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Between the Kaei and Kansei eras, there were two physicians who gained fame in Kyoto: one was Wada Tōkaku, and the other was Ogino Taishū. Taishū was from Kaga, studied medicine under Okamura Ryochiku of Echizen, and later traveled to Sakai (Sakiyo), where he learned Western medicine (Rangaku) from a certain interpreter. Upon completing his studies, he opened a clinic in the capital, becoming most renowned for treating epidemic febrile diseases (On'eki). At that time, infants from all over the country suffering from chronic stubborn diseases either went to the door of Mr. Wada or gathered at the hall of Mr. Ogino. Thus, the therapeutic skills of these two men surpassed their contemporaries, achieving unique refinement. All their experiences stemmed from practice, serving as assistance for clinical prescription; is this not commendable? I compiled this medical dialogue based on the "Ogino Family Secret Formulas" recorded by their students. As for their insights, there are several books written by Taishū, which are suitable for direct reading.

In epidemic febrile disease (On'eki), if there is urinary retention accompanied by irritability or mental confusion, it is incurable. If urinary retention is due to Yin syndrome (cold pattern), with condensation in the lower abdomen and no pain upon pressure, or if there is frequent, urgent, and dribbling urination, administer Modified Zhenwu Decoction (Zhenwu Tang), followed by the concurrent use of Cinnabar Liuyi Powder (Chensha Liuyi San). If urination returns to normal rhythm, the disease can be treated. (Note: The discussion on adding Zhenwu Tang can be found in *Wenyi Yu Bian*.)

In epidemic febrile disease (On'eki) Yin syndrome, even if there is no bowel movement for more than ten days, if the stool is not dry and hard, do not recklessly administer Rhubarb (Dahuang).

If the center of the tongue is dry in epidemic febrile disease (On'eki), it indicates heat in the chest. If the root of the tongue is dry, it indicates exhaustion of fluids in the Lower Jiao. If there is a white coating on the tongue like paste, it is due to deficiency fire flaming upward from Shaoyin. The same applies if the white coating resembles thrush.

If there is a white coating on both ends of the tongue but the central coating has peeled off in epidemic febrile disease (On'eki), or if the tongue surface is moist and red like cinnabar, this indicates pathogenic heat sinking into the Shaoyin meridian. Administer Rehmannia Root (Sheng Dihuang) directly. If Aconite Root (Fuzi) is used, double the amount of Licorice Root (Gancao).

When the heat of epidemic febrile disease (On'eki) is about to resolve, frequent urination indicates that heat is exiting through the urine. There is also a case where heat shifts to the Bladder causing frequent voiding; if the heat is resolving, the urine color will gradually clear.

For patients with epidemic febrile disease (On'eki) who are severely fatigued and deficient in Qi and Blood, Shenfu Yangrong Decoction (Shenfu Yangrong Tang) is appropriate.

For amnesia following an epidemic, Anshen Yizhi Decoction (Anshen Yizhi Tang) is appropriate.

An elderly man suffered from direct invasion by epidemic febrile disease (Zhizhong Wenyi), with headache like a knife cut, irritability, inability to lie down for even a moment, slightly cold hands and feet, and a deep, rapid, and hurried pulse. He was given Cold Fragrance Drink (Lengxiang Yinzi) for three doses, reducing the headache by half. Continuing the previous formula, he fully recovered after four or five days.

Headache like splitting in direct invasion by epidemic febrile disease (Zhizhong Wenyi) occurs because the pathogen of Kidney Jue directly attacks the Taiyang meridian, causing stiffness in the neck and back. A man suffered from this condition without fever, with headache like splitting. An old physician diagnosed it as a Yang syndrome and administered Da Chengqi Decoction (Da Chengqi Tang) without effect. Subsequently, Chaihu Qingzao Decoction (Chaihu Qingzao Tang) was given, leading to his death. Is this not tragic? (Note: Taishū deeply studied Wu Youke's theories and tested various formulas for expelling pathogens like Dayuan Yin. His methods for treating Yin epidemics also revealed secrets not mentioned by Wu, making him a loyal follower of Wu's school.)

