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[Commentary] In the initial stage of exogenous diseases, if patients present with high fever, anhidrosis (absence of sweating), sticky phlegm, and a yellow tongue coating, their condition is vastly different in severity from minor illnesses such as wind-cold common cold. If treated with light, clear, aromatic, and bland formulas such as Sanren Tang (Three Seeds Decoction) or Yinqiao San (Honeysuckle and Forsythia Powder), it is often impossible to effectively intercept and reverse the disease progression. This is based on Wu Jutong's experience, hence described as a "difficult-to-treat syndrome." However, due to his excessive reverence for Ye Tianshi's theories, despite knowing that such treatment might not be effective, he still used these prescriptions, acting as if there were no other methods. Consequently, the condition worsened day by day, which was entirely predictable. In fact, there are many TCM treatment methods. If this diagnosis had not been bound by the concept of "only clearing heat after it reaches the Qi level," and if herbs such as Commelina communis (Yazhucao), Houttuynia cordata (Yuxingcao), Scutellaria baicalensis (Huangqin), Fructus Trichosanthis (Gualouren), and Flos Mori (Sangpian) had been added early to acrid-dispersing herbs, actively controlling pulmonary inflammation and effectively intercepting and reversing the disease progression would have been possible.

On the 18th day, after two administrations of treatments clearing the Upper Jiao, the heat had decreased significantly. Heat in the palms more severe than in the dorsum of the hands indicates Interior Heat; a red-yellow and thick tongue coating indicates Excess Heat. It is appropriate to ventilate and unblock using the Bitter-Acrid-Cold method. Note: Summerheat must carry Dampness. Pain and distension upon abdominal palpation necessitate the temporary use of bitter-drying herbs. Almond paste 3 qian, genuine Coptis chinensis (stir-fried with ginger juice until yellow) 1.5 qian, Aquilaria sinensis (Guangmuxiang) 1 qian, Scorched Scutellaria baicalensis (Huangqin tan) 1 qian, Magnolia officinalis (Houpo) 1.5 qian, stir-fried black Foeniculum vulgare (Xiaohuixiang) 1.5 qian, whole Trichosanthes kirilowii (including peel and seed) 0.8 qian, stir-fried Anemarrhena asphodeloides (Zhimu) 1.5 qian, small Immature Bitter Orange (Zhishi, crushed) 1.5 qian, Areca seed (Binglang) 0.8 qian, scorched dried tangerine peel (Guangpi tan) 1 qian. Decoct in water to yield two cups, divide into two doses.

[Analysis] The pathogenic heat has moved from the Exterior to the Interior. Therefore, in the third consultation, Wei-level herbs such as Lonicera japonica (Yinhua), Forsythia suspensa (Lianqiao), Morus alba leaf (Sangye), and Mentha haplocalyx (Bohe) were removed, and Qi-level herbs such as Scutellaria baicalensis (Huangqin), Coptis chinensis (Huanglian), Thunberg fritillary bulb (Tongcao), and Anemarrhena asphodeloides (Zhimu) were adopted. Regarding abdominal distension and pain, Wu Jutong consistently attributed them to Dampness obstructing the Foot-Taiyin Spleen meridian, leading to Qi mechanism dysfunction. Given that previous attempts with damp-resolving and Qi-regulating herbs like Magnolia officinalis (Houpo) and Polyporus (Fuling) failed, he re-added numerous warm-drying Qi-regulating herbs such as Foeniculum vulgare (Huixiang), Aquilaria sinensis (Muxiang), Immature Bitter Orange (Zhishi), Areca seed (Binglang), and scorched dried tangerine peel (Guangpi tan). Analyzing the medication before and after in conjunction with the text from *Wenbing Tiaobian* ("Summerheat combines with Damp-Heat; those leaning towards summerheat heat are Summerheat-Warmth, mostly involving Hand-Taiyin Lung patterns suitable for clearing; those leaning towards summerheat dampness are Damp-Warmth, mostly involving Foot-Taiyin Spleen patterns suitable for warming"), it can be concluded: The second consultation focused mainly on lightly venting stagnant heat, targeting the Hand-Taiyin Lung meridian. Although the third consultation used bitter-cold herbs like Huangqin and Huanglian, combined with a large amount of warm-drying herbs, the primary goal was drying dampness and regulating Qi. Thus, the therapeutic focus shifted from the Hand meridians to the Foot meridians. Therefore, while the first two consultations focused on the Upper Jiao, the third consultation focused on the Middle Jiao.

