论头疼 论目痛
天师曰∶常治者，可以常法而常治之者也。如人病头疼，则以头疼常法治之∶目痛，则以目痛常法
治之是也。何必头疼而治之于两足，目痛而治之以两手乎。虽头疼实有治之两足而愈，目痛实有治之两
手而痊者，然彼必常治之而不愈不痊，然后以变法治之，非可以常治，而先求之于变法也。故一遇头
疼，即以蔓荆子一钱，川芎五钱，白芷一钱，甘草一钱，半夏一钱，细辛一钱治之，病去如扫。（〔批〕
止疼汤。）一遇目痛，以柴胡一钱，白芍三钱，当归一钱，白蒺藜二钱，甘菊花一钱，荆芥、防风
各一钱，半夏一钱，甘草五分，栀子二钱，水煎服。（〔批〕全目饮。）二剂即愈。皆无事舍常而思
变也。此常治之法，可为师也。
张公曰∶常病用常法极是，予亦不再言变也。
华君曰∶无。
论伤寒变结胸 论疟变下痢 论中风变狂 论中暑变亡阳 论反胃变噎膈
天师曰∶变法者，不可以常法治，不得已而思变之也。变症不同，用药各异，吾举其大者言之。如
伤寒变为结胸，
疟疾变为下痢，中风变为发狂，中暑变为亡阳，反胃而变成噎膈，若不以变法治之，仍以平常药饵相
治，吾见其坐毙而已矣。然则结胸之症，乃伤寒之变也，可不以变法治之乎。伤寒火邪正炽，原不可急
与饮食。若不知禁忌与之，胃中得食，不啻如宝，故茹而不出，而他脏见胃中有食，群起而争，其势猖
狂，非杯水可解，必当以变法治之。急须以栝蒌一枚捶碎，入甘草一钱，同煎服之。夫栝蒌乃陷胸之胜
物，平常人服之，必至心如遗落，今病患一旦服之，不畏其虚乎？谁知无病常人，断断不可服此，而伤
寒结胸之症，却有相宜。盖食结在胸，非大黄、芒硝、枳壳、槟榔、浓朴之类可能祛逐，必得栝蒌，始
能陷之。入于脾中，尤恐其过于下也，少加甘草留之，且得甘草之和，不致十分推荡。此变症而用变法，
真胜于用正也。
疟疾本是常症，只可以平常消导而发散之。今忽为下利等症，则变轻为重。欲发汗，则身已亡
阴，欲祛邪，则下已便物。顾上则虑下，顾下则碍上。倘仍以常法治之，奏功实少。今用人参一两，鳖甲
一两，白术三两，茯苓一两，当归一两，白芍三两，柴胡一钱，枳壳一钱，槟榔一钱，水煎服。（〔批〕补
阳消疟丹。）此方奇在用人参、白术。盖疟病则亡阳，若不急补其阳气，则下多亡阴，势必立亡。惟急
补其阳气之不足，阳生阴长，始有生机。尤妙白芍、当归之多，以滋润其肠中之阴。盖下利多。则阴亡亦
多，今用补阴之剂，则阴生阳降，自然春意融和，冰泮化水，分消水道，污秽全无，况方中又加枳壳、槟
榔，仍然去积。又妙少用柴胡，微舒肝气，使木气相安，不来克土，自然土克水之多，水润木之下，内气
既生，外邪亦散。此治下利，而疟病同除。此种治变之法，何可不知。
中风系是危症，况变发狂，死在眉睫。倘不以变法救之，何以得免于垂绝耶。方用人参三两，菖
蒲三钱，半夏三钱。南星三钱，生用附子一钱，丹砂末三钱，先将参、苓、附子等项煎汤，调入丹砂
末灌之。（〔批〕救绝至神丹。）十人中亦可救三四。盖天下无真中风之人，不过中气、中痰、中湿
而已，若不用人参、附子，大剂煎饮，何能返已去之元阳，回将绝之心气哉。况人将死之时，未有不痰上
涌者，妙在用半夏、南星以祛逐之。尤妙用菖蒲以引入心经，使附子、半夏得施其荡邪之功，而丹砂又
能镇定心气，所以往往返危为安。倘仍以寻常二陈之类以消痰，痰未必消，而心气已绝。此又症变而法
变者也。
中暑原是热症，然而热之中也，亦由于气之虚。人若气实形壮者，多难中暑。然则中暑之病，宜
补气为先，解暑为次。无如人以为热也，治表为急，治本为末。先以香薷饮治之，不效，又改用白虎汤，
又不效，乃用发散之剂，杂然并进，则火邪乘热气外走，尽趋皮肤而出，而不可止，以变为亡阳之症者多
矣。法当以人参三两，元参三两，甘草一钱，北五味一钱，生地三两救之。此方之妙，全在用人参以补元
气，用元参以凉血。盖血得凉，则气自止而不走，又有五味子之酸，以收敛肺金之气，此不止汗而汗自止
也。倘惟以四君子汤平常治法。则一杯之水，何能止车薪之发焰哉。此又变法之宜知也。
反胃症初起之时，未尝非胃病也，当时以逍遥散加黄连一钱，立止也。无如世医不知治法，乃用香砂、
浓朴、枳壳、砂仁之类，纷纷投之。不应，又改用大黄、巴豆之类下之。
又不应，乃改用黄连、黄柏、黄芩、栀子、知母大寒之品以凉之。又不应，乃改用桂枝、白果、肉桂、附
子、干姜、吴茱萸之类以热之。又不应，乃始用柴胡、荆芥、桔梗、防风、苏子之类以散之，遂成噎膈之
症矣。吾今悯之，乃传一方，用熟地一两，山茱萸四两，麦冬三钱，北五味一钱，元参一钱，当归三
钱，白芥子一钱，牛膝二钱，水煎服。（〔批〕转食至神丹。）此方之妙，全在不治翻胃，正所以治翻胃
也。盖人之反胃，乃是肾中阴水竭也。肾水不足，则大肠细小，水不足以润之，故肠细而干涸。肠既细小，
