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Deng's Commentary: It is likely that the stomach qi is fatigued and appetite is diminished, which explains why the prescription was adjusted in this manner.

Liver yang transforms into internal wind, reversing and invading the domains of the spleen and stomach; stomach fluids condense into phlegm, flowing and obstructing the collaterals of the liver and gallbladder. Numbness in the right leg and stifling oppression in the chest and diaphragm are all consequences of this. Furthermore, since both wind and fire have a nature that tends to ascend, symptoms such as rising heat, counterflow of qi, and epistaxis (nosebleed) appear. These conditions arise from irregular eating and drinking, overexertion, and emotional depression, accumulating over a long period rather than occurring overnight. The treatment requires clearing liver fire and strengthening spleen qi, which cannot be achieved in a day or two.

Saussureae Radix (Lingyangjiao), Citri Reticulatae Pericarpium (Guangpi), Gastrodiae Rhizoma (Tianma), Glycyrrhizae Radix et Rhizoma (Gancao), Aurantii Fructus Immaturus (Zhishi), Pinelliae Rhizoma (Banxia), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu), Ophiopogonis Radix (Maidong).

Yi An (Commentary by Liu Bao'er): The theoretical discussion is clear and thorough, and the prescription is comprehensive. Although it appears plain and unremarkable, it is not something an inexperienced practitioner could accomplish. White Peony Root (Baishao) should also be added.

Deng's Commentary: There are currently no definitive signs of phlegm wandering into the liver and gallbladder channels.

This is a syndrome of liver wind carrying phlegm upward and counterflowing. Cold limbs and spontaneous sweating resemble yang collapse, but it is not actually a collapse syndrome. Traction and twitching of the eyes and lips, along with occasional singing and laughing, indicate heart involvement due to pathogenic factors. Treatment should first eliminate the pathogen, then nourish the healthy qi.

Saussureae Radix (Lingyangjiao), Poria (Baifuling), Bamboo Shavings (Zhuru), Curcumae Aromatica Rhizoma (Yujin), Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Uncariae Ramulus cum Uncis (Gougou), Citri Reticulatae Pericarpium (Juhong).

Yi An: The treatment method is appropriate. Occasional singing and laughing are signs of the heart being affected by pathogens. Drugs such as Acori Tatarinowii Rhizoma (Changpu), Polygalae Radix (Yuanzhi), Arecae Semen cum Endocarpo (Dansheng), and Qingxin Niuhuang Wan can be considered for inclusion.

Deng's Commentary: It is likely that the tongue was crimson and the pulse vigorous, which is why the practitioner disregarded the symptoms of jue cold and sweating to use Saussureae Radix directly. Shengmai San might be incorporated to treat the deficiency simultaneously. Master Liu also believed it should be added.

The liver belongs to wind-wood, its nature favoring counterflow and rebellion. Its pathological changes manifest as tremors, shaking, and stiffness. The treatment should soften the wood and extinguish wind.

Rehmanniae Radix Preparata (Xishengdi), Uncariae Ramulus cum Uncis (Gougou), Angelicae Sinensis Radix (Guishen), Poria (Fuling), Epotheca Fermentata (Ejiao), Gastrodiae Rhizoma (Tianma), Saussureae Radix (Lingyangjiao), Dioscoreae Rhizoma (Shanyao), Platycladi Semen (Bairen), Tribuli Fructus (Cijili).

Yi An: This prescription can be supplemented with Quisqualis Indica Fruit (Mugua) and White Peony Root (Baishao).

Deng's Commentary: Profound and truthful words.

Spleen dysfunction leads to phlegm production; liver failure to soften leads to wind movement. Dizziness and poor appetite stem from these causes.

Atractylodis Macrocephalae Rhizoma (Baizhu), Gastrodiae Rhizoma (Tianma), Polygoni Multiflori Caulis (Shouwu), Citri Reticulatae Pericarpium (Guangpi), Pinelliae Rhizoma (Banxia), Saussureae Radix (Lingyangjiao), Poria (Fuling), Uncariae Ramulus cum Uncis (Gougou).

