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Deng's Commentary: Hematochezia (blood in stool) is attributed to dampness, which is indeed a common clinical observation and represents the insight of an experienced practitioner. If the pathology is confined to the Spleen, establishing treatment principles is relatively straightforward; however, if the condition has extended to the Kidney, it becomes much more difficult to prescribe. Currently, with symptoms of lower limb flaccidity and weakness, one cannot definitively conclude that the Kidney is involved. Although the prescribed formula is concise and appropriate, I suggest removing Shengjiang (Fresh Ginger Rhizome), and adding Paojiang (Prepared Ginger Rhizome), Sharen (Amomum Fruit), and Dangguishen (Angelica Sinensis Root Heart); if it is confirmed that the Kidney is affected, Hei Di Huang Wan (Black Rehmannia Pill) could also be used.

Sun's Commentary: For hematochezia due to deficiency, Huangtu Tang (Yellow Earth Decoction) and Guipi Tang (Restore the Spleen Decoction) are the orthodox treatments. This formula was formulated because previous nourishing and tonifying measures were ineffective. However, *Jingui Yaolue* distinguishes between Yuanxue (distal bleeding) and Jin xue (proximal bleeding), and Xu Shi proposed that hemorrhoidal bleeding should be cleared. These points must not be overlooked.

Diarrhea, dysentery, and hematochezia have persisted for five years without cure. The complexion is yellow, there is palpitations, and limbs feel weak. This disease originated from Spleen Yang failing to thrive, subsequently damaging Spleen Yin. Treatment should ideally address both Yin and Yang.

Ren Shen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuzi (Aconite Lateral Root), Zhigancao (Prepared Licorice Root), Shudihuang (Prepared Rehmannia Root), Ejiao (Donkey-hide Gelatin), Fulonggan (Stove Bottom Ash), Huangqin (Scutellaria Root).

Yi's Note: This employs the method of Lizhong Tang (Regulate the Middle Decoction) combined with Huangtu Tang. The plan is practical and profound.

Deng's Commentary: The application of ancient formulas is apt; this is essentially Huangtu Tang added with Ren Shen. There is a type of deficiency jaundice where both Yin and Yang are injured, and urine alternates between clear and yellow. This method can be borrowed for such cases, as this illness resembles deficiency jaundice.

Nasal itching, burning sensation in the heart/chest, blood in stool, emaciation, pulse is small and rapid, persisting for several years.

Huangqin (Scutellaria Root), Ejiao (Donkey-hide Gelatin), Baishao (White Peony Root), Zhigancao (Prepared Licorice Root).

Yi's Note: This presents a syndrome of Yin deficiency with latent heat. The formula is particularly concise.

Deng's Commentary: This formula is Huangqin Tang (Scutellaria Decoction) added with Ejiao. It demonstrates flexibility in using ancient formulas, offering a sense of mastery.

Sun's Commentary: A burning sensation in the heart indicates heat lurking in the Ying (Nutritive) level.

Department of External Sores

Fluid accumulation and Qi stagnation in the Liver Meridian form phlegm nodules in the neck. Although the disease manifests externally, its root lies internally. Attack therapy must be avoided; attacking will only exacerbate the condition.

Shouwu (Polygonum Multiflorum Root), Xiangbei (Fritillaria Thunbergii Bulb), Baishao (White Peony Root), Niuxi (Achyranthes Root), Gancao (Licorice Root), Muli Fen (Oyster Shell Powder), Dangguishen (Angelica Sinensis Root Heart), Shengdihuang (Rehmannia Root), Mudanpi (Moutan Bark).

Yi's Note: The discussion is balanced, and the prescription is clear and steady. Muli Fen alone can resolve phlegm and dissipate hardness.

Deng's Commentary: In patients with deficient constitutions, attack therapy is indeed contraindicated. This method is extremely principled and precise; scholars should emulate it.

For sores and ulcers, the ability to eat is crucial. First, harmonize and nourish Stomach Qi.

Shihu (Dendrobium Stem), Fuling (Poria), Yizhiren (Bitter Apricot Seed), Guya (Sprouted Grain), Mugua (Chaenomeles Fruit), Guangpi (Tangerine Peel).

Yi's Note: The case notes highlight key points, but the medication lacks sufficient potency.

Deng's Commentary: Master Liu's evaluation is very correct.