则饮食入胃不能下行，必反而上吐。治之之法，不可治上，而宜治下。方中用熟地、山茱之类，纯是补肾
中之水也。肾水足，而大肠有水相资，则大肠仍复宽转，可以容物。水路既宽，则舟楫无碍，大舸小舶，
可以顺行，又何惧区区小舟不可以转运粮食哉。此肾中虚而水不足以润大肠者，宜如是治法。若肾中寒凉而
虚者，又不如是治也。盖翻胃之名虽同，翻胃之实各异。肾中无水而翻胃者，食下喉即吐；肾中无火而翻
胃者，食久而始吐也，譬如今日食之，明日始尽将今日之物吐出者是也。方用熟地一两，附子一钱，肉桂
一钱，山茱萸四钱，麦冬五钱，北五味一钱，茯苓二钱，山药二钱，丹皮一钱，泽泻一钱，牛膝一钱，水
煎服。此方八味丸汤也，妙在用附子、肉桂于补肾水之中，使去水中补火。补火者，补命门之火也。盖脾胃
之气必得命门之火始生。譬如釜下无火，何以煮爨，未免水冷金寒，结成冰冻，必得一阳初复之气，始
解阳和。人身脾胃亦然。然而寒凉之病，止该腹痛心疼，今反无此症，乃上越而吐者何也？盖脾胃有出路，
则寒邪之气不留于中，今日日
上吐，将胃口咽门已成大道熟径，往来无所阻滞，则径情趋奔，其势甚便，又何必积蓄于中州，盘踞于心
腹，颠寒作热，以苦楚此脾胃哉。此翻胃下寒，心腹之所以不痛也。此又不治反胃，而所以治反胃也。此
变法治病之端也。
张公曰∶说得我闭口无言。汝知而不能言，今可以言矣。无可一言，惟有三叹顿首而已。惟圣者知
之，予亦不能言之也。
华君曰∶余虽有传，不及君之多而且畅。
雷公曰∶无一论不奇辟。真圣人之言，不可测也。
（反胃而用逍遥加黄连，赵养葵先生亦主此方，但此必食入即吐之症，如朝食暮吐者，又为命门无
火，当是八味汤症矣。李子永识。）
天师说：所谓“常治”，是指可以用常规方法进行治疗的情况。比如有人患头疼，就用治疗头疼的常规方法来治；有人患目痛，就用治疗目痛的常规方法来治，就是这样。何必头疼却去治双脚，目痛却去治双手呢？虽然确实有通过治疗双脚而治愈头疼、通过治疗双手而治愈目痛的情况，但那一定是因为用常规方法治疗后病情没有好转或痊愈，然后才改用变法治疗的，而不是在可以使用常规治疗时，就先寻求变法治疗。所以，一遇到头疼，就用蔓荆子一钱、川芎五钱、白芷一钱、甘草一钱、半夏一钱、细辛一钱来治疗，病邪去除就像扫尘一样迅速。（批注：止疼汤。）一遇到目痛，就用柴胡一钱、白芍三钱、当归一钱、白蒺藜二钱、甘菊花一钱、荆芥和防风各一钱、半夏一钱、甘草五分、栀子二钱，用水煎服。（批注：全目饮。）两剂药后就能痊愈。这都是不必舍弃常法而去思考变法的情况。这种常治的方法，可以作为准则。
华君说：没有异议。
论伤寒变结胸，论疟疾变下痢，论中风变狂，论中暑变亡阳，论反胃变噎膈
天师说：所谓“变法”，是指不能用常规方法治疗，不得已而采取的变化治疗方法。变症不同，用药也各异，我列举其中重大的情况来说明。比如伤寒变为结胸，疟疾变为下痢，中风变为发狂，中暑变为亡阳，反胃进而变成噎膈，如果不以变法治疗，仍然用平常的药物来医治，我看他们只会坐以待毙罢了。那么结胸这个症状，是伤寒的变症，难道不可以用变法治疗吗？伤寒火邪正盛，原本就不可以急于进食。如果不知道禁忌而给予饮食，胃中得到食物，就像得到宝贝一样，所以吃进去却吐不出来，其他脏腑看到胃中有食物，群起争夺，其势猖狂，不是杯水车薪所能解决的，必须当用变法治疗。急需将一枚栝蒌捶碎，加入甘草一钱，同煎服用。栝蒌是陷胸的良药，普通人服用它，必定会导致心神恍惚，好像丢失了什么似的，现在病人一旦服用，不怕身体虚弱吗？谁知道无病的常人，绝对不可服用此药，而伤寒结胸的症状，却有适宜之处。大概是因为食积结在胸中，非大黄、芒硝、枳壳、槟榔、厚朴这类药物能够祛除驱逐，必须得到栝蒌，才能将其陷下。药物进入脾中，尤其担心它泻下太过，所以少加甘草来留驻药性，并且得到甘草的调和作用，不至于造成十分剧烈的推荡泻下。这是变症用变法，确实胜过用正法。
疟疾本是常症，只可以用平常的消导发散方法来治疗。现在忽然变为下利等症状，则是变轻为重。想要发汗，则身体已经亡阴；想要祛邪，则下部已经排便。顾念上部则顾虑下部，顾念下部则妨碍上部。倘若仍以常法治疗，见效确实很少。现在用人参一两、鳖甲一两、白术三两、茯苓一两、当归一两、白芍三两、柴胡一钱、枳壳一钱、槟榔一钱，水煎服。（批注：补阳消疟丹。）此方奇妙之处在于使用人参、白术。因为疟疾病会导致阳气耗损，如果不急于补充阳气，则下部多泻会进一步亡阴，势必立刻死亡。只有急于补充不足的阳气，阳生则阴长，才会有生机。尤其妙在白芍、当归用量大，以滋润肠道中的阴液。因为下利多，则阴液亡失也多，现在用补阴的药剂，则阴生阳降，自然春意融和，冰融化成水，分消水道，污秽全无，况且方中又加入枳壳、槟榔，依然能去除积滞。又妙在少用柴胡，微微舒展肝气，使木气相安，不来克制土气，自然土克水的作用正常，水润木之下，内气既已生成，外邪也会消散。这是治疗下利，而疟病一同除去。这种治疗变症的方法，怎么可以不知道呢？
