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Patient Li: Summer-heat and dampness pathogens first latent within the interior, while cool wind attacks from the exterior. Internal steaming and external constraint interact and stagnate, all capable of transforming into fire. Dampness suppresses heat, causing heat to remain latent, making the heat intensity even more blazing. Therefore, when malaria manifests, there is initial chills followed by fever, with symptoms lighter during the day and heavier at night. As stated in the *Classic of Difficult Issues* (Nan Jing), this is "first injured by heat, then affected by cold." As Yu Jia Yan described, on Yin days (night), Yin aids Yin, so heat decreases and symptoms are mild; on Yang days (day), Yang aids Yang, so heat intensifies and symptoms are severe. The onset of malaria must begin from the four extremities, and subsequently inevitably disturbs the Middle Palace (Spleen and Stomach), hence chest and heart restlessness, and epigastric fullness and obstruction. Furthermore, vomiting must precede diarrhea; after diarrhea, symptoms subside slightly, but abdominal distension remains. The reason for this is that heat is excessive in the middle, steaming the dampness of water and grain, which overflows upward and discharges downward. When heat potential is vented, restlessness calms down, but residual dampness re-aggregates, thus distension recurs. Now that the malaria has subsided, the pulse is wiry and rapid, the tongue coating is white and greasy, urination is unsatisfactory. There is inherent stomach cold, and phlegm-turbidity has been abundant constitutionally. Although there has been no sweating and the exterior pathogen is unresolved, the disease mechanism leans heavily towards the interior. The treatment principle should address the interior. The main gist is to drain heat as the primary method, dispel dampness as an adjunct, and release the exterior as a helper. This also embodies the intent of resolving the exterior and interior simultaneously and treating the Triple Burner collectively.
Puerariae Radix (Ge Gen) / Scutellariae Radix (Dan Qin) / Coptidis Rhizoma (Chuan Lian) / Glycyrrhizae Radix et Rhizoma (Gan Cao) / Atractylodis Rhizoma (Cang Zhu) / Magnoliae Officinalis Cortex (Chuan Pu) / Citri Reticulatae Pericarpium (Ju Pi) / Agastaches Herba (Huo Xiang) / Pogostemonis Rhizoma (Shi Chang Pu) / Poria (Chi Ling) / Alismatis Rhizoma (Ze Xie) / Menthae Haplocalycis Herba (Bo He) / Talcum (Hua Shi) / Curcumae Aromatae Rhizoma (Yu Jin) / Bambusae Mesocarpium (Zhu Ru)

Wang Yuan's Note: Diarrhea and vomiting are concomitant symptoms, not necessarily present. They arise because summer-heat, dampness, and turbid foulness stagnate in the Middle Palace, causing the Taiyin Spleen to fail in ascending clear Qi and the Yangming Stomach to fail in descending turbid Qi, unable to differentiate properly.

Patient Yang: Over sixty years old, ill for more than ten days. Returned home via long-distance travel, enduring boat and carriage fatigue. Pulse is deep and spirit is obscure; tongue is stiff and white, with a scorched center. Body heat is not manifesting prominently, hands and feet are cold, shortness of breath with hiccups, loose stools that are foul-smelling. This indicates latent pathogens combined with accumulation, a sign of righteous qi deficiency and pathogenic invasion sinking inward. Deeply worry about collapse of jue (Jue Tu).
Rhei Radix et Rhizoma (Da Huang) / Ginseng Radix (Ren Shen) / Prepared Aconiti Lateralis Radix (Zhi Fu Zi) / Bupleuri Radix (Chai Hu) / Pinelliae Rhizoma (Ban Xia) / Poria (Fu Ling) / Citri Reticulatae Pericarpium (Chen Pi) / Scutellariae Radix (Dan Qin) / Alismatis Rhizoma (Ze Xie) / Angelicae Sinensis Radix (Dang Gui) / Aurantii Fructus Immaturus (Zhi Shi) / Syzygii Aromatis Flos (Ding Xiang) / Diospyroi Fructus (Shi Di) / Bambusae Mesocarpium (Zhu Ru)

Wang Yuan's Note: Deficient and excess patterns arrive mixed together. Prescribing requires utmost deliberation. Without solid confidence, one should start with gentle approaches; otherwise, a single error may be irrecoverable.

