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Jiang Heling, a Traditional Chinese Medicine (TCM) physician from Zhenjiang, resided at Yongsou Li, Guizhou Road. He and his wife were nearly fifty years old and had only one son born to a concubine, whom they cherished more than a precious jade pendant. At that time, the boy was eight years old and in the second grade of primary school. His constitution was originally robust; he was lively, playful, and engaged vigorously in extracurricular activities, making him generally resistant to illness. On the morning following the Dragon Boat Festival, he was taken to school by hired car with no signs of illness. However, at 11:00 AM, the school telephoned Physician Jiang to report that his son had developed fever and headache, requesting an immediate pick-up. Physician Jiang drove to the school and brought the child home. After examination, he administered a formula for releasing the exterior and reducing fever, but it was ineffective. A second dose also failed. By around 4:00 PM, the fever intensified, accompanied by severe headache, clouded consciousness, and intermittent irritability. At this stage, the child suddenly exhibited symptoms of acute convulsive disease (Ji Jing), as described above.

The family was panicked and discolored, inviting me for consultation. Physician Jiang asked, "Meningitis is prevalent at this time; could my son be suffering from this condition?" I was then only thirty years old. Observing his robust physique, I knew he was a child with a hearty appetite and, being an only son, likely consumed a varied diet. Upon palpating his epigastrium and abdomen, the child resisted pressure; the abdomen was distended, full, and hard. Inquiring about his recent diet, his mother informed me, "Due to the Dragon Boat Festival, we ate zongzi (sticky rice dumplings wrapped in bamboo leaves) three days ago. Both morning and afternoon snacks consisted of zongzi. Lunch and dinner included fish, meat, chicken, duck, and ham. Since he has always had a good appetite, we did not restrict him. Even this morning before school, he ate two large and one small zongzi, along with loquats and lychees. After returning home by car at noon, the condition deteriorated this afternoon. Please save my beloved son." Hearing this, I determined that food stagnation in the stomach and intestines (Wei Wan) caused obstruction of Fu organ Qi. Obstruction leads to closure, and closure generates internal heat, which reflects along the meridians to the brain, causing spasms. If the excess in the Stomach (Wei Jia Shi) is not urgently purged, the spasms will not cease, leading to danger. Recalling the chapter on Spasm Disease in the *Jin Gui Yao Lue*, there is a method using Da Cheng Qi Tang to treat Yangming spasm disease. I decided to follow Zhang Zhongjing's method. Thus, I prescribed Xiao Huang Lou Ge Tang, instructing them to administer it immediately without hesitation.

Physician Jiang followed my advice and prepared the medicine for administration. Initially, upon pouring it in, the child vomited much phlegm-saliva mixed with undigested food. After a brief pause, we slowly administered the medicine over twenty minutes until the first decoction was fully given. Within two hours, the child passed stool resembling glue or paste. At this point, the spasmodic symptoms subsided. Half an hour later, another bowel movement occurred, after which the child's consciousness cleared completely, and all spasmodic signs vanished. The next day, during the follow-up visit, the family expressed their gratitude repeatedly. I reduced the dosage of the previous formula and added herbs to harmonize the Stomach and clear heat. After two doses, the condition stabilized.

**Xiao Huang Lou Ge Tang Formula**: Sheng Da Huang (Rhei Radix et Rhizoma) 3 qian, Yuan Ming Fen (Natrii Sulfas) 4 qian (dissolved separately), Chao Zhi Qiao (Aurantii Fructus Immaturus) 3 qian, Quan Gua Lou (Trichosanthis Fructus) 4 qian, Fen Ge Gen (Puerariae Lobatae Radix) 3 qian, Sheng Huang Qin (Scutellariae Radix) 3 qian, Jiao Zha Rou (Crataegi Fructus) 4 qian, Lai Fu Zi (Raphani Semen) 3 qian, Xian Zhu Ye (Bambusae Folium) 30 pieces.

