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Cough with expectoration of froth, reduced appetite, nausea, and shortness of breath upon movement indicates injury to the Middle Qi (Middle Jiao energy). This cannot be cured by merely clearing the Lungs and treating the cough.

Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Maidong (Ophiopogonis Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Fuling (Poria), Jingmi (Oryzae Sativa Semen), Dazao (Ziziphi Jujubae Fructus)

Liu Yi's Note: This is a cough caused by Stomach deficiency. The formula follows the intent of the Da Banxia Tang (Major Pinellia Decoction) and Mai Men Dong Tang (Ophiopogon Decoction) from *Jin Gui Yao Lue*.

Deng's Commentary: The method is appropriate. If one also addresses the rebellious Chong Qi (Penetrating Vessel Qi), it would be more comprehensive. To subdue the Chong Qi, drugs such as Chenxiang (Aquilariae Lignum Resinatum), Geqiao (Tridacnae Concha), and Zishiying (Hematitum) can be used.

Cough with epistaxis. This is due to Yin insufficiency and internal stirring of Fire. With nausea and anorexia, the Stomach should be treated first.

Zhuru (Bambusae Caulis in Taenia), Jingmi (Oryzae Sativa Semen), Guangpi (Citri Reticulatae Pericarpium), Shihu (Dendrobii Caulis), Beimu (Fritillariae Bulbus), Xingren (Armeniacae Semen Amarum)

Treatment Note: Since there are signs of internal stirring of Fire causing epistaxis, heat-clearing and descending methods should be employed concurrently.

Deng's Commentary: It is suggested to add Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), and Lugen (Phragmitis Rhizoma) to clear and descend Lung and Stomach heat.

Sun's Commentary: Cebeiye (Platycladi Cacumen) and Maohua (Imperatae Spica) should be added.

Edema with cough and wheezing, stiffness and fullness in the neck and nape, inability to swallow fluids, and inability to urinate indicate a Lung disease. Instead of flowing downward, the Qi rebels upward, and the regulatory authority of the Lung (Zhi Jie) has failed. Even with good prescriptions, efficacy may be difficult to achieve.

Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs)

Liu Yi's Note: This is a syndrome of Phlegm-Qi congestion and obstruction, hence a heavy dose of Lung-draining agents is used.

Deng's Commentary: It is suggested to refer to the treatment methods for Fengshui (Wind-Water Edema).

The pulse is large at the Cun and Guan positions but small at the Chi position; there is dry mouth, rebellious Qi failing to descend, and cold feet that do not warm up. This indicates Yang Qi failing to anchor. One should use drugs containing Yang within Yin to treat this.

Liujun Wan (Six-Ingredient Pill with Rehmannia) plus Niuxi (Achyranthis Bidentatae Radix), Cheqian (Plantaginis Semen), Wuweizi (Schisandrae Fructus), Rougui (Cinnamomi Cortex).

Liu Yi's Note: This formula incorporates the intent of both Shenqi Wan (Kidney Qi Pill) and Duqi Wan (Nine-Ingredient Pill).

Deng's Commentary: Since Yang has lost its anchoring, using shell-type minerals (Jielei) to anchor Yang is appropriate. However, the use of Rougui and Wuweizi is only suitable if the pulse is large and open.

Sun's Commentary: Cold feet and knees are signs of deficient Yang floating upward and failing to anchor. One should tonify the Middle and assist in guiding Yang back to its origin. This formula is correct; remember this well.

The pulse rate slows, and the cough eases. However, the floating Qi does not fully return to its root. One should tonify the Lower Jiao to provide a foundation for Qi reception.

Liujun Wan plus Wuweizi (Schisandrae Fructus), Tusizi (Cuscutae Semen).

Another Pill Formula: Liujun Wan plus Wuweizi (Schisandrae Fructus), Duzhong (Eucommiae Cortex), Qianshi (Euryales Semen), Lianxu (Nelumbinis Plumula), Tusizi (Cuscutae Semen), Gouqi (Lycii Fructus), made into pills with honey. Take 5 qian per dose.

