Author: eraneven

Péng Zǐyì’s – Circular Movements in Ancient Chinese Medicine

On By eranevenIn Péng Zǐyì [彭子益], Theory (理论), Translations & Writings (译著与文章)

The following is a translation from Péng Zǐyì’s [彭子益] incredible ‘Circular Movements in Ancient Chinese Medicine 圆运动的古中医学

二十四节气圆运动简明图说

欲学中医须先认识十二经名词的所以然。欲认识名词，须先认识阴阳五行六气的所以然。欲认识阴阳五行六气，须先认识二十四节气地面上所受太阳射到的热降沉浮的圆运动。右下左上中，降沉升浮中，秋冬春夏中，西北东南中。图的虚线为地面，虚线下为地面下，虚线上为地面上。

To learn Chinese medicine, one must first understand the terminology of the twelve channels. To understand these terms, one must first grasp the principles behind yin and yang, the five phases, and the six qi [atmospheric influences]. To understand these, one must first become familiar with the circular movement of the heat that reaches the earth’s surface from the sun during the twenty-four solar terms. This movement encompasses the directions of right, bottom, left, top, and center; descending, sinking, ascending, and floating; autumn, winter, spring, and summer; and northwest, southeast, and other compass points. In the diagram [shown below], the dashed line represents the earth’s surface; below it is below ground, and above it is above ground.

图的圆线上方在云层之际，图的中心，为一个生物的环境的大气圆运动的中心。由中心以观察四维，便见一个生物所在地的宇宙范围，图的中心的中字，便是一个读者。降者，夏时太阳射到地面的热，降入土中也。沉者，降入土中的热沉入土下之水中也。升者沉入水中的热升出土上也。浮者，升出土上的热又与夏时太阳射到地面的热，同浮于地面之上也。中者，降沉升浮之中位也。

The upper part of the circle in the diagram represents the clouds, while the center represents the center of the circular atmospheric movement of a living environment. By observing from this center, one can see the universal scope of a living being’s habitat. The “center” character in the diagram signifies the reader. “Descending” refers to the heat that the sun emits to the ground during summer, which sinks into the earth. “Sinking” means this heat descends into the water beneath the earth. “Ascending” refers to the heat rising from below the earth to above the surface. “Floating” refers to this heat, which rises above the ground and coexists with the summer sun’s heat. “Center” represents the middle position among descending, sinking, ascending, and floating.

立秋为降之起点，立冬为沉之起点，立春为升之起点，立夏为浮之起点。秋分前，土上热多，土下热少。秋分则土上与土下的热平分也。春分前，土下热多，土上热少。春分则土上土下的热平分也。冬至者，由立秋降入土下的热，多至极也。夏至者，由立春升出地上的热，多至极也。降极则升，升极则降，升降不已，则生中力。亦大气圆运动自然之事也。

The point of descent begins at the start of autumn, the point of sinking begins at the start of winter, the point of ascent begins at the start of spring, and the point of floating begins at the start of summer. Before the autumn equinox, there is more heat above the ground than below. At the autumn equinox, the heat is balanced between above and below the ground. Before the spring equinox, there is more heat below the ground than above. At the spring equinox, the heat is again balanced between above and below. The winter solstice marks the peak of heat that has descended beneath the earth from the start of autumn. The summer solstice marks the peak of heat that has risen above the ground from the start of spring. When descending reaches its peak, ascending begins, and vice versa. This continuous rise and fall generate life force and are natural phenomena of the atmospheric circular movement.

植物经秋而叶落，植物个体的热下降也。经冬而添根，植物个体的热下沉也。经春而生发，植物个体的热上升也。经夏而茂长，植物个体的热上浮也。热的降沉升浮于植物个体求之最易明了。说植物个体的热的降、沉、升、浮，即是说宇宙大气的热的降沉升浮，即是说人身的热的降沉升浮。图的虚线，在宇宙为地面之际，在人身为胸下脐上之间。在脐上二寸。热性本来升浮，不能沉降，热之沉降，秋气收敛之力降沉之也。热降，为生物有生之始；热不降，为生物致死之因。详下各篇。秋气收敛详下文。

In plants, leaves fall in autumn, indicating the descent of heat within the plant. Roots grow in winter, indicating the sinking of heat within the plant. Budding in spring shows the rising of heat, while thriving growth in summer shows the floating of heat. Observing the descending, sinking, ascending, and floating of heat in plants makes this concept easy to understand.

Discussing the descending, sinking, ascending, and floating of heat in plants is akin to discussing the heat’s behaviour in the atmosphere and, ultimately, within the human body. The dashed line in the diagram represents the ground in the universe and corresponds to the space between the chest and navel in the human body, specifically two inches above the navel. Heat naturally ascends and floats and does not descend or sink by itself. The force of autumn’s energy gathering leads to the descent and sinking of heat. Heat descending marks the beginning of life for living beings; if heat does not descend, it can lead to death. More details on the autumn energy gathering will be elaborated on in subsequent sections.

阴阳

一个生物所在之地，太阳射到此地面之光热，就是阳。此地面的光热已过，与光热未来之间，就是阴（伏羲画卦，—为阳卦、––为阴卦其义即此）阳性上澎，阴性下压。阳性直上，阴性直下。阴阳交合，发生爱力，彼此相随，遂成一个圆运动。阳性动，阴性静。静则沉，动则浮。

Yin and Yang

In the place where a living being resides, the sunlight that reaches and warms the ground represents yang. The period when this light and heat have passed and the new light has not yet arrived is called yin (as depicted by Fuxi in the trigrams: “—” for the yang trigram and “– –“ for the yin trigram, symbolizing this very principle). Yang naturally rises and expands, while yin naturally descends and compresses. The movement of yang is upward, while the movement of yin is downward. When yin and yang interact, they create a force of attraction, following one another and forming a circular movement.

The nature of Yang is movement, while the nature of yin is stillness. Stillness leads to sinking, while movement leads to floating.  

由静而动则升，由动而静则降。升浮降沉一周，则生中气。中气者，生物之生命也。此大气的圆运动之所由来，亦即造化个体之所由成就。人秉造化阴阳圆运动之大气以有生。人的个体，即造化个体的遗传。先认识造化大气的阴阳，自能认识人体的阴阳。五行者，阴阳二气整个升浮降沉中的五种物质。行，即运动也。生物个体，皆有阴性阳性者，大气中有阴阳故也。此中医阴阳二字之来源也。造化二字，乃宇宙大气圆运动时，生育生物之称，亦即宇宙之称。

The transition from stillness to movement results in rising, and the transition from movement to stillness results in descending. The cycle of ascending, floating, descending, and sinking completes a round of movement, which generates centre qi. This centre qi is [the essence] of life in living beings. This is the origin of the circular movement of the atmosphere and the fundamental process through which individual beings are formed. Humans are endowed with life through the circular movement of yin and yang in the atmosphere. The human body is an inheritance of this cosmic individual creation.

By first understanding the yin and yang of the cosmic atmosphere, one can naturally understand yin and yang within the human body. The Five phases (Wood, Fire, Earth, Metal, Water) represent the five types of material present within the entire cycle of ascending, floating, descending, and sinking of yin and yang energies. [The Chinese term] xing (行) [translated as phases] implies movement.

All living beings possess both yin and yang natures because the atmosphere contains these forces. This explains the origin of the terms yin and yang in Chinese medicine. The concept of creation (造化) refers to the universal atmospheric movement that nurtures living beings and can also be seen as another name for the cosmos itself.

五行

一年的大气，夏气属火，太阳射到地面的热多。太阳射到地面的热，火也。热则上浮，故夏时大气热浮而属火气。夏时太阳旺于南方，故南方属火气。一日之午时，亦属火气。午时太阳的热，射到地面的多也。春分至立夏的热，称为君火。小满至小暑的热，称为相火。君相二字之义详见下文。

The Five Phases

The atmospheric conditions throughout the year align with the Five Phases. During summer, the atmosphere corresponds to fire, as the heat from the sun reaching the ground is at its peak. This heat is associated with fire. Since heat rises, the summer atmosphere is characterized by heat that floats upward, thus being classified as fire qi. In summer, the sun is at its strongest in the south, which is why the south is associated with fire qi. The noontime of a day is also linked to fire qi because the sun’s heat is most intense at this time.

The period from the spring equinox to the start of summer is called Sovereign [or Imperial] Fire (君火), while the period from Lesser Fullness of Grain (小满) to Lesser Summer-Heat (小暑) is called Ministerial Fire (相火). The meanings of Sovereign Fire and Ministerial Fire will be explained in more detail later.

秋气属金，秋时太阳往南，地面的压力渐大，天空之间，金气弥漫，大气的压力，即金气之下降也。天空的金气，至秋始显，故秋时大气凉降而属金气。造化之气，东升西降，降气旺于西方，故西方属金气。一日之酉时，亦属金气，酉时金气凉降之力独大也。天空之间，指地面之上言。金气详宇宙篇气象学的证明。

Metal is associated with autumn. During this time, the sun shifts southward, increasing pressure on the earth’s surface, and metal qi permeates the sky, signifying the descent of atmospheric pressure. The presence of metal qi in the sky becomes evident in autumn, leading to a cool and descending atmosphere that characterizes autumn as metal qi. The qi of creation (造化之气) rises in the east and descends in the west, with descending energy being most potent in the west, which is why the west is linked to metal qi. The hour of Yǒu (酉时, around 5-7 p.m.) is also associated with metal qi, as its cooling and descending force is most significant at this time.

[The term] “between the sky” refers to the space above the earth’s surface. The nature and behaviour of metal qi will be detailed further in the meteorological proofs found in the section on cosmology.

冬气属水。生物的生命，全是太阳射到地面的热所产生。今夏太阳射到地面的火热，即是来年生物生命之根。然此火热，必须经过秋时降入土下，经过冬时，藏于土下的水中，然后能生生物的生命。冬时大气沉而能藏，沉而能藏者水也。大气热则上浮，寒则下沉。故冬时大气，寒沉而属水气。南方在地面之上，北方在地面之下，故北方属水气。一日之子时，亦属水气。子时，大气沉极之时也。关于生物生命的宇宙，是上南下北。大气上浮之方为南，下沉之方为北。

Winter qi corresponds to water. The life of living beings is entirely dependent on the heat from the sun reaching the earth. The heat from the sun in the summer becomes the root of life for the following year. However, this fiery heat must descend into the earth during autumn and be stored in the water beneath the earth during winter before it can nourish life. In winter, the atmosphere sinks and has the ability to preserve; this ability to sink and preserve is characteristic of water. Warm air rises, while cold air sinks, so in winter, the atmosphere sinks due to coldness and is associated with water qi. The south is considered above the ground, while the north is considered below the ground; thus, the north is associated with water qi. The hour of Zǐ (子时, around 11 p.m. to 1 a.m.) is also linked to water qi as it marks the peak of atmospheric sinking. In the cosmic framework of life, the south is above and the north is below, with the direction of atmospheric ascent being southward and descent being northward.

春气属木。一年的大气圆运动，冬时为终，春时为始，终即始之根也。上年夏时，太阳射到地面之热，经秋时金气收而降于土下，又经冬时藏于土下的水中。火水化合，水气温暖，则往上升。此温暖之气，交春升泄出土，草木发生，故属木气。木者水中火气，由封藏而升泄之气也。

Spring qi corresponds to wood. The annual circular movement of the atmosphere ends in winter and begins anew in spring, with the end serving as the root of the beginning. The heat absorbed by the ground during the previous summer is collected by metal qi in autumn and descends into the earth, where it is stored within the water during winter. The fusion of fire and water produces warm water qi, which rises. This warmth rises during spring, breaking through the soil and initiating the growth of vegetation, thus corresponding to wood qi. Wood represents the ascending release of fiery energy from water, emerging from dormancy into activity.

中气属土。一年的大气，春升，夏浮，秋降，冬沉。故春气属木，夏气属火，秋气属金，冬气属水。升浮降沉，运动一周，而为一岁。夏秋之间，为圆运动的中气。地面的土气，居升浮降沉之中，为大气升降的交合，故中气属土气。金水木火土，大气圆运动之物质也。行，运动也。

此中医五行二字之来源也。故人身亦有春夏秋冬，亦有东南西北。

Center qi corresponds to earth. Throughout the year, the atmosphere follows the cycle of rising in spring, floating in summer, descending in autumn, and sinking in winter. Therefore, spring qi corresponds to wood, summer qi to fire, autumn qi to metal, and winter qi to water. The complete cycle of rising, floating, descending, and sinking forms a full year. Between summer and autumn lies the central qi, which is associated with the earth. The earth qi of the ground mediates the interactions of rising, floating, descending, and sinking in the atmosphere, making it the center of these transitions. Thus, central qi belongs to the earth phase. The five phases—metal, water, wood, fire, and earth—are materials within the circular movement of the atmosphere. [The Chinese term] xing (行) implies movement.

This is the origin of the term Five phases in Chinese medicine. Correspondingly, the human body experiences its own version of spring, summer, autumn, and winter, as well as its own directions of east, south, west, and north.

五行相生相克

五行物质，各有能力。木气有疏泄能力，火气有宣通能力，金气有收敛能力，水气有封藏能力，土气有运化能力，能力亦称势力，亦称作用。

春气由冬气而来，故曰水生木。夏气由春气而来，故曰木生火。长夏之气由夏气而来，故曰火生土。秋气由长夏之气而来，故曰土生金。冬气由秋气而来，故曰金生水。夏秋之间为长夏。

Mutual Generation and Control of the Five Phases

Each of the five phase substances possesses its own unique ability. Wood qi has the ability to course and discharge, fire qi perfuses, metal qi constrains, water qi stores and conceals, and earth qi transports and transforms. These abilities are also referred to as forces as well as functions.

