Li Beiquan, Grand Secretary, frequently vomited phlegm and saliva, suffered from internal heat with thirst, and experienced limb fatigue. His feet felt hot after exertion. He used Qingqi Huatan Tang (Clear the Qi and Transform Phlegm Decoction), but his symptoms worsened. I said, "This is phlegm formed by the flooding of Kidney Water. The treatment method should be to tonify the Kidney." He did not believe me and instead took Tun Tan Wan (Rolling Phlegm Pill). After one dose, he suffered from continuous vomiting and diarrhea, could not eat, and experienced dizziness with eyes closed. Only then did he believe me. I used Liujunzi Tang (Six Gentlemen Decoction); after several doses, his Stomach Qi gradually recovered. Subsequently, I used Liuwei Wan (Six-Ingredient Pill with Rehmannia), and after more than a month, all symptoms were completely cured.

Su Longxi, Court Herald, suffered from cough, wheezing, nasal congestion, and runny nose. I used Shen Su Yin (Ginseng and Perilla Decoction) for one dose to disperse Cold Evil, followed by Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) to solidify the Couli (pores and interstices), resulting in a cure. Later, due to exertion and anger, the condition relapsed. He self-administered the previous Shen Su Yin, which worsened his symptoms. He added Huanglian (Coptis Rhizome) and Zhishi (Immature Bitter Orange), leading to abdominal distension, anorexia, and oliguria. He then erchen Tang (Two Aged Ingredients Decoction) and Siling San (Four-Ling Powder), causing the previous symptoms to intensify until urinary retention occurred. I said, "Abdominal distension and anorexia indicate Spleen-Stomach deficiency; oliguria indicates Lung-Kidney deficiency. All are caused by inappropriate purgative treatments." I prescribed Liujunzi Tang plus Huangqi (Astragalus Root), Paojiang (Prepared Ginger), and Wuweizi (Schisandra Fruit). After two doses, all symptoms subsided rapidly. Then, using Buzhong Yiqi Tang plus Paojiang and Wuweizi for several doses, he was fully cured.

Li Beichuan, Land Official, coughed whenever he exerted himself. I used Buzhong Yiqi Tang, and he was cured. One day, the condition recurred. He self-administered Shen Su Yin, worsening his symptoms, and then took Renshen Baidu San (Ginseng and Detoxification Powder), resulting in neck stiffness, locked jaw, and opisthotonos (backward arching of the back). I said, "This is Jing Disease (spasm) transformed by erroneous sweating that depleted Body Fluids." I still used the previous formula (Buzhong Yiqi Tang) plus 1 qian of Fuzi (Prepared Aconite Root). After four doses, he recovered.

In cases of cold-induced cough, if excessive sweating is erroneously induced, leading to panting, difficult breathing, and incessant expectoration, Fei Yong (Lung Abscess) will inevitably develop.

Tan Xizeng, Imperial Attendant, suffered from cough with expectoration, and his hands and feet were often cold. I diagnosed Spleen-Lung Deficiency-Cold and used Buzhong Yiqi Tang plus Paojiang, resulting in a cure.

Wang Yongzhi, Office Director, suffered from wheezing, cough, and thirst, with a red face and dry nose. I diagnosed Heat in the Spleen and Lungs and used Erchen Tang plus Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Shanzhi (Gardenia Fruit), Jiegeng (Platycodon Root), and Maimendong (Ophiopogon Tuber), resulting in a cure.

Ruan Junpin, Vice Commissioner, suffered from cough, pale complexion, and clear nasal discharge. This indicated Spleen-Lung deficiency combined with External Pathogens. I treated him with Buzhong Yiqi Tang plus Fuling (Poria), Banxia (Pinellia Tuber), and Wuweizi, resulting in a cure. He was later stabilized using Liujunzi Tang plus Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Angelica Sinensis).

