朱丹溪治一人。病喘不得卧。肺脉沉而涩。此外有风凉湿气。遏其内热不得舒。以黄芩
陈皮、木通各一钱五分。苏叶、麻黄、桂枝各一钱。生姜、黄连各五分。甘草二分。煎服数
帖而愈。
又治吴辉妻孕时足肿。七月初旬。产后二日。因洗浴即气喘。但坐不得卧者五月矣。恶
寒。得暖稍宽。两关脉动。尺寸皆虚无。百药不效。朱以丹皮、桃仁、桂枝、茯苓、干姜、
五味、枳实、浓朴、桑皮、紫苏、栝蒌实煎服。一服即宽。三服得卧。病如失。盖作污血感
寒治之也。
震按首案宜用定喘汤。此方尚未妥贴。以黄连与沉涩脉不合也。次案用药似杂。而与病
情恰对。毫无可议。丹溪尚有一案。身痛与气喘并作。已收在痛风门。可以同阅。
汪石山治一人。体肥色白。年近六十。痰喘声如曳锯。夜不能卧。汪诊之。脉浮洪。六
七至中或有一结。曰。喘病脉洪。可治也。脉结者。痰碍经隧耳。宜用生脉汤加竹沥。服之
至十余帖。稍定。患者嫌迟。更医用三拗汤、五拗汤。势渐危。于是复以前方。服至三四十
帖。病果如失。
又治一妇人。年五十余。素有嗽病。忽一日大喘。痰出如泉。身汗如油。脉浮而洪。似
命绝之状。令速用生脉散一帖。喘定汗止。三帖后。痰亦渐少。再于前方加栝蒌实、白术、
黄芩、当归、芍药。服二十帖而安。
又一人年逾六十。病气喘。汪诊之。脉皆萦萦如蛛丝。曰。病不出是夜矣。果如期而逝
震按石山三案。以脉洪为可治。脉微细为不治。所当着眼。
又一人形长。色苍瘦。年四十。每秋凉病痰嗽气喘不能卧。春暖即安。病此多年。医用
紫苏、薄荷、荆芥等以发表。用桑皮、石膏、半夏等以疏内。虽暂轻可。不久复作。汪诊之
脉颇洪滑。此内有郁热也。秋凉则皮肤致密。内热不能发泄。故病作矣。内热者。病本也
今不治其本。徒用发散以虚其外。则愈不能当风寒。疏内以耗其津。则愈增郁热之势。遂
进三补丸加大黄、贝母、栝蒌。丸服。仍令每年立秋。先服滚痰丸四十粒。病渐安。
又一妇年五十。形色脆弱。每遇秋冬。痰嗽气喘。自汗体倦。或恶心作呕。汪诊之。脉
皆浮缓而濡。曰。表虚不御风寒。激内之郁热而然。遂用参、 各三钱。麦冬、白术各一钱
黄芩、归身、陈皮各七分。甘草、五味各五分。煎服十余帖而安。次年秋间。滞下。腹痛
后重。脉皆濡细稍滑。汪曰。此内之郁热欲下也。体虽素弱。经云。有故无殒。遂以小承气
利两三次。腹痛稍除。后重未退。再以补中益气加枳壳、黄芩、芍药煎服。仍用醋浇热砖。
布裹。坐之而愈。
震按秋凉喘嗽之证。近日甚多。若外寒束其内热。不过此证中之一种耳。然已虚实不同
如此。故必辨之以脉。乃无差误。
李士材治宋敬夫令嫒。中气素虚。食少神倦。至春初。忽然喘急。闷绝不知人。手足俱
冷。咸谓立毙矣。李曰。气虚极而金不清肃。不能下行。非大剂温补。决无生理。遂以人参
一两。干姜三钱。熟附子三钱。白术五钱。一服即苏。后服人参七斤余。姜、附各二斤。遂
全愈不复发。
又治孙芳其令嫒。久嗽而喘。凡顺气化痰。清金降火之剂。几于遍尝。绝不取效。一日
喘甚烦躁。李视其目则胀出。鼻则鼓扇。脉则浮而且大。肺胀无疑矣。遂以越婢加半夏汤投
之。一剂而减。再剂而愈。李曰。今虽愈。未可恃也。当以参术补元。助养金气。使清肃令
行。竟因循月许。终不调补。再发而不可救矣。
文学顾明华。十年哮嗽。百药无功。诊其两寸数而涩。李曰。涩者。痰火风寒。久久盘
踞。根深蒂固矣。须补养月余。行吐下之法。半年之间。凡吐下十次。服补剂百余。遂愈。
更以补中益气为丸。加鸡子秋石。服年许。永不复发。
震按士材三案。一用大剂温补。一用疏解化痰。一用吐下。间以补养。三法如鼎足。治
病无偏欹。
孙东宿治少司空凌绎泉。年已古稀。原有痰火之疾。正月初。因劳感冒。内热咳嗽。痰
中大半是血。鼻流清水。舌胎焦黄芒刺。语言强硬不清。大小便不利。喘急不能睡。亦不能
仰。以高桌安枕。日惟额伏枕上而已。医治半月不瘳。孙诊之。两手脉浮而洪。两关滑大
有力。知其内有积热痰火。为风邪所闭。复为怒气所加。故血上逆。议者以高年见红。脉大
