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Yu Zhen's commentary: The treatment method in this case is relatively simple and straightforward. However, the analysis of symptoms such as hoarseness (Guosheng Yin) and difficulty lying on one side offers profound insights. The patient recovered for six years but died from a relapse triggered by exertion and anger. This serves as a warning for those who fail to practice proper health preservation (Yangsheng).

Zhou Shenzhai treated a young woman presenting with hemoptysis (Xuetu) and fever (Fare). The fever was severe accompanied by asthma (Chuan). He prescribed Shengmai San (Generating the Pulse Powder), but the fever worsened. Her pulse became variable—sometimes large, sometimes small; sometimes tight, sometimes rapid; sometimes floating, sometimes choppy—changing unpredictably. Zhou diagnosed this as Spleen Yin deficiency causing the pulse to lose its regularity. The pulse is the residence of blood, and the Spleen governs blood. Due to blood depletion, the pulse changes erratically. He then prescribed Baoyuan Tang (Preserve the Origin Decoction), adding Northern Schisandra (Beiwei), Chinese Yam (Shanyao), Goji Berry (Gouqi), and Poria (Baifu). He heavily dosed Ginseng (Renshen) at 1.5 taels (approx. 50g). After two doses, there was improvement; after twenty doses, she was cured.

Yu Zhen's commentary: Diagnosing Spleen Yin deficiency as the cause of irregular pulses is another interpretation of erratic pulse patterns. The difficulty lies in the fact that the patient had hemoptysis, fever, and asthma, and the fever worsened after taking Shengmai San. This situation is similar to Zhang Yinguang’s case where asthma worsened after taking Bawei Wan (Eight-Ingredient Pill with Rehmannia), or the noblewoman’s case where Qi-jian (shortness of breath) worsened after taking Shendi Guben Wan (Ginseng and Rehmannia Root-Preserving Pill). Zhou attributed the pulse changes to Spleen blood depletion and thus avoided blood-tonifying herbs, opting instead for heavy doses of Ginseng. He did not doubt the efficacy of Shengmai San simply because the fever worsened; this requires both insight and mental fortitude.

Monk Shen Rou stated: Wang Shengzhi from Dantu, in his thirties, had all six pulses extremely rapid (nine beats per breath cycle). His external symptoms included coughing, facial redness, reluctance to speak, and fear of noise. He had been ill for a year and a half, having taken countless bitter-cold preparations previously. This indicates that True Qi is deficient while the pulse is rapid. The Classics state: "A rapid pulse indicates Yuan Qi deficiency" and "A rapid pulse indicates Spleen Qi deficiency." It also states: "A rapid pulse with heat belongs to deficiency." These are all signs of insufficiency. Among the six pulses, only the Spleen and Kidney pulses were surging and large. This is due to Lung Metal deficiency failing to generate Kidney Water. Theoretically, one should tonify Lung Metal to generate Kidney Water. When Water is abundant, it controls Fire; when Metal is strong, it generates Water; when Water is present, Wood is balanced; when Wood is balanced, Spleen Earth thrives, which in turn generates Metal. This is the correct treatment approach. He made an agreement with the patient: After 14-15 or more than 20 doses, sweating should occur, indicating the rise of Yang Qi and the unblocking of meridians. Following sweating, fatigue would last for 8-9 days or half a month, indicating the retreat of pathogenic factors and the weakness of healthy Qi. Or, after 10 days to half a month, Yuan Qi would gradually recover, and spirit would become clear and refreshed. Subsequently, using warm-tonifying formulas for the Spleen and Stomach might trigger phlegm movement, blood movement, swelling/toxids, or diarrhea. These phenomena should be allowed to proceed naturally, as they represent the expulsion of pathogenic qi from the zang-fu organs. Without prior explanation, patients might be alarmed by these varied transformations. Therefore, he prescribed formulas to tonify the Spleen, generate Lung Qi, and nourish Kidney Water. After 5-6 doses, the rapid pulse did not decrease, indicating True Yuan deficiency and dryness. He used the previous formula but administered only the second and third decoctions. Within less than 10 doses, the rapid pulse subsided. At this point, once the deficient fire receded, the Middle Qi became cold. He used Liujunzi Tang (Six Gentlemen Decoction) plus Ginger and Cinnamon Twig. After 5-6 doses, Spleen Qi moved, phlegm-fluids circulated, and settled in the waist and hypochondrium, causing severe pain in the Liver and Kidney regions. Where pathogenic factors gather, Qi must be deficient, further confirming Liver-Kidney deficiency. He advised external application of salt warming and internal administration of Erchen Tang (Two Aged Substances Decoction) plus Peach Kernel, Corydalis, and Coix Seed. After two doses, phlegm-blood was discharged from the Large Intestine, and pain ceased. He then used Liujunzi Tang plus White Peony Root and Schisandra to achieve a cure. If this principle were not explained in advance, one would be at a loss when lumbar and hypochondriac pain appeared.

