陷胸、泻心诸方，大抵皆治外感之实证，乃有其证虽属外感，
而其人内亏实甚者，则《伤寒论》中炙甘草汤所主之证是也。
《伤寒论》原文∶伤寒脉结代，心动悸，炙甘草汤主之。
脉之跳动，偶有止时，其止无定数者为结，言其脉结而不行，是以中止也；止有定数者曰代，言其
脉至此即少一跳动，必需他脉代之也。二脉虽皆为特别病脉，然实有轻重之分，盖结脉止无定数，不过其脉偶
阻于气血凝滞之处，而有时一止，是以为病犹轻；至代脉则止有定数，是脏腑中有一脏之气内亏，不能外
达于脉之部位，是以为病甚重也。其心动悸者，正其结代脉之所由来也。
【炙甘草汤方】甘草四两炙，生姜三两切，桂枝三两去皮，人参二两，生地黄一斤，阿胶二两，麦门
冬半升，麻子仁半升，大枣三十枚擘。
上九味，以清酒七升，水八升，先煮八味取三升，去滓纳胶，烊化消尽，温服一升，日三服，一名复脉汤。
炙甘草汤之用意甚深，而注疏家则谓，方中多用富有汁浆之药。为其心血亏少，是以心中动悸以致脉
象结代，故重用富有汁浆之药，以滋补心血，为此方中之宗旨，不知如此以论此方，则浅之乎视此方矣。试观
方中诸药，惟生地黄（即干地黄）重用一斤，地黄原补肾药也，惟当时无熟地黄，多用又恐其失于寒凉，故
煮之以酒七升、水八升，且酒水共十五升，而煮之减去十二升，是酒性原热，而又复久煮，欲变生地黄之凉性
为温性者，欲其温补肾脏也。盖脉之跳动在心，而脉之所以跳动有力者，实赖肾气上升与心气相济，是以伤寒
少阴病，因肾为病伤，遏抑肾中气化不能上与心交，无论其病为凉为热，而脉皆微弱无力，是明征也。由斯
观之，是炙甘草汤之用意，原以补助肾中之气化，俾其壮旺上升，与心中之气化相济救为要着也。至其滋补
心血，则犹方中兼治之副作用也，犹此方中所缓图者也。
方中人参原能助心脉跳动，实为方中要药，而只用二两，折为今之六钱，再三分之一，剂中只有人参
二钱，此恐分量有误，拟加倍为四钱则奏效当速也。然人参必用党参，而不用辽参，盖辽参有热性也。
脉象结代而兼有阳明实热者，但治以炙甘草汤恐难奏功，宜借用白虎加人参汤，以炙甘草汤中生地黄
代方中知母，生怀山药代方中粳米。曾治一叟，年近六旬，得伤寒证，四五日间表里大热，其脉象洪而不实，
现有代象，舌苔白而微黄，大便数日未行。为疏方，用生石膏三两，大生地一两，野台参四钱，生怀山药六
钱，甘草三钱，煎汤三盅，分三次温饮下，将三次服完，脉已不
代，热退强半，大便犹未通下，遂即原方减去石膏五钱，加天冬八钱，仍如从前煎服，病遂全愈。
炙甘草汤虽结代之脉并治，然因结轻代重，故其制方之时注
重于代，纯用补药。至结脉恒有不宜纯用补药，宜少加开通之药
始与病相宜者。近曾在津治一钱姓壮年，得伤寒证，三四日间延为诊视，其脉象洪滑甚实，或七八动一止，
或十余动一止，其止皆在左部，询其得病之由，知系未病之前曾怒动肝火，继又出门感寒，遂得斯病，因
此知其左脉之结乃肝气之不舒也。为疏方，仍白虎加人参汤加减，生石膏细末四两，知母八钱，以生山药代
粳米用六钱，野台参四钱，甘草三钱，外加生莱菔子四钱捣碎，煎汤三盅，分三次温服下。结脉虽除，而
脉象仍有余热，遂即原方将石膏减去一两，人参、莱菔子各减一钱，仍如前煎服，其大便从前四日未通，将
药三次服完后，大便通下，病遂全愈。此次所用之方中不以生地黄代知母者，因地黄之性与莱菔子不相宜也。
愚治寒温证不轻用降下之品，其人虽热入阳明之府，若无大便燥硬，欲下不下之实征，亦恒投以大剂
白虎汤清其热，热清大便恒自通下。是以愚日日临证，白虎汤实为常用之品，承气汤恒终岁不一用也。
一叟，年过六旬，大便下血，医治三十余日病益进，日下血十余次，且多血块，精神昏愦。延
为诊视，其脉洪实异常，至数不数，惟右部有止时，其止无定数乃结脉也。其舌苔纯黑，知系外感大实之证，
从前医者但知治其便血，不知治其外感实热可异也。投以白虎加人参汤，方中生石膏重用四两，为其下血日
久，又用生山药一两以代方中粳米，取其能滋阴补肾，兼能固元气也。煎汤三盅，分三次温服下，每次送服
广三七细末一钱，如此日服一剂，两日血止，大便犹日行数次，脉象之洪实大减，而其结益甚，且腹中觉胀。
询其病因，知得于恼怒之后，遂改用生莱菔子五钱，而佐以白芍、滑石、天花粉、甘草诸药（外用鲜白茅根切
碎四两煮三四沸，取其汤以代水煎药），服一剂胀消，脉之至数调匀，毫无结象而仍然有力，
