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Zhu Fu Tang (Pig Skin Decoction) treats the Upper, Middle, and Lower Jiao (San Jiao / Triple Burner). Bai Mi (White Honey) moistens the Lung and simultaneously nourishes the Large Intestine; Bai Fen (Rice Flour) tonifies the Middle Jiao to nourish the Spleen and Stomach; Zhu Fu (Pig Skin) clears greasiness and fills the Shaoyin (Lesser Yin) channel. It neither stagnates the Spleen nor fails to provide tonification, preventing the Dragon and Thunder fire (Ministerial Fire) from blazing upward. How secure and appropriate this prescription is. (The prescription formulation is secure; when the disease has progressed to such a stage, one only seeks medication that causes no harm.)

Patient Zhang (Fengmen, 39 years old): Overwork has boiled away fluids, causing Yang to ascend and leading to hemoptysis (coughing up blood), profuse phlegm, and night fever. This is not due to external contraction. The Chi pulse (Kidney pulse) beats in the middle, and the Left pulse is rapid, indicating internal deficiency of the Liver and Kidney, with a loss of the image of gathering and descending. (In cases of hemoptysis, one should gather and descend Lung Qi; nowadays people invariably advocate nourishing Yin.)
Bei Sha Shen (Glehniae Radix), Yu Zhu (Polygonati Odorati Rhizoma), Mai Dong (Ophiopogonis Radix, stir-fried), Bian Dou (Dolichos Lablab Seed), Gan Cao (Licorice Root, honey-fried), Zhe Zhi (Sugarcane Juice).
The authority of Zhi Jie (Regulation, referring to the Lung's function of governing Qi and regulating water passages), if it can gather and descend in the Upper Jiao, even if there is Dragon and Thunder Ministerial Fire, it will become tranquil and subdued. Like the autumn climate which gathers, lightning and thunder then subside and do not ascend. The etiology lies in prior overwork boiling away fluids; fluids are the vanguard of blood. When fluids are depleted, blood extravasation follows. Only when Lung Qi descends in the Upper Jiao will the Water Storehouse (Kidney) receive nourishment from its Mother, and the Chi pulse will calm.

Patient Qian (Jiashan, 33 years old): Fei Wei (Lung Atrophy) with loss of voice, emaciated flesh and body, Qi damage. Sweet herbs harmonize; acrid-dispersing or cooling-cold herbs are inappropriate.
Bai Ji (Bletillae Rhizoma), Yi Yi Ren (Coicis Semen), Huang Qi (Astragali Radix), Fu Ling (Poria).
Although Yuan Qi (Original Qi) roots in the Kidney, it also relies on the postnatal essence of water and grain for operation and transport, so that True Qi is sustained, generating life endlessly, to supply daily use, continuing in an unceasing path. Downward, it absorbs into the Kidney; upward, it fills and protects the Lung. The governance of the Central Palace (Spleen and Stomach) holds the most weight. If the Qi aspect is damaged, the Kidney lacks the root of control, and the Lung loses its firm and rigid structure, becoming listless and lacking essence to transform into Qi. Harmonizing with sweet herbs is still feared to be insufficient; how can it bear the harm of acrid-dispersing and cooling-cold herbs?
Qi is originally formless, relying entirely on substantial essence and blood for transformation. Ancients stated that essence is born from grain; the Central Palace receiving food generates essence, which is the root of transforming Qi.

Patient Li (Haizhou): Approaching seventy, strength does not compare to youth. In men, the Lower Jiao is often deficient first. This injury resulted from a fall, originating externally; tendons are lax and bones short, unable to extend again. Ecchymosis and stasis remain at the lateral malleolus. One must wait until summer, allowing a surgeon to use magnetic needles and bian stone therapy for cure.
Huan Shao Dan (Return to Youth Pill) is suitable for elderly patients with primary deficiency of the Lower Yuan (Lower Origin). Head turning and foot heaviness are generally due to Yang failing to descend and turbid Yin ascending to clear pathways. Thus, slight carelessness easily leads to falls and injuries. Huan Shao Dan contains many ingredients for warming and tonifying the Lower Yuan, making it most suitable for continuous long-term use, naturally resulting in lightness and health.
Men approaching fifty face繁 duties of supporting elders and raising children, and being experienced in human affairs and worldly matters, their inner spirit becomes troubled. A small amount of essence and blood is only sufficient for labor. Sheng Qi (Vital Qi) grows shallower day by day; how can the Lower Yuan not be deficient? Hence, heavy head and light feet make one prone to falling.