The movement of spring qi comes from winter, hence it is said, “Water generates wood.” Summer qi follows spring, so “Wood generates fire.” The qi of late [or long] summer follows summer, so “Fire generates earth.” Autumn qi comes from the energy of late summer, hence “Earth generates metal.” Finally, winter qi comes from autumn, so “Metal generates water.” The transitional period between summer and autumn is called late summer.

收敛作用，制疏泄作用，故曰金克木。宣通作用制收敛作用，故曰火克金。封藏作用制宣通作用，故曰水克火。运化作用，制封藏作用，故曰土克水。疏泄作用制运化作用，故曰木克土。运化者，运动化合也。宣通者，宣热通散也。土克水者，土能伤水分也。

The collecting function of metal restricts the coursing and discharging function of wood, therefore it is said that “Metal controls wood.” The perfusing function of fire restricts the constraining function of metal, so “Fire controls metal.” The storing function of water restricts the perfusing function of fire, so “Water controls fire.” The transporting and transforming function of earth restricts the storing function of water, so “Earth controls water.” The coursing and discharging function of wood restricts the transporting and transforming function of earth, so “Wood controls earth.” [The term] yunhua 运化 refers to transportation and transformation, involving movement and integration. [The term] xuantong 宣通refers to the perfusion of heat, enabling its circulation and dispersal. Earth controlling water refers to its ability to reduce [or contain] water.

相生者，大气圆运动次序的先后。相克者，大气圆运动对待的平衡。相生者，补其不足。相克者，制其太过。相生相克，皆圆运动自身维持自身运动之圆而已。天人之气，和平则无病。运动圆则和平，亦和平则运动圆。相生则生，相克则平。相生相克者，中医学的生理、病理、医理之事也。一年的五行圆运动，要归纳一日看。一日的五行圆运动，要归纳一息看。一呼一吸则大气升降于人身，成一整个也。天人的天字，乃整个造化的简称。

Mutual generation represents the sequential order of the circular movement of atmospheric energy, while mutual control represents the balancing mechanism within this movement. Mutual generation supplements what is lacking, while mutual control prevents excess. Both mutual generation and control are ways in which the circular movement maintains its continuity and balance. When the qi of heaven and humanity are in harmony, there is no disease. Balanced circular movement brings peace, and peace maintains circular movement. Mutual generation promotes life, while mutual control ensures balance. These concepts form the basis of physiology, pathology, and treatment in Chinese medicine.

The annual cycle of the five-phase circular movement can be reflected in a single day, and the daily cycle can be further simplified to one breath. Each breath, encompassing one inhalation and exhalation, mirrors the rising and descending of atmospheric energy within the human body, forming a complete cycle. The term “heaven” in “heaven and humanity” refers to the entirety of nature’s creation.

六气

一年大气的圆运动。春木主生，夏火主长，秋金主收，冬水主藏，中土主化。生、长、收、藏、化，五行圆运动之成功也。六气者，风、热、暑、湿、燥、寒。乃五行运动不圆，作用偏见之气。五行各一，惟火有二，故曰六气。

Six Qi

The circular movement of atmospheric energy over a year follows a pattern where spring is governed by wood, signifying growth; summer by fire, signifying development; autumn by metal, signifying collection; winter by water, signifying storage; and centre earth signifying transformation. These five phases—growth, development, collection, storage, and transformation—represent the successful completion of the five-phase cycle.

The six qi are wind, heat, summer heat, dampness, dryness, and cold. They arise when the five-phase cycle is disrupted, reflecting an imbalance in the natural influences. While each phase corresponds to one of the five qi, fire has two variations, resulting in six distinct forms of qi.

君火运行，重在上升。相火运行，重在下降。相火由秋降入水中，再由春升上，乃为君火。而君火又随相火下降，名曰五行，其实六行。因六气各有事实，故又曰六行六气。

Sovereign fire operates with an emphasis on upward movement, while ministerial fire focuses on downward movement. Ministerial fire descends into the water during autumn and rises again during spring to become sovereign fire. Meanwhile, sovereign fire follows the ministerial fire downward. This is termed the five phases, but in fact, it is a system of six phases. Since each of the six qi has its own functional role and observable phenomena, the concept is also known as the six phases and six qi.

六行六气，是融合极密，分析不开，和平不偏的圆运动。木气偏见，则病风。君火之气偏见则病热。相火偏见，则病暑。金气偏见，则病燥。水气偏见，则病寒。土气偏见，则病湿。故六气名目，而有厥阴风木，少阴君火，少阳相火，太阴湿土，阳明燥金，太阳寒水之称也。

The six phases and six qi form a deeply integrated, inseparable, balanced circular motion that maintains harmony without bias.

  • When wood qi deviates, it leads to wind diseases.
  • When sovereign fire qi deviates, it causes heat diseases.
  • When ministerial fire qi deviates, it leads to summer heat diseases.
  • When metal qi deviates, it results in dryness diseases.
  • When water qi deviates, it causes cold diseases.
  • When earth qi deviates, it leads to dampness diseases.

Thus, the six types of qi are also known by specific terms:

  • Jueyin Wind Wood (厥阴风木)
  • Shaoyin Sovereign Fire (少阴君火)
  • Shaoyang Ministerial Fire (少阳相火)
  • Taiyin Damp Earth (太阴湿土)
  • Yangming Dry Metal (阳明燥金)
  • Taiyang Cold Water (太阳寒水)

《内经》谓在地为五行，在天为六气，在事实上，说不过去。此即五行图，加一相火，名曰五行六气，其实六行六气。阳升阴降，自然之事。阴性本降，三阴之升，阴中有阳也。阳性本升，三阳之降，阳中有阴也。

In the Inner Classic (Huangdi Neijing), it is said: “On Earth, there are the Five Phases; in Heaven, there are the Six Qi.” However, this explanation alone is insufficient. The addition of ministerial fire (相火) to the Five Phases, referred to as the Five Phases and Six Qi, in fact [should be] the Six Phases and Six Qi.

The natural pattern involves the ascending of yang and the descending of yin. The intrinsic nature of yin is to descend, but the ascending of the three yin indicates the presence of yang within yin.

The intrinsic nature of yang is to ascend, yet the descent of the three yang indicates the presence of yin within yang.

金木水火，分主四维。相火土气，同主中宫。中宫在地面之际，四维距地面较远。六行六气的圆运动，四节一气。

The phases—metal, wood, water, and fire—preside over the four cardinal directions, while ministerial fire and earth qi co-govern the central palace. The central palace corresponds to the surface of the Earth, while the four cardinal directions are more distant from the Earth. The circular motion of the Six Movements and Six Qi follows the sequence of four nodes for each qi phase:

大寒、立春、雨水、惊蛰属初之气。春分、清明、谷雨、立夏属二之气。小满、芒种、夏至、小暑属三之气。大暑、立秋、处暑、白露属四之气。秋分、寒露、霜降、立冬属五之气。小雪、大雪、冬至、小寒属六之气。

The Major Cold (大寒), Beginning of Spring (立春), Rain Water (雨水), and Awakening of Insects (惊蛰) correspond to the initial qi [period]. 

The second qi [period] corresponds to Spring Equinox (春分), Pure Brightness (清明), Grain Rain (谷雨), and Beginning of Summer (立夏). 

The third qi [period] includes Lesser Fullness of Grain (小满), Grain in Ear (芒种), Summer Solstice (夏至), and Lesser Heat (小暑). 

The fourth qi [period] encompasses Greater Heat (大暑), Beginning of Autumn (立秋), End of Heat (处暑), and White Dew (白露). 

The fifth qi [period] includes Autumn Equinox (秋分), Cold Dew (寒露), Frost’s Descent (霜降), and Beginning of Winter (立冬). 

Finally, the sixth qi [period] covers Lesser Snow (小雪), Greater Snow (大雪), Winter Solstice (冬至), and Lesser Cold (小寒).

此时令病发生之根源也。圆运动的天人一气，时令病上，最为显着。内伤杂病，亦属六气，特不似时令病关系生死之速耳。因时令病，乃整个六气分散，中气消灭极易，故死甚速也。

These [divisions of the qi periods] mark the root and source of seasonal illnesses. The circular movement of qi that unifies heaven and humanity is most apparent in these seasonal diseases. While internal damage and complex diseases also relate to the Six Qi, they do not generally lead to the same rapid consequences as seasonal diseases. Seasonal illnesses are caused by the disruption of the six qi, which easily leads to the depletion of central qi, resulting in rapid fatality, due to the easy dissipation of qi balance when influenced by the changing seasons.

地面上属阳，地面下属阴。初气之时，大气由寒而温。地下水中所封藏经秋收来的阳热，动而上升。此阳热与水化合，是为木气。木气者，一年之阳根也。大寒节气，当阴极之时，故称厥阴。厥者，极也。木气主动，动而不通，则成风。故称厥阴风木。

The surface of the Earth is associated with yang, while below the surface is associated with yin. During the initial qi period, the overall climate transitions from cold to warm. The yang heat stored in underground water during autumn begins to rise in early spring, combining with water to generate wood qi. This wood qi represents the source of yang for the entire year. The solar term Major Cold (大寒) marks the extreme of yin, hence it is referred to as Jueyin (厥阴), with “jue” meaning “extreme.” Wood qi governs movement, and if is impeded, it will generate wind. As such, this is referred to as Jueyin Wind-Wood (厥阴风木).

二之气，亦从地下阴位升出地面，即木气上升之气也。此时大气较热，不似厥阴之阴极，故称少阴。木气上升之气，即水中气藏上年秋时下降的阳气。此阳气，由地下升至地上，照临大宇，光明四达，上升之象，有如君位，故称君火。此时大气由温而热，又称热火。

The second qi [period] arises from the underground yin position and manifests as the upward rising of wood qi. At this time, the atmosphere is relatively warm, not reaching the extreme of yin as seen in Jueyin, thus it is referred to as Shao [lesser] yin (少阴). The upward rising of wood qi represents the yang qi stored in water, which descended during the autumn of the previous year. This yang qi rises from the ground to the surface, illuminating the vast universe and spreading its brightness, which resembles the behavior of the sovereign; therefore, it is called Sovereign fire (君火). At this point, the atmosphere transitions from warm to hot, also referred to as heat-fire (热火). 

少阳相火三气之时，地面上阳热盛满。经暮夜大气之凉降，降入地面下之水中。然当暑热上腾之时，旋降旋升。地下水中，为生物生命之所从出。此阳热实为生命之本，地面上阳热盛满，地而下所得阳热不多，故称少阳。此阳热降入地下水中，以生中气。中气旋转，则上下交清，有如相臣之职，故称相火。此火不降，暑热熏蒸，又称暑火。

During the third qi period of Shaoyang (少阳) and Ministerial Fire (相火), the surface of the Earth is filled with abundant yang heat. As the coolness of night descends, this cool air moves down into the underground water. However, when the summer heat rises, it alternates between descending and ascending. The water underground serves as the foundation for life. This yang heat is fundamentally the source of life; with the surface having an abundance of yang heat and the underground having less, it is termed Shao [lesser] yang. This yang heat descends into the underground water in order to generate central qi. When the central qi rotates, it creates a harmonious balance between the upper and lower realms, much like the role of a minister, hence it is called Ministerial Fire. This fire does not descend, and when the summer heat lingers, it is also referred to as Summer-Heat Fire.

太阴湿土四气之时，地面上阳热盛满。地面下旧有的阳气，亦升上来。地面上非常之热，地面下非常之寒。热属阳，寒属阴。大气阴多，故称太阴。为在水下则生气，火在水上则生湿。此时地面上阳热盛满，尚未降入土下。寒热相逼，湿气濡滋。土气在升降之交，故称湿土。

During the fourth qi period of Taiyin damp earth, the surface of the ground is filled with abundant yang heat. The previously stored yang energy from below the surface also rises up. The surface experiences extreme heat, while underground, it remains extremely cold. Heat is associated with yang, and cold is associated with yin. Since there is an excess of yin in the atmosphere, it is referred to as Tai [greater] yin. In water, there is qi; when fire is above water, it generates dampness. At this time, the surface is filled with yang heat that has yet to descend into the earth. The clash of heat and cold leads to the drenching and proliferation of dampness. The earth’s qi is at the point of rising and falling, thus it is termed damp earth.

阳明燥金地面上为阳位。五气之时，地面上盛满的阳热，经秋气之收敛，正当下降。中土之下，阳气充足。湿气已收，大宇光明，阳盛而明，故称阳明。金气当旺，湿也收则燥热气结。此时地面上空的金气，压力极大，故称燥金。

Yangming dry metal occupies the yang position on the surface. During the fifth qi period, the yang heat that fills the surface, influenced by the autumn’s collection, begins to descend. Below centre earth, yang qi is abundant. Dampness has receded, the great universe is bright, and yang is flourishing and luminous; hence it is called Yangming [Yang brightness]. [When] metal qi is vigorous and dampness has also receded, dryness and heat qi bind. At this time, the atmospheric metal qi is under great pressure, hence it is called dry metal.

太阳寒水六气之时，地面上的阳热，经秋气之收敛，全行降入土下的水中。造化之气，中下为本。中下阳多，故称太阳。此阳热降入水中，水即将他封藏不泄。此时大气降压，水外即寒。水外已寒，则水内阳藏，故称寒水。

During the sixth qi period of Taiyang cold water, the yang heat from the surface, having been gathered by autumn, completely descends into the water underground. The qi of creation has its roots in the lower regions. [Since] yang is copious below the centre, it is thus referred to as Tai [greater] yang. This yang heat descends into the water, where it is stored and not discharged. At this time, the atmospheric pressure drops, and the external water becomes cold. When it is cold outside, it means the yang is stored within the water, hence it is called cold water.