大便滑泻已减半，再投以拙拟滋阴清燥汤（方系生怀山药、滑石
各一两，生杭芍六钱，甘草三钱），一剂泻止，脉亦和平。观上
所录二案，知结脉现象未必皆属内亏，恒有因气分不舒，理其气即可愈者。
又有脉非结代，而若现雀啄之象者，此亦气分有所阻隔也。曾治一少妇素日多病，于孟春中旬得伤寒，
四五日表里俱壮热，其舌苔白而中心微黄，毫无津液，脉搏近六至，重按有力，或十余动之后，或二十余动
之后，恒现有雀啄之象，有如雀之啄粟，恒连二三啄也。其呼吸外出之时，恒似有所龃龉而不能畅舒。细
问病因，知其平日司家中出入账目，其姑察账甚严，未病之先，因账有差误，曾被责斥，由此知其气息不顺
及脉象之雀啄，其原因皆由此也。问其大便自病后未行，遂仍治以前案钱姓方，将生石膏减去一两，为其津
液亏损，为加天花粉八钱，亦煎汤三盅分三次温服下，脉象已近和平，至数调匀如常，呼吸亦顺，惟大便
犹未通下，改用滋阴、润燥、清火之品，服两剂大便通下全愈。
瓜蒂散、泻心汤等方剂，大抵都是治疗外感病的实证。然而，有些病症虽然属于外感，但患者体内亏虚非常严重，这就是《伤寒论》中炙甘草汤所主治的证候。
《伤寒论》原文记载：患伤寒病，脉搏出现结代（脉律不齐），心中悸动不安，用炙甘草汤主治。
脉搏跳动时，偶尔有停顿。停顿没有固定规律的称为“结”，意思是脉搏凝结而不流畅，因此中途停止；停顿有固定规律的称为“代”，意思是脉搏跳到这里就少了一次跳动，必须由其他脉搏来替代。这两种脉象虽然都是特殊的病理性脉象，但实际上有轻重之分。大概来说，结脉停顿没有固定规律，不过是脉搏偶然阻滞在气血凝滞的地方，偶尔停跳一次，所以病情较轻；而代脉停顿有固定规律，说明脏腑中有一脏的气机内部亏虚，不能向外达于脉的部位，所以病情很重。那心中的悸动不安，正是结脉和代脉产生的原因。
【炙甘草汤方】炙甘草四两，生姜三两切片，桂枝三两去皮，人参二两，生地黄一斤，阿胶二两，麦门冬半升，麻子仁半升，大枣三十枚掰开。
以上九味药，用清酒七升、水八升，先煮前八味药，取汁三升，去渣后加入阿胶，烊化（加热使溶解）至完全消尽，每次温服一升，每日服用三次。此方又名复脉汤。
炙甘草汤的用意很深奥，但注释家却说，方中多用富含汁液的药物。他们认为因为心血亏少，导致心中悸动进而引起脉象结代，所以重用富含汁液的药物来滋补心血，这是本方的宗旨。却不知道这样评论这个方子，就把这个方子看浅了。试看方中的各种药物，只有生地黄（即干地黄）重用一斤。地黄原本是补肾的药，只是当时没有熟地黄，如果多用又恐怕其性质过于寒凉，所以用七升酒、八升水一起煮，且酒水共十五升，煮后减去十二升。这是因为酒性原本热，再加上久煮，想要将生地黄的凉性变为温性，目的是想温补肾脏。大概脉搏的跳动在心，而脉搏之所以跳动有力，实际上依赖于肾气上升与心气相互济助。所以患伤寒少阴病时，因为肾脏受病损伤，遏制了肾中的气化功能，不能向上与心相交，无论病情是寒是热，脉搏都微弱无力，这是一个明显的证据。由此看来，炙甘草汤的用意，原本是以补助肾中的气化为主，使其壮旺上升，与心中的气化相互济助作为关键所在。至于滋补心血，则是方中兼治的次要作用，是本方中缓慢图谋的部分。
方中的人参原本能辅助心脉跳动，实为方中的重要药物，但只用二两，折合现在的六钱，再取其三分之一，方中实际只有人参二钱，这恐怕是分量有误，我打算加倍为四钱，这样见效应当更快。然而人参必须用党参，而不用辽参，因为辽参有热性。
如果脉象结代并且兼有阳明经实热的，单用炙甘草汤恐怕难以奏效，适宜借用白虎加人参汤，用炙甘草汤中的生地黄代替方中的知母，用怀山药代替方中的粳米。我曾治疗一位老人，年近六十岁，得了伤寒证，四五天内表里大热，脉象洪大但不坚实，已有代脉的现象，舌苔白而微黄，大便几天未行。我为他开方，用生石膏三两，大生地一两，野台参四钱，生怀山药六钱，甘草三钱，煎汤三盅，分三次温服。将三次药服完后，脉象已不再出现代脉，热退去大半，大便仍未通下，于是就在原方基础上减去石膏五钱，加入天冬八钱，仍然像从前那样煎服，病便痊愈了。
