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Later, it was understood that the physician believed the sha toxin (toxic pathogen of exanthematous diseases such as measles) had penetrated deeply into the interior and collapsed inward. Although it was still in the period for venting the rash, it was no longer possible to guide the pathogenic factor outwards through venting methods. The immediate priority was that the toxic heat transformed into fire, the disease involved the Ying level (a level in warm disease differentiation, shallower than the Xue level), and there was a depletion of Yin fluids, leading to fluid exhaustion transforming into dryness, with the Liver wind stirring up. Without large doses of cooling the Ying level and detoxifying, nourishing Yin and clearing heat, it would be difficult to curb its momentum. The prescription used included: fresh Shengdi Huang (Rehmanniae Radix), Dan Dou Chi (Sojae Semen Praeparatum), Mu Dan Pi (Moutan Cortex), fresh Shi Hu (Dendrobii Caulis), fresh Lu Gen (Phragmitis Rhizoma) and Mao Gen (Imperatae Rhizoma), Chuan Lian (Coptidis Rhizoma), Da Huang (Rhei Radix et Rhizoma), Shan Zhi (Gardeniae Fructus), Lian Qiao Rui (Lonicerae Flos), etc., taken with Zi Xue Dan (Purple Snow Pill). It is said that after taking the medicine, the infant had a smooth bowel movement once, with dark brown stool and foul odor; immediately afterwards, the whole body sweated slightly and became moist, and the rash points were able to emerge outward. Consequently, the fever gradually subsided, wheezing eased, irritability turned to calm, convulsions stopped, consciousness cleared, and the condition improved.

The application of venting methods during the eruptive stage of measles is undeniable by anyone. However, there are many methods for venting rashes, such as acrid-warm diffusing and venting, acrid-cool diffusing and venting, Qi-tonifying supporting and venting, etc., but the use of bitter-cold purging has rarely been seen. Carefully examining this syndrome, it was characterized by rampant toxic heat, where the sha pathogen did not exit from the exterior, inevitably leading to internal collapse. Toxic heat transformed into fire, fluid exhaustion generated wind. Although the "fire" (heat pathogen) was in the Lung, the toxin was in the Yangming channel. Clearing heat and detoxifying is indeed a standard method, but it is like "pouring a cup of water on a cartload of burning charcoal," which is of no avail. Therefore, instead of using the method of "stirring boiling soup to stop boiling," the strategy of "removing firewood from under the pot" was adopted. Reflecting later, my fault lay in failing to understand the constant principles and adapt to changes.

(II) How can one differentiate syndromes without adhering to the "Four Diagnostic Methods"?
The main causes of infantile diarrhea are external contraction of summer-heat and dampness, and internal injury from milk and food. The disease location is in the Spleen and Stomach. The pathogenesis involves the failure of clear Yang to ascend and turbid Yin to descend, confusion of clear and turbid, and dysfunction of ascending and descending mechanisms, resulting in diarrhea or accompanied by vomiting and nausea. If the cause leans towards summer-heat, it is often accompanied by fever, with symptoms of sudden, urgent diarrhea; if dampness pathogen predominates, it presents as profuse watery diarrhea; if injured by milk and food, the feces have a foul odor and often contain undigested residues; if the constitution is inherently Spleen-deficient with weak Middle Warmth, pale yellow loose stools appear; if deficiency wind syndrome due to Spleen deficiency and Wood hyperactivity occurs, it belongs to dangerous conditions.