Liu Yi's Note: The discussion is steady and practical, and the prescription is appropriate.

Deng's Commentary: Treating upper disorders by targeting the lower reflects the principle of seeking the root in disease treatment.

Observing this formula suggests the patient likely has symptoms of sore waist and turbid essence.

*Case Record*: Wheezing, cold feet extending to the knees, dry lips and mouth, nasal congestion, and a deficient-small pulse. Rebellious Qi descending improperly indicates the disease is rooted in the fundamental organs. Do not indiscriminately use clearing and purging agents just because there is congealed phlegm in the neck.

Shenqi Wan (Kidney Qi Pill) 3 qian, taken with salt water.

Liu Yi's Note: The insight is mature and appropriate.

Deng's Commentary: Dry mouth and nasal congestion suggest a concurrent exterior contraction. The direct use of Shenqi Wan without hesitation is justified by the deficient-small pulse; this addresses the acute aspect first.

Chronic cough and wheezing preventing lying flat, malar flush, cold feet, chest fullness and rebellious Qi, hunger but inability to eat. This is a presentation of Lung excess above, Kidney deficiency below, and Spleen distress in the middle. However, excess cannot be attacked directly; temporarily treat the deficiency. The Middle cannot be dried harshly; temporarily warm the Lower Jiao. Moreover, the Kidney is the gate of the Stomach, and Fire is the mother of Earth (Spleen); perhaps slight tonification will yield results.

Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet)

Liu Yi's Note: It is suggested to take this with Xuanfu Daizhe Tang (Inula and Hematite Decoction) to connect the Upper and Middle layers.

Deng's Commentary: Shenqi Wan contains the meaning of warming the Middle and driving out fluid retention. Combined with Xuanfu Daizhe Tang, it treats both upper and lower, and both deficiency and excess.

Sun's Commentary: Such discussions cannot be articulated by superficial practitioners.

Both Cun pulses are floating and large; Guan and Chi pulses are deep and small. Qi rebels upward without descending, accompanied by wheezing, coughing, and copious phlegm. Liver and Kidney Qi rush upward to the Lungs. Use Shenqi Wan to tonify and guide it downward.

Shenqi Wan (Kidney Qi Pill)

Liu Yi's Note: This is a method of treating the root.

Deng's Commentary: The pathological manifestations are fully revealed in the pulse; who says pulse diagnosis is unreliable?

Lower deficiency and upper excess require treating the lower, not clearing the upper. When True Qi returns to its origin, Phlegm-Heat will naturally descend. Use Shiwei Shenqi Wan (Ten-Ingredient Kidney Qi Pill) as the main formula.

Shiwei Shenqi Wan (Ten-Ingredient Kidney Qi Pill)

Liu Yi's Note: The insight is excellent and mature.

Deng's Commentary: If the deficiency lies primarily in the Yin aspect, this method is not suitable.

Chapter on Blood Loss

Heat in the collaterals causes blood overflow, triggered by Qi contact at the Cun position; this is not comparable to Yin deficiency with floating Fire. Do not use cloying and greasy tonics.

Jingjie (Schizonepetae Herba), Danpi (Moutan Cortex), Chongwezi (Leonuri Fructus), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Yujin (Curcumae Radix), Ouji (Nelumbinis Nelumbo), Xi Shengdi (Young Rehmanniae Radix), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized).

Liu Yi's Note: The differentiation and medication show sharp, experienced eyesight.

Deng's Commentary: Dispersing pathogens, clearing heat, and guiding stasis makes the formula extremely light and effective. Using cloying tonics would inevitably cause stasis and heat to linger and burn, leading to consumptive disease.

Hematemesis triggered by labor and anger, with a slightly rapid and fine pulse and mild choking. The disease is in the Liver and Heart, caused by overthinking and mental fatigue. Plan early treatment to prevent extension to the Lungs for a favorable outcome.

