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Over sixty years of age, the innate vitality (Tianzhen) is already thin. With excessive alcohol intake and insufficient grain consumption, the Spleen and Stomach are further depleted. Medical texts state that the Stomach governs the four limbs, and the Spleen governs the muscles. The Spleen Qi should ascend to be vigorous, and the Stomach Qi should descend to be harmonious. Observing the patient's stiff and spasmodic hands and feet, along with tightness, tension, numbness, and itching in the skin and pores, is this not a sign of disharmony between the Spleen and Stomach, losing their pathway of ascending and descending? The *Neijing* mentions the great collateral of the Stomach, named Xuli (虚里), emerging from below the left breast; the current swelling of the breast is a sign of disharmony in the Stomach collaterals. Furthermore, phlegm arises from dampness, and dampness arises from the Spleen, due to the weakness of Earth (Spleen). When Earth is thick, there is no dampness; without dampness, there is no phlegm. Reviewing the various prescriptions taken, they all treated from the perspective of the Liver, assuming that all diseases arise from stagnation. However, Earth is the mother of all things. Let us analyze it through the Five Elements: although Wood is born from Water, where there is no Earth in rivers, lakes, and seas, there is no Wood growth. Therefore, the withering and drooping of tree branches and leaves must be due to the decline of Earth Qi. By cultivating the Earth, the roots become firm, fluids rise, and circulate throughout the body, allowing the Wood to flourish joyfully. Asked whether Shenqi Wan (Kidney Qi Pill) can treat numbness in the hands and feet, the answer is: Heaven generates One Water; where Water condenses, it becomes Earth; solidified, it becomes Stone; the most solid is Metal. Water, Earth, and Metal originally share one Qi. In humans, the head represents Nine (Yang) and the feet represent One (Yin); Heart and Lung reside above, Spleen and Stomach in the middle, Liver and Kidney below. At the embryonic stage, two Kidneys are formed first; these Kidneys are the root of congenital essence and the residence of Yuan Qi (Primal Qi). Shenqi Wan is a medicine for regulating the congenital aspect; it can assist the Fire of the Mingmen (Gate of Life) in the right Kidney, so that Kidney Fire generates Spleen Earth, Spleen Earth generates Lung Metal, Lung Metal generates Kidney Water, and Kidney Water generates Liver Wood. One prescription regulates all five Zang organs, and one method prepares both Water and Fire. Moreover, human hands and feet are like the branches of a tree; human Kidney and Mingmen are like the roots of a tree. How could the roots be full and robust while the branches fail to flourish luxuriantly? Directing fingers to guide arms, or watering leaves to save roots—how can one discuss the supreme Dao with such approaches?

An Bo’s commentary: A definite argument, and the metaphor is also exquisite.