五行的运动圆，合成一气。木升金降，木不病风，金不病燥。水升火降，火不病热，不病暑水不病寒。土运于中，土不病湿。运动不圆，升降不交，各现各气，则病风、热、暑、湿、燥、寒，病者，大气病也。人身之气，亦如是也。

The circular movement of the five phases forms a single qi. Wood ascends [while] metal descends; [when] wood does not [suffer from] wind disease, metal [will not suffer] from dryness disease. Water ascends [while] fire descends; [when] fire does not [suffer from] heat or summer-heat disease; water [will not suffer] from cold disease. [When the] earth moves in the center; the earth [will not suffer] from dampness disease. If the movement is not circular and ascending and descending do not interact, each [phase] manifests its own qi, leading to diseases such as wind, heat, summer heat, dampness, dryness, and cold—these are diseases of the atmosphere. The qi of the human body is also like this. 

初气之时，宜养木气。二气之时，宜养火气。三气之时，宜补相火之气。四气之时，宜养土气。五气之时，宜养金气。六气之时，宜补水气。相火下降于水中，为君火之始气。君火者，相火之终气，君火又随相火下降也。

In the period of initial qi, it is suitable to nourish wood qi. During the second qi period, it is suitable to nourish fire qi. In the third qi, it is suitable to supplement ministerial fire qi. During the fourth qi, it is suitable to nourish earth qi. In the fifth qi, [one should] nourish metal qi. In the sixth qi, it is suitable to supplement water qi. The ministerial fire descending into the water marks the beginning of the sovereign fire.The sovereign fire is the culmination of the ministerial fire’s qi, and it descends together with the ministerial fire.

_________________________________________________________

Peng Chengzu (1871-1949), courtesy name Ziyi, was a member of the Bai ethnic group from Heqing, Yunnan. His father served as an official in Guizhou, where Peng Ziyi was born and raised in a family with a strict academic environment. As he grew older, he pursued studies with renowned scholars in Guizhou, developing a wide range of knowledge. Peng had a natural passion for medicine and delved deeply into medical studies. Later, he traveled to Beijing, where he served as a physician at the Imperial Medical Institute during the late Qing Dynasty. This position allowed him access to extensive medical archives and renowned medical texts in the capital.

Peng Ziyi’s book, Circular Movements in Ancient Chinese Medicine, builds upon the ideas from The ‘Sisheng Xinyuan’ text by Huang Yuanyu, an imperial physician of the Qianlong era in the Qing Dynasty. Huang’s work focused on the concept of the circulation and rotation of central qi, rising and descending in cycles. Peng Ziyi extended this concept by introducing the idea of “circular movements of rotating axles” as a view of Qi transformation. His book explains the principles of life movement within the human body and the foundational concepts of disease treatment in Chinese medicine through clear and straightforward reasoning.

Chronic Hepatitis (A Case by Dōmei Yakazu)

On By eranevenIn Formulas (方剂), Kampo, Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

杨大华. 汉方治验选读

慢性肝炎（矢数道明治验） 

48岁妇女，5年前发病。由于有胸不适，右肩酸痛，右颈部肿，右手麻木，微热持续不退，在大学附属医院诊察，诊为急性结核性淋巴结炎，进行了链霉素和对氨基水杨酸钠治疗。 但又引起剧烈的胃障碍，出现严重黄疸，甚为惊恐，又住入其他医院诊为急性肝炎，2个月后出院。

Case taken from “Selected Readings on the Efficacy of Kampo Formulas”, by Yang Dahua

Chronic Hepatitis (A Case by Dōmei Yakazu)

A 48-year-old woman developed symptoms five years ago. She experienced chest discomfort, right shoulder pain, swelling in the right side of her neck, numbness in her right hand, and persistent mild fever. After being examined at a university-affiliated hospital, she was diagnosed with acute tuberculous lymphadenitis and treated with streptomycin and para-aminosalicylic acid. However, this led to severe stomach problems and the onset of serious jaundice. Alarmed, she was admitted to another hospital and diagnosed with acute hepatitis. After two months, she was discharged.

此后5年来，右肩酸痛，右手麻木，浮肿一向不治，过劳淋巴结立即肿大。又胸中苦于胀满，裤带一勒紧即感恶心。 体格、营养状态一般，面色尚可，脉弱，血压正常。心下紧张如板状，有剧烈压痛，右季肋下痛尤为明显。肩酸痛严重时有短气。

Over the following five years, her right shoulder pain, hand numbness, and swelling remained untreated. Her lymph nodes would swell with overwork, and she suffered from a persistent feeling of distention and fullness in her chest, with nausea when tightening her belt. Her physical condition and nutrition were average, her complexion was decent, and her pulse was weak but her blood pressure normal. She had tightness below her chest like a hard plate with intense tenderness on palpation, as well as quite noticeable pain below her right ribs. When the shoulder pain was severe, she would experience shortness of breath.

以上所见正与“心下急，郁郁微烦，胸胁苦满，心下痞硬，呕吐，腹满痛”之大柴胡汤条文几乎一致。由于右肩酸痛与右手麻木、右季肋紧张压痛相互关联，故胸胁苦满有时轻快，有时不轻快。尽管脉较弱，仍与大柴胡汤加葛根5g。 服用本方10日，5年来之肩酸痛、右手麻木、胸闷不舒，几乎痊愈。1个月后，乘汽车、电车晕车亦消失，心下痞硬和苦满等症状好转。服用3个月，宿疾一扫而光，停药。（《临床应用汉方处方解说》） 

The symptoms observed closely align with the [Original] line of Dà Chái Hú Tāng [from the Shang Han Lun]: “Distress below the heart, a feeling of depression and slight vexation, fullness in the chest and rib-sides, hard glomus below the heart, vomiting, and abdominal fullness and pain.” Because of the connection between the right shoulder pain, hand numbness, and the tightness with tenderness below the right ribs, the fullness in the chest and rib-sides would fluctuate, sometimes improving and other times remaining unchanged. Although her pulse was relatively weak, Dà Chái Hú Tāng was prescribed with the addition of 5g of gé gēn (Pueraria root).

After taking this prescription for 10 days, the shoulder pain, hand numbness, and chest discomfort she had suffered with for five years was almost completely resolved. A month later, her motion sickness while traveling in cars and trains also resolved, and her hard glomus below the heart and fullness improved. After three months, her long-standing issues were completely resolved, so she discontinued the herbs. (Explanation of the Clinical Applications of Kampo Formulas by Dōmei Yakazu).

剧烈的胃障碍，出现严重黄疸”要考虑对氨基水杨酸钠的不良反应。诊为急性肝炎不恰当，应该是药物性肝损更为合适。停药及治疗后恢复正常，此后5年来的一切不适与肝损无关。“心下紧张如板状，有剧烈压痛，右季肋下痛尤为明显”，这些腹证也不是肝脏疾病的表现。

The severe stomach disturbance and jaundice should be considered an adverse reaction to para-aminosalicylic acid. Diagnosing it as acute hepatitis was inappropriate, [whereas] drug-induced liver damage would have been more accurate. After stopping the medication and undergoing treatment, her condition returned to normal, and her discomfort over the next five years had nothing to do with liver damage. The phrase “tightness below the chest like a hard plate, with intense pain on palpation, as well as quite noticeable pain below her right ribs” does not indicate symptoms of liver disease.

患者的大柴胡汤证非常典型，因此抛开肢体症状独取腹证。加葛根可能是兼顾“右肩酸痛，右手麻木”的肢体症状。如果不加葛根，是否也一样有效？既然认准是大柴胡汤证，就没有必要加葛根。且大柴胡汤加味药多为芒硝、厚朴，加葛根则为少见。

The patient’s case was a typical presentation of Dà Chái Hú Tāng, so it was appropriate to prioritize the abdominal symptoms without giving much attention to the limb symptoms. The addition of gé gēn was likely to address the limb symptoms of right shoulder pain and hand numbness. However, would the formula have been equally effective without adding gé gēn? Since the formula aligned with the Dà Chái Hú Tāng pattern, adding gé gēn might not have been necessary. It is also not common to add gé gēn to Dà Chái Hú Tāng, whereas herbs such as máng xiāo or hòu pò are more common. 

脉弱，依然用大柴胡汤，体现了重腹证、轻脉象的理念。大柴胡汤证体现在慢性病中，脉象的反应有可能不像急性病那样强烈，也就是说，当脉象与腹证不一致时，需要舍脉从腹证。《重要汉方处方解说口诀集》（邱年永翻译）说“大柴胡汤证之脉为沉实或沉迟而有力是正证，但不必拘泥此种脉象”。并举例痈疽、下利、温病等出现大柴胡汤证时脉象等变化。也就是说，大柴胡汤证等腹证相对稳定，但脉象可以因疾病的不同而有个体差异。

The decision to use Dà Chái Hú Tāng despite the weak pulse reflects a preference for focusing on the abdominal signs as opposed to the pulse. In chronic conditions, the pulse may not react as strongly as in acute illnesses. In other words, when the pulse and abdominal signs do not align, it is necessary to prioritize the abdominal signs. The Essential Guide to Key Kampo Formulas: A Collection of Mnemonics (translated by Qiu Nianyong) states, “The pulse for the Dà Chái Hú Tāng pattern is usually deep and excess, or deep, slow and strong, yet [one] need not rigidly adhere to this pulse manifestation.” [The text] also gives examples of variances in the pulse when Dà Chái Hú Tāng is indicated in cases of abscesses, diarrhea, warm diseases, etc. This suggests that the abdominal signs associated with Dà Chái Hú Tāng are relatively stable, while the pulse can vary according to the disease.

患者的大柴胡汤腹证是否为结核性淋巴结炎所致？不得而知。肢体症状均在右侧，右季肋下痛是否与此相关？也许在汉方医生眼中，肢体的症状与腹证都属于同一种病理变化，是一棵树上的叶与花。使用大柴胡汤之后这些表现都得以解除，则大柴胡汤相当于将树连根拔起，花叶俱萎。从本案来看，肢体的症状先消失，腹证则消除缓慢，类似于花与叶的差别。花与叶对营养的需求不同，凋落自然有迟有早。腹证与肢体症状在形成上也并非一致，其成因应该更加复杂。

Was the patient’s abdominal pattern caused by tuberculous lymphadenitis? It is unclear. Her limb symptoms were all on the right side—was the pain below the right ribs related? Perhaps from the perspective of a Kampo physician, the limb and abdominal symptoms could be manifestations of the same pathological change, like leaves and flowers on the same tree. Once Dà Chái Hú Tāng was administered, all these symptoms resolved, suggesting that the formula uprooted the tree, causing both the flowers and leaves to wither. In this case, the limb symptoms disappeared first, while the abdominal symptoms resolved more slowly, akin to the different timing of the leaves and flowers falling. The development of abdominal signs and limb symptoms is not necessarily the same, and their underlying causes are likely more complex.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dōmei Yakazu (1905-2002), was a Japanese physician born in Tokyo. Dōmei graduated from the Tokyo Medical College in 1930 and later studied Chinese medicine. In 1954, he conducted pharmacological research at Tokyo Medical University, obtaining his doctorate in 1959.

For over 50 years, Dōmei Yakazu, together with Keisetsu Ōtsuka, dedicated himself to the revival of Kampo (traditional Japanese medicine) in Japan, making significant contributions to the promotion and development of Eastern medicine. His notable works include; Explanation of Key Kampo Formulas from Later Generations, Explanation of the Clinical Applications of Kampo Formulas, Practical Kampo Diagnosis and Treatment, The Great Encyclopedia of Kampo Medicine, The Medical Encyclopedia of Kampo Diagnosis and Treatment, A Brief History of Kampo over the Past Century of the Meiji Era, and A Hundred Stories of Kampo Therapy.

Liu Duzhou on Water Patterns [水证论] – Part 4

On By eranevenIn Liú Dùzhōu (刘渡舟), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

水气上冲证治

一、水气的概念（此处水气非指水肿）古人对水气的概念，有认为水气是水之寒气，如成无已注水气上冲：“水寒相搏，肺寒气逆”；也有人认为水气即是水饮，如钱天来注“水气、水饮之属也。”我认为他们似乎各自说对一半，因水与寒，往往统一发病，水指其形，寒则指其气，如影之随形，不能分离。所以水气的概念，既有水饮，也有寒气。

Water Qi upward surging patterns and treatment 

1. Concept of Water Qi (here, water qi does not refer to edema). In ancient times, there were various concepts regarding water qi. Some believed that water qi was the cold qi of water, such as in the saying by Cheng Wuji in relation to the upward surging of water qi “when water and cold clash, cold in the lung [will result in] counterflow qi.” Others believed that water qi was simply water-rheum, as mentioned by Qian Tianlai: “Water qi belongs to water-rheum.” I believe they each seem to be partially correct because water and cold often jointly cause illnesses. Water represents its form, while cold indicates its qi, like a shadow following its form, inseparable. Therefore, the concept of water qi includes both water-rheum and cold qi.

    二、水气上冲的证机

    水气上冲证，为临床常见病和多发病。历代医家比较重视，在治疗方面也有所发展。此证源出《伤寒论》及《金匮要略方论》，仲景提出以苓桂为主方的相应治疗，为后世治疗水气上冲创立了证治基础。但原文中的苓桂方证，加减化裁，有机地分列于不同的篇章，使人难以掌握全面。而无法引用。为此，进行综合归纳，提要钩玄并参以已意，务使水气上冲体系与系列方证特点而大白于医林。

    2. Patterns and Mechanisms of the Upward Surging of Water Qi

    The upward surging of water qi is a common and frequently occurring clinical condition. Physicians of various generations have attached great importance to it and have also made developments in its treatment. This condition originated from the “Shang Han Lun” and the “Jin Gui Yao Lue Fang Lun.” Zhongjing proposed the corresponding treatment mainly using the formula Linggui [Zhugan Tang], establishing the basis for the treatment of the upward surging of water qi in later generations. However, the original Linggui formula and its patterns, modifications, and variations are scattered throughout different chapters, making it difficult for people to grasp comprehensively and impossible to reference. To this end, a comprehensive summary is conducted, highlighting the essential points and incorporating personal insights, with the aim of making the characteristics of the upward surging of water qi and the related formula presentations clear to the medical community.