Re-examination: The condition remains dangerous and severe. Hope for a turning point.
Cinnamomi Ramulus (Gui Zhi) / Bupleuri Radix (Chai Hu) / Ginseng Radix (Ren Shen) / Paeoniae Radix Alba (Bai Shao) / Coptidis Rhizoma (Chuan Lian) / Pinelliae Rhizoma (Ban Xia) / Aurantii Fructus Immaturus (Zhi Shi) / Syzygii Aromatis Flos (Ding Xiang) / Citri Reticulatae Pericarpium (Chen Pi) / Amomi Fructus Rotundus (Kou Ren) / Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) / Bambusae Mesocarpium (Zhu Ru)

Second Re-examination: Latent summer-heat transforms into dryness, consuming fluids and stirring wind. Tongue is black, lips are scorched, nasal mucosa is dark, teeth are dry, consciousness is clouded, fingers are drawn/tethered. This morning, bowel movement occurred spontaneously, reportedly with slight alleviation of disease severity. However, both pulses are hurried and rapid, yin fluids are exhausted, evil fire spreads like a prairie fire. Still a dangerous sign, fearing further aggravation.
Rhinocerotis Cornu (Xi Jiao) / Saigae Tataricae Cornu (Ling Yang Jiao) / Rehmanniae Radix Recens (Xian Sheng Di) / Scrophulariae Radix (Yuan Shen) / Phragmitis Rhizoma (Lu Gen) / Uncariae Ramulus cum Uncis (Gou Gou) / Dendrobii Caulis Recens (Xian Shi Hu) / Liu Yi San / Glehniae Radix (Sha Shen) / Forsythiae Fructum (Lian Qiao) / Tectonae Herba (Tong Cao) / Hyacinthtis Orontii Semen (Tian Zhu Huang)
Zhu Huang San, taken separately mixed with liquid.

Patient Lu: Externally, there is a trend of alternating cold and heat; internally, there is heat accumulation, palpitations, and pain. Upper body presents with vexation, stifling sensation, nausea, and vomiting; lower body presents with loose, foul-smelling stools. This is new pathogen combined with latent pathogen, damp-heat and accumulation, affecting exterior, interior, and Triple Burner simultaneously. Prone to complications such as coma and hiccups. Propose resolving both exterior and interior, assisted by aromatic herbs to expel turbidity.
Bupleuri Radix (Chai Hu) / Raw Rhei Radix et Rhizoma (Sheng Da Huang) / Scutellariae Radix (Dan Qin) / Aurantii Fructus Immaturus (Zhi Shi) / Pinelliae Rhizoma (Ban Xia) / Coptidis Rhizoma (Chuan Lian) / Trichosanthis Pericarpium (Gua Lou Pi) / Poria (Chi Ling) / Curcumae Aromatae Rhizoma (Yu Jin) / Pogostemonis Rhizoma (Shi Chang Pu) / Amomi Fructus Rotundus (Kou Ren)

Re-examination: After administering the dual-resolution method, sweating and bowel movements occurred, resulting in two days of stability. Yesterday, upon getting up to look in the mirror and opening the window to view chrysanthemums, fever gradually developed. With high fever, consciousness became blurred, eyes rolled up, nearly reaching collapse. By dusk, consciousness gradually cleared, fever subsided, pulse became deep and unrising. Reported that during fever, tongue was dry and red; after fever subsided, tongue coating was yellow and greasy. This is dampness suppressing blazing heat, on the verge of dryness but not yet dry, on the verge of sinking but not yet sunk. However, it presents as a Yang syndrome with Yin pulse, which is contradictory and concerning. Tentatively prescribe He Jian's Gan Lu Yin. Within the context of clearing heat and drying dampness, add Cinnamon Twig (Gui Zhi) to unblock yang, Poria (Fu Ling) to unblock yin, Caoguo to dispel cold-dampness of the Taiyin Spleen-Earth, and Anemarrhenae Rhizoma (Zhi Mu) to clear dryness-heat of the Yangming Metal-Lung.
Gan Lu Yin minus Talcum (Hua Shi) and Atractylodis Macrocephalae Rhizoma (Bai Zhu), add Atractylodis Rhizoma (Mao Zhu), Tsaoko Cardamom Fruit (Caoguo), Anemarrhenae Rhizoma (Zhi Mu), Ginger Juice (Jiang Zhi), and Green Onion White (Cong Bai Tou).

