Library

[Background Information]
Book: Xu's Commentary on Ye Tianshi's Late-Life Prescriptions (Authentic Version)
Author: Ye Tianshi
Dynasty: Qing
Chapter: Treatment of Middle Jiao / Guiling Ganwei Decoction
Category: Formula

[Original Text Translation]

The middle jiao is unable to process grain; there is neither phlegm stagnation nor fire rising, but only a feeling of epigastric oppression and belching. After vomiting, the fullness remains. This clearly indicates a decline of Qi in the central palace (Middle Jiao/Spleen-Stomach), where Yang is weak and fails to govern movement. To further use draining and descending methods on the Qi level is a major error.

Shen (North City Lower Area): Pungent aromatics can open the upper Jiao; if Lung Qi descends, efficacy can be achieved.
Rhizoma Imperatae (Bai Gen), Fructus Amomi Rotundus (Bai Kou Ren), Semen Armeniacae Amarum (Xing Ren), Coix Seed (Yi Yi Ren), Poria (Fu Ling), Cortex Magnoliae Officinalis (Hou Po).

Liu (33 years old): Forceful exertion during martial arts practice differs from essence injury due to alcohol and sexual indulgence. Hemorrhage occurred during the late summer when heat and diarrhea were prevalent. Pain extends across the chest and adjacent bones, indicating injury to the collaterals of the Liver and Stomach.
Semen Persicae (Tao Ren), Fructus Perillae (Su Zi), Fructus Crataegi (Shan Zha), Coix Seed (Yi Yi Ren), Poria (Fu Ling), Juice of Allium Tuberosum (Jiu Cai Zi), Cortex Moutan (Mu Dan Pi), Lignum Dalbergiae Odoriferae (Jiang Xiang).

Chen: Chronic cough with loss of voice, small pulse, and cold phlegm. This is Lung deficiency with depleted Qi, not easily cured suddenly. In wine merchants, damp-turbidity pathogen and rebellious Qi are aggravated at dusk.

Sun (36 years old): Exhaustion from running and worrying causes sudden heat steaming upward, meaning the body's Yang Qi fails to interact with Yin (Essence Meaning). Numbness in the four limbs indicates internal wind generated by Yang transformation. The left side belongs to the Liver; since Liver nature is rigid, softening agents are appropriate. If alcoholic medicines are used, they will further assist the stirring of Yang, which is contradictory. (Generally, wind exists within fire; when Liver Yang is excessively vigorous, fire generates, and extreme heat transforms into wind.)
Radix Rehmanniae Preparata (Shu Di Huang), Radix Asparagi (Tian Dong), Juice of Lotus Rhizome (Ou Zhi), Semen Astragali Complanati (Sha Yuan Zi), Ramulus Euodiae (Du Zhong), Fructus Ligustri Lucidi (Nu Zhen Zi), Fried Semen Cuscutae (Gou Qi Zi), Radix Dendrobii (Chuan Hu).

Tang (56 years old): Edema of the dorsal foot muscles in summer is damp-evil adhering to the person from the earth, injuring the Taiyin (Spleen). Early stage of Yangming disease involved hemorrhage, followed by vomiting saliva and refusal to eat. Physicians did not realize that dampness injured the Spleen and Stomach, leading to such spread. (Generally, dampness injures Taiyin, heat arises in Yangming; dampness is a Yin evil, affecting the lower part first.)
Wuling San (Five-Ingredient Powder with Poria) minus Alisma (Ze Xie), added with:
Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), Cortex Magnoliae Officinalis (Hou Po), Exocarpium Citri Reticulatae (Chen Pi), Talcum (Hua Shi).

Gong (Qianjing, 68 years old): Pain above the heart and below the stomach has lasted two months. Asked about past intestinal bleeding as a drinker. Whenever pain occurs, eating less relieves it slightly; eating more causes immediate pain. It is said that drinking hot wine brings relief in the epigastrium, indicating that turbid coagulation and rich flavors all aid Yin and injure Yang, so they should be avoided. (Meat makes one less prone to hunger, vegetarian food makes one hungry quickly; always rich and turbid substances are difficult to transform. However, the Yang of the central palace is hindered by turbid Yin and greasiness, causing Yang Qi to gradually become fatigued.)
Fructus Piperis Longi (Bi Bo), Fructus Cardamomi Ruber (Hong Dou Kou), Radix Linderae (Wu Yao), Caulis Perillae (Su Geng), Rhizoma Zingiberis (Gan Jiang), Rhizoma Cyperi Rotundi (Yan Hu), Rhizoma Cyperi Rotundi Raw (Xiang Fu).
Yang Qi in the Middle and Lower Jiao is like a lantern rotating endlessly. Loose and crisp foods enter the stomach and are easily transported and transformed; essence and dregs immediately separate and return to their respective places. If rich-flavored alcoholic liquids are sticky and viscous, lingering in the intestines and stomach, even if the pivot mechanism is vigorous, what can it do against obstruction?

