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Pulse is slow and weak, pain and distension in the epigastrium, vomiting of clear saliva, indicating Spleen-Yang deficiency (Spleen-Yang deficiency). This results from chronic overwork; symptoms worsen in the afternoon because Yang Qi fails to function properly. Generally, Spleen-Yang requires unobstructed flow to facilitate transportation and transformation; warming and tonifying are essential. However, herbs that strictly "guard the middle" tend to be cloying and stagnating, and do not belong to the category of unblocking the Fu organs; they should not be used as adjuvants.

Ren Shen (Ginseng Radix), Ban Xia (Pinelliae Rhizoma), Dan Gan Jiang (Dried Ginger), Sheng Yi Zhi (Raw Alpinia Officinarum Rhizome), Fu Ling (Poria), Sheng Jiang Zhi (Fresh Ginger Juice)

For constipation, take Ban Liu Wan (Half-Sulfur Pill) intermittently, 5 fen.

Chronic hemorrhoidal bleeding with emaciated, yellowish muscles indicates blood loss leading to Qi exhaustion. Progressively, panting, edema, abdominal distension, and obstruction of both urine and stool may occur. This condition involves Cold in the Zang organs and Heat in the Fu organs. Detailed descriptions can be found in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) under the chapter on Grain Jaundice; it is extremely difficult to treat.

Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Zhi Ren (Alpinia Officinarum Seed), Tu Si Zi (Cuscutae Semen), Mu Gua (Chaenomelis Fructus), Guang Pi (Tangerine Peel)

Unsuccessful business endeavors and emotional depression transform the "Lesser Fire" into "Greater Fire." Wind-Wood carries Yang Qi upward to the vertex, causing dizziness and insomnia. This is due to Yang failing to enter Yin, not a Yin deficiency syndrome. If it were pure deficiency, how could one still eat and travel from spring to autumn? The sudden blockage in the epigastrium is caused by medication damaging the stomach appetite, leading to rebellious Stomach-Yang. Treat with modified Wen Dan Tang (Warm the Gallbladder Decoction).

Chen Pi (Tangerine Peel), Fu Ling (Poria), Dan Pi (Moutan Cortex), Zhi Pi (Gardeniae Pericarpium), Ban Xia (Pinelliae Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Sang Ye (Mulberry Leaf), Zhu Ru (Bambusae Caulis in Taenia)

Damp-Warmth diseases are most common in late summer. The qi of dampness and heat, stagnant and steaming, enters through the mouth and nose, affecting the Upper Jiao first, then gradually spreading to the Middle and Lower Jiao. This is what He Jian referred to as San Jiao disease. It is completely different from Wind-Cold or food stagnation. Zhong Jing stated: "Patients with Dampness must not be induced to sweat; sweating leads to spasms." Dampness is essentially a Yin pathogen; when it invades, it damages Yang. Sweating causes Yang to leak and scatter, while pathogens remain unresolved. Steaming dampness and stagnant heat manifest as jaundice; the steaming qi sinks, resembling the fermentation of yeast starter. At this stage, the pathology is entirely in the Qi level; Lian Qiao Chi Xiao Dou Tang (Forsythia and Adzuki Bean Decoction) can be effective. After one month, the pathogen has permeated the San Jiao, swelling starting from the left side around the ears and spreading to the right, with severe carbuncles and sores erupting. "Carbuncle" implies congestion; not only is Qi stagnant, but Blood is also blocked, steaming into pus. Loss of appetite and rapid muscle wasting indicate depleted Stomach Qi. Discussing treatment: Tonification aids congestion; clearing Heat risks collapse. None of the predecessors' established methods are applicable. Considering damp-heat and turbid pathogens congealing in the clear orifices of the head and face, I propose using light agents to dispel excess. Select aromatic herbs to avoid burdening the Stomach; if congestion is relieved and some gruel can be taken, progress is made. The Classics state: "Diseases originating from above should be treated from above." The *Ling Shu* states: "The Upper Jiao is like mist"; without light, ascending, and aromatic qi, how can it be opened?

