat pathogenicdamp-heatobstructingat
the qilevelhas transformed into a preponderance of dampness without heat, which
canbetreatedwithSJiJinZhngQSn.Whileincludingthemedicinalshuxing
gng,hup,chnpandflng,thisformulaisfurthercharacterizedbytheapplication
ofcogu,zhruandshnqwhichareaddedespeciallytotransformdampness,
dispelflth,andrecoverthespleenyang.
Symptoms of fullness in the stomach cavity and diarrhea should be treated
with W Ji Jin Zhng Q Sn, to diffuse qi movement with aromatics and dissolve
dampness with acrid-warm medicinals. Diarrhea is a sign of spleen and stomach
impairment by dampness.Therefore, to supplement the medicinalshu xing gng,
hup,chnpandflngkui(piecesofflng),dfpandcngzhareaddedto
warm the spleen qi and dry dampness, while g y is included to fortify the spleen
andharmonizethestomach.
The five entries mentioned above are similar in terms of their pathodynamic,
in that they are manifestations of an invasion of filthy dampness, which leads to
an obstruction of qi movement and subsequent disturbance of the ascending and
descending nature of the spleen and stomach.They differ, however, in amount,
severity, and accompanied symptoms.The first entry emphasizes the symptom of
distention and fullness in the stomach and abdomen due to damp-obstruction in
the spleen and stomach; the second is marked by body pain due to obstruction by
dampnessinthechannelsandcollaterals;thethirdentryischaracterizedbyayellow
tonguecoating,whichindicatesagradualtransformationtoheatfromdampness;the
fourthandfifthentriesareduetoaninternalexuberanceofdamp-turbidity,inwhich
themainsymptomsincludeawhiteslipperytonguecoating,amoderatepulseonthe
righthand,andthesensationoffullnessinthestomachcavitywithdiarrhea.
The five modified formulas of Zhng Q Sn all function to diffuse qi, transform
dampness, and to regulate and free qi movement. Medicinals hu xing, hu p,
chnpandflngareusedasthebasicingredientsinallfiveformulastotransform
and remove turbidity, rectify qi, and remove dampness. In the first formula, the
applicationofshnqandmiy,functiontoawakenthespleenandstomachqi;the
second formula is better to dredge dampness in the channels and collaterals due to
theadditionoffngj,tngco,yyrnanddduhungjun;hushisappliedin
largedosageinthethirdformulatobetterpercolateanddraindamp-heat;thelasttwo
formulasaresimilar,withcoguinthefourthtowarmandactivatethespleenand
stomach,andcngzhintheffthtodrydampness.
CaseReport
Case#1
Male,age36.Initialconsultation:August1999.
Thepatientsufferedfromaheadachethatwasmoresevereontherightside,and
hadlastedfortwoweeks.Whenitbecamepainful,hefeltasifhisheadwaswrapped
very tightly, and was unable to fall asleep. Other symptoms included distention and
stuffinessinthestomachcavityandabdomen,incompleteurinationanddefecation,a
white(tongue)coatingandamoderatepulse.HewastreatedwithmodifiedYJiJin
ZhngQSn.
Formula:

flng 15g Poria
ynchnho 10g HerbaArtemisiaeScopariae
hy 10g FoliumNelumbinis
bizh 10g RadixAngelicaeDahuricae
After taking three packs of the medicinals, his symptoms were relieved greatly.
Threemorepacksbroughtatotalrecovery.
[Reference: Zhao Long. Some Examples on theTreatment of Diseases with FiveZhng Q Sn
Formulas . Guiding Journal ofTraditional Chinese Medicine
andPharmacy.2005;20(2):44-45.]
Case#2
Female,age42.ConsultationinJuly,1999.
Thepatientschiefcomplaintwasdiarrheaforthreedaysaccompaniedbyheaviness
oftheheadandbody,anddistentionandfullnessinthestomachcavityandabdomen.
Threedaysbefore,shestarteddiarrheaduetooverintakeofcoldanduncookedfood.
Thediarrheahadbeenofwaterytextureandoccurreddozensoftimesperday.After
beingtreatedwithatransfusion,drugstostop diarrheaandXingShYngWiWn
(patentmedicinal pills for nourishing the stomach), the frequency of defecation was
reduced, but symptoms of loose stool, distention and fullness in the stomach cavity
andabdomen,andheavinessoftheheadandbodyremained.Thetonguecoatingwas
whiteandslipperyandthepulsewassoggyandmoderate.Shewasthentreatedwith
SJiJinZhngQSntoremoveflthyturbidity,rectifyqiandpercolatedampness.
Formula:

flng 12g Poria
Thepatientrecoveredaftertakingtwopacksofthemedicinals.
[Reference: Zhao Long. Some Examples on theTreatment of Diseases with FiveZhng Q Sn
Formulas . Guiding Journal ofTraditional Chinese Medicine
andPharmacy.2005;20(2):44-45.]
Source Text 3

()
Symptomsofamoderatepulse,bodypain,yellowishandslipperytonguecoating,
thirst without excessive intake of water, or even thirst without a desire to drink,
and fever abating after sweating but repeating afterwards, are due to failure of the
spleen to transport and transform dampness of water and grain in the interior, and
contraction of seasonal pathogenic dampness in the exterior (both the exterior and
interior under the attack of dampness). Neither purgation method nor inducing
sweating can be applied to treat the disease. If it is regarded as cold damage and
treated with methods of either inducing sweating or purgation, the disease will
transmute into aggravated diseases. Besides, if method of clearing heat is applied
alone,thedampnesscannotberemoved;ifmethodofdispellingdampnessisapplied
alone, the heat will become more flaming. Hung Qn Hu ShTng (Scutellaria and
Talcum Decoction) is indicated (method of combination of bitter, acrid and cold
medicinals).(SystematicDiferentiationofWarmDisease,Vol.2,ChapterMiddleJiao)
Formula

hush 3qian Talcum

dfp 2qian PericarpiumArecae
bikurn 1qian FructusAmomiRotundus
tngco 1qian MedullaTetrapanacis
zhlng 3qian Polyporus
Interpretation
Symptoms of a moderate pulse and body pain are similar to those presented in
exteriorpatternoftaiyangwind-invasion,butothersymptomssuchasanon-floating
pulse,andayellowishandslippery(tongue)coatingindicateitisnotawind-invasion
pattern. Furthermore, if it were a wind-invasion pattern, the symptoms ofbody pain
and fever would be eliminated after sweating, and the fever should not reoccur. In
this pattern, however, although the fever can be released through sweating, it will
reoccurlater. Sweatinginthispatternisdueto damp-heatsteamingmutuallyinside
the body, while the re-occurrence of fever is due to the sticky nature of dampness,
whichcontributestothefailureofsweatingtoexpelpathogenicdampnesscompletely.
Therefore,itisapatternof damp-heatobstructioninthe middlejiao,complicatedby
externalcontractionofpathogenicdampness.
As far as the therapeutic method is concerned, neither purgation nor inducing
sweating can be used in the pattern, although they are both common methods for
thetreatmentofcolddamage.Themethodofreleasingtheexteriorwithacrid-warm
medicinals will damage the defensive yang and cause convulsions; the method of
purgingtheinteriorwithbitter-coldmedicinalswilldamagethespleenandstomach
yang, and consequently lead to cold-dampdiarrhea.That is to say, the application
of either purgation or inducingsweating will result in the pattern transmuting into
aggravateddiseases.
The proper treatment should focus on clearing heat and dispelling dampness
simultaneously.The sole application of clearing heat cannot remove the dampness,
andsimilarly,thesoleapplicationofdispellingdampnesscannotdealwiththeheat,
ormayinfactmakeitmorefaming.
Hung Qn Hu ShTng is used as an example to treat this condition. In this
formula,bitter-cold hung qn functions to clear heat and dry dampness; hu sh, f
lngp,tngcoandzhlngaretoclearanddraindamp-heat;bikurnanddf
p transform and remove dampness, promote urination and move qi. All medicinals
together perform the function of clearing heat and dispelling dampness so as to
relieveallsymptoms.
CaseReport
Female,age48.Initialconsultation:August19.
Tendaysbefore,thepatienthadasuddenonsetofpalpitationsandshortnessof
breath.Shehadbeentreatedrepeatedlybythemethodofenrichingandnourishing
both qi and yin of the spleen and stomach but there had been no effect. Other
symptoms included lack of strength, yellow urine, thirst with excessive intake of
water, poor sleep, aphthous stomatitis, a red tongue with little coating covered
with a thick, viscous fluid, and a knotted pulse. Physical exam: HR 46-65 bpm, mild
tendernessunderthexiphoid,interferenceatrioventriculardissociationinECGtest.
Thepatientwasobese,andsinceithadbeenveryhotforthepastthreemonths,
she drank an excessive amount of fluids, which led to a failure of the spleen to
transport.The symptom of palpitations was due to retention of damp-heat in the
middle jiao attacking the heart; symptoms of shortness of breath and frustration
wereduetosummerheatconsumingbothbodyfluidsandqi;symptomsofexcessive
intake of water and a red tongue indicated yin deficiency; symptoms of a grimy
red tongue with little coating, a knotted pulse, and tenderness under the xiphoid
indicateddeficiency-excesscomplex.Therefore,thetreatmentprincipleshouldfocus
on clearing heat and dispelling dampness, supplementing the spleen, and boosting
yin. A combination of Hung Qn Hu ShTng and Li Jn ZTng (Six Gentlemen
Decoction)wasprescribedwithmodifcation.

hush 24g Talcum
biku 10g FructusAmomiRotundus(addedlater)
flng 12g Poria
bindu 24g SemenLablabAlbum

Onepackwasgiven,andthepatientwasadvisedtodecoctthemedicinalsinwater
andtakeonepackperday.
Aftertakingthedecoction,thesymptomsofpalpitations,frustration,shortnessof
breath and aphthous stomatitis were greatly relieved, but the patient still presented
a lack of strength, thirst, and tenderness and pain in the lower limbs.Therefore, on
thebasisoftheformerformula, chxiodu(SemenPhaseoli)30g, mfngj(Radix
CocculiTrilobi)15gandwilngxin(RadixetRhizomaClematidis)15gwereadded,
whilegnco,huxingandbinduwereremoved.Twopacksweregiven,andthe
patientwasadvisedtotakeonepackeveryotherday.
After that, all symptoms were eliminated, except for a red tongue with little
coatingandaknottedpulse.Thenthetreatmentwasthenadjustedtoaimatnourishing
theheartandrestoringthepulse,assistedbyclearingheatanddispellingdampness.
ModifedZhGnCoTng(Honey-FriedLicoriceDecoction)wasadministered.

shd 24g RadixRehmanniaePraeparata
jio 15g CollaCoriiAsini(meltedindecoction)
nnxxn 8g RadixetRhizomaAsari
bjtin 12g RadixMorindaeOfcinalis
higz 12g FructusPsoraleae
Twopacksweregiven,andthepatientwasagainadvisedtotakeonepackevery
otherday.
[Reference:LiMin-yuan.ExperienceinTreatingTransmutedPatternsoftheSpleenandStomach
Diseases.JournalofPracticalTraditionalChineseMedicine.2008;24(4):254-255.]
Source Text 4

()
When damp-heat gathers and steams inside the body with accumulation of
pathogenic qi in the channels and collaterals, patients will present severe chills and
intense fever, joint pain and restlessness, a grayish and (qi and blood) stagnated
tongue,withasallowcomplexionandyelloweyes.Itisadiseasecalleddampnessb,
and Xun BTng (Painful Obstruction-Resolving Decoction) is indicated (method of
unblockingwithbitterandacridmedicinals). (SystematicDiferentiationofWarmDisease,Vol.2,
ChapterMiddleJiao)
Formula
fngj 5qian RadixStephaniaeTetrandrae

hush 5qian Talcum
shnzh 3qian FructusGardeniae
yyrn 5qian SemenCoicis
bnxi 3qian RhizomaPinelliae(friedwithvinegar)
wncnsh 3qian FaecesBombyx
chxiodup 3qian SemenPhaseoli(peel)
Takeonecupthreetimesaday.
Interpretation
Whenpathogenicdamp-heataccumulatesandobstructsthechannelsandcollaterals,
patientswillexperienceassociatedjointpain;itisadiseasecalled dampnessbpattern.
Additional symptoms that include severe chills and intensefever, a gray and greasy
(tongue) coating, and a sallow complexion with yellow eyes indicate that there is
heatproducedinthedampness.Inthiscondition,eveniftreatedwithmedicinalsfor
dampness,therecouldbenoeffectifthosemedicinalscannotenterthechannelsand
collaterals.
Consequently,fngjisusedasthesovereigninXunBTnginordertodispelthe
dampness in the channels and collaterals, unblockb and thereby relieve pain;xng
rnfunctionstoopenlungqisoastorecoverthefunctionofthelunginfreeingand
regulatingthewaterways;hushdrainsdampnessandclearsheat;chxioduandy
yrnpercolateanddraindampnesswiththeirblandpropertysoastodispeldamp-
heatthroughurination;bnxiandcnshharmonizethestomachandtransformand
removeturbiditysothatdampnesscanbecontrolledinthemiddlejiaoanddispelled
fromthelowerjiao.Moreover,cnshandyyrnareuniquemedicinalsforrelieving
bpain;shnzhandlinqioclearheat,drainfireandresolvetoxinssoastoassistthe
othermedicinalsinrelievinghotsensations,restlessnessandjointpain.Allmedicinals
togetherachievethedesiredgoalofunblockingthecollaterals,dispellingdampness
andclearingheatwithindampness.
CaseReport
Thepatientfirstcontractedgoutfouryearsbefore,andthenthediseaseattacked
him every spring.Three days before, after drinking with friends, there was a sudden
onset of redness, swelling and pain on the joint of his right hallux, which was
accompanied by limitation and difficulty in movement.The pain was so severe that
it was apt to awaken him during the middle of the night. After oral intake of some
Western medicine without satisfactory effect, he turned toTCM for consultation.
Symptoms included redness and swelling on the first metatarsophalangeal joint of
therightfoot,alocalizedscorchingsensationwithseveretenderness,aredenlarged
tongue with teeth marks and a yellow greasy coating, and a wiry pulse. Laboratory
testsshowedbloodsedimentationrate35mm/h,anduricacid606mol/L.
The patient was slightly overweight and had a history of over consumption
of greasy, sweet and heavy food, fatigue and loose stool. He complained recently,
however, that the stool had turned dry and the urine dark.This pattern was due
to deficiency of spleen qi, internal accumulation of damp-heat, and obstruction of
vessels and collaterals due to binding conglutination of dampness and blood stasis.
The corresponding treatment principle should emphasize boosting qi and fortifying
the spleen, clearing heat and eliminating dampness, and dissolving stasis and
unblockingthecollaterals.Inthiscase,XunBTngwasusedwiththeadditionofd
lng(Pheretima),tyun(a.k.a.tbichng,EupolyphagaseuSteleophaga),pgng
yng(HerbaTaraxaci), ddng(HerbaCorydalisBungeanae), kshn(RadixSophorae
Flavescentis), dn p (Cortex Moutan), and ni x (Radix Achyranthis Bidentatae).
Threepacksweregivenforroutinedecoctionandintake.
The second consultation showed that the local swelling and pain was relieved
significantly,thepatientwasabletowalk,thestoolwasstillabitloose,whiletheurine
remainedyellow.Anothersixpackswereprescribedonthebasisoftheaboveformula,but
withtheremovalofkshnandtheadditionofflngandjiosnxin(CharredTriplet).
Subsequently, results of laboratory tests reverted to negative, with 15 mm/h of
blood sedimentation rate and 254 mol/L of uric acid.The stool and the urine also
returned to normal.With the removal of p gng yng and d dng, the patient was
giventhreemorepackstomaintainthecurativeefect.
[Reference: Chen Bao-gang, Qi Shi, Liang Shou-yi. Examples of Qi Lian-zhongs Experience in
Using Xun BTng . Liaoning Journal ofTraditional Chinese Medicine.

