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Wanshi Niuhuang Qingxin Wan (5 fen).

Wang Yuan's comment: Phlegm-heat in the Yangming channel has not yet cleared, and food was consumed hastily, leading to the severe changes described below. One should imitate Zhang Zhongjing's "food administration method," assisting with Rhubarb (Da Huang) to induce mild purgation.

Second visit: The disease has entered the thirteenth day. Body heat is present but not manifesting strongly; there is mental confusion, a short tongue, and moldy coating. Pathogenic factors have entered the area of the Pericardium (Shanzhong), causing blockage without unblocking. Urgently apply clearing, draining, and aromatic opening methods to hope for a turning point.

Rhinoceros Horn (Xijiao), Forsythia (Lianqiao), Immature Bitter Orange (Zhishi), Calamansi Seed (Tianzhuhuang), Reed Rhizome (Lugen), Acorus (Shichangpu), Black Paste (Heigao), Burdock Fruit (Niubangzi), Scrophularia (Yuanshen), Mint Root (Bohetegen), Curcuma (Yujin), Fresh Dendrobium (Xianhu).
Zixue Dan (5 fen), taken separately mixed with water.

Second visit: Mental state responds slightly to calls, but speech remains absent; pathogenic factors desire to reach the exterior but fail. Red spots on the chest and hypochondrium appear slightly, sparse and indistinct; macules desire to emerge but do not fully emerge. Bad breath, constipation, frequent passage of flatus; Yangming dryness and excess re-aggregate. Tongue is short, heart fire is scorching, tongue edges are crimson; fire at the Pericardium is blazing. Amidst aromatic opening and clearing/draining methods, incorporate drugs that generate fluids and purge excess.
Add Glehnia (Shashen), Fine Rehmannia (Xi Shengdi), and ground Rhubarb (Dahuang) to the previous formula.

Third visit: Foul breath is pungent; stomach fire is extremely strong. Macules and rashes have appeared but are insufficiently erupted. Eyes are red, spirit is blurred, pulse is surging, mouth is thirsty. Urgently employing macule resolution is essential. Ancient methods for resolving macules prioritize Baihu Tang. Now, still incorporate Xijiao Dihuang Tang to clear the nutritive level and detoxify, then resume Yunnv Jian to preserve yin.

Rhinoceros Horn (Xijiao), Black Paste (Heigao), Ophiopogon (Maidong), Calamansi Seed (Tianzhuhuang), Large Rehmannia (Da Shengdi), Anemarrhena (Zhimu), Glehnia (Shashen), American Ginseng (Yangshen), Acorus (Shichangpu), Human Waste Charcoal (Renzhonghuang), Reed Rhizome (Lugen), Gypsum (Gao Shi - pounded with mint).

Wang Yuan's comment: It is unknown if the previous formula resulted in bowel movement. If not unblocked, it can be purged again; this is what is meant by "urgent purgation to preserve yin." With Xijiao Dihuang Tang and Baihu Tang to clear heat and save fluids, and the presentation showing excess without deficiency, one may boldly administer treatment.

Fourth visit: Eyes can recognize people, tongue can extend beyond teeth; the condition shows signs of vitality. Large doses to preserve yin should be used, hoping for fluid recovery as auspicious.

Large Rehmannia (Da Shengdi), Fresh Dendrobium (Xian Shihu), Ophiopogon (Maidong), American Ginseng (Yangshen), Scrophularia (Yuanshen), Raw Licorice (Sheng Gancao), Fresh Rehmannia (Xian Shengdi), Gypsum (Shigao), Rhinoceros Horn (Xijiao), Glehnia (Shashen), Sugarcane Juice (Zheshi).

Fifth visit: Black coating is peeling, tongue substance is deep red; yin fluids are severely damaged, dryness-fire remains. Left pulse is fine and small, right pulse is surging and large; this is the sign. At this juncture of yin damage and fire prosperity, Shaoyin insufficiency and Yangming excess exist. Only Jingyue's Yunnv Jian fits best. On one hand preserve yin, on the other drain fire. Maintain this for three periods (approx. 5 days), and yin should recover.

Fresh Rehmannia (Xian Shengdi), Raw Gypsum (Sheng Shigao), Scrophularia (Yuanshen), American Ginseng (Yangshen), Large Rehmannia (Da Shengdi), Black Gardenia (Hei Shanzhi), Raw Licorice (Sheng Gancao), Anemarrhena (Zhimu), Glehnia (Shashen), Forsythia (Lianqiao), Reed Rhizome (Lugen).

