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Case 2: The course of the disease was slightly shorter. Treatment with a modified version of *Fuling Guizhi Gancao Dazao Tang* (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) resulted in stabilization after 3 doses and cure after 5 doses. In treating Ben Tun Qi (a syndrome characterized by the sensation of gas rushing upward from the lower abdomen to the chest and throat), accurate pattern differentiation is key. Generally, for deep-seated cold and chronic cold conditions, only large, acrid, and hot herbs such as Fuzi (Prepared Aconite Root) and Rougui (Cinnamon Bark) can be effective.

(28) Fan Wei (Regurgitation/Vomiting undigested food)

Patient Xie XX, Female, 55 years old, Hospital No. 763221. First visit date: September 31, 1976 [Note: Date error in original text]. History of gastric disease for over ten years; no recurrence in the past month. Pain in the middle abdomen, tenderness upon pressure. For the past three days, vomiting of food, phlegm-fluids, and acid water occurred two hours after meals. Stool was dry and difficult to pass. Back felt cold, mouth was dry, pulse was thin, anterior part of the tongue was red, and the root of the tongue had a greasy coating. Pattern Differentiation: Failure of the Stomach to descend properly, retention of Phlegm-Fluids internally, Liver Heat attacking due to deficiency, dampness accumulating in the lower jiao leading to upward surging of Qi. Therapeutic Method: Initially prescribe a method to clear Liver Heat, resolve Phlegm-Fluids, and promote purgation. Prescription: Jiang Chuan Lian (Ginger-processed Coptis Rhizome) 2.4g, Chao Wu Yu (Stir-fried Evodia Fruit) 1.5g, Chao Huang Qin (Stir-fried Scutellaria Root) 4.5g, Zhi Shi 12g, Zhi Ban Xia (Processed Pinellia Tuber) 9g, Fang Ji 12g, Jiao Mu 6g, Sheng Da Huang (Raw Rhubarb Rhizome) 4.5g, Duan Wa Leng (Calcined Arca Shell) 30g (decocted first).

October 4 (Second Visit): Stool became soft, abdominal pain ceased, slight discomfort remained, vomiting improved, appetite returned, and the greasy coating at the root of the tongue gradually dissipated. Liver Heat decreased, Phlegm-Fluids were discharged downward, and obstruction showed signs of relief. Continue with the previous method. Original prescription, 3 doses.

October 7 (Third Visit): Bowel movements normalized, vomiting did not recur, appetite increased, no discomfort after eating. Only excessive clear saliva in the mouth and occasional lower abdominal distension. Pulse thin, tongue red but mouth not dry. The condition of Fan Wei shows signs of recovery. Prescribe a method to harmonize the Stomach, resolve Phlegm-Fluids, and regulate Qi for consolidation. Chao Huang Lian (Stir-fried Coptis Rhizome) 1.8g, Chao Wu Yu (Stir-fried Evodia Fruit) 0.9g, Chuan Shi Hu (Dendrobium Officinale Stem) 12g, Fu Ling 12g, Fang Ji 12g, Jiao Mu 6g, Zhi Ban Xia (Processed Pinellia Tuber) 9g, Chao Zhi Ke (Stir-fried Aurantium Fruit) 9g, Da Fu Pi 12g, Fo Shou Pian (Buddha's Hand Slices) 4.5g. 7 doses.

(From *Zhang Boyu Medical Cases*)

