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In the twelfth lunar month of Jiashen year, at Jiangzi She, there was a nephew of the Zhu family. He was seventeen years old. He contracted an external contraction (wai gan) while traveling to the countryside. Initially, miscellaneous medications were administered indiscriminately, exacerbating the condition. After forty days, he invited me for consultation. Upon inquiring about previous treatments, it was revealed that only tonifying medicines had been used exclusively. After taking more than thirty doses, his face turned yellow, approaching jaundice; he suffered from deficiency vexation and insomnia. The six pulses were wiry and rapid. This was a residual heat syndrome caused by erroneous tonification. I prescribed Xiao Chai Hu Zhu Ye Tang (Minor Bupleurum and Bamboo Leaf Decoction). After two doses, he recovered instantly. After another two doses, he returned to normal health.

In the spring of Renwu year, a Lin surnamed villager from Shangjie Township, aged fifty, suffered from Jia Yin Shang Han (Cold Damage with internal yin deficiency). Initially, a physician was consulted, but the medication used is unknown. Nine days later, when I formally took his pulse, he expelled a roundworm from his hand. The pulses in all six positions were deficient, large, and powerless. He belched more than ten times daily. I stated: "The pulse indicates a false heat syndrome, which is actually true cold." I prescribed Li Zhong Tang (Regulate the Middle Decoction). After one dose, his vexation and thirst were reduced by half. By the next morning, the pulse had also stabilized. Upon returning home, I advised him to continue taking Renshen San Bai Tang (Ginseng and Three Whites Decoction) for several more doses. His daily activities normalized, though thirst persisted. Taking advantage of convenience, he sought treatment in Hongtang. There, he mistakenly ingested cooling herbs intended for excess heat-thirst, such as Hua Shi (Talcum) and Ge Gen (Kudzu Root). That night, he developed restlessness and delirious speech. The following day, he urgently summoned me. I assessed that the disease pattern had deteriorated beyond recovery, and he passed away the next morning.

My commentary: In this type of case, contemporary physicians often fail to distinguish between Shang Han (Cold Damage) and miscellaneous diseases, and do not differentiate between deficiency/excess or cold/heat. They indiscriminately administer acrid-cooling agents, resulting in many wrongful deaths. Therefore, detailed differentiation is necessary below. The etiology of sore throat is not singular. There are sore throats due to Shang Han and those due to miscellaneous diseases, which differ. Those belonging to Shang Han include Tai Yang (Greater Yang), Yang Ming (Yang Brightness), Yang Du (Yang Toxin), Yin Du (Yin Toxin), and Shao Yin (Lesser Yin), each distinct. Even within the Shao Yin channel alone, there are guest-heat, guest-cold, and cold-heat struggling patterns, which further differ. Additionally, there are cases where direct invasion of the three Yin channels by yin-cold causes sore throat, and cases where initial wind-pathogen invasion of the Tai Yin Lung channel causes sore throat. All the above are sore throats due to external contraction in Shang Han. Those belonging to miscellaneous diseases include phlegm-wind obstructing upward, stagnant fire ascending, stomach meridian accumulated heat, food poisoning, kidney deficiency with yin-fire flaming upward, consumptive cough with hemoptysis, and distinctions among tan e (phlegm swelling), zhuang huo e (fire swelling), and leng e (cold swelling), which also differ. All the above are sore throats due to miscellaneous diseases.

For those belonging to Shang Han and Tai Yang, appearing on the first or second day, treat with Sheng Ma Liu Wu Tang (Cimicifuga Six Substances Decoction) or other acrid-cooling preparations. For Yang Ming Yang Du, appearing on the second or third day, indicating heat-toxin attacking upward, treat with Liu Wu Tang or Liang Ge Yin (Cool the Diaphragm Drink) or other acrid-cold preparations. For Shao Yin guest-heat, resulting from transmitted disease, appearing on the fourth or fifth day, treat with Gan Cao Tang (Licorice Decoction), Ku Jiu Tang (Bitter Wine Decoction), or Zhu Fu Tang (Pig Skin Decoction), which are mild and slightly cooling. For Shao Yin cold-heat struggle, also a transmitted sore throat, treat with Jie Geng Tang (Platycodon Decoction), a mild preparation. Regarding Shao Yin guest-cold, this originates from kidney-cold hidden within the meridians and deep tissues. If initial treatment fails to warm the meridians and dissipate cold promptly, and the disease persists for ten days or more, extreme cold rushes upward causing sore throat. Treat with Ban Xia Tang (Pinellia Decoction) using acrid-hot herbs like Ban Xia (Pinellia Rhizome), Gui Zhi (Cinnamon Twig), and Gan Cao (Licorice Root). If accompanied by vomiting, diarrhea, and cold extremities, advance to Si Ni Tang (Frigid Extremities Decoction), a strongly hot preparation. For direct invasion of the three Yin channels and Yin Du, use Jiang Fu Tang (Ginger and Aconite Decoction). For Lung channel wind invasion, use Jin Fei Cao Tang (Boil Grass Decoction). All these require observing accompanying symptoms for treatment.

