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Left. The patient's constitution is characterized by excessive dampness and phlegm. After contracting wind-pathogen, which invaded the Lung and Stomach, latent fluid retention was triggered by coughing, causing the cough to worsen daily. There is pain in the right hypochondrium, turbid phlegm pervades the body, the Spirit mechanism fails to operate, and consciousness is confused. After repeatedly resolving turbid phlegm, the mental state gradually clarifies. As for the various transformations of phlegm-dampness: when it obstructs Ying and Wei (Nutritive and Defensive levels), it leads to alternating chills and fever; when it stagnates and steams the Middle Qi, grey mold-like coating appears on the tongue; when it impairs Spleen Yang and the Spleen Earth fails to transform and circulate, dry stool results; when the turbid within the clear does not descend and the clear within the turbid does not ascend, dryness ensues. These variations are manifold. Although the wind on the body surface has transformed into rashes and reached outward, the damp-phlegm remains internally constrained. Therefore, after the disease recedes, fatigue persists. Gradually, Qi obstruction and dampness sinking occur, with fullness in the lower abdomen suddenly rising from above, not only entering the abdomen past the umbilicus but also reaching the chest and epigastrium, causing a feeling of distension and pressure after eating. The Right Cun pulse is fine and choppy, the Guan position is wiry and slippery, the Chi position is deep and weak, and all three positions on the Left side appear small and weak. All these are due to the Spleen being trapped by dampness, preventing Yang Qi from circulating normally. Earth stagnation prevents Wood from dispersing freely. Consequently, dampness flowing downward reverses its course along the ascending Qi on the left, blocking the circulation mechanism of the intestines and stomach, leading to the sensation of distension and swelling. Lower pathology affecting the middle makes treatment difficult. The proposed method is to soothe Liver Wood, drain turbidity from the Fu organs, and invigorate Spleen Yang, hoping for gradual improvement in urination, free flow of dampness, and unobstructed Qi movement, which would be good news.
Dried Evodia Fruit (3 fen, soaked in honey water, removed, dried, then stir-fried with salt water)
Xia Tian Qu (2 qian, stir-fried)
Stir-bran fried Aurantium Fruit (1 qian)
Guang Chenpi (Citrus reticulata peel, 1 qian, soaked in honey water, then stir-fried with aged wall soil)
Toosendan Fruit (1.5 qian)
Poria with Skin (5 qian)
Salt-water stir-fried Cyperus Rhizome (1.5 qian)
Polyporus (2 qian)
Alisma Rhizome (1.5 qian)
Gallus Gallus Internal Golden Membrane (1 piece, roasted, powdered, taken with liquid)
Xiao Wen Zhong Wan (Minor Warming the Middle Pill, 3 qian, mixed with boiling water first)

Shen (Left). Previously suffering from fluid retention, during the transition between spring and summer, the spirit is listless, the body feels cold, appetite is poor. The Right pulse is soggy and slippery, tongue coating is slippery and moist. This is due to damp-phlegm accumulation and obstruction, preventing Spleen Yang from being inspired, thus Yang Qi cannot distribute evenly. Treat with Liu Jun Zi Tang (Six Gentlemen Decoction) modified.
Codonopsis Root (8 fen, decocted separately and added to the mixture)
Aged Tangerine Peel (1 qian)
Poria (3 qian)
Dried Ginger (4 fen)
Stir-fried Atractylodes Macrocephala Rhizome (1.5 qian)
Prepared Pinellia Tuber (1.5 qian)
Roasted Licorice Root (3 fen)
Scorched Barley Sprout (1 qian)

Second visit. Middle Jiao deficiency with internal damp-phlegm obstruction, lingering for a long time. Both Stomach Qi and Stomach Yin are damaged. The Spleen is Yin Earth, the Stomach is Yang Earth. Yin Earth requires Yang to function, and Yang Earth requires Yin to harmonize. Now there is no intake or hunger, nausea with desire to vomit, sticky and thick phlegm. Pulse is fine and wiry; the Right side is larger than the Left, the Left side feels slightly fine and soft, with a rapid tendency. Tongue has little coating, center is bare and red. This is because prolonged illness has prevented Stomach Qi recovery, and Stomach Yin has become deficient by association, leading to disharmony of the Yangming channel and loss of descending function. Propose a sweet-cool method to benefit the Stomach.
American Ginseng Root (1.5 qian, stir-fried with rice)
Sweet Apricot Kernel (3 qian)
Poria with Hostwood (3 qian)
Pinellia Fermented Paste (2 qian, stir-fried with salt water)
Dendrobium Stem (3 qian)
Raw Coix Seed Husk (3 qian)
Salt-water stir-fried Bamboo Shavings (1 qian)
Fresh Reed Rhizome (7 qian)
Master said: Superficially, this might seem like a case for Ren Shen Yi Zhi Ban Xia Xie Xin Ju Pi Zhu Ru patterns. However, the bare red tongue and wiry-rapid pulse clearly indicate Stomach Yin deficiency, so sweet-cool nourishment of the Stomach is appropriate. (Zheng Meng Zhi)

