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[Zhang Zhongjing] states: When a patient presents with high fever but desires to wrap themselves in clothing, it indicates heat at the superficial level (skin) and cold at the deep level (marrow/internal). ([The Huo Ren Shu] states: First administer Guizhi Tang [Cinnamon Twig Decoction] to treat the cold, followed by Xiaochaihu Tang [Minor Bupleurum Decoction] to treat the heat.]

[Luo Tianyi] states: Diseases have distinctions of distance and urgency; treatments must be adjusted accordingly. The Southern Expedition Marshal Bulin Jidai, aged seventy, during the winter of the Bingchen year, traveled south to Chuqiu. Officials from various regions welcomed and escorted him, offering abundant sweet wine. Consequently, he overindulged, resulting in abdominal pain, borborygmus, and spontaneous diarrhea, occurring approximately fifty times daily. He suffered from sore throat, swelling and redness around the ears, stiffness of the tongue base, and thick, sticky saliva that was difficult to expectorate unless manually induced. Speech was difficult, accompanied by restlessness and inability to sleep at night. Upon diagnosis, his pulse was floating and rapid to an extreme degree, yet sinking and fine-chord-like upon heavy pressure. I then said to Vice Censor-in-Chief Zhan Gong: Zhang Zhongjing stated that in cases of diarrhea with undigested food and body pain, one should urgently treat the interior; if bowel movements are normal, one should urgently treat the exterior. To treat the interior, use Sini Tang [Four Reversal Decoction]; to treat the exterior, use Guizhi Tang [Cinnamon Twig Decoction]. Currently, the stomach qi is unsecured, with diarrhea of undigested food and abdominal pain. Although urgent treatment is indicated, compared to the throat condition, this can wait slightly. He asked, "What do you mean?" I replied, "The Nei Jing states that sores arising in the throat are called Meng Ju [Fierce Abscess]. If this disease is treated late, the throat will become obstructed; obstruction leads to qi stagnation, and qi stagnation results in death within half a day. Therefore, urgent treatment is required." Thus, we used bian stone [stone lancet] to puncture the swollen area, releasing dark purple blood. The swelling subsided significantly shortly after. We then prescribed equal parts of Jiegeng [Platycodonis Radix], Gancao [Glycyrrhizae Radix et Rhizoma], Lianqiao [Forsythiae Fructus], Shuniu [Arctii Fructus], Jiuzhi Huangqin [Scutellariae Radix prepared with wine], Shengma [Cimicifugae Rhizoma], and Fangfeng [Saposhnikoviae Radix]. These were coarsely crushed, and each dose of approximately five qian was decocted in water until clear and taken hot. It was advised to spit out the medicine if it cooled down, as cold liquids might damage the spleen and stomach, worsening the diarrhea. After subsequent doses, the saliva cleared, swelling dissipated, and voice returned. Later, Shenying Wan [Shenying Pill], a pungent-hot preparation, was used to disperse middle-jiao cold, resolve retained food, and dry spleen dampness. Pills were chosen because they do not dissolve immediately, thus avoiding irritation to the upper jiao, only dissolving upon reaching the lesion site. This represents treating the root cause with a slow approach. After several doses, diarrhea ceased, and pain resolved. Subsequently, chest oppression and paroxysmal pain occurred. Recalling the Ling Shu: "The Upper Jiao is like mist, distributing the essence of grains, steaming the skin, filling the body, and moistening hair, akin to fog and dew irrigation; this is Qi." Now, due to advanced age and weak constitution, coupled with prolonged diarrhea, the ascending qi generated by the spleen and stomach failed to nourish the heart and lungs, causing obstruction and pain. The Classics state: "When Upper Qi is insufficient, push and uplift it. For deficiency of the Spleen, tonify with sweet flavors." We administered dispersing sweet-pungent herbs to warm and nourish the spleen and stomach, adding Shengma [Cimicifugae Rhizoma] and Renshen [Ginseng Radix et Rhizoma] to ascend and support upright qi. After a few doses, the chest felt open and comfortable, and pain stopped. The Nei Jing states: "Formulas for regulating qi must distinguish yin and yang. Internal diseases are treated internally, external diseases externally. Mild conditions are regulated, moderate ones balanced, excessive ones subdued. Following what is beneficial ensures success in every attempt." It further states: "Diseases have distances; treatments have urgency. Do not exceed the proper limits." And again: "In acute cases, treat the branch/symptom; in chronic cases, treat the root/cause." This illustrates the principle.

[Zhang Zhongjing] states: When a patient presents with severe chills but does not desire to wrap themselves in clothing, it indicates cold at the superficial level (skin) and heat at the deep level (marrow/internal). ([The Huo Ren Shu] states: First administer Baihu Jia Renshen Tang [White Tiger Decoction plus Ginseng] to treat the heat, followed by Guizhi Mahuang Ban Ge Tang [Half-and-Half Decoction of Cinnamon Twig and Ephedra] to release the exterior.])