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Tianjin, a surnamed Fan elderly woman, over fifty years old, suffered from warm disease complicated with dysentery.

Etiology Due to mental exertion in household affairs, liver fire was frequently stirred up. At that time, it was early summer, and liver yang was vigorous; its heat forced downward, leading to the onset of dysentery. Because she entered the toilet repeatedly at night, she contracted a cold, which subsequently triggered warm disease.

Symptoms She felt feverish both on the exterior and interior, occasionally felt thirsty, experienced mental restlessness and irritability, and suffered from severe abdominal pain, often groaning. She had dysentery more than ten times a day and night. After ten days, the stool became pure white mucus. The tongue coating was thick and turning yellow. Repeatedly consulting physicians and taking medicine, only treatments for dysentery using descending and opening agents were used, resulting in physical weakness so severe that she could not get out of bed. The pulse was wiry and forceful on both left and right sides, but empty upon heavy pressure, with a rate close to five beats per breath (approximately 50-60 beats per minute).

Diagnosis This condition is caused by excessive liver fire, combined with external pathogenic heat that has entered the Yangming channel, hence the wiry and forceful pulse. The emptiness upon heavy pressure is due to the excessive use of descending and opening medicines previously. The severe abdominal pain occurs because the wiry pulse indicates pain, and here it is wiry and forceful, causing disharmony of qi transformation in the abdomen, thus leading to severe pain. The restlessness is due to yin deficiency from prolonged diarrhea, preventing kidney qi from ascending to interact with the heart, thereby failing to withstand the scorching consumption of liver fire and warm heat, resulting in feelings of irritability.

Treatment should employ herbs that clear warmth and cool the liver, assisted by herbs that nourish yin and tonify healthy qi.

Prescription Raw Hang Shaoyao (Paeoniae Radix Alba) (1 liang), Huashi (Talcum) (1 liang), Raw Huai Shanyao (Dioscoreae Rhizoma) (1 liang), Tianhuafen (Trichosanthis Radix) (5 qian), Shanzha Pian (Crataegi Fructus Sliced) (4 qian), Lianqiao (Forsythiae Fructus) (3 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian).
Decoct together in a large cup of water, take warm.

Second Visit After one dose, the warm symptoms subsided by more than half, dysentery and abdominal pain resolved, and the pulse became harmonious and slow. It is proposed to use another prescription of cooling, moistening, and yin-nourishing agents to clear residual heat.

Prescription Raw Huai Shanyao (Dioscoreae Rhizoma) (1 liang), Raw Hang Shaoyao (Paeoniae Radix Alba) (6 qian), Tianhuafen (Trichosanthis Radix) (5 qian), Raw Huai Dihuang (Rehmanniae Radix) (5 qian), Xuanshen (Scrophulariae Radix) (5 qian), Shanzha Pian (Crataegi Fructus Sliced) (3 qian), Lianqiao (Forsythiae Fructus) (2 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (2 qian).
Decoct together in a large cup of water, take warm.

Outcome After two consecutive doses, the illness was completely cured. However, there was a shortage of saliva in the mouth, frequent thirst, and fatigue upon movement. It was advised to consume fine powder of Raw Huai Shanyao (Dioscoreae Rhizoma) boiled as tea, mixed with natural juice of fresh pear, taken as a snack twice daily. Within a short period, these symptoms would resolve. Shanyao naturally nourishes yin, and its tonifying power can cultivate the depletion of qi transformation. Although its nature is slightly warm, which might be slightly unsuitable for residual heat after illness, combining it with the cooling and moistening properties of fresh pear juice creates a beneficial synergy.