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Wang Zhen'guan suddenly developed bloody dysentery before the spring festival. Mengying diagnosed him, finding his pulse slippery, rapid, and deep; his face was red with a yellow tongue coating; his hands and feet were cold beyond the elbows and knees; there was hardness and pain around the navel; and urination was scanty and difficult. This was caused by latent heat. A large dose of Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), Toosendan Fructus (Chuanlianzi), Talcum (Huashi), Moutan Cortex (Danpi), Amomi Fructus (Sharen), Corydalis Rhizoma (Yanhusu), Crataegi Fructus (Shanzha), Massae Fermentatae Medicinalis (Shenqu), Flos Lonicerae Japonicae (Yinhua), and Cassiae Semen (Juemingzi) was prescribed. After two doses, the hands and feet gradually warmed, but swelling and redness appeared on the dorsum of the feet, with lumps rising like grapes, numbering twenty or so. After four doses, abdominal pain decreased, the tongue coating receded, and thirst ensued. Hawthorn fruit, Massae Fermentatae Medicinalis, and Amomi Fructus were removed from the original formula, and Pulsatillae Radix (Baitouweng), Paeoniae Radix Rubra (Chishao), and Metereopla (Haizhe) were added. Ten days later, the color of the dysenteric stool turned white, but cramping pain occurred in the leg tendons. Moutan Cortex, Talcum, and Paeoniae Radix Rubra were then removed, and Endothelium Corneum Gigeriae Galli (Jijin), Pericarpium Citri Reticulatae (Juhong), Coicis Semen (Yiyi), and Dendrobii Caulis (Shihu) were added. After two doses, the pain stopped, urination became long and abundant, and the stool color normalized. The ulceration on the feet oozed yellow fluid and then healed, allowing normal food intake. The treatment was changed to nourishing stomach yin and clearing residual heat, leading to recovery. Each dose contained approximately one liang of Flos Lonicerae Japonicae, and it took another half month for full convalescence. (A slippery, rapid, and deep pulse indicates phlegm-heat entrapment combined with yin deficiency. Facial redness is due to heat damaging lung qi. Yellow tongue coating results from dampness transforming into heat. Coldness extending beyond the elbows and knees suggests that this condition must have been worsened by mistaken use of warming tonics, which aided the pathogen; heat damaged lung qi, preventing it from reaching the exterior and descending, hence the coldness. Hardness and pain at the navel are clear evidence of phlegm and food stagnation in the abdomen. Scanty, difficult urination indicates heat damaging lung and stomach yin, causing their qi to fail to descend.)

The wife of Wu Fuzhai suffered from incessant vomiting after childbirth, unable to swallow even soup or water, accompanied by headache and profuse phlegm, with a white, slippery tongue coating. Mengying used Stem Isatidis (Sugeng), Pericarpium Citri Reticulatae (Juhong), Pinelliae Rhizoma Preparatum (Banxia), Evodiae Fructus (Wuyu), Poria (Fuling), Inulae Flos (Xuanfu), Ginger Peel (Jiangpi), Diospyros Leaf (Shidi), Haematitum (Zhi Shiying), and Bamboo Shavings (Zhuru). Symptoms improved after one dose and resolved after two. (This must be a constitution of inherent yin deficiency complicated by cold postpartum. This can be inferred from Mengying's prescription. The presence of cold is distinguished by the white, slippery tongue coating.)

Old woman Zheng suffered from coughing, feeling that phlegm rose from below the waist, and the expectorated phlegm was very cold. Physicians treated it as kidney deficiency with water overflowing. It gradually progressed to throat obstruction, making eating difficult; even when forced down, the chest felt blocked and nothing could pass. Stools were loose, and urination frequent. No one considered it anything other than a deficiency syndrome. Mengying diagnosed: Although the pulse was not very forceful, the right side showed slight wiriness and slipperiness, and the tongue coating was yellow and greasy. Could this be a deficiency? He used Weijing Decoction combined with Xuegeng Decoction plus Fritillariae Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Trichosanthis Radix (Huafen), Bamboo Shavings (Zhuru), Ophiopogonis Radix (Maidong), Loquat Leaf (Pipaye), and Diospyros Leaf (Shidi). After more than ten doses, she recovered. (Slight wiriness and slipperiness on the right side with a yellow, greasy tongue coating indicate a phlegm-heat excess syndrome. However, the phlegm-heat had not reached its peak. Previous physicians treating it as kidney deficiency with water overflowing likely mistakenly used warming tonics for spleen and kidney, resulting in these symptoms. If it were truly kidney deficiency with water overflowing, the left chi pulse would be deficient and fine, and the right pulse would be weak; the phlegm produced would be "deficiency phlegm".)

