青溪何伊样之内，患吞酸已二十余载矣。因病随年长，复加恚怒，胸膈否塞，状若两截，食入即反肢体浮肿。治者非破气消导，即清痰降火，投剂累百，未获稍安。邀予治之。左三部弦大空虚，右寸关沉而带涩，乃苦寒伤胃清阳下陷之征也。盖胃司纳受，脾主运动，胃虚则三阳不行，脾弱则三阴不化，致仓廪闭塞，贲门阻滞，奚能化导糟粕转输出入乎况。气者升于脾而降于胃，运用不息流行上下者。今胸膈气噎乃气虚而滞，非气实而满。如误认有余之象，妄施攻伐之方，不特无补于脾而反损于胃，所以投剂愈多而病势愈剧也。立方用六君子加炮姜官桂。先将代赭石一两捶末和入，清泉取水煎药。才服入口，觉胸宇不宁；忽然有声，隔绝隧道，食亦不吐。或云胃虚而用六君子，此千古正治，毋庸议论。如代赭石治法今人未闻，愿领其详。予曰：医者意也，代赭系代郡之土，禀南离之色，能生养中州，脾胃属土，土虚即以土补，乃同气相求之义也。
居君显子舍，青年患疬，因睡中惊醒，即口眼歪斜，嚼舌流血，四肢搐搦，举家惊异，邀医用治痰不效，干予诊视。因其抽掣不常，难以候脉。但望面色，黄中现青，搐搦之势，左甚于右。经曰：东方属青，入通于肝，其病为惊骇。况乎久患瘰疬，则肝胆之气尝亢于外，而阴血不荣于内。偶因梦中惊骇触动肝火，火旺而风生，风生而摇动，此自然之理也。且四肢为胃土之末，口目乃胃脉所过，木气摇土，所以喁斜瘛疯。夫舌属心脾，齿属阳明，阳明气盛则口噤，心脾气盛则舌挺，一挺一噤故令嚼舌，宜用平肝之晶佐以驱风清火。遂用二陈汤加山栀枳壳钩藤羌活防风，一剂而诸苦若失。
江右李太宰讳日宣，有如夫人，自耳至胁忽结核成块。遍延疡科均以瘰疬治之，反增发热，体瘦，口燥唇干，饮食少进。迎家君往诊，脉左关芤而无力，此肝血枯谒不能荣养诸筋，故筋脉挛缩有似瘰疬，而实非也。若以败毒清火消痰化坚之剂投之，则胃气转伤变症百出矣。当滋养肝血以濡润筋脉为要。方用四物汤加丹皮玉竹秦艽麦冬等，剂不数眼而痊。
内卿令乔殿史次君，自幼腹痛，诸医作火治、气治、积治，数年不愈。后以理中、建中相间而服亦不见效，特延予治。六脉微弦，面色青黄。予曰，切脉望色咸届肝旺凌脾，故用建中，以建中焦之气。俾脾胃治而肝木自和，诚为合法，宜多服为佳。复用数帖，益增胀痛。殿史再延商治，予细思无策，曰：贤郎之痛发必有时，或重于昼，或甚于夜，或饥饿而发，或饱逸而止，治皆不同。殿史曰：方饮食下咽，便作疼痛，得大便后，气觉稍快，若过饥则痛；交阴分则贴然。予曰；我得之矣。向者所用小建中亦是治本之方，但药酸寒甘饴发满，所以无效。贤郎尊恙缘过饥而食，食必太饱，致伤脾胃失运用之职，故得肝旺凌脾之候，所谓源同而流异者是也。今以六君子汤加山查麦芽助其建运之机，令无壅滞之患，则痛自愈也。服二剂而痛果止，所以医贵精详不可草草。
庠生范啸凡令正，向患头眩症，六脉浮滑，服消痰顺气之药略无效验。予曰：无痰不眩，此虽古语，然痰之标在脾，而其本属肾。《素问》曰：头痛巅疾，下虚上实，此之谓也。夫肝为乙木之本，肾为癸水之源，肾阴不充，肝火便发，上动于巅而眩作也。治法以扶脾为主，脾安则木自和，而肺金有养，金为水母，而子亦不虚，何眩晕之有。早用六君子汤加山萸天麻，卧时服肾气丸加人参天麻鹿茸，服之而瘥。
周浦顾公鼎，暮夜遭劫，左半身自头至足计伤三十七刀，流血几干，筋骨断折，百日以来，浓血淋沥，肉腐皮黑，痛苦不堪，不能转侧。专科俱用滋阴养血止痛生肌，反凝滞胃门，妨碍贲门，致饮食厌恶，疮口开张，乞予救疗。左寸关部位刀伤沥沥，脓水进流，大都虚微不堪寻按耳。盖虚为阴伤，微为阳弱，阴阳失职，荣卫空虚，气血衰残，肌肉溃烂。《灵枢》云；卫气者，所以温分肉而充皮毛，肥腠理而司开阉。故疮口不收，皆由卫气散失不能收敛耳。即有流脓宿血，内藏其穴，能使阳和生动，火气周流，自然脓收疮敛，长肉生肌，旬月之间可许步履如初。观者咸骇予言为迂，为此危重，不过苟延时日，安得无恙。如果回春，则先生非李乃吕先生也。遂力担承，用养营汤大剂服二十帖，疮口尽敛，饮食亦进，至百帖即能起坐。复用药酒及还少丹出入加减，四五月后可以倚杖行步，越明年便能却杖，迄今荣壮胜常，此亦偶然不可多得。
大场张公享内正，年逾四旬，伤子悲，崩涌如泉。用四物腰艾或增棕榈棉灰毫不可遏。医颇明义理，谓阳生阴长，无阳则阴不能生，用补中益气以调脾培本，势虽稍缓，然半载以来仍数日一崩，大如拳块，彻夜不卧，胸膈胀满，势甚危殆。邀予诊视，面色青黄，唇爪失泽，四肢麻木，遍体酸疼，六脉芤虚，时或见涩，此病久生郁，大虚挟寒之象。夫脾喜歌乐而恶忧思，喜温燥而恶寒湿，若投腭艾止涩之剂，则隧道壅塞而郁结作矣。若专用升柴提举之法，则元气衰耗而生发无由也。乃以归脾汤加益智炮姜，大剂，与服四帖而势缓，便能夜寐，胸膈顿宽，饮食增进。调理两月天癸始正，记前后服人参十六斤，贫者奈何。
槜李孝廉沈天生夫人，血崩不止，势如涌泉。医谓血热则行，血寒则止。四物加芩柏等剂，两昼夜不减。延家君往治。诊其脉息安静，全无病象，肌体清癯，原非壮实。知为脾胃气虚不能摄血，苦寒杂进反以潜消阳气，须用甘温之品以回生长之令。乃以补中益气汤加阿腰炮姜大补脾元，升举阳气。二剂而崩止，以后调理渐安。
