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Fengtian patient Zheng XX, aged fifty-two, contracted Warm Disease (Wen Bing) in late spring, accompanied by Chong Qi (Rebellious Qi of the Chong Vessel) rushing upward from below.

Etiology: The patient had phlegm-fluid retention (Tan Yin) in his body normally. Occasionally, due to frustrating events, Liver Fire (Gan Huo) stirred internally, causing the Chong Qi to carry phlegm-fluids upward, resulting in continuous vomiting of phlegm and water. In late spring, he caught a cold which developed into Warm Disease. The internal transmission of warm-heat pathogens triggered the Chong Qi to rush upward again.

Symptoms: Both exterior and interior exhibited high fever; there was a craving for drinking cold water; phlegm-saliva floated upward with frequent coughing and expectoration; hiccups and belching were continuous and unrelieved; distension occurred in both hypochondriac regions. The tongue coating was thick white, slightly yellow in the center. Bowel movement had not occurred for three days. The pulse on the left side was wiry, hard, and long; the pulse on the right side was surging, slippery, and long, both forceful upon heavy pressure.

This indicates that the heat of the Warm Disease has entered the Yangming Fu organs, combined with Liver Fire carrying the Chong Qi upward. Thus, the wiry and hard left pulse signifies excessive Liver Fire; its wiry, hard, and long nature is the manifestation of the Chong Vessel's Qi rushing upward. The surging and slippery right pulse indicates that warm-heat has entered the Yangming Stomach Fu organ; its surging, slippery, and long nature is also a manifestation of the Chong Qi rushing upward. This is because although the Chong Vessel is located superiorly, it has connections with both the Yangming and Jueyin meridians. To treat this syndrome, one should heavily use Baihu Tang (White Tiger Decoction) to clear Yangming heat, assisted by herbs that purge Liver fire, descend rebellious Qi, and resolve phlegm.

Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, crushed fine), Sheng Zhe Shi (Raw Haematitum, 1 liang, ground fine), Sheng Long Gu (Raw Os Draconis, 8 qian, crushed), Sheng Mu Li (Raw Concha Ostreae, 8 qian, crushed), Bai Zhi Mu (Rhizoma Anemarrhenae, 8 qian), Sheng Hang Shao (Radix Paeoniae Alba, 6 qian), Qing Ban Xia (Rhizoma Pinelliae Preparatum, 3 qian), Nong Po (Cortex Magnoliae Officinalis, 1.5 qian), Gan Cao (Radix Glycyrrhizae, 2 qian), Jing Mi (Semen Oryzae Sativae, 4 qian).

Decoct together to make three bowls of decoction, taken warm in three doses.

Outcome: After completing the three doses, the fever subsided, Qi calmed, and phlegm-saliva reduced by seventy to eighty percent. The pulse became nearly harmonious. Since bowel movement still had not occurred, the original prescription was used again with Shi Gao, Long Gu, and Mu Li each halved in dosage. One additional dose was decocted and taken, resulting in bowel movement and complete recovery.

Commentary: Medical texts rarely combine Shi Gao (Gypsum Fibrosum) with Zhe Shi (Haematitum). Even in my own practice, I have never combined them, fearing that the cold-cooling property of Shi Gao combined with the heavy-descending property of Zhe Shi would drive the medicine directly to the lower Jiao. However, when a disease requires such treatment, the disease bears the effect of the medicine, not the person. In cases like this, without heavily using Shi Gao, the severe heat of Yangming cannot be eliminated; without heavily using Zhe Shi, the rebellious upward-rushing Chong Qi cannot be controlled. This is why their combination causes no harm. If this case involved only Yangming heat-excess without rebellious Chong Qi, taking this medicine would cause immediate bowel movement or even diarrhea, making it difficult to fully eliminate the heat in the Yangming Stomach. Precisely because of the accompanying rebellious Chong Qi, bowel movement only occurred after the second dose. This is clear evidence that "the disease bears the effect, not the person." The properties of Long Gu (Os Draconis) and Mu Li (Concha Ostreae) are good at calming the Liver and restraining the Chong Qi. They are not primarily suited for treating phlegm, but Chen Xiuyuan stated that using Long Gu and Mu Li together can guide rebellious fire and overflowing fluids back to their origin, making them divine herbs for treating phlegm. The phlegm they refer to is formed by rebellious fire and overflowing fluids, exactly as seen in this case of Chong Qi rushing up and phlegm-fluids floating up. Therefore, Long Gu and Mu Li are heavily used (8 qian each) in the formula to assist Zhe Shi in descending rebellion and resolving phlegm, rather than being generally used for all types of phlegm. As for why these two herbs must be used raw: not only is it because their raw state is cool and clears heat, but also because in the three formulas in the Taiyang chapter of Shanghan Lun (Treatise on Cold Damage) using Long Gu and Mu Li, the exterior syndrome was not yet resolved. Later commentators explained that Long Gu and Mu Li consolidate righteous Qi without consolidating pathogenic factors. Thus, Zhang Zhongjing used them even when the exterior syndrome was unresolved. However, in those three formulas, no character indicating calcination ("Duan") was noted under Long Gu and Mu Li, implying they were used raw. Although their nature consolidates righteous Qi without trapping pathogens, if calcined, their nature becomes overly astringent, which would certainly hinder the treatment of external contractions. Moreover, calcination makes their qi light and floating, preventing them from sinking heavily to calm the Liver and restrain the Chong Qi, which is self-evident.