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Wei Yuheng said: Chen Eryin Rong lived in Suzhou, was nearly fifty years old, had slightly red cheeks usually, was slightly fat, and liked to drink several cups of strong liquor daily. In the past, when he was in the capital, we got along very well. Recently appointed as Vice Magistrate of Luling, he stopped by to visit me on his way. When I returned the courtesy, I saw him taking paste medicines and asked what ailment he had. He said, "I have been suffering from dizziness and vertigo recently, caused by phlegm-fluid retention." Let me feel your pulse. He smiled and said, "Have you learned medicine recently?" I replied, "I know a little." The pulse felt at both Cun positions was forceful and striking against the fingers; the Guan position on the left was wiry (Xian), and the Chi position was weak; the pulses in all six positions were slightly rapid. This indicates insufficient Yin and excessive Yang, belonging to dryness-fire syndrome, not phlegm-fluid retention. I explained the reasoning to him, but he merely nodded assentingly. Asking for his prescription, it consisted of Erchen Tang (Two-Cured Decoction), Baizhu (Atractylodis Rhizoma), Xiangfu (Cyperi Rhizoma), Yuanzhi (Polygalae Radix), Yizhi (Alpiniae Oxyphyllae Fructus), and Changpu (Acori Tatarinowii Rhizoma), various pungent, warm, drying, and aromatic herbs. I told him the medicine did not match the syndrome and that long-term use might cause other complications, yet he only nodded assentingly. Five months after parting, when he arrived at his post and returned suddenly to his residence by the lake in September, he was already ill. I visited him, and he reported that since assuming office, he had sweating on the head, worsening dizziness and vertigo, gradually decreasing appetite. Every meal stayed in the epigastrium/chest region and was difficult to swallow, eventually vomiting up after a long time. Later, he could only take congee, which he also rejected, so he tried noodles, which he also rejected. For two months, he ate only one steamed bun daily, swallowing it slowly from morning until evening; if he rushed, he would vomit. Bowel movements occurred only once every ten-plus days, hard and black like pellets. Several other doctors treated him with dozens of doses, including several taels of Renshen (Ginseng Radix et Rhizoma). He wanted to show me the previous prescriptions, saying it was unnecessary, knowing they must be the same ingredients from the earlier paste formula. It turned out to be true. This disease originated from dryness-fire, and the mistaken use of aromatic-drying herbs depleted body fluids, causing the two Yangming meridians (Hand-Yangming Large Intestine and Foot-Yangming Stomach) to become withered. It has now developed into Guange (Obstruction and Rejection) syndrome. Fortunately, the stool is not yet like sheep droppings, indicating that the Yin of the Lower Jiao has not completely exhausted. Urgently using moistening agents can still save him. I prescribed Shengdi Huang (Rehmanniae Radix), Shudi Huang (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), Roucongrong (Cynomorii Herba), Beishashen (Glehniae Radix), Danggui (Angelicae Sinensis Radix), and Niuxi (Achyranthis Bidentatae Radix) for four doses. The stool became slightly moistened, and he could drink one bowl of congee. After another four doses, congee intake increased gradually. Then, using Mahuang (Ephedrae Herba) mixed with rice, he consumed one bowl without issue. After another four doses, bowel movements normalized, and diet returned to normal. Thereafter, modifying the previous formula, I instructed him to take one hundred doses; upon recovery, he had taken only half. Three years later, the illness recurred. He urgently sought diagnosis in Hangzhou. Modifying the previous formula, he took fifty doses and remained healthy thereafter. (Li An: The cases collected in this category are not true Ye Syndrome (Dysphagia). Xu Lingtai said: Ye Syndrome cannot be cured by any method, so ancient medical records used symptoms like Fanwei (Regurgitation) and vomiting instead, with no cases treating true food obstruction. Recently, a formula circulated in Beijing uses un-furred baby mice, roasted on a yin-yang tile, ground into powder, and taken with water and wine, effective every time. This shows that diseases considered incurable by ancients actually had treatable formulas, often right before our eyes. The problem lies in lack of insight, leading to inaction.)