General diarrhea has standard treatment methods, which need not be elaborated. When diarrhea damages and depletes Stomach Yin, obvious symptoms such as irritability and dry mouth will appear, which are easy to prevent clinically. However, when Spleen damage and Yang injury lead to Slow Spleen Wind (Man Pi Feng), causing sudden collapse, one is often caught off guard. Therefore, in the prevention and treatment of various types of diarrhea, one must always pay attention to any precursors of Yang injury and timely protect Spleen Yang, which is particularly critical for infantile diarrhea. I once treated an infant, five months old, who presented with three days of diarrhea, dry retching, and refusal of milk and food. At this time, the infant was "sleeping peacefully" in the cradle, neither crying nor fussing, appearing quite "quiet," with eyes open, looking around as if "scanning left and right," slight head shaking, slight sweat on the forehead, anterior fontanelle not bulging, dry tongue, occasional tongue protrusion movements, dry and smooth skin not hot to touch, extremities cool, breathing neither coarse nor rapid, occasional sighing. Inquiring of the parents, they said: "For the past two days, the stool was like watery diarrhea, more than twenty times day and night, now reduced, mixed with green mucus. There was originally crying and irritability, now quiet, only dry retching and not eating." At that time, the parents believed the condition was improving, and with some more medicine, it could heal faster. I failed to examine carefully and prescribed based solely on the parents' report. Unexpectedly, before the family returned from buying medicine, the child had already died. News came on the third day, and outside, people were gossiping about me: "If you can't even see someone who is about to die, how can you cure illnesses?"

I learned two lessons from this case: First, subjective dereliction of duty, failing to examine the disease according to the requirements of the Four Diagnostic Methods; second, shallow insight and lack of practical clinical experience. Thus, when the sick child exhibited signs of deficiency wind stirring internally, such as indifferent expression, head shaking, and tongue playing, along with臨危 symptoms of Slow Spleen Wind, such as sweat on the forehead, cold limbs, and deep long breathing (now thinking, it might have been dehydration, acidosis, accompanied by shock symptoms of circulatory obstruction), without any awareness, how could one not fail?

(III) Panic during clinical practice, lacking composure and decisiveness
There was a patient who had been ill for six days, still wearing a head wrap, huddled under blankets fearing wind, with a red face and ears, dry mouth preferring cool drinks, slightly hoarse voice, complaining of headache like splitting, vexation and heat in the heart, body feeling as if beaten, difficulty turning over. For the past two days, there had been loose stools. Palpating the pulse, it was floating and rapid; observing the tongue, the coating was white covered with yellow, the substance tip was red, the pharynx was red and swollen. Looking at the condition, breathing was hurried; touching the skin, it was burning hot without sweat, yet the lower limbs felt unwarmed. The onset was sudden, undoubtedly an external contracted seasonal disease. The prominent symptoms were headache, bone ache, aversion to wind, and preference for cold drinks. Determining the primary syndrome required considerable thought. Consulting Zhang Zhongjing's texts, there are clauses describing "body pain and vexation, unable to turn oneself" and "aversion to wind, unwilling to remove clothing," resembling the "Wind-Dampness Combining" syndrome. However, formulas for Wind-Dampness all contain Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Praeparata), which are extremely acrid and hot, inconsistent with the dry tongue and preference for cold drinks. If approaching from the perspective of interior heat excess syndrome characterized by vexation, thirst, preference for cold drinks, wheezing, and burning skin, yet the coating lacked old yellow, the base was thin white, the abdomen was soft and non-tender, and there was loose stool, indicating no evidence of heat entering the Fu organs. Although there was great thirst, the presence of aversion to wind and no sweat meant it was not the Bai Hu Tang (White Tiger Decoction) syndrome of the Yangming channel, because Bai Hu Tang has the contraindication "if the exterior is not resolved, do not administer." If using Ma Huang Tang (Ephedra Decoction) first to resolve the exterior and then clear the interior, reviewing Ma Huang Tang syndromes revealed no mention of thirst. Meanwhile, red throat and hoarseness clearly indicated a warm-heat syndrome; administering acrid-warm herbs would be like "carrying firewood to save a fire." Thinking further, if exterior cold remained unresolved and interior heat was blazing, with cough and wheezing, then Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) seemed appropriate. After much deliberation, I planned to use Ma Xing Gan Shi Tang. The *Shang Han Lun* (Treatise on Cold Damage) contains two explicit clauses, one after purgation and one after sweating, stating "sweating with wheezing and no significant heat," clearly indicating that the indication for this formula is when the exterior syndrome has ceased. For this patient, Ma Xing Gan Shi Tang was also not the correct formula; Da Qing Long Tang (Great Blue Green Dragon Decoction) seemed more suitable. Due to unclear understanding and shallow insight, hesitating on decisions, fearing the risks of heavy doses, and even more afraid of ridicule in the medical community and causing trouble, I administered a mild, safe acrid-cool exterior-resolving formula. Ultimately, because the medicine did not match the syndrome, the condition worsened. I then invited a senior physician, who cured the patient in two doses. Inspecting his prescription, it was indeed Da Qing Long Tang.

