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[Pathogenesis] Wind-warmth seasonal toxins. First invade the Shaoyang (Lesser Yang) and Yangming (Yang Brightness) meridians. Subsequently triggered by violent cold pathogens combing with the internal heat to manifest. This is a combined disease of the three Yang meridians. The presentation resembles Taiyang cold damage. Because the chest and diaphragm are red, swollen, hot, and painful. It is named "Red Diaphragm Cold Damage" based on its visible characteristics. This disease also frequently occurs in spring.

[Symptoms] Initially presenting with fever and aversion to cold. Headache and body pain. Followed immediately by redness and swelling of the chest and diaphragm. Even external eruption of purple macules. Tongue coating red at the edges. Yellow, rough, and prickly in the center. Severely, black spots may appear within the yellow coating. If severe pain in the chest. Foul breath offensive to others. Cough with asthma. Expectoration of turbid saliva with a fishy odor indicates that the toxin has sunk inward damaging the Lung. It is about to form an internal abscess. The tongue coating is mostly thick white and putrid.

[Pulse] Left pulse floating, wiry, rapid, and urgent. Right pulse surging, abundant, wiry, and slippery. As Zhang Shiwan stated, Red Diaphragm belongs to Shaoyang wind-heat. It is not true cold damage. In reality, it is wind-warmth seasonal toxin of the combined disease of two Yang meridians. Suddenly triggered by exogenous cold invading the Taiyang (Greater Yang) meridian.

[Treatment] The method should combine internal and external treatments. Internal treatment: For mild cases, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction for Expelling Toxins) modified. Mix with Xijiao Zhi (Rhinoceros Horn Juice) (one scoop). Jinzhi (Human Feces Ferment) (one tael). For severe cases, use Tongsheng Xiaodu San (Unimpeded Toxin-Expelling Decoction) modified. (The formula is recorded in the treatment methods for Big Head Cold Damage). Resolve both exterior and interior to expel the toxin. If the exterior syndrome has subsided. But internal fire remains excessive. With coma and delirium. Constipation and dysuria. Urgently use Jiedu Chengqi Tang (Detoxifying Purgative Decoction) plus Zixue (Purple Snow). Purge fire and expel toxin to clarify the spirit. If there is muttering in sleep, spasms, or syncope. Or acute diarrhea with tenesmus. Urgently use Xiling Zhushi Tang (Rhinoceros-Horn Antelope-Horn Bamboo-Shield Decoction) (Rhinoceros Horn 8 fen, Antelope Horn 1 qian, Fresh Bamboo Leaf Heart 3 qian, Gypsum 6 qian, Red Peony Root, Forsythia, Arnebia each 2 qian, Silver Flower Dew 2 liang mixed in). Administer Zhibao Dan (Treasure of Ultimate Value Pill) (one pill). Purge fire and extinguish wind to clear the heart. If bowel and bladder movements have normalized. And consciousness is clear. Yet still coughing up turbid, foul-smelling sputum. Or even vomiting pus. With lingering dull pain in the chest. Tongue coating white and putrid covering the whole surface. Pulse right Cun position slippery, rapid, and excess. This indicates seasonal toxin damaging the Lung forming an abscess. Urgently use Jiawei Weijing Tang (Modified Reed Rhizome Decoction). [Raw Coix Seed 5 qian, Trichosanthes Kernel 4 qian, Peach Kernel, Fritillaria Cirrhosa Bulb, Licorice Root Tip each 1.5 qian, Honeysuckle, Forsythia each 2 qian, Borax 0.8 fen, Aged Mustard Green Brine 1 scoop (mixed in). First decoct Living Water Reed Rhizome, Fresh Bodhi Root, Fresh Winter Melon Peel each 2 liang to replace water.] Descend qi and move blood to open lung obstruction. Drain pus and remove decay to clear lung toxin. After toxin removal and pain cessation. If lung fire is not cleared. Continue with Sangdan Xiebai Tang (Mulberry Bark and Dandelion Decoction to Drain White). Add Wild Lily Bulb (1.5 qian). Bletilla Striata Rhizome, Albizia Bark (each 1 qian), Fresh Wild Zigzag Fern Rhizome (2 liang). Fresh Imperata Rhizome, Fresh Bodhi Root (each 1 liang, decoct these three to replace water). Cool-drain latent fire in the Lung. Clear and astringe ulcerated areas of the Lung. Finally use Erdong Ermu San (Two Winter and Two Mother Powder). Add American Ginseng Cortex (each 1.5 qian), Fresh Dendrobium (4 qian). Clear-nourish qi and fluids to conclude treatment. External treatment: Prick the swollen area with fine silver needles to release purple blood. Wipe dry the exudate with thin cotton. Immediately apply Jiedu Qingliang San (Detoxifying Cooling Powder) (Hibiscus Leaf, Isatis Leaf each 5 qian, Indigo Naturalis, Human Manure Ash each 2 qian, ground into powder. Fresh Chrysanthemum Leaf, Heavenly Lotus Leaf, crushed and juiced to mix evenly). Apply topically. Vent heat-toxin to reduce swelling. Promote rapid healing.