Pulse is deficient, fine, and rapid, indicating insufficient Yin. Shulou (scrofula/lymphatic tuberculosis) has not healed; heat resides in the Large Intestine.

Liuwei Wan (Six-Ingredient Pill) added with Gouqi (Goji Berry), Tiandong (Asparagus Tuber), Guiban (Turtle Shell), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Wuweizi (Schisandra Fruit).

Yi's Note: This refers to an anal fistula named Shulou; its origin is unknown. The pulse and symptoms indicate a consumptive state, so the focus is on tonifying the Liver and Kidney.

Deng's Commentary: The formula is quite practical, suitable specifically for treating Yin deficiency.

It is mostly named Shulou because of the vulgar name "stealing feces rat" forming a fistula.

Sun's Annotation: An anal abscess is vulgarly called "stealing feces rat," hence the term Shulou.

Department of Women

Spleen deficiency generates dampness, causing Qi stagnation and Blood instability. This differs from excessive menstruation due to Blood heat.

Baizhu (Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome), Baishao (White Peony Root), Guangpi (Tangerine Peel), Zhigancao (Prepared Licorice Root), Fuling (Poria), Niujiaosai Hui (Ash of Buffalo Horn Cavity), Chuanxiong (Ligusticum Rhizome).

Yi's Note: The diagnosis is accurate, and the medication fits perfectly.

Deng's Commentary: This appears similar in theme to Guipi Tang but is distinct in practice.

Abdominal fullness, leg swelling, diarrhea. This belongs to Taishui (fetal edema/fluid retention), caused by Spleen deficiency and dampness.

Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zexie (Alisma Rhizome), Guangpi (Tangerine Peel), Houpo (Magnolia Bark), Chuanxiong (Ligusticum Rhizome), Sueye (Perilla Leaf), Jiangpi (Ginger Peel), Huangqin (Scutellaria Root).

Yi's Note: The plans are all seasoned and appropriate.

Deng's Commentary: The orthodox method for treating fetal edema.

Sun's Commentary: Since it is described as fetal edema, Chuanxiong, which moves Blood, seems inappropriate; replacing it with Baishao would be more fitting.

Antenatal wheezing, coughing, swelling, and fullness result from Spleen dampness failing to circulate, invading the Lung. This is a disease of the Hand and Foot Taiyin meridians. Treatment focuses on resolving dampness and directing Qi downward.

Fuling (Poria), Chenpi (Aged Tangerine Peel), Baishao (White Peony Root), Zexie (Alisma Rhizome), Houpo (Magnolia Bark), Danggui (Angelica Sinensis Root), Sugeng (Perilla Stem), Xingren (Apricot Seed).

Yi's Note: The formula is quite agile; how about adding Ziwan (Aster Root) and Pipaye (Loquat Leaf)?

Deng's Commentary: Both the formula and theory are appropriate.

Ziwan and Pipaye can also enter the Lung's Ying collateral to disperse pathogens.

Sun's Commentary: For wheezing and coughing, removing Danggui's acrid-warm nature and replacing it with Zhishi (Immature Bitter Orange) and Chao Baizhu (Stir-fried Atractylodes) to transform dampness and direct Qi downward—what do you think?

Postpartum lochia fails to discharge, lower abdomen hurts, gradually developing leg swelling, facial edema, wheezing, and coughing. This is Blood stasis preceding, followed by Water flooding. One should treat both Blood and Water, following the example of Gansui (Kansui Root) and Dahuang (Rhubarb Root).

Ziwan (Aster Root), Fuling (Poria), Taoren (Peach Kernel), Niuxi (Achyranthes Root), Qingpi (Green Tangerine Peel), Xingren (Apricot Seed), Shan zha Rou (Hawthorn Flesh), Xiao Chunpu (Magnolia Bark), Yanhu (Corydalis Rhizome).

Yi's Note: Using the principle but changing the herbs, because the original formula is too harsh.

Sun's Commentary: Guizhi (Cinnamon Twig) seems like a necessary ingredient; one could also add Jingjiesui Tan (Charred Perilla Seed Head) and Xixiangfu (Cyperus Rhizome).

Second Visit: Stasis blood does not descend, instead rebelling upward. Urgently apply methods to guide it downward; otherwise, rebellion may lead to Jue (collapse).

