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The illness has persisted for twenty days. Initially, there was sore throat. Although cooling agents were administered repeatedly and the sore throat improved, complications arose: tongue stiffness, slurred speech, reduced appetite, physical fatigue, dizziness, numbness in the feet, and palpitations at Xulij (the area over the heart apex), presenting a picture of deficiency. One must strictly guard against transformations induced by internal Liver wind. If one fears that residual heat has not been extinguished, the method should be to strengthen Water and nourish Yin; there is absolutely no reason to use bitter-cold herbs again. The tongue is the sprout of the Heart, and the Kidney meridian connects to the root of the tongue; therefore, treatment should seek the way of mutual interaction between Water and Fire from the perspectives of both the Heart and the Kidney. In the morning consultation, it was stated that changes due to Liver wind should be prevented. However, in the afternoon, sudden facial paralysis (deviation of mouth and eyes), palpitations, and limb twitching occurred. This indicates deficiency of true Yin in the lower Jiao, where Water fails to nourish Wood, causing internal wind to stir, raising further fear of convulsions and syncope (Jing-Jue). The Classic states: "The Liver dislikes tension; urgently eat sweet flavors to relieve it." I followed the method of Qianjin Fumai Decoction. Over the past few days, Liver wind has subsided, but appetite remains low with nausea. Humans rely on Stomach Qi as their foundation; after a long illness with righteous Qi depletion, recovery depends entirely on dietary support. If Stomach Qi is not robust, medicinal efficacy will be difficult to achieve. The root cause lies in the previous throat condition, where decoctions and powders were used excessively, damaging the Spleen and Stomach through excessive cooling. There is no need to worry about fire; rather, one should fear transformation into deficiency-cold. The Spleen opens into the mouth; when the Spleen is harmonious, the mouth can perceive the five flavors. Cold sensation in the mouth without thirst is clear evidence of Spleen-Stomach deficiency-cold. I prescribed warming and nourishing Spleen Yang, imitating the intent of Lizhong Wan and Liujunzi Tang. After two doses, vomiting ceased and Stomach Qi stabilized, yet symptoms such as palpitations at Xulij, tongue stiffness, and facial paralysis had not improved, and deficient wind had not ceased. With reduced grain intake and weak Stomach Qi, it is indeed necessary to assist Spleen Yuan and establish Middle Qi. However, Earth is generated by Fire; since it is both deficient and cold, one must also supplement its mother (Fire).

An Bo notes: I proposed combining Zhang Jingyue's Siwei Huiyang Yin with Liuwei Yigong Jian.