**Case of Convulsion due to Fright in Women**: A woman suffered from Qi stagnation, feeling stifled in her heart, with her mind focused elsewhere. Suddenly startled by the deafening sound of a horn, she fled in terror, sweating profusely with palpitations and muscle twitching. After the fright subsided and sweat stopped, she felt dizzy and head-distended, gradually developing aversion to cold and fever. The next day, she experienced high fever, delirious speech, irritability, restlessness, dry mouth with desire to drink, dental plaque, cracked lips, purple-crimson tongue coating, and red eyes. The following day, she suddenly developed convulsions. I prescribed Bai Hu Tang combined with Xie Xin Tang, adding Ge Gen (Puerariae Lobatae Radix), Gua Lou (Trichosanthis Fructus), Yuan Zhi (Polygalae Radix), and Shi Chang Pu (Acori Tatarinowii Rhizoma). After one dose, she sweated and had bowel movements; delirium ceased, and convulsions stopped. After a second dose, fever receded, consciousness cleared, irritability stopped, and thirst ceased. Finally, using Liang Ge San combined with Zeng Ye Fa (Method of Increasing Fluids), she recovered after two doses.

Liu Shoushu was a ticket inspector for the tram company, living comfortably but often returning late at night. His wife, Wang Shi, suspected he had another home and secretly tracked him but found nothing. Liu knew of this but never confronted her. One day, knowing Liu would return with the tram after work, she waited far from the company gate. Waiting for a long time made her anxious and irritable. When her mind was focused, she became deaf to surrounding sounds. Pacing back and forth with her head down in thought, she did not notice an approaching car and its tire noise. As the car sped towards her, the driver, fearing an accident due to her not moving aside, honked loudly. Startled by the sound, Wang Shi fled in panic to the roadside. The car swept past, and she heard the driver cursing.

Helpless, Wang Shi returned home, her heart pounding, weeping upon arrival. Soon, she developed aversion to cold and fever, heavy head, and dizziness. The next day, she became irritable, restless, delirious, seeing ghosts, unable to find peace. Her mouth was dry with dental plaque, lips cracked and peeling, extremely thirsty, tongue purple-crimson, eyes red as if drunk, and eye movements sluggish. This situation seemed to require medical attention. However, the wife resented seeking a doctor, and the husband was angry and ignored her. By the third day, extreme heat rushed to the brain, causing sudden convulsions: stiff neck and limbs, clenched jaw, and upward rolling of eyes. Only then did the husband invite me.

Having learned the history, and after examination, I diagnosed that fright caused the pores to open, allowing Wind pathogen to enter, leading to cold-heat disturbance, which rapidly transformed into heat. This Wind-transformed heat combined with Liver Qi stagnation internal heat, attacking upwards, causing convulsions. Considering her dry mouth, desire to drink, irritability, and high fever, I prescribed Bai Hu Tang combined with Xie Xin Tang to clear and purge heat, adding Ge Gen (Puerariae Lobatae Radix) and Gua Lou Gen (Trichosanthis Radix) to clear heat in the channels and collaterals, and Yuan Zhi (Polygalae Radix) and Shi Chang Pu (Acori Tatarinowii Rhizoma) to calm the Heart palpitations. Cure was certain.

After taking the medicine, she had three bowel movements consecutively. After the first movement, skin continued to sweat. After the third, fever decreased significantly, and convulsions gradually subsided. The next morning, Mr. Liu reported that convulsions had completely stopped, and the patient was sleeping soundly. Upon waking, her consciousness was clear. She requested a little porridge, felt calmer, though heat remained. In the second consultation, I slightly reduced Da Huang (Rhei Radix et Rhizoma) and gave one more dose. Three more bowel movements occurred; yellow-black stool decreased greatly, fever completely resolved, and irritability and thirst ceased. In the third consultation, fearing residual pathogens and recurrence, and considering Yin fluid injury from heat-spasm, I switched to Liang Ge San combined with Zeng Ye Fa (Method of Increasing Fluids) to address both aspects. After two doses, her spirit was tranquil, Qi peaceful, and fluids restored. Dry mouth, purple tongue, dental plaque, and cracked lips all returned to normal, and she recovered.

Reflecting on the treatment of spasm disease, the *Jin Gui Yao Lue* outlines the major methods of sweating and purging. Using Xie Xin Tang instead of Cheng Qi Tang is because the heat is extreme but the abdomen is not full, avoiding the drying nature of Hou Po (Magnoliae Officinalis Cortex). Using Lou (Trichosanthis Fructus/Radix) and Ge Gen (Puerariae Lobatae Radix) instead of Gui Zhi (Cinnamomi Ramulus) is because there is heat without aversion to cold, avoiding the warmth of Gui Zhi. However, the modification of this formula is still inspired by the major principles of the *Jin Gui Yao Lue*. The subsequent use of Zeng Ye Fa (Method of Increasing Fluids) was necessary because Mrs. Wang had borne many children, her Qi and Blood were inherently deficient, and long-term Liver stagnation had injured her Yin. Given the necessity of using cooling purgatives, nourishing Yin after the disease resolves was essential.

