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Mr. Zhou, left side. In his early years, his essence and qi were not secure, leading to weakness in both legs, dizziness, and blurred vision. The syndrome belongs to deficiency consumption (Xu Lao), suitable for Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell).

Chuan Guizhi (Ramulus Cinnamomi Cassiae) 3 qian, Sheng Baishao (Radix Paeoniae Alba) 3 qian, Sheng Gancao (Radix Glycyrrhizae Preparata) 2 qian, Longgu (Os Draconis) 1 liang (decocted first), Zuo Muli (Concha Ostreae) 3 liang (decocted first), Da Hei Zao (Fructus Jujubae) 12 pieces, Shengjiang (Rhizoma Zingiberis Recens) 8 slices.

[Commentary] *Jin Gui Yao Lue* states: For men with seminal emission and women with nocturnal dreams of intercourse, Guizhi Jia Longgu Muli Tang is the primary treatment. Thus, this decoction's efficacy in treating seminal emission is well-known among physicians. However, many know it but dare not use it; instead, they tend to rely on Shenqi Wan (Kidney Qi Pill) combined with tonifying herbs such as Xuduan (Herba Dipsaci), Duzhong (Cortex Eucommiae), Nvzhenzi (Fructus Ligustri Lucidi), Tusizi (Semen Cuscutae), and Hetaorou (Semen Juglandis). My teacher treats such cases, and recovery occurs within one or two doses. I follow my teacher's method, and the results are equally effective. Mr. Huang Shunjun from the Times News Agency suffered from chronic seminal emission, which worsened with overwork. Disliking heavy medication, I prescribed Guizhi and Baishao each at 1.5 qian, Zhigancao (Prepared Licorice Root) 1 qian, Shengjiang 1 slice, and Dazao (Jujube) 4 pieces. After three doses, he recovered. Another case involves Mr. Zou Ping, who contracted bad habits in his youth and recovered only after long-term conditioning. This winter, his seminal emission recurred. Western medicine provided relief for the first two weeks, became ineffective in the third week, and exacerbated symptoms in the fourth week. The semen was thick, accompanied by back pain and dizziness upon waking, but no abdominal pain. Believing both Chinese and Western medicines were ineffective, he was deeply distressed. I comforted him, saying there was no need to fear, as I had a prescription. Given his willingness to take strong medication, I prescribed Guizhi and Baishao each at 3 qian, Zhigancao 2 qian, Shengjiang 3 large slices, Hualonggu (Flower Dragon Bone) 6 qian, and Zuomuli 8 qian. The latter two were crushed and decocted first for two hours. After one dose, seminal emission stopped that night. Although Mr. Zou was extremely anxious, his body remained unharmed. On the third day, forgetting to urinate before sleep led to one recurrence. Thereafter, it did not recur again. With modifications to the original formula, ten doses were taken consecutively, resulting in full recovery and revitalized spirit. Total intake included Guizhi and Shaoyao each 3 liang, Longgu 6 liang, and Muli 8 liang. Many other verified cases exist, too numerous to list here.

Cao Yingfu stated: This formula not only treats seminal emission but also night sweats (Dao Han). Over more than ten years, I have cured many patients, but due to its commonality, I failed to record the cases, names, and addresses. According to the principle, the base Guizhi Tang (Cinnamon Twig Decoction) was originally designed for weak Ying (Nutrient) Qi and strong Wei (Defensive) Qi, where Spleen Yang is depressed and unable to regulate sweat secretion from the muscle interstices. Therefore, pungent and sweet herbs disperse to assist Spleen Yang, allowing sweat produced in the muscle interstices to mix with existing sweat on the skin surface, harmonizing Ying Qi and stopping spontaneous sweating. Night sweats occur during sleep when Ying Qi travels to the Yang aspect; this indicates loose muscle interstices, causing sweat to leak out with Ying Qi. Since Ying is diseased while Wei is not, it signifies a disharmony between Wei and Ying. Thus, the base Guizhi Tang is used to harmonize Ying and Wei Qi, adding Longgu and Muli to anchor floating Yang, thereby stopping night sweats. If Ying and Wei are not yet harmonized, blind astringency will certainly be ineffective.

