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The pathogenic factor transmits to the Bladder (Bladder), which loses its function of transportation and excretion. The old pathogen fails to move, and new pathogens follow closely; inevitably, the condition gradually penetrates into the Mu Yuan (Membranous Origin, a location between the exterior and interior). It is like a leather bag wrapping objects. Within the circumference of the human abdomen, both the large and small Bladders reside, and the Uterus (Bao) lies within the Bladder. Because pathogens do not linger long but are transported and excreted smoothly, there is ample spaciousness. Now, Kidney Qi fails to consolidate and control itself, transmitting everything to the Bladder. The Qi of the Bladder accumulates without being excreted, losing its transformative function, thus distension is expected. The treatment method involves tonifying Kidney Water until it is sufficient; then Essence and Qi will be deeply stored, and the distension of the Bladder will naturally subside. Tonifying the Bladder to strengthen its Qi prevents the accumulation of Kidney pathogens, allowing the mechanisms of transportation and transformation to become abundant. However, tonifying the Kidney is easy, while tonifying the Bladder is difficult, because most herbs in materia medica have purgative rather than tonic properties. The classics state that insufficiency of the Bladder indicates a death sentence. Is this not because the more insufficient the Bladder becomes, the more distended it gets? When distension reaches its extreme, the pathology must reverse-transmit to the Kidney. When Kidney distension reaches its extreme, it must reverse-transmit to the Small Intestine. When Small Intestine distension reaches its extreme, it must reverse-transmit to the Spleen, eventually causing the Qi of the entire body to scatter without regulation. If physicians can perceive this early and plan ahead, they can fulfill their medical duties.

Yang Chengliu treated a woman surnamed Zhu who suffered from chest and diaphragm stuffiness, alternating chills and fever, dry mouth with thirst, and loss of appetite. Her condition worsened after taking medications for widening the middle, promoting drainage, clearing heat, and resolving the exterior. Pulse diagnosis revealed a wiry, rapid, and deep pulse at the Right Guan position; her complexion was reddish, and her tongue was dry with a slight yellow coating. He prescribed Yi Yin Di Huang Tang (Yin-Nourishing Rehmannia Decoction). Someone asked: "She has had chest fullness and inability to eat for months. Er Chen Tang and Zhi Qiao (Aurantium Fructus) still cannot unblock it; how can one administer Di Huang (Rehmanniae Radix), Shan Yao (Dioscoreae Rhizoma), Wu Wei Zi (Schisandrae Fructus), and Yu Rou (Corni Fructus), all of which are sour, astringent, yin-nourishing, and cloying substances?" Yang replied: "This condition originates from dry fire of the Liver and Gallbladder being closed and trapped within the Stomach. Its root cause lies in the insufficiency of Kidney Water. The Kidney serves as the gate of the Stomach. When Water is insufficient, Fire flares up and steams, damaging Stomach Yin. The Stomach is associated with the Liver and Gallbladder and is controlled by them. Since Kidney Water is deficient, the Yin-Wood of the Liver and Gallbladder lacks nourishment, causing dry fire to blaze alone. It then invades the deficiency of what it controls. Flaring upward causes dry mouth and throat; flowing downward causes constipation and urgent urination; blocking in the middle causes chest stuffiness. A floating, wiry pulse with an exacerbated Guan section, and a deep, fine right-hand pulse with a slippery Guan section, indicate excess Liver Wood and insufficient Spleen Blood. By soothing the Liver, assisting the Spleen, regulating Qi, and nourishing Blood, the Fire will descend, stagnation will open, and Phlegm will dissipate internally." He used Tiao Qi Yang Rong Tang (Regulate-Qi and Nourish-Formulation Decoction) added with Chen Pi (Citri Reticulatae Pericarpium) and Qian Hu (Peucedani Radix), assisted by Fu Ling (Poria) to resolve Phlegm and stop coughing, and Qing Pi (Aurantii Fructus Immaturus), Xiang Fu (Cyperii Rhizoma), Dou Ren (likely Sojae Semen Praeparatum or similar, context implies soothing liver/intestines), and Bai Shao (Paeoniae Radix Alba) to soothe the Liver and widen the intestines. In essence, when Qi flows freely like a river, Blood is naturally moistened. After several doses, Run Zi Wan (Moistening Pill) was administered intermittently, 5 fen each time. After ten days, symptoms subsided, and Liu Jun Zi Tang (Six-Gentlemen Decoction) was switched to, followed by blood-nourishing and Qi-regulating medicines. Generally, where pathogenic factors gather, Qi must be deficient. Robust individuals recover as Qi moves; weak individuals suffer disease as Qi stagnates. Later, pure tonification was used, interspersed with Qi-regulating and cough-stopping agents, resulting in recovery after fifty days.

