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Li Dongyuan treated a patient. Aged 62. He had a chronic condition of Spleen-Stomach deficiency and damage. Eye diseases occurred frequently. His body, face, and eyes were all yellow. Urine was sometimes yellow and sometimes white. Bowel movements were irregular. Food intake decreased. Shortness of breath with rebellious Qi. Lethargy and desire to sleep. Limbs weak and unable to support the body. In June, his eye disease recurred. The physician administered Xiegan San (Liver-Draining Powder) several times, but the previous ailments worsened. Li Dongyuan stated that Dahuang (Rhubarb Rhizome) and Qianniu (Morning Glory Seed), although capable of clearing damp-heat, cannot penetrate the meridians. Upon swallowing, they do not enter the Liver Meridian but first enter the Stomach. Dahuang is bitter and cold, severely damaging the Stomach Qi. Qianniu has a pungent taste and can drain Qi, severely damaging the Lung's root. Coughing became severe. This is because the excess pathogenic factors at the branch level were not eliminated, causing the root deficiency to become even more severe. Additionally, it coincided with the season of summer heat and rain. For someone who habitually suffers from jaundice, the condition thus worsened. Treatment should focus on the Zang organs of the Spleen, Stomach, and Lung, clearing damp-heat from the exterior meridians. Qing Shen Yi Qi Tang (Clear Spirit and Boost Qi Decoction) was prescribed as the main formula. Fuling (Poria), Shengma (Cimicifugae Rhizoma) each 2 fen; Zexie (Alisma Rhizome), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix) each 3 fen; Shengjiang (Zingiberis Rhizoma Recens) 4 fen. This medicine can penetrate the meridians, clear damp-heat without stagnating, thus not draining the Zang organs. It tonifies the Qi deficiency in the Lung, Spleen, and Stomach Zang organs. Qingpi (Citri Reticulatae Pericarpium Viride) 1 fen; Chenpi (Citri Reticulatae Pericarpium), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Baishao Yao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma) each 2 fen; Renshen (Ginseng Radix et Rhizoma) 5 fen. These medicines can anchor within the Zang organs without penetrating the meridians. Those that do not penetrate the meridians will not nourish pathogens within the meridians. Those that anchor can tonify the Yuan Qi of the Zang organs. Huangbai (Phellodendri Cortex) 1 fen; Maidong (Ophiopogonis Radix) 2 fen; Renshen (Ginseng Radix et Rhizoma) 2 fen; Wuweizi (Schisandrae Fructus) 3 fen. These medicines remove seasonal floating heat and damp steaming. Taken together as one dose. Two cups of water, decocted to one cup. Strain. Take slightly warm on an empty stomach. Fire is blazing intensely, Metal is latent, and Cold Water is at its extremity at this time. Therefore, emergency rescue uses Shengmai San (Generate Pulse Powder) to eliminate damp-heat and counteract its excess. The Lung desires astringency; the Heart suffers from flaccidity. Both are treated with sour flavors to astringe them. When Heart Fire is excessive, sweet flavors are used to drain it. Thus, the sweetness of Renshen (Ginseng Radix et Rhizoma) is assisted by the sourness of Wuweizi (Schisandrae Fructus). Sun Simiao said, "In summer, one should often take Wuweizi (Schisandrae Fructus) to tonify the Qi of the five Zang organs." This is correct. Maidong (Ophiopogonis Radix) is slightly bitter and cold, able to nourish the source of Water from the position of Metal, thereby purifying and descending Lung Qi. It can also eliminate cough caused by Fire insulting Metal and astringe phlegm pathogens. Slightly add Huangbai (Phellodendri Cortex) bitter and cold to anchor the position, nourish the flow of Water, settle floating Qi, and eliminate weakness in both legs.

Yu Zhen commented: This case discussion is verbose and unclear. The dosage is too light; how could it be effective? However, it remains pure and orthodox, and the principles have some insightful aspects. Therefore, it was selected.