    《伤寒论》第67条内容，是论水气上冲证治，我认为这一条是论“水心病”的代表作。

    “水心病”的病名，是受西医“风心病”病名影响而产生的，病名突出了病证的重点，反映了病的实质问题，比“水气凌心”的名称直截了当，一见便知。

    关于这一条的原文是“伤寒若吐若下后，心下逆满、气上冲胸，起则头眩，脉沉紧、发汗则动经，身为振振摇者，茯苓桂枝白术甘草汤主之。”文中的“若吐若下”，先点出了证机属虚而非实。正是心阳先虚，然后才有“水心病”的发生。

    Line 67 of the Shang Han Lun discusses the treatment of the upward surging of water qi. I believe this section represents the concept of “water heart disease.”

    The term “water heart disease” influenced the name “rheumatic heart disease” in Western medicine. The name highlights the focus of the disease, reflecting its essential problem, which is more direct than the name “water qi encroaching on the heart.”

    The line in the original text says: 

    “In cold damage [disease] following vomiting or purgation, [if there is] counterflow fullness below the heart, qi surging upward into the chest, dizziness upon rising, and a deep and tight pulse; If sweating is promoted this will stir the channels and there will be quivering and trembling, and Fuling Guizhi Baizhu Gancao Tang governs.” 

    The phrase “[following] vomiting or purgation” indicates that the mechanism of the condition is related to deficiency rather than excess. It is precisely the deficiency of heart yang that leads to the occurrence of “water heart disease.”

    心脏属火，为阳中之太阳。上居于胸，秉火阳之权威，震慑下焦水寒之邪不敢越雷池一步。今因“吐下之余定无完气”，心阳一虚，则坐镇水寒之权威失势，因此在下焦的水寒阴气便有可乘之机，乃有“水心病”发生。

    The heart belongs to fire and is the Taiyang within the Yang. It resides in the chest, holding the authority of fire Yang, intimidating the evil of water cold in the lower jiao, not daring to step beyond the threshold of the Lei Chi [or beyond its limits]. Now, due to “the deficiency of Qi after vomiting or diarrhea,” when the heart Yang is deficient, the authority of restraining water cold in the lower jiao is lost. Therefore, there is an opportunity for the cold and Yin Qi in the lower jiao to take advantage, leading to the occurrence of “water heart disease.”

    近世医者，受西医学之影响，只知“心主血脉”，“诸脉系于心”所发生的心血管瘀阻的心绞痛和冠心病。反而不知心的生理特点在于阳气。《素问•六节脏象论》说：“心者，生之本，神之变也。…为阳中之太阳，通于夏气.” 这段话是说心为生命的根本，主宰神明的变化。心有这大的功能，乃是它的阳气功能所决定。因为心属火脏，而上居于胸，胸与火皆属阳，故心称为“阳中之太阳”。心主阳气为第一位、心主血脉为第二位。心主血脉、心主神志，都与心阳的主导作用有关。如果心阳亡失，则就停止了搏动，血脉不行、神志消灭。

    In modern times, influenced by Western medicine, many physicians only recognize that “the heart governs the blood vessels” and the occurrence of angina pectoris and coronary heart disease due to blood stasis in the heart where “all vessels converge.” However, they fail to recognize the physiological characteristics of the heart lying in its Yang Qi. The Suwen • Discussion on the Six Sections on the Organs” states: “The heart is the root of life, [it is responsible] for the changes of the spirit… It is the Taiyang within the Yang, connected with the Qi of summer.” This passage means that the heart is the foundation of life, governing the changes of the spirit. The heart’s extraordinary function is determined by its Yang Qi function. As the heart belongs to the fire organ and resides in the chest, both the chest and fire belong to Yang. Therefore, the heart is referred to as the “Taiyang within Yang.” The heart primarily governs Yang Qi, followed by governing the blood vessels. Both governing the blood vessels and the spirit are related to the dominant role of heart Yang. If heart Yang is lost, pulsation stops, blood circulation ceases, and consciousness disappears.

    “水心病”以心阳虚为主，诱发水寒之邪从下而上冲打击心胸阳气、血脉的流通。同时也应该看到在“水心病”的同时，必然中焦的防水大坝的脾土，和下焦管理水气的肾阳也表现了松弛无力，不能制伏水寒之邪上行亦大有关系。“心下逆满”的“逆”之一字，义有双关，既指水气上逆之病机，而又道出相应之症状。“满”，就是胀满，或叫痞满，为上腹部的气机痞塞不通所致，因而出现胀满不通之证。

    “Water heart disease” primarily manifests as deficiency of heart Yang, which triggers the invasion of water-cold pathogens from below, attacking the circulation of heart-chest Yang Qi and the blood vessels. At the same time, it should be noted that in ‘water heart disease,’ the spleen’s earth element, which acts as a dam against water in the middle burner, and kidney yang, which governs the water Qi in the lower burner, also show signs of laxity, failing to contain the upward movement of pathogenic cold-water. The term “逆” (nì), meaning “reversal” or “counterflow,” in “counterflow fullness below the heart” carries a dual implication. It not only indicates the pathological mechanism of water Qi rising in reverse but also conveys corresponding symptoms. “Fullness” refers to distension or fullness, also known as “glomus fullness,” caused by the blockage of the Qi mechanism and lack of free flow in the upper abdomen, resulting in distension and fullness.

    “心下逆满”，旧注解为“胃脘之间”证候。殊不知此乃心脏阳虚见证之一，上虚而气不降所以为中满也。凡心脏病之心下痛与痞满，而误诊为胃脘病者，临床所见较多，医者所不可不察也。

    “Counterflow fullness below the heart,” traditionally interpreted as a symptom between the epigastrium and the stomach, is actually one of the manifestations of heart Yang deficiency. It occurs because of the deficiency of Yang Qi ascending, resulting in fullness in the middle. It’s common in clinical practice to mistake heart-related pain and fullness below the heart as gastric epigastric disorders, which physicians must be vigilant about.

    今考心阳虚于上，水寒之气动于中，故有“气上冲胸” 直犯离宫之变，仲景不言气冲于胸之具体见证，今特补述于下：胸为心之宫城，乃阳气所会之地。高学山所谓“光芒四射中，但觉一团太和之元气相聚耳”。今心阳被水寒之邪所過，则自觉胸中满闷，或兼见憋气与疼痛。肺居胸中，行使冷节之令，水寒凌肺，金寒津凝，则可出现咳嗽，气喘，痰这较乡，面部虚浮等证。

    Now, considering the deficiency of heart Yang above and the movement of water-cold Qi in the middle, hence the manifestation of “qi rushing upwards to the chest,” directly affecting the palace of separation. Zhang Zhongjing did not specifically mention the manifestations of Qi rushing to the chest, so I’ll elaborate: the chest is where the heart’s Qi congregates, a place of harmony. As Gao Xueshan said, “Rays of light radiate from the center, sensing only a gathering of the great harmonizing source qi.” If heart Yang is invaded by water-cold, the patient may feel fullness and stuffiness in the chest, accompanied by breathlessness and pain. As the lungs reside in the chest, governing the command of cold, when water-cold intrudes upon the lungs, causing the condensation of cold fluids, symptoms such as coughing, wheezing, thick phlegm, facial edema, and so on may appear.

    “起则头眩”，是指病人头晕为重，只能静卧，不敢起动。造成眩晕原因有二：一是心脾阳虚，清阳之气不足上养清窍：一是水气上冲，阴来搏阳，清阳既虚且抑所以头眩。

    “Dizziness upon rising” refers to severe dizziness upon standing, leading the patient to remain lying down out of fear of exacerbating the dizziness. There are two causes of dizziness: first, heart-spleen Yang deficiency, where insufficient clear Yang Qi ascends to nourish the head; second, the upward rush of water Qi, Yin battling against Yang, resulting in both deficiency and suppression of clear Yang, thus causing dizziness.

    我们结合临床观察，水气上冲头目尚不止此，每见视力下降，目见黑花，耳聋、鼻塞与不闻香臭等五官科疾患。

    Based on clinical observations, the manifestations of water Qi rushing upward are not limited to those mentioned above. It is often associated with disorders of the five sensory organs, including decreased vision, seeing black spots, hearing loss, nasal congestion, and loss of sense of smell.

    徐水县农民，李某某，56岁，患鼻塞证，尤以夜晚为甚，只能以口代鼻呼吸，所以口腔干涸为甚。偶因“心悸”倩余为治。辨为水气凌心之证，于苓桂术甘汤五贴。服讫而鼻塞随之痊愈。

    昌黎中学，李某年已不惑，患视网膜炎，视物右上方有黑色物体遮盖不散。曾服益气聪明汤，杞菊地黄汤等方，无效可言。余见其面黧舌水、脉弦而叉心悸头晕，辨为水气上冲、蒙蔽清阳之证。为疏苓桂术甘汤加泽泻。约服三十余剂，而眼前之黑花消失不见。

    Mr. Li, a 56-year-old farmer from Xushui County, suffered from nasal congestion, particularly severe at night, forcing him to breathe through his mouth, resulting in severe dryness of the mouth. Occasionally experiencing palpitations, he sought treatment. Diagnosed with the syndrome of water Qi encroaching on the heart, he was treated with the formula Linggui Zhugan Tang. After taking [the formula], his nasal congestion completely recovered.

    Mr. Li, a senior student at Changli High School, in his fourties, suffered from retinitis, with a dark object obstructing his upper right field of vision. He had previously tried various prescriptions such as Yiqi Congming Tang and Qiju Dihuang Tang, with little effect. Upon examination, his complexion was sallow, tongue was pale and swollen, and his pulse was wiry and irregular, [and he also experienced] palpitations and dizziness. Diagnosed with the pattern of water Qi rushing upward and obstructing clear Yang, he was prescribed Linggui Zhugan Tang with added Ze Xie. After approximately thirty doses, the dark spots in his vision disappeared.

    根据临床观察，水气上冲还往往出现咽喉不利，类似“梅核气”证，梗塞喉中，吐之不出，咽之不下。

    文革前余带学生在城子矿实习。某生治一白姓妇女，患梅核气，经用《金匮》半夏厚朴汤，已三进而丝毫无效，乃转余诊。切其脉弦，视其舌苔则水滑欲滴。余辨为水气上冲，咽喉被水寒所痹塞而非痰气之证。乃用桂枝12克，茯苓30克，白术10克，炙甘草6克，连服五剂，咽喉通利，病已愈矣。某生讶以为神，间曰：半夏厚朴汤方为何无效？

    曰：半夏厚朴汤治痰气上凝之喉痹；苓桂术甘汤则治水气上冲之喉痹。此证脉弦、舌水而是其候，误为痰气遂有“差之毫厘，谬之千里”，某生叹服。

    “脉沉紧”，沉主里，又主水病，弦紧为寒，沉紧正是水寒为病的反映。

    Based on clinical observations, water Qi rushing upward often manifests as discomfort in the throat, resembling the pattern of “plum pit qi,” where there is a sensation of obstruction in the throat, as if something is stuck and cannot be swallowed or expelled.

    Before the Cultural Revolution, I took students to intern at the Chengzi Mine. One student treated a woman surnamed Bai who had plum pit qi. She had undergone three courses of treatment with Banxia Houpo Tang from the “Jingui Yaolue” but showed no improvement, so she was referred to me for diagnosis. Upon palpating her pulse, it was wiry, and upon observing her tongue coating, it appeared moist and slippery. I diagnosed her with water Qi rushing upward, causing obstruction in the throat due to water-cold, rather than phlegm obstruction. I prescribed Guizhi 12g, Fuling 30g, Baizhu 10g, and Zhi Gancao 6g to be taken continuously for five doses. Afterward, her throat was clear and the condition was resolved. The student was amazed and asked, “Why was Banxia Houpo Tang ineffective?” I explained, “Banxia Houpo Tang is used for phlegm accumulation causing throat obstruction, while Linggui Zhugan Tang is for throat obstruction due to water Qi rushing upward. The characteristics of the wiry pulse and moist tongue coating were indicative of the latter, and mistaking it for phlegm led to the saying ‘a difference of a hair leads to a difference of a thousand miles.’ The student nodded in agreement.

    [In regards to] “a deep and tight pulse.” The depth signifies the interior, also representing water diseases, while the tightness indicates cold. Deep tightness precisely reflects the condition of a water-cold pathology.

    acupuncture in port coquitlam

    Medical Case of Professor Huang Shipei: With an 89-Year-Old Patient – Would You Dare Use 20g of Dahuang?

    On By eranevenIn Case Studies （医案), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

    黄仕沛系广州市名中医，广州中医药大学兼职副教授，南京中医药大学客座教授，十三行国医馆名誉馆长，当代经方临床大家，著名经方学者。学术上独尊经方，推崇“方证对应”，临床以大剂著称，著有《黄仕沛经方亦步亦趋录》、《黄仕沛经方亦步亦趋录（续）》、《梦回伤寒四大金刚》、《黄仕沛经方师传录》。

    Professor Huang Shipei is a renowned traditional Chinese medicine (TCM) doctor in Guangzhou, a part-time associate professor at Guangzhou University of Chinese Medicine, a visiting professor at Nanjing University of Chinese Medicine, and an honorary director at the Thirteen Halls National Medical Museum. He is a contemporary expert in classical formulas (Jingfang) and a famous scholar in the field. Academically, he exclusively focuses on classical formulas, advocating the “correspondence between formula and symptoms” approach. His clinical practice is notable for using large doses, and he has authored several books, including “Huang Shipei’s Follow-up Records of Classical Formulas,” “Huang Shipei’s Follow-up Records of Classical Formulas (Continued),” “Dreaming of the Four Great Masters of Shanghan,” and “Huang Shipei’s Record of Teaching and Transmission of Classical Formulas.”

