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Li Youlan, a fellow provincial graduate, was also proficient in medical principles. In the autumn of the Xinhai year, while residing idly in the provincial capital, he contracted a painful condition. The pain occurred sometimes in the hands, sometimes in the feet, sometimes in the head, sometimes in the abdomen, sometimes in the waist, and sometimes in the hypochondrium. It had no fixed time of onset and no fixed location. He considered it to be Bi syndrome (a disease characterized by pain, numbness, heaviness, and difficulty in movement of the limbs and joints) and took Xuming Tang without effect. He then thought it was caused by cold and took Mahuang Tang, also without effect. One day, while chatting with me leisurely, he told me: "My illness is truly unfathomable." I requested to take his pulse and found it slow and sluggish. I then said to him: "Your illness is due to Damp-Phlegm flowing and accumulating (a condition caused by dampness and phlegm circulating through meridians and organs)." Before I could continue, Li Youlan suddenly realized and said: "Correct! Correct! I already knew this; you can stop here, and I will write the rest myself." We laughed together. Two days later, his illness was completely cured. When asked what medicine he had taken, Li Youlan said: "Those who understand the art do not need explicit explanations. Try to guess what medicine it was." I said: "It was nothing more than Erchen Tang added with Cangzhu, Jianghuang, Qianghuo, and Duhuo." Li Youlan showed me the prescription, which matched my description exactly. Shi Yuqin, a literary official present, sighed and said: "The two gentlemen are indeed mind-melded."

Spleen Dampness Retaining Phlegm Disturbing the Pericardium

Furthermore, Si Tu Zhilin, Prefect Fan Qinshi, was generally obese. At that time, various provinces were raising military funds, and officials and soldiers gathered in the provincial capital, while the treasury funds were insufficient. Mr. Zhi's worry was evident on his face. By summer, he developed dementia. He was restless sitting or lying down, sometimes talking to himself, and sometimes scratching his whole body. Whenever he closed his eyes, he fell asleep and dreamed of two ghosts in front of him: one was a hanged man with a rope around his neck; the other was headless, holding its head in hand, with messy hair and blurred blood. Because of this, he could not sleep alone and did not meet with subordinates for over ten days. Doctors were invited to treat him, all saying it was karmic retribution and fearing he would not survive. Another doctor was consulted, who diagnosed Heart Blood deficiency and prescribed Tianwang Buxin Dan. His food intake suddenly decreased. When the gatekeeper invited me, I entered and saw him. He said: "The illness has reached this stage, and I fear it cannot be treated. I only ask you to judge it. Which meridian is affected? You must explain in detail, do not hide or protect." Palpating his pulse, I found all six positions string-slow and slippery, with the Cun position particularly prominent upon light pressure. Knowing it was a Phlegm syndrome, I said to Mr. Zhi: "Sir, your condition is Spleen Dampness retaining Phlegm, compounded by fatigue injuring the Spleen and floating Heart Fire, causing Phlegm-fluids to surround the Pericardium Collateral. Hence, you are sometimes confused and sometimes clear. Normally, you likely enjoy spitting up phlegm, and doing so brings relief to the chest and abdomen. Now, with Phlegm-fluids stagnant and knotted, you cannot spit them up. Moreover, your occasional irritability, agitation, thirst, palpitations accompanied by trembling of the hands and feet, and occasional difficulty in urination and defecation are all caused by Phlegm." Mr. Zhi asked: "What are the two ghosts?" I replied: "The two ghosts are also caused by chaotic Shen and Hun (Spirit and Ethereal Soul). They do not actually exist; Sir need not worry excessively. Although the symptoms are complex, I guarantee a cure." Mr. Zhi happily asked: "What medicine should I take?" I said: "Sir's illness cannot be treated with decoctions alone. First, use Fanyu Wan to induce vomiting, then Kongyan Dan to drain downwards, followed by various medicines to resolve Phlegm and strengthen the Spleen, and there will be no worries." Mr. Zhi urgently requested Fanyu Wan. I said it was mostly unavailable in the market, so I prepared it and sent it to him. After taking a few pills, within a moment, he vomited sticky phlegm strands, colored greenish-black. He felt his mental state suddenly open up and wanted to take more. I said: "The Phlegm has been vomited; taking more may damage Stomach Qi." Then I administered Kongyan Dan. Two days later, he hosted a casual meal for me, leaning on a cane, and told me: "I didn't see the two ghosts for two nights, and my spirit is clear. Your high reputation is truly admirable. May I ask what illness it would have become if untreated?" I said: "If untreated, it would become either Dian syndrome (mania) or Xian syndrome (epilepsy), or severely, Tan Jue (Phlegm Jue)." His assistants came to socialize, and I returned after the meal. Not long after, I had to return home to mourn my father's death. In August, Mr. Zhi was dismissed from office due to an official money case by imperial decree. After the case was settled, his gatekeeper Huang Wu was hanged. At the moment of execution, upon hearing the news, Mr. Zhi died of Tan Jue in his residence. Later, Xiao Mei wrote to me, still recounting Mr. Zhi's death just as I had predicted.

