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Wang Hu commented: Generally speaking, in the treatment of cold damage (Shanghan), if the exterior syndrome is urgent, sweating should be induced immediately; if the interior syndrome is urgent, purgation should be applied immediately. One should not rigidly adhere to the sequence of sweating first and then purging. If sweating and purging are applied appropriately, the treatment will not result in adverse reactions. How clear and appropriate this statement is! From this perspective, Zhang Zhongjing's use of the Taohe Chengqi Tang (Peach Kernel Decoction to Order the Qi) and Didang Tang (Definitely Sinking Decoction) in these two clauses demonstrates to people the treatment principles of flexibility and adaptation between the Taiyang (Greater Yang) and Yangming (Yang Brightness) channels. Simultaneously, it introduces formulas for Yangming disease, which is beyond doubt. In Zhang Zhongjing's clinical practice at that time, such instances originally existed. However, we living today reading the *Treatise on Cold Damage* (Shanghan Lun) must not stubbornly regard this as a fixed method for using these two formulas. If one is overly dogmatic, these two formulas may never be used again, and patients suffering from the syndromes corresponding to these formulas will forever be deprived of their primary treatment. Is this not lamentable? Readers, please examine the medical records listed for each of the two formulas. Are there any cases of Taiyang disease? None. Thus, it can be known that these two formulas indeed belong exclusively to Yangming disease, without doubt. I privately believe that the theory of "Taiyang Channel and Fu-organ" has become prevalent. Wise men do not point out its errors but are instead confused by it. Therefore, I do not spare words to analyze and refute it.

Syndrome of Didang Wan (Definitely Sinking Pill)

The wife of Qian Qinbo from Luyuan, Changshu, had her menstruation stopped for nine months. There was a mass in her abdomen causing attacking pain, and she knew herself that it was not pregnancy. The doctor prescribed multiple doses of Sanleng (Sparganii Rhizoma) and Ezhu (Curcumae Rhizoma), but there was no response. They then invited Mr. Chen Baohou for diagnosis. Mr. Chen said: "Sanleng and Ezhu can only treat blood stasis in its initial stage. Once it has already formed a mass, their strength is insufficient. I have medicine that can cure it. However, there will be a reaction after taking the medicine; hopefully, the patient will not curse me." The host agreed. At that time, three qian of Didang Wan were given, taken with boiled water. During the night, the patient crawled repeatedly on the bed, unable to bear the abdominal pain, and indeed cursed the doctor incessantly. Just before dawn, accompanied by stool passage, a large amount of foul matter was discharged. The color varied, mixed with yellow, white, and red. Only then was the pain greatly relieved. On the second day, during the follow-up visit, Mr. Chen asked: "Did you curse me last night?" The host could not hide the truth and told him everything. Then, Jiawei Siwu Tang (Modified Four Substances Decoction) was prescribed. After regulation, the patient recovered.

Cao Yingfu said: For phlegm-fluid retention syndrome, there is Shizao Tang (Ten Date Decoction); for blood-stasis syndrome, there are Didang Tang and Didang Wan. All of these can break through barriers and save lives from deathbeds. Modern practitioners of Huangdi and Neijing (traditional Chinese medicine) often fear their fierce and drastic nature and dare not use them. Even when occasionally used, they are strongly opposed. I do not know what their intentions are.

Syndrome of Baitouweng Tang (Baitouweng Decoction)

No. 14, Zhaofang Nong, Fangbang Road, Mi You. An eighty-year-old woman, whose constitution was robust, suffered from heat-dysentery with tenesmus. Both pulses were large, the tongue coating was yellow, and she could not sleep peacefully at night. It was appropriate to use Baitouweng Tang as the main formula.

