肝阳化风，逆行脾胃之分；胃液成痰，流走肝胆之络。右腿麻痹，胸膈痞闷，所有来也。而风火性皆上行，故又有火升气逆鼻衄等证。此得之饥饱劳郁，积久而成，非一朝一夕之故：也。治法清肝之火，健脾之气，亦非旦夕可图也。
诒按：持论明通，立方周匝，看似平淡无奇，实非老手不办。亦当加入白芍。
此肝风挟痰上逆之证，肢冷自汗，有似阳脱，实非脱也。目与唇口牵引，时复歌笑。治宜先却邪气，而后养正。
诒按：治法的当。时复歌笑，是心脏受邪之象。菖蒲、远志，胆星、清心牛黄丸之类，均可选入。
邓评：想必舌绛脉盛，是以不顾厥汗而直任羚羊。似可参入生脉，兼治其虚。柳师亦在应加之例。
细生地 钩钩 归身 茯苓 阿胶 天麻 羚羊角 山药 柏予仁 刺蒺藜
邓评：至理名言。
诒按：案语简炼，方亦纯净。
邓评：此等方案，既松灵，又周匝。学到如此，庶几目无难题。
四肢禀气于脾胃，脾胃虚衰，无气以禀，则为振颤。土虚木必摇，故头运也。
诒按：案语说理朴实，立方以扶正为主。似宜再加熄风之品。其所加之黄芪，恐非肝风升动者所宜。
邓评：此培土以御木法。
柳评尤属精细。
木旺乘土，土气不宣，痰涎郁聚，传走经络，故头旋脚弱，有似虚象，实则未可徒补也。
诒按：首乌似嫌其涩，不如用生于术为妥。拟再加牛膝、竹沥、姜汁。
原方已平妥，加减更切实。
神 志 门
骤尔触惊，神出于舍，舍空痰入，神不得归，是以有恍惚昏乱等证。治当逐痰以安神藏。
诒按：叙病如话如画。此等方案，非有切实功夫者不能。所谓成如容易却艰辛也
邓评：论正方切。
惊悸易泄，腰疼足软，有似虚象，而实因痰火。盖脉不弱数，形不枯瘁，未可遽与补也。
邓评：易当作遗。
诒按：痰火之邪，因惊恐而直犯肝胆，故见证如此。卧则阳气入于阴，合目则发，是阳气扰动阴脏，致痰火猝发而病作也。方中拟加羚羊角、黄连
骤惊恐惧，手足逆冷，少腹气冲即厥，阳缩汗出。下元素亏，收摄失司。宜乎助阳以镇纳。第消渴心悸，忽然腹中空洞。此风消肝厥见象，非桂附刚剂所宜。 炒黑杞子 舶茴香 当归 紫石英 细辛 桂枝 诒按：风消肝厥之证，当于温养中佐以滋阴。方中细辛一味，不识何意。愚意再加牛膝、白芍、牡蛎。
柳注加味极妥。
诒按：方极清稳。
秋冬咳嗽，春暖启安，是肾气收纳失司，阳不潜藏，致水液变化痰沫，随气射肺扰喉，喘咳不能卧息，入夜更重，清晨稍安。盖痰饮乃水寒阴浊之邪，夜为阴时，阳不用事，故重也。仲景云：饮病当以温药和之。金匮饮门，短气倚息一条，分外饮治脾，内饮治肾，二脏阴阳含蓄，自然潜藏固摄。当以肾气丸方，减牛膝、肉桂，加骨脂以敛精气。若以他药发越阳气，恐有暴厥之虑矣。
诒按：此案推阐病原，极其精凿。
往昔壮年，久寓闽粤，南方阳气易泄。中年以来，内聚痰饮，交冬背冷喘嗽，必吐痰沫，胸脘始爽。年逾六旬，恶寒喜暖，阳分之虚，亦所应尔。不宜搜逐攻劫，当养少阴肾脏。仿前辈水液化痰阻气，以致喘嗽之例。
诒按：议论明确，立方亦极精当。
邓评：牛膝本能纳降肾气，今反减去者，想为肾气失固，嫌其有滑泄之力耳。
孙评：喘不得卧，徐批叶案，桂、膝二味是最要之药，细按亦是有理。此二案均去之未用，想因痰沫甚多，恐温摄则痰束于内，而喘反甚也。后遗精门有喘而危坐者加桂、膝，可知也。凡读书总须彼此对勘，方有进境，若徒恃高唱遥吟无益也。
久遗下虚，秋冬咳甚，气冲于夜，上逆不能安卧，形寒足冷，显然水泛而为痰沫。当从内饮门治，若用肺药则谬矣。
诒按：古人云：内饮治肾。据此证情，似可兼服肾气丸，以摄下元。
肝风与痰饮相搏，内壅脏腑，外闭窍隧，以致不寐不饥，肢体麻痹。迄今经年，脉弱色悴，不攻则病不除，攻之则正益虚，最为棘手。
钩藤 菖蒲 刺蒺藜 远志 竹沥 郁金 胆星 天竺黄 另指迷茯苓丸临卧服
诒按：病属难治，而立方却周匝平稳，非学有本原者，不能办此。
肝阳因劳而化风，脾阴因滞而生痰，风痰相搏，上攻旁溢，是以昏运体痛等证见也。兹口腻不食，右关微滑，当先和养胃气，蠲除痰饮。俟胃健能食，然后培养阴气，未为晚也。
诒按：审察病机，以为立方步伐，临证者宜取法焉。
邓评：至理名言。
再增姜汁、竹茹，菊花，菖蒲根，似更美备。
风热不解，袭人肺中，为咳为喘，日哺发热，食少体倦，渐成虚损，颇难调治。勉拟钱氏阿胶散，冀其肺宁喘乎，方可再商他治。
邓评：聚饮之源，因寒因湿，鼓立方轻灵可喜，非老手不办之作。柳师所谓食古能化者，此之谓也。
诒按：案语得看病之窍，最宜留意。
肺阴不足，肺热有余，咳则涕出，肌体恶风。此热从窍泄，而气不外护也。他脏虽有病，宜先治肺。
诒按：此等证，虚实错杂。若粗工为之，或与疏散，或与补涩，均足致损。
邓评：热从窍泄，故咳则涕出，气不外护，放肌体恶风。如此直断无疑，洵有卓识。
肺病以中气健旺，能食便坚为佳。兹喘咳已久，而大便易溏，能食难运，殊非所宜。诊得脉象与前无异，但能节饮食，慎寒暖，犹可无虞。
邓评：肺病本宜清润，而脾则恶之。至此脾土已弱，故云殊非所宜。
孙评，开口如开门见山，有一目了然之妙
诒按：不刊之论，读者最宜记好
邓评：此二方看似平常，却已不易办到。
诒按：此证不甚多见，学者须记之。
邓评：此审病之关键处，盖有不易之理也。方即麦门冬汤加枇杷叶。
久嗽便溏，脉虚而数。脾肺俱病，培补中气为要。恐后泄不食，则瘦削日增也。
冶按：此亦脾肺两治之法，较前数方为切实，亦以此证中气虚寒，无咽干溺涩等虚热亢炎之证，故用药稍可着力耳。然欲求效难矣。
邓评：柳师评语精确。
阴虚于下，阳浮于上。咳呛火升，甚于暮夜。治肺无益，法当补肾。
邓评：审病既确，方亦当效。
诒按：方中少润肺之品。拟加北沙参、桑白皮。再肝之犯肺，必挟木火，栀丹亦应用之药也。
孙评：木火刑金。咳而无痰为干咳，须究其因而治之。如郁火有用加味逍遥散者。
风伤于上，湿伤于下，上为咳嗽痰多，下为跗肿酸痛。宜先治上，而后治下。
邓评：此属脾肺同病，何不参用桑白皮、薏仁、苓、橘等味为双关。
咳甚于夜间，肌热于午后，此阴亏也。浊痰咳唾，鼻流清涕，是肺热也。病本如是，奏功刁二易。拟甘咸润燥法。
邓评：制剂乎稳，惜少清阴之品
内热与外热相合，肺胃受之，则咳而不能食，头胀肌热心烦。宜清上中二焦。
脉细数促，是肝肾精血内耗，咳嗽必吐呕清涎浊沫。此冲脉气逆，自下及上，气不收纳，喘而汗出，根本先拨，药难奏功。医若见血为热，见嗽治肺，是速其凶矣。
邓评：切要之言。此下虚上实之候，斯时喘汗为急，急者先治，故立方如是。若待其脱象已定，仍需兼平痰火。
脉虚数，颧红声低，咳甚吐食，晡时热升，多烦躁。此肝肾阴亏，阳浮于上，精液变化痰沫。病已三年，是为内损，非消痰治嗽可愈。固摄下焦，必须绝欲。以饮食如故，经年可望其愈。
邓评：虚劳重症迭见，胡所恃而不恐也，犹谓经年可望其愈，惟所恃者，在乎饮食如故。盖人以胃气为本也。风消息贲，想亦未见
