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Mr. Zhang Wuyuan, my former teacher's mentor, was elderly with a pattern of excess in the upper and deficiency in the lower. Due to mental exertion from handling official documents, he suffered from insomnia during winter and spring. After contracting warm pathogens, he experienced choking cough, dizziness, and fainting. His cun pulses on both sides were flooding (Hong Da). This was due to his usual condition where Yang fails to enter Yin, causing internal wind to rise and overwhelm the head, compounded by the invasion of warm pathogens, stirring up pathogenic factors in both the exterior and interior. Symptoms included dizziness and fainting, sore throat, hoarseness, and a tongue coating black as if scorched by coal. The Heart is the sovereign organ and theoretically should not be invaded by pathogens; however, because Spring-Warmth damaged the Lung, the pathogen transmitted inversely to the Pericardium, shaking the Shen (Spirit). Furthermore, his habitual use of Cinnamon Twig Decoction (Guizhi Tang) and Aconite Pill (Fuzi) led to excessive blazing of Yang fire, depleting Ying (Nutritive) fluids internally. This is the root cause of his palpitations and insomnia. Mr. Zhang mentioned that previously, when suffering from Bi syndrome (painful obstruction) in the feet, a doctor from Huizhou used wind-dispelling herbs combined with Cinnamon Twig and Aconite with good effect, nearly three years ago. I reasoned that wind-dispelling herbs are mostly drying, let alone Cinnamon Twig and Aconite. Considering the pulse, symptoms, and season, it was appropriate to use a mild acrid-cool formula, assisting in extinguishing wind and moistening dryness with yin-nourishing and spirit-calming herbs. One dose would allow him to sleep naturally that night; two doses would eliminate the choking cough and stop palpitations and dizziness.

Initial prescription: Fresh Rehmannia Root (Sheng Di Huang, 3 qian), Glehnia Root (Shashen), Ophiopogon Tuber (Maidong), Light Bamboo Leaf (Dan Zhuye), Trichosanthes Seed (Gualou Ren), Chrysanthemum Flower (Ganju, stir-fried), Gardenia Fruit (Shanzhi), Spirit of Poria (Fushen, each 2 qian), Fritillaria Bulb (Beimu), Sweet Almond Seed (Tian Xingren, stir-fried and ground, each 1.5 qian), Ziziphus Seed (Zaoren, 0.8 fen), Sugarcane Juice (1 cup). These ingredients are clear, light, cool, and moistening; they can eliminate the diffuse pathogenic factors in the Upper Jiao, enter the orifices to extinguish wind-fire, relieve palpitations and dizziness, clear the voice, and calm the cough. Heavy and turbid herbs would be ineffective.

Second prescription: Add Asparagus Tuber (Tiantong), Polygonatum Rhizome (Yuzhu), and Lily Bulb (Baihe) to the previous formula; remove Trichosanthes Seed. After taking six or seven doses, all symptoms subsided, and the tongue color returned to normal. Subsequently, a paste formula was used: Sancai Paste (Three Powers Paste) added with Schisandra Berry (Wuweizi), Walnut Kernel (Hetao), Achyranthes Root (Niuxi), Spirit of Poria (Fushen), Ziziphus Seed (Zaoren), Biota Seed (Baiziren), White Peony Root (Baishao), Polygonatum Rhizome (Yuzhu), and Goji Berry (Qiguo), boiled into a paste and preserved with white honey. It was taken dissolved in warm water. (These herbs can facilitate communication between the Heart and Kidney, calm the mind, benefit the waist and knees, promote mutual nourishment of Metal and Water, and harmonize Yin and Yang, thus preventing the condition of excess above and deficiency below.)

Ms. Wei: Pathogens entered via the nose and lay dormant in the Mu Yuan (Diaphragm Origin). Upon onset, she experienced dizziness and headache, thirst with desire to drink, fever, irritability, vomiting, chest fullness, painful urination, and leukorrhea. The pathogen occupied the Upper and Middle Jiao. The main treatment was Congchi Decoction (Scallion and Fermented Soybean Decoction) to disperse pathogens, assisted by clearing and draining Gallbladder fire. Ingredients: Fermented Soybean (Douchi), Scallion White (Congbai), Gardenia Fruit (Shanzhi), Antelope Horn (Lingyangjiao), Tender Mulberry Leaf (Nen Sangye), Mint (Bohe), Honeysuckle Flower (Jinyinhua), Trichosanthes Root (Huafen), Talc (Huashi). (After two doses, sweating occurred and heat resolved. This was an acute onset where dispersing pathogens led to resolution.)