Guizhi Jia Longgu Muli Tang Syndrome Case Two

Mr. Ji, left side. On the night of October 12, he suffered from night sweats during sleep. The pulse was floating on the Yang position and weak on the Yin position. Guizhi Jia Longgu Muli Tang is indicated.

Chuan Guizhi 4 qian, Sheng Baishao 3 qian, Sheng Cao 1 qian, Longgu 4 qian, Zuo Muli 1 liang, Shengjiang 8 slices, Hongzao (Red Date) 12 pieces.

[Commentary] *Jin Gui Yao Lue* states: In healthy men, a weak, deficient, and fine pulse often predisposes them to night sweats. *Zhu Bing Yuan Hou Lun · Xu Lao Dao Han Hou* states: Night sweats refer to sweating during sleep caused by Yang deficiency. If prolonged, it leads to emaciation, insufficiency of Heart Qi, and loss of body fluids. Diagnosis reveals that a weak, deficient, and fine pulse in healthy men indicates night sweats.

Tanbo Shi commented: *Yi Zong Jin Jian* notes that the pulse and symptoms in this section do not match, suggesting missing text. Perhaps this arises because the pulse in deficiency consumption with night sweats is often deficient and rapid? My teacher asserts that Guizhi Jia Longgu Muli Tang is appropriate for this syndrome. As shown in this case, it is an example. After taking the medicine, the patient experienced slight warmth and sweating all over the body weekly, after which night sweats ceased. I have used this formula frequently with success comparable to treating seminal emission. Brother Wu Ningxuan once suffered from night sweats. Doctors used Fuxiaomai (Floating Wheat), Mahuanggen (Radix Ephedrae), and Nuodaogen (Rhizoma Imperatae) to stop sweating. However, the sweat stopped only superficially, not deep in the muscles, causing severe itching and discomfort. Later, he consulted medical texts, found this decoction, and took it. The sweat stopped imperceptibly. This decoction can treat night sweats, seminal emission, and even both simultaneously, typical of deficiency consumption patients.

Zhigancao Tang Syndrome Case One

Lawyer Yao Jian resides at Daxing Street outside the Small West Gate. He sought consultation; his sleep and appetite were normal. Palpation revealed a knotted and intermittent pulse (Jie Dai Mai), pausing every ten beats or so, or every twenty to thirty beats. Due to busy affairs, his heart often fluttered restlessly. This matches Zhong Jing’s description: "Palpitations with a knotted and intermittent pulse, Zhigancao Tang is the primary treatment." I prescribed this classical formula, and he recovered after about ten doses.

Zhigancao (Prepared Licorice Root) 4 qian, Shengjiang 3 qian, Guizhi 3 qian, Lu Dangshen (Codonopsis Radix) 2 qian, Shengdi (Radix Rehmanniae Preparata) 1 liang, Zhen Ejiao (Colla Corii Asini) 2 qian (melted and mixed), Maidong (Radix Ophiopogonis) 4 qian, Maren (Semen Cannabis) 4 qian, Dazao 4 pieces.

[Commentary] The original decoction method in *Shanghan Lun* uses seven sheng of clear wine and eight sheng of water, boiled together. My teacher often omits wine when using this formula, yet it remains effective. However, Ejiao should be melted separately and added later, or dissolved completely afterwards, to prevent its gelatinous nature from being absorbed by other herbs. I use at least 6 qian of Ejiao, divided into two additions, due to its heavy nature.

