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Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) states: A Kou (hollow, like a scallion stalk) pulse indicates blood deficiency; a deep, slow, and thin pulse indicates Qi depletion; a large but forceless pulse indicates Yang deficiency; a rapid but forceless pulse indicates Yin deficiency; a large and Kou pulse indicates blood loss. In a healthy person, a large pulse signifies劳损 (consumptive disease); extreme weakness also signifies consumptive disease. A micro and fine pulse indicates night sweating; a weak and soft pulse at the Cun position indicates upper Jiao deficiency; a soft and choppy pulse at the Chi position indicates lower Jiao deficiency; a soft, slippery, and rapid pulse at the Chi position indicates blood deficiency; a deep and fine pulse at both Guan positions indicates Stomach deficiency.

Mai Jing (Pulse Classic) states: A soft pulse indicates deficiency; a slow pulse indicates deficiency; a weak and minute pulse indicates deficiency; a wiry pulse indicates middle Qi deficiency; a fine and minute pulse indicates simultaneous deficiency of Qi and Blood.

Zhang Jingyue's pulse diagnosis methods contain valuable points. Regardless of whether the pulse is floating, deep, large, or small, if it gradually becomes relaxed, it indicates a gradual return of vitality. If the pulse is extremely wiry, the disease must be severe; if extremely rapid, the disease must be critical. If the pulse is wiry and fine, further compounded by tightness and rapidity, there is less than one chance in a hundred of survival.

Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill)
The main purport of this formula is to nourish Kidney Water to control Xianghuo (Ministerial Fire).
My ancestor, Yan Gong, stated: "Nourishing Water to control Ministerial Fire" refers to cases where Ministerial Fire is in excess. If Mingmen True Fire is insufficient and cannot steam and transform the Spleen and Stomach, taking Liuwei Dihuang Wan will increase damp-phlegm; in such cases, Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) should be taken regularly.
The cause of Xu Lao (Consumptive Disease) often stems from hematemesis and cough. Do hematemesis and cough always lead to consumption? Improper treatment causes the root of consumption to remain here, making it difficult to eradicate. Hematemesis arises suddenly, mostly due to Wind-Cold failing to be released through sweating, forcing blood to surge upward causing massive vomiting. If bleeding stops after one episode, no treatment is needed. (Sweat is blood, blood is sweat; seeing blood mixed with sweat means Wind-Cold resolves through the blood. Quiet rest is suitable; medication may not be necessary.) If bleeding does not stop, use Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and White Peony Decoction). If the pulse is fine, deep, and slow, and forceless upon pressure, it indicates Cold pathogen directly invading the interior, damaging Yuan Yang. When Yang is deficient, Yin must escape, causing massive hematemesis (or severe epistaxis), with slightly cold extremities. Lizhong Tang (Regulate the Middle Decoction) added with Danggui (Angelica Sinensis) and Muxiang (Aucklandia) is suitable, or Zhenyin Jian (Settle Yin Decoction) to direct rebellious Qi downward. This is a fixed method. For those with a constitution prone to Yang, affected externally by intense summer heat and internally injured by spicy, pungent, fried foods causing bleeding, Baihu Tang (White Tiger Decoction) or Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) are suitable. This is like removing firewood from under the pot so the water does not boil. Another method is to take Ban Sheng (half a Chinese unit of volume) of Dihuang juice, boil three times, add Yicunbi (a measure equivalent to an inch cube) of raw Dahuang (Rhubarb) powder, mix well, and take on an empty stomach, three times a day, for recovery. This is a secret method. Nowadays, upon seeing any case of hematemesis, people immediately use Liuwei Dihuang Wan added with Heizhi Zi (Black Gardenia), Ou Jie (Lotus Node), Baimaogen (Imperata Rhizome), Xueyutan (Burnt Human Hair), Ejiao (Donkey-Hide Gelatin), etc. This indulgence nurtures evil, inevitably transforming cough into consumptive disease.

Coughs at their onset are mostly due to Wind-Cold. The Jing (Classic) states: Skin and hair are the exterior correspondence of the Lung. I often see modern patients with this condition who do not know to release the muscle layer (solve exterior syndrome) and rashly administer Liuwei Dihuang Wan. (Adding Maidong (Ophiopogon) and Wuweizi (Schisandra) would make the disaster even more severe.) This is akin to closing the door to chase away thieves, inevitably leading to consumptive disease.