发热为惧。孙曰。此有余证。诸公认为阴虚而用滋阴降火。故不瘳。法当先驱中焦痰火积
热。后以地黄补血等剂收功。可也。乃以栝蒌、石膏各三钱。半夏曲、橘红、桑皮、前胡、
杏
仁、酒芩、苏子水煎。冲莱菔汁一小盏。一剂而血止。次日诊之。脉仍浮而洪大。尚恶寒。
此
因先时不解表。竟用滋阴。又加童便降下太速。以致风寒郁而不散。故热愈甚也。改以定喘
汤。一剂而喘减。二剂而热退不恶寒。再诊之。两手浮象已无。惟两关脉鼓指。此中焦痰积
胶固。不可不因其时而疏导之。以清中丸同当归龙荟丸共二钱进之。其夜下稠粘秽积甚多。
予忆丹溪有云。凡哮喘火盛者。白虎汤加黄连、枳实有功。正此证对腔法也。与十剂。外以
清中丸同双玉丸夜服。调理而安。
震按此人以富贵之体。古稀之年。不能卧又半月之久。亦殊危矣。乃竟用消痰发表。清
火行滞。重剂收功。可见病无一定之局。只恐弃活着而走死着。又防活着认得不清。必以半
攻半补。不攻不补。为持重之法。仍是死着也。后案喻公之蛤蚧二十枚。人参十两。可谓棋
逢敌手。
喻嘉言治施眉苍肺痿喘嗽。吐清痰。肢体痿软不能举动。脉来虚数。以蛤蚧二十枚酒浸
酥炙。人参、黑参各十两。蜜丸。时时噙化。不终剂而痊。
孙起伯肺胀。服耗气药过多。张路玉诊之。脉浮大而重按豁然。饮食不入。幸得溺清便
坚。与局方七气。每剂用人参三钱。肉桂、半夏曲、炙甘草各一钱。生姜四片。四剂霍然。
盖肺胀实证居多。此脉虚大。不当以寻常论也。
又治一尼肺胀。喘鸣肩息。服下气止嗽药不应。渐至胸腹胀满。脉得气口弦细而涩。此
必劳力气上。误饮冷水伤肺。肺气不能收敛所致也。遂与越脾汤减麻黄。加细辛、葶苈。大
泻肺气而安。
震按此方加减最巧。上案用七气汤成方亦巧。观其论脉溯因。而细心体贴之。乃知其巧
予邑有友范君。哮喘已久。向用金匮肾气丸。时效时不效。吴门缪松心先生诊之曰。伏饮
内踞有年。明是阳衰浊泛。但绵延日久。五旬外。痰中杂以血点。阴分亦渐损伤。偏刚偏柔
用药两难措置。仿金水六君煎意。用熟地炭四钱。当归炭一钱。茯苓三钱。炙草四分。川
贝一钱半。青盐、陈皮一钱。淡菜漂三钱。杏仁三钱去皮尖盐水炒。半月后复诊。晨用金匮
肾气丸以治本。晚服苓桂术甘加味以治标。生于术米泔浸切片晒三两。粗桂木晒八钱。炒半
夏二两。云苓三两。炙草六钱。杏仁霜一两六钱。鹿脊骨三两。用麻黄四钱煎汤。炙北细辛
三钱晒。水泛丸。此证向来背脊畏寒。甚则哮发。服此方而畏寒除。隔三年。忽起淋浊。茎
中痛胀。缪曰。此新病。以泻丙出壬为正治。但素有痰饮。滋腻之品。伤阳助湿。究非所宜
当变法治。庶与本证无碍。羊脊骨五钱。小木通一钱。盐水炒黄柏三分。生甘草梢五分。
赤白茯苓各半三钱。水飞辰砂五分。调入服。三剂淋浊即愈。半年后改定丸方。曰。饮踞中
焦。历年已久。前主温煦太阳寒水之脏。与病机极合。用药可无事更张。第溺管有精淋。由
来已非旦夕。虽云肾气不坚所致。其降多而升少。亦非所宜。今造一方以兼顾之。嫩毛鹿角
二两镑。羊脊骨三两炙黄打碎。生菟丝子三两晒。北细辛三钱晒。生黄 皮一两五钱晒。蜜
水炙麻黄三钱。桂枝粗木七钱晒。生于术米泔水浸晒干三两。茯苓三两晒。炙黑甘草五钱炒
黄。半夏一两五钱。杏霜一两五钱。橘红一两晒。为末。用苡仁煮浆糊丸。后隔数年。已六
旬余。换丸方用熟地四两水煮。归身一两五钱。制半夏炒黄一两半。云苓三两。橘红晒一两
炙黑甘草五钱。生台术三两米泔水浸生用。嫩毛鹿角一两五钱。蛤蚧两对去头足炙。熟附
子七钱。淮牛膝一两四钱。生左牡蛎二两研细水飞。羊脊骨三两炙黄打碎。杏仁三两去皮尖
油。北细辛三钱晒。泽泻一两五钱炒。为末。苡仁煮浆捣丸。以上诸方。摄纳肾阳。温通督
脉。疏刷肺气。开豁浊痰。标本悉能照顾。巧更极矣。宜乎服之而宿疾全瘳也。
