又思，既然木防己汤可散结聚之水，助清气之升，浊气之降，可否试用于下肢水气结聚之证呢?余久久试之，亦颇有效。曾治患者张××，女，25岁。两腿浮肿疼痛，某院诊为静脉炎，先用西药治疗20多天。后又用中西药配合治疗20多天，均无明显效果。审其证，除两下肢高度浮肿，左下肢为甚外，并见口苦而干，舌苔黄白，大便秘结，小便微黄，脉沉紧。乃予木防己汤去石膏加茯苓芒硝汤加减。处方：防己12克，桂枝10克，党参15克，芒硝6g(冲)，茯苓12克。药服2剂，大便得通，浮肿大减；继进4剂，浮肿、疼痛消失八九；又进4剂，诸证消失而愈。
白虎汤
白虎汤是汉·张仲景创立的一个方剂，原用于治疗阳明气分之伤寒，后人承其意用于治疗温病。例如，吴鞠通说：“太阴温病，脉浮洪，舌黄，渴甚，大汗面赤，恶热者，辛凉重剂，白虎汤主之。”“太阴温病，脉浮大而芤，汗大出，微喘，甚至鼻孔扇者，白虎加人参汤主之。”“形似伤寒，但右脉洪大而数，左脉反小于右，口渴甚面赤，汗大出者，名曰暑温，在于手太阴，白虎汤主之。”“手太阴暑温，或已发汗，或未发汗，而汗出不止，烦渴而喘，脉洪大有力者，白虎汤主之。”而很少见到用于妇科盆腔炎证。余宗其具有清热除烦之意，试用于急性盆腔炎证，甚效。例如：患者耿××，女，成。高热，白带增多一个多月。某院诊为急性盆腔炎，先用多种抗生素不效，继又配合中药清热解毒之剂仍不效。审其脉证，高热(体温40．2℃)，汗出，神昏谵语，手足躁扰，时而循衣摸床，舌苔黄燥，脉洪大滑数。综合脉证，诊为热人阳明气分，急以辛凉重剂，白虎汤加减。处方：生石膏120克，知母15克，甘草10克，粳米30克。服药1剂，热退(38．6℃)神清，但仍见烦渴喜饮，微汗；继进1剂，发热消失八九(体温37．6℃)。因其脉仍洪大，口渴，改予人参白虎汤4剂而愈。
水气病的标本先后
《金匮要略》云：“病若苦水，面目身体四肢皆肿，小便不利，脉之不言水，反言胸中痛，气上冲咽，状如炙肉·，当微咳喘，审如师言，其脉何类?师曰：寸口脉沉而紧，沉为水，紧为寒，沉紧相搏，结在关元，始时尚微，年盛不觉，阳衰之后，营卫相干，阳损阴盛，结寒微动，肾气上冲，喉咽塞噎，胁下急痛。医以为留饮而大下之，气击不去，其病不除。复重吐之，胃家虚烦，咽燥欲饮水，小便不利，水谷不化，面目手足浮肿。又与葶苈丸下水，当时如小差，食饮过度，肿复如前，胸胁苦痛，象若奔豚，其水扬溢，则浮咳喘逆。当先攻击冲气，令止，乃治咳，咳止，其喘白差。先治新病，病当在后。”余读此文数十次不解其意，及至有的讲义将其放于附录之后，更少问津。曾治一例，患者郑××，男，55岁。慢性支气管炎，咳喘时作20多年，近二年多来咳喘日渐加重，全身浮肿，发绀，腹胀腹痛，气短。医诊为肺源性心脏病，前后住院三次，均因不见好转而出院，改用中西药治疗，亦常因服后心悸心烦，气短加剧而数更医求治。不得已，转来太原，视其证：咳喘气短，全身浮肿，面、唇、手指，甚至整个皮肤均显紫暗之色，舌质紫暗，舌苔白黄而腻，脉沉紧而数，手足冰冷，询前医之所用方剂，多为小青龙、射干麻黄、苏子降气、葶苈大枣泻肺汤加减。综其脉证，诊为心肾阳虚，水饮上泛，急予真武汤加减2剂，药后效果罔然，再察前医之药及其效果，大都使病情加重，不得已，重读《金匮》痰饮咳嗽篇，反复琢磨上述原文，始而有悟。再问患者，云：腹满逆气上冲，冲至胸咽其病则剧，食后亦剧，下肢浮肿，而根本不谈咳喘气短之证，余虽采用诱导暗示之语，诱其谈咳喘气短之苦，患者亦不谈及。综合脉证乃断曰：水饮结于中焦之故耳，宜宗先治新病，病当在后之意，以木防己汤：木防己10克，生石膏15克，桂枝6克，党参12克，茯苓6克。服药4剂，浮肿、腹满、气短等证均大减，患者云：数年服药无一剂有效者，此方虽药廉而效宏，真良剂也。继服10剂，浮肿消失，精神倍增，紫绀亦明显改善，前后服药26剂，症状消失80％左右后，暂停服药。
