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Cao Tongjiang's mother, aged over sixty. In September, she experienced fever and poor appetite. Upon my examination, all six pulses lacked spirit (Shen), with a rate of eight beats per breath. The right Guan pulse was full on superficial palpation but empty on deep palpation. The classic texts state: "Spleen deficiency floating resembles the Lung pulse; it is also a syndrome of internal depression of fire." Spleen weakness was indeed indicated, so I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for several doses. The condition changed to malaria-like symptoms, which indicated that righteous Qi was recovering and pathogenic factors were attempting to exit. I then prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger). After four doses, she recovered. She was further regulated with Shen Ling Bai Zhu Wan (Ginseng, Poria, and Atractylodes Macrocephala Pill), returning to her previous health.

In March, my sixth younger brother, aged nine, had contracted pox (smallpox or measles) on February 18th. After the rash subsided, fever persisted. He refused food and drink, only sipping cold water, which he vomited shortly after. It took three months before he reported this. I reasoned: Lack of appetite indicates Spleen-Stomach deficiency; desire for water indicates heat; vomiting shortly after drinking indicates extreme deficiency of Middle Qi. When medicinal power acts, heat recedes; when the drug effect wanes, heat returns. This signifies weak medicinal power versus strong pathogenic qi. Upon examination, the Spleen-Stomach pulses were wiry and lacked spirit, varying between five and six beats per breath, sometimes appearing slow. The left three positions were flooding and diffuse. Observing the three passes on the finger, all were penetrating, and the Ming Guan pulse was already black. He wheezed day and night without rest, had generalized fever for six days, and had not defecated for over ten days. I performed a gallbladder enema once. The stool was neither black nor hard but loose. This was not true Yuan Qi heat, but rather Spleen-Stomach Qi deficiency failing to regulate ascending and descending functions. Urine was red and scanty; upon attempting to urinate, he cried out in extreme pain. This was caused by deficient Yang sinking downward, loss of regulation in ascending/descending, and failure of Qi transformation. I prescribed Buzhong Yiqi Tang combined with Liu Wei Di Huang Tang (Six-Ingredient Pill with Rehmannia) for three doses, adding Mai Dong (Ophiopogon Tuber) and Wu Wei Zi. Wheezing stopped immediately, and fever receded, except for persistent painful dysuria. I continued using Buzhong Yiqi Tang added with Mai Dong, Wu Wei Zi, Niu Xi (Achyranthes Root), Che Qian Zi (Plantago Seed), and Chao Hei Gan Jiang (Charred Dried Ginger) to clear Lung heat, generate fluids, raise Yang, benefit the Stomach, and warm the Middle. After one dose, hematuria occurred with some blood clots, formed by evil fire boiling dry Yin blood. After two more doses, pain ceased, appetite increased suddenly, and he fully recovered. I said: Achieving such efficacy with the previous formula—is this not the principle of tonifying Spleen and nourishing Lung, where Metal abundance generates Water, and Qi transformation naturally occurs? My late master, Laowu, stated: "It is nothing but sinking of clear Qi, failing to ascend or descend." This old gentleman emphasized this repeatedly; treating hundred diseases with no exception. Record this to instruct future generations. (This case involves Lung heat and Qi sinking causing blood accumulation in the Bladder region.)

Cao Wugang's daughter, aged seventeen. In July, due to fatigue and overwork, she developed fever and anorexia. All six pulses were flooding. I prescribed Xiaoyao San (Free and Easy Wanderer Powder) for four doses, and she recovered. From November, she suddenly developed wheezing and coughing, indicating Earth failing to generate Metal. She also experienced alternating chills and fever. Re-examination showed chaotic pulses without fixed rhythm, occasionally thread-like and indistinct. External symptoms included urgent wheezing, expectoration, anorexia, facial redness, generalized coldness, and eyes alternately reddish on the left or right. This was a critical syndrome of long-term Spleen-Stomach deficiency, gradual depletion of True Yin, and floating of deficient Yang. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui (3 fen each), Men Dong (Ophiopogon Tuber), Wu Wei Zi, and Huang Qi (implied). After two doses, cough eased slightly; after four doses, chills and fever stopped, and appetite increased. Re-examination showed the right three pulses remained wiry and fine. I used Buzhong Yiqi Tang added with Gan Jiang and Rou Gui, and at night, decocted Ba Wei Wan (Eight-Ingredient Pill) 1.5 qian. After over ten doses, she recovered. In January of the following year, the illness recurred similarly, likely due to dietary excess during festivals and incomplete recovery of Yuan Qi and Spleen-Stomach. Symptoms were heavier than before, with similar pulses, insomnia day and night. I prescribed Guipi Tang (Restore the Spleen Decoction) added with Fu Zi (3 slices), Gan Jiang and Rou Gui (2 fen each). After one dose, she slept for a night. After three more doses, I added Buzhong Yiqi Tang with Gan Jiang, Rou Gui, Shan Yao (Dioscorea Rhizome), and Po Gu Zhi (Psoralea Fructus). After twenty-plus doses, re-examination showed the right three pulses were steadier but still wiry and unharmonious. I continued the previous decoction, adding forty-plus pills of Ba Wei Wan to the decoction. After another twenty-plus doses, body temperature normalized, symptoms receded, and she stabilized. (Refer to cases of Lady Liu and Ma Jianyuan.)

