传于膀胱，膀胱失其输泻之职，旧邪未行，新邪踵至，势必以渐透入募原，如革囊裹物者然。夫人一围之腹，
大小膀胱俱居其中，而胞又居膀胱之中，惟其不久留而输泻，是以宽然有余。今肾气不自收摄，悉输膀胱，膀
胱之气蓄而不泻，失其运化，宜其胀也。治法补肾水而致充足，则精气深藏，而膀胱之胀自消；补膀胱而令气
旺，则肾邪不蓄，而输化之机自裕。然补肾易而补膀胱难，以本草诸药，多泻少补也。经于膀胱之不足者，断
以死期，岂非以膀胱愈不足则愈胀，胀极，势必逆传于肾，肾胀极，势必逆传于小肠，小肠胀极，势必逆传于
脾，乃至通身之气，散漫而无统耶？医者能早见而预图之，能事殚矣。
杨乘六治朱氏妇，病胸膈痞闷，兼寒热往来，口干作渴，饮食不进，服宽利清解药益甚。脉之，右关弦数
而沉，面色带红，舌干微黄，乃与益阴地黄汤。或曰∶胸满不食累月矣，二陈、枳壳，尚不能通，地黄、山药、
五味、萸肉，俱酸涩阴滞之物，其可投乎？曰∶此症本因肝胆燥火闭伏胃中，其原则由于肾水之不足。盖肾者，
胃之关也，水不足，则火旺熏蒸，而胃阴亏。胃与肝胆相并，且为其所胜。又肾既不足，则肝胆阴木无水以养
而燥火独炽，于是乘其所胜之虚而入之。且冲于上，则口干咽燥；流于下，则二便秘急；塞于中，则为胸闷。
脉浮弦而关更甚，右手沉细而关则带滑，此肝木有余，脾血不足之候也。与疏肝助脾，调气养血，则火降郁开，
而痰自内消矣。用调气养荣汤加陈皮、前胡，佐茯苓消痰止嗽，青皮、香附、豆仁、白芍疏肝宽肠。总之，气
得川流，则血自津润。数剂后，用润字丸间服，每次五分。十日症降序，改用六君子，改养血调气药。盖邪之
所凑，其气必虚，壮者气行则愈，弱者着而成病也。后以纯补，间用调气治嗽之品，五旬而痊。
陈三农治一少年，体薄弱，且咳血，左边一块，不时上攻作痛，左金、芦荟俱不应。诊其脉，三部虽平，
而细涩不流利，因作阴虚治，四物汤加知、柏、元参、丹参、鳖甲，数剂顿愈。
卢缝中（去声。）痞痰，忽梦一白衣妇人谓之曰∶食蔗即愈。诘朝见鬻蔗，缝揣囊中，且乏一镪，
惟有唐山一册，遂请易之。曰∶吾乃负贩者，将安用此？哀求之，遂贻数挺。缝喜而食之，至旦遂愈。（《野史》。）
按∶本草蔗能治蛔，蛔能令人痞胀。卢病迨是蛔作楚耳，故食之即愈。
张子和治显庆公僧应寺，有沉积数年，虽不卧床枕，每于四更后，心头闷硬，不能安卧，须起行寺中，习
以为常。人莫知为何病，以请于张。张令涌出涎胶一二升，如黑矾水，继出绿水，又下脓血数升，自尔胸中如
失，便能饮饵无算，安眠至晓。
一妇人小腹中有块，其脉涩，服攻药后，脉见大，以四物汤倍白术，白芍、甘草为佐。俟脉充实，间与硝
石丸，两月消尽。
至正二十五年夏六月，里人周伯安，病积气在右胁下，喘且胀者五阅月。医来，类补以温热之剂，病日剧，
几殆矣。陆君祥往视之，曰∶是息贲也，法当大下，《内经》所谓留者攻之，土郁者夺之也。积气贲门，邪未
去，其可补乎？从之，不终日而愈。（《强斋集》。）
汪石山治一人，年逾三十，形瘦苍白，病食则胸膈痞闷汗多，手肘汗出尤甚多，四肢倦怠或麻，晚食若迟，
来早必泄。初取其脉浮软近驶，两关脉乃略大，曰∶此脾虚不足也。彼曰∶尝服参术膏，胸膈亦觉痞闷，恐病
不宜于参、 。曰∶膏则稠粘，难以行散也，改用汤剂，痞或愈乎。用参、 各二钱，白术钱半，归身八分，
枳实、甘草各五分，麦冬二钱，煎服一帖，上觉胸痞而下觉失气。彼疑参、 使然。曰∶非也。使参、 使然，
但当胸痞，不当失气，恐由脾胃过虚，莫当枳、朴之耗也。宜除枳、朴，加陈皮六分，再服一帖，顿觉胸痞宽，
失气除，精神爽垲，脉皆软缓不大，亦不驶矣。可见脾胃虚者，枳、朴须慎。用为佐使，况有参、 、归、术
为之君，尚不能制，然则医之用药，可不戒乎！
张景岳治金孝廉，以劳倦伤脾，别无他症，但不食，遂用参、术、归、附、桂、姜、甘草之属，半月始愈。
后因病后，复不食如此，自分必死，仍用前药而安。
钱国宾治王元直父，腹左一痞，形如镜大，视之乃镜痞也，生于皮内肉上，可治以三品膏。巴豆、蓖麻子
肉各四两，杏仁一两，黄丹八两，香油一斤二两，熬膏药，贴二十日，一日一换，出脓一二碗。内服参、 托
里，月余收口而愈。
蒋仲芳治陈氏妇，年二十六，生痞块已十年，在脐上，月事先期，夜则五心发热，火嘈膨闷，忽一日痞作声，
上行至心下，则闷痛欲绝，为针上脘，癖下而痛定。然脐旁动气不息，复针天枢穴，动气少止。遂用当归五钱，
白芍、白术、延胡、丹皮、川芎、条芩各一钱，枳实、官桂、槟榔、木香各三分，醋炙鳖甲二钱，水煎，空心
服，至十二剂而愈。
聂久吾治刘氏妹，禀气怯弱，性情沉郁，年三十，病晚间发热，天明复止，饮食少进，烦躁不安，肉削骨
露，医药不效。诊其脉歇至。因其烦躁发热，颇用芩、连、知、柏等凉剂，虽无效，亦不觉寒凉。第恐多服伤
胃，则无生机矣。因问其热从何处起，曰∶自右胁一围先热，遂至遍身。乃悟此必气郁痰结而成痞块，胸膈壅
滞，遂燥热，气结而脉亦结，此脉与症合，不足忧也。当先攻痞，以除其根，则诸症自愈。因用磨痞丸，每日
服三次。服至三四次而块消其半，热渐退。至七八两，块消热尽除，不数月全安矣。当其痰凝气滞，痞结右胁，
不惟医者不知，而病者亦不觉也。非察其病根而拔去之，何能取效也？三棱、莪术皆醋炒，花粉、大黄酒炒，
制香附各八钱，槟榔、黄连姜汁炒、黄芩酒炒、枳实炒、贝母、连翘各六钱，山栀、前胡、青皮醋炒、延索各
五钱，广皮四钱，南木香二钱，郁金三钱，为末，先用竹沥洒润，次用粘米粉搅硬，糊丸绿豆大，每服百丸。
按∶此案与痰门陆养愚治董浔阳夫人脉症俱同，而方异，大约陆案乃剽袭耳。今此案入痞门者，俾知痞
