方书谓下焦之火生于命门，名为阴分之火，又谓之龙雷之火，实肤浅之论也。下焦之火为先天之元阳，
生于气海之元气。盖就其能撑持全身论，则为元气；就其能温暖全身论，则为元
阳。此气海之元阳，为人生命之本源，无论阴分、阳分之火，皆于此肇基。气海，纯系脂膜护绕抟结而成。
其脂膜旁出一条，与脊骨自下数第七节相连。夹其七节两旁，各有一穴，《内经》谓七节之旁中有小心也。而
气海之元阳由此透入脊中，因元阳为生命之本，故于元阳透脊之处谓之命门。由斯观之，命门之实用，
不过为气海司管钥之职，下焦之火，仍当属于气海之元阳。论下焦之火上窜不归原，亦气海元阳之浮越也。
然其病浑名火不归原，其病因原有数端，治法各有所宜，爰详细胪列于下。
有气海元气虚损，不能固摄下焦气化，致元阳因之浮越者。其脉尺弱寸强，浮大无根。其为病，或头目
眩晕，或面红耳热，或心热怔忡，或气粗息贲。宜治以净萸肉、生山药各一两，人参、玄参、代赭石、生
龙骨、生牡蛎各五钱。心中发热者，酌加生地黄、天冬各数钱，补而敛之，镇而安之，元阳自归其宅也。
方中用赭石者，因人参虽饶有温补之性，而力多上行，与赭石并用，则力专下注，且赭石重坠之性，又善佐
龙骨、牡蛎以潜阳也。有下焦真阴虚损，元阳无所系恋而浮越者。其脉象多弦数，或重按无力。其证时作
灼热，或口苦舌干，或喘嗽连连。宜用生山药、熟地黄各一两，玄参、生龙骨、生牡蛎、生龟板、甘枸杞各
五钱，生杭芍三钱，生鸡内金、甘草各钱半。此所谓壮水之主，以制阳光也。
若其下焦阴分既虚，而阳分亦微有不足者，其人上焦常热，下焦间有觉凉之时，宜治以《金匮》崔氏八味
丸，以生地易熟地（原方干地黄即是药局中生地），更宜将茯苓、泽泻分量减三分之二，将丸剂一料，
分作汤药八剂服之。
有气海元阳大虚，其下焦又积有沉寒锢冷，逼迫元阳如火之将灭，而其焰转上窜者。其脉弦迟细弱，或
两寸浮分似有力。其为证∶心中烦躁不安，上焦时作灼热，而其下焦转觉凉甚，或常
作泄泻。宜用乌附子、人参、生山药各五钱，净萸肉、胡桃肉各四钱，赭石、生杭芍、怀牛膝各三钱，云
苓片、甘草各钱半。泄泻者宜去赭石。此方书所谓引火归原之法也。方中用芍药者，非以解上焦之热，以其与
参、附并用，大能收敛元阳，下归其宅。然引火归原之法，非可概用于火不归原之证，必遇此等证与脉，
然后可用引火归原之法，又必须将药晾至微温，然后服之，方与上焦之燥热无碍。
有因冲气上冲兼胃气上逆，致气海元阳随之浮越者。其脉多弦长有力，右部尤甚，李士材脉诀歌括所谓
直上直下也。其证觉胸中满闷烦热，时作呃逆，多吐痰涎，剧者觉痰火与上冲之气杜塞咽喉，几不能息。
宜治以拙拟降胃镇冲汤（方见“论冲气上冲之病因病状病脉及治法”一节），
俾冲、胃之气下降，而诸病自愈矣。
有因用心过度，心中生热，牵动少阳相火（即胆肝中所寄之相火），上越且外越者。其脉寸关皆有力，多
兼滑象，或脉搏略数。其为病∶心中烦躁不安，多生疑惑，或多忿怒，或觉热起胁下，散于周身。治用生怀
山药细末六七钱，煮作粥，晨间送服芒硝三钱，晚送服西药臭剥两瓦。盖芒硝咸寒，善解心经之热，以开心
下热痰（此证心下多有热痰）；臭剥性亦咸寒，能解心经之热，又善制相火妄动。至送以山药粥者，因咸寒
之药与脾胃不宜，且能耗人津液，而山药则善于养脾胃、滋津液，用之送服硝、剥，取其相济以成功，
犹《金匮》之硝石矾石散送以大麦粥也。
有因心肺脾胃之阳甚虚，致寒饮停于中焦，且溢于膈上，逼迫心肺脾胃之阳上越兼外越者。其脉多弦迟
细弱，六部皆然，又间有浮大而软，按之豁然者。其现证∶或目眩耳聋，或周身发热，或觉短气，或咳喘，
或心中发热，思食鲜果，而食后转觉心中胀满病加剧者。宜用拙拟理饮汤。服数剂后，心中不觉热、转觉凉
者，去芍药。或觉气不足者，加生箭 三钱。此证如此治法，即
方书所谓用温燥健补脾胃之药可以制伏相火。不知其所伏者非相火，实系温燥之药能扫除寒饮，而心肺脾胃
之阳自安其宅也。
上所列火不归原之证，其病因虽不同，而皆系内伤。至外感之证，亦有火不归原者，伤寒、温病中之戴
阳证是也。其证之现状∶面赤、气粗、烦躁不安，脉象虽大，按之无力，又多寸盛尺虚。此乃下焦虚寒