Wang Yuan's comment: Right pulse surging and large indicates Yangming heat accumulation with stagnation is obvious.

Sixth visit: Frequent passage of flatus, throat dryness; due to dryness, voice cannot be produced. This is Yangming fire steaming, fluids failing to ascend. Focus heavily on saving yin, simultaneously unblocking the fu organs, and discuss further.

Large Rehmannia (Da Shengdi), Fresh Rehmannia (Xian Shengdi), Ophiopogon (Maidong), Raw Rhubarb (Sheng Jun), Sea Cucumber (Haishen), Northern Glehnia (Beishashen), Raw Licorice (Sheng Gancao), Scrophularia (Yuanshen), Mirabilite (Yuanmingfen).

Wang Yuan's comment: Previously lacking purgation, this still presents as excess-heat. Sea cucumber is too cloying and obstructs the diaphragm.

Seventh visit: After purgation, fluids have not returned; urgently nourish yin and awaken the stomach.

Raw American Ginseng (Sheng Yangshen), Poria (Fuling), Tangerine Peel (Juhong), Ophiopogon (Maidong), Sugarcane Peel (Zhepi), Large Rehmannia (Da Shengdi), Dendrobium (Shihu), Glehnia (Shashen).
Scrophularia (Yuanshen), Rice Sprout (Guya).

Eighth visit: Deafness, inability to hear; tongue is dry and difficult to move; yin fluids are severely damaged. Use Fumai method.

Large Rehmannia (Da Shengdi), Ophiopogon (Maidong), Scrophularia (Yuanshen), American Ginseng (Yangshen), Donkey-hide Gelatin (Ejiao - stir-fried with 3 fen Coptis/Chuanlian), Raw Licorice (Sheng Gancao), Egg Yolk (Jizihuang).

Ninth visit: Repeatedly administering large yin-nourishing doses, generating fluids is sufficient, but draining fire is insufficient. Now past three periods, dental plaque receded then reappeared, consciousness is clear; this is not failure of yin recovery, but residual dryness-fire. Now adopt a light and agile approach.

American Ginseng (Yangshen), Immature Bitter Orange (Zhike), Fritillaria (Chuanbei), Tangerine Peel (Juhong), Red Poria (Chiling), Ziziphus Seed (Zaoren - stir-fried with pig bile), Coptis (Chuanlian).
Decoct with Xuegang Soup.

Tenth visit: Various ailments tend toward peace. Every time thin rice gruel is drunk, sweat soaks the clothes; this is not deficiency, but fluid recovery and distribution of Ying Qi throughout the body. Urination is涩 painful, residual fire is not cleared. Only clearing and transforming is suitable.

Winter Melon Seed (Dongguazi), Fresh Dendrobium (Xian Shihu), Tetrapanax (Tongcao), Black Gardenia (Hei Zhi), Raw Rice Sprout (Sheng Guya), Sweet Almond (Tian Xingren), Licorice Tip (Gancao Shao).

Eleventh visit: Disease recedes. Quiet during the day, fever and mental confusion at night; this is residual heat remaining in the Ying level. Urination is hot and painful, Heart fire descends to the Small Intestine. Imitating the example of residual heat after illness, use Baihe Zhimu Huashi Tang combined with Daochi San.

Akebia (Mutong), Licorice Tip (Cao Shao), Bamboo Leaf (Zhuye), Anemarrhena (Zhimu), Fresh Rehmannia (Xian Shengdi), Talc (Huashi), Lily Bulb (Baihe).
Decoct with spring water.

Case of Fan: Constitution of Yin deficiency with dampness, contracted seasonal wind-warmth. Initially slight aversion to cold on the back, slight head distension and pain, desire to cough but unsatisfactory, heat not manifesting strongly, white greasy tongue coating, loose stool. Harshly administering dispersing drugs secretly depleted Stomach fluids, resulting in hunger but no desire to eat, lethargy with blurred spirit, continuous hiccups, faint macules and rashes. Disease just eight days, situation critical. Reviewed Mr. Zhou's prescription, truly excellent; I presumptuously added one dose of Licorice to harmonize it, possessing power to generate fluids and tonify middle; this is certainly an aid. If one says sweet flavor generates dampness or fills the middle, who does not know this! But note: thin smooth coating, no chest fullness but knowing hunger, indicates formless damp-heat with signs of Middle Jiao deficiency. This is why Ye Tianshi deeply warns against bitter-cold acrid-dispersing drugs; those who understand should observe!

