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Aconiti Lateralis Radix Praeparata (Fupian) 100g, Zingiberis Rhizoma (Ganjiang) 36g, Glycyrrhizae Radix et Rhizoma (Gancao) 12g, Cinnamomi Cortex (Shang Rougui) 10g (ground into powder, soaked in water and added to the decoction).

After taking the above prescription, the body heat subsided by four or five tenths, the pulse showed slight vitality, urine became red and copious, and a small amount of thin porridge was consumed. After another dose, the fever subsided by seven or eight tenths, defecation began to be smooth, passing black and hard stools; only cough with profuse sputum, mixed with blood, remained. The family invited several other physicians for consultation, all of whom diagnosed it as a heat syndrome, prescribing formulas invariably based on bitter-cold purgative methods. Due to the cautionary lesson of previous misdiagnosis, they dared not try lightly. Later, after the patient ate one pear, he suddenly went mad and beat people that night, with severe recurrence of high fever, similar to the initial state. He was urgently invited to treat again, at which point the matter of eating the pear was disclosed. I observed his tongue was white and slippery, and he still preferred hot drinks. This indicated that Yang Qi was still deficient and Yin-Cold had not been cleared. Urgent support of Yang was needed, yet giving yin-nourishing and cooling fruits increased interior cold, worsening the condition. I advised that it would be fortunate if raw, sour, cold foods and cooling bitter-cold medicines were strictly avoided. I continued to prescribe large doses of formulas to restore Yang and dispel cold. Doubling the dosage of the second formula, and adding Poria (Fuling) 30g, Pinelliae Tuber (Banxia) 16g, and Asari Radix (Beixixin) 4g, one dose each morning and evening, taken continuously for six doses. Upon re-examination three days later, the fever had ceased, cough and sputum gradually improved, food intake increased, urine became pale yellow and copious, and stool turned yellow and loose. The prescription was modified by removing Banxia and Beixixin, adding Amomum Fruit (Sharen), Atractylodis Macrocephalae Rhizoma (Baizhu), and Astragali Radix (Huangqi), one dose daily, taken continuously for more than ten doses, resulting in the complete resolution of all symptoms. His health subsequently exceeded its pre-illness state.

Note: Diseases are categorized into true heat and true cold syndromes, as well as true heat with false cold and true cold with false heat patterns. However, true patterns are easy to identify, while false ones are difficult to distinguish. The *Neijing* states: "In treating diseases, one must seek the root." This implies that all diseases require differentiation of Yin and Yang.

Shanghan Disease: Shaoyin Extreme Yin Resembling Yang Syndrome (II)

Mr. Qin XX, former president of a certain hospital in Yunnan Province, resided at Xiuyi Street inside the Small South Gate of Kunming City. His only son, Nianzu, aged thirteen, suffered from severe Shanghan disease with persistent fever for over twenty days. Mr. Qin was proficient in Western medicine and had treated his son with various injections and medications without effect. He invited several Western medical colleagues, including Xu and Ying, for consultation, who all declared the case incurable. Subsequently, recommended by Mr. Qin's student, Mr. Li XX, I was invited to examine the patient on January 7, 1948. The child had had unrelenting fever for over twenty days, milder in the morning and heavier at night. His complexion was dark blue-black, with slight redness on both cheeks. Lips were scorched and dry with scabs, sleepless day and night, unconscious. Breathing was panting; occasionally dazed and spiritless, alternatively restless and delirious, with hands grasping aimlessly as if picking threads from empty air. No food intake, scanty red urine, no bowel movement for several days. Tongue coating was black and dry, no thirst, swallowing only two or three mouthfuls of water when fed, refusing more. Pulse was floating and empty, powerless upon deep pressure. This indicated Shanghan transitioning to Shaoyin, excessive Yin-Cold causing Yin to repel Yang, failure of Heart and Kidney communication, resulting in an exterior false heat and interior true cold pattern of extreme Yin resembling Yang. Although exterior signs suggested dryness and heat, interior Yin-Cold was extreme, forcing Yang to float outward, indicating imminent collapse. The treatment method should be large doses to support Yang and suppress Yin, restore Yang and gather it, and communicate Heart and Kidney, to save the situation. Misidentifying this as a heat syndrome and administering bitter-cold drugs would inevitably lead to fatal danger. The prescribed formula was Baitong Tang modified.