Baitouweng (Pulsatillae Radix) 3 qian, Qinpi (Aceris Cortex) 3 qian, Chuanlian (Coptidis Rhizoma) 5 fen, Huangbo (Phellodendri Cortex) 3 qian, Sheng Chuanjun (Rhei Radix et Rhizoma) 3 qian (added later), Zhishi (Aurantii Fructus Immaturus) 1 qian, Taoren (Persicae Semen) paste 3 qian, Mangxiao (Natrii Sulfas) 2 qian (dissolved separately).

[Commentary] The surnamed Mi woman was poor. She had one son, now over thirty years old, who sold second-hand goods and was unmarried. Her mother lay in bed ill for a month. With no money to hire a doctor, how could she afford herbal medicine? The son personally cleaned all excrement from the chamber pots. Mr. Shi Huifu had an aunt living nearby. Hearing of the woman's suffering, he generously paid for a doctor to visit. This case's prescription was both the initial and final prescription. Why? After the old woman took this formula, she achieved free bowel movements and peaceful sleep. What more could she ask for? According to standard practice, post-illness regulation should follow. But the woman felt uneasy about troubling the doctor to travel far, so she was allowed to go home. She eventually regained health comparable to that of a middle-aged person.

I still recall treating a patient surnamed Yang with Baitouweng Tang. The pulse record stated: Diarrhea with bright red blood, twenty times a day, no exterior syndrome, thirst with desire to drink water, pulse was flooding (Hongda). The classic states: "Heat dysentery with tenesmus," and also: "Diarrhea with desire to drink water is due to heat; Baitouweng Tang governs it." The ingredients were: Baitouweng 3 qian, Qinpi 3 qian, Zhishi 2 qian, Huanglian (Coptidis Rhizoma) 5 fen, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 1.5 qian, Huangqin (Scutellariae Radix) 1.5 qian, Huangbo 3 qian. The follow-up visit showed great efficacy.

When there is heat in the intestines accompanied by dry fecal masses, this is excess heat, and Chengqi Tang (Order the Qi Decoction) is appropriate. When there is heat in the intestines without dry fecal masses, this is deficiency heat (speaking comparatively, meaning emptiness), and Baitouweng Tang is appropriate. When there is excess pathogenic factor in the stomach, the vomiting method is appropriate, using Gouti San (Melon Dispersant Powder).

When there is deficiency heat in the stomach (also speaking comparatively), the clearing method is appropriate, using Baihu Tang (White Tiger Decoction). Thus, having Baihu Tang in the stomach is no different from having Baitouweng Tang in the intestines. Having Chengqi Tang in the intestines is no different from having Gouti San in the stomach. However, the stomach suffers from deficiency heat more often than from excess pathogens; the intestines suffer from excess heat more often than from deficiency heat. Zhang Zhongjing selected the common and frequent patterns as the rule. Therefore, he established Baihu Tang and Chengqi Tang as the principal treatments for Yangming disease, while using Gouti San and Baitouweng Tang as auxiliary treatments. If one asks why the intestines suffer from excess heat more often and the stomach from deficiency heat more often, the answer is: The stomach is above the intestines, and the intestines are below the stomach. What is above can transmit downward, but what is below cannot return upward. The classic insight reveals this, making one smile.