孤阳上越之危候，颇类寒温中阴极似阳证。然阴极似阳，乃内外异致，戴阳证乃上下异致也。宜用《伤寒论》
通脉四逆汤，加葱、加人参治之（原方原谓面赤者加葱，面赤即戴阳证）。
特是戴阳之证不一。使果若少阴脉之沉细，或其脉非沉细而按之指下豁然毫无根柢，且至数不数者，
方可用通脉四逆汤方。若脉沉细而数或浮大而数者，其方即断不可用。曾治王××，年四十余，身形素虚，
伤寒四五日间，延为诊视。其脉关前洪滑，两尺无力。为开拙拟仙露汤，因其尺弱嘱其将药徐徐饮下，一次
只温饮一大口，防其寒凉侵下焦也。病家忽愚所嘱，竟顿饮之，遂致滑泻数次，多带冷沫，上焦益觉烦躁，
鼻如烟熏，面如火炙，其关前脉大于从前一倍，数至七至。知其已成戴阳之证，急用野台参一两，煎汤八分
茶盅，兑童便半盅（须用五岁以下童子便），将药碗置凉水盆中，候冷顿饮之。又急用知母、玄参、生地各
一两，煎汤一大碗候用。自服参后，屡诊其脉。过半点钟，脉象渐渐收敛，脉搏似又加数，遂急用候服之药
炖极热，徐徐饮下，一次只饮药一口，阅两点钟尽剂，周身微汗而愈。
按∶此证上焦原有燥热，因初次凉药顿服，通过病所，直达下焦，上焦燥热仍留。迨下焦滑泻，元阳
上浮，益助上焦之热，现种种热象，脉数七至。此时不但姜、附分毫不敢用，即单用人参，上焦之燥热亦必
格拒不受。故以童便之性下趋者佐之，又复将药候至极凉顿服下。迨迟之有倾，脉象收敛，至数加数，是下
焦得参温补之力而元阳收回，其上焦因参反激之力而燥热益增
也。故又急用大凉大润之药，乘热徐徐饮之，以清上焦之燥热，
而不使其寒凉之性复侵下焦。此于万难用药之际，仍欲用药息息吻合，实亦费尽踌躇矣。
医书称下焦之火生于命门，称为阴分之火，又叫做龙雷之火，这实在是肤浅的论断。下焦之火是先天之元阳，产生于气海的元气。大概从它能支撑全身功能来看，就称之为元气；从它能温暖全身来看，就称之为元阳。这个气海中的元阳，是人的生命本源，无论阴分还是阳分的火，都从这里奠定基础。气海，完全是由脂膜包裹、环绕、凝聚而成的。它的脂膜旁边伸出一条，与脊柱自下数第七节相连。在第七节两旁各有一个穴位，《内经》说“七节之旁中有小心”。而气海的元阳由此透入脊中，因为元阳是生命的根本，所以在元阳透入脊骨的地方称为命门。由此看来，命门的实际作用，不过是作为气海管理钥匙的职能，下焦的火，仍应当归属于气海的元阳。论述下焦之火上窜而不回归本源，也是气海元阳的浮越。然而这种病笼统地称为“火不归原”，其病因原本有几端，治法各有适宜之处，于是详细列举如下。
有因气海元气虚损，不能固摄下焦气化，导致元阳因此浮越的。其脉象尺部弱、寸部强，浮大而无根。其病症表现，或是头目眩晕，或是面红耳热，或是心中发热、心悸怔忡，或是呼吸粗重、气息上逆。适宜用净山茱萸、生山药各一两，人参、玄参、代赭石、生龙骨、生牡蛎各五钱来治疗。如果心中发热，酌情加入生地黄、天冬各数钱，以补益而收敛，镇潜而安神，元阳自然回归其宅舍。方中使用赭石的原因，是因为人参虽然富有温补的性质，但药力多向上行，与赭石并用，则药力专一向下注，而且赭石沉重坠降的性质，又善于辅助龙骨、牡蛎来潜降阳气。
有因下焦真阴虚损，元阳无所系恋而浮越的。其脉象多弦数，或重按无力。其证候时常发作灼热感，或是口苦舌干，或是气喘咳嗽不止。适宜用生山药、熟地黄各一两，玄参、生龙骨、生牡蛎、生龟板、甘枸杞各五钱，生杭白芍三钱，生鸡内金、甘草各钱半。这就是所说的“壮水之主，以制阳光”的方法。
如果其下焦阴分既已虚损，而阳分也微有不足的，其人上焦常觉发热，下焦间或有感觉凉爽的时候，适宜用《金匮要略》崔氏八味丸（即金匮肾气丸）治疗，用生地黄代替熟地黄（原方中的干地黄就是药局中生地黄），更宜将茯苓、泽泻的分量减少三分之二，将一料丸剂分成八剂汤药服用。
有因气海元阳大虚，其下焦又积存有深重的寒邪冷积，逼迫元阳如同火即将熄灭时，火焰反而上窜的情况。其脉象弦迟细弱，或两寸脉浮取时似乎有力。其证候表现为：心中烦躁不安，上焦时常发作灼热感，而下焦反而觉得非常凉，或者经常发生泄泻。适宜用乌附子、人参、生山药各五钱，净山茱萸、胡桃肉各四钱，赭石、生杭白芍、怀牛膝各三钱，云苓片、甘草各钱半。如果有泄泻症状，应当去掉赭石。这是医书中所谓的“引火归原”的方法。方中使用芍药，不是为了疏散上焦的热邪，而是因为它与人参、附子并用，能大大收敛元阳，使其下归其宅。然而，“引火归原”的方法，不能一概用于所有“火不归原”的证候，必须遇到此类证候与脉象，然后才可用“引火归原”之法，而且必须将药物晾至微温后，再服用，这样才不会对上焦的燥热造成妨碍。