Damp-Heat Internal Invasion Excess Syndrome Seminal Emission

Mr. Huang Gengyuan, from Jiangxi, obtained the rank of Juren and the title of Fan Si (Provincial Administration Commissioner) with a red-tasseled hat through donation for military funds, and was appointed Intendant of Xi'an Grain Transport. The position was lucrative, and his family wealth was substantial. However, the Intendant valued integrity and was lenient with subordinates, so they all praised him. Around fifty years old, he had suffered from seminal emission. With several concubines, an assistant who was skilled in medicine believed that having many concubines must cause deficiency. Sancai Fengsui Dan was used to tonify him, and the Intendant also focused on health preservation. He ate bird's nest and Dongshen daily to regulate his health, yet seminal emission continued. The assistant thought it had become Xu Lao (consumptive disease) and was incurable.

One afternoon, when there was nothing to do, he suddenly summoned me to the yamen and instructed me to dress casually. I hurried to obey. The Intendant came out in casual clothes, bowed, and invited me to the seat of honor. Surprised, I asked why. He said: "I have suffered from seminal emission for years. I have taken over a hundred doses of decoctions and several jin of pills, but with no effect." I asked about his diet. He replied: "Although I cannot eat much, I am certainly not unable to eat. The old master thinks I have consumptive disease, so I dare not eat much." I asked: "Do you have cough, shortness of breath, fever, or spontaneous sweating?" He said: "No." I then told him: "Since you lack these symptoms, I fear it is an excess syndrome, not a deficiency syndrome." The Intendant exclaimed: "Is there an excess syndrome for seminal emission?" I answered: "Sir has not studied medical books thoroughly, and combined with weak Spleen and Stomach, not only do doctors dare not diagnose excess, but you yourself suspect deficiency. However, seminal emission has several causes. If Ministerial Fire is too strong, leading to nocturnal emissions during dreams, Yang Qi is robust, and nourishment is appropriate. If rich and greasy foods cause Damp-Heat to invade internally, forcing emission, resolution and guidance are appropriate. If long abstinence leads to full Qi and overflowing essence, venting is appropriate. Additionally, sinking of Middle Qi and failure of Clear Yang to ascend can cause emission; excessive sexual desire and disharmony between Heart and Kidney can also cause emission. Fear and sudden anger can make the essence aperture slippery rather than secure, also leading to emission. If one emits essence spontaneously while sitting or lying down, it is a critical deficiency syndrome, most dangerous. Quack doctors do not carefully investigate the cause, failing to distinguish between deficiency-cold and excess-heat. Upon seeing seminal emission, they say it is due to excessive sexual desire; or that the young man loves lust. Patients often suffer unjust accusations, and treatments are mostly ineffective. They then blame the illness as incurable, is this not confusing?"