咽痛声哑，有肺损肺闭之分。所谓金破不鸣，金实亦不鸣也。此证从外感风热而来，当作闭治，温补非宜。所虑者，邪不外达而内并耳
邓评：此乃暴病，属肺闭，故润肺散邪以清全，金虚则鸣矣，与虚劳见是证者不得混看。
用复脉甘润法。呛止音出，得益水濡润之力也。无如胃弱便溏，此药不宜再用。仿金匮麦门冬汤义，取养土之阴，以生肺金。
诒按：此用药转换法也。
孙评：叶氏用复脉每去麻仁者因此。
久咳，便溏腹满。脾肺同病，已属难治。况脉数口干潮热，肝肾之阴，亦不足耶。
诒按：病重药轻，恐难奏效。且于肝肾，亦未顾到。拟加用水泛六味丸一两，绢包入煎。
邓评：病既危矣，方亦聊尽人事。
煎丸并进，此法极妙。
肝阳化生内风，逆乱侵犯脾胃的领域；胃中津液凝聚成痰，流窜阻滞于肝胆的经络。右腿麻木不仁，胸膈部痞塞闷胀，这些都是由此产生的症状。而且风邪和火邪的性质都趋向于上行，所以又出现了火热上冲、气机上逆导致的鼻出血等症状。这些病症是由于饥饱失常、劳累过度以及情志抑郁，长期积累而成的，并非一朝一夕形成的。治疗需要清泻肝火，健脾益气，也不是一两天就能见效的。
诒按（柳宝诒评语）：论述明达通达，处方周全严密，看似平淡无奇，实际上不是经验丰富的老手不能做到。还应当加入白芍。
这是肝风挟带痰浊上逆的证候，四肢发冷、自汗，看起来像是阳气外脱，但实际上并不是脱证。眼睛和口唇肌肉牵引抽搐，时而唱歌嬉笑。治疗应当先祛除邪气，然后再扶助正气。
诒按：治疗方法恰当。时而唱歌嬉笑，这是心脏受邪的表现。石菖蒲、远志、胆南星、清心牛黄丸之类的药物，都可以考虑选用。
邓评：想必患者舌质深红、脉象盛大，所以不顾及厥逆出汗的症状而直接使用羚羊角。似乎可以参入生脉散，兼治其虚损。柳宝诒先生也认为应该加入。
肝脏属于风木之脏，本性喜欢冲逆，其病理变化表现为震颤、摇晃、强直，治疗宜采用柔润肝木、熄止内风的方法。
细生地 钩藤 当归身 茯苓 阿胶 天麻 羚羊角 山药 柏子仁 刺蒺藜
邓评：说得极有道理。
诒按：案语简练，方剂也很纯净。
邓评：这样的治疗方案，既轻松灵活，又周全严密。学到这种程度，大概就没有什么难题了。
四肢的气血禀受于脾胃，如果脾胃虚弱衰败，没有气血输布滋养，就会出现肢体震颤。土虚则木必摇动，所以会出现头晕。
诒按：案语说理朴实，处方以扶正为主。似乎还应该再加一些熄风的药物。其中加入的黄芪，恐怕不适合肝风升动的情况。
柳宝诒的评语尤其精细。
肝木旺盛乘袭脾土，脾土之气不宣通，痰涎郁结聚集，传注流窜到经络，所以出现头晕、下肢无力，看起来像虚证，但实际上不能单纯进补。
何首乌 橘红 茯苓 薏苡仁 木瓜 钩藤 刺蒺藜 半夏 炙甘草
诒按：何首乌似乎嫌其收敛涩滞，不如使用炒白术更为妥当。打算再加入牛膝、竹沥、姜汁。
原方已经平正稳妥，加减之后更加切实有效。
神志门
突然受到惊吓，神志离舍，神舍空虚导致痰邪乘虚而入，神志无法回归，因此出现恍惚、昏乱等症状。治疗应当驱逐痰邪以安定神志。
诒按：叙述病情如同说话画画一样生动。这样的治疗方案，没有扎实功夫的人是做不到的。正所谓“成如容易却艰辛”。
邓评：论述与方药切合病机。
惊悸、容易遗泄，腰疼、足软，看起来像虚证，但实际上是因为痰火。因为脉象不弱且数，形体没有枯瘦憔悴，不可以急于进补。
诒按：这是秫夏合温胆汤加味。辨证既然准确，处方自然合乎法度。
邓评：“易”字当作“遗”字。
抽搐厥逆，闭目时发作。这是肝胆痰热所致，因惊恐引发，病名为痫厥。
诒按：痰火之邪，因惊恐而直接侵犯肝胆，所以出现这样的症状。卧下时阳气进入阴分，闭目时发作，这是阳气扰动阴脏，导致痰火猝然发作而致病。方中打算加入羚羊角、黄连。
邓评：柳宝诒建议加入羚羊角、黄连，是否加入，总要以舌苔和脉象为依据。
突然受惊恐惧，手足逆冷，少腹部气机上冲即发生厥逆，阴茎收缩、出汗。下焦元阳亏损，收摄功能失职。应当助阳以镇纳固摄。但是伴有消渴、心悸，忽然感到腹部空洞感。这是风消、肝厥的征象，不适合使用肉桂、附子等刚燥的药物。炒黑枸杞子 小茴香 当归 紫石英 细辛 桂枝
诒按：风消、肝厥的证候，应当在温养之中佐以滋阴。方中的细辛一味，不知道是什么意思。我的意见是再加入牛膝、白芍、牡蛎。
邓评：既然属于风消、肝厥，用药仍然显得温燥，与案语的分析不太协调。
柳宝诒的加注加味非常妥当。
诒按：方剂非常清稳。
痰饮门
秋冬季节咳嗽，春暖后缓解安宁，这是肾气收纳功能失职，阳气不能潜藏，导致水液变化为痰沫，随气机上逆射肺扰喉，喘息咳嗽不能平卧，入夜加重，清晨稍安。因为痰饮是水寒阴浊之邪，夜晚属阴，阳气不用事，所以症状加重。张仲景说：饮病应当用温药调和。《金匮要略》痰饮篇中，“短气倚息”一条提到，外饮治脾，内饮治肾，这两脏阴阳含蓄，自然能潜藏固摄。应当使用肾气丸方，减去牛膝、肉桂，加入补骨脂以收敛精气。如果使用其他药物发散阳气，恐怕会有暴厥的危险。
诒按：此案推演病因，极其精当确凿。
往昔壮年时，长期居住在闽粤地区，南方阳气容易耗泄。中年以来，体内积聚痰饮，到了冬天背部发冷、喘息咳嗽，必须吐出痰沫，胸脘部才感觉舒畅。年过六十，恶寒喜暖，这是阳气分虚弱的表现，也是理所当然的。不宜使用搜逐攻劫的药物，应当养护少阴肾脏。仿照前辈关于水液化痰阻气导致喘嗽的例子治疗。
诒按：议论明确，处方也非常精当。
邓评：牛膝本来具有纳降肾气的功能，现在反而减去它，想必是因为肾气失固，嫌弃它有滑泄的力量罢了。
孙评：喘息不能平卧，徐批叶天士医案中，桂枝、牛膝两味是最关键的药，仔细推敲也是有道理的。这两个医案都去掉了这两味药没用，想必是因为痰沫很多，担心温摄会导致痰束结在内，从而使喘息更严重。后面遗精门中有喘息危坐者加入桂枝、牛膝，就可以知道了。凡读书总要彼此对照考证，才能有进步，如果只依靠高声吟唱遥想是没有益处的。
长期遗精导致下焦虚损，秋冬咳嗽加重，气机夜间上冲，上逆不能安卧，身体怕冷、脚冷，显然是水泛为痰沫。应当从内饮门治疗，如果使用治肺的药就错了。
诒按：古人说：内饮治肾。根据这个证候，似乎可以兼服肾气丸，以摄纳下元。
肝风与痰饮相互搏结，内壅脏腑，外闭窍隧，导致失眠、食欲不振、肢体麻痹。至今已经一年，脉弱面色憔悴，不攻邪则病除不了，攻邪则正气更虚，最为棘手。
钩藤 石菖蒲 刺蒺藜 远志 竹沥 郁金 胆南星 天竺黄 另服指迷茯苓丸临睡前服用
诒按：病属难治，但处方却周全平稳，不是学问有本源的人，不能做到这一点。
肝阳因劳累而化风，脾阴因停滞而生痰，风痰相互搏结，上攻旁溢，所以出现头晕、身体疼痛等症状。现在口中黏腻不想吃东西，右关脉微滑，应当先调和养胃气，清除痰饮。等到胃气强健能进食后，再培养阴气，也不算晚。
诒按：审察病机，以此作为处方的步骤，临床医生应当效法。
邓评：至理名言。