[Commentary] This case involves respiratory system diseases, comparable to pneumonia. The Lung and Large Intestine are exterior-interior related; it is common for pneumonia with high fever to be accompanied by intestinal dryness and constipation. Wu Jutong's prescription Xuanbai Chengqi Tang is quite suitable for such patterns. However, during the third consultation, influenced by the theory that "summerheat must carry dampness," he misinterpreted abdominal pain and distension caused by heat scorching fluids and dry feces in the intestines as being due to dampness obstructing Qi. Consequently, he did not consider using Xuanbai Chengqi Tang. By mistaking dry feces for dampness obstruction, the emphasis on drying dampness and regulating Qi outweighed clearing heat. Under conditions of blazing excess heat, this approach inevitably accelerated the process of the disease transforming into dryness. Hence, the next day, the tongue coating became dry, yellow, and black, fully revealing signs of fluid injury.

On the 19th day, abdominal pain and distension subsided, but the tongue coating was dry, yellow, and black, and the tongue body was crimson. Cough was paroxysmal with sticky phlegm. Since children's Yin energy is not yet firm, treatment should aim to preserve Yin and reduce fever.

Ophiopogon japonicus (Maodong, without heart) 6 qian, calcined Gypsum Fibrosum (Duanshigao) 4 qian, Moutan Cortex (Danpi) 5 qian, Glehnia littoralis (Shashen) 3 qian, Rehmannia glutinosa var. profunda (Xi Shengdi) 4 qian, Semen Pruni Armeniacae (Xingren) 3 qian, Scrophularia ningpoensis (Yuanshen) 5 qian, stir-fried Anemarrhena asphodeloides (Zhimu) 2 qian, Gekko powder (Gafen) 3 qian, Rhinoceros Horn (Xijiao) 2 qian, raw Glycyrrhiza uralensis (Sheng Gancao) 1 qian. Decoct in water to yield three cups, divide into three doses.

[Analysis] The pathology progressed from the Wei (Defensive) level to the Qi level, continuing towards the Ying (Nutritive) and Xue (Blood) levels. Yin fluids were rapidly depleted by pathogenic heat, resulting in a crimson tongue and dry coating. In view of this, the treatment strategy underwent a complete reversal, shifting from primarily leaching out dampness with aromatic-drying herbs to sweet-cold moistening herbs. This marked a significant turning point in the treatment of this case. Analyzing the fourth consultation's prescription, it appears to be a modification combining Huaban Tang, Zengye Tang, and Xijiao Dihuang Tang. The purpose was to preserve Yin, reduce fever, and nourish Yin to counter Yang. Due to paroxysmal cough and sticky phlegm, Glehnia littoralis (Shashen), Gekko powder (Gafen), and Semen Pruni Armeniacae (Xingren) were added to facilitate resolving phlegm and stopping cough.

[Commentary] At the onset, Yin fluids were not significantly damaged. The acceleration of fluid depletion was due to ineffective heat-clearing and repeated use of leaching and bitter-drying herbs. Blaming the child's immature Yin energy is factually incorrect. When heat is actively depleting Yin, one must urgently clear the heat that depletes Yin. Prioritizing Yin-nourishing over heat-clearing puts the cart before the horse. The heat-clearing efficacy of Huaban Tang relies on Gypsum Fibrosum (Shigao) and Anemarrhena asphodeloides (Zhimu); however, their dosages here were less than half of the original formula, and calcined gypsum was used instead of raw gypsum, both of which are inappropriate. Furthermore, Rhinoceros Horn (Xijiao) is expensive and "can dissipate Qi and Blood," making its use unnecessary for this pattern.

