大生地 知母 元参 地骨皮 鳖甲 胡黄连 石膏 党参 炙甘草 麦冬 佩兰叶
丁 营阴内亏，头眩心嘈，下午微寒内热。能食无力，胃中有热则消谷，脾虚气弱则无力也。
党参 沙苑子 茯苓 川连 枣仁 知母 女贞子 白芍 冬术 麦冬 竹茹
王 左脉空大，肾水亏也。倦怠无力，脾气弱也。食少则阴虚，阴虚生内热，症属内伤。
补中益气加黑山栀、白芍。朝服六味丸四钱。
渊按∶阴虚有二，有营中之阴虚，有肾中之阴虚。营阴虚故从东垣，若六味地黄则治肾阴虚。
徐 二月间吐痰带血，血止之后，略兼干咳。交清明节，咳嗽渐甚。四月初，身加发热。今诊脉
细数，形容消瘦，行动气升。此属肾气先亏于下，复因劳碌感邪，延绵不已，虑成劳损。静养为佳。
阿胶 牛蒡子 炙甘草 茯苓 杏仁 川贝 款冬花 元沙参 蛤壳 枇杷叶
孙 久有咳嗽血痰之恙，今复肛门结疡，是肺遗热于大肠。
脉数音哑，劳损之根。时当夏令，火旺金衰，颇有气逆血沸之虑。
沙参 地骨皮 阿胶 白芍 麦冬 杏仁 白扁豆 川贝 枇杷叶 丹皮 白蜜（二匙，药汁调服）
高 脉沉取数，其阴内亏，其热在里，劳损之候。症见咳吐
白痰，心腹不时疼痛，痛则气满，得矢气则稍宽。病兼肝郁。据
云咳嗽已及三年，初无身热，则病从痰饮而始，宜从痰饮气郁例
治之。
法半夏 炙甘草 桂木 茯苓 冬术 陈皮 川贝 神曲 归身 丹皮 白芍 香附 沉香 橘饼
又 痰饮咳嗽发热，肺肾两亏，湿热不化。用苓桂术甘合二陈治其肺脾，都气丸兼治其肾可也。
苓桂术甘汤合二陈，加沉香、杏仁、川贝。都气丸四钱，盐花汤送下。
石 行动短气而喘，头眩心跳，得食则胀。肝肾虚而气不纳，脾胃虚而气不运。用补中益气送下六味丸。
补中益气汤加茯神、半夏、神曲，砂仁煎汤，送六味丸四钱。
某 费心太过，中气不足，湿热内蕴。咽下至胸，常若空空，行动无力，臀发湿疮。宜自安逸，防其心跳头眩。
冬术 半夏 茯苓 陈皮 归身 砂仁 党参 香附 苡仁 萆 桑枝
赵 脉沉数，手足冷，胸闷食少，脾胃衰弱。大便干燥者，
肠中之津液枯也。法当温中土，润大肠，仿菟丝子丸加减。
吴茱萸 淡苁蓉 花槟榔 怀牛膝 砂仁 柏子仁 川熟附 陈皮 菟丝子 茯苓 怀山药
渊按∶槟榔一味，取其沉降直达下焦，引领辛润诸药至大肠耳，非欲其破滞气也。
又 前方加火麻仁、郁李仁、当归。
穆 思虑伤脾之营，劳碌伤脾之气。归脾汤，补脾之营也；补中益气汤，补脾之气也。今将二方并合服之。
党参 黄 冬术 茯神 归身 炙甘草 砂仁 枣仁 升麻 柴胡 制半夏 木香 陈皮
薛 肾气虚逆，非滋不纳；脾弱运迟，滋则呆滞。然则如何
而可？曰，补肾之阳，即可以转运脾气。从仲景肾气丸化裁。
大熟地（附子三分，炒） 五味子 茯苓 怀山药 肉桂心 麦冬（
元米炒） 牛膝（盐水炒） 山萸肉 陈皮 紫石英 补故纸（盐水炒） 胡桃肉
丁 病本阳虚土弱，而乏生生之气，故脾胃大惫。时当夏
暑，温药难投，补脾虽不若补肾，然酷暑郁蒸，湿热用事，不若补脾胃为稳。
高丽参 陈皮 冬术 炮姜 茯苓 白扁豆 益智仁 谷芽
羊 病本阴虚，时当酷暑，潮热干咳，渐入损途。养阴冀其
退热，然药宜轻不宜重，恐过滋反伤脾胃也。健脾可以加餐，然亦不宜燥，恐燥则劫烁肺阴也。姑拟一方备正。
生洋参 白扁豆 五味子 丹皮 麦冬肉 地骨皮 生苡仁 怀山药 沙参 茯苓 枇杷叶
奚 黄昏咳嗽，肺热也。黎明气升，肾虚也。纳食倒饱，脾
虚也。补肾纳气治其下，清金化痰治其上，运脾培土治其中，三焦并治。
大生地 沙苑子 麦冬 川贝 茯苓 怀山药 六神曲 沙参 牛膝 枇把叶
冯 久咳痰稠，上午发热，面色青黄。左脉细数，右脉软
弱。病属上损。幸大便不溏，尚未过中及下。加谨调养，交夏至节无变再议。
党参 炙甘草 怀山药 麦冬 五味子 青蒿（酒炒） 白芍（桂枝
三分，拌炒） 川贝 茯苓 白扁豆 枣仁 煨生姜
又 咳嗽脉细数，前上午发热，今下午亦热，阴气渐伤。大
便间或带血，脾气虚也。从景岳理阴煎例。扶过夏至节，一阴来复，病无增变，庶几可延。
四君子汤合生脉散，加生地、怀山药、白芍、白扁豆、川贝、
阿胶、红枣。
赵 漏疡日久，阴津暗渗。加以咳嗽气耗，考试劳神，于是
咳甚气升，便溏内热、音哑喉痛等等，接踵而至。脉象细数，已
成劳损。夫精、气、神为人身三宝，一有所伤，便为大患，况三者皆虚乎！敢谢不敏，幸熟察焉。