Burdock Fruit (Niubangzi), Peucedanum (Qianhu), Tangerine Peel (Juhong), Calamansi Seed (Tianzhuhuang), Curcuma (Yujin), Cardamine Seed (Dao Dou Zi), Platycodon (Jiegeng), Medicated Leaven (Shenqu).
Acorus (Shichangpu), Forsythia (Lianqiao), Mint Leaf (Bohoye), Bamboo Rind (Zhuru), Licorice (Gancao), Loquat Leaf (Pipaye).

Wang Yuan's comment: This is phlegm-induced hiccup. Caused by Middle Jiao deficiency with phlegm, Stomach Qi failing to descend smoothly.

Twelfth visit: Disease exceeds ten days, warm pathogen with dampness, pathology at the junction of Qi and Ying levels. White greasy tongue coating with red edges, rashes erupted but not smooth, delirium during sleep, clarity upon waking, slow hiccups persisting, pulse soft and slightly rapid. Mr. Zhou's clearing Ying, venting Wei, regulating Qi, transforming turbidity is appropriate.

Antelope Horn (Lingyangjiao), Forsythia (Lianqiao), Calamansi Seed (Tianzhuhuang), Coptis (Chuanlian), Tangerine Peel (Juhong), Burdock Fruit (Niubangzi), Pinellia (Banxia), Clove (Dingxiang), Persimmon Calyx (Shidi), Bamboo Rind (Zhuru), Mint Root (Bohetegen), Tetrapanax (Tongcao), Imperata Root (Maogen).

Wang Yuan's comment: Sleep confusion, waking clarity, phlegm-fire blocking Upper and Middle Jiao is obvious. Formula is better than the previous one.

Thirteenth visit: Heat within dampness, spirit muddled and lethargic, clears when called, speech coherent. White greasy tongue coating, soft rapid pulse; known not to be pathogen sinking into Pericardium, but damp-heat deeply permeating Upper Jiao, Lung Qi failing to disperse and descend. Hiccups not yet removed, Stomach turbidity not transformed. Plan to legislate from Lung and Stomach.

Belamcanda (Shegan), Apricot Seed (Xingren), Curcuma (Yujin), Tangerine Peel (Juhong), Magnetite (Daizheshi), Fritillaria (Chuanbei), Glehnia (Shashen), Platycodon (Jiegeng), Tetrapanax (Tongcao), Inula Flower (Xuanfuhua), Imperata Root (Maogen), Winter Melon Seed (Dongguazi).

Wang Yuan's comment: Opening Lung and descending Stomach is more apt, thus hiccups cease and spirit clears.

Fourteenth visit: Hiccups ceased, coating slightly transformed, desire to cough but not forceful. Still modify previous method.

Remove Magnetite (Daizheshi) from previous formula, add Clam Shell (Geqiao), Red Poria (Chiling).

Fifteenth visit: Remove Inula Flower (Xuanfuhua), Belamcanda (Shegan), Platycodon (Jiegeng), add Soybean Sprout (Doujuan).

Sixteenth visit: Diarrhea several times, sticky and filthy. Stomach turbidity descending is favorable, hence lethargy over recent days; last night after stool, slightly awake and less sleep, frequently rising to defecate, feeling more mentally vexed and fatigued. Diarrhea continues, tongue coating still white, body heat harmonized; wine drinker with Middle Jiao deficiency and damp excess. Plan to harmonize Middle and transform turbidity, imitating Hezi's Ganlu Yin.

Raw American Ginseng (Sheng Yangshen), Atractylodes (Yuzhu), Red Poria (Chiling), Alisma (Zexie), Talc (Huashi), Lycium Fruit (Jiju Zi), Guang Huo Xiang, Costus Root (Muxiang), Kudzu Flower (Ge Hua), Tangerine Peel (Juhong), Tetrapanax (Tongcao), Bamboo Rind (Zhuru).

Wang Yuan's comment: Phlegm exits via stool, heat follows; Middle Jiao turbidity clears, Upper Jiao heat descends, thus ailments seem lost, turning to wakefulness and less sleep. However, coating not transformed, residual dampness not cleared, Spleen-Stomach transport not restored. Do not tonify early.