[Xiu's Commentary] Elder Shiwan treated this syndrome. Initially using Jingfang Baidu San (Schizenepta and Saposhnikovia Decoction for Expelling Toxins) without Ginseng. (Schizonepeta, Saposhnikovia each 1.5 qian, Bupleurum, Peucedanum, Notopterygium, Angelica Dahurica, Aurantium, Platycodon, Arctium, Mint, Red Poria, Ligusticum, Sweet Urine Ash each 1 qian. Mix with one cup of Jinzhi just before administration.) Added Scutellaria Baicalensis Root, Coptis Chinensis Rhizome, Rhinoceros Horn, Broussonetia Papyrifera Bark as main herbs. After exterior syndrome subsides. And stool becomes dry and constipated. Use Liangge San (Cooling Diaphragm Powder) as the main formula. If there are half-exterior half-interior symptoms. Use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Aurantium and Platycodon. Also use lancet to prick blood to vent toxin. The general idea is similar to Yu's method. Only when toxin sinks damaging the Lung forming an internal abscess. It is generally due to initial neglect by the patient. Followed by chaotic treatment by physicians. Or external rupture of Lung Abscess. Leading to redness and swelling of the chest and eruption of purple macules. If so. Then Yu and Zhang's modified Jingfang Baidu San would be inappropriate. How difficult it is to differentiate syndromes in clinical practice!

[Lian's Verification] Red Diaphragm Cold Damage. As described by predecessors Zhang Shiwan and Yu Genchu. The symptoms clearly indicate internal abscess cold damage. Mostly diagnosed and treated by surgeons. If initially Lung Abscess. Followed by redness and swelling of chest and hypochondrium with purple macules. I have cured four such cases. All imitating the methods of Elder Huixi for Lung Abscess. Fortunately achieving success. Mr. Xu said: For Lung Abscess. When pus has formed. Although *Jinkui Yaolue* states early stage can be saved. Once pus forms death ensues. However, through various treatments. Survival is possible. Probably because I encounter this syndrome often. I collected methods for treating Lung Abscess since the Tang Dynasty. Using sweet-cool drugs to clear fire. Moistening drugs to nourish blood. Slippery-descending drugs to expel phlegm. Aromatic drugs to unblock qi. Further using pearl-yellow drugs to resolve toxin. Mineral-metal drugs to fill cavities. Combining several methods. It is consistently effective. This is truly the correct treatment for Lung Abscess. Not boasting words. However, *Xu's Medical Cases* often has methods without formulas. This is also a clever way to hide shortcomings. Firstly to avoid nitpicking by later generations. Secondly to encourage students to diligently seek ancient teachings and extensively collect prescriptions. This autumn. A soldier in our Shaoxing unit. Named Chen Shiqing from Chuzhou. Suffered from lung disease in early summer. Took Western medicine repeatedly. Cough and sputum could not be cured. Late summer and early autumn. Suffered from summer-dampness combined with cold and food stagnation. Invited for consultation initially. Saw patient face red as cinnabar. Chest and diaphragm red and swollen. Comatose and mute for five days and nights. Foul breath offensive. Lips cracked teeth black. Eyes wide mouth closed. Limbs cold. Palpating chest and abdomen. Extremely hot. Diarrhea watery like pouring. Foul smell unbearable. Urine short red and dysuric. Chong vessel at umbilicus. Pulsating violently. Pulse both Cun positions sunken resembling hidden. Guan and Chi positions deep, wiry, forceful, and rapid. Becoming stronger with pressure. Opened mouth. Observed tongue. Scorched purple with prickles. Layer upon layer of black halos. Used Celsius thermometer to check temperature. Reached 105 degrees Fahrenheit (approx 40.5°C). Diagnosed as severe heat syndrome in summer-dampness