Qian Xinzhuo's daughter, aged five. In December, she suffered from anal swelling and pain, breaking into ulcers, with anorexia. She wrote to me. I said: This is Spleen-Stomach deficiency, with deficient Yang internally depressed and unable to extend, flowing downward to invade the Lung, causing Metal to be controlled. Suitable prescription: Liu Jun Zi Tang added with Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Wu Zhu Yu (Evodia Fruit), and Zhi Huang Lian (Processed Coptis Rhizome, charred black, 3 fen). After two doses, she improved, though not fully recovered. By end of January, she had fever, anorexia, stinging eyes with tears and redness, and diarrhea. Other doctors' liver-boiling medicines for infantile malnutrition (Gan syndrome) were ineffective. I again gave Si Wei Fei Er Wan (Four-Ingredient Child-Fattening Pill). Initially effective, but worsened after a few days, indicating depleted Yuan Qi and excessive attacking/draining. She came by boat for consultation. Right Guan was wiry and fine; Left Guan was flooding and diffuse. Fever intensified day and night; diarrhea occurred ten-plus times at night; coughing present. I have observed that in Spleen-Stomach insufficiency and chronic illness, the left pulse is rarely larger than the right. This aligns with Li Dongyuan's theory of Left pulse overcoming Right pulse, based on logical trends. If Spleen Earth is deficient, Lung Metal declines further; Water dries, Wood withers; withered Wood generates Fire—how can the left pulse not be larger than the right? I used the previous formula added with Gan Jiang, Rou Gui, Men Dong, and Wu Wei Zi, taken with Si Shen Wan (Four Gods Pill). For six-seven doses, symptoms fluctuated, pulse remained fine. This indicated Yuan Qi was not yet filled; changing the formula was inappropriate. The family trusted this deeply. After four more doses, eye stinging slightly relieved, indicating gradual recovery of True Yuan. Master Laowu arrived, stating the formula should only remove Chen Pi (Tangerine Peel) as it drains Qi, which the body could not bear. Removing Chen Pi for ten-plus doses reduced illness by 80%. After a few more doses, full recovery.

Lady Zhang Jingshan, aged over forty. Ill for over eight months, with generalized muscle wasting, wheezing, and anorexia. Upon examination, all six pulses were harmonious, gentle, and spirited, with four beats per breath, indicating presence of Stomach Qi. The Classics state: "Generalized muscle wasting is untreatable; pulse not matching disease indicates death." I tentatively prescribed Liu Jun Zi Tang added with Men Dong, Wu Wei Zi, and Gan Jiang for two doses. Initially uneasy, she soon slept, wheezing eased, and voice became loud. Re-examination showed all six pulses fine; Spleen and Lung pulses seemed to come and go, indicating impending collapse—a definite sign of death. After repeated inquiry, she said she felt slightly better, only lacking appetite. I thought the pulse regressed compared to before, which was highly unfavorable, yet I forced another dose of the previous formula. She then had diarrhea, increased chest/epigastric fullness, and refused water/soup. This indicated Middle Qi deficiency failing to transport. Checking the calendar, it was Yi Si day. I said: "She will die tonight. Aggravated on Jia, dying on Yi—this is the fixed rule of Five Elements." It proved true. Friend Xue Lihuan said: "Chronic illness with spirited pulse, sudden regression after medication, indicates certain death. Like a lamp about to extinguish, burning brighter before abruptly going out." (This involves hot blood accumulating in Lung collaterals post-pox. If external wind-cold and internal cold-damp are present, wheezing urgency must accompany.) I prescribed Liu Jun Zi Tang added with Gan Jiang, Rou Gui, Men Dong, Wu Wei Zi for four doses. Appetite increased suddenly, cough stopped slightly. This indicated True Yuan was not scattered, and medicinal power was effective. After ten-plus more doses, 90% recovery. However, pulse remained wiry and fine, only slightly harmonious compared to before. I advised continuing the previous formula, but she refused and stopped. Next year, illness recurred similarly, pulse unchanged. Treated with decoctions, she fully recovered, but pulse never became truly harmonious, remaining wiry and fine. I said: "Though illness abated, pulse Qi did not recover. (Long-term pulse disharmony originates in blood collaterals; harmonizing blood restores pulse.)" In March of the following year, severe recurrence. Examination same as before. Prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with Men Dong and Wu Wei Zi. Four doses cured. I reflected: Still not free of root issues. Should have taken over a hundred doses of Buzhong and major tonics to secure the Five Zang organs and prevent recurrence. Otherwise, during youth, any sexual thought would trigger unbearable asthma. Worldly physicians treat all coughs as Phlegm-Fire, using phlegm-clearing, fire-reducing, Qi-smoothing, and draining agents, damaging Spleen Earth, often leading to untreatable conditions. They do not know cough arises from Spleen-Stomach disharmony, Lung Metal losing nourishment, Metal failing to generate Water, causing Heart and Liver fires to rise internally, attacking what they cannot overcome, leading to incessant cough, weakening Lung, and further Spleen deficiency. This is "Child illness worrying Mother," driven by Qi transformation. One should tonify Spleen-Stomach, generate Lung Metal, regardless of dose count, allowing Spleen-Lung nourishment, hidden Five Elements transformation, Earth abundance generating Metal, and cough ceasing naturally.

