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Yu Jiayan treated the son of Ye Maoqing. After smallpox eruption, pus failed to form adequately; the crusts were very thin, and even after two months, some remained attached to the flesh without detaching. One night, he suffered severe abdominal pain, screamed, and fainted. Yu ordered pear juice mixed with warm water to be administered orally, after which the patient slightly recovered. Shortly after, pain returned causing fainting again; upon re-administration, he recovered once more. Yu then prescribed a decoction of Huangqin (Scutellariae Radix) 2 liang, mixed with pear juice for oral administration, which stopped the pain. He instructed the family to prepare a paste medicine for frequent intake, but they refused. Later, the abdomen suddenly became enormously distended. One night, severe pain and screaming occurred, with the small intestine protruding five cun outside the umbilicus, coiled two and a half cun each way, resembling bamboo nodes or a pot spout. The penis was twisted and folded, measuring eight to nine cun in length, bright like a lantern. This was an unprecedented case. Yu used only Ejiao (Colla Corii Asini) and Huangqin (Scutellariae Radix), administering over ten doses daily. Only after three days did urination begin; after five days, the urinary tract cleared, the umbilicus retracted, swelling subsided, and the patient recovered. Disciples asked in amazement. Yu replied: "The qi of the whole body is governed by the Lung. When the Lung is clear, qi moves freely; when turbid, qi becomes obstructed. The Lung governs skin and hair. The failure of smallpox to form pus indicates Lung heat and stagnation of fluids. Crusts adhering to flesh are called 'Jiacuo' (crab-like scales). Jiacuo often arises from Lung abscesses; 'Yong' means obstruction. Is this not caused by Lung qi obstruction? Severe abdominal pain and fainting result from extreme obstruction. Extreme obstruction blocks the water passages as well, causing qi to surge horizontally at the umbilicus, forcing the small intestine to protrude. The flaccidity and elongation of the external genitalia are merely secondary effects. Using Huangqin and Ejiao clears Lung heat and moistens Lung dryness, treating the root cause. Once qi moves, obstruction resolves; once the source is clear, the flow clears. Since the disease was extremely critical, only single herbs in large doses could descend and take effect. Thus, the prescription was mild yet effective quickly. Let me explain further using the principle of investigating things. Among birds and beasts, those with lungs have urine; those without lungs do not. Therefore, when water passages fail leading to edema and fullness, clearing the Lung is urgent. (The Lung governs the regulation of water passages; water originates from the high source [Lung], hence it is called the source of transformation.) Previous scholars did not fully elucidate this. Those who later used formulas like Wuling San, Wupi Yin, or Bazheng San to treat water diseases generally failed to grasp this principle. Formulas that aggressively attack the Bladder, akin to draining ponds, are lethal. One must be cautious." Attached: Liangyi Gao Formula: Shengdi Huang (Rehmanniae Radix) 1 jin, Yuzhu (Polygonati Odorati Rhizoma) 2 jin. Add 20 jin of water, boil for a long time, remove and mash, add another 10 jin of water, boil until flavorless, remove dregs, combine juices, and boil into a paste. Add 0.5 jin of white honey to set. Adding fresh ginger juice during boiling is also good. Take one spoonful per dose, dissolved in boiled water. It greatly moistens dryness, tonifies deficiency, clears the Heart and Lung, and treats Xiao Ke (Wasting-Thirst).

Zhao Wo's second son suffered in autumn from Lung qi failing to descend, resulting in swollen and ulcerated feet and complete absence of urination. (When Lung qi fails, these two symptoms often appear.) Pain in the umbilical region was indescribable; rubbing the left side caused pain to radiate to the right, and vice versa. Rubbing or warming the umbilicus caused pain throughout the entire area, accompanied by incessant screaming. Dozens of doses of diuretics were ineffective. Applying umbilical patches and taking 1 liang of Hupo (Succinum) powder alone were also ineffective. Upon pulse diagnosis, the condition was terminal and incurable. How tragic! (Xu Lingtai notes: Observing this case, foot swelling due to residual heat in the Lung after pathogen invasion should not be indiscriminately treated as Qi recovery or Yin deficiency requiring blood-tonifying herbs.)

