季蘅翁禀丰躯伟。望七之龄。神采不衰。近得半身不遂之证。已二年矣。病发左半。口往右 。昏厥遗
溺。初服参术颇当。为黠医簧以左半属血。不宜补气之说。几致大坏。云间施笠泽以参附疗之。稍得向安。
然概从温补。未尽病情也。诊得脉体。软滑中时带劲疾。盖痰与风杂合之证。痰为主。风为标也。又热
与寒杂合之证。热为主。寒为标也。平时手冷如冰。故痰动易至于厥。然厥已复苏。苏已呕去其痰。眠食
自若。虽冬月亦能耐寒。无取重 复絮。可知寒为外显之假寒。而热为内蕴之真热。既有内蕴之热。自蒸脾湿
为痰。久久阻塞窍隧。而卫气不周。外风易入。加以房帏不节。精气内虚。与风相召。是以杂合而成是
证耳。及今大理右半脾胃之气。以运出左半之热痰虚风。此其间有微细曲折。非只温补一端所能尽者。何也。
治杂合之病。必须用杂合之药。而随时令以尽无穷之变。即如冬月严寒用事。身内之热。为外寒所束。不得从
皮肤外泄。势必深入筋骨为害矣。故用姜附以暂撤外寒。而内热反得宣泄。若时令之热。与内蕴之热相合。复
助以姜附。三热交煽。有灼筋腐肉而已。孰是用药之权衡。可以一端尽耶。或者曰。左半风废。而察脉辨证。
指为兼痰兼热似矣。痰者脾湿所生。寄居右畔。是则先宜中右。而
何以反中左耶。既已中左。明系左半受病。而何以反治右耶。不知此正病机之最要者。但为丹溪等方书说。病
在左血多。病在右气多。教人如此认证。因而起后人之偏执。至内经则无此说也。内经但言左右者。阴阳之道
路。夫左右既为阴阳往还之道路。何尝可偏执哉。况左半虽血为主。非气以统之则不流。右半虽气为主。非血
以丽之则易散。故肝胆居左。其气常行于右。脾胃居右。其气常行于左。往来灌注。是以生生不息也。肝木主
风。脾湿为痰。而风与痰之中人。原不分于左右。但翁恃其体之健。过损精血。是以八八天癸已尽之后。左半
先亏。而右半饮食所生之痰。与皮毛所入之风。以渐积于空虚之府。而骤发始觉耳。风脉劲疾。痰脉软滑。
惟劲疾故病则大筋短缩。即舌筋亦短而蹇于言。小筋弛长。故从左而 于右。从左 右。即可知左畔
之小筋。弛而不张也。若小筋能张。则左 矣。凡治一偏之病。法宜从阴引阳。从阳引阴。从左引右。从右
引左。盖观树木之偏枯者。将溉其枯者乎。抑溉其未枯者使荣茂。而因以条畅其枯者乎。治法以参术为君臣。
以附子干姜为佐使。寒月可恃无恐。以参术为君臣。以羚羊角柴胡知母石膏为佐使。而春夏秋三时。
可无热病之累。然宜刺手足四末。以泄荣血而通气。恐热痰虚风。久而成疠也。
门人问曰。经文左右者。阴阳之道路。注解以运气之司天在泉。而有左间右间为训。遂令观者茫然。今先
生贴以往还二字。与太极动而生阳。静而生阴。天地生成之数。春秋自然之运。适相符契矣。但不知往于何
始。还于何终。可得闻乎。答曰。微哉问也。天地之道。春气始于左。而终于右。秋气始于右。而
终于左。夏气始于上。而终于下。冬气始于下。而终于上。人身亦然。经云。欲知其始。先建其母。母者五
脏相承之母也。又曰。五脏以生克而互乘。如右之肺金。往左而生肾水克肝木。左之
心火。往右而生脾土克肺金之类。其往还交织无端。然始于金
者。生则终于土。克则终于火。始于火者。生则终于木。克则终于水。此则交织中之次第也。推之十二经。如
子时注少阳胆。丑时注厥阴肝之类。亦交织中之次第也。诚建其母推其类。而始终大略睹矣。
又问曰。病机之左右上下。其往还亦有次第乎。答曰。病机往还之次第。不过顺传逆传两端。顺传者传
其所生。乃天地自然之运。如春传夏。夏传长夏。长夏传秋。秋传冬。冬复传春。原不为病。即病亦轻。逆传
者。传其所克。病轻者重。重者死矣。如春传长夏。长夏传冬。冬传夏。夏传秋。秋传春。非天地自然之
运。故为病也。曰经言间传者生。七传者死。则间传为顺传。七传为逆传无疑。曰。非也。注难经者。言间传
是顺行。隔一位而传。误认病机但从右旋左。不从左旋右。皆繇不知左右往还之理。而以讹传讹。试诘以
肾水间一位传心火。为逆传之贼邪。则无可置喙矣。故间传七传。俱于逆传中分生死耳。间传者。心病
当逆传肺。乃不传肺。而传肺所逆传之肝。肺病当逆传肝。乃不传肝。而传肝所逆传之脾。推之肝病脾病肾病
皆然。此则脏腑不受克贼。故可生也。七传者前六传已逆周五脏。第七传重复逆行。如心脏初受病。二传于肺
则肺脏伤。三传于肝则肝脏伤。四传脾。五传肾。六传仍归于心。至七传再入于肺。则肺已先伤。重受贼邪。
气绝不支矣。所谓一脏不两伤。是以死也。不比伤寒传经之邪。经尽再传。反无害也。针经云。善针者以左治
右。以右治左。夫人身之穴。左右同也。乃必互换为治。推之上下。莫不皆然。于往还之机。益明矣。