For miscellaneous disease phlegm-wind obstruction, treat with Er Chen Tang (Two Aged Substances Decoction) or Xing Xiang San (Arisaema and Citrus Powder) plus Gan Jie Tang (Licorice and Platycodon Decoction). For stagnant fire ascending, treat with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) plus Jie Geng (Platycodon) and Niu Bang Zi (Arctium Fruit). For stomach meridian accumulated heat, treat with San Huang Tang (Three Yellows Decoction) or Xie Huang San (Drain Yellow Powder). For food poisoning, use bitter-cold detoxifying agents. For kidney deficiency with yin-fire flaming upward causing sore throat, treat with Ba Wei Wan (Eight Ingredients Pill), containing Gui Zhi and Fu Zi to guide qi back to its source. For consumptive cough, hemoptysis, sore throat, and hoarseness, also use water-nourishing agents. All these require observing accompanying symptoms and pulse deficiency/excess for treatment. How can indiscriminate mixed treatment lead to wrongful death? Whose fault is it?

In the first winter month of Guiwei year, my colleague Zheng Nengren suffered from phlegm-wind obstruction and sore throat. Initial treatments exacerbated the condition upon observation of floating, wiry, and powerless pulses in all six positions. I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Dan Xing (Arisaema prepared with bile) and Rou Gui (Cinnamon Bark). After two doses, he recovered instantly, and phlegm obstruction vanished. Later, I learned that Zheng Nengren's cousin, a boy over ten years old, suffered from Shao Yin sore throat. After ten days, he could still eat a bowl of porridge per meal and move normally. However, a physician administered acrid-cooling agents. Half an hour after ingestion, he developed cold extremities and irritability, dying by the third watch. Such medication errors can turn life into death in an instant. Must one not be cautious?

In the second winter month, the wife of Wang Jieren, a government school student, suffered from Shao Yin guest-cold sore throat. Pain in the neck, back, waist, and knees was unbearable. Cold extremities and loose stools were present. The six pulses were wiry and strong, lacking stomach qi. I predicted death within three days and declined treatment. Upon investigating the cause, she had initially caught cold. A gynecologist, noting her constitutional weakness and chronic stagnation, prescribed Si Wu Tang (Four Substances Decoction) modified. This aided cold and trapped pathogens, preventing their expulsion. Days later, extreme cold rushed upward, causing throat blockage and pain. Another physician mistakenly diagnosed fire and used Xuan Shen (Scrophularia) and Gan Jie (Licorice and Platycodon), increasing irritability. On the fifteenth day, I examined the pulses and symptoms, determining the long-standing nature of the disease indicated Shao Yin cold pain. I told them the pulse and symptoms had deteriorated, and survival was impossible according to medical principles. Disbelieving, they sought further treatment. A famous physician diagnosed stagnant fire ascending and firmly administered cooling agents. He died on the eighteenth day.

In the late spring of Jiashen year, a young woman of the Wang family in Junpu suffered from liver meridian stagnant fire ascending causing sore throat. Multiple treatments failed. I prescribed Xiao Yao San (Free and Easy Wanderer Powder) with Niu Bang Zi (Arctium Fruit), Jie Geng (Platycodon), Huang Qin (Scutellaria Root), and Xiang Fu (Cyperus Rhizome). After two doses, symptoms disappeared.

In the late autumn, the wife of Lian Qingtian, a military commander, suffered from lung meridian wind-heat sore throat. The pulse was floating, large, and forceful. I prescribed Jin Fei Cao Tang (Boil Grass Decoction) with Niu Bang Zi and doubled Gan Cao (Licorice Root). She recovered after one dose.

In the mid-summer of Jiashen year, a neighbor, Mrs. Wang, who enjoyed spicy foods, suffered from stomach heat sore throat. The pulse was large, slippery, and rapid. I prescribed Gan Jie Tang (Licorice and Platycodon Decoction) with Huang Qin (Scutellaria), Huang Lian (Coptis Rhizome), Gua Lou (Trichosanthes Fruit), and Xuan Shen (Scrophularia). She recovered after two doses. For these three women, with solid pulses and solid symptoms, administering cooling agents yielded immediate results, like striking a drum. Even mediocre physicians could achieve success easily, like crumbling rotten wood. What difficulty is there? The true difficulty lies in distinguishing between deficiency/excess and cold/heat amidst apparent similarities and true/false presentations. Hitting the disease pattern accurately transforms danger into safety; this is the key.

In the first autumn month of Jiashen year, Wei Yu Can, a scholar from Jianning, who had resided long-term in Sanshan and indulged in sensual pleasures, suffered from yin-fire sore throat. Previous treatments misdiagnosed it as excess fire, continuously administering cooling agents, which increased vexation and pain. Observation of the six pulses showed them to be large, rapid, and powerless. I stated: "Kidney deficiency is extreme; fire does not return to its source but floats upward." I prescribed Liu Wei Di Huang material (Six Flavor Base) with Rou Gui (Cinnamon Bark), Mai Dong (Ophiopogon Tuber), and Renshen (Ginseng Root), with a small amount of Fu Zi (Aconite Lateral Root). After two doses, he recovered. He considered it miraculous.