江（左） 嗜饮中虚，气失旋运，水谷之气，不化为津，转化为痰。痰阻营卫，寒热交作，必得便解粘腻，痰尽
方舒。食入后中脘久痞。脉形濡弱。脾胃愈亏，则浊痰愈甚，前人有见痰休治痰之说，宜以脾胃为本。
别直参（另煎冲一钱） 炒于术（二钱） 陈橘皮（一钱） 炒竹茹（一钱） 制半夏（一钱五分） 白茯苓
（三钱） 生薏仁（三钱） 炒枳实（一钱） 缩砂仁（五分后下） 生熟谷芽（各一钱五分）
李（左） 肝木不和，腹胀脘痞不纳，时发时止，甚则心神恍惚。脉左关独弦。此厥气失疏，风阳扰攘也。
金铃子 白蒺藜 广郁金 广皮 砂仁 白芍
制香附 炒枳壳 朱茯神 炒枣仁 香橼皮
袁（右） 痞满大退，而少腹滞坠不舒。此气湿不泛于上，而压于下。再为疏通。
制香附 薤白头 云茯苓 陈皮 沉香片 整砂仁 制半夏 建泽泻 煨天麻 猪苓
二诊 少腹滞坠已舒，而右胁胀满。无非痰气窒塞。
制半夏 制香附 栝蒌仁 淡干姜 川雅连 云茯苓 炒竹茹 薤白头 白金丸
姜（左） 气虚湿痰内阻，营卫不克宣通。往来寒热，误投阴腻之物，寒热虽止，而脘痞少腹满，腿肢作酸。
此阳气不克营运。恐成胀病。
上安桂（三分饭丸） 制香附（二钱） 制半夏（二钱） 薤白头（三钱） 连皮苓（三钱） 山楂炭（四钱）
半硫丸（八分药汤送下）
陆（左） 胃气渐开，而食入后每觉痞满，片刻即舒，平日往往涌吐酸涎。舌苔虽渐化薄，而尚嫌黄浓。良
以中阳不足，湿痰不克运化。拟温理中阳。
奎党参（二钱） 蜜炙干姜（三分） 生薏仁（三钱） 橘白（一钱） 泽泻（一钱五分） 炒于术（一钱五分）
云茯苓（三钱） 制半夏（一钱） 玫瑰花（去蒂二朵）
二诊 补气温中，舌苔化清。的是中虚湿热不克旋运。但时为不寐，良以胃有湿痰，胆寒肝热也。
台参须（八分） 制半夏（一钱五分） 橘皮（一钱） 广藿香（一钱五分） 炒枳实（八分） 姜竹茹（一钱）
白茯苓（三钱） 生熟谷芽（各一钱） 缩砂仁（四分） 玫瑰花（二朵）
某 不纳不饥，稍稍纳食，中焦如阻，泛酸欲吐，寤难成寐。脉细濡，关部带滑。此湿热郁阻中州，致脾清
不升，胃浊不降。六腑以通为用，宜辛以开之。
制半夏 干姜 茯苓 焦麦芽 竹茹 上广皮 川连 泽泻 佩兰叶
二诊 辛开苦降，中脘较舒，泛酸呕吐之势稍缓。然犹杳不思纳，略进稀糜，尚觉胀满，腹中攻撑不和，
大便不解，寤难成寐。脉右部弦滑。胃府之气，略得通降，而肝肠暗动，遂令木郁土中。前法再参平肝泄木。
川雅连（淡吴萸同炒） 制半夏 茯苓神 金铃子 延胡索 广陈皮 炒枳壳 炒竹茹
三诊 胀满较舒，痞阻稍松，吐出稠痰，寤得成寐，饮食得以渐进。但脉象尚带弦滑，舌红苔黄。肝胃不
能和洽，从效方再望应手。
川楝子 制香附 茯苓神 制半夏 鲜竹茹 延胡索 小青皮 薤白头 左金丸
四诊 两和肝胃之气，似觉稍和，而胸脘仍然胀满，心胸之间，时觉烙热，痰中带红。脉左寸关带弦，尺
部数细，右寸关弦滑，尺部坚硬，舌苔白腻，而底质带红。前人谓气有余、便是火，所以心胸烙热者，良由
肝胃之气不和，气郁生火，气之所在，即火之所在也。再理肝胃之气，而和肝胃之阴。
金石斛 白蒺藜 蜜炒青皮 黑山栀 郁金 半夏曲
金铃子 土炒白芍 炒杏仁 竹茹
五诊 脉左寸关弦象稍退，右关脉弦滑亦稍柔和。胀满渐舒，略能安谷。再从肝胃调和。
金石斛 制半夏 杭白芍 茯苓 炒香豉 金铃子 广陈皮 白蒺藜 山栀 降香
六诊 两关弦象稍柔。胃纳亦日见起色，胀满已舒。但舌苔中心浓 ，微带黑色。仍当从于肝胃议治。
制半夏 金石斛 白芍 白茯苓 黑山栀 薄橘红 沉香曲 丹皮 炒杏仁 炒竹茹
