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A woman surnamed He, aged thirty-two, was five months pregnant when she contracted a warm disease (an acute febrile disease caused by warm pathogenic factors) in early autumn.

Etiology Due to heat intolerance during pregnancy, she slept facing the window at night without drawing the curtain. Wind penetrated through the window screen, leading to an exogenous contraction that transformed into a warm disease.

Symptoms Inappropriate treatment at the onset allowed the warm pathogen to transmit inward, resulting in Yangming Fu-organ excess syndrome (a interior excess-heat syndrome characterized by the interaction of evil heat and accumulated feces in the intestines). Several physicians were consulted, all stating that the etiology required the use of strongly cooling medications. However, due to her pregnancy, they dared not use them lightly. I was then invited to examine her. She presented with a red face and coarse breathing, a thick white tongue coating with yellowing in the center, dry stool, and scanty dark urine. Her pulse was surging, slippery, and forceful on both left and right sides, beating more than five times per breath cycle.

Diagnosis Based on these symptoms and pulse characteristics, it is evident that not only is the heat in the Yangming Stomach organ extremely excessive, but the heat in the Liver and Gallbladder is also very vigorous. It is presumed that she must have experienced anger-induced Liver fire prior to falling ill. If the heat is not cleared urgently, there is a risk of reckless bleeding, posing immediate danger. The treatment employed Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), using Baihu Tang to resolve the heat and adding Ren Shen (Ginseng) to protect the fetus. A prescription was issued for immediate administration.

Prescription Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, finely ground) Ye Dang Shen (Wild Codonopsis Radix, 4 qian) Sheng Huai Di Huang (Fresh Rehmanniae Radix, 1 liang) Sheng Huai Shan Yao (Fresh Dioscoreae Oppositiflorae Rhizoma, 1 liang) Sheng Hang Shao (Fresh Paeoniae Radix Alba, 5 qian) Gan Cao (Licorice Root, 3 qian)

Decoct together to yield three bowls of liquid, divided into three doses taken warm.

Formula Analysis Although this formula is not the original composition of Baihu Jia Renshen Tang, it effectively substitutes Zhi Mu (Anemarrhenae Rhizoma) with Sheng Di Huang (Rehmanniae Radix Praeparata) and Jing Mi (Oryza Sativa) with Shan Yao (Dioscoreae Rhizoma), while additionally adding Shao Yao (Paeoniae Radix). This is because both Zhi Mu and Sheng Di Huang can nourish Yin and reduce fever; however, Zhi Mu has a lubricating nature, whereas Sheng Di Huang possesses strong Kidney-nourishing properties. Both Jing Mi and Shan Yao contain viscous juices that harmonize the Stomach; Jing Mi’s juice is thick but non-sticky, while Shan Yao’s juice is thick and sticky, offering significant Kidney-fortifying power. Such flexible modification of the original formula is highly beneficial for pregnancy. The addition of Shao Yao aims to clear heat from the Liver and Gallbladder.

Second Visit After completing the three doses of the previous prescription, the patient had a bowel movement the following morning before noon. The fever had subsided by seventy to eighty percent. The pulse was no longer surging and forceful but remained strong. She still felt internal heat. It was decided to continue using cooling, moistening, and Yin-nourishing agents to clear the residual heat.

Prescription Xuan Shen (Scrophulariae Radix, 1 liang) Sheng Huai Di Huang (Fresh Rehmanniae Radix, 1 liang) Tian Hua Fen (Trichosanthis Radix, 5 qian) Sheng Hang Shao (Fresh Paeoniae Radix Alba, 5 qian) Xian Mao Gen (Imperatae Rhizoma, 4 qian) Gan Cao (Licorice Root, 2 qian)

Decoct together to yield two bowls of liquid, divided into two doses taken warm.

Outcome After taking two doses, the illness was completely resolved.

Commentary In cases of exogenous heat, the right-side pulse is typically stronger than the left. In Yangming Fu-organ excess syndrome, this distinction is particularly pronounced on the right side, as the Stomach pulse is primarily reflected at the Right Guan position. Therefore, a surging, slippery, and forceful pulse on the right side is appropriate for this case. The fact that the left-side pulse also exhibits this image indicates that there was pre-existing stagnant heat in the Liver prior to the illness, which was then激ated by the exogenous heat, causing it to flare up and manifest as a surging, slippery, and forceful pulse.