Syndrome of Pig Gallbladder Suppository

My disciple Zhang Yongnian narrated a case of his relative, surnamed Chen. A physician from Siming, Mr. Zhou, achieved success using the pig gallbladder suppository method, which is worth reference. He said: The Chen patient initially suffered from hemoptysis, with purple-black blood. After Western doctors used a hemostatic injection, the bleeding stopped. The next day, the patient's abdomen became full, and exhaustion increased daily. Half a month passed, and defecation did not occur. Honey suppositories were tried first but failed; enemas were tried but failed. Various Western laxatives were used, but ultimately failed. Someone told Chen: "Your fellow townsman Mr. Zhou is a good doctor." Chen was pleased and sent for Mr. Zhou. By then, it had been a month since the last bowel movement. Upon arrival, Mr. Zhou examined the pulse and found no abnormality; the disease was solely in the intestines. He instructed the family to find a pig gallbladder, pour it into a bowl, mix with vinegar, and use a Western enema device to administer it. As soon as it was infused, continuous flatus occurred. Within an hour, stool was discharged. It was about three cun long, made a sound when thrown on the ground, and was undamaged even when struck with a stone. It was soaked in clear water, and within half a day, the water turned completely red. It was realized that the blood vomited earlier was pathological blood. Because Western doctors stopped it with needles, it descended and coagulated in the large intestine, becoming the cause of disease. Seven days later, defecation ceased again. The previous method was repeated, and several hard fecal masses, each about three cun long, were discharged. The illness was then cured. From this, I realized that honey suppositories are suitable only for milder conditions. Tuagen (Trichosanthes Root) is difficult to obtain. Only pig gallbladder is available anytime and anywhere. Modern physicians abandoning good prescriptions is truly regrettable.

[Commentary] This case appears in *Shanghan Fawei*. Since it serves as a unique model, it is specially transcribed here. Whenever defecation has not occurred for many days, even more than ten days, and there is no diarrhea of clear fluid, this indicates dry fecal masses lodged in the rectum. The feces adhere tightly to the intestinal wall, so the more they accumulate, the harder they are to pass. At this time, if treated with Xiaoshi (Mirabilitum) and Dahuang (Rhei Radix et Rhizoma), not only would it be ineffective due to distance, but it would also vainly damage stomach qi and harm the innocent. This is why suppository methods were created. Honey suppositories are mild, but if used correctly, they can achieve superficial results.

A friend, Mr. Huang, had a grandmother over ninety years old. After being ill for ten days, she had no bowel movement, no appetite, and extreme fatigue. Doctors were at a loss and dared not prescribe. Finally, an enema device was used to infuse honey juice. After the feces were discharged, all symptoms receded, and she lived out her natural lifespan. This is an example. Recently, pharmacies have produced glycerin suppositories, which are more convenient to use and can serve as a substitute. If two or three suppositories fail to produce results, further application is permissible. Because if the intestinal wall has severe heat, two or three suppositories may not be sufficient for lubrication. If honey juice or suppositories are inadequate, pig gallbladder must be used. Human bile naturally has the function of moistening the intestines; using pig gallbladder as a substitute is a variation of organ therapy.

Mixing pig gallbladder with a little vinegar seems intended to borrow the vinegar's ability to stimulate the intestinal wall and promote peristalsis. Therefore, in the preparation of honey suppositories, a small amount of soap pod powder is sometimes added, which is essentially the same idea. Blowing a small amount of soap pod powder into the nostrils induces sneezing; how powerful is its stimulating effect?

Syndrome of Maziren Wan (Hemp Seed Pill)

Xu Zuo could eat, sweated at night during sleep, suffered from insomnia, had a large pulse, and difficulty passing stool. This is Pi Yue (Spleen Confinement).

Pi Yue Ma Ren Wan (Spleen Confinement Hemp Seed Pill), one liang, divided into three doses, taken with boiled water.

[Commentary] The original formula for Maziren Wan consists of: Maziren (Cannabis Fructus) two sheng, Shaoyao (Paeoniae Radix) half a jin, Zhishi (Aurantii Fructus Immaturus) half a jin (stir-fried), Dahuang (Rhei Radix et Rhizoma) one jin (peeled), Houpo (Magnoliae Officinalis Cortex) one chi (stir-fried, peeled), Xingren (Armeniacae Semen Amarum) one sheng (peeled, tip removed, roasted, processed separately into fat). These six ingredients are mixed with honey and formed into pills the size of paulownia seeds. What is commonly called Pi Yue Ma Ren Wan in modern pharmacies is exactly this formula. This formula uses Maziren as the sovereign herb. All seed kernels contain oil, which functions to moisten and descend. Thus, it is borrowed to relieve constipation and is suitable for patients with weak constitutions who cannot withstand harsh purgation.