On the 20th day, fluids slightly recovered, tidal fever persisted. Because old feces remained, night sweats occurred as pathogens returned to the exterior. The right pulse remained floating and large; purgatives were contraindicated. The priority was to preserve fluids and protect the lungs from fire insulting Metal (cough).

Rehmannia glutinosa var. profunda (Xi Shengdi) 6 qian, Scrophularia ningpoensis (Yuanshen) 6 qian, Dendrobium nobile (Huoshihu) 3 qian, stir-fried Paeonia lactiflora (Jiao Baishao) 4 qian, Ophiopogon japonicus (Maodong) 6 qian, Platycodon grandiflorus (Baiziren/Baizi shuang - note: text says Baizi shuang, usually Semen Platycodi or Biota, here likely Biota seed paste) 3 qian, calcined Gypsum Fibrosum (Duanshigao) 3 qian, Ostrea concha (Muli fen) 1.5 qian, Semen Pruni Armeniacae paste (Xingren ni) 2 qian, Rhinoceros Horn (Xijiao) 1 qian. Decoct in water to yield three cups, administer continuously.

[Analysis] Mentioning old feces indicates attention to dry stool. For warm diseases where heat transforms into dryness, Wu Jutong "prohibits even bitter-cold herbs." He stated: "The world only knows that bitterness reduces fire and cold clears heat, using them confidently without doubt, unaware that bitterness enters the Heart first and transforms into dryness; if ineffective, it becomes drier." "I have seen many cases of warm disease where reckless use of bitter-cold herbs led to dry exhaustion of fluids and death." Having previously used many leaching and bitter-drying herbs, and now seeing obvious fluid injury, the medication at this stage was very cautious. Guided by the concepts that "adding water allows the boat to float" and "nourishing Yin counters Yang," bitter-cold herbs like Anemarrhena asphodeloides (Zhimu) and Moutan Cortex (Danpi) were removed, and moistening herbs like Dendrobium nobile (Shihu) and Paeonia lactiflora (Baishao) were added to avoid "bitterness transforming into dryness" and enhance Yin-nourishing and fluid-generating effects. As for Glycyrrhiza uralensis (Gancao), it is unsuitable when "Yin is deficient and excess pathogens are strong." With a floating-large right pulse indicating strong pathogenic heat, it was removed. Ostrea concha (Muli) was added because it nourishes Yin and clears heat.

[Commentary] This case initially presented Wei-Qi symptoms, then Ying-Xue symptoms; initially Upper Jiao symptoms, then Lower Jiao symptoms. The condition clearly worsened progressively. Yet the case notes claim: "Clearing Upper Jiao reduced heat by half," "temporarily using bitter-drying herbs resolved abdominal pain and distension," "switching to preserving Yin slightly restored fluids," and "nourishing Yin and protecting lungs resolved all symptoms." It seems every consultation was effective. Such embellishment lacks honesty in medical record writing. During the fifth consultation, pathogenic heat was still intense; clearing fire could preserve Yin. Removing Anemarrhena asphodeloides (Zhimu) and Moutan Cortex (Danpi), and avoiding Scutellaria baicalensis (Huangqin) and Coptis chinensis (Huanglian), reflects excessive caution, possibly influenced by Ye Tianshi's saying that "when heat enters the Ying level, Qi-level herbs should be withdrawn."

On the 21st day, all symptoms resolved, with slight tidal fever. The tongue was crimson with a black coating, indicating lingering heat deep in the Blood level. Use Yin-nourishing method.