又问曰。半身不遂之病。原有左右之分。岂左右分属之后。病遂一往不返乎。而治之迄无成效者。何
也。答曰。风与痰之中人。各随所造。初无定体。病成之后。亦非一往不返也。盖有往有复者。天运人事病
机。无不皆然。如风者四时八方之气。从鼻而入。乃天之气也。痰者五谷百物之味。从口而入。脾胃之湿所
结。乃地之气也。势本相辽。亦尝相兼。全似内伤之与外感。每夹杂而易炫。故风胜者先治其风。痰胜者先治
其痰。相等则治风兼治痰。此定法也。内经云。风之中人也。先从皮毛而入。次传肌肉。次传筋。次传骨髓。
故善治者。先治皮毛。其次治肌肉。繇此观之。乃从右而渐入于左也。皮毛者右肺主之。肌肉者右胃主之。
筋脉者左肝主之。骨髓者左肾主之。从外入者转入转深。故治皮毛治肌肉。不使其深入也。又曰。湿之中人
也。先从足始。此则自下而之上。无分左右者也。但内风素胜之人。偏与外风相召。内湿素胜之人。偏与外湿
相召。内风之人。大块之噫气未动。而身已先伤。内湿之人。室中之础磉未润。而体已先重。是以治病必从其类
也。从外入者。以渐而驱之于外。从下上者。以渐而驱之于下。若任其一往不返。安贵其为治乎。
又问曰。从外入者。驱而之外。从下上者。驱而之下。骤闻令人爽然。不识古法亦有合欤。答曰。此正古
人已试之法。但未挈出。则不知作者之意耳。如治风大小续命汤。方中桂附苓术麻防等药。表里庞杂。今
人见为难用。不知用附桂者。驱在里之邪也。用苓术者。驱在中之邪也。而用麻防等表药独多者。正欲
使内邪从外而出也。至于病久体虚。风入已深。又有一气微汗之法。一旬微利之法。平调半月十日。又微微驱
散。古人原有规则也。至于治痰之规则。不见于方书。如在上者。用瓜蒂散栀豉汤等方。在左者用龙荟丸。在右
者用滚痰丸。以及虚人用竹沥达痰丸。沉寒锢冷用三建汤之类。全无奥义。岂得心应手之妙。未可传之纸上耶。
吾今为子辈传之。盖五味入口。而藏于胃。胃为水谷之海。五脏六腑之总司。人之食饮太过。而结为痰涎者。
每随脾之健运。而渗灌于经隧。其间往返之机。如海潮然。脾气行则潮去。脾气止则潮回。所以治沉锢之法。
但取辛热。微动寒痰。已后止而不用。恐痰得热而妄行。为害不浅也。不但痰得热
而妄行。即脾得热而亦过动不息。如潮之有去无回。其痰病之
决裂。可胜道哉。从来服峻补之药者。深夜亦欲得食。皆不知其故。反以能食为庆。曾不思爱惜脾气。令其
昼运夜息。乃可有常。况人身之痰。既繇胃以流于经隧。则经隧之痰。亦必返之于胃。然后可从口而上越。
从肠而下达。此惟脾气静息之时。其痰可返。故人有痰症者。早食午食而外。但宜休养。脾气不动。使
经隧之痰。得以返之于胃。而从胃之气上下。不从脾之气四达。乃为善也。试观人痰病轻者。夜间安卧。次早
即能呕出泄出。痰病重者。昏迷复醒。反能呕出泄出者。岂非未曾得食。脾气静息。而予痰以出路耶。世之喜
用热药峻攻者。能知此乎。噫。天下之服辛热。而转能夜食者多矣。肯因俚言而三思否。
胡卣臣先生曰。知之深。故言之详。然皆根据内经。而非创说。又自
有神悟。而非袭说。予向者极叹服王宇泰缪仲淳。真是齐人知管晏耳。
杨季蘅老先生身体魁梧高大，年届七十，精神神采依然不衰。最近患上了半身不遂的病症，已经两年了。发病部位在左侧半身，口角向右侧歪斜，伴有昏厥和遗尿症状。起初服用人参、白术等补气药物颇为对症，却被狡猾的医生以“左侧半身属血分，不宜补气”的说法误导，几乎导致病情恶化。云间的施笠泽用红参、附子来治疗，使病情稍见安定。然而如果一概采用温补疗法，就不能完全契合病情的复杂变化。
诊察其脉象，脉体柔软滑利中时而带有强劲急疾之象。这是痰邪与风邪混杂结合的证候，其中痰邪为主，风邪为标；同时又是热邪与寒邪混杂结合的证候，其中热邪为主，寒邪为标。他平时手脚冰冷如冰，所以痰邪扰动时容易引发昏厥。但昏厥后能迅速苏醒，苏醒后呕吐出痰液，睡眠和饮食恢复正常，即使在冬天也能耐寒，不需要穿厚重的棉絮衣物。由此可知，寒冷只是外显的假象（假寒），而体内蕴藏的热邪才是真实的本质（真热）。既然体内有蕴藏的热邪，自然会蒸腾脾脏的湿气形成痰浊，久而久之阻塞经络孔窍，导致卫气运行不畅，外部的风邪就容易侵入。再加上房事不节制，精气内虚，与风邪相互感召，从而形成了这种杂合的病症。
如今应当大力调理右侧脾胃之气，以运化排出左侧半身的热痰和虚风。这其中有着微妙细致的曲折变化，不是仅仅依靠温补这一种方法所能穷尽的。为什么呢？治疗这种杂合的病，必须使用性质复杂的药物组合，并随着时令的变化来应对无穷无尽的变局。就像在严冬时节，寒气当令，体内的热邪被外寒束缚，不能从皮肤毛孔向外宣泄，势必会深入筋骨造成危害。因此，使用干姜、附子来暂时驱散外寒，反而使得内热得以宣泄。如果是春夏季节，时令的热邪与体内蕴藏的热邪相合，如果再辅助以干姜、附子，三种热邪交相煽动，只会灼伤筋脉、腐蚀肌肉罢了。谁又能掌握用药的权衡尺度，只用一种方法就解决所有问题呢？
