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Cheng Yutang, the West Hall official of Dingxiang, was from Beijing. He took up his post in early spring but found the position extremely poor; his annual income was less than two hundred taels of silver. Moreover, local customs were particularly crude and backward, making daily life largely unsatisfactory. Since his elderly mother was in Beijing, he faced a dilemma: bringing her to support her was financially impossible, yet not bringing her was unthinkable. Burdened by worry and depression, a ding (a type of furuncle) developed on his hand. A local doctor named Niu treated him with repeated acupuncture sessions, and it healed after half a month. However, Cheng had a history of food stagnation, compounded by recent melancholy, leading to chest and diaphragm distension, loss of appetite, mental fatigue, and emaciation. Dr. Niu diagnosed this as severe deficiency after illness and prescribed Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Aconite Root) for tonification. After two doses, the distension worsened. Hearing that I was at the county yamen, he hurriedly dressed and came to visit. You'an asked about his condition and pointed to me, saying, "Dr. Run's medical skills are divine; all our friends in Shanxi and Shaanxi admire him. You should invite him to treat you." Upon examining his pulse, I found it deep and rapid in all six positions, with the right Guan position hard and forceful, almost pounding against the fingers. I smiled and said, "Your abdomen is like a well blocked with stones; the stagnation leaves no room, which explains your reduced intake. This is an excess syndrome requiring urgent purgation to restore comfort. Misdiagnosing it as deficiency would be contrary to the truth." Cheng replied, "My spirit is listless and my muscles wasted; how can this not be deficiency?" I said, "Quack doctors only know diseases from books, not those manifested on the body. Listlessness results from poor circulation of Qi and Blood; emaciation results from the inability of food to generate essence. The Spleen and Stomach are the officials of reception and transportation. With stagnation, they cannot receive; with blockage, they cannot transport. Once Stomach Qi halts, all meridians deteriorate, hence these symptoms." Cheng requested a prescription. I combined Duijin Yin (Golden Pair Drink) with Baohe Tang (Preserve Harmony Decoction). After two doses, sounds were heard in his chest and abdomen, followed by several evacuations of foul matter. Instantly, he felt intense hunger and his spirit cleared. That evening, he came carrying a lantern, prostrated himself, and said, "This prescription is truly a miraculous elixir. I did not fully believe it before, but now I see how often quacks err." I said, "The abdomen is like a granary; it must constantly exchange old grain for new. However, once old stagnation is removed, Stomach Qi is still weak, and new food easily stagnates again. You must eat sparingly." Cheng nodded. He then sent an invitation letter, which I declined out of pity for his poverty. The next day, as I packed to return home, Cheng sent an attendant to escort me several miles. Due to mud after rain, where carts could not pass, people carried the wheels. When I dismissed them, they insisted, "We dare not disobey our master's orders," and walked ten li before returning.

Mismanagement of Febrile Disease

My maternal aunt, Mrs. Wang, had observed widowhood for thirty years, living frugally and managing the household well, now having grandchildren. She was constitutionally weak but rarely took medicine. In the summer of Renxu year, she suddenly contracted a febrile disease, characterized by restlessness and a burning sensation throughout her body. Initially, her clan son-in-law, Dong, treated her. Lacking skill, Dong suspected wind pathogen and administered Xiaochaihu Tang (Minor Bupleurum Decoction) to induce sweating. The next day, her fever intensified to near-delirium, with periods of unconsciousness. My cousin, busy with farm work, sent for me urgently. Upon arrival, the family was terrified. Her pulses were deep and rapid in both hands without other abnormalities, except for a scorched black tongue coating and slightly slurred speech, though her mind remained clear. I stated, "This is a febrile disease. Dong used warming methods incorrectly. She likely suffers from diaphragmatic fullness, dry throat, thirst, constipation, and dark yellow urine. Fortunately, the blood level is clear without macules or petechiae. Though critical, it is treatable." I asked if she desired cold water; she did. I ordered two bowls of fresh well-water, which she drank completely. Immediately, her head and eyes felt clear. I then prescribed Sanhuang Jiedu Jian (Three-Yellow Detoxification Decoction) combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). After two doses, the fever subsided. Subsequently, Guishao Dihuang Tang (Rehmannia with Angelica and White Peony Decoction) was given continuously to clear heat from the blood. Five days later, she was fully recovered, except for an excessive desire to eat. I advised my cousin, "Stomach Qi is just rising; indigestible foods easily cause relapse. Restrain her diet, even if it causes offense, do not allow overeating."