Ge Ye (dysphagia/choking sensation) is caused by blood stasis, phlegm-fluid retention, or Spleen-Kidney deficiency. If caused by phlegm, food specifically chokes in the throat; use Fuzi Lizhong Decoction (Fuzi Lizhong Tang), Xuanfudaihzeshi Decoction (Xuanfu Daizheshi Tang), Erchen Decoction (Erchen Tang) added with Songjisheng (Viscum album), and moxibustion on Shenzhu (GV12) is excellent. If caused by blood stasis, food specifically chokes in the chest, marked by a mass under the right ribs; administer Wentai Decoction (Wentai Tang) to wash down Wushen San (Wushen San), or alternate the two formulas. If caused by Spleen-Kidney deficiency, food descending into the chest causes grinding pain, or eating one bite results in spitting out white foam; first moxa Qihai (CV6). Then administer Songjisheng oil, and it is advisable to take boiled juice of roasted pork; consuming the meat itself is even better. This condition is mostly incurable. Women's Ge Ye often belongs to blood stasis, which must be known.

Gu Zhang (tympanites/bloating) spreading gradually from the epigastrium to the great abdomen is excess; use Shengjiang Xiexin Decoction (Shengjiang Xiexin Tang) or Banxia Houpo Decoction (Banxia Houpo Tang - *Note: Text says Banbanxia Tang, likely Banxia Houpo or similar*). Bloating originating from the Middle Jiao should use Wenyang Decoction (Wenwei Tang) types. Bloating rising from the Lower Jiao should use Zhuangyuan Decoction (Zhuangyuan Tang) added with Mubiezi (Momordica seed). If tapping the abdomen produces a drum-like sound, it is deficiency and incurable. This distinguishes excess from deficiency. Xue Gu (blood gu/abdominal mass) rises from the lower abdomen; first administer Shengjiang Xiexin Decoction (Shengjiang Xiexin Tang), then the mass slowly dissipates, but long-term administration is required. Generally, blood stasis stops water accumulation, causing the mass to enlarge; thus, draining water first and then treating the blood level yields quick results. Alternatively, Biejia Wan (Biejia Pill) can be used as an adjunct.

Hongxiangjiao (Beriberi/Foot Qi) uses Areca Seed (Binglang) as a key herb; generally, Bing Su San (Bingsu San) added with Mugua (Chaenomeles) is suitable. For "rushing to the heart" (Hongxiangjiao Chongxin), administer Binglang powder with child's urine, or Zixue (Purple Snow) 5 fen,灌ed down with child's urine. This condition is mostly incurable.

Hot toxin Hongxiangjiao is indicated by abdominal heat, patient's self-sensation of irritability and heat, or intolerance to heat during moxibustion. Intolerance to heat during moxibustion often signals impending "rushing to the heart." If the pulse is rapid, it is critical and cannot be ignored. If the pulse is slow, there is no risk of rushing to the heart. In dry Hongxiangjiao, if moxibustion is not very painful, it is harmless; even with a rapid pulse, moxibustion is permissible.

During summer and autumn, those suffering from Hongxiangjiao should use Shengqi Wan material Fengyin Tang (likely referring to *Tang Fengyin Tang* from *Waitai Miyao*, not the *Jinkui Yaolue* formula). Taking Shengqi Wan material beforehand during cold periods prevents recurrence the following year.

If Hongxiangjiao numbness spreads to the lips, the toxicity is deep. Those suffering for years need not mention it.

For Hongxiangjiao with irritability, Biejia Wan (Biejia Pill) is appropriate.

For wind-damp Hongxiangjiao, pain is the distinguishing factor. Painful cases will not rush to the heart. If impending rush to the heart, use a formula from a Tang Dynasty Attending Physician. For mild pain, Liuwu Fuzi Decoction (Liuwu Fuzi Tang) is suitable.

The Prince of Yunzhou (Lord of Matsuyama Castle) suffered from Hongxiangjiao swelling and fullness. His attending physician gave him Carp Soup (Likou Tang); although urination improved significantly, the pain was unbearable. I diagnosed it as Wind-Toxin Hongxiangjiao. After taking Duzhong Decoction (Duzhong Tang), the pain decreased instantly, but urination became scantier daily, turning reddish and turbid. The众 (colleagues) advised continuing the previous formula, and the disease eventually healed.

