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Treatment for conditions caused by deficiency of Heart and Lung Yang, leading to the failure of Spleen dampness to ascend and Stomach Qi stagnation failing to descend. Dietary intake cannot be transformed into fine nutrients (Jingwei), instead transforming into fluid retention (Yin). When fluid retention stays at the stomach opening, it manifests as fullness and oppression; when it overflows above the diaphragm, it manifests as shortness of breath; when it soaks and fills the lung orifices, it manifests as panting and rapid breathing; when it obstructs and sticks in the throat, it manifests as coughing up sticky saliva. In severe cases, yin mist may fill the Upper Jiao, preventing Heart and Lung Yang from freely expanding, which turns into stagnation and generates heat. Alternatively, Yin qi forcing Yang outward manifests as body fever, while forcing Yang Qi floating upward manifests as deafness. However, one must examine the pulse; only if it is definitively wiry (Xian), slow (Chi), thin (Xi), and weak (Ruo) should this decoction be administered.

Bai Zhu (Atractylodis Rhizoma) - 4 qian
Gan Jiang (Zingiberis Rhizoma Recens) - 5 qian
Gui Zhi Jian (Cinnamomi Ramulus Apicalis) - 2 qian
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 qian
Fu Ling Pian (Poria) - 2 qian
Sheng Hang Shao (Paeoniae Radix Alba Cruda) - 2 qian
Ju Hong (Citri Reticulatae Pericarpium Rubrum) - 1.5 qian
Chuan Hou Po (Magnoliae Officinalis Cortex) - 1.5 qian

After taking several doses, if fluid retention has been cleared but Qi deficiency remains, add Sheng Huang Qi (Astragali Radix) a few qian according to discretion.

In this formula, Gui Zhi and Gan Jiang are used to assist Heart and Lung Yang and promote their circulation. Bai Zhu, Fu Ling, and Gan Cao are used to regulate Spleen and Stomach dampness and promote its leaching out through mild diuresis (when Fu Ling and Gan Cao are used together, they are most effective in draining dampness-induced fullness). Hou Po is used because Ye Tianshi stated: "Hou Po in large doses breaks Qi, but in small doses unblocks Yang." The intention is to borrow its warm and unblocking nature to make Stomach Yang smooth and Qi descend, accelerating the downward movement of water and grain. Ju Hong is used to assist Bai Zhu, Fu Ling, and Gan Cao in benefiting the resolution of phlegm-fluid retention. As for Bai Shao, if utilizing its bitter and neutral nature, it can prevent hot herbs from flaming upward (neutral nature tends to descend); if utilizing its sour and astringent nature, it can restrain the floating of deficient fire (The *Shennong Bencao Jing* states Bai Shao is bitter and neutral, while later generations consider it sour and astringent; its actual taste is bitter with a slight sourness). Furthermore, while hot substances are suitable for the Spleen and Stomach, they may not be suitable for the Liver and Gallbladder; thus, we utilize Bai Shao's cool and moistening nature to nourish Liver and Gallbladder Yin, thereby preventing Heat in the Liver and Gallbladder. Moreover, since it promotes urination, free urination naturally reduces phlegm-fluid retention.

A woman, approximately forty years old, often felt fullness and heat in her chest. Every ten days or so, she would experience severe panting lasting one or two days. Physicians prescribed cooling and Qi-regulating medicines. Initially, there was some effect, but long-term use worsened the condition. Later, I examined her; her pulse was deep and thin, barely perceptible. The family asked about the cause. I said: This is due to deficiency of Heart and Lung Yang, failing to circulate the Spleen and Stomach, leading to excessive production of phlegm-fluid retention. The human Spleen and Stomach belong to Earth, like the land. Heart and Lung reside above them, occupying the Taiyang region (the area above the diaphragm belongs to Taiyang, as known from the Taiyang chapter of *Shanghan Lun*). Their Yang Qi circulates freely, like the sun shining brightly in the midday sky. The water and grain ingested by the Stomach rely on this Yang Qi circulation to transform fine nutrients and generate Qi and Blood, and to transport waste into urine and feces. Clear Qi ascends, turbid Qi descends; how could phlegm-fluid retention arise? Only when Heart and Lung Yang are deficient, unable to shine like the sun, can the Spleen and Stomach fail to borrow this circulating power to transform and transport. Thus, food stagnates at the stomach opening. Like muddy puddles after heavy rain that do not dry despite days of fog, phlegm-fluid retention is generated. Once generated, accumulating day by day, stagnation filling the Upper Jiao causes oppression; soaking the lung orifices causes panting; obstructing Heart and Lung Yang from spreading causes heat. Physicians who do not recognize the source still use cold medicines to clear heat; do not be surprised that the condition worsens over time. I then prepared this decoction for her. After one dose, the heat in her heart disappeared. After several doses, she felt very cool. I removed Bai Shao, and after continuing for more than twenty doses, her chest felt open and clear, and panting did not recur.