河间司李朱思皇长公令方夫人，坐孕七月，胎肿异常，喘急不能言，并不能卧者月余，举家彷徨，投药甚乱。一医用人参白术以实脾，一医改用商陆葶苈以润肺，相去天渊，益增疑思，邀予决言。予曰：此症似危，脉幸洪滑，产前可保无虑，即应分娩之后颇费周旋耳，舍前两治，余不过一二剂便获安枕矣。座中讶出言之易，各言辨驳，予据理析之曰：胃为清阳之海，肺为元气之龠，故呼吸升于丹田，清浊输化赖于中土，若平素膏粱太过则中州积热。况胎孕内结，则相火有余，至六七月以来，肺胃用事胎渐成大，故胎气愈逼而火愈旺，凑逆于上，喘呼不卧，名曰子悬者是也。兹用参术温补则肺气壅塞，若用葶苈苦寒则胃气孤危，均致变症蜂起，岂非实实虚虚之患乎。疏方用苏梗枳壳腹皮各三钱，茯苓陈皮半夏各钱半，甘草五分，生姜三片。一帖便能言，再剂则安卧。合门信为神丹，余曰：无欢也，胎前喘急药石易疗，恐临盆在迩其喘复生，虽灵丹在握不能为也。须预惫奇策，调护真元，不致临产涣散，乃可万全。不数日产一子，甚觉强健，越两日喘果复作，惊呆无措，进食亦减常时。此胃土虚而不能生金之象，以大剂参术苓草五味肉桂数剂乃安。
歙人方李生儒人，向患左胁疼痛，服行气逐血之剂反加呕逆，甚至勺水难容．脉左沉右洪，明属怒动肝火来侮脾阴，过投峻药转伤胃气，俾三阴失职仓廪无内而化，五阳衰惫传道无由而行，所以中脘不通食反上涌，斯理之自然毋容议也。方以异功散加白芷肉桂，于土中泻水，并禁与饮食，用党参五钱，陈仓米百余粒，陈皮一钱，生姜三钱，加伏龙肝水三碗，煎耗一半，饥时略饮数口，二三日后方进稀粥，庶胃气和而食不自呕，依法而行果获奇效。
柯霭宁，患吐血后，咳嗽连声，气喘吐沫，日晡潮热。服四物知柏后，兼服苏子贝母百部丹皮之属，病势转剧，乞予治之。六脉芤软，两足浮数，知为阴枯精竭而孤阳气浮，俾肺金之气不能归纳丹田，壮火之势得以游行清道，所以娇脏受伤，喘嗽乃发。理应六味丸加五味沉香导火归源，但脾气不实。乃先以人参白术黄耆山萸山药各一钱五分，石斛丹皮各一钱，五味子廿一粒，肉桂五分，服数十帖大便始实，改用前方调养月余，咳嗽亦瘥。后三年前病复发，信用苦寒遂至不起。
云间田二府封翁，久泻肉脱，少腹疼痛，欲食下咽，泊泊有声，才入贲门，而魄门已渗出矣。或以汤药厚脾，或以丸散实肠，毫不见效，几濒于危，召予力救。望其色印堂年寿天而不泽，切其脉气口六部细弱无神，则知清阳不升，原阴下陷，非但转输失职，将见闭藏倾败矣。盖肾者胃之关也，脾之母也。后天之气土能制，先天之气肾可生。脾良由坤土，是离火所生，而艮木又属坎水所生耳。故饮食入胃如水谷在釜，虽由脾土以腐熟，亦必藉少火以生气。犹之万物，虽始于土，皆从阳气而生长，彼生生化化之气，悉属于一点元阳。所谓四大一身皆属金，不知何物是阳精也。惟命门火衰，丹田气冷，使脾脏不能运行精微，肠胃不能传化水谷，三焦无出纳之权，五阳乏敷布之导，升腾精华反趋下陷，故曰泻久亡阴，下多亡阳，阴阳根本，悉归肾中。若徒知补脾而不能补肾，是未明隔二之治也。宜用辛热之晶暖补下焦，甘温之剂资培中土，譬之炉中加火而丹易盛，灯内添油而燃不息，真有水中火发，雪里花开之妙，何虑寒谷之不回春耶。遂用人参白术炮姜炙甘草熟附子，煎成调赤石子末三钱与服，渐觉平安，十剂而痛止泄减，面色润泽，饮食增进，不一月而全愈，乃蒙赐顾，缱绻竟日而去。越明年春田公觐还，父子重逢，喜出望外，不意过食瓜果，前症复发竟难挽回，卒于仲夏庚寅日，可见木旺凌脾之验，毫发不爽也。
庠生奚易思令正，发热腹痛，呕恶不食，六脉沉郁，面黑如薰，用解郁调中之剂前症渐愈，若感怒气，应必复发。半载以来，形神憔悴，小便涩痛，小腹重坠，延予治之。予曰：癥瘕痞块多属中脘，发则形象可求，痃癖两症贴在脐旁，发则攻冲而痛，数症皆水道通利者也。今小水涩滞，少腹重坠，必身皮甲错，绕脐生疮，此系下焦肝火久郁不舒，已成小腹痈也。非予专门，应疡科调治，庶可奏效，延医治之，果如予言，越数日而痈溃，脓色稠紫，服托里养荣等剂，月余而康。
徐敬山，伤寒郁热，过经不解，愈后食复，谵语神昏，刺高胎黑，耳聋如愚，六脉洪大，此阳明胃热血化为斑之状，乃燃灯照其胸腹，果紫斑如绿豆大者，朗如列星，但未全透于肌表。宜清胃解毒，使斑点透露，则神清热减矣。用竹叶石膏汤二剂，壮热顿退，斑势掀发，但昏呆愈甚，厉声呼之亦不醒觉，将身掀动全无活意，惟气尚未绝，俱云死矣。予复诊，其脉两手皆在，不过虚微耳。盖此症始因胃热将腐，先用寒凉解其客邪，今邪火虽退，正气独孤，故两目紧闭，僵如死状，急用补胃之剂以醒胃脘真阳，生机自回也。即以生脉散合四君子汤一剂，至夜半而两目能视，乃索米粥，以后调理渐安。
妻祖黄含美，庚辰会试，患伤寒。剧甚时，家君薄游都门乃与诊视。舌黑刺高，壮热妄语，神思昏沉，奄奄一息，此为邪热内甚，亢阳外焚，脏腑燔灼，血随沸腾，斑将出矣。遂用生地丹皮元参麦冬黄连知母甘草，一剂而斑现，再剂而神清，三剂而舌刺如洗矣。
燕京礼垣房之麟，患伤寒五日，病势困殆，伊亲在太医院者七人，莫能措手，延家君治之。脉人迎紧盛，右关洪大，神思若狂，舌胎微黑。此邪热拂郁神思昏愦而如狂，亢阳煽炽火极似水而舌黑，炎炎蕴隆将成燎原，若非凉血火将焚矣。视其胸腹果有红斑，遂用化斑清火一服顿愈。
???分镇符公祖恭人，形体壮盛，五旬手指麻木，已历三载。甲辰秋偶感恚怒，忽失声仆地，痰潮如锯，眼合遣尿，六脉洪大。适于往茸城，飞骑促归。缘符公素谙医理，自谓无救，议用小续命汤，俟予决之。予曰：是方乃辛温群聚，利于祛邪，妨于养正。其故有三：盖北人气实，南人气虚，虽今古通论，然北人居南日久，服于水土，卑禀更移，肤腠亦疏，故卑下之乡，柔脆之气，每乘虚来犯，致阴阳颠倒，荣卫解散，而气虚卒中。此南北之辨者一。况中风要旨又在剖别闭脱。夫闭者，邪塞道路，正气壅塞，闭拒不通；脱者，邪胜五内，心气飞越，脱绝不续。二证攸分，相悬霄壤。故小续命汤原为角弓反张牙关紧急闭证而设，若用于眼合遗尿之脱证，是既伤其阴，复耗其阳。此闭脱之辨者二。又风为阳中阴气，内应于肝；肝为阴中阳脏，外合于风。恚怒太过，大起肝胆，内火外风，猖狂扰乱，必然挟势而乘脾土，故痰涎汹涌。责脾勿统摄，肾不归经，滋根固蒂尚恐不及，若徒事发散是为虚虚。此真似之辨者三。《灵枢》所谓虚邪偏客于身半，其入者内居荣卫。荣卫稍衰，则正气去，邪气独留，发为偏枯。端合此症，当法河间东垣用药，保全脾肾两脏庶可回春。亦以六君子加黄耆白芍桂枝钩藤竹沥姜汁，服二剂恶症俱减，脉亦收敛，但声哑如故，此肾水衰心苗枯槁。至更余后火气下行，肾精上朝方能出音。遂用地黄饮子，服至十五剂大便始通，坚黑如铁。虽有声出，状似燕语，乃朝用补中益气汤加五味麦冬以培脾，夕用地黄汤加肉苁蓉当归以滋肾。调理百日，语言如旧，步履如初，但右手稍逊于前耳。