2004;31(5):425-426.]
Source Text 5

()
Insummerheat-strikeoftaiyang,asrecordedinEssentialsfromtheGoldenCabinet,
therearesymptomsoffever,aversiontocold,aheavybodywithpain,awirythready
pulse or a hollow slow pulse, generalized cold sensation with body hairs standing
upafterurination,fourextremitiescounterflowcold,generalizedhotsensationafter
mildactivity,pantingwithanopenmouth,anddrynessofthefrontteeth.Methodof
inducingsweatingwillworsenthesymptomofaversiontocold;methodofwarming-
needle will worsen the fever; repeated application of purgative method will result
in severe strangury (painful urination due to damage of yin and sinking of heat). Li
Dong-yuans Qng ShY QTng (Li Dong-yuans Summerheat-Clearing and Qi-
BoostingDecoction)(methodofcombinationofsupportingyangwithacridandsweet
medicinals,andboostingyinwithsourandsweetmedicinals)isindicated. (Systematic
DiferentiationofWarmDisease,Vol.1,ChapterUpperJiao)
Formula
hungq 1qian RadixAstragali

hungbi 1qian CortexPhellodendriChinensis
qngp 1qian PericarpiumCitriReticulataeViride
bizh 1qian5fen RhizomaAtractylodisMacrocephalae
shngm 3fen RhizomaCimicifugae
dnggu 7fen RadixAngelicaeSinensis
zhco 1qian RadixetRhizomaGlycyrrhizaePraeparatacumMelle
shnq 1qian MassaMedicataFermentata
rnshn 1qian RadixetRhizomaGinseng
zxi 1qian RhizomaAlismatis
wwiz 8fen FructusSchisandraeChinensis
chnp 1qian PericarpiumCitriReticulatae
cngzh 1qian5fen RhizomaAtractylodis
ggn 3fen RadixPuerariaeLobatae
dzo 2mi FructusJujubae
Interpretation
Summerheat-strikeoftaiyang,asrecordedinEssentialsfromtheGoldenCabinetis
actually a patternof damagetoqi and yin by summerheat. Symptoms includefever,
aversion to cold, a sensation of body heaviness with pain, a wiry thready pulse or
a hollow slow pulse, aggravated aversion to cold after urination, four extremities
counterfowcold,generalizedhotsensationaftermildactivity,anddryfrontteeth.
In this pattern, the method of inducingsweating with acrid-warm medicinals is
prohibited,asitcanexacerbatethesymptomofaversiontocold,causingittobecome
moresevereduetouselessconsumptionofweiyang.Themethodofwarming-needle
isalsoprohibited,asfeverwillbecomemoresevereduetotheerroneousapplication
oftreatingheatwithheat.Similarly,thepurgativemethodisalsonotaviableoption,
for it will damage yin and cause frequent, difficult, and painful urination. Only by
correctlyutilizingthemethodsofclearingandresolvingsummerheat,removingand
transforming dampness, harmonizing the stomach, boosting qi and nourishing yin
canthediseasebecured.Therefore,LiDong-yuansQngShYQTngissuggested.
Inthisformula,rnshn,midng,wwizandhungqclearsummerheat,boost
qiandnourishyin.Cngzh,bizh,qngp,chnp,ggn,shngm,andshnq
removeandtransformdampness,harmonizethestomach,andlifttheyangqiofthe
middlejiao.Hungbiandzxiclearheatwithindampness.Shngjinganddzoare
toregulateandharmonizethestomachandspleen.Thisformulaisthereforesuitable
forattackofsummerheat-damponthespleenandstomach,complicatedwithqiand
yininsufciency.
CaseReport
The patient had a history of repeated onset of low-grade fever for three years.
Threeyearsago,shebegantopresentfever(T37.4~38.0);thecauseswereuncertain.
She had once been admitted as an inpatient for treatment by another hospital.
Although various exams and tests had been performed on her, the cause remained
uncertain. After treatment with medicinals for clearing heat, resolving toxins and
enrichingyinyieldedunsatisfactoryefect,sheturnedhereforconsultation
Symptoms included low grade fever, dizziness, frustration, shortness of breath
aggravated following activity, cold extremities, distention, fullness and pain in the
area of the stomach cavity and abdomen, poor appetite, normal sleep, loose stool,
normalurine,thinwhitetonguecoatingandadeepthreadypulse.
Patterndiferentiation:feverduetoqidefciency.
Treatmentprinciples:relievefeverwithsweet-warmmedicinals.
Formula:modifedQngShYQTng.

shngm 5g RhizomaCimicifugae
Sevenpacksweregivenforroutinedecoctionandintake(twiceaday,onceeach
morningandevening).
Secondconsultation:feverwasreduced;symptomsoffrustrationandshortnessof
breathwerealleviated;dizziness,abdominaldistention,andhiccupwereoccasionally
present;thestoolwasloose;thetonguecoatingwasthinandwhite,andthepulsewas
deepandthready.Theaboveformulawasusedwiththeadditionofzhqio(Fructus
Aurantii) 10 g, chih (RadixBupleuri)10g, z xi (Rhizoma Alismatis) 20 g and rn
shn (Radix et Rhizoma Ginseng) 30 g. Another seven packs were given for routine
decoctionandintake.Rnshnwasrequiredtobedecoctedaloneandthenmixedinto
theprepareddecoction.
Third consultation: fever was eliminated, symptoms of dizziness and abdominal
distentionwererelieved,theappetitewasimproved,andthestoolandurinereturned
tonormal.Onthebasisofthesecondformula, chogy (dry-friedFructusSetariae
Germinatus) 30 g, cho mi y (dry-fried Fructus Hordei Germinatus) 30 g and cho
shnzh(dry-friedFructusCrataegi)30gwereaddedtocreateanewformulawhich
was aimed at maintaining the curative effect.The patient was followed up for half a
yearwithnorecurrenceevident.
[Reference: ChenYin-huan, Chen Jing, Lin Xing-dong. Examples of Professor Zhong Jia-xis
ExperienceinTreatingFebrileDisease.NewJournalofTraditional
Source Text 6

()
Insummerheat-warmthandlatentsummerheat,whentheattackofpathogenicqi
involvesallsanjiao,patientswillpresentsymptomsofagray-whitetonguecoating, p
and fullness in the chest, tidalfever, nausea, vexation and thirst,diarrhea, sweating,
and short scanty urination, Xng Rn Hu ShTng (Apricot Kernel andTalcum
Decoction)isindicated(methodofcombinationofbitter,acridandcoldmedicinals).
(SystematicDiferentiationofWarmDisease,Vol.2,ChapterMiddleJiao)
Formula

hush 3qian Talcum
jhng 1qian5fen ExocarpiumCitriRubrum
hunglin 1qian RhizomaCoptidis
yjn 2qian RadixCurcumae
tngco 1qian MedullaTetrapanacis
bnxi 3qian RhizomaPinelliae
Interpretation
In summerheat-warmth disease and latent summerheat disease, pathogenic
summerheat-dampwillaffectalltheupperjiao,middlejiaoandlowerjiao.Symptoms
such as a white greasy tongue coating, p and fullness in the area of the chest and
stomach cavity, diarrhea and dysentery-like evacuations, and nausea are due to
pathogenic dampness; symptoms of tidalfever, sweating, and scanty urination are
due to pathogenic heat.This pattern is caused by a of dampness and heat, which
cannotbecuredbyeitheraformulaconsistingofpreponderanceofcoldmedicinalsor
aformulaconsistingofpreponderanceofhotones.
InXngRnHuShTng,xngrnisusedprimarilytodiffuselungqi,sinceonce
lung qi frees qi transformation of the urinary bladder will be promoted.Hu sh and
tngcothenassisttodraindampness;bitter-warmhupdriesdampnessandmoves
qitoeliminatepandfullness;hunglinandhungqnclearinternalheatandarrest
damp-heatdiarrheaanddysentery-likeevacuations;aromaticyjnopensconstraint;
j hng and bn xi function to move stomach qi, disperse dampness and resolve
phlegmsoastorelievevomitingandnausea.Therefore,withthisformula,pathogenic
damp-heatinthesanjiaocanbedispersedseparatelythroughthe upperjiao,middle
jiaoandlowerjiao.
CaseReport
Chiefcomplaint:repeatedoccurrenceof edemainthelowerlimbsfor20months,
andrepeatedonsetoffeverandsorethroatfornearlyonemonth.
In August 1999, the patient had presented sore throat andedema in the lower
limbsaftertakingacoldshower.Routineurinetestsmadebyalocalhospitalshowed
protein (++++), so patient was subsequently admitted as an inpatient. After having
beentreatedwithWesterndrugssuchas60mgofprednisone,vitaminCandcefobid
intravenously for 10 days, the edema had disappeared and routine urine tests came
backnegative.
However,thesymptomsre-appearedattheendofSeptember1999,withprotein
(++) in routine urine tests. Since then, the disease had reoccurred repeatedly. On
December 21, 1999, the patient was diagnosed with minimal change nephropathy
and nephrotic syndrome (NS) by kidney biopsy. He was treated with prednisone
and li gng tng (RadixTripterygii Wilfordii) administered by oral intake, and
200 mgofcyclophosphamide mixed with 20 ml of physiological saline administered
intravenously. After some days of treatment, his symptoms had been relieved. On
June12,2000,hewassenttothehospitalagainbecauseofgeneralizedsevereedema
andscantyurine(500600ml/24h).Thistime,inadditiontotheWesternhormonedrug,
hewastreatedwith modifiedShn Q Gu Sho D HungTng(Ginseng, Astragalus,
ChineseAngelica,WhitePeonyandRehmanniaDecoction,).Although
edemaandproteinuriahadbeenrelievedwiththetreatment,thediseasereoccurred
inasimilarwaycontinuouslyforsometimeafterthat.
Intherecentmonth,thepatientcaughtcommoncoldsrepeatedly,presentingfever
and sore throat. Before arriving here for consultation, he had already been treated
withciprofoxacinintravenouslybyalocalhospitalforfourdays.
Present symptoms included a dry mouth with bitter taste, thirst with a desire to
drink, no fever, no sore throat, body pain, lack of strength, generally no sweating,
poorappetite,slightnausea,andscantyurine(500ml/24h)yellowincolor.
Physical exam: complexion indicative of acute disease, poor spirit, moon face,
intensiveacneontheface,backandchest,striaegravidarmontheabdomen,severe
edema all over the body, mud-like flesh in the lower limbs when pressed (pitting
edema), dry lips with cracks, a red crimson tongue with thick yellow greasy coating,
andadeepsoggypulse.
Kidneyfunctiontestresults(oneyearprior):
Cr BUN UREA
59mol/L 4mmol/L 230mol/L
Bloodfattestresults(oneyearprior):
CHO HDL-C LDL-C VLDL-C

6.60mmol/L 1.65mmol/L 3.98mmol/L 2.14mmol/L
Liverfunctiontestresults(oneyearprior):
ALT
51u/L
Routineurinetestresults(March30,2001):
Protein ERY RBC WBC

++++ ++++ 1~2/HP 1~2/HP
Patterndiferentiation:sufusionofdamp-heatinthesanjiao.
Treatmentprinciple:difuseqi,removeandtransformdampness,andclearheat.
Formula:modifedXngRnHuShTng.

hush 30g Talcum
chohungqn 10g RadixScutellariae(dry-fried)
jhng 10g ExocarpiumCitriRubrum
xyngshn 1g RadixPanacisQuinquefolii(takenalone)
Ninepacksweregivenforroutinedecoctionandintake.
Secondconsultation:April9,2001.Aftertakingthemedicinals,theedemadecreased.
Moreover, the patient presented improved appetite and spirit, no body pain, greatly
relievednauseaandchestoppression,normalstool,normalurine(4000ml/24h),ability
to lie on one side, bitter taste in the mouth and mild dry lips, a slightly dusky red
tongue with a thin white coating, and a thready wiry pulse on the left hand and a
deepthreadypulseontheright.
Withadditionof12gofshngdhung(RadixRehmanniae)and10gofmdnp
(CortexMoutan)totheaboveformula,andbyincreasingxyngshnto2g,another
10packswereadministered.
[Reference: Ma Xiao-bei. Examples of Xu Jia-songs Experience in Using Xng Rn Hu ShTng
. Chinese Journal of Information onTraditional Chinese Medicine.
2002;9(4):72-73.]
Section4 PatternsandTreatmentof
theLowerJiao
Source Text
(
)
Whendamp-heattypewarmdiseasehaslastedforalongtimewithpathogenicqi
suffusingallsanjiao,patientspresentsymptomsofunconsciousnessduetoobstruction
oftheorifices,hardnessandfullnessinthelesserabdomen,andnodefecation,Xun
Qng Do ZhuTng (Clear-Diffusing andTurbid-Removing Decoction) is indicated
(methodofcombinationofbitter-acridandblandmedicinals). (SystematicDifferentiationof
WarmDisease,Vol.2,ChapterLowerJiao)
Formula
zhlng 5qian Polyporus