沙参 甜杏仁 麦冬（元米炒） 生甘草 川贝 茯苓 白扁豆 怀山药 十大功劳
童 年已十七，天癸未通，骨胳瘦小，先天不足也。不时鼻
衄，虚火上炎也。腹痛绵绵，中虚木横也。曾见蛔虫，木横则虫
动也。此属童损。先天不足之症，以后天补之，难矣。
茯苓 怀山药 陈皮 当归 茜草炭 乌药 冬术 白芍 丹皮 川椒 乌贼骨
廉 肾阴虚而气升喘逆，心阴虚而心跳少寐，胃气虚而痰饮
留恋，肝风动而头眩震掉，肠液枯而大便坚干。经云∶肾苦燥，
急食辛以润之。心苦缓，急食酸以收之。肝苦急，急食甘以缓之。肠胃津枯，当滋气血，拟都气丸意。
大生地（蛤粉炒） 茯神（辰砂拌） 半夏 炙甘草 五味子 沉香 柏子仁 石决明 怀山药 麦冬 西洋参
李 阴亏于下，气逆于上，抑塞于中，煎熬津液，气急痰
凝，病成煎厥。本属为难，而药必清滋，效非容易。所虑酷暑将临，外受炎蒸之热，内无宁静之期，则有甚加剧耳。
鲜生地 枣仁（猪胆汁炒） 元参 茯神 牡蛎 女贞子 石决明 羚羊角 远志（甘草汤制） 竹茹
渊按∶煎厥证《内经》述之，世不多见。大抵水亏木燥，肝
家风阳挟痰上扰，阻气机，塞窍隧，与肝风痰火有同类耳。
朱 心跳少寐，是血虚也。气攻作胀，是肝虚也。头眩筋
惕，是肝风也。食少便溏，是脾虚也。平肝气，熄肝风，养营阴，补脾土，是其治也。
制香附 青陈皮 茯苓（赤白各半） 归身 白芍 沙苑子 制首乌 神曲 砂仁 姜 枣
倪 据述有时惊悸，有时肌肉顽木，或一日溏泄数次，或数
日一大便，坚干难出，惟小便常红。此心气郁结，脾气失运。失
运则生湿，郁结则聚火。火则耗精，湿则阻气而气机不利矣。拟荆公妙香散加味，补益心脾，通达气机立法。
西洋参 黄 茯神 桔梗 远志 怀山药 麝香（调服） 辰砂 木香 川连（盐水炒） 炙甘草 麦冬（元米
炒）
共为末，藿香、陈皮汤泛丸。每朝三钱，开水送下。
徐 昔立斋治病，每定一方，令人服数十剂，非心精识果，
乌能如此！然非病家信之真，任之专，亦乌能如此！林也不才，
何敢妄希前哲。然审病既的，药当不谬。从此加鞭，以图进益。
天冬 麦冬 生地 熟地 怀山药 沙参 茯神 枣仁 牡蛎 白芍 洋参 阿胶 红枣 浮麦
此妇年三十四五，从未生育，因惊恐患怔忡头昏，耳鸣火升，发热汗出，食少便坚，将及百日。服此方
三十帖见效。即将此方加重，煎膏常服，几及一年，全愈。后生一子。
谢 汗多表虚，便泄里虚，腹痛中虚，气升肾虚。经停肝虚，多梦神虚。三焦皆病，五脏无一不虚。
姑拟培土为主，以土为万物之母也。
党参 冬术 茯苓 沙苑子 怀山药 白芍 枣仁 陈皮 五味子 白扁豆 丹皮 红枣 浮麦
渊按∶五脏皆虚，独治后天脾胃，诚为扼要。然便泄腹痛，宜少佐温脾更妙，以阳虚甚于阴虚也。
仁渊曰∶此编集痰饮咳嗽，五脏阴阳偏虚之证，非尽属虚劳也。若虚劳证，经谓∶有所劳倦，形气衰少，谷
气不盛，上焦不
行，下脘不通，胃气热，热气熏胸中，故内热。言努力劳倦，伤其中气，致中气衰少，不能布化水谷，
肺经治节不行，热气蕴于胸中，不得发越而生内热，乃伤脾胃氤氲之气也。治曰∶劳者温
之。《金匮》曰∶男子平人脉大为劳，极虚亦为劳。遗精、失血、盗汗，劳之病也。治以桂枝龙牡、小建中、
黄建中等汤，即祖《内经》劳者温之之法。HT HT 相传，后人莫得异议。然余窃
有疑焉。盖《内经》之所谓劳，乃劳伤其中气也。故以酸甘温煦之药，温之补之，使卫旺生营，脾胃阴阳之气
有所倚赖，则虚可补，劳可复。若《金匮》则相火旺而遗精，阴精虚而火升失血，
热蒸于营而盗汗，亦用甘酸温煦以养之。一则伤其中气，一则损其精血，病不同而治则同，此何故也？近世治法，
于劳倦伤中者，祖仲景、东垣。于遗精失血者，不敢祖桂枝、建中等法，都
从事于朱丹溪、葛可久滋阴之法，亦始效而终不效。良以苦寒滋降，能平炎上之火，易伤中焦之气，胃气一伤，
百药莫治，故越人有上损及中，下损及中皆不可治之说。然则丹溪、可久既不可
恃，《金匮》方究竟可用否？曰∶仲景为千古医祖，非贻误后人者。若内伤劳倦，于仲景、东垣法不得异议。若遗
精失血，自元明后诸贤无敢用其方者，诚以相火方炎，阴血上溢，投以刚热，
恐益其势耳。昔人聪明才智，岂逊于今，必有试而不合者矣。议
者多疵丹溪，余则不敢出违心之论。盖滋降之法，可暂用，不可久用。审其胃气元气可任，暂投以平炎上之火，
