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Cao (31 years old): Kidney Qi deficiency, water metabolism disorder transforming into phlegm-fluids, lower body ulceration forming a fistula. After blood loss, coughing and choking persist incessantly. Essence and blood are severely depleted, causing ministerial fire to flare up (Dragon and Thunder Fire). Yin damage extends to Yang; the condition is not minor. Quack doctors, seeing phlegm-blood and cough, indiscriminately administer cooling agents, unaware that the vital Qi stored in the Kidneys requires warmth to be maintained. If this leads to stomach Qi rebellion and diarrhea, one would sit idly by while facing a critical situation. (The vital Qi of the Kidneys refers to the spring-like ascending and warming Qi. Warmth generates life; coldness extinguishes it.)

Ren Shen (Ginseng Radix), Hu Tao Rou (Walnut Kernel), Wu Wei Zi (Schisandrae Fructus), Fu Shen (Poria with Hostwood), Xian He Che Jiao (Fresh Placenta Gel), Hu Lian Zi (Lake Lotus Seed), Qian Shi (Euryales Semen).

In treating Kidney diseases, Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Gui Ban (Testudinis Carapax et Plastrum), and Di Huang (Rehmanniae Radix) are sometimes used because their ministerial fire is excessive; clearing the heat restores mildness, rather than using cold to suppress the vital Qi. This is also consistent with the principle of Wen Dan Tang (Warming Gallbladder Decoction). Understanding this layer reveals the subtlety of using cooling agents, which is not easily explained.

Shen (25 years old): At age thirteen, he vomited blood after consuming Lu Jiao Jiao (Deer Antler Glue), and was cured later by using Gui Ban Jiao (Tortoise Shell Glue). This is because in youth, the ascending Yang constitution makes tonifying the Du Mai (Governing Vessel) inappropriate. He reports history of seminal emission and fears blood recurrence. Muscle wasting indicates Yin deficiency with偏 (partial) heat. To prevent relapse, one must avoid overexertion. Physical stillness brings mental peace, preventing disease accumulation. (Overexertion causes floating Yang to leak and escape; Yin fire rises accordingly, carrying blood upward in rebellion. Only by staying quietly in nature, maintaining innocence and tranquility, can one find the best medicine.)

Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) minus Dan Pi (Moutan Cortex) and Ze Xie (Alismatis Rhizoma), plus Shui Lu Er Xian San (Water and Land Two Immortals Powder), Fu Pen Zi (Rubiae Fructus), Hu Lian Zi (Lotus Seed), and Gui Fu Ban Xin (Tortoise Plastrum Heart).

Yang (22 years old): Yin-deficient constitution. Financial exhaustion from studying art causes fire to burn externally and scorch internally. Body fluids are depleted and cannot recover. Drinking well water daily is useless.

Nuo Dao Gen Xu (Glutinous Rice Root Hairs), Tian Dong (Asparagi Radix), Shu Di Huang (Prepared Rehmanniae Radix), Wu Wei Zi (Schisandrae Fructus).

Mo (Wuxi, 46 years old): Prone to anger, Qi and fire move in reverse. Epigastric slight obstruction (due to phlegm stagnation); Qi blockage hinders eating. First, open upper Jiao obstruction. Thin patients with rapid and wiry pulses should not receive aromatic-dry herbs. (When Qi and fire reverse, phlegm surges upward; thus, herbs must treat phlegm concurrently.)

Pi Pa Ye (Loquat Leaf), Jiang Xiang Mo (Aquilaria Wood Powder), Hei Zhi Pi (Black Gardenia Peel), Tu Lou Pi (Trichosanthis Pericarpium), Du Su Zi (Perilla Seed), Xin Hui Pi (Citrus Reticulata Peel, white part removed).

Guan (43 years old): Reduced appetite, emaciation, indigestion after eating. Pulse at Cun/Guan positions is deep, soggy, small, and choppy; Chi position is deficient and hollow. Spleen Yang should move; Kidney Yang should store. These pulse and symptom patterns indicate premature aging. Internal injury treatment focuses on regulating imbalance, not attacking pathogens. (Moving Spleen Yang is how one stores Kidney Yang.)

Ren Shen (Ginseng Radix), Fu Ling (Poria), Bi Bo (Long Pepper Fruit), Hu Lu Ba (Trigonellae Semen), Sheng Yi Zhi (Raw Alpiniae Officinarum Rhizome), Sheng Jiang (Zingiberis Rhizoma Recens).

Spleen Yang and Kidney Yang have respective preferences for movement and stillness. These two phrases contain profound medical principles encompassing countless subtle meanings; students must memorize them firmly. Knowing that moving Spleen Yang stores Kidney Yang, and storing Kidney Yang aids moving Spleen Yang, is key.

