Library

Upon the second visit, the previously wiry and slippery pulse has become considerably slower compared to yesterday following the nourishing and clearing treatment at the lower jiao. However, since lung injury by heat pathogens easily leads to Wei syndrome (a condition characterized by flaccidity and weakness of the limbs), this must not be overlooked.

The prescription is added with Benincasae Semen (Dongguazi) and Luffae Fibra Retinervata (Sigualuo).

Wheezing originates from the Kidney and manifests in the Lung. The root and branch share the same source; initially, the pathogen is excessive, followed by a decline in healthy Qi, which is not suitable for chronic illness. Heat in the upper jiao, leading to cough and developing into Fei Wei (Lung Flaccidity), was long ago discussed by Zhang Zhongjing. This is not merely about the Lung organ itself; externally scorched by fire-heat, internally reversed by Liver Fire, Metal (Lung) fails to generate Water (Kidney), and Water fails to nourish Wood (Liver). Consequently, Wood counter-rebels against Metal, causing harm as fierce as a tiger. We switch to treating the lower jiao with Guizhi Fuling Mu Dan Pi Tang (Fumai Tang) and the upper jiao with Weijing Decoction, hoping to achieve success.

Zhi Gancao (Prepared Licorice Root), Renshen (Ginseng Root), Shengdi Huang (Rehmannia Root), Maidong (Ophiopogon Tuber), Ejiao (Donkey-hide Gelatin), Dongguazi (Winter Melon Seed), Sigualuo (Luffa Fiber), Lian Gen (Lotus Rhizome), Yimi (Coix Seed), Chuan Bei Mu (Fritillaria Bulb), Zhimu (Anemarrhena Rhizome), Sang Bai Pi (Mulberry Root Bark), Gu Pi (Phellodendron Bark), Ge Qiao (Clam Shell).

Carefully analyzing the etiology, it essentially boils down to "Dryness." Nothing dries things more than Fire. Fire can be deficient or excess. If the fire is slightly cleared, it becomes deficient fire, where heat flares upward and cannot return to gather in the lower jiao. Therefore, besides yellow phlegm, pink sputum appears; the tongue is dry and rough; stool is constipated and hard, and urine is scant and firm; the skin and muscles are dry and hot; even hand tremors and sleep-talking occur, indicating that extreme heat generates wind and fluid depletion causes wind movement. Why wait until the left pulse becomes floating and the right pulse becomes thin to realize that the fire of the five emotions and Jueyang fire are also secretly drying the Metal? At this point, the Lung is already deficient. Although we seem helpless, we cannot sit idly by. We must only use Ziyao Jiufen Tang (Ziyao Jiufen Decoction). Although it may be too late to help, we must still think of "nothing moistens things better than dew," hoping for heavenly assistance to the virtuous.

Ziyao Jiufen Tang

Summer heat latent within, manifesting only at the end of autumn, is indeed late. Being late means the disease path is distant and the qi is deep, spreading horizontally to the Membrane Source (Moyuan) and outward to the Yangming channel. Thus, upon initial onset, only steaming fever is seen, difficult to resolve through sweating. It has now been twenty days. Having transformed into fire, it caused thirst and dryness, inevitably injuring the Yin aspect. Injury to Yin transforming into dryness is a typical symptom of summerheat pathogens. Moreover, Yangming Earth is where all things gather, making it prone to transforming into fire and injuring fluids. However, Yangming fire transforming and injuring fluids requires only clearing and nourishing, which is still manageable. Unfortunately, the patient's condition involves fire internalizing with food stagnation, knotting without opening, and occupying the Small Intestine. Ascending, it causes mouth sores; descending, it causes diarrhea. Persistent diarrhea turns into dysentery, with yellow stool mixed with gray-white matter, accompanied by severe pain during defecation, indicating that excess pathogens manifest as excess syndromes. If the Stomach Qi were robust and the Kidneys not deficient, using purgative agents might succeed, which would be fortunate. However, the patient has no appetite, looks exhausted, face is pale with a bluish tint, muscles are emaciated, and urine is scant. The healthy Qi of both Shaoyang and Yangming channels is depleted, and fluids are first exhausted. Urgent supplementation is needed, yet it may already be too late. How can we use purgatives? The right pulse is wiry and rapid; the left pulse is fine and small. Fine and small indicate deficiency; wiry and rapid indicate excess. This is deficiency containing excess. Treating excess hinders deficiency; tonifying deficiency hinders excess. Medication is truly difficult. Only Zhu Ling Tang (Polyporus Decoction) fits best for post-stasis Yin injury. However, while the lower jiao can be treated, the knotting in the middle jiao and the deficiency of Liver Yin remain untreated. Adding Liu Yi San (Six-to-One Powder) and assisting with Shaoyao Gancao Tang (Peony and Licorice Decoction) aims to prepare three methods in one formula, hoping for success. Otherwise, the condition will deteriorate into collapse. Submitted for correction by esteemed experts.

Zhuling (Polyporus), Ejiao (Donkey-hide Gelatin), Chiling (Red Polyporus), Zexie (Alisma Rhizome), Hongqu (Red Yeast Rice), Gancao (Licorice Root), Shaoyao (Peony Root), Huashi (Talcum), Jicaihua (Shepherd's Purse Flower, 1 liang), Biqi (Water Chestnut, 4 pieces), Haizhe (Sea Cucumber, 1 liang). Decoct these to replace water.