Ejiao (Colla Corii Asini), Danpi (Moutan Cortex), Niuxi (Achyranthis Bidentatae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Sanqi (Notoginseng Radix), Ouji (Nelumbinis Nelumbo), Tongbian (Infant Urine).

Liu Yi's Note: This is the orthodox method for treating hematemesis. It stops bleeding without leaving stasis, making it very safe.

Sun's Commentary: Hematemesis without cough can be rooted out. If the cough stops but recurs, that is the critical point.

Second Visit: Remove Danshen, Sanqi, Ouji, and Tongbian from the previous formula; add Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), and Chongwezi (Leonuri Fructus).

Another Pill Formula: Liujun Wan plus Ejiao (Colla Corii Asini), Wuweizi (Schisandrae Fructus), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Lianxu (Nelumbinis Plumula), made into pills with water.

Deng's Commentary: Guiding stasis is the primary step, followed by nourishing Yin for recovery. Reviewing the three visits, the steps are orderly.

Blood loss with cough and rebellious Qi, epigastric fullness, evening syncope, dark blood color, black stools, and an isolated large Liver pulse. This indicates retained blood stasis that has not been expelled. Do not treat the Qi; harmonize the Blood.

Zhi Dahuang (Prepared Rhei Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Taoren (Persicae Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Danpi (Moutan Cortex), Jiangxiang (Dalbergiae Odoriferae Lignum).

Liu Yi's Note: This is a specific method for treating stasis accumulation.

Deng's Commentary: This stasis accumulation is stirred by Wood-Fire. Guiding stasis is combined with draining fire; the drug selection is far from superficial. It is suggested to add Ejiao (Colla Corii Asini) to tonify the Lung, and Xuanfuhua (Inulae Flos) to descend rebellious Qi and resolve stasis and harmonize collaterals.

Sun's Commentary: Add Suzi (Perillae Fructus) and Ouji (Nelumbinis Nelumbo).

Post-illness blood loss with dark purple blood indicates pre-existing accumulation. Chest fullness confirms incomplete stasis resolution. Although Zheng Qi (Upright Qi) is deficient, sudden tonification is contraindicated; instead, guide it downward smoothly.

Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Chishao (Paeoniae Radix Rubra), Shengdi (Rehmanniae Radix), Xijiao (Rhinocerotis Cornu - *Note: Substitute with Water Buffalo Horn/Shuiniujiao in modern practice*), Yujin (Curcumae Radix), Danpi (Moutan Cortex), Chongwezi (Leonuri Fructus), Tongbian (Infant Urine).

Liu Yi's Note: There must be signs of latent heat, hence the use of Xijiao (Rhinoceros Horn) in the formula. Given the unresolved stasis, Cu Zhi Dahuang Tan (Vinegar-processed Rhubarb Charcoal) can be added.

Deng's Commentary: There must be a crimson tongue, rapid pulse, and chest/heart irritability, justifying the use of Xijiao (Rhinoceros Horn).

Master Liu's additions focus heavily on guiding stasis.

In cases of blood stasis, Yin is already injured, and Qi necessarily rebels. Now, hematemesis is dark purple with little volume, and chest fullness indicates unresolved stasis. A crimson tongue without coating shows Yin deficiency. Persistent vomiting indicates Qi rebellion. Head heaviness and cold feet suggest lower deficiency and upper collapse. Aversion to cold and delirious speech indicate weak Yang and depleted Qi. Tonification is inappropriate, and attack is impossible; this case is indeed tricky.

Renshen (Ginseng Radix), Fuling (Poria), Sanqi (Notoginseng Radix), Wuzhuyu (Evodiae Fructus), Wumei (Mume Fructus), Muli (Concha Ostreae), Chuanlian (Coptidis Rhizoma), Yujin (Curcumae Radix).

Liu Yi's Note: The disease analysis penetrates layer by layer, and the medication is solid step-by-step; this is the work of a master.

Sun's Commentary: Dark purple blood is solid evidence of stasis. Was this case caused by anger injuring the Liver, or wind-heat stirring internally, compounded by Yin deficiency and Qi depletion? Attack and tonification remain tricky. The formulation of this prescription is beyond mediocre skill.

