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The pulses at the Cun (inch) and Guan (bar) positions on both sides are large, with the left Guan pulse being particularly rapid. According to the patient's account, due to emotional depression last winter, this pulse pattern appeared first. Later, he felt restless and irritable; in the spring of this year, the irritability subsided slightly, but the cough has persisted until now. The tongue coating fluctuates between yellow and receding. This indicates that the Liver is the source of the disease, and the Kidney is where the pathology transmits. While it is well known that Liver pathology can injure the Spleen, few realize that Liver pathology can also injure the Kidney. It is like breaking a flower branch and placing it in a vase: as the branch thrives, the water in the vase is gradually absorbed. This is what is meant by Liver Yang attracting and depleting Kidney Yin. Furthermore, the Lung is the mother of the Kidney; when the child organ is deficient, it must steal Qi from the mother organ. Not only does Metal fail to control Wood, but Wood counter-attacks Metal. Rising Liver Yang strikes the Heart causing irritability, and strikes the Lung causing coughing. The pulse is large and fails to gather, and the tongue shows a yellow coating; all these are caused by Hyperactive Yang and Deficient Yin. Fortunately, sleep and appetite remain normal, with no other concurrent syndromes. The proposed treatment is to nourish the Kidney to generate Liver blood, protect the Lung metal to transform fluids. Using pungent-warm and rigidly drying herbs seems inappropriate. At the second visit, the pulse remains rapid, and the cough has been severe for several days. The night before, sleep was restless, and there was heat in the forehead and palms. This belongs to an exogenous factor of Wind-Warmth. If this were heat from Yin-Blood deficiency, it should manifest in the late afternoon (Shi hour), not in the morning. Moreover, its onset should be gradual, why so sudden? Given the weak constitution and chronic illness, one certainly cannot treat solely based on the branch/symptoms, yet one also cannot over-tonify. I will imitate the method of Mr. Wang Guangqi’s *Fengwen Tang* (Wind-Warmth Decoction).

An Bo's Note: This is an insightful and renowned discussion. Only those who have thoroughly mastered the classics and studied history extensively could produce such analysis.

The complexion is pale and the skin tender, indicating insufficient Kidney Qi. For months, the body has been plagued by illness, further distressing the Spleen Yuan (Source). Various physicians have attempted regulation and treatment, yet the condition worsens daily. We request to investigate the root cause to guide treatment. The *Classic of Difficult Issues* states: "All dampness, swelling, and fullness belong to the Spleen." Previous prescriptions of *Wuling San* (Five-Ingredient Powder with Poria) and *Wupi Yin* (Five-Rind Decoction) were not without basis. However, the Kidney serves as the gate of the Stomach; if the gate is not functioning properly, water accumulates and follows its kind. Master Zhang Zhongjing advocated the use of *Shenqi Wan* (Kidney Qi Pill), which embodies this principle. Some might argue that since the patient is young and his essence has not been depleted, tonification is unsuitable. However, since treating the branch symptoms failed, we must seek the root, as stated: "Seek what exists, seek what does not exist." Water flows to damp places, fire moves toward dryness. When the Two Yangs (Yangming) are knotted, it is called Xiao (Consumption/Thirst); when the Three Yins (Taiyin, Shaoyin, Jueyin) are knotted, it is called Shui (Water/Swelling). Those suffering from Xiao fear internal fire; those suffering from Shui fear the lack of fire. Although water diseases originate from the Three Yins, their key lies particularly in the Kidney. The Kidney resides as the Water Organ but houses Fire; this Fire is True Fire. Heaven cannot create life without this Fire, and humans cannot survive without this Water. Even the storage of fluids in the Bladder must emerge through the Qi transformation of the Gate of Life (Mingmen). Hua Yuohua said: "When Kidney Qi is strong, water returns to the Kidney; when Kidney Qi is weak, water scatters into the skin." Previously, taking *Shenqi Wan* yielded good results. Recently, due to irregular diet, the illness relapsed, and subsequent medication was ineffective. Consulting *Jiren Bian*, it records: "For this disease, using *Shenqi Wan* alone is ineffective, and using *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) alone is also ineffective. One must use *Buzhong Yiqi Tang* while swallowing *Shenqi Wan* from *Jingui Yaolue*." I strictly follow this principle.

An Bo's Note: In the autumn of the Geng year, while practicing medicine in Jianqiao, Hangzhou, I treated a scholar suffering from edema. His face and eyes were swollen shut, and his scrotum was enlarged like a measuring basket. Urine output was scanty and difficult. The pulse was deep, fine, and indistinct; the tongue coating was greasy, white, and slippery, with no thirst. Reviewing previous medical records, treatments included inducing sweating (opening the ghost door), promoting urination (cleansing the mansion), using *Wuzi Zongyan Wan* and *Wupi Yin*, or applying the *Jingui Shenqi* method. None worked, like a stone thrown into the sea. I reasoned that Kidney Qi deficiency causes water flooding and swelling; using *Shenqi Wan* as the primary agent should work. Why did it fail? I recalled the method in *Jiren Bian* of using Qi-tonifying and Yang-warming herbs to deliver *Shenqi Wan*. I showed him the book, and he agreed. Upon administration, the treatment proved effective. It appears my insight coincides with the author's.