八诊：彻夜好眠，神魂己定，是佳兆也。但脉形细小而兼滑数，数为有火，滑为有痰，细属阴虚，小属气弱，虚弱之中，兼有痰火，有时面红，有时咳嗽，有时气痞而短，有时烦热不安；更兼大便燥而小便短，筋惕肉（目闰），支体动摇，神情困倦，语言无力等证，均未平复。还宜谨慎小心。
前方加柏子仁三钱 另朱砂安神丸三十粒真珠母丸四十粒 诒按：此好眠，是痰蒙所致，未必定是佳兆。
邓评：偶得好眠，未足凭也。要知虚中夹实，当先治其实。
九诊：脏之为言，藏也。心之神，肝之魂，脾之魄，脾之意，肾之志，无不各得其藏，五脏和矣，即有不和，因藏真不足，盖有待也。而与脏相表里者为腑，腑以通为补，与脏之以塞为补者有间。因思胃主下行，肠主津液，津液不充，下行失令，故大便燥结而难通。此际不以滋养营阴，俾得施润泽，非计也。目前之治如此，将来或痰、或火、或感、或伤，偶有违和，事难逆料，断无预定之理，随时斟酌为嘱
麻仁郁李仁柏子仁松子仁各三钱 桃仁七分 陈皮人参 苏子各二钱
另朝服膏滋药，晚服丸药。
此王江泾，王姓病也。是人素有肝火上升之病。想热病之后，必有余邪余火，留于肝胆，乘虚窃发，气塞而不能卧起者，中有实痰，加于短气不足以息之体，神魂摇荡，身非己有，虚之甚矣。用真珠母丸法，先以犀角治实火，参、地补气血，俾相火得清而奠安。第二方即参入陈皮、竹油、赭石、旋覆花，挟补挟化。第三方人参固本，入龟板、芪、芍、鸡黄。第四方加入羚羊、银花，清药与补药，俱加倍用之。第五、六方，竟是十味温胆，吃重痰火一层。用药心细手和，既沉着，亦灵敏，洵可法可师之作。
邓评：腑以通为补，是至理名言。及观其立法，究属背谬。盖大便之燥结，并非阴虚液涸，仍由痰火煅炼，肠液不生，岂徒滋养营阴所能通耶。
阳络重伤，咳无虚日，而于五更为甚，口干盗汗，溺赤便溏，脉数而身热，欲成损证也；咽中已痈，虑其加喘生变，权以清热存阴。
邓评：咳于五更为重，是木火旺于寅卯也；溺赤便溏，大都挟湿热内蕴。此方尚称平善。
孙评：失血之后而得是证，非损之难治者乎。
再诊：所见病情，与前无异，喜食藕汁，咽中干痛稍轻，大便溏泄更甚。虽属肺热下移于大肠，而实则中气已虚，失其所守也。
诒按：大便溏泄，虚证中所最忌者。此证始终大便不坚，故再三反复，终不复元也。
邓评：藕汁虽能清热，亦不免助湿，湿胜故大便溏泄更甚，方内萸、地等味，恐有所碍。
孙评：大便不坚，是中无砥柱，损怯末传已露，安能望愈。且玄参虽清阴分之热，便不坚者，究宜避之，滑润故也。
四诊：便泄稀，身热轻，咽喉干痛，亦渐向愈。而咳嗽腹鸣，神疲纳少，脉小带数。想是风热递减，气阴两亏，而脾中之湿，又从而和之为患。补三阴、通三阳之外，更以崇土化湿佐之。
诒按：阴虚而挟脾湿，阳虚而挟肺火，邪实正虚，彼此相碍。凡治此等证，总须权其轻重缓急，又须心灵手敏，方能奏效。若稍涉呆滞，则效未见而弊先滋。如此证屡用六味，虽于证情亦合，究嫌落笔太重，少灵动之机括也。
孙评：脾湿是误认，乃脾阴伤而中气无权也。清润治肺则碍睥，固气温养则伤肺，故虚证遇此，大为棘手。然脾土为万物之母，中气为诸气之主，但得方法灵动，究以先立中气为要。叶氏每以小建中汤加减治之，良有以也。
柳氏云虚证便溏为最忌，真是治虚者历练有得之言。学者记之。
五诊：气阴得补渐和。不意又有燥风外感，袭入湿痰之中。微有寒热，咽痛咳嗽不止。权以清养法。
六味丸去萸 加桑叶 杏仁 陈皮 川贝 炙草 邓评：缘湿热之邪，本属留郁于内，郁极必发，故不免寒热再至。
六诊：发热恶风汗多，是属伤风之象。但伤于壮者，气行则已；伤于怯者，难免不着而为患也。大为棘手。
邓评：热蒸故多汗，湿遏则恶风，亦未必伤风乃然。且既已伤风，何堪再用熟地。
