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Second Visit:

The patient presents with tremors and shaking, which indicates that Yin pathogenic factors are contending and gaining the upper hand against the healthy Qi; once tremors occur, Yang Qi fails to recover. When this pathological momentum arises, upward rushing causes the jaw to quiver, while spreading outward leads to limb movements. As for muscle twitching and sinew palpitations, these represent only milder manifestations of the disease onset. To treat this condition, one should merely employ gentle tonification combined with calming the Heart and anchoring the Spirit (Zhen Xin An Shen). However, since the Liver fails to store the Hun (Ethereal Soul), sleep-wake cycles are disrupted; additionally, the Gallbladder is internally timid, causing frequent episodes of fright and palpitations. Complicated by Phlegm-Fire wandering inward, the prescription must simultaneously prevent Jue syndrome (reversal cold/heat) and obstruction. Submitted for the correction of Mr. Hou Shipan and Mr. Zhuxiang.

Longchi (Dragon Teeth), Renshen (Ginseng Root), Guishen (Angelica Sinensis Root Body), Yuanzhi (Polygala Root), Fushen (Poria with Hostwood), Juhong (Tangerine Peel), Zaoren (Semen Ziziphus Jujubae - stir-fried with 3 fen of Chuanlian/Coptis Rhizome), Danning (Arisaema cum Bile), Shijueming (Concha Haliotidis), Banxia (Pinellia Tuber - mixed with Zhuli/Bamboo Sap), Shumi (Sorghum Grain), Zhuru (Bamboo Shavings), Gouteng (Uncaria Ramulus cum Uncis).

Third Visit:

Tremors and shaking did not occur on the Winter Solstice, which already implicates the failure of Yang Qi to recover. If it occurs before the Winter Solstice, it is even more clearly a case of Yang Qi failing to recover, which goes without saying. Although "Yin contending and winning" is not explicitly stated, it is understood that Yin gains the upper hand because Yang Qi is insufficient and has failed to recover in time. How can Yin contend? While Yin's contention is evident, what exactly is the "Yin" that is being contested and conquered? The answer is: The Liver belongs to Yin, and Phlegm also belongs to Yin. Phlegm is generated by the Spleen; the Phlegm produced by the Spleen Meridian is stirred downward by Yin-Fire from the Liver Meridian. Once stirred, Wind is generated, and Yin-Phlegm rises counter-currently. This is the origin of tremors and shaking. Is this not merely what the *Neijing* states: "All wind disorders involving tremors and dizziness belong to the Liver"? Originally, there were symptoms of fright and palpitations, which have become more severe due to the tremors. No wonder there are symptoms such as excessive wakefulness and scanty sleep.

Renshen (Ginseng Root), Dongzhu (Atractylodes Macrocephala Rhizoma harvested in winter), Fushen (Poria with Hostwood), Zhigancao (Prepared Licorice Root), Banxia (Pinellia Tuber), Chenpi (Dried Tangerine Peel), Dashengdi (Rehmannia Glutinosa Root - large size), Maidong (Ophiopogon Tuber), Guishen (Angelica Sinensis Root Body), Baishao (White Peony Root), Zaoren (Semen Ziziphus Jujubae), Yuanzhi (Polygala Root), Shumi (Sorghum Grain), Shijueming (Concha Haliotidis), Zhuru (Bamboo Shavings), Gouteng (Uncaria Ramulus cum Uncis).

First, take Sanqian (Magnetic Cinnabar Pill) 3 qian, administered with Chenpi Decoction.

Fourth Section Discussion:

In constitutions with Yin deficiency, the single water of the Kidney originally cannot control the two Fires. This is what the *Neijing* describes as the normal state. Here, however, there are variations: under conditions of mental fatigue, Fire arises from within; during hot summer weather, Fire invades from without. These internal and external evil pathogens merge into one. When borne by long-standing Kidney Water deficiency, the Yang collaterals are injured, and blood overflows externally. If the overflow is not cleared, it transforms into cough. It may even progress to continuous coughing with sound and phlegm. Although diet remains acceptable, muscles secretly waste away. From autumn to winter, it is the season where Metal and Water generate each other. Thus, the visible symptoms appear relatively harmonious, and the patient feels at peace, unaware that in mid-spring, when Water Qi is prosperous, it may reverse-insult Metal. Metal corresponds to the Lung; when the Lung loses its clear and descending function, the voice becomes hoarse, the throat hurts, and the larynx becomes obstructed (Bi syndrome). This reveals that the Fire of One Yin and One Yang is knotted internally, affecting Metal, gradually forming a chronic wasting disease (Sun syndrome). However, the pulse is fine and rapid, but not surging (Cu). Although Yin-Fire is vigorous, Yin fluids are not yet exhausted. One can plan slowly, advancing nourishment daily, so that by the Summer Solstice, when Yin grows, recovery and auspiciousness can be predicted. Currently, the pulse is deficient and Fire is severe. Although medicine is swallowed, this is the most critical moment. Clearing heat is necessary, but tonification alone is also necessary; one must weigh between the two. Only the method of Qian Yi's Ejiao San (Donkey-Hide Gelatin Powder) can be modified and used to fit the pattern. Submitted for correction.

Ejiao (Donkey-Hide Gelatin), Madouling (Aristolochia Manshuriensis Fruit), Zhigancao (Prepared Licorice Root), Niubangzi (Arctii Fructus), Huafen (Trichosanthes Radix), Zhufu (Porcine Skin), Chuanbei (Fritillaria Cirrhosa Bulb), Qiushi (Urine Sediment), Fenghuangyi (Periostracum Bombyx Batryticatus), Maidong (Ophiopogon Tuber), Jingmi (Oryza Sativa Germen), Zhufen (Pearl Powder), Dashengdi (Rehmannia Glutinosa Root - large size), Xingren (Prunus Armeniaca Seed).

Additionally, prepare Liuwang Wan (Six-Ingredient Rehmannia Pill) using water-pellet method (3 qian), taken early in the morning with light salt water.