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(Previous prescription) Decoct five qian. Hei Zhi Pi (Gardenia Skin, 1.5 qian). Ou Zhi (Lotus Root Juice, one wine cup) to be taken by mixing. Tong Ni (Child's Urine, one large wine cup), decoct to remove foam, then mix and take.) After several days, vomiting recurred. Furthermore, the limbs were cold, with spontaneous sweating. The heart felt weak and fearful, worrying about collapse (Tuo Zheng). Mengying said: The pulse changes frequently; no wonder you suspect it is a severe deficiency syndrome. However, the four diagnostic methods—inspection, auscultation/olfaction, inquiry, and palpation—cannot rely solely on pulse diagnosis. Currently, the urine resembles Zhe Shi Tang (Ochre Decoction), turbid, crimson, and containing dregs. This clearly indicates a damp-heat disease, obvious as if the lid has been lifted. Initially, the pathogen injured the Qi level, so body fluids were scorched by heat to transform into phlegm; subsequently, it affected the Ying (Nutritive) level, causing Yin blood to become unsettled and overflow recklessly. With pathogenic factors flourishing internally, is this not an excess syndrome? Yet, the true nature resembles deficiency. The previous prescription instructed taking two doses, and the bleeding indeed stopped. Mengying said: The recurrence of hematemesis is due to the disturbance of Qi-level pathogens. To clear the pathogens in the Qi pathway, one must first remove the phlegm that serves as the pathogen's refuge. Since body fluids have been scorched by pathogenic heat to form phlegm, the phlegm becomes the nest for pathogenic heat. It is permissible to vigorously attack the excess while moderating the momentum of the disease. Initially, three qian of Gun Tan Wan (Rolling Phlegm Pill) was administered, resulting in the discharge of foul gas once, which was unprecedented smoothness in over forty days. After continuously administering Gun Tan Wan for several days, multiple stools of sticky phlegm and black feces were passed, and urination gradually became clear and abundant. The tongue coating also receded, and sleep and appetite thus stabilized. (In this case, between clearing the Liver and stopping bleeding, Gun Tan Wan was used to slowly attack and expel phlegm. Treating blood first, then phlegm, is a modified method for emergency treatment of the branch symptoms in hematemesis caused by damp-heat disturbing the Ying level.) Only the swelling in the lower part remained. Mengying said: Carefully analyzing the pulse and symptoms, the disease is not in the Spleen. Moreover, the patient has excessive hunger, dry stool, thirst, and polyuria. I was already worried about the development of Xiao Ke (Wasting-Thirst Syndrome) and hurriedly provided sweet-moistening [Yin-nourishing] herbs; how could we use diuretic methods to damage Yin and replenish Earth by depleting fluids? Furthermore, edema caused by Spleen Qi sinking differs from edema caused by dampness abundance. In the former, the condition above and below, inside and outside the knee must be connected. Now, the凹凸 (concavities and convexities) above and below, inside and outside the knee are distinct and unconnected. This is because phlegm-fluids brewed by damp-heat, having been mistakenly tonified and blocked in the Middle Jiao, were then recklessly attacked and scattered through the collaterals and tunnels. As it cannot be swept away in one go, it inevitably spreads sideways. I shall treat it with specific methods. Coincidentally, there was coughing with blood-streaked sputum, but spirit and appetite were normal. Mengying said: Do not fear. This is because too much San