七诊：多汗恶风之象渐轻，新风解矣。而咳嗽咽痛，大便溏，饮食少，仍是脾肺肾三脏皆虚之候。幸未气喘。
邓评：似乎有效，实则未必效也。
八诊：脾虚则便溏，肺虚则咳嗽，肾虚则虚火上炎，咽喉干痛，脉弱无力，元气伤矣。急宜补气育阴。
诒按：此方究非便溏所宜。
邓评：湿不化脾何以健，热不解阴亦难复。一味滋补，徒截其湿热去路。况二冬、二地，岂便溏所宜服耶。
孙评：叶氏于此等证，总以后天脾胃、先天肾主治，用异功、建中以培中，温养摄纳以治下，从根本设法，而力辟清寒肃肺之非，学者宜宗之。
九诊：精生于谷，肾之精气皆赖谷食以生之，而谷食之化，又赖脾土以运之。今便溏纳少，脾失运矣。急宜补脾为要。
另八仙长寿丸参汤下
诒按：此方亦嫌少灵活之致。
又按：此证前后方案九则，议论颇有精当处。惟用药未能面面照顾，总缘阴虚而兼便溏，彼此相碍，难于安置妥贴也。
邓评：此病因属重症，而始终鲜效者，为过虑其阴虚也。至此而云，急宜补脾用四君，而仍以都气牵合，总由阴虚二字横亘胸中故尔。
孙评：此等证惟于叶案细加参究，或有把握，还须将阴虚便溏打成一气贯穿，乃有生机。
先生之病，素禀湿热，又挟阴虚之病也。湿者何?地之气也。热者何?天之气也。天地郁蒸，湿热生焉。湿热禀于先天者，与元气混为一家，较之内伤外感之湿热，属在后天者，岂可用日语哉。设使薄滋味，远房帏，不过生疡出血而已。乃从事膏粱，更多嗜欲，斯湿热外增，阴精内耗，脏腑营卫，但有春夏之发，而无秋冬之藏，无怪乎风火相煽，而耳为之苦鸣也。当斯时也，静以养之，犹可相安无事，何又喜功生事，火上添油，致陡然头晕面赤，其一派炎炎之势，盖无非肝经之火，督脉之阳，上冒而为患。近闻用引火归原之法，以为甘温能除大热，嗟乎!未闻道也。夫甘温除大热者，良以下极阴寒，真阳上越，引其火，归其原，则坎离交媾，太极自安；若阴虚湿热蒸动于上者，投以清滋，尚难对待，况敢以火济火，明犯一误再误之戒乎!逮后，清已有法，滋亦频投，饮食能增，身体能胖，而坐立独不能久者，明是外盛中空，下虚上实，用药殊难。尝见东垣之清燥汤，丹溪之虎潜丸，润燥兼施，刚柔并进，张氏每赞此两方，谓必互用，始克有济，何故而不宗此耶。然犹有进于此者，治病必资药力，而所以载行药力者，胃气也。胃中湿热熏蒸，致吐血痰嗽，鼻塞噫气，二便失调，所谓九窍不和，都属胃病也。然则欲安内脏，先清外腑，又为第一要着矣。至秋末冬初病甚者，十月坤卦纯阴，天已静矣；而湿热反动，肾欲藏矣，而湿热仍露，能勿令病之加剧乎，附方谨复。
青盐四两 甘草八两 荸荠一斤 海蛇二斤 萆薢一两 饴糖八两 刺猬皮一两五钱 霞天曲一两五钱 十大功劳叶一斤 橘叶五两
共为末，竹沥和水泛丸。每朝四钱，服完后，合虎潜丸全料，同合常服。
柳按：方中海（虫宅），荸荠、饴糖，不能作丸，此必有误。愚意用东垣清燥汤方，合青盐以下数味为末，而用荸荠、海（虫宅）煮汁，和饴糖，竹沥泛丸乃合。
原注：起手提清湿热之病，阴虚之体，发明先天素禀湿热之故。第二段一折，折出嗜欲膏粱，因此更加阴虚。第三段再折，折出动火伤阴。第四段直辟用热之谬，下乃归到治病先治胃。通篇说理既精，笔力道老，侥有古文笔意。
诒按：推论病原，指陈治法，言言切实，绝无模糊影响之谈。最后推出先清胃腑一层，尤为洞中窾要，深合机宜。凡治阴虚湿热者，于此可悟出法门矣。
邓评：分明先后天湿热，自属高见。
将甘温除大热之旨，解得了然明白。世医动辄用引火归源者，当以此三复焉。
体胖而不耐坐立，明是外盛中空，亦知生痰湿必多，两方如清燥汤与虎潜丸互用，润燥兼施，殊称灵妙。但何以以后竟舍清燥而独取虎潜，不知何所据而如此?
