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At this time, the Lung and Large Intestine are in the phase of governing nourishment. The Lung and Large Intestine are exteriorly-interiorly related; the Lung governs Qi, while the Large Intestine governs fluids. When the Lung is invaded by excessive Fire pathogen, dryness-heat transfers to the Large Intestine. During the period when the Large Intestine is nurturing the fetus, it subsequently transfers heat to the Bao Luo (uterine collaterals). The *Neijing* states: "When a person is pregnant, they lose their voice at the ninth month; this is because the collaterals of the uterus are obstructed." The Bao Mai (uterine vessels) connect to the Kidney and network the Bao Tai (uterus and fetus). Now, heat forces upward upon the Lung, causing hoarseness, coughing, and throat pain. According to this passage from the classic texts, it clearly points out that Yin fire within the fetus causes hoarseness during the ninth month, instructing practitioners not to treat it urgently, for fear of damaging fetal Qi. It is currently only the eighth month, yet hoarseness and frequent coughing have already occurred; is this not what is meant by "collateral damage" (innocent parties suffering)? Currently, sweet-cool fluids-generating herbs are used to treat upper dryness, combined with salty-cold herbs to descend latent fire within Yin. This corresponds to the classic saying: "For heat disorder internal, treat with salty-cold." One must understand that treating disease requires observing the appropriateness of the mechanism. Nourishing Yin so that fire descends applies to chronic illness resulting in deficiency and emaciation. Once fire recedes, Yin naturally replenishes, which applies to acute illness without deficiency. Predecessors summarized the essence: "Acute diseases are mostly excess; chronic diseases are mostly deficiency." This is the principle. Is this correct? Still awaiting Mr. Hua's correction.

Bei Sha Shen (Glehniae Radix, 1 liang), Chuan Bei Mu (Fritillariae Bulbus, heart removed, not ground, 3 qian), Yuan Jing Shi (Natrii Sulfas crystallized, 3 qian), Zhi Mu (Anemarrhenae Rhizoma, 3 qian, soaked in decoction of Qiu Shi), Chan Yi (Cicadae Periostracum, wings and feet removed, 1 qian), Da Dou Juan (Sojae Semen Praeparatum, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Tian Hua Fen (Trichosanthis Radix, 3 qian), Pi Pa Lu (Loquat Leaf Lotion, 1 cup, taken with decoction), Ye Zhu Gen (Artemisiae Scopariae Radix, 3 qian), Chi Ling Shen (Poria Cocos with Red Sandalwood, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Wen Yin (Silver Ribbon, 5 fen).

Modified prescription adds Ling Yang Jiao (Capricornis Cornu, 1.5 qian), Xian Sheng Di Huang (Rehmanniae Radix Recens, 7 qian), Hei Shan Zhi (Gardeniae Fructus carbonized, 1.5 qian).

Yuanyuan notes: Latent warm pathogens emerge from interior to exterior, transmitting from deep layers to superficial layers, exiting from the Shaoyin channel to the Taiyin channel. Therefore, the condition retreats and returns, becoming light then heavy again, not entirely due to fetal heat. Rashes belong to the Lung, which governs the exterior of the whole body. Macules belong to the Stomach, which is the gathering place of all things; warm pathogens often reach the exterior through these two channels. Here, "Bao Luo" refers to the collaterals of the uterine gate, not the Pericardium Luo. The Bao Luo connects to the Kidney; the Shaoyin channel penetrates the Kidney and enters the throat. Heat pathogens ascend from Shaoyin to harass the throat, causing hoarseness. In severe cases, throat pain occurs.

Patient Bao has not had a bowel movement for half a month, now on the twelfth day of illness. Consciousness is clouded, tongue coating is black like coal, teeth are coated with dry垢. Yangming evil fire is extremely blazing, Shaoyin Yin fluids are already depleted, old feces in the intestines cannot pass, leaving no exit for evil heat. If not purged, there is fear that intense fire will rob fluids leading to spasms and syncope; if purged, there is fear of losing Yin leading to hiccups and collapse. It is extremely difficult to prescribe. I tentatively prepare one formula.