After blood loss, Qi rebels upward from below, with cold feet and hot head. The disease is in the Lower Jiao, and True Qi fails to receive.

Liujun Wan plus Wuweizi (Schisandrae Fructus), Niuxi (Achyranthis Bidentatae Radix), Muli (Concha Ostreae).

Liu Yi's Note: The formula is appropriate. Advancing further, Jin Gui Shenqi Fa (Kidney Qi Method) could be used to guide Fire downward.

Deng's Commentary: Do not rigidly adhere to Qi-descending examples; this requires profound insight.

Excessive blood loss causes Qi to rebel upward, impacting the Lungs and causing cough. This is not a primary Lung disease. Observing that severe Chong Qi rebellion causes severe cough, and mild rebellion causes mild cough, confirms this. Propose a grasping and descending method, treating the Chong Qi first.

Jin Gui Shenqi Wan minus Rougui (Cinnamon Bark), plus Muli (Concha Ostreae).

Liu Yi's Note: The differentiation is precise, and the method is mature.

Deng's Commentary: To grasp and descend Chong Qi, Fuzi (Aconite) is inferior to Rougui (Cinnamon). Why use Fuzi and remove Rougui here?

Sun's Commentary: Fuzi might also be removed. Drugs for calming and anchoring, such as Cishi (Hematitum), Wuweizi (Schisandrae Fructus), and Baishao (Paeoniae Radix Alba), should be increased in dosage.

The Cun pulse is quiet while the Chi pulse is active. After repeated blood loss, Qi rushing up from the Lower Jiao causes choking, and exertion causes shortness of breath. The disease is not in the Lung but in the Kidney. Treating the cough is useless; nourish Kidney Yin.

Shudi (Prepared Rehmanniae Radix), Tianma (Gastrodiae Rhizoma), Muli (Concha Ostreae), Fuling (Poria), Gouqi (Lycii Fructus), Yurou (Corni Fructus), Wuweizi (Schisandrae Fructus).

Liu Yi's Note: The disease is the same as the previous case. The use of Tianma (Gastrodia) in the formula is unclear.

Deng's Commentary: The previous case involved Fluid Retention; this case emphasizes Yin Deficiency. Tianma in the formula is suspected to be a typo for Tiandong (Asparagi Radix).

An isolated large Heart pulse, dry mouth, easy sweating, irritability, and blood rebellion indicate Heart Yin deficiency and isolated Heart Yang hyperactivity. Use Xijiao Dihuang Tang (Rhino-Corn and Rehmannia Decoction).

Xijiao Dihuang Tang plus Maogen (Imperatae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Shanzhi (Gardeniae Fructus).

Liu Yi's Note: The plans are concise and fitting.

Deng's Commentary: Liver Yang is likely hyperactive as well. Excessive rising of Liver Yang causes the pulse to overflow, merging Fire into the Heart pulse. Maogen (Imperatae Rhizoma) should be replaced with Danpi (Moutan Cortex).

Scattered blood spots in sputum indicate a Heart disease. Dry mouth and heart heat suggest Summerheat injury, as Summerheat tends to enter the Heart.

Shengdi (Rehmanniae Radix), Fushen (Poria with Hostwood), Bidou (Dolichoris Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex), Zhuru (Bambusae Caulis in Taenia), Maidong (Ophiopogonis Radix), Ouji (Nelumbinis Nelumbo).

Liu Yi's Note: The method is clear, spiritual, and pleasing.

Deng's Commentary: Scattered blood spots represent Heart Collateral blood. Shengdi should be Fresh Rehmannia (Xian Shengdi).

Ge Kejiu discussed treating hematemesis, often using Dushen Tang (Single Ginseng Decoction) to tonify the Heart and stabilize the Spirit after bleeding stops and stasis clears. Here, Yin-nourishing drugs are added, worrying that they might ascend and aid Lung heat.

