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Pulse diagnosis reveals the left pulse as rapid and slightly wiry, while the cun, chi, and guan positions on both hands present a deficient and rapid quality. Reviewing the medical history from five years ago, the patient suffered from distending pain in the left hypochondrium radiating to the back, unable to lie flat on a mat, and had previously vomited blood clots which were purple-black. In the human body, vomiting of watery foam conforms to the classic principle that liver disease can lead to vomiting of saliva and foam. Liver wood qi inevitably invades stomach earth, resulting in minimal food intake and weak limbs with little strength; this condition cannot be cured by cough medicines. These symptoms are all caused by rebellious liver yang attacking upwards, fundamentally due to insufficiency of liver yin. Zhang Zhongjing stated: "When seeing liver disease, first regulate the spleen and stomach," so that earth becomes thick and is not overcome by wood. There was originally a function of generating metal (lung), but according to the description, whenever eggs were consumed, the illness would necessarily worsen; thus, it is known that drugs that are stagnant and astringent do not suit the patient's condition.

North Glehnia Root (Beishashen), Raw Coix Seed (Sheng Biandou), Ophiopogon Tuber (Maidong), Fuzzy Fig Fruit (Yuzhu), Mulberry Leaf (Sangye), Raw Licorice Root (Sheng Gancao), Sugarcane Juice (Zheshuang).

The illness has persisted for more than ten days, with the body still restless and hot, tongue coating sticky and greasy, spirit dull and eyes fixed, pulse rigid and rapid, accompanied by irritability and muttering delirium. This is due to summer-heat and dampness lurking for a long time, combining with seasonal epidemic qi, causing ascendant jueyin qi. However, the *Neijing* mentions that "where dampness resides, dry qi attacks," therefore the pathology transforms from dampness to dryness. If there were no tidal steam of damp-phlegm rising, the tongue coating would have already become dry and prickly. Now, we first use fluids to nourish and cleanse the blazing fire-like heat.

Fresh Rehmannia Root (Xian Shengdi), Ophiopogon Tuber (Maidong), Chinese Plum (Wumei), Sugarcane Juice (Zheshuang), Honeysuckle Flower Dew (Yinhua Lu), Antelope Horn (Lingyangjiao), Clam Water (Bengshui).

Second consultation: The face is grimy, tongue coating white, thirst with desire to drink, shortness of breath resembling asthma, spontaneous diarrhea. This indicates foul turbid qi entering the mouth and nose, mixing and disturbing the qi of water and grain. Dampness blocks and obstructs, turbid qi steams internally, affecting all three burners. Dark, obscure macules appear on the chest, back, limbs, and joints; foul pathogens and blood qi are firmly bound together. The heart orifices are ultimately scorched by evil, leading to coma and muttering delirium...

Acorus Rhizome Juice (Shichangpu Zhi), White Cardamom Seed (Baokouren), Rhino Horn (Xijian - *Note: Use synthetic substitute in practice*), Small Green Tangerine Peel (Xiao Qingpi), Forsythia Heart (Lianqiao Xin), Honeysuckle Flower (Jinyinhua), Liu Yi San (Six-to-One Powder), Gold Juice (Jinzhi), Zhibao Dan (Treasure of Life Pill).

Third consultation: Evil has sunk inward again causing diarrhea, damaging the Jueyin channel. Symptoms include qi rushing up to strike the heart, hunger without ability to eat, dry heaving, abdominal pain—all signs of liver disease. Since the liver is the organ of extreme yin, housing ministerial fire internally, Zhang Zhongjing’s treatment method avoids purely harsh and rigid agents because the liver is called the "rigid organ." At this time, when earth qi is prosperous, water and fire are enemies; stability within five days is not guaranteed, caution is advised.

Ginseng Root (Renshen), Mild Evodia Fruit (Dan Wuyu), Angelica Sinensis Root (Danggui), White Peony Root (Baishao), Bark of Qin Pi (Qinpi), Stir-fried Chinese Plum (Chao Wumei).

Pulse is deep and faint; deep indicates interior cold, faint indicates absence of yang. Tongue coating is white like powder, diarrhea followed by thirst, severe pain when lying down. Entering summer, yin qi is inside... Whenever yin pathogens occupy, they must be unblocked by yang drugs. Danggui and Dihuang listed in Siwu Tang protect blood; although assisted by hot agents, they inadvertently support the yin pathogens. One should use purely rigid and strong drugs to directly target where turbid yin condenses for regulation; this cannot be fully explained in a few words.