Dangguishen (Angelica Sinensis Root Heart), Huashi (Talcum), Puhuang (Lygodium Spore), Tongcao (Tetrapanax Pith), Niuxi (Achyranthes Root), Qumai (Dianthus Herb), Wulingzhi (Trogopterus Dung), Chishao (Red Peony Root).

Deng's Commentary: Agile mind and skilled hands, adapting to changes. After four visits, never rigid or stuck, vibrant and lively, beyond the reach of mediocre practitioners.

Third Visit: Chest feels open but abdomen is full. Blood stasis in the Uterus. Use a mild purgative method.

Dahuang (Rhubarb Root), Qingpi (Green Tangerine Peel), Zhigancao (Prepared Licorice Root), Mudanpi (Moutan Bark), Taoren (Peach Kernel), Chishao (Red Peony Root), Dangguishen (Angelica Sinensis Root Heart).

Another Pill Formula: Niuxi (Achyranthes Root) 1 liang; Chishao (Red Peony Root), Yanhu (Corydalis Rhizome), Puhuang (Lygodium Spore), Wulingzhi (Trogopterus Dung), Chuanxiong (Ligusticum Rhizome), Guixin (Cinnamon Heart), Taoren (Peach Kernel) each 5 qian; Guiwei (Angelica Sinensis Root Tail), Mudanpi (Moutan Bark) each 8 qian.

Deng's Commentary: Switching to pills for mild guidance suggests the disease trend has subsided.

Yi's Note: Changing four formulas in succession, each deeper than the last, orderly, perfectly matching the pathogenesis.

Antenatal fetal edema, followed by severe diarrhea four days postpartum. After diarrhea, laughing led to collapse and unconsciousness. Upon recovery, pain and fullness persisted in the left hypochondrium for over three months. Emaciated, pulse deficient, poor appetite, lower abdominal fullness, leg swelling, difficulty urinating. This is Spleen disease transmitting to the Heart; since the Heart does not accept evil, it transmits to the Liver; the Liver, once diseased, transmits back to the Spleen. This is mutual conquest among the Five Zang organs, different from distension caused by food, Qi, water, and blood in the Six Fu organs. Hence, alternating attack and tonification yielded no effect. Treatment should involve draining the Liver and harmonizing the Spleen.

Baizhu (Atractylodes Macrocephala Rhizome), Mugua (Chaenomeles Fruit), Guangpi (Tangerine Peel), Jiaomu (Pepper Seeds), Fuling (Poria), Baishao (White Peony Root).

Yi's Note: For such conditions, only those with deep knowledge of ancient texts can speak a word.

Deng's Commentary: This illness critically involves the Liver and Spleen meridians, yet the treatment is flexible and thorough, truly the work of a master.

Sun's Commentary: How about stir-frying Baishao with Guimu (Cinnamon Bark)?

Selection of Ji Zhi Tang Medical Cases, Two Volumes

The above two volumes of *Ji Zhi Tang Medical Cases* were authored by Mr. Cao Renbo. His given name was Cunxin, courtesy name Renbo, pseudonym Le Shan. He was from Fushan, Changshu. Intelligent in his youth, elders regarded him as a promising talent. However, due to family poverty, a scholar's stipend was insufficient for livelihood, so he turned to medicine. He studied under Mr. Xue Xingtian. Xue was a renowned elder in the prefecture. Observing Mr. Cao's frequent inquiries, Xue said, "He who will glorify our path must be Cao Sheng." Mr. Cao lived with Xue for ten years, studying by lamplight late into the night. From *Lingshu* and *Suwen* down to works by Xue Ji and Yu Jia Yan, he researched and integrated them all. He then treated patients, achieving miraculous effects. Mr. Cao often said: "A doctor must maintain a mindset that views no disease as untreatable; those deemed untreatable are merely cases where my heart was not fully devoted." Thus, when examining patients, he pondered deeply, aligning his entire being with the patient's diet and daily life, leaving no detail unconsidered. For severe illnesses abandoned by others, Mr. Cao alone could use refined thought to cure them in a few doses. As the ancients said, bringing the dead back to life and flesh to bones, Mr. Cao truly embodied this. He also said: "Whenever pathogenesis is complex, treating one aspect hinders another, and others cannot act, I carefully research, either modifying a single formula or combining several into one. Thinking and thinking, spirits connect; where earnest effort reaches, a perfectly fitting formula is found, effective upon administration." Thus, doctors who abandon patients at the slightest sign of danger due to lack of devotion bear significant fault. Alas! Mr. Cao's words reveal his sincere heart and exquisite medical skills. His writings include *Liuyang Baiwen*, *Ji Zhi Tang Yulu*, *Guoting Lu*, and *Yanling Dizi Jilue*. Compiled and printed by his grandson Boquan Yunian, with a preface by Grand Secretary Yang Binshi. His biography is detailed in the family memoir written by Mr. Xu Tinggao. Famous for medicine, succeeding Ye and Xue, his virtue covered Wuzhong, and his fame spread overseas; people still speak of him today. Specifically, his medical cases, except for those in *Guoting Lu* and *Yanling Dizi Jilue*, had no circulating copies. This summer, I偶然ly saw records kept by his disciples at a friend's place. They contained many errors and omissions, so I borrowed them to copy, organized them sequentially, deleted redundancies, extracted essences, occasionally added comments to clarify intentions, and copied them into upper and lower volumes, so that future readers might imagine his solemn contemplation during consultations, oblivious to surroundings. Recorded by Liu Baozhi of Jiangyin in August of Gengzi, 26th Year of Guangxu.