有因冲气上冲兼胃气上逆，导致气海元阳随之浮越的。其脉象多弦长有力，右部尤其明显，李士材脉诀歌括中所说的“直上直下”即是此象。其证候感觉胸中满闷烦热，时常发生呃逆，多吐痰涎，严重时感觉痰火与上冲之气堵塞咽喉，几乎无法呼吸。适宜用本人拟定的降胃镇冲汤（方见“论冲气上冲之病因病状病脉及治法”一节），使冲气、胃气下降，各种病症自然痊愈。
有因用心过度，心中生热，牵动少阳相火（即寄居于胆肝中的相火），向上且向外浮越的。其脉象寸部、关部皆有力，多兼滑象，或脉搏略微偏数。其病症表现为：心中烦躁不安，多生疑惑，或多发愤怒，或感觉热气从胁下升起，散布于周身。治疗用生怀山药细末六七钱，煮成粥，早晨送服芒硝三钱，晚上送服西药臭剥（Bromine，溴）两瓦（约12克）。盖因芒硝咸寒，善于解除心经的热邪，以开通心下的热痰（此证心下多有热痰）；臭剥性质也是咸寒，能解除心经的热邪，又善于制约相火的妄动。至于用山药粥送服，是因为咸寒的药物与脾胃不相宜，且会耗伤人的津液，而山药善于滋养脾胃、滋生津液，用它来送服硝、剥，取其相互济助以取得成功，就像《金匮要略》中硝石矾石散用大麦粥送服一样。
有因心肺脾胃之阳甚虚，导致寒饮停聚于中焦，并且溢出于膈上，逼迫心肺脾胃之阳向上且向外浮越的。其脉象多弦迟细弱，六部脉皆如此，间或有浮大而软，按之空豁无力的情况。其现症表现为：或是目眩耳聋，或是周身发热，或是感觉短气，或是咳喘，或是心中发热，想吃鲜果，但食后反而觉得心中胀满、病情加剧。适宜用本人拟定的理饮汤。服用几剂后，心中不觉发热、反而觉得凉爽的，去掉芍药。如果感觉气不足的，加生箭芪（黄芪）三钱。此证如此治疗，就是医书中所谓用温燥健补脾胃的药物可以制伏相火。却不知道其所制伏的不是相火，实际上是温燥的药物能扫除寒饮，而心肺脾胃之阳自然安守其宅舍。
上面所列的火不归原的证候，其病因虽然不同，但都属于内伤。至于外感病证，也有火不归原的，伤寒、温病中的戴阳证就是这类。其证候的现状表现为：面赤、气粗、烦躁不安，脉象虽然大，但按之无力，又多见寸盛尺虚。这是下焦虚寒、孤阳上越的危重征候，颇类似寒温病中阴极似阳的证候。然而，阴极似阳，是由于内外原因不同所致；戴阳证则是由于上下部位不同所致。适宜用《伤寒论》通脉四逆汤，加葱、加人参来治疗（原方原文说面赤者加葱，面赤即戴阳证）。
特别是戴阳证的脉象不一。如果果真是少阴脉沉细，或其脉并非沉细但按之指下空豁毫无根柢，且至数不快的，才可以运用通脉四逆汤方。如果脉沉细而数，或浮大而数的，此方就绝对不可用。曾治疗王××，四十多岁，身体向来虚弱，患伤寒四五日时，请我去诊治。其脉关前洪滑，两尺部无力。为他开了本人拟定的仙露汤，因为尺脉弱，嘱咐他慢慢服药，一次只温热饮下一大口，防止寒凉药侵扰下焦。病人家属忽然违背我的嘱咐，竟然一次性顿服，于是导致滑泻数次，大便多带冷沫，上焦更加觉得烦躁，鼻子像被烟熏过一样，脸像被火烤一样，其关前脉比从前大一倍，脉搏次数达到每息七次。我知道这已成戴阳证，急忙用野台参一两，煎汤至八分茶盅的量，兑入童便半盅（必须用五岁以下男童的小便），将药碗放在凉水盆中，等药变冷后一次性顿服。又急忙用知母、玄参、生地各一两，煎汤一大碗备用。自服用参汤后，多次诊察其脉。过了半点钟，脉象渐渐收敛，脉搏似乎又加快，于是急忙将备用的药炖至极热，慢慢饮用，一次只喝一口药，经过两个小时服完全部药剂，周身微微出汗而痊愈。
按语：此证上焦原有燥热，因为初次凉药顿服，药力通过病所，直达下焦，上焦燥热仍然留存。等到下焦滑泻，元阳上浮，更加助长上焦的热邪，出现种种热象，脉搏数至七次。此时不但姜、附不敢用分毫，即使单用人参，上焦的燥热也必然格拒不受。所以用童便下趋的性质来辅助它，又将药等到极凉时顿服下去。等到过了一会儿，脉象收敛，至数加快，这是下焦得到人参温补之力而元阳收回，其上焦因人参的反激之力而燥热更加增加。所以又急忙用大凉大润的药物，趁热慢慢饮用，以清解上焦的燥热，而不使其寒凉性质再次侵扰下焦。这在万难用药之际，仍希望用药与病机息息吻合，实在也是费尽了斟酌推敲。