Chen Guohua, Department Director, had a history of Yin Deficiency and suffered from cough. Being knowledgeable in medicine, he first used Exterior-releasing and Phlegm-transforming agents without effect; then used Clearing-Heat and Phlegm-transforming drugs, which worsened his symptoms. I said, "This is Spleen-Lung deficiency." He did not believe me and used Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill), which exacerbated abdominal distension and reduced appetite. Symptoms of Three Yin Meridian deficiency became evident. In the morning, I used Liujunzi Tang plus Jiegeng, Shengma (Cimicifuga Rhizome), Maimendong, and Wuweizi to tonify Spleen Earth to generate Lung Metal. In the evening, I used Bawei Wan (Eight-Ingredient Pill) to tonify Mingmen Fire to generate Spleen Earth. Gradually, all symptoms improved.

The Classic states: "If you cannot treat the deficiency, how can you ask about the rest?" Here, Spleen Earth deficiency fails to generate Lung Metal, causing Lung disease. Yet, using previous medications further drains the Fire. I do not understand this approach.

Bao Xifu, Secretary, had a history of Yin Deficiency and suffered from cough. He took Qingqi Huatan Wan and Erchen Tang plus Huangqin and Huanglian, causing increased phlegm. He then used Siwu Tang plus Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), and Xuanshen (Scrophularia Root), leading to abdominal distension and hoarseness. His Right Guan pulse was floating and wiry, and his Left Chi pulse was surging and large. I said, "Since Spleen Earth cannot generate Lung Metal, and Deficient Fire attacks it, we must nourish the Source of Transformation." In the morning, I used Buzhong Yiqi Tang plus Shanzhuyu (Cornus Fruit), Maimendong, and Wuweizi. In the evening, I used Liuwei Dihuang Wan plus Wuweizi. After more than three months, fortunate enough to be cautious with his illness, he was cured.

Wang Yongzhi, Military Selection Officer, had irregular diet and lifestyle, leading to cough and expectoration. He used Phlegm-transforming and Exterior-releasing drugs. It was midsummer; his pulse was surging, rapid, and powerless. His face was full and red, expectoration was fishy-smelling, and sweating was incessant. I said, "This is a symptom of water flooding as phlegm, yet you use the previous agents; this is called doubly depleting Body Fluids. Could it not be Fei Yong (Lung Abscess)?" He did not believe me and continued taking the previous medicine. The next day, he indeed expectorated pus. His pulse was rapid, especially in the left three positions and the right Cun position. Only then did he believe me. I used Jiegeng Tang (Platycodon Decoction) for one dose; pus and rapid pulse stopped immediately. After another dose, they stopped completely. His complexion turned pale, though he remained anxious. I said, "With a pale complexion and choppy pulse, this condition will heal itself even without treatment." I administered the previous medicine once more, assisted by Liuwei Wan, and he recovered.

Li Dayong, Brocade Guard, neglected his daily routine, suffering from expectoration, spontaneous sweating, cough, and fever. He took Erchen Tang plus Huangqin, Huanglian, Zhike (Aurantium Fructus), and Shanzhi. Previous symptoms persisted, and appetite decreased. He then used Siwu Tang, Erchen Tang, Huangqin, Huanglian, Huangbai, Zhimu, and Xuanshen. Symptoms worsened, accompanied by chest and abdominal discomfort, further reduced intake, internal heat, and afternoon fever. Adding Sangbaipi (Mulberry Bark), Zisu (Perilla Leaf), Xingren (Apricot Seed), Ziwan (Aster Root), and Jiegeng led to chest and diaphragmatic distension and oliguria. Using Zhuling (Polyporus), Zexie (Alisma Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Fuling, Zhike, Qingpi (Aurantium Peel), Banxia, Huanglian, and Suzi (Perilla Seed) resulted in chest oppression, rib flaring, and urinary retention. Adding Yinchen (Artemisia Capillaris) and Tinglizi (Descurainia Seed) caused panting, inability to lie down, and anorexia. My diagnosis revealed surging and rapid pulses in all six positions, particularly severe in the Lung and Kidney areas. I said, "Since Spleen Earth cannot generate Lung Metal, and Heart Fire attacks it, this is the onset of Fei Yong (Lung Abscess). We must nourish the Source of Transformation; otherwise, delay will lead to no rescue." He did not believe me. Later, he expectorated purulent sputum and sought treatment again. I said, "Chest oppression indicates Spleen Earth failure; panting and inability to lie down indicate Lung Metal failure; urinary retention indicates Kidney Water failure; rib flaring indicates Liver Wood failure; indigestion indicates Heart Fire failure. The Source of Transformation is exhausted, and the Five Zang organs have failed. How can medicine revive them?" Indeed, he died shortly after.