某 中气虚弱，不饥不纳，二便不利，中脘痞阻，卧难成寐。脉细而滑，口腻苔浊。湿热郁阻，升降
失司。拟开上焦。
制半夏 郁金 川雅连 光杏仁 炒枳实 广陈皮 干姜 薤白头 佩兰叶 栝蒌皮 炒竹茹
二诊 中脘痞阻，饮食不进，口腻痰多。脉象濡滑。浊阻胃中。先为通降。
藿香 制半夏 金石斛 广皮 茯苓 佩兰叶
川朴 大腹皮 栝蒌皮 枳实 鲜佛手 竹茹
三诊 通降胃府，仍然不纳，略一进谷，辄中脘不舒，味变酸浊。脉象濡滑。痰湿闭阻胃口。再降胃化痰，
而宣气郁。
香豆豉 炒杏仁 黑山栀 栝蒌皮 降香屑（四分） 上川朴 制半夏 炒枳壳 生姜汁
四诊 脉象濡细，重按少力，舌苔白腻不化。不纳不饥。中气不足，不能化浊。再扶持中气，而展胃阳。
人参须 制半夏 橘白 佩兰叶 炒谷芽 益智仁 云茯苓 玫瑰花 鲜竹茹 砂仁（二粒）
五诊 扶持中气，而展胃阳，稍能知饥安谷。药既应手，宜再扩充。
人参须（八分） 淡姜渣（三分） 茯苓（三钱） 佩兰叶（八分） 玫瑰花（二朵） 益智仁（六分）
制半夏（一钱五分） 橘白（一钱） 焦麦芽（二钱）
六诊 胃气虽得稍醒，然略一多纳，气辄上冲。脉濡细，右关带滑。中气不足，不能运化，以致湿热结聚，
通降无权。拟苦辛开通。
制半夏（一钱五分） 川连（四钱） 藿香（一钱五分） 枳实（一钱） 佩兰叶（一钱） 橘皮（一钱）
干姜（二分） 茯苓（三钱） 竹茹（一钱）
江某（左侧脉象）：长期嗜酒导致中焦脾胃虚弱，气机失去正常的旋转运化功能，水谷精微不能转化为津液，反而凝聚成痰。痰浊阻滞营卫之气，导致寒热交替发作，必须等到排便排出粘腻之物，痰浊排尽后身体才能感到舒适。进食后中脘部位长时间痞塞不适。脉象表现为濡弱。脾胃越亏虚，则浊痰越严重，前人曾有“见到痰证不要只治痰”的说法，治疗应当以调理脾胃为根本。
处方：别直参（另煎冲服一钱）、炒白术（二钱）、陈皮（一钱）、炒竹茹（一钱）、制半夏（一钱五分）、白茯苓（三钱）、生薏苡仁（三钱）、炒枳实（一钱）、缩砂仁（五分，后下）、生谷芽和熟谷芽（各一钱五分）。
李某（左侧脉象）：肝木之气不和，出现腹胀、胃脘痞塞、食欲不振，症状时发时止，严重时甚至心神恍惚。左关脉独显弦象。这是厥逆之气失于疏泄，风阳扰动所致。
处方：金铃子、白蒺藜、广郁金、广陈皮、砂仁、白芍、制香附、炒枳壳、朱茯神、炒酸枣仁、香橼皮。
袁某（右侧脉象）：痞满症状已大幅消退，但少腹部仍有滞重坠胀的不适感。这是因为气湿没有泛溢于上，而是压迫于下部。再次采用疏通之法。
处方：制香附、薤白头、云茯苓、陈皮、沉香片、整砂仁、制半夏、建泽泻、煨天麻、猪苓。
第二次就诊：少腹部的滞重坠胀感已经舒缓，但右胁部出现胀满。这无非是痰气窒塞所致。
处方：制半夏、制香附、栝蒌仁、淡干姜、川雅连、云茯苓、炒竹茹、薤白头、白金丸。
姜某（左侧脉象）：气虚导致湿痰内阻，营卫之气不能宣通。出现往来寒热，误用了阴柔滋腻的药物，虽然寒热停止，但出现了胃脘痞塞、少腹胀满、腿脚肢体酸痛的症状。这是阳气不能正常营运的表现。恐怕会发展成胀病。
处方：上安桂（三分，饭丸）、制香附（二钱）、制半夏（二钱）、薤白头（三钱）、连皮茯苓（三钱）、山楂炭（四钱）、半硫丸（八分，药汤送服）。
陆某（左侧脉象）：胃气逐渐开通，但进食后每觉得痞满，片刻后即舒缓，平时往往涌吐酸水涎沫。舌苔虽然逐渐变薄，但仍嫌黄厚浓浊。这是因为中阳不足，湿痰不能运化。拟用温补调理中阳的方法。
处方：奎党参（二钱）、蜜炙干姜（三分）、生薏苡仁（三钱）、橘白（一钱）、泽泻（一钱五分）、炒白术（一钱五分）、云茯苓（三钱）、制半夏（一钱）、玫瑰花（去蒂两朵）。