Relative: Warm pathogens were internally constrained, causing dizziness, heat, and thirst. Palms felt like burning, tongue coating was pale yellow, and cun pulses were floating, large, and rapid. This indicated pathogen retention in the Upper Jiao; it was necessary to regulate the Qi aspect of the Taiyin (Lung). Ingredients: Scutellaria Root (Huangqin, wine-fried), Sichuan Fritillaria Bulb (Chuan Beimu), Almond (Xingren), Gardenia Fruit (Shanzhi), Trichosanthes Seed (Gualou Ren), Ophiopogon Tuber (Maidong), Tender Mulberry Leaf (Nen Sangye), Lotus Leaf Rim (Heye Bian). Decocted in water. After one intake, dizziness and thirst slightly settled. Remove Scutellaria and Gardenia from the original formula; add Fresh Dendrobium Stem (Xian Shihu), Scrophularia Root (Yuanshen), Trichosanthes Root (Huafen), and Sugarcane Juice (mixed in). After two doses, cured. (This was warm pathogen entering from above, resolving through the Qi aspect.)

Another Relative: Pathogen entered via the mouth, causing vomiting, thirst, aversion to heat, greasy tongue, and epigastric fullness. Warm pathogen transformed into dampness. Treatment involved opening and draining the Middle and Upper Jiao. Ingredients: Fermented Soybean (Douchi), Trichosanthes Peel (Lou Shuang), Thunberg Fritillary Vine Stem (Tongcao), Pinellia Tuber (Banxia), Coix Seed (Yiyi), Red Poria (Chiling), Bamboo Shavings (Zhuru), Aurantium Fruit (Zhiqiao), Curcuma Juice (Yujin Zhi, mixed in), Reed Rhizome (Lugen). Decocted in water. After one intake, slight sweating occurred and he recovered. At the same time, Mr. Li had similar symptoms but with dysuria. Added Centella Herb (Dengxin) and Plantago Spike (Cheqiansui) to the previous formula; also cured in one dose. (This was dampness stagnation in the Middle and Upper Jiao, resolving through permeation and leaching.)

Certain Person: Pulse was floating and large, right side rapid, with sweating but intense heat, thirst, dizziness, delirium, and irritability. Warm pathogen carried Wind-Heat, about to sink into the Ying (Nutritive) level. Ingredients: Mint (Bohe), Bullard Milk Vetch Seed (Niubangzi), Antelope Horn (Lingyangjiao), Gardenia Bark (Zhipi), Moutan Cortex (Danpi), Forsythia Fruit (Lianqiao), Tender Mulberry Leaf (Nen Sangye). Taken twice daily. By midnight, profuse sweating occurred, and body temperature cooled. (This resolved by clearing Shaoyang Gallbladder heat.)

Mr. Wu: Pathogen entered the Danzhong (Chest Center), with tongue retraction, cracked lips, closed eyes, unconsciousness, and deep coma lasting seven days and nights. Pulse was deep and rapid. This indicated deep pathogen threatening internal closure. Tentatively used Fresh Pogostemon Herba (Xian Peilan), Acorus Rhizome (Changpu), Forsythia Fruit (Lianqiao), and Honeysuckle Flower (Jinyinhua) to resolve turbidity and open closure; Fresh Rehmannia Root (Xian Shengdihuang), Ophiopogon Tuber (Maidong), Pear and Sugarcane Juice to generate fluids; Scutellaria Root (Huangqin), Anemarrhena Rhizome (Zhimu), Scrophularia Root (Yuanshen), and Dendrobium Stem (Shihu) to penetrate heat. Also administered Cow-bezoar Pills (Niuhuang Wan). After two doses, consciousness gradually cleared. Due to hot and painful urination, removed Pogostemon, Acorus, and Scutellaria; added Licorice Root Tip (Gancao Shao) and Plantago Spike (Cheqiansui) to drain bladder heat, leading to recovery. (This resolved by clearing Heat-Closure of the Pericardium.)