Medical texts state that the fire in the lower jiao (Lower Burner) originates from the Mingmen (Gate of Life), is called the fire of the yin aspect, and is also referred to as "Dragon-Lei Fire" (Fire of the Dragon and Thunder). This is actually a superficial argument. The fire in the lower jiao is the congenital Yuan Yang (Primal Yang Qi), which arises from the Yuan Qi (Primal Qi) of the Qihai (Sea of Qi). Generally speaking, regarding its ability to support the whole body, it is called Yuan Qi; regarding its ability to warm the whole body, it is called Yuan Yang. This Yuan Yang within the Qihai is the root source of human life; whether it is the fire of the yin aspect or the yang aspect, all establish their foundation here. The Qihai is formed entirely by fat membranes wrapping around and condensing. One branch extends from these membranes laterally, connecting to the seventh vertebra counting from below. On both sides of this seventh vertebra, there is an acupoint each; the *Neijing* (Classic of Internal Canon) states, "Beside the seven vertebrae lies the 'Xiaoxin' (Lesser Mind)." The Yuan Yang of the Qihai penetrates into the spine from here. Because Yuan Yang is the root of life, the place where Yuan Yang penetrates the spine is called the Mingmen (Gate of Life). From this perspective, the actual function of the Mingmen is merely to serve as the lock and key for the management of the Qihai. Therefore, the fire of the lower jiao should still be attributed to the Yuan Yang of the Qihai. Discussing the upward窜 (rushing) of lower jiao fire that fails to return to