Aconiti Lateralis Radix Praeparata (Fupian) 250g, Zingiberis Rhizoma (Ganjiang) 50g, Scallion White (Congbai) 4 stalks, Cinnamomi Cortex (Shang Rougui) 15g (ground into powder, soaked in water and added to the decoction).

After the prescription, Mr. Qin harbored doubts about Traditional Chinese Medicine. Seeing this large dose of warm-hot herbs, he dared not use them further. He told me he had another special method: transfusing blood from a patient recently recovered from Shanghan into his son, hoping for efficacy. Unexpectedly, after the blood transfusion that day, the fever intensified, abdominal pain and groaning continued incessantly, and restlessness and delirium worsened. At this point, Mr. Qin felt helpless and finally had the prescribed herbal decoction administered to his son. After taking it that night, there was slight calmness, brief sleep, fading of the dark blue-black facial color with slight moistening, pulse no longer empty and floating as yesterday, and reduced restlessness and delirium. However, the desire to sleep increased, revealing the fundamental pattern of Shaoyin deficiency-cold. Another dose of the original formula was prepared and administered.

Re-examination on January 8: Temperature slightly decreased, lips and tongue moister, restlessness stopped. Occasionally spoke confused words, vomited saliva and phlegm once. Continued using Baitong Tang modified to support Yang, suppress Yin, communicate Heart and Kidney, and transform Qi to promote water metabolism.

Aconiti Lateralis Radix Praeparata (Fupian) 300g, Zingiberis Rhizoma (Ganjiang) 30g, Poria (Fuling) 30g, Cinnamomi Cortex (Shang Rougui) 15g (ground into powder, soaked in water and added to the decoction), Scallion White (Congbai) 4 stalks.

After taking the above prescription, the patient was restless and unable to sleep all night. Mr. Qin became suspicious again and urged my urgent visit the next day. I found him washing the child's mouth with boric acid solution.

Detailed examination: Pulse slightly stronger, temperature slightly lower than before, expression indifferent, no thirst.

Diagnosed as excessive Yin-Cold and too deficient Yang. Although aided by Yang-tonifying herbs, the disease was severe and the medication light; the medicinal force clashed with the pathogen but was insufficient, like soldiers failing against enemies. The restlessness was a sign of the clash between medicine and disease, not requiring alarm. Dosage must be increased to overcome it. Prescribed large-dose Sini Tang modified.

Aconiti Lateralis Radix Praeparata (Fupian) 400g, Zingiberis Rhizoma (Ganjiang) 150g, Cinnamomi Cortex (Shang Rougui) 20g (ground into powder, soaked in water and added to the decoction), Poria with Cinnabar Coating (Zhuyi Fushen) 50g, Prepared Polygalae Radix (Zhianyuanzhi) 20g, Clove (Gongdingxiang) 5g, Raw Licorice Root (Sheng Gancao) 20g.

This prescription had strong medicinal power. To address the emergency, instructed to boil thoroughly and take one dose one hour after boiling. Re-examined at 5 PM that afternoon: condition greatly relaxed, restlessness settled, patient calm, urine longer. The disease showed signs of turning. That night, another dose of the original formula was taken. Bowel movement occurred, passing three times of dark brown watery stool. Fever subsided by more than half, restlessness and delirium ceased, and sound sleep lasted four to five hours.

Morning of the 10th: Pulse floating and moderate, lips and tongue regained moisture, black coating reduced by six or seven-tenths, fever subsided by eight or nine-tenths, showing great potential for turning danger into safety. Modified the third prescription with Cardamom Fructus (Xisha Ren) 10g, Atractylodis Rhizoma (Cangzhu) 10g, and Evodiae Fructus (Wuyu) 8g.