止其逆流之血，亦治之必须。否则温既助火，凉则伤中，日从事于轻描淡写，坐以
待毙，亦何取乎！俟血止火降后，以甘平味浓固精纳气之药以补
养之。经曰∶损者益之，精不足者，补之以味。《难经》曰∶损
其肾者益其精，损其肺者养其气。病伤精气者，仍从精气求之，庶于病情有益耳。
Sheng Dihuang (Rehmanniae Radix Preparata), Zhimu (Anemarrhenae Rhizoma), Yuanshen (Scrophulariae Radix), Digupi (Lycii Cortex), Biejia (Testudinis Carapax et Plastrum), Huhuanglian (Coptidis Rhizoma var. chinensis), Shigao (Gypsum Fibrosum), Dangshen (Codonopsis Radix), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Maidong (Ophiopogonis Radix), Peilanye (Eupatorii Folium).
Mr. Ding: Ying Yin (the yin substance constituting blood and nourishment) is deficient internally, presenting with dizziness and vertigo, cardiac discomfort (xin cao), and slight chills with internal heat in the afternoon. Although appetite is preserved, there is weakness; this is because stomach heat accelerates digestion (xiao gu), while spleen deficiency and qi weakness cause physical fatigue.
Dangshen (Codonopsis Radix), Shayuanzi (Astragali Complanati Semen), Fuling (Poria), Chuanlian (Coptidis Rhizoma), Zaoren (Ziziphi Spinosae Semen), Zhimu (Anemarrhenae Rhizoma), Nvzhenzi (Ligustri Lucidi Fructus), Baishao (Paeoniae Radix Alba), Dongzhu (Atractylodis Macrocephalae Rhizoma), Maidong (Ophiopogonis Radix), Zhuru (Bambusae Caulis in Taenia).
Mr. Wang: The left pulse is empty and large, indicating a deficiency of Kidney Water. Fatigue and weakness indicate Spleen Qi deficiency. Reduced food intake leads to Yin deficiency, and Yin deficiency generates internal heat; the syndrome belongs to internal injury.
Prescribe Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting the Qi) with Heishanzhi (Gardeniae Fructus Preparatus with Black Bran) and Baishao (Paeoniae Radix Alba). In the morning, take Liuwei Wan (Six-Ingredient Pill with Rehmannia) 4 qian.
