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My fourth son was born in the first month of the Ding Si year at our residence in Yanjing (Beijing). By the time of the White Dew solar term, he had just turned two years old. Observing that the new coolness was increasing day by day, I feared that his thin mattress might allow cold pathogenic factors to invade his body. I repeatedly instructed my family members to protect him carefully, but they did not take it seriously. A few days later, he indeed suffered from severe vomiting and diarrhea. I immediately administered herbs for warming the stomach and harmonizing the spleen, but there was no effect. Subsequently, I used a medium dose of Lizhong Tang (Regulate the Middle Decoction), which also failed. Three days later, I added San Qian (Three Mace) of Renshen (Ginseng Radix et Rhizoma), along with Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), Wuzhuyu (Evodiae Fructus, Evodia Fruit), and Neidoukou (Myristicae Semen, Nutmeg), yet still no effect. By the fourth or fifth day, he vomited whatever he breastfed; half was vomited out and half passed as diarrhea, leaving nothing remaining in his abdomen. Desperate, I increased the dosage of Renshen (Ginseng Radix et Rhizoma, Ginseng Root) to five or six qian, and added Zhi Fuzi (Prepared Aconiti Lateralis Radix, Prepared Child Root of Monkshood), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), and Rougui (Cinnamomi Cortex, Cinnamon Bark), each one or two qian. However, as soon as the medicine entered his throat, he vomited it up, retaining not a single drop. The milk he expelled was white, clean, and odorless, appearing unchanged. At this moment, his physical form and vital qi were critically endangered, with absolutely no hope of survival. Holding back tears, I sat quietly in my study, silently pondering the cause. I reasoned that cold invading the stomach caused persistent vomiting and diarrhea; if I abandoned herbs like Renshen (Ginseng Radix et Rhizoma, Ginseng Root), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), and Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood), what other methods remained? My skills seemed exhausted, and I was in an extremely difficult predicament. After much thought, a glimmer of hope arose at midnight. I surmised that his Stomach Qi (Vital Energy of the Stomach) was extremely deficient. If the flavor and aroma of the medicine were slightly incompatible, his Stomach would reject it and expel it. Moreover, Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood) has a salty taste, which can also induce vomiting; this must be the reason. Therefore, I personally evaluated the flavors and aromas, adjusting them to suit his needs. I believed that only a medicine with a sweet and spicy, palatable flavor could stabilize his Stomach Qi and preserve a chance of life. Thus, I took three qian of Hujiao (Piperis Longi Fructus, Long Pepper Fruit), crushed it, added one liang of Wei Jiang (Zingiberis Rhizoma, Roasted Ginger), and decocted it in two bowls of water until reduced to eight-tenths. This was set aside separately. Additionally, I took two liang of Renshen (Ginseng Radix et Rhizoma, Ginseng Root), decocted it in two bowls of water until reduced to one bowl, and set it aside separately. Using these two preparations aimed to utilize their pure and correct sweet and acrid aromas. I then used a tea spoon to mix them, combining ten parts of the Ginseng decoction with one part of the Pepper-Ginger mixture. The resulting flavor was mildly sweet and spicy, perfectly palatable. I kept it warm in hot water and slowly fed it to him spoonful by spoonful, gradually increasing the amount. After about an hour, he swallowed everything without vomiting, and we finally achieved efficacy. From then on, he tolerated both milk and medicine well, although the diarrhea persisted. Starting from the Fourth Watch (11 PM–1 AM), by midday, he had consumed two liang of Renshen (Ginseng Radix et Rhizoma, Ginseng Root). After finishing the Ginseng decoction, he suddenly became restless and moaned in severe pain. His family members complained, arguing that an infant’s delicate organs could not withstand such hot-natured herbs, fearing his intestines were burned. They hugged and cried. Although I suspected something else, I remained calm and thought deeply: If the medicine were truly intolerable, why was he stable during the morning hours, and why did the condition change drastically now? It must be due to several days of fasting; his Stomach Qi had just recovered, but his digestive tract was empty, causing distress from extreme hunger. There was prepared congee nearby. Showing it to them, they eagerly desired it, looking very anxious. I gave them a small cup, which they gulped down greedily, asking for more. I then gave half a bowl, which was still insufficient, so I gave another half bowl. Only then did he lie down quietly. On the next day, after adding Zhi Fuzi (Prepared Aconiti Lateralis Radix, Prepared Child Root of Monkshood), he completely recovered. Alas! The rebirth of this child was undoubtedly influenced by destiny. However, tracing the cause, the internal organs are connected to the back. Thin mattresses and night cold allowed cold to enter through the Back-Shu points (Acupoints on the back), affecting the internal organs deeply. Tracing the treatment, although the direction of medication was correct, if the flavor and aroma were incompatible and could not be absorbed, achieving efficacy would be difficult. When internal hunger triggered restlessness, if I had not intuitively grasped the mechanism, and had recklessly used cooling herbs, all previous efforts would have been wasted, leading to disastrous consequences.

