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After the treatment of purgation for warm epidemic, if the pulse becomes deep and the indications for purgation remain, another purgative measure should be taken. If after purgation the pulse becomes floating, according to the method, it should be resolved through sweating; however, if after three or five days there is still no sweat, it is because the patient's body fluids have been previously depleted.

In seasonal epidemics, if indications for purgation are present for a long time without being treated with purgatives, daily diarrhea of pure foul-smelling water occurs, ten or more times day and night, leading to dry mouth and lips, and a tongue cracked as if severed. The physician mistakenly applied Zhang Zhongjing's method for "diarrhea with accompanying heat" (exterior syndrome unresolved with interior heat diarrhea) and prescribed Gegen Huangqin Huanglian Tang (Kudzu, Coptis, Scutellaria Decoction). After taking it, the condition worsened. Upon invitation to examine, I identified this as "heat accumulation with paralogous flow" (dry stool impaction forcing fluid to leak out), urgently prescribing Dachengqi Tang (Major Order the Qi Decoction) once. A large amount of accumulated feces was expelled, resembling fermented bean paste in color and glue-like in consistency, with an exceptionally foul odor. The diarrhea stopped abruptly that evening. The next day, one dose of Qingzao Tang (Clear Dryness Decoction) was administered. The pulse remained deep; upon further purgation, the pulse became floating, the interior excess symptoms decreased, and only slight fever remained on the muscle surface. This indicates a stage where sweating should resolve the pathogen. Although sweating could not occur immediately, due to dietary intake over half a month, body fluids gradually returned, allowing sweat to appear. This is what is meant by "when water accumulates sufficiently, the channel naturally flows." Thus, it can be seen that floating pulse and body heat cannot be resolved without sweating; blood dryness and fluid depletion cannot produce sweat without replenishing fluids. Ancients stated "those who lose blood cannot sweat," while I propose "those who lose fluids cannot sweat." Although blood and fluids differ in name, their state of dryness and the resulting pathology are identical.

The syndrome originally required purgation, but due to delay and missed treatment, or obstruction by mild medications, fire pathogens became congested and closed off, consuming qi and contending with blood. Spiritual energy was nearly exhausted, leaving only evil fire remaining. This led to symptoms such as grasping at clothes (clutching bedclothes involuntarily) and picking at empty air (fingers moving as if tracing lines), muscle twitching, and persistent limb heat. The primordial spirit was about to scatter. If tonification is used, evil toxins will intensify; if attack (purgation) is used, the faint qi cannot withstand the assault. Neither attack nor tonification is feasible; both approaches fail, leaving no hope. Reluctantly, Taoshi's Huanglong Tang (Yellow Dragon Decoction) was used. In this condition, purgation leads to death, and non-purgation also leads to death. Rather than sitting and waiting for death, it is better to die holding medicine, perhaps with a one-in-ten-thousand chance of survival.

[Formula] Huanglong Tang (Yellow Dragon Decoction)
Dahuang (Rhei Radix et Rhizoma), Nongpu (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Mangxiao (Natrii Sulfas), Renshen (Ginseng Radix et Rhizoma), Dihuang (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix).
Decoct and take as usual.

[Commentary] The previous condition was indeed caused by the delay of incompetent physicians. By the time medication was administered, the effects of tonifying deficiency and draining excess were insufficient. However, in cases of severe deficiency, if not tonified, how can deficiency recover? In cases of severe excess, if not drained, how can evil depart? Reluctantly, Renshen and Dihuang are used to restore deficiency, and Chengqi formulas are used to drive out excess. This is the method of combining tonification and purgation. If encountering such conditions, using only Chengqi Tang may slightly reduce excess symptoms and briefly restore mental clarity, but subsequently, tremors of the limbs, palpitations, fear as if being hunted, cold extremities, dizziness, vertigo, stiffness of the neck and back, along with previous symptoms of grasping at clothes and picking at empty air, will appear. These are all signs of severe deficiency and critical conditions. Urgently, Renshen Yangying Tang (Ginseng Nourishing Ying Decoction) should be used. Once deficiency signs recede slightly, danger can be quickly dispelled. Since both Shanghan (Cold Damage) and Wenyi (Warm Epidemic) involve external pathogens manifesting as fire-heat and dryness syndromes, although Renshen is a divine substance for benefiting primordial qi, it tends to benefit yang and has the drawback of aiding fire and retaining evil. Under these circumstances, it is not an ideal choice, yet it is used reluctantly.

[Formula] Renshen Yangying Tang (Ginseng Nourishing Ying Decoction)
Renshen (8 fen), Maidong (Ophiopogonis Tuber, 7 fen), Liaowuweizi (Schisandrae Chinensis Fructus, 1 qian), Dihuang (5 fen), Guishen (Angelicae Sinensis Radix, 8 fen), Baishao (Paeoniae Radix Alba, 1.5 qian), Zhimu (Anemarrhenae Rhizoma, 7 fen), Chenpi (Citri Reticulatae Pericarpium, 6 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen).
Decoct and take as usual.

If a person falls ill shortly after eating meat, causing food stagnation in the stomach, even continuous use of Dachengqi Tang or Xiaochengqi Tang will only result in the expulsion of foul water and loose stools. However, adding just one ingredient, Renshen, to Chengqi Tang allows for the expulsion of undigested grains and meat retained for thirty or forty days. This is because Chengqi Tang relies on the power of Renshen to stimulate stomach qi, enabling the movement of accumulated matter.