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Luo Qianfu treated the wife of Transport Commissioner Zhao. She was nearly sixty years old. In March, she suffered from cold pain in the umbilical and abdominal regions, radiating to the hypochondrium, unbearable in intensity, with repeated restlessness and inability to lie down comfortably. First, Zhongting (CV10) acupoint was moxibusted. This point is located 1.6 cun below Danzhong (CV17) in the depression, where the Qi of the Ren Mai (Conception Vessel) emerges. Five moxa cones or fourteen to twenty-one cones were applied. Subsequently, Danggui Sini Tang (Cinnamon Twig Decoction with Angelica Root) was administered. The prescription consisted of: Danggui Wei (Tail of Angelica Sinensis Root) 7 fen, Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite Root), Huixiang (Fennel Fruit), Chaihu (Bupleurum Root) each 5 fen, Shaoyao (White Peony Root) 4 fen, Fuling (Poria), Yanhusuo (Corydalis Rhizome), Chuanlianzi (Sichuan Chinaberry Seed) each 3 fen, Zexie (Alisma Rhizome) 1 fen. After several doses, she recovered.

He also treated Huo'er Chiliedai's hernia qi. Symptoms included paroxysmal colic in the umbilical and abdominal regions, spasmodic contraction unbearable to endure, lumbar curvature preventing extension, slight relief upon applying hot compresses. The pulse was deep, small, and rapid. The *Nan Jing* states: "When the Ren Mai is diseased, men develop internal seven types of hernias," all caused by cold accumulation between the small intestine. Without potent hot-natured formulas, recovery would be impossible. Thus, Chenxiang (Agarwood), Fuzi (Prepared Aconite Root), Chuanwu (Chuanwu Rhizome), Paojiang (Prepared Ginger), Liangjiang (Galangal Rhizome), Huixiang (Fennel Fruit), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit) each 1 liang were processed into pills with vinegar, taken with rice soup. Named Chenxiang Guifu Wan (Agarwood and Aconite Pill). Taken twice daily. Intermittently, Tiantai Wuyao San (Tiantai Cyperus Powder) was given, one qian per dose, taken with hot wine infused with ginger slices. After taking these two medicines for ten days, he recovered.

Hua Boshi treated a woman suffering from cold hernia. Pain ascended from below the navel to the heart, accompanied by distension and attacking pain, with severe hypochondriac pain, vomiting, irritability, and loss of appetite. Both hands' pulses were deep, knotted, and irregular. This was due to cold in the Lower Jiao (Lower Burner). It was necessary to urgently attack the lower pathogen, not the upper. Moxibustion was applied to Zhangmen (LR13), Qihai (CV6), and Zhongwan (CV12). Yanhusuo (Corydalis Rhizome), Guizhi (Cinnamon Twig), Huajiao (Sichuan Pepper) were administered, assisted by aromatic herbs like Huixiang (Fennel Fruit) and Muxiang (Aucklandia Root), along with Fuling (Poria) and Qingpi (Aged Tangerine Peel). Every ten days, a warming and purgative pill was taken to disperse accumulated stagnation. It proved effective.

Yu Zhen commented: Although the first case mentions Ren Mai disease, the umbilical pain radiating to the hypochondrium actually involves the Jueyin Liver Meridian. Moxibusting Zhongting treats the Ren Mai, while Danggui Sini Tang treats the Liver disease. In the second case, both pulse and symptoms indicated cold, so purely hot-natured medicine was appropriate. However, the deep, small, and rapid pulse differs from deep, micro, fine, and soft; this indicates Cold Excess, not Cold Deficiency. The brilliance lay in using Tiantai Wuyao San to expel cold accumulation. Taking only one qian, especially with a better vehicle for administration, was excellent. The third case involved pain and distension with deep, knotted, irregular pulses, also indicating accumulated cold excess. However, inability to eat indicated Yuanqi (Original Qi) deficiency. Thus, moxibustion was extremely clever, as mugwort fire expels cold and strengthens Qi. Assisted by warming and unblocking medicines, and intermittently by warming and purgative medicines, the treatment strategy was orderly, truly a victorious army. The so-called warming and purgative pill was likely Tiantai Wuyao San, as it contains Muxiang, Huixiang, Wuyao, Liangjiang, Qingpi each 5 qian, Binglang (Areca Seed) 2 pieces, Badou (Croton Seed) 70 grains stir-fried with Chuanlianzi 10 pieces using bran, discarding the beans and keeping the chinaberries to utilize their nature while discarding their substance, similar to fire therapy that does not spread.

