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The young son of the Yang family in Tianjin, aged four, contracted warm-eruption disease (Wenzhen) in late spring.

Etiology: During the warm spring season, epidemic qi circulated widely, and many households suffered from this disease due to contagion.

Symptoms: The eruption on the whole body was very dense, accompanied by extreme burning heat. His eyes were closed, he appeared drowsy and confused, and frequently spoke deliriously (delirious speech). His breathing was rapid and labored; his lips were dry, cracked, purple-black, with coagulated blood adhering to them.

Pulse: Rapid and forceful. Stool was unformed, with loose diarrhea occurring two or three times daily.

Diagnosis: In cases where there is heat in the Upper Jiao (Upper Burner), it is most contraindicated to have slippery diarrhea from the Lower Jiao (Lower Burner). In this case, the heat in the Upper Jiao is extremely severe, yet the stool remains loose and diarrheal. Attempting to clear the heat might worsen the diarrhea; furthermore, since eruptions are present, there is a fear that the diarrhea will cause the pathogenic toxins to sink inward. Therefore, treatment should simultaneously clear the heat above, stop the diarrhea below, and support the expulsion of eruption toxins outward. Although the condition is dangerous, it can be cured.

Prescription: Raw Huai Yam (Sheng Huai Shanyao, 1 liang), Talcum (Huashi, 1 liang), Raw Gypsum (Sheng Shigao, 1 liang, crushed fine), Raw Hang Peony Root (Sheng Hang Shaoyao, 6 qian), Licorice Root (Gancao, 3 qian), Forsythia Fruit (Lianqiao, 3 qian), Cicada Slough (Chantui, 1.5 qian, cleaned).

Decoct together in one large cup of water, and take slowly in small doses while warm.

Outcome: The medicine was consumed over seven or eight sessions. On the following day, the fever had decreased significantly, and all symptoms showed improvement. However, he could not sleep steadily, felt restless inside, and the pulse remained forceful. Consequently, the dosages of Talcum and Raw Gypsum in the prescription were each halved. The decoction was used to administer half a pill of Angong Niuhuang Wan (Calculus Bovis Pill for Opening the Orifices). When the dregs were decocted and taken again, another half pill was administered, after which the illness completely resolved.

A student surnamed Shen in Tianjin, aged sixteen, contracted warm-eruption disease complicated by throat scarlet fever (Housha) in mid-spring.

Etiology: He played excessively at the sports field, sweating profusely, and was subsequently attacked by wind pathogens, leading to this illness.

Symptoms: Initially, he felt slight aversion to cold and headache. By the next day, both exterior and interior presented with high fever, and his throat was stuffy and painful. After consulting a physician and taking medicine, there was no relief; the pain and stuffiness in the throat seemed to worsen, and eruptions reappeared on the body. He then sought my consultation. His skin was very hot, and the eruptions were dense; even areas without eruptions were red. This is indeed what Western physicians call Scarlet Fever. He also felt intense heat in his chest. Both tonsils in the throat were swollen and red, with a white patch resembling a elm seed on the left side. He reported that not only was swallowing food painful, but breathing was also significantly obstructed. Palpation revealed a surging, slippery, and forceful pulse on both sides, beating ninety-eight times per minute. I pricked the Shaoshang (LU11) acupoint to bleed him, needled the Hegu (LI4) acupoint, and prescribed a formula to clear the throat, vent eruptions, and purge fire.

Prescription: Raw Gypsum (Sheng Shigao, 2 liang, crushed fine), Scrophularia Root (Xuanshen, 6 qian), Trichosanthes Root (Tianhuafen, 6 qian), Belamcanda Rhizome (Shegan, 3 qian), Arnebia/Bupleurum Seed (Niubangzi, 3 qian, crushed), Zhejiang Fritillary Bulb (Zhe Beimu, 3 qian), Green Forsythia Fruit (Qing Lianqiao, 3 qian), Fresh Reed Rhizome (Xian Lugen, 3 qian), Licorice Root (Gancao, 1.5 qian), Rice Grain (Jingshi, 3 qian).

Decoct in two large cups of water, and take warm in two doses.