Yao Quan, Silk Merchant, had a history of depression and anger, was nearly sixty years old, and had weak Spleen-Stomach function. He took aromatic-drying Qi-moving drugs, leading to reduced appetite and bilateral hypochondriac distension. He then took Qi-moving and Blood-breaking drugs, resulting in inability to eat, right hypochondriac pain and distension relieved by pressure. He suspected Ge Qi (Diaphragmatic Qi Stagnation) or Internal Injury from Phlegm-Fluid. I said, "This is Liver Wood overacting on Spleen Earth, and Spleen Earth failing to generate Lung Metal. If there were intra-abdominal Blood Stasis, he would dare not wear thin clothes against his skin." I used drugs to nourish the Source of Transformation. After four doses, all symptoms subsided rapidly. Believing he was cured, I said, "The Fire Season is approaching; you should tonify Spleen Earth to protect Lung Metal." He did not believe me. Later, the condition relapsed. He used drugs for Phlegm-Fire, worsening his state. Seeking treatment, his Left Guan and Right Cun pulses were slippery and rapid. I said, "This indicates internal ulceration of the Lung!" He still did not believe me, took the previous medicine, and indeed expectorated foul pus before dying.

Wu Beichuan, Academician, drank excessively, leading to phlegm obstruction and tongue rigidity. He took Fire-descending and Phlegm-transforming drugs, worsening phlegm-Qi stagnation and causing limb paralysis. I treated it as Spleen Deficiency with Damp-Heat, resulting in a cure.

Shi Zhanzhi, Upper Scholar, suffered from spring coughs, cured by Shen Su Yin plus Huangqin, Huanglian, Sangbaipi, and Xingren. In the spring of Yisi year, he fell ill again. Taking the previous medicine worsened symptoms, adding hoarseness. Seeking treatment, his Left Chi pulse was surging, rapid, and powerless. I said, "This is Kidney Meridian Deficient Fire attacking Lung Metal. We must nourish the Source of Transformation." Thus, I used Liuwei Dihuang Wan material plus Maimendong, Wuweizi, fried Shanzhi, and Buzhong Yiqi Tang, resulting in a cure.

Zhang Keming, Confucian Scholar, suffered from cough. Taking Erchen Tang plus Huangqin, Huanglian, and Zhike led to chest fullness, wheezing, and morning expectoration. Adding Suzi and Xingren caused salivary phlegm discharge, dry mouth, and thirst. I said, "Morning expectoration indicates Spleen Deficiency failing to digest food; chest fullness and wheezing indicate Spleen Deficiency failing to generate Lung Metal; spontaneous salivary phlegm indicates Spleen Deficiency failing to secure fluids; dry mouth and thirst indicate Spleen Deficiency failing to generate Body Fluids." I thus used Liujunzi Tang plus Paojiang and Rougu (Nutmeg) to warm and tonify Spleen-Stomach. Then, I used Bawei Wan to tonify the Mother of Earth (Spleen), resulting in a cure.