Cao Yingfu stated: "Jie" (Knotted) refers to obstructed and uncomfortable Yang Qi flow. "Dai" (Intermittent) refers to insufficient and discontinuous Yin Qi. "Dai" implies borrowing; if fixed assets are exhausted and one must borrow to survive, how long can it last? Thus, the "difficult to treat" mentioned in *Shanghan Lun · Taiyang Chapter* specifically refers to the Dai pulse, not the Jie pulse.

Zhigancao Tang Syndrome Case Two

Mr. Tang, left side. Initial diagnosis on October 20: Pulse was knotted and intermittent (Jie Dai), with palpitations (Xin Dong Ji). Zhigancao Tang is the primary treatment, following the method of Master Zhang Zhongjing, which cannot be altered.

Zhigancao 4 qian, Chuan Guizhi 3 qian, Lu Dangshen 3 qian, Ejiao Zhu (Ejiao Beads) 2 qian, Damaren (Hemp Seed) 1 liang, Damaidong (Ophiopogon Bulb) 8 qian, Dashengdi (Rehmannia Root) 1 liang, Shengjiang 5 slices, Hongzao 10 pieces.

[Commentary] Mr. Tang has had heart disease since spring. Every year, he travels to Hong Kong to consult the famous doctor Mr. Chen Botan. Dr. Chen uses classical formulas with heavy dosages, such as Guizhi and Shengjiang measured in liang. Boiled in a hot pot, the medicine tastes intensely spicy, yet Mr. Tang recovers quickly. This winter, palpitations and the knotted/intermittent pulse recurred. My teacher prescribed Zhigancao Tang. After three to five doses, palpitations subsided, and the pulse irregularity decreased, though it had not fully normalized. Chronic diseases require long-term treatment. Mr. Tang also suffers from constipation; bowel movements are easy with medication but difficult without, sometimes taking half an hour. Therefore, besides 1 liang of Maren, my teacher added 3 qian of Dahuang (Rhubarb Rhizome).

Second visit, October 23. Second administration of Zhigancao Tang improved appetite, but mouth dryness and shortness of breath persisted. The left Jie Dai pulse decreased slightly, but the right pulse was still not harmonious. Continue previous method with modifications. Added Zhijun (Prepared Rhubarb) due to scanty stools.

Zhigancao 5 qian, Chuan Guizhi 4 qian, Lu Dangshen 5 qian, Ejiao Zhu 2 qian, Dashudi (Prepared Rehmannia) 1 liang, Damaren 1 liang, Maidong 4 qian, Ziye (Perilla Leaf) 5 qian, Tianhuafen (Trichosanthes Root) 1 liang, Shengjiang 3 slices, Hongzao 7 pieces, Zhijun 3 qian.

Zhigancao Tang Syndrome Case Three

Previously, I treated a cook at Guangyi Hospital with Zhang Cigong. The patient had diarrhea and a knotted/intermittent pulse. Cigong prescribed Zhigancao Tang removing Maren. At that time, Mr. Chen, a relative of accountant Zheng Purong, present nearby, remarked: "This is an ancient formula; how can it treat modern illness?" Cigong argued angrily. After just one dose, the diarrhea stopped, and the pulse normalized. The illness had lasted over forty days, delayed by incompetent doctors. Without Cigong’s insight, the patient’s suffering would have been endless.

[Commentary] This case is similar to the previous one. The addition or removal of Maren holds deep meaning. The claim "ancient formulas cannot treat modern illnesses" mimics contemporary doctors' rhetoric, but lacks basis.

Cao Yingfu stated: Mr. Lu from a jade company, over sixty years old, suffered from persistent diarrhea, twenty to thirty times daily, with an irregular pulse. Recommended by Wang Youzhu, I diagnosed: "In elderly patients, a knotted pulse indicates critical illness." Referencing Zhong Jing’s intent, I combined Fuzi Lizhong Tang (Aconite and Magnolia Bark Decoction for Middle Jiao Deficiency) with Zhigancao Tang removing Maren. After five doses, the pulse normalized, and diarrhea stopped; mobility returned to normal.