Selection of Ji Zhi Tang Medical Cases, Upper Volume

Authored by Cao Cunxin (Renbo) of Changshu.

Internal Injury and Miscellaneous Diseases Department

Heart Ying and Kidney Water are mutually deficient. Liver Qi carries Liver Yang upward rebelliously. Chest feels blocked, mouth is constantly dry, hands tremble, tongue deviates, heart vexation, insomnia. Even when sleeping, soul and spirit wander, feeling disconnected from the body. Eventually, loose stools and poor appetite appear, Spleen and Stomach decline. Pulse is fine, small, lacking spirit, with intermittent pauses. Treating each symptom separately seems overwhelming. I consider that Spirit, Soul, and Hun must be allowed to reside in their proper places to generate vitality; otherwise, drifting aimlessly makes recovery uncertain. I propose adopting Xu Xueshi's Zhenzhumu Wan (Pearl Mother Pill) method.

Shijueming (Salt-fried Halloysitum), 1 liang; Ren Shen (Ginseng Root), 1 qian; Dangguishen (Angelica Sinensis Root Heart), 1.5 qian; Xijiao (Rhinoceros Horn), 5 fen; Longchi (Dragon Teeth), 3 qian; Fushen (Poria with Hostwood), 3 qian; Shengdihuang (Rehmannia Root), 4 qian; Maidong (Ophiopogon Tuber), 2 qian; Zaoren (Ziziphus Seed), 2 qian; Zhigancao (Prepared Licorice Root), 3 fen; Huaishanyao (Chinese Yam), 3 qian; Chenxiang (Agarwood), ground and mixed in, 3 fen; Zhufen (Pearl Powder), 4 fen taken first.

Yi's Note: This formula pays insufficient attention to Liver Qi. My opinion is to remove Huaishanyao and Zhigancao, add Muxiang (Aucklandia Root) and Chenpi (Tangerine Peel), then chest blockage will subside.

Deng's Commentary: Heart vexation and insomnia indicate hyperactive Heart Fire. Why are pulse and stool loose? Mostly, Fire is suppressed by Damp-Phlegm. Within clearing Heart and calming Spirit, one must incorporate acrid-dry herbs to open Phlegm, allowing Damp to transform and Phlegm to dissipate, thereby allowing Wood to flourish and Wind to clear; if nourishing cold is excessive, harm may outweigh benefit.

Sun's Commentary: The described symptoms are all caused by Phlegm-Fire harassing upwards. Even loose stools and intermittent pulse are due to Phlegm stagnating in the middle, disrupting harmony between Spleen Ying and Stomach Wei. If a consumptive syndrome reaches this stage, Zheng Qi is nearly exhausted, and there is absolutely no hope for life.

Chest blockage is not due to Qi obstruction, but Phlegm rebelling upward.

Continued Prescription: Shengdihuang (Rehmannia Root), Baishao (White Peony Root), Ren Shen (Ginseng Root), Mudanpi (Moutan Bark), Juhong (Citrus Peel), Fushen (Poria with Hostwood), Zaoren (Ziziphus Seed), Shijueming (Halloysitum), Longchi (Dragon Teeth), Shumi (Sorghum), Foshou (Buddha's Hand).