中风属于危重病症，何况变为发狂，死亡就在眼前。如果不以变法救治，怎么能免于垂死呢？方用人参三两、石菖蒲三钱、半夏三钱、天南星三钱（生用）、附子一钱、朱砂末三钱，先将人参、茯苓、附子等项煎汤，调入朱砂末灌服。（批注：救绝至神丹。）十个人中也可以救活三四个。大概天下没有真正中风的病人，不过是中气、中痰、中湿而已，若不用人参、附子，大剂量煎饮，怎么能挽回已经离去的元阳，恢复将绝的心气呢？况且人将死的时候，没有不出现痰上涌的情况，妙在用半夏、天南星来祛除驱逐痰浊。尤其妙在用石菖蒲引入心经，使附子、半夏得以施展涤荡邪气的功效，而朱砂又能镇定心气，所以往往能使危险转为平安。倘若仍以寻常的二陈汤之类来消痰，痰未必消除，而心气已经断绝。这又是症变而法变的情况。
中暑原本是热症，然而热之中人也，也是由于气虚所致。人如果气实形壮，大多难以中暑。那么中暑的病，应该以补气为先，解暑为次。无奈世人认为是热症，急于治表，轻视治本。先用香薷饮治疗，无效，又改用白虎汤，还是无效，于是使用发散药剂，杂乱地同时进用，导致火邪乘着热气向外走散，全部趋向皮肤而出，而且无法停止，从而变为亡阳症状的情况很多了。治法应当用人参三两、玄参三两、甘草一钱、北五味子一钱、生地三两来救治。此方的奇妙，全在于用人参来补元气，用玄参来凉血。因为血得凉，则气自然停止而不妄行，又有五味子的酸味，来收敛肺金之气，这不止汗而汗自止。倘若只用四君子汤的平常治法，那么一杯水，怎么能扑灭车薪之火呢？这又是宜知变法的情况。
反胃症初起之时，未尝不是胃病，当时如果用逍遥散加黄连一钱，立刻就能止住。无奈世间的医生不知道治法，乃使用香附、砂仁、厚朴、枳壳之类，纷纷投用。无效，又改用大黄、巴豆之类攻下。
又无效，乃改用黄连、黄柏、黄芩、栀子、知母等大寒之品来清热。又无效，乃改用桂枝、白果、肉桂、附子、干姜、吴茱萸之类来温补。又无效，乃始用柴胡、荆芥、桔梗、防风、苏子之类来疏散，于是形成了噎膈的症状。我现在怜悯这种情况，于是传授一方，用熟地黄一两、山茱萸四两、麦冬三钱、北五味子一钱、玄参一钱、当归三钱、白芥子一钱、牛膝二钱，水煎服。（批注：转食至神丹。）此方的奇妙，全在于不治翻胃，正所以治翻胃。大概人的反胃，乃是肾中阴水枯竭所致。肾水不足，则大肠细小，水不足以滋润它，所以肠细而干涸。肠既然细小，则饮食入胃不能下行，必然反而向上呕吐。治疗的方法，不可治上，而宜治下。方中使用熟地、山茱萸之类，纯粹是补肾中的水。肾水充足，而大肠有水相助，则大肠恢复宽转，可以容纳食物。水路既宽，则舟船无阻，大船小船，可以顺行，又何惧区区小舟不可以转运粮食呢？这是肾中虚而水不足以润大肠者，宜用这样的治法。若肾中寒凉而虚者，又不像这样治疗。大概反胃之名虽然相同，反胃的实质却各异。肾中无水而反胃者，食下喉即吐；肾中无火而反胃者，食久而始吐也，譬如今天吃的食物，明天才尽将今日之物吐出的是这种情况。方用熟地黄一两、附子一钱、肉桂一钱、山茱萸四钱、麦冬五钱、北五味子一钱、茯苓二钱、山药二钱、牡丹皮一钱、泽泻一钱、牛膝一钱，水煎服。此方是八味丸的汤剂，妙在用附子、肉桂于补肾水中，使去水中补火。补火者，补命门之火。大概脾胃之气必须得到命门之火才能生化。譬如锅下无火，何以煮饭，未免水冷金寒，结成冰冻，必须得一阳初复之气，才能解冻回暖。人身脾胃也是如此。然而寒凉之病，本该腹痛心疼，现在反而没有这些症状，而是向上呕吐为什么呢？大概脾胃有出路，则寒邪之气不留于中，如今日日向上呕吐，将胃口咽门已成大道熟径，往来无所阻滞，则顺着情势奔涌，其势甚便，又何必积蓄于中州，盘踞于心腹，颠寒作热，来苦楚脾胃呢？这是翻胃下寒，心腹之所以不痛的原因。这也是不治反胃，而所以治反胃的道理。这是变法治病的开端。
张公说：说得我闭口无言。你知而不能言，现在可以说出来了。无可一言，只有三叹顿首而已。只有圣者知道，我也不能说出来了。
华君说：我虽然有传承，不如您那么多且畅达。
雷公说：无一论不奇特独特。真是圣人的话，不可测度。
（反胃而用逍遥散加黄连，赵养葵先生也主张此方，但这必须是食入即吐的症状，如朝食暮吐者，又是命门无火，应当是八味丸汤的症状了。李子永识。）
On Headache and Eye Pain