Xi Jiao (Rhinocerotis Cornu), Xian Sheng Di Huang (Rehmanniae Radix Recens), Sheng Da Huang (Rhei Radix et Rhizoma), Fu Shen (Poria Cocos with Hostwood), Dang Gui (Angelicae Sinensis Radix), Chang Pu (Acori Tatarinowii Rhizoma), Da Sheng Di (Rehmanniae Radix Preparata), Lian Qiao (Forsythiae Fructus), Zhi Shi (Aurantii Fructus Immaturus), Mai Dong (Ophiopogonis Radix), Zhu Li (Bambusae Succus in Crustula), Yuan Ming Fen (Natrii Sulfas).

Yuanyuan notes: On one hand, nourish Yin and vent heat; on the other, unblock the fu organs. This is the safest approach. Xiao (Mang Xiao/Natrii Sulfas) and Huang (Da Huang/Rhei Radix et Rhizoma) should be used lightly.

Second visit: Bowel movements have occurred three times, spirit gradually clears, black coating has transformed. Now planning to generate fluids.

Xian Shi Hu (Dendrobii Caulis Recens, 1 liang), Chuan Bei Mu (Fritillariae Bulbus, 2 qian), Fu Shen (Poria Cocos with Hostwood, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 5 fen), Mai Dong (Ophiopogonis Radix, 3 qian), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Zhu Ru (Bambusae Caulis in Crustula, 1 qian), Bei Sha Shen (Glehniae Radix, 1 liang), Da Sheng Di (Rehmanniae Radix Preparata, 1 liang), Gan Zhe Pi (Sacchari Tabulae Cortex, 1 liang).

Patient Shen has a Yin-deficient constitution and contracted warm pathogens, with recurrent symptoms. Now on the ninth day, consciousness is intermittently confused, tongue surface is covered with fragmented rot-like coating, pulse is gradually sinking. Prevent syncope. Prepare formula awaiting Mr. Zhihe's review.

Xi Jiao (Rhinocerotis Cornu, 4 fen, ground and mixed), Lian Qiao (Forsythiae Fructus, 3 qian), Dan Pi (Moutan Cortex, 1.5 qian), Gua Lou Ren (Trichosanthis Semen, 3 qian), Xian Sheng Di (Rehmanniae Radix Recens, 5 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Xian Bo He Gen (Menthae Haplocalycis Radix, 1 liang).

Separately: Zhu Zi (Concha Margaritifera, 3 fen), Xue Po (Electri Succinum, 4 fen), finely ground, taken with Lu Gen Tang (Phragmitis Rhizoma Decoction).

Second visit: Follow previous formula, remove Gua Lou Ren, add Da Sheng Di (Rehmanniae Radix Preparata), Sheng Yang Shen (Panacis Quinquefolii Radix), Bei Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Radix).

Third visit: Yin fluids severely depleted, phlegm-fire blazing, internal wind stirring secretly, spasms and syncope imminent. Refuses to take decoction. Tentatively try soup formula.

Ren Shen Xu (Ginseng Radicula, 1 qian), Chuan Bei Mu (Fritillariae Bulbus, 2 qian), Shi Jue Ming (Haliotidis Concha, 8 qian), Xing Ren (Armeniacae Semen Amarum, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang), Zhu You (Bambusae Succus, 30 spoons, mixed), Mai Dong (Ophiopogonis Radix, 3 qian), Ling Yang Jiao (Capricornis Cornu, 1.5 qian, decocted first), Xi Ni Zhi (Pyrifoliae Juice, 1 cup, mixed), Zhe Zhi (Sacchari Tabulae Juice, 1 cup, mixed).

Fourth visit: Condition shows slight improvement. Still awaiting Mr. Jishen's judgment.