The above seven syndromes, from Da Xiexiong Tang (Major Chest-Sinking Decoction) to Maziren Wan, although differing in urgency, all involve the purgative method. Some focus on chest binding (Jie Xiong), some on blood stasis, some on stored blood, some on heat dysentery, and some on intestinal dryness. The disease location may bias toward the upper, middle, or lower parts. Purgation leads to unblocking; unblocking leads to cessation of pain. This is the general principle for treating Yangming heat accumulation.

Lower Volume

Mental Confusion

[Commentary] My friend, Mr. Shi, is from Chongming and works at the Shanghai Telegraph Bureau. One evening in early autumn of the Jiaxu year, he hurriedly invited me to treat his younger brother. Entering his room, I saw the patient lying supine on a couch. Asking about his complaints, he gave no response. I found this strange. Privately, I said to Mr. Shi: "Has your brother been deaf for a long time and cannot hear, or does he have a stiff tongue and cannot speak?" Both replied: "No." I was even more astonished. Palpating his pulse, one hand was flooding (Hongda), the other was deep and thin. Which was left and which was right, I cannot remember now. I then asked the family about the cause of the illness. They said: "He previously held a telegraph position in a certain army. Due to an incident, he was frightened, and subsequently felt mentally confused. Whenever guests came, he would sit silently facing them; after they left, he would sing disorderly. His diet and bowel/bladder functions were like those of a normal person. Only when eating, there was occasional steaming of hot qi from the Que Shang (area above the nose/bridge of the nose). Lightly, it resembled morning clouds emerging from mountains; heavily, it resembled smoke from a kiln. The appearance was quite strange. Previously, he was sent to a famous hospital in this city for treatment. After more than twenty days, the doctors still did not recognize what disease it was. Since they had no method to treat it, he was discharged yesterday. Please, sir, diagnose him." I carefully palpated his abdomen. It was absolutely not distended, nor did he resist pressure. I pondered for a long time but could not discern the crux of the syndrome. Thus, I declined, citing my incompetence, and left shamefully. The next day, Mr. Shi told me: "My brother's illness was treated by Mr. Cao Yingfu yesterday. After taking medicine, he had a massive purge, and the hot qi in the Que Shang subsided." I was startled upon hearing this, rushed to visit, and viewed the prescribed formula. I recalled the end of the case note briefly stating: "This is what Zhang Zhongjing calls Yangming disease. It is appropriate to purge, governed by Da Chengqi Tang (Major Order the Qi Decoction)." The formula was: Sheng Dahuang 3 qian, Zhishi 3 qian, Mangxiao 3 qian (dissolved), Houpo 1 qian. Several days later, I met Mr. Shi again. He informed me that his brother, after taking the medicine, could get up and had stopped singing. However, he suffered from distending pain in both hypochondria. After treatment by Master Cao, it had just healed. Examining the formula, it was Xiao Chaihu Tang (Minor Bupleurum Decoction).

Chaihu (Bupleuri Radix) 3 qian, Huangqin 3 qian, Dangshen (Codonopsis Radix) 3 qian, Banxia (Pinelliae Rhizoma) 3 qian, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Dazao (Jujubae Fructus) 12 pieces, Gancao 2 qian. Since then, Mr. Shi's brother seemed to be recovering. However, he still suffered from spontaneous sweating and lack of spirit. Master Cao administered Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell), and one dose cured him.