Certain Patient: Summer-heat pathogen is closed internally without reaching the exterior, consciousness is blurred, tongue coating is white. Fear coma or collapse. Aromatic permeation and resolution are suitable.
Agastaches Herba Recens (Xian Huo Xiang) / Hyacinthtis Orontii Semen (Tian Zhu Huang) / Pogostemonis Rhizoma (Shi Chang Pu) / Poria (Chi Ling) / Forsythiae Fructum (Lian Qiao) / Yi Yuan San / Curcumae Aromatae Rhizoma (Yu Jin) / Bambusae Mesocarpium (Zhu Ru)
Zhi Bao Dan, one pill, dissolved in Pogostemonis Rhizoma Decoction and taken separately.

Re-examination: Summer-heat and dampness internal accumulation, heat fluctuates, chest fullness, diarrhea, blurred consciousness, palpitations, menstruation has not stopped. Righteous qi is deficient carrying pathogen, fear fainting/collapse. Reported abdominal distension and nausea, temporarily use methods to widen the middle and regulate qi.
Tai Wu Shen Shu San minus Licorice (Gan Cao), add Poria (Fu Ling), Alismatis Rhizoma (Ze Xie), Perilla Stem (Su Geng), Puerariae Radix (Ge Gen), Scutellariae Radix (Dan Qin), Codonopsis Radix (Dang Shen), Bupleuri Radix (Chai Hu), Amomi Fructus Rotundus (Sha Ren), Tectonae Herba (Tong Cao) / Bambusae Mesocarpium (Zhu Ru).

Certain Patient: Pregnant six months, contracted summer-heat latent pathogen, nausea and stifling sensation. Living on a boat in hot weather, fear fainting and miscarriage.
Artemisiae Annuae Herba (Qing Hao) / Arecae Pericarpium (Da Fu Pi) / Pinelliae Rhizoma (Ban Xia) / Poria (Chi Ling) / Magnoliae Officinalis Cortex (Chuan Pu) / Scutellariae Radix (Dan Qin) / Stirred Saccharomyces Granulum (Jiao Liu Qu) / Perilla Stem (Su Geng) / Citri Reticulatae Pericarpium (Chen Pi) / Fresh Bergamia Fruit (Xian Fo Shou).

Certain Patient: Summer-heat, damp-heat obstructing the Yangming channel. Accumulated filth has passed but is not completely cleared. Nighttime heat is severe, consciousness is lethargic. Worried about fluid consumption transforming into dryness and other changes. Today, employ methods to generate fluids, drain heat, and transform turbidity as assistants.
Dendrobii Caulis Recens (Xian Shi Hu) / Poria (Chi Ling) / Forsythiae Fructum (Lian Qiao) / Fermented Soybean (Xiang Chi) / Trichosanthis Semen (Gua Lou Ren) / Large Hyacinthtis Orontii Semen (Da Zhu Huang) / Scutellariae Radix (Dan Qin) / Gardeniae Fructus (Shan Zhi) / Pogostemonis Rhizoma (Shi Chang Pu) / Bambusae Mesocarpium (Zhu Ru).

Certain Patient: Latent summer-heat illness, mostly damp-heat. In a yin-deficient constitution, pathogens are difficult to reach; this is the norm. However, yin deficiency varies greatly in severity. One must know that in this case, deficiency is not severe, and pathogens are not numerous. Tinnitus, dizziness, palpitations, thirst, chest fullness, slight chills and fever, wiry and rapid pulse. Cannot use heavy tonification, nor heavy attacking agents. As long as the pulse characteristics do not change, safety can be assured.
American Ginseng (Yang Shen) / Pinelliae Rhizoma (Ban Xia) / Poria (Fu Shen) / Chrysanthemi Flos (Gan Ju Hua) / Amomi Fructus Rotundus (Kou Ren) / Artemisiae Annuae Herba (Qing Hao) / Citri Reticulatae Pericarpium (Chen Pi) / Uncariae Ramulus cum Uncis (Gou Gou) / Tribuli Fructus (Ci Ji Li) / Sorghum Vulgare Semen (Shu Mi) / Sojae Seminis Preparatum (Dou Juan) / Bambusae Mesocarpium (Zhu Ru).

