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(Continuing from the previous text) This is indeed driven by a warm-heartedness that cannot be restrained, yet often there are many cases that can be saved. After much hesitation, I prescribed two formulas for him. One formula was *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* (White Tiger Decoction with Ginseng, substituting Chinese Yam for Rice), and the other used *Shudihuang* (Rehmanniae Radix Praeparata) 2 liang, *Sheng Shanyao* (Raw Dioscoreae Rhizoma) and *Gouqi* (Lycii Fructus) each 1 liang, *Zhen Ejiao* (True Donkey-hide Gelatin, not stir-fried) 5 qian. After decocting into a soup, four raw chicken egg yolks were stirred in. Each of these two formulas yielded one large bowl of decoction, which was taken slowly and alternately while warm. Over ten hours, after finishing all the medicine, he recovered. He said that previously when taking medicine, he felt nothing, but at this time it was as if waking from a dream. Looking at his tongue, it was still dry and black, but no longer contracted. His pulse rate remained rapid, suggesting residual heat. I then used *Xuanshen* (Scrophulariae Radix) 2 liang and *Lushen* (Codonopsis Radix) 1 liang, decocted into one large bowl of soup, taken slowly and warm, one dose per day. After two days, his bowels moved freely. Re-examining his tongue, fluids covered it completely, and the black coating had begun to peel off.

A few days later, his husband, of similar age, also contracted a Warm Disease. During the fourth or fifth day, he suffered from irritability, fever, dryness, and thirst. Someone was sent eighty *li* away to fetch one担 (dan) of ice, which he ate day and night, yet the irritability and thirst remained unchanged. He invited me again to treat him. His pulse was洪滑而长 (Hong, Hua, and Chang - surging, slippery, and long), forceful upon heavy pressure; the tongue coating was thick white with a slight yellow center. I knew that although he was advanced in years, his fire pathogen was extremely excess. Thus, I administered *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, changing the dosage of *Shigao* (Gypsum Fibrosum) in the formula to 4 liang. After taking two doses consecutively, both the fever and thirst resolved. His family members questioned doubtfully: "This condition, having consumed so much ice over the past days, saw no relief in fever and thirst. Now, using only several liang of raw *Shigao* in the formula, and taking two doses resulted in recovery. Does this not mean *Shigao* is far cooler than ice?" I replied: "Incorrect. *Shigao* is not inherently very cool. The reason why consuming ice failed to cure, but heavy use of raw *Shigao* succeeded, is because raw *Shigao* provides an outlet for the excess heat of Hanwen diseases (Cold-Warm diseases). Western physicians are not adept at treating Hanwen diseases; thus, when encountering excess heat syndromes of Hanwen, they prefer using ice, yet often fail to cure. However, raw *Shigao* has the property of inducing sweating, allowing heat to be resolved through sweat. Even if no sweat occurs after ingestion, it can disseminate internal accumulated heat, releasing it gradually through the collaterals and pores, which people naturally do not perceive."

Note: This case and the previous case involved patients of the same age and contracting illness at the same time. Yet, the former was supplemented with *Shudi* (Rehmanniae Radix) and *Gouqi* to nourish True Yin, while the latter heavily added raw *Shigao* to clear major heat. This demonstrates flexible modification based on the deficiency or excess of the disease and pulse, which is why the treatment was effective immediately.