再增加姜汁、竹茹、菊花、菖蒲根，似乎更加完美。
风热不解，侵袭人体肺部，导致咳嗽气喘，下午发热，食欲减退、身体疲倦，逐渐形成虚损，很难调治。勉强拟定钱乙的阿胶散，希望肺气宁静喘息停止，然后才可以再商量其他治疗方法。
再诊：青蒿 丹皮 鳖甲 茯苓 石斛 甘草 当归身 陈皮 白芍
邓评：前方专门治疗咳喘，此方偏向调理午后发热，也足以见到治疗的掣肘之处。
久咳脉象不数，口不干，未必立即形成损证。这是肺饮，郁伏不达的缘故。
邓评：聚饮之源，因寒因湿，鼓氏立方轻灵可喜，不是老手不能做到的作品。柳宝诒先生所说的食古能化，就是这个意思。
诒按：案语抓住了看病的窍门，最应注意。
邓评：养肺不留邪，疏风不碍虚，运用补肺阿胶散的方法进行剪裁。
肺阴不足，肺热有余，咳嗽则鼻涕流出，肌肤怕风。这是热气从孔窍泄出，而卫气不能在外护卫。其他脏腑虽然有病，应当先治肺。
诒按：这类证候，虚实错杂。如果是粗工诊治，或者用疏散法，或者用补涩法，都足以造成损害。
邓评：热气从孔窍泄出，所以咳嗽则鼻涕流出，卫气不能在外护卫，所以肌肤怕风。如此直接判断无疑，确实有卓识。
肺病以中气健旺、能食、大便坚实为佳。现在喘息咳嗽已久，而大便容易溏泄，能食但难以运化，殊非所宜。诊得脉象与前无异，只要节制饮食，注意寒暖，还可以无忧。
邓评：肺病本宜清润，但脾脏厌恶滋腻。至此脾土已经虚弱，所以说殊非所宜。
孙评：开口如开门见山，有一目了然的妙处。
诒按：不可更改的言论，读者最好牢记。
邓评：这两个方子看似平常，却已经不容易做到了。
咳嗽，进食后减轻。这是中气虚弱所致。治疗宜用培补中气、降逆气的方法。
诒按：这个证候不太常见，学者必须记住。
邓评：这是审察病情的关键之处，盖有不易之理。方剂即是麦门冬汤加枇杷叶。
久咳大便溏泄，脉虚而数。脾肺俱病，培补中气为要务。恐怕后来腹泻不吃东西，身体就会日益消瘦。
人参 白芍 扁豆 薏苡仁 陈皮 茯苓 炙甘草 山药 蜜炙炮姜炭
诒按：这也是脾肺同治的方法，比前面的几个方子更切实，也是因为此证中气虚寒，没有咽干、小便涩痛等虚热亢炎的症状，所以用药稍微可以着力。然而想要见效很难了。
阴虚于下，阳气浮越于上。咳嗽呛逆、火热上冲，在傍晚夜间加重。治肺无益，方法应当补肾。
邓评：审病既然准确，方剂也应当有效。
所加的胡桃、五味子，恐怕对火热上冲有妨碍，似乎不如沉香、蛤壳。
干咳无痰，是肝气冲犯肺部，不是肺的本病。仍宜治肝，兼滋肺气即可。
诒按：方中缺少润肺的药物。打算加入北沙参、桑白皮。再者肝之犯肺，必然挟带木火，栀子、丹皮也是应当使用的药物。
孙评：木火刑金。咳而无痰为干咳，必须探究其原因进行治疗。如郁火有用加味逍遥散的案例。
风邪伤于上部，湿邪伤于下部，上部表现为咳嗽痰多，下部表现为足背浮肿酸痛。应当先治上部，而后治下部。
邓评：这属于脾肺同病，为什么不参用桑白皮、薏苡仁、茯苓、陈皮等药味作为双管齐下的治疗？
咳嗽在夜间加重，肌肤发热在午后，这是阴亏。浊痰咳唾，鼻流清涕，这是肺热。病本如此，奏效不容易。拟定甘咸润燥法。
邓评：制剂平稳，可惜缺少清阴的药物。
内热与外热相合，肺胃受之，则咳嗽而不能进食，头胀、肌肤发热、心烦。应当清泄上中二焦。
脉细数促，是肝肾精血内耗，咳嗽必定呕吐清涎浊沫。这是冲脉气逆，自下而上，气不收纳，喘息而汗出，根本先拔，药物难以奏功。医生如果见血认为是热，见咳嗽就治肺，是加速其凶险了。
邓评：切要之言。这是下虚上实的证候，此时喘息出汗为急症，急者先治，所以处方如此。如果等到脱象已定，仍需兼平痰火。
孙评：坎炁、紫石英，也适宜增入。只有叶天士开了这个法门，或许可以挽回。
脉虚数，颧骨发红、声音低微，咳嗽剧烈吐食，午后热升，多烦躁。这是肝肾阴亏，阳气浮越于上，精液变化为痰沫。病已三年，这是内损，不是消痰治嗽可以治愈的。固摄下焦，必须禁绝房事。因为饮食如故，经年有望痊愈。
邓评：虚劳重症迭见，有什么可恃而不恐的呢？还说经年有望痊愈，惟所恃者，在于饮食如故。因为人以胃气为本。风消息贲，想必也没有见到。
脉微小，形体怕冷，久咳失音。这是气馁阳损，议定固护胃阳，取用甘温的药物。
咽痛声哑，有肺损、肺闭之分。所谓金破不鸣，金实亦不鸣。这个证候是从外感风热而来，当作闭证治疗，温补不适宜。所忧虑的是，邪气不外达而内并。
邓评：这是暴病，属肺闭，所以润肺散邪以清全，金虚则鸣矣，与虚劳见到这个证候的人不得混看。
使用复脉甘润法。呛逆停止声音发出，得益于饮水濡润的力量。无奈胃弱便溏，此药不适宜再用。仿照《金匮要略》麦门冬汤的意义，取用养土之阴，以生肺金。
诒按：这是用药转换的方法。
久咳，便溏腹满。脾肺同病，已经属难治。何况脉数口干潮热，肝肾之阴，也不足了。
诒按：病重药轻，恐怕难以奏效。而且对于肝肾，也没有顾及到。打算加入用水泛制的六味丸一两，绢包入煎。
邓评：病既危矣，方剂也聊尽人事。
煎丸并进，这个方法极妙。
Deng's Commentary: It is likely that the stomach qi is fatigued and appetite is diminished, which explains why the prescription was adjusted in this manner.
Liver yang transforms into internal wind, reversing and invading the domains of the spleen and stomach; stomach fluids condense into phlegm, flowing and obstructing the collaterals of the liver and gallbladder. Numbness in the right leg and stifling oppression in the chest and diaphragm are all consequences of this. Furthermore, since both wind and fire have a nature that tends to ascend, symptoms such as rising heat, counterflow of qi, and epistaxis (nosebleed) appear. These conditions arise from irregular eating and drinking, overexertion, and emotional depression, accumulating over a long period rather than occurring overnight. The treatment requires clearing liver fire and strengthening spleen qi, which cannot be achieved in a day or two.
