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Third consultation: Wei syndrome (flaccidity syndrome) is located in the lower part, mostly involving the Liver and Kidney. However, since the patient habitually drinks alcohol, damp-heat must inevitably be generated internally. Heat stagnates and turbid-dampness obstructs, causing Qi and Blood to fail to circulate. The sinews contract, muscles lose sensation, the body feels heavy and fixed in position; this is none other than deep-seated Dampness pathogen. If it were Yang deficiency, severe sores and ulcers should not appear. But as the disease has lasted long, it cannot be attacked rapidly; one should not count on quick efficacy. Prescription: Xi Sheng Di (Rehmanniae Radix Preparata), Gui Shen (Angelicae Sinensis Radix), Huang Bo (Phellodendri Cortex), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Rong Rong (Cynomorii Fructus), Chuan Hu (Dendrobii Caulis), Niu Xi (Achyranthis Bidentatae Radix), Ji Li (Tribuli Fructus).

Fourth consultation: Sleep and diet are normal, pulse is deep and slow. Only the inner and outer muscles of both legs have atrophied and feel numb. Over fifty years old, Yang pulses are gradually declining, the Qiao and Wei vessels (extraordinary vessels regulating movement and sensation) are not functioning properly. This is not due to the mixed invasion of Wind, Cold, and Dampness. Use warming and unblocking methods to assist the smooth flow of collaterals, imitating the ancient sages' Si Jin Jin Gang Wan (Four-Jin Golden Pill). Prescription: Rong Rong (Cynomorii Fructus), Niu Xi (Achyranthis Bidentatae Radix), Fu Ling (Poria), Bi Xie (Dioscoreae Hypoglaucae Rhizoma), Mu Gua (Chaenomelis Fructus), Gou Qi Zi (Lycii Fructus), Ji Li (Tribuli Fructus), Jin Mao Gou Ji (Cibotii Rhizoma) made into paste pills.

The Classic says: "Excessive fatigue causes Yang to hyperactive, essence is exhausted. If accumulated repeatedly into summer, it causes Jian Jue (Frying Syncope)." Because labor causes Yang Qi to relax and expand, Essence and Qi cannot fill adequately, lingering in the Yang aspect. Treatment should tonify the Kidney, preventing the Ministerial Fire of the Liver and Gallbladder from rising violently, dispersing Wind and extinguishing internal stirring, thereby preventing syncope. However, a bland diet and quiet rest are the safest approaches. Prescription: Xi Sheng Di (Rehmanniae Radix Preparata), Lian Qiao (Forsythiae Fructus), Zhi Mu (Anemarrhenae Rhizoma), Yuan Shen (Scrophulariae Radix), Sheng Bai Shao (Paeoniae Radix Alba), Zhu Ye (Bambusae Folium).

Shen Jue (Kidney Syncope) rises from the waist and spine. During attacks, hands and feet are cold, mouth foams, and the throat feels like being pierced by a knife. This is because the Foot Shaoyin Kidney Meridian ascends along the throat and clamps the root of the tongue. Yin turbidity attacks from below upwards, necessarily following the meridian. Imitate Xu Xue Shi's Jiao Fu Tang (Pepper and Aconite Decoction), focusing on unblocking Yang to drain Yin turbidity. Prescription: Pao Fu Zi (Prepared Aconiti Lateralis Radix), Dan Gan Jiang (Dried Zingiberis Rhizoma), Hu Lu Ba (Trigonellae Semen), Chuan Jiao (Zanthoxyli Pericarpium), Ban Xia (Pinelliae Tuber), Fu Ling (Poria).

Heat blazes above the navel and below the heart. A stale odor in the throat leads to unconsciousness and sudden collapse. After sweating for a period, the patient wakes up, vomiting bloody foam. This is heat obstruction in the Dan Zhong (Conception Vessel point Ren 17), causing the Heart orifices to be obscured. Without aromatic clearing and penetrating herbs, the stasis and bi-syndrome in the collaterals cannot be unblocked. Prescription: Xi Jiao (Rhinocerotis Cornu - note: substitute with Buffalo Horn in modern practice), Fu Shen (Poria with Hostwood), Tian Zhu Huang (Bambusae Calamus), She Xiang (Moschus), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Chang Pu (Acori Tatarinowii Rhizoma), Yu Jin (Curcumae Longae Radix), Bing Pian (Borneolum Syntheticum). Grind each into raw powder, make pills using decoction of Red Bean Skin, take with Zhu Ye (Bambusae Folium) decoction.

Summer-heat enters from above, first entering the Lung collaterals. As days pass, Qi-level heat pathogens reverse-transmit into the Ying (Nutrient) level, forcing their way into the Pericardium collaterals. Spirit is confused and restless, tongue is stiff and short, limbs are pulled and twitching. This is Summer-heat flowing and sinking, likely developing into Jing (Spasm) syndrome. Heat closure inside, yet limbs are not hot; heat pathogen closed internally with external collapse—is this not critical? Prescription: Xi Jian (Rhinocerotis Cornu - tip), Xian Sheng Di (Rehmanniae Radix Recens), Yuan Shen (Scrophulariae Radix), Yin Hua (Lonicerae Japonicae Flos), Shi Chang Pu (Acori Tatarinowii Rhizoma) dissolved with Zhi Bao Dan (Treasure Pill).

