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(Efficiency. (Zhu Ru, Gan Cao, Xiong [Chuanxiong], Huang Qin, Dang Gui, Mai Men Dong, Zhi Zi, Sheng Ma, Huang Bo; the above nine herbs added with Qian Gen are better.)

At the periphery of Baihui acupoint, there is a constant sensation of something rushing upwards, or intermittent pain, or tears spurting from the tear ducts without cause. This is a sign that Nao Feng (Brain Wind) is about to manifest.

Mei Du (Syphilis) has two causes: congenital transmission and acquired infection (referred to as "mold toxin"). Acquired infections account for 80%, while congenital cases account for only 20%. The symptoms mostly belong to Cold Toxin, with very few belonging to Heat Toxin.

Lu Bai Chuang (Exposed Bone Ulcer) is synonymous with Lou Chuang (Fistula), referring generally to various sores rather than a single disease. However, Lou Chuang involves leakage, whereas this condition involves closure and obstruction. Although the manifestations differ, both ultimately fail to heal.

Mei Du is divided into Cold Toxin and Heat Toxin, which must be distinguished in detail. Cold Toxin is rare, while Heat Toxin is common. Cold Toxin affects the Qi level and heals slowly; Heat Toxin affects the Blood level and heals quickly.

Cold Toxin appears mild and easy, while Heat Toxin appears severe and dangerous. Furthermore, patients with Cold Toxin have a pale white complexion like normal, whereas those with Heat Toxin have a dull, dark complexion that fluctuates. Sores from Cold Toxin may persist for years without healing but are not intense; sores from Heat Toxin spread and exacerbate rapidly. This is the key to differentiation. Ignorant physicians treat all cases uniformly, causing the most harm. (Zhu Xuan commented: Dividing syphilis into cold and heat types is an innovative view by Mr. Weng, achievable only by those with profound experience.)

In Liu Zhu Du (Flowing Abscess Toxin), if thick pus gradually turns into thin fluid, it is not a favorable sign. If pus stops flowing but fresh blood drips continuously, even if the patient can eat and feels mentally clear, death is imminent. Do not neglect this. This presentation is identical to Chou Xue (Postpartum Hemorrhage). (Decayed fluid flowing often triggers this syndrome, which is the most critical condition.)

Mr. Guishan's literary output was unparalleled among previous physicians. His works are treasures of the medical field, indispensable as daily necessities like cloth and grain. He treated no fewer than 700 to 800 patients annually. Therefore, his effective prescriptions and insightful advice serve as models for younger generations.

Xiao Ye Shi Naizheng, aged eighteen, had been pregnant for one month when fetal fluids increased progressively, causing severe edema throughout the body, especially in the lower extremities. Mouth and tongue ulcers formed, rendering him unable to consume salty foods. He drank only one or two bowls of thin porridge daily. Urine was red and difficult to pass, and bowel movements occurred every other day. The pulse was slippery, rapid, and forceful. Physicians attributed this to Spleen/Stomach deficiency failing to control water and prescribed Ren Shen (Ginseng) and Bai Zhu (Atractylodes). The condition nearly became critical, so he urgently invited me to treat him. I said, "Fetal fluids carrying Damp-Heat are not due to Stomach deficiency." I administered Zhu Ling Tang (Polyporus Decoction) with Che Qian Zi (Plantago Seed), Huang Lian (Coptis Rhizome), and Zhi Zi (Gardenia Fruit). Che Qian Zi, also known as Pian Xi, not only promotes urination but also aligns with the poetic sentiment of "suitable for pregnancy" from the Book of Songs. After five to six days, urination became smooth, swelling subsided slightly, the mouth felt harmonious, and appetite returned. The prescription was then changed to Zi Su He Qi Yin (Perilla Harmonizing Qi Decoction) with Bai Zhu and Huang Qin. Delivery occurred at the end of the month, and both mother and child survived.

The son of a minor official in the Imperial Pharmacy vomited milk six to seven times daily at five months old, with no other symptoms, except for a bluish-white complexion and slight fatigue. His parents were worried and sought my treatment. I said, "This falls under the jurisdiction of pediatric specialists; how dare I decline?" He replied, "Pediatric treatments for vomiting milk usually involve Qian Yi's Bai Zhu San, Xiang Sha Liu Jun Zi Tang, Liang Ge San, or Zi Yuan. Cases transforming into Man Pi Feng (Slow Spleen Wind) are common. Please devise a different treatment to save this child's life." Upon persistent pleading, I formulated a prescription: Ban Xia (Pinellia Tuber) as Sovereign, Fu Ling (Poria) as Minister, Huo Xiang (Patchouli) and Fu Long Gan (Vermilion Dragon Liver) as Assistants, Ding Xiang (Clove) as Envoy, and Sheng Jiang (Fresh Ginger) as Guide. Each dose was one qian, decocted in water. Additionally, Yang Zheng Dan (Nourishing Righteousness Pill) was powdered. A quantity equivalent to two sesame seeds was placed in the mouth using an ear pick, washed down with the herbal liquid, five times daily. Within ten days, vomiting ceased, and color/spirit recovered. Thus, using formulas for Fan Wei (Regurgitation) to treat infant vomiting is not strange. It is tragic that contemporary pediatricians stick to routine protocols, unaware of such strategies, allowing children to die prematurely.

