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In the late part of mid-autumn in the Jiawu year, Mr. Huang Yuanjin came to find me at the market because his wife was critically ill. His appearance was very tragic; he trembled while walking and standing, and spoke with a hesitant and sluggish tongue due to overwhelming sorrow. He handed me the diagnosis from the local physician and said, "My wife began vomiting blood (hematemesis) in excess of two bowls since mid-summer. Initially, the doctor prescribed large doses of cold-natured herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), Phellodendri Cortex (Huangbai), Rehmanniae Radix Preparata (Shengdi), and Paeoniae Radix Alba (Shaoyao). After one dose, the bleeding stopped, but soon after, she developed coughing day and night. Later, following advice that coughing after hematemesis should be treated by nourishing yin and descending fire, we used this method for over two months without effect. Instead, her symptoms worsened with panting and diarrhea, fever during the Chen and Si hours (7:00–11:00 AM), and irritability. The previous physician claimed exhaustion of skill, stating that the panting and coughing were due to fire insulting the Metal of the Lung, and the diarrhea indicated exhaustion of the Spleen and Stomach. Protecting the Spleen would intensify the fire and increase coughing/panting; nourishing yin would cause continuous diarrhea and collapse of primal qi. The classics state that coughing accompanied by lower diarrhea and upper panting is a death sentence; this case fits that description. It seems hopeless." Saying this, tears streamed down his face. Seeing his anxious demeanor, I felt a sudden alarm in my heart. The market was about five li from his home, so I walked there to examine her. Her complexion was greenish; she panted with raised shoulders and contracted neck, breathing rapidly involving the whole body, with pain in the hypochondrium and back, unable to lie down day or night. Her pulse was choppy on the left, and slippery and large on the right Cun and Guan positions. After diagnosis, seeing her brother still tearful, I patted his back and said, "Do not cry; she can still be saved."

Xu Zhongzi happened to be visiting with me and asked, "Given these severe symptoms, why do you say she can be saved?" I replied, "This is beyond your understanding. Just observe my treatment; I will tell you when it takes effect." I prescribed a decoction of Asteris Herba (Ziwan), Rubiae Radix et Rhizoma (Qiangen), Moutan Cortex (Mudanpi), Persicae Semen (Taoren), Yi Yuan San, Morus Albae Cortex Radicis (Sangbaipi), Poria (Fuling), Platycodonis Radix (Jiegeng), Trichosanthis Semen (Gualouren), Cinnamomi Ramulus (Guizhi), and Polygoni Multiflori Caulis (Baiqian), boiled in water. Before administration, half a wine glass of Chinese Chive Juice (Jiucai Zhi) was added. After taking this, the back and hypochondriac pain ceased, diarrhea reduced by half, and she could sleep, though her voice remained hoarse from coughing.

The next prescription included Armeniacae Semen Amarum (Xingren), Platycodonis Radix (Jiegeng), Asteris Herba (Ziwan), Glycyrrhizae Radix et Rhizoma (Gancao), Polygoni Multiflori Caulis (Baiqian), Schisandrae Fructus (Wuweizi), Trichosanthis Fructus (Gualou), Zingiberis Rhizoma (Ganjiang), Farfarae Flos (Kuandonghua), Perillae Fructus Fermentatus (Banxia Qu), and Tectonae Herba (Tongcao), boiled in water. After this, her voice gradually recovered, diarrhea completely stopped, but coughing persisted. A third prescription used Perillae Fructus Fermentatus (Banxia Qu), Platycodonis Radix (Jiegeng), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), Armeniacae Semen Amarum (Xingren), Morus Albae Cortex Radicis (Sangbaipi), Polygoni Multiflori Caulis (Baiqian), Coicis Semen (Yiren), Paeoniae Radix Alba (Baishao), and Moutan Cortex (Mudanpi). Finally, using Zhu Danxi's formula for coughing with hematemesis, I prescribed Baidu San (Clear the White Powder) augmented with Aurantii Fructus (Qingpi), Ginseng Radix et Rhizoma (Renshen), Poria (Baifuling), Schisandrae Fructus (Wuweizi). She recovered after conditioning and gave birth to a son the following year. In this case, Xu Zhongzi contributed significantly, as Mr. Huang was his friend. Xu Zhongzi often achieved miraculous results in treating diseases and trusted me highly, recommending me. When I first administered the medicine, many people criticized it, but Xu Zhongzi alone praised it, saying, "He must have profound insight. Everyone else retreated, yet he believes she can be saved; how can we not hope for life?" Thus, Mr. Huang trusted me exclusively.