    何某，女性，89岁。因有老年性痴呆病史，长期居住老人院。2010年7月13日开始出现食入即吐，腹胀满，大便秘结，当时无寒战发热，无腹痛、呕血、黑便等不适。即由家属送至我市某三甲医院住院，行血常规，WBC：11.98*109/L，NE：84.7%，腹部CT：不完全性肠梗阻。因患者高龄，不能耐受手术，暂予禁食，抗感染，补液支持为主，并予桃核承气汤及开塞露，灌肠。

    Case Study:

    He, female, 89 years old. 

    Senile dementia, long-term resident in a nursing home.

    From July 13, 2010, she started experiencing vomiting immediately after eating, abdominal distension and fullness, as well as constipation. No chills, fever, abdominal pain, hematemesis, or melena were reported. Her family took her to a tertiary hospital in our city, where she was admitted. Blood tests showed WBC: 11.98*10^9/L and NE: 84.7%. Abdominal CT indicated partial intestinal obstruction. Due to her advanced age and inability to tolerate surgery, she was treated with fasting, antibiotics, fluid infusions, and given Taohe Chengqi Tang to open the stoppage as well as enemas.

    灌肠后，可解少量硬便，但如是治疗十余日后，患者食入即吐及腹胀满症状未见好转，家属要求转我院继续治疗。入院时患者暂无呕吐，腹胀满而不痛，复查腹平片仍提示不全肠梗阻，仍予禁食及补液。

    Following the enema, she was able to pass a small amount of hard stool. However, after over ten days of treatment, her symptoms of vomiting after eating and abdominal distension did not improve, and her family requested a transfer to our hospital for further treatment. Upon admission, she had no vomiting but had abdominal fullness and distension without pain. Abdominal X-ray still indicated partial intestinal obstruction, so fasting and fluid infusions were continued.

    主管医师与黄仕沛教授短信联系，问其能否继续予承气汤类中药内服及灌肠，黄师认为此患者无腹痛，以胀满为主，非痞、满、燥、实、坚的大承气汤证。此患者老年体虚，虽腹胀、便秘、呕吐，但无明显腹痛，其肠梗阻的主要原因考虑为肠麻痹引起，动力不足所致。而此患者在外院已反复攻下而不愈，其虚证更明显。虽有便秘等可下之证，但并非具大承气汤痞、满、燥、实、坚之证，更不是第106条“热结膀胱，其人如狂……但少腹急结”下焦瘀血的桃核承气汤证。可试以厚朴生姜半夏甘草人参汤合小承气汤。

    The attending physician contacted Professor Huang Shipei via text message, asking whether the patient could continue taking a Chengqi Tang type of formula and the enemas. Professor Huang believed that this patient, who mainly suffers from bloating without abdominal pain, does not exhibit the symptoms typically treated by a Da Chengqi Tang pattern, such as glomus, fullness, dryness, and hardness. This elderly patient is physically weak and although experiences bloating, constipation, and vomiting, does not have obvious abdominal pain. The primary cause of the patient’s intestinal obstruction is likely intestinal paralysis, resulting in insufficient motility. The patient has undergone repeated purgative treatments at another hospital without recovery, which has further weakened her condition. Although there are symptoms of constipation that might suggest a purgative treatment, the patient does not exhibit the specific symptoms required for Da Chengqi Tang [such as] glomus, fullness, dryness, and hardness, nor the pattern described in line 106 of the Shanghan Lun [where it states] “Heat accumulation in the bladder, causing the person to be manic… with a tense and firm lower abdomen,” which would indicate a Taohe Chengqi Tang pattern of static blood in the lower burner.  He suggested trying a combination of Houpo Shengjiang Banxia Gancao Renshen Tang and Xiao Chengqi Tang:

    处方：

    法夏24g，炙甘草12g，党参30g，厚朴25g（后下），生地45g，生姜15g，枳实30g，大黄20g（后下）。服第1剂药后，次晨解黑褐色烂便1次，量约100ml，并予开塞露，灌肠后，又解黑褐色烂便1次，量约200ml。如是共服药5天，每天均有大便解出，腹胀消。本欲复查腹平片评价患者肠梗阻情况，因患者痴呆，近日精神好转后，烦躁乱动，不能配合拍片，暂未予。尝试予少量进食，食后无呕吐。得泻后，改予小柴胡汤，处方：柴胡24g，黄芩15g，法夏24g，党参30g，大枣15g，炙甘草15g，厚朴（后下）20g，枳实20g。住院15天，可进食，无呕吐，大便每日可解，予出院。

    Formula

    • Banxia 24g
    • Zhi Gancao 12g
    • Dangshen 30g
    • Houpo 25g (added later)
    • Shengdi 45g
    • Shengjiang 15g
    • Zhishi 30g
    • Dahuang 20g (added later)

    After taking the first dose, the next morning, she passed about 100ml of blackish-brown loose stool. After another enema, she passed about 200ml of blackish-brown loose stool again. She continued this treatment for five days, with daily bowel movements and reduced abdominal distension.

    We originally planned to conduct an abdominal X-ray to assess the patient’s intestinal obstruction. However, due to the patient’s dementia and recent improvement in mental state, the patient became agitated and restless, making it difficult to cooperate for the imaging, so it was temporarily postponed. We attempted to give the patient a small amount of food, and there was no vomiting after eating. After the patient had a bowel movement, we switched to Xiao Chaihu Tang.

    • Chaihu 24g
    • Huangqin 15g
    • Banxia 24g
    • Dangshen 30g
    • Dazao 15g
    • Zhi Gancao 15g
    • Houpo (added later) 20g
    • Zhishi 20g

    After 15 days of hospitalization, she could eat without vomiting and had daily bowel movements, leading to her discharge.

    The Fire Spirit Schools Emphasis on Kidney Yang 

    On By eranevenIn Case Studies （医案), Huǒ Shén Pài (火神派), Translations & Writings (译著与文章)

    Taken from ‘Classical Clinical Insights from the Fire Spirit Current’ by Zhang Cun’ti [张存悌, 经典火神派临床心悟]

    Yang qi is divided into upper, middle, and lower parts. The upper burner contains the Yang of the heart and lungs, the middle burner contains the Yang of the spleen and stomach, and the lower burner contains the Yang of the liver and kidneys. “The lower Yang is the root of the Yang of the upper and middle burners,” signifies that the Kidney Yang in the lower burner is the root of Yang qi in the upper and middle burners. In other words, among all types of Yang qi, Zheng Qin’an particularly emphasized the role of Kidney Yang. “A person’s life and destiny rely entirely on the single Yang [line] in the Kan hexagram,” indicating that Kidney Yang is the fundamental source of Yang qi in the human body and the root of life and destiny. This also forms the theoretical basis for his advocacy of using Fuzi and Sini-type prescriptions to warm and support Kidney Yang.

    圖友人黄某，乙酉九月患腹痛，每食甜物少愈。医者以为燥也，用甘润之药不效。旋用下药，痛益甚。延子诊视，六脉细小，喜按，口淡，倦怠，断为寒证。投以理中汤加木香，旋止旋发，夜间更甚。予曰：“夜为阴，阴寒盛，夜间痛更甚也。”用通脉四逆汤加白芍，十余服痊愈。（易巨荪治案）

    A friend named Mr. Huang suffered from abdominal pain in the ninth month of the Yiyou year. The pain lessened whenever he ate sweet foods. Doctors believed it to be dryness and used sweet and moistening medicines to no avail. Subsequently, they used purgative medicines, which worsened the pain. Upon examination, all six of his pulses were thin and small, he liked pressure on the abdomen, had a bland taste in his mouth, and felt fatigued. I diagnosed it as a cold condition. I prescribed Lizhong Tang with added Mu Xiang, which provided temporary relief but the pain recurred, especially at night. I said, “Night is Yin time, and Yin cold is prevalent, hence the pain worsens at night.” I then used Tongmai Sini Tang with added Baishao, and after more than ten doses, he fully recovered. (Case of Yi Jusun)

    张存悌按（以下简称张按）：此案腹痛，先从中阳论治，“投以理中汤加木香，旋止旋发”。以“夜为阴，阴寒盛，夜间痛更甚”为辨证眼目，专力扶肾阳，用通脉四逆汤加白芍而愈，值得揣摩。

    Commentary by Zhang Cunti

    In this case of abdominal pain, the initial treatment focused on the Yang of the middle burner with “Lizhong Tang plus Mu Xiang,” which provided temporary relief. The key to the differentiating [factor of the] pattern was that “night is Yin, and Yin cold is prevalent at night, hence the pain worsens at night,” leading to the decision to specifically support Kidney Yang using Tongmai Sini Tang with added Baishao, resulting in the resolution [of the condition]. This approach is worth pondering.

    Liu Duzhou on Water Patterns [水证论] – Part 3

    On By eranevenIn Liú Dùzhōu (刘渡舟), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

    二、皮水

    皮水是由于脾虚，不能运化水湿，水湿阻塞中焦，故腹中胀满；肺气虚则不能通调三焦，以致水湿停留，故下肢踝部浮肿，按之没指，为水性润下之徵。父言皮水之脉浮与风水同。但无恶风身痛等证为异。

    2. Skin Water

    Skin water is caused by spleen deficiency, which is unable to transport and transform water dampness. The blocked water dampness obstructs the middle burner, resulting in abdominal distension. If lung qi is deficient it is unable to free and regulate the triple burner, causing water dampness to accumulate. Consequently, there is swelling in the ankles and the lower limbs, with the characteristic of indentation when pressed, indicating a manifestation of dampness with a watery nature. The older generations say that the pulse of skin water is floating and shares similarities with wind-dampness, but it differs in the absence of symptoms such as aversion to wind and body pain.

    皮水治法：皮水脉浮为水在表，因势利导而发其汗，可用越婵加术汤。如果皮水为病，四肢肿；水气在皮肤中，四肢聂聂动者，可用防已茯苓汤主之（防己三两，黄芪三两，桂枝三两，茯苓六两，甘草二两。以水六升，煮取二升，分温三服）。

    Skin Water Treatment: In skin water, the pulse is floating, indicating that there is water in the surface, and in order to help it along its course, one should promote sweating. This can be achieved with the use of Yuèbì Jiā Zhú Tāng (越婵加术汤).  In skin water disease, there is swelling in the limbs, and slight movements of the limbs, which indicates that water qi is in the skin, and one can use Fángjǐ Fúlíng Tāng (防已茯苓汤), [Fángjǐ 3 liang, Huángqí 3 liang, Guìzhī 3 liang, Fúlíng 6 liang, Gāncǎo 2 liang. Boil in six sheng of water, reduce to two sheng, and take warm in three doses].

    尤怡认为“皮中水气，浸淫四末，而壅遏卫气，气水相逐，则四肢聂聂动也。防己，茯苓善驱水气，桂枝得茯苓，则不发表而反行水，且合黄芪、甘草助表中之气，以行防己、茯苓之力也”。

    According to Yóuyí, “[When there is] water qi in the skin, it seeps and spreads to the four limbs, and congests and obstructs the defense qi, leading to the mutual chasing of qi and water, [and thus] the limbs exhibit slight movements. Fángjǐ and Fúlíng are good for expelling water qi. Guì Zhī, enhances the effect of Fúlíng, and thus avoids effusing the surface but instead moves water. Moreover, the combination of Huángqí and Gāncǎo assists the qi in the surface to support the actions of Fángjǐ and Fúlíng.”

    三、正水

    正水是由于脾肾阳虚，不能气化以蒸发水湿之邪，以致水停于里而不行，故腹满而脉沉迟。水多则外溢而身体浮肿；水气上迫于肺因而作喘；若水凌于心阳，则身重短气不得卧；火不温肾，水寒下控其人则阴肿而烦躁不安；若水邪侵肝，气机被阻，故胁下与腹作痛。肝之疏泄功能乖戾，其气时而上冲，时而下降，水液随气上升，则时时津液微生； 水液随肝气下降，则小便续通；肝病犯脾，不能运化水湿，所以腹部胀大；如果水邪侵脾，脾失转输之常，不能升清降浊，水湿聚中，流于四肢，故腹胀大，四肢苦重难于活动。

    3. Regular Water 

    Regular water is due to the deficiency of spleen and kidney yang, which leads to the inability of qi transformation to evaporate pathogenic water dampness, to the extent where water settles internally and does not move, resulting in abdominal fullness and a deep-slow pulse. Copious water overflows into the surface resulting in generalized body swelling; Water qi rises upwards and distresses the lungs causing panting; If water intimidates the heart yang, it will result in generalized heaviness, shortness of breath, and an inability to sleep. [If] fire fails to warm the kidneys, water cold controls the lower [body] resulting in genital swelling as well as vexation, agitation, and disquietude; If pathogenic water invades the liver, the qi mechanism becomes obstructed, resulting in sub-costal and abdominal pain.  

    肝之疏泄功能乖戾，其气时而上冲，时而下降，水液随气上升，则时时津液微生； 水液随肝气下降，则小便续通；肝病犯脾，不能运化水湿，所以腹部胀大；如果水邪侵脾，脾失转输之常，不能升清降浊，水湿聚中，流于四肢，故腹胀大，四肢苦重难于活动。

    [If] the liver’s free coursing function is disrupted, the qi will occasionally surge upwards as well as occasionally descend. Fluids will follow the qi and ascend, resulting in the intermittent engendering of fluids. Fluids will [also] follow liver qi and descend, resulting in continuous and free urination.  [When] the liver invades the spleen, [the spleen] will be unable to move and transform water damp, resulting in abdominal distention and enlargement. If pathogenic water invades the spleen, the spleen [function] of transformation will be abnormal, and it will be unable to upbear the clear and downbear the turbid. Water damp will accumulate in the centre, flow into the four limbs and lead to abdominal distention and enlargement, and the four limbs will suffer from heaviness and have difficulty moving. 