Xu (Right). Yin deficiency in the lower part, with deficient fire floating upward. Single barking cough, sputum is greenish-blue. Nourish Yin to subdue Yang Qi; once Yang Qi is calm, dizziness will resolve.
Rehmannia Root (4 qian)
Moutan Cortex (2 qian)
Fritillaria Bulb (2 qian)
Black Soybean Coat (3 qian)
Tribulus Fruit (3 qian)
Asparagus Tuber (3 qian)
Clam Shell Powder (3 qian)
Chrysanthemum Flower (1.5 qian)
Sepia Cuttlebone (6 qian)

Left. During the period when Ministerial Fire is active, deficient fire rises and falls intermittently. When it rises, it refines fluids into phlegm, steaming the Lungs and Stomach. Throat pain occurs intermittently, with abundant, sticky phlegm. The pathogen has penetrated deeply, making treatment difficult. Tentatively prescribe phlegm-resolving herbs to reduce the steaming effect.
Glehnia Root (4 qian)
Clam Shell Powder (3 qian)
Raw Oyster Shell (5 qian)
Poria (3 qian)
Sepia Cuttlebone (1 liang)
Dendrobium Stem (4 qian)
Fritillaria Bulb (3 qian)
Trichosanthes Root (2 qian)
Bamboo Sap (1 liang)
Large Water Chestnut (4 pieces)

Lv (Left). Chronic condition involving "Zi Xia" (likely referring to specific symptoms or signs), damaging Qi over time. Weak Qi fails to transport, accumulating fluid into phlegm, obstructing Lung descent. Cough produces copious sputum filling a bowl. Pulse is deep and wiry. Although it presents as fluid retention, dry cough usually precedes the abundance of phlegm. Lung Metal is gradually drying up, potentially developing into Phlegm-Fire syndrome.
Fritillaria Bulb (3 qian)
Platycodon Root (2 qian)
Perilla Seed (3 qian)
Bamboo Sap Prepared Pinellia (1.5 qian)
Aurantium Fruit (0.7 qian)
Polygonatum Rhizome (3 qian)
Poria (3 qian)
White Honey (1.5 qian)
Tangerine Peel (1 qian)
Old Ginger (1.5 qian, last two ingredients lightly boiled in water, dried, then added to decoction)

Second visit. Using Shi Wen Lao Ren's method. Cough and abundant phlegm persist, worsening during Yin-Mao hours (5-9 AM), accompanied by irritability and sweating. Pulse is very wiry with slight rapidity. Yin essence is deficient below, Phlegm-Qi harasses above, Chong Qi carries phlegm upward, hence worsening at Yin-Mao hours. Greasy herbs are difficult to administer; treat upper and lower separately.
Polygonatum Rhizome (3 qian)
Plantago Seed (1.5 qian)
Winter Melon Seed (3 qian)
Stir-fried Perilla Seed (1.5 qian)
Fritillaria (1 qian)
Achyrantes Root (3 qian, stir-fried with salt water)
White Poria (3 qian)
Clam Shell Powder (3 qian)
Ji Sheng Shen Qi Wan (Kidney Qi Pill for Saving the Generation, 3 qian, taken with light salt water)

Third visit. Replenish Yin in Water, assist Fire in Water, remove stagnation in Water. Cough at Yin-Mao hours has decreased, phlegm is lessening. Continue treating upper and lower separately.
Prepared Pinellia Tuber (1.5 qian)
Stir-fried Perilla Seed (1 qian)
Achyrantes Root (3 qian, wine-fried)
Plantago Seed (2 qian, stir-fried with salt water)
Thin Tangerine Peel (1 qian)
White Poria (3 qian)
Purple Clam Shell (5 qian)
Stir-fried Sweet Apricot Kernel (3 qian)
Ji Sheng Shen Qi Wan (3 qian, taken with light salt water)