Mr. Zhu: Wind Wood governed the year, warm pathogens were internally blazing. Pulse was rapid, with dizziness, coughing blood. Due to Wood and Fire flaming together, pressing upwards on orifices and collaterals. Tongue was bright crimson; pathogen had entered the Ying level. Ingredients: Fresh Rehmannia Root (Xian Shengdihuang), Antelope Horn (Lingyangjiao), Scrophularia Root (Yuanshen), Forsythia Fruit (Lianqiao), Gardenia Fruit (Shanzhi), Trichosanthes Peel (Lou Shuang), Fritillaria Bulb (Beimu), Moutan Cortex (Danpi), Fresh Lotus Root (Xian Ou). After three or four doses, pulse became quiet and body temperature cooled. (This resolved by clearing Ying heat.)

Mr. Jiang: Labor injured Yin, contracted warm pathogen. Symptoms included choking cough, insomnia, epistaxis, blood-streaked sputum, bloody diarrhea, and a deficient, large, but not rapid pulse. Mistakenly treated with Bupleurum Root (Chaihu) and Kudzu Root (Gegen) for ascending and dispersing, which depleted fluids and stirred wind. Method: Regulate with sweet, sour, neutral, and moistening herbs. Ingredients: Donkey-hide Gelatin (Ejiao, dissolved in water), Ophiopogon Tuber (Maidong), Roasted Licorice Root (Zhigancao), Codonopsis Root (Lushen), Spirit of Poria (Fushen), White Peony Root (Baishao), Ziziphus Seed (Zaoren), Schisandra Berry (Wuweizi), Rehmannia Root (Shengdi), Red Date (Hongzao). After two doses, spirit calmed and bleeding stopped; then consumed rice gruel. Removed Donkey-hide Gelatin from original formula; added Sweet Almond Seed (Tian Xingren) and Chinese Yam (Shanyao). Cured after another dose. (This resolved by tonifying and regulating after pathogen damaged blood collaterals.)

Nephew: Warm pathogen constrained and transformed into heat. Symptoms: dizziness, dry mouth, dry tongue, bleeding lips. Right pulse large, left pulse vague. Sweating without relief, chest and abdominal fullness, turbid urine. Heat steamed dampness; treatment required dispersing heat and dampness from upper and lower. Ingredients: Light Fermented Soybean (Danshi), Trichosanthes Peel (Lou Shuang), Antelope Horn (Lingyangjiao), Moutan Cortex (Danpi), Ophiopogon Tuber (Maidong), Gardenia Fruit (Shanzhi), Red Poria (Chiling), Talc (Huashi), Tender Mulberry Leaf (Nen Sangye), Honeysuckle Dew (Jinyin Hua Lu). After two doses, heat lightened, thirst decreased, dizziness stopped, tongue moistened. However, delirium at night, painful dysuria, dry teeth indicated fluid deficiency and heat depletion. Ingredients: Fresh Dendrobium Stem (Xian Shihu), Reed Rhizome (Lugen), Black Soybean Skin (Heidou Pi), Trichosanthes Root (Huafen), Asparagus Tuber (Tiantong), Scrophularia Root (Yuanshen), Sugarcane Juice. After two doses, sparse red rash appeared; Lung-Wei pathogen had been excreted externally. Continued with light and clear dispersing: Forsythia Fruit (Lianqiao), Bullard Milk Vetch Seed (Niubangzi), Fresh Rehmannia Root (Xian Shengdihuang), Moutan Cortex (Danpi), Red Peony Root (Chishao), Glehnia Root (Shashen), Bamboo Leaf (Zhuye). Rash color faded. Suddenly became irritable and insomniac; tongue center gray-dry, tip crimson. Pathogen entered Heart-Ying. Feared phlegm steaming and blocking orifices; urgently cleared Ying heat and expelled phlegm. Ingredients: Rhinoceros Horn Tip (Xijiao Jian, ground juice - *Note: Substitute with Buffalo Horn in modern practice*), Rehmannia Root (Shengdi), Fresh Lotus Root (Xian Ou), Scrophularia Root (Yuanshen), Moutan Cortex (Danpi), Bamboo Shavings (Zhuru), Fritillaria Bulb (Beimu), Acorus Rhizome (Changpu). After another dose, sweating occurred and he resolved. (This was simultaneous damp-heat excess, resolving by treating Lung-Wei and Heart-Ying.)