Regarding the Ben Tun (Running Piglet) chapter in the *Jin Gui Yao Lue*, there is explicit text stating this disease arises from fright. I initially doubted it, but observing Mrs. Wang's spasm disease arising from fright, I now believe Zhang Zhongjing did not deceive us.

**Bai Hu Tang Combined with Xie Xin Tang Modified Formula**: Sheng Shi Gao (Gypsum Fibrosum) 3 liang, Fei Zhi Mu (Anemarrhenae Rhizoma) 4 qian, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 2 qian, Jin Wen Jun (Da Huang/Rhei Radix et Rhizoma) 3 qian, Sheng Huang Qin (Scutellariae Radix) 3 qian, Shang Chuan Lian (Coptidis Rhizoma) 1 qian, Fen Ge Gen (Puerariae Lobatae Radix) 4 qian, Gua Lou Gen (Trichosanthis Radix) 4 qian, Yuan Zhi Rou (Polygalae Radix) 3 qian, Shi Chang Pu (Acori Tatarinowii Rhizoma) 2 qian.

**Liang Ge San Combined with Zeng Ye Fa Formula**: Chuan Da Huang (Rhei Radix et Rhizoma) 2 qian (wine-washed), Yuan Ming Fen (Natrii Sulfas) 2 qian, Jing Lian Qiao (Forsythiae Fructum) 3 qian, Dan Huang Qin (Scutellariae Radix) 3 qian (wine-fried), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 1 qian, Sheng Shan Zhi (Gardeniae Fructus) 3 qian, Run Yuan Shen (Scrophulariae Radix) 3 qian, Da Mai Dong (Ophiopogonis Radix) 3 qian, Xian Sheng Di (Rehmanniae Radix) 4 qian.

**Aversion to Cold (Yang Deficiency Aversion to Cold Syndrome)**: The patient suffered from daily aversion to cold without other discomforts. Normally, when others wore single clothes, he wore lined clothes; when others wore cotton, he wore fur. Even in midsummer, he shivered constantly in the cold, needing to walk under the scorching sun, steaming from below and baking from above, with sweating on the skin, to feel warm. Entering a room for a moment brought back the cold. In summer nights, he covered himself with thin cotton quilts; in winter, heavy quilts and layered furs were used. The illness lasted nearly four years, with a pulse that was faint, deep, and slow. Treatment with Cui Shi Ba Wei Wan (Dr. Cui's Eight-Ingredient Pill) was ineffective. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) was also ineffective. Gui Zhi Fu Zi Tang plus Rou Gui (Cinnamomi Cortex) and Gan Jiang (Zingiberis Rhizoma) was equally ineffective. Over a year later, he suddenly died from Qi strike (stroke).

Patient Zhang Tinggan lived on Hongxing Road, Zhabei, operating a water-boiling stall. He suffered from aversion to cold for nearly four years without cure. Introduced by colleague Wang Jiefu, he consulted me. He stated the aversion to cold had no specific trigger and developed gradually. Initially, he felt slight chill, thinking it was exposure to wind, and drank ginger soup several times with partial relief. Sometimes he was not cold, sometimes slightly cold. With no other complaints, he ignored it. After about a month, the cold sensation intensified, prompting him to seek medical help. One doctor failed, the second failed, and the third failed. Switching to Western medicine with oral medications and injections yielded no results over time. There were intervals of one or two months without medication, likely due to frustration with ineffectiveness. After nearly four years of medication, the aversion to cold persisted. Later, it worsened; even in midsummer, it remained. He had to engage in physical labor under the hot sun, with direct solar radiation above and geothermal reflection below, to induce slight sweating and relieve the cold. Returning indoors and resting briefly brought back the shivering cold. In hot summer nights, he used small cotton blankets or wool throws; in winter, heavy quilts, sheepskin coats, yet the cold persisted. My pulse diagnosis revealed a faint, deep, and slow pulse, deeper at the Chi position, with no other abnormalities. Learning his family situation, I found he had one wife and one concubine, both childless. He expressed sorrow over having no heirs (like Bo Dao). I comforted him and diagnosed Kidney deficiency beyond doubt, advising him to restrain desires as he was over fifty. Indulgence depletes Essence and Qi; restraint preserves them. I instructed him to buy Cui Shi Ba Wei Wan (Dr. Cui's Eight-Ingredient Pill) from Hu Qing Yu Tang. Small doses might not work, so increased dosage was needed. Short-term use might fail, so long-term use was required. He took 50-60 pills (walnut-sized) twice daily. After two months, there was no effect, and he returned. I advised taking it three times daily for another month. Yet, it seemed as if he hadn't taken it at all, with no alleviation.