Chronic cough has damaged the Lung. Furthermore, rain and humidity have invited pathogens. There is heat but no chills; this is Dan Nue (Hot Malaria). Zhong Jing said: "Emaciation of muscles requires dietary regulation." The key is to save Stomach Qi to nourish Lung Metal. Do physicians understand this principle? Prescription: Zhu Ye (Bambusae Folium), Mai Dong (Ophiopogonis Tuber), Lian Qiao (Forsythiae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Li Pi (Pyrri Fructus Pericarpium), Qing Zhe Zhi (Saccharum Officinarum Juice).

Malaria did not resolve with sweating. Recently, there has been night sweating all night, chest fullness, loss of appetite, emaciation, large pulse, and dry constipation. Clearly, this is a Yin deficiency constitution. Malaria pathogen consumes fluids, causing clear Yang to become obstructed in the epigastrium. Propose using soft/moistening agents to preserve Yin and expel pathogens. Prescription: Zhu Juan Xin (Bamboo Leaf Core), Chen Sha Yi Yuan San (Cinnabar and Yiyuan Powder), Sheng Di (Rehmanniae Radix Preparata), Mai Dong (Ophiopogonis Tuber), Zhi Mu (Anemarrhenae Rhizoma).

Spleen channel malaria pathogens disturb the middle jiao from the four extremities. Zhong Jing's discussion on the Nine Lines of the Taiyin Channel strictly warns against purgation. It states that the Spleen is an isolated organ, its substance is Yin but its function is Yang; it prefers warmth and dislikes cold. Lack of appetite, fullness, belching: if Yang is injured, motility loses power, and stagnant turbidity spreads. Ancient sages formulated prescriptions: for Yang injury, use the Qi (aroma/energy) of herbs; for Yin injury, use the Flavor (taste/substance) of herbs. Why ignore the Yin-Yang nature of the disease and the Qi-Flavor properties of herbs? Using purgatives for obstruction and venting for fullness without distinction injures the Spleen and Stomach. Years of chronic illness... If one had studied Dong Yuan's Pi Wei Lun (Treatise on the Spleen and Stomach) carefully, such chaotic treatment would not occur. Prescription: Chao Ban Xia (Processed Pinelliae Tuber), Dan Wu Yu (Evodiae Fructus), Sheng Yi Zhi (Alpiniae Oxyphyllae Fructus), Bi Bo (Piperis Kadsurae Fructus), Gan Jiang (Zingiberis Rhizoma), Fu Ling (Poria).

Bitter-cold and acrid-hot herbs were taken excessively, severely damaging Heart Yang. Heart deficiency allows heat to retreat inward. With the arrival of recurrent malaria, the Heart spirit is confused. Prolonged delay may lead to stubborn disease. Examining the Jin Gui Yao Lue, Zhong Jing often used Shu Qi San (Chinese Tallow Tree Powder) as the treatment for Mu Nue (Mulberry Malaria). Prescription: Yun Mu Shi (Muscovite), Shu Qi (Euphorbiae Humifusae Herba), Sheng Long Gu (Fossilia Ossis Mastodi). Grind into powder, mix with boiling water, take 2 qian.

Lower Jiao essence is deficient, malaria pathogen enters the Shaoyin. When attacks start from the back, it indicates the correspondence between the Taiyang and Shaoyin exterior-interior relationship. Yin pathogen does not resolve with sweating. Expelling pathogens is correct, but Qi is easily depleted. Ginger and Aconite are purely rigid/hot, risking the depletion of Yin. Prescription: Ren Shen (Ginseng Radix et Rhizoma), Lu Rong (Cervi Pantotrichum), Gui Zhi (Cinnamomi Ramulus), Xi Xin (Asari Radix et Rhizoma), Qi Zi Tan (Carbonized Lycii Fructus), Gui Shen Tan (Carbonized Angelicae Sinensis Radix), Sheng Jiang (Zingiberis Rhizoma Recens).

Pulse is faint and slow, complexion is sallow and withered. Whenever Yang Qi is insufficient, chronic diarrhea or dysentery eventually damages the Kidney. Now edema is gradually appearing; the area under the eyes indicates Water failing due to Fire defeat. If the Lower Jiao is not warmed, merely seeing red in stool and attributing it to Spleen-Stomach damp-heat will lead to middle jiao fullness and failure. Prescription: Shu Di Tan (Carbonized Rehmanniae Radix Preparata), Dan Fu Zi (Lightly Prepared Aconiti Lateralis Radix), Fu Ling (Poria), Che Qian Zi (Plantaginis Semen), Sheng Mao Zhu (Raw Atractylodis Rhizoma), Gan Jiang (Zingiberis Rhizoma).

Pulse is wiry on the left and floating-choppy on the right. Initially, epigastric pain radiated to the hypochondrium, then the abdomen became distended and convex, food intake decreased, urination and defecation were difficult and incomplete. This is due to excessive mental strain in an elderly person. Liver Wood stagnates, Spleen Earth becomes trapped, clear and turbid mix, leading to distension. The True Essence leaks daily, Fu Yang fails to transport. Ancient masters treating distension prioritized unblocking Yang. Using Yin-nourishing soft herbs with slight Cinnamon and Aconite would condense Yin turbidity; is this a good method? Propose Ju Fang Yu Yu Liang Wan (Bureau Formula Hematite Pill) to warm the Water Organ and attack turbidity. Once slight improvement is seen, combine with warming Yang and rigid tonification. This is the treatment method for deficiency-type internal injury distension. Purging and attacking are set for tangible pathogens, different from Qi-injury diseases.