Library

Wang Yongzhi, an official of the Qing Dynasty, suddenly suffered from stroke with coma, deviation of the mouth and eyes, surging phlegm-qi, rattling sound in the throat, and deep and hidden pulses in all six positions. This was due to deficiency of true qi with wind pathogen taking advantage of the weakness. He was administered San Sheng Yin (Three Lives Decoction) one tael, plus Ren Shen (Ginseng Root) one tael, decocted and taken orally, after which he regained consciousness immediately. If symptoms such as enuresis, hand relaxation (palms open), mouth opening, and snoring sleep appear, it is considered incurable; however, there are cases of survival even with the aforementioned medicine. San Sheng Yin is a formula that unblocks meridians and treats cold-phlegm, possessing the power of breaking through gates. Each dose must be accompanied by approximately one tael of Ren Shen (Ginseng Root) to control the pathogen and supplement true qi. Otherwise, not only will it be ineffective, but it may also lead to failure. Observing the ancients' use of formulas containing Fu Zi (Aconite Lateral Root) and Shen Fu Tang (Ginseng and Aconite Decoction), the principle becomes clear.

Jiang Dayong, a prefectural judge, had a robust physique, fullness in the middle jiao with expectoration, dizziness upon exertion, and had been taking medications for clearing phlegm and regulating qi. I stated: Fullness in the middle jiao is caused by spleen qi deficiency. Excessive phlegm results from the spleen's inability to transform and transport. Dizziness arises from the spleen's inability to raise clear yang. Numbness of the fingers indicates the spleen's inability to circulate qi throughout the body. Therefore, I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fu Ling (Poria) and Ban Xia (Pinellia Tuber) to tonify the spleen earth, and Ba Wei Wan (Eight-Ingredient Pill) to tonify the mother of the spleen (kidney), resulting in recovery.

A male patient suddenly suffered from stroke with deviation of the mouth and eyes and aphasia. Upon exposure to wind-cold, his limbs became stiff and contracted, and his pulse was floating and tight. This indicated deficiency in the Hand and Foot Yangming meridians with wind-cold pathogen invading. Treatment with Qin Jiao (Radix Gentianae Macrophyllae) and Sheng Ma (Cimicifugae Rhizoma) led to slight improvement, followed by complete recovery using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi (Gardeniae Fructus). If tongue aphasia prevents speech and leg flaccidity prevents walking, it belongs to kidney qi deficiency, named Fei Syndrome (Apoplexy with Flaccidity), and should be treated with Di Huang Yin Zi (Rehmannia Decoction).

A male patient, obese and fond of drinking, presented with a stiff tongue base, unclear speech, deviation of the mouth and eyes, surging phlegm-qi, and limb paralysis. I diagnosed this as spleen deficiency with damp-heat and prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Wei Ge Gen (Baked Radix Puerariae), Shan Zhi (Gardeniae Fructus), and Shen Qu (Medicated Leaven), leading to recovery.

Gao Ruzhai, a censor, returned from Datong and told me: "I have developed wind disease. My legs are flaccid and weak when at rest, and painful like needle pricks when exerted. My pulse is flooding, rapid, and forceful." I said: "This is caused by yin deficiency of the liver and kidney with hyperactive fire. Flaccidity and weakness are the form of the true disease, while pain like cone insertion is the sign of evil fire." He recovered after taking herbs to nourish water and tonify the kidney.

Liu Mengchun, a county magistrate, had chronic phlegm, numbness in both arms, and tearing eyes. After taking wind-dispelling and phlegm-resolving medicines, his phlegm increased, his arms became painful and unable to extend, and his fingers contracted. I said: "Numbness belongs to qi deficiency. The previous medicines further injured the liver, causing fire hyperactivity and tendon contraction. Moreover, wind arises from fire. One should tonify the spleen and lung, and nourish kidney water, so that wind subsides, fire retreats, and phlegm clears." He was treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), recovering within three months.

Wang Ruhe, a jinshi degree holder, suddenly fell into a coma due to fatigue and lack of proper care. This was due to yuan qi (original qi) deficiency, with erratic movement of deficient fire carrying phlegm. He was urgently given Tong Bian (Child's Urine) to drink, and his mental clarity gradually improved. Subsequently, he took Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) each 5 qian, Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis Root) each 3 qian, Xuan Shen (Scrophulariae Radix), Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), and Zhi Gan Cao (Prepared Licorice Root) each 1 qian. His condition stabilized slightly. Observing his extreme fatigue, I prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Wu Wei Zi (Schisandra Fruit) and Mai Dong (Ophiopogon Tuber), leading to stability. This person had always had weak yuan qi. Whether due to improper daily routine, dietary fatigue, or excessive mental effort, he suffered from spermatorrhea and leukorrhea, spontaneous sweating, and night sweats; or internal heat, afternoon fever, tidal fever, and fever; or dry mouth with thirst, sore throat, and cracked tongue; or chest and breast distension, hypochondriac pain; or occasional head and neck pain, dizziness, and blurred vision; or restless mind, insomnia; or red and scanty urination with urethral pain; or dribbling after urination/defecation, coldness in the umbilical and abdominal region; or emaciation and aversion to cold in limbs; or rapid nasal breathing; or any other heat symptoms—all these are rootless deficient fire. By taking the aforementioned decoction to consolidate the root, all symptoms would subside. Attacking wind-heat would be a mistake.

