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The entire tongue swells and becomes stiff, making it difficult to speak and eat; this is called Pan She Yong (Plaque Tongue Abscess). It arises from damp-heat fire scorching the Heart君主 (Heart Sovereign). Internally administer Xijiao Tang (Rhinoceros Horn Decoction). After five or six days, observe whether a high point appears in the center of the tongue. Puncture it with a knife to release blood, and puncture under the tongue; if pus and blood are discharged, relief will gradually occur.

Redness, swelling, and pain around the anus should be quickly eliminated with blood-cooling and damp-draining herbs. If they cannot be resolved, an abscess at one site is called Gang Yong (Anal Abscess), which easily forms a fistula. If several sites ulcerate, it is named Pan Gang Yong (Plaque Anal Abscess), potentially leading to obstruction of urination and defecation. One must early on open a drain at the lowest point of flow to prevent extensive ulceration and uncontrollable fecal discharge. If the ulcer occurs between the urinary and anal openings, it is called Hai Di Lou (Sea Bottom Leak), which is extremely difficult to heal. Generally, one should nourish the Yuan Source (Primordial Origin) and apply external herbs to promote pus drainage; many such cases recover successfully.

In women, if menstruation is absent for forty to fifty days, dizziness, blurred vision, heavy body sensation, lethargy, and timidity may follow, accompanied by chest fullness, vomiting of phlegm-fluids, and worsened symptoms in deficiency patterns. There is loss of appetite or selective eating, excessive sleepiness, normal complexion, and a slow, slippery pulse. This is often misdiagnosed, leading to ineffective treatment. One should realize that amenorrhea with blood deficiency causes fetal Qi to rebel upward, causing congestion in the Middle Jiao; this is E Zu (Morning Sickness/Obstruction of Nausea). Several doses of Shun Tai Fang (Fetus-Calming Formula) are required to bring peace.
Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Zhi Qiao (Aurantii Fructus), Su Geng (Perillae Caulis), Xiang Fu (Cyperi Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Mu Xiang (Aucklandiae Radix), Chen Pi (Citri Reticulatae Pericarpium); add Sha Ren (Amomi Fructus Rotundus) if cold, add Huang Qin (Scutellariae Radix) if heat.

A child suddenly becomes weak and powerless, unable to move hands and feet, without initial chills or fever, nor pain or swelling. If it were Bi Syndrome (Obstruction Syndrome), there would be hidden pain; adults also frequently experience this. This is Yin deficiency with heat accumulation, steaming upward to damage Lung Metal, causing the lung leaves to become dry and damaged, resulting in Wei Syndrome (Flaccidity Syndrome). If untreated, it leads to disability. Treatment requires nourishing Yin and clearing heat, expecting gradual efficacy. (Attached Formula)
Shu Di Huang (Rehmanniae Radix Preparata), Zhi He Shou Wu (Polygoni Multiflori Radix Preparata), Sheng Gui Ban (Testudinis Carapax et Plastrum), Nu Zhen Zi (Ligustri Lucidi Fructus), Dan Pi (Moutan Cortex), Hei Liao Dou (Sojae Semen Nigrum), E Jiao (Asini Corii Colla), Sheng Bai Shao (Paeoniae Radix Alba), Sha Yuan Zi (Astragali Complanati Semen), Bei Sha Shen (Glehniae Radix).

