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Hua Borén treated a patient who suffered from chest stuffiness and fullness, feeling restless and agitated with symptoms resembling palpitations (Xin Ji), dizziness and headache in the head and eyes, an urge to vomit without success, mental confusion and forgetfulness, and occasional hemiplegia of one arm. Upon pulse diagnosis, the pulse at the Guan position and above was slippery and flowing, while deep pressure revealed a sinking and forceful quality. Hua stated: "This is caused by stagnant fluid retention and phlegm obstruction, lying horizontally across the chest and diaphragm. It resulted from consuming rich flavors, strong wine, fatty foods, and roasted or fried items, leading to heat accumulation generating dampness. Dampness gathers, causing phlegm saliva and retained fluids to ascend excessively." Wang Bing said, "When pathology is excessive in the upper part and does not subside, one should use emesis to drain the excess." However, during winter, when the qi descends and sinks, this method cannot be employed. Thus, they waited until a clear spring day to induce vomiting with medicine. The patient vomited copiously, expelling three to four sheng of strange-colored, glue-like phlegm. After one or two days, it was repeated; after three or four times, the chest felt thoroughly clear and comfortable.

Yu Zhen commented: Identifying this disease as phlegm-fluid retention is within everyone's capability. However, pointing out that due to the descending nature of winter, emesis should not be used follows the established methods of the sages, which is extremely correct.

Sun Dongsu treated Chen Guanglu, Song Yi Weng, who often experienced chest and diaphragm distension and pain at dawn (Wu Geng). He tried various remedies for cold, heat, warmth, and coolness without effect. Pulse diagnosis showed a weak and soft Right Cun, a normal Left pulse, and weak both Chi positions. Sun said: "This is deficiency of the Lung and Kidney meridians. Tonifying and astringing them will ensure safety." He prescribed Ren Shen (Ginseng Radix et Rhizoma), Bu Gu Zhi (Psoraleae Fructus), and Shan Zhu Yu (Corni Fructus) each 3 liang; Lu Jiao Jiao (Colla Cornus Cervi) and Lu Jiao Shuang (Cervi Cornus Colla Residuum) 5 liang; Du Zhong (Eucommiae Cortex), Ba Ji Tian (Morindae Officinalis Radix), Fu Ling (Poria), and Che Qian Zi (Plantaginis Semen) each 1.5 liang; and Shan Yao (Dioscoreae Rhizoma) 2 liang. Lu Jiao Jiao was melted with wine and made into pills. Taken on an empty stomach with light salt water. Additionally, Yu Mi Ke (Pericarpium Papaveris Rubri) 3 liang, cleaned of membranes and stir-fried with honey; He Zi (Terminaliae Chebulae Fructus) baked in flour, pitted, 1 liang; and Chen Pi (Citri Reticulatae Pericarpium) 1.5 liang were made into honey pills. One qian was taken with warm water at dawn on the pillow. After one month of administration, the disease did not recur.

Yu Zhen commented: Pills of Ren Shen and Lu Jiao are still usable by people, but formulas containing Yu Mi Ke and He Zi are unimaginable. Compared to Chen Wutang's Qin Hua Wan (Lozenge Pill), they are like bear's paw and orangutan lip—each having its unique flavor.

Li Guyu noted that every time he ate, he had a bowel movement immediately afterward, with slight abdominal tightness and chest/diaphragm fullness. When doctors administered Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), the stuffiness worsened, and urination was clear and long. Li diagnosed the pulse: Left Cun was choppy (Se), Right Cun was slippery. Deep pressure felt like a soybean, distinct and drumming. Guan and Chi pulses were wiry and small. The Left Chi pulse was long and vigorous. Based on the pulse, there was accumulated phlegm stagnating in the Lung, unable to exit, causing insecurity of Large Intestine qi. The treatment should follow Danxi’s method for his uncle: use emesis to remove upper jiao phlegm accumulation, after which stool would naturally firm up. Initially, Jie Geng (Platycodonis Radix) and Lai Fu Zi (Radish Seed) 3 qian each; Bai Kou Ren (Cardamomi Rotundus Semen), Ju Hong (Citri Reticulatae Pericarpium), and Shan Zhi Ren (Gardeniae Semen) 1 qian each; Chuan Xiong (Ligustici Chuanxiong Rhizoma) 0.5 qian; Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices; and Cong Bai (Allii Fistulosi Bulbus) 3 stalks were decocted to induce vomiting. Unable to expel all, Lai Fu Zi 1 he was ground into paste with Jiang Shui (fermented rice liquid), mixed with honey, and half a bowl drunk, finally expelling two bowls of gelatinous phlegm. Previously, stool accompanied urine; after vomiting, urine could flow independently. After three or four such sessions, the chest and abdomen felt relaxed. Initially fearful of emesis, he now felt relieved and happy, and bowel movements became less frequent. Finally, Er Chen Tang (Two-Cured Decoction) was modified with Bai Zhu (Atractylodis Macrocephalae Rhizoma), Xuan Fu Hua (Inulae Flos), and Mai Ya (Hordei Fructus Germinatus) to regulate and restore health.

