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Administered with child urine (Tongbian) and the patient regained consciousness. Such syndromes are all caused by Fire pathogen (Huoxie) clashing with Phlegm (Tan), and are not treatable with Sansheng Yin (Three Lives Decoction); even Ginger Decoction is inappropriate. (This case should be cross-referenced with Jiang Xuan's record of Xue Lizhai treating Scholar Wang Jinshi.)

Zhao Yi-de treated Academician Chen Jingchu, who collapsed while kneeling during a Daoist ritual, sweating profusely like rain. The pulse was large but empty. At fifty years old, having recently married a young wife and now exhausted by kneeling and bowing, his Yang Qi (Vital Energy) had suddenly scattered. A decoction of Dushen Tang (Single Ginseng Decoction) was urgently prepared; after drinking it continuously for half a day, the sweating stopped, and his Spirit (Shen) stabilized slightly. However, his limbs became numb/weak, and he lost his voice. Bamboo juice (Zhuli) was added to the Dushen Tang to clear the phlegm surging upwards. The next morning, he wept uncontrollably all day; upon verbal comfort, he laughed, then continued laughing excessively for five to seven days. This crying and laughing resulted from Yin Fire (Yinhuo) disturbing the Spirit, causing the organs associated with Hun (Ethereal Soul) and Po (Corporeal Soul) to interfere with each other. This corresponds to the *Neijing* saying "The Five Essences merge": when Heart Fire merges with Lung, there is laughter; when Lung Fire merges with Liver, there is sorrow. Slightly adding Coptidis Rhizoma (Lian) and Phellodendri Cortex (Bo) to drain the Fire, after eight days the laughter ceased and hand movement returned; within a month, he could walk. (From *Yitong*.)

Lu Yangyu treated Vice Minister Wu, aged fifty, who collapsed while kneeling during an ancestral worship ceremony upon returning home in honor, sweating profusely like rain, with intense body heat and unconsciousness. Some suggested administering Niuhuang Wan (Calculus Bovis Pill). The pulse at Guan and Chi positions was floating, rapid, and empty; the Cun positions penetrated into the fish-mouth area. This indicated severe Yin deficiency and extreme Yang hyperactivity. Administering Niuhuang would have been fatal. Urgently, one liter of fresh Rehmanniae Radix juice (Disheng Zhi), one liang of Ren Shen (Ginseng), five qian of Ophiopogonis Tuber (Maidong), and one hundred seeds of Schisandrae Fructus (Wuweizi) were decocted thickly and administered. After two or three doses, the Spirit stabilized slightly, sweating stopped, and he entered a state between sleep and wakefulness. At Wugeng (3-5 AM), he exhibited fear, as if being hunted. By dawn, he showed extreme anger, cursing incessantly. At noon, he laughed loudly for one or two hours. By dusk, he wept bitterly. The symptoms alternated between night and day, leading the family to suspect demonic possession. This is exactly what the *Neijing* calls "The Five Essences merging." Merging with Kidney causes fear; with Liver, anger; with Heart, joy; with Lung, sorrow. Liu Hejian stated: Improper daily regimen leads to insufficient Kidney Water and extreme Heart Fire, manifesting as this syndrome. At night, when Yin is abundant, the pathogen rests temporarily; at midday, when Yang is vigorous, the pathogen roams the five Zang organs without rest. The previous formula was used with half the amount of Ren Shen. Within ten days, he experienced only crying/laughing or only cursing/fear, alternating between consciousness and unconsciousness. He ate only when fed and did not think when not fed; bowel and bladder movements were unobstructed. Only after half a month did he become calm, followed by nourishing Qi and Blood for over a hundred doses until recovery.

Lin Zhongzun from Changxing, over fifty years old, felt bodily fatigue and dizziness after seeing off the Provincial Surveillance Commissioner. His head began to tremble and shake, he wanted to speak but could not, and experienced wheezing and counterflow qi. Everyone used Niuhuang Suheli Wan and Da/Xiao Xuming Tang for ten days with no improvement. The pulse was deep, slow, and weak, especially at the left Guan and Chi positions, indicating Liver-Kidney deficiency and sudden depletion of Essence and Qi. Inquiry revealed that due to the strictness of the Commissioner and fear of error, extreme mental labor led to illness upon return. The *Neijing* states: "All wind-induced tremors and dizziness belong to the Liver." Liu Hejian said: This is not external Wind pathogen, but results from improper regimen, insufficient Kidney Water, and excessive Heart Fire. Another classic says: "All counterflow and upward rushing belong to Fire." The current trembling and wheezing are due to this. In middle age, Kidney Qi is naturally insufficient; furthermore, fear injures the Kidneys, and excessive caution has damaged Kidney Qi. The *Neijing* says: "Fear causes Qi to sink." Voice is emitted by Qi; since Qi sinks, voice cannot emerge. Moreover, the pulses of Liver and Kidney both accompany the root of the tongue. The method should be to strengthen the Qi of these two meridians to treat the branch (symptoms); nourish the Blood of these two meridians to treat the root (cause). Use Gouqizi (Lycium Fruit) as Sovereign to tonify Kidney; Tianma (Gastrodia Rhizome) and Chuanxiong Rhizome (Chuanxiong) as Ministers to benefit Liver; add Ren Shen and a small amount of Fuzi (Aconite Lateral Root) as Assistants; and Dongdong (Tianmai and Maidong) as Envoys. Two doses, totaling several liang, significantly reduced all symptoms. Intermittent use of Bawei Wan (Eight-Ingredient Pill) for ten doses resulted in complete cure.