How can a physician achieve efficacy without first differentiating syndromes and prescribing treatment? Take winter Shang Han (Cold Damage) as an example: it begins in the Blood level of the Foot meridians and transmits to the Qi level. The pulse is floating and tight, with no sweat and aversion to wind; initially there is aversion to cold, followed by fever. Shang Feng (Wind Injury) presents with sweat, aversion to wind, and a floating, moderate pulse. Zhang Changsha (Zhang Zhongjing) has already detailed other transmission syndromes and treatments in the Shang Han Lun (Treatise on Cold Damage). Regarding Shi Xie (Seasonal Pathogens), they begin in the Qi level of the Hand meridians and transmit to the Blood level. The right pulse is surging and rapid, exceeding the left pulse. (If the pulse is deep and weak, it indicates Yang disease with Yin pulse, mostly untreatable.) There is also initial aversion to cold followed by fever, with heat radiating from inside to outside, worsening in the afternoon, accompanied by headache and restlessness. Initially, acrid-cool herbs should be used to vent the exterior; light formulas can resolve it through Chhan Han (Shivering Sweat). (If the pulse becomes calm after sweating, survival is indicated; if restless with a rapid pulse, death ensues.) Mr. Ye Tianshi of our dynasty possessed profound insight, supplementing what was lacking for millennia; one must study his works to gain understanding. What occurs in early spring is Chun Wen (Spring Warmth). If there is nasal congestion, cough, heavy voice, and restlessness, it is Feng Wen (Wind Warmth); one should lightly disperse the pathogen. What occurs in late spring and early summer is Wen Xie (Warm Pathogen), as warmth is the gradual onset of heat. After the Summer Solstice, what occurs is Re Bing (Heat Disease); at this time, various disease presentations emerge and must be carefully differentiated. As Li Likeng said, if heaven had only Spring, Autumn, and Winter without Summer, human diseases would surely be rare, because intense seasonal heat damages the Yuan Qi (Primordial Qi), causing the skin and hair pores to expand vacuously, allowing hundred diseases to take advantage and secretly arise. Re Bing presents with slight aversion to cold, followed by fever, headache, and thirst; or immediate high fever upon onset, or macules appearing after several days. If contagious among people, it is Wen Yi (Plague). If there is heavy head, nasal congestion, cough, and slight restlessness/heat, it is Feng Shu (Wind-Dampness). One should lightly disperse wind pathogens and simultaneously resolve dampness. If there is fever, aversion to cold, heavy head, thirst, profuse sweating, and a deficient pulse, it is Jing Zhong Shang Shu (Summerheat Injury in Stillness); Xiang Ru Yin (Mosla Decumbens Decoction) is appropriate. Those who work hard under the scorching sun contract Zhong Re (Heat Stroke), presenting with body heat and pain, profuse sweating, and restlessness; one must judge deficiency and excess before prescribing. Furthermore, after Start of Summer, if one seems ill with a large, empty right pulse, slight fever, fatigue, dizziness, restlessness, and loss of appetite, it is Zhu Xia Bing (Stagnant Summer Disease); Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction) is indicated. If the head feels wrapped with pain, limbs are heavy and tired, body feels heavy with board-like pain and chest fullness, despite having been ill for days, and the tongue is not dry, this is due to intense summer heat causing earth moisture to rise; summer-dampness combines and attaches to the person. When occurring in early summer, it is named Shi Wen (Damp-Warmth). This disease does not occur until late autumn, and should not be confused with other times. The best treatment is San Bai Tang (Three Whites Decoction). What occurs in early autumn is Qiu Xie (Autumn Pathogen); treating disease at this time is most difficult. Because summer-dampness has long lain dormant in the body, and when new coolness arrives, pores suddenly tighten, external coolness draws out internal pathogens, making treatment difficult to achieve quick results. If methods are incorrect, one enters dangerous territory. If autumn is excessively dry, cough and fever appear, named Qiu Zao Zheng (Autumn Dryness Syndrome); Qing Zao Jiu Fei Tang (Clear Dryness and Rescue Lung Decoction) is indicated. Dryness generates fire, punishing the ruling organ, damaging Lung Metal. Headache, thirst, and red face occurring in late autumn are called Fu Shu Wan Fa (Late Onset of Hidden Summerheat). This is even more lingering; flexible thinking and methods are required for success. Winter naturally sees much Shang Han. If winter should be cold but turns warm, contracting this warm pestilential Qi results in Dong Wen (Winter Warmth); acrid-hot dispersing drugs should not be used to forcibly sweat, only light exterior venting is needed. As for the initial stage of Shi Xie, if there is immediate high fever, confusion, delirious speech, or lethargy with mental fatigue, or slight fever and inability to recognize people, all result from righteous deficiency and Yin weakness, with heat disturbing the Shen (Spirit); this is still treatable. If upon onset there is immediate confusion and silence, convulsions of hands and feet, locked jaw, or immediate appearance of macules, or few macules after three to four days followed by denser macules two or three days later, these are all difficult to save. If one starts clear-minded but suddenly becomes confused, speaks wildly, and is irritable after seven or eight days, this is pathogen invading the Xin Bao (Pericardium). Only Zhang Zhongjing's Mai Mai Tang (Pulse-Nourishing Decoction) (remove Rou Gui/Cinnamon Twig) to nourish the source of transformation, combined with Zhi Bao Dan (Treasure of the Heart Pill) or Zi Xue Dan (Purple Snow Pill) 3 fen, taken with cool water, utilizing acrid-aromatic herbs to unblock orifices and expel turbidity, may be effective. If after several days of illness there is sudden panting (pathogenic heat steaming the Lung), hiccuping (exhaustion of Kidney Qi below), convulsions of hands and feet (pathogenic heat injuring Liver), cold limbs (heat sinking into Yin level), locked jaw, and gray-black tongue coating (not dry, indicating approaching exhaustion of Kidney Yin), these are signs of imminent death, mostly occurring in those with deficient constitutions. If by the sixth or seventh day of illness there is fever, abdominal fullness, tenderness upon pressure, constipation, dysuria, or confusion with delirious speech, and a deep, rapid, forceful pulse, Cheng Qi Tang (Order the Qi Decoction) should be used to purge. Once the Fu Organ Qi flows freely, the disease can be resolved.