disease. Prescribed Yu's Jiedu Chengqi Tang (Detoxifying Purgative Decoction). Added Zixue (Purple Snow) (9 fen), Pin Sanwu Baisan (Grade A Three-Ingredient White Powder) (1 fen, Formula uses Platycodon 5 fen, Fritillaria 4 fen, Croton Seed 1 fen. Instructed pharmacy to grind fresh and fine. Mix frequently with medicinal soup). After one decoction. Four hours passed. No change. Administered second decoction. Finished. Immediately vomited a bowl of foul sputum. Spoke. Said abdomen felt like needle pricks. Or knife cutting. Pain unbearable. Colleagues massaged for one hour. Then defecated a pile of black filth. Next morning invited again. Checked pulse. Both Cun rose and became rapid and intermittent. Guan and Chi same as yesterday. Tongue coating lost only one layer of black halo. Bowel and bladder closed. Restless muttering. Quiet self-talking and smiling. Thermometer dropped only one degree. Only limbs no longer cold but warm. Slightly modified original formula. Removed Zixue and Sanwu Baisan. Added Xijiao Zhi (Rhinoceros Horn Juice) one scoop (approx 1 qian). Fresh Plantago Asiatica Juice one scoop. Mixed with Jinzhi. Angong Niuhuang Wan (One pill). Raw Rheum Palmatum root added 2 qian. After two decoctions. Defecated black filth twice. Fever, coma, and delirium remained. Coughed foul sputum like rice porridge. Increased significantly. Room smelled unbearable. Colleagues covered noses. Consulted continuously for seven days. Modified from previous formula. Sometimes removed Angong Niuhuang Wan. Added Wang Mengying's New Ding Niuhuang Qingxin Wan. Or kept Zixue (4 fen). Pin Jiangxue (1 fen). Sometimes removed Watermelon Nitre. Added Weathered Nitre. Vomited two bowls of foul sputum daily. Black filth once daily. More often twice. Urine gradually increased. Color finally purple-red and turbid. Temperature dropped to 101.5°F (approx 38.6°C). Coma and delirium still frequent. Consciousness clearer in morning. Could respond with one or two sentences. Pulse rapid but not wiry. Umbilical pulsation subsided. Tongue coating white and putrid covering whole surface. Slight black spots appeared. Approximate total intake: Raw Rhubarb 3 taels. Jinzhi 9 taels. Zixue over 2 qian. Niuhuang Wan etc. 6 pills. Exogenous summer-dampness and food stagnation. Largely eliminated. Focused solely on treating Lung Abscess. Changed to Yu's Jiawei Weijing Tang (Modified Reed Rhizome Decoction). Ground and mixed Ta Yi Zi Jin Dan (One pill). Following Mr. Xu's method of sweet-cool clearing fire. Aromatic unblocking qi. Consulted five days consecutively. Modified from this formula. Removed Zi Jin Dan. Added Zi Jin Pian. Or added Xin Jiang, Inula Flower, Tangerine Reticulate Vein. To unblock lung collaterals. Or added Bamboo Juice, Pear Juice, Fresh Acorus Tatarinowii Rhizome Juice. To expel foul sputum. Or added processed Borax, Sweet Urine Ash, Urine-Steeped Gypsum. To resolve toxin and prevent putrefaction. Consulted five days consecutively. Suddenly chills and high fever. Restless limbs. Black sores erupted all over head, face, chest, and back. Chest and diaphragm redness and swelling subsided. Foul sputum completely gone. Vomited two bowls of white sputum daily. Sometimes sputum contained pus. Or purple blood threads like pearls. Delirium greatly reduced. Consciousness clarified. But after waking. Still confused speech. Face and lips turned white. Body emaciated. Pulse slightly rapid and faintly wiry. Tongue coating white and putrid greatly reduced. Stomach active craving food. Dry mouth desiring drink. Changed to Gu Xiaolan's Bazhi Yin (Eight Juices Drink) removing Watermelon Juice and Lotus Leaf Juice. (Sugarcane Juice, Lotus Root Juice, Pear Juice, Reed Rhizome Juice, Fresh Rehmannia Juice, Fresh Imperata Juice each one wine glass. Warm in double boiler). Added Ophiopogon Juice (2 