咳而吐沫，食少恶心，动作多喘，中气伤矣。非清肺治咳所能愈也。
邓评：方法合度，倘能兼纳冲气，似较周匝。纳冲气如沉香、蛤壳、紫石英等。
治按：既有火动而衄见证，宜兼清降。
浮肿咳喘，颈项强大，饮不得下，溺不得出，此肺病也。不下行而反上逆，治节之权废矣。虽有良剂，恐难奏效。
邓评：拟参风水治法
脉寸关大而尺小，口干，上气不下，足冷不温。此阳气不潜。当用阴中阳药治之。
邓评：阳既失潜，参以介类潜阳可也。须脉大而豁然者，桂、味始合。
孙评：足冷膝冷，是虚阳上越不潜之象，宜以补中佐引阳归原之法，如此方是也，宜切记之。
脉数减，咳亦缓。但浮气不得全归根本。宜补益下焦，以为吸受之地。
六味丸加五味子 菟丝子
又丸方：六味丸加五味子 杜仲 芡实 莲须 菟丝子 杞子 蜜丸 每服五钱
诒按：议论稳实，方亦妥贴。
邓评：上病下取，治病必求其本也。
《喘足冷至膝，唇口干，鼻塞，脉虚小。下气上逆，病在根本。勿以结痰在项，而漫用清克也。
诒按：识见老当。
邓评：口干鼻塞，不免兼有外感。今用肾气丸，直任无疑者，以脉之虚小故也，急则先治耳。
久咳喘不得卧，颧赤足冷，胸满上气，饥不能食。此肺实于上，肾虚于下，脾困于中之候也。然而实不可攻，姑治其虚，中不可燥，姑温其下。且肾为胃关，火为土母，或有小补，未可知也。
诒按：拟再用旋覆代赭汤送下，则上中两层，亦可关会矣。
邓评：肾气丸内有温中逐饮之义，再合旋赭汤光能上下同治，虚实兼到。
孙评：议论岂浮泛者能道。
两寸浮大，关尺沉小，气上而不下，喘咳多痰。肝肾之气，上冲于肺。宜以肾气丸，补而下之。
诒按：此治本之法。
邓评：病象毕露于脉，谁谓脉不足凭乎。
下虚上实，当治其下，勿清其上；真气归元，痰热自降。宜以十味肾气丸主之。
诒按：识见卓老。
失 血 门
诒按：勘证用药，老眼无花。
邓评：疏邪清热导瘀，方极轻灵中窍。若以滋腻补剂，必致瘀热留灼成劳。
吐血得劳与怒即发，脉小数微呛。病在肝心，得之思虑劳心，宜早图之，勿使延及肺家则吉。
失血咳逆，心下痞满，暮则发厥，血色黯，大便黑，肝脉独大。此有瘀血，积留不去。勿治其气，宜和其血。
诒按：此专治瘀积之法。
邓评：此瘀积被木火冲动，导瘀随以泻火，选药绝不浮泛。拟再加阿胶以补肺，旋覆以降逆，且能化瘀和络。
病后失血，色紫黑不鲜。此系病前所蓄，胸中尚满，知瘀犹未尽也。正气虽虚，未可骤补，宜顺而下之。
诒按：此必尚有郁热见证，故方中用犀角。既有留瘀未尽，可加醋炙大黄炭。
柳师加味，亍导瘀亦着力。
凡有瘀血之人，其阴已伤，其气必逆，兹吐血紫黑无多，而胸中满闷，瘀犹未尽也。而舌绛无苔，此阴之亏也。呕吐不已，则气之逆也。且头重足冷，有下虚上脱之虑。恶寒谵语，为阳弱气馁之征。此证补之不投，攻之不可，殊属棘手。
诒按：论病则层层俱透，用药亦步步着实，此为高手。
孙评：血色紫黑，是瘀之实据。此症得元因怒伤肝乎，或抉风热内动乎，而又阴亏气馁，攻补仍属棘手。斯方之制，已非平庸手笔。
血去过多，气必上逆，肺被其冲，故作咳嗽。此非肺自病也。观其冲气甚则咳甚，冲气缓则咳缓，可以知矣。拟摄降法，先治冲气。
诒按：认证独的，法亦老当
孙评：附子似亦可去。惟镇摄之味如磁石、五味、白芍之类，当宜加重。
脉寸静尺动，屡经失血，觉气从下焦上冲则呛，劳动则气促不舒。此病不在肺而在肾。治嗽无益，宜滋肾阴。
心脉独大，口干易汗，善怒血逆。此心阴不足，心阳独亢。宜犀角地黄汤。
诒按：方案均精简熨帖。
邓评：此肝阳未尝不亢。盖肝阳过升，脉乃上溢，溢则并火于心脉矣。茅根宜易丹皮。
痰中有血点散漫，此心病也。口干心热，当是伤暑，因暑喜归心故耳。
诒按：方法清灵可喜。
葛可久论吐血治法，每于血止瘀消之后，用独参汤以益心定志。兹以阴药参之，虑其上升而助肺热也。
劳伤失血，心下痛闷，不当作阴虚证治。但脉数咳嗽潮热，恐其渐入阴损一途耳。
治按：此证如早服补涩，则留瘀化热，最易致损。须看其虚实兼到，绝不犯手。
邓评：此方以导瘀热为主。是二虚一实，先治其实之旨。
孙评：认定痛闷着笔。
点清血症致损之由，使人豁然开朗。如此评论，有益于人不少
闭不足而阳有余，肝善逆而肺多郁。脉数气喘咳逆，见血胁痛。治宜滋降，更宜静养；不尔，恐其血逆不已也。
离经之血未净，而郁于内，寒热之邪交煽，而乱其气，是以瞠满呕泄，寒热口燥。治当乎其乱气，导其积血，元气虽虚，未可骤补也。
诒按：此证挟外感之邪，可加荆芥炭、黑棺豆衣。
邓评：此失血中偶有之症，故绝少成法可遵。窃思失血之后，中气必虚，木火必亢。就此见证，不但有寒热交煽之邪，抑且有土木相仇之意，戊己丸法亦可参用。至柳师所加，固未尝不善也，方中牛膝可去之。
久咳见血，音喑咽痛，乍有寒热。此风寒久伏，伤肺成劳。拟钱氏补肺法，声出则佳。
邓评：钱氏补肺法内用甜杏仁。此系风寒久伏，当以苦杏为准。若进步求治，可仿葛氏保和汤例。
又膏方：阿胶 贝母 甘草 橘红 杏仁 苏子 米糖 白蜜 姜汁 紫苑 木通 梨汁 桔梗 牛膝 萝卜汁 茯苓
诒按：此正虚邪实之证，用药能两面兼顾，尚称稳适。
虚 损 门
虚损至食减形瘦，当以后天脾胃为要。异功散五六服，颇得加谷。今春半地气上升，肝木用事，热升心悸，汗出复咳，咳甚见血，肝阳上炽，络血遂沸。昨进和阳养阴之剂，得木火稍乎，仍以前方加白芍，制朋：安土。
邓评：随机应变，医之能事也。今阳火内动，故须阴静之药以制之，勿汲汲乎培土可也。
罗氏论虚劳之证，多因邪伏血郁而得，不独阴亏一端也。临晚寒热，时减时增，其为阳陷入阴可知。滋肾生旰，最为合法，略加损益，不必更张也。
诒按：于养阴中，加柴胡以达邪，佐鳖甲以搜阴。虚实兼到，极为灵巧。然既云邪伏血郁，似宜加当归。
邓评：凡由寒热成劳者，惟罗氏立法为最善。今观此方，便觉更胜一筹，所谓在于临时权衡耳。所云血郁宜加当归，以其能活血疏邪。
孙评：邪伏血郁，浅学者每蛮补不已，致邪愈伏则阴愈伤，血愈郁则火益炽，虚劳死症成而至不可挽矣。实则仲景大黄庶虫丸、薯蓣丸、鳖甲煎丸三方，早示法则矣。
邪伏血郁，用当归之辛润者以透之，最切最妙之法也。柳氏于按语中申明之，省许摹拟矣。
熟地改用生地极佳
再诊：热渐减，头中时痛，脉数不退，喉中痰滞不清。
诒按：似当兼清痰滞。两方中熟地，不如改用生地为稳。
邓评：此症肝阳已旺，头中时痛，想系柴胡太升，鼓即改用青蒿，且痰滞不清，有欲咳之状矣。
邓评：前之阳升，仍由阴虚，既体不发热，宜减去蒿、鳖，即有余邪，丹皮足以清之，或再加当归以疏托。
面黧形瘦，脉虚而数，咳嗽气促，腰膝无力，大便时溏。此先后天俱虚，虑其延成虚损。清润治肺之品，能戕中气，勿更投也
诒按：案语浮治虚要旨，方亦精当。
邓评：审见证，先天受伤为重，鼓用药以培补先天为要。
孙评：今人凡遇咳嗽，不察虚实，率用清润肃肺，不知能戕中气，反速其死。今指明其弊，有功不少。