Qi (Notoginseng Root) was chewed previously, causing astringency and retaining blood stasis; stopping bleeding forcibly is most inappropriate. Vomiting out the stasis is excellent. However, Metal and Wood must be treated together, hoping that the cough stops without shaking the blood collaterals. Gan Lu Yin (Sweet Dew Decoction) plus Ou Zhi (Lotus Root Juice) and Tong Ni (Child's Urine) was given. After four doses, bleeding stopped, and the cough calmed down. (Da Sheng Di (Rehmanniae Radix Recens, 8 qian), Ming Tian Dong (Asparagi Cortex, sliced thin, 6 qian), Hua Mai Dong (Liriopes Bulbus, 4 qian), soaked in boiling water, squeezed for juice, mixed and taken after filtering dregs; Cha Shi Hu (Dendrobii Caulis, pounded, decocted first, 1 liang), Jiu Chao Xi Yin Chen (Artemisiae Scopariae Herba, wine-fried, 2 qian), Jiu Chao Ku Qin (Scutellariae Radix, wine-fried, 1 qian), Chao Zhi Qiao (Aurantii Fructus, fried, 1.5 qian), Jiang Pi Ye (Perillae Folium wrapped with ginger, added later, 3 qian), Ou Zhi (Lotus Root Juice, one wine cup, mixed); Tong Ni (Child's Urine, two large wine cups), decoct to remove foam, then mix with medicine and take warm.) Thus, focusing specifically on treating the lower swelling, Gu Ben Tang (Solidify the Root Decoction) was modified with Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Bei Mu (Fritillariae Bulbus), Hua Fen (Trichosanthis Radix), Xuan Fu Hua (Inulae Flos), Ju Luo (Citri Reticulatae Pericarpii Retinervum), Si Gua Luo (Luffae Fructus Rete), Ling Yang Jiao (Capris Cornu), Lian He (Meliae Semen), Cong Xu (Allii Fistulosi Radix), Dou Juan (Sojae Semen Praeparatum), Yi Ren (Coicis Semen), Zhu Li (Bambusae Succus) in varying combinations. Within two or three doses, the elevated and swollen areas felt very itchy; scratching produced fluid like sweat with the smell of green onion. (Da Sheng Di (Rehmanniae Radix Recens, 8 qian), Ming Tian Dong (Asparagi Cortex, sliced, 6 qian), Hua Mai Dong (Liriopes Bulbus, 4 qian), Jiu Chao Zhi Mu (Anemarrhenae Rhizoma, wine-fried, 2 qian), Jiu Chao Chuan Huang Bai (Phellodendri Chinensis Cortex, wine-fried, 1 qian), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 4 qian), Nan Hua Fen (Trichosanthis Radix, 3 qian), Xuan Fu Hua (Inulae Flos, wrapped in silk, 3 qian), Jing Ju Luo (Citri Reticulatae Pericarpii Retinervum, added later, 1.5 qian); after two doses, remove Zhi Mu, Huang Bai, and Bei Mu, add Si Gua Luo (Luffae Fructus Rete, 3 qian), Ling Yang Jiao (Capris Cornu, ground and mixed, 1 qian), Lian He (Meliae Semen, pounded, decocted first, 4 qian), Xian Cong Xu (Allii Fistulosi Radix, fresh, added later, 1 qian), Da Dou Juan (Sojae Semen Praeparatum, added later, 3 qian), Sheng Yi Ren (Coicis Semen, pounded, 8 qian), Jiang Zhu Li (Zingiberis Succus, one large wine cup, mixed); take medicine warm.) After six or seven days, both legs felt dry, thin, and painful, and the scrotum subsided accordingly. Mengying said: Using these moistening herbs to reduce swelling still resulted in dryness and sore throat; if we had followed the majority opinion and administered spleen-drying and water-draining agents, what would have happened? Cold-damp damages Yang, while Heat-damp damages Yin. Blood belongs to Yin. For post-recovery care, it is best to nourish the blood, slightly assisting with Zhu Li (Bambusae Succus) to search out residual phlegm in the collaterals, ensuring no future complications arise after recovery. This is a method within a method. After taking the medicine, diet was regulated, and urination and defecation were normal. Fortunately, there was no worry of Wasting-Thirst Syndrome, and the patient completely recovered.