Carp Soup (Likou Tang) for edema is indicated primarily when there is abdominal fullness; it is ineffective without abdominal fullness. Kobayashi Oryu (a physician in Kyoto) found Likou Tang combined with Suzi Jiangqi Decoction (Suzi Jiangqi Tang) also effective. (Carp soup is quite effective for water diseases. However, it should not be eaten by those with Spleen-Stomach disharmony, loose stools, vomiting, or nausea. Note: Fan Wang's formula includes a vinegar-boiling method; mixing with vinegar for consumption would be better.)

For treating edema using Dao Shui Fuling Tang (Dao Shui Fuling Decoction), palpitation below the heart is the main indication. If there is specifically fluid retention below the heart, Shipin Yin (Shipin Yin) is suitable. Other options include Mufangji Tang (Mufangji Decoction) or Liuwu Fuzi Tang (Liuwu Fuzi Decoction), selected according to the syndrome.

In edema cases, if urination is not very frequent but the swelling qi decreases, it is because where water gathers, Qi also gathers. When Qi disperses, water also diminishes. If sinking inward, Qi fails to rise, so water cannot flow and sinks internally. To raise Qi, use Zhenwu Tang (Zhenwu Decoction) or Zhuangyuan Tang (Zhuangyuan Decoction). Swelling of the penis and scrotum is also deficiency edema; use Shengqi Wan (Shengqi Pill).

Edema during pregnancy that worsens as fetal Qi grows is due to the fetus pressing on the water passages; it resolves after delivery.

Zi Xian (eclampsia/pregnancy convulsion) is treated with Shaoyao Gancao Decoction (Shaoyao Gancao Tang) added with Ganjiang (Dried Ginger), and child's urine as an adjunct. Prenatal Zi Xian is no different from postpartum Jing (spasm); thus, Gancao Ganjiang Tang (Gancao Ganjiang Decoction) is also suitable. Jiaojia San (Jiaojia Powder) from *Funren Liangfang* also treats Rou Jing (soft spasm). Postpartum Jing treated with Doulin Jiu (Bean-soaked Wine) works because wine Qi relaxes the sinews. These methods are not limited to postpartum conditions but can treat spasm in miscellaneous diseases.

For gout (Tongfeng), releasing the exterior is the priority; Yuebi Jiashu Fuzi Decoction (Yuebi Jiashu Fuzi Tang) is essential. Finally, administering a purgative is best, such as Shenyou Wan (Shenyou Pill). Without draining water toxins, there is no complete cure. (For severe heat gout, Yugong San is ineffective; Shenyou Wan is faster.)

For vomiting unresponsive to various anti-emetics, use Ginseng (Renshen) alone, 5 fen, decocted strongly. (Boil 2 li of water to obtain 8 shao.) Strain, add a little Fulonggan (Dragon's House Earth) powder, and take the clarified liquid.

For incessant salivation unresponsive to anthelmintics, it belongs to Kidney Fluid deficiency described in *Suwen*; use Shengqi Wan (Shengqi Pill). Another cause is cold fluid in the Stomach upper jiao; Zhongjing said, "Those who frequently spit saliva for a long time are treated with Lizhong Wan (Lizhong Pill)."

Chest pain syndromes involve phlegm-fluid or blood stasis. Phlegm pain is mostly on the left; blood pain is mostly on the right. For phlegm, select Qing Shi Hua Tan Tang (Qingshi Huatan Decoction), Zhishi Xiebai Guizhi Tang (Zhishi Xiebai Guizhi Decoction), or Kongyan Dan (Kongyan Pill). For blood stasis, use Dachaihu Tang (Dachaihu Decoction), Longdan Tang (Longdan Decoction), or Wushen San (Wushen San). Recklessly administering blood-breaking agents causes hematemesis; this must be known.

For Zhen Xin Tong (true heart pain), drinking sesame oil is best. Diseases involving the Heart are mostly incurable.

Huo Luan (cholera/vomiting and diarrhea) is mostly due to stagnation in the Stomach; thus, reducing diet during midsummer prevents it. Pediatric summer-heat Huo Luan especially arises from diet. Steamed buns should not be eaten; breastfed infants suffer less, indicating the dietary cause. For severe and critical heat, use Zhuye Shigao Tang (Zhuye Shigao Decoction) or Baihu Tang (Baihu Decoction). For Gan Huo Luan (dry cholera), use Dachengqi Tang (Dachengqi Decoction); do not recklessly use Guiti San (Guiti Powder). Regulation should use Fuzi Lizhong Tang added with Guizhi (Cinnamon Twig) or Buzhong Yiqi Tang added with Fuzi.

