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Luo Qianfu treated the son-in-law of Vice Minister Wang. The patient was twenty-five years old. In November, due to physical exertion, worry, overthinking, and vexation, combined with irregular diet, he fell ill. He frequently experienced dry heat, fatigue, and night sweats that soaked his bedding. He had no appetite, shortness of breath, and a sallow, lusterless complexion. Luo palpated his pulse as floating, rapid, short, and choppy, with both Cun positions extremely small. He told him, "This is a critical condition. Although treatment may bring temporary relief, he will certainly die in spring. You should inform his parents-in-law." His wife did not accept this and changed doctors. By January, he indeed died from restlessness and heat. One day, Vice Minister Wang said to Luo, "My son-in-law died exactly as you predicted. I wish to hear the reasoning." Luo replied, "This is not difficult to understand. The *Neijing* states: 'When the host wins, it is adverse; when the guest wins, it follows. This is the way of Heaven.' Generally speaking, the seasonal climate is the guest, and the human body is the host. During the three winter months, everyone fears cold, yet he alone experiences restlessness, heat, and night sweats. This indicates that the seasonal climate cannot secure his Yang Qi, and the external pathogen cannot overcome the internal heat. Even the heavenly and earthly seasonal climates cannot control it, so how can medicine help? Winter is the month of closure and storage. Yang Qi should lie dormant deep underground, only to emerge in spring as thunder and wind, stirring and opening all things. This is the way of nurturing life. If winter storage is not secure, spring growth will not be lush, and there will be epidemics. Therefore, the Yin Qi of the human body should also lie dormant within, not disturbing itself, and not leaking through the skin, causing frequent depletion of Qi. This corresponds to winter storage. Your son-in-law sweats during the month of storage, meaning his Kidney Water is already exhausted. How can Liver Wood generate in spring? With Yang Qi cut off internally and lacking nourishment, if he does not die, what else can he wait for?" He sighed and left.

Yu Zhen commented: This discussion serves as a clear mirror for consumptive and weak diseases. Why was it not included in similar cases? Additionally, Master Luo treated Han Ziyu's father, who was sixty years old. He suffered from Xiao Ke (Wasting and Thirsting syndrome). In winter, he developed increased restlessness and heat, requiring him to be naked and placing ice on his chest and armpits for relief. His pulse was deep, fine, and rapid. Luo also said, "The human body is the host, and the seasonal climate is the guest. In severe cold weather, his heat became even more intense. The Classics state that when one cannot control the controlling season, it is called 'True Excess' (Zhen Qiang). This is a sign of isolated Yang and severed Yin, which is invariably fatal." The principle is the same as the previous case.

Xue Lizhai treated Han Yongzhi, a provincial official, aged forty-six. In mid-summer, excessive sexual activity led to irritability, heat, thirst, incessant drinking, dysuria with astringency, constipation, profuse expectoration, redness of the face and eyes, prickles all over the tongue, dry and cracked lips, generalized fever, sometimes feeling like thorns without fixed locations, and burning pain in the soles of the feet exacerbated by water application. His pulse was surging and disordered. This indicated Kidney Yin deficiency with Yang having no attachment, manifesting externally. It was not excess Fire. Generally, great heat that does not respond to cooling indicates a lack of Water (Yin). One must vigorously tonify the Yin. Thus, he used one jin of Jiajian Bawei Wan (Modified Eight-Ingredient Pill) material, adding one liang of Rougui (Cinnamon Twig). It was boiled rapidly in water to make six bowls, served cold. Within half an hour, most was consumed. Upon waking, he ate a bowl of warm porridge, then slept until evening, drinking another bowl of the warm medicine. He slept until dawn, ate two bowls of hot porridge, and all symptoms subsided. The next day, he felt cold, with coldness extending to his knees, and symptoms returned. Some thought it was Shanghan (Cold Damage). Xue said, "No. Severe cold that does not respond to warming indicates a lack of Fire (Yang). Yang Qi is also deficient." He urgently prescribed one dose of Bawei Wan. Symptoms eased slightly. After four doses, symptoms receded again. Stool was not passed for thirteen days. Zhu Dan (Pig Gallbladder) was used for enema. Symptoms returned. Urgently, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was given for four doses, finally taking effect.