Ni (Fengqiao, 23 years old): Labor injury damages Ying and Wei. Cannot tolerate繁琐 (complexity/busyness). Yuan Qi is insufficient, and acquired true Yuan is weak. Ancients used sweet-warm flavors to regulate from the middle. (Treating Heart Ying and Lung Wei reveals that the Heart is the Supreme Yang within Yang.)

Jian Zhong Fa (Establish Middle Method) adds Ren Shen (Ginseng Radix), Gui Xin (Cinnamomi Ramulus), Dang Gui (Angelicae Sinensis Radix).

Heart Ying and Lung Wei are actually governed by the Heart. As the Supreme Yang, the Heart governs Ying and Wei. Jian Zhong decoction with Ginseng, Cinnamon Twig, and Angelica builds the palace city of the Heart Master.

Shao (Fengqiao, 77 years old): Elderly person with swollen flesh and enlarged bones in extremities. Qi and Blood are exhausted, unable to nourish. Internal wind arises secretly, termed "Wind invading extremities."

Sang Ji Sheng (Taxilli Herba), Gou Qi Zi (Lycii Fructus), Hu Zhang Gu (Panther Bone - *Note: Modern ethical substitution often applies, but text says Tiger Palm Bone*), Sha Yuan Ji Li (Astragali Complanati Semen).

Boil into paste as usual, do not use honey to consolidate.

Xu (23 years old): Internal injury after blood loss; phlegm-cough gradually causes hoarseness. Essence and blood are first damaged; Dragon Fire within Yin flares up. Repeated episodes make recovery difficult. Filling the Lower Yuan may lack potency. Quacks see blood and use yin-nourishing/descending herbs; see cough and use lung-clearing/phlegm-resolving herbs. They do not know kidney fluids are refined into phlegm by Yin fire. Frequent attacks will be fatal. (Every time blood loss is followed by phlegm-cough, it is caused by initially administering cooling-yin herbs that suppress fire.) Long-term maintenance involves taking Jing Yue Yi Qi Dan. (Kidneys govern five fluids, nourish muscles, and irrigate vessels. Yin fire day and night refines all into dry phlegm.)

Xu (17 years old): Deficient constitution. Cold invades Liver collaterals causing hernia. Propose warming, nourishing Ying, harmonizing, and blood-invigorating methods for hernia.

Chao Ju He (Stir-fried Tangerine Seed), Gui Xin (Cinnamon Heart), Cu Gui Zhi (Coarse Cinnamon Twig), Gui Shen (Angelicae Sinensis Radix Segment), Fu Ling (Poria), Dong Kui Zi (Abutilonis Semen), Xiao Hui Xiang (Foeniculi Fructus).

Wang (Lujia, 36 years old): Pure Yang-Qi category medicines were effective, indicating the patient's illness resulted from irregular consumption of alcohol, meat, and cold foods, leading to internal dampness accumulating and damaging Yang. Carelessness with diet will lead to danger.

Sheng Bai Zhu (Raw Atractylodis Macrocephalae Rhizoma), Chao Hei Sheng Fu Zi (Stir-fried Black Raw Aconite Lateralis Radix Preparata), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma).

Xu (26 years old): Youthful scholar sitting long hours; Heart Yang becomes hyperactive and sinks, injuring Kidneys. Chaotic medical treatment damages Stomach and Xu Li (Vital Region). Distension, fullness, vomiting water, and spermatorrhea persist. This is invisible mutual damage. (Miao Xiang San.)

Ren Shen (Ginseng Radix), Bao Mu Fu Shen (Poria wrapped in hostwood), Yuan Zhi (Polygalae Radix), Fu Ling (Poria), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Sha Ren Ke (Amomi Fructus Shell), Qing Hua Long Gu (Blue-flowered Fossilized Bones), Zhi Cao (Honey-fried Licorice Root).

Wang (29 years old): Jue syndrome for five years. Pulse is fine and hurried. Kidney and Liver essence/blood are internally deficient. Winter storage fails to descend; Zang Yin cannot hold. Jue Yang internal wind flies, clouding spirit. Disease is in Zhi Yin (Profound Yin). Heat gathers above the halfway point of the body, due to shallow roots of the Lower Yuan. To cure, one must live quietly in forests, cut off worldly affairs for a year. Cold/heat tunnels, Yin/Yang intersections must not separate. (This formula is the most agile and penetrating among tonics. The tunnel Yin-Yang intersection governs Du and Ren vessels. Du and Ren are the two seas of Yin-Yang meridians. Heaven-Earth axis intersection empties these life-seas, leading to separation. Five Zangs lose roots. Tonics must reach this depth, not just treat symptoms generally.)