[Commentary] Fan Wei refers to a syndrome where food enters the stomach, fails to digest, and is eventually vomited out completely. It is often caused by Qi stagnation, accumulation, blood stasis, consumption of raw/cold/alcoholic foods, or depletion of Stomach Yin and Spleen-Kidney Yang, leading to failure of the Stomach to descend, hence "food enters and is thrown up." Although ancients stated "food entering and being thrown out indicates lack of Fire," clinical observations show distinctions between deficiency/excess and cold/heat. This case was diagnosed with pyloric obstruction in Western medicine, consistent with the TCM syndrome of Fan Wei. Symptoms included abdominal pain, vomiting two hours after eating, and dry stool. The pattern is failure of Stomach descent, with food and Phlegm-Fluids obstructing the middle jiao, accompanied by vomiting acid water and a red tongue, indicating Liver Heat invading the Stomach. Thus, Zuo Jin Wan (Left Metal Pill) was used to open with acridity and descend with bitterness to clear Liver Heat and harmonize the Stomach. Additionally, Fang Ji, Jiao Mu, Fu Ling, and Huang Qin were used for their acrid-bitter purgative action to restore Stomach descent and achieve cure.

(29) E Ni (Hiccup)

Case 1: Wang XX, Male, 31 years old. Continuous hiccups for eight days. Constipation for several days; previous bowel movement was dry, causing anal pain and significant bleeding. A拳-sized mass rose on the right side of the umbilicus, accompanied by epigastric pain. Xuan Fu Hua (Inula Flower) 9g, Dai Zhe Shi (Magnetite) 9g, Gong Ding Xiang (Sichuan Clove) 3g, Da Huang (Rhubarb Rhizome) 6g, Mang Xiao (Mirabilite) 9g, Shi Di (Persimmon Calyx) 5 pieces.

Follow-up: After one dose, hiccups stopped. Epigastric pain reduced today. Bowel movements three to four times, with slight tenesmus. Chuan Pu (Magnolia Bark) 9g, Chuan Lian (Coptis Rhizome) 3g, Guang Mu Xiang (Vetiver Root) 3g, Chen Pi (Citrus Peel) 6g, Huang Qin (Scutellaria Root) 6g. Two doses, then discontinue treatment. (From Jiang Chunhua Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 4:56, 1959)

Case 2: Shao XX, Male, 63 years old. First visit date: July 11, 1952. Food does not digest after entering the stomach; hiccups occur intermittently, causing pain due to stagnation, which intensifies after entering the abdomen. This is due to disharmony between the Liver and Spleen, with both Qi and Food stagnation. Having persisted for over a month, it is urgent to harmonize and resolve, preventing progression to Ge Zheng (Obstruction Syndrome). Kong Sha Shen (Adenophora Root) 12g, Jiao Dong Zhu (Charred Atractylodes Macrocephala Rhizome) 9g, Chao Zhi Ke (Stir-fried Aurantium Fruit) 9g, Lian Shui Shao Chuan Pu (Magnolia Bark boiled in water) 3g, Huang Yu Jin (Turmeric Tuber) 9g, Zhi Ru He Mo (Processed Frankincense and Myrrh) each 9g, Chen Xiang Qu (Aquilaria Fermented Mass) 9g, Sheng Shu Dao Ya (Raw and Fried Rice Sprouts) each 9g, Fo Shou Pian (Buddha's Hand Slices) 9g, Jiao Ji Jin (Charred Chicken Gizzard Lining) 9g, Bai Kou Ren (White Cardamom Seed) 9g, Gan Cao Shao (Licorice Tip) 6g, Xian He Geng (Fresh Lotus Stem) 1 chi, Sheng Bi Qi (Raw Water Chestnut) 3 pieces, crushed.

July 13 (Second Visit): Abdominal pain cured, but hiccups persist. Swallowing causes slight pain in the stomach. Liver and Stomach are not yet harmonized; continue according to the previous method. Nan Sha Shen (Adenophora Root) 12g, Wu Wei Bing Lang (Areca Nut with Areca Seed) 9g, Yu Jin (Curcuma Tuber) 9g, Chao Zhi Ke (Stir-fried Aurantium Fruit) 9g, Jiao Ji Jin (Charred Chicken Gizzard Lining) 9g, Fo Shou Pian (Buddha's Hand Slices) 9g, Kou Ren (Cardamom Seed) 6g, Liu Shen Qu (Six-Ingredient Fermented Mass) 9g, Chao Dao Ya (Stir-fried Rice Sprouts) 9g, Tu Chao Hang Shao (Earth-stir-fried White Peony Root) 9g, Gan Cao (Licorice Root) 3g, Xian He Geng (Fresh Lotus Stem) 1 chi.