Kong Guangyu suffered from loose stools for a long time, accompanied by a black tongue coating and shortness of breath. From spring to winter, treatments were ineffective. Mengying examined him and said: Overwork of the mind scorches Yin with Yang. People see loose stools and immediately administer warming-middle herbs, unaware that the Lung suffers from Fire punishment, losing its clear and descending function, leading to shortness of breath in the upper Jiao; thus, the Water source does not generate, naturally resulting in scanty urine and diarrhea. Administering methods to soothe the Lung, clear the Heart, cool the Liver, and nourish the Kidney indeed led to gradual improvement. (Loose stools are mostly Cold-Deficiency syndromes, but "black tongue coating and shortness of breath" are the key words, indicating this loose stool is not a Cold-Deficiency syndrome. "Scanty urine and diarrhea" reveals the essence. While diarrhea is often Cold-Deficiency, scanty urine indicates Heat-Excess and Yin injury. Although diarrhea combined with scanty urine, black tongue, and shortness of breath points to blazing Heat and Yin injury, this type of diarrhea must have abnormal odor; Cold diarrhea is odorless, while Heat diarrhea has a strong odor. Prescription uses Huo Shui Lu Gen (Fresh Reed Rhizome, 2 liang), Jiu Chao Ya Lian (Coptidis Rhizoma, wine-fried, 8 fen), Bei Sha Shen (Glehniae Radix, 8 qian), Hua Mai Dong (Liriopes Bulbus, 4 qian), Nan Hua Fen (Trichosanthis Radix, 5 qian), Xian Shi Hu (Dendrobii Caulis, fresh, pounded, decocted first, 1 liang), Chuan Lian He (Meliae Semen, pounded, decocted first, 4 qian), Dan Hai (Concha Meretricis et Arcae, decocted first, 4 liang), Lian Pi Bi Qi (Dioscoreae Hypoglaucae Tuber, with skin, smashed, 2 liang), Sheng Ge Qiao (Concha Tridacnidae, 1 liang), Hai Fu Shi (Lithomarge, 5 qian, the latter two pounded and decocted first), Wu Mei Rou (Mume Fructus, 3 qian), Xuan Shen Pian (Scrophulariae Radix, 8 qian), soaked in boiling water, mixed and taken after filtering dregs.)

The wife of Zhou Jusheng suffered from sour dragging sensation in the lower abdomen, frequent and painful urination. Physicians administered promoting-drainage herbs without effect, followed by lifting and warming-tonifying methods; all techniques were tried, leading to loss of appetite and insomnia, thirst but afraid to drink, and palpitations upon hearing sounds. Mengying palpated the pulse and said: This is a Jueyin (Liver) disease. One cannot merely treat the Foot-Taiyang (Bladder) channel. First, administer salty-bitter herbs to drain Heat, then use sweet-moist herbs to nourish Yin. Without using any promoting-drainage herbs, the patient recovered. (Promoting-drainage treats Excess syndromes. Sour dragging in the lower abdomen results from Heat scorching fluids; frequent and painful urination indicates Heat-Excess complicated by Yin Deficiency. Lack of bowel movement shows the source of generation in Lung and Stomach is damaged; palpitations upon sound indicate severe depletion of Heart and Liver Yin. First, salty-bitter herbs drain Heat to treat the Excess; subsequently, sweet-moist herbs nourish Yin to treat the Deficiency. This case is Excess complicated by Deficiency; using promoting-drainage would violate the prohibition against further weakening the deficient. Prescription: Bai Tou Weng (Pulsatillae Radix, 3 qian), Jiu Chao Chuan Lian (Coptidis Rhizoma, wine-fried, 8 fen), Jiu Chao Chuan Huang Bai (Phellodendri Chinensis Cortex, wine-fried, 3 qian), Wu Mei Rou (Mume Fructus, 3 qian), Sheng Bai Ji Li (Tribuli Fructus, thorns removed, 3 qian), Zheng Bai Shao (Paeoniae Radix Alba, whole, pounded, decocted first, 2 liang), Xue Bie Jia (Trionycis Carapax et Plastrum, pounded, charred, simmered for eight minutes, 4 liang), Gan Hai Shen (Holothuriae Edulis, 5 qian, soaked in warm water, cleaned of sand, used to decoct medicine), Xuan Shen Pian (Scrophulariae Radix, 8 qian). Modified prescription: Da Sheng Di (Rehmanniae Radix Recens, 8 qian), Xuan Shen Pian (Scrophulariae Radix, 1 liang), Jin Yin Hua (Lonicerae Japonicae Flos, 1.5 liang), Pu Tao Gan (Vitis Viniferae Fructus, 3 qian), Ming Tian Dong (Asparagi Cortex, sliced, 6 qian), Fei Yu Zhu (Polygonati Odorati Rhizoma, 3 qian), Tu Si Bing (Cuscutae Semen, 5 qian), Wu Mei Rou (Mume Fructus, 3 qian), Gui Ban Jiao (Testudinis Carapax et Plastrum Gelatinum, 2 qian, stewed and mixed), Chuan Lian He (Meliae Semen, pounded, decocted first, 4 qian).)