Saussureae Radix (Lingyangjiao), Citri Reticulatae Pericarpium (Guangpi), Gastrodiae Rhizoma (Tianma), Glycyrrhizae Radix et Rhizoma (Gancao), Aurantii Fructus Immaturus (Zhishi), Pinelliae Rhizoma (Banxia), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu), Ophiopogonis Radix (Maidong).
Yi An (Commentary by Liu Bao'er): The theoretical discussion is clear and thorough, and the prescription is comprehensive. Although it appears plain and unremarkable, it is not something an inexperienced practitioner could accomplish. White Peony Root (Baishao) should also be added.
Deng's Commentary: There are currently no definitive signs of phlegm wandering into the liver and gallbladder channels.
This is a syndrome of liver wind carrying phlegm upward and counterflowing. Cold limbs and spontaneous sweating resemble yang collapse, but it is not actually a collapse syndrome. Traction and twitching of the eyes and lips, along with occasional singing and laughing, indicate heart involvement due to pathogenic factors. Treatment should first eliminate the pathogen, then nourish the healthy qi.
Saussureae Radix (Lingyangjiao), Poria (Baifuling), Bamboo Shavings (Zhuru), Curcumae Aromatica Rhizoma (Yujin), Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Uncariae Ramulus cum Uncis (Gougou), Citri Reticulatae Pericarpium (Juhong).
Yi An: The treatment method is appropriate. Occasional singing and laughing are signs of the heart being affected by pathogens. Drugs such as Acori Tatarinowii Rhizoma (Changpu), Polygalae Radix (Yuanzhi), Arecae Semen cum Endocarpo (Dansheng), and Qingxin Niuhuang Wan can be considered for inclusion.
Deng's Commentary: It is likely that the tongue was crimson and the pulse vigorous, which is why the practitioner disregarded the symptoms of jue cold and sweating to use Saussureae Radix directly. Shengmai San might be incorporated to treat the deficiency simultaneously. Master Liu also believed it should be added.
The liver belongs to wind-wood, its nature favoring counterflow and rebellion. Its pathological changes manifest as tremors, shaking, and stiffness. The treatment should soften the wood and extinguish wind.
Rehmanniae Radix Preparata (Xishengdi), Uncariae Ramulus cum Uncis (Gougou), Angelicae Sinensis Radix (Guishen), Poria (Fuling), Epotheca Fermentata (Ejiao), Gastrodiae Rhizoma (Tianma), Saussureae Radix (Lingyangjiao), Dioscoreae Rhizoma (Shanyao), Platycladi Semen (Bairen), Tribuli Fructus (Cijili).
Yi An: This prescription can be supplemented with Quisqualis Indica Fruit (Mugua) and White Peony Root (Baishao).
Deng's Commentary: Profound and truthful words.