Zou Chunyuan (Ziquan), under fifty years old, suffered stroke: deafness, nasal congestion, obstruction of urination and defecation, paralysis and coldness of limbs, and aphasia. Some said: "He speaks of deceased persons," and he had already been given a coin's worth of Niuhuang. Others said: "The classics state those losing Yang see ghosts, those losing Yin go blind. Now he speaks of the dead and sees nothing, confirming ghost-sightings and blindness." Also, Jiegu said: Stroke affecting Fu organs involves the four limbs; affecting Zang organs obstructs the nine orifices. Now limbs are paralyzed and upper/lower orifices blocked, indicating simultaneous Zang-Fu involvement. Furthermore, the six pulses are wiry and rapid without order. The *Maijue* says: "Stroke pulses that are slow and floating are auspicious; urgent, solid, large, and rapid indicate isolated souls and peril." Both pulse and symptoms are critical, suggesting no hope of life. A prescription was made with five qian of Ren Shen, one liang of Shudi (Prepared Rehmannia), and two and a half qian each of Guizhi (Cinnamon Twig) and Fuzi, but not yet administered. Lu Zhi took the pulse: superficially extremely rapid and urgent, moderately slightly缓和 (soothing), indicating remaining Stomach Qi, though heavy pressure on Chi positions felt empty. He said: Simultaneous tonification of Yin and Yang is indeed the root treatment, but during upper/lower obstruction, it may not take effect immediately. One must first open the bowels and bladder so that turbid Yin descends, allowing Clear Yang to ascend, before discussing tonification. The classics say: In acute onset, treat the branch first, then the root. Everyone believed the condition was too critical to delay, so they administered the previous tonic. After several doses, the medicine remained in the chest, making noise when rubbed but not reaching the abdomen. Upon re-examination, the pulse remained the same. Lu took dozens of homemade Shenyue Wan pills from his sleeve, pried open the mouth, inserted them, and administered light ginger soup. Once the medicine went down, Baihui (GV20) acupoint was moxa-burned to raise Yang Qi, and Guanyuan (CV4) was moxa-burned to prevent Yang sinking. After one or two moxa cones, eyes opened, brows furrowed. Asked if painful? He nodded; limbs moved slightly. Told to endure up to seven cones for survival; he nodded again. Near the end of moxibustion, he needed to defecate; subsequently, both anterior and posterior passages opened, expelling much filth. Shortly after, another stool passed. He was instructed to quickly prepare the previous medicine with double the Ren Shen. When he had a second bowel movement and felt dizzy, the medicine was slowly administered, and he regained consciousness. Thereafter, consciousness gradually improved, but limb tremors and left-sided hemiplegia persisted. In major Qi-Blood tonifying medicines, small amounts of wind-dispelling, Qi-regulating, and phlegm-resolving herbs such as Qinjiao (Gentiana Macrophylla), Quanxie (Scorpion), Jiangcan (Bombyx Batryticatus), Wuyao (Lindera Root), Xing (Tian Nan Xing), and Ban (Ban Xia) were added. Treatment lasted over a year until recovery. Initially, Qi-Blood deficiency was the root, and orifice obstruction was the branch. Opening the obstruction first addressed the acute branch. Later, addressing wind symptoms while focusing on tonifying Qi-Blood with minor wind herbs addressed the chronic root.

