Situ Zhilin (a provincial governor) was originally obese. During a period when provinces were raising military funds, officials gathered in the provincial capital. However, due to depleted treasury reserves, Situ grew increasingly anxious. By summer, he developed peculiar symptoms: restlessness, random muttering, full-body itching, and immediate drowsiness upon closing his eyes. His nightmares consistently featured two ghosts—one hanging him with a noose, the other headless while clutching a bloody, disheveled skull. These visions forced him to avoid solitary sleep and cease official duties for over ten days.
Initial physicians diagnosed “ghostly retribution” and declared his condition terminal. A subsequent doctor prescribed Heavenly King Heart-Nourishing Pill (Tian Wang Bu Xin Dan) for “heart blood deficiency,” but this worsened his appetite. When summoned, I found him stating: “My illness seems hopeless, but I beg for your thorough diagnosis.”
Diagnosis
Pulse examination revealed a wiry, slow, slippery pulse (particularly floating at the cun position). I identified Tan Syndrome (phlegm disorder): “Your spleen dampness has generated phlegm, compounded by fatigue-induced spleen damage and heart fire agitation. This phlegm now encases the pericardium network, causing mental confusion. You likely relied on expectoration for chest relief, but current phlegm consolidation prevents this. Secondary symptoms—irritability, thirst, tremors, and urinary/defecatory difficulties—all stem from phlegm stagnation.”
Regarding the ghosts, I clarified: “These are mental disturbances, not real entities. Full recovery is achievable.”
Treatment Protocol
1，Vomiting Therapy: Alumen Depression Pill (Fan Yu Wan)
Custom preparation (commercially unavailable).
Effect: Expelled green-black viscous phlegm within 15 minutes, restoring mental clarity.
2，Phlegm Elimination: Phlegm-Controlling Elixir (Kong Xian Dan)
Administered post-vomiting to avoid gastric injury.
3，Consolidation: Long-term spleen-strengthening/phlegm-resolving formulas
Outcome
After two days: Ghost visions ceased, cognition normalized. When asked about prognosis without (used in traditional contexts): “Progression to psychosis, epilepsy, or fatal Phlegm Syncope (respiratory obstruction).”
Follow-up
I departed for maternal funeral rites (neijian). By August, Situ was dismissed for embezzlement. His accomplice Huang Wu faced execution. Upon hearing the execution news, Situ suffered fatal Phlegm Syncope at his residence. Colleague Xiao Mei later confirmed the death matched my prediction.
Key Terms
- Tan Syndrome (痰证): Metabolic disorder of bodily mucus in TCM
- Pericardium Network (心包络): Protective tissue surrounding the heart
- Phlegm Syncope (痰厥): Life-threatening phlegm-induced airway obstruction
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