For example, a patient named Hou XX, male, 12 years old. After eating ice cream, he suddenly suffered from severe abdominal pain and was unable to pass flatus. The physician prescribed Compound Dachengqi Decoction (Compound Major Order the Qi Decoction) and Radish with Rhubarb and Mirabilite Decoction, but without effect. I was invited to consult. Upon examination, his abdominal pain was extremely severe, with occasional rising and falling of masses in the abdomen, yet the abdominal muscles remained soft upon palpation. The tongue coating was white, and the pulse was wiry, tight, and rapid. Synthesizing the pulse and symptoms, I reasoned: This is cold pathogen directly attacking the Spleen and Stomach, not an excess syndrome; treatment should focus on warming the middle and dispersing cold. Prescription: Dingxiang (Clove) 10g, Muxiang (Aucklandia Root) 10g, Rougui (Cinnamon Bark) 10g, Xiaohuixiang (Fennel Fruit) 6g, Wuzhuyu (Evodia Fruit) 10g.
After taking one dose, the illness was cured.

In coma syndromes such as epidemic encephalitis B, physicians generally consider it to belong to Shuwarm (Summerheat-Warmth, acute exogenous febrile disease caused by summerheat-warmth pathogens in summer). Treatment should utilize Baihu Tang (White Tiger Decoction, for clearing excess heat from the Qi level) and Qingwen Baidu Yin (Clear Plague and Resolve Toxin Decoction, for clearing heat, detoxifying, and cooling blood). For coma, Angong Niuhuang Wan (Calculus Bovis Pill for Opening Orifices, for clearing heat and opening orifices) and Zixue Dan (Purple Snow Elixir, for clearing heat and calming convulsions) are added. However, clinical observations do not always align with this. Without combining abdominal diagnosis (diagnosis via palpation of the abdomen), we often find ourselves at a loss. I once treated a patient named Zhen XX, male, 24 years old. He had epidemic encephalitis B with high fever and coma for 7 days. Physicians treated him with Western medicine, modified Baihu Tang, Qingwen Baidu Yin, and Angong Niuhuang Wan, but without effect. Examination revealed unconsciousness, cold limbs (Tijue), yellow and dry tongue coating, and a hidden pulse. Palpation showed a distended, hard, and painful abdomen. Synthesizing the pulse and symptoms, the diagnosis was Fu-shi Re Jue Ti Jue Syndrome (Body Cold Limbs due to Intestinal Excess Heat, where internal accumulation of intestinal excess heat prevents Yang Qi from reaching the extremities). The treatment plan was bitter-cold purgation. Prescription: Dahuang (Rhubarb Root and Rhizome) 24g, Mangxiao (Mirabilite) 10g, Zhishi (Immature Bitter Orange) 15g, Houpo (Magnolia Bark) 16g, Yuanshen (Scrophularia Root) 40g.
After one dose, bowel movements were unblocked, and consciousness was restored.

Another case is patient Jin XX, female, 25 years old. She suffered from epidemic encephalitis B with coma and high fever for 5 days. Initial treatment with Western medicine, Qingwen Baidu Yin, and Angong Niuhuang Wan was ineffective. I was invited to treat her. Examination showed mental confusion, incontinence of urine and feces, cold and unwarm limbs, pale tongue body, thin white tongue coating, and a faint pulse nearly imperceptible. Palpation revealed a soft and empty abdomen. The diagnosis was exhaustion of Yang Qi with Yin excess forcing Yang outward (Yin Sheng Ge Yang). Emergency treatment focused on restoring Yang and rescuing from collapse (Huiyang Jiuni). Prescription: Fuzi (Prepared Aconite Lateral Root) 6g, Ganjiang (Dried Ginger) 6g, Gancao (Licorice Root) 6g, Renshen (Ginseng Root) 6g. After one dose, consciousness was clear, limbs were warm, and body temperature returned to normal.