Recalling five years ago, a clan sister, aged seventy-three, suddenly developed paralysis. I was invited to diagnose her. Upon arrival, I found another physician present. He had prescribed one dose consisting of herbs for dispersing wind, tonifying Qi, and resolving phlegm, which seemed very prudent. I did not prescribe another formula. The next day, her pulse became Hong and Chang (surging and long), indicating it had transformed into a Shanghan (Cold Damage) syndrome. Prior to this, a close relative of my maternal grandfather had scheduled an appointment for me on this day. As my carriage arrived and I was about to leave, I told the attending physician: "This condition involves latent paralysis pathology internally, now triggered by Shanghan. It is a simultaneous presentation of two diseases. However, paralysis progresses slowly, whereas Shanghan progresses rapidly. This case shows Yangming excess heat manifested in the pulse. It absolutely requires *Baihu Jia Renshen Tang* (White Tiger Decoction with Ginseng). You must dare to use it; there will be no error." The subsequent physician, fearing the cold nature of *Shigao*, and doubting whether cooling herbs could be lightly used for paralysis, delayed for two days. The condition became critical, and she was urgently summoned again. By the time I arrived, it was midnight. Her pulse was Hong and Shu (rapid), forceful enough to beat against the fingers; she panted severely, her tongue was stiff and straight, and she could hardly speak. Fortunately, the pharmacy was in the same village. I urgently obtained one dose of *Baihu Jia Renshen Tang*, using 3 liang of raw *Shigao*. Decocted into two zhong (bowls), it was taken warm in two portions. The condition improved slightly. Then, I took 4 liang of raw *Shigao* alone, boiled into one large bowl of juice, and drank it slowly. By noon, after finishing the dose, she recovered. Later, the paralysis was not fully cured by other treatments, and other physicians blamed me, claiming that the use of *Shigao* previously hindered recovery. Alas! Among those over seventy suffering from paralysis, how many recover? Did they not consider that when I used *Shigao*, I was rescuing a life that was already exhausted? Moreover, *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) treats heat-induced paralysis and epilepsy with *Fengyin Tang* (Wind-Driving Decoction), which originally combines *Shigao* with *Hanshuishi* (Halloysitum Rubrum). Those who slandered me had likely never seen *Jinkui Yaolue* in their lives.

I once treated a young man who was constitutionally weak and frequently ill. In early summer, he contracted a Warm Syndrome, with heat in both exterior and interior. Medical treatment failed to resolve it. Coincidentally, I returned from treating others elsewhere and passed by his home. Knowing his father well, I entered to examine him. His pulse was Shu (rapid) approaching six beats per breath. Although not Hong Hua Gu Zhi (surging, slippery, and drum-like), there was definite excess heat. The tongue coating was slightly yellow; although not very dry, it lacked fluids. There was a prepared dose of medicine unswallowed, still consisting of exterior-releasing agents, prescribed by the doctor who had just left. I told his father: "This disease is external excess heat that has entered the Yangming Fu organ. The reason the pulse is not Hong Hua is due to chronic deficiency of Yuan Qi (Primal Qi). For Yangming Fu heat syndromes, exterior-releasing methods are absolutely contraindicated. Furthermore, given the rapid pulse and short fluids, along with signs of True Yin deficiency, sweating is especially taboo." His father seemed to understand and requested a new prescription. I intended to use *Baihu Jia Renshen Tang*, but considering that using *Renshen* (Ginseng Radix) would require more *Shigao*, and his father was overly cautious and might suspect or refuse it, I only prescribed *Baihu Tang* (White Tiger Decoction), using 2 liang of raw *Shigao*. I instructed him to decoct into two tea bowls, taken warm in two portions. If residual fire remained, clearing heat medicines should be taken again. After speaking, I returned home. Later, I heard that after taking the medicine, his illness resolved. More than ten days later, his bowels became dry and constipated again, and his legs swelled slightly. He was about to invite me again. However, a friend of his father, claiming medical knowledge, stated that the leg swelling was caused by excessive consumption of raw *Shigao*. Who would have known it was actually due to insufficient *Shigao*? The patient's family mistakenly listened to him, changed doctors, and administered a large dose of *Chengqi Tang* (Purgative Decoction). After ingestion, the patient fell silent and died after several days. That self-proclaimed knowledgeable person merely wanted to show off his strengths and falsely criticize others' weaknesses. He did not realize that his words were sufficient to cause death.

Regarding postpartum conditions, cold-natured herbs are contraindicated. However, if it is truly a postpartum Warm Syndrome with dry heat in the heart, thick yellow tongue coating, and Hong Shi (surging and solid) pulse, it is appropriate to administer *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, substituting *Xuanshen* (Scrophulariae Radix) for *Zhimu* (Anemarrhenae Rhizoma) for even better results. In mild postpartum Warm Syndromes where heat enters the Yangming Fu but the pulse is not significantly Hong Shi, I often heavily use 1 to 2 liang of *Xuanshen*, which usually yields immediate effect. For severe cases, *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* with *Xuanshen* replacing *Zhimu* is necessary for efficacy. This is because both *Shigao* and *Xuanshen* are explicitly recorded in *Shennong Bencao Jing* (Divine Farmer's Materia Medica) to treat postpartum conditions. Thus, for mild postpartum Warm Diseases, *Xuanshen* alone can be used. For severe cases, *Shigao* and *Xuanshen* can be combined. However, *Shigao* must be accompanied by *Renshen*, because during the postpartum period, although the heat is excess, the body is deficient. *Zhimu* is not used because *Shennong Bencao Jing* does not record its efficacy for postpartum conditions; I dare not act subjectively and casually use cold herbs for postpartum treatment.