Yi An: The case notes are concise, and the prescription is pure.

Deng's Commentary: Such prescriptions are both flexible and comprehensive. Once one reaches this level, there are seemingly no difficult cases.

The four limbs derive their qi from the spleen and stomach. If the spleen and stomach are weak and deficient, lacking qi to nourish them, tremors occur. When earth is deficient, wood must shake, leading to dizziness.

Guipi Decoction modified with Astragali Radix (Huangqi) and Gastrodiae Rhizoma (Tianma).

Yi An: The case notes offer朴实 (simple/practical) reasoning, and the prescription focuses on supporting healthy qi. It seems additional wind-extinguishing herbs should be added. The Astragali Radix included here may not be suitable for cases of rising liver wind.

Deng's Commentary: This is a method of fortifying earth to control wood.

Liu's commentary is particularly refined.

Excessive liver wood attacks spleen earth; spleen qi fails to circulate freely. Phlegm and saliva accumulate and spread through the collaterals, causing dizziness and lower limb weakness. Although it resembles a deficiency pattern, it cannot be treated solely with tonification.

Polygoni Multiflori Caulis (Shouwu), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Coicis Semen (Yiren), Quisqualis Indica Fruit (Mugua), Uncariae Ramulus cum Uncis (Gouteng), Tribuli Fructus (Cijili), Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Zhi Cao).

Yi An: Polygoni Multiflori Caulis seems too astringent; using stir-fried Atractylodis Rhizoma (Baizhu) would be more appropriate. I propose adding Achyranthis Bidentatae Radix (Niuxi), Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi).

Deng's Commentary: The condition is likely to progress to a stroke-like illness.

The original prescription is already balanced and sound; modifications make it even more practical.

Spirit Gate

Sudden fright causes the spirit to leave its residence; the empty residence allows phlegm to enter, preventing the spirit from returning. Thus, symptoms such as trance and confusion occur. Treatment should expel phlegm to calm and store the spirit.

Pinelliae Rhizoma (Banxia), Arecae Semen cum Endocarpo (Dansheng), Uncariae Ramulus cum Uncis (Gouteng), Bamboo Shavings (Zhuru), Poria Cum Pinodia (Fushen), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus (Heizhi), Aurantii Fructus Immaturus (Zhishi).

Yi An: The description of the disease is vivid and expressive. Such prescriptions require solid practical skills. As the saying goes, "It seems easy when accomplished, yet it is arduous."

Deng's Commentary: The discussion and prescription are precise.

Palpitations, easy seminal emission, lower back pain, and weak legs resemble deficiency but are actually caused by phlegm-fire. Since the pulse is not weak but rapid, and the body is not emaciated, immediate tonification is inappropriate.

Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Sorghi Fructus (Sumi), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Bamboo Shavings (Zhuru), Polygalae Radix (Yuanzhi), Acori Tatarinowii Rhizoma (Shichangpu).

Yi An: This is Sumi Xia combined with Wendan Decoction with modifications. With accurate differentiation, the prescription naturally falls into place.

Deng's Commentary: "Yi" should be read as "Yi" (emission).

Oyster Shell (Muli) and White Peony Root (Baishao) should still be added.

Convulsions and jue cold, occurring upon closing the eyes. This is liver-gallbladder phlegm-heat, triggered by fright, named epilepsy-jue.

Pinelliae Rhizoma (Banxia), Citri Reticulatae Pericarpium (Juhong), Bamboo Shavings (Zhuru), Arecae Semen cum Endocarpo (Dansheng), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Acori Tatarinowii Rhizoma (Shichangpu), Aurantii Fructus Immaturus (Zhishi), Poria (Fuling).