Zhu Danxi treated a patient. He suffered from wheezing (asthma) and could not lie down. The lung pulse was deep and choppy (Chen Se). This was due to external wind-cold-dampness obstructing internal heat, preventing it from dispersing. Huangqin (Scutellariae Radix), Chenpi (Citri Reticulatae Pericarpium), and Mutong (Akebiae Caulis) were each used in 1.5 qian; Suye (Perillae Folium), Mahuang (Ephedrae Herba), and Guizhi (Cinnamomi Ramulus) were each used in 1 qian; Shengjiang (Zingiberis Rhizoma Recens) and Huanglian (Coptidis Rhizoma) were each used in 0.5 qian; Gancao (Glycyrrhizae Radix et Rhizoma) was used in 0.2 qian. After taking several doses of the decoction, he recovered.
He also treated the wife of Wu Hui, who had swollen feet during pregnancy. In early July, two days after childbirth, she developed wheezing immediately after bathing. She could only sit and could not lie down for five months. She felt aversion to cold, which was slightly relieved by warmth. The pulses at both Guan positions were rapid and moving, while the Cun and Chi positions were empty and deficient. Various medicines had been ineffective. Zhu Danxi prescribed Mudanpi (Moutan Cortex), Taoren (Persicae Semen), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Ganjiang (Zingiberis Rhizoma), Wubeizi (Schisandrae Fructus), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Sangpiba (Mori Cortex), Zisu (Perillae Folium), and Gualoushi (Trichosanthis Fructus). After one dose, she felt relief; after three doses, she could lie down, and the illness vanished as if it had never existed. This was because it was treated as cold invasion complicated by blood stasis.