钬安内脏，先清外腑，亦是要言。此案竟是一篇大议论，非平日有功夫者不能道只字。方药轻清鲜弊；惟饴糖一味。不免与湿热有碍。
身热，手心热，少力神倦，游利脉濡。此睥阳下陷，阴火上乘。甘温能除大热，正为此等证设也。
此与前案互参，则甘温能除大热之旨，自了然于心胸矣。
劳倦而招风湿，右脉濡小，左脉浮弦，舌苔薄白，溺赤便溏，肢体疫楚，神倦嗜卧，少纳口干。
升阳益胃汤参、术、芪、草、夏、陈、苓、泽、羌、独、防．柴、连、芍、姜．枣。加川朴青皮
诒按：此与前证略同，故用药亦相似。
诒按：脾喜温升，宜香燥；胃喜清降，宜柔润。脾阳健则能运，胃阴充则能纳。凡脾胃同治者，用药须识此意。愚意去熟地，加石斛，似与胃虚者更宜。
孙评：柳氏言之亲切有味，药亦确切不移。
五腑六腑，皆有营卫，营卫不调，则寒热分争。此病分争之后，肌肉暗消，因思脾主肌肉，肌肉暗消，正所以昭脾之营卫虚也。无怪乎脘痞纳少，力乏嗜卧，脉形软弱，有种种脾虚见象。于法当健脾为主，而八八已过之年，阳气必衰，又宜兼壮元阳，使火土合德，尤为要务。
心脉宜大者反小，肾脉宜沉者反浮；浮则为伤，小则为虚。想是读书攻苦，心肾不交，失其封藏之职。夫心肾即婴儿姹女，欲其交者，须得黄婆为之媒合。黄属中央，脾土所主，舍补中宫之外，皆属徒然。
诒按：借丹诀以谈医理，原一贯也。此案说理颇精，惜未能指列病状。
邓评：肾脉浮者宜补真阴；须得黄婆为之媒合者，不果于交心肾之中，参以疏补中官，为黄婆媒合之义也。
昼为阳，阳旺应不恶寒；夜为阴，阴旺应不发热。兹乃日间恶寒，夜间发热，何以阴阳相反若是耶?此无他，阳虚则恶寒于日，阴虚则发热予夜。阴阳之正气既虚，所有疟后余邪，无处不可为患，足为之浮，腹为之满，溺为之短。一饮一食，脾为之不运；生饮生痰，肺为之咳嗽。脉从内变，而为细弦。夫形瘦色黄舌白，阳分比阴分更亏，极易致喘。
原注：案则一线穿成，药则理中去参，以理其本，桂枝以和其标，二陈、朴、杏以化其邪，乃丝丝入筘之方。
邓按：似乎阴阳两虚之证，实是湿遏热伏之候。盖阳被湿困而莫振，阴为热迫而不胜也。今立方仍以祛邪为先，使湿开而热达之意。
脾为阴土，胃为阳土，阳土病则见呕恶，阴土病则见泄泻。二者互相为患，此平则彼发，令人应接不暇。现在呕止而泄，似脾病而胃不病。不知脾胃属土，木必乘之，不乘胃土而呕，必乘脾土而泄。治病必求其本，本在木，当先平木。必使阳土阴土，皆不受所乘，方为正治。
舌乃心之苗。舌上之苔剥落不生者久矣，是心阴不足、心阳有余也。
中 风 门
类中之余，足不任身，手难举物，尺脉无力。阴阳并弱。拟用河间地黄饮子法。
邓评：尺脉无力，阴阳并弱，为地黄饮子的对题旨。但类中之症，于本虚之中，更必有风痰湿热错杂其间。观其膏方加萆薢，三诊加蝎尾，亦从可知矣。
再诊：手之举动稍和，足之步履如旧。盖缘阳气难于充足耳。
Eighth Consultation: Slept well throughout the night, and the spirit (Shen) and soul (Hun) have settled; this is a favorable sign. However, the pulse is fine (Xi) and small (Xiao), accompanied by slippery (Hua) and rapid (Shu). Rapid indicates fire, slippery indicates phlegm, fine belongs to Yin deficiency, and small belongs to Qi weakness. Within this deficiency and weakness, there is an accompaniment of phlegm-fire. Sometimes the face is red, sometimes there is coughing, sometimes chest stuffiness with shortness of breath, and sometimes irritability and restlessness due to heat. Additionally, there is dry stool and scanty urine, muscle twitching (Jin Ti Rou Tiao), trembling of limbs, mental fatigue, and weak speech. These symptoms have not yet subsided. Caution is still required.