My fellow villager Xiaolian Xiangpu's mother was seventy-seven years old. She had suffered from epigastric/chest disharmony for two years. As spring ended, her food intake decreased further. By mid-autumn, she began vomiting and could not eat. Some attributed it to Spleen-Stomach deficiency-cold and prescribed Erchen Tang, Er Zhu (Baizhu and Zhuru), Buguzhi (Psoraleae Fructus), Wuzhuyu (Evodiae Fructus), Shengjiang (Zingiberis Rhizoma Recens), and Rougui (Cinnamomi Cortex), various pungent-aromatic-drying-hot drugs, totaling dozens of doses. This led to an inability to swallow even soups or drinks. Forcing a single cup resulted in doubled vomiting, expelling yellow saliva with a fishy odor. She had lost hope in medicine. Reluctantly summoning me to diagnose, her pulses at both hands were imperceptible. Coldness extended from her feet above the knees and from her hands above the elbows. Her tongue coating was white, but the tongue body was purple. Only her spirit was relatively clear, and she could manage daily activities independently. I diagnosed this as Elderly San Yin Blood Deficiency with Ministerial Fire counterflow. The cold limbs were due to heat excess causing Jue (Cold Extremities) from mistaken medication; the absent pulses indicated Ying (Nutritive) Qi deficiency unable to reach the Cun Kou; the white coating with purple body indicated Liver Fire attacking Lung Metal, preventing its descent. I prescribed Shengdi Huang (Rehmanniae Radix), Gouqi Zi (Lycii Fructus), Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), Louren (Trichosanthis Semen), Niuxi (Achyranthis Bidentatae Radix), Yiyiren (Coicis Semen), and Chuanlianzi (Meliae Fructus). Someone asked, "Everyone treats this as cold, but you say fire. How do you verify this?" I said, "Just ask the patient about urination." Soon, the answer was only a few drops daily. Another asked, "Ancients said heat below causes Guan (Closing), and cold above causes Ge (Rejecting). Are you biased towards heat?" I replied, "If so, why did the previous Ginger and Cinnamon fail, while current medication stops vomiting?" After a few doses, blue veins suddenly appeared on her palms and dorsum of hands. Since the Liver governs tendons, the Wood element received nourishment and expanded suddenly. Adding three fen of Huanglian (Coptidis Rhizoma), her limbs warmed, urination increased, and the veins receded. Adding five to seven qian of Shudi Huang (Rehmanniae Radix Preparata), she recovered completely after over ten doses. Later, a boil appeared on her fingertips. When asked why, I said, "Is this brewed by pungent-aromatic-drying-hot drugs?" She agreed, saying, "With this boil, there is no disaster."

My clansman De Wu was seventy-five years old. He was prone to depression and enjoyed drinking. In summer, he occasionally vomited but recovered spontaneously. In early autumn, catching cold triggered recurrence, improving slightly with pungent-drying drugs. In late autumn, catching cold again caused severe exacerbation. Every food intake induced vomiting, expelling several basins of saliva daily. Soups and drinks were impossible for dozens of days. Previous doctors exclusively used Erchen Tang, Shengjiang (Zingiberis Rhizoma Recens), and Rougui (Cinnamomi Cortex), worsening the condition with each dose. Vomited material amounted to hundreds of stones. His pulse was surging, large, and striking. His face and forehead showed a jadesite color. The Classic says: "All rebellious upward rushing belongs to Fire." His nature was hasty, hence immediate vomiting after eating. I prescribed heavy doses of Gouqi (Lycii Fructus), Dihuang (Rehmanniae Radix), Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), Yiyiren (Coicis Semen), adding three to four fen of Huanglian (Coptidis Rhizoma). Improvement after one dose, reduction after two. Asked if water chestnuts could be eaten, he said yes. Eating several jin reduced symptoms further, so he stopped medication. Half a month later, mild recurrence occurred. Reinforcing the previous formula with heavy Shudi Huang (Rehmanniae Radix Preparata) led to recovery. Someone asked, "The elderly have declining Yang Qi. Is using Huanglian too much?" I asked, "Where does the theory of elderly Yang deficiency come from?" The person fell silent.

