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Constitution is deficient, with multiple births; this time, after being pregnant for three months, she suffered a miscarriage (half-birth). Qi followed the blood in its loss, leading to frequent syncope. Fortunately, life was saved by Dushen Tang (Single Ginseng Decoction).

Recently, fever persists without abating, accompanied by occasional aversion to cold, a white tongue coating, and a preference for hot drinks. There is headache and physical fatigue. The pulse is rapid yet forceless. Synthesizing the pulse and symptoms, it is clearly a deficiency of both Qi and Blood. Even if there are external pathogens, one must hesitate to attack them due to the fragile state of the vital organs (fear of harming the host while trying to eliminate the pest). Danxi stated: "Postpartum treatment should primarily focus on greatly tonifying Qi and Blood, treating other conditions as secondary." Following the principle of using sweet-warm methods to eliminate great heat.

In the afternoon follow-up consultation, the pulse appeared similar. After taking medicine in the morning, she slept peacefully for a while, but soon experienced alternating chills and fever. This belongs to dual deficiency of Yin and Yang, where Zheng Qi (Upright Qi) is insufficient to resist; it is not malaria. Administer another dose of the residue from the original prescription, and discuss further tomorrow. After two administrations of sweet-warm formulas, yesterday at noon, severe fever followed chills. While being supported out of bed, urinary incontinence occurred. Fever did not gradually subside until midnight. I deeply fear that chills and fever will recur this afternoon, overwhelming her strength. Speculating on the cause of these chills and fevers, it is either a dual deficiency of Yin and Yang, or Zheng Qi deficiency allowing pathogenic invasion. In this critical situation, regardless of the presence of pathogens, the sole focus is on supporting Yuan Qi (Primordial Qi) and consolidating the root. Assisting Zheng Qi is indeed the way to dispel pathogens. Materia Medica states that Ren Shen (Ginseng Radix) can restore Yuan Qi from the realm of nothingness. Ancients relied entirely on the power of Ren Shen to manage cases of Qi following blood loss. Although the dosage of yesterday's medicine was increased, it lacked the potency of Ren Shen, hence the lack of efficacy. Yesterday at noon, chills and fever returned, and mental and physical exhaustion worsened. After the second watch (10 PM - 2 AM), the fever gradually subsided. However, rising from bed and exertion immediately triggered syncope. Upon entering the consulting room just now, syncope recurred. Continuous administration of large doses of warm-tonic medicines has yet to show results. If one claims the chills and fever are due to external factors, seeing such a wretched condition, how can one continue to treat only the branch manifestations? Still adhering to the original prescription, supplemented with He Che (Placenta Hominis), urgently to salvage Zhen Yuan (True Primordial Qi). Physicians should treat the person, not just the disease.

Last night, syncope occurred frequently. Just now, upon examination, the Right pulse was weak and soft, while the Left still showed a rapid rate. The body is fatigued and weak, Qi is timid, and speech is reluctant. The signs of deficiency are undeniable. The illness stems from constitutional deficiency and miscarriage, compounded by entangled chills and fever, creating turbulent waves. Currently, fever has subsided and consciousness is clear, showing minor efficacy. However, the onset of the disease was violent; the house of health is shaking. The previous discussion of tonifying Yuan Qi and Guipi Tang (Restore the Spleen Decoction) has progressed further to nourishing Ying (Nutritive) Qi.

Two days have passed without consultation, and the pulse remains unchanged. During the previous fever, the pulse became rapid due to heat agitation. Now that external heat has subsided, it should theoretically be缓和 (moderate/soothing). Why has the rapidity not yet normalized? The mouth is not dry or thirsty, indicating no fire signs. It is simply that excessive blood loss during childbirth caused a deficiency of Ying Yin (Nutritive Yin). Since the pulse is a derivative of blood, it remains rapid and irregular. However, all medicines are herbal roots; when True Primordial Qi is depleted, how can it be swiftly restored? With Ren Shen's potency difficult to achieve and no other strategies available, the previous formula had pungent-warm substances removed, slightly supplemented with gentle-moistening items.

Postpartum metrorrhagia and syncope involve a great deficit of Qi and Blood, with an unstable pivot of Yin and Yang, presenting various signs of exhaustion. Relying on various warm-tonic medications, efforts were made to salvage the patient. Chills and fever have been eliminated, stomach Qi is harmonious, and appetite has returned. Unfortunately, events are full of setbacks; a carbuncle developed on the buttocks. Pain and discomfort persisted. After the abscess ruptured and pus drained, pain slightly stabilized. Then, damp-pathogen invasion occurred, causing abdominal pain and diarrhea—complications arising unexpectedly. Temporarily administered Xiangsha Liujun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction). After pain and diarrhea resolve, vigorous tonification of True Primordial Qi is still required, hoping for recovery.

An Bo's commentary: The Master's prescriptions are invariably accurate, and dosages are never wasted. However, this woman's True Primordial Qi is already ruined, and death is imminent. We are merely doing our human best.