Yu Zhen commented: For the first case, Dingchuan Tang (Calming Wheezing Decoction) would have been appropriate. This prescription was not quite suitable, as Huanglian (Coptidis Rhizoma) does not match the deep and choppy pulse. The second case's medication seemed chaotic but matched the condition perfectly, leaving nothing to criticize. Zhu Danxi had another case where body pain and wheezing occurred simultaneously, which is recorded under the Gout section and can be read together.
Wang Shishan treated a man who was fat with a pale complexion, nearing sixty years old. His phlegm-wheezing sounded like a sawing motion, and he could not lie down at night. Wang diagnosed his pulse as floating and surging (Hong), with occasional knotted beats (Jie) among six or seven beats per respiration. He said, "In wheezing diseases, a surging pulse indicates treatability. A knotted pulse is caused by phlegm obstructing the meridians." He recommended Shengmai San (Pulse-Generating Powder) with added Zhuli (Bamboo Sap). After taking more than ten doses, the condition stabilized somewhat. The patient, dissatisfied with the slow progress, consulted another doctor who prescribed San'ao Tang (Three Unbinding Decoction) and Wu'ao Tang. The condition gradually became critical. They then returned to the previous formula. After taking thirty to forty doses, the illness disappeared completely.
He also treated a woman over fifty years old who had a chronic cough. Suddenly, one day she experienced severe wheezing, expectorating phlegm like a spring, sweating profusely like oil, with a floating and surging pulse, resembling a state of impending death. He ordered her to take one dose of Shengmai San (Pulse-Generating Powder) immediately. The wheezing stopped, and sweating ceased. After three doses, the phlegm decreased gradually. He then added Gualoushi (Trichosanthis Fructus), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix) to the previous formula. After twenty doses, she recovered.
Another patient, over sixty years old, suffered from wheezing. Wang diagnosed his pulse as extremely fine and thread-like, like a spider's silk. He said, "The patient will die before tonight." Indeed, he died as predicted.
Yu Zhen commented: In Wang Shishan's three cases, a surging pulse indicated treatability, while a minute and fine pulse indicated untreatability. This distinction should be noted.
Another patient was tall, with a dark and thin complexion, aged forty. Every autumn when the weather cooled, he suffered from phlegm-cough and wheezing, unable to lie down. He recovered when spring warmed up. He had suffered from this for many years. Doctors used Zisu (Perillae Folium), Bohe (Menthae Haplocalycis Herba), and Jingjie (Schizonepetae Spica) to release the exterior. They used Sangpiba (Mori Cortex), Shigao (Gypsum Fibrosum), and Banxia (Pinelliae Rhizoma) to clear the interior. Although symptoms temporarily improved, they soon recurred. Wang diagnosed his pulse as somewhat surging and slippery. He determined there was internal stagnant heat. When autumn cooled, the skin pores closed tightly, preventing internal heat from dissipating, thus triggering the illness. Internal heat was the root cause. Now, failing to treat the root, doctors merely used dispersing agents that weakened the exterior, making the patient less able to withstand wind and cold. Using agents to clear the interior consumed fluids, further increasing the stagnant heat. Therefore, he administered Sanbu Wan (Three Tonics Pill) with Dahuang (Rhei Radix et Rhizoma), Beimu (Fritillariae Cirrhosae Bulbus), and Gualou (Trichosanthis Fructus), made into pills. He also instructed the patient to take Guntan Wan (Rolling Phlegm Pill), forty pills, every year before Start of Autumn. The illness gradually subsided.