Note by Yuan: There are two types of Yin deficiency: Ying-level Yin deficiency and Kidney Yin deficiency. For Ying-level Yin deficiency, one should follow Li Dongyuan's methods; Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) treats Kidney Yin deficiency.
Mr. Xu: In February, he expectorated phlegm mixed with blood. After the bleeding stopped, a slight dry cough remained. Around the Qingming Festival, the cough worsened. By early April, fever intensified. Current pulse is fine and rapid, body is emaciated, and breath rushes upward upon movement. This indicates initial deficiency of Kidney Qi at the lower jiao, compounded by labor-induced pathogen invasion, leading to a lingering condition feared to develop into consumptive disease (lao sun). Rest is advisable.
Ejiao (Donkey-hide Gelatin), Niubangzi (Arctii Fructus), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Fuling (Poria), Xingren (Armeniacae Semen Amarum), Chuanbei (Fritillariae Cirrhosae Bulbus), Kuandonghua (Farfarae Flos), Yuanshashen (Glehniae Radix), Geqiao (Tridacnis Concha), Pipaye (Loquasi Folium).
Mr. Sun: He has long suffered from cough with bloody sputum. Now, sores have appeared on the anus, indicating that Lung heat has been transmitted to the Large Intestine.
Rapid pulse and hoarseness are the root of consumptive disease. It is summer, Fire is prosperous and Metal is weak, raising concerns of rebellious Qi and boiling Blood.
Shashen (Glehniae Radix), Digupi (Lycii Cortex), Ejiao (Donkey-hide Gelatin), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Xingren (Armeniacae Semen Amarum), Baibiandou (Dolichoris Semen), Chuanbei (Fritillariae Cirrhosae Bulbus), Pipaye (Loquasi Folium), Danpi (Moutan Cortex), Baimi (Honey, 2 spoons, mixed with decoction).
Mr. Gao: The pulse is rapid when pressed deeply, indicating internal Yin deficiency and interior Heat, signs of consumptive disease. Symptoms include coughing up white phlegm, intermittent pain in the heart and abdomen, abdominal distension during pain, relieved by flatus. The disease involves Liver Qi stagnation. Cough has persisted for nearly three years, initially without fever, suggesting onset from Phlegm-Fluid retention. Treatment should follow the pattern of Phlegm-Fluid and Qi stagnation.
Banxia (Pinelliae Rhizoma Preparatum), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Guimu (Cinnamomi Ramulus), Fuling (Poria), Dongzhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Chuanbei (Fritillariae Cirrhosae Bulbus), Shenqu (Massa Medicata Fermentata), Guishen (Angelicae Sinensis Radix), Danpi (Moutan Cortex), Baishao (Paeoniae Radix Alba), Xiangfu (Cyperi Rhizoma), Chenxiang (Aquilariae Lignum Resinatum), Jubing (Citri Reticulatae Pericarpium Preparatum).
Second visit: Phlegm-fluid cough with fever, Lung and Kidney dual deficiency, damp-heat not transforming. Use Linggui Zhugan Tang (Decoction of Poria, Cinnamon Twig, Atractylodes, and Licorice) combined with Erchen Tang (Two-Aged Decoction) to treat Lung and Spleen; Duqi Wan (Nine-Ingredient Pill) to treat Kidney.
Linggui Zhugan Tang combined with Erchen Tang, add Chenxiang (Aquilariae Lignum Resinatum), Xingren (Armeniacae Semen Amarum), Chuanbei (Fritillariae Cirrhosae Bulbus). Duqi Wan (Nine-Ingredient Pill) 4 qian, taken with salt water.
Mr. Shi: Shortness of breath and wheezing upon movement, dizziness and palpitations, abdominal distension after eating. Liver and Kidney deficiency fails to grasp Qi; Spleen and Stomach deficiency fails to move Qi. Use Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting the Qi) to administer Liuwei Wan (Six-Ingredient Pill with Rehmannia).
Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting the Qi) add Fushen (Poria with Hostwood), Banxia (Pinelliae Rhizoma Preparatum), Shenqu (Massa Medicata Fermentata), decocted with Sharen (Amomi Fructus), to administer Liuwei Wan (Six-Ingredient Pill with Rehmannia) 4 qian.
Patient [Name Unknown]: Excessive mental effort depletes Middle Qi, leading to internal accumulation of damp-heat. Sensation of emptiness from throat to chest, weakness upon movement, damp sores on buttocks. Maintain ease and rest, prevent palpitations and dizziness.
Dongzhu (Atractylodis Macrocephalae Rhizoma), Banxia (Pinelliae Rhizoma Preparatum), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Guishen (Angelicae Sinensis Radix), Sharen (Amomi Fructus), Dangshen (Codonopsis Radix), Xiangfu (Cyperi Rhizoma), Yiren (Coicis Semen), Bixie (Dioscoreae Hypoglaucae Rhizoma), Sangzhi (Mori Ramulus).
