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Administration of Qi-regulating herbs, taken concurrently with Spleen-tonifying herbs, led to recovery. This is because Heart Fire generates Spleen Earth; this case presents another perspective beyond the theory that "Mingmen Fire generates Spleen Earth."

Emperor Huizong of Song suffered from a Spleen disorder due to excessive consumption of ice. The imperial physicians were ineffective. Yang Jie was summoned and prescribed Dali Zhong Wan (Great Center Pill). The Emperor said, "I have taken it many times." Yang Jie replied, "The cause of the illness is eating ice. I request to decoct this medicine with ice, addressing the root cause of the disease." The patient recovered.

Yu Zhen's commentary: This offers yet another perspective beyond various treatment methods. Those who are insightful can draw inferences by analogy.

Li Shicai treated Zhang Zhonghui, a man from Fujian. He habitually indulged in alcohol and enjoyed eating melons and fruits. Suddenly, he suffered from severe diarrhea. All treatments using diuretic or damp-drying methods failed. Li palpated his six pulses as floating. Citing the classic saying, "Wind injury in Spring leads to undigested stool diarrhea in Summer," he used Ephedrae Herba (Mahuang) 3 qian, Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) 2 qian each, Licorice Root (Gancao) and Cimicifugae Rhizoma (Shengma) 1 qian each. The patient recovered after profuse sweating.

Yu Zhen's commentary: This follows the method of Dai Renli treating Zhao Mingzhi, adding Renshen and Baizhu for greater stability.

Miao Zhongchun stated: Zhuang Lianzhi from Jintan was robust and had a good appetite. In mid-summer, he suddenly developed diarrhea. Any medicinal porridge or vegetables felt like needles upon swallowing, causing burning pain throughout the abdomen. Gas rose first from the left, then the right, filling the abdomen, triggering an urgent need to defecate. Defecation was loud and voluminous, with the anus feeling like it was burning. Episodes followed one another without pause, requiring frequent trips to the toilet over a long period. The excrement was clear water filling the vessel, with white lipid floating on top. Food and medicine passed through undigested. Even during sleep, he experienced fecal incontinence. Physicians attributed it to food stagnation, summerheat, or cold invasion. Various medicines were administered ineffectively, like pouring water on stone. After about a month, his muscles wasted away, and he despaired. Upon examination, the pulse was surging, large, and rapid, indicating a heat-fire pathology. Prescription: Coptidis Rhizoma (Huanglian) 3 qian, Paeoniae Radix Alba (Baishao) 5 qian, Poria (Fuling), Dolichos Semen (Bian Dou), Dendrobii Caulis (Shihu), Plantaginis Seed (Cheqianzi) 3 qian each, Citri Reticulatae Pericarpium (Juhong) 2 qian, Roasted Licorice Root (Zhi Gancao) 1 qian. The decoction was cooled with well water, and one cup of child's urine was added. Upon ingestion, it felt like drinking peppermint juice, cooling the Heart and Spleen. The abdominal burning ceased immediately. He slept until dawn, and the watery diarrhea stopped. After three doses, stools solidified. Previously, warm foods aggravated the condition, while cold foods provided relief. Later, nausea and aversion to cold appeared, so the prescription was changed to warm natured herbs, bringing comfort. I stated, "This indicates the retreat of fire." Added to the previous formula: Ginseng Radix et Rhizoma (Renshen) 2.5 qian, Astragali Radix (Huangqi) 3 qian, Nelumbinis Semen (Lianrou) 40 grains, Red Fermented Rice (Hongqu) 1.5 qian, Cimicifugae Rhizoma (Shengma) 0.5 qian, Huanglian halved. After five to six doses, Shengma was removed. After thirty more doses, diarrhea ceased. However, Spleen Qi remained weak, lacking appetite, and slight tea intake caused intestinal distension and tearing pain. I explained, "Severe diarrhea depletes Yin. Tonification is required. Blindly using aromatic-dry herbs for temporary relief would damage Yuan Qi, leading to fatal abdominal distension." A pill formula was prescribed: Rehmanniae Radix Preparata (Shu Dihuang) 8 liang, Corni Fructus (Yurou), Dioscoreae Rhizoma (Shanyao), Renshen, Huangqi 5 liang each, Achyranthis Bidentatae Radix (Niuxi), Schisandrae Fructus (Wuweizi), Baishao 6 liang each, Zhi Gancao 1 liang, Human Placenta (Ziheche) 2 units. Honey pills taken fasting. Concurrently, the decoction was continued. Trusting me completely, he adhered to these formulas for nearly three years. His Spleen and Stomach function recovered, appetite returned, and body mass increased. After recovery, I advised abstinence from sexual activity for over a year. While visiting his wife's family, he uncovered a conspiracy, revealing that the acute diarrhea was caused by Crotonis Fructus (Badou) toxicity. Materia Medica states Huanglian with cold water resolves Badou toxicity. My formula coincidentally matched this. Had standard treatments for stagnation, cold, or summerheat been used, the error would be immense. Even if diagnosed as heat, contemporary doctors used only 0.7-1 qian of Huanglian. Who would dare use 4 qian for a month-long diarrhea suspected to be deficiency-cold? This demonstrates the importance of divine insight in pulse diagnosis and treatment.