Yu Zhen commented: This case is quite similar in symptoms and pulse to the seventy-nine-year-old father of Gu Dayou in the Shanghan section, but it is not listed under Shanghan because the described symptoms first mention irritability, thirst, drinking, dysuria, expectoration, red face, and dry tongue, followed by generalized fever. This situation is distinctly unlike Shanghan, which typically starts with fever and gradually presents with irritability, thirst, dysuria, and dry tongue. The Gu case begins with headache and fever, which clearly distinguishes it. Lizhai's treatment method is indeed unique. However, using one liang of Cinnamon Twig for Yin deficiency seems hard to justify as a standard. Moreover, earlier it was stated there was no Water, using one jin of Modified Eight-Ingredient material, where "modified" merely meant removing Fuzi (Aconite Root) and adding Wuweizi (Schisandra Berry). Later it was stated there was no Fire, using one dose of Bawei Wan, which is only one-tenth of the previous amount. Why such disparity in weight and importance before and after? I preserve this theory for discussion with experts.

Lizhai also treated Wang Yidao, a student at the prefectural academy. His Yuan Qi (Primal Qi) was inherently weak. Due to accumulated fatigue from examinations, he developed high fever in winter. Tears froze upon exiting the eyes. His eyes were red, chest exposed, breathing shallow and nearly absent. His pulse was surging and large, beating against the finger, but empty upon pressure. His tongue was dry and prickly. This was true cold inside and false heat outside. He was ordered to take Shiquan Dabu Tang (Complete Great Tonifying Decoction). He was instructed, "After taking this medicine, your pulse should converge, which would be good." Soon after, he fell into a deep sleep. Upon waking, he felt aversion to cold and added clothing. His pulse suddenly became minute and thread-like. This was the true image of deficiency-cold. He was given one liang of Renshen (Ginseng Root) and three qian of Shufu Zi (Prepared Aconite Child), decocted in water and taken in one dose, bringing peace. At night, his pulse collapsed again. Two liang of Renshen and five qian of Shufu Zi were given, leading to recovery. Later, large doses of Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Dangshen (Codonopsis Root - *Note: Text says Guishen, likely Danggui*), and Zhigancao (Honey-fried Licorice Root) were used for conditioning, resulting in full recovery.

Yu Zhen commented: High fever, exposed chest, red eyes, frozen tears, and a dry, prickly tongue are purely signs of Fire. Only the shallow, nearly absent breathing indicates deficiency. A surging, large pulse beating against the finger but empty upon pressure confirms internal deficiency-cold and external false heat. After taking warming and tonifying medicines, the pulse should converge; this is a golden rule that must be memorized. Additionally, Lizhai treated a seventy-nine-year-old man who, after intercourse, developed headache and fever with various fire signs. His pulse was surging, large, and disordered, but forceful upon pressure. This differs in pulse from the previous case despite similar symptoms, warranting careful study.

Li Shizhen recorded himself: At age twenty, due to a cold, prolonged cough, and violation of abstinence, he suffered from bone-steaming fever, skin feeling like burning embers, expectorating about one bowl of phlegm daily, irritability and thirst in summer, and nearly losing sleep and appetite. His six pulses were slightly surging. He took Chaihu (Bupleurum Root), Maidong (Ophiopogon Tuber), Jingli (Acanthopanacis Senticosi Caulis juice), and other medicines for over a month, worsening significantly. His father偶然ly recalled Li Dongyuan's treatment for lung heat like burning embers, irritability, thirst, worse in daytime, indicating Qi-level heat. The remedy is Yiwei Huangqin Tang (Single-Herb Scutellaria Decoction) to drain Fire from the Lung Qi level. Following the prescription, he used one liang of Pianhuangqin (Scutellaria Baicalensis Root), decocted in water and taken in one dose. The next day, body heat completely subsided, and cough and phlegm resolved. The medicine hit the mark precisely, effective as quickly as a drumbeat.