July 18 (Third Visit): Patient reports feeling safe with medication, but cannot sleep flat; lying down causes a blocking sensation in the stomach and blocked Qi. Both Qi and Food stagnation have not resolved; continue according to the previous method. Kong Sha Shen (Adenophora Root) 12g, Jiang Chuan Pu (Ginger-processed Magnolia Bark) 3g, Liu Shen Qu (Six-Ingredient Fermented Mass) 9g, Shan Zha Tan (Charred Hawthorn Fruit) 9g, Wu Wei Bing Lang (Areca Nut with Areca Seed) 9g, Yan Sha Ren (Salt-processed Amomum Fruit) 6g, Qing Mu Xiang (Vetiver Root) 6g, Chao Dao Ya (Stir-fried Rice Sprouts) 9g, Huang Yu Jin (Turmeric Tuber) 6g, Huo Xiang Geng (Pogostemon Stem) 6g, Jiao Ji Jin (Charred Chicken Gizzard Lining) 9g, Fo Shou Pian (Buddha's Hand Slices) 9g, Xian He Geng (Fresh Lotus Stem) 1 chi.

July 22 (Fourth Visit): Condition lightened after medication, but relapsed suddenly due to fatigue. Blocking sensation and pain in the stomach worsened. Still treat based on the root cause. Kong Sha Shen (Adenophora Root) 9g, Ku Jie Geng (Bitter Platycodon Root) 9g, Chen Xiang Qu (Aquilaria Fermented Mass) 9g, Zhen Yu Jin (True Curcuma Tuber) 9g, Guang Mu Xiang (Vetiver Root) 6g, Yan Sha Ren (Salt-processed Amomum Fruit) 6g, Chuan Niu Xi (Cyathula Root) 9g, Kou Ren (Cardamom Seed) 3g, Hua Bing Lang (Flowered Areca Nut) 9g, Shou Wu Teng (Polygonum Vine) 12g, Chao Dao Ya (Stir-fried Rice Sprouts) 9g, Gan Cao Shao (Licorice Tip) 3g, Xian He Geng (Fresh Lotus Stem) 1 chi.

August 1 (Fifth Visit): Food regurgitates and vomits after entering the stomach; abdominal pain persists, worsening at night during sleep. Intestine and Spleen disharmony causes intermittent onset; still treat based on the root cause. Nan Sha Shen (Adenophora Root) 12g, Lian Shui Chao Chuan Pu (Magnolia Bark stir-fried with water) 3g, Liu Shen Qu (Six-Ingredient Fermented Mass) 9g, Jiao Ji Jin (Charred Chicken Gizzard Lining) 9g, Fo Shou Pian (Buddha's Hand Slices) 9g, Sheng Shu Dao Ya (Raw and Fried Rice Sprouts) each 9g, Chuan Huang Lian (Coptis Rhizome) and Mu Xiang (Vetiver Root) each 1.5g, Zhi Ru He Mo (Processed Frankincense and Myrrh) each 6g, Yan Sha Ren (Salt-processed Amomum Fruit) 6g, Wu Wei Bing Lang (Areca Nut with Areca Seed) 9g, Ling Ci Shi (Magnetite) 12g (decocted first), Chi Shao Yao (Red Peony Root) 9g, Sheng He Geng (Fresh Lotus Stem) 1 chi.