The Intendant rose abruptly and said: "Listening to your explanation, everything is precise and clear. My heart is opened. Then my seminal emission is definitely not a deficiency syndrome. Please examine me." I palpated his pulse: slow and firm, especially at the Right Guan position. I told him: "Sir's illness is what we call Damp-Heat internal invasion. You often feel stifling in the chest and diaphragm, and your stool feels heavy. Resolution and guidance are indicated. I prescribe Zhenheng Shenshi Tang." The Intendant read the prescription and feared Huanglian might not be suitable, and Houpo and Cangzhu might damage Stomach Qi. I said: "Weiling Tang is a key medicine for Damp-Heat. Pingwei San aims to cultivate the deficient Earth element to bring it to balance, not to flatten it. This was explained clearly by predecessors. Regarding the use of Huanglian and Chuanxiong in this formula, I also doubted it initially. Upon careful reflection, bitterness dries Dampness. Using Huanglian charred uses its bitterness, not its coolness. Damp-Heat can cause blood stasis; Chuanxiong moves it. Zhenheng's formula has deep meaning. Sir, if preconceptions remain in your mind, how can another mistake be tolerated? Others will surely say this is not a medicine for treating seminal emission. But treating disease requires seeking the root. If the root is treated, the branches will not remain untreatable. Rest assured and take four doses. Regularly take Xiangsha Liujun Wan to regulate. Not only will emission cease, but your appetite will also double." The Intendant followed my advice. Five days later, at dinner, he told me: "Before, I found your words reasonable but secretly doubted them. Now, after taking your medicine, emission has stopped. I truly feel increased energy and good appetite, and even my virility is strong. If not for your profound understanding, I would almost have wronged you. This shows that medical practice has no fixed formulas; it lies in investigating principles and adapting accordingly." Later, I received several letters of inquiry from him even after I returned home to mourn.

Pulse Diagnosis Like Adjudicating Cases

Ancients said using medicine is like using troops. I once said diagnosing by pulse is like adjudicating cases. The subtle meanings and profound principles have been detailed by predecessors. Only Mr. Shicai's Four-Character Key Principles are concise and appropriate. He said: "In all four seasons, the Pulse Stomach Qi is the foundation, which is the crucial point for diagnosticians." Generally, Stomach Qi is the Spirit of the pulse. What is called Spirit, described to the utmost, is summarized as "forceful." I believe the word "forceful" is not enough to exhaust the meaning of "Spirit." Forcefulness combined with mobility, neither fast nor slow, neither soft nor hard, is like the aura of weak willows in spring breeze. Based on this reference, one misses rarely. Adjudicating a case involves identifying the principal culprit, corroborating evidence, the cause of the incident, the place of harm, accomplices, and false accusations. Once the investigation is accurate, the severity of punishment follows. Taking one aspect as an example: in the syndrome of Spleen Dampness retaining Phlegm, the pulse must be Deep-Slippery. Thus, Deep-Slippy is the principal culprit. Spleen Dampness implies difficult defecation; retained Phlegm implies reduced appetite; this is corroborating evidence. If Dampness comes from excessive water intake, the pulse may additionally be String-like; if from fatigue and overthinking, it may additionally be Weak; these are causes of the incident. If Dampness causes diarrhea, or Phlegm causes cough, then in diarrhea, the Right Chi pulse must be Deficient; in cough, the Right Cun pulse is also Slippery; this is complicity. And in Spleen Dampness, dietary intake cannot be transformed effectively, leading to insufficient Jing fluids, so the Left Chi pulse must be Choppy; this is false accusation. As long as the principal culprit is identified, strengthening the Spleen and resolving Phlegm will cure the disease. If one treats diarrhea by stopping it, or cough by clearing it, one abandons the principal culprit and punishes the innocent, inevitably failing to cure the disease and instead adding other illnesses. Therefore, the use of medicine relies on dozens of ancient established formulas passed down. Whether they work or not depends not on the writer's confusion, but on the practitioner's unclear finger diagnosis.

