Rebirth 1977 Great Era

Chapter 1361 Li Zhengji's Prescription Improved by An Donglai (Bonus Chapter for Monthly Tickets)

"How did Li Zhengji prescribe the medicine?" Fang Yan asked the old man.

"After examining me, Li Zhengji told me that the root cause of this illness was that the liver qi could not be smoothly released due to emotional stagnation, which in turn affected the spleen and stomach functions. So although the main symptom of this illness is hiccups, the source of the disease is the stagnation of liver qi caused by emotions (anger)."

"Simply put, the original root cause was belching, and the subsequent symptom was hiccups. Because it didn't get better for a long time, it was called 'persistent hiccups with belching.' Of the two symptoms, hiccups are more urgent and more serious. According to the principle of 'treating the immediate symptoms first in an emergency,' the hiccups should be treated first."

"His treatment approach and prescription were as follows: use a prescription like 'Clove and Persimmon Calyx Decoction' specifically for treating hiccups, and combine it with a prescription like 'Inula and Hematite Decoction' specifically for treating belching."

He also said that because the old lady had a problem of "kidney not receiving qi", any stubborn hiccups caused by kidney deficiency or the elderly must be treated by tonifying the deficiency and warming the kidney yang.

"So his treatment plan for me was to soothe the liver and relieve nausea, harmonize the stomach and regulate qi, and supplement the kidneys to help the qi flow."

Fang Yan nodded upon hearing this; given Li Zhengji's abilities, this question shouldn't be too difficult for him.

Even in a graduate program where top talents abound, he would likely be one of the very best.

Lu Donghua continued speaking at this moment:
"The prescription was quite long."

"Look, I've written it all down here."

He then took out a form, the handwriting of which was clearly written by Li Zhengji.

方言看看方子，里面有：太子参30g、代赭石30g、柿蒂10g、刀豆子10g、韭菜子10g、姜半夏10g、苏子10g、旋覆花10g（包煎）、苏梗10g、竹茹10g、陈皮5g、川连（黄连）3g、甘草5g、丁香3g。

At this moment, Anton also came over. After looking at it, he first raised a question:
"The effects of leek seeds recorded in medical books are to nourish the liver and kidneys, warm the waist and knees, and strengthen yang and consolidate essence. They are mainly used to treat lower back pain, nocturnal emission, premature ejaculation, and impotence caused by kidney deficiency. They have never been said to cure hiccups."

The dialect explanation is as follows:
"Li Zhengji used this medicine based on two ideas: one is that 'heavy medicinal materials can suppress and lower qi' and 'plant seeds can help lower qi'; the other is that leek seeds can nourish the liver and kidneys."

"However, these chive seeds are black in color and hard in texture, so they are not easy to crush. They need to be stir-fried first and then crushed for better results."

"Another herb is 'sword bean kernel.' Zhang Shiwan, a physician in the Qing Dynasty, wrote in his book that sword bean kernel can warm and replenish vital energy and kidney yang. Its seeds can treat persistent hiccups after a serious illness. Its effects are somewhat similar to leek seeds, but the effect is slightly weaker. Combining these two herbs can complement each other and make the effect more obvious."

Li Zhengji studied under many famous doctors from various places who came to Beijing. He used this prescription quite well, but the style was different from his previous ones. Recently, Li Zhengji has been learning local dialects when writing prescriptions, always trying to create some style variations.

Lu Donghua said:
"Yes, I had the same question back then, and Li Zhengji gave a similar explanation."

Fang Yan nodded and said:
"Good."

Anton asked in dialect:

"Master, I have an idea, but I don't know if it's right."

Upon hearing this, Fang Yan realized his apprentice had other treatment ideas, which he naturally encouraged. He said:

"Come on, tell me what you think."

After carefully reading Li Zhengji's prescription, Anton thought for a moment and then said:

“Master, his plan focuses on the two pathogenesis of ‘liver qi stagnation affecting the stomach’ and ‘kidney failing to receive qi’. It uses the approach of calming the liver and suppressing rebellious qi, harmonizing the stomach and regulating qi, and supplementing with warming the kidneys to receive qi. It uses clove and persimmon calyx decoction combined with inula and hematite decoction with kidney-tonifying herbs. This approach is very orthodox and takes into account both hiccups, belching and deficiency symptoms. In particular, the idea of ​​using leek seeds and sword beans to warm the kidneys to receive qi and stop hiccups is very ingenious.”