At the third follow-up, seeing no improvement, I considered Spleen and Stomach Yang deficiency might be the cause, so I tried Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction). Following Zhang Zhongjing's method, I used 6 qian of Zhi Gan Cao (Prepared Licorice Root) and 3 qian of Gan Jiang (Dried Ginger), administering ten doses quickly, but it was ineffective. I then increased Gan Cao to 1 liang and Gan Jiang to 6 qian, continuing for five doses, still ineffective. The patient remained hopeful and begged for further attempts.

I felt at a loss. Reflecting deeply, I considered that while the disease manifested in the Exterior, Exterior Yang deficiency combined with Interior Yang deficiency might be the cause. I reluctantly prescribed Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction plus Aconite) with added Ginger and Cinnamon, in heavy doses. Five doses were ineffective. Another five doses were taken to observe progress, but after ten days, there was still no effect. Due to repeated failures, I firmly declined further treatment. The most bizarre aspect was that despite trying three different formulas, the patient reacted as if he had taken nothing. If the prescription were incorrect, other reactions should have occurred, but none appeared. If correct, why did large doses and long-term use fail? This unresolved case remains a lifelong regret and a mystery for nearly thirty years. In the subsequent twenty-plus years, I never encountered a similar case. Generally, physicians record successful treatments but omit failures. I break this tradition here to record my failure, informing my colleagues, lamenting my shallow knowledge and lack of experience, and hoping for guidance from experts.

**Cui Shi Ba Wei Di Huang Wan Formula**: Shu Di Huang (Rehmanniae Radix Preparata) 8 liang (steamed nine times, mashed), Gan Shan Yao (Dioscoreae Rhizoma) 4 liang, Shan Zhu Yu (Corni Fructus) 4 liang, Bai Fu Ling (Poria) 3 liang, Mu Dan Pi (Moutan Cortex) 3 liang, Ze Xie (Alismatis Rhizoma) 3 liang, Shang Rou Gui (Cinnamomi Cortex) 1 liang, Fu Zi (Aconiti Lateralis Radix Preparata) 1 liang (soaked, skin and umbilicus removed). Grind into fine powder, mix with refined honey to make pills the size of walnut seeds. Take 30 pills twice daily (morning and evening) with warm wine.

Note: This formula was taken in doses of 60-80 pills.

**Gan Cao Gan Jiang Tang Formula**: Zhi Gan Cao (Prepared Licorice Root) 1 liang, Pao Jiang Tan (Charred Ginger) 6 qian.
Note: This represents the increased dosage used in the second attempt.

**Gui Zhi Fu Zi Tang Plus Rou Gui and Gan Jiang Formula**: Chuan Gui Zhi (Cinnamomi Ramulus) 5 qian, Jing Shao Yao (Paeoniae Radix Alba) 5 qian, Zhi Gan Cao (Prepared Licorice Root) 3 qian, Sheng/Shu Fu Zi (Raw/Cooked Aconite Lateralis Radix) 4 qian each, Shang Rou Gui (Cinnamon Bark) 1 qian, Pao Jiang Tan (Charred Ginger) 3 qian, Sheng Jiang (Fresh Ginger) 3 qian, Da Zao (Jujubae Fructus) 15 pieces.
Note: Using both raw and cooked Aconite aims to warm the interior and reach the exterior simultaneously.

**Excessive Hunger (Acute Excessive Hunger Syndrome)**: A young student of average constitution suddenly developed excessive hunger. He ate six meals a day, each in large quantities, totaling about eighteen bowls of rice. He reported no other discomforts, only feeling intense hunger two to three hours after eating, unbearable, while bowel movements remained normal. The family was terrified. I learned he had fallen once while playing football, but this was not confirmed as the cause. I tentatively prescribed Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) minus Rou Gui (Cinnamon Bark) plus Huang Jing (Polygonati Rhizoma). After two doses, symptoms decreased; after four doses, he stabilized.