络脉空隙，气必游行作痛，最虑春末夏初，地中阳气上升，血随气溢，趁此绸缪，当填精益髓。盖阴虚咳嗽，是他脏累及于肺，若治以清凉，不独病不去而胃伤食减，立成虚损，难为力矣。
熟地 金樱子膏 鹿角霜 五味子 湘莲子 萸肉 山药 茯苓 海参（漂净熬膏）右为细末即以二膏捣丸
邓评：看方药知有遗精之证，然与咳嗽合推，大都挟肝阳化火，上升下降所致； 游行作痛，亦由乎此。方内鹿角霜恐有所碍，拟再加丹皮、白芍、牡蛎、旋覆花。
孙评：柳氏如是指明，省学者摹拟。
汗 病 门
汗出偏沮，脉来不柔，时自歇止。知肝阳有余，而胃阴不足，于是稠痰浊火，扰动于中，壅滞于外。目前虽尚安和，然古人治未病，不治己病。知者见微知著，须加意调摄为当。
诒按：此想系左半有汗，右半无汗之证。细绎案语，是防其将患偏痱之意。
孙评：柳氏如此指点，是真有书本功夫者。
心阴不足，心阳易动，则汗多善惊；肾阴不足，肾气不固，则无梦而泄。以汗为心液，而精藏于肾故也。
诒按：案语心肾并重，方药似专重于心。再加五味子、牡蛎、沙苑等摄肾之品，则周匝矣。
邓评：洞达病情，了无疑义。
原方已属乎妥，再加敛摄之品，尤为切实。
诸 郁 门
中年脘闷，多暧多咳，此气郁不解也。纳谷已减，未可破泄耗气，宜从胸痹例，微通上焦之阳。
诒按：方法轻灵。
邓评：病由痰气交阻，肺胃不主通降，拟加枇杷叶、竹茹、旋覆花。
诒按：此于《金匮》成方中，加旋覆，杷叶，最有巧思。
咳嗽且吐泡沫，饮食减少并伴有恶心，稍微活动就气喘，这是中气受损的表现。这不是单纯清肺止咳所能治愈的。
柳诒按：这是胃虚引起的咳嗽。方剂取法《金匮要略》大半夏汤和麦门冬汤两方的意旨。
邓评：治疗方法合乎法度，如果能兼顾平冲逆之气，似乎更加周全。平冲逆之气可用沉香、蛤壳、紫石英等药。
咳嗽且鼻出血。这是阴液不足，虚火内动所致。恶心不食，应当先治疗胃部。
治按：既然有虚火内动导致鼻出血的症状，应当兼用清热降逆之法。
身体浮肿，咳嗽气喘，颈项强直有力，喝水咽不下去，小便排不出来，这是肺部的病变。肺气不能下行反而上逆，肺主治节的功能废弛了。即使有良方，恐怕也难以见效。
邓评：建议参考风水病的治疗方法。
脉象寸关部大而尺部小，口干，气机上逆不能下行，脚冷不温。这是阳气不能潜藏。应当使用阴中寓阳的药物来治疗。
邓评：阳气既然失于潜藏，配合介类药物潜阳是可以的。但必须是脉大而豁然开朗者，肉桂、五味子的用法才合适。
孙评：脚冷膝盖冷，是虚阳上浮不能潜藏的征象，应当用补益中气佐以引火归原的方法，像这个方子就是对的，务必牢记。
脉数减慢，咳嗽也缓和了。但浮游之气不能完全回归根本。应当补益下焦，作为纳气吸受的基础。
又制丸方：六味地黄丸加五味子 杜仲 芡实 莲须 菟丝子 枸杞子 蜂蜜为丸，每次服用五钱。
柳诒按：议论稳重切实，方剂也妥帖。
邓评：上病下取，治病必求其本。
《喘足冷至膝，唇口干，鼻塞，脉虚小。下气上逆，病在根本。不要因为有结聚之痰在颈部，就随意使用清利攻伐的药物。
柳诒按：见识老练恰当。
邓评：口干鼻塞，不免兼有外感。现在使用肾气丸，直接任用没有疑问，是因为脉象虚小的缘故，急则治其标。
久咳气喘不能平卧，颧骨发红，脚冷，胸满气逆，饥饿但不能进食。这是肺气实于上，肾虚于下，脾困于中的证候。然而实证不可攻伐，姑且治疗其虚证；中焦不可燥烈，姑且温补下焦。况且肾为胃之关，命门火为脾土之母，或许能有微小的补益，未可知也。
柳诒按：建议再用旋覆代赭汤送服，那么上焦和中焦两层，也可以贯通了。
邓评：肾气丸内有温中逐饮的含义，再合用旋覆代赭汤，能够上下同治，虚实兼顾。
孙评：这种议论岂是肤浅之人能说出的。
两手寸脉浮大，关尺脉沉小，气上逆不能下行，气喘咳嗽多痰。肝肾之气上冲于肺。应当用肾气丸，补益并引导其下行。
柳诒按：这是治本的方法。
邓评：病象完全显露在脉象上，谁说脉诊不足以凭信呢？
下虚上实，应当治疗下焦，不要清利上焦；真气回归本源，痰热自然下降。宜用十味肾气丸为主方。
柳诒按：见识卓越老练。
失血门
络脉热盛血液溢出，被寸口脉气所触动，不是阴虚火浮可比。千万不要用滋腻的药物来治疗。
柳诒按：辨证用药，眼光老辣准确。
邓评：疏风邪、清热、导瘀血，方剂极其轻灵中肯。如果用滋腻补剂，必然导致瘀热留滞灼伤而成劳损。
吐血因劳累和愤怒而发作，脉数稍细微呛咳。病位在肝心，由思虑劳心所致，应当及早谋划治疗，不要使病情延及肺部则吉利。
柳诒按：这是治疗吐血的正规方法。能止血而没有留下瘀血的弊端，最为稳妥。
孙评：吐血但不咳嗽，还可以除根。如果咳嗽虽然停止，但必会复发，这是关键的话。
复诊：前方去掉丹参、三七、藕汁、童便，加入生地、白芍、茺蔚子。
失血伴咳嗽气逆，心下痞满，傍晚发厥，血色暗，大便黑，肝脉独大。这是有瘀血，积留不去。不要治疗气机，宜调和血液。
柳诒按：这是专门治疗瘀积的方法。
邓评：此瘀积被肝木火气冲动，故导瘀同时泻火，选药绝不肤浅。建议再加阿胶以补肺，旋覆花以降逆，且能化瘀和络。
病后失血，血色紫黑不鲜亮。这是病前蓄积的瘀血，胸部仍然胀满，知道瘀血未尽。正气虽然虚弱，不可骤补，宜顺势而下之。
柳诒按：这必定还有郁热的症状，所以方中使用犀角。既然有留瘀未尽，可加醋炙大黄炭。
邓评：想必有舌质绛红、脉数、心胸烦热的症状，所以方中可用犀角。
柳师加味，在导瘀方面也很着力。
凡是体内有瘀血的人，阴液已伤，气机必然上逆，现在吐血紫黑量不多，而胸中满闷，说明瘀血未尽。舌绛无苔，这是阴液亏损。呕吐不止，则是气机上逆。且头重脚冷，有下虚上脱的忧虑。恶寒谵语，是阳气衰弱、气馁的征象。此证补之不对症，攻之不可行，确实棘手。
柳诒按：论病层层透彻，用药步步着实，这是高手。
孙评：血色紫黑，是瘀血的实据。此症得元因怒伤肝吗，还是风热内动呢，而又阴亏气馁，攻补仍属棘手。此方的制定，已非平庸手笔。
柳诒按：方剂也妥当。如果再进一层，可用金匮肾气法，以引导火气下行。
血液流失过多，气必然上逆，肺受到冲击，所以作咳嗽。这不是肺本身的病变。观察其冲气甚则咳甚，冲气缓则咳缓，就可以知道了。拟用摄降法，先治疗冲气。
柳诒按：辨证独到，方法老练恰当。
邓评：摄降冲气，附子不如肉桂，现在反而用附子去肉桂，为什么呢？
孙评：附子似乎也可去掉。只有镇摄的药物如磁石、五味子、白芍之类，应当加重。
脉象寸部静而尺部动，屡经失血，感觉气从下焦上冲则呛咳，劳动则气促不适。此病不在肺而在肾。治嗽无益，宜滋补肾阴。
心脉独大，口干易出汗，容易发怒血逆。这是心阴不足，心阳独亢。宜用犀角地黄汤。
邓评：此肝阳也未尝不亢。盖肝阳过升，脉乃上溢，溢则并火于心脉矣。白茅根宜换成丹皮。
痰中有散漫的血点，这是心病。口干心热，应当是伤暑，因为暑气喜归于心故耳。
葛可久论述吐血治法，每每在血止瘀消之后，用独参汤以益心定志。现在用滋阴药参入，担心其上升而助长肺热。