症，有痰结一端也。
化痞膏方，密陀僧六两，阿魏五钱，羌活一两，水红花子三钱，同研细末，用香油一斤熬膏，退火摊贴。
凡患此症，肌肤定无毫毛，须看准，以笔圈记，方用膏贴。多年者，只用两张。内服克坚酒，水红花子研三钱，
浸火酒两斤，日服三次，随量饮之。
病邪传入膀胱，膀胱失去其输注和排泄的功能，旧的病邪未能排出，新的病邪接踵而至，病势必然逐渐透入募原（半表半里之膜原），就像革囊包裹物体一样。人的腹部周围，大小膀胱都位于其中，而胞宫又位于膀胱之中，正因为病邪不能久留而能顺利输泻，所以腹部显得宽裕有余。现在肾气不能自我固摄，全部输送到膀胱，膀胱之气蓄积而不能排泄，失去了运化功能，理应出现胀满。治疗方法是补肾水使其充足，那么精气就会深藏，膀胱的胀满自然消除；补益膀胱使其气旺，那么肾中的邪气就不会蓄积，输化和运转的机能自然充裕。然而补肾容易而补膀胱难，因为本草中的药物，大多具有泻的作用而少具有补的作用。医经对于膀胱不足的情况，断言为死期，难道不是因为膀胱越不足就越胀满，胀满到了极点，病势必然逆向传变于肾，肾胀满到了极点，病势必然逆向传变于小肠，小肠胀满到了极点，病势必然逆向传变于脾，以至于全身之气散漫而无统摄吗？医生如果能早见病机并预先谋划治疗，就能竭尽医道了。
杨乘六治疗朱氏妇人，病症表现为胸膈痞闷，兼有寒热往来，口干作渴，饮食不进，服用宽中利气、清热解表的药物后病情反而加重。诊脉发现右关脉弦数而沉，面色带红，舌干微黄，于是给予益阴地黄汤。有人问：“胸满不食已经累月了，二陈汤、枳壳尚且不能通利，地黄、山药、五味子、山茱萸都是酸涩阴滞的药物，怎么可以投用呢？”杨乘六说：“此症本因肝胆燥火闭伏于胃中，其病机根源在于肾水不足。盖肾是胃的关口，水不足，则火旺熏蒸，导致胃阴亏损。胃与肝胆相并，且受其克制。既然肾水不足，那么肝胆之阴木无水滋养而燥火独炽，于是乘其所胜之虚而入侵。火热上冲，则口干咽燥；流注于下，则二便秘急；阻塞于中，则为胸闷。脉象浮弦而关部更甚，右手脉沉细而关部带滑，这是肝木有余、脾血不足的征候。采用疏肝助脾、调气养血的方法，则火降郁开，痰自内消。”使用调气养荣汤加陈皮、前胡，佐以茯苓消痰止嗽，青皮、香附、豆仁、白芍疏肝宽肠。总之，气若能像河流般流通，血自然得到津液滋润。服用数剂后，改用润字丸间服，每次五分。十日后症状减轻，改为六君子汤，再改用养血调气药。大抵邪气所凑集之处，正气必虚，壮盛者气行则愈，虚弱者气滞着而成病。后来以纯补为主，间用调气治嗽的药物，五十天后痊愈。
陈三农治疗一名少年，体质薄弱，且有咳血症状，左侧有一块肿块，不时上攻作痛，服用左金丸、芦荟均无效。诊其脉，三部虽然平和，但细涩不流利，因此按阴虚论治，使用四物汤加知母、黄柏、玄参、丹参、鳖甲，数剂后顿愈。
卢缝中患有痞痰，忽然梦见一位白衣妇人对他说：“吃甘蔗就能痊愈。”第二天见到卖甘蔗的，卢缝中将甘蔗揣在怀中，但缺少一枚铜钱，只有一册唐山（地名或书名）的书，于是请求交换。卖蔗人说：“我是挑担的小贩，要这书有什么用？”卢缝中哀求他，于是送给他几根甘蔗。卢缝中高兴地吃了，到第二天就痊愈了。（出自《野史》。）
按语：本草记载甘蔗能治蛔虫，蛔虫能令人产生痞胀。卢某的病直到这时才知是蛔虫作祟所致，所以吃了甘蔗就痊愈了。
张子和治疗显庆公僧应寺的一位僧人，患有沉积数年的疾病，虽然不下卧床枕，但每于四更之后，心头闷硬，不能安卧，必须起身在寺中行走，习以为常。人们不知道这是什么病，便向张子和请教。张子和令其涌吐出一二升黑矾水样的涎胶，继而又吐出绿水，又排下脓血数升，从此胸中如释重负，便能大量饮食，安睡至天亮。
一妇人小腹中有肿块，其脉涩，服用攻伐药物后，脉象变得洪大，使用四物汤倍加白术，以白芍、甘草为佐使。等到脉象充实，间服硝石丸，两个月后肿块完全消除。
至正二十五年夏六月，同乡周伯安，病积气在右胁下，喘促且胀满五个月。医生来诊治，误用温热补剂，病情日益加重，几乎危殆。陆君祥前往诊治，说：“这是息贲病，法当用峻下之法，《内经》所谓‘留者攻之，土郁者夺之’。积气在贲门，邪气未去，岂可进补？”患者听从了他的建议，不到一天就痊愈了。（出自《强斋集》。）
汪石山治疗一人，年过三十，形体消瘦苍白，进食则胸膈痞闷汗多，手肘处出汗尤其多，四肢倦怠或麻木，晚上吃饭若晚，次日早晨必定腹泻。初诊取脉，脉浮软近快，两关脉略大，说：“这是脾虚不足。”那人说：“曾经服用参术膏，胸膈也觉痞闷，恐怕病不宜于人参、白术。”汪石山说：“膏剂稠粘，难以行散，改用汤剂，痞闷或许能愈。”用人参、白术各二钱，白术钱半（此处原文可能有误，通常参术同用，疑为笔误或特指），当归身八分，枳实、甘草各五分，麦冬二钱，煎服一帖，上部觉得胸痞，下部觉得排气。那人怀疑是人参、白术造成的。汪石山说：“不是这样。如果是人参、白术造成，应当只是胸痞，不应当排气，恐怕是由于脾胃过虚，承受不住枳实、厚朴的耗散作用。应当去除枳实、厚朴，加陈皮六分，再服一帖，顿时觉得胸痞宽舒，排气停止，精神清爽，脉皆软缓不大，也不快了。可见脾胃虚者，枳实、厚朴须谨慎使用。作为佐使药，况且有人参、白术、当归、白术为之君药，尚且不能制约，那么医生用药，能不戒慎吗！”
张景岳治疗金孝廉，因劳倦伤脾，别无其他症状，只是不进食，于是用人参、白术、当归、附子、肉桂、干姜、甘草等药，半个月才痊愈。后来因病后复发，再次出现不进食的情况，自己认为必死无疑，仍然使用前面的药物而安定下来。