Fan Xiyun suffered facial deviation, limb spasm, spontaneous sweating, and aversion to wind. Acupuncture, topical applications, and various wind-dispelling herbs failed for half a year. Pulse: left floating and tight, right洪缓 (surging and slow). This is Wind pathogen lodging in the Yangming channel, stagnating and transforming into Heat. Although dispersal is indicated, the pathogen is confined to one channel; mixing herbs from other channels attacks non-pathogenic areas, merely weakening the exterior without removing the pathogen, thus worsening aversion to wind and sweating without correcting facial deviation. The classics state: "The Foot-Yangming Stomach meridian flanks the mouth and circles the lips." This disease affects the mouth and lips, belonging solely to the Yangming channel; Mahuang (Ephedra), Guizhi, and Qianghuo (Notopterygium) are not suitable. Use Gegen (Pueraria Root) five qian and Shengma (Cimicifugae Rhizome) two qian to drive out stubborn Yangming pathogens; Baizhi (Angelica Dahurica) two qian and Jiangcan one qian five fen to correct head/face qi deviation; Huangqi (Astragalus Root) one qian five fen and Guizhi five fen to secure the loose exterior; Jiegeng (Platycodon Root) one qian and Gancao (Licorice Root) five fen to carry the herbs upward. Effective in two doses, cured in several doses. Later, nourished Ying Blood, fortified the interstices, and added minor clearing-heat and resolving-phlegm herbs for regulation. (Cross-reference with Xu Shumi's case.)

Li Sitang's mother, sixty years old, very obese, suddenly collapsed in January with stroke symptoms: unconsciousness, locked jaw, throat rattle, and limb paralysis. Niuhuang Wan and Xiao Xuming Tang were ineffective. Pulse: floating, surging, slippery, more pronounced on the right. Due to rich diet and strong constitution, the pulse was abundant. The classics state: "Diabetes, sudden falls, hemiplegia, atrophy, cold limbs, Qi fullness, and counterflow in fat nobles are due to Phlegm from rich food." Also: "Excess Earth causes inability to move limbs." Danxi said: "Dampness generates Phlegm, Phlegm generates Heat, Heat generates Wind." First, use Hezi's method of inducing vomiting. Administer Xixian San (Sputum-Expelling Powder) mixed with vinegar juice, expelling about a bowl of phlegm. Shortly after, Sanhua Tang was administered; by evening, two or three stools passed, throat sounds ceased, and speech returned. However, consciousness was not fully clear, indicating upper/lower blockage was cleared but middle Jiao accumulation remained. Erchen Tang (Two-Aged Decoction) with Zhishi (Immature Bitter Orange), Huanglian (Coptis), Laifuzi (Radish Seed), Muxiang (Aucklandia), and Baokouren (Cardamom) was given twice daily. Within days, consciousness improved, hunger returned, and thin porridge was allowed. For constipation, Runzi Wan (Moistening Pill) five fen with ginger juice in warm water was taken daily. Occasional spasms and dryness indicated blood consumption and fluid depletion; Siwu Tang (Four Substances Decoction) with Qiniao, Huangqin (Scutellaria), and Gancao for dozens of doses cured her in three months.

Lu Zuyu treated Zhao Yiyang, over fifty, who collapsed with stroke: locked jaw, eyes rolling up, clenched hands, and limb tremors. Xixian San blown into nose expelled bowls of thick phlegm. Two doses of Xiao Xuming Tang worsened condition: mouth open, hands relaxed, eyes closed, urinary incontinence, cold limbs, unconsciousness, throat rattle, and fever. Pulse: surging, slippery, with intermittent pauses. Condition critically dangerous. Prescribed Erchen Tang with Nanting (Arisaema), Zhishi to guide phlegm; Siwu Tang to nourish blood; assisted by Yazao (Gleditsia Spine), ginger juice, and Zhuli. Two doses reduced phlegm/wheezing; six doses cleared consciousness. Switched to Renshen, Baizhu (Atractylodes), Danggui (Angelica Sinensis), and Shaoyao (Peony) to greatly tonify Qi and Blood, resulting in stability.

Li Cuiyan, nearly seventy, obese and overworked. While walking outside, saw double images, doubled paths, and doubled doors, collapsed suddenly. Brought home, reluctant to speak but able to describe symptoms. Treated as stroke with phlegm-resolving and wind-dispelling herbs for over ten doses, leading to cold sweat like rain, fright, tremors, and unconsciousness. Left Cun pulse floating and large but empty on pressure; others slow, weak, and empty. Consciousness dim, unable to speak. This is deficiency collapse; primary treatment should tonify Zheng Qi (Upright Qi). Six Junzi Tang (Six Gentlemen Decoction) plus Huangqi, Danggui, Dihuang, Shaoyao, Tianma, Duzhong (Eucommia), Niuxi (Achyranthes), and Zaoren (Jujube Seed) stopped sweating in two doses; speech and recognition returned in five doses; cured in seven to eight doses. Added three qian of Ren Shen per dose; after twenty-plus doses, eating and walking normalized.