Mr. Zhao: Pulse is deep and rapid, cold hands and feet, chest fullness, poor appetite, Spleen and Stomach weakness. Dry stool indicates depletion of intestinal fluids. Treatment should warm the Middle Earth and moisten the Large Intestine, modeled after Tusizi Wan (Cuscutae Seed Pill) with modifications.
Wuzhuyu (Evodiae Fructus), Rongrong (Cistanches Herba), Binglang (Arecae Semen), Huainiuxi (Achyranthis Bidentatae Radix), Sharen (Amomi Fructus), Baiziren (Platycladi Semen), Chushufu (Aconiti Lateralis Radix Preparata), Chenpi (Citri Reticulatae Pericarpium), Tusizi (Cuscutae Semen), Fuling (Poria), Huaishanyao (Dioscoreae Oppositae Rhizoma).
Note by Yuan: Binglang (Arecae Semen) is used for its descending nature reaching the Lower Jiao, guiding acrid-moistening herbs to the Large Intestine, not for breaking Qi stagnation.
Second visit: Add Huomaren (Cannabis Fructus), Yuliren (Pruni Semen), Danggui (Angelicae Sinensis Radix) to the previous formula.
Mr. Mu: Worry injures Spleen Ying (Blood/Nutrient); labor injures Spleen Qi. Guipi Tang (Restore the Spleen Decoction) tonifies Spleen Ying; Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting the Qi) tonifies Spleen Qi. Combine both formulas now.
Dangshen (Codonopsis Radix), Huangqi (Astragali Radix), Dongzhu (Atractylodis Macrocephalae Rhizoma), Fushen (Poria with Hostwood), Guishen (Angelicae Sinensis Radix), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Sharen (Amomi Fructus), Zaoren (Ziziphi Spinosae Semen), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Zhi Banxia (Pinelliae Rhizoma Preparatum), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium).
Mr. Xue: Kidney Qi deficiency with rebellion requires Yin nourishment to grasp Qi; Spleen weakness with slow transport makes Yin nourishment cloying. Solution: Tonify Kidney Yang to facilitate Spleen Qi transport. Modify Zhang Zhongjing’s Shenqi Wan (Kidney Qi Pill).
Shudihuang (Rehmanniae Radix Preparata), Fuzi (Aconiti Lateralis Radix Preparata, 3 fen, stir-fried), Wuweizi (Schisandrae Fructus), Fuling (Poria), Huaishanyao (Dioscoreae Oppositae Rhizoma), Rouguixin (Cinnamomi Cortex), Maidong (Ophiopogonis Radix, stir-fried with rice), Niuxi (Achyranthis Bidentatae Radix, stir-fried with salt water), Shanzhuyu (Corni Fructus), Chenpi (Citri Reticulatae Pericarpium), Zhi Shiyin (Fluvial Quartz), Guyezi (Psoraleae Fructus, stir-fried with salt water), Hutao Ren (Juglandis Semen).
Mr. Ding: The disease originates from Yang deficiency and weak Earth, lacking generative Qi, causing severe Spleen-Stomach exhaustion. During summer heat, warming herbs are difficult to use. While tonifying Kidney is superior, damp-heat prevails in stifling heat; tonifying Spleen-Stomach is safer.
Gaolian Shen (Korean Ginseng), Chenpi (Citri Reticulatae Pericarpium), Dongzhu (Atractylodis Macrocephalae Rhizoma), Paojiang (Zingiberis Rhizoma Preparatum), Fuling (Poria), Baibiandou (Dolichoris Semen), Yizhiren (Alpiniae Oxyphyllae Fructus), Guya (Hordei Fructus Germinatus).
Mr. Yang: Disease originates from Yin deficiency. During intense summer heat, tidal fever and dry cough progress toward consumptive disease. Nourishing Yin aims to reduce fever; herbs should be light, not heavy, to avoid damaging Spleen-Stomach with excessive cloying. Strengthening Spleen aids appetite but should not be drying, to avoid consuming Lung Yin. Prescribe as follows for standard treatment.
Yangshenshen (American Ginseng), Baibiandou (Dolichoris Semen), Wuweizi (Schisandrae Fructus), Danpi (Moutan Cortex), Maidongrou (Ophiopogonis Medulla), Digupi (Lycii Cortex), Sheng Yiren (Coicis Semen), Huaishanyao (Dioscoreae Oppositae Rhizoma), Shashen (Glehniae Radix), Fuling (Poria), Pipaye (Loquasi Folium).
Mr. Xi: Evening cough indicates Lung Heat. Dawnward Qi rising indicates Kidney deficiency. Early satiety indicates Spleen deficiency. Tonify Kidney and grasp Qi below; clear Metal and resolve Phlegm above; move Spleen and cultivate Earth in the middle. Treat all three Jiaos.