I once said that diagnosing by pulse requires integrating the three positions and twelve zang-fu organs, referencing and deliberating, to form a definite view. If one diagnoses the Cun but forgets the Chi, or the Right but forgets the Left; if Slippery means treating Phlegm, or Rapid means removing Heat, although there may be minor effects, it is difficult to cure the disease, let alone if the investigation is unclear and efficacy is uncertain. I leave this for the discerning to deliberate.

Damp-Heat Internal Invasion Excess Syndrome Hematemesis

Mr. Wu Zhitian, from Guoxian County, served as a county magistrate in Shaanxi after passing the Jinshi examination, and was later promoted to Intendant of Yulin. Since Yulin was poor, he held the post remotely from the province. The Intendant was known for his hearty drinking and developed hematemesis due to alcohol accumulation. While I was waiting for appointment in the province, he invited me to visit him one day. Discussing his illness, he said: "I have had hematemesis for years, worsening with depression. I have seen more than ten doctors. Some said it was Spleen injury from overthinking; some said Liver injury from sudden anger; some said reckless bleeding from Blood Heat. Some were effective, others not, but the root was never removed. Please treat me." Seeing his robust physique, ruddy complexion, and hearty appetite, I knew it was not a deficiency syndrome. I diagnosed his pulse: the Left side was Deep-Firm (not pathological); the Right Guan was Deep-String-Rapid. I told him: "Sir has an excess syndrome, not a deficiency syndrome. If it were Spleen injury from overthinking, there would be palpitations, amnesia, and fright. If it were reckless bleeding from Blood Heat, there would be fever, thirst, dizziness, and vertigo. If it were Liver injury from sudden anger, there would be distension in both hypochondria, stifling in the chest and diaphragm, and vomiting. Since none of these symptoms are present, the previous doctors were mistaken. In my opinion, it must be Damp-Heat internal invasion. Heat causes blood stasis, so the vomited blood must be purple-dark and often clotted. There is often stabbing pain in the stomach area, urine is often red, stools are dry and difficult, sometimes with blood." The Intendant said: "Your words are impeccable. How should it be treated?" I said: "First, use Gegua Jieying Tang to clear the Stomach, then use Zhizhu Weiling Wan to move stasis. Regulate with a bland diet. Within a month, I guarantee no recurrence." The Intendant followed the regimen. He recovered in twenty days. Later, he returned home to mourn his father, living frugally, and taught at Xihe Academy in Fen. I also returned home to mourn. We were separated by sixty li but maintained frequent correspondence.

Spleen Deficiency Food Stagnation Irregular Menstruation

Several months later, I escorted my cousin to the prefectural examination, meeting the Intendant daily.

Regarding Ms. Ru Jun, she said: "My menses are irregular, with constant pain in the umbilical and abdominal regions, lethargy, and loss of appetite. Occasionally conceiving, I miscarry at three or four months. Previously in Guoxian, I took countless medicines. Now I have asked Professor Qi and Assistant Qian Laofu to treat me, but the illness persists. All think it is consumption. Please judge." Ms. Ru appeared simply dressed, humble and plain, and bowed to me. I returned the bow. Her pulse was Deficient in all six positions, without any Rapid signs, especially at the Right Guan. I told the Intendant: "This is a syndrome of Spleen Deficiency and Earth Decline, hence low spirit and food stagnation. As for irregular menstruation and miscarriage, it is due to the inability of Middle Qi to consolidate. It is highly treatable. However, it requires accumulation of days and months; it is not a disease curable in a day or two. If treatment is delayed, prolonged diarrhea or chronic cough with fever, red face, and aversion to cold may develop, becoming true consumption. I first prescribe Liujunzi Tang added with Yizhi, Ganjiang, and Qianshi, instructing eight doses, followed by Zisheng Jianpi Wan." The Intendant asked: "How many jin of pills should be taken?" I said: "The more, the better."

Later, I returned to Jiezhou, and the Intendant settled accounts and returned to Guoxian. Two years later, I met his eldest son in the provincial capital and asked about her previous condition. He said: "Recently, her body has become very robust. Last winter, she gave birth to a daughter. My father often mentions this with gratitude."

