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Madam Sheng, in the summer, suffered from a heat disease characterized by intense internal heat, absence of sweating, irritability, thirst, mental confusion, and delirium. After more than ten days of treatment without relief, while her husband was away on business, her son-in-law, Mr. Yin Qian (Tingyu), requested my consultation.

Upon examination, I found her pulse rapid and tongue coating yellow, and stated to him: "This is a heat disease; it must be treated with clearing methods." I prescribed Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) for her.

Around midnight, urgent knocking was heard at the door. Upon opening it, Mr. Yin entered in panic, saying, "The condition is critical." When asked why, he explained: "After taking your excellent prescription, she took the first decoction, but showed no reaction by evening. After taking the second decoction, she became even quieter, then suddenly experienced chills and limb tremors. Shortly after, she sweated profusely like syrup, her skin became cold, breathing weak, eyes closed, and unresponsive. Everyone thought she was dying and blamed the medicine for being too cooling. They wanted to administer Shenfu Tang (Ginseng and Aconite Decoction) to rescue the collapsing Yang, and urgently sought a re-examination to decide."

I went immediately. Touching her skin, it was indeed cold, but upon careful palpation, although the pulse was deficient, its rhythm was harmonious and moderate, not rapid or frantic. I said, "No need to worry. This is 'Zhan Han' (Battle Sweat). Due to insufficient constitutional Qi and rampant pathogenic factors, I used heavy clearing agents to drive out the pathogens. The pathogens could not remain, so they contended with the healthy Qi, resulting in shivering followed by sweating. Although the pathogens are resolving, the healthy Qi is also depleted. Let her rest quietly; do not disturb her. Once Yuan Qi (Original Qi) recovers, her skin will naturally warm up, and consciousness will return. If we suddenly administer Shenfu (Ginseng and Aconite), there is a fear that residual heat may flare up again, causing harm."

Ye Tianshi, in his discussion on warm diseases resolving through battle sweat, mentioned that after resolution, stomach Qi is empty, citing cases where skin remains cold for twenty-four hours. I showed them the book, and their doubts were dispelled. I prescribed another formula: Shengmai San (Generate the Pulse Powder) added with Fushen (Poria with Hostwood), Yuzhu (Polygonatum Odoratum Rhizome), Baishao (White Peony Root), and Gancao (Licorice Root). I instructed them to have it decocted and administered once she regained consciousness, along with some thin rice gruel to nourish Stomach Qi.

The next morning, Mr. Yin came to thank me, saying: "If not for your firm judgment last night, we would almost have been misled by others' remarks. Following your advice to keep quiet, after that period passed, the sweat stopped and spirit returned. We hurriedly gave the decocted medicine, and she slept until dawn. Her skin is now warm, only feeling physically tired and mentally sluggish." Subsequently, using methods to support Zheng Qi (Upright Qi), nourish Yin, and harmonize the Stomach, she gradually recovered.

An Bo notes: If this syndrome presented with a rapid and forceful pulse, spontaneous sweating like rain, restlessness and irritability, and unsettled spirit, it would indicate collapse of Qi and floating of Yang. In such a case, large doses of Yang-restoring formulas should be administered immediately. This is vastly different from the case described above.