Examining the clauses for Da Qing Long Tang, ninety percent describe the pulse and syndrome of Ma Huang Tang, with the addition of only "vexation." The original text also states "no sweating with vexation," explaining that the origin of vexation is the lack of sweating. Da Qing Long Tang achieved efficacy by resolving exterior cold and clearing interior heat; using the formula for the corresponding syndrome.

Reflecting privately, the reason this disease escalated was that at the beginning, Ma Huang Tang was not administered promptly. Because cold pathogen constrained the exterior, the disease was in the Taiyang channel. Sweating should have occurred but did not, leading to stagnation generating heat. From initial slight fever and thirst, it progressed to craving cold water, slight sore throat, advancing to red and swollen throat and hoarseness. Pores closed, internal heat had no outlet. Therefore, heat affecting the Lung caused wheezing, descending downward caused loose stools. Various manifestations can be summarized as "Exterior Cold and Interior Heat." Afterwards, I felt doubly ashamed, regretting reading the books without investigating their meaning, panicking during clinical practice, lacking the decisive spirit of composure, careful examination, boldness, and caution, coupled with selfish thoughts, which surely cannot be tolerated by the Way of Medicine.

Learning from others' strengths while maintaining one's own judgment

Book knowledge is certainly to be learned, but practical insights from teachers and peers are even more valuable. Therefore, whenever there is something that surpasses oneself, one should travel thousands of miles to accept it and seek guidance. The spirit of scholarship lies in being unashamed to ask subordinates, truly learning the "knife-edge" experiences of others.

(I) Every word contains "fragments of gold and jade"
I once treated a patient with insomnia, with red malar flush, rising fire, and restless irritation throughout the night. Multiple administrations of liver-calming, yang-subduing, heart-nourishing, and spirit-calming agents, taken for over ten days, yielded no effect. My teacher added Pig Bile (Zhu Dan) and Gentian Root (Long Dan Cao), both bitter medicines, to my original prescription. After just three doses, the patient slept peacefully and recovered suddenly. The teacher said: "Deficiency fire should be subdued, excess fire should be drained. This patient, with malar flush, rising fire, and restlessness, indicates excess fire in the Liver and Gallbladder."

Another case involved a young girl with urinary retention. Long-term catheterization caused severe infection of the perineum, with redness, swelling, and ulceration of the vulva. Despite repeated treatments with Chinese and Western medicines, urine still dripped drop by drop, causing extreme suffering. She invited me for consultation. Differentiating as Damp-Heat pouring downward, after one week of treatment, the condition did not improve, but limb edema, coarse breathing, aversion to wind, and fever increased. I invited an old classmate for consultation. He inquired in detail, reviewed all previous management methods, thought for a long time, and seemed to realize something, telling me: "This is actually a 'lifting the lid off the teapot' syndrome." He prescribed Sheng Huang Qi (Astragali Radix) 20g, Jie Geng (Platycodonis Radix) 18g, Sheng Ma (Cimicifugae Rhizoma) and Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g each, decocted strongly to replace tea, taken orally in small amounts multiple times daily. Additionally, Jin Yin Hua (Lonicerae Japonicae Flos) and Sheng Gan Cao were decocted to fumigate and wash the perineum, twice to three times daily. After three to four days, urination resumed spontaneously, the catheter was removed, and subsequently, the swelling and ulceration of the genital area gradually receded and healed.

The "lifting the lid off the teapot" method applies to oliguria/urinary retention cases belonging to Qi deficiency with sinking. The theory and method are not unfamiliar, but redness, swelling, and ulceration of the perineum clearly indicate a Damp-Heat syndrome, combined with scanty urine, seemingly contradicting the syndrome. Who would know that the Lung governs the Qi transformation of the whole body; if Lung Qi is insufficient, how can Qi transformation reach the Zhou Du (Bladder)? Sheng Huang Qi combined with Sheng Ma and Jie Geng both tonifies Qi and lifts the sinking. Moreover, Huang Qi expels toxicity and reduces swelling, having a flesh-generating and wound-closing effect on chronic non-healing ulcers, making it an essential herb for surgery. Medicine is a highly refined and subtle discipline. Due to careless reading and superficial understanding, swallowing things whole without chewing, one becomes a quack doctor who treats the head when the head hurts and the foot when the foot is sick.

