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[Formulas: Jisheng Shenqi Tang (Kidney Qi Decoction for Production) / Xiaojianzhong Tang (Minor Construct the Middle Decoction)]

Yang qi has states of opening and closing, allowing qi to flow, circulate, and be unobstructed. Shaoyang (Lesser Yang) serves as a pivot, and Shaoyin (Lesser Yin) also serves as a pivot. Regarding the abnormal opening and closing of yang qi, it is not only due to weak yang qi, but also because Shaoyin is depleted. Since the Kidneys cannot transform qi, if one further uses lung-targeting drugs that damage true qi, then only Jisheng Shenqi Tang (Kidney Qi Decoction for Production) is suitable.

Patient Shen (33 years old), in early spring when it was still cold, the lake water dried up requiring excavation. Due to heavy labor such as carrying loads, living in a cold and damp place, this led to internal injury from exhaustion, weak qi with aggravated cough, alternating chills and fever. At this time, dispersing and clearing lung methods are strictly contraindicated (Dispersing and clearing lungs to treat cough is not wrong, yet it has killed many people.)

Patient Yu (from Qimen, 28 years old), qi attacks from the lower abdomen to the epigastrium causing pain, then gradually descends and dissipates. Inquiry reveals the illness stems from fright, originating from rebellious qi of the Liver and Kidneys.
Referring to Zhang Zhongjing’s examples of Jueyin disease, pure rigid [yang-warming] methods are not used alone (The method follows *Jingui Yaolue*: sour astringency, pungent opening, bitter descending.)
Prescription: Wumei (Mume Fruit), Baiji (Chinese Knotweed Rhizome), Chuanjiao (Sichuan Pepper), Chuanlianzi (Golden Rain Tree Fruit), Guizhi (Cinnamon Twig), Dan Jiangjiang (Light Dried Ginger).

Patient Shen (35 years old), this cough is caused by fluid retention knotting in collateral branches. Treating the Lung is ineffective. Recently, anger caused vomiting and rebellious qi, chills and fever persisted for a month, profuse sweating without thirst, pale white tongue, body pain偏向 left side, throat itching inevitably causes cough (For fluid retention knotting in collateral branches, use moistening and clearing methods, not pungent-unblocking methods, lest it force dryness and heat.)
Prescription: Yuzhu (Polygonatum Rhizome), Dashashen (Glehnia Root), Miren (Coix Seed), Sheng Cao (Raw Licorice Root), Bian Dou (Lablab Bean), Fuling (Poria).

Patient Jin (from Meidun, 24 years old), thin individuals easily become dry and prone to heat. Nourishing Stomach yin and harmonizing Liver yang can be taken for a long time (Nourishing Stomach yin is essentially harmonizing Liver yang; they should not be treated separately.)
Prescription: Da Shengdi (Rehmannia Root), Qing Ejiao (Donkey-Hide Gelatin), Dan Tiantong (Asparagus Fern Stem), Beishashen (Glehnia Root), Mahuang (Ephedra Herb - *Note: Text says Mahuang but context implies Hemp seed or similar, likely Mahong/Mahong Ren given list, actually text says Mahong/Ren? Text says "Ma Ren" usually Hemp Seed, here "Ma Ren"* -> Mahong (Hemp Seed), Baishao (White Peony Root).

Patient You (from Qimen, 43 years old), the chest belongs to the upper half of the body, which is where yang qi flows. It is said that occasional blockage occurs, and belching brings relief. Previous medicines all used cloying blood-nourishing herbs like Cornus and Rehmannia. Moreover, middle-aged physical labor easily damages qi (The disease involves qi damage. Instead of using pungent-warm tonifying-unblocking methods, loose-moistening and regulating methods were used. The treatment deviates from the norm, containing profound meaning.)
Take Sangma Wan (Mulberry and Cannabis Pill) in the morning, and Weixi Wan (Weiyi Pill) at night.
Qi in the meridians must rely on body fluids to circulate. When fluids are sufficient, flow is smooth; when fluids are depleted, qi becomes stagnant. Others regulating qi always use pungent-dry drugs to open pathways, only Ye Tianshi deeply understands that qi relies on blood to move, so he often uses drugs to replenish fluids, adding slightly to promote stagnation and benefit qi movement.