Chuan Guizhi (Cinnamomi Ramulus) 3 qian, Da Baishao (Paeoniae Radix Alba) 3 qian, Sheng Gancao 2 qian, Shengjiang 3 slices, Dazao 12 pieces, Hua Longgu (Fossilia Ossis Mastodi) 5 qian, Duan Muli (Concha Ostreae) 5 qian (the latter two decocted first). From then on, his health exceeded that of ordinary people. One day, walking with his brother, he encountered me on the road. They smiled and nodded as they passed. The next day, meeting Mr. Shi, I asked what his brother said on the road yesterday. Mr. Shi said: "Nothing." I insisted on asking, and he laughed, saying: "He said my brother's pulse diagnosis was inaccurate." I could not help but feel ashamed again. Thus, I deeply admired my master's miraculous medical skills and presented gifts to join his school.

[Further Commentary] The patient in this case seemed to suffer from what is called mental illness or neurosis. However, Western medicine using neurological drugs showed no effect. Traditional Chinese medicine using classical formulas achieved significant results. The principle is profound and unfathomable. It is perhaps what is meant by 'treating diseases requires seeking the root.' The initial formula was a Yangming formula, the second a Shaoyang (Lesser Yang) formula, and the final a Taiyang formula. Using these three formulas to unblock the stagnation of these three channels, all illnesses were cured. Perhaps when he caught a chill that day, the meridians and organs throughout the body became stagnant due to fright? However, diet and bowel/bladder functions were normal, the abdomen did not hurt, and he did not resist pressure. Who would dare use Chengqi Tang? Yet my master, solely because of the hot qi in the Que Shang, boldly used it. This is likely what is meant by 'seeing one symptom is sufficient; it is not necessary that all symptoms be present.' Cao Yingfu said: "I could not identify this syndrome either. Only by palpating the pulse did I see that the right pulse was extremely flooding and the left pulse was extremely minute. Yin was insufficient and Yang was excessive. I thought it was the pulse of Shaoyin losing to Duyang, and not a counterflow syndrome. Combined with the hot qi emerging from the Que Shang, the condition belonged to Yangming, matching the flooding right pulse. Thus, I decided it was a definite indication for Da Chengqi Tang, without expecting such a rapid response."

Intestinal Abscess I

Shi Huifu resided on the third floor, No. 775, Fangbang Road, inside the city of Shanghai.

[Commentary] Mr. Shi Huifu previously came for consultation regarding his illness. He said: "I frequently suffer from abdominal pain. Medication provides slight relief, but it recurs every other day. Doctors consider it hernia and commonly use qi-regulating agents." I examined him carefully and determined it was intestinal abscess, which Western medicine calls appendicitis or peritonitis. It should be treated with purgation. It improved slightly but relapsed after a few days. The case and prescription are as follows.

Abdominal pain biased to the right, recurring after improvement, dry and bound stool. Prescribe Dahuang Mudan Tang (Rhubarb and Moutan Decoction).

Sheng Chuanjun 1.5 qian, Yuanmingfen (Mirabilitum) 3 qian (dissolved), Taoren 2 qian, Danpi (Moutan Cortex) 2 qian, Baijiangcao (Patriniae Herba) 3 qian, Sheng Yiren (Coicis Semen) 4 qian, Shu Fuku (Aconiti Lateralis Radix Praeparata) 1 qian, Zhishi Tan (Aurantii Fructus Immaturus Charred) 2 qian, Da Baishao 2 qian, Foshou (Citri Sarcodactylis Fructus) 1.5 qian. This was the prescription for April 18th. After three doses, a large amount of material was discharged, and abdominal pain decreased significantly. By the 25th, only faint pain remained in the affected area. A different doctor treated him with formulas to vent Jueyin qi. The formula was: Ruan Chaihu (Bupleuri Radix) 1.5 qian, Zhishi Tan 2 qian, Da Baishao 2 qian, Qingchenpi (Citri Reticulatae Pericarpium) and Chenpi each 1.5 qian, Yunling (Poria) 3 qian, Xiangfu (Cyperi Rhizoma) 2 qian, Jinlingzi (Meliosmae Fructus) 3 qian, Zhi Rumei (Commiphora Resina and Boswelliae Resina) each 0.8 fen, Xiaohuixiang (Foeniculi Fructus) 0.8 fen, Zhi Gouji (Evodiae Fructus) 3 qian, Qingjieye (Citri Reticulatae Folium) 1.5 qian, Lulutong (Liquidambaris Fructus) 3 qian. After one day of administration, the illness neither advanced nor retreated. On the second day, abdominal distension worsened, and he requested consultation again. Examination revealed that the previously right-sided abdominal distending pain had now spread to distension on both sides of the entire abdomen. Pressure elicited little resistance. The six characters from the classic, "abdominal skin tight, soft upon pressure" (Fu Pi Ji, An Zhi Ru), accurately described the situation and could not be altered. The patient frowned and reported: "What shall we do?" I said: "Do not worry, the previous formula can still be used." So I wrote: "Intestinal abscess recurs after temporary relief. Current examination shows distension around the lower abdomen, soft upon pressure, faint pain, and unsatisfactory bowel movements. Again prescribing the original method."