Regarding ancient formulas, Zhong Jing demonstrated modification methods in *Shanghan Lun* and *Jin Gui Yao Lue*. Modified herbs need not go beyond classical formulas. For instance, add Renshen (Ginseng) and remove Baishao for Yin deficiency; add Baishao and remove Huangqin (Scutellaria Root) for abdominal pain. These precedents are established and undeniable. When I use this formula, I adhere to the base formula if it fits the syndrome. Since Cigong removed Maren for diarrhea, I increase Maren or add Dahuang for constipation. For cold-damp diarrhea, I combine with Fuzi Lizhong Tang. For insomnia, I add Suanzaoren (Ziziphus Seed) and Zhusha (Cinnabar). This is merely adapting to symptoms, nothing extraordinary. Zhong Jing’s method should indeed be applied thus.

[Additional Commentary] I have used this formula over a hundred times without failure. The main symptom is palpitations. If a knotted/intermittent pulse appears, the condition is severe, requiring higher dosages. Otherwise, mild dizziness indicates a lighter condition, responding even better. The mechanism of palpitations is blood deficiency, hence the pulse is exceptionally fine and small. Severe cases in women often affect menstruation. During intense palpitations, the left atrium throbs uncontrollably. Gallbladder Qi is weaker than usual, unable to withstand sudden fright or loud noises. Insomnia may occur, leading to deficiency sweating, known as "Yin deficiency failing to contain Yang." Upon taking this decoction, Heart Blood gradually replenishes. Palpitations calm, dizziness vanishes, menstruation regulates, deficiency sweating stops, and the pulse restores. Its efficacy is boundless. The formula consists of 70% Yin-nourishing herbs and 30% Yang-warming herbs; Yin is the substance, Yang is the function. Shengdi should be at least 6 qian, and Guizhi at least 1.5 qian to be effective. If one hesitates to use heavy doses due to fears that Shengdi is cloying or Guizhi is too hot, they are unfit to discuss classical formulas.

[Additional Commentary] Pulses in this syndrome are mostly rapid, often exceeding 100 beats per minute; slow pulses (<60 bpm) are rare. After taking the decoction, rapid pulses slow down, and slow pulses speed up, approaching standard rates. Excess and deficit are balanced; this formula reduces excess and supplements deficit, demonstrating great power. In severe blood deficiency, the pulse is extremely fragile to pressure. Initially palpable, it disappears after a minute. Heavy pressing yields nothing. Unskilled doctors become confused. Releasing pressure and waiting allows the pulse to return. Why is it unresponsive to pressure? Because blood is scarce. After three to five doses of this decoction, the pulse stabilizes and becomes palpable. These are personal experiences, not fabrications. Theoretically, pulses on both hands should be identical, but in practice, they often differ significantly. Pulse theory is complex, as illustrated here.

Xiao Jianzhong Tang Syndrome Case One

Ms. Wang, right side. Abdominal pain, relieved by pressure. During pain, she feels cold air pressing down from above. Pulse is deficient and wiry (Xuan), with slight aversion to cold. This is Liver invading Spleen. Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is indicated.

Chuan Guizhi 3 qian, Da Baishao 6 qian, Sheng Cao 2 qian, Shengjiang 5 slices, Dazao 12 pieces, Yitang (Maltose) 1 liang.

[Commentary] *Shanghan Lun* states: In cold damage, if palpitations and irritability occur on the second or third day, Xiao Jianzhong Tang is indicated. Also: In cold damage, if the Yang pulse is rough and the Yin pulse is wiry, acute abdominal pain is expected; initially prescribe Xiao Jianzhong Tang. *Jin Gui Yao Lue* states: For deficiency consumption with internal urgency, palpitations, epistaxis, abdominal pain, nocturnal seminal emission, limb soreness, heat in hands and feet, dry throat, and dry mouth, Xiao Jianzhong Tang is indicated. It does not explicitly mention cold air pressing from the chest to the abdomen. However, my teacher treats this downward-pressing cold sensation with abdominal pain using this formula with miraculous effect.