Cuishi Bawei Wan (Dr. Cui's Eight-Ingredient Pill)
(This formula existed before Zhang Zhongjing; he included it in Jingui Yaolue, hence its name Jinkui Shenqi Wan.) Its main purport is to warm the Kidneys and expel Water Pathogens.
This formula appears five times in Jingui Yaolue: First in Chapter 5, treating Hongjiao (Gout/Edema) ascending to the lower abdomen with numbness; second in Chapter 6, treating Xu Lao lumbar pain with difficulty urinating; third in Chapter 12, stating that shortness of breath with slight fluid retention should be treated by promoting urination, using Shenqi Wan as the primary formula; fourth in Chapter 13, treating male Xiao Ke (Wasting-Thirst) with frequent urination, drinking one dou and urinating one dou; fifth in Chapter 22, treating women with Zhuanbao (bladder torsion/inversion) unable to urinate, which heals by promoting urination.
Observing these five entries, they mostly treat diseases of the lower abdomen and Bladder. Since the Kidney is the Water Organ, all water diseases return to it, hence Fuling (Poria), Zexie (Alisma), and Shanyao (Dioscorea) are used to promote urination. However, excessive diuresis harms Kidney Yin which dislikes dryness, so Shudi (Prepared Rehmannia), Yurou (Cornus), and Danpi (Moutan) are used to nourish and astringe. Furthermore, since water is associated with Cold pathogens, Fuzi (Aconite) and Rougui (Cinnamon Bark) are used to assist Yang and unblock obstruction. They complement each other, focusing primarily on unblocking the Kidneys and promoting urination; this is the true meaning of Bawei Wan. Xue Yi and Zhao Xianke borrowed it as a fire-tonifying method, which is not entirely appropriate. It is strictly contraindicated for those with polyuria.

Xiao Jianzhong Tang (Minor Construct the Middle Decoction)
The text states: Treats Xu Lao with Li Ji (abdominal tension/pain), palpitations, epistaxis, abdominal pain, nocturnal seminal emission, soreness and pain in the four limbs, vexing heat in the hands and feet, dry throat, and dry mouth.
Yu Jiayan said: Urgently establish the Middle Qi so that food intake increases and fluids flourish, thereby generating blood and essence to restore the insufficiency of True Yin. Use only the sweet flavor derived from grains (Earth element), avoiding sour, pungent, salty, and bitter flavors. There is no better method than this.

Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction)
Same as the previous formula plus Huangqi (Astragalus) 1.5 liang. For shortness of breath and chest fullness, add Shengjiang (Fresh Ginger); for abdominal fullness, remove Zaoju (Jujube) and add Fuling (Poria) 1.5 liang; for treating Lung deficiency and insufficiency, add Banxia (Pinellia) 3 liang when tonifying Qi.

Qianjin Fang (Prescriptions Worth a Thousand Gold) treats men and women with accumulated Cold Qi stagnation, or failure to return to normal after severe illness. Symptoms include heavy limbs, soreness and pain in muscles and bones, shallow breathing, panting upon movement, chest fullness and urgency, stiffness and pain in the waist and back, emptiness and palpitations in the heart, dry throat and lips, lack of luster in the face and body, loss of taste, hypochondriac fullness and abdominal distension, heavy head unable to lift, sleeping much and rising little. Severe cases last years, mild cases a hundred days, gradually leading to emaciation and exhaustion of the Five Zang organs, making recovery difficult. All six pulses are insufficient, with Cold Qi causing lower abdominal tension, emaciation, and myriad diseases. This is named Huangqi Jianzhong Tang.

Renshen Jianzhong Tang (Ginseng Construct the Middle Decoction)
Same as the previous formula plus Renshen (Ginseng) 2 liang, treating Xu Lao spontaneous sweating.

Danggui Jianzhong Tang (Angelica Construct the Middle Decoction)
Same as the previous formula plus Danggui (Angelica Sinensis) 2 liang, treating female blood deficiency with spontaneous sweating.

Bawei Da Jianzhong Tang (Eight-Ingredient Major Construct the Middle Decoction)
Treats insufficiency of Middle Qi, cold extremities, lower abdominal cramping, abdominal fullness with anorexia, retraction of the genitals with profuse sweating, cold pain in the abdomen, dry lips with seminal emission, alternating chills and fever with vexation, soreness and pain in the four limbs, and rootless, unanchored Fire emerging from the skin manifesting as rashes, macules, cold reversal, vomiting, etc.
Herbs: Huangqi (Astragalus), Danggui (Angelica Sinensis), Guixin (Cinnamon Heart - cinnamon bark peeled of its outer layer, not the modern Rouguixin), Jiubaishao (White Peony soaked in wine), Renshen (Ginseng), Gancao (Licorice, roasted, 1 qian each), Banxia (Pinellia, processed), Fuzi (Aconite, prepared, 2.5 qian each).
Take 5 qian per dose, add 3 slices of ginger and 2 jujubes, decoct and drink.

Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction)
Treats individuals with chronic seminal loss, lower abdominal tension and urgency, cold glans penis, dizziness, and hair loss. Pulse is extremely deficient, Kou, and slow, indicating undigested food in stool (Qinggu), seminal loss, and blood depletion. Pulses presenting as various Kou, moving, or slightly tight indicate seminal loss in men and dream-interactive sleep in women.
Yu Shi said: Using Guizhi Tang regulates the sluggish Ying and Wei, and the deficient pulse vessels. Adding Longgu (Dragon Bone) and Muli (Oyster Shell) astringes to stop Qinggu, blood loss, and seminal loss. One formula grasps two key aspects, truly worthy of esteem.

Duanju states: For emaciation with floating heat and sweating, remove Guizhi and add Baiwei (Anemarrhena) and Fuzi (Aconite) 1.5 qian each, hence called Erjia Longgu Tang (Two-Added Dragon Bone Decoction).
Although Guizhi is paramount for regulating Ying and Wei, if the person has Floating Deficient Yang on the exterior, Fuzi and Baiwei should be added to secure Yang and assist astringency; Guizhi should not be used.

Zhang Shiwang said: For blood loss and seminal loss, the world uses herbs to tonify blood and Qi. But Zhang Zhongjing uniquely cites Guizhi Tang because the body's Qi and Blood rely entirely on postnatal food and water for generation. Food and water enter the Stomach; the clear part becomes Ying (Nutritive) Qi, and the turbid part becomes Wei (Defensive) Qi. If Ying Qi fails to nourish, upper heat causes blood overflow; if Wei Qi fails to protect, lower cold causes seminal loss. Thus, harmonizing Ying and Wei is primary. When Ying and Wei are harmonized, the Three Jiao perform their duties, and Fire returns to its root. Heat ceases to be hot, cold ceases to be cold, nutrients are transformed, and the source of essence and blood is supported. Given the massive loss, fearing lower Jiao deficiency and sliding inability to hold, Longgu is added to enter the Liver to anchor the Soul, and Muli to enter the Kidney to secure Essence; both are fundamental medicines for securing storage and sealing. As for the variations of Xiao Jianzhong Tang, they are divine formulas for treating Xu Lao. Later generations specialized in nourishing Yin and descending Fire, causing misdiagnosis and harm. Cases not yet critical can be reversed using these formulas.

Da Jianzhong Tang (All seen in Jingui Yaolue)
Severe Cold in the heart and chest, painful vomiting preventing food intake, Cold in the abdomen, Qi surging upward causing skin to bulge with visible heads and feet, pain above and below, intolerable to touch.

Ye Tianshi's Modified Da Jianzhong Tang
Adopts the method of Pungent-Sweet transforming into Yang.
Herbs: Renshen (Ginseng), Guixin (Cinnamon Heart), Guishen (Angelica Root Body), Chuanjiao (Sichuan Pepper, stir-fried until oil exudes), Fuling (Poria), Zhigancao (Roasted Licorice), Baishao (White Peony), Yitang (Maltose), Lanzao (Orlando Jujube).
Note: Ganjiang (Dried Ginger) in the original formula is indispensable.

Ye Tianshi's Modified Xiao Jianzhong Tang
Pulse is deficient on the right and small on the left, slight chill on the back, slightly cold limbs, much phlegm with slight vomiting, reduced appetite and bland taste. This indicates weakened Stomach Yang, with Wei Qi unable to support, presenting as intermittent slight chills and fevers, short dark urine, and slightly loose stools. This is not an Excess pathogen. One should establish Middle Qi to maintain Ying and Wei. Li Dongyuan said: The Stomach is the root of Wei Qi, and the Spleen is the source of Ying Qi. Bias toward heat or cold is not the correct treatment.
Herbs: Renshen (Ginseng), Guishen (Angelica Root Body, stir-fried with rice), Guizhimu (Cinnamon Twig Wood), Baishao (White Peony), Lanzao (Orlando Jujube).
Note: Jiang (Ginger) in this formula is indispensable.