Yu Zhen's commentary: Monk Shen Rou’s five books specialize in treating consumptive diseases (Xu Lao). His theory includes concepts of "Second Pass" and "Third Pass." His medication method involves discarding the first decoction and using the second and third. His differentiation of Yin/Yang and Cold/Heat differs from others, focusing specifically on warm-tonification, establishing his own school. This case reveals his tendency to innovate and assert superiority.

[Appendix] Ye Tianshi treated a 20-year-old man. In summer, he suffered from coughing with occasional blood, alternating chills and fever, reduced appetite, gradual emaciation, no thirst, occasional falls during movement, fluctuating severity day by day, bleeding gums, and thick bloody mucus on the gums in the morning. The pulse was fine and slightly rapid. Physicians treated it as a weak condition, trying various Yin-nourishing drugs like Dihuang (Rehmannia) and Donggu (Ophiopogon) without effect. Ye Tianshi used Reed Rhizome, Talcum, Apricot Seed, Coix Seed, Thunberg Fritillary Stem, Uncaria, and White Cardamom. He instructed: "Take 20 doses for a complete cure. If fewer than 20 doses, malaria will follow later." The patient took 10 doses and recovered completely, stopping medication for ten months. Indeed, malaria developed. He resumed the previous prescription, and the malaria resolved.

Yu Zhen's commentary: This is latent summerheat resembling consumptive disease, hence the prediction of subsequent malaria. Had Zhou Shenzhai or Monk Shen Rou treated this, their methods would likely have differed.

[Appendix] Tian Weng treated Lord Huang’s consumption case, stating: Generally, internal depletion of essence and blood constitutes Xu (deficiency); inability to self-recover constitutes Sun (damage). One must distinguish whether it originates from above or below, from Yin or Yang, to guide regulation. This illness began with alcohol consumption and mental overexertion, injuring Ying Qi first. Heart Yang descended, and Kidney Yin failed to contain and store. He frequently experienced nocturnal emissions. Last summer, he first had diarrhea, followed by malaria. Although influenced by summerheat, dampness, and heat pathogens, the gathering of pathogenic factors implies prior deficiency of root Qi. Blood adheres to collaterals; there are fifteen collaterals. Collateral injury causes blood extravasation, unable to be contained. This is due to extreme movement of Yang Qi without restraint, akin to hurricanes and waves. As Yang wind subsides, it will gradually slow. However, what has left is hard to retrieve. Thus, "when blood is lost, tonify Qi," as formless Qi can generate formed blood. One must rest the body and calm the mind, achieving Yin-Yang balance to ensure success. Medication should follow the vital energy of the four seasons. For occasional exterior pathogens, light prescriptions should be used briefly. During winter and spring, treatment followed this method. Entering summer, complexion and pulse stabilized, yet internal root Qi had not fully recovered. In late summer, Yang dissipates and Earth Qi rises, raising fears of relapse. Indeed, due to moldy dampness and sudden warmth stagnation, Qi in all vessels leaked, and blood in collaterals boiled violently. Sustained damage depleted Zang-Fu essence; the Eight Extraordinary Vessels lacked Qi support. Chong and Ren vessels rose from the front, causing cough, retching, and hot flashes. Qiao and Wei vessels lost protection; Du vessel lost authority. Blazing sun intensified, lipids daily diminished. Urgently protect the Great Qi to encompass and gather, gradually guiding and retracting, hoping to grasp the root. Secondly, harmonize the Middle Jiao to restore appetite and digestion. After 100 days of stability, reconsider. Cooling treatments for cough and harsh warm-tonics should be discarded. During hot weather, take Shengmai San in the afternoon. If loose stools or diarrhea occur, stop it. Take one Dan pill per dose. For residual symptoms, use Sangpiaoxiao San (Mantis Egg Case Powder). For digestive disharmony, use Yigong San (Extraordinary Merit Powder) plus stir-fried black Divine Qu and stir-fried black Malt. Si Junzi Tang (Four Gentlemen Decoction) and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) should be alternated.