A man suffered from summer expectoration or cough. Stomach-Fire clearing drugs were ineffective. I diagnosed Fire invading Lung Metal and used Maimendong Tang (Ophiopogon Decoction), resulting in a cure. Later, exertion caused cough relapse. I used Buzhong Yiqi Tang plus Jiegeng, Shanzhi, Pianqin (Scutellaria Root), Maimendong, and Wuweizi, resulting in a cure. However, due to dry mouth, fatigue, and dark, scanty urination, he used Shengmai San (Generate the Pulse Powder) daily and recovered. For cough due to Stomach Fire with phlegm, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is suitable. For Stomach Qi deficiency, Buzhong Yiqi Tang plus Beimu (Fritillaria Bulb) and Jiegeng is suitable. For Deficient Fire rushing upward, Shengmai San delivered with Dihuang Wan is suitable to protect Lung Qi and generate Kidney Water. These are disorders of the True Zang organs; without nourishing the Source of Transformation, recovery is impossible.

A woman suffered from cough, hypochondriac pain, and fever, worsening in the late afternoon. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Shudi (Rehmannia Root), resulting in a cure. Over a year later, due to anger and labor, previous symptoms returned, along with Taiyang meridian pain, alternating chills and fever, cough, and urinary incontinence. All belong to Liver Fire and Blood Deficiency. For vaginal prolapse and flaccid bi-syndrome, I used the previous powder and Dihuang Wan, resulting in improvement after over a month.

My cousin's wife suffered from cough, fever, vomiting of phlegm and saliva (about five to six bowls day and night), restless panting and cough, chest oppression, irritability, thirst, anorexia, and metrorrhagia like a gush. This indicated Mingmen Fire Decline and Spleen Earth Deficiency-Cold. I treated her with Bawei Wan and Fuzi Lizhong Tang (Aconite and Licorice Central-Warming Decoction) with modifications, resulting in a cure. See "Metrorrhagia" in *Gynecological Essentials*.

A woman, mistreated by her mother-in-law, suffered from cough, chest-diaphragmatic discomfort, and loss of taste. This indicated dual injury to Spleen and Lung, with Phlegm stagnating in the middle. I first used Guipi Tang (Restore the Spleen Decoction) plus Shanzhi, Fuxiong (Chuanxiong), Beimu, and Jiegeng. Symptoms gradually improved. Later, she took Liujunzi Tang plus Chuanxiong, Danggui, and Jiegeng intermittently, resulting in a cure.

A woman suffered from cough, abundant morning expectoration, and nighttime panting with insomnia. I stated that morning phlegm is transformed from food due to Spleen Deficiency, while nighttime panting is caused by Deficient Fire rushing upward due to Lung Deficiency. I used Buzhong Yiqi Tang plus Maimendong and Wuweizi, resulting in a cure.

A woman developed malaria with vomiting after eating and getting angry. She took Huoxiang Zhengqi San (Agarwood and Magnolia Bark Powder) for two doses and was cured. Later, anger caused excessive expectoration, delirium, intense heat, chest-hypochondriac distension and pain (relieved by pressure), and a surging pulse that was minute upon deep palpation. This belonged to Blood Deficiency in the Liver and Spleen meridians. I used Jiawei Xiaoyao San plus Shudi and Chuanxiong. After two doses, pulse and symptoms subsided rapidly. Then, using Shiquan Dabu Tang (Ten Great Tonifying Decoction), she was stabilized. If this case were treated with draining and unblocking agents, it would violate the prohibition against "making deficiency more deficient."

The eldest son of Chen Daofu, Upper Scholar, had Kidney Meridian depletion and chronic cough, worsening in the afternoon. I said, "We must tonify Spleen Earth and nourish the Source of Transformation, so that Metal and Water can generate each other naturally." It was early spring. He did not believe me and took Huangbai and Zhimu. By summer, he expectorated phlegm, craved water, had frequent urination, and his face appeared crimson. I prescribed Baizhu, Danggui, Fuling, Chenpi (Tangerine Peel), Maimendong, Wuweizi, Danpi (Moutan Cortex), and Zexiei for four doses. Then, I made pills from Renshen (Ginseng Root), Huangqi, Shudi, and Shanzhuyu for him to take. Symptoms subsided rapidly. Upon re-examination, believing he had accepted my advice, I continued prescribing the same medicine. However, he remained stubborn and refused to take it, ultimately leading to his death.

Postpartum cough is discussed in *Gynecological Essentials*.