Another woman, fifty years old, had a fragile constitution. Every autumn and winter, she suffered from phlegm-cough and wheezing, spontaneous sweating, fatigue, nausea, and vomiting. Wang diagnosed her pulse as floating, moderate, and soft (Ru). He said, "Exterior deficiency fails to resist wind and cold, stirring up internal stagnant heat." He prescribed Renshen (Ginseng Radix) and [missing character, likely Huangqi] each in 3 qian, Maidong (Ophiopogonis Tuber) and Baizhu (Atractylodis Macrocephalae Rhizoma) each in 1 qian, Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), and Chenpi (Citri Reticulatae Pericarpium) each in 0.7 qian, Gancao (Glycyrrhizae Radix et Rhizoma) and Wubeizi (Schisandrae Fructus) each in 0.5 qian. After more than ten doses, she recovered. In the following autumn, she suffered from dysentery with abdominal pain and tenesmus. Her pulse was soft, fine, and slightly slippery. Wang said, "This is internal stagnant heat attempting to move downward." Although her body was inherently weak, the Classic states: "If there is an excess pathogen, there will be no damage." He used Xiao Chengqi Tang (Minor Order the Qi Decoction) to purge twice or thrice. Abdominal pain slightly resolved, but tenesmus remained. He then prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Zhike (Aurantii Fructus), Huangqin (Scutellariae Radix), and Shaoyao (Paeoniae Radix). He also instructed her to sit on hot bricks soaked in vinegar, wrapped in cloth. She recovered.
Yu Zhen commented: Cases of wheezing and cough due to autumn cooling are common recently. If external cold binds internal heat, it is just one type of such syndrome. However, the differentiation between deficiency and excess is so distinct here. Therefore, one must differentiate based on the pulse to avoid errors.
Li Shicai treated the daughter of Song Jingfu. Her middle qi was inherently deficient, with poor appetite and mental fatigue. In early spring, she suddenly developed severe wheezing, fainting and losing consciousness. Her hands and feet were cold. Everyone believed she would die immediately. Li said, "Extreme qi deficiency causes the Metal (Lung) to lose its clarity and descending function. Without large doses of warming tonification, there is no hope." He prescribed Renshen (Ginseng Radix) in 1 liang, Ganjiang (Zingiberis Rhizoma) in 3 qian, Shufu Zi (Aconiti Lateralis Radix Praeparata) in 3 qian, and Baizhu (Atractylodis Macrocephalae Rhizoma) in 5 qian. She revived after one dose. Later, she took more than 7 jin of Renshen (Ginseng Radix) and 2 jin each of Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata). She fully recovered and did not relapse.
He also treated the daughter of Sun Fangqi, who suffered from chronic cough and wheezing. She had tried almost all formulas for regulating qi, resolving phlegm, clearing metal (lung), and descending fire, without effect. One day, her wheezing was severe with irritability. Li observed her eyes protruding and nostrils flaring. Her pulse was floating and large. It was undoubtedly Lung Distension. He administered Yuebi Jia Banxia Tang (Yuebi Decoction with Pinellia). Symptoms reduced after one dose and resolved after two. Li said, "Although cured now, do not rely on this. You must use Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) to tonify primordial qi and nourish the Metal, allowing the Lung's clarifying and descending functions to operate normally." Unfortunately, care was delayed for over a month, and no tonification was performed. The disease recurred and became incurable.
Gu Minghua, a scholar, suffered from asthma and cough for ten years with no response to various medicines. Li palpated his Cun positions on both wrists as rapid and choppy. Li said, "Choppy indicates that phlegm-fire, wind, and cold have lodged deeply for a long time, rooted firmly." He advised tonification for over a month, followed by emetic and purgative therapies. Within half a year, he underwent emesis and purgation ten times and took over a hundred doses of tonics. He recovered. He then took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) made into pills, added with Ji Dan Qiu Shi (Chicken Egg Calcareous Concretion). After taking it for about a year, he never relapsed.
Yu Zhen commented: Li Shicai's three cases utilized large-dose warming tonification, exterior-releasing and phlegm-resolving methods, and emetic-purgative methods interspersed with tonification. These three approaches stood firm like a tripod, treating diseases without bias.