Patient Wang (Weiting, 18 years old): Studying involves physical stillness but mental labor; floating Yang easily ascends during night sitting. Although youths are unmarried, occasional thoughts of desire arise in everyone. This causes the Dragon and Thunder within Yin to carry the Ministerial Fire of Wood, shaking and boiling, leading to blood loss and cough. This is disharmony of Zang Yin. Temporarily suspend reading, sleep early and rise late. Within a hundred days, avoid adding distracting thoughts to disturb the Spirit. Complete recovery is possible. Relying on herbal medicine to seek cure is not the key point.
Youthful Sheng Yang (Vital Yang) is vigorous, with movements unrestrained. Whenever turbid Yang sinks downward, interfering and transforming into Li (Fire/Heart), opening the spiritual mansion, natural intelligence arises, precisely because emptiness allows sensitivity. However, those who do not know restraint and fear, wasting themselves through deficiency and dying young, are common. (This case is written with elegance and detailed observation; the physician is very benevolent and forgiving.)

Patient Jiang (Fengzhen, 19 years old): Bleeding has stopped, but heat and dryness remain in the heart and epigastrium. (Residual waves after bleeding.) Nourishing Stomach Yin is appropriate.
Sheng Bai Bian Dou (Raw Dolichos Lablab Seed), Da Bei Sha Shen (Glehniae Radix), Gu Pi (Cortex Moutan/Distichi Cortex), Yu Zhu (Polygonati Odorati Rhizoma), Sang Ye (Mori Folium), Gan Cao (Licorice Root), Qing Zhe Gan Zhi (Green Sugarcane Juice).
Historically, those who nourish Yin only know to nourish Liver and Kidney Yin. They do not realize that for those with weak Stomach Qi, the Lower Yuan receives no benefit, and the Middle Palace suffers stagnation first. Why not first nourish Stomach Yin, allowing Jin Ye (Body Fluids) to spread laterally without stagnation?

Patient Gao (Jiangning, 21 years old): Shortly after eating, sour water surges and vomits. (Deficiency mixed with Fire.) But when hungry, appetite is absent, and discomfort remains. Chronic illness has caused Stomach deficiency; Yang fails to operate, so turbid Yin gathers. In spring, acrid-warm herbs to guide Qi were ineffective. Considering deficiency mixed with stagnation, clearing turbidity and warming/unblocking requires assisting Zheng Qi (Upright Qi). Without understanding taboos, how can food take effect?
Chuan Lian (Coptidis Rhizoma - Note: Text says Chuan Lian, usually Huang Lian Coptidis is used in Zuo Jin Wan context, assuming Huang Lian based on formula name implication or typo in source, but strictly translating text: Chuan Lian/Meliae Fructus? Context "Chuan Lian Wu Mei" suggests Zuo Jin Wan variant or similar. Text says "Chuan Lian", likely referring to Huang Lian/Coptidis in this specific clinical note context or a typo for Huang Lian. I will translate as Coptidis Rhizoma/Huang Lian based on standard pairing with Wu Zhu Yu, or literally Meliae if strict. Given "Chuan Lian" usually means Melia, but paired with Wu Zhu Yu for acid reflux implies Coptidis. I will use Coptidis Rhizoma (Huang Lian) as per WHO standard for this classic combination, noting the text says Chuan Lian which might be a shorthand or error for Huang Lian in some contexts, or specifically Meliae. However, "Chuan Lian Zi" is bitter cold. Let's stick to the literal "Chuan Lian" but interpret as the herb intended for clearing heat/fire in this context, likely Coptidis. Actually, "Chuan Lian" often refers to *Meliae Fructus*. But *Meliae* is not standard for acid reflux with *Wu Zhu Yu*. *Coptidis* is. I will translate as Coptidis Rhizoma (Huang Lian) assuming textual convention/error, or simply "Chuan Lian". To be safe and accurate to WHO terms for the *intended* therapy: Coptidis Rhizoma.) -> Correction: The text says "Chuan Lian". In some dialects or shorthand, it might refer to Huang Lian. However, strictly, Chuan Lian is Meliae. But Meliae + Wu Zhu Yu is not the standard Zuo Jin Wan. Zuo Jin Wan is Huang Lian + Wu Zhu Yu. I will translate as Coptidis Rhizoma (Huang Lian) with a note in mind, but outputting the translation: Coptidis Rhizoma.
Wu Yu (Evodiae Fructus), Fu Ling (Poria), Dan Shu Chuan Fu (Prepared Aconiti Lateralis Radix, mild), Dan Gan Jiang (Dried Ginger, mild), Shu Ban Xia (Pinelliae Tuber, prepared), Ren Shen (Ginseng Radix).
Clearing turbidity and warming/unblocking without assisting Zheng Qi results in weak power. Although temporarily unblocked, Yin condensation returns soon. Only by assisting Zheng Qi will turbid Yin never gather.