**Case of He Yiyang's Wife from Qingxi:** She had suffered from acid regurgitation for over twenty years. As her condition worsened with age, compounded by anger, she experienced chest and diaphragm blockage, feeling as if her body were severed in two, with immediate vomiting after eating and edema of the limbs. Previous physicians prescribed either qi-breaking and digestion-promoting herbs or phlegm-clearing and fire-purging remedies; hundreds of doses yielded no relief. I was invited to treat her. The pulse at the three positions on the left wrist was wiry, large, and empty; the cun and guan positions on the right wrist were deep and choppy. These are signs of stomach qi damaged by bitter-cold herbs and sinking of clear yang. Generally, the Stomach is responsible for receiving food, while the Spleen governs transportation and transformation. When Stomach qi is deficient, the Qi of the Three Yang channels cannot circulate; when Spleen qi is weak, the Qi of the Three Yin channels fails to transform. This leads to closure of the granary (digestive tract), obstruction of the cardia, and an inability to digest waste and regulate intake and output. Furthermore, Qi ascends from the Spleen and descends from the Stomach, circulating ceaselessly above and below. The current qi stagnation in the chest and diaphragm is due to qi deficiency causing stasis, not excess qi causing fullness. If mistaken for an excess pattern and treated with attacking formulas, it will not benefit the Spleen but will further damage the Stomach, which explains why more medication led to a more severe condition. I formulated a prescription using Liujunzi Tang (Six Gentlemen Decoction) [Yiqi Jianpi, Zaohua Huatan] added with Paojiang (Roasted Ginger) and Guigui (Cinnamon Twig). One liang of Daizheshi (Hematite) was crushed into powder and mixed in, and the medicine was decocted with clear spring water. Upon taking the first dose, she felt unease in the chest; suddenly, there was a