Sun Dongsu treated Ling Yiquan, Vice Minister, who was nearly eighty years old. He had a history of phlegm-fire. In early January, due to labor and catching a cold, he developed internal heat and cough. More than half of his sputum was blood. His nose ran clear fluid. His tongue coating was scorched yellow with prickles. His speech was stiff and unclear. Urination and defecation were difficult. He wheezed severely, unable to sleep or lie supine. He placed pillows on a high table and rested his forehead on them daily. Doctors treated him for half a month without improvement. Sun diagnosed his pulses as floating and surging on both wrists, with slippery and large, forceful pulses at both Guan positions. He knew there was accumulated heat and phlegm-fire internally, blocked by wind pathogens, exacerbated by anger, causing blood to rebel upward. Critics feared the red sputum, large pulse, and fever in an elderly patient. Sun said, "This is an excess syndrome. The physicians assumed yin deficiency and used yin-nourishing and fire-descending herbs, hence no improvement." The method should be to first drive out the middle jiao phlegm-fire and accumulated heat, then use Rehmannia blood-tonifying formulas to conclude treatment. He prescribed Gualou (Trichosanthis Fructus) and Shigao (Gypsum Fibrosum) each in 3 qian, Banxiaqu (Prepared Pinelliae Rhizoma), Juhong (Tangerine Peel), Sangpiba (Mori Cortex), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Jiu Huangqin (Wine-fried Scutellariae Radix), and Suzi (Perillae Fructus) decocted in water. He mixed in a small cup of Laifu Zhi (Radish Juice). After one dose, bleeding stopped. The next day, his pulse was still floating and surging-large, and he still had aversion to cold. This was because the exterior was not released initially, and yin-nourishing herbs were used directly, compounded by the rapid downward action of Tongbian (Child's Urine), causing wind-cold to stagnate and disperse poorly, thus intensifying the heat. He changed to Dingchuan Tang (Calming Wheezing Decoction). After one dose, wheezing reduced; after two doses, fever subsided, and aversion to cold disappeared. On re-examination, the floating quality of the pulses on both wrists was gone, but the Guan pulses beat forcefully against the fingers. This indicated stubborn phlegm accumulation in the middle jiao, which needed to be guided out according to the timing. He administered Qingzhong Wan (Clear the Middle Pill) combined with Danggui Longhui Wan (Angelica and Picrasma Pill), totaling 2 qian. That night, he passed a large amount of thick, sticky, foul stool. I recalled Zhu Danxi saying: "For asthma with excessive fire, Baihu Tang (White Tiger Decoction) plus Huanglian (Coptidis Rhizoma) and Zhishi (Aurantii Fructus Immaturus) is effective." This precisely matches this case. He gave ten doses. Externally, he used Qingzhong Wan (Clear the Middle Pill) and Shuangyu Wan (Double Jade Pill) taken at night for conditioning. The patient recovered.
Yu Zhen commented: This patient, of noble status and nearly eighty years old, unable to lie down for half a month, was in a perilous state. Yet, heavy doses of phlegm-resolving, exterior-releasing, fire-clearing, and stagnation-moving herbs achieved success. This shows that diseases have no fixed patterns. One must fear discarding viable treatments for fatal ones, or misidentifying viable conditions. Insisting on half-attack half-tonify or non-attack non-tonify methods as cautious measures remains a fatal error. The subsequent case by Yu Jiayan using 20 Gejie (Geckos) and 10 liang of Renshen (Ginseng Radix) was a worthy match.
Yu Jiayan treated Shi Meicang suffering from Lung萎 (Lung Atrophy) with wheezing and cough. He expectorated clear phlegm. His limbs were atrophic and weak, unable to move. His pulse was deficient and rapid. He prescribed 20 Gejie (Gekkonis Squama) soaked in wine and roasted with butter, along with 10 liang each of Renshen (Ginseng Radix) and Heishen (Polygonati Odorati Rhizoma). Made into honey pills, they were held in the mouth frequently. He recovered before finishing the course.
