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Wang Ziyu's condition was critical when Wang Mengying was finally summoned. Wang Mengying said, "The patient has a Yin-deficient constitution with Summerheat-Heat pathogens firmly entrenched; this is likely due to the prior mistaken administration of tonic medicines." His uncle, Wang Shaohong, replied, "My nephew has always been frail; the physician administered Shudi (Rehmanniae Radix Preparata) and similar herbs for over ten doses." Wang Mengying stated, "In Summerheat-Heat syndromes, one should only consider using Shengdi (Rehmanniae Radix) once the pathogen has entered the Blood level. Why use Shudi at the onset of illness? Do you only recognize constitutional deficiency while ignoring exogenous diseases?" Ancient sages treating Summerheat merely warned against inappropriate exterior-releasing and warming-tonifying methods. Who would have predicted that modern physicians would commit the sin of using cloying and greasy herbs beyond established protocols? One error led to this state, yet there is no repentance. This is like oil mixing with flour or lacquer adding to glue—how can it be reversed? The next day, he indeed passed away. Xiaomi Sheyin (a courtesy title referring to Wang Ziyu), having no male heir, died suddenly shortly after marriage, which is truly tragic.

Pan Hongcha Fangbo's grandson, Pan Yiting, was employed as a tutor in the Xu Shuangnan household. During intense heat, he drank a bowl of cold Shihua (Tongue Fern) soup, subsequently developing epigastric fullness and oppression, with his limbs gradually becoming cold up past the elbows and knees. His pulse was hidden (Fu), accompanied by spontaneous sweating. Physician Fang diagnosed this as "Yang deficiency with Cold Summerheat," predicting imminent collapse of Yang Qi. He prescribed a large dose of Jiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata), Ding (Caryophylli Flos), and Rougui (Cinnamomi Cortex) to restore Yang. (At that time, Xu Shuangnan was in Suzhou.) His third son, Li Shu, was alarmed by the prescription and invited clan member Xu Zhijing to diagnose and decide. Xu Zhijing said, "These medicines must absolutely not be taken. Given the critical urgency, we must consult Wang Mengying contrary to convention." It was already midnight when Wang Mengying arrived. He said, "Having contracted Summerheat-Heat, and then having the chest cavity frozen by cold beverages, the Great Qi cannot rotate. Hence, cold limbs, hidden pulse, and obstruction of urination and defecation. Quickly take Liu Yi San (Six-to-One Powder) one liang, stir with light salt water, clarify and remove dregs, then mix with Zi Xue Dan (Purple Snow Pill) one qian."

On the following day, during the second consultation: the pulse emerged, the chest felt relieved, urination resumed, limbs warmed, mouth became dry, tongue was crimson, and Summerheat symptoms fully manifested, transforming into Malaria. Multiple doses of Baihu Tang (White Tiger Decoction) were given, resulting in recovery. In the Bingwu year, he passed the provincial examination.

Madam Sima of Kang Kanghou suffered from long-term mental overstrain, causing Heart Fire to float outward, presenting with facial redness and toothache. After eating watermelon, she developed epigastric oppression and discomfort, preferring hot compressions, diarrhea, and lack of appetite. She felt her tongue was swollen and thick by several inches, with a grayish, greasy coating. Wang Mengying prescribed Houpo (Magnoliae Officinalis Cortex), Huashi (Talcum), Congbai (Allii Fistulosi Bulbus), Xiebai (Allii Macrostemonis Bulbus), Pipaye (Loquat Leaf), Jupi (Citri Reticulatae Pericarpium), Bohe (Menthae Haplocalycis Herba), Xuanfu (Inulae Flos), and Shentoucao (Artemisiae Scopariae Herba). One dose resulted in rapid recovery.