Glehnia littoralis (Shashen) 3 qian, large Rehmannia glutinosa (Da Shengdi) 5 qian, Ostrea concha (Muli) 3 qian, Ophiopogon japonicus (Maodong, without heart) 6 qian, stir-fried Paeonia lactiflora (Jiao Baishao) 4 qian, Moutan Cortex (Danpi) 3 qian, Asparagus cochinchinensis (Tiantong) 1.5 qian, Biota seed paste (Baizi shuang) 3 qian, roasted Glycyrrhiza uralensis (Zhi Gancao) 2 qian. First decoction yields two cups, second yields one cup, divide into three doses.

On the 22nd day, fluids were exhausted, tongue black and dry. Use Fumai method (Pulse-restoring method).

Large Rehmannia glutinosa (Da Shengdi) 6 qian, Ophiopogon japonicus (Maodong, without heart) 6 qian, Biota seed paste (Baizi shuang) 4 qian, stir-fried Paeonia lactiflora (Chao Baishao) 6 qian, Moutan Cortex (Danpi) 4 qian, Cannabis sativa seed (Huomaren) 3 qian, fresh Trionyx sinensis shell (Sheng Biejia) 6 qian, Donkey-hide gelatin (Ejiao, dissolved) 3 qian, roasted Glycyrrhiza uralensis (Zhi Gancao) 3 qian, raw Ostrea concha (Sheng Muli) 4 qian. First decoction yields three cups, take today; second yields one cup, take tomorrow morning.

[Analysis] In the sixth consultation, Yin deficiency symptoms became increasingly apparent. Herbs like Dendrobium nobile (Shihu), Gypsum Fibrosum (Shigao), and Semen Pruni Armeniacae (Xingren) focused on treating Lung and Stomach. Removing these and adding roasted Glycyrrhiza uralensis (Zhi Gancao), combined with Rehmannia (Di), Paeonia (Shao), and Ophiopogon (Maodong), indicated preparation for using Fumai Tang. Reusing Moutan Cortex (Danpi) was due to lingering heat in the Blood level; adding Asparagus cochinchinensis (Tiantong) strengthened heat-clearing and Yin-nourishing effects. By the 22nd day, fluid exhaustion was undeniable. Following the understanding that "Fumai is the general commander for heat damaging Yin," treatment formally addressed Lower Jiao Warm Disease. Wu Jutong believed: When heat deeply invades the Lower Jiao, causing dry tongue and black teeth, one must prevent spasms and convulsions, not wait for them to occur. Thus, "using Fumai to restore Yin, adding shellfish-type minerals to anchor Yang," forming Erjia Fumai Tang, modified to "allow Yin and Yang to interact, so spasms may not occur."

[Commentary] From the 19th day onwards, the focus was constantly on preserving Yin, rejecting leaching and warm-drying herbs, and being cautious with bitter-cold heat-clearing herbs. Yet after three days, fluids were still "exhausted." This resulted from neglecting lung heat-clearing. Since pulmonary inflammation was not effectively controlled, and pathogenic heat was scorching Yin and damaging fluids like a galloping horse, rigid adherence to merely "preserving Yin" made the drug-induced damage worse. Lu Jiuzhi's fierce criticism of the Ye school's ineffective heat-clearing was justified. Using Dendrobium nobile (Shihu) to nourish the Stomach was also inappropriate, criticized by Yun Tieqiao. Issues like "Fumai being the general commander for heat damaging Yin" have been discussed elsewhere, so I will not repeat them.

On the 23rd day, the right pulse remained rapid. Residual pathogens had fallen into the Lung, causing severe cough with difficult expectoration. Propose sweet-moistening and cool ventilation of Lung Qi.

Ophiopogon japonicus (Maodong, without heart) 1 liang, fine Rehmannia glutinosa (Xi Shengdi) 5 qian, Fritillaria thunbergii (Xiangbei) 3 qian, Glehnia littoralis (Shashen) 3 qian, Semen Pruni Armeniacae paste (Xingren ni) 3 qian, Morus alba leaf (Dong Sangye) 3 qian, Polygonatum odoratum (Yuzhu) 3 qian, Platycodon grandiflorus (Ku Jiegeng) 3 qian, Glycyrrhiza uralensis (Gancao) 3 qian, Moutan Cortex (Danpi) 2 qian, Chrysanthemum morifolium (Chujuhua) 3 qian, Pyrus bretschneideri skin (Lipi) 3 qian. One dose decocted twice, each yielding two tea cups, total four doses.