The Heavenly Master said: "Chang Zhi" (Routine Treatment) refers to conditions that can be treated with routine methods. For instance, if a person suffers from headache, one should treat it using the routine method for headaches; if they suffer from eye pain, one should treat it using the routine method for eye pain. Why must one treat a headache by addressing the feet, or eye pain by addressing the hands? Although there are indeed cases where treating the feet cures a headache, or treating the hands cures eye pain, these situations arise only after routine treatments have failed to improve or cure the condition, prompting a shift to Bian Zhi (Variable/Alternative Treatment). It is not appropriate to seek alternative treatments first when routine treatment is still applicable. Therefore, upon encountering a headache, one should use Jing Jie (Scutellaria Barbata, though text says Man Jing Zi - *Correction: Man Jing Zi is Vitex Agnus-Castus fruit*) 1 qian, Chuan Xiong 5 qian, Bai Zhi 1 qian, Gan Cao 1 qian, Ban Xia 1 qian, and Xi Xin 1 qian. The illness will be cleared as swiftly as sweeping dust. (Annotation: Zhi Teng Tang / Pain-Relieving Decoction.) Upon encountering eye pain, one should use Chai Hu 1 qian, Bai Shao 3 qian, Dang Gui 1 qian, Bai Ji Li 2 qian, Gao Ju Hua 1 qian, Jing Jie and Fang Feng each 1 qian, Ban Xia 1 qian, Gan Cao 0.5 qian, and Zhi Zi 2 qian, decocted in water. (Annotation: Quan Mu Yin / Complete Eye Drink.) Recovery occurs within two doses. These are all instances where one does not need to abandon routine methods to consider alternative ones. This routine treatment method serves as a standard.
Lord Zhang said: Treating common diseases with common methods is absolutely correct. I will no longer discuss alternative treatments.
Lord Hua said: No objection.
On Tai Yang Disease Evolving into Jie Xiong, on Malaria Evolving into Dysentery, on Stroke Evolving into Madness, on Heatstroke Evolving into Collapse of Yang, on Regurgitation Evolving into Dysphagia