炙甘草汤虽然结脉和代脉都能治疗，但因为结脉轻、代脉重，所以在制定方剂时注重于代脉，纯用补药。至于结脉常常不适合纯用补药，适宜稍微加入疏通的药物才适合病情。最近曾在天津治疗一位姓钱的壮年人，得了伤寒证，三四天后延请我诊治，他的脉象洪滑非常坚实，或者七八次跳动停一次，或者十余次跳动停一次，所有的停顿都在左手部位。询问他得病的原因，知道是在生病之前曾发怒动了肝火，接着又出门感受寒气，于是得了这个病，因此知道他左脉的结脉是由于肝气不舒畅所致。我为他开方，仍然是白虎加人参汤加减，用生石膏细末四两，知母八钱，用生山药代替粳米用六钱，野台参四钱，甘草三钱，另外外加生莱菔子四钱捣碎，煎汤三盅，分三次温服。结脉虽然消除了，但脉象仍有余热，于是就在原方中将石膏减去一两，人参、莱菔子各减一钱，仍然像以前那样煎服。他的大便从前四天未通，将药三次服完后，大便通下，病便痊愈了。这次所用的方子中没有用生地黄代替知母，是因为地黄的性质与莱菔子不相宜。
我治疗寒温证不轻易使用降下攻伐的药物，病人即使热入阳明之腑，如果没有大便燥硬、欲下不下这样的实证表现，也常常投以大剂量的白虎汤来清热，热清后大便通常自然通下。所以我每天临证，白虎汤确实是常用之品，承气汤往往整年都不使用一次。
有一位老人，年过六十，大便下血，医治三十多天病情加重，每天下血十多次，且有很多血块，精神昏沉迷糊。延请我诊治，他的脉象洪实异常，至数不快，只有右部有停顿，停顿没有固定规律，这是结脉。他的舌苔纯黑，知道这是外感大实的证候，以前的医生只知道治疗他的便血，不知道治疗外感实热，这真是奇怪啊。我投以白虎加人参汤，方中生石膏重用四两，因为他下血日久，又用生山药一两代替方中的粳米，取其能滋阴补肾，兼能固护元气。煎汤三盅，分三次温服，每次送服广三七细末一钱。如此每天服用一剂，两天后血止，大便仍然每天数次，脉象的洪实大减，但结脉更加严重，且腹中觉得胀满。询问病因，知道是恼怒之后得的，于是改用生莱菔子五钱，并佐以白芍、滑石、天花粉、甘草等药（外用鲜白茅根切碎四两煮三四沸，取其汤水代替普通水煎药），服用一剂后胀消，脉的至数调匀，毫无结脉现象而且仍然有力，大便滑泻已减半，再投以我自己拟定的滋阴清燥汤（方系生怀山药、滑石各一两，生杭芍六钱，甘草三钱），一剂后泻止，脉象也平和了。观察上面记录的两个医案，可知结脉现象未必都属于内亏，常常有因为气分不舒畅，调理气机即可痊愈的情况。
又有脉象不是结代，却呈现如雀啄般的形象，这也是气分有所阻隔所致。曾治疗一位少妇，平日多病，在孟春中旬得了伤寒，四五天内表里都壮热，她的舌苔白而中心微黄，毫无津液，脉搏接近六至，重按有力，或者十余次跳动之后，或者二十余次跳动之后，经常呈现雀啄的形象，就像麻雀啄米粒一样，常常连续二三啄。她呼吸外出时，常常好像有抵触而不能顺畅舒展。仔细询问病因，知道她平日掌管家中出入账目，婆婆查账很严，生病之前，因为账目有差错，曾被责骂，由此知道她气息不顺及脉象呈雀啄的原因都在于此。问她大便自生病后未行，于是仍然治疗前面那个钱姓病人的方子，将生石膏减去一两，因为她津液亏损，加入天花粉八钱，也是煎汤三盅分三次温服。脉象已接近平和，至数调匀如常，呼吸也顺畅，只是大便仍未通下，改用滋阴、润燥、清火的药物，服用两剂后大便通下，全愈。
The formulas such as Xuanxiong Tang (Chest-Trap Decoction) and Xiexin Tang (Drain the Epigastrium Decoction) generally treat excess syndromes of external contraction. However, there are cases where the syndrome belongs to external contraction, yet the patient suffers from severe internal deficiency; this is the syndrome governed by Zhigancao Tang (Rehmannia Root and Licorice Decoction) in the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases).