On the 24th day, black tongue coating receded, pulse remained rapid, cough persisted, mild abdominal distension.

Fine Rehmannia glutinosa (Xi Shengdi) 5 qian, Ophiopogon japonicus (Maodong, without heart) 5 qian, Agastache rugosa stem (Huoxiang geng) 2 qian, Poria cocos block (Fuling kuai) 3 qian, Glehnia littoralis (Shashen) 3 qian, Curcuma aromatica root tuber (Guang Yujin) 1.5 qian, Semen Pruni Armeniacae powder (Xingren fen) 3 qian, Moutan Cortex (Danpi) 3 qian, Phaseolus vulgaris (Sheng Bian Dou) 3 qian, Platycodon grandiflorus (Ku Jiegeng) 3 qian, Fritillaria thunbergii (Xiangbei) 2 qian. Decoct to yield three cups, residue decoct again for one cup, divide into four doses.

[Analysis] In the eighth consultation, pulmonary lesions remained obvious, so treatment returned to the Upper Jiao. Herbs like Fritillaria thunbergii (Xiangbei), Platycodon grandiflorus (Jiegeng), Pyrus bretschneideri skin (Lipi), Morus alba leaf (Sangye), and Semen Pruni Armeniacae paste (Xingren ni) had been used initially. Now, with severe cough and difficult expectoration, dosages were increased for better effect. "Chrysanthemum can tonify Metal and Water organs, so it is used to supplement deficiencies." Sangju Yin is Wu Jutong's standard formula for Hand-Taiyin Warm Disease. "For Blood level involvement, remove Mentha haplocalyx (Bohe) and Phragmites rhizome (Lugen), add Ophiopogon japonicus (Maodong), fine Rehmannia glutinosa (Xi Shengdi), Polygonatum odoratum (Yuzhu), and Moutan Cortex (Danpi)." This is a standard modification of Sangju Yin. Since the disease remained in the Lung, the therapeutic focus shifted back from the Lower Jiao to the Upper Jiao. After Erjia Fumai Tang, Sangju Yin modifications were used, marking another turning point. However, in the ninth consultation, fever and cough persisted, and abdominal distension increased. Considering the prior use of bitter-drying followed by moistening herbs over many days, the Spleen and Stomach must have been injured. Dosages of Yin-nourishing herbs like Ophiopogon japonicus (Maodong) and Polygonatum odoratum (Yuzhu) were reduced or removed, and Spleen-strengthening, damp-leaching, aromatic Qi-regulating herbs like Phaseolus vulgaris (Bian Dou), Agastache rugosa (Huoxiang), Poria cocos (Fuling), and Curcuma aromatica root tuber (Yujin) were added to strengthen the Middle Jiao and resolve distension.

[Commentary] This case treated Upper Jiao, then Middle Jiao, then Lower Jiao, now restarting Upper Jiao treatment. The ninth consultation shifted focus back to Middle Jiao, and the tenth to Lower Jiao. Applying Three-Jiao differentiation to treat Warm Disease in this manner is extraordinary. Actually, the disease site remained in the Lung. Initial treatment was too light and non-specific. First error: reckless use of bitter-drying herbs accelerated dryness transformation. Second error: obsession with preserving Yin allowed heat to scorch Yin. Frequent administration of such drugs interfered with the body's self-regulation. Thus, despite a vigorous adolescent patient and a disease not comparable to tuberculosis or lung cancer, the course was prolonged. This case failed to attack pathogens effectively, and Yin-nourishing did not aid recovery. Pulmonary lesions seemed untreated. It was certainly not that pathogens originally invaded the Lower Jiao, nor that residual pathogens fell into the Lung on the 23rd day. Anyone with basic modern medical knowledge would understand this.