Yi An: Phlegm-fire pathogens, triggered by fright, directly attack the liver and gallbladder, resulting in these manifestations. When lying down, yang qi enters yin; closing the eyes triggers this, indicating yang disturbing yin organs, causing sudden phlegm-fire onset. I propose adding Saussureae Radix (Lingyangjiao) and Coptidis Rhizoma (Huanglian) to the prescription.

Deng's Commentary: Whether to add Saussureae Radix and Coptidis Rhizoma as suggested by Liu depends entirely on the tongue coating and pulse.

Sudden fright and fear cause cold extremities; qi rushing from the lower abdomen leads to jue cold, penile retraction, and sweating. Lower jiao yuan qi is deficient, and retention/control functions fail. One should assist yang to settle and grasp. However, with polydipsia, palpitations, and sudden emptiness in the abdomen, these are signs of wind-xiao and liver jue, unsuitable for harsh warming agents like Cinnamon Twig (Guizhi) and Aconite Root (Fuzi). Stir-fried Black Goji Berry (Qizi), Small Fennel Fruit (Bo Huixiang), Angelicae Sinensis Radix (Danggui), Purple Quartz (Zishiyang), Asarum Radix (Xixin), Cinnamon Twig (Guizhi).

Yi An: For wind-xiao and liver jue, one should supplement yin within warming-nourishing methods. The use of Asarum Radix here is unclear. I suggest adding Achyranthis Bidentatae Radix (Niuxi), White Peony Root (Baishao), and Oyster Shell (Muli).

Deng's Commentary: Given it is wind-xiao and liver jue, the medication remains too warm and drying, inconsistent with the case analysis.

Liu's annotated additions are very appropriate.

Sun's Commentary: Asarum Radix (Xixin) might be a typo for Rehmanniae Radix Preparata (Xishengdi).

Liver fire carrying phlegm upward and counterflowing leads to jue and dian diseases.

Pinelliae Rhizoma (Banxia), Uncariae Ramulus cum Uncis (Gouteng), Poria (Fuling), Aurantii Fructus Immaturus (Zhishi), Citri Reticulatae Pericarpium (Guangpi), Bamboo Shavings (Zhuru), Curcumae Aromatica Rhizoma (Yujin), Saussureae Radix (Lingyangjiao).

Yi An: The prescription is extremely clear and stable.

Phlegm and Fluids Gate

Lung Fluid Retention

Asterae Radix (Ziwan), Pinelliae Rhizoma (Banxia), Morus Alba Cortex (Sangpi), Cynanchi Stauntonii Radix (Baiqian), Armeniacae Semen Amarum (Xingren).

Yi An: Fluid retention is in the lung, not affecting the stomach, so only lung-specific drugs are used.

Deng's Commentary: Comparing this case with later ones reveals differences in severity and depth.

Fluid retention shooting into the lung causes cough.

Pinelliae Rhizoma (Banxia), Armeniacae Semen Amarum (Xingren), Zingiberis Rhizoma Recens (Ganjiang), Schisandrae Fructus (Bei Wuwei Zi), White Peony Root (Baishao), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Poria (Fuling), Cinnamon Twig (Guizhi).

Yi An: This is the standard treatment for fluid retention.

Autumn and winter coughs, resolving in spring warmth, indicate kidney qi failing to retain and yang failing to submerge. This causes water fluids to transform into phlegm foam, which shoots into the lung and disturbs the throat with qi, causing wheezing and coughing that prevents lying flat. Symptoms worsen at night and improve slightly in the morning. Phlegm-fluid is a cold-yin turbid pathogen; night is yin time when yang is inactive, hence the worsening. Zhang Zhongjing stated: "Fluid diseases should be treated with warm herbs to harmonize them." In the *Jin Gui Yao Lue* chapter on fluid retention, the section on "shortness of breath leaning forward" mentions treating external fluid with the spleen and internal fluid with the kidney. These two organs' yin and yang naturally submerge and retain. One should use Shenqi Wan, removing Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), and adding Psoraleae Fructus (Buguzhi) to consolidate essence and qi. Using other drugs to disperse yang qi risks sudden jue cold.