The Heavenly Master said: "Bian Zhi" (Variable/Alternative Treatment) refers to conditions that cannot be treated with routine methods, necessitating a change in approach due to circumstances. Different evolving symptoms require different medications. I will discuss the major cases. For example, Tai Yang disease evolving into Jie Xiong (Chest Binding), malaria evolving into dysentery, stroke evolving into madness, heatstroke evolving into collapse of Yang, and regurgitation progressing to dysphagia—if these are not treated with alternative methods but instead with ordinary medicines, I fear the patients will simply sit and die. Thus, Jie Xiong, being an evolution of Tai Yang disease, certainly requires alternative treatment. In Tai Yang disease, fire pathogenic factors are rampant, and food intake should initially be avoided. If one ignores this contraindication and provides food, the stomach treats it like treasure, retaining it without vomiting. Other organs, seeing food in the stomach, compete fiercely, creating a chaotic situation that cannot be resolved with a cup of water. Alternative treatment is necessary. One should crush one Gua Lou (Trichosanthes Fruit), add 1 qian of Gan Cao, and decoct together for administration. Gua Lou is a superior agent for resolving chest binding. Ordinary people taking it might experience mental confusion, as if losing something. Would a patient not fear weakness from such intake? Yet, while healthy individuals must absolutely avoid this, it is suitable for Tai Yang disease complicated by Jie Xiong. Food stagnation in the chest cannot be expelled by Da Huang, Mang Xiao, Zhi Ke, Bing Lang, or Hou Po alone; Gua Lou is required to sink and resolve it. To prevent excessive purgation affecting the spleen, a small amount of Gan Cao is added to retain the medicine and harmonize, preventing violent purging. Treating an evolving symptom with an alternative method truly surpasses using standard methods.