Follow-up Visit: Re-examined after noon the next day. The exterior and interior heat had subsided slightly, the surging and slippery pulse had weakened somewhat, and the eruptions had increased slightly. He had not had a bowel movement for the previous three days, but passed stool once at this time. Inspecting the throat again, the swelling and redness appeared increased, and the white patches were larger. The patient stated that drinking water now required effort to swallow, and respiratory obstruction seemed worse. I said: "This is an extremely dangerous condition; it is imperative to prick the affected area to release blood." Using a Gui-style scalpel, I made long incisions on the swollen and red areas on both sides of the throat, releasing some dark purple blood. Immediately, breathing became smooth. I planned to administer another dose to clear heat, reduce swelling, and support the expulsion of eruption toxins.

Prescription: Raw Gypsum (Sheng Shigao, 1 liang, crushed fine), Trichosanthes Root (Tianhuafen, 6 qian), Red Peony Root (Chishao, 3 qian), Isatis Root (Banlangen, 3 qian), Arnebia/Bupleurum Seed (Niubangzi, 3 qian, crushed fine), Raw Coptis/Pollen (Sheng Puhuang, 3 qian), Zhejiang Fritillary Bulb (Zhe Beimu, 3 qian), Green Forsythia Fruit (Qing Lianqiao, 3 qian), Fresh Reed Rhizome (Xian Lugen, 3 qian).

Decoct in one and a half large cups of water, and take warm in two doses.

Formula Analysis: Regarding Red Peony Root (Chishao), Zhang Yinan and Chen Xiuyuan suspected it was the root of a wild mountain herb because its texture was coarse, distinctly different from the peony roots cultivated in gardens. However, this material originates from the Three Northeastern Provinces. I visited the region personally and saw slopes covered with this type of peony, which blooms single-petaled red flowers about one-third the size of common peony flowers, yet the leaves are undoubtedly those of peony. Perhaps the South also has Chishao, but its roots remain white; here, both the flower and root are red, making it effective at entering the Blood level to invigorate blood and resolve stasis. Additionally, while Zhejiang Fritillary Bulb (Zhe Beimu) is inferior to Sichuan Fritillary Bulb (Chuan Beimu) for treating coughs, it seems superior for treating sores/ulcers because its bitter and cool nature clears heat and resolves toxicity.

Outcome: After taking two doses consecutively, the illness completely resolved.

Commentary: The *Ling Shu* chapter on Carbuncles and Ulcers in the *Nei Jing* states: "When a carbuncle develops in the pharynx, it is called Mengju (Fierce Abscess). If Mengju is not treated, it turns into pus. If the pus is not drained, blocking the throat, death occurs within half a day." In this case, the progressive swelling and redness on both sides of the throat constitute a Mengju. If pus forms and is not drained, danger is imminent. In severe cases, one must wait for suppuration before draining, but often there is no time to wait. Therefore, when swelling and redness severely obstruct breathing, emergency pricking to release dark purple blood causes the swelling and redness to subside immediately. This is referred to as "preemptive prevention." Furthermore, if drainage occurs after suppuration, the wound often ulcerates; if drained before suppuration, the puncture wounds heal within half a day.

Throat conditions originally differ between internal injury and external contraction. For internal injuries, although clearing heat is prioritized, it is appropriate to add small amounts of dispersing agents. For example, the use of Mint (Bohe) and Forsythia (Lianqiao) in the formula *Bai Hou Ji Biao Jue Wei*. For external contractions, while dispersing agents are not contraindicated, they should be pungent-cool rather than pungent-warm. Herbs such as Mint, Forsythia, Cicada Slough, and Reed Rhizome are excellent dispersing agents. Some argue that Ephedra (Mahuang) can be used for throat conditions caused by external contraction, provided it is heavily counterbalanced with Raw Gypsum. The Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) from the *Shanghan Lun* is indeed an excellent formula for external contraction throat conditions. Specifically, since that formula was not originally designed for throat conditions, the ratio of Gypsum to Ephedra is only two-to-one. If borrowed for external throat conditions, the dosage of Gypsum should be ten times that of Ephedra. In cases of excessive excess fire from external contraction, increasing the Gypsum dosage is particularly prudent. Thus, when I use this approach for external throat conditions, Ephedra is rarely used beyond 1 qian, whereas Raw Gypsum is commonly used at over 1 liang, or heavily up to 2 liang. However, this discussion applies only to throat conditions where swelling and redness are not severe. If swelling becomes severe enough to obstruct breathing, neither Ephedra nor Mint should be used; hence, the formula for this specific case only employed Forsythia and Reed Rhizome. The above discussions cover heat-type throat conditions regardless of internal or external etiology. Occasionally, throat variations may present as true cold with false heat, requiring separate therapeutic strategies.