Lv Dongzhuang treated Jiang Zhonglian, a man from Huizhou, who had fever and aversion to cold due to cold pathogen constraining fire. Both mandibles swelled to the size of a sheng (unit of volume), resembling Leitou Feng (Thunder Head Wind, commonly known as Pig Head Wind). Numerous hard lumps appeared on the arms. There was no appetite, constipation, mania, restlessness, and thirst. The pulse was floating, rapid, and disordered. Physicians treated it as toxic heat from Cold Damage. Lv said: "Incorrect. This is dryness driving wind generation." He prescribed a large dose of Shugan Yishen Tang (Liver-Soothing and Kidney-Nourishing Decoction), increasing Shudi Huang (Rehmanniae Radix Preparata) to 3 liang. After five doses, swelling subsided and bowels moved. After ten doses, fever ceased and appetite improved. He then used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) to cure the patient.

Lu Xiaoyu treated the nephew of Li Anwu, aged thirteen, suffering from intestinal dryness and constipation, intermittent rectal prolapse, nasal nodules, and occasional epistaxis. He loved reading; the illness resulted from overexertion and recurred with fatigue, resisting treatment for a long time. Examination revealed emaciation, red face, body heat, and a fine, rapid pulse. Lu stated: "This is a constitutional Fire-Dryness syndrome. If sexual activity occurs before completion of development, it will become consumption. Urgent treatment is needed. Avoid rich flavors and limit reading/studying to allow healing." He used Tiandong (Asparagi Radix) and Maidong (Ophiopogonis Radix) each 1 jin, Shengdi Huang (Rehmanniae Radix) 0.5 jin, and Renshen (Ginseng Radix) 4 liang, constituting a modified Santai Gao (Three Powers Paste). After one course, attacks became rare. After three courses, nearly fully recovered within a year.

Wan Mizhai treated a fourteen-year-old girl who, after convulsions, could not extend her right thumb and index finger. Other physicians used wind-dispelling herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Tianma (Gastrodiae Rhizoma), Quanxie (Scorpio), Jiangcan (Bombyx Batryticatus), and Chantui (Cicadae Periostracum), worsening the condition. Wan said: "Limbs paralysis is due to Blood deficiency. Extension without flexion indicates lax tendons; flexion without extension indicates contracted tendons. All are signs of Blood deficiency failing to nourish tendons. The thumb is governed by the Hand-Taiyin Lung Meridian; the index finger by the Hand-Yangming Large Intestine Meridian. Both belong to Dry Metal. This is a Blood-Dryness disease. Wind herbs generate wind and dryness, worsening Blood deficiency and the disease. He prescribed Huangqi (Astragali Radix), Renshen (Ginseng Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Shengdi Huang (Rehmanniae Radix), Shudi Huang (Rehmanniae Radix Preparata), and Danggui (Angelicae Sinensis Radix) in equal parts, with Guigui (Cinnamomi Ramulus) halved as a guiding herb to reach the fingers. Powdered and made into honey pills the size of Euryale seeds. One pill taken after meals with warm water."

Ma Yuanyi treated Zhou Kai, ill for a month with dry mouth and throat, chest fullness, inability to eat, and closure of both stool and urine. Pulse was deficient and choppy. This was Miner Yang (Lesser Yin) exogenous heat and Kidney meridian deficiency-dryness. The Kidney opens into the two yin orifices. With Kidney Yin depleted, the orifices lose lubrication, causing closure of stool and urine. The Lesser Yin meridian circulates along the throat and surrounds the tongue base; Kidney heat causes meridian heat, leading to dry mouth and throat. The Kidney is the gate of the Stomach. If the gate is blocked, Stomach qi is obstructed, causing chest fullness and anorexia. Ma prescribed Zhang Zhongjing's Zhufu Tang (Pig Skin Decoction). Pigs are water animals; their qi enters the Kidney first. Pig skin is salty and can resolve Lesser Yin exogenous heat, serving as the sovereign herb. White honey was added to moisten dryness and relieve irritability; rice flour was added to tonify deficiency and boost qi. After two doses, heat and dryness resolved, bowel movements normalized, appetite returned, and the patient recovered.