第二次就诊：通过补气温中，舌苔变得清透。确属中焦虚损、湿热不能旋转运化。但时常失眠，这是因为胃中有湿痰，胆寒肝热所致。
处方：台参须（八分）、制半夏（一钱五分）、橘皮（一钱）、广藿香（一钱五分）、炒枳实（八分）、姜竹茹（一钱）、白茯苓（三钱）、生谷芽和熟谷芽（各一钱）、缩砂仁（四分）、玫瑰花（两朵）。
某患者：不想进食也不觉饥饿，稍微吃一点食物，中焦就像被阻隔一样，反酸想吐，难以入睡。脉象细而濡，关部带滑象。这是湿热郁阻中焦，导致脾的清阳不升，胃的浊阴不降。六腑以通畅为用，宜用辛味药物来开散郁结。
处方：制半夏、干姜、茯苓、焦麦芽、竹茹、上广皮、川连、泽泻、佩兰叶。
第二次就诊：经过辛开苦降的治疗，中脘部较为舒适，反酸呕吐的趋势稍缓。然而仍然毫无食欲，稍微吃点稀粥，还觉得胀满，腹中攻撑不适，大便不通，难以入睡。右部脉象弦滑。胃腑之气略得通降，但肝肠暗动，致使木气郁结于土中。前方法再配合平肝泄木之法。
处方：川雅连（淡吴茱萸同炒）、制半夏、茯苓神、金铃子、延胡索、广陈皮、炒枳壳、炒竹茹。
第三次就诊：胀满较前舒缓，痞塞阻塞稍松，吐出稠痰，能够入睡，饮食得以逐渐进用。但脉象仍带弦滑，舌红苔黄。肝胃不能和谐融洽，希望效法前方能应手见效。
处方：川楝子、制香附、茯苓神、制半夏、鲜竹茹、延胡索、小青皮、薤白头、左金丸。
第四次就诊：调和肝胃之气，似乎稍见缓和，但胸脘仍然胀满，心胸之间时常感觉灼热，痰中带血。左寸关脉带弦，尺部数而细；右寸关脉弦滑，尺部坚硬；舌苔白腻，但底色带红。前人曾说“气有余便是火”，所以心胸灼热的，确实是由于肝胃之气不和，气郁而生火，气所在的地方，就是火所在的地方。再次调理肝胃之气，并调和肝胃之阴。
处方：金石斛、白蒺藜、蜜炒青皮、黑山栀、郁金、半夏曲、金铃子、土炒白芍、炒杏仁、竹茹。
第五次就诊：左寸关脉弦象稍退，右关脉弦滑也稍显柔和。胀满逐渐舒缓，略能安受谷物。再从调和肝胃入手。
处方：金石斛、制半夏、杭白芍、茯苓、炒香豉、金铃子、广陈皮、白蒺藜、山栀、降香。
第六次就诊：两关脉弦象稍显柔和。胃纳也日渐好转，胀满已舒缓。但舌苔中心浓厚，微带黑色。仍应当从肝胃方面议治。
处方：制半夏、金石斛、白芍、白茯苓、黑山栀、薄橘红、沉香曲、丹皮、炒杏仁、炒竹茹。
某患者：中气虚弱，不思饮食，大小便不利，中脘痞塞阻塞，躺下难以入睡。脉细而滑，口腻苔浊。湿热郁阻，升降功能失调。拟用开宣上焦的方法。
处方：制半夏、郁金、川雅连、光杏仁、炒枳实、广陈皮、干姜、薤白头、佩兰叶、栝蒌皮、炒竹茹。
第二次就诊：中脘痞塞阻塞，饮食不进，口腻痰多。脉象濡滑。浊邪阻滞胃中。先采用通降之法。
处方：藿香、制半夏、金石斛、广皮、茯苓、佩兰叶、川朴、大腹皮、栝蒌皮、枳实、鲜佛手、竹茹。
第三次就诊：通降胃腑之后，仍然不能进食，稍微一进谷食，就中脘不舒服，味道变为酸浊。脉象濡滑。痰湿闭阻胃口。再次降胃化痰，并宣通气郁。
处方：香豆豉、炒杏仁、黑山栀、栝蒌皮、降香屑（四分）、上川朴、制半夏、炒枳壳、生姜汁。
第四次就诊：脉象濡细，重按无力，舌苔白腻不化。不想进食也不觉饥饿。中气不足，不能化除浊邪。再次扶持中气，并展布胃阳。
处方：人参须、制半夏、橘白、佩兰叶、炒谷芽、益智仁、云茯苓、玫瑰花、鲜竹茹、砂仁（两粒）。
第五次就诊：扶持中气，展布胃阳，稍能知饥并能安受谷物。药物既然有效，宜再扩充方意。
处方：人参须（八分）、淡姜渣（三分）、茯苓（三钱）、佩兰叶（八分）、玫瑰花（两朵）、益智仁（六分）、制半夏（一钱五分）、橘白（一钱）、焦麦芽（二钱）。