sound within, as if a passage were blocked, yet food was no longer vomited. Some remarked that using Liujunzi Tang for stomach deficiency is a time-honored correct treatment, requiring no discussion. However, the use of Hematite is rarely heard of today; please explain the details. I said: A physician must rely on intuition. Hematite is soil from Dai Commandery, possessing the color of the South (Li trigram/Fire), and can nourish the Central Earth (Spleen/Stomach). Since Spleen and Stomach belong to Earth, tonifying deficiency with Earth follows the principle of "similar qi seeking each other."
**Case of Ju Junxian:** In his youth, he suffered from scrofula (lymphatic tuberculosis). After being startled awake during sleep, he developed facial paralysis (deviation of mouth and eye), biting his tongue with bleeding, and spasms of the four limbs. The family was terrified. Physicians treating him for phlegm were ineffective, so I was consulted. Due to irregular spasms, the pulse could not be taken. His complexion showed yellow with hints of green, and the spasms were more severe on the left than the right. The Classics state: The East corresponds to Green and connects internally with the Liver; its disease manifests as fright. Moreover, chronic scrofula indicates hyperactive Qi of the Liver and Gallbladder externally, while Yin blood fails to nourish internally. The sudden fright in the dream stirred up Liver Fire; excessive fire generates Wind, and Wind causes shaking—this is natural law. The four limbs are the extremities of Stomach Earth; the mouth and eyes are pathways of the Stomach meridian. Wood agitation disturbs Earth, causing deviation and spasms. The tongue belongs to Heart and Spleen; teeth belong to the Yangming channel. Excess Yangming Qi causes lockjaw; excess Heart/Spleen Qi causes tongue protrusion. The combination of protrusion and locking results in tongue biting. Treatment should focus on pacifying the Liver, assisted by wind-dispelling and fire-purging herbs. I prescribed Erchen Tang (Two Aged Decoction) [Zaohua Tan, Liqi Hezhong] added with Zhizi (Gardenia Fruit), Zhike (Aurantium Fructus), Gouteng (Uncaria Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), and Fangfeng (Saposhnikoviae Radix). One dose relieved all suffering.