flng 6qian Poria
hnshush 6qian Glauberitum
wncnsh 4qian FaecesBombycis
zoji 3qian FructusGleditsiae(withoutpeel)
Takeonecuptwiceaday.Keeptakinguntildefecationisunblocked.
Interpretation
If damp-heat type warm disease has lasted for a prolonged period of time, the
pathogenicqiwillcompletelysuffusethesanjiao.Whenitobstructsintheupperjiao,
patients will present unconsciousness due to blockage of the heart orifices; when it
obstructs in the lower jiao, patients will present hardness and fullness in the lesser
abdomen(lateralaspectsofthelowerabdomen),andconstipationduetoblockageof
thefuqiinthelargeintestine.ThispatterncanbetreatedwithXunQngDoZhu
Tng. In this formula, zh lng and f lng function to percolate and drain dampness
withtheirblandproperty.Hnshushclearsanddrainsdamp-heatthroughthelarge
intestines.Wncnshandzojiareusedasapair:sweetandacrid-warmwncnsh
isgoodatremovingturbidpathogenicqiinthelowerjiao;acrid-warmzojiisactive
andiscapableofdryingdampness,openingobstructions,andpromotingdefecation,
whichinturnpromotestheopeningoftheheartorifce.
It is necessary to mention here that no other special medicinals that function to
open the orifices exist in this formula.This not only indicates that the symptom of
unconsciousness presented in the case is not so serious, but also implies that the
key pathodynamic of unconsciousness lies inno defecation, which means there
is no way for pathogenic qi to exit.Therefore, only if qi movement of the large
intestineisunblockedwithdampnessandturbiditybeingdispelledcanthemindbe
cleared naturally. If the symptom of unconsciousness is very severe, however, it is
recommended that one combine this formula with S H XingWn (Storax Pill), in
ordertofurtherstrengthenthefunctionofopeningtheorifce.
CaseReport
Chief complaint: repeated onset of frequent urination for over one year, with
aggravation and even urinary blockage for 12 days.The patient began to present
frequent,urgentandpainfulurinationoneyearprior.Sincethesymptomswerenotso
severe,shedidnotreceiveanytreatment.
Twelve days before, after hemorrhoid surgery, she presented constipation and
aggravated symptoms of frequent, urgent and painful urination, which eventually
progressed to no urination. She was treated by some local doctors with Chinese
medicinals to clear heat, promote urination and relieve strangury,Western anti-
inflammatory drugs, and even repeated urethral catheterization, but no satisfactory
efectwasachieved,sosheturnedhereforconsultation.
Symptoms included no urination, distention and pain in the lower abdomen,
nauseawithadesiretovomit,inabilitytoeatordrink,mentalconfusion,constipation,
aredtonguewithgreasyyellowcoating,andawirythreadypulse.
Physicalexamination:hunchinginthelowerabdomen,extremelyfullurinarybladder
palpable 4 cm below the umbilicus, with urgent tenderness, mild retroperitoneal
painuponpercussionoftheareaofthekidneys,andanexcessivelyfullbladderwith
hydronephrosisapparentinultrasound.
CMdiagnosis:emergentpatternofdribblingurinaryblockage.
Treatmentprinciples:clear-dispersingandturbid-conducting.
Formula: combination of Xun Qng Do ZhuTng and B Zhng Sn (Eight
CorrectionsPowder)withmodifcation.
wncnsh 30g FaecesBombycis

zhlng 15g Polyporus
flng 15g Poria
hnshush 20g Glauberitum(decoctedfrst)
zojiz 8g FructusGleditsiae
chqinrn 30g SemenPlantaginis(wrapped)
binx 15g HerbaPolygoniAvicularis
dhung 8g RadixetRhizomaRhei(addedlater)
hijnsh 30g SporaLygodii(wrapped)
Onepackwasgiven.
Revisit on June 23: after taking two decoctions, the patient defecated a large
amount of dry stool, urination was profuse, and symptoms of distention and pain
in the lower abdomen were eliminated; spirit and appetite were both improved.
However, mild symptoms of frequent, urgent and painful urination still existed, and
routine urine test results were BLD (++) andWBC (+++). After having been treated
withtheaboveformulawithmodifcation,shewaseventuallycuredcompletely.
[Reference: ZhangYu-lei. Application of Clear-dispersing andTurbid-conductingTreatment
in Emergency . Journal of Emergency inTraditional Chinese Medicine.
2007;16(3):363-364.]
615
Glossary
GlossaryI:TheYellowEmperorsInnerClassic
Terms Chinese Pinyin Interpretation Page
b-obstruction b Thisprobleminvariablyinvolves 113,
painassoissometimesalsocalled 160-
painfulb-obstruction.Inmuchof 164,
Westernliteratureonthis,there 167-
seemstobeanearequalsignbetween 170,
b-obstructionandarthritisand/ 174-
orrheumatoidarthritis.Thisis 176
incorrectandmisleading.Whilejoint
painisperhapsthemostcommon
manifestationoftheproblem,
classicallyspeaking,b-obstruction
canalsobeusedtodescribepainful
blockagesinothertissueslikebone,
sinew,thevessels,muscleandeven
theheart.Thecommonetiologyis
localizedblockage(thoughitmaybe
serialasinmovingb-obstruction)
fromawind/cold/dampcombination
andinvariablyresultsinsomesort
oflocalizedpain.Insomecases,the
blockagemaytransformintoheatand
presentwithheatsignsaswell.
ChngQTng chngqtng Aseriesofformulasusedtopromote 132
(PurgativeDecoction) evacuationofthebowels.
familyofdecoctions
coolnesstopenetrate tutinling Needlingtechniquethatproducesa 160
theheavens sensationoflocalizedcoolnessinthe
patientwhenapplied.
doynexercises doyn ThetwoChinesecharacterstogether 35
meantoguideanddrawout.Theterm
referstoaseriesofexercisesintended
toopenandkeepopenthechannelsof
thebody.Theyareoftenconsidereda
subsetofqigong.
earthlybranches dzh SeetheTable2belowforthetwelveearthly 36
branchesandtheircorrespondences.
fretoburnthe shoshn Needlingtechniquethatproducesa 160
mountain hu sensationoflocalizedheatinthepatient
whenapplied.
Continued
foodingandspotting bnglu Agynecologicalconditionwithtwo 135-
presentationsthatcanleadtoeach 136
other.Floodingisuncontrolleduterine
bleeding,whilespottingisminor
untimelydischargesofbloodbetween
periods.
four-divisions sfnl Acalendarcombiningthedual 9
calendar characteristicsofthelunarcalendar
andthatofreturnyearstocreate
ayinandyanglunisolarcalendar,
i.e.,onebasedonbothlunarand
solarcycles.Theheavenlystemsand
earthlybranchesareakeyfeatureof
thecalculationofthecalendar.
heattoxins rd Ifleftunattended,heatcan"cook" 92,
thetissuesdevitalizingthemand 105,
eventuallyresultinginthereleaseof 173
substancestoxictothebody
heavenlystems tingn Seethetable1belowforthetenheavenly 36
stemsandtheircorrespondences.
heavenlystemsand tingnd Twonumberingsystemsusedin 36
earthlybranches zh tandemforcalendarscienceandin
thecalculationofcyclesofweather
andmanyotherthings.Thereareten
heavenlystemsandtwelveearthly
branches.
massesand zhngji Solidmassesthatmanifestinthe 131
accumulations abdomen.Ofthetwocharacters,zhng
aremassesthatarehard,immovable
withafxedlocusofpain,whilejiare
movablewithnofxedlocusofpain.
Mawangdui mwngdu AnarcheologicalsiteinChangsha, 7,25
archeologicaldig Chinacontainingthebodiesofthree
noblesfromtheWesternHanDynasty.
Anumberofimportantearlymedical
textswerefoundatthesite.
mumpscheek zhsi TheoldChinesetermformumps.Of 93
thetwocharacters,thefrstzhrefers
toscrofulousswellingsandsoresor
sometimesspecifcallytomumps;the
secondcharactersitocheeks.
Glossary 617
Continued
p-accumulation p mn Aspleenandstomachpatternwherein 139
anexternalinvasionofpathogenic
factors,improperprocessingoffood,
theaccumulationofphlegmand
dampness,emotionaldistressor
weakspleenandstomachresultin
lossofproperfunctionofthespleen
andstomach,inabilitytofacilitatethe
risingandsinkingactionsoftheqi
dynamicandfromthisresultingin
ablockageofstomachqi.Symptoms
includestomachdiscomfort,nopain
onpressurenorobviousdistension
withthetissuesremainingsoftwhen
palpated.
qi-basedmonism qyyunln Theideathateverythingtraces 8,10
Or backtoqiasthesinglefundamental
Or yunqln underlyingnature/structureofthe
universe.
summerheatsyncope shju Aconditionoffaintinginthe 154
summerheatduetoqidefciency
enablingphlegmtosurgeupwardand
striketheheartresultinginafaint.
urinaryretention lngb Aresultofimpairedfunctioningof 140
thekidneyandbladder,theproblem
manifestsasdribbling(lng)or
outrightinabilitytourinate(b).
waterrheum shiyn Fluidmetabolismpathology. 78
Thisparticularpathologyismost
commonlyseenafectingthemiddle
andupperpartofthebody.The
etiologyislocalizedaccumulations
offuidthatmaydirectlyafectthe
functioningoftheheart,lungsorother
organs.Ofthetwo,wateristhinwhile
rheumismoreviscous,butbecause
itcanbedifculttotellspecifcally
whichitiswithsuchaninternalissue,
itiscommontousethetwoterms
together.
water,dampness, shishtn Oftenusedtoindicatevaryingdegrees 78
phlegmandrheum yn offuidmetabolismpathology.Water
andrheumtendtobeaccumulations
(usuallylocalized)whiledampness
andphlegmareoftenmoresystemic.
Table1 TheTenHeavenlyStems
Heavenly Yin/
Pinyin FivePhase Meaning Organ BodyPart
Stem Yang
ji Yang Wood Allwoodthatruns Gallbladder Head
1stHS (BigBrother) up;trunkofatree,
etc.
y Yin Wood Allwoodthat Liver Shoulders
2ndHS (LittleBrother) goeshorizontal;
branches,moss,
grass,fowers,etc.
bng Yang Fire Heat Small Forehead
3rdHS (BigBrother) Intestine
dng Yin Fire Light Heart Teethand
4thHS (LittleBrother) tongue
w Yang Earth Stone Stomach Noseand
5thHS (BigBrother) face
J Yin Earth Soil Spleen Noseand
6thHS (LittleBrother) face
gng Yang Metal Unrefnedore, Large Sinews
7thHS (BigBrother) usuallystillinthe Intestine
ground
xn Yin Metal Refnedore; Lung Chest
8thHS (LittleBrother) crystals
rn Yang Water Allwaterthat Bladder Lower
9thHS (BigBrother) traveldownwards, legs
rivers,rain,etc.
gu Yin Water Allwaterthat Kidney Feet
10thHS (LittleBrother) travelsup,steam,
clouds,etc.(i.e.,
watertransformed
byheat.)
Table2 TheTwelveEarthlyBranchesandtheirCorrespondences
Earthly LunarMonthof
Pinyin TimeofDay AssociatedChannel
Branch theYear
z 11th 11pmto1am Footshaoyanggallbladder
1stEB lunarmonth
chu 12th 1amto3am Footjueyin
2ndEB lunarmonth liver
yn 1st 3amto5am Handtaiyin
3rdEB lunarmonth lung
mo 2nd 5amto7am Handyangminglarge
4thEB lunarmonth intestine
Glossary 619
Continued
Earthly LunarMonthof
Pinyin TimeofDay AssociatedChannel
Branch theYear
chn 3rd 7amto9am Footyangmingstomach
5thEB lunarmonth
s 4th 9amto11am Foottaiyin
6thEB lunarmonth spleen
w 5th 11amto1pm Handshaoyinheart
7thEB lunarmonth
wi 6th 1pmto3pm Handtaiyang
8thEB lunarmonth smallintestine
shn 7th 3pmto5pm Foottaiyangbladder
9thEB lunarmonth
yu 8th 5pmto7pm Footshaoyinkidney
10thEB lunarmonth
x 9th 7pmto9pm Handjueyinpericardium
11thEB lunarmonth
hi 10th 9pmto11pm Handshaoyang
11thEB lunarmonth sanjiao
GlossaryII:EssentialsfromtheGoldenCabinet
abdominalurgency lj (1)urgetodefecate;(2)contractionof 384-385,
malegenitalorgan 387,492,
500
bsyndrome bzhng Agroupofdiseaseswhosepresence 373,376,
(pattern) indicatestheinvasionofwind,cold, 378-379
dampnessorheatpathogenicqiinthe
channels;involvesmuscles,sinews,bones
andjoints;andpresentswithlocalized
pain,soreness,heaviness,orhotness,
andevenarticularswelling,stifnessand
deformities.Itisrelatedtoarthralgia.
bloodb xib Atypeofimpedimentdiseasemarkedby 380-381
localnumbnessofextremities
chestb xingb Adiseasecharacterizedbyparoxysmsof 401-410
pectoralpain,andsometimesaccompanied
byfeelingsofchestoppression.
coldshn hn Adiseasecharacterizedbyvisceral 482
shn defciencycoldandcontractionofwind-
coldpathogen,presentingprimarilywith
severeabnormalpain.
concretion zhng Ahardmassintheabdomenwhichis 473-476
unmovablewhenpressed.
Continued
conduction doyn Promotionofhealthandpreventionof 366
exercises diseasebyspeciallydesignedphysical
movementsandbreathingexercises,also
calledguidingandconductingexercise.
waisting-thirst xiok Anydiseasedstatecharacterizedby 358
polydipsia,polyphagia,andpolyuria.
Similartodiabetes
dryblood gnxi Apathomechanismfactorcharacterized 391,486,
bydefcientfreandstaticblood,whichis 487
presentindiseasessuchasamenorrhea,
andaccompaniedbysymptomsand
signslikeemaciation,nodesireforfood
ordrinkandbone-steamingtidalfever.
fetalspotting tilu Vaginalbleedingduringpregnancy, 475
whichmightindicatethepossibilityof
miscarriage.
fvetaxations wlo (1)fveexcessivebehaviorsthatresult 391
intaxationdisease(i.e.,useoftheeyes,
lyingdown,sitting,standing,and
walking);(2)defciencyofthefveorgans
glomus p Alocalizedsubjectivefeelingoffullness 405-407,
andblockage. 409-410,
414,422,
424-425,
446,448,
465-466
grainjaundice gdn Adiseaseprecipitatedbyimproperdiet 450-452
andaccumulationofdampnessandheat
asaconsequenceoffoodretentioninthe
middlejiao.
guestqi kq Theqithatcontrolstheseasonalchanges 366
oftheclimateinaparticularyear.
joint-running lji Adiseasecharacterizedbyrednessand 375-378
disease fng swellingofmultiplejoints,withacute
painanddifcultyinbendingand
stretching,andfnallydevelopinginto
articulardeformity.
kidneyfxity shn Adiseasecharacterizedchiefybypain, 416-417
zhu feelingofcoldnessandheavinessinthe
lumbarregionanddifcultyinrotating
thespineexacerbatedbycold.
lateafternoon rbsu Rbreferstothetimearoundshen 372,452
periodfrom3p.m.to5p.m.
Glossary 621
Continued
legqi jioq AdiseaseinCMrecognizedasan 377-378
accumulationofheatinthelower
extremityduetodampnessstagnation.
Itarisesfromanexternalattackof
pathogenicdampnessandheatcombined
withimpairmentofthevisceradueto
improperdiet.
liverfxity gn Adiseasedconditionarisingwhenqi 414-415
zhu andbloodoftheliverchannelbecome
depressedandstagnant.
lodgedrheum liyn Adiseasemarkedprimarilybyacold 421
sensationonthebackaboutthesizeof
one'shandandhypochondriacpain.
Itisusuallyamanifestationofyang
defciencyandyinexcessofthespleen,
lungandkidney.
lungwilting fiwi Adiseaseofthelungduetochronic 395
cough,markedbyatrophyofthe
lungwithshortnessofbreathand
expectoration.
plum-pitqi mih Adiseasecharacterizedbyasensation 494
q ofaforeignbodypresentinthethroat
whichcanbeneitherswallowednor
ejected,alsoknownasglobushystericus.
sexualtaxation nlo Akindofjaundiceassociatedwithsexual 452-454,
jaundice dn overindulgenceandinternalblockageof 462
staticblood.
skinwaterdisease pshu Pittingedemaaccompaniedbyabdominal 440
distensionandafoatingpulse.
striaeand cul AnanatomicallocationinCM.Itrefers 367
interstices, tothetissuesinthespacebetweenthe
interstitialspace musclesandskin.
stomachrefux wifn Adiseasecharacterizedbydistentionin 465
theabdomenaftereating,morningintake
offoodandvomitingindigestedfoodin
theeveningandviceversa.
trueorigin yun Thecombinationofinnateqiand 366-367
zhn acquiredqi,servingasthephysical
substrataanddynamicforceofallvital
functions,alsoknownasgenuineqi.
welling-abscess fiyng Adiseasethatreferstoanabscessinthe 396
ofthelung/lung lungmarkedbyspittingpurulentsputum
abscess withblood.
Continued
windb fngb Apatternattributedtostagnationof 380-381
pathogenicwind-cold-dampness(with
predominanceofwind)insinews,bones
andjointspresentingwithwandering
jointpainwithinhibitedmovement,a
thinwhitetonguecoating,andafoating
pulse.
windwater fng Atypeofedemaespeciallyoftheface 432,434,
shu andhead,ascribedtoattackonthelung 436-437,
bypathogenicwind,characterizedby 443
asuddenonsetofedemaaccompanied
byfeverwithaversiontowind,aching
joints,andoliguria.
wristpulse cnku AnanatomicpositioninCM.Itislocated 380
intheareaoftheradialarteryproximal
totheheadoftheradiusonbothwrists.
yellowsweatdisease hung Adiseasecharacterizedbyyellowish 442
hn sweating,oftenamanifestationofan
obstructionofyingandwei.
GlossaryIII:WarmDiseaseTheory
dampness b pattern shb Akindofdiseasehappenswhen 604
(a.k.absyndrome) pathogenicdamp-heataccumulates
andobstructsthechannelsand
collaterals,patientswillexperience
associatedjointspain.
lower jiao is like the xijiord Thefunctionsofthelowerjiao 515
dregsinaditch areurination,viathekidneyand
bladder,anddefecationthroughthe
intestines.Thetreatmentprocess
isjustlikedredginganirrigation
system;oncetheimpedimentis
removed,thewaterwaywillfow
unimpeded.
membranesource myun Halfexteriorandhalfinterior 517-
wherelatentpathogenicqiisoften 519,
located.Inwarmdisease,itisthe 523-
keypassagethroughwhichexterior 524,
pathogenicqientersthebodyand 592-
interiorpathogengoesoutofthe 593
body.
Glossary 623
Continued
m i d d l e j i a o i s l i k e zhng jio r Themiddlejiaospleenandstomach 515
fermentedfoam u decomposewaterandgrain,
transformthemintoessence,and
thentransportthistothelung.This
functionisjustlikemakingwine.
shiversweating zhnhn Sweatingaftershivering.This 580-
happenswhenhealthyqiand 581
pathogenicqistruggle.Itoften
happensinwarmdisease.
splenicpureheat pdn Thisdiseaseisoftenduetoan 523
addictiontoeatingsweetandfatty
foods,whichleadstodamp-heat
generationinthespleen.
upperjiaoislikemist shng jio r Theheartandlungresideinupper 515
w jiao.Thelunggovernsqi,andthe
heartgovernsblood.Whenthey
performtheirfunctionsofdifusing
anddispersing,theyareableto
transportanddistributeqiand
blood,whichwarmsandnourishes
theskin,sinews,andbones,and
opensandregulatestheinterstices,
justasthefoganddewmoistenthe
earth.
ve nt h e at t h ro u g h turzhunq Akindofmethodtotreatwarm 509
theqi disease.Whenthepathogenicheat
hasjustenteredtheyin,itslocation
isnotdeep;thisisauniquestage
duringwhichoneappliesthenovel
treatmentofventingheatfromthe
yinglevelthroughtheqilevel.In
otherwords,acrid-coolherbssuch
asynhu(FlosLonicerae),linqio
(FructusForsythiae)andzhy
(FoliumPhyllostachydisHenonis)
thatclearanddischargeqilevelheat
shouldbeaddedtoaformulathat
clearsandpurgesheattoxininthe
yinglevel.Inthisway,theheattoxin
canbeventedthroughtheqilevel.
624
Appendix
Measurements in the Essentials from
the Golden Cabinet
WeightConversionTable
Unit Conversion Grams(g)
zh() 1zh=100sh() 0.65
fn() 1fn=6zh 3.906
ling() 1ling=4fn 15.625
jn() 1jn=16ling 250
VolumeConversionTable
Unit Conversion Milliliters(ml)
gu() 1gu=64sh 0.5
cu() 1cu=4gu 2
yu() 1yu=5cu 10
g() 1g=2yu 20
shng() 1shng=10g 200
du() 1du=10shng 2000
h() 1h=10du 20,000
ApproximateMedicinalWeightof1Sheng
Weight Weight
Medicinal Medicinal
(g/persheng) (g/persheng)
zhr 24 yyrn 150
bim 280 fxiomi 100
shjio 50 xingch 124
bnxi 120 mngchng 16
chxiodu 160 kshn 40
torn 120 qco 60
xngrn 122 midng 120
chshzh 218 kuz 140
ytng 270 xiomi 140
dngguz 30 jp 40
Appendix MeasurementsintheEssentialsfromtheGoldenCabinet 625
Continued
Weight Weight
Medicinal Medicinal
(g/persheng) (g/persheng)
mzrn 100 zhchng 44
jngm 160 wijng 24
wwiz 90 gulurn 100
tnglz 120 mngxio 160
lgnbip 80 xibi 60
wzhy 80
ApproximateWeightof10Pieces
Medicinal Size Weight(g)
Large 200
fz
Mediumtolarge 150
Large 100
chunw
Mediumtolarge 70
bnxi Large 20
wmi Mediumtolarge 30
zhz Mediumtolarge 15
dzo Mediumtolarge 30
xngrn Large 4
torn Large 4
Large 100
zhsh Medium 60
Small 30
mngchng Large 1
shgo Egg-sizedpieces 1000
qungulu Mediumtolarge 500
hz Mediumtolarge 40
bih Large 100
gnsu Large 25
zhchng Large 9
Large 30
shuzh
Mediumtolarge 20
shgn Withoutsprouts 15
Reference:
1.SungYuk-Ming. Understanding the Jin GuiYao Lue: A PracticalTextbook. Beijing:
PeoplesMedicalPublishingHouse;2009.p.717-719.
2.LiKe-guang,ZhangJia-li.InterpretationoftheEssentialsfromtheGoldenCabinet.2nd
ed.2.Shanghai:ShanghaiScientificandTechnicalPublishers;
2010.p.659-661.
627
General Index
abdominalurgency,384,385,492 anechoicmass,476
A aberrantqi,367 anger,96,97,99,144
abrightyellowcoloring,458 abnormalabsenceofchestbind, anginapectoris,405,487
adisharmonyofyingandwei,370 225 angry,99
afeelingofemptinessinthe abnormalaversiontocoldinthe anguishorheatpainintheheart,
epigastricregion,490 afternoon,453 456
afeverishsensation,373 abnormalyellowing,460 anxiety,384,389
alowvoice,487 abscessoftheappendix,392 aphoniaaftercold,495
apoorappetite,498 abscesses,485 aplasticanemia,386
asensationlikeantscrawlingon absenceofgreatfever,229,230 appendicitis,475
theskin,497 absenceofgreatheatefusion,267, AquilariaWoodStagnation-
abdominalanxiety,385 268 MovingPill,449
abdominalbloating,388,406,447 absenceofsweating,370 arrhythmia,412
abdominaldistention,441,446, absenceofthirst,218,288,289,309, arthritis,370,373,434,441
447,453 310,313,417 ascendingcounterfowofexcess
abdominaldistentionworsenedby absentdefecation,189 heat,467
fuidintake,435 absorptioninexcessivethought, ascendingcounterfowofstomach
abdominalfamilymasses,189 497 qi,471
abdominalfullness,391,451,454 achingjoints,373 ascendingcounterfowofturbid
abdominalfullnessanddistention, acidregurgitation,388,434 phlegm,468
270 activehepatitis,392 ascendingqistrikingtheheart,339
abdominalfullnesswithhardness acutecholecystitis,468 ascitesduetocirrhosis,441,446
andpain,189 acutedisease,367,368 ascitesinlivercirrhosis,422
abdominalpain,69,386,478,481, acutegastritis,468 ashipoints,174
482,483,485,486,487,502,503 acutehepatitis,468 assistantneedling,170,173,176
abdominalpainassociatedwith acuteicterichepatitis,444 asthma,156,399,400,438,495
liverdepressionwithspleen acute/chronicgastritis,425 asthmaticbronchitis,397,399
defciencyandqistagnation adjunctneedling,170,172,176 AstragalusandCinnamonTwig
withdampnessobstruction,481 aggravateddisease,219 FiveSubstancesDecoction,113
abdominalpainduring aggravationintheafternoon,373 atrophicgastritis,388
menstruation,476,501 agitation,485 Attackingwithfre,370
abdominalpainduringpregnancy, alcoholicintemperance,456 audibleborborygmus,425
478 alcohol-inducedinjury,449 auditory,497
abdominalpaininpregnancy,480 alternatingchillsandfever,189, AugmentedandWidelyAmended
abdominalpainorstomachache 285,288,289,299,300 AnnotatedYellowEmperorsInner
duetospleenandstomach alternatingfeverandchills,190 ClassicofMedicine,4
defciency,386 amenorrhea,422,474 autoimmunethrombocytopenic
abdominalpainsosevereastolead aninabilitytoliedown,485 purpura,392
tounconsciousness,492 ancestralqi,445 autumndryness,506,542
abdominalspasmsorpain,385 AncientGreekandRomanmedi- aversiontocold,188,189,194,195,
abdominaltenderness,474 cine,20 196,197,198,199,200,201,205,
209,213,214,215,216,217,218, DiscourseonSubtleDetailsof Change,9

