Comprehensive Collection of Famous Classics in Traditional Chinese Medicine Internal Medicine

Author: Chief Editor: Sheng Weizhong
Publisher:
Publishing Date: 1997-08-01
Features: Excerpt: Volume One Distinguishes Yin and Yang Syndromes: "How profound! Yin and Yang syndromes cannot be overlooked. Observing the Neijing, where it discusses the transformations of myriad diseases, their origins are all due to excessive joy and anger, irregular diet, improper cold and heat exposure, and injuries from labor. The six are the original qi, grain qi, nourishing qi, clear qi, defensive qi, and the ascending qi of the Yang organs. These are all synonyms for the qi of the stomach and spleen; in essence, they are one. If the spleen and stomach are injured, the middle qi is deficient; if the middle qi is deficient, the yang qi of all six fu organs is extinguished externally. Therefore, the Classics state that when the qi of the five zang organs is extinguished externally, it is the disease of the original qi of the six fu organs. When qi injures the zang, the form responds, indicating that the true qi of the five zang and six fu organs is all deficient. Only yin fire is excessively, dominating the yang, causing the defensive qi and nourishing qi to lose their guard, and various diseases arise. The transformations are all due to the deficiency of the middle qi, which gives rise to them. Later, if the spleen and stomach suffer from labor and injury, and diet is again irregular, indulging in illness for a long time, when things calm down and the heart is at ease, excessive eating leads to a severe exacerbation of the disease. In general, external injuries from wind-cold and the six pathogenic evils are excess syndromes, which should be purged, not tonified; irregular diet and middle qi deficiency are deficiency syndromes, which should be tonified, not purged. All physicians in the world take the syndrome of irregular diet, labor and injury, and middle qi deficiency, which should be tonified, as excess syndromes of external wind-cold and pathogenic evils, excessively purging the exterior, causing the defensive and nourishing qi to extinguish externally, and death occurs within ten days. As the ancients said, 'A slight error leads to a vast divergence; can it not be clearly distinguished?' According to the Yin-Yang Correspondence Grand Theory: 'The pathogenic evils of heaven affect the five zang organs when they are sensed.' The eight beneficial evils are wind evils that injure the tendons and bones. Wind enters from above, injuring the tendons, and cold injuring the bones, as they are tangible substances affected by disease, located in the lower jiao, the liver and kidney. The liver and kidney are the qi of the earth. The Difficult Classic explains: 'The qi of the liver and kidney has been extinguished internally, as the liver governs the tendons and the kidney governs the bones. Therefore, when wind evils are sensed, the tendons and bones ache. When the tendons and bones are extinguished, the root of the liver and kidney is also extinguished, which is an excess syndrome.' It also states: 'The cold and heat of food and drink affect the six fu organs when sensed.' The seven damages are internal injuries from diet. The Yellow Emperor's Acupuncture Classic explains: 'Appropriate diet is not observed, and labor and injury are excessive, with dampness entering from below. This refers to the deficiency of the qi of the spleen and stomach, which instead flows downward, and to the extreme, the fire of the pulse reverses upward. This is the disease of the invisible original qi, located in the upper jiao, the heart and lung. The heart and lung are the qi of heaven. Therefore, the Difficult Classic explains: 'The qi of the heart and lung has been extinguished externally, as the heart governs the nourishing qi and the lung governs the defensive qi. Nourishing qi is blood, and the vessels are the house of blood, where the spirit resides. Defensive qi is the alias of the seven spirits of the original qi, protecting the whole body, located in the skin and hair. When the lung is extinguished, the skin and hair are extinguished first, and the spirit has no place to rely on. Therefore, internal injuries from diet also cause aversion to wind and cold, as the nourishing and defensive qi are lost, and there is no yang to nourish the skin and hair, unable to resist wind and cold. When the skin and hair are extinguished, the root of the heart and lung is also extinguished. This is because the stomach qi does not ascend, and the original qi does not generate, unable to nourish the heart and lung, which is a deficiency syndrome.' Among those who are ill, those who suffer from irregular diet, labor and injury, and then are injured by excessive eating are extremely numerous, while those injured externally are occasionally found. The common people do not understand, often mistaking deficiency syndromes of the original qi as excess syndromes of external wind-cold and surface fullness, and instead draining the heart and lung, excessively extinguishing the exterior, how can they not die? The ancients said, 'Excessively treating excess and deficiency treating deficiency—doctors kill