A young Manchu woman suffered from bleeding during pregnancy. Physicians administered tonics, but bleeding continued. Occasionally, when bleeding stopped, she vomited blood. This persisted for over two years, and fetal movement gradually began in the abdomen, confirming pregnancy. However, prolonged bleeding upwards and downwards led to immediate vomiting upon eating. The pulse was slippery, rapid, and forceful, indicating excess qi and blood heat. The syndrome was not deficiency; tonics only aggravated the disease, causing more bleeding. Without blood nourishment, the fetus failed to grow. The reason it did not abort was the solidity of the qi aspect. Large doses of Ying-nourishing (clearing the nutritive level) herbs were given, stopping the bleeding. However, she frequently vomited thin foam, vomited immediately upon drinking, felt thirsty, palpitations, shortness of breath, and a sensation of急促 (rapid/strained breathing). Western Ginseng (Yangshen), Ophiopogonis Radix (Maidong), Anemarrhenae Rhizoma (Zhimu), Dendrobii Caulis (Shihu), Loquat Leaf (Pipaye), Bamboo Shavings (Zhuru), Diospyros Leaf (Shidi), Raw White Peony Root (Baishao), Chaenomelis Fructus (Mugua), and heavily dosed Mume Fruit (Wumei) were administered. Relief came after one cup. The differentiation in the original case was thorough. The usual method of treating diseases is to address the Wei (Defensive) level before the Ying (Nutritive) level; here, clearing the Ying level was applied immediately, representing a modified treatment for preserving the fetus. In the Qi-clearing formula, the inclusion of Western Ginseng, Ophiopogonis Radix, Dendrobii Caulis, and Diospyros Leaf was because previous physicians, mistaking the condition for kidney deficiency with water overflowing, mistakenly used warming tonics, severely damaging lung and stomach yin. Heavy use of Zhimu, Wumei, Mugua, and Baishao, with their sour and bitter properties, drains liver fire to clear lung heat, preventing vomiting upon drinking and shortness of breath. Zhimu combined with Maidong, Shidi, Yangshen, and Shihu utilizes the principle of "bitter and sweet generating yin," preventing thirst and palpitations.)

Miss Zhu Xiaohui, daughter of Zhu Xiaohui, suddenly developed swelling of the cheeks extending to the lips and nose, to the point where her mouth could not open and her tongue could not protrude. This was warm-toxin. She was treated with Belamcandae Rhizoma (Shegan), Sophorae Tonkinensis Radix et Cortex (Shandougen), Ipomoeae Herba (Mabo), Antelope Horn (Lingyangjiao), Menthae Haplocalycis Herba (Bohe), Flos Lonicerae Japonicae (Yinhua), Fritillariae Bulbus (Beimu), Trichosanthis Radix (Huafen), Armeniacae Semen Amarum (Xingren), and Tuber Farfarae (Tianzhuhuang). Purple Snow (Zixue) was applied inside the lips, Xi Lei San was blown into the external throat, and olive pits were ground and applied to the swollen area. Indeed, tough saliva was expectorated, and the swelling gradually subsided.

A man suffered from hematochezia. Physicians administered warming tonics. Although the bleeding stopped, diarrhea and edema ensued. This persisted for half a year. The pulse was rapid, and the tongue crimson. The original disease was damp-heat; warming tonics instead damaged yin fluids. Scutellariae Radix, Coptidis Rhizoma, Gardeniae Fructus, Paeoniae Radix, Morus Folium (Sangye), Moutan Cortex, Flos Lonicerae Japonicae, Dendrobii Caulis, Toosendan Fructus, Benincasae Exocarpium (Dongguapi), Testudinis et Chelydrae Carapax et Plastrum (Biejia), and Endothelium Corneum Gigeriae Galli were prescribed. Recovery occurred within ten days. (Rapid pulse and crimson tongue both indicate yin deficiency with accompanying heat.)