228,241,242,243,249,250,263, PulseEssentials,34,114,116,118, BasicQuestionsChapter70
264,265,267,268,271,285,289, 126 TheGreatTreatiseonthe
291,292,293,298,308,312,315, BasicQuestionsChapter18 AdministrationoftheFive
320,321,326,327,328,349,370, DiscourseonQiManifestationina Constants,31
438,511,512,519,524,529,533, HealthyPerson,14,111 BasicQuestionsChapter74Great
540,542,543,557,559,572,576, BasicQuestionsChapter2Great TreatiseontheEssentialsof
586,589,590,591,592,606,607 TreatiseonRegulatingtheSpiritin UltimateTruth,32,101,130,134
aversiontocoldandfever,458 theFourSeasons,151 BasicQuestionsChapter76
aversiontocoldenvironments,412 BasicQuestionsChapter20 DiscourseonExplicating
aversiontocoldinlateafternoon, DiscourseontheThreeSectionsand CompliancePatterns,12
453 NineIndicators,14 BasicQuestionsChapter8
aversiontoheat,263,264,265,266, BasicQuestionsChapter25 DiscoursesfromtheSecretClassic
268,548 DiscourseonTreasuringLifeand oftheMiraculousOrchid,61
aversiontowind,195,197,198, CompletingthePhysicalForm,15, BasicQuestionsChapter9Discourse
199,201,202,205,206,209,210, 55 ontheSexagenaryCyclesand
212,213,214,215,267,268,433, BasicQuestionsChapter26The OrganManifestation,23,65
436,437,438 EightProper(Directionsand) bnglu,135
aversiontowindandcold,371 SpiritualBrilliance,12 b,370,378,381,403
aversiontowind-cold,211,230 BasicQuestionsChapter28 bin-stone,24,128
DiscourseonOverallDiscrimination BiJiJinWn,131
B ofDefciencyandExcess,108 bindingandfullnessofthechest,
backpain,33 BasicQuestionsChapter3 406
backpainpenetratingtotheheart, DiscourseontheGenerationofQi bindingheat,256
412 andCommunicatingwithHeaven, bindinginthechestandrib-sides,
back-shpoints,121 46,51,52,94 285,287,299
BiHJiRnShnTng,154 BasicQuestionsChapter33 b-obstruction,113,161,164,167,
BiHTng,117,130 DiscourseonDiscriminatingHot 168,170,175
BiTngJiZhDnZhTng,50 Diseases,106 b-obstructionpain,163
BiTngTng,50,51 BasicQuestionsChapter38 bsyndrome,32,33,370,373,376,
BasicQuestionsChapter1Discourse DiscourseonCoughs,156 378
ontheHeavenlyTruthofAncient BasicQuestionsChapter4True BL13,173
Antiquity,142,146 WordsfromtheGoldenCabinet,17, BL15,173
BasicQuestionsChapter10 45 BL18,165,167
DiscourseontheCreationand BasicQuestionsChapter5The BL21,173
FormationoftheFiveZang-Organs, GreatTreatiseonYinYang BL60,161
74 CorrespondenceinPhenomena,11, blackjaundice,452,453
BasicQuestionsChapter11Further 19,35,38,40,42,44,48,50,51, blackteeth,568
DiscourseontheFiveZang- 53,54,92,138 blackishdiscolorationorevenasa
Organs,112,128 BasicQuestionsChapter52 darkmaculaonthecenterofthe
BasicQuestionsChapter12 DiscourseonNeedlingProhibitions, forehead,453
DiscourseonDiferingTreatments 163 bladder,45,57,58,60,62,65,66,
andAppropriateStrategies,23 BasicQuestionsChapter68The 103,453
BasicQuestionsChapter13 GreatTreatiseontheSixSubtle bladderchannel,453
DiscourseonMovingEssenceand Profundities,18,43 bleed,509,510,522,532,537,563,
ChangingQi,123 BasicQuestionsChapter69The 564,566,567
BasicQuestionsChapter17 GreatTreatiseonQiExchangeand bleeding,370,474,475,479
GeneralIndex 629
bleedingduetoobstructionof BZhngYQTng,131 chestpainandshortnessofbreath,