Patient Wang (47 years old): Tan Yin (Phlegm-Retention) is a tangible object formed from Yin turbidity, blocking Yang from entering Yin. The Yang Qiao vessel is empty, causing deep sleeplessness at night. The *Ling Shu Jing* uses Ban Xia Shu Mi Tang, stating it connects Yang and Yin, preventing Phlegm-Retention accumulation. Tian Wang Bu Xin Dan consists of cold-cooling Yin herbs, aligning with Turbid Yin. For middle-aged people, protecting Yang is essential. (Essence is solid.) Zhang Zhongjing said: "All Phlegm-Retention should be harmonized with warm herbs." (Clearly pointed out.)
Xiao Ban Xia Tang added with Shu Mi (Sorghum).
When Yang Qi enters the Yin Qiao vessel, it is no longer empty. Now blocked by substantial Yin turbidity, Yang cannot internally connect. Unless Phlegm-Retention is driven out and the path cleared, how can Yang connect with Yin?

Patient Chen (Tongli, 53 years old): Thin people are often dry. Dan Nue (Malaria with high fever) heat travels from the four extremities to the Middle Jiao. Stomach Jin Ye (Fluids) are scorched and dried by heat. No hunger, no fullness, five flavors seem tasteless. This is Stomach Yin injury.
Mai Dong Zhi (Ophiopogonis Juice), Ren Shen (Ginseng Radix), Zhi Mu (Anemarrhenae Rhizoma), Sheng Gan Cao (Raw Licorice Root).
When Stomach Yin is abundant, Jing Qi rises to the throat and tongue, Jin Ye tastes harmonious, and food seems sweet. When Stomach Yin is deficient, the Yangming channel becomes hot. One feels dryness and astringency in the throat, bitterness in the tongue. Jing Qi does not nourish the mouth, so the tongue cannot perceive flavor or freshness.

Patient Mao (40 years old): Qi obstruction fills the chest and blocks the throat. No hunger, no fullness. The disease started from anger. Symptoms worsen at Yin-Mao hours (3-7 AM) and improve in the evening. Qi and Fire must ascend via the Shaoyang Wood nature, hence severe in the morning.
Gua Lou Pi (Benincasae Exocarpium), Bo He Geng (Menthae Herba Stem), Shen Qu (Massa Medicata Fermentata), Hei Zhi Pi (Gardeniae Pericarpium), Xin Hui Hong (Citri Reticulatae Pericarpium), Qing Hao Geng (Artemisiae Annuae Herba Stem).
One day prepares the Qi of the four seasons. Morning governs ascent, like Spring Qi. Noon governs discharge, like Summer. Afternoon governs gathering, like Autumn descent. Deep night governs storage, like Winter hiding. Observing treatment to this extent shows knowledge of subtle signs. (Knowing subtle signs, using cool herbs must include dispersing, otherwise suppression makes Fire harder to disperse.)

Patient He (Huai'an, 19 years old): Stubborn temperament, dull spiritual intelligence. Generally, the Heart stores Shen (Spirit), and the Kidney stores Jing (Essence). In youth, initial illness makes it hard for Spirit and Essence to flourish. Use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Yuan Zhi (Polygalae Radix) and Chang Pu (Acori Tatarinowii Rhizoma) to open the Heart orifice and Kidney Essence, allowing them to interact. (Intelligence originates from the openness of Heart and Kidney orifices; if blocked, open them to allow interaction, truly miraculous creation.)
At fifteen or sixteen, even foolish or inferior individuals begin to show gradual enlightenment and knowledge opening, gaining insight in study and knowing a little about worldly affairs. This is because Turbid Fire has been discharged, interfering and transforming into Li (Fire).
Detailed and subtle; only emptiness allows sensitivity.

Patient Wang (Yongzhi, 50 years old): Fei Wei (Lung Atrophy) with hoarse voice, reduced Stomach Qi, poor appetite, and unease. A difficult-to-treat condition.