Renshen (Ginseng Radix), Shashen (Glehniae Radix), Shengdi (Rehmanniae Radix), Ejiao (Colla Corii Asini), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria).

Liu Yi's Note: This is the standard method for using Renshen after blood loss.

Deng's Commentary: Combining with Yin-nourishing drugs is superior to Dushen Tang alone.

Consumption-related blood loss with epigastric pain and oppression should not be treated as Yin deficiency. However, a rapid pulse, cough, and tidal fever suggest a gradual progression toward Yin damage.

Shengdi (Rehmanniae Radix), Taoren (Persicae Semen), Zhaca (Crataegi Fructus Carbonized), Yujin (Curcumae Radix), Chishao (Paeoniae Radix Rubra), Zhi Dahuang (Prepared Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex).

Treatment Note: If astringents and tonics are taken early in this case, stasis will remain and transform into heat, easily leading to consumption. One must address both deficiency and excess carefully, avoiding errors.

Deng's Commentary: This formula focuses on guiding stasis and heat. It follows the principle of treating excess first in a pattern of two deficiencies and one excess.

Sun's Commentary: Focuses on the pain and oppression.

Clarifying the causes of consumptive disease in blood disorders brings clarity. Such commentary is highly beneficial.

Insufficient closure with excess Yang, Liver prone to rebellion, and Lung prone to depression. Rapid pulse, wheezing, cough, blood appearance, and hypochondriac pain. Treatment should involve nourishing and descending, along with rest. Otherwise, blood rebellion may persist.

Xiao Shengdi (Young Rehmanniae Radix), Jingjie Tan (Schizonepetae Herba Carbonized), Baishao (Paeoniae Radix Alba), Tongbian (Infant Urine), Yujin (Curcumae Radix), Ouji (Nelumbinis Nelumbo), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized).

Liu Yi's Note: This is also a syndrome of Qi and Fire rebelling upward. Niuxi (Achyranthis Bidentatae Radix) and Danpi (Moutan Cortex) can be added.

Deng's Commentary: This is Wind-Heat combining with Wood-Fire, depressing and rebelling into the Lung collaterals; thus, the method must be light and delicate.

Unresolved blood outside the vessels stagnates internally; Cold-Heat pathogens stir each other and disrupt Qi, causing chest fullness, vomiting, diarrhea, chills, fever, and dry mouth. Treatment should regulate the disrupted Qi and guide the accumulated blood. Although Yuan Qi (Original Qi) is deficient, sudden tonification is contraindicated.

Danpi (Moutan Cortex), Zhaca (Crataegi Fructus Carbonized), Zelan (Lycopus Herba), Chishao (Paeoniae Radix Rubra), Yujin (Curcumae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Xiaoji (Artemisiae Capillaris Herba).

Liu Yi's Note: This case involves external pathogens. Jingjie Tan (Schizonepetae Herba Carbonized) and Heidouyi (Sojae Semen Nigrum Testa) can be added.

Deng's Commentary: This is an occasional symptom in blood loss, so few established formulas apply. After blood loss, Middle Qi is definitely deficient, and Wood-Fire is hyperactive. Beyond the Cold-Heat interaction, there is a conflict between Wood and Earth; Wuji Wan (Five-Ingredient Pill) could be considered. Master Liu's additions are good, but Niuxi (Achyranthis Bidentatae Radix) in the formula can be removed.

Sun's Commentary: Charred Jingjie disperses external Wind and guides stasis, showing great ingenuity.

Chronic cough with blood, hoarseness, sore throat, and alternating chills and fever indicate long-standing潜伏 Cold-Wind injuring the Lung, leading to consumption. Use Qian's Lung-Tonifying Method; voice return indicates improvement.

Ejiao (Colla Corii Asini), Xingren (Armeniacae Semen Amarum), Madouling (Aristolochiae Fructus), Niubang (Arctii Fructus), Yiren (Coicis Semen), Beimu (Fritillariae Bulbus), Nuomi (Oryzae Sativa Germen).