Wu (39 years old): Hemorrhage since childhood is residual heat from parents, causing后天 (Post-Heaven) True Yin to be weak. Fortunately, stomach appetite is strong, preventing progression to consumptive weakness. Blood dysentery for sixteen months (this is a deficiency syndrome); abdomen does not hurt, but anus feels heavy and sinking, constantly feeling like defecation is imminent. Secular practitioners see dysentery and universally treat the Liver and Stomach; this is Kidney deficiency, where Yin and Yang orifices at the lower part are insecure. Securing and holding the lower part is correct. (Kidney Qi grasps and secures, tightening the lower origin, establishing the gate. If sinking like wanting to defecate, Qi is not secure. If additionally damp-heat pours downward, morning defecation urge cannot last long.)
Carbonized Radix Rehmanniae (Shu Di Tan), Carbonized Fructus Corni (Yu Rou Tan), Rhizoma Dioscoreae (Shan Yao), Fructus Schisandrae (Wu Wei Zi), Raw Radix Paeoniae Alba (Bai Shao), Poria (Fu Ling).

Wang (53 years old): Has daughters but no sons. Choking cough is severe at dusk (Shen hour). Muscles are emaciated. Summer hemorrhage. Heaven's mandate was suddenly warm, Yang floated and heat scorched, weak Yin had no way to control it. Essence damage leads to Yin fire scorching; absolute abstinence allows regeneration. At fifty without offspring, one must judge circumstances and preserve integrity. (In summer, Yang Qi floats, heat is fierce. Floating Yang means True Yang scatters, sweating leads to deficiency; scorching heat boils Yin portion, fluids dry up. This should be analyzed in two layers.)
Radix Rehmanniae (Shu Di), Carapax et Plastrum Testudinis (Gui Jia), Colla Corii Asini (E Jiao), Radix Achyranthis Bidentatae (Niu Xi), Poria Cum Pinellia (Fu Shen), Radix Polygalae (Yuan Zhi), Fructus Corni (Yu Rou), Sal Quale (Qing Yan), Semen Astragali Complanati (Sha Yuan Zi), Fructus Schisandrae (Wu Wei), Semen Platycladi (Bai Zi Ren).

Cheng (22 years old): Accidentally ate something that obstructs Qi, causing chest fullness and lack of appetite. Pulse is small, choppy, and aversion to cold. Clear Yang is injured; using purely resolving and attacking methods is inappropriate.
Semen Armeniacae Amarum (Xing Ren), Rhizoma Zingiberis Recens (Sheng Jiang), Exocarpium Citri Reticulatae (Chen Pi), Cortex Magnoliae Officinalis (Hou Po), Fructus Piperis Longi (Bi Bo), Raw Fructus Alpiniae Oxyphyllae (Sheng Yi Zhi), Suhexiang Wan (Styrax Pill).

Li (25 years old): Essence leakage and impotence, internal withering, damaging the extraordinary vessels. Six years of chronic condition, medicine is hard to achieve effect. (Yang Qiao, Yin Qiao, Yang Wei, Yin Wei all lose their governance.)
Radix Cibotii (Rou Cong Rong), Fructus Cynomorii (Suo Yang), Colla Carnis Ovis (Yang Rou Jiao), Fructus Foeniculi (Hui Xiang), Semen Cuscutae (Tu Si Zi), Sal Quale (Qing Yan).

Dai (Fengqiao): Using Lung medicines to open upper Qi was ineffective. Patient says phlegm tastes salty, anal canal is narrow, Qi rebels from Kidney ascending into throat. Use Zishen Wan (Kidney-Nourishing Pill). Take 3 qian each time, washed down with salt water. (Kidney Qi rebelling upward into throat, using Zishen Wan to guide downward, how clever and ingenious.)
Lung Qi controls the descent of all Qi in the body; Kidney Qi is regulated by it, thus not rebelling upward. But since Kidney Qi easily rises, combined with Lung medicines opening the upper Qi, it rebels upward even more easily.