Analyzing the pharmacology: Baishao activates venous blood. Specifically, venous blood from the lower body flows upward to the vena cava and returns to the heart. In this syndrome, pathology likely exists in the veins, causing reverse airflow downward, leading to pain. Heavy use of Baishao increases venous return force, resolving pathology and curing the disease. Previously, Brother Wu Ningxuan suffered from abdominal pain unresponsive to long-term treatment. Consulting medical texts, he found Xiao Jianzhong Tang. He recorded the original formula, using 6 qian of Baishao and 3 qian of Guizhi. He considered these doses very light (one-tenth of ancient standards) and omitted Yitang. After ingestion, abdominal pain vanished, leaving a hollow feeling, comfortable under pressure. This was due to excessive venous return, insufficient arterial adjustment, and lack of Yitang supplementation. Ningxuan recounted this vividly, providing clear evidence. Students should remember this principle and correlate it with the following Bunteng (Rushing Pig) cases for comprehensive understanding.

Modern doctors rarely use Yitang. I once chatted with an old pharmacy assistant, asking if he ever saw prescriptions containing Yitang. He laughed and said no, revealing a trend. Ancient scholar Wang Ren’an stated: "Modern users of Xiao Jianzhong Tang absolutely avoid Yitang, losing Zhong Jing’s original intent." This has been the case for a long time, evoking sighs. Using Xiao Jianzhong Tang without Yitang is like using Guizhi Tang without Guizhi—is this logical?

Xiao Jianzhong Tang Syndrome Case Two

Ms. Gu, right side. Postpartum on October 26. Menstruation occurs every forty days. Epigastric distension and pain after meals. Recently, menstruation started with pain in the abdomen and hypogastrium. Pain is followed by heavy bleeding, then suddenly stops. Pain recurs the next afternoon, bringing menstrual flow again, which stops, then resumes the following day. Both pulses are wiry. This is Liver and Gallbladder invading Spleen deficiency. Xiao Jianzhong Tang plus Chaihu (Bupleurum Root) and Huangqin (Scutellaria Root) is indicated.

Guizhi 3 qian, Sheng Baishao 5 qian, Zhigancao 2 qian, Ruan Chaihu 3 qian, Jiu Qin (Wine-fried Scutellaria) 1 qian, Tai Wuyao (Lindera Root) 1.5 qian, Shengjiang 5 slices, Hongzao 12 pieces, Yitang 3 liang. (Note: One dose stopped pain and menstruation; family continued for two doses, resulting in full recovery.)

[Commentary] I initially suspected Wendang Tang (Warm the Meridian Decoction) with Qu (Medicated Leaven). Brother Wu Ningxuan strongly supported this formula. The teacher said: *Shanghan Lun* states: "If Xiao Jianzhong Tang fails, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated." I do not wait for failure; I add Chaihu and Huangqin preemptively. Is this not acceptable? Moreover, gynecological menstrual disorders are often treated with Chaihu formulas. Observe accordingly. The next day, reports confirmed improvement.

Danggui Jianzhong Tang Syndrome

Sister Zong. November 17. Menstruation approaching, preceded by abdominal pain. Left three positions pulse is deficient, indicating blood deficiency. Danggui Jianzhong Tang is indicated.

Quan Danggui (Angelica Sinensis) 4 qian, Chuan Guizhi 3 qian, Chi Baishao (Red and White Peony Roots) each 3 qian, Sheng Gancao 1.5 qian, Shengjiang 3 slices, Hongzao 7 pieces, Yitang 2 liang (mixed in).

[Commentary] Danggui Jianzhong Tang is a modified Guizhi Tang. Taking this formula as an example: Gancao is insufficient, so Yitang is added. Baishao is insufficient, so Chishao (Red Peony Root) is added. Guizhi is insufficient, so Danggui is added. *Ben Cao Jing* records Guizhi treats upper Qi cough and rebellion; Danggui treats cough and rebellion of upper Qi. The difference is minimal. I use concise writing to explain the principle here, leaving details for readers.

