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[Morning: Er Miao Di Huang Tang Decoction]
Rehmanniae Radix Preparata (8 qian), Corni Fructus (2 qian), Paeoniae Rubra Cortex (2 qian), Poria (2 qian), Dioscoreae Rhizoma (2 qian), Alismatis Rhizoma (1.5 qian).
Phellodendri Cortex Preparata (stir-fried with salt and wine until brown, 0.8 fen), Aconiti Lateralis Radix Preparata (2 qian). Add ten stalks of Juncus effusus (Dengxincao) and twenty seeds of Nelumbinis Semen (Jianlianzi, pitted). Decoct in water to yield 80% of the original volume. Take warm on an empty stomach.

[Noon: Modified Bu Zhong Yi Qi Tang Decoction]
Ginseng Radix (3 qian, to preserve primordial qi and secure the middle), Astragali Radix (2 qian, to assist the exterior and protect Wei Qi), Ziziphi Spinosae Semen (stir-fried and crushed, 3 qian, to tonify the organ governing spirit and assist the official of dispersion), Atractylodis Macrocephalae Rhizoma (stir-fried yellow, 3 qian, to aid Spleen in overcoming dampness), Angelicae Sinensis Radix (wine-stir-fried, 1.5 qian, to harmonize and nourish Ying and Blood), Poria (2 qian, to gently leach out turbid qi), Glycyrrhizae Radix et Rhizoma Preparata (0.8 fen, i.e., to harmonize drug properties and tonify Spleen, allowing drugs to linger in the Middle Jiao to expel disease; stir-fried with honey and wine), Cimicifugae Rhizoma (0.4 fen, raising clear Yang causes turbid Yin to descend naturally), Saposhnikoviae Radix (wine-stir-fried tender root, 0.6 fen, assisting Cimicifugae to lift sunken Qi). Add fresh Ginger and Jujube. Decoct in water. Take one dose after noon meal. Decoct the dregs again for evening use, followed by inducing vomiting.

A young man who held an official position but suffered disappointment resigned and returned to a reclusive life. His depression led to illness, which corresponds to what the *Neijing* calls "Tuo Ying" (Loss of Essence) when one goes from high status to low, and "Shi Jing" (Loss of Spirit) when one goes from wealth to poverty. This resulted in daily consumption of Qi and Blood, and the Spirit failing to manifest outwardly. The pulse was wiry, fine, and choppy at all six positions. Any food entering the Stomach transformed entirely into Phlegm. He could only sleep after coughing up all phlegm and saliva; if not fully expelled, he would not stop. Thus, body fluids were consumed internally, unable to moisten the exterior. Consequently, muscles gradually wasted away, chills occurred, and appetite was poor. I reasoned that Wei Qi (Defensive Qi) fills the skin and hair, warms the muscle intervals, controls opening and closing of the pores, and protects the body surface. However, Ying Qi (Nutritive Qi) usually follows Wei Qi to moisten the skin and nourish the collaterals. Now, since Middle Qi is both weak and depressed, Qi stagnates and fails to circulate freely. How can it fill the skin, warm the muscles, and open the pores? Without Wei Qi protection on the exterior, chills occur; without Qi transportation to the exterior, blood fails to nourish, leading to dry skin. With deficient Middle Qi and impaired Spleen transport, food steams and stagnates into Phlegm, preventing its transformation into body fluids and then Blood. Therefore, not only do the pores of the body surface become dry and blocked, but the pores of the intestines and stomach also fail to be warmed, filled, opened, and dispersed, becoming dense and obstructed. How can body fluids flow outside the collaterals and skin? Moreover, as body fluids stagnate into Phlegm, the more Phlegm there is, the more depleted the body fluids become. I used Ginseng Radix to preserve primordial Qi and secure the Middle as the Sovereign drug, Astragali Radix to assist the exterior and protect Wei Qi as the Minister drug, Angelicae Sinensis Radix to harmonize and nourish Ying and Blood, Atractylodis Macrocephalae Rhizoma to aid Spleen in overcoming dampness, Ophiopogonis Radix to protect Lung Qi, Schisandrae Fructus to astringe scattered essence, and Glycyrrhizae Radix et Rhizoma Preparata to harmonize drug properties and tonify Spleen as the Assistant drugs. Cinnamon Twig (Guizhi) has acrid-sweet properties that harmonize Ying and Wei, warm the muscles, and reach the exterior. Ephedrae Herba (Mahuang) is light, ascending, and potent, leading the other drugs to penetrate the skin and hair, driving out latent Yin-congealed Phlegm and transforming it into Yang-harmonious body fluids, serving as the Guide drug. Fearing that the acrid-hot nature of Cinnamon Twig and Ephedra might consume Ying Yin, I added White Peony Root (Baishao) to harmonize the Liver and suppress the harshness of these two drugs. This is essentially the Mahuang Guizhi Tang used by Master Dongyuan to treat bleeding due to external cold invasion and internal heat accumulation. I further added Atractylodis Macrocephalae Rhizoma because its rigid nature acts quickly, firmly securing the Middle and cutting off the disease source without being disturbed by external factors. The guiding agents included fresh Ginger and Jujube, chosen for their acrid-sweet taste to aid Spleen in generating body fluids and assist the Spirit in rising clearly and vigorously. After taking two or three doses, the pulse energy gradually became full and spirited, and phlegm-cough resolved. I then instructed him to take Shibu Wan (Ten Tonics Pill) on an empty stomach to tonify Kidney, and during the day, use a modified Guipi Yangying Decoction to regulate Heart and Spleen Qi and Blood for peace.

Physicians must cultivate their own spirit and focus exclusively on their medical practice, avoiding any external affairs, because medicine relies on intention. Diagnosing pulses, differentiating symptoms, and prescribing formulas rely entirely on mental focus. If one's spirit is insufficient, differentiation and prescription will inevitably be tedious and hasty, lacking deep contemplation. Furthermore, focusing on medical practice leads to academic progress and broad understanding, enabling one to investigate things and benefit humanity. If one rushes after external affairs, the mind scatters and intention becomes chaotic, making it impossible to intuitively grasp subtleties or dedicate oneself to benefiting others.

The human body prioritizes the Spleen and Stomach. All diseases depend on the presence of Stomach Qi for life and its absence for death. Why? When encountering illness, regardless of external contraction or internal injury, forbidding diet and indiscriminately administering drugs turns the Stomach and Spleen—the sea of water and grain—into mere containers for medicine. This merely disturbs pure Qi, triggering cycles of excess and deficiency. The aggressive nature of herbal tonification and purgation, and the conflicting energies of cold and heat, battle within, while the peaceful flavors of grains and meats that nourish are exhausted internally. Stomach Qi declines daily, and all Zang-Fu organs become distressed. This is nominally treating disease but actually causing it. Each Zang organ has its spirit. Intense cravings for specific foods reflect the desires of the respective organ spirits, seeking self-rescue due to insufficiency of that organ's essence and blood. For example, pregnant women with deficient Liver and Kidney may crave sour and salty foods; elderly people with deficient essence and blood may crave meat. Therefore, foods desired by patients should only be moderated, never completely cut off. If patients tire of long-term medication, the condition can be temporarily managed by pausing drugs and introducing preferred foods. Once Stomach Qi strengthens, spirit can be nourished. If the disease severity necessitates medication, choose mild-flavored herbs that are easy to ingest without damaging Stomach Qi. Ignoring this principle—cutting off desired foods and forcing damaging drugs—injures Stomach Qi, depletes the source of transformation, and makes recovery difficult. Moreover, many cases involve taking medicines for conditions they do not have!