第六次就诊：胃气虽然稍得苏醒，但稍微多吃一点，气就向上冲逆。脉濡细，右关带滑。中气不足，不能运化，以致湿热结聚，通降功能无权。拟用苦辛开通之法。
处方：制半夏（一钱五分）、川连（四钱）、藿香（一钱五分）、枳实（一钱）、佩兰叶（一钱）、橘皮（一钱）、干姜（二分）、茯苓（三钱）、竹茹（一钱）。
Jiang (Left): Long-term indulgence in alcohol has led to deficiency of the Middle Jiao (Middle Burner), causing Qi to lose its normal rotational movement. The essence of food and water fails to transform into body fluids, instead condensing into Phlegm. Phlegm obstructs Ying (Nutritive) and Wei (Defensive) Qi, resulting in alternating chills and fever. Relief is only achieved after defecation expels sticky substances, clearing the phlegm. After eating, there is prolonged fullness and stuffiness in the epigastrium. The pulse is soft and weak. The more deficient the Spleen and Stomach become, the worse the turbid phlegm becomes. As predecessors said, "When encountering Phlegm, do not merely treat the Phlegm"; treatment should focus on regulating the Spleen and Stomach as the root.
Prescription: Bie Zhi Shen (Ginseng Radix, separately decocted and taken with the liquid, 1 qian), Chao Yu Zhu (Atractylodis Rhizoma, stir-fried, 2 qian), Chen Ju Pi (Citri Reticulatae Pericarpium, 1 qian), Chao Zhu Ru (Bambusae Caulis in Taeniam, stir-fried, 1 qian), Zhi Ban Xia (Pinelliae Rhizoma, processed, 1.5 qian), Bai Fu Ling (Poria, 3 qian), Sheng Yi Ren (Coicis Semen, raw, 3 qian), Chao Zhi Shi (Immature Bitter Orange Fruit, stir-fried, 1 qian), Suo Sha Ren (Amomi Fructus, 0.5 qian, added later), Sheng Shu Gu Ya (Oryza Sativa Germen, raw and cooked, each 1.5 qian).