Original text of *Shanghan Lun*: In cold damage, if the pulse is Jie-Dai (knotted and intermittent), and there is palpitation of the heart, Zhigancao Tang (Rehmannia Root and Licorice Decoction) should be administered.
When the pulse beats, it occasionally stops. If the stoppage has no fixed number, it is called "Jie" (Knotted), meaning the pulse is knotted and does not flow smoothly, thus stopping midway; if the stoppage has a fixed number, it is called "Dai" (Intermittent), meaning that when the pulse reaches this point, one beat is missing, and another pulse must substitute for it. Although both pulses are special pathological pulses, there is indeed a distinction in severity. Generally, Jie pulse stops without a fixed number; it is merely that the pulse occasionally obstructs at places where Qi and Blood are stagnant, stopping once in a while, so the disease is still mild. As for Dai pulse, the stoppage has a fixed number, indicating that the Qi of one Zang organ within the viscera is internally deficient and cannot reach outward to the pulse site, so the disease is very severe. The palpitation of the heart is precisely the origin of the Jie and Dai pulses.
[Zhigancao Tang Formula] Zhi Gancao (Honey-fried Licorice Root) 4 liang, Shengjiang (Fresh Ginger) 3 liang sliced, Guizhi (Cinnamon Twig) 3 liang peeled, Renshen (Ginseng Root) 2 liang, Sheng Dihuang (Raw Rehmannia Root) 1 jin, Ejiao (Donkey-hide Gelatin) 2 liang, Maimendong (Ophiopogon Tuber) half sheng, Maziren (Hemp Seed) half sheng, Dazao (Jujube Fruit) 30 pieces split open.
These nine ingredients are boiled with 7 sheng of clear wine and 8 sheng of water. First, boil the first eight ingredients to obtain 3 sheng of liquid, remove the dregs, add the gelatin, melt it completely until dissolved, and take 1 sheng warm each time, three times a day. This formula is also named Fumai Tang (Restore the Pulse Decoction).