[Appendix] Miao Zhongchun said: After stopping the diarrhea, I feared Yuan Qi sinking and used Shengma to lift it, unaware of the toxicity. Premature use of Shengma caused turbid Qi to mix in the Upper Jiao, resulting in indescribable chest discomfort, resembling burning or palpitations. Spicy-warm foods exacerbated the suffering. Zhuang Yisheng suggested: Since the pathology is in the Upper Jiao and liquids pass through quickly, decoctions may be ineffective. Use Qinhua Wan (Holding-and-Melting Pill): Fritillariae Bulbus (Beimu) 5 qian, Sophorae Flavescentis Radix (Kushen) 1 liang, Menthae Haplocalycis Folium (Longnao Bohe) 2 qian, Aquilariae Lignum Resinatum (Chenxiang) 4 qian, Renshen 5 qian. Powdered, honey-pilled. Hold one pill after lunch and before bed. After four pills, a sensation of downward movement occurred, curing three years of suffering overnight.

Yu Zhen's commentary: Using cold medicine cold initially was achievable. However, treating extreme distension and loss of appetite with Shu Dihuang, Yurou, Renshen, Huangqi, Wuweizi, and Ziheche instead of Liujunzi Tang or Wupi Tang was exceptional. Zhuang Yisheng's Qinhua Wan was also difficult to match.

Sun Yikui treated Lady Wu Yonglan, wife of the magistrate of Lishui. Every pre-dawn hour (Wugeng), she belched and then defecated. Her abdomen was often distended and occasionally painful. Pulses at Cun and Guan on both hands were surging and slippery; Chi pulses were deep and hidden. Sun diagnosed food stagnation and phlegm-fluid retention in the intestines and stomach. He prescribed Zongguan Wan 3 qian, taken with Ginger Decoction. Bowel movements improved but were not smooth. Shenhou Xianglian Wan was added for regulation. External/adjunctive use of Talcum (Huashi), Licorice Root (Gancao), Aucklandiae Radix (Muxiang), Aurantii Fructus (Zhike), Crataegi Fructus (Shanzha), Citri Reticulatae Pericarpium (Chenpi), Baishao, and Wine-processed Coptidis Rhizoma (Jiu Lian) resolved the issue.

Wu Jiuyi suffered morning abdominal pain and diarrhea for half a year. Stools were green, abdomen distended. Diagnosed as Spleen-Kidney diarrhea. Moxibustion on Guanyuan (CV4) 30 moxibuns and Spleen-Kidney tonics failed. He knew medicine himself, noting absence of Cun/Guan pulses, only deep-slippery Guan pulses, fearing pulse extinction from chronic diarrhea. Dongsu (Sun Yikui) diagnosed Middle Jiao food-stagnation-phlegm diarrhea. The accumulation hides the pulses. Purging is needed; tonification is wrong. The patient feared purgatives. Sun cited Suwen: "If there is a pathogen, there is no harm [to the healthy Qi]." Delaying treatment weakens Yuan Qi further. He prescribed Baohe Wan 2 qian plus Beijji Wan 3 pills at Wugeng. By Si hour, half a bucket of thick accumulation was expelled, relieving pain. Pulses returned the next day. Regulation with Dongyuan Muxiang Huazhi Wan completed the cure.