Zhu Danxi said: "In my youth, I consumed too many citrus fruits, forming phlegm-fluid retention under the right hypochondrium. I stopped eating them. One day, after strenuous mountain walking, hungry and thirsty, I ate oranges and taro. The orange stirred up old retention, and the taro further obstructed Qi. Immediately, the right testicle swelled, alternating chills and fever. Considering that Spleen and Lung govern the right side, the retained fluids and stagnant Qi sank downward, injuring the tendons of the Taiyin and Yangming meridians. The pathogen entered the scrotum, attaching to the testis causing swelling. Dai Hansheng said diseases are treated based on upper or lower location. Similarly, Wood Stagnation causing hernia, if in the lower part, cannot be treated with emesis; it must be guided out from below. However, I ponder: since diseases differ, can treatments be the same? Now, hunger and labor injured the Spleen, causing Spleen Qi to sink; it must be lifted. Then Stomach Qi will not sink further, and retention can move. Using purgatives might cause further sinking of Stomach Qi. First, take one or two doses of stomach-regulating medicine. The next morning, use 'Shenshi' (spirit-guiding) to direct Qi to the Lower Jiao, inducing retching upwards. When the movement of retention under the ribs reaches the Middle Jiao, induce vomiting. After vomiting, the swelling halves. Repeat vomiting the next morning. Afterward, harmonize Stomach Qi and unblock collaterals. Recovery in two to three days. This method is used for alcohol injury and water retention affecting the right side..."

Yu Zhen commented: This passage previously had two lines missing from *Mingyi Leian*, making the text disjointed and incomprehensible. Recording it fully from the original edition reveals the profound logic. The method of guiding Qi to the Lower Jiao and moving towards the hypochondrium is vastly safer than Dai Hansheng's emetic drugs. Reading *Jingyue Quanshu*, I recorded his father Shoufeng Gong's emetic method: usually upon waking at dawn, slowly swallowing air to induce belching to lift Qi. If Qi feels insufficient, swallow air to belch, lifting continuously until phlegm-saliva rises. If lips swell or throat hurts after vomiting, rinse and swallow cool water. Breakfast after vomiting excludes all flavors, consuming only light porridge to nourish clear Qi in the Stomach. From age forty, no alcohol was consumed; emesis performed two to three times monthly. From age sixty, once every month or half-month. Used for over forty years, becoming healthier with age. For any illness, regardless of exterior/interior or excess/deficiency, no medicine was taken; only one emetic session cured it immediately. Living past eighty, still able to climb mountains. Copying ancient texts by lamplight, I felt exhilarated. Dai Hansheng's Dusheng Chetiao Fang is far less gentle than this. Yet I ponder: Yangming Stomach Meridian flows downward normally; vomiting reverses this. Frequent vomiting should shorten life, yet it extends it. I dare not believe this.

A person drank water after an illness, suffering severe pain in the left testicle. Dadun (LR1) was moxibusted, and Yaomo Gao (Waist-Massaging Ointment) was massaged onto the scrotum up to Henggu (GB29), covered with warm cloth. Pain ceased immediately, and swelling subsided overnight.

Yu Zhen commented: This case lacks profound meaning, but the method is good and can be kept for reference.

Wang Shishan treated a man in his twenties who stood in water for a long time, overworking himself, resulting in hernia pain. During pain, lumps formed in the abdomen, rising and falling like rolling waves, causing severe pain. Pulses were thin, wiry, and slow, feeling rough upon pressure. He said: "This is a Blood disease." Consulting medical books, there are seven types of hernia, none suitable for purgation. Treatments mostly use warming and dispersing herbs, addressing Qi. Here, the method must change. Xiaochengqi Tang (Minor Order the Yang Decoction) plus Taoren (Peach Kernel) was used to purge. Pain vanished instantly. Three days later, it recurred worse. Light pulse was wiry and large; heavy pulse was scattered and rough. Puzzled, he asked about diet. The patient replied: "Only ate two eggs." Wang said: "I understand." Induced vomiting with fingers, expelled everything. Pain resolved.