Ma Yuanyi treated Zhou Mou, unconscious and mute, resembling stroke for half a month. Right pulse deficient, minute, and powerless, indicating Yang deficiency. Chest fullness or staring blankly indicates Upper Jiao Yang dysfunction. Weak knees and inability to turn indicate Lower Jiao Yang dysfunction. With diminished Yang, Yin takes over; without warming tonification, Yin grows daily while Yang declines. Like seasonal change without warmth, how can life persist? Prescribed Fugui Lizhong Tang (Aconite and Cinnamon Regulate Middle Decoction) to greatly tonify Yuan Qi. After half a month, clarity returned, bowels moved; after one month, appetite improved, and walking resumed. Concurrent use of Bawei Wan aided regulation and stability.

Feng Chuzhan treated Zhang Quanbu, who developed palpitations and tinnitus from past overwork. Doctors treated phlegm, inducing a bucket of sputum, then used Guntan Wan (Rolling Phlegm Pill). Although phlegm cleared, Spirit was depleted. In early autumn, he collapsed stiffly, with phlegm rattle, eye deviation, mouth opening, limb rigidity, and profuse sweating—critical condition. All six pulse positions were vast and boundless, indicating impending collapse. Urgently, three liang of Ren Shen, two liang of Baizhu, and five qian of Fuzi were decocted thickly and administered. Three doses daily, timed appropriately. Pulse stabilized, body heat moderated, sweating decreased. Next day, two doses day, one night. By third day, symptoms lessened, but stiffness/unconsciousness persisted; effort was insufficient, branch symptoms calmed, but Yuan Shen (Original Spirit) not restored. Continue previous formula; after dosing, administer half cup of thick rice juice to protect Stomach Qi and assist medicine. Discouraged adding wind herbs ("How dare I disperse when preservation is hard enough?"), phlegm herbs ("How dare I resolve when preservation is difficult?"), or cooling herbs ("Even worse! Original Yang is collapsing; saving it is barely sufficient, how dare I cool it?"). My heavy use of Baizhu and Fuzi strengthens Ren Shen's Yuan Qi tonification; resolving phlegm, dispelling wind, and calming fire are inherent in this strategy. Touching on branch treatment would cause deficiency syndromes to swarm, making matters harder. Defying convention, I avoided them. Total usage in three days: 35 liang Ren Shen, 6 liang Fuzi, 24 liang Baizhu. Evening: sudden ability to speak, slight consciousness, ate half bowl porridge, slept; rattle and eye deviation persisted. Morning (Yang phase): Major Qi-Blood tonics for Heart/Spleen (Zaoren, Danggui, Baizhu, Shaoyao, Fushen, Yuanzhi, Ren Shen, Guiyuan, Wuweizi). Afternoon (Yin phase): Bawei Tang flushed with concentrated Ren Shen juice. After six-seven days, symptoms calmed. Daily Ren Shen 4-5 liang. Later mornings: Shengmai Yin with Bawei Wan, adding Niuxi, Duzhong, Lurong (Deer Antler), Wuweizi (4-5 qian). Midday: Modified Guipi Tang and Bawei Tang. Gradual strengthening, doubled appetite, recovered in one month. Treating critical conditions relies entirely on effective root regulation; naturally, pathogen has no place. Ancients said: Recognize branch, focus on root; treat thousands without harm.

Tan Zhangke, over sixty, suddenly fainted with surging phlegm and unconsciousness. Vomit一碗 (bowl) of phlegm, slightly revived. Porter forcefully carried him in sedan chair, gripping legs. Doctor gave wind-dispersing, heat-clearing, phlegm-resolving herbs; after ten days, phlegm undiminished, irritability doubled, headache and leg pain worsened. Pulse: Cun positions very surging and large; Chi and right Guan positions very deep and minute. Isolated Yang hyperactive above, weak Yin unable to grasp; Middle Jiao Spleen Earth also deficient, Yang has no storage, floats to vertex causing distension/pain. Method: Strengthen Water to control it, cultivate Earth to store it, tonify Fire to guide it, assist with Lung-nourishing/Metal-clearing to achieve Autumn descending function, thus gathering and storing. Shudi (Rehmannia) eight qian as Sovereign; milk-fried Baizhu five qian as Minister; rice-fried Maidong three qian as Assistant; processed Fuzi one qian five fen as Envoy. Decocted separately, five qian Ren Shen decocted juice mixed in. Headache instantly reduced, symptoms gradually resolved. Leg pain remained due to porter's grip injury; finger marks visible. External cause requires external treatment: raw pork loin mashed with cinnamon powder, scallion white, salt, applied thickly to site. Previously suffered morning diarrhea and poor appetite; morning empty stomach: Ren Shen soup with Bawei Wan. Noon before meals: Fried Baizhu thirty liang, processed Fuzi three liang boiled into paste, mixed with six liang Ren Shen powder, formed fine pills, swallow three qian with warm water. After half month, Spleen/Stomach strengthened, spirit increased.