劳伤失血，心下痛闷，不应当当作阴虚证治疗。但脉数咳嗽潮热，恐怕其逐渐进入阴损一途。
治按：此证如果早服补涩药，则留瘀化热，最容易导致虚损。须看其虚实兼顾，绝不犯手。
邓评：此方以导瘀热为主。是二虚一实，先治其实的原则。
孙评：认定痛闷着笔。
点清血症致损的原因，使人豁然开朗。如此评论，有益于人不少。
闭藏不足而阳有余，肝气善逆而肺气多郁。脉数气喘咳逆，见血胁痛。治疗宜滋阴降逆，更宜静养；不然，恐怕其血逆不止。
离经之血未净，而郁于内，寒热之邪交煽，而扰乱其气，所以胸满呕泄，寒热口燥。治疗当理顺其乱气，引导其积血，元气虽虚，不可骤补。
邓评：这是失血中偶有的症状，所以绝少成法可遵。窃思失血之后，中气必虚，肝木火气必亢。就此见证，不但有寒热交煽之邪，抑且有土木相仇之意，戊己丸法亦可参用。至于柳师所加，固然未尝不好，方中牛膝可去掉。
久咳见血，声音嘶哑咽喉痛，忽有寒热。这是风寒久伏，伤肺成劳。拟用钱氏补肺法，声音发出则佳。
邓评：钱氏补肺法内用甜杏仁。此为风寒久伏，当以苦杏仁为准。若进步求治，可仿葛氏保和汤例。
又膏方：阿胶 贝母 甘草 橘红 杏仁 苏子 米糖 白蜜 姜汁 紫菀 木通 梨汁 桔梗 牛膝 萝卜汁 茯苓
柳诒按：此正虚邪实的证候，用药能两面兼顾，尚称稳适。
虚损门
虚损到饮食减少形体消瘦，应当以后天脾胃为重。异功散五六服，颇得增加谷食。今春半地气上升，肝木用事，热升心悸，汗出复咳，咳甚见血，肝阳上炽，络血遂沸。昨日进和阳养阴之剂，得木火稍平，仍以前方加白芍，制约朋火（指相火），安土（健脾）。
邓评：随机应变，是医生的能事。现在阳火内动，故须阴静之药以制约它，不要急于培土。
罗氏论述虚劳之证，多因邪伏血郁而得，不独阴亏一端也。临晚寒热，时减时增，其为阳陷入阴可知。滋肾生肝，最为合法，略加损益，不必更张。
柳诒按：于养阴中，加柴胡以达邪，佐鳖甲以搜阴。虚实兼顾，极为灵巧。然既云邪伏血郁，似宜加当归。
邓评：凡由寒热成劳者，惟罗氏立法为最善。今观此方，便觉更胜一筹，所谓在于临时权衡耳。所说血郁宜加当归，以其能活血疏邪。
孙评：邪伏血郁，浅学者每蛮补不已，致邪愈伏则阴愈伤，血愈郁则火益炽，虚劳死症成而至不可挽矣。实则仲景大黄庶虫丸、薯蓣丸、鳖甲煎丸三方，早示法则矣。
邪伏血郁，用当归之辛润者以透之，最切最妙之法也。柳氏于按语中申明之，省许摹拟矣。
复诊：热渐减，头中时痛，脉数不退，喉中痰滞不清。
邓评：此症肝阳已旺，头中时痛，想系柴胡太升，鼓即改用青蒿，且痰滞不清，有欲咳之状矣。
邓评：前之阳升，仍由阴虚，既体不发热，宜减去蒿、鳖，即有余邪，丹皮足以清之，或再加当归以疏托。
面色黧黑形体消瘦，脉虚而数，咳嗽气促，腰膝无力，大便时溏。这是先后天俱虚，虑其延成虚损。清润治肺之品，能戕害中气，勿更投也。
邓评：审见证，先天受伤为重，故用药以培补先天为要。
孙评：今人凡遇咳嗽，不察虚实，率用清润肃肺，不知能戕中气，反速其死。今指明其弊，有功不少。
络脉空隙，气必游行作痛，最虑春末夏初，地中阳气上升，血随气溢，趁此绸缪，当填精益髓。盖阴虚咳嗽，是他脏累及于肺，若治以清凉，不独病不去而胃伤食减，立成虚损，难为力矣。
熟地黄 金樱子膏 鹿角霜 五味子 湘莲子 山茱萸 山药 茯苓 海参（漂净熬膏）右为细末即以二膏捣丸。
邓评：看方药知有遗精之证，然与咳嗽合推，大都挟肝阳化火，上升下降所致；游行作痛，亦由乎此。方内鹿角霜恐有所碍，拟再加丹皮、白芍、牡蛎、旋覆花。
孙评：柳氏如是指明，省学者摹拟。
汗病门
汗出偏沮（半身出汗），脉来不柔，时自歇止。知肝阳有余，而胃阴不足，于是稠痰浊火，扰动于中，壅滞于外。目前虽尚安和，然古人治未病，不治已病。知者见微知著，须加意调摄为当。
柳诒按：此想系左半有汗，右半无汗之证。细绎案语，是防其将患偏痱之意。
孙评：柳氏如此指点，是真有书本功夫者。
心阴不足，心阳易动，则汗多善惊；肾阴不足，肾气不固，则无梦而泄。以汗为心液，而精藏于肾故也。
柳诒按：案语心肾并重，方药似专重于心。再加五味子、牡蛎、沙苑等摄肾之品，则周匝矣。
邓评：洞达病情，了无疑义。
原方已属乎妥，再加敛摄之品，尤为切实。
诸郁门
中年脘闷，多嗳多咳，此气郁不解也。纳谷已减，未可破泄耗气，宜从胸痹例，微通上焦之阳。
柳诒按：方法轻灵。
Cough with expectoration of froth, reduced appetite, nausea, and shortness of breath upon movement indicates injury to the Middle Qi (Middle Jiao energy). This cannot be cured by merely clearing the Lungs and treating the cough.
Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Maidong (Ophiopogonis Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Fuling (Poria), Jingmi (Oryzae Sativa Semen), Dazao (Ziziphi Jujubae Fructus)
Liu Yi's Note: This is a cough caused by Stomach deficiency. The formula follows the intent of the Da Banxia Tang (Major Pinellia Decoction) and Mai Men Dong Tang (Ophiopogon Decoction) from *Jin Gui Yao Lue*.
Deng's Commentary: The method is appropriate. If one also addresses the rebellious Chong Qi (Penetrating Vessel Qi), it would be more comprehensive. To subdue the Chong Qi, drugs such as Chenxiang (Aquilariae Lignum Resinatum), Geqiao (Tridacnae Concha), and Zishiying (Hematitum) can be used.
Cough with epistaxis. This is due to Yin insufficiency and internal stirring of Fire. With nausea and anorexia, the Stomach should be treated first.