Ms., wife of Xu Shaoqing, was the niece of the late physician Mr. Chen Qidong. At the beginning of summer, she contracted a common cold. He Xinzhi administered Qingjie (Clearing and Resolving) formulas ten times consecutively, but the illness did not subside slightly. Wang Mengying was invited to diagnose. The pulse was Xian (Wiry), Hong (Surging), Huo (Hollow), and Da (Large), especially on the right side. Symptoms included extreme thirst, profuse sweating, ability to eat but delirious speech, facial redness, cold feet, and insomnia throughout the night. Wang Mengying said, "Although the syndrome belongs to Warmth, her True Yin has been deficient since youth, and long-term mental strain caused Heart Yang to escape outward, stirring internal Wind. Fortunately, a discerning doctor treated her without using warming and releasing agents, so there is still hope." He prescribed Longgu (Fossilia Ossis Mastodi), Muli (Concha Ostreae), Xijiao (Rhinocerotis Cornu), Zhenzhu (Margarita), Guiban (Carapax et Plastrum Testudinis), Biejia (Carapax et Plastrum Trionycis), Beimu (Fritillariae Cirrhosae Bulbus), Zhuli (Bambusae Sap), Zhuye (Bambusae Folium), Chencha (Stibnatum Rubrum), Xiaomai (Tritici Fructus), Yuan Shen (Scrophulariae Radix), Danshen (Salviae Miltiorrhizae Radix), Shengdi (Rehmanniae Radix), and Maidong (Ophiopogonis Tuber) in a large dose. Externally, red-hot iron was quenched in vinegar for inhalation; Muli powder was applied to stop sweating; raw Fuzi paste was applied to Yongquan (KI 1). After just one dose, a relative recommended Dr. Hu to examine her. Dr. Hu strongly criticized Wang's approach, advocating for a method to vent rashes. The family, confused, administered Dr. Hu's decoction. The patient became mentally confused and hallucinated seeing her uncle Chen Qidong strangling her throat, preventing swallowing. She instructed, "You should take Mr. Wang's medicine." Xu Shaoqing was greatly alarmed upon hearing this and exclusively continued Wang's medication. The condition gradually improved. However, Yin fluids were difficult to restore; frequent administration of sweet, moistening, and sedating herbs was required for over a month before she could get out of bed. In the late summer, menstruation occurred. She remained emotionally distressed and prone to fright. Wang Mengying prescribed Maidong, Renshen Xu (Ginseng Fibers), Shudi, Shiyin (Quartz), Fushen (Poria with Hostwood), Longyan (Longan Aril), Gancao (Glycyrrhizae Radix et Rhizoma), Xiaomai, Dazao (Jujubae Fructus), and Sanjia (Three Turtle Shells) for convalescence.

At the end of autumn, upon returning to her natal home, she lightly contracted external pathogens, presenting with alternating chills and fever resembling malaria. Wang Mengying administered clearing and resolving herbs, bringing relief. Dr. Hu remarked to relatives, "This case resulted from improper treatment in summer, allowing pathogens to linger. Further cooling will surely cause death." Dr. Tang concurred. The Xu family engaged Dr. Tang, who claimed their Yang Qi was damaged and deep cold had lain dormant. He prescribed Lizhong Tang (Regulate the Middle Decoction) plus Weilingxian (Akebiae Caulis), Guizhi (Cinnamomi Ramulus), Banxia (Pinelliae Rhizoma), Houpo, Shengjiang (Zingiberis Rhizoma Recens), and Dazao. The patient suspected the herbs were too drying and pungent. Dr. Tang used honey to swallow and wipe the tongue, speaking persuasively. The family was convinced. Initially, stomach Qi seemed strengthened, but soon phlegm-cough, anorexia, a yellow coating covering the tongue, muscle wasting, amenorrhea, internal heat, profuse sweating, palpitations, and insomnia ensued, confining her to bed. The patient firmly refused further medication, though twenty doses had already been taken. He Xinzhi was consulted again but found the situation difficult to manage. They were advised to seek Wang Mengying. The pulse was wiry, fine, soft, and rapid. She also developed a perineal abscess (Xuanyong). Wang declared that even divine medicine could not save her.