On the 25th day, dark old feces were passed last night, tidal fever subsided, lips and tongue remained crimson. Where heat passes, Yin is inevitably damaged. Use Fumai method to restore Yin.

Large Rehmannia glutinosa (Da Shengdi) 8 qian, Ophiopogon japonicus (Maodong, without heart) 1 liang, Cannabis sativa seed (Huomaren) 3 qian, stir-fried Paeonia lactiflora (Chao Baishao) 6 qian, Glehnia littoralis (Shashen) 3 qian, genuine Donkey-hide gelatin (Zhen Ejiao, dissolved) 2 qian, fresh Trionyx sinensis shell (Sheng Biejia) 5 qian, Scrophularia ningpoensis (Yuanshen) 3 qian, roasted Glycyrrhiza uralensis (Zhi Gancao) 3 qian, raw Ostrea concha powder (Sheng Muli fen) 5 qian, Moutan Cortex (Danpi) 3 qian. Water eight bowls, boil down to three bowls, divide into three doses. Residue boil again for one bowl, take tomorrow morning.

On the 26th day, more old feces passed. Pathogens retreated by 80-90%, but healthy Yin was deficient, hence loss of appetite. Dry cough without phlegm at night.

Large Rehmannia glutinosa (Da Shengdi) 8 qian, Ophiopogon japonicus (Maodong, without heart) 6 qian, Cannabis sativa seed (Huomaren) 3 qian, raw Paeonia lactiflora (Sheng Baishao) 5 qian, Asparagus cochinchinensis (Tiantong) 2 qian, Ostrea concha powder (Muli fen) 3 qian, Glehnia littoralis (Beishashen) 3 qian, Donkey-hide gelatin (Ejiao, dissolved) 3 qian, roasted Glycyrrhiza uralensis (Zhi Gancao) 3 qian. Decoct to yield three cups, divide into three doses. Externally: Pear juice, water chestnut juice, and lotus root juice, one small wine glass each, warmed in double boiler, taken frequently.

On the 27th day, heat damaged fluids, stool dry, slight tidal fever, dry cough with red throat. Use sweet-moistening method.

Fine Rehmannia glutinosa (Xi Shengdi) 5 qian, Scrophularia ningpoensis (Yuanshen) 6 qian, stir-fried black Anemarrhena asphodeloides (Zhimu) 2 qian, Cannabis sativa seed (Huomaren) 3 qian, Ophiopogon japonicus (Maodong, without heart) 6 qian, Donkey-hide gelatin (Ejiao) 2 qian, Prunus armeniaca kernel (Yuliren) 2 qian, Glehnia littoralis (Shashen) 3 qian, Pear juice 1 cup (mixed in), Water chestnut juice 1 cup (mixed in). Decoct to yield three cups, divide into two doses.

[Analysis] This school believes regarding exogenous febrile diseases: "Warm disease is Yang pathogen; Fire insults Metal, attacking the Lung first. Fire flares upward, hard to descend. Transferring heat out through the Fu organs is the path of disease resolution." Noting that tidal fever subsided and symptoms improved after passing old feces, it was known that abdominal pain and tenderness were due to dry feces. Thus, Phaseolus vulgaris (Bian Dou) and Poria cocos (Fuling) were no longer used. Subsequent mentions of old feces showed great importance attached to this. However, since Yin injury had not recovered, Yin-nourishing and moistening methods were continued. On the 25th day, to prevent spasms, Erjia Fumai Tang modifications were still used, similar to the seventh consultation. After passing more old feces and improving, the 26th day switched to Yi Jia Fumai Tang modifications. By the 27th day, with persistent tidal fever and dry feces after taking Yi Jia Fumai Tang, Zengye Tang modifications were used to nourish Yin, clear heat, and moisten dryness to promote bowel movement.