Yu Zhen commented: The Right Cun being slippery and forceful indicates lung phlegm accumulation; the Left Chi being long and vigorous indicates that emesis can be used without damaging healthy qi.

Zhang Jingyue treated a young man who drank alcohol regularly and often suffered from irregular meals. One day, after a meal, he experienced severe pain in the hypochondrium. Self-medicating with qi-regulating and stasis-resolving drugs failed. He then used emesis, expelling all food. Post-emesis, rebellious qi rose; although hypochondriac pain ceased, qi congested the chest and diaphragm, worsening distension and pain, accompanied by vomiting. Further use of stasis-breaking and qi-penetrating drugs stopped vomiting and pain, but a hard, tender mass formed under the left breast and rib cage. The umbilicus, abdomen, and diaphragm were blocked, preventing downward movement. At Xu, Hai, Zi, and Chou hours (9 PM–3 AM), distension became unbearable. Since vomiting had stopped, purgatives were considered. Drugs like Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas), San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), and Ba Dou (Crotonis Fructus), along with methods using Radish seeds, Mang Xiao, garlic, and orange leaves applied externally, were ineffective. Aggression only increased distension. Suspecting spleen qi injury, tonification seemed inappropriate. For over twenty days, no soup or water could enter. Desperate and awaiting death, manual massage was attempted. The patient pointed to a spot under the rib where pressing caused pain radiating to the chest and abdomen. Careful palpation located the Zhangmen (LR13) acupoint. Zhangmen is the Front-Mu point of the Spleen and the Hui-Meeting point of the Zang organs. The area below the breast and between ribs corresponds to the Xu Li large collateral, the pathway of Stomach qi, where qi connects to Zhangmen. Realizing the daily fluctuation indicated non-organic qi pathology rather than有形 (tangible) accumulation, and that pressing one area affected another confirming qi-level disease, fire therapy was chosen to disperse qi. Fourteen moxa cones were applied to Zhangmen (LR13), combined with Shen Xiang San (Divine Fragrance Powder) taken three to four times daily. Distension gradually subsided, and appetite improved, saving his life.

Yu Zhen commented: Moxibustion can supplement what emesis, purgation, and tonification cannot achieve, though results vary. Its efficacy here likely stems from the patient’s youth.