Huangqi Jianzhong Tang Syndrome (Including Student’s Verified Case)

Ms. Wang, initial diagnosis. Amenorrhea for nine months, coughing for four months, unresponsive to multiple treatments. Pulse is deficient and rapid; tongue coating is thin and greasy. Profuse night sweats every morning, dizziness, palpitations, chest tightness, flank pain, abdominal pain relieved by pressure, poor appetite with nausea, restless sleep, copious saliva when coughing. The condition has persisted, implying chronicity. Plan to treat night sweats first; proceed further if effective.

Chuan Guizhi 1 qian, Da Baishao 2 qian, Sheng Gancao 8 fen, Shengjiang 1 slice, Hongzao 4 pieces, Zongzitang (Zongzi Sugar/Maltose Candy) 4 pieces, Quan Danggui 2 qian, Hualonggu 4 qian (decocted first), Duanshui Muli (Calcined Oyster Shell) 4 qian (decocted first).

[Commentary] Ms. Wang was introduced by a friend. Age sixteen. Amenorrhea started this spring, lasting nine months. Reason given: excessive fruit consumption. Skin lusterless, continuous coughing, panting even climbing stairs slowly. Other symptoms match the pulse record, commonly known as "Dry Blood Consumption" (Gan Xue Lao). Consulted many Chinese and Western doctors, sought folk remedies, but the condition worsened daily. Initial pulse was extremely fine and rapid, over 140 beats per minute, twice the normal rate. Traditional view: Wood Fire insulting Metal, a ominous sign. Modern view: Severe pulmonary anemia causes vessel constriction, poor prognosis. Patient lies curled in bed all day to alleviate chills. Difficult to prescribe while facing her. Meditating on the core issues: 1. Amenorrhea; 2. Lung disease with cough; 3. Abdominal pain, chills, and night sweats. Should I use purgatives to open menstruation? No masses in abdomen, but deficiency cannot tolerate harsh attacks. Should I use lung herbs to stop cough? Tuberculosis bacteria are thriving, hard to eradicate. Finally, treat abdominal pain, chills, and night sweats. Use Danggui Jianzhong Tang combined with Guizhi Longgu Muli method, prescribing a very light dose. Zongzitang is made from Yitang, sold in candy shops, more convenient than raw Yitang; this is my teacher’s method. The pharmacy staff laughed, saying sugar as medicine is humorous.

Three days later, the patient returned for follow-up, overjoyed and grateful.

Second visit. Third administration of light Danggui Jianzhong Tang plus Longgu and Muli. Night sweats reduced by 30-40%, abdominal pain greatly decreased, aversion to wind ceased, chest comfort improved. Pulse rate dropped from 140 to 120 bpm, becoming regular. Bowel movements smoother, cough less frequent, dizziness and palpitations slightly improved. Previous formula fits, but dosage is too light. Increase dosage now. Wait for complete cessation of night sweats, then plan to open menstruation.

Zhi Huangqi (Prepared Astragalus Root) 3 qian, Chuan Guizhi 1.5 qian, Rouguixin (Cinnamon Heart) 2 fen, Zhigancao 1.5 qian, Da Baishao 3 qian, Quan Danggui 4 qian, Shengjiang 2 slices, Hongzao 8 pieces, Zongzitang 6 pieces, Longgu 6 qian (decocted first), Muli 8 qian (decocted first).

[Commentary] Patient stated: Initially, any slight movement at night caused unbearable panting. Three hours after taking the previous formula, panting stabilized. Even slight activity caused no harm. After three doses, symptoms greatly reduced. Food intake increased from half a bowl to a full bowl. I initially thought stabilizing abdominal pain was sufficient merit, but unexpectedly, cough also improved, and pulse slowed and regulated.