Sheng Dihuang (Rehmanniae Radix), Shayuanzi (Astragali Complanati Semen), Maidong (Ophiopogonis Radix), Chuanbei (Fritillariae Cirrhosae Bulbus), Fuling (Poria), Huaishanyao (Dioscoreae Oppositae Rhizoma), Liushenqu (Six-Ingredient Mass Medicata Fermentata), Shashen (Glehniae Radix), Niuxi (Achyranthis Bidentatae Radix), Pipaye (Loquasi Folium).
Mr. Feng: Long-term cough with thick sputum, morning fever, greenish-yellow complexion. Left pulse fine and rapid, right pulse soft and weak. Disease belongs to Upper Damage. Fortunately, stool is not loose, not yet involving Middle or Lower Jiao. Careful nursing advised; re-evaluate after Summer Solstice if no changes.
Dangshen (Codonopsis Radix), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Huaishanyao (Dioscoreae Oppositae Rhizoma), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Qinghao (Artemisiae Annuae Herba, wine-fried), Baishao (Paeoniae Radix Alba, stir-fried with 3 fen Guizhi), Chuanbei (Fritillariae Cirrhosae Bulbus), Fuling (Poria), Baibiandou (Dolichoris Semen), Zaoren (Ziziphi Spinosae Semen), Wei Jiangsheng (Roasted Ginger).
Second visit: Cough with fine-rapid pulse. Morning fever previously, now afternoon fever too; Yin Qi gradually injured. Occasional blood in stool indicates Spleen Qi deficiency. Follow Zhang Jingyue’s Liyin Jian (Infusion for Nourishing Yin) pattern. Survive until Summer Solstice, when Yin returns; if no worsening, recovery may be possible.
Sijunzi Tang (Four Gentlemen Decoction) combined with Shengmai San (Generate the Pulse Powder), add Shengdi (Rehmanniae Radix), Huaishanyao (Dioscoreae Oppositae Rhizoma), Baishao (Paeoniae Radix Alba), Baibiandou (Dolichoris Semen), Chuanbei (Fritillariae Cirrhosae Bulbus), Ejiao (Donkey-hide Gelatin), Hongzao (Jujubae Fructus).
Mr. Zhao: Chronic fistula leaks Yin fluids. Cough consumes Qi; examination stress harms Spirit. Cough worsens with Qi rising, loose stool, internal heat, hoarseness, and sore throat follow. Pulse is fine and rapid; consumptive disease is established. Essence, Qi, and Spirit are the Three Treasures of the body. Injury to any is disastrous, especially when all three are deficient. I decline competence; please consider carefully.
Shashen (Glehniae Radix), Tian Xingren (Sweet Apricot Kernel), Maidong (Ophiopogonis Radix, stir-fried with rice), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Chuanbei (Fritillariae Cirrhosae Bulbus), Fuling (Poria), Baibiandou (Dolichoris Semen), Huaishanyao (Dioscoreae Oppositae Rhizoma), Shida Gonglao (Mahoniae Leaf).
Boy, age 17: Tian Gui (menstruation/reproductive function) has not arrived; bones are thin and small, indicating congenital insufficiency. Frequent epistaxis indicates deficient Fire flaming upward. Dull abdominal pain indicates Middle deficiency with Liver Wood overacting. History of roundworms confirms Liver Wood agitation. This is childhood damage. Congenital insufficiency is hard to treat by strengthening Post-Heaven sources.
Fuling (Poria), Huaishanyao (Dioscoreae Oppositae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), Qiancao Tan (Rubiae Radix et Rhizoma Charred), Wuyao (Linderae Radix), Dongzhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Danpi (Moutan Cortex), Chuanjiao (Zanthoxyli Pericarpium), Wuzhegu (Sepiae Endoconcha).
Mr. Lian: Kidney Yin deficiency causes Qi rising and wheezing; Heart Yin deficiency causes palpitations and insomnia; Stomach Qi deficiency allows Phlegm-Fluid retention; Liver Wind stirring causes dizziness and tremors; Intestinal fluid depletion causes hard stool. *Neijing* states: Kidney dislikes dryness, urgently eat acrid to moisten it. Heart dislikes laxity, urgently eat sour to astringe it. Liver dislikes urgency, urgently eat sweet to relax it. With gut fluid depletion, nourish Qi and Blood. Model after Duqi Wan (Nine-Ingredient Pill).