Qi Stagnation Water Accumulation Phlegm Obstructing Lung Orifices

Phlegm diseases, when severe, cause Jue (fainting). Falling unconscious without cause, if misdiagnosed and mistreated, recovery is impossible, making it most dangerous. Tracing the cause, it is largely due to Qi Depression, causing Phlegm to obstruct the Stomach entrance, leading to unconsciousness. Old methods used Sansheng Yin to induce vomiting, a rapid treatment attacking the branch. If Phlegm does not obstruct the Stomach but obstructs the Lung, entering the clear orifices, it is even harder to handle. The syndrome involves no fainting, consciousness remains, but Qi in the chest and diaphragm can exit but not enter, constantly showing opisthotonos, until soup and water cannot be swallowed. Swallowing causes Qi rebellion and wheezing.

A cloth merchant named An Rong in our village, though a merchant, was highly respected. In the summer of Xinyou, his second son died at age one; his third daughter also died of consumption at home. Within a month, his second daughter's husband and nephew died successively in one day. The second daughter was young; the husband's clan members, fearing they would abscond with property, ignored the dead and disputed the estate. An knew this, angrily argued with them, and the clan dispersed. Having already harbored grief from losing children, the incident with the second daughter added to his anger. Returning home, he contracted chest fullness and diarrhea. Seeking my treatment, his pulse was String-like and sluggish. I told him: "This is Qi Stagnation and Water Accumulation." I used Xiangsha Weiling Wan to resolve it. The illness healed early. An was stingy with money and did not take further medicine, and I forgot about it. Over ten days later, he urgently sent someone to summon me. I thought the diarrhea was unresolved. Examining him quickly, I found Qi rebelling with a gurgling sound, unable to swallow saliva. I asked if there was fullness in the diaphragm and chest. He said: "No." Lifting his wrist, his hands were ice-cold, all six pulses were Hidden and invisible, except the Cun position which was Slippery-Rapid. I said: "This is Phlegm obstructing the Lung orifices." The Lung orifices are where Qi enters and exits. Now obstructed by Phlegm, Qi cannot enter. If it were in the Stomach, sudden coma and aphasia would occur, and Sansheng Yin could induce vomiting. Now in the Lung tube, vomiting may not expel it, and there is no easy solution. I hastily excused myself. An firmly requested a prescription. I gave him Muxiang Shunqi Yin perfunctorily. Coming out, I told his partners: "An's illness will certainly not recover; prepare for the worst." His partners did not believe it. Delaying until the next morning, they came to inspect, and An was already gasping with open mouth, unable to speak. Seeing his danger, his cousin invited me again. I firmly declined. They asked neighbors to perform Fuji (spirit writing). After taking a prescription, he could speak somewhat, summoned family members to settle affairs, and died turning over.