Chen San Nong treated a young man with a weak constitution and hemoptysis. There was a mass on the left side that occasionally attacked upwards causing pain. Zuo Jin Wan (Left Metal Pill) and Lu Hui (Aloe) were ineffective. His pulse was peaceful across the three positions but fine, choppy, and unsmooth. Therefore, it was treated as Yin Deficiency using Si Wu Tang (Four-Substance Decoction) added with Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Xuan Shen (Scrophulariae Radix), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), and Bie Jia (Testudinis Carapax et Plastrum). After several doses, he recovered instantly.

Lu Feng Zhong suffered from Pi Tan (Stagnant Phlegm). He suddenly dreamed of a white-clad woman who told him: "Eating sugarcane will cure you." The next morning, seeing a sugarcane vendor, Lu put sugarcane in his pocket but lacked a coin. He only had a book titled "Tang Shan" and requested an exchange. The vendor said: "I am a peddler; what use is this book?" Lu pleaded, and the vendor gave him several stalks. Lu happily ate them and was cured by dawn. (From *Ye Shi* / Unofficial History.)

Commentary: Materia Medica states that sugarcane treats roundworms (Hui Chong), and roundworms cause abdominal distension and stagnation. Lu's illness was caused by roundworms at this time, hence eating sugarcane cured him.

Zhang Zi He treated a monk at Ying Si Temple under Duke Xianqing. He suffered from a condition accumulated over several years. Although not bedridden, every day after the fourth watch (1-3 AM), he felt stifling hardness in his heart/chest area and could not sleep peacefully, requiring him to walk around the temple, becoming accustomed to this routine. No one knew what disease it was, so they consulted Zhang. Zhang induced vomiting of one or two sheng of black alum-water-like saliva and mucus, followed by green water, and then purging of pus and blood totaling several sheng. From then on, his chest felt relieved, he could drink and eat without limit, and slept soundly until dawn.

A woman had a mass in her lower abdomen with a choppy pulse. After taking attacking/purgative medicines, her pulse became large. She was given Si Wu Tang (Four-Substance Decoction) with doubled Bai Zhu (Atractylodis Macrocephalae Rhizoma), assisted by Bai Shao (Paeoniae Radix Alba) and Gan Cao (Glycyrrhizae Radix). Once the pulse became substantial, Xiao Shi Wan (Niter Pill) was administered intermittently. The mass disappeared completely in two months.

In the summer of June, 25th year of Zhizheng, a villager named Zhou Bo An suffered from accumulated Qi under the right hypochondrium, with wheezing and distension for five months. Physicians came and mistakenly treated him with warm-tonifying agents, worsening his condition daily until he was nearly dead. Lu Jun Xiang examined him and said: "This is Xi Ben (Breath-Rushing Disease). The method requires drastic purgation, as stated in the *Nei Jing*: 'Those that remain should be attacked; those with Earth stagnation should be deprived.' Accumulated Qi at the贲门 (Cardia/Gateway) means the pathogen has not left; how can tonification be applied?" He followed the advice and recovered in less than a day. (From *Qiang Zhai Ji*.)