The intention behind Zhigancao Tang is profound, but commentators claim that the formula uses many drugs rich in juice. They argue that because Heart Blood is deficient, causing palpitations and leading to Jie-Dai pulses, heavy use of juicy drugs is intended to nourish Heart Blood, which they consider the main purpose of this formula. However, discussing the formula in this way superficializes its true value. Observe the drugs in the formula: only Sheng Dihuang (i.e., Gan Dihuang/Dried Rehmannia Root) is used in a heavy dose of 1 jin. Dihuang is originally a Kidney-nourishing drug. Since Shu Dihuang (Prepared Rehmannia Root) was unavailable at that time, and using too much raw Dihuang might be too cooling, it was boiled with 7 sheng of wine and 8 sheng of water. With a total of 15 sheng of wine and water, the volume reduced by 12 sheng after boiling. Since wine nature is hot, and prolonged boiling aims to transform the cool nature of raw Dihuang into a warm nature, the intent is to warm-tonify the Kidneys. The heartbeat originates in the Heart, but the strength of the pulse relies on Kidney Qi rising to assist Heart Qi. Therefore, in Shaoyin cold damage, when the Kidney is injured and suppresses Kidney Qi transformation, preventing it from ascending to interact with the Heart, regardless of whether the disease is cold or hot, the pulse becomes weak and powerless. This is clear evidence. Thus, the intention of Zhigancao Tang is primarily to assist Kidney Qi transformation, making it vigorous and ascending, to mutually assist Heart Qi transformation as the key measure. Nourishing Heart Blood is merely a secondary effect treated concurrently in the formula, something slowly addressed.
Renshen (Ginseng Root) in the formula can originally assist Heart pulse beating and is an essential drug, but only 2 liang are used, equivalent to 6 qian today. Taking one-third of this amount leaves only 2 qian of Renshen in the dose. This may be an error in dosage; I propose doubling it to 4 qian for faster efficacy. However, Dangshen (Codonopsis Root) must be used instead of Liaoshen (Korean Ginseng), as Liaoshen has a hot nature.
If the pulse presents Jie-Dai combined with Yangming Excess Heat, treating solely with Zhigancao Tang may fail. It is advisable to borrow Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction), replacing Zhimu (Anemarrhena Rhizome) in that formula with Sheng Dihuang (Raw Rehmannia Root) from Zhigancao Tang, and replacing Jingmi (Rice Grain) with Huai Shanyao (Chinese Yam Rhizome). I once treated an elderly man near sixty years old who contracted cold damage. Within four to five days, he had severe heat in both exterior and interior. His pulse was Hong (Surging) but not solid, showing signs of Dai pulse. His tongue coating was white with slight yellow, and he had not had a bowel movement for several days. I prescribed: Sheng Shigao (Raw Gypsum) 3 liang, Da Shengdi (Large Raw Rehmannia) 1 liang, Ye Taishen (Wild Codonopsis) 4 qian, Sheng Huai Shanyao (Fresh Chinese Yam) 6 qian, Gancao (Licorice Root) 3 qian. Boiled to make 3 zhong of decoction, taken warm in three doses. After finishing all three doses, the Dai pulse disappeared, heat subsided by more than half, but the bowels remained unopened. I then modified the original formula by reducing Shigao by 5 qian and adding Tiandong (Asparagus Tuber) 8 qian, brewing and administering as before. The illness was completely cured.
Although Zhigancao Tang treats both Jie and Dai pulses, since Jie is mild and Dai is severe, the formula formulation focuses on Dai, using purely tonifying drugs. However, Jie pulse often does not suit pure tonification; it is better to add a small amount of opening/unblocking drugs to suit the condition. Recently, I treated a young adult surnamed Qian in Tianjin for cold damage. He sought my consultation after three to four days. His pulse was Hong (Surging) and Hua (Slippery) and very solid, stopping every seven or eight beats, or every ten-plus beats. All stoppages were on the left side. Asking about the cause, I learned that before falling ill, he had angered his Liver Fire, followed by exposure to cold outdoors. Thus, I knew the Jie pulse on the left was due to constrained Liver Qi. I prescribed a modification of Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction): Sheng Shigao (Raw Gypsum) fine powder 4 liang, Zhimu (Anemarrhena Rhizome) 8 qian, Sheng Shanyao (Chinese Yam) replacing Jingmi (Rice) 6 qian, Ye Taishen (Wild Codonopsis) 4 qian, Gancao (Licorice Root) 3 qian, plus Sheng Laifuzi (Raw Radish Seed) 4 qian crushed. Boiled to 3 zhong of decoction, taken warm in three doses. The Jie pulse was eliminated, but residual heat remained in the pulse. I then reduced Shigao in the original formula by 1 liang, and reduced Renshen and Laifuzi by 1 qian each, brewing and administering as before. His bowels, which had been unopened for four days, moved after completing the three doses, and the illness was cured. In this prescription, I did not replace Zhimu with Sheng Dihuang because Dihuang's nature is incompatible with Laifuzi.