Deng's Commentary: Qian's Lung-Tonifying Method uses sweet Almond. For long-standing Cold-Wind, bitter Almond is appropriate. For progressive treatment, follow Ge's Baohe Tang example.

Another Paste Formula: Ejiao (Colla Corii Asini), Beimu (Fritillariae Bulbus), Gancao (Glycyrrhizae Radix et Rhizoma), Juhong (Citri Reticulatae Pericarpium Flavum), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), Mitang (Sugar from Rice), Bami (White Honey), Jiangzhi (Zingiberis Rhizoma Recens Juice), Ziwan (Asternatis Radix), Mutong (Akebiae Caulis), Lizhi (Pyriformis Fructus), Jiegeng (Platycodonis Radix), Niuxi (Achyranthis Bidentatae Radix), Luobozhi (Raphani Semen).

Liu Yi's Note: This is a case of Righteous Qi deficiency and Pathogenic Excess. The medication balances both sides, remaining stable and appropriate.

Deng's Commentary: Light and appropriate, likely a variation of Baohe Tang.

Chapter on Consumption and Damage

When consumption leads to reduced food intake and emaciation, priority must be given to the Post-Heaven Spleen and Stomach. Several doses of Yigong San (Extraordinary Power Powder) have improved appetite. In mid-spring, Earth Qi rises, and Liver Wood dominates. Rising Heat causes palpitations, sweating, and recurrent cough. Severe coughing leads to blood appearance due to blazing Liver Yang and boiling collateral blood. Yesterday, a formula harmonizing Yang and nourishing Yin was administered, slightly calming Wood-Fire. Continue with the previous formula plus Baishao (Paeoniae Radix Alba) to control Minister Fire and calm the Earth.

Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Ejiao (Colla Corii Asini), Nvzhenzi (Ligustri Lucidi Fructus), Gancao (Glycyrrhizae Radix et Rhizoma).

Liu Yi's Note: The formula is stable. Muli (Concha Ostreae) and Danpi (Moutan Cortex) can be added.

Deng's Commentary: Adapting to changes is the physician's skill. With internal Yang-Fire stirring, Yin-stilling drugs are needed to control it. Do not rush to tonify Earth.

Sun's Commentary: Master Liu's addition also harmonizes Yang and nourishes Yin.

Luo Shi discusses consumptive disease, often caused by latent pathogens and blood stasis, not just Yin deficiency. Evening chills and fever, fluctuating in intensity, indicate Yang sinking into Yin. Zishen Shengan (Nourishing Kidney and Generating Liver) is most appropriate. Minor adjustments suffice; no need for major changes.

Shudi (Prepared Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Danpi (Moutan Cortex), Shanyao (Dioscoreae Rhizoma), Chaihu (Bupleuri Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Biejia (Testudinis Carapax et Plastrum).

Liu Yi's Note: Adding Chaihu (Bupleuri Radix) to reach pathogens and Biejia (Testudinis Carapax et Plastrum) to search for Yin within Yin-nourishing herbs addresses both deficiency and excess cleverly. However, since it mentions latent pathogens and blood stasis, Danggui (Angelicae Sinensis Radix) should arguably be added.

Deng's Commentary: For consumption arising from chills and fever, Luo Shi's legislation is best. This formula seems even better, relying on temporary weighing of factors. Adding Danggui (Angelicae Sinensis Radix) for blood stasis is correct as it invigorates blood and disperses pathogens.

Sun's Commentary: Superficial practitioners often blindly tonify latent pathogens and blood stasis, causing pathogens to hide deeper, Yin to injure more, blood to stagnate more, and Fire to blaze more, leading to fatal consumption. Actually, Zhang Zhongjing's Dacheng Chang Wan, Shuyu Wan, and Biejia Jian Wan have long shown the rules.

Using the pungent and moistening properties of Danggui (Angelicae Sinensis Radix) to penetrate latent pathogens and blood stasis is the most pertinent and wonderful method. Master Liu clarifies this in his notes, saving others from imitation.