Shenqi Wan minus Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), plus Psoraleae Fructus (Buguzhi).

Yi An: This case deduces the pathology with extreme precision.

In his prime, he lived long-term in Fujian and Guangdong, where southern yang qi is easily depleted. Since middle age, internal phlegm-fluid accumulated. In winter, he experiences back chills, wheezing, and coughing, requiring expectoration of phlegm foam before feeling relief in the chest and epigastrium. Over sixty years old, fearing cold and preferring warmth, this reflects deficiency in the yang division, which is expected. Searching and purging attacks are unsuitable; instead, the Shaoyin kidney should be nourished. Following predecessors' examples of water transforming into phlegm obstructing qi causing wheezing and coughing:

Shenqi Wan minus Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), plus Schisandrae Fructus (Bei Wuweizi) and Aquilariae Lignum Resinatum (Chenxiang).

Yi An: The discussion is clear, and the prescription is highly appropriate.

Deng's Commentary: Achyranthis Bidentatae Radix (Niuxi) naturally guides kidney qi downward. Removing it now suggests concern that its slippery-draining property might further destabilize the already insecure kidney qi.

Sun's Commentary: In Xu's critique of Ye Tianshi's cases, Cinnamon Twig (Guizhi) and Achyranthis Bidentatae Radix (Niuxi) are cited as crucial for wheezing unable to lie flat. Careful analysis shows merit in this. Both cases omitted these, likely because excessive phlegm foam made one fear that warming-retaining methods would trap phlegm internally, worsening wheezing. Later, in the seminal emission section, Guizhi and Niuxi were added for wheezing patients sitting upright, confirming this logic. Reading requires cross-referencing to progress; mere rhetorical flourish is useless.

Long-term seminal emission leads to lower deficiency. Cough worsens in autumn/winter; qi rushes upward at night, preventing restful sleep. Body chills and cold feet clearly indicate water flooding transforming into phlegm foam. Treat according to the Internal Fluid category; using lung drugs would be erroneous.

Cinnamon Twig (Guizhi), Poria (Fuling), Schisandrae Fructus (Wuweizi), Glycyrrhizae Radix et Rhizoma (Zhi Cao), White Peony Root (Baishao), Zingiberis Rhizoma Recens (Ganjiang).

Yi An: Ancients said: "Internal fluid is treated via the kidney." Based on this presentation, combining with Shenqi Wan to secure the lower origin seems appropriate.

Deng's Commentary: Proposes adding Cuscutae Semen (Tusizi), Oyster Shell (Muli), and Moutan Cortex (Danpi).

Liver wind combats phlegm-fluid, obstructing internal zang-fu and closing external orifices/collaterals, leading to insomnia, anorexia, and limb numbness. Having persisted for a year, with weak pulse and sallow complexion, attacking without tonifying leaves the disease; attacking while weakening healthy qi makes it most difficult.

Uncariae Ramulus cum Uncis (Gouteng), Acori Tatarinowii Rhizoma (Changpu), Tribuli Fructus (Cijili), Polygalae Radix (Yuanzhi), Bamboo Sap (Zhuli), Curcumae Aromatica Rhizoma (Yujin), Arecae Semen cum Endocarpo (Dansheng), Hyacinthtis Amethystea (Tianzhuhuang). Take Zhimi Fuling Wan separately before bed.

Yi An: The disease is difficult to treat, yet the prescription is comprehensive and steady, achievable only by those with deep scholarly roots.

Deng's Commentary: Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), and Oyster Shell (Muli) seem suitable for inclusion.

Sun's Commentary: Poria (Fuling) and Pinelliae Rhizoma (Banxia) are suitable for decoction.

Liver yang transforms into wind due to fatigue; spleen yin generates phlegm due to stagnation. Wind-phlegm combats, attacking upward and spreading sideways, causing dizziness and body pain. Currently, oral stickiness and anorexia with a slightly slippery right guan pulse indicate the need to first harmonize and nourish stomach qi, eliminating phlegm-fluid. Only after stomach health and appetite return should yin be cultivated.