A six-year-old boy had a scrotum swollen like a cup, penile skin smooth and blister-like. A doctor tried draining dampness and moving Qi without effect. Wang diagnosed pulses as soggy and slow. He said: "Slow and forceless pulses indicate Qi Deficiency. The Classic states: The Bladder is the mansion of fluids; only through Qi transformation can they exit. Qi deficiency fails to transform and expel. Yang-raising and Qi-tonifying is needed." Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, removing Danggui (Angelica Sinensis Root) and Chaihu (Bupleurum Root), adding Fuling (Poria) and Niuxi (Achyranthes Root). After two doses, the scrotum wrinkled and swelling reduced; after three doses, full recovery.

Yu Zhen commented: These two cases represent standard pulse-based diagnosis. The first diagnosed blood stasis via wiry-rough pulses; the second diagnosed Qi deficiency via soggy-slow pulses. Effectiveness relied on palpation. The first changed warming/dispersing to cold/purgative; the second removed Danggui/Chaihu, adding Fuling/Niuxi, showing scholarly depth. However, attributing the recurrence in the first case to two eggs is questionable. The pain relief was likely due to the emetic method.

Cibu Huang Xinyang Gong had chronic Spleen diarrhea, bloody stools, and foot pain. Six pulses were slippery and rapid. Jiuzhu Huanglian (Alcohol-boiled Coptis Rhizome) was used as the sovereign herb, assisted by Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). Diarrhea and bleeding stopped. Over a year later, he developed Hu Hernia (Intermittent Hernia), protruding from the scrotum during the day and retracting at night, with intermittent pain. Wu Xinso prescribed Huyan Wan (Tiger-Hiding Pill) and Huanshao Dan (Return to Youth Elixir), leading to recovery. Initially Heat in the Middle, later Cold in the Middle; despite opposite drug natures, both worked because chronic illness is treated via deficiency.

Yu Zhen commented: Mr. Ye stated that Dai Hansheng's methods originally included discussions on Huyan Wan, which later doctors discarded. This case shows later doctors did use it. The *Zhinan* section on hernia has few cases but many methods, rich in material and skillful in application, surpassing others. My fellow townsman Mr. Wan Fengjiang, a veteran幕府 official near seventy, suddenly suffered hernia. Checking ancient formulas, he strictly followed Sansheng Huixiang Wan (Three-Layer Fennel Pill) for a month, achieving full cure. This proves ancient formulas often have miraculous effects, not just Huyan Wan.

Yin Wenhui of Changzhou loved strong liquor, capable of drinking five jin. In May, entering Fujian, sudden floodwaters forced him to wade seven li. Severe abdominal pain ensued. Half a month later, the right testicle swelled to the size of a dou. Fujian doctors used Liver Meridian herbs, which were warming, with no result for half a year. He consulted Li Shicai. Li said: "Liquor addiction fills the interior with Damp-Heat; wading floods binds the exterior with Damp-Cold." Weiling Tang (Stomach-Poria Decoction) plus Zhizi (Gardenia Fruit), Huangbai (Phellodendron Bark), Zhike (Aurantium Fructus), Huixiang (Fennel Fruit) was prescribed. Ten doses slightly reduced symptoms. Made into pills, taken until fifteen jin total, resulting in complete recovery without recurrence.

Yu Zhen commented: Using Sansheng Huixiang Wan here would certainly be inappropriate. Li's analysis confirms medicine values flexibility. The subsequent case is also pure and exemplary.

Luoyuanbin, a scholar, suffered hernia for ten years, looking emaciated. Li Shicai examined him: a mass in the left hypochondrium, arm-sized, making gurgling sounds when held with a hot hand, even attacking the heart causing suffocation, revived only by hot vinegar fumigation. Li said: "This is what the Classics call Jue Hernia." Zhihe Danggui Sini Tang was used. After half a month, the mass gradually shrank. Huyuan Wan (Eight-Ingredient Pill) was taken intermittently for half a year without cessation. The mass completely disappeared without recurrence.

