Library

In the early spring of the Jia Shen year, Lian Xiangwu was over fifty years old. He usually had many concubines and managed salt affairs outside, leading to a deficiency of both Heart and Kidney (Zang-Fu organs). He presented with fever, coughing up phlegm, impotence, weakness in the legs, redness of the cheeks, emaciation, constipation, and clear urination. The pulse on the left side was floating, slow, and powerless; the right side was also surging and irregular. Previous physicians treated him with herbs such as Jundonghua (Dendranthema Flos), Maidong (Ophiopogonis Radix), Juhong (Citri Reticulatae Pericarpium), Shihu (Dendrobii Caulis), and Beimu (Fritillariae Bulbus). He coughed up more than ten bowls of phlegm daily. His fatigue worsened. I said this resulted from indulgence in sexual activities, causing long-term depletion of essence and blood, leading to gradual illness. His cough and fever were due to the withering of Kidney Water (Yin fluid), failing to control Fire, which rose to attack Lung Metal. As for the phlegm, it was Kidney fluid surging upward and failing to distribute, not originating from the Spleen. Red cheeks indicated Fire scorching the Lungs manifesting externally; emaciation indicated Spleen Qi decline, where Fire fails to generate Earth. The floating and slow pulses of Liver and Kidney indicated being controlled by Metal and Earth, suggesting an unfavorable prognosis. However, since Stomach Qi was not yet exhausted and appetite remained normal, there was still hope. But strict administration of over two hundred doses was required for effect. The method required strengthening the Master of Water to control Solar Fire. We used Liuwei Wan (Six-Ingredient Pill with Rehmannia), removing Zexie (Alismatis Rhizoma) and adding Renshen (Ginseng Radix et Rhizoma), Guijiao (Colla Testudinis), and Zhigancao (Prepared Licorice Root). After a few days, cough and phlegm decreased significantly, down to about one bowl per day, and fatigue lessened. By forty-plus doses, the condition neither improved nor worsened. I said this is like pouring a cup of water on a cartload of burning firewood; how can it be cured suddenly? One must persist with long-term medication. Once the medicinal power is sufficient, the pathogen will naturally resolve. He did not believe me and consulted other physicians who confidently claimed cure within ten doses. After just two doses, he vomited phlegm profusely and experienced chest oppression. Examination revealed they used Qiongyu Gao (Jade Essence Paste), mostly sweet-cold herbs clearing Fire. Only then did he believe my words and re-hire me. I said this case had entered a fatal stage; initially sustained by a thread of innate Stomach Qi, now ruined by cold-natured agents, Earth Qi is nearly extinct, and nothing can be done. He would die in autumn. I declined treatment. Others invited Zhang Mingqing. Zhang told Lian: "All phlegm belongs to the Spleen, not the Kidney." He was puzzled by my novel theory of "phlegm in the Kidney Meridian." Lian showed him medical cases from Li Zai (Xue Ji), after which Zhang ceased arguing but criticized: "If following Li Zai's method for consumptive disease, it should be ineffective." I retorted: "Even relying on Danxi's theories has faults." Zhang only prescribed Si Jun Zi San (Four Gentlemen Powder) type formulas. Knowing the patient was near death and difficult to revive, I noted that Li Zai's methods were superior and should not be lightly disparaged. Xiangwu indeed died on August 14th. I recorded the details for those suffering similarly and appended Li Zai's verified cases for Yin deficiency below.