August 4 (Sixth Visit): All conditions lightened, but stomach feels dull and unopen, food stagnation not resolved. Food tends to accumulate in the epigastrium after swallowing, causing distension and pain. Treat based on the root cause. Kong Sha Shen (Adenophora Root) 12g, Huang Yu Jin (Turmeric Tuber) 9g, Chen Xiang (Aquilaria Wood) 9g, Yan Sha Ren (Salt-processed Amomum Fruit) 9g, Fu Chao Ji Shi (Bran-stir-fried Aurantium Fruit) 6g, Jiao Ji Jin (Charred Chicken Gizzard Lining) 9g, Chao Dao Ya (Stir-fried Rice Sprouts) 12g, Fu Pi (Areca Pericarp) 9g, Yan Chao Bing Lang (Salt-stir-fried Areca Nut) 9g, Ku Xing Ren (Bitter Apricot Seed) 9g, Guang Mu Xiang (Vetiver Root) 9g, Pi Fu Ling (Poria with Brown Skin) 12g, Fo Shou Pian (Buddha's Hand Slices) 9g, Gan Ou Jie (Dried Lotus Rhizome Node) 5 pieces.

August 7 (Seventh Visit): All conditions cured, but still vomiting phlegm-fluids; without vomiting, hiccups surge upward causing discomfort. Stomach Heat and Spleen Dampness; treat based on the root cause. Nan Sha Shen (Adenophora Root) 12g, Jiao Dong Zhu (Charred Atractylodes Macrocephala Rhizome) 9g, Chao Zhi Ke (Stir-fried Aurantium Fruit) 9g, Bai Kou Ren (White Cardamom Seed) 9g, Huang Yu Jin (Turmeric Tuber) 9g, Lian Shui Chao Chuan Pu (Magnolia Bark stir-fried with water) 3g, Jiu Huang Qin (Wine-processed Scutellaria Root) 9g, Liu Shen Qu (Six-Ingredient Fermented Mass) 9g, Wu Wei Bing Lang (Areca Nut with Areca Seed) 9g, Qing Zhu Ru (Green Bamboo Shavings) 9g, Yan Sha Ren (Salt-processed Amomum Fruit) 6g, Gan Cao Shao (Licorice Tip) 6g, Sheng He Ye (Fresh Lotus Leaf) 1 corner with stem 5 cun. (Organized by Zhang Shaozhong: Xiao Longyou Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 2:115, 1958)

[Commentary] E Ni refers to a syndrome characterized by upward surging of Qi, continuous hiccup sounds, and inability to control oneself. It generally resolves spontaneously, but can persist continuously for days or even half a month.

Case 1: Hiccups continuous for over a week, constipation for several days. Pattern: Stomach Qi reversing upward, Fu-organ Qi blocked. Used Xuan Fu Hua, Dai Zhe Shi, Ding Xiang, and Shi Di to descend rebellious Qi; Da Huang, Chuan Pu, and Mang Xiao to unblock Fu-organ Qi. Cured in one dose.

Case 2: Pattern: Liver-Spleen disharmony, Qi and Food stagnation causing abdominal pain and hiccups. Dr. Xiao repeatedly emphasized "still treat based on the root cause." What is the root here? Qi and Food stagnation, with disharmony among the Liver, Spleen, and Stomach, is the root. Qi stagnation causes pain; Qi reversal causes hiccups. Regulating Qi and resolving stagnation is the method to treat the root. When Qi flows smoothly and stagnation clears, abdominal pain and hiccups will subside.

(30) Ou Tu (Vomiting)

Case 1: Tong XX, Female, 35 years old. Vomiting incessantly while waiting, hair disheveled, beating chest, face red, thick greasy tongue coating white turning yellow. Complained of difficulty in the chest, feeling like burning, with Qi surging upward. Chai Hu (Bupleurum Root) 9g, Zhu Li (Bamboo Sap) 30g, Fu Ling (Poria) 9g, Zhen Zhu Mu (Pearl Shell) 30g, Qing Pi (Aurantium Peel) 6g, Chuan Lian (Coptis Rhizome) 2.4g, Su Zi (Perilla Fruit) 9g, Bai Shao (White Peony Root) 9g, Gou Teng (Uncaria Tendril) 9g, Gua Lou Pi (Trichosanthes Peel) 9g, Gui Zhi (Cinnamon Twig) 3g.