Seventeenth visit: Disease retreated, dampness not cleared. Modify previous formula.

Add Ginseng Tendril (Renshen Xu), Atractylodes (Yuzhu), Medicated Leaven (Shenqu), Rice Sprout (Guya) to previous formula.

Case of Sun: Warm pathogen attacks Lung, Lung loses clear descent; damp carries heat to generate phlegm, fire carries Qi to reverse upward.
Wheezing and hoarse phlegm, dry tongue and greasy mouth. Yesterday's pulse reportedly wiry and hard, current pulse small, choppy and rapid; yin fluids secretly damaged, Yuan Qi gradually weakened, concern for wheezing, sweating, syncope, and collapse. Warm pathogen disease belongs to Hand meridians; Lung and Stomach are high positions, treatment should favor clearing and descending. Phlegm surges with Qi, resolving phlegm prioritizes descending Qi; Qi reverses due to fire, descending Qi prioritizes clearing and descending. Tentatively prescribe one formula for expert consideration.

Fresh Dendrobium (Xian Shihu), Belamcanda (Shegan), Apricot Seed (Xingren), Elephant Fritillaria (Xiangbei), Glehnia (Shashen), Perilla Fruit (Suzi), Mulberry Bark (Sangpi), Agarwood (Chenxiang), Reed Rhizome (Lugen), Bamboo Oil (Zhuyou - taken with liquid), Winter Melon Seed (Dongguazi), Loquat Leaf (Pipaye), Ginger Juice (Jiangzhi).

Wang Yuan's comment: Discussion is clear, worthy of study. Replacing Agarwood (Chenxiang) with Scutellaria (Huangqin) in the formula would be better. Since heat transforms and Lung clears, no worry about lack of descent. All Lung-clearing drugs can descend Qi; Agarwood belongs to Wood, descends Liver but not Lung.

Case of Huang: Dry crimson tongue, dry teeth and scorched lips, phlegm wheezing and coarse breathing, fine rapid pulse. Formless pathogenic heat steams the Pericardium,有形 phlegm-turbidity blocks Lung and Stomach, fluids dried, Zheng Qi internally deficient, fear of syncope and collapse. Plan to resolve phlegm and purge heat to treat symptoms, support Zheng and generate fluids to treat root. Must achieve calm phlegm-wheezing and clear spirit before proceeding.

Antelope Horn (Lingyangjiao), Inula Flower (Xuanfuhua), Lepidium Seed (Tingli), Apricot Seed (Xingren), Fritillaria (Chuanbei), Fresh Dendrobium (Xian Shihu), Scrophularia (Yuanshen), Imperata Root (Maogen).
Bamboo Oil (Zhuyou), Agarwood (Chenxiang), Magnetite (Daizheshi), Perilla Fruit (Suzi), Ginger Juice (Jiangzhi), Guntan Wan (3 qian, delivered with Ginseng decoction).

Second visit: Head sweating profusely, phlegm-wheezing unceasing, pulse surging and large, complexion dark and dull, red dry tongue, dry gums and scorched lips. Shaoyin yin fluid insufficiency, Yangming pathogenic fire excess; fire carries Qi upward reversal, Lung fails to descend causing wheezing; condition dangerous, deep concern for syncope/collapse. Tentatively plan to save Shaoyin fluids, clear Yangming fire, tonify Qi to consolidate sweat, calm Lung to stop wheezing; maneuvering carefully, hoping for effective response.

Large Rehmannia (Da Shengdi - pounded with Halloysite/Hai Fusshi), American Ginseng (Yangshen), Achyranthes (Niuxi), Schisandra (Wuweizi), Gypsum (Shigao), Mulberry Bark (Sangpi), Fritillaria (Chuanbei).
Roasted Licorice (Zhi Gancao), Ophiopogon (Maidong), Ginseng (1 qian, decocted separately, taken with liquid).
Decoct aged Rice (Chen Jingmi) as water substitute.

Wang Yuan's comment: Surging pulse combined with head sweat and blue-green face indicates significant Upper Excess and Lower Deficiency. From supplementing lower and grasping Qi, conceived clearing heat and saving fluids method, thus effective. Ginseng, Gypsum, Rice save Lung and clear heat, which is also saving Kidney.