Yu Zhen's commentary: Both cases employ "Treat obstruction with unblocking" (Tong Yin Tong Yong). Zongguan Wan + Shenhou Xianglian Wan is one approach; Baohe Wan + Beijji Wan is another. Careful syndrome differentiation is key. Neither used Renshen/Baizhu for regulation; the second case used Muxiang Huazhi Wan, showing mastery within principles.

Yu Jiayan treated Chen Yanzhi's dysentery. History of intestinal wind bleeding for 30 years. Obese and healthy until sudden massive hematochezia in winter due to worry and depression damaging Liver and Spleen. By spring, blood exhausted, followed by dust-like water, then intestinal mucus. Food passed straight through like an arrow. Rectal prolapse of 3-5 cun. Dysentery >20 times/day. Edematous face, dry lips/mouth/nose. Prognosis: terminal. Yu identified five signs of treatability: 1. Eyes still bright (Upper Jiao Yin intact despite Lower Jiao Yin loss). 2. Sweating rare, hallucinations rare (Spleen Yang lost, other Yangs intact). 3. Stomach accepts small amounts of food, no vomiting (Organs not severed). 4. Sleep possible, no fever (Yang not hyperactive). 5. Pulse weak but responsive to stimulation (Constitution strong). Pathology: Spleen damaged, Yang trapped in Yin, hot air escaping anus like burning. Survival depends on restoring Spleen Yang. Treatment: First, Renshen Tang with Chishizhi powder to stabilize. Then, pills of Renshen, Baizhu, Chishizhi, and Yuyuliang. Full recovery.

Vice Minister Li Pingcha had strict dietary habits. After defecation, he experienced periodic chills and fever, resembling exterior syndrome. Actually, it was interior injury from straining during constipation, causing Yin to invade Yang (chills) then Yang to overcome Yin (fever). Previous treatment for exterior syndrome failed. Misdiagnosed as damp-heat, treated with slippery/diuretic herbs, transforming constipation into intestinal discharge (Chang Pi). Urgent, burning defecation. More diuretics (Huashi, Mutong, Fuling, etc.) were used, worsening Yin deficiency and fluid depletion. Food passed through rapidly. Large doses of Renshen caused upper congestion due to lower emptiness. Chest discomfort, phlegm obstruction, dry mouth/throat, insomnia. Only light/bland foods tolerated. Chronic diarrhea injured Yin; sweating injured Yang. Cun pulses floating/empty (Yang floating up); Guan/Chi pulses fine/weak (Yin sinking down). Yin and Yang disconnected. Proposal: Sijunzi Tang (Four Gentlemen Decoction) as base for Spleen/Stomach. Remove Fuling (too draining). Add Corni Fructus (Yurou) to secure Liver Qi, Wuweizi to secure Kidney Qi, Chaenomelis Fructus (Mu Gua) to secure Stomach Qi, Baishao to secure Spleen/Zang Qi. Combined with Renshen/Baizhu tonification, Gancao moderation, and Shengma lifting. This gathers scattered Qi centrally. Prevents upper pulse excess, borborygmus, profuse discharge, and anal burning. Emphasizes securing scattered Qi. Heavy dosage decoction concentrated into paste, mixed with Yuyuliang and Chishizhi powders, taken frequently and slowly. Ancient saying: Lower Jiao diseases require Yuyuliang and Chishizhi to fill emptiness and restore adhesion. Slippery stones caused injury; astringent stones cure it via sympathetic resonance.

Yu Zhen's commentary: These cases use astringents to secure collapse, a traditional method for chronic dysentery. The second case uses heavy sour-astringents, a new method.

Zhou Shenzhai treated a man with periumbilical pain leading to diarrhea. Diagnosis: Spleen deficiency with Kidney Water flooding upward (Cold in Kidney). Treatment: Warm Kidney to stop water flooding; raise Stomach Qi to strengthen Earth and stop pain. Formula: Angelicae Dahuricae Radix (Baizhi) 7 qian, Northern Schisandra (Bei Wei), Deer Antler (Lurong), Renshen, Prepared Ginger (Pao Jiang) 1 liang each. Pill made with millet paste, taken with warm water.

Yu Zhen's commentary: Concise statement, excellent formula. Ye Tianshi noted chronic diarrhea damages Kidney, reducing appetite and Yang function. Bashen Shenqi Wan draws Yang from Yin, yielding little effect. Formulas with Lurong, Renshen, Yangqishi, Fuling, Paofuzi, and Ganjiang are superior...