Mrs. Hu, around fifty, often suffered from hypochondriac pain with a mass, sometimes heart pain, and severe vomiting. Her son, a doctor, used Erchen Tang plus Zuojin Wan (Left Metal Pill), Yujin (Curcumae Radix), and Xiangfu (Cyperi Rhizoma). Initially slight improvement, then ineffective. An old doctor prescribed Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Yanhusuo (Corydalis Rhizoma), and Xiaohuixiang (Foeniculi Fructus). Initially effective, but upon recurrence, vomiting intensified. Upon my diagnosis, she had not eaten for days, nearing Ge Syndrome (Obstruction). Fortunately, stool was not constipated but loose, urine was short and scanty, mouth bitter and dry. Pulse at Left Guan was wiry, small, and rapid; both Cun pulses were drum-like. Prescribed Shengdi Huang (Rehmanniae Radix), Gouqi Zi (Lycii Fructus), Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), and Jiulian (Huanglian processed with wine). Recovered after several doses.

Old Man Fang Tianhu, nearly seventy, suffered from heart and hypochondriac pain. An old doctor prescribed Erchen Tang plus Renshen (Ginseng Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Fuzi (Aconiti Lateralis Radix Praeparata). Over months and years, this led to inability to ingest food, a mouth full of mush-like substance, insomnia day and night. Only hearing drums and singing allowed slight sleep. Upon diagnosis, the six pulses lacked Stomach Qi. I said, "This is Blood Ge (Blood Obstruction), starting from impetuous Liver Fire causing frequent rage. Blood follows Qi upward, reversing in the epigastrium. Meeting Yang-gan drugs depleted fluids, causing collateral withering and stagnation. Blood coagulates and fails to descend. Heat and blood stasis in the Stomach prevent food intake, hence preference for music. Now True Yin is exhausted, leaving solitary Yang. It is incurable." Reluctantly providing a formula: Shudi Huang (Rehmanniae Radix Preparata) 1 liang, Gouqi Zi (Lycii Fructus) 5 qian, Shashen (Glehniae Radix) 3 qian, Maidong (Ophiopogonis Radix) 2 qian. Each dose allowed sweet sleep for 2-3 hours, similar to hearing music. This did not help the Ge Syndrome. Later, he vomited several bowls of blood and died.

Mr. Xu Guangchuan, forty-six years old. Loved heavy drinking and rich, fried foods. Left hypochondriac pain and distension, invading Stomach collaterals. Liver and Kidney injured; should nourish Water to support Wood. Nanjing doctors had vulgar understanding. Used Erchen Tang, Wuxiang Wan (Five-Aromatic Pill), Liujunzi Tang (Six-Gentlemen Decoction), Liuyu Tang (Six-Stagnation Decoction), Xiangsha Liujunzi Tang, Zuojin Wan, Xiaoyao San, Yueju Wan. Variations of these only. Treated for half a year with no benefit. I had a good relationship with his son-in-law, revealing the truth. Told him this is Blood Ge, needing prevention. Mid-autumn arrived, diet increasingly obstructed. Remembering my words, the principle was profound. Subsequent visits, advised against trying the medicine. Year ended, hematemesis like pulp. Resumed diagnosis, proposed Yin-nourishing agents, everyone deemed it wrong. Went to Suzhou in Spring, sought treatment from Miao. Miao prescribed Sesame, Black Bean, Jianghui (likely a specific herb or error, kept as transliteration), Mulberry Leaf, hoping to prolong life. Who knew disease entered the Zang-Fu marrow, efficacy failed. Guange formed, unable to accept liquids. Long decline ended during Mangzhong (Grain in Ear solar term). (Xiong An: This imitates the case of Shi Peiran treating Xu Zanwu in the Bi section, effectively serving as an elegy.)