Ling Yang Jiao (Capricornis Cornu), Xian Sheng Di (Rehmanniae Radix Recens), Da Sheng Di (Rehmanniae Radix Preparata), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Xian Shi Hu (Dendrobii Caulis Recens), Bei Sha Shen (Glehniae Radix).
Shi Jue Ming (Haliotidis Concha), Xi Yang Shen (Panacis Quinquefolii Radix), Gou Gou (Uncariae Ramulus cum Uncis), Lu Gen (Phragmitis Rhizoma), Zhu You (Bambusae Succus), Fu Shen (Poria Cocos with Hostwood), Zhe Zhi (Sacchari Tabulae Juice), Li Zhi (Piriformis Fructus Juice), Dan Jiang Zhi (Zingiberis Rhizoma Recens Juice), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens), Xuan Shen (Scrophulariae Radix, last two added by Mr. Jishen).

Yuanyuan notes: Previous formulas were sufficient in nourishing Yin but insufficient in clearing fire, leading to the subsequent drawback of lingering evil heat.

Fifth visit: Follow previous formula, add Yuan Jing Shi (Natrii Sulfas crystallized), awaiting Mr. Jishen's judgment.

Da Sheng Di (Rehmanniae Radix Preparata), Chuan Bei Mu (Fritillariae Bulbus), Xian Shi Hu (Dendrobii Caulis Recens), Shi Jue Ming (Haliotidis Concha), Xuan Shen (Scrophulariae Radix), Dan Pi (Moutan Cortex), Mai Dong (Ophiopogonis Radix), Sheng Yang Shen (Panacis Quinquefolii Radix), Bei Sha Shen (Glehniae Radix), Lu Gen (Phragmitis Rhizoma), Gan Zhe Zhi (Sacchari Tabulae Juice).

Sixth visit: Fu organ qi blocked, Yang fire not descending, Yin fluids not ascending. Although Yuan Qi is deficient, it is necessary to unblock the fu organs.

Da Sheng Di (Rehmanniae Radix Preparata, 8 qian), Xian Shi Hu (Dendrobii Caulis Recens, 5 fen), Bei Sha Shen (Glehniae Radix, 1 liang), Xuan Shen (Scrophulariae Radix, 3 qian), Zhi Mu (Anemarrhenae Rhizoma, 1.5 qian).
Sheng Da Huang (Rhei Radix et Rhizoma, 3 qian), Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Yang Shen (Panacis Quinquefolii Radix, 3 qian), Mai Dong (Ophiopogonis Radix, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang).

Patient Hong: Warm pathogens just started, chest fullness, headache, fever with sweating. First, use cool resolution method.

Niu Bang Zi (Armeniaceae Semen, 3 qian), Dou Chi (Sojae Semen Preparatum, 3 qian), Hei Shan Zhi (Gardeniae Fructus carbonized, 3 qian), Lian Qiao (Forsythiae Fructus, 3 qian), Jie Geng (Platycodonis Radix, 3 qian), Ju Hong (Citri Reticulatae Pericarpium Rubrum, 3 qian), Jing Jie (Schizonepetae Spica, 3 qian), Xing Ren (Armeniacae Semen Amarum, 3 qian), Bo He (Menthae Haplocalycis Herba, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang).

Patient Qin: Sweating was excessive, fluids stolen internally. Yesterday, generated fluids to expel pathogens. Although sweat did not appear, rash spots transformed. Although heat did not subside, pulse became slightly harmonious. This is a good omen. Tongue coating is black but not very dry, consciousness is blurred but occasionally clear. Xi Jiao (Rhinocerotis Cornu) and Di Huang (Rehmanniae Radix) can be used, but the general trend has not changed, so no need to change the formula. Still follow previous formula with additions.