Madam Zhengshi of He Jinjie, who suffered from Liver Jue (Liver Convulsion) habitually, contracted a cold in mid-summer. Shen Yueting treated it as a Warmth syndrome. Internal wind did not flare up abruptly, but she experienced diarrhea, a fine and wiry pulse, thirst with excessive drinking, phlegm, anorexia, and insomnia. Wang Mengying was consulted and prescribed Baitouweng Tang (Pulsatillae Decoction) plus Sanjia, Shihu (Dendrobii Caulis), Fuling (Poria), and Zhuru (Bambusae Caulis in Taenia). The condition stabilized. Subsequently, strong tonification ensured full recovery.

Ji Quan, younger brother of Hu Mengshen, presented with black spots (severe rash/variola-like disease), turbid coating, chaotic pulse, coarse breathing, and a dirty complexion. Wang Mengying immediately administered Liangge San (Cool the Chest Powder). Defecation became smooth, and epigastric oppression resolved. All rashes erupted and spread. The pulse became slippery, rapid, and surging. Large doses of cooling, moistening, and purgative-clearing herbs were given. Dosage was reduced only after ten days when diarrhea ceased. Later, he fell into a deep coma. Everyone doubted the treatment. Wang Mengying explained, "Phlegm-heat remains vigorous." He continued large doses. Indeed, copious sticky phlegm was expectorated for days, after which sleep and appetite gradually normalized.

During this epidemic, when both illnesses raged, the family was panicked. Other physicians suggested warming tonics for the first symptom (attributed to Spirit not residing in its house) and deemed the second symptom hopeless. Listeners were alarmed. Fortunately, Ji Quan's wife possessed unique insight and trusted Wang Mengying unreservedly, allowing him to work without hindrance, leading to successful outcomes for all.

Miss Granddaughter of Pu Dongming, constitutionally Yin-deficient, often had night fevers and insomnia if eating little. In mid-summer, she contracted a cold, developed rashes, and menstruated irregularly. Wang Mengying used Xijiao, Lingyangjiao (Saigae Tataricae Cornu), Zhimu (Anemarrhenae Rhizoma), Beimu, Shigao (Gypsum Fibrosum), Shengdi, Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Huafen (Trichosanthis Radix), Gancao, Zhuye, and Lugeng (Phragmitis Rhizoma). After rashes cleared and spirit settled, she suffered extreme nasal dryness, burning pain upon inhalation, and even cold limbs. Yuanshen (Scrophulariae Radix), Zhuru, Juye (Chrysanthemi Folium), and Hegan (Nelumbinis Petiolus) were added, alleviating symptoms. However, palpitations, salivation, insomnia, thirst, sweating, and black stools ensued. The prescription was changed to Xiyangshen (American Ginseng), Shengdi, Maidong, Xiaomai, Zhuye, Huanglian (Coptidis Rhizoma), Zhenzhu, Baihe (Lilii Bulbus), Beimu, Shihu, Muli, Guiban, and Zhezhijue (Sugarcane Juice). She recovered and married Yao Yizhai in late autumn.

In mid-summer, continuous rain lasted a month, causing floods. In late summer, scorching heat prevailed, and many suffered from heat diseases. Shen Xiaoyuan fell ill in Yue. Physicians recognized dampness but missed the transformation into heat, prescribing Pingwei San (Peace the Stomach Powder) for several doses. This resulted in high fever, delirium, and critical danger. Upon returning to Hangzhou, landlord Wu Zhongzhuang requested Wang Mengying's diagnosis. Pulse was slippery, solid, and rapid; extreme thirst, red urine, and overflow diarrhea were present. Shi Gao and Dahuang (Rhei Radix et Rhizoma) were given, and multiple purgations led to recovery. Wu wished to distribute medicine to help others and asked Wang to formulate a reliable method. Wang said, "I dare not act subjectively. Historically, Ye Tianshi's Ganlu Xiaodu Dan (Sweet Dew Detoxifying Powder) and Shenxi Dan (Divine Calamity Pill) are the most appropriate for Damp-Warmth and Summer-Epidemic. One treats the Qi level, the other the Ying level. Their frameworks are complete. Even with combined syndromes, flexibility exists; one need not rigidly adhere to Si Tian Zai Quan theories. With this year's famine, next year may bring a strange epidemic. However, 'Ganlu' sounds too cold, and 'Xiaodu' might be mistaken for external treatments. Therefore, I renamed it Puji Jieyi Dan (Universal Relief Epidemic-Detoxifying Pill). Mr. Wu and other charitable families distributed it according to the formula, saving countless lives."

