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Red macules belong to the blood level, while white papules (white vesicles appearing on the skin) belong to the qi level. When both qi and blood are diseased, white papules and red macules occur concurrently. If they erupt, the disease should resolve, and the spirit must become clear. However, in this case, although both white papules and red macules have erupted, the spirit is instead lethargic, body heat persists, respiration is short, accompanied by a retracted tongue with a red body, thin grey coating, spontaneous sweating over the whole body, coldness in the lower legs and calves, and even trembling of the lower lip and spasms of the hands. Yesterday there was excessive laughter, involuntary urination; originally there was coughing, but now silence prevails; water is swallowed when given, but not craved when not offered. The pulse at the right cun position is slippery and rapid, the guan position is soggy and soft, while the left hand pulses are all fine and small, vague upon pressure. It is presumed that external wind pathogen triggered latent pathogens, which were then obstructed by damp-phlegm, injuring the yuan qi, allowing the pathogen to enter the Jueyin meridians of the foot and hand. The condition is critical and prone to gradual collapse; as the pathogen exits via sweat, the yuan qi also dissipates with it. At this moment of intense conflict between pathogen and healthy qi, medication is particularly difficult. Reluctantly adopting the principle for deficiency and emaciation with shortness of breath, the aim is to hope that the pathogen is eliminated without the yuan qi perishing with it; this is currently the primary priority.

Zhu Ye (Bamboo Leaf), Shi Gao (Gypsum Fibrosum), Ren Shen (Ginseng Radix et Rhizoma), Mai Dong (Ophiopogonis Tuber), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Chao Gu Ya (Stellariae Fructus Stir-fried), Sheng Di Huang (Rehmanniae Radix), Hua Fen (Trichosanthis Radix), Yuan Zhi (Polygalae Radix), Fu Ling (Poria), Gou Teng (Uncariae Ramulus cum Uncis), Niu Xi (Achyranthis Bidentatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Xi Jiao (Rhino Ceratosis).

Pain in the epigastrium directly behind the heart, followed by aversion to cold and fever resembling malaria, and even frequent hiccups. This is due to warm pathogen external contraction, turbid pathogen internal retention, compounded by the knotting of damp-phlegm and food stagnation in the middle jiao. Now, if the yang qi of the middle jiao is strengthened internally, the contracted pathogen can be easily transformed and expelled. However, the yuan qi here is originally deficient, and subsequent injury by various pathogens leaves no strength to eliminate them, prolonging the illness for many days. Thus, the pulse is empty and wiry, the expression is fatigued, indicating a time when tonification is imperative. Yet, the tongue coating is white and greasy, dryness desires hot drinks, and numbness precedes in the lower body. Now, more numbness, hiccups, nausea, and vomiting occur; the pathogen lingers in the lung and stomach, while kidney qi also declines, making medication extremely difficult to balance. Nevertheless, by warming and nourishing the middle jiao, assisted by agents regulating the upper and lower, three benefits may be achieved simultaneously, hoping for recovery soon; otherwise, breathing may become asthmatic, and likely sweating on the forehead will increase. Submitted for the correction of distinguished gentlemen.

Ren Shen (Ginseng Radix et Rhizoma), Yu Zhu (Atractylodis Macrocephalae Rhizoma), Chuan Fu Zi (Aconiti Lateralis Radix Praeparata), Gan Jiang (Zingiberis Rhizoma), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata), Fu Pen Zi (Rubi Cauliflorii Fructus), Ban Xia (Pinelliae Rhizoma), Hou Po (Magnoliae Officinalis Cortex), Ding Xiang (Caryophylli Flos), Mai Dong (Ophiopogonis Tuber), Huo Xiang (Pogostemonis Herba), Mu Gua (Chaenomelis Fructus), Zhe Shi (Hematitum), Mao Gen (Imperatae Rhizoma), Pi Pa Ye (Loquats Leaf).