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(Pain) Pain. Or pain in the chest and diaphragm. Or belching. Food is difficult to digest at night. Or leaning on objects with hands, leading to numbness after a long time. Often afraid of cold, not afraid of heat. Previously had hernia (Shan), posteriorly has internal hemorrhoids (Nei Zhi), which flare up upon exertion. Initial diagnosis: Left pulse is deep, weak, and slow; Right pulse is floating, soft, and powerless. Subsequent diagnoses every three to five days. Sometimes the Heart and Lung areas show floating and deficient pulses, which do not respond to pressure. Sometimes the Spleen pulse feels resistant to light pressure but insufficient upon heavy pressure. Sometimes rapid or slow, floating or deep, large or small, changing unpredictably. The pulse is unpredictable because Qi and Blood are deficient and follow the Fire pathogenic factor. It is like a hypocritical person who changes morning and evening without any consistency. Comparing the pulse with the syndrome, the deficiency is undeniable. Exertion consumes Qi and injures the Lung; Lung injury leads to hoarseness. Exertion also injures the Spleen; Spleen injury leads to food accumulation. The anterior hernia and posterior hemorrhoids that flare up upon exertion are all due to Qi consumption from exertion, Qi deficiency sinking downward, and failure of ascending and descending functions. Moreover, the Spleen likes warmth and dislikes cold, and the Lung also dislikes cold. Thus it is said: "Cold affecting the body and cold drinks injure the Lung." For the already injured Spleen and Lung, if further injured by cold-natured medicines, how can the voice not be hoarse? How can the tongue coating not appear? Tongue coating, Zhang Zhongjing called it Cold in the Stomach and Heat in the Dantian. Insomnia at night is due to the Son stealing Qi from the Mother, Heart Qi deficiency, and restless Shen. Blood streaks in phlegm are due to Spleen injury failing to secure Blood.

Chest pain and belching are due to Qi deficiency failing to promote transportation, causing food stagnation in the Middle Jiao leading to belching; or stagnation in the Upper Jiao leading to chest pain. Therefore, use Dangshen (Codonopsis Root) and Baizhu (Atractylodes Macrocephala Rhizome) 4 qian each, Maidong (Ophiopogon Tuber), Danggui (Angelica Sinensis Radix), and Zhebei Mu (Fritillaria Thunbergii Bulb) 1 qian each, Yuanzhi (Polygala Root), Zaoren (Ziziphus Seed), Danpi (Moutan Cortex), and Fushen (Poria with Hostwood) 8 fen each, Shichangpu (Acorus Tatarinowii Rhizome) and Gancao (Licorice Root) 5 fen each. If there is food stagnation, add Shanzha (Hawthorn Fruit) and Maiya (Hordeum Germinatum). Adjust according to the disease. Taken for over a year, gradually recovered. This disease belongs to Dryness-Heat, so Baizhu is not even dared to be used, let alone other drying agents.

Another case: A patient, over twenty years old, thin and frail complexion, suffering from hemoptysis. Doctors used Yin-nourishing, Fire-descending, and Dryness-clearing medicines, delaying for three years without improvement. Another doctor used Renshen Su Yin (Ginseng and Perilla Decoction) minus Renshen, and the condition worsened. Wang Ji diagnosed. Pulse was five beats per breath but fine. All syndromes were adverse and untreatable. Someone asked: "Five beats is a balanced pulse, why untreatable?" Wang said: "The Five Zang organs are exhausted, the Six Fu organs are depleted. Even if the Nine Pulses are harmonious, it is death." Looking at his form and syndrome, all belong to death omens. The Classics say: "Muscle depletion with severe heat leads to death. Cough with diarrhea and upper panting leads to death. Cough with inability to sleep on the left causing Liver distension, or inability to sleep on the right causing Lung distension, are all death syndromes." Now he violates all of them. Although he can eat, it does not nourish flesh and skin; he is close to death. Five days later, he indeed died. Anyone suffering from Consumption (Xu Lao) who violates the aforementioned syndromes, or coughs with hoarseness, throat pain preventing medicine/food intake, or coughs with anal bleeding, are all beyond rescue. Physicians must know this.

Yu Jiayan treated a person who habitually suffered from blood loss. One morning, suddenly vomiting violently, pouring out a basin of blood. Qi congested in the throat, spirit wandering, high fever as if steaming, neck tendons thick and stiff. Diagnosing the pulse, the Chi position was very chaotic. He said: "This is due to excessive sexual exertion last night." He examined the blood color, red like the sun. Returning to the bedroom, he said: "The Shaoyin meridian connects to the root of the tongue. Shaoyin is the Kidney. Now the Kidney's blood is gushing out, the tongue root is already stiff. No method can save this emergency. Reluctantly, I will use one dose of pill medicine to stabilize Yuan Qi. If Qi can return to the Dantian, we can plan slowly." So, decocted Renshen (Ginseng Root) soup strongly to swallow thirty pills of Heixi Dan (Black Tin Pill). Sound emerged from the throat, medicine gradually entered the lower abdomen. Soon the tongue became soft and able to speak, but no voice. Urgently used a moistening purgative agent to follow the previous medicine. Then gave Ejiao (Donkey-hide Gelatin) 1 liang dissolved, taken hot in three doses. Finished in half a day. Body heat gradually receded, neck tendons subsided. Started eating congee, given Kidney-tonifying medicine, adding Qushi (Mineral Salt), and recovered.