spoons). Light Bamboo Juice (1 scoop). Jie KT Grass Root Juice (1 scoop). Sweet-moistening to nourish stomach. To supplement blood. Taken for four doses. Appetite greatly opened. Ate one large bowl of porridge per meal. Five meals day and night. Blood threads and beads in sputum. Ultimately could not be removed. Lingering dull pain in chest. Stool turned tender yellow. Alternately loose and dry. Changed to *Gujin Luyan* Jiegeng Tang (Platycodon Decoction). (White Platycodon, Raw Licorice Joint, Angelica Sinensis Root, Atractylodes Macrocephala Rhizome each 1 qian. Raw Coix Seed 5 qian. Raw Mulberry Bark 3 qian. Fine Rehmannia Root 2 qian. Patrinia Herba 0.8 fen). Added Glehnia Root (4 qian). Sweet Stone Lotus Seed (1.5 qian, pounded). Dual tonify Lung and Spleen to clear residual toxin. Additionally take Wang's Shengling Dan modified. (Pearl Powder, Musk each 3 fen. Amber 6 fen. Mastic, Processed Borax, Urine-Steeped Gypsum each 1 qian. Myrobalan, Cinnabar each 5 fen. Grind all medicines finely. Add 5.5 mace of flying noodle silk from mill. Grind extremely uniform. The magic lies in flying noodle silk traveling well into fine lung tubes). Take 5 fen each time. Send down with decoction of Fresh Imperata Rhizome and Fresh Bodhi Root (each 1 liang). One dose day and night. After finishing. Chest pain stopped. Sputum-blood removed. Confirmed Mr. Xu's theory that pearl-yellow products resolve toxin. Mineral-metal products fill cavities. Precise and unchangeable. Also learned that Ma Peizhi's view on Musk wandering and leaking true qi. Contraindicated in Lung Abscess. Is also difficult to rigidly adhere to. Finally used *Jinkui* Maidong Tang (Ophiopogon Decoction). Added Huo Dendrobium, Raw Polygonatum Odoratum Rhizome (each 3 qian). Dual tonify qi and fluids to conclude treatment. Fortunately the person was young and strong. Disease vanished suddenly. Daily life and diet returned to normal.

[Rongzhai's Commentary] "Red Diaphragm Cold Damage". Mr. Lianchen stated it is essentially "Lung Abscess". I carefully verified the symptoms described by Yu. Most parts align with Lung Abscess. Except for the phrase "even external eruption of purple macules". Which does not match Lung Abscess syndrome perfectly. Regarding treatment: Mr. Lianchen used "Zixue 9 fen mixed with Sanwu Baisan 1 fen." This is indeed an effective formula. The April 1955 issue of *Chinese Medicine Journal* reported two cases of Wang Huanting treating Lung Abscess with Jiegeng Baisan. These are living facts. Mr. Cao Yingfu from Jiangyin treating Lung Abscess. Also advocated first using opening and draining. Then clearing and nourishing. Consistent with the therapies of Mr. Yu and Mr. He. Mr. Cao said: "For treating this syndrome. When abscess pus accumulates in the Lung. One must first open Lung qi and clear stagnant heat. This is the first step. When Lung qi is dispersed. But expectoration is difficult. Then resolve and expel abscess pus. This is the second step. When foul sputum is exhausted. But sticky phlegm not yet formed into pus. Continues to be coughed up. Then break phlegm knots. This is the third step. When sticky phlegm gradually decreases. Broken areas of Lung need repair. Then nourish Lung yin. This is the fourth step. For repair formulas. Qianjin Huanghun Tang is best. Hunhun refers to Albizia Bark. Zhang Lu Yu stated that when two trunks touch. They fuse inseparably. Taking advantage of its stickiness sufficiently repairs Lung fissures. Achieving full effect. More stable than commonly transmitted Bletilla. Dare to share my thoughts. To inform colleagues." This experience introduction. Makes Yu's use of "Bletilla, Albizia Bark" to "clear and astringe Lung ulcerated cavities". Explained and proven by Mr. Cao. Not only clarifies principles and insights. But also enhances efficacy.