    脾为水困，津液不生，气亦不足，故见口渴、少气。脾不散精于肺，肺不通调水道以行决渎，故小便难；如果水寒之邪盛于下，肾阳衰弱，不能温化水气，水气增多，故腹大，脐肿，腰痛，不得溺也。肾阳不温阳气不充，故阴下湿如牛鼻上汗，其足逆冷；阳气不华于上，其面反瘦。

    The spleen, when encumbered by water, fails to generate bodily fluids, resulting in insufficient qi, which manifests with thirst and shortness of breath. [When] the spleen fails to distribute essence to the lungs, the lungs are unable to regulate the water ways in order to move and keep the sluices clear, which results in difficult urination. If pathogenic cold water is exuberant in the lower [body], kidney yang [becomes] depleted and is unable to warm and transform water qi. Water qi will increase, resulting in an enlarged abdomen, swelling of the umbilicus, lumbar pain, and an inability to urinate. [When] kidney yang fails to warm and yang qi is insufficient, this leads to the descent of damp with [conditions] such as ox’s nose, upper sweating and counterflow cold. [When] yang qi fails to [supply] luster to the upper, the face becomes thin. 

    五脏水邪，因其生理各异，故病理与证候而不相同。然而五脏水邪病，其中肺、脾、肾三脏阳气之虚衰，不能行气化津而使水邪内停则是它们的共性。因此，在治疗申总以通阳化气，消阴利水之法实为上策。

    The pathologies of pathogenic water in the five viscera differ due to their distinct physiological functions, resulting in varying patterns and symptoms. However, a commonality among diseases involving pathogenic water in the lungs, spleen, and kidneys is the deficiency and debilitation of yang qi in these organs. This deficiency hinders the proper movement of qi and transformation of fluids, which leads to the internal collection of water. Therefore, in the treatment of these conditions, prioritizing methods that free yang, transform qi, disperse yin, and disinhibit water are considered the optimal strategies.

    后世医家，将水分为阴、阳两类，阳水为热为实，治以驱邪为主。如水气逼肺而作喘，通调不利而小便短涩，治用苏葶丸（苏子、葶苈子）或沉香琥珀丸（苦葶苈子、郁李仁、防己、沉香、陈皮、琥珀、杏仁、苏子、赤茯苓、泽泻、麝香）。若通身水肿，二便不利，脉来浮滑，其人体力不衰者，可用疏凿饮子，外散内利（椒目、赤小豆、槟榔、商陆、木通、羌活、秦艽、大腹皮、茯苓皮、泽泻）；如果形气稍差，或年老体弱之人，则用外散内利两解之法，如茯苓导水汤最为理想（泽泻、茯苓、桑皮、木香、木瓜、砂仁、陈皮、白术、苏叶、大腹皮、麦冬、槟榔）。

    Later generations of medical practitioners, categorized water into yin and yang. Yang water is considered hot and excess, and the primary focus in treatment is to expel pathogenic factors. For instance, if water and qi oppress the lungs causing wheezing or inhibit smooth flow leading to short and hesitant urination, treatments such as Sūtíng Wán (zi su zi and ting li zi) or Chénxiāng Hǔpò Wán (ku ting li zi, yu li ren, fang ji, chen xiang, chen pi, hu po, xing ren, su zi, chi fu ling, ze xie, and she xiang) are recommended. If there is generalized edema, inhibited urination and bowel movements, with a floating and slippery pulse, and the patient is strong, then Shūzáo Yǐnzǐ, a method that scatters the exterior and disinhibits the interior (containing jiao mu, chi xiao dou, bing lang, shang lu, mu tong, qiang huo, qin jiao, da fu pi, fu ling pi, ze xie) may be used. If the person’s constitution is slightly weak or they are elderly and frail, a combination of a surface scattering and internal disinhibition method may be used to resolve [the condition]. The ideal choice in such cases is Fúlíng Dǎoshuǐ Tāng (ze xie, fu ling, sang pi, mu xiang, mu gua, sha ren, chen pi, bai zhu, su ye, da fu pi, mai dong, bing lang).

    阴水为寒为虚，如果大便溏薄，畏寒气怯、脉软肢冷者，宜用温补之法，如补中益气汤（人参、黄芪、炙甘草、白术、陈皮、升麻、柴胡，当归、生姜、大枣）。或用实脾饮、（白术、茯苓、炙草，木香，木瓜、附子、槟榔、草果、干姜）：如果脉沉面黧，小便不利心悸、头眩、背恶寒者，可用真武汤（附子、白本、生姜、白芍、茯苓）。如果尺脉沉迟，或见细小，小便不利，而又腰酸脚弱者，可用金匮肾气丸缓治为上。

    Yin water is considered cold and deficient. If there are thin sloppy stools, a fear of  cold, qi timidity, and a soft pulse with cold limbs, a warming and supplementing method is appropriate. For instance, Bǔzhōng Yìqì Tāng (ren shen, huang qi, zhi gan cao, bai zhu, chen pi, sheng ma, chai hu, dang gui, sheng jiang, da zao) can be used. Alternatively, Shípí Yǐn (bai zhu, fu ling, zhi [gan] cao, mu xiang, mu gua, fu zi, bing lang, cao guo, gan jiang) may be used. If the pulse is deep, complexion yellowish-black, [and there is] inhibited urination, palpitations, dizziness, and a cold back, Zhēnwǔ Tāng (fu zi, bai shao, sheng jiang, bai shao, fu ling) is recommended. If the chǐ pulse is deep and slow, or thin and small, with inhibited urination, accompanied by lower back pain and weak legs, Jīnguì Shènqì Wán is valued above else. 

    清人吳谦有外治之法，其中的“贴脐琥珀丹”颇具巧思，用之多验（巴豆去油12.克，轻粉6克，硫黄 3克，研匀成饼。先用新棉一片布脐上，内饼，外用帛缚，时许自然泻下恶水，待下三五次后，去掉药饼，以粥补住。日久形羸，隔一日取一次，一饼可救三五人）。

    The Qing Dynasty physician, Wúqiān had [several] external treatment methods. Among them, his “Tiēqí Hǔpò Dān” was particularly ingenious, and its use was highly effective. To prepare, take 12 grams of Bādòu (with oil removed), 6 grams of Qīngfěn, and 3 grams of Liúhuáng. Grind evenly and form into cakes. First, a fresh piece of cotton is placed over the navel, the cake placed inside, and secured with silk. Over some time, malign water will naturally drain. After three to five drainages, remove the medicinal cake and replace it with a gruel dressing. Over time, the appearance will fade, and the treatment is administered once every other day. One cake can benefit three to five individuals.

    吴谦认为肿胀之病，“属虚寒者，自宜投诸温补之药，而用之俱无效验者，虚中必有实邪也。欲投诸攻下之药而又难堪，然不攻之终无法也。须行九补一攻之法，是用补养之药九日，俟其有可攻之机，而一日用泻下之药攻之。然攻药亦须初起少少与之，不胜病渐加之，必审其药与元气相当，逐邪而不伤正始为法也。其后或补七日、攻一日；补五日、攻一日；补三日、攻一日。缓缓求之，以愈为度”。

    Wúqiān believed that for swelling diseases, if they are attributed to deficiency and cold, the use of warm-supplementing medicinals alone may prove ineffective. He theorized that if there is no improvement with the sole use of supplementing medicinals, there must be excess pathogens within deficiency.  While wanting to resort to offensive purgative [medicinals] is challenging, avoiding their use altogether is also not a feasible solution. He proposed a method of [using] supplementation for nine days followed by one purging day. This involves administering supplementing medicinals for nine days, and afterwards attacking the mechanism, by using draining medicinals for one day. The purgative medicinals should be administered gradually, starting with a small amount and increasing it as the disease progresses. It is essential to ensure that the medicine matches the [patients] original qi, expelling the pathogenic factor without damaging the right [qi]. Afterwards [one] may possibly supplement for seven days, attack for one; supplement for five days, attack for one; and supplement for three days, attack for one. Gradually seek it out, using the cure [as] the measure.  

    余在临床，治此病颇能体会吴氏用心之苦，因而勤求博采，对肿胀大症，如用补药无效而又不能峻攻时，受用自制方，名曰“白玉消胀汤”甚佳（茯苓30克，玉米须30克，白茅根30克，抽葫芦12克，冬瓜皮30克，大腹皮10克，益母草15克，车前草15克，土元10克，茜草10克，川棟子10克，延胡10克，紫菀10克，枳壳10克）。

    此方通气行水，活血助疏，上利肺气以行治节，下开水府而畅三焦。虽亦有逐邪之力，然无伤正损人之弊，施诸补药以后而肿胀不减者用之，每获良效。

    In the clinical setting, I deeply empathize with the challenges faced by Dr. Wú [Qiān] in treating this disease. Therefore, I have been diligent in seeking knowledge and when dealing with conditions of significant swelling, especially when supplementing medicinals prove ineffective and drastic attacking methods are not suitable, I have found great success in using a personal formula I’ve named “Báiyù Xiāozhàng Tāng [White Jade Distention Dispersing Decoction]”, which consists of fu ling 30g, yu mi xu 30g, bai mao gen 30g, chou hu lu 12g, dong gua pi 30g, da fu pi 10g, yi mu cao 15g, che qian zi 15g, tu yuan 10g, qian cao 10g, chuan lian zi 10g, yan hu suo 10g, zi wan 10g, zhi qiao 10g.

    This formula frees qi, moves water, quickens the blood, and assists coursing. In the upper [body] it disinhibits lung qi in order to conduct management and regulation, and in the lower [body] it opens the water mansion and frees the triple burner.  Although it possesses the ability to expel pathogenic factors, it does so without damaging the right [qi] and causing harm to the patient. It is particularly effective when used after supplementing medicinals have failed to reduce swelling, consistently yielding positive results.

    水肿是一个病状，有许多原因可以引发，如肝硬化腹水，肾炎病的水肿，心脏病水肿，营养不良水肿等，则实非本文所能全部概括。

    Edema [water swelling] is a medical condition with numerous potential causes, such as ascites due to liver cirrhosis, edema due to nephritis, cardiac edema related to heart disease, malnutrition-induced edema, etc. It is beyond the scope of this article to comprehensively cover all possible causes of edema.

    四、石水

    石水是由于肾阳虚衰，不能温化水湿，水气不能从小便排出体外，而下结于少腹，故腹胀如石坚硬。病在下焦，属于水气内结，切其脉沉而不起。水结于下，未及于肺，所以其人不喘。水气在肾而凌于肝，可见胁下胀满疼痛等证。

    4. Stone Water

    Stone-water is a condition resulting from the deficiency and debilitation of kidney yang, leading to the inability of warming and transforming water dampness. [Therefore] water qi is unable to be expelled from the body through the urine, causing binding in the lower abdomen, which manifests with abdominal distention, which is hard and rigid resembling a stone. The pathology is focused in the lower burner, and characterized by the internal binding of water qi, with a pulse that is deep and fails to rise. As the water binds in the lower region and has not reached the lungs, individuals with this condition do not exhibit wheezing. When water qi is in the kidneys and affects the liver, symptoms such as fullness, distension, and pain below the ribs may be observed.

    总而言之，四水之中，风水与皮水相类属表；正水与石水相类属里；但风水恶风，皮水不恶风；正水自喘，石水不自喘为异，临证之时须加以鉴别。

    石水的治疗，可选用温补脾肾，佐以舒肝通络之法，如真武汤加桂枝，川棟子、元胡、石楠藤，小茴香等药物。

    In summary, among the four types of water [conditions], wind-water and skin-water are associated with the exterior, while regular-water and stone-water are associated with the interior. However, wind-water is associated with aversion to wind, while skin-water does not have this aversion. Regular-water may cause wheezing on its own, while stone-water does not. It is essential to differentiate between them in clinical practice. 

    For the treatment of stone-water, [one] may first use warming and supplementing medicinals for the spleen and kidneys, along with assistant medicinals to course the liver and free the network vessels. Examples include Zhēnwǔ Tāng with added gui zhi, chuan lian zi, yuan hu, shi nan teng, as well as aromatic herbs like xiao hui xiang.

    Liu Duzhou on Water Patterns [水证论] – Part 2

    On By eranevenIn Formulas (方剂), Jīn Guì Yào Lüè (金匱要略), Liú Dùzhōu (刘渡舟), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

    From ‘Essential Points on Clinical Patterns in the Shanghan Lun’. [刘渡舟-伤寒论临证指要]

    水气病脉证并治

    Water Qi Disease, Pulses, Patterns, and Treatment. 

    [The following are lines found within the Jingui Yaolue Water Qi chapter] 

    《金匮•水气病脉证篇》：“少阴脉，紧而沉，紧则为痛，沉则为水，小便即难。

    “[When] the shaoyin pulse is tight and deep, tight signifies that there is pain, while deep signifies that there is water, [with] difficult urination.” [JGYL 14.9] 

    脉得诸沉者，当责有水，身体肿重”。

    “[When] all pulses are deep, this is the responsibility of water, and manifests with generalized swelling and heaviness.”  [JGYL 14.10] 

    “跌阳脉当伏，今反紧，本自有寒疝瘕，腹中痛。医反下之，下之则胸满短气。

    “The instep yang pulse should be hidden, but conversely now it is tight, this is because there is cold at the root with mounting conglomerations and abdominal pain. If a physician incorrectly purges, this will result in chest fullness and shortness of breath.” [JGYL 14.6] 

    跌阳脉当伏，今反数，本自有热，消谷，小便数，今反不利，此欲作水”。

    “The instep yang pulse should be hidden, but conversely now it is rapid, this is because there is heat at the root, causing dispersion of grain and frequent urination. If the urination is inhibited, this means water is soon to rise.”  [JGYL 14.7] 

    “寸口脉弦而紧，弦则卫气不行，即恶寒，水不沾流，走于肠间”。

    “[When] the cun kou pulse is wiry and tight, wiry signifies that the defensive [qi] is not moving, which manifests with aversion to cold, and water that does not moisten and flow, [but is] running into the intestines.”  [JGYL 14.9] 

    又“夫水病人，目下有卧蚕，面目鲜泽，脉伏其人消渴，病水腹大，小便不利，其脉沉绝者，有水，可下之。

    “A patient with water disease has sleeping silkworms below the eyes, a bright sheen in the face and eyes, a deep pulse, and dispersion thirst. [If] water disease manifests with an enlarged abdomen, inhibited urination, and a deep and expiring pulse, [this indicates] water, which can be purged.” [JGYL 14.11] 

    又“水病脉出者死。” 

    “In water disease, [when] the pulse bursts out, [the patient] will die.”  [JGYL 14.10] 

    以上援引《金匮》对水肿病的脉诊、色诊、问诊以及预后不良之诊，对指导临床意义非凡。 水气病可分为四种类型：风水、皮水、正水、石水。至于五胜之水气，可列人正水，石水之范畴。 大肿精那实而正不虚的有三种洽疗友法，即发汗，利小便与攻下之法。这就是《内经》说的“开鬼门，洁净府”的治疗原则。

    The above quotes from the “Jingui” regarding the pulse diagnosis, color diagnosis, questioning, and the prognosis of edema have extraordinary significance in guiding clinical practice. Water qi can be classified into four types: wind-water, skin-water, true-water, and stone-water. As for five viscera water qi, they fall into the categories of true-water and stone-water. There are three effective therapeutic methods for excess and non-deficient major swelling, namely sweat effusing, urination disinhibiting, and offensive purging. This corresponds to the treatment principle mentioned in the “Neijing” as “opening the ghost gate and cleansing the mansion.”