Pinelliae Rhizoma (Banxia), Sorghi Fructus (Sumi), Ophiopogonis Radix (Maidong), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling).

Yi An: Examining the pathogenesis to guide prescription steps is a model for clinicians.

Deng's Commentary: Profound and truthful words.

Adding Ginger Juice (Jiangzhi), Bamboo Shavings (Zhuru), Chrysanthemi Flos (Juhua), and Acori Tatarinowii Rhizoma Root (Changpu Gen) would make it more complete.

Cough and Wheezing Gate

Unresolved wind-heat invades the lungs, causing cough and wheezing. Afternoon fever, poor appetite, and fatigue gradually lead to consumptive disease, difficult to regulate. Tentatively prescribing Qian Yi's Ejiao San, hoping to calm lung qi and stop wheezing, before discussing other treatments.

Epimedi Herba? No, Epimedium is Yinyanghuo. Here it refers to Epimedi Herba? Wait, Qian Yi's Ejiao San usually contains Ejiao, Fuling, Malolou Ling, Yimi, Xingren, Gancao, Nuomi, Qianshi.
Epotheca Fermentata (Ejiao), Poria (Fuling), Aristolochiae Radix (Madoulou Ling), Coicis Semen (Yimi), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Glutinous Rice (Nuomi), Euryales Semen (Qianshi).

Sun's Commentary: Deficiency mixed with excess requires observing the skill of balancing both.

Deng's Commentary: Use of Euryales Semen (Qianshi) likely addresses seminal emission.

Second Visit: Artemisiae Annuae Herba (Qinghao), Moutan Cortex (Danpi), Testudinis Carapax et Plastrum (Biejia), Poria (Fuling), Dendrobii Caulis (Shihu), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Guishen), Citri Reticulatae Pericarpium (Guangpi), White Peony Root (Baishao).

Yi An: This is a pattern of righteous deficiency combined with external pathogen invasion, i.e., internal injury complicated by external contraction.

Deng's Commentary: The previous formula focused on cough/wheeze; this one leans toward managing afternoon fever, showing therapeutic constraints.

Long-term cough with non-rapid pulse and dry mouth does not necessarily indicate consumptive disease. This is lung fluid retention, stagnant and unexpressed.

Magnoliae Officinalis Cortex (Houpo), Roasted Ginger (Weijiang), Morus Alba Cortex (Sangpi), Armeniacae Semen Amarum (Xingren), Citri Reticulatae Pericarpium (Guangpi), Glycyrrhizae Radix et Rhizoma (Gancao), Pinelliae Rhizoma (Banxia).

Yi An: This is cold-fluid injuring the lung, an internal excess pattern.

Deng's Commentary: The source of accumulated fluid stems from cold and damp. Dr. Gu's prescription is light, agile, and pleasing, a work only an old hand could produce. This exemplifies Master Liu's concept of "digesting ancient knowledge."

Constitutional deficiency with pathogen stagnation, lung collaterals unclear. Pulse is soggy and fine, fortunately not rapid.

Glehniae Radix (Shashen), Mori Folium (Sangye), Armeniacae Semen Amarum (Xingren), Poria (Fuling), Aristolochiae Radix (Madoulou Ling), Fritilliriae Thunbergii Bulbus (Beimu), Glycyrrhizae Radix et Rhizoma (Gancao), Japonica Rice (Jingmi).

Yi An: The case notes capture the essence of diagnosis, worthy of attention.

Deng's Commentary: Nourishing lung without retaining pathogens, dispersing wind without hindering deficiency. This is a modification of Qian Yi's Bu Fei Ejiao Fa.

Lung yin deficiency with excess lung heat. Cough produces nasal discharge; skin fears wind. Heat escapes through orifices, while qi fails to protect externally. Even if other organs are diseased, treat the lung first.

