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Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) and Sheng Mai San (Generate the Pulse Powder) are essential formulas in the category of heatstroke treatment, both containing Ren Shen (Panax Ginseng Radix et Rhizoma). What is there to worry about? The patient did not believe this at all. Despite repeated explanations, he remained unconvinced. I wished to leave but was detained by heavy rain and forced to stay for lunch. I then said again, "Why not take the medicine as discussed now? If you feel uncomfortable, methods can be used to resolve it immediately." He reluctantly agreed and took the medicine, still anxious, fearing increased abdominal distension. Soon after, his condition became remarkably calm; after a long time, his mental clarity improved slightly, and he occasionally spoke one or two sentences. Only then did he stop doubting the use of Ren Shen. After ten days of regulation and treatment, he completely recovered.

Chen Ziping treated a patient who, in August, suffered from fever and delirium, with no appetite and constipation. All physicians considered it Shang Han (Cold Damage Disease). Initially, they used exterior-releasing methods, followed by purgative methods, but neither was effective. After more than fifty days, Ren Shen was administered, which slightly reduced the fever; however, when the dosage of Ren Shen was reduced, the fever returned. This led them to suspect deficiency even more strongly, so they used potent tonifying herbs, yet the lack of appetite and constipation persisted. Upon examination, the six pulses were harmonious, showing absolutely no signs of impending death. Chen stated that it is impossible for a Shang Han case to survive fifty days without eating or having a bowel movement. Knowing that the patient had been running around attending a funeral during the summer, he concluded that this was undoubtedly Zhong Shu (Heatstroke). The error lay in treating it as Shang Han and administering Ren Shen tonics; the heat pathogen, aided by the tonic, became entrenched, leading to this state. He prescribed Liu Yi San (Six-to-One Powder) mixed with cool water. The patient desired this, and taking more was not harmful. After ingestion, he slept immediately. Upon waking, he had a bowel movement, regained his appetite, and recovered within a few days.

Wu Qiao treated the wife of Wu Honglu, aged thirty. She was naturally obese and had eaten normally during the summer heat but failed to rise the next morning. Upon inspection, her eyes were closed, she was comatose, and her lips, tongue, and mouth were dark black. Phlegm rattled loudly like drumbeats, preventing even a spoonful of liquid from being swallowed; even medicines from the Qian Jin Fang (Prescriptions Worth a Thousand Gold) could not be administered. Wu Qiao was summoned. His six pulses were floating and soggy. He told Wu Honglu, "This is due to pre-existing wind-phlegm combined with heatstroke." He immediately administered Nong Po Xiang Ru Yin (Aucklandia and Mosla Decoction) and ground Niuhuang Wan (Calculus Bovis Pill) for instillation. The medicine went down, and the phlegm sound decreased. Further doses caused the black color to fade to dark brown. By dusk, her complexion resembled that of sheep liver; by the next morning, it was only slightly purple. Tonifying agents were then added. After five days, she opened her eyes and could speak. By the following day, she had largely recovered. (From *Tai Han Ji*.)