Patient Hu: Latent summer-heat for three pentads (15 days). Blurred consciousness, hiccups, slight spasms of hands and limbs, profuse phlegm, white tongue coating, thirst but little desire to drink, low voice, pulse large and deficient. Extremely tricky. Suddenly today, whole body is dry and itchy, restless and uneasy. Carefully inquiring about the cause, never sweated. According to Zhang Zhongjing: Incomplete sweating causes itching like insects crawling under the skin, due to chronic deficiency. Wu Keyou said: Dry and itchy hair roots, mental agitation like burning, named "Medicine Vexation" (Yao Fan), due to deficiency of Middle Qi. *Jin Gui Yao Lue* states: Voice sounding like coming from a jar indicates dampness in Middle Qi. Also according to *Nei Jing*: Speaking with weak, low voice is called "Qi Deprivation" (Duo Qi). Inferring from this, clearly it is Middle Qi deficiency with turbid retention, fluid exhaustion, and phlegm-misting. The situation is extremely critical. Only harmonizing the middle and promoting transformation, allowing Stomach Qi to distribute itself naturally, can we hope for a chance of survival.
American Ginseng (3 qian) / Tangerine Peel Cake (Ju Bing, 3 qian) / Sweet Almond (Tian Xing Ren, 3 qian) / Sojae Seminis Preparatum (Dou Juan, 5 qian) / Honeyed Plum (Mi Mei, 1 piece) / Glehniae Radix (Bei Sha Shen, 3 qian) / Ophiopogonis Tuber (Mai Dong, 3 qian) / Loquat Leaf (Pi Pa Ye, honey-fried, 2 slices) / Ginger Juice (Jiang Zhi, small amount).
The above formula takes pungent-sweet to transform turbidity, sour-sweet to generate fluids. Examining Wu Keyou's section on Medicine Vexation, where heavy use of Ginseng and Ginger harmonizes the middle and promotes transformation, the method has historical precedent.

Certain Patient: Ying-Yin has been deficient since youth, latent pathogen emerges late. Heat rises vigorously, heart burning, chest tightness, tongue center bare and red, edges thin and white. Malaria pathogen just starting, fear aggravation.
Fermented Soybean (Dou Chi) / Poria (Chi Ling) / Pinelliae Rhizoma (Ban Xia) / Glehniae Radix (Sha Shen) / Mori Folium (Sang Ye) / Artemisiae Annuae Herba (Qing Hao) / Black Gardeniae Fructus (Hei Shan Zhi) / Citri Reticulatae Pericarpium (Chen Pi) / Scutellariae Radix (Dan Qin).

Certain Patient: Ill for nine days, heat fluctuates, consciousness blurred, tongue dry and black. This is latent pathogen congestion, consuming fluids and entering the Ying level. Elderly patients are most prone to coma and convulsion changes.
Rehmanniae Radix Recens (Xian Sheng Di) / Trichosanthis Radix (Tian Hua Fen) / Black Gardeniae Fructus (Hei Shan Zhi) / Rhinocerotis Cornu (Xi Jiao) / Pogostemonis Rhizoma (Shi Chang Pu) / Fragrant Fermented Soybean (Xiang Dou Chi) / Dendrobii Caulis Recens (Xian Shi Hu) / Menthae Haplocalycis Herba (Bo He Ye) / Forsythiae Fructum (Lian Qiao) / Phragmitis Rhizoma (Lu Gen) / Hyacinthtis Orontii Semen (Tian Zhu Huang).

Patient Wu: Summer-heat and dampness latent in Taiyin, Middle Jiao Yang Qi fails to transform. Consciousness is muddled, appearing asleep. Body heat not prominent, limbs cold, pulse soggy, fingers tethered, tongue root stiff. Signs of wind-phlegm blocking collaterals. After taking methods to unblock Yang and benefit Yin, cloud-steaming rain-transforming, the illness did not increase or decrease significantly. However, tongue coating is thick grey-white, taste of sweetness in mouth is extreme. Turbidity in the Middle Palace, Yang cannot expand and transform. Imitate Suo Pi Yin to awaken the middle and transform damp-turbidity. When turbidity transforms, sweetness decreases; when Yang expands, confusion clears.
Codonopsis Radix (Dang Shen) / Mume Fructus (Wu Mei) / Light Dried Ginger (Dan Gan Jiang) / Tsaoko Cardamom Fruit (Caoguo) / Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) / Amomi Fructus Rotundus (Sha Ren) / Atractylodis Rhizoma (Mao Zhu) / Rehmanniae Radix (Da Sheng Di) / Poria (Fu Ling) / Ginger (Sheng Jiang) / Jujube (Da Zao).