Zhuru (Bambusae Caulis in Taenia), Jingmi (Oryzae Sativa Semen), Guangpi (Citri Reticulatae Pericarpium), Shihu (Dendrobii Caulis), Beimu (Fritillariae Bulbus), Xingren (Armeniacae Semen Amarum)
Treatment Note: Since there are signs of internal stirring of Fire causing epistaxis, heat-clearing and descending methods should be employed concurrently.
Deng's Commentary: It is suggested to add Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), and Lugen (Phragmitis Rhizoma) to clear and descend Lung and Stomach heat.
Sun's Commentary: Cebeiye (Platycladi Cacumen) and Maohua (Imperatae Spica) should be added.
Edema with cough and wheezing, stiffness and fullness in the neck and nape, inability to swallow fluids, and inability to urinate indicate a Lung disease. Instead of flowing downward, the Qi rebels upward, and the regulatory authority of the Lung (Zhi Jie) has failed. Even with good prescriptions, efficacy may be difficult to achieve.
Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs)
Liu Yi's Note: This is a syndrome of Phlegm-Qi congestion and obstruction, hence a heavy dose of Lung-draining agents is used.
Deng's Commentary: It is suggested to refer to the treatment methods for Fengshui (Wind-Water Edema).
The pulse is large at the Cun and Guan positions but small at the Chi position; there is dry mouth, rebellious Qi failing to descend, and cold feet that do not warm up. This indicates Yang Qi failing to anchor. One should use drugs containing Yang within Yin to treat this.
Liujun Wan (Six-Ingredient Pill with Rehmannia) plus Niuxi (Achyranthis Bidentatae Radix), Cheqian (Plantaginis Semen), Wuweizi (Schisandrae Fructus), Rougui (Cinnamomi Cortex).
Liu Yi's Note: This formula incorporates the intent of both Shenqi Wan (Kidney Qi Pill) and Duqi Wan (Nine-Ingredient Pill).
Deng's Commentary: Since Yang has lost its anchoring, using shell-type minerals (Jielei) to anchor Yang is appropriate. However, the use of Rougui and Wuweizi is only suitable if the pulse is large and open.
Sun's Commentary: Cold feet and knees are signs of deficient Yang floating upward and failing to anchor. One should tonify the Middle and assist in guiding Yang back to its origin. This formula is correct; remember this well.
The pulse rate slows, and the cough eases. However, the floating Qi does not fully return to its root. One should tonify the Lower Jiao to provide a foundation for Qi reception.
Liujun Wan plus Wuweizi (Schisandrae Fructus), Tusizi (Cuscutae Semen).
Another Pill Formula: Liujun Wan plus Wuweizi (Schisandrae Fructus), Duzhong (Eucommiae Cortex), Qianshi (Euryales Semen), Lianxu (Nelumbinis Plumula), Tusizi (Cuscutae Semen), Gouqi (Lycii Fructus), made into pills with honey. Take 5 qian per dose.