Re-examination on the 11th: Defecated freely several times, color still dark brown. Fever completely subsided, black scabs on lips shed, black coating further reduced, mouth full of fluids. Over twelve hours, defecated more than ten times. Mr. and Mrs. Qin were worried, fearing intestinal bleeding or perforation. Every time their son defecated, they cried in panic. I explained in detail: It is due to internal excess of cold-damp evil Yin, accumulation in the abdomen like ice and frost. Now, warmed by Yang herbs, the evil Yin retreats, True Yang returns, melting the ice and frost. The prescribed formulas are not purgatives; the expelled material is internally retained cold-damp filth, a good omen of disease removal. When pathogens leave, Zheng Qi naturally settles, ensuring safety. Thus, the family's doubts lessened, continuing treatment. Large doses of warming-transforming formulas continued day and night.

Aconiti Lateralis Radix Praeparata (Fupian) 400g, Zingiberis Rhizoma (Ganjiang) 80g, Cinnamomi Cortex (Shang Rougui) 20g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 10g, Poria (Fuling) 50g, Coicis Semen (Yiren) 20g, Arecae Seed (Kouren) 8g, Licorice Root (Gancao) 30g.

Examination on the 12th: After taking medicine, defecated more than ten times, color gradually turning yellow, urine clearer and longer, black coating fully gone, remaining white-slippery coating. Appetite restored, feeling hungry anytime seeking food. In the late stage of Shanghan, Yang Qi has not recovered, Spleen and Stomach are also deficient. Careful regulation is needed to prevent relapse due to diet or labor. Only small frequent meals are suitable. Next prescription for regulation:

Aconiti Lateralis Radix Praeparata (Fupian) 400g, Zingiberis Rhizoma (Ganjiang) 80g, Cinnamomi Cortex (Shang Rougui) 20g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 10g, Astragali Radix (Huangqi) 30g, Prepared Licorice Root (Zhigancao) 20g, Longan Aril (Yuanrou) 30g.

Examination on the 13th: Defecated only twice, yellow and loose, lips ruddy, white-slippery coating completely gone, mind clear, food intake increased, sound sleep at night, pulse calm, body cool, major illness receded. But Yang Qi still deficient, body emaciated, sweating upon movement. Prescribed Huangqi Jianzhong Tang modified with Guizhi and Fuzi for regulation.

Aconiti Lateralis Radix Praeparata (Fupian) 300g, Astragali Radix (Huangqi) 80g, Cinnamon Twig (Guizhi) 20g, Paeoniae Radix Alba (Hangshao) 30g, Prepared Licorice Root (Zhigancao) 20g, Cinnamomi Cortex (Shang Rougui) 20g (ground into powder, soaked in water and added to the decoction), Fresh Ginger (Shengjiang) 30g, Jujube (Dazao) 4 pieces, Maltose (Yitang) 30g (dissolved and added).

Examination on the 14th: Pulse deep, moderate, and spirited, lips and tongue ruddy, diarrhea stopped, urine clear and long, slight cough, occasional abdominal pain. Prescribed Sini Tang modified.

Aconiti Lateralis Radix Praeparata (Fupian) 300g, Zingiberis Rhizoma (Ganjiang) 100g, Asari Radix (Beixixin) 8g, Cinnamomi Cortex (Shang Rougui) 11g (ground into powder, soaked in water and added to the decoction), Tangerine Peel (Guangchenpi) 10g, Processed Pinellia (Faxia) 10g, Licorice Root (Gancao) 10g.

Examination on the 15th: Cough and abdominal pain stopped, only Zheng Qi still deficient, fatigue rising and lying down. Continued with Sini Tang plus Ginseng and Astragalus for convalescence. Took five or six doses and recovered, thereafter constitution normal.

Shanghan Disease: Shaoyin Excessive Yin Repelling Yang Syndrome. Son of Ma XX, thirteen years old, residing in Kunming City. On November 22, 1945, suffering from Shanghan for over twenty days, untreated by doctors. Cold pathogen entered Yin level, repelling True Yang to float outward, causing body heat heavier at night, body temperature over 40°C, contrary lack of aversion to cold, red cheeks, scorched lips with scabs, dizziness, anorexia, desire to sleep but spiritless, little drinking, vexation, chest tightness, nausea, scanty red urine, no bowel movement for days, whole body covered in white miliary rash (Bai Bao), pulse deep and tight, tongue coating white and greasy. This is a manifestation of Yang deficiency and Yin excess. Treatment method: Support Yang and warm transformation, break Yin and restore Yang.