Sun Qibo suffered from Lung Distension. Having taken too many qi-consuming medicines, Zhang Luyu diagnosed him. His pulse was floating and large, but hollow upon heavy pressure. He could not eat. Fortunately, his urine was clear and stool firm. Zhang administered Jufang Qiqi Tang (Bureau Formula Seven Qi Decoction). Each dose contained 3 qian of Renshen (Ginseng Radix), 1 qian each of Rougui (Cinnamomi Cortex), Banxiaqu (Prepared Pinelliae Rhizoma), and Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), and 4 slices of Shengjiang (Zingiberis Rhizoma Recens). He recovered after four doses. Most cases of Lung Distension are excess syndromes. However, this pulse was deficient and large, so it should not be judged by ordinary standards.
He also treated a nun with Lung Distension. She wheezed audibly and raised her shoulders to breathe. Medicines for descending qi and stopping cough were ineffective. Gradually, her chest and abdomen became distended. Her pulse at the Qi Kou position was string-taut, fine, and choppy. This was certainly due to physical exertion and anger, combined with accidentally drinking cold water injuring the Lung, causing the Lung qi to fail to converge. He administered Yuebi Tang (Yuebi Decoction) with reduced Mahuang (Ephedrae Herba), adding Xixin (Asari Radix et Rhizoma) and Tingli (Lepidii Semen). This strongly drained Lung qi, and she recovered.
Yu Zhen commented: The modifications to this formula were most ingenious. The use of the complete Jufang Qiqi Tang (Bureau Formula Seven Qi Decoction) in the previous case was also clever. Observing their analysis of the pulse and tracing the cause, and their careful consideration, reveals their ingenuity.
A friend of mine, Mr. Fan, in my county, had suffered from asthma for a long time. He had previously used Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill), with intermittent efficacy. Mr. Miao Songxin from Wu Men diagnosed him, saying: "Hidden fluid retention has occupied the interior for years, clearly indicating yang deficiency and turbid flooding. However, having persisted for a long time, beyond age fifty, blood spots appeared in the phlegm, indicating gradual injury to the yin aspect. It is difficult to decide whether to use overly rigid or overly soft medications." Following the intent of Jinshui Liu Jun Jian (Metal and Water Six Gentlemen Decoction), he used Shudihuang Tan (Charred Prepared Rehmanniae Radix) in 4 qian, Danggui Tan (Charred Angelicae Sinensis Radix) in 1 qian, Fuling (Poria) in 3 qian, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) in 4 fen, Chuanbei (Fritillariae Cirrhosae Bulbus) in 1.5 qian, Qingyan (Halituss Glaucophyllae Fructus) and Chenpi (Citri Reticulatae Pericarpium) each in 1 qian, Dancai (Mytili Edulis Corpus) washed in 3 qian, and Xingren (Armeniacae Semen Amarum) in 3 qian, peeled, tipped removed, and stir-fried with salt water. After half a month, on re-examination, he was instructed to take Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) in the morning to treat the root, and Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) with modifications in the evening to treat the branch. Raw Baizhu (Atractylodis Macrocephalae Rhizoma) soaked in rice wash, sliced, and dried in 3 liang, Coarse Guizhi (Cinnamomi Ramulus) dried in 8 qian, Stir-fried Banxia (Pinelliae Rhizoma) in 2 liang, Yunling (Poria) in 3 liang, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) in 6 qian, Xingren Frost (Armeniacae Semen Amarum powder) in 1.6 liang, Deer spine bone in 3 liang. Decoct Mahuang (Ephedrae Herba) in 4 qian in water, add Zhibei Xixin (Prepared Asari Radix et Rhizoma) dried in 3 qian. Make pills with water. This patient