The wife of Lu Nongfu experienced occasional epigastric pain ten days postpartum. Specialists prescribed warming tonics. Due to cold-qi rebellion, she suffered spontaneous sweating, insomnia, inability to defecate despite effort, and leakage of watery stools while lying down. She was thirsty, prone to vomiting, and refused all food. The pulse was wiry, rapid, and slippery. The root cause was yin deficiency with liver-yang harassing the stomach; mistaken administration of warming, tonifying, and astringent herbs caused complete failure of qi descent, leading to a multitude of symptoms. Sha Shen, Bamboo Shavings, Toosendan Fructus, Corydalis Rhizoma, Gardeniae Fructus, Coptidis Rhizoma, Pericarpium Citri Reticulatae, Fritillariae Bulbus, Armeniacae Semen Amarum, Dendrobii Caulis, and Loquat Leaf were used to soothe the lungs and harmonize the liver and stomach. Relief came after one cup. However, dull pain persisted in the lower abdomen. Armeniacae Semen Amarum, Fritillariae Bulbus, and Bamboo Shavings were removed from the previous formula, and Anemarrhenae Rhizoma, Trichosanthis Radix, Cynomorii Fructus (Rongrong), Paeoniae Radix Alba (Baishao), Tangerine Seed (Juhe), and Metereopla were added. Stagnant feces were passed, and she recovered. (Yin deficiency with liver-yang harassing the stomach was the remote cause; warming tonics obstructing the lungs was the proximate cause. Treatment focused on the heavier proximate cause.)

Zhou Zichao suffered from aversion to cold, headache, and fever, resembling Taiyang disease, but accompanied by pain and distension in the epigastrium. The right-side pulse was deep and slippery; the tongue coating was yellow, and there was no thirst. Urine resembled the color of Suxmu (Dragon's Blood). Initially, Congchi Tang (Scallion and Soybean Decoction) was modified with Gardeniae Fructus, Coptidis Rhizoma, Armeniacae Semen Amarum, Fritillariae Bulbus, Trichosanthis Peel (Gualou Pi), and Pericarpium Citri Reticulatae. After taking it, slight sweating occurred, aversion to cold ceased, and aversion to heat began. Even slightly warm soups caused severe qi rebellion. The external pathogen had resolved; clearing phlegm-heat was indicated. Anemarrhenae Rhizoma, Trichosanthis Radix, Armeniacae Semen Amarum, Fritillariae Bulbus, Inulae Flos, Talcum, Dendrobii Caulis, Pericarpium Citri Reticulatae, Loquat Leaf, Imperatae Rhizoma (Magen), Phragmitis Rhizoma (Lugen), and Metereopla were given. Indeed, much gelatinous phlegm was expectorated. Only panting upon exertion remained. Nourishing the lower jiao was added to the upper-jiao-soothing method to conclude the treatment successfully. (Headache often relates to liver-yang; epigastric pain and distension indicate liver-yang harassing the stomach. Deep, slippery right pulse indicates phlegm-heat trapped in the qi level. Combined with yellow coating, no thirst, and dark urine, this confirms latent heat. Thus, Congchi Tang combined with the bitter-cold of Huanglian was used to ascend and drain. Fresh Scallion White, Fermented Soybean (Douchi), Gardeniae Fructus, Coptidis Rhizoma, Armeniacae Semen Amarum, Pericarpium Citri Reticulatae, and Fritillariae Bulbus were used. The cessation of aversion to cold and onset of aversion to heat indicates that phlegm-heat was cleared and dispersed. Anemarrhenae Rhizoma, Trichosanthis Radix, Armeniacae Semen Amarum, Pericarpium Citri Reticulatae, Fritillariae Bulbus, Inulae Flos, Talcum, Dendrobii Caulis, Loquat Leaf, Phragmitis Rhizoma, and Metereopla were used. Panting upon exertion required adding Concha Meretricis et Cyclinae (Geke), Magnetitum (Zheishi), Testudinis Carapax et Plastrum (Biejia), Scrophulariae Radix (Yuanshen), and Asparagi Radix (Tianmen Dong) to the previous formula.)