Gao, an assistant director of the Court of Imperial Entertainments, had always had weak spleen and stomach. Due to dietary irregularities and fatigue, he experienced abdominal pain and chest oppression. Mistakenly using Da Huang (Rhubarb Rhizome) and other purgatives, he developed delirious speech, irritability, headache, panting, sweating, frequent vomiting and diarrhea, and occasional coma. His pulse was large and disordered. He was treated with Liu Jun Zi Tang (Six Gentlemen Decoction) added with Pao Jiang (Prepared Ginger), stabilizing after four doses. However, he remained fatigued with poor appetite, dry mouth, and fever, with floating and rapid pulses in all six positions. He desired to use fire-clearing medicines. I said: "Intermittent fever indicates no real fire (it is deficient fire); a floating and large pulse indicates blood deficiency; a floating and empty pulse indicates qi deficiency." This was due to stomach deficiency and loss of the five zang organs, manifesting as deficiency syndromes. Taking spleen and stomach-tonifying agents resolved all symptoms.

Xu Keming, a county magistrate, suffered from evening fever, dry mouth, fatigue, red and scanty urination, and soreness/pain in both legs due to improper diet. I treated him with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Being knowledgeable in medicine, he self-prescribed Si Wu Tang (Four Substance Decoction) with Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhenae Rhizoma). This resulted in dizziness, red eyes, tinnitus, dry lips, alternating chills and fever, surging phlegm, hot and painful defecation, and red/scanty urination. He then used Si Wu Tang (Four Substance Decoction) with Huang Qin (Scutellaria Root), Lian Zi (Lotus Plumule), and Zhi Shi (Immature Bitter Orange), leading to chest/diaphragm oppression and poor appetite, with profuse sweating like water. He subsequently used Er Chen Tang (Two Aged Ingredients Decoction) with Huang Qin (Scutellaria Root), Lian Zi (Lotus Plumule), Huang Bo (Phellodendron Bark), Zhi Mu (Anemarrhenae Rhizoma), Mai Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Fruit), resulting in delirious speech and waving of hands. Repeated treatments worsened his condition. Seeking my help again, I prescribed Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) each 5 qian, Dang Gui (Angelica Sinensis Root) and Bai Zhu (Atractylodes Rhizome) each 3 qian, Yuan Zhi (Polygalae Radix), Fu Shen (Poria with Hostwood), Suan Zao Ren (Ziziphus Seed), and Zhi Gan Cao (Prepared Licorice Root) each 1 qian. He slept deeply after ingestion, stabilizing after four doses, and finally recovered with调理 (conditioning) using Ba Zhen Tang (Eight Treasure Decoction).所谓的 "yin deficiency" is actually lung deficiency; the spleen is the ultimate yin, and the aforementioned symptoms arise from spleen deficiency. The spleen derives from the stomach; therefore, sweet-warm agents are used to generate yuan qi in the stomach and eliminate great heat. Why use bitter-cold agents to injure spleen blood? If the aforementioned symptoms indeed belonged to kidney yin deficiency, it would merely be because kidney yang deficiency fails to generate yin. In such cases, bitter-cold agents are especially inappropriate. One should use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to tonify the mother. Mistaking spleen deficiency for kidney deficiency and arbitrarily using Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhenae Rhizoma) damages the generating qi of the stomach, harming many people. Generally, deficiency of the three foot yin meridians is often caused by dietary irregularities and labor, leading to the kidney failing to generate liver wood, the liver failing to generate fire, thereby injuring spleen earth and failing to nourish and transform. By tonifying spleen earth, metal becomes prosperous, water generates, wood is balanced, and mutual generation occurs naturally.

A scholar, accustomed to hard work, suffered from hematochezia (blood in stool) due to dietary irregularities, with blood color either bright red or dark. Half a year later, he alternated between hematochezia and night sweats, or aversion to cold and fever. Hemostatic and antiperspirant medicines were ineffective. His six pulses were floating and large, while the heart and spleen pulses were choppy. This was due to overthinking injuring the heart and spleen, failing to control blood and return it to its source. Blood is sweat, and sweat is blood; their red/dark color, along with hematochezia and night sweats, reflects the subtle variations in the ascending and descending of fire. Aversion to cold and fever indicate joint deficiency of qi and blood. Therefore, in the morning, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used to tonify the source of spleen and lung and lift sunken qi; in the afternoon, Gui Pi Tang (Restore the Spleen Decoction) added with Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Fruit) was used to tonify heart and spleen blood and collect dissipating fluids. Within two months, all symptoms resolved.

Ma Sheng, a young man, suffered from fever, vexation, thirst, and occasional headache. Yesterday, dispersing medicines were used, which aggravated panting, abdominal pain, profuse sweating like water, and day-and-night delirium. I reasoned this was due to injury of yuan qi (original qi) from labor and mistaken sweating therapy. His abdomen and heart area preferred pressure, which was confirmed. I prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Fu Zi (Aconite Lateral Root) 1 qian. He slept deeply, unresponsive to waking, and upon awakening, all symptoms had retreated. Two more doses led to recovery. For ordinary people, dietary irregularities and improper lifestyle leading to all kinds of "fire" symptoms belong to internal true cold and external false heat. Thus, the abdomen prefers warmth, and the mouth fears cold substances. This represents insufficiency of both form/qi and pathology/qi. The treatment method should be purely tonifying the upper yuan qi.