钱国宾治疗王元直的父亲，腹部左侧有一个痞块，形状如镜子大小，视之乃是镜痞，生于皮内肉上，可用三品膏治疗。巴豆、蓖麻子肉各四两，杏仁一两，黄丹八两，香油一斤二两，熬制成膏药，贴敷二十天，一天换一次，流出脓液一二碗。内服人参、黄芪托里，一个多月伤口愈合而痊愈。
蒋仲芳治疗陈氏妇人，年龄二十六岁，生痞块已十年，位于脐上，月经先期，夜间五心发热，嘈杂膨闷，忽一日痞块作响，上行至心下，则闷痛欲绝，为其针刺上脘穴，痞块下行而疼痛定止。然而脐旁动气不息，又针刺天枢穴，动气稍止。遂用当归五钱，白芍、白术、延胡索、丹皮、川芎、黄芩各一钱，枳实、官桂、槟榔、木香各三分，醋炙鳖甲二钱，水煎，空腹服用，服至十二剂而痊愈。
聂久吾治疗刘氏妹妹，禀赋气怯弱，性情沉郁，年三十岁，病晚间发热，天明复止，饮食少进，烦躁不安，肌肉消瘦骨露，医药无效。诊其脉歇至（间歇脉）。因其烦躁发热，颇用黄芩、黄连、知母、黄柏等凉剂，虽无效，也不觉寒凉。只恐多服伤胃，则无生机矣。于是问其热从何处起，回答说：“从右胁一圈先热，遂至遍身。”于是悟出此必是气郁痰结而成痞块，胸膈壅滞，遂致燥热，气结而脉亦结，此脉与症合，不足为忧。应当先攻痞，以除其根，则诸症自愈。于是使用磨痞丸，每日服三次。服至三四次而块消其半，热渐退。至七八两，块消热尽除，不数月全安矣。当其痰凝气滞，痞结右胁，不惟医者不知，而病者亦不觉也。非察其病根而拔去之，何能取效也？三棱、莪术皆醋炒，花粉、大黄酒炒，制香附各八钱，槟榔、黄连姜汁炒、黄芩酒炒、枳实炒、贝母、连翘各六钱，山栀、前胡、青皮醋炒、延胡索各五钱，广皮四钱，南木香二钱，郁金三钱，为末，先用竹沥洒润，次用粘米粉搅硬，糊丸绿豆大，每服百丸。
按语：此案与痰门陆养愚治疗董浔阳夫人的脉症俱同，而方异，大约陆案乃剽袭耳。今此案入痞门者，俾知痞症，有痰结一端也。
化痞膏方：密陀僧六两，阿魏五钱，羌活一两，水红花子三钱，同研细末，用香油一斤熬膏，退火摊贴。凡患此症，肌肤定无毫毛，须看准，以笔圈记，方用膏贴。多年者，只用两张。内服克坚酒：水红花子研三钱，浸火酒两斤，日服三次，随量饮之。
The pathogenic factor transmits to the Bladder (Bladder), which loses its function of transportation and excretion. The old pathogen fails to move, and new pathogens follow closely; inevitably, the condition gradually penetrates into the Mu Yuan (Membranous Origin, a location between the exterior and interior). It is like a leather bag wrapping objects. Within the circumference of the human abdomen, both the large and small Bladders reside, and the Uterus (Bao) lies within the Bladder. Because pathogens do not linger long but are transported and excreted smoothly, there is ample spaciousness. Now, Kidney Qi fails to consolidate and control itself, transmitting everything to the Bladder. The Qi of the Bladder accumulates without being excreted, losing its transformative function, thus distension is expected. The treatment method involves tonifying Kidney Water until it is sufficient; then Essence and Qi will be deeply stored, and the distension of the Bladder will naturally subside. Tonifying the Bladder to strengthen its Qi prevents the accumulation of Kidney pathogens, allowing the mechanisms of transportation and transformation to become abundant. However, tonifying the Kidney is easy, while tonifying the Bladder is difficult, because most herbs in materia medica have purgative rather than tonic properties. The classics state that insufficiency of the Bladder indicates a death