A merchant's servant, aged twenty, suffered from Nong Lin (Purulent Strangury) for several days, experiencing intermittent mild chills and fever, with reduced appetite. Pulse was deep, small, and rapid. Abdominal examination revealed no pathology, though the patient appeared somewhat depressed. I diagnosed Liver Meridian Damp-Heat and prescribed Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction). Ten days later, a messenger arrived hastily reporting massive hematochezia and imminent death. I rushed to examine him. He lay supine on the bed, breathing faintly. The six pulses were flooding, rapid, and empty. I urgently administered Du Shen Tang (Single Ginseng Decoction), but it was vomited immediately, followed by dry heaving, profuse forehead sweating, and distress. Seven roundworms were vomited. I attempted Xiao Ban Xia Jia Fu Ling Wu Mei Shu Zhu Tang (Minor Pinellia plus Poria, Sour Plum, and Sichuan Pepper Decoction), but vomiting worsened. Contemplating Sun Simiao's use of single Gan Cao (Licorice Root) to stop vomiting, I reasoned it would pacify the worms. Following this method, vomiting stopped, and breathing stabilized. While attendants were changing the sheets and cleaning up, they uncovered the lower body. The scrotum was ruptured with a hole as if gouged out; both testes had fallen onto the bed, size of chicken eggs, slightly flattened, white with red filaments缠绕. Everyone was shocked and reported to me. I said, "Jiang Huangnan once considered scrotal rupture a rarity in history. Testicular detachment is truly extraordinary. Although castrated humans and gelded pigs survive, this case resulted from Mei Du (Syphilis) condensing in the scrotum, similar to 'Bad Nose Candlestick Chan' (nasal destruction from syphilis). With proper care, he should survive." Subsequent management led to full recovery.

The etiology of Hong Jiao Jiao (Hong Kong Foot / Beriberi) includes: Damp-Evil invading the feet and obstructing meridians; Kidney Qi deficiency leading to improper fluid metabolism; or excessive rich food causing Spleen/Stomach Damp-Stagnation. Prevention requires avoiding sitting long in damp places, wearing wet clothes, walking in fog, or walking on ground after rain where vapor rises. Avoid overeating fish, dark cakes, and strong flavors. Avoid excessive alcohol, drunken sleep, excessive intercourse, and intercourse while drunk. Avoid prolonged sitting/standing and irregular physical labor. Observing these five points prevents not only Hong Jiao Jiao but also other diseases; it is the secret to longevity.

Infant vomiting milk has many causes but essentially falls into Deficiency and Excess categories. Causes include: Congenital Spleen/Stomach deficiency failing to digest/distribute milk; Overfeeding leading to accumulation rejecting new milk; or latent Fetal Toxin in intestines/stomach repelling milk, or fighting with milk to form stubborn phlegm accumulating in the chest/diaphragm. This condition is more common in wealthy families than poor ones. Treatments favor cooling/clearing, but warming/nourishing methods are also used. Some cases respond to middle-jiao regulation, phlegm resolution, food digestion, Qi descending, or parasite expulsion. Treatment must be based on syndrome differentiation.

In Xu Lao (Consumptive Disease) and extreme deficiency syndromes, blackening and swelling of the distal finger joints occasionally occur. This is caused by meridians failing to fill the extremities and stasis/dead blood. It is unknown if predecessors mentioned this.

I heard from Tai Tian Long Yuan regarding edema combined with Hong Jiao Jiao presenting with epigastric fullness/hardness. There is a key to distinguishing Chong Xin (Rushing to Heart) from Pi (Glomus). Floating, easily palpable glomus carries no risk of rushing to the heart. Deep, hard-to-palpate glomus poses unpredictable dangers. Careful differentiation is required.

In chronic illness, regardless of syndrome, if ribs protrude like wrinkles, survival is rare.

Zhang Zhongjing stated: "Shaoyin disease, with fine and weak pulse, and desire to sleep, indicates Shaoyin pathogen entering deeply interior, with Yang Qi exhaustion." This applies not only to Shang Han but also to any chronic illness where speech/eating is accompanied by drowsiness, indicating a fatal prognosis.

Zheng Zhi Yao Jue states: "Sudden vomiting of purple-black blood in stroke indicates death." This verification applies to all diseases, not just stroke.

Before examining a patient, if a physician pre-determines a formula based on inquiry, the actual diagnosis may lose its essence. One must examine with an open mind, then deliberate before prescribing.

Colloquial terms Shan Xie (Hernia Diarrhea), Shan Li (Hernia Dysentery), Shan Lin (Hernia Strangury) correspond to medical texts' Qi Xie, Qi Li, Qi Lin.