Fourth visit. Phlegm-cough is gradually lightening. It truly belongs to Kidney deficiency failing to draw Lung Qi downward. Mr. Jian Bin stated that Shu Di Huang (Prepared Rehmannia) is the holy medicine for resolving phlegm. Although his view may be biased, it is not without merit.
Stir-fried Cornus Fruit (2 qian)
White Poria (3 qian)
Plantago Seed (3 qian, stir-fried with salt water)
Stir-fried Sweet Apricot Kernel (3 qian)
Chinese Yam (3 qian)
Purple Clam Shell (5 qian)
Achyrantes Root (3 qian, stir-fried with salt water)
Qi Wei Du Qi Wan (Seven-Ingredient Pill to Restore Kidney Qi, 3 qian)
Ji Sheng Shen Qi Wan (2 qian, combined with the previous pill, divided into two doses)

Chen (Right). One Yang is about to recover, Yang Qi rises, Wood attacks Earth. After dysentery, Qi mechanism is disharmonious, occasionally accompanied by confusion, with abundant thick phlegm. Residual power of Liver Wood is not yet pacified, and misty Phlegm-Qi is not resolved. Propose to pacify Liver and resolve phlegm.
Chaenomeles Fruit (1.5 qian, sliced)
Tangerine Peel (1 qian)
Stir-fried Bamboo Shavings (1 qian)
Clam Shell Powder (3 qian, wrapped)
Prepared Cyperus Rhizome (2 qian, pounded)
Cloud Poria (3 qian)
Aged Arisaema with Bile (0.5 fen)
Bamboo Sap Prepared Pinellia (1.5 qian)
Light Evodia Fruit (2 fen)
Coptis Rhizome (5 fen, stir-fried together with Evodia)

Second visit. Liver Heat surges upward, confusion persists. In the clear and open areas, Phlegm-Heat pervades, causing heavy confusion. Again, drain heat and resolve phlegm.
Salt-treated Pinellia Tuber (1.5 qian)
Broad Orange Peel (1 qian)
Gardenia Fruit (3 qian)
Stir-fried Bamboo Shavings (1 qian)
Stir-fried Trichosanthes Peel (3 qian)
Moutan Cortex (2 qian)
White Poria (3 qian)
Chinese Wheat Grain (3 qian)
Stir-fried Sweet Apricot Kernel (3 qian)
Mulberry Leaf (1 qian)
Coptis Rhizome (4 fen)
Rice Sprout (2 qian)

Unknown. Phlegm and Qi intersect and obstruct Yangming. Epigastric bloating after eating. Upon attack, all Qi becomes closed and depressed, unable to vomit upward or defecate downward. Pulse is wiry and slippery. Dry mouth and thirst, Fire arises from Qi transformation, Qi is blocked by Phlegm. Resolve phlegm and open depression.
Fermented Soybean (3 qian)
Curcuma Aromatica Rhizome (1.5 qian)
Apricot Kernel Paste (3 qian)
Immature Bitter Orange (1 qian)
Gardenia Fruit (2 qian)
Poria (4 qian)
Salt-water stir-fried Bamboo Shavings (1 qian)
Bai Jin Wan (White Gold Pill, 0.5 fen)
Trichosanthes Peel (4 qian)
Loquat Leaf (4 pieces)
During attacks, take Dang Gui Long Hui Wan (1 qian) and Meng Shi Gun Tan Wan (2 qian) with boiling water.

Unknown. Liver and Kidney are empty, unable to store and receive. Yin essence has not recovered, Middle Qi is again deficient, resulting in loss of rotational power. Damp-phlegm is hard to transport, obstructing below the Lungs, causing rebellious Qi and shortness of breath. Phlegm obstructs above, dampness tends downward, causing swelling in both calves. Frequently administering Kidney-tonifying and anchoring prescriptions yields little relief. Indeed, anchoring herbs cannot resolve phlegm; while the Kidney desires reception, the Lung does not descend, creating many obstacles. If we switch entirely to descending Lung and resolving phlegm agents, we fear opening the upper will further deplete the lower. Pulse is deficient and wiry, Right side soggy and slippery. This matches Mr. Shi Wen's description of Phlegm-Fire syndrome. We fear being caught between two extremes, failing to control its spread.
Stir-fried Polygonatum Rhizome (3 qian)
Raw Licorice Root (0.7 qian)
Cloud Poria (4 qian)
Broad Orange Peel (2 qian)
Raw Coix Seed (7 qian)
Fritillaria Bulb (3 qian, heart removed)
Bitter Platycodon Root (1 qian)
Aster Root (2 qian, honey-roasted)
Fresh Ginger (3 qian, honey-roasted)
Winter Melon Peel (1 liang, stir-fried with two other ingredients to decoct as water substitute)