Luo Qianfu treated Wuyan Zhengqing. In February, due to official duties and labor, irregular diet, Heart Fire invaded the Spleen, causing Spleen Qi deficiency. Anger caused Qi rebellion and injured the Liver. There was epigastric fullness and distension, fatigue in the four limbs, numbness of the body. Subsequently, the body and eyes turned yellow, with a slight bluish tint. The complexion was dark. The mind was restless and agitated, palpitations and insecurity. Giddiness and urge to vomit. Dislike of raw and cold foods. Slow digestion of food, passing undigested grains occasionally. Urine was scanty, obstructed, red-black. Fever occurred between Chen and Si hours (7 AM - 9 AM), stopping at dusk. Especially severe in April. Luo diagnosed the pulse as floating and slow. *Jin Gui Yao Lue* states: "Floating pulse at Cun indicates Wind; slow pulse indicates Bi syndrome. Bi is not Zhong Feng (Stroke). The four limbs suffer from irritability. The color of the Spleen must be yellow. Stagnant heat circulates." Tight pulse at Fuyang indicates Spleen injury. Wind-Cold struggle. Eating causes dizziness. Grain Qi does not digest. The Stomach suffers from turbidity. Turbid Qi flows downward. Urine is blocked. Yin is affected by Cold. Heat flows into the Bladder. The whole body turns yellow, named Gu Dan (Grain Jaundice). Yinchene Ye (Artemisiae Scopariae Herba) 1 qian; Fuling (Poria) 5 fen; Zhizi Ren (Gardeniae Semen), Cangzhu (Atractylodis Rhizoma) peeled and fried, Baizhu (Atractylodis Macrocephalae Rhizoma) each 3 qian; Sheng Huangqin (Scutellariae Radix) 6 fen; Huanglian (Coptidis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Zhuling (Polyporus), Zexie (Alisma Rhizome), Chenpi (Citri Reticulatae Pericarpium), Han Fangji (Stephaniae Tetrandrae Radix) each 2 fen; Qingpi (Citri Reticulatae Pericarpium Viride) peeled 1 fen. Made into one dose. Three cups of long-flowing water, decocted to one cup. Named Fuling Zhizi Yinchene Tang (Poria, Gardenia, and Mugwort Decoction). One dose reduced symptoms by half; two doses led to good recovery. *Nei Jing* states: "Heat rampant within is treated with sour-cold, assisted by bitter-sweet." Also, "Dampness transforms via Fire; if Heat overcomes, treat with bitter-cold, drain with bitter,渗 with bland." Zhizi (Gardeniae Fructus) and Yinchene (Artemisiae Scopariae Herba) are bitter and cold, able to drain damp-heat and resolve jaundice, hence used as Sovereign herbs. *Nan Jing* states: "Bitter addresses epigastric fullness." Huanglian (Coptidis Rhizoma) and Zhishi (Aurantii Fructus Immaturus) are bitter and cold, draining epigastric fullness. The Lung governs Qi. Now Heat has damaged Qi, causing body numbness. Huangqin (Scutellariae Radix) is bitter and cold, draining fire and tonifying Qi, hence used as Minister herbs. Er Zhu (Atractylodes Rhizomes) are bitter, sweet, and warm; Qingpi (Citri Reticulatae Pericarpium Viride) is bitter, pungent, and warm. They can remove damp-heat in the Stomach, drain stagnation, and nourish righteous Qi. Han Fangji (Stephaniae Tetrandrae Radix) is bitter and cold, removing retained dampness from the twelve meridians. Zexie (Alisma Rhizome) is salty and neutral. Fuling (Poria) and Zhuling (Polyporus) are sweet and neutral. They guide heat from the Bladder, promote urination, and relieve urinary obstruction.