Wang Yuan's Note: Based on tongue coating and sweet taste, damp-phlegm obstructing the Middle Palace, Yang failing to expand and transform is undeniable. Codonopsis, Mume Fructus, and Rehmanniae Radix are sour-sweet, aiding Yin and cloying the diaphragm, highly inappropriate. How can contradictions reach this extent! Finger tethering, although belonging to Wood dryness and Earth deficiency, Liver Wind stirring internally, given the current upper-middle Jiao damp-phlegm misting and closing, Lung-Stomach Qi mechanism cannot distribute, even if wishing to nourish Yin, what if Stomach Qi does not transform! Treating disease should address the urgent and major issues first; treating head for headache makes one a mediocre practitioner.

Patient Zhao: Elderly, primordial Qi deficient since youth. Before illness, already fatigued and weak, slight cough. For five to six days, added fever, heat fluctuates. This is new pathogen taking advantage of deficiency to attack, triggering late emergence of latent pathogen. Current pulse is small, rapid, and deficient. Dry cough wanting to vomit, tongue edges bare and red, root coating white. Severe heat, no sweat, fluid exhaustion with pathogen retention, fear transformation into dryness and coma.
Glehniae Radix (Bei Sha Shen) / Perillae Fructus (Su Zi) / Artemisiae Annuae Herba (Qing Hao) / Armeniacae Semen Amarum (Xing Ren) / Fritillariae Thunbergii Bulbus (Chuan Bei) / Arctii Fructus (Niu Bang Zi) / Peucedani Radix (Qian Hu) / Citri Reticulatae Pericarpium Rubrum (Ju Hong) / Tectonae Herba (Tong Cao) / Loquat Leaf (Pi Pa Ye).

Patient Wu: Latent pathogen internal accumulation causes Dan Malaria, external manifestation is flowing abscess (Liu Zhu). Entering Lung causes wheezing and cough; pouring into Intestines causes loose stools. Righteous Qi is too weak to support. In young children, this easily leads to惊风 (Convulsions).
Artemisiae Annuae Herba (Qing Hao) / Armeniacae Semen Amarum (Xing Ren) / Scutellariae Radix (Dan Qin) / Alismatis Rhizoma (Ze Xie) / Schizonepetae Spica (Jing Jie) / Fritillariae Cirrhosae Bulbus (Xiang Bei) / Platycodonis Radix (Jie Geng) / Citri Reticulatae Pericarpium Rubrum (Ju Hong) / Poria (Chi Ling) / Liu Yi San / Double Hook Uncariae Ramulus cum Uncis (Shuang Gou Gou).

Patient Tong: Latent pathogen emerges late, cool in morning, hot in evening, headache, chest tightness, white tongue, no sweat. Seems suitable for dispersing and reaching. As for lower back pain and blurred vision, it is internal Yin deficiency, pathogens difficult to reach, fear lingering entanglement. Should be careful.
Gastrodiae Rhizoma (Qin Jiao) / Poria (Chi Ling) / Artemisiae Annuae Herba (Qing Hao) / Perilla Stem (Su Geng) / Armeniacae Semen Amarum (Xing Ren) / Chrysanthemi Flos (Gan Ju Hua) / Aurantii Fructus Immaturus (Zhi Shi) / Eucommiae Cortex (Du Zhong, stir-fried with ginger juice) / Fermented Soybean (Dou Chi) / Mori Folium (Sang Ye).

Patient Gu: Ill for only three days, no significant external heat, but deficient vexation and stifling sensation, restless, disturbed sleep with chaotic thoughts, tongue coating white and greasy, nausea wanting to vomit, borborygmus, loose foul-smelling stools. Pathogen and accumulation inside, Qi mechanism not reaching. Use Gardeniae Fructus and Fermented Soybean to vent upwards, Citri Reticulatae Pericarpium and Magnoliae Officinalis Cortex to regulate the middle, Puerariae Radix to scatter, Poria to drain, Pinelliae Rhizoma and Sorghum Vulgare Semen to harmonize Stomach and connect Yin-Yang. When Yin and Yang intersect, sleep is achieved. Discuss again tomorrow.

Wang Yuan's Note: Onset is damp-phlegm carrying accumulation, obstructing Middle Palace, heat stagnant not reaching. Do not轻视 (look down upon) it just because external heat is not prominent.