Regarding urinary retention within Longbi Syndrome (dysuria/retention of urine), most physicians advocate Tongyang Li Shui (Warming Yang to promote diuresis). Clinically, only some patients respond effectively to this method; others do not. Careful reflection suggests this is largely due to neglecting abdominal diagnosis. I once treated patient Zhao XX, female, 32 years old. Following pelvic fracture surgery and bladder rupture repair, she had been unable to urinate or defecate. Recently, due to a urinary tract infection, she developed fever with profuse sweating, dizziness, fatigue, shortness of breath, significant abdominal distension, thirst with desire to drink, and a body temperature of 39°C. Frequent use of Chinese and Western medicines was ineffective. Detailed examination showed a red tongue body, thin yellow coating, and a deficient, large, slippery, and rapid pulse. Palpation revealed the abdomen was still soft. The diagnosis was deficiency of both Qi and Yin as the root, with damp-heat in the Bladder and impaired Qi transformation as the branch. Treatment focused on tonifying Qi and nourishing Yin, while removing dampness and clearing heat. Prescription: Shengma (Cimicifuga Rhizome) 10g, Chaihu (Bupleurum Root) 10g, Jiegeng (Platycodon Root) 10g, Zhike (Bitter Orange) 10g, Zhimu (Anemarrhena Rhizome) 10g, Maidong (Ophiopogon Tuber) 10g, Huangqi (Astragalus Root) 20g, Rougui (Cinnamon Bark) 2g.
After one dose, fever subsided, and urination and defecation resumed. After three additional doses, most symptoms disappeared.

I also treated patient Shen XX, female, 45 years old, with a urinary tract infection and urinary retention. Initial treatment with Western medicine, catheterization, and Chinese herbs for clearing heat and promoting urination was ineffective. Detailed observation of her symptoms included fever and aversion to cold, nausea and vomiting, abdominal fullness and pain, oliguria and anuria, dizziness and headache, restlessness, yellow tongue coating, and a wiry, slippery, rapid pulse. Palpation revealed tense, hard, and painful abdominal muscles. Synthesizing the pulse and symptoms, the diagnosis was Shaoyang-Yangming Combined Syndrome (simultaneous involvement of the Shaoyang and Yangming channels). The treatment plan was harmonizing Shaoyang and purging interior excess (Hexie Gongli). Prescription: Chaihu (Bupleurum Root) 20g, Baishao (White Peony Root) 10g, Banxia (Pinellia Tuber) 10g, Huangqin (Scutellaria Root) 10g, Zhishi (Immature Bitter Orange) 10g, Dahuang (Rhubarb Root and Rhizome) 10g, Wuyao (Lindera Fruit) 10g, Shengjiang (Fresh Ginger) 4 slices, Ziye (Perilla Leaf) 6g.
After one dose, most symptoms subsided, and urination and defecation resumed. After four additional doses, most symptoms disappeared.

In Phlegm-Fluids diseases such as cor pulmonale, physicians invariably use Wenfei Huayin (Warming the Lung to transform fluids) and Wenyang Lishui (Warming Yang to promote diuresis); however, my application of these methods has often been ineffective. The reason lies mostly in failing to distinguish between deficiency and excess. I once treated patient Ge XX, male, 45 years old. He had chronic bronchitis for 40 years and cor pulmonale for 3 years. Besides Western medicine, he had taken over a thousand doses of Chinese herbs for resolving phlegm, calming asthma, strengthening the heart, and promoting diuresis, yet saw no effect. Detailed examination revealed coughing and wheezing, edema with oliguria, cold hands and feet, purple-dark tongue body, yellow-white tongue coating, and a fine, rapid, hurried, and intermittent pulse. Palpation showed slight abdominal distension, tense abdominal muscles with tenderness, and shortness of breath when moderate pressure was applied. Synthesizing the pulse and symptoms, I reasoned: This is not merely Heart-Kidney Yang Deficiency, but also fluid retention congealing in the Middle Jiao. Treatment should utilize Mufangji Tang (Moutan and Stephermia Decoction) to mediate Yin and Yang, transform fluids, and calm asthma. Prescription: Fangji (Stephermia Root) 10g, Guizhi (Cinnamon Twig) 10g, Renshen (Ginseng Root) 10g, Fuling (Poria) 10g, Xingren (Apricot Seed) 10g, Cangzhu (Atractylodes Rhizome) 10g, Dahuang (Rhubarb Root and Rhizome) 2g, Sheng Shigao (Gypsum Fibrosum) 15g.
After two doses, most symptoms subsided. After fifteen additional doses, almost all symptoms disappeared.