Malaria is typically a common condition, treatable with routine digestion-promoting and dispersing methods. However, if it suddenly evolves into diarrhea, the condition has worsened from mild to severe. Sweating is contraindicated as yin fluids are already depleted; expelling pathogens is hindered by lower bowel evacuation. Addressing the upper affects the lower, and vice versa. Routine treatment yields little success. Now, use Ren Shen 1 liang, Bie Jia 1 liang, Bai Zhu 3 liang, Fu Ling 1 liang, Dang Gui 1 liang, Bai Shao 3 liang, Chai Hu 1 qian, Zhi Ke 1 qian, and Bing Lang 1 qian, decocted in water. (Annotation: Bu Yang Xiao Nue Dan / Yang-Supplementing Malaria-Resolving Pill.) The brilliance of this formula lies in using Ren Shen and Bai Zhu. Malaria depletes yang qi; failing to urgently tonify yang leads to further yin loss through diarrhea, resulting in imminent death. Urgently supplementing insufficient yang allows yang generation to foster yin growth, restoring vitality. The generous use of Bai Shao and Dang Gui moistens intestinal yin. Since frequent diarrhea causes significant yin loss, tonifying yin promotes yin generation and yang descent, creating a harmonious state like melting ice, clearing turbid matter through the water pathways. Furthermore, Zhi Ke and Bing Lang remove stagnation. The subtle use of Chai Hu gently soothes liver qi, ensuring wood does not overact on earth, allowing earth to control water properly, moistening wood below. Internal qi generates, external pathogens disperse. This treats diarrhea while simultaneously resolving malaria. How can one ignore such methods for evolving conditions?
Stroke is a critical condition; evolving into madness implies imminent death. Without alternative rescue methods, how can one avoid near-death? Use Ren Shen 3 liang, Shi Chang Pu 3 qian, Ban Xia 3 qian, Nan Xing 3 qian (raw), Fu Zi 1 qian, and Zhu Sha powder 3 qian. Decoct Ren Shen, Fu Ling, Fu Zi, etc., in water, mix in Zhu Sha powder, and administer. (Annotation: Jiu Jue Zhi Shen Dan / Spirit-Emergency Resuscitation Pill.) Three out of ten patients may be saved. There are no true "wind strokes"; rather, they involve qi blockage, phlegm obstruction, or dampness. Without large doses of Ren Shen and Fu Zi, how can one restore lost primordial yang and revive fading heart qi? Near death, phlegm surges upward; Ban Xia and Nan Xing effectively expel phlegm. Shi Chang Pu guides the herbs into the Heart meridian, allowing Fu Zi and Ban Xia to dispel pathogens, while Zhu Sha calms the heart qi, often turning danger into safety. Using routine Er Chen Tang to resolve phlegm fails to clear phlegm and results in heart qi failure. This illustrates changing methods for changing symptoms.
Heatstroke is originally a heat condition, yet susceptibility arises from qi deficiency. Robust individuals rarely suffer heatstroke. Thus, tonifying qi takes precedence over resolving heat. Ignoring this, physicians mistakenly prioritize superficial treatment over root treatment. Initial use of Xiang Ru Yin fails, followed by Bai Hu Tang, also failing. Subsequently, various dispersing agents are mixed indiscriminately, causing fire pathogens to follow heat outward to the skin uncontrollably, leading to collapse of Yang. The correct method uses Ren Shen 3 liang, Xuan Shen 3 liang, Gan Cao 1 qian, Bei Wu Wei Zi 1 qian, and Sheng Di 3 liang. The efficacy relies on Ren Shen tonifying primordial qi and Xuan Shen cooling blood. Cooling blood stops erratic qi movement. The sour taste of Wu Wei Zi收敛 (astringes) lung qi, stopping sweating without explicit antiperspirants. Using routine Si Jun Zi Tang would be like trying to extinguish a burning cartload of firewood with a cup of water. Knowledge of alternative methods is essential here.