Follow-up: After one dose, symptoms disappeared completely; patient seemed like a different person yesterday and today. Tongue still has white greasy coating, chest feels stuffy. Chai Hu (Bupleurum Root) 9g, Bai Shao (White Peony Root) 9g, Su Zi (Perilla Fruit) 9g, Gui Zhi (Cinnamon Twig) 6g, Guang Yu Jin (Curcuma Tuber) 9g, Chen Pi (Citrus Peel) 6g, Fu Ling (Poria) 9g, Gua Lou Pi (Trichosanthes Peel) 9g, Xiang Fu (Cyperus Rhizome) 6g. After 3 doses, no recurrence, discontinue treatment. (From Jiang Chunhua Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 4:56, 1959)

Case 2: Zheng XX, Male, 32 years old. First visit date: March 21, 1964. For two years, experienced occasional morning-for-evening vomiting or evening-for-morning vomiting. Recently attacks more frequent, vomiting once every one or two days. Besides food, large amounts of acid water are vomited. Usually tasteless in mouth, epigastric fullness after eating, depression and discomfort, heartburn, lower back pain, extremities cool. Bowel movements acceptable, urine clear and long, frequency increased. Complexion normal, lips red, tongue body red, coating thin white and slippery, pulse deep, thin, and weak. X-ray fluoroscopy reported gastric ptosis of 4 cm.

This case presents mouth blandness, epigastric distension, cool extremities, clear and frequent urination, and deep thin weak pulse, indicating a picture of Cold. Treatment should warm and tonify Middle Yang. However, red lips and tongue body, vomiting much acid water, and heartburn indicate internal郁 Fire. Overall, this is due to Spleen-Kidney Deficiency Cold with Heat in the Diaphragm, forming a pattern of Upper Heat and Lower Cold, with both Excess and Deficiency present. Lower Cold should be warmed, Upper Heat should be cleared. Initially use a modified Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) to harmonize. Bai Pi Shen (White Skin Ginseng) and Zhu Ban Xia (Boiled Pinellia Tuber) each 9g, Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), Gan Jiang (Dried Ginger), Wu Zhu Yu (Evodia Fruit) each 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g, Da Zao (Jujube) 3 pieces. Take continuously for 4 doses.

April 9: Since treatment, only mild vomiting twice, vomitus was clear water and phlegm-fluids, mixed with a little rice, no sour smell, heartburn removed. But clear saliva occasionally surges, extremities remain cool, bowel movements normal, urine still clear, long, and frequent. Lips and tongue color normal, coating thin white and slippery. Upper Heat cleared, now focus on warming Middle and Lower Jiao. Po Gu Zhi (Psoralea Fruit), Chao Bai Zhu (Stir-fried Atractylodes Rhizome), Tu Si Zi (Cuscuta Seed) each 9g, Wu Zhu Yu (Evodia Fruit), Wei Rou Dou (Nutmeg baked) each 4.5g, Gan Jiang (Dried Ginger), Zhi Gan Cao (Honey-fried Licorice Root) each 3g, Ming Dang Shen (Codonopsis Root) 15g, Sheng Jiang (Fresh Ginger) 6g. Take for 5 doses.

April 29: Vomited water three times in the past half month, none mixed with food. Other symptoms same as last time. Continuous warming of the Middle yielded little effect because the power to benefit Fire was insufficient. Use a modified Gui Fu Li Zhong Tang (Cinnamon, Aconite, and Gastrodia-Licorice-Centralizing Decoction). Zhi Chuan Wu (Processed Sichuan Aconite Child Root), Chao Bai Zhu (Stir-fried Atractylodes Rhizome), Bu Gu Zhi (Psoralea Fruit), Zhu Ban Xia (Boiled Pinellia Tuber) each 9g, Bai Bai Shen (White Sun-dried Ginseng), Wei Rou Dou (Nutmeg baked), Gan Jiang (Dried Ginger), Zhi Gan Cao (Honey-fried Licorice Root) each 6g, Rou Gui (Cinnamon Bark) 1.2g (powdered and taken with decoction). In the prescription, Chuan Wu is decocted first with Gan Jiang and Zhi Gan Cao for one hour, then other herbs are added. One dose every three days, taken continuously for 10 doses. All symptoms basically disappeared. Follow-up for three months, symptoms basically controlled. (Yu Changrong, *Understanding and Practice of the Rule of Benefiting Fire to Generate Earth*, *Chinese Journal of Traditional Medical Science and Technology* 11:25, 1964)

