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Nephew ××, aged fifty-three, contracted a warm disease (Wenbing) in the late part of the second lunar month, accompanied by vomiting, diarrhea, and spasmodic pain in the leg tendons.

Etiology: He had a chronic history of spasmodic pain in the leg tendons; during attacks, he was bedridden and unable to rise. One day, while at his shop, the old ailment suddenly flared up. He hurriedly took a carriage back to his residence. Due to sweating from the leg pain and exposure to wind on the road, he developed a warm disease, followed by simultaneous vomiting and diarrhea.

Symptoms: There was high fever both in the exterior and interior. Vomiting continued incessantly; even small sips of water were vomited out. He experienced diarrhea more than ten times within a day and night. Having been ill for three days, he had no urine output at all. During severe leg pain, he often cried out in agony. His pulse was floating and wiry on the left side, seemingly forceful but empty upon heavy pressure. On the right side, it was wiry, long, and forceful, feeling very hard upon heavy pressure, with more than five beats per breath.

Diagnosis: This condition arises because the Yin aspect has been deficient since youth, failing to nourish the tendons, leading to spasmodic pain in the leg tendons. Now, compounded by external high fever transmitting into the Yangming channel to scorch and consume the Yin aspect, the pulse presents as wiry and hard rather than surging, slippery, and forceful. This is a manifestation of excessive fire and deficient Yin. The vomiting occurs because the right pulse is wiry, hard, and long, indicating rebellious Chong Qi rushing upward, causing Stomach Qi to fail to descend and instead rebel upwards. The difficulty in urination and loose stool result from Yin deficiency and Kidney deficiency, which impair the ability to filter fluids; water flows into the Large Intestine, and the Qi transformation in the Lower Jiao fails to secure and control. I should employ my formulated Ziyin Xuanjie Tang (Yin-Nourishing and Ventilating Decoction) to clear heat, nourish Yin, and regulate bowel and bladder movements, supplemented with herbs that stop vomiting and soothe tendons to relieve pain.

Prescription: Raw Huai Yam (Shan Yao) (1 liang), Talcum (Hua Shi) (1 liang), Raw Hang Peony Root (Bai Shao) (1 liang), Processed Pinellia Rhizome (Ban Xia) (4 qian, rinsed three times with warm water), Crushed Bamboo Shavings (Zhu Ru) (3 qian), Purified Indigo Naturalis (Qing Dai) (2 qian), Forsythia Fruit (Lian Qiao) (1.5 qian), Cicada Slough (Chan Tui) (1.5 qian), Licorice Root (Gan Cao) (3 qian), Whole Centipede (Qu Wu Gong) (one large specimen, powdered).
Ten ingredients in total. Decoct the first nine ingredients in one large bowl of water, and take the powder mixed with the decoction to prevent vomiting.
Divide into three doses, taken warm. The centipede powder should also be divided into three doses and taken with the decoction. After taking the medicine, hold a slice of fresh ginger in the mouth to prevent nausea.

Formula Analysis: Cicada Slough is used not only because it can expel pathogens outward, but also because the cicada feeds only on water and does not eat solid food, producing urine but no feces. Therefore, its slough also possesses the power to promote urination and consolidate stools. Centipede is used because it naturally regulates the brain marrow and nerves. The spasmodic pain of the leg tendons, although due to Liver Blood deficiency failing to nourish the tendons, is indeed related to the nerve branches distributed in the legs. With Centipede to regulate them, the nerves will not act recklessly.

Second Visit: After taking the medicine, vomiting did not cease, fortunately, none of the three doses were vomited out. Urination occurred twice, and diarrhea completely stopped. Leg pain improved by more than half, but high fever persisted in both exterior and interior, and the pulse remained wiry, long, and forceful. Since the loose stool has ceased, I dare to use a heavy dose to clear the heat of Yangming. Once the heat of the Yangming Stomach is cleared, vomiting should stop spontaneously.

Prescription: Raw Gypsum (Shi Gao) (3 liang, crushed fine), Raw Huai Yam (Shan Yao) (1.5 liang), Raw Rehmannia Root (Shu Di Huang) (1 liang), Raw Hang Peony Root (Bai Shao) (5 qian), Talcum (Hua Shi) (5 qian), Crushed Bamboo Shavings (Zhu Ru) (3 qian), Licorice Root (Gan Cao) (3 qian).
Decoct together in one large bowl, divide into four doses, and drink warm.

Formula Analysis: According to the standard protocol for using Baihu Tang (White Tiger Decoction), Ren Shen (Ginseng Root) should be added after sweating, vomiting, or purging methods. In this formula, Raw Rehmannia replaces Zhi Mu (Anemarrhena Rhizome), and Raw Huai Yam replaces Jing Mi (Rice Grain). Used together with Gypsum and Licorice, this constitutes Baihu Tang. However, Ren Shen is omitted because vomiting has not yet ceased; adding it might assist the rising of Stomach Qi. Thus, the formula is modified: Raw Huai Yam is heavily used (1.5 liang). Its mild, thick, and sticky fluid can replace Rice Grain to harmonize the Stomach, and its function of tonifying Spleen and nourishing Kidney can replace Ginseng to benefit Qi and Blood. As for using Hua Shi (Talcum) and Bai Shao (Peony Root) alongside Baihu Tang, it is because both herbs are good at promoting free flow of urine, preventing water retention from returning to the Large Intestine. Furthermore, when Bai Shao is combined with Gan Cao, it forms Gancao Shaoyao Tang (Licorice and Peony Decoction). Zhang Zhongjing used it to restore True Yin. The patency of urine in the previous prescription was largely due to the efficacy of Peony Root (for Yin deficiency causing urinary difficulty, heavy use of Peony Root is necessary for effect). Moreover, the wiry pulse corresponds to the Liver channel. The wiry and hard pulse in this case indicates blazing heat in the Liver channel. Peony Root generates Liver Blood and clears Liver Heat, making it an essential herb for softening the Liver and treating wiry-hard pulses.

Third Visit: After completing the four doses, the heat in both exterior and interior subsided by more than half, leg pain completely resolved, and the pulse became milder compared to before. However, vomiting was not fully cured; there was still nausea and reluctance to eat. Fortunately, the stool remained formed. First, administer 1.5 liang of finely powdered Raw Hematite (Zhe Shi), decocted in 1.5 bowls of water, divided into three doses. After the second dose, the epigastrium felt open, and nausea disappeared completely. Stop the Hematite decoction and consume a large bowl of thin rice gruel. Then, prescribe another formula to clear residual heat.

Prescription: Raw Gypsum (Shi Gao) (1 liang, crushed fine), Raw Huai Yam (Shan Yao) (1 liang), Raw Rehmannia Root (Shu Di Huang) (1 liang), Raw Hang Peony Root (Bai Shao) (6 qian), Licorice Root (Gan Cao) (2 qian).
Decoct together in two bowls, divide into two doses, and drink warm.

Outcome: After completing the two doses, the heat in both exterior and interior completely vanished, and the bowels moved once smoothly. The illness was thoroughly cured. However, the pulse still beat five times per breath, indicating that True Yin had not fully recovered. Instruct the patient to grind Raw Huai Yam finely and sieve it. Use 7-8 qian or 1 liang each time, cook into porridge, mix with brown sugar, and take as a snack. If prolonged use causes chest stuffiness, take 5 fen of the Western medicine "Buprost" (likely referring to a digestive enzyme or similar agent available at the time) with it. If Western medicine is unavailable, substitute with 3 fen of finely powdered Raw Chicken Gizzard Lining (Ji Nei Jin).