Third visit: Sweat slightly stopped, wheezing slightly calmed, large pulse slightly softened. But Qi still urgent, mental restlessness, red dry tongue, dental plaque and scorched lips. Fluids not yet returned, deficient Yang not yet rested, ascending Qi not yet descended; though passed dangerous ridge, not yet on flat road. Lower abdomen seems to have signs of eruption, which is also an exit for pathogen. Still plan to save Shaoyin, clear Yangming, hope for turning point.

Large Rehmannia (Da Shengdi - stir-fried with Aragonite/Shufen), American Ginseng (Yangshen), Glehnia (Shashen), Scrophularia (Yuanshen), Ophiopogon (Maidong), Fresh Rehmannia (Xian Shengdi), Achyranthes (Niuxi), Tetrapanax (Tongcao), Soybean Sprout (Doujuan), Schisandra (Wuweizi), Bamboo Leaf (Zhuye), Loquat Leaf (Pipaye).
Decoct aged Rice (Chen Jingmi) as water substitute.

Wang Yuan's comment: Previous formula effective, this is logical step-by-step. Tetrapanax and Soybean Sprout are bland and渗 to vent exterior. Fear they consume fluids. Do not worry about pathogen not leaving; once fluids and Qi return, pathogen will not endure.

Fourth visit: Yin fluids slightly returned, Qi and fire not yet peaceful. Still proceed cautiously, hoping to avoid complications.

Large Rehmannia (Da Shengdi), American Ginseng (Yangshen), Glehnia (Shashen), Scrophularia (Yuanshen), Alisma (Zexie), Ophiopogon (Maidong), Calamansi Seed (Tianzhuhuang), Fresh Dendrobium (Xian Shihu), Abalone Shell (Shijueming), Poria Spirit (Fushen), Reed Rhizome (Lugen).

Case of Zhang: Warm pathogen unresolved for two periods (10 days), pulse surging, large and hollow; mental confusion like drunkenness, pale red tongue without coating. Taking decoction does not reject it, not taking does not seek it; muttering like whispering, repeating instructions.
Yesterday used aromatic opening, spirit slightly improved. But judging by symptoms, it is fluid depletion and dryness. Must use sweet-cold to moisten dryness and generate fluids, allowing Qi transformation and fluid recovery to ensure safety. Briefly establish method for reference, awaiting expert discussion.

Large Rehmannia (Da Shengdi), Fresh Dendrobium (Xian Shihu), Glehnia (Shashen), Poria (Fuling), Ophiopogon (Maidong), Antelope Horn (Lingyangjiao), Fresh Rehmannia (Xian Shengdi), Calamansi Seed (Tianzhuhuang), Sugarcane Juice (Zheshi), Reed Tip (Lugenjian).

Wang Yuan's comment: Case language is elegant, method concise, only achievable by those with both learning and experience.

Case of Xu: Warm pathogen internally stored, phlegm-turbidity floats upward. High fever without sweat, blurred consciousness, rebellious Qi with much phlegm, greasy tongue tip red, constipation. Prevent syncope/collapse.

Antelope Horn (Lingyangjiao), Lepidium Seed (Tingli), Apricot Seed (Xingren), Fritillaria (Chuanbei), Calamansi Seed (Tianzhuhuang), Black Gardenia (Hei Shanzhi), Trichosanthes Seed (Louren), Immature Bitter Orange (Zhishi), Fermented Soybean (Douchi), Acorus (Shichangpu).
Guntan Wan 3 qian. This formula is effective.

Wang Yuan's comment: Excess-heat with phlegm, Guntan Wan is very suitable, decoction formula is also good.

Case of Wu: Warm pathogen five days, dry yellow tongue coating, high fever without sweat, chest and abdomen board-like fullness, hardness and pain, intolerable to touch. This belongs to Jie Xiong (Chest Binding). Restlessness, wheezing, spitting saliva. Prevent wheezing-syncope.

Black Gardenia (Hei Shanzhi), Fermented Soybean (Douchi), Trichosanthes Seed (Louren), Coptis (Chuanlian), Apricot Seed (Xingren), Raw Rhubarb (Sheng Dahuang), Lepidium Seed (Tingli), Bupleurum (Chaihu), Immature Bitter Orange (Zhishi), Light Scutellaria (Dan Qin), Mirabilite (Yuanmingfen), Soap Pod (Zaojiao Zi).
For all Jie Xiong cases, restlessness and shortness of breath indicate death. This formula is a combination of Da Chaihu Tang, Da/Xiao Xie Xiong Tang, and Zhi Chi Tang.