Sheng Dihuang (Rehmanniae Radix, stir-fried with clam powder), Fushen (Poria with Cinnabar), Banxia (Pinelliae Rhizoma Preparatum), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Wuweizi (Schisandrae Fructus), Chenxiang (Aquilariae Lignum Resinatum), Baiziren (Platycladi Semen), Shijueming (Arginae Concha), Huaishanyao (Dioscoreae Oppositae Rhizoma), Maidong (Ophiopogonis Radix), Xiyangshen (American Ginseng).
Mr. Li: Yin deficiency below, Qi rebellion above, obstruction in the middle, boiling fluids, urgent Qi and congealed Phlegm, resulting in Jian Jue (Frying Syncope). Difficult case; clear-nourishing herbs required, efficacy not easy to achieve. Concern: approaching summer heat, external steaming heat, internal lack of tranquility, may worsen significantly.
Xian Shengdi (Fresh Rehmanniae Radix), Zaoren (Ziziphi Spinosae Semen, stir-fried with pig bile juice), Yuanshen (Scrophulariae Radix), Fushen (Poria with Hostwood), Muli (Concha Ostreae), Nvzhenzi (Ligustri Lucidi Fructus), Shijueming (Arginae Concha), Lingyangjiao (Saigae Tataricae Cornu), Yuanzhi (Polygalae Radix, processed with licorice decoction), Zhuru (Bambusae Caulis in Taenia).
Note by Yuan: Jian Jue (Frying Syncope) is described in *Neijing* but rarely seen clinically. Generally, Water deficiency leads to Wood dryness; Liver Wind and Phlegm harass upward, obstructing Qi mechanism and blocking orifices, similar to Liver Wind and Phlegm-Fire.
Ms. Zhu: Palpitations and insomnia indicate Blood deficiency. Qi attacking causing distension indicates Liver deficiency. Dizziness and muscle twitching indicate Liver Wind. Poor appetite and loose stool indicate Spleen deficiency. Calm Liver Qi, extinguish Liver Wind, nourish Ying Yin, tonify Spleen Earth. This is the treatment principle.
Zhi Xiangfu (Cyperi Rhizoma), Qingchenpi (Citri Reticulatae Pericarpium), Fuling (Poria, red and white half each), Guishen (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Shayuanzi (Astragali Complanati Semen), Zhi Shouwu (Polygoni Multiflori Radix Preparata), Shenqu (Massa Medicata Fermentata), Sharen (Amomi Fructus), Jiang (Zingiberis Rhizoma), Zao (Jujubae Fructus).
Mr. Ni: Reports occasional palpitations, sometimes numb muscles, diarrhea several times a day, or constipation every few days, only urine is often red. This is Heart Qi depression and Spleen Qi failure to transport. Failure to transport generates dampness; depression gathers Fire. Fire consumes Essence; dampness obstructs Qi, hindering Qi mechanism. Prescribe Jinggong Miaoxiang San (Prime Minister’s Wonderful Fragrance Powder) with additions, to tonify Heart and Spleen, unblock Qi mechanism.
Xiyangshen (American Ginseng), Huangqi (Astragali Radix), Fushen (Poria with Hostwood), Jiegeng (Platycodonis Radix), Yuanzhi (Polygalae Radix), Huaishanyao (Dioscoreae Oppositae Rhizoma), Shexiang (Moschus, mixed), Chensha (Cinnabar), Muxiang (Aucklandiae Radix), Chuanlian (Coptidis Rhizoma, stir-fried with salt water), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey), Maidong (Ophiopogonis Radix, stir-fried with rice).
Grind to powder, pill with Huoxiang (Agastaches Herba) and Chenpi (Citri Reticulatae Pericarpium) decoction. Take 3 qian every morning with boiled water.
Mr. Xu: Formerly, Xue Lizhai prescribed one formula for dozens of doses. Without precise insight, how could he? But without patient trust and compliance, how could it work? I am unworthy, dare not imitate predecessors. However, if diagnosis is accurate, prescription will not err. I will strive for improvement.
Tiantong (Asparagi Radix), Maidong (Ophiopogonis Radix), Shengdi (Rehmanniae Radix), Shudi (Rehmanniae Radix Preparata), Huaishanyao (Dioscoreae Oppositae Rhizoma), Shashen (Glehniae Radix), Fushen (Poria with Hostwood), Zaoren (Ziziphi Spinosae Semen), Muli (Concha Ostreae), Baishao (Paeoniae Radix Alba), Yangshenshen (American Ginseng), Ejiao (Donkey-hide Gelatin), Hongzao (Jujubae Fructus), Fumai (Triticum Levis Floating Grain).
This woman, aged 34-35, never gave birth. Due to fright, she developed panic attacks, dizziness, tinnitus, rising fire, fever, sweating, poor appetite, and hard stool for nearly 100 days. After 30 doses of this formula, improvement was seen. The formula was strengthened and made into an extract for long-term use, nearly a year, resulting in complete cure. She later bore a son.