The previous prescription adds Semen Platicodoni (Baizi Ren) 3 qian. Separately, take Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) 30 pills and Zhenzhumu Wan (Mother-of-Pearl Pill) 40 pills. Yi's Note: This good sleep is caused by phlegm turbidity clouding the mind, and may not necessarily be a favorable sign.
Deng's Comment: Occasional good sleep is not sufficient evidence. One must understand that this is a deficiency pattern with excess complications; one should first treat the excess.
Sun's Comment: The analysis of the pulse indeed conforms to the pathogenesis, grasping the essence. The commentary truly captures the spirit.
Ninth Consultation: The term "Zang" (Viscera) implies storage. The Shen (Spirit) of the Heart, the Hun (Soul) of the Liver, the Po (Corporeal Soul) of the Spleen (Note: Text says Spleen, usually Lung), the Yi (Intellect) of the Spleen, and the Zhi (Will) of the Kidney are all stored in their respective organs. When the Five Zang are harmonious, even if disharmony occurs, it is due to insufficiency of the True Qi of the Zang, implying a need for recovery. The Fu (Bowels) are exterior-interior related to the Zang. The Fu benefit from unblocking and draining, which differs from the Zang benefiting from consolidation and astringency. Considering that the Stomach governs descending, and the Intestines govern fluids, when fluids are insufficient and the descending function fails, stool becomes dry and difficult to pass. At this time, failing to nourish Ying-Yin to allow for moistening is not a long-term strategy. The current treatment is as such; in the future, if phlegm, fire, external pathogens, or internal injuries cause occasional discomfort, the outcome is unpredictable, and there is no fixed rule. One must adjust according to circumstances.
Semen Cannabis (Maren), Semen Pruni (Yuliren), Semen Platicodoni (Baizi Ren), Semen Pini (Songziren) each 3 qian; Tao Ren 7 fen; Chen Pi, Renshen, Zi Su Zi each 2 qian.
Additionally, take herbal paste in the morning and pills at night.
This is the case of a Mr. Wang from Wang Jiangjing. This person has a chronic condition of Liver Fire rising. It is likely that after a febrile disease, residual pathogens and lingering fire remained in the Liver and Gallbladder, flaring up due to deficiency. Qi obstruction prevents lying down or getting up. There is substantial phlegm inside, added to a constitution already suffering from shortness of breath and insufficient qi. The spirit and soul are agitated, and the body feels alien, indicating extreme deficiency. Using the method of Zhenzhumu Wan, start with Xi Jiao (Rhinoceros Horn - substitute with Buffalo Horn in modern practice) to treat excess fire, and Renshen and Di Huang to tonify Qi and Blood, so that Ministerial Fire can be cleared and stabilized. The second prescription adds Chen Pi, Zhu Li (Bamboo Sap), Shi Zhe Shi (Magnetite), and Xuan Fu Hua (Inula Flower), combining tonification with transformation. The third prescription uses Renshen to consolidate the root, adding Gui Ban (Tortoise Shell), Huang Qi, Bai Shao, and Ji Nei Jin (Chicken Gizzard Lining - text says Ji Huang/Egg Yolk). The fourth prescription adds Ling Yang Jiao (Antelope Horn) and Jin Yin Hua (Honeysuckle), doubling the dosage of both clearing and tonifying herbs. The fifth and sixth prescriptions essentially follow the logic of Shi Wei Wendan Tang (Ten-Ingredient Phlegm-Calming Decoction), heavily addressing phlegm-fire. The medication shows meticulous thought and gentle handling, being both steady and agile, truly worthy of emulation and study.
Deng's Comment: "The Fu benefit from unblocking" is a profound truth. However, looking at his prescription method, it ultimately contradicts this principle. The dryness of stool is not merely due to Yin deficiency and fluid exhaustion, but is refined by phlegm-fire, preventing intestinal fluid production. How can nourishing Ying-Yin alone resolve constipation?
Yang collaterals are severely damaged, causing daily coughing, worse at Wu Geng (3-5 AM). Dry mouth, night sweats, red urine, loose stools, rapid pulse, and fever suggest progression towards a Consumption disorder (Sun Zheng). The throat has developed an abscess, raising concern for asthma and complications. Temporarily employ clearing heat and preserving Yin.
Huang Qin Tang combined with Zhu Fu Tang plus Mu Li (Oyster Shell).