I also treated patient Wu XX, female, 75 years old. After left lung resection, she developed cor pulmonale secondary to chronic bronchitis, emphysema, and infection in the right lung. Extensive use of Chinese and Western medicines was ineffective. Examination showed fluctuating consciousness, muttering and delirium, shortness of breath difficult to sustain, whole-body sweating, edema with oliguria, purple-dark lips and digits, a peeled tongue with no coating and a purple-dark body, and a deficient, large, slippery, rapid, hurried, and intermittent pulse. Palpation revealed an abdomen shaped like a boat, soft and lacking elasticity. Synthesizing the pulse and symptoms, the diagnosis was impending depletion of Qi and Yin, with Phlegm-Fluids obstructing the Lung. Treatment focused on tonifying Qi and nourishing Yin, resolving phlegm, and calming asthma. Prescription: Huangqi (Astragalus Root) 15g, Renshen (Ginseng Root) 10g, Ziwan (Aster Root) 10g, Fuling (Poria) 10g, Chaihu (Bupleurum Root) 10g, Banxia (Pinellia Tuber) 10g, Zhimu (Anemarrhena Rhizome) 10g, Shengdi (Rehmannia Root) 10g, Baishao (White Peony Root) 10g, Maidong (Ophiopogon Tuber) 10g, Rougui (Cinnamon Bark) 10g, Gancao (Licorice Root) 10g, Digupi (Dogwood Bark) 10g.
After one dose, consciousness cleared, and other symptoms reduced. After twenty additional doses, all symptoms disappeared.

In Phlegm-Fluids diseases such as heart failure, many physicians claim Zhenwu Tang (True Warrior Decoction) is effective, and some introduce Jiefeng Lihuang Wan (Peucedanum, Semen Persicae, and Rheum Pill). How to differentiate? Abdominal diagnosis. I once treated patient Yue XX, female, 25 years old. She had rheumatic heart disease with mitral stenosis and insufficiency, atrial fibrillation for 5 years, and heart failure for half a year. Treatment with Western medicine, modified Zhenwu Tang, Suzi Jiangqi Tang (Perilla Fruit Decoction for Descending Qi), and Xiao Qinglong Tang (Minor Green Dragon Decoction) initially improved her condition, but over the subsequent 4–5 months, there was no further improvement. Detailed observation revealed panting, coughing, shortness of breath, edema with oliguria, purple-dark lips and digits, yellow-white tongue coating, and a deep, fine, hurried, and intermittent pulse. Palpation showed hardness and pain in the epigastrium. Synthesizing the pulse and symptoms, the diagnosis was dual deficiency of Qi and Blood as the root, with Qi stagnation, Blood stasis, and Phlegm-excess obstruction as the branch. Treatment focused on tonifying Qi and nourishing Blood to support the root, regulating Qi, invigorating Blood, drying dampness, and transforming fluids to treat the branch. Prescription: Huangqi (Astragalus Root) 30g, Danggui (Angelica Sinensis Root) 10g, Renshen (Ginseng Root) 10g, Danshen (Salvia Miltiorrhiza Root) 30g, Shengdi (Rehmannia Root) 10g, Huangjing (Polygonatum Rhizome) 10g, Cangzhu (Atractylodes Rhizome) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 10g, Qingpi (Green Tangerine Peel) 10g, Chenpi (Aged Tangerine Peel) 10g, Chaihu (Bupleurum Root) 10g, Sanleng (Sparganium Rhizome) 10g, Ezhu (Curcuma Rhizome) 10g, Bohe (Mint) 3g, Guizhi (Cinnamon Twig) 10g, Fangji (Stephermia Root) 10g, Yejiaoteng (Polygonum Multiflorum Vine) 30g, Sheng Shigao (Gypsum Fibrosum) 15g.
After one dose, all symptoms subsided. After thirty additional doses, all symptoms completely disappeared.