sentence. Is this not because the more insufficient the Bladder becomes, the more distended it gets? When distension reaches its extreme, the pathology must reverse-transmit to the Kidney. When Kidney distension reaches its extreme, it must reverse-transmit to the Small Intestine. When Small Intestine distension reaches its extreme, it must reverse-transmit to the Spleen, eventually causing the Qi of the entire body to scatter without regulation. If physicians can perceive this early and plan ahead, they can fulfill their medical duties.
Yang Chengliu treated a woman surnamed Zhu who suffered from chest and diaphragm stuffiness, alternating chills and fever, dry mouth with thirst, and loss of appetite. Her condition worsened after taking medications for widening the middle, promoting drainage, clearing heat, and resolving the exterior. Pulse diagnosis revealed a wiry, rapid, and deep pulse at the Right Guan position; her complexion was reddish, and her tongue was dry with a slight yellow coating. He prescribed Yi Yin Di Huang Tang (Yin-Nourishing Rehmannia Decoction). Someone asked: "She has had chest fullness and inability to eat for months. Er Chen Tang and Zhi Qiao (Aurantium Fructus) still cannot unblock it; how can one administer Di Huang (Rehmanniae Radix), Shan Yao (Dioscoreae Rhizoma), Wu Wei Zi (Schisandrae Fructus), and Yu Rou (Corni Fructus), all of which are sour, astringent, yin-nourishing, and cloying substances?" Yang replied: "This condition originates from dry fire of the Liver and Gallbladder being closed and trapped within the Stomach. Its root cause lies in the insufficiency of Kidney Water. The Kidney serves as the gate of the Stomach. When Water is insufficient, Fire flares up and steams, damaging Stomach Yin. The Stomach is associated with the Liver and Gallbladder and is controlled by them. Since Kidney Water is deficient, the Yin-Wood of the Liver and Gallbladder lacks nourishment, causing dry fire to blaze alone. It then invades the deficiency of what it controls. Flaring upward causes dry mouth and throat; flowing downward causes constipation and urgent urination; blocking in the middle causes chest stuffiness. A floating, wiry pulse with an exacerbated Guan section, and a deep, fine right-hand pulse with a slippery