有人问：左侧半身风废，通过诊脉辨证，指出兼有痰邪和热邪似乎是对的。痰是由脾湿产生的，寄居在右侧，那么应该先治疗右侧，为什么反而治疗左侧呢？既然已经确定是左侧患病，为什么反而治疗右侧呢？不知道这正是病机中最关键的地方。只是因为丹溪等人的方书说：“病在左侧血多，病在右侧气多”，教导人们这样去认识病症，因而导致了后人的偏执。但在《黄帝内经》中并没有这种说法。《内经》只说左右是阴阳之道路。既然左右是阴阳往还的道路，哪里可以偏执一端呢？况且左侧半身虽然以血为主，但没有气的统摄则血液无法流动；右侧半身虽然以气为主，但没有血的依附则气容易散失。所以肝胆居于左侧，但其气常运行于右侧；脾胃居于右侧，但其气常运行于左侧。气与血往来灌注，生生不息。肝木主风，脾湿生痰，而风和痰侵袭人体，原本就不分左右。只是这位老先生倚仗身体健壮，过度损耗精血，所以在八八六十四岁天癸已尽之后，左侧半身先出现亏虚，而右侧由饮食生成的痰浊，以及从皮毛进入的风邪，便逐渐积聚在空虚的脏腑中，直到突然发作才察觉到。风邪的脉象劲疾，痰邪的脉象软滑。正因为脉象劲疾，所以发病时大筋短缩，连舌头的筋也短缩而导致言语蹇涩；小筋弛长，所以左侧的症状牵涉到右侧。从左牵连到右，就可以知道左侧的小筋是弛缓而不紧张的。如果小筋能够紧张有力，左侧就能恢复活动了。凡是治疗偏侧的疾病，治法应当遵循“从阴引阳，从阳引阴，从左引右，从右引左”的原则。这就像观察树木偏枯的情况，是浇灌枯萎的部分呢，还是浇灌未枯萎的部分使其繁荣茂盛，从而间接疏通枯萎的部分呢？
在治疗上，以人参、白术作为君药和臣药，以附子、干姜作为佐药和使药，那么在寒冷的月份可以无所畏惧地使用。以人参、白术作为君药和臣药，以羚羊角、柴胡、知母、石膏作为佐药和使药，那么在春、夏、秋三个季节可以避免热病的困扰。此外，适宜针刺手足四末，以泄除营血中的郁热并通畅气机，恐怕热痰和虚风日久会变成恶疾。
门人问道：经文说“左右者，阴阳之道路”，注解中以运气学说中的司天在泉，以及左间右间来训释，使得观看的人感到茫然。现在先生您用“往还”二字来解释，这与太极动而生阳、静而生阴，天地生成的数理，以及春秋自然的运行规律，恰好相符契。只是不知道“往”始于何处，“还”终于何处，可以听您讲讲吗？我回答说：这个问题很精微啊。天地的道理，春气始于左侧而终于右侧，秋气始于右侧而终于左侧，夏气始于上方而终于下方，冬气始于下方而终于上方。人身也是如此。经书说：“欲知其始，先建其母。”这里的“母”是指五脏相生相克的根本。又说，五脏通过生克关系互相乘侮。比如右侧的肺金，往左侧运行而生肾水，肾水又克制肝木；左侧的心火，往右侧运行而生脾土，脾土又克制肺金等等。这种往还交织没有尽头，但如果从金开始，相生则终于土，相克则终于火；从火开始，相生则终于木，相克则终于水。这就是交织中的次序。推演到十二经脉，如子时注入手少阳胆经，丑时注入足厥阴肝经等，也是交织中的次序。确实确立了根本并推演其类属，那么始终的大略情况就清楚了。
又问：病机的左右上下往还也有次序吗？回答说：病机往还的次序，不过顺传和逆传两种。顺传是传其所生，这是天地自然的运行规律，如春传夏，夏传长夏，长夏传秋，秋传冬，冬复传春，原本不算病，即使生病也很轻。逆传是传其所克，病轻者会变重，重者会死亡。如春传长夏，长夏传冬，冬传夏，夏传秋，秋传春，这不是天地自然的运行规律，所以会致病。有人说：经书说“间传者生，七传者死”，那么间传就是顺传，七传就是逆传，毫无疑问。我说：不对。注释《难经》的人说间传是顺行，隔一位而传，错误地认为病机只是从右旋转到左，不从左旋转到右，这都是因为不知道左右往还的道理，以讹传讹。试问如果肾水隔一位传心火，这是逆传的贼邪，那就无话可说了。所以间传和七传，都是在逆传中区分生死。所谓间传，是指心病本该逆传肺，却不传肺，而是传肺所逆传的肝；肺病本该逆传肝，却不传肝，而是传肝所逆传的脾。推及肝病、脾病、肾病都是如此。这是因为脏腑不受克贼，所以可以存活。所谓七传，是指前六次传变已经逆遍五脏，第七次传变再次逆行。如心脏初受病，第二次传于肺则肺脏受伤，第三次传于肝则肝脏受伤，第四次传脾，第五次传肾，第六次仍归于心，到了第七次再入于肺，此时肺已经先受伤，再次受到贼邪侵害，气绝而不支，所以死亡。这就是所谓的“一脏不两伤”。不像伤寒传经的邪气，经尽后再传，反而无害。《针经》说：善于针刺的人，以左治右，以右治左。人身上的穴位，左右是相同的，但必须互换来治疗，推及其他上下部位，没有不是这样的，这在往还的机理上更加明确了。
