典藏书目

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Diarrhea accompanied by fever indicates a fatal outcome." This discusses the general rule. Zhang Zhongjing states: "In diarrhea, if the hands and feet are not cold, but rather there is fever, death will not occur." This discusses acute conditions. Generally, in sudden diseases, the presence of Yang Qi leads to life, while its absence leads to death. Therefore, in deficiency-cold diarrhea, if the hands and feet are not cold, but there is fever, it may be that the patient's True Yang (Zhen Yang, the fundamental Yang energy of the body) has not yet dissipated, or that after taking warming and tonifying herbs, Yang Qi returns. These are both auspicious signs. At this time, one should only gather the Yang and harmonize the Yin. If one worries about the fever and instead follows routine methods using clearing and resolving herbs, few will not cause death.

Zhang Zhongjing states: "In diarrhea, if the hands and feet are cold and there is no pulse, moxibustion fails to warm them, and if the pulse does not return, but slight panting occurs, death ensues."

The three Yang meridians of the hand originate from the hands, and the three Yin meridians of the foot originate from the feet; thus, the hands and feet are the root of all Yang meridians, and the pulse is the precursor of Qi and Blood. In a healthy person, movement during respiration circulates Qi, blood fills the form, Yang exits and Yin enters, each serving as the root of the other. If Yin-Cold is extremely excessive, Yang Qi cannot distribute through the meridians, body fluids fail to circulate, accumulate and flow downward causing diarrhea, the pulse becomes absent, and the hands and feet become cold, moving far away from life. At this stage, medicinal herbs cannot reach the disease site; temporarily, moxibustion with mugwort (Ai Ye, 艾叶) should be used to test whether the patient's Yang Qi still exists? If slight Yang has not perished, guided by the warmth of moxa, it can redistribute through the meridians, and the hands and feet turn warm. Subsequently, warming-meridian and returning-Yang herbs should be administered to continue treatment. If it is rootless Yang, it may instead rush upward reversely due to the fire of moxa, causing panting; then Yang escapes from the upper jiao and will not return. Alas! All things touch the warmth of Yang to expand and grow, and touch the chill of Yin to wither and die. People harm their own Yang, perhaps excusing themselves as ignorant; doctors possess the art of saving lives, yet they harm others' Yang, hastening their death. Do they also excuse themselves as ignorant?

Zhang Zhongjing further states: "In diarrhea, with slight fever and thirst, and a weak pulse, recovery will occur spontaneously."

In the previous section, I interpreted Zhang Zhongjing's intent: after moxibustion, when the hands and feet turn warm, one should immediately follow up with warming-meridian and returning-Yang herbs. Observing this clause regarding spontaneous recovery without medication, its subtlety becomes broader upon deeper analysis. Regarding pulse differentiation: in diarrhea, a deep-choppy pulse indicates tenesmus; a large pulse indicates the disease has not ceased; a weak-and-rapid pulse indicates it is about to stop spontaneously. Although the text mentions fever but not death, the essence here is precise: those with weak-and-rapid pulses whose diarrhea is about to stop merely avoid death; the disease is not eliminated. Here, it specifically mentions a weak pulse, indicating Yin receding and Yang recovering. Externally, this manifests as slight fever; internally, as slight thirst. Between the exterior and interior, there is only slight disharmony; it heals spontaneously without treatment, and treating it would likely prevent recovery. Wherever Zhang Zhongjing emphasizes crucial points, he remains implicit like a golden needle not yet passed. Now I presume to clarify it: generally, in exogenous patterns, exterior involvement causes fever, interior involvement causes thirst. Not only should slight fever not be completely eradicated, but thirst also varies. For instance, in Shaoyin disease, spontaneous diarrhea with thirst for five to six days, if the urine is white, it is not due to interior heat, but because Kidney Deficiency draws water to save itself. If one treats this thirst as interior heat, would it not kill the patient? Thus, I interpret Zhang Zhongjing's intent: "Heals spontaneously without treatment; treatment leads to non-recovery," referring to physicians who consider all variables and adapt to thousands of changes, which are rare in the world.

Zhang Zhongjing further states: "In diarrhea, if the pulse is rapid and there is thirst, recovery will occur spontaneously. If it does not heal, pus and blood will appear in the stool, due to the presence of Heat."

The pathogenesis of this clause is not only key to treating Taiyang disease, but also requires careful consideration when treating Yin diseases. Diarrhea originating from Yang deficiency and Yin excess, presenting with a rapid pulse and thirst, indicates that although initially Yin was excessive, Yang has now recovered, hence spontaneous recovery. If it does not heal, it implies not just Yang recovery, but Yang overcoming Yin excessively, leading to pus and blood in the stool. In the theory of Five Movements and Six Qi, an excess force is followed by a counteracting force. The *Neijing* states, "Do not assist the counteraction," which is considered supreme treatment. This shows that counteraction inevitably brings excessive harm. Since counteraction has already occurred, what is sought by assisting it again? In treating Yin diseases, if Yang has already recovered and one assists it again, is it not inviting hyperactivity and regret?

Zhang Zhongjing further states: "In diarrhea, if the pulse is deep and slow, the patient's face shows slight redness, the body has slight fever, and the stool contains undigested food, there will inevitably be vertigo/dizziness (Yu Mao, 郁冒), sweating, and resolution. The patient must have slight fever. The reason is 'Face Floating Yang' (Dai Yang, 戴阳) due to lower deficiency."

When Taiyang and Yangming diseases combine, a continuous bright red face indicates Yang Qi stagnation in the exterior, requiring exterior release. Here, in diarrhea with a deep-slow pulse, slight facial redness, and slight body fever, it is Yin-Cold repelling Yang outward, causing slight body fever. Repelling Yang upward causes slight facial redness. Zhang Zhongjing attributes this to lower deficiency, meaning Yang is absent below, yet appears above and outside, hence termed deficiency. When deficient Yang floats outward and upward, critical signs are evident. If the patient's Yang still has roots, or if warming herbs are taken to overcome Yin and assist Yang, Yang returns and contends with Yin; recovery can be expected without fear. Once Yang returns, Yin cannot repel it. However, since Yin is still excessive and unwilling to descend, there will be brief vertigo/dizziness, after which Yang overcomes Yin, and Yin transforms into sweat. Yin exiting as sweat means pathogens resolve from the exterior, and diarrhea naturally stops. Vertigo/dizziness and sweating resemble the image of dragons fighting in the wild, with black and yellow blood, symbolizing Yang entering and Yin exiting, turning from critical to safe. The mechanism is so formidable; who says Yin pathogens can be allowed to flourish?

Zhang Zhongjing further states: "After diarrhea, if the pulse is absent and the hands and feet are cold, but occasionally the pulse returns and the hands and feet become warm, life is preserved; if the pulse does not return, death ensues."

An absent pulse indicates not only the absence of Yang, but also the absence of Yin. If Yang Qi is scattered, how can Yin Qi not perish? Occasional pulse return means the hidden pulse re-emerges; does the pulse ever cease for even a breath? Zhang Zhongjing uses moxibustion precisely to unblock Yang Qi and observe whether the pulse is absent or hidden. Hence, his formula is named Tongmai Sini Tang (Pulse-Returning Decoction). After administration, diarrhea stops. If the pulse still does not emerge, it indicates the medicine has had a major effect, proving it was not true pulse absence. Adding Ren Shen (Ginseng Radix) to replenish lost blood allows the pulse to emerge naturally. Established methods are present; one should study them carefully.