them!' If not, let the ears and eyes of the common people bear witness. Previously, in the year Renchen, the capital was placed under martial law, and by the late March, those who were besieged suffered for half a month. After the siege was lifted, not a single person in the capital was unaffected, and those who fell ill and died followed one after another. In the twelve gates of the capital, each gate sent daily, with the most sending two thousand and the least not less than a thousand, like this for nearly three months. Are these millions all suffering from external wind-cold and injury? Generally, within the besieged city, irregular diet and labor and injury are well known. Due to hunger in the morning and excessive eating in the evening, irregular living habits, improper cold and heat exposure, and movement for three or two months, the stomach qi has been deficient for a long time. Suddenly, after excessive eating, they are injured, and if treatment is improper, death is inevitable. Not only is this the case in Daliang, but in the Zhenyou and Xingding periods, places like Dongping, Taiyuan, and Fengxiang, after the siege was lifted, many suffered from illness and death. When I was in Daliang, I personally witnessed cases where the exterior was attacked, some were purged with , and some were purged with Chengqi Tang. Soon, they developed and jaundice, and then were treated with Xianteng Tang, pills, and Chenping Tang, and none survived. This was not originally cold damage, but due to treatment errors, it became similar to true cold damage, all the fault of the medicine. The past cannot be changed, but the future can still be addressed. I have written an essay titled Distinguishing Internal and External Injuries and Dispelling Confusion, based on the effective methods I have tested in my life, explaining the remaining theories of the ancients, listing the changes of recent times, hoping that those who are like-minded can examine whether they are correct, learn by analogy, and avoid the mistakes of future generations. What crime can I escape by daring to change them?
In ancient times, pulse diagnosis distinguished between internal and external injuries by examining the Ren and Qi gates. If the pulse at Ren was larger than at Qi, it was external injury; if the pulse at Qi was larger than at Ren, it was internal injury. This method of differentiation is correct, but it is not complete. External wind-cold syndromes are excess syndromes, as the guest evils come first, and the disease must appear on the left hand. The left hand governs the exterior, and it circulates the Yang twenty-five times. Internal injuries from diet and irregular diet, as well as excessive labor and injury, are all deficiency syndromes, which must appear on the right hand. The right hand governs the interior, and it circulates the Yin twenty-five times. Therefore, external wind-cold syndromes cause the Ren pulse at the left cun to be floating and tense, and upon pressing, it becomes large and strong. Tension is more urgent than stringiness, indicating the pulse of the foot Taiyang and cold water. Upon pressing, it is large and strong, with the pulse of the hand Shaoyin heart fire appearing, Ding and Ren combining, internally revealing large and strong, which is the pulse of cold damage. If external wind injury occurs, the Ren pulse is slow and larger than the Qi pulse by one, two, or three times. If internal injury occurs from diet, the Qi pulse at the right cun is larger than the Ren pulse by one time. If the injury is severe, it is twice as large if it affects the Shaoyin, and three times as large if it affects the Taiyin. This is the pulse of internal injury from diet. If diet is irregular and labor and injury are excessive, the heart pulse appears at the Qi gate, indicating that the heart fire punishes the lung, and the liver wood, aided by the heart fire, also attacks the lung. The classics say: 'To offend the overpowered and to be fearless is to be.' Therefore, the pulse at the Qi gate is tense, large, and rough, with intermittent roughness. Roughness is the original pulse of the lung; intermittent indicates that the original qi is not connected. The pulse of the spleen and stomach deficiency is large and strong with rapidity, indicating that the heart fire punishes the lung; tension indicates that the liver wood, aided by the heart fire, reversely the lung metal. If there is no excessive labor and injury, only the pulse of the spleen at the right guan is large and rapid, larger than the other five pulses, with rapidity showing slowness, and intermittent roughness. If diet is irregular and cold and heat exposure are improper, the pulse of the stomach at the right guan is first weakened, and to the extreme, it is invisible, only revealing the large and rapid pulse of the spleen with slowness, and intermittent roughness. If there is undigested food, the pulse at the right guan is deep and slippery. The classics say: 'A slippery pulse indicates undigested food.' With this differentiation, is it not clear and obvious? However, in the mountains and wilds, without a doctor, how can the pulse be diagnosed? Therefore, I also describe the syndromes to distinguish them.
