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Huang initially suffered from an external contraction and was treated by various doctors for more than ten days, but his condition worsened. He then sought my treatment. The patient complained of severe abdominal pain that was hard to the touch, mild fever in the evening, sweating, especially on the hands and feet, yellow urine, difficulty in defecation, and had not eaten for three days. Upon examination, his tongue was bright red with a yellow coating that was not very dry, and his pulse was deep and strong. Reviewing the previous prescriptions, they were mostly disorganized. I prescribed the Major Purgative Decoction for him.

The next day, he called for another consultation. I thought the prescription had been effective, but later learned that after I left, the host doubted the potency of the medicine and used another doctor's prescription instead, which worsened the condition. The patient deeply resented his family for not using my prescription and informed me of this. I then increased the dosage of the original Major Purgative Decoction and advised to take two doses consecutively, expecting bowel movements. If there were no movements, another dose should be taken without hesitation.

Two days later, he called for another consultation and reported that after taking two doses of the medicine the previous night, he passed a large amount of black stool. This morning, he had a little porridge, and most of his symptoms had improved by 70-80%. I then modified the prescription by reducing the amount of Rhubarb Rhizoma in the Bupleurum Decoction. After two more doses, all the black stool was expelled, and the illness was completely gone. Finally, he asked for a prescription for recuperation.

Some might ask, why was there no delirious speech in this case of Major Purgative syndrome? Since Major Purgative Decoction is for dry stool in the abdomen, how did you diagnose it as food accumulation? I replied, "The Treatise on Cold Damage Diseases states, 'If there is no bowel movement for six or seven days, with unresolved irritability, abdominal distension, and pain, this indicates dry stool.' It further explains, 'The reason for this is the presence of retained food, hence the Major Purgative Decoction is appropriate.' Also, under the section on the combination of Yangming and Shaoyang diseases, it states, 'A slippery and rapid pulse indicates retained food, and the Major Purgative Decoction is appropriate.' The chapter on retained food in the Golden Chamber also frequently prescribes the Major Purgative Decoction, which needs no further elaboration. Retained food and dry stool are essentially the same, differing only slightly. The presence or absence of delirious speech is not a strict criterion. Zhang Zhongjing originally mentioned that in Yangming disease with tidal fever and slightly hard stool, the Major Purgative Decoction could be used, without insisting on the presence of delirious speech. If this condition had been delayed for another day or two, delirious speech and ghost-seeing symptoms would have occurred, leading to floccillation, slight panting, and staring, culminating in a fatal case of yin exhaustion." Yangming Shaoyang