its origin is essentially the floating and drifting of the Qihai's Yuan Yang. However, although this disease is broadly named "Fire Failing to Return to Its Origin," there are several distinct etiological factors, each requiring specific treatment methods. These are detailed below.
There is a case where the Yuan Qi of the Qihai is deficient and damaged, failing to secure and control the qi transformation of the lower jiao, causing the Yuan Yang to float and drift due to this deficiency. The pulse is weak at the chi (cun-knee) position and strong at the cun (wrist) position, floating, large, and rootless. Symptoms may include dizziness and vertigo of the head and eyes, redness of the face and heat in the ears, heat in the heart with palpitations (Zhen Tong), or coarse breathing with rebellious qi. Treatment should employ Jing Yurou (Cleaned Cornus Fruit) and Sheng Shanyao (Raw Dioscorea Rhizome), each 1 liang; Renshen (Ginseng Root), Xuanshen (Scrophularia Root), Daizheshi (Haematite), Sheng Longgu (Fossilized Bones), and Sheng Muli (Oyster Shell), each 5 qian. If there is heat in the heart, add Sheng Dihuang (Raw Rehmannia Root) and Tiandong (Asparagus Tuber) in varying amounts of several qian. This method tonifies and astringes, anchors and calms, allowing the Yuan Yang to naturally return to its residence. The reason for using Daizheshi (Haematite) in the formula is that although Renshen (Ginseng Root) has abundant warming and tonifying properties, its force tends to move upward. When used together with Daizheshi (Haematite), the force focuses downward. Moreover, the heavy and sinking nature of Daizheshi (Haematite) assists Longgu (Fossilized Bones) and Muli (Oyster Shell) in subduing yang.