Yu Zhen commented: This case differs vastly from Lizhai's treatment. Patients are like faces; they vary infinitely without fixed forms. A physician must be like a mirror reflecting the face, showing its shape, so beauty and ugliness are naturally distinguished, avoiding misdiagnosis.

Gao Guozai treated Chen Jiting. He suffered from body heat. From Mao-Chen hours (7-11 AM), upper body heat; Shen-You hours (3-7 PM), middle body heat; Hai-Zi hours (9 PM-1 AM), lower body heat. Heat intensified at the soles of the feet, cycling repeatedly. Day and night, the cycle continued without interruption. Long-term medication was ineffective. He grew progressively weaker. Gao palpated his pulse as minute and weak, with the Right Chi position hidden and unrising. He reasoned that a hidden Chi pulse indicates Kidney deficiency. The day-and-night cycling heat indicates wandering Kidney Fire. Heat at the soles at Zi hour indicates Kidney Fire returning downward. If, upon returning downward, its nature could be secured and prevented from rising, the heat would cease. One must emulate the alchemical furnace method. Alchemists use two Yangcheng jars. One contains mercury and pills, filled tightly. The other is empty. The two jar mouths are joined, tied, and sealed with salt mud, then heated. When the upper empty jar becomes red-hot, wet paper must be placed on its bottom, frequently moistened with cold water. Because the lower jar's contents are driven by fire for a long time, they gradually rise toward the empty jar, like ascending medicine flying upward. However, mercury is very active; even if it enters the empty jar, it can return to the old jar. It must reach a cool place to stabilize its substance. Thus, wet paper on the bottom ensures the pill stays firmly. Now imitating this method to formulate medicine: Use Tongbian Zhi Guiban (Turtle Shell steamed with child's urine) one liang, Shudi (Rehmannia Glutinosa Root prepared) and Gouqi (Lycium Fruit) seven qian each, Maidong (Ophiopogon Tuber) five qian, and Yurou (Cornus Fruit) four qian. These five herbs tonify Kidney and nourish Yin, like mercury and pills. Fuzi (Aconite Lateralis Radix Preparata) two qian guides Fire back to its source via contrary treatment, like the alchemical fire. Huangbai (Phellodendron Bark) seven qian descends Fire, like the wet paper and water at the jar bottom. Decocted at dusk, taken at Zi hour. Previous medicines accumulated in the chest and were hard to pass. This medicine felt easy to pass in the chest. After three doses, heat removed and illness cured.

Yu Zhen commented: This case attributes the issue to Kidney deficiency with Fire not returning to its origin. Large-dose Kidney tonification with "treating heat with cold" (referring to the method or context of guiding fire) fits the symptoms well, though perhaps less so the pulse. However, his theoretical reasoning is worthy of instruction for posterity.