Deng's Commentary: Selected herbs are superior to the previous formula, thus achieving slight efficacy.

Second Visit: Intermittent pulse has smoothed, loose stools have ceased, chest blockage has slightly eased, hand tremors have stabilized. However, waking exceeds sleeping; internal Hun and Po are unsettled. Chest oppression and epigastric stuffiness indicate turbid Phlegm obstructing upwards has not descended. I will incorporate the method of Unblocking Yang and Suppressing Rebellion into the previous formula, hoping for success.

Zhenzhumu Wan (Pearl Mother Pill): Zhenzhumu (Mother-of-Pearl), Shudihuang (Prepared Rehmannia), Danggui (Angelica), Ren Shen (Ginseng), Zaoren (Ziziphus Seed), Baiziren (Biota Seed), Fushen (Poria with Hostwood), Xijiao (Rhinoceros Horn), Longchi (Dragon Teeth), Chenxiang (Agarwood). Remove Baiziren and Danggui. Add Xuanfuhua (Inula Flower) 1.5 qian, Daizheshi (Haematitum) 3 qian, Chenpi (Tangerine Peel) 0.7 qian, Dongzhu (Winter Atractylodes) 7 qian, Zhigancao (Prepared Licorice Root) 5 fen, Baishao (White Peony Root) 2 qian, Maidong (Ophiopogon Tuber) 3 qian. Decoct with Ganlan Shui (Water stirred vigorously), mix in Zhuli (Bamboo Sap) 1 liang.

Yi's Note: The case mentions "Unblocking Yang and Suppressing Rebellion." The formula uses Xuanfuhua and Daizheshi to suppress rebellion, but Dongzhu, Baishao, Maidong, and Zhigancao cannot be considered as "Unblocking Yang."

Deng's Commentary: Is the pulse intermittence also due to epidemic influence?

The phrase "chest oppression and epigastric stuffiness, turbid Phlegm obstructing upwards has not descended" hits the mark. Yet the formula still uses Dihuang and Maidong; although the theory is correct, the medication is inappropriate. I suggest incorporating the Wendan method, such as Banxia (Pinellia Rhizome), Zhishi (Immature Bitter Orange), Changpu (Acorus Rhizome), Zhuru (Bamboo Sap).

Third Visit: Sleep obtained at midnight, Heart and Kidney have interacted. Lung Po and Liver Hun can naturally reside in their respective organs. However, Heart easily becomes vexed, Spirit is fatigued, Qi is short, chest remains oppressed, pulse is still fine and small, feet are restless. Pulse deficiency and symptom deficiency constitute double deficiency, complicated by Damp-Phlegm. Phlegm is tangible Fire; Fire is intangible Phlegm. Method should prioritize securing the Root, assisting with resolving Phlegm.

Renshen Guben Wan (Ginseng Root-Securing Pill) added with Guiban (Turtle Shell) 5 qian, Zhifushen (Prepared Poria with Hostwood) 3 qian, Zaoren (Ziziphus Seed) 2 qian, Baishao (White Peony Root) 3 qian, Huaixiao Mai (Wheat) 3 qian, Chenpi (Tangerine Peel) 1 qian, Xuanfuhua (Inula Flower) 1.5 qian, Baiziren (Biota Seed, oil removed) 1.5 qian, Dongzhu (Winter Atractylodes) 0.5 qian. Separate: Zhufen (Pearl Powder) 2 fen, Zhuyou (Bamboo Oil) 20 spoons, Jizihuang (Egg Yolk) 1 piece mixed in.

Yi's Note: In treating Phlegm diseases, heavily investing in Maidong and Dihuang—is this not suspected of being cloying?

Deng's Commentary: Master Liu's critique is accurate.

All kinds of suffering are nothing but obstruction by Damp-Phlegm. The case states Damp-Phlegm causes harm, and Phlegm is tangible Fire, Fire is intangible Phlegm. Why still emphasize tonification? Ultimately, the concept of "Yin Deficiency" dominates the mind.

Sun's Commentary: Regarding Phlegm-Fire for twenty days, how can modern practitioners see so clearly? Given this, the method should be clearing Fire and transforming Phlegm.

