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Zhu Danxi treated a patient. Due to heart pain, the patient had taken excessive amounts of hot-natured medicines for a long time and also suffered from acid regurgitation (swallowing acid). Zhu prescribed Erchen Tang (Phlegm-Resolving Decoction) with added Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Taoren (Persicae Semen), Yuliren (Prunus Armeniaca Seed), and Zexie (Alismatis Rhizoma). After taking the medicine, the patient vomited up sour, bitter, black fluid resembling rotten wood ear mushrooms multiple times. After prolonged use, the heart pain was cured, but acid regurgitation remained frequent. A lump of acid would surge from the chest and diaphragm up to the throat, causing great distress. Therefore, Huanglian (Coptidis Rhizoma) was decocted strongly and cooled. When the acid lump was about to rise, several drops were administered. Within half a day, after several bowel movements, the condition healed. The medication was then stopped, and the patient was nourished with light congee for one month. By this time, it had been over ten days since the Spring Festival. There was slight distension and urgency at the Zhongwan (CV12) point, the complexion appeared bluish, and there was slight panting. The weather was still cold. This was because the Spleen Earth had been weakened by long-term illness, and upon encountering the Wood Qi in command, the Spleen was overwhelmed by the Liver. Suju Liuhe Tang (Six-Harmony Decoction) was urgently administered, and the patient stabilized in four days.

Xue Lizhai treated a scholar. The patient had a sallow complexion, discomfort in the chest and diaphragm, acid regurgitation accompanied by belching of putrid food, and frequent use of Qi-regulating and phlegm-resolving medicines led to loose stools, poor appetite, and physical fatigue. This indicated deficiency-cold of the Spleen and Stomach. Liu Junzi Tang (Six-Gentlemen Decoction) with Paojiang (Prepared Ginger) and Muxiang (Aucklandiae Radix) was used, leading to gradual improvement. Simultaneously, Sishen Wan (Four-Spirit Pill) was taken to restore Yuan Qi (Primordial Qi).

My commentary: The above two cases, one treating heat and the other treating cold, both achieved excellence. In Zhu’s case, the use of the counter-assistance method of Zuojin Wan (Left Metal Pill) was avoided, showing the highest insight. In Xue’s case, regarding Sishen Wan, it would be more appropriate to remove Wuweizi (Schisandrae Fructus) and Roudoukou (Myristicae Semen) and replace them with Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Jiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata). Xue had another case where the presenting symptoms were identical, except for swelling and pain in the toes and oozing between the fingers. The patient had previously taken Erchen Tang, Ermiao San (Two-Awesome Powder), Huanglian (Coptidis Rhizoma), and Zhishi (Aurantii Fructus Immaturus). Xue cured him using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Fuling (Poria) and Banxia (Pinelliae Rhizoma). This was indeed a meticulously tailored prescription. It illustrates that Spleen deficiency with cold and Spleen deficiency with dampness are similar yet distinct. Zhou Shenzhai treated acid regurgitation using only Wuzhuyu (Evodiae Fructus), detailing its efficacy, which focused solely on the characters "cold-dampness."

Sun Dongsu treated Ye Runzhai. Approaching forty years of age, he suffered from epigastric clanging (zao re - a sensation of hunger mixed with discomfort). He loved eating meat, especially chicken, and could not go a day without it. If deprived, his body would swell, he would feel weak, and his spirit would be unsettled. He urgently needed meat; seeing it, he would devour it. However, once the meat entered his stomach, severe abdominal pain ensued. Only after vomiting thick sour water and saliva did the pain subside. Once slightly relieved, he craved meat again. People suspected demonic possession. Sun diagnosed unequal pulse sizes across the six positions. Observing his face, his lips were red and his cheeks yellow. Upon inquiry, he said that although the pain was bitter, he could endure it; but when the clanging occurred, his whole body felt itchy and restless, leaving him helpless and unable to control his limbs, feeling as if near death. He urgently needed meat to save his life. Sun said: Based on the complexion and pulse, this is a worm infestation, not demonic possession. First, Xionghuang Wan (Realgar Pill) was given, but without effect. It was changed to Nifen (Calomel) 5 fen, Shijunzi powder (Quisqualis Indica Seed) 1 qian, made into a cake beaten with an egg, and fed on an empty stomach at wu geng (3-5 AM). At chen shi (7-9 AM), ten long pinworms were passed, two of which were large, over chi (approx. 30 cm) in length. In the afternoon, over a hundred small worms were passed. From then on, he no longer desired meat, and the clanging symptom greatly improved.

My commentary: Regarding clanging (zao re), Zhu Danxi attributed it to phlegm stirred by fire, considering it a precursor to ye ge (dysphagia/chest obstruction). Thus, he often used Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Cangzhu (Atractylodis Rhizoma), Banxia (Pinelliae Rhizoma), and Baishao (Paeoniae Radix Alba). However, there are cases caused by excessive thinking damaging blood, or Kidney Yin deficiency with Stomach Fire, which require Dihuang (Rehmanniae Radix), Ejiao (Asini Corii Colla), Baiziren (Biota Semen), Maidong (Ophiopogonis Radix), Shihu (Dendrobii Caulis), and Lugeng (Phragmitis Rhizoma). This case, however, involved worms eroding fat and essence, which was not recorded in the clanging section, so it was specially selected. Years ago, I saw Ye Tianshi treat a woman with chest stuffiness and epigastric clanging using Shi Jueming (Haliotidis Concha) boiled in salt water 3 qian, Shuang Sangye (Mulbai Folium frosted by frost) 2 qian, Danpi (Moutan Cortex) 1 qian, Hei Zhi (Gardeniae Fructus charred) 1 qian, Sanjiao Heihuma (Sesamum indicum seed) 2 qian, Xi Dihuang (Rehmanniae Radix Preparata) 3 qian. She recovered after four doses. This represents clanging caused by Liver Fire stagnating in the Stomach.