Li Zai stated: In analyzing consumptive diseases, if Kidney Yin essence is insufficient, Yang lacks transformation, and deficient Fire moves recklessly causing previous symptoms, use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify, so that when Yin prospers, Yang transforms. If Spleen deficiency fails to generate Kidney, resulting in dual deficiency of Yin and Yang, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan to nourish Yuan Qi and moisten Kidney Water. If Yin-Yang collaterals are injured, and blood follows Qi flooding outward causing various hemorrhagic conditions, use Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelicae Sinensis Radix) to purely tonify Spleen Qi to guide blood back into its vessels. Furthermore, young men who excessively indulge in sexual desire often first present with tidal fever, night sweats, cough, and fatigue. This belongs to deficiency of the Foot Three Yin meridians, characterized by deficient heat without true fire, manifesting as daytime onset with nighttime cessation or vice versa, occurring intermittently. Use Liuwei Wan as the main formula, regulating and tonifying the Spleen and Stomach with Buzhong Yiqi Tang. If Spleen-Stomach damage precedes, prioritize Buzhong Yiqi Tang and use Liuwei Wan to gently preserve Liver-Kidney. Many recover. Misusing Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) damages Spleen-Stomach further, reducing intake, weakening all Zang-Fu, sinking Yuan Qi, causing abdominal distension and diarrhea, which becomes incurable. Regarding Zhang Biya, whose red face, thirst, copious phlegm, and dizziness were caused by Kidney deficiency allowing Water to flood, Liuwei Wan cured him. For deficient Fire flaring upward due to Kidney Yin deficiency, use Liuwei Wan; for Cold-phlegm surging due to Kidney Qi deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill); for hemoptysis/phlegm-blood due to Liver-Kidney Yin deficiency, use Liuwei Wan; for turbid phlegm due to Kidney Qi failure descending fluids, representing True Zang pathology, use Liuwei Wan primarily. Strengthening Kidney Qi clarifies fluids, eliminating phlegm. Generally, tidal fever, general fever, or afternoon fever indicates simultaneous damage to Five Zang organs, treat with Liuwei Wan; Qi-Blood deficiency requires Shiquan Dabu Tang (Perfect Golden Great Tonification Decoction). Regarding Li Bei quan, who spat saliva, felt internal heat/thirst, fatigue, and hot feet upon exertion, Qingqi Huatan Tang worsened his condition. I diagnosed Kidney Water flooding creating phlegm and advised tonifying Kidney. He refused, taking Tansui Wan (Phlegm-Rolling Pill), resulting in vomiting/diarrhea, inability to eat, dizziness, and closed eyes. Only then did he accept Liujunzi Tang (Six Gentlemen Decoction) to restore Stomach Qi, followed by Liuwei Wan for a month, curing all symptoms. Chen Daofu's eldest son suffered Kidney meridian deficiency with chronic worsening cough in the afternoon. I advised tonifying Spleen Earth to nourish the source, allowing Metal-Water mutual generation. Mengchun disagreed, using Huangbai and Zhimu. By summer, he vomited phlegm, craved water, had frequent urination, and flushed face. I prescribed Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui, Fuling (Poria), Wuweizi (Schisandrae Fructus), Chenpi (Citri Reticulatae Pericarpium), Maidong, Danpi (Moutan Cortex), and Zexie for four doses, then prepared pills with Renshen, Shudi (Rehmanniae Radix Preparata), and Shanzhuyu (Corni Fructus). Symptoms retreated. Upon follow-up, assuming compliance, I continued the prescription. He stubbornly refused, leading to death. Huang Bolin had fever, phlegm, dry mouth, and fatigue. Self-administered Buzhong Yiqi Tang failed. I diagnosed dual deficiency of Metal and Water, cured by combining Dihuang Wan. A man with inner thigh pain treated with damp-draining/phlegm-resolving herbs developed pain radiating to buttocks, red face, phlegm, and hot heels. I diagnosed deficient Fire flaring upward from Kidney deficiency and advised nourishing the source. He refused, took Huangbai/Zhimu, and died. Internal injury fever due to irregular diet or overwork depletes Yuan Qi, allowing Deficient Fire to invade Earth position, causing mild fever; treat with Buzhong Yiqi Tang to raise Yang. Fever from physical labor or excessive sex depleting essence/blood involves reckless Deficient Fire; treat with Liuwei Wan to tonify Yin. Do not mistake it for Excess Fire and use Huangbai/Zhimu. Chen Lvzhen, due to excessive sexual activity, had intermittent fever, constant drinking, spermatorrhea, and dribbling urine in winter. Using Siwu Tang with Huangqin (Scutellariae Radix) and Lianzi (Nelumbinis Semen) worsened symptoms, adding phlegm and mouth ulcers. Erchen Tang with Huangbai/Zhimu caused chest discomfort and poor appetite. Adding Zhike (Aurantii Fructus) and Xiangfu (Cyperi Rhizoma) caused abdominal distension and loose stools. Pulse was floating-large but fine-deep upon pressure. Morning: Sijunzi Tang with Shudi/Danggui. Evening: Jiaban Bawei Wan (Modified Eight-Ingredient Pill) applied with Fuzi (Aconiti Lateralis Radix Preparata) mixed with saliva to Yongquan (KI1). Gradually recovered. Later used Shiquan Dabu Tang. Constipation and lower abdominal distension indicated dry rectum, treated with pig gallbladder. Severe fatigue and sudden increase in phlegm-heat were stabilized with Danshen Tang (Single Ginseng Decoction), then cured with previous formulas. For exertional fever with floating-surge pulse, I advised careful lifestyle management, otherwise untreatable. He dismissed my advice. Relapse occurred in summer of Yi Si year; he took Siwu Tang with Huangbai/Zhimu and died. These fifteen cases summarize Mr. Li Zai's methods for treating Yin-deficiency phlegm and consumptive diseases. He sought the root and nourished the transformation source, differing greatly from ancient and modern practitioners. Those wishing to understand fully should examine complete case records.