若水气心下坚大如盘者，但除其水而不理其气，亦难奏功。曾治患者，马××，男，15岁。浮肿尿少三个多月，某院先诊为急性肾炎，与西药及中药清热解毒，利水消肿药治疗，不效，转入某院。一周后，浮肿尿少更加严重，腹大如鼓，恶心呕吐，恶寒发热，咳喘难卧，唇鼻青紫。经检查，诊为肾病综合征，肺炎、心力衰竭。改用红霉素、青霉素、地塞米松，治疗一周仍然不效。邀请中医诊治，云：脾虚湿盛，给予健脾和胃，利水止吐之剂治之。一剂后，不但不效，反见高热寒战，体温升至40．2℃。乃又停止中药，改用单纯西药治疗。两日后，诸证不减，又改邀笔者会诊。查其证见恶寒发热，浮肿至甚，两眼睁开时仅有一线可见，视物模糊，腹大如鼓，唇青鼻扇，喘而短气，神疲懒言，头热耳冷，足厥口苦，舌质淡，舌苔黄，脉沉而紧。综其脉证，乃心肾阳虚，水饮上泛，凌犯心肺之重证，今复感寒?内外合邪，表里同病，正虚邪实，桂枝去芍加麻辛附子汤证也。仲景云：“气分，心下坚，大如盘，边如旋杯，水饮所作，桂枝去芍药加麻辛附子汤主之。”故拟：麻黄9克，桂枝12克，炙甘草9克，附子12克，细辛6克，知母9克，防己15克，生姜4片，大枣7个。药进1剂，是夜咳喘、恶寒发热顿减，尿量增加，体温38．2℃，次日呕吐停止，食纳少进，精神倍增，尿蛋白亦由（++++）减至（++），继进7剂，浮肿全消，喘咳、发热停止，纳食大增。再询其证，咽喉干痛，痰多不利，舌苔薄黄，脉滑数，证脉合参，诊为痰热阻肺，改予清热化痰，四逆散加味：柴胡9克，枳壳9克，白芍9克，桔梗9克，杏仁9克，牛蒡子9克，黄芩9克，蝉蜕9克，苏叶6克，薄荷6克，瓜蒌15克，甘草6克，连续服用14剂，患者突然头晕头痛，”如坐舟船，查血压180／140mmHg，停服激素，改加环磷酰胺，—周后血压恢复正常，但此时尿蛋白又增至+++，并见红细胞10—30个，白细胞100，颗粒管型2—3个，又改为激素配合中药治疗，半月后，尿常规：蛋白+～++，红细胞5-10个，白细胞30，但因库欣综合征日渐严重，不得已停用一切西药。改用中药：黄芪30克，白术9克，防己9克，瞿麦9克，茅根30克，益母草30克，服药20剂未见进退。再审其证，舌苔薄白，质淡，脉弦滑。乃云：肾阳式微，湿热蕴结，拟附子2克，肉桂2克，黄柏12克，知母12克，服药10剂，尿检正常，又服30剂而愈。
又思考，既然木防己汤能够消散结聚的水湿，助长清气的上升和浊气的下降，是否可以尝试用于下肢水气结聚的病证呢？我经过长时间的试用，发现颇为有效。曾治疗患者张某某，女性，25岁。双腿浮肿疼痛，某医院诊断为静脉炎，先用西药治疗二十多天。后又用中西药配合治疗二十多天，均无明显效果。审查其证候，除双下肢高度浮肿，左下肢更为严重外，还见口苦而干，舌苔黄白相间，大便秘结，小便微黄，脉象沉紧。于是给予木防己汤去掉石膏，加入茯苓、芒硝的方剂进行加减。处方：防己12克，桂枝10克，党参15克，芒硝6克（冲服），茯苓12克。服药2剂后，大便通畅，浮肿大幅减轻；继续服用4剂，浮肿、疼痛消失八九成；再服用4剂，所有症状消失而痊愈。
白虎汤
白虎汤是汉代张仲景创立的一个方剂，原本用于治疗阳明气分受邪的伤寒病，后人继承其意用于治疗温病。例如，吴鞠通说：“太阴温病，脉象浮洪，舌苔黄，极度口渴，大汗出且面赤，怕热者，用辛凉重剂白虎汤主治。”“太阴温病，脉象浮大而芤，汗大量出，轻微气喘，甚至鼻孔煽动者，用白虎加人参汤主治。”“症状类似伤寒，但右脉洪大而数，左脉反而小于右脉，极度口渴且面赤，大汗出者，名为暑温，病在手太阴肺经，用白虎汤主治。”“手太阴暑温，或者已经发汗，或者未发汗，但汗出不止，烦躁口渴且气喘，脉象洪大有力者，用白虎汤主治。”很少见到将其用于妇科盆腔炎证。我领悟到它具有清热除烦的作用，尝试用于急性盆腔炎证，效果显著。例如：患者耿某某，女性，成年。高热，白带增多一个多月。某医院诊断为急性盆腔炎，先用多种抗生素无效，继而又配合中药清热解毒之剂仍无效。审查其脉证，高热（体温40.2℃），汗出，神志昏迷胡言乱语，手足躁动不安，时而摸床沿衣物，舌苔黄燥，脉象洪大滑数。综合脉证，诊断为热入阳明气分，紧急使用辛凉重剂白虎汤加减。处方：生石膏120克，知母15克，甘草10克，粳米30克。服药1剂，热退（38.6℃）神志清醒，但仍见烦躁口渴喜饮，微汗；继续服用1剂，发热消失八九成（体温37.6℃）。因其脉仍洪大，口渴，改用人参白虎汤4剂而痊愈。
水气病的标本先后