Therefore, I wrote this account to illustrate the severity of the disease, the relevance of herb flavors and aromas, and the importance of flexible clinical adaptation. Nevertheless, this applies specifically to my own son, allowing me the confidence to treat him thus. If it were another person's child with the same condition, when using a few qian of Renshen (Ginseng Radix et Rhizoma, Ginseng Root) yielded no immediate effect, unaware that the medicinal force had not yet reached the disease site, people would likely complain and accuse me of misdiagnosis, switching to bitter-cold herbs, which would inevitably lead to death. They would then blame the use of Renshen (Ginseng Radix et Rhizoma, Ginseng Root). How could right and wrong be distinguished in such cases? Thus, I elaborate further to broaden people's understanding.

The eldest son of Du Zhihui Qian Xuyang was two years old. In late summer, injury from raw fruits damaged his Spleen, leading to diarrhea followed by dysentery. Mr. Qian, being skilled in medicine, knew this was merely an injury from cold and raw foods. He prescribed herbs for warming the Spleen, such as Renshen (Ginseng Radix et Rhizoma, Ginseng Root), Baizhu (Atractylodis Macrocephalae Rhizoma, Large-headed Atractylodes Rhizome), Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), and Rougui (Cinnamomi Cortex, Cinnamon Bark). However, the diarrhea and dysentery did not improve, and ulcers gradually appeared on his lips and mouth. He consulted me, saying, "This child is clearly injured by cold and raw foods. Now that warm herbs are ineffective, what should we do?" I replied, "This is because diarrhea has injured Yin, and the sudden introduction of pungent-spicy herbs has caused deficiency fire to flare upward. Without changing to Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood), the fire cannot return to its source." Two doses were administered, but the lip and mouth ulcers and throat swelling worsened significantly, manifesting on the head and face, and the condition deteriorated. He came to me again, saying, "The medication is so incompatible. Could it truly be dampness transforming into heat?" Upon palpating the pulse, I said, "Both the upper pulse and the lower discharges indicate true heat, but the root belongs to Yang deficiency. The current ineffectiveness of heat-inducing herbs is suspicious, but ultimately, using cold herbs would be fatal without doubt. I suspect the medicinal force has not yet taken full effect." Mr. Qian said, "There is another symptom suggesting true cold: he insists that any soup or drink must be boiling hot. We cannot drink it, but he swallows it calmly despite his swollen and painful throat and mouth. Is this not evidence?" I said, "Exactly, exactly." Consequently, I increased the dosage of Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Child Root of Monkshood) by one qian and five fen, and added Shengjiang (Zingiberis Rhizoma Recens, Fresh Ginger), Rougui (Cinnamomi Cortex, Cinnamon Bark), Roudoukou (Myristicae Semen, Nutmeg), Renshen (Ginseng Radix et Rhizoma, Ginseng Root), and Shudi (Rehmanniae Radix Praeparata, Prepared Rehmannia Root). The diarrhea gradually stopped, and once it ceased, the throat and mouth symptoms resolved completely within a day. Distinguishing between similar and different conditions is so difficult; without firm conviction, there would be no chance of survival. Since experiencing this, I have gradually reached a state of 'no confusion' (Bu Huo). For subsequent children with similar syndromes and treatments, all were preserved. Reflecting on this, where lies the key to this 'no confusion'? It lies in knowing the root of the disease. Clinicians must be cautious!