Puji Jieyi Dan: Wang Mengying annotated: "This is the main formula for Damp-Warmth and Time Epidemics. According to the *Suwen*, Five Movements divide steps. Thirteen days after Spring Equinox, the second movement (Fire) begins, warming the sky. Ten days after Grain in Ear, the second palace (Earth) begins, humidifying the earth. Warmth and humidity vaporize together with intense solar heat, melting stone and flowing metal. Humans within this Qi intersection inhale these energies; if retained, they form Warmth, Heat, Summerheat, and Epidemic diseases. Symptoms include fever, fatigue, chest tightness, abdominal distension, limb soreness, pharyngeal swelling, rashes, jaundice, parotid swelling, thirst, red urine, constipation, vomiting, diarrhea, malaria, dysentery, strangury, turbidity, and sores. If the tongue coating is pale white, thick, or dry yellow, the Summerheat-Damp-Heat-Epidemic pathogen is still in the Qi level. This pill acts effectively. Furthermore, bland diet (My mother ate vegetarian food in summer, saying: You doctors should know, in plague years, rich and poor alike cannot avoid infection unless they practice 'clearing the fields and fortifying walls.' Vegetarians alone remain uninfected because their stomachs are clear and empty, preventing pathogen retention. Profound words! I record them carefully.) and abstinence from alcohol and sex are immortal prescriptions for prevention. Wise ones should note this. Physicians adapting this accurately can achieve perfect results. (Referencing Yu Jiayan, Zhang Shiweng, Ye Tianshi, Shen Yaofeng.)"

Shenxi Dan: Wang Mengying annotated: "For Warmth, Summerheat, and Epidemic diseases where pathogens do not resolve quickly, consuming fluids and injuring the Ying level, leading to reverse transmission and internal entrapment, manifesting as spasms, convulsions, coma, delirium, and rashes: if the tongue is dry and glossy, purple-crimson, round and stiff, or has a black coating, use this pill. If early symptoms show irritability, red tongue, and dry mouth, Warmth/Summerheat has directly entered the Ying level. During extreme heat, Yin-deficient individuals and postpartum women suffer this most. Urgent use of this pill can often save them. Do not rigidly count days or mistakenly use other drugs. It also treats severe variola toxins with purple spots, critical conditions, and residual toxicity after smallpox/chickenpox causing oral ulcers, throat rot, red eyes, and restlessness. (Based on Ye's methods, referencing clinical cases.)"

Chen Yunquan suddenly suffered from coma and delirium. Wang Mengying was summoned late at night. Pulse was slippery and rapid; coating was greasy and yellow. This indicated habitual phlegm combined with Summerheat inhalation. One dose of clearing/resolving herbs transformed the condition into malaria, and the pulse stabilized. Some argued his weak constitution precluded cooling herbs and insisted on Renshen. The family was confused, but Wang insisted against it. Summerheat pulses mimic deficiency, and lung obstruction mimics Qi deficiency shortness of breath. When constitution is initially deficient, disease must be removed first. Heat injures Qi; clearing Summerheat protects Original Qi. He Xinzhi agreed. Continuous administration of modified Baihu Tang cured him.

The following spring, grieving his maternal family's death, he contracted Warmth pathogens again. Neglecting proper management, the condition worsened. By the time Wang returned from Yuzhang to diagnose, it was incurable.

