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Liu XX, aged twenty-five, contracted a warm disease (Wenbing) in late spring.

Etiology From the months of Zheng and Er (lunar calendar), he constantly felt heat in the heart region, had a poor appetite, and preferred sitting in cool, shaded places. Due to slight exposure to external pathogens, a warm disease ensued.

Symptoms When the illness first began, local physicians were consulted. After seven or eight days, the condition worsened. His spirit was confused and lethargic; he lay curled up with eyes closed, appearing half-asleep, and was reluctant to speak. His throat was slightly painful, lips dry and cracked, tongue dry and atrophic, with a thin yellow coating turning black. He drank frequently but remained unmoistened. He lacked desire for food, managing only to force down about one bowl of rice soup per day. He reported that his heart region felt hot and dry, and his whole body felt sore and weak. Palpation of the skin did not reveal significant heat; body temperature was 37.8°C. The pulse in all six positions was weak, deep, and fine on the left side, with a normal rate. Bowel movements had not occurred for four days, and urination was scanty, red, and difficult.

Diagnosis This is a latent pathogen triggered by external factors, transforming into a warm disease due to kidney deficiency and invading the Shaoyin channel. The *Neijing* states: "Injury by cold in winter leads to warm diseases in spring." This refers to mild cold injury in winter that does not immediately manifest as Cold Damage (Shanghan) but lies latent within the Sanjiao (Triple Burner) membranes, obstructing the ascending and descending of Qi transformation, secretly generating internal heat. When Yang energy sprouts in spring, this generated heat is often stimulated by spring Yang to become a warm disease. However, such warm diseases do not necessarily invade the Shaoyin. The *Neijing* also states: "Failure to store essence in winter leads to warm diseases in spring." This refers to individuals who fail to store essence in winter, leading to Yin deficiency and excessive internal heat. When Yang returns in spring, their internal heat increases further; slight external stimulation can then trigger a warm disease. Such warm diseases also do not necessarily invade the Shaoyin. Only when an individual suffers from both winter cold injury and failure to store essence does the latent cold in the Sanjiao transform into heat with spring Yang, and due to inherent essence deficiency, it invades the Shaoyin vacuously. If such conditions transform into heat and invade Shaoyin before spring, they constitute Shaoyin Cold Damage, specifically the Shanghan Shaoyin syndrome after two to three days, suitable for treatment with Huanglian Ejiao Tang. If they transform into heat and invade Shaoyin only upon reaching spring, they may be named Shaoyin Warm Disease, characterized by internal excess heat and a pulse becoming faint and fine. Indeed, the pulse originates from the Heart; it requires Kidney Yin to ascend and harmonize with Heart Yang for the pulse to beat with strength. In this case, because warm pathogens invaded the Shaoyin, preventing the mutual assistance between Heart and Kidney, although there is internal excess heat, the pulse becomes faint and fine. The throat pain occurs because the Shaoyin meridian connects to the throat, and heat pathogens follow the meridian upward. The cracked lips and dry, atrophic tongue result from True Yin in the Kidneys being suppressed by heat pathogens, unable to ascend, while hyperactive Yang in the Heart rises recklessly, burning and consuming body fluids. The heat and dryness in the heart region, along with dry stool and red, difficult urination, are all caused by Yin deficiency and Yang hyperactivity. Because Kidney Yin and Heart Yang cannot function together, spirit becomes confused, eyes close, and the body curls up, with reluctance to speak. This indicates heat pathogens deeply entrenched and obstruction of Qi transformation, representing a critical condition in warm diseases. One must not consider it easily treatable merely because the pulse appears devoid of fire signs and the body is not significantly hot. I previously formulated Kanli Hugen Tang (Kanli Mutual Root Decoction) to treat this condition. Now, I have slightly modified it to suit the symptoms.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, finely crushed) Yetaishen (Wild Taishen Root, 4 qian) Sheng Huai Dihuang (Fresh Rehmanniae Radix, 1 liang) Sheng Huai Shanyao (Fresh Dioscoreae Rhizoma, 8 qian) Xuanshen (Scrophulariae Radix, 5 qian) Liaoshashen (Glehniae Radix, 5 qian) Gancao (Licorice Root, 3 qian) Xian Maogen (Fresh Imperatae Rhizoma, 5 qian)

The eight herbs are processed as follows: Decoct the first seven herbs for more than ten boils, then add fresh Maogen and decoct for seven or eight boils. Strain to obtain three portions of clear decoction. Take orally in three divided doses, warm. For each dose, mix in one raw chicken egg yolk. If fresh Maogen is unavailable, use 1.5 liang of dried Maogen, boil in water for several times, and use the resulting water to decoct the other herbs.

Formula Analysis Excess heat in warm diseases is best resolved by Raw Gypsum Fibrosum. Assisted by Ginseng Radix et Rhizoma, it resolves heat due to both pathogenic excess and righteous deficiency. Further assisted by Rehmanniae Radix and Dioscoreae Rhizoma (Yin-nourishing herbs), it resolves heat due to Kidney deficiency and Yin deficiency. Moreover, combining Ginseng Radix et Rhizoma with Yin-nourishing herbs assists Kidney Yin in ascending to resolve upper Jiao dryness-heat. Chicken Egg Yolk is used because chemists note it contains adrenal medulla secretions, making it a crucial tonic for the Kidneys. Imperatae Rhizoma is used for its cooling and dispersing properties; acting as a guiding herb, it enables deeply sunk heat pathogens to rise and disperse externally, eliminating them completely.

Second Visit After completing three doses, body temperature increased, the pulse became stronger and approached a surging and slippery quality, all symptoms alleviated, and spirit revived. However, residual heat remained in the heart region, and bowels were still unopened. It is appropriate to use a large dose of cooling and moistening herbs to clear the heat, supplemented with a small amount of Qi-tonifying herbs.

Prescription Sheng Shigao (Raw Gypsum Fibrosum, 1 liang, finely crushed) Dalushen (Large Luduan Ginseng Radix et Rhizoma, 3 qian) Sheng Huai Dihuang (Fresh Rehmanniae Radix, 1 liang) Xuanshen (Scrophulariae Radix, 8 qian) Liaoshashen (Glehniae Radix, 8 qian) Dagouqi (Large Lycii Fructus, 6 qian) Gancao (Licorice Root, 2 qian) Xian Maogen (Fresh Imperatae Rhizoma, 4 qian)

The eight herbs are processed as follows: Decoct the first seven herbs for more than ten boils, then add Maogen and decoct for seven or eight boils. Strain to obtain two large portions of clear decoction. Take orally in two divided doses, warm. For each dose, mix in one raw chicken egg yolk.

Outcome After taking two consecutive doses, bowel movements occurred, and the patient recovered completely.

Explanation The sinking and fine pulse in this case indicates that Kidney Qi fails to ascend to the Heart, resulting in non-interaction between Heart and Kidney. After medication, the pulse approaching surging and slippery indicates that Kidney Qi has ascended to the Heart, achieving interaction between Heart and Kidney. Due to this Heart-Kidney interaction, all symptoms alleviated, unlike ordinary warm diseases where a surging and large pulse indicates worsening condition.