Spleen dysfunction leads to phlegm production; liver failure to soften leads to wind movement. Dizziness and poor appetite stem from these causes.
Atractylodis Macrocephalae Rhizoma (Baizhu), Gastrodiae Rhizoma (Tianma), Polygoni Multiflori Caulis (Shouwu), Citri Reticulatae Pericarpium (Guangpi), Pinelliae Rhizoma (Banxia), Saussureae Radix (Lingyangjiao), Poria (Fuling), Uncariae Ramulus cum Uncis (Gougou).
Yi An: The case notes are concise, and the prescription is pure.
Deng's Commentary: Such prescriptions are both flexible and comprehensive. Once one reaches this level, there are seemingly no difficult cases.
The four limbs derive their qi from the spleen and stomach. If the spleen and stomach are weak and deficient, lacking qi to nourish them, tremors occur. When earth is deficient, wood must shake, leading to dizziness.
Guipi Decoction modified with Astragali Radix (Huangqi) and Gastrodiae Rhizoma (Tianma).
Yi An: The case notes offer朴实 (simple/practical) reasoning, and the prescription focuses on supporting healthy qi. It seems additional wind-extinguishing herbs should be added. The Astragali Radix included here may not be suitable for cases of rising liver wind.
Deng's Commentary: This is a method of fortifying earth to control wood.
Liu's commentary is particularly refined.
Excessive liver wood attacks spleen earth; spleen qi fails to circulate freely. Phlegm and saliva accumulate and spread through the collaterals, causing dizziness and lower limb weakness. Although it resembles a deficiency pattern, it cannot be treated solely with tonification.
Polygoni Multiflori Caulis (Shouwu), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Coicis Semen (Yiren), Quisqualis Indica Fruit (Mugua), Uncariae Ramulus cum Uncis (Gouteng), Tribuli Fructus (Cijili), Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Zhi Cao).
Yi An: Polygoni Multiflori Caulis seems too astringent; using stir-fried Atractylodis Rhizoma (Baizhu) would be more appropriate. I propose adding Achyranthis Bidentatae Radix (Niuxi), Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi).
Deng's Commentary: The condition is likely to progress to a stroke-like illness.
The original prescription is already balanced and sound; modifications make it even more practical.
Spirit Gate
Sudden fright causes the spirit to leave its residence; the empty residence allows phlegm to enter, preventing the spirit from returning. Thus, symptoms such as trance and confusion occur. Treatment should expel phlegm to calm and store the spirit.
Pinelliae Rhizoma (Banxia), Arecae Semen cum Endocarpo (Dansheng), Uncariae Ramulus cum Uncis (Gouteng), Bamboo Shavings (Zhuru), Poria Cum Pinodia (Fushen), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus (Heizhi), Aurantii Fructus Immaturus (Zhishi).
Yi An: The description of the disease is vivid and expressive. Such prescriptions require solid practical skills. As the saying goes, "It seems easy when accomplished, yet it is arduous."
Deng's Commentary: The discussion and prescription are precise.
Palpitations, easy seminal emission, lower back pain, and weak legs resemble deficiency but are actually caused by phlegm-fire. Since the pulse is not weak but rapid, and the body is not emaciated, immediate tonification is inappropriate.
Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Sorghi Fructus (Sumi), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Bamboo Shavings (Zhuru), Polygalae Radix (Yuanzhi), Acori Tatarinowii Rhizoma (Shichangpu).
Yi An: This is Sumi Xia combined with Wendan Decoction with modifications. With accurate differentiation, the prescription naturally falls into place.
Deng's Commentary: "Yi" should be read as "Yi" (emission).
Oyster Shell (Muli) and White Peony Root (Baishao) should still be added.
Convulsions and jue cold, occurring upon closing the eyes. This is liver-gallbladder phlegm-heat, triggered by fright, named epilepsy-jue.
Pinelliae Rhizoma (Banxia), Citri Reticulatae Pericarpium (Juhong), Bamboo Shavings (Zhuru), Arecae Semen cum Endocarpo (Dansheng), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Acori Tatarinowii Rhizoma (Shichangpu), Aurantii Fructus Immaturus (Zhishi), Poria (Fuling).
Yi An: Phlegm-fire pathogens, triggered by fright, directly attack the liver and gallbladder, resulting in these manifestations. When lying down, yang qi enters yin; closing the eyes triggers this, indicating yang disturbing yin organs, causing sudden phlegm-fire onset. I propose adding Saussureae Radix (Lingyangjiao) and Coptidis Rhizoma (Huanglian) to the prescription.
Deng's Commentary: Whether to add Saussureae Radix and Coptidis Rhizoma as suggested by Liu depends entirely on the tongue coating and pulse.
Sudden fright and fear cause cold extremities; qi rushing from the lower abdomen leads to jue cold, penile retraction, and sweating. Lower jiao yuan qi is deficient, and retention/control functions fail. One should assist yang to settle and grasp. However, with polydipsia, palpitations, and sudden emptiness in the abdomen, these are signs of wind-xiao and liver jue, unsuitable for harsh warming agents like Cinnamon Twig (Guizhi) and Aconite Root (Fuzi). Stir-fried Black Goji Berry (Qizi), Small Fennel Fruit (Bo Huixiang), Angelicae Sinensis Radix (Danggui), Purple Quartz (Zishiyang), Asarum Radix (Xixin), Cinnamon Twig (Guizhi).
Yi An: For wind-xiao and liver jue, one should supplement yin within warming-nourishing methods. The use of Asarum Radix here is unclear. I suggest adding Achyranthis Bidentatae Radix (Niuxi), White Peony Root (Baishao), and Oyster Shell (Muli).
Deng's Commentary: Given it is wind-xiao and liver jue, the medication remains too warm and drying, inconsistent with the case analysis.
Liu's annotated additions are very appropriate.
Sun's Commentary: Asarum Radix (Xixin) might be a typo for Rehmanniae Radix Preparata (Xishengdi).
Liver fire carrying phlegm upward and counterflowing leads to jue and dian diseases.
Pinelliae Rhizoma (Banxia), Uncariae Ramulus cum Uncis (Gouteng), Poria (Fuling), Aurantii Fructus Immaturus (Zhishi), Citri Reticulatae Pericarpium (Guangpi), Bamboo Shavings (Zhuru), Curcumae Aromatica Rhizoma (Yujin), Saussureae Radix (Lingyangjiao).
Yi An: The prescription is extremely clear and stable.
Phlegm and Fluids Gate
Lung Fluid Retention
Asterae Radix (Ziwan), Pinelliae Rhizoma (Banxia), Morus Alba Cortex (Sangpi), Cynanchi Stauntonii Radix (Baiqian), Armeniacae Semen Amarum (Xingren).
Yi An: Fluid retention is in the lung, not affecting the stomach, so only lung-specific drugs are used.
Deng's Commentary: Comparing this case with later ones reveals differences in severity and depth.
Fluid retention shooting into the lung causes cough.
