Autumn Warm Disease Complicated by Latent Pathogen Transforming into Heat

Patient Information
Xu, a 59-year-old woman from Tianjin, contracted a warm disease in early autumn with underlying latent pathogen transforming into heat.

Etiology
Relocation-related fatigue, exposure to dry heat, and wind invasion while sweating triggered the illness. Her inherent irritability, chronic stress, and liver fire predisposition exacerbated the condition.

Clinical Manifestations
Morning: mild generalized fever with fatigue. Afternoon: abrupt intensification of internal and external heat. Evening: bedridden, lethargic, incessant groaning. Pulse: deep, taut, and wiry on the left; surging, replete, and rapid (~6 beats/respiration) on the right. Tongue: swollen, nearly coatless. Chronic dry stools.

Diagnosis

​Left wiry pulse: Stagnant liver qi causing groaning (an unconscious attempt to vent qi).

​Right surging pulse: Latent heat invading Yangming, explaining rapid disease progression.
Treatment priority: Clear Yangming heat with White Tiger Decoction (白虎汤), supplemented with qi-regulating and liver-soothing herbs.

Prescription

​White Tiger Decoction Plus Modifications:

Gypsum Fibrosum (2 liang, crushed)

Anemarrhena asphodeloides (8 qian)

Raw Raphanus seeds (3 qian, crushed)

Forsythia suspensa (3 qian)

Glycyrrhiza uralensis (2 qian)

Oryza sativa (4 qian)
Decocted into two bowls; taken warm in two doses.

Formula Rationale

​Raphanus seeds: Unprocessed to prioritize ascending action, dispersing liver stagnation.

​Forsythia suspensa: Dual role—releasing exterior and soothing liver qi. Synergizes with gypsum to clear heat while resolving stagnation.

Follow-up
After two doses: Profuse sweating reduced heat by 70–80%, mental clarity restored.

​Pulse: Left remained wiry but less deep; right lost surging quality but stayed forceful. Rate slowed.

​Residual symptoms: Occasional internal heat, hunger without appetite.
Revised Prescription (Nourish yin, clear residual heat):

Scrophularia ningpoensis (1 liang)

Glehnia littoralis (5 qian)

Paeonia lactiflora (4 qian)

Hordeum vulgare sprouts (3 qian)

Fresh Imperata cylindrica root (4 qian)

Talcum (3 qian)

Glycyrrhiza uralensis (2 qian)
Decocted into one bowl; talcum promotes diuresis to expel heat.

Outcome
After two doses: Bowel movement normalized, heat resolved, appetite restored. Pulse stabilized but remained slightly rapid. Final regimen:

Scrophularia ningpoensis (1.5 liang)

Panax ginseng (3 qian)
Decocted for several days to consolidate recovery.

Key Notes

Pathomechanism: Latent heat (from liver stagnation and stress) synergized with autumn dryness and external wind, rapidly invading Yangming.

Therapeutic strategy: Prioritized Yangming heat clearance before addressing yin deficiency, aligning with "treat the acute first" principle.

Forsythia’s dual action exemplifies TCM herb versatility in multitarget therapy.