Epotheca Fermentata (Ejiao), Fritilliriae Thunbergii Bulbus (Beimu), Glehniae Radix (Shashen), Aristolochiae Radix (Madoulou Ling), Armeniacae Semen Amarum (Xingren), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Glutinous Rice (Nuomi).

Yi An: These patterns involve mixed deficiency and excess. Crude practitioners might use dispersing or astringent-tonifying methods, both harmful.

Deng's Commentary: Heat escaping through orifices causes nasal discharge with cough; qi failing to protect externally causes skin aversion to wind. This direct judgment shows profound insight.

Lung disease benefits from strong middle qi, good appetite, and firm stools. Long-term wheezing/cough with loose stools and difficulty digesting food is unfavorable. Pulse matches previous readings. Controlling diet and avoiding cold/heat may prevent worry.

Glehniae Radix (Shashen), Fritilliriae Thunbergii Bulbus (Beimu), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Armeniacae Semen Amarum (Xingren), Coicis Semen (Yiren), Citri Reticulatae Pericarpium (Juhong), Loquat Leaf (Pipaye).

Deng's Commentary: Lung disease suits clearing/moistening, but spleen dislikes cloying. Here spleen earth is weak, hence "unfavorable."

Sun's Commentary: Opening like opening a door to see mountains, offering instant clarity.

Another Pill Formula: Liuwei Dihuang Wan plus Schisandrae Fructus (Wuweizi) and Cinnamon Bark (Rougui).

Yi An: Unalterable theory, readers should memorize this well.

Deng's Commentary: These two formulas seem ordinary but are hard to achieve.

Cough decreases after eating. Caused by middle qi deficiency. Treatment should fortify middle and descend qi.

Ginseng Radix et Rhizoma (Renshen), Pinelliae Rhizoma (Banxia), Sorghi Fructus (Sumi), Jujubae Fructus (Nanzao), Ophiopogonis Radix (Maidong), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Loquat Leaf (Pipaye).

Yi An: This pattern is rare; students must remember it.

Deng's Commentary: This grasps the key to diagnosing the disease, based on immutable principles. The formula is Maidong Tang plus Loquat Leaf.

Long-term cough with loose stools, deficient and rapid pulse. Spleen and lung both diseased; fortifying middle qi is essential. Fear of future diarrhea and anorexia leading to emaciation.

Ginseng Radix et Rhizoma (Renshen), White Peony Root (Baishao), Lablab Seed (Biandou), Coicis Semen (Yiren), Citri Reticulatae Pericarpium (Guangpi), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Dioscoreae Rhizoma (Shanyao), Honey-roasted Charred Ginger (Mi Zhi Pao Jiang Tan).

Yi An: This is another spleen-lung dual treatment method, more practical than previous formulas. Because this pattern involves middle qi deficiency-cold without yin-deficiency heat signs (dry throat, dysuria), medication can be stronger. However, achieving efficacy will be difficult.

Deng's Commentary: Master Liu's commentary is precise.

Yin deficient below, yang floating above. Coughing spasms and rising fire worsen at night. Treating lung is useless; method should tonify kidney.

Prepared Rehmanniae Radix (Shudi), Goji Berry (Qizi), Asparagi Radix (Tiantong), White Peony Root (Baishao), Poria (Fuling), Dioscoreae Rhizoma (Shanyao), Moutan Cortex (Danpi), Testudinis Carapax et Plastrum (Guiban).

Yi An: Walnut Kernel (Hetao) and Schisandrae Fructus (Wuweizi) can be added to this formula.

Deng's Commentary: Accurate diagnosis ensures effective prescription.

Added Walnut Kernel (Hetao) and Schisandrae Fructus (Wuweizi) might hinder rising fire; Aquilae Lignum (Chenxiang) and Tridacna Concha (Geqiao) seem better.

Dry cough without phlegm indicates liver qi rushing into lung, not a primary lung disease. Treat liver primarily, supplementing lung qi secondarily.