Fumai Tang (Restore the Pulse Decoction), also known as Zhigancao Tang (Roasted Licorice Decoction, formula seen in Shanghan Lun).
Treats various deficiencies and insufficiencies, sweating with chest stuffiness, knotted and intermittent pulse, palpitations. If the patient moves normally, death occurs within 100 days; if critical, death occurs in 11 days. (This is a formula for treating empty and exhausted blood vessels.)
It is used to harmonize blood. Whenever a knotted or intermittent pulse appears, even if the patient moves normally, death occurs within 100 days. If more critical and unable to move, death occurs within 10 days. The statement is very clear; previous interpreters were mostly mistaken.
Yu Jiayan said: This is Zhang Zhongjing's holy formula for treating Shanghan with knotted/intermittent pulse and palpitations, where pathogenic factors are few and deficiency is many. It is not recorded in Jingui Yaolue, but since Qianjin Yi frequently used this formula for Xu Lao, it is credible, hence named the Qianjin Formula. Patients with Xu Lao constitution often have exterior heat mixed with Yin deficiency, hence the mention of sweating and stuffiness in the text. Releasing the exterior is wrong, and treating Yin deficiency alone is also wrong. Only by using this formula successfully can the pulse emerge and heat resolve, making the patient feel refreshed; this is truly a holy method. However, Xu Lao patients usually have deficient Stomach fluids, unlike the acute Shanghan with few pathogens and much deficiency. The large doses of Guizhi and Shengjiang cause fluids to escape outward with the heat. Once fluids escape outward, they are hard to recover, often resulting in profuse sweating for a day and night. After passing this hurdle, one must urgently modify the base formula by removing Guizhi and Shengjiang, adding Renshen (Ginseng) in triple dosage, following closely behind. Only then can fluids regenerate, causing Ying and Wei to flourish and various deficiencies to recover. Is this not a significant benefit!

Ye Tianshi's Modified Fumai Tang
This case states: The pulse is deficient and fine, night fever and morning chill, vexation, fatigue, thirst, and sweating. Visceral fluids are already depleted. During the spring wind season, following Zhang Zhongshi's example that whenever Yuan Qi is injured, Sweet Herbs should be given.
Sun Xindian noted: For treating Xu Lao, apart from Jianzhong methods, there is no way out. However, for cases where Spleen Yang is not deficient but the Stomach has Dry Fire, one should follow contemporary experts' methods of nourishing Stomach Yin.
Ye Tianshi said: Taiyin Damp Earth requires Yang to function; Yangming Dry Earth requires Yin to be peaceful. Because the Spleen likes dryness and the Stomach likes moistness. From this method, I have realized countless techniques. The formulas listed below should be studied deeply.

Ye's Stomach-Nourishing Formula
Treats Stomach deficiency with poor appetite, Earth failing to generate Metal, low voice and weak Qi.
Herbs: Maidong (Ophiopogon), Sheng Biandou (Raw Broad Bean), Yuzhu (Polygonatum Odoratum), Gancao (Licorice), Sangye (Mulberry Leaf), Shashen (Glehnia).
Sheng Guya (Sprouted Grain), Guang Chenpi (Tangerine Peel), Baizhu (Atractylodes), Mailen (Wheat Kernel), Shihu (Dendrobium), Wumei (Mume Fruit) can all be added. If extremely dry, add Sugarcane Juice.

Ye's Formula
Treats Yin deficiency with night sweats. Does not use Danggui Lihuang Tang because its bitter taste is unfavorable to the Stomach. This formula uses Sour-Sweet transforming into Yin. (Combined with the previous Modified Da Jianzhong Tang's Pungent-Sweet transforming into Yang, one can understand the subtlety of herb selection.)
Herbs: Renshen (Ginseng), Shudi (Prepared Rehmannia), Wuwei Zi (Schisandra), Zhigancao (Roasted Licorice), Hulian (Nelumbo Seed), Fushen (Poria with Pine Root).

Another Formula The Jing states: For those lacking form, warm with Qi; for those lacking essence, tonify with Flavor. If food intake is normal but muscles daily waste away, one should use flesh-and-blood substances to nourish.
Herbs: Niu Suimoi (Ox Marrow), Yang Suimoi (Sheep Marrow), Zhu Suimoi (Pig Marrow), Fushen (Poria with Pine Root), Gouqi (Goji Berry), Danggui (Angelica Sinensis), Hulian (Nelumbo Seed), Qianshi (Euryale Seed).