In the Bingyin year of Zhiyuan, June. Continuous rain. Many people suffered from damp-warmth. Han Junxiang from Zhending, due to excessive labor, drank cool tea when thirsty, and ate cold foods. Consequently, he developed headache, joint pain, heavy body, chest fullness, and loss of appetite. He believed it was external contraction and internal injury. He took Tongsheng San (Universal Rescue Powder) twice, worsening his body fatigue. Physicians used Baijiesan (Hundred Resolutions Powder) to induce sweating. After four days, Xiaochaihu Tang (Minor Bupleurum Decoction) twice was taken, adding irritability, heat, restlessness, and thirst. After six more days, Sanyi Chengqi Tang (Three-One Purging Decoction) was used to purge. Restlessness and thirst became even worse. Then Baixhu Jia Renshen Tang (White Tiger plus Ginseng Decoction) and Chaihu Yinzi (Bupleurum Drink) were given. The illness increased. Another physician used Huanglian Jiedu Tang (Coptis Detoxification Decoction), Zhusha Gao (Cinnabar Paste), Zhibao Dan (Precious Treasure Pill). By the seventeenth day, the condition worsened. It transformed into yellow body and eyes, heavy limbs, aversion to cold on the back, cold skin, epigastric hardness and fullness, painful upon pressure. Eyes felt dry, unwilling to open. Vision blurred. Reluctance to speak. Spontaneous sweating. Urine clear and frequent. Bowel movements incomplete. Luo diagnosed the pulse as tight and fine, empty upon pressure. Both Cun pulses were short, not reaching their normal position. This condition arose from seasonal heat leading to excessive consumption of cold drinks, compounded by excessive use of cold-cooling medicines. This aided Water to attack Heart, which then insulted Earth. First imprisoning the Mother, then harassing the Son. The Classics state: "Harass what is not overcome, attack what is overcome." At this time of continuous rain, Cold and Damp combined. This is clearly Yin-type Jaundice. Luo prescribed Yinchene Fuzi Ganjiang Tang (Mugwort, Aconite, and Ginger Decoction) as the main formula. *Nei Jing* states: "Cold rampant within is treated with sweet-hot, assisted by bitter-pungent." "Dampness rampant and victorious is balanced with bitter-hot,渗 with bland, dried with bitter." Fuzi (Aconiti Lateralis Radix Praeparata) and Ganjiang (Zingiberis Radix) are pungent, sweet, and greatly hot, dispersing middle Cold, hence used as Sovereign herbs. Banxia (Pinelliae Rhizoma), Caodoukou (Cardamomi Fructus) are pungent and hot. Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium) are bitter, sweet, and warm. Strengthen Spleen and dry Dampness, hence used as Minister herbs. Shengjiang (Zingiberis Rhizoma Recens) is pungent and warm to disperse. Zexie (Alisma Rhizome) is sweet and neutral to渗. Zhishi (Aurantii Fructus Immaturus) is bitter and slightly cold to drain fullness. Yinchene (Artemisiae Scopariae Herba) is bitter and slightly cold, its Qi is light and floating. Assisted by Jiang (Ginger) and Fu (Aconite), it can remove Cold-Damp from skin and interstices and resolve jaundice, hence used as Assistant and Envoy herbs. Decoct and take 1 liang. Previous symptoms reduced by half. Second dose eliminated them completely. Then Lizhong Tang (Regulate the Middle Decoction) was given. Within a few days, Qi recovered. Some questioned: "Jaundice is generally considered Heat. Now, during peak summer heat, treating with Hot medicines cured him. Why?" Luo replied: "It depends on the principle." Cheng Wuji said: "Yin syndromes have two types. One originates from initial external Cold pathogen invading Yin meridians, or eating cold foods injuring the Taiyang Meridian. The other starts as a Yang syndrome, treated with Cold, excessive cooling transforms Yang into Yin." Now Han Junxiang, due to summer heat, consumed cold foods injuring the Spleen, and took excessive cold medicines. Yin Qi became dominant, Yang Qi nearly exhausted. Combined with rainy season Cold-Damp, jaundice erupted. Zhang Zhongjing said, "Seek it within Cold-Damp." Li Sishun said, "Resolving while using excessive cold damages the sovereign; purging while chasing bandits injures the ruler." This is exactly the case. How dare we exceed the prescriptions of the sages? Someone said: "Jieggu's learning has its origins."

Yu Zhen commented: These two cases. The former is Damp-Heat, the latter is Damp-Cold. The disease is indeed easy to distinguish. But the discussion of treatment and herbs is entirely based on *Nei Jing*. Because his learning has a solid foundation.

Yu Tianmin treated a man. Over thirty years old. Suffered from Gu Dan (Grain Jaundice). Sought treatment. Used Weiling Tang (Stomach and Five-Layer Decoction) minus Gui (Cinnamon Twig), plus Yinchene (Artemisiae Scopariae Herba). Dozens of doses. Jaundice resolved. He thought himself cured. Did not take medicine for ten days. Later that evening, went blind. Yu said: "This is called Que Mu (Sparrow Eye/Night Blindness). It is due to abundant Damp-Phlegm and surplus Liver Fire." Used cooked pig liver mixed with Yeming Sha (Chiropterae Faeces) made into pills. Took them, vision returned to normal. Came to thank. Yu said: "Not yet. If you do not early take medicines to subdue Liver, tonify Spleen, and eliminate Phlegm, it will surely develop into Gu Zhang (Abdominal Mass/Ascites)." He did not believe. Half a month later, abdomen gradually distended, fullness. Sought treatment again. Still used Weiling Tang doubled Er Zhu (Atractylodes Rhizomes), plus Mutong (Akebiae Caulis), Maidong (Ophiopogonis Radix) decocted to soup, taken with Tuojin Wan (Gold-Removing Pill). One month to recover.