The pulse is fine, weak, and soggy. The illness has persisted for a long time, starting with diarrhea, followed by bloody stools, gradually leading to poor appetite and nausea, physical fatigue, and mental confusion, with medicines proving ineffective. Slightly administering acrid-warm herbs causes increased bleeding; slightly using cooling herbs reduces food intake. It is difficult to find a way forward. However, medicine values flexibility; one should not see a disease and merely treat the disease, nor fixate on a single viewpoint. The Classics state: "Excessive dampness leads to five types of diarrhea." The illness began with diarrhea; Spleen deficiency酿 (brews) dampness. Treating dampness is indeed suitable with drying methods, but the Spleen commands blood. If overly harsh drying agents are used excessively, they disturb the blood, causing continuous internal hemorrhage and injury to the Yin collaterals. Unfortunately, Yin-nourishing substances are often cloying and stagnant, which does not suit the Spleen and Stomach well. Therefore, tonifying the Central Palace (Middle Jiao) and extracting the Mother of Earth (Spleen) is an urgent necessity. Ancient sages treating blood disorders often achieved success with Stomach medicines; when Earth is thick, it naturally overcomes dampness. Prescribing light flavors to nourish Stomach Qi and sweet flavors to benefit Spleen Yin, based on Jiahe Yin (Grain Nourishing Decoction). After taking the medicine for a few days, grain intake slightly increased. Observing the symptoms, they resembled dysentery. Since prolonged dysentery invariably depletes righteous Qi, one must cultivate the original essence to support vital energy. Described as feeling hungry and uncomfortable in the epigastrium, this belongs to Yin loss from lower hemorrhage, accompanied by Qi injury. Seeing that eating brings comfort, the condition is revealed. Increase the dosage of Renshen (Ginseng Radix et Rhizoma) in the formula, assist with Wumei (Mume Fructus), utilizing its sour property to generate fluids and astringe blood. Further consulting medical books, discussing the root of chronic dysentery lying in the convoluted parts of the Large Intestine, where drug power cannot reach, there is a prescription called Zhisheng Dan (Supreme Holy Pill). I imitated this method, with many verified treatments, available for reference. The Classics say: "Injury to Yin collaterals causes internal blood overflow." Why did clearing heat and nourishing Yin fail? The Classics state: "Ying (Nutrient) Qi originates from the Middle Jiao; the Middle Jiao extracts juices, transforms them into red, which is called Blood." The Middle Jiao refers to the Stomach. The Stomach is the sea of water and grain, a meridian abundant in Qi and Blood. For superficial illnesses, diet remains normal, old goes and new comes; for deep illnesses, grain is scarce, Qi declines, generation cannot compensate for consumption. The Spleen and Stomach are connected by membranes; if the Stomach is weak, transformation and transportation lack authority; if the Spleen is deficient, commanding and controlling blood fails. Texts state: "Regardless of Yin/Yang or Cold/Heat, first harmonize the Spleen and Stomach." All things take Earth as their root; Yuan Qi takes Earth as its dwelling. It is proposed to advance Guipi Tang (Restore the Spleen Decoction), which should be done thus. Also described is a history of Liver Yang rushing upward, recently exacerbated. Add Shouwu (Polygoni Multiflori Radix) to the formula, which can nourish Yin and secure containment, unlike the cloying nature of Shudi (Rehmanniae Radix Preparata). Wumei is avoided due to acidity, so it may be omitted. However, intestinal sliding has lasted long; astringents must be added to prevent collapse. Li Xianzhi said: "Diseases in the Lower Jiao are hard to diagnose; one must use Yuliang (Kaolin) and Chishizhi (Halloysitum Rubrum)." Loose stools but increased food intake indicate a good opportunity. The illness has plagued for two months, injuring Qi and Blood, hence soreness in the sacrum, sudden pain at Jiache (ST6), urgency during defecation, and weakness in movement. Initially, the plan was to specifically tonify Spleen and Stomach, which is the method of benefiting Qi when Blood is lost. Subsequently advancing Guipi Tang is the formula for tonifying the Mother when deficient. Mr. Li Shicai said: "The root of congenital essence is in the Kidney; the root of acquired essence is in the Spleen. If these two Zang organs are harmonious, the whole body is cured." Now that food intake has increased and diarrhea decreased, and Spleen and Stomach are regulated, it is appropriate to add Kidney tonics. After a month of treatment, all symptoms reduced, sleep and appetite were peaceful, and spirit gradually grew. The constitution is inherently Yin-deficient; plus bloody stools, long-term injury to Yin collaterals. Repeatedly taking Stomach medicines filled the Qi aspect, but Yin remained unfulfilled. Metal is the source of generating Water; dry Metal cannot generate Water, hence upper chest dryness, nasal itching, coughing, and wheezing. Medicines follow the disease's shift; strategies change like moving steps. Physicians should be like pearls rolling on a plate, valued for agility. Insufficient Qi is Cold; excess Qi is Fire. Revised plan: Nourish Yin and moisten the Lung, promote Metal-Water mutual generation; returning fluids will naturally moisten dryness. The Classics say: "Avoid empty evils and thieving winds in due time." After the illness, the body is deficient, compounded by external factors, causing chills, headache, and epigastric stuffiness with nausea. However, the tongue has no coating, and the pulse is not rapid; the pathogenic factor is known to be not severe. Righteous Qi is insufficient, so direct exterior-dispersing is inappropriate; treatment should support righteousness to drive out evil. Once the exterior contraction is resolved, hemorrhoids flare up, with anal pain and recurrent red blood. However, bowel movements occur only once daily, not loose or diarrheal; this is hemorrhoidal blood, distinct from previous intestinal bleeding. When hemorrhoids subside, bleeding should stop spontaneously. Feeling hunger and able to eat, slight pain in the epigastrium after meals: the Stomach governs reception, the Spleen governs transportation. If Spleen health fails, transportation is slow. If pain were truly caused by food stagnation, there would be fullness and lack of hunger. Dihuang (Rehmanniae Radix) benefits Yin excellently but is slightly cloying, unfavorable to the Spleen. Temporarily discuss nourishing the Stomach and regulating the Spleen; reassess progress at the next visit. According to reports, usually fearing wind on the left side in winter and spring, and experiencing upper Jiao heat and stuffiness in summer and autumn, prescribing clearing and dispersing herbs works while taken but returns afterward. Estimating the cause, it is likely disharmony of Ying and Wei (Nutrient and Defensive) Qi, with the fence not solid; where evil gathers, Qi must be deficient. There is no principle that six excesses (pathogens) linger in the body for a long time. Unless seeking the root, merely treating symptoms superficially is useless. Wait until the new illness resolves, then plan again. The lower extreme is the Po Men (anus); the Po Men serves the five Zang organs. Excessive loss of hemorrhoidal blood leads to Yin deficiency and Yang floating, causing upper Jiao dry heat and dry cough. Yang adding to Yin is called sweat. Previously, diarrhea was heavy and intake low, so imitating the method of concluding with Stomach medicines was used. Now, bowel movements are normal, with increased appetite and frequent hunger; the condition is completely different. Danxi stated that men have constant excess of Yang and insufficiency of Yin; Yang moves, Yin stills. Reasonably, one should nourish Yin to balance Yang, using stillness to control movement. Reported that every autumn, coughs occur, and clearing-moistening agents are quite effective. Currently, after infection, fearing residual pathogens, Dihuang is too cloying and seems unsuitable. Considering the constitution is deficient and the infection occasional, the pathogen was not much; since expelled, it is unlikely to remain. Lung and Large Intestine are exterior-interior related; intestinal heat steams upward, Lung dryness causes itching, itching causes coughing. This is the cause of coughing, not related to Wind, but actually due to Dryness. The Classics say: "For Dryness, moisten it." Hemorrhoidal blood and coughing return to the same path; no need to treat separately.

An Bo’s commentary: The Large Intestine is a Fu organ of Dryness, nourished by Moisture. Proposing the intent of Sangma Wan (Mulberry Seed Pill), treating interior and exterior simultaneously.