Pinelliae Rhizoma (Banxia), Armeniacae Semen Amarum (Xingren), Zingiberis Rhizoma Recens (Ganjiang), Schisandrae Fructus (Bei Wuwei Zi), White Peony Root (Baishao), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Poria (Fuling), Cinnamon Twig (Guizhi).
Yi An: This is the standard treatment for fluid retention.
Autumn and winter coughs, resolving in spring warmth, indicate kidney qi failing to retain and yang failing to submerge. This causes water fluids to transform into phlegm foam, which shoots into the lung and disturbs the throat with qi, causing wheezing and coughing that prevents lying flat. Symptoms worsen at night and improve slightly in the morning. Phlegm-fluid is a cold-yin turbid pathogen; night is yin time when yang is inactive, hence the worsening. Zhang Zhongjing stated: "Fluid diseases should be treated with warm herbs to harmonize them." In the *Jin Gui Yao Lue* chapter on fluid retention, the section on "shortness of breath leaning forward" mentions treating external fluid with the spleen and internal fluid with the kidney. These two organs' yin and yang naturally submerge and retain. One should use Shenqi Wan, removing Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), and adding Psoraleae Fructus (Buguzhi) to consolidate essence and qi. Using other drugs to disperse yang qi risks sudden jue cold.
Shenqi Wan minus Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), plus Psoraleae Fructus (Buguzhi).
Yi An: This case deduces the pathology with extreme precision.
In his prime, he lived long-term in Fujian and Guangdong, where southern yang qi is easily depleted. Since middle age, internal phlegm-fluid accumulated. In winter, he experiences back chills, wheezing, and coughing, requiring expectoration of phlegm foam before feeling relief in the chest and epigastrium. Over sixty years old, fearing cold and preferring warmth, this reflects deficiency in the yang division, which is expected. Searching and purging attacks are unsuitable; instead, the Shaoyin kidney should be nourished. Following predecessors' examples of water transforming into phlegm obstructing qi causing wheezing and coughing:
Shenqi Wan minus Achyranthis Bidentatae Radix (Niuxi) and Cinnamon Bark (Rougui), plus Schisandrae Fructus (Bei Wuweizi) and Aquilariae Lignum Resinatum (Chenxiang).
Yi An: The discussion is clear, and the prescription is highly appropriate.
Deng's Commentary: Achyranthis Bidentatae Radix (Niuxi) naturally guides kidney qi downward. Removing it now suggests concern that its slippery-draining property might further destabilize the already insecure kidney qi.
Sun's Commentary: In Xu's critique of Ye Tianshi's cases, Cinnamon Twig (Guizhi) and Achyranthis Bidentatae Radix (Niuxi) are cited as crucial for wheezing unable to lie flat. Careful analysis shows merit in this. Both cases omitted these, likely because excessive phlegm foam made one fear that warming-retaining methods would trap phlegm internally, worsening wheezing. Later, in the seminal emission section, Guizhi and Niuxi were added for wheezing patients sitting upright, confirming this logic. Reading requires cross-referencing to progress; mere rhetorical flourish is useless.
Long-term seminal emission leads to lower deficiency. Cough worsens in autumn/winter; qi rushes upward at night, preventing restful sleep. Body chills and cold feet clearly indicate water flooding transforming into phlegm foam. Treat according to the Internal Fluid category; using lung drugs would be erroneous.
Cinnamon Twig (Guizhi), Poria (Fuling), Schisandrae Fructus (Wuweizi), Glycyrrhizae Radix et Rhizoma (Zhi Cao), White Peony Root (Baishao), Zingiberis Rhizoma Recens (Ganjiang).
Yi An: Ancients said: "Internal fluid is treated via the kidney." Based on this presentation, combining with Shenqi Wan to secure the lower origin seems appropriate.
Deng's Commentary: Proposes adding Cuscutae Semen (Tusizi), Oyster Shell (Muli), and Moutan Cortex (Danpi).
Liver wind combats phlegm-fluid, obstructing internal zang-fu and closing external orifices/collaterals, leading to insomnia, anorexia, and limb numbness. Having persisted for a year, with weak pulse and sallow complexion, attacking without tonifying leaves the disease; attacking while weakening healthy qi makes it most difficult.
Uncariae Ramulus cum Uncis (Gouteng), Acori Tatarinowii Rhizoma (Changpu), Tribuli Fructus (Cijili), Polygalae Radix (Yuanzhi), Bamboo Sap (Zhuli), Curcumae Aromatica Rhizoma (Yujin), Arecae Semen cum Endocarpo (Dansheng), Hyacinthtis Amethystea (Tianzhuhuang). Take Zhimi Fuling Wan separately before bed.
Yi An: The disease is difficult to treat, yet the prescription is comprehensive and steady, achievable only by those with deep scholarly roots.
Deng's Commentary: Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), and Oyster Shell (Muli) seem suitable for inclusion.
Sun's Commentary: Poria (Fuling) and Pinelliae Rhizoma (Banxia) are suitable for decoction.
Liver yang transforms into wind due to fatigue; spleen yin generates phlegm due to stagnation. Wind-phlegm combats, attacking upward and spreading sideways, causing dizziness and body pain. Currently, oral stickiness and anorexia with a slightly slippery right guan pulse indicate the need to first harmonize and nourish stomach qi, eliminating phlegm-fluid. Only after stomach health and appetite return should yin be cultivated.
Pinelliae Rhizoma (Banxia), Sorghi Fructus (Sumi), Ophiopogonis Radix (Maidong), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling).
Yi An: Examining the pathogenesis to guide prescription steps is a model for clinicians.
Deng's Commentary: Profound and truthful words.
Adding Ginger Juice (Jiangzhi), Bamboo Shavings (Zhuru), Chrysanthemi Flos (Juhua), and Acori Tatarinowii Rhizoma Root (Changpu Gen) would make it more complete.
Cough and Wheezing Gate
Unresolved wind-heat invades the lungs, causing cough and wheezing. Afternoon fever, poor appetite, and fatigue gradually lead to consumptive disease, difficult to regulate. Tentatively prescribing Qian Yi's Ejiao San, hoping to calm lung qi and stop wheezing, before discussing other treatments.
Epimedi Herba? No, Epimedium is Yinyanghuo. Here it refers to Epimedi Herba? Wait, Qian Yi's Ejiao San usually contains Ejiao, Fuling, Malolou Ling, Yimi, Xingren, Gancao, Nuomi, Qianshi.
Epotheca Fermentata (Ejiao), Poria (Fuling), Aristolochiae Radix (Madoulou Ling), Coicis Semen (Yimi), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Glutinous Rice (Nuomi), Euryales Semen (Qianshi).
Sun's Commentary: Deficiency mixed with excess requires observing the skill of balancing both.
Deng's Commentary: Use of Euryales Semen (Qianshi) likely addresses seminal emission.
Second Visit: Artemisiae Annuae Herba (Qinghao), Moutan Cortex (Danpi), Testudinis Carapax et Plastrum (Biejia), Poria (Fuling), Dendrobii Caulis (Shihu), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Guishen), Citri Reticulatae Pericarpium (Guangpi), White Peony Root (Baishao).
Yi An: This is a pattern of righteous deficiency combined with external pathogen invasion, i.e., internal injury complicated by external contraction.
Deng's Commentary: The previous formula focused on cough/wheeze; this one leans toward managing afternoon fever, showing therapeutic constraints.
Long-term cough with non-rapid pulse and dry mouth does not necessarily indicate consumptive disease. This is lung fluid retention, stagnant and unexpressed.
Magnoliae Officinalis Cortex (Houpo), Roasted Ginger (Weijiang), Morus Alba Cortex (Sangpi), Armeniacae Semen Amarum (Xingren), Citri Reticulatae Pericarpium (Guangpi), Glycyrrhizae Radix et Rhizoma (Gancao), Pinelliae Rhizoma (Banxia).
Yi An: This is cold-fluid injuring the lung, an internal excess pattern.
Deng's Commentary: The source of accumulated fluid stems from cold and damp. Dr. Gu's prescription is light, agile, and pleasing, a work only an old hand could produce. This exemplifies Master Liu's concept of "digesting ancient knowledge."
Constitutional deficiency with pathogen stagnation, lung collaterals unclear. Pulse is soggy and fine, fortunately not rapid.
Glehniae Radix (Shashen), Mori Folium (Sangye), Armeniacae Semen Amarum (Xingren), Poria (Fuling), Aristolochiae Radix (Madoulou Ling), Fritilliriae Thunbergii Bulbus (Beimu), Glycyrrhizae Radix et Rhizoma (Gancao), Japonica Rice (Jingmi).
Yi An: The case notes capture the essence of diagnosis, worthy of attention.
Deng's Commentary: Nourishing lung without retaining pathogens, dispersing wind without hindering deficiency. This is a modification of Qian Yi's Bu Fei Ejiao Fa.
Lung yin deficiency with excess lung heat. Cough produces nasal discharge; skin fears wind. Heat escapes through orifices, while qi fails to protect externally. Even if other organs are diseased, treat the lung first.
Epotheca Fermentata (Ejiao), Fritilliriae Thunbergii Bulbus (Beimu), Glehniae Radix (Shashen), Aristolochiae Radix (Madoulou Ling), Armeniacae Semen Amarum (Xingren), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Glutinous Rice (Nuomi).
Yi An: These patterns involve mixed deficiency and excess. Crude practitioners might use dispersing or astringent-tonifying methods, both harmful.
Deng's Commentary: Heat escaping through orifices causes nasal discharge with cough; qi failing to protect externally causes skin aversion to wind. This direct judgment shows profound insight.
Lung disease benefits from strong middle qi, good appetite, and firm stools. Long-term wheezing/cough with loose stools and difficulty digesting food is unfavorable. Pulse matches previous readings. Controlling diet and avoiding cold/heat may prevent worry.
Glehniae Radix (Shashen), Fritilliriae Thunbergii Bulbus (Beimu), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Armeniacae Semen Amarum (Xingren), Coicis Semen (Yiren), Citri Reticulatae Pericarpium (Juhong), Loquat Leaf (Pipaye).
Deng's Commentary: Lung disease suits clearing/moistening, but spleen dislikes cloying. Here spleen earth is weak, hence "unfavorable."
Sun's Commentary: Opening like opening a door to see mountains, offering instant clarity.
Another Pill Formula: Liuwei Dihuang Wan plus Schisandrae Fructus (Wuweizi) and Cinnamon Bark (Rougui).
Yi An: Unalterable theory, readers should memorize this well.
Deng's Commentary: These two formulas seem ordinary but are hard to achieve.
Cough decreases after eating. Caused by middle qi deficiency. Treatment should fortify middle and descend qi.
Ginseng Radix et Rhizoma (Renshen), Pinelliae Rhizoma (Banxia), Sorghi Fructus (Sumi), Jujubae Fructus (Nanzao), Ophiopogonis Radix (Maidong), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Loquat Leaf (Pipaye).
Yi An: This pattern is rare; students must remember it.
Deng's Commentary: This grasps the key to diagnosing the disease, based on immutable principles. The formula is Maidong Tang plus Loquat Leaf.
Long-term cough with loose stools, deficient and rapid pulse. Spleen and lung both diseased; fortifying middle qi is essential. Fear of future diarrhea and anorexia leading to emaciation.
Ginseng Radix et Rhizoma (Renshen), White Peony Root (Baishao), Lablab Seed (Biandou), Coicis Semen (Yiren), Citri Reticulatae Pericarpium (Guangpi), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Dioscoreae Rhizoma (Shanyao), Honey-roasted Charred Ginger (Mi Zhi Pao Jiang Tan).
Yi An: This is another spleen-lung dual treatment method, more practical than previous formulas. Because this pattern involves middle qi deficiency-cold without yin-deficiency heat signs (dry throat, dysuria), medication can be stronger. However, achieving efficacy will be difficult.
Deng's Commentary: Master Liu's commentary is precise.
Yin deficient below, yang floating above. Coughing spasms and rising fire worsen at night. Treating lung is useless; method should tonify kidney.
Prepared Rehmanniae Radix (Shudi), Goji Berry (Qizi), Asparagi Radix (Tiantong), White Peony Root (Baishao), Poria (Fuling), Dioscoreae Rhizoma (Shanyao), Moutan Cortex (Danpi), Testudinis Carapax et Plastrum (Guiban).
Yi An: Walnut Kernel (Hetao) and Schisandrae Fructus (Wuweizi) can be added to this formula.
Deng's Commentary: Accurate diagnosis ensures effective prescription.
Added Walnut Kernel (Hetao) and Schisandrae Fructus (Wuweizi) might hinder rising fire; Aquilae Lignum (Chenxiang) and Tridacna Concha (Geqiao) seem better.
Dry cough without phlegm indicates liver qi rushing into lung, not a primary lung disease. Treat liver primarily, supplementing lung qi secondarily.
Coptidis Rhizoma (Huanglian), White Peony Root (Baishao), Mume Fructus (Wumei), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Guishen), Oyster Shell (Muli), Poria (Fuling).
Yi An: Prescription lacks moistening lung herbs. Propose adding Glehniae Radix (Beishashen) and Morus Alba Cortex (Sangbaipi). Liver attacking lung must carry wood-fire; Gardeniae Fructus (Zhizi) and Moutan Cortex (Danpi) are also indicated.
Deng's Commentary: Original formula is practical; Master Liu's additions are perfect.
Sun's Commentary: Wood-fire insulting metal. Dry cough requires investigating cause. For constrained fire, Jiawei Xiaoyao San may be used.
Wind injures upper body, damp injures lower body. Upper presents as cough with profuse phlegm; lower as ankle swelling and soreness. Treat upper first, then lower.