What should be grasped in the diagnosis of critical and severe conditions?
Critical and severe conditions are diseases characterized by sudden onset, critical severity, and rapid changes. A slight negligence can often lead to irreparable consequences. Therefore, physicians must be able to make correct judgments and determine treatment measures within a short period.
To make correct judgments, many physicians have proposed practical methods based on their personal clinical experience and insights. For example: Grasping Etiology, Grasping Urination and Defecation, and Grasping Pulse Diagnosis proposed in *Neijing* (The Yellow Emperor's Classic of Internal Medicine); Grasping Six Channels proposed in *Shanghan Lun* (Treatise on Cold Damage Disorders); Grasping Six Essentials proposed by Zhang Jingyue; and Grasping Tongue Manifestations and Macules/Rashes proposed by Ye Tianshi. All these approaches are similar in nature.
Through repeated clinical practice, the author believes that focusing on the following aspects is appropriate:

One: Grasping the Chief Complaint
"Grasping the chief complaint" refers to focusing on the patient's own statement of their condition, specifically the first few sentences of their narrative. This method requires prioritizing the initial statements made by the patient, treating extensive supplementary materials provided by the patient merely as reference data, and regarding statements from others outside the patient as even less reliable references. For example: In a patient with high fever, if the first one or two sentences describing the condition are "aversion to cold and body pain," we should first determine it as a Exterior-Cold Syndrome. Regardless of how high the temperature is, this primary determination stands. If the description is "alternating chills and fever," it belongs to the Shaoyang Half-Exterior Half-Interior Syndrome. If there is fever without aversion to cold, it is determined as an Interior-Heat Syndrome. Similarly, in a patient with arrhythmia, if the first one or two sentences describe "palpitations in the epigastrium with rebellious Qi rushing upward," it should be determined as Cold-Fluids. If the description is "palpitations in the precordial region," it belongs to Liver Qi Stagnation. If it is "palpitations behind the sternum," one should consider Heart Yang Deficiency. It needs to be explained here: ① Never use substitute narratives from others as the standard, because others' narratives often replace facts with imagination. For instance, someone with a close relationship to the patient might exaggerate the severity, claiming the fever is extremely serious and demanding immediate heat-clearing and detoxification, while someone with a discordant relationship might downplay the severity, leading the physician astray. ② Never use the patient's supplementary opinions on symptoms as the main basis for consideration. Because supplementary opinions are often influenced by other factors, stated with distorted facts, or based on others' diagnoses, they often mislead the physician. ③ Never use a specific Western medical disease name as the primary consideration for TCM diagnosis, ignoring TCM diagnostic principles. For example, assuming that a Western diagnosis of shock automatically equates to a Deficiency Syndrome in TCM often leads to major errors due to ignoring the actual situation of Cold/Heat and Deficiency/Excess. ④ Never use instrument examinations as indicators for measuring TCM diagnosis. For example, using thermometer readings to determine Cold/Heat or Exterior/Interior.

Two: Grasping Etiology
"Grasping etiology" refers to identifying the direct cause of the disease. For example: In cases of sudden syncope, shock, or coma triggered by anger, any diagnosis considered must account for this factor, namely "Stagnation" (Yu) as the fundamental cause of onset; otherwise, effectiveness is hard to achieve. Similarly, in cases of sudden vomiting, coma, or syncope after drinking alcohol, any diagnosis must consider the factor of alcohol consumption. The same applies to poisoning or carbon monoxide poisoning. It needs to be explained here: ① Never diagnose blindly or determine treatment solely based on symptoms without considering etiology; ② Never abandon history and focus only on symptoms, simply attributing the worsening of certain diseases to specific causes; ③ Never simply attribute the second cause of a disease to its deterioration, thereby missing rescue opportunities.