Jiang Huangnan treated his nephew Sanyang suffering from Dan (Jaundice). Skin and eyes yellow. Urine red. Left pulse wiry and rapid. Right three positions originally did not respond to finger pressure. Now deep pressing reveals faint pulse under fingers. Symptoms include afternoon fever, subsiding at Wugeng (3-5 AM). Used Yinchen Wuling San (Mugwort and Five-Ingredient Powder with Poria) minus Gui (Cinnamon Twig), plus Danggui (Angelicae Sinensis Radix), Zhizi (Gardeniae Fructus), Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix). Several doses. Then used Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction), which is Bawu (Eight substances) minus Xiong (Ligustici Chuanxiong Rhizoma), plus Huangqi (Astragali Radix), Chenpi (Citri Reticulatae Pericarpium), Wuwei Zi (Schisandrae Fructus), Jiang (Ginger), Zao (Jujubae Fructus). Combined with human milk and child urine. Fever subsided for three days, then recurred. Occurring every other day in the afternoon. Muscle heat burning fingers. Pulse near wiry. Treated as Malaria and cured. Years later, eyes turned yellow again. Lunch difficult to digest, urine yellow. Used Huangqi Jianzhong Tang (Astragalus Regulate the Middle Decoction) minus Gui (Cinnamon Twig), plus Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Banxia (Pinelliae Rhizoma), Shenqu (Massae Fermentatae Medicinalis), Maiya (Hordei Fructus Germinatus), small amount of Jiang (Ginger). Jaundice resolved.

Yu Zhen commented: The treatment methods of these two cases are all plain, moderate, and upright. But the previous abdominal mass and the subsequent jaundice were new diseases, not transformations from chronic illness. Hence they matched the prescribed formulas perfectly.

Miao Zhongchun said: Gu Zhonggong from the Imperial Academy, after the grief of losing his wife, fell ill in bed. A physician examined him, came out in surprise, saying he would die soon. I was invited to examine him. The three positions of the left hand were peaceful. The Cun and Chi of the right hand were also unharmed. Only the Guan position was imperceptible. Observing his appearance closely, though emaciated, his spirit was calm. I asked him: "Were you extremely angry?" He said yes. I said: "This is anger causing Qi to congregate in the Liver, and the Spleen Earth being injured. The Classics say, 'Extreme anger cuts off form and Qi.' How much more so for one pulse position? Nothing strange. However, there is accumulation in the Spleen, and a slight yellow tint in the eyes. Fear of developing jaundice." Two or three days later, indeed the whole body turned yellow. Took Yinchene (Artemisiae Scopariae Herba), water-draining, Liver-calming, Qi-smoothing medicines. Several doses and recovered.

Yu Zhen commented: *Jin Gui Yao Lue* states: "For Dan disease, set a period of eighteen days. If cured after ten days or more, but worsens, it is difficult to treat." Based on my experience, it is never inaccurate. Some turn yellow after other diseases; others show other diseases after turning yellow. Must clear all yellow within half a month to one month, then other diseases can be treated. If other diseases heal first but yellow remains, persisting for one and a half to two years, other diseases will reappear leading to death. Generally, alcohol injury, depression/stagnation, and epigastric pain are the roots of jaundice. Diarrhea, swelling, and anorexia are the final stages of jaundice. If epidemic disease causes jaundice, many die. As the proverb says, "Wen Huang" (Plague Jaundice). Only those with strong Yuan Qi, determining whether it is Blood Stasis or Damp-Heat, purging and clearing it, where yellow subsides and heat retreats, can be safe. Ancient medical cases never mentioned prolonged jaundice. This can serve as evidence for my words. Like this case, Guan pulse invisible, yet recovered in several doses. Know that it was due to extreme anger, temporarily invisible. If no anger occurred, Guan pulse invisible for days, slight yellow in eyes, this is a sign of Spleen exhaustion. Death is certain.