For malaria, use Dayuan Yin (Dayuan Decoction) added with Chaihu (Bupleurum); other formulas like Jiwei Qingpi Yin (Jiwei Qingpi Yin) combined with Caoguo (Black Cardamom) are best. For Yin malaria, there is no other treatment; use Dayuan Yin types. When the attack occurs during the day, it should be intercepted.

Pain above the left breast with cough indicates Fei Yong (lung abscess); early stage uses Siwei Yiyiren Tang (Siwei Yiyiren Decoction) or Gancao Ganjiang Tang (Gancao Ganjiang Decoction). Spontaneous ulceration and oozing from the umbilicus indicates Spleen-Stomach damp-heat; use Pingwei San (Pingwei Powder) added with Dahuang (Rhubarb), applying Chiwu San (Chiwu San) or Qiliang Mo (Qiliang Powder) to the umbilicus.

Vertigo has two pathways: fainting due to fluid retention uses Linggui Zhugan Tang (Linggui Zhugan Decoction) or Benqi Tang (Benqi Decoction) added with Fuling (Poria); Benqi Tang added with Fuling directs downward, and adding Fuzi enhances this downward force. Vertigo due to Qi deficiency uses Buzhong Yiqi Tang (Buzhong Yiqi Decoction) added with Fuzi.

Epigastric fullness and hardness due to retained fluid is treated by Shengjiang Xiexin Tang (Shengjiang Xiexin Decoction). If not full/hard, use Fuling Yin (Fuling Drink) or Wuling San (Wuling Powder). If retained fluid causes moving Qi in the abdomen, or Kidney deficiency causes Qi rushing upward, use Guizhi, Longgu, Gancao, Muli added with Fuling Tang. Epilepsy also uses this formula. There is an additional secret formula.

Blood Lin (painful urinary dysfunction with blood) uses Longdan Xiegan Tang (Longdan Xiegan Decoction) or Bazheng San (Bazheng Powder). Purulent Lin uses Bibi Tang (Bibi Decoction). Stone Lin uses Touquan San (Touquan Powder); apply Hupo You (Amber Oil) to a catheter inserted into the urethra to facilitate stone expulsion. Cold Lin uses Shengfu San (Shengfu Powder); for chills after urination, this formula is most effective. Jidan Zhi Xionghuang San (Egg-Yolk Processed Xionghuang Powder) also treats this condition.

Constipation is effectively treated by Jidan Zhi Xionghuang San. The formula: remove egg white, keep yolk, mix with Xionghuang San, refine, wrap in wet paper, bury in hot ash until cool, remove shell, grind to powder, and take with warm water.

A mass under the right ribcage indicates impending hematemesis. For women with irregular menstruation and hematemesis, it is Ni Jing (retrograde menstruation); the blood is black, treated with Dachaihu Tang (Dachaihu Decoction) or Sanhuang Xiexin Tang (Sanhuang Xiexin Decoction). Bleeding from the Liver belongs to blood stasis (black blood), treated with the previous formulas. Bleeding from the Lung is fresh blood; even a drop is difficult to treat; first use Jiawei Baihe Dihuang Tang (Modified Baihe Dihuang Decoction) or Xijiao Dihuang Tang (Xijiao Dihuang Decoction). Hematemesis in drinkers belongs to Stomach blood stasis; use Sanhuang Xiexin Tang. If bleeding does not stop, it belongs to Spleen blood; use Lizhong Tang. Prolonged lower bleeding leads to Spleen failure to control blood, stopping naturally. Dubu San (Dubu Powder) treats hematemesis and lower bleeding but is ineffective for fresh blood epistaxis. For lower bleeding, eat sea fish, not river fish. (Note: Dubu San consists solely of dried persimmon powder.)

