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Xia Yuzhu said: Predecessors stated that illness acquired through activity is "Zhongre" (Heatstroke due to exertion), while illness acquired through stillness is "Zhongshu" (Summerheat stroke due to rest). This statement is very correct. However, the clinical manifestations of Zhongshu and Zhongre are indistinguishable; both Zhongshu and Zhongre present with thirst. Both Zhongre and Zhongshu patients may speak deliriously. If one does not carefully examine the patient's complexion and physical appearance, knowing merely whether it was caused by movement or stillness is of what benefit? For instance, when a Zhongshu patient speaks deliriously, their voice is low and flat; whereas a Zhongre patient speaks deliriously with a frantic and robust tone. Yet, this alone may still fail to reveal the truth. One need only inspect the mouth: if the tongue color is pale white, the lips lack blood color, and the breath is weak and cold, it is Zhongshu. It is appropriate to use Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), which will bring about an immediate cure. If the lips and tongue are both red, the exhaled breath feels like fire, and urination is dark and scanty/difficult, it is definitely Heart Meridian Zhongre. It is appropriate to decoct Tongcao (Akebiae Caulis) and Bohe (Menthae Haplocalycis Herba) in water, then mix in one cup of water prepared by grinding Jiaojiao (Rhinocerotis Cornu) and half a cup of water prepared by Lingyangjiao (Saigae Tataricae Cornu), and administer together with the decoction to resolve the condition.

In the year Ji Hai, my uncle's grandson, aged four, fell ill. Initially, my uncle had been at odds with my father for a long time. My aunt asked me to go treat him, but the whole household obstructed me, fearing and saying, "If his grandson dies, the disaster will be severe." I said, "I have eyes to see; there is no need for excessive worry." Upon examination, the child's breath was faint, complexion extremely pale, lips and tongue pale white, and he was speaking nonsensical words. I identified it as Zhongshu. I administered Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), and he recovered after one dose.

Fang Shaowen, a county scholar from Chuanshan, had only one son, who was my son-in-law. At seventeen years old, he fell ill. Because I specialized only in pediatrics, they invited two internal medicine physicians to treat him jointly. Seeing the patient speaking deliriously, those physicians treated it as a heat syndrome. They used copious amounts of cooling agents such as Jiaojiao (Rhinocerotis Cornu), Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), and Shigao (Gypsum Fibrosum). The illness worsened significantly. They urgently notified me. Upon visiting, I found the patient lying stiffly like a corpse, with cold breath, and white lips and tongue. This was a symptom of Zhongshu, yet it was mistakenly diagnosed as Zhongre, which is truly strange. I used Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), and he recovered immediately after one dose. This serves as proof that internal medicine physicians relying on pulse diagnosis are not as effective as pediatricians relying on observing complexion and distinguishing orifices.

There are six types of night crying.

First, the face is deep red with many tears; crying ceases slightly without light, but intensifies upon seeing light. This is due to Heart Heat. When encountering fire, the interaction of two Yangs causes intensified crying upon seeing light. The signs include heat in the hands, abdomen, and feet, and dark urine. Tuina techniques should include Water Bottom Moon Retrieval (Shuidi Laoyue), Drawing Water Up to Heavenly River (Yinshui Shang Tianhe), Clearing the Six Fu Organs (Tui Xia Liufu), and Moving Eight Trigrams (Yun Bagua), pushing Kan into Gen. Medicinally, use Daochi San (Guide Out Red Powder) plus Zhiren (Gardeniae Semen), Bohe (Menthae Haplocalycis Herba), and Tianma (Gastrodiae Rhizoma).

Second, there is much crying and little sleep, which stops at dawn. The complexion is greenish-white, and stools are also greenish-white. Treatment should warm the Lower Jiao (Lower Burner). Use Beijifang (Emergency Formula).

Third, fright caused by foreign objects. The eyes gaze at something, the mouth cannot speak, but the child is startled and palpitations occur during sleep, crying loudly while holding the mother. The complexion is purple-black. Treatment should use Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), Fushen (Poria cum Ramo Pini), Yuanzhi (Polygalae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma).

Fourth, crying due to deficiency of both Spleen and Stomach, accompanied by vomiting, diarrhea, and poor appetite. Treatment should use Liujunzi Tang (Six Gentlemen Decoction) plus Paojiang (Zingiberis Rhizoma Preparatum) and Muxiang (Aucklandiae Radix).

Fifth, crying due to insufficiency of Heart Blood. The signs include sudden palpitations during deep sleep, pale white tongue, and a complexion that is not notably abnormal (or pale). It is appropriate to use Anshen Tang (Calm Spirit Decoction).

Sixth, crying due to Cold Viscera and intestinal pain. Crying ceases when the abdomen is pressed with hand, but resumes when the hand is removed. The signs include a greenish face, cold hands, and refusal to suckle milk. Treatment uses Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), and Juapi (Citri Reticulatae Pericarpium), taken in equal parts.

Night crying outside these categories is certainly not a disease. It may be that the child has become accustomed to playing with lights upon waking at night, thus crying when there is no light. Or it may be crying because the wet nurse lacks milk.