《金匮要略》说：“病人若苦于水肿，面目身体四肢皆肿，小便不利，切脉时不说有水病，反而说胸中痛，气上冲咽喉，感觉像有烤肉堵着，应当轻微咳嗽气喘，如果确实像老师所说，他的脉象是什么样？老师说：寸口脉沉而紧，沉主水，紧主寒，沉紧相搏结在关元穴处，开始时症状轻微，年富力强时不觉察，阳气衰退之后，营卫相互干扰，阳损阴盛，结聚的寒气微微发动，肾气上冲，喉咽堵塞噎塞，胁下急痛。医生误以为是留饮而用峻下法，气逆击打不去，病情不除。又重复使用吐法，导致胃家虚烦，咽燥想喝水，小便不利，水谷不化，面目手足浮肿。又给予葶苈丸攻下水气，当时稍微好转，饮食过度，浮肿又像以前一样，胸胁苦痛，像奔豚病发作，水气扬溢，则出现浮肿咳嗽气喘逆。应当先攻击冲气，使其停止，然后治咳，咳止，其喘自然好转。先治新病，旧病当在后。”我读这篇文章几十次都不理解其意，直到有的讲义将其放在附录之后，更少有人问津。曾治疗一例，患者郑某某，男性，55岁。慢性支气管炎，咳喘时作20多年，近两年来咳喘日渐加重，全身浮肿，发绀，腹胀腹痛，气短。医生诊断为肺源性心脏病，前后住院三次，均因不见好转而出院，改用中西药治疗，也常因服药后心悸心烦，气短加剧而多次换医求治。不得已，转来太原，观察其证候：咳喘气短，全身浮肿，面、唇、手指，甚至整个皮肤均显紫暗之色，舌质紫暗，舌苔白黄而腻，脉沉紧而数，手足冰冷，询问前医所用方剂，多为小青龙汤、射干麻黄汤、苏子降气汤、葶苈大枣泻肺汤加减。综合其脉证，诊断为心肾阳虚，水饮上泛，紧急给予真武汤加减2剂，药后效果毫无反应，再考察前医的药物及其效果，大都使病情加重，不得已，重读《金匮要略》痰饮咳嗽篇，反复琢磨上述原文，始而有悟。再询问患者，说：腹满逆气上冲，冲至胸咽病情则剧烈，食后也剧烈，下肢浮肿，根本不谈咳喘气短之证，我虽采用诱导暗示的语言，诱使他谈咳喘气短之苦，患者也不谈及。综合脉证乃断定：是水饮结于中焦的缘故，应当遵循先治新病，旧病当在后的意思，使用木防己汤：木防己10克，生石膏15克，桂枝6克，党参12克，茯苓6克。服药4剂，浮肿、腹满、气短等证均大幅减轻，患者说：数年服药无一剂有效者，此方虽然药价低廉而疗效宏大，真是良剂啊。继续服用10剂，浮肿消失，精神倍增，紫绀亦明显改善，前后服药26剂，症状消失80%左右后，暂停服药。
如果水气导致心下坚硬如盘者，只去除水气而不调理气机，也难以奏效。曾治疗患者马某某，男性，15岁。浮肿尿少三个多月，某医院先诊断为急性肾炎，给予西药及中药清热解毒、利水消肿药治疗，无效，转入某医院。一周后，浮肿尿少更加严重，腹大如鼓，恶心呕吐，恶寒发热，咳喘难卧，唇鼻青紫。经检查，诊断为肾病综合征，肺炎、心力衰竭。改用红霉素、青霉素、地塞米松，治疗一周仍然无效。邀请中医诊治，说：脾虚湿盛，给予健脾和胃、利水止吐之剂治疗。一剂后，不仅无效，反见高热寒战，体温升至40.2℃。于是又停止中药，改用单纯西药治疗。两日后，诸证不减，又改邀笔者会诊。查其证见恶寒发热，浮肿至极，两眼睁开时仅有一线可见，视物模糊，腹大如鼓，唇青鼻扇，喘而短气，神疲懒言，头热耳冷，足厥冷口苦，舌质淡，舌苔黄，脉沉而紧。综合脉证，乃心肾阳虚，水饮上泛，凌犯心肺的重证，如今又感受寒邪，内外合邪，表里同病，正虚邪实，属于桂枝去芍药加麻黄细辛附子汤证。仲景说：“气分病，心下坚硬，大如盘，边如旋杯，由水饮所作，用桂枝去芍药加麻黄细辛附子汤主治。”故拟定：麻黄9克，桂枝12克，炙甘草9克，附子12克，细辛6克，知母9克，防己15克，生姜4片，大枣7个。药进1剂，当晚咳喘、恶寒发热顿减，尿量增加，体温38.2℃，次日呕吐停止，食欲稍进，精神倍增，尿蛋白也由（++++）减至（++），继续服用7剂，浮肿全消，喘咳、发热停止，纳食大增。再询问其证候，咽喉干痛，痰多不利，舌苔薄黄，脉滑数，证脉合参，诊断为痰热阻肺，改予清热化痰，四逆散加味：柴胡9克，枳壳9克，白芍9克，桔梗9克，杏仁9克，牛蒡子9克，黄芩9克，蝉蜕9克，苏叶6克，薄荷6克，瓜蒌15克，甘草6克，连续服用14剂，患者突然头晕头痛，”如坐舟船”，查血压180/140mmHg，停服激素，改加环磷酰胺，一周后血压恢复正常，但此时尿蛋白又增至+++，并见红细胞10-30个，白细胞100，颗粒管型2-3个，又改为激素配合中药治疗，半月后，尿常规：蛋白+～++，红细胞5-10个，白细胞30，但因库欣综合征日渐严重，不得已停用一切西药。改用中药：黄芪30克，白术9克，防己9克，瞿麦9克，茅根30克，益母草30克，服药20剂未见进退。再审其证候，舌苔薄白，质淡，脉弦滑。于是说：肾阳式微，湿热蕴结，拟定附子2克，肉桂2克，黄柏12克，知母12克，服药10剂，尿检正常，又服30剂而痊愈。