Coptidis Rhizoma (Huanglian), White Peony Root (Baishao), Mume Fructus (Wumei), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Guishen), Oyster Shell (Muli), Poria (Fuling).

Yi An: Prescription lacks moistening lung herbs. Propose adding Glehniae Radix (Beishashen) and Morus Alba Cortex (Sangbaipi). Liver attacking lung must carry wood-fire; Gardeniae Fructus (Zhizi) and Moutan Cortex (Danpi) are also indicated.

Deng's Commentary: Original formula is practical; Master Liu's additions are perfect.

Sun's Commentary: Wood-fire insulting metal. Dry cough requires investigating cause. For constrained fire, Jiawei Xiaoyao San may be used.

Wind injures upper body, damp injures lower body. Upper presents as cough with profuse phlegm; lower as ankle swelling and soreness. Treat upper first, then lower.

Menthae Haplocalycis Herba (Bohe), Armeniacae Semen Amarum (Xingren), Platycodonis Radix (Jiegeng), Inulae Flos (Xuanfuhua), Glycyrrhizae Radix et Rhizoma (Gancao), Fritilliriae Cirrhosae Bulbus (Xiangbei), Forsythiae Fructus (Lianqiao), Peucedani Radix (Qianhu).

Yi An: Lung governs regulation of the whole body, so treating lung takes precedence.

Deng's Commentary: This is simultaneous spleen-lung disease. Why not use Mullein Leaf (Sangbaipi), Coicis Semen (Yiren), Poria (Ling), and Citri Reticulatae Pericarpium (Ju) for a dual approach?

Cough worse at night, skin fever in afternoon indicates yin deficiency. Turbid phlegm expectoration and clear nasal discharge indicate lung heat. Disease nature makes quick recovery difficult. Propose sweet-salty drying-moistening method.

Epotheca Fermentata (Ejiao), Bird's Nest (Yanwo), Glehniae Radix (Shashen), Pyrocalcitum (Haifushi), Benincasae Exocarpium (Gualou Shuang), Fritilliriae Thunbergii Bulbus (Chuanbei), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao).

Yi An: Phlegm in this pattern is dry and sticky, hence the medication.

Deng's Commentary: Preparation is stable, but lacks yin-clearing herbs.

Internal heat combines with external heat, affecting lung and stomach, causing cough, anorexia, head distension, skin fever, and irritability. Clear upper and middle jiao.

Artemisiae Scopariae Herba? No, Zhu Ye is Lophatheri Herba.
Lophatheri Herba (Zhuye), Phragmitis Rhizoma (Lugen), Trichosanthis Radix (Huafen), Armeniacae Semen Amarum (Xingren), Fritilliriae Thunbergii Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Platycodonis Radix (Jiegeng), Citri Reticulatae Pericarpium (Juhong).

Yi An: This is cough from external warm-dryness, hence specific clearing/draining.

Deng's Commentary: Disease is lung-stomach wind-heat; prescription is light and apt.

Fine, rapid, and intermittent pulse indicates consumption of liver-kidney essence-blood. Cough produces vomiting of clear saliva and turbid foam. Chong mai qi counterflows from bottom to top, qi fails to retain, wheezing with sweating. Root is uprooted; drugs struggle to work. If doctors see blood as heat and cough as lung issue, they accelerate disaster.

Ginseng Radix et Rhizoma (processed with Autumn Salt) (Renshen - Qiushi Zhi), Prepared Rehmanniae Radix (Shudi), Schisandrae Fructus (Wuweizi), Purple-skinned Walnut Kernel (Ziyi Hetao).

Yi An: This is a difficult-to-treat pattern, unique among cough categories.

Deng's Commentary: Essential words. This is lower deficiency and upper excess. Wheezing and sweating are urgent; urgent matters treated first, hence the prescription. If collapse signs establish, must also calm phlegm-fire.

Sun's Commentary: Kanqi and Purple Quartz (Zishiyang) should be added. Only Ye Tianshi opened this gate; perhaps it can be salvaged.

