Xu, aged 35, fell ill due to excessive labor, internal accumulation of depressive heat, and new cold externally constricting. At the onset of the illness, he experienced fever and chills, headache, heart vexation and heat, body pain, occasional sweating, dry mouth and tongue, flushed face, and a pulse that was tight and rapid. He had taken a releasing exterior with pungent-cool formula, including a modified Lonicera and Forsythia Powder, but no sweat was induced and the illness was not resolved, instead the cold and heat intensified. This condition was originally due to internal heat being blocked by external cold. The pungent-cool ingredients such as Lonicera and Forsythia had minimal releasing exterior effect and could not disperse the external cold or relieve the depressive heat. Although Ephedra Decoction could disperse, its pungent-warm nature would exacerbate the internal heat and increase irritability. To clear heat while also dispersing the external pathogen, the Cinnamon Twig Two Spleen-Qi Effusing One Decoction was necessary. A modified Cinnamon Twig Two Spleen-Qi Effusing One Decoction was prescribed:
Cinnamon Twig 5g, Peony Root 10g, Ephedra 8g, Forsythia 12g, raw Gypsum 15g, Fresh Ginger Rhizome 6g, Liquorice Root 6g
. After taking two doses, he experienced profuse sweating all over, the fever and chills were resolved, he felt lighter, and the headache was gone. However, he still felt vexation and heat in the heart, fatigue, and reduced appetite. Subsequently, two more doses of a formula for clearing heat and harmonizing the stomach were administered, and all symptoms were suddenly resolved.