    一、风水

    风水由于风邪侵袭肌表，故脉来而浮；若卫气虚不能固表，则脉浮软而见汗出恶风之证；荣卫之行涩，水道不利，而水湿滞于分肉，则身重而懒于活动。

    【治法】疏风益卫，健脾利湿

    【方药】防己黄芪汤

    防已一两，甘草半两（炙），白术七钱半，黄芪一两（去芦）

    上倒麻豆大、每抄五钱匕、生姜四片、大枣一枚、水盏半、煎八分，去渣温服，良久再服。喘者加麻黄半两，胃中不和者加芍药三分，气上冲者加桂枝三分；下有陈寒者加细辛三分。服后当如虫行皮中，从腰下如冰，后坐被上，又以一被绕腰下，温令微汗，瘥。

    I. Wind-Water

    Wind-water occurs due to the invasion of wind pathogens in the fleshy exterior, resulting in a floating pulse. If defensive qi is deficient and cannot secure the exterior, the pulse becomes floating and soft, accompanied by symptoms such as sweating and aversion to wind. The circulation of nutrient and defensive qi becomes obstructed, leading to water stagnation in the muscles, causing heaviness and reluctance to move.

    [Treatment Method] Course wind, boost the defensive [qi], strengthen the spleen, and disinhibit dampness.

    [Prescription] Fangji Huangqi Tang

    Fangji (1-2 liang), Gancao (half liang, roasted), Baizhu (seven and a half qian), Huangqi (1 liang, husked)

    Cut the above [ingredients] to the size of hemp seeds. Scoop up five qian-spoonfuls per dose [and add this with] four slices of shengjiang and one dazao to a cup and-a-half of water. Boil this down to eight tenths and remove the dregs. Take warm and wait a while before taking more. For panting, use an additional half liang of mahuang. For disharmony in the stomach, add three fen of shaoyao. For upward surging qi, add three fen of guizhi. For old cold in the lower body, add three fen of xixin. After taking [the formula, the patient should feel a sensation] like bugs crawling in the skin and icy coldness from the waist down. [Have the patient] sit on a bedcover and wrap another bedcover around them below the waist, to make them warm enough to cause a slight sweat. This will bring about recovery.

    如果风水而一身悉肿，脉浮，恶风，反映了风邪袭于肌表，肺气之治节不利，决渎失司，水溢皮肤，故一身悉肿。风邪客表则恶风，气血向外抗邪故脉浮；风性疏泄可见汗出；汗出则阳气得泄，故身无大热。此证治以越婢汤，宣肺以利小便，清热以散风邪。

    If wind-water manifests in generalized swelling with a floating pulse and aversion to wind, it indicates that wind pathogens have attacked the fleshy exterior. [Here] lung qi is hindered, leading to the loss of control [of water] with water overflowing into the skin, which results in generalized swelling. When wind pathogens settle in the exterior, there is aversion to wind, and [because] qi and blood move towards the surface to contend with the pathogen, the pulse becomes floating. Sweating is a manifestation of the free coursing nature of wind. [With] sweating, yang qi is discharged, therefore there is no major heat in the body. For the treatment of this condition, Yuebi Tang is used to diffuse the lungs, promote urination, and clear heat in order to scatter wind pathogens.

    越婢汤方

    麻黄六两，石膏半斤，生姜三两，甘草二两，大枣十五. 校以水六升，先煮麻黄去上沫，内诸药，煮取三升、分温三服。恶风者加附子一枚，炮。

    方中麻黄宣肺以利水，石膏清解郁热以肃肺气之下降；

    甘草补脾以扶正；姜、枣调和荣卫以行阴阳。

    Yuè Bì Tāng

    Mahuang 6 liang, Shigao 1/2 jin, Shengjiang 3 liang, Gancao 2 liang, Dazao 15 pieces. 

    In 6 sheng of water, first boil the mahuang and remove the foam that rises to the top. Add the remaining ingredients and boil until three sheng remain. Separate and take warm in three doses. With aversion to wind, add one piece of blast fried fuzi. 

    Within the formula mahuang diffuses the lungs and disinhibits water. Shigao clears and resolves depressed heat, addressing the downbearing of lung qi.

    Gancao supplements the spleen in order to support the right [qi]. Shengjiang and dazao harmonize the nutritive and defense in order to move Yin and Yang.

    以上两证，虽同为“风水”而有虚实之分（亦如桂枝汤和麻黄汤虚实之分）。审其虚者，则用防己黄芪汤，一定抓住“身重汗出恶风”的主证；审其实者，则用越婢汤，一定抓住“脉浮、恶风、身肿不渴”的主证。

    The two conditions above, though both involving “wind-water,” are differentiated based on deficiency and excess (similar to the differentiation between Guizhi Tang and Mahuang Tang). For deficiency, use Fangji Huangqi Tang to address the main symptoms of “body heaviness, sweating and aversion to wind.” For excess, use Yuèbì Tāng, focusing on the main symptoms of “floating pulse, aversion to wind, body swelling, and no thirst.”

    对水肿发作时需要察其部位而治之。才能达到“因势利导”使水邪乃服。仲景曰：“诸有水者，腰以下肿，当利小便；腰以上肿，当发汗乃愈。”凡腰以上肿，多因风寒湿邪，侵于肌表，闭郁肺气，水湿停留而成。故治宜宣通肺气，开发毛窍，使在外之水从汗液排出；腰以下肿，有虚有实；虚者为阳气不足，不能化气行水而使水邪停居于下；实者为水湿之邪停留于下而为水肿，但其人正气不虚、脉沉而有力，兼见小便不利，以及腹部胀满证。

    When treating edema, it’s crucial to observe its location and treat accordingly. [When one] is able to “guide ones actions according to the circumstances”, [then] water pathogens can be addressed. Zhang Zhongjing said; 

    “In all cases of water, with swelling below the waist, one must disinhibit urination; for those with swelling above the waist, one must effuse sweat in order to resolve.” 

    All swelling above the waist is often caused by wind-cold-damp, which invade the fleshy exterior and block and depress lung qi, [which results in] the settling of water-damp. Therefore, suitable treatment is to diffuse and free lung qi, open and effuse the orifices, and cause the discharge of water on the surface though the sweat. For swelling below the waist, there is both deficiency and excess. Deficiency is due to insufficiency of yang qi, which is unable to transform qi and move water, which leads to the stoppage and residing of water pathogens in the lower body. Excess is the result of water-damp pathogens that have stopped and settled in the lower body with water swelling. Although the patients right qi is not deficient, the pulse is deep yet strong, and is accompanied by inhibited urination as well as abdominal distention and fullness signs.

    腰以上肿，发汗当用越婢加术汤（即越婢汤加白术四两）；腰以下肿，而阳虚气寒，小便不利当用真武汤；脉沉有力而小便不利者，当用牡蛎泽泻散（牡蛎、泽泻、瓜蒌根、蜀漆、葶苈子、商陆根、海藻各等分，同捣，下筛散），更于白中治之，白饮和服方寸匕，日三服。小便利，止后服。

    For swelling above the waist, [one must] effuse sweat by using Yuebi Jiazhu Tang [Yuebi Tang with 4 liang of Baizhu]. For swelling below the waist, due to yang deficiency qi cold with inhibited urination, use Zhenwu Tang. When the pulse is deep and strong and the urination is inhibited, use Muli Zexie San [equal parts muli, zexie, guslougen, shuqi, tinglizi, shanglugen, and haizao pounded and sieved into a powder].  Work [the powder] in a mortar to blend with a white [rice] cool decoction. Take a square inch spoonful three times a day. [If] urination is uninhibited cease taking [the decoction].

    水之去路有二：在表者发汗，在里者渗利，因势利导，使水气得去而愈。但临床所见，也有腰以上肿，而内渗于里；腰以下肿，而外溢于表，以致肺气不宣，肾气不化，大气不转。如此则可变通其治：如以发汗去其表邪，又要兼用滲利，务使在里之水可以尽去；腰以下肿，既要渗利，又应“提壶揭盖”开其肺气，使上窍通而下窍利，则水邪方能尽去。发汗与利小便治水两大法宝，此外对于正虚者又有温阳化气，健脾运水、扶正祛邪、益气固表等法。应变通选用而不拘于一格。

    There are two roads for the elimination of water: through the exterior by means of sweat effusion, and through the interior by means of percolation and disinhibiting. By guiding one’s actions according to circumstances, water qi can be expelled resulting in resolution [of the condition]. However, in clinic one may see [cases] with swelling above the waist and inward percolation to the interior; swelling below the waist and outward seepage into the exterior resulting in lung qi not diffusing, kidney qi not transforming and major qi not shifting. 

    In such cases, flexibility is needed for treatment, such as effusing sweat to eliminate the exterior pathogen, while at the same time using a percolating and disinhibiting [method] to ensure that water in the interior can be completely expelled.  [For] swelling below the waist, we already want to percolate and disinhibit, and also apply the “lift the pot and remove the lid” [method] to open lung qi, which causes the upper orifices to be free and the lower orifices to be disinhibited, resulting in the complete expulsion of water pathogens. 

    Sweat effusion and disinhibiting urination are two magic weapons for treating water [diseases]. In addition, for those with deficiency patterns, there is the method of warming yang and transforming qi, strengthening the spleen and moving water, supporting the right and dispelling pathogens, and boosting qi to secure the exterior, among other techniques. One should be flexible in choosing and applying these methods, without adhering strictly to a single approach.

    Liu Duzhou on Water Patterns [水证论]

    On By eranevenIn Jīn Guì Yào Lüè (金匱要略), Liú Dùzhōu (刘渡舟), Shāng Hán Lùn (伤寒论)

    From ‘Essential Points on Clinical Patterns in the Shanghan Lun’. [刘渡舟-伤寒论临证指要]

    The following is a direct translation from the water chapter in Professor Liu’s brief but mighty text ‘Essential Points on Clinical Patterns in the Shanghan Lun’. My plan is to translate the entire chapter over the next little while as time permits, with the eventual goal of translating the entire text. This first section provides an overview of the concept and generation of water pathologies. Later sections will discuss the main presentations and treatments. 

    水证”，指的是因于水邪伤人所致的各种病证。

    水是构成人体的重要物质。《佛经》言人禀四大而成形（即地、水、火、风），《内经》言人禀五行而生（即水、火、木、金、土）。但水能载舟，亦能覆舟，有二重性，有其用，亦有其害。今援引《伤寒论》和《金匮要略》两书中的有关水证之文，并参以己意，试论如下。

    The term ‘water patterns’ 水证 refers to the various illnesses caused by damage due to pathogenic water.

    Water is an essential substance in the human body. In the Buddhist scriptures, it is said that humans inherit the four elements to form their bodies (earth, water, fire, and wind), while in the Neijing, it says that humans inherit the five phases to live (water, fire, wood, metal, and earth). However, water, with its dual nature of being able to carry a boat or overturn it, can be both beneficial and harmful. I will now cite the relevant lines on water patterns from the Shanghan Lun and Jingui Yaolue as well as add personal insights, and analysis below.

    水证的形成

    水为有形之邪，其性寒冽，最伤阳气。水在人体的新陈代谢，正如《素问•经脉别论》所说：“饮人于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行，合于四时五脏阴阳，揆度以労常也”。

    考本文之义，是指脏腑气化对水液的代谢而言。

    Formation of Water Disorders

    Water, as a tangible evil, has a cold and icy nature, which is extremely damaging to yang qi. In its discussion on water metabolism in the human body, the chapter on the ‘Differentiation of Channels’ in the Suwen says:  

    “Water is ingested into the stomach, circulates and overflows its essence and qi upward to the spleen, where the spleen’s qi disperses the essence, which ascends to the lungs, [which then] regulate the water pathways, descends [water] to the bladder, and distributes water essence through the four limbs and the five vessels simultaneously. [When] this process aligns with the interaction of the four seasons, the five organs, and yin-yang balance, the estimates and measures [text] regards this as normal.”

    In the context of this text, it refers to the qi transformation of the organs in relation to the metabolism of water and fluids. 

