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Sun Wenyuan treated the wife of Ma Di'an, who had originally suffered from dietary excess damaging her interior, compounded by an external invasion of wind-cold. Previous treatments using methods for internal injury and external contraction resulted in fever at dawn (when Yang energy is flourishing), dry lips, incessant palpitations and rushing sensations in the chest, cold hands and feet (heat jue syndrome), and slippery-rapid pulses in both cun positions (a full cun pulse indicates fire rushing upward). Sun stated: "This is a rare phlegm disorder" (a fabricated diagnosis). He prescribed Xiao Xian Xiong Tang (Small Chest-Opening Decoction) modified with Bai Shao (White Peony Root), Luobo Zi (Radish Seed), Qian Hu (Peucedani Radix), and Jiu Qin (Scutellariae Radix prepared with wine). After two doses, bowel movement occurred the following morning, expelling eight roundworms (no rare phlegm was observed). The chest rushing ceased, but she felt weak. On re-examination, the cun pulses were halved, while the chi pulses slightly rose. She was managed with Er Chen Tang (Two-Cured Decoction) modified with Bai Shao and Jiu Qin. Later, Dang Gui (Angelicae Sinensis Radix) was added to four additional doses, resulting in complete recovery. (Xu Dachun's commentary: There are indeed cases where latent phlegm carrying fire rushes upward, causing chest palpitations. I once treated the wife of Jiang Zuhou with Xue Geng Tang (Snow Broth) combined with Zhuli (Bamboo Sap) and Zixue San (Purple Snow Powder), achieving a cure. Although this case was not a rare phlegm disorder, one should not overly dismiss Sun's theoretical framework.)

Commentary: This condition arose because excessive dispersal during fever disturbed the internal fire, causing it to rush upward and induce chest palpitations, which agitated the roundworms. The immediate use of Xiao Xian Xiong Tang utilized Huang Lian (Coptidis Rhizoma) for its bitter-cold property to descend fire, Gua Lou Ren (Trichosanthis Semen) for its sweet-cold property to clear fire, and Zhi Shi (Aurantii Fructus Immaturus) for its harsh purgative action to attack stagnation. With the pathogen removed and jue resolved, the roundworms descended accordingly. The weakness was indeed due to the harshness of the purgation, not the presence of rare phlegm. Sun Wenyuan specialized in diagnosing based on "phlegm," and his inaccuracies often resemble this case. (Xu Dachun's commentary: Roundworms move due to heat, causing chest palpitations; when heat descends and worms move downward, the illness resolves naturally. Sun's treatment was fortunate in hitting the mark; Wei's critique has some impropriety.)

Zhang Jingyue treated a young woman surnamed Wang, under twenty years old, who habitually enjoyed melons and raw/cold foods. She frequently suffered from heart and abdominal pain, lasting several days without eating upon each onset. Years later, each episode involved vomiting roundworms. Initially few, the number increased daily, with each episode expelling 10-20 worms and lasting ten days without food intake. Physicians only knew how to attack parasites; they returned after removal, and various medicines failed. Observing her pulse and symptoms, Zhang deduced that damage from raw/cold foods caused spleen-stomach deficiency-cold and accumulation of yin-dampness, leading to this syndrome. Without warming the stomach and nourishing the spleen to cut off the source of cold-damp generation, removing worms would be futile as they would regenerate. He prepared Wen Zang Wan (Warm Viscera Pill) for her, and she recovered before finishing the medication. Later, indulging again in raw fruits caused a relapse, which was settled with the previous medicine. (Original note: Regarding parasite treatment, if no other malnutrition-heat syndromes are present, the primary approach should be warming and tonifying the spleen and stomach. Xu Dachun's commentary: The argument is outstanding, yet many cases are caused by heat.)