Note: Zhao Xuemin's *Bencao Gangmu Shiyi* states: Shidachuan, also known as Longya Cao (Dragon Tooth Grass). Grows on mountains, sprouts at Lixia (Start of Summer), leaves have fine hairs, stems 1-2 chi high, flowers spike at Hanlu (Cold Dew), yellow small flowers, roots have white buds pointed like dragon teeth, stems have white hairs, top opens yellow flowers, hence named Jinding Longya (Golden-Topped Dragon Tooth). Also called Tie Hufeng (Iron Hornet) due to black old roots resembling it. Another variety, Ziding Longya (Purple-Topped Dragon Tooth), has white-haired stems, hairy leaves, spikes at Cold Dew, purple flower spikes, sprouts in Feb, leaves lie flat, withers in Sept, harvested in July. Zhao Xuemin said: I planted this grass, seeing stalks after Xiaoshu (Minor Heat), flowering at Dashu (Major Heat), spikes like Persicaria barbata (Biancaobian). Flowers cluster yellow on stems. Realizing Persicaria barbata has purple flowers, hence Purple-Topped Dragon Tooth. This has yellow flowers, hence Golden-Topped Dragon Tooth, distinct from Diwugong (Ground Centipede). Because it shares the name Diwugong, some confuse it with Shijianchuan. Li's *Caomi* says: Shijianchuan grows in bamboo forests, few leaves like Mugwort, flowers 1 chi high, treats trauma and chest qi. Thus Shijianchuan leaves resemble Mugwort, differing from Shidachuan's deep-veined serrated leaves. People also call it Tiexianshu (Iron Broom), common in mountains, green square stems, purple lines, leaves like Ziding Longya, fine white hairs, small yellow flowers in July, fruit like broom bristles, pricks hands, hence Qiantiaozhen (Thousand Needles). Supplementary formula: Take Shidachuan tops monthly (one in March, three in April, etc., based on month number). Crush juice, mix with human and goat milk, divine effect. Ge Syndrome, from Jiang Yunshan's transmitted formula. Jiang Yi's *Yaojing Shiyi* says: Ye Ge Fanwei (Dysphagia, Regurgitation) always considered incurable by doctors and patients. I obtained this agent, 9/10 effective, wrote a song: "Who knows Shidachuan? Green deep veins, serrated edges. Width less than inch, length double. Round stems embrace. Autumn yellow flowers, five petals. Flat small fruits, needle clusters. Old roots two chi tall. Spring seedlings follow shoulders. Large leaves sandwich small ones, layers fresh. Bitter-pungent-neutral, enters Intestines-Lungs. Pierces intestines-stomach, breaks hardness. Harvest stems-leaves crush juice, sugarcane juice-white wine assist. Dysphagia drinking transforms phlegm instantly, fluids restore merit first. World ignorant, few know. Qi-Huang unrecognized, name spreads vainly. Cinnabar Gouliu, Ge Xian's deeds. I love health preservation verses." Observing Zhao's comparison, Tiexianshu's green square stem resembles the Daoist's square stem-green leaf description. But Daoist didn't specify flower color or purple lines. Zhao cited square stem but no concavity, resembling Motherwort. Whether same or different, hard to guess. However, such Ge-treating grass exists here, undeniably true. Preserve for experts.

Gu Zhang (Tympanites) and Ge Syndrome are both major illnesses. However, Gu Zhang is treatable, while Ge Syndrome is not. Gu Zhang involves accumulation of substances in the middle, presenting as Excess syndrome; Ge Syndrome involves inability to receive food, presenting as Deficiency syndrome. Excess is treatable; Deficiency is not, which is the norm. Gu Zhang arises from Spleen-Stomach weakness failing to transform, with Phlegm, Blood, Qi, or Food condensing in the middle, causing distension. Treatment should first purge accumulations, then tonify Middle Qi, allowing gradual digestion. The *Neijing* offers Jishi Li (Chicken Dropping Fermented Liquid), illustrating this method. Later Gu Zhang formulas also show efficacy. Only when Zang-Fu Qi is exhausted, arms thin, umbilicus protruding, palms and back flat/full, green veins encircling abdomen—all appearing together—is it incurable. Ge Syndrome results from Liver Fire invading Stomach, Wood insulting Earth, termed Robber Evil. Epigastric region becomes withered, ceasing function. Only a tiny aperture remains, blocked by Phlegm-Saliva and Blood Stasis, preventing food descent. Even forced ingestion leads to vomiting. Life depends on diet. The Classic says: Grain enters Stomach, transmits to Lung, nourishing all Zang-Fu. Now food does not enter, so all Zang-Fu exhaust. Those with this syndrome, if accepting minimal grain, die within a year; if none, within half a year. Illnesses starting in Spring die in Autumn; starting in Autumn die in Spring, times of Metal-Wood conflict. Sudden vomiting, intermittent vomiting, or in youth, is Fanwei (Regurgitation), not Ge Syndrome, which is treatable. Conditions resembling Gu Zhang, like Edema, may require acupuncture or purgation. Symptoms vary, treatments change infinitely. Physicians should seek diverse methods and apply them appropriately.