**Case of the Concubine of Li Taizai Rixuan from Jiangyou:** A lump formed suddenly from the ear to the hypochondrium. All surgeons treated it as scrofula, resulting in increased fever, emaciation, dry mouth and lips, and poor appetite. My father was summoned. The left guan position was hollow (Kou) and forceless, indicating depleted Liver Blood failing to nourish tendons, causing tendon contraction resembling scrofula but not being it. Using detoxifying, fire-purging, phlegm-resolving, and hardness-softening herbs would damage Stomach Qi and cause myriad complications. The priority should be nourishing Liver Blood to moisten tendons. I prescribed Siwu Tang (Four Substance Decoction) [Buxue Xuexue] added with Mudanpi (Moutan Cortex), Yuzhu (Polygonati Odorati Rhizoma), Qinjiao (Gentianae Macrophyllae Radix), and Maidong (Ophiopogonis Radix). Recovery occurred in just a few doses.
**Case of the Second Son of Neiqing Ling Qo Dian Shi:** He had abdominal pain since childhood. Various physicians treated it as Heat, Qi stagnation, or accumulation without success for years. Later, Lizhong Tang (Regulate the Middle Decoction) and Jianzhong Tang (Establish the Middle Decoction) were used alternately without effect. I was consulted. The six pulses were slightly wiry, and the complexion was greenish-yellow. I diagnosed Liver Qi exuberance insulting the Spleen. The previous use of Jianzhong Tang aimed to establish Middle Jiao Qi, harmonizing Spleen/Stomach and calming Liver Wood, which was appropriate. However, after several doses, distension and pain increased. Upon inquiry, I asked about the timing of pain: daytime vs. night, hunger vs. fullness? The patient stated pain occurred immediately upon swallowing food, relieved slightly after defecation, and worsened with extreme hunger but ceased in the Yin hours. I realized the cause: Xiaojianzhong Tang is a root-treatment formula, but its sour, cold, and sweet properties caused fullness. The patient’s condition resulted from eating too much after starvation, damaging Spleen/Stomach transport functions, leading to Liver insulting Spleen. This is "same source, different flow." I prescribed Liujunzi Tang added with Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus) to assist transport and prevent stagnation. Pain ceased after two doses. Medicine requires precision, not carelessness.
**Case of the Wife of Xiangsheng Fan Xiaofan:** She suffered from vertigo. The six pulses were floating and slippery. Phlegm-resolving and qi-smoothing herbs were slightly ineffective. I stated: "No phlegm, no vertigo" is an ancient saying, but the branch of phlegm lies in the Spleen, while the root lies in the Kidney. The *Suwen* states: "Headache and disorders of the vertex indicate deficiency below and excess above." The Liver is the root of Yi Wood; the Kidney is the source of Gui Water. Insufficient Kidney Yin allows Liver Fire to flare, moving upward to the vertex causing vertigo. Treatment should prioritize supporting the Spleen; when the Spleen is stable, Wood harmonizes, and Lung Metal is nourished. Metal is the mother of Water; if the child is not deficient, vertigo ceases. Morning: Liujunzi Tang added with Shanyuzhi (Cornus Fructus) and Tianma (Gastrodiae Rhizoma). Night: Shenqi Wan (Kidney Qi Pill) added with Renshen (Ginseng Radix), Tianma, and Lurong (Cervi Cornu Degelatinatum). She recovered.
**Case of Mr. Gu Ding from Zhoupu:** He was robbed at night, sustaining thirty-seven knife wounds on the left side from head to foot, losing nearly a thousand units of blood, with broken bones and tendons. For one hundred days, pus drained continuously, flesh rotted, skin turned black, and he suffered unbearable pain, unable to turn. Specialists used yin-nourishing, blood-tonifying, pain-relieving, and muscle-generating herbs, which instead stagnated the Stomach gate and obstructed the cardia, causing aversion to food and open wounds. I was consulted. The wound at the left cun/guan area oozed pus; the pulse was extremely weak and difficult to feel. Deficiency indicates Yin injury; weakness indicates Yang decline. With dysfunctional Yin/Yang, empty Ying/Wei, and depleted Qi/Blood, muscles ulcerate. The *Lingshu* states: Wei Qi warms the flesh, fills the skin, thickens the interstices, and controls opening/closing. Open wounds result from scattered Wei Qi failing to consolidate. Even with pus and old blood, if Yang energy moves and Fire circulates, pus will stop, wounds will close, and flesh will regenerate. Within weeks, walking should resume. Observers thought this absurd given the severity, expecting only delayed death. If he recovers, you must be a deity. I took responsibility, prescribing large doses of Yangying Tang (Nourish Camp Decoction) for twenty doses. Wounds closed, appetite returned. After one hundred doses, he could sit up. Medicinal wine and Huanshao Dan (Return to Youth Pill) were adjusted. After four to five months, he walked with a cane; the next year, he discarded it. He remains robust, a rare occurrence.