Bei Sha Shen (Glehniae Radix, 1 liang), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Xian Shi Hu (Dendrobii Caulis Recens, 1 liang), Lian Qiao (Forsythiae Fructus, 3 qian), Mai Dong (Ophiopogonis Radix, 3 qian), Fu Shen (Poria Cocos with Hostwood, 3 qian, mixed with Cinnabar), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Xuan Shen (Scrophulariae Radix, 3 qian), Mao Gen (Imperatae Rhizoma, 1 liang, heart removed), Deng Xin (Junci Medulla, 3 chi, mixed with Cinnabar), Jiu Jie Chang Pu (Acori Tatarinowii Rhizoma, 8 fen).

Yuanyuan notes: For blurred consciousness and black tongue coating, Xian Shi Hu (Dendrobii Caulis Recens) can be used, but Bei Sha Shen (Glehniae Radix) should not be used. Although it nourishes Lung Yin, it is feared to tonify Lung and assist phlegm production; Mai Dong (Ophiopogonis Radix) is similar. This old physician likes using these two herbs; both flaws and merits are present.

Patient Zhang: Long-term hematochezia, Yin qi injured first from below. Now contracted warm pathogens with accumulation, Lung and Stomach Qi obstructed. Upper asthma, lower diarrhea, fever, thirst, tongue crimson like vermilion, forehead sweating incessantly, whole body no sweat, pulse fine, rapid, and hurried. Signs of syncope and collapse are dangerous. Tentatively propose a formula for correction.

Ge Gen (Puerariae Lobatae Radix, 1 qian), Huang Qin (Scutellariae Radix, 1.5 qian), Shi Gao (Gypsum Fibrosum, 3 qian, ground with Bo He), Chi Ling Shen (Poria Cocos with Red Sandalwood, 3 qian), Huang Lian (Coptidis Rhizoma, 4 fen).
Xing Ren (Armeniacae Semen Amarum, 3 qian), Niu Bang Zi (Armeniaceae Semen, stir-fried with Yuan Mi, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Pi Pa Ye (Eriobotryae Folium, 3 slices).

Decoct above herbs with 2 cups of water until 1 cup remains. Separately decoct:
Ren Shen (Panacis Ginseng Radix, 1 qian), Mai Dong (Ophiopogonis Radix, 1.5 qian), Wu Wei Zi (Schisandrae Fructus, stir-fried, 5 fen), Sheng Di (Rehmanniae Radix, 4 qian), E Jiao (Colla Corii Asini, stir-fried with Ge Fen, 2 qian).
Decoct separately with 2 cups of water until half cup remains. Mix with previous decoction, take slowly.

This is a compound method. The disease is warm pathogens, but Yin deficiency leads to collapse, hence this method. Generally, sudden asthma is excess, and high fever with dry tongue should be treated with clearing and resolving. Only when there is long-term hematochezia and current uncontrollable diarrhea, described as "asthma without rest, dysentery without stop, unable to take food or drink," is it considered untreatable. Thus, it is necessary to save Yin, hoping for a miracle.

Yuanyuan notes: Yin blood consumed below, Spleen Qi injured in middle, so once warm pathogens contract, upper asthma and lower diarrhea occur. Diarrhea is Spleen sinking, asthma is Kidney rebellion. Two organs failing to maintain function makes syncope and collapse easy. Forehead sweating indicates Yin not holding and Yang floating outward. Body no sweat indicates Yin fluid deficiency and Qi unable to transform. Tongue crimson like vermilion indicates Stomach Yin deficiency and Heart Fire blazing. Pulse fine, rapid, and hurried indicates Yin blood deficiency and evil fire lurking. Both formulas show ingenuity, but Ge Gen (Puerariae Lobatae Radix) is too ascending, and Niu Bang Zi (Armeniaceae Semen) is too draining to Lung. Since both Yin and Yang are deficient, Middle Qi does not hold. Although Qi sinks, it should not be lifted; although no sweat, it should not be induced. Urgently protect Middle Qi and Yin fluids, fearing it may still be too late. However, such dedication is deeply respected.

Child patient: Yangming heat pathogens abundant, purple macules appeared all over body, epistaxis and gum erosion. Urgently use clearing and resolving, prevent internal collapse.