Deng's Comment: Cough worsening at Wu Geng indicates Wood-Fire flourishing during Yin-Mao hours. Red urine and loose stools largely indicate damp-heat accumulation internally. This formula is relatively balanced and appropriate.
Sun's Comment: After blood loss, presenting such a syndrome is indeed a difficult-to-treat Consumption disorder.
Second Visit: The observed condition is unchanged from before. The patient desires lotus root juice, and throat dryness/pain has slightly eased, but diarrhea is more severe. Although this belongs to Lung Heat transferring to the Large Intestine, practically, Middle Qi is already deficient and has lost its holding power.
Liu Wei Wan (Six-Ingredient Rehmannia Pill) plus Mu Li, Chuan Bei Mu (Fritillaria Bulb), Xuan Shen (Scrophularia Root), Dan Huang Qin (Light Scutellaria Root).
Yi's Note: Loose stools are the most taboo in deficiency patterns. Since this patient's stool was never hard throughout, repeated attempts failed to restore health.
Deng's Comment: Lotus root juice clears heat but also aids dampness; excessive dampness causes worse diarrhea. Ingredients like Yu Zhu (Cornus) and Di Huang in the formula may hinder progress.
Sun's Comment: Soft stool indicates lack of central support, revealing late-stage Consumption. Recovery is unlikely. Moreover, Xuan Shen clears Yin heat but should be avoided for soft stools due to its lubricating nature.
Third Visit: Diarrhea has stopped, but cough persists. Throat pain and night sweats remain, with a rapid pulse. Heat pathogens remain in the Lung Meridian.
Bu Fei E Jiao San (Tonify Lung Ass-Escollop Powder) plus Bai Shao, Sheng Di Huang, Dan Huang Qin, Xuan Shen, Shan Yao.
Deng's Comment: E Jiao and Sheng Di Huang are not suitable for patients with pathogenic factors.
Fourth Visit: Loose stools, mild fever, and gradually improving throat dryness/pain. However, cough, abdominal borborygmus, fatigue, and poor appetite persist, with a small, slightly rapid pulse. Wind-Heat is decreasing, leading to Qi and Yin dual deficiency, while Dampness in the Spleen exacerbates the condition. Besides tonifying the Three Yin and unblocking the Three Yang, one must additionally strengthen the Earth element to transform dampness.
Liu Wei Wan plus Mu Li, Dan Huang Qin, Bai Zhu (Yu Zhu), Fang Feng, Chen Pi, Zhi Gan Cao.
Yi's Note: Yin deficiency with Spleen Dampness, Yang deficiency with Lung Fire; excess pathogens and deficiency coexist, hindering each other. Treating such cases requires weighing severity and urgency, and possessing mental agility. Stiffness leads to side effects before efficacy. Repeated use of Liu Wei Wan fits the condition but lacks flexibility.
Deng's Comment: Knowing there is Spleen Dampness, how can Yu Zhu and Di Huang in Liu Wei Wan not interfere?
Sun's Comment: Spleen Dampness is a misdiagnosis; it is actually Spleen Yin injury and powerless Middle Qi. Clearing/moistening harms the Spleen, while warming/tonifying harms the Lung. Thus, deficiency cases are tricky. However, Spleen Earth is the mother of all things, and Middle Qi is the master of all Qi. With flexible methods, establishing Middle Qi is key. Ye Tianshi often uses Xiao Jian Zhong Tang with modifications, which is sound.
Liu states that loose stools are the greatest taboo in deficiency cases. Scholars should remember this experienced advice.
Fifth Visit: Qi and Yin are gradually harmonized through tonification. Unexpectedly, Dry-Wind external pathogen invades amidst Damp-Phlegm. Mild chills and fever, persistent throat pain and cough. Temporarily employ a clearing and nourishing method.
Liu Wei Wan minus Yu Zhu, plus Sang Ye, Xing Ren, Chen Pi, Chuan Bei Mu, Zhi Gan Cao.
Deng's Comment: Since Damp-Heat pathogens were stagnating internally, extreme stagnation leads to eruption, hence the return of chills and fever.
Sixth Visit: Fever, aversion to wind, and profuse sweating indicate Wind Strike. In robust individuals, Qi movement resolves it; in frail individuals, it leaves pathology. Very difficult to manage.
Liu Wei Wan combined with Yu Ping Feng San (Jade Windscreen Powder) plus Sang Ye, Xuan Shen, Chuan Bei Mu, Ju Hong, Gan Cao.
Deng's Comment: Heat steaming causes sweating; Dampness obstructing causes aversion to wind. It may not be Wind Strike. Moreover, if Wind Strike has occurred, using Shu Di Huang is inadvisable.