In my treatment of cold and warm diseases, I rarely use purgative/descending agents. Even if heat enters the Fu organs of Yangming, if there are no signs of dry, hard stool or the desire to purge but inability to do so, I often administer large doses of Baihu Tang (White Tiger Decoction) to clear heat. Once the heat clears, the bowels usually move spontaneously. Therefore, in my daily clinical practice, Baihu Tang is indeed a commonly used formula, while Chengqi Tang (Order the Qi Decoction) is hardly used throughout the year.
I treated an elderly man over sixty years old suffering from bloody stools. After thirty-plus days of medical treatment, his condition worsened, with more than ten episodes of bloody stool daily, containing many blood clots, and mental confusion. Upon examination, his pulse was extremely Hong (Surging) and Shi (Solid), with a normal rate, but stoppages occurred only on the right side. These stoppages had no fixed number, identifying it as a Jie (Knotted) pulse. His tongue coating was entirely black, indicating a severe external contraction with excess syndrome. It was strange that previous doctors only treated the bloody stool, ignoring the external excess heat. I administered Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction), heavily dosing Sheng Shigao (Raw Gypsum) at 4 liang. Because of the prolonged bleeding, I added Sheng Shanyao (Chinese Yam) 1 liang to replace Jingmi (Rice), utilizing its ability to nourish Yin, tonify the Kidneys, and secure Yuan Qi. Boiled to 3 zhong of decoction, taken warm in three doses. Each dose was accompanied by 1 qian of Guang Sanqi (Notoginseng Root Powder). Administered once daily, bleeding stopped after two days. Bowel movements continued several times daily, the pulse's Hong-Shi quality decreased significantly, but the Jie pulse became more severe, accompanied by abdominal distension. Inquiry revealed the cause was anger. I switched to Sheng Laifuzi (Raw Radish Seed) 5 qian, assisted by Baishao (White Peony Root), Huashi (Talcum), Tianhua Fen (Trichosanthes Root), and Gancao (Licorice Root). Additionally, fresh Baixiaogen (Imperata Rhizome) 4 liang chopped was boiled for three to four boils, and the resulting water was used to decoct the herbs. After one dose, distension resolved, the pulse rate became regular, the Jie phenomenon disappeared while remaining forceful, and loose diarrhea halved. I then administered my own formulated Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), consisting of Sheng Huai Shanyao (Chinese Yam) and Huashi (Talcum) each 1 liang, Sheng Hangshaoyao (Hangzhou White Peony Root) 6 qian, and Gancao (Licorice Root) 3 qian. After one dose, diarrhea stopped, and the pulse became peaceful. Observing the two cases recorded above, one can see that Jie pulse phenomena do not necessarily belong to internal deficiency; often, they result from constrained Qi, and regulating Qi can lead to recovery.
There are also cases where the pulse is neither Jie nor Dai, but presents a Quezhao (Sparrow Pecking) image. This is also due to obstruction in the Qi level. I once treated a young woman who was chronically ill. In mid-Mengchun (early spring), she contracted cold damage. Within four to five days, she had high fever in both exterior and interior. Her tongue coating was white with slight yellow in the center, lacking fluids. Her pulse was near six beats per breath, strong upon deep pressure. After every ten-plus or twenty-plus beats, a Quezhao (Sparrow Pecking) image often appeared, resembling a sparrow pecking millet, often pecking two or three times consecutively. When exhaling, her breathing seemed obstructed and unable to flow smoothly. Detailed inquiry into the cause revealed that she managed household accounts, and her mother-in-law checked them strictly. Before falling ill, she was reprimanded for accounting errors. Thus, her irregular breathing and Quezhao pulse were caused by this emotional trauma. She reported no bowel movement since the onset of illness. I treated her with the same formula used for Mr. Qian, reducing Sheng Shigao (Raw Gypsum) by 1 liang. Due to fluid depletion, I added Tianhua Fen (Trichosanthes Root) 8 qian. Brewed to 3 zhong of decoction, taken warm in three doses. The pulse approached peace, the rate became regular, and breathing smoothed out. Only the bowels remained unopened. I switched to drugs that nourish Yin, moisten dryness, and clear fire. After two doses, the bowels moved, and she recovered completely.