Liu Yi's Note: The discussion is steady and practical, and the prescription is appropriate.
Deng's Commentary: Treating upper disorders by targeting the lower reflects the principle of seeking the root in disease treatment.
Observing this formula suggests the patient likely has symptoms of sore waist and turbid essence.
*Case Record*: Wheezing, cold feet extending to the knees, dry lips and mouth, nasal congestion, and a deficient-small pulse. Rebellious Qi descending improperly indicates the disease is rooted in the fundamental organs. Do not indiscriminately use clearing and purging agents just because there is congealed phlegm in the neck.
Shenqi Wan (Kidney Qi Pill) 3 qian, taken with salt water.
Liu Yi's Note: The insight is mature and appropriate.
Deng's Commentary: Dry mouth and nasal congestion suggest a concurrent exterior contraction. The direct use of Shenqi Wan without hesitation is justified by the deficient-small pulse; this addresses the acute aspect first.
Chronic cough and wheezing preventing lying flat, malar flush, cold feet, chest fullness and rebellious Qi, hunger but inability to eat. This is a presentation of Lung excess above, Kidney deficiency below, and Spleen distress in the middle. However, excess cannot be attacked directly; temporarily treat the deficiency. The Middle cannot be dried harshly; temporarily warm the Lower Jiao. Moreover, the Kidney is the gate of the Stomach, and Fire is the mother of Earth (Spleen); perhaps slight tonification will yield results.
Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet)
Liu Yi's Note: It is suggested to take this with Xuanfu Daizhe Tang (Inula and Hematite Decoction) to connect the Upper and Middle layers.
Deng's Commentary: Shenqi Wan contains the meaning of warming the Middle and driving out fluid retention. Combined with Xuanfu Daizhe Tang, it treats both upper and lower, and both deficiency and excess.
Sun's Commentary: Such discussions cannot be articulated by superficial practitioners.
Both Cun pulses are floating and large; Guan and Chi pulses are deep and small. Qi rebels upward without descending, accompanied by wheezing, coughing, and copious phlegm. Liver and Kidney Qi rush upward to the Lungs. Use Shenqi Wan to tonify and guide it downward.
Shenqi Wan (Kidney Qi Pill)
Liu Yi's Note: This is a method of treating the root.
Deng's Commentary: The pathological manifestations are fully revealed in the pulse; who says pulse diagnosis is unreliable?
Lower deficiency and upper excess require treating the lower, not clearing the upper. When True Qi returns to its origin, Phlegm-Heat will naturally descend. Use Shiwei Shenqi Wan (Ten-Ingredient Kidney Qi Pill) as the main formula.
Shiwei Shenqi Wan (Ten-Ingredient Kidney Qi Pill)
Liu Yi's Note: The insight is excellent and mature.
Deng's Commentary: If the deficiency lies primarily in the Yin aspect, this method is not suitable.
Chapter on Blood Loss
Heat in the collaterals causes blood overflow, triggered by Qi contact at the Cun position; this is not comparable to Yin deficiency with floating Fire. Do not use cloying and greasy tonics.
Jingjie (Schizonepetae Herba), Danpi (Moutan Cortex), Chongwezi (Leonuri Fructus), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Yujin (Curcumae Radix), Ouji (Nelumbinis Nelumbo), Xi Shengdi (Young Rehmanniae Radix), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized).
Liu Yi's Note: The differentiation and medication show sharp, experienced eyesight.
Deng's Commentary: Dispersing pathogens, clearing heat, and guiding stasis makes the formula extremely light and effective. Using cloying tonics would inevitably cause stasis and heat to linger and burn, leading to consumptive disease.
Hematemesis triggered by labor and anger, with a slightly rapid and fine pulse and mild choking. The disease is in the Liver and Heart, caused by overthinking and mental fatigue. Plan early treatment to prevent extension to the Lungs for a favorable outcome.
Ejiao (Colla Corii Asini), Danpi (Moutan Cortex), Niuxi (Achyranthis Bidentatae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Sanqi (Notoginseng Radix), Ouji (Nelumbinis Nelumbo), Tongbian (Infant Urine).
Liu Yi's Note: This is the orthodox method for treating hematemesis. It stops bleeding without leaving stasis, making it very safe.
Sun's Commentary: Hematemesis without cough can be rooted out. If the cough stops but recurs, that is the critical point.
Second Visit: Remove Danshen, Sanqi, Ouji, and Tongbian from the previous formula; add Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), and Chongwezi (Leonuri Fructus).
Another Pill Formula: Liujun Wan plus Ejiao (Colla Corii Asini), Wuweizi (Schisandrae Fructus), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Lianxu (Nelumbinis Plumula), made into pills with water.
Deng's Commentary: Guiding stasis is the primary step, followed by nourishing Yin for recovery. Reviewing the three visits, the steps are orderly.
Blood loss with cough and rebellious Qi, epigastric fullness, evening syncope, dark blood color, black stools, and an isolated large Liver pulse. This indicates retained blood stasis that has not been expelled. Do not treat the Qi; harmonize the Blood.
Zhi Dahuang (Prepared Rhei Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Taoren (Persicae Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Danpi (Moutan Cortex), Jiangxiang (Dalbergiae Odoriferae Lignum).
Liu Yi's Note: This is a specific method for treating stasis accumulation.
Deng's Commentary: This stasis accumulation is stirred by Wood-Fire. Guiding stasis is combined with draining fire; the drug selection is far from superficial. It is suggested to add Ejiao (Colla Corii Asini) to tonify the Lung, and Xuanfuhua (Inulae Flos) to descend rebellious Qi and resolve stasis and harmonize collaterals.
Sun's Commentary: Add Suzi (Perillae Fructus) and Ouji (Nelumbinis Nelumbo).
Post-illness blood loss with dark purple blood indicates pre-existing accumulation. Chest fullness confirms incomplete stasis resolution. Although Zheng Qi (Upright Qi) is deficient, sudden tonification is contraindicated; instead, guide it downward smoothly.
Xiaoji Tan (Artemisiae Capillaris Herba Carbonized), Chishao (Paeoniae Radix Rubra), Shengdi (Rehmanniae Radix), Xijiao (Rhinocerotis Cornu - *Note: Substitute with Water Buffalo Horn/Shuiniujiao in modern practice*), Yujin (Curcumae Radix), Danpi (Moutan Cortex), Chongwezi (Leonuri Fructus), Tongbian (Infant Urine).
Liu Yi's Note: There must be signs of latent heat, hence the use of Xijiao (Rhinoceros Horn) in the formula. Given the unresolved stasis, Cu Zhi Dahuang Tan (Vinegar-processed Rhubarb Charcoal) can be added.
Deng's Commentary: There must be a crimson tongue, rapid pulse, and chest/heart irritability, justifying the use of Xijiao (Rhinoceros Horn).
Master Liu's additions focus heavily on guiding stasis.