Li (Left): Liver Wood Qi is disharmonious, presenting with abdominal distension, epigastric stuffiness, and poor appetite. Symptoms come and go; when severe, mental confusion occurs. The left Guan position pulse is exclusively wiry. This is due to rebellious Qi failing to disperse, causing Wind-Yang to disturb.
Prescription: Jin Ling Zi (Meliosmae Fructus), Bai Ji Li (Tribuli Fructus), Guang Yu Jin (Curcumae Radix), Guang Pi (Citri Reticulatae Pericarpium), Sha Ren (Amomi Fructus), Bai Shao (Paeoniae Radix Alba), Zhi Xiang Fu (Cyperi Rhizoma, processed), Chao Zhi Qiao (Aurantii Fructus Immaturus, stir-fried), Zhu Fu Shen (Poria with Hostwood, cinnabar-coated), Chao Zao Ren (Ziziphi Spinosae Semen, stir-fried), Xiang Yuan Pi (Fortunelleae Exocarpium).
Yuan (Right): Fullness and stuffiness have significantly subsided, but there is a sensation of stagnation and heaviness in the lower abdomen. This indicates that Qi and Dampness are not rising but pressing downwards. Treatment continues with unblocking and dredging methods.
Prescription: Zhi Xiang Fu (Cyperi Rhizoma, processed), Xie Bai (Allii Macrostemonis Bulbus), Yun Fu Ling (Poria, 3 qian), Chen Pi (Citri Reticulatae Pericarpium), Chen Xiang Pian (Aquilariae Lignum Resinatum, sliced), Zheng Sha Ren (Amomi Fructus, whole), Zhi Ban Xia (Pinelliae Rhizoma, processed), Jian Ze Xie (Alismatis Rhizoma, Jian variety), Wei Tian Ma (Gastrodiae Rhizoma, baked), Zhu Ling (Polyporus, 3 qian).
Second Visit: The heaviness and stagnation in the lower abdomen have relieved, but there is distension in the right hypochondrium. This is nothing other than obstruction by Phlegm-Qi.
Prescription: Zhi Ban Xia (Pinelliae Rhizoma, processed), Zhi Xiang Fu (Cyperi Rhizoma, processed), Gua Lou Ren (Trichosanthis Semen, 3 qian), Dan Gan Jiang (Zingiberis Rhizoma, pale dried, 3 qian), Chuan Ya Lian (Coptidis Rhizoma, 3 qian), Yun Fu Ling (Poria, 3 qian), Chao Zhu Ru (Bambusae Caulis in Taeniam, stir-fried, 3 qian), Xie Bai (Allii Macrostemonis Bulbus, 3 qian), Bai Jin Wan (White Gold Pill).
Jiang (Left): Qi deficiency leads to internal obstruction by Damp-Phlegm, preventing the free circulation of Ying and Wei Qi. There are alternating chills and fever. Misuse of Yin-nourishing and cloying herbs stopped the chills and fever but resulted in epigastric stuffiness, lower abdominal fullness, and soreness/aching in the legs and limbs. This indicates Yang Qi cannot circulate and nourish properly. There is fear it may develop into an Abdominal Distension disease.
Prescription: Shang An Gui (Cinnamomi Cortex, top grade, 0.3 qian, rice pill), Zhi Xiang Fu (Cyperi Rhizoma, processed, 2 qian), Zhi Ban Xia (Pinelliae Rhizoma, processed, 2 qian), Xie Bai (Allii Macrostemonis Bulbus, 3 qian), Lian Pi Fu Ling (Poria with skin, 3 qian), Shan Zha Tan (Crataegi Fructus charred, 4 qian), Ban Liu Wan (Half-Sulfur Pill, 0.8 fen, taken with herbal decoction).
Lu (Left): Stomach Qi is gradually opening, but after eating, one feels stuffiness and fullness, which resolves after a moment. Usually, there is regurgitation of sour saliva. Although the tongue coating is becoming thinner, it remains yellow and thick. This is due to insufficiency of Middle Yang, failing to transform and transport Damp-Phlegm. The plan is to warm and regulate Middle Yang.