Early dysentery prioritizes releasing the exterior. If approaching Jin Kou Li (anorexic dysentery), early purgation is needed; use Dachaihu Jia Mangxiao Tang (Dachaihu with Mangxiao Decoction). If oral medication is difficult to swallow, instill raw radish juice to enable ingestion. Cold dysentery often belongs to Xiexin Tang patterns, Buzhong Jia Dahuang Tang patterns, or treatments with Fuzi.

Yin-type cough is difficult to treat. Coughing when lying horizontally but not when supine indicates fluid retention; use Shenyou Wan. Zi Sou (pregnancy cough) is due to fetal Qi growth causing fluid retention below the heart; use Danggui Shaoyao San (Danggui Shaoyao Powder).

Diarrhea without specific differentiation uses Weiling Tang (Weiling Decoction) or Buzhong Tang (Buzhong Decoction); others include Yangwei Tang (Yangwei Decoction), Huoxiang Zhengqi San (Huoxiang Zhengqi Powder), or Zhenwu Tang. Immediate defecation after eating indicates Spleen deficiency. Mild cases use Buzhong Tang; severe cases use Buzhong Yiqi Tang. Chronic diarrhea requires regulating the Middle Jiao; use Fuzi Lizhong Tang added with Chishizhi (Red Halloysite) or Afuyuan Wan (Afuyuan Pill). Diarrhea often results from failure to separate clear and turbid; thus, promoting urination to separate water and waste is appropriate. The text states: "For persistent diarrhea, promote urination." Promoting urination uses Chunze Tang added with Fuzi. Middle Jiao cases use Buzhong Tang or Shengjiang Xiexin Tang. After diarrhea resolves, if the pulse is slow, fine, and weak, with diarrhea at midnight or dawn, it indicates Mingmen True Yang deficiency; use Chengqi Tang or Shenling Baizhu San. Excess cases use Dahuang Wan (Dahuang Pill).

Zaot (epigastric discomfort) is Water Qi carrying Fire; use Sanhuang Xiexin Tang or Shengjiang Xiexin Tang, but ineffective if the epigastrium is not full/stuffy. (Note: For zaot without epigastric fullness, use Xuanfuhua Tang or decocted Wuzhuyu. *Gujin Yitong* describes zaot as sudden burning in the abdomen, emptiness, ambiguous sensations of hunger/pain/spiciness, with relief after eating.)

Huang Pang (yellow puffiness) is sometimes attributed to inhaling fecal dust, which is not unreasonable, as it affects lower classes more than higher ones; use Zaofan Wan (Alum Pill). For men after blood loss or women with thin blood presenting this way, use Siwei Buchu Tang (Four-Ingredient Blood-Nourishing Decoction), not Alum. (Note: Yellowing from ingesting feces is mentioned in *Bencao Tujing* citing Cui Yuanliang: accidental ingestion of rat feces causes jaundice.)

Fengdu Zhong (wind-toxin swelling) is common in young adults, rare in the elderly. Red, swollen legs that do not spontaneously ulcerate should first be released externally using Yiji San (Yiji Powder), followed by purgation with Yugong San (Yugong Powder). Treatment is similar to gout.

Patients with irregular breathing that intermittently recovers will die within five to six days. The Classics state: Exhalation comes from the Lung; inhalation enters the Liver and Kidneys. Irregular breathing means exhalation fails to return to the Kidneys and floats up to the Liver.

Intermittent irritability, red lips, periodic发作, occasional nausea, and malar flush upon smelling food indicate roundworms; treat with Lizhong Anhui Tang (Lizhong Anthelmintic Decoction) added with Gancao and Fuzi.

Fan Wei (regurgitation/vomiting undigested food) requires abstaining from solid food; only rice water and Lizhong Tang, Banban Wenpi Tang are suitable. If caused by Water Qi, accompanied by epigastric palpitation, use Shengjiang Xiexin Tang. (Note: This condition also involves reducing fluid intake. Taishū had a theory on reducing fluids, unseen here, detailed in Dongpo's writings.)

Chuanhu Ju (ankle carbuncle) without distinguishing medial/lateral swelling/pain uses Duzhong Tang added with Fushe (Viper). Severe cases use Yugong San as an adjunct.

Jielu (craniopharyngeal separation/open fontanelle) growing gradually requires bandaging. Early stages use Liuwei Wan (Six-Ingredient Pill) added with Lurong (Deer Antler); this formula treats Jielu and the five delays/two deficiencies. Based on Xue Ji's theory.