staticblood,501 burningsensationsintheheart, 409
bleedingwithabdominalpain 339 cheststufnessandglomus,410
duringpregnancy,477 bursitis,168 chestyang,402,407
bloating,449 chestyangqitorpidity,406
bloodamassement,223 C chestyangtorpidity,402
bloodamassment,222,223,225, cankersores,435,436 childphase,366
226,263 carbuncles,168,170 childbirth,492
bloodb,380,381 cardiacfailure,397 chongmaiandrenmai,500,501
bloodclots,474 cardiacspasm,425 chongmai,147,477,490
blooddefciency,483 cardiopulmonarydiseases,402 chronicbloodstasis,392
blooddefciencyandcold cardiospasm,466 chronicbronchitis,395,410,438
congealingpatterns,345 carotidartery,128 chroniccholecystitis,392,405
blooddefciencyduetoblood CelestialPalace(tintng,), chronicdiarrhea,422
stasis,391 453 chronicdisease,367,368,471
blooddefciencyfrommenstruation Center-SupplementingandQi- chronicdiseasewithblood
andchildbirth,462 BoostingDecoction,131 stagnation,392
bloodlevel,507,509,510,528,534, cervicalcancer,392 chronicdysentery,386
535,536,542,566,571,580,581, chn-needle,166 chronicgastritis,386,395,405,415
582 channelneedling,164,165,167 chronicgastroenteritis,410
bloodretentionpatterns,188 channelpassage,262,294,295 chronichepaticdiseases,415
bloodstasis,474,475,476 channels,367 chronichepatitis,386,495
bloodvessels,57,58 channelsandcollaterals,30 chronicinternalcold,347
bloodweakness,492 Channelsandvessels,30 chronicnephritis,119
blood-breakingandstasis- Channel-UnblockingforFrigid chronicobstructivepulmonary
attackingmethod,223 ExtremitiesDecoction,50 disease(COPD),405
Blood-NourishingandSpirit- checksvomiting,466 chronicpain,376
CalmingPill,87 chemotherapy/radiotherapy,425 chronicpelviccellulitiswith
bodyfuids,78,82,103,131 ChnXingDoZhWn,449 discharge,475
Bodyhairneedling,164,166,168 ChngQTng,132 chronicpelvicinfammation,501
bodypain,585,595,597,598,600, chestb,401,402,403,404,406,407, chronicpharyngitis,395,495
601,610,611 409 chronicrenalinsufciency,441
bone,57,58,121 chestbwithqiblockage,410 chronicstomachproblems,388
boneb-obstruction,160,162,163, chestbwithtorpidheartyang,410 chronicvomiting,466
168,169,176 chestbwithtorpidyang,407 CZhWn,86
BookofChanges,159 chestbind,189,191,245,246,251, CinnabarSpirit-CalmingPill,132
bowelexcess,273,276 252,254,286 CinnamonTwigandLicorice
bowel-qiobstruction,277 chestbindwithexcessheat,245 Decoction,53
brain,57,58 chestbwithqiblockage,409,410 CinnamonTwigDecoction,127
branchexcess,433 chestconstriction,400 CinnamonTwigDecoctionwith
branchphlegm-fuidstagnation, chestdistention,405 AddedAconite,48
466 chestfullness,285,301,403,407, cirrhosis,454
breakbinding,245,246 413 ClassicofPoems,6
Breastfeeding,489 chestfullnessandpain,408 ClassicoftheMountainsandSeas,6
bronchialasthma,402,410 chestfullnessandtightness,397 clearfoamyexpectoration,420
bronchialpneumonia,399 chestoppression,441,495 clearheat,376
bronchitis,405,410,495 chestpain,397,407,409,470 clearurine,308,318,319
clearyang,420 cold-dampjaundice,462 constraintheatintheheart,456

clear-fooddiarrhea,315,327 cold-dampobstruction,305 contagioushepatitis,456
closequarterneedling,169,170, cold-damppattern,378 contractingpainintheabdomen,
172,176 cold-dampstagnating,369 482
clots,474 cold-dampness,305,307,308,322, convergingvalleyneedling,160,
cold,92,93,95,96,97,98,100,101, 378 161,162,163
102,103,104,370,378 cold-dampnessintheinterior,370 CookedKernelPowder,87
coldandheatcomplexpattern,385, cold-heatcomplex,252,253,254, coolnesstopenetratetheheavens,
386 255,257,338,341,342 160
coldbsyndrome,379 coldnessontheback,425 coronaryanginapectoris,402,410,
colddamage,183,186,188,190, cold-transformationpattern,193 412
193,194,195,196,197,198,216, colitis,41 coronaryheartdisease,73,410,
217,237,238,239,242,243,245, collaterals,367 415,487
251,252,253,254,256,258,259, combinationofpathogenicwind, coronaryheartdiseasewith
263,264,265,267,268,269,270, cold,anddampness,376 ventricularprematurebeat
271,281,287,288,291,292,299, combineddisease,192,194 (VPB),407
301,302,326,340,341,343 complexdiseases,183,186 costalorepigastricregions,420
colddamageafectingyangming, complexinternaldiseases,182,186 CostusrootandAmomum
264 concertedneedling,169,170,171, Stomach-NourishingPill,449
colddamagepattern,196,198,293 174 cough,156,162,395,396,397,399,
colddamagewithchestbind,244 concretion,474,475,476 400,410,411,420,424,441,511,
colddampness,321 ConcurrentandTransmuted 524,526,529,531,545,546,547,
colddiarrhea,343 Patterns,196 548,549,555,556,559,563,576,
coldextremities,407,412 concurrentpatterns,189,196,212, 588
Coldintheinterior,265 285 coughing,401,422,424,442
coldinthelesserabdomen,499 conductionexercises,366 coughingandpanting,394,395
coldinthelowerabdomen,430 confictbetweencoldandheat,472 coughingwithdifcultyin
coldjoints,378 congealingphlegmandqi expectoratingsputum,395
coldpain,483 stagnationinthethroat,494 counterfow,399,407
Coldqi,40 congestionbelowtheheart,425 counterfowcold,191
coldretainedfuidshiddeninthe constantorintermittent counterfowqi,409,425
lung,398 spontaneoussweating,437 counterfowqiascent,395,397
coldreversal,335,347 constipated,498 counterfowreversal,334
coldrheumconstrainedinthe constipation,59,413,417,449,456, crimsontongue,521,528,536,564,
lung,399 466,472,497 566,569,574,575,576,592,593,
coldsensation,484 constrainwater,324 610
coldsensationinthecalves,444 constrainwaterbyfortifyingearth, crying,497
coldsensationintheexternal 420 cnku,380
genitalia,383 constrainedfre,289,295,296,298, cnkupulse,402
coldsensationsmaybefeltinthe 300 cyanosedlips,412
externalgenitalia,382 constrainedheatintheheart cyanosednailsandlips,413
coldsweat,412 channel,456 cyst,476
coldtransformation,315,317,318, constrainedweiyang,437 cystitis,410
336 constrainedyang,316,335
coldtransmutationpattern,190 constraint,495 D
cold-damp,305,306 constraintandsuppressionofthe diyng,50
cold-dampb,416 sevenemotions,494 damageofchongmaiandrenmai,
GeneralIndex 631
478 darkeningoftheforehead,453 DDngTng,131

dampheat,94 deafness,52 dzh,36
dampwarmth,506,543 debilitationofchongmaiandren diabetes,429
damp-heat,515,517,518,521,522, mai,501 diabetesinsipidus,428
523,528,529,530,538,539,560, deepexcesspulse,189 diabetesmellitus,428
561,563,578,579,580,581,582, defensiveorprotectiveqi,367 diagnosticdiferentiation,27
583,584,587,589,590,591,592, defensiveqi,43,98,159 diarrhea,41,59,105,126,150,378,
593,594,595,597,598,601,602, defciencyfre,395,396 383,386,422,423,471,492,589,
604,605,609,611,612,613 defciencyheat,394 590,596,598,599,601,609
damp-heataccumulation,282,451 defciencyofbothyinandyang, diarrheanervosa,422
damp-heatandbloodstagnation, 383,385,386 diarrheawithlowerheaviness,333
452 defciencyofheartblood,389 difculturination,190,206,289,
damp-heatbinding,529 Defciencyofliveryin,389 324,334
damp-heatbindingandbrewing defciencyofliveryinandheart difcultyindefecating,392
internally,281,282 blood,389 difcultyinfallingasleep,417
damp-heatbindinginyangming, defciencyofthecollateralvessels, difcultyinfoodanddrinkintake,
452 380 468
Damp-heatbrewinginternally,282, defciencytaxation,385,388,391 difcultyorpaininswallowing,
291 defciencyvexation,227,228,269, 494
damp-heatjaundice,462 276,389 difcultyinstretchingthejoints,
damp-heatobstruction,344 defciencyvexationandagitation, 373
damp-heatpatternnon-icteric 471 difcultyinswallowing,395
hepatitiswithheatbinding defciencyvomiting,465 difcultywalking,376
inthestomachandattacking defciency-cold,241,250,306,307, directattack,192,194
upwardtoharasstheheart,456 309,315,337 directqidownward,463
damp-heattypejaundice,462 defciency-colddiarrhea,241 Directtreatment,36
damp-heatwarmdisease,518 defciency-fre,395 directscounterfowdownward,
damp-heat-qiaccumulation,523 defciency-taxationcough,395 466
dampness,92,94,95,100,101,102, defcientcoldinchongmaiandren disinhibitedurination,285,288,
103,126,370,372,373,376,378 mai,501 299,300,301,302
DampnessandSummerheat defcientstomach,465 disperseglomus,407
Stroke,184,185 delayedmenstruation,483,500, dispersecoldnesstodrain
dampnessb,604 501 dampness,371
dampnessintheexterior,370 deliriousspeech,189,190,262,271, Disquietudeintheheartandchest,
dampnessismoresignifcantthan 272,273,274,275,276,279,287, 451
heat,458 288,301,302 dissipatecold,376
damp-warmdisease,540 delirium,86 dissipatecoldandharmonizethe
dnzhng,61 depletionofbodyfuids,466 stomach,463
doyn,26,35 depression,389,495 dissipatesmasses,466
darkmenseswithclots,476 depressiontypeofschizophrenia, dissipatingrheumandmasses,463
darkspotsonthegums,lips, 497 distantpathneedling,164,165,167
nipples,orpalmcreases,453 derangement,489,490 distendingbreastpain,405
darkyellowskincolor,458 dermatologicaldisease,168 distendingheadache,425
darkyellowurine,458 desireandinabilitytovomit,318 distendingpain,454
darkyellowishdiscolorationofthe desirefordrinkingwater,492 distendingpaininherlower
skinandictericsclera,462 desireonlytosleep,314,316 abdomen,503
darkenedeyes,391 deviatedmouth,168 distendingpaininthelower
abdomen,392 drynessofthethroatandmouth, eliminatedampness,376

distensioninthechest,420 385,386 emaciated,375,422
distention,445 Dryness-ClearingandLung- emaciation,376,387,428,478
distentionandfullness,487 RescuingDecoction,131 emotionalattacksofhysteria,497
distentioninthefanks,419 dryness-excess,271 emotionaldepression,446
distressbelowtheheart,294,295 dryness-excessbinding,273 Emotionaltrauma,497
distressedbreathing,441 dryness-fre,189 emphysema,438
DivineHusbandman,6 dryness-heat,189,261,262,266, endometrialdisplacementor
divisionneedling,164,165,167 271,273,277 dystopia,475
dizziness,81,99,105,121,376,378, dryness-heatharassingtheheart, enlargementoftheliverand
383,384,390,419,420,425,451, 270 spleen,392
464,468 DU26,124 EphedraDecoction,96,130
dizzy,498 db,161 epidemichemorrhagicfever,468
Donkey-HideGelatinand Dualdebilitationofyinandyang, epigastricandabdominal
MugwortDecoction,137 380 distension,454
downbearcounterfow,228,235, dualdefciency,386 epigastricdistention,449,458
236,252,253,259,290,298,338, dualdefciencyofyinandyang, epigastricglomusandblockage,
349,350,424 388 250
downbearingcounterfow,254,295 dullstomachache,388 epigastricpain,466
dream-disturbedsleep,407 duskyyellowcolorofhisskin,462 epistaxis,487,488
dreamingofintercourse,383 dyschezia,405,406 rHungBngDiSn,93
dreamsofsexualintercourse,382 dysentery,41,491,492 erectiledysfunction,39
droolingandfoamingatthe dysfunctionofthespleenand esophagealspasm,495
mouth,348,349 stomach,388 essence,30,46,47,51,62,78,80,84,
dryandwitheredskin,371 dysfunctionaluterinebleeding, 87,88,96,98,123
drybelchingwithfoodmalodor, 478,501 Essencebrightness,118
253 dysmenorrhea,475,483,487,501 essence-qi,29,32,34,46,57,58,74,
dryblood,391 dyspnea,405,424,441 88,98,112,115,118,120,123,
drycough,490 dyspepsia,384 124,126,131,132,146,177
drylips,500 dysuria,438 essence-spirit,30,61,123,124,126,
drylipswithnodesireforwater, 142
487 E EupatoriiandLycopiDecoction,74
drymouth,395,489,497,511,513, earlierheavenessence,146,148 eveningfevers,500
544,547,548,553,556,565,568, early-stagejaundice,458 excessheatinstomachand
569,586,588,610 earthrealm,159 intestines,467
drymouthwithnodesiretodrink, earthlybranches,36 excessofcold-damp,378
422 ectopicpregnancy,475 excesspattern,261,270,351,518,
dryretching,199,201,216,217, edema,433,434,436,437,438,439, 532,552
254,255,256,257,327,328,348, 440,441,442,445,446,447,495, excesspatternoflungabscess,397
469 512,572,610,611 excessivealcoholconsumption,448
drythroat,395 edemabelowthewaist,430 excessiveclearurine,431
dryness,92 edemaintheextremities,438 excessivecoldyininteriorly,402
drynessinthemouth,429 edemainthelowerextremities,428 excessivedreaming,497
drynessinthemouthwithadesire Egyptians,19 excessiveheatcomplicatedwith
forcooldrinks,472 eightmedicinalapplication moderatedampness,456
drynessinthemouthwithlittle methods,501 excessiveleukorrhea,392
desiretodrink,471 eightsolarterms,23 excessivemenstrualfow,500
GeneralIndex 633
excessiveseminalemission,383 exuberantyinrepellingyang,315, afternoon,372

excessivesexualintercourse,367 327,328 Fifty-EighthDifculty,186
excessivesweating,370 exuberantyin-cold,406 fre,101,102,103,104
excessivesweatingdamagingheart exudativepleuritis,397 frecounterfow,189,395
yang,233 eyepain,467 Fireheatpathogenicqi,102
excessivethinking,97,497 fretoburnthemountain,160
exhaustqiandfuid,539 F fveelement,365
EX-LE5,161 facialpufness,447 fvemovements,36
expansionneedling,169,170,174 faintandthreadypulses,314,316 fvemovementsandthesixqi,36
expectoratingcopiousphlegmy- faintpulse,316,317,320,327,328, fvephasestheories,28,36
saliva,andgeneralpufness,397 340,341 Fivephasestheory,9
expectorationofwhitefoamy fatigue,384,388,392,397,407,422, FiveSubstancesPowderwith
sputum,410 428,434,438,462,465,478,498, Poria,132
expelcold-dampness,378 501 fvetaxations,391
expelwind,370,376 fear,96 Five-PeelBeverage,79
exteriorandinteriordampness, fearofcold,388 faccidmuscles,434
370 fearfulheartpalpitations,63 foatneedling,169,172,176
exteriorcoldandinteriorwater- feather-warmthfever,199,201 floatingandhollowpulse,549,
rheum,217 feelasifinsectsaremovingwithin 550
exteriordefciency,432 hisskin,432 fooding,500
exteriorexcess,211,212,219,317 feelingofphlegmblockedinthe foodingandspotting,135,136
exteriorpattern,195,204,208,211, throat,495 foodingandspotting,500
219,225,239,240,241,243,247, fish,173 fuidsfailtobearupward,430
250,254,259,264,268,285,292, femininebleeding,477 foodcannotbedigested,451
293,295,300,319,320,324,370 fetalmovement,474 footshaoyinchannel,172
exteriorwei-yang,369 fetal-likemovement,475 foottaiyangbladderchannel,175
exteriorwind-cold,216,218 Fetusmalnutrition,478 formlesspathogenicheat,248,
exteriorwind-dampness,372 fetusmoving,474 249
exterior-interiorrelationship,285, fetusstirring,474 formlesspathogenicheatharassing
305,315,337,338 fever,109,117,162,370,438,443, thechest,329
exterior-resolving,219,241,285, 456,472,487,489,506,511,512, FormulasforFifty-twoDiseases,7
302 513,518,519,524,525,529,530, fortifesthespleen,466
externalcauses,367 531,536,540,542,543,544,545, fourextremitiesreversalcold,412
externalpathogen,381 546,548,549,559,560,562,563, frequentdiarrhea,423
externalsigns,263,264,267,268 564,570,571,572,573,576,577, frequenturinationatnight,428
externalwindpathogen,378 578,579,580,581,585,586,587, fright,144
externally-contractedpathogens, 588,589,590,591,592,593,594, FrigidExtremitiesDecoction,50,
188 597,600,601,604,606,607,608, 124
externally-contracteddisease,182, 609,610 fullness,445,448,485,495
186,188 feverinthelateafternoon,373 fullnessacrossthechest,412
extraordinaryorgans,58 feverofunidentifedorigin,386 fullnessanddistentioninthechest,
Extremedefciencywithsevere feverovercomingorrelapsing 396,397
emaciation,391 pattern,191 fullnessandoppression,485
extremeheaviness,190 feverish,384 fullnessandpaininthechest,402
exuberanceofyin-cold,326 feverishnessinthepalmsandsoles fullnessandstabbingpain,500
exuberantheat,456 ofthefeet,471 fullnessofthelowerabdomen,453
exuberantphlegm-rheum,404,405 feversaggravatedinthelate fu-organ,15,17,27,28,29,46,52,
58,61,63,74,112,120,148,156, GinsengSupportingand half-exteriorpattern,193