In cases of blood stasis, Yin is already injured, and Qi necessarily rebels. Now, hematemesis is dark purple with little volume, and chest fullness indicates unresolved stasis. A crimson tongue without coating shows Yin deficiency. Persistent vomiting indicates Qi rebellion. Head heaviness and cold feet suggest lower deficiency and upper collapse. Aversion to cold and delirious speech indicate weak Yang and depleted Qi. Tonification is inappropriate, and attack is impossible; this case is indeed tricky.
Renshen (Ginseng Radix), Fuling (Poria), Sanqi (Notoginseng Radix), Wuzhuyu (Evodiae Fructus), Wumei (Mume Fructus), Muli (Concha Ostreae), Chuanlian (Coptidis Rhizoma), Yujin (Curcumae Radix).
Liu Yi's Note: The disease analysis penetrates layer by layer, and the medication is solid step-by-step; this is the work of a master.
Sun's Commentary: Dark purple blood is solid evidence of stasis. Was this case caused by anger injuring the Liver, or wind-heat stirring internally, compounded by Yin deficiency and Qi depletion? Attack and tonification remain tricky. The formulation of this prescription is beyond mediocre skill.
After blood loss, Qi rebels upward from below, with cold feet and hot head. The disease is in the Lower Jiao, and True Qi fails to receive.
Liujun Wan plus Wuweizi (Schisandrae Fructus), Niuxi (Achyranthis Bidentatae Radix), Muli (Concha Ostreae).
Liu Yi's Note: The formula is appropriate. Advancing further, Jin Gui Shenqi Fa (Kidney Qi Method) could be used to guide Fire downward.
Deng's Commentary: Do not rigidly adhere to Qi-descending examples; this requires profound insight.
Excessive blood loss causes Qi to rebel upward, impacting the Lungs and causing cough. This is not a primary Lung disease. Observing that severe Chong Qi rebellion causes severe cough, and mild rebellion causes mild cough, confirms this. Propose a grasping and descending method, treating the Chong Qi first.
Jin Gui Shenqi Wan minus Rougui (Cinnamon Bark), plus Muli (Concha Ostreae).
Liu Yi's Note: The differentiation is precise, and the method is mature.
Deng's Commentary: To grasp and descend Chong Qi, Fuzi (Aconite) is inferior to Rougui (Cinnamon). Why use Fuzi and remove Rougui here?
Sun's Commentary: Fuzi might also be removed. Drugs for calming and anchoring, such as Cishi (Hematitum), Wuweizi (Schisandrae Fructus), and Baishao (Paeoniae Radix Alba), should be increased in dosage.
The Cun pulse is quiet while the Chi pulse is active. After repeated blood loss, Qi rushing up from the Lower Jiao causes choking, and exertion causes shortness of breath. The disease is not in the Lung but in the Kidney. Treating the cough is useless; nourish Kidney Yin.
Shudi (Prepared Rehmanniae Radix), Tianma (Gastrodiae Rhizoma), Muli (Concha Ostreae), Fuling (Poria), Gouqi (Lycii Fructus), Yurou (Corni Fructus), Wuweizi (Schisandrae Fructus).
Liu Yi's Note: The disease is the same as the previous case. The use of Tianma (Gastrodia) in the formula is unclear.
Deng's Commentary: The previous case involved Fluid Retention; this case emphasizes Yin Deficiency. Tianma in the formula is suspected to be a typo for Tiandong (Asparagi Radix).
An isolated large Heart pulse, dry mouth, easy sweating, irritability, and blood rebellion indicate Heart Yin deficiency and isolated Heart Yang hyperactivity. Use Xijiao Dihuang Tang (Rhino-Corn and Rehmannia Decoction).
Xijiao Dihuang Tang plus Maogen (Imperatae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Shanzhi (Gardeniae Fructus).
Liu Yi's Note: The plans are concise and fitting.
Deng's Commentary: Liver Yang is likely hyperactive as well. Excessive rising of Liver Yang causes the pulse to overflow, merging Fire into the Heart pulse. Maogen (Imperatae Rhizoma) should be replaced with Danpi (Moutan Cortex).
Scattered blood spots in sputum indicate a Heart disease. Dry mouth and heart heat suggest Summerheat injury, as Summerheat tends to enter the Heart.
Shengdi (Rehmanniae Radix), Fushen (Poria with Hostwood), Bidou (Dolichoris Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex), Zhuru (Bambusae Caulis in Taenia), Maidong (Ophiopogonis Radix), Ouji (Nelumbinis Nelumbo).
Liu Yi's Note: The method is clear, spiritual, and pleasing.
Deng's Commentary: Scattered blood spots represent Heart Collateral blood. Shengdi should be Fresh Rehmannia (Xian Shengdi).
Ge Kejiu discussed treating hematemesis, often using Dushen Tang (Single Ginseng Decoction) to tonify the Heart and stabilize the Spirit after bleeding stops and stasis clears. Here, Yin-nourishing drugs are added, worrying that they might ascend and aid Lung heat.
Renshen (Ginseng Radix), Shashen (Glehniae Radix), Shengdi (Rehmanniae Radix), Ejiao (Colla Corii Asini), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria).
Liu Yi's Note: This is the standard method for using Renshen after blood loss.
Deng's Commentary: Combining with Yin-nourishing drugs is superior to Dushen Tang alone.
Consumption-related blood loss with epigastric pain and oppression should not be treated as Yin deficiency. However, a rapid pulse, cough, and tidal fever suggest a gradual progression toward Yin damage.
Shengdi (Rehmanniae Radix), Taoren (Persicae Semen), Zhaca (Crataegi Fructus Carbonized), Yujin (Curcumae Radix), Chishao (Paeoniae Radix Rubra), Zhi Dahuang (Prepared Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex).
Treatment Note: If astringents and tonics are taken early in this case, stasis will remain and transform into heat, easily leading to consumption. One must address both deficiency and excess carefully, avoiding errors.
Deng's Commentary: This formula focuses on guiding stasis and heat. It follows the principle of treating excess first in a pattern of two deficiencies and one excess.
Sun's Commentary: Focuses on the pain and oppression.
Clarifying the causes of consumptive disease in blood disorders brings clarity. Such commentary is highly beneficial.
Insufficient closure with excess Yang, Liver prone to rebellion, and Lung prone to depression. Rapid pulse, wheezing, cough, blood appearance, and hypochondriac pain. Treatment should involve nourishing and descending, along with rest. Otherwise, blood rebellion may persist.
Xiao Shengdi (Young Rehmanniae Radix), Jingjie Tan (Schizonepetae Herba Carbonized), Baishao (Paeoniae Radix Alba), Tongbian (Infant Urine), Yujin (Curcumae Radix), Ouji (Nelumbinis Nelumbo), Xiaoji Tan (Artemisiae Capillaris Herba Carbonized).
Liu Yi's Note: This is also a syndrome of Qi and Fire rebelling upward. Niuxi (Achyranthis Bidentatae Radix) and Danpi (Moutan Cortex) can be added.
