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My cousin Huang Jiutang has constitutionally been deficient and cold. He previously suffered from abdominal pain, which remained stable after taking warming medicines. In recent years, the pain shifted to the upper epigastrium (upper abdomen), accompanied by rebellious Qi and vomiting, with a gradual decrease in food intake. In the autumn of the Dinghai year, the illness worsened significantly; he could not retain any food. He self-administered formulas belonging to Lizhong Tang (Regulate the Middle Decoction) and Liu Junzi Tang (Six Gentlemen Decoction) to warm and regulate Spleen Yang, but there was no response. His body became emaciated, his Qi weak, and he was bedridden. He sent a messenger to summon me urgently.

Upon examination, his pulse showed little Stomach Qi and excessive Xian (Wiry) pulse. His complexion was cyan-white and lusterless. He considered his condition desperate. I said, "No need to worry; the treatment simply missed the key point." Although his constitution is typically deficient and cold, suitable for warming regulation, based on the current pulse and symptoms, the cause lies in an unrelaxed state of mind, leading to Liver Wood stagnation and failure to diffuse. The Jueyin (Liver) channel invades the Yangming (Stomach) channel, causing Liver Qi to rebel and spread horizontally, resulting in the Stomach's failure to descend. Zhongjing stated: "In Jueyin disease, Qi rushes upward to the heart, causing heat and pain in the chest, hunger without desire to eat." The Liver is the official of the General; its nature is rigid and impatient. Although both the Spleen and Stomach belong to Earth, they must be treated separately and cannot be discussed generally. Ye Tianshi said: "The Stomach governs reception and acceptance; the Spleen governs transportation and transformation. The Spleen thrives when ascending; the Stomach harmonizes when descending. Taiyin Damp Earth begins to function only with Yang; Yangming Dry Earth finds peace naturally with Yin." These words truly elucidated theories not previously expounded by predecessors. Observing that food is vomited immediately upon ingestion, it is evident that the pathology resides in the Stomach, not the Spleen. Lizhong Tang and Liu Junzi Tang are herbs targeting the Spleen and cannot treat the Stomach. Now that the Stomach is empty like a valley, it requires the support of Ginseng to achieve efficacy. As purchasing Ginseng is difficult for a poor scholar, I considered a secondary option and substituted it with Korean Ginseng (Ginseng Cornea). Thus, within Liu Junzi Tang, I removed the retaining properties of Atractylodis Macrocephalae Rhizoma (Baizhu) and Glycyrrhizae Radix et Rhizoma (Gancao), and added Zanthoxyli Fructus (Chuanjiao), Mume Fructus (Wumei), Zingiberis Rhizoma Recens (Ganjiang), Chaenomelis Fructus (Mugua), and Paeoniae Radix Alba (Baishao). Separately, aged rice (Chencangmi) was decocted in water for administration. The herbs combined pungent and sour flavors, adhering to the method of restraining the Liver and calming the Stomach. I then took my leave.

The following day, Cousin Jiutang sent a letter stating: "The miraculous prescription, taken for two doses, relieved the pain and stopped vomiting; he could slightly consume grain. It proved very effective and efficacious. I am deeply grateful and admiring. I implore you to modify the formula, making slight adjustments according to the original method, and continue taking it to achieve recovery." In the spring of the following year, we met at the residence of Mr. Rao Yang in the prefectural city. His demeanor was far superior to before.

Note by Anbo: This case also involves long-standing illness leading to Stomach deficiency, hence allowing the tolerance of Korean Ginseng. However, it is essential to incorporate Mume Fructus, Zanthoxyli Fructus, and Chaenomelis Fructus, imitating the method of Anwei Wan (Stomach-Calming Pill), combining the three methods of Pungent Dispersing, Sour Astringing, and Sweet Moderating.