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A fifteen-year-old boy surnamed Chen from Tianjin contracted a warm disease (Wen Bing, febrile diseases caused by warm pathogens) in mid-autumn, accompanied by epistaxis (nosebleed) and hematochezia (blood in stool).

Etiology: Initially, he suffered from generalized fever with spots appearing on the body, resembling measles. The physician treated him with cooling herbs to clear heat, after which the spots receded. After taking several doses of cooling medicine, the systemic fever subsided, but he felt frequent irritability in the chest. Over ten days later, due to a slight external contraction, the fever suddenly relapsed.

Symptoms: Severe heat in both exterior and interior, two episodes of epistaxis, and urine occasionally containing blood. He suffered from severe vomiting, unable to retain food or drink, and most ingested medicines were vomited out. He felt as if his chest was being scorched by heat, accompanied by palpitations (Zhen Tong, anxiety and palpitation) that were unbearable. His pulse was unstable and rapid, exceeding five beats per respiration, forceful on both left and right sides when lightly pressed, but empty upon heavy pressure. The tongue coating was white turning yellow, and there had been no bowel movement for three days. It was originally intended to administer Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), but fear of inducing vomiting prevented this.

Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, finely powdered); Sheng Huai Shan Yao (Fresh Dioscorea Opposita Rhizoma, 2 liang).

Decoct together in a large bowl of water. Allow the patient to drink it slowly while warm. To prevent vomiting, administer only one large mouthful at a time, ensuring the entire dose is consumed within four hours.

Formula Analysis: In cases of vomiting, decoctions often induce vomiting, whereas congee usually does not. Decocting 2 liang of fresh Shan Yao yields a thick liquid similar to congee, without any medicinal taste. Its sticky nature naturally adheres to the stomach after ingestion. Furthermore, its warming and tonifying properties can secure the lower jiao (Lower Burner) to stop hematochezia and nourish heart qi to treat palpitations. Used to treat this condition of warm disease complicated by deficiency, combined with Shi Gao, where Shi Gao clears the warm heat and Shan Yao tonifies the deficiency, this formula is functionally equivalent to Baihu Jia Renshen Tang.

Follow-up Visit: On the second day, the fever had subsided by seventy to eighty percent, palpitations ceased, slight intake of food did not cause vomiting, and both epistaxis and hematochezia had resolved. The pulse strength decreased, but the rate remained rapid.

Prescription: Xuan Shen (Scrophulariae Radix, 2 liang); Lu Shen (Codonopsis Pilosula, 5 qian); Lian Qiao (Forsythiae Fructus, 5 qian).

Outcome: Decocted in a large bowl of water, taken slowly while warm. Upon completion of the dose, the patient recovered, and bowel movements resumed normally.

Formula Analysis: The reason the fever had largely subsided but the pulse remained rapid was due to heat arising from yin deficiency. The combination of Xuan Shen and Lu Shen is effective in clearing heat from yin deficiency. However, fearing latent pathogenic factors related to the previous rash/toxins, Lian Qiao was added to vent them outward.

Commentary: If this patient could have retained medication, administering a large dose of Baihu Jia Renshen Tang would have normalized the pulse rate after the high fever subsided. Due to vomiting induced by medication, the formula was modified by heavily using 2 liang of fresh Shan Yao decocted with Raw Shi Gao. Shan Yao strengthens the spleen and nourishes the kidney; although its tonifying power is not as strong as Ren Shen (Ginseng), it shares similar properties. After the high fever subsided, the pulse remained rapid, so 2 liang of Xuan Shen was used to replace Shi Gao, leveraging its ability to nourish true yin and clear residual exogenous heat. It was combined with 5 qian each of Lu Shen and Lian Qiao. Lu Shen is the ancient form of Ren Shen. This prescription is derived from the principles of Baihu Jia Renshen Tang; thus, the deficient heat is easily cleared, and Lian Qiao assists Xuan Shen’s cooling and moistening properties to vent outward through the skin, facilitating the clearance of residual heat.