Deng's Commentary: This is Wind-Heat combining with Wood-Fire, depressing and rebelling into the Lung collaterals; thus, the method must be light and delicate.
Unresolved blood outside the vessels stagnates internally; Cold-Heat pathogens stir each other and disrupt Qi, causing chest fullness, vomiting, diarrhea, chills, fever, and dry mouth. Treatment should regulate the disrupted Qi and guide the accumulated blood. Although Yuan Qi (Original Qi) is deficient, sudden tonification is contraindicated.
Danpi (Moutan Cortex), Zhaca (Crataegi Fructus Carbonized), Zelan (Lycopus Herba), Chishao (Paeoniae Radix Rubra), Yujin (Curcumae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Xiaoji (Artemisiae Capillaris Herba).
Liu Yi's Note: This case involves external pathogens. Jingjie Tan (Schizonepetae Herba Carbonized) and Heidouyi (Sojae Semen Nigrum Testa) can be added.
Deng's Commentary: This is an occasional symptom in blood loss, so few established formulas apply. After blood loss, Middle Qi is definitely deficient, and Wood-Fire is hyperactive. Beyond the Cold-Heat interaction, there is a conflict between Wood and Earth; Wuji Wan (Five-Ingredient Pill) could be considered. Master Liu's additions are good, but Niuxi (Achyranthis Bidentatae Radix) in the formula can be removed.
Sun's Commentary: Charred Jingjie disperses external Wind and guides stasis, showing great ingenuity.
Chronic cough with blood, hoarseness, sore throat, and alternating chills and fever indicate long-standing潜伏 Cold-Wind injuring the Lung, leading to consumption. Use Qian's Lung-Tonifying Method; voice return indicates improvement.
Ejiao (Colla Corii Asini), Xingren (Armeniacae Semen Amarum), Madouling (Aristolochiae Fructus), Niubang (Arctii Fructus), Yiren (Coicis Semen), Beimu (Fritillariae Bulbus), Nuomi (Oryzae Sativa Germen).
Deng's Commentary: Qian's Lung-Tonifying Method uses sweet Almond. For long-standing Cold-Wind, bitter Almond is appropriate. For progressive treatment, follow Ge's Baohe Tang example.
Another Paste Formula: Ejiao (Colla Corii Asini), Beimu (Fritillariae Bulbus), Gancao (Glycyrrhizae Radix et Rhizoma), Juhong (Citri Reticulatae Pericarpium Flavum), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), Mitang (Sugar from Rice), Bami (White Honey), Jiangzhi (Zingiberis Rhizoma Recens Juice), Ziwan (Asternatis Radix), Mutong (Akebiae Caulis), Lizhi (Pyriformis Fructus), Jiegeng (Platycodonis Radix), Niuxi (Achyranthis Bidentatae Radix), Luobozhi (Raphani Semen).
Liu Yi's Note: This is a case of Righteous Qi deficiency and Pathogenic Excess. The medication balances both sides, remaining stable and appropriate.
Deng's Commentary: Light and appropriate, likely a variation of Baohe Tang.
Chapter on Consumption and Damage
When consumption leads to reduced food intake and emaciation, priority must be given to the Post-Heaven Spleen and Stomach. Several doses of Yigong San (Extraordinary Power Powder) have improved appetite. In mid-spring, Earth Qi rises, and Liver Wood dominates. Rising Heat causes palpitations, sweating, and recurrent cough. Severe coughing leads to blood appearance due to blazing Liver Yang and boiling collateral blood. Yesterday, a formula harmonizing Yang and nourishing Yin was administered, slightly calming Wood-Fire. Continue with the previous formula plus Baishao (Paeoniae Radix Alba) to control Minister Fire and calm the Earth.
Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Ejiao (Colla Corii Asini), Nvzhenzi (Ligustri Lucidi Fructus), Gancao (Glycyrrhizae Radix et Rhizoma).
Liu Yi's Note: The formula is stable. Muli (Concha Ostreae) and Danpi (Moutan Cortex) can be added.
Deng's Commentary: Adapting to changes is the physician's skill. With internal Yang-Fire stirring, Yin-stilling drugs are needed to control it. Do not rush to tonify Earth.
Sun's Commentary: Master Liu's addition also harmonizes Yang and nourishes Yin.
Luo Shi discusses consumptive disease, often caused by latent pathogens and blood stasis, not just Yin deficiency. Evening chills and fever, fluctuating in intensity, indicate Yang sinking into Yin. Zishen Shengan (Nourishing Kidney and Generating Liver) is most appropriate. Minor adjustments suffice; no need for major changes.
Shudi (Prepared Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Danpi (Moutan Cortex), Shanyao (Dioscoreae Rhizoma), Chaihu (Bupleuri Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Biejia (Testudinis Carapax et Plastrum).
Liu Yi's Note: Adding Chaihu (Bupleuri Radix) to reach pathogens and Biejia (Testudinis Carapax et Plastrum) to search for Yin within Yin-nourishing herbs addresses both deficiency and excess cleverly. However, since it mentions latent pathogens and blood stasis, Danggui (Angelicae Sinensis Radix) should arguably be added.
Deng's Commentary: For consumption arising from chills and fever, Luo Shi's legislation is best. This formula seems even better, relying on temporary weighing of factors. Adding Danggui (Angelicae Sinensis Radix) for blood stasis is correct as it invigorates blood and disperses pathogens.
Sun's Commentary: Superficial practitioners often blindly tonify latent pathogens and blood stasis, causing pathogens to hide deeper, Yin to injure more, blood to stagnate more, and Fire to blaze more, leading to fatal consumption. Actually, Zhang Zhongjing's Dacheng Chang Wan, Shuyu Wan, and Biejia Jian Wan have long shown the rules.
Using the pungent and moistening properties of Danggui (Angelicae Sinensis Radix) to penetrate latent pathogens and blood stasis is the most pertinent and wonderful method. Master Liu clarifies this in his notes, saving others from imitation.
Replacing Shudi (Prepared Rehmanniae Radix) with Shengdi (Rehmanniae Radix) is excellent.
Second Visit: Heat gradually subsides, intermittent headache, persistent rapid pulse, and unclear phlegm stagnation in the throat.
Qinghao (Artemisiae Annuae Herba), Danpi (Moutan Cortex), Shudi (Prepared Rehmanniae Radix), Biejia (Testudinis Carapax et Plastrum), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Xiaomai (Tritici Fructus).
Liu Yi's Note: Clearing phlegm stagnation should be addressed concurrently. Replacing Shudi (Prepared Rehmanniae Radix) with Shengdi (Rehmanniae Radix) in both formulas is safer.
Deng's Commentary: Liver Yang is already hyperactive; the intermittent headache may be due to Chaihu being too ascending. Switching to Qinghao (Artemisiae Annuae Herba) is timely. The unclear phlegm suggests impending cough.
Third Visit: Although the body is not hot, the pulse remains fine and rapid. Nourish Yin Qi.