Replacing Shudi (Prepared Rehmanniae Radix) with Shengdi (Rehmanniae Radix) is excellent.

Second Visit: Heat gradually subsides, intermittent headache, persistent rapid pulse, and unclear phlegm stagnation in the throat.

Qinghao (Artemisiae Annuae Herba), Danpi (Moutan Cortex), Shudi (Prepared Rehmanniae Radix), Biejia (Testudinis Carapax et Plastrum), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Xiaomai (Tritici Fructus).

Liu Yi's Note: Clearing phlegm stagnation should be addressed concurrently. Replacing Shudi (Prepared Rehmanniae Radix) with Shengdi (Rehmanniae Radix) in both formulas is safer.

Deng's Commentary: Liver Yang is already hyperactive; the intermittent headache may be due to Chaihu being too ascending. Switching to Qinghao (Artemisiae Annuae Herba) is timely. The unclear phlegm suggests impending cough.

Third Visit: Although the body is not hot, the pulse remains fine and rapid. Nourish Yin Qi.

Liujun Wan minus Yurou (Corni Fructus) and Zexie (Alismatis Rhizoma), plus Baishao (Paeoniae Radix Alba), Niuxi (Achyranthis Bidentatae Radix), Qinghao (Artemisiae Annuae Herba), Biejia (Testudinis Carapax et Plastrum).

Deng's Commentary: Previous Yang rising was due to Yin deficiency. Since the body is not hot, remove Qinghao and Biejia. If residual pathogens remain, Danpi (Moutan Cortex) is sufficient to clear them, or add Danggui (Angelicae Sinensis Radix) to disperse and support.

Dark complexion, emaciation, deficient and rapid pulse, cough with shortness of breath, weak waist and knees, and loose stools indicate deficiency of both Pre-Heaven and Post-Heaven sources, fearing progression to consumption. Cooling and moistening Lung treatments damage Middle Qi; do not administer further.

Ziheche (Placenta Humana), Shudi (Prepared Rehmanniae Radix), Shanyao (Dioscoreae Rhizoma), Yurou (Corni Fructus), Wuweizi (Schisandrae Fructus), Danpi (Moutan Cortex), Fuling (Poria), Duzhong (Eucommiae Cortex), Zexie (Alismatis Rhizoma), Niuxi (Achyranthis Bidentatae Radix), made into pills with honey. Take 5 qian per dose.

Liu Yi's Note: The case summary highlights the key points of treating deficiency; the formula is also precise.

Deng's Commentary: Assessing the symptoms, Pre-Heaven injury is severe; thus, medication should prioritize tonifying Pre-Heaven.

Sun's Commentary: Nowadays, physicians encounter coughs without distinguishing deficiency or excess, routinely using cooling and moistening Lung-astringents. They do not realize these damage Middle Qi and accelerate death. Pointing out this flaw is of great merit.

Collateral gaps allow Qi to wander and cause pain. One must fear late spring and early summer when Earth Yang rises, causing Blood to overflow with Qi. Taking advantage of this time to consolidate, one should fill Essence and marrow. Yin-deficient cough is often caused by other organs affecting the Lung. Treating with cooling agents not only fails to cure the disease but damages the Stomach, reduces appetite, and immediately leads to consumption, which is hard to reverse.

Shudi (Prepared Rehmanniae Radix), Jinyingzi Gao (Cherokee Rose Fruit Paste), Lujiaoshuang (Cervi Cornu Degelatinatum), Wuweizi (Schisandrae Fructus), Xianglianzi (Nelumbinis Semen), Yurou (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Haishen (Holothuria - cleaned and boiled into paste). Grind all into fine powder and mix with the two pastes to make pills.

Liu Yi's Note: There must be symptoms like spermatorrhea and sore waist; hence, the medication does not focus on cough.