There is a case where the True Yin of the lower jiao is deficient and damaged, leaving the Yuan Yang without attachment, causing it to float and drift. The pulse is often wiry and rapid, or powerless upon deep pressure. Symptoms include intermittent burning heat sensations, bitter taste in the mouth and dry tongue, or continuous wheezing and coughing. Treatment should use Sheng Shanyao (Raw Dioscorea Rhizome) and Shu Dihuang (Prepared Rehmannia Root), each 1 liang; Xuanshen (Scrophularia Root), Sheng Longgu (Fossilized Bones), Sheng Muli (Oyster Shell), Sheng Guiban (Turtle Carapace), Gouqizi (Goji Berry), each 5 qian; Sheng Hangshaoyao (Raw Paeonia Lactiflora Root) 3 qian; Sheng Jineijin (Chicken Gizzard Membrane) and Gancao (Licorice Root), each 1.5 qian. This is what is referred to as "Strengthening the Master of Water to Control the Sunlight."
If the yin aspect of the lower jiao is deficient, and the yang aspect is also slightly insufficient, the person often feels heat in the upper jiao (Upper Burner), while the lower jiao occasionally feels cool. Treatment should employ Cui Shi Ba Wei Wan (Cui's Eight-Ingredient Pill) from the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), substituting Sheng Dihuang (Raw Rehmannia Root) for Shu Dihuang (Prepared Rehmannia Root) (the original Fanggan Di Huang was Sheng Dihuang in pharmacy stores). Furthermore, reduce the dosage of Fuling (Poria) and Zexie (Alisma Rhizome) by two-thirds. Prepare one dose of pills and divide it into eight doses of decoction for administration.
There is a case where the Yuan Yang of the Qihai is severely deficient, and the lower jiao is accumulated with deep cold and stubborn chill, forcing the Yuan Yang upward like a flame about to extinguish but flaring up. The pulse is wiry, slow, fine, and weak, or the two cun positions seem powerful upon superficial palpation. Symptoms include: restlessness and irritability in the heart, intermittent burning heat in the upper jiao, while the lower jiao feels extremely cold, or frequent diarrhea. Treatment should use Wufuzi (Prepared Aconite Root), Renshen (Ginseng Root), and Sheng Shanyao (Raw Dioscorea Rhizome), each 5 qian; Jing Yurou (Cleaned Cornus Fruit) and Hutao Ren (Walnut Kernel), each 4 qian; Daizheshi (Haematite), Sheng Hangshaoyao (Raw Paeonia Lactiflora Root), and Huainiuxi (Achyranthes Root), each 3 qian; Yunlingpian (Sliced Poria) and Gancao (Licorice Root), each 1.5 qian. If diarrhea is present, remove Daizheshi (Haematite). This is the method known in medical texts as "Guiding Fire Back to Its Source." The reason for using Shaoyao (Paeonia Root) in the formula is not to dissipate heat in the upper jiao, but because when combined with Renshen (Ginseng Root) and Fuzi (Aconite Root), it greatly converges the Yuan Yang, guiding it back to its residence. However, the method of "Guiding Fire Back to Its Source" cannot be universally applied to all cases of "Fire Failing to Return to Its Origin." It must only be used when encountering such specific symptoms and pulses. Furthermore, the medicine must be cooled to slightly warm before ingestion, so as not to interfere with the dryness and heat in the upper jiao.