164,165,167 NourishingPill,132 half-interior,193
fu-organessence-qi,112 glomerulonephritis,438 handtaiyinlungchannel,103,112
glomus,241,242,248,249,250,251, happiness,96,97,144
G 253,254,255,256,257,259,276, harassingtheheart,276
gallbladder,45,57,58,60,61,65, 286,295,405,407,409,414,422, harassingtheheart-spirit,273
66,435,456,458 425,446,448,465,466 hardeningandfullnessbelowthe
gallbladderchannels,497 glomusandfullness,241,249,252, heart,421
Gallbladderconstraint,289 257,259,406 hardnessandfullnessbelowthe
gallbladderfre,189 glomusandfullnessbelowthe heart,256
gallbladderfrefaresup,284,286 heart,255 hardnessandfullnessinthe
Gallbladderfrefaringupward, glomusandhardness,240,253, epigastrium,247,257
302 254,258,259,288,289,296 hardnessand/orfullnessbelowthe
gallbladderqiconstraint,289,303 glomusbelowtheheart,248 heart,448
GnMiDZoTng,144 glomuspattern,252 harmtothefetusqi,478
gnsh,165,167 GoldNeedlePlumBlossomPoem harmonyofthemouth,321
GaoBao-heng,4 Transcription,168 hastybreathing,397
gastralgia,422 grainjaundice,450,451,452 hg,161
gastricandgastroduodenalulcers, grainqi,158 headache,33,99,105,390,458,498,
395 grainqilevel,158 511,513,536,537,549,553,559,
gastricconditions,388 GrandSimplicityofTheYellow 564,585,588,589,590,593,594,
gastricrefux,434,435 EmperorsInnerClassic,4 599
gastriculcer,466 greasycoating,511,513,519,521, healthyqi,32,97,101,106,109,138,
gastritis,388 524,529,531,556,605,610 142,158
gastroatonia,495 greatdrainingneedling,164,166, heart,13,15,45,46,58,60,61,63,
gastrointestinalneurosis,392 168 65,66,74,78,86,87,88,98,101,
gastrointestinalulcer,386 greatexcesspain,311,313 102,103,104,113,119,121,150,
gastroptosis,495 greatvexationandthirst,266,268 160,161,163,366,407,425,448,
gastroptosisandindigestion,448 grief,96,98,144 453,485,497,500
GB34,121,161 grieved,498 heartb-obstruction,169
GGnXiBiSn,67 grippinglowerabdominalpain,474 heartblooddefciency,385
generalmusclesoreness,373 GuanziEarthNumbers,10 heartchannel,446
generalizedbleeding,487 guardingtopreventothersfrom heartfailure,397,412,425,441
generalizedchestand touching,474 heartfrefamingupward,533
hypochondriacpain,415 Guestqi,366 heartpain,170,404,405,412
generalizededema,441,443,444, GuLngJ,149 Heartpainpenetratingtotheback,
446,447 GuZhGnCoTng,53 412
generalizedheaviness,285,301, GuZhJiFZTng,48 heartpalpations,78,82
302 GuZhTng,127 heartqi,446
generalizedpain,372,373,484 gynecologicalbleeding,477 heartspirit,497
generalizedpurplepatchesonher gynecologicaldiseases,478 heartthrobbingandpalpitations,
skin,487 243
generalizedswelling,437 H heartyang,403
generalizedtwitching,324 habitualabortion,478,501 heartyangdefciency,446
generalizedtwitchingand hairloss,383 heartyangqidefciency,446
trembling,323 halfneedling,160,161,162 heart-fre,314,329,330
generalizedyellowing,453 half-exteriorhalf-interior,252 heart-freexuberance,329,330
GeneralIndex 635
heart-kidneyinteraction,314,330 121 410,415

heart-spirit,489 humanrealm,159 interiorcoldwithexteriorheat,
heat,92,96,97,98,100,101,103, hungerbutwithnodesiretoeat, 327,328
372,376 339 interiordefciency,239,271,316,
heatbinding,552,563 hyperemia,511,512,547,559 319
heatdiarrhea,232,350,351,491 hypertension,167,425 interiorheatpattern,309
heatdisease,186 hysteria,495,497 intermittentabdominalpain,190
heatexcess,244 hysteromyoma,501 internalcauses,367
heatglomus,248,250 internaldryblood,391
heatharassingheart-shen,229,329 I internalheat,216
heatharassingthechestand ichthyosis,392 internalwater-rheum,218
diaphragm,228 icterichepatitis,454 interstices,367
heatharassingtheheart,224 ictericsclera,454,458 intestinaladhesion,392
heatintheinterior,265 ictericscleraandskindiscoloration, intestinalobstruction,425,468
heatontheundersidesofthefeet, 460 irregularenlargementofthe
453 icycoldsensationfromthewaist uterus,474
heatpathogenicqi,104 down,432 irregularmenses,501
heatpatterns,261,262,264,265 impedimentpain,402 irregularmenstruation,392
heattoxins,92 inabilitytoconcentrate,390 irritability,373
heattransformation,315,317,318, inabilitytoeat,451 itchiness,167
329,336 inabilitytoeatordrink,391
heattransmutationpattern,190 inabilitytoliedown,404,424,485 J
heattypediarrheaandrectal inabilitytoliefat,397 jaundice,370,450,451,452,453,
heaviness,492 inabilitytoproduceasweat,371 454,455,457,458,461,462
heat-coldcomplex,193 incessantbelching,258,259 jerkingsinewsandtwitchingfesh,
heat-painwithintheheart,190 incessantdiarrhea,231,240,241, 214
heat-transformationpattern,193 242,307 jiao,518
heavenrealm,159 incessantretching,285,294,295 JioiTng,137
heavenlystems,36 Incessantspotting,474 jn-andy-fuids,60
heaviness,434,438 incontinence,90 JnZhnF,159
heavyache,483 increasedclearurine,431 JnZhnMiHuShCho,168
hematemesis,487,488 increasedurineoutput,430 jngj,63
hematuria,439 indescribableagitation,456 jng-channeldisease,192
hemiplegia,168 infertility,483,501 jointinfammation,163
hemolyticjaundice,andiron infertilityduetochronicpelvic jointpain,381
defciencyanemia,386 infammatorydiseases,392 jointswellinganddeformity,376
hepatocirrhosis(orascites),487 infuenza,107 joint-runningdisease,375,376,378
hiccough,467,469,470,471,472 inhibitedurination,188,190,217, Joy,97
highbloodpressure,105 220,221,262,281,282,285,323, joyoranger,497
highfever,438 325,333,422,430,451,456,461 jqu,173
hives,67 insecurityoftheinterstices,433 jue-reversalcold,190
hotneedling,164,166,168 insomnia,63,82,86,89,383,386, jueyincoldpattern,191
Hotqi,40 388,389,390,456,497,498 jueyinheatpattern,191
hou-period,23 insomniaduetoblooddefciency jueyinliverchanneldamp-heat,351
HungQGuZhWWTng,113 oftheheartandliver,389
Huang-fuMi,3 insufcientlactation,422 K
hui-meetingpointofthesinews, intercostalneuralgia,168,402,405, Kant,12
KI3,161,172 Laterheavenessence,148 long-termdefciency,482

kidney,15,45,58,60,62,65,66,87, laughter,89 long-termdefciencytaxation,391
88,98,100,102,103,119,126, legqi,377 loosestools,388,407,454
146,150,161,162,367,417,427, leopardspotneedling,160,161, losingconsciousness,492
428,429,430,453,454 162,163 lossofappetite,441
kidneyandspleendefciency,454 LI4,161 lossofconsciousness,33,492
kidneydefciency,163,428,454 linqun,155,157 lowappetite,454
Kidneyessence,98,121,146,148 Licorice,WheatandJujube lowfeverinlateafternoon,444
kidneyessence-qi,121 Decoction,144 lowgradefeverindiabetes,386
kidneyfre,453 liqu,157 lowvoice,471
kidneyfxity,416,417 Lifecultivation,26 lowerabdomen,488
kidneyhydrocele,422 limbreversal,241,341 lowerabdominalpain,501
kidneyqi,66,98,146,148,427,428, LinYi,4 lowerabdominalurgency,500
430 lipsaredry,500 lowerbacksoreness,392
kidneyqidefciency,427 liquorjaundice,452,456 lowerjiao,82,97,98,140,416,417,
kidneyyang,148,428,431,454 listlessness,487 453,455,514,515,516,517,518,
kidneyyangdefciency,427,428, LiuHe-jian,507 527,544,552,569,575,581,582,
431 liver,15,45,46,58,60,61,65,66, 589,590,591,609,610,612,613
kidneyyin,148,428,453,454 74,87,88,97,100,102,104,119, lowerjiaocoldness,430
kidneyyindefciency,385,427 150,160,161,365,366,367,454, lowerjiaowasting-thirst,427,428
kidneyyindepletion,330,332 456,458,480,485,495,497,502 lowerjiaoyangdefciencywith
kidneys,46,121 liverchannel,414 water-rheum,430
kidney-water,314,329,330,337 liverconstraint,481,498 lowerjiaoyin-cold,413
kneepain,436 liverdefciency,366 LU1,173
knln,161 liverdisharmonies,365 LU7,157
liverexcess,366,480 lumbarpainandsoreness,481
L liverfreburningthebodyfuids, lung,15,45,58,60,61,65,66,67,
labor,482,489,490,491 339 74,82,87,88,98,100,102,103,
laboredbreathing,398,400 liverfxity,414 113,121,126,150,160,161,162,
labyrinthitis,425 liverstagnation,289 395,396,397,398,399,409,433,
lackofappetite,435 liveryin,389 435,438,439,440,441
lackofbodyfuids,394 liver-coldinvadingthestomach, lungabscess,396
lackofstrength,472,501 349 lungandkidneyyindepletion,218
lackofthirstorhunger,497 liver-spleendisharmony,480,502 lungqi,394,397,399,401,402,409,
lackofwarmthinthefour Liver-warmingDecoctior,38 424,446,495
extremities,428 liver-wood,365 lungqicounterfow,400
lackofwarmthinthehandsand LoadstoneandCinnabarPill,86 lungqidefciency,433,435
feet,371 localizedcoldsensation,420 lungqifailingtodifuse,370
lackofwarmthinthelimbs,501 localizednumbnessofthemuscles, lungqistagnation,397
LnCoTng,74 381 lungsilicosis,395
largeintestine,45,57,58,60,62,65, lochia,485,488 lungyindefciency,394,396
66,103 lochiadischarge,488,492 lungs,46
lassitude,465,472 lodgedrheum,421 lung-wei,547
lateafternoontidalfever,452 lngb,140 lunisolarcalendar,9
lateafternoonwatch,372 longstandingdiarrhea,315,340 lu-networkneedling,164,165,167
latentsummerheat,506,512,529, longstandinginabilitytoconceive, LV2,165,167
539,572,609 500 LV3,165,167
GeneralIndex 637
LyciumBerry,Chrysanthemum 438,446,449,456,475,480,497, nineneedles,24

andRehmanniaPill,100 514,515,516,517,519,523,524, NineScrolls,4
549,581,583,584,587,589,590, noappetite,487
M 591,592,594,595,597,601,602, nocturnalemissions,383
MHungTng,96,130 607,609,610 non-interactionoftheheartand
maculae,510,520,529,530,534, migraines,168 kidney,329
535,536,537,538,544,560,561, mildabdominalfullness,458 normalqi,367
562 mildchestb,409 nosebleed,385,467
mib,113 miliariaalba,520,538,539,540,541 nostrilfaring,549
majorchestbindpattern,247 mind-bodydualism,21 NotopterygiumDampness-Drying
malaria,581,591,592 minorchestbind,247 Decoction,131
malignanttumor,425 MiraculousTurtleCollection,149 NunGnJin,39
mania,52,86 miscarriage,478 numbness,75,163,376,381
marrow,57,58,121 miscellaneousgynecological numbnessoflips,tongue,and
massesandaccumulations,131 disorders,475 limbs,378
MasterWansBovineBezoarHeart- moderatepulse,577,596,597,598, nutritionaledema,441
ClearingPill,90 599,600,601 nutritiveqi,66,77,82,88,98,159,
matchedpairneedling,169,170, morningsickness,495 367
173 motionsickness,425
Mawangduiarcheologicaldig,7, mouthsore,467 O
25 mouthulceration,572 obese,446
medicalclimatology,37 moveqiandexpeldampness,373 Observation,33,115,119
medicalgeography,23 movingb-obstruction,174 obstructionofchestyang,405
medicalpsychology,23 MLSn,132 OdeoftheGoldNeedle,159
medicinalpairing,370 M-UE-1,124 odorlesswhitevaginaldischarge,
melanosisfacieifeminae,392 mumpscheek,93 476
MelonStalkPowder,132 muscleb-obstruction,160,162 onthevergeofexpiration,327,341,
membranesource,492,518,519, musculoskeletalpainand/or 345
523,524,592,593 arthralgia,378 openandtransferneedling,169,
Menieresdisease,420,464,468 myocardialinfarction,412 170,172,175
menopausalsyndrome,490 oppositeneedling,164,166,168
menses,478 N oppressioninthechest,483,490,
menstrualcycle,490 nasalcongestion,396 496
menstrualdischarge,474 nasalstufness,52 oralulcer,468
menstrualdisordersorpostponed nausea,376,420,462,470,511,519, orange-yellowcoloredskin,456
menstruation,487 524,540,544,586,593,594,609, organmanifestation,11
menstrualirregularities,478 610,612,613 organmanifestationtheory,28,29
menstruating,500 nauseawithoutvomiting,422 organreversal,340,341,352
menstruation,474,475,476,478, nauseated,456 organs,367
490,501,502 needlingthepasses,160,161,163 originalqi,367
menstruationwasirregularor nigun,172 outburstsoflaughter,497
inhibited,474 nephritis,392,434,441 ovariancyst,501
MethodofNeedling,12 neuralweakness,497 overindulgenceinsexoralcohol,
middleandupperjiao,470,487 neurasthenia,386,389,390 427
middlejiao,29,41,77,78,82,112, neuritis,175 overlappingdiseases,192,194
126,131,376,388,392,397,402, neurodermatitis,175 oviductobstructiongivingriseto
404,406,407,409,410,412,425, neurosis,389 infertility,475
OysterShellPowder,132 pathogenicdamp-heat,581,582, 501