Chen Wutang stated: "My eldest son, Kui, previously suffered from spermatorrhea. In the winter of Ding Mao (Tianqi era), the condition worsened severely. Qi leaked from the kidney orifice like smoke, intermittently. Sleep and appetite decreased, body wasted, bones weakened, and stools were difficult, dark in color. Pig bile mixed with Da Huang (Rhei Radix et Rhizoma) and Zao Jiao (Gleditsiae Sinensis Spina) powder was used as an enema. Initially effective, clearing upper heat. By June of Wu Chen, however, enemas caused worse constipation. Recognizing that pig bile and Da Huang are bitter-cold, and Zao Jiao strips fat, seeking moisture led to dryness. Pig bile juice was removed, replaced with honey and warm water for enemas. Long-term use eventually eased defecation. By August of Wu Chen, he could not get out of bed. By May of Ji Si, muscles wasted further, sleep/appetite dropped, chest felt occupied, abdomen empty, upper body stuffy. Small amounts of food stayed lodged, belching occurred after 6-7 hours, breathing was obstructed. Thinking deficiency caused stagnation, Ren Shen (Ginseng Radix et Rhizoma) increased oppression. Thinking thick phlegm/blood stasis, resolving agents failed. He feared cold even in summer, covering heavily, yet had no fever or thirst. Voice was soft but clear, complexion white but not red or black. Ate only two bowls of porridge daily or fasted entirely. Friends expected imminent death, yet he survived two years. Famous doctors Gao Guozai and Sun Jianxin failed. Suzhou doctor Ke Qin (Ke Yubo) was invited. Ke spoke grandly, initially pleasing, but treatments failed. Recalling past history: Large Intestine qi control was lost, causing chest stuffiness. Excessive fear of epistaxis led to heavy use of child urine and yin-nourishing/clearing herbs, improving stool but leaving abdominal emptiness and unchanged chest stuffiness. More stool meant more chest stuffiness. Strategies to open upper and tonify lower were futile. Doctor Zhang Chengxi from Zhenjiang was summoned. After two consultations, Zhang said: 'For chronic male illness, assess prognosis via Tai Xi (KI3) and Chong Yang (ST42) pulses. Here, six positions show no danger; Tai Xi and Chong Yang have root. Death is unlikely.' This syndrome is called 'Lower Collapse' (Xia Tuo). If upper yang severs and yin cannot ascend to interact with yang, it is Lower Collapse (leaking qi from yin orifices). If lower yin severs and yang cannot descend to interact with yin, it is Upper Collapse (air from ears). Physicians attribute hemorrhage to 'erroneous vessel wandering,' unaware qi disorders also exhibit this. Kidney grasps qi; excessive draining causes deficiency, so kidney qi fails to grasp, wandering erratically. The Classic says: 'Intercourse after drunkenness/full meals causes five zang reversal.' Reversal refers to qi chaos. Without lifting qi back to its meridian, leakage continues. Leakage causes qi deficiency; lower qi deficiency leads to upper phlegm knotting, hindering digestion and causing stuffiness. Treatment should resolve stagnation, not mistakenly nourish yin. It requires lifting and lowering together for unblocking, not just moving qi. Mistaking this for yin deficiency and declaring consumptive disease untreatable is a major error. Yin deficiency generates internal heat; how could severe yin deficiency with a year-and-a-half bedridden state lack bone-steaming tidal fever? Yin-nourishing drugs are useless and hinder opening the chest and eating. Only by widening the diaphragm daily and increasing grain qi daily will yin nourish itself. Complexion will return soon. Decoction: Su Zi (Perillae Fructus), Shan Zha (Crataegi Fructus) 2 qian each; Ju Hong (Citri Reticulatae Pericarpium), Ban Xia Qu (Pinelliae Fermentatum) 1.5 qian each; Fu Ling (Poria), Wu Yao (Linderae Radix), Xiang Fu (Cyperi Rhizoma), Wu Gu Chong (Phallus Infundibuliformis) 1 qian each; Sheng Ma (Cimicifugae Rhizoma) 0.8 qian; Chai Hu (Bupleuri Radix) 0.4 qian. Add Leek Juice (Jiu Zhi) 2 spoons before taking. This formula focuses on resolving stagnation, using ascending and descending actions mutually, very refined. Twenty doses yielded little immediate effect, but compared to previous treatments that added symptoms, it was heaven and earth apart. In early autumn, Zhang left. I expanded his principle of resolving stagnation, creating my own Qin Hua Wan (Lozenge Pill): Ren Shen (Ginseng Radix et Rhizoma) 6 qian; Vine-processed Xiang Fu (Cyperi Rhizoma), Ju Hong (Citri Reticulatae Pericarpium) 4 qian each; Bei Mu (Fritillariae Cirrhosae Bulbus), Jie Geng (Platycodonis Radix) 3 qian each; Song Luo Cha (Tea) 2 qian; Bai Peng Sha (Borax), Xi Niu Huang (Bovis Calculus), Gan Chan (Toad Skin) calcined 1 qian each; Bo He Ye (Menthae Haplocalycis Folium) 0.3 qian. Steamed Wumei (Mume Fructus) 2 qian mashed, mixed with Zhu Li (Bambusae Caulis in Taenia) and Li Gao (Pyrus Sinkiangensis Fruit Juice) into pills. Each pill 1 qian. My chest lump originated from lying down after noon meals. Using lozenges ensured constant medicinal qi circulating between Lung and Stomach during sleep. As knots formed, medicine dispersed them; new knots didn't form, old ones dissolved. Treating a sleeping-induced ailment while sleeping. Since disease was above diaphragm, harsh decoctions or sinking pills were unsuitable; slow absorption via lozenges works cumulatively. After 60-70 pills, diaphragm widened. Doctors suspected qi sinking, fearing autumn exacerbation due to Metal's descending nature. I replied: Lung governs qi; when qi receives its command, descending descends, ascending ascends, fulfilling duties. It's not just descending. Clear ascending and turbid descending means qi-sinking disease should heal in late autumn. In August, accidental wheat flour ingestion led to taking Chen Xiang Wan (Aloes Wood Pill), suddenly expelling several sheng of gelatinous phlegm, instantly clearing chest. Likely medicine took effect, yuan qi returned, pathogen had no place, descending naturally. Though weak and emaciated, bedridden status persisted. End of winter, doctors feared spring Wood excess worsening Spleen disease. I said: Fear not. Spleen受制 by Liver fears Wood invasion. Now it is Spleen *stagnation*, not weakness. Winter closure aggravates stagnation; Spring Wood helps unblock. Later, fruit intake increased, skin gained luster. Five zang dynamics change thus. Clinging to standard generation/restriction cycles errs. In April of Geng Wu, Zhang returned: 'Gelatinous phlegm gone, disease root pulled. Bone weakness preventing standing is dampness lingering in Spleen meridian.' Prescribed Bai Zhu Decoction: Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 jin, Cang Zhu (Atractylodis Rhizoma) 4 liang, boiled into paste. Before finishing dose, he stood up. This rare, chronic illness took nearly 1000 days of treatment to fully recover, hence recorded in detail.

Yu Zhen commented: Mr. Chen, a scholar-official, discussed medical principles with profound depth. His Qin Hua Wan treatment was subtle and matched the pathology, surpassing even old physicians. Dr. Zhang Chengxi’s use of Bai Zhu Decoction, identifying bone weakness as Spleen dampness rather than Kidney deficiency, showed insight far superior to others.