Distinguishing between cold and heat: External wind-cold syndromes and the disease from irregular diet, labor, and injury, as well as internal injury from diet, all have cold and heat. All physicians in the world take the disease from irregular diet, labor, and injury as external wind-cold and excess syndromes of the exterior, excessively purging the exterior, and countless people die in vain! This is all because they do not distinguish between cold and heat. Now, let me explain it in detail. External wind-cold causes fever and aversion to cold, with both cold and heat appearing together. The heat is a scorching heat, and a floating heat, as if feathers brush the skin, indicating that the heat is on the exterior, as the cold evil invades the high. The skin and hair are the division of yang, the part nourished by the original defensive qi. When the cold evil invades, it suppresses the yang, and the yang cannot extend, so it causes fever. The face is red, the nose is blocked and obstructed, the heart is restless and agitated, and it is slightly as if the skin is exposed, unable to resist the cold. The superficial heat of the exterior is limited to this. The aversion to cold is such that even if heavy clothes are worn, curtains are drawn, and one is near a blazing fire, they cannot resist the cold. Day by day, the aversion to cold increases, and it only stops when it enters the interior and manifests as lower syndromes. The cold and heat alternate without interruption. The disease from irregular diet, labor, and injury, or from injury, may also have a headache, nape pain, and lower back pain, which are slightly similar to the superficial syndrome of Taiyang, but the rest is different, as explained in the text. The deficiency disease of the interior has no yang on the exterior to resist wind and cold, which is often the case. The restless heat in the kidney region occurs occasionally, and is slightly different from external and internal cold evil. The aversion to wind and cold is due to the deficiency of the spleen and stomach, and the nourishing qi flows downward to dominate the kidney and liver, which is the gradual progression of phlegm and qi inversion. If the stomach qi is normal, when food enters the stomach, the nourishing qi rises to soothe the heart and lung, nourishing the original qi of the skin and hair of the upper jiao. When it flows downward, the heart and lung have no reception, and there is no yang in the skin and hair, losing the protection of the nourishing and defensive qi, so the yang part between the skin and hair is weak, and they are easily aversed to wind and cold, or when in a cold and damp place, without any sunny place, they are aversed to it. This is often the case and does not interrupt. But if they avoid wind and cold and seek warm places, or add clothing and bedding to warm and nourish the skin, the aversion to wind and cold disappears. This heat is not the superficial heat of cold damage, but the restless heat in the kidney region caused by the dampness flowing downward from the spleen and stomach, blocking the lower part, causing yin fire to rise, causing steamy restless heat, reaching the top of the head, spreading to the skin and hair, and restless heat throughout the body. It must be that when the clothes are removed and one lives in a cold and damp place, it is resolved, or when the heat is extreme and sweating occurs, it is resolved. How can external aversion to wind and cold cause sweating? If sweating occurs, the disease is cured. With this differentiation, is it not as clear as black and white? When the interior is deficient and injured, the heat is dry. Or, if wind and cold are inhaled, they suppress the yin fire, causing the throat and esophagus to be blocked. The inhaled air wants to enter, but is resisted by the fire of the pulse above the diaphragm, preventing the yin qi from entering. The qi in the chest is blocked by external wind and cold and cannot extend, causing the mouth to open and eyes to stare. To the extreme, the sound is emitted externally, and the qi cannot ascend or descend, blocking the throat and the qi wanting to exhaust.