Wang Shengzhi from Dantu, aged over thirty. All six pulses were nine beats per breath. External symptoms: cough, facial redness, reluctance to speak, fear of noise. Seasonal disease lasted half a year. Previous use of bitter-cold drugs damaged Spleen Qi. Also, rapid pulse indicates heat belonging to deficiency—all signs of insufficiency. Among the six pulses, Spleen and Kidney pulses were flooding and large, indicating Lung Metal failing to generate Kidney Water. Reasonably, one should tonify Lung Metal to generate Kidney Water. Abundant Water controls Fire; abundant Metal generates Water and levels Wood. Level Wood makes Spleen Earth abundant, which generates Metal again. This is correct treatment. I told him: After taking fifteen to twenty doses, sweating should occur, indicating rising Yang and unblocked collaterals. Post-sweat, fatigue should follow. After eight-nine days or half a month, pathogen retreats and Zheng Qi is deficient. Or after ten days/half a month, Yuan Qi gradually recovers, fatigue disappears. Thereafter, warming-tonifying Spleen-Stomach agents may cause Phlegm movement, Blood movement, swelling/toxins, or diarrhea. These phenomena should be allowed to occur naturally, representing pathogenic factors in Zang-Fu attempting to exit. Without prior warning, patients might be startled by varied changes. I prescribed formulas to tonify Spleen, generate Lung, and nourish Kidney Water. After five-six doses, rapid pulse did not decrease, indicating True Yuan deficiency and dryness. I used the previous formula, skipping the first decoction, taking second and third decoctions. Within ten doses, rapid pulse disappeared. As deficient fire retreated, Middle Qi became cold. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui for five-six doses. Spleen Qi moved, Phlegm-Fluids flowed, settling in waist/spine, causing severe Liver-Kidney pain. Where pathogen gathers, Qi is deficient, confirming Liver-Kidney deficiency. (This is dead blood from stomach epigastrium flowing down without outlet.) I instructed external salt-warming and internal Er Chen Tang added with Tao Ren (Peach Kernel), Yuan Hu Suo (Corydalis Rhizome), and Yi Yi Ren (Coix Seed) for two doses. Large intestine expelled phlegm-blood, pain stopped. (Blood indicates heat/pain; Phlegm indicates cold/wheezing. Long-term bitter-cold use still resulting in blood expulsion and cure indicates robust constitution.) I then used tonifying Spleen Liu Jun Zi Tang added with Wu Wei Zi and Bai Shao (White Peony Root) for cure. Without understanding this logic, one would be lost when lumbar pain appeared.

A woman, aged fifty. During urination, a snow-white ice-like block sometimes blocked the vaginal opening. To urinate, she had to manually extract urine, otherwise difficult. I said: This is Stomach Cold-Dampness, due to cold Spleen Qi condensing and sinking to the vaginal opening. Spleen-Stomach Qi has not collapsed, merely sunk. I prescribed Liu Jun Zi Tang added with Gan Jiang and Rou Gui. Not many doses were needed for cure.

A woman with chronic劳症 (consumption/fatigue syndrome). In April, epigastric fullness, abdominal distension, anorexia, diarrhea ten-plus times day and night. Pulse: Liver-Kidney wiry and unharmonious, indicating Liver-Kidney deficiency-cold. Treatment: Po Gu Zhi (1 qian), Du Zhong (1.5 qian), Shan Yu (3 fen), Shu Di (3 fen), Wu Zhu Yu (3 fen), Gan Cao (2 fen), Wu Yao (3 fen), Chen Xiang (3 fen ground). Four doses showed slight improvement; eight doses allowed soup intake; twenty doses cured.