Deficient and rapid pulse, malar flush, low voice, severe cough with vomiting food, afternoon heat rise, frequent irritability. Liver-kidney yin deficiency, yang floating above, essence-fluid transforming into phlegm foam. Disease duration three years; this is internal consumption, not curable by phlegm-resolving/cough-stopping alone. Secure lower jiao; must abstain from sexual activity. With normal diet, recovery expected over a year.

Duqi Wan plus Ligustri Lucidi Fructus (Nvzhenzi), Goji Berry (Gouqizi), Asparagi Radix (Tiantong).

Yi An: Medication is quite practical.

Deng's Commentary: Severe consumptive diseases appear repeatedly; what is there to rely on without fear? Claiming yearly recovery relies solely on normal diet. Humans base life on stomach qi. Fengxiao and Xiben [terms] likely unseen.

Minute and faint pulse, body chills, long-term cough with loss of voice. Qi exhausted, yang damaged. Propose securing stomach yang using sweet-warm agents.

Honey-roasted Ginger (Mi Zhi Shengjiang), Glycyrrhizae Radix et Rhizoma (Zhi Cao), White Peony Root (Baishao), Astragali Radix (Huangqi), Jujubae Fructus (Dazao).

Yi An: Another method for deficiency cough.

Deng's Commentary: Internal closure by cold-fluid necessitates Honey-roasted Ginger as chief drug.

Throat pain and hoarseness distinguish between lung damage and lung closure. "Metal broken does not ring; metal full also does not ring." This case stems from external wind-heat; treat as closure. Warming-tonification is unsuitable. Concern is pathogen not exteriorizing but merging internally.

Epotheca Fermentata (Ejiao), Armeniacae Semen Amarum (Xingren), Platycodonis Radix (Jiegeng), Fritilliriae Thunbergii Bulbus (Beimu), Arctii Fructus (Niubang), Scrophulariae Radix (Xuanshen), Glycyrrhizae Radix et Rhizoma (Gancao), Japonica Rice (Jingmi), Aristolochiae Radix (Madoulou Ling).

Yi An: Similar to Qian Yi's Bu Fei San, a method treating both deficiency and excess.

Deng's Commentary: Acute disease, lung closure type. Moisten lung and scatter pathogen to clear; if metal is deficient, it rings. Do not confuse with consumptive disease presenting similarly.

Sun's Commentary: If wind-heat is internally closed, Ma Xing Shi Gan Tang should be used to clear and disperse.

Use Fumai Decoction sweet-moistening method. Spasms stop, voice returns, benefiting from water-moistening power. However, weak stomach and loose stools contraindicate further use. Follow *Jin Gui* Maidong Tang principle: nourish earth yin to generate lung metal.

Maidong Tang.

Yi An: This is a method of changing medication strategy.

Deng's Commentary: Consumptive disease hoarseness. Stomach weak and loose stools make recovery difficult even if effective.

Sun's Commentary: Ye Tianshi often removes Sesame Seed (Maren) from Fumai Decoction for this reason.

Long-term cough, loose stools, abdominal fullness. Spleen-lung simultaneous disease, already difficult. Plus rapid pulse, dry mouth, tidal fever, liver-kidney yin insufficient.

White Peony Root (Baishao), Coicis Semen (Yiren), Poria (Fuling), Lotus Seed (Lianrou), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Citri Reticulatae Pericarpium (Guangpi), Lablab Seed (Biandou).

Yi An: Disease heavy, medicine light; efficacy unlikely. Liver-kidney neglected. Propose adding Water-pill Liuwei Wan (1 liang), wrapped in silk for decoction.

Deng's Commentary: Disease critical; prescription does its best.

Decoction and pills together, excellent method.

Sun's Commentary: Flexible mind.

Seasonal pathogen with loose stools: pathogen descending is an exit route. Primary disease with loose stools means middle qi injured first. Humans base life on stomach qi; if root unstable, treatment is hard.