After success, Yu Mingfu and Zha Zhongxiu asked me, "The illness started with hematemesis. Fever, irritability, panting, and coughing are all signs of Fire pathogen. The previous physicians used methods to nourish yin and descend fire, which seemed correct, yet the condition worsened. Why?" I answered, "For a physician, prescribing medicine is not difficult; recognizing the disease is." They said, "People criticize you for not following standard formulas and relying on subjective judgment. In Mr. Huang's case, everyone viewed it as a Fire syndrome and used cold-cooling herbs. You alone used warm herbs. Although successful, some fear for your reputation." I said, "The root cause was Fire, but the severity resulted from overly harsh treatment. When blood first gushed, it was like a spring; how could one episode of vomiting clear it all? Residual blood must have remained trapped in the collaterals. Overlooking this, the physician used a large cold-dose to stop bleeding instantly. Large cold agents cannot truly stop bleeding; they merely congeal the blood. Blood congealed in collaterals obstructs the airway. Qi stagnation and blood stasis worsened daily. Qi stagnation generated phlegm. With both phlegm and blood stasis blocking the collaterals, Lung Qi became obstructed, causing coughing and hoarseness. Without examining this, if one applies phlegm-resolving and blood-stasis-dispelling methods but simultaneously uses yin-nourishing and bitter-cold agents, the phlegm and stasis become more congealed, and the airway more obstructed. Eventually, Stomach cold and Spleen weakness caused diarrhea, and day-night panting prevented lying down. The classics state: 'If upper heat is not cleared and middle cold arises, Yin excess repels Yang,' leading to coughing and vomiting. Therefore, I initially used Guizhi and Ganjiang to warm the Stomach, and Taoren, Jiucai Zhi, Mudanpi, and Qiangen to invigorate blood and resolve stasis. Hence, panting stopped and diarrhea ceased. Li Dongyuan said: 'The Spleen and Stomach prefer warmth and dislike cold.' This is true. Ancients said: Medicine is not valued for adhering rigidly to formulas, but for appropriateness. A formula is like a military formation or a carpenter's compass and square. Formations can be taught, but not the art of battle; compasses can be taught, but not craftsmanship. As Yue Fei told Zong Ze, 'The subtlety of application lies in the mind.' Though I operate outside worldly constraints, I do not violate medical principles. Only by maintaining principles can one truly understand formulas. Understanding formulas and aligning with principles is not something ordinary people can achieve. Ancient physicians could extend the lives of those with deficiency-fatigue syndromes (Xu Que) by three to five years, even in untreatable cases. Today, patients with deficiency-fatigue die within half a year, blaming the 'Heavenly Origin Luck' (Tianyuan Yunqi). But does luck affect everyone equally? My mother lived to 86, my father nearly 90, my aunt 95, and my cousin Wang Chunyuan's father over 90, all vigorous as youths. The cause of premature death is the error of nourishing yin and descending fire, not Heaven's fault. This method originated with Zhu Danxi, promoted by Wang Jiezhai and He Daying, becoming a widespread trend—a major flaw today that people ignore. My master ancestor, Mr. Wang Shishan, exposed this error, but few followed. One voice amidst many opposing ones makes the harm of yin-nourishing persist endlessly. Remember this, Xu Zhongzi."

Zha Zhongxiu asked again, "How did you determine this was Middle Cold rather than Yin-deficiency Fire, and why attribute the panting to blood stasis?" I said, "Pulse and symptoms provide evidence. The *Mai Jing* states: 'Choppy pulse indicates Qi stagnation; Qi stagnation leads to blood stasis.' After massive hematemesis, a single dose of large cold medicine stopped the flow, congealing residual blood. This congealed blood obstructed the airway, causing panting. The classics say: 'What comes from before is Root; what comes from after is Branch.' Here, I treated the Root with blood-invigorating and stasis-resolving agents, and the Branch with warm Stomach agents. Hence, diarrhea stopped and panting settled. If it were Yin-deficiency Fire moving, the pulse would be fine and rapid. Here, the pulse is slippery and large, not indicative of Yin deficiency. Symptoms of Yin-deficiency panting/cough include tidal fever at night and red cheeks. Here, fever occurred in the Yang hours (Chen/Si), and the complexion was greenish. Thus, it was not Yin-deficiency Fire, but Fire agitated upward by misused cold-cooling herbs. The classics say: 'Water flows to dampness, Fire moves to dryness.' With Middle Jiao cold, Fire cannot descend, just as lightning flashes brighter in storms but fades at sunrise. Also, Yin-deficiency Fire rises from the Yongquan point (KI 1) upwards. Here, knees were cold while upper body was hot, and Chi pulses were weak, likely due to Qi rising from coughing. The classics say: 'Cold form and cold drinks injure the Lung.' Lung Qi was blocked by cold herbs, unable to descend, causing coughing and sour regurgitation. *Danxi Zuanyao* states: 'Yin Qi is below, Yang Qi is above.' For panting, coughing, and vomiting, I used Baidu San plus Renshen, Fuling, Wuweizi, and Qingpi. I did not follow Liu Wansu’s view that 'all vomiting and sour regurgitation belong to Fire.' Moreover, in the Jiawu year, Wet Earth governed the luck cycle. August (You month) is a time of declining Water and Earth. The *Neijing* says: 'Do not violate seasons; do not replace transformation.' The Spleen dislikes dampness; excessive dampness causes diarrhea and generates phlegm. Previous physicians ignored seasonal luck, blindly using yin-nourishing and fire-descending herbs, promoting dampness and phlegm. How could phlegm resolve then? *Danxi Zuanyao* says: 'Solidify Spleen Earth, dry Spleen Dampness—this is the root of treating phlegm.' Following this principle yielded immediate results, like a drum responding to a beat. Thus, I say: Recognizing the disease is harder than prescribing medicine."