Wang Yuan's comment: For restlessness, no sweat, and wheezing, Bupleurum (Chaihu) should not be used. Using Bupleurum repeats the old track of treating Cold Damage. Fortunately, Niter, Rhubarb, Coptis, and Apricot Seed manage the center; otherwise, it would be ruined.

Second visit: After purgation, hardness/fullness of Jie Xiong dissipated, but restlessness and mania vary不定ly, dry tongue coating, thirst for cold drinks, high fever without sweat. Pathogen still in Qi level. Use bitter-acrid-cold to clear interior and reach exterior, hoping for battle-sweat without complication. Fortunately high fever without sweat allows hope for battle-sweat. If sweat occurs and high fever persists, pathogen sinks inward. This formula is Sanhuang Shigao Tang, Jisu San combined with Zhi Chi Tang.

Third visit: Battle-sweat achieved, pulse quiet, body cool, pathogen resolved. Yellow tongue coating remains, residual Stomach turbidity not cleared, still suitable for harmonizing and transforming.

Fritillaria (Chuanbei), Red Poria (Chiling), Fermented Soybean (Douchi - stir-fried), Forsythia (Lianqiao), Black Gardenia (Hei Shanzhi), Tetrapanax (Tongcao), Talc (Huashi), Immature Bitter Orange (Zhike - stir-fried), Bamboo Rind (Zhuru).
General principle for formulas after battle-sweat with quiet pulse and cool body is not outside this.

Case of Yan: Post-illness Yuan Qi not recovered, warm pathogen takes advantage of deficiency to emerge. Initially high fever and blurred spirit, dry tongue, shoulder/arm/hypochondriac pain. Just two days, pathogen not dispersed/reached, already signs of fluid depletion; clearly a serious condition. Treatment here should reach pathogen to release exterior. But Ye Tianshi said: If tongue is dry initially and spirit slightly blurred, urgently nourish Zheng, slightly add pathogen-reaching drugs. If coma occurs then rescue interior, there is risk of being caught off guard.

Northern Glehnia (Beishashen - 1 liang), Burdock (Niubang - 3 qian), Apricot Seed (Xingren - 3 qian), Scorched Medicated Leaven (Jiao Qu - 3 qian), Black Gardenia (Hei Shanzhi - 1.5 qian), Fermented Soybean (Douchi - 3 qian), Forsythia (Lianqiao - 3 qian), Calamansi Seed (Tianzhuhuang - 1 qian), Immature Bitter Orange (Zhike - 1 qian), Imperata Root (Maogen - 1 liang), Fresh Mint Root (Xian Bohetegen - 5 qian).

Wang Yuan's comment: Deeply inherits Ye Tianshi's core transmission.

Case of Sun: Constitution with chronic Ying Yin deficiency, contracted warm pathogen, disease begins with limb numbness and chills/fever, quickly followed by diarrhea, blurred spirit. Now seven days, pulse rapid and surging, dry tongue and teeth, must have rapid breathing. Yangming fire just blazing, Shaoyin yin already depleted. Also abdominal hardness/pain, constipation for three days. Accumulation inside not descending, Qi and fire float entirely upward. Seems suitable to prioritize descending/unblocking. But yin fluids severely depleted, must first nourish fluids. Tentatively prescribe one formula for discussion.

Fresh Rehmannia (Xian Shengdi - 1.4 liang), Northern Glehnia (Beishashen - 2 liang), Ground Perilla Stem (Mo Sugen - 5 fen, taken with liquid), Apricot Seed (Xingren - 3 qian), Calamansi Seed (Tianzhuhuang - 1.5 qian), Poria Spirit (Fushen - 3 qian), Ophiopogon (Maidong - 5 qian), Fritillaria (Chuanbei - 3 qian), Sydney Juice (Xini Zhi - 1 cup, taken with liquid), Loquat Leaf (Pipaye - 3 slices).

Wang Yuan's comment: First nourish Zheng and save fluids, this is experienced wisdom without illusion.

Second visit: Fluids returned, tongue moist, sweating profuse, heat trend retreated. Only mental restlessness and insomnia, constipation. Still modify previous formula.

Remove Perilla Stem (Sugen) from previous formula, add Fine Rehmannia (Xi Shengdi - 1 liang), Asparagus Root (Tiandong - 3 qian), Hemp Seed (Maren - 3 qian).