Fourth Visit: Excess of Wind, Fire, and Phlegm lingers in the Liver Meridian, preventing Blood from returning to the Liver during sleep, so Hun cannot return with it. Muscle twitching awakens the patient; previous symptoms like shortness of Qi are all due to this. Furthermore, arising after years of illness, both Qi and Blood are deficient, unable to withstand further strain. The treated formulas do not deviate from Xu Xueshi's methods. Currently, pulse is fine and small with a stringy quality. Although there is no intermittent pause, there is still restlessness. Ultimately, storms are unavoidable; one cannot rely solely on the ability to eat.

Shijueming (Salt-fried Halloysitum) 3 qian, Maidong (Ophiopogon Tuber) 2 qian, Xijiao (Rhinoceros Horn) 5 fen, Baiziren (Biota Seed) 3 qian, Longchi (Dragon Teeth) 3 qian, Zaoren (Ziziphus Seed, salt-water fried) 3 qian, Dangguishen (Angelica Sinensis Root Heart) 0.7 qian, Dashudi (Large Prepared Rehmannia, stir-fried with Fusshi Fen) 6 qian, Lingyangjiao (Antelope Horn) 1 qian, Dongzhu (Winter Atractylodes) 1.5 qian, Baishao (White Peony Root) 3 qian, Chenpi (Tangerine Peel) 1 qian, Ren Shen (Ginseng Root) 2 qian, Fushen (Poria with Hostwood) 3 qian, Yinhua (Honeysuckle Flower) 1 qian, Bohe (Mint) 5 fen. Separate: Jinbo (Gold Foil) 2 sheets, Zhuli (Bamboo Sap) 1 liang, Zhenzhufen (Pearl Powder) 3 fen, Jiangzhi (Ginger Juice) 1 spoon mixed in.

Yi's Note: What is the intention behind using Yinhua and Bohe in the formula?

Deng's Commentary: Phlegm-Fire pathology often allows for good appetite.

Reviewing the four formulas, although they contain pathogen-dispelling herbs, they actually contain many Phlegm-nourishing items, hence rarely achieving efficacy.

Sun's Commentary: Arising after years of illness, it must be caused by mistaken tonification and astringency during the acute phase, leading to internal entanglement of Phlegm-Heat.

Fifth Visit: Slept soundly the previous night, but yesterday became less sleepy again. Sleeping occurred after Zi hour, indicating residual pathogenic factors in the Liver and Gallbladder meridians. Additionally, Phlegm-Fire obstructs Qi, alternating between rebellion and calm. When Qi rebels, face turns red, palpitations occur, even muscle twitching and tendon trembling, vexation and heat, restlessness. Pulse varies accordingly, as stated: "When Heart Fire moves, Ministerial Fire follows." Besides regulation, quiet rest is essential to keep Heart Fire still, allowing gradual entry onto a smooth path.

Ren Shen (Ginseng Root), Danshen (Salvia Root), Maidong (Ophiopogon Tuber), Xuanshen (Scrophularia Root) each 2 qian; Xuanfuhua (Inula Flower), Dongzhu (Winter Atractylodes) each 1.5 qian; Juhong (Citrus Peel) 1 qian; Xiaomai (Wheat) 5 qian; Zaoren (Ziziphus Seed), Chuanlian (Coptis Rhizome) decocted juice for stir-frying.

Fushen (Poria with Hostwood), Chuanbei (Fritillaria Cirrhosa Bulb) each 3 qian; Zhigancao (Prepared Licorice Root) 4 fen; Pipaye (Loquat Leaf), Zhuru (Bamboo Sap) each 3 qian; Zhufen (Pearl Powder) 3 fen mixed in.

Yi's Note: Ministerial Fire belongs to Shaoyang, i.e., Gallbladder Fire. Chuanlian and Zhuru in the formula fit the pathogenesis well.

Deng's Commentary: Stating that the Liver and Gallbladder have residual excess pathogens, plus Phlegm-Fire obstructing Qi, is indeed correct.

This formula is tonifying without stagnation, exerting more effort on clearing and transforming Phlegm-Fire, hence achieving slight efficacy.

Sixth Visit: All minor ailments are eliminated, achieved by clearing, transforming, tonifying, and nourishing meticulously, resulting in this slight effect. The concern is sleeping and waking at improper times. Heart Yang is too hyperactive, Spirit Qi wanders outward. Wei Qi travels alone in Yang, Yang Qiao Meridian is full. Fullness prevents entry into Yin, making Yin deficiency obvious. Incorporating Yin-nourishing items into the previous formula—will it yield results?