Wang Shi Shan treated a man over thirty years old, thin and pale. Eating caused chest/diaphragm stuffiness and excessive sweating, especially at the elbows. His limbs were fatigued or numb. If dinner was late, he would definitely have diarrhea the next morning. Initial pulse diagnosis showed a floating, soft, slightly rapid pulse, with the two Guan sections slightly large. Wang said: "This is Spleen Qi deficiency." The patient said: "I once took Shen Zhu Gao (Ginseng and Atractylodes Paste), and my chest felt stuffy too. I fear my condition is unsuitable for Ren Shen (Ginseng Radix) and Bai Zhu." Wang replied: "Pastes are thick and sticky, making it hard for Qi to circulate. Switch to decoction; perhaps the stuffiness will resolve." He prescribed Ren Shen and Bai Zhu (text says "Shen, [missing character likely Zhu/Bai Zhu]" each 2 qian), Bai Zhu 1.5 qian, Dang Gui (Angelicae Sinensis Radix) 0.8 qian, Zhi Shi (Aurantii Fructus), and Gan Cao 0.5 qian each, Mai Dong (Ophiopogonis Radix) 2 qian. After one dose, the upper body felt stuffy, but the lower body passed gas. The patient suspected Ren Shen and Bai Zhu caused this. Wang said: "No. If Ren Shen and Bai Zhu caused it, there would only be chest stuffiness, not passing gas. It is likely due to excessive Spleen/Stomach deficiency, unable to withstand the draining nature of Zhi Shi and Hou Po (Magnoliae Officinalis Cortex)." He advised removing Zhi Shi and Hou Po, adding Chen Pi 0.6 qian, and taking another dose. Immediately, chest stuffiness eased, gas passage stopped, spirit refreshed, and the pulse became soft, slow, not large, and not rapid. This shows that for Spleen/Stomach deficiency, Zhi Shi and Hou Po must be used cautiously. Even as assistants, with Ren Shen, Bai Zhu, Dang Gui, and Bai Zhu as sovereigns, they might not be controlled. Thus, physicians must beware of medication!

Zhang Jing Yue treated Jin Xiao Liang, whose Spleen was injured by fatigue and overwork, with no other symptoms except anorexia. He used Ren Shen, Bai Zhu, Dang Gui, Fu Zi (Aconiti Lateralis Radix Praeparata), Gui Zhi (Cinnamomi Ramulus), Jiang (Zingiberis Rhizoma), and Gan Cao. It took half a month to heal. Later, after an illness, he again lost his appetite and assumed he would die. He still used the previous medicines and stabilized.

Qian Guo Bin treated the father of Wang Yuan Zhi, who had a Pi mass on the left side of the abdomen, mirror-sized, identified as Mirror Pi (Jing Pi), growing inside the skin on the flesh. It was treatable with San Pin Gao (Three-Treasure Paste). Ba Dou (Crotonis Fructus) and Bi Ma Zi Rou (Ricini Semen) each 4 liang, Xing Ren (Armeniacae Semen Amarum) 1 liang, Huang Dan (Lithargyri), 8 liang, and Xiang You (Sesame Oil) 1 jin 2 liang were boiled into a paste. Applied for 20 days, changed once daily, discharging 1-2 bowls of pus. Internally, Ren Shen and Huang Qi (Astragali Radix) were used to support the interior. The wound healed in over a month.

Jiang Zhong Fang treated a woman surnamed Chen, aged 26, who had developed a Pi mass ten years prior, located above the umbilicus. Her menstruation came early. At night, she felt heat in the five centers (palms, soles, chest), acid regurgitation, bloating, and stuffiness. Suddenly, the Pi mass made a sound, moved upward to below the heart, causing unbearable stifling pain. Needling Shang Wan (CV13) caused the Pi mass to move down and pain ceased. However, pulsation beside the umbilicus continued. Needling Tian Shu (ST25) reduced the pulsation. Then, Dang Gui 5 qian, Bai Shao, Bai Zhu, Yan Hu Suo (Corydalis Rhizoma), Dan Pi (Moutan Cortex), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix) each 1 qian, Zhi Shi, Guan Gui (Cinnamomi Cortex), Bing Lang (Arecae Semen), Mu Xiang (Aucklandiae Radix) each 3 fen, Cu Zhi Bie Jia (Vinegar-processed Testudinis Carapax et Plastrum) 2 qian were decocted in water and taken on an empty stomach. She recovered after twelve doses.