Aconiti Lateralis Radix Praeparata (Fupian) 26g, Zingiberis Rhizoma (Ganjiang) 10g, Cinnamomi Cortex (Shang Rougui) 3g (ground into powder, soaked in water and added to the decoction), Poria (Fuling) 10g, Scallion White (Congbai) 4 stalks.

Re-examination on the 23rd: After taking yesterday's prescription, vomited several bowls of saliva/phlegm, indicating warm herbs moving, a sign of disease removal. Still feverish, dizzy, spiritless, no thirst. This is extreme cold of Shanghan, internal excess of Yin-Cold, Yang unable to overcome Yin, definitely no heat syndrome. Treatment method unchanged.

Aconiti Lateralis Radix Praeparata (Fupian) 50g, Zingiberis Rhizoma (Ganjiang) 13g, Cinnamomi Cortex (Shang Rougui) 3g (ground into powder, soaked in water and added to the decoction), Poria (Fuling) 10g, Hordeum Vulgare Sprout (Maiya) 6g, Scallion White (Congbai) 4 stalks.

Third examination on the 24th: Tongue coating white, greasy and moist, pulse relatively moderate. Had one bowel movement last night, black color, initially hard then loose. This indicates heavy interior cold, Yang still deficient, Yang not storing, still tidal fever, milder in morning, heavier at night, dizziness, desire to sleep but spiritless. Prescribed large dose to support Yang and suppress Yin.

Aconiti Lateralis Radix Praeparata (Fupian) 60g, Zingiberis Rhizoma (Ganjiang) 13g, Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Poria (Fuling) 10g, Cardamom Fructus (Xisha Ren) 3g, Clove (Gongding) 1.3g, Licorice Root (Gancao) 3g.

Fourth examination on the 25th: Morning pulse, five beats per breath, resembling normal pulse. Tongue coating white, slippery, thick and greasy. Body temperature slightly dropped to 39.5°C. Had one bowel movement last night, vexation and chest tightness slightly reduced, achieved sound sleep. Only prolonged interior cold remains heavy, repelling True Yang, floating outward causing tidal fever, red cheeks, much spontaneous sweat, dizziness, spiritless. This is Middle Yang failing to transport, Yin-Cold obstructing, chest and abdominal distension still preventing eating, hot drinks only two or three spoonfuls. Must drive out all interior cold and evil Yin before True Yang can return to its residence. How could tidal fever and other symptoms not subside!

Aconiti Lateralis Radix Praeparata (Fupian) 100g, Zingiberis Rhizoma (Ganjiang) 16g, Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Poria with Cinnabar Coating (Fushen) 10g, Licorice Root (Gancao) 10g.

Fifth examination on the 26th: After taking yesterday's prescription twice, felt inner restlessness after night dose. This is heavy warm herbs stirring Yin-Cold, medicinal force clashing with pathogen. By morning, aided by Heavenly Yang, saw calmness and sleep. Current examination: Temperature dropped to 38.7°C, breathing peaceful, pulse five beats per breath, tongue coating still white, greasy and slippery. Long-standing stomach cold, still no appetite, profuse sputum without black blood. Belongs to cold-phlegm and blood stasis transforming and retreating, not comparable to heat severely burning Yin. Fortunately, cheek redness faded, white miliary rash healing, temperature dropping, good omen of disease receding. This disease is extremely deficient-cold, definitely no heat evidence. I stick to my principle, still supporting Yang, warming transformation, and assisting Zheng.

Aconiti Lateralis Radix Praeparata (Fupian) 180g, Zingiberis Rhizoma (Ganjiang) 16g, Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Licorice Root (Gancao) 10g.