Prescription: Kui Dang Shen (Codonopsis Radix, Kui brand, 2 qian), Mi Zhi Gan Jiang (Zingiberis Rhizoma, honey-roasted, 0.3 qian), Sheng Yi Ren (Coicis Semen, raw, 3 qian), Ju Bai (Citri Reticulatae Pericarpium album, 1 qian), Ze Xie (Alismatis Rhizoma, 1.5 qian), Chao Yu Zhu (Atractylodis Rhizoma, stir-fried, 1.5 qian), Yun Fu Ling (Poria, 3 qian), Zhi Ban Xia (Pinelliae Rhizoma, processed, 1 qian), Mei Gui Hua (Rosa Rugosa, stems removed, 2 flowers).
Second Visit: By tonifying Qi and warming the Middle, the tongue coating has cleared. Indeed, this is Middle Deficiency with Damp-Heat failing to rotate and transport. However, insomnia occurs occasionally, caused by Damp-Phlegm in the Stomach, Cold Gallbladder, and Heat Liver.
Prescription: Tai Shen Xu (Codonopsis Radix tendril, 0.8 fen), Zhi Ban Xia (Pinelliae Rhizoma, processed, 1.5 qian), Ju Pi (Citri Reticulatae Pericarpium, 1 qian), Guang Huo Xiang (Agastaches Herba, Guangxi variety, 1.5 qian), Chao Zhi Shi (Immature Bitter Orange Fruit, stir-fried, 0.8 fen), Jiang Zhu Ru (Bambusae Caulis in Taeniam, ginger-processed, 1 qian), Bai Fu Ling (Poria, 3 qian), Sheng Shu Gu Ya (Oryza Sativa Germinatio, raw and cooked, each 1 qian), Suo Sha Ren (Amomi Fructus, 0.4 qian), Mei Gui Hua (Rosa Rugosa, 2 flowers).
Patient: Poor appetite and lack of hunger. Slight intake causes blockage in the Middle Jiao, acid regurgitation, and urge to vomit. Difficulty falling asleep. Pulse is fine and soft, Guan position slippery. This is Damp-Heat郁阻 (stagnating) in the Middle Jiao, causing Spleen Clear Yang not to ascend and Stomach Turbid Yin not to descend. The Six Fu organs function through unblocked flow; thus, Acrid flavors should be used to open the obstruction.
Prescription: Zhi Ban Xia (Pinelliae Rhizoma, processed), Gan Jiang (Zingiberis Rhizoma dried), Fu Ling (Poria), Jiao Mai Ya (Hordei Fructus Germinatus charred), Zhu Ru (Bambusae Caulis in Taeniam), Shang Guang Pi (Citri Reticulatae Pericarpium, upper grade), Chuan Lian (Coptidis Rhizoma), Ze Xie (Alismatis Rhizoma), Pei Lan Ye (Eupatorii Herba).
Second Visit: After Acrid-Opening and Bitter-Descent, the epigastrium is more comfortable, and the trend of acid regurgitation and vomiting has slowed. However, there is still no desire to eat; even slight intake of thin gruel causes bloating, abdominal pushing discomfort, constipation, and insomnia. The Right side pulse is wiry and slippery. Stomach Qi has slightly achieved descent, but Liver and Intestines are subtly moving, causing Wood Stagnation within Earth. The previous method should be combined with soothing Liver and draining Wood.
Prescription: Chuan Ya Lian (Coptidis Rhizoma, stir-fried with Dan Wu Yu), Zhi Ban Xia (Pinelliae Rhizoma, processed), Fu Ling Shen (Poria with Hostwood), Jin Ling Zi (Meliosmae Fructus), Yan Hu Suo (Corydalis Rhizoma), Guang Chen Pi (Citri Reticulatae Pericarpium), Chao Zhi Qiao (Aurantii Fructus Immaturus, stir-fried), Chao Zhu Ru (Bambusae Caulis in Taeniam, stir-fried).
Third Visit: Distension has eased, stuffiness has loosened, thick phlegm was expectorated, sleep is possible, and diet is gradually improving. But the pulse remains wiry and slippery, tongue red with yellow coating. Liver and Stomach cannot harmonize. Hoping for efficacy following the previous formula.
Prescription: Chuan Lian Zi (Meliae Fructus), Zhi Xiang Fu (Cyperi Rhizoma, processed), Fu Ling Shen (Poria with Hostwood), Zhi Ban Xia (Pinelliae Rhizoma, processed), Xian Zhu Ru (Bambusae Caulis in Taeniam, fresh), Yan Hu Suo (Corydalis Rhizoma), Xiao Qing Pi (Citri Reticulatae Pericarpium viride), Xie Bai (Allii Macrostemonis Bulbus), Zuo Jin Wan (Left Metal Pill).