"However, after carefully considering the patient's condition as described by the old man, especially her tongue and pulse, her red tongue with little coating, her purplish-red and cracked lips, her deep, thin and weak pulse, especially in the cun position, and her symptoms of extreme emaciation, poor appetite, dry mouth and bitter taste, I felt that there was a core contradiction that might not have been completely resolved."

Fang Yan nodded, signaling him to continue.

Encouraged, Anton continued:
"The root cause of this contradiction is severe 'deficiency of both Qi and Yin,' while the manifestation is 'liver stagnation and Qi reversal,' and it is also accompanied by 'floating deficiency fire.'"

Anton pointed to the prescription and analyzed:
"Evidence of Qi and Yin deficiency as the root cause: extreme emaciation like that of an 80 or 90-year-old, lethargy, eating only two ounces of food a day, and a deep, thready, and weak pulse, especially in the cun position, indicate severe Qi deficiency; a red tongue with little coating, dry mouth, and chapped, purplish-red lips indicate severe Yin deficiency."

"The evidence for liver qi stagnation and rebellious qi is that the disease originated from emotional stimulation caused by arguing, with persistent belching and hiccups, and a wiry pulse, which is consistent with liver qi stagnation, rebellious qi invading the stomach, and stomach qi rising upwards."

"Evidence of upward floating of deficiency fire: red tongue, purplish-red lips, and bitter taste in the mouth are manifestations of yin deficiency failing to control yang, resulting in upward floating of deficiency fire. A slightly greasy tongue root suggests or may have mild dampness and turbidity, which I believe may be related to long-term qi stagnation and impaired transportation, but overall, yin deficiency and fire excess are the main characteristics."

"His prescription included Codonopsis pilosula to replenish qi, and Pinellia ternata, bamboo shavings, and Coptis chinensis to clear heat and resolve phlegm, taking into account both qi deficiency and phlegm-heat. However, the herbs in the prescription, such as clove, persimmon calyx, sword bean, leek seed, perilla stem, and tangerine peel, are pungent, warm, fragrant, and drying in nature. Although hematite and Inula japonica were used to sedate and descend rebellious qi, and Coptis chinensis and bamboo shavings were used to clear heat, the main effect was still to warm, disperse, and descend qi."

“My concern is that these warming and drying herbs, when used by patients with severe qi and yin deficiency and floating deficiency fire, although intended to suppress hiccups, may further deplete the already insufficient yin fluids and worsen the deficiency fire. This is similar to the old man's initial concern about ‘soothing the liver but fearing damage to yin.’ In the short term, the hiccups may be stopped due to the effect of suppressing the rebellious qi, but in the long run, it may not be beneficial to the root cause and may even aggravate the symptoms of yin deficiency and excessive fire, such as more dry mouth, irritability, and poorer sleep.” “Therefore, I am thinking, could we change our approach, taking ‘nourishing qi and yin and containing deficiency fire’ as the fundamental principle, while ‘soothing the liver and relieving stagnation and clearing stomach rebellion’ as the secondary principle? Simply put, nourishing yin and reducing fire should be the main focus, while soothing the liver and harmonizing the stomach should be the secondary principle.”

After hearing Anton's explanation, Lu Donghua also showed a thoughtful expression.

Fang Yan smiled and nodded, saying to him:
"Come on, be more specific."

Anton was actually observing Fang Yan's expression as he spoke; if something seemed off, he was prepared to stop. However, Fang Yan's attitude was consistently encouraging, so he mustered his courage and said:

"The prescription I plan to give is as follows..."

He took out the paper and pen he had with him and began to write on the table:
“西洋参10g、麦冬15g、石斛15g、生白芍15g、绿萼梅6g、旋覆花10g(包煎)、代赭石20-30g(先煎)、枇杷叶15g(去毛)、竹茹10g、黄连3g、茯苓15g、生薏苡仁20g、生甘草5g。”

"The core of my prescription lies in vigorously nourishing the depleted Qi and Yin, fundamentally nourishing the rising deficiency fire. I use the mild and gentle green plum blossom to relieve liver stagnation, avoiding the consumption of Yin by pungent, warm, and drying herbs. I retain the most crucial combination of anti-rebellious herbs in the original prescription, Inula japonica and hematite, and add the cooling and moistening loquat leaf to strengthen the anti-rebellious and heat-clearing effects. Bamboo shavings and Coptis chinensis clear away heat and phlegm, and Poria cocos and raw coix seed eliminate dampness and turbidity. Their neutral or slightly cold nature ensures they do not harm Yin fluids. The overall medicinal properties are sweet, cool, moistening, and descending, which better matches the patient's core pathogenesis of severe Qi and Yin deficiency, rising deficiency fire, and liver stagnation with Qi reversal. This avoids the potential for excessive heat and Yin damage caused by a large number of warm and drying herbs."