Qing Ju Ye (Green Chrysanthemum Leaf), He Ye Bian (Lotus Leaf Margin), Jin Yin Hua (Lonicerae Japonicae Flos), Xiang Bei Mu (Fritillariae Thunbergii Bulbus), Lv Dou Pi (Vigna Radiata Testa), Ma Dou Ling (Aristolochiae Manshuriensis Radix), Lian Qiao (Forsythiae Fructus), She Ye (Belamcandae Rhizoma)

Decoct, leave exposed overnight, and add a small cup of Jin Zhi (Golden Juice) before administration.

The patient is obese, constitution compromised by excessive labor, injuring Yang Qi. Symptoms include vomiting food, fever without headache, indicating this is no longer external Wind-Cold. Intermittent irritability, thirst, dry lips, and black tongue coating suggest internal latent Heat. This Heat spreads from the Mu Yuan (Sea of Origin) to the San Jiao, similar to Malaria pathogens contesting Ying and Wei levels. However, given chronic overwork and latent pathogens, the pulse is small and slow, non-resilient upon pressure, confirming this diagnosis. Bowels and bladder are relatively open, and slight food intake is possible; thus, there is no stagnation. Zhong Jing provided no formula for single-Heat without Cold cases, advising dietary management instead. Later scholars proposed sweet-cold herbs to nourish Stomach Yin, which naturally resolves the Heat.

Zhu Ye (Bambusae Folium), Hua Fen (Trichosanthis Radix), Mai Dong (Ophiopogonis Tuber), Lian Qiao (Forsythiae Fructus), Sheng Di Huang (Rehmanniae Radix), Xing Ren (Armeniacae Semen Amarum), Zhe Jiang (Sugarcane Juice)

During Yin-Mao hours (3-7 AM), Shaoyang moves internally, bleeding occurs in collaterals, accompanied by alternating chills and fever, vomiting, sudden diarrhea, and inability to lie on the left side. Wood (Liver) inevitably attacks Earth (Spleen/Stomach); Gallbladder bile cannot store properly, leading to scant sleep and frequent waking. Earth organs are suppressed, reducing appetite and taste. Treatment should tonify Earth and soothe Wood.

Ren Shen (Ginseng Radix), Shan Yao (Dioscoreae Rhizoma), Zhi Cao (Prepared Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bian Dou (Lablab Semen Album), Dan Pi (Moutan Cortex)

For deficiency-type diarrhea, Yi Gong San (Benefiting the Work Powder) combined with Li Zhong Wan (Regulate the Middle Pill) warms Yang by tonifying Spleen and Stomach. However, in cases of blood loss and spermatorrhea with long-term depletion of Metal and Water, Yin lacks upper ascent, causing sore throat and aphonia, while diarrhea persists. Summer-heat and dampness absorbed in late summer interact with floating internal Qi, causing malnutrition ulcers. Qi obstruction hinders eating; this is root deficiency complicated by summer-heat and dampness. Pure tonification will fail. Use light, thin-qi formulas to clear the Upper Jiao first, then consider tonification.

Lu Gen (Phragmitis Rhizoma), Ma Dou Ling (Aristolochiae Manshuriensis Radix), Tong Cao (Tetrapanacis Medulla), Yi Yi Ren (Coicis Semen), Hua Shi (Talcum), Xi Gua Cui Yi (Watermelon Rind)

Thin individuals have Yin deficiency, making them susceptible to Heat entering Yin. Post-illness spermatorrhea results from weak Yin failing to secure. Diarrhea in summer-autumn is due to internal invasion of summer-heat and dampness... [Text fragment missing]. Modern famous physicians erroneously transmit concepts of Yin syndromes, harming many. In summary, spermatorrhea with Yin deficiency and post-diuretic Yin injury are not suitable for harsh, acrid-warm agents. A soft-yang/hard-yin approach should be devised.