Xue Lizhai treated Zhou Shangshe with Spleen-Stomach deficiency. After taking Yangwei Tang (Stomach-Nourishing Decoction) and Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill), there was initial improvement followed by increased deficiency. Mouth and tongue ulcers worsened with fatigue; bitter-cold drugs caused vomiting. This was Middle Qi deficiency-cold. Lizhai treated with Lizhong Tang (Regulate the Middle Decoction) for slight improvement, then Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Banxia (Pinelliae Rhizoma) and Fuling (Poria) for full recovery over a month. Yangwei Tang consists of aromatic-drying herbs. If food stagnation or cold-stagnation in the Middle Jiao exists, these herbs dry and open Stomach qi, digesting retained food, which is somewhat logical. However, long-term use dries fluids further and weakens Stomach qi. Using them on a patient with inherent Stomach deficiency would inevitably exacerbate the disease.

Xue Lizhai treated a man whose palms thickened, cracked, and shed white scales in autumn, accompanied by internal heat and fatigue. This was Liver-Spleen Blood-Dryness, manifesting during the Autumn Metal season. He prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Chuanxiong (Chuanxiong Rhizoma) and Shudi Huang (Rehmanniae Radix Preparata) for over thirty doses to cure. Subsequently, Liuwei Wan (Six-Ingredient Pill with Rehmannia) with Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix) was taken. Half a year later, thick white skin appeared between finger webs, dorsal hands, legs, and wrists, feeling numb when scratched. Long-term use of previous medications eventually cured it.

A woman with habitual evening fever and irregular menstruation initially experienced red, itchy palms. In autumn, palms thickened, cracked, and shed white scales. This was Liver-Spleen Blood-Dryness. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Jingjie (Schizonepetae Spica), Gouteng (Uncariae Ramulus cum Uncis), Chuanxiong (Chuanxiong Rhizoma), and Shudi Huang (Rehmanniae Radix Preparata) for over fifty doses, followed by Guipi Tang (Restore the Spleen Decoction) for twenty doses, and finally Liuwei Wan (Six-Ingredient Pill with Rehmannia) to prevent recurrence.

Jiang Zhongfang treated his cousin's wife, Han Zhennü, who observed chastity in youth, was diligent, filial, and ascetic, eating vegetarian food and chanting sutras, resulting in chronic Qi-Blood deficiency and poor complexion. In spring of the Yisi year, she caught wind-cold, causing chest and abdominal distension. By summer, she suffered stabbing pain in the chest and hypochondrium, and back pain as if carrying a stone, resistant to treatments. By late autumn and early winter, she felt her intestines shrink to thread-thin size. Any food entering the stomach spun rapidly left and right, moving swiftly, causing abnormal narrowness and stagnation, unbearable pain, worsening with solar terms. Pulse was rapid on the right and choppy on the left. Jiang stated: "Rapid pulse indicates Qi-Dryness; choppy pulse indicates Blood-Deficiency. Blood deficiency leads to dry fluids and shrinking intestines, causing narrowness. Qi-Dryness causes rapid movement, preventing food from settling, hence the swift motion." He prescribed Danggui (Angelicae Sinensis Radix) 5 qian, Jiupao Baishao (Vinegar-processed White Peony Root) 2 qian, and Chuanxiong (Chuanxiong Rhizoma) 1 qian as sovereign herbs to tonify Blood. To loosen tightness, he added Fupi (Citri Reticulatae Pericarpium) 7 fen; to unblock stickiness, Huashi (Talcum) 1 qian; to moisten dryness, Suzi (Perillae Fructus) 2 qian; to slow rapid movement, Gancao (Glycyrrhizae Radix et Rhizoma) 2 fen. After four doses, symptoms gradually decreased. After 50-60 doses, Ying Qi (Nutritive Qi) began to flow. Pastes and pills were used for over a year of recuperation before significant improvement.