[Commentary] Ou Tu refers to a syndrome caused by failure of the Stomach to descend and Qi reversing upward. Etiologies include external pathogens, overeating, emotional frustration, or damage to Stomach Yin after febrile diseases, all of which can injure the Stomach and cause vomiting.

Case 1: Qi surging upward, incessant vomiting, red face, thick coating, chest feeling like burning, indicating Stomach Heat. Treatment: Soothe Qi, descend rebellion, clear Stomach Heat, stop vomiting. Cured in one dose. Later consolidated with Qi-regulating and Liver-soothing methods.

Case 2: Upper Heat and Lower Cold, Excess and Deficiency combined. Initially used modified Ban Xia Xie Xin Tang to harmonize Stomach, descend rebellion, open knots, and remove fullness, focusing on clearing Upper and warming Lower. Later focused solely on warming Middle and Lower Jiao using modified Gui Fu Li Zhong Tang to benefit Fire and generate Earth, warming Kidney and strengthening Spleen, while harmonizing the Middle. All conditions cured. This case treats sequentially, balancing Excess and Deficiency, showing great insight into the application of the "Benefit Fire to Generate Earth" method.

Swelling also decreased, diet gradually increased, pulse remained as before. Continue with previous method. Prescription: Hai Piao Xiao (Cuttlefish Bone) 9g, Jian Bei (Fritillaria Bulb) 6g, E Jiao Zhu (Donkey-hide Gelatin Pearl) 9g, Bai Ji (Bletilla Rhizome) 9g, Wa Leng Zi (Arca Shell) 9g, Mu Li (Oyster Shell) 9g, Sha Shen (Glehnia Root) 9g, Huai Shan Yao (Chinese Yam) 12g, Shi Hu (Dendrobium Stem) 9g, Yu Zhu (Polygonatum Odoratum Rhizome) 9g, Sheng Di (Rehmannia Root) 9g, Mai Dong (Ophiopogon Tuber) 9g, Ji Nei Jin (Chicken Gizzard Lining) 6g, Fu Shen (Poria with Pine Root) 9g, Gan Cao (Licorice Root) 3g. After taking 10 doses of the above prescription, basically returned to normal. (Organized by Li Kegan: Two Cases of Li Sichi, *New Medicine Magazine* 7:22, 1978)