Nie Jiu Wu treated Sister Liu, who had a timid constitution and a depressed temperament, aged 30. She suffered from evening fever that stopped at dawn, poor appetite, restlessness, emaciation, and bone prominence. Medical treatments failed. Her pulse showed intermittent skips. Due to restlessness and fever, cooling agents like Huang Qin, Huang Lian (Coptidis Rhizoma), Zhi Mu, and Huang Bo were used heavily. Though ineffective, no cold signs appeared. Fearing excessive intake would damage the Stomach and kill vitality, he asked where the heat started. She answered: "Heat starts in a circle around the right hypochondrium, then spreads to the whole body." He realized this must be a Pi mass formed by Qi stagnation and Phlegm knotting, causing chest/diaphragm congestion and subsequent dry heat. Qi knotting leads to pulse knotting. The pulse matches the symptoms, so there is no need to worry. First, attack the Pi to remove the root, and all symptoms will heal spontaneously. He used Mo Pi Wan (Pi-Grinding Pill), taken three times daily. After 3-4 doses, the mass halved, and fever subsided. After 7-8 liang, the mass disappeared, fever vanished, and she fully recovered within months. When Phlegm condensed and Qi stagnated, forming a Pi mass in the right hypochondrium, neither the physician nor the patient noticed it. Without examining the root and extracting it, how could efficacy be achieved? San Leng (Sparganii Rhizoma) and E Zhu (Curcumae Rhizoma) were vinegar-fried; Hua Fen (Trichosanthis Radix) and Da Huang (Rhei Radix et Rhizoma) were wine-fried; Zhi Xiang Fu (Prepared Cyperi Rhizoma) 8 qian each; Bing Lang, Huang Lian (Ginger-juice fried), Huang Qin (Wine-fried), Zhi Shi (Fried), Bei Mu (Fritillariae Bulbus), Lian Qiao (Forsythiae Fructus) each 6 qian; Shan Zhi (Gardeniae Fructus), Qian Hu, Qing Pi (Vinegar-fried), Yan Suo (likely Yan Hu Suo) each 5 qian; Guang Pi (Tangerine Peel) 4 qian; Nan Mu Xiang (Costi Radix) 2 qian; Yu Jin (Curcumae Longae Radix) 3 qian. These were powdered, moistened with Bamboo Juice (Zhu Li), mixed with sticky rice flour to harden, and formed into pills the size of mung beans. Each dose was 100 pills.

Commentary: This case shares identical pulse and symptom patterns with Lu Yang Yu's treatment of Madam Dong Xun Yang in the Phlegm category, but the formulas differ. Likely, Lu's case was plagiarized. Including this case in the Pi category informs us that Pi syndromes include Phlegm-knotting.

Hua Pi Gao Formula (Pi-Dissolving Paste): Mi Tuo Seng (Pilosi Litharge) 6 liang, A Wei (Ferulae Resina) 5 qian, Qiang Huo (Notopterygii Rhizoma et Radix) 1 liang, Shui Hong Hua Zi (Alternantherae Philoxeroides Semen) 3 qian. All ground into fine powder. Boiled in 1 jin of Sesame Oil to make a paste. Remove fire toxicity before spreading and applying. For patients with this syndrome, the skin definitely lacks hair. Mark the spot accurately with a pen before applying the paste. For chronic cases, only two pastes are needed. Internally, Ke Jian Jiu (Hardness-Clearing Wine): 3 qian of Shui Hong Hua Zi ground, soaked in 2 jin of Fire Wine (Baijiu). Take three times daily according to tolerance.