Febrile Disease in Late Summer

Yang Qingli's daughter, aged six or seven, contracted a febrile disease. A wandering practitioner named Chang treated her, suspecting warm pathogen, and used Jingfang Baidu Tang (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) without effect. Then Doctor Zhu was consulted. Zhu, formerly a merchant with rudimentary herbal knowledge, suspected wind pathogen and prescribed Tongsheng San (Universal Salvation Powder), but the fever persisted. Desperate, Yang invited me. Her pulse was deep and rapid, and her body burned like fire. I told him, "This is the same as my aunt's case, neither wind nor warm pathogen. Clear the blood heat, and the fever will stop. Using Jingjie and Fangfeng to disperse is wrong. In spring and winter, pores are closed by wind-cold, so dispersants are used. Now, in late summer heat, pores are open; dispersing further will consume Qi." Yang argued, "The doctor intends to induce sweat." I replied, "If there is no sweat, inducing it is acceptable. If there is sweat, why induce more?" Yang added, "Doctors consider this sweat merely due to hot weather, not physiological sweat, hence the need to induce." I enlightened him, "Sweat is essentially body fluids; there is no distinction. This sweat comes from your daughter's body; would induced sweat come from someone else? If you insist on using Mahuang (Ephedra), Chaihu (Bupleurum), and Gegen (Pueraria) to force endless sweating until Qi is exhausted, you risk killing patients. How many lives have been lost due to such ignorance?" Yang was speechless. I prescribed Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction). Yang, obsessed with wealth, never returned to check efficacy, which I did not inquire about, though success was uncertain.

Yin Deficiency with Blood Heat

Mr. Zhang Yueweng's third brother suffered from dry blood and heavy digestion, contracting a febrile disease with sore throat. Dr. Zhang Baoyu from Qing County examined him and frightened him by diagnosing Hongsha Hamawang (Red Rash Toad Plague), claiming it was dangerous and likely untreatable. His mother was anxious. Mr. Zhang invited me. I said, "No danger. It is neither rash nor plague, merely Yin deficiency with blood heat. Two herbs will cure it." Mr. Zhang urgently requested the prescription. I prescribed Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) modified with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). The next day, upon visiting Mr. Zhang, his brother was smiling at the door. He reported, "After taking the medicine, I slept soundly until midnight, after which my body felt clear; only slight weakness remains." I warned, "The disease has just receded; maintain dietary restraint and avoid exertion. Otherwise, relapse may occur, which would be incurable." He listened, and after a few days, returned to school.

Water Retention with Wheezing and Cough

Yu Tan's daughter, just one year old, suddenly developed alternating wheezing and coughing with fever. Yu Tan assumed it was a common cold and ignored it, but it worsened daily. While visiting her brother, I was asked to examine her. Her face was red, body hot, and throat sounded like sawing. I initially hypothesized phlegm, assuming the wet nurse fed her while sleeping and internal heat obstructed digestion, producing phlegm. I suggested giving two or three Baiyu Bing (White Jade Cakes). After administration, fever subsided slightly, but abdominal distension persisted, and wheezing continued. Re-examining her, I noted her eyes were dull and closed, spirit lethargic, and throat sounds unchanged. Yu Tan feared death. I checked her fingerprint, finding a red thread extending to the Wind Gate, and palpated her diaphragm, hearing gurgling sounds. I realized, "It is not phlegm, but water retention. There must be difficult urination, puffy eyelids, and vomiting with cough." The wet nurse confirmed this. I prescribed Wuling Ganlu Yin (Five-Ling Sweet Dew Decoction) to be drunk as tea. The next day, upon inquiry, she had urinated over ten times, abdominal distension resolved, and spirit improved. I recommended another dose, and within two days, she recovered fully.