Sichuan Aconite Carpal Root (Chuan Fuzi), Black Sichuan Aconite Lateral Root (Hei Chuanwu), Evodia Fruit (Wuzhuyu), Dried Ginger (Ganjiang), Pig Bile (Zhu Danzhi).

Second consultation: Yin-cold pathogens occupy the lower abdomen; unless purely yang and rigid agents enter the land of solid ice, the yin coagulation will not resolve. This is like General Zhou Yafu’s army descending from heaven. The physician used Shenqi Tang, which has more yin and less yang, immediately worsening the condition and even preventing eating, indicating the medicine did not match the syndrome. Imitate the method of Tongmai Sini Decoction.

Aconite Root (Fuzi), Dried Ginger (Ganjiang), Pig Bile (Zhu Danzhi).

At fifty-four years old, yang qi is daily declining. The Yangming meridians and collaterals are empty and deficient, unable to bind sinews and bones to facilitate joint movement, resulting in shoulder pain, limb numbness, sensation of head and eyes being covered, and flaccid weakness. This is deficiency below and excess above, with heat in collaterals and internal wind boiling up. As summer arrives, yang rises severely; using damp-draining and phlegm-resolving methods will certainly not address the disease. Recommendation: Clear...

Rhino Horn (Xi Jiao - *Note: Use synthetic substitute*), Fresh Rehmannia Root (Xian Shengdi), Scrophularia Root (Yuanshen), Forsythia Fruit (Lianqiao), Mulberry Leaf (Sangye), Moutan Cortex (Danpi), Gastrodia Tuber (Tianma), Uncaria Ramulus cum Uncis (Gouteng).

Lower body flaccidity... preceded by seminal emission, wet eczema, frequent use of draining/diuretic drugs, further injuring yin and yang. Although Renshen, Baizhu, and Fuling nourish spleen and lung to boost qi, they failed to save the lower jiao. It is like cold causing yang to weaken, vomiting food after meals, indicating sudden decline of stomach yang and failure of defensive exterior functions. However, diseases of the lower jiao all belong to injury of essence and blood. Two administrations of warming, unblocking, and softening agents: since the kidney dislikes dryness, chronic illness requires unblocking the Ren and Du vessels. Combining unblocking and securing also refers to ancient sages' methods like Si Jin Jian Bu. As for stomach medicine, it must be used separately. The stomach fu governs qi; qi moving downward is smooth. Li Dongyuan has principles of raising yang and benefiting the stomach, which seems contradictory. However, are Huangqin and Huanglian not bitter-descending qi? For one or two days after vomiting, stop treating the lower jiao blood level; instead, use drugs to support yang and regulate the stomach. After two days, secure both middle and lower jiao. The *Neijing* states the Yangming meridian binds sinews and bones to facilitate joint movement; this disease aligns with this principle.

Deer Antler Glue (Lurong), Angelica Sinensis Root Head (Guishen), Biota Seed (Baizi Shuang), Poria (Fuling), Cistanche Stem (Rongcong), Morinda Officinalis Root (Baji), Psoralea Fruit (Buguzhi), Dendrobium Stem (Chuan Shihu), Achyranthes Root (Niuxi), Goji Berry (Gouqizi).

After vomiting, intermittently take Banxia Houpo Tang (actually Banxia Tang per title) with added Dried Ginger (Ganjiang) and Ginger Juice (Jiangzhi).

Second consultation: Long summer damp-heat causes sluggish circulation of meridians and qi. Additionally, the lower origin and collaterals are already deficient, leading to flaccidity intolerant of walking, often feeling sore and painful. Stool is sometimes loose, all belonging to liver and kidney pathology. However, tonifying the lower must be assisted by promoting circulation of collaterals, which is the correct treatment method. Fearing that damp-heat may disturb again after summer, preventive management is undertaken.

Deer Antler Frost (Lujiaoshuang), Raw Atractylodes Macrocephala Rhizome (Sheng Maoyu), Poria (Fuling), Cistanche Stem (Rongcong), Angelica Sinensis Root Head (Guishen), Prepared Rehmannia Root (Shudi), Mulberry Fruit (Sangshenzi), Morinda Officinalis Root (Baji), Polygala Root (Yuanzhi), Fennel Seed (Huixiang), Wine-steamed Golden Dogtail Fern Rhizome (Jiu Zheng Jinmaojigu).