The wife of Pu Shutang, five months pregnant, contracted Spring-Warmth. She was thirsty, prone to vomiting, had high fever without sweat. Mengying observed irritability and delirious speech, with a yellow but non-dry tongue coating, stating: "Phlegm-heat obstructing qi." The disease had not transmitted to the Ying level; blood-invigorating drugs were forbidden. Palpation of the chest revealed hardness and pain, yet bowel movements continued. The method should focus on opening the upper jiao. Xiaoxianxiong Tang (Minor Chest Trap Decoction) was modified with Acori Tatarinowii Rhizoma (Shichangpu), Aurantii Fructus Immaturus (Zhishi), Armeniacae Semen Amarum, Fritillariae Bulbus, Bamboo Shavings, Curcumae Radix (Yujin), Gardeniae Fructus, and Forsythiae Fructum (Liqiao), decocted in Radish Decoction. However, the heart and abdomen felt like burning, vomiting stopped but she could not retain food. A large dose of sweet-cold herbs with Wumei was administered frequently, leading to gradual recovery. She gave birth to a healthy child in autumn. (Heart and abdomen feeling like burning, with vomiting stopping but inability to eat, resulted from yin deficiency constitution and shortness of fluids, preventing qi from moistening and descending. Anemarrhenae Rhizoma, Benincasae Exocarpium, Lycii Cortex (Digupi), Scrophulariae Radix, Rehmanniae Radix Preparata (Disheng), Cynomorii Fructus, Flos Lonicerae Japonicae, Inulae Flos, and Mume Fruit were used. Fresh Radish was boiled to decoct the medicine.)

Hu Zhenhua, in his sixties, suffered from painful bleeding of urine and turbid fluid after urination. He claimed his urine stream was long and forceful, suggesting it was not a fire syndrome. Mengying observed a slippery and rapid pulse and prescribed Scrophulariae Radix, Rehmanniae Radix, Rhinoceros Horn (Xijiao - note: substitute with buffalo horn in modern practice), Gardeniae Fructus, Toosendan Fructus, Sophorae Flavescentis Flos (Huairui), Platycladi Cacumen (Cebai), Anemarrhenae Rhizoma, Trichosanthis Radix, Dendrobii Caulis, Flos Lonicerae Japonicae, Glycyrrhizae Radix et Rhizoma (Caogaoshao), and Mung Bean (Lvdou). Recovery occurred within ten days. Four years later, he died of another illness. (This must be a yang-predominant constitution. The slippery, rapid, forceful pulse indicates the formula's bitter-cold nature. Scrophulariae Radix, Rehmanniae Radix, Rhinoceros Horn, Gardeniae Fructus, Toosendan Fructus, Sophorae Flavescentis Flos, Platycladi Cacumen, Anemarrhenae Rhizoma, Flos Lonicerae Japonicae, Glycyrrhizae Radix et Rhizoma, and Mung Bean were used.)

Madam Guan suffered from bloody dysentery since last autumn, unresponsive to many doctors. By late spring, Mengying diagnosed a wiry, rapid pulse, yellow tongue coating, thirst, abdominal distension with bearing-down sensation, daily heat worsening at night. Baitouweng Tang (Pulsatilla Decoction) was combined with Linglizi San (Toosendan and Corydalis Powder) plus Scutellariae Radix, Paeoniae Radix, Gardeniae Fructus, and Dendrobii Caulis, taken with Zhuche Wan (Stop Dysentery Pill). Recovery occurred within ten days. (This syndrome involves significant damage to qi-level yin by heat pathogens; the patient's constitution must be robust. The inclusion of Ganjiang (Dried Ginger) in Zhuche Wan allows the administration of a purely bitter-cold formula.)