587,592,597,598,604,610 peripheralpolyneuritis,381
P pathogenicfactors,31,32,92,97, perniciousvomitingduring
pain,167,381,485 106,109,136,175 pregnancy,425
painandswellinginthejoints,375 pathogenicheat,437,510,511,513, persistentdiarrhea,422
painandswellingintheknees,434 514,515,522,524,525,528,532, persistentpaininthelower
paininherlowerabdomen,501 534,535,536,546,550,562,563, abdomen,481
paininthechestandback,401, 566,568,570,571,574,575,580, pertussis,495
403,404 582,584,609 pestilence,506
painintheepigastricregion,422 pathogenicqi,12,32,33,36,67,73, pharyngitis,396
painintheepigastricregionor 88,94,101,102,103,105,106, phlegmexuberance,404
stomach,412 107,108,115,116,117,119,126, phlegmturbidity,407
paininthekneeandanklejoint, 127,131,132,134,135,136,138, phlegm-rheum,221,238,259,410,
376,378 139,143,154,158,161,162,163, 419,420,425
paininthelowerabdomen,485, 166,169,172,175,176,177,186, phlegm-rheumcollecting
501 187,188,189,190,191,192,193, internally,308
paininthestomachandabdomen, 365,367,455,464,506,509,510, pdn,74
483 511,512,513,514,516,517,518, p-needle,164,166
palaceofessencebrightness,120 520,521,522,523,524,525,526, pittingedema,441,444
palaceoftheblood,115,116 528,529,532,535,536,538,541, pivotdysfunction,295
palaceofthechestcenter,120 542,544,546,547,548,551,555, pivotmechanism,284,300,302
palaceoftheheartandlung,121 560,561,563,566,571,572,573, pleuralefusion,398
palaceofthekidney,120,121 579,580,581,582,583,584,588, plum-pitqi,494
palaceofthemarrow,120,121 590,592,593,604,609,612,613 plum-pitsensation,494
palaceofthesinews,121 pathogenicturbidyin,425 pneumonia,370
palacesofblood,78 pathogenicwateroverfow,438 poorappetite,397,400,417,447,
palecomplexion,412,569,578,579 pathogenicwind,376,433,437 472,479
pallor,428 pathogenicyin,584 poorsleep,472
palpablehardmass,487 pathogenicyininvasion,404 postpartumabdominalpain,484,
palpation,34 pathogens,417,433 485,486
palpitations,386,402,407,420,425, patientcannotliesupine,404 postpartumfoodingandcough
442 patterndiferentiation,105 duetobloodstasis,415
panting,103,395,397,400,401, patternofcold-dampnessinthe postpartumheattypediarrhea,492
404,420,432,441,549,550,554, exterior,369 postpartumhemorrhage,478
557,576,606 patternofpiercing,474 postpartumillnesses,386
papule,520,529,530,534,535,536, patternsofyindefciencyfreand postpartumurineretention,475
537,538,544,545 lungwilting,395 preferencefordarkness,497
paranoid-typeschizophrenia,389 PC6,172 pregnancy,474,475,481
paresthesia,113 penetratingthecovering,156 Pre-QinDynastyscience,10
paroxysmaldiscomfort,460 PeonyandLicoriceDecoction,131 pricklingpain,381
partialpyloricobstruction,466 periarthritisoftheshoulderjoints, primalqitheory,8
pathogen,367,397,399,421,450, 381 profusedreaming,383
452,487,500 pericardialefusion,422 profuselochiadischarge,492
pathogenic,506,514,515,529,535, pericarditis,405 profusesweating,434,435,438,497
538,561,562,578,586,588,589, pericardium,61,514,528,529,535, profuseuterinebleeding,500
590,591,597,600,601,609 562 prolongedscantyuterinebleeding,
Pathogeniccold,482 perimenopausalsyndrome,497, 474
GeneralIndex 639
promotebloodcirculation,476 phlegm,495 retchingandvomiting,470

promotingsweatingtoexpelwind, qisurgingupward,432 retchingandvomitingdue
371 qisurgingupwardstothechest,237 tostomachcoldcausingqi
psoriasis,373,392 Qitransformation,29 counterfow,470
pufness,397 QingHuShngShTng,131 retchingcounterfow,489,490
pufyeyes,373 qi-basedmonism,8 retentionoflochia,475
pufyface,434,438 qi-blood,517 reversal,469,470
pufyswollenface,400 Qi-BoostingIntelligenceDecoction, reversalcold,274,328,334,335,
pullingpainbetweentheheartand 52 338,341,342,345,347
back,412 QngZoJiFiTng,131 reversalcoldandnumbness,335
pulmonaryheartdisease,397,410, qi-period,23 reversalcounterfowcoldpattern,
422,425,441,446 QuanYuan-qi,4 191
pulmonarytuberculosis,395 quietnesswithnodesireforfood, reversalsyncope,102
pulse,14,53,54,111,112,114,128, 285 reversetreatment,36,134
184,185 reverse-fow,327
pulsediagnosis,34,111,116,117 R reverse-fowoftheextremities,327
PurgativeDecoction,132 radialartery,116,128 reverse-fowofthelimbs,315
purplenails,487 radialpulseposition,112,113 rheum,402,404,409,410,419,420,
purpleringsaroundhereyes,487 rapidbreath,412 421,422,424,425,449
pyloricinsufciency,425 rectalheaviness,312,334,338,350, rheumaccumulation,409
pyloricobstruction,466 492 rheumaccumulationandqi
redandwhiteloosestools,492 stagnation,409
Q redlips,478 rheuminvadesthestomach,425
qi,399,507,509,510,514,516,517, reddishcomplexion,568 rheumpattern,423
518,519,520,521,522,523,525, reducedappetite,387 rheumaticarthritis,378,381
526,528,529,532,535,536,538, reductionism,21 rheumaticheartdisease,397,410,
539,540,541,542,543,546,550, refusalofanylightorsound,497 412,441,446
551,554,555,560,562,563,564, regulateqi,407 rheumatoidarthritis,163,373,376,
567,572,573,574,575,578,579, relaxtension,209,312,378 381
580,581,584,585,586,587,588, releasetheexterioranddifusethe ribpain,33
589,590,591,592,595,597,598, lung,424 RN12,173
600,601,602,604,605,607,608, releasingdarkness,156 RN14,173
609,611,613 removebloodstasis,476 RN17,61
qiblockage,409 removingclaws,156 RN23,155,157
qicounterfow,409,410,469 renmai,477 rootdefciency,433,434
qidefciency,381,433,434 RnShnYngRngWn,132 rootofpost-heaven,261
QJDHungWn,100 RnShSn,87 rootofthecongenitalconstitution,
qilevel,510,511,512,513,518,524, rnzhng,124 314
529,535,536,538,539,542,548, renaledemaduringpregnancy,438 rottendregs,189
549,550,561,563,580,581,582, repeatedmiscarriage,475 roundwormreversal,340,341,342,
587,589,596,598 requitedneedling,169,170 352
Qimovementtheory,36 ResistanceDecoction,131 rumblingintestines,254,255,257
qirushingupwardtotheheart,190 resolvingdoubt,156 runningpigletdisease,234,235,
qistagnationandchestpaindueto restlessness,86,456,487,498 236
torpidityofyangqiinthechest, restrictedmovement,378
402 retainedfuidpattern,445 S
qistagnationandcongealing retching,465,469,489 saggingsensation,298,351
sallowappearance,461 303 skinwater,440

sallowcomplexion,453 shaoyangpivotmechanism,189 skinwaterdisease,440
sallowyellowfacialcomplexion, shaoyangwindstrike,287 sleepingincurled-upposture,315
387 shaoyangyangming,262 slightsweating,372
snynjio,157 shaoyinkidneychannel,170 slighttwitching,441
sanjiao,45,57,58,60,62,65,66,82, ShaoyinYangConstraintPattern, slippery,511,513,529,531,536,
148,507,509,515,517,518,529, 333 540,556,564,591,596,598,600,
580,581,582,591,594,597,612 ShenNong,6 601
sanjiaopatternidentifcation,509, ShngYngYWiTng,41 smallintestine,45,57,58,60,65,66
518 ShiGuan-qing,50 softtissueinjuryofthechest
sanjiaoqi,518 ShiSong,5 wallandsuppurativecostal
ScallionYang-FreeingDecoction, shxun,124 chondritis,402
50 shiversweating,292 softenhardnessanddissipate
ScallionYang-FreeingDecoction shock,412 concretions,476
withaddedPigGall,50 shootingpain,415 somethingblockedinhisthroat,
scantyandpalemenses,501 shortandrapidbreath,410 495
scantydarkurineanddifculty shortnessofbreath,376,395,398, somethingstuckinherthroat,494
voiding,458 401,403,404,407,409,420,422, somnolence,390
scantyurination,397 471,483,484,487 sorethroat,438
scantyuterinebleeding,477 shortnessofbreathafterexertion, soreness,386
sciatica,168,381 472 sorenessandpain,381
scrofula,168 sh-transportneedling,164,167 sorenessinthelowerbackand
seaofwaterandgrain,112 SNTng,50 coldnessintheknees,431
seasonaldivisions,23 SignsandTreatmentofTetany,184, SP6,157
seminalemission,382,383 185 SP9,161
seminalemission,dreamingofsex, sinewb-obstruction,160,163,169 spasms,105
andheartpalpitations,383 sinewsandjoints,375 spermatorrhea,383
seminalloss,383 sixexternalpathogenicfactors,97, spirit,13,15,26,29,30,32,34,43,
sequelaeofapoplexy,381 98 46,63,84,85,86,97,98,103,104,
sequelaeofstrokeorconcussion, sixjng-channel,185,187,190 119,120,123,124,132,143
487 sixjng-channeldisease,187,188, spiritbrilliance,38,60
sequelaeofviralmeningitis,392 191,192 spiritpoints,30
settletheheart,425 sixjng-channelpattern spiritqi,150
sevenemotions,30,31,144 diferentiation,185,187 spirit-brightness,125,126,314,489
severebloodstasisinpatientswith sixjng-channelpattern spitting,401
fairlystrongconstitutions,487 diferentiationsystem,186,188, spleen,15,45,46,58,60,61,65,66,
severedamp-heatjaundice,456 194 87,88,100,102,126,160,162,
severejointpain,376,378 sixpathogenicfactors,31,33,92, 365,388,391,417,419,420,433,
severepanting,397 101,105 435,438,440,441,448,450,456,
severeswelling,376 sixpathogenicqi,95 462,479,480,485,495,497,500,
sexagenary,36 sixqi,36 502
sexualtaxationjaundice,452,453, SJ17,155,156,157 spleenandstomachdisharmony,
454,462 skindisease,434 451
shakingofthedust,155,156,157 skindiseaseswithyellowfaceand spleenandstomachyang
ShoYoGnCoTng,131 brownmarks,475 defciency,419
shaoyang,66 skindisorders,373 spleendefciency,438,461,466,481
Shaoyangpivotdysfunction,289, skinulcers,168 spleendefciencypattern,462
GeneralIndex 641
spleenqi,435,448,497 stomachfuid,394,521,532,535, sweatsoaking,443

spleenyang,448 536 sweating,370,433,443
spleenyangdefciency,420,441 stomachfuiddamage,533 sweatingfromthehandsandfeet,
spleen-earth,365 stomachheat,520,522,532,533, 189
spleen-stomachdefciencycold, 534,535,549 sweatinglimitedtotheupper
241,310,343 stomachheatexuberance,261 body,444
spontaneousdiarrhea,297,307, stomachpaininearlystomach sweatingonhisheadandface,400
309,313,318,323,421,422 cancer,386 swelling,170,373
spontaneousdiarrheawiththirst, stomachprolapse,386 swellinginthelowerextremities,
318 stomachqi,409,425,454,466,470, 410
spontaneoussweating,188,189, 472 swellinginthelowerlimbs,458
203,211,234,263,265,328,422, stomachqiascendingcounterfow, swellingoftheface,eyes,and
437,487 463 body,396
sporadicfeelingsofobstruction, stomachqidefciency,465 swellingofthelowerextremities,
496 stomachqidisharmony,469,489 411
spotting,500 stomachqireversal,465
spottingduetoyinandblood stomachrefux,465 T
defciency,478 stomachyin,395 tichng,165,167
springwarmth,506,576 stomachyindefciency,395 tix,161,172
sputum,495,496 stomachache,387,388 taiyangbladderchannel,165,453
ST35,161 Stomach-family,263 taiyangchannel,103,127
stabbingpain,488 Stomach-familyexcess,263 taiyangcolddamage,198,210,211,
stabbingpainbehindthesternum, StoraxPill,119 213,215,217,289
412 straightintoneedling,169,170, taiyangjng-channelpattern,192
stagnationofqiandblood,375 171,175 taiyangwaterretention,188
stagnationofyangqi,378 strainedspleen,278,279,280 taiyangwindstrike,198,199,200,
startled,96,97,98 streamingsweating,271 201,202,211,214,215,229
startlement,144 Stream-ReducingPill,127 taiyangwindstrikepattern,196
stasis-typemania,226 stroke,163 taiyangyangming,262
steamingfever,271 stufnessandfullnessofthechest, taiyinwarmdisease,549
steamingheatefusionand 411 taiyinwind-warmth,542
quivering,252 SHXingWn,119 Takayasuarteritis,113
steamingstomachheat,302 succussionsplash,458 tangerine-coloredyellowing,281
stemcounterfow,326 summerheat,94,586 taxation,483
stirringfetus,478 summerheatpathogenicqi,94,95 tendernessinthechest,398
stomach,45,57,58,60,61,65,66, summerheatsyncope,154 tendernesstotouch,474
82,103,104,112,126,172,391, summerheat-warmth,506,543,585 tenesmus,392
395,410,438,449,450,456,462, SuQunWn,127 tenosynovitis,175
463,464,466,467,470,471,485, SupplementtoImportantFormulas tension,497
489,495,500 WorthaThousandGoldPieces,183 tensionandurgencyofthelower
stomachcavity,82 supportyangandfosteryin,315 abdomen,383
stomachcoldqicounterfow,469 sweat,509,510,511,513,524,525, TheArtofWar,12
stomachcoldwithqicounterfow, 529,530,533,538,539,540,541, TheClassicofDifcultIssues,186
469 544,548,549,550,551,570,571, TheImperialBookofChannelsand
stomachdiscomfortofunknown 572,576,579,580,581,585,586, Vessels,25
origin,495 587,589,590,600,601,606,607, TheMoxibustionClassicoftheEleven
stomachdisharmony,432 609,610 FootandArmVessels,7,24
TheMoxibustionClassicoftheEleven thirsty,542,543,548,551,594 qi,isnottreatingitcorrectly,495