[Commentary] The disease course was long. By the 25th day, it had essentially entered the recovery phase. Spontaneous defecation on the 24th day indicated gradual recovery of self-regulation. If earlier treatment had emphasized lung heat-clearing and purgative heat-draining, shortening the course would have been possible. Changing to Yin-nourishing and moistening on the 25th day was not a major error. However, the failure to effectively clear heat and purge bowels meant old feces reaccumulated and tidal fever returned.

On the 28th day, latent summerheat internally溃 (ruptured/manifested), with slight white papules appearing. Pulse slightly harmonized compared to before. Second time tongue coating transformed, no bowel movement.

Ophiopogon japonicus (Maodong, without heart) 6 qian, large Rehmannia glutinosa (Da Shengdi) 5 qian, Codonopsis pilosula (Maoshen) 3 qian, Glehnia littoralis (Shashen) 3 qian, Arctium lappa seed (Niubangzi, stir-fried and ground) 3 qian, Donkey-hide gelatin (Ejiao) 1.5 qian, Forsythia suspensa (Lianqiao, with heart) 2 qian, raw Glycyrrhiza uralensis (Sheng Gancao) 1 qian, Hemp seed (Maren) 3 qian, Lonicera japonica (Yinhua, stir-fried) 2 qian. Decoct to yield three cups, divide into three doses. After taking this, bowel movement occurred that evening.

On the 4th day of the 9th lunar month, tidal fever recurred, no bowel movement for four days. Dry feces reaccumulated. Administer Zengye Chengqi Tang to gently harmonize.

Codonopsis pilosula and Glehnia littoralis (Er Shen) 5 qian, fine Rehmannia glutinosa (Xi Shengdi) 5 qian, Rheum palmatum (Dahuang, raw) 2 qian, Ophiopogon japonicus (Maodong, without heart) 5 qian, roasted Glycyrrhiza uralensis (Zhi Gancao) 1 qian. Decoct to yield two cups, divide into two doses. After taking this, dark dry feces were passed, tidal fever subsided, pulse quieted. Thereafter, treatment concluded with Yin-nourishing.

[Analysis] Appearance of white papules indicates pathogenic factors emerging outward, showing continued improvement. Thus, on the 28th day, Zengye Tang was the main formula, with Lonicera japonica (Yinhua), Forsythia suspensa (Lianqiao), and Arctium lappa seed (Niubangzi) added to assist Yin-nourishing and pathogen-expelling. On the 29th day, due to dry feces resolving and reaccumulating, and unresolved tidal fever, a method combining clearing and nourishing, attacking and tonifying was adopted.

[Commentary] The Lung and Large Intestine are exterior-interior related. High fever caused by pulmonary inflammation leading to internal dry feces accumulation makes purgative heat-draining a noteworthy treatment method. This case initially presented abdominal pain and tenderness, but dry feces accumulation was never considered. Thus, Zengye Chengqi Tang was only used late in the disease course during recovery, which was clearly too late.

Conclusion: Theoretically, *Wenbing Tiaobian* contains numerous flaws and contradictions. Clinically, medical records like those above in *Wu Jutong's Medical Cases* show routine errors and poor efficacy. This is a fact. Many post-Qing physicians blindly learned from and praised him. No wonder some say the Ye Tianshi school's light-clearing herbal methods caused regression in TCM therapeutics. This is indeed an issue that cannot be ignored.

Volume 3 Miscellaneous Discussions on Exogenous Febrile Diseases

There are three schools of thought in treating exogenous febrile diseases after the Qing Dynasty.

Schools of thought in treating exogenous febrile diseases after the Qing Dynasty, recorded in medical books, include the Ye-Wu School, Menghe Medical School, Shao School of Cold Damage, Yun School, and Zhu School, etc. Generally, these schools are classified into two major branches: the Cold Damage School and the Warm Heat School. However, in my opinion, the schools of thought in treating exogenous febrile diseases after the Qing Dynasty actually form a tripod structure. I will briefly describe the three below: