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Zu Sao (Clan sister-in-law) Wang Shi experienced chills and fever, headache, generalized body pain, eyeball pain, lower abdominal pain, tenesmus (urgency with little passage), passing of red and white purulent blood more than thirty times a day, and thirst. This was malaria and dysentery occurring simultaneously. She was prescribed Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Qing Hao (Artemisiae Annuae Herba), Zhi Ke (Aurantii Fructus), Jiu Huang Qin (Scutellariae Radix prepared with wine), Jiu Lian Lian (Coptidis Rhizoma prepared with wine), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Gui Zhi (Cinnamomi Ramulus), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma) decocted in water for oral administration, along with Shen Shou Xiang Lian Wan (Divine Bestowal Fragrant Coptis Pill) applied externally. That night, the dysentery decreased by nine-tenths, but generalized body pain persisted, with slight aversion to cold, no fever, and only slight dizziness. The prescription was changed to Chuan Xiong, Chuan Dang Gui (Angelicae Sinensis Radix from Sichuan), Bai Shao, Mu Xiang (Aucklandiae Radix), Gui Pi (Cinnamomi Cortex), Chen Pi (Citri Reticulatae Pericarpium), Jiu Lian Lian, and Jiu Huang Qin, which regulated her condition for three days until she fully recovered.

Zhong's nephew grandson went to the prefectural city for the imperial examination. Due to overeating beef noodles and hard labor, he developed malaria. Physicians in the city treated him for half a month, causing his form and spirit to become emaciated. Although the malaria subsided, his abdomen became distended like a winnowing basket. Huang Furen (Lady Huang) of Jiansuo was Zhong's secret mother-in-law. Famous physicians were successively invited, all attributing the post-malaria abdominal distension to the presence of "Mamo" (malaria mass). Various medicines for dissipating masses proved ineffective. Then, Wupi Yin (Five-Bark Decoction) was used to promote diuresis without effect. An attack-based purgative method was being considered when I arrived. Observing his sallow complexion, thirst, scanty and difficult urination, unbearable abdominal distension, swelling below the knees preventing walking, leg swelling extending to the scrotum, qi stagnation preventing lying flat, minimal food intake, and a pulse rate of only four beats per cycle, large but not firm, I said: This is a syndrome of middle-fullness due to true qi deficiency. The treatment should warm and tonify the lower origin while regulating the spleen; the disease can still be cured. Purgation would be fatal. His father had a deep bond with me, and as he now holds office in Henan, how could I not take responsibility? However, the formula used by friends from Xi County contained Zao Jia (Gleditsiae Sinensis Fructus), Bing Lang (Arecae Semen), San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Jiang Huang (Curcumae Longae Rhizoma), Ting Li Zi (Lepidii Semen), Mu Tong (Akebiae Caulis), Zhi Shi (Aurantii Fructus Immaturus), Chen Pi, Hou Po (Magnoliae Officinalis Cortex), Shan Zhi (Gardeniae Fructus), Da Huang (Rhei Radix et Rhizoma), Qian Niu (Pharbitidis Semen), and Huang Lian (Coptidis Rhizoma)—all substances powerful enough to break down pathogens. Seeing these shocked me. Since I could not refuse the physician recommended by Lady Huang, I was hesitating when fortunately, his uncle, Mr. Xiting, understood my intentions. They dismissed the Xi doctor and entrusted the case entirely to me. I immediately prescribed Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 3 qian, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 5 fen, Da Fu Zi (Aconiti Lateralis Radix Praeparata), Pao Gan Jiang (Zingiberis Rhizoma Praeparatum), and Gui Xin (Cinnamomi Ramulus medullary part) each 1 qian, Po Gu Zhi (Psoraleae Fructus) 2 qian, Sang Bai Pi (Mori Cortex), Sha Ren (Amomi Fructus Rotundus), Fu Ling (Poria), and Ze Xie (Alismatis Rhizoma) each 8 fen, decocted in water for drinking. That night, urination improved slightly, and panting eased. After five days of continuous administration, the abdomen relaxed somewhat, and the skin wrinkled. However, after eating pig stomach and large dates, the distension returned. The previous formula's Ren Shen and Bai Zhu were increased to 5 qian each, plus Chen Pi 8 fen. After another twenty doses, the abdominal distension reduced by more than half, allowing him to lie on his pillow and walk again. The prescription was changed to Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) added with Po Gu Zhi and Rou Gui (Cinnamomi Cortex) for convalescence, leading to stability. Mr. Xiting asked: With such severe abdominal distension, such intense thirst, and such scanty, difficult urination, everyone considered it heat and excess. Why did you achieve success with warming and tonifying? I replied: Have you not seen that ancients named this middle-fullness due to qi deficiency as "Gu Zhang" (Drum Distension)? It is precisely because of qi deficiency that middle-fullness forms; if qi were not deficient, where would middle-fullness come from? Moreover, in drum distension, the outer skin is tight and hard while the inside is empty. If purged further, the true yuan (original essence) will collapse, and life cannot be restored. Therefore, only tonification is possible. Thirst and scanty urine are both caused by weak yuan qi failing to circulate. Clear qi fails to ascend, causing thirst; turbid qi fails to descend, causing absence of urine. This is the state of "Pi" (Stagnation/Obstruction) where heaven and earth do not interact. By specifically tonifying the lower origin, we enrich water and fire, allow yang qi to ascend, turbid qi to descend, and middle qi to move, thereby curing all diseases.