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Xu Zhuofeng was a person who consumed much alcohol and was prone to anger. He presented with hematemesis (vomiting blood) from above, hematuria (blood in urine) from below, coughing, and hoarseness. A clan physician diagnosed it as Zhai (consumption/tuberculosis) and declined treatment. I was invited to examine him. His left Guan pulse was wiry and large; his right Cun pulse, at the lower half of the finger position, felt clustered like Coicis Semen (Job's tears). I said: This is a syndrome of excess. Treating it as consumption is incorrect. Someone questioned me, saying: Everyone considers this case to be consumption, yet you alone say it is not. However, why does loss of blood lead to hoarseness? I replied: He has a fondness for wine. Wine belongs to damp-heat and aids fire to generate phlegm. The nature of fire is flaming upward, forcing Lung Qi to fail to descend. Accumulation generates phlegm, which obstructs the Lung orifices. The Lung corresponds to Metal and governs voice. As the classics state: "When metal is hollow, it rings." If metal is obstructed and blocked, then hoarseness occurs. This is hoarseness due to phlegm obstruction, not hoarseness due to Fei Wei (withered lung). His temperament is also prone to anger. The *Neijing* states: "Anger injures the Liver; severely, it causes vomiting blood and downward discharge." Since blood follows Qi, when Qi moves recklessly, blood follows recklessly and fails to return to its vessels, hence vomiting from above and urinating blood from below. The method should be to clear heat, resolve depression, transform phlegm, and guide blood back to its origin. The illness can be cured within half a month. If one treats it as consumption and uses herbs such as Rehmanniae Radix (Shu Di Huang), Asparagi Rhizoma (Tian Dong), Ophiopogonis Radix (Mai Dong), Achyranthis Bidentatae Radix (Niu Xi), and Corni Fructus (Shan Zhu Yu), it will worsen the obstruction and increase heat. How can the voice recover? Blood follows Qi; if Qi is not cleared and settled, how can blood return to its origin? You gentlemen observe. I used Talcum (Huashi) and Artemisiae Annuae Herba (Qinghao) to resolve alcohol-heat as sovereign drugs; Fritillariae Bulbus (Beimu), Curcumae Radix (Yujin), Gossampini Semen (Shanzhiren), and Cyperi Rhizoma (Xiangfu) to resolve depression as minister drugs; Armeniacae Semen Amarum (Xingren) and Platycodonis Radix (Jiegeng) combined with Beimu to transform phlegm as assistant drugs; Moutan Cortex (Danpi), Salviae Miltiorrhizae Radix (Danshen), Cirsii Japonici Herba (Xiaoji), and Glycyrrhizae Radix et Rhizoma (Gancao) to guide blood to its origin as envoy drugs. After taking ten doses, the blood indeed returned to its origin. Then, I used one liang of Beimu, soaked in child's urine for one day, ground into powder, mixed equally with Diospyros Fruit Frost (Shishuang), taken frequently and melted on the tongue. Within five days, the voice became clear and bright. The total time did not exceed half a month.

My clan sister-in-law, Lady Junru, was sixty years old and had been a widow for over ten years. She suffered from dysentery with both red and white discharge, slight abdominal pain, occurring more than twenty times day and night. She vomited phlegm and saliva and had not eaten a single grain of rice for two months. Daily, she only drank eggs beaten into thin white wine. Her muscles wasted away completely, and various medicines were ineffective. Upon my return, I examined her. All six pulses were slippery and rapid. I determined it was caused by damp-heat, phlegm, and fire. I prescribed Erchen Tang added with Yiyuan San, Coptidis Rhizoma (Huanglian) stir-fried with ginger juice, and Scutellariae Radix (Huangqin). After taking nearly forty doses, the vomiting stopped and the dysentery healed. Her condition was nearly critical. The reason I could treat her successfully was relying on the preservation of her Shen (Spirit). Only when Shen is preserved, even if Xingqi (form and Qi) are insufficient and there is no food intake, death can still be avoided. This is what a physician must observe.