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The illness has persisted for three months. The pulse is large and rapid (da er ji). Symptoms include choking cough, qi rushing upward, chest fullness, back distension, inability to sleep peacefully at night, and upon lying down, qi rushes upward causing difficult breathing. There is ulceration of the eyelids, red tongue, dry mouth, and vexation in the heart. Examining all pulses and symptoms, this belongs to the Lung affected by Dryness pathogen. Compounded by depression, phlegm and qi are knotted together, blocking the Lung orifices, leading to the loss of clear descending function,酿 (brewing) into a dangerous condition of Fei Bi (Lung Obstruction Syndrome). The Lung is the master of Qi; when Lung Qi rebels, all Qi follows it in rebellion. In normal times, the constitution is deficient and can tolerate tonification; however, now tonifying agents are contraindicated. Although tonification would further deplete deficiency (Xu Xu), the disease is excess (Shi); without removing the pathogen, mere tonification is of no benefit. The Classic states: "All Qi stagnations belong to the Lung." Injury to Dryness in autumn leads to cough in winter. Currently, only clearing Dryness and opening obstruction (Xuan Bi) is viable. Hopefully, once the chest expands and obstruction opens, there will be a turning point. Following the method of Wei Jing Tang from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). After taking four doses, the dryness in the throat and mouth slightly decreased, and the scorched coating on the root of the tongue receded. However, the pulse remains unchanged, and Bi symptoms still occur intermittently. When severe, there is chest and diaphragm distension, incessant wheezing, and a desire for someone to beat or massage the area. Expectoration of turbid phlegm brings slight relief. The disease arises from Dryness pathogen harbored in the Upper Jiao, with failure of regulation (Zhi Jie). Phlegm obstructs formless Fire, and Fire scalds formed Phlegm, mutually harming each other. "Bi" means closure; internal closure leads to external collapse, which is extremely critical and urgent. Because the Upper Jiao is not open, one cannot tonify the Lower Jiao; thus, every time tonifying agents are administered, the closure worsens. The phlegm accumulated in the Lung orifices is like floating silk in a house, vines on a tree, or moss on a stone—sticky, adhesive, and spreading. How can ordinary phlegm-resolving herbs cut through this? Adding Gua Lou Pi (Trichosanthis Pericarpium) and Hai Shi (Pumex) to the original formula aims to lightly clear and open obstruction, but the symptoms did not subside. This is because the Lower Deficiency cannot accept tonification, and the Upper Excess cannot be resolved by unblocking methods. Both resolving and tonifying are difficult, making the case quite tricky. According to the patient's account, whenever the Bi is severe, only drinking radish water can slightly calm the phlegm and Qi. From this, we deduce that stubborn phlegm must be sticking to the lung tubes, blocking Qi mechanism. Frequent use of Wei Jing Tang was ineffective; we must proceed to the method of Ting Li (Descurainiae Semen / Lepidii Semen). It is not that we do not worry about the elderly patient's deficient constitution being unable to bear harsh attacks, but in this critical situation, if we hesitate out of fear, how much of the body will remain? Wei Jing Tang and Ting Li Da Zao Xie Fei Tang are the two major methods for treating Lung Bi in *Jin Gui*. Previously, due to advanced age and chronic illness, I dared not suddenly use the harsh attack of Ting Li, choosing only the light and clear Wei Jing Tang to open obstruction, hoping the disease would go without injuring Yuan Qi. Although medication showed minor effects, the obstruction was ultimately not fully opened. The previous discussion that Dry-Heat brews phlegm, blocking Lung orifice Qi mechanism and causing loss of clear descending function, thereby leading to rebellion and fullness, was not erroneous. Stubborn phlegm spreads like stubborn people who do not submit to royal governance; if one does not endure severity and instead tolerates leniency, how will banditry cease? The added Ting Li, though a last resort, is logically inevitable, not merely gambling on luck. Currently, the Bi trend has slightly loosened, proving the principle that "with pathology present, there is no injury" (You Gu Wu Yun). Harsh drugs have always been suitable for temporary use, not constant use. However, the condition has lasted for months, with Phlegm-Heat diffusing to an extreme degree. Now that it has slightly opened, if we change course immediately, the root cause remains, and recurrence is feared. Today morning, nosebleed continued, indicating Lung Fire is not yet cleared. Added Shi Gao (Gypsum Fibrosum), Shan Zhi (Gardeniae Fructus), and Zhu Li (Bambusae Succus) to the prescription to eliminate residual waves of Phlegm-Heat. Tonight, the Bi should decrease further, allowing for adjustment tomorrow. The elderly patient has been ill for over 100 days, with congealed phlegm and stagnant Qi, uncomfortable Lung Bi, Upper Excess and Lower Deficiency. Originally, it was hard to find a solution. After several consultations, given the fierce Phlegm-Fire heat which cannot tolerate tonification, we initially used Wei Jing Tang to lightly clear and diffuse the Lung, then advanced to Ting Li to wash away fluid retention and remove phlegm, assisted by Shi Gao, Shan Zhi, and Zhu Li to clear residual Phlegm-Heat. These are established methods of the ancients, not fabricated. Now that Bi symptoms have slightly decreased and deficiency signs are gradually emerging, considering the advanced age and long illness, fearing the Yuan Qi may not sustain, we discuss adding methods to protect Metal (Lung) and support Righteous Qi (Zheng Qi).

An Bo's commentary: The Master's prescription usage is meticulous and precise, unlike the chaotic and vague practices of recent mediocre practitioners.