**Case of the Principal Wife of Zhang Gongxiang from Dachang:** Over forty, grieving her son, she suffered vaginal bleeding like a gushing spring. Siwu Tang, Aiye (Artemisiae Argyi Folium), Zonglü (Areca Seed Husk), and Mianhui (Cotton Ash) failed to stop it. A knowledgeable physician suggested Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to regulate Spleen and tonify the root. Although slightly effective, she still bled heavily every few days for half a year, forming fist-sized clots, insomnia, and chest distension, in critical condition. I examined her: greenish-yellow complexion, lusterless lips/nails, numb limbs, body aches, hollow/empty pulses occasionally choppy. This is long-standing illness with depression, severe deficiency with Cold. The Spleen prefers joy over sorrow, warmth/dryness over cold/damp. Using Aijia (Moxa and Ligusticum) astringents would block meridians and increase depression. Using only Shengma/Chaihu lifting methods would deplete Yuan Qi. I prescribed Guipi Tang (Restore the Spleen Decoction) added with Yizhiren (Alpinia Oxyphylla Fructus) and Paojiang. Large doses for four doses reduced symptoms, allowed sleep, widened the chest, and improved appetite. After two months of regulation, menstruation normalized. She consumed sixteen jin of Renshen. How can the poor afford this?
**Case of the Wife of Shen Tiansheng, Xiaolian from Zuili:** Uncontrollable uterine bleeding (Benbeng). Physicians argued heat causes flow, cold stops it. Siwu Tang plus Huangqin (Scutellariae Radix) and Huangbai (Phellodendri Cortex) failed for two days. My father treated her. Pulse was calm, no pathological signs; body thin, not strong. Diagnosed Spleen/Stomach Qi deficiency failing to control blood. Bitter-cold herbs suppressed Yang. Used sweet-warm herbs to restore growth. Prescribed Bu Zhong Yi Qi Tang added with Ejiao (Donkey-Hide Gelatin) and Paojiang to tonify Spleen Yuan and lift Yang. Bleeding stopped after two doses; gradual recovery followed.
**Case of the Wife of Zhu Sihuang, Changgong, from Hejian Simli:** Pregnant seven months, abnormal fetal swelling, wheezing unable to speak or lie down for a month. Family panicked, medications chaotic. One doctor used Renshen/Baizhu to solidify Spleen; another used Shanglu (Phytolaccae Radix) and Tinglizi (Lepidii Semen) to moisten Lung. Contradictory approaches increased doubt. I advised: The pulse is flooding and slippery; prenatal safety is assured, though delivery may be complicated. Discarding previous treatments, one or two doses would bring peace. Critics doubted my ease. I reasoned: Stomach is the sea of Clear Yang; Lung is the bellows of Yuan Qi. Respiration rises from Dantian; purification relies on Middle Earth. Excessive rich diet causes Middle Jiao heat. Pregnancy binds internal phase-fire; by six/seven months, Lung/Stomach dominate, fetus grows large, forcing Fire upward, causing wheezing and inability to lie down—called "Zixuan" (Fetal Suspension). Warm tonics (Renshen/Baizhu) would block Lung Qi; bitter-cold (Tinglizi) would endanger Stomach Qi, causing real-excess/false-deficiency errors. I prescribed Suzhugen (Perillae Caulis), Zhike, Fupi (Magnolia Bark) 3 qian each; Fuling (Poria), Chenpi (Citrus Peel), Banxia (Pinelliae Rhizoma) 1.5 qian each; Gancao (Licorice Root) 0.5 qian; Shengjiang (Fresh Ginger) 3 slices. One dose allowed speech; two doses allowed sleep. Family called it divine. I warned: Prenatal wheezing is easy to treat, but postpartum recurrence is likely. Prepare strategies to protect Yuan Yuan before birth. She delivered a healthy boy. Two days later, wheezing recurred, appetite dropped. This indicated Spleen Earth deficiency failing to generate Lung Metal. Large doses of Renshen, Baizhu, Fuling, Gancao, Wuweizi (Schisandrae Fructus), and Rougui (Cinnamon Bark) resolved it.