Lu Buanyuan treated the father of Chen Mengzhu. He caught cold in June at a Shandong inn, lingering ill. By February the next year, sudden acute pain in the lower abdomen and waist occurred. Holding the external kidneys tightly was required; loosening meant death. Lu said: "This is Small Intestine Fu disease. The Classic says: Small Intestine disease causes back and thigh pain radiating to the testicles." Qianghuo (Notopterygium Rhizome) entering the Taiyang Small Intestine meridian was used, assisted by Huangbai (Phellodendron Bark), Fuling (Poria), Rougui (Cinnamon Bark), etc., and the Weizhong (BL40) acupoint was scraped. Pain stopped immediately. Feet became weak. Lu said: "The cause was summer heat-cold; Taiyang pathogens remained unresolved, entering the Fu organ. Originally, cold pathogen trapped fire; it requires summer heat to fully activate blood vessels and expel pathogens." Indeed, in May when weather warmed, purple spots appeared on the body, sweating reached the feet, and health returned.

Yu Zhen commented: This case cites classics to prove pathology without forcing connections. Medication and scraping methods were excellent. Tracing the origin of weakness to the disease source was truly insightful...

Yu Jiayan treated Governor Hu Yongchong's father. A hernia in the lower abdomen, egg-shaped. After several attacks, it grew larger and longer, easily descending into the scrotum but difficult to return. Slight cold exposure triggered it. Relief required the cold gas in the mass to turn warm before shrinking. Otherwise, it felt like a bottle lying across the hips, half in the abdomen, half in the scrotum, hard as stone. Gas rushed into tendons around the waist, navel, front, and back, causing simultaneous distension. Attacking the Stomach caused severe vomiting; attacking the vertex caused tremors and aversion to cold. Yu said: "This is Earth Qi attacking upward. In the theory of Yuan, Hui, Yun, Shi, Xu and Hai are confused because Earth Qi mixes with Heaven." Large doses of Renshen (Ginseng Root), Fuzi (Prepared Aconite Root), Jiang (Ginger), Rougui (Cinnamon Bark) were used to urgently drive out Yin Qi. Loud sounds emerged from the anus, and immediate recovery occurred. Later, it recurred. Another doctor used Shiquan Dabu Tang (Complete Great Tonifying Decoction) for over twenty doses with no effect. Yu said: "For pregnant women with Shanghan, if Mahuang, Guizhi, Xiaoshi, Dahuang are unavoidable, adding Siwu Tang prevents harm to the fetus. Why would removing pathogenic masses require protecting them with Siwu Tang? Even Sijunzi Tang is too mild for such urgent matters. Only fierce herbs like Jiang, Rougui, Fuzi can subdue hidden Yin pathogens. But their harsh nature is unsuitable for daily use. During attacks, they cause dry mouth and bitter taste. Since the hard mass is far in the lower abdomen with no clear end date, treatment should involve making small pills of Jiang, Rougui, Fuzi, dried hard, then coating them with thick decoctions of Renshen and Baizhu. This way, the throat and Stomach perceive Renshen/Baizhu first, hiding the fierce herbs until they reach the mass site, where their potency is revealed, potentially breaking the hardness and nest."

Yu Zhen commented: Xichang's theory is plausible yet flawed. Coating fierce herbs with outer layers prevents irritation to the throat and esophagus. However, in the Stomach, digestion must occur for medicinal properties to reach the disease site. Undigested pills would pass into the intestines and be excreted. How could they dissolve only in the lower abdomen and hips? This theory originates from Lu Yuanying's method of wrapping Lizhong Wan in Zixue. But Zixue treats throat heat, and Lizhong treats Middle Jiao cold, assuming digestion occurs in the Middle Jiao. Hot medicine taken cold follows similar logic. Baitong Tang plus human urine and pig bile uses Yin herbs as guides due to Yin excess repelling Yang. Can this be cited as an outer-coat argument? Cinnabar and Qingdai coatings borrow color as guides for Heart and Liver meridians; do they escort medicine to these organs? Therefore, I abridged and recorded this saying.