YinandYangVessels,7,24 thoracicrheum,423 treatingsimilarconditionswith
TheSpiritualPivotChapter18 threadypulsesonthevergeof diferentmethods,409
GenerationandComingTogetherof expiration,338,345 TreatiseonColdDamage,124,182,
NutritiveandDefensive[Qi],82 threatenedmiscarriage,478 183,184,185,186,192,194
TheSpiritualPivotChapter30 threedepthsofneedling,158 TreatiseonColdDamageand
DiferentiatingQi,77,80 threerealms,20,21,22,159 MiscellaneousDiseases,4,182,
TheSpiritualPivotChapter34Five threesectionsandnineindicators, 183,184
Turmoils,177 34 TreatiseonColdDamageAnnotated
TheSpiritualPivotChapter4 throatcongestion,496 andExplained,184
PathogenicQiandthePathogenic throatdiscomfortduetothe trueorigin,366
FormoftheZangandFuOrgans, presenceofthickstickyphlegm, TrueWarriorDecoction,79
34 395 turbiddampnessinternal
TheSpiritualPivotChapter45 throatitching,547 obstruction,241
ExternalConjectures,10,19 throatwascongested,495 turbidheat,273,275,276
TheSpiritualPivotChapter47Root throbbingandpalpitationofthe turbidpathogen,464
Zang-Organ,29 heart,242 turbidpathogenicqi,468
TheSpiritualPivotChapter55 thromboangitisobliterans,392 turbidyinascendingcounterfow,
CounterfowandFlow,12 tingn,36 307,318,337,349
TheSpiritualPivotChapter7 tinrng,155,156,157 TurtleShellDecoctedPill,131
ApplyingtheNeedles,158,161, tintng,453 TwoYellow,BorneoandIndigo
164,170 tidalfever,189,262,271,273,275, Powder,93
TheSpiritualPivotChapter72 276,279,285
CommunicatingwithHeaven,34 tinea,167 U
TheSpiritualPivotChapter73 tinnitus,52,420,468,483,484 unabletoliefat,481
AppointedAbilities,28 tiredness,98 unabletosleeponherback,481
TheSpiritualPivotChapter TngMiSNTng,50,51 uncontrollableboutsofsorrow,497
75NeedlingtheTrueandthe tonsillitis,438 uncontrolledseminalemission,385
Pathological,155,156 toothacheduetofrefaming undigestedfoodinthevomit,465
TheSpiritualPivotChapter79 upward,467 ungratifyingdefecation,298,303
DiscourseontheDewofthe torpidyangqi,409 uninhibitedurination,225,323,
Seasons,16 toxicswellings,163 324,462
TheSpiritualPivotChapter8Root TraditionalIndianmedicine,20 unremittingsorrow,497
Spirit,85,88 traditionalmedicines,19 upperandlowermiddlejiao,446
TheSystematicClassicofAcupuncture transformationandtransportation, uppergastrointestinalbleeding,
andMoxibustion,3,5 365 468
TheYellowEmperorsInnerClassic,3 transmissionandtransmutation, upperjiao,77,82,96,98,402,409,
thecalcysts,175 191 424,431,514,515,516,517,521,
theoryofqimovement,23 transmutedoraggravateddiseases, 527,528,544,546,551,559,581,
thickfuids,77,78,80 197 587,589,590,591,609,610,612
thinfatwarts,373 transmutedpattern,196,219,220, upperjiaodryness,430
thinfuids,77,80,154 230,281,286 upperjiaoqilevel,528
thinsloppystools,479 transmutedtaiyangpatterns,196, upraisingneedling,169,170,171,
thinninghair,434 219 175
thirst,431,443,458,489 transportneedling,160,161,162, uprightqi,188,189,191,192,375
thirstandhunger,428,429 163 upwardcarryingofyang,50
thirstwithprofusedrinking,431 treatingphlegmwithouttreating uremia,441
GeneralIndex 643
uremiainnephritis,425 395,409,420,425,462,463,464, 254

uremicedema,422 465,466,467,468,470,471,495 water-qisurgingupward,237
ureteralcalculi,417 vomitingintheeveningoffood water-rheum,217,221,237,254,
urgencyandpain,388 eateninthemorning,465 255,289,299,300,323,324,422,
urgencyofthebladder,453 vomitinginthemorningoffood 447
urinaryretention,140 eatenintheevening,465 water-rheumandfoodstagnation,
urinarytractinfection,127 254,255
urticaria,67,370 W water-rheumcollectinginternally,
uterinebleeding,477,478,479 waisting-thirst,338,339,340 217,218,333
uterinefbroids,392,475 WnShNiHungQngXnWn, water-rheumcollectsinternally,
uterinehypoplasia,501 90 300,324
uterus,58,453,500 wanderingpain,444 water-rheuminthechestand
wanderingpaininthejoints,371 diaphgram,252
V WangAn-dao,507 waxingandwaningofyinand
vaginalbleeding,474,478 WangBing,4 yang,191
vaginalbleedingduringpregnancy, WangShu-he,4 weakconstitutions,471
475,478,479 warmdisease,186,195,506,507, weakness,465,498
vaginaluterinebleeding,478 509,511,514,515,520,522,532, weaknessandsorenessinthewaist
vertigo,52,420 536,539,542,544,546,548,550, andknees,428
vesicularmoles,392 552,558,563,566,569,571,576, wei,378,443,451,507,509,511,512,
vesselb-obstruction,113 578,580,582,586,589,590,591, 514,533,542,543,544,561,588,
vessels,77,80,87,114 593,612 607
vestibularneuritis,425 warmdiseasepathogenicqi,506 weiexteriorinsecurity,438
vexation,373,388,389,390,444, warmepidemic,542,543,568 weilevel,510,511,538,539,542,
485,487,489,490,497,498 warmmalaria,543 543,544,588
vexationandgeneralizedpain,369 warmthechannels,376 weiqi,88,95,381,439,440,441,
vexed,498 warmtoxin,506,543,558,568 453,511,514,533
vexingfeeling,456 warm-damp,186 weiqidefciency,433,437
vexingheat,386 warm-febrile,542,543 wish,173
vexingheatoftheextremities,385 warm-febriledisease,539,561 weiyang,435,437,441,444
vexinghungerwithoutappetite, warmingtheearthtocontrolwater, Wei-Qi-Ying-Bloodlevel,509
388 417 wei-yang,195,198
vexingpain,285,292,293 washingthemouthwithwater welling-abscessofthelung,396
viralmyocarditis,425 withoutdesiretoswallowit,395 welling-abscesses,484,485
visceralagitation,490,497 wasting-thirst,190,220,427 Westernmedicine,20
visceralagitationduetodual wateramassment,220,221,339, wheezing,103,156,157,162,422
defciencyoftheheartand 340 WhiteTigerDecoction,117,130
spleen,497 waterandheatbinding,332,333 WhiteTigerDecoctionPlus
visceralbind,189 waterandheatbindingtogether, Ginseng,154
visceralbindpattern,191 332 White-DrainingPowderwith
visualhallucinations,497 watercounterfow,220,221 Puerariae,67
vividdreaming,86 waterqidiseases,441 whoopingcough,395,399
volvulusofstomachand waterrheum,78,430 wind,92,95,100,101,102,104,370,
conception,466 waterstagnation,433 373
vomit,466,511,519,540,554,555, water-qi,216,217,238,254,255, windb,380,381
566,610,613 323,324,332 winddampness,434
vomiting,58,103,104,121,378, water-qibelowtherib-sides,253, windheat,92
windstrike,186,188,193,195,196, yangpathogenicqi,102,158 yinandyang,8,26,27,28,29,34,

197,198,199,211,220,221,256, yangqi,41,47,49,52,93,94,102, 35,36,38,40,46
288,289,291 104,114,125,151,404,412,417, yinandyangdualdefciency,387
windstrikepattern,195,202,204 421,430 yinblood,532
windwater,432,434,436 yangqiblockage,404 yincoldexuberance,326
wind-cold,195,196,197,198,201, yangqidefciency,402 yindefciency,492
204,205,210,211,213,215,217, yangqiinthechest,402 yinessence,47,49,52
218,319 yangqiofthechest,401 yinjaundice,462
wind-coldexteriorpattern,369 YangShang-shan,4 ynlngqun,161
wind-cold-damp,376 YngXunShnWn,87 yinneedling,170,172,176
wind-damp,375 yangyellowing,282 yinpathogen,412
wind-dampexteriorexcessb yangming,500,527,532,536,548, yinpathogenicqi,95,158,586
pattern,373 549,550,568,579,582 yinqi,49,102,114
wind-dampexteriorpattern,433 yangmingabdominalmasspattern, Yntuhn,382
Wind-dampness,372,375 189 YinYangandtheFivePhases,26
wind-warmth,506,538,539,542, Yangmingbowelexcess,275,276 yin-blood,390
543,545,546,547,549,568 yangmingbowelexcesspatterns, yin-cold,538
wind-warmthcough,547 273 yin-coldcongealingandbinding,
wind-water,432,433,437,443 yangmingdamp-heat,452,453 412
wind-watertypeedema,373 yangmingexcesspatterns,262,277 yin-coldexuberance,315,318,327
winterwarmth,542,543,568 yangmingfu-organpattern,552 yin-fuid,579
witheredcomplexion,388 yangmingfu-organsolid-mass,552 ying,381,443,451,507,509,510,
womanspouch,57 yangminginteriorexcess,272,285, 528,529,530,534,536,542,544,
worry,97,98,144 286,295 560,563,564,566,581,582
WuJu-tong,544,547,552,586 yangminginternalheat-mass yingandwei,381
WLngSn,132 disease,193 yingblood,528,562
WPYn,79 yangmingqi,452 yinglevel,510,512,513,528,529,
WuYou-ke,523,592 yangmingstomachheat,532,538 536,560,561,562,563,566
yangmingwarmdisease,551 yingqi,82,92
X Yang-RaisingandStomach- ying,wei,qi,andblood,380
xyn,161 BoostingDecoction,41 Ying-BloodLevel,542
XingShYngWiWn,449 Yang-SupplementingandFive- ying-yin,388
xiok,190,430,431 ReturningDecoction,132 yin-humorexhaustion,328
XiHungSn,157 YeTian-shi,510,526,532,563,566 yin-yang,517
xnsh,173 YellowEmperor,3 YuJia-yan,540,543,555
xngjin,165,167 yellowsweatdisease,442,443,444
XuFeng,159 yellow-coloredskin,458 Z
Yellow-DrainingPowder zang,17,50,52,61,63,74,112,120,
Y yellowing,461 148,164
yangconstraint,215,334,335 YJng,159 zang-fu,517
yangconstraintwithreversal,315 YQCngMngTng,52 zang-fuorgan,31,33,54,118,153,
yangdefciency,376,380,386 yin,506,516,517,519,520,522,524, 167,173,176
Yangdefciencycold 527,528,532,533,538,541,542, zang-fuorgans,15,18,26,27,28,30,
transformation,315 546,550,551,552,563,566,567, 32,33,34,62,63,78,88,89,104,
yangdefciencyrheum-collection, 569,570,571,572,574,575,576, 111,119,143,144
324 577,578,579,580,582,589,590, zang-organs,15,27,28,30,46,53,
ynglngqun,121,161 602,606,607 58,120,123,148,156,167
GeneralIndex 645
zhsi,93 ZhnWTng,79 zhngf,173

ZhangJie-bin,11 zhngji,131 zhngwn,173
ZhangZhong-jing,4,50,51,475, zhengyangyangming,262 ZhShnShnWn,132
503 ZhZhTng,449
Notes

646
Notes

647
Notes

648
Notes

649
ProjectEditors:XuQian-qian,ZhouLingLiuShui
CopyEditor:HarryLardner
BookDesigner:GuoMiaoZhangYa-nan
CoverDesigner:GuoMiaoZhangYa-nan
Typesetter:ShanSi
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InternationalStandardLibraryofChineseMedicine

Chinese Medical Classics:

Chinese Medical Classics:

CIP 2014 099198

Book Title: ChineseMedicalClassics:SelectedReadings(InternationalStandard

Copyright 2014 by Peoples Medical Publishing House. Allrightsreserved.No

Dr. Chen Ming, MD, Ph.D., professor and doctorate

Paul Francis Ryan trained and practiced Chinese

Pa u l F. R y a n , M . S . D i p l . O M , L . Ac . ( N Y, Martin Schweizer, Ph.D. Molecular Biology,

The series is designed for Chinese medicine (CM) education in English-speaking

Volume OneSelected Readings from The

Volume TwoSelected Readings from

Volume ThreeSelected Readings from

Volume FourSelected Readings from

Glossary. .................................................................................................................. 615

AppendixMeasurements in the Essentials

General Index.................................................................................................... 627

Formation, Revisions, and Development of the Inner Classic

Chronology of Its Formation

Revisions and Development

The Basic Theoretical System of Thought in the Inner Classic

Formation of the Theoretical System in the Inner Classic

different diseases. In 1973, at the Mawangdui archeological dig 1 in Changsha,

The Construction of Chinese Medicine Theory

(SWn-B Zhng Shn Mng Ln, ) 1 there is a wonderful section

ordinary.Inthis regard, by comparison to a state of health, illness isunusual, while

Special Characteristics of the Theory Found in the Inner Classic

The Scholarly Value of the Inner Classic

That said, however, one needs to see howreductionism andmind-body

calendar science, meteorology, biology, geology, psychology and philosophy.The

Theoretical Content of the Inner Classic

Yin Yang and the Five Phases

problem.Forexample,in TheSpiritualPivotChapter73AppointedAbilities itsays:

Organ Manifestation Theory

Blood, Qi, Essence, and Spirit

Etiology and Pathodynamics

Principles and Methods of Treatment

yang. Elimination of disease pathogenic qi involves working with the forces of

The Five Movements and the Six Qi

clarity.When clear qi is below, it generates diarrhea with undigested food.When

dngshn 15g RadixCodonopsis

flng 15g Poria

1 Thecharacter orderin thesourcetext ismale andfemale;logically,however,itshouldbefemaleand

bisho 15g RadixPaeoniaeAlba

guzh 12g RamulusCinnamomi

bisho 30g RadixPaeoniaeAlba

gnco 10g RadixetRhizomaGlycyrrhizae

cchih 10g RadixBupleuri(vinegar-fried)

dnggu 10g RadixAngelicaeSinensis

xunh 20g RhizomaCorydalis

xingf 10g RhizomaCyperi

chunxing 10g RhizomaChuanxiong

hup 10g CortexMagnoliaeOfcinalis

zhsh 15g FructusAurantiiImmaturus

dnshn 10g RadixetRhizomaSalviaeMiltiorrhizae

yjn 10g RadixCurcumae

fxiomi 30g FructusTriticiLevis

dzo 6pcs FructusJujubae

ggn nodosageindicated RadixPuerariaeLobatae

moving and transforming qi of the spleen-stomach enables food to be transformed

yjiotng 18g CaulisPolygoniMultifori

zhnzhm 30g ConchaMargaritiferaeUsta

ggn 30g RadixPuerariaeLobatae

Book Title: ChineseMedicalClassics:SelectedReadings(InternationalStandard

Volume OneSelected Readings from The

Volume TwoSelected Readings from

Volume ThreeSelected Readings from

Volume FourSelected Readings from

AppendixMeasurements in the Essentials