Case of Cai: Warm pathogen causes macules and rashes, always involving Lung and Stomach meridians. Pathogenic heat stagnates and steams, reaching exterior from interior. Blood level heat blazing causes macules, Qi level heat blazing causes rashes. Pathogen enters from exterior, transmits from Qi to Ying. Heat exits from interior, reaches from Ying to Qi. This case: macules first appear on chest, body feels no heat. After several days, chills and fever start, then rashes spread. Seems Ying level had latent heat initially, then warm pathogen gathered, Lung and Stomach affected, starting with cough, chills, fever etc. However, macules about to resolve, rashes fully erupted; even if residual pathogen exists, clearing and resolving should suffice; instead chest stuffiness, restlessness, Qi rising, nausea, sore throat difficult to swallow, why? Indeed pregnant eight months, coinciding with Taiyin/Yangming nourishing fetus period, pathogenic heat severe in Lung/Stomach, fetal Qi loses shade and reverses upward, thus chest Qi rises, restlessness unable to lie down; isn't it that although disease originates from heat, actually it is fetal Qi rushing upward causing it? Current plan: clear/resolve Lung/Stomach warm pathogen to transform macule/rash heat toxin, this is correct treatment. But under prairie fire, fluids burned and damaged, must also nourish fluids. Fetal Qi rising causes fastest changes, especially must first calm fetal Qi. Lung governs the whole body, must also descend Lung Qi. Lung Qi descends and lying becomes possible, fetus calms and does not rush upward, thus avoiding fear of wheezing/syncope.

Fresh Rehmannia (Xian Shengdi - 1 liang), Light Fermented Soybean (Dan Douchi - 3 qian, pounded together with fresh Rehmannia), Fritillaria Mother Bulb (Chuanbeimu - 3 qian), Ground Perilla Stem (Mo Sugen - 5 fen, taken with liquid), Ground Rhinoceros Horn (Mo Xijiao - 5 fen, taken with liquid), Ground Curcuma (Mo Yujin - 5 fen, taken with liquid), Patterned Silver (Wenyin - 1 liang, decocted first), Scrophularia (Yuanshen - 2 qian), Anemarrhena (Baiwei - 3 qian), Bamboo Rind (Zhuru - 1 qian), Wild Ramie Root (Ye Zhu Gen - 5 qian), Loquat Leaf (Pipaye - 3 slices, remove hairs).

Second visit: Warm pathogen received from above, transmits from Qi to Ying; transformed fire ascends, from Stomach to Lung. Throat belongs to Lung meridian, pharynx belongs to Stomach meridian. Generally throat diseases are mostly excess fire, due to Lung/Stomach Yang prosperity. Kidney meridian circulates throat, Liver meridian winds pharynx; deficiency fire relates to Kidney/Liver Yin deficiency. This is the general outline. This case: after macules/rashes, throat pain red, entirely due to pathogenic fire blazing. Treatment plan, Xijiao Dihuang, does not go beyond sweet-cold clearing/resolving. Yesterday vomited red phlegm, nothing but Qi/fire steaming. Now observing pulse/color, spirit feels refreshed and clear. Happy to meet confidant, jointly deliberate and ponder, thankfully thank owner, turning worry/doubt to relief. Start of Summer is today, disease reducing means retreating; carrying child during this illness, fetus not moving means safe. Bowel movement just通畅, also sign of turning point. Carefully regulate, hope to avoid criticism of impatience. Briefly write a few lines, humbly request review.

Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Fritillaria (Chuanbei), Fresh Dendrobium (Xian Shihu), Scrophularia (Yuanshen), Anemarrhena (Zhimu), Fresh Rehmannia (Xian Shengdi), Ophiopogon (Maidong), Loquat Leaf (Pipaye).
Honeysuckle Dew (Jinyinhua Lu), Mung Bean Skin (Lv Dou Pi) decocted soup, mixed with Bird's Nest Soup (Yanwo Tang) to drink frequently.

Third visit: After warm pathogen burns fiercely, residual heat surely not clean; under Lung/Stomach prairie fire, yin fluids must suffer damage. Nourishing yin lies not in blood but in fluids and sweat, Ye Tianshi's famous saying; calming fetus requires smoothing Qi, deficient fire fears ascending, gynecology's key theory. This case: fetus reaches two periods, warm-rash retreated, how can pathogenic fire blaze again? Throat swelling subsided, why does dry pain prevail again? The reason is, fetus at seven-eight months,