Gui Fu Ban Xin (Tortoise Plastrum Heart), Huo Ling Ci Shi (Active Magnetitum), Shan Yu Rou (Corni Fructus), Xi Chuan Shi Hu (Dendrobii Nobile Caulis), Chen Sha (Cinnabaris), Chuan Niu Xi (Cyathulae Radix), Ren Zhong Bai (Urina Seca), Huang Bai (Phellodendri Cortex).

Among 360 shellfish, the turtle is chief. Black color corresponds to North Kan Trigram. Water-Yin subdues Yang. Salty taste is pure Yin, entering Ren Mai Yin Sea directly. Magnetite is heavy, enters Kidneys to control Liver Yang rising. Cinnabar calms Heart Spirit, balancing Water and Fire. Cornus fruit is sour, enters Liver to astringe Liver. Cyathula assists into Lower Jiao. Ren Zhong Bai is salty, Huang Bai is bitter, entering Yin. Salty/Bitter controls floating upward. Dendrobium clears Yin fire, strengthens bones/tendons. This is the main idea of the formula.

Bian Que saw the Crown Prince of Guo with corpse-Jue disease, saying: "Above are severed Yang collaterals; below are broken Yin knots." Thus, the human body has its own life-knot. Roots interlock, knotting Yin and Yang, operating day and night in endless cycles. Five Zangs and Six Fu are the root of life. Outside Zang/Fu, there are roots of Zang/Fu. Pre-heaven Heaven South Earth North, Post-heaven South Li North Kan, all revolve here as the pivot of creation. Understanding origins, treating to this level, is profoundly subtle.

In past years, Pan Feng treated He Huzhan's phlegm disease, diagnosed Yin deficiency, prescribed largely following this principle, and it was effective.

Zhang: Robust physique, wiry pulse, limb numbness, chest/back Qi disharmony, sudden stabbing pain at vertex. This is emotional depression, Qi heat steaming, Liver/Gallbladder Wood-Fire transforming into Wind, scorcing tendons attacking vertex. If violent anger or labor occurs, risk of falling paralysis or apoplexy. (Understanding this clearly reveals heat steams phlegm, not just Wood-Fire boiling.)

Ren Shen (Ginseng Radix), Fu Ling (Poria), Zhen Ban Qu (True Half-Koji), Mu Gua (Chaenomelis Fructus), Ci Ji Li (Tribuli Fructus), Xin Hui Pi (Citrus Reticulata Peel).

Er Chen Tang (Two-Cured Decoction) has already been used. Generally, robust patients with wiry pulses indicate phlegm-fluids.

Gu: Labor injury damages form/Qi/Cold. Fine pulse, blood loss. Chaotic drugs damage Stomach, reduced food intake. Must use Ren Shen to benefit Stomach. Cooling drugs for cough will cause death. (Ren Shen Dang Gui Jian Zhong Fa minus Ginger.)

Ren Shen (Ginseng Radix), Zhi Cao (Honey-fried Licorice Root), Nan Zao (Southern Jujube), Yi Tang (Maltose), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Gui Zhi (Cinnamomi Ramulus).

Xu: Internal injury Liver/Kidney, chronic cough with blood loss. Recent aversion to cold, vomiting bowl-full of blood. Winter storage fails, Yin damage extends to Yang. Method should be Zhen Yuan Jian (True Origin Decoction) for warming/nourishing.

Ren Shen (Ginseng Radix), Shu Di Huang (Prepared Rehmanniae Radix), Gui Xin (Cinnamon Heart), Fu Ling (Poria), Wu Wei Zi (Schisandrae Fructus), Bai Shao (Paeoniae Radix Alba), Tong Bian (Human Urine, half cup).

Niu (Huzhou, 28 years old): 5-6 years of stomach pain, attacks with vomiting and constipation. (Excellent prescription.)

Tao Ren (Stir-fried Peach Seed), Ma Ren (Hemp Seed), Mo Zhi (Ink Juice), Yan Hu (Corydalis Rhizome), Gui Xu (Angelicae Sinensis Radix Tip), Nan Zha (Stir-fried Hawthorn Fruit).

Add 15 spoons of Chive Juice.

This is Jue Yin closure with rebellious Qi. Use Tong You Fa (Open the Dark Method) to vent Jue Yin, following its nature so disease resolves itself. Do not use aromatic-dry herbs.

Sun (22 years old): Chest is where Clear Yang circulates. Youthful Qi is weak; management/stress disturbs Shen Ji (Divine Mechanism). Disease name: Xiong Bi (Chest Bi). Zhong Jing uses light agents to unblock Upper Jiao Yang.

Xie Bai (Macrostemonis Bulbus), Gui Zhi (Cinnamomi Ramulus), Ban Xia (Pinelliae Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Fu Ling (Poria), Bai Jiu (White Wine).

Shen (Yuhang, 26 years old): Lao Bing (Chronic Exhaustion Disease) with dried water and exhausted Kidneys is untreatable.