Pu Shutang fell ill with immediate cold limbs, hidden pulse, aversion to cold, fever, headache (worse on the left), and thirst alone. Two doses of Congchi Tang were given. Fever subsided, but the pulse remained hidden, limbs were cold beyond elbows and knees, and bowel movements were frequent. People suspected deficiency-cold. Mengying said: "This resembles Yin-Jue (Cold Reversal), but thirst and dark urine reveal the truth. How can we assume cold just because reversal occurs immediately?" Cool-clearing herbs were administered directly. Fever recurred, and cold limbs/hidden pulse persisted. Fortunately, the patient trusted the treatment. On the seventh day, red water was passed in stool, urethral pain occurred during urination, along with nausea,烦躁 (irritability), and insomnia. People feared for his life. Mengying said: "Heat has moved downward; a turning point is possible." Baitouweng Tang plus Flos Lonicerae Japonicae, Tongcao, Scutellariae Radix, Paeoniae Radix, Bamboo Shavings, Talcum, Anemarrhenae Rhizoma, Dendrobii Caulis, Gardeniae Fructus, Toosendan Fructus, and Antelope Horn were given for three days. Red water stopped, limbs warmed. Delirium and confusion appeared. Wangshi Xijiao Dihuang Tang (Wang's Rhinoceros Horn and Rehmannia Decoction) was given for one dose. Limbs warmed, pulse became slippery and rapid, tongue coating turned gray-yellow, extreme thirst and enuresis occurred. Patient described feeling like lying on a roasting oven. Scrophulariae Radix, Flos Lonicerae Japonicae, Bambusae Folium (Zhuye), Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma, Fritillariae Bulbus, Gardeniae Fructus, and Dendrobii Caulis were added. One dose allowed sleep. Tongue coating turned black and dry. Trichosanthis Radix was added. One dose reduced fever, caused sweating on head/face, lethargy, and difficulty urinating. Mengying commented: "Fortunately, I saw him early, allowing me to strive for life amidst death. Unlike others whose conditions worsened due to misdiagnosis. I did not explicitly state the danger to avoid alarming the family. Now vitality is restored, but true yin is not yet recovered. Adhere strictly to my method, and success will follow naturally. Do not waver, lest you ruin the mountain by missing a basket of earth. Thanks to a few understanding patients who followed Mengying's advice." Western Ginseng, Rehmanniae Radix, Cynomorii Fructus, Ophiopogonis Radix, Toosendan Fructus, Paeoniae Radix, Anemarrhenae Rhizoma, and Dendrobii Caulis were administered. One dose allowed urination and request for porridge. Two doses cleared black coating. Three doses brought clarity of spirit, loud voice, moist tongue, and returning fluids. Only tough phlegm remained stuck, with mild left-sided headache. Erzhi Wan (Two Winter Pills), Mori Folium, Chrysanthemi Flos, Fritillariae Bulbus, and Ostreae Concha were added. Five more doses led to passage of hard stool. All ailments resolved, sleep and appetite normalized, and recovery was achieved. (Thirst, dark urine, and cold limbs constitute irrefutable evidence of latent heat. Note: Family prejudices are hard to eradicate. Even Mengying's prescriptions may have been cautious initially, focusing on light, clear, and dispersing methods. If Xuegeng Tang (Metereopla, Water Chestnut, etc.) had been used initially with bitter-warm and cool-moist herbs, universal sweating might have expelled latent heat through pores. Xu Lingtai stated: 'For dry pathogens, use moist-clearing to induce sweat.' Warm-pathology headache relates to liver-yang and inherent yin deficiency. When treating such headaches, besides bitter-warm light agents, I usually use Scrophulariae Radix and Rehmanniae Radix (one liang total, using either one), soaked in boiling water, decocted in that water, following Mengying's principle of 'heavy drugs lightly administered' to clear upper and tonify lower simultaneously. Dosage adjusted based on yin deficiency severity. This case, if treated initially with light-sweating methods, might not have revealed such severe latent heat. For pathogenic patterns without sweat: tonify yang to induce sweat in yang-deficiency; tonify yin to induce sweat in yin-deficiency. Yu Jia Yan said: 'One-third external contraction, seven-tenths internal injury'; internal injury is heavier. Mengying)