Ren Shen (Ginseng Radix), Shan Yao (Dioscoreae Rhizoma), Chuan Hu (Dendrobii Nodule), Qian Shi (Euryales Semen), Fu Ling (Poria), Sheng Di Tan (Charred Rehmanniae Radix)

Seven-year chronic illness, heart palpitations with heat confusion, teeth grinding, tongue biting, Yin fire losing control, Yang flaring wildly. Previous formulas regulated Jueyin and Yangming harmonizing Yang; subsequent formulas used salty-pure Yin to fill the water source to generate Wood. The disease persists. Self-reported frequent spermatorrhea triggers relapse. Spring and summer seasons... [Text fragment missing]. Spermatorrhea depletes Kidney fluids; labor depletes Gallbladder bile. Can one expect Spring Yang to remain undisturbed? Impossible.

Shu Di Huang (Prepared Rehmanniae Radix), Rou Cong Rong (Cistanche Deserticolae Herba), Wu Wei Zi (Schisandrae Chinensis Fructus), Long Gu (Fossilia Ossis Mastodi et Scapulae), Fu Ling (Poria), Zuo Mu Li (Left Oyster Shell), Shi Chang Pu (Acori Tatarinowii Rhizoma), Yuan Zhi (Polygalae Radix), Chuan Hu (Dendrobii Nodule), Shan Yu Rou (Corni Fructus)

Pulse is wiry and rapid, right side large; tongue is crimson; face slightly swollen; cough, vomiting, rebellious Qi, heart heat, abdominal distension, preference for lying on the right side, internal and external heat at night. Illness began in May, lasting 100 days with ignorance of hunger/fullness, caused by worry and anger. All Qi mechanisms reverse. Lesser Fire transforms into Greater Fire; vexing heat persists, fluids dry up, internal wind stirs, all belonging to Yang transformation. Symptoms largely indicate Liver disease. In Autumn, when Metal rules, Wood remains disordered; daily tidal fever worsens. Disease is constrained勞 (consumptive fatigue), difficult to prolong. Propose salty-bitter clearing and nourishing Jueyin Yin to harmonize Yang.

E Jiao (Donkey-Hide Gelatin), Chuan Lian (Coptidis Rhizoma), Sheng Di Huang (Rehmanniae Radix), Nuomi (Glutinous Rice), Bai Shao (Paeoniae Radix Alba), Ji Zi Huang (Chicken Egg Yolk)

Second visit: Pulse reaches 100 beats per minute, right wiry-rapid, left fine-rapid. Alternating chills and fever, anhidrosis, thirst, vomiting, hemoptysis during illness, menorrhagia. Pathogenic Heat forces reckless blood movement. Chronic disorders of the Extraordinary Vessels indicate internal deficiency; thus, pathogens sink into deficiency, becoming intense Jueyin Heat invading Yangming. Symptoms include vomiting, oppression, anorexia, dark purple eyelids, photophobia, throat obstruction, headache. Jueyin Heat pathogens connect Stomach and penetrate Diaphragm, ascending to facial orifices. Preceded by chills then fever, hunger without desire to eat, thirst, Qi rushing to heart, belching. These examples are in Zhong Jing's Jueyin Chapter. Latent pathogens in Supreme Yin must burn until exhausted. Exteriorizing harms Yang; purging robs Yin. Only salty flavors go directly to Yin levels; combine with bitter-cold to clear latent Heat. While clearing pathogens, protect Yin. For every point of pathogen retreat, preserve a point of Yin, hoping for slight recovery.

E Jiao (Donkey-Hide Gelatin), Ji Zi Huang (Chicken Egg Yolk), Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex)

Right pulse is peaceful; left Cun-Guan pulses are wiry and sharp. Face is reddish. Constitution is slender, possessing Wood-Fire characteristics, prone to activity. Added to mental stress and worry, the Five Zang Yangs are blazing. Naturally, wakefulness exceeds sleep, internal wind does not extinguish, dizziness arises spontaneously. Classics state: "Yang Qi enters Yin; when Yin is full, sleep occurs." Indecision causes Fire to move and Yin to injure; Liver Yang acts alone, lacking Yin harmony, Hun (Ethereal Soul) does not store, causing restless sleep. Main treatment is tonifying Yin and harmonizing Yang. Propose modified Bu Xin Dan (Tonify the Heart Pill), simultaneously harmonizing Liver Yang.