Another Formula
Treats flesh wasting and fat depletion, gasping for air, wanting to cough but unable to produce sound, requiring squatting and pressing the hypochondrium to gain strength. Upon waking, the throat is dry up to the chest and epigastrium. This indicates exhaustion of the Five Fluids, considered untreatable. Borrowing human body marrow/fat as a plan for continuation.
Herbs: Xian Heche (Fresh Placenta - Note: This ingredient should not be used), Ren Ru Zhi (Human Milk), Zhen Qiushi (True Autumn Stone), Xueyu Hui (Ash of Burnt Human Hair).

For Yin deficiency with Floating Yang, the method of using shellfish/shells to subdue Yang is suitable. Liuwei Wan, removing Danpi and Zexie, adding Qiushi (Autumn Stone), Guijiao (Turtle Shell Gelatin), Muli (Oyster Shell), Hulian (Nelumbo Seed), etc. If Haishen Jiao (Sea Cucumber Gelatin), Dancai Jiao (Mussel Gelatin), or Yanwo (Swallow's Nest) are used, it is all of this intent.
Changsun Xindian noted: In extreme deficiency, emotionless herbs cannot tonify. If emaciation is extreme, various marrows and Lamb Gelatin are necessary; for extreme Yin deficiency within Yin, Turtle Shell Gelatin, Human Milk, Powdered Oyster Shell, Autumn Stone, and Cervus Elaphus Antler Velvet are necessary; for extreme Yang deficiency within Yin, Deer Antler Gelatin, Deer Antler Velvet, and Yellow Dog Testicles are necessary. Apply this principle举一反三 (infer other cases from one instance).

Hei Dihuang Wan (Black Rehmannia Pill)
Treats Yang excess and Yin decline, Spleen and Stomach insufficiency, sexual exhaustion damage, emaciation and weakness, complexion often greenish-yellow without constant color. This is a Kidney-tonifying and Stomach-nourishing agent.
Herbs: Cangzhu (Atractylodes Lancea, 1 jin, soaked in oil), Shudi (Prepared Rehmannia, 1 jin), Wuweizi (Schisandra, 0.5 jin), Ganjiang (Dried Ginger, 1 liang in autumn/winter, 5 qian in summer, 7 qian in spring).
Grind into powder, make pills with jujube paste, size of wutong seeds. Take 100 pills with rice soup. Excellent for treating chronic hemorrhoids due to blood deficiency. (This is a holy medicine for treating blood loss with Spleen Cold.)

Tianzhen Wan (Innocent Truth Pill)
Treats all cases of excessive blood loss, emaciated body and limbs, inability to eat, intestinal slipping and diarrhea, exhaustion of fluids. Long-term use generates blood, tonifies Qi, warms the Stomach, and preserves youth.
Herbs: Sheng Yangrou (Raw Lamb Meat, 7 jin, remove fascia/fat/skin, slice open and insert powdered herbs below), Rongrong (Cistanche, 10 liang), Danggui (Angelica Sinensis, 12 liang, washed, peel removed), Shanyao (Dioscorea, 10 liang, wet ones peeled), Tiandong (Asparagus/Tienma, 1 jin, remove heart, bake dry).
Grind the four herbs into powder, place inside the lamb meat, wrap securely. Boil in 4 bottles of pure wine until wine is exhausted, then add 2 sheng of water and boil until meat is tender. Add Huangqi (Astragalus) powder 5 liang, Renshen (Ginseng) powder 2 liang, Baizhu (Atractylodes) powder 2 liang. Pound into thin cakes, sun-dry, and dry over paper suspended above fire. Make pills with refined honey, size of wutong seeds. Take 100 pills, increasing to 200-300 pills, with warm wine, twice a day.

Xini Gao (Xini Paste)
Treats hemoptysis and hematemesis, chronic consumptive cough that does not stop.
Herbs: Xini (Snipe, 60 birds, extract 20 cups of juice), Shengdi (Rehmannia), Maogen (Imperata Rhizome), Ou (Lotus Root) (each extract 10 cups of juice), Luobo (Radish), Maidong (Ophiopogon) (each extract 5 cups of juice).
Decoct the six ingredients, refine with 1 jin of honey and 8 liang of maltose, add half a cup of ginger juice, boil again until thick like稀糊 (thin paste), forming the paste. Take 1-2 spoons daily, hold in mouth and swallow.