(II) Bit-by-bit experience actually contains universal laws
"The dysentery has no stopping method" is a universal law, but it does not mean that all dysentery patients cannot use stopping and tonifying methods. "Acute dysentery belongs to Excess," "Chronic dysentery mostly belongs to Deficiency," are also basic laws, but they cannot be regarded as immutable dogmas.

I recall accompanying my teacher to treat a dysentery patient who had been bedridden for over three months, emaciated. Contracted in summer and autumn, now in mid-winter, the dysentery still did not stop, mixing red and white, frequent and uncontrollable, small amount and unsatisfactory, abdominal pain and tenesmus, aversion to eating, loss of stomach Qi, sallow complexion, extremely weak spirit, dry and dull white coating, pale red substance, with fragmented erosion at the edges. Reviewing previous prescriptions, they were all tonifying, astringing, and stopping dysentery, or warming and moving the Spleen and Stomach. At that time, the differentiation was: Middle Qi already deficient, pathogenic toxins entrenched internally, consuming Yin and damaging, Spleen Yang already trapped. To guide out the accumulation would further injure righteous Qi; warming the Middle would consume Stomach Yin; nourishing Yin would further trap Spleen Yang. Treatment faced the dilemma of attending to one aspect while neglecting another. The teacher scratched his head, pondered, and resolutely administered a combination of warming and unblocking. The medicine consisted only of Da Huang (Rhei Radix et Rhizoma) and Rou Gui (Cinnamomi Cortex), not decocted, but soaked, extracting their aroma. After administration, the passage of accumulated pus and bloody stool was very smooth, extremely foul-smelling, and the condition gradually improved and healed.

According to this case, it arose from mismanagement, causing pathogenic accumulation to remain in the convolutions of the Large Intestine. The disease caused deficiency, rather than deficiency causing the disease. Thus, although there was great emaciation, there was also great excess.

Not using attacking or tonifying methods, but employing warming and unblocking, was because Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) might hinder Spleen transportation and obstruct Da Huang's purgative action. Rou Gui is warm and regulates Qi, restraining the bitter-cold nature of Da Huang. With the encouragement of Spleen Yang, it assists Da Huang's pushing power, achieving a synergistic complementary effect. At that time, fearing collapse from a single purge, a bowl of rice porridge was placed by the bedside. After purging, it was warmed and drunk. The method was quite commendable, and the consideration extremely thorough. Later, I changed this prescription into a powder form and used it for cases of persistent bacterial dysentery in children and acute bacterial dysentery with poor response to antibiotics, often obtaining satisfactory results.

(III) Learning "knife-edge" experience, the key lies in "flexible" application
The so-called "knife-edge" experience means having unique insights academically, standing up to repetition clinically, and being able to solve "key" problems. The value of such experience lies in its summary through long-term practice.