A woman, approximately thirty years old, was naturally plump. Phlegm-saliva was stagnant in her chest, hindering digestion, and she often felt irritability and heat in the Upper Jiao. She accidentally took Meng Shi Gun Tan Wan with good effect, so she took it daily. Initially, her appetite increased; subsequently, it gradually decreased; later, if she missed a dose, she could not eat at all. Long-term use yielded no effect. She ate only once a day, little by little, and still could not digest it. She also frequently felt rising heat and tinnitus almost causing deafness. She began to suspect the medicine was incorrect for her syndrome. She sought my consultation. Her pulse was floating and large, but soft upon pressure. I said: This syndrome involves deficiency of Heart and Lung Yang and weakness of Spleen and Stomach Qi, caused by excessive use of bitter-cold purgative medicines. Therefore, the symptoms and pulse present as such. I proposed treating her with Li Yin Tang. The family said previous physicians found she could not tolerate even small amounts of Gui Zhi and Fu Zi, fearing she could not handle hot medicines again. I said: Gui Zhi and Fu Zi are not the primary treatments for Heart, Lung, Spleen, and Stomach conditions. Moreover, using tiny amounts for a severe illness results in light medication for heavy disease, explaining why she could not tolerate them. If my proposed Li Yin Tang matches this syndrome perfectly, taking it will surely have no adverse changes. If you fear this medicine and dare not take it lightly, simply try taking five qian of Gan Jiang alone. Following my advice, after decocting and taking Gan Jiang, her tinnitus stopped immediately, and she felt her chest open shortly after. Subsequently, Li Yin Tang was administered. After several doses, she felt very cool in her heart. Gan Jiang was increased to one liang, and after more than twenty doses, the disease was eradicated.

A woman, approximately forty years old, suffered from fullness, oppression, and irritability in the Upper Jiao. She craved cool foods, but eating them worsened the fullness. She also had morning diarrhea that persisted for a long time without healing, worsening the fullness until it threatened to become abdominal distension (Gu Zhang). Repeated medical consultations and medications, mostly involving half-tonifying and half-purgative formulas, or adjuvants of cooling or astringent properties, were ineffective. Upon examination, her pulse was wiry, thin, and slow. I determined it was cold-fluid retention knotting in the chest, blocking Qi transformation. I intended to prescribe Li Yin Tang, but the family hesitated, seeming afraid to take it. They were instructed to first decoct and take a few qian of Gan Jiang, which instantly relieved the chest irritability. Due to her morning diarrhea, I modified Li Yin Tang by removing Hou Po and Bai Shao, adding Sheng Ji Nei Jin (Endothelium Corneum Gigeriae Galli) 1.5 qian and Gu Bu Zhi (Psoraleae Fructus) 3 qian. After more than ten doses, all illnesses were cured.

A woman near fifty years old often felt shortness of breath and reduced appetite. Repeated medical treatments, including dispersing, ascending, or tonifying Spleen and Stomach with Qi-regulating agents, were completely ineffective. Gradually, her intake decreased, she became emaciated and bedridden, gasping for life. The family considered it an incurable case. Hearing that I frequently saved critical cases in the neighboring village, they consulted me again. Her pulse was wiry, thin, and nearly imperceptible. She frequently spat thin saliva. Asking about her sensation, she reported a blockage at the stomach opening preventing Qi from reaching upward, indicating condensation of cold-fluid retention. I prescribed Li Yin Tang, changing Gan Jiang to seven qian. After three doses, the stomach opening opened. Feeling weak respiration, I added Sheng Huang Qi 3 qian to the formula. After more than ten doses, she fully recovered. Medical texts state that fluid retention (Yin) is condensed water, while phlegm (Tan) is congealed fire, implying Yin is cold and Tan is hot. However, Yin syndromes naturally divide into cold and hot types. Hot Yin often results from excessive worry and thought, potentially leading to mania, though fluid is rarely expectorated. Cold Yin results from deficiency of Heart and Lung Yang, presenting with various symptoms as described under the formula name. Moreover, frequent expectoration of thin saliva, chronic shortness of breath, and poor appetite are clear signs (Later generations define thin phlegm as Yin and thick phlegm as Tan, differing from the Four Fluid Retentions in *Jingui Yaolue*).

Han XX from the county, coming from a family of physicians, aged forty-four, contracted a strange disease. While lying down, he frequently experienced convulsions that started and stopped quickly, resembling chills, resolving within a single breath. Even when not convulsing, touching him with a hand would trigger immediate convulsions. Self-treatment failed, and other physicians were unsuccessful. The condition persisted for half a year, worsening gradually. Upon examination, his pulse was very wiry and thin. His dietary intake was scant. I identified deficiency and exhaustion of Heart, Lung, Spleen, and Stomach Yang, failing to transform fine nutrients to generate Qi and Blood. Blood deficiency fails to nourish sinews, and Qi deficiency fails to fill the body, causing convulsions. It occurs during sleep because Qi flow is obstructed when recumbent. Touch triggers it because Qi deficiency leads to aversion to pressure. I prescribed Li Yin Tang. After several doses, his appetite increased, and convulsions improved. After twenty doses, the disease did not recur.