Further reflection led to the question: Since Mufangji Tang (Caulis Stephaniae Tetrandrae Decoction) can dissipate accumulated water-dampness and facilitate the ascending of clear qi and descending of turbid qi, could it be tentatively applied to conditions characterized by water-dampness accumulation in the lower limbs? After prolonged clinical trial, I found it quite effective. I once treated a patient, Ms. Zhang XX, female, 25 years old. She suffered from edema and pain in both legs. A certain hospital diagnosed her with phlebitis. She was first treated with Western medicine for over 20 days, followed by combined Chinese and Western medicine treatment for another 20 days, without significant effect. Upon examination, besides severe edema in both lower limbs (more pronounced on the left), she presented with bitter taste and dryness in the mouth, yellowish-white tongue coating, constipation, slightly yellow urine, and a deep-tight pulse. Therefore, I prescribed a modified formula based on Mufangji Tang, removing Shigao (Gypsum Fibrosum) and adding Fuling (Poria) and Mangxiao (Natrii Sulfas). The prescription consisted of: Fangji (Radix Stephaniae Tetrandrae) 12g, Guizhi (Ramulus Cinnamomi) 10g, Dangshen (Radix Codonopsis) 15g, Mangxiao (Natrii Sulfas) 6g (to be dissolved in the decoction), and Fuling (Poria) 12g. After taking two doses, bowel movements became unobstructed, and edema significantly decreased; after continuing for four more doses, edema and pain disappeared by 80-90%; after another four doses, all symptoms resolved, and she recovered.