Guan section, indicate excess Liver Wood and insufficient Spleen Blood. By soothing the Liver, assisting the Spleen, regulating Qi, and nourishing Blood, the Fire will descend, stagnation will open, and Phlegm will dissipate internally." He used Tiao Qi Yang Rong Tang (Regulate-Qi and Nourish-Formulation Decoction) added with Chen Pi (Citri Reticulatae Pericarpium) and Qian Hu (Peucedani Radix), assisted by Fu Ling (Poria) to resolve Phlegm and stop coughing, and Qing Pi (Aurantii Fructus Immaturus), Xiang Fu (Cyperii Rhizoma), Dou Ren (likely Sojae Semen Praeparatum or similar, context implies soothing liver/intestines), and Bai Shao (Paeoniae Radix Alba) to soothe the Liver and widen the intestines. In essence, when Qi flows freely like a river, Blood is naturally moistened. After several doses, Run Zi Wan (Moistening Pill) was administered intermittently, 5 fen each time. After ten days, symptoms subsided, and Liu Jun Zi Tang (Six-Gentlemen Decoction) was switched to, followed by blood-nourishing and Qi-regulating medicines. Generally, where pathogenic factors gather, Qi must be deficient. Robust individuals recover as Qi moves; weak individuals suffer disease as Qi stagnates. Later, pure tonification was used, interspersed with Qi-regulating and cough-stopping agents, resulting in recovery after fifty days.
Chen San Nong treated a young man with a weak constitution and hemoptysis. There was a mass on the left side that occasionally attacked upwards causing pain. Zuo Jin Wan (Left Metal Pill) and Lu Hui (Aloe) were ineffective. His pulse was peaceful across the three positions but fine, choppy, and unsmooth. Therefore, it was treated as Yin Deficiency using Si Wu Tang (Four-Substance Decoction) added with Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Xuan Shen (Scrophulariae Radix), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), and Bie Jia (Testudinis Carapax et Plastrum). After several doses, he recovered instantly.
Lu Feng Zhong suffered from Pi Tan (Stagnant Phlegm). He suddenly dreamed of a white-clad woman who told him: "Eating sugarcane will cure you." The next morning, seeing a sugarcane vendor, Lu put sugarcane in his pocket but lacked a coin. He only had a book titled "Tang Shan" and requested an exchange. The vendor said: "I am a peddler; what use is this book?" Lu pleaded, and the vendor gave him several stalks. Lu happily ate them and was cured by dawn. (From *Ye Shi* / Unofficial History.)
Commentary: Materia Medica states that sugarcane treats roundworms (Hui Chong), and roundworms cause abdominal distension and stagnation. Lu's illness was caused by roundworms at this time, hence eating sugarcane cured him.
Zhang Zi He treated a monk at Ying Si Temple under Duke Xianqing. He suffered from a condition accumulated over several years. Although not bedridden, every day after the fourth watch (1-3 AM), he felt stifling hardness in his heart/chest area and could not sleep peacefully, requiring him to walk around the temple, becoming accustomed to this routine. No one knew what disease it was, so they consulted Zhang. Zhang induced vomiting of one or two sheng of black alum-water-like saliva and mucus, followed by green water, and then purging of pus and blood totaling several sheng. From then on, his chest felt relieved, he could drink and eat without limit, and slept soundly until dawn.
A woman had a mass in her lower abdomen with a choppy pulse. After taking attacking/purgative medicines, her pulse became large. She was given Si Wu Tang (Four-Substance Decoction) with doubled Bai Zhu (Atractylodis Macrocephalae Rhizoma), assisted by Bai Shao (Paeoniae Radix Alba) and Gan Cao (Glycyrrhizae Radix). Once the pulse became substantial, Xiao Shi Wan (Niter Pill) was administered intermittently. The mass disappeared completely in two months.
In the summer of June, 25th year of Zhizheng, a villager named Zhou Bo An suffered from accumulated Qi under the right hypochondrium, with wheezing and distension for five months. Physicians came and mistakenly treated him with warm-tonifying agents, worsening his condition daily until he was nearly dead. Lu Jun Xiang examined him and said: "This is Xi Ben (Breath-Rushing Disease). The method requires drastic purgation, as stated in the *Nei Jing*: 'Those that remain should be attacked; those with Earth stagnation should be deprived.' Accumulated Qi at the贲门 (Cardia/Gateway) means the pathogen has not left; how can tonification be applied?" He followed the advice and recovered in less than a day. (From *Qiang Zhai Ji*.)
Wang Shi Shan treated a man over thirty years old, thin and pale. Eating caused chest/diaphragm stuffiness and excessive sweating, especially at the elbows. His limbs were fatigued or numb. If dinner was late, he would definitely have diarrhea the next morning. Initial pulse diagnosis showed a floating, soft, slightly rapid pulse, with the two Guan sections slightly large. Wang said: "This is Spleen Qi deficiency." The patient said: "I once took Shen Zhu Gao (Ginseng and Atractylodes Paste), and my chest felt stuffy too. I fear my condition is unsuitable for Ren Shen (Ginseng Radix) and Bai Zhu." Wang replied: "Pastes are thick and sticky, making it hard for Qi to circulate. Switch to decoction; perhaps the stuffiness will resolve." He prescribed Ren Shen and Bai Zhu (text says "Shen, [missing character likely Zhu/Bai Zhu]" each 2 qian), Bai Zhu 1.5 qian, Dang Gui (Angelicae Sinensis Radix) 0.8 qian, Zhi Shi (Aurantii Fructus), and Gan Cao 0.5 qian each, Mai Dong (Ophiopogonis Radix) 2 qian. After one dose, the upper body felt stuffy, but the lower body passed gas. The patient suspected Ren Shen and Bai Zhu caused this. Wang said: "No. If Ren Shen and Bai Zhu caused it, there would only be chest stuffiness, not passing gas. It is likely due to excessive Spleen/Stomach deficiency, unable to withstand the draining nature of Zhi Shi and Hou Po (Magnoliae Officinalis Cortex)." He advised removing Zhi Shi and Hou Po, adding Chen Pi 0.6 qian, and taking another dose. Immediately, chest stuffiness eased, gas passage stopped, spirit refreshed, and the pulse became soft, slow, not large, and not rapid. This shows that for Spleen/Stomach deficiency, Zhi Shi and Hou Po must be used cautiously. Even as assistants, with Ren Shen, Bai Zhu, Dang Gui, and Bai Zhu as sovereigns, they might not be controlled. Thus, physicians must beware of medication!
Zhang Jing Yue treated Jin Xiao Liang, whose Spleen was injured by fatigue and overwork, with no other symptoms except anorexia. He used Ren Shen, Bai Zhu, Dang Gui, Fu Zi (Aconiti Lateralis Radix Praeparata), Gui Zhi (Cinnamomi Ramulus), Jiang (Zingiberis Rhizoma), and Gan Cao. It took half a month to heal. Later, after an illness, he again lost his appetite and assumed he would die. He still used the previous medicines and stabilized.
Qian Guo Bin treated the father of Wang Yuan Zhi, who had a Pi mass on the left side of the abdomen, mirror-sized, identified as Mirror Pi (Jing Pi), growing inside the skin on the flesh. It was treatable with San Pin Gao (Three-Treasure Paste). Ba Dou (Crotonis Fructus) and Bi Ma Zi Rou (Ricini Semen) each 4 liang, Xing Ren (Armeniacae Semen Amarum) 1 liang, Huang Dan (Lithargyri), 8 liang, and Xiang You (Sesame Oil) 1 jin 2 liang were boiled into a paste. Applied for 20 days, changed once daily, discharging 1-2 bowls of pus. Internally, Ren Shen and Huang Qi (Astragali Radix) were used to support the interior. The wound healed in over a month.