Case 4: Lv XX, Female, age unspecified. Correspondence first visit date: August 31, 1975. Patient had 6 pregnancies between 1960 and 1968, with 5 abortions and 1 full-term delivery. Starting autumn/winter 1969, menstrual irregularities began, followed by sudden amenorrhea, decreased libido, aversion to cold, general weakness, somnolence, poor memory, emotional apathy, slow reaction to surroundings, fear of cold, excessive sweating, lower back and spine pain, generalized muscle and joint soreness, obvious swelling of face and hands that rebounds immediately upon pressure, weight increased from 120 jin to 140 jin, hair loss, sparse eyebrows, palpitations and hidden pain in precordial area, chest tightness, slow pulse rate, high blood pressure, poor appetite, postprandial abdominal distension, loose stools, low urine output, basal metabolic rate below normal. Diagnosed with "Hypothyroidism." Maintained on Thyroxine tablets 90mg daily for three years. Tongue body pale and fat, coating white, moist, and thick, pulse deep, slow, and thin. Pattern Differentiation: Originating from multiple abortions, damaging Chong and Ren vessels, depleting Ying Blood, and severely weakening Spleen-Kidney Yang Qi. Therapeutic Method: Secure Chong and Ren, regulate Qi and Blood, support Spleen and warm Kidney. Prescription: (1) Formula: Huang Qi (Astragalus Root) 30g, Dang Shen (Codonopsis Root) 18g, Bai Zhu (Atractylodes Rhizome) 24g, Dang Gui (Angelica Sinensis Root) 12g, Zhi Gan Cao (Honey-fried Licorice Root), Chai Hu (Bupleurum Root), Sheng Ma (Cimicifuga Rhizome) each 6g, Ba Ji Tian (Morinda Root), Qi Zi (Goji Berry) each 9g, Chen Pi (Citrus Peel) 3g. (2) Formula: Huang Qi (Astragalus Root) 18g, Fu Ling (Poria) 30g, Bai Zhu (Atractylodes Rhizome), Shou Wu (Polygonum Multiflorum Root) each 24g, Ze Xie (Alisma Rhizome), Gui Zhi (Cinnamon Twig), Shan Yao (Chinese Yam), Yin Yang Huo (Epimedium Leaf) each 9g, Tu Si Zi (Cuscuta Seed) 12g. Alternate formulas: (1) for 3 days, (2) for 1 day. After over 20 days of treatment, spirit improved, appetite increased, stools formed, swelling of face and limbs, back pain, and fear of cold all alleviated. Continued with modifications of the above formula for nearly one year (sometimes self-administered thyroid hormone tablets, not exceeding 30mg daily), resumed full-time work, continued medication for consolidation. (Prescribed by Deng Tietao, Organized by Zhao Licheng et al.: *Chronic Kidney Yang Deficiency Edema (Hypothyroidism)*, *Zhejiang Journal of Traditional Chinese Medicine*: 363, 1980)

Case 5: Hu Zuo, June 10. Just reached adulthood (weak crown), chest and epigastrium feel narrow and constricted, phlegm-fluids often stagnant, coughing fits easily arise, tongue coating sticky and not transforming, frequent seminal emission, initially with dreams then without, emaciated body, depleted spirit, Heart and Kidney deficient, Ministerial Fire not concealed, Lung has Phlegm-Dampness. Not suitable for biased tonification; use pill formula for slow regulation. Da Shu Di (Prepared Rehmannia Root) 150g, Duan Mu Li (Calcined Oyster Shell) 150g, Hei Liao Dou (Black Soybean) 120g, Nu Zhen Zi (Ligustrum Fruit) 30g, Fen Dan Pi (Moutan Cortex) 45g, Chuan Huang Bo (Phellodendron Bark) 45g, Jian Ze Xie (Alisma Rhizome) 60g (salt-stir-fried), Che Qian Zi (Plantago Seed) 90g (salt-stir-fried), Yun Fu Ling (Poria) 60g, Jiao Bai Zhu (Charred Atractylodes Rhizome) 60g, Tu Si Zi (Cuscuta Seed) 120g, Bao Mu Fu Shen (Poria wrapped in pine root) 60g, Xiang Lian Zi (Lotus Seed with plumule) 150g. Grind all herbs into fine powder, use Fei Yu Zhu (Polygonatum Odoratum Rhizome) 60g decoction to form pills. Size of Sophora seeds, take 9g nightly with light salt water. (Introduced by Zhang Zanchen: "Introduction to Mr. Xie Liheng's Medical Experience," *Shanghai Journal of Traditional Chinese Medicine* 10:16, 1964)

[Commentary] Xu Sun refers to the general term for various chronic diseases caused by organ depletion and Yuan Qi weakness. Whether due to congenital insufficiency, acquired imbalance, prolonged illness neglecting nourishment, or accumulated labor and internal injury, gradually leading to Yuan Qi depletion manifesting as various deficiency patterns. During pattern differentiation, distinguish whether Yin, Yang, Qi, or Blood is deficient, and follow principles such as "Deficiency requires tonification" and "Depletion requires benefit" for regulation and treatment.