Baihu Tang (White Tiger Decoction)
Baihu Tang (White Tiger Decoction) is a formula established by Zhang Zhongjing of the Han Dynasty, originally used to treat Shaoyang Yangming Qi-level Shanghan (Cold Damage), and later inherited by subsequent generations for treating Wenyi (Warm Diseases). For instance, Wu Jutong stated: "In Taiyin Wenyi (Warm Disease of the Lung), if the pulse is floating and surging, the tongue coating is yellow, thirst is extreme, sweating is profuse with facial redness, and aversion to heat, Baihu Tang (White Tiger Decoction), a heavy辛-Liang (Acrid-Cool) agent, should be used." "In Taiyin Wenyi, if the pulse is floating, large, and knotted (Kou), sweating is profuse, there is slight asthma, or even flaring of the nostrils, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used." "Symptoms resembling Shanghan, but with a right pulse that is surging, large, and rapid, while the left pulse is smaller than the right, accompanied by extreme thirst, facial redness, and profuse sweating, is named Shuwen (Summerheat-Warmth) affecting the Hand-Taiyin Lung meridian; Baihu Tang (White Tiger Decoction) should be used." "For Hand-Taiyin Shuwen, whether sweat has been induced or not, if sweating continues incessantly, accompanied by irritability, extreme thirst, asthma, and a surging, large, and forceful pulse, Baihu Tang (White Tiger Decoction) should be used." It is rarely seen being used for gynecological pelvic inflammatory disease. Grasping its function of clearing heat and relieving irritability, I attempted to use it for acute pelvic inflammatory disease with great efficacy. For example: Patient Ms. Geng XX, female, adult. She suffered from high fever and increased leukorrhea for over a month. A certain hospital diagnosed acute pelvic inflammatory disease. Initial treatment with various antibiotics failed, and subsequent combination with Chinese herbal medicines for clearing heat and detoxifying also failed. Examination of her pulse and symptoms revealed high fever (body temperature 40.2°C), sweating, delirium, restlessness of hands and feet, occasionally touching the bedclothes, yellow and dry tongue coating, and a surging, large, slippery, and rapid pulse. Synthesizing these findings, the diagnosis was Heat entering the Yangming Qi level. Urgently, a heavy辛-Liang (Acrid-Cool) agent, Baihu Tang (White Tiger Decoction), was prescribed with modifications. The prescription included: Shigao (Gypsum Fibrosum) 120g, Zhimu (Rhizoma Anemarrhenae) 15g, Gancao (Radix Glycyrrhizae) 10g, and Jingmi (Oryza Sativa) 30g. After one dose, the fever subsided (38.6°C) and consciousness cleared, though irritability, thirst, preference for drinking, and slight sweating persisted. After another dose, fever subsided by 80-90% (37.6°C). Due to the persisting surging pulse and thirst, Ren Shen Baihu Tang (Ginseng White Tiger Decoction) was given for four doses, leading to recovery.