Sixth examination on the 30th: Previous three days, family consulted Western doctors, who withdrew citing critical condition and lack of specific drugs, then returned to me for rescue. Current examination: Pulse slow, weak, powerless, tongue coating white and moist, urine clearer and longer, still tidal fever at night, patient extremely weak. This is Three Yin deficiency-cold syndrome. Disease prolonged, Yang Qi extremely deficient, delay risks collapse and Yang loss. Still supporting Yang, suppressing Yin, strengthening Heart and assisting Zheng.

Aconiti Lateralis Radix Praeparata (Fupian) 130g, Zingiberis Rhizoma (Ganjiang) 16g, Cinnamomi Cortex (Shang Rougui) 6g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 5g, Clove (Gongding) 3g, Licorice Root (Gancao) 10g.

Seventh examination on December 1st: Temperature dropped to 37°C, pulse slow and weak, four beats per breath, cheek redness completely gone, revealing deficient-cold appearance, dull and lusterless. Sweated last night, after fever subsided, now aversion to cold. Indicates Yin retreating, Yang returning. Yang has recovered but is weak and powerless to defend exterior. Had one bowel movement last night, dark brown and loose. Although lips scorched with black scabs, never thirsty. This is Three Yin extreme cold syndrome, Yang Qi too deficient. Still supporting Yang and Zheng.

Aconiti Lateralis Radix Praeparata (Fupian) 130g, Zingiberis Rhizoma (Ganjiang) 20g, Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 10g, Poria with Cinnabar Coating (Fushen) 10g, Coicis Semen (Yiren) 20g, Licorice Root (Gancao) 10g.

Eighth examination on the 2nd: Morning examination, temperature 37.2°C, pulse slow and weak, four beats per breath, tongue white and moist, all conditions improving, bland taste, no appetite. This is prolonged disease causing central palace too cold, Spleen-Stomach Yang deficiency, loss of transport authority. Wait until evil Yin is driven out, Middle Yang recovers, then appetite will return. Still supporting Yang and Zheng.

Aconiti Lateralis Radix Praeparata (Fupian) 130g, Zingiberis Rhizoma (Ganjiang) 25g, Cinnamomi Cortex (Shang Rougui) 6g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 10g, Black Cardamom (Lao Kou Ren) 3g, Prepared Licorice Root (Zhigancao) 10g.

Ninth examination on the 3rd: Temperature 37.8°C, pulse moderate, black scabs on lips shed, tongue coating receded, lips and tongue ruddy, no thirst, Stomach Qi recovering, desiring drink, slight cough at night. Interior cold not yet cleared, Yuan Yang still deficient. Still supporting Yang and assisting Zheng, slightly aiding cough. Avoid early tonification.

Aconiti Lateralis Radix Praeparata (Fupian) 100g, Zingiberis Rhizoma (Ganjiang) 25g, Cinnamomi Cortex (Shang Rougui) 6g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 5g, Processed Pinellia (Faxia) 10g, Prepared Adenophorae Radix (Zhidonghua) 5g, Evodiae Fructus (Wuyu) 6g, Prepared Licorice Root (Zhigancao) 10g.

Tenth examination on the 4th: Temperature dropped to 36.7°C, cough stopped, Yang Qi still deficient, continue yesterday's prescription for one dose.

Eleventh examination on the 5th: Pulse slow and weak, coating gone, lips and tongue ruddy, no thirst, urine clear and long, morning temperature 36.5°C, only little sleep, poor appetite, occasional cold sweat on head. Yang Qi too deficient. Continue supporting Yang, strengthening Stomach, nourishing Heart and calming Spirit.

Aconiti Lateralis Radix Praeparata (Fupian) 160g, Zingiberis Rhizoma (Ganjiang) 65g, Cardamom Fructus (Xisha Ren) 6g (crushed), Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Black Cardamom (Lao Kou Ren) 3g (crushed), Prepared Polygalae Radix (Zhianyuanzhi) 6g, Poria with Cinnabar Coating (Zhuyi Fushen) 10g, Fried Ziziphus Seed (Chao Zaoren) 10g, Amber (Hupo) 3g (ground into powder, taken with decoction), Licorice Root (Gancao) 6g.