Case 1: Pattern: Congenital insufficiency affecting acquired constitution, leading to Spleen-Stomach deficiency. Treated with Zi Sheng Wan. The original formula was created by Miu Zhongchun by modifying Shen Ling Bai Zhu San from *He Ji Ju Fang* (Formulas of the Imperial Pharmacy Bureau). Focuses on tonification assisted by regulation, with compatible compatibility and appropriate balance of tonifying and unblocking.

Case 2: Pattern: Yin-Blood deficiency, Ying-Blood heat and dryness. Administered agents to moisten fluids, nourish Yin, cool Ying, and moisten dryness. The prescription was unremarkable but highly effective.

Case 3: Originated after massive blood loss. Although abdominal pain was seen, it was not due to Qi stagnation and Cold coagulation, but rather Stomach Yin deficiency. Physicians often overlook this, frequently prescribing acrid-warming Qi-regulating and pain-relieving agents for stomach diseases, which反而 makes abdominal pain worse. Reading this case carefully serves as a warning.

Case 4 and Case 2: Although Western diagnoses are the same, TCM pattern differentiation differs. Treatment supports Spleen, warms Kidney, secures Chong-Ren, and regulates Qi-Blood. Formulas (1) and (2) have different focuses. Formula (1) leans towards strengthening Spleen and caring for Kidney; Formula (2) leans towards warming Kidney and caring for Spleen. Alternating (1) and (2) provides tonification without dryness, suitable for long-term use. The prescription is stable; acting too hastily may lead to failure.

Case 5: Chronic deficiency treated with pill formula for slow results. Herbs in the formula have tonifying effects without dryness hazards. Prescription and herb selection are well-measured.

(10) Nu Xue (Epistaxis/Nosebleed)

Case 1: Song X, 47 years old, Male. Headache, dizziness, dry and hot sensation in mouth, occasional nose and gum bleeding for one year. Face red, blood pressure gradually increasing (from 80/60 to 130/100 mmHg). Tongue body purple-dark, coating yellow-brown thick and greasy, pulse deep, wiry, and rapid. Blood test: RBC 6.13 million/mm³, Hemoglobin 20.5g, bone marrow image significantly hyperplastic. Diagnosed with Polycythemia Vera. Pattern Differentiation: Liver Heat surging upward, Blood Stasis stagnating internally. Therapeutic Method: Clear Liver, cool Blood, transform Stasis, eliminate stagnation. Prescription: Long Dan Cao (Gentian Root) 15g, Huang Qin (Scutellaria Root) 15g, Ze Xie (Alisma Rhizome) 15g, Chuan Xiong (Ligusticum Rhizome) 15g, Ou Jie (Lotus Rhizome Node) 30g, Bai Mao Gen (Imperata Rhizome) 30g, Ji Xue Teng (Spatholobus Stem) 30g, Shan Zhi (Gardenia Fruit) 9g, Tao Ren (Peach Seed) 9g, Hong Hua (Carthamus Flower) 9g, San Leng (Burreed Tuber) 18g, E Zhu (Curcuma Tuber) 18g, Yin Chai Hu (Stellaria Root) 12g, Yin Hua (Honeysuckle Flower) 20g, Dan Pi (Moutan Cortex) 5g, Lu Hui (Aloe) 2g, Qing Dai (Indigo Naturalis) 3g (taken with decoction). Taken continuously for 23 doses. Headache and dizziness significantly reduced, bleeding stopped, blood pressure dropped to 99/60 mmHg, RBC dropped to 4.9 million, Hemoglobin dropped to 17.9g. However, loose stools and fatigue appeared, pulse turned deep and thin. Reduce Long Dan Cao and remove Lu Hui from previous prescription, continue for 3 months. Symptoms disappeared, blood count and blood pressure maintained within normal range. (Prescribed by Guo Shikui, Organized by Weng Weiliang et al.: *Curing Polycythemia Vera with Clearing Liver and Resolving Stagnation Method*, *Zhejiang Journal of Traditional Chinese Medicine*: 38, 1980)