Fourth Visit: Harmonizing Liver and Stomach Qi seems slightly effective, but chest and epigastrium remain distended. A burning heat is felt in the heart/chest area, and blood appears in phlegm. Left Cun-Guan pulse is wiry, Chi pulse rapid and fine; Right Cun-Guan pulse wiry and slippery, Chi pulse hard; tongue coating white and greasy, but underlying substance is red. Predecessors stated, "Excess Qi is Fire." Thus, the burning heat in the chest is due to Disharmony of Liver-Stomach Qi, where Qi stagnation generates Fire. Wherever Qi resides, Fire resides. Re-treat Liver-Stomach Qi and harmonize Liver-Stomach Yin.
Prescription: Jin Shi Hu (Dendrobii Caulis), Bai Ji Li (Tribuli Fructus), Mi Chao Qing Pi (Citri Reticulatae Pericarpium viride, honey-stir-fried), Hei Shan Zhi (Gardeniae Fructus charred), Yu Jin (Curcumae Radix), Ban Xia Qu (Pinelliae Fermentum), Jin Ling Zi (Meliosmae Fructus), Tu Chao Bai Shao (Paeoniae Radix Alba, earth-stir-fried), Chao Xing Ren (Armeniacae Semen Amarum, stir-fried), Zhu Ru (Bambusae Caulis in Taeniam).
Fifth Visit: Left Cun-Guan wiry image has slightly receded; Right Guan wiry-slippery image has softened. Distension gradually relieves, able to tolerate grains slightly. Continue harmonizing Liver and Stomach.
Prescription: Jin Shi Hu (Dendrobii Caulis), Zhi Ban Xia (Pinelliae Rhizoma, processed), Hang Bai Shao (Paeoniae Radix Alba, Hangzhou variety), Fu Ling (Poria), Chao Xiang Chi (Sojae Semens Praeparatum, stir-fried), Jin Ling Zi (Meliosmae Fructus), Guang Chen Pi (Citri Reticulatae Pericarpium), Bai Ji Li (Tribuli Fructus), Shan Zhi (Gardeniae Fructus), Jiang Xiang (Dalbergiae Odoriferae Lignum).
Sixth Visit: Both Guan pulses are slightly softer. Stomach appetite shows daily improvement, distension relieved. However, the center of the tongue coating is thick, slightly black. Treatment should still focus on Liver and Stomach.
Prescription: Zhi Ban Xia (Pinelliae Rhizoma, processed), Jin Shi Hu (Dendrobii Caulis), Bai Shao (Paeoniae Radix Alba), Bai Fu Ling (Poria), Hei Shan Zhi (Gardeniae Fructus charred), Bo Ju Hong (Citri Reticulatae Pericarpium, thin peel), Chen Xiang Qu (Aquilariae Lignum Resinatum fermentum), Dan Pi (Moutan Cortex), Chao Xing Ren (Armeniacae Semen Amarum, stir-fried), Chao Zhu Ru (Bambusae Caulis in Taeniam, stir-fried).
Patient: Middle Qi deficiency, no hunger or appetite, difficulty with urination and defecation, epigastric stuffiness/blockage, difficulty sleeping. Pulse fine and slippery, mouth feels sticky with turbid coating. Damp-Heat stagnation, failure of ascending and descending functions. Plan to open the Upper Jiao.
Prescription: Zhi Ban Xia (Pinelliae Rhizoma, processed), Yu Jin (Curcumae Radix), Chuan Ya Lian (Coptidis Rhizoma), Guang Xing Ren (Armeniacae Semen Amarum, light), Chao Zhi Shi (Immature Bitter Orange Fruit, stir-fried), Guang Chen Pi (Citri Reticulatae Pericarpium), Gan Jiang (Zingiberis Rhizoma dried), Xie Bai (Allii Macrostemonis Bulbus), Pei Lan Ye (Eupatorii Herba), Gua Lou Pi (Trichosanthis Pericarpium), Chao Zhu Ru (Bambusae Caulis in Taeniam, stir-fried).