又问：半身不遂的病，原本有左右之分，难道左右分属之后，病势就一往不返了吗？而治疗至今没有成效的，是什么原因呢？回答说：风邪和痰邪侵袭人体，各自随着造化的规律，最初没有固定的形体。病成之后，也不是一往不返的。大概是有往必有复，天运、人事、病机，无不都是如此。如风，是四时八方之气，从鼻而入，这是天之气；痰，是五谷百物的味道，从口而入，是脾胃之湿凝结而成，这是地之气。两者的势力本来相隔遥远，但也曾经兼夹。全像内伤病与外感病一样，每夹杂在一起而容易混淆。所以风胜者先治风，痰胜者先治痰，两者相等则治风兼治痰，这是定法。《内经》说：风邪中人，先从皮毛而入，其次传肌肉，其次传筋，其次传骨髓。所以善于治疗的人，先治皮毛，其次治肌肉。由此看来，这是从右渐入于左。皮毛由右侧肺脏主管，肌肉由右侧胃脏主管，筋脉由左侧肝脏主管，骨髓由左侧肾脏主管。从外入内的病邪转入转深，所以治疗皮毛和肌肉，是为了不让它深入。又说：湿邪中人，先从足部开始，这是自下而上，不分左右的。但是内风素来旺盛的人，特别容易与外风相感召；内湿素来旺盛的人，特别容易与外湿相感召。内风之人，大地的大气未动，身体已经先受伤；内湿之人，室内的柱础未润，身体已经先沉重。所以治病必须从其同类。从外入的，逐渐将其驱逐到体外；从下上的，逐渐将其驱逐向下。如果任由其一去不返，还要治疗做什么呢？
又问：从外入的，驱逐到外面；从下上的，驱逐到下面。乍听令人爽快，不知古法也有符合的吗？回答说：这正是古人已经尝试过的方法，只是没有明确提出来，所以不知道作者的本意罢了。如治疗风证的大小续命汤，方中含有桂枝、附子、茯苓、白术、麻黄、防风等药物，表里庞杂，今人见到觉得难以使用。不知道用附子、桂枝，是为了驱散在里的邪气；用茯苓、白术，是为了驱散在中的邪气；而单独多用麻黄、防风等解表药，正是想要使内邪从外而出。至于病久体虚，风邪已深入，又有一气微汗的方法，一旬微利的方法，平调半月或十日，又微微驱散，古人原有规则。至于治痰的规则，不见于方书。如在上的，用瓜蒂散、栀豉汤等方；在左的，用龙荟丸；在右的，用滚痰丸；以及虚人用竹沥达痰丸，沉寒锢冷用三建汤之类，全无奥义，难道是得心应手的妙处，不可传之于纸面吗？我现在为你们传授这些。五味入口，藏于胃，胃是水谷之海，五脏六腑的总司。人的饮食太过，结为痰涎，往往随着脾的健运，渗灌于经络隧道。其间往返的机理，如同海潮一般。脾气行则潮去，脾气止则潮回。所以治疗沉锢之法，只取辛热药物，微微动摇寒痰，随后停止不用，恐怕痰得热而妄行，危害不浅。不但痰得热而妄行，即脾得热也会过度运动不停息，如潮水有去无回，那痰病的决裂，能说尽吗？从来服用峻补药物的人，深夜也想进食，都不知其中的缘故，反而以能食为庆幸，曾不思爱惜脾气，让它白天运化晚上休息，这样才能有常态。何况人身之痰，既然由胃流于经络隧道，那么经络隧道之痰，也必须返还于胃，然后才能从口向上涌吐，从肠道向下排泄。这只有在脾气静息的时候，痰才能返还。所以有痰症的人，除了早午两餐之外，只宜休养，让脾气不动，使经络隧道之痰得以返还于胃，并从胃的气机上下运行，而不从脾的气机四达，这才是善法。试看人患痰病轻的，夜间安卧，次日早晨就能呕出或泄出；痰病重的，昏迷后苏醒，反而能呕出或泄出的，岂不是因为未曾进食，脾气静息，而给予痰出路吗？世间喜欢用热药峻攻的人，能知道这些吗？唉，天下服用辛热药物而反而能夜间进食的人很多了，肯因这些浅近之言而深思吗？
胡卣臣先生说：了解得深刻，所以讲解得详细。然而这些都依据《内经》，并非创说；又有自己的神悟，并非袭用旧说。我以前极叹服王宇泰、缪仲淳，真是齐国人懂得管仲、晏婴啊。