Seventh Visit: Symptoms of sweating and aversion to wind are lightening; new wind pathogen is resolving. However, cough, throat pain, loose stools, and poor diet indicate deficiency of Spleen, Lung, and Kidney. Fortunately, no asthma.
Yu Zhu Yin Zi (Yu Zhu, Fu Ling, Gan Cao, Jie Geng, Chen Pi, Chuan Bei Mu, Zi Wan, Ginger) combined with Zhu Fu Tang and Yu Ping Feng San plus Mai Dong, Shan Yao.
Deng's Comment: Seems effective, but likely not truly effective.
Eighth Visit: Spleen deficiency causes loose stools; Lung deficiency causes cough; Kidney deficiency causes empty fire flaming upward, causing throat dryness/pain. Pulse is weak and forceless; Yuan Qi is injured. Urgently tonify Qi and nurture Yin.
Renshen, Tian Dong, Dong Dong, Sheng Di, Shu Di, Huang Qi, Chen Pi, E Jiao, Xing Ren, Bai He, Gan Cao.
Yi's Note: This formula is unsuitable for loose stools.
Deng's Comment: If Dampness is not transformed, how can the Spleen function? If Heat is not resolved, how can Yin recover? Blind tonification blocks the exit of Damp-Heat. Furthermore, Tian Dong, Dong Dong, Sheng Di, and Shu Di are unsuitable for loose stools.
Sun's Comment: Ye Tianshi treats such cases by focusing on Post-Heaven Spleen/Stomach and Pre-Heaven Kidney, using Yi Gong San and Xiao Jian Zhong Tang to cultivate the Middle, and warming/nourishing to treat the Lower. He criticizes cold/clearing Lung methods. Scholars should follow this.
Ninth Visit: Essence is generated from Grain. Kidney Essence relies on food, and food digestion relies on Spleen Earth transport. Now, loose stools and poor intake indicate Spleen failure to transport. Urgently tonify the Spleen.
Du Qi Wan combined with Si Jun Zi Tang and Bai Hua Gao.
Separately, take Ba Xian Chang Shou Wan with Ginseng decoction.
Yi's Note: This formula also lacks flexibility.
Additional Note: The nine consultations discuss the etiology and treatment reasonably well. However, medications did not cover all aspects because Yin deficiency and loose stools hinder each other, making management difficult.
Deng's Comment: The disease is severe, and lack of effect stems from over-worrying about Yin deficiency. Here, urging Spleen tonification with Si Jun Zi Tang but still combining with Du Qi Wan shows "Yin deficiency" remains a mental block.
Sun's Comment: For such cases, studying Ye Tianshi's records offers insight. One must integrate Yin deficiency and loose stools into a coherent whole to find vitality.
The Master's illness involves innate Damp-Heat and concurrent Yin deficiency. Dampness is Earth Qi; Heat is Heaven Qi. Heaven and Earth stagnation generates Damp-Heat. Innate Damp-Heat mixes with Yuan Qi, differing from acquired Damp-Heat. If one ate bland food and abstained from sex, only sores or bleeding would occur. Instead, indulging in rich foods and desires increased external Damp-Heat and consumed internal Yin Essence. Zang-Fu and Ying-Wei only dispersed in Spring/Summer without storing in Autumn/Winter. No wonder Wind-Fire fanned each other, causing tinnitus. At this time, quiet cultivation could maintain peace. Why seek merit and add fuel to the fire, causing sudden dizziness and red face? This blazing momentum is Liver Fire and Du Mai Yang rising. Recently, "Guiding Fire Back to Source" (Yin Huo Gui Yuan) was used, claiming Sweet-Warm can remove great heat. Alas! Ignorance. Sweet-Warm removes great heat only when extreme Cold forces True Yang to float; guiding fire back restores Kan-Li interaction. But for Yin deficiency with Damp-Heat steaming upward, clearing/moistening is hard enough; using Fire to aid Fire violates caution. Later, clearing and moistening improved diet and weight, but inability to sit/stand indicates external fullness/internal emptiness, lower deficiency/upper excess, making treatment hard. Dong Yuan's Qing Zao Tang and Dan Xi's Hu Qian Wan combine moistening/drying and soft/hard. Zhang praised using them together. Why not follow this? Further, treating disease relies on medicine, but Stomach Qi carries medicine. Damp-Heat in Stomach causes hemoptysis, cough, nasal congestion, belching, and bowel/bladder dysfunction. "Nine orifices disharmony belong to Stomach disease." To calm internal organs, clear external Fu first—this is primary. In late Autumn/Winter, pure Yin month, Heaven is quiet, but Damp-Heat rebounds, Kidney wants to store but Damp-Heat exposes itself, worsening disease. Attached formula:
Qing Yan (Green Salt) 4 liang, Gan Cao 8 liang, Bi Qi 1 jin, Hai She 2 jin, Bi Xie 1 liang, Yi Tang 8 liang, Ci Wei Pi 1.5 liang, Xia Tian Qu 1.5 liang, Shi Da Gong Lao Ye 1 jin, Ju Ye 5 liang.