Mrs. Li Dechang contracted a cold in mid-summer. Diagnosed as dampness, she received drying agents, causing diarrhea. Suspecting sinking Qi due to age, she switched to Spleen-tonifying methods. This led to rebellious Qi, coma, profuse sweating, and retracted tongue. Funeral arrangements were made before Wang was consulted. Pulse was surging, rapid, and boundless, worse on the right Chi position. Large doses of Xijiao, Shigao, Huangqin (Scutellariae Radix), Huanglian, Huangbai (Phellodendri Cortex), Zhimu, Huafen, Zhizi, Shihu, Zhuye, Lianxin (Nelumbinis Plumula), Yuan Shen, and Shengdi were given. Zi Xue Dan was mixed with cold snow water. Within a day, her tongue protruded, throat and tongue became red and ulcerated, and swallowing water was painful. The three yellows (Huanglian, Huangbai, Huangqin) were removed; Jinyinhua (Lonicerae Japonicae Flos), Shegan (Belamcandae Rhizoma), and Dougen (Phaseoli Semen) were added, and Xilei San was insufflated. After three days, pulse and symptoms harmonized, and thin gruel was tolerated. Sweet-cool mild agents were given. Ten days later, hard black stool was passed, and she recovered.

Hu Renqiu felt slight discomfort during intense heat. A physician used Chaihu (Bupleuri Radix), Gegen (Puerariae Radix), and Xiangru (Moslae Herba) to release the exterior, causing aversion to cold and chest oppression. Another physician used Zhike (Aurantii Fructus), Houpo, and Binglang (Arecae Semen) to purge, worsening the condition. Wang Mengying diagnosed: spontaneous sweating, extremely cold limbs and back, faint breath, and minute, spiritless pulse. He said, "Constitutional deficiency with impending Yang collapse, caused by misdiagnosing an exterior syndrome." He prescribed Niujin Tang (Rescue the Reversed Decoction) plus Renshen and Huangqi (Astragali Radix). Gradual improvement followed. Qi-tonifying and fluid-generating herbs regulated her for a month until recovery.

In the summer of the Renyin year, someone contracted Summerheat-Dampness, mistreated with warming/releasing herbs, leading to delirium, coma, and critical danger. An abscess with foul pus erupted between the anus and scrotum, deep and large. Surgeons diagnosed Xuanyong (Perineal Abscess). External applications failed. Wang diagnosed: "Xuanyong is a chronic wasting condition formed gradually. This acute onset with foul odor indicates internal accumulation of damp-heat toxin from rich foods, combined with external Summerheat, draining downward. Do not apply external meds to block outward expulsion. However, stiff purple-red tongue, fine slippery-rapid pulse indicate excess external pathogen, latent heat, and severe Yin deficiency fearing fluid exhaustion." First, Ying-level clearing agents were given. After three doses, spirit clarified. Then, Yangming-level cooling/moistening agents smoothed bowels, cleared heat, and purified pus. Sweet-moistening nourishing herbs flattened the wound over a month. Convalescence with Renshen and Huangqi restored health.

Jin Xiaogeng had fever for two weeks. Exterior-releasing herbs failed to induce sweat. Warming tonics caused diarrhea and urinary retention, dry mouth, emaciation, and critical danger. Recommended by Hu Renqiu, Wang diagnosed: Right Cun pulse was uniquely deep, rapid, and numbing. "Summerheat-Heat trapped in the Lung Meridian." He prescribed Baihu Tang, Weijing Tang (Euphrasiae Decoction), and Tianshui San (Heavenly Water Powder) plus Fuling, Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), and Beimu. After ingestion, rashes covered the head and face densely, crystal-clear. Everyone feared this. Wang said, "This is Lung pathogen venting." Indeed, skin became moist, fever subsided, diarrhea stopped, and appetite returned. Twenty-plus doses of sweet-cool moistening herbs healed the rashes. A rare case.