Patient Hu (22 years old), Kidney deficiency with spermatorrhea. In autumn and winter last year, filling yin and securing retention methods were effective. Entering spring and summer, spermatorrhea recurred, acid regurgitation, lack of appetite, excessive phlegm and vomiting. Clearly, Stomach qi is rebellious with heat constraint, and cleaning/clearing methods are prioritized (The Kidney is the gate of the Stomach. If the gate is empty, turbid yang rebels upward, Stomach qi also rebels, with constrained heat damaging the middle jiao.)
Prescription: Chuanlian (Coptis Rhizome), Jiegeng (Platycodon Root), Guang Huogen (Patchouli Stem), Yiyiren (Coix Seed), Ju Bai (Tangerine White Pith), Baokouren (Amomum Fruit Seed).
Previously had chronic spermatorrhea, effectively treated with filling yin and securing retention. Now entering spring and summer, recurrence with acid regurgitation and lack of appetite indicates Yangming involvement with damp-heat. Heat fails to disperse, steaming phlegm causing vomiting. This is distinct from the previous condition; consult again when convenient.

Patient Cao (34 years old), prolonged pain inevitably leaves blood stasis accumulation. Recurrent episodes are treated with pungent-unblocking drugs entering the collaterals.
Prescription: Taoren (Peach Kernel), Guixu (Angelica Sinensis Tail), Mahong (Hemp Seed), Baizi Ren (Biota Seed), Jiangzhi (Costus Juice).
All pain resides in the collaterals. Prolonged pain leads to stasis accumulation, which also enters the collaterals. Treating collaterals primarily requires pungent-unblocking methods to enter and dredge.

Patient Wang (33 years old), internal deficiency of Liver blood leads to yin deficiency below, causing yang to rebel upward excessively, transforming into wind and dryness. For Hong Kong foot (gouty arthritis) with tendon spasms and bone pain, lacking lipid nourishment, spring and summer floating yang exacerbates the condition. This is most characteristic of yang failing to enter and interact with yin, ascending to clear orifices, causing eye pain and head heaviness (Yang is active; if it does not stay below, it rushes upward,) restlessness preventing sleep. Treatment should moisten dryness, nourish fluids, and guide yang downward (When yang does not enter yin, it cannot vaporize lipids below to nourish tendons and bones, hence floating yang rebels upward, obscuring clear orifices. Guiding yang downward benefits both.)
Prescription: Xian Shengdi (Fresh Rehmannia Root), Dan Tiantong (Asparagus Fern Stem), Qing Ejiao (Donkey-Hide Gelatin), Da Mahong (Large Hemp Seed), Baizi Ren (Biota Seed), Fei Zhimu (Anemarrhena Rhizome).
Initially, yin deficiency could not retain yang; subsequently, rising yang could not generate yin. Ultimately, it returns to dual deficiency of yin and yang.
Adding bitter-descending herbs to fluid-nourishing drugs guides yang back down. (This patient's Stomach qi is still intact, thus tolerating these sweet-cold drugs.)

Patient Sun (59 years old), food intake followed by qi rushing upward, phlegm rising blocking the throat with dryness, this is Fanwei (Regurgitation/Vomiting). The root cause lies in long-term accumulated overwork. Unnoticed in youth, it manifests after years of qi and blood decline. People often have this symptom, rarely cured by doctors, but self-management with physical and mental ease helps (Stabilize symptoms to nourish spirit and descend fire.) Life expectancy can be extended (Overworked individuals invariably damage qi and yang. Weak foundation triggers true fire rebellion, rising without descending, causing regurgitation.)
Prescription: Hei Zhi (Black Gardenia), Banxia (Pinellia Tuber), Juhong (Aged Tangerine Peel), Fuling (Poria), Jinhu (Dendrobium Stem), Zhuli (Bamboo Sap - 1 liang), Jiangzhi (Ginger Juice - 3 fen).
This formula eliminates phlegm-fluids, assisted by clearing fire.