Grandnephew: Warm pathogen transformed into heat, causing dizziness and phlegm-cough. Used acrid-cool clearing of the upper. Ingredients: Fermented Soybean (Douchi), Almond (Xingren), Fritillaria Bulb (Beimu, each 1.5 qian), Mint (Bohe), Gardenia Fruit (Shanzhi), Trichosanthes Root (Huafen, each 1 qian), Talc (Huashi), Red Poria (Chiling, each 3 qian), plus Centella Herb (Dengxin) and Mulberry Leaf (Sangye). After two doses, heat receded. Then regulated Stomach Yin with sweet-cool herbs. (This resolved by descending phlegm-heat, treating Lung and Stomach.)

Relative: Warm pathogen reversed into the Pericardium. Consciousness fluctuated between clarity and confusion. Tongue dry, completely lacking moisture. Delirious, manic, refusing clothes and bedding. To sweep away scorching heat-phlegm, urgently used aromatic herbs to resolve turbidity. Ingredients: Rhinoceros Horn Tip (Xijiao Jian, 0.8 fen), Fresh Rehmannia Root (Xian Shengdihuang, 1 liang), Scrophularia Root (Yuanshen), Ophiopogon Tuber (Maidong, each 5 qian), Forsythia Fruit (Lianqiao), Gardenia Fruit (Shanzhi), Curcuma Tuber (Yujin, each 2 qian), Pear and Sugarcane Juice (each 1 cup, mixed in), plus one pill of Zhibao Dan (Treasure of Life Pill). Taken twice daily. All symptoms immediately retreated. (This resolved by large-dose fluid rescue and opening closure.)

Certain Person: High fever, red eyes, irritability, insomnia, widespread maculopapular rash. Urgently used fluid-rescuing and yin-nourishing methods. Tongue turned black and dry, hiccups, syncope. Took large dose of Xijiao Dahuang Tang (Rhinoceros Horn and Rhubarb Decoction) plus Zhibao Dan, without effect. Still used large dose of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), 3-4 times daily, plus Zixue (Purple Snow Powder, 0.3 fen). Hiccups stopped, syncope reversed, body cooled, and he recovered. (This resolved by large-dose cooling the Heart and purging fire.)

Mrs. Ma: Elderly, warm pathogen combined with stagnation. Dampness obstructed epigastrium causing fullness, tongue retraction, thirst with desire to drink, profuse watery diarrhea. This was "heat binding with peripheral flow" (Re Jie Pang Liu). Used Dachengqi Tang (Major Order the Qi Decoction) until stools were black and hard, then damp-stagnation exhausted, epigastric fullness relieved, and tongue moistened. (This resolved by attacking and sweeping damp-stagnation.)

Mr. Pan: Latent pathogen emerged internally, unresolved for ten days. Delirium, deafness, emaciation, pure bloody diarrhea, lip retraction, stiff tongue, deep rapid pulse. Pathogen sank into Blood level; condition critical. Urgently used Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Donkey-hide Gelatin (Ejiao), Scrophularia Root (Yuanshen), Gardenia Fruit (Shanzhi), Fresh Lotus Root (Xian Ou), Black Soybean Skin (Heidou Pi), and Bamboo Heart (Zhuxixin). After four doses, delirium and deafness cleared, bloody diarrhea stopped, appetite for rice gruel returned. (This resolved by treating latent pathogen from the Blood level.)

Child of Chen family: Contracted warm pathogen at one year old. Pathogenic heat internally closed, crimson tongue, dry fluids. Used Ophiopogon Tuber (Maidong), Forsythia Fruit (Lianqiao), Gardenia Heart (Zhixin), Acorus Rhizome (Changpu), Bamboo Shavings (Zhuru), plus Zixue (Purple Snow Powder, 0.2 fen). Resolved by sweating. (This directly purged Heart-Pericardium pathogenic heat.)

Mr. Li: Alternating chills and fever, slight sweating, thirst, choking cough, floating flooding pulse. This was Spring-Warmth invading the Lung. Used mild acrid-cool formula, method for Hand-Taiyin (Lung). Ingredients: Gardenia Fruit (Shanzhi), Light Fermented Soybean (Danshi), Platycodon Root (Jiegeng), Trichosanthes Root (Huafen), Almond (Xingren), Fritillaria Bulb (Xiangbei), Mulberry Root Bark (Sangpi, honey-fried), Mint (Bohe), Sugarcane Juice (mixed in). After two doses, cough reduced. Removed Gardenia, Fermented Soybean, Platycodon, and Trichosanthes Root; added Trichosanthes Fruit (Gualou), Tangerine Peel (Juhong), and Peucedanum Root (Qianhu). Cured. (This pathogen affecting the Lung resolved from the Wei level.)