Zhang Xugu treated the wife of Zhou Xiaomei, who contracted summer-heat pathogen in June. She had a fever for five days before seeing Mr. Li. After one dose of dispersing herbs, her condition worsened the next day. A new physician, hearing of several days of constipation, prescribed Da Huang (Rhei Radix et Rhizoma) in large quantities, along with heavy doses of Xian Sheng Di Huang (Rehmanniae Radix Recens), Chai Hu (Bupleuri Radix), and Nong Po (Magnoliae Officinalis Cortex). Two bowel movements occurred, and the patient felt relieved. However, she experienced chills in the late afternoon, fever at dusk, which subsided at dawn, and insomnia throughout the night. Zhang examined her and asked about the cause. He explained: "Summer-heat is a combination of fire and dampness. Dampness is a yin pathogen that obstructs heat, preventing its release. Mr. Li’s use of dispersing herbs allowed the dampness to open and the heat to penetrate, which was not incorrect. However, the subsequent misuse of purgatives caused the pathogen to sink into the yin level, resulting in night fever without daytime fever, indicating a severe progression. Once the pathogen enters yin, returning it to yang is difficult. We must rotate the pivot mechanism and clear the heat from the yin level simultaneously." He used Cao Guo (Tsaoko Fructus), Cang Zhu (Atractylodis Rhizoma), and Nong Po to awaken the spleen, resolve dampness, and penetrate the membranous origin; Chai Hu to rotate the Shaoyin pivot; Qing Hao (Artemisiae Annuae Herba), Bie Jia (Testudinis Carapax et Plastrum), Zhi Mu (Anemarrhenae Rhizoma), and Huang Bo (Phellodendri Cortex) to clear heat from the yin level. After two days, there was no effect. The pulse was deficient and soft, thirst was intense with continuous tea drinking, abdominal fullness was present, and both urination and defecation were obstructed. She could not eat anything; even rice soup made her mouth sour. This indicated severe damage to the Middle Qi. Therefore, Zhi Mu was removed from the previous formula and Ren Shen was added. After another two days, urination improved slightly, but other symptoms persisted. The pulse remained soft and lacked spirit, and she continued to refuse food. It had been twelve days. Zhang warned that if this continued, the Stomach Qi would fail, and recovery would be impossible. Since both Spleen and Kidney were damaged, Yuan Qi (Original Qi) was powerless, and the San Jiao (Triple Burner) lost its qi transformation function, causing the pathogen to close inward. Kidney damage impaired opening and closing, leading to constipation; Spleen damage impaired transportation, leading to abdominal fullness. With Yang depleted, body fluids were not generated, causing severe thirst. Without Fu Zi (Aconiti Lateralis Radix Praeparata) and Gan Jiang (Zingiberis Rhizoma) to greatly assist Yang, the pathogen could not transform. Thus, Dang Shen (Codonopsis Radix), Cao Guo, Cang Zhu, Nong Po, Fu Zi, Gan Jiang, Sheng Jiang (Zingiberis Rhizoma Recens), Wu Mei (Mume Fructus), and Bai Shao (Paeoniae Radix Alba) were used, with a small amount of Huang Lian (Coptidis Rhizoma). After two days, abdominal fullness decreased, and loose stool like glue was passed. She began to consume thin porridge. After another two days, abdominal fullness resolved, porridge intake increased significantly, and urine volume increased. Nightly fever persisted, but chills ceased. This indicated the dampness had transformed, leaving only heat. Therefore, Fu Zi and Wu Mei were removed from the previous formula, and Zhi Mu (3 qian) and Sheng Shi Gao (Gypsum Fibrosum, 5 qian) were added. After two days, the fever completely subsided, and she recovered with clearing and tonifying regulation.

Li commented: After erroneous purgation in this case, heat left while dampness remained, merely injuring the Spleen and Stomach. Ultimately, the heat within the dampness was not fully eliminated. With Spleen and Stomach injured, and during the afternoon when Yang Qi declines, chills occurred. Heat trapped in dampness disturbed Ying Qi (Nutritive Qi), causing fever and insomnia. Damp-heat obstructed Qi mechanism, preventing fluid generation, causing thirst. At this stage, diuretic and bland herbs combined with aromatic spleen-awakening drugs should have been used for immediate cure. Instead, drying agents were used to forcibly drain, and cold herbs were added, further damaging the Spleen, hence ineffectiveness. Subsequently, strong acrid-dry herbs were used to forcibly drain; the Spleen Qi gained power from these herbs, and the dampness was entirely transformed by the rigid dryness. Thus, cold herbs were used to conclude the treatment. This was a series of errors masquerading as success and cannot serve as a standard. The inclusion of Wu Mei and Bai Shao in the formula was particularly meaningless. The physician claimed it was derived from Wumei Wan (Mume Pill), which is deceptive.

He from Xiaoshan felt unwell in summer, believing he had heatstroke. He ate one watermelon and took several doses of cooling herbs. Later, he had no other discomfort, only poor appetite. He forced himself to drink one or two bowls of thin porridge daily, finding it tasteless, yet he moved freely. Urine was pale yellow, stool was dry and infrequent, chest and abdomen were not distended, complexion was normal, and the tongue was bright red without coating, resembling Stomach Yin Deficiency. However, he disliked soups/liquids. The pulse was imperceptible at superficial and middle depths, but at the deep level (to the bone), it was thread-like and faint. Physicians still wanted to administer cooling herbs. He said: "This condition is neither evil fire nor Stomach Yin Deficiency, but severe depletion of Yuan Yang (Original Yang). Fortunately, urine is pale yellow and stool is firm, indicating solid Kidney Qi and root presence. Taking more cooling herbs will surely cause death." He used Fuzi Lizhong Tang (Aconite and Licorice Decoction for Regulating the Middle) minus Bai Zhu, plus Dang Gui (Angelicae Sinensis Radix) and Gui Zhi (Cinnamomi Ramulus) to nourish Ying. Several doses yielded no effect. Gui Zhi was removed, and Rou Gui (Cinnamomi Cortex), Wu Zhu Yu (Evodiae Fructus), and Huang Qi (Astragali Radix) were added. Over ten doses, there was no change. Another ten doses of the same formula also failed. Analyzing carefully: since urination was patent and stool was dry, Kidney Essence was not exhausted. Why did the Stomach remain closed? After stopping medication for four to five days, the situation remained the same. Thus, hot herbs were discarded. Heavy doses of Lu Jiao Jiao (Colla Cornus Cervi) were used, assisted by Gou Qi Zi (Lycii Fructus), Dang Gui, Ren Shen, Huang Qi, Rong Rui (Cynomorii Herba), and Guang Chen Pi (Citri Reticulatae Pericarpium) to moisten and nourish Yang. After ten doses, Lung pulse harmonized slightly, and diet increased marginally. After another ten doses, Stomach function opened, bowels moved, but the patient became weak and unable to sit up. After half a month of nourishment, he could get out of bed.