Sheng Chuanjun 3 qian, Fen Danpi 3 qian, Dongguazi (Benincasae Semen) 4 qian, Mangxiao 3 qian (dissolved), Taoren 3 qian, Baijiangcao 3 qian, Shu Fuqian 1.5 qian, Da Baishao 4 qian, Jiao Zha Tan (Crataegi Fructus Charred) 3 qian, Xi Qingpi (Citri Reticulatae Pericarpium Viride) 1.5 qian. This formula was taken at noon. There was no movement in the afternoon. By midnight, the urge to defecate arose, and a large amount of foul matter was discharged. The next day, he returned for consultation, saying: "My abdomen feels slightly relieved after defecation." I examined him. Although the illness had reduced by one or two degrees, it was still unresolved. I said: "Although the previous formula matched the pattern, it was still too light."

Mr. Shi said: "Then what should be done?" I said: "You should ask my master to use a heavy formula. Do you have the courage to take it?" He said: "I am willing to obey." He then visited my master for the initial consultation.

Initial Consultation: Intestinal abscess has undergone multiple purgations, but the root cause remains. Yesterday, Dr. Jiang used Dahuang Mudan Tang, and abdominal distension slightly decreased. Based on the syndrome, purgation is still indicated. Continue with the original method with modifications.

Sheng Chuanjun 5 qian (added later), Donggua Ren (Benincasae Semen) 1 liang, Taoren 80 grains, Fen Danpi 1 liang, Danggui (Angelicae Sinensis Radix) 5 qian, Mangxiao 3 qian (dissolved), Du Chidou (Vignaumbellatae Semen) 4 liang (decocted thickly, then add previous medicines).

[Commentary] Mr. Shi took this formula to the pharmacy to prepare the herbs. The pharmacist showed reluctance. He said: "Why use such drastic medicines?" Mr. Shi said: "Do not worry. I have taken such medicines many times before." The pharmacist asked: "How old is this gentleman?" Mr. Shi replied: "Over seventy." The pharmacist said: "Indeed, this is truly an experienced and learned physician." He generously provided the medicine. According to Mr. Shi, he had a bowel movement four hours after taking it, much more refreshing than when he took my previous prescription with 3 qian of Dahuang, which took over ten hours to work. The most material was discharged that night, all black and foul-smelling. He changed clothes frequently, too many times to count. After the vigorous discharge, abdominal pain decreased greatly, and swelling subsided. He came for the second consultation the next day.

Second Consultation: Yesterday, Dahuang Mudan Tang was used, adding Danggui and Chidou. The discharged sticky reddish material was neither pus nor blood. Such evil turbidity remaining in the intestines for a long time must transform into black river-mud-like substance. After taking the decoction, water flowed down in the intestines, making gurgling sounds. This syndrome must have an obstruction in the intestines, hence called abscess (Yong). Yong means blockage. If the blockage is not opened, how can there be any benefit? The root cause is not eliminated. The previous method should be continued but with reduced dosage.