Twelfth examination on the 6th: Pulse and temperature normal, lips and tongue ruddy, ate food yesterday, sleep improved, Yang Qi still deficient. Still supporting Yang and assisting Zheng.

Aconiti Lateralis Radix Praeparata (Fupian) 130g, Zingiberis Rhizoma (Ganjiang) 20g, Cinnamomi Cortex (Shang Rougui) 5g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 6g, Codonopsis Radix (Ming Dangshen) 20g, Licorice Root (Gancao) 6g.

Thirteenth examination on the 7th: Pulse, tongue, and temperature normal, urination and defecation smooth, diet and spirit improved, major illness receded, gradually adding regulation and tonification, recovery expected. Prescribed Fu Yang Jian Zhong for convalescence. Health restored after several doses.

Aconiti Lateralis Radix Praeparata (Fupian) 100g, Zingiberis Rhizoma (Ganjiang) 16g, Cardamom Fructus (Xisha Ren) 6g (crushed), Black Cardamom (Lao Kou Ren) 3g (crushed), Cinnamomi Cortex (Shang Rougui) 10g (ground into powder, soaked in water and added to the decoction), Astragali Radix (Huangqi) 20g, Codonopsis Radix (Ming Dangshen) 20g, Prepared Licorice Root (Zhigancao) 6g.

Pediatric Shanghan Disease with Critical Intestinal Hemorrhage

Son of Zhang XX, eight years old, from Binchuan County, Yunnan Province. In April 1945, suffering from Shanghan for over ten days, treated at former Kunhua Hospital, condition worsening, moved home. On April 23, consulted me. Face blue, lips white and scorched, tongue red and moist, no coating, pulse string-tight, empty and powerless upon pressure, tidal fever, milder in day, heavier at night, confused consciousness, disordered speech, abdominal distension like drum, had passed bloody stool twice, scanty red urine, emaciated. This is Shanghan, cold entering Yin level, Yin-Evil spreading in abdomen, Yuan Yang greatly deficient, critical condition, fear of Yang collapse. Must treat by supporting Yang and suppressing Yin. However, after warm herbs, stirring Yin-Cold will cause vomiting and diarrhea. Due to too deficient Zheng Qi, a thread of residual Yang about to collapse, fear of phlegm-rattle and asthma collapse during vomiting/diarrhea. Thinking carefully, only fighting a desperate battle offers hope of rescue. Hesitation misses the opportunity, regretting too late. Urgently prescribed Tongmai Sini Tang plus Cinnamomi Cortex.

Black Aconiti Lateralis Radix Praeparata (Hei Fupian) 100g, Zingiberis Rhizoma (Ganjiang) 26g, Raw Licorice Root (Sheng Cao) 10g, Cinnamomi Cortex (Shang Rougui) 10g (ground into powder, soaked in water and added to the decoction), Scallion White (Congbai) 2 stalks.

At 7 PM that evening, Mr. Zhang came to inform that after two doses, immediately vomited saliva, then passed black stool, abdominal distension reduced by half, fortunately no asthma or phlegm-rattle, only spirit too weak. Immediately informed him that condition is turning, should continue original prescription for one dose.

Morning re-examination on the 24th: Vomiting and diarrhea after yesterday's dose, abdominal distension gone, string-tight pulse flattened, tidal fever subsided. Due to prolonged severe Shanghan, Yuan Yang exhausted. Although distension resolved, evil Yin not cleared, Yang Qi not filled, scattered and masterless, still dazed and spiritless, occasionally restless speaking confused words. However, condition has turned, no doubt, still supporting Yang and suppressing Yin.

Aconiti Lateralis Radix Praeparata (Fupian) 130g, Zingiberis Rhizoma (Ganjiang) 26g, Cinnamomi Cortex (Shang Rougui) 13g (ground into powder, soaked in water and added to the decoction), Cardamom Fructus (Xisha Ren) 4g, Poria (Fuling) 16g, Prepared Polygalae Radix (Zhianyuanzhi) 3g, Raw Licorice Root (Sheng Cao) 4g.