Mr. He: Rough breathing, red eyes, crimson tongue, red rash, unresponsive spirit, flooding rapid pulse, nighttime irritability and insomnia. Pathogen had entered Ying level. Urgently needed clearing and penetrating. If digestive and fluid-depleting methods were used again, fluid exhaustion and spasms would result. Ingredients: Rhinoceros Horn Juice (Xijiao Zhi - *Substitute Buffalo Horn*), Fresh Rehmannia Root (Xian Shengdihuang), Asparagus Tuber (Tiantong), Ophiopogon Tuber (Maidong), Scrophularia Root (Yuanshen), Red Peony Root (Chishao), Moutan Cortex (Danpi), Forsythia Fruit (Lianqiao), Lotus Root Juice (Ou Zhi), Acorus Rhizome (Changpu). Three times daily. Profuse sweating, heat receded, consciousness cleared. However, right pulse was long and large, indicating lingering Stomach fire. Ingredients: Gypsum (Shigao), White Peony Root (Baishao), Scutellaria Root (Huangqin), Anemarrhena Rhizome (Zhimu), Licorice Root (Gancao). After several bowel movements, pulse normalized. During sleep, fingers twitched slightly, indicating fluid deficiency stirring wind, threatening spasms. Ingredients: Donkey-hide Gelatin (Ejiao, dissolved in water), Rehmannia Root (Shengdi), Uncaria Ramulus (Gouteng), Angelica Sinensis (Danggui), White Peony Root (Baishao), Dendrobium Stem (Shihu), Ziziphus Seed (Zaoren). After several doses, symptoms subsided. (This resolved by nourishing fluids and extinguishing wind for Ying deficiency.)

Mr. Wang: Before Summer Solstice, sudden cold-wind invasion. Pathogen inhaled and lodged in Mu Yuan. Heat, thirst with desire to drink, epigastric rejection, heat steaming dampness, vomiting, chest fullness, midday irritability, greasy white tongue, rapid pulse, turbid urine. Dampness prevailed. Treatment first leached dampness while clearing heat; once dampness is drained, heat becomes isolated. Ingredients: Agastache Stem (Huogeng), Pogostemon Herba (Peilan) to drive out turbidity; Thunberg Fritillary Vine Stem (Tongcao), Talc (Huashi), Reed Rhizome (Lugen) to expel dampness; Trichosanthes Fruit (Gualou), Fritillaria Bulb (Beimu) to wash away phlegm; Antelope Horn (Lingyangjiao), Gardenia Fruit (Shanzhi), Moutan Cortex (Danpi) to clear Gallbladder fire; Fresh Rehmannia Root (Xian Shengdihuang), Forsythia Fruit (Lianqiao), Ophiopogon Tuber (Maidong) to purge Heart fire. Twice daily. Sweating, clear urine, vomiting/fullness ceased, heat/thirst reduced. However, pulse remained rapid, cun pulses large, occasional irritability and insomnia, indicating impending rash. Next morning, rash appeared, tongue coating turned yellow, indicating heat prevailed. Treatment focused on penetrating heat outside dampness so dampness would not rise. Removed Agastache, Pogostemon, Thunberg Fritillary Vine Stem, Talc, Reed Rhizome, Antelope Horn, etc., from original formula. Added Scutellaria Root (Huangqin), Pear Juice (Lizhi) to clear Lung; Bullard Milk Vetch Seed (Niubangzi), Honeysuckle Flower (Jinyinhua), Forsythia Fruit (Lianqiao), Red Peony Root (Chishao) to vent rash; Artemisia Annua (Qinghao), Dendrobium Stem (Shihu), Anemarrhena Rhizome (Zhimu), Glehnia Root (Shashen) to reduce heat and generate fluids. After two or three doses, profuse sweating, uniform pulse, yellow coating disappeared. Daily consumption of hot barley porridge restored Yin and achieved complete recovery. (This resolved by separating and benefiting damp-heat, and cooling/rash-toxin.)