Sheng Chuanjun 3 qian, Danpi 5 qian, Taoren 50 grains, Danggui 5 qian, Donggua Ren 1 liang, Chi Shao (Paeoniae Radix Rubra) 5 qian, Mangxiao 2 qian (dissolved), Baijiangcao 5 qian, Du Chidou 4 liang (decocted, then add previous medicines).

[Commentary] Mr. Shi took this formula for two days, totaling two doses. He had massive bowel movements at night, exhausting himself running between the bed and the toilet. Besides the river-mud-like filth, white pus-water was also discharged. Passing this water caused severe pain. Mr. Shi said, calculating the material discharged over three nights, it must have filled more than one vessel. My abdomen is large, but where did so much filth come from? This is amazing! On the third day, Mr. Shi took the original formula. I visited him personally at his home. Mr. Shi said: "I didn't tell the teacher yesterday that the discharged material was like river mud, yet the teacher recorded in the case: 'Must transform into black river mud.' Alas, how miraculous!" I smiled and nodded. After sitting and talking for a while, I asked Mr. Shi about the cause of his illness. He said: "In past years, when ill, I often refused medication. My father firmly believed in immortals and Buddhas and often ordered me to take incense ash. Was the illness caused by this?" But at this time, the material discharged by Mr. Shi had gradually changed from black to purple-red coffee color.

Third Consultation: After two administrations of modified Dahuang Mudan Tang, the accumulated filth in the intestines gradually thinned. However, pressing the area diagonally below the navel near the lower abdomen still caused pain, indicating the root cause was not entirely gone. Continue with the previous method, reducing Mangxiao and Dahuang to harmonize.

Fen Danpi 1 liang, Donggua Zi 1 liang, Sheng Yiren 1 liang, Taoren Ni (Persicae Semen Paste) 5 qian, Baijiangcao 5 qian, Jing Chi Shao (Paeoniae Radix Rubra) 6 qian, Sheng Gancao 2 qian, Danggui 5 qian, Jiegeng (Platycodonis Radix) 3 qian, Du Chidou 4 liang (decocted to replace water).

[Commentary] Mr. Shi took this formula for six doses. The discharged material gradually changed from coffee color to green. Mixed within the green were black particles resembling silkworm feces. The lower abdominal pain improved, but the ascending tendons felt slightly pulled and uncomfortable. After six doses, medication was stopped for two days, leading to the fourth consultation.

Fourth Consultation: The intestinal abscess is nearly cured. However, upon waking each morning to defecate, the affected area still feels distended, fearing the chronic root remains. Yet, after multiple purgations, the blood aspect is severely deficient. He experiences frequent dizziness, and the pulse is large, indicating deficiency. Treatment should primarily tonify righteousness (Zheng Qi), assisted by promoting the water passages of the lower jiao.

Da Chuanxiong (Ligustici Chuanxiong Rhizoma) 1 liang, Quan Danggui 5 qian, Da Shudi (Rehmanniae Radix Praeparata) 4 qian, Chun Sharen (Amomi Fructus Rotundus) 1 qian, Chi Baishao (Paeoniae Radix Rubra and Alba) each 3 qian, Zhuling (Polyporus) 3 qian, Ming Tianma (Gastrodiae Rhizoma) 4 qian, Chenpi 3 qian, Zexie (Alismatis Rhizoma) 2 qian, Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 5 qian, Dongkui Zi (Malvae Semen) 5 qian.

[Commentary] After Mr. Shi took this formula for tonifying righteousness and separating turbidity, the previous pain during bowel movements ceased. Also, the previous green color turned yellow. However, among seven parts yellow, three parts remain green. Mr. Shi had a history of spermatorrhea, which recurred at this time. Perhaps this was due to the strong diuretic nature of the formula? However, he felt absolutely no fatigue after emission, so it was not a concern.

Intestinal Abscess II