**Case of Fang Lisheng Ru Ren from Xi:** Chronic left hypochondriac pain. Qi-moving and blood-stagnating herbs worsened vomiting, even preventing water intake. Left pulse deep, right pulse flooding. Anger stirred Liver Fire insulting Spleen Yin. Harsh drugs damaged Stomach Qi. Three Yin channels failed; Five Yang channels exhausted. Middle Jiao blocked, food regurgitated. Natural consequence. I prescribed Yigong San (Extraordinary Success Powder) added with Baizhi (Angelicae Dahuricae Radix) and Rougui. To drain water within Earth, fasting was required. Dangshen (Codonopsis Radix) 5 qian, Chencangmi (Aged Rice Grain) >100 grains, Chenpi 1 qian, Shengjiang 3 qian, decocted in Fulonggan (Dragon’s Liver Soil) water. Sip when hungry. After 2-3 days, thin congee introduced. Stomach Qi harmonized, vomiting ceased. Miraculous effect.
**Case of Ke Ainin:** Post-hematemesis, continuous cough, wheezing with froth, afternoon tidal fever. Siwu Tang plus Zhimu (Anemarrhenae Rhizoma) and Huangbai failed. Added Su Zi (Perillae Fructus), Beimu (Fritillariae Bulbus), Duban (Stemonae Radix), Mudanpi. Condition worsened. Six pulses hollow and soft; feet floating and rapid. Diagnosed Yin exhaustion, essence depletion, floating isolated Yang. Lung Metal Qi failed to descend to Dantian; vigorous Fire roamed clear pathways, injuring delicate organs, causing wheezing/cough. Should use Liuwei Wan (Six-Ingredient Pill) plus Wuweizi (Schisandrae Fructus) and Chenxiang (Aquilariae Lignum) to guide Fire back to source. But Spleen Qi was not solid. First prescribed Renshen, Baizhu, Huangqi (Astragali Radix), Shanyuzhi, Shanyao (Dioscoreae Rhizoma) 1.5 qian each; Shihu (Dendrobii Caulis), Mudanpi 1 qian each; Wuweizi 21 grains; Rougui 0.5 fen. Dozens of doses solidified stool. Then switched to previous formula for a month; cough resolved. Three years later, relapse due to bitter-cold abuse led to death.
**Case of Fengweng Tian Erfu from Yunjian:** Chronic diarrhea with muscle wasting, lower abdominal pain. Food made gurgling sounds upon swallowing; entered cardia, exited anus immediately. Thickening Spleen decoctions and solidifying Intestine pills failed. Near death. Forehead/Nose areas dull and lusterless. Six positions of Qi Kou pulse fine, weak, spiritless. Clear Yang not ascending; Primordial Yin sinking. Transport failed; storage collapsing. Kidney is the gate of Stomach and mother of Spleen. Postnatal Qi controlled by Earth; Prenatal Qi generated by Kidney. Spleen is Kun Earth, born from Li Fire; Gen Wood born from Kan Water. Food in Stomach is like grain in a pot; Spleen Earth roasts it, but needs Minor Fire to generate Qi. Like all things starting in Earth, they grow via Yang Qi. Life-transformation Qi belongs to one point of Yuan Yang. "The four greats and whole body belong to Metal," but what is Yang Essence? Only Mingmen Fire decline and Dantian Cold cause Spleen failure to transport essences, intestines to transform food, Sanjiao to manage entry/exit, and Five Yang to distribute. Ascending essences sink. Thus, chronic diarrhea loses Yin; profuse loss loses Yang. Yin/Yang roots reside in Kidney. Tonifying Spleen without Kidney ignores the "treatment of separation by two." Use acrid-hot herbs to warm Lower Jiao; sweet-warm herbs to cultivate Middle Earth. Like adding fire to a furnace or oil to a lamp. Used Renshen, Baizhu, Paojiang, Zhi Gancao (Prepared Licorice), Shufu Zi (Prepared Aconite Root). Decocted, mixed with Chishi Zi (Hematitum) powder 3 qian. Gradual peace; ten doses stopped pain/diarrhea, restored complexion/appetite. Full recovery in one month. Visited for a day. Next spring, after reunion, overeating fruits caused relapse. Died in mid-summer. Proof of Wood insulting Spleen is precise.
**Case of the Wife of Xi Yisi, Xiangsheng:** Fever, abdominal pain, nausea/anorexia. Six pulses deep and depressed, face black as smoked. Depression-resolving and middle-regulating herbs helped initially, but anger triggered relapse. Half-year decline, painful urination, heavy lower abdomen. I diagnosed: Masses usually in Middle Jiao; Xuanpi adheres to umbilicus. Current urinary retention and heaviness indicate skin scaling and periumbilical sores. Lower Jiao Liver Fire long-depressed became a lower abdominal abscess. Not my specialty; should see surgeon. Surgeon confirmed; abscess ruptured with thick purple pus. Tuoli Yangrong (Support Interior and Nourish Camp) herbs cured her in a month.