Second Visit: Epigastric stuffiness/blockage, inability to eat, sticky mouth with much phlegm. Pulse soft and slippery. Turbidity obstructing the Stomach. First, use descending methods.
Prescription: Huo Xiang (Agastaches Herba), Zhi Ban Xia (Pinelliae Rhizoma, processed), Jin Shi Hu (Dendrobii Caulis), Guang Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria), Pei Lan Ye (Eupatorii Herba), Chuan Po (Magnoliae Officinalis Cortex), Da Fu Pi (Arecae Pericarpium), Gua Lou Pi (Trichosanthis Pericarpium), Zhi Shi (Immature Bitter Orange Fruit), Xian Fo Shou (Citri Sarcodactylis Fructus, fresh), Zhu Ru (Bambusae Caulis in Taeniam).
Third Visit: After descending Stomach Qi, still unable to eat. Slight intake causes epigastric discomfort, taste turns sour and turbid. Pulse soft and slippery. Damp-Phlegm closing the Stomach gate. Again, descend Stomach, resolve Phlegm, and ventilate Qi stagnation.
Prescription: Xiang Dou Chi (Sojae Semens Praeparatum, fragrant), Chao Xing Ren (Armeniacae Semen Amarum, stir-fried), Hei Shan Zhi (Gardeniae Fructus charred), Gua Lou Pi (Trichosanthis Pericarpium), Jiang Xiang Xie (Dalbergiae Odoriferae Lignum powder, 0.4 qian), Shang Chuan Po (Magnoliae Officinalis Cortex, upper grade), Zhi Ban Xia (Pinelliae Rhizoma, processed), Chao Zhi Qiao (Aurantii Fructus Immaturus, stir-fried), Sheng Jiang Zhi (Zingiberis Rhizoma fresh juice).
Fourth Visit: Pulse soft and fine, weak upon heavy pressure. Tongue coating white and greasy, not transforming. No hunger or appetite. Middle Qi insufficient, unable to transform turbidity. Again, support Middle Qi and expand Stomach Yang.
Prescription: Ren Shen Xu (Ginseng Radix tendril), Zhi Ban Xia (Pinelliae Rhizoma, processed), Ju Bai (Citri Reticulatae Pericarpium album), Pei Lan Ye (Eupatorii Herba), Chao Gu Ya (Oryza Sativa Germinatio, stir-fried), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Yun Fu Ling (Poria), Mei Gui Hua (Rosa Rugosa), Xian Zhu Ru (Bambusae Caulis in Taeniam, fresh), Sha Ren (Amomi Fructus, 2 grains).
Fifth Visit: Supporting Middle Qi and expanding Stomach Yang allows slight awareness of hunger and tolerance of grains. Since the medicine is effective, expand the prescription further.
Prescription: Ren Shen Xu (Ginseng Radix tendril, 0.8 fen), Dan Jiang Zha (Zingiberis Rhizoma dried residue, 0.3 qian), Fu Ling (Poria, 3 qian), Pei Lan Ye (Eupatorii Herba, 0.8 fen), Mei Gui Hua (Rosa Rugosa, 2 flowers), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 0.6 fen), Zhi Ban Xia (Pinelliae Rhizoma, processed, 1.5 qian), Ju Bai (Citri Reticulatae Pericarpium album, 1 qian), Jiao Mai Ya (Hordei Fructus Germinatus charred, 2 qian).
Sixth Visit: Stomach Qi has slightly awakened, but slight overeating causes Qi to rush upward. Pulse soft and fine, Right Guan slippery. Middle Qi insufficient, unable to transport, leading to Damp-Heat aggregation and loss of descending power. Plan for Bitter-Acrid Opening.
Prescription: Zhi Ban Xia (Pinelliae Rhizoma, processed, 1.5 qian), Chuan Lian (Coptidis Rhizoma, 4 qian), Huo Xiang (Agastaches Herba, 1.5 qian), Zhi Shi (Immature Bitter Orange Fruit, 1 qian), Pei Lan Ye (Eupatorii Herba, 1 qian), Ju Pi (Citri Reticulatae Pericarpium, 1 qian), Gan Jiang (Zingiberis Rhizoma dried, 0.2 fen), Fu Ling (Poria, 3 qian), Zhu Ru (Bambusae Caulis in Taeniam, 1 qian).