Regurgitation initially stems from stomach issues; at onset, Xiao Yao San plus 1 qian of Huang Lian could stop it immediately. Unaware physicians use Xiang Fu, Sha Ren, Hou Po, Zhi Ke, etc., without effect. They then try Da Huang and Ba Dou for purging. Still ineffective, they switch to cold herbs like Huang Lian, Huang Bo, Huang Qin, Zhi Zi, and Zhi Mu. Still ineffective, they use warm herbs like Gui Zhi, Rou Gui, Fu Zi, Gan Jiang, and Wu Zhu Yu. Still ineffective, they use dispersing herbs like Chai Hu, Jing Jie, Jie Geng, Fang Feng, and Su Zi, finally resulting in dysphagia. Pitying this, I transmit a formula: Shu Di Huang 1 liang, Shan Zhu Yu 4 liang, Mai Dong 3 qian, Bei Wu Wei Zi 1 qian, Xuan Shen 1 qian, Dang Gui 3 qian, Bai Jie Zi 1 qian, Niu Xi 2 qian, decocted in water. (Annotation: Zhuan Shi Zhi Shen Dan / Food-Turning Spirit-Emergency Pill.) Its brilliance lies in treating regurgitation by not directly targeting the stomach but addressing the root. Regurgitation results from exhaustion of kidney yin water. Insufficient kidney water leads to narrow, dry intestines, preventing food descent and causing upward vomiting. Treatment should focus downward, not upward. Shu Di and Shan Zhu Yu tonify kidney water. Sufficient kidney water nourishes the large intestine, widening it to accommodate food. With wide waterways, vessels move freely; why worry about small boats failing to transport grain? This applies to regurgitation due to kidney deficiency and lack of moisture. For kidney cold-deficiency, the approach differs. Though named similarly, regurgitation varies in nature. Kidney water deficiency causes immediate vomiting after eating; kidney fire deficiency causes delayed vomiting (e.g., eating today, vomiting tomorrow). For the latter, use Shu Di Huang 1 liang, Fu Zi 1 qian, Rou Gui 1 qian, Shan Zhu Yu 4 qian, Mai Dong 5 qian, Bei Wu Wei Zi 1 qian, Fu Ling 2 qian, Shan Yao 2 qian, Mu Dan Pi 1 qian, Ze Xie 1 qian, Niu Xi 1 qian, decocted in water. This is Ba Wei Wan in decoction form. Its subtlety lies in adding Fu Zi and Rou Gui to tonify water, thereby supplementing fire within water. Supplementing fire means tonifying Ming Men (Gate of Life) fire, which generates spleen-stomach qi. Without fire under the pot, cooking is impossible; cold water and metal freeze. Only with the return of yang warmth can thawing occur. Similarly, spleen-stomach needs this warmth. Cold diseases usually cause abdominal pain, but here, vomiting predominates because the exit is open, allowing cold pathogens to escape upward easily rather than stagnating in the center. This explains the absence of abdominal pain in lower-cold regurgitation. This is treating regurgitation by not directly attacking it. This marks the beginning of treating diseases via alternative methods.
Lord Zhang said: Your words leave me speechless. You knew but could not express it; now you can. I have nothing more to say, only three sighs and bows. Only sages understand; I cannot explain it further.
Lord Hua said: My transmission is inferior to yours in both quantity and clarity.
Lord Lei said: Every discussion is unique and profound. Truly the words of a sage, unfathomable.
(Note: Regarding using Xiao Yao San with Huang Lian for regurgitation, Mr. Zhao Yangkui also advocated this formula, but it applies specifically to immediate vomiting after eating. For morning eating and evening vomiting, indicating lack of Ming Men fire, Ba Wei Wan decoction is indicated. Recorded by Li Ziyong.)