My friend Wu XX, deeply versed in medicine, had a nephew XX who also knew medicine. A relative hired XX to treat a postpartum illness. Before leaving, Wu XX instructed him: "If it is indeed postpartum warmth with significant excess in the Yangming Stomach Fu, non-use of *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* from *Zhongzhong Canxi Lu* (Records of Integrating Traditional Chinese and Western Medicine), with *Xuanshen* replacing *Zhimu*, is unacceptable." Upon diagnosis, it was indeed a postpartum Warm Syndrome with very solid disease pulses. XX followed the instructions and prescribed the medicine. However, pharmacies refused to dispense it, stating that raw *Shigao* is absolutely contraindicated postpartum. The patient's family became suspicious, and XX returned. The family consulted other doctors for several days until the condition became critical, then sought XX again. I went with the medicine, administered it according to method, and one dose resulted in recovery.

Appendix:
Letter from Dong XX of Cangxian County:
Zhao XX suffered from a Warm Disease. The physician prescribed *Guizhi Tang* (Cinnamon Twig Decoction), resulting in increased heat, thirst, and shortness of breath. Then *Chaihu Tang* (Bupleurum Decoction) was given, making the heat worse, adding wheezing and coughing, frequent expectoration of phlegm-saliva, and inability to lie down for six or seven days. The physician claimed the disease was too severe to treat. The whole family was terrified and helpless. His brother XX invited me to treat him. Upon arrival, the patient was panting with shoulder breathing, sweating on the head, with heat in both exterior and interior. The tongue coating was deep gray, contracted, and unable to speak. Emergency pulse examination revealed Floating, Rapid, and Forceful, but empty upon heavy pressure. I reasoned that this case involved extreme Yangming heat and impending exhaustion of Yin, truly a damaged syndrome caused by mistaken use of *Guizhi* and *Chaihu*. I urgently prescribed *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, substituting *Xuanshen* for *Zhimu*. After two consecutive doses, thirst ceased, wheezing stopped, the pulse was no longer floating and rapid but remained forceful, the tongue extended and speech resumed, though phlegm-cough did not improve much. Subsequently, *Conglong Tang* (Following Dragon Decoction) was prescribed, removing *Suzi* (Perillae Fructus), adding 4 qian of *Renshen* and 8 qian of *Tiantong* (Asparagi Radix). After seven doses, full recovery occurred.

Also: A surnamed Zhao woman, in her twenties, eight or nine days postpartum, suddenly contracted a Warm Disease. Due to mistaken use of hot herbs to induce sweating, she developed heat, thirst, wheezing, and shortness of breath. The tongue coating was dry and black; she exhibited 'seeking clothes and bed-rubbing' (signs of delirium), calling for cold water, which the family dared not give. The pulse was Xuan Shu (wiry and rapid) and forceful, seven beats per breath. I urgently prescribed *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*. Since it was postpartum, *Xuanshen* replaced *Zhimu*. Raw *Shigao* was heavily used at 4 liang. Additionally, *Shengdi* (Rehmanniae Radix) and *Baishao* (Paeoniae Radix Alba) were added, several qian each. Decocted into one large bowl, taken warm in four portions, recovery occurred after finishing the dose. At that time, a knowledgeable physician was present, questioning doubtfully: "Postpartum contraindicates cold herbs. Why such boldness in heavily using raw *Shigao*? And since both *Zhimu* and *Xuanshen* are cold, why must *Xuanshen* replace *Zhimu*?" I answered: "The principles are all in *Zhongzhong Canxi Lu*." I took the book from my travel bag to show the physician. After careful observation for a while, he sighed in admiration.