Deng's Commentary: The herbs indicate spermatorrhea. Combined with cough, this largely involves Liver Yang transforming into Fire, causing rising and falling issues; wandering pain is also due to this. Lujiaoshuang (Cervi Cornu Degelatinatum) in the formula may be obstructive. It is suggested to add Danpi (Moutan Cortex), Baishao (Paeoniae Radix Alba), Muli (Concha Ostreae), and Xuanfuhua (Inulae Flos).

Sun's Commentary: Master Liu's clarification saves scholars from imitation.

Chapter on Sweating Disorders

Hemihidrosis (sweating on one side), non-supple pulse, and intermittent stopping indicate excess Liver Yang and insufficient Stomach Yin. Consequently, thick phlegm, turbid fire, disturb internally and obstruct externally. Although currently peaceful, ancients treated disease before it arose, not after it appeared. Wise people see the significant from the subtle; careful regulation is appropriate.

Renshen (Ginseng Radix), Chuan Shihu (Dendrobii Caulis), Maidong (Ophiopogonis Radix), Nanzao (Ziziphi Jujubae Fructus), Zhi Banxia (Prepared Pinelliae Rhizoma), Danpi (Moutan Cortex), Fuling (Poria), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Xiaomai (Tritici Fructus).

Liu Yi's Note: This is likely hemihidrosis with sweating on the left and none on the right. Analyzing the case notes, it aims to prevent Bioplegia (Hemiplegia).

Deng's Commentary: This follows the Mai Men Dong Tang (Ophiopogon Decoction) method from *Jin Gui*. Utilizing ancient formulas with adaptation and appropriate modifications.

Sun's Commentary: Master Liu's guidance shows true scholarly foundation.

Heart Yin deficiency allows Heart Yang to move easily, causing excessive sweating and fright; Kidney Yin deficiency fails to secure Kidney Qi, causing nocturnal emission without dreams. Sweat is the fluid of the Heart, and Essence is stored in the Kidney.

Shengdi (Rehmanniae Radix), Fushen (Poria with Hostwood), Gancao (Glycyrrhizae Radix et Rhizoma), Maidong (Ophiopogonis Radix), Chuanlian (Coptidis Rhizoma), Baizi Ren (Platycladi Semen), Yuanshen (Scrophulariae Radix), Xiaomai (Tritici Fructus), Dazao (Ziziphi Jujubae Fructus).

Liu Yi's Note: The case notes emphasize both Heart and Kidney, but the formula seems focused on the Heart. Adding Wuweizi (Schisandrae Fructus), Muli (Concha Ostreae), and Shayuan (Astragali Complanati Semen) to secure the Kidney would make it comprehensive.

Deng's Commentary: Thorough understanding of the pathology, without doubt.

The original formula is adequate; adding astringent and securing agents makes it even more practical.

Chapter on Various Depressions

Epigastric oppression in middle age, frequent belching and coughing, indicates unresolved Qi Depression. Reduced food intake means breaking and draining Qi is contraindicated. Follow the approach for Xiongbi (Chest Bi), gently unblocking Upper Jiao Yang.

Xiebai (Allii Macrostemonis Bulbus), Gualou (Trichosanthis Fructus), Banxia (Pinelliae Rhizoma), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Jiangzhi (Zingiberis Rhizoma Recens Juice).

Liu Yi's Note: The method is light and delicate.

Deng's Commentary: The disease is caused by Phlegm-Qi intermingling obstruction, with Lung and Stomach failing to govern descending. It is suggested to add Pipaye (Eriobotryae Folium), Zhuru (Bambusae Caulis in Taenia), and Xuanfuhua (Inulae Flos).

Depressed Qi condensing in the throat, unable to swallow or spit out, is the beginning of Meiheqi (Plum-Pit Qi).

Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Sugeng (Perillae Caulis), Xuanfuhua (Inulae Flos), Juhong (Citri Reticulatae Pericarpium Flavum), Pipaye (Eriobotryae Folium), Jiangzhi (Zingiberis Rhizoma Recens Juice).

Liu Yi's Note: Adding Xuanfuhua (Inulae Flos) and Pipaye (Eriobotryae Folium) to the established formula from *Jin Gui* shows great ingenuity.