Patient Ding (48 years old), daily consumption of alcohol and rich foods aids yin pathogens, forming tangible knots in the epigastrium, areas where yang qi normally flows. Zhang Zhongjing’s Xianxiong and Xiexin formulas treat pi-jie (glomus obstruction), addressing external pathogens sinking inward. Here, it is an internal injury, differing from yang-pathogen knotting.
Prescription: Biba (Long Pepper), Liangjiang (Galangal Rhizome), Wuyao (Lindera Root), Chuanwu (Aconite Lateral Root), Hong Doukou (Red Cardamom), Xiangfu (Cyperus Rhizome), Fuling (Poria).
A combination of pungent-warm herbs to assist yang and move qi, driving out yin-turbidity and breaking up accumulations.

Patient Deng (27 years old), essence damaged below, extraordinary vessels emptied over time, Yangwei Mai (Yang Linking Vessel) has gaps. Chills and fever have lasted months, persisting for a long time, gradually affecting the Middle Jiao. Appetite remains but with fullness and loose stools. Yin damage has entered yang positions, constituting a major consumptive disease. Ignorant folk doctors only use cooling and descending methods (Damage below should not exceed the Spleen. Yin damage affecting yang has surpassed the Middle Jiao. Prognosis is poor, fortunately, the patient tolerates warm-dry herbs.)
Prescription: Renshen (Ginseng Root), Mirong (Male Deer Antler), Sheng Tusizi (Dodder Seed), Chaohei Chuanjiao (Stir-fried Black Sichuan Pepper), Fuling (Poria), Chaohei Huixiang (Stir-fried Black Fennel Fruit).
The Yangwei and Yinwei vessels maintain the continuous connection of whole-body yin and yang, ensuring circulation of Ying and Wei, penetration of blood vessels, endless cycles, and stable yin-yang interaction. If these vessels have gaps, yin and yang will disconnect, causing alternating chills and fever, and dissipation of Yuan qi.

Patient Wang (18 years old), True yin is insufficient. Winter storage failed. Spring yang initially moves, internal yin-fire scorches, forming ulcers and pus, further damaging blood. This cough is qi scorching from floating yang. Late afternoon and evening bring mental restlessness. Treatment targets Shaoyin (Blood assists True yin. Since it is not stored, and yin-fire scorches essence, plus pus formation damaging blood. With Lower Jiao deficiency, heavy doses to nourish and solidify yin are necessary.)
Prescription: Wu Jiao (Turtle Shell Glue), Gui Fubanxin (Turtle Plastron Center), Huangbai (Phellodendron Bark), Tiantong (Asparagus Fern Stem), Chuan Shihu (Dendrobium Officinale), Shengdi (Rehmannia Root).
Purely yin-nourishing, non-yang-warming drugs are used because the patient’s fire is dry and scorches metal (Lung).

Patient Zhang (31 years old), abdominal distension alone, soft upon pressure, audible breathing sounds (This is damp-heat, not cold coagulation.) Inquiry reveals difficult urination and defecation. Daily drinking gathers dampness transforming into heat, accumulating in Spleen and Stomach. Dampness injures Taiyin, heat arises from Yangming. Dampness is the root, heat is the branch (Dampness injuring Taiyin, heat arising from Yangming clarifies the situation brilliantly.)
Prescription: Mian Yinchen (Artemisia Capillaris), Fuling Pi (Poria Skin), Jinhu (Dendrobium Stem), Dafupi (Areca Peel), Wancansha (Silkworm Frass), Hanshuishi (Calcitum).
Distension due to damp-heat stagnation and accumulation should be treated according to damp-heat principles. Medication must be skillful; one cannot generally use warming and tonifying Kidney Qi methods.

Patient Shen (29 years old), Men: Left relates to Blood, Right to Qi. Left-side numbness indicates Blood deficiency generating Wind, extending to the right cheek and Yangming meridian. Use pungent-sweet blood-regulating herbs to manage qi within blood (This is a case of blood-heat generating wind.)
Prescription: Gouqi (Goji Berry), Juhua (Chrysanthemum Flower), Cijili (Tribulus Fruit), Sangjisheng (Taxillus Branch).
Honey pills.

