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The ascending and descending of Qi mechanism follows the heavenly degree, which is the great Dao of heaven and earth's opening and closing. As years pass, true Qi and true essence decline; pathogenic Qi becomes dominant, causing the heavenly Qi to descend and contract excessively. The disease manifests as frequent resistance (vigorous struggle between healthy Qi and pathogen) and a tendency to rebel upward, failing to store when it should, thus violating the heavenly degree.

He (Wangjia Alley, 27 years old): Complexion is depleted, pulse is rapid. Cough is severe during Cold Dew and Frost Descent solar terms. Body shivers due to wind-cold affecting the skin and muscles. Defensive Yang is empty and sparse, with Qi leakage. Physicians fail to recognize this, rendering them blind doctors.

Cai (Nanhao, 43 years old): Excessive mental exertion causes floating Yang of Liver and Kidney to rush upward, resulting in inability to sleep at night.

Gu (Tieping Alley, 16 years old): In tender years, tendons and vessels were not yet firm. Straining while hugging caused Qi and Blood circulation to be obstructed, touching the chest and back, leading to asymmetric bone protrusion and damage. This belongs to deficiency, not external pathogens. The upper half of the body is Yang, governing Qi. Consequently, a fistula formed on the right anus for over a year. True Yin and the Five Fluids are all injured. Food enters the Stomach, transmits to the Small Intestine, and only then undergoes transformation. Due to coughing up phlegm that cannot be expectorated, vomiting occurs until all ingested matter is expelled. Sore throat and loss of voice occur; saliva foam is spit out but remains in the throat. Clearly, Dragon Fire (Ministerial Fire) within the Shaoyin Kidney meridian flashes internally, burning Yin fluids upward, steaming and transforming into saliva foam, causing internal damage to Essence and Blood. Physicians seeing cough and hoarseness use methods to clear Metal and moisten Lung, failing to understand the source of choking cough; this is treating a critical condition incorrectly. (Old brush annotation.)

Zhu (Yixing, 19 years old): Spleen and Kidney both injured after malaria and dysentery. Use Miao’s method.

Zhou (Jinkui, 19 years old): Summer latent damp-heat transforms into malaria-like symptoms in autumn. Pathogens not fully resolved, forming sores. Appetite present but food not digested.有形 mass in abdomen. Spleen and Stomach disharmony. Use Dongyuan’s method.

Li: Long-term labor injures Yang. Stomach pain with acid regurgitation, excessive phlegm (True Yang injury leads to more vigorous fire, hence acid regurgitation and phlegm; warming the Middle will cause pathogenic fire to subside naturally.)
Prepared Pinellia Rhizome (Shu Banxia), Corydalis Rhizome (Yanhusuo), Trigonella Foenum-graecum Seed (Huluba), Galangal Rhizome (Gaoliangjiang), Old Ginger (Laoshengjiang), Toosendan Fruit (Chuanlianzi), Lump Poria (Kuai Fuling).

Wang (Nanjing, 28 years old): Pain and soreness in tendons and bones at Huantiao point. Youthful accumulated labor injures Yang Wei Vessel, blood is scant, guarding function is weak.
Angelica Sinensis Root (Guishen), Goji Berry (Gouqi), Raw Tiger Tibia Bone (Sheng Hu Jinggu), Morinda Officinalis Root (Baji), Achyranthes Bidentata Root (Chuan Niuxi), Astragalus Complanatus Seed (Shayuan), Green Salt (Qingyan), Lamb Gelatin Pill (Yangrou Jiaowan).

Zhang (Hengjing, 37 years old): Labor damages deficient constitution. Distension disease just healed. Anger causes Qi stagnation, anorexia, obstruction of both bowel and bladder. Discuss intestinal bi (obstruction) using Danxi’s method of opening Lung.
Apricot Kernel (Xingren), Aster Tataricus Root (Ziwan), Benincasa Hispid Peel (Loupi), Perilla Fruit (Suzi), Mulberry Leaf (Sangye), Peach Kernel (Taoren).

Huang (Jiaxing, 53 years old): Internal emotional depression. Heart pain like twisting. Emaciated body, dry fluids. Do not use drying-hot medicines.
Fried Peach Kernel (Chao Taoren), Biota Seed (Baizi), Corydalis (Yanhu), Fried Moutan Cortex (Chao Danpi), Sesame (Xiaohuma), Uncaria Rhynchophylla (Gouteng).

Zhang (Daxing): Essence not yet generated, forced emission of tangible essence. Hardest to replenish and prosper. No fertility to date. Emaciated, poor appetite. Prone to seminal emission, thin semen. Constitution and pulse cannot tolerate harsh Yang-tonifying drugs. Propose borrowing flesh-and-blood sentient substances to nourish Essence and Blood.
Cistanche Deserticola (Dan Congrong), Deer Whip (Lu Bian), Morinda Officinalis Root (Baji), Achyranthes Bidentata Root (Niuxi), Sheep Kidney (Yangshen), Cynomorium Songaricum (Suoyang), Goji Berry (Gouqi), Green Salt (Qingyan), Cuscuta Seed (Tusi), Fennel (Bo Huixiang).
Prescription is precise and solid.

Dai (Fengqiao, 52 years old): Throat tube seems narrow. Descending of whole-body Qi relies entirely on Lung. Due to Stomach heat rising, Lung loses its function. With advancing age, Qi knots and obstructs. Light flavors rectify the Upper Jiao. Medicines should be light in Qi to resolve dryness (Lung relies on Stomach; if Stomach heat rises, Lung loses function. Clearing and descending Lung focuses on clearing and moistening; resolving dryness allows natural descent).
Loquat Leaf (Pipaye), Perilla Fruit (Suzi), Coix Seed (Miren), Mulberry Leaf (Sangye), Aquilaria Wood (Xiang), Poria (Fuling).
Lung losing function stems from dryness; Stomach has fire heat rising, scorching the delicate organ, losing nourishment. Thus, treating Lung values resolving dryness, and resolving dryness lies in light Qi.

Ma (Lujia Bridge): Turbid pathogen stops, foot swelling begins. Knee joint pain and swelling. Started in summer-autumn, likely carrying Earth Qi. Dampness received from below. Wine drinkers have internal dampness steaming mutually. External and internal pathogens combine. Decoctions will definitely not take effect.