Chu Zhonghe from Fengyi, kept vegetarian diet for seventeen years. In September, suffered nocturnal emission, followed by fright. This indicated emptiness of Five Zang, dryness/depletion of Jin-Ye, Liver Wood generating Wind, Wind-Fire fanning flames, causing Jing to move and emit. Attacking and tonifying both failed. First, moisten-nourish Spleen-Stomach. Once Spleen-Stomach moist, Jin-Ye distributes, nourishing all bones. Re-examination one month later: Lung pulse large (Earth fails to generate Metal); Left Chi slender-long (Metal fails to generate Water); others flooding-gentle but not fluent. (Flooding-gentle non-fluent indicates fluid deficiency and blood dryness, floating without root. Fortunately not in Chi position. Slender-long Left Chi is root pulse for emission/fright, due to Lower Jiao cold air rising.) Prescribed Lung-tonifying formula. Four doses made pulse harmonious and long—method of "tonifying deficiency by tonifying its mother." Previously anorexic, prescribed Yi Gong San added with Huang Qi, Gui, Shao, Wu Wei Zi to tonify Spleen/generate Lung, Lung regenerate Kidney, Three Zang generating each other. Restless sleep, prescribed Guipi Tang intermittently. Yuan Qi gradually filled, spirit emerged. Over half a month later, added Tai Su Wan for full recovery.

January of Gengwu year. Examined Mr. Yongwu. Left three pulses: sunken, withered, fine, small, choppy—indicating劳伤 (injury from overwork) affecting sinews/bones/Qi. Right three pulses: floating, flooding, rapid; both sides 8-9 beats—indicating dietary/labor fatigue injuring Spleen. Symptoms: mental confusion/fatigue, fever. Initially due to undigested food, treated with digestion-promoting agents, leading to this state. I reasoned: Though pulse rapid, age high, symptoms severe, the long-gentle quality allows survival. Prescribed Bao Yuan Tang added with Gui, Shao, Wu Wei Zi, Hei Jiang (3 fen). Several doses: floating-flooding pulse contained, rapid pulse receded. Only anorexia remained, indicating Spleen-Stomach not open. No sweat after medication indicates Qi not fully vigorous, collaterals not yet unblocked. Fear of subsequent toxin eruption, as Five Zang pathogens not fully excreted; toxin must attack one meridian to exit. Given his chronic depression/overwork, toxin must exit from deficient Zang. Soon, a toxin erupted on Shaoyang meridian, extremely painful, hard as iron. Moxibustion with many moxa cones caused swelling to dissipate. Another swelling appeared nearby; more moxa stopped pain. Ears front/back stiff. Blood moving but stagnation not fully dispersed, collaterals not fully unblocked. Prescribed Bao Yuan Tang assisting Spleen, activating blood, unblocking collaterals. Suddenly, left half-body sweated heavily/stickily. Left belongs to Yang, indicating Yang Qi activation. Next day, felt internal unrest/restlessness, sign of impending sweat. Indeed, afternoon generalized sweating and diarrhea occurred, indicating Middle Qi deficiency-cold. (Diarrhea may involve retained phlegm/fluids exiting via Qi transformation, not solely deficiency-cold; observe form/color carefully.) Administered Zhong He San with Ginseng Decoction. Slight hunger returned, abdominal pain subsided. Next day re-examination: All six pulses six beats; two Chi pulses wiry. Indicates Lower Jiao deficiency-cold, Dantian Qi cold, Mingmen Fire deficient, failing to generate Spleen Earth. "Tonify deficiency by tonifying mother." Anorexia with false fullness: Main formula Liu Jun Zi Tang. Add Po Gu Zhi, Xiao Hui Xiang to warm Lower Jiao/generate Fire (Fire generates Earth). Add Hei Jiang to warm Middle, aiding slight food intake and transportation. Add Gui, Shao, Wu Wei Zi to collect Lung Metal/generate Water, ensuring Water ascends/Fire descends. Thereafter, Spleen Qi gradually strengthened, diet increased, stagnant blood in swelling transformed to pus. Generally, Spleen-Stomach disease in elderly during peak Spring Wood time: passing this hurdle without abdominal fullness ensures safety. (Abdominal fullness is Taiyin sinking; Chest Bi is Yangming sinking. Upper Ren Mai deficiency stems from dead blood sinking failing to warm/transform. Elderly/chronic deficiency patients suddenly showing abdominal fullness, chest bi, fatigue, reduced appetite usually do not survive. Pulse paradoxically gentle/long, as if healthy.)