The Sequence of Treating Root and Branch in Water-Qi Diseases
Jinkui Yaolue states: "If a patient suffers from edema, with swelling of the face, eyes, body, and limbs, and difficulty urinating, yet upon palpation does not mention water disease but instead complains of chest pain, sensation of Qi rushing up to the throat as if a piece of roasted meat were stuck, and mild coughing and asthma, if this matches what the master said, what would the pulse resemble? The master replied: The Cun Kou (radial artery at the wrist) pulse is deep and tight. Deep indicates water, tight indicates cold. The combination of deep and tight pulses binds at the Guan Yuan point. Initially, the condition is subtle and unnoticed in youth. After Yang Qi declines, Ying (Nutritive) and Wei (Defensive) Qi interfere with each other. Yang damage leads to Yin excess, causing the bound cold to move slightly, and Kidney Qi rushes upward, blocking the throat and esophagus, with urgency and pain under the ribs. Physicians mistook this for retained fluid and administered harsh purgatives. The Qi strike remained, and the disease was not cured. Repeated emesis caused deficiency and irritability in the Stomach, dry throat craving water, difficulty urinating, indigestion, and edema of the face, eyes, and extremities. Another administration of Tingli Wan (Descurainiae Semen/Papaveris Fructus Pill) to drain water provided temporary relief, but overeating caused the edema to return, along with chest and hypochondriac pain, resembling Ben Tun (Running Piglet) syndrome. When water overflows, it causes edema, coughing, asthma, and counterflow. One should first attack the rushing Qi to stop it, then treat the cough; once the cough stops, the asthma will naturally improve. Treat the new illness first, and the old illness will follow." I read this passage dozens of times without understanding it. Later, when some textbooks placed it in the appendix, it received even less attention. I once treated a case: Patient Mr. Zheng XX, male, 55 years old. He had chronic bronchitis with intermittent coughing and asthma for over 20 years, worsening over the past two years. He presented with generalized edema, cyanosis, abdominal distension and pain, and shortness of breath. Diagnosed with cor pulmonale, he was hospitalized three times without improvement. Western and Chinese medicine treatments often exacerbated palpitations, irritability, and shortness of breath, forcing him to seek different doctors. Reluctantly, he came to Taiyuan. Observation revealed: coughing, asthma, shortness of breath, generalized edema, purple-dark discoloration of the face, lips, fingers, and entire skin, purple-dark tongue body, white-yellow greasy tongue coating, deep-tight-rapid pulse, and cold extremities. Previous prescriptions mostly included Xiao Qinglong Tang (Minor Blue Dragon Decoction), Shegan Mahuang Tang (Belamcanda and Ephedra Decoction), Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction), or Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction Draining the Lung). Synthesizing the pulse and symptoms, the diagnosis was Heart-Kidney Yang Deficiency with Water-Fluids flooding upward. I urgently prescribed Zhenwu Tang (True Warrior Decoction) with modifications for two doses, but there was no effect. Re-evaluating the previous prescriptions and their effects, which largely worsened the condition, I reluctantly re-read the Phlegm-Fluids and Coughing chapter of Jinkui Yaolue, pondering the original text repeatedly, until I gained insight. Asking the patient again, he mentioned abdominal fullness and Qi rushing upward to the chest and throat, worsening the condition, especially after eating, and edema in the lower limbs, but did not mention coughing or shortness of breath despite my attempts to elicit this information. Synthesizing the pulse and symptoms, I concluded: This is due to Water-Fluids binding in the Middle Jiao. Following the principle of 'treating the new illness first,' I used Mufangji Tang: Mufangji (Caulis Stephaniae Tetrandrae) 10g, Shigao (Gypsum Fibrosum) 15g, Guizhi (Ramulus Cinnamomi) 6g, Dangshen (Radix Codonopsis) 12g, and Fuling (Poria) 6g. After four doses, edema, abdominal fullness, and shortness of breath significantly decreased. The patient said, "I have taken medicine for years without any effective dose. Although this prescription is inexpensive, its effect is profound; truly a good formula." Continuing for ten more doses, edema disappeared, spirit improved markedly, and cyanosis improved significantly. After 26 doses in total, symptoms disappeared by about 80%, and medication was paused.