Mr. Yang Jiheng possessed a robust and tall physique. At the age of seventy, his spirit and vitality remained unimpaired. Recently, he developed hemiplegia (half-body paralysis), which has persisted for two years. The onset occurred on the left side of the body, with the mouth deviating to the right, accompanied by syncope (fainting) and urinary incontinence. Initially, the administration of Ginseng Radix et Rhizoma (Renshen) and Atractylodis Rhizoma (Baizhu) was quite appropriate. However, a cunning physician misled him with the theory that "the left half belongs to blood and should not be supplemented with Qi," nearly causing severe deterioration. Shi Lizé from Yunjian treated him with Ginseng Radix et Rhizoma (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi), bringing slight relief. Nevertheless, adopting a blanket approach of warming and tonification does not fully address the complexity of the condition.
Pulse diagnosis revealed a pulse quality that was soft and slippery, occasionally interspersed with forceful and rapid characteristics. This indicates a syndrome where Phlegm (Tan) and Wind (Feng) are mixed, with Phlegm as the root and Wind as the branch; simultaneously, it is a syndrome where Heat (Re) and Cold (Han) are mixed, with Heat as the root and Cold as the branch. His hands and feet are usually cold like ice, so when Phlegm stirs, it easily leads to syncope. However, after regaining consciousness, he vomits up the Phlegm, and his sleep and appetite return to normal. He can endure the cold even in winter without needing heavy cotton padding. This reveals that the coldness is merely an external false appearance (False Cold), while the heat retained internally is the true nature (True Heat). Since there is internal heat, it naturally steams Spleen dampness into Phlegm. Over time, this obstructs the collaterals and orifices, preventing the proper circulation of Wei Qi (Defensive Qi), making the exterior susceptible to invasion by External Wind. Additionally, immoderate sexual activity has depleted his Essence and Qi internally, attracting Wind. Thus, these factors combine to form this complex syndrome.