always had cold intolerance in the back, which worsened into asthma attacks. Taking this formula eliminated cold intolerance. Three years later, he suddenly developed strangury with turbid urine and painful swelling in the penis. Mr. Miao said, "This is a new disease. Clearing Fire (Bing) to expel Water (Ren) is the correct treatment. However, since he has chronic phlegm-fluid retention, cloying and moistening products injure yang and assist dampness, which is ultimately unsuitable. We must change the treatment method to avoid interfering with the original condition." He prescribed Yangjigu (Sheep Spine Bone) in 5 qian, Xia Mutong (Akebiae Caulis) in 1 qian, Huangbai (Phellodendri Cortex) stir-fried with salt water until yellow in 3 fen, Sheng Gancao Shao (Tip of Raw Glycyrrhizae Radix et Rhizoma) in 5 fen, Chi Fuling (Red Poria) and Bai Fuling (White Poria) each in 1.5 qian, Shui Fei Zhensha (Water-triturated Cinnabar) in 5 fen. Mix and take. Strangury healed after three doses. Half a year later, he revised the pill formula, stating: "Fluid retention occupying the middle jiao has lasted for years. The previous formula primarily warmed the Taiyang and Han Shui organs, which aligned well with the pathology. No need to change the medication. However, the urethral spermuria has existed for a long time. Although attributed to insecure Kidney qi, excessive descent and insufficient ascent are also inappropriate. Now, creating a formula to address both." He prescribed Nen Mao Lujiao (Young Velvet Antler) shaved in 2 liang, Yangjigu (Sheep Spine Bone) roasted yellow and crushed in 3 liang, Sheng Tusizi (Dodder Seed) dried in 3 liang, Bei Xixin (Asari Radix et Rhizoma) dried in 3 qian, Sheng Huangqi Pi (Astragali Membranacei Cortex) dried in 1.5 liang, Mi Shui Zhi Mahuang (Honey-water fried Ephedrae Herba) in 3 qian, Guizhi Cu Mu (Coarse Cinnamomi Ramulus) dried in 7 qian, Sheng Baizhu (Raw Atractylodis Macrocephalae Rhizoma) soaked in rice wash, dried in 3 liang, Fuling (Poria) dried in 3 liang, Zhei Hei Gancao (Roasted Black Glycyrrhizae Radix et Rhizoma) stir-fried yellow in 5 qian, Banxia (Pinelliae Rhizoma) in 1.5 liang, Xingshuang (Armeniacae Semen Amarum powder) in 1.5 liang, Juhong (Tangerine Peel) dried in 1 liang. Make powder, use Yiiren (Coix Seed) paste to make pills. Years later, when he was over sixty, he changed the pill formula again: Shudihuang (Prepared Rehmanniae Radix) boiled in water in 4 liang, Danggui Shen (Angelicae Sinensis Radix tip) in 1.5 liang, Zhi Banxia (Processed Pinelliae Rhizoma) stir-fried yellow in 1.5 liang, Yunling (Poria) in 3 liang, Juhong (Tangerine Peel) dried in 1 liang, Zhei Hei Gancao (Roasted Black Glycyrrhizae Radix et Rhizoma) in 5 qian, Sheng Taizhu (Raw Atractylodis Rhizoma) soaked in rice wash in 3 liang, Nen Mao Lujiao (Young Velvet Antler) in 1.5 liang, Gejie (Gekkonis Squama) two pairs, head and feet removed, roasted, Shufu Zi (Aconiti Lateralis Radix Praeparata) in 7 qian, Huai Niuxi (Achyranthis Bidentatae Radix) in 1.4 liang, Sheng Zuomuli (Raw Oyster Shell) ground fine and water-triturated in 2 liang, Yangjigu (Sheep Spine Bone) roasted yellow and crushed in 3 liang, Xingren (Armeniacae Semen Amarum) peeled, tips removed, oil extracted in 3 liang, Bei Xixin (Asari Radix et Rhizoma) dried in 3 qian, Zexie (Alismatis Rhizoma) stir-fried in 1.5 liang. Make powder, use Yiiren (Coix Seed) paste to crush and make pills. All these formulas grasped Kidney yang, warmed and unblocked the Du Mai (Governing Vessel), ventilated Lung qi, and cleared turbid phlegm. Both root and branch were attended to. The ingenuity was extreme. It is no wonder that taking them completely cured the chronic disease.