If water-dampness causes hardness in the epigastrium like a plate, merely removing the water without regulating Qi will hardly achieve success. I once treated a patient, Mr. Ma XX, male, 15 years old. Edema and oliguria for over three months. Initially diagnosed with acute nephritis at a certain hospital, treated with Western medicine and Chinese herbs for clearing heat, detoxifying, and promoting diuresis, without effect. Transferred to another hospital. A week later, edema and oliguria worsened, abdomen distended like a drum, nausea and vomiting, aversion to cold and fever, difficult breathing preventing lying down, and blue-purple lips and nose. Examination diagnosed nephrotic syndrome, pneumonia, and heart failure. Treatment with erythromycin, penicillin, and dexamethasone for a week was ineffective. Invited TCM consultation, who diagnosed Spleen Deficiency with Dampness Excess, prescribing herbs to strengthen the Spleen, harmonize the Stomach, promote diuresis, and stop vomiting. After one dose, not only was there no effect, but high fever and chills developed, with temperature rising to 40.2°C. Chinese medicine was stopped, and pure Western medicine resumed. Two days later, symptoms persisted, and I was invited to consult. Examination revealed: aversion to cold and fever, severe edema (eyes open only to a slit), blurred vision, abdominal distension like a drum, blue lips and flaring nostrils, asthma with shortness of breath, fatigue and reluctance to speak, hot head with cold ears, cold feet with bitter taste, pale tongue body, yellow tongue coating, and deep-tight pulse. Synthesizing these, the diagnosis was severe Heart-Kidney Yang Deficiency with Water-Fluids flooding upward, harassing the Heart and Lungs, complicated by external Cold invasion, resulting in interior-exterior simultaneous disease, Righteous Qi deficiency and Pathogenic Excess. This corresponds to the pattern for Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Asarum, and Aconite Decoction). Zhongjing stated: "Qi-level disease, hardness in the epigastrium, large as a plate, edges like a turned cup, caused by water-fluids, is treated with Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang." Thus, I formulated: Mahuang (Herba Ephedrae) 9g, Guizhi (Ramulus Cinnamomi) 12g, Zhi Gancao (Prepared Radix Glycyrrhizae) 9g, Fuzi (Radix Aconiti Lateralis Preparata) 12g, Xixin (Herba Asari) 6g, Zhimu (Rhizoma Anemarrhenae) 9g, Fangji (Radix Stephaniae Tetrandrae) 15g, Shengjiang (Rhizoma Zingiberis Recens) 4 slices, and Dazao (Fructus Jujubae) 7 pieces. After one dose, coughing, asthma, aversion to cold, and fever subsided drastically that night, urine volume increased, temperature dropped to 38.2°C. The next day, vomiting stopped, appetite slightly improved, spirit doubled, and urinary protein decreased from (++++) to (++). Continuing for seven more doses, edema completely resolved, asthma and fever ceased, and appetite greatly increased. Further inquiry revealed dry and painful throat, excessive difficult-to-expectorate sputum, thin-yellow tongue coating, and slippery-rapid pulse. Combining symptoms and pulse, the diagnosis was Phlegm-Heat obstructing the Lungs. I switched to clearing heat and resolving phlegm, using Sizni San (Four Reversal Powder) with additions: Chaihu (Radix Bupleuri) 9g, Zhike (Fructus Aurantii) 9g, Baishao (Radix Paeoniae Alba) 9g, Jiegeng (Radix Platycodi) 9g, Xingren (Semen Pruni Armeniacae) 9g, Niubangzi (Fructus Arctii) 9g, Huangqin (Radix Scutellariae) 9g, Chantui (Periostracum Cicadae) 9g, Ziye (Folium Perillae) 6g, Bohe (Herba Menthae) 6g, Gualou (Fructus Trichosanthis) 15g, and Gancao (Radix Glycyrrhizae) 6g. After continuous use for 14 doses, the patient suddenly experienced dizziness and headache, "like sitting in a boat," with blood pressure 180/140 mmHg. Hormones were stopped, and Cyclophosphamide was added. Blood pressure normalized after a week, but urinary protein increased to (+++), with RBCs 10-30/WHP, WBCs 100, and granular casts 2-3/HP. Treatment switched back to hormones combined with Chinese medicine. Half a month later, urinalysis showed protein +~++, RBCs 5-10/WHP, WBCs 30. However, due to worsening Cushing's syndrome, all Western medicines were unfortunately discontinued. Chinese medicine was changed to: Huangqi (Radix Astragali) 30g, Baizhu (Rhizoma Atractylodis Macrocephalae) 9g, Fangji (Radix Stephaniae Tetrandrae) 9g, Qumai (Herba Dianthi) 9g, Maogen (Rhizoma Imperatae) 30g, and Yimucao (Herba Leonuri) 30g. After 20 doses, no progress was observed. Re-examining the symptoms: thin-white tongue coating, pale body, wiry-slippery pulse. I diagnosed: Kidney Yang Decline with Damp-Heat accumulation. Prescribed: Fuzi (Radix Aconiti Lateralis Preparata) 2g, Rougui (Cortex Cinnamomi) 2g, Huangbai (Cortex Phellodendri) 12g, and Zhimu (Rhizoma Anemarrhenae) 12g. After 10 doses, urinalysis normalized. After another 30 doses, full recovery was achieved.