Xu (Changshu): Galloping labor shakes the essence, essence becomes foul, urine turbid, followed by bleeding from sinews. True Yin is greatly drained downward. Chest fullness, unaware of hunger, abdominal borborygmi and moving attacks. This is Clear Yang knotted and closed in the upper part (Weak Yang failing to descend causes sound). These cases all fail to know Yin-Yang deficiency-excess (essence excess), merely using light-draining and cooling-descending methods, which反而 (instead) injures Yang in the Stomach. (This syndrome damages lower affecting upper, from Yin damaging Yang, using Miaoxiang [presumably a formula name or method] is most stable.)
Poria (Fu Ling), Honey-fried Radix Glycyrrhizae (Zhi Gan Cao), Roasted Radix Aucklandiae (Mu Xiang), Radix Ginseng (Ren Shen), Poria Cum Pinellia (Fu Shen), Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), Raw Radix Hordei Germinata (Gu Ya), New Hui Peel (Xin Hui Pi).

Chu (Yixing, 33 years old): Cannot conceive, feels body is not agile. Yang within Yin is insufficient, essence and Qi are not firm and full. Do not speak of attacking disease, must benefit the constitution. The source of generation and transformation lies in fire within water. Propose Banlong Wan. (The mechanism of reproduction requires Yang to generate, Yin to form, most valuing fire within water.)

Wang (Shantang, 24 years old): Pain occurs once every eight days. Recently no appetite, stool unsatisfactory. Whenever pain occurs, vomits yellow turbid fluid, water hard to swallow. Turbid Qi surges upward from below, presenting as vomiting. Stagnant Qi in intestines does not move, saliva in stomach does not drain. Turbid Qi surging upward from below is due to stagnant Qi in intestines not moving and saliva in stomach not draining.
Banliu Wan (Half-Sulfur Pill), take 1.2 qian each time.
Stagnant Qi in intestines and saliva in stomach do not move or drain because of insufficient Yang Qi in intestines and stomach. Yin evil and turbid evil turn to rebel and surge upward. Must use Pinellia to direct rebellion downward, Sulfur to warm and unblock. So that stagnant Qi moves and saliva drains.

Ji (Shitahou, 48 years old): Summer jaundice is Spleen-Stomach damp-heat transforming Qi. Treating jaundice with Yinchen (Artemisiae Scopariae Herba) is bitter, clear, light, and draining. Right hypochondrium area is Xuri acupoint. Long-term intake of cold medicines injures Stomach, Qi obstruction forms mass. Asked about unsatisfactory stool. Use Awei Wan (Ferula Pill), take 1 qian each time. (Long-term cold medicine intake leads to subsequent variant jaundice, damp-heat lingering, Awei Wan resolves and attacks it.)

Zhuang (Xinsheng, 22 years old): Smoke harms Lung, choking and reverse flow, throat pain. Clear heat from Qi level. Light can be light and floating; heavy flavor is not for treating upper.
Radix Glehniae (Da Sha Shen), Tegmen Phaseoli Volubilis (Lu Dou Pi), Rhizoma Polygonati Odorati (Wei Rui), Folium Mori (Sang Ye), Raw Radix Glycyrrhizae (Sheng Gan Cao), Medulla Junci (Deng Xin).

Shen (52 years old): Vertex near brain, long-term pain sunken bone. In youth, disregarded life, True essence leaked, brain marrow not full. Summer lacks Yin internal protection, pain and weakness prevent getting out of bed. Fifty-two, declining, unlikely to replenish essence and restore origin. (Summer Qi leaks injuring Yang, and Yin lack cannot internally protect, resisting heat. This is why disease mechanism is hard to grasp uniformly.)
Carapax Testudinis Abdominalis (Gui Fu Jia Xin), Cortex Phellodendri (Huang Bai), Os Tigris (Hu Jing Gu), Radix Rehmanniae Preparata (Shu Di), Fructus Cynomorii (Suo Yang), Niu Xi stir-fried with salt water.
Honey pills.

Yang (38 years old): Disease not recovered, forced labor injures Qi. Moving Qi attacks in chest and abdomen, or presents as horizontal blockage. All are weak Clear Yang, failing to govern rotation.