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Physician Li Chen suffered from Shanghan (Cold Damage). He had fever, redness of the face and eyes, upward rushing of Qi, abdominal fullness, and obstruction of both urination and defecation. There was no sweating, and the pulse was tight and long. I instructed him to take Dachengqi Tang (Major Order the Qi Decoction). Other physicians gave him Xiaochaihu Tang (Minor Order the Gallbladder Decoction), but it was ineffective. They then administered Daxiaohu Tang (Greater Order the Gallbladder Decoction), which also failed. Finally, they increased the dosage of Daxiaohu Tang significantly. His bowels moved, dry feces were passed, and he recovered. He boasted, "Indeed, Dachengqi Tang was not needed." I smiled and said, "You only sought immediate relief without realizing the disaster you would leave for later. Although the illness has subsided, sores and ulcers will certainly develop." Half a month later, red sores suddenly appeared all over his body. The next day, a swelling like a plate erupted on his back, hard as stone, with unbearable pain. He was extremely worried, thinking it was a carbuncle on the back, and urgently summoned me. I said, "This is a manifestation of sores and ulcers. If you had taken Chengqi Decoction that day, you would have avoided this trouble today." After several days of treatment, he recovered. Someone asked how I knew it would result in sores and ulcers. I said, "Zhang Zhongjing stated: 'If the Duyang pulse is slippery and tight, the Stomach Qi is excess and the Spleen Qi is strong. Holding excess to strike strength causes pain to injure oneself; holding a blade in hand leads to sores.' The progression of disease has depth and shallowness, and the power of medicine has heaviness and lightness. The practitioner must examine the condition of the patient accordingly. If the disease is deep, administer heavy formulas; if the disease is light, administer light formulas. This is just like holding a balance scale, where every grain counts without bias. Otherwise, why use the Seven Formulas and Ten Dosage Forms? Now, the pathogenic toxin in this patient is so deep that one must rely on Radix et Rhizoma Rhei (Dahuang, 大黄) and Natrii Sulfas (Puxiao, 朴硝) to purge the toxic qi from the Zang-Fu organs and meridians. After two or three bowel movements, the pathogenic toxins will be eliminated. These doctors are cautious but fail to clearly see the root cause. Because Daxiaohu Tang produced stool, they assumed that because bowel movement resumed, the patient was cured. They did not realize that leaving the toxin behind would inevitably lead to sores and ulcers. If they had listened to my advice at that time, how could such a disaster have occurred?"

A nun suffered from headache, body heat, vexation, thirst, and restlessness. Her pulse was large and deficient upon examination. When asked, she reported dark urine, aversion to cold on the back, and gooseflesh. This was diagnosed as Zhongshu (Heatstroke) with facial greasiness. The physician treated it as a Rebing (Heat Disease) but dared not administer medication. I prescribed Baihu Tang (White Tiger Decoction), and she recovered after several days.
In commentary: Zhang Zhongjing stated, "A deficient pulse with body heat results from Shangshu (Summerheat Injury)." He also asked, "Why is the pulse wiry, fine, hollow, and slow?" The Suwen (Classic of Difficult Issues) states: "Cold injures the form; Heat injures Qi." Since Heat injures Qi but not the form, Qi diminishes, resulting in a weak and deficient pulse. Therefore, wiry, slow, hollow, and fine pulses are all indicative of deficiency, which can be understood thusly.