Grind to powder, pill with Zhu Li (Bamboo Sap) and water. Take 4 qian every morning. After finishing, combine with full Hu Qian Wan ingredients for regular use.
Liu's Note: Hai She, Bi Qi, and Yi Tang cannot form pills; this must be an error. My opinion: Use Dong Yuan's Qing Zao Tang powder mixed with Green Salt etc., then boil Bi Qi and Hai She in liquid, mix with Yi Tang and Zhu Li to pill.
Original Note: Opening clarifies Damp-Heat in Yin-deficient body, explaining innate Damp-Heat. Second part转折s to show how rich food/desires worsen Yin deficiency. Third part转折s to show moving fire injures Yin. Fourth part refutes using heat, returning to treating Stomach first. Reasoning is precise, writing is vigorous, retaining classical style.
Yi's Note: Analyzing etiology and prescribing methods is practical and clear. Finally emphasizing clearing Stomach Fu hits the crucial point, fitting the mechanism perfectly. Those treating Yin deficiency with Damp-Heat can learn from this.
Deng's Comment: Clearly distinguishing Pre-Heaven and Post-Heaven Damp-Heat is insightful. Explaining "Sweet-Warm removes great heat" clearly. Physicians who casually use "Guiding Fire Back to Source" should reflect on this.
Obesity with intolerance to sitting/standing indicates external fullness/internal emptiness, suggesting much phlegm-damp. Combining Qing Zao Tang and Hu Qian Wan, moistening/drying together, is clever. But why abandon Qing Zao later for only Hu Qian? Unknown basis.
Calming internal organs starts with clearing external Fu—important words. This case is a major discourse, requiring deep study. Medications are light and clean; only Yi Tang might hinder Damp-Heat.
Body heat, palm heat, fatigue, fatigue, soggy pulse. This is Spleen Yang sinking, Yin Fire ascending. Sweet-Warm removes great heat, designed for such cases.
Bu Zhong Yi Qi Tang plus Bie Jia (Turtle Shell).
Yi's Note: This is Spleen deficiency with internal heat; Dong Yuan's method is most suitable.
Deng's Comment: If Yin and Yang are both damaged and this formula fails, consider Jing Yue's Li Yin Jian.
Comparing with previous cases clarifies "Sweet-Warm removes great heat."
Fatigue attracting Wind-Damp. Right pulse soggy/small, left pulse floating/stringy. Thin white coating, red urine, loose stools, body ache, fatigue, desire to sleep, poor appetite, dry mouth.
Sheng Yang Yi Wei Tang (Renshen, Bai Zhu, Huang Qi, Gan Cao, Ban Xia, Chen Pi, Fu Ling, Ze Xie, Qiang Huo, Du Huo, Fang Feng, Chai Hu, Huang Lian, Bai Shao, Sheng Jiang, Da Zao), plus Hou Po, Qing Pi.
Yi's Note: Similar to previous case, so similar medication.
Deng's Comment: Remove Huang Qi, Chai Hu, Huang Lian.
Stomach deficiency causes tasteless eating; Spleen deficiency causes irregular transformation.
Liu Jun Zi Tang combined with Zhi Zhong Tang plus Shu Di, Yi Zhi Ren, Jing Mi.
Yi's Note: Spleen likes warm ascending/aromatic drying; Stomach likes cool descending/soft moistening. Strong Spleen Yang transports; sufficient Stomach Yin accepts. When treating both, recognize this. I suggest removing Shu Di and adding Shi Hu for Stomach deficiency.
Deng's Comment: Shu Di clogs Spleen/Stomach. Even for Kidney deficiency, Gou Qi Zi and Sha Yuan Zi are better.
Sun's Comment: Liu speaks vividly and accurately.
Five Fu and Six Fu have Ying-Wei. Disharmony causes alternating chills/fever. After conflict, muscles waste. Spleen governs muscles; wasting indicates Spleen Ying-Wei deficiency. Hence epigastric stuffiness, poor intake, fatigue, desire to sleep, weak pulse—all Spleen deficiency signs. Method: Tonify Spleen primarily. Patient is over 64 (8x8), Yang must decline; also strengthen Yuan Yang to harmonize Fire and Earth.