Yu Zhen's commentary: Mr. Tian’s discussion is truly the highest wisdom for treating consumptive diseases. His formulas are the elixir of life for such conditions. Compared to those specializing solely in Yin-nourishment or Yang-tonification, his approach balances bias with correctness, differing vastly like heaven and earth.

Yu Jiayan treated the eldest daughter of Yang Jideng. She had amenorrhea for over a year, fever, poor appetite, emaciation, and excessive sweating, developing into consumption. Physicians saw excessive sweating and mistakenly diagnosed deficiency, prescribing Ginseng and Atractylodes, which worsened her condition. Yu Jiayan observed sweat flowing like steam from a steamer and said: "The curable aspect of this case lies entirely in the sweating. Since menstrual blood is internally blocked, there is only one pathway for exit through the skin pores, as sweat is also blood. If there were no sweat and blood did not flow, the skin and hair would become dry and brittle, leading to death. Use extremely bitter medicines to draw blood inward and connect downward to the Chong Mai (Penetrating Vessel), so heat will subside, menstruation will resume, and sweat will stop spontaneously. Tonics cannot achieve this." He prescribed Longhui Wan (Dragon Gallbladder Pill) three times daily. After over a month, she suddenly felt slight menstrual flow, and sweat/heat slightly eased. He reduced the dosage to once every other day. Another month later, heavy menstruation lasted five days, and all illnesses resolved.

Yu Zhen's commentary: This case demonstrates the highest insight and clever medication. Fortunately, she did not cough, and although her appetite was low, it was not severely reduced, allowing bitter-cold herbs to succeed. But was the pulse rapid? Large? Forceful? If the pulse were fine, rapid, and forceless, accompanied by loose stools and poor appetite, could this formula be used? Reflecting on cases of consumption seen throughout my life, most involve True Yin deficiency. Cases suitable for heavy bitter-cold herbs like this, or heavy warm-tonics like those used by Li Shicai for Mr. He and Ms. Feng, are rare. Even in *Lin Zheng Gao Zhi* (Guidelines for Clinical Practice), more than half involve Yin-filling, and equal amounts involve mild tonification combining Ginseng with Yin-nourishing herbs. Yin-filling with "products of flesh and blood" (organic substances) such as Placenta Gelatin, Donkey-Hide Gelatin, Tortoise and Deer Antler Gelatin, Sea Cucumber, Razor Clam gelatin, Pig and Sheep Spinal Marrow, Beef Leg Marrow, as well as Autumn Stone, Hair Charcoal, Milk Powder, Deer Penis, and Deer Tail, constitute the "bamboo broken, bamboo repairs" method. Gentle tonics include Cistanche, Goji, Raspberry, and Elk Antler. Cool-moistening herbs include Rehmannia, Ophiopogon, Scrophularia, Moutan, Privet Fruit, Pear Syrup, and Loquat Leaf Syrup. These are accessible to everyone. Combining them appropriately forms a prescription. However, effective results are likely rare. Yang deficiency is easy to treat; Yin exhaustion is difficult to cure. Like a potted plant with dry soil and withered roots, watering it with a spoonful of water daily cannot hope for survival. Only spiritual rain can revive it. Where does rain come from? Earth Qi rises to form clouds, then Heaven Qi descends as rain. The interaction of Heaven and Earth generates all things. In the human body, the Spleen and Stomach are the Earth. If Spleen-Stomach health is robust, appetite good, and digestion efficient, the essence of food and drink ascends to the Lungs, resembling clouds. The Lungs then irrigate the hundred vessels with their essence, resembling rain. Though this is old wisdom, it is the core principle of nourishing Yin. To ensure Spleen-Stomach robustness, Ginseng is paramount, yet one cannot rely solely on Ginseng. The subtleties of this mechanism are hard to exhaust in words.