There is a case where Chong Qi (Penetrating Vessel Qi) rushes upward accompanied by Stomach Qi rebellion, causing the Yuan Yang of the Qihai to float and drift along with it. The pulse is often wiry, long, and forceful, especially on the right side, described in Li Shicai's Pulse Rhyme as "straight up and straight down." Symptoms include a sensation of fullness, oppression, and irritability in the chest, frequent hiccups, excessive expectoration of phlegm-saliva, and in severe cases, a sensation of phlegm-fire and rushing qi blocking the throat, making breathing nearly impossible. Treatment should employ my formulated Jiangwei Zhenchong Tang (Stomach-Descending and Penetrating-Vessel-Anchoring Decoction) (see section "On the Etiology, Symptoms, Pulse, and Treatment of Penetrating Vessel Qi Rushing Upward"), allowing the Chong Qi and Stomach Qi to descend, thereby curing all diseases spontaneously.
There is a case where excessive mental exertion generates heat in the heart, stirring up the Shaoyang Xiang Huo (Ministerial Fire) (which resides in the Gallbladder and Liver), causing it to rush upward and outward. The pulse at the cun and guan positions is forceful, often slippery, or slightly rapid. Symptoms include: restlessness and irritability in the heart, excessive doubtfulness, frequent anger, or a sensation of heat rising from the hypochondrium and dispersing throughout the body. Treatment uses Xi Huaishanyao (Fine Powder of Wild Yam Rhizome) 6–7 qian, boiled into porridge. In the morning, administer Mangxiao (Mirabilite) 3 qian with the porridge; in the evening, administer Western Medicine "Choubao" (Bromine) 2 wa (approx. 12g) with the porridge. Mangxiao (Mirabilite) is salty and cold, effectively resolving heat in the Heart Meridian and opening heat-phlegm under the heart (this condition often involves heat-phlegm under the heart); Choubao (Bromine) is also salty and cold, resolving heat in the Heart Meridian and restraining the reckless movement of Ministerial Fire. The reason for using Shan Yao (Yam) porridge for administration is that salty-cold medicines are incompatible with the Spleen and Stomach and can consume body fluids, whereas Shan Yao (Yam) nourishes the Spleen and Stomach and generates fluids. Using it to deliver Mangxiao (Mirabilite) and Choubao (Bromine) seeks mutual assistance for success, similar to how Xiaoshi Fanshi San (Niter and Alum Powder) in the *Jingui Yaolue* is administered with Barley Porridge.
There is a case where the Yang of the Heart, Lung, Spleen, and Stomach is severely deficient, leading to the retention of Cold-Fluid in the middle jiao (Middle Burner), overflowing above the diaphragm, and forcing the Yang of the Heart, Lung, Spleen, and Stomach to rush upward and outward. The pulse is often wiry, slow, fine, and weak across all six positions, or occasionally floating, large, and soft, feeling empty upon pressure. Present symptoms include: dizziness and deafness, generalized fever, shortness of breath, coughing and wheezing, heat in the heart, and a desire for fresh fruits, yet after eating, abdominal fullness worsens the condition. Treatment should employ my formulated Liyin Tang (Regulating Fluids Decoction). After taking several doses, if the heart no longer feels hot and instead feels cool, remove Shaoyao (Paeonia Root). If there is a sensation of qi deficiency, add Sheng Jianqi (Raw Astragalus Root) 3 qian. Treating this condition in this manner corresponds to the medical text assertion that warming, drying, and strengthening Spleen-Stomach medicines can suppress Ministerial Fire. However, what is suppressed is not Ministerial Fire itself; rather, the warming-drying medicines eliminate Cold-Fluid, allowing the Yang of the Heart, Lung, Spleen, and Stomach to naturally remain in its residence.
The aforementioned cases of "Fire Failing to Return to Its Origin," although differing in etiology, are all internal injuries. Regarding external contraction diseases, there are also cases of "Fire Failing to Return to Its Origin," such as the Daiyang Syndrome (Floating Yang Syndrome) in Shanghan (Cold Damage) and Wenbing (Warm Diseases). The current presentation includes: red face, coarse breathing, restlessness and irritability. Although the pulse is large, it is powerless upon pressure, and often shows excess at the cun position and deficiency at the chi position. This is a critical sign of deficiency-cold in the lower jiao with solitary yang rushing upward, resembling the syndrome of extreme yin mimicking yang in cold-warm diseases. However, "extreme yin mimicking yang" results from internal-external contradictions, whereas "Daiyang Syndrome" results from upper-lower contradictions. Treatment should employ Tongmai Sini Tang (Pulse-Reviving Four-Reversal Decoction) from the *Shanghan Lun* (Treatise on Cold Damage), adding Congbai (Green Onion White) and Renshen (Ginseng Root) (the original text states to add Congbai for red face, and red face indicates Daiyang Syndrome).
