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Wen Gui, who was skilled in composing literary works for his clan, was a relative of Qiyuan (Sun Yikui) moving between his maternal and paternal households. He resided in an inn in Changxing. He suffered from fever that persisted day and night, accompanied by thirst, dry teeth, dry nose, thick yellow tongue coating, and insomnia. Medication proved ineffective. I happened to arrive at Zhicheng, and Qiyuan invited me to diagnose him. The pulse was uniformly surging (Hong) and rapid (Shu), with vomiting and nausea, chest and diaphragm fullness and oppression, scanty dark red urine, and the passage of only clear water in the stool. I prescribed Shigao (Gypsum Fibrosum) 7 qian, Zhimu (Anemarrhenae Rhizoma) 5 qian, Gancao (Licorice Root) 1 qian, Ruan Chaihu (Bupleuri Radix) 5 qian, Gegen (Puerariae Lobatae Radix) 3 qian, Huangqin (Scutellariae Radix) 2 qian, Zhike (Aurantii Fructus Immaturus), Zhuru (Bambusae Caulis in Taenia), and Jiegeng (Platycodonis Radix) each 1 qian. After taking three doses consecutively, the vomiting and nausea ceased, and the chest and diaphragm felt relaxed, but the fever remained unsubsided, there was no sweat, and diarrhea continued.

Someone asked me why I did not use Chailing Tang (Bupleurum and Pinellia Decoction) to reduce fever and stop diarrhea, suggesting that the Gypsum had exacerbated the diarrhea. I jokingly replied, "Am I an incompetent doctor ('three-legged cat')? How could I recognize this as a syndrome suitable for Chailing Tang?" I retained Chaihu (Bupleuri Radix) and Shigao (Gypsum Fibrosum) each at 7 qian as the sovereign drugs (Jun), Gegen (Puerariae Lobatae Radix) and Zhimu (Anemarrhenae Rhizoma) each at 5 qian as the minister drugs (Chen), Huangqin (Scutellariae Radix) and Gancao (Licorice Root) each at 1 qian as the assistant drugs (Zuo), along with five slices of Shengjiang (Zingiberis Rhizoma Recens). Administered quickly over two doses, profuse sweating ensued, the fever subsided, diarrhea stopped, thirst ceased, and sleep returned.

Due to other engagements, I left three additional doses and instructed him: "Your Stomach Qi has just recovered; you will naturally desire food. Be cautious and do not overeat. If you eat too much, residual heat may recur, leading to 'food relapse' (Shi Fu), making treatment difficult. Be very careful!" Five days later, indeed, he fell ill again due to dietary indiscretion. Upon my return, the fever was more severe than before, accompanied by deep restlessness (Ao Nu), delirium at night resembling seeing ghosts, extreme thirst, dry teeth, and a scorched black tongue coating with prickles, indicating a critical condition. I used the previous formula adding Zhishi (Aurantii Fructus) and Zhizi (Gardeniae Fructus) each 3 qian, and Danshidou (Sojae Semen Praeparatum) 2 qian. After two doses, the restlessness ceased, but other symptoms persisted, worsening at night. I removed Danshidou from the formula and added Huanglian (Coptidis Rhizoma), Maidong (Ophiopogonis Radix), Shengdi (Rehmanniae Radix), and Baishao (Paeoniae Radix Alba). Two doses were taken per day. The black tongue coating was scraped off using ginger soaked in well water, and Xuanmingfen (Natrii Sulfas Depuratus) mixed with honey was applied to the tongue to remove the coating. After three days of medication, slight sweating occurred, all symptoms significantly diminished. I repeatedly advised strict dietary control, and after half a month of regulation, he fully recovered.

Qiyuan asked: "People initially believed this syndrome was 'Leak-bottom Shanghan' (Taiyang disease with diarrhea). They argued that your refusal to use Chailing Tang to reduce fever and stop diarrhea, and your use of Gypsum, was incorrect. Yet, Gypsum ultimately achieved the cure. Why?" I said: "This is an excellent question. Medicine values accurate syndrome differentiation. This case is a combined disease of Shaoyang (Lesser Yang) and Yangming (Greater Yang). Chaihu (Bupleuri Radix), Baihu Tang (White Tiger Decoction), and Gegen (Puerariae Lobatae Radix) are specific remedies for these two meridians. Taking them can resolve muscle-layer heat and stop thirst. Chailing Tang is indicated for combined Taiyang-Shaoyang disease. It contains Wuling San (Five-Ingredient Powder with Poria), which treats interior syndromes of the Taiyang meridian. Since this is not a Taiyang syndrome, how dare I use it? Moreover, it contains Ren Shen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Rougui (Cinnamomi Cortex), all of which are hot and drying in nature. Misuse would certainly cause macules/rashes. Given the dry teeth and scorched black tongue, how could I dare use Fuling (Poria), Zexie (Alismatis Rhizoma), and Zhuling (Polyporus) to promote urination, thereby further depleting body fluids? Ancients stated: 'Consider Shanghan a major disease; if one misjudges the syndrome and prescribes wrongly, life and death are immediately decided.' The *Shanghan Lun* states: 'Do not induce sweating, do not purge, do not promote urination'; this is called the 'Three Prohibitions.' Thus, it is said: 'Shaoyang and Yangming diseases, not following the root or branch, follow the middle treatment method.' Xiao Chaihu Tang (Minor Bupleurum Decoction) and Baihu Tang (White Tiger Decoction) are middle-treatment formulas. People only see diarrhea and call it 'leak-bottom,' failing to observe that the discharge is clear water without undigested food residue, which is caused by extreme heat. This syndrome is actually Spring-Warmth seasonal epidemic. By using dispersing methods to raise clear Qi and induce slight sweating, the diarrhea should stop naturally. Could such diarrhea be stopped by Wuling San? Forcing its cessation would be detrimental.

Qiyuan asked: "Why are symptoms worse at night, resembling seeing ghosts?" I said: "This is because heat has entered the Blood Chamber (Xue Shi)." Qiyuan asked: "Do men also have a Blood Chamber?" I said: "Both men and women have a Blood Chamber. The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) are the sea of blood. These two vessels attach to the Yangming meridian. In this case, Yangming heat has transmitted into the Sea of Blood. Therefore, adding Shengdi (Rehmanniae Radix) and Baishao (Paeoniae Radix Alba) was effective. In my treatment of Shanghan, when fever persists despite using Chaige Jieji Tang (Bupleurum and Pueraria Decoction to Resolve the Muscle Layer) or Chaihu Baihu Tang (Bupleurum and White Tiger Decoction), adding these two herbs ensures the fever subsides and sweat emerges. Furthermore, afternoon and night are governed by the Yin aspect. To resolve heat in the Sea of Blood, these two herbs must be used to achieve success. This is my humble insight." Qiyuan said: "Excellent. I wish to record this to instruct future practitioners."