Mr. Xie: Profuse sweating indicates Exterior deficiency; diarrhea indicates Interior deficiency; abdominal pain indicates Middle deficiency; rising Qi indicates Kidney deficiency. Amenorrhea indicates Liver deficiency; frequent dreams indicate Spirit deficiency. All three Jiaos are diseased; none of the Five Zang organs are free from deficiency. Tentatively prioritize cultivating Earth (Spleen), as Earth is the mother of all things.
Dangshen (Codonopsis Radix), Dongzhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Shayuanzi (Astragali Complanati Semen), Huaishanyao (Dioscoreae Oppositae Rhizoma), Baishao (Paeoniae Radix Alba), Zaoren (Ziziphi Spinosae Semen), Chenpi (Citri Reticulatae Pericarpium), Wuweizi (Schisandrae Fructus), Baibiandou (Dolichoris Semen), Danpi (Moutan Cortex), Hongzao (Jujubae Fructus), Fumai (Triticum Levis Floating Grain).
Note by Yuan: When all Five Zang organs are deficient, treating only the Post-Heaven Spleen-Stomach is indeed crucial. However, for diarrhea and abdominal pain, adding mild warming Spleen herbs would be better, as Yang deficiency exceeds Yin deficiency.
Ren Yuan said: This collection gathers cases of Phlegm-Fluid and cough due to partial deficiency of Yin-Yang in the Five Zang organs, not all belonging to Consumptive Disease (Xu Lao). Regarding Xu Lao, *Neijing* states: Labor and fatigue cause decline of form and Qi, insufficient grain Qi, failure of Upper Jiao circulation, blockage of Lower Wan, Stomach Heat steaming the chest, thus internal heat. Effortful labor injures Middle Qi, causing Middle Qi decline, inability to transform grain and water, failure of Lung governance, Heat accumulating in the chest, generating internal heat, injuring the harmonious Qi of Spleen and Stomach. Treatment: "For exhaustion, use warmth." *Jingui Yaolue* states: In men, a large pulse in health indicates Lao; extreme deficiency also indicates Lao. Nocturnal emission, hemorrhage, night sweats are diseases of Lao. Treat with Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction), Xiaojianzhong Tang (Minor Construct the Middle Decoction), Huangjianzhong Tang, following *Neijing*'s "labor implies warmth" method. Descendants agree. Yet I have doubts. *Neijing*'s "labor" refers to Middle Qi injury from fatigue, treated with sour-sweet-warming herbs to warm and tonify, making Wei vigorous to generate Ying, relying on Spleen-Stomach Yin-Yang Qi, thus deficiency can be tonified, labor recovered. *Jingui*'s Lao involves Hyperactive Fire causing nocturnal emission, Yin essence deficiency causing rising fire and hemorrhage, Heat steaming Ying causing night sweats, also treated with sweet-sour-warming nourishment. One injures Middle Qi, the other damages Essence-Blood. Different diseases, same treatment, why? Recent practice follows Zhang Zhongjing and Li Dongyuan for labor-injured Middle Qi. For emission/hemorrhage,不敢 (dare not) follow Guizhi/Jianzhong methods, instead using Zhu Danxi and Ge Kejiu’s Yin-nourishing methods. Initially effective, ultimately ineffective. Bitter-cold descending herbs calm flaming Fire but easily injure Middle Jiao Qi. Once Stomach Qi is injured, hundred drugs cannot treat. Hence Yue You (Bian Que) said: Upper damage affecting Middle, and Lower damage affecting Middle, are untreatable. If Danxi/Kejiu are unreliable, are *Jingui* formulas usable? Answer: Zhang Zhongjing is the ancestor of medicine, not misleading descendants. For internal injury/labor, Zhongjing/Dongyuan methods are indisputable. For emission/hemorrhage, since Yuan/Ming, scholars dare not use these formulas, truly because Hyperactive Fire is blazing, Yin Blood overflowing, using hot/guaranteed herbs might exacerbate the situation. Ancients were smart; surely they tried and found mismatch. Critics blame Danxi; I dare not speak against conscience. Descending-nourishing methods can be used temporarily, not long-term. Assess if Stomach/Essence Qi can bear it; temporarily use to calm Fire and stop bleeding, which is necessary. Otherwise, warmth aids Fire, coolness injures Middle; doing nothing lightly leads to death. What is the point! After bleeding stops and Fire descends, use sweet-pungent-strong flavored herbs to consolidate Essence and grasp Qi for nourishment. *Classic*: "For deficiency, benefit it; for Essence insufficiency, tonify with flavor." *Nanjing*: "Damage to Kidney, benefit Essence; damage to Lung, nourish Qi." For diseases injuring Essence-Qi, seek from Essence-Qi, beneficial to condition.