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Hu XX from Tianjin, aged fifty-four, contracted a warm disease (Wen Bing) accompanied by sore throat in the middle of autumn.

Etiology: Excessive mental labor secretly generated internal heat. Additionally, drinking cow's milk twice daily as a snack also aids heat generation. Internal heat surged upward, causing a sensation of discomfort in the throat. Upon contracting wind-warmth (Feng Wen) in mid-autumn, severe throat pain suddenly occurred.

Symptoms: Both exterior and interior felt feverish; throat pain hindered eating. Heat in the heart region frequently surged upward, exacerbating the throat pain. The body felt sore, lazy, and weak; stool was dry. The pulse was floating, slippery, and long, with the right Guan position particularly forceful upon heavy pressure. The tongue was covered with a white coating.

Diagnosis: The pulse remains floating, and the tongue coating remains white, indicating that since the illness began only two days ago, the exterior syndrome has not yet resolved. However, the right Guan pulse is forceful upon heavy pressure, and there is a frequent sensation of heat surging to the throat, indicating a combination of internal injury and external contraction. It is appropriate to use a heavy dose to clear heat from the stomach fu organ, supplemented slightly with exterior-resolving agents. Once the exterior is resolved and the interior cleared, the throat pain should heal spontaneously.

Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, four liang, crushed); Aspirin (one grain).

Decoct the Raw Gypsum alone in a large bowl of water. While hot, dissolve the Aspirin into the decoction and administer. Since Aspirin is an excellent acid-cool agent for resolving the muscle layer, when used in large quantities with Gypsum, the combined heat of internal injury and external contraction will transform into sweat and resolve shortly after ingestion.

Outcome: Approximately half an hour after ingestion, slight sweating appeared on the upper body but did not pervade the whole body. After another hour, the sensation of heat surging from the heart ceased, and throat pain diminished. At 1:00 PM, a second dose of the original prescription was taken before bed at night. The entire body sweated profusely, allowing for a peaceful night's sleep. By the next morning, all symptoms had vanished.

Gao XX from the neighboring village, aged twenty-five, contracted a warm disease in mid-summer.

Etiology: In early mid-summer, approaching wheat harvest, he traveled far for business and rushed home to harvest wheat, walking long distances under the scorching sun. The physical exertion was extreme, leading to the contraction of a warm disease. His uncle XX and cousin Mao XX were both renowned physicians in the county, skilled in treating warm diseases. They treated him jointly for ten days without effect, likely because his excessive labor caused constitutional deficiency, preventing the pathogen from being expelled outward.

Symptoms: Upon my examination, his eyes were clear but blind; his hands wandered over clothes and bedposts, moving restlessly; he spoke deliriously and was completely unconscious. Previously, he suffered from loose stools; although this had stopped, he still passed loose stools once or twice monthly. The pulse was floating and powerless, with the right Cun position particularly prominent; the two Chi positions disappeared upon pressure. The pulse rate was one hundred twenty beats per minute. The tongue coating was thin and yellow, dry in the center, and slightly black.

Diagnosis: The clarity of the eyes without fire signs, coupled with blindness, indicates that Kidney Yin is nearly exhausted. The restless hand movements indicate that Liver Wind has stirred. The condition has reached a critical point of danger. Fortunately, the floating pulse indicates the pathogen remains in the Taiyang channel; the prominence of the right Cun pulse suggests impending sweating. The reason for impending but absent sweating is that bodily sweat is like heavenly rain; just as heaven and earth produce rain only when Yin and Yang harmonize, the body produces sweat only when Yin and Yang harmonize. Here, the Chi pulses are very weak; Yang rises but Yin does not respond, hence no sweat. One should use substantial Yin-nourishing herbs to assist Yin in responding to Yang, which will naturally induce sweating, leading to recovery. This is not forced sweating; forced sweating would lead to collapse. By regulating Yin and Yang to allow spontaneous sweating, recovery is ensured.

Prescription: Shu Huai Di Huang (Prepared Rehmanniae Radix, two liang); Sheng Huai Shan Yao (Fresh Dioscoreae Rhizoma, one liang); Xuan Shen (Scrophulariae Radix, one liang); Da Gan Gou Qi Zi (Large Sweet Lycii Fructus, one liang); Gan Cao (Licorice Root, three qian); Zhen E Jiao (True Donkey-hide Gelatin, four qian).

These six herbs: Decoct the first five in a large bowl of water, strain, dissolve the E Jiao, and drink slowly in divided doses while warm.

Outcome: Medication preparation started at 10:00 AM and finished by 2:00 PM. The patient became quieter than before, and the pulse showed improvement. He continued taking the original prescription in a large bowl, administered gradually. By candlelight (evening), he sweated profusely throughout the body, and the illness was cured abruptly. This case was recorded in *Compilation of Verified Cases by Famous Doctors Nationwide*. He Lianchen expressed doubt about this case, believing that given the described condition, it was truly incurable. Therefore, this case is reprinted here to verify its factual basis.

Commentary: I have observed that the qi transformation of heaven and earth changes every few decades. Physicians should adjust their medication according to these transformations, as patients' diseases shift with the climate. Before I studied medicine, I saw physicians treating cold damage and warm diseases often using purgatives. When heat transmitted to the interior and stool became slightly firm, they used Cheng Qi Tang (Order the Qi Decoction) to purge, resulting in cure. This practice lasted about twenty years. When I began studying medicine, such methods often failed, and the medical texts I read, such as Zhao's *Yi Guan*, Zhang Jingyue's *Complete Works*, and Feng's *Jin Nang*, favored the use of Prepared Rehmannia (Shu Di Huang), even for exterior syndromes. My cure of this case benefited greatly from studying these texts. Besides this case, there are many verified cases of curing complicated cold/warm diseases with heavy doses of Shu Di Huang (see several cases following the explanation of Rehmannia). This efficacy arose because the medication coincided with the prevailing climate. After curing this case, Mao XX and Gao XX, who agreed with me, imitated my formula to cure several exterior deficiency cases, changing their previous prescribing habits. Later, when I passed forty, I felt the climate changed again; patients mostly suffered from Qi deficiency or sinking Qi, often accompanying exterior syndromes. When using Bai Hu Tang (White Tiger Decoction), adding Ren Shen (Ginseng Root) was often necessary for efficacy. For initial exterior syndromes requiring release, adding Huang Qi (Astragalus Root) was often effective. This pattern persisted for several years.

Since 1921, however, diseases have predominantly manifested as Hyperactive Yang. It is appropriate to use large doses of cooling and moistening herbs to nourish Yin and balance Yang. Exterior excess-heat syndromes often require large doses of Bai Hu Tang, supplemented with cooling and moistening agents. Furthermore, the qi transformation of viscera and bowels often ascends without descending, leading to cerebral congestion or insomnia. These result from excessive qi ascent and uncontrolled Hyperactive Yang. Treatment should stabilize qi transformation and submerge the Yang aspect, assisted by heavy doses of cooling and moistening herbs, for the disease to be treatable. This confirms that as heavenly qi transforms, human diseases follow, necessitating adjustments in medical treatment. Thus, I realize that ancient famous physicians' books appear biased not due to error, but because the climate of their times differed. Having practiced medicine for fifty years, I can detail my experiences.