Re-examination: Latent summer-heat emerges in autumn. The later it emerges, the deeper it is latent. Thus, the disease manifests with great fluctuations—hot for one day, receding for one day. It is neither intermittent malaria nor Dan Malaria. Dan Malaria is only heat without chills; intermittent malaria is alternating chills and heat. This case has slight chills and fever, heat lasts one day and night then recedes, but recession is not complete. Named "Latent Summer-Heat," this explanation is most logical. Summer-heat must carry dampness. Damp accumulation transforms heat and steams phlegm; phlegm is hard to expectorate, heat consumes fluids. Heavy body belongs to dampness, restlessness belongs to heat. Thirst with heat, but little desire to drink, still shows dampness suppressing blazing heat. Tongue coating white and dry indicates dampness in Qi level; Qi deficiency means dampness is hard to transform. Ye Tianshi said: White and thin tongue coating indicates Lung fluid injury. Ill for eight days, pathogen not dispersed and reached. Current prescription need not be harsh, but must release exterior without injuring righteousness, remove dampness without injuring Yin, clear heat without assisting dampness, generate fluids without hindering turbidity. Moderate and peaceful, patiently take the medicine. Support through two pentads (approx. 20 days), then hope for gradual peace.
Black Gardeniae Fructus (Hei Shan Zhi) / Forsythiae Fructum (Lian Qiao) / Poria (Fu Ling) / Fritillariae Thunbergii Bulbus (Chuan Bei) / Tectonae Herba (Tong Cao) / Glehniae Radix (Bei Sha Shen) / Talcum (Hua Shi) / Alismatis Rhizoma (Ze Xie) / Fermented Soybean (Dou Chi) / Loquat Leaf (Pi Pa Ye) / Fresh Mint Root (Xian Bo He Gen).

Wang Yuan's Note: Latent pathogen is deep and heavy, Spleen-Lung Qi is weak, strength insufficient to transform and reach, hence great fluctuations.

Patient Ma: Young child, latent dampness carrying accumulation, obstructing intestines and stomach, steaming phlegm transforming heat, Lung Qi blocked and closed. Hence diarrhea first, then cough, followed by fever. Now diarrhea has stopped, instead rapid breathing and hoarse phlegm sounds, Lung Qi blockage is even worse. Treatment principle should treat Lung first, fear Lung distension leading to惊风 (Convulsions), changes unpredictable.
Descurainiae Semen seu Lepidii Semen (Ting Li Zi, 3 qian) / Raphini Semen (Lai Fu Zi, 3 qian) / Liu Yi San (3 qian) / Loquat Leaf (Pi Pa Ye, 3 slices).

Wang Yuan's Note: Suppressing heaviness, eliminating phlegm, draining Lung, clearing heat, transforming accumulation, are all included herein.

Re-examination: Phlegm, asthma, and counterflow Qi have subsided by more than half. Heat fluctuates, recedes and returns. Malaria is common now, must prevent transition to malaria.
White Radish Juice (1 cup) / Fresh Mint Juice (half cup).
These two ingredients slightly decocted, dregs removed, add Rock Sugar (3 qian), melt, then mix with one drop of Ginger Juice and take.

Wang Yuan's Note: This formula is even better.

Patient He: Latent summer-heat carrying accumulation, light chills, heavy heat, already over a month. Tongue center scorched yellow, edges white and greasy. Yangming accumulated heat, transforming fire, consuming fluids, refining turbidity into phlegm, approaching misting closure. Epigastric pain refusing pressure. Two purgations done, pain still not reduced, coating not transformed. Only clearing and transforming can sweep away the excess. Propose Liang Ge San modified.
Liang Ge San / Dendrobii Caulis Recens (Xian Shi Hu) / Coptidis Rhizoma (Chuan Lian).
After two purgations, tongue center still scorched yellow, so purgation method can still be used. However, tongue edges white and greasy indicate carrying water qi. Adding Pinelliae Rhizoma (Ban Xia) to Liang Ge San is also acceptable.

Patient Lu: Latent pathogen carrying accumulation, only heat without chills, headache, epistaxis, loose watery stools. Heat intense in interior. Propose clearing interior and releasing exterior method.
Ge Gen Qin Lian Tang / Fermented Soybean (Dou Chi) / Forsythiae Fructum (Lian Qiao) / Aurantii Fructus Immaturus (Zhi Shi) / Black Gardeniae Fructus (Hei Shan Zhi).
Epistaxis and loose watery stools indicate heat. Not using Rhinocerotis Cornu (Xi Jiao) because tongue coating is white. Not using Rhei Radix et Rhizoma (Da Huang) because epigastrium and abdomen are not painful on pressure.