Lady Jing, near fifty, stroke for five-six days, continuous sweating, fixed eyes, locked jaw, incontinence. Considered incurable. Pulse: very faint, but heavy pressure shows natural rhythm without haste/slowness—this is Stomach Qi. She said: Incontinence belongs to immediate collapse syndrome, hence untreatable. But after many days, how can one not urinate? Sitting idle for days without collapse proves not terminal. Administered Shenfu Tang (Ginseng and Aconite Decoction) two-three doses, gradually revived; heavy warming tonification led to cure.

Jin Jiaoyu, summer intense fever, headache, cough. Doctor diagnosed cold, used Qianghuo, Qianhu, Zisu, JuPi, Banxia, Zhike. Before finishing, headache shattered, tongue stiff, sticky sweat, left arm numb, Spirit exhausted. Pulse surging, large, empty, slow, powerless. Identified as Qi-deficiency stroke-like syndrome, mistakenly treated with dispersal. During this dissipating time, nearly became collapse syndrome. Prescribed Shudi one liang two qian, Maidong three qian, fried Baizhu four qian, Niuxi two qian four fen, Wuweizi eight fen, processed Fuzi one qian five fen, Ren Shen eight qian decocted separately and mixed. Three doses daily; cured in five days. Li Xiangsheng, same day illness, identical symptoms, one dose of dispersal, night-long sweating, died next day.

Zhang Luyu treated Zhao Mingyuan, spring exam winner, normally weak pulses, stroke unresolved for a year. Left hand three positions wiry, large, firm—Kidney Yin injury, vigorous Fire consuming Qi. Renying pulse slanting inward to Cun indicates Three Yang excess overflowing into Yangwei vessel, risking fall and insensitivity. Right hand three positions floating, slow, with slight slipperiness above Qikou indicates Phlegm surging in Diaphragm. Clear Yang position occupied by Phlegm-Qi, invading Heart Master, causing unclear consciousness and erroneous speech. Some noted corner-of-mouth saliva and fixed eyes, assuming pathogen in meridians, used wind-dispelling/phlegm-guiding herbs. Ignored that this is Kidney Qi failing to connect to Heart, Heart deficiency-Heat generating Wind; not suitable for wind-drying herbs. Some noted frequent clear urination, assuming Kidney deficiency, used Bawei Wan (strong Fire). Ignored that although deficient, deficient Yang hides in Liver, causing easy erection and hunger; not suitable for Fire-tonifying/Yin-consuming herbs. Some noted history of dysentery with phlegm-blood foam after stool, used Buzhong Yiqi. Ignored that Spleen Qi sinking in Lower Jiao can use lifting herbs, but this is residual Yin deficiency dysentery; what Clear Qi is below? Using Shengma/Chaihu lifts Liver/Kidney, agitates deficient Yang and Phlegm-Fluid in Diaphragm, risking wheezing/distension. Prescribed Hejian Dihuang Yinzi to assist Kidney, connect Heart, achieving both goals. Must avoid rich flavors and sexual activity; otherwise, medicine helps little. Wise people prioritize proper regulation.

Guard Jin Hanguang's relative, stroke: limbs immobile, wheezing with shoulder breathing, sound like sawing wood, unable to lie flat, no sleep/eat for half month. Pulse rapid-large, powerless on long pressure, Chi increasingly empty; above refers to right Cun/Guan. Left Guan/Chi wiry-rapid, shrinking on pressure; only Cun rapid-abundant. Occasional dizziness/confusion. Previous Erchen/Daotan with Qiniao/Tianma ineffective. Niuhuang Wan worsened phlegm/critical. Used Liujunzi Tang plus Dansing/Zhuli or Huanglian/Danggui. Four doses removed wheezing; two more doses improved eating/sleeping; four more doses enabled limb movement. Over ten doses, slow walking possible.

Gu E, Prefect of Hanchuan, elderly wife, Qi-deficient with abundant phlegm, depressed. Suddenly fell from bed, tongue stiff/mute, limb paralysis. Ate wet noodles that day; doctor used digestion-promoting herbs, ineffective, worsened exhaustion, unconsciousness, head/neck swelling. Pulse: six positions deficient, soft, powerless. Doctor still noted six-seven days no stool, planned purgatives.