Currently, it is necessary to vigorously regulate the Qi of the Spleen and Stomach on the right side to transport and eliminate the Heat-Phlegm and Deficient Wind from the left side. There are subtle complexities here that cannot be addressed solely by warming and tonifying. Why? Treating such mixed syndromes requires the use of complex herbal combinations and adapting to the endless variations brought by seasonal changes. For instance, during the severe cold of winter, internal heat is constrained by external cold and cannot dissipate through the skin, inevitably penetrating deep into the sinews and bones to cause harm. Therefore, using dried Ginger (Shengjiang) and Prepared Aconite Root (Fuzi) temporarily dispels the external cold, allowing the internal heat to vent. If, however, in warmer seasons, the seasonal heat combines with internal heat, and one still assists with Ginger and Aconite, the three heats will fan each other, burning sinews and rotting flesh. Who can master the balance of medication to handle all situations with a single method?
One might ask: In left-sided wind paralysis, pulse diagnosis and symptom differentiation indicate the presence of Phlegm and Heat, which seems correct. Phlegm is generated from Spleen dampness and resides on the right side; thus, one should first treat the right side, yet why treat the left? Since the disease is clearly on the left, why treat the right? This is precisely the most critical aspect of the pathogenesis. It stems from the teachings in Fangshu (medical formularies) by Danxi, stating "disease on the left involves more blood, disease on the right involves more Qi," which led later generations to hold biased views. However, the *Huangdi Neijing* (Yellow Emperor's Inner Canon) contains no such statement. The *Neijing* only states that the left and right are the pathways of Yin and Yang. If the left and right are pathways for the mutual movement of Yin and Yang, how can one be partial? Moreover, although the left side is primarily governed by Blood, without Qi to command it, Blood cannot flow. Although the right side is primarily governed by Qi, without Blood to anchor it, Qi easily scatters. Thus, the Liver and Gallbladder reside on the left, but their Qi often circulates to the right; the Spleen and Stomach reside on the right, but their Qi often circulates to the left. Their mutual infusion ensures continuous life processes. The Liver Wood governs Wind, and Spleen Dampness generates Phlegm; when Wind and Phlegm attack the human body, they do not distinguish between left and right. However, relying on his strong constitution, the patient overconsumed his Essence and Blood. After the age of sixty-four (eight times eight), when Tian Gui (reproductive essence) had exhausted, the left side became deficient first. Consequently, Phlegm generated from diet on the right side and Wind entering from the skin pores gradually accumulated in the empty organs, manifesting suddenly. Wind presents with a forceful and rapid pulse; Phlegm presents with a soft and slippery pulse. Due to the forceful pulse, the large sinews shorten, causing the tongue sinews to also shorten, leading to speech impediment. The small sinews become lax and elongated, causing symptoms to spread from the left to the right. Observing this spread indicates that the small sinews on the left are lax and lack tension. If the small sinews could tense up, the left side would recover. For treating unilateral diseases, the method should follow "drawing Yang from Yin, drawing Yin from Yang, drawing from the left to the right, and drawing from the right to the left." Consider a tree with one side withered: do you water the withered part, or do you water the healthy part to make it flourish, thereby indirectly nourishing the withered part?
In treatment, Ginseng Radix et Rhizoma (Renshen) and Atractylodis Rhizoma (Baizhu) serve as Sovereign (Jun) and Minister (Chen) herbs. With Aconiti Lateralis Radix Praeparata (Fuzi) and Zingiberis Rhizoma Recens (Shengjiang) as Assistant (Zuo) and Envoy (Shi) herbs, one can fearlessly use this formula in cold months. Conversely, with Renshen and Baizhu as Sovereign and Minister, and Antelopis Cornu (Lingyangjiao), Bupleuri Radix (Chaihu), Anemarrhenae Rhizoma (Zhimu), and Gypsum Fibrosum (Shigao) as Assistant and Envoy herbs, one can avoid heat-related complications in spring, summer, and autumn. Additionally, acupuncture at the four extremities of the hands and feet is suitable to drain Ying Blood (Nutritive Blood) and promote Qi circulation, fearing that Heat-Phlegm and Deficient Wind may eventually become leprosy-like conditions.