Stomach Accumulation Limb Swelling

Mr. Li Gengtang, originally from Wujin, served as Commander of Wenzhou, later promoted to Brigadier General of Jiangxi. The post was poor, so he retired and returned home. His eldest son, Hao Dongqiao, served as a clerk in the Ministry of Revenue. His second son, Hao Lianfeng, failed multiple examinations, was widely read, and had a close relationship with me in the hometown. Although Mr. Li was retired, his character was straightforward, resolving disputes, and relied upon by the community. In the spring of Gengshen, Dongqiao was implicated in the Beijing official money shop case and imprisoned by the Board of Punishments. Over a year later, the case was unresolved, and Mr. Li worried at home. In the summer of Xinyou, he suddenly suffered chest and diaphragm fullness, loss of appetite, leading to swelling of hands and feet. A doctor suspected Edema and used diuretics without effect. Another doctor thought it was Deficiency and used Shenqi Wan, also without effect, and the swelling worsened. Coincidentally, I met Lianfeng at a relative's funeral and was invited to treat him. His six pulses were Firm, with the Right Guan hard and pressing against the fingers. I told him: "This is Stomach injury from food, an excess syndrome. Usually eating rich foods, accumulation stagnates in the Stomach. The Stomach governs the four limbs. If Stomach Qi is harmonious, limbs are calm; if Stomach Qi is stagnant, limbs swell. This is inevitable. Moreover, since Stomach Qi is stagnant, even a cup of tea can accumulate. Although urination is difficult, it is not because water floods causing edema. Merely promoting urination will be ineffective. Furthermore, this illness is due to internal Damp-Heat. Using Shudi to astringe and Fuzi to block will only increase swelling! Only being elderly with Yang Deficiency and naturally weak Spleen and Stomach means no quick cure. But to reduce swelling is easy." I used Shenshi Tang added with Zhishi, Mutong, and Niuxi to resolve and guide. Lianfeng seemed to think it too harsh. I said: "This is treating the branch in acute situations. Let Stomach Qi flow, and accumulation will dissolve, swelling will heal. No need to specifically treat urination; urination will certainly improve." Later, use Spleen-strengthening and Stomach-nourishing medicines, requiring three to five months to succeed. He took it. After one dose, swelling subsided; after three doses, six-tenths disappeared. Lianfeng wrote: "Unexpectedly, your literary reputation yielded skills that suddenly cured my chronic illness. Ancients said: Those serving parents must know medicine. I am truly ashamed. Tomorrow, please examine me again; I will await you with broom in hand." I visited. Pulse was slightly harmonious, but Right Guan remained unchanged. I told him: "Stomach Qi has moved but is not yet unblocked." Asked if urination was smooth. He said: "Not yet." Added Tingli and Erchou to drain. Urination increased to over ten bowls, abdomen relaxed, and appetite returned. Subsequently, Zisheng Jianpi Wan formula was taken as decoction. I told him: "You must dislike decoctions; pills are fine." Lianfeng, facing the autumn examination, wanted to go to the province, fearing swelling recurrence. I said: "Just avoid taking Fuzi, Dongshen, Shudi, etc., and gradually nourish. No fear. Only the elderly with Qi Deficiency require more time." Seeing no obstacle, Lianfeng packed for the exam. Mr. Li's eldest daughter also knew medicine and could read. An old servant also practiced medicine. After Lianfeng left, seeing her emaciated, they strongly advised taking Shudi, Maidong, bird's nest, Dongshen, etc., to greatly tonify Qi and Blood; seeing she could eat, they nourished her daily with chicken, duck, pork, and fish. Within half a month, although swelling did not recur, chest and abdomen remained stagnant, and urination was still difficult.

Lianfeng returned from the examination and invited me again. Both Chi pulses were thread-like, and the Left Guan had a Hasty image, indicating an inauspicious sign. I gave Liujunzi Wan perfunctorily and declined further treatment.

Two Formulas for Preserving Fetus and Increasing Milk

Miscarriage at three months is not due to injury. Generally, women are prone to depression, causing Liver Heat knotting, leading to corruption and dissolution. Baotai Wuyou San from Dasheng Pian is most effective, tested repeatedly with success. Upon first feeling pregnant, take one dose monthly according to the formula. Not only will there be no risk of miscarriage, but also no difficult labor, malpresentation, retained placenta, or postpartum blood syncope. Truly an immortal formula.

Regarding insufficient milk, there are several causes: those with original Qi and Blood deficiency; those with unopened milk apertures; those inhibited by spicy foods; those due to anger and Qi depression; others with food accumulation and water retention, or external Wind-Cold attack, can all lead to reduced milk. Milk is Blood. Blood follows Qi. Abundant Qi means abundance; declining Qi means scarcity; depressed Qi means stagnation; hot Qi means knotting. Doctors only treat the Qi, making it flow freely. There is absolutely no reason for milk not to flow. Only in elderly women, with true Qi already deficient, is the reduction real. Even taking Ginseng and Deer Antler, ultimately, plants, birds, and beasts, being withered substances, cannot add to milk production.