Rulao (postpartum consumptive disease) early stage uses Danggui Jianzhong Tang (Danggui Jianzhong Decoction). (Note: *Qianjin Fang*'s Neibu Jianzhong Tang indications are verifiable.)

Women with shoulder/back stiffness improve with vaginal suppositories/douches. If epigastric fullness exists, use Shengjiang Xiexin Tang. (Note: Shoulder/back stiffness in women is often due to Pi Ji masses; Yan Nian Banxia Tang is most effective.)

Acute wheezing is effectively treated by Banxia powder mixed with Shengjiang juice and Qu (yeast).

Deficiency of fluids causing constipation with urgency indicates Lower Jiao Qi collapse; raise Qi using Buzhong Yiqi Tang. Without urgency, use Liucheng Tang. The distinction is that Buzhong Yiqi Tang lacks "abdominal strength," while Liucheng Tang possesses it. If Liucheng Tang pattern presents with weakness, add Lurong.

Zhuye clears chest irritability; Zhuru resolves phlegm; they have different indications. Chest stuffiness is treated by Zhizi; epigastric-to-chest issues are treated by Huanglian; each has its specialty.

Infant night crying uses Anchong San (Anthelmintic Powder). (Note: Anchong San treats heart pain from worms and infant night crying effectively. Calcined lead oxide, Areca nut, Chinaberry seed, Pyrethrum flower, and white powder are processed and taken with warm rice drink.)

Jiu Zabi (rhinophyma/alcohol nose) strictly prohibits alcohol. Prick with a three-edged needle to bleed occasionally; give Xinyi Qingfei Yin (Xinyi Lung-Clearing Decoction).

Naolou (brain drip/rhinorrhea) is heat brewing in the brain causing purulent discharge; the ancient belief of brain heat transferring to the lungs is erroneous. Initially yellow fluid, later white turbidity, severe cases overflow into the throat, continuous dripping. Though resembling clear mucus, drying on paper reveals yellow color. Use Naolou formula. Nasal polyps resemble this but present with congestion. Polyps start white, turn peach-blossom colored, or plum-red in severe cases. Differentiate by congestion. Nasal polyp treatment involves inserting a strip of paper with Guiti powder onto the polyp to drain yellow fluid.

Prince Tsuna of Dengu Palace had constant clear nasal discharge without other illnesses. I diagnosed Lung Cold, treated with Jiegao Wan (Soap Pod Pill) taken with date decoction, and moxa on Dazhui (GV14) and Shenzhu (GV12); cured in seven days.

Syphilis sores belong to exterior patterns; release the exterior. Meiyang Yiji San (Meiyang One-Dose Powder) added with Fanbi is primary. Using Yi Liang Wubao Dan initially is incorrect.

Chan Chuang (chancre) pastes are not ideal; applying Qiliang Mo is better. (Note: Meiyang Yiji San is found in *Waike Dacheng*.)

Chan Chuang on the penile surface is a Taiyang meridian pattern; Meiyang Yiji San is primary. On the lateral aspect is a Shaoyang meridian pattern, a malignant sign.

Preserving the straight tendon on the glans without ulceration is crucial; ulceration allows toxin to ascend to the throat and nose bridge. Zhulei Chan also uses Yiji San, combined with Jiedu Zijin Dan.

Numbness of ten fingers during pregnancy is due to Blood Heat, common in summer. Mild cases resolve after delivery without medicine; severe cases use Chai Ling Siwu Tang.

Women's leukorrhea is often due to toxic dampness; careful diagnosis is essential.

Ben Tun Qi (running piglet Qi) is deficiency; Zhi Yin (branch fluid retention) is excess. Similar symptoms, but vastly different treatments; precise diagnosis is necessary.

Excessive external water indicates Wei Qi decline; use Huangqi Tang (Astragalus Decoction).

Mei He Qi (plum-pit Qi) follows Banxia Houpo Tang principles. However, since authentic Houpo is scarce, Shengjiang Xiexin Tang may be used provisionally.

Duzhong Tang treats leg cramps on the right but not the left.

Diagnosing patients requires observing clarity/confusion in the eyes and crispness/clumsiness in the voice; if both are clear, death is avoided.