A disciple asked: The classic text states, "The left and right are the pathways of Yin and Yang." Annotations explain this using the Luck Theory (Yunqi) of Si Tian and Zai Quan, and the Left/Right Intercalaries, leaving readers confused. Now, you interpret this with the word "mutual movement" (Wang Huan), which aligns perfectly with Taiji generating Yang through motion and Yin through stillness, the numbers of Heaven and Earth's creation, and the natural cycles of Spring and Autumn. However, I do not know where "movement" begins and where "return" ends. Could you explain? I replied: This is a profound question. The Way of Heaven and Earth dictates that Spring Qi begins on the left and ends on the right; Autumn Qi begins on the right and ends on the left; Summer Qi begins above and ends below; Winter Qi begins below and ends above. The human body follows the same pattern. The classics say, "To know the beginning, first establish the mother." The "mother" refers to the source of the mutual generation of the Five Zang Organs. It is also said that the Five Zang Organs mutually overcome via generation and restriction. For example, Lung Metal on the right moves to the left to generate Kidney Water, which then restricts Liver Wood; Heart Fire on the left moves to the right to generate Spleen Earth, which then restricts Lung Metal. This mutual movement is interwoven endlessly. However, starting from Metal, generation ends in Earth, and restriction ends in Fire; starting from Fire, generation ends in Wood, and restriction ends in Water. This is the sequence within the interweaving. Extending this to the Twelve Meridians, such as Zi hour injecting Shaoyang Gallbladder and Chou hour injecting Jueyin Liver, also follows this sequence. Indeed, by establishing the root and deducing the categories, the general outline of beginnings and endings becomes clear.
Another question: Does the mutual movement of pathogenesis in the left/right and upper/lower have a sequence? I answered: The sequence of pathogenesis movement consists only of Smooth Transmission (Shun Chuan) and Reverse Transmission (Ni Chuan). Smooth transmission passes to what it generates, following the natural order of Heaven and Earth (e.g., Spring to Summer, Summer to Late Summer, Late Summer to Autumn, Autumn to Winter, Winter back to Spring). This is not considered pathological, or if it is, it is mild. Reverse transmission passes to what it restricts; mild illness becomes severe, and severe illness leads to death. For example, Spring transmitting to Late Summer, Late Summer to Winter, Winter to Summer, Summer to Autumn, and Autumn to Spring—this contradicts the natural order and causes disease. Some say: The classics state "intermittent transmission implies survival, seven-fold transmission implies death," so intermittent transmission must be smooth, and seven-fold transmission must be reverse. I say: No. Commentators on the *Nanjing* claim intermittent transmission is smooth, skipping one organ. This error arises from mistakenly believing pathogenesis only rotates right-to-left and not left-to-right, due to ignorance of the left-right mutual movement principle. If we question whether Kidney Water skipping one organ to transmit to Heart Fire is reverse transmission (a thief pathogen), they would have no answer. Thus, both intermittent and seven-fold transmissions determine life and death within the context of reverse transmission. Intermittent transmission means: Heart disease should reverse-transmit to Lung, but instead transmits to Liver (which Lung restricts); Lung disease should reverse-transmit to Liver, but instead transmits to Spleen (which Liver restricts). This applies to Liver, Spleen, and Kidney diseases as well. Because the organs are not subjected to restrictive theft, survival is possible. Seven-fold transmission means: The previous six transmissions have already covered the five Zang organs in reverse order. The seventh transmission repeats the reverse cycle. For instance, Heart disease starts; second transmission injures Lung; third injures Liver; fourth Spleen; fifth Kidney; sixth returns to Heart; seventh enters Lung again. Since Lung was already injured earlier, it suffers a second blow from the thief pathogen, leading to Qi exhaustion and death. This is the "one Zang cannot bear two injuries" principle. Unlike Shanghan (Cold Damage) meridian transmission, where completing the cycle and re-transmitting is harmless. The *Zhenjing* (Classic of Acupuncture) states: "A skilled acupuncturist treats the right with the left, and the left with the right." Acupoints on the body are symmetrical left and right, yet treatment must be exchanged. This applies to upper and lower parts as well, clarifying the mechanism of mutual movement.