Patient Li (28 years old), Sour plums drain qi and injure the Middle. Rising yang causes bleeding. Proposal: Nourish Stomach yin.
Prescription: Sheng Baibian Dou (Raw Lablab Bean), Fei Baizhimu (Fat Anemarrhena Rhizome), Sheng Gancao (Raw Licorice Root), Maimendong (Ophiopogon Tuber), Tian Beishashen (Sweet Glehnia Root).
Sourness is astringent, but excess aids Wood qi, making Liver strong and rampant, leading to excessive draining of Middle qi. Wood insults Earth, Stomach blood becomes unsettled and bleeds.
Proposal: Nourish Stomach yin to satisfy Wood’s absorption needs, simultaneously generating blood and nourishing Lung, thereby restraining Wood.

Patient Xu (Cu Ku Xiang), aging leads to natural weakness of Lower Yuan, with little qi for consolidation. Pungent herbs enter the Kidney; pungent-sweet moistening drugs are quite effective. Yang qi within yin ascends via Yangming meridian to the nose. One should replace pungent with sour for static calming (Yin contains turbid qi; this symptom likely involves feeling foul odor in the nose. Hence, replacing pungent with sour to astringe.)
Prescription: Zi Hetao (Walnut Kernel), Yurou (Cornus Fruit), Wuwei Zi (Schisandra Berry), Fuling (Poria), Suoyang (Cynomorium Stem), Buguzhi (Psoralea Fruit), Qingyan Wan (Blue Salt Pill).
Using sour-salty descending methods to gather, and Suoyang to lock yang qi. Yang within yin is the True Fire of Lower Yuan, originally meant to remain latent, not flare upward.

Patient Wang, Summer dampness transforms into heat. Clearing and purifying the Qi level improved by 70-80%. As dampness resolves, dryness prevails, leading to rebound (Agile recovery,) Stomach fluids are not yet robust, taste is poor. Generating fluids should use sweet-cool methods, such as *Jingui* Maimendong Tang (Carefully study the word 'ru' [like], do not rigidly prescribe Maimendong Tang as a fixed formula.)
Once dampness resolves, worry immediately about dryness prevailing. A lively mind source allows flexibility; how would a dull person know where to start?

Patient Song (50 years old), *Neijing* states: Insufficiency of Middle qi leads to changes in urination and defecation. Lack of appetite and bitter taste indicate Spleen yang failing to rotate, transporting Stomach fluids. Meridians have been sluggish for a long time. Labor damages qi level, summer-heat pathogen involves deficiency/excess. Proposal: Suopi Yin (Shrink Spleen Decoction) (Spleen with damp-heat becomes flaccid and elongated, unable to rotate. Shrinking it with sweet-tonifying, sour-astringing, pungent-opening, bland-draining methods restores vigorous transport.)
Prescription: Renshen (Ginseng Root), Guangpi (Tangerine Peel), Wumei Rou (Mume Fruit Flesh), Wei Jiang (Baked Ginger), Yizhiren (Alpinia Oxyphylla Fruit), Fuling (Poria).

Patient Zhang (49 years old), habitual physical labor damages yang. Sorrow and grief internally damage Zang yin, causing reversal and chaos in the twelve meridians, confusion of qi and blood. Pain in front and back desires massage. Relief comes when movement allows slight circulation. Sleep and appetite are disturbed; how can medicine cure this? Sorrow and depression injure first; establish treatment based on Heart Ying and Lung Wei (Seven emotions disturb internally, obstructing Ying and Wei. Managing both Heart Ying and Lung Wei clears and calms the master of spirit. Herbal selection requires careful attention.)
Prescription: Chuanbei (Fritillaria Bulb), Pipaye (Loquat Leaf), Songziren (Pine Nut), Baizi Ren (Biota Seed), Suzi (Perilla Fruit), Mahong (Hemp Seed).
When disease reaches reversal of meridians and confusion of qi and blood, where does the physician begin? First manage Heart Ying and Lung Wei to rectify the root of qi and blood. When the Monarch is calm, the twelve officials are peaceful. This demonstrates the starting point for future practitioners.
This disease first damages yang, then yin. Formulas do not use heavy dual tonification of yin and yang. First, manage Heart Ying and Lung Wei, regulate reversed meridians, and confuse qi and blood. Initially seeming circuitous, upon reflection, calming the Monarch first before tonifying shows proper medical methodology.