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Tianjin resident Shu XX, aged forty-five, contracted warm disease (Wen Bing) accompanied by scarlet rash (Sha Zhen) in mid-summer.

Etiology: Mr. Shu was originally proficient in medical arts. During the epidemic of warm diseases and rashes, he went out multiple times to diagnose and treat others, contracting the infection and thus falling ill with this condition.

Symptoms: For the preceding few days, he treated himself, repeatedly taking herbs for releasing the exterior, venting rashes, and clearing heat. Although the rash had fully erupted over his entire body, the fever persisted, prompting him to request my consultation. He felt heat in both the interior and exterior, accompanied by extreme restlessness and irritability, with no moment of tranquility. His pulse was weak and faint, his tongue coating thin and slightly yellow, bowel movements occurred once daily without being dry or loose, and urination was dark, scanty, and difficult.

Diagnosis: This condition likely originated from latent pathogenic qi transforming into heat, which was triggered by external infectious transmission. The three-jiao fatty membranes allowed the pathogen to penetrate into the Shaoyin channel, suppressing Kidney Qi, preventing it from ascending to harmonize with Heart Fire. Consequently, the tongue coating turned yellow, and urine became scanty and dark. The Yangming fu-organ heat was substantial, yet the pulse remained powerless. The extreme restlessness was due to the failure of Water and Fire energies to interact. Although this is a warm disease, it is essentially identical to the heat syndrome of Shaoyin Cold Damage (Shanghan), hence the pulse resembles that of Shaoyin Cold Damage. Treatment should employ Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), with slight modifications to the original formula, supplemented by herbs that support the exterior to expel rash toxins.

Prescription: Raw Gypsum (Lianghua Shi, 2 liang, crushed fine); Dalu Ren Shen (Codonopsis Radix, 4 qian); Tian Hua Fen (Trichosanthis Radix, 8 qian); Sheng Huai Shan Yao (Dioscoreae Rhizoma, 8 qian); Fresh Mao Gen (Imperatae Rhizoma, 4 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian).
Decoct together to yield two bowls of decoction, taken warm in two divided doses.

Formula Analysis: This formula is based on Baihu Jia Renshen Tang, substituting Tian Hua Fen for Zhi Mu (Anemarrhenae Rhizoma), Sheng Shan Yao for Jing Mi (Oryzae Fructus Germinatus), and adding fresh Mao Gen. Both Tian Hua Fen and Zhi Mu clear heat, but Tian Hua Fen additionally resolves toxicity. Both Shan Yao and Jing Mi harmonize the Stomach, but Shan Yao additionally nourishes the Kidney. The intent of using Baihu Tang is to treat exterior excess heat; these modifications allow it to simultaneously clear deficiency heat and resolve rash toxins. Furthermore, adding Ren Shen treats heat characterized by excess symptoms but a deficient pulse, while guiding with fresh Mao Gen addresses heat sinking downward in warm diseases.

Follow-up Visit: After one dose of the prescribed medicine, the fever subsided by more than half, and restlessness significantly decreased, allowing for brief periods of peaceful sleep. However, after noon the next day, fever and restlessness returned to their previous state, and the pulse remained weak. Therefore, the dosage of Raw Gypsum was increased to 3 liang, and Dalu Ren Shen to 5 qian, yielding three bowls of decoction to be taken warm in three divided doses. Each dose was mixed with one raw chicken egg yolk. Although the condition improved initially, it relapsed, and bowel movements increased to twice daily. Recognizing that such cold-natured herbs could no longer be administered, I suddenly realized the correct approach for treating this case.

Prescription: Fresh Bai Mao Gen (Imperatae Rhizoma, 6 liang, chopped).
Add five bowls of cool water. Boil briefly on the stove, then immediately remove the pot from the direct flame, placing it about three inches away. Wait ten minutes, then boil again briefly, and remove from the flame again. Wait another ten minutes. When the Imperata rhizome sinks to the bottom, the decoction is ready. If it does not sink, boil briefly once more. Approximately three bowls of clear decoction can be obtained. Drink it all at once while hot; achieving a slight sweat is ideal.

Outcome: Following this method, two doses resulted in complete recovery.

Commentary: In this case, the latent qi transforming into heat resides primarily in the three jiao, but the bacterial infection first affects the upper jiao. As the toxic heat combines, it spreads like mist throughout the entire body's zang-fu organs and meridians without distinction. Imperata root is cool and dispersing, capable of unblocking meridians and zang-fu organs thoroughly. Its nature is very mild; therefore, high doses are required for efficacy. Thus, a single dose uses six liang. Its cooling and dispersing power exhausts the toxic heat within the zang-fu and meridians (with slight sweating and diuresis serving as the pathways for expulsion). Once the toxic heat is cleared, restlessness naturally ceases. In my fifty years of clinical practice, I have used Baihu Jia Renshen Tang countless times, almost always with immediate effect. In this instance, two attempts failed, yet fresh Imperata root succeeded. This was not something I previously knew, but rather a sudden insight that proved effective upon repeated use. I record this in detail to open a new avenue for treating warm diseases with rashes. If the pulse is surging, slippery, and solid, heavy doses of Gypsum should still be used for clearing, or a combination of Gypsum and Imperata may be employed. Additionally, fresh Bai Mao Gen must be used, and the specific decoction method is essential for efficacy. Based on prior success, high doses may reach ten liang, and low doses must still be four liang; otherwise, the previous prescriptions containing only four qian of Imperata were ineffective, indicating the necessity of higher doses. If fresh roots are unavailable in pharmacies, they can be dug from depressions where water collects, as they grow everywhere. If dug in excess and not used immediately, bury them in moist soil to preserve them indefinitely.