Previous formula added with Shengdihuang (Rehmannia Root) 5 qian, Chendanxing (Arisaema with Citrus Peel) 5 fen.

Separate: Zhenzhumu Wan (Pearl Mother Pill), Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) each 50 pellets.

Yi's Note: Insomnia in this case is caused by Phlegm-Fire in the Liver and Gallbladder. The case cites *Neijing*'s text on "Yang Qiao Meridian fullness," which is forced; interpreting "Yin deficiency" in classics as Yin Blood deficiency is especially contrary to the original intent.

Deng's Commentary: Shengdihuang fears obstructing Phlegm.

Sun's Commentary: Carefully reviewing this illness, Phlegm-Fire must disturb the Liver and Gallbladder, causing mental unrest. Medications taken: nourishing aids Phlegm, tonifying stagnates Qi. Among nine formulas, this one is most effective, with novel and fitting medication thoughts. The concern is that herbs for transforming Phlegm and extinguishing Wind do not precisely target the organs, so the disease does not immediately resolve. Pipaye and Chuanbei are unsuitable for Liver/Gallbladder, targeting Lung Phlegm; Danshen removes stasis, Zhufen clears Heart, Maidong nourishes Lung—all missing the precise point. Replace with Tianma (Gastrodia Rhizome), Danzhi Banxia (Gall-blistered Pinellia), Hei Zhi (Black Gardenia), Gougou (Uncaria Hook), Jili (Tribulus Fruit), and it will be correct. Xuanshen clears Fire, but Sheng Muli (Raw Oyster Shell) is better. Add Baishao to secure Liver Yin without cloying properties. Proposed formula below:

Wei Tianma (Baked Gastrodia), Yan Banxia (Salt Pinellia), Fuling (Poria), Ren Shen (Ginseng), Chao Baishao (Stir-fried White Peony), Jiangzhi Chao Shanzhi (Ginger Juice Stir-fried Gardenia), Gougou (Uncaria Hook), Bai Jili (White Tribulus), Sheng Muli (Raw Oyster Shell), Chuanlian Chao Zaoren (Coptis Stir-fried Ziziphus Seed), Zhuru (Bamboo Sap), Zhishi (Immature Bitter Orange).

Nanxing (Arisaema) is drying and fierce, capable of dispelling Wind-Phlegm. Coated with Ox Gall to remove fierceness, adopt gentleness, and guide into the Gallbladder Meridian, fitting this disease best. Such ingenuity is rare.

Seventh Visit: Of all things participating in Heaven and Earth, none is more precious than normal sleep and eating. Now, taste is known in food, but sleep is uneasy. Last night, sleep and wakefulness alternated; waking was uncomfortable, sleeping was uneasy, demonstrating Wei Qi failing to enter Yin, lingering alone in Yang. Liu's Note: The case notes are disjointed and forced, primarily due to misinterpreting the character "Yin" in the classics, making the explanation illogical. Yang Qiao Meridian fullness means Ying Blood cannot be sufficient, muscles cannot be moistened. Unless Yang generates Yin, and Yin sufficiency retains Yang, how can one gradually enter a good state? However, Ying Blood, not generated by the Heart, how can it be stored in the Liver and unified by the Spleen? To rely on emotionless herbs to make emotional flesh and blood grow and develop—how easy is that? Moreover, in this state of Phlegm-Fire irritability, temporary relief after eating, internal moving Deficient Wind, muscle twitching, limb shaking, and difficult defecation, it is even harder to exert force. Urgent careful regulation is needed.

Previous formula removed Xuanshen, Xuanfuhua, Zhufen, Danshen. Added Huangqi (Astragalus Root) 1 qian, Yuanzhi (Polygala Root) 3 fen, Dangguishen (Angelica Sinensis Root Heart) 1 qian, Banxia (Pinellia Rhizome, pig gall-blistered) 1.5 qian, Muxiang (Aucklandia Root) 3 fen, Yuanyanrou (Longan Flesh) 3 pieces.

Separate: Zhenzhumu Wan (Pearl Mother Pill) 40 pellets, Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) 30 pellets.

Yi Zhuo: Huangqi is not very suitable for this condition; Pig Gall-blistered Banxia shows novel thinking.

Deng's Commentary: Discomfort and unease are nothing but Phlegm-Fire pathology. The citation of "Yang Qiao Meridian fullness" from the classics is indeed forced.