Another question: Hemiplegia originally distinguishes between left and right. After distinguishing left and right, does the disease proceed irreversibly? Why has treatment been ineffective? I answered: Wind and Phlegm attack humans according to their own nature, initially having no fixed form. Once the disease forms, it does not proceed irreversibly. Generally, there is forward movement and return. This applies to Heavenly cycles, human affairs, and pathogenesis. Wind is the Qi of the four seasons and eight directions, entering through the nose—it is Heavenly Qi. Phlegm is the taste of grains and foods, entering through the mouth, condensed from Spleen-Stomach dampness—it is Earthly Qi. Their forces are distant but can combine. They resemble Internal Injury combined with External Contraction, often mixing and confusing diagnosis. Therefore, if Wind dominates, treat Wind first; if Phlegm dominates, treat Phlegm first; if equal, treat both. This is the fixed rule. The *Neijing* says: Wind attacking humans enters first through the skin and hair, then muscles, then sinews, then bone marrow. Skilled practitioners treat the skin/hair first, then muscles. From this, we see the progression from right to left. Skin/hair is governed by the Right Lung; muscles by the Right Stomach; sinews/meridians by the Left Liver; bone marrow by the Left Kidney. Pathogens entering from outside go deeper; thus, treating skin/muscles prevents deep penetration. Also: Dampness attacks humans starting from the feet, moving upward regardless of left or right. However, individuals with inherent excess Internal Wind are prone to attracting External Wind; those with inherent excess Internal Dampness attract External Dampness. Those with Internal Wind are injured before the great atmospheric changes occur; those with Internal Dampness feel heavy before the room's foundation stones become moist. Therefore, treatment must follow the category. Pathogens entering from outside should be gradually driven out; pathogens rising from below should be gradually driven down. Allowing them to proceed irreversibly defeats the purpose of treatment.
Another question: Driving out pathogens from outside and down from below sounds refreshing. Do ancient methods align with this? I answered: These are methods tested by ancients but not explicitly stated, so their intent is unknown. For example, in Da Xiao Xu Ming Tang (Large and Small Life-Extending Decoctions) for treating Wind, formulas contain Guizhi Tang (Cinnamon Twig Decoction) ingredients like Cinnamomi Ramulus (Guizhi), Fuzi, Poria (Fuling), Baizhu, Ephedrae Herba (Mahuang), and Saposhnikoviae Radix (Fangfeng). The combination of interior and exterior treatments is complex, and modern practitioners find it difficult to use. However, using Fuzi and Guizhi drives out interior pathogens; using Fuling and Baizhu drives out middle-jiao pathogens; using more Mahuang and Fangfeng (exterior-releasing herbs) aims to expel interior pathogens from the exterior. For chronic illness with deficiency and deep-penetrating Wind, there are methods for slight sweating with one breath, slight purgation over ten days, balancing for fifteen to thirty days, and gentle dispersal. Ancients had established rules. Rules for treating Phlegm are not found in formularies. For Phlegm in the upper jiao, use Citri Reticulatae Pericarpium Verum (Gua Di San) and Gardeniae Fructus cum Soja Fermentata (Zhi Chi Tang); on the left, use Longdan Xiegan Wan (Dragon Gallbladder Draining Pill); on the right, use Gun Tan Wan (Rolling Phlegm Pill); for deficient patients, use Zhuli Datang Wan (Bamboo Juice Phlegm-Expelling Pill); for deep cold and stagnation, use San Jian Tang (Three Establishments Decoction). These seem simple, but perhaps the subtlety of mastery cannot be written down. I now teach you these principles. Five flavors enter the mouth and store in the Stomach. The Stomach is the Sea of Water and Grain and the commander of the Five Zang and Six Fu organs. Excessive eating condenses into Phlegm-Saliva, which spreads into the collaterals along with the Spleen's transportation function. This mutual movement resembles tides. When Spleen Qi moves, the tide goes out; when Spleen Qi stops, the tide returns. Therefore, treating deep stagnation uses only pungent-hot herbs to slightly stir cold Phlegm, then stops. If continued, Phlegm may move recklessly due to heat, causing significant harm. Not only Phlegm, but the Spleen itself may overwork incessantly, like a tide with no return, leading to catastrophic Phlegm disorders. People taking harsh tonics often desire food late at night, unaware of the reason, rejoicing in their appetite. They fail to cherish Spleen Qi, allowing it to transform by day and rest by night to maintain regularity. Furthermore, since body Phlegm flows from the Stomach to the collaterals, Phlegm in the collaterals must return to the Stomach to be expelled via vomiting or defecation. This can only happen when Spleen Qi is at rest. Therefore, Phlegm patients should rest between breakfast and lunch, keeping Spleen Qi inactive so Phlegm in collaterals can return to the Stomach and move up/down via Stomach Qi, rather than spreading via Spleen Qi. Observe that patients with mild Phlegm disease sleep peacefully at night and vomit/defecate Phlegm early the next morning. Severe patients, upon waking from coma, can also expel Phlegm. Is this not because fasting allows Spleen Qi to rest, providing an exit for Phlegm? Those who love using hot herbs for aggressive attack rarely understand this. Alas, many take pungent-hot herbs and gain nighttime appetite. Will they ponder these humble words?
Mr. Hu Youchen said: Your knowledge is profound, hence your explanation is detailed. Yet all is based on the *Neijing*, not original invention; yet it possesses divine insight, not mere imitation. I previously admired Wang Yutai and Miu Zhongchun greatly; they truly understood Guan Zhong and Yan Ying as the people of Qi did.