Xi Jiao (Rhinocerotis Cornu), Shi Gao (Gypsum Fibrosum), Bo He (Menthae Haplocalycis Herba), Qian Cao (Rubiae Radix et Rhizoma), Dan Pi (Moutan Cortex), Xian Sheng Di (Rehmanniae Radix Recens), Lian Qiao (Forsythiae Fructus), Zi Cao (Arnebiae Radix seu Lithospermi Radix), Xuan Shen (Scrophulariae Radix), Mao Gen (Imperatae Rhizoma) and Lu Gen (Phragmitis Rhizoma).

Yuanyuan says: Regarding warm pathogens, predecessors often treated them identically to Cold Damage (Shanghan). Since Yu Jiayan, efforts were made to refute this, yet still failed to break free. Until Ye Tianshi opened a new path, and Wu Jutong continued it, the treatment of warm-heat diseases began to flourish greatly. However, this was not the fault of predecessors; they were misled by ancients. The first error lies in the *Neijing*: "Heat diseases are a category of Cold Damage." Thus, it was believed that Cold Damage is warm disease, and warm disease is Cold Damage, without distinction. The second error lies in Wang Shuhe compiling Zhang Zhongjing's *Treatise on Cold Damage*, inserting warm diseases into Cold Damage, considering warm-heat as a transformation of Cold Damage. Later people proposed spring transforms to warm, summer transforms to hot, but actually Cold Damage and warm-heat are worlds apart. However, warm diseases are not monolithic; there are Winter-Warm, Spring-Warm, Winter-Warm emerging in Spring, Wind-Warm with rashes, and Damp-Warm distinctions. Wind-Warm and rashes belong to Spring-Warm, caused by contracting spring thieving winds, damaging skin and hair, combining internally with Lung, stirring latent warm pathogens, thus presenting with cough, airway obstruction, coarse breathing, or rashes. Disease is in Lung and Stomach Qi level, suitable for pungent-cool light dispersal of Upper Jiao, not heavy agents or Blood-level herbs. If Winter-Warm or Spring-Warm are mild, also in Lung and Stomach, with cough and shortness of breath; severe cases may originate from Shaoyang or Shaoyin. Some even involve Jueyin, due to prior Yin essence deficiency, with evil heat accumulating in deficiency areas. Once triggered, Shaoyin Yin essence is immediately exhausted, fluids dried up, followed by coma, spasms, and tremors. Rising with lower back and hypochondriac pain, sweating without relief, should not be underestimated. Waist is the residence of Kidney, hypochondrium is where Shaoyang meridions travel. Insufficient Kidney Water leads to blazing Wood-Fire. Our Wu region is located in warm, low-lying areas, where dampness moves earliest. Winter-Warm with dampness is rare. Spring-Warm often has phlegm and dampness; Damp-Warm is dampness and heat combined. Clearing heat especially requires opening dampness. Clearing heat uses bitter-draining and cool-moistening; opening dampness must assist with pungent-unblocking and bland-leaching, whereas drying methods are unsuitable. Because dampness transforms with heat, only heat is seen, not dampness. With warm pathogens, inspecting the tongue is paramount; do not induce sweating arbitrarily. If sweating exists, certainly do not induce again; even if no sweating, observe fluid status. If heat is intense and fluids deficient, reckless sweating easily causes coma and spasms, mildly cough and shortness of breath, severely epistaxis and gingival bleeding. Differentiating Six Channels is same as Cold Damage, but treatment methods are vastly different. From Han-Tang to Yuan-Ming, Cold Damage formulas were mostly used for warm-heat diseases. Although Ye Tianshi and others vigorously elucidated its principles, country doctors, following traditions and reading *Tangtou Gejue* and *Yizong Bidu* daily, still use Qiang Huo, Du Huo, Chai Hu, Qian Hu as standard exterior-releasing formulas. The disaster has not ceased.