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Shenyang's Gao XX, aged thirty-two. Due to latent pathogenic qi (latent pathogenic factor that remains dormant in the body after winter cold exposure and manifests as warm disease in spring) transforming into heat and injuring the Lung, he developed a syndrome of pulmonary consumption cough.

Etiology: At the end of the twelfth lunar month, he was exposed to cold and chill. The disease did not manifest immediately, but from then on, his body ceased to sweat. Subsequently, he gradually felt heat in the heart region. By mid-spring, the heat intensified. His appetite decreased, cough developed, and it gradually evolved into pulmonary consumption.

Symptoms: His cough was lighter during the day and heavier at night. Occasionally, coughing was accompanied by asthma (wheezing). His body was emaciated and weak, with soreness and pain in the bones and sinews. His spirit was occasionally confused and drowsy. He felt hunger in the abdomen but often had no desire to swallow food. Previously, he only felt heat in the heart region; now, he frequently felt heat throughout the whole body. His stool was dry, and his urine was scanty and dark red. The pulse was wiry and long on both left and right sides. On the right side, deep pressure revealed strength. The pulse rate was five beats per breath.

Diagnosis: The cause of this disease is indeed due to latent pathogenic qi transforming into heat and lingering for a long time. It not only injures the Lung but also affects all Zang-Fu organs. According to the patient's description, if the cold contracted at the end of the twelfth month had caused immediate illness, it would have been Cold Damage (Shanghan). However, because the contracted cold was mild, it did not cause immediate illness. Instead, it remained latent in the Sanjiao adipose membrane between the exterior and interior, obstructing the ascending, descending, flowing, and circulating mechanisms of Qi transformation. Therefore, his body ceased to sweat, and the heart gradually became heated. When the time reached mid-spring, Yang Qi began to stir. Originally, it should have transformed into heat following the Spring Yang to become Warm Disease (as stated in the *Neijing*: "If injured by cold in winter, one will suffer from warm diseases in spring"). However, the heat generated was not like the sudden, severe outbreak of Warm Disease that moves from the interior to the exterior. Instead, it spread diffusely through the Sanjiao adipose membrane to various Zang-Fu organs. Thus, the Stomach received the heat, leading to loss of appetite; the Heart received the heat, leading to mental confusion; the Kidney received the heat, leading to Yin deficiency tidal fever; the Liver received the heat, leading to soreness and pain in the bones and sinews; and the Lung receiving the heat, leading to cough and expectoration, which is the most obvious manifestation. To treat this syndrome, one should primarily clear the heat of the latent pathogenic qi, assisted by herbs that nourish Jin-Ye (body fluids).

Prescription: Raw Gypsum (Shi Gao, 1 liang, crushed), Codonopsis Radix (Dang Shen, 3 qian), Trichosanthes Root (Tian Hua Fen, 8 qian), Scrophularia Root (Xuan Shen, 8 qian), Raw Paeonia Lactiflora Root (Sheng Hang Shao, 5 qian), Licorice Root (Gan Cao, 1.5 qian), Forsythia Fruit (Lian Qiao, 3 qian), Talcum (Hua Shi, 3 qian), Fresh Imperata Rhizome (Xian Mao Gen, 3 qian), Belamcanda Rhizome (She Gan, 3 qian), Raw Polygala Root (Sheng Yuan Zhi, 2 qian).

Decoct together with water to make one and a half large bowls. Take warm, divided into two doses. If fresh Imperata Rhizome is unavailable, fresh Phragmites Rhizome (Lu Gen) can be used as a substitute.

Formula Analysis: The rationale of the formula uses Gypsum to clear the heat of the latent pathogenic qi, assisted by Forsythia and Imperata Rhizome, allowing the heat to exit through the skin pores. Further assisted by Talcum and Paeonia Lactiflora Root, allowing the heat to drain out through the urinary pathway. Trichosanthes Root and Scrophularia Root are added because Gypsum can only clear excess heat, whereas Trichosanthes Root and Scrophularia Root can also clear deficient heat. Belamcanda Rhizome and Polygala Root are used because Gypsum clears the Lung and calms cough, while adding Belamcanda Rhizome and Polygala Root further promotes phlegm resolution and calms wheezing. Licorice Root is used to slow down the downward tendency of the cooling herbs, preventing their cold nature from invading the Lower Jiao. As for adding Codonopsis, it actually imitates the principle of Baihu Tang plus Ginseng Decoction (Baihu Jia Renshen Tang). For those with weak constitutions, Gypsum must be used with Ginseng to effectively expel deeply hidden pathogenic heat.

Follow-up Visit: After taking the medicine continuously for four doses, the fever subsided by two-thirds, and the cough with expectoration improved by more than half. Appetite increased, and the pulse became relaxed and moderate. It was known that the heat of the latent pathogenic qi had dissipated, and what remained was only the heat of Yin deficiency. A formula to nourish Yin should be administered again. Taking several more doses will lead to complete recovery.

Prescription: Raw Chinese Yam (Shan Yao, 1 liang), Large Sweet Goji Berry (Gou Qi Zi, 8 qian), Scrophularia Root (Xuan Shen, 5 qian), Raw Rehmannia Root (Sheng Di Huang, 5 qian), Glehnia Root (Sha Shen, 5 qian), Raw Paeonia Lactiflora Root (Sheng Hang Shao, 3 qian), Raw Polygala Root (Sheng Yuan Zhi, 2 qian), Fritillaria Cirrhosa Bulb (Chuan Bei Mu, 2 qian), Raw Chicken Gizzard Membrane (Sheng Ji Nei Jin, 1.5 qian, yellow part, crushed), Licorice Root (Gan Cao, 1.5 qian).

Decoct together with water to make one large bowl. Take warm. The reason for adding Chicken Gizzard Membrane is not only to help the Stomach digest food but also to utilize its ability to resolve stagnation and cloying nature of other herbs.

Outcome: After taking the medicine continuously for five doses, the illness was completely cured. However, there were occasional coughs at night. He was instructed to stop taking the decoction and use raw Chinese Yam powder boiled into porridge, sweetened with white sugar, taken as a snack daily to consolidate the recovery.