Severe Deficiency, Abdominal Distension, and Plum-Pit Qi

The mother-in-law of neighbor Yang Bentan was impoverished, relying entirely on her son-in-law, who was also unemployed and struggling financially. Both lived in sorrow. Out of love for his daughter, Yang Bentan invited me to treat his mother-in-law, who suffered from increased coughing and wheezing, abdominal distension, and anorexia. Upon arrival, she appeared sallow and emaciated, with faint breathing. She reported days of not eating and a sensation of obstruction in the throat, unable to swallow or spit out, which others attributed to seasonal qi. Her pulses were deep and weak, with the Chi positions thread-like. I diagnosed severe deficiency requiring strong tonification with dozens of doses, along with emotional regulation. The throat sensation was Plum-Pit Qi (Meiheqi), not seasonal qi, and would resolve in three doses. Yang Bentan pleaded for relief of the throat and appetite first, citing financial hardship for expensive tonic prescriptions. I agreed and prescribed Siqi Tang (Four-Seven Decoction) with Jupi (Tangerine Peel) and Xiangfu (Cyperus Rhizome) to regulate Qi. By night, the throat obstruction felt like it had descended into the abdomen, breathing became smooth, and after two doses, appetite returned and spirit improved. Yang Bentan reported apparent recovery. I cautioned, "Siqi Tang only unblocks pathways and does not address the root deficiency. The temporary relief is due to long-standing stagnation. If delayed further, appetite may fail again. The pulse is poor; continuing treatment may waste money without benefit." Yang Bentan accepted this.

Qi Stagnation with Hypochondriac Pain

Mrs. Zhang Shimei, whose husband was unreliable, lived in constant depression and had a rebellious nature. Any dissatisfaction with food or clothing led to arguments. In the summer of Renxu year, her second son died of throat swelling caused by food stagnation and stomach heat, following improper treatment by neighbor Zhang Baoyu, who used acupuncture and cloth wiping. Mrs. Zhang's grief exacerbated her condition, causing chest pain, anorexia, drowsiness, and dizziness. Upon examination, her pulses were deep and stagnant, especially in the Liver position. I diagnosed Qi stagnation, curable in a few doses, provided she avoided anger. I prescribed Xiangsha Siqi Tang (Cyperi and Amomum Four-Seven Decoction). She recovered after three doses.

Violent Anger Injuring Liver and Heat Entering the Blood Chamber

My cousin Li Xiaopu, a scholar-official, served under his uncle, the Prefect of Yuzhou. After his uncle was dismissed due to Nian rebel disturbances, Xiaopu contributed to city defense and received a fifth-rank honor. Returning to Jiexiu in Xinyou year, we became close friends. One day, his nephew sought help for his niece-in-law, who had been critically ill for months despite seeing numerous doctors. I examined the patient, who lay wrapped in blankets, emaciated with pale lips and nails. I identified signs of Blood depletion and suspected postpartum complications. Her mother revealed she had suffered a miscarriage in April and had been bedridden since. Suspecting severe Blood deficiency, I considered Shengyu Tang (Holy to Restore Life Decoction). However, observing purple, raised blood vessels on her face and a deep, rapid pulse with a hard left Guan position, I realized this was violent anger injuring the Liver, with heat entering the Blood Chamber. The patient likely had a volatile temperament, experiencing hypochondriac pain, red eyes, tinnitus, and subsequent Spleen and Lung damage manifesting as cough, diarrhea, fever, and palpitations. Without immediate treatment, consumption (Laozai) might develop. I prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) combined with Zuojin Wan (Left Metal Pill). I warned that while full recovery was unlikely, improvement was expected in four doses. Five days later, Xiaopu informed me the patient refused medication due to household disputes, and the matter was dropped.

Food Stagnation with Chest Fullness

The second wife of Hao Yuanlin, a neighbor, managed the household well and was respected locally. In early autumn, she developed anorexia, mental fatigue, and chest fullness. At over fifty years old and accustomed to hard labor, her son Tingkai sought my help. She appeared Qi-deficient and sallow, denying headache or fever. Her right Guan pulse was prominent, indicating food stagnation. I assured her it was easily curable in three doses. She refused decoctions due to previous vomiting experiences. I offered pills instead. Her son consented to try Baohe Wan (Preserve Harmony Pills). She took only three or four qian, after which sounds arose in her diaphragm, followed by nocturnal diarrhea. The next day, she rose with restored spirit and appetite. Her son later praised the treatment repeatedly.

