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Previously suffering from a blood disorder, the episode had lasted nearly a month. The physician's use of the method "tonifying Qi for blood loss" (Bu Yi Fa) was not incorrect. However, it is concerning that the pulse is rapid and restless, muscles are emaciated, and the throat is dry. The patient suffers from violent coughing to the extent that they cannot lie flat; when the cough is severe, blood is expectorated, and bleeding stops when the cough subsides. The loss of blood disrupts Yin and Yang; Yin fails to anchor Yang, and Water (Kidney Yin) fails to control Fire. At this time, the dryness of Metal (Lung/Autumn) holds sway, and the Lung is scorched by Fire, causing the transformation between Metal and Water to fail. As stated in *Yi Guan*: "If one does not administer Sweet-Cold herbs to descend Fire, but instead abruptly uses Ginseng to tonify Yang, this is not a medical error, but a failure to understand the sequence of treatment." The patient describes a sudden sensation of vexation and oppression in the chest and epigastrium, followed by frequent coughing and hemoptysis. The Chong Mai (Penetrating Vessel) is the Sea of Blood; its channel originates at Qichuan (ST30), ascends alongside the umbilicus to the chest. When the Chong Mai pulses, all other vessels move. Is this not due to Yin-Fire rising from the Lower Jiao, with blood ascending along with the fire? Fire below the Dantian is called Shao Huo (Mild Fire), which generates Qi; Fire above the Dantian is called Zhuang Huo (Blazing Fire), which consumes Qi. To stop the bleeding, one must stop the cough. To stop the cough, one must extinguish the fire. However, ordinary clearing-heat and cough-stopping herbs will not suffice. It is essential to cause the Yin-Fire of the Lower Jiao to subside and hide, preventing it from counterflowing, so that Metal is not scorched; once the cough stops, the bleeding will naturally cease.

An Bo notes: Prescribe Yi Yin Decoction (One-Yin Decoction), adding Qing Qian (Lead) and Shan Yu Rou (Cornus Fruit), to gather and restrain the counterflow of the Chong Mai.

The previous strategy of calming the Stomach and restraining the Liver resulted in slight cessation of vomiting, yet the epigastrium remains distended and painful, and defecation has not occurred. There is hand tremors and eye deviation, dry teeth and lips, yellow tongue coating, and hot skin. The symptoms of Liver Wind causing spasms and syncope are already prominent. According to the history, the etiology involves emotional depression and stagnation combined with food retention. Depression injures the Liver; food retention injures the Stomach. Liver Wood stagnation should be dispersed; Fu organ diseases should be unblocked. Yesterday, following Zhang Zhongjing's principle that Jueyin syndromes require purgation, several hard fecal pellets were passed. The central distension softened slightly, and drinking no longer induced vomiting. However, Liver Wind has not yet subsided, and spasms/syncope persist. There is hot skin, thirst, red face, dry teeth, and gastric discomfort. The disease stems from Liver Wood depression and obstruction of Fu Qi, transforming into Fire and Wind. Although Lower Jiao Fu Qi has been unblocked, Upper Epigastric Fire has not yet descended. For now, the plan is to calm the Liver, extinguish Wind, relieve stagnation, and clear Heat. All types of Jue (reversal/cold extremities) belong to the Liver. The Liver is the Zang organ of Wind-Wood, harboring Ministerial Fire within, with a Yin substance and Yang function. When Liver Qi counterflows upward, it impacts the Stomach, preventing food intake; this indicates the presence of Fire. Ancient texts state that Cold and Hot Qi knotting in the Heart-Xia forms Pi (fullness/stagnation); blocking in the Heart-Xia forms Ge (regurgitation/blockage). It is also said: In Jueyin disease, Qi rushes up to the Heart, causing heat and pain in the heart, hunger without desire to eat. Borrowing from Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction), removing substances that retain/middle-tonify. Liver stagnation counterflowing to the Stomach obstructs Stomach descent, causing Middle Jiao blockage, anorexia, and constipation. Over recent days, Liver Wind has calmed somewhat, and epigastric heat has decreased, but chest fullness remains unrelieved, and there is no appetite. Previously used moistening purgatives slightly resolved hard stool. Last night, there were two urges to defecate, but none occurred, suggesting residual retained pathogenic factors. The Stomach should be unblocked, and the Liver cooled; this is the principle of treatment. Depression combined with food retention agitates Liver Wind, causing unconsciousness, limb convulsions, vexatious heat, chest fullness, anorexia, and constipation. Previously, Cheng Qi Tang (Order the Qi Decoction) and Xie Xin Tang (Heart-Draining Decoction) were effective, but relapse occurred after anger. Despite daily medical visits, the syndrome persists. The patient reports epigastric heat and oppression, thirst, dry lips, throbbing headache with tendon tension, occasional Qi rushing upward triggering syncope, and difficulty defecating. The prolonged and recurrent nature makes it difficult to find a solution. However, stirring soup to stop boiling is inferior to removing firewood from under the pot. Once Yangming Fu Qi is unblocked, Jueyin Wind-Wood will naturally level out. Yet, success or failure, even the wisdom of Zhuge Liang could not predict. Defecation became unblocked then closed again; epigastric fullness remains, tender on pressure, food cannot pass down. Purgative methods have been used twice; dry stool is cleared, and heat-retention should have been expelled. Why is it so firmly entrenched? Delayed for twenty days, speech is faint, form is fatigued; it seems attack/purgation cannot be repeated. Helplessly, the fullness/clumping does not open, tonification is not accepted. Still adhering to "Earth stagnation requires seizing/draining," there is meaning in treating the appearance of deficiency with draining methods.

An Bo notes: The variability of diseases depends on whether the patient's family is wise or foolish. Like people today, when a disease changes, many doctors gather; some discuss Cold, others discuss Heat. How can the number of those misled be calculated? That Mr. [the patient] trusted one doctor until the end without changing, is due to timing, fortune, and destiny. I sigh and put down my book. Generally, in the path of medicine, those destined to meet Heavenly Doctors (Tian Yi Xing) are fortunate; why do they encounter them often while this person does not?