To understand the subtleties of ancient clinical practice, nothing beats studying their verified cases. I intended to compile their essence into a book, but old age prevented completion. Sad! (Reading senior physicians' cases expands students' minds and broadens practitioners' perspectives; flexibility depends on good learning.)

Dysmenorrhea responds well to Tao He Cheng Qi Tang (Peach Kernel Draining the Epigastrium Decoction) with Fu Zi (Aconite Root). This derives from Yu Jia Yan's *Yi Yu Cao* treating lumbar pain after Shang Han. (Another theory attributes this to Liu Bao Yi.)

Mu Nai Yi Fang (Styrax Resin) and Xue Jie (Dragon's Blood), equal parts made into pills, treat Gan Xue Lao (Dry Blood Consumption). Styrax resolves stasis and revitalizes true Yuan, hence its efficacy.

Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) with Hai Fu Shi (Sea Float Stone) shows miraculous effects for Mei He Qi (Plum-Pit Qi).

For lingering residual heat after Meisha (Chickenpox/Rubella), Chai Hu Si Wu Tang (Bupleurum Four Substance Decoction) is appropriate. (Ting commented: Post-rash treatment generally emphasizes clearing and moistening, hence this formula.)

Sudden vomiting in major acute illnesses is often untreatable, typical of Hong Jiao Jiao Chong Xin (Beriberi Rushing to Heart).

Contemporary "Lin" (Strangury) often refers to Syphilis. As described in *Chuang Yang Jing Quan Shu* as Nei Zhu Xia Gai (Internal Injection of Chancre), treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Long Dan Cao (Gentian Root) and Che Qian Zi. Also referenced in *Zheng Zhi Yao Jue* as Xiao Bian Zhu Gan Chuang Lei. Do not confuse with ancient Lin syndromes. (Dong Guo held this view but lacked rigorous verification.)

A slave suffered indescribable chest oppression upon touching his thumb, unresponsive to various treatments. I diagnosed Blood/Qi Flow Obstruction and prescribed Huo Luo Liu Qi Yin (Unblocking Meridians Circulating Qi Decoction), resulting in rapid cure.

*Tan Huo Dian Xue* states: "Labor disease with left hypochondriac pain preventing turning is Gan Ye Yi Gan (Liver Leaf Dryness), named Gan Xue Tong (Dry Blood Pain). Liver Meridian is exhausted; death is inevitable." This originates from *Zhi Zhi Fang*, and such cases are common today. Misdiagnosing as Gan Ji (Liver Accumulation) and treating with Xiong Dan (Bear Gallbladder) yields no effect, as expected. (Shan Tian Ye Guang noted: *Su Wen · Ci Jin Lun* says 'Liver grows on the left, Lung stores on the right.' 'Grows' means generating Qi on the left. 'Left' does not denote anatomical position. Clinical evidence supports soothing/draining Liver for left-sided pathology.)

*Zhu Shi Xin Yi Ji* states: "Malaria arriving daily on schedule is called Miao Xin. It should be dispersed according to the primary syndrome; direct attack or interception is premature. Variations in timing indicate rising Zheng Qi rejecting Xie Qi, called Miao Shuai. Interception can then be tested. This reasoning is sound."

For Dysentery appearing deficient yet not truly deficient, or excess yet not truly excess, use Shen Gui Shao Yao Tang (Ginseng, Angelica, and Peony Decoction) combined with Nie Shi's Third Dysentery Formula, made into pills with rice paste, taken with warm water.

Legendary folk remedies often originate from Ben Cao appendices; these should be studied.

Lord Mito (Wen Gong) fell ill. Initially, he experienced difficulty defecating, chest fullness, and shortness of breath for two to three days, fluctuating in severity. I was summoned. Pulse was slippery, rapid, and rootless. Complexion was dark blue-green. Epigastrium was slightly full and tense. Abdomen showed no movement. Umbilical region was soft like cotton. I determined the pathology was Upper Excess and Lower Deficiency, developing over time. Attendants observed normal activity and missed the severity. I told them: "Though resembling Zhi Yin (Fluid Retention), this is actually Middle Qi exhaustion, a critical condition. Treatment requires vigorous tonification with Chen Xiang (Agarwood) added, followed by Hei Xi Dan (Black Tin Pill) to restore Yang and anchor rebellious Qi. Even this may be insufficient." Attendants were panicked or skeptical. Next day, tea-brown sputum was vomited intermittently. On the third day, pulse showed one stop per ten beats. I warned: "This syndrome and pulse indicate organ Qi exhaustion; acute change is feared. Moxibustion on Tianshu, Qihai, Zusanli, and Jiexu is needed to nourish Lower Yuan." Physicians disagreed, hesitated, and administered Qi-descending agents. By dusk, approaching defecation, he gasped and fainted suddenly. I was summoned but arrived too late. I sighed: "Even if untreatable, earlier recognition by attendants and subtle observation by physicians might have prevented this outcome."