Also: My maternal grandfather's cousin, due to postpartum Warm Disease, took tonic herbs for over twenty doses, leading to severe heat, thirst, and profuse sweating. She repeatedly demanded cold water. Physicians forbade giving it; she desperately wanted to jump into a well. When I examined her, her tongue was black, lips scorched, eyes fixed, delirious and manic. Pulse was Xi Shu (fine and rapid) but forceful. Urination was red and difficult; stool was purple-black, sticky, and poorly discharged. This was due to postpartum blood deficiency compounded by Warm Disease and mistaken tonic use, causing external pathogens no exit and internal heat burning, depleting Yin-blood instantly. I urgently prescribed *Baihu Jia Renshen Tang*, using *Shanyao* (Dioscoreae Rhizoma) and *Xuanshen* to replace *Jingmi* (Oryzae Semen) and *Zhimu*. After ingestion, she slept peacefully for one night. At dawn, symptoms recurred with heat and thirst as before. Carefully considering that postpartum blood chamber emptiness allows evil heat to enter vacuity, causing purple-black stool, I decided to regulate with *Taoren Chengqi Tang* (Peach Kernel Purgative Decoction) to purge blood stasis, expecting evil heat to descend with it. Due to red/difficult urination and bladder heat accumulation, I added 4 qian of *Huashi* (Kaolin) and half a qian of *Gancao* (Glycyrrhizae Radix). The local pharmacy, belonging to her clan, declared the medicine undrinkable. The family was highly suspicious and consulted the previous physician. The previous physician stated: "I treated this three times; warming tonics worsened it. Yesterday, *Baihu Jia Renshen Tang* brought slight relief; taking *Chengqi Tang* should be fine." The family then dared to decoct and take it. With 6 qian of *Dahuang* (Rhei Radix et Rhizoma) heavily used, decocted into 1.5 zhong, taken warm in three portions. After three hours, two stools like glue/paint and one fresh red stool were passed. Urination cleared, pulse normalized, body cooled, and she recovered.

Also: Son of Zhao XX, nineteen years old, accidentally contracted a Warm Disease. The physician purged too early, leading to eighteen days of bowel obstruction. Symptoms included heat, thirst, wheezing, fullness, dry black tongue coating, gum bleeding, blindness, delirium, abdominal distension like a drum, and umbilical protrusion two cun. Multiple treatments failed. Suddenly, spontaneous loose stools occurred, containing undigested food, excreted immediately after eating. Pulse was completely hidden (Fu). Body cold, extremities inverted, breath nearly gone. Initially bewildered, after detailed inquiry into past symptoms and medications, I realized it was Extreme Yang resembling Yin, where deep heat causes deep inversion (Jue). However, the loose diarrhea had to be stopped first to prevent heat pathogen from flowing sideways, before treating the heat-Jue. I urgently used 3 qian of *Yetaishen* (Wild Panax Notoginseng/Ginseng), 6 qian each of *Dashudi* (Prepared Rehmanniae Radix), *Sheng Shanyao*, and *Huashi*. After decoction and ingestion, diarrhea stopped, pulse emerged—Hong, Chang, Hua, Shu (surging, long, slippery, rapid), especially in the Right position. Subsequently, I planned a large dose of *Baihu Jia Renshen Tang*, using 8 liang of raw *Shigao*. Body heat returned, inversion reversed, peaceful sleep for one night. Next morning, symptoms recurred. Palpating the abdomen, hard masses were felt; heavy pressure caused frowning/pain. Given the abdominal distension and umbilical protrusion, I knew there was much dry feces inside. I switched to 1 liang of *Dahuang*, 6 qian of *Mangxiao* (Natrii Sulfas), 8 qian each of *Zhesshi* (Haematitum) and *Louren* (Trichosanthis Semen). Decocted into one large zhong, taken warm in two portions. Twenty-seven pieces of dry feces were passed, and she recovered.

Letter from Yang XX of Tieling, Fengtian Province:
Mrs. Zhang in our village contracted a Warm Disease, followed by miscarriage, which she ignored. Four or five days later, the disease flared up widely. Doctors were consulted everywhere, all stating that Warm Disease with miscarriage, plus excessive evil heat, had no curable formula. Her husband came to my door requesting treatment. Upon arrival, I saw the patient could not recognize people; spirit was confused; thirsty and desiring water; loose diarrhea; pulse rapid approaching eight beats per breath, fine and weak; tongue coating yellow at edges, black in center, contracted and unable to extend. Due to dryness-heat combined with loose diarrhea, I first prescribed *Ziyin Qingzao Tang* (Nourish Yin Clear Dryness Decoction). After one dose, diarrhea stopped, heat slightly improved. Subsequently, I prescribed a large dose of *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*. Because it was postpartum, *Xuanshen* replaced *Zhimu*. Because of tongue contraction and rapid pulse indicating severe Yin deficiency, I added *Gouqi* and *Shengdi*. Decocted into one large bowl, three raw chicken egg yolks were stirred in. Taken warm in multiple portions slowly. Spirit refreshed, tongue extended. After three consecutive doses, full recovery occurred.