Three: Grasping Abdominal Diagnosis
Since the Spleen and Stomach are the pivot of Qi mechanism ascent and descent and the foundation of acquired constitution, grasping abdominal diagnosis in critical conditions is crucial. From clinical experience, without palpating the abdomen, one cannot determine the Deficiency or Excess nature of critical conditions. Several points must be noted here: ① Never judge as Deficiency Syndrome and administer tonification without palpating the abdomen; ② Never determine Cold or Heat Syndrome solely based on the Deficiency/Excess findings of abdominal palpation; ③ Never neglect the location of Deficiency/Excess in the disease site. As stated in *Shanghan Lun*, locations such as "exactly at the epigastrium" or "from the epigastrium down to the lower abdomen" must be clearly identified.

Four: Grasping Pulse Diagnosis
*Neijing* considers pulse diagnosis the method for discerning the subtleties of disease, and *Nanjing* considers pulse appearance the method for diagnosing the life/death and fortune/misfortune of the Zang-Fu organs. Therefore, pulse appearance must be examined when judging critical conditions. Thus, Zhang Zhongjing pointed out in *Shanghan Lun* and *Jingui Yaolue* that to judge the nature of a disease, one must first grasp the pulse. However, when taking the pulse in critical conditions, attention must be paid to: ① Never determine the diagnosis solely based on pulse appearance, because one pulse type can be caused by multiple reasons. Relying on pulse alone without combining other diagnostic methods often leads to bewilderment; ② Never ignore mixed phenomena in the pulse and seek only the principal pulse; ③ Never ignore the pulse and focus only on symptoms, which fails to reveal the true cause of the disease.

Five: Grasping Urination and Defecation
*Neijing* states that urination and defecation deserve special attention in critical conditions because they are key to understanding the Deficiency/Excess and Exterior/Interior status of the Zang-Fu organs. Particularly noteworthy here are constipation and incontinence. For example: Coma with incontinence indicates Deficiency; coma with difficulty in urination/defecation indicates Excess. Otherwise, reversing Deficiency and Excess—tonifying Excess or purging Deficiency—will inevitably worsen the condition. However, relying solely on constipation and incontinence for diagnosis in critical conditions often leads to purging the Deficient and tonifying the Excess. To overcome this defect, I believe attention should also be paid to: ① Combining with abdominal diagnosis; for instance, abdominal fullness, tenderness, and constipation indicate Excess, while soft abdomen, preference for pressure, and constipation indicate Deficiency; ② Combining with pulse diagnosis. For example, constipation with abdominal pain and refusal of pressure is difficult to classify as Cold or Heat without combining with the pulse.

Six: Grasping Spirit/Mental State
Since Spirit (Shen) is governed by the Heart, and the Heart is the Sovereign Official, understanding whether the spirit is comatose, dull, or clear is vital for assessing the severity, location, and nature of the disease. Therefore, in diagnosing critical conditions, changes in mental state often serve as markers for the success or failure of rescue efforts. However, as a criterion for judging prognosis, mental state changes should not be viewed in isolation but combined with other diagnostics to prevent mistaking "Desolation Syndrome" (Zhong Zheng, a sign of imminent death) for recovery. Thus, while grasping mental state, one should also note: ① Combine with other diagnostic methods; ② Combine with etiology.