Liujun Wan minus Yurou (Corni Fructus) and Zexie (Alismatis Rhizoma), plus Baishao (Paeoniae Radix Alba), Niuxi (Achyranthis Bidentatae Radix), Qinghao (Artemisiae Annuae Herba), Biejia (Testudinis Carapax et Plastrum).
Deng's Commentary: Previous Yang rising was due to Yin deficiency. Since the body is not hot, remove Qinghao and Biejia. If residual pathogens remain, Danpi (Moutan Cortex) is sufficient to clear them, or add Danggui (Angelicae Sinensis Radix) to disperse and support.
Dark complexion, emaciation, deficient and rapid pulse, cough with shortness of breath, weak waist and knees, and loose stools indicate deficiency of both Pre-Heaven and Post-Heaven sources, fearing progression to consumption. Cooling and moistening Lung treatments damage Middle Qi; do not administer further.
Ziheche (Placenta Humana), Shudi (Prepared Rehmanniae Radix), Shanyao (Dioscoreae Rhizoma), Yurou (Corni Fructus), Wuweizi (Schisandrae Fructus), Danpi (Moutan Cortex), Fuling (Poria), Duzhong (Eucommiae Cortex), Zexie (Alismatis Rhizoma), Niuxi (Achyranthis Bidentatae Radix), made into pills with honey. Take 5 qian per dose.
Liu Yi's Note: The case summary highlights the key points of treating deficiency; the formula is also precise.
Deng's Commentary: Assessing the symptoms, Pre-Heaven injury is severe; thus, medication should prioritize tonifying Pre-Heaven.
Sun's Commentary: Nowadays, physicians encounter coughs without distinguishing deficiency or excess, routinely using cooling and moistening Lung-astringents. They do not realize these damage Middle Qi and accelerate death. Pointing out this flaw is of great merit.
Collateral gaps allow Qi to wander and cause pain. One must fear late spring and early summer when Earth Yang rises, causing Blood to overflow with Qi. Taking advantage of this time to consolidate, one should fill Essence and marrow. Yin-deficient cough is often caused by other organs affecting the Lung. Treating with cooling agents not only fails to cure the disease but damages the Stomach, reduces appetite, and immediately leads to consumption, which is hard to reverse.
Shudi (Prepared Rehmanniae Radix), Jinyingzi Gao (Cherokee Rose Fruit Paste), Lujiaoshuang (Cervi Cornu Degelatinatum), Wuweizi (Schisandrae Fructus), Xianglianzi (Nelumbinis Semen), Yurou (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Haishen (Holothuria - cleaned and boiled into paste). Grind all into fine powder and mix with the two pastes to make pills.
Liu Yi's Note: There must be symptoms like spermatorrhea and sore waist; hence, the medication does not focus on cough.
Deng's Commentary: The herbs indicate spermatorrhea. Combined with cough, this largely involves Liver Yang transforming into Fire, causing rising and falling issues; wandering pain is also due to this. Lujiaoshuang (Cervi Cornu Degelatinatum) in the formula may be obstructive. It is suggested to add Danpi (Moutan Cortex), Baishao (Paeoniae Radix Alba), Muli (Concha Ostreae), and Xuanfuhua (Inulae Flos).
Sun's Commentary: Master Liu's clarification saves scholars from imitation.
Chapter on Sweating Disorders
Hemihidrosis (sweating on one side), non-supple pulse, and intermittent stopping indicate excess Liver Yang and insufficient Stomach Yin. Consequently, thick phlegm, turbid fire, disturb internally and obstruct externally. Although currently peaceful, ancients treated disease before it arose, not after it appeared. Wise people see the significant from the subtle; careful regulation is appropriate.
Renshen (Ginseng Radix), Chuan Shihu (Dendrobii Caulis), Maidong (Ophiopogonis Radix), Nanzao (Ziziphi Jujubae Fructus), Zhi Banxia (Prepared Pinelliae Rhizoma), Danpi (Moutan Cortex), Fuling (Poria), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Xiaomai (Tritici Fructus).
Liu Yi's Note: This is likely hemihidrosis with sweating on the left and none on the right. Analyzing the case notes, it aims to prevent Bioplegia (Hemiplegia).
Deng's Commentary: This follows the Mai Men Dong Tang (Ophiopogon Decoction) method from *Jin Gui*. Utilizing ancient formulas with adaptation and appropriate modifications.
Sun's Commentary: Master Liu's guidance shows true scholarly foundation.
Heart Yin deficiency allows Heart Yang to move easily, causing excessive sweating and fright; Kidney Yin deficiency fails to secure Kidney Qi, causing nocturnal emission without dreams. Sweat is the fluid of the Heart, and Essence is stored in the Kidney.
Shengdi (Rehmanniae Radix), Fushen (Poria with Hostwood), Gancao (Glycyrrhizae Radix et Rhizoma), Maidong (Ophiopogonis Radix), Chuanlian (Coptidis Rhizoma), Baizi Ren (Platycladi Semen), Yuanshen (Scrophulariae Radix), Xiaomai (Tritici Fructus), Dazao (Ziziphi Jujubae Fructus).
Liu Yi's Note: The case notes emphasize both Heart and Kidney, but the formula seems focused on the Heart. Adding Wuweizi (Schisandrae Fructus), Muli (Concha Ostreae), and Shayuan (Astragali Complanati Semen) to secure the Kidney would make it comprehensive.
Deng's Commentary: Thorough understanding of the pathology, without doubt.
The original formula is adequate; adding astringent and securing agents makes it even more practical.
Chapter on Various Depressions
Epigastric oppression in middle age, frequent belching and coughing, indicates unresolved Qi Depression. Reduced food intake means breaking and draining Qi is contraindicated. Follow the approach for Xiongbi (Chest Bi), gently unblocking Upper Jiao Yang.
Xiebai (Allii Macrostemonis Bulbus), Gualou (Trichosanthis Fructus), Banxia (Pinelliae Rhizoma), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Jiangzhi (Zingiberis Rhizoma Recens Juice).
Liu Yi's Note: The method is light and delicate.
Deng's Commentary: The disease is caused by Phlegm-Qi intermingling obstruction, with Lung and Stomach failing to govern descending. It is suggested to add Pipaye (Eriobotryae Folium), Zhuru (Bambusae Caulis in Taenia), and Xuanfuhua (Inulae Flos).
Depressed Qi condensing in the throat, unable to swallow or spit out, is the beginning of Meiheqi (Plum-Pit Qi).
Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), Fuling (Poria), Sugeng (Perillae Caulis), Xuanfuhua (Inulae Flos), Juhong (Citri Reticulatae Pericarpium Flavum), Pipaye (Eriobotryae Folium), Jiangzhi (Zingiberis Rhizoma Recens Juice).
Liu Yi's Note: Adding Xuanfuhua (Inulae Flos) and Pipaye (Eriobotryae Folium) to the established formula from *Jin Gui* shows great ingenuity.