Qi Stagnation with Phlegm Obstruction

The sister of cousin Zhang Yuetan married poorly and was greedy and irritable, leading to chronic irritability, phlegm production, and food stagnation. She suffered from mental lethargy, anorexia, chest and abdominal distension, and suspected tuberculosis. Upon examination, her pulse was deep and hidden, visible only with heavy pressure. I diagnosed Qi stagnation with phlegm obstruction. The Stomach Qi was blocked by phlegm, preventing clear Yang from ascending and turbid Yin from descending, causing dizziness, thick neck, dry mouth, abdominal fullness, and constipation. I prescribed Weiling Chengqi Tang (Weiling and Dachengqi Decoction). After two doses, she evacuated foul matter multiple times and expressed great relief. A subsequent dose of Xiangsha Liujun Wan (Cyperi and Amomum Six-Gentleman Pill) restored her strength significantly.

Pediatric Liver Gan Disease

Duan Kekuan's grandson suffered from Gan disease (malnutrition/parasitic disorder) for several days. A folk healer misdiagnosed it as Pi (abdominal mass) and incised his earlobe and tiger's mouth, worsening the condition. Days later, the child exhibited sunken eyes, large head, thin neck, visible abdominal veins, and sleep-like mouth opening. Duan brought him to me. I explained that folk 'Pi' corresponds to ancient 'Gan'. There are various types affecting different organs; this was Liver Gan. Symptoms included initial vomiting, then hypochondriac distension. Liver fire rising caused tearing and photophobia, progressing to corneal opacity (cloudy film). Within three months, blindness would ensue, followed by liver destruction and death. Although salvageable, delay beyond a month would be fatal. Duan, wealthy but stingy, hesitated. I advised that prioritizing money over life leads to abandonment after minor improvements. He agreed to treatment. I applied Tu Yi San (Film-Removing Powder) and Xiaoyao San (Free and Easy Wanderer Powder) to clear the Liver. The cloudiness cleared, and spirit improved. I then prescribed Huapi Xiao Gan Tang (Abdominal Mass and Gan Disease Resolving Decoction). Days later, the grandson was cured, though Duan cited heat to limit medication. I warned that although the disease was gone, Yuan Qi (Original Qi) and Spleen were still weak. Without robust tonification, relapse was certain. I recommended Lubin Xiao Gan Wan (Aloe Vera Gan Resolving Pills) exceeding half a jin. Duan smiled but his compliance was doubtful, illustrating that petty individuals are unworthy of discussing health matters.

Food Stagnation Causing Middle Jiao Blockage

Madam Xingyun, wife of Prefect Lianfang, was the daughter of Mr. Yiquan from Lingshi. Skilled in calligraphy, music, and games, she assisted her husband, who rose from student to Prefect of Yuzhou through merit. She managed daily affairs efficiently. However, Lianfang became decadent, frequented prostitutes, and lost his post due to ineffective suppression of rebels. Although reinstated, he sat idly in the provincial capital, estranged from his wife. In autumn of Xinyou year, Madam Xingyun returned to Jiexiu due to declining family fortunes and aging parents. She once painted a peach blossom fan for me, which I deeply appreciated. In summer of Renxu year, she fell ill. Upon examination, her clothes were neat, but her pulse was deep and hidden in all positions. I diagnosed Qi stagnation and prescribed Xiaoyao San (Free and Easy Wanderer Powder). As she understood medicine, she agreed. She recovered after two doses. A month later, at a banquet, Xiaopu informed me that Sister Wu (Madam Xingyun) was ill again. She complained of chills, fever, and limb heaviness, suspecting epidemic disease. After taking Chaihu Siwu Tang (Bupleurum and Four Substance Decoction), she experienced abdominal pain that worsened throughout the day. Examination showed normal pulses except for a solid and stagnant right Guan position. I diagnosed food stagnation causing Qi blockage in the Middle Jiao, not external contraction or epidemic. Symptoms included pain, distension, chest oppression, and belching. I prescribed Huoxiang Zhengqi San (Agastache and Patchouli Powder to Rectify the Qi). She agreed, and after two doses, she fully recovered, sending thanks via Xiaopu.