    水先入于胃，藉胃气的腐熟之功，使水液游行于下，并摄取水之精气而上运于脾。夫脾与胃相表里，而又能为胃行其津液，故脾又将水精而上归于肺。归肺之水精，处于上升的阶段，故称“地气上为云”。水至高源，又借肺气的呼吸与“通调”，才能或散或降，而润泽周身。所谓“通调”指肺有通达，调节三焦水道的功能。使水津或向外宣发叫“浮”，或向内下降叫“沉”。若与上述的“地气上为云”对照，这个阶段则叫“天气下为雨”

    Water first enters the stomach, undergoes the fermenting function of stomach qi, allowing the fluid to circulate downward and absorb the essence of water, which then rises to the spleen. The spleen and stomach are interiorly and exteriorly related, and the spleen assists the stomach in managing its fluids, whereas the spleen further transports the essence of water to the lungs. The water essence which has returned to the lungs in the ascending phase, is termed “earthly qi rising as clouds.” When the water reaches its highest source, it relies on the lung qi’s breathing and regulation as well as its “freeing and regulating” [effect] in order to scatter and descend, thereby moistening the entire body. The term “freeing and regulating” refers to the lung’s function in coordinating the water pathways of the Triple Burner. The movement of water-fluids towards the exterior through diffusion and effusion is referred to as “floating”, [while] downward descending internally is referred to as “sinking”. This process, compared to the earlier phrase “earthly qi rising as clouds,” is described as “heavenly qi descending as rain.”

    凡下行之水，最后必归于肾，藉肾的气化功能，又使水之清者，上升于肺；水之浊者，则下输膀胱，或蓄或泻，以为生理之常。这就不难看出，水的代谢，是由胃、脾、肺、肾、三焦五经之气；经过升、降、浮、沉的生理运动，方成其“水精四布，五经并行”的新陈代谢作用. 如果“五经”之气化失调，则使司水之功能受到障碍，尤以阳气不能化阴，气机不能行水之故，则使水的代谢，不能顺利进行，因而构成气寒水凝，或流溢失序，或上冒清阳，水之气为寒，寒阴邪必犯阳气，因此，水寒浩淼难制，在表在里，沿三焦以为害，于是各种水证逐次发生。

    All descending water ultimately returns to the kidneys. Through the kidney’s transformative function, clear water ascends to the lungs, and turbid water descends to the bladder, either accumulating or releasing, maintaining a physiological balance. It is evident that water metabolism involves the qi of the stomach, spleen, lungs, kidneys, and the Triple Burner, undergoing physiological movements of ascending, descending, floating, and sinking, resulting in the dynamic metabolic functions of “distributing water essence through the four limbs and the five vessels simultaneously.” 

    If there is an imbalance in the qi transformation of the “five vessels,” hindering the water regulatory functions, especially the inability of yang qi to transform yin, and the inability of the qi mechanism to manage water, water metabolism cannot proceed smoothly. This disruption leads to the formation of cold-water congealment, chaotic overflow, or the upward surge of clear yang. As the qi of water is cold, this invariably invades yang qi. As a result, this vast cold water is difficult to control, causing harm both externally and internally along the Triple Burner, leading to the successive occurrence of various water disorders.

    “水肿”，肿之由于水气者。《灵枢•水胀篇》曰：“水始起也。目窠上微肿，如新卧起之状，其颈脉动时咳，阴股间寒，足胫肿，腹乃大，其水已成矣。以手按其腹，随手而起，如裹水之状，此其候也”。

    《素间•气厥论》曰：“肺移寒于肾，为涌水。涌水者，按腹不坚，水气客于大肠，疾行则鸣濯濯，如囊裹浆，水之病也”。

    Water swelling/edema [水肿] is a condition caused by water qi. The Lingshu, Water distention chapter states: 

    “[When] water begins to rise the eye sockets are slightly swollen, like the appearance upon waking. The neck pulses move with coughing at times. [When] there is cold between the yin thighs [inside of the thighs], swelling of the legs and ankles, and the abdomen becomes large, [this[ indicates that water has already accumulated. When pressing the abdomen with the hands, it rises along with the hands, resembling a water-filled state. These are its signs.”

    The Suwen, Discourse on qi desertion says: 

    “If the lungs transmit cold to the kidneys, it results in surging water. In surging water, the abdomen is not firm when pressed. Water qi has settled in the large intestine. [If] the patient moves quickly, there are gurgling sounds, similar to a bag holding fluids. This is a water disease.”

    《水热穴论》“肾何以能聚水而生病？肾者，胃之关也，关门不利，故聚水而从其类也。上下溢于皮肤，故为附肿。胕肿者，聚水而生病也”。

    水肿为脾、肺、肾三脏之病变。盖水为至阴，其本在肾；水化于气，其标在肺；水惟畏土，其制在脾。若肺虚则气不化精而化水；脾虚则土不制水而反乘，肾虚则水无所主而妄行。水不归经，则逆而上泛，故传人于脾，则肌肉浮肿；传入于肺，则气息喘急。分而言之，三脏各有所主；合而言之，则总由火气衰微，肾中之气不能化，故水道不通，溢而为肿. 

    The Suwen, Discourse on Acupoints to treat Water and Heat says: 

    “The kidneys, how can they generate disease by gathering water? The kidneys are the gate of the stomach. If the gate is not [opening] freely, water accumulates and follows its kind. Above and below it overflows to the skin, causing attached swelling. Swelling is the result of water accumulation.”

    Edema is a pathological change involving the spleen, lungs, and kidneys. Since water is extreme yin, its root is in the kidneys; water transforms into qi, and its manifestation is in the lungs; water fears earth, and its control is in the spleen. If the lungs are deficient, qi cannot transform into essence but transforms into water. If the spleen is deficient, earth cannot control water and, instead, is overcome by it. If the kidneys are deficient, water has no master and flows recklessly. When water does not follow its channel, it runs counterflow and floods upwards. When it enters the spleen, muscles become swollen; when it enters the lungs, breathing becomes rapid. In summary, each organ has its respective role, but it is ultimately due to the decline of fire qi, resulting in the inability of kidney qi to transform, leading to obstruction of the waterways, overflow, and swelling.

    Cinnamon Twig Decoction (guì zhī tāng)

    On By eranevenIn Case Studies （医案), Huáng Huáng (黃煌), Jīng Fāng (经方), Translations & Writings (译著与文章)

    The following is a very small snippet of the common cold/influenza section from our translation of Professor Huáng Huáng’s latest book, which will be published and released in January 2024 by Eastland Press. I am so honoured to have been a part of the translation team for this beautiful book alongside Daniel Eng and Craig Mitchell. Hope you enjoy.

    Indications: Used for deficient patients who have come down with the common cold. This formula is commonly used for common colds in patients who have had major illnesses, surgery, chemotherapy, excessive medications, are menstruating or are postpartum, have congenital weaknesses, are debilitated, elderly, or are frequently ill. It has been observed in clinical practice that many of these patients do not present with obvious fevers, but instead with fear of cold, weakness, a runny nose with clear mucus, and a pale and dark tongue; These patients commonly experience spontaneous sweating, an aversion to drafts, fever or a subjective sensation of being hot, a feeling of upward surging, palpitations, and a floating, weak and slack pulse.

    Important Issues: After taking the formula, one should drink hot congee. The congee can be made of millet or rice, which should be cooked over a gentle heat until the grain has broken down completely. The second important issue is that drafts and cold should be avoided, and ideally one should cover up until a sweat has been obtained. The third is that the patient should be advised to consume light and bland food and drink in order to avoid any extra burden on the digestive system.

    Usage And Modifications:

    1. This is an ancient formula used for strengthening and fatigue recovery. It is applicable for diseases with signs and symptoms of palpitations, abdominal pain, spontaneous sweating, emaciation, a weak pulse, etc. It can also adjust and regulate a weak and deficient constitution. It is unsuitable for overweight patients or those with edema.

    2. Modifications:

    • For fatigue, profuse sweating, and cold and painful joints, add Aconiti Radix lateralis praeparata (zhì fù zǐ) 10g.

    • For profuse sweating and a sallow complexion, add Astragali Radix (huáng qí) 15g.

    With emaciation and a poor appetite, add Codonopsis Radix (dǎng shēn) 15g

    With stiffness and pain in the nape and back, dizziness and headache, add Puerariae Radix (gé gēn) 30g.

    Representative Case History:

    Fifty-four-year-old female, 156cm/64kg.

    Initial consultation on September 27, 2014.

    History: Sinusitis for over 20 years, with a weekly tendency to catch a cold. With these colds she would experience headaches, frequent sneezing, an aversion to drafts, and sweating from the head. She would also be hungry easily, crave sweet foods, and have a difficult time falling asleep.

    Signs: dark, red complexion; dark and dull lips; dark, red tongue; a thick tongue coating; and a moderate pulse, at 72 beats per minute.

    Prescription: Cinnamomi Ramulus (guì zhī) 10g, Cinnamomi Cortex (ròu guì) 5g, Paeoniae Radix alba (bái sháo) 15g, Zingiberis Rhizoma (gān jiāng) 5g, Jujubae Fructus (dà zǎo) 30g, Glycyrrhizae Radix (gān cǎo) 10g, Astragali Radix (huáng qí) 30g; 10 packets; 5 days on and 2 days off.

    Second consultation on October 7, 2014: After taking the formula, she did not sneeze, and had not contracted a common cold in 7 days. Her appetite and sleep were improved, yet she still woke easily. She continued with another 15 packets of the same formula, one packet taken every other day.

    Transformative Tales: Harnessing the Power of Chinese Medicine – Two Remarkable Case Studies

    On By eranevenIn Case Studies （医案), Formulas (方剂), Jīn Guì Yào Lüè (金匱要略), Medicinals (中草药), Translations & Writings (译著与文章)

    I’d like to share two cases from my personal clinic, involving patients I saw this week for follow-up after they started their Chinese herbal formulas. The first patient had never tried Chinese herbs before, so this was a new experience for her. The second patient, of Chinese descent, had grown up taking herbs her grandmother would prepare for her, so she was quite used to the ‘deliciousness’ of the herbs. The purpose of these two cases is to illustrate the remarkable effectiveness of Chinese herbal medicine, especially in situations where their allopathic physicians had few treatment options to offer.

    In a follow up post, I will discuss my reasoning for the formula selections as well as the underlying mechanisms involved.

    Case 1

    Initial consultation on August 25, 2023.

    A 43-year-old female presented with a longstanding issue of pain in her hands that had been bothering her for over 15 years, and it had recently worsened. This pain was significantly affecting her ability to work, as she is a sculptor and a professor. She had been managing the pain with Ibuprofen, but this approach had become less effective in recent times.

    The pain was localized exclusively to her hands and would cause them to swell up easily, appearing “puffy” without any noticeable discoloration. This pain also had a negative impact on her range of motion and grip strength, which was affecting her ability to engage in activities such as swimming. Rest provided some relief from the pain. Additionally, she was experiencing edema in her feet and hands and had frequent and inhibited urination. She also reported occasional dry mouth and thirst, and her hands, feet, and nose would become cold while the rest of her body remained warm.

    Despite these discomforts, she maintained a good appetite without experiencing bloating. She mentioned being a light sleeper and often woke up due to the pain. The patient also had varicose veins and spider veins, dry heels, and occasional headaches. She had a tendency to sweat easily.

    Notably, there were no complaints of dizziness or palpitations, and while she experienced occasional nausea, it was not a frequent occurrence. Her bowel movements were regular. The consultation was conducted via video, so no pulse reading was performed.

    Formula: Fangji Huangqi Tang + Wuling San + Guizhi Fuling Wan

    Fangji 18g
    Huangqi 25g
    Cangzhu 20g
    Gancao 15g
    Ganjiang 18g
    Fuling 20g
    Zhuling 18g
    Zexie 25g
    Guizhi 20g
    Chishao 20g
    Mudanpi 20g
    Taoren 18g

    Raw herb powder – 9g daily.

    Follow-up on September 29, 2023. The patient reported significant improvement. After just one week on the prescribed formula, the pain in her hands had subsided dramatically, and she has not experienced any soreness or flares since then. She has not needed any pain medication and was able to swim and work without any issues. The swelling in her hands and feet had also reduced, with a more substantial improvement in her hands. Urination was less inhibited and easier, and all other symptoms were under control.

    The same formula was continued for the time being, with a follow-up scheduled for November.

    Case 2

    Initial consultation on August 25, 2023.

    A 37-year-old female presented with a chronic issue of dry eyes that had been troubling her for several years. Notably, the condition had been progressively worsening over the past few months. Her eyes would frequently become red, feel gritty, and occasionally produce excess tears, although this excessive tearing did not alleviate the dryness. She found wearing contact lenses uncomfortable. She had undergone a procedure before COVID to address potential blockages, but it had provided limited relief, and she had not pursued any further procedures since then. She also experienced frontal headaches, which were related to eye strain. She had a tendency to feel cold easily, suffered from hot flashes preceding her menstrual period, and had regular bouts of constipation, with a bowel movement occurring every other day. Additionally, she complained of dryness in her mouth and throat. She had previously received treatment for dizziness, which was no longer a concern. There were no issues with nausea, night sweats, palpitations, sleep quality, or appetite, and she did not experience reflux. Pulses were deep-thin and wiry bilaterally.

    Formula: Wen Jing Tang (standard doses), with the addition of Gegen (25g) and Juhua (20g). Raw herb powder – 8g daily.

    Follow-up on September 29, 2023: the patient reported experiencing several good days over the past month when her eyes felt great. While there were still some bad days, these were often associated with increased screen time and the quality of her sleep the night before. The redness in her eyes had significantly reduced, and they were no longer gritty. She also noticed that she could lubricate her eyes more easily with a few blinks, whereas previously, it took several minutes. Although there was improvement in her bowel movements, they were not yet perfect. She had also observed a warm sensation throughout her body after drinking the formula, and her general sensitivity to cold had improved. The patient had recently experienced a canker sore outbreak, and had neglected to mention during the previous visit that this was a relatively common experience during times of stress. A week prior to the follow-up appointment, she had undergone an eye assessment, which diagnosed her with moderate-severe dry eye syndrome. Treatment options involving invasive procedures were offered, but given the positive effects of the herbs thus far, she opted to monitor her progress over the next few months before deciding on any further procedures. The same formula was continued, with Wuzhuyu reduced to 6g and the addition of Huanglian (6g) and Zhishi (18g).