Patient Li: Latent pathogen damp-heat internal accumulation, Triple Burner Qi mechanism not reaching. Afternoon fever, chest tightness, head distension, scanty urine, no sweat. Tongue coating white and greasy, pulse soft and fine. Propose opening upper, regulating middle, seeping lower, imitating He Jian's method.
Sojae Seminis Preparatum (Dou Juan) / Armeniacae Semen Amarum (Xing Ren) / Citri Reticulatae Pericarpium (Chen Pi) / Agastaches Herba Stem (Huo Geng) / Talcum (Hua Shi) / Poria (Chi Ling) / Platycodonis Radix (Jie Geng) / Pinelliae Rhizoma (Ban Xia) / Stirred Saccharomyces Granulum (Jiao Liu Qu) / Magnoliae Officinalis Cortex (Chuan Pu) / Tectonae Herba (Tong Cao).

Patient Hu: Chronic phlegm-fluids and cough, hemoptysis earlier this summer, caused by Lung heated by oppression. These past six-seven days, latent summer-heat internal accumulation, cool wind external attack. Onset started with shivering then high fever, heat fluctuates. Exterior sweating not smooth, interior heat not retreating. Reason: Phlegm-fluids obstruct in chest, Lung and Stomach lose their disseminating and reaching functions. Tongue base crimson, looks sticky. Tongue center coating white and thick like a bean-sized patch, this is the sign of latent summer-heat carrying phlegm-fluids, let alone rapid breathing and hoarse phlegm! Reported six times diarrhea on the 26th, until now constipation. Abdomen pressed feels hard and obstructed, but not hard/painful. Urine initially red and turbid, now pale red not turbid. Damp-heat and phlegm-turbidity gather in chest. Because Lung Metal fails to descend, cannot transmit downward to Bladder, thus damp-turbidity rebels upward causing phlegm-asthma-counterflow Qi. Disease mechanism is here, danger is also here. Treatment principle must address this: eliminate phlegm, drain heat, descend Qi, clear Lung. Essential in the formula, but clearing and purifying Upper Jiao is especially crucial.
Descurainiae Semen seu Lepidii Semen (Ting Li Zi) / Curcumae Aromatae Rhizoma (Yu Jin) / Fritillariae Thunbergii Bulbus (Chuan Bei) / Armeniacae Semen Amarum (Xing Ren) / Aurantii Fructus Immaturus (Zhi Shi) / Saigae Tataricae Cornu (Ling Yang Jiao) / Arisaema Cum Bile (Dan Xing) / Forsythiae Fructum (Lian Qiao).
Poria (Chi Ling) / Bamboo Oil (Zhu You) / Loquat Leaf (Pi Pa Ye) / Gun Tan Wan (Decocted wrapped in silk).

Patient Chen: Residual pathogen and accumulation linger, not cleared; Primordial Qi and Yin consumed, nearing exhaustion. Temporarily stop bitter medicines, use stomach-awakening formula. Transform Qi, generate fluids, avoid heavy/turbid substances. Change decoction to steam-distilled dew, method takes lightness and clarity. Follow Dong Yuan's modifications, hoping for lucky success.
Qing Shu Yi Qi Tang / Lotus Leaf (He Ye) / Fragrant Rice Leaf (Xiang Dao Ye).
Steam-distilled dew, warm take 4-5 cups every morning.

Wang Yuan's Note: Decoctions, pills, pastes, powders, ancients had specific meanings, not empty formalities. Changing decoction to dew, taking lightness/clarity, is suitable only when major pathogen is gone and Stomach Qi cannot bear bitter medicines. Here it fits perfectly.

Patient Xu: Heat latent in Heart/Chest, dampness accumulating in Spleen/Stomach. Ill started like malaria, extending two months. Chest heat/stifling, no appetite, never sweated. Tongue base crimson, coating like soy sauce patches. This is verification of dampness suppressing heat. No sweat indicates fluid deficiency, vainly inducing sweat is useless. Generate fluids, penetrate heat, transform dampness, open appetite. When Stomach Qi distributes, sweat comes naturally.
Coptidis Rhizoma (Chuan Lian) / Black Gardeniae Fructus (Hei Shan Zhi) / Fermented Soybean (Dou Chi) / Broadleaf Tangerine Peel (Guang Pi) / Elsholtziae Herba (Xiang Ru) / Ophiopogonis Tuber (Mai Dong) / Poria (Chi Ling) / Menthae Haplocalycis Herba (Bo He) / Ginger (Sheng Jiang) / Liu Yi San.
This medicine decocted, exposed overnight, warm take in early morning.