Jiang Zhong Fang treated a woman surnamed Chen, aged 26, who had developed a Pi mass ten years prior, located above the umbilicus. Her menstruation came early. At night, she felt heat in the five centers (palms, soles, chest), acid regurgitation, bloating, and stuffiness. Suddenly, the Pi mass made a sound, moved upward to below the heart, causing unbearable stifling pain. Needling Shang Wan (CV13) caused the Pi mass to move down and pain ceased. However, pulsation beside the umbilicus continued. Needling Tian Shu (ST25) reduced the pulsation. Then, Dang Gui 5 qian, Bai Shao, Bai Zhu, Yan Hu Suo (Corydalis Rhizoma), Dan Pi (Moutan Cortex), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix) each 1 qian, Zhi Shi, Guan Gui (Cinnamomi Cortex), Bing Lang (Arecae Semen), Mu Xiang (Aucklandiae Radix) each 3 fen, Cu Zhi Bie Jia (Vinegar-processed Testudinis Carapax et Plastrum) 2 qian were decocted in water and taken on an empty stomach. She recovered after twelve doses.
Nie Jiu Wu treated Sister Liu, who had a timid constitution and a depressed temperament, aged 30. She suffered from evening fever that stopped at dawn, poor appetite, restlessness, emaciation, and bone prominence. Medical treatments failed. Her pulse showed intermittent skips. Due to restlessness and fever, cooling agents like Huang Qin, Huang Lian (Coptidis Rhizoma), Zhi Mu, and Huang Bo were used heavily. Though ineffective, no cold signs appeared. Fearing excessive intake would damage the Stomach and kill vitality, he asked where the heat started. She answered: "Heat starts in a circle around the right hypochondrium, then spreads to the whole body." He realized this must be a Pi mass formed by Qi stagnation and Phlegm knotting, causing chest/diaphragm congestion and subsequent dry heat. Qi knotting leads to pulse knotting. The pulse matches the symptoms, so there is no need to worry. First, attack the Pi to remove the root, and all symptoms will heal spontaneously. He used Mo Pi Wan (Pi-Grinding Pill), taken three times daily. After 3-4 doses, the mass halved, and fever subsided. After 7-8 liang, the mass disappeared, fever vanished, and she fully recovered within months. When Phlegm condensed and Qi stagnated, forming a Pi mass in the right hypochondrium, neither the physician nor the patient noticed it. Without examining the root and extracting it, how could efficacy be achieved? San Leng (Sparganii Rhizoma) and E Zhu (Curcumae Rhizoma) were vinegar-fried; Hua Fen (Trichosanthis Radix) and Da Huang (Rhei Radix et Rhizoma) were wine-fried; Zhi Xiang Fu (Prepared Cyperi Rhizoma) 8 qian each; Bing Lang, Huang Lian (Ginger-juice fried), Huang Qin (Wine-fried), Zhi Shi (Fried), Bei Mu (Fritillariae Bulbus), Lian Qiao (Forsythiae Fructus) each 6 qian; Shan Zhi (Gardeniae Fructus), Qian Hu, Qing Pi (Vinegar-fried), Yan Suo (likely Yan Hu Suo) each 5 qian; Guang Pi (Tangerine Peel) 4 qian; Nan Mu Xiang (Costi Radix) 2 qian; Yu Jin (Curcumae Longae Radix) 3 qian. These were powdered, moistened with Bamboo Juice (Zhu Li), mixed with sticky rice flour to harden, and formed into pills the size of mung beans. Each dose was 100 pills.
Commentary: This case shares identical pulse and symptom patterns with Lu Yang Yu's treatment of Madam Dong Xun Yang in the Phlegm category, but the formulas differ. Likely, Lu's case was plagiarized. Including this case in the Pi category informs us that Pi syndromes include Phlegm-knotting.
Hua Pi Gao Formula (Pi-Dissolving Paste): Mi Tuo Seng (Pilosi Litharge) 6 liang, A Wei (Ferulae Resina) 5 qian, Qiang Huo (Notopterygii Rhizoma et Radix) 1 liang, Shui Hong Hua Zi (Alternantherae Philoxeroides Semen) 3 qian. All ground into fine powder. Boiled in 1 jin of Sesame Oil to make a paste. Remove fire toxicity before spreading and applying. For patients with this syndrome, the skin definitely lacks hair. Mark the spot accurately with a pen before applying the paste. For chronic cases, only two pastes are needed. Internally, Ke Jian Jiu (Hardness-Clearing Wine): 3 qian of Shui Hong Hua Zi ground, soaked in 2 jin of Fire Wine (Baijiu). Take three times daily according to tolerance.