In the past, I studied pediatrics with Xu Xiaopu from Shanghai. He was famous for his skill in using warm and hot medicines, often applying warm herbs in severe cases of pediatric acute febrile diseases, especially measles complicated with pneumonia. At that time, I did not understand: ① Measles is a warm-heat disease; how can warm medicines be used to treat warm diseases? ② Children have a "Pure Yang" constitution; why are warm medicines not prohibited? ③ What is the role and significance when warm and cold medicines are used simultaneously? It took me several years to truly understand these issues. First, the measles pneumonia in acute febrile diseases treated by Old Xu basically belonged to adverse and altered syndromes within measles. Clinically, it presented with grayish-dull complexion, indifferent spirit, and fine, rapid, and forceless pulse, indicating Qi-Yang insufficiency. From a modern medical perspective, most were deficiency syndromes such as pneumonia complicated with heart failure, respiratory and circulatory disorders. Thus, the disease was not due to pathogenic excess, but righteous deficiency. Timely application of warming Yang and saving from collapse methods prevented collapse. If waiting until collapse signs fully appeared, it would be too late. The key to Old Xu's skill in using warm medicines lay in grasping early and accurately. Second, regarding the physiological "Pure Yang Constitution" of children, although there are different interpretations, the pathological "prone to deficiency and excess," "prone to cold and heat" is objectively existing. Therefore, using warm medicines in warm-heat diseases is not a standard method, but a treatment for alterations. Third, the simultaneous use of warming and clearing has existed since ancient times. Although not created by Mr. Xu, he had unique approaches to combining warming and clearing. Especially for severe cases of acute febrile diseases where pathogenic toxins are rampant and righteous Qi cannot withstand them, participating bitter-cold detoxifying agents in the warming Yang and saving from collapse method can indeed play a good role. In the past, when treating "measles complicated with pneumonia," for cases complicated with adenovirus or Staphylococcus aureus infection, when long-term treatment with both Chinese and Western medicines was ineffective, and righteous Qi could not overcome pathogens, using the above methods resulted in success, which was not uncommon. We also found that for certain cases complicated with purulent lesions, reusing raw Da Huang to purge the bowels and detoxify, when righteous Qi had not yet declined, yielded gratifying results.

Seeking ancient teachings while forging new paths

As a TCM practitioner with high seniority, bearing the dual task of inheriting the past and ushering in the future, shoulder-to-shoulder with medical, teaching, and research responsibilities, the duty is heavy. Things are developing, situations are advancing. One should live and learn until old age, continuously practice, continuously explore, and advance to new levels. In recent years, I have done the following:

(I) Regarding different academic viewpoints, one must stand on practice
Regarding the physiological and constitutional characteristics of childhood, pediatric scholars of past generations have long held different views of "Pure Yang Constitution" and "Young Yin and Young Yang," which have had a great impact on later generations. Those arguing for "Pure Yang" believe that children inherit Pure Yang, and after contracting disease, they easily transform into heat and fire. Therefore, in treatment, emphasis should be placed on the application of cold and cool medicines, avoiding acrid-warm products, as warm medicines can assist heat and generate fire, listed as contraindicated. Those arguing for "Young Yin and Young Yang" believe that in infancy, vitality is vigorous, developing towards perfection and maturity. In the process of development, relying on Yang for growth and Yin for nourishment, however, Yang is insufficient, and Yin is not yet abundant. Therefore, in treatment, attention should be paid to protecting Yang Qi. To further study these different academic viewpoints, we made a preliminary comparison between Yin-injury-predominant and Yang-injury-predominant cases among sixty-one critically ill children from three hundred hospitalized cases. Among the sixty-one cases, forty-one were under two years old, twelve were between two and six years old, and eight were around ten years old. Regarding disease types, acute diseases predominated, mainly pediatric pneumonia, toxic indigestion, typhoid fever, etc. The condition upon admission was serious, and nineteen cases were already accompanied by heart failure and circulatory disorders. We explored the clinical phenomena and actual significance of "Young Yin and Young Yang" during the disease process based on condition records and medication rules.

1. Facial inspection. Cyanotic-gray and pale faces were common, accounting for more than 50% of total cases. The younger the age, the more frequent the occurrence.

2. Mental state. The most common was listlessness and indifference, with dull eyes. Infants showed this more obviously.

3. Tongue coating and substance. Smooth white coating, pale red or pale white substance accounted for 57% of the total; yellow coating, greasy coating, white coating, and red substance accounted for 43%. The manifestation of tongue substance and coating was consistent with the clinical signs of the children.

4. Pulse. For older children, the pulse was predominantly deep and fine, or fine and rapid.

Among the treatment records of the sixty-one critically ill cases, twenty-six completely used the Yang-restoring and collapse-saving method dominated by Ren Shen (Ginseng Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata); twelve cases involved simultaneous Yin and Yang injury, treated with Sheng Mai San (Generate the Pulse Powder) plus Fu Zi, Long Gu (Fossilia Ossis Mastodi), and Mu Li (Concha Ostreae); thirteen cases purely used Yin-nourishing, heat-clearing, and bitter-cold detoxifying methods, all of whom were older children.