Patient Pu: Latent pathogen carrying accumulation, blocking Middle Palace. Malaria attacks daily, lighter then heavier. Heavy attacks bring blurred consciousness and restlessness, tossing like mad. This is food accumulation steaming phlegm, evil heat transforming fire, phlegm-fire misting Pericardium Collateral. Fear wind stirring and convulsions. Pulse deep-solid, tongue coating yellow. Pathogen accumulates in Yangming. Treatment principle should purge downwards, imitate Da Chai Hu Tang example for discussion.
Bupleuri Radix (Chai Hu) / Scutellariae Radix (Dan Qin) / Magnoliae Officinalis Cortex (Chuan Pu) / Aurantii Fructus Immaturus (Zhi Shi) / Raw Rhei Radix et Rhizoma (Sheng Da Huang) / Trichosanthis Semen (Gua Lou Ren) / Pinelliae Rhizoma (Ban Xia).

Re-examination: After purging, heat clean, consciousness clear, seemingly recovered. However, illness receded too fast, still fear unpredictable changes. Prescribe formula to watch for turning point.
Coptidis Rhizoma (Chuan Lian, stir-fried with ginger juice) / Citri Reticulatae Pericarpium (Chen Pi) / Pinelliae Rhizoma (Ban Xia) / Light Fermented Soybean (Dan Dou Chi) / Scutellariae Radix (Dan Qin) / Aurantii Fructus Immaturus (Zhi Shi) / Curcumae Aromatae Rhizoma (Yu Jin) / Trichosanthis Semen (Gua Lou Ren) / Six Spirit Qu (Liu Shen Qu) / Bambusae Mesocarpium (Zhu Ru).
Illness receding too fast, still fearing changes, words of experience should be heeded.

Re-examination: Generally, post-purgation methods always modify Xie Xin Tang. Why still use Trichosanthis Semen and Aurantii Fructus Immaturus? Because chest fullness not relieved, tongue coating not transformed.

Re-examination: Yesterday malaria came, hands/feet cold, immediately abdominal Qi distension, blocking throat, nearly reaching collapse, but not confused/mad. This is Shaoyin Malaria pathogen, sinking internally into Jueyin, moving upward to Pericardium causes confusion/madness, attacking downward Spleen Earth causes abdominal distension. Spleen and Stomach are exterior-interior. Previous day confusion/madness, disease mechanism leaned Yangming, so law was purging downward. Now abdominal distension, white tongue, fine pulse, disease mechanism leans Taiyin. Law should be pungent-warm to unblock Yang, transporting Middle Qi is key. Adapt to changes, urgent matters first. Do not say using cold vs hot is unequal.
Scutellariae Radix (Dan Qin) / Pinelliae Rhizoma (Ban Xia) / Citri Reticulatae Pericarpium (Chen Pi) / Poria (Fu Ling) / Prepared Aconiti Lateralis Radix (Shu Fu Zi) / Magnoliae Officinalis Cortex (Chuan Pu) / Syzygii Aromatis Flos (Ding Xiang) / Areca Seed (Bing Lang) / Tsaoko Cardamom Fruit (Caoguo) / White Amomi Fructus (Bai Kou Ren) / Tectonae Herba (Tong Cao).
Front formula used cold, rear formula uses hot. Medicines used according to symptoms, agile conversion, avoiding世俗 suspicion, truly a heart of blood/passion.

Wang Yuan's Note: Shaoyin Yin Evil, overwhelming Sovereign Fire, attacking Spleen Earth. Classic says: Excess controls what it cannot overcome, and insults what it overcomes. This case is experienced. Must turn language this way to avoid blame from patient family; otherwise, despite good intentions, slander is invited.

Re-examination: Administering Ginger/Aconzi, Da Yuan, Shen, Xiang, Er Chen compound mixture, throat phlegm sound instantly flattened, abdominal distension relaxed. Now pulse slow-large, spirit calm, slight abdominal fullness, phlegm profuse and sticky. Spleen Yang Qi though unblocked, cold-heat phlegm-fluid not transformed. Still follow previous method, lighten its dosage.
Front formula minus Aconiti Lateralis Radix (Fu Zi) and Areca Seed (Bing Lang), add Arecae Pericarpium (Da Fu Pi).

Re-examination: Abdominal Qi slightly calmed, residual damp-heat pathogen not finished, hence slight chills and fever, returning to malaria image. Head distension, body pain, hungry able to eat. Treatment principle propose dispersing and harmonizing, additionally regulating Ying and Wei.