Seven: Grasping Sweating
The presence or absence of sweating is not only an important basis for measuring Deficiency/Excess, Qi/Blood involvement, and Closing/Opening Syndromes in general critical conditions, but also a key indicator of prognosis. For example: Regarding fever, sweating may indicate Deficiency or Yangming Excess Heat; no sweating may indicate Exterior-Cold Excess or Half-Exterior Half-Interior Syndrome. In coma, sweating may indicate Qi Collapse or dual Qi-Yin Collapse; no sweating indicates Excess or Closing Syndromes. When evaluating the value of sweating, note: ① Location of sweating; sweating only on the head may indicate Stagnant Heat, Excess Heat, or Kidney failing to grasp Qi; whole-body sweating may indicate Yangming Qi-level Excess Heat, Qi Collapse, or dual Qi-Yin Collapse; ② Temperature of sweat; cold sweat indicates Yang Collapse, while hot sweat may indicate Excess Heat or Yin Collapse; ③ Other symptoms present simultaneously with sweating; ④ Time and characteristics of sweating; for example, tidal fever with afternoon sweating indicates Yangming Excess Heat.

Eight: Grasping Cold/Heat of Limbs
Since the Spleen governs the limbs and Clear Yang fills the limbs, the cold/heat of limbs in critical conditions is extremely important for measuring the prosperity/decline of Yang Qi and the Spleen/Stomach. Therefore, critical conditions require grasping the limbs: Generally speaking: ① In Heat Syndromes, warm limbs indicate Heat, cold limbs indicate Cold; however, heat followed by cold often indicates "Deep Heat with Deep Cold Limbs" (Re Shen Jue Shen), while cold followed by heat indicates reduction of Heat; ② In miscellaneous diseases, warmth indicates return of Yang, cold indicates Yang Deficiency. However, when grasping limb temperature, it should be combined with pulse, abdominal diagnosis, and urination/defecation, otherwise erroneous judgments may easily occur.

Nine: Grasping Tongue Manifestations
Tongue diagnosis is particularly important in Warm Diseases. From the perspective of critical conditions, generally three aspects of the tongue should be noted: ① Moisture of tongue coating: Moist indicates Cold, Fluids, or Dampness; dry indicates Heat or injury to Body Fluids. ② Color of coating: Generally mainly yellow and white. The pathology indicated must be determined in combination with moisture; for example, dry yellow indicates Excess Heat, dry white indicates injury to Body Fluids. ③ Color of tongue body: Pale white and moist indicates Cold/Yang Deficiency; red indicates Heat; crimson indicates Heat in Ying and Blood levels; purple indicates Stasis or Cold. When grasping tongue manifestations in critical conditions, I believe attention should be paid to: ① Combining with pulse and abdominal diagnosis; ② Noting that seeing this tongue necessarily implies this syndrome.

Ten: Grasping Macules and Rashes
The presence or absence of macules and rashes in critical conditions is an important marker for determining whether pathogenic factors are in the Qi level or Blood level. Among them, macules relate to the Stomach, rashes to the Lung; macules belonging to the Blood level are common, and rashes belonging to the Qi level are numerous, so particular attention should be paid. However, in specific application, it should be combined with: ① Changes in tongue manifestation; for example, no obvious change in tongue body indicates primarily Qi level involvement, while red/crimson tongue body indicates primarily Blood level involvement; ② Abdominal diagnosis; hard and painful abdomen indicates Fu-Organ Excess Heat Syndrome, while non-full/painful abdomen indicates not Fu-Organ Excess Heat Syndrome; ③ Stool; loose, odorless stool indicates Yin Macules, while constipation with abdominal fullness indicates Excess Heat; ④ Pulse; slippery and rapid indicates Excess Heat, deficient and large indicates dual Qi-Blood Deficiency or dual Qi-Yin Deficiency, slow and choppy indicates Deficiency-Cold, etc.

How to Diagnose Mixed Syndromes
From a large number of clinical facts, although there are some so-called pure Deficiency, Excess, Cold, Heat, Exterior, Interior, Yin, or Yang Syndromes, they are very few in number, especially in miscellaneous diseases. Therefore, how to examine, diagnose, and treat mixed syndromes has become an important issue in the diagnosis and treatment of diseases.