Two years before the Anti-Japanese War, in Jiabang, South Shanghai, Mr. Dai Ruru's eldest son studied at Minli Middle School. He went to school at 8:00 AM and returned for lunch at noon. One day, around 10:00 AM, he hurried home demanding vegetarian food from his mother, saying he didn't know why but felt extremely hungry. His mother was surprised, asking how he could be so hungry after eating three bowls of porridge and one big pancake with fried dough sticks that morning. The son replied he didn't know either. During the break after the second class, he came home again, urging his mother to feed him quickly before the third class. His mother served him a large bowl of leftover rice mixed with hot water, equivalent to two normal bowls. He ate hastily and left, as the school was nearby. Upon returning at noon, he cried out that he was starving. His father returned, heard this, and was shocked. He ordered food to be brought, and the family ate together. Mr. Dai observed his son eating differently than usual, swallowing without much chewing. He finished four full bowls of rice. It was nearly 1:00 PM, and he hurried off to school. Surprisingly, at 3:30 PM, he returned home demanding food again. His mother gave him the remaining lunch. He ate three bowls, threw down his chopsticks, and left. Returning at 5:00 PM, he demanded food again. Eating two bowls, his mother stopped him, suggesting he control his appetite until dinner at 6:00 PM. He reluctantly agreed. At dinner, he ate two bowls of rice and three bowls of porridge.

Mr. Dai was astonished. Thinking it might be accidental since there were no other symptoms, the next day, the hunger was exactly the same as the previous day.

At 5:00 PM, he brought his son to me. I examined the pulse, which was slightly large and rapid, but not indicative of a serious disease. He mentioned playing football earlier and falling, but with no injury, this seemed insufficient to explain such excessive eating. Medical literature describes excessive hunger, but usually involves frequent hunger with slightly increased intake, not this extreme amount of nearly nineteen bowls a day. Bowel movements were normal. I pondered deeply, unable to determine the cause, having never seen such a case. Mr. Dai urged me to find a solution. I reasoned that such excessive eating implies a need due to deficiency. Deficiency requires tonification. For tonifying both Qi and Blood, Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) is excellent. However, it contains Rou Gui (Cinnamon Bark), which is warming, suitable for post-illness deficiency but not necessarily for this case. Since the student was not recovering from a major illness, I decided to remove Rou Gui and add Huang Jing (Polygonati Rhizoma) to solidify and nourish. The Materia Medica states that long-term use of Huang Jing prevents hunger. This truly exemplifies "medicine relies on intuition." I formulated the prescription based on this intuition, finding it somewhat amusing. I prescribed the following for two doses to observe efficacy. After one dose, he felt slight improvement. After two more doses, significant improvement. After three doses, the sensation of hunger ceased abruptly. Later, Mr. Dai and his son thanked me. Laughing, Mr. Dai said, "If my beloved son eats like this every day, my monthly salary would only suffice for his meals." We laughed together.

**Shi Quan Da Bu Tang Minus Rou Gui Plus Huang Jing Formula**: Xi Dang Shen (Codonopsis Radix) 4 qian, Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma) 4 qian, Yun Fu Ling (Poria) 4 qian, Zhi Gan Cao (Prepared Licorice Root) 3 qian, Da Shu Di (Prepared Rehmannia Root) 4 qian, Chuan Xiong (Chuanxiong Rhizoma) 3 qian, Quan Dang Gui (Angelicae Sinensis Radix) 4 qian, Chao Bai Shao (Paeoniae Radix Alba Preparata) 3 qian, Zhi Huang Qi (Astragali Radix) 4 qian, Zheng Huang Jing (Polygonati Rhizoma) 5 qian, Hong Zao (Jujubae Fructus) 10 pieces, Sheng Jiang (Fresh Ginger) 2 qian.

**Measles Complicated by Food Stagnation (Severe Case)**: A three-year-old girl first cried for a long distance, allowing Wind pathogen to attack the Lung, followed by consumption of rich and greasy foods, severely injuring the Spleen and Stomach. Four to five days later, she suddenly developed fever and contracted measles. The next day, fever was burning high, skin dry and anhidrotic, rash suddenly disappeared, breathing was panting, eyes red, face crimson with purplish-dark hue, tongue coating thick, greasy, dry, and yellow, bowel obstruction, urine dark red, gums rotting, foul breath, irritability, presenting a critical state. I administered a modified formula combining Xie Xin Cheng Qi (Purging Heart and Bowels) with Zeng Ye Fa (Method of Increasing Fluids). Profuse purging led to stabilization. However, due to discontinuation of medication, the condition ultimately deteriorated, resulting in death.