A few days prior, during consultation, I considered this to be a case of constitutional deficiency, where summer-heat injured Stomach Yin. Various vomitings and acid regurgitation belong to heat. I discussed imitating Huangtu Daohua Tang to nourish the Stomach and cleanse pathogens. After taking the medicine, vomiting decreased and heat alleviated, but the greasy tongue coating remained, the pulse remained rapid and unharmonious, sleep was still unsatisfactory, and there was mental restlessness and body agitation. With righteous deficiency and lingering pathogens, the approach was to support righteousness while managing residual waves. Although the therapeutic method was not incorrect, the regret was that prolonged heat and frequent vomiting led to extreme physical exhaustion, closed eyes with little spirit, indicating injury not only to Yin but also to Qi. The concern was not whether the pathogen would be eliminated, but whether righteousness could be maintained. One cannot rely on the slight reduction of vomiting as a minor success and become complacent. Last night, sleep remained disturbed. At Si hour today, suddenly consciousness was lost and teeth were clenched, resembling convulsions. The yellow-greasy tongue coating was worse than before. Although the syndrome had lasted several days, latent pathogens had not emerged, and the constitution was inherently deficient. Moreover, after three pentads (15 days), both dispelling pathogens and supporting righteousness were difficult. Summer-heat tends to injure the Heart, and wind tends to injure the Liver; entering the Heart causes coma, entering the Liver causes spasms, making the danger so severe. I tentatively formulated Ganlu Yin combined with Gan Yi Laoren Tang to nourish righteousness and cleanse pathogens, holding steady without change, hoping to turn danger into safety. Summer-heat hides internally and manifests late in autumn. Previously, seeing the rampant heat, cooling was unavoidable. Fearing that righteous Qi could not withstand it, I supplemented with nourishing Yin and consolidating the root to prevent convulsions and collapse-type heat variations. The condition was lighter in the morning and heavier in the evening, with thirst, mental irritability, and a yellow tongue coating turning black, confirming blazing internal heat. If urgent preventive measures ("moving the firewood from under the cauldron") are not taken, disastrous consequences ("scorched heads and broken foreheads") will surely follow. Fortunately, the heat receded, allowing for a smooth path. Constitutional deficiency with latent summer-heat, lasting many days; although pathogenic heat decreased, righteous Qi became more deficient. The patient reported internal burning irritability and thirst for cold drinks, confirming that pathogenic heat was not cleared. However, given the extreme physical fatigue, cooling herbs could hardly be advanced again. As stated in the previous case, "not worrying about the failure to eliminate pathogens, but worrying about the failure to maintain righteousness," is indeed not false. Knowing that excess pathogens and deficient righteousness preclude direct purgation, and unaware that accumulated pathogenic heat was blazing, leading to a scorching tongue coating, confusion, and impending syncope, the discussed strategy of nourishing Yin, consolidating righteousness, clearing heat, and cleansing pathogens seemed inadequate upon seeing these signs. With pathogens not cleared and righteousness on the verge of collapse, how could treatment proceed? Combining Fumai Tang and Shengmai San, I hoped for success. Yesterday, I formulated a plan to urgently consolidate True Yuan to save the critical state. During the night, there was wild shouting, fainting, and sweating. By dawn, consciousness gradually returned, the large pulse slightly converged, facial redness slightly receded, the tongue coating remained yellow, thirst persisted, and slight heat remained on the forehead and palms, with fatigue unchanged. Only when asked about the origin of the disease could the patient respond slightly, which was somewhat better than yesterday's comatose state. Constitutional deficiency carrying pathogens, entangled for four pentads; righteous deficiency is self-evident, and residual embers seem unextinguished. Although bitter-cold herbs are contraindicated, sweet-cold herbs can be used as adjuvants. The syndrome has approached a month; recovering from danger, although due to sticky latent pathogens being difficult to drive out rapidly, it is also because righteous Qi is insufficient and lacks the strength to expel them. In treating diseases of constitutional deficiency compounded by external contraction, the beginning is the most difficult to handle, unlike robust constitutions where releasing the exterior or purging the interior easily eliminates pathogens and cures the disease. Clear mind and spirit suggest a turning point, but muscle heat has not receded, and the urge to defecate exists without passage. This is certainly not caused by excess heat, but by unextinguished deficient flames. I still propose nurturing Yin, consolidating righteousness, moistening fluids, and preserving Jin-Ye. When Yin blood moistens downward, bowel movement will naturally occur. Despite nourishing Yin and moistening, the bowel remains unemptied, heat is not fully cleared, and the patient reports mental irritability, thirst, and preference for raw/cold foods. This generally belongs to prolonged heat injuring Yin and hijacking Jin-Ye. Although Zhang Zhongjing had the method of urgent purgation to preserve Jin-Ye, with currently unstable righteous Qi, how could such a prescription be considered? Examining the theories of Zhang Jiabin and Gao Gufeng regarding cold damage and warm-summer fevers, where intense heat injures Yin leading to black tongues and constipation, they all used Zuogui Wan, Liuwei Dihuang Wan, and Ganlu Yin instead of Baihu Tang and Chengqi Tang. Although见效 (effectiveness) was slower, it was steadier and safer. I strictly followed their principles. The syndrome was lingering and unpredictable. Current pulse is fine/weak, physical fatigue, Qi sinking—all are deficiency signs. External heat has lightened, tongue coating has receded, so internal heat is likely minimal. Bowel unemptied, abdomen painless, let nature take its course. Hunger returns, consuming congee, Stomach Qi gradually opens. Focus entirely on consolidating the root and cultivating Yuan Qi. At this critical juncture ("nine ren" deep), extra caution is paramount.

An Bo notes: This syndrome is extremely numerous and critical, fitting indications for Zixue Dan, Niuhuang Zhibao Dan. Meticulous observation and concentration are required. Since the patient previously suffered from deficient Liver wind, I decided to focus on the four characters "Extreme Heat Injuring Yin." A slight lack of attention could lead to death upon administration of medicine; how can one not be cautious?

Another note: Recently, Mr. Wu Jutong's Zengye Method, taking the meaning of "adding water to help the boat move," has profound significance. My treatment of this syndrome has been very effective. The response is immediate like a drumstick striking a drum, so I reference it to enlighten future students.