However, Daiyang Syndrome presents with varied pulses. Only if the pulse is truly deep and fine like the Shaoyin pulse, or if it is not deep and fine but feels empty and rootless upon pressure, with a non-rapid rate, can Tongmai Sini Tang (Pulse-Reviving Four-Reversal Decoction) be used. If the pulse is deep, fine, and rapid, or floating, large, and rapid, this formula must absolutely not be used. I once treated Patient Wang XX, aged over forty, who was constitutionally weak. During the fourth or fifth day of Shanghan (Cold Damage), he sought my consultation. His pulse was surging and slippery anterior to the guan position, while the two chi positions were powerless. I prescribed my formulated Xinlu Tang (Immortal Dew Decoction). Due to the weak chi pulse, I instructed him to drink the medicine slowly, taking only one large warm sip at a time, to prevent cold-cold medicines from invading the lower jiao. The patient's family suddenly disregarded my instructions and administered the entire dose at once. Consequently, he experienced watery diarrhea several times, with stool containing much cold froth. The upper jiao became increasingly irritable, his nose felt as if smoked, and his face felt as if roasted by fire. His pulse anterior to the guan position doubled in size, reaching seven beats per respiration. Recognizing this had become Daiyang Syndrome (Floating Yang Syndrome), I urgently prepared Ye Taishen (Wild Taihang Ginseng Root) 1 liang, decocted to 0.8 cup, mixed with half a cup of Tongbian (Child Urine) (must be from a boy under five years old). I placed the medicine bowl in a basin of cold water, waited for it to cool completely, and then administered it in one gulp. I also urgently decocted Zhimu (Anemarrhena Rhizome), Xuanshen (Scrophularia Root), and Sheng Dihuang (Raw Rehmannia Root), each 1 liang, into a large bowl for backup. After administering the ginseng decoction, I frequently checked his pulse. Half an hour later, the pulse gradually converged, but the rate seemed to increase further. I urgently heated the backup medicine to boiling point and administered it slowly, one sip at a time. Over two hours, the entire dose was consumed, resulting in a slight general sweating and recovery.
Note: This condition originally had dryness-heat in the upper jiao. Because the initial cold medicine was taken in one gulp, passing through the diseased area directly to the lower jiao, the dryness-heat in the upper jiao remained. When the lower jiao suffered watery diarrhea, the Yuan Yang floated upward, further assisting the heat in the upper jiao, presenting various heat signs and a pulse rate of seven beats. At this time, not only dare I not use Ginger (Shengjiang/Ganjiang) and Aconite (Fuzi) in the slightest amount, but even single-use of Renshen (Ginseng Root) would be rejected by the dryness-heat in the upper jiao. Therefore, I used the downward-pouring nature of Tongbian (Child Urine) to assist it, and administered the medicine when extremely cold in one gulp. After a short while, the pulse converged, and the rate increased. This indicated that the lower jiao received the warming-tonifying power of Renshen (Ginseng Root), causing the Yuan Yang to return, while the upper jiao experienced increased dryness-heat due to the reverse-stimulating effect of Renshen (Ginseng Root). Thus, I urgently employed large-cooling and large-moistening medicines, administered hot and slowly, to clear the dryness-heat in the upper jiao without allowing the cold-natured properties to invade the lower jiao again. In this extremely difficult situation for medication, striving for every prescription to align perfectly with the pathology required immense deliberation.