Sun Dongsu treated the son of Xu Sanquan. Every afternoon he had fever until dawn. Night fever was more severe. Right hypochondriac distension and pain, coughing with pulling pain. Treated as Malaria (Nue) with no effect. It lasted over twenty days with no reduction in fever. Later physicians considered it deficiency heat and administered Renshen (Ginseng) and Baizhu (Atractylodes), increasing pain. Sun palpated his pulse: Left was wiry and large; Right was slippery, large, and pounding against the finger. He said, "The *Neijing* states: 'Left and right are the pathways of Yin and Yang.' Based on the pulse, Liver-Gallbladder Fire is congealed by Phlegm. This likely resulted from forced literary work and excessive overthinking. The nature of Wood and Fire could not flow freely, stagnating and causing pain. Worsening at night indicates excess Liver pathogen. Initial treatment should only regulate Liver Qi; one dose could cure. Mistakenly treating as Malaria agitated the Fire. Tonifying with Renshen and Baizhu blocked Qi, preventing sweating and causing the tongue coating to become like沉香 (Agarwood) color, indicating extreme heat." He prescribed Xiaoxianxiong Tang (Small Trap in the Chest Decoction) using Dagualou (Trichosanthes Fruit) one liang, Huanglian (Coptis Rhizome) three qian, Banxia (Pinellia Tuber) two qian, plus Qianhu (Peucedanum Root) and Qingpi (Citrus Reticulata Pericarpium viride) one qian each, decocted and taken. At night, he gave Danggui Longhui Wan (Angelica and Gardenia Pill) to mildly purge. Pain stopped, heat retreated, and he recovered fully after two doses.

Pan Jiansuo's servant, aged sixteen or seventeen, had afternoon fever. Physicians considered it Yin deficiency and used Yin-nourishing and Fire-descending medicines for over thirty doses. Fever worsened, abdomen gradually bloated, complexion greenish-white. Still prescribed Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), etc. After another thirty doses, the abdomen was as large as a bucket, hard as stone, food intake greatly reduced, yellow hair forming tufts, shiny forehead, thirst, complete wasting of thigh muscles, large eyes, small face, dry and rough skin like pine bark, looking like a dying skeleton. Sun Dongsu arrived, observed his eye spirit, noting five percent remained. He said, "This is not a death prognosis; it is the error of the prescriber. Like a tree, if the root rots and branches wither, strength cannot revive it. Here, the withering is due to axes damaging branches while the root remains. With proper irrigation, survival is possible." He prescribed Shenshou Dan (Divine Bestowal Pill), one pill daily, fed with four liang of boiled pork. After ten days, the abdomen softened by half, fever reduced by half, spirit and color improved. Pan asked, "What disease is this?" Sun said, "This is Gan Ji (Infestation Accumulation). Mistakenly diagnosed as Kidney deficiency and treated with Yin-nourishing medicines caused further stagnation. How could the abdomen not become large and hard? Moreover, this heat is Damp-Heat caused by Spleen deficiency. Yin-nourishing agents are damp in nature. Heat combined with dampness intensifies. Since the Spleen belongs to Earth, it likes dryness and dislikes dampness." He prescribed Da Luluhuan (Large Aloe Pill) and Fei'er Wan (Fatten Child Pill) for one month of conditioning, resulting in full recovery.

Yu Zhen commented: Fever has two major categories. One is external cause, as the *Neijing* states: "All heat diseases belong to the category of Shanghan." The other is internal cause, as the *Neijing* states: "Yin deficiency generates heat." However, among Shanghan types, there are already distinctions for Wind, Summerheat, Dampness, Damp-Heat, Wind-Damp, Warm Disease, Heat Disease, Wind-Warm, Dan Malaria, and Bi Syndrome of the legs, totaling over ten types. Regarding internal causes, besides Yin deficiency, there are Labor/Fatigue Internal Injury, Yin Excess repelling Yang, Qi Deficiency, Blood Deficiency, Fire Stagnation, Yang Stagnation, Food Retention, Alcohol Injury, Hidden Phlegm, Fluid Accumulation, Blood Stasis, and Sores/Ulcers. Are there not more threads? Once the cause is identified, meridians must be differentiated. Beyond the Twelve Regular Meridians, there are Extraordinary Vessels. For example, Yang Wei Mai pathology causes chills and fever. This cannot be treated as Malaria. Therefore, clinical differentiation must be meticulous. Just as in Sun Dongsu's two cases: one involves Liver Meridian Stagnant Fire, the other Gan Ji resembling Consumption. Without clear insight, how could success be achieved?