Menthae Haplocalycis Herba (Bohe), Armeniacae Semen Amarum (Xingren), Platycodonis Radix (Jiegeng), Inulae Flos (Xuanfuhua), Glycyrrhizae Radix et Rhizoma (Gancao), Fritilliriae Cirrhosae Bulbus (Xiangbei), Forsythiae Fructus (Lianqiao), Peucedani Radix (Qianhu).
Yi An: Lung governs regulation of the whole body, so treating lung takes precedence.
Deng's Commentary: This is simultaneous spleen-lung disease. Why not use Mullein Leaf (Sangbaipi), Coicis Semen (Yiren), Poria (Ling), and Citri Reticulatae Pericarpium (Ju) for a dual approach?
Cough worse at night, skin fever in afternoon indicates yin deficiency. Turbid phlegm expectoration and clear nasal discharge indicate lung heat. Disease nature makes quick recovery difficult. Propose sweet-salty drying-moistening method.
Epotheca Fermentata (Ejiao), Bird's Nest (Yanwo), Glehniae Radix (Shashen), Pyrocalcitum (Haifushi), Benincasae Exocarpium (Gualou Shuang), Fritilliriae Thunbergii Bulbus (Chuanbei), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao).
Yi An: Phlegm in this pattern is dry and sticky, hence the medication.
Deng's Commentary: Preparation is stable, but lacks yin-clearing herbs.
Internal heat combines with external heat, affecting lung and stomach, causing cough, anorexia, head distension, skin fever, and irritability. Clear upper and middle jiao.
Artemisiae Scopariae Herba? No, Zhu Ye is Lophatheri Herba.
Lophatheri Herba (Zhuye), Phragmitis Rhizoma (Lugen), Trichosanthis Radix (Huafen), Armeniacae Semen Amarum (Xingren), Fritilliriae Thunbergii Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Platycodonis Radix (Jiegeng), Citri Reticulatae Pericarpium (Juhong).
Yi An: This is cough from external warm-dryness, hence specific clearing/draining.
Deng's Commentary: Disease is lung-stomach wind-heat; prescription is light and apt.
Fine, rapid, and intermittent pulse indicates consumption of liver-kidney essence-blood. Cough produces vomiting of clear saliva and turbid foam. Chong mai qi counterflows from bottom to top, qi fails to retain, wheezing with sweating. Root is uprooted; drugs struggle to work. If doctors see blood as heat and cough as lung issue, they accelerate disaster.
Ginseng Radix et Rhizoma (processed with Autumn Salt) (Renshen - Qiushi Zhi), Prepared Rehmanniae Radix (Shudi), Schisandrae Fructus (Wuweizi), Purple-skinned Walnut Kernel (Ziyi Hetao).
Yi An: This is a difficult-to-treat pattern, unique among cough categories.
Deng's Commentary: Essential words. This is lower deficiency and upper excess. Wheezing and sweating are urgent; urgent matters treated first, hence the prescription. If collapse signs establish, must also calm phlegm-fire.
Sun's Commentary: Kanqi and Purple Quartz (Zishiyang) should be added. Only Ye Tianshi opened this gate; perhaps it can be salvaged.
Deficient and rapid pulse, malar flush, low voice, severe cough with vomiting food, afternoon heat rise, frequent irritability. Liver-kidney yin deficiency, yang floating above, essence-fluid transforming into phlegm foam. Disease duration three years; this is internal consumption, not curable by phlegm-resolving/cough-stopping alone. Secure lower jiao; must abstain from sexual activity. With normal diet, recovery expected over a year.
Duqi Wan plus Ligustri Lucidi Fructus (Nvzhenzi), Goji Berry (Gouqizi), Asparagi Radix (Tiantong).
Yi An: Medication is quite practical.
Deng's Commentary: Severe consumptive diseases appear repeatedly; what is there to rely on without fear? Claiming yearly recovery relies solely on normal diet. Humans base life on stomach qi. Fengxiao and Xiben [terms] likely unseen.
Minute and faint pulse, body chills, long-term cough with loss of voice. Qi exhausted, yang damaged. Propose securing stomach yang using sweet-warm agents.
Honey-roasted Ginger (Mi Zhi Shengjiang), Glycyrrhizae Radix et Rhizoma (Zhi Cao), White Peony Root (Baishao), Astragali Radix (Huangqi), Jujubae Fructus (Dazao).
Yi An: Another method for deficiency cough.
Deng's Commentary: Internal closure by cold-fluid necessitates Honey-roasted Ginger as chief drug.
Throat pain and hoarseness distinguish between lung damage and lung closure. "Metal broken does not ring; metal full also does not ring." This case stems from external wind-heat; treat as closure. Warming-tonification is unsuitable. Concern is pathogen not exteriorizing but merging internally.
Epotheca Fermentata (Ejiao), Armeniacae Semen Amarum (Xingren), Platycodonis Radix (Jiegeng), Fritilliriae Thunbergii Bulbus (Beimu), Arctii Fructus (Niubang), Scrophulariae Radix (Xuanshen), Glycyrrhizae Radix et Rhizoma (Gancao), Japonica Rice (Jingmi), Aristolochiae Radix (Madoulou Ling).
Yi An: Similar to Qian Yi's Bu Fei San, a method treating both deficiency and excess.
Deng's Commentary: Acute disease, lung closure type. Moisten lung and scatter pathogen to clear; if metal is deficient, it rings. Do not confuse with consumptive disease presenting similarly.
Sun's Commentary: If wind-heat is internally closed, Ma Xing Shi Gan Tang should be used to clear and disperse.
Use Fumai Decoction sweet-moistening method. Spasms stop, voice returns, benefiting from water-moistening power. However, weak stomach and loose stools contraindicate further use. Follow *Jin Gui* Maidong Tang principle: nourish earth yin to generate lung metal.
Maidong Tang.
Yi An: This is a method of changing medication strategy.
Deng's Commentary: Consumptive disease hoarseness. Stomach weak and loose stools make recovery difficult even if effective.
Sun's Commentary: Ye Tianshi often removes Sesame Seed (Maren) from Fumai Decoction for this reason.
Long-term cough, loose stools, abdominal fullness. Spleen-lung simultaneous disease, already difficult. Plus rapid pulse, dry mouth, tidal fever, liver-kidney yin insufficient.
White Peony Root (Baishao), Coicis Semen (Yiren), Poria (Fuling), Lotus Seed (Lianrou), Glycyrrhizae Radix et Rhizoma (Zhi Cao), Citri Reticulatae Pericarpium (Guangpi), Lablab Seed (Biandou).
Yi An: Disease heavy, medicine light; efficacy unlikely. Liver-kidney neglected. Propose adding Water-pill Liuwei Wan (1 liang), wrapped in silk for decoction.
Deng's Commentary: Disease critical; prescription does its best.
Decoction and pills together, excellent method.
Sun's Commentary: Flexible mind.
Seasonal pathogen with loose stools: pathogen descending is an exit route. Primary disease with loose stools means middle qi injured first. Humans base life on stomach qi; if root unstable, treatment is hard.