**Case of Xu Jingshan:** Typhoid with stagnant heat, passing stages unresolved, dietary relapse after recovery. Delirium, coma, high prickly black tongue, deafness, flooding-large pulses. Yangming Stomach Heat transforming blood into macules. Lamp illumination revealed purple bean-sized spots on chest/abdomen, bright as stars, not fully erupted. Clear Stomach and detoxify to reveal spots, reducing heat/spirit disturbance. Zhuyeshigu Tang (Bamboo Leaf and石膏 Decoction) for two doses. High fever subsided, spots erupted, but coma worsened, unresponsive to shouting, body limp, only breath remaining. Others declared death. Re-examination: Pulses present but weak/virtual. Initial Stomach Heat decayed; cold herbs cleared pathogen but depleted Righteous Qi. Eyes closed, stiff as dead. Urgently tonify Stomach to awaken True Yang. Shengmai San (Generate the Pulse Powder) combined with Sijunzi Tang (Four Gentlemen Decoction) [Yiqi Jianpi]. By midnight, eyes opened, requested rice porridge. Gradual recovery.
**Case of Huang Hanmei, Ancestor’s Wife:** Gengchen Imperial Exam, typhoid. Severe stage: Black prickly tongue, high fever, delirium, coma, near death. Pathogenic Heat internal, Hyperactive Yang external burning, organs scorched, blood boiling, macules impending. Shengdi (Rehmanniae Radix), Mudanpi, Yuanshen (Scrophulariae Radix), Maidong, Huanglian (Coptidis Rhizoma), Zhimu, Gancao. One dose: macules appeared. Two doses: spirit cleared. Three doses: tongue pricks washed away.
**Case of Fang Zhilin, Yanjing Liyuan:** Typhoid five days, critical. Seven relatives in Imperial Medical Academy helpless. My father treated. Renying pulse tight/full, right Guan flooding-large, spirit manic, tongue coating slightly black. Pathogenic Heat constrained, spirit confused/manic; Hyperactive Yang blazing, Fire extreme resembling Water (black tongue). Burning heat threatening wildfire. Cool Blood to save from burning. Red macules on chest/abdomen confirmed. Huaban Qinghuo (Macule-Clearing Fire-Purging) one dose cured.
**Case of Gongren, Ancestor of ??? Fen Town:** Robust build, fifty years old, finger numbness for three years. Autumn Jiachen, angered, suddenly fell silent, collapsed, phlegm roaring like saw, eyes closed, incontinence, six pulses flooding-large. Rushed home. Ancestor knew medicine, deemed hopeless, proposed Xiao Xuming Tang (Minor Continuation of Life Decoction), awaiting my decision. I said: This formula gathers acrid-warm herbs, good for expelling pathogens, bad for nourishing Righteous Qi. Three reasons: 1. North people have solid Qi, South people deficient. Northerners in South adapt, pores loosen, vulnerable to soft/brittle Qi invading, causing Yin/Yang inversion, Ying/Wei dissolution, and Qi-deficiency stroke. North/South distinction one. 2. Stroke key is distinguishing Bi (Closure) and Tuo (Collapse). Bi: Pathogen blocks, Righteous Qi congested, closed off. Tuo: Pathogen wins, Heart Qi flies away, collapse. Vast difference. Xiao Xuming Tang is for Bi (opisthotonos, lockjaw). Using for Tuo (closed eyes, incontinence) injures Yin and consumes Yang. Closure/Collapse distinction two. 3. Wind is Yang containing Yin, corresponding to Liver. Liver is Yin containing Yang, combining with Wind. Excessive anger raises Liver/Gallbladder, internal Fire and external Wind disrupt, attacking Spleen Earth, causing surging phlegm. Blame Spleen for lack of control, Kidney for not returning to meridian. Nourishing roots is hard enough; dispersing makes deficiency worse. True/False distinction three. *Lingshu*: Deficient evil stays half-body, enters Ying/Wei. Declining Ying/Wei leaves Righteous Qi, Pathogen remains, causing hemiplegia. Matches this case. Follow Hejian/Dongyuan methods, preserve Spleen/Kidney. Liujunzi Tang added with Huangqi (Astragali Radix), Baishao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Gouteng (Uncariae Ramulus), Zhuli (Bambusa Sap), Jiangzhi (Zingiberis Juice). Two doses: symptoms reduced, pulse converged. Voice hoarse: Kidney Water decline, Heart sprout withered. After watch, Fire descends, Kidney Essence ascends, voice returns. Dihuang Yinzi (Rehmannia Decoction) fifteen doses: stool passed, hard black. Voice like swallows. Morning: Bu Zhong Yi Qi Tang + Wuweizi/Maidong to tonify Spleen. Evening: Dihuang Tang + Roushurong (Cynomorii Herba), Danggui (Angelicae Sinensis Radix) to nourish Kidney. Hundred days regulation: speech/walking normal, right hand slightly weaker.