Ren Shen (Ginseng Radix), Sheng Di Huang (Rehmanniae Radix), Yuan Shen (Scrophulariae Radix), Jie Geng (Platycodonis Radix), Chuan Lian (Coptidis Rhizoma), Fu Shen (Poria with Hostwood), Tian Dong (Asparagi Tuber), Dan Shen (Salviae Miltiorrhizae Radix), Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix), Ling Yang Jiao (Saiga Tataricae Cornu), Hu Po (Amber), Mai Dong (Ophiopogonis Tuber), Bai Shao (Paeoniae Radix Alba), Bai Ren (Biotae Semen), Shi Chang Pu (Acori Tatarinowii Rhizoma)

Prepare pills with refined honey.

Five days ago, distension was in the epigastrium, accompanied by coldness in the middle and lower abdomen. Proposed using Ren Shen, Fu Zi, Chuan Wu to drive out congealed Yin-Cold; this is not a deficiency-tonifying formula. [Fragment missing] promoting Yang unblocking is excellent. If Yang Qi flows smoothly, why worry about water-dampness not departing?

Ren Shen (Ginseng Radix), Shu Chuan Fu Zi (Prepared Aconiti Lateralis Radix), Da Hui Xiang (Foeniculi Fructus), Sheng Dan Gan Jiang (Raw Dried Ginger), Fu Ling (Poria), Chuan Li Zi (Toosendan Fructus), Chuan Jiao (Zanthoxyli Pericarpium)

Mix with a cup of Tong Bian (Child's Urine).

Pulse wiry-rapid, abdominal distension with diarrhea, spontaneous tearing, body cramping pain during menstruation, amenorrhea in autumn-winter. Two years of illness, ineffective treatments... [Fragment missing]. Dry Blood stagnation cannot be cured by tonification alone. Propose simultaneous treatment of Jueyin and Yangming, sour-bitter clearing Heat first, harmonizing and tonifying Stomach Qi as adjuvant.

Wu Zhu Yu (Evodiae Fructus), Chuan Lian (Coptidis Rhizoma), Hu Lian (Coptidis Rhizoma var.), Chuan Li Zi (Toosendan Fructus), Wu Mei (Mume Fructus), Ren Shen (Ginseng Radix), Bai Shao (Paeoniae Radix Alba), Yan Hu Suo (Corydalis Rhizoma), Yun Ling (Poria), Xiang Fu (Cyperi Rhizoma), Nan Zao (Chinese Date)

Pills made with Yi Mu Cao Gao (Leonurus Herbaceous Extract) and Wu Mei Rou (Mume Fruit Pulp).

Phlegm-Fluids are transformed from turbid Yin, obstructing Yang, preventing entry into Yin. Empty Yin Qiao vessel causes poor night sleep. *Ling Shu* uses Ban Xia Shu Mi Tang (Pinellia and Millet Decoction) to unblock Yang and connect Yin, preventing fluid accumulation. Tian Wang Bu Xin Dan consists of cold-cool Yin herbs, aligning with Turbid Yin. For middle-aged patients, protecting Yang is crucial, as stated in *Jin Gui*: "Must use warm herbs to harmonize."

Ban Xia (Pinelliae Rhizoma), Shu Mi (Millet), Fu Ling (Poria)

Youthful patient with green-yellow complexion, small pulse lacking spirit. Frequent vomiting since childhood clearly indicates disharmony of diet and temperature, leading to Middle Qi deficiency. Cough is not external contraction; dispersing is inappropriate. Treat with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction).