Library

The author's younger male cousin, ××, aged thirty-eight, contracted a warm disease (Wenbing, febrile disease) while traveling to Tianjin in early summer.

Etiology: The weather was hot at the time. He pulled a light cart by himself during the journey, exerting himself excessively. After sweating and being exposed to wind, he developed a warm disease upon arriving in Tianjin.

Symptoms: He felt intense heat both on the exterior and interior. When closing his eyes, he frequently spoke deliriously, mostly talking about matters related to physical labor. His tongue coating was white and thick. He had not had a bowel movement for three days. The pulse was wiry and hard on the left side, and surging, full, and floating on the right side, with a rate exceeding five beats per cun (approximately fifty beats per minute).

Diagnosis: This condition arose because long-distance travel, hot weather, and fatigue caused accumulated heat within the zang-fu organs prior to the invasion of external pathogens, causing the heat to flare up suddenly. The wiry and hard left pulse indicates injury to the yin aspect of the Liver and Kidney due to excessive physical labor. The surging and full right pulse indicates that the heat in the Yangming Fu organs has become solid. The presence of surging and full qualities combined with floating indicates that the condition still involves the exterior. The proposed treatment is Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction), substituting Xuanshen (Scrophulariae Radix) for Zhimu (Anemarrhenae Rhizoma), and Sheng Huai Shanyao (Raw Dioscorea Hypoglauca Tuber) for Jingmi (Oryza Sativa Germ), assisted by herbs that vent the exterior to guide the heat outward.

Prescription: Sheng Shigao (Calcitum, raw gypsum, 3 liang, crushed) Dalushen (Codonopsis Radix, specifically from Lu region, 4 qian) Xuanshen (Scrophulariae Radix, 1 liang) Sheng Huai Shanyao (Raw Dioscorea Hypoglauca Tuber, 6 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian) Aspirin (1 grain)

Decoct the first five ingredients together to make two large bowls of decoction. First, take one bowl warm. Half an hour later, take the Aspirin with boiled water. After sweating occurs, take the remaining half bowl in two divided doses, warm.

Outcome: After taking one bowl of the medicine, the delirium ceased immediately. Shortly after taking the Aspirin, he sweated profusely over his entire body. Subsequently, he slowly consumed the remaining decoction, and the illness was completely cured.

Commentary: In Baihu Tang (White Tiger Decoction), Shigao (Calcitum) is the chief herb, used in a heavy dose of 3 liang, to treat the surging and full quality of the right pulse. Adding Renshen (Ginseng Radix et Rhizoma) to Baihu Tang, and substituting Xuanshen (Scrophulariae Radix) for Zhimu (Anemarrhenae Rhizoma) and Sheng Shanyao (Dioscoreae Hypoglaucae Tuber) for Jingmi (Oryzae Semen Germinatum), provides significant yin-nourishing power alongside heat-clearing effects (the combination of Shigao and Renshen can rapidly restore true yin amidst severe heat), thereby treating the wiry and hard quality of the left pulse. Using medicine is like using troops; carefully assessing the enemy situation and maintaining orderly formations ensures victory in battle. Since the pulse also showed a floating quality, indicating that the exterior syndrome had not yet resolved, it could still be resolved through sweating. Therefore, Aspirin, which is good at venting the exterior, was added to guide sweating out. This is called facilitating the pathogenesis according to its nature. If Aspirin is unavailable, adding 1 qian Bohe Ye (Menthae Haplocalycis Folium) and 2 qian Lianqiao (Forsythiae Fructus) to the prescription can also induce sweating.