Qiu (Left). Wind contraction is gradually resolving, retained fluid and old phlegm are emerging successively. However, Qi is insufficient to push, and fluids are insufficient to lubricate. Zhang Jian Bin stated that Shu Di Huang is the holy medicine for resolving phlegm, which implies this meaning. Otherwise, how could Rehmannia resolve phlegm? The previous method had minor deviations,不宜 changing it now.
Shangdang Codonopsis Root (3 qian, stir-fried with rice)
Roasted Rehmannia Root (5 qian)
Poria and Poria with Hostwood (2 qian each)
Plantago Seed (1.5 qian)
Raw Atractylodes Macrocephala Rhizome (2 qian)
Roasted Turtle Shell (5 qian)
Clam Shell Powder (3 qian)
Strong Eucommia Bark (3 qian)
Moutan Cortex (2 qian)

Li (Left). According to the history, initially fatigue, gradually progressing to aphonia. The Classics say: Spleen disease causes limbs to be unusable; unusable means weakness. Progressing from fatigue to aphonia seems unlike Spleen disease. Little do they know that dampness traps the Spleen and accumulates in the Stomach, with damp-heat steaming upward to the Lungs. Lung heat prevents voice projection. At that time, it should be compared to the example of Metal being scorched by Fire and thus not sounding. Feet are weak, comparable to the example of Spleen-Stomach damp-heat steaming upward, Lung heat scorching leaves, leading to flaccidity syndrome. Although not the exact diagnosis, it can be understood intuitively. Reading the prescription, using Bai Shao (Peony Root) immediately lowered the voice due to its astringent nature. Lung and Spleen are simultaneously diseased. Lung is Dry Metal, so for damp-heat, acrid-warm herbs should be advanced. At this juncture, it seems appropriate to circulate and transform Qi mechanism, clear and transform damp-heat, and expand/clear the steaming inflammation. However, repeated administration of Ginseng and Astragalus, frequent use of Winter Anemone and Rehmannia caused damp-heat to stagnate and fail to move. Gradually, Ying and Wei throughout the body became depressed. Bowel movement every seven to eight days, chest and abdomen knotted, mass in lower abdomen, formless upon palpation, swelling of scrotum and feet, difficulty breathing. Strange changes are all due to Wei Qi depression. Depression causes Qi stagnation, stagnation prevents movement, how else could such manifestations occur? Ma Huang opens Lung Qi, hence initial small efficacy, but lacking the ability to clear Spleen-Stomach damp-heat, it worked initially but failed ultimately. Nan Xing and Ban Xia dispel damp-phlegm but have the drawback of damaging Lung Yin, hence dryness felt after taking them. Our Liver combines with Spleen to ascend, Gallbladder combines with Stomach to descend. Since Wei Qi is depressed, how can Stomach Earth descend? If Stomach Earth does not descend, Gallbladder Qi cannot descend alone. Thus, there is only Liver Wood ascending, but no Gallbladder Wood descending, causing blurry vision, dizziness, and vigorous Liver Yang. Later methods from Jin Gui were used, seeming to narrow the mind, fearing sudden syncope or collapse. Better to stop medication temporarily. After half a month, administer my proposed prescription for seven to eight doses to observe dynamics. In short, better to miss one dose than take a wrong one. Use only if there is a precise and stable method; otherwise, abstain. Asking about illness and prescribing medicine feels vague. I wonder if my confidant agrees. My frankness may be disliked by colleagues, but I borrow this paper to speak face-to-face.
Stemona Bulb (3 qian)
Trichosanthes Root (2 qian)
Zhen Jian Qu (Medicated Leaven, 2 qian)
Chuanxiong Rhizome (1 qian)
Mulberry Frost Leaf (1 qian)
Curcuma Aromatica Rhizome (3 qian)
Prepared Cyperus Rhizome (3 qian)
Moutan Cortex (2 qian)
Salt-water stir-fried Broad Orange Peel (1.5 qian)