A man with a white face and robust build contracted heatstroke in summer. He recovered after two doses of cooling-resolving herbs because the pathogen was light. Ten days later, he was re-infected. He self-administered Su He Wan (Liquid Amber Pill), covered himself to induce sweating, causing massive loss of body fluids. Heat pathogen sank inward. Additionally, being young and prone to sexual excess, his pulse was empty, rapid, and rootless. Zhang said: "Su He Wan is acrid-warm and penetrating; it is suitable for cold but strictly contraindicated for summer-heat." Reluctantly, sweet-cool and bland herbs were given to nourish Yin and harmonize Yang. After four to five days, the pulse improved slightly, but the Chi position (Kidney area) was very empty. Fever persisted, with delirium at night and clarity at dawn. Tongue had a thin coating, pale yellow on edges, white and slippery in center. He drank two to three bowls of porridge daily. For over ten days, the condition did not improve or worsen. If herbs were too draining, he became exhausted; if tonified, heat intensified. One day, upon changing beds, he sweated profusely, mouth opened, and eyes seemed ready to protrude. Shu Di Huang (Rehmanniae Radix Preparata, 1 liang 2 qian), Fu Zi (4 qian), and Nong Po (2 qian) were combined with Er Chen Tang (Two-Cured Decoction) in appropriate amounts, decocted in a large bowl. Half was taken at dusk, leading to deep sleep. After waking at second watch, the remaining half was taken, with no adverse sensation. After midnight, delirium recurred, clearing at dawn. Pulse showed slight spirit but became faster. Tongue center coating turned yellow (due to Fu Zi). Chest and abdomen were comfortable, and he could eat porridge. Then, Bai Hu Tang (White Tiger Decoction) plus Xi Sheng Di Huang was used. After several days, pulse improved, and porridge intake increased. However, fever persisted, and night delirium continued. The Left Guan position (Liver/Gallbladder area) was specifically stagnant and deep. Zhang reasoned: Clarity by day and confusion by night indicates Heat Entering Blood Chamber (Xue Shi). The Blood Chamber is governed by Jueyin (Liver/Pericardium), hence the stagnation at Left Guan. Zhang Zhongjing prescribed puncturing Qimen (LR14) for such cases where pathogen binds in blood. Lacking acupuncture knowledge, Zhang used Gui Xu (Asari Radix et Rhizoma), Chi Shao (Paeoniae Radix Rubra), Xin Jiang (Safflower), Qing Hao, Bie Jia, Chai Hu, Huang Qin (Scutellariae Radix), and Xi Sheng Di Huang. Five to six doses were completely ineffective. It had been over a month. Due to the family's insistence, Zhang pondered overnight without solution. Suddenly remembering Laifu Dan (Reviving Life Pill) contains Ling Zhi (Pini Semen), which specifically enters Jueyin. Summer-damp turbid pathogen differs from Shang Han, explaining previous failure. Ling Zhi attacks turbidity with turbidity, combined with Xiao Ming Fen (Mirabilitum) and Da Huang, reaching the deepest Yin, assisting Original Qi to expel pathogen, promising efficacy. Thus, Chai Hu was removed from the previous formula, and 1 qian of Laifu Dan was sent. That night, he slept peacefully without delirium. After three consecutive doses, fever subsided. Suddenly, he passed a large volume of deep green, thick, glue-like urine. The family was alarmed. Zhang said: "The root of the disease is eradicated." Because of his youth and sexual excess, damp pathogen entered Liver and Kidney through deficiency. Thus, although the presentation resembled Shang Han's Heat Entering Blood Chamber, the pathogen was different, rendering previous drugs ineffective. Laifu Dan’s method of attacking turbidity with turbidity proved miraculous. He subsequently recovered with tonifying herbs.