Wu Long Wan combined with Xiang Sha Liu Jun Wan plus Shou Wu, Dang Gui.
Deng's Comment: After chills/fever, muscle wasting indicates latent heat consuming Yin.
Heart pulse should be large but is small; Kidney pulse should be deep but is floating. Floating indicates injury, small indicates deficiency. Likely from intense study, Heart-Kidney non-interaction, losing sealing/storage function. Heart/Kidney are Infant/Chang Nv; need Huang Po (Yellow Mother) to mediate. Yellow belongs to Center/Spleen Earth. Without tonifying Middle Palace, other efforts are futile.
Gui Pi Tang.
Yi's Note: Using alchemical terms for medical theory is consistent. Case reasoning is excellent, but lacks specific symptom listing.
Deng's Comment: Floating Kidney pulse needs True Yin tonification. "Need Huang Po to mediate" means supplementing/dredging Middle Palace to facilitate Heart-Kidney intersection.
Sun's Comment: This is Middle Deficiency Insomnia.
Day is Yang, strong Yang shouldn't fear cold; Night is Yin, strong Yin shouldn't have fever. Now daytime chills, nighttime fever. Why opposite Yin/Yang? Simply: Yang deficiency causes daytime chills; Yin deficiency causes nighttime fever. Both Zheng Qi are deficient. Residual pathogens post-malaria can cause issues anywhere: feet float, abdomen full, urine short. Eating/drinking fails to transport via Spleen; generating phlegm causes Lung cough. Pulse changes internally to fine/stringy. Thin body, yellow complexion, white tongue indicate Yang deficiency exceeds Yin deficiency, easily leading to asthma.
Gui Zhi Jia Hou Po Xing Ren Tang plus Fu Zi, Gan Jiang, Bai Zhu, Ban Xia, Ju Hong.
Original Note: Case is cohesive. Medicine uses Li Zhong Tang base to treat root, Gui Zhi to harmonize branch, Er Chen/Hou Po/Xing Ren to transform pathogens. A tightly woven formula.
Deng's Note: Seems Yin/Yang dual deficiency, but actually Dampness suppressing Heat. Yang trapped by Dampness cannot rise; Yin oppressed by Heat cannot endure. Prescribing focuses on expelling pathogens first, opening Dampness to reach Heat.
Spleen is Yin Earth, Stomach is Yang Earth. Yang Earth disease causes vomiting/nausea; Yin Earth disease causes diarrhea. They harm each other alternately. Currently vomiting stops, diarrhea continues, suggesting Spleen disease, not Stomach. But Spleen/Stomach are Earth, Wood attacks them. If not attacking Stomach to vomit, it attacks Spleen to cause diarrhea. Treat root: Root is Wood, soothe Wood first. Ensure both Earths are not attacked for correct treatment.
Li Zhong Tang, Wu Mei Wan, Wu Xian San (Wu Zhu Yu, Fu Ling) plus Bai Shao.
Yi's Note: Pathogenesis analysis is thorough; treatment selection is appropriate.
Deng's Comment: Complex diseases require deep thinking. This case should involve abdominal pain.
Sun's Comment: Should use Mu Gua.
Tongue is Heart sprout. Peeling coating for a long time indicates Heart Yin deficiency and Heart Yang excess.
Huang Lian E Jiao Tang minus Huang Qin, plus Da Sheng Di.
Yi's Note: Stomach Yin exhaustion often causes this. Heart Yin deficiency theory is also a valid approach.
Deng's Comment: Blaming peeling coating solely on Heart Yin suggests tongue must be crimson.
Wind Stroke Section
Residual symptoms of stroke-like illness: legs unable to bear weight, hands unable to lift objects, Chi pulse forceless. Yin and Yang both weak. Propose He Jian's Di Huang Yin Zi method.
Shu Di, Rong Rong, Chuan Fu, Niu Xi, Shi Hu, Yuan Zhi, Ba Ji, Gan Ju.
Deng's Comment: Forceless Chi pulse and weak Yin/Yang fit Di Huang Yin Zi. But stroke-like illnesses have Wind-Phlegm-Damp-Heat mixed with deficiency. Adding Bi Xie in paste and Scorpion tail in third visit confirms this.
Second Visit: Hand movement slightly improved, leg walking unchanged. Due to difficulty replenishing Yang Qi.
Liu Jun Zi Tang plus Shu Di, Ba Ji, Bai Shao, Chuan Fu, Hu Gu.
Paste Formula: Gui Shao Liu Jun Zi Wan plus Hu Gu, Ba Ji, Tu Si Zi, Rong Rong, Shou Wu, Du Zhong, Bi Xie.