"Of course, this is just one of my ideas. The key is to focus more on resolving the fundamental contradiction of Qi and Yin deficiency, and then treat hiccups and belching on that basis. As for the effect, we still need to see clinical verification. His prescription is definitely effective, but my approach may focus more on the point of 'Yin-preserving liquid'."

Fang Yan nodded and said:

"This prescription breaks away from Li Zhengji's framework of 'liver stagnation affecting the stomach and kidney failing to receive qi,' and emphasizes that the root cause is deficiency of both qi and yin, while the symptoms are upward floating of deficiency fire and liver stagnation and qi reversal."

"This plan focuses on nourishing yin and qi, and containing deficiency fire. It chooses a combination of drugs that soothe the liver and relieve stagnation rather than those that are pungent and dispersing. It also takes more care to deal with dampness and turbidity. The goal is to better protect the patient's extremely depleted qi and yin while stopping hiccups, and to avoid the potential depletion of warm and drying drugs."

"Overall, this approach does not negate Li Zhengji's plan, but rather optimizes it from the perspective of 'protecting Yin fluids,' making it more suitable for long-term treatment of patients."

Hearing his master's affirmation, Anton was so happy he almost jumped for joy.

After studying for so long, I've finally earned my master's approval for prescribing a medicine today.

Lu Donghua hadn't expected that his grand-disciple would come up with a new solution after he finished his analysis. Although he had explained Li Zhengji's entire dialectical thinking first, which was a solution after the illness had been clearly explained and was not very difficult, this new idea showed that An Dong did indeed have some knowledge.

Fang Yan looked at the prescription and said:
"Not bad, not bad, but there's one small detail that could be reconsidered."

"Huh?" Anton was taken aback.

He looked at the prescription he had written and was a little confused.

Fang Yan then pointed upwards and said:

"The patient's pulse is deep and weak, especially at the cun position, indicating a predisposition to kidney deficiency. Your prescription focuses on qi and yin, without directly tonifying the liver and kidneys. If you want to better align with the pathogenesis of 'kidney failing to receive qi,' you could add 3 to 5 grams of dodder seed. This herb is neutral in nature, tonifying the kidneys without being warming or drying, and will not disrupt the overall sweet and cool properties of the herb. It can also subtly address the deficiency of kidney qi, making the 'receiving qi' effect more stable."

Anton stared at the prescription for two seconds, then suddenly slapped his thigh:
"That's right! I was only thinking about the yin aspect of qi, and I overlooked the root cause of 'kidneys not receiving qi'!"

He quickly picked up his pen and added "3g of dodder seed" to the end of the prescription. As he wrote, he said, "Dodder seed is neutral in nature. It nourishes the liver and kidneys without causing dryness. Adding it will not disrupt the sweet and cool base, and it can also help to gather qi. This way, the 'gathering qi' effect is sufficient, and it will not just descend without gathering."

Fang Yan then pointed to the "hematite" on the prescription and added:
"Actually, there's another small point. Although hematite has a strong effect in relieving nausea and vomiting, it is cold in nature. If the patient has qi and yin deficiency, using 30 grams might damage the spleen and stomach. You can start with 20 grams. If the effect of relieving nausea and vomiting is not enough, you can slowly increase it to 25 grams. This gradual approach is more stable for the body."

Anton quickly changed "20-30g" to "20g (can be increased to 25g if necessary)," his eyes filled with excitement as he looked up.
"Master, with just this little bit of your prescription, there's absolutely nothing wrong with it! If I really encounter a patient like this, I should be able to prescribe it following this approach, right?"

"Yes, it can work, but we still need to remember to make dynamic adjustments," Fang Yan said, leaning back in his chair.

"If the patient's dry mouth is relieved after two doses, but the hiccups don't stop, increase the Inula japonica to 12 grams; if the phlegm is reduced, reduce the Bambusa textilis to 8 grams. Don't stick to one prescription and use it all at once. Traditional Chinese medicine diagnosis emphasizes adapting the prescription to the individual patient's condition."

Lu Donghua, standing to the side, nodded and said with satisfaction:

"I think this recipe is pretty good, not bad at all!"

The old man discovered that his lineage, which had been withering away, had suddenly started to flourish again after he took Fang Yan as his apprentice in his later years.

The apprentice is impressive, and the grand-apprentice is no less so!
PS: I got another 200 monthly votes, so after finishing this chapter I still owe everyone 75,000. The more I pay back, the more I owe?

There will be more in the afternoon
(End of this chapter)