Shi Wan treated Tang Yuanzhou, a Ministry of Justice official, aged 82, with blood in phlegm. Various calming cough and stopping blood medicines were ineffective. Pulse at the Qi Kou position was hollow and large, both Chi positions slightly tight. Complexion withered and white. Repeated coughing could not expel phlegm; only when coughing severely did yellow clumped phlegm appear. This is simultaneous deficiency of Essence, Qi, and Spirit, combined with Heat injury consuming Jin Ye (Body Fluids), thus moving Lung and Stomach blood during coughing. Because he usually has much Fire and cannot tolerate warm tonification, Shi Wan used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) combined with Shengmai San (Generate the Pulse Powder) plus Weirui (Polygonatum Odoratum Rhizome), decocted into a paste. Taking advantage of Metal generating Water, nourishing source and flow, the hemoptysis naturally cleared. There was no need to use phlegm-blood medicines.

He also treated Qian Shuzhao, who suffered from chronic cough and hemoptysis for four or five days continuously. Occasional flushing and red face, sometimes vomiting basins or bowls full, sometimes pink phlegm. At night, fever and spontaneous sweating. One night, vomited a mass resembling fish intestines, mixed with fresh blood. Late afternoon, sudden continuous gushing, spirit dim and about to collapse.灌 Tongzi Xiaobian (Child's Urine) did not stop it. Colleagues consulted without strategy. Thinking that since the stagnant material had been expelled, it was time for strong tonification, Shi Wan urgently advanced Dushen Tang (Single Ginseng Decoction). Condition stabilized slightly. Because the pulse was rapid, frantic, and powerless, he added Rougui (Cinnamon Bark), Pa Jiang (Prepared Ginger), and a little Tongzi Xiaobian. Guiding the momentum to converge the rebellious Deficient Yang. Consumed two liang of Renshen in one night. Next morning, condition slightly stabilized, bleeding stopped, congee gradually ingested, pulse and respiration harmonized. Changed to Liuwei Dihuang Wan decocted as soup to tonify True Yin. Settled in half a month. Meanwhile, Hu Youzeng also suffered from Consumption and hemoptysis. One night, vomited a strip resembling a gecko, head and feet distinct, color like cherry. Died within half a day.

Lu Hui'an said: "In the past, I suffered from hemoptysis, gushing violently like a tide, lasting seven or eight days. Famous doctors in Wu could not stop it. Shen Siya from Yunjian, residing in Wu, was invited to treat me. He generously took responsibility. Asking for his prescription: Renshen 3 liang, Fuzi (Aconite Lateralis Radix Preparata) 1 liang, Rougui 1 qian. The whole family was panicked and confused, daring not use it lightly. Two days later, bleeding increased. Re-invited him. Asked to change to a milder formula. He said: 'The disease is more severe than before. The previous formula is exactly what needs adjustment to have effect.' Increased Renshen to 5 liang, Fuzi to 2 liang. Relatives were even more shocked. He said: 'Panting, vomiting, blood loss, continuing for days. Plus facial flushing and cold lower limbs. This is a sign of impending True Yang collapse. Life hangs by a breath. If medicine is not taken today, tomorrow it will be too late.' Nephews begged to reduce Renshen and Fuzi. He insisted firmly, urging bold administration. I sat waiting for success. Relatives saw my critical state and his willingness to wait, assuming safety. So we followed the prescription. He happily provided over twenty pieces of prepared Fuzi, chopped, weighing 2 liang as stated, with 5 liang Renshen. Decocted, added a large bowl of Tongzi Xiaobian and Dihuang juice, mixed with Rougui powder, taken cold. Shortly after taking, slight sweat appeared from lower limbs to feet, then fell into deep sleep. Upon waking, bleeding stopped, panting settled, body relaxed, gradually able to turn. Gave 12 taels of silver to conclude treatment, refused. Increased to 20 taels, then accepted. After recovery, Mr. Sheng Jianyuan saw the efficacy of one dose, deeply suspicious and amazed. Inquired that normally, when healthy, he constantly took about 1 liang of Renshen daily without interruption. Although now using 5 liang for strong tonification, boiled only briefly, the flavor not fully extracted, it could still suffice. As for blood syndromes, using 2 liang of Fuzi was unheard of since ancient times. Secretly sent to the medicine maker, who said he was accustomed to collecting Fuzi juice into Gancao. His Fuzi had been decocted over ten times. Although 2 liang was used, it was equivalent to only 2-3 qian of un-decocted Fuzi. Only then did I realize the techniques of physicians are such."

Feichou treated Xu Binxu, son of Su Tianruo. After new marriage, in mid-May, suddenly vomiting several sheng of blood. Invited at night, decoction not ready. Ordered decoction of Renshen 5 qian, mixed with Tongzi Xiaobian and administered. Next morning, all doctors gathered, believing Renshen tonifies and traps blood stasis, difficult to use lightly. Discussed using Shengdi (Rehmannia Root), Shanzhi (Gardenia Fruit), Niuxi (Achyranthes Root), etc. I said: "Six pulses are deficient, minute, and rapid. No stasis is known. Blood loss requires Qi tonification, a sage's established method. If you say Renshen tonifies stasis, do you not consider that Blood coagulates with Cold, causing future trouble? Now the spirit has no master, turning causes fainting. Without strong Renshen, how to secure the collapsing Yuan Qi?" So administered 1 liang of Renshen. After two doses, instantly peaceful. Then alternated Sizijun Zi Tang (Four Gentlemen Decoction), Baoyuan Tang (Preserve Origin Decoction), and Liuwei Dihuang Wan. Later regulated with Wuguji Wan (Black Bone Chicken Pill) and recovered.