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Mr. Hu XX from Tianjin, aged forty-two, contracted diarrhea accompanied by burning heat in early autumn.

Etiology: His elder brother died of dysentery. Mr. Hu managed all matters regarding the shop and his brother's funeral alone. Following intense grief and mental exhaustion, he developed diarrhea and generalized feverish sensation.

Symptoms: He experienced fourteen to fifteen episodes of diarrhea per day and night. Abdominal pain preceded each bowel movement, intensifying after defecation, subsiding only after some time. Around 1:00 PM daily, he felt a generalized burning heat, though not severe; this sensation gradually subsided after 3:00 AM. The pulse was weak in all six positions, particularly pronounced at the Chi (Cun-Kou) position on both wrists.

Diagnosis: This syndrome is attributed to deficiency-cold in the Lower Jiao (Lower Burner) and deficiency of the Great Qi in the Chest. Severe cold in the Lower Jiao can force the Yuan Yang (Original Fire) to float upward. When the Great Qi in the chest is severely deficient, it often fails to retain and secure, causing Wei Qi (Defensive Qi) to float outward. The combination of floating Yuan Yang and floating Wei Qi results in generalized burning heat. The occurrence of heat in the afternoon is because Yin-cold in the Lower Jiao becomes more abundant after noon, while the Great Qi in the chest becomes more deficient (The Great Qi in the chest refers to the Yang Qi of the Upper Jiao; as Yin dominates in the afternoon, the Great Qi appears even more deficient). This is fundamentally a deficiency-cold diarrhea syndrome, which should not be difficult to treat. However, physicians, noting the afternoon fever, dared not administer warming and tonifying prescriptions, leading to repeated treatment failures. I propose treating with a large dose of warming and tonifying herbs, while simultaneously consolidating the Yuan Yang to return it to its source. Thus, the diarrhea will cease, and the burning heat will resolve.

Prescription:
Bai Zhu (Atractylodis Rhizoma, stir-fried), 5 qian;
Shu Di Huang (Rehmanniae Radix Praeparata), 1 liang;
Sheng Shan Yao (Dioscoreae Rhizoma, raw), 1 liang;
Jing Yu Rou (Corni Fructus), 5 qian;
Gan Jiang (Zingiberis Rhizoma), 3 qian;
Wu Fu Zi (Aconiti Lateralis Radix Praeparata), 3 qian;
Sheng Hang Shao (Paeoniae Radix Alba, raw), 3 qian;
Yun Ling Pian (Poria Sclerotium slices), 2 qian;
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), 3 qian.
Decoct together in a large cup of water, take warm.

Follow-up Visit: After one dose, the fever resolved. After three doses, the diarrhea improved significantly, and the pulse became stronger than before. Therefore, slight modifications were made to the original prescription for continued administration.

Prescription:
Bai Zhu (Atractylodis Rhizoma, stir-fried), 6 qian;
Shu Di Huang (Rehmanniae Radix Praeparata), 1 liang;
Sheng Shan Yao (Dioscoreae Rhizoma, raw), 1 liang;
Jing Yu Rou (Corni Fructus), 5 qian;
Long Yan Rou (Longans Arillus), 5 qian;
Gan Jiang (Zingiberis Rhizoma), 4 qian;
Wu Fu Zi (Aconiti Lateralis Radix Praeparata), 4 qian;
Yun Ling Pian (Poria Sclerotium slices), 2 qian;
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), 3 qian.

Outcome: After continuous administration of over ten doses, the illness was completely cured.

Commentary: The inclusion of Shao Yao (Paeoniae Radix) among the major warming and tonifying herbs is intended to utilize its synergy with Fu Zi (Aconiti Lateralis Radix Praeparata) to consolidate the Yuan Yang and guide it back to the Yin, while also promoting diuresis to facilitate the resolution of diarrhea. In the subsequent prescription, Shao Yao was removed because the body was no longer hot, the Yuan Yang had returned to its residence, and the diarrhea was nearly resolved. With Yun Ling Pian (Poria Sclerotium) still present to promote diuresis, there was no further need for Shao Yao.